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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 />C. Actively at Life <br />In the event the Actively at Work/Hospital Confinement Provision is waived in the Qualification of <br />the Offer, it is the intent of this Treaty to waive the Actively at Work/Hospital Confmement <br />provision to the extent that Covered Persons are Actively at Life. Actively at Life means that a <br />Covered Person is able to perform the same lifestyle functions of a person of similar age and sex <br />who is in good health. Covered Persons who cannot meet this Actively at Life requirement on the <br />Treaty effective date are considered disabled persons. Subject to disclosure, a disabled person <br />may be covered if approved in writing, and shown in the Qualification of the Offer. <br /> <br />In the event that application is made to include retired persons and/or persons who have elected <br />COBRA (whether the COBRA election is effective on the Treaty Effective Date or not), such <br />persons are subject to the Actively at Life requirement. <br /> <br />D. Mental-Nervous-Alcohol-Drug Abuse Benefits: <br />Coverage of expenses for the treatment of Mental and Nervous conditions, Alcohol Abuse or Drug <br />Abuse is limited to the lesser of the maximum benefits shown in the Plan or $25,000.00 in excess <br />of the Specific Retention Amount for any Treaty Year. Any payments which exceed $25,000.00 in <br />excess of the Specific Retention Amount are not considered Eligible Expenses for the Aggregate <br />Excess Coverage <br /> <br />7. EXCLUSIONS <br /> <br />This Treaty will not reimburse you for any loss or expense caused by or resulting from any of the <br />following: <br /> <br />I. Expenses incurred while the Plan is not in force with respect to the Covered Person, or for a person <br />not covered under the Plan. <br /> <br />2. Expenses which result from any prescription card service or any pre-paid prescription drug plan, <br />dental, vision, or weekly income benefits, unless specifically indicated on the Application <br />approved by Us. <br /> <br />3. Liability assumed by you under any contract or service agreement other than the Plan. <br /> <br />4. Expenses which are incurred for treatment which violates any statutes or regulation. <br /> <br />5. Expenses which are billed in excess of the usual and customary charge for locality where <br />incurred; or any amount paid which is in excess of the Benefit Plan. <br /> <br />6. Expenses for accidental injury or sickness for which the Covered Person would be entitled to <br />benefits under any Worker's Compensation or Occupational Disease statute or law whether or not <br />such coverage is actually in force. <br /> <br />7. Cost of the administration of claims payments, or other service( s) provided by your Administrator, <br />consulting fees and/or expenses of any litigation. <br /> <br />8. Expenses resulting from the commission of a crime or illegal act. <br /> <br />9. Expenses resulting from and arising out of or caused by or contributed to or in consequence of <br />war, hostilities (whether war be declared or not), invasion, civil war, insurrection or riot. <br /> <br />10. Expenses incurred in connection with suicide or any intentionally self-inflicted injury or illness, <br />whether the Covered Person was sane or insane when he or she committed the act. <br /> <br />II. Expenses as a result of extra-contractual damages, consequential damages or punitive damages. <br /> <br />7 <br />
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