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Res 2000-130
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7/24/2006 10:25:35 AM
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City Clerk
City Clerk - Document
Resolutions
City Clerk - Type
Contract
Number
2000-130
Date
6/26/2000
Volume Book
141
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<br />4. SPECIFIC EXCESS COVERAGE <br /> <br />A. In accordance with the terms of this Treaty, We will pay the Specific Excess benefit, if any, to you <br />within 60 days or as soon as is reasonably possible after receipt and acceptance by Us, following <br />an audit, of the proof of loss and proof of payment for Eligible Expenses under the Plan. <br /> <br />B. The Specific Excess Benefit with respect to each Covered Person for any Treaty Year, or fraction <br />thereof, shall be determined by taking the Benefit Plan payments which are approved for <br />reimbursement by Us with respect to the Covered Person, subtracting the Specific Retention <br />Amount and multiplying the difference by the Reimbursement Factor. In no event shall the <br />Specific Excess benefit for any Treaty Year exceed the Specific Annual Maximum Amount. <br /> <br />S. AGGREGATE EXCESS COVERAGE <br /> <br />A. In accordance with terms of this Treaty, We will pay the Aggregate Excess benefit, if any, to you <br />within a reasonable time after the end of each Treaty Year (or within a reasonable time after <br />termination of this Treaty if the Treaty terminates during, the Treaty Year) after receipt, audit and <br />acceptance by Us of proof of loss and proof of payment for Eligible Expenses under the Plan for <br />which reimbursement is requested. <br /> <br />B. The Aggregate Excess Benefit for each Treaty Year, or fraction thereof, is the Benefit Plan <br />payments paid for Eligible Expenses during the Treaty Year, less <br /> <br />(I) The greater of the Minimum Annual Aggregate Retention Amount shown in the Application or <br />the Annual Aggregate Retention Amount; and <br /> <br />(2) The Specific Excess benefits which have been or will be reimbursed by Us under the Specific <br />Excess Coverage; and <br /> <br />(3) Any payments which are in excess of the Limitations of Coverage or which are excluded under <br />this Treaty multiplied by the Reimbursement Factor and subject to the maximum amount <br />specified under Aggregate Excess Coverage in the Application. <br /> <br />6. LIMITATIONS OF COVERAGE <br /> <br />A. Liability of Reimbursement <br />We will not have the responsibility or obligation under this Treaty to directly reimburse any <br />Covered Person or provider of professional or medical services for any benefits which you have <br />agreed to provide under the terms of the Plan. Our sole liability hereunder is to you, in accordance <br />with the terms of this Treaty. <br /> <br />B. Actively at W orkIHospital Confinement <br />Notwithstanding any provisions to the contrary in the Plan, if a Covered Person is not actively at <br />work at his normal occupation for the number of hours for which he or she is normally scheduled <br />or a dependent is hospital confmed, or is unable to engage in normal activities of a person in good <br />health of like age and sex, when this Treaty becomes effective, or when hislher coverage under the <br />Plan would otherwise take effect, iflater, then (1) no covered benefits shall be provided under this <br />Treaty for any expenses incurred; and (2) no expenses incurred shall be used to satisfy either the <br />Specific Retention Amount or the Annual Aggregate Retention Amount unless they were incurred <br />on or after the day next following the date such Covered Person returns to work on a full-time <br />basis or such dependent's hospital confinement ends or such dependent meets the Actively at Life <br />requirement provided, that such Covered Person or such dependent still meets the eligibility <br />requirements of the Plan. <br /> <br />6 <br />
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