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
Major Medical. Your major medical plan will pay reasonable charges for the following if medically necessary: - by a licensed hospital, limited to semi-private accommodations including out-patient charges, in Canada, and for a temporary period outside Canada in the case of a resident of Canada who requires hospitalization due to an emergency while travelling or on vacation or because treatment is not available in Canada. In all cases, charges by a chronic or convalescent hospital for a covered person 65 years of age or over, shall be excluded. - for services rendered outside the province of residence of the covered person, and excludes such services rendered outside Canada except when such services are required due to an emergency while travelling or on vacation or when treatment is not available in Canada, by a physician, legally licensed to practice medicine, in excess of the charges allowed under the health insurance plan of the province of residence of the covered person. The maximum amount payable by the company for such services shall not exceed the amount specified in the fee schedule of the province of residence of the covered person, except in the case of an emergency while the covered person is travelling or on vacation or when treatment is not available in Canada when the amount payable shall be unlimited. - for 90% of drugs and medicines which require the written prescription of a physician or dentist for purchase, excluding the following:
Major Medical. The Major Medical benefit is designed to complement the Provincial Health Plan. Should the Provincial Plan change to include any of the expenses currently eligible under this plan, the Sifto Canada Plan will automatically adjust accordingly. Major Medical benefits are extended to employees (and their eligible dependants) who continue active employment with the Company after age sixty-five (65) years of age. The benefit pays a percentage of all eligible expenses, including skilled nursing care and outpatient care, recommended as necessary by a physician which are reasonable and customary in the area in which the expenses are incurred and which are in excess of any other benefits payable under this plan and in excess of the deductible.
i) The deductible is the amount of eligible expenses each calendar year which must be paid in full by the employee before any benefits are payable. The deductible is twenty-five dollars ($25.00) for those insured for employee only coverage; or fifty dollars ($50.00) for those insured for employee and dependent coverage. Eligible expenses incurred in the last three (3) months of the calendar year which are not sufficient to be applied against the deductible for that year will also be applied against the deductible for the next year.
ii) The appropriate portion of the following expenses will be paid, provided the expenses charged are reasonable and medically necessary: Prescription Drugs at one hundred percent (100%) after co- pay as provided by the Prescription Card system described in the plan booklet Mental and Nervous Disorders payable at eighty percent (80%) General and Medical Expenses payable at eighty percent (80%). This benefit provides eighty percent (80%) coverage for initial placement of insulin pumps and, eighty percent (80%) coverage for insulin pump replacements every twenty-four (24) months. The Major Ontario Medical benefit shall provide coverage for emergency treatment outside Ontario. The plan will reimburse emergency treatment costs according to reasonable and customary fees for the area in which they were incurred as follows:
1) in excess of the benefits provided by the provincial hospital insurance program and under the basic hospital benefit, for a maximum of thirty-one (31) days per period of disability,
2) for the professional services of a physician over and above the amounts recognized by OHIP. This coverage is subject to any and all other plan provisions (e.g. deductible). Employees should refer to th...
Major Medical. Executive shall be provided with major medical insurance unless Executive elects to retain his current insurance whereby Company agrees to pay for same as long as the amount paid by Company does not exceed any sum paid for major medical insurance for any senior executive of the Company. Any amount over and above shall be borne by and be the responsibility of the Executive.
Major Medical. The Board will annually provide a fully paid individual major medical plan to all regular full-time bargaining unit employees. The Board will also make available major medical benefit plan(s) at an additional cost above the fully paid Board contribution for individual coverage. If an employee’s regular employment ends during the course of the twelve month period of the plan, the benefits will end on the employee’s last work day of that active employment. However, if the employee successfully completes their contract year as evidenced by reappointment or if the employee would have been reappointed as evidenced by a satisfactory evaluation, but is not reappointed due to a reduction in force, or because the employee chooses to resign, the coverage will continue through the day prior to the start of the work calendar for the new School year. The employee may continue these benefits after these dates in accordance with the COBRA law by paying the premium. The full annual premium cost to the Board for the group health insurance package shall be considered a vital part of the employee's compensation. The full amount of premium increase from year to year shall be considered as a benefit increase in lieu of a salary increase deducted from dollars available for salary increases. Specific benefits shall be as delineated in “The School District of Osceola County Florida Medical Indemnity Plan Document” and shall be available through the Risk Management Office. The plan summary, including “Coverages” and “Exclusions/Limitations,” will be provided to every employee. The Association and the individual employees shall be notified prior to any plan changes. The insurance carrier shall be decided upon by the Board. Dependent coverage shall be available at the expense of the employee. Where two members of the same family are employed by the School District, the total amount paid for the spouse shall be credited toward the cost of dependent coverage. Employees may request that physicians be added to the plans(s) through the insurance committee; however, it is understood the network provider makes the determination. When an employee chooses to participate in a health plan, the employee may choose any of the employee paid dental plans available for their dependents.
Major Medical. The Employer agrees to implement a major medical $10 -$20 No Co-Insurance Plan (similar to Blue Cross E.H.
Major Medical. The Company shall provide a Major Medical Supplement Program that shall provide an eighty (80%) percent co-insurance benefit. (see Appendix '1') A pay direct prescription drug card will be issued to all eligible employees to be utilized at pharmacies who honour this card system. This drug program will provide eighty (80%) percent coverage of all eligible prescriptions and eighty (80%) percent for dispensing fees to a maximum of eight dollars ($8.00) paid by the Company. In instances where the prescription drug card system cannot be utilized, the claim may be submitted to the insurance carrier on the prescribed form. This program will cover cost of drugs which are prescribed by a legally licensed medical practitioner or chiropractor and will cover drugs which require a legal prescription only. No other drugs will be covered by this plan, regardless of whether or not they are prescribed. Co-ordination of benefits will apply to both to the prescription drug card and the reimbursement system.
Major Medical. The Employer agrees to pay one hundred percent (100%) of the billed single/family rate, whichever is applicable, for employees who participate in the plan. If an employee is otherwise covered, the employer shall not be obligated to contribute. The Employer will continue the drug card with a seven dollars and fifty cents ($7.50) dispensing fee cap and a one dollar ($1.00) deductible per prescription (positive enrolment to be included). Reimbursement for prescribed drugs covered by the Plan will be based on the cost of the lowest cost interchangeable drug, unless there is a documented adverse reaction to the drug or where the employee’s doctor stipulates in writing that there are other medical reasons why the lowest cost interchangeable drug cannot be prescribed.
Major Medical. The Employer agrees to pay one hundred percent (100%) of the billed single/family rate, whichever is applicable, for employees who participate in the plan. If an employee is otherwise covered, the Employer shall not be obligated to contribute. Reimbursement for prescribed drugs covered by the Plan will be based on the cost of the lowest cost interchangeable drug, unless there is a documented adverse reaction to the drug or where the employee’s doctor stipulates in writing that there are other medical reasons why the lowest cost interchangeable drug cannot be prescribed. The Employer will continue the drug card with a seven dollars and fifty cents ($7.50) dispensing fee cap and a one dollar ($1.00) deductible per prescription (positive enrolment to be included).
Major Medical. The Employer will provide a Major Medical Plan providing for a Drug Card with a seven dollar and fifty cent ($7.50) dispensing cap fee and a one dollar ($1.00) deductible per prescription for employees covered by this Agreement who have completed their probationary period. The Employer agrees to pay one hundred percent (100%) of the billed single/family rate, whichever is applicable, for employees who participate in the plan.
a. Amend the generic drug substitution provision to provide for: • Lowest cost interchangeable drug • Enhanced generic – requires medical evidence for drugs where physician indicates “no substitution” • Lowest priced drug in a therapeutic class
b. The Plan will include a paramedical coverage bank which covers the following services from paramedical providers who are licensed or registered in the province of Canada in which the services are provided: • Osteopath • Chiropractor • Podiatrist or Chiropodist • Naturopath or Homeopath • Audiologist • Physiotherapist • Psychologist • Speech Therapist • Acupuncturist • Massage therapist • Ophthalmologist or optometrist to a maximum of seven hundred and fifty dollars ($750.00) insured person/year. Coverage for any and all paramedical services as set out above requires a written referral from the employee’s physician.
