Common use of Health Maintenance Organizations Clause in Contracts

Health Maintenance Organizations. The University offers multiple HMO Plans. All HMOs will offer two (2) levels of benefits – Enhanced and Standard. The chart below contains the key features of all HMOs. A detailed description, including how members will qualify for the Enhanced or Standard coverage, will be provided in the annual open enrollment materials that are distributed to each member. Enhanced Standard Deductible (Single/Family) $0 $200/$400 Co-Insurance N/A 80%/20% Out of Pocket Max (including deductible) N/A $2,200/$4,400 Office/Urgent Care Co-Pay $20 $30 Prescription Co-Pay Generic $7 $10 Preferred Brand Name $15 $20 Non-Preferred Brand Name $30 $50 Note: the Standard Prescription Co-Pays for Priority Health are $7/$15/$30 Information about Plan benefits, plan design and open enrollment materials may be obtained from the University’s Benefit and Compensation Services Office and will be provided by the medical carriers. All benefits of the HMO plans are subject to specific HMO policy provisions and the Group Operating Agreements between Oakland University and the HMO. 199. Medical Insurance Opt Out. Employees who are covered by another health insurance plan shall have the option to decline health insurance coverage from the University. Employees who elect to opt out of the health insurance coverage shall be paid $1,000 per year by the University. A signed waiver form must be completed and submitted to the Benefit and Compensation Services Office every year during open enrollment to be eligible for the opt out payment. Employees who are hired after January 1 or who experience a life-altering event may elect payment in lieu of enrollment, but will be paid on a prorated basis. An employee must provide proof of other health insurance prior to being authorized to opt out and receive payment.

Health Maintenance Organizations. The University offers multiple three HMO Plans. All three (3) HMOs will offer two (2) levels of benefits – Enhanced and Standard. The chart below contains the key features of all three (3) HMOs. A detailed description, including how members will qualify for the Enhanced or Standard coverage, will be provided in the annual open enrollment materials that are distributed to each member. Enhanced Standard Deductible (Single/Family) $0 $200/$400 Co-Insurance N/A 80%/20% Out of Pocket Max (including deductible) N/A $2,200/$4,400 Office/Urgent Care Co-Pay $20 $30 Prescription Co-Pay Generic $7 $10 Preferred Brand Name $15 $20 Non-Preferred Brand Name $30 $50 Note: the Standard Prescription Co-Pays for Priority Health are $7/$15/$30 Information about Plan benefits, plan design and open enrollment materials may be obtained from the University’s Benefit and Compensation Services Office and will be provided by the medical carriers. All benefits of the HMO plans are subject to specific HMO policy provisions and the Group Operating Agreements between Oakland University and the HMO. 199202. Medical Insurance Opt Out. Employees who are covered by another health insurance plan shall have the option to decline health insurance coverage from the University. Employees who elect to opt out of the health insurance coverage shall be paid $1,000 per year by the University. A signed waiver form must be completed and submitted to the Benefit and Compensation Services Office every year during open enrollment to be eligible for the opt out payment. Employees who are hired after January 1 or who experience a life-altering event may elect payment in lieu of enrollment, but will be paid on a prorated basis. An employee must provide proof of other health insurance prior to being authorized to opt out and receive payment.