Health Care Benefits. A. Each regular, full-time employee may elect coverage for himself and his eligible dependents* under one of the following health insurance plans:
1. Blue Cross/Blue Shield of Michigan Flexible Blue 3 with Flexible Blue Rx Prescription Drug Coverage with a Health Savings Account (hereinafter collectively referred to as the “H.S.A Plan”). The Employer shall pay for the illustrated premium cost of this coverage and make an annual contribution to each participating employee’s Health Savings Account in the amount of $500 for those selecting single coverage and $1,000 for those selecting Employee & Spouse, Employee Child(ren) or Family coverage, or the maximum annual amount the Employer is permitted to pay under Section 3 of the Publicly Funded Health Insurance Contribution Act, Public Act 152 of the Michigan Public Acts of 2011, whichever results in the lesser Employer contribution to the cost of such plan. Employees may, at their option, make additional contributions through bi-weekly pre-tax payroll deduction as permitted by applicable law.
2. Blue Cross/Blue Shield of Michigan Community Blue PPO Option 3 Revised Plan with Blue Preferred Rx Prescription Drug Coverage with a 50% co-pay ($5 floor and a $50 ceiling). Employees shall pay the difference between the illustrated premium cost of this coverage and the amount of the Employer’s total contribution towards the cost of coverage under the H.S.A. Plan as described in Section 1 (a) (1), for the same level of benefit (i.e. single, employee/spouse, employee/child(ren) and family), or pay the difference between the total cost of such coverage and the maximum annual amount the Employer is permitted to pay under Section 3 of the Publicly Funded Health Insurance Contribution Act, Public Act 152 of the Michigan Public Acts of 2011, whichever results in the greater employee contribution.
3. Blue Cross/Blue Shield of Michigan Community Blue PPO Option 6 Revised Plan with Blue Preferred Rx Prescription Drug Coverage with a 50% co-pay ($5 floor and a $50 ceiling). Employees shall pay the difference between the illustrated premium cost of this coverage and the amount of the Employer’s total contribution towards the cost of coverage under the H.S.A. Plan as described in Section 1 (a) (1), for the same level of benefit (i.e. single, employee/spouse, employee/child(ren) and family), or pay the difference between the total cost of such coverage and the maximum annual amount the Employer is permitted to pay under Section 3 o...
Health Care Benefits. Blue Cross and Blue Shield will provide benefits for Members based upon the coverage that is in effect for the Member at the time the services are furnished and on contractual agreements made with providers. No action may be brought against Blue Cross and Blue Shield for failure to provide benefits unless brought within two years from the date the cause of action arises. You will be solely responsible for complying with all applicable provisions of the Employee Retirement Income Security Act of 1974, as amended (ERISA). This includes the fiduciary responsibilities of administering your benefits plans, maintaining adequate funding to support these plans and providing required notices to Members. Solely for the benefits plans provided under this Agreement, and not for purposes of the wellness services and programs described in Attachment 1 or the Account-Based Offerings described in Attachment 2, Blue Cross and Blue Shield is the fiduciary to whom you have granted full discretionary authority to make decisions regarding the amount, form and timing of benefits; to conduct medical necessity review; to apply utilization management; to exercise fair and impartial review of denied claims for services; and to resolve any other matter under the benefits plan which is raised by a Member or identified by Blue Cross and Blue Shield regarding entitlement to benefits as described in the Subscriber Certificates for your benefits plan. All determinations of Blue Cross and Blue Shield with respect to any matter within its assigned responsibility will be conclusive and binding on all persons unless it can be shown that the interpretation or determination was arbitrary and capricious. You agree that all your eligible employees are employed by you or by a subsidiary entirely owned by you. In the event that any such subsidiary is covered by this Agreement, you represent and warrant that you have the authority to enter into this Agreement on behalf of yourself and of every subsidiary that is covered by this Agreement. You, for yourself and for your subsidiaries covered under this Agreement, agree that you and each and every subsidiary are jointly and severally liable for payment of all premium charges owed under this Agreement. In the event that any such subsidiary is sold or is no longer entirely owned by you, you must notify Blue Cross and Blue Shield immediately.
Health Care Benefits. The agreement reached at the State bargaining table concerning health care benefits shall be applicable to bargaining unit employees.
Health Care Benefits. An amount equal to three (3) times the full annual cost of coverage for medical, dental and vision benefits under the Company’s Health Care Plan and Vision Insurance Plan provided to Executive and his covered dependents for the year in which Executive’s Covered Termination Date occurs, in a lump sum in cash within sixty (60) days after the Covered Termination Date. In no event shall the benefits provided for in Sections 2(a), (d), (e) and (f) above or any payment provided for in (c) above that is not subject to Code Section 409A be paid later than March 15th of the calendar year immediately following the calendar year in which the Executive’s Covered Termination Date occurs.
Health Care Benefits. The District will maintain employee health care benefits at its expense during the duration of the leave. However, in the event that the employee does not return from leave for a reason other than continuation or reoccurrence of a serious health condition, the onset of a new serious health care condition, or circumstances beyond the control of the employee, the District may exercise its right to recover premium costs.
Health Care Benefits. The Company agrees to include Employee in health care benefits made available to its employees and officers, if any, which may include major medical insurance for Employee and his family members, long-term disability insurance, and such other health care benefits as may be provided from time to time by the Company to its employees and officers.
Health Care Benefits. 153. The level of the City’s contribution to health benefits will be set annually in accordance with the requirements of Charter Sections A8.423 and A8.428.
Health Care Benefits. For the 20192021-2021 2023 biennium, the Employer will contribute an amount equal to eighty-five percent (85%) of the total weighted average of the projected medical premium for each bargaining unit employee eligible for insurance each month, as determined by the Public Employees Benefits Board. The projected medical premium is the weighted average across all plans, across all tiers.
Health Care Benefits. 1.1. During the term of this agreement, the employee contribution for the medical and prescription drug plan shall be fifteen percent (15%) for single coverage and twenty percent (20%) for all other coverage levels of the total cumulative cost of those plans. The medical and prescription drug plan associated with these percentages shall be what is referred to in the 2016 plan year as Plan A. Plan design for Plan A shall remain substantially similar for the life of the Agreement. Notwithstanding the foregoing, Plan A shall, effective January 1, 2020, also include the coverage required by the Affordable Care Act (“ACA”) as of September 23, 2010, including, without limitation, those preventative services provided without any employee copayment or co-insurance or deductible. The University’s obligation to provide the coverage required by the ACA, including, without limitation, the preventative services without any employee copayment or coinsurance or deductible, shall continue without regard to the continuing existence of the ACA. Descriptions of Plan A medical, Plan A prescription drug, and dental insurance benefits are set forth in Appendices I-III.
1.2. Other medical and prescription drug plans may be offered during this agreement whose overall cost to the employee may be more or less than the base plan, Plan A, and are subject to change on an annual basis. The employee premium contribution percentages for other medical and prescription drug plan participants shall not exceed the percentages paid by Plan A participants.
1.3. During the life of this Agreement, the employee contributions for the dental plan, regardless of the coverage level, shall be 20% of the total cumulative cost of the dental plan.
1.4. The total cumulative cost of the medical, prescription drug, and dental plans shall be established by the University prior to the fall open enrollment period for the next calendar year. Increases shall be applied at the beginning of each plan year, January 1.
1.5. Eligibility for health insurance coverage shall be limited to dependents through the end of the month they turn age 26.
1.6. BGSU reserves the option to add an additional pharmacy drug classification for specialty medications. If added, the member out of pocket provisions shall match the in force brand drug specifications. The specialty classification may include additional utilization restrictions including but not limited to: restricted specialty pharmacy network; prior authorization and step t...
Health Care Benefits. If you are totally disabled when your Major Medical Benefit terminates, benefits for such disability will be payable, as long as you remain disabled, up to a maximum period of 365 days after termination. If one of your covered dependents is hospitalized when your insurance terminates, then benefits will be payable in the same manner as your own, until your dependent is discharged from the hospital. Extension of the Major Medical Benefit will cease if the Policy should terminate. In most cases no Dental benefits are payable for expenses incurred after the date your insurance terminates even if a Treatment Plan has been filed and benefits have been determined by The Insurance Company prior to the date your insurance terminates. However, under the following circumstances benefits are payable:
