R89-148 AUTHORIZING APPLICATIONS FOR GROUP HEALTH INSURANCE COVERAGES

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Exhibit A HEALTH CARE PLAN ADOPTION AGREEMENT The undersigned employer hereby adopts, executes and establishes the City of Decatur Health Care Plan (the "Plan"), as set forth in the Plan documents hereto attached.This Adoption Agreement forms a part of the Plan. 1. Name of Employer: City of Decatur 2. Effective Date of Plan: November l, 1989 3. Eligible Person means: �J A full-time employee of the Employer ❑ qful�-time employee who is a member of c��a or��,o�� �Retirees 4. Classification of Eligible Person: C�AII persons who meet the definition of Eligible Person stated above. ❑ Class A: All persons who meet the definition of Eligible Person stated above including persons who are affected by TEFRA and/or COBRA and who have not selected Medicare as their primary coverage. Class B: All persons who meet the definition of Eligible Person stated above who are not affected by TEFRA and/or COBRA and are eligible for and have their primary coverage provided by Medicare. O See attached Classifications. In the event a spouse of an Eligible Person, who is otherwise eligible for coverage as a Covered Person and who is affected by TEFRA and/or COBRA, selects Medicare as his/her primary coverage, then, such spouse shall not be eligible for coverage. 5. Full-Time Employee means: C�A person who is regularly scheduled to work a minimum of 30 hours per week and who is actively at work and on the permanent payroll of the Employer. ❑ 6. Limiting age for covered unmarried children means: The last day of the calendar month in which the limiting age is reached. 7. 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. CJ The last day of the calendar month in which such person ceases to meet the definition of an Eligible Person. � 8. The Eligibility Date for a person who becomes an Eligible Person after the Effective Date of the Plan is: L�J The date of employment ❑ The first day of the month following full catendar month(s)of employment. ❑ The first day of the month following the date of employment. � The day of employment. 9. The Enrollment Period during which an Eligible Person may apply for coverage if he did not apply prior to his Eligibility Date or if he did not apply for Family Coverage when eligible to do so is: The thirtieth (30th day after eligibility date. Such Person's Coverage Date or Family Coverage Date is: Determined by the Employer