5-4.0-100125 - Tarpon Springs - FMIT - Coverage Agreement Signed.pdf

This document is a Coverage Agreement between the Florida Municipal Insurance Trust (FMIT) and the City of Tarpon Springs, effective from 10/01/2025 to 09/30/2026. The agreement covers a medical health insurance plan through UnitedHealthcare Choice Plus Plan 15, with specific details on medical coverage including Rx copays and mail order prescription rates.

The premium structure is tiered based on employee coverage levels: Employee-only coverage is $925.31 per period, Employee + Spouse is $1,772.52, Employee + Children is $1,662.78, and Employee + Family is $2,510.03. The agreement includes provisions for COBRA continuation of health coverage and requires a 45-day written notice for termination. The document was signed by representatives from both FMIT and the City of Tarpon Springs on 08/22/2025, finalizing the insurance coverage terms for the specified period.