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<br />) <br /> <br />TABLE OF CONTENTS <br /> <br />') <br /> <br />I. <br /> <br />GENERAL..................................................................................................................................................1 <br /> <br />II. INTERPRETATION .................................................................................................................................. 1 <br /> <br />III. DEFINITIONS ........................................................................................................................................... 2 <br /> <br />IV. ELIGIBILITY ............................................................................................................................................ 8 <br /> <br />V. ENROLLMENT....................................................................................................................................... 10 <br /> <br />VI. EFFECTIVE DATE OF MEMBERSHlP..............................................................................................12 <br /> <br />VII. MONTHLY PAYMENTS AND CO-PAYMENTS................................................................................. 12 <br /> <br />) <br /> <br />VIII. CONVERSION ........................................................................................................................................ 13 <br /> <br />IX. TERMINATION ...................................................................................................................................... 15 <br /> <br />X. SCHEDULE OF BASIC BENEFITS ..................................................................................................... 21 <br /> <br />XI. LIMITATIONS OF BASIC BENEFITS ................................................................................................ 28 <br /> <br />XII. EXCLUSIONS FROM BASIC BENEFITS ..........................................................................................30 <br /> <br />XIII. COORDINATION OF BENEFITS ........................................................................................................ 34 <br /> <br />) <br /> <br />XIV. SUBROGATION AND RIGHT OF RECOVERy................................................................................ 36 <br /> <br />XV. DISCLAIMER OF LIABILITY ............................................................................................................. 38 <br /> <br />XVI. GRIEVANCE PROCEDURE ................................................................................................................. 38 <br /> <br />XVII. J\USCELLANEOUS ................................................................................................................................44 <br /> <br />AV-GJOO-2009 <br />MP-5319 (10/09) <br />