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HomeMy WebLinkAboutContract No. 2014-2560PreferredOne- INSURANCE COMPANY 6105 Golden Hills Drive Golden Valley, MN 55416 April 15, 2014 City of Columbia Heights Attn: Linda Magee 590 — 40th Ave. N E Columbia Heights, MN 55421 Dear Linda Magee: 40 ®5 Enclosed please find a revised Group Master Contract for City of Columbia Heights. This revised Group Master Contract is effective as of January 1, 2014, and reflects a change in the eligibility language and waiting period. Please replace this Group Master Contract with the Group Master Contract which was originally sent to you on March 31, 2014. Please review and feel free to call us with any questions. Thank you. Sincerely, Compliance Department PreferredOne Insurance Company Enclosures PCH 10409 cc: Johnson McCann Attn: Gayle McCann 206 E. Little Canada Rd. St. Paul, MN 55117 -1332 (Copy of GMC only) (763) 847 -4000 ■ Fax: (763) 847 -4010 ■ www.preferredone.com An Equal Employment Opportunity/Affirmative Action Employer PreferredOne Insurance Company Group Master Contract Employer: Employer Group No.: Address: Effective Date: City- of Columbia HeitZhts PCH10409 of record with PIC January 1, 2014 This Group Master Contract ( "GMC") is entered into by and between PreferredOne Insurance Company ( "PIC") and City of Columbia Heights ( "Employer "). This GMC includes the attached Exhibits A and B, and combined with the related Certificate(s) of Coverage ( "COC") for the PIC products the Employer has selected to offer to its qualified employees, any amendments and any other documents that are incorporated herein by reference (but specifically excluding the Summary of Benefits and Coverage), constitute the entire contract between us. Acceptance and Effective Date of this Contract. The Employer accepts this GMC by electing coverage under the COC and timely remitting the first premium payment to PIC. The GMC is effective on the effective date once the Employer receives this GMC from PIC and timely remits the first premium payment for the plan year to PIC as set forth herein. Coverage under this GMC and the COC is effective at 12:01 a.m. Central Time on the first day of the first month for which PIC timely receives payment of the applicable premium. Governing Law and Miscellaneous. This GMC is issued and delivered to the Employer in Minnesota. Except as otherwise stated in this GMC and the COC, the GMC and the COC are governed by applicable federal law including the Affordable Care Act, and the laws of Minnesota. PIC has discretionary authority to determine eligibility for benefits and to interpret and construe terms, conditions, limitations and exclusions of this GMC and the COC. No agent or broker has the authority to change this GMC or the COC, or to waive any of their provisions. IN WITNESS WHEREOF, PIC hereby executes this GMC on April 15, 2014. PreferredOne Insurance Company 6105 Golden Hills Drive Golden Valley, MN 55416 (763) 847.4013 AZ--- By: Paul Geiwitz Executive Vice President and Chief Marketing Officer Any person who knowingly and with intent to defraud makes a misstatement of material fact or withholds or conceals material information commits a fraudulent act, which is a crime. PIC07- 736 -R8 1 GMC (LG) (1/14) DEFINITIONS Italicized words in this GMC are either defined terms that have the same meaning as the defined terms in the COC, some of which are restated here for clarity, or certain defined terms which are newly stated below, and are used only in this GMC. Affordable Care Act The federal Patient Protection and Affordable Care Act, Public Law 111 -148, as amended, including the federal Health Care and Education Reconciliation Act of 2010, Public Law 111 -152, and any amendments to, and any federal guidance and regulations issued under these acts. Full -time Employee An employee who is regularly scheduled to work at least the minimum number of hours per week specified by the employer in the GMC. Plan Year The period of time from the Employer's initial effective date of coverage under the GMC until the Employer's next renewal date of the GMC. Thereafter, a 12- consecutive month period from the renewal date until the next renewal date while the GMC remains in force during which a health plan provides coverage for health benefits, which may be a calendar year or a fiscal year; and which shall be consistent with the Employer's effective date of coverage under this GMC and with the period of coverage for the Employer's qualified employees under the COC. The Employer's 2014 plan year is the calendar year, January 1 through December 31, 2014. Qualified Employee An employee of an eligible employer whom PIC determines has met the eligibility requirements set forth in this COC for enrolling in this COC. EMPLOYER CERTIFICATION The Employer certifies that, in accordance with 45 CFR §147.116, the eligibility conditions and waiting periods imposed by the Employer under this GMC and the COC do not violate the requirements of that section of the Affordable Care Act. ENROLLMENT Enrollment Periods The Employer will offer to each of its eligible employees the opportunity to become a subscriber under this GMC. In addition, Employer will provide an open enrollment period of at least 14- calendar days once per calendar year. PIC reserves the right to add additional annual open enrollment periods and to impose limits on such enrollment periods, in its sole discretion, or as necessary to comply with applicable federal or state law. Only qualified employees are permitted to enroll and re- enroll themselves and their eligible dependents during these periods, except as otherwise permitted in this GMC. Submitting Enrollment and Termination Information The Employer agrees to submit enrollment and disenrollment information to PIC in a timely manner and in a format acceptable to PIC, and will submit it so that PIC 1) receives a qualified employee's completed enrollment application without undue delay and no later than 30 calendar days after an employee's eligibility date, and 2) receives notice of termination of a member's coverage within 90 calendar days after the date the termination is effective. PIC07- 736 -R8 2 GMC (LG) (1/14) Enrollment and Termination Effective Dates When the Employer and PIC approve a qualified employee's eligibility and enrollment application, the employee's and any enrolled dependent's coverage is effective as described in Exhibit B, and is expressly subject to the conditions described in the COC. When a member disenrolls or terminates coverage, the effective date is determined in accordance with the "Ending Your Coverage" section in the COC. DOCUMENTS AND INFORMATION Member Documents The Employer will ensure that members and potential members timely receive all documents to which they are entitled by applicable law, including without limitation the COC; any ERISA- required summary plan description, summary of material modifications, and Form 5500 report; and the summary of benefits and coverage required under the Affordable Care Act, and any amendments thereto. If the Employer determines that any of these documents, other than the COC, are required by law to be published in a non - English language, or if the Employer receives any request that reasonably might have the effect of requiring publication of member notices or other member documents other than the COC in a non - English language, maintenance of a non - English language customer assistance process, or the provision of similar services, the Employer will timely notify PIC. In the event of a conflict between any English language and non - English language versions of member notices or other member documents, PIC will administer coverage and provide services in accordance with the English language versions of the documents. Supplemental Information Requests The Employer will comply with PIC's request for information and /or data regarding the Employer's plan and the Employer, including but not limited to, information regarding members for which PIC must provide reporting to regulatory authorities as required by federal or state law (such as Medicare reporting), and PIC is entitled to fully rely on such information. The Employer agrees to compensate PIC for any fees or fines incurred by PIC as a result of the Employer's failure to provide notice or information, or otherwise comply with the foregoing. When the Employer has knowledge that any enrolled dependent member resides at an address that is different from the last known address of the relevant subscriber, the Employer will immediately notify PIC. PREMIUM BILLING AND PAYMENT, COMMISSIONS AND COVERAGE Premium Billing PIC will bill the Employer for each full month of coverage by multiplying the applicable premium rate set forth in Exhibit A, by the number of persons enrolled. PIC will bill a full month's premium for members whose coverage is effective on or before the fifteenth day of the month; and will not bill for members whose coverage is effective after the fifteenth day of the month. PIC will bill the Employer no more frequently than once each month and the Employer agrees to timely pay the amount billed. PIC will reflect enrollments and disenrollments for a month in the subsequent month's billing. Amount and Timing of Payments Premium payments for a coverage month are due on the first day of that month. The Employer must pay, and PIC must receive, the Employer's premium payment on or before the premium due date, which is the first day of each month. The premium rate is effective for Employer's plan year or such longer period as set forth in Exhibit A; provided however, that PIC may change the premium rate set forth in Exhibit A: 1) when PIC becomes subject to any federal, state or local taxes, penalties, fees or regulatory assessments, and such change shall be effective upon written notice to the Employer; and 2) upon the occurrence of an event listed in the "Notice" section, effective on the date the event occurs. The scope of coverage provided is anticipated to change at least annually in response to any federal and state law changes; additionally PIC may change PIC07- 736 -R8 3 GMC (LG) (1/14) the scope of coverage upon required notice, to the extent allowed under applicable law. The coverage provided under this GMC and the COC and the premiums due for that coverage may change each year in order to meet federal or state regulatory requirements. Any change in coverage required by statute or regulation becomes effective according to statute or regulation. PIC allows a 20- calendar day grace period, to the 21" day of a month, for the Employer to make the applicable monthly premium payment. If all or a portion of the premium remains unpaid at the end of a grace period, the GMC will terminate in accordance with the "Termination of Coverage" section; PIC may pursue collection against the Employer for such unpaid premium; and PIC may assess a finance charge on the due and owing funds calculated on a daily basis at a rate equal to an annual rate of three (3) percentage points over the 3 -month London Interbank Offered Rate (LIBOR) as of the date on which the fees are due. The Employer hereby agrees to the imposition of such finance charges and agrees to pay the same when imposed. If the Employer makes a premium payment after the due date, but prior to expiration of the grace period, PIC, in its discretion, may require the Employer to authorize PIC to make electronic fund transfers from the Employer's financial institution for subsequent premium payments. If the GMC is not reinstated by payment of any unpaid premium, PIC is not responsible for claims for covered services received after termination. Commission Payments to Brokers PIC pays certain commissions and other payments to brokers for placement of the Employer's business with PIC. The amount of commissions and other payments may vary from time to time depending on the commission structure and the nature of the business placed with PIC. At the Employer's request and without charge, PIC will furnish information regarding the actual commission and other payments (if any) paid to brokers in connection with the Employer's contract with PIC. Benefit Coverage In consideration of the premiums paid by the Employer and its enrolled employees, PIC will arrange for the provision to members of the benefits described in the COC. In so doing, PIC may enter into agreements with providers of health care, one or more insurers, and such other individuals and entities as may be necessary to enable PIC to fulfill its obligations under this GMC. PIC will provide a summary of benefits and coverage to Employer as required by applicable law. In the event of a conflict between the GMC, the COC, the applicable summary plan description, the summary of benefits and coverage, and any other member documents, PIC will administer coverage and provide services in accordance with this GMC and the COC. By payment of the first premium owed PIC under this GMC, the Employer certifies to PIC that the COC listed in Exhibit A and issued by PIC shall be used solely in connection with a health savings account (HSA), within the meaning of Internal Revenue Code (Code) Section 223 and the regulations thereunder and Minnesota law regarding health savings accounts, established by a subscriber or by the Employer on behalf of a subscriber. Changes in Coverage PIC may modify the GMC, including the COC, 1) if and when the Employer renews the coverage so long as such modification is consistent with any applicable statute or regulation; 2) if a change in coverage is requested by the Employer, in which case the modification is effective on the date mutually agreed to with PIC; and 3) if required to comply with applicable statute or regulation, in which case the modification becomes effective according to statute or regulation. Only an officer of PIC has the authority to make or change the GMC. In addition to the provisions of the "Termination of GMC" section and the "Rescission of Coverage or GMC by PIC" section, PIC may non -renew or discontinue the GMC if 1) the Employer does not pay premiums in accordance with the GMC; 2) the Employer has performed an act or practice that constitutes PIC07- 736 -R8 4 GMC (LG) (1/14) fraud or made an intentional misrepresentation of material fact in connection with the coverage; 3) the Employer has not complied with any applicable GMC contribution or participation provisions, except as provided under the COC; 4) all of the Employer's employees no longer live, reside or work in Minnesota; or 5) the Employer no longer maintains a primary business office in Minnesota. PIC may discontinue offering all health insurance in the group health insurance market, including coverage under this GMC and the COC, if PIC is ceasing to offer coverage in the group health insurance market in which the Employer has purchased the coverage, in which case PIC will provide notice at least 180 calendar days before the date the coverage will be discontinued. PIC may also discontinue offering the coverage purchased under this GMC, in which case PIC will offer the option to purchase another group health insurance coverage PIC currently offers to employers; PIC will provide notice at least 90 calendar days before the date the coverage will be discontinued; and the change will be effective on a uniform basis without regard to any health status - related factor or claims experience regarding any covered or otherwise eligible individual. Benefit Coverage for Plans Exempt from, or Entitled to the Accommodation Regarding, the Affordable Care Act Requirements for Coverage of Preventive Contraceptive Services for Women If, under the exemption for certain qualifying "religious employers" (as described in the amended interim final rules issued on August 1, 2011, by the Departments of Treasury, Labor, and Health and Human Services, and in final rules issued on February 15, 2012, and July 2, 2013, as they may be amended from time to time), or under the accommodation for certain qualifying "eligible employers" (as described in the final rules issued on July 2, 2013, as they may be amended from time to time), the Employer claims exempt status or entitlement to the accommodation, with respect to the Affordable Care Act's requirement that non - grandfathered group health plans cover FDA - approved contraceptive services for women without cost sharing, then the Employer must timely complete and return to PIC a written certification of entitlement to such exempt status or to the accommodation with respect to its plan, on the certification form required by and available from PIC. The Employer must also promptly, and without undue delay, notify PIC of any circumstances that change Employer's exempt or accommodation status. Further, if the Employer believes it is an "eligible employer" that is entitled to the "accommodation" (as defined under the final rules issued on July 2, 2013, as they may be amended from time to time), which requires that insurers or issuers provide payments for certain contraceptives for covered employees of eligible employers and their covered dependents, and which does not permit insurers or issuers to charge the eligible employer or the employee for such contraceptive benefit, PIC will provide such financial accommodation only when and while all of the following requirements are met: 1. The Employer's plan is non - grandfathered; and 2. The Employer's plan is not entitled to the exemption from the Affordable Care Act's requirement that certain contraceptive services for women be covered without cost sharing; and 3. The Employer opposes providing coverage for all of such contraceptive services on account of religious objections; and 4. The Employer is organized and operates as a non - profit entity; and 5. The organization holds itself out as a religious organization; and 6. At all times on and after February 10, 2012, the Employer's plan does not provide coverage of all or the same subset of women's contraceptive or sterilization services and supplies that is otherwise required by the Affordable Care Act, because of the Employer's religious beliefs, and does so consistent with any applicable state law; and PIC07- 736 -R8 5 GMC (LG) (1/14) 7. The Employer notifies enrolled members (participants in the group health plan), as required by the Affordable Care Act, that the full range of contraceptive coverage is not provided under the plan for each plan year that begins on or after August 1, 2012, and distributes such notice in any application materials that are distributed in connection with enrollment or re- enrollment for each plan year that begins on or after August 1, 2012; and 8. The Employer certifies that it meets requirements in 2 -7; retains a copy of the certification; and makes it available for PIC's examination as of the first day of each plan year to which the accommodation applies; and 9. The Employer provides proof of each of the foregoing satisfactory to PIC and as requested by PIC. NOTICES Employer Notice to PIC of Certain Events The Employer shall immediately notify PIC of the occurrence of any of the following events: 1. A material change of 10% or more in the number of its employees through merger, acquisition, and /or business unit changes; 2. Additional offerings of other carrier benefit plans to its qualified employees; 3. A change in its contribution funding levels or contribution formulas for coverage under the COC; 4. Loss of qualified employee status or dependent eligibility for any individual; 5. Newly eligible qualified employees; 6. The Employer determines that any member documents other than the COC are required by law to be published in a non - English language, or Employer receives any request that reasonably might have the effect of requiring publication of member notices or other member documents other than the COC in a non - English language, maintenance of a non - English language customer assistance process, or the provision of similar services; 7. The Employer ceases doing business in Minnesota, or moves its office /work location out of Minnesota; 8. Discovery of any misrepresentation (including an omission) of material fact or fraud in connection with this GMC or coverage under the COC; or 9. Disclosure of a Health Savings Account (HSA) or Health Reimbursement Arrangement (HRA) account offering, its contribution funding levels or contribution formulas and any changes thereto. The Employer will timely provide to PIC all information, data, certifications and attestations requested by PIC, including but not limited to those required by or resulting from the Affordable Care Act, and specifically including all certifications of entitlement to exemption or accommodation with respect to coverage of preventive contraceptive services for women, and further shall provide timely notice to PIC of any and all changes affecting such information, data, certifications and attestations. PIC is entitled to fully rely on all such information. Delivery of Notices All notices required to be given to PIC under this GMC shall be written and personally delivered, effective on delivery, or sent by United States mail, postage prepaid, effective on the day following the date deposited in the mail. PIC07- 736 -R8 6 GMC (LG) (1/14) If PIC terminates the GMC and coverage under the COC for nonpayment of premium, PIC will provide 30 days' advance written notice to subscribers. Coverage will terminate on the date as described in item "4." of the "Termination of GMC" provision. If PIC rescinds coverage, the notice of rescission it sends subscribers will be effective 30 calendar days after the date postmarked by the United States Postal Service. If PIC terminates the GMC for "Employer Instructed Retroactive Termination ", the notice of cancellation it sends subscribers will be effective 30 calendar days after the date postmarked by the United States Postal Service. In mailing any notices to subscribers, PIC may rely upon the addresses supplied by the Employer, which the Employer will update every 12 months while this GMC is in effect. EMPLOYER INSTRUCTED RETROACTIVE TERMINATION When the Employer requests that PIC retroactively terminate a member's coverage, PIC will require a written directive from the Employer attesting that: 1) the request is a result of a good -faith error or processing delay by the Employer, 2) the member did not knowingly contribute to the error or delay, and 3) the member had no reasonable basis for relying on the existence of coverage during the period for which retroactive termination is being requested. PIC will retroactively terminate to the extent permitted by law. The Employer will be eligible to receive a premium credit for a maximum period of 3 months. For example, if a valid request to terminate a member effective May 31, 2014, is received and processed prior to the scheduled September 2014 bill run (done in mid - August), Employer will receive full premium credit back through June 2014 (June, July, August). If, however, this same request is received and processed after the scheduled September bill run, the credit will be reflected on the subsequent month's billing (October), and will only credit Employer back to July (July, August, September), and thus the Employer will forfeit the June premium credit. RIGHT TO AUDIT PIC may require proof of eligibility status regarding any member from the member or the Employer and may, at reasonable times and upon reasonable notice, audit or have audited the Employer's records regarding eligibility, enrollment, termination, premiums, and the coverage provided hereunder. If PIC determines that, after reasonable requests the Employer or member has failed to provide sufficient proof of eligibility status, PIC may rescind or terminate the coverage of the member, the Employer, or both, to the extent permitted by law. TERMINATION OF GMC This GMC may be terminated by the Employer and /or PIC as follows: 1. By the Employer on at least 30 calendar days' advance written notice of termination to PIC. If the 30 calendar day notice period ends on a date other than the last day of the month, the effective date of the termination will be delayed until the last day of that month. For example, if notice is given June 15, the 30 calendar day notice period will end July 15 and the termination will be effective July 31. Premium will be charged through the effective date of termination of the GMC and the Employer is responsible for its payment. An Employer- coordinated termination of all members simultaneously will be considered termination of this GMC by the Employer according to this provision and not a termination requested by the subscriber, and the Employer will not receive premium credit according to the section entitled "Premium Billing." PIC07- 736 -R8 7 GMC (LG) (1/14) 2. By PIC, with at least 30 calendar days' written notice of termination to the Employer and subscribers, except that PIC may terminate this GMC effective on the last day of the month in which one of the following events occurs: a. Employer fails to pay or PIC doesn't receive a premium payment in a timely manner under the terms of this GMC; b. Employer fails to comply with a material provision of this GMC relating to contributions or participation, or any other material provision; c. Employer ceases doing business in Minnesota, or moves its office /work location out of Minnesota. 3. By PIC, immediately upon discovery of any misrepresentation (including an omission) of material fact or fraud in connection with this GMC or coverage hereunder. 4. By PIC for nonpayment of the premium. RESCISSION OF COVERAGE OR GMC BY PIC "Eligible employees" and "qualified dependents" are only those persons who meet the requirements for those terms in EXHIBIT B of the GMC and the COC section regarding eligibility and enrollment. PIC's agreement to enroll and maintain enrollment of any person is in reliance on representations made by the Employer, that person and other persons, including about that person's qualifications as an eligible employee or qualified dependent. PIC will rescind coverage, which may include group coverage under this GMC, as provided by notice and permitted by applicable law for any member to the extent that PIC determines that the member (or anyone who sought or is seeking coverage on that member's behalf, including a subscriber, the Employer or an agent representing the member, a subscriber or the Employer), performed an act, practice or omission that constitutes fraud, or that the member made an intentional misrepresentation of material fact (including a misleading omission of material fact). "Material facts" may include but are not limited to statements or omissions on enrollment applications and claims for coverage or reimbursement. For example, statements or omissions that misrepresent a person's initial or continuing status as an eligible employee (such as when an employee's hours are reduced to less than the qualifying minimum) or a qualified dependent will result in rescission of coverage as provided by notice and permitted by applicable law. If PIC rescinds coverage, PIC will take all reasonable actions to recover amounts paid to providers for benefits received since the effective date of the rescission and then refund all premium less any amounts not recovered from providers. If PIC rescinds coverage, PIC will provide written notice to each affected subscriber at least 30 days in advance of implementation of the rescission, and rescission will be effective as of the effective date of the coverage or for any lesser period as provided by notice and as required by applicable law. RIGHTS AND OBLIGATIONS UPON TERMINATION OR RESCISSION OF GMC Upon termination or rescission of this GMC, neither party has any further obligation to the other party, provided, however, that such termination or rescission will not release either party of its obligations with respect to: 1. Obligations including payment obligations accrued before and up to the termination date; or 2. The indemnity provisions hereof. PIC07- 736 -R8 8 GMC (LG) (1/14) INDEMNIFICATION PIC will defend, hold harmless and indemnify the Employer from and against any and all claims, liabilities, damages or judgments asserted against, imposed upon or incurred by the Employer that result from third -party claims arising out of the negligence of PIC or PIC's employees, agents and representatives in the discharge of its or their responsibilities to a member. Excepting negligence by PIC or PIC's employees, agents and representatives in the discharge of its or their responsibilities under the GMC, Employer will defend, hold harmless and indemnify PIC from and against any and all claims, liabilities, damages or judgments, including attorney fees, resulting from third - party claims. Employer's duty to defend (but not to hold harmless and indemnify) will arise only if PIC, in its sole discretion, tenders such defense to the Employer. INCONTESTABILITY Statements the Employer or a member, or anyone seeking coverage on that person's behalf, makes relating to insurability will be considered representations and not warranties. After the GMC is in effect, its validity cannot be contested, except for nonpayment of premium or a fraudulent misrepresentation. After a member's coverage is in effect, its validity cannot be contested except for a fraudulent misrepresentation or an intentional misrepresentation of material fact (including a misleading omission of material fact). PIC07- 736 -R8 9 GMC (LG) (1/14) EXHIBIT A Group Master Contract By and Between PreferredOne Insurance Company and City of Columbia Heights The following terms and provisions are incorporated into the GMC to which this Exhibit A is attached: 1. MONTHLY PREMIUM RATE: The monthly premium rates for plan year are: Rates for 15.100.2.V Open Access Network Employee $879.28 Family $2,022.34 Rates for 1500.100.2RxF Open Access Network $592.63 $1,363.05 Rates for Rates for 1500.100.2RxF 2500.100.4Rx PreferredHealth Open Access Network Network $474.11 $530.73 $1,090.44 $1,220.68 The monthly premium rates for renewals will be provided in the "renewal rate packet" that PIC will send to the Employer at least 30 days before the renewal date. If a subscriber enrolls a dependent under the COC who is not considered the subscriber's tax dependent for health care benefits under the Internal Revenue Code, then federal tax law requires that the value of the coverage provided to such dependents be imputed as income to the subscriber on the subscriber's W -2. It is the Employer's, and not PIC's, responsibility to determine the appropriate tax treatment of, and fulfill all required reporting requirements for, coverage for all subscribers and dependents covered under the COC. a. PIC will collect and remit Employee Assistance Program (EAP) service fees to a third party EAP service vendor on behalf of the group. b. As requested by the Employer and agreed to by PIC, PIC collects and remits wellness or fitness service fees to a designated third party wellness service vendor on behalf of the Employer and /or members. c. PIC offers and provides wellness or fitness incentives and services to members covered under the GMC in connection with wellness or fitness services received from designated third party wellness or fitness service vendors. d. If a member's age is misstated on the subscriber's enrollment form, or if unintentional errors are made, PIC will refund overpayments or collect the balance due based on the member's correct information, and subsequent premiums will be based on the corrected information. PIC07- 736 -R8 10 GMC (LG) (1/14) EXHIBIT B Group Master Contract By and Between PreferredOne Insurance Company and City of Columbia Heights The following terms and provisions are incorporated into the GMC to which this Exhibit B is attached: 1. PARTICIPATION REQUIREMENTS: PIC does not impose minimum participation requirements for Employer to purchase coverage under this GMC at initial application. For Employer to be permitted to renew coverage from this GMC and the COC, at least 75% of all qualified employees of the Employer who have not waived coverage due to coverage under another plan, but no less than 50% of all qualified employees must participate in the coverage renewed from this GMC and the COC, or in another group health plan issued by PIC. Certain employees are permitted to waive coverage under this GMC and the COC due to: 1) coverage under another group health plan; 2) coverage under Medicare parts A and B; or 3) coverage under medical assistance under Minnesota Statutes Chapter 256B or general assistance medical care under Minnesota Statutes Chapter 256D, and they are excluded in meeting the participation requirements. Employees who want to waive coverage for these permitted reasons must do so in writing to the Employer, and the Employer must notify PIC. PIC has the right to review such waivers upon request. 2. CONTRIBUTION REQUIREMENTS: PIC does not impose a minimum contribution requirement for Employer to purchase coverage under this GMC at initial application. For Employer to be permitted to renew coverage from this GMC and the COC, the Employer must contribute at least 50% of the total premium for each enrolled qualified employee's coverage for the renewal plan year. 3. EMPLOYEES WHO ARE ELIGIBLE: The Employer has elected to allow qualified employees who live, reside or work in or work for an Employer whose office /work location is in Minnesota and who are in the following employee classes, to enroll in coverage under the COC: a. All full -time employees defined as working a minimum of 40 hours per week. b. All elected officials. c. RETIRED: Retirees are eligible under Minn. Stat. § 471.61. d. Special Rules. "Employee" means a person employed by the Employer and does not include, by way of example but not limitation, any of the following when they do not have direct employment relationships with the Employer: relatives of the Employer, owners of the Employer, members of the Board of Directors of the Employer, independent contractors and business associates of the Employer, ex- spouses of eligible employees, and retirees. "Employee" means an individual employed for at least 40 hours per week and includes a sole proprietor or a partner of a partnership, if the sole proprietor or partner is included under a health benefit plan of the Employer, but does not include individuals who work on a temporary, seasonal, or substitute basis. (Also includes certain retirees required to be covered under certain provisions of state law.) 4. ELECTION REGARDING COVERAGE FOR DEPENDENTS: The Employer has elected to offer coverage to qualified employees' eligible dependents. Qualified employees must enroll for coverage as subscribers to be permitted to enroll their eligible dependents. PIC07- 736 -R8 11 GMC (LG) (1/14) 5. WAITING PERIOD AND EFFECTIVE DATE OF COVERAGE: a. Waiting Period. The Employer imposes a waiting period on qualified employees as follows: No waiting period. b. Coverage Effective Date. Coverage begins first day, date of employment, provided that application for coverage is received within 31 days of the date of eligibility. 6. REHIRES: Treat as new employee, subject to the waiting period. PIC07- 736 -R8 12 GMC (LG) (1/14)