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AMENDMENT #4 - APPLICATION FOR GROUP COVERAGE FOR POLICY #50703 - DELETE REFERRALS ON POINT-OF-SERVICE PLANS, OTHER INSURANCE INFORMATION CAN NOW BE TAKEN OVER PHONE. STUDENT STATUS REQUIRED ONCE PER YEAR & CAN BE TAKEN OVER PHONE, EMERGENCY ROOM PHYSICIANS NOW PAID BASED ON NETWORK STATUS OF FACILITY. FINALLY, ANESTHESIOLOGIS & ASST. SURGEONS WHICH ARE NON-NETWORK ARE PAID THE NETWORK COINSURANCE IF HOSPITAL IS A NETWORK HOSPITAL, EFFECTIVE DECEMBER 12/1/2006 (NOTE: PER HUMAN RESOURCES, GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY SIGNATURE NOT NECESSARY) (ASSISTANT CITY MANAGER SIGNED 3/6/2008)