CONSTRUCTION OF PLAN. To the extent that state law shall not be preempted by the Employee Retirement Income Security Act, as amended from time to time, or any other laws of the United States heretofore or hereafter enacted, as the same may be amended from time to time, this Plan shall be administered, construed and enforced according to the laws of the State of Ohio. Any podiatric procedure not listed may be included in this Schedule if it is determined that such procedure falls within the intent and scope of this Schedule and is performed by a Doctor of Podiatric Medicine (D.P.M.) or Doctor of Surgical Chiropody (D.S.C.) provided such procedure would usually be performed by a Physician. INCISION Drainage of infected steatoma Drainage of a furuncle Drainage of a small subcutaneous abscess Drainage of carbuncle Drainage of a large subcutaneous abscess Drainage of onychia or paronychia, with or without complete or partial evulsion of nail Incision and removal of foreign body Drainage of hematoma Puncture aspiration of abscess or hematoma EXCISION Biopsy of skin or subcutaneous tissue Local excision of small benign neoplastic cicatricial, inflammatory or congenital lesion Excision of carbuncle Wide excision of lesion with or without graft or plastic closure Excision of a nail, nail bed or nail fold, simple/radical Excision of bone cyst, chondroma, small bone Excision of exostosis - small bone Excision of calcaneal spur SUTURE Primary, secondary or delayed suture of wounds. REPAIR Xxxxxxxx Operation for recurrent dislocation of toe or toes, one or more joints on each toe Metatarso-phalangeal joint, bunion operation, simple, unilateral or bilateral, radical, unilateral or bilateral Arthrodesis fusion of joint with or without tendon transplant hammer toe operation hallux rigidus, repair of tarsal joints, one or more other joints of lower extremity Foot, triple arthrodesis, unilateral or bilateral Foot, with tendon transplantation Club foot and application of cast, unilateral or bilateral FRACTURES (Including the application of plaster casts, traction or other devices, such as skeletal traction or introduction of wire or pins.) Tarsal (except astragalus and calcis), simple closed reduction Tarsal, one or more, open reduction Astragalus, simple closed reduction Astragalus, open reduction Os calcis, simple, closed reduction simple or compound, open reduction Metatarsal, one, simple, closed reduction one, simple or compound, open reduction more than one toe, simple, closed reduction Phalanx or phalanges, one toe, simple, closed reduction one toe, compound more than one toe, simple, closed reduction DISLOCATIONS Phalanx, one toe, simple closed reduction Phalanx, more than one toe, simple, closed reduction Metatarsal, one bone, simple, closed reduction Metatarsal, more than one toe, simple, closed reduction Tarsal, one bone, simple, closed reduction Astragalo tarsal, simple closed reduction APPENDIX 2 TO PART II, ARTICLE II SCHEDULE OF ORAL SURGICAL PROCEDURES Description of Procedure CPT Physician Current Procedural Terminology ORAL SURGERY Removal of metal plate, screw & wire (subject to X-ray examination and pathological report) 21089 LIPS Cheiloplasty - plastic reconstruction operation on lip 40650 Plastic repair of hare-lip 40760 PALATE Uvulectomy 42140 Palatoplasty for cleft palate (primary, secondary, minor, major, unilateral, bilateral, soft or hard) 42200 TREATMENT OF FRACTURES Maxilla, open reduction, teeth immobilized (if present) 21346 Maxilla, closed reduction, teeth immobilized (if present) 21345 Mandible, open reduction, teeth immobilized (if present) 21462 Mandible, closed reduction, teeth immobilized (if present) 21453 Malar and/or zygomatic arch, open reduction 21360 Malar and/or zygomatic arch, closed reduction 21355 Maxilla, open reduction, teeth immobilized 21423 Maxilla, closed reduction, teeth immobilized 21421 Mandible, open reduction, teeth immobilized 21470 Mandible, closed reduction, teeth immobilized 21450 Malar and/or zygomatic arch, open reduction 21365 Malar and/or zygomatic arch, closed reduction 21355 REDUCTION OF DISLOCATIONS Closed reduction of dislocation, temporomandibular joint 21480 APPENDIX 3 TO PART II, ARTICLE II BENEFIT SCHEDULE FOR NEW HIRES AFTER COMPLETION OF 90 DAYS OF CREDITED SERVICE. EXCEPT FOR THE BENEFIT SCHEDULE BELOW ALL OTHER BENEFITS DESCRIBED IN PART II, ARTICLE II, THE HEALTH INCENTIVE PLAN, WILL APPLY. In-Network Deductible $500 individual and $1,000 family Out-of-Network Deductible $1,000 individual and $2,000 family In-Network Coinsurance 80% Out-of-Network Coinsurance 60% In-Network Stop loss $3,000 individual and $6,000 family Out-of-Network Stop loss $5,000 individual and $10,000 family . Subject to the conditions stated in Article VI, the Employer agrees to provide the benefits of its Health Care Expense Account and Supplemental Health Care Expense Account and Dependent Care Expense Account set forth in this Part II, Article III (the "Plan" for purposes of this Article III) effective as of the Effective Date and for the duration of the CBA thereafter on the terms hereinafter set forth in this Article III. The Employer may arrange with the Company to provide the Plan benefits under a plan maintained by the Company, but in no event shall the Company or any other member of the Controlled Group (other than the Employer) be liable for the benefits under this Part II, Article III. The Employer shall be solely responsible for the benefits under this Part II, Article III.
Appears in 1 contract
Samples: Pension and Insurance Agreement
CONSTRUCTION OF PLAN. To the extent that state law shall not be preempted by the Employee Retirement Income Security Act, as amended from time to time, or any other laws of the United States heretofore or hereafter enacted, as the same may be amended from time to time, this Plan shall be administered, construed and enforced according to the laws of the State of Ohio. Any podiatric procedure not listed may be included in this Schedule if it is determined that such procedure falls within the intent and scope of this Schedule and is performed by a Doctor of Podiatric Medicine (D.P.M.) or Doctor of Surgical Chiropody (D.S.C.) provided such procedure would usually be performed by a Physician. INCISION Drainage of infected steatoma Drainage of a furuncle Drainage of a small subcutaneous abscess Drainage of carbuncle Drainage of a large subcutaneous abscess Drainage of onychia or paronychia, with or without complete or partial evulsion of nail Incision and removal of foreign body Drainage of hematoma Puncture aspiration of abscess or hematoma EXCISION Biopsy of skin or subcutaneous tissue Local excision of small benign neoplastic cicatricial, inflammatory or congenital lesion Excision of carbuncle Wide excision of lesion with or without graft or plastic closure Excision of a nail, nail bed or nail fold, simple/radical Excision of bone cyst, chondroma, small bone Excision of exostosis - small bone Excision of calcaneal spur SUTURE Primary, secondary or delayed suture of wounds. REPAIR Xxxxxxxx Bankhart Operation for recurrent dislocation of toe or toes, one or more joints on each toe Metatarso-phalangeal joint, bunion operation, simple, unilateral or bilateral, radical, unilateral or bilateral Arthrodesis fusion of joint with or without tendon transplant hammer toe operation hallux rigidus, repair of tarsal joints, one or more other joints of lower extremity Foot, triple arthrodesis, unilateral or bilateral Foot, with tendon transplantation Club foot and application of cast, unilateral or bilateral FRACTURES (Including the application of plaster casts, traction or other devices, such as skeletal traction or introduction of wire or pins.) Tarsal (except astragalus and calcis), simple closed reduction Tarsal, one or more, open reduction Astragalus, simple closed reduction Astragalus, open reduction Os calcis, simple, closed reduction simple or compound, open reduction Metatarsal, one, simple, closed reduction one, simple or compound, open reduction more than one toe, simple, closed reduction Phalanx or phalanges, one toe, simple, closed reduction one toe, compound more than one toe, simple, closed reduction DISLOCATIONS Phalanx, one toe, simple closed reduction Phalanx, more than one toe, simple, closed reduction Metatarsal, one bone, simple, closed reduction Metatarsal, more than one toe, simple, closed reduction Tarsal, one bone, simple, closed reduction Astragalo tarsal, simple closed reduction APPENDIX 2 TO PART II, ARTICLE II SCHEDULE OF ORAL SURGICAL PROCEDURES Description of Procedure CPT Physician Current Procedural Terminology ORAL SURGERY Removal of metal plate, screw & wire (subject to X-ray examination and pathological report) 21089 LIPS Cheiloplasty - plastic reconstruction operation on lip 40650 Plastic repair of hare-lip 40760 PALATE Uvulectomy 42140 Palatoplasty for cleft palate (primary, secondary, minor, major, unilateral, bilateral, soft or hard) 42200 TREATMENT OF FRACTURES Maxilla, open reduction, teeth immobilized (if present) 21346 Maxilla, closed reduction, teeth immobilized (if present) 21345 Mandible, open reduction, teeth immobilized (if present) 21462 Mandible, closed reduction, teeth immobilized (if present) 21453 Malar and/or zygomatic arch, open reduction 21360 Malar and/or zygomatic arch, closed reduction 21355 Maxilla, open reduction, teeth immobilized 21423 Maxilla, closed reduction, teeth immobilized 21421 Mandible, open reduction, teeth immobilized 21470 Mandible, closed reduction, teeth immobilized 21450 Malar and/or zygomatic arch, open reduction 21365 Malar and/or zygomatic arch, closed reduction 21355 REDUCTION OF DISLOCATIONS Closed reduction of dislocation, temporomandibular joint 21480 APPENDIX 3 TO PART II, ARTICLE II BENEFIT SCHEDULE FOR NEW HIRES AFTER COMPLETION OF 90 DAYS OF CREDITED SERVICE. EXCEPT FOR THE BENEFIT SCHEDULE BELOW ALL OTHER BENEFITS DESCRIBED IN PART II, ARTICLE II, THE HEALTH INCENTIVE PLAN, WILL APPLY. In-Network Deductible $500 individual and $1,000 family Out-of-Network Deductible $1,000 individual and $2,000 family In-Network Coinsurance 80% Out-of-Network Coinsurance 60% In-Network Stop loss $3,000 individual and $6,000 family Out-of-Network Stop loss $5,000 individual and $10,000 family . Subject to the conditions stated in Article VI, the Employer agrees to provide the benefits of its Health Care Expense Account and Supplemental Health Care Expense Account and Dependent Care Expense Account set forth in this Part II, Article III II (the "Plan" for purposes of this Article IIIII) effective as of the Effective Date and for the duration of the CBA thereafter on the terms hereinafter set forth in this Article IIIII. The Employer may arrange with the Company to provide the Plan benefits under a plan maintained by the Company, but in no event shall the Company or any other member of the Controlled Group (other than the Employer) be liable for the benefits under this Part Article II, Article III. The Employer shall be solely responsible for the benefits under this Part Article II, Article III.
Appears in 1 contract
Samples: Pension & Insurance Agreement
CONSTRUCTION OF PLAN. To the extent that state law shall not be preempted by the Employee Retirement Income Security Act, as amended from time to time, or any other laws of the United States heretofore or hereafter enacted, as the same may be amended from time to time, this Plan shall be administered, construed and enforced according to the laws of the State of Ohio. Any podiatric procedure not listed may be included in this Schedule if it is determined that such procedure falls within the intent and scope of this Schedule and is performed by a Doctor of Podiatric Medicine (D.P.M.) or Doctor of Surgical Chiropody (D.S.C.) provided such procedure would usually be performed by a Physician. INCISION Drainage of infected steatoma Drainage of a furuncle Drainage of a small subcutaneous abscess Drainage of carbuncle Drainage of a large subcutaneous abscess Drainage of onychia or paronychia, with or without complete or partial evulsion of nail Incision and removal of foreign body Drainage of hematoma Puncture aspiration of abscess or hematoma EXCISION Biopsy of skin or subcutaneous tissue Local excision of small benign neoplastic cicatricial, inflammatory or congenital lesion Excision of carbuncle Wide excision of lesion with or without graft or plastic closure Excision of a nail, nail bed or nail fold, simple/radical Excision of bone cyst, chondroma, small bone Excision of exostosis - small bone Excision of calcaneal spur SUTURE Primary, secondary or delayed suture of wounds. REPAIR Xxxxxxxx Bankhart Operation for recurrent dislocation of toe or toes, one or more joints on each toe Metatarso-phalangeal joint, bunion operation, simple, unilateral or bilateral, radical, unilateral or bilateral Arthrodesis fusion of joint with or without tendon transplant hammer toe operation hallux rigidus, repair of tarsal joints, one or more other joints of lower extremity Foot, triple arthrodesis, unilateral or bilateral Foot, with tendon transplantation Club foot and application of cast, unilateral or bilateral FRACTURES (Including the application of plaster casts, traction or other devices, such as skeletal traction or introduction of wire or pins.) Tarsal (except astragalus and calcis), simple closed reduction Tarsal, one or more, open reduction Astragalus, simple closed reduction Astragalus, open reduction Os calcis, simple, closed reduction simple or compound, open reduction Metatarsal, one, simple, closed reduction one, simple or compound, open reduction more than one toe, simple, closed reduction Phalanx or phalanges, one toe, simple, closed reduction one toe, compound more than one toe, simple, closed reduction DISLOCATIONS Phalanx, one toe, simple closed reduction Phalanx, more than one toe, simple, closed reduction Metatarsal, one bone, simple, closed reduction Metatarsal, more than one toe, simple, closed reduction Tarsal, one bone, simple, closed reduction Astragalo tarsal, simple closed reduction APPENDIX 2 TO PART II, ARTICLE II SCHEDULE OF ORAL SURGICAL PROCEDURES Physician Current Description of Procedure CPT Physician Current Procedural Terminology ORAL SURGERY Removal of metal plate, screw & wire (subject to X-ray examination and pathological report) 21089 LIPS Cheiloplasty - plastic reconstruction operation on lip 40650 Plastic repair of hare-lip 40760 PALATE Uvulectomy 42140 Palatoplasty for cleft palate (primary, secondary, minor, major, unilateral, bilateral, soft or hard) 42200 TREATMENT OF FRACTURES Maxilla, open reduction, teeth immobilized (if present) 21346 Maxilla, closed reduction, teeth immobilized (if present) 21345 Mandible, open reduction, teeth immobilized (if present) 21462 Mandible, closed reduction, teeth immobilized (if present) 21453 Malar and/or zygomatic arch, open reduction 21360 Malar and/or zygomatic arch, closed reduction 21355 TREATMENT OF COMPOUND FRACTURES Maxilla, open reduction, teeth immobilized 21423 Maxilla, closed reduction, teeth immobilized 21421 Mandible, open reduction, teeth immobilized 21470 Mandible, closed reduction, teeth immobilized 21450 Malar and/or zygomatic arch, open reduction 21365 Malar and/or zygomatic arch, closed reduction 21355 REDUCTION OF DISLOCATIONS Closed reduction of dislocation, temporomandibular joint 21480 APPENDIX 3 TO PART II, ARTICLE II BENEFIT SCHEDULE FOR NEW HIRES AFTER COMPLETION OF 90 DAYS OF CREDITED SERVICE. EXCEPT FOR THE BENEFIT SCHEDULE BELOW ALL OTHER BENEFITS DESCRIBED IN PART II, ARTICLE II, THE HEALTH INCENTIVE PLAN, WILL APPLY. In-Network Deductible $500 individual and $1,000 family Out-of-Network Deductible $1,000 individual and $2,000 family In-Network Coinsurance 80% Out-of-Network Coinsurance 60% In-Network Stop loss $3,000 individual and $6,000 family Out-of-Network Stop loss $5,000 individual and $10,000 family . Subject to the conditions stated in Article VI, the Employer agrees to provide the benefits of its Health Care Expense Account and Supplemental Health Care Expense Account and Dependent Care Expense Account set forth in this Part II, Article III (the "Plan" for purposes of this Article III) effective as of the Effective Date and for the duration of the CBA thereafter on the terms hereinafter set forth in this Article III. The Employer may arrange with the Company to provide the Plan benefits under a plan maintained by the Company, but in no event shall the Company or any other member of the Controlled Group (other than the Employer) be liable for the benefits under this Part II, Article III. The Employer shall be solely responsible for the benefits under this Part II, Article III.
Appears in 1 contract
Samples: Pension and Insurance Agreement
CONSTRUCTION OF PLAN. To the extent that state law shall not be preempted by the Employee Retirement Income Security Act, as amended from time to time, or any other laws of the United States heretofore or hereafter enacted, as the same may be amended from time to time, this Plan shall be administered, construed and enforced according to the laws of the State of Ohio. Any podiatric procedure not listed may be included in this Schedule if it is determined that such procedure falls within the intent and scope of this Schedule and is performed by a Doctor of Podiatric Medicine (D.P.M.) or Doctor of Surgical Chiropody (D.S.C.) provided such procedure would usually be performed by a Physician. INCISION Drainage of infected steatoma Drainage of a furuncle Drainage of a small subcutaneous abscess Drainage of carbuncle Drainage of a large subcutaneous abscess Drainage of onychia or paronychia, with or without complete or partial evulsion of nail Incision and removal of foreign body Drainage of hematoma Puncture aspiration of abscess or hematoma EXCISION Biopsy of skin or subcutaneous tissue Local excision of small benign neoplastic cicatricial, inflammatory or congenital lesion Excision of carbuncle Wide excision of lesion with or without graft or plastic closure Excision of a nail, nail bed or nail fold, simple/radical Excision of bone cyst, chondroma, small bone Excision of exostosis - small bone Excision of calcaneal spur SUTURE Primary, secondary or delayed suture of wounds. REPAIR Xxxxxxxx Bankhart Operation for recurrent dislocation of toe or toes, one or more joints on each toe Metatarso-phalangeal joint, bunion operation, simple, unilateral or bilateral, radical, unilateral or bilateral Arthrodesis fusion of joint with or without tendon transplant hammer toe operation hallux rigidus, repair of tarsal joints, one or more other joints of lower extremity Foot, triple arthrodesis, unilateral or bilateral Foot, with tendon transplantation Club foot and application of cast, unilateral or bilateral FRACTURES (Including the application of plaster casts, traction or other devices, such as skeletal traction or introduction of wire or pins.) Tarsal (except astragalus and calcis), simple closed reduction Tarsal, one or more, open reduction Astragalus, simple closed reduction Astragalus, open reduction Os calcis, simple, closed reduction simple or compound, open reduction Metatarsal, one, simple, closed reduction one, simple or compound, open reduction more than one toe, simple, closed reduction Phalanx or phalanges, one toe, simple, closed reduction one toe, compound more than one toe, simple, closed reduction DISLOCATIONS Phalanx, one toe, simple closed reduction Phalanx, more than one toe, simple, closed reduction Metatarsal, one bone, simple, closed reduction Metatarsal, more than one toe, simple, closed reduction Tarsal, one bone, simple, closed reduction Astragalo tarsal, simple closed reduction APPENDIX 2 TO PART II, ARTICLE II I Description of Procedure SCHEDULE OF ORAL SURGICAL PROCEDURES Description of Procedure CPT Physician Current Procedural Terminology ORAL SURGERY Removal of metal plate, screw & wire (subject to X-ray examination and pathological report) 21089 LIPS Cheiloplasty - plastic reconstruction operation on lip 40650 Plastic repair of hare-lip 40760 PALATE Uvulectomy 42140 Palatoplasty for cleft palate (primary, secondary, minor, major, unilateral, bilateral, soft or hard) 42200 TREATMENT OF FRACTURES Maxilla, open reduction, teeth immobilized (if present) 21346 Maxilla, closed reduction, teeth immobilized (if present) 21345 Mandible, open reduction, teeth immobilized (if present) 21462 Mandible, closed reduction, teeth immobilized (if present) 21453 Malar and/or zygomatic arch, open reduction 21360 Malar and/or zygomatic arch, closed reduction 21355 TREATMENT OF COMPOUND FRACTURES Maxilla, open reduction, teeth immobilized 21423 Maxilla, closed reduction, teeth immobilized 21421 Mandible, open reduction, teeth immobilized 21470 Mandible, closed reduction, teeth immobilized 21450 Malar and/or zygomatic arch, open reduction 21365 Malar and/or zygomatic arch, closed reduction 21355 REDUCTION OF DISLOCATIONS Closed reduction of dislocation, temporomandibular joint 21480 APPENDIX 3 TO PART II, ARTICLE II BENEFIT SCHEDULE FOR NEW HIRES AFTER COMPLETION OF 90 DAYS OF CREDITED SERVICE. EXCEPT FOR THE BENEFIT SCHEDULE BELOW ALL OTHER BENEFITS DESCRIBED IN PART II, ARTICLE III, THE HEALTH INCENTIVE PLAN, WILL APPLY. In-Network Deductible $500 individual and $1,000 family Out-of-Network Deductible $1,000 individual and $2,000 family In-Network Coinsurance 80% Out-ofif-Network Coinsurance 60% In-Network Stop loss $3,000 individual and $6,000 family Out-of-Network Stop loss $5,000 individual and $10,000 family . Subject to the conditions stated in Article VI, the Employer agrees to provide the benefits of its Health Care Expense Account and Supplemental Health Care Expense Account and Dependent Care Expense Account set forth in this Part II, Article III II (the "Plan" for purposes of this Article IIIII) effective as of the Effective Date and for the duration of the CBA thereafter on the terms hereinafter set forth in this Article IIIII. The Employer may arrange with the Company to provide the Plan benefits under a plan maintained by the Company, but in no event shall the Company or any other member of the Controlled Group (other than the Employer) be liable for the benefits under this Part Article II, Article III. The Employer shall be solely responsible for the benefits under this Part Article II, Article III.
Appears in 1 contract
Samples: Pension & Insurance Agreement
CONSTRUCTION OF PLAN. To the extent that state law shall not be preempted by the Employee Retirement Income Security Act, as amended from time to time, or any other laws of the United States heretofore or hereafter enacted, as the same may be amended from time to time, this Plan shall be administered, construed and enforced according to the laws of the State of Ohio. Any podiatric procedure not listed may be included in this Schedule if it is determined that such procedure falls within the intent and scope of this Schedule and is performed by a Doctor of Podiatric Medicine (D.P.M.) or Doctor of Surgical Chiropody (D.S.C.) provided such procedure would usually be performed by a Physician. INCISION Drainage of infected steatoma Drainage of a furuncle Drainage of a small subcutaneous abscess Drainage of carbuncle Drainage of a large subcutaneous abscess Drainage of onychia or paronychia, with or without complete or partial evulsion of nail Incision and removal of foreign body Drainage of hematoma Puncture aspiration of abscess or hematoma EXCISION Biopsy of skin or subcutaneous tissue Local excision of small benign neoplastic cicatricial, inflammatory or congenital lesion Excision of carbuncle Wide excision of lesion with or without graft or plastic closure Excision of a nail, nail bed or nail fold, simple/radical Excision of bone cyst, chondroma, small bone Excision of exostosis - small bone Excision of calcaneal spur SUTURE Primary, secondary or delayed suture of wounds. REPAIR Xxxxxxxx Bankhart Operation for recurrent dislocation of toe or toes, one or more joints on each toe Metatarso-phalangeal joint, bunion operation, simple, unilateral or bilateral, radical, unilateral or bilateral Arthrodesis fusion of joint with or without tendon transplant hammer toe operation hallux rigidus, repair of tarsal joints, one or more other joints of lower extremity Foot, triple arthrodesis, unilateral or bilateral Foot, with tendon transplantation Club foot and application of cast, unilateral or bilateral FRACTURES (Including the application of plaster casts, traction or other devices, such as skeletal traction or introduction of wire or pins.) Tarsal (except astragalus and calcis), simple closed reduction Tarsal, one or more, open reduction Astragalus, simple closed reduction Astragalus, open reduction Os calcis, simple, closed reduction simple or compound, open reduction Metatarsal, one, simple, closed reduction one, simple or compound, open reduction more than one toe, simple, closed reduction Phalanx or phalanges, one toe, simple, closed reduction one toe, compound more than one toe, simple, closed reduction DISLOCATIONS Phalanx, one toe, simple closed reduction Phalanx, more than one toe, simple, closed reduction Metatarsal, one bone, simple, closed reduction Metatarsal, more than one toe, simple, closed reduction Tarsal, one bone, simple, closed reduction Astragalo tarsal, simple closed reduction APPENDIX 2 TO PART II, ARTICLE II I SCHEDULE OF ORAL SURGICAL PROCEDURES Description of Procedure CPT Physician Current Procedural Terminology ORAL SURGERY Removal of metal plate, screw & wire (subject to X-ray examination and pathological report) 21089 LIPS Cheiloplasty - plastic reconstruction operation on lip 40650 Plastic repair of hare-lip 40760 PALATE Uvulectomy 42140 Palatoplasty for cleft palate (primary, secondary, minor, major, unilateral, bilateral, soft or hard) 42200 TREATMENT OF FRACTURES Maxilla, open reduction, teeth immobilized (if present) 21346 Maxilla, closed reduction, teeth immobilized (if present) 21345 Mandible, open reduction, teeth immobilized (if present) 21462 Mandible, closed reduction, teeth immobilized (if present) 21453 Malar and/or zygomatic arch, open reduction 21360 Malar and/or zygomatic arch, closed reduction 21355 Maxilla, open reduction, teeth immobilized 21423 Maxilla, closed reduction, teeth immobilized 21421 Mandible, open reduction, teeth immobilized 21470 Mandible, closed reduction, teeth immobilized 21450 Malar and/or zygomatic arch, open reduction 21365 Malar and/or zygomatic arch, closed reduction 21355 REDUCTION OF DISLOCATIONS Closed reduction of dislocation, temporomandibular joint 21480 APPENDIX 3 TO PART II, ARTICLE II BENEFIT SCHEDULE FOR NEW HIRES AFTER COMPLETION OF 90 DAYS OF CREDITED SERVICE. EXCEPT FOR THE BENEFIT SCHEDULE BELOW ALL OTHER BENEFITS DESCRIBED IN PART II, ARTICLE III, THE HEALTH INCENTIVE PLAN, WILL APPLY. In-Network Deductible $500 individual and $1,000 family Out-of-Network Deductible $1,000 individual and $2,000 family In-Network Coinsurance 80% Out-ofif-Network Coinsurance 60% In-Network Stop loss $3,000 individual and $6,000 family Out-of-Network Stop loss $5,000 individual and $10,000 family . Subject to the conditions stated in Article VI, the Employer agrees to provide the benefits of its Health Care Expense Account and Supplemental Health Care Expense Account and Dependent Care Expense Account set forth in this Part II, Article III II (the "Plan" for purposes of this Article IIIII) effective as of the Effective Date and for the duration of the CBA thereafter on the terms hereinafter set forth in this Article IIIII. The Employer may arrange with the Company to provide the Plan benefits under a plan maintained by the Company, but in no event shall the Company or any other member of the Controlled Group (other than the Employer) be liable for the benefits under this Part Article II, Article III. The Employer shall be solely responsible for the benefits under this Part Article II, Article III.
Appears in 1 contract
Samples: Pension & Insurance Agreement