Level of Benefits in the Point of Service (POS) Plan. The University shall continue in force, for the term of this Agreement, the POS plan as described in Appendices B-1 and B-2. Except as noted in Appendix B, the POS plan shall provide at least the same coverage and level of benefits as provided under the prior CBA. There shall be no decrease in these benefits over the term of this Agreement. The plan changes described in Appendix B-1 will go into effect on January 1, 2017. The plan changes described in Appendix B-2 will go into effect on January 1, 2019. In addition, the reimbursement rate for each covered out-of- network medical procedure or service, shall be, at a minimum, set at 395% of the National Medicare schedules. In the event that the University’s POS health plan triggers the excise tax under the Affordable Care Act (i.e., the “Cadillac Tax”), then on the first day of the plan year in which that tax would take effect, the University will first cease contributions to the Flex-Plan and Health Reimbursement Accounts, if any, and pay the funds designated by the member or required by this Agreement in the form of wages. In addition, in the event that these actions are not sufficient to avoid the effect of the Cadillac Tax, the University may also modify the in- network POS plan design as set forth in the University’s plan design option framework dated July 11, 2016 to the extent required to avoid the tax (attached as Appendix E).
Level of Benefits in the Point of Service (POS) Plan. The University shall continue in force, for the term of this Agreement, a POS plan as specified in the 2012 SPD. Except as noted herein, the POS plan shall provide at least the same coverage and level of benefits as provided under the prior CBA. There shall be no decrease in these benefits over the term of this Agreement. Effective January 1, 2012, the plan changes identified in the Summary of Benefits dated January 1, 2012 attached as Appendix B will go into effect. In addition, the reimbursement rate for each covered out-of-network medical procedure or service, shall be, at a minimum, set at 395% of the National Medicare schedules. The copayment on the prescription drug plan shall be $10/$25/$40, respectively for generic, formulary and preferred. One hundred (100%) percent of covered expenses, exclusive of copayments and deductibles, shall be reimbursed after an out-of-pocket expenditure of three thousand ($3,000) dollars for individual coverage and six thousand ($6,000) dollars for family coverage.
