Laserfiche WebLink
INTRODUCTION <br /> This document is a description of City of Decatur(the City of Decatur Group Health Self-Insurance Program Plan). <br /> No oral interpretations can change this Plan.The Plan described is desib ed to protect Pian Participants against <br /> certain catastrophic health expenses. <br /> Coverage under the Plan will take effect for an eligible Employee and desib ated Dependents when the Employee <br /> and such Dependents satisfy all the eligibility requirements of the Plan. <br /> The Employer fully intends to maintain this Plan indefinitely.However, it reserves the right to terminate, suspend, <br /> discontinue or amend the Plan at any time and for any reason. <br /> Changes in the Plan may occur in any or all parts of the Plan including benefit coverage,deductibles, maximums, <br /> exclusions, limitations,definitions,eligibility and the like. <br /> Failure to follow the eligibility or enrollment requirements of this Plan may result in delay of coverage or no <br /> coverage at all. Reimbursement from the Plan can be reduced or denied because of certain provisions in the Plan, <br /> such as coordination of benefits, subrogation,exclusions,timeliness of COBRA elections, utilization review or other <br /> cost management requirements,lack of Medical Necessity, lack of timely filing of claims or lack of coverage.These <br /> provisions are explained in summary fashion in this document;additional information is available from the Plan <br /> Administrator at no extra cost. <br /> The Plan will pay benefits only for the expenses incurred while this coverage is in force.No benefits are payable for <br /> expenses incurred before coverage began or after coverage terminated,even if the expenses were incurred as a result <br /> of an accident,injury or disease that occurred,began, or existed while coverage was in force.An expense for a <br /> service or supply is incurred on the date the service or supply is fumished. <br /> If the Plan is ternunated,amended, or benefits are eliminated, the rights of Covered Persons are limited to Covered <br /> Charges incurred before ternunation, amendment or elimination. <br /> This document summarizes the Plan rights and benefits for covered Employees and their Dependents and is divided <br /> into the following parts: <br /> Eligibility,Funding,Effective Date and Termination.Explains eligibility for coverage under the Plan, funding of <br /> the Plan and when the coverage takes effect and terminates. <br /> Schedule of Benefits.Provides an outline of the Plan reimbursement formulas as well as payment limits on certain <br /> services. <br /> Benefit Descriptions.Explains when the benefit applies and the types of charges covered. <br /> Cost Management Services.Explains the methods used to curb unnecessary and excessive charges. <br /> This part should be read carefully since each Participant is required to take action to assure that the <br /> maximum payment levels under the Plan are paid. <br /> Defined Terms.Detines those Plan terms that have a specific meaning. <br /> Plan Exclusions.Shows what charges are not covered. <br /> Claim Provisions.Explains the rules for filing claims and the claim appeal process. <br /> Coordination of Benefits.Shows the Plan payment order when a person is covered under more than one plan. <br /> Third Party Recovery Provision.Explains the Plan's rights to recover payment of charges when a Covered Person <br /> has a claim against another person because of injuries sustained. <br /> 1 <br />