Group Medical Sample Clauses

Group Medical. The Board of Education will provide the employees with a HDHP/HSA with the following provisions: High Deductible Health Plan (HDHP)/Health Savings Account (HSA) with a $2,500/$5,000 deductible with Board funding of 50% of the HDHP Deductible into the HSA on or about July 1st; For Medical Services 100% in-network coverage after satisfaction of deductible , 70%, out-of-network coverage with a $3,000/$6,000 in-network out of pocket maximum, out-of-network, $5,500/$11,000 out of pocket maximum. Once the deductible is reached, then following co-pays apply to the cost of in-network prescription drugs: $10 retail generic; $25 retail brand formulary; $40 retail brand non-formulary; 30 day supply at retail; mail order maintenance drugs at 2X retail co-pay with a 90 day supply. Prescription management provisions: Mandatory generic; Quantity limits; Step therapy; Prior authorization; ED drugs not covered; Exclusive specialty Anthem specialty drug accumulator rules and Anthem cost relief program will be added Add prior authorization through American Imaging Management or a similar program for MRI, CAT scans and other imaging procedures See further details in the grid immediately below. HDHP Plan Deductible $2,500/$5,000 Combined In/Out In-Network You Pay Out-of-Network You Pay Coinsurance 0% Med 30% Med & RX RX Deductible then subject to Copays: $10/$25/$40 Deductible then 30% (as any other expense) Coinsurance Max $0 Medical $1,000/2,000 RX Includes In-Network Post Ded. RX Copays $2,000/4,000 Includes OON Coinsurance Combined In/Out "Out-of-Pocket Max” $5,500/$11,000 (includes Deductible, In/Out Coinsurance and In-Net Post Ded. Rx Copays) In-Network You Pay Out-of-Network You Pay Preventive Care 100% (Deductible does not apply) Deductible then Coinsurance 100% of Board’s HSA contribution funding will be deposited on or about July 1st of each year. Employees enrolled in the HDHP but not eligible to participate in the HSA (for example due to Medicare enrollment or receiving medical services under or through the VA) may continue in the HDHP without any Board contribution into the HSA. However, the HDHP premium cost share shall be reduced by the dollar value of what the Board would otherwise have contributed into the HSA, but not to exceed the dollar value of the premium cost share.

Group Medical. Each full-time teacher under contract may elect to participate in the Group Medical Plan. Initial enrollment in the plan can only be made during the annual thirty (30) day period immediately following the renewal date of the policy with the carrier. In the case of newly hired teachers, enrollment can only be made during the thirty (30) day period immediately following the initial date of employment. Enrollment at any other time is subject to the approval of the Superintendent and should be allowed only in cases of extenuating circumstances which would result in the employees and/or their dependents being uninsured. The amount specified below will be paid by the school employer towards the cost of the hospitalization insurance for each full-time teacher employed under contract and enrolled in the group plan, with the teacher paying not less than one dollar ($l.00) per year. Maximum School Employer Payment Per Teacher 1. Single - Up to the lesser of $4,980 or all but $1.00 of the cost of the premium per year. 2. Employee/Child - Up to the lesser of $7,895 or all but $1.00 of the cost of the premium per year. 3. Employee/Spouse - Up to the lesser of $10,035 or all but $1.00 of the cost of the premium per year. 4. Family - Up to the lesser of $12,145 or all but $1.00 of the cost of the premium per year.

Group Medical. In the school year 2016-17, the employee will be responsible for 13.75% of the monthly premium and the Board of Education will pay 86.25% of the total monthly premium. In the school year 2017-18, the employee will be responsible for 14.5% and the Board of Education will pay 85.5%. Any employee may choose the SHP2 or SHP3 option for insurance coverage at the rate of 93% being covered by the Board and 7% paid by the employee.

Group Medical a. On an annual basis, eligible participating employees shall elect on a form In-Network Out-of-Network Annual Deductible (Individual/A<><>regate Family) $2000/4000 Co-insurance 0% after deductible 20% co-insurance after deductible, subject to co- insurance limits Co-insurance Maximum (Individual/Aggregate Family) $3,00016,000 (Out of network Coinsurance and In-network post deductible RX copavs) Cost Share Maximum (Individual/A,u,regate Familv) $4,000/6,850 Lifetime Maximum Unlimited $1,000,000 Preventive Care Deductible waived NIA Prescription Drug Coverage Subject to deductible, once deductible is met, then $5/30/45 copay per prescription. MP4 Prescription. provided by the Board to participate in the following option: A Health Savings Account (HSA) (with plan design noted below): The parties also agree to the additional benefit management plans: • Care Management Preferred (requires pre-certification for outpatient procedures and provides after-care services) • Standard Formulary for prescriptions • Accredo Specialty Network (required for specialty drugs) • Preventive generic Rx Coverage (Certain generic drugs available at no cost) 9.5. Employee Premium Cost share: 2024-251 2025-26 2026-27 HDHP/H.S.A. 17.0% 17.5% 18.0% 1 Upon the effective date of the agreement the new 2024-25 premium rates will be applied and employees will be credited for any delta between the 2023-24 rates at 17.0% and the 2024-25 rates at 17.0%, if applicable.

Group Medical. Effective the 1st day of the month following the date of hire, full-time and part-time employees who are regularly scheduled to work twenty (20) or more hours per week will be eligible to participate in the Employer’s medical insurance program. The Employer’s medical insurance program consists of a Preferred EPO, Limited PPO, Premier PPO, and a Value Plan. Effective in plan year 2021, bargaining unit employees shall participate in the Prospect Wellness Plan. The terms of the plan shall be consistent with those set forth in the 2019 employee benefits guide and shall remain in effect for the life of this Agreement. Prospect’s spousal eligibility rules for benefits shall continue to apply to bargaining unit employees. For purpose of those rules, effective with plan year 2020, a spouse who is eligible to participate in a medical plan through their own employer but not a dental or vision plan, the spouse shall be eligible to participate in Prospect’s dental/vision coverage. Employees who are seen by physicians at Our Lady of Fatima Hospital shall not be charged any co-pays or fees that are not called for by the plan design, provided that in the event of a situation where an employee is charged in a manner inconsistent with plan design, the employee promptly brings the issue to the attention of HR as soon as is practical, with the supporting documentation, for resolution. Employees and the Employer will share the premium cost of the plans on the following basis: Full-time 85% 15% Part-time 70% 30%

Group Medical. Upon expiration of ▇▇▇▇▇▇▇▇’ coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985, 29 U.S.C. §§ 1161-1168 (“COBRA”), ▇▇▇▇▇▇▇▇ and his wife shall be covered by Frontier’s Executive Retiree Medical Plan (“Medical Plan”) (See Exhibit A) as of the date COBRA continuation coverage ceases and shall be eligible under this Agreement to continue coverage under the Medical Plan until ▇▇▇▇▇▇▇▇ reaches age 65 and for his wife until she reaches age 65 (the “Additional Coverage Term”) under the following conditions: (a) ▇▇▇▇▇▇▇▇ qualifies for the “Minimum Benefit” coverage provided by the Medical Plan. (b) No dependent may be added during the Additional Coverage Term. (c) Coverage for the Additional Coverage Term shall remain in effect only if ▇▇▇▇▇▇▇▇ timely remits to the Frontier group health plan payment of the monthly premium for the plan coverage. (d) The monthly premium shall be as provided in the Executive Retiree Medical Plan and communicated annually to ▇▇▇▇▇▇▇▇ by Frontier. Any premium change shall be assessed prospectively only. (e) If ▇▇▇▇▇▇▇▇ or his wife becomes entitled to participate in any other health plan, e.g., through an employer group health plan or a governmental program such as Medicare, that provides substantially similar benefits and coverage as provided under the Medical Plan, coverage for the affected individual under the Medical Plan shall terminate immediately, retroactive to the date the affected individual became entitled to participate in such other health plan. (f) Coverage for ▇▇▇▇▇▇▇▇’ wife shall cease immediately upon divorce from ▇▇▇▇▇▇▇▇, retroactive to the date of divorce. (g) Coverage for ▇▇▇▇▇▇▇▇ and his wife shall cease immediately if ▇▇▇▇▇▇▇▇ breaches any of the restrictive covenants contained in paragraph 8 of this Agreement, retroactive to the date of breach. (h) ▇▇▇▇▇▇▇▇ acknowledges and agrees that during the Additional Coverage Term, Frontier reserves the right to amend or terminate the Medical Plan or increase the active employee premium to be paid at Frontier’s discretion, to the extent that such changes are not limited to ▇▇▇▇▇▇▇▇ and other participants receive continuation coverage pursuant to a substantially similar increase or revision of the Medical Plan. Under this Agreement, Frontier will provide ▇▇▇▇▇▇▇▇ with two (2) months advance notice prior to any decision to amend or terminate the Medical Plan or increase the premium to be paid.

Group Medical. 1. The Board shall provide hospitalization, medical and surgical coverage to each unit member, either single or family, at the unit member's discretion. The coverage provided shall be substantially equivalent to current coverage. 2. For Employees scheduled to work an average of six (6) or more hours per day and for employees with 10 or more years of service scheduled to work an average of at least four (4) hours per day, the Board shall pay eighty percent (80%) of the single or family premium per month and the unit member shall pay twenty (20%) percent of the single and/or family premium per month. For employees with fewer than 10 years of service scheduled to work an average of at least four (4) hours per day but fewer than six (6) hours per day, the Board shall pay a percentage of the single or family premium per month as follows: Up to 5 years 50% 60% 5 years 55% 60% 6 years 60% 60% 7 years 65% 65% 8 years 70% 70% 9 years 75% 75% The unit member's share will be paid by payroll deduction. The Board will not make any contribution to the premium cost of insurance for an Employee scheduled to work an average of less than four (4) hours per day. 3. The Board may change carriers with sixty (60) days' notice to the Union, but benefits and services provided under the new plan shall be substantially equivalent to the benefits and services provided in the current plan. 4. Teamsters members were given an opportunity to remain with the current insurance plan or choose a New Base Plan or a Health Savings Account (HSA) Option. They had until November 30, 2017 to choose. 5. All new employees hired after July 1, 2020 will will be offered the HSA medical plan. 6. Once any current employee opts for the New Base Plan or HSA Option, they cannot opt back to the current existing plan. 7. Once any employee opts out of the Board’s major medical plans, if they choose to return, they must enroll in the HSA plan 8. Once any employee opts for the HSA Plan, they cannot elect the New Base Plan. 9. Open enrollment will be during the month of November each calendar year with the coverage to start January 1st of the next calendar year. In order to complete the annual open enrollment process, employees must attend the open enrollment meeting at a time and location specified by the Board. 10. If a current employee chooses the HSA Option with lower out of pocket (OOP), the following will take place: 2020-2021 The district will fund $1,000/single plan and $2,000 family plan for any current...

Group Medical. A. The Employer shall establish and maintain a group medical health program for each permanent Employee effective on their first day of employment as a permanent employee. For the plan year beginning July 1, 2018, and continuing through June 30, 2023, each month the Employer will pay 90% for single coverage 90% for employee + child(ren) 90% for employee + spouse 90% for family coverage Beginning July 1, 2018, and continuing through June 30, 2023, the Employer’s contribution set out above will increase by 2 percentage points for employees who qualify for the Employer’s “Wellness Program”. B. For the term of this contract the Employer will make available a flexible benefits spending account plan. Participation in said plan will be voluntary.

Group Medical. 22 Section A. Eligibility 22 Section B. Level of Benefits 23 Section C. Member Contribution for Dependent Coverage 23 Section D. Catastrophic Coverage 24 Section E. Survivors Benefits 24 Section F. Retired Employees 25 ARTICLE 19. LIFE INSURANCE 26 ARTICLE 20. INDEMNIFICATION 26