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Home My WebLink AboutMinnesota life Application City of Oak Park Heights e e . Memo May 17, 2013 To: Eric Johnson From: Betty C Re: Life In'surance During January I was notified b Lincoln Life that it was being purchased by another insurance company. The new insurance company had a B rating (similar rating systems to Moody's). I asked Gary to check into the possibility of changing coverage with a better rated company. He and Bill Singer, the agent that sold us Lincoln Life found a different company, Minnesota Life Insurance Company, AA2 rating. The new company offers the same coverage but with an estimated savings of $720 /year to the city. Our ann ual expense for this benefit is $5337.24. The City presently pays for $50,000 of basic life insurance and an additional $50,000 AD &D per employee along with $10,000 coverage for a spouse and $5,000 per dependent child. This change will require the employees to fill out an enrollment form and a form for Beneficiary Designations. If these meets with your approval, there is a Policy holder Application that needs to be signed by you. I have attached it. Please sign as soon as you are able as we are looking at changing this by June 1, 2013. Group Term Life Policyholder Application MINNESOTA LIFE Minnesota Life Insurance Company - A Securian Company 400 Robert Street North • St. Paul, Minnesota 55101 -2098 Application is hereby made to Minnesota Life Insurance Company for a Group Term Life insurance plan providing life insurance and other supplemental benefits as indicated below. Applicant (policyholder) City of Oak Park Heights Address(street, city, state, zip) 14168 Oak Park Blvd Contact name Title Telephone number Gary Brunkhorst Finance 651- 439 -4439 E -mail address Fax number gbrunkhorst@cityofoakparkheights.com 651 -439 -0574 Plan Design: Please indicate the Group Term Life plan by checking the appropriate boxes below. The Accelerated Benefits Rider is always included. Plan Design Policyholder Paid (Basic) Employee Paid (Supplemental) Group Employee Term Life El El Employee Accidental Death and Dismemberment ❑ El Employee Waiver of Premium E E Group Spouse Term Life ❑ ❑ Spouse Accidental Death and Dismemberment ❑ ❑ Spouse Waiver of Premium ❑ ❑ Dependents Term Life Rider (Spouse and Child) ❑ m Child Term Life Rider ❑ ❑ Other: ❑ ❑ Financials: ow Non- Standard L Remit Cost Plus Uni- Nicotine Nicotine Participating Participating Rates Rates Employee Basic 0 ❑ ❑ ❑ L1 ❑ Employee Supplemental* Z ❑ ❑ ❑ El ❑ Spouse* Yl ❑ ❑ ❑ IZI ❑ AD &D* g ❑ ❑ ❑ N/A N/A Child* WI ❑ ❑ ❑ N/A N/A Packaged Dependents* LI ❑ ❑ ❑ N/A N/A * Standard is Non - Participating Who will administer this plan? g Minnesota Life ❑ Policyholder If the policyholder administers the plan, the policyholder will maintain records (including beneficiary designations, insurance amounts, and name and address changes) and provide Minnesota Life with monthly information (number of insureds, total amount of insurance, premium rate and total premium) and annual participant data. Minnesota Life Agrees To Provide: 1. Life insurance to those who have satisfied the eligibility and any underwriting requirements. 2. Enrollment materials necessary to implement the plan of insurance. 3. All underwriting, claims and actuarial services as necessary. The Policyholder Agrees To Provide: 1. Employee information to Minnesota Life to facilitate preparation of enrollment materials and plan set -up if required. 2. Payroll deduction facilities to collect premiums from insured employees, accounting for such premiums and remittance of such premiums to Minnesota Life. 3. Reasonable administrative assistance to Minnesota Life with regard to notification of insured terminations, changes in payroll deduction authorizations and the distribution of materials to employees. Either Minnesota Lif- or the Policyholder can terminate the group policy by giving the other party 31 days advance written notice. Thi h %roup policy is effective (date) June 1, 2013 and unless terminated by either party, will ai- , effect for a one year period and shall thereafter renew for additional one year periods. FOR TH ' • 1 ' OLDER Policy older Employer identification number City if Oak , - i Heights 41- 0941681 Si. atur- Title D ate x art 1 11:1 411 4A S 'Q/ L— Sl 10113 FOR INN .OTA LIFE Agent, bro -r or representative Agent, broker o '- presentative lice ' nesota Life agency number Allan Rot 1010413 Agency Signa, • . ' Date A.T.Grou • LLC x 03 -30565 Minnesota Life 1 MINNESOTA LIFE INSURANCE COMPANY COMPENSATION NOTICE & DISCLOSURE STATEMENT 1. Policyholder: City of Oak Park Heights 2. Policy Number(s): 34215 -G 3. Insurance Product(s): Group Term Life 4. Producer /Intermediary: AT Group LLC 5. Producer /Intermediary will receive sales commissions equal to the following amounts, expressed as percentages of gross annual premium: First Year: 15.00% Renewal Years: 15.00% 6. The insurance rates and fees offered by Minnesota Life for the Policy Number(s) listed above contain allowances to cover the cost of the commissions paid to Producer /Intermediary. There will be no additional charge to Policyholder for this compensation beyond the rates and fees agreed to for the Policy Number(s) identified above. Minnesota Life will not pay any additional compensation to Producer /Intermediary without the prior written authorization of Policyholder. 7. Effective Date of Compensation: June 1, 2013 MINNESOTA LIFE INSURANCE COMPANY By _ . Date April 16, 2013 Signature Title Assistant Secretary ACKNOWLEDGEMENT BY AUTHORIZED REPRESENTATIVE OF POLICYHOLDER I acknowledge that I have received and read the Compensation Notice and Disclosure Statement above. I authorize Minnesota - ife to include the Policy Number(s) identified in 2 above in the calculation of sales commissions as - _ r'•ed in 5 above. I understand that if Schedule A of Form 5500 is required, all compensatio ill •e eported on this form. I understand that if I have further questions regarding the payment of les o issions I can call Minnesota Life at 1- 888 - 826 -2645 or e-mail them at groupcom -yen - ' (•� ecurian.com. ,., / By 1 Date a / (Signature) Title d r . mrn ' r i'z►� -- compensation disclosure form 34215.doc MINNESOTA LIFE INSURANCE COMPANY RATE CONFIRMATION 1. Policyholder: City of Oak Park Heights 2. Policy Number(s): 34215 -G 3. Insurance Product(s): Basic Term Life and AD &D, Employee and Spouse Supplemental Term Life and AD &D, Dependent Life and Child Term Life and AD &D. The insurance rates included in this rate confirmation include compensation as outlined in the Compensation Notice & Disclosure Statement. 4. Rate Coverage Period: June 1, 2013 — May 31, 2016 Premium Rates: Basic Life: $0.19 / $1,000 / month Basic AD &D: $0.02 / $1,000 / month Employee and Spouse Supplemental Life: Abe Rate / $1,000 / Month Under 25 $0.05 25 -29 $0.06 30 -34 $0.08 35 -39 $0.09 40 -44 $0.12 45 -49 $0.21 50 -54 $0.37 55 -59 $0.61 60 -64 $0.75 65 -69 $1.31 70 -74 $2.06 75* $2.38 `Additional Supplemental rates are available beyond age 75 upon request Child Life: $0.14 / $1,000 / month Dependent Life: $3.00 per unit / month Employee, Spouse and Child Supplemental AD &D: $0.02 / $1,000 / month MINNESOTA LIFE INSURANCE COMPANY By Date April 16, 2013 Brian Anderson Title 2 Vice President ACKNOWLEDGEMENT BY AUTHORIZED REPRESENTATIVE OF POLICYHOLDER This document confirms that the rates stated above are the agreed upon rates for the specified policy numbers. These rates will be charged for coverage amounts effective during the Rate Coverage Period listed above. Minnesota Life reserves the right to adjust the rates at any time in the event of plan design changes, modifications to t - • efinition of eligible employees, or significant demographic changes in the group. We define signific- nt • anges to mean a change in the volume within a coverage or across coverages of mo . a 15 %. By Date i3 Title r • , ,v 4 sTIN.- -Tat