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Blue Cross and <br />Blue Shield <br />of Minnesota <br />P.0. Box 0455O» St. Paul, Minnesota 55164 <br />74 -0^AE7TC-8\-`C>' PROPOSAL <br />F 0 R CITY OF LITTLE CANADA <br />AWARE Cold is a unique, new approach to health care coverage. It <br />includes all the features employees want most in a health care plan, <br />AWARE Cold is affordable, simple to use and the result is unmatched <br />employee satisfaction. <br />lhe AWARE Cold plan is available because of the efforts of Blue Cross <br />and Blue Shield of Minnesota to bring together hospitals, physicians and <br />consumers to provide superior benefits at a price you can afford. <br />THE AWARE COLD NETWORK: UNMATCHED COVERAGE AND SIMPLICITY <br />180% coverage for preventive care such as routine physicals, <br />well baby care, immonizations/ eye and ear exams. <br />188% coverage for outpatient services such as emergency care, pre- <br />operative testing, chemotherapy, and radiation therapy. <br />100Z coverage for inpatient semi-private room for 365 days/year. <br />100% coverage for physician services such as office visits, surgery, <br />in-hospital visits, obstetrical (groups less than 15, <br />conception most occur while covered), and anesthesia` <br />Prescription drugs with a $4^58 co-payment for ,drugs within the formulary. <br />Out of network services covered at a reduced benefit,' <br />Other benefits covered at 180Z or reduced benefit as described in <br />the contract or certificate. <br />This is only an outline of benefits, all benefits are detailed in <br />the contract or certificate~ <br />*Life Insurance: $ 010000 <br />Dependent Life: NO <br />*Short Term <br />Waiting <br />Benefit <br />Disability: <br />Period: <br />Period: <br />Dental AWARE: <br />*These products <br />Number Eligible 7 <br />1> <br />2) <br />3> <br />4) <br />$ 100 <br />1st Day Accident - 8th Day Sickness <br />26 Weeks <br />Diagnostic and Preventive only <br />underwritten by MIT Life. Incorporated, <br />Average Monthly <br />Health Rate: <br />Single $ 53^81 <br />Family $ 254^71 <br />Monthly Charge; <br />Health: <br />Life: <br />STD: <br />Dental: <br />Grand Total: <br />$ <br />$ <br />$ <br />$ <br />$ <br />1582^86 <br />45.00 <br />56^9O <br />88+36 <br />1764`32 <br />1,582.06 <br />80.36 <br />1,662.42 <br />Rates based upon an effective date of 11/81/87 <br />Monthly Payments will be based upon census data of employees/ <br />dependents actually enrolled for the plan. <br />Rates subject to change upon medical underwriting review, <br />Do not cancel your current plan until formal notice of acccntance <br />is given, Page 49 <br />