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TO: BOARD OF SUPERVISORS
Contra
FROM: Mark Finucane, Health Services Director Costa
By: Elizabpth .Sp oxer, Contracts Administrator
��}���,P.ZY, County
DATE: OCtobei J3, 1984
SUBJECT: Approval of Health Plan Service Agreement with Jake's Variety
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION
RECOMMENDATION
Approve Health Plan Service Agreement as follows:
Number: 29-733
Department: Health Services — Contra Costa Health Plan
Group: Jake's Variety
Term: November 1, 1984 through October 31, 1985
Monthly Premium
for Plan Members: Subscriber Only $ 69.13
Subscriber and One Dependent $138.26
Subscriber and Two or More Dependents $186.61
Service: Availability of Health Plan to Group's employees
BACKGROUND
On June 5, 1984 the Board adopted Resolution No. 84/328 for Contra Costa
Health Plan Rate Structure for public employee groups, private groups,
private non—group subscribers and private non—group Medicare (Medi—Key)
subscribers. Upon executed on this agreement, the employees of Jake's
Variety will be entitled to join the Health Plan and will receive services
in accordance with the standard Health Plan Service Agreement. The
agreement is in the standard form approved by County Counsel and no County
funds are required.
SH
Attachments
CONTINUED ON ATTACHMENT: YES SIGNATURE•
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMEWDAlTION OF BOARD COMMITTEE
APPROVE OTHER
SIGNATURE(S)
ACTION OF BOARD ON APPROVED AS RECOMMENDED OTHER
VOTE OF SUPERVISORS
X UNANIMOUS (ABSENT I HEREBY CERTIFY THAT THIS IS A TRUE
AYES: NOES: AND CORRECT COPY OF AN ACTION TAKEN
ABSENT: ABSTAIN: AND ENTERED ON THE MINUTES OF THE BOARD
ORIG: Health Services (Contracts) OF SUPERVISORS ON THE DATE SHOWN.
County Administrator
CC: Auditor-Controller ATTESTED l/C.�a _(3 �9�u
Contractor
Phil Batchelor, Clerk of the Board of
Supervisors and County Administrator
Z . 00009'7
M302/7-83 BY DEPUTY