SANTA ANA POLICE BENEVOLENT ASSOCIATION (7)

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LETTER OF UNDERSTANDING AND AGREEMENT BETWEEN THE CITY OF SANTA ANA AND THE SANTA ANA POLICE BENEVOLENT ASSOCIATION The City of Santa Ana and the Santa Ana Police Benevolent Association agree that the existing plan document for the self-insured, indemnity health insurance plan (UWACO- administered) provided by the City for its employees and their dependents will be amended to provide for the following changes: 1. That the wording of the Deductible Amount clause will be revised so as to ensure that the benefit will continue to be administered in the manner in which it is being currently administered. 2. That the following clause regarding pre-existing conditions will be added: "With respect to a sickness or accidental injury existing prior to becoming insured for these benefits, no expenses incurred will be considered Eligible Medical Expenses, and no benefits will be payable, except expenses incurred in connection with such sickness or accidental injury after: A. A period of at least three (3) consecutive months has been completed on or after the effective date of his or her insurance, during which time the Insured or Insured Dependent has incurred no expenses and received no medical treatment in connection with the sickness or accidental injury; B. A period of at least twelve (12) consecutive months has elapsed, during } which time the Insured or Insured Dependent has been continuously insured for these benefits; or C. A period of at least six (6) consecutive months has elapsed, with respect to an Insured only, during which time the Insured has been continuously insured for these benefits and has been continuously actively at work." 3. That the following clause regarding the individual stop-loss limit on out-of- pocket expenses will be added: "When an Insured or an Insured Dependent has incurred $500 in out-of-pocket expenses in a calendar year due to the 80% co-insurance feature of the plan, the plan will pay 100% of the excess on any expenses covered by the plan incurred during the remainder of that calendar year. This $500 limit is in addition to the required $100 deductible amount per person per year. Any out-of-pocket expenses applied against the $500 stop-loss limit by an Insured or Insured Dependent during the last three months of the calendar year shall be carried over and applied against the $500 stop-loss limit for the next succeeding Calendar Year. "Out-of-pocket" means the coninsurance amounts paid by the Insured or Insured Dependent."