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KUBES v. AMERICAN MED. SEC.

June 15, 1995

LORI KUBES, Plaintiff,
v.
AMERICAN MEDICAL SECURITY, INC., and UNITED WISCONSIN LIFE INSURANCE COMPANY, Defendants.



The opinion of the court was delivered by: JAMES L. FOREMAN

 FOREMAN, District Judge:

 Before the Court is the defendants' Motion for Summary Judgment (Document No. 15). For the reasons stated more fully below, the Court finds that the motion should be granted insofar as it relates to the claims raised in the plaintiff's complaint.

 I. FACTS

 The basic facts of this case are not in dispute. The plaintiff, Lori Kubes, was covered under a group health insurance policy through her employer, the Center for Comprehensive Services in Carbondale, Illinois. While the plan was in effect, the plaintiff incurred medical expenses related to infertility testing and treatment. The defendants refused to pay the plaintiff's claims, asserting that such charges are excluded from the insurance plan's coverage.

 The insurance policy was issued by defendant United Wisconsin Life Insurance Co. to a multi-employer trust in Alabama. Defendant American Medical Security is the administrator of the insurance policy and the trust. A master policy was issued to the Alabama trust and remains in the trust's possession. The plaintiff was given a certificate of coverage.

 Under the heading "Policy Provisions," the document states that "the Employee certificate of group insurance is hereby attached to and is made part of the Policy. All provisions in the certificate shall hereby apply to the Policy. . . ." The remainder of the document sets forth specific provisions governing the minimum participation requirements for employers, special requirements for employee and dependent insurance, termination of the participating employer, and termination of the policy. It does not list any of the actual benefits provided by the various insurance plans.

 The employee certificate sets forth a detailed description of the benefits under the various insurance programs, as well as enrollment and termination provisions, claims information, and other general provisions. Certain provisions pertinent to this action are highlighted below.

 The definitions section of the certificate states that "POLICY means the group insurance contract under which coverages are provided to Insured Persons. This certificate of group insurance is evidence of that contract." The "General Provisions" section of the certificate includes the following:

 
CERTIFICATE
 
We will issue a certificate to each insured Employee. It summarizes Your rights and benefits under the Policy.
 
ENTIRE CONTRACT; CHANGES
 
The entire contract of insurance consists of the Policy, the Employer group application ...

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