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Home My WebLink AboutJULY 8, 1985 MINUTES Cit@ (Df "WORLD'S LARGEST RESORT CITY" CFIY COUNCIL MA YOR HAROLD HFJSCROBER, At L-g, VICE-MAYOR REBA S. MCLINAM @.. A- B-gh JOhW A. RAEW, Dik.W- @k NANCY A. CREECH, At @ RO@ L @ V@ B..h @h @ M RENLEY @ @A H@ JACK JEWINGS. JR.. L@-- B-wh LOUIS R. JONES, By@ @h RODFRT G. JONM. Al @, J, HENRY MCOY, JR., B-gh MEMA E OBERAU)ORF At L.,V. 281 CTRY HALL BUILDING RUTH HODGES SMRFH. CVC, aty @k CITY COUNCIL AGENDA MUNICIPAL @ VIRGINIA @ Cff, VIRGINIA MU6-MM 18041427@ July 8, 1985 Virginia Beach City Council BRIEFING - Conference Room - 10:00 AM Interia CIP Presentation a. Priorities b. Water and Sewer ITEM I. MEFTING OF VIRGINIA BEACH CITY COUNCIL - Conference Room - 1:00 PM A. CALL TO ORDER - Mayor Harold Heischober B. ROLL CALL OF COUNCIL C. MOTION TO RECESS INTO EXECUTIVE SESSION ITEM II. REGULAR SESSION OF VIRGINIA BEACH CITY COUNCIL - Council Chambers - 2 PM A. IRVOCATION: Reverend Charles H. Jones Pastor, Kempsville Baptist Church B. PLEDGE OF ALLEGIANCE TO THE FLAG OF THE UNITED STATES OF AMERICA C. ELECTRONIC ROLL CALL OF CITY COUNCIL D. CITY MANAGER'S ADMINISTRATIVE ITEMS ----- ----- F. MINUTES Motion to accept/approve the Minutes of July 1, 1985. G. PLANNING 1. Application of Gerald and Eva Phelps for a Subdivision variance [Section 4.4(b)] located on the north side of Lake Bradford Drive, west of Pleasure House Road (Bayside Borough). a. Letter from the City Manager transmits the recommendation of the Planning Commission for approval. 2. Application of Paul L. Strassberg for a Subdivision variance [Section 4.4(c)] located on the west side of North Lynnhaven Road, south of Shakespeare Drive (Lynnhaven Borough). a. Letter from the City Manager Lransmits the recommendation of the Planning Commission for approval. 3. Application of Gordon Realty and Vaz, Inc. for changes of zoning on parcels located on the north side of Bonney Road, southeast of Independence Boulevard (Kempsville Borough): From I-' Lght I ndustrial District to B-3 General-Business Distric, n a 24 '394 -square foot loi; AND, From B-2 Community-Business District to B-3 General Business District on a 3.32-acres. a. Letter from the City Manager Lransmits the recommendation of the Planning Commission for approval. 4. Application of Walter J. and Margaret S. Leveridge for a change of zonine, from R-6 Residential District to R-8 Residential District on a 2.75-acre parcel located on the west side of Beaufort Avenue, north of Athens Boulevard (Bayside Borough). a. Letter from the City Manager transmits the recommendation of tlie Planning Commission to allow withdrawal. 5. Application of Johnson, Inc. t/a Henry Johnson Tire Center for a conditional use permit for tire sales, installation, and repair on a 32,670-square foot parcel located at the northwest corner of Laskin Road and Oriole Drive (Lynnhaven Borough). a. Letter from the City Manager transmits the recommendation of the Planning Commission for approval. 6 Application of Larkspur Professional Building, Inc. for a change of zoning from P-1 Preservation District to B-2 Community-Business District on a 1.412-acre parcel located north of Holland Road, east of Edwin Drive (Kempsville Borough). a. Letter from the City Manager transmits the recommendation of the Planning Commission for approval. 7. Application of John R. Pflug, Jr. for changes of zoning (Bayside Borough): From B-3 General-Business District to I-I Light Industrial District on a 3.716-acre parcel-located at the southern extremity of Lavender Lane, Lots 43-47, Block 58, Parcel 1B, Euclid Place; AND, From 1-1 Light Industrial District to B-3 General-Business District on a 3.013-acre parcel located at the southwest corner of Cleveland Street and Lavender Lane, Lots 1-28/29- 33, Block 57, Euclid Place. a. Letter from the City Manager transmits the recommendation of the Planning Commission for approval. 8. Application of Melvin A. and Jimmie A. Koch for a cond illioanal.u e.,ermit for an increase in density (thirteen add on I n 71:)on a 14,000-square foot parcel located at the northwest corner of 37th Street and Atlantic Avenue (Virginia Beach Borough). a. Letter from the City Manager transmits the recommendation of the Planning Commission for oval. 9. Application of J & A Associates for a change of zoning from A-1 Apartment District to B-4 Resort Commercial District on @7,000-square foot parcel located on the north side of 29th Street, west of Pacific Avenue (Virginia Beach Borough). a. Letter from the City Manager transmits the recommendation of the Planning Commission for approval. 10. Application of Thomas M. and Lela F. Murphy for a conditional use permilt: for an increase in density to 120 7od-ging units on a 25,/Oo-square foot parcel located at the northeast corner of Pacific Avenue and 10th Street (Virginia Beach Borough). a. Letter from the City Manager transmits the recommendation of the Planning Commission for approval. 11. Application of Billy H. Barnes for a conditional use permit for a day care center on a 35,284-squ r. f-Ot parcel located at the northeast corner of Salem Road and Zodiac Lane (Kempsville Borough). a. Letter from the City Kanager transmits the recommendation of the Planning Commission for approval. 12. Application of Joseph H. Watson, Jr. and Gail Z. Watson for a conditional use permit for a miniature golf course and golf sales store on a 6.01-acre parcel located on the south side of Virginia Beach Boulevard, west of Parker Lane (Lynnhaven Borough). a. Letter from the City Manager transmits the recommendation of the Planning Commission for approval. 13. Application of Pacific Corporation for a change of zonia& from A-1 Apartment District to 0-1 Office District on a 14,000-square foot parcel located on the south side of 35th Street, east of Arctic Avenue (Virginia Beach Borough). a. Letter from the City nanager transmits the recommendation of the Planning Commission for approval. 14. Application of Contractors Grading and Equipment Corporation for a conditional use permit for a contractor's storage yard on a 2.376-acre parcel located at the northwest corner of South Birdneck Road and Bell's Road (Lynnhaven Borough). a. Letter from the City Manager transmits the recommendation of the Planning Commission for approval. 15. Application of Oglesby-Arnhold Realty, Ltd. for changes of zoning on parcels located between Holland Road and Princess Anne Road, west of Landstown Road (Princess Anne Borough): From AG-2 Agricultural District to R-5 Residential District on a32.8-acres; AND, From AG-1 Agricultural District to R-5 Residential District on a70.15-acres- a. Letter from the City Manager transmits the recommendation of the Planning Commission for approval. 16. Application of Breeden-Oglesby for a change of zoniae from B-2 Community-Business District to B-4 Resort-Commercial District on an 11.9-acre parcel located on the east side of Military Highway, north of Brockman Avenue (Kempsville Borough). a. Letter from the City Manager transmits the recommendation of the Planning Commission for approval. 17. Application of O.W.L., Ltd. for a Subdivision variance [Section 4.4(b)] located east of Mill Dam Road on the western shore on Linkhorn Bay (Lynnhaven Borough). a. Letter from the City Manager transmits the recommendation of the Planning Commission for approval. 18. Application of J. Parks Atkinson for a conditional use permit for fifteen apartment units on a 1.278-acre parcel located on the west side of South Oriole Drive, north of Laskin Road (Lynnhaven Borough). a. Letter from the City Manager transmits the recommendation of the Planning Commission for denial. 19. 20. Application of Aloro, Aloro, et als for a conditional use permit for a home for adults on a 6.15-acre parcel located on the west side of Centerville Turnpike, south of Kempsville Road (Kempsville Borough). a. Letter from the City Manager transmits the recommendation of the Planning Commission for denial. H. RESOLUTION Resolution authorizing the enlargement of the nonconforming structure located at 1611 15th Street, Virginia Beach Borough (property of Ollie Jamell). 1. ORDINANCES 1. Ordinance to amend and reordain Section 36-58 of the Code of the City of Virginia Beach pertaining to parking and discharge of passengers at Pavilion. 2. Ordinance authorizing the Mayor to execute an employment agreement for the City Manager. J. CONSENT AGENDA All matters listed under the Consent Agenda are considered in the ordinary course of business by City Council and will be enacted by one motion in the form listed. If an item is removed from the Consent Agenda, it will be discussed and voted upon separately. 1. Ordinance autborizing and directing the City Manager to execute contracts for Health Care Coverage for Municipal Employees. 2. Ordinance, on SECOND READING, to accept and appropriate a Grant Award from the Department of Housing and Urban Development to the Community Development Eleventh Program Year ($2,466,000). 3. Ordinance, on FIRST READLNG, to appropriate $727,415 to the General Fund for FY 1984 Lease/Purchase Assets delivered in FY 1985 AND to increase revenues by the same amount. 4. Ordinance, on FIRST READING, to accept and appropriate a $29,655 Grant for funding a Safety Kids Program 5. Appointment of William E. Bynum, assistant City Attorney, effective July 15, 1985, be confirmed by City Council pursuant to Section 2-166 of the Code of the City of Virginia Beach. 6. Appointment of Will-iam M. Macali, Assistant City Attorney, effective August 1, 1985, be confirmed by City Council pursuant to Section 2-166 of the Code of the City of Virginia Beach. 7 Ordinance to authorize a temporary encroachment into a portion of the rights-of-way of Mill Dan Road and Briarcliff Lane, to O.W.L., LTD., its assigns and successors in title. 8. Ordinance to authorize a temporary encroachment into a portion of the right-of-way of Dam Neck Road at General Booth Boulevard to the United States Government, Department of the Navy, Atlantic Division, Naval Facilities Engineering Command. 9. Ordinance appointing Viewers in the petition of The City of Virginia Beach for the closure of a portion of Claudia Drive (Bayside Borough). 10. Ordinance authorizing tax refunds in the amount of $2,529.48. K. APPOINTMENTS 1. Planning Commission 2. Local Government Study Commission L. UNFINISHED BUSINESS M. NEW BUSINESS 1. Route 44 - Proposed Flyover - Independence Boulevard/Baxter Road: Presentation by Mr. C. Oral Lambert, Jr., Director of Department of Public Works. N. ADJOURNMENT 1. Motion to adjourn. COUNCIL RECESS - JULY 15, 22, 29 NEXT REGULAR MEETING OF CITY COUNCIL AUGUST 5, 1985 8 Item II-H.1 MINUTES ITEM 23958 Upon motioii by Couiicilwoman Creech, seconded by Couiicilman Feixtress, City Couiicil APPROVED the MINUTES of July 8, 1985, with the following CORRECTION: FRONT PACE - BRIEFING - The fourth paragraph should be corrected as per the following: City Council discussed the alternate program proposed by the RESORT AREA ADVISORY COMMISSION and their request for a FIVE-YEAR COMMITTMENT. The I-NTERI-M-GAPITAT.-.EMPR9VEMENT PROGRAM A BUDGETARY APPROPRIATION iiicludes $1.86-Million for the TESORT AREA REVITALIZATION. The 5-Year Capital Improvement Program will be reviewed agaiii in October. Votilig: 11-0 Couiicil Members Votiiig Aye: Johii A. Baum, Nancy A. Creech, Robert E. Felitress, Mayor Harold Heischober, Barbara M. Henley, H. Jack Jeniiings, Jr., Louis R. Joties, Robert C. Jones, Vice Mayor Reba S. McClanali, J. Hetiry McCoy, Jr., D.D.S., aiid Meyera E. Obert)dorf Coulicil Members Votiiig Nay: Notie Couiicil Members Absetit: None August 5, 1985 M I N U T E S VIRGINIA BEACH CITY COUNCIL Virginia Beach, Virginia B R I E F I N G July 8, 1985 10:00 A.M. The BRTEFING was called to order by Mayor Harold Heischober iii the Co,ifereiice Room on July 8, 1985, at 10:00 in the moriiiiig. The City Manager advised the Staff was not i,i a position to discuss the WATER AND SEWER CAPITAL IMPROVEMENT PROGRAM aiid this has beeti RESCHEDULED for August 5, 1985. Councilmeti Robert Jones aiid Robert Feiitress preseiited their report of the meetiiig with the RESORT AREA ADVISORY COMMTSSION aild preseiited copies of the Chairma,i's letter to Members of City Couiicil. (A copy of this letter and attachments is hereby made a part of the record). City Council discussed the alteriiate program proposed by the RESORT AREA .ADVISORY COI@ISSION aiid their request for a FIVE-YEAR COMMITTMENT. The !NTERIM CAPLTAL IMPROVEMENT PROGRAM iiicludes $1.86-Millio@i for the RESORT AREA REVTTALIZATION. The 5-Year Capital Tmprovemetit Program will be reviewed agai[i in October. City Council considered the coiistruction of the Bayside Recreatioii Ceiiter atid improvemeiits to the Kempsville Library. A review of the contract with Virgiiiia Beach Arts Cetiter was requested. The delay of Salem schools was reviewed a@id estimated to be six (6) inoiiths. The Ceiiter for Effective Lear,iiiig a@id Great Neck Recreatioti Ceiiter were discussed. The loss of $15-Million Reveiiue Shariiig was discussed iii relatio@i to the $12-Millioii Undesigiiated Fuild Balalice. iii atteiidance were: CITY COUNCIL Johli A. Baum Naiicy A. Creech Robert E. Fetitress Mayor Harold Heischober Barbara M. Heiiley H. Jack Jeiiiii@igs, Jr. Louis R. Jo@ies Robert G. Joiies Vice Mayor Reba S. McClatiali J. Hetiry McCoy, Jr., D.D.S. Meyera E. Oberildorf STAFF Thomas H. Muehlenbeck, City Maiiager Giles Dodd, Assistaiit City Manager for Admiiiistratioil Ruth Hodges Smith, CMC, City Clerk Edgar D. Block, Assistaiit City Maiager for A,ialysis & Evaluatioii Hector A. Rivera, Assistaiit City Maiiager for Huma,i Services Michael Barrett, Assistaiit City Ma@iager aiid Director of Virgiiiia Beach Resort Area Advisory Commissioii Harold Whitehurst, Director of Parks aiid Recreatio,i David Grochmal, Director of Ceileral Services Pamela Li.gle, Director of Public liiformatioti Jerald Banaga,i, Real Estate Assessor July 8, 1985 M I N U T E S VIRGINIA BEACH CITY COUNCIL Virginia Beach, Virginia July 8, 1985 The Regular Meeting of the Cou@icil of the City of Virgiiiia Beach, Virgiiiia, was called to order by Mayor Harold Heischober i@i the Co@ifere@ice Room, City Hall Buildiiig, oii Monday, July 8, 1985, at 1:00 iii the aftertioo@i. Council Members Present: Joh@i A. Baum, Nancy A. Creech, Robert E. Fe@itress, Mayor Harold Heischober, Barbara M. Heiiley, Louis R. Jones, Robert G. Joiies, Vice Mayor Reba S. McCla,iaii, aiid Meyera E. Oberiidorf Council Members Abseiit: H. Jack Jeniiings, Jr., aiid J. Henry McCoy, Jr., D.D.S. Couiicilman Jeiiiiiiigs entered the EXECUTIVE SESSION at 1:08 p.m. Cou,icilman McCoy entered the EXECUTIVE SESSION at 1:02 p.m. July 8, 1985 - 2 - ITEM # 23894 Mayor Heischober entertained a motion to permit Couticil to conduct its EXECU- TIVE SESSION pursuant to Section 2.1-344, Code of Virgiiiia, as amended, for the following purposes, to be followed by the REGULAR MEETING. 1. PERSONNEL MATTERS: Discussion or consideratioii of employment, assignment, appoilitment, promotioll, performaiice, demotion, salaries, discipliiiing or resignation of public officers, appointees or employees. 2. PUBLICLY HELD PROPERTY: Discussion or coiisideratioti of tbe conditioii, acquisitioii or use of real property for public purpose, or of the disposition of publicly held property, or of plaiis for the future of an institution which could affect the value of property owned or desirable for ownership by such institution. 3. LEGAL HATTERS: Coiisultatioii with legal coulisel or briefings by staff members, consultants or attoriieys, peitaining to actual or potential litigation, or other legal matters withiii the jurisdictioti of the public body. Upon motioli by Councilwoman Creech, seconded by Councilman Louis Jolies, City Council voted to proceed into the EXECUTLVE SESSION to be followed by the REGULAR SESSION. Voting: 10-0 Couiicil Members Votilig Aye: John A. Baum, Nancy A. Creech, Robert E. Fentress, Mayor Harold Heischober, Barbara M. Heiiley, Louis R. Jo@ies, Robert G. Joiies, Vice Mayor Reba S. McClanan, J. Heiiry McCoy, Jr., D.D.S., and Meyera E. Oberndorf Council Members Voting Nay: None Council Members Absent: H. Jack Jennings, Jr. July 8, 1985 - 3 - R E G U L A R S E S S I 0 N VIRGINIA BEACH CITY COUNCIL July 8, 1985 2:00 p.m. Mayor Heischober called to order the Regular Session of the Virgiiiia Beach City Council iii the Couiicil Chambers, City Hall Building, on Moliday, July 8, 1985, at 2:00 in the afternoon. Council Members Preseiit: Johii A. Baum, Naiicy A. Creech, Robert E. Fentress, Mayor Harold Heischober, Barbara M. Henley, H. Jack Jelinings, Jr., Louis R. Jones, Robert G. Jones, Vice Mayor Reba S. McClanan, J. Heilry McCoy, Jr., D.D.S., and Meyera E. Oberndorf Council Members Absent: None INVOCATION: Reverend Charles H. Jones Pastor Kempsvilie Baptist Church PLEDGE OF ALLEGIANCE TO THE FLAG OF THE UNITED STATES OF AMERICA July 8, 1985 - 4 - CITY MANAGER'S ADMINISTRATIVE ITEMS Item 11-D.1 CONSENT AGENDA ADD-ON ITEMS ITEM # 23895 The City Maiiager advised of the ADDITION of two items to the CONSENT AGENDA. These two items are the LOW BID of ASPHALTS ROADS & MATERLALS COMPANY, INC., in the amouiit of $343,402.80 for the BITUMINOUS CONCRETE MAINTENANCE RE- SURFACING SCHEDULE; and, the LOW BID of SLURRY PAVERS, INC., in the amount of $166,513.23 for the 1985-86 IMULSIFIED ASPHALT SLURRY SEAL SCHEDULE. Item II-D.2 CONSENT AGENDA HEALTH CARE COVERAGE ITEM # 23896 Councilman Jetiniiigs referenced an Ordinaiice authoriziiig and directing the City Manager to execute contracts for HEALTH CARE COVERAGE for MUNICIPAL EMPLOYEES (See item II-J.1 of the Consent Ageiida). Councilman Jen@iings requested this item be pulled for a separate vote. Item 11-D.3 CONSENT AGENDA CLAUDIA DRIVE CLOSURE ITEM # 23897 Couiicilwomati Oberndorf refereiiced aii Ordinaiice appoiliting VIEWERS iii the petition of the City of Virginia Beach for the closure of a portion of CLAUDIA DRIVE (Bayside Borough) (See Item II-J.9 of the CONSENT AGENDA). Councilwomaii Ober@idorf requested this item be pulled for discussion as to why the City wished to close CLAUDIA DRIVE. July 8, 1985 - 5 - MAYOR/COUNCIL - DISCUSSION OF PERTINENT MATTERS Item II-E.1 NEW BUSINESS ITEM # 23898 Mayor Heischober referenced the application of J. PARKS ATKINSON for a Con- ditioiial Use Permit for FIFTEEN APARTMENT UNITS on a 1.278-acre parcel located on the west side of South Oriole Drive, north of Laskin Road (Lyniihaven Borough). (See Item 11-I of the PLANNING AGENDA). A letter has beeii received from the applicant, J. PARKS ATKINSON, requesting WITHDRAWAL of said application. Item II-E.2 NEW BUSINESS ITEM # 23899 Councilman McCoy referenced the Presentation by C. Oral Lambert, Jr., Director of the Department of Public Works,coxiceriiing ROUTE 44 - PROPOSED FLYOVER - INDEPENDENCE BOULEVARD/BAXTER ROAD (See Item II-M.1 under NEW BUSINESS). This Item will be RESCHEDULED. July 8, 1985 6 Item II-F.1 MINUTES ITEM # 23900 Upon motioii by Coulicilwoman Creech, secoilded by Councilma,i McCoy, city Couixcil APPROVED the MINUTES of July 1, 1985. Voting: 11-0 Council Members Voting Aye: Johii A. Baue, Naiicy A. Creech, Robert E. Fentress@ Mayor Harold Heischobert Barbara M. Henley, H. Jack Jenniilgs, Jr., Louis R. Jones, Robert G. Jones, Vice Mayor Reba S. McClanan, J. Heiiry McCoy, Jr., D.D.S., and Meyera E. Oberiidorf. Coulicil Members Votiiig Nay: Notie Coulicil Members Absetit: Notie *Verbal Aye July 8, 1985 7 Item II-G.1 PLANNING 1TEM # 23901 Attoriiey William Wahab represeiited the applicant and presented a petitioli in favor of the application (said petition is hereby made a part of the record). Upon motioii by Councilmaii Louis Jones, secoiided by Councilman Felitress, City Council APPROVED the application of GERALD aiid EVA PHELPS for a Varia,,e to Sectioii 4.4(b) of the Subdiviio, Ordi,ia,ice. Appeal from Decisiofis of Admitiistrative Officers in regard to certain elements of the Subdivi,io, Ordinance, Subdivision for Gerald and Eva Phelps. Property located on the north Side of Lake Bradford Drive, 335.6 feet west of Pleasure House Road. Plats with more detailed informatioii are available in the Departmeiit of Plaiiiiing. BAYSIDE BOROUGH. The following conditioii shall be required: No further resubdivison of this parcel. Voting: 11-0 Council Members Vatilig Aye: John A. Baum, Naiicy A. Creech, Robert E. Feiitress, Mayor Harold Heischober, Barbara M. Henley, H. Jack Jeiiiiings, Jr., Louis R. Jones, Robert C. Jones, Vice Mayor Reba S. McClaiiall, J. Heilry McCoy, Jr., D.D.S., and Meyera E. Oberndorf. Couiicil Members Voting Nay: Noiie Couiicil Members Ab6ent: None July 8, 1985 8 Item II-G.2 PLANNING ITEM # 23902 Attoriiey Grover Wright represented the applicant Upon motion by Councilmaii Jennings, seconded by Councilmaii Fentress, City Couiicil APPROVED the application of PAUL L. STRASSBERG for a Variance to Section 4.4 (c) of the Subdivision Ordinance. Appeal from Decisions of Admiiiistrative Officers in regard to certain elements of the Subdivision Ordinaiice, Subdivision for Paul L. Strassberg. Property located on the west side of North Lynn- haven Road, 65.4 feet south of Shakespeare Drive. Plats with more detailed information are available in the Department of Plaiiiiiiig. LYNNHAVEN BOPOUGH. Votiiig: 11-0 Council Members Voting Aye: John A. Baum, Nancy A. Creech, Robert E. Fe@itress, Mayor Harold Heischober, Barbara M. Henley, R. Jack Jennings, Jr., Louis R. Jones, Robert G. Joiies, Vice Mayor Reba S. McClatiali, J. Henry McCoy, Jr., D.D.S., aiid Meyera E. Oberiidorf. Council Members Voting Nay: None Council Members Abseiit: Noiie July 8, 1985 9 Item 11-G.3 PLANNING ITEM # 23903 Alan Gordon, the applicaiit, represented the application Upon motion by Couiicilman McCoy, seconded by Councilwoman Oberndorf, City Council ADOPTED Ordinaiices upon application of GORDON REALTY AND VAZ, INC. for Changes of Zoniilg as per the followilig: ORDINANCE UPON APPLICATION OF GORDON REALTY AND VAZ, INC. FOR A CHANGE OF ZONING DISTRICT CLASSI- FICATION FROM I-1 TO B-3 Z0785994 BE IT HEREBY ORDAINED BY THE COUNCIL OF THE CITY OF VIRGINIA BFACH, VIRGINIA Ordiiiance upou application of Gordon Realty and Vaz, Iiic. for a Change of Zoning District Classification from 1-1 Light Industrial District to B-3 General- Business District on certaiii property located on the northeast side of Boniiey Road, 810 feet more or less southeast of Iiidependence Boulevard. Said parcel con- tains 24,394 square feet more or less. Plats with more detailed iiiformation are available iii the De- partment of Plaiiiiiilg. KEMPSVILLE BOROUGR. A N D, ORDINANCE UPON APPLICAT10N OF GORDON REALTY AND VAZ, INC. FOR A CHANGE OF ZONING DISTRICT CLASSIFICATION FROM B-2 TO B-3 Z0785995 BE 1T HEREBY ORDAINED BY THE COUNCIL OF THE CITY OF VIRGINIA BEACH, VIRGINIA Ordiiiance upoii application of Gordon Realty and Vaz, Inc., for a Change of Zoning District Classification from B-2 Commuiiity-Business District to B-3 Geiieral-Business Dis- trict on certaiii property located on the northeast side of Bonney Road, 380 feet more or less southeast of In- depeiideiice Boulevard. Said parcel contains 3.32 acres. Plats with more detailed information are available in the Department of Planniiig. KEMPSVILLE BOROUGH. This Ordinance shall be effective upoii the date of adoption. Adopted by the Council of the City of Virginia Beach, Virginia, oil the Eighth day of July, Nineteeii Hundred and Eighty-five. July 8, 1985 - 10 - item II-G.3 PLANNING ITEM # 23903 (Continued) Voting: 11-0 Couiicil Members Votiiig Aye: Johii A. Baum, Nancy A. Creech, Robert E. Fentress, Mayor Harold Heischober, Barbara M. Heiiley, H. Jack Jenniiigs, Jr., Louis R. Joiies, Robert G. Jones, Vice Mayor Reba S. McClanan, J. Henry McCoy, Jr., D.D.S., and Meyera E. Oberiidorf. Council Members Voting Nay: Notie Council Members Absent: Noiie July 8, 1985 item II-G.4 PLANNING ITEM 23904 Michael M. Fitzgerald, resideiit, registered iii OPPOSITION to Approval of 6aid applicatioii, but not WITHDRAWAL Upon motioii by Councilman Louis Jones, seconded by Councilwomaii Oberndorf, City Couiicil ALLOWED WITHDRAWAL of an Ordiiiance upoii applicatioil of WALTER J. & MARGARET S. LEVERIDGE for a Chaiige of Zoning District Classificatioli as per the following: ORDlNANCE UPON APPLICATION OF WALTER J. AND MARGARET S. LEVERIDGE FOR A CHANGE OF ZONING DISTRICT CLASSI- FICATION FROM R-6 TO R-8 Ordinance upon application of Walter J. and Margaret S. Leveridge for a Change of Zoning District Classification from R-6 Residential District to R-8 Resideiitial District on the west side of Beaufort Avenue, 160 feet more or less iiorth of Athens Boulevard. Said parcel contains 2.75 acres. Plats with more detailed iaformatioii are available in the Departmetit of Plannilig. BAYSIDE BOROUGH. Voting: 11-0 Council Members Votiiig Aye: Johii A. Baum, Naiicy A. Creech, Robert E. Feiitress, Mayor Harold Heischober, Barbara M. Henley, H. Jack Jetiniiigs, Jr., Louis R. Joues, Robert G. Joiies, Vice Mayor Reba S. McClaiian, J. Henry McCoy, Jr., D.D.S., and Meyera E. Oberiidorf. Cbuiicil Members Voting Nay: None Council Members Absent: None July 8, 1985 - 12 - Item 11-G.5 PLANNING ITEM # 23905 Attor,ey J. Randall Forbes represe,,ted the applicant Hetiry Johiison, the applicant, also spoke concerning his applicatioii Upoli motion by Couticilmaii Jeniiings, secoiided by Coulicilmail Feiitress, City Cuncil ADOPTED an Ordinance upon application of JOHNSON, INC., t/a HENRY JOHNSON TIRE CENTER for a Co@iditioiial Use Permit as per the followiiig: ORDINANCE UPON APPLICATION OF JOHNSON, INC., T/A HENRY JOHNSON TIRE CENTER FOR A CONDITIONAL USE PERMIT FOR TIRE SALES, INSTALLATION AND REPAIR R0785759 BE IT HEREBY ORDAINED BY THE COUNCIL OF TJIE CITY OF VIRGINIA BEACH, VIRGINIA Ordiiiaiice upon applicatioii of Johnson, Itic., T/A Henry Johnson Tire Center for a Goiiditional Use Permit for tire sales, iiistallation a@,d r,-p..r . ert-i- Property located at the iiorthwest corder of Laskiii Road aiid Oriole Drive. Said parcel is located at 1000 Laskiii Road aiid coiitains 32,670 square feet. Plats with more detailed informatioLi are available in the Departmeiit of Plaiiiiiiig. LYNNHAVEN BOROUGH. The following codditioti shall be required: 1. Approval shall be for a five-year period. This Ordiiiance shall be effective upon the date of adoption. Adopted by the Council of the City of Virginia Beach, Virginia, on the Eig 7ed and Eighty-five. Voting: 11-0 Council Members Votiiig Aye: John A. Baum, Nancy A. Creech, Robert E. Fentress, Mayor Harold Heischober, Barbara M. Henley, H. Jack Jenniiigs, Jr., Louis R. Jones, Robert G. Jones, Vice Mayor Reba S. McClanan, J. Heiiry McCoy, Jr., D.D.S., and Meyera E. Oberlidorf. Council Members Voting Nay: Noiie Council Members Absent: None July 8, 1985 - 13 - Item II-G.6 PLANNING ITEM # 23906 Curtis Catroti, the applicaiit, represented himself Upon motiou by Councilmaii McCoy, seconded by Couiicilwoman Oberndorf, City Council ADOPTED aii Ordiiiaiice upaii applicatioii of LARKSPUR PROFESSIONAL BUILDING, 1NC. for a Change of Zoiiilig as per the followiiig: ORDINANCE UPON APPLICATION OF LARKSPUR PROFESSIONAL BUILDING, INC. FOR A CHANGE OF ZONING DISTRICT CLASSIFICATION FROM P-1 TO B-2 Z0785996 BE IT HEREBY ORDAINED BY THE COUNCIL OF THE CITY OF VIRGINIA BEACH, VIRGINIA Ordinatice upoii applicatioti of Larkspur Professional Building, Iiic., for a Chaiige of Zoiiing District Classi- ficatioti from P-1 Preservation District to B-2 Community- Busiiiess District on certain property located 166.47 feet north of Holland Road, 814.19 feet east of Edwin Drive. Said parcel contaiiis 1.412 acres. Plats with more de- tailed information are available iii the Department of Plaiinitig. KEMPSVILLE BOROUGH. This Ordiiiaiice shall be effective upon the date of adoption. Adopted by the Council of the City of Virgiiiia Beach, Virgillia, on the Eighth day of Julv. Niiietp.,, B,liidred and Eighty-five, Votiilg: 11-0 Council Members Votiiig Aye: John A. Baum, Nancy A. Creech, Robert E. Fentress, Mayor Harold Heischober, Barbara M. Henley, H. Jack Jeiiniiigs, Jr., Louis R. Jones, Robert G. Joi)es, Vice Mayor Reba S. McClaiian, J. Henry McCoy, Jr., D.D.S., aiid Meyera E. Oberndorf. Council Members Voting Nay: None Council Members Abseiit; None July 8, 1985 - 14 - Item II-H. 7 PLANNING ITEM # 23907 Attorney Robert Cromwell represented the applicant Upon motion by Councilman Louis Jones, seconded by Couiicilwoman Oberiidorf, City Council ADOPTED Ordinances upoii applicatioii of JOHN R. PFLUG, JR., for Changes of Zoiiiiig as per the followd-ng: ORDINANCE UPON APPLICATION OF JOHN R. PFLUG, JR., FOR A CHANGE OF ZONING DISTRICT CLASSIFICATION FROM B-3 TO I-I Z0785997 BE 1T HEREBY ORDAINED tY THE COUNCIL OF THE CITY OF VIRGINIA BEACH, VIRGINIA Ordinance upon applicatioii of John R. Pflug, Jr., for a Change of Zoning Di5trict Classification from B-3 General- Business District to 1-1 Light Iiidustrial District on parcels located at the southern extremity of Lavender Lane on a portion of Lots 43-47, Block 58 and a portion of Parcel I B, Euclid Place. Said parcel contains 3.716 acres. Plats with more detailed information are avail- able in the Departmeiit of Planning. BAYSIDE BOROUGH. A N D, ORDINANCE UPON APPLICATION OF JOHN R. PFLUG, JR., FOR A CHANCE OF ZONING DISTRICT CLASSIFICATION FROM I-I TO B-3 Z0785998 BE IT HEREBY ORDAINED BY TilE COUNCIL OF THE CLTY OF VLRGINIA BEACH, VIRGINIA Ordinance upon applicatioii of John R. Pflug, Jr., for a Change of Zoning District Classification from I-I Light Industrial District to B-3 General-Business District at the southwest corner of Cleveland Street and Lavender Lane on Lots 1-28 and Parts of Lots 29-33, Block 57, Euclid Place. Said parcel contaiiis 3.013 acres. Plats with more detailed information are available iii the De- partment of Planning. BAYSIDE BOROUGH. Prior to the chaiiging of the official zoniiig maps, the following condition shall be met; FiDal approval of the street closures for Maynard Avenue and Lavender Lane. These Ordinances shall be effective upon the date of adoption. Adopted by the Council of the City of Virginia Beach, Virginia, on the Eighth day of July, Nineteen Hundred and Eighty-five. July 8, 1985 - 15 - Item TI-H.7 PLANNING ITEM # 23907 (Contiiiued) VOtiLIg: 11-0 Council Members Votiilg Aye. John A. Baum, Nancy A. Creech, Robert E. Fentress, Mayor Harold Heischober, Barbara M. Henley, H. Jack Jeniiings, Jr., Louis R. Jones, Robert G. Jones, Vice Mayor Reba S. McClanan, J. Henry McCoy, Jr., D.D.S., and Meyera E. OberLidorf. Council Members Votiiig Nay: Noiie Couiicil Members Abseiit. NoLie July 8, 1985 - 16 - Item II-H.8 PLANNING ITEM # 23908 Attoriiey Grover Wright represeiited the applicaiit Upon motioli by Councilman Fentress, seconded by Councilman Jennings, City Couiicil ADOPTED aLi Ordinance upon application of MELVIN A. AND JIMMIE A. KOCH for a Conditional Uae Permit as per the following: ORDINANCE UPON APPLICATION OF MELVIN A. AND JIMMIE A. KOCH FOR A CONDITIONAL USE PERMIT FOR AN INCREASE IN DENSITY R0785760 BE IT HEREBY ORDAINED BY THE COUNCIL OF THE CITY OF VIRGINIA BEACH, VIRGINIA Ordinance upon application of Melvin A. and Jimmie A. Koch for a Conditional Use Permit for an increabe iii density (13 additional units) on certain property lo- cated at the northwest corner of 37th Street and Atlantic Avenue. Said parcel is located at 201 and 203 37th Street and contains 14,000 square feet. Plats with more detailed information are available in the Department of Planning. VIRGINIA BEACH BOROUGH. The followitig condition shall be required: 1. Required parking is to be provided on site. This Ordiiiance shall be effective upon the date of adoption. Adopted by the Couiicil of the City of Virginia Beach, Virginia, on the Eighth day of July, Nineteen Hundred and Eighty-five. Voting: 11-0 Council Members Voting Aye: John A. Baum, Nancy A. Creech, Robert E. Fentress, Mayor Harold Heischober, Barbara M. Heilley, R. Jack Jennings, Jr., Louis R. Joiies, Robert G. Jones, Vice Mayor Reba S. McClanan, J. Henry McCoy, Jr., D.D.S., alid Meyera E. Oberndorf. Council Members Voting Nay: None July 8, 1985 Council Members Absent: Nolie - 17 - Item II-G.9 PLANNING ITEM # 23909 Attorney Moody Stallings represeiited the applicaiit Upoii motion by Couiicilmaii Fentress, seconded by Couiicilwomaii Creech, City Council ADOPTED an Ordinatice upon applicatioii of J & A ASSOCIATES for a Chalige of Zoning per the followiiag: ORDINANCE UPON APPLICATION OF J & A ASSOCIATES FOR A CFLANGE OF ZONING DISTRICT CLASSIFICATION FROM A-1 TO B-4 Z0785999 BE IT HEREBY ORDAINED BY THE COUNCIL OF THE CITY OF VIRGINIA BEACH, VIRGINIA Ordiaance upon application of J & A Associates for a Change of Zoning District Classification from A-1 Apartment District to B-4 Resort Commercial District oii certain property located on the north side of 29th Street, 200 feet west of Pacific Aveiiue. Property located at 309 29th Street and coiitains 7,000 square feet. VIRGINIA BEACH BOROUGH. This Ordinaiice shall be effective upon the date of adoption. Adopted by the Council of the City of Virgiiiia Beach, Virginia, oli the Eighth day of July, Niiieteen Huiidred atid Eighty-five. Voting: 11-0 Council Members Voting Aye: Johii A. Baum, Nancy A. Creech, Robert E. Fetitress, Mayor Harold Heischober, Barbara M. Heiiley, H. Jack Jenniligs, Jr., Louis R. Jones, Robert G. Joties, Vice Mayor Reba S. McClanan, J. Henry McCoy, Jr., D.D.S., and Meyera E. Oberndorf. Couticil Members Voting Nay: Noiie Council Members Absent: Noiie July 8, 1985 - 18 - Item II-G.10 PLANNING ITEM # 23910 Attoriiey Grover Wright represented the applicalit. Upon motioii by Councilman Feiitress, seconded by Councilman Louis Jaiies, City Council ADOPTED an Ordinance upon application of THOMAS M. AND LELA F. MURPHY for a Conditional Use Permit for aii increase iii density as per the following: ORDINANCE UPON APPLICATION OF THOMAS M. AND LELA F. MURPHY FOR A CONDITIONAL USE PERMIT FOR AN INGRFASE IN DENSITY. R0785761 BE IT HEREBY ORDAINED BY THE COUNCIL OF THE CITY OF VIRGINIA BEACH, VIRGINIA Ordinaiice upon application of Thomas M. and Lela F. Murphy for a Conditional Use Permit for aii increase in delisity to 120 lodging units per acre on Lots 5,6 and 9, Block 11, Virginia Beach Developmelit Company. Said parcel is located at 1005 Pacific Avenue and contains 25,700 square feet. VIRGINIA BEACH BOROUGH. The following condition shall be required: 1. Required parking is to be provided on site. *Attorney Grover Wright referenced correction in the advertisement of the appli- cation of THOMAS M. AND LELA F. MURPHY for a Conditional Use Permit. The increase in density was not 120 lodging units on a 25,700-square foot parcel, but 120 uiiits per acre, for a total of 70 nit,. This Ordinance shall be effective upon the date of adoption. Adopted by the Co,,iicil of the City of Virginia Beach, Virgiiiia, oil the Eighth day of July, NiiieteeLi Hutidred and Eighty-five. Voting: 11-0 Council Members Voting Aye: John A. Baum, Nancy A. Creech, Robert E. Feutress, Mayor Harold Heischober, Barbara M. Heiiley, H. Jack Jeiinings, Jr., Louis R. Jonest Robert G. Jones, Vice Mayor Reba S. McClaiian, J. Henry McCoy, Jr., D.D.S., and Meyera E. Oberndorf. Council Members Votiiig Nay: Noiie Couiicil Members Absent: Noiie July 8, 1985 *Verbal Aye - 19 - Item II-G.11 PLANNING ITEM # 23911 Billy H. Bariies, the applicatit, represented himself Upon motion by Gouiicilman McCoy, secouded by Councilwoman Oberndorf, City Council ADOPTED an Ordiiiance upon applicatioii of BILLY H. BARNES for a Con- tioiial Use Permit as per the following: ORDINANCE UPON APPLICATION OF BILLY H. BARNES FOR A CONDITIONAL USE PERMIT FOR A DAY CARE CENTER R0785762 BE IT HEREBY ORDAINED BY THE COUNCIL OF THE CITY OF VIRGINIA BEACH, VIRGTNIA Ordinance upon applicatioii of Billy H. Bariies for a Conditioiial Use Permit for a day care center at the tiortheast@o@nir of-Salem Road and Zodiac Latie. Said parcel is located at 1744 Salem Road and coiitains 35,284 square feet. Plats with more detailed information are available i@i the Department of Plaiiiii@ig.KEMPSVILLE BOROUGH@ The followi.tig cotiditioiis shall be required: 1. A variable width dedicatioii along the frontage on Salem Road to match the alignment oii file with the Departineiit of Public Works/Survey and Mapping Divisioii. 2. Dedication of right-of-way aloiig the frontage oii Salem Road for the proposed bicycle path as per the Virginia Beach Bikeway Plan on file with the Planiiing Departmelit. 3. Area adjaceiit to Zodiac Lane and Salem Road as showii on the subdivision plat submitted as part of this appli- cation shall be fenced in if used as a play area for the day care center. This Ordinance shall be effective upon the date of adoption. Adopted by the Council of the City of Virgiiiia Beach, Virgiiiia, oli the Eig Votiiig: 11-0 Couiicil Members Voting Aye: John A. Baum, Nancy A. Creech, Robert E. Fentress, Mayor Harold Heischober, Barbara M. Heiiley, H. Jack Jenniiigs, Jr., Louis R. Jones, Robert G. Joiies, Vice Mayor Reba S. McClanan, J. Heliry McCoy, Jr., D.D.S., aiid Meyera E. Oberiidorf. Council Members Votiiig Nay: None Council Members Absent: Notie July 8, 1985 - 20 - item II-G.12 PLANNING ITEM # 23912 Attorney Grover Wright represeiited the applicant Upoii motion by Couiicilmaii Jennings, seconded by Councilman Louis Jones, City Council ADOPTED an Ordinance upoti applicatioii of JOSEPH H. WATSON, JR., AND GAIL Z. WATSON for a Conditioiial Use Permit as per the followilig: ORDINANCE UPON APPLICATION OF JOSEPH H. WATSON, JR., AND GAIL Z. WATSON FOR A CONDITIONAL USE PERMIT FOR A MINATURE GOLF COURSE AND GOLF SALES STORE R0785763 BE IT HEREBY ORDAINED BY THE COUNCIL OF THE CITY OF VIRGINIA BF-ACH, VIRGINIA Ordinance upon application of Joseph R. Watson, Jr., and Gail Z. Watson for a Conditioiial Use Permit for a miiiature golf course and golf sales store on the south side of Virginia Beach Boulevard, 410 feet inore or less west of Parker Lane. Said parcel coiitains 6.01 acres. Plats with more detailed information are available in the Departmeiit of Planiiing. LYNNHAVEN BOROUGH. The following coiiditioiis shall be required: 1. A variable width reservation of right-of-way, for a period of 10 years, along the frontage of Virginia Beach Boulevard to match the alignment on Sheets 50 and 50A of the Virginia Beach Boulevard Plans - Project #0058-134- 101, PE-101, C-503, RW-203, B-602, Parcel 343, on file with the Department of Public Works/Etigiiieering Divisioli. 2. Conditions as specified on the site plan submitted with the use permit. 3. No loud music will be permitted. This Ordiiiance shall be effective upon the date of adoptioli. Adopted by the Council of the City of Virginia Beach, Virginia, on the Eighth day of July, Nineteeri Hulidred and Eighty-five. Voting: 11-0 Council Members Voting Aye: John A. Baum, Nancy A. Creech, Robert E. Fentress, Mayor Harold Heischober, Barbara M. Henley, H. Jack Jennings, Jr., Louis R. Jones, Robert G. Jones, Vice Mayor Reba S. McClanan, J. Heiiry McCoy, Jr., D.D.S., and Meyera E. Oberndorf. Council Members Voting Nay: None Coulicil Members Abseiit: None July 8, 1985 - 21 - Item II-G.13 PLANNING ITEM # 23913 Attorney Robert Cromwell represented the applicant Upon motion by Councilman Fentress, seconded by CouncilmaLi Jenniiigs, City Couticil ADOPTED an Ordinance upon applicatioii of Pacific Corporatio,i for a Chaiige of Zoning as per the following: ORDINANCE UPON APPLIGATION OF PACIFIC CORPORATION FOR A CHANGE OF ZONING DISTRICT CLASSIFICATION FROM A-1 TO 0-1 Z07851000 BE IT HEREBY ORDAINED BY THE COUNCIL OF THE CITY OF VIRGINIA BEACH, VIRGINIA Ordinance upon application of Pacific Corporation for a Chaiige of Zaiiiiig District Classification from A-1 Apartment District to 0-1 Office district oii the south side of 35th Street, 200 feet east of Arctic Avenue. Said parcels are located at 308 aiid 310 35th Street aiid contain 14,000 square feet. VIRGINIA BEACH BOROUGH The following COLidition shall be required: 1. Geiieral adherence to the site plaii preselited by the applicalit's represe@itative at the City Cou@icil meetiiig July 8, 1985. This Ordinaiice shall be effective upon the date of adoptioli. Adopted by the Couiicil of the City of Virginia Beach, Virginia, oli the Eighth day of July, Nineteen HUDdred aiid Eighty-five. Voting: 11-0 Council Members Votiiig Aye: John A. Baum, Nancy A. Creech, Robert E. Fentress, Mayor Harold Heischober, Barbara M. Heiiley, H. Jack Jennings, Jr., Louis R. Jones, Robert G. Joiies, Vice Mayor Reba S. Mcclaliali, J. Heilry McCoy, Jr., D.D.S., atid Meyera E. Oberiidorf. Couiicil Members Voting Nay; Noiie Cou-icil Members Abseiit: None July 8, 1985 - 22 - Item 11-G.14 PLANNING ITEM # 23914 Attorney Robert Cromwell represented the applicalit Upon motion by Councilman Jeiiiiiiigs, seconded by Councilman Felitress, City Council ADOPTED an Ordinance upon application of CONTRACTORS GRADING & EQUIPMENT CORPORATION for a Coliditional Use Permit as per the following: ORDINANCE UPON APPLICATION OF CONTRACTOR'S GRADING AND EQUIPMENT CORPORATION FOR A CONDITIONAL USE PERMIT FOR A CONTRACTOR'S STORAGE YARD R0785764 BE IT HEREBY ORDAINED BY THE COUNCIL OF THE CITY OF VIRGINIA BEACH, VIRGINIA Ordinance upon application of Contractors Grading & Equipment Corporation for a Coliditional Use Permit for a contractor's storage yard at the northwest corner of South Birdneck Road and Bell's Road. Said parcel is located at 1194 Bell's Road and contains 2.376 acres. Plats with more detailed information are available in the Department of Plalining LYNNHAVEN BOROUGH. Ihe followitig conditions shall be required: 1. Approval is for a period of one-@@-yea-r- two (2) years. 2. Heavy landscapirig along the eastern and southern boundary of Bells Road and Sbuth Bitdneck Road, if, in fact the fetice ever extends to South Birdiieck Road. This Ordinance shall be effective upon the date of adoption. Adopted by the Couiicil of the City of Virgiiiia Beach, Virginia, ati the Eighth day of July, Niiieteen Hundred and Eighty-five. Votilig: 11-0 Council Members Voting Aye: Johii A. Baum, Nancy A. Creech, Robert E. FeLitress, Mayor Harold Heischober, Barbara M. Henley, H. Jack Jeniiings, Jr., Louis R. Jones, Robert G. Joties, Vice Mayor Reba S. McClaliaii, J. Henry McCoy, Jr., D.D.S., and Meyera E. Oberndorf. Coulicil Members Voting Nay: None Council Members Abseiit: Notie July 8, 1985 - 23 - Item 11-G.15 PLANNING ITEM # 23915 Attoriiey Robert Cromwell represeiited the applicalit Upoii motioii by Vice Mayor McClanan, secoiided by Councilwoman Creech, City Council ADOPTED Orditiances upon application of OGLESBY-ARNHOLD REALTY,LTD. for Changes of Zoiiing exclusive of the property south of the VEPCO right- of-way which encompasses approximately 17.2 acres. ORDINANCE UPON APPLICATION OF OGLESBY-ARNHOLD REALTY LTD., FOR A CHANGE OF ZONING DISTRICT CLASSIFICATION FROM AG-2 TO R-5 Z07851001 BE IT HEREBY ORDAINED BY THE COUNCIL OF THE CITY OF VIRGINIA BEACH, VIRGINIA Ordinance upon application of Ogleaby-Arnhold Realty Ltd., for a Change of Zoning District Classificdtioii from AG-2 Agricultural District to R-5 Residential District on certain parcels located oii the north side of Holland Road, 310 feet more or less east of Delft Drive, and on the south aide of Hollaiid Road, 310 feet more or less east of Delft Drive. Said parcels contain 32.8 acres. Plats with more detailed information are available in the Department of Planning. PRINCESS ANNE BOROUGH. A N D, ORDINANCE UPON APPLICATION OF OGLESBY-ARNHOLD REALTY LTD., FOR A CHANGE OF ZONING DISTRICT CLASSIFICATION FROM AG-1 TO R-5 Z07851002 BE IT HEREBY ORDAINED BY THE COUNCIL OF THE CITY OF VIRGINIA BEACU, VIRGINIA Ordinance upon application of Oglesby-Arnhold Realty, Ltd., for a Change of Zbning District Cldssification from AG-1 Agricultural District to R-5 Residential District on certaiu parcels located 600 feet north of Hollaiid Road, 350 feet more or less east of Delft Drive and 600 feet south of Hollaild Road, 310 feet more or less east of Delft Drive Said parcels contains 70.15 acres. Plats with more de- tailed informatioii are available in the Department of Planning. PRINCESS ANNE BOROUGH. Prior to the changing of the official zoning maps, the followiug conditions shall be met: 1. A variable width dedication of right-of-way aloiig the frontage oii Holland Road to provide for an ultimate 90- foot right-of-way as per the Master Street and Highway Plaii aiid in accordaiice with the alignment shown on the Courthouse Circulatioii Plan on file with the City En- gineer's Office. 2. A variable width dedication of right-of-way along the froiitage on Princess Aniie Road/Ferrell Parkway as per the Master Street and Highway Plan and in accordance with the Courthouse Circulation Plan on file with the City Engiiieer's Office. 3. Dedicatioii of right-of-way along the VEPCO right-of-way as per the Virginia Beach Bikeway Plan. July 8, 1985 - 24 - Item II-G.15 PLANNING ITEM # 23915 (Coiitiilued) These Ordiliaiices shall be effective upoll the date of adoption. Adopted by the Council of the City of Virginia Beach, Virgillia, oii the Eighth day of July, Nineteea Huiidred aiid Eighty-five. Voting: 11-0 Council Members Votiiig Aye: Johii A. Baum, Nancy A. Creech, Robert E. Fentress, Mayor Harold Heischober, Barbara M. Henley, H. Jack Jeiiiiiiigs, Jr., Louis R. Joiies, Robert G. Joiies, Vice Mayor Reba S. Mcclatian, J. Henry McCoy, Jr., D.D.S., and Meyera E. Oberlidorf. Couiicil Members Voting Nay: Naiie COULICil Members Absetit: None July 8, 1985 - 25 - Item II-G.16 PLANNING ITEM # 23916 Attoriiey Robert Croinwell represeiited the application Raymond Breeden, the applicant, also spoke coiiceriiing his application Upoii motion by Councilmaii McCoy, secoiided by Councilwoman Oberiidorf, City Council ADOPTED an ordiiiance upon application of BREEDEN-OGLESBY for a Chaiige of Zoniiig Classification as per the following: ORDINANCE UPON APPLICATION OF BREEDEN-OGLESBY FOR A CHANGE OF ZONING DISTRICT CLASSIFICATION FROM B-2 TO B-4 Z07851003 BE IT HEREBY ORDAINED BY THE COUNCIL OF THE CITY OF VIRGINTA BEACH, VIRGINIA Ordinance upoii application of Breeden-oglesby for a Chaiige of Zoiiitig District Classification from B-2 Community-Business District to B-4 Resort-Commercial District oii certaiii property located oii the east side of North Military Highway, 670 feet more or less liorth of Brockman Aveiiue. Said parcel contailis 11.9 acres. Plats with more detailed information are available iii the Department of Plaiiiiing. KEMPSVILLE BOROUGH. The following condition shall be required: 1. Subject to a limit of tweiity-four (24) ullits per acre o@i eight acres to be used for apartments. This Orditiaiice shall be effective upon the date of adoption. Adopted by the Couticil of the City of Virgiiiia Beach, Virginia, oil the Eighth day of July, Nineteen Hundred and Eighty-five. Voting: 11-0 Council Members Votiilg Aye: Johii A. Baum, Nancy A. Creech, Robert E. Fentress, Mayor Harold Heischober, Barbara M. Henley, H. Jack Jeniiings, Jr., Louis R. Joties, Robert G. Joiies, Vice Mayor Reba S. McClaiian, J. Henry McCoy, Jr., D.D.S., and Meyera E. Oberndorf. Council Members Voting Nay: None Council Members Absent: Notie July 8, 1985 - 26 - Item 11-G.17 PLANNING ITEM # 23917 Attorney Robert Cromwell represeiited the applicant David Oglesby, the applica,it, also 6poke concer@iing this application Dr. Abbot Granoff, Presideiit of the LiiikhorLi Cove Civic League, advised Couiicil their Civic League had no objection to the Subdivisio@i Varia@ices requested by O.W.L. on the flag lots, but did have a great deal of concern about the projected fill for this proposed developmelit. Dr. Joe Buchaiian, President of the Great Neck Association of Civic Leagues, had to leave but Dr. Granoff read his statement into the record: "The Great Neck Association of Civic Leagues is specificially supportive of City policy regarding WETLANDS regulations, the COMPREHENSIVE PLAN as regards this parcel and if the parcel does not comply, the GREAT NECK ASSOCIATION OF CIVIC LEAGUES opposes it." Upoii motio@i by Couacilman Jenn ings, seconded by Councilmati Baum, City Couticil APPROVED an applicatioti of O.W.L., LTD. for a Varia,ice to Section 4.4 (b) of the Subdivisio@i Ordiiiaiice. Appeal from Decisions of Administrative Officers in regard to certain elements of the Subdivsion Ordinalice, Subdivision for O.W.L., Ltd. Parcels are shown as Lot 4 and Lot 8 on the preliminary subdivisioii plan eLititled "Brighto. on the Bay, Section 3" o,i file i@i the Department of Plannir@g. LYNNHAVEN BOROUGH. This VARIANCE shall be subject to the followiiig condition; 1. City Water a@id Sewer shall be required. Voting: 10-1 Council Members Voting Aye: John A. Baum, Naiicy A. Creech, Robert E. Felitress, Mayor Harold Heischober, Barbara M. Heiile@, H. Jack Jeiinings, Jr., Louis R. Jones, Robert G. Joiies, Vice Mayor Reba S. McClanan, aiid J. Henry McCoy, Jr., D.D.S. Council Members Votiag Nay: Meyera E. Oberadorf Couticil Members Absent: No.ie Councilman Baum advised of the possibility of a demonstration tour of VARIANCES on the water APPROVED by City Council. Council would tour with City Staff and a demotistration would be given on the engineering process to prevent siltatioll. Verbal Aye July 8, 1985 - 27 - Item II-18 PLANNING 1TEM # 23918 J. Parks Atkinson, the applicant, presented City Couiicil with a letter requesting WITHDRAWAL (said letter is hereby made a part of the record). Attorney Gleiiii Croshaw, represented the BIRNECK POINT CIVIC LEAGUE, aiid registered iii OPPOSITION to WITHDRAWAL of the applicatioll Upoii motioii by Councilman Jennings, seconded by Couiicilmaii Baum, City Council DENIED an Ordiiiatice upon application of J. PARKS ATKINSON for a Conditional Use Permit as per the following: ORDINANCE UPON APPLICATION OF J. PARKS ATKINSON FOR A CONDITIONAL USE PERMIT FOR 15 APARTMENT UNITS Ordinance upoii application of J. Parks Atkiiison for a Conditional Use Permit for 15 apartment uiiits on the west side of South Oriole Drive 187.58 feet north of Laskiii Road. Said parcel contains 1.278 acres. Plats with more detailed information are available ia the Departmeiit of Planiiing. LYNNHAVEN BOROUGH Voting: 11-0 Council Members Votiilg Aye: John A. Baum, Nancy A. Creech, Robert E. Felitress, Mayor Harold Heischober, Barbara M. Heuley, R. Jack Jeiinings, Jr., Louis R. Jones, Robert G. Joiies, Vice Mayor Reba S. McClanan, J. Heilry McCoy, Jr., D.D.S., aiid Meyera E. Oberiidorf. Council Members Voting Nay: Nolie Couiicil Members Abseiit: None July 8, 1985 - 28 - Item 11-G-19 PLANNING ITEM # 23919 Attoriiey Glenn Croshaw represented the applicarit Sam Houstoti spoke concerning affordable uliits for the elderly Upon motioii by Couiicilmaii McCoy, seconded by Coulicilwoman Oberndorf, City Council DENIED ati ordiiiance upon applicatioii c)f ALORO, ALORO, et al for a Conditional Use Permit as per the followilig: ORDINANCE UPON APPLICATION OF ALORO, ALORO, ET AL FOR A CONDITONAL USE PERMIT FOR A HOME FOR ADULTS Ordinatice upon application of Aloro, Aloro, et al for a Conditional Use Permit for a home for adults oii the west side of Ceiiterville Turiipike, 2436 feet south of Kempsville Road. Said parcel is located at 2027 Ceiiterville Turnpike and contaii)s 6.15 acres. Plats with more detailed itiformatioii are available iii the Department of Planniiig. KEMPSVILLE BOROUGH Votiiig: 10-1 Couiicil Members Votilig Aye: Johii A. Baum, Nancy A. Creech, Robert E. Fentress, Mayor Harold Heischober, Barbara M. Heiiley, Louis R. Jones, Robert G. Jones, Vice Mayor Reba S. McClanan, J. Heiiry McCoy, Jr., D.D.S., aiid Meyera E. Oberndorf Council Members Voting Nay: H. Jack Jeniiings, Jr., Council Members Abseiit: Notie July 8, 1985 - 29 - Item II-R.1 RESOLUTION ITEM # 23920 Attorney R. J. Nutter represelited the applicant Upon motion by Councilman Pentress, seconded by Councilman Louis Jones, City Council ADOPTED a Resolution authorizing the enlargemeiit of the NONCONFORMING STRUCTURE located at 611 15th Street, Virginia Beach Borough (property of OLLIE JAMELL). Voting: 10-0 Council Members Votilig Aye: John A. Baum, Nancy A. Creech, Robert E. Feiitress, Mayor Harold Heischober, Barbara M. Heiiley, H. Jack Jennings, Jr., Louis R. Joiies, Robert G. Joiies, Vice Mayor Reba S. McClalian, and Meyera E. Oberiidorf Couiicil Members Votitig Nay: None Couiicil Members Absent: J. Henry McCoy, Jr., D.D.S. July 8, 1985 - 29a - RESC)I,UTIOti AUT110i@IZIN(, OF Till@', NC)NCONF'O@ING S'Ul,'.tJCTUi@- f,(@(-'ATEI) AT 611 15th STI@ET LI'ACII FOR(-)UGII (PROPERTY OF OLLI]@' JANIELI,) WifEREAS, Mr. Ollic JaiLell desires to alter Ilis duplex located at 611 15th Street, @lirq;-nia Ileach, "ir(Jiniz,, sho%in oil tliat certain survey entitlod "Site Plan of Lots 9, 10, 11; biock 17; Plat of Lakewood" (tlie "Survey"), a cor@y o@@ wiiich is attached liereto and made a part hereof; and WliEREAS, the present use does not conform to the pr,D@,,isions of the Coiiiprehensive Zonizi_q Ordinaiice because duplexes are not allowed in th(-, R-7 Zoning Di.strict; and WIIEREP,S, pursuant to Section 105(d) o@ thc-, Comprehensive Zoning Ordinance, City CotLncil may authorize the enlargerient or extension of a nonconforniing use and the enlargement of a nonconforming structure@ if Council finds that the use as enlarged or extended and the structure as enlarqed are equally appropriate or ificre iipl)rcpriate to the zc)iiin(I district than are the existin(j nonconformitics; NOW, TIJEJ@'OPE, BE IT RESOLVE-',D BY TIJE COUNCIL OF T!iE CII'Y OF VIRGINIA BEACH, VIRGINIA: That City Council hereby finds tlie enlargement or extension of the n()nconforitting use and the enlargtment of thc t-iui-,ccnforming use (duplex), located at 611 15th Strec,,t, 11-ifclinia B@ach, Virgiiiia, as showri on the ';urvey, Ire equally ar)propriate or irore appropriate to the zoninq district in which they are located ttian are the existing noncc)nf(irmities; and tho City Council herfby authorizes tlc! ciilargeiii@nt c)r extension of the nonconforif@in(,T use and thc enlargeiT@ent of thf-@ nonconforming structure in the manner shown on the Survey. Adopted by the Council of the City of \Iirginia Be@ach, Virginia, on July 8, 1985 July 8, 1985 29b V kk 2 Fl - oolp 2 ,15 1,9 Z&@@ 17 @,g r 2 0. 0 0 y N.A.SCHIPPELL c 9 OtT I P I IR P N 0 p 119 0 4 I 0 N A L E 14 0 1 k! E 9 IR //ZV.4,y aa 44 AVIK@.. im@MPOLK. V^. r tq,o 14 r. ( a o a a a 4 0 0 7 July 8, 1985 - 30 - Item II-H.2a. RESOLUTION ITEM # 23921 ADD-ON Upon motioii by Couiicilman Louis Jones, seconded by Councilwomall Oberndorf, City Council ADOPTED the following Resolutioli: A RESOLUTION TO AMEND THE LIST OF PROJECTS INCLUDED IN THE CAPITAL IMPROVEMENT PROGRAM FOR THE FISCAL YEARS 1984-85 THROUGH 1988-89. Voting: 10-0 Couiicil Members Voting Aye: John A. Baum, Nancy A. Creech, Robert E. Fentress, Mayor Harold Heischober, Barbara M. Henley, H. Jack Jennings, Jr., Louis R. Jones, Robert G. Jones, Vice Mayor Reba S. McClanau, and Meyera E. Obertidorf Council Members Voting Nay: Noiie Council Members Abseiit: J. Henry McCoy, Jr., D.D.S. July 8, 1985 30a - ,z 1- z 10 0 A RESOLUTION TO AMEND THE t- LIST OF PROJECTS INCLUDED IN THE CAPITAL It4pROVEMENT PROGRAN FOR THE FISCAL YEARS 1984-85 THROUGH 1988-89 CL WHEREAS, on December 17, 1984, Council adopted a resolution approving the projects listed in the proposed capital improvement program for the fiscal years 1984-85 through 1988-89, and WREREAS, it was further resolved by Council that the projects included in the capital improvement program were for planning purposes only and may be deleted, altered, or rescheduled in any manner at any time by City Council, and WHEREAS, Council deems it necessary to amend the Capital Improvement Program for fiscal years 1984-85 through 1988-89 to meet capital project needs of the city. NOW, THEREFORE, BE IT RESOLVED BY THE COUNCIL OF THE CITY OF VIRGINIA BEACH, that the Capital Improvement Program for fiscal year 1984-85 through 1988-89 is hereby amended as shown in the attached summaries to meet the capital project needs of the city through fiscal year 1989. BE IT FURTHER RESOLVED, that the projects shall be financed from funds to be provided periodically by City Council, and until funds are so pro- vided, the projects are for planning purposes only and may be deleted, altered or rescheduled in any manner at any time by City Council. This resolution shall be in effect from the date of its adoption. Adopted by the Council of the City of Virginia Beach, Virginia on the 8th day of July 1985. July 8, 1985 KAR/13 RES2 - 31 - Item II-H.2b. ORDINANCE ADD-ON ITEM # 23922 Upoii motion by Councilman Louis Jones, secoiided by CouncilwomaLi Oberiidorf, City Couticil APPROVED, on FIRST READING, the followilig Ordinalice: ORDINANCE TO APPROPRIATE $23,681,088 TO VARIOUS CAPITAL PROJECT FUNDS TO AMEND THE CAPITAL IM- PROVEMENT PROGRAM FOR THE FISCAL YEARS 1984-85 AND 1985-86 Voting: 10-0 Couiicil Members Voting Aye: John A. Baum, Nancy A. Creech, Robert E. Fentress, Mayor Harold Heischober, Barbara M. Henley, H. Jack Jeiinings, Jr., Louis R. Jones, Robert G. Jones, Vice Mayor Reba S. McClanan, and Meyera E. Oberndorf Council Members Voting Nay: None Council Members Absent: J. Henry McCoy, Jr., D.D.S. July 8, 1985 31a - z 1- 1 .4 Z 0 v 7 0 01 t- AN ORDINANCE TO APPROPRIATE $23,681,088 TO VARIOUS CKPITAL PROJECT FUNDS TO > AMEND THE CAPITAL IMPROVEMENT PROGRAM 0 FOR THE FISCAL YEARS 1984-85 AND 1985-86 WHEREAS, on December 17, 1984, Council adopted a resolution approving the Capital Improvement Program for fiscal years 1984-85 through 1988-89, and WHEREAS, Council deems it necessary to amend the Capital Improvement Program to meet urgent capital project needs of the city, and WHEREAS, the amendment of the Capital Improvement Program requires the appropriation of $23,681,088 from General Fund Balance to the various capital project funds. NOW, THEREFORE, BE IT ORDAINED BY THE COUNCIL OF THE CITY OF VIRGINIA BEACH, that appropriations in the amount of $23,681,088 are hereby transferred from General Fund Balance to the various capital projects funds for the following purposes: Purpose Amount School Projects $ 1,354,765 Engineering and Highway Projects 21,066,183 Building Projects 400,000 Parks and Recreation Projects 860,140 Total $ 23,681,088 BE IT FURTHER ORDAINFD that funds be appropriated and reallocated as necessary in the various capital project funds in order to finance the adopted revised Capital Improvement Program for fiscal years 1984-85 and 1985-86. This ordinance shall be in effect from the date of its adoption. Adopted by the Council of the City of Virginia Beach, Virginia on the day of 1985. FIRST READING July 8, 1935 SECOND READING July 8, 1985 KAR/13 ORD19 - 32 - Item II-H.2c. ORDINANCE ADD-ON ITEM # 23923 Upon motion by Councilman Louis Jones, secoiided by Councilwoman Oberadorf, City Couticil APPROVED, ON FIRST READING, the following Ordinarice: ORDINANCE TO AMEND SECTION 5 OF THE ORDINANCE MAKING APPROPRIATIONS FOR THE FISCAL YEAR BEGINNING JULY 2, 1985, AND ENDING JUNE 30, 1986, BY ADDING A NEW PARA- GRAPH RELATING TO A RETENTION OF A PERCENTAGE OF THE BUDGET FOR CITY AND SCHOOL DEBT SERVICE. Voting: 10-0 Council Members Voting Aye: John A. Baum, Nancy A. Creech, Robert E. Fentress, Mayor Harold Heischober, Barbara M. Hetiley, H. Jack Jeniiiiigs, Jr., Louis R. Jones, Robert G. Joiies, Vice Mayor Reba S. McClanaii, aild Meyera E. Oberiidorf Council Members Voting Nay: None Council Members Abseiit: J. Henry McCoy, Jr., D.D.S. July 8, 1985 32a z z 0 o Z -Z @O z z < 0 AN ORDINANCE TO AMEND SECTION 5 ne OF THE ORDINANCE MAKING APPROPRIATIONS FOR THE FISCAL YEAR BEGINNING JULY 1, 1985 AND ENDING JUNE 30, 1986 BY ADDING A NEW PARAGRAPH RELATING TO A RETENTION OF A PERCENTAGE OF THE BUDGET FOR CITY AND SCHOOL DEBT SERVICE Section 5. All balances of the appropriations payable out of each fund of the City Treasury unencumbered at the close of business for the fiscal year ending on the thirtieth (30th) day of June, 1985, except, as otherwise provided for, are hereby declared to be lapsed into the surplus of the respective funds, except School Operating Fund which shall lapse into the General Fund Surplus, and may be used for the payment of the appropriatioas which may be made in the appropriation ordinance for the fiscal year beginning July 1, 1985. However, there shall be retained in the General Fund Surplus an undesignated amount not less than the range of seventy-five (75) to one hundred (100) percent of the budget for city and school debt service payments for the fiscal year beginning July 1, 1985. The undesignated General Fund Surplus is to be used for contingencies and emergency situations and not to support appropriations app in the ordinance for the fiscal year beginning July 1, 1985, except upon sub- sequent authorization by City Council. First Reading: July 8, 1985 Second Reading: Adopted by the Council of the City of Virginia Beach, Virginia, on the day of 1985. July 8, 1985 L-1-ORD13 - 33 - Item II-H.2d. ORDINANCE ADD-ON ITEM # 23924 Upoii motioii by Couiicilman Louis Jones, seconded by Councilwoman Oberlidorf, CiLy Council ADOPTED the following Ordinalice: ORDINANCE TO TRANSFER CAPITAL PROJECT FUNDS BETWEEN PROJECTS IN THE 1984 PUBLIC IMPROVEMENT BONDS ISSUE AND BETWEEN PROJECTS IN THE REVENUE SHARING ALLOCATION 16th ENTITLEMENT Votiiig: 10-0 Council Members Voting Aye: John A. Baum, Nancy A. Creech, Robert E. Fentress, Mayor Harold Heischober, Barbara M. Heiiley, H. Jack Jenniiigs, Jr., Louis R. Jones, Robert G. Joiies, Vice Mayor Reba S. McClanan, and Meyera E. Oberndorf Council Members Votitig Nay: Noiie Council Members Absent: J. Henry McCoy, Jr., D.D.S. July 8, 1985 33a - z 1- z 0 0 z z AN ORDINANCE TO TRANSFER CAPITAL PROJECT FUNDS BETWEEN PROJECTS IN TRE < 1984 PUBLIC IMPROVEMENT BONDS ISSUE > n AND BETWEEN PROJECTS IN THE REVENUE 0 SHARING ALLOCATION - 16TH ENTITLEMENT Ce U. CL EREAS, on December 10, 1984, Council authorized the issuance of the 1984 public improvement bonds in the maximum amount of $21,400,000, and WHEREAS, on January 1, 1985, Council appropriated revenue aharirig funds for the sixteenth entitlement period in the amount of $5,500,000, and WHEREAS, due to the need to amend the current Capital Improvement Program, it will be necessary to reallocate funds between capital projects included in the 1984 public improvement bond issue and between capital projects funded from the revenue sharing allocation. NOW, THEREFORE, BE IT ORDAINED BY THE COUNCIL OF THE CITY OF VIRGINIA BEACH, that funds in the 1984 public improvement bonds issue and in the sixteenth entitlement revenue sharing allocation are hereby transferred as shown below to provide for current needs of capital projects. Transferred From and To Public Improvement Revenue Project Bonds Sharing 2-819 Ocean Park Storm Drainage + 540,000 + 236,432 2-823 Salem Canal Improvements-Phase I - - 236,432 2-989 Rosemont Road-Phase III + 50,000 - 4-801 Virginia Beach Recreation Center- Great Neck-Phase I + 45,000 4-933 Virginia Beach Recreation Center- Bayside - 635,000 - Net Transfer -0- -0- This ordinance shall be in effect from the date of its adoption. Adopted by the Council of the City of Virginia Beach, Virginia on the 8th day of July 1985. July 8, 1985 KAR/13 ORD20 34 - Item ORDINANCE ITEM # 23925 Upon motioti by Councilman Fentre ... .... iided by councilwoman Creech, city COUnCil ADOPTED an Ordiiiance to Amend a.d Reordain Section 36-58 of the Code of the City of Virgiiiia Beach pertaining to PARKIN(; and DISC@GE OF PASSENGERS AT PAVILION. Votil)g: 9-0 Council Members Voting Aye; John A. Baum, Nancy A. Creech, Robert E. Fentress, Mayor Harold Heischober, Barbara M. Hetiley, Louis R. Joiies, Robert G. Joiies, Vice Mayor Reba S. McClaiian, and Meyera E. Oberndorf Council Members Votiiig Nay; Noiie Council Members Abseiit: H. Jack Jeniiiiigs, Jr., aiid J. Henry McCoy, Jr., D.D.S. July 8, 1985 34a - AN ORDINANCE TO AMEND AND REORDAIN SECTION 16-58 OF THE CODE OF THE CITY OF VIRGINIA BEACH PERTAINING TO PARKING AND DISCHARGE OF PASSENGERS AT PAVILION BE IT ORDAINED BY THE COUNCIT OF THE CITY OF VIRGINIA BEACH, VIRGINIA: That Section 36-58, of the Code of the City of Virginia Beach, Virginia, pertaining to parking and discharge of passengers at Pavilion, is hereby amended and reordained as follows: Section 36-58. Parking and discharge of passengers at Virginia Beach Pavilion. All charter buses may park in the designated bus parking spaces 4n at the east end of the parking lot of the Virginia Beach Pavilion by first obtaining the-reaervabion a permit from the manager security office of the Virginia Beach Paviolion. The reservedr All ehartered charter buses parking at the Virginia Beach Pavilion must have such permits permit prominently displayed on the left side of the windshield at all times while parked within the parking lot of the Virgin,ia Beach Pavilion. The number of reservations permits issued shall be determined by the number of available spaces for buses at the Virginia Beach Pavilion and shall be alloted on a first come, first served basis. All charter buses may pick up or discharge passengers in the parking lot of the Virginia Beach Pavilion without obtaining a July 8, 1985 34b - permit provided that such charter bus does not remain parked in the parking lot in excess of fifteen (15) minutes. Adopted this 8th of -July--, 1985, by the Council of the City of Virginia Beach, Virginia. RmB/da 7/3/85 APPROVED AS i'O CONTE-NTS -PART EINT RNEY JulY 8, 1985 -2- - 35 - Item II-I.2 ORDINANCE ITEM # 23926 Upon motion by Councilmaii Louis Jones, seconded by Councilwoman Creech, City Council ADOPTED an Ordiiiance authoriziiig the Mayor to execute an EMPLOYMENT AGREEMENT for the CITY MANAGER. Voting: 9-0 Council Members Voting Aye: John A. Baum, Nancy A. Creech, Robert E. Fentress, Mayor Harold Heischober, Barbara M. Henley, Louis R. Joiies, Robert G. Jones, Vice Mayor Reba S. McClanan, and Meyera E. Oberndorf Council Members Voting Nay: None Council Members Absent: H. Jack Jennings, Jr., and J. Henry McCoy, Jr., D.D.S. July 8, 1985 - 35a - REQUESTED BY: CITY COUNCIL AN ORDINANCE AUTHORIZING THE MAYOR TO EXECUTE AN EMPLOYMENT AGREEMENT FOR THE CITY t4ANAGER BE IT ORDAINED BY THE COUNCIL OF THE CITY OF VIRGINIA BEACH, VIRGINIA: 1. That the attached Agreement (Exhibit A) is hereby approved and incorporated by reference; 2. That the Mayor is hereby authorized to execute said Agreement.; and 3. This Ordinance shall be effective retroactively from June 1, 1985. ADOPTED: July 8, 1985 JDB/da 7/3/85 APPROVED AS TO CONTENT DEPARTMEN CITY ATTORNEY July 8, 1985 35b This Agreement made this day of 1985, by and between the CITY OF VIRGINIA BEACH, VIRGINIA, a municipal corporation, hereinafter sometimes referred to as 'City" and THOMAS H. MUEHLENBECK, hereinafter sometimes referred to as "Employee.' W I T N E S S E T H WHEREAS, the City wishes to employ Thomas H. Muehlenbeck as its City manager as provided in Section 4.01 of the Charter of the City of Virginia Beach, and WHEREAS, Thomas H. Muehlenbeck agrees to accept such employment, and WHEREAS, the parties hereto desire to set Eorth herein the terms and conditions of such employment, NOW, THEREFORE, for and in consideration of the mutual covenants and obligations set forth herein and other good and valuable consideration, the parties hereto agree as follows: Article I - Duties (a) Employee shall perform the functions and duties of the position of City Manager in accordance with the provisions of the Charter of the City of Virginia Beach and all other applicable statutes and ordinances. (b) Employee shall perform such functions and duties in accordance with the policy and direction of the City Council. July 8, 1985 35c (c) Employee shall also perform any other legally permissible duties or functions as the City Council may see fit to assign him at any time during the term hereof. Article II - Term of A ment (a) Except as otherwise provided herein, this Agreement shall be for a term of three (3) calendar years (36 months) commencing June 1, 1984, and endinq May 31, 1987. (b) Except as provided by Article III, below, during the term hereof, Employee agrees to remain in the exclusive employ of the City. (c) Nothing herein shall be deemed to limit in any way the authority of City Council to terminate the Employee at any time; provided, however, that such termination shall be in accordance with the provisions of Article III below. (d) Nothing herein shall be deemed to limit the right of Employee to voluntarily resign; provided, however, that such resignation shall be in accordance with Article III below. Article III - Termination and Resignation .(a) In the event the Employee is terminated by the City before the expiration of the term of this Agreement, and at the time of such termination Employee is under no physical or mental incapacity which would prevent him from performing the duties of City Manager, the City Council shall continue to compensate Employee in accordance with the provisions of Article IV hereof as may have been increased by subsequent actions of City Council -2- July 8.1 1985 35d for the duration of this Agreement, subject to the provision of paragraphs (1), (2), (3) and (4) below. All other benefits hereunder, however, shall cease as of the date of termination. (1) Such post-termination compensation shall cease, however, if Employee has been offered comparable employment elsewhere. (2) Employee agrees to use due diligence to secure such comparable employment as expeditiously as possible. (3) If Employee is terminated for misfeasance, malfeasance, or nonfeasance in office all compensation by the City shall end as of the date of termination. (4) If Employee is terminated after the expiration date of this Agreement for reasons other than those set forth in paragraph (a)(3) above, he shall continue to receive as severance pay the compensation installments set forth in Article IV as may have been increased by the City Council for three (3) months following the date of such termination. (b) If Employee voluntarily resigns, then all compensation and benefits shall cease as of the effective date of such resignation. Employee shall give the City ninety (90) days written notice of any such resignation; provided, however, it is expressly understood that City Council may waive any or all of this ninety (90) day notice requirement. JulY 8, 1985 -3- 35e - Article IV - Compensation City agrees to pay Employee for services rendered pursuant hereto an annual gross salary of Eighty-Five Thousand Dollars ($85,000.00), payable in installments at the same time and in the same manner as other City employees are paid. Such annual gross salary and such additional sum may be increased from time to time by action of the City Council. Article V - Automobile Allowance In lieu of supplying a City-owned vehicle for use by Employee in conducting City business, City agrees to pay Employee a car allowance in the sum of Four Hundred Dollars ($400.00) per month which sum may be increased from time to time by action of the City Council. In consideration thereof, Employee shall provide his own vehicle and shall be responsible for all fuel, maintenance, insurance, and other expenses related to the operation thereof. Article VI - Fringe Benefits Employee shall receive fringe benefits such as annual leave, sick leave, life insurance, hospitalization, Virginia Supplemental Retirement System, etc. in accordance with existing City policies and ordinances as applicable to all other City employees. Nothing herein shall be constructed to prevent changes in the nature of such benefits to Employee should such benefits be subsequently altered for all other City employees. -4- July 8, 1985 35f Article VII - Hours of ment it is recognized that the nature of Employee's position requires flexible hours. Therefore, Employee in consideration of his compensation shall work whatever hours are necessary to satisfactorily perform the functions and-duties of City Manager. Article VIII - Dues and Subscriptions City agrees to pay professional dues and subscriptions of Employee necessary for his membership and participation in national, regional, state, and local associations and organizations of a job-related nature and for travel and associated expenses of employee to secure his attendance at professional meetings and conferences, as budgeted and approved by the City Council. Article IX - General Business Related Expenses Except as specifically provided in Articles V and VIII, the City agrees to reimburse Employee for job-related expenditures in accordance with existing City policy. Article X - Other Terms and Conditions of Employment (a) The City Council may at any time prescribe any other terms and conditions of employment related to Employee's performance as City Manager as it may deem necessary, provided such terms and conditions are not inconsistent with the specific provisions of this Aqreement. July 8, 1985 35g (b) City agrees to provide insurance coverage and legal counsel for Employee in matters relating to his official duties within the scope of his employment, as is provided to all other City employees. (c) All provisions of state or city law or policy relating to terms and conditions of municipal employment generally as they now exist or may hereafter be amended shall apply to Employee. Provided, however, that should any such law or policy be so changed as to be inconsistent with the terms hereof, this Agreement shall be deemed amended so as to comply with such law or policy change. (d) The text herein shall constitute the entire Agreement between the parties and shall only be amended by a writing executed by both parties. (e) If any provision hereof shall be deemed unlawful, invalid,' ultra vires, or otherwise unenforceable, the remainder of the Agreement shall be deemed severable and shall remain in full force and effect. (f) This Agreement shall be construed in accordance with the laws of the Commonwealth of Virginia. (g) This Agreement supersedes any other agreement between the parties. IN WITNESS WHEREOF, the City of Virginia Beach has caused this Agreement to be executed in its behalf by its mayor in accordance with an ordinance of the City Council authorizing -6- JulY 8, 1985 - 35h such execution, and Employee, Thomas H. Muehlenbeck, has executed this Agreement, both the day and year first above written. CITY OF VIRGINIA BEACH, VIRGINIA By Mayor THOMAS H. MUEHLENBECK Approved as to Content Approved as to form 1EY Attorney Approved as to Availability of Funds JDB/da (48.12) 4/19/82 4/ 2 2/8 2 5/7/82 6/20/8 4 6/2 1 /8 4 -7- July 8, 1985 - 36 - Item II-J. CONSENT AGENDA ITEM # 23927 Upon motioti by Couiicilmaii Baum, secoiided by Couticilwomati Creech, City Council APPROVED in ONE MOTION Items 1 through 12 of the CONSENT AGENDA with the exception of Item 1, which was voted on separately. Voting: 11-0 Council Members Voting Aye; John A. Baum, Naiicy A. Creech, Robert E. Fentress, Mayor Harold Heischober, Barbara M. Heiiley, H. Jack Jennit)gS, Jr., Louis R. Jonesl Robert G. Jones, Vice Mayor Reba S. McClanaii, J. Heliry McCoy, Jr., D.D.S., and Meyera E. Oberndorf. Council Members Votiiig Nay: Noiie Council Members Absent: None *Verbal Aye July 8, 1985 3 7 Item II-J. I CONSENT AGENDA ITEM # 23928 Upon motion by Councilman McCoy, seconded by Councilwoman Creech, City Couiicil ADOPTED an Ordinance authorizing alid directing the City Manager to execute contracts for HF-ALTH CARE COVERAGE for MUNICIPAL Et4PLOYEES. Voting: 10-0 Council Members Voting Aye: John A. Baum, Naucy A. Creech, Robert E. Feiitress, Mayor Harold Heischober, Barbara M. Henley, Louis R. Jones, Robert G. Joiies, Vice Mayor Reba S. McClanaii, J. Henry McCoy, Jr., D.D.S., and Meyera E. Oberndorf Council Members Voting Nay: None Council Members Abseiit: Noiie Council Members Abstaining; H. Jack Jenniiigs, Jr. July 8, 1985 37a AN ORDINANCE AUTHORIZING AND DTRECTTNG THE CITY MANAGER TO EXECUTE CONTRACTS FOR HEALTH CARE COVERAGE FOR KUNICIPAL EMPLOYEES WHEREAS, on June 10, 1985, City Council authorized the City Manager to prepare the necessary contracts with Blue Cross/Blue Shield of Virginia, United Medical Plan of Virginia, and HMO Plus to provide health care coverage, including dental care, for municipal employees, and WHEREAS, the contracts have been prepared and reviewed by city staff and the City Attorney's Office. NOW, THEREFORE, BE IT RESOLVED BY THE COUNCIL OF THE CITY OF VIRGINIA BEACH that the City Manager is hereby authorized and directed to enter into contracts with Blue Cross/Blue Shield of Virginia, United Medical Plan of Virginia, and HMO Plus to provide health care coverage including dental care, for muni- cipal employees to begin August 1, 1985. Said Agreements are attached hereto and the same are hereby approved. This ordinance is effective from the date of its adoption. Ad,ji)L,2d I)y the. Council of the City of Virginia i3each, Virgiiiia on 8th day of July 1985. JCM/VL/32 July 8, 1985 United GROUP MASTER CONTRACT AAedical ACCEPTANCE AGREEMENT Plan [:)F VIRGINIA Agreement, dated as of this 13 day of June 19@5 betweenUnitedMedica[Planofvirginia,lnc. (United Medical), and the undersigned Contract Holder. Preliminary Facts: United Medical operates a comprehensive prepaid program of health care, and has arranged tor health care ser- vices and benefits to be provided to persons who have met the eligibility requirements specified in the Group Master Contract attached hereto (the "Contract"). The goal of United Medical is to promote the health of its Members, to ar- range for the provision of high-quality health services, and to preserve and enhance patient dignity. The Contract Holder wishes to provide for the health care of certain persons as described in the Contract. NOW, THEREFORE, in consideration of the premises,and the promises and mutual covenants contained in this Agreement and the Contract, United Medical and the Contract Holder agree and covenant as follows: 1. United Medical, subject to all the conditions and provisions of the Contract, and in reliance upon the statements of each Subscriber in his enrollment application, shall provide the services and benefits and the other rights and privileges which are set forth in the Contract, which shall take effect on August 1the Effec- tive Date. 2. TheContract,includingailattachments,endorsements,andridersincorporatedintheContractbyreference, is delivered by United Medical in consideration of the payment of premiums by the Contract Holder. No services are deliverable under the Contract In the absence of current payment of such premiums. I S@ .4 3 are payable to United Medical on or before t@- "he-@" day of 'T@ms each ca ndarmonth,atthehomeofficeofUnitedMedical,uniessotherwisespecifiedbyUnitedMedical in writing. The payment otany premium shall not maintain coverage under this Contract in force beyond the date when the next premium becomes payable. The monthly premium rates on the Contract Effective Date are as follows: Rates: Employee Only ($68.32), Employee Plus Minor ($100.92), Employee Plus !-'amily ($172.96), Medicare Carveout ($66.33). Benofits include Plan 100 plus the Prescription Drug and the Plental H@-alth T,iders. outnationt mental Heajth visits have been increased from 20 to "O visits per year..the sarie co-r)avment applies, Term of Rates: August 1. 1985-.Ti@n@ 10, IqP(, (11 -@,2 P..&..r w 4. UnitedMedicalreservestherighttol4newpremiumratesunderthisContractattheendoftheTermofRates specified in Paragraph 3 above and upon filing with the Virginia State Corporation Commission. Notice of any new premium rates shall be given to the Contract Holder @al foF llqe w4 o" /@/l/ 5. TheContractNumberforthisAgreementis 752 he term o ts Agreement shall be from August 1, 1985 to June 30, 1986 and the Anniversary Date shall be July 1, 1986 IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by duly authorized representatives this 13 day of June 1 9@5 UNITEDMEDICALPLANOFVIRGINIA,INC. CONTRACTHOLDER: /) CITY OF VIRGINIA BEAC14, BY: /1 , @ ". @ @, @ @ - ", VIRGINIA BEACH, VA I;illiam J.@Pastore Vice President and BY: General llanager TITLE TITLE Ak,pktjv@L) - !, , , 6 @, @ i . i @ @ @ @ - SiGt4ATIJ -,e [:-, fi@ @. - 2,6, i 1- D,f@ United Medical MENTAL HEALTH CARE RIDER Plan OF VIRGINIA In consideration of the premium paid, the following language is incorporated in the Group Master Contract and the Schedule of Benefits: 1. Whenauthorizedorapproved byaparticipating PrimaryPhysician,theMembershall haveasa benefit additional mental health care, including conditions involving drug and alcohol abuse, forevaluation orcrisis intervention treatment oranycombination thereof foracute conditions. The total benefit is limited to any combination of the following, up to the equivalent of 30 inpatient days. a. As an inpatient, up to 30 hospital days per Contract Year, or b. Up to 60 days as a daycare patient, in an authorized facility per Contract year. 2. "Daycare" is defined as treatment of the Member in an authorized facility on a day-to-day basis with release of the Member at the conclusion of treatment each day, and in which no overnight stay is involved. In calculating the benef it, one daycare day shall equal one-half in- patient day. 3. Exclusions: The following services are not covered: a. Mental health care for the following conditions after diagnosis if, in the professional judgement of the Primary Physician, they would not be subject to significant improve- ment with short-term therapeutic management: Chronic psychosis, intractable personality disorders, mental retardation, psychiatric therapy on court order oras acondition of parole or probation, chronic organic brain syndrome, and developmental and Iearning disabilities. 4. All of the terms and provisions of the Contract, the Schedule of Benefits, and Evidence of Coverage, as prejiously modified by non-expired and non-cancelled riders, remain unaffected by this Rider. CONTRACT HOLDER UNITED MEDICAL PLAN OIF VlRqINIA, INC. BY BY VICE PRESIDENT All, Title Title United ,Medical PRESCRIPTION DRUG RIDER Plan C:)F VIRGINIA In consideration of the premium paid, the following language is incorporated in the Group master Contract and the Schedule of Benefits: 1. Definitions a. "Participating Pharmacy" means a pharmacy which has contracted with United Medical to provide prescription services to Members. b. "Prescription Drug" means (i) any medical substance required by law to be dispensed only by prescription, or (ii) injectible insulin or (iii) oral contraceptives. 2. Bonef Its . I n considerat ion of a $3.00 co-payment per presc ri pt ion or ref i I 1, the Mem t>ers shal I have as an additional benefit Prescription Drugs when prescribed by a Participating Physician or authorized Specialist referred by the Participating Physician in connection with covered medical care as described in the Schedule of Benefits. Prescriptions must be filled at a Par- ticipating Pharmacy chosen by the Member and the prescription must be written and f illed for a Member currently covered under the Prescription Drug Rider. If an emergency prescription is required when the Member is located beyond a 50-mile radius from a Participating Pharmacy, United Medical will reimburse, subject to professional review, 75% of the cost of the prescription, less any applicable co-payments. If a generic substitute for a Prescription Drug is included in the Virginia Voluntary For- mulary or such other Formulary as may be established by United Medical, then Member's prescription will be filled with the appropriate generic substitute, if available. 3. Limitations Initial prescriptions or prescription refills for each $3.00 co-payment are limited to: a. 100 unit doses or a 34 day supply, whichever is less; b. 8 fluid ounces of liquid; or C. A three month supply of any oral contraceptive drug. 4. Exclusions a. Prescription drugs not prescribed by a Participating Physician or authorized Specialist referred by the Participating Physician or f illed at a Participating Pharmacy, except in the case of an emergency described in Section 2. b. Drugs which do not require a prescription, as defined. C. The administration of a drug or medication. d. Therapeutic devices or appliances, including but not limited to hypodermic needies and syringes. e. Dietary supplements, including non-therapeutic vitamins. f. Drugs and medications for conditions excluded in the Schedule of Benefits. 5. All the terms and conditions and provisions of the Group MQster Contract, the Schedule of Benef its, and Evidence of Coverage, as previously modif ied by non-expired and non-cancelled riders, remain unaffected by this Rider. CONTRACT HOLDER UNITED RGINIA, INC. BY By VICE PRESIDENT AND GENERAL MAIIAGER Title Title United Medical GROUP MASTER CONTRACT Plan OF VIR@INIA SECTION 1 - DEFINITIONS 1.1 "Acceptance Agreement" means the 1.10 "EffectiveDate"meansthedatespecified Agreement whereby United Medical agrees to furn- in Paragraph 1 of the Acceptance Agreement. ish health services to certain Members in considera- 1.1 1 "Employee" means an employee, partner tion for premiums paid by the Contract Holder. or bona fide member of a Group or a sole proprietor 1.2 "Anniversary Date" means the date speci- and who qualif ies for health care coverage under the fied in Paragraph 6 of the Acceptance Agreement. Group's eligibility requirements to receive health 1.3 "Benefits" means those hospital, benefits coverage. medical, surgical and other services and procedures 1.12 "Group" means a group of Subscribers and those appliances, tests, medicines, devices and which has been accepted by United Medical whose emergency benefits listed on the Benefit Schedule premiums are remitted to United Medical by the attached hereto, as limited and qualified in this Con- Contract Holder. tract and in the Schedule of Exclusions and Limita- 1.13 "Health Professionals" means physi- tions attached hereto. cians, dentists, nurses, podiatrists, optometrists, 1.4 "Contract"meanstheGroupMasterCon- physicians' assistants, psychologists, social tract issued to the Contract Holder by United workers, and other professionals engaged in the Medical. delivery of health services and who are licensed 1.5 "Contract Holdee' means an individual, where such licensing is required by state law. partnership, association, corporation or organization 1.14 "Home Health Agency" means any organ- which agrees to pay or collect and remit the prem- ization certified as such under the Medicare law, or iums for coverage payable on behalf of United otherwise approved by United Medical for the Medical Members either by payroll deductions or delivery of non-physician patient care in the home of otherwise to United Medical and has caused an Ac- a Member. ceptance Agreement to be executed. The Contract 1.15 "Hospital" means an institution rendering Holder shall receive any notice, card, literature or inpatient therapy and ancillary services approved by contract amendment from United Medical on behalf United Medical which is licensed as a Hospital and of Group Members. The Contract Holder shall act which is accredited by the Joint Commission on Ac- only as agent of Members in the Contract Holder's creditation of Hospitals. A Hospital may be a Group, and shall not be the agent of United Medical general, acute care institution or a specialty institu- for any purpose. tion; provided that in either case it is appropriately 1.6 "Contract Yeae' means each 12-consecu- accredited as aforesaid, and licensed by the proper tive-month period, depending upon the Effective state authorities. Date. 1.16 "HospitalServices"meansthoseservices 1.7 "ContributoryCoverage"meanscoverage for registered bed patients or outpatients which are for which the Contract 41older may establish re- listed in the Schedule of Benefits of this Contract. quired contributions to be made by a Member, but 1.17 "Medical Services" means those profes- which are included in the Contract Holder's monthly sional services of Physicians and paramedical per- payments. sonnel, including medical, surgical, diagnostic, 1.8 "Co-payment" means the amount re- therapeutic and preventive services which are listed quired to be paid by or on behalf of a Member in con- in the Schedule of Benefits. nection with the services set forth in the Schedule of 1.18 "Medicare Law" means Title XVIII of the Benefits. Co-payments paid by or on behalf of a Social Security Act and all amendments thereto. Member during a Contract Year shall not exceed 1.19 "Member" means any Subscriber or 100% of the applicable Subscriber's total annual Dependent as described in Sections 1.34 and 1.9. premium cost for such Contract Year which is paid 1.20 "Open Enrollment Period" means a period by or on behalf of the Subscriber. of not less than ten consecutive working days in 1.9 "Dependent" means any person in a Sub- each calendar year, during which each Employee of scriber's family who meets all the requirements of the Group is given the opportunity to select among Section 2.2 of this Contract, is enrolled hereunder, the alternatives included in the Contract Holder's and is subject to premium requirements as set forth health benefit program. hereunder. 1.21 "Participating Health Professional" determined by United Medical to meet reasonable means a health professional who has entered into a standards as applied by any of the aforesaid contractual agreement with United Medical for the authorities. provision of services to Members on an agreed-upon 1.33 "Specialist Physician" means a Physician basis. who provides medical care in any generally accepted 1.22 "Participating Home Health Agency" medical specialty or subspecialty. means a Home Health Agency which has entered in- 1.34 "Subscriber"meansanapplicantcertified to a contractual agreement with United Medical for by the Contract Holder as being an Employee in the provision of Home Health services as described good standing of thegroup who meetsall applicable in the Scheduleof Benefits to Members on a pervisit eligibility requirements of Section 2.1 of this Con- or otherwise agreed-upon basis. tract and enrolls hereunder, and is subject to 1.23 "Participating Hospital" means a Hospital premium requirements as set forth in the Schedule which has entered into a contractual agreement with of Benefits, United Medical for the provision of inpatient serv- 1.35 "United Medical" means United Medical ices, as described and defined in the Schedule of Plan of Virginia, Inc. Benefits, to Members on an agreed-upon basis. 1.24 "Participating Physician" means a Primary Physician or Specialist Physician who has contracted with United Medical to provide medical SECTION 2 - ELIGIBILITY care and services to Members. 1.25 "Participating Provider" is a Provider 2.1 To be eligible to enroll as a Subscriber, a which or who has entered into a contractual agree- person must reside in the United Medical Service ment with United Medical for the provision of serv- Area and be: ices to Members on an agreed-upon basis. (a) An Employee; and 1.26 "Participating Skilled Nursing Facility" (b) Entitled on his own behalf to par- means a Skilled Nursing Facility which has entered ticipate in the medical and hospital into a contractual agreement with United Medical for care benefits arranged by Group. the provision of Skilled Nursing Facility services as 2.2 To be eligible to enroll as a Dependent, a described and defined in the Schedule of Benefits to person must be: Members on an agreed-upon basis. (a) The spouse of a Subscriber; or 1.27 "Physician" means a duly licensed doctor (b) A dependent unmarried child residing of medicine. with Subscriber or with Subscriber's 1.28 "Premium Due Bate" means the date former spouse in the United Medical specified in Paragraph 3 of the Acceptance Agree- Service Area who is (i) under nineteen ment. years of age; or (ii) nineteen years and 1.29 "Primary Physician" means a Physician older while incapable of self-support who provides primary care medical services as a because of mental retardation or general or family care practitioner, or in some cases, physical handicap, which retardation as an internist or pediatrician. or handicap commenced prior to age 1.30 "Provider" means a Physician or other nineteen; or (iii) under twenty-three Health Professional or a Hospital, Skilled Nursing years of age and attending a recog- Facility, or Home Health Agency. nized college or university, trade or 1.31 "Service Area" means the service area secondary school on a full time basis. to be served by United Medical as approved by the Foster children, step-children and Virginia State Corporation Commission, namely legally adopted children as well as the cities of Chesapeake, Hampton, Newport natural children, are included. News, Norfolk, Portsmouth, Poquoson, Smithfield, Newborn children will be treated as Suffolk, Virginia Beach and Williamsburg, Virginia, Dependents from birth in accordance and the counties of Isle of Wight, James City and with Section 4(c). York. 2.3 Change of Group Eligibility Rules - The 1.32 "Skilled Nursing Facility" means an in- composition of Group and requirements determin- stitution or a distinct part of an institution licensed ing eligibility for membership in Group which exist at or approved under staie or local law, which is the effective date of this Contract are material to the primarily engaged in providing skilled nursing care execution of this Contract by United Medical. During and related services, and is approved as a Skilled the term of this Contract, no change in Group's Nursing Facility, Extended Care Facility, or Nursing eligibility or participation requirements shall be per- Care Facility by the Joint Commission on Accredita- mitted to affect eligibility or enrollment under this tion of Hospitals or is certified as a Skilled Nursing Contract unless such change is agreed to by United Facility under the Medicare law, or is otherwise Medical and the Contract Holder. SECTION 3 SECTION 4 ELIGIBILITY DATES AND ENROLLMENT PERIODS EFFECTIVE DATE OF COVERAGE 3.1 Persons who meet the requirements of Subject to payment of applicable monthly Section 2 may enroll to become Members only by premiums provided for in Paragraph 3 of the Accep- submitting completed application forms provided by tance Agreement and to the provisions of this Con- United Medical. tract, coverage under this Contract shall become ef- 3.2 The following eligibility dates are applic- fective on the earlier of the following dates: able to Members: (a) When an Employee makes written ap- (a) Any person who satisfies the require- plications for himself or for his ment of Section 2.1 on the Effective Dependents for participating in the Date of this Contract shall become United Medical program prior to his or eligible on such date. their eligibility date, coverage will be (b) Any person who first satisfies the re- effective on the eligibility date. quirements of Section 2.1 after the ef- (b) When an Employee fails to enroll fective date of this Contract shall himself orany of his Dependents prior become eligible on the Premium Due to his or their eligibility date, coverage Date next following the date as of for the Employee or his Dependents which he has satisfied said re- will not become effective until the quirements, provided written applica- Employee submits a properly com- tion is made to United Medical and pleted application form furnished by received by United Medical prior to United Medical during an Open Enroll- the eligibility date. ment Period. (c) Any person who first satisfies the re- (c) Coverage for a newborn child of a quirements of Section 2.2 for enroll- Member is effective at the time of ment as a Dependent of a Subscriber b i rt h. Such coverage shall after the effective date of this Con- automatically extend for a period of tract shall become eligible on the 31 days after birth. Member shall have Premium Due Date next following the the right, within the 31-day period date as of which he satisfied said re- afterthe birth of the newborn child, to quirements, provided written applica- continue coverage for the child tion is made to United Medical and beyond the 31 day period by enrolling received by United Medical prior to the newborn child as a Dependent in the eligibility date. Coverage for a the United Medical program (see Sec- newborn child shall begin at the time tion 3.2(c)), provided that all eligibility of birth subject to the provisions of requirements of Section 2.2 have Section 4(c). been met and the premium required 3.3 The Contract Holder shall provide an under the Acceptance Agreement has Open Enrollment Period of at least ten working days been paid for said child. All such each Contract Year, during which those Employees enrollments are not effective unless of the Group that are so eligible may enroll in United the Member submits a properly com- Medical without application of waiting periods or ex- pleted application form, specifically clusions or limitations based on health status or, if naming the newborn child to be add- already so enrolled, may transfer to a health plan of ed so that United Medical receives the Contract Holder for which they are eligible. Any such application form before the end Employee electing to enroll or transfer must affirma- of the 31-day period after the birth of tively so state in writing to the Contract Holder and the child. United Medical. Any Employee enrolling in United SECTION 5 Medical must submit a completed application form TERMINATION OF COVERAGE supplied by United Medical. 3.4 lnadditiontotheGroupEnrollmentPeriod 5.1 Coverage under ti,is Contract for a provided for in Section 3.3, the Contract Holder and Subscriber will terminate as follows: United Medical shall permit new Employees and Em- (a) If the Subscriber ceases to meet the ployees who have changed their place of residence eligibility requirements of Section into the United Medical Service Area to elect to en- 2.1, coverage will terminate on the roll in United Medical without application of waiting next Premium Due Date following the periods or exclusions or limitations based on health date on which the Subscriber ceases status. to meet the eligibility requirements, subject to the conversion privilege of Section 6. (b) If this Contract terminates pursuant United Medical shall have no further to Section 9, coverage shall terminate liability or responsibility under this as provided in Section 9. Contract, with respect to such (c) In the event any Subscriber fails to Member or Member's Dependents. make any required co-payment pro- 5.2 Coverage under this Contract for a Sub- vided for in the Schedule of Benefits scriber's Dependents wili be terminated as follows: with respect to such Subscriber or his (a) If the Subscriber ceases to meet the Dependents, coverage hereunder eligibility requirements of Section 2.1, shall terminate for the Subscriber and coverage shall terminate on the next his Dependents 15 days after notice is Premium Due Date afterthe Subscrib- given to the Subscriber and Contract er ceases to meet the eligibility re- Holder by United Medical of such fail- quirements, subject to the conversion ure and subject to the Grievance Pro- privilege of Section 6. cedure. At the effective date of such (b) If this Contract terminates pursuant termination, premiums received on to Section 9, coverage shall terminate account of such terminated Subscrib- as provided in Section 9. er or Subscriber's Dependents ap- (c) If any required contribution or co-pay- plicable to periods atter the effective ment is not made when due, coverage date of termination shall be refunded shall terminate as indicated in Sec- to the Contract Holder and United tion 5.1(c). Medical shall have no further liability (d) If the Subscriber and his Dependents or responsibility with respect to such become covered under an alternative Subscriber or Subscriber's Depend- health benetit plan, as provided in ents under this Contract. Section 5.1(d), coverage under this (d) If the Subscriber becomes covered Contract shall terminate upon the ef- under an alternative health benefit fective date of such other coverage. plan or under any other plan, which is (e) If the conditions of Section 5.1(e) ap- offered bg, through or in connection ply, coverage shall terminate as indi- with the Group as an option in lieu of cated in such Section. coverage under this Contract, cover- (f) If the conditions of Section 5.1(f) age hereunder shall terminate upon apply, coverage shall terminate as in- the effective date of such othercover- dicated in such Section. age. (g) If the coverage of the Subscriber ter- (e) If the Subscriber commits fraud or minates for any other reason, cover- material misrepresentation in apply- age of his Dependents shall terminate ing for or obtaining coverage under in the same manner. this Contract, or of misuse of the (h) If a Dependent ceases to meet the eli- identification document issued by gibility requirements of Section 2.2, United Medical, or in allowing un- coverage shall terminate at the next authorized persons, i.e., persons Premium Due Date after which the other than those named on the docu- Dependent no longer meets the re- ments to use United Medical ser- quirements of Section 2.2, subject to vices, coverage hereunder shall ter- the conversion privilege of Section 6. minate immediately. SECTION 6 - CONVERSION If United Medical, after reasonable ef- forts, shall be unable to establish and 6.1 If any Subscriber or his Dependents shall maintain a satisfactory physician- cease to be eligible to continue as a Subscriber or patient relationship with a Member, Dependent for any reason other than those set torth then the rights of such Member under in Section 5.1(c), 5.1(d), 5.1(e), 5.1(f), 5.2(c), 5.2(d), this Contract may be terminated on 5.2(e), 5.2(f), or 7.1, then said Subscriber or Depen- not less than 30 days' written notice dent may, within 31 days after termination of to Member and Contract Holder, sub- coverage under this Contract convert his member- ject to the Grievance Procedure. At ship effective as of the date of such termination to the effective date of such termina- individual membership without furnishing evidence tion, prepayments received on ac- of insurability, in accordance with such rules and count of such terminated Member or regulations governing such items as the initial pay- Members for the period after the ef- ment, the form of such agreement and all terms and fective date of termination shall be conditions thereof as United Medical may have in ef. refunded to the Contract Holder and fect at the time of his application for conversion. During such 31-day period, he will be entitled to con. Member was not notified prior to the provision of tinuation of benefits (unless benefits otherwise ex- such benefit that the same would not be medically pire under this Cohtract), provided that application necessary. shall have been made to United Medical for such 7.3 Hospital Rules - Members are subject to non-group coverage and the applicable initial all the rules and regulations of each Hospital and premium is paid therefore prior to the end of such other facility in which benefits are provided. 31-day period. 7.4 Reports and Records - United Medical is 6.2 lfaSubscriber'scoverageunderthisCon- entitiedtoreceivefromanyproviderofservicestoa tract terminates as a result of the Subscriber's death Member information reasonably necessary in con- and on the date of such termination such Subscriber nection with the administration of this Contract but is covered under this Contract for coverage with subject to all applicable confidentiality re- respect to Dependents, the privilege of converting to quirements, as defined in Section 7.10. By accep- an individual membership agreement under the con- tance of coverage under this Contract, Subscriber, ditions stated above may be exercised by the Sub- for himself, and for all Dependents covered scriber's surviving Dependents. hereunder, authorizes every Provider rendering ser- 6.3 lntheeventcoverageunderthiscontract vices hereunder to disclose all facts pertaining to with respect to a Subscriber's child terminates sole- such care and treatment, and to the physical condi- ly because such child marries or attains the limiting tion of a Member, to United Medical upon request, age for eligible dependent children with respect to and render reports pertaining to the same, and per- whom coverage is provided under this Contract, mit copying of records by United Medical. such child shall have the privilege of converting to an 7.5 Refusing Treatment - A Member may for individual membership agreement under the same personal reasons, refuse to accept proced@res, conditions as would apply to the Member were he medicines, or course of treatment recommended by then terminating employment or no longer a bona a Participating Physician. If such Participating Physi- fide member of Group. cian (after a second Participating Physician's opi- nion, if requested by a Member) believes that no pro- fessionally acceptable alternative exists, and if after SECTION 7 - GENERAL PROVISIONS being so advised, a Member still refuses to follow the recommended treatment or procedure, the 7.1 Identification Card - Cards issued by Member will be given no further treatment for the United Medical to Members pursuant to this Con- condition involved. In that case, neither the Physi- tract are for identification purposes only. Posses- cian, United Medical, Participating Hospital, Par- sion of a United Medical identification card confers ticipating Skilled Nursing Facility, nor Participating no right to services or benefits, under this Contract, Home Health Agency will have further responsibility and misuse of such identification cards may be to provide benefits available for such condition. grounds for termination of Member's coverage pur- United Medical will provide written notice to a suant to Section 5.1(e). To be entitled to such ser- Member of a decision not to give further treatment vices or benef its, the holder of the card must, in fact, for a particular condition. This decision is subject to be a Member on whose behalf all applicable the Grievance Procedure. I)remium charges under this Contract have actually 7.6 Assignment of Benefits - All rights of been paid. Any person receiving services or benefits Members to receive benefits hereunder are personal to which he is not then entitled pursuant to the provi- to Members and may not be assigned to anyone sions of this Contract shall be charged therefore at else. prevailing rates. If any Member permits the use of his 7.7 Independent Contractor Relationship - United Medical identification card by any other per- (a) The relationships among United son, such card may be retained by United Medical, Medical and Participating Physicians, and all rights of such Member and his Dependents and among United Medical, Par- pursuant to this Contract shall be immediately ter- ticipating Hospitals, Participating minable, subject to the Grievance Procedure. Skilled Nursing Facilities, or Par- 7.2 MedicalNecessity-Memberswillreceive ticipating Home Health Agencies, are benefits under the Contract only when medically independent contractor relation- necessary. United Medical may determine, following ships. Neither such individuals nor Utilization Review, whether any benefit provided such institutions or agencies are under the Contract was medically necessary. agents or employees of United However, United Medical will not seek reimburse- Medical and neither United Medical ment from a Member for the cost of any benefit pro- nor any employee of United Medical vided under the Contract found to have been is an employee or agent of any Par- medically unnecessary, provided that proper referral ticipating Hospital, Participating Skill- under the terms of the Contract was made and that ed Nursing Facility or Participating Home Health Agency. (C) When rules (A) and (B) (b) Participating Physicians maintain the above do not establish an physician-patient relationship with order of benefit determina- Members and are solely responsible tion, the benefits of the to Members for all Medical Services plan which has covered which are rendered by Participating such Member for the Physicians. longer period of time will (c) Neither Group nor Contract Holder be determined first. nor any Member is the agent or (b) When any benefits are available as representative of United Medical, its primary benefits to a Member under agents or employees, or any Par- the Medicare Law those benefits will ticipating Hospital, Participating Skill- be determined first and benefits ed Nursing Facility or Participating available under this Contract will be Home Health Agency or any other reduced accordingly. person or organization with which (c) If a Member who has enrolled under United Medical has made or hereafter this Contract is entitied to inpatient shall make arrangements for services benefits under another contract or under this Contract. policy of insurance due to inpatient 7.8 Coordination of Benefits With Other care which began while the Member Health Plans - If any benefits to which a Member is was enrolled under a previously held entitied under the Contract are also covered under policy, United Medical will pay, sub- any other health benefit plan or insurance policy, the ject to co-payments under this Con- benefits hereunder shall be reduced to the extent tract, the difference between en- that benefits are available to the Member under such titlements under this Contract and en- other plan or policy whether or not a claim is made titlements under the other contract or for the same. This provision does not apply to a poli6y of insurance. policy issued to and in the name of the Member. (d) For purposes of this provision, United (a) The rules establishing the order of Medical may, subject to applicable benefit determination between this confidentiality requirements, as Contract and any other plan covering defined in Section 7.10 below, release the Member on whose behalf a claim to or obtain from any insurance com- is made are as follows: pany or other organization necessary (i) The benefits of a plan which information under this provision. Any does not have a "coordination of member claiming benefits under the benefits with other health plans" Contract must furnish to United provision shall in all cases be Medical all information deemed determined before the benefits necessary by it to implement this pro- of this Contract. vision. (ii) With respect to the benefits of a (e) None of the above rules as to coor- plan which does contain such a dinationof benefitswillserveasabar- provision, the following rules will rier to the Member first receiving apply: direct health services from United (A) The benefits of a plan Medical which are covered under this which covers such Contract. Member other than as a 7.9 Inability to Provide Service - If war, public Dependent will be deter- disaster, public emergency, general epidemic, or mined before the benefits other similar conditions prevent all Providers from of a plan which covers providing services under this Contract to Members, such Member as a depen- the only obligation of United Medical shall be to re- dent; fund theamount of unearned prepaid premiums held (B) The benefits of a plan by United Medical on the date such events occur. which covers such Further, in the event that due to circumstances not Memberasa Dependent of reasonably within the control of United Medical, a male Member will be such as complete or partial destruction of facilities, determined before the riot, civil insurrection, disability of a significant part benefits of a plan which of Participating Hospital, Participating Skilled Nurs- covers such Member as a ing Facility, or similar causes, the rendering of Dependent of a female Medical or Hospital Services provided under this Member; and Contract is delayed or rendered impractical, United Medical shall not have any liability or obligation on written form satisfactory to United Medical of the re- account of such delay or such failure to provide ser- quested change, addition, or deletion. vices, except for that of refunding the amount of the 7.13 LimitationonServices-Exceptincasesof unearned prepaid premiums held by United Medical medical emergency as provided in the Schedule of on the date such events occur. In the event that Benefits, services are available only from Par- United Medical facilities are unavailable for any of ticipating Providers, and United Medical shall not the above reasonsi United Medical will attempt to have any liability or obligation whatsoever on ac- provide service in non-United Medical facilities count of any service or benef it sought or received by within United Medical's service area. If United a Member from any Physician, Hospital, Skilled Nur- Medical becomes unable to provide benefits under sing Facility, Home Health Agency or other person, thisContract, it may, upon approval of thevirginia In- institution or organization unless prior ar- surance Department, terminate this Contract after rangements are made by United Medical. 30 days' general notice of such condition to Members. During this period, United Medical will be liable for payment of all services covered by this SECTION 8 - GROUP PERSONNEL DATA Contract for any Member who is hospitalized for 8.1 TheGroupshallfurnishtoUnitedMedical reason of medical necessity until the Member is monthly during the period of this Contract, on the discharged from the Hospital. In addition, United formsapprovedbyUnitedMedical,suchinformation Medical will attempt to, but is not to be required to, as may reasonably be required for the purpo@e of assist Member in obtaining alternate health in- enrolling members of the Group under this Contract, surance coverage. processing terminations and effecting changes in 7.10 Confidentiality-Informationfrommedical family status and transfer of employment of records of Members and information received from Members. United Medical shall furnish to the Group Physicians, Hospitals, and other Health Profes- such information concerning enrollment and other sionals incident to the doctor-patient relationship or matter@ as the Group may reasonably require. hospital-patient relationship shall be kept confiden- 8.2 Clerical errors or delays in keeping or tial; and except for use incident to bona f ide medical reporting data relative to coverage will not invalidate research and education, or reasonably necessary in coverage which would otherwise be validly in force connection with the administration of this Contract, or continue coverage which would otherwise be or in the compiling of aggregate statistical data, may validly terminated, but, upon discovery of such not be disclosed without the consent of the Member. errors or delays, an equitable adjustment of charges 7.11 GrievanceProcedure-Membersareentitl- shall be made. However, in no case will adjustments ed to have any grievances heard by United Medical be made effective more than two Premium Due and United Medical is obliged to hear and resolve Dates prior to the date United Medical is notif ied, in a such grievances, including grievances against Par- written form satisfactory to United Medical, of the re- ticipating Physicians and other health delivery pro- quested addition, deletion, or change in coverage. viders which provide health services for United Medical, in an equitable fashion according to the rules and procedures set forth in the Grievance Pro- cedure. SECTION 9 7.12 Clerical Records - United Medical shall TERMINATION OF GROUP COVERAGE keep a record of Members. The Group shall forward AND RENEWAL the information required to United Medical under 9.1 This Contract may be terminated by the Section 8 in connection with the administration of Contract Holder at the end of the term of this Con- this Contract. All records of the Group which have a tract by giving 30 days' prior written notice to United bearing on the coverage shall be open for inspection Medical. by United Medical at any reasonable time. United 9.2 Subject to the payment of premiums pro- Medical shall not be liable for the fulfillment of any vided for in the Accebtance Agreement, this Con- obligation dependent upon such information prior to tract may be renewed by timely payment of the ap- its receipt in a form satisfactory to United Medical. propriate premium, provided however, coverage of Incorrect information furnished may be corrected if the Group may be cancelled by United Medical by United Medical shall not have acted to its prejudice giving 60 days' prior written notice to Contract by relying on it. Coverage underthisagreernent shall Holder under the following circumstances: not be invalidated by failure of the Group, due to (a) If the Group, in obtaining coverage clerical error. However, in no case will any changes, hereunder, shall be guilty of fraud or additions, or deletions in United Medical's Member material misrepresentation of fact, list be made effective more than two Premium Due (b) Upon default in the payment of Dates prior to the date United Medical is notified in a premiums required under Section 9. 9.3 Continuation of Coverage - Any Member 1D.6 Workmen'sCompensation-ThisContract who is receiving inpatient care in a Hospital or is not in lieu of and does not affect any requirement Skilled Nursing Facility under the Contract on the for coverage by Workmen's Compensation' date coverage under this Contract is discontinued is 10.7 Construction - (a) This Contract has been covered in accordance with the Contract until entered into and delivered, and shall be consirued discharged from such inpatient stay. according to the laws of, the Commonwealth of Virginia, and 42 U.S.C. " 300e et seq. For simplicity of expression, pronouns and other terms are sometimes expressed in one number and gender, SECTION 10 - MISCELLANEOUS but where appropriate to the context, these terms 10.1 By this Contract, Contract Holder makes shall be deemed to include each of the other United Medical coverage available to persons who numbers and genders. The underlined headings are are eligible under Section 2. However this Contract for convenience and shall not affect interpretation. shall be subject to amendment, modification or ter- (b) United Medical operates this comprehen- mination in accordance with any provision hereof or sive prepaid program of health care on a direct ser- by mutual written agreement between United vice rather than an indemnity basis in order to pro- Medical and Contract Holder without the consent or vide the advantages of integrated medical and concurrence of thli Members. By electing medical hospital facilities and of coordinated medical prac- and hospital coverage pursuant to this Contract, or tices as provided in 42 U.S.C. " 300e et seq. and any accepting benefits hereunder, all Members legally amendments thereto; and the interpretation of this capable of contracting, and the legal representatives Contract shall be guided by the direct services of all Members incapable of contracting, agree to all nature of United Medical's prepaid program. its terms, conditions and provisions. 10.8 EvidenceofCoverage-UnitedMedicalwill 10.2 Members or Employees shall complete deliver to each Subscriber, Evidence of Coverage as and submit to United Medical such applications, or agreed upon between United Medical and the Con- other forms or statements as United Medical may tract Holder, setting forth a statement of the reasonably request. Members represent that all in- coverage of such Member to whom benefits formation contained in such applications, forms or hereunder may be provided. statements submitted to United Medical incident to 10.9 Notices - Any notice under this Contract enrollment under this Contract or the administration may be given by United States Mail, postage prepaid, of this Contract shall be true, correct, and complete addressed as follows: and all rights to benefits under this Contract are sub. ject to the condition that all such information shall If to United Medical: be true, correct, and complete. United Medical Plan of Virginia, Inc. 10.3 United Medical may adopt reasonable Post Office Box 8007 policies, procedures, rules and interpretations to Virginia Beach, Virginia 23450 promote orderly and efficient administration of this Contract. If to Member: 10.4 No agent or other person, except an of- To last address known by United ficer of United Medical, has authority to waive any Medical conditions or restrictions of this Contract, to extend the time for making a payment, or to bind United If to Contract Holder: Medical by making any promise or representation or by giving or receiving any information. Nochange in this Contract shall be valid unless evidence by an en- dorsement on it signed by one of the aforesaid of- f icers. 10.5 Entire Contract @ This Contract con- stitutes the entire contract between the parties hereto, pertaining to the subject matter hereof, and supercedes all prior and contemporaneous ar- rangements, understandings, negotiations, and discussions, whether written or oral, of the parties; and there are no warranties, representations, or other agreements between the parties in connection with the subject matter of this contract, except as specifically set forth in this Contract. No supple- ment,modificationorwaiverof thiscontractshalibe binding unless executed in writing by the parties. HMO#PLUS - The HealthCaring Network of Virginia Post Office Box 12150 Norfolk, Virginia 23502 CO/ (804) 461-4047 CITY OF VIRGINIA BEACH AN AFFILIATE OF BLUE CROSS AND BWE SHIELD OF VIRGINIA Virginia Health Maintenance Orpiiization, Inc., t/a "HMO PWS:' aiid C, ty of Virginia Beach ("the GrouiY'), hcreby agree that, in considerafion of the payment of premiums by Group as @et forth on the Face Sheet, Section I above, HMO PWS shall contract and/or arrange for health services in accordance with the terms and provisions of this Agreement and HMO PWS Evidence of Coverage, which is attached hereto and made a part hereof, and shall make tilese services available to eligible Subscribers of the Group and their family Dependents who elect to enroll hereunder with HMO PLIJS. Such persons, once earoued, are referred to as "Members." Ii. Group Eligibility requirements on the effective date of Subscri- Efigible Subscribers of the Group and ber's coverage, coverage shall commence as of their family Dependents shau be those persons Subscriber's effective date. For aU other Depen- who meet the foflowing special eligibibty re- dents, coverage shafl be effecfive as set forth in quirements (if any) and who otherwise safisfy the HMO PWS Evidence of Coverage. the terms and provisions of the HMO PWS 3. Individuals seeking to enrou in HMO PLIJS Evidence of Coverage. Such eligibifity require- who were not previously efigible for HMO ments carinot be altered for the dura6on of this PWS coverage hereunder may do so ordy if Agreement without the consent of HMO appbcation is made to HMO PWS within 31 PWS. Employees are eligible to days after they become efigible for coverage enroll in program on 1st day hereunder. Subscribers: IV. Payments of employment. Coverage will be effectiva The Group agrees to reniit on or befoce 1st day of month following deduction. the @um due date, the apphcable total Depencrents: monthly pren-dum set forth in the preniium Same schedule on the Face Sheet, Secfion 1, for each efigible Subscriber enroued hereunder who elects HMO PWS membership for him/herself and Ill. Enrollment and Effective Date of his or her famfly Dependents. HMO PLUS Coverage may change the pre@um schedule as of any The Group hereby agrees to offer HMO aruiiversary date of tWs Agreement by givirig at PWS memberswp to aU efigible Subscribers of least 30 days written notice to the Group prior the Group. It is understood that efigible Sub- to such anniversary date. If premium payment scribers of the Group shau be free to choose is not made in fufl by the Group on or prior to either HMO PWS membership or such other the pre@um due date, a 30-day grace period coverage as may be available through the Group shau be granted to the Group for payment during both the i@6a] and subsequent open without interest charge. If payment is not re- enroLLment periods. Every efigible Subscriber of ceived by the expiration of the grace period, the Group shall be given a Wr opportunity to then this Agreement shall terminate as of the elect one of such op6ons over the other and end of the period for wwch prenijum was paid. shaN not be pen@d by the Group because of Payments accepted by HMO PWS after the such a choice. grace period shau be subject to a late penalty The Group agrees that, after the open en- charge of 1.2507o of the total premium amount roL[rnent period under this Agreement, each due calculated for each 30-day period the new employee will be given the opportunity to amount remains outstanding. elect HMO PWS membership as a procedure V. Cooperation of employment and that enroument in accor- The Group agrees to cooperate with HMO dance with sucli election wifl become efl@ctive PWS by advising Subscribers of policy and %vhen sucli person attains Lhe status of an eligi- service information and by aflowirig enrollment ble Subscriber as provided in this Agmement representatives fair and masonable access to and the HMO PWS Evidence of Coverage. potenfial Subscribers for the purpose of enrou- Subject to the Grou[Ys payment of apphcable nient. The Group shall make the appropriate monthly premiums, the receipt of an apphcation payrofl deduc6ons, if apphcable, for Subscribers by HMO PWS for each prospective Subscriber who elect HMO PWS membership aild shau and eligible Dependents of the Subscriber, aild defiver to Mcnibers the HMO PWS Evidence tlie provisions of this Agruenient, coverage of Coverage, iiotices aiid identification cards under tllis Agreement shau becoilie ettective on when requested by HMO PWS. Tlie Group the foflowing dates: also agrees to cooperate with HMO PWS in 1. f-or Subscribers, coverage shall be effective obtaining inforniatioii about enrolled Members on the first day of the motith l'ollowiiig al)plica- which is relevant to claims of eligibility, reini- tion and receipt of preinium. bursemeiit, coordination of benefils and proper 2. For a Dependent who satisfies all eligibility adniinistr@itioii of tliis Agicement. The Corotip vill also give at least 60 days notice to I IMO crage oi@ i Mciiiber is tcritiiiizited for cause, pre- PWS of- its iniciit to oll@r HMO coverage in iiiiuni payjiicnts received oji bl[ialf of the ter- addition to the coverage provided under tliis miiiated Meiiiber applicable to periods al@ter the AgreeiTient. effective date of termination, sliall be ricfutided Vi. Group Contribution to Group within 30 days, and neither HMO Group sliall offer HMO PWS to all Sub- PWS nor aiiy Plaii provider sliall have aiiy scribers of the Group on terms no less favorable liability uiider this @,reemcnt Lo such termin- with respect to the group contribution thaii ated Member. tllose applicable to sucli other health benefits X. Coordination of Benefits coverage as may be available through the A. Benefits Subject to COB Group. Except as hereinafter provided, tlie All benefits provided under tliis Agree- group contributions set forth above in the pre- ment are subject io this Section X. Through mium schedule of the Face Sheet, Section 1, this Group Enrollment Agreement and the shaE not be changed during the term of this attached Evidence of Coverage, the Group and Agreement unless such charige is agreed to in Members agree to permit HMO PWS to co- writing by HMO PWS. If, however, the group ordinate iLs obhgations under this A@ment contribution to such other coverage as may be with paymenls available from any other group available through the Group is increased during Ilealth insurance that covers the Member. the term of this Agreement, Group agrees to B. Definitions increase its contribudon for HMO PWS cover- 1. "Plan" means any plan providing age, effective the first premium due date follow- benefits or services for or by reason of medical ing such increase. or dental cart or treatment, which benefits or VII. Administration services are provided by (i) group or blanket in- Group agrees to fur@sh HMO PWS on a surance coverage, (d) service plan contracts, monthly basis, on HMO PWS approved group practice, and other pmpayment group forms, such informadon as may reasonably be coverage, (iii) any coverage under labor- required by HMO PWS for the administration management trusteed plans, union welfare of the HMO PLLJS program. In addition, plans, employer organizadon plans, or employee HMO PWS may at reasonable fimes exaniine benefit organization plans, and (iv) any cover- Group's tecords with respect to eligibility and age under goverrunental programs. The term premium payments hereunder. Clerical error, "PlaiY' shall be construed separately with re- whether by the Group or HMO PWS, in spect to each poficy, contract, or other arrange- keepirig any record pertairdng to the coverage ment for benefits or services and separately under this Agreement wiE not invalidate cover- with respect to that portion of ariy such poficy, age otherwise validly in force or, subject to the contract, or other arrangement which reserves provisions of Section VIII immediately fohow- the right to take the benefits or services of ing, continue coverage otherwise validly termi- other Plans into consideration in deter@ning its nated. benefils and tliat portion tliat does not. VIII. Ineligible Members 2. "This Plan" means that porfion of If a Member becomes inefigible as a mem- tNs Agreenient which provides the benefils that ber of the Group, the Group fails to advise are subject to this provision. HMO PWS of such Member's inefigibifity, and 3. 'Allowable Expense" means any the Group continues to make arry of the pre- necessary, reasonable, and customary item of mium payments specified herein for such Mem- expense all or part of which is covered under ber, then any such premium payment wiU be rufuilded by HMO PWS to Group, but only if at least one of the Plans under which the per- (i) Group notifies HMO PWS of such Mem- son tbr wlioni claim is made is eiirolled. ber's iiiefigibifity no later than 90 days after the When a Plan'provides benefits in the date eligibifity ceased and (ii) HMO PWS has form of services rather than cash payments, the not provided or arranged for coveird health itasonable cash value of each service rendered services for the Member after the Member's eli- sliall be deemed to be an Aflowable Expense gibility ceased and before HMO PWS received and a betiefit paid. timely notice of the Member's ineligibility. 4. "Claim Determination PLriod" IX. Termination of Member's Coverage means tlie calciidar year. Subject to the HMO PWS Evidence of C, Effect on Benefits Coverage relating to terniination of a Mernber's 1. This provision shall apply in deter- coverage lbr cause, coverage of a Meniber shall niining tlie beiiet@its as to a Member covered otherwi.,e terminate on the last dty for %vhicii Linder tllis Plail for Iny Claim Deterinination ptvmiuni payments liave been paid for tliat I'Lriod if, for tlie Allo%vable Expenses iilcuri-ed Mciiiber by Group to HMO PWS. 11' tile cov- as 10 SLICI) I-)ersoji duriiig SLICII [vriod, tile SLIITI ol ciiii(i li;ts iiot iciiiztri ied, tlie beiiel@its ol@ a l@lan a. tlie beiief-its that %vould be payable %vliicii co%,crs tlie c[iild @Ls a dcl)eiidcilt ol- tile under tliis Plan in thc abscilce of this provision, parent with CLIStOdY of tlie child will be deier- and inined before the benefils of a Plan which b. the benefits that would be payable covers the child as a dependent of the parent under afl other Plans in the absence therein of without custody; provisions of similar purpose to this provision (ii) Wilen the parents are divorced and the par-eiit with custody of tlie cilild has would exceed such Allowable Expenses. reiiiarr-ied, the bencfits of a Plan which covers 2. As to any Claim Determination the child as a depeiident of the parent witli Period with respect to which this provision is custody shall be determined befort the benefits applicable, the benefits that would be payable of a Plan %Yllich covers that child as a depen- under this Plan in the absence of tNs provision dent of the stepparent, and the benefils of a for the ABowable Expenses incurred as to such Plan which covers tliat child as a dependent of person during such Claim Determination the steppareilt will be determined before the Period shafl be reduced to the extent necessary benefils of a Plan wliich covers that cilild as a so that the sum of such reduced benefits and dependent of tlie parent without custody. all the benefits payable for such ABowable Notwithstandiilg (i) and (ii) above, Expenses under aH other Plans, except as pro- if there is a court decree which would other- vided in item 3. of this Section C., shafl not wise estabfish f-inancial responsibifity for the exceed the total of such Auowable Expenses. medical, dental or other health cait expenses Benefits payable under another Plan include the with respect to the chhd, the benefits of a Plan benefiLs that would have been payable had which covers the clidd as a dependent of the claim been duly made therefor. parent with such financial responsibdity shao be 3. If determined before the benefits of arry other a. another Plan which is involved in Plan which covers tlie child as a dependent item 2. of this Section C. and which contains a child. provision coordina6ng its benefits with those of c. When rules a. and b. do not tWs Plan would, according to its rules, deter- establish an order of benefit determination, the mine its benefits after the benef-its of this Plan benefits of a Plan wnch has coveied the person have been determined, and for the longer period of time shaU be deter- b. the rules set forth in item 5. of mined before tlie benefits of a Plan which has this Section C. would tequire this Plan to deter- covered such person the shorter period of time, mine its benefits before such other Plan provided that: (i) the benefils of a Plan covering then the benefits of such other Plan wifl be the person on whose expenses claim is based as i-nored for the purposes of deternlining the a laid-off or wtired employee, or dependent of benefits under this Plan. such person, shau be determined after the ben- 4. If another Plan which is involved in efits of any other Ptan covering such person as item 2. of this Section C. does not contain a an employee, other than a laid-off or retired provision coordinating its benefits with those of employee, or dependent of such person; and this Plan then the benefits of such other Plan (ii) if either plaii does not have a shall be determined before the benefits of this provision rcpfding laid-off or retired employees, Plan. which results in that Plan dctermiiiing iLs bene- 5. For the purposes of item 3. of this fits after tlie otlier, theii the provisions of (i) Section C., the rules establishiilg the order of above shall iiot apply. benefit determination am: 6. Wheil tliis provision operates to re- a. Tlie benefits of a Plan whicii duce the total amount of benefits othervase covers a person other than as a dependent sliah payable as to a person covemd under this Plan be determitied first; during any Claini Determination PLriod, each benefit that would be payable in the absence of b. The benefits of a Plan which tliis provisioil sh@ill be reduced proportionately, covers the person as a dependent child of the and such reduced amoutit sliall be charged parent whose birthday Uls earlier in the calen- against any applicable benefit limit of this Plan. dar year shau be deterniined first except ill the follo%ving cases: D. Right to Receive and Release Neces- (i) When the parenls are separated sary Information or divorced and the parent with custody of the For tlie purposes of@ determining tlie appli- cability of and ijilpleniciitilig tlie teriiis of tliis or wgulatioil. Cosititiued payiiient of tlie pre- provision of@ iiiis lllan or any provisioil of@ siiiii- iiiiuni by Group subsequelit to sucil 30-day lar purpose of any other Plan, HMO PLLJS iiotice sliall constitute acceptince of such may, without tlie consent of or notice to aily ILmendinent. No agciit of IIMO PWS lias the person, relmse to or obtain from any other authority to cliange tliis AWeement, %vaive any insurance company or other organization or of its provisions or restrictions, or extend tlie person any informadon, with respect to any time for making a paynient. persoii, which HMO PLUS deenis to be neces- Xiii. Health Status sa-ry for s(icli plirposes. Any person claiming 14MO PLUS will not expel or refuse to re- bLnef-iLs under this Plaii shall furnisli HMO enrou any Meniber because of such person's PWS such informati@n as may be necessary to state of healtli or Iiis requiremenls for lledth implement this provision. services. In addition, HMO PLUS will tiot IC- E. Facility of Payment fuse to enroll individual efigible members of Whenever payments which should have Group on basis of the hath status or health been made under this Plan in accordance with cam needs of those individuals. this provision have been made tinder any other XIV. Termination Plans, HMO PWS shau have the right, exercis- This Agreement entered into this abic alone and in iLs sole discwtion, to pay over day of , 198 to any organizations making such other pay- wifl beconic eftective on I Ajjqitqt- , 1985 ments any amounls it shar deterniine to be at 12:01 a.in. Eastern Time, subject to pay- warranted iri order to satisfy the intent of this ment of preniiums as provided herein, and will provision, and amounts so paid shall be remain in force and effect for a period of 12 deemed to be benef-its paid tinder this Plan months and for each 12-month period Lhere- and, to the extent of such payments, HMO after subject to the right of either HMO PWS PUJS shall be funy discharged from habifity or the Group to terminate tws @ement upon under this Plan. at least 30 days written nofice prior to any an- F. Right of Recovery niversary date. Arry nofice under this Agree- V,/henever payments have been made by ment may be giveii by U@ted States Mail, first HMO PUJS "ith respect to Allowable class, postage prepaid, addressed as fohows: Expenses in a total amount, at any fime, in excess of the maximum amount of payment necessary at that dme to sa6sfy the intent of If to Virginia Hath Maintenance Organization, this provision, HMO PWS shau have the right Inc. to recover such payments, to the extent of such Post Off-ice Box 26623 excess, from among one or mort of the follow- Richmond, VA 23261 ing, as HMO PWS stiah determine: any per- sons to or for or with respect to whom such If to Group: payments were made, any other insurance com- pa@es (except with respect to non-group poli- City Hall Building, Municipal Center cies), ariy other organizations. Xi. Entire Agreement Virginia Beach, Virginia 23456 This Group EnroUment @ement, the Such termination shafl be complete as to attached HMO PWS Evidence of Coverage all Members and stiall be effective as of tlie last and the applicadon of the employee constitu@ day for which prcmium payment has been the eiitire agreeinent between the parties. To tne made by Group and accepted by liMO PWS. extent there is an express conflict between tile Group EnroRment Agreement and the HMO PWS Evidence of Coverage attached hereto VIRGINIA HEALTH N4AINTENANCE tlie Group EnroHment Agreement shafl cont;,I. ORGANIZATION, INC. Xi[. Amendments and Waivers E.xcept as provided in Section IV of this By: Agreeinent, dl clianges to tliis Agreemeiit illust Picsident be [)y aiiiendiiieiit. Aiiy such ailleildilielit sliall City of Virginia Beach be in writing aiid niust be approved aiid exe- cuted by the President ot'l-IMO PWS. HMO (Group) PWS specificitily reserves tlie riglit to aitiend B),: the Evidence of@ Coverage during tlie term of this Agreement upon 30 days notice to GroLlp THOMAS H. MUEHLENBECK or at any tinie %vhen requii-ed by applicable la Title: City Manager 180ONS (R 3/8i) Al,ll-r(OVED AS 'fO C:ikTiFIU) AS TO Ai,,JL/,btLiTy OF F:UN@ Cily .1 (!Iry Virgiiiia Health Maintenance Organization, Inc. HMOOPLUS TI,@ H,!@.111,C; .... @i N@l@olk,,l :oup Enrollment Agreement 1. Face Sheet Group Naine City of Virginia Beach Group Address St,@@t City Zip Cd@ City Hall Building, Municipal Center, Virginia Beach Virginia 23456 Group Contact Na ... Titi, N.. Eugene LeJeune Payroll Administrator Group Number Effective Date Anniversary Month & Year sic Division No. 1 8/1/85 7/1/86 Division Address Division Contact Benerit Option PWS 3 El PWS 5 PreiWum Schedule Total Monthly Preniium Subscriber Contribution Group Contribution Single Subscriber $ 65.00 $ 5.00 $ 60.00 Subscriber and One Dependent $ 89.00 $ 29.00 $ 60.00 Subscriber, Spouse and Dcpendents $ 156.00 $ 96.00 $ 60.00 Premium Due Date: The last business day of the month preceding next montws coverage %4aximum Annual Copayment:' Type of Coverage Maximum Copayments Single Subscriber $ 500.00 Subscriber and One Dependent $1,000.00 Subscriber, Spouse and Dependents $ 500.00 per member up to a maximum of $2,000.00 Open Enrollment Period: June 17, 1985 - July 24, 1985 Initial Eligibility Date: The day of the month following days of continuous ernployment. Reinstatement Period: Treated as new employee. Terrrination of Employment: Extension Period: Miscellaneous: *Employees are eligible to enroll in program on first day of employment. Coverage will be effective the first day of month following,deduction. Marketing Representative Name: Robert L. Walters/John Rando This Face Sheet is Section I of the Group Enrollinent Agreement ('Agfeement"). Many of the terms set forth on this Face Sheet air used iii other sections of the Agreement. Uiiless otherwise noted, wheir the terms set fortli above appear iii these other sections, they shall have tlie meaning ascrit)Ld to theni in this Sectioll 1. Foriii No. 180002 (R 1/85) Virginia Health Maintenance Organization, Inc. Evidence of Coverage i HMO 0 PL The HeiltliCari(ig Network of Virgiiii@i Table of Contents Page Eiiroliment ............................4 in@uctiori .............. Inside front cover Effective Date of Coverage ................4 HMO PLUS-Tlie Organization ... inside front Termitiatioil of Coverae .................4 cover Conversion fi-om Group to Non-GrOLIP Meniber Identification Card ....... Inside front Coverage ...........................6 cover Copayments ...........................6 Appointments .........................I Coordination of Benefits .................6 Appointment Tips ......................I Reimbursement Request .................. 6 Referrals ..............................I Service Area ..........................7 Changing Your Primary Care Physician .....I Double Coverage .......................7 Routine Care-Health Assessments ......... I Relationship of Contracting Parties .........7 Routine Visits ..........................I Medical Information ....................7 Telephone Advice .......................I important Limitation ....................8 Urgent Care ...........................I Poficies and Procedures .................. 8 Emergency and Out of Area Care ..........2 Modifications ..........................8 Schedule of Benefits, Exclusions and Further Limitations .....................8 Copayments .........................2 Notices to Members .....................8 Responsibilities .........................2 Group EnroUment Agreement .............8 Changes In Coverage ....................3 Definitions ............................8 Complaint and Grievance Procedure ........ 3 Schedule of Benefits, Exclusions and Eligibility .............................3 Copayments .................... (insert) 1. Introduction - Encouraging health habits which promote This Evidence of Coverage is designed to help werness through appropriate health educadon you, the Subscriber, and your enrc)fled Depen- programs in such areas as weiglit reduction, dents understand the Virgi@a Health Mainten- copirig with stress, physical fitness, nutrition, ance Organization, Inc. ("HMO PWS") pre- high blood prtssure, and diabetes. paid program so that you may participate fully iii your Ilealth care plan. It is issued as part of HMO PWS contracts with Plan Physicians, as the Agreement between HMO PWS and your defined hmin, for the provisioii and arrange- employer. If, at anv time, you have questions, ment of Health Services for Members. From concerns or compfaints regarding any aspect of among the Plan Physicians, you wiu choose HMO PWS, do not hesitate to call. The HMO your personal or "Primary Care Physician" and PWS admi@strative office is open a Primary Care Physician for your Dependents. Monday-Friday. A Primary Care Physician is a physician who will provide primary health care and coordinate 2. HMO PLUS-The Organization the other Health Services requimd under the HMO PWS is an HMO which provides an HMO PWS prepaid program. A list of Prim- alternative to the normal fee for service method ary Care Physicians and Plan Physicians is pro- of' delivering Health Services. This alternative vided to each Subscriber upon enrollment and ijivolves ptyiilg a fixed, monthly preiiiium to may be revised by HMO PLUS from time to HMO PWS for access to a compreheilsive set tiine. of coordiiiated Healili Sei-vices, as defiiied herein. 3. Member Identification Card F@ach Subscriber will receive two Member iden- Tlie HMO PWS program encoltrages niainten- til'icatioii cards at the tinie of enroliment. Tliese ailce of@ good llealth thrOLigli prevelitive et'fol-ts citi-ds are to be used by you or yotil- DCj)Cll- wliicli you ciiii Lake SLIC11 aS: deiits betbi-e obtaiiiiiig access to approved - Periodic "individualized" health assessmeiits. Health Services. Identification cards air not - CO[ISL]Iting %vitli yolir Primary Care Physician transt@rable. Use of tlie ideiitification card bY an at tlie first sigii of illness. unautliorized persoii will result in teriniiiation Treatiiig disease in its carly sliges. ol' ii)eiiibers[iii) iii HMO 13WS alid iii obli@i- tioii to p@iy li)r tlie services oblailied- flossession ol@ iiii idcii(il@icatioil card coiifel-s lio 1-iglit to @ilicl ollici licilltli I)iol@ssiotials to piovidc a liMO 13WS sei-vices or beiiel'its. To bc eiititled colliplete raiige ol@ licaltli care scrvices. Iii iliost to HMO PWS services or beiiefits, aii idelitifi- circunistaiices, fefei-rals \\,ill be linlited to iliese cation card liolder must, iii @ct, be a Mciiiber pliysicians. oil \vliose belialf all applicable preniiuins liave actually been paid. We encourage Subscribers 7. Changing Your Primary Care to carry the HMO PL-LJS identificatioil card Physician \vitli tliem at all times. If your card is lost or 11' you or one of your Dependeilts etirolled iii stolen, please notify HMO PLUS imiiiediately. HMO 13LUS desire to cliange a 13riinary Care Pliysician, you inust call HMO PWS' adillinis- 4. Appointments ti-aiive olfices and express your desii-e to iiiake To make an appointment with your Primary sucli change to a Member RepresenLative. A Care Physician, just call the Primary Care form will be completed with your assistance. 13liysician's on@ice at the number indicated on The cliange will be effective upon the first day the list of Plan Providers furnished you upon of tlie month following tile submission of tlie eilrollment. If you are experiencing an urgent cliange form, subject to notification of and ac- illiiess or injury, call your Primary Care Physi- ceptance by tlie newly selected Primary Car-e cian and describe the problem so necessary ar- Physician and HMO PWS approval. rangements may be made for you. S. Routine Care-Health Assessments S. Appointment Tips Itidividual liealth assessmeilts are ali iniportatit To help your Primary Care Physiciarfs office part of your hmtli care and they are one of schedule your appointment, please fohow these tlie benefits covered under the HMO PWS procedures: program. Factors such as age, sex, lifestyle and - Have your HMO PWS identification card health history determine the nature of the tesls ready so you can give the receptionist your required and the frequency of examillations. Member number and the Subscriber's name as Your Primary Care Physician wiU determine the it appears on the identification card. frequency and scope of your periodic health ,c - Know the name of your Primary Care exams. As a result of the health assessment, the Physician. Primary Care Pliysician may make recommen- - Be prepared to describe the nature of your dations for changes in your lifestyle. It is up to problem so that your visit may be appropriately you to maintain your health. scheduled. - Have paper and pencil handy to take down 9. Routine Visits any information you @ght be given. For routine visits, always telephone your - Be on time for your appointment. Primary Care Physicia@s office for an appoint- ment. Your Primary Care Pliysician cati serve 6. Referrals you best when you schedule an appointment. Your Primary Cate Physician will advise and formaUy arrange for all necessary consultations If you are unable to keep an appointment, and irferrals to other Plan Physicians or, if no please call your Primary Care Physician's office Plan Physician is available, non-Plan Physician at least 24 hours in advance or as soon as consultanLs. These referrals and consultations possible. This wiU free your Primary Care %vih require a written request for specific ser- Physician to help someoile else who needs care. vices from your Primary Care Physician to the appropriate teferral consultant. Referral atid 10. Telephone Advice consultation services may take place at your Frequently a telephone call to your Primary Primary Care PhysiciarYs office, at aliother Cate Physician's office may be sufficielit to liall- consuitant's office, or at a hospital, if necessary. dle a problem. Do not hesitate to cafl whenever You must have an authorization fi-om your you have a medical problem. Dependiilg upon Primary Care Physician. Remember, unauthor- the inedical urgency of your situation and the ized visits to other physicians are not coveitd availability of your Primary Care Physician, services. Except in case of an Eniergency, you niay llave to wait a reasonable time t@or a described below, if you make an unautliorized call back from YOLir Primary Care Physiciaii. visit to a pliysician or other healtli provider, you assume responsibility for the cost of the ser- U. Urgent Care vices. In addition, HMO PLIJS and/or Medical Aii Urgeiit Care situation (defined in PArt 35) Group(s) coiltract with consullant physicians is one tliat is important, bLIt iiot an Eiiiergeiicy I as described belo@v. Urgcni health probleiiis are iiecessai-y out-ol-pocket expcliscs I*or ali Ciller- usually marked by rapid onset of persistent or gency room visit. If it is impossible to call your utitisual discomfort associated with an illness or Primary Care Physician, you may contact tlie injury. These problems may include high fever, covering physician wlio is a Plan Physician to vonliting, sprains, fractures, and minor cuts. direct your cart. If, because of the nature of Gcnerally, an Urgent Care situation, although the Emergency, it is impossible to call a Pizin potentially serious, can be handled through Pllysician, you stiould go to the nearest emer- yotir Primary Care Physician's office. gency ficility. In tllis event, HMO PWS will cover the Member for medically necessary If you have an urgent problem, @ys call your Eniergency services, even when provided by a Primary Care Physician and indicate this to the non-Plan Provider hospitw. A Member must receptionist. Be prepared to describe your notify HMO PWS of Emergency services re- symptoms. Your call may be put through to ceived from a non-Plan Provider hospital within your Primary Care Physician or another Plan 48 hours after care is commenced or as soon Physician. In addition, you may be given first thereafter as possible. This notification is neces- aid advice or instructions to come directly to sary so that HMO PWS may verify coverage the Primary Care Physiciarfs office or other for the hospital and transfer necessary medical facility. If you are asked to come to your information. Primary Care Physiciarfs office, a time wiH be scheduled for you. If your Primary Care Physi- Remember, HMO PLIJS does not cover routine cian is not av"able, another Plan Physician or elective care provided outside the Service may see you. Area. To obtain advice for urgent problems and 13. Schedule of Benefits, Exclusions Emergency care after hours, caU your Primary and Copayments Care Physician. If your Primary Care Physician A Schedule of Benef-its, Exclusions and Copay- is not available, thete is a Plan Physician on ments is included at the back of this Evidence caU 24 hours a day, seven days a week, includ- of Coverage as Attachment A. The Health Ser- ing hofidays. Specific information tegarding how vices fisted as covered in Attachment A ait to contact your Primary Care Physician is con- coverrd to the same extent they would be if tained in the booklet you received upon they had been set forth in this Evidence of enrollment. Coverage in fuH. 12. Emergency and Out of Area Care 14. Responsibilities As an HMO PLJJS Member you are covered You assume certaiii responsibilities as you enter for in-area and out-of-area Emergency care. into a partnersliip with HMO PWS to protect The term "Emergency" is defined in Part 35. It your healtli and that of your family. It is im- means a bodily injury or serious ibness which portant that you understand your responsibifities threatens loss of fife, Emb or senses and re- as an HMO PLUS Member. quires the Member to seek immediate medical attention under circumstances or at a fime or AH Members are responsible for learning how location which effectively precludes the Member the HMO PWS system works. You can do this from seeking such care from or through a Pri- by carefully studying and referring to this mary Care Physician. Emergencies are heart at- Evidence of Coverage, and by always asking t;icks, cardiovascular accidents, llemorrhaging, whenever you are uncertain about how to use poisonings, loss of consciousness, respiration HMO PLUS services properl@@ SI)ecifically, accideilts, convulsions, atid other acute condi- your iesponsibilities include: tioils as HMO PWS sliall determine to be - Working as a partner with HMO PWS in SL)ch. Any emergency room or other emergency maintaining your health and using tlie system service clzdm, wliettler within or outside tile properly and efficiently. Service Area (as defined in Part 35), that does - Clioosing a Primary Care Physician. You ate not meet tlie above criteria will not be paid by urged to establisi) a personal, continuous rela- liMO PLIJS. Medical necessity will be deter- tioilship witli your 13rimary Care Physician aild iiiined by retrospcctive medical review. the otlier niembers of his/her primary care L team. Maintaining this on-going reiationship is in the event of an Emergency, call your Pri- an essential part of yolir healtli care. If, for marv Care Physician at aiiy time dty or night. any reasoii, you wish to cliaiige pllysicians, you I By calling, you %vill get appropriate iiistructioiis may select aiioilier Priniary Care Pllysician. regarding Eiiiergeiicy care aild avoid ally ul)- 2 HoNvever, tlie Pi-iniary Care Pliysician's relatioil- shil) witli HMO IILLJS oi a Medical Group to Mciiibcr iiecds, a coiiil)lailit @ind g[-ievalice iiiay teriiiinate. Tile Tclitti@)ilsliij) betweeil HMO procedure lias beeii devclolxd by HMO IIWS. I'WS aiid the Medical Groul) with which your Ili-imary Care Physiciail is associated may ter- If you iiave a concern, please feel ftee to dis- niiiiate. In eitlier event, you will be required to cuss it witil aii IIMO PWS Mciiiber Rcliivseil- select a new Primary Cale Pllysician. HMO tative. Most I)robleiiis aiid coiicertis can be IIWS does not guarantee tlie continued avail- settled iii t[iis way. If you arv still not satist'ied ability of a particular Primary Care Pliysician with tlie wsults aiid you wisil to purSL]e tile or Medical Group. matter furtlier, YOLI Must file a forinal coni- - Being aware and informed about your own plaint statemeiit witli HMO PWS withiii 60 healtli aiid physical condition. days al@ter tlie occurrence wliich gives rise to the - Being oii tinie lbr appointinents. complaint. It will be reviewed and processed in - Notifying your Primary Care Physician accordance witli the HMO PWS grievance promptly if you are unable to keep an policy whicli iilciudes a formal review and in- appoititnient. vestigation and report to tlie Meniber by a stat@f I Following the advice of your Primary Care officer of HMO PWS. If the Member is not Physician. satisfied with t[iis report, the Member can ir- - Knowing what rriedication you are taking, quest that his/her grievance be reviewed by the why you atr taking it, and the proper way to grievance review committee of HMO PWS. A take it. request to the grievance review committee must , Learning to recognize true Emergency situa- be made within 15 days after receipt of the staff tions and how to handle them. report. Making the fifestyle changes recommended by your Primary Care Physician. The committee wiU make a decision with regard Makiiig your preniium payments (Copay- to the grievance within 20 days after receipt of ments are paid at the time of visit) on time if the request for review. they are not paid directly to your employer. - Making sure that HMO PLIJS is notified of For further detafls concer@ng the HMO PWS arry changes in family size, address, phone grievance procedure, please cafl the HMO number, or membership status, as described PWS administrative offices. below. - Utilizing the complaint and grievance proce- 17. Eligibility dure described below if you are unable to satis- Subscriber. To be efigible to enrofl as a Sub- factority resolve yo6r concerns. scriber, a person must be employed in the Ser- vice Arta, be entitled to participate in his 15. Changes In Coverage employer's health benefits program, and comply Airy cliange in your employment, residence or witli any probationa[y or other efigibility re- number of Dependents affecls your coverage. quirements establislied by the employer and HMO PWS must be informed promptly of identified in the Agreement with HMO PWS. these changes in order to avoid a lapse in cov- erage or a problem in contacting you. Please Dependents. To be efigible to enrofl as a make suit that HMO PWS is notified as soon Dependent, a person must meet all eligibility as possible, but no more than 31 days later, if requirements of the employer (including any age 1. There is a change in your marital status. limit estabhshed by (he employer) and in addi- 2. A Dependent loses efigibifity for membership tion to sucli ehgibility requiiemenls, be tlie through marriage, exceeding the age limit, etc. Subscriber's legal spouse, or the Subscriber's 3. You gain a Dependent. unmarried dependent child (a child who 4. You change your addmss or phone ntiniber. receives niore thaii 5007o of his support from 5. You change your place of employment. the Subscriber) 19 years of age or under of 6. You or covered Dependent(s) assunie perma- either the Subscriber or the Subscriber's spouse. nent residence outside tlie Service Arca. Newborn children are entitled to coverage as set forth below. Gratidchildren of a Subscriber or For iiiforniation regardiilg clianges in covei-,Ige, Subscriber's spouse are not eligible tbr Depeil- %L contact the HMO PWS Member RepresenLi- dent coverage under HMO PWS. Cliildren tive or your group administrator. adopted by tlie Subscriber will become eligible as of tlie date tile adoptioti becomes final, pro- 16. Complaint and Grievance Procedure vided proof of adoption (sucli as a COLirt oider) Iii order for HMO 13LUS to wiiiain respoiisive is provided to HMO PWS aiid so long as all 3 oilicr eligibility requirements contained herein 18. Enrollment are satisfied. Unniarried children who are A Subscribei- may enroll any eligible Depen- uilable to support themselves because of mental dents by subniitting completed HMO PWS or physical handicap and who have been enroll- niembership application forms listing sucli ed in HMO PWS will not have their HMO Dependents. Newborn children are covered as [:IWS coverage terminated upon attainment of described above. No persoil is e[igible to re- tticir 20th birthday or, if a full-time student, as enroll in HMO PWS who has had coverage described below, upon attainment of their 23rd teriiiinated as described liereafter iii "Termina- birthday, if proof of such handicap and tion for Cause." dependency is furnished HMO PWS within 31 days of the Dependent's 20th or 23rd birthday, Arry Dependent who is not enrolled in HMO whicliever is applicable, and each birthday PLJJS within 31 days after becoming eligible thereafter. may not enroll until the employer's next open enrollment period. StuderTt Dependents. Eligible Dependent children shall also include children of the Sub- 19. Effective Date of Coverage scriber or Subscriber's spouse who are over the Subject to the payment of apphcable premiums age of 19 years but under the age of 23 and at- and HMO PWS' receipt of an apphcation tending a recognized coflege or university, trade from or on behalf of each eligible person to be or secondary school on a fufl-time basis. For enrobed in HMO PWS, coverage for you and purposes of this section, "full-time basis" your enrobed Dependents wiU begin on the first means a noncorrespondence course which in- day of the month foflowing your appfication for cludes school attendance with a subject load enrollment in HMO PwS. However, a different sufficient, if successfuby completed, to attain effective date may be agmed to by HMO PLJJS the educational or training objective within the and your employer in @ Agreement. Your period generally accepted as mi@mum for employer xvib inform you if the effective date completion of the academic or training program for HMO PLUS coverage varies frorri the first concerned. day of the month, or you may contact HMO PWS. For purposes of this "Student Dependents" sec- tion, full-time students who attend school and 1. The coverage of persons who enrou during reside outside the Service Area shafl only be the employer's open enroflment period is effec- covered for Emergency and Urgent Care ser- tive as of the first day of the month forowing vices, as defined in Part 35, herein. conclusion of the open enroument period or as otherwise agreed to by your empioyer and The limiting ages referenced above may differ HMO PLUS in the Agreement. for your group. The limiting ages, if different, are set forth in the Agreement between your 2. Coverage of newborns shafl commence at employer and HMO PWS. Contact your birth and continue for a period of 31 days. If employer or HMO PWS if you have any the newborn is enrobed during such 31-day questions. period and applicable premium paid, coverage shaR continue for such newborn after the 31-day Newborn Children Dependents. Coverage of period. newborn children of a Subscriber shafl become ciTective at birth and continue for a period of 3. Coverape of newly acquired DependenLs who 31 days following birth, Any Healtli Services enrou in AMO PLLJS wifl become effective on provided to the newborn child during tliis the first day of the month following application 3i-day period will be covered. However, for subject to the enrollment limitations and pay- cover,ige of newborn children to continue ment of premium refet-enced above. beyond this 31-day period, newborn children mu.st be enrolled by a paitnt within 31 days 20. Termination of Coverage follo%ving birth and the full premilim paid for Termination for Cause. Termination of HMO the ciiiii-e I)eriod tbr ",hicli coverage is ill et'l@ct. pWS co\,era_Pe for a Member for cause will oc- if a Subscriber does not comply witil these cur as follows: requirements, coverage of the newborn child shall termiiiate as of tlie 32nd day following 1. lt@ a Niembei- fails to piy, has paid on his birtli. 4belialf, or makes satisfactory arrangemenls tO pay aily amount due I-IMO PLLJS, or t@lils to iiieii(ted by a Priiiiai-y Care I'llysician or otlici inake any required Copayment, coverage will fllaii Pliysician. Wlicii tlie l@Iall 13liysician re- terminate ell@ctive immediately upon 30 days gards sucli tvfusal as iiicompatible willi the coll- written notice. tinuance of the physician-patient relatioilship bstruciiiig tlie provision of proper aild as o 2. If a Member permits the use of his identifi- medical care, HMO PLIJS may termillate tlie cation card by any other person or uses coverage of such Member and disciaim all another person's card, HMO PLIJS may relain finaiicial responsibility for any further Health the card and terminate the Member's coverage Service costs incurred by such Member. (and, if the Member is a Subscriber, the cover- age of any of his Dependents) eftective immedi- Termination for LDss of Eligibility. Subject to ately upon written notice. the conversion privileges set forth below, the coverage of any Member who ceases to be eligi- 3. Members represent that aH information con- ble wiB terminate at the end of the day upon tained in applications, questiorinaires, forms or which efigibilit-y ceased, unless otherwise agreed statements submitted to HMO PWS incident to to by HMO PWS and your employer. In the HMO PWS coverage and its adniinistration is event of Subscriber's death, coverage wifl ter- true, correct, and complete, and if a Member minate for covered Dependents of Subscriber knowingly furnishes incorrect or incomplete in- on the last day of the period for which pay- formation which consfitutes a material misrepre- ments have been made by or on behalf of Sub- sentation, then the rights of the Member niay scriber, subject to the conversion privileges de- be terminated effective immediately upon writ- scribed in tWs Evidence of Coverage. ten notice. Membe@ so terrninated shafl be responsible to pay charges for all services pro- Termination for Employer Default. Only vided to the Member hereunder that are related Members for whom the stipulated payment is to such incorrect or incomplete information. actuafly received by HMO PWS shafl be en- Such charges shau be at the Usual and Cus- titled to Health Services and then ordy for the tomary Fees (as defined in Part 35) of the period for which such payment is received. If health care provider that rendered the service. payment is not made in full by your employer on or prior to the premium due date (generally 4. If a Member fails to cooperate with HMO the last business day of each month preceding PWS in the implementation of coordination of the next motith's coverage), a grace period shan benef-its recoveries or any other double cov@e be granted to your employer for payment. The source, HMO PWS may terminate the grace period sllafl begin on the p@um due Member's coverage upon 30 days written notice. date and continue for 30 days. If payment is not made k\,ithin the grace period, your cover- 5. If a Member is guilty of fraud, gross or a.-e (and that of your Dependents) @\,ifl termin- repeated misbehavior, including but not bmited ate as of the end of the period for %v@ch to, abusive behavior to Plan Physicians and monthly charges have been paid. HMO PWS adrni@strative personnel, in apply- ing for or seeking any benefits under this Evidence of Coverage, then the rights of such Reinstatement. A Member shafl not be rein- Member under this Evidence of Coverage may stated automaticahy if coverage is ter@nated. be terminated effective immediately upoll writ- Re-apphcation is necessary. teii notice. Termination by Employer. The A-,reenient 6. When, after reasonable efforts (to iticlude between HMO PWS and your employer lylay cliaii-,in-, pilysicians), a Member's Primary Care be terininated by your eiiiployer or HMO Plivsiciaii or other Plan Pllysician is unable to PWS. In iiiis event, coverage shall terminate est.iblisli or maintain a satisfactory pliysician- for all Mciiibers as of tlie et'fective date ol' tel,- patient relationship with the Member, HMO minatioii of the Agreement. All rights to bene- PWS inay terminate the Member's coverage fits sliall cease as of the effective date of ter- aiid it@ the Mciliber is a Subscriber, tiie covei'age iiiinatioii. Ul)on teriniiiatioil ol' tlie Agreeiiielit, ol@ aiiy of his Depeiideiits, upon 30 days writteil HMO 13WS will cooperate with your eiiiploycr notice. Evidence of an utisatisfactory physician- in atteniptiiig to niake equitable arrangements patieiit relationship includes a Member's refu@ for coiltinuiiig care of@ a Member hospitaiized to accept procedL@S or treatmeiii recom- on the teriiiiiiatioii date. 5 21. Conversion From Group To Non-GrouP flilly in providing this inibrination to HMO PW@i and l@ailure to cooperale may result iii Coverage If tlie coverage of a Member terniinates due terinination of coverage. A delay iii HMO solely to loss of eligibility and Member has not PWS' receipt of Lhis information will result in had coverage terminated for those reasons set a delay in the pay-nt of your claim. fortli in the "Termination of Cause" part of this Evidence of Coverage, then the Member Wlien you enrolled iii HMO PLIJS, YOu MaY may convert his membership to non-group liave indicated some other l@orm of insurance membership without furnishing evidence of in- available to you-- perhaps through some gov- surability. In order to obtain non-group mem- criiment program, or your spouse's place of bership, a Member must submit a conipleted employment. We will verify this from time to change status form within 31 days of the date tinie. Please help US WiLh a prompt reply or a of iermination of group coverage. PL-rsons eligi- telephone caU in the event you become efigible ble to convert who reside in the Service Area for another form of coverage. may obtain non-group membership with HMO PWS. Persons eligible to convert who live out In determining which insurance coverage is to of the Service Atea wifl be offered non-group be considered primarily responsible for pay- membership with a Blue Cross or Blue Shield ment, the roflowing general rules of thumb plan serving the area into which they move. In apply: either case, non-group membership will be of- fered without evidence of insurabifity but in ac- cordance with afi terms and condifions of the 1. If any member of your faniily has his or her non-group memberswp as may be in effect at own coverage through another poficy (perhaps the time of conversion. your spouse is coveted at work), that coverage is considered primary for him/her. 22. Copayments Copayments for certain Health Services are set 2. If your dependent children are coveted under forth in the attached Benefits, Exclusions and both a husband's aiid wife's individual policies, Copayments Schedule. These amounts are the the insurance plan of the parent whose birthday financial responsibifity of the Member. fafls earber in the calendar year is considered Copaynients should be paid by or on behalf of primary for those children. the Member at the time the Health Service is rendered. A Member need not pay additional 3. If neither of the above cases apply, but there Copayments when his total arinual Copayments is another form of insurance available, the reach $500.00 in a calendar year; provided, poficy which has been in existence longer is Copayments appticable to cerltin services considered primar@,. covered hereunder are not counted toward this annual Copayment Entit and CopaymenLs for The above rules may be affected in the event of those services are never waived. Covered ser- the divorce of a dependent child's parents, or vices for which Copayments are not counted when an employee is retired or laid off. For toward the annual Copayment hmit are in- ase contact the HMO further information, ple dicated on the Copayments Schedule. If . Member appfics to HMO PLIJS within 45 days PWS Member Representative. of the end of the calendar year, any HMO PWS reserves the right to contact any Copayments, except those whicii are never otlier insurance compaiiy, organization, or per- %N,aived'paid in excess of the annual Copay- son which may assist in determirdng the appli- iiicilt finu't shau be refunded to the Member. cability of coordination of benefits, without consent or notice to the Member. If HMO 23. Coordination Of Benefits PWS becomes a%vare that other coverage ex- If you are covered by other group llealth insur- isted after having made payment for expenses ailce which duplicates some HMO PLIJS bene- w[iich would have been covered under the other t@its, HMO PWS %vill coordinate beilefits with plati, HMO PWS also reserves the riglit to tliat plati as set forth in the Agreeiiient. Both claim reimbursement, paymcnt, or transfer of plans will work together to piovide you witil sucil l@Linds 1rom tlie otlier plan or tlie Member. 10007o of allowable medical services, while avoiding dLIplicate paymeilt for tlie same bene- 24. Reimbursement Request l@its. it is expected tliat Mciilbers will cooperate liMO PLLJS Mciiibers pie-l),Iy theii- healili 6 care, aiid ilius it will seldoni be iiecessary to eiiii)loyer'.% liability laws or sucli otlier insura[ice subiilit a rvquest for reimbursemeilt for all out- are payable to atid retaiiied by HMO PWS or of-pocket expense. Members are expected to use the Plail Provider entitled t[icreto. their Primary Care Pilysician for all their primary care needs and obtain the advance Medicare. Except as otherwise provided by authorization of their Primary Care Physician applicable federal law, HMO PWS benefits for bcibrv receiving cart from otlier sources. Members iged 65 or older, or Members other- wise eligible for Medicai-e paymeiiis, do not In a few instances, however, you may pay out- duplicate any benefit for which these Members of-pocket for a service for which you are en- are eligible under the Medicare Act, iiicludilig titied to Feimbursement. For example, this might Part,B of tile Medicare Act. All sums payable occur if you paid for Emergency services re- for services provided-hereunder to Members ceived outside the Service Area. HMO PWS which are covered under Medicare are payable should always be notified of such a situation to and retained by HMO PWS or the Plan within 48 hours or sooner, if possible. Then Provider eiltitled thereto. you must submit to HMO PWS an itemized bill with receipt(s) along with the HMO PWS Members! Cooperation. Each Member shall reimbursement request form. If the request is complete and submit to HMO PWS such con- for services which are covered under your con- sents, releases, applications, assignments and tract with HMO PWS, your request wiU be other documents as may be requested by HMO approved and the payment sent to you. PWS in order to obtain or assure reimburse- ment under Medicare, workers' compensation In order to receive mimbursement, you must or similar statute, or any other pubfic or private submit bius and the HMO PWS reimburse- insurance coverage for which the Member is efi- ment request form within 60 days of the date gible. Any Member who is eligible to and fails you mceive the services. If you have arry ques- to enrofl in Medicare, including Part B, or tions about this type of reimbursement, please otherwise cooperate with HMO PWS in ad- feel free to cafl an HMO PWS Member Repre- ministering "s Part 26 may have his coverage senEative. In no event shau HMO PWS be (and, if the Member is a Subscriber, the coner- responsible for claims fik-d with HMO PLJJS age of any of his Dependents) terminated as in- after one year from the date tile services were dicated in Part 20, "Termination of Coverage". rendered to the Member. 27. Relationship Of Contracting Parties 2S. Service Area Plan Physicians maintain the physician-patieiit The Service Area means the geograpwc area miationship with Members and are solely re- \vithin which tlie HMO PWS services are sponsible to Members for aH medical services. available. Except for Emergencies or xvhen Tlie relationsliip between HMO PWS and authorized in advance by HMO PWS or your Plan Physicians, and between HMO PLUS and Pritilary Care Pliysician, all of your Healtli other Plan providers of Health Services, is an Ser%,ices niust be received witlliii tlie Service iiidependent contractor relationsliip. Plan Pliysi- Ar,ea. cians and Plan Providers of Healtli Services are not enipioyees or agents of HMO PWS and The Service Arra is described in the booklet iieither HMO PWS nor any eniployee of YOLI ileceived upon eiirolit-neiit atid may be I-e- HMO PWS is an employee or ageilt of Plan vised b), HMO PWS upoii notice to your Pliysiciaiis ot- stich providers. For the purposes ciiiployer. of tliis Evideiice of Covet-@e, no elliployer nor aily Meinber is tile agent or represenlative of 26. Double Coverage HMO PWS, and neitlier shall be liable for any Workers' Compensation and Other In- acts or oniissioiis of HMO PWS, its apents or surance. HMO PWS benefits for Members eiiiployees, or aiiy oilier persoii or o@,iiiization eligible for workers' compensation or similar ",ith which HMO PUJS has madc or hmafter eiiiployer's liability laws or any other public or stiall niake arratigeiiieiil,; lbr tlie peribrmaiice of I)rivate iiisuralice covera_@e do liot duplicate any services. bliiet@it lbr wliich such Menibers are eligible under the workers' compensation or similar 28. Medical Information eniployer's liability laws, or ally other public or HMO PL-LJS is etititled to jeceive t@roni any pro- private insuratice coverage. All sums payable for vicier of@ services to Meiiiber, ini@orm@itioli sei-vices provided Ilei-eunder to Membei-s pur- i-ezisoiiably necessai-y in coiinectioii %%,ith the ad- SLIZI]II to %vorkci-s' conipeiisatioii or SLICII oilier 7 niiiiistratioii ol@ tllis Evidcilce of Covelzie bLIt subject (o all @il)l)licable coiii@ideiiiiality lCqLlilc- liMO IIIWS i-estilis iii ilic l@icilities, Ivi-soliliel, iiiciiis. By accei)ting coverage ulidel- [[Iis Evi- oi- f@iiiaiicial resout-ces of@ HMO IIWS being deiice of@ Coverage, tlie Mciiiber autlioi-izes uii@iviiiiablc to piovide or ai-iziilgc li)j- tlie I)Iovi- eveiy provider i-eiidering ,,ei-vices liereuiider to sioii of@ covefvd @i-vices, 1-iMO IILJJS slizill disclose all @cts pcriaining to slicii cafe and niake a good f@iiih elli)rt to I)rovide or al-range twatinent and pliysical coiiditioji ot@ tlie N/leiiiber lbr (lie I)I'OViSiOll Of@ SLich services takilig ifito to ilie sanie and periiiit col)ying of@ tecoi-ds by accouiit tlie iiiipact ol' the event. Iii sucil all HMO I)WS. Int@oriii@itioil f@rolli illedicii] recol-ds eveiii, HMO IIWS ztiid HMO PWS I'l@in Pi-o- ot@ Members and inforniation received l@rom videi-s shall rrnder covered liospital and iiiedical piiysiciails, sui-geons or hospitals iiicideilt to tile services iii so f@r as 1)ractical, ajid accordiilg to doctor-patient or hospilai-patient jvlatioilsliip their best judgment, but HMO PWS and such sliall be kept confidential, and except lbr use providers shall iilcur no liability or obligation reasonably necessary in connection with the ad- for delay, or failure to provide or arrange for ministration of this Evidence of Coverage, and services if such failuir or delay is caused by to comply with the government requir-ements sucli an event. establislied by law, may not be disclosed without the consent of the Member. 33. Notices To Members Any notice to a Member shall be sent to the 29. Important Limitation Subscriber's last known address on HMO Except in cases of Emergency services, in order PLIJS' enrollment records or to the Group, to be covered under JIMO PWS, each whichever of the t%vo HMO PWS shafl deter- Member must obtain Health Services only mine to be appropriate. under the dimction and authorization of the Member's Primary Care Physician or other 34. Group Enrollment Agreement Plan Physician. In addition, except as otherwise In the event of any inconsistency bet%veen the directed by a Primary Care Physician, each information conlained in this Evidence of Cov- Member must uti@ ordy Plan Providers, as erage with the Agreement between HMO PWS def-ined in Part 35 below and as directed by and your employer, the Agreement wifl control. such physicians. Failure to abide by these HMO Specific questions related to your employer's PWS procedures wfll result in denial by HMO agreement with HMO PWS may be directed to PWS of coverage for the apphcable services. the HMO PWS administrative offices. 30. Policies And Procedures 35. Definitions HMO PWS may adopt reasonable poficies, Agreement means the Group Erirollment procedurrs, rules and interpretations to promote Agreement, between HMO PWS and your orderly and efficient administration of coverage employer, of which this Evidence of Coverage is under tliis Evidence of Covera,@e. a part. 31. Modifications Copayment means the amount t-equired to be Any provision, term, benefit or condition of paid by a Member in connection with the your coverage and this Evidence of Coverage Health Services set forth in the Schedule of niay be amended, i-evised, or deleted in accor- Benef-its, Exclusions and CopaymenLs included dance with the terms of the Agreement between with this Evidence of Coverage. HMO PWS and your employer. This may be done without your consent or concurrence. In Dependent means any niember of a Subscri- tliis regard, HMO PWS may issue a iiew Evi- ber's I'amily, NN,ho nieets all of tlie requirements detice of Coverage and/or new Benel'it Scliedule of Part 17, "Efigibifity," of this Evidence of %%,Iiicli describe the Member's coverage or issue Coverage, who is enrofled hereunder, and for aiiy cliange related to tlie above. %%,Iiom the prepayment ivquired tinder the Agieeinent has actually been received by HMO 32. Further Limitations 13ws. Tlie rights of Mciiibers and obliptiolis of HMO PWS are subject to tlie follo@vilig Emergency iiieans a bodily iiijury or serious liiilitations: illness which tiireatelis loss of life, limb or setises and requires the Member to seek im- To tlie exteiit ihat a natural disaster, %yar, i-iot, iiiediate niedical attention under circuiiistailces civil iiistirrection, epi(Jeiilic or any otlier ei-ner- or at a tiine or location wliich efrecti%-ely ,-,Ciicy or siiililar event ilot witliin tlie coiltrol of I)TeCludes the Member froin SCCkilig SLIC[I care 8 t@roiii or (lirougli a [lriiiiary Care I'llysiciail. Mciiibcrs. A list of@ ['Izlli lliovidet's is I)i-ovidcd Hciti-i attitcks, cardiovascuiar accideilts, I)cnlor- to etch SLibsci-iber upoil cilroillilelit, aild a CLII'- rhagiilg, poisoniilgs, loss of consciousness, rvilt list iiity be obi@iiiied froiii HMO l@WS. tv,.,piratioti accidents, convulsions, and oilier Sucli list sliall bc wvised by HMO L@LUS Ironi acute coilditions as HMO PWS sliall determine tinic to tinie as HMO IJWS deciiis necessary. to bc such are Emergencies. Primary Care Physician ineans the wi-,,oiial Health Center(s) means physicians' oll@ices pliysician you li@ive sciccted to provide YOLir pi-i- and/or ciiiiical facilities operated for tlie provi- mary healili care and coordinate the otlier sioti of certain outpatient Health Services to Health Services you iilay require under tlie Members. A current list of Health Centers is HMO PWS prepaid program. It also nleans available from HMO PWS. This list may be the physician you have chosen for your Depeii- revised by HMO PWS from time to tinie as detits. Prii-nary Care Physicians are always HMO PWS deems necessary. selected from aniong Plan Physicians. Priinary Car-e Physicians specialize in the areas of gen- Health Services means those hospital and eral practice, family practice, internal mediciiie, medical services which are described as covered and pediatrics. in the Schedule of Benefits, Exclusions and Copayments included with this Evidence of Service Area means the geographic area Coverage and which arr performed, prescribed within which HMO PWS services are avail- or directed by a Plan Physician. able. Except either for Emergencies or when authorized in advance by HMO PWS or a HMO PWS means Virginia Health Mainten- Primary Care Pllysician, afl Health Services ance Organization, Inc., a Virginia corporation must be teceived within the Service Area. organized and operating as a health mainten- HMO PLJJS' Service Atea is described in the ance organization which is affibated with Blue booklet you received upon enrollment and niay Cross and Blue Shie.ld of Virginia. be revised by HMO PWS froin time to time. Medical Group means any physician group Subscriber means the efigible employee who practice(s) which has entered into a written has elected coverage for Iiimself and his Depen- agreement with HMO PWS for the provision dents (if any), wlio meets the eligibiuty require- of medical services to Members under this ments of Part 17 of this Evidence of Coverage Evidence of Coverage. A current list of Medical and enrous hereunder, and for whom the Groups may be obtained from HMO PLUS. prepayment required by the Agreement shall Tliis list shall be revised by HMO PWS from have been received by HMO PWS. time to time as HMO PWS deems necessary, Urgent Care means a health problem usually Member means any Subscriber or Dependent marked by rapid onset of persistent or unusual as defined herein. discomfort associated with an illness or injury. These problems may include high fever, vomit- Plan Physician means a duly licensed doctor ing, sprains, fractures and niinor cuts. An of medicine or osteopathy who is associated Urgent Care situation, although potentially seri- with or erigaged by a Medical Group, or who ous, can usuafly be handled through your Pri- lias otherwise agreed with HMO PWS or mary Care Pllysician's office. Medical Group as a specialist physician to pro- vide niedical services to Members. A Plan Usual and Customary Fee means the fee Pliysician's agreement with HMO PWS, em- %vilicli a physician or other provider of a partic- ployment or association with a Medical Group, ular service usually charges his patients for the or @ement as a specialist pllysician, nlay ter- same service, aiid whicli is within the range of iiiinate and tlie Meiiiber inay be required to fees customarily charged by otlier pliysicialls or select another Plan Physician (if a Primary other providers located within the immediate Care Physiciaii) ot- will be referred to another geographic area wliere the service is i-endeied Iliziii Pli@,siciaii for specialty caic. iiiider compaiable Ci[VLlllistaiices. Plan Provider nieaiis a Medical Group, Plan Pliysiciaii, liospital, skilled nursing facility, or aiiy otlier duly licet)sed ilistitution or healtli professioiial uildei- coilti-act witli HMO PWS oi- iLs designee to provide Hatli SLi-vices to 9 ATTACHMENT A BENEFITS, EXCLUSIO NS AND COPAYMENTS SCHEDULE Subject to all ternis, conditions and definitions by a Primary Cai@ I:Iliysiciaii (incilidiiig suigical iii the Evidence of Coverage, Mciiibers air eil- procedures, anestilesia aiid coilsultatioii Nvitli titled to teceive the Health Services listed as and titatnient by cotisulting 1)liysicians) aiv pro- covewd in tliis BeiiefiLs, Exclusiolis and Copay- vided %N,hile tlie Mcmber is adniitted to a lllaii inents SLhedule. Except as otherwise provided Provider liospital as a registered bcd paticilt. iii the Evidence of Coverage and this scliedule, 2. Plan Physicians! Offices. All diagnostic all tlicse services must be: and treatment services of Primary Care llliysi- -prescribed or directed by the Member's Pri- cians and otlier Plan Physicians which are m- mary Care Physician, quested or directed by a 13i-imary Care Physi- *performed by a Plan Provider, and cian are provided, including preventive services, -received in the Service Atta. surgical procedures, surgically implanted pros- A. HOSPITAL SERVICES thetic devices, and consultation with the treat- 1. Admissions. Only Plan Physicians may ar- ment by consulting physicians at medical offices i@ange for hospital admissions of Members and at such other places as directed and prc- whose iflnesses or injuries ricquire hospilal ser- scribed by a Primary Care Physician. In addi- vices. These admissions must be coordinated tion, hemodialysis and peritoneal treatment ser- through tlie Member's Primary Care Physician. vices wiU be provided at such places as a Pri- Special rules apply in Emergencies; these spe- mary Care Physician directs. The Member wiu cial rules are outhned in Section N. of this be required to pay a Copayment per pliysiciali schedule. office visit for diagnosis and treatment purposes 2. Benefits. Hospital services include semi- as set forth in tlie CopaymenLs Schedule. private room and board (or private room when 3. Ambulatory Surgical Services. All medicafly necessary and ordered by a Plan medicauy necessary ambulatory surgical ser- Physician), general nursing caie and the foflow- vices wiU be provided when ordered by a Plan ing additional facifities, services, and supphes Physician. prescribed by Plan Physicians and received by C- PREVENTIVE SERVICES the Member: meals aad special diets when The fohowing preventive Health Services are medicaUy necessary, use of operating room and provided without cliarge when directed or pre- related facifities, use of intensive care or cardiac scribed by a Primary Care Physician: well-baby care units and services, x-ray services, labora- care from birth, periodic health evaluations for tory and other diagnostic tests, drugs, medica- adults and childreii, vision and hearing sc@n- tions, biologicals, anesthesia and oxygen ser- ing for Members up to age 18 by a Priniary vices, special duty nursing when medically Care Physician, and pediatric and adult ini- necessary, short-term physical therapy, radiation muruzations in accordance with accepted iiiedi- therapy, short-term inhalation therapy, cal practices. chemotherapy, short-term occupational and D. X-RAY AND LABORATORY short-term speech therapy, admiilistration of AH x-ray and laboratory tests, services, and whole blood and blood plasma, surgicafly im- materials, including diagnostic x-rays, x-ray planted prosthetic devices, artificial limbs, tlierapy, chemotherapy, fluoroscopy, clec- ortliopedic apphances and orthopedic braces, ti-ocat-diogranis, laboratoiy tests, and tliei-apeutic and the use of durable medical equipment radiology services are provided when I)er- when medically necessary as part of ilipatient formed, prescribed, or directed by Plail care. Pi-oviders. 3. lnpatient Mental Health Services. Cai-e E. MATERNITY CARE iii a Plan Provider hospital for acute sliort-term 1. Pregnancy and Childbirth. Full Plan Pro- I)s@,ciiiatric coiiditions (including insaiiity, inental @,ider care, including piie-iiatal and post-natal iiiiiess or nervous disorders) is limited to 30 care is provided wlien arranged by a Plan d,tys per member per calendar year. As with au I)Iiysician. Mater@ty caiie includes tlie following oiliei- adiiiissioiis, tliis liospital caic iilust be sci vices for t[ic nioilici bel'ore atid dliring coll- coordiiiated tlli-ougli tlie Pi-imal-y Cale t@iiiemeiii aiid duiiii" tlie I)OSt-I)al-tu[ii I)CI-iod: Pliysician. 131an Provider liospital services, includiiig use of B. MEDICAL SERVICES delivery room; Plaii Pliysician iiiedical services, 1. While Hospitalized. All sel-vices of Plail iiicludiiig opei-atioiis aiid special procedures I'llysiciaiis aiid 131aii Provider llospital I)ersoiiiiel SLICII is caesareaii sectioii wile[i al-i-aiiged by a wliicli aiv, in citlier case, Tvquired or directed I'lan 13[iysiciaii; aiiestliesia; iiijectabics; x-r@iy @iiid l@iboi-@tioi-y 1/2Lrvices. Covei-@igc ol@ ilc\%,bol-ii I'llysiciall LIJ) to 2() otiti),itictit %!isiis I)Cr Mcilibei cliildi-eii is stibject to the coilditioiis sci loilli iii per caleild@ii ),ear, but otily \\,Iiell iliese visits tiic Evidence of Coverage. are iiecessary aild al)pt-opriate for silort-tcrill 2. Family Planning. Voluntary t@iiii[y plaiiiiiiig evaluatioti ajid crisis iiiiervctltion. I-lic Mciilber scrvices and infertility set-vices directcd or piv- sliall be responsible foi- a Col)aynielit pcr out- sci ibed by a Plan 13hysician are provided. Tliese paticiii mental licalth visit as set fi)rtll ill tlie SC]-ViCCS ifICILide sterilization pi-ocedures, such as Copiiynietits Scliedule. ILibal ligation and vasectomy, and int-ertility J. ALCOHOLISM AND DRUG ABUSE COL)iisciiii,g aiid sci-vices. lio\vcver, lion- SERVICES I)t,cscriptioii contraceptive devices, iii vitro @r- Diagnosis and niedical treatnient for alcoholisin iilizzitioii, ajid eiilbryo transplaiits are not aiid for abuse of drugs (includiiig detoxification coN,ewd betiefits. The Member shall be required and whabilitation for alcoholisni or drug abuse to pay tlie Copayment set fortli in the Co- on either an outpatient or inpatient basis, wlien payiiieiits Schedule per outpatient visit fol- determined by a Primary Care Physician to be voluiiiary family plannilig and infertility medically appropriate) are provided wilen services. directed or prescribed by a Primary Cam Phy- F ORAL SURGERY sician. Medical services for the abuse of or ad- Although dental services in general are not pro- diction to alcohol or drugs, including ancillary vided, the fbilowing limited oral surgical pro- medical services, wifl be provided by HMO ceduies %Yhen autliorized by a Primary Care PWS or arranged through appropriate referi-al. Physician are provided: Referral for anciflary non-medical services (such (1) Oral surgery related to tumors and injury to as vocational mhabihtation and employment the jaw bone or surrounding tissue; and counseling) may be made but, except as pro- (2)Treatnient of acute accidental trauma to vided below, services provided the Member soutid natural teeth. after such referral wifl not be covered. An in- G. EXTENDED CARE SERVICES patient oriented program for rehabilitative ser- The follo%%,ing items and services will be pro- vices for the treatment of alcohohsm or drug vided to a Member who is an inpatient of a addiction, when authorized by the Member's skilled nursing facility when directed or pre- Primary Care Physician, wiU be covered for up scribed by a Plan Physician and coordinated to 30 days every calendar year. There shall be a witli the Pritnary Care Physician: Plan Physi- fifetime Umit per Member of 90 days of such cian visits; room and board in se@-private care. RehabiUtative services in a residential facil- accommodations; short-term rehabifitative ser- ity are not covered. The Member sliafl be vices, subject to the limitations set forth in Sec- responsible to pay the Copayment set forth in tioii H, belonv; drugs, biologicals, and supplies tlie Copayments Schedule for outpatient furiiished for use in the skilled nursing facifity; alcoholism and drug abuse services. and other inedically necessary services and K. HOME HEALTH CARE supplies which are not excluded under the 1. House Calls. All necessary liouse calls by a E%-idciice of Coverage. Coverage in a skilled Priniary Care Physician %vhen the nature of the nursijig facility is limited to 100 days per illness, injury, or pregnancy-related condition Member per calendar year. Custodial or dictates (as determined by tile Primary Care doniiciiiary care in a skilled nursing facility or Physiciaii) are provided. The Member sliall be any other facility is not covered. required to pay a Copaynient as set fortli in tlie H. REHABILITATIVE SERVICES Copayinents Schedule. Sliort-term physical, speech and occupational 2. Home Health Services. The followilig illerapy atid otlier medically necessai-y rellabili- items aiid services %N-ill be provided iii tile t,itive ser@-ices for medical conditions on either Nleniber's home by, or under tile supervision aii outpatient or inpatient basis are provided of', a pi-ofessioiial ntirse oii a part-tinie or iiiier- @N-lieti directed or prescribed by a Plan Pliysician nlittent basis %vhen dii-ected or pi-escribed tild aild coordinated with the Member's Primary periodically tvviewed by a Priinary Care Pliysi- Cai-e Physician. Short-term rehabilitative ser- ciaii and when such care is determined by the vices art liniited to those services whicli, iii tlie Priinary Carv Physician to reqtiii-e tlie services iLid,,,iiieiii of tlie 131an Pliysician, can be cx- of a prot@ssioilal niiise or traiiied lionle liealili lxcted to i-esult iii sigiiificailt impi-oveiileiii of aicle: IILII'Sillg care, silort-teriii icliabilitative sci- tlie Member's condition witllin a period of 60 ViCeS (SLibject to the litniuitioiis set lbrth in SLc- diiys and are Iiinited to 60 days fioni iilitiatioll tion H, above); niedical SLIpplies; aild otiler ot@ iieatmeiit per i[Iiiess or coiidition. niedically iiecessary services aiid supplies w[iicli 1. OUTPATIENT MENTAL HEALTH SERVICES aiv ilot exclLILICd uiidcr tliis EN idefice of@ Covel-- OLlipatieiii iiieiital liedth services sliall bc I)[-o- ige. liomeillaker sei-vices or oilier lioll-illedical vi(le(I \vlicii ciiiec(ed oi I)iicsci-ibe(i Liy @l Piziii scivices \Yiil iiot be 1)i-ovicicd. 3. Durable Medical Equipment. Reili@ll ol' Wlicle sticii visit cloes liot icstilt ill @ill iiij)@itieiit nie(lic@illy iieccssary durabic iiiedical CqLlipll)Cllt adiiiissioii, tlie Mciiiber sliall be ivqllil@d to I)ZIY (oi- pui-cliase il'sucli I)ujcllase would be less a Cop@tyiiient lor such boiia l@ide visit to ail ilian tlie iviital costs, as deiermined by HMO ciiiel-gclicy fzicility as set fortli in tllc PWS), such as wheelchairs, sui-gical beds and Copayiiietits respirators will be coveivd for home use wheii (c) Medically iieccssaiy iii-nbulaiice service %vill authorized by a Priniary Care Pllysician. How- be proviclccl WillIOLit cilai_@e wiiiiiii tlie Service cvcr, bcnel@its l@or durable medical equipiiicni are Awa if SLICII service is ordered by a Priniiry Iiiiiited to $1,000 per Mcinber per calendar Care 13]lysician. Ill ail Eniel-gelicy, a Prinial-y year. Care Pliy.,,ician'.1/2 oi-der is not ruquired. L. HEALTH EDUCATION AND NUTRITIONAL 2. Outside the Service Area. COUNSELING SERVICES (a) Emei-geiicy sei-vices outside tile Service Area Health education services to include education am provided to assist a Member wlio sustaiiis in the appropriate use of HMO PWS are cov- accideiltal injury or becomes ifl while teniporar- ered \vlien furnished by Plan Providers. Health ily away froni his irgular residence and from education services include nutritional counseling tlie Service Area. Accordingly, benefits for as it relates to regulations of diet for control of these services are limited to Emerl,,encies in discase and instructions on achieving and which care is required immediately and unex- maintaining physical and mental health and pre- pectedly. Neither elective care nor care required venting ihness and injury. as a result of circumstances which could M. OUTPATIENT PRESCRIPITION DRUG reasonably liave beeii foreseen prior to depar- SERVICES ture from the Service At-ea is coveted. Services Prescribed (legend) drugs incidental to out- for maternity care (Section E above) do not patient care are covered when prescribed by a cover normal term detivery outside the Service Plan Physician. Benefits shafl also include com- Area, but do include earlier complicatiolis of pounded medications of which at least one in- pregnancy or unexpected delivery occurring gredient is a prescription (legend) drug, inject- outside the Service Area. able insuhn and syringes, and needies for the (b) If an Emergeiicy occurs when the Member admi6stration thereof. Prescription contracep- is temporarily outside the Service Area, tlie tive devices and birth control pius @ also Member sliould oblain emergency care at the covered. For each prescription, HMO PWS nearest emergency facility. Covered emergency xviB cover up to a 31-day or 100-unit supply, services iiiclude niedica[ly necessai-y emergelicy Nvhichever is greater. The Member shau be ambulance service aiid emergency hospital ser- responsible for the Copayment set forth in the vices received as a registered bed patient in a Copaymeiits Schedule. general liospital. N. EMERGENCY SERVICES (c) Urgeiit Care may be provided outside the 1. Within the Service Area. Sei-vice Area by aiiy pliysiciati or liealili prol@s- (a) Medical care is available through Primary sioiial qualified to render sucli cai-e. Carr Pilysicians 7 days a week, 24 hours a day. (d) Contiiiuing or follow-up ittatment for acci- Iii the eveiii of an Emergency, tlie Nlember dental injury or emergency illness is limited to iliust contact his/lier Primary Care Physician Emergency or Urgent Car-e required befoit the oi ' if the Primai-y Care Physician is not avail- Meiilber can, without medically harmi@ul or in- able, tlie coveriiig physician who is a Plan Phy- jurious consequejices, return to the Service sician. One of these two will make arrange- Ai-ea. Benefits for contiiiuing or follow-up iiieiits tbr tlie Meinber's eiiiergeiicy cai-e. If tile @atment are pi-ovided only in tlie Service Eiiiergeiicy is so urgent tliat inimediate action is Area, subject to all provisions of [iiis Evidence (leniaiided, tlie Member should go to the licar- of Covelilge. est al)l)i-opriate emergeticy facility. (e) Except as otherwise provided in tlie (b) HMO PWS covei-s services tendered in aii Copayiiients Scliedule, there are no ciiier,eiicy f,,icilit@, N\,hen tlie coiiditioti treated is Col)ayniciits for services irceived by a Member ail Eniergency, as tliat term is defined in tile outside tlie Service Area. Evideiice of Coverage. Routilie alict lirgelit inat- 3. Notification. In tlie eveiit of ail Emergelicy ters niust aINNays be treated by tlie Member.s ileqllii-ing liospitalization in a non-Plan Provider 13i-iiiiary Cat-e Pli@,siciaii ot- ailother l@laii Physi- liospital, tlie Meiiibei- iiiust [lotit'@- HMO IIWS ciaii. If tlie Member obtains ti-eatniciit elsewhere witlliii 48 liours after care is com'itienced or as and it is determitied by HMO PWS that tlie sooii tliereat@ter as practical. For OULpatient conditioii tivated \\,as not aii Emergency, tlie eiiiel-gciicy sel-vices, tlie Mciiiber iiiust tiotify Iiis Member ",ill be liablc lbr tlie ciltire I)aynient Pi-iniary Cai-c Pliysiciaii witliiii 24 liouis al-tel lbr tliat ti-eatment. caiv is coiiiiiieticed oi- as soon iliei@al@ter as I)i-@ictical. EXCLUSIONS ztiid livi(iiicilt), zilveoleciollIN" ti@@illiicllt ol* I)CI-i- I lie lollox@,iiig sci-% ices iiiid bciicl@its @tiC CXCILICICCI odoiii@il cli,;e@isc @ilicl @IIIN' ollici deiii@ll 1/2c] @ iccs 1,1-oiil covcl@ige uiidci- tile Evidelice ol Coveikge: uiilcss sncil-iciilly I)i-ovided ioi- lici-eiii. 1. @,rvices of noti-Plati Pi-ovideis, except f@or 14. Long-teriii pllysicii and speecii therai)y ,iiid Enicrgencies or wlien alithorized in advancc by otlier rehabilitation services. AS LISCD llereiii, HNIO PUJS or a Priniary Care 13liysiciaii. "lotig-teriii" sh@ill iiieaii iii excess of 60 d@i@,s. 2. Tlie cost of covered services for wliicti bene- 15. Experiniental medical, stii-gic,,il, or licaltli l@its aic piyable under any workers' conipensa- care procedures aild drugs, as deteriniiied by tioii oi- ciiiployer's liability law or otlier legisla- HMO PL.LJS. tioii ot@ similar purpose. 16. 13rocedures, services aild supplies telated to 3. Services and (teatment of mental tetardatioli, sex translbrmatioiis. oilier i-nenlal healtli services (including lolig- 17. Care lbr mililary ,-,ervice conilccted disabili- ierni psychotherapy or psychoanalysis), and ties and conditions for which the Member is developmental and learning disorders, except as legally entitled to services and for which facili- provided herein. ties are reasonably accessible to the Member. 4. Vision and hearing care, except medical ser- 18. The cost of care for conditions that federal, vices (as set forth in Section B above) requirud state or local law mquires be treated in a public for the diagnosis and treatment of diseases of, facility or services or supplies provided or ar- or injury to, the eyes or ears and preventive ser- ranged by a governmental facifity for which no vices as set forth in Section C above. charge would be made if the Member liad no 5. Reconstructive or cosmetic surgery, including health benefits insurance. weight reduction surgery and prosthetic penile 19. Except as provided herein, iion-medical an- implants, unless previously approved as medic- cillary services and prolonged rehabilitative ser- ally and functionally necessary by HMO PWS. vices for the treatment of alcoholism or drug Conditions resulting from elective cosmetic or abuse, including prolonged @habilitation ser- reconstructive procedures performed without vices in a residential facility. autliorization of a Plan Physician or HMO 20. The cost of services covered under the PWS are not covered. However, reconstructive Medicare or Medicaid Act. Subject to the pro- mammoplasty fouowing radical mastectomy is a visions of Part 26 of the Evidence of Coverage, covered benefit. HMO PLUS or its designee win file the 6. Corrective appbances or artificial aids (such Member's Medicare or Medicaid claims for as contact lenses, eyeglasses, and hearing aids) Health Services. Medicare or Medicaid will pay and fitting tliemof, except as provided herein. HMO PLIJS or its designee directly. However, 7. Private or special duty nursing, except when if foi- any reason Medicare or Medicaid pays prescribed by tlie Member's Primary Care the Member directly, HMO PWS or its designee Pliysician. will bill tlie Member for the amount to which 8. Tlie cost of xvhole blood or blood products the Member is entitled under Medicare or and the cost of securing the services of profes- Medicaid. sional blood donors. Ho%vever, the administra- 21. Any types of services, supplies or treat- tion of whole blood and blood products shall ments not specifically provided herein. The be a covered benefit if directed or prescribed by term "services" as used in these exclusions in- a Plan Pliysician or HMO PLUS. cludes supplies or medical items. 9. Personal or comfort items (such as radio, 22. Organ transplants, except wlien authorized television, telephone and guest meals) and pri- by HMO PWS for kidney transplants, liver vate i-ooms, unless the latter are medically transplants for children with biliary atresia, and necessary duriiig inpatient hospitalizlition. cornea[ traiisplants. Hcai-i transplai)[s and 10. Custodial, domiciliary, resideiitial, or con- donor medical and transportation costs aie not valesceiit care. iiicluded. I 1. Rotitine pliysical exaniinations for insul-ance, 23. Court-oidered examiliatioiis aild cam e\cept eiiiployiiient, or immunizations required for as covei-ed herein. travel. Physical examinations for children tinder 24. In vitio l@rtilizatioil, ellibryo tralispialit, a,-,e 19 aiv liiiiited to oiie physical exaiiiiiiatioll aiid aitificial licarts. 1)er calciidai- vear. This limitation does not 25. Services for radial keratotomy, a suigical al)i)ly to %veil-baby cai-e. procedure to coriect illyopia. 12. Reveisal of voliiiitarily indticed iilfertility. 26. Rotitiiie foot caie SLIC)I as i-eiiioval of cot-ns 13. SLrvices ivlated to tlie cai-e, l@illiiig, rujiloval oi- callouses @iiid tlie ti iiiiiiiillg ol@ li@tils. ot- ruplacciiieiii of@ teeth. Exaiiiples 01@ CXCILldCd 27. Services wliicii are not medically iiecessai-y. sei-vices iiiclude, but aie tiot Iiiiiited to, al)icocc- However, iii all iiistances, Healtli Services toiiiy (deiiial iuot wsectioii), oitliodoiitics, ioot- I)i-esciibed or directed by a lllaii Physiciztii xvill c@itizil tivatiiiciii, SOft tiSSLIC inil)@tctioils, niyo- be dceiiied iiiedic@illy iiccess@iiy. l@zicial I)aiii dyst@uiictioii syiidroiiie (eva[Lt@itiOll 180001 (IZ 3/85) COPAYMENTS SCHEDULE 1. Office Visits. The Member shall be responsible for a $3.00 Copayment per physician office visit for purposes of diagnosis and treatment; provided, office visits for routine periodic physical examinations, including prenatal and postnatal visits, shall not be subject to the Copayment. 2. Outpatient Voluntary Family Planning and Infertility Services. The Member shafl be responsible for a $3.00 Copayment per outpatient visit for purpo@es of outpatient voluntary family planning and irlfertifity services. 3. Outpatient Mental Health Services. ach outpatient mental health visit shafl be subject to a Copayment of 2007o of charges. 4. House Calls. The Member shafl be responsible for a $3.00 Copayment per physician home visit. 5. Emergency Facility Services. The Member shau be responsible for a $20.00 Copayment per use of an emergency facility which does not result in the Member's direct admission to the hospital as an inpatient. This Copayment apphes within or outside the Service Area. 6. Alcoholism and Drug Abuse Services. For outpatient alcohohsm and drug abuse services, the Member shau be responsible for a Copayment of 20'7o of charges per visit. 7. Outpatient Prescription Drug Services. The Member shar be respon- sible for a $2.00 Copayment per prescription or prescription refifl. This Copayment shau not be counted toward the annual Copayment Emit described in the Evidence of Coverage. Also, this Copayment is never waived even if the annual Copayment hmit is reached. 180007 (R 3/85) AMENDMENT Oii ilie daicset bv H,%IO PLLIS, ihis atiieiidiiient @coiiies 1),trt c)f @out- F@,idelice of it is is@sued in rcilirn for plymeni of the ))rol)er cliai--,es. @'our c@ilenliar 'Neai liiiiit f@)l. olitpaticiii iiiciiiil liealili @ei-vik:es is Cll,'ill,)CCI FfX)!Il 10 OLttl)itlie[Il \ i@it@ to 30 OLILpiitient visii,;. Sectioli 1. of tlie Beiiefits, E.XCILI@ions and C,)I),I@-IllelItS S(-'t)CCILlie (Ati-.tchniviit A) tr.) %OLII' E%,idence of Co\cr,-@-PC is thcrcfore chinc!cd to i-ead as foho\k,s@ 1. OUTPATIENT MENTAL HEALTH SERVICES Otktl)atielit iiielitat lical[ii wfvic@, %@lleii clirected ot- pi@eribed b)@ @t Plaii Pli%siciaii, ,Ilall be pm\,ided ror iii) to 30 oliipatient vi,,its per Meiiibcr J)Cl@ c@eiid@ir btit otllv %@;licii [fiese % isit@ ai-c niedicidy ticccssiry anci il)pi-olii-iate fot- shoi-t-IC! Ill e\!IILIULiOll @iti(i ctisis iiitet-@ciiii(:)ii. Tile ,\4embei sliafl bc rc@pori,,ible F(.)i- a COPt%'IIICllt @vr OLILpatieiit iiieiitat licaltil \,isiL, a-i 'iet foi [ti in thc Coptymcni.@ Shedule. Unless otlict-wise aiiieticiell, Lill oilier tei-ilis iii @,,.,Lir E%iLICI),:e Of Co%-crx-,:c reiii,,Iin LLI)Ciiaiiged. HNIO PLLIS Pre@icient METAMATRIX COMPREHENSIVE GROUPCONTRACT ("Contract") Issued By BLUE CROSS AND BLUE SHIELD OF VIRGINIA ("Plan") to CrrY OF VIRGINIA BEACH ("Contract Holder" or "Group") The Plan agrees that persons defined as Members under this Contract shan be provided the health services enumerated herein, subject to the terms and conditions hereof, for a period of 11 months beginning at 12:01 a.m. on August 1, 1985, and ending at 12:00 Midnight on June 30, 1986, and from year to year thereafter unless, and until, the Contract is terminated in the manner provided herein. The initial 11-month period and each succeeding one-year period shar each be referred to herein as a "Contract Year." bi consideration of the forevoing, the Contract Holder agrees to pay the subscription charges provided for in this Contract; to receive on behalf of, and deliver to, its Subscribers membership cards and all notices from the Plan; and to otherwise perform the obligations imposed upon it as agent of its Subscribers under this Contract. In Witness Whereof, this Contract (consisting of the following pages I through 48, Annex A, and Annex B) has been executed this day of 1985. BLUE CROSS AND BLUE SHIELD OF VIRGINIA B y d,.in P. Mun@on Vice President and Contract Officer CITY OF VIRGINIA BEACH BY GROUP CONTRACT NUMBER X-24690/X-24691/X-24720 COMPREHENSIVE CONTRACT TABLE OF CONTEN@ SECTION TITLE PAGE I DEFINITIONS 1 n SCHEDULE OF ELIGIBILITY 9 ill SCHEDULE OF BENEFITS 12 rv COMPREHENSIVE HEALTH CARE BENEFITS 24 v DENTAL BENEFITS 34 vi EXCLUSIONS 37 VH GENERAL PROVISIONS 40 vin PAYMENTS TO THE PLAN FOR SERVICES 48 ANNEX A ANNEX B x-24690/X-24691/X-24720 SECTION I - DEFINITIONS A. ALLOIV ABLE CHARGE - this term is defined in two ways: 1. For Covered Services which are rendered by a Physician or Other Professional Provider ' the term "Allowable Charge" shau be the Usual, Customary, and Reasonable Charge. 2. For Covered Services which are rendered by a Provider other than a Physician or Other Professional Provider, the term "Allowable Charge" shau be the Plan's Reasonable Charge. B. AMBULATORY SURGICAL FACILITY - a facility with an organized staff of Physicians, which: has ?ermanent facilities and equipment for the primary purpose of performing surgical procedures on an outpatient basis, provtdes treatment by or under the supervision of Physicians or nursing services whenever the patient is in the facility, 3. does not provide inpatient accommodations, and is not, other than incidentally, a facility used as an office or clinic for the private practice of a Physician. C. BENEFIT PERIOD - except when used in Paragraph _q. of the General Provisions Section, is the specified period of time during which Covered Services must be incurred in order to be eligible for payment by the Plan. A charge for a Covered Service shau be considered to have been incurred on the date the service or supply was provided to a Member. D. BENEFrrS SEC'NON - a major benefit category as indicated in the Table of Contents. E. BENEFITS AFTER TERMINATION - the benefits, if any, available when a person ceases to be a Member. F. CALENDAR YEAR - the period from January 1 through the following December 31. G. CHIROPRACTOR - a duly licensed Doctor of Chiropractic. H. CLINICAL SOCIAL WORKER, - a duly licensed clinical social worker. 1. CONTRACT - this agreement including the Group Application and riders, if any, between the Plan and the Group, referred to as the Master Group Contract or Contract. 2 - X-24690/X-24691/X-24720 J. CONTRACT DATE - the date, specified on the acceptance page of this Contract, on which coverage under this Contract commences for the Group. K. CO-PAYMENT - a percentage of tbe Allowable Char.@e, the Usual, Customary, and Reasonable Charge, or the Plan's Reasonable Charge for which a Member is responsible per specified Covered Service. For example, if the payment percentage listed in the "Amount" column in a particular Schedule of Benefits is "80% of the Allowable Charge", the Member's Co-payment Amount for that Covered Service is the other 20% of the AUowable Char@.e. L. COVERED SERVICE - a service or supply specified in this Contract for which benefits will be provided when rendered by a Provider. M. CUSTODIAL CARE - care provided primarily for maintenance o'f the patient or which is designed essentially to assist the patient in meeting his activities of daily living and which is not primarily provided for its therapeutic value in the treatment of an iuness, disease, bodily injury, or condition. Custodial care includes but is not limited to help in walking, bathing, dressing, feeding, preparation of special diets and supervision over self-administration of medications not requiring constant attention of trained medical personnel. N. DEDUCTIBLE - a specified amount of Covered Services, usually expressed in dollars, that must be incurred by a Member before the Plan wiU assume any liability for an or part of the remaining Covered Services. 0. DENTIST - a licensed dentist or Physician. P. DEPENDENT - a Member other than the Subscriber as specified in the Schedule of hgibility. DIAGNOSTIC SERVICE - the fouowing procedures ordered by a Physician or Other Professional Provider because of specific symptoms to determine a definite condition or disease. Diagnostic Services are covered to the extent specified in the Schedule of Benefits and Benefits Sections. Radiology, ultrasound, and nuclear medicine; 2. Laboratory and pathology; ECG, EEG, and other electronic diagnostic medical procedures. R. EFFECTIVE DATE - according to the Schedule of Eligibility, the date on which coverage for a Member begins under this Contract. S. ELIGIBLE PERSON - a person entitled to apply to be a Subscriber as specified in the Schedule of Eligibility. 3 - x-24690/X-24691/X-24720 T. EXPERIMENTAL/INVESTIGATIVE - the use of any treatment, procedure, facility, equipment, drugs, devices, o@suppiies not yet recognized as accepted medical practice by the Plan and any of such items requiring federal or other governmental agency approval not granted at the time services were rendered. U. FAMILY COVERAGE - coverage for the Subscriber and one or more of the Subscriber's Dependents. V. HOME HEALTH CARE AGENCY - shall mean a Participating Provider Hospital or a certified home health facilit-y, either of which are listed as "contracting" with resoect to its Home Health Care Benefits program by the Plan. If located outside Virginia, the Home Health Care Agency may be listed as "contracting" or "participating" by any other Blue Cross plan. In either case, the agency must be listed as such at the time the Member receives the service for which coverage is sought. W. HOSPICE - a facility or agency duly licensed as a hospice by the state in which it operates. X. HOSPICE CONFINEMENT - A series of treatments rendered by a Hospice. A new Hospice Confinement will begin when 90 days without care rendered by a Hospice elapses. Y. HOSPITAL - a Provider that is a short term, acute, general or mental hospital which: is a duly licensed institution, for compensation from its patients, is primarily engaged in providing inpatient diagnostic and therapeutic services for the diagnosis, treatment, and care of injured and sick persons by or under the supervision ot Physicians, provides 24-hour nursing service by or under the supervision of registered graduate nurses, 4. is not other than incidentany a: a. skflled nursing facility, i7. nursing home, c. custodial care home, 'j. health resort, e. spa or sanitarium, place for rest, place for the aged, !I. place for the provision of hospice care, i. place for the treatment of pulmonary tuberculosis. The term Hospital shau also mean an Ambulatory Surgical Facility. 4 - X-24690/X-24691/X-24720 Z. INPATIENT - a Member who is treated as a registered bed patient in a Hospital or Other Facility Provider and for whom a room and board charge is made. AA. MEDICAL CARE - Professional services rendered by a Physician or Other ProfessionaFPr-ovider for the treatment of an illness, injury, or pregnancy-related condition. AB. MEDICALLY NECESSARY (or Medical Nece - the services or supplies provided by a Hospital, Physician, or Other Provider that are required to identify or treat a Member's illness, injury, or pregnancy-related condition and which, as determined by the Plan, are: 1. consistent with the symptom or diagnosis and treatment of the Member's condition, disease, ailment or injury; appropriate with regard to standards of good medical practice; 3. not solely for the convenience of a Member, Physician, Hospital or Other Provider; 4. the most appropriate supply or level of service which can be safely provided to the Member. When applied to the care of an Inpatient, it further means that the Member's medical symptoms or condition require that the services cannot be safely provided to the Member as an Outpatient or at a lesser level of institutional care. AC. MEDICARE - the programs of health care for the aged and disabled established by Title XVIII of the Social Security Act of 1965, as amended. AD. MEMBER - the Subscriber, and if Family Coverage is in force, the Subscriber's Dependents, but only to the extent that coverage for any such Subscriber or Dependent has been duly elected and is In force and for whom requisite payments hereunder are being made to the Plan. AE. MENTAL ILLNESS - an emotional or mental disorder which, according to generauy accepted medical professional standards, is susceptible to treatment. AF. OTHER PROVIDER - a person or entity other than a Hospital or Physician which is licensed to render Covered Services. Other Providers include: 1. OTHER FACILITY PROVIDER - an institution or entity only as listed: SkiUed Nursing Facility Substance Abuse @eatment Facuity Home Health Care Agency Hospice x-24690/X-24691/X-24720 2. OTHER PROFESSIONAL PROVIDER - a person or practitioner only as listed: Doctor of Osteopathy Doctor of Dental Surgery Doctor of Podiatry Doctor of Chiropody Optometrist Optician Psychologist Chiropractor Dentist Clinical Social Worker Professional Counselor AG. OUTPATIENT - a Member who receives services or supplies while not an Inpatient. AH. OUT-OF-POCKET EXPENSE - except as set forth in the Schedule of Benefits for Comprehensive liealth Care Benefits, the Deductibles and Co-payments for which a Member is responsible. AI. PHYSICIAN - a person who is a duly licensed Doctor of Medicine and legally entitled to Practice medicine in all its branches. AJ. PLAN'S REASONABLE CHARGE - the charge that the Plan determines is reasonable for Covered Services provided to a Member. AK. PRE-EXISTING CONDITION - this is a condition which displayed signs or symptoms before the MemEer's Effective Date, including, but not limited to, exacerbations or complications of such condition. The signs or symptoms referred to in the preceding sentence must be ones of which the Member was aware or should reasonably have been aware. A condition meeting the criteria set forth in this paragraph win be a Pre-existing Condition even though: 1. The condition was not correctly diagnosed before the Member's Effective Date, and 2. The Member was not treated for the condition before his Effective Date. AL. PROFESSIONAL COUNSELOR - a duly licensed professional counselor. AM. PROVIDER - a Hospital, Physician, or Other Provider, licensed where required, and performing within scope of license. 1. PARTICIPATING PROVIDER - a Provider which is listed as "participating" or "contracting" by the Plan. If located outside Virginia, an Other Facility Provider may be listed as "participating" or "contracting" by another Blue Cross plan. In either case, the Participating Provider must be listed as sucb at the time the Member receives the service for which coverage is sought. 6 - X-24690/X-24691/X-24720 2. NON-PARTICIPATING PROVIDER - a Provider that does not meet the definition of a Participating Provider. A N.. SKILLED NURSING FACILITY - an Other Facility Provider which is primarily engaged in providing skilled nursing and related services on an Inpatient basis to patients requiring convalescent and rehabilitative care. Such care is rendered by or under the supervision of Physicians. A SkiUed Nursing Facility is not, other than incidentally, a place that provides: 1. minimal care, custodial care, ambulatory care, or part-time care services, or 2. care or treatment of Mental Illness, alcoholism, drug abuse, or pulmonary tuberculosis. A Skilled Nursing Facility must be listed as "contracting" or "participating" with a Blue Cross plan at the time the Member is admitted into the facility. Within the State of Virginia, the contract must be with the Plan. No services by or through a Non-Participating or Non-Contracting SkiUed Nursing Facility wiU be provided under this Contract. AO. SUBSCRIBER - an Eligible Person who has satisfied the specifications of the Schedule of 'Eligibility and has enrolled for coverage. A P.. SUBSTANCE ABUSE TREATMENT FACILITY - an institution providing a continuous, structured, 24-hour per day program of Inpatient treatment and rehabilitation for drug dependence or alcoholism. A Substance Abuse Treatment Facility must be licensed to provide this type of care by the state in which it operates. Aa. SURGERY the performance of generaby accepted operative and cutting procedures including specialized instrumentations, endoscopic examinations, and other invasive procedures, 2. the correction of fractures and dislocations, 3. usual and related pre-operative and post-operative care, and other procedures as reasonably approved by the Plan. AR. THERAPY SERVICE - the following services or supplies ordered by a Physician or Other Professional Provider used for the treatment of an illness or injury to promote the recovery of the Member. Therapy Services are covered to the extent specified in the Schedule of Benefits and Benefits Sections. 1. RADIATION THERAPY The treatment of disease by x-ray, radium, or radioactive isotopes. 7 - X-24690/X-24691/X-24720 2. CliEMOTHERAPY The treatment of malignant disease by chemical or biolo.-ical antineoplastic agents. 3. DIALYSIS TREATMENTS The treatment of an acute renal failure or chronic irreversible renal insufficiency for removal of waste materials from the body. This includes hemodialysis and peritoneal dialysis. 4. PHYSICAL THERAPY The treatment by physical means, hydrotherapy, heat, or similar modalities, physical agents, bio-mechanical and neuro-physiolo.mical principles, and devices to relieve pain, restore maximum function, and prevent disability following disease, injury, or loss of a limb. S. RESPIRATION THERAPY Introduction of dry moist gases into the lungs to treat an illness or injury. 6. OCCUPATIONAL TIIERAPY Treatment of a pliysically disabled person by means of constructive activities designed and adapted to promote the restoration of the person's ability to accomplish satisfactorily the ordinary tasks of daily living and those required by the person's particular occupational role. 7. SPEECH THERAPY Treatment for the correction of a speech impairment resulting from disease, Surgery, injury, congenital and developmental anomaly, or previous therapeutic process. AS. USUAL, CUSTOMARY, AND REASONABLE CHARGE 1. USUAL CHARGE - the amount most consistently charged by an individual Physician or Other Professional Provider to patients for a given service. 2. CUSTOMARY CHARGE - a charge which falls within the range of Usual Charges for a given service biued by most Physicians or Other Professional Providers with similar training and experience within the Plan's operating area. 3. REASONABLE CHARGE - a charge which meets the Usual and Customary criteria, or which the Plan determines is reasonable in light of the complexity of treatment of the particular case. In aU cases, the Usual, Customary, and Reasonable Charge will be as determined by the Plan or by the Blue Cross or Blue Shield plan serving the area in which the service is rendered. Payment of this amount will discharge the Plan of any further liability for the service. 8 - X-24690/X-24691/X-24720 AT. VISIT - a brief period during which a Member meets with a Physician or another person whose services are covered under the Benefits Section with respect to which the term is used. 9 - X-24690/X-24691/X-24720 SECTION H - SCHEDULE OF ELIGIBILITY A. ELIGIBLE PERSON Eligible Person is defined as one of the following persons who is determined to be eligible for coverage under this Contract by the Contraet Holder- .1. an employee of the Contract Holder who works t least 20 hours per week; 2. a retired employee of the Contract Holder; or any other person represented by the Contract Holder, provided that prior written approval of that person's eligibility is obtained from the Plan. The date that a person becomes eligible shall be as determined by the Contract Holder. B. ELIGIBLE DEPENDENT Eligible "Dependents" are defined as: 1. the Subscriber's spouse, 2. the Subscriber's unmarried dependent children, including newborn children, step-children, legally adopted children, and other children who reside with the Subscriber in the normal parent-child relationship. The limiting age for enrolling unmarried dependent children is 19 years of a@.e. Coverage for the Subscriber's unmarried dependent child enroued under this Contract before a.ae 19 WiU terminate at the end of the Calendar Year in which such dependent child reaches age 19. 3. the Subscriber's unmarried dependent children 19 years of age or over who is incapable of self-support because of mental retardation, mental iuness, or physical incapacity which commenced prior to the child's attaining 19 years of age. The Plan may require a Physician's periodic certification as to the Member's disability. 4. the Subscriber's unmarried dependent child 19 years of age or over who is a fuU-time student, advance written notice of which fact has been furnished to the Plan by the Subscriber, provided, however, such student shan not be afforded coverage under this Contract if he attains age 23, ceases to be a fuU-time student, or marries, whichever event first occurs. However, if the fUU-time student becomes incapable of self-support because of mental retaroation, mental illness, or physical incapacity that commenced prior to the student's attaining 23 years of age, coverage shan continue. The Plan uses the definition for dependency provided in the ljnited States Internal Revenue Code and its regulations. Except as provided in Paragraph B.2. above, Dependent coverage will terminate at the end of the month in which the Dependent ceases to be eligible under this Contract. 10 - X-24690/X-24691/X-24720 C. TYPES OF COVERACE @pe 1: a. Benefits cover only Subscriber; or -5. Benefits cover only one Dependent of a Subscriber. Type 2: a. Benefits cover Subscriber and his Dependents; or -6. Benefits cover three or more Dependents of a Subscriber. Type 3: a. Benefits cover Subscriber and one Dependent who falls within a category defined in Paragraphs B.2., 11.1., or B.4. of this Section; or b. Benefits cover only two Dependents of a Subscriber. D. ELECTION OF COVERAGE A Subscriber may elect the Type of Coverage desired for himself, himself and his Dependent or Dependents, or his Dependent or Dependents , as the case may be, by completing and filing with the Plan through the Contract Holder an application approved by the Plan. E. COMMENCEMENT OF COVERAGE 1. For a Subscriber who elected coverage during the initial enroument period for the employees of the Contract Holder, coverage for himself and, if elected, his Dependents shan commence on the Contract Date. 2. For a Subscriber who becomes eligible subsequent to the initial enroument of emplgyees, and who elects coverage before or within thirty-one (31) days after becoming eligible therefor, coverage for himself and, if elected, his Dependents shah, if appropriate notice and remittance is made therefor, commence the first day of the month next following the date of such election. For the purposes of this Section, appropriate notice shall be deemed receipt by the Plan of a completed application. 3. For a Subscriber wbose Dependent or Dependents become eligible subsequent to the initial enrollment of employees, and who elects coverage for such Dependent or Dependents before, or within thirty-one (31) days after, such Dependent or Dependents become eligible, coverage for such Dependent or Dependents shall, if appropriate notice and remittance is made, commence the first day of the month next fouowing the month in which such Dependent or Dependents become eligible therefor. For the purposes of this Section, appropriate notice shall be deemed receipt by the Plan of a completed application. 4. A covered Subscriber who marries or otherwise becomes eligible for Type 2 coverage after the Effective Date of his coverage shau have a period of thirty-one (31) days after becoming eligible for such coverage within which to elect coverage for his Dependents. Coverage for such Dependents, if elected within the thirty-one (31) days, and if appropriate notice and remittance is X-24690/X-24691/X-24720 made, shall commence the first day of the month next following the date of such election. For the purposes of this Section, appropriate notice shall be deemed receipt by the Plan of a completed application. 5. A Subscriber with Type 1 coverage who becomes eligible for Type 3 covera@e after the Effective Date of his coverage shall have a period of thirty-one (3'1) days after becoming eligible for such coverage within which to elect coverage for his Dependent. Coverage for such Dependent, if elected within the thirty-one (31) days, and if appropriate notice and remittance is made therefor, shall commence the first day of the month next following the date of such election. For the purposes of this Section, appropriate notice shall be deemed receipt by the Plan of a completed application. 6. If a Subscriber does not elect available coverage before or within thirty-one (31) days after first becoming eligible therefor, coverage may be elected at any subsequent time, in which event, subject to approval by the Contract Holder, coverage shall commence the first day of the month next following the date of such election. 7. Additional Dependents of a Subscriber with Type 2 coveraa.e shall be covered from the date they first become Dependents. Additional newborn Dependents of a Subscriber with any other Type of Coverage which covers a Dependent of the Subscriber shall be covered for a period of thirty-one (31) days after birth but only for covered services rendered to such newborn Dependents for the treatment of an illness or injury. For coveral.e to continue beyond this thirty-one (31) day period, the Subscriber must properly elect Type 2 or Type 3 coverage pursuant to Paragraph E.4. or E.5. of this Section. 8. A Subscriber may change from @pe 2 or Type 3 coverage to Type 1 coverage, or from Type 2 covera.ae to Type 3 coverage, at any time by giving notice to the Contract Holder. Such change in coverage, unless prompted by a change in the Subscriber's marital status, shau become effective on the first day of the month fouowing receipt of notice by the Contract Holder. If such a change in coverage is prompted by a change in the Subscriber's marital status, it shau become effective on the first day of the month fouowing the date of the change in marital status, provided, however, that no change so prompted shall retroactively take effect more than three (3) months prior to receipt of notice by the Contract Holder. F. SPECIAL ELIGIBILITY PROVISIONS 1. The Contract Holder shall, at its sole discretion, determine which of its Members shau be eligible for coverage under Benefits Section V, Dental Benefits, only and shall notify the Plan as to this selection. 2. The Contract Holder shall, at its sole discretion, determine which of its Members shau be eligible for coverage under either Comprehensive Health Care Schedule of Benefits-A or Comprehensive Health Care Schedule of Benefits-B of this Contract and shall notify the Plan as to this selection. 12 - X-24690/X-24691/X-24720 SECTION Ill SCHEDULE OF BENEFITS - A for Comprehensive Health Care Benefits Subject to tbe Exclusions, conditions, and limitations of this Contract, a Member is entitled to benefits for Covered Services described in the Comprehensive Health Care Benefits Section during a Benefit Period, subject to the Deductible, if any, and in the amounts as specified in this Schedule of Benefits when the Covered Services are rendered by a Participating Provider. The allowance for Covered Services when rendered by a Non-Participating Provider is specified in the General Provisions. BENEFrr PERIOD Calendar Year DEDUCTIBLE $150 per Benefit Period per Member. FAMILY DEDUCTIBLE No more than 2 times the individual Deductible must be satisfied in each Benefit Period by Members enrolled under one Family Coveraa.e. If 2 or more Members under the same Family Coverage incur expenses for Covered Services as a result of injuries received in the same accident, only one Deductible will be applied to the aggregate of such charges. OUT-OF-PO'CKET LIMrr When a Member incurs $1,000 in Out-of-pocket Expenses in one Benefit Period, the Plan win pay that Member's Out-of-pocket Expenses for any other Covered Service he receives during the remainder of that Benefit Period. MAXIMUM $20,000,000 per lifetime per Member in the aggregate under this and aU other Plan major medical, comprehensive, or wraparound medical/surgical sections, articles, certificates, or contracts. 13 - X-24690/X-24691/X-24720 SECTION El (CONT'D) COVERED SERVICES AMOUNT INPATIENT HOSPITAL SERVICES 80% of the Allowable Char.me, no Deductible. Bed, Board, and General Nursing Services and Ancillary Services OUTPATIENT HOSPrrAL SERVICES 80% of the Allowable Char.@e except as otherwise indicated below. Emergency Accident Care 80% of the AUowable Charge, no Deductible. EmergencX Medical Care Sur@ery Pre-Admission Testing 100% of the Allowable Charge, no Deductible. SURGICAL/MEDICAL SERVICES 80% of the Allowable Charge except as otherwise indicated below. Inpatient Surgery Outpatient Surgery Inpatient Medical Services Outpatient Medical Services OUTPATIENT DIAGNOSTIC SERVICES 80% of the Allowable Charge. Radiolo.-y, Ultrasound, and Nuclear Medicine Laboratory and Pathology ECG, EEG, and Other Electronic Diagnostic Medical Procedures OUTPATIENT THERAPY SERVICES 80% of the ARowable Charge. Radiation Therapy Chemotherapy Dialysis Treatment Physical Therapy Respiration Therapy Occupational Therapy Speech Therapy 14 - X-24690/X-24691/X-24720 SECTION Ill (CONTD) MATERNITY CARE SERVICES Same as Inpatient and Outpatient Tiospital Services and Surpical/Medical Services. ELECTIVE ABORTION Same as Inpatient and Outpatient Hospital Services and Surgical/Medical Services. PSYCHIATRIC CARE SERVICES Inpatient Facility Services Same as Inpatient Hospital Services except that benefits are limited to 30 days of Inpatient care per Benefit Period for the treatment and rehabilitation of dru.a abuse and alcoholism. Inpatient Medical Services Same as Inpatient Medical Services except that benefits are limited to 30 days of Inpatient Medical Care per Benefit Period for the treatment and rehabilitation of drug abuse and alcoholism. Outpatient Psychiatric Services 80% of the Allowable Charge. AMBULANCE SERVICES 80% of the Allowable Charge. PRIVATE DUTY NURSING SERVICES 80% of the AUowable Charge. SKILLED NURSING FACILITY SERVICES 80% of the ABowable Charge, but limited to $65.00 per day. HOME HEALTH CARE SERVICES 80% of the ARowable Charge, no Deductible. DENTAL SERVICES RELATED TO ACCIDENTAL INJURY 80% of the Allowable Charge. PRESCRIPTION DRUGS 80% of the AUowable Charge. DURABLE MEDICAL EQUIPMENT 80% of the AUowable Charge. PROSTHETIC APPLIANCES 80% of the AUowable Charge. ORTHOTIC DEVICES 80% of the AUowable Charge. EYEGLASSES AND CONTACT LENSES 80% of the ARowable Charge. MEDICAL SUPPLIES 80% of the Allowable Charge. 15- X-24690/X-24691/X-24720 SECTION III (CONT'D) HOSPICE CARE Inpatient Hospice Care 80% of the AUowable Charae, up to $150.00 per day and $3,000 per Hospice Confinement. Outpatient Hospice Care 80% of the Allowable Charge, up to $2,000 per Hospice Confinement. Bereavement Counseling 80% of the Allowable Charge up to $200 per Hospice Confinement. SPECIAL EXCEPTIONS 1. Covered Services rendered in a 100% of the Allowable Charge, Physician's or Other Professional no Deductible. Provider's office or Ambulatory Surgical Facility for an accidental injury. 2. Covered Services rendered on an 80% of the AUowable Char.@e, Outpatient basis for a medical no Deductible. emergency, as determined by the Plan. 3. Covered Services rendered on the 100% of the AUowable Char.ae, same day as and in connection with no Deductible. Outpatient Surgery. 4. Medical Care for the purpose of 100% of the AUowable Charge, obtaining a second or third no Deductible. surgical opinion when a Physician has recommended an elective surgical procedure. 5. Surgical procedures listed on 40% of the Allowable Charge, 100% Annex B (a) when a second surgical of the AUowable Charge with no opinion by a qualified Physician Deductible if Surgery is rendered was not obtained prior to Surgery, on an Outpatient basis. The 60% or (b) when neither a second nor Co-payment shall not be an a third surgical opinion confirms Out-of-pocket Expense. the need for such Surgery. 16 - X-24690/X-24691/X-24720 SECTION Ill (CONT'D) SPECIAL EXCLUSIONS 1. If a Member is admitted to a Hospital or Substance Abuse Treatment Facility on a Friday or Saturday and the Plan determines that the admission was not the result of: a. a medical emergency; b. an accidental injury occurring within 48 hours of the admission; c. a surgical procedure to be performed within the first two days of the admission; d. obstetrics; or e. medical necessity, in tbe sole discretion of the Plan, when supported by a statement from the attending physician, then the admission will not be a Covered Service under this Contract. 17- X-24690/X-24691/X-24720 SECTION Hi SCliEDULE OF BENEFITS - B for Comprehensive ijealth Care Benefits Subject to the Exclusions, conditions, and limitations of this Contract, a Member is entitled to benefits for Covered Services described in the Comprehensive ijealth Care Benefits Section during a Benefit Period, subject to the Deductible, if any, and in the amounts as specified in this Schedule of Benefits whe, the Covered Services are rendered by a Participating Provider. The allowance for Covered Services when rendered by a Non-Participating Provider is specified in the General Provisions. BENEFIT PERIOD Calendar Year DEDUCTIBLE $500 per Benefit Period per Member. FAMTLY DEDUCTIBLE No more than 2 times the individual Deductible must be satisfied in each Benefit Period by Members enroued under one Family Covorage. If 2 or more Members under the same Family Coverage incur expenses for Covered Services as a result of injuries received in the same accident, only one Deductible will be applied to the aggregate of such charges. OUT-OF-PO CKET LIMrr When a Member incurs $5,000 in Out-of-pocket Expenses in one Benefit Period, the Plan WiU pay that Member's Out-of-pocket Expenses for any other Covered Service he receives during the remainder of that Benefit Period. Out-of-pocket Expenses shall not include any expense incurred for Outpatient Psychiatric Care Services. FAMILY OUT-OF-POCKET LIMIT When Members under the same Family Coverage have incurred a total of $15,000 in Out-of-pocket Expenses in one Benefit Period, the Plan will pay the Out-of-pocket Expenses for any other Covered Service received by any Member enrolled under that same Family Coverage during the remainder of that Benefit Period. - 18 - X-24690/X-24691/X-24720 SECTION Ill (CONT'D) MAXT,MUM $20,000,000 per lifetime per Member in the ago.,regate under this and au other Plan major medical, comprehensive, or wraparound medical/surgical sections, articles, certificates, or contracts. COVERED SERVICES AMOUNT INPATIENT HOSPITAL SERVICES 8096 of the Allowable Chara.e. Bed, Board, and General Nursing Services and Ancillary Services OUTPATIENT HOSPITAL SERVICES 80% of the Allowable Charge except as otherwise indicated below. Emergency Accident Care Emergency Medical Care Surgery Pre-Admission Testing SURGICAL/MEDICAL SERVICES 80% of the Allowable Charge except as otherwise indicated below. InPatient Surgery Outpatient Surgery Inpatient Medical Services Outpatient Medical Services OUTPATIENT DIAGNOSTIC SERVICES 80% of the Allowable Charge. Radiology, Ultrasound, and Nuclear Medicine Laboratory and Pathology ECG, EEG, and Other Electronic Diagnostic Medical Procedures 19 - X-24690/X-24691/X-24720 SECTION Ill (CONT'D) OUTPATIENT THERAPY SERVICES 80% of the AHowable Char.@e. Radiation Therapy Chemotherapy Dialysis Treatment Physical Therapy Respiration Therapy Occupational Therapy Speech Therapy MATERNITY CARE SERVICES Same as Inpatient and Outpatient Hospital Services and Surgical/Medical Services. ELECTIVE ABORTION Same as Inpatient and Outpatient Hospital Services and Surgical/Medical Services. PSYCHIATRIC CARE SERVICES Inpatient Facuity Services Same as Inpatient Hospital Services except that benefits are limited to 30 days of Inpatient care per Benefit Period. Inpatient Medical Services Same as Inpatient Medical Services except that benefits are limited to 30 days of Inpatient Medical Care per Benefit Period. Outpatient Psychiatric Services 50% of the AUowable Charge. Benefits are limited to $500 per Benefit Period. AMBULANCE SERVICES 80% of the AUowable Charge. PRIVATE DUTY NURSING SERVICES 80% of the AHowable Charge. SKILLED NURSING FACILITY SERVICES 80% of the AHowable Charge, but limited to $65.00 per day. HOME HEALTH CARE SERVICES 80% of the AUowable Charge, no Deductible. DENTAL SERVICES RELATED TO ACCIDENTAL INJURY 80% of the AUowable Charge. PRESCRIPTION DRUGS 80% of the AUowable Charge. 20 - X-24690/X-24691/X-24720 SECTION M (CONT'D) DURABLE MEDICAL EQUIP-MENT 80% of the Allowable Charge. PROSTHETIC APPLIANCES 80% of the Alloivable Charge. ORTHOTIC DEVICES 80% of the Allowable Char.@e. EYEGLASSES AND CONTACT LENSES 80% of the Allowable Charge. MEDICAL SUPPLIES 80% of the AUowable Char@e. HOSPICE CARE Inpatient Hospice Care 80% of the AUowable Charae, up to $150.00 per day and $3,000 per Hospice Confinement. Outpatient Hospice Care 80% of the Allowable Char.@e, up to $2,000 per Hospice Confinement. Bereavement Counseling 80% of the AUowable Charge up to $200 per Hospice Confinement. SPECIAL EXCEPTIONS 1. Medical Care for the purpose of 100% of the Allowable Char.@e, obtaining a second or third no Deductible. surgical opinion wben a Physician has recommended an elective SUrgical procedure. 2. Surgical procedures listed on 40% of the Allowable Charge, 80% Annex B (a) when a second surgical of the Allowable Charge if Surgery opinion by a qualified Physician is rendered on an Outpatient basis. was not obtained prior to Surgery, The 60% Co-payment shau not be an or (b) when neither a second nor Out-of-pocket Expense. a third surgical opinion confirms the need for such Surgery. SPECIAL EXCLUSIONS 1. If a Member is admitted to a Hospital or Substance Abuse 'fteatment Facility on a Friday or Saturday and the Plan determines that the admission was not the result of: a. a medical emergency; b. an accidental injury occurring within 48 hours of the admission; c. a surgical procedure to be performed within the first two days of the admission; 21- X-24690/X-24691/X-24720 d. obstetrics; or e. medical necessity, in the sole discretion of the Plan, when supported by a statement from the attending physician, then the admission will not be a Covered Service under this Contract. 22 - X-24690/X-24691/X-24720 SECTION Ill (CONT'D) SCHEDULE OF BENEFITS for Dental Benefits Subject to the Exclusions, conditions, and limitations of this Contract, a Member is entitled to benefits for Covered Services described in the Dental Benefits Section during a Benefit Period, subject to the Deductible, if any, and the amounts as specified in this Schedule of Benefits when the Covered Services are rendered by a Participating Provider. The allowance for Covered Services when rendered by a Non-Participating Provider is specified in the General Provisions. BENEFIT PERIOD Calendar Year MAXIMUM $1,000 Per Benefit Period. COVERED SERVICES AMOUNT DIAGNOSTIC AND PREVENTIVE 100% of Usual, Customary, and SERVICES Reasonable Charge. PRIMARY SERVICES 70% of Usual, Customary, and Reasonable Charge for Covered Maintenance Services Services listed. Oral Surgical Services Periodontic Services PROSTHETIC AND COMPLEX 50% of Usual, Customary, and RESTORATIVE SERVICES and Reasonable Charge for Covered Complex Restorative Services Services listed. Dentures, Partials and Bridges Denture Adjustments and Relining Fixed Bridge Repairs 23 - X-24690/X-24691/X-24720 SEC"ON Ill (CONT'D) LI,MITATIONS ON FREQUENCY OR AGE DIAGNOSTIC AND PREVENTIVE 2 of each of the following per SERVICES Benefit Period: * oral exams, * bitewing x-rays, * topical fluoride applications, * pulp vitality tests. One fuU mouth x-ray every 3 years. Benefits for fluoride applications and space maintainers are available only to Members under age 19. PROSTHETIC AND COMPLEX Plan must approve permanent crowns RESTORATIVE SERVICES for Members under age 16. RePlacement of prosthetic appliance once every 5 years under this Contract. PREDETERMINATION Predetermination is required for a Course of @eatment involving inlays, onlays, crowns, complete or partial dentures, fixed bridges, extractions of six or more teeth, Periodontics, or any tooth moving appliance if covered under this Contract. 24 - x-24690/X-24691/X-24720 SECTION IV - COMPREHENSIVE HEALTH CARE BENEFITS Subject to tbe Exclusions, conditions, and limitations of this Contract, a Member is entitled to the benefits of this Benefits Section for services rendered by a Hospital, Physician or Other Provider in the amounts specified in the Schedule of Benefits. lbe benefits of this Benefits Section will be provided only to the extent not provided under under any other Benefits Section of this Contract. Expenses incurred for Covered Services in the last 3 months of a Benefit Period which were applied to that Benefit Period's Deductible wiU be applied to the Deductible of the next Benefit Period. If the Group changes carriers during a Member's Benefit Period, expenses incurred by that Member during the last partial Benefit Period for services covered by the prior carrier will be applied to the Deductible of the initial Benefit Period under this Contract. The following are Covered Services: A. HOSPrrAL SERVICES BED, BOARD, AND GENERAL NURSING SERVICE Bed, board, and general nursing service when a Member is an Inpatient in: a. a room with two or more beds. A private room, but only to the extent of the Hospital's most common charge for its semi-private rooms plus $5.00 (except that if a Member is admitted to a Hospital where all the rooms are private, the daily benefit wiU not exceed the average semi-private room charge for other Hospitals in the community). c. a bed in a Special Care Unit - a designated unit which has concentrated aU facilities, equipment, and supportive services for the provision of an intensive level of care of criticauy Ul Inpatients. 2. ANCILLARY SERVICES Hospital services and supplies including, but not restricted to: a. use of operating, delivery and treatment rooms; !I. prescribed drugs; c. whole blood, administration of blood, and blood processing; anesthesia, anesthesia supplies and services rendered by an employee of the Hospital or Other Facility Provider; e. medical and surgical dressings, supplies, casts, and splints; T Diagnostic Services; and j. Therapy Services. 3. EMERGENCY ACCIDENT CARE Hospital services and supplies for the Outpatient emergency treatment of traumatic bodily injuries resulting from an accident. 25 - X-24690/X-24691/X-24720 4. EMERGENCY MEDICAL CARE Hospital services and supplies for the Outpatient emergency treatment of a sudden onset of a medical condition manifesting itself by acute symptoms that require immediate medical attention. 5. SURGERY Hospital services and supplies for Outpatient Surgtry including removal of sutures, anesthesia, anesthesia supplies and services rendered by an employee of the Hospital or Other Facility Provider other than the surgeon or assistant at surgery. 6. PRE-ADMISSION TESTING Tests and studies required in connection with the Member's admission rendered or accepted by a Hospital on an Outpatient basis within 10 days prior to a scheduled admission to the Hospital as an Inpatient. B. SURGICAL/MEDIC@L SERVICES 1. SURGICAL SERVICES Surgery (1). Surgery performed by a Physician or Other Professional Provider. Separate payment wiU not be made for pre- and post-operative services. (2). If more than one surgical procedure is performed during the same operation, the total benefits payable wiU be calculated as fouows: (a) the amount payable for the primary procedure, plus (b) 50 percent of the amount that would have been payable for each of the next three procedures had those procedures been performed alone. No additional benefits are payable for more than four procedures performed during one operation. Special Surgery (1). Sterilization Sterilization and procedures to reverse sterilization regardless of their Medical Necessity. (2). Oral Surgery Oral Surgery for the fouowing: @a) Surgical removal of fuU bony impactions, 26 - X-24690/X-24691/X-24720 (b) mandibular staple implant provided the procedure is not done in preparation of the mouth for dentures, (c) maxillary or mandibular frenectorny, (d) Alveolectomy when related to tooth extraction, and (e) Orthognathic surgery in the presence of severe handicapping malocculusion with proper docurnentation. C. Assistant At Surgery Services of a Physician who actively assists the operating surgeon in the Performance of covered Surgery. d. Anestbesia Administration of anesthesia ordered by the attending Physician and rendered by a Physician or Other Professional Provider other than the surgeon or assistant at surgery. 2. INPATIENT MEDICAL SERVICES Medical Care by a Physician or Other Professional Provider to a Member b, is a Hospital inpatient for a condition not related to Surgery, pregnancy, or Mental IUness, except as specifically provided. Inpatient Medical Care Visits b. Intensive Medical Care Medical Care rendered to a Member wbose condition requires a Physician's constant attendance and treatment for a prolonged period of time. c. Concurrent Care (1). Medical Care rendered concurrently with Surgery during one Hospital stay by a Physician otber than the operating surgeon for treatment of a medical condition separate from the condition for which Surgery was performed. (2). Medical Care by two or more Physicians rendered concurrently during one Hospital stay when the nature or severity of the Member's condition requires the skills of separate Physicians. d. Consultation Consultation services rendered to a Hospital Inpatient by another Physician at the request of the attending Physician. Consultation does not include staff consultations which are required by Hospital rules and reg,ulations. e. Newborn Care The initial Inpatient Visit to examine the newborn. 27 - X-24690/X-24691/X-24720 3. OUTPATIENT MEDICAL SERVICES Medical Care rendered by a Physician or Other Professional Provider to a Member who is an Outpatient for a ,nditi,n not related to Surgery, pregnancy, or Mental rllness, except as specifically provided. a. Emergency Accident Care Medical Care for the emergency treatment of traumatic bodily injuries resultin.a from an accident. b. Emerfrency Medical Care Medical Care for emergency treatment of a sudden onset of a medical condition manifesting itself by acute symptoms that require immediate attention. c. Home, Office and Other Outpatient Visits Medical Care Visits and consultation for the examination, diagnosis, and treatment of an injury or illness. C. OUTPATIENT DIAGNOSTIC SERVICES The fouowing Diagnostic Services which are rendered on an Outpatient basis: 1. Radioloay, Ultrasound and Nuclear Medicine 2. Laboratory and Pathology 3. tCG, EEG, and Other Electronic Diagnostic Medical Procedures D. OUTPATIENT THERAPY SERVICES 7be fouowing Therapy Services wbich are rendered on an Outpatient basis: 1. Radiation Therapy 2. Chemotherapy 3. Dialysis Treatment 4. Physical Therapy 5. Respiration Therapy 6. Occupational Therapy 1. Speech Therapy Under this Paragraph D., any one of the last four Therapy Services may be furnished and billed For by a therapist or therapists appropriately licensed, certified, or otherwise qualified (as determined by the Plan) to render such 28 - X-24690/X-24691/X-24720 service(s), provided however, that the Therapy Service is prescribed by a Physician or Other Professional Provider licensed to do so. E. MATERNITY SERVI(-,ES Hospital Services and Surgical/Medical Services rendered by a Hospital, Physician or Other Provider for: 1. NORMAL PREGNANCY Normal pregnancy includes any condition usually associated with tbe management of a difficult pregnancy but is not considered a complication of pregnancy. 2. COMPLICATIONS OF PREGNANCY Physical effects directly caused by pregnancy but which are not considered from a medical viewpoint to be the effect of normal pregnancy, including conditions related to ectopic pregnancy or those that require cesarean section. 3. INTERRUPTIONS OF PREGNANCY a. Miscarriaa.e b. Therapeutic Abortion 4. NURSERY CARE Ordinary nursery care of the newborn infant. 5. PRE-NATAL AND POST-NATAL CARE Pre-i)atal and post-natal care of the mother but only if the mother is eligible to receive Maternity Services under this Benefits Section at the time the pre- and post-natal care is rendered. Benefits are not provided for Maternity Services for Dependent children. P. ELECTIVE ABORTION Hospital Services and Surgical/Medical Services provided for Elective Abortion by a Hospital, Physician or Other Provider. Benefits are not provided for Elective Abortion for Dependent children. G. PSYCHIATRIC CARE SERVICES 1. INPATIENT FACILITY SERVICES Hospital Services provided for the Inpatient treatment of Mental Ulness by a Hospital or Other Facility Provider. 29 - X-24690/X-24691/X-24720 2. INPATIENT MEDICAL SERVICES The fouowing services provided for the Inpatient treatment of Mental Ulness by a Physician or Other Professional Provider: a. Individual Psychotherapy b. Group Psychotherapy L. Psychological Testin.a d. Family Counseling Counseling with family members to assist in the Member patient's diagnosis and treatment. e. Convulsive Therapy @eatment Electroshock treatment or convulsive dru@ therapy including anestbesia when administered concurrently with the tr'eatment by the same Physician or Professional Provider. 3. OUTPATIENT PSYCHIATRIC CARE SERVICES for the Covered Inpatient Facility and Medical Services hen provided Outpatient treatment of Mental Illness by a Hospital, Physician or Other Provider. 4. DRUG ABUSE AND ALCOHOLISM The benefits for the treatment of Mental luness are also provided for the treatment of drug abuse and alcoholism. H. AMBULANCE SERVICE Professional ambulance service providing local transportation by means of a specially designed and equipped vehicle used only for transporting the sick and injured: a. from a Member's home or scene of accident or medical emergency to a Hospital, b. between Hospitals, between a Hospital and Skilled Nursing Facility, when the Hospital or Skilled Nursing Facility to which the Member is transported the closest one which can provide Covered Services appropriate to the Member's condition. If there is no Hospital or SkiUed Nursing Facility in the local area that can then provide Covered Services appropriate to the Member's condition, Ambulance Service includes transportation to the closest Hospital or SkiUed Nursing Facility outside the local area that can provide the necessary service. 1. PRIVATE DUTY NURSING SERVICES Private Duty Nursing Services of an actively practicing Registered Nurse (RN) or Licensed Practical Nurse (LPN) when ordered by a Physician. -30- X-24690/X-24G91/X-24720 1. INPATIENT SERVICES Nursing services that the Plan determines are of such a nattire or degree of complexity or quantity that they could not be or are not usually provided by the regular nursina. staff of the Provider. 2. HOME SERVICES Nursing services that the Plan determines require the skills of an RN or LPN. No benefits will be provided for the services of a nurse who ordinarily resides in the Member's home or is a member of the Member's immediate family. J. SKILLED NURSING FACILITY SERVICES Hospital Services provided to an Inpatient of a Skilled Nursing Facility. Surgical/Medical Services provided to an Inpatient of a SkiUed Nursin@. Facility. 3. No benefits are payable: a. after the Member has reached the maximum level of recovery possible for his or her particular condition and no longer requires definitive treatment other than routine supportive care; b. when confinement in a Skilled Nursing Facility is intended solely to assist the Member with the activities of daily living or to provide an institutional environment for the convenience of a Member; c. for the treatment of alcoholism, drug addiction or Mental alness. K. HOME HEALTH CARE SERVICES The fquowing services provided to an essentiauy homebound Member by a Hospital progratn for Home Health Care or Community Home Health Care Agency: 1. Professional services of an RN or LPN. .1. Physical therapy, occupational therapy and speech therapy. 3. Medical and surgical supplies provided by the Home Health Care Provider. 4. Prescribed drugs. Oxygen and its administration. 6. Medical social services consultations. 7. Health aide services to a Member who is receiving covered nursing or therapy services. Home Health Care benefits will be provided only wben prescribed by the Member's attending Physician. The attending Physician must file with the Plan the Member's 31 - X-24690/X-24691/X-24720 plan of treatment on a form acceptable to the Plan. The Plan must approve Home Health Care Services for payment before these services are rendered. The Member must be essentially confined at home and Home Health Care Services must be rendered for treatment of the same illness, injury, or pre,.nancy-related condition for which the Member was in the Hospital or Other Facility Provider. No Home Health Care benefits wiU be provided for: 1. bomemaker services. 2. maintenance therapy. dialysis treatment. purchase or rental of dialysis equipment. 5. food or home delivered meals. L. DENTAL SERVICES RELATED TO ACCIDENTAL INJURY Dental services rendered by a Physician or Dentist which are required as a result of accidental injury to the jaws, sound natural teeth, mouth or face occurring on or after the @Member's Effective Date. Injury as a result of chewing or biting shall not be considered an accidental injury. tM. PRESCRIPTION DRUGS Injectable insulin and drugs that under federal law may only be dispensed by written prescription and which are approved for general use by the United States Food and Drug Administration. The drugs must be dispensed on or after the Member's Effective Date by a licensed pharmacy for the Outpatient use of the Member. N. DURABLE MEDICAL EQUIPMENT The rental (but not to exceed the total cost of purchase) or, at the option of the Plan, the purchase of durable medical equipment when prescribed by a Physician or Other Professional Provider and required for therapeutic use. 1. Durable medical equipment consists of, but is not restricted to, the following- a. Renal Dialysis, b. Hospital-type beds, c. Traction equipment, d. Wheelchairs, and e. Walkers. 32 - X-24690/X-24691/X-24720 2. The fohowing items will not be Covered Services: a. Exercise equipment, b. Air conditioners, c. Dehumidifiers, d. Whirlpool baths, and e. Other equipment which has both a non-therapeutic and therapeutic use. 0. PROSTHETIC APPT,IANCES Purchase, fitting, necessary adjustments, repairs, and replacements of prosthetic devices and supplies wbich replace all or part of an absent body organ (including contiguous tissue) or replace all or part of the function of a permanently inoperative or malfunctioning body organ (excluding dental appliances). P. ORTHOTIC DEVICES A rigid or semi-rigid supportive device which restricts or eliminates motion of a weak or diseased body part. _q. EYEGLASSES AND CONTACT LENSES The purchase and fitting of a Member's eyeglasses or contact lenses is a Covered Service only under the following circumstances: a. When the eyeglasses or contact lenses are prescribed to replace human lenses lost as the result of intra-ocular surgery or injury to the eye; b. When "Pinholell glasses are prescribed for use after surgery for a detached retina; and c. When lenses are prescribed instead of surgery in the fouowing situations: (1). Contact lenses used for the treatment of infantile glaucoma; (2). Corneal or scleral lenses prescribed in connection with keratonconus; (3). Scleral lenses prescribed to retain moisture when normal tearing is not possible or is not adequate; and (4). Corneal or scleral lenses required to reduce a corneal irregularity (other than astigmatism). 2. A maximum of one set of eyeglasses or one set of contact lenses will be a Covered Service for the original prescription or for any change in the original prescription. Services for examination and replacement of these eyeglasses or contact lenses wiU be covered 2rovided the prescription change is related to the condition which required the original prescription. 33 - X-24690/X-24691/X-24720 R. MEDICAL SUPPLIES Medical supplies prescribed by the Member's attending Physician are Covered Services. Medical supplies consist of, but are not restricted to, the followin-.: .L. Syringes and needles required by the Member's medical condition; 2. SterUe dressing for burns and cancer; 3. Catheters; 4. Colostomy bags and related medical supplies; and .1. Oxygen and equipment for its administration. S. HOSPICE CARE 1. The services listed in Paragraph A., Hospital Services, and Paragraph I(-., Home Health Care Services, of this Benefits Section which are rendered by WHospice on an inpatient or outpatient basis. 2. Bereavement counseling sessions for members of the Member's immediate family and other individuals with significant personal ties to the Member which are rendered by a liospice. 34- X-24690/X-246911X-24720 SECnON V - DENTAL BENEFITS Subject to the Exclusions, conditions, and limitations of this Contract, a Member is entitled to the benefits of this Benefits Section for services rendered by a Dentist or Other Professional Provider in the amounts specified in the Schedule of Benefits. However, any limitation or exclusion of benefits for Pre-existing Conditions shan not apply to the benefits provided under this Benefits Section. A. DEFINITTONS Course of Treatment Any number of procedures or treatments performed by a Dentist in a planned series resultin@ from an examination in which the need for such procedures or treatments was determined. B. COVERED SE-RVICES Diagnostic and Preventive Services consisting of: a. Initial oral examination and periodic oral examinations, subject to the Limitations on Frequency or Age as specified in the Schedule of Benefits. b. Dental x-rays. One fuU mouth x-ray and one additional set of bitewin@ x-rays subject to the Limitations on Frequency or Age as specified in the Schedule of Benefits. c. Prophylaxis, subject to the Limitations on Frequency or Age as specified in the Schedule of Benefits. Topical fluoride application, subject to the Limitation on Frequency or Age as specified in the Schedule of Benefits. e. PaHiative emergency treatment and emergency oral examinations not including permanent restorations or services. Space maintainers up to the age specified in the Schedule of Benefits. Biopsies of the oral tissue when a biopsy report is submitted. h. Pulp vitality tests, subject to the Limitations on Frequency or Age as specified in the Schedule of Benefits. Primary Services consisting of: Maintenance Services limited to: (1) Fillings (2) Endodontics (3) Repair of removable dentures 35- X-24690/X-24691/X-24720 (4) Recementing of crowns, inlays, and/or bridges (5) Stainless steel crowns (6) Visits by a Dentist to a Member's home when Medically Necessary in order to render a covered dental service. b. Oral Surgical Services when not covered under basic Contract are limited to: (1) Simple extractions (2) Oral Sur.@ery including surgical removal of teeth and maxillary or mandibular intrabony cysts and procedures performed for the preparation of the moutb for dentures. (3) Apicectony (4) Hemisection (5) General anesthesia administered in connection with a covered dental service only if administered by an individual licensed to administer general anestliesia. c. Periodontics limited to: (1) Gingivectomy and gingivoplasty (2) Gingival curettage (3) Osseous surgery, including flap entry and closure (4) Mucogingivoplastic surgery (5) Periodontal scaling and root planing 3. Prosthetic and Complex Restorative Services consisting of: a. Complex Restorative Services (1) Inlays (not part of bridge) (2) Onlays (not part of bridge) (3) Crown (not part of bridge). However, benefits will not be provided for the replacement of a defective or lost crown inserted after the Member's Effective Date until the number of years specified in the Schedule of Benefits has elapsed. b. Dentures, fuU and partial, and fixed bridges, subject to the following: (1) Benefits will not be provided for any appliance replacement inserted after the Member's Effective Date until the number of years specified in the Schedule of Benefits has elapsed or for dentures or bridges which are able to be made serviceable; and 36 - X-24690/X-24691/X-24720 (2) Benefits will be limited to the standard procedures for prosthetic services and wiU not be provided for personalized restorations or specialized techniques in the construction of dentures or bridges. c. Denture Adjustments and ReliniTi.@. Benefits for denture adjustments are limited to services rendered during the number of months following denture placements as specified in the Schedule of Benefits. d. Fixed Bridge Repairs C. SPECIAL EXCLUSIONS AND LIMITATIONS 1. Care Rendered By More Than One Dentist In the event a Member transfers from the care of one Dentist to another Dentist during the Course of Treatment, or if more than one Dentist renders services for one dental procedure, the Plan wiU be liable for no more than the amount for which it would have been liable had but one Dentist rendered the service. 2. Alternate Course of Treatment In all cases involving services in which the Dentist or the Member select a Course of Treatment, benefits wiU be based on the procedure that is consistent with sound professional standards of dental practice for the dental condition concerned and which carries the lesser fee. 3. Predetermination of Benefits Subject to the requirements specified in the Schedule of Benefits, a written report prepared by a Dentist showing the planned treatment of a Member, and an estimate of the Dentist's charges, must be submitted to the Plan prior to the commencement of a Course of Treatment. Copies of X-rays, photographs, aild models must also be furnished to the Plan, if requested. The Plan will review the report and such other materials submitted for review, taking into consideration alternative Courses of Treatment, and will notify the Member and the Dentist of the benefits which wiU be provided under this Benefits Section. 4. Exclusions No benefits will be provided under Dental Benefits for: a. Dental services with respect to congenital or developmental malformation or primarily for cosmetic or anesthetic purposes except as specified in this Benefits Section. Appliances or restorations necessary to increase vertical dimensions or restore or correct the occlusion. c. Gold foil restorations. 37 - X-24690/X-24691/X-24720 SEC'MON VI - EXCLUSIONS No benefits wiU be provided for services or SUpplies: 1. Which are not prescribed by or performed by or upon the direction of a Physician or Other Professional Provider; 2. Which are not Medically Necessary, as determined by the Plan in its sole discretion; 3. Rendered by other than Hospitals, Physicians, and Other Providers; 4. Which are Experimental/Investigative in nature; For any illness or bodily injury which occurs in the course of employment if benefits or compensation are available, in whole or in part, under the provisions of any legislation of any governmental unit. This exclusion applies whether or not the Member claims the benefits or compensation and whether or not the Member recovers losses from a third party. 6. To the extent benefits are provided by any governmental unit; For any illness or injury suffered after the Member's Effective Date as a result of any act of war; 8. For which a Member would have no legal obligation to pay in the absence of this or any simuar coverage; 9. Received from a dental or medical department maintained by or on behalf of an employer, a mutual association, labor union, trust, or similar person or group; 10. Surgery intended solely to improve appearance, but not to restore bodily function or correct deformity resulting from disease, trauma, congenital or developmental anomalies, or previous therapeutic processes; 11. Rendered by a Provider who is a member of the Member's immediate family; 12. Rendered prior to the Member's Effective Date or during an Inpatient admission that commenced prior to the Member's Effective Date; 13. Incurred after the date of termination of the Member's coverage except as provided in the General Provisions Section; 14. For personal hygiene and convenience items such as, but not limited to, air conditioners, humidifiers, or physical fitness equipment; 15. For telephone consultations, charges for failure to keep a scheduled visit, or charges for completion of a claim form; 16. For Inpatient admissions which are primarily for observation or diagnostic studies; 17. For Custodial Care, residential care, or rest cures; 18. For palliative or cosmetic foot care including flat foot conditions, supportive devices for the foot, the treatment of subluxations of the foot, care of eorns, 38- X-24690/X-24691/X-24720 bunions (except capsular or bone surgery), calluses, toe nails, fallen arches, weak feet, chronic foot strain, and symptomatic complaints of the fect; 19. For routine or periodic physical examinations, screening examinations (including x-ray examinations made without film), immunizations, and other care not related to a specific illness, injury, or pregnancy-related condition whicti is known or reasonably suspected; 20. For dentistry or dental processes, except as provided in Sections IV or V; 11. For eyeglasses or contact lenses and the vision examination for prescribing or fitting eyeglasses or contact lenses except as provided in Section IV; 12. For hearing aids or examinations for the prescription or fitting of hearing aids; 13. For liospital admissions which are primarily for physical therapy which could have been rendered on an outpatient basis; 14. For any treatment leading to or in connection with transsexual sur,.ery; 25. To the extent payment has been made under Medicare or would have been made if a Member had applied for Medicare and claimed Medicare benefits; 26. Which are for conditions related to autistic disease of childhood, hyperkinetic syndromes, learning disabilities, behavioral problems, mental retardation, or for bospitalization for environmental change; 27. Care by interns, residents, or house physicians for which a separate charge is made; 28. Services for pregnancy or a pregnancy-related condition provided to Dependent chUdren; 29. For treatment of obesity, except for surgical treatment of morbid obesity when weight is at least twice the ideal weight specified for frame, age, height, and sex in the most recent Metropolitan Life imurance tables; 30. For treatment of sexual dysfunction not related to organic disease; 31. Services for radial keratotomy, a surgical procedure to correct myopia; and 32. Which are services rendered during the first 12 months of a Member's enronment for a Pre-existing Condition. This exclusion does not apply: a. to an infant who has been covered under this Contract since birth, b. to services for a Pre-existing Condition rendered after the expiration of a 90-day period ending on or after the Member's Effective Date during which the Member received no health care service or supplies for the Pre-existing Condition, or c. to a Member who enrolls effective on the Contract Date. 39 - X-24690/X-24691/X-24720 Credit toward the 12-month time requirement of this Paragraph shall be given for continuous participation under any other Blue Cross or Blue Shield contract, if such contract was in effect on the date immediately preceding the Member's Effective Date. 40 - X-24690/X-24691/X-24720 SEC'nON VII - GENERAL PROVISIONS A. ENTIRE CONTRACT; C]IANGES This Contract with the applications of @the Subscribers, is the entire Contract between the Contract Holder and the Plan. Except as provided in Annex A, no change in this Contract will be effective until approved in writing by a Plan officer or his authorized designee. No agent or representative of the Plan, other than a Plan officer or bis designee, may change this Contract or waive any of its provisions. B. BENEFITS TO WHICH MEMBERS ARE ENTITLED Subject to all of the terms of this Contract, a Member is entitled to benefits for Covered Services in the amounts specified in the Schedule of Benefits. 2. The benefits will be provided only for Covered Services which the Member received on or after the Member's Effective Date. Further, in case of Inpatient Covered Services rendered by a Hospital or Other Facility Provider, the Member must have been admitted to a liospital or Other Facility Provider on or after the Member's Effective Date. 3. Benefits for Covered Services in this Contract will be provided only for services and supplies which are rendered by the Providers set forth as such in the Definitions Section of this Contract and regularly included in such Providers' charges. There is one exception: a Physician or Otlier Professional Provider (in either case, the "Employer") may delegate to his employee the responsibility for performing a Covered Service. The Plan will determine whether there exists a bona fide employer-employee relationship from information furnished by t e@m l@oyer. The withholding of federal and state income and social security taxes from the employee's salary by the Employer will be one indication that such a relationship exists. In addition, to be covered, a service delegated to an employee must be one which: a. both the Employer and the employee are Ucensed to render; !I. is performed under the direct supervision of the Employer such that the Employer, not his employee, is the one primarily responsible for the patient's care; and c. is billed for by the Employer. The employee's service is available as a substitute for the Employer's service. For this reason, the Plan wiR not pay a supervisory or other fee for the same service performed by both the Employer and his employee. C. RECORDS OF MEMBER ELIGIBILITY AND CliANGES IN MEMBER ELIGIBILITY 1. The Group must furnish the Plan with any data required by the Plan for coverage for Members under this Contract. In addition, the Group must provilde prompt notification to the Plan of the effective date of any changes in a Member's coverage status under this Contract. 41- X-24690/X-24691/X-24720 2. All notification by the Group to the Plan must be furnished on forms approved by the Plan. The notification must include all information reasonably required by the Plan to effect chanoes. 3. Clerical errors or deliys iii recording or reportinf,, data will not invalidate coverage which would otherwise be in force or contillue coverage which would otherwise terminate. Upon discovery of errors or delays, an equitable adjustment of subscription charges and benefits wiU be made. 4. The Group is liable for the cost of aU Contract benefits which are provided for services rendered to a terminated Member after his effective date of termination because of the Group's failure to notify the Plan of such Member's termination on or before the termination date. D. TERMINATION OF THE (' ROUP CONTRACT 1. The Group may cancel this Contract on any Contract anniversary date by giving written notice to the Plan at least thirty (30) days in advance. The Plan may cancel this Contract or any Contract anniversary date by @.iving written notice to tlie Group at least ninety (90) days in advance, except that the Plan may not cancel this Contract effective prior to June 30, 1988. 2. This Contract may be terminated, at the Plan's option, for the Group's non-payment of the appropriate payment when due or for the Group's failure to perform any obligation required by this Contract. E. TERMINATION OF AME.MBERIS COVERAGE UNDER THE GROUP CONTRACT 1. When the Member ceases to be an Eligible Person or Eligible Dependent, or the required contribution is not paid, the Member's coverage WiU terminate at the end of the last month for which payment was made. 2. Termination of the Group Contract automatically terminates au the Members, coverage. It is the responsibility of the Group to notify au the Members of the termination of the coverage. However, coverage wiU be terminated regardless of whether or not the notice is given. P. CONVERSION PRRVILEGE In the event coverage of a Member ceases for reasons other than termination of the Group Contract, the Member may apply to the Plan for enronment under any non-poup contract or certificate for which he is eligible; provided, that if application is made and the subscription charge paid within thirty-one (31) days after his termination, credit shall be given for his prior continuous enronment for the purpose of satisfying the waiting periods, if any, of these contracts for which he is eligible. G. NOTICE OF CLAIM 1. The Plan will not be liable under this Contract unless written notice is furnished to the Plan that Covered Services have been rendered to a Member. 42- X-24690/X-24691/X-24720 Written notice must be given within sixty (60) days after the termination of the Covered Services. The notice must include the data necessary for the Plan to determine benefits. An expense will be considered incurred on the date the service or supply was rendered. 2. FaUure to give notice to the Plan within the time specified will not reduce any benefit if it is shown that the notice was given as soon as reasonably possible, but in no event will the Plan be required to accept notice more than twelve (12) months after Covered Services are rendered. Ti. RELEASE OF INFORMATION AND PRIVACY PROTECTION 1. Each Member agrees tbat any person or entity having information relating to an illness, injury, or pregnancy-related condition for which benefits are claimed under this Contract may furnish to the Plan, upon its request, any information (including copies of records) relating to the illness, injury, or pregnancy-related condition. In addition, the Plan may furnish similar information to other entities providing similar benefits at their request. 2. Information is collected in order to administer the Member's coverage. , In Virginia, information which is collected is disclosed to others only as auowed by the Vir.@inia insurance Information and Privacy Protection Act. Under this Act, ca ch covered person has a right to see and correct aU "personal information," as that term is defined in the Act. A more complete notice of the Plan's information practices is available upon request. 1. LIMITATION OF ACTIONS No action at law or suit in equity may be brought against the Plan more than twelve (12) months after the date on which the cause of action accrued with respect to any matter relating to: this Contract; the Plan's performance under this Contract; or any statement made by employees, officers, or directors of the Plan concerning the Contract or the benefits avauable to a Member. J. PERSONAL BENEFM AND ASSIGNMENT OF PAYMENT 1. The Covered Services available under this Contract are personal. A Member may not assign the right to receive Covered Services. 2. A Member may not assign the right to receive payment for Covered Services. There is one exception. Under this Contract, a Member may assign the right to receive payment for any Covered Service which the Contract lists as payable at (1) less than 80% of the Plan's Reasonable Charge, (2) less than 80% of the Usual, Customary, and Reasonable Charge, or (3) less than 80% of the Allowable Charge. Prior payments to anyone, whether or not there has been an assignment of payment, shall not constitute a waiver of, or otherwise restrict, the Plan's right to direct future payments to a Member or any other individual or facility. 43- X-24690/X-24691/X-24720 3. Once Covered Services are rendered by a Provider, the Plan will not honor Member requests not to pay the claims submitted by the Provider. Tlie Plan will have no liability to any person because of its rejection of the request. K. MEMBER/PROVIDER RELATIONSHIP 1. The choice of a Provider is solely the Member's. The plan does not furnish Covered Services but only makes payment for Covered Services received by Members. The Plan is not liable for any act or omission of any Provider. The Plan has no responsibility for a Provider's failure or refusal to render Covered Services to a Member. 3. The use or non-use of an adjective such as Participating or Non-Participating in modifying any Provider is not a statement as to the ability of the Provider. L. BROCHURES AND/OR IDENTIFICATION CARDS The Plan or the Contract Holder may provide brochures or booklets, which describe this Contract's benefits and provide claims filing instructions. ln the event of a conflict between this Contract and these documents, this Contract will prevail. M. PARTICIPATING PLAN The Plan may make an agreement with any appropriate entity (referred to as a Participating Plan) to provide, in whole or in part, benefits for Covered Services to Members. N. APPLICABLE LAW This Contract is entered into in, and is subject to the laws of, the Commonwealth of Virginia. 0. NOTICE Any notice required under this Contract must be in writing. Notice given to the Group wiU be sent to the Group's address stated in the Group Appucation. Notice given to the Plan will be sent to the Plan's address stated in the Group AppUcation. Notice given to a Member will be sent, at the Plan's option, either to the Group or to the Member's address as it appears on the records of the Plan. The Group, the Plan, or a Member may, by written notice, indicate a new address for giving notice. P. HUMAN ORGAN AND TISSUE TRANSPLANT If a human organ or tissue transplant is provided from a living donor to a human transplant recipient: 1. When both the recipient and the donor are Members, each is entitled to the benefits of this Contract; 44 - X-24690/X-24691/X-24720 2. When only the recipi@nt is a Member, both the donor and the recipient are entitled to the benefits of this Contract. The donor benefits are limited to only those not provided or available to the donor froin any other source. This includes, but is not limited to, other insurance coverage, or other Blue Cross or Blue Shield coverage, or any government program. Benefits provided to the donor will be charged against the recipient's coverage under this Contract; 3. When only the donor is a Member, the donor is entitled to the benefits of this Contract. The benefits are limited to only those not provided or available to the donor from any other source. This includes, but is not limited to, other insurance coverage or other Blue Cross or Blue Shield coverage or any government program available to the recipient. No benefits will be provided to the non-Member transplant recipient. COORDINATION OF BENEFITS AU benefits provided under this Contract are subject to this provision. Benefits wiU not be increased by virtue of this provision. 1. DEFINITIONS In addition to the Definitions of this Contract, the following definitions apply to this provision. a. "Other Contract" means any arrangement providing health care benefits or services throu.,h: (i) group or blanket insurance coverage; (ii) Blue Cross, Blue Shield, health maintenance organization, and other prepayment coverage; (iii) coverage under labor management trusteed plans, union welfare plans, employer organization plans, _or employee benefit organization plans; and (iv) coverage under any tax supported or government program to the extent permitted by law. "Other Contract" shall be applied separately with respect to each arrangement for benefits or services and separately with respect to that portion of any arrangement which reserves the right to take the benefits or services of Other Contracts into consideration in determining its benefits and that portion which does not. When benefits are provided in the form of services, the reasonable cash value of each service shall be deemed the benefit. The Plan wiU not determine the existence of any Other Contract, or &mount of benefits payable under any Other Contract except this Contract. The payment of benefits under this Contract shau be affected by the benefits payable under Other Contracts only to the extent that the Plan is furnished with information regarding Other Contracts by the Group or Member or any other organization or person. 45 - X-24690/X-24691/X-24720 "Dependent" means, for any Other Contract, any person who qualifies as a dependent under that Contract. 2. EFFECT ON BENEFITS a. This provision shall apply in determining the benefits of this Contract for any Benefit Period if, for the Covered Services received durin@. that period, the sum of the benefits payable under this Contract, except as provided for in this paragraph, and the benefits payable under Other Contracts would exceed the Covered Services. b. Except as provided in item c. of this Section, the benefits payable under this Contract for Covered @ervices received during a Benefit Period will be reduced so that the sum of the reduced benefits and the benefits payable for Covered Services under Other Contracts does not exceed the total of Covered Services. Benefits payable under Other Contracts include the benefits that would have been payable had claim been made. If, (i) an Other Contract contains a provision coordinating its benefits with those of this Contract and its rules require the benefits of this Contract to be determined first, and' (ii) the rules set forth in item d. of this Section require the benefits of this Contract to be determined first, then the benefits of the Other Contract wiU be ignored in determinin@. the benefits under this Contract. d. For the purpose of Paragraph 2.c. of this Section, the order of benefit determination rules are: (i) The benefits of a contract which covers the person as other than a Dependent shan be determined first; (ii) The benefits of a contract which covers the person as a Dependent of the person whose month and day of birth occurs earuest in the Calendar Year shau be determined first, except that in the case of a Dependent chfld, (a) when the parents are separated or divorced and the parent with custody of the child has not remarried, the benefits of a contract which covers the child as a dependent of the parent with custody shan be determined first; (b) when the parents are divorced and the parent with custody of the child bas remarried, the benefits of a contract which covers the child as a dependent of the parent with custody shaR be determined before the benefits of a contract which covers that child as a dependent of the stepparent, and the benefits of a contract which covers that child as a dependent of the stepparent shall be determined before the benefits of a contract which covers the child as a dependent of the parent without custody; 46 - X-24690/X-24691/X-24726 (c) Notwithstanding (a) and (b) above, if there is a court decree which establishes a parent's financial responsibility for the child's covered health care expenses, the benefits of a contract which covers the child as a dependent of that parent shall be determined first; (iii) When rules (i) and (ii) above do not establish an order of benefit determination, the benefits of a coiitract which has covered the person for the longest uninterrupted period of time shall be determined first. There is one exception to this last rule. This exception applies when the contracts have the same priority rules for retired or laid-off employees. In this case, the benefits of the contract which covers the Member as a working employee or dependent of a working employee will be determined first. e. If an Other Contract does not contain provisions establishin., the same order of benefit determination rules, the benefits under that contract will be determined before the benefits under this Contract. There is one exception. If the Other Contract's coordination of benefits provision corresponding to rule (ii) provides that the contract which covers the person as a Dependent of a man shall be determined first, then this provision of tile Other Contract shall be used in decidin,. the order of benefit determination under this Contract in lieu of rule (ii) above. f. A Blue Cross and Blue Shield plan participating in the administration of this Contract has the option to administer the order of benefit determination rules in accordance with its own policy in lieu of the rules set forth above. 3. FACILITY OF PAYMENT Whenever payments should have been made under this Contract in accordance with this provision, but the payments have been made under any Other Contract, the Plan has the right to pay to any organization that has made such payment any amounts it determines to be warranted to satisfy the intent of this provision. Amounts so paid shar be deemed to b6 benefits paid under this Contract and, to the extent of the payments for Covered Services, the Plan shar be fully discharged from liability under this Contract. 4. RIGHT OF RECOVERY a. Whenever payments have been made by the Plan for Covered Services in excess of the maximum amount of payment necessary at that time to satisfy the intent of this provision, irrespective of to whom paid, the Plan shall have the right to recover the excess from among the fouowing, as the Plan shau determine: any persons to or for whom such payments were made, any insurance company, or any other organization. b. The Subscriber, personauy and on behalf of Family Members shall, upon request, execute and deliver such documents as may be required and do whatever else is necessary to secure the Plan's rights to recover the excess payments. 47 - X-24690/X-24691/X-24720 R. BE14EFITS AFTER TERMINATION OF COVERACE Benefits will be continued for Covered Services rendered after termination of a Member's coveraa.e: 1. If the Subscriber is required to pay the whole or any part of the subscription charges required under the terms of this Contract, benefits under this provision shall not be provided if such Subscriber ceases to pay such subscription charges while this Contract is in effect. 2. If the Member is an Inpatient on the day coverage terminates, the benefits of this Contract shau be provided: a. until the maximum amount of benefits has been paid; or '5. until the Inpatient stay ends; or c. until the end of the Benefit Period in which coverage terminated; or until the Member becomes covered without limitation as to the condition for which he is receiving inpatient care under any other group coverage; whichever occurs first. S. LlmrPATION ON DAMAGES In the event a Member or his representative sues the Plan or any director, officer, or employee of the Plan actina. in his capacity as a director, officer, or employee, the damages shall be limited to the Member's actual damages. The damages will not exceed the amount of any claim not properly paid as of the time the la%vsuit is filed. In no event shall this Contract be interpreted so that punitive or indirect damages, legal fees, or damages for emotional distress or mental anguish are available. T. PLAN'S CONTINUING RIGHTS On occasion, the Plan may not insist on strict performance of all terms of this Contract. Failure to apply terms or conditions does not mean the Plan waives or gives up any future rights under this Contract. U. PARTICIPATING AND NON-PARTICIPATING PROVIDFR REIMBURSEMFNT Benefit amounts, as specified in the Schedules of Benefits, refer to Covered Services rendered by a Participating Provider, which are regularly included in such Provider's charges and are billed by and payable to such Provider. The auowance for Covered Services rendered by a Non-Participating Provider which are regularly included in such Provider's charges and are billed by and payable to such Provider will be the same as that otherwise available to a Participating Provider. 48 - X-24690/X-24691/X-24720 SECTION VIU - PAYMENTS TO THE PLAN FOR SERVICES The payments to the Plan for services wiU be as set forth in Annex A which is attached to and made a part of the Contract as if the same were set forth in the Contract in fuU. Effective August 1, 1985 Page 1 of 4 ANNEX A TO GROUP CONTRACT NUMBER X-24690/X-24691/X-24720 PAYMENTS TO THE PLAN FOR SERVICES A. Definitions As used herein, the following terms shall have the meanings indicated: 1. Subscription Charges shall mean all amounts payable by the Contract Holder to the Plan under this Contract, including Monthly Subscription Charges. .1. Monthlv Subscription Charges shall mean the amounts payable by the Contract Holder to the Plan each month pursuant to Paragraph B. of this Annex. 3. Claims Expenses shau mean the sum of: a. The charges of Hospitals and other health care facilities for services and supplies that are covered under this Contract, less (1) any deductibles, co-insurance amounts and other portions of such char,.es that are not covered under this Contract, and (2) any part of any provider payment differential that the Plan, in its sole discretion, may pass on to the Contract Holder; and b. The amounts paid by the Plan for services and supplies that are covered under this Contract which are rendered or furnished by covered providers other than Hospitals and other health care facilities. 4. Excessive Claims ExDenses shau mean the amounts by which each Member's Claims Expenses adjudicated in a single Contract Year exceed $20,000, pl- -Y portion of any provider payment differential that the Plan, in its sole discretion, may allow and determine to be applicable to such $20,000. 5. The Review Period for each Contract Year shau be the 12-month period ending on the last day of the 6th month of such Contract Year, except that the Review Period for the first Contract Year shall be the 5-month period ending on December 31, 1985. Page 2 of 4 Chargeable Costs shall mean the sum of: a. Claims Expenses, minus Excessive Claims Expenses; b. The Plan's estimate of incurred but unreported claims for services and supplies covered under this Contract; and C. Claims processing and other costs incident to the administration of this Contract, to include (but not restricted to): (1). an Excessive Claims Expenses pooling charge of 14.0% of Claims Expenses, and (2). a Plan reserve charge of 2.5% of Subscription Char.@es for the period for which Chargeable Costs are determined. B. Payments by the Contract Holder On August 1, 1985, and on the first day of each month thereafter, the Contract Holder wiU pay the Plan the following Monthly Subscription Charges for each Type of Coverage selected by each Subscriber: Comprehensive Comprehensive Schedule of Benefits-A Schedule of Benefits-B Dental Only Type of Coverage Monthly Charge Monthly Charge Monthly Charge @pe 1 $125.00 $98.86 $6.20 Type 2 $125.00 $98.86 $6.20 Type 3 $125.00 $98.86 $6.20 A grace period ending on the 15th consecutive calendar date following the due date shau be allowed within which the Contract Holder may pay Monthly Subscription Charges. Acceptance of payment by the Plan after such grace period shaU not be deemed thereafter to waive any obligations of the Contract Holder for payment of Monthly Subscription Charges hereunder. C. Annual Revisions 1. The Plan may revise the terms, conditions, and amounts set forth in this Annex for any Contract Year by notifying the Contract Holder in writing of such revisions Page 3 of 4 at least one hundred thirty-five (135) days before the beginning of such Contract Year. If any of the revisions referred to in this Para.araph C.I. are unacceptable to the Contract Holder, then, any otber provision of this Contract to the contrary notwithstanding, this Contract may be terminated by the Contract Holder effective at the commencement of the Contract Year for which these revisions are proposed. The Contract Holder shau terminate the Contract for the reasons set forth herein by giving the Plan written notice at least ten (10) days prior to the beginnin.@ of such Contract Year. 2. At the time the Contract Holder is notified of the revisions referred to in Para.araph C.I. above, the Plan shau provide the Contract Holder with a statement (the "Review Statement") setting forth the Chargeable Costs incurred and the Subscription Charges paid durin@. the Review Period for such Contract Year. The Review Statement shall also reflect any accumulated excess of Subscription Char@.es over Chargeable Costs or Chargeable Costs over Subscription Charges from the beginning of the Contract to the end of the Review Period for which the Review Statement is prepared. The Plan shan take any such excess into account in revising Monthly Subscription Charges for the Contract Year forowing the one for which the Review Statement is prepared, provided, however, that the Plan and the Contract Holder Imay agree to do otherwise in writing in advance of such Contract Year. The maximum amount of any accumulated excess of Chargeable Costs over Subscription 7 Charges that may be carried forward into the accounting for the Contract Year beginning July 1, 1986 shau be limited to 15% of the Subscription Charges couected for the Contract Year beginning August 1, 1985. D. Termination If this Contract is terminated, the Plan shau within two years of the effective date of termination conduct a final accounting. 'Me final accounting shan set forth the amount of Chargeable Costs incurred and Subscription Chara.es paid since the end of the period covered by the most recent Review Statement and the accumulated excess of Chargeable Page 4 of 4 Costs over Subscription Charges or Subscription Charges over Char@.eable Costs since the beginning of this Contract. The final accounting shau reflect Excessive Claims Expenses adjudicated and approved by the Plan since the end of the period covered by the most recent Review Statement. If the final accounting shows an accumulated excess of Subscription Charges over Chargeable Costs since the beginning of this Contract, then the Plan shall pay the amount of such excess to the Contract Holder. Any such payment shaU be made within thirty (30) days of submission of the final accounting and shall constitute final settlement of this Contract. If, on the other hand, the final accountin.@ shows an accumulated excess of Chargeable Costs over Subscription Char.@es since the beginning of this Contract, the Contract Holder shau not be liable to the Plan for the amount of such excess. For the purposes of the immediately preceding sentence, submission of the final accounting shall constitute final settlement of this Contract. E.. From the period August 1, 1985 to the date of final settlement referred to in Paragraph D.2. of this Annex, tlie Plan will credit or charge the Contract Holder interest on monthly cash flow. Monthly cash flow for a given month is the accumulated excess of Chargeable Costs over Subscription Charges or the accumulated excess of Subscription Charges over Chargeable Costs as of the last day of that month taking into account any interest credited or cbarged for the previous month. The rate- of interest credited or charged shau be equal to the rate of return of the Plan's internal investment portfolio less a management fee of .75% per annum. However, the rate of interest shan be guaranteed to be at least 12% per annum. Interest shau be credited or charged at the end of each Contract Year and at the time of final settlement. Effective August 1, 1985 Page 1 of 1 ANNEX B TO GROUP CONTRACT NU@IBER X-24690/X-24691/X-24720 SECOND SURGICAL OPINION REQUIRED ELECTIVE PROCEDURE CODES Appendectomy (non-emergency) Arterial excision, graft or by-pass Arthrotomy of knee Cholecystectomy (excision of gall bladder) Colectomy (excision of all or part of the colon) Gastroplasty (obesity surgery) Hemorrhoidectomy, internal and external only Hernia repair, inguinal Hysterectomy Ileum By-pass (obesity) Laminectomy (removal of intervertebral disc) Lens extraction (cataract removal) Ligation and/or stripping of varicose veins Meniscectom'y (excision semilunar cartuage of knee joint) Oscular muscles, any type of operation Osteotomy of smauer bones (bone graft) Salpingectomy and/or oophorectomy (excision of any ovary and/or uterine tube) Tendon lesion excision, bther than digits Thyroidectomy, subtotal or partial (thyroid gland) TonsiUectomy and/or adenoidectomy Total knee or hip joint replacement Transurethral prostatectomy (prostate gland) - 38 - Item 11-J.2 CONSENT AGENDA ITEM # 23929 Upon motion by Couiicilmaii Baum, secoiided by Couiicilwoman Creech, CitY Council ADOPTED an Ordinance, on SECOND READING, to accept and appropriate a GRANT AWARD from the DEPARTMENT OF HOUSLNG AND URBAN DEVELOPMENT to the COMMUNITY DEVELOPMENT ELEVENTH PROGRAM YEAR in the amount of $2,466,000. Voting: 11-0 Council Members Voting Aye: John A. Baum, Nancy A. Creech, Robert E. Fentress, Mayor Harold Heischober, Barbara M. Henley, H. Jack dennings, Jr., Louis R. Jones@ Robert G. Joiies, Vice Mayor Reba S. McClatiaii, J. Henry McCoy, Jr., D.D.S., and Meyera E. Oberndorf. Council Members Voting Nay: None Council Members Absent: Naiie *Verbal Aye July 8, 1985 - 38a - AN ORDItiAtICE TO ACCEPT A GRANT AWARD FROM TliE DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT AND TO APPROPRIATE FUNDING FOR TtiE COMMUNITY DEVELOPMENT FLEVENTH FIROG.RAII YFAR VIHEREAS, the Department of Housina and Urban Development (H(JD) has awarded a grant of $2,466,000 for funding the Community Development Eleventh Program Year, and WHEREAS, the Department of Housinq and Urban Development ha5 approved the Community Development Eleventh Program Year budget. NOW, THEREFORE, BE IT ORDAINED BY THE COUNCIL OF THE CITY OF VIRGINIA BEACH, VIRGINIA: That funding from HUD be accepted and funds appropriated for the followinq projects and purposes: APPROPRIATIONS ACTIVITY $ 400,000 Gracetovin Streets/Drainage lmprovenients - Construction 155,000 Lake Smith Water/Sewer/Streets/Drainage Improvements - Additional Construction Costs 200,000 Newsone Farm Street/Drainage Improvements - Acquisition 26,000 Queen City kJater/Sewer - Fngineering 54i,ooo Seatack Street/Drainage Improvements Phase IIA - Acquisi tion/Construction 164,833 Housing Rehabilitation 175,500 Replacement Housing/Relocation 105,000 Last Resort Housing Loans 25,000 Homesharing Program 46,704 Code Enforcement/Demolition/Clearance 169,296 Housinq Programs Administration 4,595 Black Heritaqe Awareness Cultural Activities 284,322 General Management and Oversicht 168,750 Contingencies $2,IT O@00 TOTAL APPROPRIATIONS That the appropriations will be financed by $2,466,000 in federal funds frof, the Department of Housing and Urban Development. FIRST READING: July 1, 1985 SECOND READING: July 8, 1985 Adopted by the Council of the City of I/irginia Beach on the day of July 1985. Approved As To Content: Approved as to Form: S . 5@ Mary. U@t'.ck, D', Da d Department of Housing & Com- City Attorney's 'Iffice munity Development July 8, 1985 - 39 - Item 11-J.3 CONSENT AGENDA ITEM # 23930 Upon motion by Couiicilman Baum, secoiided by Councilwoman Creech, City Council APPROVED an Ordinance, on FIRST READING, to appropriate $727,415 to the Geiieral Fuiid for FY 1984 LEASE/PURCHASE ASSETS delivered in YY 1985 AND to increase revenues by the same amount. Votiiig: 11-0 Couticil Members Voting Aye: Johii A. Baum, Nancy A. Creech, Robert E. Fetitress, Mayor Harold Heischober, Barbara M. Henley, H. Jack Jenniiigs, Jr., Louis R. JoLies@ Robert G. Joiies, Vice Mayor Reba S. McClanaii, J. Henry McCoy, Jr., D.D.S., and Meyera E. Oberadorf. Council Members Votitig Nay: Noiie Couiicil Members Ab6ent: None *Verbal Aye July 8, 1985 - 39a - AN ORDINANCE TO APPROPRTATE $727,415 TO THE GENEPAL FUND FOR FY 1984 LEASE/PURCHASE ASSETS DELIVERED IN FY 1985 AND TO INCREASE REVENUES BY THE SAME AMOUNT WHEREAS, the FY 1983-84 Operating Budget included assets to be financed through lease/purchase agreements, and WHEREAS, due to delays, certain assets ordered in FY 1984 totaling $727,415 were not delivered until FY 1985, and WHEREAS, to conform with generally accepted accounting principles, there is now a need to appropriate the full costs of the lease/purchases in the respective budget units, and WHEREAS, the appropriations will be offset by an increase of $727,415 in revenues as a result of proceeds from the lease/purchase agreements. NOW THEREFORE, BE IT ORDAINED BY THE COUNCIL OF THE CITY OF VIRGINIA BEACH, VIRGINIA that funds in the amount f $727,415 are hereby appropriated to the General Fund as shown below to cover the cost of FY 1984 lease/purchases delivered in FY 1985. Budget Unit DepartmenL Total Cost 04031 - Research Finance $ 31,454 04033 - Accounting Finance 20,141 05001 - Director Personnel 19,266 10312 - Refuse Collection Public Works 99,145 10312 - Refuse Collection Public Works 248,955 13010 - Management and Support Planning 32,685 15217 - Pavilion Economic Development 40,158 16032 - Grounds Maintenance General Services 43,910 19010 - Prevention Fire 39,128 19020 - Suppression Fire 152,573 $ 727 415 BE IT FURTHER ORDAINED, that the appropriations be offset by an increase of $727,415 in estimated revenues in the General Fund. This ordinance shall be effective from the date of its adoption. Adopted by the Council of the City of Virginia Beach on the day of 19 July 8, 1985 FIRST READING: July 8, 1985 SECOND READING: 40 - Item ii-J.4 CONSENT AGENDA ITEM # 23931 Upoii motion by Councilman Baum, seconded by Couiicilwoman Creech, City Couiicil APPROVED, on FIRST READING, an Ordiiiaiice to accept aiid appropriate a $29,655 GRANT for funding a SAFETY KIDS PROGRAM. Voting: 11-0 Council Members Votiiig Aye: John A. Baum, Naiicy A. Creech, Robert E. Fentress, Mayor Harold Heischober, Barbara M. Henley, H. Jack Jennings, Jr., Louis R. Jones@ Robert G. Jones, Vice Mayor Reba S. McClatian, J. Henry McCoy, Jr., D.D.S., and Meyera E. Oberndorf. Couiicil Members Voting Nay: None Council Members Absent: None *Verbal Aye July 8, 1985 40a - AN ORDINANCE TO ACCEPT A $29,655 GRANT FOR FUNDING A SAFETY KIDS PROGRAM AND TO APPROPRIATE THOSE FUNDS WHEREAS, the City of Virginia Beach is concerned with preventing children from becoming victims of sexual abuse, and WHEREAS, the Virginia Family Violence Prevention Program has awarded the City a grant totalling $29,655 to fund such a prevention program designed to meet the needs of children ages 0 to 5. NOW, THEREFORE, BE IT ORDAINED BY THE COUNCIL OF THE CITY OF VIRGINIA BEACH, that a grant totalling $29,655 be accepted and appropriated for the purpose of funding a Safety Kids Program, and BE IT ORDAINED, that one employee position be created, to exist during the grant period, to be paid from the grant funds. This ordinance shall be in effect from the date of its adoption. Adopted by the Council of the City of Virginia Beach, Virginia on the day of 1985. FIRST READING: July 8, 1985 SECOND READING: July 8, 1985 - 41 - Item II-J.5 CONSENT AGENDA ITEM # 23932 Upon motion by Councilman Baum, secotided by Councilwomaii Creech, City Coulicil, pursuant to Sectioii 2-166 of the Code of the City of Virginia Beach, CONFIRMED the APPOINTMENT of WILLIAM E. BYNUM as ASSISTANT CITY ATTORNEY effective July 15, 1985. Voting: 11-0 Couiicil Members Voting Aye: John A. Baum, Nancy A. Creech, Robert E. Fentress, Mayor Harold Heischober, Barbara M. Henley, H. Jack Jeiinitigs, Jr., Louis R. Jones,*Robert G. Jones, Vice Mayor Reba S. McClailan, J. Heiiry McCoy, Jr., D.D.S., and Meyera E. Oberndorf. Council Members Voting Nay: None Couiicil Members Abseiit: None *Verbal Aye July 8, 1985 - 42 - Item II-J.6 CONSENT AGENDA ITEM # 23933 Upoii niotion by Councilman Baum, seconded by Councilwoman Creech, City Couiicil, pursua@it to Sectioii 2-166 of the Code of the City of Virginia Beach, CONFIRMED the APPOINTMENT of WILLIAM M. MACALI as ASSISTANT CITY ATTORNEY, effective August 1, 1985. Votilig: 11-0 Couiicil Members Voting Aye: John A. Baum, Nancy A. Creech, Robert E. Felitress, Mayor Harold Heischober, Barbara M. Heiiley, H. Jack Jeniiiiigs, Jr., Louis R. Joiies* Robert C. Jones, Vice Mayor Reba S. McClanaii, J. Henry McCoy, Jr., D.D.S., aiid Meyera E. Oberndorf. Council Members Votiiig Nay: None Couiicil Members Absent: None *Verbal Aye July 8, 1985 - 43 - Item 11-J.7 CONSENT AGENDA 1TEM # 23934 Upon motioii by Couiicilman Baum, secoiided by Councilwoman Creech, City Council, ADOPTED aii Ordiiiance to authorize a temporary ENCROACHMENT into a portioti of the rights-of-way of MILL DAM ROAD aiid BRIARCLIFF LANE to O.W.L., LTD., its assigns and successors iii title. This Encroachment shall be subject to the following coiiditions: 1. The owner agrees to remove the encroachmetit when notified by the City, at no expense to the City. 2. The owner agrees to keep and hold the City free aiid harmless of any liability as a result of the encroachment. 3. The owner agrees to maintaiii said encroachmelit so as not to become uiisightly or a hazard. 4. This encroachmeiit shall not be in effect until an agreement has beeii executed encompassing the above coiiditioiis. Votiiig: 11-0 Couiicil Members Voting Aye: John A. Baum, Nancy A. Creech, Robert E. Felitress, Mayor Harold Heischober, Barbara M. Henley, H. Jack Jennitigs, Jr., Louis R. Jonest Robert G. Jones, Vice Mayor Reba S. McClanan, J. Heiiry McCoy, Jr., D.D.S., and Meyera E. Oberiidorf. Couiicil Members Voting Nay: None Couiicil Members Absetit: None *Verbal Aye July 8, 1985 - 43a - AN ORDINANCE TO AUTHORIZE A TEMPORARY ENCROACHMENT INTO A PORTION OF THE RIGHTS-OF-WAY OF MILL DAM ROAD AND BRIARCLIFF LANE, TO O.W.L., LTD., ITS ASSIGNS AND SUCCESSORS IN TITLE BE IT ORDAINED BY THE COUNCIL OF THE CITY OF VIRGINIA BEACH, VIRGINIA: That pursuant to the authority and to the extent thereof contained in Section 15.1-893, Code of Virginia, 1950, as amended, the O.W.L., LTD., its assigns and successors in title are authorized to construct and maintain a temporary encroachment into a portion of the City riqhts-of-way of Mill Dam Road and Briarcliff Lane. That the temporary encroachment herein authorized is for the purpose of constructing and maintaining a brick construction fence and subdivision identification siqn and that said encroachment shall be constructed in accordance with the City of Virginia Beach Public Works Department's specifications as to size, alignment and location, and further that such temporary encroachment is more particularly described as follows: An area of encroachment into a portion of the City's right-of-way known as Mill Dam Road and Briarcliff Lane as shown on that certain plat entitled: "SIGN ENCROACHMENT FOR O.W.L., LTD. LYNNHAVEN BOROUGH VIRGINIA BEACH, VIRGINIA O.W.L., LTD. SCALE: 1"=30' MAY 6, 1985 BALDWIN AND GREGG, LTD. ENGINEERS-SURVEYORS, PLANNERS NORFOLK, VIRGINIA," a copy of which is on file in the Virginia Beach Department of Public Works and to which reference is made for a more particular description. PROVIDED, HOWEVER, that the temporary encroachment herein authorized shall terminate upon notice by the City of Virginia Beach to any officer of O.W.L., LTD., its assigns and successors in title and within thirty (30) days after such notice is given, said encroachment shall be removed from the City July 8, 1985 - 43b - rights-of-way of Mill Dam Roa(i and Briarcliff Lane and that O.W.L., LTD., its assigns and successors in title shall bear all costs and expenses of such removal. And PROVIDED FURTHER, that it is expressly understood and agreed that O.W.L., LTD., its assiqns and successors in title shall indemnify and hold harmless the City of Virqinia Beach, its agents and employees from and aqainst all claims, damages, losses, and expenses includina reasonable attorney's fees in case it shall be necessary to file or defend an action arising out of the location or existence of such encroachment; and PROVIDED FURTHER, this ordinance shall not be in effect until such time that O.W.L., LTD., executes an agreement with the City of Virginia Beach encompassing the afore-mentioned provisions and other provisions deemed appropriate by the City Attorney. Adopted by the Council of the City of Virqinia Beach, virqinia, on the 8th day of July 1985 GLF/re 6/4/85 (29H) APPR@VED AS rO SiGNAI!,JR; DFPART@A-:'@T A@ -2- July 8, 1985 -7. C7 - i@ FT 43d 2 39 6 6.00 io.,l Z z z z 3 NOW OR FORMERLY Fr THE SCHOOL BOARD OF THE a: 0 CITY OF VIRGINIA BEACH co w (M.S. 67 P. 41) @mo (D.B. 946 P. 380) z@a: LOL' I'D A ww "E@ 50.44' THUNDERBIRD 0 DRIVE cr A@ (5 O') BRIARCLIFF LANE (6 S') OR FORMERLY O.W.L., LTD. (D.B. 2264, P. 265) PROPOSED BRICK WALL f-RIGHT-OF-wAy 5' 1 0. 5' PROPOSED IIDEWALK ,7 EXI B GUTTER SECTION A-A LOCATION OF PROPOSED WALL- SIGN ENCROACHMENT FOR O.W.L,, LTD. LYNNHAVEN BOROUGH VIRGINIA BEACH, VIRGINIA CL W. L., LTD. SCALE: 1" - 3d MAY 6, 1985 BALDWIN AND GREGG, LTD. ENGINEEKS . SURVEyom$ . PLAN NE "S July 8, 1985 NORFOLK, VIRGINIA - 44 - Item 11-J.8 CONSENT AGENDA ITEM # 23935 Upon motion by Councilman Baum, secoiided by Councilwoman Creech, City Council, ADOPTED an Ordiiiance to authorize a temporary ENCROACHMENT into a portioii of the right-of-way of DAM NECK ROAD at General Booth Bouievard to the United States Goveriiment, DEPARTMENT OF THE NAVY, ATLANTIC DIVISION, NAVAL FACILITIES ENGINEERING COMMAND. This Encroachment shall be subject to the followilig conditions: 1. The owiier agrees to remove the encroachment when iiotified by the City, at no expeiise to the City. 2. The owner agrees to keep aiid hold the City free aiid harmless of aiiy liabi-Lity as a result of the encroachment. 3. The owiier agrees to maintaiii said eiicroachment so as iiot to become uiisightly or a hazard. 4. This encroachmeiit shall iiot be iii effect utitil ati agreement has beeti executed encompassiiig the above coiiditions. Voting: 11-0 Council Members Votiiig Aye: John A. Baum, Naticy A. Creech, Robert E. Fentress, Mayor Harold Heischober, Barbara M. Heiiley, H. Jack JeLiniiigs, Jr., Louis R. Jones,*Robert G. Jones, Vice Mayor Reba S. McClanaii, J. Henry McCoy, Jr., D.D.S., aiid Meyera E. Oberndorf. Council Members Votitig Nay: None Council Members Abseiit: None *Verbal Aye July 8, 1985 - 44a - AN ORDINANCE TO AUTHORIZE A TEMPORARY ENCROACHMENT INTO A PORTION OF THE RIGHT-OF-WAY OF DAM NECK ROAD AT GENERAL BOOTH BOULEVARD TO THE UNITED STATES GOVERNMENT, DEPARTMENT OF THE NAVY, ATLANTIC DIVISION, NAVAL FACILITIES ENGINEERING COMMAND BE IT ORDAINED BY THE COUNCIL OF THE CITY OF VIRGINIA BEACH, VIRGINIA: That pursuant to the authority and to the extent thereof contained in Section 15.1-893, Code of Virginia, 1950, as amended, the United States Government, Department of the Navy, Atlantic Division, Naval Facilities Engineering Command is authorized to construct and maintain a temporary encroachment into a portion of the City right-of-way of Dam Neck Road at General Booth Boulevard. That the temporary encroachment herein authorized is for the purpose of naval facilities identification sign and that said encroachment shall be constructed in accordance with the City of Virginia Beach Public Works Department's specifications as to size, alignment and location, and further that such temporary encroachment is more particularly described as follows: An area of encroachment into a portion of the City's right-of-way known as Dam Neck Road, as shown on that certain plat entitled: "FCTC, ATLANTIC, PROPOSED SIGN LOCATION," a copy of which is on file in the Virginia Beach Department of Public works and to which reference is made for a more particular description. PROVIDED, HOWEVER, that the temporary encroachment herein authorized shall terminate upon notice by the City of Virginia Beach to any officer of the United States Government, Department of the Navy, Atlantic Division, Naval Facilities July 8, 1985 - 44b - Engineerinq Command and within thirty (30) days after such notice is given, said encroachment shall be removed from the City right-of-way of Dam Neck Road by the United States Government, Deparment of the Navy, Atlantic Division, Naval Facilities Enqineering Command and that the United States Government, Department of the Navy, Atlantic Division, Naval Facilities Engineering Command shall bear all costs and expenses of such removal. And PROVIDED FURTHER, that it is expressly understood and agreed that the party of the second part shall reimburse the City of Virginia Beach for reasonable attorney's fees should it become necessary to file or defend an action arising out of the location or existence of such temporary encroachment. The liability, if any, of the party of the second part for death or injury to any person, or the loss of or damage to any property shall be determined in accordance with applicable provisions of the Federal Tort Claims Act, 28 USC 2671 et sea. PROVIDED FURTHER, this ordinance shall not be in effect until such time that the United States Government, Department of the Navy, Atlantic Division, Naval Facilities Engineering Command executes an agreement with the City of Virginia Beach encompassing the afore-mentioned provisions and other provisions deemed appropriate by the City Attorney. Adopted by the Council of the City of Virginia Beach, Virginia, on the 8th day of July 19 85 GLF/re 6/11/85 (29A) APPiZOVED A@ TC t.C)rl f@'ll DEP@@RTM,-NT AP Eo FO,@@.A 'p@OV SIG" CITY AT-,',)@"4EY -2- July 8, 1985 ol z (D U) C) July 8, 19 LLJ U) C) 0- 0 CL 44d L2 LLI z 1- 2 Z w cr. LL 0 2 E9 to July 8, 1985 - 45 - Item Il- j. 9 CONENT AGENDA ITEM # 23936 Upon motion by Councilman Baum, seconded by Couticilwoman Creech, City Council ADOPTED an Ordiiiance appointing VIEWERS in the petition of the CITY OF VIRGINIA BEACH for the closure of a portion of CLAUDIA DRIVE (Bayside Borough). The Viewers are: Robert J. Scott Director of Plaiiiiing C. Oral Lambert, Jr., Director of Public Works David M. Grochmal Director of General Services Voting: 11-0 Couticil Members Votiiig Aye: John A. Baum, Nancy A. Creech, Robert E. Felitress, Mayor Harold Heischober, Barbara M. Heiiley, H. Jack Jennings, Jr., Louis R. Janest Robert G. Joiies, Vice Mayor Reba S. McClaiian, J. Henry McCoy, Jr., D.D.S., aiid Meyera E. Oberndorf. Council Members Votitig Nay: None Council Members Absent: None *Verbal Aye July 8, 1985 - 45a - ORDINANCE APPOINTING VIEWERS WHEREAS, the City of Virqinia Beach, Virqinia, a municipal corporation, has given due and proper notice in accordance with the statutes for such cases made and provided that they will on July 8, 1985, apply to the City of Virqinia Beach, virginia, for the appointment of Viewers to view the below-described property and report in writinq to the City Council whether, in the opinion of the Viewers, what, if any, inconvenience would result from the discontinuance of the hereinafter described portion of that certain street and has filed such application with the said Council. NOW, THEREFORE, BE IT ORDAINED BY THE COUNCIL OF THE CITY OF VIRGINIA BEACH, VIRGINIA: That Robert J. Scott, Director of Plaiiiiitig -C. Oral Lambert, Jr., Director of Public Works and David M. Grochmal, Director of General Services are hereby appointed to view the below-described property and report in writing to the Council, as soon as possible, whether, in their opinion, what, if any, inconvenience would result in the discontinuing and vacatinq of a portion of that certain street of variable width located in the City of Virginia Beach, Virginia, and more particularly described as follows: That certain section of Claudia Drive, more particularly described as follows: Beginninq at a point on the southern right-of-way line of Claudia Drive at a point 39.71 feet from the southern boundary line of lot 57, as shown on the plat of Lakeview Park, recorded in the Office of the Clerk of the Circuit Court of the City of Virginia Beach, in Map Book 29, at Paqe 67, and from said point of beginninq continuina along the southern right-of-way line of Claudia Drive south 24* 52' 40" east a distance of 60 feet to a point, and preceding along the same said right-of-way line on an arc 21* 24' 15" for a distance of 93.39 feet to a point, thence continuinq along an arc 79' 081 31" a distance of 62.16 feet to a point, and continuing alonq a curve of 32' 561 47" a distance of 57.50 feet to a point, and continuing along an arc July 8, 1985 - 45b - 107* 32' 50" a distance of 375.41 feet to the point of beginning as shown on the above-referenced plat. The above plat is available for review in the Office of the City Attorney, Municipal Center, Virginia Beach, Virginia. Adopted by the Council of the City of Virginia Beach, Virginia, on the 8th day of July 1985. KJC/da 5/3 0/8 5 6/5/85 23.1 -2- July 8, 1985 45c NOTICE PLEASE TAKE NOI'ICE that at the meeting of th(L@ Council of the City of Virginia Beach, Virginia, to be hcld on the 8th ,day of July, 1985, at 2 p.m., at the City Hall of the City of Virginia Beach, Princcss Anne Station, the undersigned will petition the Councii for appoin- tment of Viewers to view the below-dcscribed portion of the below-described street and report to the City Council whether in the opinion of the Viewe@s, what, if any, inconveniencc would result. from the vacating, closing, and discontinuing of same, the said portion of Claudia Drive as on that certain plat entitled "Plat showing property to bc ex- changed between the City of VirgiWa Beach and Richard S. and Alice P. Pittman Bayside Borough Virginia Beach, Virginia," prepared by thc Bureau of Surveys and Mapping, Engineering Division, Depar- ,jcuea@ @ of Pu,@? May9-t984!* That certain section of Claudia Drive, more particularly dcscribed as follows: Beginning at a point on the southern right- of-way line of Claudia Drive at a point 39.71 feet from the southern boundary line of lot 57, as shown on the plat of Lakeview Park. recorded in the Office of the Clerkof Circuit Court of the City of Virginia Beach, in Map Book 29, at Page 67, and from said point of beginning con- tinuing along the southern right- of-way line of Claudia Drive south 241 52' 40" east of distance of 60 feet to a point, and preceding along the same said right-of-wa,, line on an arc 21' 24' 15" for a distance of 93.39 fcct to a point. thence continuing along an arc 791 08' 3 1 " a distan- ce of 62.16 feet to a point, and continuing along a curve of 321 56' 47" a distance of 57.50 fect to a point, and continuing along an arc 107* 32' 50" a distance of 375.41 feet to the point of begin- ning as shown on the above- referenced plat. The above plat is available for review in the Office of the City Attorney, Municipal Center, Virginia Beach, Virginia. At that time anyone may ap- pear and present their views. After the report of the Viewers is received, at the next regular meeting of the City Council, or as soon thereafter as the matter can be placed on the agenda, the un- dersigned will Petition the City Council to vacate, close, and discontinue the said portion of Claudia Drive. Ruth H. Smith, CMC City Clerk ta\\ 179-12 2t 6-26 VB - July 8, 1985 45d k2it J. DALE BIMSON CIII TTO@@E, MU@ICIPAI CR@TE@ VI@311.1. BEAC@, "@GINI@ 23456-9--@z (8041 421-4E'l CERTIFICATE OF VESTING OF TITLE 1, Kevin J. Cosgrove, Assistant City Attorney for the City of Virginia Beach, Virginia, do hereby certify that: 1. I am an attorney-at-law and represent the City of Virginia Beach, Virginia, the Petitioner. 2. If the below-described property is discontinued, closed, and vacated by the CC)uncil of the City of Virginia Beach, Virginia, then title to said property will vest in the adjacent prope rt@, owners, Richard S. and Aiice P. Pittman. The said propert@, referred to herein is hereby described as follows: That certain section of Claud-@a Drive, more particularly described as follows: Beginning at a point on the southern right-of-way liiie of Claudia Drive at a point 39.71 feet from the southern boundar,.7 line of lot 57, as showii on the plat C)f Lakeview Park, recorded in the Office of the Clerk of the Circuit Court of the City of Virqinia Beach, in Map Book 29, at Page 67, and from said k,oint of beginning continuing along the southern right-of-way line of Ciaudia Drive south 24@ 52' 40" east a distanc(-, of 60 feet tc) a point, and preceding aloliq the same said right-of-w@y iine on an arc 21@ 24' 15" for a distaiice of 93.39 feet to a point, thence coll- tinuing alojig aii arc 79@ 08' 31" a distance of i.ly 8, 1985 - 45e - 62.16 fect to a point, and cc)ntinuing along a curve of 32@ 56' 47" a distance of 57.50 feet to a point, and continuing along an arc 107@ 321 50" a distance of 375.41 feet to the point of beginning as shown on the above-referenced plat. -2- July 8, 1985 - 45f - IN THE MATTER OF THE CIOSING, VACATING, AND DISCONTINUING OF A PORTION OF THAT CERTAIN STREET KNOWN AS CLAUDIA DRIVE, AS SHOWN ON THAT CERTAIN PLAT ENTITLED "PLAT SHOWING PROPERTY TO BE EXCHANGED BETWEEN THE CITY OF VIRGINIA BEACH AND RICHARD S. AND ALICE P. PITTMAN BAYSIDE BOROUGH VIRGINIA BEACH, VIRGINIA," WHICH PLAT IS AVAILABLE FOR REVIEW IN THE OFFICE OF THE CITY ATTORNEY, MUNICIPAL CENTER, VIRGINIA BEACH, VIRGINIA P E T I T I 0 N TO: THE HONORABLE MAYOR AND MEMBERS OF VIRGINIA BEACH CITY COUNCIL: Your Petitioner, City of Virginia Beach, Virginia, respectfully represents as follows: 1. That pursuant to the provisions of SS15.1-364, Code of Virqinia, 1950, as amended, your Petitioner applies for the vacatinq, closing, and discontinuance of Claudia Drive as shown on that certain plat entitled "PLAT SHOWING PROPERTY TO BE EXCHANGED BETWEEN THE CITY OF VIRGINIA BEACH AND RICHARD S. AND ALICE P. PITTMAN BAYSIDE BOROUGH VIRGINIA BEACH, VIRGINIA,', prepared by the Bureau of Surveys and Mapping, Enqineerinq Division, Department of Public Works, dated May 9, 1984. That certain section of Claudia Drive, more particularly described as follows: Beginning at a point on the southern right-of-way line of Claudia Drive at a point 39.71 feet from the southern boundary line of lot 57, as shown on the plat of Lakeview Park, recorded in the Office of the Clerk of the Circuit Court of the City of virginia Beach, in Map Book 29, at Page 67, and from said point of beginning July 8, 1985 - 45g - continuing along the southern riqht-of-way line of Claudia Drive south 24- 52, 40" east a distance of 60 feet to a point, and precedinq along the same said riqht-of-way line on an arc 21* 24' 15" for a distance of 93.39 feet to a point, thence continuing along an arc 79* 081 3111 a distance of 62.16 feet to a point, and continuing alonq a curve of 32* 561 47" a distance of 57.50 feet to a point, and continuinq alonq an arc 107* 32' 50" a distance of 375.41 feet to the point of beginning as shown on the above-referenced plat. The above plat is available for review in the Office of the City Attorney, Municipal Center, virginia Beach, virginia. 2. That the closure of the aforedescribed street is requested to facilitate the realignment of the right-of-way at the intersection of Claudia Drive. 3. That no inconvenience will result to any persons by reason of said closing, vacation, and discontinuance of said streets. 4. That on the and days of 1985, Notice 6f the presenting of this Application to City Council for appointment of Viewers was published in the Virqinia Beach Sun News, a publication having general circulation throughout the City. 5. That Richard S. and Alice P. Pittman are the fee simple owners of all land along and adjacent to and affected by said portion of the platted street to be closed and, -2- July 8, 1985 45h - consequently, are the only landowners to be affected by the same. CITY OF VIRGINIA BEACH, VIRGINIA By -ff &Ilqof r ns Kevin J. Cosgrove Assistant City Attorney Municipal Center virginia Beach, Virginia 23456 (23.1) -3- July 8, 1985 45i z City of Virginia Beacii closure of a portion of Claudia Drive - Bayside Borough July 8, 1985 - 46 - Item II-J.10 CONSENT AGENDA ITEM # 23937 Upon motion by Couiicilmaii Baum, secoiided by Councilwomati Creech, City Council ADOPTED aii Ordiiiaiice authorizing Tax Refunds in the amount of $2,529.48 upon application of Certain Persoils alid upon certification of the City Treasurer for Paymeiit. Voting: 11-0 Couilcil Meinbers Votiiig Aye: Johii A. Baum, Naiicy A. Creech, Robert E. Fentress, Mayor Harold Heischober, Barbara M. Heiiley, H. Jack Jennings, Jr., Louis R. Jonesl Robert G. Joiies, Vice Mayor Reba S. McClaliall, J. Henry McCoy, Jr., D.D.S., and Meyera E. Oberndorf. Couticil Members Votiiig Nay: None Couiicil Members Abseiit: None *Verbal Aye July 8, 1985 ORM NO. C.A- 7 46a - 6/21/85 EMC AN ORDINANCE AUTHORIZING TAX REFUNDS UPON APPLICATION OF CERTAIN PERSONS AND UPON CERTIFICATION OF THE TREASURER FOR PAYMENT BE IT ORDAINED BY THE COUNCIL OF THE CITY OF VIRGINIA BEACH, VIRGINIA: That the following applications for tax refunds upon certification of the Treasurer are hereby approved: NAME Tax Type Ticket Exonera- Da!e Penalty lnt. Total Year of Tax Number tion No. paid R G & Frances R Moore 84 RE(1/2) 60107-5 12/5/83 1,874.80 Earl T Hayden 82 RE(1/2) 34222-2 12/5/81 7.20 Earl T Hayden 82 RE(2/2) 34222-2 6/5/82 7.20 Edward R & Janet Klocko 85 pp 89466-7 5/21/85 30.00 Stanley L & Patricia Camin 85 pp 25446-6 5/16/85 30.00 Ronald A & Elaine Baker 85 pp 7491-8 5/24/85 22.50 Keith M Sutyar 84 pp 148363-6 6/5/84 30.00 Raymond S Murden 84 pp 109620-7 5/23/84 28.68 Harold & Nancy Huff 84 pp 56828-0 7/2/84 205.56 Jack G Vaughan 84 pp 203247-0 12/5/84 199.50 Craig A Rosenberg 84 pp 213891-9 5/29/84 20.52 Effie T Gardner 84 pp 55570-2 5/22/85 42.52 Sullivan Leasing Co N/A Pkng 48896 6/11/85 20.00 Matthew Rogers N/A Pkng 47986 6/23/85 5.00 Jane C Chitty N/A Pkng 94084 6/12/85 6.00 Total 2,529.48 This ordinance shall be effective trom date of adoption. The above abatement(s) totaling C, were approved by the Council of the City of Virginia Beach on the 8 day of 1985. Jo --- App ved as to form: Ruth Hodges Smith City Clerk july 8, 1985 - 47 - Item II-J.11 CONSENT AGENDA ITEM # 23938 ADD-ON Upoii motion by Councilmaii Baum, secotided by Councilwoman Creech, City Council APPROVED the LOW BID of ASPHALT ROADS & MATERIALS COMPANY, INC., in the amount of $343,402.80 for the BITUMINOUS CONCRETE IFAINTENANCE RESURFACING SCHEDULE; AND, AUTHORIZED the City Manager to enter iiito the necessary agreements for the implementation of this project. Voting; 11-0 Council Members Voting Aye: John A. Baum, Nancy A. Creech, Robert E. Fentress, Mayor Harold Heischober, Barbara M. Henley, H. Jack Jennings, Jr., Louis R. Jonest Robert G. Jones, Vice Mayor Reba S. McClaliati, J. Henry McCoy, Jr., D.D.S., and Meyera E. Oberndorf. Couiicil Members Voting Nay: None Council Members Absent: None *Verbal Aye July 8, 1985 - 48 - Item II-J.12 ITEM # 23939 CONSENT AGENDA ADD-ON Upon motion by Couiicilman Baum, seconded by Councilwoman Creech, City Council APPROVED the LOW BID of SLURRY PAVERS, INC. in the amount of $166,513.23 for the 1985-86 Et4ULSIFIED ASPHALT SLURRY SEAL SCHEDULE; AND, AUTHORIZED the City Mailager to enter iiito the necessary agreements for the implementation of this project. Voting: 11-0 Council Members Voting Aye: John A. Baum, Naiicy A. Creech, Robert E. Feiitress, Mayor Harold Heischober, Barbara M. Heiiley, H. Jack Jennings, Jr., Louis R. Jones# Robert G. Jones, Vice Mayor Reba S. McClanan, J. Henry McCoy, Jr., D.D.S., aiid Meyera E. Oberndorf. Couiicil Members Voting Nay: None Council Members Absent: None *Verbal Aye July 8, 1985 - 49 - Item II-L.1 UNFINISHED BUSINESS ADD-ON BACK BAY STUDY COMMISSION ITEM # 23940 Councilwoman Henley referenced the request of City Council to have the BACK BAY STUDY COMMISSION priortize their recomendations for pre5etitation. Councilwoman Henley advised the Commissioii is awaiting word from the GAME COMMISSION as to whether they will participate in funding the RELOCATION OF THE Pump. The priorities of the BACK BAY COMMISSION depeiid upoii this particular aspect as to the extent of the GAME COMMISSION's participation. BY CONSENSUS, City Council SCHEDULED for the Meetiiig of August 12, 1985, the PRIORITIES of the BACK BAY STUDY COMMISSION. Item II-L.2 UNFINISHED BUSLNESS ADD-ON O.W.L. LTD. ENCROACHMENT ITEM # 23941 Couiicilman Robert Joiies referenced the Ordiiiaiice to authorize a temporary ENCROACHMENT iiito a portion of the rights-of-way of MILL DAM ROAD and BRIARCLIFF LANE to O.W.L., LTD. (See Item II-J.7 of the Coiiselit Agenda). Couiicilmaii Robert Jones complimeiited them on the constructioll of the magiiificent brick wall oil BRTGHTON ON THE BAY. Item II-L.3 UNFINISHED BUSINESS ITEM # 23942 ADD-ON "DOG KILLING DOMESTIC ANIMALS ORDINANCE" Couiicilwomaii Oberudorf requested City Council advise the City Attorney to prepare an appropriate ADDENDLTM to the Ordiiiaiice to Add Sectioii 5-51 of the Code of the City of Virginia Beach pertainiiig to DOG KILLING DOMESTIC ANIMALS. This Ordinance was ADOPTED oii July 1, 1985. BY CONSENSUS, City Couiicil will consider a proposal to amend this aforemelitioiied Ordinance to clarify that same will iiot affect those DOGS whose territorial rights are affected by feiices or property security. July 8, 1985 - 50 - Item II-M.1 NEW BUSINESS PROPOSED FLYOVER ITEM # 23943 INDEPENDENCE BOULEVARD/BAXTER ROAD BY CONSENSUS, City Couiicil RESCHEDULED Presentation of PROPOSED FLYOVER - ROUTE 44 - INDEPENDENCE BOULEVARD/BAXTER ROAD. Councilman McCoy advised that Couiicil realized this PROPOSED FLYOVER would affect property owners along this particular section, but Council was unable to proceed uiitil they are informed by the State as to whether they can assist in establighing this FLYOVER. July 8, 1985 - 51 - Item II-M.2 NEW BUSINESS CREATIVE DESIGNS CONDITIONAL USE PERMIT ITEM # 23944 Upon motion by Councilmaii Robert Joiies, secotided by Councilwomai Oberndorf, City Council SCHEDULED for August 5, 1985, RECONSIDERATION of a Coiiditioii i@i the application of CREATIVE DESIGNS for a Coliditional Use Permit. This Coiiditional Use Permit was APPROVED on Jutie 24, 1985, alid the condition to be AMENDED is as follows: Approval shall be for a limitatioii of tweiity years. Voting: 10-0 Council Members Voting Aye: John A. Baum, Nancy A. Creech, Robert E. Fentress, Mayor Harold Heischober, Barbara M. Heiiley, Louis R. Joiies, Robert G. Joiies, Vice Mayor Reba S. McClaiiaii, J. Henry McCoy, Jr., D.D.S., atid Meyera E. Oberiidorf Couiicil Members Voting Nay: None Couiicil Members Absetit: H. Jack Jeiiiiitigs, Jr. July 8, 1985 - 52 - Item II-N.1 RECESS INTO EXECUTIVE SESS10N ITEM # 23945 In accordaiice with Sectioii 2.1-344, Code of Virgiiiia, as ameiided, aiid upoii motioii by Couiicilwoma.i Creech, secolided by Couiicilman Baum, City Couticil voted to RECESS into EXECUTIVE SESSION for discussioii of Personnel Matters, and Legal Matters, after which to returil to Regular Sessioii to consider appoilitments to City ageiicies (5:05 p.m.) Votiiig: 11-0 Council Members Voti,ig Aye: Johii A. Baum, Nancy A. Creech, Robert E. Fentress, Mayor Harold Heischober, Barbara M. Henley, H. Jack JetitiiLigs, Jr., Louis R. Joiies, Robert G. Joiies* Vice Mayor Reba S. McClanan, J. Henry McCoy, Jr., D.D.S., and Meyera E. Oberndorf. Council Members Voti,ig Nay: Notie Council Members Absetit: None *Verbal Aye July 8, 1985 - 53 - Item II-K.1 APPOINTEMENTS ITEM # 23946 By CONSENSUS, City Couiicil RESCHEDULED the following APPOINTMENTS: PLANNING COMMISSION july 8, 1985 - 54 - Item II-K.2 APPOINTMENTS ITEM # 23947 Upon NOMINATION by Councilman Robert Jones, City Council APPOINTED to the LOCAL GOVERNMENT STUDY COMMISSION the following: Thomas Aiken Jack Barnes Anne F. Bright Edmund D. Carlsoti Robert B. Cromwell, Jr. F. Reid Ervin Richard D. Guy Robert A. Lawson, Jr. Robin R. Reese Robert M. Stanton George Vakos AND AUTHORIZED the services of Professor Clifton McCleskey, Uuiversity of Virgiriia, Charlottesville, Virginia, as ADVISOR to the Commission at a fee of Two Hulidred Fifty ($250) Dollars per day, NOT TO EXCEED Two Thousand ($2,000) dollars, PLUS a per them of Seventy-Five ($75) Dollars for travel, lodgiiig alid meals. Voting: 11-0* Couiicil Members Votitig Aye: John A. Baum, Nancy A. Creech, Robert E. Fentress, Mayor Harold Heischober, Barbara M. Henley, H. Jack Jeliniligs, Jr., Louis R. Jones, Robert G. Joiies, Vice Mayor Reba S. McClanan, J. Henry McCoy, Jr., D.D.S., and Meyera E. Oberndorf. Council Members Voting Nay; None Council Members Absetit: None *VERBAL VOTE July 8, 1985 - 55 - Item 11-N.2 ADJOURNMENT ITEM # 23948 UpoLi motio@i by Couiicilmati Jetiiiitigs, atid BY ACCLAMATION, City Cou@icil ADJOURNED tlie meeti,ig at 6:15 p.m. Beverly OIF'Hooks Chief Deputy City Clerk @h Hodges Sm-ith, CMC Mayor -Harolci Hei City Clerk City of Virgiiiia Beacli Virgi,iia /bli