Common use of First 1000 Plan Clause in Contracts

First 1000 Plan. The First 1000 Plan has no premium payments. There is a $15 co-payment for each office visit/medical treatment received by participants from network providers. Each enrollee is provided an allowance of $500 per calendar year toward medical services provided at network providers (exclusive of visit/treatment co-payments, prescription co-payments, and mental health and substance abuse co-payments). Once the $500 allowance has been exhausted, the enrollee pays 100% of all medical costs up to an annual maximum of: Network Non-Network Single $1000 $3000 Double $2000 $6000 Family $3000 $9000 After payment of the maximum annual deductibles (noted above), network benefits are then covered at 100% or 80% for specified services; and non-network benefits are covered at 70% or 60% for specified services. There is an additional co-pay of $100 per day for the first five days of any inpatient admission. Prescription drugs, at pharmacies specified by the plan, have a co-payment of $10 for a generic formulary, $20 for non-generic formulary, and $30 for non-generic non- formulary. The prescription drug co-payment for mail order, 90-day supply is $20 for generic formulary, $40 for non-generic formulary, and $60 for non-generic non-formulary. There is a $100 co-payment for each emergency room visit, except that no co-payment is required if the patient is admitted as an in-patient as a result of the emergency. Bargaining Unit members who enroll in this plan must attend an information session to review the requirements and guidelines of the plan.

First 1000 Plan. The First 1000 Plan has no premium payments. There is a $15 co-payment for each office visit/medical treatment received by participants from network providers. Each enrollee is provided an allowance of $500 per calendar year toward medical services provided at network providers (exclusive of visit/treatment co-payments, prescription co-payments, and mental health and substance abuse co-payments). Once the $500 allowance has been exhausted, the enrollee pays 100% of all medical costs up to an annual maximum of: Network Non-Network Single $1000 $3000 Double $2000 $6000 Family $3000 $9000 After payment of the maximum annual deductibles (noted above), network benefits are then covered at 100% or 80% for specified services; and non-network benefits are covered at 70% or 60% for specified services. There is an additional co-pay of $100 per day for the first five days of any inpatient admission. Prescription drugs, at pharmacies specified by the plan, have a co-payment of $10 for a generic formulary, $20 for non-generic formulary, and $30 for non-generic non- formulary. The prescription drug co-payment for mail order, 90-day supply is $20 for generic formulary, $40 for non-generic formulary, and $60 for non-generic non-formulary. There is a $100 co-payment for each emergency room visit, except that no co-payment is required if the patient is admitted as an in-patient as a result of the emergency. Bargaining Unit unit members who enroll in this plan must attend an information session to review the requirements and guidelines of the plan.

First 1000 Plan. The First 1000 Plan has no premium payments. There is a $15 co-payment for each office visit/medical treatment received by participants from network providers. Each enrollee is provided an allowance of $500 per calendar year toward medical services provided at network providers (exclusive of visit/treatment co-payments, prescription co-payments, and mental health and substance abuse co-payments). Once the $500 allowance has been exhausted, the enrollee pays 100% of all medical costs up to an annual maximum of: Network Non-Network Single $1000 $3000 Double $2000 $6000 Family $3000 $9000 After payment of the maximum annual deductibles (noted above), network benefits are then covered at 100% or 80% for specified services; and non-network benefits are covered at 70% or 60% for specified services. There is an additional co-pay of $100 per day for the first five days of any inpatient admission. Prescription drugs, at pharmacies specified by the plan, have a co-payment of $10 for a generic formulary, $20 for non-generic formulary, and $30 for non-generic non- formulary. The prescription drug co-payment for mail order, 90-day supply is $20 for generic formulary, $40 for non-generic formulary, and $60 for non-generic non-formulary. There is a $100 co-payment for each emergency room visit, except that no co-payment is required if the patient is admitted as an in-patient as a result of the emergency. Bargaining Unit members who enroll in this plan must attend an information session to review the requirements and guidelines of the plan.