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Reso 98-109
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Reso 98-109
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Last modified
7/2/2024 11:41:11 AM
Creation date
1/25/2006 1:56:19 PM
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CityClerk-Resolutions
Resolution Type
Resolution
Resolution Number
98-109
Date (mm/dd/yyyy)
12/17/1998
Description
Agmt w/Florida Municipal Insurance Trust for Employee Insurances
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<br />Ronda Municipal Insurance Trust <br /> <br />Medical Master Plan of Benefits <br /> <br />(41) Services or supplies for injuries sustained or sickness contracted while in <br />any military force of any country while such country is engaged in war or <br />hostilities (whether or not declared), or while performing police duty as a <br />member of any military organization. <br /> <br />(42) Services or supplies for injury or illness that results from deliberately and <br />voluntarily undertaking activities that subject the participant to unnecessary <br />exposure to danger or unnecessary exposure to obvious risk of injury. This <br />exclusion shall not apply to services or supplies for injury or illness resulting <br />from the participant's participation in sponsored sporting events or <br />traditional recreational activities. <br /> <br />(43) Services or supplies for complications, which result from or arise out of the <br />provision of services or supplies that are excluded under this Section. <br /> <br />(44) Fees in excess of the percentage specified in the Schedule of Benefits, or in <br />excess of reasonable fees. <br /> <br />Benefits payable under this Plan will be limited to services provided and expenses <br />incurred within the continental United States. Any expenses incurred by a <br />participant outside the continental United States will be subject to approval by the <br />Trust. <br /> <br />SECTION IX - COORDINATION OF BENEFITS <br /> <br />The purpose of health care coverage is to help meet actual expenses. In line with that <br />purpose, this Plan contains a non-profit provision coordinating it with other plans, <br />including group plans under which a participant is covered, so that the total benefits <br />available will not exceed 100% of the allowable expenses. <br /> <br />Primary Coverage - A plan without a coordinating provision is always the primary <br />plan. . If all plans have this provision: <br /> <br />(1) !he plan covering the person as an employee rather than as a dependent is <br />primary; <br /> <br />(2) the plan covering the person as an active employee or as a dependent of an <br />active employee rather than Medicare is primary; <br /> <br />(3) if a child is covered under both parents' plans, the plan for the parent with <br />the earliest birthdate in the calendar year is primary; <br /> <br />(4) if a dependent child is covered under both parents' plans, and both parents <br />have the same birthday, the plan which has covered the parent for a longer <br />period of time is primary; <br /> <br />(5) if a dependent child is covered under both parents' plans, and the parents <br />are divorced or separated, the primary plan will be determined in the <br />following ord~r: <br /> <br />· First, the plan of the parent with custody of the child; <br />· Secbnd, the plan of the spouse of the parent with the custody of the child; <br />and <br />· Third, the plan of the parent not having custody of the child; <br />
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