Reso 98-109 - Laserfiche WebLink

Home Browse Search

Ronda Municipal Insurance Trust Medical Master Plan of Benefits Medicare deductible. (3) The Medicare Part B deductible is paid by the Plan at 100% per calendar year. (4) The Medicare Part B coinsurance is paid by the Plan for eligible reasonable fees incurred as determined by Medicare, (5) Prescription Medicines - When ordered by a physician, consistent with the treatment of a specific diagnosis, when dispensed by a licensed pharmacist, and when obtained through the mandatory prescription program provided in Section XVI of this Plan. Vitamins, minerals, and over-the-counter medications are not eligible expenses. Expenses are subject to the individual calendar year deductible and coinsurance as set forth in the former employer's Schedule of Benefits. (6) The Lifetime Maximum for all Medicare Supplement benefits is $1,000,000. Alcohol and Drue: Dependency Benefit - As used in this Section "alcoholic" means a participant who chronically and habitually uses alcoholic beverages to the extent that it injures his/her health, substantially interferes with his/her social or economic functioning, or to the extent that he/she has lost the power of self- control with respect to the use of such beverages. As used in this Section "drug dependent" means a participant who is dependent upon, or by reason of repeated use is in eminent danger of becoming dependent upon, any substance controlled under Ch. 893, F.S. The reasonable fees incurred as a result of the necessary care and treatment of an alcoholic or a drug dependent shall be covered, subject to the following terms, conditions and limitations: (1) Care and treatment must be provided by, provided under the supervision of, or prescribed by a state licensed physician or psychologist; (2) Care and treatment must be pursuant to a program accredited by the Joint Commission on Accreditation of Hospitals or approved by the State of Florida; (3). Benefits are limited to coverage stated on the Schedule of Benefits, with a $4,000 lifetime maximum; (4) Detoxification will not be considered a benefit under an outpatient program. Midwifery and Birth Center Benefit - The reasonable fees for midwifery services performed by a Certified Nurse Midwife or midwife and the reasonable fees incurred by a Birth Center for services and supplies furnished to a participant for prenatal care, delivery and postpartum care rendered within twenty-four (24) hours of delivery shall be covered, subject to all Plan provisions, deductibles, and coinsurance; provided, however, dependent children shall not be entitled to this benefit. Hospice Care Benefit - A participant will be eligible for hospice care benefits under this Plan if written approval is provided in advance by the Trust. The Trust will not provide written approval unless a written statement is submitted to the Trust by the Hospic; Care Agency and the attending physician outlining: (l) and attesting that the patient is terminally ill, (2) and attesting that the patient has a life expectancy of six (6) months or less,