City of Long Beach - File #: 30876_011

• File #: 30876_011
• Version: 1
• Name: GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY - AMENDMENT #11
• Type: Conformed Contract
• Status: CCIS
• File created: 10/20/2008
• In control: City Clerk
• On agenda: 9/18/2007
• Final action: 9/18/2007
• Title: AMENDMENT #11 - APPLICATION FOR GROUP COVERAGE FOR POLICY #50703 - ADD COORDINATION OF BENEFITS FOR PRESCRIPTION DRUGS FOR HUSBAND-WIFE TEAMS WHO WORK FOR CITY. REIMBURSEMENT IS LIMITED TO Rx-DRUG CO-PAYS. Rx-DRUG COVERAGE IS PROVIDED BY MEDCO. MEMBER WILL SUBMIT AN Rx-DRUG RECEIPT SHOWING CO-PAY PAID BY MEMBER FOR REIMBURSEMENT. THIS AMENDMENT DOES NOT APPLY TO MEDICARE SUPP PLAN, OR THRIFT PLAN. ADD SERVICE CODES FOR "DG" & "GENDG" AT 100%, EEFECTIVE 1/1/2008 (NOTE: PER HUMAN RESOURCES, GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY SIGNATURE NOT NECESSARY) (ASSISTANT CITY MANAGER SIGNED 3/6/2008)
• Sponsors: Human Resources
• Indexes: Amendments, Insurance
• Related files: 07-1098

Date	Ver.	Action By	Action	Result
9/18/2007	1	City Council	authorize City Manager

TITLE

AMENDMENT #11 - APPLICATION FOR GROUP COVERAGE FOR POLICY #50703 - ADD COORDINATION OF BENEFITS FOR PRESCRIPTION DRUGS FOR HUSBAND-WIFE TEAMS WHO WORK FOR CITY.  REIMBURSEMENT IS LIMITED TO Rx-DRUG CO-PAYS.  Rx-DRUG COVERAGE IS PROVIDED BY MEDCO.  MEMBER WILL SUBMIT AN Rx-DRUG RECEIPT SHOWING CO-PAY PAID BY MEMBER FOR REIMBURSEMENT.  THIS AMENDMENT DOES NOT APPLY TO MEDICARE SUPP PLAN, OR THRIFT PLAN.  ADD SERVICE CODES FOR "DG" & "GENDG" AT 100%, EEFECTIVE 1/1/2008 (NOTE:  PER HUMAN RESOURCES, GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY SIGNATURE NOT NECESSARY) (ASSISTANT CITY MANAGER SIGNED 3/6/2008)