Hospital, Surgical, and Major Medical Sample Clauses

Hospital, Surgical, and Major Medical. Refer to Certificate of Coverage, Appendix K.
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Hospital, Surgical, and Major Medical. 1. The Board will contribute 100% of the premium rate for individual coverage and 90% of the premium rate for dependent coverage for group health insurance coverage. The plan provided will be the Blue Cross Blue Shield UB3 17X Insurance Plan or its' equivalent. Also included will be a Major Medical Insurance Program to include $1,000,000 in one benefit period or in two or more benefit periods. The Major Medical Insurance Program will provide for $100 individual deductible per calendar year or a $200 family aggregate deductible per calendar year. For purposes of this provision, the DCMO BOCES Consortium Health Plan is considered equivalent. The District will provide a major medical 80/20 prescription drug card as soon as it can be made available. The employee contribution will be modified as follows: Effective July 1, 2008 – Unit members will be responsible for 1.0% of the premium for individual coverage. Unit members opting for dependent coverage will be responsible for 1.0% of the premium for individual coverage plus 10% of the difference between the dependent (family or two-person) and individual coverage premium amounts. Effective July 1, 2009 – Unit members will be responsible for 2.0% of the premium for individual coverage. Unit members opting for dependent coverage will be responsible for 2.0% of the premium for individual coverage plus 10% of the difference between the dependent (family or two-person) and individual coverage premium amounts. Effective July 1, 2010 – Unit members will be responsible for 3.0% of the premium for individual coverage. Unit members opting for dependent coverage will be responsible for 3.0% of the premium for individual coverage plus 10% of the difference between the dependent (family or two-person) and individual coverage premium amounts. Effective July 1, 2011 – Unit members will be responsible for 4.0% of the premium for individual coverage. Unit members opting for dependent coverage will be responsible for 4.0% of the premium for individual coverage plus 10% of the difference between the dependent (family or two-person) and individual coverage premium amounts.
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Hospital, Surgical, and Major Medical. SCHEDULE OF BENEFITS The Schedule of Benefits is a summary of the Co-payments and other limits when you receive Covered Services from a Provider. Please refer to the Covered Services section for a more complete explanation of the specific services covered by the Plan. All Covered Services are subject to the conditions, exclusions, limitations, terms and provisions of this Benefit Booklet including any attachments or riders. This Schedule of Benefits lists the Member’s responsibility for Covered Services and supplies. Benefit Period Calendar Year Dependent Age Limit To the end of the calendar year in which the child attains age 19; or to the end of the calendar year in which the child attains age 23 if the child is enrolled as a full-time student at an accredited school or college. Enrollment September 1 through September 30 and January 1 through January 30. Pre-Existing Period Non-Late Enrollee 12 months after your Enrollment Date Late Enrollee 18 months after your Enrollment Date Deductible Network Non-Network Per Person $0 $200 Per Family $0 $400 Out-of-Pocket Limit Network Non-Network Per Person $ 500 $1,000 Per Family $1,000 $2,000 [Note: The Out-of-Pocket Limit includes all Deductibles and/or percentage Co- payments you incur in a Benefit Period. However, all flat Co-payments do not apply toward the Out-of-Pocket Limit. Once the Member and/or family Out-of-Pocket Limit is satisfied, no additional Co-payments will be required for the Member and/or family for the remainder of the Benefit Period except for all flat Co-payments. [Network and Non-Network Deductibles, Co-payments, and Out-of-Pocket Limits are separate and do not accumulate toward each other. The Deductibles(s) apply only to Covered Services with a percentage Co-payment.] Lifetime Maximum for All Covered Services $2,000,000 Covered Services Co-payments/Maximums Network Non-Network Preventive Care $15 Co-payment 20% Co-payment Maximum allowance per Benefit Period Unlimited $500 Physician Office Services $15 Co-payment 20% Co-payment Inpatient Services 10% Co-insurance 20% Co-payment Maximum days per Benefit Period for Physical Medicine and Rehabilitation Unlimited Maximum days per Benefit Period for Skilled Nursing Care Facility Services 120 days (Daily room and board limited to the facility’s semi-private room rate) Outpatient Facility Services 10% Co-insurance 20% Co-payment Therapy Services (when rendered as Physician’s Office Services or Outpatient Facility Services) Network Co-payment ba...
Sample 1
Hospital, Surgical, and Major Medical. 1. Effective July 1, 2015 the Board will contribute 91% of the premiums rate for individual and dependent coverage for group health insurance coverage.
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Related to Hospital, Surgical, and Major Medical

  • Hospital This plan covers behavioral health services if you are inpatient at a general or specialty hospital. See Inpatient Services in Section 3 for additional information. Residential Treatment Facility This plan covers services at behavioral health residential treatment facilities, which provide: • clinical treatment; • medication evaluation management; and • 24-hour on site availability of health professional staff, as required by licensing regulations. Intermediate Care Services This plan covers intermediate care services, which are facility-based programs that are: • more intensive than traditional outpatient services; • less intensive than 24-hour inpatient hospital or residential treatment facility services; and • used as a step down from a higher level of care; or • used a step-up from standard care level of care. Intermediate care services include the following: • Partial Hospital Program (PHP) – PHPs are structured and medically supervised day, evening, or nighttime treatment programs providing individualized treatment plans. A PHP typically runs for five hours a day, five days per week. • Intensive Outpatient Program (IOP) – An IOP provides substantial clinical support for patients who are either in transition from a higher level of care or at risk for admission to a higher level of care. An IOP typically runs for three hours per day, three days per week.

  • Hospital Services The Hospital will:

  • Medical There shall be an open enrollment period for medical coverage in each year of this Agreement. An employee may elect no medical coverage during any open enrollment period. An employee who has elected no medical coverage may elect medical coverage during an open enrollment period. No pre-existing condition limitations will apply.

  • Hospital and Medical Insurance The University shall make available health insurance to the employees covered by this agreement to the same extent and in the same manner as is available to other University employees, such as Faculty and the Executive, Administrative and Professional Staff employees. It is the University's goal to have the same health insurance plans offered uniformly to all University groups and employees.

  • Orthodontics We Cover orthodontics used to help restore oral structures to health and function and to treat serious medical conditions such as: cleft palate and cleft lip; maxillary/mandibular micrognathia (underdeveloped upper or lower jaw); extreme mandibular prognathism; severe asymmetry (craniofacial anomalies); ankylosis of the temporomandibular joint; and other significant skeletal dysplasias. Procedures include but are not limited to: • Rapid Palatal Expansion (RPE); • Placement of component parts (e.g. brackets, bands); • Interceptive orthodontic treatment; • Comprehensive orthodontic treatment (during which orthodontic appliances are placed for active treatment and periodically adjusted); • Removable appliance therapy; and • Orthodontic retention (removal of appliances, construction and placement of retainers).

  • Prosthodontics We Cover prosthodontic services as follows: • Removable complete or partial dentures, for Members 15 years of age and above, including six (6) months follow-up care; • Additional services including insertion of identification slips, repairs, relines and rebases and treatment of cleft palate; and • Interim prosthesis for Members five (5) to 15 years of age. We do not Cover implants or implant related services. Fixed bridges are not Covered unless they are required: • For replacement of a single upper anterior (central/lateral incisor or cuspid) in a patient with an otherwise full complement of natural, functional and/or restored teeth; • For cleft palate stabilization; or • Due to the presence of any neurologic or physiologic condition that would preclude the placement of a removable prosthesis, as demonstrated by medical documentation.

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