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<br />') <br /> <br />AvMED <br /> <br />AVMED, INC. d/b/a AVMED Health Plans <br />Group Medical and Hospital Service Contract <br />Group Master Application <br /> <br />Contract Number(s): <br />Subscribing Group Name: <br />Effective Date: <br /> <br />108498 <br /> <br />City of Sunny Isles Beach <br />03/01/10 <br /> <br />Group Contract <br /> <br />q <br /> <br />This Group Contract prl?vides the benefits listed below: <br /> <br />Identifier <br />AV-OPEN ACCESS-HMO-25/1000/2000-09 <br />AV-Open Acess-09 <br />AV-Deductible/Co-insurance Amendment-09 <br />A V -LG-RX-2x-l 0/20/30/75/50%-OC-B-09 <br />AV-Gl00-MHPH-09 <br />AV-G1 00-SAPH-09 <br />AV-Gl00-ETP-R-97 <br />AV-Mammogram-05 <br /> <br />HUALTII PLANS <br /> <br />Descriotion <br />Summary of Benefits <br />Open Access <br />Ded & Co-ins <br />Prescription Drug <br />IP Mental Health <br />Substance Abuse <br />ETOP <br />Mammogram <br /> <br />Eliaibilitv <br /> <br />Active Employees (Class 1) are required to work 25 hours per week to become eligible for coverage under this Contract. <br />Employees will become eligible for coverage on the first of the month following the first day of employment. <br /> <br />Management Employees (Class 1) are required to work 25 hours per week to become eligible for coverage under this <br />Contract. Employees will become eligible for coverage on the first of the month following the first day of employment. <br /> <br />Termination <br /> <br />For Active Employees (Class 1), termination of coverage under this Contract shall become effective End of Month. <br /> <br />For Management Employees (Class 1), termination of coverage under this Contract shall become effective End of Month. <br /> <br />Monthlv MembershiD Charaes <br /> <br />Subscriber Only... <br /> <br />Subscriber plus Spouse.. <br /> <br />Subscriber plus One Dependent (No Spouse) ... <br /> <br />Subscriber plus Two or More Dependents ..... <br /> <br />Subscriber plus Spouse and One or More Dependents .. <br /> <br />AV-Masler Application-O? <br />MP-202? WOll <br /> <br />$406.37 <br /> <br />$902.15 <br /> <br />$759.80 <br />$75980 <br />$1,149.79 <br />