R-2018-5860 - 9/13/2018 RESOLUTION NO. R-2018-5860
WHEREAS, the City of Round Rock (the "City") has duly advertised for proposals for
voluntary employee-paid accident coverage and voluntary employee-paid critical illness coverage
commencing January 1, 2019; and
WHEREAS, Metropolitan Life Insurance Company ("MetLife") has submitted a proposal to
provide said services, and said proposal has been determined to be the most advantageous to the City
considering the price and other evaluation factors included in the request for proposals; and
WHEREAS, the City Council desires to accept the proposal of MetLife and authorize the
Mayor to execute applications for coverage to MetLife and other related documents required for the
implementation of said benefits,Now Therefore
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF ROUND ROCK,
TEXAS:
That the proposal of MetLife for provision of voluntary employee-paid accident coverage and
voluntary employee-paid critical illness coverage is hereby accepted, as the proposal is determined to
be the most advantageous to the City considering the price and other evaluation factors included in the
request for proposals.
That the Mayor is hereby authorized and directed to execute on behalf of the City the
applications for coverage with MetLife and other related documents required for the implementation of
said benefits, a copy of such documents 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
0112.1804;00408851/ss2
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 13th day of September, 2018.
CRAIG NiORGMayor
City of Round Rick, Texas
ATTEST:
Fitt"- law
SARA L. WHITE, City Clerk
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EXHIBIT
„A„
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Group, Voluntary &Worksite Benefits
Metropolitan Life Insurance Company p p Y
200 Park Avenue
New York, NY 10166
Statement of Responsibility
MetLife will be responsible to the group policyholder for the performance of its administrative obligations under the group
policy, this agreement and any other written agreement between MetLife and the group policyholder. If MetLife uses a
third party in connection with any of MetLife's administrative obligations, MetLife will remain responsible to the group
policyholder for the performance by the third party of those administrative obligations. The third party will work under the
control and direction of Metlife and Metlife will be solely responsible for the acts, errors and omissions of the third party.
The group policyholder will be responsible to MetLife for the performance of its administrative obligations under the group
policy, this agreement and any other written agreement between MetLife and the group policyholder. If the group
policyholder uses a third party in connection with any of the group policyholder's administrative obligations, the group
policyholder will remain responsible to MetLife for the performance by the third party of those administrative obligations.
The third party will work under the control and the direction of the group policyholder and the group policyholder will be
solely responsible for the acts, errors and omissions of the third party.
To be completed by Policyholder:
Craig Morgan E
(Name of Authorized Representative) (Title of Authorized Representative)
City of Round Rock Texas
(Signature of Policyholder Authorized Representative) (Group Policyholder Name)
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Signed at:
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(City) (State) Date(MM(DD/YYYY)
To be completed by Metropolitan Life Insurance Company:
Jame W. Reid
Executive Vice President MM/DD/YYYY Date
Group,'���`oluntar� &Worksite Benefits ( )
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CUSTOMER AGREEMENT
City of Round Rock Texas
221 East Main Street
ROUND ROCK, TX 78664
09/04/2018
Dear Laurie Hadley
Thank you for choosing a benefits program from Metropolitan Life Insurance Company ("MetLife") and the
MetLife family of Companies. We are excited to be providing benefits for City of Round Rock Texas
employees. To get started, please sign a copy of this letter below.
The benefits you have chosen for your Critical Illness Insurance, Accident Insurance are listed in the
schedules already provided to you. If your MetLife benefit offerings change; we will reflect those changes in a
new schedule.
MetLife will offer the benefits listed on the attached schedules ("MetLife Benefits")to all eligible
individuals. Individuals who obtain benefits are referred to as "Participants".
: .
For each of the MetLife Benefits listed on the attached schedule; MetLife will provide as applicable
either; a group insurance policy and insurance certificates; individually underwritten insurance policies;
a detailed benefits schedule; or one or more administrative agreements. These documents will detail
the benefits provided, costs, effective date, and other important terms. Nothing in this letter changes
any of the terms of the group or individual insurance policies, certificates or other applicable
administrative agreements.
MetLife will comply with all laws applicable to MetLife's activities in connection with the MetLife
Benefits,
4. MetLife will provide information and materials that eligible individuals need to understand the MetLife
Benefits.
5. MetLife will process eligibility information and payroll deductions in accordance with MetLife's policies
and procedures for each MetLife Benefit. MetLife will be responsible for all pricing and individual
underwriting decisions.
6. MetLife will provide account managernent services to City of Round Rock Texas and customer service
to eligible individuals.
MetLife will treat all non-public personal information about eligible individuals in a confidential manner
and in accordance with all applicable laws.
8. Participants no longer employed by City of Round Rock Texas (and where applicable, their
dependents) may continue certain benefits with MetLife in accordance with MetLife's policies and
procedures.
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(continued)
City of Round Rock° exas'S RESPONSIBILIT IES: '
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I. City of Round Rock Texas will communicate the MetLife Benefits to all eligible individuals and
distribute enrollment materials. City of Round Rock Texas will provide MetLife with full access to the
eligible population. City of Round Rock Texas will perform its administrative obligations to the fullest
extent to drive maximum participation in MetLife Benefits by all eligible individuals. [For Auto &
Nome coverage; City of Round Rock Texas will provide employee contact information to support
home mailings managed by MetLife up to four times throughout a calendar year. The campaigns will
be chosen by MetLife, and can be customized by adding the employer logo.]
?. City of Round Rock Texas will process enrollments and will report to MetLife the identity of all
Participants. For certain MetLife Benefits, MetLife requires that City of Round Rock Texas will
provide a list of all Eligible Employees and provide regular updates thereto. City of Round Rock
Texas will provide this if required to do so. MetLife and City of Round Rock Texas will agree upon
the timing and format of this enrollment information.
I City of Round Rock Texas will not use the name or Brand of MetLife or create or distribute materials
regarding the MetLife Benefits without MetLife's approval.
4, City of Round Rock Texas will comply with all laws applicable to City of Round Rock Texas's
activities in connection with the MetLife Benefits.
E Where Participants contribute to the cost of the MetLife Benefits. City of Round Rock Texas will
provide payroll deductions for amounts due in connection with the MetLife Benefits and will remit
payments to MetLife.
City of Round Rock Texas will be responsible for any filings required by the Department of Labor or
other Federal or State agencies. Upon request, MetLife will provide applicable information
necessary to make such filings.
If City of Round Rock Texas is represented by an insurance agent or broker for purposes of a
MetLife Benefit, City of Round Rock Texas agrees to inform MetLife of any change in its insurance
agent or broker.
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We look forward to serving your benefit needs! If the terms of this letter are acceptable to City of Round Rock
Texas, please sign below.
Very Truly Yours, Accepted and Agreed to:
#'�>Ei ROPO I Tt N LI"EE h aRA NE » t 4 � n City of ound R oc k 3teXa s
Craig Morgan
Name of Authorized Representative
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{ By Title of Authorized Representative
Executive Vice President
Title
Signature of Authorized Representative
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Meftife'
Metropolitan Life Insurance Company
20OPark Avenue, New York, New York
APPLICATION FOR GROUP INSURANCE
The applicant named below is applying for Group Insurance to provide coverage for the class(es) of persons specified
below.
APPLICANT DATA
1. Full legal name ofApplicant: o (the"Policyholder")
2.Address: 221 East Main Street City ROUND ROCK State TX Zip 78e64
EFFECTIVE DATE
The effective date ofthe applied for group insurance will ba 01/01/2019 subject hnN4edLife'nacceptance of
this application and the applicant's payment of the Premium due on or before such date.
SITUS
Group Policy forms will be issued for delivery in and governed by the laws of TEXAS
COVERAGE DATA
Employees/Members Dependents
Critical IllInsurance Critical Illness Insurance
Accident Insurance Accident Insurance
PREMIUM DATA
Premiums will bepaid: Monthly Quarterly Annually Other.-
Attached
therAttenhed is on edmsnoo payment of: $U
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AGREEMENT
The Applicant signing below agrees to accept the terms and provisions of all Group Policy forms issued pursuant to
thio application; including all Exhibito, amendments and endorsements, if any.
Fraud Warning.Any person who knowingly and with intent to defraud any insurance company orother person files an
application for insurance or statement of claim containing any materially false infonnation, or conceals for the purpose
of misleading, information concerning any fact material thereto commits a fraudulent insurance eot, which is a crime
and subjects such person tocriminal and civil penalties.
Signature ofApplicant's Authorized Representative
Signed at: City . State Date:
Name ofAuthorized Representative Craig Morgan
Title ofAuthorized Representative
Applicant's Signature
Signature of Licensed MetLife Agent orResident Agent as required by |avv
Agent's State License No. 985808 Date: 08/23/2018
Name of Agent: Andrew Clifton
Agent'a8igna1ure CW,oiv
GAPp13-O2
TX