2nd Amendment 12/15/2010Monroe County Board of County Commissioners
Group Health Plan Document
Amendment #2
WHEREAS, the Monroe County Board of County Commissioners ("Plan Sponsor")
sponsors the Monroe County Group Health Plan ("Plan") effective January 1, 2010; and
WHEREAS, the Plan Sponsor reserves the right to amend the Plan at any time; and
WHEREAS, in light of the adoption of the Patient Protection and Affordable Care Act
("PPACA"), the Plan must be amended in certain particulars; and
NOW, THEREFORE, pursuant to the Plan amendment provisions, the Plan shall be
amended effective January 1, 2011 as follows:
1. Page 1-2: The "Accumulated Total Lifetime Maximum Benefit" line item of Section
1 C of the Plan is amended to read as follows:
"Accumulated Total Lifetime Maximum Benefit Per Covered Participant (includes
medical care services & pharmaceuticals) .................. Unlimited
2. Page 1-2: The "Autism Spectrum Disorder" line item of Section 1 C of the Plan is
amended to read as follows:
"Autism Spectrum Disorder Per Covered Plan Participant Per Calendar Year ......
....... $36,000"
3. Page 4-1: The Introduction section of Section 4 of the Plan is amended to read as
follows:
"Introduction
Covered Plan Participants when initially enrolled in the Plan will be subject to a Pre-
existing Condition exclusionary period, except for the following properly -enrolled
individuals: newborn or adopted dependents; and individuals under the age of 19. A
Covered Plan Participant with Creditable Coverage in effect for a continuous period
of 12 months or longer prior to initial enrollment will not be subject to a Pre-existing
Condition exclusionary period."
4. Page 7-3: The Exclusion under the "Autism" section of Section 7 of the Plan is
amended to read as follows:
"Exclusion — The plan will not pay for Covered Services which exceed the annual
maximum for Autism Spectrum Disorder listed in the Schedule of Benefits."
5. Page 9-2: Paragraph 3a of the "Eligibility Requirements for Dependent(s)" subsection
of Section 9 of the Plan is amended to read as follows:
"a. is under the age of 26 or is still within the Calendar Year in which he or she
reaches age 26 and who is not eligible to enroll in an eligible employer -sponsored
health plan other than a grandfathered health plan of a parent; or"
6. Page 11-1: Paragraph 2 of the "Termination of a Covered Dependent's Coverage"
subsection of Section 11 is amended to read as follows:
"2. on the date the Covered Dependent's coverage terminates for any reason;
a. As further clarification for purposes of this subsection, a Covered Dependent
child who has reached the end of the Calendar Year in which he or she
becomes 26, but who has not reached the end of the Calendar Year in which
the Covered Dependent child becomes 30 will lose coverage if the Covered
Dependent child incurs any of the following:
i. marriage;
ii. no longer resides in Florida or is no longer a full-time or part-time
student;
iii. obtains a dependent (e.g., through birth or adoption);
iv. obtains other coverage; or
V. on the date of termination of the Covered Employee's coverage. "
PASSED AND ADOPTED by the Board of County Commissioners of Monroe County,
Florida, at a regular meeting of said Board held on the 15th day of December , 2010.
Mayor Heather Carruthers
Mayor Pro Tern David Rice
Commissioner George Neugent
C Commissioner Kim Wigington
fturnissioner Sylvia Murphy
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BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
MON E COUNTY ATTORNEY
AP OV&HL.
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XV
NTIA HALL
ASSIST T COUIJTY ATTORNEY