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drugs (excluding toiletries, cosmetics and dietary supplements taken for general <br />health), insulin, eyeglasses, hearing aid appliances, and similar prosthetic devices, <br />and medical related transportation expense; provided, however, that Medical Care <br />shall not include any cosmetic procedure that is not medically necessary. <br />(k) "Participant" means an Eligible Employee of the Employer who <br />has satisfied the participation conditions of Article 3. A person who becomes a <br />Participant shall remain a Participant until the eligibility requirements are no <br />longer met. Loss of eligibility shall not have an impact on Participant's ability to <br />receive all benefits due the Participant under the provisions of the Plan while <br />satisfying eligibility requirements. <br />(1) "Payment and Health Care Operations" Payment means activities <br />undertaken by the Employer to obtain premiums or determine or fulfill its <br />responsibility for coverage and provisions of plan benefits that relate to an <br />individual to whom health care is provided. <br />Payment activities include, but are not limited to, the following: <br />i. Eligibility determinations, coverage and cost <br />determinations including co-pays, plan maximums, and sharing of <br />premium amounts; <br />ii. Coordination of benefits determinations; <br />iii. Adjudication of health benefits claims including appeals <br />and other payment disputes; <br />iv. Establishing employee contributions; <br />v. Subrogation of health benefit claims; <br />5 City of Roseville MPD <br />