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ADMINISTRATIVE AGREEMENTConnecticut General Life Insurance Corn ADMINISTRATIVE AGREEMENT For POLICYHOLDER: City of Clearwater ACCOUNT NUMBER: 3331468 POLICY NUMBER(S): BASE, COPAY, NBASE, NCPAY, NPOS, POS EFFECTIVE DATE OF RIDER: January 1, 2010 ISSUE DATE OF RIDER: January 6, 2010 1. '11ie following definitions apply to this Agreement: a. "Plan" means the plan established by the Policyholder for a certain Class of Employees. b. "Plan Benefits" means the Benefits in the Plan that are listed below for each Class of Employees. Rates For Employee For Dependent Class of Employees Benefit Insurance Insurance Each Employee All Benefits A Rate or Rates as established by written agreement between the Policyholder and the Insurance Company. C. "Policy Month" means the period starting on a monthly Premium Due Date and ending on the day before the next monthly Premium Due Date; except that the first Policy Month starts on January 1, 2010 and the last Policy Month ends on the day this Agreement terminates. d. "Monthly Amount" for each Class of Employees for each Benefit means the amount for any Policy Month that equals the number of Employees in that class multiplied by its Rate per Employee for that Policy Month for that Benefit. If the Plan Benefits covered by this Agreement include Short Term Disability, then the "Monthly Amount" for each Class of Employees for each Short Term Disability Benefit means the amount for any Policy Month that equals the total Weekly Benefit in force on that date multiplied by the Monthly Rate per $10.00 of Weekly Benefit for that Policy Month for that Benefit. e. "Policy Year" means the period starting on a policy Anniversary Date and ending on the day before the next policy.Anniversary Date; except that the first Policy Year starts on January 1., 2010 and the last Policy Year ends on the day this Agreement terminates. GM5810 1 FL Connecticut General Life Insurance Company f "Maximum Monthly Payment" for each Policy Month means the sum, for that Policy Month, of the Monthly Amount for each Class of Employees for each Benefit listed .in item 1. b. g, "Maximum Yearly Payment" for each Policy Year means the sum of the Maximum Monthly Payments for each Policy Month in that Policy Year. h. "Benefit Payment Account" means the bank account of the Policyholder from which Plan Benefit payments for which he is liable are made. 2. The Policyholder is liable each Policy Month for payment of all Plan Benefits up to the sum of a. the greater of: (i) the Maximum Monthly Payment for that month, or (ii) 95% of the Maximum Monthly Payment for the preceding Policy Month; and b. any excess of (i) the sum of the Maximum Monthly Payments for each preceding Policy Month of the current Policy Year; over (ii) the sum of the Plan Benefits paid by the Policyholder in such Policy Months. 3. The Insurance Company, acting for the Policyholder will: a. dctermine the amount of any Plan Benefits that an Employee may be entitled to under item (2) above; b, pay all Plan Benefits so determined; and c. defend any action brought in connection with any claim for Plan Benefits so determined and make such settlement as it deems appropriate. 4. The Insurance Company will perform its duties as agent for the Policyholder with reasonable care and diligence and will be liable for any action not taken in good faith. The Policyholder will not sustain any loss with respect to this Agreement because of the dishonest, fraudulent or criminal acts of any employee of the Insurance Company. 5. During any Policy Month the Insurance Company is obligated to pay all Plan Benefits that exceed the Plan Benefits the Policyholder has to pay during that Policy Month. 6. The Insurance Company will determine the amount of any Plan Benefits which an Employee may be entitled to under item (5) above. It will defend any action brought in connection with any claim for Plan Benefits so determined and make such settlement as it deems appropriate. GM5910 2 1^L Connecticut General Life Insurance Company 7. The Policyholder will carry out his obligation to pay Plan Benefits as described in item (2) above by providing sufficient funds in the Benefits Payment Account to pay from it all benefits payable by him under the Plan in a timely manner. 8. An Employee making a claim for Plan Benefits shall submit such claim to the Insurance Company, subject to the policy requirements relating to Notice of Claim and Proofs of Loss. When any claim for Plan Benefits has been approved, the Insurance Company will determine if such claim or any part of it is an obligation of the Policyholder or of the Insurance Company. Payment of such claim will be made in accordance with this determination which, where made in good faith, will be binding on the Insurance Company and the Policyholder. 10. If any payment is approved in relation to a contested claim, the Insurance Company will determine, based on the date payment is actually made, if such payment or any part of it is an obligation of the Policyholder or of the Insurance Company. Benefit payments made in accordance with the terms of any judgement or settlement will be deemed benefits paid to Employees under the Plan for the month in which such judgment or settlement is satisfied. 11. The obligations of the Insurance Company and the Policyholder under this Agreement will be mutually exclusive and neither party will be liable for the obligations of the other. 12. The Monthly Premium Rate in the policy will not apply to any Class of Employees and Benefits affected by this Agreement. Instead, the following will be used: A Rate or Rates as established by written agreement between the Policyholder and the Insurance Company. When included in Plan Benefits, the following are not affected by this Rider; the Monthly Premium Rate in the policy will continue to apply to these benefits: the Experience Protection Benefit, the Family Security Benefit, guaranteed cost behavioral care (including Medical Benefits for Mental Illness and for Alcohol and Drug Abuse) and coverage for persons age 65 or older for whom Medicare is the primary payer. 13. In addition to the premium determined in accordance with item (12) above, a Supplemental Premium will be due on each Monthly Premium Due Date. Payment of such Supplemental Premium will be waived contemporaneously with a subsequent Monthly Supplemental Premium becoming due. The Supplemental Premium outstanding at termination of this Agreement will be payable on the date of such termination. The amount of the Supplemental Premium will be determined by use of a formula agreed upon by the Insurance Company and the Policyholder. In no event will the Supplemental Premium be greater than the amount which the Insurance Company would have accrued in accordance with its normal underwriting practices but for this Agreement for both reserves and for premium taxes and expenses associated with claim payments issued after this Agreement temninates. GM5810 3 FL V-5 & 3a rL V-2 (2) Connecticut General Life Insurance Company _ 14. The Insurance Company has the right to change the Monthly Premium Rate, the Supplemental Premium, the Monthly Amount, and the Maximum Monthly Payment as of (a) any policy Anniversary Date; (b) the date of any change in the Plan; (C) except for the Supplemental Premium, the date this Agreement terminates; and (d) at such other times as are provided for in the policy. 15. This Agreement will automatically terminate on the earliest date below: a. the date the Plan ends; b. the close of the third consecutive business day during which the Policyholder has failed to provide sufficient funds in the Benefit Payment Account to pay Plan Benefits as they arise. (For the purposes of this item, the close of business on any day will occur at any time when deposits made to the Benefit Payment Account on that day will be credited to it as of the next busuicss day by the bank in which the Benefit Payment Account is maintained); C. the date the policy terminates. In any case this Agreement may be terminated by: (a) the Policyholder, on any Premium Due Date, if he gives written notice in advance of that date to the Insurance Company, and (b) the Insurance Company, at any time, if it gives the Policyholder 31 days' advance notice. 16. When this Agreement terminates, the sum of (a), (b) and (c) below will be due and payable without delay by the Policyholder to the Insurance Company: a. all unpaid monthly premiums; b. the Supplemental Premium; and c. any excess of- (i) the sum of the Maximum Monthly Payments for each of the Policy Months in the last Policy Year, over (ii) the sum of (a) all Plan Benefits the Policyholder has paid for such Policy Year; and (b) all Plan Benefits not yet paid at the time of such termination which the Policyholder must pay under the terms of this Agreement for such Policy Year. GM5810 4 FL Connecticut General Life Insurance Corn 17. When this Agreement terminates, the Policyholder will, be responsible for the payment of all Plan Benefits for which checks were issued on the Benefit Payment Account before this Agreement terminated, but not for payment of any other Plan Benefits under this Agreement after its termination CONNECTICUT GENERAL LIFE INSURANCE COMPANY By: Zj?R24A? Name: Esther LaPointe Title: Contractual Agreement Unit Manager EL/dcm Accepted by: CITY OF CLEARWATER By: See Attached Signature page Name: Title: Executed thi_ day of ?" - in the year GM5810 5 FL Signature page for City of Clearwater for: 2010 Cigna Health Care - Connecticut General Life Insurance Company, Policy Number 3331468 - Florida Countersigned: Frank V. Hibbard Mayor Approved as to form: Leslie K. Dougal - s Assistant City Attor y CITY OF CLEARWATER, FLORIDA By: s4t&, 1? • . William B. Horne II City Manager Attest: