Benefit Plan Design. In the event Employer wishes to implement Benefit Plan design changes including, but not limited to, implementation of Coinsurance or increase of Copayment/Deductible, the pricing in the BPA Addendum may no longer be applicable. If such Benefit Plan design changes impact the existing pricing, a new BPA Addendum pricing must be negotiated. Revised pricing proposed by Claim Administrator shall be effective pursuant to Section 6.4 Amending and Ex. 2 Section 3.3 of this Agreement, provided that if Parties cannot agree on the terms of the new BPA Addendum pricing, Employer shall be allowed to (a) proceed to dispute resolution, as set forth in the Agreement or
Benefit Plan Design. C.10.1. Confirm that benefits include annual examination, frames, lenses, and/or contact lenses and some form of indemnified payment to contracted providers for each component of benefits.
Benefit Plan Design. Consultant will help to ensure that benefit designs are consistent with the strategic benchmarks and targets set forth in the strategic benefit planning process.
Benefit Plan Design. In the event Employer wishes to implement Benefit Plan design changes for example implementation of Coinsurance or increase of Copayment/Deductible, the pricing in the BPA Addendum may no longer be applicable. If such Benefit Plan design changes impact the existing pricing, a new BPA Addendum pricing must be negotiated. Revised pricing proposed by Claim Administrator shall be effective pursuant to Section 6.4 Amending and Ex. 2 Section 3.3 of this Agreement, provided that if Parties cannot agree on the terms of the new BPA Addendum pricing, Employer shall be allowed to (a) proceed to dispute resolution, as set forth in the Agreement or (b) terminate this Exhibit with 90 days’ prior written notice to the other Party. Failure to reach agreement on the new Addendum pricing shall not be a breach of contract.
Benefit Plan Design. School District of the City of Harrisburg High Option On the chart below, you'll see what your plan pays for specific services. You may be responsible for a facility fee, clinic charge or similar fee or charge (in addition to any professional fees) if your office visit or service is provided at a location that qualifies as a hospital department or a satellite building of a hospital Benefit In Network Out of Network General Provisions Benefit Period(1) Calendar Year Deductible (per benefit period) Individual Family $250 $500 $1,000 $2,000 Plan Pays – payment based on the plan allowance 100% after deductible 80% after deductible Out-of-Pocket Limit (Once met, plan pays 100% coinsurance for the rest of the benefit period) Individual Family none none $3,000 $6,000 Total Maximum Out-of-Pocket (Includes deductible, coinsurance, copays, prescription drug cost sharing and other qualified medical expenses, Network only) (2) Once met, the plan pays 100% of covered services for the rest of the benefit period. Individual Family $6,350 $12,700 not applicable not applicable Office/Clinic/Urgent Care Visits Retail Clinic Visits 100% after $20 copay One copay per provider per date of service 80% after deductible Primary Care Provider Office Visits & Virtual Visits 100% after $20 copay One copay per provider per date of service 80% after deductible Specialist Office & Virtual Visit 100% after $20 copay One copay per provider per date of service 80% after deductible Virtual Visit Originating Site Fee 100% after deductible 80% after deductible Urgent Care Center Visits 100% after $20 copay One copay per provider per date of service 80% after deductible Telemedicine Services (3) 100% after $20 copay not covered Preventive Care (4) Routine Adult Physical Exams 100% (deductible does not apply) 80% after deductible Adult Immunizations 100% (deductible does not apply) 80% after deductible Colorectal Cancer Screening 100% (deductible does not apply) 80% after deductible Routine Gynecological Exam 100% (deductible does not apply) 80% (deductible does not apply) Routine Pap Smear 100% (deductible does not apply) 80% (deductible does not apply) Mammograms, Annual Routine 100% (deductible does not apply) 80% after deductible Mammograms, Medically Necessary 100% (deductible does not apply) 80% after deductible Diagnostic Services and Procedures 100% (deductible does not apply) 80% after deductible Routine Pediatric Physical Exams 100% (deductible does not apply) 80% after deductible Pe...
