HomeMy WebLinkAboutES05-336 - Other - Standard Insurance Company - Group Insurance Policy Endorsement - 12/03/2009 Records Maindgem e-tit
KENT Document
WASHINGTON
CONTRACT COVER SHEET
This is to be completed by the Contract Manager prior to submission to City Clerks Office. All
portions are to be completed, if you have questions, please contact City Clerks Office.
Vendor Name: AZAD Vendor Number:
JD Edwards Number
Contract Number: (_7 S
This is assigned by Deputy City Clerk
Description: Cl-�f�/`�dli
Detail:
Project Name:
Contract Effective Date: Termination Date: 1�l
Contract Renewal Notice (Days):
Number of days required notice for termination or renewal or amendment
Contract Manager: i_.LDepartment: ,.
Abstract:
S Public\RecordsManagement\Forms\ContractCOver\ADCL7832 07/02
GROUP INSURANCE POLICY ENDORSEMENT
Attached to and made a part of Group Policy
Issued to City of Kent as Policyholder under
Group Y Polic 339619
In order to comply with the Washington Domestic Partner law, effective December 3, 2009, the
following endorsement is attached to and made a part of the group insurance policy referenced
above If the group policy contains existing domestic partner language, the following definition
applies only to the extent the existing language does not meet the minimum requirements of
the Washington law.
If the plan provides Life Insurance or Accidental Death and Dismemberment, it will be amended
as follows:
The term "spouse" or "Spouse" is defined as follows:
Spouse means•
1. A person to whom you are legally married, or
2 Your Domestic Partner. Your Domestic Partner means an individual recognized as
such under applicable law
For purposes of insurance under the Group Policy, Spouse does not include a person
who is a full-time member of the armed forces of any country, a person from whom
you are divorced or from whom you have terminated a Domestic Partner relationship
If the plan provides Long Term Disability or Dental Insurance, it will be amended as follows:
The term "spouse" or "Spouse" is defined as follows
Spouse means•
1. A person to whom you are legally married; or
2 Your Domestic Partner Your Domestic Partner means an individual recognized as
such under applicable law.
If a plan provides Dependents Life Insurance a special enrollment period is available for a
dependent domestic partner to enroll. The enrollment penod expires September 30, 2012
STANDARD INSURANCE COMPANY
BY
i
Prestd+ tC Csxparatr Secretary
339619 -C,City of Kent, BL
C-2