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RESOLUTION
RE : APPROVAL OF AMENDMENT NO. 8 TO GROUP POLICY NO. GM-8864 --
PACIFIC MUTUAL LIFE INSURANCE COMPANY AND WELD COUNTY AS
POLICYHOLDER.
WHEREAS, the Board of County Commissioners of Weld County,
Colorado, pursuant to Colorado statute and the Weld County Home
Rule Charter, is vested with the authority of determining the
affairs of Weld County, Colorado, and
WHEREAS, heretofore, Weld County, by Resolution, did enter
into a contract with Pacific Mutual Life Insurance Company for
group insurance covering Weld County Employees under various
group insurance policies, including group policy No. GM-8864 ,
and amendments thereto, and
WHEREAS , Pacific Mutual Life Insurance Company has submit-
ted an amendment entitled Amendment No. 8 to group policy No.
GM-8864 which amendment makes changes in the original group
policy No. GM-8864 , and
WHEREAS , the Board of County Commissioners of Weld County,
Colorado believes it to be in the best interest of Weld County
to accept the aforementioned Amendment No. 8 to policy No.
GM-8864.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Com-
missioners of Weld County, Colorado, that the hereinabove men-
tioned Amendment No. 8 to group policy No. GM-8864 concerning
a policy issued by Pacific Mutual Life Insurance Company to
Weld County as policyholder, be and hereby is approved.
The above and foregoing Resolution was, on motion duly made
and seconded, adopted by the following vote on the 27th day of
June, A.D. , 1977.
The above and foregoing Resolution was read into the record
and signed on the 29th day of June, A.D. , 1977.
BOARD OF COUNTY COMMISSIONERS
WELD C TY, COLOP DO
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ATTEST: 11
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Weld County Clerk and Recorder
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- POLICYHOLDER'S COPY
•
AMENDMENT NO. 8
Attached to and part of Group Policy No. GM-8864 by and between Pacific Mutual Life Insurance
Company, and the Policyholder,
WELD COUNTY, COIDRADO.
The Policyholder and Pacific Mutual hereby agree that the policy is amended, as of the effective date
stated on each amended page, by deleting from the policy the page or pages thereof listed under
Column I and inserting into the policy the attached page or pages listed under Column II, each marked
by "Amendment No. 8 effective January 1, 1977".
COLUMN I - PAGES DELETED COLUMN II - PAGES INSERTED
10A-2-b 10A-2-b
IN WITNESS WHEREOF, the parties hereto have, by their duly authorized representatives set their hands
on the date set forth beneath their respective signatures.
POLICYHOLDER PACIFIC MUTUAL LIFE INSURANCE COMPANY
gnat a of Officer President 1511TITLE Chairman Pro Tan 4'1Ssj 7 e594/0-44.
Board of County Ca[missioners Secretary
DATE June 29, J 977 ATTEST "'✓ / � �' " _" ���
Registrar
DATE F4A---e.
/ , /7 7
GR-4827-B
COMPREHENSIVE MAJOR MEDICAL EXPENSE BENEFITS (Continued)
(XV) charges incurred in connection with any illness contracted or sustained by a covered person before the effective date of the
insurance under this policy with respect to such person; but this exception shall not apply as to
(a) charges not in excess of$5,000.00 incurred,during the first policy year by or on behalf of a covered person with respect
to whom insurance hereunder became effective on the effective date of this policy;
(b) charges not in excess of$1,000.00 incurred,during the fast twelve months of coverage, by or on behalf of a covered
person with respect to whom insurance hereunder becomes effective after the effective date of this policy; or
(c) charges incurred by or on behalf of any covered person after the end of any ninety-day period ending subsequent to the
effective date of the insurance hereunder with respect to such person, during which period such person receives for or in
connection with such illness neither medical, surgical, hospital, or nursing treatment or services of any kind, nor any
drugs a medicines lawfully obtainable only upon prescription of a physician;
(d) charges incurred by or on behalf of any covered person more than one year after the effective date of the insurance
hereunder with respect to such person; or
(e) charges incurred by or on behalf of a covered person who is employed in the Policyholder's Health Department, or who
is a dependent of such employee, who became covered under this policy on January 1, 1977, and was covered imme-
diately before that date under a Blue Cross-Blue Shield group plan.
In no event shall the eligible charges include charges for services, treatments or supplies which are not reasonably necessary for the
care and treatment of the illness, nor shall charges for any services, treatments or supplies which are unreasonably priced be included
in excess of reasonable charges therefor.
COORDINATION OF BENEFITS. All benefits under this policy payable for charges incurred or as a credit toward any applicable
cash deductible are subject to this provision.
The term "allowable expense" means any necessary, reasonable, and customary item of expense at least a portion of which is
covered under at least one of the plans covering the person for whom claim is made.
The tern "plan" includes the benefits payable under this policy and any other hospital, surgical, medical or major medical bene-
fits provided by (f) group, blanket or franchise insurance coverage, (11) group Blue Cross, group Blue Shield, group practice, and
other prepayment group coverage, (iii) any coverage under labor-management trusteed plans, union welfare plans, employer
organization plans, or employee benefit organization plans, and (iv) any coverage under governmental programs, and any cover-
age required or provided by any statute.
The term "plan" shall be construed separately with respect to each policy, contract, or other arrangement for benefits or services
and separately with respect to that portion of any such policy, contract or other arrangement which reserves the right to take the
benefits or services of other plans into consideration in determining its benefits and that portion which doei not.
Benefits under this policy will be reduced if, with respect to any calendar year, the benefits that would be payable under all plans
in the absence of this provision and similar provisions in other plans would exceed the total allowable expense.
Notwithstanding any other provisions of this policy, if this provision applies, the benefits payable under this policy with respect
to a covered person will be reduced so that the total payments provided or available to or for the benefit of such person, under all
plans as defined above, do not exceed 100%of the allowable expense.
Whenever payments which should have been made under this policy in accordance with this provision have been made under any
other plan, the Insurance Company shall have the right, exercisable alone in its sole discretion, to pay over to any organizations
makeing such other payment any amounts it shall determine to be warranted in order to satisfy the intent of this provision, and
amounts so paid shall be deemed to be benefits paid under this policy and, to the extent of such payments, the Insurance Com-
pany shall be full discharged from liability under this policy.
Whenever payments have been made by the Insurance Company with respect to allowable expenses in a total amount, at any
time, in excess of the maximum amount of payment necessary at that time to satisfy the intent of this provision, the Insurance
Company shall have the right to recover such payments, to the extent of such excess, from among one or more of the following
as the Insurance Company shall determine:
(a) any persons to, or for, or with respect to whom such payments were made;
(b) any other insurance companies; or
(c) any otherorganizations.
GR.231 (8864) PAGE 10A-2-b
AMENDMENT NO. 8 EFFECTIVE JANUARY 1, 1977
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