Common use of Hospital/Surgical/Major Medical Insurance Clause in Contracts

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 $2.00

Hospital/Surgical/Major Medical Insurance. If The Board shall purchase what is referred to in the employees 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 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 see best meet your individual needs each time you need medical coverage. When you use a doctor United Health Care participating provider, you receive "In-Network" coverage. When you receive care from a provider out of the United Health Care 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 you 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 (Network" coverage. IN-NETWORK OUT-OF-NETWORK Plan Features -Physician Services 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 Visit Copay - Plan Coinsurance - Emergency Room Copay Waived if Admitted - Individual Deductible - Family Deductible - Individual Out-ofOf-Pocket Maximums (Including Deductible) Preferred Providers Individual - $450.00 Family - $700.00 NonOut-Preferred Providers Individual - $500.00 Family - $750.00 Combined for Preferred and NonOf-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 Pocket Lifetime Maximum $1,000.00 Human Organ Transplant Lifetime Maximum 20 Copay Per Visit 100%; Some Services 80/20% $1,000,000.00 Hospital Xxxx Xxxx50 N/A N/A $750 $1,500 Unlimited N/A 80% $50 $150 $300 $850 $1,700 $1,000,000 Covered Services Physician Office Visits - Routine Physical Examination - Diagnostic Lab & X-Audit Program 50%Ray - Well Child Care/Immunizations - Preventive Care - Routine Vision & Hearing Exams (Limited to 1 every 12 Months) - Mammograms & Pap Tests $20 Copay Per Visit 20% of Eligible Expenses Not Covered 20% of Eligible Expenses $500 to age 1; $150 ages 1-9 Not Covered Not Covered 20% of Eligible Expenses Outpatient Diagnostic Services - Diagnostic, up Laboratory and X-Ray 100% 20% of Eligible Expenses Outpatient Surgery - Outpatient Surgical Care 100% 20% of Eligible Expenses Outpatient Rehabilitation (In Office) - Physical Therapy - Occupational Therapy - Speech Therapy (50 treatments of any combination) - Spinal Manipulation (Limited to $250.00 Lifetime Plan Maximum 500 per year) $1,000,000.00 Lifetime Maximum Reinstatement 20 Copay $2,000.00 20 Copay $20 Copay Not Covered 50% of Eligible Expenses 50% of Eligible Expenses 50% of Eligible Expenses Deductible waived; then 20% of Eligible Expenses Hospital Care - Room and board - Diagnostic Laboratory and X-Ray - Misc. Charges $250 copay per Calendar Year Mail Order Prescription Drug Program Co-pay per Prescription admission 20% of Eligible Expenses Professional Fees - Inpatient - Surgeon/Physicians 100% 20% of Eligible Expenses Maternity Care - Physician Prenatal and Postnatal Care 100% 20% of Eligible Expenses Emergency Care - Hospital Emergency Care (Copay Waived if Admitted) - Urgent Care Centers $2.0075.00 Copay $35.00 Copay 20% of Eligible Expenses 20% of Eligible Expenses - Ambulance Services 100% 100%

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. The shared premiums will remain at the current levels. This will take effect during the October 2013 enrollment period. a. Changes can only be made during the open enrollment period; b. Requests must be submitted in September 2013 to take effect in October 2013. 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. Eligible employees hired prior to 2007 will pay three percent (3%) of their insurance costs with the Board paying ninety-seven percent (97%) of the cost. 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 Schedule of Benefits 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 $2.00

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. The shared premiums will remain at the current levels. This will take effect during the October 2013 enrollment period. a. Changes can only be made during the open enrollment period; b. Requests must be submitted in September 2013 to take effect in October 2013. 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. A one-time payment of two hundred fifty dollars ($250) shall be made to those employees who transition from ninety-seven percent (97%) insurance premiums to ninety-five percent (95%) during the 2014-2015 school year. This payment shall be made in the second pay of November, 2014. A one-time payment of two hundred fifty dollars ($250.00) shall be made to those employees who transition from ninety-five percent (95%) to ninety-three percent (93%) insurance premiums during the 2015- 2016 school year. This payment shall be made in the second pay of November, 2015. 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 Schedule of Benefits 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 $2.00