Reso 98-109 - Laserfiche WebLink

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Flonda Municipal Insurance Trust Medical Master Plan of Beneflts accompany the employee's supplemental application for 'coverage for such child. As a condition of continued coverage, the employee shall immediately provide the Trust with a certified copy of the judgment of adoption upon its entry and the employee shall, upon request, provide to the Trust, under oath, such information as is reasonably necessary to keep the Trust apprised of the stage of the adoption proceeding. @ In the event of an adoption or placement for adoption (other than newborn), legal guardianship or court order, the effective date of coverage shall be from the date of the child's placement in the employee's residence or date specified by court order. If application is not received within thirty (30) days of the effective date, the Trust reserves the right to charge an additional premium for coverage of such child(ren) from the effective date to the date of receipt of application. As a condition of coverage, the employee shall provide the Trust with a certified copy of the judgment of adoption, guardianship or court order. (d) Pre-existing limitations will apply, as outlined in Section X. (4) Those eligible employees who refuse coverage for themselves or their eligible dependents under this Plan, those employees applying for coverage, including dependent coverage, under this Plan subsequent to the effective date of the Participation Agreement of the employer, or those employees and dependents who do not satisfy the coverage provisions specified in Paragraphs (1), (2), and (3) of this Section may apply for coverage at a later date by medical statement application. Such employee, on behalf of himself/herself or his/her dependents, shall provide the Trust with a completed medical statement application and such applicants shall be subject to the applicable rules and regulations of the Trust. The Trust will review all medical statement applications and provide the eligible employee's employer with a notice of acceptance or notice of rejection. If accepted, the effective date of coverage for such applicant shall be the frrst day of the month following the receipt of notice of such acceptance. Pre-existing limitations will apply, as outlined in Section X. The employer shall submit such form and any required medical statement application, together-with any contribution due to the Trust, as a prerequisite to the coverage of such employee or dependent under this Plan. Certificates of creditable coverage, as specified in Section X, should be provided at the time an application for enrollment is made by the eligible employee and their eligible dependents. The employer does not act as an agent of the Trust in the enrollment and withdrawal of its employees and their eligible dependents. Notwithstanding, and in addition to, any other conditions expressed herein for coverage or payment of benefits and services, coverage for each employee and eligible dependents under this Plan shall commence no earlier than the first day of the month immediately following the date on which the Trust has actually received a properly and accurately completed and executed enrollment form and any required medical statement application and the contribution attributable to the particular employee and eligible dependents. a 6.1_1___ _....---..1.__ ___... 1_ ...._ r_....-A..I.. A' RAftAflh 17 IQA\ Page 11