CM-07-11-243PARTICIPATION AGREEMENT
TO: Trustee of the TAGCO MULTIPLE EMPLOYER TRUST
The Undersigned Employer hereby requests that it be approved as a Participating
Employer under the TAGCO Multiple Employer Trust. The undersigned Employer
wants to make certain insurance coverage under an insurance policy(ies) issued to the
Trustee available to its former employees and the relatives of former employees who may
be eligible to apply for said coverage.
The undersigned Employer represents that:
1. It has established or is establishing and will maintain an employee welfare benefit
plan, which includes certain life and/or accident and health and/or disability
income benefits.
2. The purpose of its participation in this Trust is to obtain the insurance coverage
available under policy(ies) issued to the Trustee in order to fund its obligation
under said plan.
3. Unless otherwise provided in plan documents, the benefits available under said
plan are identical to and subject to the same terms and conditions as those
provided under policy(ies) issued to the Trustee and applicable to the undersigned
Employer.
4. In those cases where it does not pay all the premium for insurance coverages
available through its participation in this Trust, it will endorse the insurance
coverage available to its former employees and certain relatives of former
employees through the Trust and it will cooperate with the Insurer and its agent in
establishing and maintaining a list bill or payroll deduction or other method of
collecting and paying premiums due for its Insured Persons in accordance with
the Insurer's reasonable requests.
The undersigned Employer understands and agrees that in no event will the Trustee of
The TAGCO Multiple Employer Trust be a Plan Administrator or other fiduciary as to a
Participating Employer's employee welfare benefit plan.
The undersigned Employer agrees: (1) to be bound by the terms and conditions of said
Trust Agreement and any amendments thereto, and to assume all obligations of a
Participating Employer under said Trust Agreement; (2) to be bound by the terms and
conditions of any insurance policy(ies) issued to the Trustee covering certain employees
of the Employer; and (3) to accept the terms of the proposal, if any, attached to this
Participation Agreement.
The undersigned Employer agrees to furnish, and permit the inspection of, any records of
information required by the Settlor, Trustee or Insurer under said Trust in connection
with the administration of the Insurance Fund under said Trust. Trustee or Settlor shall,
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Participation Agreement
Page 1 of 2
upon written request, provide a copy of the Trust Agreement and such insurance
policy(ies) to a Participating Employer.
The undersigned Employer understands that the effective date of any insurance coverage
will depend on the terms of the policy(ies) issued or to be issued to the Trustee, and that
each eligible individual must apply to and be approved for coverage by the Insurer under
said policy(ies). The Employer further understands that said insurance policy(ies) issued
to the Trustee may be amended or canceled by the Insurer, and that the Settlor may
terminate said Trust, and that participation of a Participating Employer and coverage of
its Insured Persons may be terminated by the Insurer if the Participating Employer fails to
comply with the terms of the Trust, Policy(ies) or proposal.
Date: I�''
Employer:
By:
Name:
Title:
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The above named Employer is approved as a Participating Employer in the
TAGCO Multiple Employers Trust.
Participation Agreement
Page 2 of 2
DATE: November 7, 2007
SUBJECT: City Manager Approval, November 16, 2007
ITEM: Request that the City Manager signs the attached Participation Agreement between
TAGCO Multiple Employer Trust and City of Round Rock.
Department: Finance Department
Staff Person: Cindy Demers
Justification: The signing of this application will enable the City to become a participating
employer under the TAGCO Multiple Employer Trust.
Funding:
Cost: None
Source of funds: N/A
Outside Resources: N/A
Background Information: By becoming a participating employer under the TAGCO
Multiple Employer Trust the City has the ability to offer The Hartford Group Retiree Health
Benefit Plans with Part D coverage. These plans are supplemental insurance to the coverage
provided by Medicare. These plans will allow retirees to move from the City's Aetna plan to
the supplemental insurance plans.
This application is being processed without Legal review prior to agenda submission. .
Public Comment: N/A
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