Emergency and Urgent Care. Emergency Room After annual Part B deductible – 80% coverage of Medicare eligible expenses for the facility and doctor charges (co-insurance/co-payment waived if admitted within 1-3 days of the emergency room visit). Not covered outside the United States except under limited circumstances. Plan 65 pays the Annual Part B deductible and 20% coverage for Medicare eligible expenses. M/M Medicare and Plan 65 pay in full. No balance due. Urgi-Centers After annual Part B deductible – 80% coverage of Medicare eligible expenses for the doctor charges. Not covered outside the United States except under limited circumstances (this is not emergency care, and in most cases, is out of the service area). Plan 65 pays the annual Part B deductible and 20% coverage for Medicare eligible expenses. M/M Medicare and Plan 65 pay in full. No balance due. Inpatient Services Hospitalization Member must pay the inpatient hospital deductible and co-payment for each benefit period for Medicare eligible expenses. A benefit period begins the day the member is admitted into a hospital or skilled nursing facility. The benefit period ends when member has not received hospital or skilled nursing care for 60 days in a row. If member goes into hospital after one benefit period has ended, a new benefit period begins. There is no limit to the number of benefit periods a member can have. Days 1-60: an initial deductible of $792 (inpatient deductible). Days 61-90: $198 co-payment each day. Days 91-150 (reserve days): $396 co-payment each day. (The 60 lifetime reserve days can only be used once).) Plan 65 will pay for the inpatient hospital deductible and the co-payment for Medicare eligible expenses. Upon exhaustion of all Medicare Hospital inpatient coverage including the lifetime reserve days, member is covered up to 90% of all Medicare Part A eligible expenses for hospitalization not covered by Medicare subject to a lifetime maximum benefit of an additional 365 days. Skilled Nursing Care and custodial care are not covered. Days 1-60: an initial deductible of $792 (inpatient deductible). Days 61-90: $198 co-payment each day. Days 91-150: (reserve days): $396 co- payment each day. (The 60 lifetime reserve days can only be used once.) M/M Not applicable. Skilled Nursing Member is responsible for each hospitalization benefit period, following at least 3-day covered hospital stay. There is a limit of 100 days for each benefit period. Must be a Medicare certified skilled nursing facility to receive the following coverage: Days 1-20: 100% coverage for each day Days 21-100: $97 for each day Plan 65 and M/M Skilled nursing facilities are not covered. The member is responsible for all deductibles, co- payments, and non-covered services. Inpatient Rehab Facility Considered a hospitalization – Please refer to Hospitalization summary (above). Considered a hospitalization – Please refer to Hospitalization summary (above). Organ Transplant Considered a hospitalization – Please refer to Hospitalization summary (above). Medicare Part B helps pay for heart, lung, kidney, pancreas, and liver transplants under certain conditions. Considered a hospitalization – Please refer to Hospitalization summary (above). Inpatient Mental Health Care Considered a hospitalization – Please refer to Hospitalization summary (above). There is a 190- day lifetime limit in a psychiatric hospital. Considered a hospitalization – Please refer to Hospitalization summary (above). Outpatient/Office Mental Health Care After annual Part B deductible – 50% coverage of Medicare eligible expenses Plan 65 pays the Annual Part B deductible and 20% coverage for Medicare eligible expenses. M/M will provide coverage for the remaining co-payment of Medicare eligible expenses after meeting the $200 annual deductible. Inpatient Chemical Dependency Considered a hospitalization – Please refer to Hospitalization summary (above). Plan 65 and M/M Chemical Depend- ency services are not covered. The member is responsible for all deducti- bles, co-payments, and non-covered services. Outpatient Chemical Dependency After annual Part B deductible – 80% coverage of Medicare eligible expenses. Plan 65 and M/M Chemical Depend- ency services are not covered. The member is responsible for all deducti- bles, co-payments, and non-covered services. Additional Services Physical, Speech & Occupational Therapy - Outpatient After annual Part B deductible – 80% coverage of Medicare eligible expenses Plan 65 Pays the Annual Part B deductible and 20% coverage for Medicare eligible expenses M/M Medicare and Plan 65 pay in full. No balance due. Chiropractic Medicine After annual Part B deductible – 80% coverage of Medicare eligible expenses for manual manipulation of the spine (to correct subluxation, provided by chiropractors or qualified other providers). Routine chiropractic services are not covered. Plan 65 pays the Annual Part B deductible and 20% coverage for Medicare eligible expenses. M/M Routine chiropractic services are covered after meeting the $200 annual deductible. Ambulance After annual Part B deductible – 80% coverage of Medicare eligible expenses. (Medically necessary ambulance service.) Air ambulanc- es not covered. Plan 65 pays the annual Part B deductible and 20% coverage for Medicare eligible expenses. Air ambulance not covered. M/M No balance as Medicare and Plan 65 pays in full. Durable Medical Equip- ment After annual Part B deductible – 80% coverage of Medicare eligible expenses Plan 65 pays the annual Part B deductible and 20% coverage for Medicare eligible expenses. M/M No balance as Medicare and Plan 65 pay in full. Home Health & Hospice Care Hospice – Member is responsible for part of the cost of outpatient drugs and inpatient respite care. Must receive care from any Medicare certified hospice. Home Health Care – 100% coverage for all covered home health visits. Includes medically intermittent skilled nursing care, home health aid services, and rehabilitation services, etc. Hospice Plan 65 Medicare pays eligible expenses at 100% except limited coinsurance for outpatient drugs and inpatient respite care. M/M will pay for FDA approved prescriptions after $200 annual deductible and 80%. Home Health Care Plan 65 No balance as Medicare pays in full M/M No balance as Medicare pays in full Eyeglasses & Contact Lenses Member is covered for one pair of eyeglasses or contact lenses after each cataract surgery (annual deductible applies) otherwise not covered. Plan 65 no coverage M/M no coverage Hearing Aids Routine hearing exams and hearing aids are not covered. After annual Part B deductible – 80% coverage of Medicare eligible expenses for diagnostic hearing exams. Plan 65 Hearing aids are not covered. Plan 65 pays the annual Part B deductible and 20% for Medicare eligible expenses for diagnostic hearing exams. M/M Hearing aids are not covered INDEX Arbitration 2, 5, 39, 40 Bids 3, 4 Blue Cross , 42, v Board of Public Safety 5, 14, 25, 32, 39, 40 Boats 16 Call Back 43 Chief 1, 2, 3, 4, 5, 10, 15, 17, 18, 20, 27, 29, 30, 31, 38, 39, 40, 46 Clothing 23, 24 Contract negotiations 5 Dental , 42, v Detailed 7, 15 Details 15, 19, 20, 30 Disability 27, 30, 32, 46, 47 Disability Pension 46 Disabled 8, 30 Double Time 19 Dues 2 Duration 9, 50 Duties 7, 12, 13, 14, 15, 25, 26, 28, 30, 31, 32, 34, 35, 43 Employee Contribution 44 Escalator 46 Fire Alarm 10, 17, 18, 22, 36, 37 Fire Prevention 10, 17, 18, 31, 36, 37 Floater 4 Grievances 4, 5, 38, 39, 40 Heart 30, 46, 48 Holidays 3, 19, 22 Hydrants 15 Injuries 7, 8, 9, 25, 28, 29, 32 Ladders 16, 33 Life Insurance 43, 44 Light Duty 31, 32 Medical Insurance 42 Military Buy Back 46 Minimum Xxxxxxx 8, 9, 31, 34 National Fire Academy 7 Out of Rank 8 Overtime 16, 17, 18, 21, 28 Parades 19 Pension 8, 37, 43, 44, 45, 46, 47, 48 Personal Leave 25, 26 Personnel Records 33 Presumed 30 Presumption 48 Probationary 20, 23, 49 Promotional 8, 9, 10, 11, 12, 13 Promotions 3, 10 Rescue 8, 9, 10, 12, 13, 14 Resign 13, 20 Respiratory 30, 46 Retire 42, 46 Retiree 35, 43 Retirement 21, 26, 27, 37, 46, 47 Rules and Regulations 32, 40 Salaries 1, 6, 12, 18, 19, 22, 32, 34, 36, 37, 45, 46 School , 6, 13, 21, 24, v Seniority 2, 3, 4, 5, 11, 19, 37, 48 Service Jackets 33 Sick Leave 25, 26, 27, 28, 30 Sickness 7, 9, 25, 28 Social Security 46, 48 Transfers 3, 4, 15, 37 Trial Period 3, 4 Tuition 5 Uniform 2, 24 Union Business 5 Vacancy 3, 4, 7, 8, 9, 10, 13 Vacation 4, 9, 20, 21 Vested 45 Vesting 45
Appears in 2 contracts
Emergency and Urgent Care. Emergency Room After annual Part B deductible – 80% coverage of Medicare eligible expenses for the facility and doctor charges (co-insurance/co-payment waived if admitted within 1-3 days of the emergency room visit). Not covered outside the United States except under limited circumstances. Plan 65 pays the Annual Part B deductible and 20% coverage for Medicare eligible expenses. M/M Medicare and Plan 65 pay in full. No balance due. Urgi-Centers After annual Part B deductible – 80% coverage of Medicare eligible expenses for the doctor charges. Not covered outside the United States except under limited circumstances (this is not emergency care, and in most cases, is out of the service area). Plan 65 pays the annual Part B deductible and 20% coverage for Medicare eligible expenses. M/M Medicare and Plan 65 pay in full. No balance due. Inpatient Services Hospitalization Member must pay the inpatient hospital deductible and co-payment for each benefit period for Medicare eligible expenses. A benefit period begins the day the member is admitted into a hospital or skilled nursing facility. The benefit period ends when member has not received hospital or skilled nursing care for 60 days in a row. If member goes into hospital after one benefit period has ended, a new benefit period begins. There is no limit to the number of benefit periods a member can have. Days 1-60: an initial deductible of $792 (inpatient deductible). Days 61-90: $198 co-payment each day. Days 91-150 (reserve days): $396 co-payment each day. (The 60 lifetime reserve days can only be used once).) Plan 65 will pay for the inpatient hospital deductible and the co-payment for Medicare eligible expenses. Upon exhaustion of all Medicare Hospital inpatient coverage including the lifetime reserve days, member is covered up to 90% of all Medicare Part A eligible expenses for hospitalization not covered by Medicare subject to a lifetime maximum benefit of an additional 365 days. Skilled Nursing Care and custodial care are not covered. Days 1-60: an initial deductible of $792 (inpatient deductible). Days 61-90: $198 co-payment each day. Days 91-150: (reserve days): $396 co- payment each day. (The 60 lifetime reserve days can only be used once.) M/M Not applicable. Skilled Nursing Member is responsible for each hospitalization benefit period, following at least 3-day covered hospital stay. There is a limit of 100 days for each benefit period. Must be a Medicare certified skilled nursing facility to receive the following coverage: Days 1-20: 100% coverage for each day Days 21-100: $97 for each day Plan 65 and M/M Skilled nursing facilities are not covered. The member is responsible for all deductibles, co- payments, and non-covered services. Inpatient Rehab Facility Considered a hospitalization – Please refer to Hospitalization summary (above). Considered a hospitalization – Please refer to Hospitalization summary (above). Organ Transplant Considered a hospitalization – Please refer to Hospitalization summary (above). Medicare Part B helps pay for heart, lung, kidney, pancreas, and liver transplants under certain conditions. Considered a hospitalization – Please refer to Hospitalization summary (above). Inpatient Mental Health Care Considered a hospitalization – Please refer to Hospitalization summary (above). There is a 190- day lifetime limit in a psychiatric hospital. Considered a hospitalization – Please refer to Hospitalization summary (above). Outpatient/Office Mental Health Care After annual Part B deductible – 50% coverage of Medicare eligible expenses Plan 65 pays the Annual Part B deductible and 20% coverage for Medicare eligible expenses. M/M will provide coverage for the remaining co-payment of Medicare eligible expenses after meeting the $200 annual deductible. Inpatient Chemical Dependency Considered a hospitalization – Please refer to Hospitalization summary (above). Plan 65 and M/M Chemical Depend- ency Dependency services are not covered. The member is responsible for all deducti- blesdeductibles, co-payments, and non-non- covered services. Outpatient Chemical Dependency After annual Part B deductible – 80% coverage of Medicare eligible expenses. Plan 65 and M/M Chemical Depend- ency Dependency services are not covered. The member is responsible for all deducti- blesdeductibles, co-payments, and non-non- covered services. Additional Services Physical, Speech & Occupational Therapy - Outpatient After annual Part B deductible – 80% coverage of Medicare eligible expenses Plan 65 Pays the Annual Part B deductible and 20% coverage for Medicare eligible expenses M/M Medicare and Plan 65 pay in full. No balance due. Chiropractic Medicine After annual Part B deductible – 80% coverage of Medicare eligible expenses for manual manipulation of the spine (to correct subluxation, provided by chiropractors or qualified other providers). Routine chiropractic services are not covered. Plan 65 pays the Annual Part B deductible and 20% coverage for Medicare eligible expenses. M/M Routine chiropractic services are covered after meeting the $200 annual deductible. Ambulance After annual Part B deductible – 80% coverage of Medicare eligible expenses. (Medically necessary ambulance service.) Air ambulanc- es ambulances not covered. Plan 65 pays the annual Part B deductible and 20% coverage for Medicare eligible expenses. Air ambulance not covered. M/M No balance as Medicare and Plan 65 pays in full. Durable Medical Equip- ment Equipment After annual Part B deductible – 80% coverage of Medicare eligible expenses Plan 65 pays the annual Part B deductible and 20% coverage for Medicare eligible expenses. M/M No balance as Medicare and Plan 65 pay in full. Home Health & Hospice Care Hospice – Member is responsible for part of the cost of outpatient drugs and inpatient respite care. Must receive care from any Medicare certified hospice. Home Health Care – 100% coverage for all covered home health visits. Includes medically intermittent skilled nursing care, home health aid services, and rehabilitation services, etc. Hospice Plan 65 Medicare pays eligible expenses at 100% except limited coinsurance for outpatient drugs and inpatient respite care. M/M will pay for FDA approved prescriptions after $200 annual deductible and 80%. Home Health Care Plan 65 No balance as Medicare pays in full M/M No balance as Medicare pays in full Eyeglasses & Contact Lenses Member is covered for one pair of eyeglasses or contact lenses after each cataract surgery (annual deductible applies) otherwise not covered. Plan 65 no coverage M/M no coverage Hearing Aids Routine hearing exams and hearing aids are not covered. After annual Part B deductible – 80% coverage of Medicare eligible expenses for diagnostic hearing exams. Plan 65 Hearing aids are not covered. Plan 65 pays the annual Part B deductible and 20% for Medicare eligible expenses for diagnostic hearing exams. M/M Hearing aids are not covered INDEX Arbitration 2, 5, 39, 40 Bids 3, 4 Blue Cross , 42, v Board of Public Safety 5, 14, 25, 32, 39, 40 Boats 16 Call Back 43 Chief 1, 2, 3, 4, 5, 10, 15, 17, 18, 20, 27, 29, 30, 31, 38, 39, 40, 46 Clothing 23, 24 Contract negotiations 5 Dental , 42, v Detailed 7, 15 Details 15, 19, 20, 30 Disability 27, 30, 32, 46, 47 Disability Pension 46 Disabled 8, 30 Double Time 19 Dues 2 Duration 9, 50 Duties 7, 12, 13, 14, 15, 25, 26, 28, 30, 31, 32, 34, 35, 43 Employee Contribution 44 Escalator 46 Fire Alarm 10, 17, 18, 22, 36, 37 Fire Prevention 10, 17, 18, 31, 36, 37 Floater 4 Grievances 4, 5, 38, 39, 40 Heart 30, 46, 48 Holidays 3, 19, 22 Hydrants 15 Injuries 7, 8, 9, 25, 28, 29, 32 Ladders 16, 33 Life Insurance 43, 44 Light Duty 31, 32 Medical Insurance 42 Military Buy Back 46 Minimum Xxxxxxx 8, 9, 31, 34 National Fire Academy 7 Out of Rank 8 Overtime 16, 17, 18, 21, 28 Parades 19 Pension 8, 37, 43, 44, 45, 46, 47, 48 Personal Leave 25, 26 Personnel Records 33 Presumed 30 Presumption 48 Probationary 20, 23, 49 Promotional 8, 9, 10, 11, 12, 13 Promotions 3, 10 Rescue 8, 9, 10, 12, 13, 14 Resign 13, 20 Respiratory 30, 46 Retire 42, 46 Retiree 35, 43 Retirement 21, 26, 27, 37, 46, 47 Rules and Regulations 32, 40 Salaries 1, 6, 12, 18, 19, 22, 32, 34, 36, 37, 45, 46 School , 6, 13, 21, 24, v Seniority 2, 3, 4, 5, 11, 19, 37, 48 Service Jackets 33 Sick Leave 25, 26, 27, 28, 30 Sickness 7, 9, 25, 28 Social Security 46, 48 Transfers 3, 4, 15, 37 Trial Period 3, 4 Tuition 5 Uniform 2, 24 Union Business 5 Vacancy 3, 4, 7, 8, 9, 10, 13 Vacation 4, 9, 20, 21 Vested 45 Vesting 45
Appears in 2 contracts
