Common use of Hospital, Surgical and Major Medical Insurance Clause in Contracts

Hospital, Surgical and Major Medical Insurance. The Board shall comply with all applicable provisions of the Affordable Care Act and shall undertake all reasonable efforts to promptly notify employees of changes to the plan design that may occur as a result of such compliance. The Board shall provide through a carrier single and family coverage for hospital, surgical and major medical insurance or their equivalent to Option 1 through December 31, 2016. Effective January 1, 2017, the board shall provide through a carrier, single and family coverage for hospital, surgical and major medical insurance or their equivalent to Plan 2 coverage as outlined in this agreement (Medical Mutual of Ohio Super Med Plus). The annual open enrollment period shall be September 1 through September 30. 1. Should the Board decide to change carrier(s), the WTA President shall be notified in writing of any such change not fewer than thirty (30) days prior to the change in carrier(s). The WTA President shall receive a copy of the new contract when available. 2. The Option 1 Coverage has the following benefits: Deductible: $100 Single/$200 Family In-Network Copayment: 100% after deductible In-Network 90%/10% of next $5000 Single/$10000 Family after deductible Out of Network *Copay Limits: Does not apply In-Network *Does not include deductible (For a more detailed description of the benefits, refer to the Summary Plan Description.) Description Option 1 Plan In Network Out of Network Deductible Coinsurance $100 Single $200 Family 100% $200 Single $400 Family 90/10% Out of Pocket Max (excludes deductible) None $500 Single $1000 Family Inpatient Hospital 100% after deductible 90% after deductible Room & Board 100% after deductible 90% after deductible Ancillary Services 100% after 90% after deductible deductible Emergency Room 100% after 90% after Services deductible deductible X ray and Lab 100% after 90% after Services deductible deductible Home Health Care 100% after 90% after Services deductible deductible Skilled Nursing 100% after 90% after Facility deductible deductible Surgery & Anesthesia 100% UCR 90% UCR after after deductible deductible In-Hospital 100% UCR 90% UCR Medical Visits after after deductible deductible Office Visits $10 copay $10 copay Per visit then per visit then 100% - no 90% deductible Office Visit – PAP test 100% 90% Routine Physicals (age 10 through adult) $10 copay Not Covered per visit then 100% - Subject to $200 max every 24 months Well Child Care (birth to age 9) $10 copay $10 copay per visit; then per visit then 100% - Subject deductible & 90% to $1000 max birth to age, and $500 max ages 1-9 X ray & Lab Services 100% UCR 90% UCR (Includes one annual after after routine mammogram per deductible deductible Ohio Law and one annual routine PAP smear)

Hospital, Surgical and Major Medical Insurance. The Board shall comply with all applicable provisions of the Affordable Care Act and shall undertake all reasonable efforts to promptly notify employees of changes to the plan design that may occur as a result of such compliance. The Board shall provide through a carrier single and family coverage for hospital, surgical and major medical insurance or their equivalent to Option 1 through December 31, 2016. Effective January 1, 2017, the board shall provide through a carrier, single and family coverage for hospital, surgical and major medical insurance or their equivalent to Plan 2 coverage as outlined in this agreement (Medical Mutual of Ohio Super Med Plus). The annual open enrollment period shall be September 1 through September 30. 1. Should the Board decide to change carrier(s), the WTA President shall be notified in writing of any such change not fewer than thirty (30) days prior to the change in carrier(s). The WTA President shall receive a copy of the new contract when available. 2. The Option 1 Coverage has the following benefits: Deductible: $100 Single/$200 Family In-Network $200 Single/$400 Family Out of Network Copayment: 100% after deductible In-Network 90%/10% of next $5000 Single/$10000 Family after deductible Out of Network *Copay Limits: Does not apply In-Network $500 Single/$1000 Family Out of Network *Does not include deductible (For a more detailed description of the benefits, refer to the Summary Plan Description.) Description Option 1 Plan Deductible In Network $100 Single Out of Network Deductible $200 Single Coinsurance $100 Single $200 Family 100% $200 Single $400 Family 90/10% Out of Pocket Max (excludes deductible) None $500 Single $1000 Family Inpatient Hospital 100% after deductible 90% after deductible Room & Board 100% after deductible 90% after deductible Ancillary Services 100% after 90% after deductible deductible Emergency Room 100% after 90% after Services deductible deductible X ray and Lab 100% after 90% after Services deductible deductible Home Health Care 100% after 90% after Services deductible deductible Skilled Nursing 100% after 90% after Facility deductible deductible Surgery & Anesthesia 100% UCR 90% UCR after after deductible deductible In-Hospital 100% UCR 90% UCR Medical Visits after after deductible deductible Office Visits $10 copay $10 copay Per visit then per visit then 100% - no 90% deductible Office Visit – PAP test 100% 90% Routine Physicals (age 10 through adult) $10 copay Not Covered per visit then 100% - Subject to $200 max every 24 months Well Child Care (birth to age 9) $10 copay $10 copay per visit; then per visit then 100% - Subject deductible & 90% to $1000 max birth to age, and $500 max ages 1-9 X ray & Lab Services 100% UCR 90% UCR (Includes one annual after after routine mammogram per deductible deductible Ohio Law and one annual routine PAP smear)

Hospital, Surgical and Major Medical Insurance. The Board shall comply with all applicable provisions of the Affordable Care Act and shall undertake all reasonable efforts to promptly notify employees of changes to the plan design that may occur as a result of such compliance. The Board shall provide through a carrier single and family coverage for hospital, surgical and major medical insurance or their equivalent to Option 1 through December 31, 2016. Effective January 1, 2017, the board shall provide through a carrier, single and family coverage for hospital, surgical and major medical insurance or their equivalent to Plan 2 coverage as outlined in this agreement (Medical Mutual of Ohio Super Med Plus). The annual open enrollment period shall be September 1 through September 30. 1. Should the Board decide to change carrier(s), the WTA President shall be notified in writing of any such change not fewer than thirty (30) days prior to the change in carrier(s). The WTA President shall receive a copy of the new contract when available. 2. The Option 1 Coverage has the following benefits: Deductible: $100 Single/$200 Family In-Network Copayment: 100% after deductible In-Network 90%/10% of next $5000 Single/$10000 Family after deductible Out of Network *Copay Limits: Does not apply In-Network *Does not include deductible (For a more detailed description of the benefits, refer to the Summary Plan Description.) Description Option 1 Plan In Network Out of Network Deductible Coinsurance $100 Single $200 Family 100% $200 Single $400 Family 90/10% Out of Pocket Max (excludes deductible) None $500 Single $1000 Family Inpatient Hospital 100% after deductible 90% after deductible Room & Board 100% after deductible 90% after deductible Ancillary Services 100% after 90% after deductible deductible Emergency Room 100% after 90% after Services deductible deductible X ray and Lab 100% after 90% after Services deductible deductible Home Health Care 100% after 90% after Services deductible deductible Skilled Nursing 100% after 90% after Facility deductible deductible Surgery & Anesthesia 100% UCR 90% UCR after after deductible deductible In-Hospital 100% UCR 90% UCR Medical Visits after after deductible deductible Office Visits $10 copay $10 copay Per visit then per visit then 100% - no 90% deductible Office Visit – PAP test 100% 90% Routine Physicals (age 10 through adult) $10 copay Not Covered per visit then 100% - Subject to $200 max every 24 months Well Child Care (birth to age 9) $10 copay $10 copay per visit; then per visit then 100% - Subject deductible & 90% to $1000 max birth to age, and $500 max ages 1-9 X ray & Lab Services 100% UCR 90% UCR (Includes one annual after after routine mammogram per deductible deductible Ohio Law and one annual routine PAP smear)

Hospital, Surgical and Major Medical Insurance. The Board shall comply with all applicable provisions of the Affordable Care Act and shall undertake all reasonable efforts to promptly notify employees of changes to the plan design that may occur as a result of such compliance. The Board shall provide through a carrier single and family coverage for hospital, surgical and major medical insurance or their equivalent to Option 1 through December 31, 2016. Effective January 1, 2017, the board shall provide through a carrier, single and family coverage for hospital, surgical and major medical insurance or their equivalent to Plan 2 coverage as outlined in this agreement (Medical Mutual of Ohio Super Med Plus). The annual open enrollment period shall be September 1 through September 30. 1. Should the Board decide to change carrier(s), the WTA President shall be notified in writing of any such change not fewer than thirty (30) days prior to the change in carrier(s). The WTA President shall receive a copy of the new contract when available. 2. The Option 1 Coverage has the following benefits: Deductible: $100 Single/$200 Family In-Network $200 Single/$400 Family Out of Network Copayment: 100% after deductible In-Network 90%/10% of next $5000 Single/$10000 Family after deductible Out of Network *Copay Limits: Does not apply In-Network $500 Single/$1000 Family Out of Network *Does not include deductible (For a more detailed description of the benefits, refer to the Summary Plan Description.) Description Option 1 Plan In Network Out of Network Deductible Coinsurance $100 Single $200 Family 100% $200 Single $400 Family 90/10% Out of Pocket Max (excludes deductible) None $500 Single $1000 Family Inpatient Hospital 100% after deductible 90% after deductible Room & Board 100% after deductible 90% after deductible Ancillary Services 100% after 90% after deductible deductible Emergency Room 100% after 90% after Services deductible deductible X ray and Lab 100% after 90% after Services deductible deductible Home Health Care 100% after 90% after Services deductible deductible Skilled Nursing 100% after 90% after Facility deductible deductible Surgery & Anesthesia 100% UCR 90% UCR after after deductible deductible In-Hospital 100% UCR 90% UCR Medical Visits after after deductible deductible Office Visits $10 copay $10 copay Per visit then per visit then 100% - no 90% deductible Office Visit – PAP test 100% 90% Routine Physicals (age 10 through adult) $10 copay Not Covered per visit then 100% - Subject to $200 max every 24 months Well Child Care (birth to age 9) $10 copay $10 copay per visit; then per visit then 100% - Subject deductible & 90% to $1000 max birth to age, and $500 max ages 1-9 X ray & Lab Services 100% UCR 90% UCR (Includes one annual after after routine mammogram per deductible deductible Ohio Law and one annual routine PAP smear)

Hospital, Surgical and Major Medical Insurance. The Board shall comply with all applicable provisions of the Affordable Care Act and shall undertake all reasonable efforts to promptly notify employees of changes to the plan design that may occur as a result of such compliance. The Board shall provide through a carrier single and family coverage for hospital, surgical and major medical insurance or their equivalent to Option 1 through December 31, 2016. Effective January 1, 2017, the board shall provide through a carrier, single and family coverage for hospital, surgical and major medical insurance or their equivalent to Plan 2 coverage as outlined in this agreement (Medical Mutual of Ohio Super Med Plus). The annual open enrollment period shall be September 1 through September 30. 1. Should the Board decide to change carrier(s), the WTA President shall be notified in writing of any such change not fewer than thirty (30) days prior to the change in carrier(s). The WTA President shall receive a copy of the new contract when available. 2. The Option 1 Coverage has the following benefits: Deductible: $100 Single/$200 Family In-Network $200 Single/$400 Family Out of Network Copayment: 100% after deductible In-Network 90%/10% of next $5000 Single/$10000 Family after deductible Out of Network *Copay Limits: Does not apply In-Network $500 Single/$1000 Family Out of Network *Does not include deductible (For a more detailed description of the benefits, refer to the Summary Plan Description.) Description Option 1 Plan In Network Out of Network Deductible Coinsurance $100 Single $200 Family 100% $200 Single $400 Family 90/10% Out of Pocket Max (excludes deductible) None $500 Single $1000 Family Inpatient Hospital 100% after deductible 90% after deductible Room & Board 100% after deductible 90% after deductible Ancillary Services 100% after 90% after deductible deductible Emergency Room 100% after 90% after Services deductible deductible X ray and Lab 100% after 90% after Services deductible deductible Home Health Care 100% after 90% after Services deductible deductible Skilled Nursing 100% after 90% after Facility deductible deductible Surgery & Anesthesia 100% UCR 90% UCR after after deductible deductible In-Hospital 100% UCR 90% UCR Medical Visits after after deductible deductible Office Visits $10 copay $10 copay Per visit then per visit then 100% - no 90% deductible Office Visit – PAP test 100% 90% Routine Physicals (age 10 through adult) $10 copay Not Covered per visit then 100% - Subject to $200 max every 24 months Well Child Care (birth to age 9) $10 copay $10 copay per visit; then per visit then 100% - Subject deductible & 90% to $1000 max birth to age, and $500 max ages 1-9 X ray & Lab Services 100% UCR 90% UCR (Includes one annual after after routine mammogram per deductible deductible Ohio Law and one annual routine PAP smear)