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1996-033-RES WHEREAS, CITY COUNCIL DID HERETOFORE ON THE 13TH DAY OF FEBRUARY 1995
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1996-033-RES WHEREAS, CITY COUNCIL DID HERETOFORE ON THE 13TH DAY OF FEBRUARY 1995
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Last modified
8/18/2006 4:31:41 PM
Creation date
4/6/2005 5:19:58 AM
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CITY CLERK
Doc Name
1996
Doc Type
Resolution
CITY CLERK - Date
4/8/1996
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<br />b. "Contractin~ Hosoital" mcans any Hospital with which an Agreement has been executed providing <br /> <br />for discounts available to the Contractor, which has an effectivc datc on or after January I, 1992, and <br /> <br />which continues in effect during the teml of this Addendum. <br /> <br />c. "Covered Service" means a Contracting Hospital health care service which qualifies for the <br /> <br />application of payment under the terms of the Plan. <br /> <br />d. "Covered Service Amount" means the amount eligible for reimbursement under the Plan for any <br /> <br />Hospital health care service or supply provided to Participants for which benefits are provided by a <br /> <br />Contracting Hospital pursuant to the Plan after application of applicable co-payments and deductibles, <br /> <br />which amount is based on the regular rate charged by the Hospital for such services or supplies. <br /> <br />"Covered Service Amount" includes only those hospital admissions which commence after the <br /> <br />effective date of this Addendum which are paid by Contractor while this Addendum is in force and <br />effect. <br /> <br />e. "Discount" shall mean the difference between Covered Servicc Amount and the amount which the <br /> <br />Hospital requires to be paid for those Services as determined in accordance with its applicable <br /> <br />Discount Agreement. <br /> <br />SECTION 3. APPLICATION OF DISCOUNT <br />3.1 The Contractor shall perform claims administration services pursuant to the Administrative Services <br />Agreement between the parties. Subject to Section 5 hereof, all applicable Discounts allowed to the <br />Contractor shall be applied to Covered Service Amounts which are incurred in connection with the <br />admission of a Participant to a Contracting Hospital and which occur while this Addendum is in force <br /> <br />and effect and while a Member Hospital Agreement is in effect with the Hospital providing the care. <br /> <br />2 <br />
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