Reso 98-109 - Laserfiche WebLink

Home Browse Search

Rorlda Municipal Insurance Trust Medical Master Plan of Benefits Service Provider means a state licensed person or organization providing services deemed to be covered expenses under this Plan. Sickness means a bodily disorder, illness, or infirmity, which has been or is diagnosed by a physician. Skilled Nursinll Facility means a state licensed institution which provides '24 hour nursing care for a patient whose condition does not warrant hospitalization and has been approved for payment by the Trust. The facility can operate independently or as part of a hospital. Total Disability means a medically determinable physical or mental impairment which renders a participant so incapacitated as to be unable to engage in any gainful occupation, within the range of hisJher normal ability, and taking into consideration education, training and work experience. Trust means the Florida Municipal Insurance Trust, its Trustees and individuals or organizations designated by the Trustees to act on their behalf. SECTION II - DEDUCTIBLES Individual Deductible - In the event the participant shall incur expenses for covered medical services on or after their effective date of coverage, benefits will be provided as follows for such expenses (except for any amount in excess of the reasonable fee). Such expenses shall be subject to a deductible applicable under this Plan, and as set forth in the Schedule of Benefits, for each covered participant during each calendar year. FamUy Deductible - All covered participants within a family shall be subject to the maximum accumulative deductible as set forth in the Schedule of Benefits during each calendar year. - Deductible credit from employer's prior coverage - In the event a participant has incurred and paid covered expenses during a calendar year under any other group health insurance plan issued to the employer which was in effect immediately prior to the participant's coverage under this Plan, then the amount of such covered and paid expenses shall be credited toward the participant's deductible under this Plan for that calendar year. SECTION III - LIFETIME MAXIMUM AND RESTORATION OF BENEFITS Each participant' is entitled to the services listed below when incurred while the Plan is in force and when necessary and consistent with the accident or sickness for which the participant is being treated.