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2003-040 Resolution
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2003-040 Resolution
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Last modified
1/10/2014 3:23:34 PM
Creation date
12/26/2013 9:36:07 AM
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North Olmsted Legislation
Legislation Number
2003-040
Legislation Date
3/18/2003
Year
2003
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STOP LOSS CONTRACT <br />between <br />MEDICAL MUTUAL OF OHIO <br />("Medical Mutual of Ohio") <br />2060 East Ninth Street <br />Cleveland, OH 44115-1355 <br />and <br />THE CITY OF NORTH OLMSTED <br />(the "Plan Sponsor") <br />Number: 621634 <br />The Effective Date of the Stop Loss Contract (the "Contract") is January 1, 2003 at <br />12:01 a.m., regardless of the date executed by the Plan Sponsor and Medical Mutual of <br />Ohio. The Contract Period is shown on Exhibit A. <br />1. DEFINITIONS <br />BENEFIT BOOK(S): the Summary Plan Description (SPD) or other applicable <br />documents that describe the Covered Services, benefits, eligibility requirements <br />and other features and limitations of the Plan with respect to the Participants. <br />CLAIMS ADMINISTRATOR: the entity employed by the Plan Sponsor to pay <br />claims for Covered Services under the Plan for Covered Persons. The Claims <br />Administrator is Medical Mutual Services, L. L. C. <br />COVERED PERSON: the Participant and the Participant's Eligible Dependent(s) <br />as defined in the Benefit Book(s). <br />COVERED SERVICE(S): a Provider's service, supply or accommodation <br />described in the Benefit Books, schedules of benefits, riders, addenda or <br />Amendments. <br />PAID CLAIM: a claim for Covered Services for which payment has been made <br />by the Claims Administrator on behalf of the Plan Sponsor. A claim is <br />considered a Paid Claim as of the date shown on the check written by the Claims <br />Administrator. <br />PARTICIPANT: a person, employed by the Plan Sponsor, who is eligible for and <br />has elected to enroll in coverage under the Plan. <br />PLAN: the program of health care coverage established by the Plan Sponsor for <br />its Participants, the terms of which are set forth in the Benefit Book(s). <br />STOP LOSS - AGGREGATE: the maximum amount of Paid Claims for which <br />the Plan Sponsor shall be liable for the Contract Period for the lines of business <br />listed on Exhibit A. The components of the Aggregate Stop Loss are: <br />CCX0202 Page 1 090102 <br />03 eCityofNorthOlmsted S L <br />
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