Hospital-Surgical. For the duration of this Agreement, the County shall provide a comprehensive hospital- surgical-major medical coverage policy and a $25 deductible dental plan. The County will continue to provide a Dental Maintenance Organization (currently Dental Associates) with a $2,200 annual cap, a $20 co-pay and a 50% split on orthodontia. Effective January 1, 2007, the Dental Associates annual cap will increase to $2,500 per eligible participant. Active employees will have the option of choosing one of two Network options, In-Network or Out- of-Network. Said option must be executed during the open enroll- ment period which will last for one month, from October 1 through October 31 of the current year.
A. All physician visits and all diagnostic lab, x-ray, CT scan, MRI, etc., subject to the following co-pay with a cap of 40 visits for single/ 60 visits for a family of two/ and 80 visits for a family of three or more: 2006 - $27.00 2007 - $29.00 2008 - $30.00 B. All in-patient and out-patient and ER visits subject to the following: In-Pat. $100 Out-Pat. $100 ER $100 Any admission or referral to a physician to schedule either In- or Out-Patient surgery within five days of an ER visit will not be subject to the In- or Out-Patient $100 deductible. Rx – Co-Pays Generic - $10.00* Formulary Brand - $22.00** Non-formulary Brand - $44.00** * includes 90 day supply ** two co-pays for 90 day supply DENTAL • Annual cap = $2,200 (increasing to $2,500 on 1/1/07) • No deductible • Co-pay = $20/visit • Orthodontia coverage = 50% split • Routine cleaning & xrays = free twice a year A. All claims subject to a $600 deductible to a maximum of three (3) per family. B. After the deductible is satisfied, co-insurance of 75%/25% on the next $7,000 ($1,750) single and $13,000 ($3,250) family. C. All in-patient and out-patient and ER visits subject to the deductible and the 75%/25% split in “B” above. Rx – Co-Pays Generic - $10.00* Formulary Brand - $22.00** Non-formulary Brand - $44.00** * includes 90 day supply ** two co-pays for 90 day supply DENTAL • Annual cap = $1,250 • $25 deductible per person • Preventive & basic services = 80%/20% split on usual & customary charges • Major & prosthodontic services = 50% split • Orthodontia coverage = $1,000 lifetime
(a) For employees enrolled for coverage for the employee only---the full premium cost of the coverage.
(b) For employees enrolled for coverage for the employee and his/her dependents---the full premium cost of the coverage.
(c) During th...
Hospital-Surgical. For the duration of this Agreement, the County shall provide a comprehensive hospital-surgical-major medical coverage policy and a $25 deductible dental plan. See Plan document for further details. The County will continue to provide a Dental Maintenance Organization (currently Dental Associates) with a $2,200 annual cap, a $20 co-pay and a 50% split on orthodontia. Effective January 1, 2007, the Dental Associates annual cap will increase to $2,500 per eligible participant. Active employees will have the option of choosing one of two Network options, In-Network or Out-of-Network. Said option must be executed during the open enrollment period which will last for one month, from October 1 through October 31 of the current year.
(a) For employees enrolled for coverage for the employee only---the full premium cost of the coverage.
(b) For employees enrolled for coverage for the employee and his/her dependents---the full premium cost of the coverage.
(c) During the life of this Agreement, the County agrees to maintain hospital- surgical-major medical and dental coverage at levels equivalent to coverages presently in effect, and to improve such coverage where possible.
(d) An employee who becomes totally disabled due to work connected injury or illness shall continue to receive coverage paid by the County during such period of total disability until such employee becomes eligible for coverage under any present or future federal hospital-surgical-major medical insurance plan; and
(e) An employee who is out due to illness shall continue to receive coverage paid by the County for six (6) months after such employee exhausts his Pay Maintenance Plan benefits. Such employee can continue coverage for an additional six (6) month period by paying, in advance, to the Personnel Department the monthly premium as set by the County for his coverage.
(f) PLAN ONE. (Standard Plan - Current Retirees Only) This health insurance plan shall incorporate a major medical deductible of 100/300, 80% (County)-20% (employee) on next $10,000, including outpatient diagnostic and x-ray, supplemental hospital and emergency medical benefits.
Hospital-Surgical. Medical Benefits
1. Effective July 1, 2013, the maximum monthly contribution of the College towards the premiums, payable on behalf of employees participating in the College’s sponsored health insurance plan who are entitled to employer paid contributions towards those premiums, shall not exceed the applicable annual legislatively-fixed/hard caps for full family, two person, or single coverage. Should the Board of Trustees elect the 80/20 option under Public Act 152 of 2011, the College shall pay 80% of the applicable premiums for eligible employees and their families. Premium contributions will be collected on a monthly or bi-weekly basis, whichever is applicable (e.g. no deductions will occur until new plans are implemented and an open enrollment is complete). PPO and HMO hospital-medical-surgical and prescription drug coverages shall subject to revision only upon the mutual agreement of the College and Union.
2. The coverage for which the Board shall contribute under the foregoing may be, at the teacher's option, coverage for (1) self only or (2) self and family (including only spouse and eligible dependents). Coverage shall be provided only if proper enrollment forms and/or contract revision forms have been properly filed with the Office of Human Resources.
3. Teachers may enroll under the "new hire" clause, within thirty (30) days of the date of original employment. Subsequent opportunities to enroll in either of the above plans shall be provided only during enrollment periods specified by the carrier.
4. Teachers on approved leaves of absence, as provided in this contract, may retain coverage for group hospital-medical-surgical, dental, optical, hearing, term life, accidental death or dismemberment insurance, and long term care benefits at group rates, provided written approval is obtained by the administration from the insurer's underwriting department. The teacher must make the premium payments to the Board in advance by the first of each month, or the teacher shall forfeit all rights under this provision, with exception of those covered by Sabbatical Leave.
Hospital-Surgical. Medical Benefits
1. Effective July 1, 2013, the maximum monthly contribution of the College towards the premiums, payable on behalf of employees participating in the College’s sponsored health insurance plan who are entitled to employer paid contributions towards those premiums, shall not exceed the applicable annual legislatively fixed/hard caps for full
2. The coverage for which the Board shall contribute under the foregoing may be, at the teacher's option, coverage for (1) self only or (2) self and family (including only spouse and eligible dependents). Coverage shall be provided only if proper enrollment forms and/or contract revision forms have been properly filed with the Office of Human Resources.
3. Teachers may enroll under the "new hire" clause, within thirty (30) days of the date of original employment. Subsequent opportunities to enroll in either of the above plans shall be provided only during enrollment periods specified by the carrier.
4. Teachers on approved leaves of absence, as provided in this contract, may retain coverage for group hospital-medical-surgical, dental, optical, hearing, term life, accidental death or dismemberment insurance, and long-term care benefits at group rates, provided written approval is obtained by the administration from the insurer's underwriting department. The teacher must make the premium payments to the Board in advance by the first of each month, or the teacher shall forfeit all rights under this provision, with exception of those covered by Sabbatical Leave.
Hospital-Surgical. Medical-Vision-Dental-Life-LTD Insurance
(a) The contract language (with respect to insurance) will be modified according to vendor selection prior to May 30, 2012, and incorporated throughout this agreement as it relates to health insurance coverage.
(b) Teachers shall select coverage for hospital-surgical-medical benefits through Michigan Education Special Services Association (MESSA) MESSA Choices or MESSA ABC Plan 1 for those electing health insurance and Plan B for those not electing health insurance.
(c) The Board will limit its payment to the Hard Cap Limits as set by PA 152. The employee portion shall be paid with pre-tax dollars.
(d) Teachers married to other teachers who are members of the OPEA are entitled to select A or B below. One spouse shall select A, and the other shall select B, including the TDA.
X. XXXXX Choices $500/$1,000 deductable, $20 Co-pay and MESSA Saver RX or MESSA ABC Plan 1 $1,250/$2,500 deductable with HSA
B. LTD 66 2/3%. Plan II, 120 calendar day modified fill waiting period, $3,000 maximum monthly benefit. 5% minimum payout. Alcoholism/drug same as any other illness; mental/nervous same as any other illness, family social security offset and cost of living allowance.
C. Delta dental, 80/80/80;$1000; 80: $1,300 or Plan C-03, 50/50/50; $1000 for those covered by another dental plan equal to or greater than Plan C/03, with internal and external coordination of benefits on both plans.
D. Negotiated life, $40,000, AD&D.
E. VSP III with internal and external coordination of benefits.
A. If less than 20 bargaining unit members are enrolled in PLAN B, the members will receive $400 per month – cash in lieu of heath insurance. When 20 or more bargaining unit members are enrolled in PLAN B, the members will receive $550 per month – cash in lieu of heath insurance.
B. Delta dental plan, 100:90/90/90; $1500 or Plan C-03, 50/50/50; $1000 for those covered by another dental plan equal to or greater than Plan C-03, with internal and external coordination of benefits on both plans.
C. VSP III with internal and external coordination of benefits on both plans.
D. Negotiated life, $50,000, AD&D.
E. LTD - same as Plan A LTD.
F. Dependent life: spouse, $10,000; each eligible child, $5,000.
Hospital-Surgical. For the duration of this Agreement, the Employer shall make payment to the carrier to be selected by the Employer and funds sufficient to pay for a comprehensive hospital-surgical-major medical coverage policy including Outpatient Diagnostic and X-Ray, Supplemental Hospital and Emergency Medical benefits as follows:
(a) For employees enrolled for coverage for the employee only -- the full premium cost of the coverage.
(b) For employees enrolled for coverage for the employee and his/her dependents -- the full premium cost of the coverage.
(c) During the life of this Agreement, the Employer agrees to maintain hospital-surgical-major medical coverage at levels equivalent to coverages presently in effect, and to improve such coverage where possible.
(d) An employee who becomes totally disabled due to work connected injury or illness shall continue to receive coverage paid by the Employer during such period of total disability until such employee becomes eligible for coverage under any present or future federal hospital-surgical-medical insurance plan; and
(e) An employee who is out due to illness shall continue to receive coverage paid by the Employer for six (6) months after such employee exhausts his sick leave benefits. Such employee can continue coverage for an additional six (6) month period by paying, in advance, to the Director's Office, the monthly premium for his coverage.
Hospital-Surgical. Medical Benefits may be extended to same-sex domestic partners per the criteria and requirements outlined in Appendix B.
Hospital-Surgical. Medical-Vision-Dental-Life-LTD Insurance
(a) Teachers shall select coverage for hospital-surgical-medical benefits through Michigan Education Special Services Association (MESSA) MESSA Choices or MESSA ABC Plan 1 for those electing health insurance and Plan B for those not electing health insurance.
(b) The Board will limit its payment to the Hard Cap Limits as set by PA152. The employee portion shall be paid with pre-tax dollars.
(c) Teachers married to other teachers who are members of the OPEA are entitled to select A or B below. One spouse shall select A, and the other shall select B, including the TDA.
X. XXXXX Choices $500/$1,000 deductible, $20 Co-pay and MESSA Saver RX or MESSA ABC Plan 1 $1,300/$2,600 (adjusted annually by insurance provider) deductible with HSA
B. LTD 66 2/3%. Plan II, 120 calendar day modified fill waiting period, $3,000 maximum monthly benefit. 5% minimum payout. Alcoholism/drug same as any other illness; mental/nervous same as any other illness, family social security offset and cost of living allowance.
C. Delta dental, 90/80/80; $1500; 50: $1,300 or Plan C 03, 50/50/50; $1000 for those covered by another dental plan equal to or greater than Plan C/03, with internal and external coordination of benefits on both plans.
D. Negotiated life, $40,000, AD&D.
E. VSP 3 Gold with internal and external coordination of benefits.
A. If less than 20 bargaining unit members are enrolled in PLAN B, the members will receive $400 per month – cash in lieu of health insurance. When 20 or more bargaining unit members are enrolled in PLAN B, the members will receive $550 per month – cash in lieu of health insurance.
B. Delta dental plan, 90/80/80; $1500; 50; $1500 or Plan C-03, 50/50/50; $1000 for those covered by another dental plan equal to or greater than Plan C-03, with internal and external coordination of benefits on both plans.
C. VSP 3 Gold with internal and external coordination of benefits on both plans.
D. Negotiated life, $50,000, AD&D.
E. LTD - same as Plan A LTD.
F. Dependent life: spouse, $10,000; each eligible child, $5,000.
(d) Coverage for which the Board will contribute under the foregoing may be, at the teacher's option, protection for (1) self only, or (2) self and family.
(e) Teachers may enroll under the "new hire" clause, within thirty (30) days of the date of original employment. Subsequent opportunities to enroll in the above plan shall be provided during enrollment periods specified by the carrier.
(f) The Board will ma...
Hospital-Surgical. The Company shall continue, during the life of this Agreement, to make the employee group hospitalization-surgical insurance which was in force immediately prior to this Agreement available to all employees and dependents upon the same basis as existed prior to this Agreement except that the Company shall pay eighty-five percent (85%) of the premium cost for the Class of coverage chosen. The Company shall also, for the life of this Agreement, make available to employees eligible to participate in, and participating in, such basic hospitalization-surgical insurance plan, a plan of 80-20 (in network) and 60-40 (out of network) major medical insurance, in the amount of $5,000,000.00 with $250/$500 deductible with a out of pocket expense of $1,500 for single and $3,000 for family. A $15 office visit co-pay.
Hospital-Surgical a. Effective retroactive to January 1, 2020, a member who elects to enroll in the base plan shall pay 14% of the 2020 monthly premium, unless the member has obtained an age appropriate wellness examination during the previous calendar year on or before December 31, 2019. Having done so, the monthly premium contribution shall be reduced to 13% for that calendar year (e.g., premium contribution will be reduced to 13% of the 2020 monthly premium for calendar year 2020 if an employee obtains an age appropriate wellness examination during calendar year 2019. Effective retroactive to January 1, 2021, a member who elects to enroll in the base plan shall pay 19% of the 2021 monthly premium, unless the member has obtained an age appropriate wellness examination during the previous calendar year on or before November 15. Having done so, the monthly premium contribution shall be reduced to 14% for that calendar year (e.g., premium contribution will be reduced to 14% of the 2021 monthly premium for calendar year 2021 if an employee obtains an age appropriate wellness examination during calendar year 2020 on or before November 15). Effective January 1, 2022, a member who elects to enroll in the base plan shall pay 20% of the 2022 monthly premium, unless the member has obtained an age appropriate wellness examination during the previous calendar year on or before November 15. Having done so, the monthly premium contribution shall be reduced to 15% for that calendar year (e.g., premium contribution will be reduced to 15% of the 2022 monthly premium for calendar year 2022 if an employee obtains an age appropriate wellness examination during calendar year 2021 on or before November 15). An “age appropriate wellness examination” shall be in accordance with the guidelines set forth by the member’s plan.
b. The premium contribution for any high deductible plan shall be determined by the Health Care Committee (“HCC”). However, an employee choosing the High Deductible Plan will pay an additional 1% of the premium if he/she does not obtain an age appropriate physical exam during the previous calendar year on or before November 15. Effective retroactive to January 1, 2020, an employee choosing the High Deductible Plan will pay an additional 1% of the premium if he/she does not obtain an age appropriate physical exam during the previous calendar year on or before Nov. 15. Effective retroactive to January 1, 2021, an employee choosing the High Deductible Plan will pay an additional...
