Common use of HOSPITAL AND MEDICAL INSURANCE AND SUPPLEMENTAL BENEFITS Clause in Contracts

HOSPITAL AND MEDICAL INSURANCE AND SUPPLEMENTAL BENEFITS. Section 1. Eligible full-time COACHES shall be provided an annual opportunity to make health plan enrollment changes. Eligible COACHES shall be those determined by the health plans in accordance with the eligibility provisions of the State System of Higher Education Group Health Program (SSHEGHP). The choice among plans shall be operated as follows: A. The option to elect the coverage in a plan shall be made available to those eligible full-time COACHES who reside within the service area of the plan. B. The amount and kind of benefits available to eligible full-time COACHES shall be those offered by the plan and contracted for by the STATE SYSTEM. C. The option to elect coverage under a plan shall be available during annual open enrollment periods designated by the STATE SYSTEM and the plans. Eligible Regular full-time COACHES who move into a plan’s service area may choose from available plans. Eligible Regular full-time COACHES who leave the service area or who are dissatisfied with an HMO may elect coverage in the PPO (plan design as referenced at subsection 1.F of this Article). D. Effective January 1, 2017, the current Health Maintenance Organization (HMO) plan will be closed to new enrollments. E. The UPMC HMO will remain in place for COACHES enrolled in the plan prior to January 1, 2017, but will be modified effective July 1, 2017 to have the same plan design features as those in effect for the PPO plan, including member deductibles and copays. F. The STATE SYSTEM will offer a Preferred Provider Organization (PPO) plan. The plan design for the PPO shall be as referenced in Appendix G. A. The STATE SYSTEM shall provide dependency coverage where the dependents, spouses/domestic partners and children, of the eligible Regular full-time COACH qualify under such plan. B. Spouse/Domestic Partner Coverage: Effective for COACHES hired on or after July 1, 2013, if a COACH wishes to enroll their spouse or domestic partner in a STATE SYSTEM health plan, and that spouse or partner is eligible for coverage under their own employer’s plan, the spouse/partner shall be required to enroll in that other employer’s plan (which shall be their primary coverage), as a condition of eligibility for secondary coverage under the STATE SYSTEM plan, without regard to the amount of the cost-sharing required under the spouse/partner’s plan, and without regard to any incentive the spouse/partner’s plan may offer to the spouse/partner not to enroll. In the event that the spouse/partner loses coverage through their employer, the spouse/partner’s coverage under the STATE SYSTEM plan shall immediately become primary. Section 3. The STATE SYSTEM shall continue to provide each Regular part-time COACH who is expected to be in an active pay status at least fifty percent (50%) of the time every pay period in their service period with fifty percent (50%) STATE SYSTEM paid coverage under the PPO plan. In addition, it shall provide fifty percent (50%) STATE SYSTEM paid dependency coverage where the dependents, spouses/domestic partners and children, of the Regular part-time COACH qualify under such plan. Eligible Regular part-time COACHES shall contribute fifty percent (50%) of the STATE SYSTEM’s cost of coverage for the type of contract for the health and prescription drug plan selected by each Regular part-time COACH in addition to the percentage of salary contribution required under Section 6.A. Section 4. The STATE SYSTEM shall provide prescription drug coverage for all of the SSHEGHP plans through a prescription drug card. The prescription drug coverage shall include: A. A three-tier open formulary with retail co-payments of $10 for generic, $30 for brand formulary, and $50 for brand non-formulary drugs for up to a thirty (30) day supply. B. Co-payments for mail order prescriptions of two times the retail co-payments set forth in A. above for up to a ninety (90) day supply. C. There shall be no deductible for prescription coverage. D. If a physician prescribes a brand name drug and indicates no substitution, then the COACH will not pay the difference between that drug and the generic drug. However, if a COACH chooses a brand name drug when their physician has indicated that substitution of a generic drug is acceptable, the COACH must pay the difference in the cost between the brand name drug and the generic drug. E. Effective July 1, 2017, the STATE SYSTEM will implement prescription drug clinical management programs [Managed RX Coverage Program (MRxC), including step edits, and expansion of Managed Prior Authorization Program] to encourage cost-effective utilization. F. Effective July 1, 2017, the STATE SYSTEM will establish a mandatory Specialty Pharmacy Vendor program. COACHES and their enrolled dependents who need to obtain specialty medications must purchase those medications from the designated Specialty Pharmacy Vendor to receive the in-network benefit. A. Regular full-time and Regular part-time COACHES who are granted leave with or without pay will continue to receive benefits as described in accordance with Article 9, Sections 2., 4., 5., or 13.F.1., as applicable. Medical and prescription benefits will continue provided that the required contribution is paid while on leave. The STATE SYSTEM shall continue to pay the entire premium for supplemental benefits under the Management Benefits Program. B. Regular part-time COACHES and Regular full-time COACHES who are placed on suspension or who are granted leave without pay for longer than one (1) full pay period, for any reason other than leave under Article 9, Section 2., 4., 5., or 13., as applicable, will be permitted to continue coverage under COBRA provisions or on a direct pay basis. C. Medical, prescription and supplemental benefits shall cease on the date a COACH terminates employment. For the purposes of this section, termination of employment does not include death. For surviving dependents, when the last day of employment falls between the first and the 14th of the month, coverage will end on the last day of that month. When the last day of employment falls between the 15th and the last day of the month, coverage will end on the 14th of the following month. Section 6.

HOSPITAL AND MEDICAL INSURANCE AND SUPPLEMENTAL BENEFITS. Section 1. Eligible full-time COACHES shall be provided an annual opportunity to make health plan enrollment changes. Eligible COACHES shall be those determined by the health plans in accordance with the eligibility provisions of the State System of Higher Education Group Health Program (SSHEGHP). The choice among plans shall be operated as follows: A. The option to elect the coverage in a plan shall be made available to those eligible full-time COACHES who reside within the service area of the plan. B. The amount and kind of benefits available to eligible full-time COACHES shall be those offered by the plan and contracted for by the STATE SYSTEM. C. The option to elect coverage under a plan shall be available during annual open enrollment periods designated by the STATE SYSTEM and the plans. Eligible Regular full-time COACHES who move into a plan’s service area may choose from available plans. Eligible Regular full-time COACHES who leave the service area or who are dissatisfied with an HMO may elect coverage in the PPO (plan design as referenced at subsection 1.F of this Article). D. Effective January 1, 2017, the current Health Maintenance Organization (HMO) plan will be closed to new enrollments. E. The UPMC HMO will remain in place for COACHES enrolled in the plan prior to January 1, 2017, but will be modified effective July 1, 2017 to have the same plan design features as those in effect for the PPO plan, including member deductibles and copays. F. The STATE SYSTEM will offer a Preferred Provider Organization (PPO) plan. The plan design for the PPO shall be as referenced in Appendix G. A. The STATE SYSTEM shall provide dependency coverage where the dependents, spouses/domestic partners and children, of the eligible Regular full-time COACH qualify under such plan. B. Spouse/Domestic Partner Coverage: Effective for COACHES hired on or after July 1, 2013, if a COACH wishes to enroll their spouse or domestic partner in a STATE SYSTEM health plan, and that spouse or partner is eligible for coverage under their own employer’s plan, the spouse/partner shall be required to enroll in that other employer’s plan (which shall be their primary coverage), as a condition of eligibility for secondary coverage under the STATE SYSTEM plan, without regard to the amount of the cost-sharing required under the spouse/partner’s plan, and without regard to any incentive the spouse/partner’s plan may offer to the spouse/partner not to enroll. In the event that the spouse/partner loses coverage through their employer, the spouse/partner’s coverage under the STATE SYSTEM plan shall immediately become primary. Section 3. The STATE SYSTEM shall continue to provide each Regular part-time COACH who is expected to be in an active pay status at least fifty percent (50%) of the time every pay period in their service period with fifty percent (50%) STATE SYSTEM paid coverage under the PPO plan. In addition, it shall provide fifty percent (50%) STATE SYSTEM paid dependency coverage where the dependents, spouses/domestic partners and children, of the Regular part-time COACH qualify under such plan. Eligible Regular part-time COACHES shall contribute fifty percent (50%) of the STATE SYSTEM’s cost of coverage for the type of contract for the health and prescription drug plan selected by each Regular part-time COACH in addition to the percentage of salary contribution required under Section 6.A. Section 4. The STATE SYSTEM shall provide prescription drug coverage for all of the SSHEGHP plans through a prescription drug card. The prescription drug coverage shall include: A. A three-tier open formulary with retail co-payments of $10 for generic, $30 for brand formulary, and $50 for brand non-formulary drugs for up to a thirty (30) day supply. B. Co-payments for mail order prescriptions of two times the retail co-payments set forth in A. above for up to a ninety (90) day supply. C. There shall be no deductible for prescription coverage. D. If X. Xx a physician prescribes a brand name drug and indicates no substitution, then the COACH will not pay the difference between that drug and the generic drug. However, if a COACH chooses a brand name drug when their physician has indicated that substitution of a generic drug is acceptable, the COACH must pay the difference in the cost between the brand name drug and the generic drug. E. Effective July 1, 2017, the STATE SYSTEM will implement prescription drug clinical management programs [Managed RX Coverage Program (MRxC), including step edits, and expansion of Managed Prior Authorization Program] to encourage cost-effective utilization. F. Effective July 1, 2017, the STATE SYSTEM will establish a mandatory Specialty Pharmacy Vendor program. COACHES and their enrolled dependents who need to obtain specialty medications must purchase those medications from the designated Specialty Pharmacy Vendor to receive the in-network benefit. A. Regular full-time and Regular part-time COACHES who are granted leave with or without pay will continue to receive benefits as described in accordance with Article 9, Sections 2., 4., 5., or 13.F.1., as applicable. Medical and prescription benefits will continue provided that the required contribution is paid while on leave. The STATE SYSTEM shall continue to pay the entire premium for supplemental benefits under the Management Benefits Program. B. Regular part-time COACHES and Regular full-time COACHES who are placed on suspension or who are granted leave without pay for longer than one (1) full pay period, for any reason other than leave under Article 9, Section 2., 4., 5., or 13., as applicable, will be permitted to continue coverage under COBRA provisions or on a direct pay basis. C. Medical, prescription and supplemental benefits shall cease on the date a COACH terminates employment. For the purposes of this section, termination of employment does not include death. For surviving dependents, when the last day of employment falls between the first and the 14th of the month, coverage will end on the last day of that month. When the last day of employment falls between the 15th and the last day of the month, coverage will end on the 14th of the following month. Section 6.

HOSPITAL AND MEDICAL INSURANCE AND SUPPLEMENTAL BENEFITS. Section 1. Eligible full-time COACHES shall be provided an annual opportunity to make health plan enrollment changes. Eligible COACHES shall be those determined by the health plans in accordance with the eligibility provisions of the State System of Higher Education Group Health Program (SSHEGHP). The choice among plans shall be operated as follows: A. The option to elect the coverage in a plan shall be made available to those eligible full-time COACHES who reside within the service area of the plan. B. The amount and kind of benefits available to eligible full-time COACHES shall be those offered by the plan and contracted for by the STATE SYSTEM. C. The option to elect coverage under a plan shall be available during annual open enrollment periods designated by the STATE SYSTEM and the plans. Eligible Regular full-time COACHES who move into a plan’s service area may choose from available plans. Eligible Regular full-time COACHES who leave the service area or who are dissatisfied with an HMO may elect coverage in the PPO (plan design as referenced at subsection 1.F of this Article). D. Effective January 1, 2017, the current Health Maintenance Organization (HMO) plan will be closed to new enrollments. E. The UPMC HMO will remain in place for COACHES enrolled in the plan prior to January 1, 2017, but will be modified effective July 1, 2017 to have the same plan design features as those in effect for the PPO plan, including member deductibles and copays. F. The STATE SYSTEM will offer a Preferred Provider Organization (PPO) plan. The plan design for the PPO shall be as referenced in Appendix G. A. The STATE SYSTEM shall provide dependency coverage where the dependents, spouses/domestic partners and children, of the eligible Regular full-time COACH qualify under such plan. B. Spouse/Domestic Partner Coverage: Effective for COACHES hired on or after July 1, 2013, if a COACH wishes to enroll their his or her spouse or domestic partner in a STATE SYSTEM health plan, and that spouse or partner is eligible for coverage under their his or her own employer’s plan, the spouse/partner shall be required to enroll in that other employer’s plan (which shall be their his or her primary coverage), as a condition of eligibility for secondary coverage under the STATE SYSTEM plan, without regard to the amount of the cost-sharing required under the spouse/partner’s plan, and without regard to any incentive the spouse/partner’s plan may offer to the spouse/partner not to enroll. In the event that the spouse/partner loses coverage through their employer, the spouse/partner’s coverage under the STATE SYSTEM plan shall immediately become primary. Section 3. The STATE SYSTEM shall continue to provide each Regular part-time COACH who is expected to be in an active pay status at least fifty percent (50%) of the time every pay period in their service period with fifty percent (50%) STATE SYSTEM paid coverage under the PPO plan. In addition, it shall provide fifty percent (50%) STATE SYSTEM paid dependency coverage where the dependents, spouses/domestic partners and children, of the Regular part-time COACH qualify under such plan. Eligible Regular part-time COACHES shall contribute fifty percent (50%) of the STATE SYSTEM’s cost of coverage for the type of contract for the health and prescription drug plan selected by each Regular part-time COACH in addition to the percentage of salary contribution required under Section 6.A. Section 4. The STATE SYSTEM shall provide prescription drug coverage for all of the SSHEGHP plans through a prescription drug card. The prescription drug coverage shall include: A. A three-tier open formulary with retail co-payments of $10 for generic, $30 for brand formulary, and $50 for brand non-formulary drugs for up to a thirty (30) day supply. B. Co-payments for mail order prescriptions of two times the retail co-payments set forth in A. above for up to a ninety (90) day supply. C. There shall be no deductible for prescription coverage. D. If a physician prescribes a brand name drug and indicates no substitution, then the COACH will not pay the difference between that drug and the generic drug. However, if a COACH chooses a brand name drug when their physician has indicated that substitution of a generic drug is acceptable, the COACH must pay the difference in the cost between the brand name drug and the generic drug. E. Effective July 1, 2017, the STATE SYSTEM will implement prescription drug clinical management programs [Managed RX Coverage Program (MRxC), including step edits, and expansion of Managed Prior Authorization Program] to encourage cost-effective utilization. F. Effective July 1, 2017, the STATE SYSTEM will establish a mandatory Specialty Pharmacy Vendor program. COACHES and their enrolled dependents who need to obtain specialty medications must purchase those medications from the designated Specialty Pharmacy Vendor to receive the in-network benefit. A. Regular full-time and Regular part-time COACHES who are granted leave with or without pay will continue to receive benefits as described in accordance with Article 9, Sections 2., 4., 5., or 13.F.1., as applicable. Medical and prescription benefits will continue provided that the required contribution is paid while on leave. The STATE SYSTEM shall continue to pay the entire premium for supplemental benefits under the Management Benefits Program. B. Regular part-time COACHES and Regular full-time COACHES who are placed on suspension or who are granted leave without pay for longer than one (1) full pay period, for any reason other than leave under Article 9, Section 2., 4., 5., or 13., as applicable, will be permitted to continue coverage under COBRA provisions or on a direct pay basis. C. Medical, prescription and supplemental benefits shall cease on the date a COACH terminates employment. For the purposes of this section, termination of employment does not include death. For surviving dependents, when the last day of employment falls between the first and the 14th of the month, coverage will end on the last day of that month. When the last day of employment falls between the 15th and the last day of the month, coverage will end on the 14th of the following month. Section 6.

HOSPITAL AND MEDICAL INSURANCE AND SUPPLEMENTAL BENEFITS. Section 1. Eligible full-time COACHES shall be provided an annual opportunity to make health plan enrollment changes. Eligible COACHES shall be those determined by the health plans in accordance with the eligibility provisions of the State System of Higher Education Group Health Program (SSHEGHP). The choice among plans shall be operated as follows: A. The option to elect the coverage in a plan shall be made available to those eligible full-time COACHES who reside within the service area of the plan. B. The amount and kind of benefits available to eligible full-time COACHES shall be those offered by the plan and contracted for by the STATE SYSTEM. C. The option to elect coverage under a plan shall be available during annual open enrollment periods designated by the STATE SYSTEM and the plans. Eligible Regular full-time COACHES who move into a plan’s service area may choose from available plans. Eligible Regular full-time COACHES who leave the service area or who are dissatisfied with an HMO may elect coverage in the PPO (plan design as referenced at subsection 1.F of this Article). D. Effective January 1, 2017, the current Health Maintenance Organization (HMO) plan plans will be closed to new enrollments. E. Effective July 1, 2017, the Keystone East HMO, the Keystone Central HMO and the Xxxxxxxxx HMO plans will be eliminated. COACHES enrolled in those HMO plans will be enrolled in the PPO plan unless they choose to waive coverage. The UPMC HMO will remain in place for COACHES enrolled in the plan prior to January 1, 2017, but will be modified effective July 1, 2017 to have the same plan design features as those in effect for the PPO plan, including member deductibles and copays. The indemnity plan for active COACHES was terminated effective July 1, 2015. F. The STATE SYSTEM State System will offer a Preferred Provider Organization (PPO) plan. The plan design for the PPO shall be as referenced in the Memorandum of Agreement of February 6, 2004, except as follows: (a) effective July 1, 2013, the office visit copay for specialists shall be increased from $15 to $25; and (b) effective July 1, 2013, the copay for an emergency room visit shall be increased from $50 to $100 (waived if admitted). Effective January 1, 2017, the PPO plan design will be modified as described in Appendix G.1. A. The STATE SYSTEM shall provide dependency coverage where the dependents, spouses/domestic partners and children, of the eligible Regular full-time COACH qualify under such plan. B. Spouse/Domestic Partner Coverage: Effective for COACHES hired on or after July 1, 2013, if a COACH wishes to enroll their his or her spouse or domestic partner in a STATE SYSTEM health plan, and that spouse or partner is eligible for coverage under their his or her own employer’s plan, the spouse/partner shall be required to enroll in that other employer’s plan (which shall be their his or her primary coverage), as a condition of eligibility for secondary coverage under the STATE SYSTEM plan, without regard to the amount of the cost-sharing required under the spouse/partner’s plan, and without regard to any incentive the spouse/partner’s plan may offer to the spouse/partner not to enroll. In the event that the spouse/partner loses coverage through their his/her employer, the spouse/partner’s coverage under the STATE SYSTEM plan shall immediately become primary. Section 3. The STATE SYSTEM State System shall continue to provide each Regular part-time COACH who is expected to be in an active pay status at least fifty percent (50%) of the time every pay period in their his/her service period with fifty percent (50%) STATE SYSTEM State System paid coverage under the PPO plan. In addition, it shall provide fifty percent (50%) STATE SYSTEM State System paid dependency coverage where the dependents, spouses/domestic partners and children, of the Regular part-time COACH qualify under such plan. Eligible Regular part-time COACHES shall contribute fifty percent (50%) of the STATE SYSTEMState System’s cost of coverage for the type of contract for the health and prescription drug plan selected by each Regular part-time COACH in addition to the percentage of salary contribution required under Section 6.A. Section 4. The STATE SYSTEM shall provide prescription drug coverage for all of the SSHEGHP plans through a prescription drug card. The prescription drug coverage shall include: A. A three-tier open formulary with retail co-payments of $5 for generic, $18 for brand formulary, and $36 for brand non-formulary drugs for up to a thirty (30) day supply. Effective January 1, 2017, these retail co-payments shall be increased to $10 for generic, $30 for brand formulary, and $50 for brand non-formulary drugs for up to a thirty (30) day supply. B. Co-payments for mail order prescriptions of two times the retail co-co- payments set forth in A. above for up to a ninety (90) day supply. C. There shall be no deductible for prescription coverage. D. If a physician prescribes a brand name drug and indicates no substitution, then the COACH will not pay the difference between that drug and the generic drug. However, if a COACH chooses a brand name drug when their his/her physician has indicated that substitution of a generic drug is acceptable, the COACH must pay the difference in the cost between the brand name drug and the generic drug. E. Effective July 1, 2017, the STATE SYSTEM will implement prescription drug clinical management programs [Managed RX Coverage Program (MRxC), including step edits, and expansion of Managed Prior Authorization Program] to encourage cost-effective utilization. F. Effective July 1, 2017, the STATE SYSTEM will establish a mandatory Specialty Pharmacy Vendor program. COACHES and their enrolled dependents who need to obtain specialty medications must purchase those medications from the designated Specialty Pharmacy Vendor to receive the in-network benefit. A. Regular full-time and Regular part-time COACHES who are granted leave with or without pay due to sickness or parental leave will continue to receive medical and prescription benefits as described in accordance with Article 9, Sections 2., 4., 5., or 13.F.1., as applicableunder the State System of Higher Education Group Health Plan (SSHEGHP) and supplemental benefits under the Management Benefits Program for up to six (6) months. Regular full-time and Regular part-time COACHES who are granted family care leave will continue to receive medical and prescription benefits and supplemental benefits under the Management Benefits Program for up to twelve (12) weeks. Medical and prescription benefits will continue provided that the required contribution is paid while on leave. If the Regular full- time and Regular part-time COACH does not pay their share of the premium, coverage will be cancelled and they will be permitted to continue coverage under COBRA provisions or on a direct pay basis. The STATE SYSTEM State System shall continue to pay the entire premium for supplemental benefits under the Management Benefits Program. B. Regular part-time COACHES and Regular full-time COACHES who are placed on suspension or who are granted leave without pay for any reason other than for sickness, parental, or family care leave for longer than one (1) full pay period, for any reason other or who are on leave without pay due to sickness or parental leave, longer than leave under Article 9, Section 2., 4., 5.six (6) months, or 13., as applicable, family care leave longer than twelve (12) weeks will be permitted to continue coverage under COBRA provisions or on a direct pay basis. C. Medical, prescription and supplemental benefits shall cease on the date a COACH terminates employment. For the purposes of this section, termination of employment does not include death. For surviving dependents, when the last day of employment falls between the first and the 14th of the month, coverage will end on the last day of that month. When the last day of employment falls between the 15th and the last day of the month, coverage will end on the 14th of the following month. Section 6.

HOSPITAL AND MEDICAL INSURANCE AND SUPPLEMENTAL BENEFITS. Section 1. Eligible The State System shall provide each eligible Regular full-time COACHES shall be provided an annual opportunity to make health COACH a choice annually between enrollment in a Health Maintenance Organization (HMO) plan enrollment changesor a Preferred Provider Organization (PPO) plan (plan design as referenced in the Memorandum of Agreement of February 6, 2004). Eligible COACHES shall be those determined by the health plans in accordance with the eligibility provisions of the State System of Higher Education Group Health Program (SSHEGHP). The choice among plans shall be operated as follows: A. The option to elect the coverage in a plan shall be made available to those eligible full-time COACHES who reside within the service area of the plan. B. The amount and kind of benefits available to eligible full-time COACHES shall be those offered by the plan and contracted for by the STATE SYSTEM. C. The option to elect coverage under a plan shall be available during annual open enrollment periods designated by the STATE SYSTEM and the plans. Eligible Regular full-time COACHES who move into a plan’s service area may choose from available plans. Eligible Regular full-time COACHES who leave the service area or who are dissatisfied with an HMO may elect coverage in the PPO (plan design as referenced at subsection 1.F of this Article)or another available plan. D. Effective January July 1, 20172007, the current Health Maintenance Organization (HMO) indemnity plan will be closed to new enrollments. E. The UPMC HMO will remain in place for . Only eligible COACHES enrolled in the indemnity plan prior on July 1, 2007, may continue to participate in the plan. Provisions regarding the indemnity plan are set forth in Appendix G. E. An open enrollment period shall be scheduled for eligible COACHES enrolled in the indemnity plan on July 1, 2007, for a two (2) week period in November 2007 with enrollment selections to be effective January 1, 20172008. If a COACH eligible to participate in the open enrollment does not specifically reselect the indemnity plan, but will be modified effective July 1, 2017 to have the same plan design features as those in effect for he/she shall default into the PPO plan, including member deductibles and copays. F. The During the term of this Agreement, the STATE SYSTEM will offer a Preferred Provider Organization consumer driven health plan option (PPOhigh deductible health plan and health savings account) planto eligible COACHES. The consumer driven health plan design for the PPO option shall be as referenced in Appendix G.developed and recommended by the Health Care Cost Containment Committee. A. Section 2. The STATE SYSTEM shall provide dependency coverage where the dependents, spouses/domestic partners and children, of the eligible Regular full-time COACH qualify under such plan. B. Spouse/Domestic Partner Coverage: Effective for COACHES hired on or after July 1, 2013, if a COACH wishes to enroll their spouse or domestic partner in a STATE SYSTEM health plan, and that spouse or partner is eligible for coverage under their own employer’s plan, the spouse/partner shall be required to enroll in that other employer’s plan (which shall be their primary coverage), as a condition of eligibility for secondary coverage under the STATE SYSTEM plan, without regard to the amount of the cost-sharing required under the spouse/partner’s plan, and without regard to any incentive the spouse/partner’s plan may offer to the spouse/partner not to enroll. In the event that the spouse/partner loses coverage through their employer, the spouse/partner’s coverage under the STATE SYSTEM plan shall immediately become primaryplans. Section 3. The STATE SYSTEM State System shall continue to provide each Regular part-time COACH who is expected to be in an active pay status at least fifty percent (50%) of the time every pay period in their his/her service period with fifty percent (50%) STATE SYSTEM State System paid coverage under the indemnity plan, consistent with Section 1.D, or PPO plan. In addition, it shall provide fifty percent (50%) STATE SYSTEM State System paid dependency coverage where the dependents, spouses/domestic partners and children, of the Regular part-time COACH qualify under such plan. Eligible Regular part-time COACHES shall contribute fifty percent (50%) of the STATE SYSTEMState System’s cost of coverage for the type of contract for the health and prescription drug plan selected by each Regular part-part- time COACH in addition to the percentage of salary contribution required under Section 6.A. Section 4. The STATE SYSTEM shall provide prescription drug coverage for all of the SSHEGHP plans through a prescription drug card. The prescription drug coverage shall include: A. A three-tier open formulary with retail co-payments of $10 5 for generic, $30 10 for brand formulary, and $50 20 for brand non-formulary drugs for up to a thirty (30) day supply. Effective January 1, 2008, these co-payments shall change to $0 for generic, $15 for brand formulary, and $30 for brand non-formulary. B. Co-payments for mail order prescriptions of two times the retail co-payments set forth in A. A above for up to a ninety (90) day supply. C. There A deductible for all prescription coverage (total retail and mail order) of $100 per person / $300 per family maximum per calendar year. Effective January 1, 2008, these deductibles shall be no deductible for prescription coverageeliminated. D. If a physician prescribes a brand name drug and indicates no substitution, then the COACH will not pay the difference between that drug and the generic drug. However, if a COACH chooses a brand name drug when their his/her physician has indicated that substitution of a generic drug is acceptable, the COACH must pay the difference in the cost between the brand name drug and the generic drug. E. Effective July 1, 2017, the STATE SYSTEM will implement prescription drug clinical management programs [Managed RX Coverage Program (MRxC), including step edits, and expansion of Managed Prior Authorization Program] to encourage cost-effective utilization. F. Effective July 1, 2017, the STATE SYSTEM will establish a mandatory Specialty Pharmacy Vendor program. COACHES and their enrolled dependents who need to obtain specialty medications must purchase those medications from the designated Specialty Pharmacy Vendor to receive the in-network benefit. A. Regular full-time and Regular part-time COACHES who are granted leave with or without pay due to sickness or parental leave will continue to receive medical and prescription benefits as described in accordance with Article 9, Sections 2., 4., 5., or 13.F.1., as applicableunder the State System of Higher Education Group Health Plan (SSHEGHP) and supplemental benefits under the Management Benefits Program for up to six (6) months. Regular full-time and Regular part-time COACHES who are granted family care leave will continue to receive medical and prescription benefits and supplemental benefits under the Management Benefits Program for up to twelve (12) weeks. Medical and prescription benefits will continue provided that the required contribution is paid while on leave. If the Regular full- time and Regular part-time COACH does not pay their share of the premium, coverage will be cancelled and they will be permitted to continue coverage under COBRA provisions or on a direct pay basis. The STATE SYSTEM State System shall continue to pay the entire premium for supplemental benefits under the Management Benefits Program. B. Regular part-time COACHES and Regular full-time COACHES who are placed on suspension or who are granted leave without pay for any reason other than for sickness, parental, or family care leave for longer than one (1) full pay period, for any reason other or who are on leave without pay due to sickness or parental leave, longer than leave under Article 9, Section 2., 4., 5.six (6) months, or 13., as applicable, family care leave longer than twelve (12) weeks will be permitted to continue coverage under COBRA provisions or on a direct pay basis. C. Medical, prescription and supplemental benefits shall cease on the date a COACH terminates employment. For the purposes of this section, termination of employment does not include death. For surviving dependents, when the last day of employment falls between the first and the 14th of the month, coverage will end on the last day of that month. When the last day of employment falls between the 15th and the last day of the month, coverage will end on the 14th of the following month. Section 6.