Full-Time and Part-Time Employees. When determining employer contributions for Medical, Dental, and Vision Coverage, employees shall be considered “Full Time” if said employee has been employed to work thirty (30) hours or more per week. “Part-Time” employees are those employees hired by the Board working at least twenty (20) hours, but less than thirty (30) hours per week. Vision and Dental Premiums The Board agrees to contribute: • 86.5% of Dental and Vision premiums for full-time employees. • 65% of Dental and Vision premiums for part-time employees. Medical Premiums Beginning 07/01/16, the Board agrees to contribute 86.5% of the cost of medical insurance premiums for family or single coverage for full-time employees and 50% of the cost of medical insurance premiums for family or single coverage for part-time employees. Employees not considered full- or part-time may purchase Dental, Vision, or Medical insurance at their own expense. Plan Designs – Effective July 1, 2016 LERC PREMIUM PLAN DETAILS In-Network Out-of-Network 90% Co-Insurance 60% Co-Insurance $750 Single Deductible $1,500 Single Deductible $1,500 Family Deductible $3,000 Family Deductible $1,500 Coinsurance Limit Single (excluding deductible, medical and RX copays) $3,000 Coinsurance Limit Single (excluding deductible, medical and RX copays) $3,000 Coinsurance Limit Family (excluding deductible, medical and RX copays) $6,000 Coinsurance Limit Family (excluding deductible, medical and RX copays) Retail Pharmacy (30-day supply): Generic --$10.00 Preferred -- $25.00 Non-Preferred -- $50.00 Specialty --$60.00 Mail Order Pharmacy (90-day supply): Generic --$20.00 Preferred -- $50.00 Non-Preferred -- $100.00 Maximum Out-of-Pocket Limit or MOOP (including deductible, coinsurance, medical and drug copays) $6,600/$13,200 (Single/Family) LERC STANDARD PLAN DETAILS In-Network Out-of-Network 80% Co-Insurance 60% Co-Insurance $1,000 Single Deductible $2,000 Single Deductible $2,000 Family Deductible $4,000 Family Deductible $2,000 Coinsurance Limit Single (excluding deductible, medical and RX copays) $4,000 Coinsurance Limit Single (excluding deductible, medical and RX copays) $4,000 Coinsurance Limit Family (excluding deductible, medical and RX copays) $8,000 Coinsurance Limit Family (excluding deductible, medical and RX copays) Retail Pharmacy (30-day supply): Generic --$15.00 Preferred -- $30.00 Non-Preferred -- $60.00 Specialty --$100.00 Mail Order Pharmacy (90-day supply): Generic --$30.00 Preferred -- $60.00 Non-Preferred -- $120.00 Maximum Out-of-Pocket Limit or MOOP (including deductible, coinsurance, medical and drug copays) $6,600/$13,200 (Single/Family) LERC BASIC PLAN DETAILS In-Network Out-of-Network 90% Co-Insurance 60% Co-Insurance $2,000 Single Deductible $4,000 Single Deductible $4,000 Family Deductible $8,000 Family Deductible $3,000 Coinsurance Limit Single (excluding deductible, medical and RX copays) $6,000 Coinsurance Limit Single (excluding deductible, medical and RX copays) $6,000 Coinsurance Limit Family (excluding deductible, medical and RX copays) $12,000 Coinsurance Limit Family (excluding deductible, medical and RX copays) Retail Pharmacy (30-day supply): Must meet deductible first then meds are: Mail Order Pharmacy (90-day supply): Must meet deductible first then meds are: Generic --$10.00 Preferred -- $25.00 Non-Preferred -- $50.00 Specialty -- $60.00 Generic --$30.00 Preferred -- $50.00 Non-Preferred -- $100.00 Maximum Out-of-Pocket Limit or MOOP (including deductible, coinsurance, medical and drug copays) $6,450/$12,900 (Single/Family) The Board of Education also offers a Minimum Value Plan Designed to meet the requirements of the Affordable Care Act. To get details regarding this plan, please see the Board’s Treasurer.
Appears in 2 contracts
Samples: Following Agreement, Negotiated Agreement
Full-Time and Part-Time Employees. When determining employer contributions for Medical, Dental, and Vision Coverage, employees shall be considered “Full Time” if said employee has been employed to work thirty (30) hours or more per week. “Part-Time” employees are those employees hired by the Board working at least twenty (20) hours, but less than thirty (30) hours per week. Vision and Dental Premiums The Board agrees to contribute: • 86.5% of Dental and Vision premiums for full-time employees. • 65% of Dental and Vision premiums for part-time employees. Medical Premiums Beginning 07/01/16, the Board agrees to contribute 86.5% of the cost of medical insurance premiums for family or single coverage for full-time employees and 50% of the cost of medical insurance premiums for family or single coverage for part-time employees. Employees not considered full- or part-time may purchase Dental, Vision, or Medical insurance at their own expense. Plan Designs – Effective July 1, 2016 LERC PREMIUM PLAN DETAILS In-Network Out-of-Network 90% Co-Insurance 60% Co-Insurance $750 Single Deductible $1,500 Single Deductible $1,500 Family Deductible $3,000 Family Deductible $1,500 Coinsurance Limit Single (excluding deductible, medical and RX copays) $3,000 Coinsurance Limit Single (excluding deductible, medical and RX copays) $3,000 Coinsurance Limit Family (excluding deductible, medical and RX copays) $6,000 Coinsurance Limit Family (excluding deductible, medical and RX copays) Retail Pharmacy (30-day supply): Generic --$10.00 Preferred -- $25.00 Non-Preferred -- $50.00 Specialty --$60.00 Mail Order Pharmacy (90-day supply): Generic --$20.00 Preferred -- $50.00 Non-Preferred -- $100.00 Maximum Out-of-Pocket Limit or MOOP (including deductible, coinsurance, medical and drug copays) $6,600/$13,200 (Single/Family) LERC STANDARD PLAN DETAILS In-Network Out-of-Network 80% Co-Insurance 60% Co-Insurance $1,000 Single Deductible $2,000 Single Deductible $2,000 Family Deductible $4,000 Family Deductible $2,000 Coinsurance Limit Single (excluding deductible, medical and RX copays) $4,000 Coinsurance Limit Single (excluding deductible, medical and RX copays) $4,000 Coinsurance Limit Family (excluding deductible, medical and RX copays) $8,000 Coinsurance Limit Family (excluding deductible, medical and RX copays) Retail Pharmacy (30-day supply): Generic --$15.00 Preferred -- $30.00 Non-Preferred -- $60.00 Specialty --$100.00 Mail Order Pharmacy (90-day supply): Generic --$30.00 Preferred -- $60.00 Non-Preferred -- $120.00 Maximum Out-of-Pocket Limit or MOOP (including deductible, coinsurance, medical and drug copays) $6,600/$13,200 (Single/Family) LERC BASIC PLAN DETAILS In-Network Out-of-Network 90% Co-Insurance 60% Co-Insurance $2,000 Single Deductible $4,000 Single Deductible $4,000 Family Deductible $8,000 Family Deductible $3,000 Coinsurance Limit Single (excluding deductible, medical and RX copays) $6,000 Coinsurance Limit Single (excluding deductible, medical and RX copays) $6,000 Coinsurance Limit Family (excluding deductible, medical and RX copays) $12,000 Coinsurance Limit Family (excluding deductible, medical and RX copays) Retail Pharmacy (30-day supply): Must meet deductible first then meds are: Generic --$10.00 Preferred -- $25.00 Mail Order Pharmacy (90-day supply): Must meet deductible first then meds are: Generic --$10.00 --$30.00 Preferred -- $25.00 50.00 Non-Preferred -- $50.00 Specialty -- $60.00 Generic --$30.00 Preferred -- $50.00 Non-Preferred -- $100.00 Maximum Out-of-Pocket Limit or MOOP (including deductible, coinsurance, medical and drug copays) $6,450/$12,900 (Single/Family) The Board of Education also offers a Minimum Value Plan Designed to meet the requirements of the Affordable Care Act. To get details regarding this plan, please see the Board’s Treasurer. Office and Emergency Visits: Premium Standard Basic OV Copay $25 $30 Deductible Urgent Care Visit $40 $45 then Specialist Visit $40 $45 coinsurance ER Copay - Emergency $100 $150 ER Copay - Non-emergency Preventive Care (formerly Wellness): $200 $200 Immunizations 100% In-network Routine Physical 100% In-network Routine PSA 100% In-network Endoscopies 100% In-network Pap Test Exam 100% In-network PPACA Expanded Wellness Svcs 100% In-network Wellness Incentive Employees who are enrolled in the Board’s medical insurance plan and participate in and complete the preventative health screenings and online health assessment on or before November 1 of the applicable year, shall receive a credit ($250.00/Single and $500.00/Family) toward the employee’s deductible. Working Spouse Rule – Effective January 1, 2015. Any spouse that has single medical/prescription drug insurance coverage available through his/her employer, business, organization or retirement plan, that costs 25% or more of the premium cost, must enroll in that coverage and the Board’s Medical Plan will coordinate as secondary payer for any and all services provided. It is the employee’s responsibility to advise the Treasurer immediately (and not later than 30 days after any change in eligibility) if the employee’s spouse becomes eligible to participate in group medical/ prescription drug insurance sponsored by his/her employer, business, organization or retirement plan or if the contribution for single coverage changes. Upon becoming eligible, the employee’s spouse must enroll in single coverage under any group medical/prescription drug insurance sponsored by his/her employer, business, organization, or retirement plan unless he/she is exempt from this requirement because the cost for single coverage under the lowest cost plan is 25% or more of the premium cost. Any spouse who fails to enroll in any group medical/prescription drug insurance coverage sponsored by his/her employer, business, organization, or any retirement plan, as required by this rule, shall be ineligible for benefits under such group insurance coverage sponsored by the Board. Every employee whose spouse participates under the Board’s medical/prescription drug insurance coverage shall complete and submit to the Plan, upon request, a written certification verifying whether his/her spouse is eligible to participate in group medical/prescription drug insurance coverage sponsored by the spouse’s employer, business, organization, or any retirement plan. If any employee fails to complete and submit the certification form by the required date, such employee’s spouse will be removed immediately from all group medical/prescription drug insurance coverage sponsored by the Board. Additional documentation may be required. If you submit false information, or fail to timely advise the Treasurer of a change in your spouse’s eligibility for employer, business, organization, or retirement plan sponsored group medical/prescription drug insurance, and such false information or such failure by you results in the Plan providing benefits to which your spouse is not entitled, you will be personally liable to the Plan for reimbursement of benefits and expenses, including attorneys’ fees and costs, incurred by the Plan. Any amount to be reimbursed by you may be deducted from the benefits to which you would otherwise be entitled. In addition, your spouse will be terminated immediately from group medical/prescription drug insurance coverage under the Plan. If you submit false information, you may be subject to disciplinary action, up to and including termination of employment.
Appears in 1 contract
Samples: Negotiated Agreement
Full-Time and Part-Time Employees. When determining employer contributions for Medical, Dental, and Vision Coverage, employees shall be considered “Full Time” if said employee has been employed to work thirty (30) hours or more per week. “Part-Time” employees are those employees hired by the Board working at least twenty (20) hours, but less than thirty (30) hours per week. Vision and Dental Premiums The Board agrees to contribute: • 86.5% of Dental and Vision premiums for full-time employees. • 65% of Dental and Vision premiums for part-time employees. Medical Premiums Beginning 07/01/16, the Board agrees to contribute 86.5% of the cost of medical insurance premiums for family or single coverage for full-time employees and 50% of the cost of medical insurance premiums for family or single coverage for part-time employees. Employees not considered full- or part-time may purchase Dental, Vision, or Medical insurance at their own expense. Plan Designs – Effective July 1, 2016 LERC PREMIUM PLAN DETAILS In-Network Out-of-Network 90% Co-Insurance 60% Co-Insurance $750 Single Deductible $1,500 Single Deductible $1,500 Family Deductible $3,000 Family Deductible $1,500 Coinsurance Limit Single (excluding deductible, medical and RX copays) $3,000 Coinsurance Limit Single (excluding deductible, medical and RX copays) $3,000 Coinsurance Limit Family (excluding deductible, medical and RX copays) $6,000 Coinsurance Limit Family (excluding deductible, medical and RX copays) Retail Pharmacy (30-day supply): Generic --$10.00 Preferred -- $25.00 Non-Preferred -- $50.00 Specialty --$60.00 Mail Order Pharmacy (90-day supply): Generic --$20.00 Preferred -- $50.00 Non-Preferred -- $100.00 Maximum Out-of-Pocket Limit or MOOP (including deductible, coinsurance, medical and drug copays) $6,600/$13,200 (Single/Family) LERC STANDARD PLAN DETAILS In-Network Out-of-Network 80% Co-Insurance 60% Co-Insurance $1,000 Single Deductible $2,000 Single Deductible $2,000 Family Deductible $4,000 Family Deductible $2,000 Coinsurance Limit Single (excluding deductible, medical and RX copays) $4,000 Coinsurance Limit Single (excluding deductible, medical and RX copays) $4,000 Coinsurance Limit Family (excluding deductible, medical and RX copays) $8,000 Coinsurance Limit Family (excluding deductible, medical and RX copays) Retail Pharmacy (30-day supply): Generic --$15.00 Preferred -- $30.00 Non-Preferred -- $60.00 Specialty --$100.00 Mail Order Pharmacy (90-day supply): Generic --$30.00 Preferred -- $60.00 Non-Preferred -- $120.00 Maximum Out-of-Pocket Limit or MOOP (including deductible, coinsurance, medical and drug copays) $6,600/$13,200 (Single/Family) LERC BASIC PLAN DETAILS In-Network Out-of-Network 90% Co-Insurance 60% Co-Insurance $2,000 Single Deductible $4,000 Single Deductible $4,000 Family Deductible $8,000 Family Deductible $3,000 Coinsurance Limit Single (excluding deductible, medical and RX copays) $6,000 Coinsurance Limit Single (excluding deductible, medical and RX copays) $6,000 Coinsurance Limit Family (excluding deductible, medical and RX copays) $12,000 Coinsurance Limit Family (excluding deductible, medical and RX copays) Retail Pharmacy (30-day supply): Must meet deductible first then meds are: Generic --$10.00 Preferred -- $25.00 Mail Order Pharmacy (90-day supply): Must meet deductible first then meds are: Generic --$10.00 --$30.00 Preferred -- $25.00 50.00 Non-Preferred -- $50.00 Specialty -- $60.00 Generic --$30.00 Preferred -- $50.00 Non-Preferred -- $100.00 Maximum Out-of-Pocket Limit or MOOP (including deductible, coinsurance, medical and drug copays) $6,450/$12,900 (Single/Family) The Board of Education also offers a Minimum Value Plan Designed to meet the requirements of the Affordable Care Act. To get details regarding this plan, please see the Board’s Treasurer. Office and Emergency Visits: Premium Standard Basic OV Copay $25 $30 Deductible Urgent Care Visit $40 $45 then Specialist Visit $40 $45 coinsurance ER Copay - Emergency $100 $150 ER Copay - Non-emergency Preventive Care (formerly Wellness): $200 $200 Immunizations 100% In-network Routine Physical 100% In-network Routine PSA 100% In-network Endoscopies 100% In-network Pap Test Exam 100% In-network PPACA Expanded Wellness Svcs 100% In-network Wellness Incentive Employees who are enrolled in the Board’s medical insurance plan and participate in and complete the preventative health screenings and online health assessment on or before November 1 of the applicable year, shall receive a credit ($250.00/Single and $500.00/Family) toward the employee’s deductible. Working Spouse Rule – Effective January 1, 2015. Any spouse that has single medical/prescription drug insurance coverage available through his/her employer, business, organization or retirement plan, that costs 25% or more of the premium cost, must enroll in that coverage and the Board’s Medical Plan will coordinate as secondary payer for any and all services provided. It is the employee’s responsibility to advise the Treasurer immediately (and not later than 30 days after any change in eligibility) if the employee’s spouse becomes eligible to participate in group medical/ prescription drug insurance sponsored by his/her employer, business, organization or retirement plan or if the contribution for single coverage changes. Upon becoming eligible, the employee’s spouse must enroll in single coverage under any group medical/prescription drug insurance sponsored by his/her employer, business, organization, or retirement plan unless he/she is exempt from this requirement because the cost for single coverage under the lowest cost plan is 25% or more of the premium cost. Any spouse who fails to enroll in any group medical/prescription drug insurance coverage sponsored by his/her employer, business, organization, or any retirement plan, as required by this rule, shall be ineligible for benefits under such group insurance coverage sponsored by the Board. Every employee whose spouse participates under the Board’s medical/prescription drug insurance coverage shall complete and submit to the Plan, upon request, a written certification verifying whether his/her spouse is eligible to participate in group medical/prescription drug insurance coverage sponsored by the spouse’s employer, business, organization, or any retirement plan. If any employee fails to complete and submit the certification form by the required date, such employee’s spouse will be removed immediately from all group medical/prescription drug insurance coverage sponsored by the Board. Additional documentation may be required. If you submit false information, or fail to timely advise the Treasurer of a change in your spouse’s eligibility for employer, business, organization, or retirement plan sponsored group medical/prescription drug insurance, and such false information or such failure by you results in the Plan providing benefits to which your spouse is not entitled, you will be personally liable to the Plan for reimbursement of benefits and expenses, including attorneys’ fees and costs, incurred by the Plan. Any amount to be reimbursed by you may be deducted from the benefits to which you would otherwise be entitled. In addition, your spouse will be terminated immediately from group medical/prescription drug insurance coverage under the Plan. If you submit false information, you may be subject to disciplinary action, up to and including termination of employment.
Appears in 1 contract
Samples: Negotiated Agreement
