HomeMy WebLinkAboutContract 37690-A2CONTR CNO' T31 9 0
GROUP POLICY AMENDMENT NO. 2
Attached to and made a part of Group Policy 644013-A issued to
City of Fort Worth as Policyholder.
Effective May 1, 20081 the Group Policy is amended to provide the following:
1. The Premium And Renewal portion of the Coverage Features is amended to provide the following:
Premium Due Dates: September 1, 2005 and the first day of each calendar
month thereafter.
Effective each May 1, premiums will be adjusted to reflect
each Member's Predisability Earnings as of the Prior
February 1" and the Member's current age.
2. The Predisability Earnings section is amended to read as follows:
PREDISABILITY EARNINGS
Predisability Earnings means the greater of:
1. Your monthly rate of earnings as reported on February ls` (representing the prior year's
income) that will be used for determining your benefits under your Employer's retirement
plan;
2. Your current hourly rate of earnings in effect on the prior February ls` ; or
3. Your current hourly rate of earnings if you become a Member after February 1"
Any change in your Predisability Earnings after your last full day of Active Work will not affect your
LTD Benefit.
(REG WITH CO1Vn LT.PD.OT.1X
AMENDMENT NOT IN FORCE UNLESS SIGNED BY AN AUTHORIZED REPRESENTATIVE OF THE
POLICYHOLDER AND RETURNED TO STANDARD INSURANCE COMPANY WITHIN 30 DAYS OF
ISSUE.
Dated 20 �� at
City of Fort Worth
Karen L. Montgomery
. Assistant City Manager
�y
Group Policy�No�.��4�013-A
Attested by:
Marty Hendrix, Lity Secretary
Page 1 of Amendment No 2
STANDARD INSURANCE COMPANY
IC �
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President Corporate Secretary
Group Policy No. 644013-A Page 2 of Amendment No 2