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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)