Health Insurance Plan Design Sample Clauses

Health Insurance Plan Design. For the period beginning January 1, 2013 and expiring on June 30, 2016, the plan design for the Network Blue New England Deductible includes the following: • The $1,000/$2,000 deductible does not apply to prescription drug benefits, emergency room visits, doctors’ office visits and other services as described below. • The out of pocket maximum is $2,000 per individual per plan year and $4,000 per family per plan year. This includes all deductible costs and co-pays that are more than $100 and it does not include prescription drug co-pays • There is not any overall benefit maximum • Routine adult physical exams and tests-$0 co-pay • Preventive dental pediatric care-$0 co-pay (one visit every six months) • Routine colonoscopy-$0 co-pay • Routine GYN exams-$0 co-pay • Family planning-$0 co-pay • Maternity services, inpatient-no cost after deductible • Maternity services, outpatient-$20 co-pay • Well newborn inpatient care- no cost after deductible • Infertility services-inpatient services -no cost after deductible • Infertility office or health center medical care services and surgery-$20 co-pay (deductible does not apply) • Routine hearing exams and tests-$0 co-pay • Routine vision care-$0 co-pay (one every twenty-four months) • Ambulance services-$0 co-pay • Home health care-$0 co-pay • Hospice services-$0 co-pay • Mental health and substance abuse biologically based and non-biologically based inpatient services-$0 co-pay • Mental health and substance abuse biologically based and non-biologically based outpatient services-$20 co-pay (deductible does not apply) • Medical formulas-$0 co-pay ($5,000 benefit limit per member per year) • Oxygen and respiratory therapy-no cost after deductible • Prosthetic devices-no cost after deductible • Inpatient medical and surgical care in a general or chronic disease hospital-no cost after deductible • Inpatient care in a rehabilitation hospital (sixty days per calendar year)-no cost after deductible • Inpatient care in a skilled nursing facility (one hundred days per calendar year)-no cost after deductible • Cardiac rehabilitation-$20 co-pay after deductible • Chiropractor services diagnostic lab tests and x-rays-no cost after deductible • Chiropractor services outpatient medical care-$20 co-pay (deductible does not apply) • Dialysis services-outpatient-no cost after deductible • Dialysis services-home-$0 co-pay • Early intervention services-$0 co-pay • Emergency room services-$100 co-pay per visit (deductible does not app...
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Health Insurance Plan Design. The Town offers three health insurance plan options including a preferred provider organization (PPO) option, a health maintenance organization (HMO) option and a high deductible health plan (HDHP) option including a health savings account (HSA). Effective June 30, 2017 the PPO option will no longer be offered. The plan designs for these options shall be posted in Appendix C of this Agreement. The Town will also provide eligible family members coverage for any employee who elects such coverage. The Town reserves the right to change insurance carriers provided that coverage under new plans is equal to coverage presently in effect including access to health care providers, provided that the Union is notified of the proposed change at least thirty (30) days prior to implementation. There shall be a one-time special open enrollment period for thirty-one (31) days to give eligible employees the opportunity to consider all three plan options and to be held as soon as practicable following implementation of this Agreement.
Sample 1
Health Insurance Plan Design. The Town offers two health insurance plan options including a health maintenance organization (HMO) option and a high deductible health plan (HDHP) option including a health savings account (HSA). The plan designs for these options shall be posted in Appendix C of this Agreement. The Town will also provide eligible family members coverage for any employee who elects such coverage. The Town reserves the right to change health insurance carriers provided that coverage under new plans is substantially equivalent to and not overall less favorable to Employees to the coverage presently in effect including access to health care providers, and further provided that the Union is notified of the proposed change at least thirty (30) days prior to implementation.
Sample 1
Health Insurance Plan Design. The Town offers two health insurance plan options including a health maintenance organization (HMO) option and a high deductible health plan (HDHP) option including a health savings account (HSA).
Sample 1
Health Insurance Plan Design. (A) Effective January 1, 2015, employees will have the choice between a point of service plan (the “Co-Pay Plan”), and a high deductible major medical plan with a health savings account (the “HSA Plan”). Employees may elect to move from plan to plan during subsequent open enrollment periods. (1) For all employees who elect the HSA Plan, the COUNTY will deposit an amount equivalent to the annual deductible, based on their enrollment as individual or family, into the employee’s health savings account within the first five (5) business days following January 1, 2015. (2) For all employees who elect the HSA Plan, the COUNTY will deposit an amount equivalent to the annual deductible, based on their enrollment as individual or family, into the employee’s health savings account within the first five (5) business days following January 1, 2016. (3) For all employees who elect the HSA Plan, the COUNTY will deposit an amount equivalent to the annual deductible, based on their enrollment as individual or family, into the employee’s health savings account within the first five (5) business days following January 1, 2017. (B) Opt Out (1) For the plan years January 1, 2014 to December 31, 2017, the COUNTY will offer an “opt out” provision for employees who determine that they do not require medical and vision insurance coverage through the County plans. (2) The monthly amount that an employee would receive is $350.00 in lieu of medical and vision insurance coverage. (3) The employee will be required to provide proof of other coverage at the time of the declination of County medical and vision insurance, and is required to have continuous medical coverage.
Sample 1

Related to Health Insurance Plan Design

  • Health Insurance The Couple agrees that: (check one)

  • Retiree Health Insurance Retired members of the Department receiving, or to receive City of Lincoln monthly pension checks, may participate in the group comprehensive health care plan for active City employees, provided that each retiree so desiring will execute the required forms in a timely fashion, and further provided that each retiree will be required to pay the full monthly cost at the current rates subject to any rate increases which may occur from time to time. Such payment will be made by payroll deduction from pension checks, or by direct payment in the case of an early retiree.

  • Health Insurance Benefits To the extent provided by the federal COBRA law or, if applicable, state insurance laws, and by the Company’s current group health insurance policies, Executive will be eligible to continue Executive’s group health insurance benefits at Executive’s own expense. If Executive timely elects continued coverage under COBRA, the Company shall pay Executive’s COBRA premiums, and any applicable Company COBRA premiums, necessary to continue Executive’s then-current coverage for a period of 12 months after the date of Executive’s termination of employment; provided, however, that any such payments will cease if Executive voluntarily enrolls in a health insurance plan offered by another employer or entity during the period in which the Company is paying such premiums. Executive agrees to immediately notify the Company in writing of any such enrollment. Notwithstanding the foregoing, if the Company determines, in its sole discretion, that it cannot provide the foregoing benefit without potentially incurring financial costs or penalties under applicable law (including, without limitation, Section 2716 of the Public Health Service Act), the Company shall in lieu thereof provide to Executive a taxable monthly amount to continue his group health insurance coverage in effect on the date of separation from service (which amount shall be based on the premium for the first month of COBRA coverage), which payments shall be made regardless of whether Executive elects COBRA continuation coverage and shall commence in the month following the month in which Executive incurs a separation from service and shall end on the earlier of (x) the date on which Executive voluntarily enrolls in a health insurance plan offered by another employer or entity during the period in which the Company is paying such amounts and (y) 12 months after the date of Executive’s separation from service.

  • Group Health Insurance The Employer shall provide a comprehensive health care insurance program for all permanent full-time and part-time employees. Health Plan characteristics and benefits shall be as provided in the Employer’s Agreement with the Ohio Civil Service Employees Association (hereinafter OCSEA). Regardless of the plan, employees will pay fifteen percent (15%) of the premium and the Employer will pay eighty-five percent (85%) of the premium; however for any alternative plans offered pursuant to the Agreement with OCSEA, the employees’ premium share will be determined by the Director of DAS, but will not exceed fifteen percent (15%) of the premium. The Employer’s premium share shall be paid on behalf of eligible employees as provided in the Employer’s Agreement with OCSEA. Employees who include a spouse as a dependent for healthcare coverage shall pay a surcharge as provided in the Employer’s Agreement with OCSEA. Eligibility provisions for employees enrolling in State provided health care plans shall remain the same as those in effect in the Employer’s Agreement with OCSEA. The Employer reserves the right to perform dependent eligibility audits upon recommendation of the Joint Health Care Committee. Health care costs paid on behalf of ineligible dependents will be subject to recovery. Deductibles, co-payments, and other plan design provisions for all benefit programs shall be the same as those prescribed in the Employer’s Agreement with OCSEA. Every year the Employer shall conduct an open enrollment period, at which time employees shall be able to enroll in a health plan, continue enrollment in their current plan, switch to another plan, subject to plan availability in their area, or waive coverage. The timing of the open enrollment period shall be established by the Director of the Department of Administrative Services (DAS), in consultation with the Joint Health Care Committee. Changes outside of open enrollment may only occur as prescribed in the Employer’s Agreement with OCSEA. Open Enrollment Fairs shall be held in accordance with Employer’s Agreement with OCSEA. There shall be established a Joint Health Care Committee composed of representatives of management, and of the various labor Unions representing State employees. The Committee shall meet regularly to monitor the operation of the State’s health care plans, and to make recommendations for the improvement of the plans and cost containment procedures. The Employer shall provide funding for dental, vision and the life benefits as described in Article 21 of the Employer’s Agreement with OCSEA and the Union’s Benefits Trust. Employee health insurance payments will be deducted from every paycheck. In the event an employee is receiving disability leave or Workers’ Compensation benefits, the Employer- policyholder shall continue, at no cost to the employee, the coverage of group health insurance for such employee for the period of such leave, but not beyond twelve (12) months. If the employee’s leave extends beyond twelve

  • 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.

  • Health Insurance Coverage (a) An employee who is laid off or separated from employment on or after July 1, 1994, under circumstances which entitle such employee to reemployment rights under this Article, other than pursuant to Section 23, may elect to continue membership in their health benefit plan, upon advance payment of the regular percentage contribution to the cost of the plan, during the first six

  • Health Plan An appropriately licensed entity that has entered into a contract with Subcontractor, either directly or indirectly, under which Subcontractor provides certain administrative services for Health Plan pursuant to the State Contract. For purposes of this Appendix, Health Plan refers to UnitedHealthcare Insurance Company.

  • Medical Plan ‌ Eligible employees and dependants shall be covered by the British Columbia Medical Services Plan or carrier approved by the British Columbia Medical Services Commission. The Employer shall pay one hundred percent (100%) of the premium. An eligible employee who wishes to have coverage for other than dependants may do so provided the Medical Plan is agreeable and the extra premium is paid by the employee through payroll deduction. Membership shall be a condition of employment for eligible employees who shall be enrolled for coverage following the completion of three (3) months’ employment or upon the initial date of employment for those employees with portable service as outlined in Article 14.12.

  • Group Insurance Plan The carriers, coverage, and terms and conditions of participation under the District’s Group Insurance Plan are subject to change in accordance with the applicable provisions of Title I, Division 4, Chapter 10 of the California Government Code (Section 3500 et seq.) (Xxxxxx‐Milias‐Xxxxx Act). a. The District contracts with CalPERS for health plan coverage for all regular and newly hired employees (eligibility to be defined by the “CalPERS health plan”). Booklets on the insurance plans will be available to all participants. b. Employees may choose from the available plans offered by CalPERS. Additional premiums will be borne by the employee through payroll deductions and paid to CalPERS by the District each month; and the additional cost for monthly premiums will be deducted evenly from the first and second payroll period of each month. To the extent allowed by law, the District will attempt to deduct the employee’s premium contribution from pre‐tax dollars.

  • Employee Assistance Plan The District will provide an Employee Assistance Plan (EAP) which allows each employee to refer themselves confidentially to the EAP provider. To protect confidentiality, any data which the provider transmits to the District shall be summary only. The Employee Assistance Plan will include individual and/or family counseling.

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