Reso 98-109 - Laserfiche WebLink

Home Browse Search

Ronda Municipal Insurance Trust Medical Master Plan of Beneflts provided under Section I - Dependent. (5) Coverage of the employee, and spouse and dependents of an employee shall automatically cease upon the employee becoming entitled to the benefits provided under the Title XVIII of the Social Security Act (Medicare). (6) Subject to the provisions of Paragraphs (1) and (2) of Section III, the coverage of any participant shall terminate automatically when the maximum benefits for which such participant is eligible have been paid. Coverage for any remaining family participants shall, unless otherwise terminated in accordance with provisions hereof, continue so long as payment of required contributions is timely made. A certificate of creditable coverage will be issued to all participants whose coverage terminates. The certificate will be sent by First Class Mail to the participant's last known address. In addition, the Trust shall issue a certificate of credible coverage to a participant upon request, for up to 24 months following the end of the participant's coverage under this Plan. Conversion Privilee:e on Termination of Eligibility (1) A participant whose coverage under this Plan is terminated for any reason and who has been validly and continuously covered under this Plan for at least three (3) months immediately prior to such termination shall be entitled to purchase a converted policy. The participant must apply to the Trust for the converted policy in writing and must pay the first premium attributable to the converted policy within thirty-one (31) days of the date of termination, The premium for such policy will be determined with premium rates applicable to the age and class of risk of each participant that is to be covered under the policy and to the type and amount of coverage provided, however, in no event shall such premium exceed 200 percent of the standard risk rate as established by the Florida Comprehensive Health Association, adjusted for differences in benefit levels and structure between the converted policy and the policy offered by the Florida Comprehensive Health Association. The converted policy will be issued without evidence of insurability and will be effective on the day following the termination of coverage under this Plan. (2) A participant is not entitled to a converted policy: (a) If termination is the result of the participant or employer's failure to timely pay a required contribution. (b) If any discontinued coverage under this Plan is replaced by similar group coverage within thirty-one (31) days of the date of termination of this Plan. (c) If the participant is covered or eligible to be covered by Medicare. (d) If the person is covered or eligible to be covered under a group policy or similar benefits are available to the participant under state or federal law, and the coverage or benefits, when combined with the benefits of the converted policy, will result in the participant's overinsurance. (3) The terms and coverage conditions in and benefits provider under the converted policy will be designed to comply with S. 627.6675, F.S., and the terms of S. 627.6675, F.S., shall prevail to the extent of any conflict with the terms of this 'Plan. (4) The converted policy may be issued by an authorized insurer selected by the Trust to provide conversion coverage. · .Unless otherMse stated In the Schedule of Benefits (7/98) Page 27