1st Amendment 07/21/2010
Monroe County Board of County Commissioners
Group Health Plan Document
Alllendlllent #1
THIS AMENDMENT to the Monroe County Board of County Commissioners
Group Health Plan Document (the "Plan Sponsor") effective this rt day of August, 2010.
WHEREAS, the Plan Sponsor reserves the right to amend the Plan at any time; and
WHEREAS, this Amendment has been duly adopted by the Plan Sponsor to
incorporate the following provisions.
NOW, TIIEREFORE, pursuant to the Plan amendment provision, the Plan shall be
amended as follows:
Page 1-1
Amend Section 1 - Schedule of Benefits to read as follows:
B. OFFICE~ SERVICES
Benefit Description
In-Network
Out-of-Network
l)h\"slcian ()ffice \!islts
1 O()O 0 of,\ llo\ved
,\nl()Unt, no l)educrible
after a $20
4500
.1'hc co-pay l)enefit includes physician office
visit routine cart.\ diagnosis and treat1l1cnt
of an illness or non-\v()rk related injury. '],he
benefit docs nor include diagnostics, surgical
procedures.. fHf ospital sef\'iccs, obstetric care,
radiation, speech or phy'sical therapy.
'l'he benefit not include chirc)pracrors (see
Benefit I\Iaxinlunls ~pinal I\Ianipulations and
l\Iassage 'fhcra )\).
\dult \X!eJlncss IZcfer tC) licncfit [\faxin1unls
() f . \ lIo\vcd \ 1110un t
$400 \Iaxinlunl ,\llo\ved
L\ ftet' $20 co"... Jar
S400 !\[axinlU1l1
.\U()\vcd
()ffice [)iagnostics 75()'(j 45u'(j
(Billed \vith or \virhout an office visit) of,\llo\ved\tTIount of ; \llo\vcd ,\tTIount
I)urable l\fedical Equipment, Prosthetics and 750/0 450/0
()rthotics of -1\llo\ved 1\mount of I\llowed Amount
Note: A Covered Plan Participant should verify a Provider's participation status prior to receiving
Health Care Services. To verify a Provider's participation status just access anyone of our three
PPO Networks through our \veb site at
http://n1()nroccofl.virtualto\vl1hall.net/llages/i\Ionroe(:01,'1 C;rouplnsurancc/itldcx or contact the
Benefits Office at 305-292-4579 or 305-292-4446 for assistance.
10f2
Monroe County Board of County Commissioners
Group Health Plan Document
Amendment #1
Effective August 1, 2010
PASSED AND ADOPTED by the Board of Cout]! commi~f Monroe County, Florida,
at a regular meeting of said Board held on the ~ day of ,2010.
Ma~{or Sylvia Murphy Yes
Ma~ror Pro Tern Heather Carruthers Yes
Conlmissioner Kim Wigington Yes
Conlmissioner George Neugent Yes
.Conlmissioner Mario Di Gennaro Yes
L"r~~'t:~~~'l'JNY L. KOLHAGE, Clerk
...~~~-\ ~....S:-.:.; /
"':-:'. (/. '/ r/ ./\ / ;J
.......By..~.~;.,.. '1fL.~'//..~~~/'>~
D~puty clerk
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
By
.~
Ma yor/Chairperson
MONROE lJ /\TTORNEY
~f\PPR?~~[) .A,S TO FORM:
(h/,j~ I r r:J0u';' Cu t/-.-hd:'1ft":; dl
CHRISTINE M. LI~_4BERT-BARROWS
ASSISTANT COUl\ffY ATTORNEY
Date ----4-tL~.f-tTd.cl[~_.-
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