CITY OF HIALEAH SELF-FUNDED GROUP HEALTH PROGRAM BASE PLAN. A. The City will provide a health benefit program that utilizes a managed care approach, commonly referred to as a preferred provider organization (PPO). This managed health care program will provide the employees with a comprehensive health care network. The provider network will consist of doctors, hospitals and other services, including a prescription drug program, who have agreed to offer medical services to employees at reduced negotiated fees. Maximum plan benefits will be received when the employee uses the participating provider network. The In-Network co-payment for doctor office visits are as provided in Exhibit 38A or shall be based on the most current open enrollment memorandum provided to employees as may be amended from year to year based upon the City of Hialeah Risk Management Department’s corresponding open enrollment for its various insurance programs. In-Network co-insurance for doctor visits only will be paid as provided in Exhibit 38A or shall be based on the most current open enrollment memorandum provided to employees as may be amended from year to year based upon the City of Hialeah Risk Management Department’s corresponding open enrollment for its various insurance programs, where the City will reimburse the negotiated charges. When utilizing In-Network providers, benefits will be paid as provided in Exhibit 38A or shall be based on the most current open enrollment memorandum provided to employees as may be amended from year to year based upon the City of Hialeah Risk Management Department’s corresponding open enrollment for its various insurance programs . Should employees utilize Out-of-Network services, they will be responsible for increased deductibles and co-payments.
CITY OF HIALEAH SELF-FUNDED GROUP HEALTH PROGRAM BASE PLAN. A. The City will provide a health benefit program that utilizes a managed care approach, commonly referred to as a preferred provider organization (PPO). This managed health care program will provide the employees with a comprehensive health care network. The provider network will consist of doctors, hospitals and other services, including a prescription drug program, who have agreed to offer medical services to employees at reduced negotiated fees. Maximum plan benefits will be received when the employee uses the participating provider network. The In-Network co-payment for doctor office visits are $25.00/visit and $50.00/visit for specialistsas provided in Exhibit 38A or shall be based on the most current open enrollment memorandum provided to employees as may be amended from year to year based upon the City of Hialeah Risk Management Department’s corresponding open enrollment for its various insurance programs. In-Network co-insurance for doctor visits only will be paid at 100%as provided in Exhibit 38A or shall be based on the most current open enrollment memorandum provided to employees as may be amended from year to year based upon the City of Hialeah Risk Management Department’s corresponding open enrollment for its various insurance programs, where the City will reimburse the negotiated charges. When utilizing In-Network providers, benefits will be paid as provided in Exhibit 38A or shall be based on the most current open enrollment memorandum provided to employees as may be amended from year to year based upon the City of Hialeah Risk Management Department’s corresponding open enrollment for its various insurance programs at a 80%/20% co-insurance basis. Should employees utilize Out-of-Network services, they will be responsible for increased deductibles and co-payments.
