Appendix C/Benefits Summary. Section 8 and 9 Short Term Disability
Appendix C/Benefits Summary Sample Clauses
Related to Appendix C/Benefits Summary
Description of Benefits The benefits available under this Plan will be as defined in Item F(5) of the Adoption Agreement.
Summary of Benefits Plan Feature Employee Co-pay - Network Only Preventive and Diagnostic Services • Examination • Cleaning • x-rays $0 $0 $0 Minor Restorative • Fillings and extractions • Oral surgery • Endodontic services1 • Periodontal services1 $0 $40-$196 based on specific service $45-$310 based on specific service $25-$145 based on specific service 1 Additional employee co-pay if approved specialist performs services. Major Restorative • Crowns • Bridges • Complete Dentures $92-$190 based on specific service $115-$291 based on specific service $249-$264 based on specific service Complete Orthodontics $1,850 co-pay D PPO “Buy Up” Option (Voluntary) Summary of Benefits Plan Feature In Network/Out of Network Class I (Preventative) 100%/100% Class II (Basic/Restorative) 80%/80% Class III (Major) 60%/60% Class IV (Orthodontia - adult ortho is included) 50%/50% Annual Deductible per Member (does not apply to Class I services) $50/$50 Orthodontia Lifetime Max $1,500/$1,500
Program Benefits Under the Probation Status, the Participating Contractor will be eligible for all contractor incentives, its customers will have access to financing offered through the Program, and income- eligible households will be eligible to receive Program incentives.
Explanation of Benefits Contractor shall send each Enrollee an Explanation of Benefits to Enrollees in Plans that issue Explanation of Benefits or similar documents as required by Federal and State laws, rules, and regulations. The Explanation of Benefits and other documents shall be in a form that is consistent with industry standards.
Predetermination of Benefits If charges for a planned course of treatment by a licensed dentist would exceed $300.00, proposed details and x-rays should be submitted to the Plan Administrator for approval. Failure to do so may result in a payment of a lesser benefit amount because of the difficulty in determining the need for such treatment after it has been provided. Dental x-rays will be promptly returned to the dentist.
Workplace Safety Insurance Benefits (WSIB) Top Up Benefits If the employee is in a class of employees that, on August 31, 2012, was entitled to use unused sick leave credits for the purpose of topping up benefits received under the Workplace Safety and Insurance Act, 1997;
Compensation Schedule Except as otherwise provided herein, employees shall be compensated within the pay range assigned to the classification of the position in which they are employed and in accordance with the pertinent conditions of employment enumerated in this Agreement. Sec. 503 REGULAR PAY DAY: Employees shall be paid on or about the Friday following the end of the biweekly payroll period.
Effective Date of Benefit Termination Medical, dental and life coverage termination will take effect on the first of the month following the loss of eligible employee or dependent status. Disability benefit coverage terminations will take effect on the day following loss of eligible employee status.
APPENDIX F Appendix F, HBITS Processes and Forms, attached hereto, is hereby expressly made a part of this Contract as fully as if set forth at length herein. The Parties agree that the processes and forms set forth in this appendix may be updated as necessary, such as to facilitate the development of a web portal or other automated systems. OGS reserves the right to make changes to these processes and forms without seeking the prior written approval of the Department of Law or OSC, however, OGS agrees that any such changes shall comply with the terms and conditions of this Contract and not be material or substantive in nature. The Parties agree that detailed instructions for the completion of these forms shall be set forth in the “How to Use” document presented on the OGS web site or as part of the web portal or other automated system. Form 8, Monthly Report, shall be submitted electronically in Microsoft Excel 2007 or higher format, which will be separately provided by OGS.
Effective Date of Benefits Your coverage will become effective on your date of eligibility, provided you are actively at work on a full time basis. If you are not actively at work on the date insurance would normally commence, coverage will begin on your return to work full time for full pay.
