Loading...
HomeMy WebLinkAboutES10-045 - Original - LifeWise Assurance Company - Contract - 01/01/2010 w Records Marvagerne-n � - O KENT WA=„,�GToN = Document CONTRACT COVER SHEET This is to be completed by the Contract Manager prior to submission to City Clerks Office. All portions are to be completed. If you have questions, please contact City Clerk's Office. Vendor Name: ats S u 40r& GL Ojprn pA-AlY Vendor Number: g1 Lk 13 ID Edwards Number Contract Number: e 51 C) - C)�!� This is assigned by City Clerk's Office Project Name: 42610 STD P Co ismf,ZII,'a Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment VContract ❑ Other: Contract Effective Date: C) I • D I - 20 110 Termination Date: 1 oZ-3 -e2010 Contract Renewal Notice (Days): Number of days required notice for termination or renewal or amendment Contract Manager: Department: C. S• POt-0C 1:2. Detail: (i.e. address, location, parcel number, tax id, etc.): CV" 3116110 S Public\RecordsManagement\Forms\ContractCover\adcc7832 1 11/08 i LifeWise Assurance Company LJFEWISE 7001 —220'h St S.W. Mountlake Terrace, WA 98043-2124 Life I Disability I Stop Loss STOP LOSS INSURANCE POLICY LifeWise Assurance Company, Mountlake Terrace, Washington (herein we, our, and us) agrees with the policyholder to pay benefits under the provisions of the Policy POLICY NUMBER: WA-618212-9999 POLICYHOLDER: City of Kent POLICY EFFECTIVE DATE: January 1, 2010 POLICY ANNIVERSARY: January first of each year This Policy is issued in consideration of the policyholder's application and payment of premiums and will take effect on the Policy effective date This Policy is delivered in, and governed by the laws of, the State of Washington The policyholder's Plan, Schedule of Coverage, and all provisions In this and the following pages, and any amendments and endorsements included on the date of issue or added later, are part of this Policy Throughout this Policy, "you" and "your" refer to the policyholder LifeWise Assurance Company has, by its President, executed this Policy as of 12 01 am on the Policy Effective Date at Mountlake Terrace, Washington Rick Grover President and Chief Executive Officer LifeWise Assurance Company SLP WA (09-08) A TABLE OF CONTENTS WA-518212-9999 Effective 01-01-10 Title Section Schedule of Coverage 1 Definitions 2 Aggregate Stop Loss 3 Specific Stop Loss 4 General Provisions 5 Additional Provisions 6 Advance Funding for Individual Excess Loss Application 7 SLP WA (09-08) 1 Table of Contents 4 SECTION 1 LJFEWISE SCHEDULE OF COVERAGE Policyholder: City of Kent WA-618212-9999 Life I Disability I Stop Loss POLICY PERIOD January 1, 2010 through December 31, 2010 COVERAGE PROVIDED (Provided if checked): 1.1 ® AGGREGATE STOP LOSS Attachment Level ❑ 120% ❑ 125% ® Other 200% Aggregate Expense Incurral Period From January 1, 2009 through December 31, 2010 Aggregate Expense Payment Period From January 1, 2010 through December 31, 2010 A Covered Benefits ® Medical ❑ Dental ❑ Vision ❑ Weekly Disability Income ® Prescription Drugs B Aggregate Deductible (Composite) Composite Units Medical/Rx Aggregate Monthly Factor $1,865 51 C Minimum Annual Aggregate Deductible- Greater of $19,095,000 or 95% of the First Monthly Aggregate Deductible times 12. D Limit of Liability 100% of eligible expenses you pay under your Plan, in excess of the deductible, will be reimbursed to a maximum of$1,000,000. E Claim Review is ® end of Policy Period ❑ Monthly with $ threshold F Monthly Premium Rate (Composite Units) $0 01 per Employee 1.2 ® SPECIFIC STOP LOSS Specific Expense Incurral Period. From January 1, 2009 through December 31, 2010 Specific Expense Payment Period- From January 1, 2010 through December 31, 2010 A. Covered Benefits ® Medical ❑ Dental ❑ Vision ❑ Weekly Disability Income ® Prescription Drugs B $150,000 Individual Specific Deductible per person C $N/A Aggregating Specific Deductible per contract year D. Limit of Liability 100% of eligible expenses you pay under your Plan, in excess of the deductibles, will be reimbursed to a lifetime maximum of$2,000,000 E Specific Advanced Funding ® Yes ❑ No F Monthly Premium Rate ❑ Employee Only $ Family Rate $ ® Composite Employee & Dependent $44 65 1.3 ❑ TERMINAL LIABILITY PROTECTION ❑ Yes ® No If yes, number of months. SLP WA (09-08) 2 Schedule of Coverage J SECTION 2 DEFINITIONS The following definitions apply unless otherwise required by the context With the exception of "we", "us", `bur", "you" and "yours", these definitions are capitalized throughout the policy 21 Administrator means the third party administrator selected by you to perform certain functions for your Plan The term "administrator" as used in the Policy does not refer to the Plan administrator used in the Employee Retirement Income Security Act of 1974, unless you have specifically appointed the administrator as such We are not the Administrator We must approve the third party administrator selected by you 22 Aggregate Attachment Point is equal to the greater of A The sum of the Monthly Aggregate Attachment Points for the Policy Period shown in the Schedule, or B the Minimum Aggregate Attachment Point shown in the Schedule 23 Covered Benefits means those services and/or supplies received or obtained by a Covered Person that are covered by the Plan and Incurred during the Expense Incurral Period as stated in the Schedule 24 Covered Person means an employee or his or her dependent that are enrolled in the Plan during the Expense Incurral Period 25 Expense Incurral Period means the period of time as stated in the Schedule for which a Covered Person may Incur Covered Benefits under the Plan In the event that the Policy terminates prior to the end of the Policy Period stated in the Schedule, the Expense Incurral Period is modified, separately for Aggregate and Specific, to end on that date rather than at the end of the Policy Period 26 Expense Payment Period means the period of time stated in the Schedule for which you may pay for Covered Benefits under the Plan In the event that the policy terminates prior to the end of the Policy Period stated in the Schedule, the Expense Payment Period is modified, separately for Aggregate and Specific, to end on that date rather than at the end of the Policy Period plus the length of time, if any, between the end of the Expense Incurral Period stated in the Schedule and the end of the Expense Payment Period stated in the Schedule 27 Incur or Incurred means the date on which Covered Benefits was received and/or obtained by a Covered Person under your Plan 28 Initial Effective Date means the date specified in the Schedule when the Policy first becomes effective 2.9 Pay or Paid means the date your check or draft for payment of Covered Benefits is issued and mailed or electronically deposited directly to the payee, within the policy period, and that the account upon which the payment is drawn contains sufficient funds to permit the check or draft to be honored SLP WA (09-08) 3 Definitions SECTION 2 DEFINITIONS (Continued) 210 Plan means the employee benefit plan you have adopted in writing to provide benefits to your employees and their dependents, if applicable 211 Policy means this policy, any amendments to this policy, the policyholder application, Plan, and Schedule 212 Policy Period means the period of time that this Policy is effective as stated in the Schedule 213 Schedule means the Schedule of Coverage that is part of your Policy. 214 We, us and our means LifeWise Assurance Company. 215 You and your means the Policyholder SLID WA (09-08) 4 Definitions SECTION 3 AGGREGATE STOP LOSS INSURANCE 31 We will reimburse you or, if directed by you, the Administrator for a percentage of Covered Benefits Incurred during the Aggregate Expense Incurral Period and Paid by you during the Aggregate Expense Payment Period as stated in the Schedule subject to the limitations and exclusions outlined in Section 3 2 below We will only reimburse you or the Administrator for your payments that exceed the deductibles shown in the Schedule, however, the minimum risk you are required to retain is 120% of expected paid claims The percentage we will reimburse and our limits of liability are stated in the Schedule 32 There is no coverage for payments you make A which we have already reimbursed you, B which have been or will be reimbursed by another third party including, but not limited to, an insurance company or reinsurance company, or C the earlier of (i) after your Aggregate Expense Payment Period ends or (u) if the Policy is terminated prior to the completion of the applicable Policy Period, after the Policy termination date In addition, if you are covered by Specific Stop Loss in addition to Aggregate Stop Loss, we will not reimburse you for payments under the Aggregate Stop Loss if A you have been reimbursed for such payments under Specific Stop Loss, or B those payments exceed our limit of liability for Specific Stop Loss 33 The Aggregate Deductible is determined as follows A The Aggregate Deductible is the sum of the monthly deductibles for the Policy Period stated in the Schedule B Each monthly deductible is determined by multiplying the number of covered units for that month by the factors shown in the Schedule The monthly deductible cannot be reduced by more than 5% per month for any reason C The deductible is subject to the minimum Aggregate Deductible stated in the Schedule If claim review is monthly, as shown in the Schedule, the minimum Aggregate Deductible will be adjusted for the purpose of claim review to equal the minimum Aggregate Deductible stated in the Schedule multiplied by the result of the number of months elapsed in the Policy Period divided by the total number of months in the Policy Period D The monthly factors shown in the Schedule only apply to the Policy Period shown in the Schedule Factors for each Policy Period are shown in separate Schedules SLP WA (09-08) 5 Aggregate Insurance f L C SECTION 4 SPECIFIC STOP LOSS INSURANCE 4.1 We will reimburse you or the Administrator for a percentage of Covered Benefits Incurred during the Specific Expense Incurral Period and Paid by you or the Administrator during the Specific Expense Payment Period as stated in the Schedule subject to the limitations and exclusions outlined in Section 2 below We will only reimburse you for your payments that exceed the Individual Specific Deductibles shown in the Schedule The percentage we will reimburse and our limits of liability are shown in the Schedule 4.2 A separate Specific deductible applies to each Policy Period for each Covered Person under your Plan There is no coverage for payments you make. A which we have already reimbursed you, B which have been or will be reimbursed by another third party including, but not limited to an insurance company or reinsurance company, or C. the earlier of i after your Specific Expense Payment Period ends, or u if the Policy is terminated prior to the completion of the applicable Policy Period, after the Policy termination date SLP WA (09-08) 6 Specific Insurance 4 • a SECTION 5 GENERAL PROVISIONS 5.1 Limitations of Coverage A Regardless of any provisions to the contrary in your Plan, we will not provide coverage or accept liability under this Policy for the following persons 1. Any employee who was not covered under your prior stop loss policy, if any, that immediately precedes the Initial Effective Date of this Policy unless the employee meets the eligibility and actively-at-work provisions of your Plan on the Initial Effective Date of this Policy 2 Any dependent who was not covered under your prior stop loss policy, if any, that immediately precedes the Initial Effective Date of this Policy unless the dependent meets the eligibility and not-hospital-confined provisions of your Plan on the Initial Effective Date of this Policy B Payments you make for these persons may be applied toward either the Specific Stop Loss Deductible, Aggregating Specific Stop Loss Deductible or the Aggregate Stop Loss Deductible only under the following conditions 1 the employee meets the eligibility and actively-at-work provisions of your Plan and returns to work on a full-time basis Only payments you make during the Expense Payment Period for Covered Benefits Incurred after the date the employee becomes eligible under your Plan and during the Expense Incurral Period can be counted toward any deductible 2 The dependent meets the eligibility and not-hospital-confined provisions of your Plan and is no longer hospital confined Only payments you make during the Expense Payment Period for Covered Benefits Incurred after the date the dependent becomes eligible under your Plan and during the Expense Incurral Period can be counted toward any deductible 52 Evidence of Insurability We will not accept liability under this Policy for certain persons until they have submitted satisfactory evidence of insurability and have been approved for coverage The following persons must submit evidence of insurability A Persons who apply for or become eligible for coverage under your Plan while insured under Medical Conversion issued under this Policy B Persons who apply for coverage under your Plan more than 31 days after the date on which they become eligible This includes persons transferring from another employer-sponsored Plan such as a health maintenance organization (HMO) 53 Limitation of Liability Our liability under your Policy is limited to reimbursing you or, if directed by you, the Administrator for payments you have made during the Expense Payment Period for Covered Benefits Incurred during the Expense Incurral Period for Covered Persons We will not reimburse any amounts Paid outside of your Plan We will not reimburse any Covered Person or provider of services or supplies We are not liable for punitive, exemplary, special or consequential damages SLP WA (09-08) 7 General Provisions SECTION 5 GENERAL PROVISIONS (Continued) 54 Indemnification You agree to indemnify and hold us harmless from and against any and all claims, losses, liabilities, damages, costs or expenses of any kind incurred by us, including, without limitation, reasonable attorney's fees, arising out of or in connection with a breach of this Policy or error or omission by you, your officers, employees, agents or Administrator under this Policy 5.5 War Exclusion We will not reimburse you for any loss or expense caused by or resulting from war War means declared or undeclared war, whether civil or international, and any substantial armed conflict between organized forces of a military nature 56 Subrogation You may be entitled to recover from third parties for Covered Benefits that you pay under your Plan We will not reimburse you for any payments you recover or the cost associated with making such recovery You cannot use the recovered amount to meet any deductible under this Policy If we have reimbursed you for all or part of a particular Covered Benefit that you Paid and you later recover reimbursement from a third party, you must repay us within thirty (30) days of receipt of such recovery, regardless of whether your Policy is still in force on the date you recover Your repayment may be reduced prorata by the reasonable and necessary expenses you pay in recovering from the third party Within thirty (30) days following the end of each Policy Period, you must provide us with a list of all potential subrogation recoveries for payments that either you have already received reimbursement from us or you are submitting to us for reimbursement 57 Administration If you use the services of an Administrator to perform any functions for your Plan, the Administrator performs as your agent We will not be held liable for any act, error or omission of an Administrator, including amounts Paid outside of your Plan Changes in Administrators must be approved in writing by us or we have the right to terminate coverage (See Section 5 21) 58 Records and Review You must maintain appropriate records regarding administration of your Plan for a minimum period of six (6) years Within a reasonable time period following our request, you must allow us to review and copy, during normal business hours, all records affecting our liability under your Policy 5.9 Audit We have the right to inspect and audit all your records and procedures, as well as those of your Administrator and to require, upon request, proof satisfactory to us that the payments which are the basis of any claim have been made SLP WA (09-08) 8 General Provisions SECTION 5 GENERAL PROVISIONS (Continued) 510 Claims Under This Policv If you submit a claim to us, you must do so in writing to our Home Office within 90 days after the end of the Expense Payment Period for which claim is made You must provide us with whatever information we need for proof of A covered Benefit Incurred during the Expense Incurred Period, B payment by you for the Covered Benefit during the Expense Payment Period, and C meeting of any deductible We will not refuse to reimburse you merely because you were late in submitting the claim to us, as long as you submitted it as soon as reasonably possible and within one year We will not pay any benefits if we have not received all premiums due We will reimburse you under Aggregate Stop Loss after we receive your request for reimbursement but not sooner than the end of the Policy Period, unless the Monthly Claim Review is included in the Policy as indicated in the Schedule 5,11 Entire Contract This Policy, along with any Attachments, Riders, Endorsements or Amendments, and the Application completed by you constitutes the entire contract of insurance between us 5.12 Legal Action You cannot file suit until 60 days after the date on which you submit proof of claim as required by your Policy You cannot file suit more than six years after the date on which you must give us proof of claim The six year limitation is extended, if necessary, to agree with the time period allowed by the law of the jurisdiction in which this Policy is issued 513 Governing Law and Venue This Policy is delivered in, and governed by the laws of, the State of Washington, without regard to conflict of law principles You consent to personal jurisdiction and agree that all judicial proceedings shall be brought in the Superior Court in King County, Washington located in Seattle, Washington 514 Notice of Appeal You must notify us in writing if it appears benefits will be payable under the Policy due to any objection, notice of legal action, or complaint you or your Administrator receives 5.15 Worker's Compensation This Policy does not cover expenses your Plan covers that are also eligible expenses covered by Worker's Compensation or similar law whether or not such coverage is actually in force 5.16 Change in Plan Covered Benefits that are insured under your Stop Loss Insurance Policy constitute a part of your Stop Loss Insurance Policy Any changes to Covered Benefits made during the Policy Period must be approved by us in writing If you make changes in your Plan, those changes become a part of your Stop Loss Insurance Policy only after we approve them in writing Changes in Administrators must be approved in writing by us SLP WA (09-08) 9 General Provisions r M SECTION 5 GENERAL PROVISIONS (Continued) 517 Notice For the purpose of any notice required from us, notice to the Administrator will be considered notice to you and notice to you will be considered notice to the Administrator Any notice required from you shall be in writing and sent, postage prepaid, to us at 7001 — 220th Street SW, MS 225, Mountlake Terrace, Washington 98043 518 Amendment Your Policy may be changed at any time by a written agreement signed by you and us Notice to any agent or knowledge possessed by any person cannot change your Policy or stop us from asserting our rights We will not change the rates or factors more often than once every Policy Period unless you change your Plan or add employees in other locations or industries 519 Premiums You must pay premiums to us at our Home Office We must receive payment within 15 calendar days from the date the premium statement was issued Your payment will only continue your insurance until the next premium due date 520 Grace Period If, before any premium due date except the first, you have not given written notice to us of your intention to terminate the policy, a grace period of 31 days will be given in which to pay the premium then due The Policy will stay in effect during that time If the premium due is not paid by the end of the grace period, the Policy will automatically terminate on the last day for which premium was paid and any claims incurred after the premium due date will not be covered by the Policy, except that if you have given written notice in advance of an earlier date of termination, the Policy will terminate as of the earlier date 5 21 Termination A You may terminate your Policy at any time by giving us written notice Your Policy will end no sooner than the end of the month following the month the termination notice was received by us B We may terminate your Policy at any time by giving you 45 days written notice for the following reasons 1. You fad to comply with a provision of your Policy, 2 You fad to perform your Policy obligations in good faith, or 3 If you fail to maintain a minimum of 50 Covered Persons in each of two consecutive months. C. If this Policy terminates for any reason during the Policy Period, there will be no proration of the Minimum Aggregate Deductible. D We may terminate the Policy if a change in Administrators is not approved in writing by us. (See Section 5 7) SLP WA (09-08) 10 General Provisions y "a SECTION 5 GENERAL PROVISIONS (Continued) 522 Renewal We may refuse to renew your Policy by giving you 45 days written notice Otherwise, your Policy will automatically renew on each Policy anniversary if you continue to pay premiums at the rates we set We reserve the right to adjust our renewal offer if the average paid claims in the last two months of the Policy Period exceeds the average paid claims of the immediate prior three months by 20% or more 523 Clerical Error Clerical error, whether made by us or you or your Administrator, in keeping records will not invalidate coverage that otherwise should be in force or continue coverage that otherwise should be terminated 524 Conformity With Statutes If any time limitations with respect to giving notice of claim or furnishing proof of loss or bringing action is less than that permitted by law in the jurisdiction governing the Policy, that time limit is extended to the minimum permitted by law 525 Refund of Over-reimbursement If we, you, or your Administrator determine that we have over-reimbursed you under this Policy, You will promptly refund such over-reimbursement to us within sixty (60) days of such a determination If we are required to take legal action to collect such over-reimbursement, you agree to indemnify us for any costs of collection, including, but not limited to, attorneys fees and court costs The right to recovery shall survive the termination of this policy 526 Responsibility For Your Administrator You are solely responsible for the actions of your Administrator, and any other agent of yours Your Administrator acts on your behalf, not on our behalf Your Administrator is not our agent We are not responsible for any compensation owed to, or claimed by your Administrator or other agents for services provided to, or on behalf of, your Plan This Policy does not make us a party to any agreement between you and your Administrator, nor does it make your Administrator a party to this policy 5 27 Bankruptcy or Insolvency The bankruptcy, insolvency, dissolution, receivership or liquidation of you, your plan or your Administrator will not impose upon us any obligations other than those set forth in this Policy SLP WA(09-08) 11 General Provisions 4 SECTION 6 ADDITIONAL PROVISIONS Advance Funding—Individual Excess Loss Advance funding is available to you for Covered Benefits Incurred during the Expense Incurral Period and paid by your Administrator during the Expense Payment Period upon meeting all of the following conditions A The Individual Specific Deductible for a Covered Person has been met, and B Covered Benefits eligible for advance funding are those that exceed the Individual Specific Deductible, and C Claims available for advance funding must be fully processed and Paid by your Administrator within the Expense Payment Period and according to your Plan, and D Your Administrator must bill us monthly for claims Paid under the advanced funding request but in no event within 60 days after the end of the Expense Payment Period specified in this Policy Requests received after that date are not eligible for advance funding, and E. We will remit payment for approved claims to your Administrator within 30 days of receipt of advanced funding request SLP WA (09-08) 12 Advance Funding Lifetl me Assurance Company DFEWISE ' PO Box 2272 Seattle,WA 98111-2272 Life t bive6illrr I Hop Lava STOP LOSS INSURANCE APPLICATION The undersigned applicarst(you and your)applies for the following coverage: Applicant Detaits Legal Name of Applicant. City of Kent Address 220 Fourth Ave Si, Kent, WA 98032-5896 Name of Third Party Administrator- Premera Blue Gross Address: 7001 22e St SW, Mountlake Terrace,WA 98043-2124 Proposed Effective Date 01/01/2010 No insurance is in force until and unless approved by LifeWise Assurance Company(we, us and our)at our Home Office, Deposit based on 853 _ employees and 596 dependent units, of $38,096-00 is enclosed to apply to the first payment under the policy, if issued. Aggregate Stop Loss 0 Yes ❑ No ❑120% ❑1251% Other 200 % 1. Benefits to be covered: 0 Medical ❑ Dental ❑Vision ❑Weekly Disability income ® Prescription Drugs ❑ tither: 2 Aggregate Deductible: Composite units Medlca_yel gPI V"Dentall Visionl Rxl Otherl Monthly Factor $1,865 51 $ $ $ $ 3. We will reimburse you 100% of expenses you pay under your plan In excess of the deductible The maximum we will reimburse you per policy period: 0$1,000,000 ❑Other- $ 4. Contract Basis: ❑ 12112 ❑ 12115 ❑ 15112 24112 5. Claim Review: ❑ Monthly with a $ Threshold ® End of Policy Period 6 Monthly Premium Rate- $0.0 i_. _ per Composite Employee Specific Stop Loss 0 Yes ❑ No 1 Benefits to be covered: ®Medical ❑ Dental ❑Vision ❑Weekly Disability Income ®Prescription Drugs ❑Other: 2. $150,000 deductible per person 3 We will reimburse you 100%of expenses you pay under your plan in excess of the deductible The maximum we will reimburse you per person, lifetime ❑ $1,000,000 10 Other, 02.COO,000 Gp 4. Contract Basis ❑ 12112 ❑ 12115 ❑ 15112 24112 _ 5. Aggregating Specific ❑ Yes No If yes, $ deductible per contract year 6 Specific Advanced Funding. ® Yes ❑No 7, Monthly Premium Rate- (checklct:mplete only one) ❑ Employee Only $ Dependent$ ® Composite Employee&Dependent $44.65 Terminal Ltabliity Protection ❑Yes ®No if yes,number of months: Please see reverse side for fraud statements. Signatures Date i Signed at +Officers Signature officer's Name and Title tt SLP App(09--08) Application Fraud Statements Arizona: Any life insurance producer, examining physician or other person who knowingly makes a false or fraudulent statement or representation on or relative to an application for life or disability insurance, or who makes any such statement to obtain a fee,commission,money or benefit is guilty of a Class 2 misdemeanor. California: Any person who knowingly presents a false or fraudulent claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison. New Mexico. Any person who knowingly presents a false or fraudulent claim for payment of a loss of benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to civil fines and criminal penalties. Washinaton: It is a crime to knowingly provide false, incomplete, or misleading information to an Insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines, and denial of insurance benefits. All other states: Any person who knowingly presents a false or fraudulent claim for payment of a loss or beneflt or knowingly presents false information in an application for Insurance may be guilty of a crime and may be subject to civil fines and criminal penalties. fi 3 SLIP App(09-08) Application f y AMENDMENT NO. 01 This amendment becomes a part of Stop Loss Policy No WA-518212-99999 issued to City of Kent, the Policyholder It is stipulated and agreed that Effective January 1, 2010, revised January 20, 2010. The following pages are replaced: Page 3—4, Definitions All other terms and conditions of the contract remain unchanged LifeWise Assurance Company Rick Grover President and Chief Executive Officer 1 Instructions Retain copy with your policy. SLIP WA AMD (09-08) Amendment i SECTION 2 DEFINITIONS Effective 01-01-10 Revised 01-20-10 The following definitions apply unless otherwise required by the context. With the exception of "we", "us", 'bur", "you" and "yours", these definitions are capitalized throughout the policy 21 Administrator means the third party administrator selected by you to perform certain functions for your Plan The term "administrator" as used in the Policy does not refer to the Plan administrator used in the Employee Retirement Income Security Act of 1974, unless you have specifically appointed the administrator as such We are not the Administrator We must approve the third party administrator selected by you 22 Aggregate Attachment Point is equal to the greater of A The sum of the Monthly Aggregate Attachment Points for the Policy Period shown in the Schedule, or B the Minimum Aggregate Attachment Point shown in the Schedule 23 Covered Benefits means those services and/or supplies received or obtained by a Covered Person that are covered by the Plan and Incurred during the Expense Incurral Period as stated in the Schedule 24 Covered Person means an employee or his or her dependent or a Leoff 1 retiree or his or her dependent that are enrolled in the Plan during the Expense Incurral Period 25 Expense Incurral Period means the period of time as stated in the Schedule for which a Covered Person may Incur Covered Benefits under the Plan In the event that the Policy terminates prior to the end of the Policy Period stated in the Schedule, the Expense Incurral Period is modified, separately for Aggregate and Specific, to end on that date rather than at the end of the Policy Period 26 Expense Payment Period means the period of time stated in the Schedule for which you may pay for Covered Benefits under the Plan In the event that the policy terminates prior to the end of the Policy Period stated in the Schedule, the Expense Payment Period is modified, separately for Aggregate and Specific, to end on that date rather than at the end of the Policy Period plus the length of time, if any, between the end of the Expense Incurral Period stated in the Schedule and the end of the Expense Payment Period stated in the Schedule 27 Incur or Incurred means the date on which Covered Benefits was received and/or obtained by a Covered Person under your Plan. 28 Initial Effective Date means the date specified in the Schedule when the Policy first becomes effective 29 Pay or Paid means the date your check or draft for payment of Covered Benefits is issued and mailed or electronically deposited directly to the payee, within the policy period, and that the account upon which the payment is drawn contains sufficient funds to permit the check or draft to be honored. SLP WA (09-08) 3 Definitions f SECTION 2 DEFINITIONS (Continued) Effective 01-01-10 Revised 01-20-10 2 10 Plan means the employee benefit plan you have adopted in writing to provide benefits to your employees and their dependents, if applicable 211 Policy means this policy, any amendments to this policy, the policyholder application, Plan, and Schedule 212 Policy Period means the period of time that this Policy is effective as stated in the Schedule. 213 Schedule means the Schedule of Coverage that is part of your Policy. 2.14 We, us and our means LifeWise Assurance Company 215 You and your means the Policyholder. SLP WA (09-08) 4 Definitions a i