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s..\1 VII. SUPPLEMENTAL INFORMATION A. Claim Charges 1. THP, being a Federally qualified HMO does not base its premiums on a per group utilization basis. Instead, the premiums are calculated under the community rating system which means the City of San Marcos's utilization is part of a community pool. The rates are then calculated according to community health care costs. D. Retention 2. E. The individual conversion policy is different from the City of San Marcos's proposed benefit package. All THP members who convert to individual coverage are enrolled in the same benefit package. Those members who move outside the THP enrollment area may enroll in an individual policy underwritten by Lincoln National. Administration of Claims 5. All of the mentí~ned services are covered benefits when medically necessary and autorized by the member's Primary Care Physican with the exception of Chiropractors and Podiatrists. Instead, services by an Orthopedic Specialist would be recommended. THP, too, intends to comply with all TEFRA and COBRA provisions. 7. 8. The claim representatives and other THP staff are available from 8-5 Monday through Friday to serve our members. M. Premium premium best of format. billing statements will be provided monthly with each employee's itemized and totaled at the bottom of the page. THP will work to its abilitiy to provide any additional reports in the requested Please see copies of statements behind this page. P. Q. THP is currently developing the Management, wellness workshops, exercise/physical fitness, baby and medical/first aid classes. Termination of the contract would require 60 days written notice. THP's liability would cease at the requested date of termination. following Health Education Services. Stress smoking cessation, nutrition/weight loss-, care, family planning, preparation for birth, R. THP's members may convert to an individual policy(see above item D). COBRA eligible employees may maintain membership in THP for the required period of time as long as they continúe to reside within the THP service area which ~onsists of Travis, Hays, Lee,Caldwell, Williamson,Bastrop and Burnet counties. COBRA participants would maintain the same benefits as employees. a. THP benefit programs are preprinted. The cover letter and/or a benefit comparison (HMO vs Indemnity Plan) can be included to explain the program. THP will furnish all printed materials at no additional cost to the City of San Marcos. Each new member receives a member packet which consists of the member's I.D. card, contract, and member handbook. A THP staff member will contact each new member to welcome him/her to the plan and answer any Questions. T. U.