HomeMy WebLinkAbout000182.tiff AMENDATORY RIDER
This Rider forms a part of the Individual Excess Risk Insurance Agreement
issued by HARTFORD ACCIDENT AND INDEMNITY COMPANY to:
WELD COUNTY
Rider Effective Date: January 1 , 1985
The Agreement is amended by the addition or deletion of the pages listed
below:
Page Numbers of Pages Added Page Numbers of Pages Deleted
ISL - 3.0 Rev. Eff. 1 -1 -85 ISL - 3.0
In all other respects, the Agreement remains the same.
Signed by the Insurance Company on / �'� �� 5� �91 r
Date
Secretar Registrar
182
GR-11221 1643C
DEFINITIONS
As used in this agreement:
. We, our, or us, means Hartford Accident and Indemnity Company or
any of its subsidiaries or affiliates which it designates to
perform the functions and the obligations to which it agrees in
this agreement.
. You or your means the employer named in the Schedule.
. He means he or she.
. His means his or her.
. Employee Benefit Plan or The Plan means the benefit plan that you
have established for Eligible Participants.
The insurance provided under this agreement applies only to the
Type of Benefits provided under the Employee Benefit Plan that
are listed in the Schedule.
. Plan Document means the written description of The Plan which is
attached to and forms a part of this agreement.
The insurance provided under this agreement is subject to all of
the terms and provisions of the Plan Document, except as
otherwise noted in this agreement.
. Eligible Participant means employees and dependents who are
eligible for benefits in accordance with the Plan Document, but
not including retired employees or their dependents.
. Proof of Loss means written evidence of a claim on a form
customarily required by the Administrator and satisfactory to us.
. Consecutive Months means, with respect to the Deductible
Accumulation Period, 365 consecutive days that begins when a
Covered Expense is Incurred. With respect to a Reimbursement
Period, Consecutive Months means 365 consecutive days that begins
when the Deductible Amount is met.
. Covered Expenses mean only those expenses that are payable under
the terms of the Plan Document and which represent the Type of
Benefits shown in the Schedule. The expenses must arise from
services and supplies which are medically necessary to diagnose
or treat an Eligible Participant's sickness, injury or pregnancy.
GR-11221 ISL - 3.0 Rev. Eff. 1 -1 -85 SL313
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