Health Benefits. For the eighteen (18) month period following the Termination Date, provided that Executive is eligible for, and timely elects COBRA continuation coverage, the Company will pay on Executive’s behalf, the monthly cost of COBRA continuation coverage under the Company’s group health plan for Executive and, where applicable, her spouse and dependents, at the level in effect as of the Termination Date, adjusted for any increase in such level paid by the Company for active employees, less the employee portion of the applicable premiums that Executive would have paid had she remained employed during the such eighteen (18) month period (the COBRA continuation coverage period shall run concurrently with the eighteen (18) month period that COBRA premium payments are made on Executive’s behalf under this subsection 1(a)(ii)). The reimbursements described herein shall be paid in monthly installments, commencing on the sixtieth (60th) day following the Termination Date, provided that the first such installment payment shall include any unpaid reimbursements that would have been made during the first sixty (60) days following the Termination Date. Notwithstanding the foregoing, the Company’s payment of the monthly COBRA premiums in accordance with this subsection 1(a)(ii) shall cease immediately upon the earlier of: (A) the end of the eighteen (18) month period following the Termination Date, or (B) the date that Executive is eligible for comparable coverage with a subsequent employer. Executive agrees to notify the Company in writing immediately if subsequent employment is accepted prior to the end of the eighteen (18) month period following the Termination Date and Executive agrees to repay to the Company any COBRA premium amount paid on Executive’s behalf during such period for any period of employment during which group health coverage is available through a subsequent employer. Notwithstanding the foregoing, the Company reserves the right to restructure the foregoing COBRA premium payment arrangement in any manner necessary or appropriate to avoid fines, penalties or negative tax consequences to the Company or Executive (including, without limitation, to avoid any penalty imposed for violation of the nondiscrimination requirements under the Patient Protection and Affordable Care Act or the guidance issued thereunder), as determined by the Company in its sole and absolute discretion.
Appears in 5 contracts
Samples: Separation and Consulting Services Agreement (Valeritas Holdings Inc.), Separation and Consulting Services Agreement (Valeritas Holdings Inc.), Separation and Consulting Services Agreement (Valeritas Holdings Inc.)
Health Benefits. For the eighteen twelve (1812) month period following the Termination Date, provided that Executive is eligible for, and timely elects COBRA continuation coverage, the Company will pay on Executive’s behalf, the monthly cost of COBRA continuation coverage under the Company’s group health plan for Executive and, where applicable, her his spouse and dependents, at the level in effect as of the Termination Date, adjusted for any increase in such level paid by the Company for active employees, less the employee portion of the applicable premiums that Executive would have paid had she he remained employed during the such eighteen twelve (1812) month period (the COBRA continuation coverage period shall run concurrently with the eighteen twelve (1812) month period that COBRA premium payments are made on Executive’s behalf under this subsection 1(a)(ii)). The reimbursements described herein shall be paid in monthly installments, commencing These payments on Executive’s behalf will commence within the sixtieth sixty (60th) day 60)-day period following the Termination Date, provided that Date and will be paid on the first such installment payment shall include any unpaid reimbursements that would have been made during payroll date of each month through the first sixty twelfth (6012th) days month following the Termination Date. Notwithstanding the foregoing, the Company’s payment of the monthly COBRA premiums in accordance with this subsection 1(a)(ii) shall cease immediately upon the earlier of: (A) the end of the eighteen twelve (1812) month period following the Termination Date, or (B) the date that Executive is eligible for comparable coverage with a subsequent employer. Executive agrees to notify the Company in writing immediately if subsequent employment is accepted prior to the end of the eighteen twelve (1812) month period following the Termination Date and Executive agrees to repay to the Company any COBRA premium amount paid on Executive’s behalf during such period for any period of employment during which group health coverage is available through a subsequent employer. Notwithstanding the foregoing, the Company reserves the right to restructure the foregoing COBRA premium payment arrangement in any manner necessary or appropriate to avoid fines, penalties or negative tax consequences to the Company or Executive (including, without limitation, to avoid any penalty imposed for violation of the nondiscrimination requirements under the Patient Protection and Affordable Care Act or the guidance issued thereunder), as determined by the Company in its sole and absolute discretion.
Appears in 4 contracts
Samples: Employment Agreement (Antares Pharma, Inc.), Employment Agreement (Antares Pharma, Inc.), Employment Agreement (Antares Pharma, Inc.)
Health Benefits. For (a) Effective January 1, 1995, the eighteen (18) month period following County will alter the Termination Datebasis for determining its contribution with respect to each separate medical and hospitalization plan, provided that Executive is eligible forcalculated separately for employee, employee +1, and timely elects COBRA continuation family coverage, the Company will pay on Executive’s behalf, the monthly cost of COBRA continuation coverage under the Company’s group health plan for Executive and, where applicable, her spouse and dependents, at the level in effect as to 80 percent of the Termination Datepremium charged for an HMO or, adjusted for any increase in such level paid by the Company for active employeescase of self-insured plans, less the employee portion 80 percent of the applicable premiums that Executive would have paid had she remained employed during projected premium rate for the such eighteen (18) month period (calendar year in which the COBRA continuation coverage period shall run concurrently with the eighteen (18) month period that COBRA premium payments rates are made on Executive’s behalf under this subsection 1(a)(ii))to be effective. The reimbursements described herein rates for each self-insured plan shall be paid in monthly installments, commencing on the sixtieth (60th) day following the Termination Date, provided that the first such installment payment shall include any unpaid reimbursements that would have been made during the first sixty (60) days following the Termination Date. Notwithstanding the foregoing, the Company’s payment of the monthly COBRA premiums in accordance calculated using standard actuarial principles with this subsection 1(a)(ii) shall cease immediately upon the earlier of: (A) the end of the eighteen (18) month period following the Termination Date, or (B) the date that Executive is eligible for comparable coverage with a subsequent employer. Executive agrees to notify the Company in writing immediately if subsequent employment is accepted prior to the end of the eighteen (18) month period following the Termination Date and Executive agrees to repay to the Company any COBRA premium amount paid on Executive’s behalf during such period for any period of employment during which group health coverage is available through a subsequent employer. Notwithstanding the foregoing, the Company reserves the right to restructure the foregoing COBRA premium payment arrangement in any manner necessary or appropriate to avoid fines, penalties or negative tax consequences to the Company or Executive (including, without limitation, to avoid any penalty imposed for violation of the nondiscrimination requirements under the Patient Protection and Affordable Care Act or the guidance issued thereunder), separate medical trends as determined by the Company Employer's actuary, which reflect plan design. The Union shall be provided with information (including but not limited to all actuarial and consultant reports) enabling it to review the premium determinations. In all other respects the level of benefits and services provided in its sole the comprehensive health benefit program shall remain unchanged except as provided below. 1
(1) Effective January 1, 2009, the County shall continue to provide prescription plans (High Option and absolute discretionStandard Option). Bargaining unit employees who select the standard option prescription plan shall pay 20 percent of the total premium cost of the standard option prescription drug plan offered by the employer. The employer shall pay the remaining 80 percent of the total premium cost of the standard option plan. Should the bargaining unit employee select the high option prescription drug plan, the employer shall pay 80 percent of the total premium cost of the standard option prescription drug plan offered 1 Per action taken on May 26, 2011, the County Council did not approve full funding for this provision. On that date, the Council adopted a different cost-sharing arrangement for bargaining unit employees, to become effective on January 1, 2012. See Appendix XXI.
(2) Both prescription plans shall restrict generics. In the event the bargaining unit employee elects to receive a brand medication when a generic medication is available, the member shall pay the cost difference between the brand and generic medication. In the event a physician requires a brand medication; the employee shall not be responsible for the difference in cost.
(3) Both prescription plans shall incentivize mail-order prescriptions. In the event the employee fills a prescription at retail more than twice, rather than utilizing mail-order, the member shall pay the cost difference.
(4) Effective January 1, 2014, the Prescription Drug Plan will no longer offer the 90-day post formulary change grace period granted upon formulary changes. Plan participants affected by formulary changes shall be notified a minimum of90 days prior to the effective date of the formulary change. The Employer shall approve up to a 90-day post formulary change grace period for members based upon the member's particular circumstances.
(5) The following will be referred to the Employee Benefits Committee under Article 21.3 for discussion, review, and implementation during FY 2017:
(i) Generic Step Therapy: This program requires that the members use cost- effective alternatives within the same therapeutic class, as first line therapy before brand name prescriptions are covered.
(ii) Specialty Pharmacy Guideline Management: This program is designed to support the member to ensure appropriate utilization for specialty medications. The program helps ensure the member meets sophisticated and robust criteria before a first dispense, helps ensure that the members experiences expected therapeutic outcomes while on therapy, and ensures that unsafe or ineffective therapy is discontinued. Current Members using medications subject to this program will be grandfathered. Grandfathered status does not apply if the member's drug therapy changes.
(iii) Advanced Control Specialty Formulary: This program promotes cost effective care for members utilizing specialty medications by encouraging utilization of clinically appropriate and lowest next cost medications. Existing medications subject to this program are updated periodically.
(iv) Pharmacy Advisor Counseling at CVS retail: This program is seamlessly integrated into the member's retail purchase workflow, to provide for a clinical consultation with the retail pharmacist when opportunities to improve adherence or close a gap in therapy have been identified. 2 Per action taken on May 26, 2011, the County Council did not approve full funding for this provision. On that date, the Council adopted a different cost-sharing arrangement for bargaining unit employees, to become effective on January 1, 2012. See Appendix XXL
(v) Effective July 1, 2017, or as soon as administratively possible. Exclusive Specialty Pharmacy- a program that requires plan members to purchase specialty medications through the pharmacy benefit manager's exclusive specialty pharmacy arrangement. Any medication that the pharmacy benefit manager ("PBM") does not designate as a specialty medication is not subject to this requirement. In instances where the specialty medication is not available at the PBM's specialty pharmacy, the PBM shall coordinate purchasing arrangements with another specialty pharmacy within the PBM network. 3 At the member's request, the pharmacy benefit manager will deliver the specialty medication to the member's home, the member physician's office, or to a retail pharmacy of the member's choosing that is part of the PBM's pharmacy network.
(c) Effective January 1, 2009, the County shall continue to provide prescription plans (High Option and Standard Option). Bargaining unit employees who select the standard option prescription plan shall pay 20 percent of the total premium cost of the standard option prescription plan offered by the employer. The employer shall pay the remaining 80 percent of the total premium cost of the standard option plan. Should the bargaining unit employee select the high option prescription drug plan, the employer shall pay 80 percent of the total premium cost of the standard option prescription drug plan offered by the employer. The bargaining unit employee shall pay the remainder of the high option prescription drug plan premium. Both prescription plans shall restrict generics. In the event the bargaining unit employee elects to receive a brand medication when a generic medication is available, the member shall pay the cost difference between the brand and generic medication. In the event a physician requires a brand medication, the employee shall not be responsible for the difference in cost. Both prescription plans shall incentivize mail-order prescriptions. In the event the employee fills a prescription at retail more than twice, rather than utilizing mail-order, the member shall pay the cost difference.
(d) Three health maintenance organizations (HMOs) will be open to employees hired before July 1, 1993, two for employees hired on or after July 1, 1993.
(e) For employees enrolled in the current POS medical plan and who reside outside the service area as defined by the current POS medical plan, a schedule of benefits comparable to the current in-network and out-of-network benefit levels of the current POS medical plan will be available as an out-of-area plan through a preferred provider organization (PPO) plan.
Appears in 3 contracts
Samples: Collective Bargaining Agreement, Collective Bargaining Agreement, Collective Bargaining Agreement
Health Benefits. For (a) Effective January 1, 1995, the eighteen (18) month period following County will alter the Termination Datebasis for determining its contribution with respect to each separate medical and hospitalization plan, provided that Executive is eligible forcalculated separately for employee, employee +1, and timely elects COBRA continuation family coverage, the Company will pay on Executive’s behalf, the monthly cost of COBRA continuation coverage under the Company’s group health plan for Executive and, where applicable, her spouse and dependents, at the level in effect as to 80 percent of the Termination Datepremium charged for an HMO or, adjusted for any increase in such level paid by the Company for active employeescase of self-insured plans, less the employee portion 80 percent of the applicable premiums that Executive would have paid had she remained employed during projected premium rate for the such eighteen (18) month period (calendar year in which the COBRA continuation coverage period shall run concurrently with the eighteen (18) month period that COBRA premium payments rates are made on Executive’s behalf under this subsection 1(a)(ii))to be effective. The reimbursements described herein rates for each self-insured plan shall be paid in monthly installments, commencing on the sixtieth (60th) day following the Termination Date, provided that the first such installment payment shall include any unpaid reimbursements that would have been made during the first sixty (60) days following the Termination Date. Notwithstanding the foregoing, the Company’s payment of the monthly COBRA premiums in accordance calculated using standard actuarial principles with this subsection 1(a)(ii) shall cease immediately upon the earlier of: (A) the end of the eighteen (18) month period following the Termination Date, or (B) the date that Executive is eligible for comparable coverage with a subsequent employer. Executive agrees to notify the Company in writing immediately if subsequent employment is accepted prior to the end of the eighteen (18) month period following the Termination Date and Executive agrees to repay to the Company any COBRA premium amount paid on Executive’s behalf during such period for any period of employment during which group health coverage is available through a subsequent employer. Notwithstanding the foregoing, the Company reserves the right to restructure the foregoing COBRA premium payment arrangement in any manner necessary or appropriate to avoid fines, penalties or negative tax consequences to the Company or Executive (including, without limitation, to avoid any penalty imposed for violation of the nondiscrimination requirements under the Patient Protection and Affordable Care Act or the guidance issued thereunder), separate medical trends as determined by the Company Employer's actuary, which reflect plan design. The Union shall be provided with information (including but not limited to all actuarial and consultant reports) enabling it to review the premium determinations. In all other respects the level of benefits and services provided in its sole the comprehensive health benefit program shall remain unchanged except as provided below.1
(1) Effective January 1, 2009, the County shall continue to provide prescription plans (High Option and absolute discretionStandard Option). Bargaining unit employees who select the standard option prescription plan shall pay 20 percent of the total premium cost of the standard option prescription drug plan offered by the employer. The employer shall pay the remaining 80 percent of the total premium cost of the standard option plan. Should the bargaining unit employee select the high option prescription drug plan, the employer shall pay 80 percent of the total premium cost of the standard option prescription drug plan offered 1 Per action taken on May 26, 2011, the County Council did not approve full funding for this provision. On that date, the Council adopted a different cost-sharing arrangement for bargaining unit employees, to become effective on January 1, 2012. See Appendix XXI.
(2) Both prescription plans shall restrict generics. In the event the bargaining unit employee elects to receive a brand medication when a generic medication is available, the member shall pay the cost difference between the brand and generic medication. In the event a physician requires a brand medication; the employee shall not be responsible for the difference in cost.
(3) Both prescription plans shall incentivize mail-order prescriptions. In the event the employee fills a prescription at retail more than twice, rather than utilizing mail-order, the member shall pay the cost difference.
(4) Effective January 1, 2014, the Prescription Drug Plan will no longer offer the 90-day post formulary change grace period granted upon formulary changes. Plan participants affected by formulary changes shall be notified a minimum of90 days prior to the effective date of the formulary change. The Employer shall approve up to a 90-day post formulary change grace period for members based upon the member's particular circumstances.
(5) The following will be referred to the Employee Benefits Committee under Article 21.3 for discussion, review, and implementation during FY 2017:
(i) Generic Step Therapy: This program requires that the members use cost- effective alternatives within the same therapeutic class, as first line therapy before brand name prescriptions are covered.
(ii) Specialty Pharmacy Guideline Management: This program is designed to support the member to ensure appropriate utilization for specialty medications. The program helps ensure the member meets sophisticated and robust criteria before a first dispense, helps ensure that the members experiences expected therapeutic outcomes while on therapy, and ensures that unsafe or ineffective therapy is discontinued. Current Members using medications subject to this program will be grandfathered. Grandfathered status does not apply if the member's drug therapy changes.
(iii) Advanced Control Specialty Formulary: This program promotes cost effective care for members utilizing specialty medications by encouraging utilization of clinically appropriate and lowest next cost medications. Existing medications subject to this program are updated periodically.
(iv) Pharmacy Advisor Counseling at CVS retail: This program is seamlessly integrated into the member's retail purchase workflow, to provide for a clinical consultation with the retail pharmacist when opportunities to improve adherence or close a gap in therapy have been identified. 2 Per action taken on May 26, 2011, the County Council did not approve full funding for this provision. On that date, the Council adopted a different cost-sharing arrangement for bargaining unit employees, to become effective on January 1, 2012. See Appendix XXL
(v) Effective July 1, 2017, or as soon as administratively possible. Exclusive Specialty Pharmacy- a program that requires plan members to purchase specialty medications through the pharmacy benefit manager's exclusive specialty pharmacy arrangement. Any medication that the pharmacy benefit manager ("PBM") does not designate as a specialty medication is not subject to this requirement. In instances where the specialty medication is not available at the PBM's specialty pharmacy, the PBM shall coordinate purchasing arrangements with another specialty pharmacy within the PBM network.3 At the member's request, the pharmacy benefit manager will deliver the specialty medication to the member's home, the member physician's office, or to a retail pharmacy of the member's choosing that is part of the PBM's pharmacy network.
(c) Effective January 1, 2009, the County shall continue to provide prescription plans (High Option and Standard Option). Bargaining unit employees who select the standard option prescription plan shall pay 20 percent of the total premium cost of the standard option prescription plan offered by the employer. The employer shall pay the remaining 80 percent of the total premium cost of the standard option plan. Should the bargaining unit employee select the high option prescription drug plan, the employer shall pay 80 percent of the total premium cost of the standard option prescription drug plan offered by the employer. The bargaining unit employee shall pay the remainder of the high option prescription drug plan premium. Both prescription plans shall restrict generics. In the event the bargaining unit employee elects to receive a brand medication when a generic medication is available, the member shall pay the cost difference between the brand and generic medication. In the event a physician requires a brand medication, the employee shall not be responsible for the difference in cost. Both prescription plans shall incentivize mail-order prescriptions. In the event the employee fills a prescription at retail more than twice, rather than utilizing mail-order, the member shall pay the cost difference.
(d) Three health maintenance organizations (HMOs) will be open to employees hired before July 1, 1993, two for employees hired on or after July 1, 1993.
(e) For employees enrolled in the current POS medical plan and who reside outside the service area as defined by the current POS medical plan, a schedule of benefits comparable to the current in-network and out-of-network benefit levels of the current POS medical plan will be available as an out-of-area plan through a preferred provider organization (PPO) plan.
Appears in 2 contracts
Samples: Collective Bargaining Agreement, Collective Bargaining Agreement
Health Benefits. For the eighteen twelve (1812) month period following the Termination Date, provided that Executive is eligible for, and timely elects COBRA continuation coverage, the Company will pay on Executive’s behalf, the monthly cost of COBRA continuation coverage under the Company’s group health plan for Executive and, where applicable, her his spouse and dependents, at the level in effect as of the Termination Date, adjusted for any increase in such level paid by the Company for active employees, less the employee portion of the applicable premiums that Executive would have paid had she he remained employed during the such eighteen twelve (1812) month period (the COBRA continuation coverage period shall run concurrently with the eighteen twelve (1812) month period that COBRA premium reimbursement payments are made on Executive’s behalf under this subsection 1(a)(ii)). The reimbursements described herein shall be paid in monthly installments, commencing These payments on Executive’s behalf will commence within the sixtieth sixty (60th) day 60)-day period following the Termination Date, provided that Date and will be paid on the first such installment payment shall include any unpaid reimbursements that would have been made during payroll date of each month through the first sixty twelfth (6012th) days month following the Termination Date. Notwithstanding the foregoing, the Company’s payment of the monthly COBRA premiums in accordance with this subsection 1(a)(ii) shall cease immediately upon the earlier of: (A) the end of the eighteen twelve (1812) month period following the Termination Date, or (B) the date that Executive is eligible for comparable coverage with a subsequent employer. Executive agrees to notify the Company in writing immediately if subsequent employment is accepted prior to the end of the eighteen twelve (1812) month period following the Termination Date and Executive agrees to repay to the Company any COBRA premium amount paid on Executive’s behalf during such period for any period of employment during which group health coverage is available through a subsequent employer. Notwithstanding the foregoing, the Company reserves the right to restructure the foregoing COBRA premium payment arrangement in any manner necessary or appropriate to avoid fines, penalties or negative tax consequences to the Company or Executive (including, without limitation, to avoid any penalty imposed for violation of the nondiscrimination requirements under the Patient Protection and Affordable Care Act or the guidance issued thereunder), as determined by the Company in its sole and absolute discretion.
Appears in 2 contracts
Samples: Employment Agreement (Antares Pharma, Inc.), Employment Agreement (Antares Pharma, Inc.)
Health Benefits. For the eighteen (18) month period 19.1 The CITY agrees to provide non-occupational health insurance coverage for each eligible regular employee and eligible dependents thereof immediately following the Termination Date, period of exclusion provided that Executive is eligible for, and timely elects COBRA continuation coverage, by the Company will pay on Executive’s behalf, the monthly cost of COBRA continuation coverage under the Company’s group health plan for Executive and, where applicable, her spouse and dependents, at the level in effect as terms of the Termination Date, adjusted for any increase plan document.
19.2 A CITY health insurance contribution in such level paid by the Company for active employees, less amount listed below will be added to the employee employee’s gross pay. This portion of the applicable premiums that Executive would have employee’s gross pay is hereinafter referred to as the “Contribution.” As part of this collective bargaining agreement, employees are required to participate in the CITY’s health insurance plan on either a pre-tax or post-tax basis. If an employee elects to participate on a pre-tax basis, the employee shall authorize a payroll deduction from the employee’s gross pay equal to the CITY’s contribution. This deduction from the employee’s gross pay will be paid had she remained employed during into a fund maintained to provide health benefits for eligible employees.
19.3 If an employee elects to participate on a post-tax basis, the such eighteen (18) month period (the COBRA continuation coverage period shall run concurrently with the eighteen (18) month period that COBRA premium payments are made on Executive’s behalf under this subsection 1(a)(ii)). The reimbursements described herein Contribution shall be paid in monthly installments, commencing on taxable income to the sixtieth (60th) day following employee and the Termination Date, provided that employee shall authorize the first such installment payment shall include any unpaid reimbursements that would have been made during the first sixty (60) days following the Termination Date. Notwithstanding the foregoing, the Company’s payment of the monthly COBRA premiums in accordance with Contribution value, after its deemed receipt, toward the employee’s health insurance.
19.4 It is hereby acknowledged that both employee and employer retirement contributions will be required on this subsection 1(a)(ii) shall cease immediately upon additional gross income, causing a decrease to the earlier of: (A) the end net income of the eighteen (18) month period following employee. It is also the Termination Dateintent of the employees and the CITY that the Contribution be excluded from the determination of the employee’s “regular rate” of compensation as that phrase is defined under 29 U.S.C. § 207(e)(4). In the event that any subsequent law, court, arbitrator, or (B) other lawful authority determines that the date inclusion of the CITY’s health insurance contribution in the employee’s gross pay should be included in overtime compensation calculations, then the parties agree that Executive is eligible for comparable coverage with there will be a subsequent employer. Executive agrees to notify the Company in writing immediately if subsequent employment is accepted prior corresponding adjustment to the end affected hourly rate, pay or benefit to carry out the intent of this provision. The intent of such adjustment will be to result in the least net financial effect on both the employee and the CITY.
19.5 The CITY contribution amount included in base wages for retirement enhancement purposes shall be capped at the current contribution rate of $361.39 per biweekly paycheck.
19.6 Health premiums will be shared with the CITY paying 85 (eighty-five) percent of the eighteen premium and the Employee paying 15 (18fifteen) month period following percent of the Termination Date and Executive agrees to repay to the Company any COBRA premium amount paid on Executive’s behalf during such period for any period of employment during which group health coverage is available through a subsequent employer. Notwithstanding the foregoing, the Company premium.
A. The CITY reserves the right to restructure add to, delete from, or modify the foregoing COBRA premium payment arrangement in current benefit plan with no obligation to negotiate, and retains the right to delete or modify any manner necessary or appropriate to avoid fines, penalties or negative tax consequences to the Company or Executive (including, without limitation, to avoid any penalty imposed for violation all of the nondiscrimination requirements under added benefits with no obligation to negotiate.
B. The CITY shall be at liberty to make an independent selection of the Patient Protection and Affordable Care Act insurance or indemnity carrier, including the guidance issued thereunder), as determined by the Company in its sole and absolute discretionoption of partially or fully self-funding with no obligation to negotiate.
Appears in 2 contracts
Samples: Collective Bargaining Agreement, Collective Bargaining Agreement
Health Benefits. For Executive may continue Executive’s health care coverage in accordance with the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended (“COBRA”), including coverage for any eligible dependents enrolled at the time of termination of Executive’s employment if eligible for COBRA coverage. To be eligible for such coverage, Executive must timely elect COBRA coverage and must remain otherwise eligible for such COBRA coverage.
7.2.1 AOI will reimburse Executive to the extent that the cost of his monthly premiums for coverage under COBRA exceed Executive’s share of monthly premiums to participate in AOI’s health care coverage at the time of termination. AOI will make such reimbursements for up to the first eighteen (18) month period following months (twelve (12) months if Executive is receiving severance pursuant to Section 7.1.2) of the Termination Date, provided that Severance Period or until Executive is eligible forfor health insurance coverage through a subsequent employer, whichever is earlier. Executive agrees to immediately notify AOI in the event he secures subsequent employment and timely elects becomes eligible for group health coverage. Amounts paid under this Section 7.2.1 are intended to constitute reimbursement for medical benefits under Treasury Regulation Section 1.409A-1(b)(9)(v)(B).
7.2.2 During the Severance Period, if Executive exhausts his COBRA continuation coveragecoverage but fails to become eligible for health insurance coverage through a subsequent employer or Medicare, Executive shall have the Company sole responsibility to obtain health insurance coverage for himself and his dependents. If Executive is receiving severance pay under Section 7.1.1, AOI will pay on Executive’s behalf, reimburse Executive for the costs of his monthly cost of COBRA continuation premiums for replacement health insurance coverage under the Company(including coverage for any eligible dependents enrolled in AOI’s group health plan for Executive and, where applicable, her spouse and dependents, plans at the level in effect as time of the Termination Date, adjusted for any increase in such level paid by the Company for active employees, less the employee portion termination of the applicable premiums that Executive would have paid had she remained employed during the such eighteen (18) month period (the COBRA continuation coverage period shall run concurrently with the eighteen (18) month period that COBRA premium payments are made on Executive’s behalf under this subsection 1(a)(iiemployment)), if any. The AOI will make such reimbursements described herein shall be paid in monthly installments, commencing on for the sixtieth (60th) day following period between the Termination Date, provided that the first such installment payment shall include any unpaid reimbursements that would have been made during the first sixty (60) days following the Termination Date. Notwithstanding the foregoing, the Company’s payment exhaustion of the monthly COBRA premiums in accordance with this subsection 1(a)(ii) shall cease immediately upon the earlier of: (A) coverage and the end of the eighteen (18) month period following the Termination DateSeverance Period, or (B) the date that until Executive is becomes eligible for comparable health insurance coverage with a subsequent employer. Executive agrees to notify the Company in writing immediately if subsequent employment is accepted prior to the end of the eighteen (18) month period following the Termination Date and Executive agrees to repay to the Company any COBRA premium amount paid on Executive’s behalf during such period for any period of employment during which group health coverage is available through a subsequent employer, whichever occurs sooner. Notwithstanding In no event shall AOI reimburse Executive for any health care insurance premiums after the foregoingexpiration of the Severance Period.
7.2.3 To the extent benefits are to be provided pursuant to Section 7 of this Agreement, AOI shall make reasonable efforts to provide such benefits. However, if the Company reserves provision of any benefit under this Section 7 is not permissible at the right time of Executive’s termination or during the Severance Period pursuant to restructure the foregoing COBRA premium payment arrangement terms of the plan or under federal or state law, AOI shall not be responsible for providing such benefits and shall have no liability under this Agreement for providing such benefits or for compensating Executive for AOI’s inability to provide the benefits.
7.2.4 Expenses eligible for reimbursement under this Section 7.2 in a calendar year shall not affect any expenses eligible for reimbursement or in-kind benefits to be provided in any manner necessary other calendar year. Executive’s rights under this Section 7.2 are not subject to liquidation or appropriate to avoid fines, penalties or negative tax consequences to exchange for any other benefit. Reimbursements under this Section 7.2 will not be paid later than the Company or Executive (including, without limitation, to avoid any penalty imposed for violation last day of Executive’s taxable year following the nondiscrimination requirements under taxable year in which the Patient Protection and Affordable Care Act or the guidance issued thereunder), as determined by the Company in its sole and absolute discretionexpense was incurred.
Appears in 1 contract
Samples: Executive Employment Agreement (Alliance One International, Inc.)
Health Benefits. For Section 1. Employees shall be covered under the eighteen (18) month period following County health benefit plan with Blue Cross/Blue Shield Plan of New Jersey or, at the Termination Dateelection of the employee, enrollment in Physicians Health Services, an approved HMO, the latter being at the employee's additional cost. The Employer reserves the right to change insurance carriers or to change or modify existing coverage at any time during the term of this Agreement, provided that Executive the coverage is eligible forsubstantially similar to the coverage then in effect. The Employer will give notice to the Union of its intention to change any such coverage. The following provisions applicable to the health insurance coverage shall be maintained during the term of this Agreement.
(a) Deductibles shall be increased to $200 per person and $400 per family;
(b) Co-insurance for major medical insurance shall be 80%/20% up to $5,000.00, and timely elects COBRA continuation thereafter 100% coverage, ;
(c) Pre-Admission Review with 50% cut back for non compliance shall be implemented.
(d) Cost-sharing or employee contributions of premium for dependent coverage in the Company will pay on Executive’s behalf, the monthly cost amount of COBRA continuation coverage under the Company’s group health plan for Executive and, where applicable, her spouse and dependents, at the level in effect as of the Termination Date, adjusted $10.00 per month for any increase in such level paid the average cost per employee in 1994 over 1993. Effective October 1, 1995 or as soon thereafter as possible, the Blue Cross/Blue Shield Health Insurance coverage program known and designated as "Blue Select" and interchangeably as “Horizon PPO” will replace the traditional indemnity health insurance coverage currently being provided by the Company for active employees, less Employer. Employees who retire after the employee portion implementation of the applicable premiums "Blue Select" plan will be able to submit prescription charges to that Executive would have paid had she remained employed during plan in the such eighteen (18) month period (same manner and under the COBRA continuation coverage period shall run concurrently with the eighteen (18) month period that COBRA premium payments same terms and conditions as current retirees are made on Executive’s behalf under this subsection 1(a)(ii))able to submit their prescription charges.
Section 2. The reimbursements described herein shall Prescription Plan There will be paid in monthly installments, commencing on the sixtieth (60th) day following the Termination Date, provided that the first such installment payment shall include any unpaid reimbursements that would have been made during the first sixty (60) days following the Termination Date. Notwithstanding the foregoing, the Company’s payment of the monthly COBRA premiums in accordance with this subsection 1(a)(ii) shall cease immediately upon the earlier ofa Drug Prescription Plan as follows: (Aa) the end of the eighteen (18) month period following the Termination Date, or (B) the date that Executive Co-payment provisions shall be: $10.00 co-pay per prescription for brand name where generic is eligible available; $5.00 co-pay per prescription for comparable coverage with a subsequent employer. Executive agrees to notify the Company in writing immediately if subsequent employment is accepted prior to the end of the eighteen (18) month period following the Termination Date and Executive agrees to repay to the Company any COBRA premium amount paid on Executive’s behalf during such period for any period of employment during which group health coverage brand name where no generic is available through a subsequent employer. Notwithstanding the foregoing, the Company reserves the right to restructure the foregoing COBRA premium payment arrangement in any manner necessary or appropriate to avoid fines, penalties or negative tax consequences to the Company or Executive (including, without limitation, to avoid any penalty imposed brand name is required by doctor; $3.00 co-pay per prescription for violation of the nondiscrimination requirements under the Patient Protection and Affordable Care Act or the guidance issued thereunder), as determined by the Company in its sole and absolute discretiongeneric; No co-pay for mail order prescription.
Appears in 1 contract
Samples: Collective Bargaining Agreement
Health Benefits. For the eighteen twelve (1812) month period following the Termination Date, provided that Executive is eligible for, and timely elects COBRA continuation coverageCOBRA, the Company will pay on Executive’s behalf, reimburse Executive for the monthly COBRA cost of COBRA continuation continued medical and dental coverage under the Company’s group health plan for Executive and, where applicable, her spouse and dependents, at the level in effect as of the Termination Date, adjusted for any increase in such level paid by the Company for active employees, less the employee portion of the applicable premiums that Executive would have paid had she remained employed during the such eighteen twelve (1812) month period (the COBRA continuation coverage period shall run concurrently with the eighteen twelve (1812) month period that COBRA premium payments are made on Executive’s behalf Executive is provided with medical and dental coverage under this subsection 1(a)(ii1(c)(ii)). The These reimbursements described herein shall be paid in monthly installments, commencing on will commence within the sixtieth sixty (60th) day 60)-day period following the Termination DateDate and will be paid on the first payroll date of each month, provided that Executive demonstrates proof of payment of the first such installment applicable premiums prior to the applicable reimbursement payment shall include any unpaid reimbursements that would have been made during the first sixty (60) days following the Termination Datedate. Notwithstanding the foregoing, the Company’s payment reimbursement of the monthly COBRA premiums in accordance with this subsection 1(a)(ii) shall cease immediately upon the earlier of: (A) the end of the eighteen twelve (1812) month period following the Termination Date, or (B) the date that Executive is eligible for comparable coverage with a subsequent employer. Executive agrees to notify the Company in writing immediately if subsequent employment is accepted prior to the end of the eighteen twelve (1812) month period following the Termination Date and Executive agrees to repay to the Company any COBRA premium amount paid on Executive’s behalf reimbursement received during such period for any period of employment during which group health coverage is available through a subsequent employer. Notwithstanding the foregoing, the Company reserves the right to restructure the foregoing COBRA premium payment reimbursement arrangement in any manner necessary or appropriate to avoid fines, penalties or negative tax consequences to the Company or Executive (including, without limitation, to avoid any penalty imposed for violation of the nondiscrimination requirements under the Patient Protection and Affordable Care Act or the guidance issued thereunder), as determined by the Company in its sole and absolute discretion.
Appears in 1 contract
Samples: Separation and Consulting Services Agreement (Antares Pharma, Inc.)
Health Benefits. For 1. The Borough agrees to provide each employee with health insurance as provided in the eighteen (18) month period following "New Jersey State Health Benefits Program." This coverage shall be fully paid by the Termination DateBorough for all employees and their families, provided that Executive is eligible for, and timely elects COBRA continuation coverage, any deductible shall be the Company will pay on Executive’s behalf, specific responsibility of the monthly cost employee.
2. The Borough agrees to provide each employee with a Dental Plan with an insurance company selected by the Borough containing coverages as determined by the Borough. In lieu of COBRA continuation coverage under the Company’s group health plan Dental Plan provided by the designated insurance carrier, the Borough will permit employees to elect to accept payment directly from the Borough as follows: The Borough will pay One Hundred ($100.00) Dollars for Executive andeach single Police Officer, where applicableTwo Hundred ($200.00) Dollars for each married Police Officer, her spouse and dependentsThree Hundred ($300.00) Dollars for each married Police Officer who has one or more children. For convenience of making payment, at the level aforesaid payments in effect as lieu of the Termination Date, adjusted for any increase in such level paid by the Company for active employees, less the employee portion of the applicable premiums that Executive would have paid had she remained employed during the such eighteen (18) month period (the COBRA continuation coverage period insured Dental Plan shall run concurrently be added to and included with the eighteen (clothing allowance set forth in Article 18) month period that COBRA premium payments are made on Executive’s behalf under this subsection 1(a)(ii)).
3. The reimbursements described herein shall be paid in monthly installmentsAdditionally, commencing on the sixtieth (60th) day following the Termination Date, provided parties acknowledge and agree that the first such installment payment shall include any unpaid reimbursements that would have been made during Borough will provide all employees covered by this agreement with prescription drug coverage through the first sixty (60) days following the Termination Date. Notwithstanding the foregoing, the Company’s payment of the monthly COBRA premiums State Health Benefits Program in accordance with this subsection 1(a)(ii) shall cease immediately upon the earlier of: (A) the end terms and conditions of the eighteen (18) month period following program in which the Termination Date, or (B) Borough is enrolled. Employees shall be obligated to make co-pay payments in accordance with such program.
4. Life insurance coverage and a retirement plan are provided under the date that Executive is eligible for comparable coverage New Jersey Police and Fireman's Retirement System and in accordance with a subsequent employerits requirements.
5. Executive agrees to notify the Company in writing immediately if subsequent employment is accepted prior to the end of the eighteen (18) month period following the Termination Date and Executive agrees to repay to the Company any COBRA premium amount paid on Executive’s behalf during such period for any period of employment during which group health coverage is available through a subsequent employer. Notwithstanding the foregoing, the Company The Borough reserves the right to restructure review and change the foregoing COBRA premium payment arrangement in any manner necessary or appropriate to avoid fines, penalties or negative tax consequences Health Benefit Coverages set forth above during this contract as long as the level of coverage provided is on balance appreciably comparable to the Company current coverages. Prior to any such change, the Borough will provide the PBA with thirty (30) days notice and will allow the PBA to review and compare the proposed new coverages with the current coverages.
6. Any Police Officer who elects special retirement with twenty (20) years of creditable service shall receive the same health insurance benefits as if he or Executive she had retired with twenty five (including, without limitation, to avoid any penalty imposed for violation 25) years of the nondiscrimination requirements creditable service under the Patient Protection provisions of Chapter 111 PL. 1973 as amended, including health benefits for surviving spouse and Affordable Care Act or the guidance issued thereunder), as determined by the Company in its sole and absolute discretionchildren to age 23.
Appears in 1 contract
Samples: Collective Bargaining Agreement
Health Benefits. For Section 1:
(A) Eligible employees shall choose one of the eighteen below listed medical insurance plans. The employee's eligible dependents shall also be covered under the plan selected by the employee. Medallion Plan Base Hospital, Wrap Around, Major Medical Plan (18Employer's Medical Insurance Plan) month period following The HMO option
(B) Effective January 1, 2005, each employee covered by the Termination DateMedallion Plan shall have an amount deducted from each paycheck, provided that Executive which shall be equal to the annual equivalent of five percent (5%) of the annual medical insurance premium.
(C) An employee who is currently covered by the Medallion Plan and enrolls in the Employer's Medical Plan or the HMO option shall not be permitted to be enrolled back into the Medallion Plan unless there has been a change in the employee’s spousal medical coverage or a change in the employee’s family status.
(D) Employees hired after June 1, 1993 shall not be eligible for, and timely elects COBRA continuation coverage, the Company will pay on Executive’s behalf, the monthly cost of COBRA continuation for coverage under the CompanyMedallion Plan and they may select either the Employer's Medical Plan or HMO only.
(E) Effective January 1, 2005, each employee covered by the Employer’s group health plan Medical Plan (wraparound medical Insurance plan) and the HMO Option shall have an amount deducted from each paycheck which shall be equal to the annual equivalent of three percent (3%) of the annual medical insurance premium.
(F) Plan changes to deductibles, co-payments and mail order prescriptions for Executive andretiree coverage shall be implemented pursuant to the Memorandum of Agreement signed by the parties on December 2, where applicable2009. The co-pay for the “stand-alone” Prescription Drug Plan for employees and their eligible dependents shall be: $5.00 for generic drugs $10.00 for Brand Name Drugs $15.00 for Formulary Drugs Effective upon execution of this agreement, her spouse the co-pay for all Prescription Drug Plans for employees and their eligible dependents, at for the level duration of this Agreement shall be: $5.00 for generic drugs $10.00 for Brand Name Drugs $20.00 for non-preferred drugs Employer will offer a plan by which employees may set aside a portion of their salaries in effect as the form of flexible spending accounts, pursuant to Section 125 of the Termination DateInternal Revenue Code, adjusted for any increase in such level paid by the Company for active employees, less the employee portion payments of the applicable premiums that Executive would have paid had she remained employed during the such eighteen (18) month period (the COBRA continuation coverage period shall run concurrently with the eighteen (18) month period that COBRA premium payments are made on Executive’s behalf under this subsection 1(a)(ii)). The reimbursements described herein shall be paid in monthly installments, commencing on the sixtieth (60th) day following the Termination Date, provided that the first such installment payment shall include any unpaid reimbursements that would have been made during the first sixty (60) days following the Termination Date. Notwithstanding the foregoing, the Company’s payment of the monthly COBRA premiums in accordance with this subsection 1(a)(ii) shall cease immediately upon the earlier of: (A) the end of the eighteen (18) month period following the Termination Date, unreimbursable eligible medical or (B) the date that Executive is eligible for comparable coverage with a subsequent employer. Executive agrees to notify the Company in writing immediately if subsequent employment is accepted prior to the end of the eighteen (18) month period following the Termination Date and Executive agrees to repay to the Company any COBRA premium amount paid on Executive’s behalf during such period for any period of employment during which group health coverage is available through a subsequent employer. Notwithstanding the foregoing, the Company reserves the right to restructure the foregoing COBRA premium payment arrangement in any manner necessary or appropriate to avoid fines, penalties or negative tax consequences to the Company or Executive (including, without limitation, to avoid any penalty imposed for violation of the nondiscrimination requirements under the Patient Protection and Affordable Care Act or the guidance issued thereunder), as determined by the Company in its sole and absolute discretiondependent care expenses.
Appears in 1 contract
Samples: Collective Bargaining Agreement
Health Benefits. For Executive may continue Executive’s health care coverage in accordance with the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended (“COBRA”), including coverage for any eligible dependents enrolled at the time of termination of Executive’s employment if eligible for COBRA coverage. To be eligible for such coverage, Executive must timely elect COBRA coverage and must remain otherwise eligible for such COBRA coverage.
7.2.1 AOI will reimburse Executive to the extent that the cost of his monthly premiums for coverage under COBRA exceed Executive’s share of monthly premiums to participate in AOI’s health care coverage at the time of termination. AOI will make such reimbursements for up to the first eighteen (18) month period following months (twelve (12) months if Executive is receiving severance pursuant to Section 7.1.2) of the Termination Date, provided that Severance Period or until Executive is eligible forfor health insurance coverage through a subsequent employer, whichever is earlier. Executive agrees to immediately notify AOI in the event he secures subsequent employment and timely elects becomes eligible for group health coverage. Amounts paid under this Section 7.2.1 are intended to constitute reimbursement for medical benefits under Treasury Regulation Section 1.409A-1(b)(9)(v)(B).
7.2.2 During the Severance Period, if Executive exhausts his COBRA continuation coveragecoverage but fails to become eligible for health insurance coverage through a subsequent employer or Medicare, Executive shall have the Company sole responsibility to obtain health insurance coverage for himself and his dependents. If Executive is receiving severance pay under Section 7.1.1, AOI will pay on Executive’s behalf, reimburse Executive for the costs of his monthly cost of COBRA continuation premiums for replacement health insurance coverage under the Company(including coverage for any eligible dependents enrolled in AOI’s group health plan for Executive and, where applicable, her spouse and dependents, plans at the level in effect as time of the Termination Date, adjusted for any increase in such level paid by the Company for active employees, less the employee portion termination of the applicable premiums that Executive would have paid had she remained employed during the such eighteen (18) month period (the COBRA continuation coverage period shall run concurrently with the eighteen (18) month period that COBRA premium payments are made on Executive’s behalf under this subsection 1(a)(iiemployment)). The , if any; provided however, that such reimbursements described herein shall be paid in monthly installments, commencing on the sixtieth (60th) day following the Termination Date, provided that the first such installment payment shall include any unpaid reimbursements that would have been made during the first sixty (60) days following the Termination Date. Notwithstanding the foregoing, the Company’s payment of not exceed the monthly amount being reimbursed to Executive at the time his right to coverage under COBRA premiums in accordance with this subsection 1(a)(ii) shall cease immediately upon ends. AOI will make such reimbursements for the earlier of: (A) period between the exhaustion of COBRA coverage and the end of the eighteen (18) month period following the Termination DateSeverance Period, or (B) the date that until Executive is becomes eligible for comparable health insurance coverage with a subsequent employer. Executive agrees to notify the Company in writing immediately if subsequent employment is accepted prior to the end of the eighteen (18) month period following the Termination Date and Executive agrees to repay to the Company any COBRA premium amount paid on Executive’s behalf during such period for any period of employment during which group health coverage is available through a subsequent employer, whichever occurs sooner. Notwithstanding In no event shall AOI reimburse Executive for any health care insurance premiums after the foregoingexpiration of the Severance Period. Any reimbursement amount provided in Section 7.2.2 shall be capped at $12,000 per year in the aggregate.
7.2.3 To the extent benefits are to be provided pursuant to Section 7 of this Agreement, AOI shall make reasonable efforts to provide such benefits. However, if the Company reserves provision of any benefit under this Section 7 is not permissible at the right time of Executive’s termination or during the Severance Period pursuant to restructure the foregoing COBRA premium payment arrangement terms of the plan or under federal or state law, AOI shall not be responsible for providing such benefits and shall have no liability under this Agreement for providing such benefits or for compensating Executive for AOI’s inability to provide the benefits.
7.2.4 Expenses eligible for reimbursement under this Section 7.2 in a calendar year shall not affect any expenses eligible for reimbursement or in-kind benefits to be provided in any manner necessary other calendar year. Executive’s rights under this Section 7.2 are not subject to liquidation or appropriate to avoid fines, penalties or negative tax consequences to exchange for any other benefit. Reimbursements under this Section 7.2 will not be paid later than the Company or Executive (including, without limitation, to avoid any penalty imposed for violation last day of Executive’s taxable year following the nondiscrimination requirements under taxable year in which the Patient Protection and Affordable Care Act or the guidance issued thereunder), as determined by the Company in its sole and absolute discretionexpense was incurred.
Appears in 1 contract
Samples: Executive Employment Agreement (Alliance One International, Inc.)
Health Benefits. For (i) Lxxxx has indicated that he plans to elect to continue his group health benefits (medical and dental) in accordance with the eighteen Consolidated Omnibus Budget Reconciliation Act of 1986, as amended (18) such law referred to herein as “COBRA”, and the continuation of coverage under COBRA referred to herein as “COBRA Coverage”). Assuming that Lxxxx so elects and subject to Lxxxx’x timely completion of election forms, COBRA Coverage will begin on the first day of the month period immediately following the Termination Date, provided that Executive is eligible for, and timely elects COBRA continuation coverage, the Company will pay on Executive’s behalf, the monthly cost of COBRA continuation coverage under the Company’s group health plan for Executive month in which Lxxxx’x employment with CarMax ends and, where applicablesubject to any change in COBRA or other applicable law and the provisions of this Agreement, her spouse and dependents, at the level shall remain in effect as for a period of the Termination Date, adjusted for any increase in such level paid by the Company for active employees, less the employee portion of the applicable premiums that Executive would have paid had she remained employed during the such eighteen up to 18 months (18) month period (the “COBRA continuation coverage period shall run concurrently with the eighteen (18) month period that COBRA premium payments are made on Executive’s behalf under this subsection 1(a)(ii)Coverage Period”). The reimbursements described herein parties acknowledge that the COBRA Coverage Period and the Term may commence on different dates and that the COBRA Coverage Period will end prior to the expiration of the Term. If Lxxxx does not elect to continue his group health benefits under COBRA, then CarMax shall have no obligation to Lxxxx with respect to health benefits by virtue of this Agreement.
(ii) In connection with the COBRA Coverage and for the duration of the COBRA Coverage Period, Lxxxx shall be paid in monthly installments, commencing on the sixtieth (60th) day following the Termination Date, provided that the first such installment payment shall include any unpaid reimbursements that responsible for an amount equal to what Lxxxx would have been made during otherwise paid if he had remained an active employee of CarMax (“Lxxxx Premium”), and CarMax shall be responsible for the first sixty remaining costs, including the COBRA administration fee, relative to Lxxxx’x COBRA Coverage (60) days following “CarMax Premium”). Lxxxx, however, shall be responsible for remitting full payment in an amount that represents the Termination Date. Notwithstanding the foregoing, the Company’s payment sum of the monthly Lxxxx Premium and the CarMax Premium to the COBRA premiums administrator in accordance with this subsection 1(a)(ii) COBRA requirements. The parties shall cease immediately upon mutually determine the earlier of: (A) process by which Lxxxx receives reimbursement from CarMax for the end CarMax Premium remitted by Lxxxx. CarMax shall advise Lxxxx of the eighteen Lxxxx Premium amount and the CarMax Premium amount, and shall also advise Lxxxx of any changes in these amounts during the COBRA Coverage Period as soon as such amounts are determined. Lxxxx acknowledges that the Lxxxx Premium is subject to increase during the COBRA Coverage Period.
(18iii) month period following Lxxxx agrees to complete all COBRA election forms in accordance with COBRA requirements. Lxxxx further agrees that his failure to complete such election forms or his failure to remit the Termination DateLxxxx Premium and the CarMax Premium to the COBRA administrator in accordance with COBRA requirements will result in cancellation of the COBRA Coverage and agrees that, once cancelled, CarMax shall have no further obligation hereunder with respect to Lxxxx’x health benefits.
(iv) If Lxxxx obtains coverage independently or (B) the date that Executive is obtains or becomes eligible for comparable coverage with under another/other group health plan(s) (including, but not limited to, those of a subsequent employer. Executive agrees ) that provide(s) for substantially equal or greater benefits to Lxxxx as the COBRA Coverage, Lxxxx shall notify CarMax immediately and the Company in writing immediately if subsequent employment is accepted prior to COBRA Coverage, and CarMax’s obligations with respect thereto, shall terminate on the end last day of the eighteen (18) month in which the new coverage commenced. If Lxxxx and/or his beneficiaries become entitled to COBRA for a period following beyond the Termination Date and Executive agrees to repay to the Company COBRA Coverage Period, Lxxxx and/or his beneficiaries, as applicable, shall be responsible for any premium, including any COBRA premium amount paid on Executive’s behalf during administration fee, relative to such period for any period of employment during which group health coverage is available through a subsequent employer. Notwithstanding the foregoing, the Company reserves the right to restructure the foregoing COBRA premium payment arrangement in any manner necessary or appropriate to avoid fines, penalties or negative tax consequences to the Company or Executive (including, without limitation, to avoid any penalty imposed for violation of the nondiscrimination requirements under the Patient Protection and Affordable Care Act or the guidance issued thereunder), as determined by the Company in its sole and absolute discretioncoverage.
Appears in 1 contract
Samples: Consulting Agreement (Carmax Inc)
Health Benefits. For the eighteen fifteen (1815) month period following the Termination Date, provided that Executive is eligible for, and timely elects COBRA continuation coverage, the Company will pay on Executive’s behalf, the monthly cost of COBRA continuation coverage under the Company’s group health plan for Executive and, where applicable, her his spouse and dependents, at the level in effect as of the Termination Date, adjusted for any increase in such level paid by the Company for active employees, less the employee portion of the applicable premiums that Executive would have paid had she he remained employed during the such eighteen fifteen (1815) month period (the COBRA continuation coverage period shall run concurrently with the eighteen fifteen (1815) month period that COBRA premium payments are made on Executive’s behalf under this subsection 1(a)(ii)). The reimbursements described herein shall be paid in monthly installments, commencing These payments on Executive’s behalf will commence within the sixtieth sixty (60th) day 60)-day period following the Termination Date, provided that Date and will be paid on the first such installment payment shall include any unpaid reimbursements that would have been made during payroll date of each month through the first sixty fifteenth (6015th) days month following the Termination Date. Notwithstanding the foregoing, the Company’s payment of the monthly COBRA premiums in accordance with this subsection 1(a)(ii) shall cease immediately upon the earlier of: (A) the end of the eighteen fifteen (1815) month period following the Termination Date, or (B) the date that Executive is eligible for comparable coverage with a subsequent employer. Executive agrees to notify the Company in writing immediately if subsequent employment is accepted prior to the end of the eighteen fifteen (1815) month period following the Termination Date and Executive agrees to repay to the Company any COBRA premium amount paid on Executive’s behalf during such period for any period of employment during which group health coverage is available through a subsequent employer. Notwithstanding the foregoing, the Company reserves the right to restructure the foregoing COBRA premium payment arrangement in any manner necessary or appropriate to avoid fines, penalties or negative tax consequences to the Company or Executive (including, without limitation, to avoid any penalty imposed for violation of the nondiscrimination requirements under the Patient Protection and Affordable Care Act or the guidance issued thereunder), as determined by the Company in its sole and absolute discretion.
Appears in 1 contract
Health Benefits. For (i) Seller's group health, dental and vision plans shall be liable for any and all claims under such group health, dental or vision plan (within the eighteen (18meaning of section 5000(b)(1) month period following of the Termination Code) maintained by Seller or the Company for employees of the Company, and their dependents, with respect to which covered health or medical service expenses were incurred prior to the Effective Date. The Company shall be liable for any and all such claims with respect to which any health or medical service was incurred on or after the Effective Date, (1) as provided that Executive is eligible forfor in sub-paragraph (iii) below during the period of time beginning on the Effective Date and ending on June 30, 1999 (the "Extended Coverage Period"), and timely elects COBRA continuation coverage(2) on and after July 1, 1999, Buyer or Company will provide a plan for employees of the Company, and their dependents, who are covered by the corresponding group health, dental or vision plan of the Seller on the Effective Date or otherwise within the Extended Coverage Period, which will have no eligibility waiting periods, will waive pre-existing conditions and "actively at work" requirements and which will credit any health or medical service expenses incurred during the 1999 plan year and throughout the Extended Coverage Period for purposes of applying the deductible and out of pocket limits under the Company's or the Buyer's group health, dental or vision plan.
(ii) Seller's group health, dental and vision plans shall be liable for any administrative expenses associated with such plans maintained by the Seller or the Company for employees and retirees of the Company, and their dependents, where such administrative expenses were incurred prior to the Effective Date. The Company or Buyer shall be responsible for any administrative expenses associated with establishing or maintaining a group health, dental or vision plan for Company employees, and their dependents, on and after July 1, 1999, and shall be responsible for such administrative expenses as are provided for in sub-paragraph (iii) below with respect to the Extended Coverage Period.
(iii) During the Extended Coverage Period, Company employees and their dependents shall continue to be eligible for coverage under the Seller's group health, dental and vision plans pursuant to the eligibility rules of those plans; however, the Company will pay on Executive’s behalfor Buyer shall reimburse the Seller for (1) its administrative expenses associated with providing such coverage to Company employees and their dependents during the Extended Coverage Period, the monthly cost of COBRA continuation coverage under the Company’s group and (2) all covered health plan for Executive and, where applicable, her spouse and dependents, at the level in effect as of the Termination Date, adjusted for any increase in such level or medical service expenses actually paid by the Seller, for which the Seller does not otherwise receive reimbursements from an insurer, with respect to covered health or medical service expenses by Company employees or their dependents under such plans incurred during the Extended Coverage Period. Company or Buyer shall deliver such reimbursements to Seller within thirty (30) days of receipt of notice and supporting documentation from the Seller regarding any such expenses.
(iv) The Company shall not be liable for active employees(and, less to the employee portion extent applicable, shall not claim) any retrospective adjustments pertaining to the operation of the applicable premiums that Executive would have paid had she remained employed during Seller's group health, dental and vision plans for the such eighteen (18) month period (the COBRA continuation coverage period shall run concurrently with the eighteen (18) month period that COBRA premium payments are made on Executive’s behalf under this subsection 1(a)(ii)). The reimbursements described herein shall be paid in monthly installments, commencing on the sixtieth (60th) day following the Termination Date, provided that the first such installment payment shall include any unpaid reimbursements that would have been made during the first sixty (60) days following the Termination Date. Notwithstanding the foregoing, the Company’s payment of the monthly COBRA premiums in accordance with this subsection 1(a)(ii) shall cease immediately upon the earlier of: (A) the end of the eighteen (18) month period following the Termination Date, or (B) the date that Executive is eligible for comparable coverage with a subsequent employer. Executive agrees to notify the Company in writing immediately if subsequent employment is accepted prior to the end of the eighteen (18) month period following the Termination Date and Executive agrees to repay to the Company any COBRA premium amount paid on Executive’s behalf during such period for any period of employment during which group health coverage is available through a subsequent employer. Notwithstanding the foregoing, the Company reserves the right to restructure the foregoing COBRA premium payment arrangement in any manner necessary or appropriate to avoid fines, penalties or negative tax consequences to the Company or Executive (including, without limitation, to avoid any penalty imposed for violation of the nondiscrimination requirements under the Patient Protection and Affordable Care Act or the guidance issued thereunder), as determined by the Company in its sole and absolute discretion1999 plan year.
Appears in 1 contract
Samples: Stock Purchase Agreement (Roper Industries Inc /De/)
Health Benefits. For the eighteen (18) month period following the Termination DateIf you timely elect continued coverage under COBRA or, provided that Executive is eligible forif applicable, state insurance laws, for yourself and timely elects COBRA continuation coverage, the Company will pay on Executive’s behalf, the monthly cost of COBRA continuation coverage your covered dependents under the Company’s group health plan for Executive andplans following termination, where the Company shall pay that portion of your COBRA premiums or, if applicable, her spouse portions of your premiums for continuation coverage under state insurance laws, in either case, that it was paying for you and your covered dependents, at the level ’ health insurance coverage in effect as of for yourself (and your covered dependents) on the Termination Separation Date (such COBRA or state continuation premium the “COBRA Premium” or “COBRA Premiums”) until the earliest of: (i) six (6) months following the Separation Date, adjusted ; (ii) the date when you become eligible for substantially equivalent health insurance coverage in connection with new employment or self-employment; or (iii) the date you cease to be eligible for COBRA or state continuation coverage for any increase in reason, including plan termination (such level paid by period from the Company for active employeestermination date through the earlier of (i)-(iii), less the employee portion of the applicable premiums that Executive would have paid had she remained employed during the such eighteen (18) month period (the “COBRA continuation coverage period shall run concurrently with the eighteen (18) month period that COBRA premium payments are made on Executive’s behalf under this subsection 1(a)(iiPayment Period”)). The reimbursements described herein shall be paid in monthly installments, commencing on the sixtieth (60th) day following the Termination Date, provided that the first such installment payment shall include any unpaid reimbursements that would have been made during the first sixty (60) days following the Termination Date. Notwithstanding the foregoing, if at any time the Company’s Company determines that its payment of the monthly COBRA premiums Premiums on your behalf would result in accordance with a violation of applicable law (including, but not limited to, the 2010 Patient Protection and Affordable Care Act, as amended by the 2010 Health Care and Education Reconciliation Act), then in lieu of paying the COBRA Premiums pursuant to this subsection 1(a)(ii) Section, the Company shall cease immediately upon pay you on the earlier of: (A) the end last day of each remaining month of the eighteen COBRA Payment Period, a fully taxable cash payment equal to the COBRA Premium for such respective month, subject to applicable tax withholding (18) month such amount, the “Special COBRA Payment”), such Special COBRA Payment to be made without regard to the COBRA period following the Termination Date, or (B) the date that Executive is eligible for comparable coverage with a subsequent employer. Executive agrees to notify the Company in writing immediately if subsequent employment is accepted prior to the end of the eighteen (18) month period following the Termination Date COBRA Payment Period. Nothing in this Agreement shall deprive you of your rights under COBRA or ERISA for benefits under plans and Executive agrees to repay to the Company any COBRA premium amount paid on Executive’s behalf during such period for any period of policies arising under your employment during which group health coverage is available through a subsequent employer. Notwithstanding the foregoing, the Company reserves the right to restructure the foregoing COBRA premium payment arrangement in any manner necessary or appropriate to avoid fines, penalties or negative tax consequences to the Company or Executive (including, without limitation, to avoid any penalty imposed for violation of the nondiscrimination requirements under the Patient Protection and Affordable Care Act or the guidance issued thereunder), as determined by the Company in its sole and absolute discretionCompany.
Appears in 1 contract
Health Benefits. For (A) All eligible employees shall choose one of the eighteen below listed medical insurance plans. The employee's eligible dependents shall also be covered under the plan selected by the employee. Medallion Plan Base Hospital, Wrap Around, Major Medical Plan (18Employer's Medical Insurance Plan) month period following Alternative Base Hospital, Wrap Around, Major Medical Plan (non-contributory) The HMO option
(B) Each employed covered by the Termination DateMedallion plan shall have an amount deducted from each paycheck, provided that Executive is eligible for, and timely elects COBRA continuation coveragewhich shall be equal to the annual equivalent of five percent (5%) of the annual medical insurance premium. Upon expiration of the Agreement, the Company will pay on Executive’s behalfdollar value of the deduction shall remain unchanged until a successor Agreement is negotiated.
(C) An employee who is currently covered by the Medallion Plan and enrolls in the Employer's Medical Plan or the HMO option shall not be permitted to be enrolled back into the Medallion Plan unless there has been a change in the employee's spousal medical coverage or a change in the employee's family status.
(D) In the event that the enrollment of the employees covered by this Agreement in the Medallion Plan falls below 15 employees, the monthly cost of COBRA continuation Medallion Plan shall no longer be offered as an option. The remaining employee enrollment in the Medallion Plan shall be enrolled in either the Employer's Medical Plan, alternative base hospital, wrap around, major medical insurance plan or HMO, at the employee's option.
(E) Employees hired after November 25, 1992 shall not be eligible for coverage under the Company’s group health Medallion Plan and they may select either the Employer's Medical Insurance Plan, alternative base hospital, wrap around, major medical plan for Executive andor HMO option only.
(F) Effective January 1, where applicable2003, her spouse and dependents, at the level in effect as amount deducted from each paycheck shall be equal to the annual equivalent of three percent of the Termination Dateannual premium for the base hospital wraparound major medical plan (Employer’s plan) or HMO Option. Effective January 1, adjusted for any increase in such level paid by the Company for active employees2007 and retroactive to that day, less the employee portion of the applicable premiums that Executive would have paid had she remained employed during the such eighteen (18) month period (the COBRA continuation coverage period shall run concurrently with the eighteen (18) month period that COBRA premium payments are made on Executive’s behalf under this subsection 1(a)(ii)). The reimbursements described herein employees medical contributions shall be paid in monthly installments, commencing on the sixtieth (60th) day following the Termination Date, provided that the first such installment payment shall include any unpaid reimbursements that would have been made during the first sixty (60) days following the Termination Date. Notwithstanding the foregoing, the Company’s payment of the monthly COBRA premiums bi-weekly deductions as applicable in accordance with this subsection 1(a)(ii) shall cease immediately upon the earlier of: (A) the end Schedule A appended hereto. The dollar amount of the eighteen (18) month period following the Termination Datededuction in 2008 shall not be increased until a successor agreement is negotiated.
Section 2: Effective January 1, or (B) the date that Executive is eligible for comparable coverage with a subsequent employer. Executive agrees to notify the Company in writing immediately if subsequent employment is accepted prior to the end of the eighteen (18) month period following the Termination Date and Executive agrees to repay to the Company any COBRA premium amount paid on Executive’s behalf during such period for any period of employment during which group health coverage is available through a subsequent employer. Notwithstanding the foregoing2003, the Company reserves the right to restructure the foregoing COBRA premium payment arrangement in any manner necessary or appropriate to avoid fines, penalties or negative tax consequences to the Company or Executive (including, without limitation, to avoid any penalty imposed prescription drug co-pay for violation of the nondiscrimination requirements under the Patient Protection employees and Affordable Care Act or the guidance issued thereunder), as determined eligible dependents covered by the Company in its sole Medallion and absolute discretion.Wrap Around Plans shall be:
Appears in 1 contract
Samples: Collective Bargaining Agreement
Health Benefits. For (a) Effective January 1, 1995, the eighteen (18) month period following County will alter the Termination Datebasis for determining its contribution with respect to each separate medical and hospitalization plan, provided that Executive is eligible forcalculated separately for employee, employee +1, and timely elects COBRA continuation family coverage, the Company will pay on Executive’s behalf, the monthly cost of COBRA continuation coverage under the Company’s group health plan for Executive and, where applicable, her spouse and dependents, at the level in effect as to 80 percent of the Termination Datepremium charged for an HMO or, adjusted for any increase in such level paid by the Company for active employeescase of self-insured plans, less the employee portion 80 percent of the applicable premiums that Executive would have paid had she remained employed during projected premium rate for the such eighteen (18) month period (calendar year in which the COBRA continuation coverage period shall run concurrently with the eighteen (18) month period that COBRA premium payments rates are made on Executive’s behalf under this subsection 1(a)(ii))to be effective. The reimbursements described herein rates for each self-insured plan shall be paid in monthly installments, commencing on the sixtieth (60th) day following the Termination Date, provided that the first such installment payment shall include any unpaid reimbursements that would have been made during the first sixty (60) days following the Termination Date. Notwithstanding the foregoing, the Company’s payment of the monthly COBRA premiums in accordance calculated using standard actuarial principles with this subsection 1(a)(ii) shall cease immediately upon the earlier of: (A) the end of the eighteen (18) month period following the Termination Date, or (B) the date that Executive is eligible for comparable coverage with a subsequent employer. Executive agrees to notify the Company in writing immediately if subsequent employment is accepted prior to the end of the eighteen (18) month period following the Termination Date and Executive agrees to repay to the Company any COBRA premium amount paid on Executive’s behalf during such period for any period of employment during which group health coverage is available through a subsequent employer. Notwithstanding the foregoing, the Company reserves the right to restructure the foregoing COBRA premium payment arrangement in any manner necessary or appropriate to avoid fines, penalties or negative tax consequences to the Company or Executive (including, without limitation, to avoid any penalty imposed for violation of the nondiscrimination requirements under the Patient Protection and Affordable Care Act or the guidance issued thereunder), separate medical trends as determined by the Company Employer's actuary, which reflect plan design. The Union shall be provided with information (including but not limited to all actuarial and consultant reports) enabling it to review the premium determinations. In all other respects the level of benefits and services provided in its sole the comprehensive health benefit program shall remain unchanged except as provided below.1
(1) Effective January 1, 2009, the County shall continue to provide prescription plans (High Option and absolute discretionStandard Option). Bargaining unit employees who select the standard option prescription plan shall pay 20 percent of the total premium cost of the standard option prescription drug plan offered by the employer. The employer shall pay the remaining 80 percent of the total premium cost of the standard option plan. Should the bargaining unit employee select the high option prescription drug plan, the employer shall pay 80 percent of the total premium cost of the standard option prescription drug plan offered 1 Per action taken on May 26, 2011, the County Council did not approve full funding for this provision. On that date, the Council adopted a different cost-sharing arrangement for bargaining unit employees, to become effective on January 1, 2012. See Appendix XXI.
(2) Both prescription plans shall restrict generics. In the event the bargaining unit employee elects to receive a brand medication when a generic medication is available, the member shall pay the cost difference between the brand and generic medication. In the event a physician requires a brand medication; the employee shall not be responsible for the difference in cost.
(3) Both prescription plans shall incentivize mail-order prescriptions. In the event the employee fills a prescription at retail more than twice, rather than utilizing mail-order, the member shall pay the cost difference.
(4) Effective January 1, 2014, the Prescription Drug Plan will no longer offer the 90-day post formulary change grace period granted upon formulary changes. Plan participants affected by formulary changes shall be notified a minimum of90 days prior to the effective date of the formulary change. The Employer shall approve up to a 90-day post formulary change grace period for members based upon the member's particular circumstances.
(5) The following will be referred to the Employee Benefits Committee under Article 21.3 for discussion, review, and implementation during FY 2017:
(i) Generic Step Therapy: This program requires that the members use cost- effective alternatives within the same therapeutic class, as first line therapy before brand name prescriptions are covered.
(ii) Specialty Pharmacy Guideline Management: This program is designed to support the member to ensure appropriate utilization for specialty medications. The program helps ensure the member meets sophisticated and robust criteria before a first dispense, helps ensure that the members experiences expected therapeutic outcomes while on therapy, and ensures that unsafe or ineffective therapy is discontinued. Current Members using medications subject to this program will be grandfathered. Grandfathered status does not apply if the member's drug therapy changes.
(iii) Advanced Control Specialty Formulary: This program promotes cost effective care for members utilizing specialty medications by encouraging utilization of clinically appropriate and lowest next cost medications. Existing medications subject to this program are updated periodically.
(iv) Pharmacy Advisor Counseling at CVS retail: This program is seamlessly integrated into the member's retail purchase workflow, to provide for a clinical consultation with the retail pharmacist when opportunities to improve adherence or close a gap in therapy have been identified. 2 Per action taken on May 26, 2011, the County Council did not approve full funding for this provision. On that date, the Council adopted a different cost-sharing arrangement for bargaining unit employees, to become effective on January 1, 2012. See Appendix XXL 2F
(v) Effective July 1, 2017, or as soon as administratively possible. Exclusive Specialty Pharmacy- a program that requires plan members to purchase specialty medications through the pharmacy benefit manager's exclusive specialty pharmacy arrangement. Any medication that the pharmacy benefit manager ("PBM") does not designate as a specialty medication is not subject to this requirement. In instances where the specialty medication is not available at the PBM's specialty pharmacy, the PBM shall coordinate purchasing arrangements with another specialty pharmacy within the PBM network.3 At the member's request, the pharmacy benefit manager will deliver the specialty medication to the member's home, the member physician's office, or to a retail pharmacy of the member's choosing that is part of the PBM's pharmacy network.
(c) Effective January 1, 2009, the County shall continue to provide prescription plans (High Option and Standard Option). Bargaining unit employees who select the standard option prescription plan shall pay 20 percent of the total premium cost of the standard option prescription plan offered by the employer. The employer shall pay the remaining 80 percent of the total premium cost of the standard option plan. Should the bargaining unit employee select the high option prescription drug plan, the employer shall pay 80 percent of the total premium cost of the standard option prescription drug plan offered by the employer. The bargaining unit employee shall pay the remainder of the high option prescription drug plan premium. Both prescription plans shall restrict generics. In the event the bargaining unit employee elects to receive a brand medication when a generic medication is available, the member shall pay the cost difference between the brand and generic medication. In the event a physician requires a brand medication, the employee shall not be responsible for the difference in cost. Both prescription plans shall incentivize mail-order prescriptions. In the event the employee fills a prescription at retail more than twice, rather than utilizing mail-order, the member shall pay the cost difference.
(d) Three health maintenance organizations (HMOs) will be open to employees hired before July 1, 1993, two for employees hired on or after July 1, 1993.
(e) For employees enrolled in the current POS medical plan and who reside outside the service area as defined by the current POS medical plan, a schedule of benefits comparable to the current in-network and out-of-network benefit levels of the current POS medical plan will be available as an out-of-area plan through a preferred provider organization (PPO) plan.
Appears in 1 contract
Samples: Collective Bargaining Agreement
Health Benefits. For (a) Effective January 1, 1995, the eighteen (18) month period following County will alter the Termination Datebasis for determining its contribution with respect to each separate medical and hospitalization plan, provided that Executive is eligible forcalculated separately for employee, employee +1, and timely elects COBRA continuation family coverage, the Company will pay on Executive’s behalf, the monthly cost of COBRA continuation coverage under the Company’s group health plan for Executive and, where applicable, her spouse and dependents, at the level in effect as to 80 percent of the Termination Datepremium charged for an HMO or, adjusted for any increase in such level paid by the Company for active employeescase of self-insured plans, less the employee portion 80 percent of the applicable premiums that Executive would have paid had she remained employed during projected premium rate for the such eighteen (18) month period (calendar year in which the COBRA continuation coverage period shall run concurrently with the eighteen (18) month period that COBRA premium payments rates are made on Executive’s behalf under this subsection 1(a)(ii))to be effective. The reimbursements described herein rates for each self-insured plan shall be paid in monthly installments, commencing on the sixtieth (60th) day following the Termination Date, provided that the first such installment payment shall include any unpaid reimbursements that would have been made during the first sixty (60) days following the Termination Date. Notwithstanding the foregoing, the Company’s payment of the monthly COBRA premiums in accordance calculated using standard actuarial principles with this subsection 1(a)(ii) shall cease immediately upon the earlier of: (A) the end of the eighteen (18) month period following the Termination Date, or (B) the date that Executive is eligible for comparable coverage with a subsequent employer. Executive agrees to notify the Company in writing immediately if subsequent employment is accepted prior to the end of the eighteen (18) month period following the Termination Date and Executive agrees to repay to the Company any COBRA premium amount paid on Executive’s behalf during such period for any period of employment during which group health coverage is available through a subsequent employer. Notwithstanding the foregoing, the Company reserves the right to restructure the foregoing COBRA premium payment arrangement in any manner necessary or appropriate to avoid fines, penalties or negative tax consequences to the Company or Executive (including, without limitation, to avoid any penalty imposed for violation of the nondiscrimination requirements under the Patient Protection and Affordable Care Act or the guidance issued thereunder), separate medical trends as determined by the Company Employer's actuary, which reflect plan design. The Union shall be provided with information (including but not limited to all actuarial and consultant reports) enabling it to review the premium determinations. In all other respects the level of benefits and services provided in its sole the comprehensive health benefit program shall remain unchanged except as provided below. 1
(1) Effective January 1, 2009, the County shall continue to provide prescription plans (High Option and absolute discretionStandard Option). Bargaining unit employees who select the standard option prescription plan shall pay 20 percent of the total premium cost of the standard option prescription drug plan offered by the employer. The employer shall pay the remaining 80 percent of the total premium cost of the standard option plan. Should the bargaining unit employee select the high option prescription drug plan, the employer shall pay 80 percent of the total premium cost of the
(2) Both prescription plans shall restrict generics. In the event the bargaining unit employee elects to receive a brand medication when a generic medication is available, the member shall pay the cost difference between the brand and generic medication. In the event a physician requires a brand medication, the employee shall not be responsible for the difference in cost.
(3) Both prescription plans shall incentivize mail-order prescriptions. In the event the employee fills a prescription at retail more than twice, rather than utilizing mail-order, the member shall pay the cost difference.
(4) Effective January 1, 2014, the Prescription Drug Plan will no longer offer the 90-day post formulary change grace period granted upon formulary changes. Plan participants affected by formulary changes shall be notified a minimum of 90 days prior to the effective date of the formulary change. The Employer shall approve up to a 90 day post formulary change grace period for members based upon the member’s particular circumstances.
Appears in 1 contract
Samples: Collective Bargaining Agreement
Health Benefits. For the eighteen (18) month period following the Termination Date, provided that Executive is eligible for, The Company shall continue to provide for existing full-time newspersons and timely elects COBRA continuation their dependents such hospitalization coverage, major medical coverage, life, vision, dental coverage, short-term and long-term disability insurance as is provided through the Smitx Xxxlth Insurance Plan also known as the STC or Sunrise Health Plan. The Company will shall pay on Executive’s behalf75% and the employee shall pay 25% of such increases in the costs for individual or dependent coverage. The Employer shall be free to change carriers and alter, amend or discontinue such plans so long as it does not discriminate between the newspersons and the non-bargaining employees with regard to such benefits. Existing full-time newspersons employed prior to January 3, 1996, shall have the option to continue their enrollments in such HMO plans as were in force and which remain available at the employee contribution rate of $26.50 per pay period for dependent coverage; and $4.15 per pay period for single coverage. Future cost increases shall be divided in the same manner as with the Smitx Xxxn (75% Company, 25% Employee), except that in no event shall the dollar amount of the Company's share of such increase in the HMO cost exceed the Company's share of dollars paid for the increase in the above described Sunrise Plan in any year. Additionally, should employees elect to continue participation in such HMO's, the monthly cost of COBRA continuation coverage under employer will provide a special life insurance plan to supplement the Company’s group health HMO plan for Executive and, where applicable, her spouse and dependents, at the level in effect as of the Termination Date, adjusted for any increase in such level paid by the Company for active employees, less wherein the employee portion of the applicable premiums that Executive would have paid had she remained employed during the such eighteen (18) month period (the COBRA continuation coverage period shall run concurrently with the eighteen (18) month period that COBRA premium payments are made on Executive’s behalf under this subsection 1(a)(ii)). The reimbursements described herein shall be paid in monthly installments, commencing on the sixtieth (60th) day following the Termination Date, provided that the first such installment payment shall include any unpaid reimbursements that would have been made during the first sixty (60) days following the Termination Date. Notwithstanding the foregoing, the Company’s payment of the monthly COBRA premiums in accordance with this subsection 1(a)(ii) shall cease immediately upon the earlier of: (A) the end of the eighteen (18) month period following the Termination Date, or (B) the date that Executive is eligible for comparable will receive term life insurance coverage with a subsequent death benefit computed at the rate of one and one-half times his or her annual salary, to a maximum of $200,000. The total cost of such additional life insurance protection shall be borne by the employer. Executive agrees to notify Employees hired after January 3, 1996, who qualify as full-time newspersons shall receive the Company in writing immediately if subsequent employment is accepted prior health insurance plans noted above and will be eligible for the HMO option. Such employees hired after January 3, 1996, shall pay the same employee contribution rate of $96.35 per pay period for dependent coverage and $17.97 per pay period by single coverage . If an existing employee returns, for the purpose of enrollment, to the end of Smitx xxxn after leaving, he or she shall be responsible for the eighteen (18) month period following the Termination Date and Executive agrees to repay to the Company any COBRA premium amount paid on Executive’s behalf during such period for any period of employment during which group health coverage is available through a subsequent employer. Notwithstanding the foregoing, the Company reserves the right to restructure the foregoing COBRA premium payment arrangement in any manner necessary or appropriate to avoid fines, penalties or negative tax consequences to the Company or Executive (including, without limitation, to avoid any penalty imposed for violation of the nondiscrimination requirements under the Patient Protection and Affordable Care Act or the guidance issued thereunder), employee contribution rate as determined by for new employees entering the Company in its sole and absolute discretionSmitx Xxxrise Plan.
Appears in 1 contract
Samples: Aftra/Wtov Tv Minimum Basic Agreement for Newsroom Employee (STC Broadcasting Inc)
Health Benefits. For In accordance with RCW 41.26 (Law Enforcement Officers' and Fire Fighters' Retirement System) or other applicable State laws, the eighteen (18) month period following Employer shall provide a medical program for the Termination DateEmployee at no cost to the Employee. The Employer shall pay medical, dental and life insurance premiums for all Employees. At the present time, medical insurance is provided through the LEOFF Health and Welfare Trust for active LEOFF I Employees and from either LEOFF Health and Welfare Trust or other medical insurance that Executive is eligible forhas been selected and made available by the Airport for LEOFF II Employees. Dental and life insurance coverage for both LEOFF I and LEOFF II Employees shall be that selected and made available to other Airport Employees. The Employer also agrees to pay 100% of all medical and dental premiums that are applicable to the Employee and their dependent/s up to the total premium amount charged for LEOFF I firefighters, including the Employee and dependent/s, by the LEOFF Health and Welfare Trust. EXCEPT THAT, beginning on Jan. 1, 2006, Employees shall pay 5% of the medical insurance premiums that are applicable to their dependents, and timely elects COBRA continuation coverage, the Company will Employer shall pay on Executive’s behalf, the monthly cost 95% of COBRA continuation coverage under the Company’s group health plan for Executive and, where applicable, her spouse and dependents, at the level in effect as those premiums. The Employer shall continue to pay 100% of the Termination Date, adjusted premium for any increase in such level paid by the Company for active employees, less Employee based on the employee portion LEOFF Health & Welfare Trust premium rate. The Employer shall pay 100% of the applicable dental premiums that Executive would have paid had she remained employed during for the such eighteen (18) month period (the COBRA continuation coverage period shall run concurrently with the eighteen (18) month period that COBRA premium payments are dental program selected and made on Executive’s behalf under this subsection 1(a)(ii))available to other Airport Employees and their dependents. The reimbursements described herein shall be paid in monthly installments, commencing on the sixtieth (60th) day following the Termination Date, provided that the first such installment payment shall include any unpaid reimbursements that would have been made during the first sixty (60) days following the Termination Date. Notwithstanding the foregoing, the Company’s payment of the monthly COBRA premiums in accordance with this subsection 1(a)(ii) shall cease immediately upon the earlier of: (A) the end of the eighteen (18) month period following the Termination Date, or (B) the date that Executive is eligible for comparable coverage with a subsequent employer. Executive agrees to notify the Company in writing immediately if subsequent employment is accepted prior to the end of the eighteen (18) month period following the Termination Date and Executive agrees to repay to the Company any COBRA premium amount paid on Executive’s behalf during such period for any period of employment during which group health coverage is available through a subsequent employer. Notwithstanding the foregoing, the Company Employer reserves the right to restructure choose the foregoing COBRA premium payment arrangement most economical medical and dental insurance providers of substantially equivalent coverage as agreed upon in the current contract. Further, any manner necessary or appropriate to avoid fines, penalties or negative tax consequences to determination by the Company or Executive (including, without limitation, to avoid any penalty imposed for violation of the nondiscrimination requirements under the Patient Protection and Affordable Care Act or the guidance issued thereunder)applicable insurance company which, as determined a result of Employee's failure to follow the procedures set forth by such insurance company, that reduces benefits or otherwise penalizes the Company Employee shall be the responsibility and liability of such Employee and will not be the liability of Employer. Employer agrees to provide Union involvement in its sole and absolute discretionthe evaluation of medical/dental health care providers prior to any changes being made in the current coverage plans.
Appears in 1 contract
Samples: Collective Bargaining Agreement
Health Benefits. For 29.01 When the eighteen enrollment and other requirements of the insurer(s) have been met, the Employer shall take steps to contract for and implement the following group plans:
(18a) month period following the Termination DateAlberta Blue Cross Extended Health Benefits Plan, provided or equivalent which will provide for eighty per cent (80%) direct payment provision for physician or dentist prescription medication that Executive is eligible for, and timely elects COBRA continuation coverage, the Company will pay on Executive’s behalf, the monthly cost of COBRA continuation coverage under the CompanyPlan and prescribed in accordance with the Plan.
(b) Alberta Blue Cross Dental Plan, or equivalent, which provides for the reimbursement of eighty per cent (80%) of eligible Basic Services; fifty per cent (50%) of all eligible Extensive Services; and fifty per cent (50%) of eligible Orthodontic Services, in accordance with the current Alberta Blue Cross usual and customary dental fees. A maximum annual reimbursement of three thousand dollars ($3,000) per insured person per benefit year shall apply to Extensive Services. Orthodontic Services shall be subject to a lifetime maximum reimbursement of three thousand dollars ($3,000) per insured person;
(c) Alberta Health Care Insurance Plan;
(d) A Benefit Plan inclusive of:
(i) Group Life Insurance;
(ii) Accidental Death and Dismemberment;
(iii) Short-Term Disability (income replacement for a period of up to one hundred and twenty [120] working days during a qualifying disability equal to sixty-six point six seven per cent [66.67%] of basic weekly earnings [regularly scheduled weekly hours multiplied by the Employee’s group health plan for Executive and, Basic Rate of Pay at the date of disability determines the level of weekly benefit coverage] to the established maximum following a seven [7] calendar day elimination period where applicable, her spouse and dependents, at the level in effect as of the Termination Date, adjusted for any increase in such level paid by the Company for active employees, less the employee portion of the applicable premiums that Executive would have paid had she remained employed during the such eighteen (18) month period (the COBRA continuation coverage period shall run concurrently with the eighteen (18) month period that COBRA premium payments are made on Executive’s behalf under this subsection 1(a)(ii)). The reimbursements described herein Short-Term Disability shall be paid in monthly installments, commencing become effective on the sixtieth (60th) first [1st] working day following the Termination Dateexpiry of sick leave credits in the case of absence due to injury or hospitalization. In the particular case of Employees who have insufficient sick leave credits to satisfy the seven [7] calendar day elimination period, provided that the first such installment payment Short-Term Disability shall include any unpaid reimbursements that would have been made during commence on the first sixty (60) days eight [8th] day following the Termination Date. Notwithstanding the foregoing, the Company’s payment commencement of the monthly COBRA premiums in accordance with this subsection 1(a)(ii) shall cease immediately upon the earlier of: (A) the end of the eighteen (18) month period following the Termination Date, or (B) the date that Executive is eligible for comparable coverage with a subsequent employer. Executive agrees to notify the Company in writing immediately if subsequent employment is accepted prior to the end of the eighteen (18) month period following the Termination Date and Executive agrees to repay to the Company any COBRA premium amount paid on Executive’s behalf during such period for any period of employment during which group health coverage is available through a subsequent employer. Notwithstanding the foregoing, the Company reserves the right to restructure the foregoing COBRA premium payment arrangement in any manner necessary or appropriate to avoid fines, penalties or negative tax consequences to the Company or Executive (including, without limitation, to avoid any penalty imposed for violation of the nondiscrimination requirements under the Patient Protection and Affordable Care Act or the guidance issued thereundernon-hospitalized sickness), as determined by the Company in its sole and absolute discretion.;
Appears in 1 contract
Samples: Collective Agreement
Health Benefits. For a) The Township agrees to provide health insurance for all employees and their dependents.
b) Employees shall contribute toward the eighteen cost of their health and prescription base rate premium costs. The rate of contribution will be a percentage of the total annual premium cost of all selected coverage for the employee and their dependents. Effective January 1, 2011 and continuing through December 31, 2012 the contribution amount shall be three percent (183%) month period following the Termination Dateof total selected health and prescription coverage premium. Effective January 1, provided that Executive is eligible for2013, and timely elects COBRA continuation coveragecontinuing, the Company contribution amount shall be three and one-quarter percent (3.25%) of total selected health and prescription coverage premium.
c) Should an employee choose to opt-out of the health and prescription coverage pursuant to the polices and procedures established by the Township the employee shall not be responsible or required to contribute the three percent (3%) of total selected health and prescription coverage premium as required by Section 15.1 b of this Agreement.
Section 15.2 The Township agrees to provide a drug prescription program for employees and their dependents. Employees will be required to contribute toward the cost of prescription coverage as provided in Section 15.1 b of this Agreement. The Township will pay 50% on Executive’s behalf, the monthly cost of COBRA continuation coverage under the Company’s group health an approved dental plan for Executive and, where applicable, her spouse employees and dependents, at the level in effect as of the Termination Date, adjusted for any increase in such level paid by the Company for active employees, less the employee portion of the applicable premiums that Executive would have paid had she remained employed during the such eighteen (18) month period (the COBRA continuation coverage period shall run concurrently with the eighteen (18) month period that COBRA premium payments are made on Executive’s behalf under this subsection 1(a)(ii)). The reimbursements described herein shall be paid in monthly installments, commencing on the sixtieth (60th) day following the Termination Date, provided that the first such installment payment shall include any unpaid reimbursements that would have been made during the first sixty (60) days following the Termination Date. Notwithstanding the foregoing, the Company’s payment of the monthly COBRA premiums in accordance with this subsection 1(a)(ii) shall cease immediately upon the earlier of: (A) the end of the eighteen (18) month period following the Termination Date, or (B) the date that Executive is eligible for comparable coverage with a subsequent employer. Executive agrees to notify the Company in writing immediately if subsequent employment is accepted prior to the end of the eighteen (18) month period following the Termination Date their families and Executive agrees to repay to the Company any COBRA premium amount paid on Executive’s behalf during such period for any period of employment during which group health coverage is available through a subsequent employer. Notwithstanding the foregoing, the Company reserves the right to restructure choose the foregoing COBRA premium payment arrangement insurance carrier. Employees shall have the option to participate in any manner necessary this program.
a) The Township will pay $250.00 per employee for the purpose of a physical/eye exam, eye glasses or appropriate contact lenses per year, as long as dual coverage is not in effect.
b) Employees will have the option of having the physical exam performed by a physician designated by the Township. Should the employee choose this option, the Township will pay for the cost of said exam. However, in either case the employee must agree to avoid fines, penalties or negative tax consequences allow the physician to release to the Company Township a statement, the contents of which shall be limited to the following:
1) The employee is in good health; or
2) The employee should seek further advise from his/her personal physician Should the employee not agree to release this statement the Township will not bear the cost of said exam or Executive will not reimburse the employee for the cost depending on the option chosen. These statements shall be confidential and will only be authorized for release to the Municipal Manager.
Section 15.5 The Township will pay for a life insurance policy in the amount of $5,000.00 for natural death and will increase to $10,000.00 in the event of an accidental death. The Township reserves the right to choose the insurance carrier for this program.
a) The Township agrees to provide retirement benefits in accordance with applicable New Jersey statutes that would apply to eligible retired employees that had an original hire date of December 31, 2009 or prior. Employees hired on or after January 1, 2010 shall not be entitled to post retirement health benefits.
b) Any employee, regardless of hire date, that retires on or after February 2, 2014 and is eligible for post-retirement health care benefits shall contribute no less than one percent (including, without limitation, to avoid any penalty imposed for violation 1%) of their pensionable benefit toward the nondiscrimination requirements cost of said post-retirement benefits or an amount set by New Jersey Statute that requires a higher contribution.
Section 15.7 Post retirement health benefits will be provided through the New Jersey State Health Benefits Program. Retirees qualify under the Patient Protection following conditions:
a) Disability retirement
b) Service retirement with at least 25 years of service in a state approved pension system and Affordable Care Act at least 10 years with Xxxxxxxx Township.
c) Service retirement at age 62 or older with at least 15 years service with Xxxxxxxx Township. The limit of post-retirement coverage is as follows:
a) Retirement under age 55, Township pays for coverage for 10 years from date of retirement for retiree and dependents.
b) Retirement between ages 55 and 60, Township pays for coverage until age 65 for retiree and dependents.
c) Retirement between ages 60 and 65, Township pays for coverage until age 65 for retiree and dependents and pays for coverage for only retiree for a period of 5 years from the guidance issued thereunderdate of retirement. (Example: employee retires on 63rd birthday, Township pays coverage cost for retiree and dependent to age 65 and pays coverage cost for retiree only until 68th birthday.)
d) Retirement at age 65 or older, as determined by Township pays for coverage for 5-years from date of retirement – retiree only.
e) Above periods of eligibility of post-retirement health care coverage will not be applicable to employees hired on or after January 1, 2010. Employees hired on or after January 1, 2010 shall not be eligible for post-retirement benefits.
Section 15.8 The Township shall provide employees the Company option of their enrollment in its sole and absolute discretionthe IRS Code Section 125 Plan.
Section 15.9 Employees will be eligible to re-enroll during the year under special circumstances.
Appears in 1 contract
Samples: Employment Agreement
Health Benefits. For 20.01 Eligible Employees must be regularly scheduled to work a minimum of thirty-eight point seven five (38.75) hours per pay period to continue to be eligible for health benefits.
20.02 An Employee is eligible to receive health benefits after they have successfully completed their probationary period.
20.03 Group benefit costs will be allocated as follows: Accidental Death and Dismemberment 100% Employer Long Term Disability 100% Employee Life and Dependent Life Insurance 100% Employer Optional * Health and Dental Services 55% Employer and 45% Employee Effective the eighteen (18) month pay period following ratification this amount shall be revised to 65% Employer and 35% Employee DRAFT * Mandatory unless Employee elects to waive coverage through the Termination DateCanterbury plan because their spouse has coverage through their Employer.
20.04 Employees must continue to pay their share of the benefit plan costs during periods of extended absences of fifteen days or more, provided that Executive is eligible forwhich are due to illness, and timely elects COBRA continuation coveragematernity leave or leave without pay. For Employees who are disabled, the Company Employer will continue to pay its share of premiums as currently established until the Waiver of Premiums is approved or until the Employee’s disability has existed for at least six (6) months for the last day worked, whichever is longer.
20.05 An Employee may, with written notice to the business office, opt out of the plan during extended absences and be reinstated on Executive’s behalftheir return to work.
20.06 The Employer shall provide the Union with a copy of the benefit plan. If the Employer changes the plan or benefit provider, the monthly cost replacement plan shall provide coverage at least equivalent to the previous plan.
20.07 Effective January 1, 2023, a Health Spending Account in the annual amount of COBRA continuation coverage under two hundred dollars ($200) shall be available to all Full-time Employees. For Part-time and Temporary Employees, this amount shall be pro-rated based on the Company’s group health plan for Executive and, where applicable, her spouse and dependents, at the level in effect as of the Termination Date, adjusted for any increase in such level paid by the Company for active employees, less the employee portion of the applicable premiums that Executive would have paid had she remained employed during the such eighteen Employees full-time equivalency (18) month period (the COBRA continuation coverage period shall run concurrently with the eighteen (18) month period that COBRA premium payments are made on Executive’s behalf under this subsection 1(a)(ii)FTE). The reimbursements described herein shall Reimbursement of allowable medical and dental expenses may be paid in monthly installments, commencing on the sixtieth (60th) day following the Termination Date, provided that the first such installment payment shall include any unpaid reimbursements that would have been made during the first sixty (60) days following the Termination Dateclaimed against an Employees Health Spending Account. Notwithstanding the foregoing, the Company’s payment of the monthly COBRA premiums in accordance with this subsection 1(a)(ii) shall cease immediately upon the earlier of: (A) the end of the eighteen (18) month period following the Termination Date, or (B) the date that Executive is eligible Unused amounts can be carried over for comparable coverage with a one subsequent employer. Executive agrees to notify the Company in writing immediately if subsequent employment is accepted prior to the end of the eighteen (18) month period following the Termination Date and Executive agrees to repay to the Company any COBRA premium amount paid on Executive’s behalf during such period for any period of employment during which group health coverage is available through a subsequent employer. Notwithstanding the foregoing, the Company reserves the right to restructure the foregoing COBRA premium payment arrangement in any manner necessary or appropriate to avoid fines, penalties or negative tax consequences to the Company or Executive (including, without limitation, to avoid any penalty imposed for violation of the nondiscrimination requirements under the Patient Protection and Affordable Care Act or the guidance issued thereunder), as determined by the Company in its sole and absolute discretionyear.
21.01 General Conditions
Appears in 1 contract
Samples: Collective Agreement
Health Benefits. For The Company agrees to continue to make available and pay the same proportion of the deductible and portion of the premium as it currently does for participation for the Executive and his spouse, Xxx. Xxxxxxxxx Xxxxx, to the extent each is eligible under Maryland continuation of benefits laws, in the Company’s health benefit plans (including medical and dental plans) or programs equivalent to those that are offered to the key executive employees of Company as may be established from time to time by the Company management or its Board of Directors (the “Health Plans”) on substantially the same basis as is in effect for the Company’s active employees for a period of eighteen (18) months commencing on the first day of the month period next-following the Termination Date, provided that Separation Date (the “Continuation Period”). If and to the extent Executive is and his spouse cease to be eligible for, and timely elects COBRA continuation coverage, the Company will pay on Executive’s behalf, the monthly cost of COBRA continuation for coverage under the Company’s group health plan for Executive andHealth Plans, where applicable, her spouse and dependentsrespectively, at any point after the level in effect as commencement of the Termination Date, adjusted for any increase in such level paid by the Company for active employees, less the employee portion of the applicable premiums that Executive would have paid had she remained employed during the such eighteen (18) month period (the COBRA continuation coverage period shall run concurrently with the eighteen (18) month period that COBRA premium payments are made on Executive’s behalf under this subsection 1(a)(ii)). The reimbursements described herein shall be paid in monthly installments, commencing on the sixtieth (60th) day following the Termination Date, provided that the first such installment payment shall include any unpaid reimbursements that would have been made during the first sixty (60) days following the Termination Date. Notwithstanding the foregoing, the Company’s payment of the monthly COBRA premiums in accordance with this subsection 1(a)(ii) shall cease immediately upon the earlier of: (A) the end of the eighteen (18) month period following the Termination Date, or (B) the date that Executive is eligible for comparable coverage with a subsequent employer. Executive agrees to notify the Company in writing immediately if subsequent employment is accepted Continuation Period but prior to the end of the Continuation Period, continuation coverage under the Health Plans or any available alternate coverage shall be provided to the Executive and his spouse in accordance with the applicable requirements of Maryland law for up to eighteen (18) month period following months (the Termination Date “Continuation Coverage”); provided, that any such Continuation Coverage shall be provided at the same proportion of the deductible and Executive agrees to repay portion of the premium, if available, as may then be in effect for the Company’s active employees generally. In the event the Executive’s or his spouse’s eligibility for Continuation Coverage ends prior to the Company any COBRA premium amount paid on Executive’s behalf during such period for any period expiration of employment during which group health coverage is available through a subsequent employer. Notwithstanding the foregoingContinuation Period, the Company reserves shall, upon the right to restructure presentation of receipts or invoices, promptly reimburse the foregoing COBRA premium payment arrangement in Executive and/or his spouse for the costs of any manner necessary or appropriate to avoid finesreplacement coverage they may thereafter secure until the end of the Continuation Period; provided, penalties or negative tax consequences that the amount of the Company’s reimbursement for such alternative coverage shall be no greater than hundred and fifty percent (150%) of the cost of coverage it otherwise would have provided to the Company Executive in connection with the Continuation Coverage (the “Coverage Maximum”). The Executive acknowledges and agrees that the Company’s obligations to pay or Executive (including, without limitation, to avoid any penalty imposed for violation reimburse the costs of such Continuation Coverage or alternative coverage shall terminate at the end of the nondiscrimination requirements under Continuation Period. The Executive acknowledges and agrees that the Patient Protection Company’s reimbursement for the alternative coverage contemplated hereunder shall be limited to the Coverage Maximum. The Executive further acknowledges and Affordable Care Act agrees to pay all federal, state and any other taxes in connection with or the guidance issued thereunder), as determined caused by the Company’s providing the Continuation Coverage (or alternative coverage) contemplated hereunder; provided, however, in the event that the Company in its sole and absolute discretionreports any such Continuation Coverage as a taxable benefit to the Executive, the Company hereby agrees to provide the Executive written notice of any such report.
Appears in 1 contract
Samples: Termination and Consulting Agreement (Cytomedix Inc)