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HomeMy WebLinkAboutMetLifeMet` ife ,12-„,,,71,1427<pf Metropolitan Life Insurance Company One Madison Avenue, New York, New York 10010-3690 Metropolitan Life Insurance Company ("MetLife"), a stock company, will pay the benefits specified in the Exhibits of this policy subject to the terms and provisions of this policy. The Schedule of Exhibits lists each Exhibit to this policy, to whom It applies and its effective dale. Policyholder: City of Miami Group Policy No.: 117353-1-G EFFECTIVE DATE This policy will take effect on January 1, 2005, POLICY ANNIVERSARIES Policy anniversaries will be January 1, 2006 and each subsequent January 1. PREMIUM PAYMENTS This policy Is issued In return for the payment by the Policyholder of required Premiums. Premiums are payable at the home office of MetLife or to its authorized agent, The first Premium is duo on and must be paid by this policy's effective date. Any later Premiums are due monthly in advance on the first day of each Policy Month. These dates are the Premium Due Dates. POLICY SITUS This policy Is issued for delivery In and governed by the laws of Florida. Signed as of this policy's effective date at MelLife's home office in New York, New York. OA, Gwenn L. Carr Vice President and Secr Signed by _ (A MetLife'licensed agent or resident agent as required by law.) Robert H. Benmosche Chairman, Presidenland Chief Executive Officer GROUP DENTAL INSURANCE POLICY GPNP99 117353.1-G.;' Date /2 /5 oy NON -DIVIDEND PAYING --- -Page 1 TABLE OF CONTENTS Suction Pago POLICY FACE PAGE Effective Date 1 Policy Anniversaries 1 Premium Payments 1 Policy Sltus 1 DEFINITIONS 3 SCHEDULE OF INSURANCE 4 ELIGIBILITY AND EFFECTIVE DATES OF INSURANCE 4 CONTRIBUTIONS 4 PREMIUM RATE(S) Initial Rate(s) Frequency of Premium Payment 4 Computation of Premium 4 Premiums for Changes in Insurance 4 Right to Change Premium Rates 5 GRACE PERIOD END OF INSURANCE PROVIDED BY THIS POLICY 6 REINSTATEMENT 7 GENERAL PROVISIONS Entire Contract 7 Policy Changes or Waivers 7 Incontestability: Statements Made by the Policyholder 7 Incontestability: Statements Made by Covered Persons 7 Certificates 8 Assignment 8 Data Needed 8 Misstatement of Ago • 8 Non -Dividend Paying 8 Conformity with Law 8 SCHEDULE OF EXHIBITS SCH/EXHIBITS EXHIBIT 1, Schedule of Premium Rates EXHIBIT1 EXHIBIT 2: Certificate Forms EXHIBtT2 GPNP99 117353.1-G _ Pago 2 DEFINITIONS As used in this policy, the terms listed below will have the meanings defined below. When.dofined temps are used in this policy, they will appear with Initial capitalization. The plural use of a term defined in the singular will share the same meaning. Contribution means the amount the Policyholder may require the Employee to pay towards the total Premium that MetLife charges for the insurance provided by this policy, Contributory Insurance means insurance for which the Policyholder may require the Employee to pay at least part of the Premium. Covered Person means an Employee and/or a Dependent as set forth In the Exhibit which applies to the Employee. Dependent Is defined in the Exhibit which applies to the Employee. Employee Is described in the Exhibit whlch'applles to the Employee. Employer means the Policyholder shown on page 1. Noncontributory Insurance means Insurance for which the Policyholder may not require the Employee to pay any part of the Premium. Policy Anniversary is defined on page 1. Policy Month, The first Policy Month will begin on the effective date shown on page 1. Subsequent Policy Months will begin on the same day of each subsequent calendar month. Premium means the amount the Policyholder must pay to MelLife for all tho insurance provided under this policy, Premium Due Date is defined on page 1. Signed means any symbol or method executed or adopted by a person with the present Intention to authenticate a record, and which is on or transmitted by paper or electronic media, and which is consistent with applicable law. Written or Writing means a record which is on or transmitted by paper or electronic media, and which is consistent with applicable law. GPNP99 117353-1-G Page 3 SCHEDULE OF INSURANCE The Schedules of'lnsurancs which apply under policy are set forth in the Exhibits. ELIGIBILITY AND EFFECTIVE DATES OF INSURANCE The Eligibility and Effective Dates of Insurance provisions that apply under this policy are sot forth in the Exhibits. CONTRIBUTIONS The maximum amount that an Employee may be required to contribute to the cost of Contributory Insurance will not exceed the Premium charged for the amounts of such insurance. PREMIUM RATE(S) Initial Rate(s) The initial Premium rate(s) are shown in Exhibit 1. Froquency of Premium Payment Premiums for this policy will be paid as shown on page 1. MetLife and the Policyholder may agree that payment be made in advance every 3, 6 or 12 months. Computation of Premium The Premium due on any Premium Due Date Is determined by the total amount of insurance provided by this policy on such Premium Due Date, multiplied by the appropriate Premium rate(s) which aro then in effect subject to any Premium adjustments, If applicable. MetLife may use any reasonable method to compute Premiums due under this policy. Premiums for Changes In Insurance For insurance that takes effect after the first day of a Policy Month, Premium will be charged from the first day of the next Policy Month, However, If a policy amendment or evidence of good health is required for such insurance, Premium will be charged as of the date such insurance takes effect. if this policy ends, or if insurance ends for a class of persons, Premium will be charged to the date insurance ends. If Insurance ends for other reasons, Premium will be charged to the end of the Policy Month in which Insurance ends. GPNP99 117353.1-G Page 4 --f PREMIUM RATES (Continued) Right to Change Premium Rates MetLife may change Premium rates for changes which materially affect the risk assumed for the insuranco provided by this policy, as follows: 1. when this policy Is amended or endorsed; 2, when a class of eligible persons Is added to or deleted from this policy for any reason including corporate restructuring, acquisition, spin-off or similar situations; 3, when a Policyholder's subsidiary, affiliate, division, branch or other similar entity is added to or deleted from this policy for any reason Including corporate restructuring, acquisition, spin-off or similar situations; 4. when there Is a significant change in the geographic distribution of insured Employees; 5. when applicable taw requires a change In: a, the Insurance provided by thls policy; and/or b. the class of persons eligible for insurance under this policy; or 6. when a Premium Due Date coincides with or next follows: a. a change greater than 10% In the number of Covered Persons since the later of the policy Effective Dale and the last date Premium rates were changed; or b, a change greater than 10% In the amount of Insurance provided by this policy since the later of the policy Effective Date and the last date Premium rates were changed. MetLife will notify the Policyholder, In Writing, at feast 60 days before a Premium rate change, In addition, MetLife may change Premium rates: 1. except as may be stated in Exhibit 1, any date on or after the first Policy Anniversary; this will be done no more frequently than every 12 months and only if MetLife notifies the Policyholder, in Writing, at least 60 days before such change; and 2. on any other date agreed to by MetLife and the Policyholder. The new Premium rates will apply only to Premiums due on or after the date the rate change takes effect, GPNP99 117353-1-G Page 5 GRACE PERIOD Each Premium due after the effective date of this policy may be paid up to 31 days after its Premium Duo Date, This period Is the grace period. The Insurance provided by this policy will stay in offact during this period. MetLife will notify the Policyholder in Writing that, if the Premium Is not paid by the end of the grace period, thls policy will end at the end of the last day of the graco period. If MetLife fails to give Written notice to the Policyholder, thls policy will continue in effect until the date such notico Is given, Policyholder's intent to end this policy during the grace period. The Policyholder may notify MetLife in Writing prior to the end of the grace period of its intent lo end this policy before the end of the grace period. In this case, this policy will end on the later of: 1. the date stated in the notice; or 2. the date MetLife receives the notice. If the Policyholder replaces this policy with another group insurance policy but dons not givo MetLife notice of Intent to end thls policy, the grace period provisions will apply. Grace period extensions. MetLife may extend the grace period by giving Written notice to the Policyholder. Such notice will state the date this policy will end If the Premium remains unpaid, Premiums must be paid for a grace period, any extension of such period and any period insurance under This policy was in effect for which Premium was not paid. END OF INSURANCE PROVIDED BY THIS POLICY The Policyholder can end this policy by giving 90 days advance Written notice to MetLife. The policy wit end on the later of: 1. the date stated in the notice; or 2. the date MetLife receives the notice. MetLife can end this policy as follows: 1. on the date Premium Is not paid when due, subject to the Grace Period provisions; or 2, on any Premium Due Date, by giving the Policyholder 90 days advance Written notice, if less than: a. 75% of persons eligible under this policy are insured for Contributory Insurance; b. 100% of persons eligible under this policy are insured for Noncontributory Insurance; or c, 50 Employees are Insured by this Policy; 3. on any Premium Due Date, by giving the Policyholder 90 days advance Written notico, if tho Policyholder falls to provide information on a timely basis or perform any obligations required by this policy or any applicable law; or GPNP99 117353-1-G Page G END OF INSURANCE PROVIDED BY THiS POLICY (Continued) 4. on any Policy Anniversary, except during a Rate Guarantee Period as may be provided in Exhibit 1, by giving the Policyholder 90 days advance Written notice. This policy will end on the date on which the last certificate in affect under this policy ends, If this policy ends, all Premlums due must be paid. if MetLlfe accepts Premium after the date this policy ends, such acceptance will not act to reinstate the policy, MetLlfe will refund any unearned Premium. REINSTATEMENT The Policyholder may request to reinstate this policy within one year from tho date it ended. The request must be in Writing and it must provide MetLife with information that MelLife requires to consider such request. If MetLlfe approves the request, the policy will be reinstated on the date stated in Writing by MetLlfe. GENERAL PROVISIONS Entire Contract, The entire contract is made up of the following: 1. this policy, Including its Exhibits; 2. the Policyholder's application; and 3. the amendments and endorsements to this policy, if any, Policy Changes or Waivers. The terms and provisions of this policy may be changed, at any timo, without the consent of the Covered Persons or anyone else with a beneficial interest in it. MetLifo will issuo amendments or endorsements to effect such changes. MetLife will only make changes that are consistent with applicable law. An amendment or endorsement will not affect the insurance provided under certificates issued before the effective date of the change, unless retroactivity is consistent with applicable law. An officer of MetLife must approve in Writing any change or waiver of the terms and provisions of this policy. A sales representative, or other MetLife employee, who is not an officer of MetLife does not have MetLife's authority to approve such changes or waivers, A change or waiver will be evidenced by an amendment Signed by an officer of MetLife and the Policyholder or an endorsement Signed by an officer of MetLite. A copy of the amendment or endorsement will be provided to the Policyholder for attachment to this policy. Incontestability: Statements Made by the Policyholder. My statement made by the Policyholder will be considered a representation and not a warranty. MetLife will not use such statement to avoid insuranco, reduce benefits or defend a claim unless It is contained in a Written application. MotLife will not use such statement to contest life insurance after it has been in force for 2 years from its effective date, or date of last reinstatement, unless the statement is fraudulent. incontestability: Statements Made by Covered Persons. Any statement made by a Covered Person will be considered a representation and not a warranty. MetLlfe wit not use such statement to avoid insurance, reduce benefits or defend a claim unless the following requirements are met: 1. the statement Is in a Written application or enrollment form; 2, the Covered Person has Signed the application or enrollment form; and -3, a copy of the application or enrollment form has bean given to tho Covered Person or his beneficiary. MetLlfe will not use a Covered Person's statements which relate to insurability to contest life insurance after it has been In force for 2 years during his life, unless the statement is fraudulent. In addition, MetLifo will not use such statements *to contest an increase or benefit addition to such insurance after the increase or benefit has been In force for 2 years during his life, unless the statement Is fraudulent. - GPNP99 117353-1-G Page 7 GENERAL PROVISIONS (Continued) Certificates. MetLife w1111ssue indiVidual•cettificetes to the Policyholder for delivery to each Covered Person, as appropriate, Such certificate will describe the Covered Person's benefits and rights under this policy. "Certificate" Includes any of Mett lfe's insurance riders, notices or other attachments to the certificate. Assignment. The rights and benefits under this policy are not assignable prior to a claim for benefits, except as required by law or as permitted by MetLife. Data Needed. The Policyholder will provide MetLife with all the data needed to compute Premiums and carry out the terms of this policy, MetLife rnay examine such data at any reasonable timo. If MetLlfo or the Policyholder make a clerical error In keeping the data, the Premium and/or benefits will be adjusted according to the correct data. An error will not end insurance validly in effect, nor will It continuo insurance validly ended. Misstatement of Ago. If a Covered Person's age is misstated, the correct age will be used to determine if Insurance is in effect and, as appropriate, adjust the Premium and/or benefits. Non -Dividend Paying. Thls policy does not pay dividends. Conformity with Law. If the terms and provisions of this policy do not conform to any applicable law, this policy shall be interpreted to so conform, GPNP99 117353-1-G Page 8 SCHEDULE OF EXHIBITS Exhibit Effective Number Exhibit Type Applies To Date 1 Schedule of Premium Rates All Covered January 1, 2005 Persons 2 Certificate Forms Ali Covered January 1, 200E Persons GPNP99 117353-1-G SCHIEXHIBITS DATE, January 1, 2005 EXHIBIT 1 SCHEDULE OF PREMIUM RATES The Initial monthly Premium rates for the Insurance provided by this policy aro as follows: Rate Guarantee Period Subject to the Right to Change Premium Rates provision on page 5, the Dental Insurance Premium rates will be In effect for the period which begins on January 1, 2005 and ends on December 31, 2005. Class I - Executives Dental ExpenseBenefits: $50.1'7 per Employee Insured hereunder forDentalExpense Benefits on his or her own account and $153,35 per Employee Insured hereunder for Dental Expense Benefits on his or her own account and on account of all Dependents. Class II — All Other Employees Dental Expense Benefits: - $36.81 per Employee insured hereunder for Dental Expense Benefits on his or her own account; $75,80 per Employee insured hereunder for Dental Expense Benefits on his or her own account and on account of his or her Dependent Spouse; $75,13 per Employee insured hereunder for Dental Expense Benefits on his or her own account and on account of his or her Dependent Child(ren); and $134.02 per Employee Insured hereunder for Dental Expense Benefits on his or her own account and on account of all Dependents GPNP99 EXHIBIT1 117353-1-G DATE: January 1, 2005 EXHIBIT 2 CERTIFICATE FORMS Certificate Number 1 2 GPNP99 - EXHIBIT2 Certificate Form G.23000 Series with any numerical and alphabetical suffix as shown In the Certificate Applies To Class I - Executives Effective Date January 1, 2005 G.23000 Series with Class II - All Other Employees January 1, 2005 any numerical and alphabetical suffix as shown in the Certificate 117353-1-G DATE: January 1, 2005 Memorandum of Agreement This Memorandum of Agreement is made and entered into as of this 14th day of December, 2004 by and between Metropolitan Life insurance Company, a New York corporation ("MetLife") and the City of Miami, a municipal corporation ("City of Miami"). WHEREAS, MetLife issued a group dental Insurance policy, policy number 117353 to the City of Miami (the Group Policy"); and WHEREAS, The City of Miami and MetLife wish to elaborate on the parties' understanding relative to the Group Policy, NOW, THEREFORE, in consideration of the mutual covenants and agreements contained herein, the parties agree as follows: 1. General Conditions, To the extent that any term or condition of this Memorandum of Agreement contradicts or conflicts with any term of the Group Policy, the Group Policy shall be controlling. The parties agree that this memorandum of Agreement incorporates by reference the City of Miami RFP No. t103-04- 077 (the "RFP") and MetLife's response of 09/17/2004 made in reply thereto ("MetLife's Reply") to the extent that the RFP and MetLife's Reply addresses items that are not addressed in the Group Policy,. 2. Term. MetLife will agree to periodically renew the Group Policy at the City of Miami's request so that it remains in force for a period of three (3) years following the effective date ("Initial Three Year Period'). Following the Initial Three Year Period, at the City of Miami's request, MetLife will agree to periodically renew the Group Policy so that It remains in force for a period of two (2) years following the initial Three Year Period (the "First Two Year Period"). At the end of the First Two Year Period, at the City of Miami's request, MetLife will agree to periodically renew the Group Policy so that it remains in force for a period of two years (the "Second Two Year Period"). MetLife's obligation to periodically renew the Group Policy as stated herein is subject to all of the terms and conditions of the Group Policy, including, but not limited, to, timely payment of premiums, and minimum participation requirements. City of Miami understands and agrees that MetLife reserves the right to change premium rates as stated in the Group Policy during the Initial Three Year Period, the First Two Year Period and the Second Two Year Period, 3. Policy Changes. MetLife will not change the terms of the Group Policy without the consent of the City of Miami, which consent shall not be unreasonably withheld, provided, however, that MetLife may, without the consent of the City of Miami: (1) change premium rates as stated in the Group Policy; (2) make any change that it ie required to make under applicable law or pursuant to a request of state insurance aulhorities; or (3) make any change that is generally applicable to group dental insurance policyholders of MetLife. IN WITNESS WHEREOF, the parties hereto have caused this Memorandum of Agreement to be executed by their respective officials thereunto duly authorized, this the day and year above written. Metropolitan Life Insurance Company A State of New York Corporation By: Title "City" ATTEST... Priscli a A. Thompson, City Clerk APPROVED AS TO FORM AND CORRECTNESS: Jorge I. Fe City Attor Maio of L , County of hu �.ic1\U. Signed boforo rim on .day of l'Ve-6 ,%tfd 2 l by . �'• . c. Notary Public CITY OF INIIAMI, a niunicip^I corporati . n By: Joe • rriola, City Manager APPROVED AS TO INSURANCE REQUIREMENTS' ania Carrillo, Risk Management Administrator