Advantage Benefit Chart for Services Incurred During Plan Years 2010 and Sample Clauses

Advantage Benefit Chart for Services Incurred During Plan Years 2010 and. 13 2011 2012 and 2013. 2010 and 2011 2012 Benefit Provision Benefit Level 1 The member pays: Benefit Level 2 The member pays: Benefit Level 3 The member pays: Benefit Level 4 The member pays: Deductible for all services except drugs and preventive care (S/F) $50/$100 $140/$280 $350/$700 $600/$1,200 Office visit copay/urgent care (copay waived for preventive services) 1) Having taken health assessment and opted-in for health coaching 2) Not having taken health assessment or not having opted- in for health coaching 1) $17 2) $22 1) $22 2) $27 1) $27 2) $32 1) $37 2) $42 Convenience Clinic (deductible waived) $10 $10 $10 $10 2010 and 2011 2012 Benefit Provision Benefit Level 1 The member pays: Benefit Level 2 The member pays: Benefit Level 3 The member pays: Benefit Level 4 The member pays: Emergency room copay $75 $75 $75 N/A – subject to Deductible and 25% Coinsurance to OOP maximum Facility copays • Per inpatient admission (waived for admission to Center of Excellence) • Per outpatient surgery $85 $55 $180 $110 $450 $220 N/A – subject to Deductible and 25% Coinsurance to OOP maximum N/A – subject to Deductible and 25% Coinsurance to OOP maximum Coinsurance for MRI/CT scan services 5% 5% 10% N/A – subject to Deductible and 25% Coinsurance to OOP maximum Coinsurance for services NOT subject to copays 5% (95% coverage after payment of deductible) 5% (95% coverage after payment of deductible) 10% (90% coverage after payment of deductible) 25% for all services to OOP maximum after deductible Coinsurance for durable medical equipment 20% (80% coverage after payment of 20% coinsurance) 20% (80% coverage after payment of 20% coinsurance) 20% (80% coverage after payment of 20% coinsurance) 25% for all services to OOP maximum after deductible Copay for three-tier prescription drug plan Tier 1: $10 Tier 2: $16 Tier 3: $36 Tier 1: $10 Tier 2: $16 Tier 3: $36 Tier 1: $10 Tier 2: $16 Tier 3: $36 Tier 1: $10 Tier 2: $16 Tier 3: $36 Maximum drug out- of-pocket limit (S/F) $800/$1,600 $800/$1,600 $800/$1,600 $800/$1,600 Maximum non-drug out-of-pocket limit (S/F) $1,100/$2,200 $1,100/$2,200 $1,100/$2,200 $1,100/$2,200 2013 Benefit Provision Benefit Level 1 The member pays: Benefit Level 2 The member pays: Benefit Level 3 The member pays: Benefit Level 4 The member pays: Deductible for all services except drugs and preventive care (S/F) $75/$150 $180/$360 $400/$800 $1,000/$2,000 Office visit copay/ urgent care (copay waived for preventive services) 1) Having taken health ass...
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Advantage Benefit Chart for Services Incurred During Plan Years 2010 and. 8 2011 2012 and 2013. 2010 and 2011 2012 Benefit Provision Benefit Level 1 The member pays: Benefit Level 2 The member pays: Benefit Level 3 The member pays: Benefit Level 4 The member pays: Deductible for all services except drugs and preventive care (S/F) $50/$100 $140/$280 $350/$700 $600/$1,200 Office visit copay/urgent care (copay waived for preventive services) 1) Having taken health assessment and opted-in for health coaching 2) Not having taken health assessment or not having opted- in for health coaching 1) $17 2) $22 1) $22 2) $27 1) $27 2) $32 1) $37 2) $42 Convenience Clinic (deductible waived) $10 $10 $10 $10

Related to Advantage Benefit Chart for Services Incurred During Plan Years 2010 and

  • Canceling Dependent Coverage During Open Enrollment In addition to the above situations, dependent health or dependent dental coverage may also be cancelled for any reason during the open enrollment period that applies to each type of plan (as long as allowed under the applicable provisions, regulations and rules of the federal and state law in effect at the beginning of the plan year).

  • Interconnection Customer Compensation for Actions During Emergency Condition The CAISO shall compensate the Interconnection Customer in accordance with the CAISO Tariff for its provision of real and reactive power and other Emergency Condition services that the Interconnection Customer provides to support the CAISO Controlled Grid during an Emergency Condition in accordance with Article 11.6.

  • Dependent Care Salary Reduction Plan The Employer agrees to maintain the current dependent care salary reduction plan that allows eligible employees, covered by this Agreement, the option to participate in a dependent care reimbursement program for work-related dependent care expenses on a pretax basis as permitted by federal tax law or regulation.

  • DEPENDENT CARE REIMBURSEMENT ACCOUNT During the term of this MOU, Management agrees to maintain a Dependent Care Reimbursement Account (DCRA), qualified under Section 129 of the Internal Revenue Code, for active employees who are members of LACERS, provided that sufficient enrollment is maintained to continue to make the account available. Enrollment in the DCRA is at the discretion of each employee. All contributions into the DCRA and related administrative fees shall be paid by employees who are enrolled in the plan. As a qualified Section 129 Plan, the DCRA shall be administered according to the rules and regulations specified for such plans by the Internal Revenue Service.

  • Benefit Waiting Period Allowance (a) An employee who qualifies for and takes leave pursuant to 21.1 or 21.2 and is required by Employment Insurance to serve a one-week waiting period for Employment Insurance Maternity/Parental benefits, shall be paid a leave allowance equivalent to one week at 85% of the employee's basic pay.

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