Loading...
HomeMy WebLinkAboutCAG1994-0090 - Other - Blue Cross of Washington and Alaska - Administrative Service Contract -Confirmation of Renewal and Contract Changes - 01/01/1994 Group Name: City of Kent Program Number(s) :13596, -01, -02 Renewal Date: January 1, 1994 The following program changes are being presented with your renewal. Please indicate below which optional items you wish included in your program and sign and return this form. If the state or federal government mandates any additional change in benefits after this renewal packet is issued, a supplemental notice will be provided. YES Part A. BOILERPLATE CHANGES X All of the boilerplate program changes presented in Part A will be included in your program. Please indicate on the second page of this renewal any changes that are not acceptable. YES NO PART B. OPTIONAL PROGRAM CHANGES Not applicable at this time. YES PART C. STATE LEGISLATIVE CHANGES X The mandated change presented in Part C will be included in your contract. YES NO PART D. STATE MANDATED BENEFIT OFFERINGS Please indicate if you wish the mandated benefit offerings presented in Part D included in your program. Add Coverage for Chiropractic Care as any other care Add TMJ Benefit YES NO PART E. FEDERAL LEGISLATIVE CHANGES X The mandated change presented in Part E will be included in your program. 2 - City of Kent OTHER INFORMATION Our records indicate the legal address for the City of Kent is: 220 Fourth Ave. South Kent, WA 98031 If this information is not accurate, please indicate your correct address below. Your current eligibility provisions are set forth in your benefit booklet under the section entitled "STARTING OUT IN THE PROGRAM." Please review this section; indicate below any eligibility changes you wish implemented at the time of renewal. Our records indicate that this benefit program is part of an IRS Section 125 Cafeteria Plan. Is this information still accurate? Yes )—( No If there are any other changes you wish to make to your existing program at renewal, please indicate below. B er or ate Marketing Representative Date Underwriter Date RETURN THIS FORM TO BLUE CROSS OF WASHINGTON AND ALASKA 3 - City of Kent PART A: BOILERPLATE CHANGES • NEW BOOKLET SIZE In response to numerous requests, we are pleased to announce that we now have technology that enables us to produce laser printed benefit booklets in a new size - 8 1/2" by 11". We will begin phasing in the new larger booklet size for all Blue Cross and HeealthPouus products. Standardizing the booklet size for all products supports ongoing efforts to reduce administrative costs and provides our customers with a booklet size that is easier to read, handle and store. • ADVANTAGECARE (UTILIZATION MANAGEMENT) The $200 Inpatient Hospital Care Deductible will be discontinued. However, preauthorization must still be requested for all nonemergency admissions and readmissions. In Washington or Alaska, the enrollee's physician or hospital will handle the preauthorization. For services outside Washington and Alaska, the enrollee will need to initiate the preauthorization process as explained in the "AdvantageCare" section of their booklet. Appropriate booklet text revisions will be made to reflect this change. • NEWBORN NURSERY CHARGES We will now process a mother's hospital inpatient charges separately from the newborn's routine nursery charges. The newborn's benefits will no longer be contingent on the mother being eligible. This change is being required by the Office of the Insurance Commissioner. Your booklet will be revised by the addition of the following benefit: "Routine Newborn Care Hospital routine care for a newborn child of the employee or spouse is covered during the child's initial hospital confinement at birth. Covered services include hospital nursery services for up to the first 72 hours following birth. Please Note: Benefits for routine newborn care and for care of an ill baby are provided under the child's coverage, subject to his or her own deductible and coinsurance requirements. Enrollment requirements for newborns are explained elsewhere in this booklet under "Starting Out In The Program." 4 - City of Kent • ELIGIBILITY PROVISl AS (STARTING OUT IN THE PROGRAM. • Enrollment When an employee marries and wishes to include his or her newly acquired dependent(s) under the program, we will now allow up to 60 days from the date of marriage to receive the enrollment application; this was previously a 30-day period. • Transfer Provision A new paragraph pertaining to Health Care Reform will be added to your Transfer Provision. It will read as follows: "If the waiting period provision of this Tranfer Provision is in conflict with RCW 48.44 [section to be completed once Section 285 of SSB 53.04 law is codified] or any regulation implementing RCW 48.441 this section will be deemed amended to conform with the minimum requirements of said statute and regulation on the date prescribed therein." • UNINSURED AND UNDERINSURED MOTORIST COVERAGE In a recent Washington Supreme Court decision, the court held that uninsured motorist or underinsured motorist ("UIM") exclusionary clauses are void if they exclude coverage for medical expenses before the enrollee is fully compensated for all other damages, including those for lost wages, pain and suffering. An exclusionary clause relating to UIM coverage should be applied only if the health insurer can show it is necessary to prevent a double recovery for the enrollee's medical expenses. The section of your booklet entitled "General Limitations And Exclusions" currently contains an exclusion for services and supplies to the extent that benefits are "payable" for them under another type of liability Policy. The exclusion reads as follows: "Services or supplies to the extent that benefits are payable for them under any motor vehicle medical, motor vehicle no-fault, uninsured motorist, underinsured motorist, personal injury protection (PIP), commercial liability, homeowner's policy, or similar type of coverage." To comply with the court decision we will be changing the exclusion and addressing Uninsured and Underinsured Motorist Coverage elsewhere in the booklet.. The new exclusion will read as follows: "Services and supplies to the extent that benefits are payable under the terms of any contract or insurance offering: • Motor vehicle medical, motor vehicle no-fault, or personal injury protection (PIP) coverage; or, • Commercial premises or homeowner's medical premises coverage, or other similar type of contract or insurance." 5 - City of Kent Under the section of the booklet entitled "Subrogation," the "Notification" provision has been deleted and moved to "General Provisions." In addition, the first paragraph under "Recovering Payment" will be revised to read as follows: "If you bring an action or claim against another person, you must also seek recovery of the benefits we paid under this program. We may, however, assert our right to recover benefits directly from the other person, or from you. If we do so, you do not need to take any action on behalf of us. You must, however, do nothing to impair our right of recovery. Should we assert our right of recovery directly, we have the right to join as a party in the action or claim you brought. You must promptly notify us in writing in advance of any settlement you intend to make of your action or claims." A new provision entitled "Uninsured and Underinsured Motorist Coverage" will follow the "Subrogation" provision and will read as follows: "Uninsured and Underinsured Motorist Coverage We have the right to be reimbursed for benefits provided, but only to the extent that benefits are also paid for such services and supplies under the terms of a motor vehicle uninsured motorist and/or underinsured motorist (UIM) policy or similar type of insurance or contract. The amount of reimbursement that we are entitled to receive under this provision is the amount in excess of the amount you receive from all insurance sources which fully compensate you for all damages arising from the accidental injury for which such benefits have been paid." A new provision entitled "Notice Of Other Coverage" will be added to the "General Provisions" section and will read as follows: "Notice Of Other Coverage As a condition of receiving benefits under this program, you must notify us of: • Any legal action or claim against another party for a condition or injury for which we paid benefits; and the name and address of that party's insurance carrier. • The name and address of any insurance carrier providing personal injury protection (PIP) , underinsured motorist, uninsured motorist, or any other insurance under which you are or may be entitled to recover compensation. • The name of any other group insurance plan(s) under which you are covered." 6 - City of Kent • ALLOWABLE CHARGE DEFINITIOft Blue Cross of Washington and Alaska corporate direction involves changing our current reimbursement methodology in mid 1994 to a relativity based system (e.g. RBRVS) . All professional provider services will be reimbursed under this same new system. Enrollees using contracted (Preferred & Participating) providers, will continue to be held harmless for any amount in excess of the allowable charge. In order to implement this change in mid 1994, current contractual language will be modified to the following: "Allowable Charge We reserve the right to determine the allowable charge for any given service. • Providers Who Have Contracts With BCWA For Hospitals: the allowable charge is the hospital's billed charge for medically necessary covered services. Hospitals that have contracts with BCWA agree not to bill you for any charges above the amount agreed upon by us and the hospital, except for any deductibles, coinsurance, copayments, amounts in excess of stated benefit maximums, and charges for noncovered services for which you are responsible. Your liability for deductibles, coinsurance, copayments, and amounts applied toward benefit maximums, will be calculated on the basis of the hospital's billed charge. We will deduct these amounts payable by the enrollee prior to calculating our liability for payment. For Nonhospital Providers: the allowable charge is the amount agreed upon by us and the provider for medically necessary covered services. Nonhospital providers that have contracts with BCWA agree not to bill you for any charges above the amount agreed upon by us and the provider, except for any deductibles, coinsurance, copayments, amounts in excess of stated benefit maximums, and charges for noncovered services for which you are responsible. Your liability for deductibles, coinsurance, copayments, and amounts applied toward benefit maximums, will be calculated on the basis of the allowable charge. 7 - City of Kent • For Providers Who Do Not Have Contracts With BCWA The allowable charge will be no greater than the maximum allowance we otherwise would have allowed had the medically necessary covered services been furnished by a provider that has a contract in effect with BCWA. When you seek services from providers that do not have contracts with BCWA, your liability is for any amount above the allowable charge, and for any deductibles, coinsurance, copayments, amounts in excess of stated benefit maximums, and charges for noncovered services." • "MEDICALLY NECESSARY" DEFINITION The "Medically Necessary" definition in your booklet will be revised to comply with regulatory directives. The new definition will read as follows: "Medically Necessary Those covered services and supplies which are, in our judgement, determined to meet all of the following requirements. They must be: • Essential to, consistent with, and provided for the diagnosis or the direct care and treatment of an illness, accidental injury, or condition harmful or threatening to the enrollee's life or health, unless provided for preventive services when specified as covered under this program. • Appropriate and consistent with the diagnosis as specified in accordance with authoritative medical or scientific literature. • Not primarily for the convenience of the enrollee, the enrollee's family, the enrollee's physician, or another provider. • The least costly of the alternative supplies or levels of service which can safely be provided to the enrollee. • Not primarily for research or data accumulation. The fact that the covered services were furnished, prescribed, or approved by a physician or other provider does not in itself mean that the services were medically necessary." 8 - City of Kent • DISCLOSURE PROVIS1,,AS New Blue Cross and Blue Shie.La Association disclosure regulations require that the following provisions be added to the your Contract Administration Agreement: • "Independent Corporation The Plan Sponsor hereby expressly acknowledges, on behalf of itself and all of its eligible employees and their eligible dependents, its understanding that this Contract Administration Agreement constitutes an Agreement solely between the Plan Sponsor and the Contract Administrator, that the Contract Administrator is an independent corporation operating under a license with the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans (the "Association") permitting the Contract Administrator to use the Blue Cross Service Mark in the States of Washington and Alaska, and that the Contract Administrator is not contracting as the agent of the Association. The Plan Sponsor further acknowledges and agrees that it has not entered into this Contract Administration Agreement based upon representations by any person other than the Contract Administrator, and that no person, entity or organization other than the Contract Administrator shall be held accountable or liable to the Plan Sponsor for any of the Contract Administrator's obligations to the Plan Sponsor created under this Contract Administration Agreement. This provision shall not create any additional obligations whatsoever on the Contract Administrator's part other than those obligations created under other provisions of this Contract Administration Agreement." • While BCWA has no immediate plans to amend its corporate structure, the following contract assignment provision allows us to broaden our flexibility to respond to the dynamic environment that we are all facing in the arena of health care reform. "Rights Of Assignment Notwithstanding any other provision in this Contract Administration Agreement, and subject to any limitations of state or federal law, in the event that the Contract Administrator merges or consolidates with another corporation or entity, or does business under another name or jointly with another entity, or transfers this Contract Administration Agreement to another corporation or entity, this Contract Administation Agreement shall remain in full force and effect in accordance with its terms, and bind the Plan Sponsor and the successor corporation or other entity. In such event, the Contract Administrator guarantees that all all it's obligations under this Contract Administration Agreement will be performed by the successor entity." 9 - City of Kent Section 10, 10.05 "Assignment" found in the Contract Administration Agreement will be revised as follows: "Assignment The Plan Sponsor shall not assign this agreement or any o f it's the duties or responsibilities hereunder without prior approval Contract Administrator." • PRESCRIPTION DRUG BENEFIT Your Pharmacy Drug Benefit will be revised and the following changes will be made: • For maintenance drugs, benefits are provided up to a 90-day, instead of a 100-day supply; the number of listed maintenance drugs has increased. • We've clarified that the human growth hormone drugs are not covered under the benefit. • For drugs purchased from nonparticipating pharmacies in Washington or Alaska, we now pay 60 percent of the amount we would allow for the same drug purchased at a participating pharmacy. • We've added a disclosure statement which states that we participate in a program that allows us to receive discounts on the costs of prescription drugs. The net saving generated from the discounts are passed along to you on a pro rata basis. A copy of the revised benefit is attached for reference. 10 - City of Kent PHARMACY DRUG BENEFIT This Pharmacy Drug Benefit provides coverage for medically necessary prescription drugs and insulin when prescribed by a physician for your use outside of a medical facility and dispensed by a licensed pharmacist in a retail pharmacy licensed by the state in which the pharmacy is located. For the purposes of this program, a prescription drug is any medical substance that, under federal law, must be labeled as follows: "Caution: Federal law prohibits dispensing without a prescription." It does not include any drugs labeled, "Caution--limited by federal law to investigational use." Benefits Prescription Drug Copayment Each enrollee must pay a copayment for each separate prescription or refill. The copayment amount for Generic Prescriptions is $3. The copayment amount for Brand flame Prescriptions is $7. Benefit Payment Percentages After you've paid the required copayment, the following benefits will be provided for covered prescription drugs: Participating Pharmacies In Washington Or Alaska, And Pharmacies Outside Washington And Alaska, Including Pro-Sery Pharmacies For each prescription and refill, we pay 100 percent of the amount a participating or Pro-Sery pharmacy has agreed to accept as payment in full. Nonparticipating Pharmacies In Washington Or Alaska We pay 60 percent of the amount we would have allowed for the same prescription or refill purchased at a participating pharmacy. Please Note: The copayments and coinsurance of this benefit cannot be used to satisfy any deductible or coinsurance maximum of any other benefit under this program. The deductibles and coinsurance of the Comprehensive Medical Benefits of this program do not apply to this benefit. Dispensing Limitations Acute Legend Drugs Benefits for acute legend drugs are limited to a 34-day supply. 11 - City of Kent Maintenance Legend Drugs Benefits for the following therapeutic drug classes are limited to - 90-day supply: Antiarthritic drugs Cardiac drugs Anticholinergics and Diuretics parasympatholytic agents Hormones Anticoagulants Hypotensive agents Anticonvulsants Immunosuppresants (e. g. cyclosporine) Antidiabetic agents Thyroid preparations Antifungal agents Urinary and intestinal Antihistamines anti-infectives Broncho dilators Prescription Drug Volume Discount Program Blue Cross of Washington and Alaska participates in a program that provides discounts on the costs of certain prescription drugs used by our enrollees on y the volume discount an annual basis. The total net savings generated b program is applied toward future rate calculations and/or settlements, on a pro rata basis, for all group and individual contracts with prescription drug coverage. Limitations In addition to "General Limitations And Exclusions," we will not provide this benefit for: • Contraceptive drugs and related services. • Prescription vitamins and food supplements. • Smoking cessation drugs or products. • Fertility drugs, regardless of their intended use. • Therapeutic devices or appliances (including, but not limited to, hypodermic needles, syringes, support garments, and other nonmedical substances), regardless of their intended use. • Immunization agents; biological sera, such as rabies serum; blood or blood plasma. • Services other than prescription drugs; administration or injection of any drug; drugs delivered or administered by the prescriber. • Any prescription or refill that is in excess of the quantity specified by a physician, or that is dispensed after one year from the physician's order. 12 - City of Kent • Take-home prescription drugs dispensed and billed by a medical facility. • Any claim or demai_ for injury or damage arising ii. connection with the manufacturing, compounding, dispensing, or use of any prescription drug. • Any drugs prescribed or dispensed in a manner contrary to normal medical or pharmaceutical practice. • Non-legend drugs (over-the-counter), other than insulin and ephedrine-containing products (e.g. emergency allergy treatment kits); drugs which by law do not require a physician's prescription. • Drugs which are prescribed or dispensed for cosmetic use. • Human growth hormone drugs. • Any intravenous therapy drugs or solutions; injectables or other prescriptions requiring parenteral administration or use (other than insulin) . Prescription drugs covered under this benefit are not eligible for Comprehensive Medical Benefits. Submission Of Prescription Drug Claims To make a claim for covered prescription drugs, please follow these steps: • Participating Pharmacies In Washington Or Alaska All you need to pay is the required copayment for each prescription or refill. You don't have to send us a claim; just show your coverage identification card to the pharmacist, and he or she will bill directly. If you don't show your identification card, you will have to pay the full cost of the prescription and submit the claim yourself to the address listed below. Please call or write to us for a list of pharmacies that participate in our pharmacy drug program. • Pro-Sere Pharmacies Outside Washington And Alaska Your identification card will also be honored at pharmacies in the other 48 states, Puerto Rico, and the District of Columbia that have contracts with a company called Pro-Serv. When you show your identification card, these pharmacies will bill directly, just like a participating pharmacy in Washington or Alaska. All you need to pay is the required copayment for each prescription and refill. If you don't show your identification card, you will have to pay the full cost of the prescription and submit the claim yourself to the address listed below. Please call Pro-Sery at 1-800-962-7378 to find out if a particular pharmacy outside of Washington and Alaska has a Pro-Sery contract. 13 - City of Kent There are Pro-Sery pharmacies in Washington and Alabia, too, but unless they also have a participating agreement with us, they are considered to be nonparticipating pharmacies. • Nonparticipating Pharmacies In Washington Or Alaska And Pharmacies Outside Washington And Alaska Without Pro-Sere Contracts You will have to pay the full cost of the prescriptions or refills bought at these pharmacies. Fill out a prescription drug claim form and send it to to following address. (Please ask your pharmacist to help y ou fill the form.) Blue Cross of Washington and Alaska P. 0. Box 7363 London, Kentucky 40742-7363 PART B. OPTIONAL CHANGES Not applicable. 14 - City of Kent inRT C. STATE LEGISLATIVE CHANGEo EXPERIMENTAL SERVICES EXCLUSION The State of Washington adopted a new regulation effective November 21, 1992, which required us to provide specific information about experimental and investigative services and appropriate language was incorporated into your Plan Document. Since that time, the Office of the Insurance Commissioner has required additional changes to that language to clarify intent. The changes are as follows: The following new definition will be added: "Experimental/Investigative Any service, including a treatment, procedure, facility, equipment, drug, drug usage, medical device, or supply which, as determined by Blue Cross of Washington and Alaska, meets one or more of the following criteria: • A drug or device, which cannot be lawfully marketed without the approval of the United States Food and Drug Administration, has not been granted such approval on the date it is furnished. • A facility or provider has not demonstrated proficiency in the service, based on experience, outcome, or volume of cases. • Reliable evidence shows the service is the subject of ongoing clinical trials to determine its maximum tolerated dose, toxicity, safety, or efficacy. • Reliable evidence shows that the service is not as safe and effective for a particular medical condition, as compared to other generally available services, and that it poses a significant risk to the enrollee's health or safety. Reliable evidence means only published reports and articles in authoritative medical and scientific literature, scientific results of the provider of care's written protocols, or scientific data from another provider studying the same service. The documentation used to establish our criteria will be made available for your examination, at our office, if you send us a written request." 15 - City of Kent The existing excll. .on for experimental services wi-.� be deleted and replaced with the following text: "Any service or supply which Blue Cross of Washington and Alaska determines is experimental or investigative on the date it is furnished. Our determination is based on the criteria stated in the definition of "Experimental/Investigative. If we determine that a service is experimental or investigative, and therefore not covered, you may appeal our decision. We will respond in writing within 20 working days after receipt of a claim or other fully documented request for benefits, or a fully documented appeal. The 20-day period may be extended only with your informed written consent." The first bulleted paragraph under Prior Approval" in your Organ And Bone Marrow Transplant benefit will be deleted and replaced with the following text: • ,The type of transplant must not be, in our determination, experimental or investigative. Our determination is based on the criteria stated in the definition of "Experimental/Investigative." The types of transplants that now meet our criteria include heart, heart/double lung, liver, kidney, pancreas, and certain autologous and allogeneic bone marrow transplants. Please Rote: Corneal transplants and skin grafts are covered under this program's other benefits." Under the limitations and exclusions to the Organ and Bone Marrow benefit: 1. The following item will be deleted: "• Services and supplies that are deemed experimental or investigative by us." 2. The next item will be amended as follows: 0 "Nonhuman or mechanical organs, unless we determine they are not ex erimental or investigative according to the criteria stated under "Definitions." 16 - City of Kent The new regulatior., on experimental and investigate : procedures also require revisions to the "Claim Appeal Procedures". Blue Cross of Washington and Alaska must now respond to appeals within 20 days if services are denied as experimental. The 60-day response provision under "Appeal Procedures" will be revised to read: "Our response will be mailed to you within 60 days of our receipt of the appeal. If we need more time to review an appeal, our response will not be delayed longer than 60 more days. If this should happen, You will be told of the delay and the reasons for it. The 60-day period does not apply if you are appealing our decision to deny benefits for services determined to be experimental or investigative. We will respond to those appeals within 20 working days after receipt of all documentation reasonably required to make a decision. The 20-day period may be extended only with your informed written consent. The decision made in response to any written appeal is final in our opinion." 17 - City of Kent PAR"' D. STATE MANDATED BENEFIT OFFS" *TGS CHIROPRACTIC CARE All health carriers must offer, as an option, benefits for chiropractic care on the same basis as any other care. Your current program provides limited benefits for chiropractic care. The rate adjustment for this option is: CONTINUED GROUP COVERAGE AND MEDICARE You have the option of adding a provision to your program that offers a three-month extension of group coverage to Medicare beneficiaries not eligible for COBRA. TMJ BENEFIT In accordance with Washington State law all health carriers must offer, as an option, TMJ coverage. If you elect to add this optional coverage to your medical program, eligible medical and dental services will be paid as any other medical or dental condition, up to a calendar year maximum of $1,000 per enrollee, and a lifetime benefit maximum of $5,000 per enrollee. The additional rate to add this benefit is: PART E. FEDERAL LEGISLATIVE CHANGES Family and Medical Leave Act of 1993 (Public Law 1033) The Family and Medical Leave Act of 1993 became effective August 5, 1993. The following sentence will be added to your existing "Leave of Absence" provision to bring it into compliance with the requirements of the Act. "The 180-day leave of absence period counts towards the maximum Cobra continuation period, except as prohibited by the Family and Medical Leave Act of 1993 (Public Law 1033) ." 18 - City of Kent sUPPLEM MTA1, RENEWAL NOTICE GROUP NAME: City of Kent GROUP NUMBER(S) : 13595, 13596, 13596 & Segments RENEWAL DATE: January 1, 1994 As a result of OBRA '93, we are required to make additional changes to your 1994 contract which effect the following provisions: WAITING PERIODS The following will be added to your "Waiting Periods" provision: "This waiting period limitation does not apply to the subscriber's: • natural newborn child, provided the child has been covered under this program since birth. • adoptive child, provided the child has been covered under this program since placement for adoption with the subscriber." DEPENDENT ELIGIBILITY Your "Dependent Eligibility" provision will be revised to read as follows: "To be eligible for coverage as a dependent under this program, the family member must be: • The lawful spouse of the subscriber, unless legally separated. • A "child" under 23 years of age, unmarried, and primarily dependent upon the subscriber for support. A "child" is: A natural offspring of either or both the subscriber or spouse; A legally adopted child of either or both the subscriber or spouse; or A child "placed" with the subscriber for the purpose of legal • adoption in accordance with state law. "Placed" for adoption means assumption and retention by the subscriber of a legal obligation for primary support of a child in anticipation of adoption of such child." r Ij A r FIBER COVERAGE BEGINS The following exception will be added to the "When Coverage Begins" section of your benefit booklet: "However, when we receive a completed enrollment application for a child covered under a medical child support order within 60 days of the date of the order, coverage for an otherwise eligible child that is required under the order will become effective on the date of the order. Otherwise, coverage will become effective on the subscription charge due date that coincides with or next follows the date of application for coverage. The application may be submitted by the subscriber, the child's custodial parent, or a state agency administering Medicaid. When Subscription Charges being paid do not already include coverage for dependent children, they will begin from the effective date of the child." The paragraph that addresses when an enrollee is confined in a medical facility on his or her effective date (found under "When Coverage Begins") will be replaced by the following: "If an enrollee is confined in a medical facility on his or her effective date as part of an inpatient stay that began prior to his or her effective date, no benefits will be available for expenses incurred prior to his or her discharge from that facility or from any other facility to which he or she is transferred. This restriction does not apply to a subscriber's natural newborn child, provided the child was born on or after the subscriber's effective date, or to a child placed with the subscriber for the purpose of legal adoption in accordance with state law, provided placement occurred on or after the subscriber's effective date." GENERAL PROVISIONS The "Right To And Payment Of Benefits" section found under "GENERAL PROVISIONS" in your benefit booklet will be replaced by the following: "Right To And Payment Of Benefits All rights to the benefits of this program are available only to enrollees. We will not honor any attempted assignment, garnishment, attachment or transfer of any right of this program. At our option and in accordance with federal and state law, we may Pay the benefits of this program to the subscriber, provider, other carrier, or other party legally entitled to such payment under federal or state medical child support laws, or ,jointly to any of these. Such payment will discharge our obligation to the extent of the amount paid so that we will not be liable to anyone aggrieved by our choice of payee." �..• v.. cvo U(V 0stss U CRU95 WA/AA -i-+-* R L EVANS Q002/002 PART D. STATE MABDATED BENEB�f 0MRINGS CFIIRGPW%(:T1 C CARE All health carriers must offer, as an option, benefits for chiropractic Care on the same basis as any other care. Your current program provides limited benefits for chiropractic care. The rate adjustment for this option is: CONTIi9= GROur COVERA[ AND MEAXCABE YOU have the Option of adding a provision to your program that offers s three-month extension of group coverage to Medicare beneficiaries not eligible for COBRA. TMJ HZIMMIT In accordance with Washington State law all health carriers must offer, as an option, TM.l Coverage. If you elect to add this optional coverage to your medical program, eligible medical and dental services will be paid as any other medical or dental coudi.tion, up to a calendar year maximum of $1,000 per enrollee, and a lifetime benefit maximum of $5,000 per enrollee. The additional rate to add this benefit is: FART B. YEDILQ LEGISLA7M CBA1MS Pamily and Medical Leave Act of 2923 (Public Law 1033) The Family and Medical Leave Act of 1993 became effeatiwe August 5, 1993. The following sentence will he added to your existing "Leave of Absence" provision to bring it into compliance with the requirements of the Act. "?he 180-day leave of absence period,counts towards the maximum Cobra corktimualtion period, except as prohibited by the Family and Medical Leave Act of 1993 (public Law 1033)." 19 - City of Kent