Laserfiche WebLink
<br />Alnerican <br /> <br />Stop Loss <br /> <br />;-"':.HJn..:c Brn~\.'ra~\'" SI...'r\ 1t....'I....... Illl..: <br /> <br />July 1, 1999 <br /> <br />Mr. Keith Carmichael <br />Nieman Hanks Puryear Benefits <br />515 Congress Avenue <br />Austin, TX 78701 <br /> <br />RE: City of San Marcos <br /> <br />Dear Keith: <br /> <br />American Stop Loss Insurance Brokerage Services, Inc. (ASl) thanks you for your continued business anc <br />we look forward to this opportunity to continue working with you. As agreed, we have placed the City of <br />San Marcos' medical stop loss coverage effective August 1. 1999 with American National Insurance <br />Company, and we promise to serve you well. Enclosed please find the Application from American Nationa' <br />Insurance Company based on the following terms (as noted In our last proposal): <br /> <br />Group Name: City of San Marcos <br /> <br />Effective Date: August 1, 1999 <br /> <br />Carrier: American National Insurance Company <br /> <br />Specific Cover80e <br />Deductible: <br />Single Rate: <br />Family Rate: <br />Contract Basis: <br />Specific Coverage: <br /> <br />$ 40,000 <br />$24.03 <br />$50.39 <br />15/12 <br />Medical -J <br /> <br />Rx -J Dental <br /> <br />Other: <br /> <br />AQore08te CoveraQe <br />Aggregate Factor: <br />Single: $211.76 <br />Family: $569.64 <br />Aggregate Premium: $5.37/ Composite <br />Contract Basis: 15/12 <br />Aggregate Coverage: Medical L Rx -J Dental <br /> <br />Other: <br /> <br />Please forward the original completed Application to us along with a check for the first month's premium <br />made out to American Stop Loss as soon as possible. Please use the enclosed self-bill invoice for <br />premium payment (if exact enrollment is not available. please estimate the enrollments for the first <br />month. <br /> <br />250 Commercial Street · Suite 200 · Worcester. MA 01608 · Phone 800-944-7659 · FAX 508-799-0161 <br />Email: info@ameri\.:an.topl()~..c(1m.\\.en.j!;:.\\\\\\Jn1crican.;topI0...com <br />