Comprehensive Hospitalization Benefits. The Board will provide hospitalization, medical, and major medical coverage for the staff as follows:
A. One hundred (100) per cent payment for single plan coverage.
B. Ninety-five (95) per cent payment of premium for family plan coverage.
C. Once a dependent child reaches their 24th birthday, the employee pays $150.00 per month for premium. Dependent child will retain coverage until they reach their 26th birthday (end of 25th year per contract cap).
D. There will be no pre-existing condition restriction for new teachers.
E. Staff may have the option of electing health insurance coverage with a Board approved HMO carrier. If the rate charged for the HMO plan elected exceeds the rate set for the District's health insurance coverage provided under A and B above, the employee shall be responsible to pay the excess cost through monthly payroll deductions.
F. The employee’s out of pocket expense for prescriptions is limited to $5.00 per generic prescription and $15.00 per name brand prescription. This coverage is to include: Comprehensive PPO hospital benefits: Common semi-private room allowance (C.S.P.), (See letter A on page 60) under the family plan, and in- and out-patient diagnostic services, and pre-admission services and $250 deductible for each inpatient hospital admission to a maximum of $2,000 annually. Surgical benefits: Payment of all the usual and customary charges, and in- and out-patient diagnostic services. $2,000,000 maximum for hospitalization and doctor expenses: maximum employee out of pocket expense of $1,250; $250 calendar year deductible per person (maximum three deductibles per family per year); 100% co-insurance for hospital; 80% co-insurance for medical and surgical; dependents covered until they reach their 26th birthday under the family plan. Non-PPO hospital benefits are reduced by 20% and a higher out of pocket expense will apply. All claims shall be subject to the right of reimbursement. If a teacher dies, the spouse will be provided family plan coverage with Xxxxxx’x health carrier, at no cost to the Board, for one year. Any change in health insurance carrier requires that the coverage remains equivalent. The Union will be consulted prior to bid acceptance to verify that coverage remains equivalent.
Comprehensive Hospitalization Benefits. The Board will provide hospitalization, medical, and major medical coverage for the staff as follows:
Comprehensive Hospitalization Benefits.
1. The Boardwillprovidehospitalization, medical, andmajormedicalcoverageforthe staff as follows with exception that employees hired on or after July 1, 2022 shall have the option of HMO or BCO PPO coverage only:
a. Ninety-eight percent (98%) payment for single plan HMO coverage.
b. Ninety-threepercent (93%) payment of premium for HMO family insurance plan coverage for each school year.
c. Ninety-four percent (94%) payment for singleplan BCO PPO coverage. Employees on the traditional single PPO plan on June 30, 2022 may remain on the plan at eighty-eight percent (88%) Board paid coverage.
d. Eighty-ninepercent (89%) payment for familyplan BCO PPO coverage. Employees on the traditional family PPO plan on June 30, 2022 may remain on the plan at eighty-three percent (83%) Board paid coverage.
e. Any employees with traditional PPO coverage on June 30, 2022 who elect a different plan may not return to traditional PPO coverage.
f. There will be no preexisting conditions for new employees.
g. The out of pocket expense for prescriptions is limited to $10.00 per generic prescription, $40.00 per formulary brand prescription, and $60.00 per non- formulary brand prescription. The ninety (90) day mail order copayment structure shall be $20.00 for generic prescriptions, $80.00 for formulary prescriptions, and $120.00 for non-formulary prescriptions.
h. Upon retirement, a retiree may elect health insurance continuation coverage under the District’s plan in accordance with IMRF rules and regulations. All costs associated with insurance continuation shall be the responsibility of theretiree. BCO PPO Tier 1 Tier 2 Tier 3 Coinsurance 90% 70% 50% Deductible: (Single / Family) $500/$1500 $1000/$3000 $2000/$6000 Total Out of Pocket; (Including Deductible) $1500/$4500 $3000/$9000 $6000/$18000 Copays Apply to the Out of Pocket Yes Yes Yes Office Visit Copay: $25/$50 $50/$100 Deductible, 50% Telehealth $25 $25 $25 ER Copay Deductible, 90% Deductible, 70% Deductible, 50% Inpatient Hospital Deductible, 90% Deductible, 70% $0 copay, Deductible, 50% Outpatient Surgery Deductible, 90% Deductible, 70% Deductible, 50% Clerical staff employed on or before July 1, 2021 who were previously enrolled in single PPO insurance prior to this Agreement who switch to single HMO coverage shall receive a two thousand dollar ($2000) one-time payment by February of the 2022-2023 school year. Clerical staff employed on or before July 1, 2021 who were previously enrolled in family PPO insura...
Comprehensive Hospitalization Benefits. The Board will provide hospitalization, medical, and major medical coverage for the staff as follows:
1) Ninety-eight percent (98%) payment for single plan HMO coverage.
2) Ninety-three percent (93%) payment of premium for HMO family insurance plan coverage.
3) Eighty-eight percent (88%) payment for single plan PPO coverage.
4) Eighty-three percent (83%) payment for family plan PPO coverage.
5) Dependent child will retain coverage until they reach their 26th birthday (end of 25th year per contract cap).
6) The employee’s out of pocket expense for prescriptions is limited to $10.00 per generic prescription, $40 for formulary brand drugs and $60 for non-formulary brand drugs. Mail order copayment structure is $20 for generic, $80 for formulary brands and $120 for non- formulary medications. Teachers employed on or before July 1, 2021 who switch from single PPO or BCO PPO to HMO health insurance coverage in any year of this Agreement shall receive a two thousand dollar ($2,000) one-time payment by the second pay date in February of that school year. Teachers employed on or before July 1, 2021 who switch from family PPO or BCO PPO to HMO health insurance coverage in any year of this Agreement shall receive a four thousand dollar ($4,000) one-time payment by the second pay date in February of that school year. Teachers newly hired on or after July 1, 2022 who select HMO health insurance coverage in any year of this Agreement shall receive a five hundred dollar ($500) one-time payment by the second pay date in February of that school year. These one-time payments shall sunset effective June 30, 2024. This coverage is to include: Comprehensive PPO hospital benefits: Common semi-private room allowance (C.S.P.), (See letter A on page 60) under the family plan, and in- and out-patient diagnostic services, and pre- admission services and $250 deductible per day for up to three (3) days for each inpatient hospital admission to a maximum of $1,500 annually for an individual covered under PPO. Any emergency room visit by an individual covered under either plan, PPO and HMO, shall require a payment of $250 per visit. Surgical benefits: Payment of all the usual and customary charges, and in- and out-patient diagnostic services. Maximum for hospitalization and doctor expenses: maximum employee out of pocket expense of $1,750; $750 calendar year deductible per person (maximum three deductibles per family per year); 100% co-insurance for hospital; 80% co-insurance...
Comprehensive Hospitalization Benefits. The Board will provide hospitalization, medical, and major medical coverage for the staff as follows:
A. One hundred (100) per cent payment for single plan coverage.
B. Ninety-two per cent (92%) payment of premium for PPO family insurance plan coverage or HMO family insurance plan coverage.
C. Dependent child will retain coverage until they reach their 26th birthday (end of 25th year per contract cap).
D. The employee’s out of pocket expense for prescriptions is limited to $10.00 per generic prescription and $20.00 per name brand prescription. This coverage is to include: Comprehensive PPO hospital benefits: Common semi-private room allowance (C.S.P.), (See letter A on page 60) under the family plan, and in- and out-patient diagnostic services, and pre-admission services and $250 deductible per day for up to three (3) days for each inpatient hospital admission to a maximum of Any emergency room visit by an individual covered under either plan, PPO and HMO, shall require a payment of $100 per visit. Surgical benefits: Payment of all the usual and customary charges, and in- and out-patient diagnostic services. Non-PPO hospital benefits are reduced by 20% and a higher out of pocket expense will apply. All claims shall be subject to the right of reimbursement. If a teacher dies, the spouse will be provided family plan coverage with Xxxxxx’x health carrier, at no cost to the Board, for one year. Any change in health insurance carrier requires that the coverage remains equivalent. The Union will be consulted prior to bid acceptance to verify that coverage remains equivalent.
