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GROUP POLICY - OPTIONS PPO CERTICATE OF COVERAGE .of UNITED HEALTH CARE INSURANCE COMPANY P.O. Box 150450450 Columbus Blvd. Hartford, CT 06115-0450 Call 1-800-526-2414 to obtain information about coverage or for assistance in resolving complaints. A STOCK COMPANY ENROLLING GROUP POLICY NUMBER EFFECTIVE DATE ANNIVERSARY DATE City of Clearwater 82403 January 1, 2002 January 1, 2003 GROUP POLICY ("Policy") This Policy is issued to the Enrolling Group by United HealthCare Insurance Company ("Company") for the purpose of describing the terms and conditions for coverage of Health Services. The Policy includes the Certificate of Coverage ("Certificate") attached as Attachment A. In the event of any conflict between the body of the Policy and the Certificate, the body of the Policy shall govern. Note.: . Coverage under the Policy is subiect to an annual deductible prOVISIOn. The Company has, by its President and Secretary, executed this Policy at its principal office in Hartford, Connecticut. UNITED HEALTHCARE INSURANCE COMPANY UNITED HEAL THCARE INSURANCE CaMP ANY J-.LA/3/ ??1~.!t""rJ Ronald B. Colby, President and CEO Matthew L. Friedman, Secretary AN ACCIDENT AND HEALTH INSURANCE POLICY Contact Customer Service at 1-800-526-2414 for benefit inquiries or to file a complaint FLCGrp30I(l/97)(Rev 12/98) l~D United Healthcare Insurance Company Policy Number 82403 Approved as to form: cc. 1- CITY OF CLEARWATER, FLORIDA By: ~~.~.,...~ IlIiam B. Horne II City Manager Attest: . ~ the grace period extend beyond the date the Policy terminates. The Emolling Group shall remain liable to the Company for the payment of Premium due for any period in which the Policy is in force. This Policy shall automatically terminate retroactive to the last paid date of Coverage if the grace period expires and any Premium remains unpaid, or if Company receives written notice of termination from the Emolling Group during the grace period. ARTICLE 4 - ENROLLMENT AND ELIGIBILITY 4.1 Initial Eligibility Period. Eligible Persons and their Dependents may emoll in Company during their Initial Eligibility Period (within 31 days of the date they first become Eligible Persons or Dependents). The Eligible Employee must submit a signed and accurately completed emollment form. Eligible Employees who fail to emoll during the Initial Eligibility Period shall be considered late emollees and must provide proof of good health. Late emollments under this Policy must be accepted in writing by the Company in order to be effective. 4.2 Eligibility Conditions. Eligibility conditions, in addition to those specified in Section 2 of the Certificate, are listed in Attachment B. 4.3 Effective Date of Policy. This Policy becomes effective on the effective date shown above at 12:01 a.m standard time at the Emolling Group's address and may be continued in effect by the timely payment of Premiums when due at such rates as may be determined by the Company in accordance with Article 3. 4.4 Anniversary Date of Policy. The first anniversary of this Policy shall be the anniversary date shown above. Subsequent anniversaries shall be the same date each year thereafter. A first policy year is determined from the effective date. Subsequent anniversaries are determined from the anniversary date of this Policy. 4.5 Effective Date of Coverage. Coverage for properly emolled Eligible Employees and their Dependents shall begin on the date specified in Attachment B. ARTICLE 5 - POLICY TERMINATION 5.1 Termination of this Policy by the Enrolling Group. The Emolling Group may terminate this Policy as of any Premium due date giving the Company at least 31 days prior written notice. 5.2 Termination of This Policy by the Company. This Policy and all Coverage under this Policy shall automatically terminate on the earliest of the dates specified below: A. As of any Premium due date if the Emolling Group has not paid the required Premium by the end of the grace period. B. On the date specified by the Company, after at least 90 days prior written notice to the Emolling Group and participants that this Policy shall be terminated because the Company will no longer issue this particular type of group health benefit plan within the applicable market. C. On the date specified by the Company, after at least 180 days prior written notice to the applicable state authority, the Emolling Group and participants that this Policy shall be terminated because the Company will no longer issue any employer health benefit plan within the applicable market. D. On the effective date of the Coverage, if the Emolling Group has performed an act or practice that constitutes fraud or made a material misrepresentation of material fact under the terms of this Policy. E. On the date specified by the Company, when the membership of an employer in a bona fide association, on the basis of which coverage is provided, ceases. 5.3 Non-renewal of the Policy by the Company. The Company guarantees the Emolling Group the right to renew this Policy each year, at the Emolling Group's option. However, the Company may refuse to renew this Policy and all Coverage provided under this Policy if the Emolling Group has failed to comply with a material provision of the Company which relates to rules for contributions or group participation. FLCGrp301 (l/97)(Rev 12/98) 3 :VI ; administrator or named fiduciary of the welfare plan, other than as specifically identified by the plan sponsor of the welfare plan, as those terms are used in ERlSA. 6.8 Clerical Error. Clerical error shall not deprive any individual of coverage under this Policy or create a right to additional benefits. Failure by the Enrolling Group to report the termination of coverage shall not continue such coverage beyond the date it is scheduled to terminate according to the terms of this Policy. Upon discovery of a clerical error, any necessary appropriate adjustment in Premiums shall be made. However, no such adjustment in Premiums or coverage shall be granted by Company to the Enrolling Group for more than 60 days of coverage prior to the date Company received notification of such clerical error. 6.9 Workers' Compensation Not Affected. The coverage provided under this Policy does not substitute for and does not affect any requirements for coverage by Workers' Compensation Insurance. 6.10 Conformity with Statutes. Any provision of this Policy which, on its effective date, is in conflict with the requirements of proper statutes or regulations of the jurisdiction in which it is delivered is hereby amended to conform to the minimum requirements of such statutes and regulations. 6.11 Notice. Written notice given by Company to an authorized representative of the Enrolling Group shall be deemed notice to all affected Covered Persons in the administration of this Policy, including termination of this Policy. The Enrolling Group shall be responsible for conveying such notices to Covered Persons. 6.12 Certification of Coverage Forms. As required by Florida law, the Company will produce Certification of Coverage forms for Covered Persons who lose Coverage under the Policy on or after the effective date of the Policy. The Enrolling Group agrees to provide all necessary eligibility and termination data that the Enrolling Group provides to the Company's eligibility systems in accordance with the Company's data specifications, and which is available in the Company's eligibility systems as of the date the form is generated. The Certification of Coverage forms will only include periods of Coverage that the Company administers under this Policy. FLCGI1J301(l/97)(Rev 12/98) 5 (.)Ill .. ~ ATTACHMENT B ELIGIBILITY AND EFFECTIVE DATE OF COVERAGE Board of Directors Other: l None 4.5 Effective Date of Coverage. Coverage for properly enrolled Eligible Persons and their Dependents shall begin on: _ The day following the last day of the required waiting period. l The fIrst day of the month following the month in which the waiting period was completed. _ The date the employee was hired. FLCGrp301 (1/97)(Rev 12/98) 7 197716 - 01/09/2002 ')tJ UNITED HEALTHCARE INSURANCE COMPANY UNITED HEAL THCARE OPTIONS PPO CERTIFICATE OF COVERAGE FOR City of Clearwater GROUP NUMBER: 82403 EFFECTIVE DATE: January 1,2002 Offered and Underwritten by United HealthCare Insurance Company UnitedHealthcare@ ~ A UnitedHealth Group Company United HealthCare Insurance Company CERTIFICATE OF COVERAGE This Certificate of Coverage ("Certificate") sets forth your rights and obligations as a Covered Person, It is important that you READ YOUR CERTIFICATE CAREFULLY and familiarize yourself with its terms and conditions. The Policy may require that the Insured contribute to the required Premiums. Information regarding the Premium and any portion of the Premium cost an Insured must pay can be obtained from the Enrolling Group. United HealthCare Insurance Company ("Company") agrees with the Enrolling Group to provide Coverage for Health Services to Covered Persons, subject to the terms, conditions, exclusions and limitations of the Policy. The Policy is issued on the basis of the Enrolling Group's application and payment of the required Policy Charges. The Enrolling Group's application is made a part of the Policy. The Company shall not be deemed or construed as an employer for any purpose with respect to the administration or provision of benefits under the Enrolling Group's benefit plan. The Company shall not be responsible for fulfilling any duties or obligations of an employer with respect to the Enrolling Group's benefit plan. The Policy shall take effect on the date specified and will be continued in force by the timely payment of the required Policy Charges when due, subject to termination of the Policy as provided. All Coverage under the Policy shall begin at 12:01 a.m. and end at 12:00 midnight at the Enrolling Group's address. The Policy is delivered in the State of Florida. UNITED HEALTHCARE INSURANCE CaMP ANY ~13/ Ronald B. Colby, President and CEO This policy certificate contains a deductible Contact Customer Service at 800-526-2414 for benefit inquiries or to file a Complaint 2000-FL-UHI-LG ,4~ Health Services Covered Under the Policy In order for Health Services to be Covered as Network Benefits, you must obtain all Health Services directly from or through a Network provider, with the exception of Emergency Health Services. So that you will not be required to pay bills for non-Covered services, you must always verify the participation status of a Physician, Hospital or other provider. From time to time, the participation status of a provider may change. You can verify the participation status by calling the Company. If necessary, the Company can provide assistance in referring you to Network providers. Only Medically Necessary Health Services are Covered under the Policy. The fact that a Physician has performed or prescribed a procedure or treatment or the fact that it may be the only available treatment for an Injury, Sickness or Mental Illness does not mean that the procedure or treatment is a Covered Health Service under the Policy. The Company has sole and exclusive discretion in interpreting the benefits Covered under the Policy and the other terms, conditions, limitations and exclusions set out in the Policy and in making factual determinations related to the Policy and its benefits. The Company may, from time to time, delegate discretionary authority to other persons or entities providing services in regard to the Policy. The Company reserves the right to change, interpret, modify, withdraw or add benefits or terminate the Policy, in its sole discretion, as permitted by law, without the approval of Covered Persons. No person or entity has any authority to make any oral changes or amendments to the Policy. The Company may, in certain circumstances for purposes of overall cost savings or efficiency and in its . sole discretion, provide Coverage for services which would otherwise not be Covered. The fact that the Company does so in any particular case shall not in any way be deemed to require it to do so in other similar cases. The Company may, in its sole discretion, arrange for various persons or entities to provide administrative services in regard to the Policy, including claims processing and utilization management services. The identity of the service providers and the nature of the services provided may be changed from time to time in the Company's sole discretion and without prior notice to or approval by Covered Persons. You must cooperate with those persons or entities in the performance of their responsibilities. Similarly, the Company may, from time to time, require additional information from you to verify your eligibility or your right to receive Coverage for services under the Policy. You are obligated to provide this information. Failure to provide it may result in Coverage being delayed or denied. Coupons and Incentives At various times the Company may offer coupons or other incentives to encourage your participation in various wellness programs or certain disease management programs. The decision about whether or not you choose to participate is yours alone, but you are encouraged to discuss participating in such programs with your Network Physician and to follow his or her advice. These incentives do not alter or affect the Health Services Covered under the Policy. Contact the Company if you have any questions. Important Note About Services The Company does not provide Health Services or practice medicine. Rather the Company arranges for providers of Health Services to participate in a Network. Network providers are independent practitioners and are not employees of the Company. The Company, therefore, makes payment to Network providers through various types of contractual arrangements. These arrangements may include financial incentives to promote the delivery of health care in a cost efficient and effective manner. Such financial incentives are not intended to impact your access to Health Services. Examples of financial incentives for Network providers are: · Bonuses for individual and/or aggregate performance based on factors which may include quality, member satisfaction, and/or cost effectiveness. 2000-FL-UHI-LG ~ Table of Contents SECTION 1 - DEFINITIONS ..................................................................................................................... 1 SECTION 2 - ENROLLMENT AND EFFECTIVE DATE OF COVERAGE........................................... 7 SECTION 3 - TERMINATION OF COVERAGE .....................................................................................9 SECTION 4 - REIMBURSEMENT..........................................................................................................11 SECTION 5 - COMPLAINT PROCEDURES..........................................................................................13 SECTION 6 - GENERAL PROVISIONS.................................................................................................14 SECTION 7 - COORDINATION OF BENEFITS....................................................................................16 SECTION 8 - SUBROGATION AND REFUND OF EXPENSES ..........................................................20 SECTION 9 - CONTINUATION OF COVERAGE AND CONVERSION............................................. 22 SECTION 10 - PROCEDURES FOR OBTAINING BENEFITS ............................................................25 SECTION 11 - COVERED HEALTH SERVICES ..................................................................................28 SECTION 12 - GENERAL EXCLUSIONS .............................................................................................33 SECTION 13 - SCHEDULE OF BENEFITS ........................................................................................... 37 OUTPATIENT PRESCRIPTION DRUG PRODUCT RIDER ....................................................................43 2000-FL-UHI-LG f(.l "Custodial Care" - services that: A. Are non-health related services, such as assistance in activities of daily living (including but not limited to feeding, dressing, bathing, transferring and ambulating);or B. Are health-related services which do not seek to cure, or which are provided during periods when the medical condition of the patient who requires the service is not changing; or C. Do not require continued administration by trained medical personnel. "Dependent" - (1) the Insured's legal spouse or (2) an unmarried dependent child of the Insured or the Insured's spouse or (3) the newborn child of any covered dependent other than the Insured's spouse (coverage terminates 18 months after the birth of the newborn child). The term "child" includes a natural child, stepchild, a legally adopted child, a child placed for adoption, a foster child, and a child for whom legal guardianship has been awarded to the Insured or the Insured's spouse. The defmition of "Dependent" is subject to the following conditions and limitations: · Dependent includes any unmarried dependent child under 25 years of age. · A Dependent includes an unmarried dependent child who is 25 years of age or older, but less than 25 years of age only if you furnish evidence upon our request, satisfactory to us, of all the following conditions: 1. The child must be primarily dependent upon the Insured for support and maintenance; and 2. The child is living with the Insured, or the child is a full-time or part-time student. The Insured must reimburse Us for any Benefits that We pay for a child at a time when the child did not satisfy these conditions. We may agree with the Enrolling Group to increase these age limits, if it is specified in Article 4 of the Policy and otherwise stated in Section 13, "Schedule of Benefits". The term "Dependent" also includes a child for whom health care coverage is required through a 'Qualified Medical Child Support Order' or other court or administrative order, even if the child does not reside within the Company's geographical area. The Enrolling Group is responsible for determining if an order meets the criteria of a Qualified Medical Child Support Order. The term "Dependent" does not include anyone who is also enrolled as an Insured, nor can anyone be a "Dependent" of more than one Insured. "Designated Facility" - a Hospital, named by the Company as a Designated Facility, which has entered into an agreement with or on behalf of the Company to render Covered Health Services for treatment of specified diseases or conditions. A Designated Facility mayor may not be located within the Covered Person's geographic area. "Durable Medical Equipment" - medical equipment which: (1) can withstand repeated use; (2) is not disposable; (3) is used to serve a medical purpose; (4) is generally not useful to a person in the absence of a Sickness or Injury; and (5) is appropriate for use in the home. "Eligible .Expenses" - Eligible Expenses for Covered Health Services, incurred while the Policy is in effect, are determined as stated below: 1. For Network Benefits: A. When Covered Health Services are received from Network providers, Eligible Expenses are the Company's contracted fee(s) for the Health Service with that provider; B. When Covered Health Services are received from non-Network providers as a result of an Emergency or as otherwise arranged by the Company, Eligible Expenses are the fee(s) negotiated between the Company and the non-Network provider. 2. For Non-Network Benefits: 2000-FL-UHI-LG 2 "Health Services" - the health care services and supplies Covered under the Policy, except to the extent that such health care services and supplies are limited or excluded. "Home Health Agency" - a program or entity which is (1) engaged in providing health care services in the home; and (2) authorized as required by the law of jurisdiction in which treatment is received. "Hospice Care" - an integrated program of palliative and support services provided through a properly licensed or accredited hospice agency to terminally ill Covered Persons. Hospice Care may include physical, psychological, social and spiritual care, and short-term bereavement counseling for immediate family members of the Covered Person. "Hospital" - an institution, operated as required by law, which: (1) is primarily engaged in providing Health Services on an inpatient basis for the care and treatment of injured or sick individuals through medical, diagnostic and surgical facilities by or under the supervision of a staff of Physicians; (2) has 24 hour nursing services; and (3) is accredited as a Hospital by the Joint Commission on Accreditation of Healthcare Organizations or by the American Osteopathic Hospital Association. A Hospital is not primarily a place for rest, custodial care or care of the aged and is not a nursing home, convalescent home or similar institution. "Initial Eligibility Period" - the initial period of time, determined by the Company and the Enrolling Group, during which Eligible Persons may enroll themselves and Dependents under the Policy. "Injury" - bodily damage other than Sickness, including all related conditions and recurrent symptoms. "Inpatient Rehabilitation Facility" - a Hospital or a special unit of a Hospital designated as an Inpatient Rehabilitation Facility which provides rehabilitation Health Services (physical therapy, occupational therapy and/or speech therapy) on an inpatient basis as permitted by the law of jurisdiction in which treatment is received. "Insured" - an Eligible Person who is properly enrolled for Coverage under the Policy. The Insured is the person (who is not a Dependent) on whose behalf the Policy is issued to the Enrolling Group. "Maximum Policy Benefit" - the maximum amount paid for Non-Network Benefits Network and Non- Network Benefits during the entire period of time that the Covered Person is Covered under the Policy or any Policy, issued by the Company to the Enrolling Group, that replaces the Policy. The Maximum Policy Benefit is stated in Section 13, Schedule of Benefits. "Medically Necessary" - health care services and supplies which meet each of the following criteria: A. It is supported by national medical standards of practice; B. It is consistent with conclusions of prevailing medical research that: 1. Demonstrate that the health service has a beneficial effect on health outcomes; and 2. Is based on trials that meet either of the following designs: a. Well-conducted randomized controlled trials. (Two or more treatments are compared to each other, and the patient is not allowed to choose which treatment is received.) b. Well-conducted cohort studies. (Patients who receive study treatment are compared to a group of patients who receive standard therapy. The comparison group must be nearly identical to the study treatment group.) C. It is a cost-effective method and yields a similar or better outcome to other available alternatives. D. It is a health care service or supply described in Section II as a Covered Health Service, which is not excluded under Section 12. All new teclmologies, procedures and treatments are decided based upon the language in B.2 above. "Medicare" - Parts A, B and C of the insurance program established by Title XVIII, United States Social Security Act, as amended by 42 U.S.C. Sections 1394, et seq. and as later amended. 2000-FL-UHI-LG 4 0:) "Pregnancy" - includes prenatal and postnatal care, childbirth, and any complications associated with Pregnancy. "Premium" - the periodic fee required for each Insured and each Emolled Dependent in accordance with the terms of the Policy. "Reconstructive Surgery" - surgery which is incidental to an Injury, Sickness or Congenital Anomaly when the primary purpose is to improve physiological functioning of the involved part of the body. The fact that physical appearance may change or improve as a result of Reconstructive Surgery does not classify such surgery as cosmetic when a physical impairment exists, and the surgery restores or improves function. "Rider" - any attached description of Health Services Covered under the Policy. Health Services provided by a Rider may be subject to payment of additional Premiums. Riders are effective only when signed by the Company and are subject to all conditions, limitations and exclusions of the Policy except for those that are specifically amended. "Semi-private Room" - a room with 2 or more beds. The difference in cost between a Semi-private Room and a private room is Covered only when a private room is Medically Necessary or when a Semi-private Room is not available. "Sickness" - physical illness, disease or Pregnancy. The term "Sickness" as used in this Certificate does not include Mental Illness or substance abuse, regardless of the cause or origin of the Mental Illness or substance abuse. "Skilled Care Services" - skilled nursing, skilled teaching, and skilled rehabilitation services which meet all of the following criteria: A. Must be delivered or supervised by licensed technical or professional medical personnel in order to obtain the specified medical outcome, and provide for the safety ofthe patient; B. Are ordered by a Physician; and C. Are not Custodial Care. Determination of Benefits for Skilled Care Services is made based on both the skilled nature of the service and the need for Physician-directed medical management. A service will not be determined to be "skilled" simply because there is not an available caregiver. "Skilled Nursing Facility" - a Hospital or nursing facility which is licensed and operated in accordance with the law of jurisdiction inwhich treatment is received. "Sound Natural Tooth" - a virgin or umestored tooth, or a tooth which has no decay, no filling on more than two surfaces, no gum disease associated with bone loss, no root canal therapy, is not a dental implant, and functions normally in chewing and speech. "Substance Abuse Services" - services and supplies Covered under the Policy for the diagnosis and treatment of alcoholism and substance abuse disorders which are listed in the current Diagnostic and Statistical Manual of the American Psychiatric Association, unless specifically excluded from Coverage under the Policy. The fact that a disorder is listed in the Diagnostic and Statistical Manual of the American Psychiatric Association does not mean that treatment of the disorder is Covered. "Total Disability" or "Totally Disabled" - an Insured's inability to perform all of the substantial and material duties of his or her regular employment or occupation; and a Dependent's inability to perform the normal activities of a person oflike age and sex. "Urgent Care Center" - a non-Hospital-based facility which provides Health Services which are required in order to prevent serious deterioration of a Covered Person's health and that are required as a result of an unforeseen Sickness, Injury, or onset of threatening symptoms. 2000-FL-UHI-LG 6 (',() conditions are met: (a) The Eligible Person and/or Dependent had existing health coverage under another plan at the time of the Initial Eligibility Period or Open Enrollment Period; and (b) Coverage under the prior plan was terminated as a result of loss of eligibility (including, without limitation, legal separation, divorce or death), termination of employer contributions, or in the case of COBRA continuation coverage, the coverage was exhausted. A special enrollment period is not available if coverage under the prior plan was tenninated for cause or as a result of failure to pay premiums on a timely basis. Coverage under the Policy is effective only if the Company receives any required Premium and a properly completed enrollment form within 31 days of the date coverage under the prior plan terminated. A special enrollment period is also available for an Eligible Person and for any Dependent whose status as a Dependent is affected by a marriage, birth, placement for adoption or adoption, as required by federal law. In such cases you must submit the required Premium and a properly completed enrollment form within 31 days. In the case of newborn and adopted dependents, if the Insured fails to enroll the new dependent within the fIrst 31 days, but enrolls the new dependent within 60 days of the event, the Insured will be required to pay an additional premium from the date of birth or placement. If written notice is given within 60 days of the date of birth or placement, Coverage will not be denied for failure to timely or to pre-enroll the dependent. If written notice is not given within 60 days of birth or placement, the newborn or adopted child may be enrolled during the next Open Enrollment Period. 2000-FL-UHI-LG 8 /Y.l year. Failure to provide such satisfactory proof at the request of the Company will result in the termination of the Emolled Dependent's Coverage under the Policy. Section 3.3 Extended Coverage for Total Disability. A temporary extension of Coverage, only for treatment of the condition causing a Total Disability, will be granted to a Covered Person who is Totally Disabled on the date the person's Coverage is terminated. Benefits will be Covered until (a) the Total Disability ends; (b) twelve months from the date of Total Disability; or (c) the date the maximum benefits available under the Policy have been provided, whichever occurs first. Such benefits are subject to the terms and conditions of the Policy. Section 3.4 Extended Coverage for Pregnancy. If a Covered Person is pregnant on the date the person's Coverage terminates, benefits for the pregnancy will be extended to Cover Eligible Expenses related directly to the pregnancy. Such benefits will be extended until the pregnancy ends, regardless of whether the group policyholder or other entity secures replacement coverage from a new insurer or foregoes the provision of coverage unless coverage by the succeeding plan is required by statute. Section 3.5 Payment and Reimbursement Upon Termination. Termination of Coverage shall not affect any request for reimbursement of Eligible Expenses for Health Services rendered prior to the effective date of termination. Your request for reimbursement must be furnished as required in Section 4. 2000-FL-UHI-LG 10 IX1 The Insured is responsible for the recovery of excess Copayments. The Insured must notify the Company in writing that excess Copayments have been paid no later than 90 days after the end of the calendar year. This notification must include proof satisfactory to the Company of the payment of Copayments. Section 4.5 Limitation of Action for Reimbursement. You do not have the right to bring any legal proceeding or action against the Company to recover reimbursement until 60 days after you have properly submitted a request for reimbursement, as described above. If you bring such legal proceedings or actions against the Company after the expiration of the applicable statute of limitations from the time written proof ofloss is required to be given, you forfeit your rights to bring any action against the Company. 2000-FL-UHI-LG 12 00 SECTION 6 - GENERAL PROVISIONS Section 6.1 Entire Policy. The Policy issued to the Enrolling Group, including the Certificate of Coverage as Attachment A, the Enrolling Group's application, Amendments and Riders, constitute the entire Policy. All statements made by the Enrolling Group or by an Insured shall, in the absence of fraud, be deemed representations and not warranties. Section 6.2 Limitation of Action. You do not have the right to bring any legal proceeding or action against the Company without first completing the complaint procedure specified in Section 5. If you bring such legal proceedings or actions against the Company after the expiration of the applicable statute of limitations from the time written proof of loss is required to be given, you forfeit your rights to bring any action against the company. The only exception to this limitation of action is that reimbursement of Eligible Expenses, as set forth in Section 4 of this Certificate, is subject to the limitation of action provision of that section. Section 6.3 Time Limit on Certain Defenses. No statement, except a fraudulent statement, made by the Enrolling Group shall be used to void the Policy after it has been in force for a period of two years. Section 6.4 Amendments and Alterations. Amendments to the Policy are effective upon 31 days written notice to the Enrolling Group. Riders are effective on the date specified by the Company. No change will be made to the Policy unless it is made by an Amendment or a Rider which is signed by an officer of the Company. No agent has authority to change the Policy or to waive any of its provisions. Section 6.5 Relationship Between Parties. The relationships between the Company and Network providers and relationships between the Company and Enrolling Groups, are solely contractual relationships between independent contractors. Network providers and Enrolling Groups are not agents or employees of the Company, nor is the Company or any employee of the Company an agent or employee of Network providers or Enrolling Groups. The relationship between a Network provider and any Covered Person is that of provider and patient. The Network provider is solely responsible for the services provided to any Covered Person. The relationship between the Enrolling Group and Covered Persons is that of employer and employee, Dependent or other Coverage classification as defined in the Policy. The Enrolling Group is solely responsible for enrollment and Coverage classification changes (including termination of a Covered Person's Coverage through the Company), for the timely payment of the Policy Charge to the Company, and for notifying Covered Persons of the termination of the Policy. Section 6.6 Records. You must furnish the Company with all information and proofs which it may reasonably require regarding any matters pertaining to the Policy. By accepting Coverage under the Policy, you authorize and direct any person or institution that has provided services to you, to furnish the Company any and all information and records or copies of records relating to the services provided to you. The Company has the right to request this information at any reasonable time. This applies to all Covered Persons, including Enrolled Dependents whether or not they have signed the Insured's enrollment form. The Company agrees that such information and records will be considered confidential. The Company has the right to release any and all records concerning health care services which are necessary to implement and administer the terms of the Policy or for appropriate medical review or quality assessment. The Company or its Network providers are permitted to charge you reasonable fees to cover costs for completing requested medical abstracts or forms which you have requested. In some cases, the Company will designate other persons or entities to request records or information from or related to you and to release those records as necessary. The Company's designees have the same rights to this information as does the Company. 2000-FL-UHI-LG 14 ./.fIJ SECTION 7 - COORDINATION OF BENEFITS Section 7.1 Coordination of Benefits Applicability. This coordination of benefits (COB) provIsIon applies when a person has health care coverage under more than one Coverage Plan. "Coverage Plan" is defmed below. The order of benefit determination rules below determine which Coverage Plan will pay as the primary Coverage Plan. The primary Coverage Plan that pays first pays without regard to the possibility that another Coverage Plan may cover some expenses. A secondary Coverage Plan pays after the primary Coverage Plan and may reduce the benefits it pays so that payments from all group Coverage Plans do not exceed 100% of the total allowable expense. Section7.2 Definitions. For purposes of Section 7, terms are defined as follows: A. A "Coverage Plan" is any of the following that provides benefits or services for medical or dental care or treatment. However, if separate contracts are used to provide coordinated coverage for members of a group, the separate contracts are considered parts of the same Coverage Plan and there is no COB among those separate contracts. 1. "Plan" includes: group insurance, closed panel or other forms of group or group-type coverage (whether insured or uninsured); medical care components of group long-term care contracts, such as skilled nursing care; medical benefits under group or individual automobile contracts; and Medicare or other governmental benefits, as permitted by law. 2. "Plan" does not include: individual or family insurance; closed panel or other individual coverage (except for group-type coverage); school accident type coverage; benefits for non- medical components of group long-term care policies; Medicare supplement policies, Medicaid policies and coverage under other governmental plans, unless permitted by law. Each contract for coverage under (1) or (2) is a separate Coverage Plan. If a Coverage Plan has two parts and COB rules apply only to one of the two, each of the parts is treated as a separate Coverage Plan. B. The order of benefit determination rules determine whether this Coverage Plan is a "primary Coverage Plan" or "secondary Coverage Plan" when compared to another Coverage Plan covering the person. When this Coverage Plan is primary, its benefits are determined before those of any other Coverage Plan and without considering any other Coverage Plan's benefits. When this Coverage Plan is secondary, its benefits are determined after those of another Coverage Plan and may be reduced because of the primary Coverage Plan's benefits. C. "Allowable expense" means a health care service or expense, including deductibles and copayments, that is covered at least in part by any of the Coverage Plans covering the person. When a Coverage Plan provides benefits in the form of services, (for example an HMO) the reasonable cash value of each service will be considered an allowable expense and a benefit paid. An expense or service that is not covered by any of the Coverage Plans is not an allowable expense. The following are examples of expenses or services that are not allowable expenses: 1. If a covered person is confined in a private hospital room, the difference between the cost of a semi-private room in the hospital and the private room, (unless the patient's stay in a private hospital room is medically necessary in terms of generally accepted medical practice, or one of the Coverage Plans routinely provides coverage for hospital private rooms) is not an allowable expense. 2. If a person is covered by 2 or more Coverage Plans that compute their benefit payments on the basis of usual and customary fees, any amount in excess of the highest of the usual and customary fees for a specific benefit is not an allowable expense. 2000-FL-UHI-LG 16 11 a. The primary Coverage Plan is the Coverage Plan of the parent whose birthday is earlier in the year if: 1) The parents are married; 2) The parents are not separated (whether or not they ever have been married); or 3) A court decree awards joint custody without specifying that one party has the responsibility to provide health care coverage. Ifboth parents have the same birthday, the Coverage Plan that covered either of the parents longer is primary. b. If the specific terms of a court decree state that one of the parents is responsible for the child's health care expenses or health care coverage and the Coverage Plan of that parent has actual knowledge of those terms, that Coverage Plan is primary. This rule applies to claim determination periods or Coverage Plan years commencing after the Coverage Plan is given notice of the court decree. c. If the parents are not married, or are separated (whether or not they ever have been married) or are divorced, the order of benefits is: 1) The Coverage Plan of the custodial parent; 2) The Coverage Plan of the spouse of the custodial parent; 3) The Coverage Plan of the noncustodial parent; and then 4) The Coverage Plan of the spouse of the noncustodial parent. 3. Active or inactive employee. The Coverage Plan that covers a person as an employee who is neither laid off nor retired is primary. The same would hold true if a person is a dependent of a person covered as a retiree and an employee. If the other Coverage Plan does not have this rule, and if, as a result, the Coverage Plans do not agree on the order of benefits, this rule is ignored. Coverage provided an individual as a retired worker and as a dependent of an actively working spouse will be determined under the rule labeled D(I). 4. Continuation coverage. If a person whose coverage is provided under a right of continuation provided by federal or state law also is covered under another Coverage Plan, the Coverage Plan covering the person as an employee, member, subscriber. or retiree (or as that person's dependent) is primary, and the continuation coverage is secondary. If the other Coverage Plan does not have this rule, and if, as a result, the Coverage Plans do not agree on the order of benefits, this rule is ignored. 5. Longer or shorter length of coverage. The Coverage Plan that covered the person as an employee, member, subscriber or retiree longer is primary. 6. If a husband or wife is covered under this Coverage Plan as an Insured and as a Covered Dependent, the dependent benefits will be coordinated as if they were provided under another Coverage Plan, this means the person's Insured benefit will pay first. Section 7.4 Effect on the Benefits of This Coverage Plan. A. When this Coverage Plan is secondary, it may reduce its benefits so that the total benefits paid or provided by all Coverage Plans during a claim determination period are not more than 100 percent of total allowable expenses. The difference between the benefit payments that this Coverage Plan would have paid had it been the primary Coverage Plan, and the benefit payments that it actually paid or provided shall be recorded as a benefit reserve for the covered person and used by this Coverage Plan to pay any allowable expenses, not otherwise paid during the claim determination period. As each claim is submitted, this Coverage Plan will: 1. Determine its obligation to payor provide benefits under its contract; 2. Determine whether a benefit reserve has been recorded for the covered person; and 2000- FL-UHI - LG 18 .'kJ SECTION 8 - SUBROGATION AND REFUND OF EXPENSES Subrogation is the substitution of one person or entity in the place of another with reference to a lawful claim, demand or right. The Company shall be subrogated to and shall succeed to all rights of recovery, under any legal theory of any type, for the reasonable value of services and benefits provided by the Company to you from: (i) third parties, including any person alleged to have caused you to suffer injuries or damages; (ii) your employer; or (iii) any person or entity obligated to provide benefits or payments to Covered Persons, including benefits or payments for underinsured or uninsured motorist protection (these third parties and persons or entities are collectively referred to as "Third Parties"). You agree to assign to the Company all rights of recovery against Third Parties, to the extent of the reasonable value of services and benefits provided by the Company, plus reasonable costs of collection. Y oushall cooperate with the Company in protecting the Company's legal rights to subrogation and reimbursement, and acknowledge that the Company's rights shall be considered as the first priority claim against Third Parties, to be paid before any other claims by you are paid. You shall do nothing to prejudice the Company's rights under this provision, either before or after the need for services or benefits under the Policy. The Company may, at its option, take necessary and appropriate action to preserve its rights under these subrogation provisions, including filing suit in your name. For the reasonable value of services provided under the Policy, the Company may collect, at its option, amounts from the proceeds of any settlement (whether before or after any determination of liability) or judgment that may be recovered by you or your legal representative, regardless of whether or not you have been fully compensated. You shall hold in trust any proceeds of settlement or judgment for the benefit of the Company under these subrogation provisions and the Company shall be entitled to recover reasonable attorney fees from you incurred in collecting proceeds held by you. You shall not accept any settlement that does not fully compensate or reimburse the Company without the written.approval of the Company. You agree to execute and deliver such documents (including a written confirmation of assignment, and consent to release medical records), and provide such help (including responding to requests for infonnation about any accident or injuries and making court appearances) as may be reasonably requested by the Company. Refund of Overpayments. If the Company pays benefits for expenses incurred on account of a Covered Person, that Covered Person or any other person or organization that was paid must make a refund to the Company if: A. All or some of the expenses were not paid by the Covered Person or did not legally have to be paid by the Covered Person, or B. All or some of the payment made by the Company exceeded the benefits under the Policy. The refund equals the amount the Company paid in excess of the amount it should have paid under the Policy. If the refund is due from another person or organization, the Covered Person agrees to help the Company get the refund when requested. If the Covered Person, or any other person or organization that was paid, does not promptly refund the full amount, the Company may reduce the amount of any future benefits that are payable under the Policy. The Company may also reduce future benefits under any other group benefits plan administered by the Company for the Emolling Group. The reductions will equal the amount of the required refund. The Company may have other rights in addition to the right to reduce future benefits. Reimbursement of Benefits Paid. If the Company pays benefits for expenses incurred on account of a Covered Person, the Insured or any other person or organization that was paid must make a refund to the Company if all or some of the expenses were recovered from or paid by a source other than the Policy as a result of claims against a third party for negligence, wrongful acts or omissions. The refund equals the amount of the recovery or payment, up to the amount the Company paid. 2000-FL-UHI-LG 20 XI SECTION 9 - CONTINUATION OF COVERAGE AND CONVERSION Section 9.1 Continuation Coverage. A Covered Person whose Coverage ends under the Policy may be entitled to elect continuation Coverage in accordance with federal law (under COBRA) and as outlined in Sections 9.2 through 9.4 below. Continuation Coverage under COBRA (Consolidated Omnibus Budget Reconciliation Act) shall apply only to Enrolling Groups which are subject to the provisions of COBRA. Covered Persons should contact the Enrolling Group's plan administrator to determine if he or she is entitled to continue Coverage under COBRA. For the pwpose of continuation Coverage under COBRA, a newborn child of an Insured or a child placed for adoption with the Insured during the period of continuation coverage shall be considered on the same basis as an Insured. Continuation Coverage for Covered Persons who selected continuation coverage under a prior plan which was replaced by Coverage under the Policy shall terminate as scheduled under the prior plan or in accordance with the terminating events set forth in Section 9.4 below, whichever is earlier. In no event shall the Company be obligated to provide continuation Coverage to a Covered Person if the Enrolling Group or its designated plan administrator fails to perform its responsibilities under federal law. These responsibilities include but are not limited to notifying the Covered Person in a timely manner of the right to elect continuation Coverage and notifying the Company in a timely manner of the Covered Person's election of continuation Coverage. It is the Insured's responsibility to notify the Enrolling Group within 60 days of the date an Enrolled Dependent loses eligibility due to divorce or due to an Enrolled Dependent child losing eligibility (i.e. reaching the limiting age or failing to meet the criteria of a Full-time Student.) If you fail to notify the Enrolling Group of these events within the. 60 day period, the Enrolling Group and its designated plan administrator are not obligated to provide continuation Coverage for that Enrolled Dependent. The Company is not the Enrolling Group's designated Plan Administrator and does not assume any responsibilities of a Plan Administrator pursuant to federal law . A Covered Person whose Coverage would otherwise end under the Policy may be entitled to elect continuation Coverage in accordance with federal law, as outlined in Sections 9.2 through 9.4 below. Section 9.2 Qualifying Events for Continuation Coverage Under Federal Law. If the Covered Person's Coverage terminated due to one of the following qualifying events, he or she is entitled to continue Coverage. The Covered Person may elect the same Coverage that he or she had at the time of the qualifying event. A. Termination of the Insured from employment with the Enrolling Group or reduction of hours, for any reason other than gross misconduct; or B. Death of the Insured; or C. Divorce or legal separation of the Insured; or D. Loss of eligibility by an Enrolled Dependent who is a child; or E. Entitlement of the Insured to Medicare benefits; or F. The Enrolling Group filing for bankruptcy, under Title XI, United States Code, on or after July 1, 1986, but only for a retired Insured and his or her Enrolled Dependents. This is also a qualifying event for any retired Insured and his or her Enrolled Dependents if there is a substantial elimination of coverage within one year before or after the date the bankruptcy was filed. Section 9.3 Notification Requirements and Election Period for Continuation Coverage Under Federal Law. The Covered Person must notify the Enrolling Group's designated plan administrator within 60 days of his or her divorce, legal separation or loss of eligibility as an Enrolled Dependent. A Covered 2000-FL-UHI- LG 22 M . Continuation Coverage for Enrolled Dependents of an Insured whose continuation Coverage terminates because the Insured becomes entitled to Medicare may be extended for an additional period of time. Such Covered Persons should contact the Enrolling Group's designated plan administrator for information regarding the continuation period. Section 9.5 Conversion. If your Coverage terminates for one of the reasons described below, you may make application to the Company for coverage under a conversion contract without furnishing evidence of insurability. Reasons for termination: A. The Insured is retired or pensioned; or B. Because you cease to be eligible as an Insured or Enrolled Dependent; or c.' Because continuation Coverage expires; or D. The entire Policy terminates and is not replaced. Application and payment of the initial Premium must be made within 63 days after termination of Coverage under the Policy. A conversion contract shall be issued in accordance with the terms and conditions in effect at the time of application and may be substantially different from Coverage provided under the Policy. Section 9.6 Conversion Exceptions. Conversion is not available if: A. Coverage ended due to Your failure to make timely required Premium payments. B. Any discontinued group coverage is replaced by a succeeding carrier within 31 days. C. The person was not continuously Covered under the Policy (and a prior plan for which the Policy replaced) for a period of at least 3 months, ending with the date of termination. 2000- FL-UHI - LG 24 '1 - When you notify the Company, we can work with you to implement the Care Coordination™ process. We will provide you information about additional services such as disease management programs, health education, pre-admission counseling and patient advocacy. A. Admission to a Hospital, Skilled Nursing Facility or Inpatient Rehabilitation Facility. Notification is not required for an admission for inpatient maternity services related to delivery when Confinement is limited to 48 hours for a mother and newborn for any delivery other than a cesarean section, and 96 hours for a cesarean section delivery. . Notify us five business days before an elective admission, and within one business day or the same day of admission for non-elective admissions. For Emergency admissions,. notify us within one business day or the same day (or as soon as reasonably possible.) . If you don't notify us, Coverage will be reduced as described in 10.2. B. Admission to a Hospital for maternity services that extend beyond the minimum stay requirements listed in Section 11.10 or which are not related to delivery. . Notify us as soon as possible. . If you don't notify us, Coverage will be reduced as described in 10.2. C. Reconstructive Surgery. (Notify us to verify that the service is Reconstructive, rather than a cosmetic procedure. Cosmetic procedures are excluded) . Notify us five business days before receiving services. . If you don't notify us, Coverage will be reduced as described in 10.2. D. Home Health Care Services. .Nursing, physical Therapy, Occupational Therapy, Speech Therapy, Respiratory Therapy, Infusion Service and Hospice. . Notify us five business days before receiving services. . If you don't notify us, Coverage will be reduced as described in 10.2. E. Accident-related dental services. . Notify us five business days before receiving services . If you don't notify us, Coverage will be reduced as described in 10.2. F. Rental or purchase of Durable Medical Equipment that costs more than $1,000 (either purchase price or cumulative rental for a single item.) . Notify us five business days before rental or purchase. . If you don't notify us, you will be responsible for paying all charges and no benefits will be paid. G. Purchase ofa prosthetic that costs more than $1,000. . Notify us five business days before purchase. . If you don't notify us, you will be responsible for paying all charges and no benefits will be paid. H. Transplants. . Notify us five business days before receiving services. . If you don't notify us, Coverage will be reduced as described in 10.2. I. End Stage Renal Disease Services . Notify us five business days before receiving services. . If you don't notify us, you will be responsible for paying all charges and no benefits will be paid. 2000-FL-UHl-LG 26 ..rrJ - SECTION 11 - COVERED HEALTH SERVICES Health Services described in this section are Covered when such services are: A. Medically Necessary (refer to definition in Section I); B. provided by or under the direction of a Physician or other appropriate provider as specifically described; and C. not excluded as described in Section 12, General Exclusions. Network Benefits are subject to satisfaction of the Annual Deductible and the payment of any Copayment and payment of the percentage of Eligible Expenses listed under the "Network Copayment or Coinsurance" column in Section 13. Covered Health Services must be provided by or directed by a Network Physician. Network Benefits include Emergency Health Services and referral Health Services received from non- Network providers as described in Section 10. Non-Network Benefits are subject to satisfaction of the Annual Deductible and payment of Copayments and payment of the percentage Eligible Expenses listed under the "Non-Network Copayment or Coinsurance" column in Section 13. Covered Health Services must be obtained from non-Network providers. Covered Health Services are subject to satisfaction of Annual Deductible and Copayments or Coinsurance as described in Section 13, Schedule of Benefits. Section 11.1 Medical Services in a Physician's Office. Health Services provided by or through a Physician in the Physician's office. Covered Health Services includes preventive medical care such as well- baby and well-child care including Child Health SuperVision Services in accordance with state law, routine physical examinations, vision and hearing screenings, voluntary family planning and immunizations. Section 11.2 Eye Examinations. Eye examinations provided by a provider in the provider's office. Refractive eye examinations are limited to one every two calendar years. Section 11.3 Allergy Services in a Physician's Office. Allergy Health Services provided by or through a Physician. Health Services must be provided in the Physician's office. Section 11.4 Professional Fees for Surgical and Medical Services. Professional fees for surgical services and other medical care provided by or through a Physician. Health Services must be provided in a Hospital, Skilled Nursing Facility, Inpatient Rehabilitation Facility or Alternate Facility. Section 11.5 Inpatient Hospital and Related Health Services. Commement, including room and board, and services and supplies provided during Confinement (in a Semi-private Room) in a Hospital. Health Services must be provided by or through a Physician. Certain Health Services rendered during a Covered Person's Confinement are subject to separate benefit restrictions and/or Copayments as described elsewhere in this Certificate. Section 11.6 Transplantation Health Services. Health Services for transplants when ordered by a Network Physician provided at or arranged by a Designated Facility for transplants. Transplantation Health Services must be rendered in accordance with the Company's policies for transplantation Health Services. Coverage is provided for cornea, kidney, kidney/pancreas, liver, heart, lung, and heart/lung transplants. Coverage is also provided for bone marrow transplants (either from the Covered Person or a compatible donor) and peripheral Stem Cell transplants, with or without high dose chemotherapy, rendered in accordance with the Company's policies for transplantation Health Services. The reasonable costs of searching for the donor may be limited to immediate family members and the National Bone Marrow Donor Program. Contact the Company for information about the Company's policies on transplantation Health Services, including benefits that may be available for travel and lodging. 2000-FL-UHI-LG 28 .10 one home care visit. Federal law does not prohibit the mother's or newborn's attending Physician, after consulting with the mother, from discharging the mother or her newborn child earlier than 48 hours (or 96 hours, as applicable). You should notify the Company as soon as reasonably possible in the event that Confmement for the mother and/or the newborn will extend beyond these minimum time frames. The purpose of the notification is to coordinate with the Company to ensure that all Health Services related to the extended Confmement will be Covered. Limitations will not be placed on any Maternity Services Covered under this section that have been determined to be Medically Necessary. Section 11.12 Outpatient Mental Health and Substance Abuse Services. Coverage for mental health, substance abuse and chemical dependency evaluations and referral services, short-term individual, family and/or group outpatient therapeutic services (including intensive outpatient therapy) and crisis intervention. Health Services must be provided by or under the direction of the Mental Health/Substance Abuse Designee. Contact the Mental Health/Substance Abuse Designee at the telephone number on your ID card. Coverage is limited as stated in Section 13, Schedule of Benefits. Section 11.13 Inpatient Mental Health and Substance Abuse Services. Coverage for Mental Health and/or Substance Abuse Services provided on an inpatient or intermediate care basis, as determined to be Medically Necessary by the Mental Health/Substance Abuse Designee. Confinement is provided only on a Semi-private Room basis. At the discretion of the Mental Health/Substance Abuse Designee, two sessions of intermediate care (e.g. partial hospitalization) may be substituted for one inpatient day. Coverage is limited as stated in Section 13, Schedule of Benefits. Coverage includes detoxification from abusive chemicals or substances and is limited to physical detoxification when necessary to protect the physical health and well-being of the Covered Person. Referrals to a Network provider shall in all cases be at the sole discretion of the Mental Health/Substance Abuse Designee. .. Section 11.14 Home Health Agency Services. Part-time, intermittent Health Services of a Home Health Agency, when provided under the direction of a Physician. Home Health Agency services are Covered only when Skilled Care Services are required. Home Health Agency Services must be provided in your home, by or under the supervision of a registered nurse. Coverage is limited as stated in Section 13, Schedule of Benefits. Section 11.15 Skilled Nursing Facility/Inpatient Rehabilitation Facility Services. Confmement (in a Semi-private Room), including medical services and supplies, when provided under the direction of a Physician. Health Services must be provided in a Skilled Nursing Facility or Inpatient Rehabilitation Facility and are Covered only for the care and treatment of an Injury or Siclrness which otherwise would require Confmement in a Hospital. Coverage is limited as stated in Section 13, Schedule of Benefits. Section 11.16 Hospice Care. Coverage for Hospice Care which is recommended by a Physician, and provided through a provider designated by the Company. Contact the Company for information about the Company's policies for Hospice Care. Coverage is limited as stated in Section 13, Schedule of Benefits. Section 11.17 Ambulance Services. Emergency ambulance transportation by a licensed ambulance service to the nearest Hospital where Emergency Health Services can be rendered including transportation costs of a newborn to and from the nearest appropriate facility to treat the newborn's condition. Such transportation must be certified by the attending Physician as Medically Necessary to protect the health and safety of the newborn child. Section 11.18 Accident-related Dental Services. Services performed by a Doctor of Dental Surgery, "D.D.S.," or Doctor of Medical Dentistry, "D.M.D." for the treatment of any Sound Natural Tooth made necessary as a result of accident related damage. Coverage is provided only when services are required due to an external trauma that results in dental damage to a Sound Natural Tooth. The dental damage must be of sufficient significance that initial contact for evaluation must occur within 72 hours of the accident and completed within 12 months of the accident. No Coverage is provided unless the dentist certifies to the Company that the tooth was a Sound Natural Tooth that was injured as a result of an accident. (Incidents 2000-FL-UHI-LG 30 /~ Rehabilitation services must be performed in a Hospital or Skilled Nursing Facility or through a Home Health Agency or other provider and provided under the direction of a Physician. Section 11.22 Infertility Services. Health Services for the diagnosis and treatment of infertility when provided by or under the direction of a Physician. Coverage is limited as stated in Section 13, Schedule of Benefits. Section 11.23 Reconstructive Surgery. Coverage for Reconstructive Surgery when provided by a Physician in the Physician's office, at a Hospital or Alternate Facility. Specifically Covered are: A. The surgical repair of a Congenital Anomaly or syndrome if the Congenital Anomaly or syndrome is listed in a recognized atlas of congenital anomalies or syndromes. B. Breast reconstruction following mastectomy, including reconstruction of the non-affected breast to achieve symmetry. (Other services required by the Women's Health and Cancer Rights Act of 1998, including breast prosthesis and treatment of complications, are Covered in the same manner and at the same level as any other Health Service.) Section 11.24 Cleft Lip and Cleft Palate Treatment. Treatment of cleft lip and cleft palate for any Covered Person under the age of 18 includes medical, dental, speech therapy, audiology and nutritional Health Services. All Health Services must be Medically Necessary and under the direction of a Physician. Section 11.25 Bones or Joints of the Jaw and Facial Region. Medically Necessary Health Services for diagnostic and surgical procedures involving bones or joints of the jaw and facial region to treat conditions caused by congenital or developmental defonnity, Sickness or Injury. Note: Covered Health Services do not include care or treatment of the teeth or gums, intraoral prosthetic devices or surgical procedures for cosmetic purposes. Section 11.26 Diabetes Treatment. Coverage for Medically Necessary diabetes equipment, supplies and diabetes self-management training and educational programs when provided by or under the direction of a Physician. Diabetes self-management training includes training provided to a Covered Person after the initial diagnosis in the care and management of that condition, including nutritional counseling and proper use of diabetes equipment and supplies. Section 11.27 Certain Prescription and Non-prescription Enteral Formulas. Including low protein food products for home use when prescribed by a Physician as Medically Necessary for the treatment of inherited diseases of amino acid, organic acid, carbohydrate, or fat metabolism as well as malabsorption originating from congenital defects present at birth or acquired during the neonatal period. Coverage for inherited diseases of amino acids and organic acids includes food products modified to be low protein for Covered Persons through the age of24. Coverage is limited as stated in Section 13, Schedule of Benefits. Section 11.28 Osteoporosis diagnosis, treatment and management. Health Services for high-risk individuals, including, but not limited to: (a) estrogen-deficient individuals who are clinically at risk for osteoporosis; (b) individuals who have vertebral abnonnalities; (c) individuals who are receiving long-term glucocorticoid (steroid) therapy; (d) individual who have primary hyperparathyroidism, and (e) individuals who have a family history of osteoporosis. Such Health Services must be provided under the direction of a Physician. 2000-FL-UHI-LG 32 of) Coverage under the Policy. Health Services and associated expenses for transplants involving mechanical or animal organs. J. Health Services and associated expenses for organ or tissue transplants are excluded, except those specified as Covered in Section 11 and in the Company's policies for transplantation Health Services. Any solid organ transplant otherwise Covered under the Policy that is performed as a treatment for cancer. K. Health Services and associated expenses for megavitamin therapy; psychosurgery; nutritional-based therapy. L. Services and supplies for smoking cessation programs and the treatment of nicotine addiction are excluded. M.. Surrogate parenting. Non-Medically Necessary amniocentesis. Health Services and associated expenses for sex transformation operations and for reversal of voluntary sterilizations. N. Repair or replacement for any otherwise Covered implant. Penile implants for the treatment of impotence having a non-organic origin. Implants for the purpose of contraception more often than once every 4 years. O. Except when necessitated due to a change in medical condition - such that the present prosthesis no longer functions adequately, the repair, replacement or duplicate prosthetic or Durable Medical Equipment is excluded. Replacement of prosthetics or Durable Medical Equipment due to breakage or malfunction is excluded. Replacement of prosthetics or Durable Medical Equipment for the sole purpose of technical modification or enhancement is excluded. P. Orthotic appliances (including shoe orthotics) are excluded. Personal comfort items, including air conditioners and humidifiers,. eVen though prescribed by a Physician are excluded. Q. Growth hormone therapy except as may be provided as a prescription drug benefit for a documented growth hormone deficiency, Turner's Syndrome, growth delay due to cranial radiation, or chronic renal disease. R. Travel or transportation expenses, even though prescribed by a Physician. (Ambulance and Transplant travel services are Covered as described in Section 11.) S. Health Services for treatment of military service-related disabilities, when the Covered Person is legally entitled to other coverage and facilities are reasonably available to the Covered Person. T. Mental Health and/or Substance Abuse Services rendered in connection with conditions not classified in the current edition of the Diagnostic and Statistical Manual of the American Psychiatric Association. Mental Health and/or Substance Abuse Services, when such services extend beyond the period necessary for short-term evaluation, diagnosis, treatment or crisis intervention. Specifically excluded are Mental Health/Substance Abuse Services for the treatment of insomnia and other sleep disorders, dementia, neurological disorders and other disorders with a known physical basis. U. Mental Health Services for the treatment of Mental Illnesses which will not substantially improve beyond the current level of functioning, or for conditions not subject to favorable modification or management according to generally accepted standards of psychiatric care, as determined by the Mental Health/Substance Abuse Designee, including, but not limited to, conduct and impulse control disorders; personality disorders; and paraphilias. V. Mental Health and/or Substance Abuse Services for the following: (1) services utilizing methadone treatment as maintenance, L.A.A.M. (l-Alpha-Acetyl-Methadol), Cyclazocine, or their equivalents; and (2) services and treatment provided in connection with or to comply with involuntary commitments, police detentions and other similar arrangements, unless coordinated with the Mental Health/Substance Abuse Designee. 2000-FL-UHI-LG 34 /7.'J n. Health Services and associated expenses for in vitro fertilization; gamete intrafallopian transfer (GIFT) procedures; zygote intrafallopian transfer (ZIFf) procedures; embryo transport; surrogate parenting; donor semen and related costs including collection and preparation; and drugs for the treatment of infertility . KK. Charges incurred in connection with the provision or fitting of hearing aids, eye glasses or contact lenses. Optometric therapy is excluded. LL. In the event that a non-Network provider routinely waives Copayments and/or the Annual Deductible for a particular Health Service, the Health Service for which the Copayments and/or Annual Deductible are waived is not Covered. MM. Medical and surgical treatment of excessive sweating (hyperhidrosis). NN. Medical and surgical treatments for snoring, except when provided as a part of treatment for documented obstructive sleep apnea. Oral appliances for snoring. 00. Routine foot care, including the cutting or removal of corns and calluses; the trimming cutting, clipping or debriding of nails; and other hygienic and preventive maintenance care, such as cleaning and soaking the feet, the use of skin creams to maintain skin tone and any other service performed in the absence of localized illness, injury or symptoms involving the foot. Treatment involving otherwise covered services such as diagnosis and treatment of ulcers, wounds or infections, treatment of warts on the foot and treatment required because of metabolic, neurologic or peripheral vascular disease is covered. Treatment of flat foot. Treatment of subluxation of the foot. PP. Nutritional counseling and related services for either individuals or groups. QQ. Wigs 2000-FL-UHI-LG 36 .-a? SECTION - BENEFIT NETWORK COPAYMENT NON-NETWORK DESCRIPTION OR COINSURANCE COPAYMENTOR COINSURANCE 11.6 Transplantation Health *10% of Eligible Expenses. *30% of Eligible Expenses. Services 11.7 Outpatient Emergency $50 per visit. Covered as a Network Benefit. Health Services Copayment waived if Confined within 24 hours for the same condition. Does not apply to Out-of-Pocket Maximum. 11.8 Urgent Care Center $35 per visit. 30% of Eligible Expenses. Does not apply to Out-of-Pocket Maximum. 11.9 Outpatient Surgery, *10% of Eligible Expenses. *30% of Eligible Expenses. Diagnostic and Therapeutic Services 11.10 Mammography No Copayment. Covered as a Network Benefit. 11,11 Maternity Services Same as 11.1, 11.4, 11.5, and Same as. 11.1, 11.4, 11.5, and 11.9. 11.9. 11.12 Outpatient Mental Health $15 per individual visit; 30% of Eligible Expenses. and Substance Abuse $10 per group visit. Services Limited to 20 visits per calendar year. Visits are combined for In-Network and Non-Network benefits. Must be coordinated through the Mental Health/Substance Abuse Designee. Does not apply to Out-of- Pocket Maximum. 2000-FL-UHI-LG 38 (Y.) SECTION - BENEFIT NETWORK COPAYMENT NON-NETWORK DESCRIPTION OR COINSURANCE COPAYMENTOR COINSURANCE 11.20 Prosthetic Devices and * 1 0% of Eligible Expenses. *30% of Eligible Expenses. Durable Medical Prior authorization required when Prior authorization required Equipment the cost exceeds $1,000. when the cost exceeds $1,000. Network and Non- Network Benefits for Durable Medical Equipment are subject to the combined limit of $2,500 per calendar year. All Coverage for Durable Medical Equipment is limited to $50,000 during the entire period of time a Covered Person is enrolled for Coverage under the Policy. 11.21 Outpatient Rehabilitation 10% of Eligible Expenses. 30% of Eligible Expenses. Services (Physical therapy, occupational therapy, '. speech therapy, and cardiac/pulmonary rehabilitation. ) Network and Non- Network Benefits are subject to combined limits as follows: 20 visits of physical therapy per calendar year. 20 visits of occupational therapy per calendar year. 20 visits of speech therapy per calendar year. 36 visits of cardiac/pulmonary rehabilitation per calendar year. 11.22 Infertility Services 10% of Eligible Expenses. 30% of Eligible Expenses. Limited to $2,000 per calendar year. 11.23 Reconstructive Surgery *10% of Eligible Expenses. *30% of Eligible Expenses. 11.24 Cleft Lip and Cleft palate Same as 11.1, 11.4, 11.5, 11.9, Same as 11.1, 11.4, 11.5, 11.9, Treatment 11.21. 11.21. 2000-FL-UHI-LG 40 0-11 SECTION - ELIGIBILITY DESCRIPTION 1. Initial Eligibility Period. The Initial Eligibility Period shall begin on the date determined by the Enrolling Group and the Company and shall end on the date determined by the Enrolling Group and the Company. 2. "Eligibility. The following conditions are in addition to those specified in Section 2 of the Certificate: Waiting or probationary period for newly Eligible Persons shall be as follows: None. . Excluded classes of persons, if any: Part-time, and Temporary. Coverage classifications other than employee, if any: None. Other: None. 3. Effective Date. The first day of the month following the month in which the waiting period was completed. 4. Minimum Participation Requirement. The minimum participation requirements are: 2 Eligible Persons and; Eligible Persons enrolled for Coverage under this Policy. 2000-FL-UHI-LG 42 /:;A} exclusions in your Certificate of Coverage and as listed at the end of this Rider in the section entitled "Exclusions" . Outpatient Prescription Drug Products must be: · Medically Necessary; · or prescribed to prevent conception; and · the preferred version of a Dual-Marketed drug. Prior Authorization. Certain Prescription Drug Products require prior authorization from the Company or its designee. (Prior authorization is the process of obtaining approval for certain Prescription Drug Products, prior to dispensing, using guidelines approved by the Company.) Prior authorization is to be obtained from the Company by the prescribing provider or the pharmacist when Prescription Drug Products are dispensed at a Network Phannacy. When Prescription Drug Products are dispensed at a non-Network Pharmacy, you are responsible for obtaining the required prior authorization. The list of Prescription Drug Products and the Coverage criteria requiring prior authorization are subject to periodic review and modification by the Company. A current list of Prescription Drug Products requiring prior authorization is available by contacting the Company at the telephone number on your ill card. If prior authorization is not obtained prior to the pharmacy dispensing the Prescription Drug Product, you can ask the Company to consider reimbursement after you have obtained your Prescription Drug Product. However, the Prescription Drug Product may not be authorized for Coverage after the Company reviews the documentation provided. If Coverage is authorized after the Company reviews the documentation, you will pay more than if authorization is obtained prior to the Prescription Drug Product being dispensed.at a Network Pharmacy. This is because when you obtain the prescription without prior authorization, you will be required to pay for the Prescription Drug Product at the phannacy. The Company's contracted pharmacy reimbursement rates will not be available to you. When you seek reimbursement from the Company as described in the Certificate of Coverage, the amount of reimbursement will be based on the Predominant Reimbursement Rate. When you submit a claim on this basis, you will pay more because you failed to verify your eligibility when the Prescription Drug Product was dispensed. 3. Supplv Limits. Coverage of Prescription Drug Products is subject to the supply limits shown below. Note: Some products may be subject to additional supply limits based on Coverage criteria developed by the Company. The limit may restrict either the amount dispensed per Prescription Order or Refill, or the amount dispensed per month's supply. A current quantity level list of Prescription Drug Products that have been assigned maximum quantity levels for dispensing may be obtained from the Company. The list is subject to periodic review and modification by the Company. For a single Copayment you may receive a Prescription Drug Product up to the supply limit stated. Retail Network or Retail Non-Network Pharmacy If the Prescription Drug Product is dispensed by a retail Network or non-Network Phannacy, the following limits apply: · As written by the provider, up to a consecutive 31 day supply of a Prescription Drug Product, unless adjusted based on the drug manufacturer's packaging size. · A one cycle supply of an oral contraceptive. Up to three cycles can be purchased at one time if a Copayment is paid for each cycle supplied. Mail Service Network Pharmacy If the Prescription Drug Product is dispensed by a mail service Network Pharmacy, the supply limit is as written by the provider, up to a consecutive 90 day supply of a Prescription Drug Product, unless adjusted based on the drug manufacturer's packaging size. UHI-RX-FL 44 ~ and Therapeutics Committee objectively evaluates drugs for therapeutic treatment, safety and cost in order to establish Coverage policies and guidelines which promote quality and cost-effective drug therapy. The evaluation includes, but is not limited to: 1) medical appropriateness; 2) Medical Necessity; 3) safety and efficacy; 4) needs for specific indications; 5) supply limits; 6) prior authorization; and 7) Copayment levels. Even after a drug is included on the Preferred Drug List, this evaluation continues at least annually or as new information becomes available. 7. Coupons and Incentives. At various times the Company may offer coupons or other incentives for certain drugs on the Preferred Drug List. Only your doctor can determine whether a change in your Prescription Order or Refill is appropriate for your medical condition. 8. Exclusions. Exclusions from Coverage listed in the Certificate apply also to this Rider. In addition, the following exclusions from Coverage under this Rider include but are not limited to: (a.) Coverage for Prescription Drug Products for the amount dispensed (days supply or quantity limit) which exceeds the supply limit. (6.) Drugs which are prescribed, dispensed or intended for use while you are Confined in a Hospital, Skilled Nursing Facility, or Alternate Facility. (c.) Experimental, Investigational or Unproven Services and medications; medications used for experimental indications and/or dosage regimens determined by the Company to be experimental. "Experimental" does not include pharmacological regimens for the treatment of cancer if such drugs are recognized as acceptable treatment in one of the standard reference compendia, but have not been approved by the FDA. Contact the Company for details. (d.) Prescription Drug Products furnished by the local, state or federal government. Any Prescription Drug Product to the extent payment or benefits are provided or available from the local, state or . . federal government (for example, Medicare) whether or not payment or benefits are received, except as otherwise provided by law. (e.) Prescription Drug Products for any condition, Injury, Sickness or Mental Illness arising out of, or in the course of, employment for which benefits are available under any workers' compensation law or other similar laws, whether or not a claim for such benefits is made or payment or benefits are received. (f.) Any product dispensed for the purpose of appetite suppression and other weight loss products. (g.) Compounded drugs not containing at least one ingredient requiring a Prescription Order or Refill. (h.) Drugs available over-the-counter that do not require a Prescription Order or Refill by federal or state law before being dispensed. Any drug that is therapeutically equivalent to an over-the- counter drug. (i.) Injectable drugs, except when the drug can be self-administered, as defined by the Company. (j.) Durable Medical Equipment. Prescribed and non-prescribed outpatient supplies, other than the diabetic supplies and inhaler spacers specifically stated as Covered. (k.) General and injectable vitamins, except the following which require a Prescription Order or Refill: prenatal vitamins, vitamins with fluoride, and single entity vitamins. (1.) Unit dose packaging of Prescription Drug Products. (m.) Medications for cosmetic purposes only. (n.) Prescription Drug Products that are newly approved by the FDA until they are reviewed by the Company or its designee. This exclusion does not pertain if the newly approved FDA drug is pertinent to a Covered Persons condition and all other known approved FDA drugs have proven to be non-effective in treating such Covered Person's condition. UHI-RX-FL 46 ~