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Res 1988-077
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Res 1988-077
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8/9/2007 11:15:13 AM
Creation date
8/9/2007 11:15:13 AM
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City Clerk
City Clerk - Document
Resolutions
City Clerk - Type
Contract
Number
1988-77
Date
7/11/1988
Volume Book
91
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<br />"Emeq;¡ency" is a sudden arid unexpected Qnset of arl acute illness or <br />accidental Injury requiring immediate diagnosis and treatment to avoid <br />jel)pat'dy to the 1 i fe and health of a Covered Persc,r,. Heart attacks, <br />poisonings, loss of consciousness or respiration, convulsions and excessive <br />uncontrolled bleeding are examples Qf medical emergencies. <br /> <br />"Enrollee" means any employee of the Enrolling Unit who (1) is eligible on <br />his or her own behalf and not by virtue of being an Eligible Dependent to <br />participate in the health benefits provided under this Contract; (2) <br />t'esides in the Service Area; (3) meets the group's eligibility requirements <br />specified in the group's application and other provisions in thisCQntract; <br />~nd (4) is enrolled f~r coverage ~ndEr this Contract. <br /> <br />"Enrolling Unit" means any employer or I)ther entity with whom this Contract <br />is made. <br /> <br />"Expet'imel'"ltal Unproven Pt'clcedUt'es" meal'"lS medical, surgical I:)r psychiatric <br />pt"Jcedut'es I:)t' h'eatments and pharmacological regimes not genet'ally accepted <br />by the medical community, including but not limited tQ Qrgan transplants <br />(except kidney and CQrnea transplants and liver transplants in children <br />wi th bi I iat'y ab'esia) , si last ic implants, megavitamin therapy, <br />psychosurgery, and nutritional based therapy for Alcoholism. Health Plan <br />reserves the right to change the definition of Experimental Unproven <br />Pt'IJcedlJt'es, ft'()m time tQ time, S() as tQ add I:)r delete certain medical, <br />surgical or psychiatric procedures or treatments or pharmacological <br />t'eg imes. <br /> <br />"Fami ly Dependerlt" means a person er¡r.::olled for coverage undet' this Contract <br />who is (1) the Ent'Qllee's spouse or' (2) an unmarried dependent child of <br />either the Enrollee or the Enrollee's spouse, subject to the following <br />conditions and limitations: <br /> <br />GM-12-5 <br /> <br />(1) <br /> <br />The tet'l'Il "Family Dependel"lt" shall include any unmarried child who <br />is (a) less than 19 years of age or (b) 19 years, but less than <br />23 years of age if (i) such child is not regularly employed on a <br />full-time basis, and (ii) evidence satisfactory to Health Plan <br />that the child is a full-time student at an accredited <br />educational institution and is primarily dependent on the <br />Em'ollee fm' suppclrt arid maintenance is furnished annually to <br />He~lth Plan, or more frequently as requested. <br /> <br />(2} <br /> <br />The tet'm "clepel'"lderlt child" as used het'ein shall include any <br />stepchild legally adQpted child who is a member of the <br />Em'l:<llee's househQld and whcl for purposes IJf Fedet'al Income Tax <br />pUt'poses can be claimed as an exempt ion, f,:)stet' chi ld Qr any <br />other ch i ld whl) is primari ly dependent upc.n the Enrollee f'Jr <br />SllppOt't and r'esides with the Em'()llee in a customat'y pat'ent-child <br />relat i.::onsh i p. <br /> <br />(,3 ) <br /> <br />An unmarried dependent child who is incapable of self-support <br />because Ijf mental disability or physical handicap, when coverage <br />of such child would terminate upon attaining the specified <br />limiting age, ~ill continue to be covered as a Family Dependent <br />subject to the provisions of extended coverage in Section VI of <br />th i:; C.::.ntr'act. <br />
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