Common use of Design Changes To Contain Costs Clause in Contracts

Design Changes To Contain Costs. (a) The Plan’s MMCP shall be revised as follows: (1) The Office Visit Co-Payment for In-Network Services shall be increased to $20.00 for each office visit to a provider in general practice or who specializes in pediatrics, obstetricsgynecology, family practice or internal medicine, and $35.00 for each office visit to any other provider; (2) The Urgent Care Center Co-Payment for In-Network Services shall be increased to $25.00 for each visit; (3) The Emergency Room Co-Payment for In-Network Services shall be increased to at least $50.00 for each visit, but if the care received meets the applicable Plan definition of an Emergency, the Plan will reimburse the employee for the full amount paid for such care, except for $25.00 if the visit does not result in hospital admission. For purposes of this Paragraph, the phrase “at least” shall be interpreted and applied consistent with practice under the Plan preceding the date of this Agreement; (4) The Annual Deductible for Out-of-Network Services shall be increased to $300.00 per individual and $900.00 per family; (5) The Annual Out-of-Pocket Maximum for Out-of-Network Services shall be increased to $2,000 per individual and $4,000 per family. (b) The Plan’s Comprehensive Health Care Benefit shall be revised as follows: (1) The Annual Deductible shall be increased to $200.00 per individual and $400.00 per family; (2) The Annual Out-of-Pocket Maximum shall be increased to $2,000 per individual and $4,000 per family. (c) The Plan’s Prescription Drug Card Program co-payments to In-Network Pharmacies per prescription are revised as follows: (1) Generic Drug – increase to $10.00; (2) Brand Name (Non-Generic) Drug On Program Administrator’s Formulary – increase to $20.00; (3) Brand Name (Non-Generic) Drug Not On Program Administrator’s Formulary – increase to $30.00; (4) Brand Name (Non-Generic) Drug on Program Administrator’s Formulary that is not ordered by the patient’s physician by writing “Dispense as Written” on the prescription and there is an equivalent Generic Drug increase to $20.00 plus the difference between the GenericDrug and the Brand Name (Non-Generic) Drug; (5) Brand Name (Non-Generic) Drug Not On Program Administrator’s Formulary that is not ordered by the patient’s physician by writing “dispense as Written” on the prescription and there is an equivalent Generic Drugincrease to $30.00 plus the difference between the Generic Drug and the Brand Name (Non- Generic) Drug. (d) The Plan’s Mail Order Prescription Drug Program co-payments per prescription are revised as follows: (1) Generic Drug – increase to $20.00; (2) Brand Name (Non-Generic) Drug On Program Administrator’s Formulary – increase to $30.00; (3) Brand Name (Non-Generic) Drug Not on Program Administrator’s Formulary – increase to $60.00. (e) For purposes of the Plan, the term “children” as used in connection with determining “Eligible Dependents” under the Plan, shall be defined as follows: “Children include: o natural children, o stepchildren, o adopted children (including children placed with you for adoption), and o your grandchildren, provided they have their legal residence with you and are dependent for care and support mainly upon you and wholly, in the aggregate, upon themselves, you, your spouse, scholarships and the like, and governmental disability benefits and the like.” (f) The definition of the term “children”, as used in connection with determinations of “Eligible Dependents” under the terms of the Dental Plan and the Vision Plan, respectively, shall be revised as provided in subsection (e) above. (g) Blue Cross Blue Shield programs that are currently available under the Plan will be made available for selection by employees covered by this Agreement who choose coverage under the MMCP in all areas where the MMCP is made available under the Plan and throughout the United States for selection by such employees who choose coverage under the CHCB. (h) During a prescribed election period preceding January 1, 2008, and preceding each January 1 thereafter, employees may certify to the Plan or its designee in writing that they have health care coverage (which includes medical, prescription drug, and mental health/substance abuse benefits) under another group health plan or health insurance policy that they identify by name and, where applicable, by group number, and for that reason they elect to forego coverage for foreign-to- occupation health benefits for themselves and their dependents under the Plan and under any Hospital Association plan in which they participate. Such election is hereafter referred to as an “Opt-Out Election” and, where exercised, will eliminate an employer’s obligation to make a contribution to the Plan and/or dues offset payment to a Hospital Association for foreign-to-occupation health benefitsfor the employee and his dependents. Each employee who makes an Opt-Out Election will be paid by his employer $100 for each month that his employer is required to make a contribution to the Plan on his behalf for life insurance and accidental death and dismemberment benefits as a result of compensated service rendered, or vacation pay received, by the employee during the prior month; provided, however, that the employee’s Opt- Out Election is in effect for the entire month. If an event described below in the final paragraph of this subsection (h) occurs subsequent to an employee’s Opt-Out Election, the employee may, upon providing the Plan or its designee with proof satisfactory to it of the occurrence of such event, revoke his or her Opt-Out Election. An employee may also revoke his or her Opt-Out Election by providing the Plan or its designee with proof satisfactory to it that, after the employee made the Opt- Out Election, a person became a dependent of the employee through a marriage, birth, or adoption or placement for adoption. An employee who revokes an Opt-Out Election will, along with his or her dependents, be once again covered (effective the first day of the first month following such revocation that the employee and/or his dependents would have been covered but for the Opt-Out Election the employee had previously made) for foreign to-occupation health benefits under the Plan or, in the case of an employee who is a member of a Hospital Association, by the Plan (for dependent coverage) and by the Hospital Association (for employee coverage). See Side Letter No. 6. The following events are the events referred to in the immediately preceding paragraph: (1) the employee loses eligibility under, or there is a termination of employer contributions for, the other coverage that allowed the employee to make the Opt-Out Election, or (2) if COBRA was the source of such other coverage, that COBRA coverage is exhausted. (i) Plan participants and their beneficiaries who live in an area where, as of the date of this Agreement, they may choose between MMCP and CHCB coverage shall no longer have a choice, but shall be enrolled in the MMCP. This subsection is not intended to have any application to employees covered by this Agreement who reside in any geographic area where MMCP is not offered as of the date of such Agreement. Mandatory enrollment in MMCP for such employees shall be governed exclusively by Part A, Section 2(b) of this Article. (j) The design changes contained in this Section shall become effective on July 1, 2007 or as soon thereafter as practicable.

Design Changes To Contain Costs. (a) The Plan’s MMCP Managed Medical Care Program (“MMCP”) shall be revised as follows: (1) The Office Visit Co-Payment for In-Network Services shall be increased to $20.00 for each office visit to a provider in general practice or who specializes in pediatrics, obstetricsgynecologyobstetrics- gynecology, family practice or internal medicine, and $35.00 for each office visit to any other provider; (2) The Urgent Care Center Co-Payment for In-Network Services shall be increased to $25.00 for each visit; (3) The Emergency Room Co-Payment for In-Network Services shall be increased to at least $50.00 for each visit, but if the care received meets the applicable Plan definition of an Emergency, the Plan will reimburse the employee for the full amount paid for such care, except for $25.00 if the visit does not result in hospital admission. For purposes of this Paragraph, the phrase “at least” shall be interpreted and applied consistent with practice under the Plan preceding the date of this Agreement; (4) The Annual Deductible for Out-of-Network Services shall be increased to $300.00 per individual and $900.00 per family; (5) The Annual Out-of-Pocket Maximum for Out-of-Network Services shall be increased to $2,000 per individual and $4,000 per family. (b) The Plan’s Comprehensive Health Care Benefit shall be revised as follows: (1) The Annual Deductible shall be increased to $200.00 per individual and $400.00 per family; (2) The Annual Out-of-Pocket Maximum shall be increased to $2,000 per individual and $4,000 per family. (c) The Plan’s Prescription Drug Card Program co-payments to In-In- Network Pharmacies per prescription are revised as follows: (1) Generic Drug – increase to $10.00; (2) Brand Name (Non-Generic) Drug On Program Administrator’s Formulary – increase to $20.00; (3) Brand Name (Non-Generic) Drug Not On Program Administrator’s Formulary – increase to $30.00; (4) Brand Name (Non-Generic) Drug on Program Administrator’s Formulary that is not ordered by the patient’s physician by writing “Dispense as Written” on the prescription and there is an equivalent Generic Drug -- increase to $20.00 plus the difference between the GenericDrug Generic Drug and the Brand Name (Non-Generic) Drug; (5) Brand Name (Non-Generic) Drug Not On Program Administrator’s Formulary that is not ordered by the patient’s physician by writing “dispense as Written” on the prescription and there is an equivalent Generic Drugincrease Drug -- increase to $30.00 plus the difference between the Generic Drug and the Brand Name (Non- Non-Generic) Drug. (d) The Plan’s Mail Order Prescription Drug Program co-payments per prescription are revised as follows: (1) Generic Drug – increase to $20.00; (2) Brand Name (Non-Generic) Drug On Program Administrator’s Formulary – increase to $30.00; (3) Brand Name (Non-Generic) Drug Not on Program Administrator’s Formulary – increase to $60.00. (e) For purposes of the Plan, the term “children” as used in connection with determining “Eligible Dependents” under the Plan, shall be defined as follows: “Children include: o natural children, o stepchildren, o adopted children (including children placed with you for adoption), and o your grandchildren, provided they have their legal residence with you and are dependent for care and support mainly upon you and wholly, in the aggregate, upon themselves, you, your spouse, scholarships and the like, and governmental disability benefits and the like.” (f) The definition of the term “children”, as used in connection with determinations of “Eligible Dependents” under the terms of the Dental Plan and the Vision Plan, respectively, shall be revised as provided in subsection (e) above. (g) Blue Cross Blue Shield programs that are currently available under the Plan will be made available for selection by employees covered by this Agreement who choose coverage under the MMCP in all areas where the MMCP is made available under the Plan and throughout the United States for selection by such employees who choose coverage under the CHCB. (h) During a prescribed election period preceding January 1, 2008, and preceding each January 1 thereafter, employees may certify to the Plan or its designee in writing that they have health care coverage (which includes medical, prescription drug, and mental health/substance abuse benefits) under another group health plan or health insurance policy that they identify by name and, where applicable, by group number, and for that reason they elect to forego coverage for foreign-to- occupation health benefits for themselves and their dependents under the Plan and under any Hospital Association plan in which they participate. Such election is hereafter referred to as an “Opt-Out Election” and, where exercised, will eliminate an employer’s obligation to make a contribution to the Plan and/or dues offset payment to a Hospital Association for foreign-to-occupation health benefitsfor the employee and his dependents. Each employee who makes an Opt-Out Election will be paid by his employer $100 for each month that his employer is required to make a contribution to the Plan on his behalf for life insurance and accidental death and dismemberment benefits as a result of compensated service rendered, or vacation pay received, by the employee during the prior month; provided, however, that the employee’s Opt- Out Election is in effect for the entire month. If an event described below in the final paragraph of this subsection (h) occurs subsequent to an employee’s Opt-Out Election, the employee may, upon providing the Plan or its designee with proof satisfactory to it of the occurrence of such event, revoke his or her Opt-Out Election. An employee may also revoke his or her Opt-Out Election by providing the Plan or its designee with proof satisfactory to it that, after the employee made the Opt- Out Election, a person became a dependent of the employee through a marriage, birth, or adoption or placement for adoption. An employee who revokes an Opt-Out Election will, along with his or her dependents, be once again covered (effective the first day of the first month following such revocation that the employee and/or his dependents would have been covered but for the Opt-Out Election the employee had previously made) for foreign to-occupation health benefits under the Plan or, in the case of an employee who is a member of a Hospital Association, by the Plan (for dependent coverage) and by the Hospital Association (for employee coverage). See Side Letter No. 6. The following events are the events referred to in the immediately preceding paragraph: (1) the employee loses eligibility under, or there is a termination of employer contributions for, the other coverage that allowed the employee to make the Opt-Out Election, or (2) if COBRA was the source of such other coverage, that COBRA coverage is exhausted. (i) Plan participants and their beneficiaries who live in an area where, as of the date of this Agreement, they may choose between MMCP and CHCB coverage shall no longer have a choice, but shall be enrolled in the MMCP. This subsection is not intended to have any application to employees covered by this Agreement who reside in any geographic area where MMCP is not offered as of the date of such Agreement. Mandatory enrollment in MMCP for such employees shall be governed exclusively by Part A, Section 2(b) of this Article. (j) The design changes contained in this Section shall become effective on July 1, 2007 or as soon thereafter as practicable.

Design Changes To Contain Costs. (a) The Plan’s MMCP Managed Medical Care Program (“MMCP”) shall be revised as follows: (1) The Office Visit Co-Payment for In-Network Services shall be increased to $20.00 for each office visit to a provider in general practice or who specializes in pediatrics, obstetricsgynecologyobstetrics- gynecology, family practice or internal medicine, and $35.00 for each office visit to any other provider; (2) The Urgent Care Center Co-Payment for In-Network Services shall be increased to $25.00 for each visit; (3) The Emergency Room Co-Payment for In-Network Services shall be increased to at least $50.00 for each visit, but if the care received meets the applicable Plan definition of an Emergency, the Plan will reimburse the employee for the full amount paid for such care, except for $25.00 if the visit does not result in hospital admission. For purposes of this Paragraph, the phrase “at least” shall be interpreted and applied consistent with practice under the Plan preceding the date of this Agreement; (4) The Annual Deductible for Out-of-Network Services shall be increased to $300.00 per individual and $900.00 per family; (5) The Annual Out-of-Pocket Maximum for Out-of-Network Services shall be increased to $2,000 per individual and $4,000 per family. (b) The Plan’s Comprehensive Health Care Benefit shall be revised as follows: (1) The Annual Deductible shall be increased to $200.00 per individual and $400.00 per family; (2) The Annual Out-of-Pocket Maximum shall be increased to $2,000 per individual and $4,000 per family. (c) The Plan’s Prescription Drug Card Program co-payments to In-In- Network Pharmacies per prescription are revised as follows: (1) Generic Drug – increase to $10.00; (2) Brand Name (Non-Generic) Drug On Program Administrator’s Formulary – increase to $20.00; (3) Brand Name (Non-Generic) Drug Not On Program Administrator’s Formulary – increase to $30.00; (4) Brand Name (Non-Generic) Drug on Program Administrator’s Formulary that is not ordered by the patient’s physician by writing “Dispense as Written” on the prescription and there is an equivalent Generic Drug Drug-- increase to $20.00 plus the difference between the GenericDrug Generic Drug and the Brand Name (Non-Generic) Drug; (5) Brand Name (Non-Generic) Drug Not On Program Administrator’s Formulary that is not ordered by the patient’s physician by writing “dispense as Written” on the prescription and there is an equivalent Generic Drugincrease Drug-- increase to $30.00 plus the difference between the Generic Drug and the Brand Name (Non- Non-Generic) Drug. (d) The Plan’s Mail Order Prescription Drug Program co-payments per prescription are revised as follows: (1) Generic Drug – increase to $20.00; (2) Brand Name (Non-Generic) Drug On Program Administrator’s Formulary – increase to $30.00; (3) Brand Name (Non-Generic) Drug Not on Program Administrator’s Formulary – increase to $60.00. (e) For purposes of the Plan, the term “children” as used in connection with determining “Eligible Dependents” under the Plan, shall be defined as follows: “Children include: o natural children, o stepchildren, o adopted children (including children placed with you for adoption), and o your grandchildren, provided they have their legal residence with you and are dependent for care and support mainly upon you and wholly, in the aggregate, upon themselves, you, your spouse, scholarships and the like, and governmental disability benefits and the like.” (f) The definition of the term “children”, as used in connection with determinations of “Eligible Dependents” under the terms of the Dental Plan and the Vision Plan, respectively, shall be revised as provided in subsection (e) above. (g) Blue Cross Blue Shield programs that are currently available under the Plan will be made available for selection by employees covered by this Agreement who choose coverage under the MMCP in all areas where the MMCP is made available under the Plan and throughout the United States for selection by such employees who choose coverage under the CHCB. (h) During a prescribed election period preceding January 1, 2008, and preceding each January 1 thereafter, employees may certify to the Plan or its designee in writing that they have health care coverage (which includes medical, prescription drug, and mental health/substance abuse benefits) under another group health plan or health insurance policy that they identify by name and, where applicable, by group number, and for that reason they elect to forego coverage for foreign-to- occupation health benefits for themselves and their dependents under the Plan and under any Hospital Association plan in which they participate. Such election is hereafter referred to as an “Opt-Out Election” and, where exercised, will eliminate an employer’s obligation to make a contribution to the Plan and/or dues offset payment to a Hospital Association for foreign-to-occupation health benefitsfor the employee and his dependents. Each employee who makes an Opt-Out Election will be paid by his employer $100 for each month that his employer is required to make a contribution to the Plan on his behalf for life insurance and accidental death and dismemberment benefits as a result of compensated service rendered, or vacation pay received, by the employee during the prior month; provided, however, that the employee’s Opt- Out Election is in effect for the entire month. If an event described below in the final paragraph of this subsection (h) occurs subsequent to an employee’s Opt-Out Election, the employee may, upon providing the Plan or its designee with proof satisfactory to it of the occurrence of such event, revoke his or her Opt-Out Election. An employee may also revoke his or her Opt-Out Election by providing the Plan or its designee with proof satisfactory to it that, after the employee made the Opt- Out Election, a person became a dependent of the employee through a marriage, birth, or adoption or placement for adoption. An employee who revokes an Opt-Out Election will, along with his or her dependents, be once again covered (effective the first day of the first month following such revocation that the employee and/or his dependents would have been covered but for the Opt-Out Election the employee had previously made) for foreign to-occupation health benefits under the Plan or, in the case of an employee who is a member of a Hospital Association, by the Plan (for dependent coverage) and by the Hospital Association (for employee coverage). See Side Letter No. 6. The following events are the events referred to in the immediately preceding paragraph: (1) the employee loses eligibility under, or there is a termination of employer contributions for, the other coverage that allowed the employee to make the Opt-Out Election, or (2) if COBRA was the source of such other coverage, that COBRA coverage is exhausted. (i) Plan participants Participants and their beneficiaries who live in an area where, as of the date of this Agreement, they may choose between MMCP and CHCB coverage shall no longer have a choice, but shall be enrolled in the MMCP. This subsection is not intended to have any application to employees covered by this Agreement who reside in any geographic area where MMCP is not offered as of the date of such Agreement. Mandatory enrollment in MMCP for such employees shall be governed exclusively by Part A, Section 2(b) of this Article. (ji) The design changes contained in this Section Section, with the exception of subsection (h) above, shall become effective on July 1, 2007 the date of this Agreement or as soon thereafter as practicable. Subsection (h) shall become effective as soon as practicable.

Design Changes To Contain Costs. (a) The Plan’s MMCP shall be revised as follows: (1) The Office Visit Co-Payment for In-Network Services shall be increased to $20.00 for each office visit to a provider in general practice or who specializes in pediatrics, obstetricsgynecologyobstetrics/gynecology, family practice or internal medicine, and $35.00 for each office visit to any other provider; (2) The Urgent Care Center Co-Payment for In-Network Services shall be increased to $25.00 for each visit; (3) The Emergency Room Co-Payment for In-Network Services shall be increased to at least $50.00 for each visit, but if the care received meets the applicable Plan definition of an Emergency, the Plan will reimburse the employee for the full amount paid for such care, except for $25.00 if the visit does not result in hospital admission. For purposes of this Paragraph, the phrase “at least” shall be interpreted and applied consistent with practice under the Plan preceding the date of this Agreement; (4) The Annual Deductible for Out-of-Network Services shall be increased to $300.00 per individual and $900.00 per family; (5) The Annual Out-of-Pocket Maximum for Out-of-Network Services shall be increased to $2,000 per individual and $4,000 per family. (b) The Plan’s Comprehensive Health Care Benefit shall be revised as follows: (1) The Annual Deductible shall be increased to $200.00 per individual and $400.00 per family; (2) The Annual Out-of-Pocket Maximum shall be increased to $2,000 per individual and $4,000 per family. (c) The Plan’s Prescription Drug Card Program co-payments to In-Network Pharmacies per prescription are revised as follows: (1) Generic Drug – increase to $10.00; (2) Brand Name (Non-Generic) Drug On Program Administrator’s Formulary – increase to $20.00; (3) Brand Name (Non-Generic) Drug Not On Program Administrator’s Formulary – increase to $30.00; (4) Brand Name (Non-Generic) Drug on Program Administrator’s Formulary that is not ordered by the patient’s physician by writing “Dispense as Written” on the prescription and there is an equivalent Generic Drug increase to $20.00 plus the difference between the GenericDrug and the Brand Name (Non-Generic) Drug; (5) Brand Name (Non-Generic) Drug Not On Program Administrator’s Formulary that is not ordered by the patient’s physician by writing “dispense as Written” on the prescription and there is an equivalent Generic Drugincrease to $30.00 plus the difference between the Generic Drug and the Brand Name (Non- Generic) Drug. (d) The Plan’s Mail Order Prescription Drug Program co-payments per prescription are revised as follows: (1) Generic Drug – increase to $20.00; (2) Brand Name (Non-Generic) Drug On Program Administrator’s Formulary – increase to $30.00; (3) Brand Name (Non-Generic) Drug Not on Program Administrator’s Formulary – increase to $60.00. (e) For purposes of the Plan, the term “children” as used in connection with determining “Eligible Dependents” under the Plan, shall be defined as follows: “Children include: o natural children, o stepchildren, o adopted children (including children placed with you for adoption), and o your grandchildren, provided they have their legal residence with you and are dependent for care and support mainly upon you and wholly, in the aggregate, upon themselves, you, your spouse, scholarships and the like, and governmental disability benefits and the like.” (f) The definition of the term “children”, as used in connection with determinations of “Eligible Dependents” under the terms of the Dental Plan and the Vision Plan, respectively, shall be revised as provided in subsection (e) above. (g) Blue Cross Blue Shield programs that are currently available under the Plan will be made available for selection by employees covered by this Agreement who choose coverage under the MMCP in all areas where the MMCP is made available under the Plan and throughout the United States for selection by such employees who choose coverage under the CHCB. (h) During a prescribed election period preceding January 1, 2008, and preceding each January 1 thereafter, employees may certify to the Plan or its designee in writing that they have health care coverage (which includes medical, prescription drug, and mental health/substance abuse benefits) under another group health plan or health insurance policy that they identify by name and, where applicable, by group number, and for that reason they elect to forego coverage for foreign-to- occupation health benefits for themselves and their dependents under the Plan and under any Hospital Association plan in which they participate. Such election is hereafter referred to as an “Opt-Out Election” and, where exercised, will eliminate an employer’s obligation to make a contribution to the Plan and/or dues offset payment to a Hospital Association for foreign-to-occupation health benefitsfor benefits for the employee and his dependents. Each employee who makes an Opt-Out Election will be paid by his employer $100 for each month that his employer is required to make a contribution to the Plan on his behalf for life insurance and accidental death and dismemberment benefits as a result of compensated service rendered, or vacation pay received, by the employee during the prior month; provided, however, that the employee’s Opt- Out Election is in effect for the entire month. If an event described below in the final paragraph of this subsection (h) occurs subsequent to an employee’s Opt-Out Election, the employee may, upon providing the Plan or its designee with proof satisfactory to it of the occurrence of such event, revoke his or her Opt-Out Election. An employee may also revoke his or her Opt-Out Election by providing the Plan or its designee with proof satisfactory to it that, after the employee made the Opt- Out Election, a person became a dependent of the employee through a marriage, birth, or adoption or placement for adoption. An employee who revokes an Opt-Out Election will, along with his or her dependents, be once again covered (effective the first day of the first month following such revocation that the employee and/or his dependents would have been covered but for the Opt-Out Election the employee had previously made) for foreign to-occupation health benefits under the Plan or, in the case of an employee who is a member of a Hospital Association, by the Plan (for dependent coverage) and by the Hospital Association (for employee coverage). See Side Letter No. 6. The following events are the events referred to in the immediately preceding paragraph: (1) the employee loses eligibility under, or there is a termination of employer contributions for, the other coverage that allowed the employee to make the Opt-Out Election, orcontributions (2) if COBRA was the source of such other coverage, that COBRA coverage is exhausted. (i) Plan participants and their beneficiaries who live in an area where, as of the date of this Agreement, they may choose between MMCP and CHCB coverage shall no longer have a choice, but shall be enrolled in the MMCP. This subsection is not intended to have any application to employees covered by this Agreement who reside in any geographic area where MMCP is not offered as of the date of such Agreement. Mandatory enrollment in MMCP for such employees shall be governed exclusively by Part A, Section 2(b) of this Article. (j) The design changes contained in this Section shall become effective on July 1, 2007 or as soon thereafter as practicable.