Hold Harmless/Change in Healthcare Insurer. In the event the Committee elects to change healthcare insurance coverage as provided herein, it shall reimburse a covered individual whose primary care physician does not participate in the network of the selected healthcare insurer for any out-of-network costs incurred for services provided in the subscriber agreement. For purposes of this article, the term primary care physician shall include the following categories: 1. internal medicine; 2. family practice; 3. general practice; 4. pediatrics; and 5. obstetrics and gynecology/primary care. For purposes of this article, a covered individual must have a relationship with a primary care physician at least thirty (30) days before the date the Committee changes health insurance coverage to qualify for Committee reimbursement. In addition, the Committee shall reimburse a covered individual for out-of-network costs incurred for treatment provided by a physician and/or other healthcare service provider (e.g. counselor) with whom ongoing treatment had been initiated at least thirty (30) days prior to the date the Committee changes health insurance coverage. A “relationship” with either a primary physician or specialists shall be sufficiently demonstrated by (1) prior or current treatment by the same individual (2) a referral from the member or covered family member’s current primary physician, or (3) an appointment scheduled with the physician or specialist in question. The reimbursement obligations of the Committee as set forth above are expressly limited to a period of twelve (12) months.
Appears in 4 contracts
Samples: Collective Bargaining Agreement, Collective Bargaining Agreement, Collective Bargaining Agreement
