HomeMy Public PortalAboutr 08:165
#08-165
JULY 10, 2008
FH-0170-0501
STATE OF NEW JERSEY
DEPARTMENT OF THE TREASURY
DIVISION OF PENSIONS AND BENEFITS
NEW JERSEY STATE HEALTH BENEFITS PROGRAM
PO Box 299 Trenton, New Jersey 08625-0299
RESOLUTION
A RESOLUTION to elect a premium delay option as selected below.
o One month delay (initial election)
[g! Two month delay (initial election)
o Add additional one month delay for a maximum premium delay of two months
(for locations that have previously adopted a one month premium delay)
BE IT RESOLVED:
The Bd{,OI..\.~ '"
o ~ CQlft~V<'- ~
Name of Employer - County - SHBP #
hereby resolves to exercise its premium delay option under the SHBP as selected above, commencing
Oc~obQ"r-I.). (JOB
,
with the
premium.
We understand that, should our group eiect to terminate SHBP participation sometime in the future or the
Program ceases to exist, any delayed premiums will become due and payable immediately. We understand
that this premium delay shall take effect 60 days foilowing receipt of this resolution by the State Health
Benefits Commission.
We understand, in accordance with N.J.S.A, 17:9-5.3(b), fhat full payment of health benefit charges must
be received on or before the due date printed on the bill and that interest shall be applied to the total
transmittal of health benefit charges from the day following the due date until the day payment is received.
I hereby certify that the foregoing is a true and correct
copy of a resolution duly adopted by the
!SoroLl. Z}\ 0 ~ CAAevQ:t-
Name of Employer
onthel()~ dayof c9- AA~
,20 of.
~~
0.
~
Signature
Assistant Municipal Clerk
Official Title
BELLINO - Yes
COT~ON~. Y"t'
DIAZ - Yes
KRUM - Yes
NAPLES - Absent
SITARZ - Yes
~LJ:9li~V-