HomeMy WebLinkAbout1987-423
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28 11-9-87
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RESOLUTION NO. 87-423
RESOLUTION OF THE CITY OF SAN BERNARDINO AUTHORIZING THE
EXECUTION OF AN AMENDMENT TO AGREEMENT WITH PRIVATE MEDICAL-
CARE! INC.! EXTENDING THE TEffi~ FOR AN ADDITIONAL YEAR EFFECT-
IVE JANUARY 1, 1988.
BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF THE
CITY OF SAN BERNARDINO AS FOLLOWS:
SECTION 1. The Mayor of the City of San San Bernardino
is hereby authorized and directed to execute on behalf of
said City an amendment to agreement with Private Medical
Care, Inc., extending the term for an additional year,
effective January 1, 1988, relating to an Optical Plan for
employees and dependents, a copy of which is attached hereto,
marked Exhibit "A" and incorporated herein by reference as
fully as though set forth at length.
I HEREBY CERTIFY that the foregoing Resolution was duly
adopted by the Mayor and Common Council of the City of San
Bernardino at a regular __ meeting thereof, held on the
7th
December
day of
, 1987, by the following
vote, to wit:
AYES:
Council Members Estrada, Reilly, Flores,
Maudsley, Minor, Pope-Ludlam
NAYS:
None
ABSENT:
Council Member Miller
The foregoing resolution is hereby approved this
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28 11-9-87
day of
December
Bernardino
to form and legal content:
..4. ~..
, 111II) DENTAL HMLTH PLAN
IMIII Affiliated with Delta Dental Plan
AMENDMENT
TO
OPTICAL HEALTH CARE AGREEMENT
(PREPAID)
THIS AGREEMENT is made by and between PRIVATE MEDICAL-CARE, INC. and CITY OF SAN
BERNARDINO, PMI GROUP #9040, for the purpose of amendi ng the ori gi na 1 Prepa i d
Optical Health Care Agreement as follows:
1. The term of the Agreement as noted on page 1, number 1, shall be amended to
read January 1, 1988 through December 31, 1988.
2. Group shall provide a list of eligible subscribers each month shall be
amended to read commencing January 1, 1988 as noted on page 2, number 2.
3. The following new Coordination of Benefits language is hereby added to page
3 of the Agreement:
2.4
If an eligible person is entitled under a group insurance policy or any
other group health benefits program (including another PMI program) to
receive or be reimbursed for the cost of optical services which are also
Benefits under this program, and if the other policy or program is "primary"
under the ru 1 es descri bed in Pa ragraph 2.4 (a) be low, then the cos t of
opti ca 1 servi ces rendered by non-Primary Optometri sts under thi s program
shall be reimbursed only to the extent that the optical services are
Benefits and are not fully paid for or provided under the terms of the other
policy or program. If this program is "primary" under those rules, Benefits
shall be provided as if the other policy or program did not exist and any
payment recei ved by a Denti st from other coverage sha 11 be app 1 i ed to any
copayments due from an eligible person.
a. If the other policy or program principally covers services or expenses
other than opti ca 1 care, th i s program sha 11 be "pri ma ry . II Otherwi se,
the determination of which policy or program is IIprimary" shall be
governed by the following rules:
1) The policy or program covering the patient as other than a
dependent shall be primary over the policy or program covering the
patient as a dependent.
2) The policy or program covering a child as a dependent of a parent
whose birthday occurs earlier in a calendar year shall be primary
over the po 1 icy or program coveri ng a chi 1 d as a dependent of a
parent whose birthday occurs later in a calendar year (except for
a dependent chi 1 d whose parents are separated or di vorced as
described in (3) below).
1-88.RE.189
5122 Katella Avenue, Suite 206, Los Alamitos, CA 90720 (213) 493-6661, (714) 978-6624
So. California 1-800-325-4529 No. California 1-800-422-4234 Nationwide 1-800-821-2058
€XlIll3i( ,4
,
3) In the case of a dependent child whose parents are legally
separated or divorced:
a) If the parent with custody has not remarried, the policy or
program covering the child as a dependent of the parent with
custody shall be primary over the policy or program covering
the child as a dependent of the parent without custody.
b) If the parent with custody has remarried, the policy or
program covering the child as a dependent of the parent with
custody shall be primary over the policy or program covering
the child as a dependent of the stepparent, and the policy or
program covering the child as a dependent of the stepparent
sha 11 be primary over the pol icy or program coveri ng the
child as a dependent of the parent without custody.
c) If there is a court decree that establishes financial
responsibility for optical services which are Benefits under
this program, then notwithstanding 3 (a) and 3 (b), the
po 1 icy or program coveri ng the chi 1 d as a dependent of the
parent with such financial responsibility shall be primary
over any other policy or program covering the child.
4) If the primary policy or program cannot be determined by the rules
described in (1), (2) or (3), the policy or program which has
covered the eligible person for the longer period of time shall be
primary, with the following exception: A policy or program
covering the eligible person as a laid-off or retired employee or
the dependent of a 1 aid-off or reti red employee sha 11 not be
primary under this rule (4) over a policy or program covering the
e 1 i gi b 1 e person as an employee or the dependent of an employee.
However, if the provisions of the other policy or program do not
include this exception, which results in neither program being
primary, then this exception shall not apply.
b. An e 1 i gi b 1 e person sha 11 provi de to PMI and PMI may re 1 ease to or
obtain from any insurance company or other organization, any
information about the eligible person that is needed to administer this
Paragraph 2.4. PMI shall, in its sole discretion, determine whether
any reimbursement to an insurance company or other organi zati on is
warranted under this Paragraph 2.4, and any such reimbursement paid
shall be deemed to be Benefits under this Agreement. PMI shall have
the right to recover from a dentist, eligible person, insurance company
or other organization, as PMI chooses, the amount of any Benefits paid
by PMI which exceed its obligations under the terms of this
Paragraph 2.4.
A 11 other aspects of the Prepa i d Opti ca 1 Health Care Agreement currently in
effect remain the same.
1-88.RE.190
IN WITNESS WHEREOF, the parties have exe~is Agreement and have affixed
their signatures on the ll:/v- day of. 198~.
CITY OF SAN BERNARDINO
PMI GR UP #9040
PRIVATE MEDICAL-CARE, INC.
Slgnatur
&~( VttLJY /I&r
PrOnt Name and T1 le
/
By: ~i~Y~ oy,'tfy~ /O~~~~~7
,/ ) ,., ,
~ L LL- -p )~ 0 D ~.r:i0J
Title
By:
P.O. Box 1318
Address
San Bernardino CA 92402
City State Zip
714/384-5002
Telephone Number
Approved as to form
and legal content:
1-88.RE.191