Basic Plan. By-Law A.-3571-328 June 16, 1994: The Corporation of the City of London elected to participate in the Ontario Municipal Employees Retirement System. 1987 - 85 Factor introduced for NRA 60 1991 - Introduction of a 30 Year Early Retirement Provision 1992 - Contributions cease after 35 years The following pension by-laws shall form supplements to this agreement:
Basic Plan. The basic insurance program shall include a $10.00 generic/$40.00 Brand name prescription drug rider with the Blue Care Network Two Tier Closed Formulary Plan, with contraceptive coverage.
Basic Plan. All services are subject to an annual deductible of $50 per person and $100 per family. Preventive services are covered at 100%. After paying the deductible, the plan provides usual, customary, and reasonable (UCR) coverage at 100% for diagnostic and restorative services, and 80% for major services. Orthodontia is not covered.
Basic Plan. During the term of this Agreement, Basic Plan health insurance benefits shall be the same as the Basic Plan benefits that were provided in the 2007-2009 City/Union Agreement, and as follows:
a. Every medical procedure that can be performed on an outpatient basis shall not be covered by these benefits when the procedure is performed on a hospital inpatient basis. Procedures that can be performed on an outpatient basis that are done on an inpatient basis in conjunction with other procedures requiring inpatient status, or any procedures performed on an inpatient basis that constitute a medically verifiable exception (as determined by the Pre-Admission Review Contractor) to the requirement that it be performed on an outpatient basis, shall be covered.
b. Existing benefits provided under the "Hospital Surgical-Medical Contract Base Coverage" part of the Basic Plan for inpatient hospital treatment of alcoholism, drug abuse and nervous and mental disorders, shall be available to each participant for a maximum of thirty (30) days during any one calendar year. For inpatient hospital treatment of nervous and mental disorders only, an extension to such maximum of no more than 30 additional days during the calendar year may be allowed where such extension is medically justifiable. All other provisions in respect to such benefits shall remain unchanged. Existing benefits provided under the "Major Medical Coverage" part of the Basic Plan for inpatient hospital treatment of alcoholism, drug abuse and nervous and mental disorders shall remain unchanged.
c. The maximum aggregate allowance limitation per participant during each calendar year on benefits providing outpatient services for alcoholism, drug abuse and nervous and mental disorders rendered in the outpatient department of a hospital or in an outpatient treatment facility, or a physician' s office that are provided under the "Hospital Surgical-Medical Contract Base Coverage" part of the Basic Plan shall be $2,000. All other provisions in respect to such benefits shall remain unchanged. Existing benefits provided under the "Major Medical Coverage" part of the Basic Plan for benefits that provide outpatient services for alcoholism, drug abuse and nervous and mental disorders rendered in the outpatient department of a hospital or in an outpatient treatment facility shall remain unchanged, including the current maximum benefits provided under the "Major Medical Coverage" part of the Basic Plan for benefits for professi...
Basic Plan. All services are subject to an annual deductible of $25 per person and $75 per family. After paying the deductible, the plan provides usual, customary, and reasonable (UCR) coverage at 100% for preventive, diagnostic, and restorative services and 80% for major services. Orthodontia is not covered.
Basic Plan. Each five-unit block of approved course work is worth $10.00 per month during months worked for eight hour per day employees. Pay is prorated for those who work less time except that no part-time employee shall receive less than $5.00 per month for each five- unit block during months worked.
Basic Plan. The basic insurance program shall include a $10.00 generic/$40.00 Brand name prescription drug rider with the Blue Cross/Blue Shield Two Tier Closed Formulary Plan, with contraceptive coverage. The Community Blue PPO Plan III consists of a $250.00 deductible per person per year, with a limit of $500.00 per family per year. After the deductible portion is met, the employee is responsible for a 20% co-pay on covered charges up to a maximum of $2,000.00 per year.
Basic Plan. The main body of a plan; a basic plan is a primary document and may include attachments, appendices and annexes. Attachment: A supplementary document that is necessarily attached to a primary document in order to address deficiencies; inclusion of an attachment is necessary for a primary document to be complete.
Basic Plan. During the term of this Agreement, Basic Plan health insurance benefits shall be the same as the benefits provided in the 2003 City/Association Agreement except for the following changes in these benefits:
(1) Every medical procedure that can be performed on an outpatient basis shall not be covered by these benefits when the procedure is performed on a hospital inpatient basis. Procedures that can be performed on an outpatient basis that are done on an inpatient basis in conjunction with other procedures requiring inpatient status, or any procedures performed on an inpatient basis that constitute a medically verifiable exception (as determined by the Utilization Review Contractor) to the requirement that it be performed on an outpatient basis, shall be covered.
(2) A Utilization Review Case Management (UR/CM) Program shall cover all elective procedures. Elective procedures subject to the UR/CM program shall include all treatments for mental health disorders and substance abuse and home health care services. The program would be an independent review that assures each patient that the proposed hospitalization is necessary, based upon the medical condition of the patient, delivered in the most appropriate medical setting (inpatient or outpatient) and fair and equitably priced. Whenever an elective procedure is recommended for an employee, or his/her dependents, by a physician, the employee shall be required to notify the designated UR/CM program representative of this fact by telephone at the time such procedure is recommended, in accordance with procedures established by the Employee Benefits Manager for that purpose. Any elective procedure not submitted to the designated UR/CM program representative shall not be covered by these benefits. UR/CM shall determine whether or not a procedure is elective. Within 48 hours of the hospital admission time for any urgent or emergency procedure performed on an employee, or his/her dependents, the employee or adult responsible for him/her, shall be required to notify the designated UR/CM program representative of this fact by telephone in accordance with procedures established by the Employee Benefits Manager for that purpose; provided however, that if bona fide medical circumstances applicable to the employee preclude compliance with the 48-hour notification requirement, UR/CM shall authorize reasonable extension of this time limit consistent with such medical circumstances or the availability an adult responsible for...
Basic Plan. After an annual deductible of $50 per person, $150 per family, this plan pays 80% of covered preventive, diagnostic and restorative services and 60% of covered prosthodontic services to a yearly maximum of $500 per person. Orthodontia is not covered.
