PROFESSIONAL CONSULTANT SERVICES AGREEMENT
STANDARD INSURANCE COMPANY
Group Critical Illness Insurance
THIS PROFESSIONAL CONSULTANT SERVICES AGREEMENT ("Agreement") is made and entered into this _ 20 ("Effective Date"), by and between the CITY OF RIVERSIDE, a California charter city and municipal corporation ("City"), and STANDARD INSURANCE COMPANY an Oregon corporation ("Consultant").
Scope of Services. City agrees to retain and does hereby retain Consultant and Consultant agrees to provide the services more particularly described in Exhibit "A," "Scope of Services" ("Services"), attached hereto and incorporated herein by reference, in conjunction with Critical Illness Insurance ("Project").
Term. This Agreement shall be effective April 1, 2022 and shall remain in effect until January 1, 2024 unless otherwise terminated pursuant to the provisions herein. The parties have the option to extend for two additional two-year terms.
3. Compensation/Payment. Consultant shall perform the Services under this Agreement for the compensation in accordance with the terms set forth in Exhibit "B." All compensation/premiums shall be paid by the employees that choose to participate in the plan. Said payments shall be made in accordance with City's usual accounting procedures upon receipt and approval of an itemized invoice setting forth the services performed. The invoices shall be delivered to City at the address set forth in Section 4 hereof.
Notices. Any notices required to be given, hereunder shall be in writing and shall be personally served or given by mail. Any notice given by mail shall be deemed given when deposited in the United States Mail, certified and postage prepaid, addressed to the party to be served as follows:
To City To Consultant
Human Resources Standard Insurance Company
City of Riverside Attn: Teresa A. Lollar, ACS
Attn: Jennifer Brown 1100 Southwest Sixth Avenue
3900 Main Street Portland, OR 97204
Riverside, CA 92522
1 Prevailing Wage. If applicable, Consultant and all subcontractors are required to pay the general prevailing wage rates of per diem wages and overtime and holiday wages determined by the Director of the Department of Industrial Relations under Section 1720 et seq. of the California Labor Code and implemented by Resolution No. 13346 of the City Council of the City of Riverside. determination available on-line
www.dir.ca.gov/dlsr/DPreWageDetermination.htm and is referred to and made a part hereof; the wage rates therein ascertained, determined, and specified are referred to and made a part hereof as though fully set forth herein.
referred to herein as Contract Administrator.
Standard of Performance. While performing the Services, Consultant shall exercise the reasonable professional care and skill customarily exercised by reputable members of Consultant's profession practicing in the Metropolitan Southern California Area, and shall use reasonable diligence and best judgment while exercising its professional skill and expertise.
Personnel. Consultant shall furnish all personnel necessary to perform the Services and shall be responsible for their performance and compensation. Consultant recognizes that the qualifications and experience of the personnel to be used are vital to professional and timely completion of the Services. The key personnel listed in Exhibit "C" attached hereto and incorporated herein by this reference and assigned to perform portions of the Services shall remain assigned through completion of the Services, unless otherwise mutually agreed by the parties in writing, or caused by hardship or resignation in which case substitutes shall be subject to City approval.
Assignment and Subcontracting. Neither party shall assign any right, interest, or obligation in or under this Agreement to any other entity without prior written consent of the other party. In any event, no assignment shall be made unless the assignee expressly assumes the obligations of assignor under this Agreement, in a writing satisfactory to the parties. Consultant acknowledges that any assignment may, at the City's sole discretion, require City Manager and/or City Council approval. Consultant shall not subcontract any portion of the work required by this Agreement without prior written approval by the responsible City Contract Administrator.
Subcontracts, if any, shall contain a provision making them subject to all provisions stipulated in this Agreement, including without limitation, the insurance obligations set forth in Section 12. The Consultant acknowledges and agrees that the City is an intended beneficiary of any work performed by any subcontractor for purposes of establishing a duty of care between any subcontractor and the City.
10. Independent Contractor. In the performance of this Agreement, Consultant, and Consultant's employees, subcontractors and agents, shall act in an independent capacity as independent contractors, and not as officers or employees of the City of Riverside. Consultant acknowledges and agrees that the City has no obligation to pay or withhold state or federal taxes or to provide workers' compensation or unemployment insurance to Consultant, or to Consultant's employees, subcontractors and agents. Consultant, as an independent contractor, shall be responsible for any and all taxes that apply to Consultant as an employer. 2 11. Indemnification.
11.1 Design Professional Defined. For purposes of this Agreement, "Design Professional" includes the following:
A. An individual licensed as an architect pursuant to Chapter 3 (commencing with Section 5500) of Division 3 of the Business and Professions Code, and a business entity offering architectural services in B. An individual licensed as a landscape architect pursuant to Chapter 3.5 Consins Covia cousines of potterin and shape arcince and services in accordance with that chapter.
C. An individual registered as a professional engineer pursuant to Chapter 7 (commencing with Section 6700) of Division 3 of the Business and Professions Code, and a business entity offering professional engineering services in accordance with that chapter.
D. An individual licensed as a professional land surveyor pursuant to Chapter 15 (commencing with Section 8700) of Division 3 of the Business and Professions Code, and a business entity offering professional land surveying services in accordance with that chapter.
11.2 Defense Obligation For Design Professional Liability. Consultant agrees, at its cost and expense, to promptly defend the City, and the City's employees, officers, managers, agents and council members (collectively the "Parties to be Defended") from and against any and all claims, allegations, lawsuits, arbitration proceedings, administrative proceedings, regulatory proceedings, or other legal proceedings to the extent the same arise out of, pertain to, or relate to the negligence, recklessness or willful misconduct of Consultant, or anyone employed by or working under the Consultant or for services rendered to the Consultant in the performance of the Agreement, notwithstanding that the City may have benefited from its work or services and whether or not caused in part by the negligence of an Indemnified Party. Consultant agrees to provide this defense immediately upon written notice from the City, and with well qualified, adequately insured and experienced legal counsel acceptable to City. Consultant will reimburse City for reasonable defense costs for claims arising out of Consultant's professional negligence based on the percentage of Consultant's liability. This obligation to defend as set forth herein is binding on the successors, assigns and heirs of Consultant and shall survive the termination of Consultant's Services under this Agreement.
11.3 Indemnity For Design Professional Liability. When the law establishes a professional standard of care for Consultant's services, to the fullest extent permitted by law, Consultant shall indemnify, protect and hold harmless the City and the City's employees, officers, managers, agents, and Council Members ("Indemnified Parties") from and against any and all claim for damage, charge, lawsuit, action, judicial, administrative, regulatory or arbitration proceeding, damage, cost, expense (including counsel and expert fees), judgment, civil fines and penalties, 3 liabilities or losses of any kind or nature whatsoever to the extent the same arise out of, pertain to, or relate to the negligence, recklessness or willful misconduct of Consultant, or anyone employed by or working under the Consultant or for services rendered to the Consultant in the performance of the Agreement, notwithstanding that the City may have benefited from its work or services and whether or not caused in part by the negligence of an Indemnified Party.
11.4 Defense Obligation For Other Than Design Professional Liability.
Consultant agrees, at its cost and expense, to promptly defend the City, and the City's employees, officers, managers, agents and council members (collectively the "Parties to be Defended"') from and against any and all claims, allegations, lawsuits, arbitration proceedings, administrative proceedings, regulatory proceedings, or other legal proceedings which arise out of, or relate to, or are in any way connected with: 1) the Services, work, activities, operations, or duties of the Consultant, or of anyone employed by or working under the Consultant, or 2) any breach of the Agreement by the Consultant. This duty to defend shall apply whether or not such claims, allegations, lawsuits or proceedings have merit or are meritless, or which involve claims or allegations that any or all of the Parties to be Defended were actively, passively, or concurrently negligent, or which otherwise assert that the Parties to be Defended are responsible, in whole or in part, for any loss, damage or injury.
Consultant agrees to provide this defense immediately upon written notice from the City, and with well qualified, adequately insured and experienced legal counsel acceptable to City. This obligation to defend as set forth herein is binding on the successors, assigns and heirs of Consultant and shall survive the termination of Consultant's Services under this Agreement.
11.5 Indemnity For Other Than Design Professional Liability. Except as to the sole negligence or willful misconduct of the City, Consultant agrees to indemnify, protect and hold harmless the Indemnified Parties from and against any claim for damage, charge, lawsuit, action, judicial, administrative, regulatory or arbitration proceeding, damage, cost, expense (including counsel and expert fees), judgment, civil fine and penalties, liabilities or losses of any kind or nature whatsoever whether actual, threatened or alleged, which arise out of, pertain to, or relate to, or are a consequence of, or are attributable to, or are in any manner connected with the performance of the Services, work, activities, operations or duties of the Consultant, or anyone employed by or working under the Consultant or for services rendered to Consultant in the performance of this Agreement, notwithstanding that the City may have benefited from its work or services. This indemnification provision shall apply to any acts, omissions, negligence, recklessness, or will ful misconduct, whether active or passive, on the part of the Consultant or anyone employed or working under the Consultant.
12. Insurance.
12.1 Consultant shall provide satisfactory evidence of, and shall thereafter maintain during the term of
12.1.1 Limitations. These minimum amounts of coverage shall not constitute any limitation or cap on Consultant's indemnification obligations under Section 11 hereof. 4 12.1.2 Ratings. Any insurance policy or coverage provided by Consultant or subcontractors as required by this Agreement shall be deemed inadequate and a material breach of this Agreement, unless such policy or coverage is issued by insurance companies authorized to transact insurance business in the State of California with a policy holder's rating of A or higher and a Financial Class of VII or higher.
12.1.3 Cancellation. The policies shall not be canceled unless thirty (30) days' prior written notification of intended cancellation has been given to City by certified or registered mail, postage prepaid.
12.1.4 Adequacy. The City, its officers, employees and agents make no representation that the types or limits of insurance specified to be carried by Consultant pursuant to this Agreement are adequate to protect Consultant. If Consultant believes that any required insurance coverage is inadequate, Consultant will obtain such additional insurance coverage as Consultant deems adequate, at Consultant's sole expense.
12.2 Workers' Compensation Insurance. By executing this Agreement, Consultant certifies that Consultant is aware of and will comply with Section 3700 of the Labor Code of the State of California requiring every employer to be insured against liability for workers' compensation, or to undertake self-insurance before commencing any of the work. Consultant shall carry the insurance or provide for self-insurance required by California law to protect said Consultant from claims under the Workers' Compensation Act. Prior to City's execution of this Agreement, Consultant shall file with City either 1) a certificate of insurance showing that such insurance is in effect, or that Consultant is self-insured for such coverage, or 2) a certified statement that Consultant has no employees, and acknowledging that if Consultant does employ any person, the necessary certificate of insurance will immediately be filed with City. Any certificate filed with City shall provide that City will be given ten (10) days' prior written notice before modification or cancellation thereof.
12.3 Commercial General Liability and Automobile Insurance. Prior to City's execution of this Agreement, Consultant shall obtain, and shall thereafter maintain during the term of this Agreement, commercial general liability insurance and automobile liability insurance as required to insure Consultant against damages for personal injury, including accidental death, as well as from claims for property damage, which may arise from or which may concern operations by anyone directly or indirectly employed by, connected with, or acting for or on behalf of Consultant.
The City, and its officers, employees and agents, shall be named as additional insureds under the Consultant's insurance policies.
12.3.1 Consultant's commercial general liability insurance policy shall cover both bodily injury (including death) and property damage (including, but not limited to, premises operations liability, products-completed operations liability, independent contractor's liability, personal injury liability, and contractual liability) in an amount not less than $1,000,000 per occurrence and a general aggregate limit in the amount of not less than $2,000,000.
12.3.2 Consultant's automobile liability policy shall cover both bodily injury and property damage in an amount not less than $1,000,000 per occurrence and an aggregate limit of not less than $1,000,000. All of Consultant's automobile and/or commercial general liability 5 insurance policies shall cover all vehicles used in connection with Consultant's performance of this Agreement, Which vehicles shall include, but are not limited to, Consultant owned vehicles, Consultant leased vehicles, Consultant's employee vehicles, non-Consultant owned vehicles and hired vehicles.
12.3.3 Prior to City's execution of this Agreement, copies of insurance policies or original certificates along with additional insured endorsements acceptable to the City evidencing the coverage required by this Agreement, for both commercial general and automobile liability insurance, shall be filed with City and shall include the City and its officers, employees and agents, as additional insureds. Said policies shall be in the usual form of commercial general and automobile liability insurance policies, but shall include the following provisions:
are added as additional insureds under this policy, solely for work done by and on behalf of the named insured for the City of Riverside.
12.3.4 The insurance policy or policies shall also comply with the following provisions:
a. The policy shall be endorsed to waive any right of subrogation against the City and its sub-consultants, employees, officers and agents for services performed under this Agreement.
b. If the policy is written on a claims made basis, the certificate should so specify and the policy must continue in force for one year after completion of the services. The retroactive date of coverage must also be listed.
c. The policy shall specify that the insurance provided by Consultant will be considered primary and not contributory to any other insurance available to the City and Endorsement No. CG 20010413 shall be provided to the City.
12.4 Errors and Omissions Insurance. Prior to City's execution of this Agreement, Consultant shall obtain, and shall thereafter maintain during the term of this Agreement, errors and omissions professional liability insurance in the minimum amount of $1,000,000 to protect the City from claims resulting from the Consultant's activities.
Subcontractors' Insurance. Consultant shall require all its subcontractors to carry insurance, in an amount sufficient to cover the risk of injury, damage or loss that may be caused by the subcontractors scope of work and activities provided in furtherance of this Agreement, including, but without limitation, the following coverages: Workers Compensation, Commercial General Liability, Errors and Omissions, and Automobile liability. Upon City's request, Consultant shall provide City with satisfactory evidence that Subcontractors have obtained insurance policies and coverages required by this section.
13. Business Tax. Consultant understands that the Services performed under this Agreement constitutes doing business in the City of Riverside, and Consultant agrees that Consultant will register for and pay a business tax pursuant to Chapter 5.04 of the Riverside Municipal Code and keep such tax certificate current during the term of this Agreement.
14. Time of Essence. Time is of the essence for each and every provision of this Agreement.
15. City's Right to Employ Other Consultants. City reserves the right to employ other Consultants in connection with the Project. If the City is required to employ another consultant to complete Consultant's work, due to the failure of the Consultant to perform, or due to the breach of any of the provisions of this Agreement, the City reserves the right to seek reimbursement from Consultant.
16. Accounting Records. Consultant shall maintain complete and accurate records with respect to costs incurred under this Agreement. All such records shall be clearly identifiable.
Consultant shall allow a representative of City during normal business hours to examine, audit, and make transcripts or copies of such records and any other documents created pursuant to this Agreement. Consultant shall allow inspection of all work, data, documents, proceedings, and activities related to the Agreement for a period of three (3) years from the date of final payment under this Agreement.
17. Confidentiality. All ideas, memoranda, specifications, plans, procedures, drawings, descriptions, computer program data, input record data, written information, and other materials either created by or provided to Consultant in connection with the performance of this Agreement shall be held confidential by Consultant, except as otherwise directed by City's Contract Administrator. Nothing furnished to Consultant which is otherwise known to the Consultant or is generally known, or has become known, to the related industry shall be deemed confidential.
Consultant shall not use City's name or insignia, photographs of the Project, or any publicity pertaining to the Services or the Project in any magazine, trade paper, newspaper, television or radio production, website, or other similar medium without the prior written consent of the City.
18. Ownership of Documents. All reports, maps, drawings and other contract deliverables prepared under this Agreement by Consultant shall be and remain the property of City.
Consultant shall not release to others information furnished by City without prior express written approval of City.
19. Copyrights. Consultant agrees that any work prepared for City which is eligible for copyright protection in the United States or elsewhere shall be a work made for hire. If any such work is deemed for any reason not to be a work made for hire, Consultant assigns all right, title and interest in the copyright in such work, and all extensions and renewals thereof, to City, and agrees to provide all assistance reasonably requested by City in the establishment, preservation and enforcement of its copyright in such work, such assistance to be provided at City's expense but without any additional compensation to Consultant. Consultant agrees to waive all moral rights relating to the work developed or produced, including without limitation any and all rights of identification of authorship and any and all rights of approval, restriction or limitation on use or subsequent modifications.
7 20. Conflict of Interest. Consultant, for itself and on behalf of the individuals listed in Exhibit "C," represents and warrants that by the execution of this Agreement, they have no interest, present or contemplated, in the Project affected by the above-described Services. Consultant further warrants that neither Consultant, nor the individuals listed in Exhibit "C" have any real property, business interests or income interests that will be affected by this projector, alternatively, that Consultant will file with the City an affidavit disclosing any such interest.
21. Solicitation. Consultant warrants that Consultant has not employed or retained any person or agency to solicit or secure this Agreement, nor has it entered into any agreement or understanding for a commission, percentage, brokerage, or contingent fee to be paid to secure this Agreement. For breach of this warranty, City shall have the right to terminate this Agreement without liability and pay Consultant only for the value of work Consultant has actually performed, or, in its sole discretion, to deduct from the Agreement price or otherwise recover from Consultant the full amount of such commission, percentage, brokerage or commission fee. The remedies specified in this section shall be in addition to and not in lieu of those remedies otherwise specified in this Agreement.
22. General Compliance With Laws. Consultant shall keep fully informed of federal, state and local laws and ordinances and regulations which in any manner affect those employed by Consultant, or in anyway affect the performance of services by Consultant pursuant to this Agreement. Consultant shall at all times observe and comply with all such laws, ordinances and regulations, and shall be solely responsible for any failure to comply with all applicable laws, ordinances and regulations. Consultant represents and warrants that Consultant has obtained all necessary licenses to perform the Scope of Services and that such licenses are in good standing.
Consultant further represents and warrants that the services provided herein shall conform to all ordinances, policies and practices of the City of Riverside.
23. Waiver. No action or failure to act by the City shall constitute a waiver of any right or duty afforded City under this Agreement, nor shall any such action or failure to act constitute approval of or acquiescence in any breach thereunder, except as may be specifically, provided in this Agreement or as may be otherwise agreed in writing.
24. Amendments. This Agreement may be modified or amended only by a written agreement and/or change order executed by the Consultant and City.
25. Termination. City, by notifying Consultant in writing, shall have the right to terminate any or all of Consultant's services and work covered by this Agreement at any time. In the event of such termination, Consultant may submit Consultant's final written statement of the amount of Consultant's services as of the date of such termination based upon the ratio that the work completed bears to the total work required to make the report complete, subject to the City's rights under Sections 15 and 26 hereof. In ascertaining the work actually rendered through the termination date, City shall consider completed work, work in progress and complete and incomplete reports and other documents only after delivered to City.
25.1 Other than as stated below, City shall give Consultant thirty (30) days' prior written notice prior to termination.
8 25.2 City may terminate this Agreement upon fifteen (15) days' written notice to Consultant, in the event:
25.2.1 Consultant substantially fails to perform or materially breaches the Agreement; or
25.2.2 City decides to abandon or postpone the Project.
Offsets. Consultant acknowledges and agrees that with respect to any business tax or penalties thereon, utility charges, invoiced fee or other debt which Consultant owes or may owe to the City, City reserves the right to withhold and offset said amounts from payments or refunds or reimbursements owed by City to Consultant. Notice of such withholding and offset, shall promptly be given to Consultant by City in writing. In the event of a dispute as to the amount owed or whether such amount is owed to the City, City will hold such disputed amount until either the appropriate appeal process has been completed or until the dispute has been resolved.
27. Successors and Assigns. This Agreement shall be binding upon City and its successors and assigns, and upon Consultant and its permitted successors and assigns, and shall not be assigned by Consultant, either in whole or in part, except as otherwise provided in paragraph 9 of this Agreement.
28. Venue. Any action at law or in equity brought by either of the parties hereto for the purpose of enforcing a right or rights provided for by this Agreement shall be tried in the Superior Court, County of Riverside, State of California, and the parties hereby waive all provisions of law providing for a change of venue in such proceedings to any other county. In the event either party hereto shall bring suit to enforce any term of this Agreement or to recover any damages for and on account of the breach of any term or condition of this Agreement, it is mutually agreed that each party will bear their own attorney's fees and costs.
29. Nondiscrimination. During Consultant's performance of this Agreement, Consultant shall not discriminate on the grounds of race, religious creed, color, national origin, ancestry, age, physical disability, mental disability, medical condition, including the medical condition ot Acquired Immune Deficiency Syndrome (AIDS) or any condition related thereto, marital status, sex, genetic information, gender, gender identity, gender expression, or sexual orientation, military and veteran status, in the selection and retention of employees and subcontractors and the procurement of materials and equipment, except as provided in Section 12940 of the California Government Code.
Further, Consultant agrees to conform to the requirements of the Americans with Disabilities Act in the performance of this Agreement.
Severability. Each provision, term, condition, covenant and/or restriction, in whole and in part, of this Agreement shall be considered severable. In the event any provision, term, condition, covenant and/or restriction, in whole and/or in part, of this Agreement is declared invalid, unconstitutional, or void for any reason, such provision or part thereof shall be severed from this Agreement and shall not affect any other provision, term, condition, covenant and/or restriction of this Agreement, and the remainder of the Agreement shall continue in full force and effect. 9 Authority. The individuals executing this Agreement and the instruments referenced herein on behalf of Consultant each represent and warrant that they have the legal power, right and actual authority to bind Consultant to the terms and conditions hereof and thereof.
32. Entire Agreement. This Agreement constitutes the final, complete, and exclusive statement of the terms of the agreement between the parties pertaining to the subject matter of this Agreement and supersedes all prior and contemporaneous understandings or agreements of the parties. Neither party has been induced to enter into this Agreement by and neither party is relying on, any representation or warranty outside those expressly set forth in this Agreement.
33. Interpretation. City and Consultant acknowledge and agree that this Agreement is the product of mutual arms-length negotiations and accordingly, the rule of construction, which provides that the ambiguities in a document shall be construed against the drafter of that document, shall have no application to the interpretation and enforcement of this Agreement.
33.1 Titles and captions are for convenience of reference only and do not define, describe or limit the scope or the intent of the Agreement or any of its terms. Reference to section numbers, are to sections in the Agreement unless expressly stated otherwise.
33.2 This Agreement shall be governed by and construed in accordance with the laws of the State of California in effect at the time of the execution of this Agreement.
33.3 In the event of a conflict between the body of this Agreement and Exhibit"A" - Scope of Services hereto, the terms contained in Exhibit "A" shall be controlling.
34. Exhibits. The following exhibits attached hereto are incorporated herein to this Agreement by this reference:
Exhibit "A" - Scope of Services
Exhibit "B" - Compensation
Exhibit "C" - Key Personnel
10 IN WITNESS WHEREOF, City and Consultant have caused this Agreement to be duly executed the day and year first above written.
CITY OF RIVERSIDE, a California STANDARD INSURANCE COMPANY charter city and municipal corporation an Oregon corporation By: -
City Manager
ans Dukhouse
AVP, Sales Operations + Denkal
[Title]
Attest:_
City Clerk
Certified as to Availability of Funds:
Kevin Erdahl
By:_ [Printed Name]
Chief Financial Officer AVP, Underwriting
[Title]
Approved as to Form:
318M
Office of the City Attorney
11 EXHIBIT "A"
SCOPE OF SERVICES
STANDARD INSURANCE COMPANY
A Stock Life Insurance Company
900 SW Fifth Avenue
Portland, Oregon 97204-1282
(503) 321-7000
GROUP CRITICAL ILLNESS INSURANCE POLICY
Policyholder: City Of Riverside
Group Policy Number: 641996-G
Group Policy Effective Date: 05/01/2022
State of Issue: California
The consideration for this Group Policy is the application of the Policyholder and the payment by the Policyholder of premiums as provided herein.
Subject to The Group Policy and Premium Payment sections, this Group Policy (a) is issued for the Initial Rate Guarantee Period shown in Eligibility, Premium Rates, And Participation Requirement and (b) may be renewed for successive renewal periods by the payment of the premium set by us on each renewal date. The length of each renewal period will be set by us, but will not be less than 12 months.
For purposes of effective dates and ending dates under this Group Policy, all days begin and end at 12:00 midnight Standard Time at the Policyholder's address.
All provisions on this and the following pages are part of this Group Policy. "You" and "your" mean the Member. 'We", "us", , and "our" mean Standard Insurance Company. Other defined terms appear with their initial letters capitalized. Section and provision headings, and references to them, appear in boldface type.
The Group Policy is a legal contract between the Policyholder and us. Please read the Group Policy carefully.
THIS POLICY IS NOT IN LIEU OF AND DOES NOT AFFECT ANY REQUIREMENT FOR COVERAGE BY WORKMEN'S COMPENSATION INSURANCE.
THIS IS A LIMITED BENEFIT POLICY THAT PROVIDES CRITICAL ILLNESS BENEFITS. THIS POLICY DOES NOT PROVIDE COMPREHENSIVE HEALTH INSURANCE COVERAGE. THIS IS A SUPPLEMENT TO HEALTH INSURANCE. IT IS NOT A SUBSTITUTE FOR ESSENTIAL HEALTH BENEFITS OR MINIMUM ESSENTIAL COVERAGE AS DEFINED IN FEDERAL LAW. IT DOES NOT PROVIDE COVERAGE FOR HOSPITAL, MEDICAL, SURGICAL OR MAJOR MEDICAL EXPENSES.
THIS LIMITED BENEFIT POLICY IS NOT A MEDICARE SUPPLEMENT POLICY. FOR MEMBERS ELIGIBLE FOR MEDICARE, REVIEW THE "GUIDE TO HEALTH INSURANCE FOR PEOPLE WITH MEDICARE' AVAILABLE FROM US.
STANDARD INSURANCE COMPANY
By
Chairman, President and CEO Corporate Secretary
GP0614-CI
Table of Contents
ELIGIBILITY, PREMIUM RATES, AND PARTICIPATION REQUIREMENT 1 Eligibility... .....1
Premium Rates and Renewals ...1
Participation Requirement 1
THE GROUP POLICY.... ... 2
The Group Policy; Entire Contract. 2
Changes to the Group Policy. 2
Incontestability of Group Policy 2
Termination of the Group Policy. ....2
PREMIUM PAYMENT ... 3
Premiums.. 3
Contributions from Members .. 3
Changes in Premium Rates 3
Premium Adjustments
Grace Period and Termination for Nonpayment... 4
GENERAL PROVISIONS 4
Certificates 4
Records and Reports.. 4
Agency and Release 4
4 Subrogation
Notice of Suit
GP0614-CI
ELIGIBILITY, PREMIUM RATES, AND PARTICIPATION REQUIREMENT Eligibility
Employer(s): City Of Riverside
Eligible Class(es): All Members
Premium Rates and Renewals
Member and Dependents:
The rates below are not combined rates for the Member and Spouse, rather they are for each individually.
Age of Member
Annual rates per $1000 of
coverage
Age < 25 $7.080
Age 25-29 $7.080
Age 30-34 $11.160
Age 35-39 $11.160
Age 40-44 T$19,680
Age 45-49 $19.680
Age 50-54 $32.400
Age 55-59 $32.400
Age 60-64 $54.960
Premium Due Date: 05/01/2022 and the first day of each calendar month thereafter.
Initial Rate Guarantee Period: 05/01/2022 to 01/01/2024 Grace Period: 60 days from Premium Due Date
Notice of Rate Change: 180 days
Notice of Termination: 31 days
Participation Requirement
Minimum Participation Number: 10 insured Members
GP0614-CI - 1-
THE GROUP POLICY
The Group Policy; Entire Contract
The Group Policy is the entire contract between the Policyholder and us. We will provide benefits according to the terms of the Group Policy.
The Group Policy consists of the following:
• This group critical illness insurance policy issued by us to the Policyholder and identified by the Group Policy Number.
• The Policyholder's attached application.
• Group critical illness insurance certificates with the same Group Policy Number. • Any amendments to the Group Policy or certificates.
The Policyholder's rights or the rights of any Member will only be affected by provisions that are part of the Group Policy. Only an executive officer of Standard Insurance Company may bind us by making a promise or a representation; or accept a representation that relates to the Group Policy.
Changes to the Group Policy
Benefits under the Group Policy are limited to its terms, including any valid amendment. No change or amendment will be valid unless it is approved in writing by one of our executive officers and given to the Policyholder for attachment to the Group Policy. No agent has authority to change the Group Policy, or to waive any of its provisions. The Policyholder, an Employer, and their respective employees or representatives have no right or authority to change or amend the Group Policy or to waive any of its terms or provisions without our signed written approval.
We may change the Group Policy in whole or in part when any change or clarification in law or governmental regulation affects our obligations under the Group Policy, or with the Policyholder's consent.
Any such change or amendment of the Group Policy may apply to current or future Members or to any separate classes or groups of Members.
Incontestability of Group Policy
Any statement made by the Policyholder to obtain the Group Policy is a representation and not a warranty.
No misrepresentation by the Policyholder will be used to deny a claim or to deny the validity of the Group Policy unless all of the following are true:
• The Group Policy would not have been issued if we had known the truth. • We have given the Policyholder a copy of a written instrument signed by the Policyholder which contains the misrepresentation.
The validity of the Group Policy will not be contested after it has been in force for two years, except for fraudulent misrepresentations.
Termination of the Group Policy
The Group Policy may be terminated by us or the Policyholder according to its terms. It will terminate automatically for nonpayment of premium.
The Policyholder may terminate the Group Policy in whole, and may terminate insurance for any class or group of Members, at any time by giving us written notice. The effective date of termination will be the date GP0614-CI - 2-
stated in the notice. If no date is stated in the notice, then the effective date of termination will be the last day of the calendar month for which the premium was paid in full.
We may terminate the Group Policy as follows:
• On any Premium Due Date if the number of persons insured is less than the Minimum Participation Number shown in Eligibility, Premium Rates, and Participation Requirement. • On any Premium Due Date if we determine that the Policyholder has failed to promptly furnish any necessary information requested by us, or has failed to perform any other obligations relating to the Group Policy.
The minimum advance Notice of Termination by us is stated in Eligibility, Premium Rates, and Participation Requirement.
With respect to a Member or Spouse who has continued insurance under the Continuation of Insurance (Portability) for the Member provision or Continuation of Insurance (Portability) for the Spouse provision, continued coverage will not terminate unless it would otherwise terminate under the terms of the Continuation of Insurance (Portability) for the Member provision or Continuation of Insurance (Portability) for the Spouse provision.
PREMIUM PAYMENT
Premiums
Each premium is payable on or before its Premium Due Date to us. The premium due on each Premium Due Date is the sum of the premiums for all Members and Dependents then insured. Premium Rates are shown in Eligibility, Premium Rates, and Participation Requirement.
The payment of each premium as it becomes due will maintain the Group Policy in force until the next Premium Due Date.
Contributions from Members
The Policyholder determines the amount, if any, of each Member's contribution toward the cost of insurance under the Group Policy.
Changes in Premium Rates
We may change Premium Rates whenever:
• A change or clarification in law or governmental regulation affects the amount payable under the Group Policy. Any such change in Premium Rates will reflect only the change in our obligations. • Factors material to underwriting the risk we assumed under the Group Policy with respect to an Employer, including, but not limited to, number of persons insured, age, gender, and occupational classification, change by 25% or more.
• The premium contribution arrangement for Members is changed or varies from that stated in the Group Policy when issued or last renewed.
• We and the Policyholder or the Employer mutually agree to change Premium Rates.
Except as provided above, Premium Rates will not be changed during the Initial Rate Guarantee Period shown in Eligibility, Premium Rates, and Participation Requirement. Thereafter, except as provided above, we may change Premium Rates upon 180 days advance written notice to the Policyholder. Any such change in Premium Rates may be made effective on any Premium Due Date, but no such change will be made more than once in any contract year. Contract years are successive 12 month periods computed from the end of the Initial Rate Guarantee Period.
GP0614-CI - 3 -
Premium Adjustments
Premium adjustments involving a return of unearned premiums to the Policyholder will be limited to the 12 months just before the date we receive a request for premium adjustment.
Grace Period and Termination for Nonpayment
If a premium is not paid on or before its Premium Due Date, it may be paid during the Grace Period shown in Eligibility, Premium Rates, And Participation Requirement. The Group Policy or an Employer's coverage under the Group Policy will remain in force during the Grace Period.
If the premium is not paid during the Grace Period, the Group Policy will terminate automatically at the end of the Grace Period.
The Policyholder is liable for premium for insurance during the Grace Period. We may charge interest at the legal rate for any premium which is not paid during the Grace Period, beginning with the first day after the Grace Period.
GENERAL PROVISIONS
Certificates
We will issue a certificate to the Policyholder showing the coverage under the Group Policy. The Policyholder will distribute a certificate to each insured Member.
Records and Reports
The Policyholder will furnish on our forms all information reasonably necessary to administer the Group Policy. We have the right at all reasonable times to inspect the payroll and other records of the Policyholder which relate to insurance under the Group Policy.
Agency and Release
Individuals selected by the Policyholder or by any Employer to secure coverage under the Group Policy or to perform their administrative function under it, represent and act on behalf of the person selecting them, and do not represent or act on behalf of Standard Insurance Company. The Policyholder, Employer and such individuals have no authority to alter, expand or extend our liability or to waive, modify or compromise any defense or right we may have under the Group Policy. The Policyholder and each Employer hereby release, hold harmless and indemnify Standard Insurance Company from any liability arising from or related to any negligence, error, omission, misrepresentation or dishonesty of any of them or their representatives, agents or employees.
Subrogation
pary, we wing am any waition under or a repel a real of any at or mis rating may have against a third party.
Notice of Suit
The Policyholder or Employer shall promptly give us written notice of any lawsuit or other legal proceedings arising under the Group Policy.
GP0614-CI - 4-
NOTICE OF PROTECTION PROVIDED BY
CALIFORNIA LIFE AND HEALTH INSURANCE GUARANTEE ASSOCIATION This notice provides a brief summary regarding the protections provided to policyholders by the California Life and Health Insurance Guarantee Association ('the Association"). The purpose of the Association is to assure that policyholders will be protected, within certain limits, in the unlikely event that a member insurer of the Association ecomes financially unable to meet its obligations.
This protection was created under California law, which determines who and what is covered and the amounts of coverage.
Below is a brief summary of the coverages, exclusions and limits provided by the Association. This summary does not cover all provisions of the law; nor does it in any way change anyone's rights or obligations or the rights or obligations of the Association.
COVERAGE
• Persons Covered
Generally, an individual is covered by the Association if the insurer was a member of the Association and the individual lives in California at the time the insurer is determined by a court to be insolvent. Coverage is also provided to policy beneficiaries, payees or assignees, whether or not they live in California. • Amounts of Coverage
The basic coverage protections provided by the Association are as follows. • Life Insurance, Annuities and Structured Settlement Annuities For life insurance policies, annuities and structured settlement annuities, the Association will provide the following:
• Life Insurance
80% of death benefits but not to exceed $300,000
80% of cash surrender or withdrawal values but not to exceed $100,000 • Annuities and Structured Settlement Annuities
80% of the present value of annuity benefits, including net cash withdrawal and net cash surrender values but not to exceed $250.000
The maximum amount of protection provided by the Association to an individual, for all life insurance, annuities and structured settlement annuities is $300,000, regardless of the number of policies or contracts covering the individual.
Health Insurance
The maximum amount of protection provided by the Association to an individual, as of July 1, 2016, is $546,741. This amount will increase or decrease based upon changes in the health care cost component of the consumer price index to the date on which an insurer becomes an insolvent insurer. Changes to this amount will be posted on the Association's website www.califega.org.
COVERAGE LIMITATIONS AND EXCLUSIONS FROM COVERAGE
The Association may not provide coverage for this policy. Coverage by the Association generally requires residency in California. You should not rely on coverage by the Association in selecting an insurance company or in selecting an insurance policy.
The following policies and persons are among those that are excluded from Association coverage:
• A policy or contract issued by an insurer that was not authorized to do business in California when it issued the policy or contract
• A policy issued by a health care service plan (HMO), a hospital or medical service organization, a charitable organization, a fraternal benefit society, a mandatory state pooling plan, a mutual assessment company, an insurance exchange, or a grants and annuities society • If the person is provided coverage by the guaranty association of another state • Unallocated annuity contracts; that is, contracts which are not issued to and owned by an individual and which do not guaranty annuity benefits to an individual • Employer and association plans, to the extent they are self-funded or uninsured • A policy or contract providing any health care benefits under Medicare Part C or Part D • An annuity issued by an organization that is only licensed to issue charitable gift annuities • Any policy or portion of a policy which is not guaranteed by the insurer or for which the individual has assumed the risk, such as certain investment elements of a variable life insurance policy or a variable annuity contract
• Any policy of reinsurance unless an assumption certificate was issued Interest rate yields (including implied yields) that exceed limits that are specified in Insurance Code Section 1607.02(b)(2)(C).
NOTICES
Insurance companies or their agents are required by law to give or send you this notice. Policyholders with additional questions should first contact their insurer or agent. To learn more about coverages provided by the Association, please visit the Association's website at www.califega.org, or contact either of the following:
California Life and Health Insurance California Department of Insurance Guarantee Association Consumer Communications Bureau
PO Box 16860 300 South Spring Street
Beverly Hills, CA 90209-3319 Los Angeles CA 90013
(323) 782-0182 (800) 927-4357
Insurance companies and agents are not allowed by California law to use the existence of the Association or its coverage to solicit, induce or encourage you to purchase any form of insurance.
When selecting an insurance company, you should not rely on Association coverage. If there is any inconsistency between this notice and California law, then California law will control
CALIFORNIA NOTICE OF COMPLAINT PROCEDURE
Should any dispute arise about your premium or about a claim that you have filed, write to th company that issued the group policy at:
Standard Insurance Company
PO Box 711
Portland, OR 97207
(971) 321-7000
If the problem is not resolved, you may also write to the State of California at:
Department of Insurance
300 5. Spring street, in oL
Los Angeles, CA 90013
1-800-927-HELP (4357)
This notice of complaint procedure is for information only and does not become a part or condition of this group policy/certificate.
EXHIBIT "B"
COMPENSATION
STANDARD INSURANCE COMPANY
A Stock Life Insurance Company
900 SW Fifth Avenue
Portland, Oregon 97204-1282
(503) 321-7000
GROUP CRITICAL ILLNESS INSURANCE POLICY
Policyholder: City Of Riverside
Group Policy Number: 641996-G
Group Policy Effective Date: 05/01/2022
State of Issue: California
The consideration for this Group Policy is the application of the Policyholder and the payment by the Policyholder of premiums as provided herein.
Subject to The Group Policy and Premium Payment sections, this Group Policy (a) is issued for the Initial Rate Guarantee Period shown in Eligibility, Premium Rates, And Participation Requirement and (b) may be renewed for successive renewal periods by the payment of the premium set by us on each renewal date. length of each renewal period will be set by us, but will not be less than 12 months.
For purposes of effective dates and ending dates under this Group Policy, all days begin and end at 12:00 midnight Standard Time at the Policyholder's address.
All provisions on this and the following pages are part of this Group Policy. "You" and "your" mean the Member. "We", "us". ', and "our" mean Standard Insurance Company. Other defined terms appear with their initial letters capitalized. Section and provision headings, and references to them, appear in boldface type.
The Group Policy is a legal contract between the Policyholder and us. Please read the Group Policy carefully.
THIS POLICY IS NOT IN LIEU OF AND DOES NOT AFFECT ANY REQUIREMENT FOR COVERAGE BY WORKMEN'S COMPENSATION INSURANCE.
THIS IS A LIMITED BENEFIT POLICY THAT PROVIDES CRITICAL ILLNESS BENEFITS. THIS POLICY DOES NOT PROVIDE COMPREHENSIVE HEALTH INSURANCE COVERAGE. THIS IS A SUPPLEMENT TO HEALTH INSURANCE. IT IS NOT A SUBSTITUTE FOR ESSENTIAL HEALTH BENEFITS OR MINIMUM ESSENTIAL COVERAGE AS DEFINED IN FEDERAL LAW. IT DOES NOT PROVIDE COVERAGE FOR HOSPITAL, MEDICAL, SURGICAL OR MAJOR MEDICAL EXPENSES.
AVAILABLE FROM US.
STANDARD INSURANCE COMPANY
By
Chairman, President and CEO Corporate Secretary
GP0614-CI
Table of Contents
ELIGIBILITY, PREMIUM RATES, AND PARTICIPATION REQUIREMENT 1 Eligibility.... ....1
Premium Rates and Renewals. ...1
Participation Requirement ...1
THE GROUP POLICY... 2
The Group Policy; Entire Contract 2
Changes to the Group Policy. .2
Incontestability of Group Policy 2
Termination of the Group Policy. .2
PREMIUM PAYMENT.. 3
Premiums. 3
Contributions from Members. 3
Changes in Premium Rates..
Premium Adjustments
Grace Period and Termination for Nonpayment...
GENERAL PROVISIONS 4
Certificates 4
Records and Reports.. 4
Agency and Release .. 4
Subrogation 4
Notice of Suit
GP0614-CI
ELIGIBILITY, PREMIUM RATES, AND PARTICIPATION REQUIREMENT Eligibility
Employer(s): City Of Riverside
Eligible Class(es): All Members
Premium Rates and Renewals
Member and Dependents:
The rates below are not combined rates for the Member and Spouse, rather they are for each individually.
Age of Member
Annual rates per $1000 of
coverage
Age < 25 $7.080
Age 25-29 $7.080
Age 30-34 $11.160
Age 35-39 | $11.160
Age 40-44 $19.680
Age 45-49 $19.680
Age 50-54 $32.400
Age 55-59 $32.400
Age 60-64 $54.960
Premium Due Date: 05/01/2022 and the first day of each calendar month thereafter.
Initial Rate Guarantee Period: 05/01/2022 to 01/01/2024 Grace Period: 60 days from Premium Due Date
Notice of Rate Change: 180 days
Notice of Termination: 31 days
Participation Requirement
Minimum Participation Number: 10 insured Members
GP0614-CI - 1-
THE GROUP POLICY
The Group Policy; Entire Contract
The Group Policy is the entire contract between the Policyholder and us. We will provide benefits according to the terms of the Group Policy.
The Group Policy consists of the following:
• This group critical illness insurance policy issued by us to the Policyholder and identified by the Group Policy Number.
The Policyholder's attached application.
• Group critical illness insurance certificates with the same Group Policy Number. • Any amendments to the Group Policy or certificates.
The Policyholder's rights or the rights of any Member will only be affected by provisions that are part of the Group Policy. Only an executive officer of Standard Insurance Company may bind us by making a promise or a representation; or accept a representation that relates to the Group Policy.
Changes to the Group Policy
Benefits under the Group Policy are limited to its terms, including any valid amendment. No change or amendment will be valid unless it is approved in writing by one of our executive officers and given to the Policyholder for attachment to the Group Policy. No agent has authority to change the Group Policy, or to waive any of its provisions. The Policyholder, an Employer, and their respective employees or representatives have no right or authority to change or amend the Group Policy or to waive any of its terms or provisions without our signed written approval.
We may change the Group Policy in whole or in part when any change or clarification in law or governmental regulation affects our obligations under the Group Policy, or with the Policyholder's consent.
Any such change or amendment of the Group Policy may apply to current or future Members or to any separate classes or groups of Members.
Incontestability of Group Policy
Any statement made by the Policyholder to obtain the Group Policy is a representation and not a warranty.
No misrepresentation by the Policyholder will be used to deny a claim or to deny the validity of the Group Policy unless all of the following are true:
• The Group Policy would not have been issued if we had known the truth. • We have given the Policyholder a copy of a written instrument signed by the Policyholder which contains the misrepresentation.
The validity of the Group Policy will not be contested after it has been in force for two years, except for fraudulent misrepresentations.
Termination of the Group Policy
The Group Policy may be terminated by us or the Policyholder according to its terms. It will terminate automatically for nonpayment of premium.
The Policyholder may terminate the Group Policy in whole, and may terminate insurance for any class or group of Members, at any time by giving us written notice. The effective date of termination will be the date GP0614-CI - 2-
stated in the notice. If no date is stated in the notice, then the effective date of termination will be the last day of the calendar month for which the premium was paid in full.
We may terminate the Group Policy as follows:
• On any Premium Due Date if the number of persons insured is less than the Minimum Participation Number shown in Eligibility, Premium Rates, and Participation Requirement. • On any Premium Due Date if we determine that the Policyholder has failed to promptly furnish any necessary information requested by us, or has failed to perform any other obligations relating to the Group Policy.
The minimum advance Notice of Termination by us is stated in Eligibility, Premium Rates, and Participation Requirement.
With respect to a Member or Spouse who has continued insurance under the Continuation of Insurance (Portability) for the Member provision or Continuation of Insurance (Portability) for the Spouse provision, continued coverage will not terminate unless it would otherwise terminate under the terms of the Continuation of Insurance (Portability) for the Member provision or Continuation of Insurance (Portability) for the Spouse provision.
PREMIUM PAYMENT
Premiums
Each premium is payable on or before its Premium Due Date to us. The premium due on each Premium Due Date is the sum of the premiums for all Members and Dependents then insured. Premium Rates are shown in Eligibility, Premium Rates, and Participation Requirement.
The payment of each premium as it becomes due will maintain the Group Policy in force until the next Premium Due Date.
Contributions from Members
The Policyholder determines the amount, if any, of each Member's contribution toward the cost of insurance under the Group Policy.
Changes in Premium Rates
We may change Premium Rates whenever:
• A change or clarification in law or governmental regulation affects the amount payable under the Group Policy. Any such change in Premium Rates will reflect only the change in our obligations. • Factors material to underwriting the risk we assumed under the Group Policy with respect to an Employer, including, but not limited to, number of persons insured, age, gender, and occupational classification, change by 25% or more.
• The premium contribution arrangement for Members is changed or varies from that stated in the Group Policy when issued or last renewed.
• We and the Policyholder or the Employer mutually agree to change Premium Rates.
Except as provided above, Premium Rates will not be changed during the Initial Rate Guarantee Period shown in Eligibility, Premium Rates, and Participation Requirement. Thereafter, except as provided above, we may change Premium Rates upon 180 days advance written notice to the Policyholder. Any such change in Premium Rates may be made effective on any Premium Due Date, but no such change will be made more than once in any contract year. Contract years are successive 12 month periods computed from the end of the Initial Rate Guarantee Period.
GP0614-CI - 3-
Premium Adjustments
Premium adjustments involving a return of unearned premiums to the Policyholder will be limited to the 12 months just before the date we receive a request for premium adjustment.
Grace Period and Termination for Nonpayment
If a premium is not paid on or before its Premium Due Date, it may be paid during the Grace Period shown in Eligibility, Premium Rates, And Participation Requirement. The Group Policy or an Employer's coverage under the Group Policy will remain in force during the Grace Period.
If the premium is not paid during the Grace Period, the Group Policy will terminate automatically at the end of the Grace Period.
The Policyholder is liable for premium for insurance during the Grace Period. We may charge interest at the legal rate for any premium which is not paid during the Grace Period, beginning with the first day after the Grace Period.
GENERAL PROVISIONS
Certificates
We will issue a certificate to the Policyholder showing the coverage under the Group Policy. The Policyholder will distribute a certificate to each insured Member.
Records and Reports
The Policyholder will furnish on our forms all information reasonably necessary to administer the Group Policy. We have the right at all reasonable times to inspect the payroll and other records of the Policyholder which relate to insurance under the Group Policy.
Agency and Release
Individuals selected by the Policyholder or by any Employer to secure coverage under the Group Policy or to perform their administrative function under it, represent and act on behalf of the person selecting them, and do not represent or act on behalf of Standard Insurance Company. The Policyholder, Employer and such individuals have no authority to alter, expand or extend our liability or to waive, modify or compromise any defense or right we may have under the Group Policy. The Policyholder and each Employer hereby release, hold harmless and indemnify Standard Insurance Company from any liability arising from or related to any negligence, error, omission, misrepresentation or dishonesty of any of them or their representatives, agents or employees.
Subrogation
If Critical Illness Benefits are paid to you under the Group Policy as a result of any act or omission of a third party, we will not claim any subrogation rights for any recovery or right of recovery you or your Dependent may have against a third party.
Notice of Suit
The Policyholder or Employer shall promptly give us written notice of any lawsuit or other legal proceedings arising under the Group Policy.
GP0614-CI - 4-
NOTICE OF PROTECTION PROVIDED BY
CALIFORNIA LIFE AND HEALTH INSURANCE GUARANTEE ASSOCIATION This notice provides a brief summary regarding the protections provided to policyholders by the California Life and Health Insurance Guarantee Association ("the Association"). The purpose of the Association is to assure that policyholders will be protected, within certain limits, in the unlikely event that a member insurer of the Association becomes financially unable to meet its obligations. Insurance companies licensed in California to sell life insurance, health insurance, annuities and structured settlement annuities are members of the Association. The protection provided by the Association is not unlimited and is not a substitute for consumers' care in selecting insurers. This protection was created under California law, which determines who and what is covered and the amounts of coverage.
Below is a brief summary of the coverages, exclusions and limits provided by the Association. This summary does not cover all provisions of the law; nor does it in any way change anyone's rights or obligations or the rights or obligations of the Association.
COVERAGE
• Persons Covered
Generally, an individual is covered by the Association if the insurer was a member of the Association and the individual lives in California at the time the insurer is determined by a court to be insolvent. Coverage is also provided to policy beneficiaries, payees or assignees, whether or not they live in California. • Amounts of Coverage
The basic coverage protections provided by the Association are as follows. • Life Insurance, Annuities and Structured Settlement Annuities For life insurance policies, annuities and structured settlement annuities, the Association will provide the following:
• Life Insurance
80% of death benefits but not to exceed $300,000
80% of cash surrender or withdrawal values but not to exceed $100,000 • Annuities and Structured Settlement Annuities
80% of the present value of annuity benefits, including net cash withdrawal and net cash surrender values but not to exceed $250,000
The maximum amount of protection provided by the Association to an individual, for all life insurance, annuities and structured settlement annuities is $300,000, regardless of the number of policies o ontracts covering the individua
Health Insurance
The maximum amount of protection provided by the Association to an individual, as of July 1, 2016, is $546,741. This amount will increase or decrease based upon changes in the health care cost componen of the consumer price index to the date on which an insurer becomes an insolvent insurer. Changes to this amount will be posted on the Association's website www.califega.org.
COVERAGE LIMITATIONS AND EXCLUSIONS FROM COVERAGE
The Association may not provide coverage for this policy. Coverage by the Association generally requires residency in California. You should not rely on coverage by the Association in selecting an insurance company or in selecting an insurance policy.
The following policies and persons are among those that are excluded from Association coverage:
• A policy or contract issued by an insurer that was not authorized to do business in California when it issued the policy or contract
• A policy issued by a health care service plan (HMO), a hospital or medical service organization, a charitable organization, a fraternal benefit society, a mandatory state pooling plan, a mutual assessment company, an insurance exchange, or a grants and annuities society • If the person is provided coverage by the guaranty association of another state • Unallocated annuity contracts; that is, contracts which are not issued to and owned by an individual and which do not guaranty annuity benefits to an individual • Employer and association plans, to the extent they are self-funded or uninsured • A policy or contract providing any health care benefits under Medicare Part C or Part D • An annuity issued by an organization that is only licensed to issue charitable gift annuities • Any policy or portion of a policy which is not guaranteed by the insurer or for which the individual has assumed the risk, such as certain investment elements of a variable life insurance policy or a variable annuity contract
• Any policy of reinsurance unless an assumption certificate was issued Interest rate yields (including implied yields) that exceed limits that are specified in Insurance Code Section 1607.02(b)(2)(C).
NOTICES
Insurance companies or their agents are required by law to give or send you this notice. Policyholders with additional questions should first contact their insurer or agent. To learn more about coverages provided by the Association, please visit the Association's website at www.califega.org, or contact either of the following:
California Life and Health Insurance California Department of Insurance Guarantee Association Consumer Communications Bureau
PO Box 16860 300 South Spring Street
Beverly Hills, CA 90209-3319 Los Angeles CA 90013
(323) 782-0182 (800) 927-4357
Insurance companies and agents are not allowed by California law to use the existence of the Association or its coverage to solicit, induce or encourage you to purchase any form of insurance.
When selecting an insurance company, you should not rely on Association coverage. If there is any inconsistency between this notice and California law, then California law will control.
CALIFORNIA NOTICE OF COMPLAINT PROCEDURE
Should any dispute arise about your premium or about a claim that you have filed, write to th company that issued the group policy at
Standard Insurance Company
PO Box 711
Portland, OR 97207
(971) 321-7000
If the problem is not resolved, you may also write to the State of California at:
Department of Insurance
Consumer Services Divisior
300 S. Spring Street, 11th FL
Los Angeles, CA 90013
1-800-927-HELP (4357)
This notice of complaint procedure is for information only and does not become a part or condition of this group policy/certificate.
EXHIBIT "C"
KEY PERSONNEL
Not Applicable for this Agreement