2010-06-07_(2).pdf - 19318.8K - BridgeportCT.gov

LU
Customer Name Bridgeport City BOE
Administrative Services Only Agreement
Exhibit A Plan Document
ERISA Plan No 501
A Summary Plan Document or Plan Booklet that includes Plan Benefits and Members rights and
responsibilities under the Plan will be
provided by Employer to Connecticut Gtmeral and attached hereto
IfEmployer has not
provided Connecticut General with a copy of its finalized Plan Booklet by the time
this Agreement is effective Connecticut General will administer the Plan in aCI ordance with the medical
management and claims administration policies and procedures and or practices
then to its own
applicable
health insurance business and the definitions and other language contained in the draft version of the Plan
Booklet provided by Connecticut General to Employer Connecticut General will continue to administer
the Plan in this manner until Connecticut General receives the finalized Plan Booklet and follows its
preparation and review process Afterthat time Connecticut General will use the finalized Plan Booklet
to administer Plan
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