Benefit Structure Clause Samples
The Benefit Structure clause defines the specific types and levels of benefits that are provided under an agreement, such as insurance or employee benefit plans. It outlines what benefits are available, who is eligible to receive them, and any conditions or limitations that apply. For example, it may detail coverage amounts, waiting periods, or exclusions for certain services. This clause ensures that all parties have a clear understanding of the benefits offered and helps prevent disputes by setting precise expectations regarding entitlements.
Benefit Structure a. Maximums: $1,000 per person per year (January 1 through December 31) Orthodontia: $2,000 lifetime per person Preventive: Twice per year
b. Deductible: Preventive $0 Basic Benefits $0 Prosthetics $0 Orthodontia $0 c. Co-Insurance*: Preventive 100% Basic Benefits 50% Major Services 50% Orthodontia 65% * Reimbursement Subject to Reasonable and Customary Fee.
Benefit Structure. 10.2.1 To those qualifying for The Plan under §10.1 of this Article after December 31, 2013, The Plan will pay up to 100% of the Anthem HMO Select amount for the appropriate tier rate effective July 1, 2014, as well as dental and vision. Those retirees receiving benefits under The Plan on December 31, 2014 will have their District contribution “grandfathered in” as their base rate with annual adjustments applied as detailed in 10.2.2 and 10.2.3 of this Article.
10.2.2 The percentage of the District contribution paid by The Plan for retirees will be determined as follows: Retiring at age 60-64: Plan pays 100% Retiring at age 59: Plan pays 95% Retiree pays 5% Retiring at age 58: Plan pays 90% Retiree pays 10% *Retiring at age 57: Plan pays 85% Retiree pays 15% *Retiring at age 56: Plan pays 80% Retiree pays 20% *Retiring at age 55: Plan pays 75% Retiree pays 25% This concept is the same as the State Teachers Retirement System: Full benefits are available at age 60, lesser benefits with earlier retirement. Those retiring before age 60 will receive benefits for more years than those retiring at age 60 or beyond, thus receiving more actual dollars in benefits, even though they are receiving a lower percentage of compensation.
10.2.3 If the annual premium increase is 10% or less, The Plan will pick up half of that increase and the retiree will pick up the other half. If the annual premium increases by more than 10%, the retiree will also pay the remainder of the premium increase over 10%. For example, consider the base at exactly $4000 for simplicity. If the premium increases 5%, or $200, The Plan will pick up $100 and the retiree will pick up the other $100, the same as it is now. If the premium increases 10%, or $400, The Plan will pick up $200 and the retiree will pick up the other $200, the same as it is now. If the premium increases 15%, or $600, The Plan will pick up $200 and the retiree will pick up the other $400.
10.2.4 The Plan will be reviewed annually in terms of the fund balance, the number of retirees on The Plan, and the number of new retirees joining The Plan. As it becomes necessary, District funds (lottery or other) will be considered in order to keep The Plan solvent.
10.2.5 The level of coverage is to be determined annually by the DTA Council upon the recommendation of the Retiree Health Benefits (Plan) Committee.
10.2.6 The coverage included in The Plan shall be for both the retired employee and spouse. Any additional fees for upgrades or su...
Benefit Structure a. Maximums: $1,000 per person per policy year (January 1 - December 31) Orthodontia: $2,000 lifetime per person Preventive: Twice per policy year
b. Deductible: Preventive: $0 Basic Benefits: $0 Major Services: $0 Orthodontia: $0 c. Co-Insurance*: Preventive: 100% UCR Basic Benefits: 50% UCR Major Services: 50% UCR Orthodontia: 65% UCR d. Description of Benefits:
Benefit Structure. If you are currently retired and collecting a monthly benefit, complete Section 2. • If you are not yet collecting a benefit, complete Section 3.
Benefit Structure. District shall provide a health and welfare benefit 4 program for all unit members who have a regular job assignment 5 of twenty (20) or more hours per week. The District will provide 6 up to the maximum contributions for each tier for the following 7 coverages:
Benefit Structure. 3 The District shall provide a health and welfare benefit program for all unit members who 4 have a regular job assignment of twenty (20) or more hours per week. The District will provide up 5 to the maximum contributions for each tier for the following coverages:
6 a. Medical/vision insurance
7 b. Chiropractic
8 c. Dental insurance
9 d. Long-term Care
10 e. Life insurance ($50,000 term)
11 f. Employee Assistance Program
12 g. Long-term disability insurance 13 Effective with the 2018 benefits year, health benefit plans will be available through the California 14 Schools Voluntary Employee Benefits Association ("VEBA"). The medical plans available 15 through VEBA are (Kaiser & United HealthCare), dental (Delta Dental), vision (VSP), and EAP 16 (Optum). Effective November, 2019, VEBA will also offer a Harmony plan.
17 1. The District shall pay 100% of the employee only premiums for Kaiser, United 18 Health care Network 1, Harmony and Alliance HMO plans.
19 2. For the United Health Care Network 2 the District shall pay the employee only 20 premium of the United Health Care Network 1 plan, and the employee shall pay 21 the remaining premium difference for the Network 2 plan.
22 3. For the employees selecting coverage with dependents (encompasses all tiers to 23 include spouse, children, and family), the District will pay 80% of the employee 24 and dependent premiums of the United Health Care Network 1 and Kaiser plans.
25 4. For the employees selecting coverage with dependents ((encompasses all tiers to 26 include spouse, children, and family) in the United Health Care Network 2 and 27 Alliance HMO plans, the District will pay an amount equal to 80% of the 28 employee and dependent premiums of the United Health Care Network 1 plan, and 1 the employee will pay the remaining premium difference for the Network 2 and
Benefit Structure. There shall be an employee co-payment of twenty-five dollars. Service intervals are as follows: