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1980 002 Ordinance
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1980 002 Ordinance
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Last modified
11/19/2018 3:50:35 PM
Creation date
7/26/2018 6:25:48 AM
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Template:
Legislation-Meeting Minutes
Document Type
Ordinance
Number
002
Date
1/30/1980
Year
1980
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DEFINITIONS (®ther Than Dental Expense Insurance) <br />klospital - <br />(1) Alegally operated institution primarily providing inpatient medical care and treatment through medical, <br />" - diagnostic and major surgical facilities on its premises, under supervision of a staff of doctors, and with 24- <br />hour-a-day nursing service, or <br />(2) Any other institution accredited as a hospital by the Joint Commission on Accreditation of Hospitals. <br />However, "hospital" does not include a nursing home nor an institution, or part of one, used mainly as a facility <br />for convalescence, nursing, rest, the aged or care of drug addicts. <br />In some states, coverage may also be provided for confinements in certain off-premise facilities such as <br />ambulatory surgical centers, and facilities for treatment of mental illness, drug addiction or alcoholism which do <br />not meet this definition. Your booklet-certificate will indicate if you have such coverage. <br />This definition does not apply to Limited Medical Expense Benefit. For these benefits the definition of hospital is <br />as defined by Medicare. <br />Convalescent Nursing Home-An institution meeting .the following requirements: <br />(1) It is operated legally and primarily provides the following services for convalescents-room, board and 24- <br />hour-a-day nursing service by professional nurses arid such other nurses as are needed to provide adequate <br />medical care. <br />(2) The services are under the full-time supervision of a proprietor or an employee who is a doctor or registered <br />graduate nurse (R.N.). <br />(3) It maintains adequate medical records, and has available doctors' services under an established agreement if <br />not supervised by a doctor. <br />However, "convalescent nursing home" does not include an institution, or part of one, used mainly as a facility <br />for rest, the aged or care of drug addicts. <br />DEFINITIONS (For Dental Expense Insurance ®ption) <br />Treatment Plan-A dentist's report, on a form satisfactory to Prudential, which (1) itemizes the dental services <br />recommended by the dentist for your necessary dental care, (2) shows the dentist's charge for each dental service <br />and (3) is accompanied by supporting pre-operative X-rays. <br />Benefit Year-With respect to an employee and his or her covered dependents, if any, a period of twelve months <br />commencing on the date the employee (not a dependent) became insured or on any anniversary of that date. <br />ELIGIBLE DEPENDENTS <br />Your eligible dependents are your spouse and unmarried children less than 19 years of age. Unmarried children <br />19 years or over are also eligible provided they wholly depend upon you for support and are full-time students in <br />an educational institution. Persons on active duty in any military, naval or air force are not eligible dependents. <br />Stepchildren, foster children and legally adopted children are considered your children if they wholly depend on <br />you for support. While you remain covered, a dependent child mentally or physically incapacitated from earning a <br />living may continue medical care coverage under the plan if proof of such incapacity is received by Prudential as <br />required. <br />If Dependent Term Life Insurance is provided, children must be 14 days of age or older to be covered, and an <br />upper age exclusion may apply. <br />When dependents health care coverage is a part of the plan,, the newborn children of employees who have not <br />yet elected such coverage are automatically and without charge covered for the first 31 days following birth. <br />C LA I I\/I S <br />Your employer will supply you with claim forms and further information. Should you or your employer need help, <br />see your Prudential representative or consult your telephone directory for the telephone number and address of <br />the local Prudential office. <br />13 <br />
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