Reso 98-109 - Laserfiche WebLink

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Ronda Municipal Insurance Trust Medical Master Plan of Benefits Subject to the provIsIons of this Section for each participant under this Plan, the maximum liability of the Trust to such participant during the entire period such participant is covered hereunder shall be the amount specified in the Schedule of Benefits. (l) If, at any time, benefits totaling at least $1,000 have become payable under this Plan to any participant, the maximum liability of the Trust with respect to such participant during the subsequent period such participant is covered under this Plan may be restored to the amount specified in the Schedule of Benefits upon receipt and approval by the Trust of evidence of such participant's insurability. Such restoration will not be made during a calendar year in which expenses were incurred. Evidence of insurability must be furnished without expense to the Trust. (2) If, during anyone calendar year, more than $1,000 in benefits has become payable on behalf of a participant, said participant shall automatically be entitled to $1,000 in restored benefits commencing with the next succeeding year, regardless of whether the amount in the Schedule of Benefits has been reached. Items (1) and (2) of this Section do not pertain to the specific lifetime maximums of limited benefits. SECTION IV - MAXIMUM EXPENSE TO PARTICIPANTS When the covered expenses of a participant reach the amount specified in the Schedule of Benefits, subject to the coinsurance provisions, all further covered expenses for that calendar year will be paid at 100% of the actual reasonable fees, up to the Lifetime Maximum of the Plan. SECTION V - ELIGIBILITY AND ENROLLMENT Commencement of Coverage - Subject to any waiting period set forth under this Plan and to any other condition of commencement expressed in this Plan, coverage hereunder shall commence as follows: (1) In the event an employer had no group health plan covering its employees and dependents in effect immediately prior to the effective date of this Plan, all employees in the employ of such employer on the effective date of this Plan, and their eligible dependents, except a dependent that is totally disabled or a dependent that has been exposed to the HIV infection or a specific sickness or medical condition derived from such exposure, shall be eligible to participate in this Plan. Coverage shall commence as of the effective date of the Participation Agreement of the employer without proof of insurability provided the Trust receives a properly and accurately completed and executed enrol\ment form and any required medical statement application no later than 30 days following the effective date of the Participation Agreement. If .. Unless otherwise stated In the Schedule of Benefits (7/98) Page 7