Reso 98-109 - Laserfiche WebLink

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Ronda Municipal Insurance Trust Medical Malter Plan of Beneflts the State of Florida for the purpose of insuring a group of individuals; (b) Any plan, program or insurance policy, andjor PIP automobile insurance as required and defined in the Florida Statutes, which provides benefits or makes payments to or on behalf of a participant for hospital, medical andj or other health care expenses; (c) any group contract issued to this Trust; (d) Any coverage under a plan or a law of any federal, state or local government or any political subdivision thereof, including but not limited to, coverage under Medicare, andjor any other federal, state or local government-sponsored program or programs, unless otherwise provided by law; A participant shall have no right to benefits under this Plan if said participant elects to waive any entitlement to benefits provided under any plan described in this paragraph. The participant shall provide, execute and deliver such information, instruments and papers, and do whatever else is necessary to secure the instruments and papers, and the Trust's rights under this paragraph. (31) Expenses that are covered under Parts A and B of Medicare, if the participant is not an active employee or the dependent of an active employee. (32) Treatment andj or drugs received in a veterans hospital or government facility due to a service connected disability. (33) Any service or supplies provided before coverage begins or after coverage terminates, for the group or for the participant, except to the extent and in the manner provided by Florida law and in the manner provided under Sections X, XIII, XIV and xv. (34) Personal comfort articles such as beauty and barber services, radio, and television. (35) All other services or supplies not furnished by a hospital for inpatient andj or . outpatient treatment or specifical.ly listed as covered expenses. (36) Discounts applied to total expenses by health care providers will not be used to satisfy deductibles or coinsurance under this Plan. (37) Any treatment for injury or sickness which a contributing cause was the participant's commission of, or attempt to commit, a felony, or the participant being engaged in any illegal act. (38) Preexisting conditions, except to the extent and in the manner provided in Section X. (39) Services or supplies for any occupational condition, ailment or injury arising out of or in the course of employment for wage or profit or any other endeavor for potential profit or gain, or services which are furnished to a participant under the laws of the United States or any state or political subdivision thereof, for which the participant shal.l have no right under this Plan, even though the participant elects to waive that right to such benefits or service. (40) Services or supplies for injury or illness resulting from suicide or attempted suicide, self-inflicted injury or self-induced illness, whether sane or insane. This includes participation in and/ or incitement of an altercation.