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Res 2000-130
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7/24/2006 10:25:35 AM
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7/24/2006 10:24:50 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 />3. DEFINITIONS <br /> <br />APPLICATION/SCHEDULE, APPUCATION or SCHEDULE means your Excess Loss Reinsurance <br />Coverage Application! Schedule and the Qualification of the Offer. Application to Us is subject to <br />acceptance by Us, and if approved, "ill become a part of this Treaty. <br /> <br />BENEFIT PLAN (Also called the Plan) means the welfare benefits you have agreed to provide under <br />a plan of benefits for the Covered Units. These benefits are as defined in the written form of such <br />Plan, which is in effect and on file with the Reinsurer as of the Effective Date of your coverage <br />including any amendments to such Plan that are approved pursuant to the pro\isions of this Treaty. <br /> <br />PLAN BENEFITS PAYMENT ON AN INCURRED AND PAID BASIS mean, for a Treaty Year, the <br />total amount of benefits under the Plan to which Covered Units or Covered Persons become entitled <br />under the Plan and are paid pursuant to the Plan, subject to any limitation of this Treaty. Such amount <br />of benefits shall only include the Eligible Expense incurred by Covered Units or Covered Persons on <br />or after the Effective Date and paid (1) within the Treaty Year, or (2) if provided in the Application, <br />within the stated number of months after the expiration date of the current Treaty Year. <br /> <br />PLAN BENEFIT PAYMENTS ON A PAID BASIS mean, for a Treaty Year, the total amount of <br />benefits which are paid pursuant to the Plan for which Covered Units or Covered Persons or are <br />entitled to under the Plan as of the effective date of this Treaty. Subject to any limitations of this <br />Treaty, such amount of benefits shall include only the Eligible Expenses incurred by Covered Units or <br />Covered Persons up to the limits stated on the Application and paid during the Treaty Year. <br /> <br />Whether on an Incurred and Paid Basis or on a Paid Basis as set forth in the Application, such benefits <br />shall not include: Deductibles, co-insurance amount any other expenses or claims which are not <br />reimbursable under the terms of the Plan or expenses which are reimbursable from any other source; <br />or expenses of litigations or administrative costs. An Eligible Expense will be considered to be <br />incurred by the Plan for Covered Units or Covered Persons at the time the service, or the supply to <br />which it relates, is provided. Drafts, checks and wire or other transfer of funds that are honored by the <br />institution upon which the transfer has been drawn are counted as amounts paid. <br /> <br />EXPERIMENTAL means medical practices, procedures, services or supplies which are considered <br />experimental or investigational by ED.A. (Food and Drug, Administration) or AM.A. (American <br />Medical Association) or the Department of Health and Human Services guidelines. The above will <br />not be eligible for deductible accumulation or excess reimbursement under this Treaty. <br /> <br />ELIGffiLE EXPENSES mean the charges which are covered and for which benefits are payable under <br />the Plan. <br /> <br />DATE OF ISSUE means the date of issuance of a claim check or draft because of Eligible Expenses <br />provided that the check or draft has been placed in the U.S. Mail or other means of conveyance to the <br />payee. It is presumed that checks or drafts placed in the mail are payable and "ill clear the bank <br />account within a reasonable amount of time. The issue and placement of a draft or check in the mail is <br />to be done in a standard and consistent manner in accord with the agreement that you have with your <br />Administrator and your Administrator is presumed to be consistent in his daily operation. <br /> <br />COVERED UNIT means an individual employee, an employee with dependents, or such other defined <br />unit as shown by endorsement to this Treaty and which art covered under the Plan. <br /> <br />NUMBER OF COVERED UNITS means the total number of Covered Units existing in anyone <br />Treaty Month. The Number of CO'I.ered Units for the fIrst Treaty Month of the first Treaty Year is <br />shown in the Application. The Number of Covered Units for subsequent Treaty Months and Treaty <br />Years will be determined on a monthly basis in accordance with the definition of Covered Units and <br />with the eligibility requirements of the Plan. <br /> <br />COVERED PERSON means a Covered Unit, or, in the case of a dependent, a member of a Covered <br />Unit. <br /> <br />4 <br />
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