2016-614-E HR - Magellan Healthcare, Inc. - EAP services to OC Employees

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DocuSign Envelope ID:CADCC57A-44C1-4CBC-B33C-8C1C3E594289 ACORD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) ‘.,...-' 6/17/2017 9/27/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONT PRODUCER Lockton Companies NAME:CT 1185 Avenue of the Americas,Suite 2010 PHONE FAX New York 10036 (A/C.No,Ext): (NC,No): 646-572-7300 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Lexington Insurance Company 19437 INSURED MAGELLAN HEALTH,INC. INSURER B:Liberty Mutual Fire Insurance Company 23035 1345009 4800 N. SCOTTSDALE ROAD INSURER C:Liberty Insurance Corporation 42404 SCOTTSDALE AZ 85351 INSURER D: INSURER E: INSURER F: COVERAGES MAGHEOI CERTIFICATE NUMBER: 11461505 REVISION NUMBER: XXXXXXX THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY N N 7055341 6/17/2016 6/17/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE RETE CLAIMS-MADE X OCCUR PREMISES O(Ea occur ence) $ 50,000 MED EXP(Any one person) X000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY PRO-JECT LOC PRODUCTS-COMP/OPAGG $ 1,000,000 OTHER: $ B AUTOMOBILE LIABILITY N N AS2-651-004219-116 10/1/2016 10/1/2017 COMBINED SINGLE LIMIT $ (Ea accident) 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ XXXXXXX AOUTOS ONLY SCHEDULED BODILY INJURY(Per accident) $ XXXXXXX HIRED NON-OWNED PROPERTY DAMAGE $ XXXXXXX AUTOS ONLY AUTOS ONLY (Per accident) X COMP.$1,000 X COLL.$1,000 $ XXXXXXX A UMBRELLA LIAB OCCUR N N 7055342 6/17/2016 6/17/2017 EACH OCCURRENCE $ 10,000,000 X EXCESS LIAB X CLAIMS-MADE AGGREGATE $ 10,000,000 DED RETENTION$ $ XXXXXXX WORKERS PER OTH- C AND EMPLOYERS'LIABILITY N WC7-651-004219-106 10/1/2016 10/1/2017 STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N N/A E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 A MANAGECARE LIAB. N N 01-423-23-98 6/17/2016 6/17/2017 $10,000,000 per Med Incident A CLATMS MADE STR applies per policy $10,000,000 Aggregate A terms&conditions • DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER.APPLICABLE TO THE CARRIERS LISTED AND THE POLICY TERM(S)REFERENCED. EVIDENCE OF COVERAGE CERTIFICATE HOLDER CANCELLATION 11461505 MAGELLAN HEALTH, INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 4800 N. SCOTTSDALE ROAD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SCOTTSDALE AZ 85351 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATI E e ° a s 77 ©1088-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD