R2000-207 AUTHORIZING APPLICATIONS

Home Browse Search

� Exhibit B PLAN DOCUMENT ADOPTION AGREEMENT The undersigned Employer hereby adopts, executes and establishes the employee welfare benefit plan ("Plan") as set forth in the Plan Document to which this Adoption Agreement is attached. This Adoption Agreement forms a part of the Plan. 1. Name of the Employer: City of Decatur 2. Employer Group Number: P06856 and 992844 3. Name of Employer's Plan Administrator(The Claim Administrator does not serve as Plan Administra- tor): Mr. J. Barry Leonard 4. Effective Date of Plan: November 1, 2000 5. ERISA Plan Year: November 1 st 6. Eligible Person means: • A full-time employee of the Employer • Retirees who are otherwise eligible per terms of the city labor agreement or administrative policy. 7. Full-Time Employee means: � • A person who is regularly scheduled to work a minimum of 30 hours per week and on the perma- nent payroll of the Employer. 8. Limiting Age: • The limiting age for covered unmarried children is 23; coverage is automatically terminated on the birthday. 9. The Effective Date of Termination for a person who ceases to meet the definition of an Eligible Person: • The date such person ceases to meet the definition of Eligible Person. 10. The Eligibility Date for a person who becomes an Eligible Person after the Effective Date of the Plan is: • The date of employment. 11. Enrollment: Specia/Enrollment: An Eligible Person may apply for coverage, Family coverage or add dependents within thirty-one (31) days of a qualifying event if he/she did not apply prior to his/her Eligibility Date or when eligible to do so. Such person's Coverage Date, Family Coverage Date, and/or dependent's Coverage Date will be the effective date of the qualifying event or, in the event of Special Enrollment due to termination of previous coverage, the date of application of coverage. Late Enrollment. An Eligible Person may apply for coverage, Family coverage or add dependents if he/she did not apply prior to his/her Eligibility Date or did not apply when eligible to do so. Such person's Coverage Date, Family Coverage Date, and/or dependent's Coverage Date will be a date mutually agreed to by the Claim Administrator and the Employer. Open Enrollment An Eligible Person may apply for coverage, Family coverage or add dependents � if he/she did not apply prior to his/her Eligibility Date or did not apply when eligible to do so, during the Employer's Open Enrollment Period.