Common use of Health Care Cost Containment Clause in Contracts

Health Care Cost Containment. The Employer at its option may implement any of all of the following health care cost containment programs: (a) Pre-admission certification of the necessity of hospitalization (BC-BSM predetermination program or equivalent). (b) Excluded from reimbursement under the prescription drug program are cosmetic drugs and non-prescription smoking cessation aids. (c) Excluded from benefits coverage are maternity benefits for persons acting as surrogate mothers. (d) When more than one family member is employed by the Employer, there shall be no duplicate coverage by Employer health plans. (e) In the event of any payment under the Employer’s health insurance plan on behalf of any person covered by such insurance plan, the Employer shall be subrogated to the extent of said payment to the covered person’s right of recovery therefore against any persons or organization in a tort action. It is further understood between the parties that subrogation applies to direct medical expenses paid and not to subjective damages such as “pain and suffering.” (f) In a joint continuing effort to control the cost of insurance, the Employer and the Union agree to a strict coordination of benefits program which is designed to prevent people from making a profit on health insurance by collecting more than the actual cost of covered services. Under this program, the benefits payable under Employer health insurance and any other group health insurance policy which an employee or any covered dependent may have will not exceed the total amount of medical expenses.