Laserfiche WebLink
<br />SECTION I-SCHEDULE OF EXCESS WSS INSURANCE <br />(hereinafter referred to as the "Schedule") <br /> <br />POUCYHOLDER.: City of La Porte <br /> <br />ADDRESS: 604 West FairmODt Pal"kway <br />LaPorte, TX 77571 <br /> <br />ADMINISTRATOR.: Tens M1IDiclpal League IEBP <br /> <br />ADDRESS: 1821 Rndaerford Lane, S1dte 300 <br />ADstiD, TX 78754 <br /> <br />AIL AMOUNTS AND NUMBERS SHOWN IN TIllS SCHEDULE APPLY ONLY TO THE POllCY <br />PERIOD JNEFFECl'. ANEW Sr.mmULE WllLBB ISSUED FOR EACHNEWPOUCY PERIOD. <br /> <br />A. X AGGREGATE EXCESS LOSS INSURANCE: <br /> <br />1. BENEFITS COVERED: <br /> <br />x... Medical Dental <br />x.. Prescription DJUg Card <br /> <br />2. POLICYBASlSIBENEFIT PERIOD: <br /> <br />_ Week:1yJncome <br /> <br />Vision <br /> <br />Eligible Expenses IncDrrcd frOm _10/01/03_ through 03/31105; and <br /> <br /> <br />Eligible Expenses Paid ftom 04101104 through _ 0313lJOS <br /> <br />If this Policv terminsdeA prior to the Ex,pimtion Date. no. A22reeate Excess Loss Ben.e:6.1s <br />will be paV8ble and premimn paid will not be refundable. . <br /> <br />3. JNII'IAL AGGREGATE A'ITACBMENT POINT: $3.426.277.00 <br /> <br />4. MINlMUM AGGREGATE A1TACBMENT POINT: $3.426.277.00 <br /> <br />s. BENEFIT PERCENTAGE PAYABLE ~ ACCORDANCE WITH SECrION 3: 100% <br /> <br />. . <br />~. MAXIMUM AGGREGATE BENEFIT (WHILE COVERED, AND WHILE THIS <br />POLICY IS IN FORCE): . $1.000..000 <br /> <br />7. AGGREGATE MONmLYFACTOR(S): Single: S313A2 Family: S940.25 <br />Composite: <br />. Covered UnitslenroDmcnt: <br />Single: _143~Family:_256_ <br />Composite: _399_ . <br /> <br />SL-2001 <br /> <br />3 <br /> <br />(6101) <br />