Common use of HOSPITALIZATION AND MAJOR MEDICAL INSURANCE Clause in Contracts

HOSPITALIZATION AND MAJOR MEDICAL INSURANCE. The group major medical, vision and dental insurance policy will be maintained by the District throughout the term of this Agreement. The District reserves the right to institute cost containment measures relative to insurance coverage so long as the basic level of insurance benefits remains substantially similar to the insurance coverage in effect at the time of this Agreement. Such changes may include, but are not limited to mandatory second opinions for elective surgery, pre-admission and continuing admission review, prohibition on weekend admissions except in emergency situations and mandatory out-patient elective surgery for certain designated surgical procedures. The Board may provide a high-deductible insurance plan with a Health Reimbursement Account. The Health Reimbursement Account shall be funded solely by the Board and not by the employees. Employees shall be reimbursed for all additional amounts actually paid because of the higher deductible that would not have been assessed against the current deductible in the network. Reimbursement requests shall not be denied without written explanation describing the reason(s) for the denial and stating any necessary steps required to have the reimbursement approved. Such explanation must be provided within a reasonable amount of time from the employee's submission of a reimbursement request. Reimbursement will be concluded within ten business days of submission of a reimbursement request. A reimbursement request form will be available on the district employee portal Through the term of this contract, the District will pay the individual members group major medical, vision and dental insurance policy premium for all full-time faculty. The term of the insurance will run from the first day of the contract year to August 31st. All new employees will start on the first of the month following their start day. New employees hired after September 1st will begin insurance the 1st of the next month, unless the start date is before the 10th of said month, they will begin insurance immediately. Through the term of this contract, all full time Association members will pay a monthly contribution toward their major medical, dental and vision insurance. All full-time teachers will pay 9.5% of the cost of medical, dental, vision not to exceed $840 per year. Any changes to the deductible and out of pocket costs of any insurance program, except for out of network costs, will not affect the employee. Employee deductibles and out of pocket costs shall remain as follows: in-network out-of-network Deductible-single $500 $5000 Deductible-Family $1500 $15,000 OOP-Single $2500 $9000 OOP-Family $7500 $20,400 The District will pay a proportional share of the individual part time teacher’s medical/vision/dental insurance based on the part time employee’s FTE. Employees that work less than 30 hours per week (.82 FTE) will not qualify for life insurance. A teacher will not be required to accept District insurance. Full time faculty members may elect dependent coverage with the premiums for the coverage deducted through payroll deductions. For full time faculty members that choose dependent coverage, the District will contribute 65% of the employee’s family dependent medical premium to offset the cost. The Board contribution to employee’s family dependent coverage will not exceed $1,500 a month. In the event that other employee dependent options are available and the employee meets the qualifications in the preceding sentence, the District will contribute 50% of the employee’s spouse only medical premium, and 50% of the employee’s child/children only medical premium. The Board contribution to the employee’s spouse only and child/children only medical premium will not exceed $1,200 a month. The District will not contribute toward the employee’s dependent dental or vision insurance premium. A District directed insurance committee; including members of the Association shall convene no later than February, and annually to begin assessment of the current coverage. The committee will investigate alternative insurance carriers, coverage and related matters to advise the District. Nothing herein shall be construed to limit the District's discretion as to the carrier or the insurance policy at the time. The extent of coverage under any insurance policies referred to in this agreement shall be governed by the terms and conditions as set forth in the policies. Any questions or disputes concerning the insurance policies or benefits there under shall be resolved in accordance with the terms set forth in said policies and shall not be subject to the grievance and arbitration procedure set forth in this agreement. The failure of any insurance carrier(s) to provide any benefit for which it is contracted or is obligated shall result in no liability to the District, nor shall such failure be considered by a breach of the District of any obligation undertaken under this or any other agreement. However, nothing in this agreement shall be construed to relieve any insurance carrier(s) from any liability that it may have to the District, faculty member or beneficiary of any faculty member.

HOSPITALIZATION AND MAJOR MEDICAL INSURANCE. The group major medical, vision and dental insurance policy will be maintained by the District throughout the term of this Agreement. The District reserves the right to institute cost containment measures relative to insurance coverage so long as the basic level of insurance benefits remains substantially similar to the insurance coverage in effect at the time of this Agreement. Such changes may include, but are not limited to mandatory second opinions for elective surgery, pre-admission and continuing admission review, prohibition on weekend admissions except in emergency situations and mandatory out-patient elective surgery for certain designated surgical procedures. The Board may provide a high-deductible insurance plan with a Health Reimbursement Account. The Health Reimbursement Account shall be funded solely by the Board and not by the employees. Employees shall be reimbursed for all additional amounts actually paid because of the higher deductible that would not have been assessed against the current deductible in the network. Reimbursement requests shall not be denied without written explanation describing the reason(s) for the denial and stating any necessary steps required to have the reimbursement approved. Such explanation must be provided within a reasonable amount of time from the employee's submission of a reimbursement request. Reimbursement will be concluded within ten business days of submission of a reimbursement request. A reimbursement request form will be available on the district employee portal Through the term of this contract, the District will pay the individual members group major medical, vision and dental insurance policy premium for all full-full time faculty. The term of the insurance will run from the first day of the contract year September 1st to August 31st. All new employees will start on the first of the month following their start day. New employees hired after September 1st will begin insurance the 1st of the next month, unless the start date is before the 10th of said month, they will begin insurance immediately. Through the term of this contract, all full time Association members will pay a monthly contribution toward their major medical, dental and vision insurance. All full-full time teachers will pay 9.5% of the cost of medical, dental, vision not to exceed $840 per year. Any changes to the deductible and out of pocket costs of any insurance program, except for out of network costs, will not affect the employee. Employee deductibles and out of pocket costs shall remain as follows: in-network out-of-network Deductible-single $500 $5000 Deductible-Family $1500 $15,000 OOP-Single $2500 $9000 OOP-Family $7500 $20,400 The District will pay a proportional share of the individual part time teacher’s medical/vision/dental insurance based on the part time employee’s FTE. Employees that work less than 30 hours per week (.82 FTE) will not qualify for life insurance. A teacher will not be required to accept District insurance. Full time faculty members may elect dependent coverage with the premiums for the coverage deducted through payroll deductions. For full time faculty members that choose dependent coverage, the District will contribute 6545% of the employee’s family dependent medical premium to offset the cost. The Board contribution to employee’s family dependent coverage will not exceed $1,500 a month. In the event that other employee dependent options are available and the employee meets the qualifications in the preceding sentence, the District will contribute 5015% of the employee’s spouse only medical premium, and 5013% of the employee’s child/children only medical premium. The Board contribution to the employee’s spouse only and child/children only medical premium will not exceed $1,200 a month. The District will not contribute toward the employee’s dependent dental or vision insurance premium. A District directed insurance committee; including members of the Association shall convene no later than February, and annually to begin assessment of the current coverage. The committee will investigate alternative insurance carriers, coverage and related matters to advise the District. Nothing herein shall be construed to limit the District's discretion as to the carrier or the insurance policy at the time. The extent of coverage under any insurance policies referred to in this agreement shall be governed by the terms and conditions as set forth in the policies. Any questions or disputes concerning the insurance policies or benefits there under shall be resolved in accordance with the terms set forth in said policies and shall not be subject to the grievance and arbitration procedure set forth in this agreement. The failure of any insurance carrier(s) to provide any benefit for which it is contracted or is obligated shall result in no liability to the District, nor shall such failure be considered by a breach of the District of any obligation undertaken under this or any other agreement. However, nothing in this agreement shall be construed to relieve any insurance carrier(s) from any liability that it may have to the District, faculty member or beneficiary of any faculty member.

HOSPITALIZATION AND MAJOR MEDICAL INSURANCE. The group major medicalBoard, vision and dental insurance policy will be maintained by the District throughout the term of this Agreement, will maintain a group major medical and dental insurance policy. The District Board reserves the right to institute cost containment measures relative to insurance coverage so long as the basic level of insurance benefits remains substantially similar to the insurance coverage in effect at the time of this Agreementthat time. Such changes may include, but are not limited to to, mandatory second opinions for elective surgery, pre-admission and continuing admission review, and prohibition on weekend admissions except in emergency situations situations, and mandatory out-patient outpatient elective surgery for certain designated surgical procedures. Through the term of this contract the Board will pay the individual member’s group major medical and dental insurance policy premium for all full-time employees. For purposes of this Article, full time employees are defined as employees who work and are paid for over 7.5 hours a day on a five-day a week basis for the school year. Employees who are currently insured as of July 1, 2019 and working 30 hours or more per week will continue to qualify for insurance as long as they continue in the same position, inclusive of being honorably dismissed and recalled to that same position. The Board may provide a high-deductible insurance plan with a Health Reimbursement Account. The Health Reimbursement Account shall be funded solely by the Board and not by the employees. Employees shall be reimbursed for all additional amounts actually paid because of the higher deductible that would not have been assessed against the current deductible deductibles set forth in the networktable below. Reimbursement requests shall not be denied without written explanation describing the reason(s) for the denial and stating any necessary steps required to have the reimbursement approved. Such explanation must be provided within a reasonable amount of time from the employee's submission of a reimbursement request. Reimbursement will be concluded within ten business days of submission of a reimbursement request. A reimbursement request form will be available on the district employee portal portal. Any changes to the deductible and out of pocket costs of any insurance program, except for out of network costs, will not affect the employee. Employee deductibles and out of pocket costs shall remain as follows: Table 1 In-network Out-of-network Single $ 500 $ 5,000 Family $1,500 $15,000 OOP-Single $2,500 $ 9,000 OOP-Family $7,500 $20,400 Through the term of this contract, the District will pay the individual members group major medical, vision and dental insurance policy premium for all full-time facultyemployees. The term of the insurance will run from the first day of the contract year September 1st to August 31st. All new employees will start on the first of the month following their start day. New employees hired after September 1st will begin insurance the 1st of the next month, unless the start date is before the 10th of said month, they will begin insurance immediately. Through the term of this contract, all full time Association members will pay a monthly contribution of $10.00 toward their major medical, dental and vision insurance. All fullFull-time teachers will pay 9.5% of the cost of medical, dental, vision not employees that elect to exceed $840 per year. Any changes to the deductible and out of pocket costs of any insurance program, except for out of network costs, will not affect the employee. Employee deductibles and out of pocket costs shall remain as follows: in-network out-of-network Deductible-single $500 $5000 Deductible-Family $1500 $15,000 OOP-Single $2500 $9000 OOP-Family $7500 $20,400 The District will pay a proportional share of the individual part time teacher’s medical/vision/dental insurance based on the part time employee’s FTE. Employees that work less than 30 hours per week (.82 FTE) will not qualify for life insurance. A teacher will not be required to accept District insurance. Full time faculty members do so may elect choose dependent coverage with the premiums for the coverage deducted paid through payroll deductions. Employees may elect to do so annually during the open enrollment window. In the event a current part-time employee becomes a full-time employee the employee shall be eligible to take advantage of this provision. For full time faculty members that choose dependent coverage, the District will contribute 6545% of the employee’s family dependent medical premium to offset the cost. The Board contribution to employee’s family dependent coverage will not exceed $1,500 a month. In the event that other employee dependent options are available and the employee meets the qualifications in the preceding sentenceavailable, the District will contribute 5015% of the employee’s spouse only medical premium, premium and 5010% of the employee’s child/children only medical premium. The Board contribution to the employee’s spouse only and child/children only medical premium will not exceed $1,200 a month. The District will not contribute toward the employee’s dependent dental or vision insurance premium. Employees who choose not to take dependent health coverage during the annual open enrollment who experience life-changing circumstances that terminate other insurance coverage or add additional dependents may opt for dependent coverage outside the annual window within thirty (30) days of said life-changing circumstances. A District Board directed insurance committee; , including members of the Association NBESS, shall convene annually no later than February, and annually February to begin assessment of the current coverage. The committee will investigate alternative insurance carriers, coverage coverage, and related matters to advise the DistrictBoard. Nothing herein shall be construed to limit the District's Board’s discretion as to the carrier or the insurance policy at the time. The extent of coverage under any insurance policies referred to in this agreement shall be governed by the terms and conditions as set forth in the policies. Any questions or disputes between the insurance provider and the insured concerning the insurance policies or benefits there under hereunder shall be resolved in accordance with the terms set forth in said policies and shall not be subject to the grievance and arbitration procedure set forth in this agreement. The failure of any insurance carrier(s) to provide any benefit for which it is contracted or is obligated shall result in no liability to the District, nor shall such failure be considered by a breach of the District of any obligation undertaken under this or any other agreement. However, nothing in this agreement shall be construed to relieve any an insurance carrier(s) from any liability that it may have to the DistrictBoard, faculty member employee or beneficiary of any faculty memberan employee. An employee will not be required to accept District insurance.

HOSPITALIZATION AND MAJOR MEDICAL INSURANCE. The group major medical, vision and dental insurance policy will be maintained by the District throughout the term of this Agreement. The District reserves the right to institute cost containment measures relative to insurance coverage so long as the basic level of insurance benefits remains substantially similar to the insurance coverage in effect at the time of this Agreement. Such changes may include, but are not limited to mandatory second opinions for elective surgery, pre-admission and continuing admission review, prohibition on weekend admissions except in emergency situations and mandatory out-patient elective surgery for certain designated surgical procedures. The Board may provide a high-deductible insurance plan with a Health Reimbursement Account. The Health Reimbursement Account shall be funded solely by the Board and not by the employees. Employees shall be reimbursed for all additional amounts actually paid because of the higher deductible that would not have been assessed against the current deductible in the network. Reimbursement requests shall not be denied without written explanation describing the reason(s) for the denial and stating any necessary steps required to have the reimbursement approved. Such explanation must be provided within a reasonable amount of time from the employee's submission of a reimbursement request. Reimbursement will be concluded within ten business days of submission of a reimbursement request. A reimbursement request form will be available on the district employee portal Through the term of this contract, the District will pay the individual members group major medical, vision and dental insurance policy premium for all full-full time faculty. The term of the insurance will run from the first day of the contract year September 1st to August 31st. All new employees will start on the first of the month following their start day. New employees hired after September 1st will begin insurance the 1st of the next month, unless the start date is before the 10th of said month, they will begin insurance immediately. Through the term of this contract, all full time Association members will pay a monthly contribution toward their major medical, dental and vision insurance. All full-full time teachers will pay 9.5% of the cost of medical, dental, vision not to exceed $840 per year. Any changes to the deductible and out of pocket costs of any insurance program, except for out of network costs, will not affect the employee. Employee deductibles and out of pocket costs shall remain as follows: in-network out-of-network Deductible-single $500 $5000 Deductible-Family $1500 $15,000 OOP-Single $2500 $9000 OOP-Family $7500 $20,400 The District will pay a proportional share of the individual part time teacher’s medical/vision/dental insurance based on the part time employee’s FTE. Employees that work less than 30 hours per week (.82 FTE) will not qualify for life insurance. A teacher will not be required to accept District insurance. Full time faculty members may elect dependent coverage with the premiums for the coverage deducted through payroll deductions. For full time faculty members that choose dependent coverage, the District will contribute 65% of 45%of the employee’s family dependent medical premium to offset the cost. The Board contribution to employee’s family dependent coverage will not exceed $1,500 a month. In the event that other employee dependent options are available and the employee meets the qualifications in the preceding sentence, the District will contribute 50% of 15%of the employee’s spouse only medical premium, and 50% of 13%of the employee’s child/children only medical premium. The Board contribution to the employee’s spouse only and child/children only medical premium will not exceed $1,200 a month. The District will not contribute toward the employee’s dependent dental or vision insurance premium. A District directed insurance committee; including members of the Association shall convene no later than February, and annually to begin assessment of the current coverage. The committee will investigate alternative insurance carriers, coverage and related matters to advise the District. Nothing herein shall be construed to limit the District's discretion as to the carrier or the insurance policy at the time. The extent of coverage under any insurance policies referred to in this agreement shall be governed by the terms and conditions as set forth in the policies. Any questions or disputes concerning the insurance policies or benefits there under shall be resolved in accordance with the terms set forth in said policies and shall not be subject to the grievance and arbitration procedure set forth in this agreement. The failure of any insurance carrier(s) to provide any benefit for which it is contracted or is obligated shall result in no liability to the District, nor shall such failure be considered by a breach of the District of any obligation undertaken under this or any other agreement. However, nothing in this agreement shall be construed to relieve any insurance carrier(s) from any liability that it may have to the District, faculty member or beneficiary of any faculty member.