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”). 12.3.2 The Board shall provide Preferred Provider Plans as follows: 12.3.2.1 Eligible teachers employed on or before July 1, 2008, wanting health insurance coverage, including prescription drug coverage, shall choose from the PPO plans as offered by the Consortium and shown in Appendix D of this Agreement. Such eligible teachers choosing coverage shall contribute as follows: During the Agreement PP0-1 shall contribute 10% and PP0-2 shall contribute 10%, while eligible teachers choosing PP0-3 shall pay no premium costs. Eligible teachers employed after July 1, 2008, shall choose from PP0-2 or PP0-3. Such eligible teachers choosing PP0-2 shall contribute 10% of the monthly premium costs by payroll deduction, while eligible teachers choosing PP0-3 shall pay no premium costs. Any subsequent change from one of the PPO plans may be made only during the annual open enrollment period or in response to a major change recognized by the insurer as "catastrophic" such as due to the death of a spouse, divorce, marriage, etc. Eligible teachers employed after July 1, 2008, may change between PP0-2 or PP0-3 only. Upon effecting this change, the eligible teacher shall pay the required percent of the monthly premium costs each month by payroll deduction. The amount of the monthly premium cost to the eligible teacher, shall not exceed 10% of the premium for PP0-1 or 10% of the premium for PP0-2. Eligible part-time teachers (those employed .5 F.T.E. or more) shall receive such coverage on a pro-rata board share basis based upon a 7.25 hour workday. 12.3.2.2 If the Board receives a premium holiday from the Consortium, the amount of the eligible teacher contribution of the premium holiday shall be passed on to the participating eligible teachers. 12.3.2.3 The level of healthcare benefits for the overall plan shall not be lessened for the term of this Agreement. If the benefit levels for any of the plans described herein become enriched during the life of this Agreement, such enriched benefit levels shall apply to eligible teachers enrolled in the particular plans. 12.3.2.4 The Board agrees to provide an Int...
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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. 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.) B. The maximum coinsurance out-of-pocket expense (single/family) under the PPO plan shall be $1,000 single/$2,000 family in network and $3,000 single/$6,000 family out-of-network. C. The maximum benefit period deductible (single/family) shall be $500 single/$1,000 family in network and $1,500 single/$3,000 family out-of-network.
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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. 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. 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. 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 copay Deductible, 20% copay Childhood Immunizations ...
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Related to Hospitalization, Surgical, and Major Medical

  • 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. 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. 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.

  • Medical Care Leave An Employee who is unable to make the necessary arrangements for maintenance of personal health care outside of scheduled work time, shall be granted time off with pay. Such time off shall not exceed sixteen (16) working hours per calendar year. Hours in excess of sixteen (16) hours per calendar year shall be deducted from the Employee's sick leave accumulation.

  • 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.

  • Prosthodontics We Cover prosthodontic services as follows:

  • Pharmacy Pharmacy hereby represents that neither Pharmacy, nor, to the best of Pharmacy’s knowledge, Pharmacist, Pharmacy’s employees, agents or independent

  • Clinical Management for Behavioral Health Services (CMBHS) System 1. request access to CMBHS via the CMBHS Helpline at (000) 000-0000. 2. use the CMBHS time frames specified by System Agency. 3. use System Agency-specified functionality of the CMBHS in its entirety. 4. submit all bills and reports to System Agency through the CMBHS, unless otherwise instructed.

  • Health Care Operations “Health Care Operations” shall have the same meaning as the term “health care operations” in 45 CFR §164.501.

  • Chiropractic Services This plan covers chiropractic visits up to the benefit limit shown in the Summary of Medical Benefits. The benefit limit applies to any visit for the purposes of chiropractic treatment or diagnosis.

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