Affecting Active Employees Clause Samples
The "Affecting Active Employees" clause defines how certain terms or actions within an agreement will impact employees who are currently employed and actively working for the company. This clause typically clarifies whether changes—such as modifications to benefits, compensation, or employment conditions—apply to those still on the payroll, as opposed to former employees or those on leave. Its core function is to ensure clarity regarding the scope of contractual changes, preventing misunderstandings about who is subject to new or altered terms.
Affecting Active Employees. 1. Premium Shares shall increase as follows.
a. By 1% 7/1/19, but this shall not increase premium share to over 15%.
b. By 1% 7/1/20 but this shall not increase premium share to over 15%.
c. By 1% 7 /1/21 but this shall not increase premium share to over 16%.
d. Notwithstanding the above, current premium shares which are over the cap for a given year shall neither be raised nor lowered by this agreement.
2. Design Changes to Save Money and Improve Health. The parties shall implement the following changes as soon as administratively feasible.
Affecting Active Employees. 1. Premium Shares shall increase as follows.
a. By 1% 7/1/19, but this shall not increase premium share to over 15%.
b. By 1% 7/1/20 but this shall not increase premium share to over 15%.
c. By 1% 7/1/21 but this shall not increase premium share to over 16%.
d. Notwithstanding the above, current premium shares which are over the cap for a given year shall neither be raised nor lowered by this agreement.
2. Design Changes to Save Money and Improve Health. The parties shall implement the following changes as soon as administratively feasible.
a. Implement the CVS/Caremark standard formulary. The member’s doctor is final appeal step if the doctor certifies non-formulary drug is medically necessary. The parties may substitute the formula of another PBM provider as applicable through the normal RFP process.
b. Non-HEP drugs co-pays shall go to $5/10/25/40. First two tiers are clinically equivalent generics, with the first to incent choosing lower priced generics. The next two tiers are preferred and non-preferred brand names. The co-pays for drugs prescribed to treat conditions under the HEP Chronic Disease Program shall not be affected by this change. There shall be no change to current physician waiver process.
c. The co-pay for unnecessary emergency room visits increase to $250; current waiver rules shall apply.
d. The Plan’s Physical and Occupational Therapy (“PT/OT”) medical necessity standard shall be implemented consistently through a utilization management program.
e. Adopt a Design structure that encourages treatment choice of high quality, high value providers by:
i. Vendor recommended ranking of primary care doctors and specialists to reduce co-pays for high value providers. Current co-pays remain for all other providers
ii. “Smart shopper” provides rebates for numerous procedures based on quality and safety standards and cost of provider. Non smart-shopper providers remain at current cost.
iii. “Site of service” continues 100% coverage for all labs, diagnostic, and high cost imaging, for preferred in network labs, institutes higher co-share for non - preferred and of non-network labs. Statewide coverage required for preferred labs.
iv. Specifications for the above three changes are set forth in Attachment A, below.
Affecting Active Employees. 1. Premium Shares shall increase as follows.
a. By 1% 7/1/19, but this shall not increase premium share to over 15%.
b. By 1% 7/1/20 but this shall not increase premium share to over 15%.
c. By 1% 7/1/21 but this shall not increase premium share to over 16%.
d. Notwithstanding the above, current premium shares which are over the cap for a given year shall neither be raised nor lowered by this agreement.
2. Design Changes to Save Money and Improve Health. The parties shall implement the following changes as soon as administratively feasible.
a. Implement the CVS/Caremark standard formulary. The member’s doctor is final appeal step if the doctor certifies non-formulary drug is medically necessary. The parties may substitute the formula of another PBM provider as applicable through the normal RFP process.
b. Non-HEP drugs co-pays shall go to $5/10/25/40. First two tiers are clinically equivalent generics, with the first to incent choosing lower priced generics. The next two tiers are preferred and non-preferred brand names. The co-pays for drugs prescribed to treat conditions under the HEP Chronic Disease Program shall not be affected by this change. There shall be no change to current physician waiver process.
c. The co-pay for unnecessary emergency room visits increase to $250; current waiver rules shall apply.
d. The Plan’s Physical and Occupational Therapy (“PT/OT”) medical necessity standard shall be implemented consistently through a utilization management program.
e. Adopt a Design structure that encourages treatment choice of high quality, high value providers by: