CM-2015-958 - 10/19/2015City of Round Rock
ROUND ROCK
TEXAS Agenda Item Summary
Agenda Number:
Title: Employers Agreement for Employees Paid Benefits with AIG Benefits
Solutions
Type: City Manager Item
Governing Body: City Manager Approval
Agenda Date: 10/23/2015
Dept Director:
Cost:
Indexes:
Attachments: AIG Employee Paid Benefits 10 19 15
Department:
Text of Legislative File CM -2015-958
Employers Agreement for Employees Paid Benefits with AIG Benefits Solutions
Consider executing an Employee Agreement with AIG Benefits Solutions for employee paid voluntary
benefits (Critical Illness and Accident Insurance). This document outlines how the employee deductions
will be sent to AIG for these voluntary benefits.
Staff recommends approval
City of Round Rock Page 1 Printed on 1012912015
LEGAL DEPARTMENT APPROVAL FOR CITY COUNCIL/CITY MANAGER ACTION
Required for Submission of ALL City Council and City Manager Items
Department Name: HR
Project Mgr/Resource: Valerie Francois
Council Action:
ORDINANCE
Agenda wording
City Manager Approval
Employers Agreement for Employee Paid
Project Name: Benefits
Contractor/Vendor: AIG Benefits Solutions
FXX-J RESOLUTION
CMA Wording
Consider executing an Employee Agreement with AIG Benefits Solutions for employee paid benefits.
Attorney Approval
Attorney
Date t 6 L,6 bs
O:\wdox\SCClnts\0124\1501\MISC\00344303.XLS Updated 6/3/08
AIG Benefit Solutions
Underwritten by
American General Life Insurance Company*
Houston, Texas
Benefit Solutions The United States Life Insurance Company In the City of New York
New York,, New York
Employers Agreement
National Union Fire Insurance Company of Pittsburgh, PA
For Employee Paid Products
New York, New York
Administrative Office: P. O. Box 9000 Amarillo, TX 79105
'This company does not solicit business in New York
Phone: (800) 231-3655 & Fax: (713) 831-3929
Instructions: Complete Sections 1 through 4.
Section 1: Employer Information
City of Round Rock
Employer Name
231 E. Main Street Round Rock, TX 78664
Employer Address City, State Zip
Jay Light
Contact Name andTitle Phone Email
Number of Eligible Employees 805 Full-time
Part-time Years in Business 205
Have you had any notable increases or decreases in the number of employees over the past 12 months?
❑ Yes 0 No
If yes, please explain:
Number of Locations 1 Type of Business Government Municipality SIC Code
Section 2: Product Information
Life Products
Group - Master Application must be completed.
Individual
❑ Personal Universal Life
In addition to employees, coverage will be offered to:
❑ Spouse ❑ Dependent Children
❑ Waiver of Monthly Deduction Rider
❑ Accidental Death Benefit Rider
❑Terminal Illness Benefit Rider
❑ Children's Insurance Benefit Rider
❑ Future Guaranteed Insurability Rider (FGIR)
❑ PersonalTerm Life
❑ GroupTerm Life
❑ Group AD & D
❑ Waiver of Monthly Deduction Rider
❑Group Supplemental AD & D
❑Accidental Death Benefit Rider
❑Group Supplemental Life
❑Terminal Illness Benefit Rider
❑ Children's Insurance Benefit Rider
Accident and
Health Products
Group - Master Application must be completed.
Individual
❑ Personal Critical Illness ❑ With cancer
0 Group Critical Illness
coverage ❑ Without cancer coverage
❑ Benefit Extension Rider. Rider is available with cancer
coverage only.
❑ Loss of Independent Living Rider
❑ Medical Personnel/HIV Benefit Rider
Section 125 ❑ Yes ❑ No
AIGB100413 803/14
Accident and Health Products
Individual Group — Master Application must be completed.
❑ Personal Accident ❑ 24 hour ❑ Off -the -job
® Group Hospital Accident
❑ Group Hospital Indemnity
❑ Accident Only Disability Income Rider
❑ 24 hour ❑ Off -the -job
MO MS MT NC ND NE
❑ AD&D Rider
NM NV NY OH OK OR
❑ Hospital Cash Rider
SC SD TN TX X UT VA
Section 125 ❑Yes ❑ No
WI WV WY
❑ Group Short -Term Disability
❑ Group Long -Term Disability
Benefit Period* Elimination Period*
Same as above
*Benefit & Elimination period may vary by state
3mos
07n014/14
6 mos
❑ 7/7 ❑ 14/14 ❑ 30/30
12 mos
❑ 7/7 [114/14 ❑ 30/30 ❑ 90/90 ❑ 180/180
24 mos
0 14/14 0 30/30 13 90/90 ❑ 180/180
Section 125 ❑ Yes ❑ No
Employee Information: Please indicate the number of Employees in each state.
AL AK AR AZ CA CO
CT DC
DE FL GA HI IA ID
IL IN
KS KY LA MA MD ME
MI MN
MO MS MT NC ND NE
NH NJ
NM NV NY OH OK OR
PA RI
SC SD TN TX X UT VA
VT WA
WI WV WY
Note. Not all products or riders are approved in all states.
Section 3: Billing Information
Same as above
Billing Contact Name
Billing Address City, State Zip
Bill should be mailed to the attention of (please write name)
Phone Fax Email
Do you have a centralized payroll? OYes ❑ No If no, how many payroll centers do you have?
How are the employees paid? ❑ Weekly ❑ Bi -Weekly ❑ Monthly m Semi-monthly
❑ Other
❑ Skip Period
Number of insurance deductions per year 24 What is the first deduction date? 12.20.2015
How are employees identified? ❑ Social Security No. m Employee ID No.
How will deductions be administered? 0 Electronic transfer of payroll data ❑ Paper -bill
2 AIG8100413 803/14
Section 4: Authorization
Upon the written approval of American General Life Companies to include its domestic life insurance affiliates (collectively AGLC")
regarding a voluntary insurance program with the Employer identified above ("Employer"), Employer agreesto establish a voluntary
insurance program (the "Program") under which its eligible employees ("Employees") may purchase individual life and/or accident
and health products issued by AGLC and arrange for payment of the premiums for such insurance by payroll deduction. Accordingly,
Employer and AGLC agree as follows:
1. Employer agrees to allow AGLC representatives reasonable access to eligible Employees during regular working hours for the
purpose of promoting, explaining and/or enrolling such Employees in the Program on at least an annual basis. Employer agrees
to provide AGLC representatives with a private area conducive to Employee confidentiality in which to meet with such Employees.
2. Employer agrees to honor and administer all requests from eligible Employees participating in the Program ("Participant") for
periodic payroll deductions for the payment of insurance premiums and/or deposits as specified by Participant.
3. AGLC agrees to submit to Employer, if requested by Employer, periodic statements indicating the amount of premium to be
deducted from each Participant's payroll. Employer agrees to remitto AGLC all payroll deductions accumulated on behalf of each
Participant, in the amounts indicated in periodic statements furnished to Employer by AGLC, in a timely manner.
4. Employer and AGLC may terminate the Program upon 60 calendar days written notice to the nonterminating party. Following
such termination, a Participant who is eligible to maintain insurance coverage must pay premiums directly to AGLC.
5. If a Participant elects to terminate his or her participation in the Program, Employer agrees to notify AGLC of
such termination no later than the date of Employer's next remittance to AGLC of the accumulated deductions
following such termination.
6. Employer and AGLC agree that Employer is not responsible for the premium payment of any Participant after the termination of
such Participant's employment. However, Employer shall be responsible for remitting all funds which were deducted from such
Participants payroll prior to the effective date of termination of Participant's employment.
7. Each party agrees to treat confidentially, all information, records and materials obtained by it in connection with this Agreement
and any enrollment of Employees in the Program.
8. This Agreement does not amend or alter the terms of any individual life and/or accident and health products or contract.
9. THISAGREEMENT SHALL BE CONSTRUEDAND SHALL BE IN FORCE IN ACCORDANCEWITHTHE LAWS OF THE STATE OFTEXAS.
This agreement, including the data and information provided by Employer and all representations, warranties
and agreements set forth in this Agreement, constitutes the entire understanding and agreement between the
Employer and AGLC. Employer understands that no Program will be deemed to be established without the prior
written approval of AGLC.
By signing this Agreement, Employer represents and warrants that Employer has reviewed the information
contained in this Employer's Agreement, and that the information is true, correct and complete in all respects.
Employer understands and agrees that AGLC will rely on the information set forth in this Employer's Agreement
in determining an offer for insurance coverage, if any, for eligible employees of Employer. In this regard, AGLC
reserves the right, at any time, to change or withdraw an offer provided to Employer, in the event of incorrect or
incomplete information or other related errors in connection with this Employer's Agreement. Employer will be
promptly notified in writing by AGLC in the event of any changes to or withdrawal of AGLC offer for insurance
coverage for eligible employees of Employer.
Employer:
Signature:
Print Name:
Title:
Date:
American General Life Insurance Company
Signed:
Print Name:
Date:
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Producer:
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Signature:
Print Name:
Harold R Denton 6Z J
Title:
Senior VP
Date: 10/15/2015
MG100413 803/14