Common use of Hospitalization and Major Medical Clause in Contracts

Hospitalization and Major Medical. 14.01 The Buckeye Local Board of Education shall make available to each certified employee hospitalization and major medical insurance, dental insurance and prescription coverage. Beginning FY 2019 All existing employees will be offered the following: HMO Plan Deductibles: $500 Single/$1,000 Family Employees Share: 10% Board Share: 90% *All plans are defined as inclusive of the combined premium of medical and dental. Option B will be the only plan available for new employees hired on or after September 1, 2019. Xxxxxxxxxxx Agency Inc. BUCKEYE LOCAL SCHOOLS HMO $20 W/$500 Deductible Option B – HMO $20 W/$2,000 Deductible Benefits: In-Network In-Network Annual Deductible Single Family Coinsurance Plan Year Deductible $500 $1,000 0% Plan Year Deductible $2,000 $4,000 0% Out of Pocket maximum (includes Deductible in OOP) Single Family Lifetime Maximum Includes deductible, medical & RX Copays $6,850 $13,700 Unlimited Includes deductible, medical & RX Copays $6,850 $13,700 Unlimited Physician Office Visit Primary Care Specialist Preventative $20 copay $20 copay No Cost Share $20 copay $20 copay No Cost Share Hospital Services $0 after deductible $0 after deductible Emergency Services Urgent Care Emergency Room $35 copay $150 copay $35 copay $150 copay Other Services Durable Medical Equipment & Prosthetics (see certificate for limitations) Spinal Manipulation $0 after deductible (Limited to Plan’s basic allowance) $20 Copay-20 Visit Limit $0 after deductible (Limited to Plan’s basic allowance) $20 Copay-20 Visit Limit Notes: Insulin pumps & supplies, durable medical equipment, prosthetics, and orthotics are covered at 100%, after deductible, limited to Plan’s basic allowance. Biofeedback therapy, family planning, and infertility services are covered at 100% after deductible. (See certificate of coverage for limitations) Insulin pumps & supplies, durable medical equipment, prosthetics & orthotics are covered at 100%, after deductible, limited to Plan’s basic allowance. Biofeedback therapy, family planning & infertility services are covered at 100% after deductible (see certificate of limitations) Prescription Drugs OOP Maximum None None Retail Tier 1 Tier 2 Tier 3 Tier 4 $10 copay $20 copay $50 copay 30% coins or $300 copay $10 copay $20 copay $50 copay 30% coins or $300 copay Mail Order Tier 1 Tier 2 Tier 3 Tier 4 $25 copay $50 copay $125 copay 30% or $300 $25 copay $50 copay $125 copay 30% or $300 For a complete list of Benefit changes and limitations, please see the Health Plan summary of benefits or certificate of coverage The dual health insurance coverage is no longer permitted. Married couples, which are both employed by the School District are eligible for either one of the following:

Hospitalization and Major Medical. 14.01 The Buckeye Local Board of Education shall make available to each certified employee hospitalization and major medical insurance, dental insurance and prescription coverage. Beginning FY 2019 All existing employees will be offered the following: HMO Plan Deductibles: $500 Single/$1,000 Family Employees Share: 10% Board Share: 90% *All plans are defined as inclusive of the combined premium of medical and dental. Option B will be the only plan available for new employees hired on or after September 1, 2019. Xxxxxxxxxxx Agency Inc. BUCKEYE LOCAL SCHOOLS HMO $20 W/$500 Deductible Option B – HMO $20 W/$2,000 Deductible Benefits: In-Network In-Network Annual Deductible Single Family Coinsurance Plan Year Deductible Plan Year Deductible Single $500 $2,000 Family $1,000 $4,000 Coinsurance 0% Plan Year Deductible $2,000 $4,000 0% Out of Pocket maximum (includes Deductible in OOP) Single Family Lifetime Maximum Includes deductible, medical & Includes deductible, maximum (includes RX Copays medical & RX Copays. Deductible in OOP) $6,850 $13,700 Unlimited Includes deductible, medical & RX Copays $6,850 Single $13,700 $13,700 Family Unlimited Unlimited Lifetime Maximum Physician Office Visit Primary Care Specialist Preventative $20 copay $20 copay No Cost Share Specialist $20 copay $20 copay Preventative No Cost Share No Cost Share Hospital Services $0 after deductible $0 after deductible Emergency Services Urgent Care Emergency Room $35 copay $150 copay $35 copay $150 copay Other Services Durable Medical Equipment & Prosthetics (see certificate for limitations) Spinal Manipulation $0 after deductible (Limited to Plan’s basic allowance) $0 after deductible (Limited to Plan’s basic allowance) $20 Copay-20 Visit Limit $0 after deductible (Limited to Plan’s basic allowance) $20 Copay-20 Visit Limit Spinal Manipulation Notes: Insulin pumps & supplies, durable medical equipment, prosthetics, and orthotics are covered at 100%, after deductible, limited to Plan’s basic allowance. Biofeedback therapy, family planning, and infertility services are covered at 100% after deductible. (See certificate of coverage for limitations) Insulin pumps & supplies, durable medical equipment, prosthetics & orthotics are covered at 100%, after deductible, limited to Plan’s basic allowance. Biofeedback therapy, family planning & infertility services are covered at 100% after deductible (see certificate of limitations) Prescription Drugs OOP Maximum None None Retail Tier 1 Tier 2 Tier 3 Tier 4 $10 copay $20 copay $50 copay 30% coins or $300 copay $10 copay $20 copay $50 copay Tier 4 30% coins or $300 copay 30% coins or $300 copay Mail Order Tier 1 Tier 2 Tier 3 Tier 4 $25 copay $25 copay Tier 2 $50 copay $50 copay Tier 3 $125 copay $125 copay Tier 4 30% or $300 $25 copay $50 copay $125 copay 30% or $300 For a complete list of Benefit changes and limitations, please see the Health Plan summary of benefits or certificate of coverage coverage. The dual health insurance coverage is no longer permitted. Married couples, which are both employed by the School District are eligible for either one of the following:

Hospitalization and Major Medical. 14.01 The Buckeye Local Board of Education shall make available to each certified employee hospitalization and major medical insurance, dental insurance and prescription coverage. Beginning FY 2019 All existing employees will be offered the following: HMO Health Insurance Plan Deductibles: $500 Single/$1,000 Family Employees Share: 10% Board Share: 90% *All plans are defined as inclusive of the combined premium of medical and dental. Option B will be the only plan available for new employees hired on or after September 1, 2019. Xxxxxxxxxxx Agency Inc. BUCKEYE LOCAL SCHOOLS HMO Option A - Health Insurance $20 W/$500 Deductible Option B – HMO –Health Insurance $20 W/$2,000 Deductible Benefits: In-Network In-Network Annual Deductible Single Family Coinsurance Plan Year Deductible Plan Year Deductible Single $500 $2,000 Family $1,000 $4,000 Coinsurance 0% Plan Year Deductible $2,000 $4,000 0% Out of Pocket maximum (includes Deductible in OOP) Single Family Lifetime Maximum Includes deductible, medical & RX Copays $6,850 $13,700 Unlimited Includes deductible, medical & maximum (includes RX Copays RX Copays. Deductible in OOP) $6,850 $6,850 Single $13,700 $13,700 Family Unlimited Physician Office Visit Unlimited Primary Care Specialist Preventative $20 copay $20 copay No Cost Share Specialist $20 copay $20 copay Preventative No Cost Share No Cost Share Hospital Services $0 after deductible $0 after deductible Emergency Services Urgent Care Emergency Room $35 copay $150 copay $35 copay $150 copay Other Services Durable Medical Equipment & Prosthetics (see certificate for limitations) Spinal Manipulation $0 after deductible (Limited to Plan’s basic allowance) $0 after deductible (Limited to Plan’s basic allowance) $20 Copay-20 Visit Limit $0 after deductible (Limited to Plan’s basic allowance) $20 Copay-20 Visit Limit Spinal Manipulation Notes: Insulin pumps & supplies, durable medical equipment, prosthetics, and orthotics are covered at 100%, after deductible, limited to Plan’s basic allowance. Biofeedback therapy, family planning, and infertility services are covered at 100% after deductible. (See certificate of coverage for limitations) Insulin pumps & supplies, durable medical equipment, prosthetics & orthotics are covered at 100%, after deductible, limited to Plan’s basic allowance. Biofeedback therapy, family planning & infertility services are covered at 100% after deductible (see certificate of limitations) Prescription Drugs OOP Maximum None None Retail Tier 1 $10 copay $10 copay Tier 2 Tier 3 Tier 4 $10 copay $20 copay $50 copay 30% coins or $300 copay $10 copay $20 copay $50 copay 30% coins or $300 copay Mail Order Tier 1 Tier 2 Tier 3 Tier 4 $25 copay $50 copay $125 copay 30% or $300 $25 copay $50 copay $125 copay 30% or $300 For a complete list of Benefit changes and limitations, please see the Health Plan summary of benefits or certificate of coverage coverage. The dual health insurance coverage is no longer permitted. Married couples, which are both employed by the School District are eligible for either one of the following: