Hospital/Surgical/Major Medical Insurance Sample Clauses

Hospital/Surgical/Major Medical Insurance. The Board shall purchase what is referred to in the health insurance industry or business as "point- of-service" medical insurance. This insurance purchased by the Board shall be insurance which meets or exceeds the specifications below. All unit members of the bargaining unit shall be entitled to participate in the plan as set forth below either on a single, employee plus kids, or family plan as is appropriate under the circumstances and requirements of the insurer. Premiums will be deducted from two (2) pays each month. Employer-employee percentage contribution for medical health insurance premiums will be: Employer pays 85% Employee pays 15% United Health Care has designed this health care benefit program, which permits you to choose benefit options to best meet your individual needs each time you need medical coverage. When you use a United Health Care participating provider, you receive "In-Network" coverage. When you receive care from a provider out of the United Health Care network, you will receive "Out-of-Network" coverage.
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Hospital/Surgical/Major Medical Insurance. If the employees choose to see a doctor out of network, the coinsurance would be 70/30 instead of the normal 90/10. Any eligible employee who wishes to waive medical, dental, and vision insurance for the school year will receive an additional $2,000.00 per year, paid through payroll. New hires as of 2007-2008 will pay fifteen percent (15%) of their insurance costs with the Board picking up eighty-five percent (85%) of the cost. Spouses of new hires must be covered under their own insurance plan, if one is offered at their place of employment. This will be decided on a monthly basis. Written confirmation of availability of insurance may be required of the spouses’ employment. Plan Name: Xxxxxxx-Xxxxxxxx Health Benefit Fund Third Party Administrator: Medical Mutual Plus Network PPO: Medical Mutual of Ohio Plan Number: 501 Covered Comprehensive Medical Benefits are subject to the deductible and paid at the percentages listed below: Deductible - Individual - $250.00 - Family - $500.00 Coinsurance Outpatient Mental Illness, 80% of the Usual and Customary Alcoholism, and Substance Charge Abuse Treatment (Charges do not apply to the Out-of-Pocket Maximum) Well Child Care Preferred Providers 100% of the Usual and Customary (Office visits are subject Charge to a $5.00 co-pay.) Non-Preferred Providers 90% of the Usual and Customary Charge All other treatment 90% of the Usual and Customary Charge Out-of-Pocket Maximums (Including Deductible) Preferred Providers Individual - $450.00 Family - $700.00 Non-Preferred Providers Individual - $500.00 Family - $750.00 Combined for Preferred and Non-Preferred Providers Individual - $500.00 Family - $750.00 Benefit Maximum Inpatient Hospital Charges 120 Days per Confinement Private Room Maximum Average Semi-Private Room Rate + $10.00 Special Care Facility Calendar Year Maximum $1,000.00 Daily Allowable Maximum $35.00 Outpatient Mental Illness, Alcoholism, and Substance Abuse Treatment Calendar Year Maximum $1,200.00 Daily Allowable Maximum $45.00 Benefit Maximum Routine Mammogram Calendar Year Maximum $85.00 Routine Pap Smear Calendar Year Maximum 1 Pap Smear Well Child Care Birth to age 1 $500.00 Age 1 to age 9 $150.00 per Calendar year TMJ Lifetime Maximum $1,000.00 Human Organ Transplant Lifetime Maximum $1,000,000.00 Hospital Xxxx Xxxx-Audit Program 50%, up to $250.00 Lifetime Plan Maximum $1,000,000.00 Lifetime Maximum Reinstatement $2,000.00 per Calendar Year Mail Order Prescription Drug Program Co-pay per Prescription $2...
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Hospital/Surgical/Major Medical Insurance. The Colonel Xxxxxxxx Local Schools will offer any insurance plan to its employees that have been adopted and offered by the Wyandot-Xxxxxxxx Consortium. a. Changes can only be made during the open enrollment period except in circumstances of life events; b. Before any plan changes can occur, the district will meet with the CCEA insurance committee to discuss said changes recommended by the Wyandot-Xxxxxxxx Consortium. Any eligible employee who wishes to waive medical, dental, and vision insurance for the school year will receive an additional $2,000.00 per year, paid through payroll. Employees hired prior to the 2007-2008 school year will pay eight percent (8%) of their insurance premium costs with the Board picking up ninety-two percent (92%) of the premium cost. Effective in year one of the contract (2018-2019), the Board agrees to make a one-time lump sum payment equal to the difference in premium cost of going from 7% to 8%. The one-time lump sum payment shall be paid out in the first paycheck in December of 2018. New hires and employees hired during or after the 2007-2008 school year shall pay fifteen (15%) of their insurance premium cost with the Board picking up eighty-five (85%) of the premium cost. Spouses of new hires must be covered under their own insurance plan, if one is offered at their place of employment. This will be decided on a monthly basis. Written confirmation of availability of insurance may be required of the spouses’ employment.
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Hospital/Surgical/Major Medical Insurance. The Board of Education shall purchase, from a carrier licensed by the State of Ohio, medical insurance and make it available to each eligible member of the bargaining unit. The Board may choose to purchase medical insurance independently or by joining a consortium. The Board will offer at least two plans: a High Deductible (H.S.A.) plan and a traditional POS/PPO or similar plan. These plans contain four (4) tiers, Single, Employee and Spouse, Employee and child(ren), and Family. The Board and the eligible employee shall share the cost of medical insurance. The Board shall pay 86% of the premium and the employee shall pay 14% of the premium. Health insurance coverage will be offered to employees who average at least thirty (30) hours per week for the previous school year. The parties agree to establish a District Insurance/Healthcare Benefits Review Committee for the purpose of examining the District’s current healthcare benefit offerings, Wellness Program and exploring alternatives. The Committee will be comprised of three (3) representatives from each bargaining unit, and up to three (3) additional representatives on behalf of the Board. The Committee will meet monthly. Either party may request consultants to be present at Committee meetings. Insurance coverage shall continue to be in full force and effect until August 31st in the year a staff member retires. This applies to teachers who work the entire school year and not to teachers who do not complete the entire school year (exceptions – end of May). If any employee has a current health care plan provided by the Board, the Board shall provide one thousand two hundred dollars per year ($1200/year) for each family and six hundred dollars per year ($600/year) for a single plan who elect to opt out of the Board provided plan. Any employee with a spouse employed in the District shall receive six hundred dollars per year ($600/year), if he/she elects to opt out of health insurance coverage and remain under the spouse’s plan. Employees shall notify the Board if they elect to opt out of the Board provided health insurance plan during open enrollment. Persons who opt out of health insurance coverage shall be paid following the end of a plan year. Employees may revert to plan coverage if any COBRA situation attaches. The open enrollment period will be held in the fall for the following plan year beginning on January 1, 2021 and continue every year of this contract pending approval of the insurance carrier.
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Hospital/Surgical/Major Medical Insurance. 1. The Board of Education will pay for hospital/surgical/major medical insurance for each employee. Specifications for the coverage shall be no less than those contained in the PORTAGE AREA SCHOOLS CONSORTIUM, except as specified in this article. 2. The Board of Education will pay ninety-five percent (95%) of the single premium or eighty-five percent (85%) of the family premium cost. 3. The parties recognize the necessity to contain the cost of the insurance program. Therefore, the parties agree that the following cost containment provisions shall be implemented in the hospitalization insurance plan: a. requirement for a second opinion except in cases of emergency. b. pre certification and pre admission testing for outpatient surgery as well as inpatient surgery. c. no weekend hospital entrance except in cases of emergency. d. extension of the pre-existing condition exclusion to both basic hospital and major medical benefits for all employees hired after January 1, 1993. (This provision not valid effective July 1, 2014.) e. expansion of rules for spouse coverage, along with the Board option to pay the spouse’s share of any contributory plan. f. requirement that spouses take workers’ compensation benefits, where applicable. g. limitation of penalty for failure to pre-certify to a maximum penalty of five hundred dollars ($500.00).
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Hospital/Surgical/Major Medical Insurance. 1. The Board of Education will pay for hospital/surgical/major medical insurance for each employee. Specifications for the coverage shall be no less than those contained in the PORTAGE AREA SCHOOLS CONSORTIUM, except as specified in this article. 2. The Board of Education will pay one hundred percent (100%) of the single premium or ninety percent (90%) of the family premium cost. 3. The parties recognize the necessity to contain the cost of the insurance program. Therefore, the parties agree that the following cost containment provisions shall be implemented in the hospitalization insurance plan: a. requirement for a second opinion except in cases of emergency. b. pre certification and pre admission testing for outpatient surgery as well as inpatient surgery. c. no weekend hospital entrance except in cases of emergency. d. extension of the pre-existing condition exclusion to both basic hospital and major medical benefits for all employees hired after January 1, 1993. e. expansion of rules for spouse coverage, along with the Board option to pay the spouse’s share of any contributory plan. f. requirement that spouses take workers’ compensation benefits, where applicable. g. limitation of penalty for failure to pre-certify to a maximum penalty of five hundred dollars ($500.00).
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Hospital/Surgical/Major Medical Insurance. The Board shall pay 85% of the enrollment costs.
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Related to Hospital/Surgical/Major Medical Insurance

  • Medical Insurance The Company shall provide to Executive, Executive's spouse and children, at its sole cost, such health, dental and optical insurance as the Company may from time to time make available to its other executive employees.

  • Basic Medical Insurance All regular Employees may choose to be covered by the medical plan for which the British Columbia Medical Plan is the licensed carrier. Benefits and premiums shall be in accordance with the existing policy of the plan. The Employer will pay one hundred percent (100%) of the regular premium.

  • Retiree Medical Insurance Retiree insurance coverage is included within each medical plan for all retirees under the age of 65 years, through self-payment. The Employer shall make available an appropriate medical plan for all eligible retirees ages 65 years or older.

  • Optical Insurance 1. The Board shall provide Group I employees a vision plan comparable to the VSP 3 plan. 2. The Board shall provide Group II employees a vision plan comparable to the VSP 1 plan.

  • Trauma Insurance All employees will be covered by an Incolink administered lump sum insurance policy providing financial compensation in the event of a major work related (ie. WorkCover) accident resulting in death or permanent total disablement. The full and precise conditions of this cover will be in accordance with the terms of the policy, but in general will provide that, in the event of a workplace accident occurring which results in either the death or total permanent disablement of a worker covered by this Agreement, a lump sum payment as specified below will made. The defined payments are: With dependants $250,000 Without dependants $150,000 This benefit has been agreed to by the company on the grounds that premium costs have been set at $7 per week/worker and will not exceed that amount. In the event of insurance costs rising, it is agreed that the table of defined benefits will be reduced so as to maintain the $7 premium figure. To maintain this cover the company agrees to pay the amounts every week for each employee.

  • HEALTH PROGRAM 3701 Health examinations required by the Employer shall be provided by the Employer and shall be at the expense of the Employer. 3702 Time off without loss of regular pay shall be allowed at a time determined by the Employer for such medical examinations and laboratory tests, provided that these are performed on the Employer’s premises, or at a facility designated by the Employer. 3703 With the approval of the Employer, a nurse may choose to be examined by a physician of her/his own choice, at her/his own expense, as long as the Employer receives a statement as to the fitness of the nurse from the physician. 3704 Time off for medical and dental examinations and/or treatments may be granted and such time off, including necessary travel time, shall be chargeable against accumulated income protection benefits.

  • Hospital Services The Hospital will: 6.1.1 achieve the Performance Standards described in the Schedules and the HSAA Indicator Technical Specifications; 6.1.2 not reduce, stop, start, expand, cease to provide or transfer the provision of Hospital Services to another hospital or to another site of the Hospital if such action would result in the Hospital being unable to achieve the Performance Standards described in the Schedules and the HSAA Indicator Technical Specifications; and 6.1.3 not restrict or refuse the provision of Hospital Services that are funded by the Funder to an individual, directly or indirectly, based on the geographic area in which the person resides in Ontario, and will establish a policy prohibiting any health care professional providing services at the Hospital, including physicians, from doing the same.

  • 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. 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. 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.

  • Dental Insurance The State agrees to pay one hundred percent (100%) of the employee premium of a dental insurance program for full-time employees. The benefit levels of this program shall provide one hundred percent (100%) coverage for preventive care and eighty percent (80%) coverage for general service care. The State agrees to provide payroll deduction for dental insurance, provided such arrangements are agreed to by the insurance carrier. Dependent coverage will be available provided there is sufficient employee participation in the dental insurance program. Dependent coverage will be at the employees' expense.

  • Health Care Insurance While a faculty member is on an approved leave of this type, the faculty member will be advised regarding the right to continue health care benefits in accordance with COBRA during the period of unpaid absence.

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