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RESOLUTION NO. /.:3'/-<'/
RESOLUTION OF THE CITY OF SAN BERNARDINO AUTHORIZING THE
EXECUTION OF AN AMENDMENT TO THE AGREEMENT WITH KAISER FOUNDATION
HEALTH PLAN, INC., RELATING TO THE ADDITION OF INJECTABLE BENEFITS1
TO THE CITY'S GROUP HEALTH PLAN.
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BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF THE CITY
5 OF SAN BERNARDINO AS FOLLOWS:
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SECTION 1. The Mayor of the City of San Bernardino is
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hereby authorized and directed to execute on behalf of said City
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an amendment to the agreement with Kaiser Foundation Health Plan,
Inc., relating to the addition of injectable benefits to the City's
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Group Health Plan, a copy of which is attached hereto, marked
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Exhibit "A" and incorporated herein by reference as fully as
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though set forth at length.
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I HEREBY CERTIFY that the foregoing resolution was duly
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AYES:
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NAYS:
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ABSENT:
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~ The foregoing
of ~~ '
1978.
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an Bernar 1no
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KAISER FOUNDATION HEALTH PLAN, INC.
A Nonprofit Corporation
Southern California Region
GROUP MEDICAL AND HOSPITAL SERVICE AGREEMENT
ADDITIONAL PROVISIONS
INJECTABLES
The following additional provisions amend the Group Medical and Hospital Service Agreement:
1. Section F-l-a(ii) is amended to read as follows:
(il) In Medical Offices. Emergency Departments. and on Home Visits. All prescribed
medications, radioactive materials used for therapeutic purposes and allergy treatment materials
administered at Medical Offices, and Hospital emergency departments, and on home visits are
provided without charge to Medicare Members and Part B Members, and at a reasonable
charge to all other Members. Allergy test materials are provided without charge to all Members.
Injectables (including immune serums, human origin) which were developed and in general
use for specific diseases on April I of the year immediately preceding the year in which this
Agreement was entered into or last renewed are provided \vithout charge.
Exhibit "A"
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KAISER FOUNDATION HEALTH PLAN, INC._._
. A Nonprofit" Corporation
Southern California Region
GROUP MEDICAL AND HOSPITAL SERVICE AGREEMENT
AMENDMENT
The Group Medical and Hospital Service Agreement between Kaiser Foundation Healtlt Plan. Inc. and the
Group named below is amended as set forth below and in the attachment.
Section F-l-a(ii) of the Benefit Schedule is superseded by the.amend-
ment enclosed herein entitled "Injectables".
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MONTIlLY PAYMENTS:
The monthly payments per Family Unit required under this Agreement are:
Basic Rate Strocture
Subscriber only
Subscriber with one Family Dependent
Subscriber with two or more Family Dependents
Variables to Basic Rate Structure
For each Member age 65 or older who is (a) not entitled to benefits under
Part B of Medicare. or (b) entitled to benefits under Part B of Medicare
but has not assigned such benefits to Health Plan
For each Member (up to 3 per Family Unit) entitled to benefits under both
Parts A and B of Medicare who has assigned Part B benefits to Health Plan:
Subscriber
Subscriber's spouse (or child of Subscriber if unmarried)
Other Family Dependent
Total
$..~.?~.?,.l;i..
$..li.4...5..<l..
$__9L.3.8..
Add
$_.m7.A.fiB__
Subtract
Subtract
Subtract
$.J..a.,.l.9..
$..1.8._.1.6..
$..U_.'1.6..
Accepted mm..J.P"I'>.M.&.?........O::.,....... 19.1.Z.
Group: City of San Bernardino
300 N. :YD" Street
San Bernardino, CA 92418
Executed at Los Angeles. California to take effect as of
January 1. 1978.
Date .m.....p.."g.~m1:?"x:..1.!;i..........., 19.7..7...
Attn: Ms. Janet Zylstra,
Personnel
KAISER FOUNDATION HEALTH PLAN, INC.
A California nonprofit corporation
By
By
By
Southern California Region
Group Representative
(Jan.78)
Group 66-00