Comprehensive Major Medical. Continuation of 18 existing plan without modification of benefits, except as noted. 19 20 (a) Effective January 1, 2016, $300/$600 deductible; 20% co- 21 insurance; $1,000 individual/$2,000 family per year out-of- 22 pocket limit (in addition to deductible). 24 (b) Effective January 1, 2016, $500/$1,000 deductible; 40% co- 25 insurance; $5,000 individual/$10,000 family per year out-of- 26 pocket limit (in addition to deductible).
Comprehensive Major Medical. The City shall maintain preferred provider organization(s) (PPO) for both medical and prescription drug services.
(1) A two hundred dollar ($200.00) annual single deductible with an eighty/twenty percent (80/20%) coinsurance of the next fifteen hundred dollars ($1,500.00) in reasonable charges or three hundred dollars ($300.00), for a total out-of-pocket maximum of five hundred dollars ($500.00) per single contract per year. Effective January 1, 2018, a three hundred dollar ($300.00) annual single deductible with an eighty/twenty percent (80/20%) coinsurance of the next two thousand dollars ($2,000.00) in reasonable charges or four hundred dollars ($400.00), for a total out-of-pocket maximum of seven hundred dollars ($700.00) per single contract per year.
(2) A four hundred dollars ($400.00) annual family deductible with an eighty/twenty percent (80/20%) coinsurance of the next two thousand dollars ($2,000.00) of reasonable charges or four hundred dollars ($400.00), for a total out-of-pocket maximum of eight hundred dollars ($800.00) per family contract per year. Effective January 1, 2018, a six hundred dollar ($600.00) annual family deductible with an eighty/twenty percent (80/20%) coinsurance of the next three thousand dollars ($3,000.00) of reasonable charges or six hundred dollars ($600.00), for a total out-of-pocket maximum of one thousand two hundred dollars ($1,200.00) per family contract per year.
(3) If an employee and/or an eligible dependent receive services from a preferred provider (PPO), reimbursements will be paid at the current coinsurance rate of eighty/twenty percent (80/20%) of reasonable charges. If the participating providers are not used, coinsurance will reduce to sixty/forty percent (60/40%) of reasonable charges. The additional twenty-percent (20%) coinsurance will be the employee's responsibility and is not counted toward the deductible or out-of- pocket maximum. Effective January 1, 2018, if an in-network provider is not used, coinsurance will reduce to sixty/forty percent (60/40%) of one hundred forty percent (140%) of the published reimbursement rates allowed by Medicare; the annual deductible will be increased to eight hundred dollars ($800.00) per single contract per year and one thousand six hundred dollars ($1,600.00) per family contract per year; and the out of pocket maximum will be increased to one thousand six hundred dollars ($1,600.00) per single contract per year and three thousand two hundred dollars ($3,200.00) per...
Comprehensive Major Medical. The City shall maintain preferred provider organization(s) (PPO) for both medical and prescription drug services.
(1) A two hundred dollar ($200.00) annual deductible with an eighty/twenty percent (80/20%) coinsurance of the next fifteen hundred dollars ($1,500.00) in reasonable charges or three hundred dollars ($300.00), for a total out-of-pocket maximum of five hundred dollars ($500.00) per single contract per year.
(2) A four hundred dollars ($400.00) annual family deductible with an eighty/twenty percent (80/20%) coinsurance of the next two thousand dollars ($2,000.00) of reasonable charges or four hundred dollars ($400.00), for a total out-of-pocket maximum of eight hundred dollars ($800.00) per family contract per year.
(3) If an employee and/or an eligible dependent receive services from a preferred provider (PPO), reimbursements will be paid at the current coinsurance rate of 80/20 percent of reasonable charges. If the participating providers are not used, coinsurance will reduce to 60/40 percent of reasonable charges. The additional twenty-percent (20%) coinsurance will be the employee's responsibility and is not counted toward the deductible or out-of-pocket maximum.
(4) The employee's annual out-of-pocket maximum for individual coverage shall be five hundred dollars ($500), and the employee's annual out-of-pocket maximum for family coverage shall be eight hundred dollars ($800).
(5) The plan will cover routine physicals, exams and immunizations up to a maximum of $150.00 per individual for covered persons age nine and over; a $300.00 family maximum, subject to deductibles, coinsurance, and out-of-pocket maximums will apply.
(6) A mental health/substance abuse case management benefit whereby an eligible participant may elect to exchange unused mental health or substance abuse inpatient days for other needed mental health or substance abuse benefits as determined medically necessary by the plan administrator. The medical necessity and exchange rate shall be determined by the plan administrator.
(7) Outpatient alcohol or drug treatment (substance abuse) payments will be limited to 50% of 25 visits per calendar year per individual when provided by a non-network provider. Outpatient alcohol or drug treatment (substance abuse) payments will continue to be limited to a total of twenty-five (25) visits per calendar year per individual when provided by a network provider. An office co- payment of twenty-five dollars ($25.00) per in-network visit will app...
Comprehensive Major Medical. If the employee and/or dependent receive services from a preferred provider (PPO), reimbursements will remain at the current eighty/twenty percent (80/20%) coinsurance and will be subject to the single and family deductibles and out-of- pocket maximums listed in Appendix D. The reimbursement rate will be determined based on reasonable charges, not usual, customary and reasonable. Deductibles, Out-of-Pocket Maximums and visit limits will fully reset on January 1st of each year.
Comprehensive Major Medical. (1) A $200 annual deductible with an 80/20 percent co-insurance of the next $1,500 of reasonable charges or $300, for a total out-of-pocket maximum of $500 per single contract per year.
(2) A $400 annual family deductible, with an 80/20 percent co-insurance of the next $2,000 of reasonable charges or $400, for a total out-of-pocket maximum of $800 per family contract.
(3) The reimbursement rate will be determined based on reasonable charges, not usual, customary and reasonable. Effective January 1, 2018, if the employee and/or dependent receive services from a preferred provider (PPO), reimbursements will remain at the current eighty/twenty percent (80/20%) coinsurance and will be subject to the single and family deductibles and out-of-pocket maximums listed in Appendix D.
Comprehensive Major Medical. (1) A $200 annual deductible with an 80/20 percent co-insurance of the next $1,500 of reasonable charges or $300, for a total out-of-pocket maximum of $500 per single contract per year.
(2) A $400 annual family deductible, with an 80/20 percent co-insurance of the next $2,000 of reasonable charges or $400, for a total out-of-pocket maximum of $800 per family contract.
(3) The reimbursement rate will be determined based on reasonable charges, not usual, customary and reasonable.
Comprehensive Major Medical. This section has been superseded and replaced by the parties' December 13, 2018 Memorandum of Understanding (MOU). With respect to insurance (Topics 1-4), the MOU remains in effect for Benefit Year 2020. Pursuant to Article 19, Section 1, the topic of insurance is subject to reopening for Benefit Year 2021.
Comprehensive Major Medical. The City shall maintain preferred provider organization(s) (PPO) for both medical and prescription drug services.
(1) A two hundred dollar ($200.00) annual single deductible with an eighty/twenty percent (80/20%) coinsurance of the next fifteen hundred dollars ($1,500.00) in reasonable charges or three hundred dollars ($300.00), for a total out-of-pocket maximum of five hundred dollars ($500.00) per single contract per year.
(2) A four hundred dollars ($400.00) annual family deductible with an eighty/twenty percent (80/20%) coinsurance of the next two thousand dollars ($2,000.00) of reasonable charges or four hundred dollars ($400.00), for a total out-of-pocket maximum of eight hundred dollars ($800.00) per family contract per year.
(3) If an employee and/or an eligible dependent receive services from a preferred provider (PPO), reimbursements will be paid at the current coinsurance rate of 80/20 percent of reasonable charges. If the participating providers are not used, coinsurance will reduce to 60/40 percent of reasonable charges. The additional twenty-percent (20%) coinsurance will be the employee's responsibility and is not counted toward the deductible or out-of-pocket maximum.
Comprehensive Major Medical. The Board of School Trustees will provide to eligible employees on a voluntary basis a medical insurance program. Following are the required annual employee contributions Employee’s will see a modest 5% increase to their contribution levels. Employees who were eligible for insurance prior to 2006 and enrolled prior to 2012: Plan A Single $ 1,274 Family $ 3,690 Plan B Single $ 185 Family $ 779 The following are required annual contributions to the medical insurance plans offered for employees currently working twenty to thirty-nine (20-39) hours or more per week. Plan B Single $ 1,508 Family $ 4,022 Plan B Single $ 3,767 Family $ 10,057
a. Those specifically named employees on Attachment I who represent employees who are eligible for medical insurance as of January 1, 2006, will be considered a grandfathered employee.
b. Effective January 1, 2012, all employees not currently enrolled in the medical insurance program as of the date of this Agreement and all future hires will only have the option to elect Plan B, as revised or replaced by the Corporation in future years. Such employees working 20 hours or more will be eligible for coverage.
c. Employee’s insurance contributions will be based on the hours worked per week as of October 15th of each school year.
d. Two eligible employees married to each other without dependent children each pay the Single Plan contribution. Two eligible employees married to each other with dependent children pay one Family contribution.
e. Effective beginning with the 2015-2016 school year, employees’ hours including the key-to-key calculation will be used to determine insurance eligibility.
Comprehensive Major Medical. (1) Weight loss schedule limited to examination charges only. Food supplements in the treatment of obesity are excluded.
(2) Services rendered by a Hospice Care program will be covered. Covered services include those services for which the employee and covered dependents are eligible during a hospital admission.
(3) Physical therapy, occupational therapy and/or chiropractic visits will be covered up to a combined annual maximum of thirty (30) visits per person, based upon medical necessity.
(4) Maternity benefits will be covered as follows: At least forty-eight (48) hours inpatient hospital care following a normal vaginal delivery; at least ninety-six (96) hours inpatient hospital care following a cesarean section; and physician directed follow-up care, unless the mother and attending provider mutually consent that the mother and child can be discharged earlier.
(5) If the employee and/or dependent receive services from a preferred provider (PPO), reimbursements will remain at the current eighty/twenty percent (80/20%) coinsurance and will be subject to the single and family deductibles and out-of-pocket maximums listed in Appendix F. Deductibles, Out-of-Pocket Maximums and visit limits will fully reset on January 1st of each year.
(6) If the employee and/or dependent receive services from a preferred provider (PPO), reimbursements will remain at the current eighty/twenty percent (80/20%) coinsurance and will be subject to the single and family deductibles and out-of-pocket maximums listed in Appendix F. Deductibles, Out-of-Pocket Maximums and visit limits will fully reset on January 1st of each year.
(7) If a preferred provider is not used, coinsurance will be reduced to sixty/forty percent (60/40%) of one hundred forty percent (140%) of the published reimbursement rates allowed by Medicare and subject to the single and family deductibles and out-of-pocket maximums listed in Appendix F. Any network modifications made by the plan administrator will apply.
(8) Temporomandibular joint pain dysfunction, syndrome or disease or any related conditions collectively referred to as "TMJ" or "TMD" will be covered on the basis of medical necessity, up to a lifetime maximum of two hundred dollars ($200.00). This limit does not apply to surgical services on the jaw hinge.
(9) Preventive care services, as defined and updated under the Affordable Care Act (“ACA”), will be provided by doctors and health care professionals within the City’s plan provider network without co...
