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R-10-12-16-10E1 - 12/16/2010RESOLUTION NO. R -10-12-16-10E1 WHEREAS, the City of Round Rock desires to provide long term disability insurance for eligible City employees, Now Therefore BE IT RESOLVED BY THE COUNCIL OF THE CITY OF ROUND ROCK, TEXAS, That the Mayor is hereby authorized and directed to execute on behalf of the City an Application for Group Insurance with Standard Insurance Company to provide long term disability, a copy of same being attached hereto as Exhibit "A" and incorporated herein for all purposes. The City Council hereby finds and declares that written notice of the date, hour, place and subject of the meeting at which this Resolution was adopted was posted and that such meeting was open to the public as required by law at all times during which this Resolution and the subject matter hereof were discussed, considered and formally acted upon, all as required by the Open Meetings Act, Chapter 551, Texas Government Code, as amended. RESOLVED this 16th day of December, 2010. ALAN MCGRAW, Mayor City of Round Rock, Texas ATTEST: gi444/1. • I.{.-26btk SARA L. WHITE, City Secretary O \wdo x\SCC1nts\0112\ 1005\MUNICIPAL \00209256.DOC/rmc EXHIBIT IR TneStandard Benefits at a Glance for the City of Round Rock Effective Date January 1, 2011 Group Long Term Disability Insurance Group Long Term Disability (LTD) insurance from Standard Insurance Company provides financial protection for eligible employees by promising to pay a percentage of monthly earnings in the event of a covered disability. The cost of this insurance is paid by the City of Round Rock. Eligibility Eligible Employee A regular employee of the employer working at least 30 hours each week. An eligible employee does not include a temporary or seasonal employee, full-time member of the armed forces, leased employee or an independent contractor. Waiting Period Before Becoming Eligible for Insurance If you are already an eligible employee on the date the group policy is effective, you are eligible on that date. If you become an eligible employee after the group policy effective date, the eligibility waiting period varies and you should contact your human resources representative for additional information. Benefits Monthly Benefit 60 percent of the first $8,333 of monthly predisability earnings, reduced by deductible income (e.g., work earnings, workers' compensation, state disability, etc.). Maximum Monthly Benefit $5,000 Minimum Monthly Benefit $100 Waiting Period Before Benefits Become Payable 180 days Standard Insurance Company 1100 SW Sixth Avenue Portland OR 97204 SI 13271 -ROUND ROCK- CITY OF 1 of 2 (9/10) Definition of Disability For the benefit waiting period and the first 24 months for which LTD benefits are paid, being unable as a result of physical disease, injury, pregnancy or mental disorder to perform with reasonable continuity the material duties of the employee's own occupation and suffering a Toss of at least 20 percent of predisability earnings when working in the employee's own occupation. The employee is not disabled when earning 60 percent or more of predisability earnings in any occupation. After that, being unable as a result of physical disease, injury, pregnancy or mental disorder to perform with reasonable continuity the material duties of any occupation which: • The employee is able to perform, due to education, training or experience, • Is available at one or more locations in the national economy, and • The employee can be expected to eam at least 60 percent of predisability earnings within 12 months of retuming to work, regardless of whether the employee is working in any other occupation. Maximum Benefit Period If an employee becomes disabled before age 62, LTD benefits may continue until age 65. If an employee becomes disabled at age 62 or older, the benefit duration is determined by the age when disability begins: Age Maximum Benefit Period 62 3 years 6 months 63 3 years 64 2 years 6 months 65 2 years 66 1 year 9 months 67 1 year 6 months 68 1 year 3 months 69+ 1 year Other Features & Services • 24 hour coverage, including coverage for work-related disabilities • Survivor Benefit • Return to Work Responsibility and Incentive • Reasonable Accommodation Expense Benefit • Temporary Recovery Provision • Waiver of Premium while LTD benefits are payable • Rehabilitation Plan Provision • Employee Assistance Program This information is only a brief description of the group LTD insurance policy sponsored by the City of Round Rock The controlling provisions will be in the group policy issued by The Standard. The group policy contains a detailed description of the imitations,nedudions in benefits, exdusions and when The Standard and the employer may increase the cost of coverage, amend or cancel the policy. A group certificate of insurance that describes the terms and conditions of the group policy is amiable for employees who become insured according to its terms. For more complete details of coverage, contact your human resources reloresentabve. Standard Insurance Company 1100 SW Sixth Avenue Portland OR 97204 SI 13271 -ROUND ROCK- CITY OF 2 of 2 (9/10) STANDARD INSURANCE COMPANY Employee Benefits - Underwriting 900 SW Fifth Ave. Portland, OR 97204-1282 Please type or print Application for Group Insurance For Use in Texas REQUESTED EFFECTIVE DATE Shmar(y 1 ."to 1 I APPLICANT Full Leal Name of Group (Exactly as it is to be shown in the policy.) Cry((9ck_ Street A ress ?-I S'T� City N& 1ts3• Phone Number (SI L) ,21' - s-41 O Group Contact Li Napv r Contact's Phone No. if different ( SI L) !..I a- S`i 1 1 Contact's FAX No. if different ( ) Nature of Business C- T y 6oJCr t ivvr.r.. State 1—E1 -P4-5 Zip Code 714GLI- FAX Number ( SIL) 2-1 as. - SJ 9 3 Contact's Title 4014404J 1RssoJ(CXS sttJS - r M6lL. INSURANCE COVERAGE REQUESTED ❑ Life Only 0 Supplemental Life 0 Dental/Employees ["LTD 0 Eye Care O Life & AD&D 0 Additional/Optional Life 0 Dental/Employees and Dep(s) 0 STD ❑ ❑ Dependent Life ❑ Stand Alone AD&D 0 Dental/Orthodontia 0 LTD with Transitional Duty Agreement OTHER INSURANCE A. Does this insurance supplement other insurance? 0 Yes gislo If yes, specify for each line of coverage and Insurance Carrier: B. Does this insurance replace existing insurance? 0 Yes RNo If yes, specify for each existing line of coverage: • Please submit a copy of each in force policy, certificate or plan document. Effective date of Prior Plan: Termination date of Prior Plan: ACTIVE WORK REQUIREMENT: A person must meet an Active Work requirement to become insured. Members who have not met an Active Work requirement are not insured until returning to work for one full day and meeting all other contractual requirements. Initial: Note: Some members who do not meet an Active Work requirement may be eligible for Waiver of Premium with a prior carrier. APPLICANT AGREES THAT: I hereby apply for Group Insurance as provided in the attached proposal. The above information is true and correct to the best of the Applicant's knowledge and belief. it forms the basis for this request for group insurance. If the requested insurance is acceptable to Standard Insurance Company under its current rules and practices and is legally permissible, a Group Policy will be issued In the language customarily used by Standard. It will be effective on the date determined by Standard. No producer has the authority to guarantee the acceptability of the requested insurance. Standard may issue separate Group Policies if more than one coverage is requested in this Application. The insurance, if approved, will be subject to Standard Insurance Company's usual underwriting requirements, including the exclusions and limitations in the Group Policy and, if applicable, Evidence Of Insurability. The effective date of insurance for which a person is required to submit satisfactory Evidence Of Insurability will be determined in accordance with the terms of the Group Policy, subject to the Active Work requirement. No premiums will be collected or paid by the Applicant for such insurance until notification of approval. No material describing coverage under the Group Policy will be distributed by the Applicant to any person to be insured without the prior written consent of Standard Insurance Company. Premium rate quotations were based on data submitted to Standard. Final premium rates will be determined by the actual composition of the group. The consideration for any Group Policy which may be issued is this Application and the payment of premiums. Payment of premium after receipt of the Group Policy is acceptance of the terms of the Group Policy. This Application is made a part of the Group Policy. Applicant authorizes the producer, broker of record, or consultant to receive information regarding the applicant's claims status and experience that the applicant has a right to receive and which is reasonably necessary to assist the applicant in conducting a review of the information. Signature and Title of Applicant's Authorized Representative Date (Must be signed or submitted prior to the requested effective date.) Initial Deposit $ SI 11201 1 of 2 (5/08) isk maStar}dard New Business Submission Checklist for Policy Number. To ensure your application for group insurance is processed correctly and in a timely manner, we will need the following: [-2(. Application for Group Insurance. Please review application and verify it has been completed in its entirety (ensure Active Work is initialed, effective date is included, signature and date present, etc.). ❑ Check for first month's premium (based upon premium information from the sold proposal), payable to Standard Insurance Company. ❑ Copy of "Sold" Proposal and any e-mail exceptions not documented in proposal. ❑ Prior Carrier policy and a copy of their most recent billing statement if you are replacing coverage. ❑ Complete Census, including each employee's First and Last name, Date of Birth, Date of Hire, Occupation, Social Security # (if list billing or using the Electronic Enrollment Tool), Insured Eamings, Eamings Mode (e.g. monthly, weekly, annually) and Gender. Please e-mail census to your sales representative in Microsoft Excel format. If... Then... Voluntary or contributory coverages were sold The census should also include: • Elected benefit information for employee, spouse and child • Spouse's name and date of birth (if spouse benefits were sold) Dental and/or Vision was sold The census or enrollment forms should include: • Home Address • Dependent elections with names • Dependent relationship (child, spouse, domestic partner) • Dates of birth of each dependent electing coverage Other completed forms if applicable: ❑ Medical History Statements ❑ STD Tax Service 0 Health Advocate Implementation Form Agreement Group Information Federal Tax ID Form of Organization (select one) ❑ Association ❑ C -Corporation 0 S -Corporation ® Govemment / Public Unit ❑ Limited Liability Company 0 Partnership 0 Sole Proprietorship 0 School District ❑ PC - Professional Corporation ****IF PC are they taxed as an 0 S -Corporation or a 0 C- Corporation Affiliates? 0 YES 0 NO If YES, please provide (on a separate page) the following information regarding all affiliates: Full legal name, address, city, state, ZIP code, Employer Tax ID, form of organization and nature of business. Certificates / Summary Plan Descriptions Are separate Certificates by class needed? ❑ YES [ ' NO 0 Not Applicable Certificates will be available through AdminEASE (online policy administration tool). If you have different requirements, please describe: Definition of a Member Definition of a Member will include all active employees and owners working at least �0 hours per week. (rates may change if member definition varies from what was originally proposed) Are you excluding anyone from coverage that MEETS the Definition above? ❑ YES (J "NO If yes, please provide details: Are you including anyone that DOES NOT meet the member definition above? (E.g. grandfathered, retired employees) 0 YES ['NO If yes, please provide details: Should domestic partner wording be in contract? 0 YES I161O New Business Submission Checklist Page 1 of 4 5/27/2010 Age Graded Rates and Spouse Coverage J p rJ u A r y f For age graded rates, update age: • January 1, annually RI On policy anniversary • First of the month following date of birth If applicable, is spouse premium based on spouse age, or member age? • Spouse 0 Member Are spouse age reductions based on spouse age or member age? 0 Spouse 0 Member Tax Free Benefits Do you "gross up" salary for tax-free disability benefits? ■ YES 'ZINO Does this vary by class? ■ YES ❑ NO If YES, please clarify. Premium Contributions Will the employer pay 100% of the premium for all coverage requested? I'YES 0 NO If NO, what percentage of premium does the employer pay? % Basic Life/AD&D % Dental Employee % Other: % Additional Life/ AD&D % Dental Dependent % Other: % STD % Vision Employee % LTD % Vision Dependent % Dependent Life Dental and/or Vision Premium Is the employee portion of the premium paid through a Section 125 / POP plan? 0 YES 0 NO *If the dental and/or vision is voluntary (typically 100% employee paid), a Section 125 plan is required. What is the Section 125 plan year? 0 Calendar year 0 Other / Will The Standard administer COBRA If YES, there will be a rating impact if not included at the time of proposal. for dental or vision? 0 YES ■ NO Contact Information Executive correspondence contact (name): Phone: E-mail: . /� Administrative / Claims contact (name): L l6 t l� U NT11 E r 1 Same as Executive d Phone: 51 a- alb '5f91 E-mail: 13 Q rouNCi— rock. fix, oS . Mailing address (if different than Policyholder's): Billing contact (name): ■ Same as Executive or Administrative Phone: E-mail: . Which contact should be used for online policy ❑ Executive Er Administrative / ❑ Billing administration (AdminEASE) setup? Claims Is there a Third Party Administrator (TPA) involved? 0 YES Ii' NO If YES, please provide information below. TPA Name: Address: Phone: Broker / Commission Information Broker 1 Name: Firm Name: Phone : E-mail: . Commission level: 0 Normal 1 Flat % 0 None 0 Other. Commission split (by product): Commissions payable to: 0 Fimi 0 Individual Producer ID: . To be filled out by SIC Broker 2 Name (if applicable): Firm Name: . Phone: E-mail: . Commission level: 0 Normal 1 Flat % ❑ None 0 Other. Commission split (by product): Commissions payable to: 0 Firm 0 Individual Producer ID: To be filled out by SIC New Business Submission Checklist Page 3 of 4 5/27/2010 ROUND ROCK, TEXAS PURPOSE. PASSION. PROSPERITY City Council Agenda Summary Sheet Agenda Item No. 10E1. Consider a resolution authorizing the Mayor to execute an application for Tong -term Agenda Caption: disability insurance with the Standard Insurance Company. Meeting Date: December 16, 2010 Department: Human Resources Staff Person making presentation: Teresa Bledsoe Human Resources Director Item Summary: This Agreement will provide eligible employees partial replacement of their income if they become disable and unable to work. By offering this benefit it can help attract and retain employees and even serve as a reward to long- term employees. Strategic Plan Relevance: Goal 13.0 Continue and enhance sound business and financial practices and tools. Cost: Payments paid monthly based on covered lives per month (776 lives ets. $7,415) Source of Funds: General Fund Professional Services/Utility Fund Date of Public Hearing (if required): N/A Recommended Action: Approval EXECUTED DOCUMENT FOLLOWS STANDARD INSURANCE COMPANY Employee Benefits - Underwriting 900 SW Fifth Ave. Portland, OR 97204-1282 Application for Group Insurance For Use in Texas Please type or print REQUESTED EFFECTIVE DATE SI►euprry 1, .2.0 11 APPLICANT Full Legal Name of Group (Exactly as it is to be shown in the policy.) Gory of trL 0_0 CNC_ Street A ress vFt-W- Wv t•ST«� 1V City & 6— Phone Number (SIL ) 4 i O Group Contact LI tvaA; CoVNT1dr-r. Contact's Phone No. if different (SI Z) D-1 d' S`1 ei 1 Nature of Business C.-%1/ 6oV �f {tel Ms f�l'1" State Ti=1<-k-S Zip Code 7ds;GY- FAX Number( Sl L) ZItSy93 Contact's Title 140t0064, 6-1000-(S gcosi- ir Mb L. Contact's FAX No. if different ( INSURANCE COVERAGE REQUESTED ❑ Life Only 0 Supplemental Life ❑ Dental/Employees ['LTD ❑ Eye Care ❑ Life & AD&D ❑ Additional/Optional Life ❑ Dental/Employees and Dep(s) ❑ STD ❑ ❑ Dependent Life 0 Stand Alone AD&D ❑ Dental/Orthodontia 0 LTD with Transitional Duty Agreement OTHER INSURANCE A. Does this insurance supplement other insurance? 0 Yes IE/No If yes, specify for each line of coverage and Insurance Carrier: B. Does this insurance replace existing insurance? 0 Yes []'No If yes, specify for each existing line of coverage: • Please submit a copy of each in force policy, certificate or plan document. Effective date of Prior Plan: Termination date of Prior Plan: ACTIVE WORK REQUIREMENT: A person must meet an Active Work requirement to become insured. Members who have not met an Active Work requirement are not insured until returning to work for one full day and meeting all other contractual requirements. Initial: Note: Some members who do not meet an Active Work requirement may be eligible for Waiver of Premium with a prior carrier. APPLICANT AGREES THAT: I hereby apply for Group Insurance as provided in the attached proposal. The above information is true and correct to the best of the Applicant's knowledge and belief. It forms the basis for this request for group insurance. If the requested insurance is acceptable to Standard Insurance Company under its current rules and practices and is legally permissible, a Group Policy will be issued in the language customarily used by Standard. It will be effective on the date determined by Standard. No producer has the authority to guarantee the acceptability of the requested insurance. Standard may issue separate Group Policies if more than one coverage is requested in this Application. The insurance, if approved, will be subject to Standard Insurance Company's usual underwriting requirements, including the exclusions and limitations in the Group Policy and, if applicable, Evidence Of Insurability. The effective date of insurance for which a person is required to submit satisfactory Evidence Of Insurability will be determined in accordance with the terms of the Group Policy, subject to the Active Work requirement. No premiums will be collected or paid by the Applicant for such insurance until notification of approval. No material describing coverage under the Group Policy will be distributed by the Applicant to any person to be insured without the prior written consent of Standard Insurance Company. Premium rate quotations were based on data submitted to Standard. Final premium rates will be determined by the actual composition of the group. The consideration for any Group Policy which may be issued is this Application and the payment of premiums. Payment of premium after receipt of the Group Policy is acceptance of the terms of the Group Policy. This Application is made a part of the Group Policy. Applicant authorizes the producer, broker of record, or consultant to receive information regarding the applicant's claims status and experience that the applican s a right to receive and which is reasonably necessary to assist the applicant in conducting a review of the information. al' Al Signature and e of Applicant's Authorized Representative a•!L•to Date (Must be signed or submitted prior to the requested effective date.) Initial Deposit $ SI 11201 lo- (lo- (WI 1 of 2 (5/08) 11111 TheStandard New Business Submission Checklist for Policy Number. To ensure your application for group insurance is processed correctly and in a timely manner, we will need the following: 21 . Application for Group Insurance. Please review application and verify it has been completed in its entirety (ensure Active Work is initialed, effective date is included, signature and date present, etc.). ❑ Check for first month's premium (based upon premium information from the sold proposal), payable to Standard Insurance Company. ❑ Copy of "Sold" Proposal and any e-mail exceptions not documented in proposal. ❑ Prior Carrier policy and a copy of their most recent billing statement if you are replacing coverage. ❑ Complete Census, including each employee's First and Last name, Date of Birth, Date of Hire, Occupation, Social Security # (if list billing or using the Electronic Enrollment Tool), Insured Earnings, Eamings Mode (e.g. monthly, weekly, annually) and Gender. Please.e-mail census to your sales representative in Microsoft Excel format. If... Then... Voluntary or contributory coverages were sold The census should also include: • Elected benefit information for employee, spouse and child • Spouse's name and date of birth (if spouse benefits were sold) Dental and/or Vision was sold The census or enrollment forms should include: • Home Address • Dependent elections with names • Dependent relationship (child, spouse, domestic partner) • Dates of birth of each dependent electing coverage Other completed forms if applicable: ❑ Medical History ❑ STD Tax Service 0 Health Advocate Statements Agreement Implementation Form Group Information Federal Tax ID Form of Organization (select one) ❑ Association 0 C -Corporation 0 S -Corporation 0 Govemment / Public Unit ❑ Limited Liability Company 0 Partnership 0 Sole Proprietorship 0 School District ❑ PC - Professional Corporation """"IF PC are they taxed as an 0 S -Corporation or a 0 C- Corporation Affiliates? 0 YES 0 NO If YES, please provide (on a separate page) the following information regarding all affiliates: Full legal name, address, city, state, ZIP code, Employer Tax ID, form of organization and nature of business. Certificates / Summary Plan Descriptions Are separate Certificates by class needed? 0 YES (' NO 0 Not Applicable Certificates will be available through AdminEASE (online policy administration tool). If you have different requirements, please describe: Definition of a Member Definition of a Member will include all active employees and owners working at least hours per week. (rates may change if member definition varies from what was originally proposed) Are you excluding anyone from coverage that MEETS the Definition above? 0 YES ["NO If yes, please provide details: Are you including anyone that DOES NOT meet the member definition above? (E.g. grandfathered, retired employees) 0 YES [ 'NO If yes, please provide details: Should domestic partner wording be in contract? 0 YES lO New Business Submission Checklist Page 1 of 4 5/27/2010 Age Graded Rates and Spouse Coverage J q n) u A r y 1 For age graded rates, update age: ■ January 1, annually Ig On policy anniversary 0 First of the month following date of birth If applicable, is spouse premium based on spouse age, or member age? 0 Spouse ❑ Member Are spouse age reductions based on spouse age or member age? • Spouse 0 Member Tax Free Benefits Do you "gross up" salary for tax-free disability benefits? 0 YES 1NO Does this vary by class? 0 YES 0 NO If YES, please clarify. Premium Contributions Will the employer pay 100% of the premium for all coverage requested? ►[YES ■ NO If NO, what percentage of premium does the employer pay? % Basic Life/AD&D % Dental Employee % Other: % Additional Life/ AD&D % Dental Dependent % Other: % STD % Vision Employee % LTD % Vision Dependent % Dependent Life Dental and/or Vision Premium Is the employee portion of the premium paid through a Section 125 / POP plan? • YES ■ NO *If the dental and/or vision is voluntary (typically 100% employee paid), a Section 125 plan is required. What is the Section 125 plan year? 0 Calendar year 0 Other / Will The Standard administer COBRA If YES, there will be a rating impact if included the time not at of proposal. for dental or vision? ■ YES ❑ NO Contact Information Executive correspondence contact (name): Phone: E-mail: / n Cf Administrative / Claims contact (name): L / 1V fl CUNT) €f 0 Same as Executive Phone: 5 / a- a($ sy9 J E-mail:!3 Q rouNc/-rock, 75( as . Mailing address (if different than Policyholder's): Billing contact (name): 0 Same as Executive or Administrative Phone: E-mail: . Which contact should be used for online policy ❑ Executive IJ Administrative / ❑ Billing administration (AdminEASE) setup? Claims Is there a Third Party Administrator (TPA) involved? ■ YES E' NO If YES, please provide information below. TPA Name: Address: Phone: Broker / Commission Information Broker 1 Name: Firm Name: Phone : E-mail: Commission level: 0 Normal 0 Flat % 0 None ❑ Other: Commission split (by product): Commissions payable to: 0 Firm 1 Individual Producer ID: To be filled out by SIC Broker 2 Name (if applicable): Firm Name: , Phone: E-mail: Commission level: 0 Normal 0 Flat % 0 None 0 Other. Commission split (by product): Commissions payable to: 1 Firm 1 Individual Producer ID: To be filled out by SIC New Business Submission Checklist Page 3 of 4 5/27/2010 1Nik -n,eStandard° Benefits at a Glance for the City of Round Rock Effective Date January 1, 2011 Group Long Term Disability Insurance Group Long Term Disability (LTD) insurance from Standard Insurance Company provides financial protection for eligible employees by promising to pay a percentage of monthly earnings in the event of a covered disability. The cost of this insurance is paid by the City of Round Rock. Eligibility Eligible Employee A regular employee of the employer working at least 30 hours each week. An eligible employee does not include a temporary or seasonal employee, full-time member of the armed forces, leased employee or an independent contractor. Waiting Period Before Becoming Eligible for Insurance If you are already an eligible employee on the date the group policy is effective, you are eligible on that date. If you become an eligible employee after the group policy effective date, the eligibility waiting period varies and you should contact your human resources representative for additional information. Benefits Monthly Benefit 60 percent of the first $8,333 of monthly predisability earnings, reduced by deductible income (e.g., work earnings, workers' compensation, state disability, etc.). Maximum Monthly Benefit $5,000 Minimum Monthly Benefit $100 Waiting Period Before Benefits Become Payable 180 days Standard Insurance Company 1100 SW Sixth Avenue Portland OR 97204 SI 13271 -ROUND ROCK- CITY OF 1 of 2 (9110) Definition of Disability For the benefit waiting period and the first 24 months for which LTD benefits are paid, being unable as a result of physical disease, injury, pregnancy or mental disorder to perform with reasonable continuity the material duties of the employee's own occupation and suffering a Toss of at least 20 percent of predisability eamings when working in the employee's own occupation. The employee is not disabled when eaming 60 percent or more of predisability eamings in any occupation. After that, being unable as a result of physical disease, injury, pregnancy or mental disorder to perform with reasonable continuity the material duties of any occupation which: • The employee is able to perform, due to education, training or experience, • Is available at one or more locations in the national economy, and • The employee can be expected to eam at least 60 percent of predisability eamings within 12 months of returning to work, regardless of whether the employee is working in any other occupation. Maximum Benefit Period If an employee becomes disabled before age 62, LTD benefits may continue until age 65. If an employee becomes disabled at age 62 or older, the benefit duration is determined by the age when disability begins: Age Maximum Benefit Period 62 3 years 6 months 63 3 years 64 2 years 6 months 65 2 years 66 1 year 9 months 67 1 year 6 months 68 1 year 3 months 69+ 1 year Other Features & Services • 24 hour coverage, including coverage for work-related disabilities • Survivor Benefit • Return to Work Responsibility and Incentive • Reasonable Accommodation Expense Benefit • Temporary Recovery Provision • Waiver of Premium while LTD benefits are payable • Rehabilitation Plan Provision • Employee Assistance Program This information is onlya brief description ofthe group LTD insurance policy sponsored by the City of Round Rock The controlling provisions will be in the group policy issued by The Standard. The group policy contains a detailed description ofthe limitations, reductions in benefits, exclusions and when The Standard and the employer may increase the cost of coverage, amend or cancel the policy. Agroup certificate of insurance that describes the terms and conditions of the group policy is available for employees who become insured according to its terms. For more complete details of coverage, contact your human resources representative. Standard Insurance Company 1100 SW Sixth Avenue Portland OR 97204 SI 13271 -ROUND ROCK- CITY OF 2 of 2 (9/1 0)