Reso 98-109 - Laserfiche WebLink

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Rorlda Municipal Insurance Trust Medical Master Plan of Benefits (1) lnitial eligibility period - within 30 days of satisfaction of the Plan waiting period. (a) New employees, and their eligible dependents, except totally disabled dependents and dependents exposed to the HIV infection or a specific sickness or medical condition derived from such exposure, shall be eligible to participate in this Plan without proof of insurability, and shall commence on the first billing date following the eligibility requirements set forth above. If the enrollment form is not received on or before the expiration of the period set forth above, any application for coverage by a new employee or their dependents will be governed by the provisions set forth in Paragraph (4) of this section. (b) Except as otherwise provided in Commencement of Coverage Paragraph (2), in the event an employee or eligible dependent is hospital confmed, totally disabled or otherwise disabled when coverage would otherwise begin, coverage will begin the billing date of the month following the employee or dependent's return to good health when able to perform the normal activities of a well person of the same age and sex. This subsection does not apply to a newborn child of an employee covered for dependent coverage at the time of birth. (c) In the event an employee's coverage terminates due to termination of employment and such employee returns to full-time employment within ninety (90) days, such employee's coverage may be reinstated without completing the period of continuous employment set forth in the Employer's Participation Agreement, provided an enrollment form is received by the Trust within thirty (30) days of the employee's return to employment. If the enrollment form is received more than thirty (30) days after the employee's return to employment, any application for coverage will be governed by the provisions set forth in Paragraph (4) of this section. (d) In the event an employee was covered under this Plan through another employer within thirty (30) days prior to beginning employment with this employer, such employee will not be required to complete the period of continuous employment set forth in the Employer's Participation Agreement, provided an enrollment form is received by the Trust within thirty (30) days of beginning employment with this employer. Required contributions must be paid at the new employer's rates from the prior billing date for reinstatement of continuous coverage. If the enrollment form is received more than thirty (30) days after the employee's return to employment, any application for coverage will be governed by the provisions set forth in Paragraph (4) of this section. (e) Pre-existing limitations will apply, as outlined in Section X. (2) Open enrollment period - within 30 days of the Plan's policy renewal anniversary. Eligible employees can enroll in the Plan or terminate coverage during the open enrollment period. Pre-existing limitations will apply, as outlined in Section X, If application is received 30 days or more following the Plan's policy renewal anniversary, any application for coverage by an employee or eligible dependents will be governed by the provisions set forth in Paragraph (4) of this section. ..,'............_......~~,l~. ..._..~....~<..L. -, I' ,t." .....,. ._ .__