Hospitalization, Surgical, and Major Medical Sample Clauses

Hospitalization, Surgical, and Major Medical. 12.3.1 The Board shall provide hospitalization, major medical, dental, and vision insurance policies for each eligible teacher, the teacher’s spouse, and eligible dependent children. The hospitalization and major medical insurance shall be provided through and in accord with the medical plan options provided by the Trumbull County Schools Insurance Consortium (“Consortium”).
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Hospitalization, Surgical, and Major Medical. The City will continue to provide comprehensive hospitalization, surgical and major medical coverage for all full-time members and their dependents. Beginning January 1, 1999, or at some date thereafter, the City may implement a Preferred Provider Organization (PPO). The Plan if implemented will provide for the following deductibles and co-payments as follows: NETWORKS PROVIDERS NON-NETWORK PROVIDERS Annual Deductible Single Family None None $ 500.00 $1000.00 Office Visit Co-pay $10.00 NIA ER Visit Co-Pay $50.00 unless admitted into the hospital, otherwise co- insurance will apply in excess of the deductible NIA Co-insurance Single Family 90110% of first $1,000 80/20% of next $3,000 90110% of first $2,000 80120% of next $5,000 50150% of first $5,000 50150% of first $10,000 The parties acknowledge that all of the "wellness benefits" added to the plan effective January 1, 1992 are subject to all of the generally applicable plan limits, such as deductibles and co-payments. Contributions will be deducted from the member's gross income prior to taxes, subject to compliance with all applicable federal tax regulations. Effective January 1, 2012 employees will contribute to the cost of the health benefit plan in an amount equal to 11% of the established monthly COBRA rate utilized by the City. Effective January 1, 2013 employees will contribute to the cost of the health benefit plan in an amount equal to 15% of the established monthly COBRA rate utilized by the City. Annually, on April of the following years, the percentage of COBRA will be established. Annual changes to the calculated COBRA rate will be applied to the monthly employee contributions on the first full pay period in April of each year. Contributions will be deducted from all members in a paid status based on twelve (12) months times the monthly rate, divided by the number of pay periods per year (26). An example would be: $68.33/mo. x 12 = $819.96, $819.96/26 pay periods= $31.53 per pay period. In the event federal tax regulations are changed so that medical benefit plans are no longer tax exempt, the City will not be responsible to pick up the member's tax burden. The City will permit employees who have alternate health options through a spouse to opt out of the City plan in return for a payment of $100 per month. Families who have both spouses employed full time by the City of Delaware will not be eligible to opt out of the plan. One spouse will carry the cost of the plan. The employee will provid...
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Hospitalization, Surgical, and Major Medical. The Board agrees to pay on behalf of each employee who regularly works seven or more hours per day, eighty percent (80%) of the cost of a single, employee plus children, or family contract with major medical. For employees who regularly work less than seven hours per day, the percentage of the premium for such medical insurance to be paid by the Board shall be eighty percent (80%) multiplied by the fraction expressed as the number of hours such employee is regularly scheduled to work divided by seven (7).
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Hospitalization, Surgical, and Major Medical. The Board agrees to pay on behalf of each full time professional staff member eighty percent (80%) of the cost of a single, employee plus child, or family contract with major medical. For teachers who are part-time, the percentage of the premium for such medical insurance to be paid by the Board shall be eighty percent (80%) multiplied by the fraction expressed as the number of hours such teacher is regularly scheduled to work divided by seven and one-half (7 l/2). (See 7.07)
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Hospitalization, Surgical, and Major Medical. A. The Board will provide a PPO medical plan, and the employee's monthly contribution for employees who work twenty (20) hours or more of the school week shall be: 7/1/2019 – 6/30/2022 Family PPO Plan Year 1: Year 2: Year 3: $256.00 $276.00 $296.00 Single PPO Plan Year 1: Year 2: Year 3: $100.00 $110.00 $120.00 This coverage shall be for all employees who work twenty (20) hours or more of the school week with the provision that this coverage is to be non-duplicating. (Non-duplicating hospitalization insurance coverage means the employee and/or the employee's dependents are covered by only one payroll deduction hospitalization plan. Supplemental plans that would contain coverage beyond that supplied in the basic plan shall be permitted.)
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Hospitalization, Surgical, and Major Medical. A. The Board will provide a PPO medical plan, and the employee's monthly contribution for employees who work twenty (20) hours or more of the school week shall be Fifteen percent (15.0%) of the total premium, with the Board paying Eighty-five percent (85.0%) of the premium cost. This coverage shall be for all employees who work twenty (20) hours or more of the school week with the provision that this coverage is to be non-duplicating. (Non-duplicating hospitalization insurance coverage means the employee and/or the employee's dependents are covered by only one payroll deduction hospitalization plan. Supplemental plans that would contain coverage beyond that supplied in the basic plan shall be permitted.)
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Hospitalization, Surgical, and Major Medical. A Health Care Advisory Committee shall be established for the purpose of monitoring the use and effectiveness of the three health care plans offered, their cost to both the District and the bargaining unit members, and new options in health care as they become available. Additionally, the committee shall review recommendations made by the Lancaster-Lebanon Public School Employees’ Health Care Cooperative (“EHCC”) for the purpose of advising or making recommendations to the Board and or Association where effective changes in medical practice, coverage, or cost would provide such benefit as warrant changes to the Health Care Plan(s) during the term of the contract. In the event the EHCC recommends a uniform plan for districts in the County during the term of this contract, the parties shall meet to reach agreement on the appropriate timing and manner of implementation and any other related changes deemed necessary. The committee would consist of at least two representatives of both the District and Association appointed by their respective memberships and would meet prior to the enrollment period each year and/or at the request of either the District or the Association. The School District shall provide hospitalization, surgical and major medical benefits through the options shown below and employees shall pay a monthly contribution for such coverage in the amounts shown on Exhibit K. It is further agreed that, effective upon the signing of this agreement, no new enrollees shall be permitted in the indemnity plan. EASTERN LANCASTER COUNTY SCHOOL DISTRICT Choose to enroll in One of the Following Plans Effective 11/1/06** Current Indemnity Plan (No new enrollees) Preferred Provider Organization Plan (PPO) Health Maintenance Organization (HMO) Point-of-Service Plan In-Network Out-of-Network Physician Referral Non-Physician Referral Claim Forms Yes No Yes No Yes Pre-Admission (In Patient) N/A Physician Patient Physician Patient Annual Deductible ♦ Individual ♦ Family $200 $600 $200 $600 $400 $1.200 $0 $0 $400 $1,200 Co-Payment Annual Out-of-Pocket (including deductible except for Mental Health, Drug & Alcohol) ♦ Individual ♦ Family 80/20% to $2,000 $600 $1,800 80/20% to $2,000 $600 $1,800 80/20% to $4,000 $1,200 $3,600 $0 $0 80/20% to $4,000 $1,200 $3,600 Family Practice Physician Office Visits Deductible, 20% copay Deductible, 20% copay Deductible, 20% copay $10 copay Deductible, 20% copay Well Child Care from Birth Not Covered 100% Deductible, 20% copay $10 co...
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Related to Hospitalization, Surgical, and Major Medical

  • Hospitals a. In every Hospital:

  • Medical There shall be an open enrollment period for medical coverage in each year of this Agreement. An employee may elect no medical coverage during any open enrollment period. An employee who has elected no medical coverage may elect medical coverage during an open enrollment period. No pre-existing condition limitations will apply.

  • Major Medical Program provides benefits after basic coverage is exhausted, and for medical office visits, ambulance care and durable equipment. Notes: Deductible $100 per individual, $300/family Coinsurance 80/20 Stop Loss $2,000 per individual Outpatient Psychiatric Per State Mandate

  • 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. Residential Treatment Facility 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. Intermediate Care Services 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.

  • Hospitalization In the event an employee is hospitalized overnight, the employee will have access to their EIB accrual at the first day of absence due to the hospitalization. Same day surgery, if requiring five (5) or more days of recovery, may also be paid from the employee’s EIB account.

  • Orthodontics We Cover orthodontics used to help restore oral structures to health and function and to treat serious medical conditions such as: cleft palate and cleft lip; maxillary/mandibular micrognathia (underdeveloped upper or lower jaw); extreme mandibular prognathism; severe asymmetry (craniofacial anomalies); ankylosis of the temporomandibular joint; and other significant skeletal dysplasias. Procedures include but are not limited to: • Rapid Palatal Expansion (RPE); • Placement of component parts (e.g. brackets, bands); • Interceptive orthodontic treatment; • Comprehensive orthodontic treatment (during which orthodontic appliances are placed for active treatment and periodically adjusted); • Removable appliance therapy; and • Orthodontic retention (removal of appliances, construction and placement of retainers).

  • Prosthodontics We Cover prosthodontic services as follows: • Removable complete or partial dentures, for Members 15 years of age and above, including six (6) months follow-up care; • Additional services including insertion of identification slips, repairs, relines and rebases and treatment of cleft palate; and • Interim prosthesis for Members five (5) to 15 years of age. We do not Cover implants or implant related services. Fixed bridges are not Covered unless they are required: • For replacement of a single upper anterior (central/lateral incisor or cuspid) in a patient with an otherwise full complement of natural, functional and/or restored teeth; • For cleft palate stabilization; or • Due to the presence of any neurologic or physiologic condition that would preclude the placement of a removable prosthesis, as demonstrated by medical documentation.

  • Medical Exams 18.1: The Sheriff's Department may require a physical and/or psychological exam by a doctor, at the Employer's expense, to determine the employee's ability to perform his/her regular duties, if deemed appropriate. The employee may obtain a second opinion, at the employee's expense, and in the event there is a dispute between the Employer's doctor and the employee's doctor, both of these doctors shall select a third doctor, whose decision shall be final and binding on the parties. The expense for the third doctor's opinion shall be split 50-50 by the Employer and the employee if not covered by the employee's insurance.

  • Outpatient Dental Anesthesia Services This plan covers anesthesia services received in connection with a dental service when provided in a hospital or freestanding ambulatory surgical center and: • the use of this is medically necessary; and • the setting in which the service is received is determined to be appropriate. This plan also covers facility fees associated with these services.

  • Pharmacy Pharmacy hereby represents that neither Pharmacy, nor, to the best of Pharmacy’s knowledge, Pharmacist, Pharmacy’s employees, agents or independent contractors involved in the provision of services have been excluded from participation in any Federally-funded health care programs, including, but not limited to, Medicare and Medicaid.

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