A. Cooperate with the DEPARTMENT in preparing additional information for distribution to ELIGIBLE EMPLOYEES or EMPLOYERS as may be necessary for the proper administration of the PROGRAM. B. Provide non-discriminatory services to participants that include services for the physically and hearing impaired. C. Provide adequate access by telephone, local office, internet, or other appropriate means. D. Conduct surveys to solicit information from participants or EMPLOYERS and analyze results, upon request by the BOARD or the DEPARTMENT. 5.5 Reports MINNESOTA LIFE shall provide the following reports to the DEPARTMENT. Monthly reports shall be provided within thirty (30) days from the end of each month; quarterly reports shall be provided within thirty (30) days from the end of the quarter. A. A POLICY YEAR report of the financial status of the PROGRAM, disclosing value of program assets, liabilities, analysis of cash receipts and disbursements, and other relevant information as may be reasonably requested by the DEPARTMENT, annually by June 30. B. An annual recommendation on the next year's premium rates to the DEPARTMENT for its concurrence and then to the BOARD for its approval. C. A quarterly report on performance standards. D. An annual report on the satisfaction survey of participating EMPLOYERS. E. Actuarial and administrative studies on the feasibility and/or cost of proposed legislative or procedural changes, as requested by the DEPARTMENT. F. A list of retired EMPLOYEES enrolled in the life insurance program, whose premiums are being deducted from their WRS annuity, in a format and time frame that is mutually acceptable to the DEPARTMENT and MINNESOTA LIFE. ARTICLE VI. PERFORMANCE STANDARDS AND PENALTIES 6.1 Performance Standards The following performance standards may be modified as circumstances warrant, by mutual agreement between the DEPARTMENT and MINNESOTA LIFE. Quantitative Standards MINNESOTA LIFE
4. The fact that any insured EMPLOYEE is entitled to continue insurance the policy with or without the requirement of any contribution toward premiums. 5. The application of statutes and contract provisions regarding the fact of coverage, whether an EMPLOYEE is entitled to enroll or to continue coverage termination of employment, and similar matters. 6. To the extent not delegated to MINNESOTA LIFE, the review and approval or denial of requests from EMPLOYERS for enrollment of EMPLOYEES based on EMPLOYER error. E. Accept and maintain all beneficiary designations and provide proper designation to MINNESOTA LIFE at time of claim. When necessary, assist MINNESOTA LIFE to determine eligible beneficiary(ies) under Wis. Stat. § 40.02 (8). All decisions relating to determination of eligible beneficiary(ies) will be the responsibility of the DEPARTMENT. F. Administer the appeal process by which interested parties may contest the Department's determinations related to the PROGRAM. These appeals are ultimately decided by the BOARD. G. Fully cooperate with MINNESOTA LIFE regarding any claim or litigation against any or all of the DEPARTMENT, the BOARD and MINNESOTA LIFE including but not limited to providing relevant records, technical assistance and witnesses if necessary to the defense of such litigation. H. a STATE premium reporting/membership information system is in place: 1. Initially process applications from STATE EMPLOYEES who are transferring between STATE agencies, or applying under evidence of insurability. 2. Process cancellation forms. 3. Provide evidence of coverage for premium waivers. 4. Receive notice of claim, determine fact of coverage and certify amount of coverage and other required information to MINNESOTA LIFE when an insured individual retires, dies, applies for a living benefit, or elects to convert life insurance to pay health insurance premiums. 7.3 Premium Payment and Reporting A. The DEPARTMENT shall require each EMPLOYER to remit the total monthly premium due for its active insured EMPLOYEES. The total monthly premium due shall be as described in Policy No. 2832-G under "Premiums." B. The DEPARTMENT shall arrange for premium payment from the salaries and wages of all insured EMPLOYES from STATE agencies and remit to MINNESOTA LIFE, unless a different reporting and remittance method is created. C. The DEPARTMENT shall deduct premiums from annuities of insured retirees under age 65 and remit to MINNESOTA LIFE. Amendment No. 1 Effective
Replaces pages F-2 and F-4 with new pages F-2 and F-4 of Exhibit F effective January 1, 2010. This amendment updates the stop-loss basis for the local government employee life insurance plans to show the new stop-loss rates effective January 1, 2010. Minnesota Life Insurance Company this ________day of_____________________, 2010 By ____________________________________ Chair The State of Wisconsin Group Insurance Board this ________day of________________, 2010 By ____________________________________ Chair EXHIBIT F STOP-LOSS PROVISION (cont'd) SCHEDULE OF MONTHLY STOP-LOSS PER $1,000 OF INSURANCE for Insurance of a Greater or Lesser Amount will be Proportionate) LOCAL GOVERNMENT EMPLOYEE PLAN Attained Age Rate Attained Age Rate Attained Age Rate 17 $ .07 45 $ .16 73 $ 2.93 18 .07 46 .17 74 3.43 19 .07 47 .19 75 3.85 20 .07 48 .22 76 4.36 21 .07 49 .26 77 4.87 22 .07 50 .24 78 5.44 23 .07 51 .27 79 6.04 24 .07 52 .29 80 6.65 25 .07 53 .32 81 7.30 26 .07 54 .36 82 7.91 27 .07 55 .45 83 8.58
28 .07 56 .48 84 9.33 29 .07 57 .52 85 10.17 30 .07 58 .54 86 11.10 31 .07 59 .56 87 12.04 32 .08 60 .67 88 13.05 33 .08 61 .72 89 14.22 34 .09 62 .78 90 15.48 35 .09 63 .84 91 16.82 36 .10 64 .90 92 18.20 37 .11 65 1.02 93 19.60 38 .11 66 1.22 94 21.06 39 .12 67 1.41 95 22.57 40 .12 68 1.59 96 24.14 41 .13 69 1.68 97 25.76 42 .15 70 1.90 98 51.18 43 .15 71 2.12 99 81.59 44 .16 72 2.51 100 83.33 F-2 EXHIBIT F STOP-LOSS PROVISION (cont'd) SCHEDULE OF MONTHLY STOP-LOSS RATES PER $1,000 OF INSURANCE (Rates for Insurance of a Greater or Lesser Amount will be Proportionate) LOCAL GOVERNMENT EMPLOYEE PLAN Attained Age Rate Attained Age Rate Attained Age Rate 17 $ .06 45 $ .13 73 $2.52 18 .06 46 .14 74 2.94 19 .06 47 .16 75 3.30 20 .06 48 .19 76 3.73 21 .06 49 .22 77 4.18 22 .06 50 .20 78 4.67 23 .06 51 .23 79 5.17 24 .06 52 .25 80 5.70 25 .06 53 .28 81 6.26 26 .06 54 .31 82 6.78 27 .06 55 .38 83 7.35