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GROUP CHOICE GROUP POLICY WITH: 00382 - CITY OF MOSCO\\' EFFECTIVE: November 1, 1996 This Policy made and entered into, effective as of the l s: day of November, 1996. by and between 'l\·1edical Service Bureau of Idahoƒ Inc., Blue Shield of Idaho, a non-profit Idaho corporation, hereinafter called "MSB-Biue Shield". and CITY OF MOSCOW, hereinafter called the "Employer" or ''Group", acting solely as agent for its employees or Insureds_ \Vitnesseth: In consideration of the timely pa::-'ment by the Group or Insureds of the premium st1pulated, MSB-B1ue Shield agrees to fum ish to eligible and enrolled Insureds. benefits for Ɠecessary Medical, SurgicaL and Hospital Services, as hereinafter described, subject wall of the terms, conditions. exclusions, .and limitations hereinafter set fonh. including_ applications for enrollment endorsements, schedules and amendments now or hereinafter anached here!O and'or by reference made part he:-eof GCH-7/96 GROUP GCH-EE7/96 GROUP DC-1/96 GROUP DC-BE-1/96 GROUP VlO GROUP In witness \\·hereof, :he POLICY CHOICE DENTJ...L DENTJ. L VISION *****POLICY ATTACHME:\TS GEN`RAL PROVISIONS Ah SCHEDULE OF BENEFITS - Benefit Endorsaent CARE - General Provisions and Sched'..lle c= Beroefi ts CkRE PLA-b - Benefit Endorsement Cflc PLAd - 10 (Vl0-10/95) hereto caused :his Policy to executed this day of Sovnn ber. 1996. .\'!EDlCAL SERVICE BCREAL OF IDAHO. BLLE SHIELD OF IDAHO Rich Nelson. President CEO GROLP'S ACCEPT A:\CE The terms, conditions, exclusions: and limitations of this Policy are hereby accep1ed. i acknowledge that the arrached Benefits Endorsement pages include ail selected benefit opiions and that any options not specifically listed have not been selected. GCH-GP-7!96 ---PAGE BREAK--- 00382 CITY OF t-10SC0\'J P 0 BOX 9203 t-JOSCOW I D 83843 l-[PHONE REDACTED] SAI..SS EXECUTIVE: !-1IKE tv1l\C DOVJELL GEORGE I REMINGTON EFFECTIVE: 11/0l/96 BENEFITS Sl, OCO CD:' OE' ?OCKE:":"· PREMIUM SCHEDULE w E . ---PAGE BREAK--- ' cal Service Bureau of idaho, inc . BlueShield of ldal1o HEALTHSENSE GROUP POLICY WITH: 50277 - CITY OF MOSCOW EFFECTIVE: November 1, 1996 HealthSense. This Policy· made and entered into, effective as of the 1 s: day of November. 1996, by and between Medical Service Bureau ofidaho. Inc Blue Shield ofidaho, a non-profit Idaho corporation. hereinafter calied "MSB-Biue Shield", and CJTY OF MOSCOW, hereinafter calied the ''Group", acting solely as agent for its employees or Members. \Vitnesseth: In consideration of the timely pa;.'ment by the Group or Members of the premium stipulated, MSB-Blue Shield agrees to furnish to eligible and enrolled Members, benet1ts for 1"ecessary Medical, Surgical, and Hospital Services. as hereinafter described, subject to all of the tenns, conditions, exclusions, and limitations hereinafter set forth, including applications for coverage, endorsements, schedules and amendments nO\V or hereinafter auached hereto and/or by reference made part here-of. *****POLICY ATTACHME?-