Reso 98-109 - Laserfiche WebLink

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Ronda Municipal Insurance Trust Medica' Master Plan of Beneflts following: (1) The maximum coverage period date allowed for the qualifying event; (2) The date on which the employer ceases to provide any group health plan to all employees; (3) As provided in Section XI, if the qualified beneficiary fails to pay contributions within thirty (30) days after they become due; (4) The date the qualified beneficiary becomes covered under another group health plan (as an employee or otherwise) with similar coverage, which does not contain any exclusions or limitations for pre-existing conditions; (5) The date the qualified beneficiary becomes entitled to Medicare benefits; (6) If the coverage period is twenty-nine (29) months and the employee ceases to be totally disabled, on the first day of the month within the coverage period that begins more than eighteen (18) months after the date of termination and is more than thirty (30) days after the date on which the employee ceased to be totally disabled under Title II or XVI of the Social Security Act. However, in no event shall the coverage period extend beyond twenty-nine (29) months from the date of termination. Notwithstanding the above, in no event shall said coverage extend beyond the twenty-nine (29) month coverage period. A certificate of creditable coverage will be issued at the end of the continuation of coverage period. 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. If COBRA is elected and the eighteen (18) or thirty-six (36) months maximum time frame is exhausted, the qualified beneficiary may be eligible for coverage under an individual plan (through an insurer of their choice) on a guaranteed issue basis without any pre-existing condition limitations. In the event the Plan offers a conversion privilege, the qualified beneficiary shall be entitled to said conversion privilege provided the qualified beneficiary applies for such conversion plan during the last 180 days of the period of continuation coverage. Coordination of Benefits with other plans for COBRA recipients will follow current National Association of Insurance Commissioners (NAIC) recommendations. SECTION XVI - PRESCRIPTION DRUGS Coverage is provided for prescription medications prescribed by a physician which are intended for use outside a hospital, skilled nursing facility or treatment facility. Benefits will be paid at the coverage level shown on the Schedule of Benefits. Presenting your prescription identification card each time you request a prescribed medication will ensure that the provider knows that you are part of the plan. A generic prescription drug will be provided unless the prescribing physician specifies a brand name drug. . In addition to the applicable exclusions specified in Section VIII, no coverage is provided for: