Health Care Plan Structure Sample Clauses

Health Care Plan Structure. The health care plan shall be structured and governed by the actual health care plan document. The City has the authority to restructure benefits, with the exception of hospitalization deductibles, maximum out of pocket amounts and reimbursement percentages. The City also has the authority to restructure network composition of the preferred provider network. The City retains the right to negotiate with insurance and/or medical providers for benefits, coverage and administration under CitiCare Fire Health Insurance Plan or any successor plan. A summary of the current plan structure, which is subject to change as stated above, is as follows: CITICARE FIRE HEALTH INSURANCE PLAN THIS IS A SUMMARY ONLY, PLAN DOCUMENT WILL GOVERN BENEFITS IN NETWORK(Participating Providers) OUT-OF-NETWORK PLAN YEAR DEDUCTIBLE No Plan Year Deductible $200 Per Individual $500 Max Family PHYSICIAN SERVICES In-Patient Out-Patient Emergency Room $15.00 Co-Pay 70/30% Co-Insurance LABORATORY SERVICES Physician's Office Lab Facilities Hospitals $10.00 Co-Pay 70/30% Co-Insurance X-Rays Physician's Office: X-Ray Facilities: $10.00 Co-Pay$15.00 Co-Pay 70/30% Co-Insurance Emergency Room Services $50 Co-Pay Then 80/20% Co-Insurance 70/30% Co-Insurance Hospitalization (In-Patient) $200 Individual Deductible$600 Max Family Deductible then 85/15% Co-Insurance 70/30% Co-Insurance Hospitalization (Out-Patient) $100 Deductible Per Individual$250 Max Family Deductible then 85/15% Co-Insurance 70/30% Co-Insurance Retail Prescriptions Co-Pays:$0 – Generic$20 – Preferred Brand$40 – Non-Preferred Brand No Deductible 70/30% Co-Insurance Prescriptions Mandatory Mail Order 90 Day Supply of Maintenance Prescriptions Co-Pays:$0 – Generic$20 – Preferred Brand$40 – Non-Preferred Brand No Deductible 70/30% Co-Insurance Out-Of-Pocket Cost Excluding Co-Pays & Deductibles $500 Per Individual$1,250 Max Family $700 Per Individual $1,750 Max Family Lifetime Maximum Benefit = $2,000,000, unless otherwise required by law. * Employees and dependents covered by the CitiCare Fire Health Insurance Plan will be excluded from the drug formulary. ** Emergency Room Services. Will increase to $50.00 Co-Pay provided that 2 minor emergency clinics are included, one on the Southside of Corpus Christi and the other in the Calallen area. Should the number of minor emergency clinics fall below 2 for more than 90 consecutive days the Co-Pay will be $15.00. Other eligible services and eligible medical supplies as shown in the CitiCare...
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Related to Health Care Plan Structure

  • HEALTH CARE PLANS ‌ Notwithstanding the references to the Pacific Blue Cross Plans in this article, the parties agree that Employers, who are not currently providing benefits under the Pacific Blue Cross Plans may continue to provide the benefits through another carrier providing that the overall level of benefits is comparable to the level of benefits under the Pacific Blue Cross Plans.

  • Dental Care Plan The Welfare Plan will include a Dental Care Plan which will reimburse members for expenses incurred in respect of the coverages summarized in Appendix "1". The Plan will not duplicate benefits provided now or which may be provided in the future by any government program.

  • Extended Health Care Plan (a) The Employer shall pay the monthly premium for regular employees entitled to coverage under a mutually acceptable Extended Health Care Plan.

  • Health Care Savings Plan As provided in this Agreement, eligible ASF Members will participate in the health care savings plan (HCSP) established under Minnesota Statute 352.98, and as administered by the Plan Administrator. The Employer is responsible only for transferring funds, as specified in this agreement, to the Plan Administrator.

  • Health Care Operations Health Care Operations shall have the meaning set out in its definition at 45 C.F.R. § 164.501, as such provision is currently drafted and as it is subsequently updated, amended or revised.

  • Covered Health Care Services We agree to provide coverage for medically necessary covered health care services listed in this agreement. If a service or category of service is not specifically listed as covered, it is not covered under this agreement. Only services that we have reviewed and determined are eligible for coverage under this agreement are covered. All other services are not covered. See Section 1.4 for how we identify new services and our guidelines for reviewing and making coverage determinations. We only cover a service listed in this agreement if it is medically necessary. We review medical necessity in accordance with our medical policies and related guidelines. The term medically necessary is defined in Section 8.0 - Glossary. It does not include all medically appropriate services. The amount of coverage we provide for each health care service differs according to whether or not the service is received: • as an inpatient; • as an outpatient; • in your home; • in a doctor’s office; or • from a pharmacy. Also coverage differs depending on whether: • the health care provider is a network provider or non-network provider; • deductibles (if any), copayments, or maximum benefit apply; • you have reached your plan year maximum out-of-pocket expense; • there are any exclusions from coverage that apply; or • our allowance for a covered health care service is less than the amount of your copayment and deductible (if any). In this case, you will be responsible to pay up to our allowance when services are rendered by a network provider. Please see the Summary of Medical Benefits to determine the benefit limits and amount that you pay for the covered health care services listed below. Please see the Summary of Pharmacy Benefits to determine the benefit limits and amount that you pay for prescription drug and diabetic equipment and supplies purchased at a pharmacy.

  • Health Care Spending Account After six (6) months of permanent employment, full time and part time (20/40 or greater) employees may elect to participate in a Health Care Spending Account (HCSA) Program designed to qualify for tax savings under Section 125 of the Internal Revenue Code, but such savings are not guaranteed. The HCSA Program allows employees to set aside a predetermined amount of money from their pay, not to exceed the maximum amount authorized by federal law, per calendar year, of before tax dollars, for health care expenses not reimbursed by any other health benefit plans. HCSA dollars may be expended on any eligible medical expenses allowed by Internal Revenue Code Section 125. Any unused balance is forfeited and cannot be recovered by the employee.

  • Vision Care Plan The County agrees to provide a Vision Care Plan for all employees and dependents. The Plan will be the Vision Service Plan - Plan A with benefits at 12/12/24 month intervals and with twenty dollar ($20.00) deductible for examinations and twenty dollar ($20.00) deductible for materials. The County will fully pay the monthly premium for the employee and dependents and pick up inflationary costs during the term of the Agreement.

  • Health Care Committee A Health Insurance Committee shall be established and maintained with at least three (3) representatives appointed by the Association and three (3) representatives appointed by the Superintendent. The purpose of the Committee shall be to make recommendations designed to optimize the quality of health care available to District employees and improve cost effectiveness of the health insurance program. Committee members shall review data, work with the District insurance consultant, collaborate on making recommendations for changes in plan design, review bids by insurance companies, and ultimately consider recommending plan changes to their respective constituencies. The Committee is not empowered to unilaterally make changes in health care benefits without ratification by the Association and approval by the Board. The creation of the Committee does not diminish or in any way reduce the Board’s and Association’s rights or responsibilities.

  • 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:

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