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Medical and Pharmacy Coverage Sample Clauses

Medical and Pharmacy Coverage. The City will provide health insurance coverage to employees through a high deductible health plan with an associated health savings account (HSA) or a High Reimbursement Account (HRA). An HRA is for those employees ineligible for an HSA based on being covered by other healthcare coverage like Medicare or TriCare.
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Medical and Pharmacy Coverage. The City will provide health insurance coverage to Employees through a high deductible healthcare plan with an associated health savings account (HSA) or a Health Reimbursement Account (HRA). An HRA is for those employees ineligible for an HSA based on being covered by other healthcare coverage like Medicare or TRICARE. As a result of new Federal Regulations set forth by the Equal Employment Opportunity Commission (EEOC) pertaining to incentivizing wellness plans which go into effect on January 1, 2017, the following construct is agreed upon with 2017 being a transition year.
Medical and Pharmacy CoverageThe City shall make available group medical and pharmacy benefits to all employees and dependents who meet the eligibility of the plan. The plan design of this program shall be substantially the same as that in effect on December 31, 2013 with the following exceptions, which shall become effective upon execution of this Agreement.
Medical and Pharmacy Coverage. The City will provide health insurance coverage to Employees through a high deductible healthcare plan with an associated health savings account (HSA) or a Health Reimbursement Account (HRA). An HRA is for those employees ineligible for an HSA based on being covered by other healthcare coverage like Medicare or TRICARE. The City will charge a premium for medical coverage at the following base rates: Single Coverage: $1,875 Family Coverage: $3,750 These premiums can be waived depending on the participation in the Healthy by Choice wellness program and meeting its associated standards as follows: Single Coverage: $750 Family Coverage: $1,500 $225 per health factor for blood pressure, cholesterol and tobacco-free status $450 per health factor for BMI/waist circumference or HRA based on their participation of the HBC program in that initial year. The premium and waiver of the premium associated with the wellness program will be based on the enrollment period for the HBC program in the initial year. In addition to the base rates, if an employee or covered spouse is a tobacco user, then a tobacco use premium will be charged as follows: Premium Equivalent Contribution (Tobacco Use Premium Surcharge). A tobacco use premium surcharge of 15% of the premium equivalent based on the level of single coverage for tobacco use if either the employee or covered spouse uses tobacco. In the event that both the employee and the spouse use tobacco, then a premium surcharge of 15% of the premium equivalent based the level of single coverage shall be applied to both the employee and the spouse for a total of 30%. The employee and/or spouse may make a request for an alternative standard during open enrollment and the City will work with an employee (and, if they wish, the to earn the same reward by different means. This tobacco use premium will be waived for the tobacco user if the tobacco user successfully participates in an alternative of this document. If coverage is elected and an alternative standard is not requested and completed, then the premium surcharge for tobacco use will be charged through payroll deduction evenly over the year. Annual Deductibles Single Coverage = $2,500 Family Coverage = $5,000 The City will make automatic annual contributions paid out in the month of January to each the coverage level. These will be made in the following annual amounts: Single Coverage: $1,875 Family Coverage: $3,750 Covered items include, but are not necessarily limited to annual ...
Medical and Pharmacy Coverage. The City will provide health insurance coverage to Employees through a high deductible healthcare plan with an associated health savings account (HSA) or a Health Reimbursement Account (HRA). An HRA is for those employees ineligible for an HSA based on being covered by other healthcare coverage like Medicare or TRICARE. The City will charge a premium for medical coverage at the following base rates: Single Coverage: $1,875 Family Coverage: $3,750 These premiums can be waived depending on the employee’s and spouse’s, if applicable, participation in the Healthy by Choice wellness program and meeting its associated standards as follows: Single Coverage: $750 Family Coverage: $1,500 $225 per health factor for blood pressure, cholesterol and tobacco-free status $450 per health factor for BMI/waist circumference Participating employees hired during the year shall have the City’s contribution to their HSA or HRA based on their participation of the HBC program in that initial year. The premium and waiver of the premium associated with the wellness program will be based on the enrollment period for the HBC program in the initial year. In addition to the base rates, if an employee or covered spouse is a tobacco user, then a tobacco use premium will be charged as follows:

Related to Medical and Pharmacy Coverage

  • 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.

  • Medical Coverage The Executive shall be entitled to such continuation of health care coverage as is required under, and in accordance with, applicable law or otherwise provided in accordance with the Company’s policies. The Executive shall be notified in writing of the Executive’s rights to continue such coverage after the termination of the Executive’s employment pursuant to this Section 3(d)(iv), provided that the Executive timely complies with the conditions to continue such coverage. The Executive understands and acknowledges that the Executive is responsible to make all payments required for any such continued health care coverage that the Executive may choose to receive.

  • Wellness i. To support the statewide goal for a healthy and productive workforce, employees are encouraged to participate in a Well-Being Assessment survey. Employees will be granted work time and may use a state computer to complete the survey. ii. The Coalition of Unions agrees to partner with the Employer to educate their members on the wellness program and encourage participation. Eligible, enrolled subscribers who register for the Smart Health Program and complete the Well-Being Assessment will be eligible to receive a twenty-five dollar ($25) gift certificate. In addition, eligible, enrolled subscribers shall have the option to earn an annual one hundred twenty-five dollars ($125.00) or more wellness incentive in the form of reduction in deductible or deposit into the Health Savings Account upon successful completion of required Smart Health Program activities. During the term of this Agreement, the Steering Committee created by Executive Order 13-06 shall make recommendations to the PEBB regarding changes to the wellness incentive or the elements of the Smart Health Program.

  • Medical Plan ‌ Eligible employees and dependants shall be covered by the British Columbia Medical Services Plan or carrier approved by the British Columbia Medical Services Commission. The Employer shall pay one hundred percent (100%) of the premium. An eligible employee who wishes to have coverage for other than dependants may do so provided the Medical Plan is agreeable and the extra premium is paid by the employee through payroll deduction. Membership shall be a condition of employment for eligible employees who shall be enrolled for coverage following the completion of three (3) months’ employment or upon the initial date of employment for those employees with portable service as outlined in Article 14.12.

  • Medical and Dental Coverage The County and Union agree that this Memorandum of Understanding shall be reopened at the County's request to meet and confer to discuss and mutually agree upon changes related to the Medical and Dental Plans, benefits, and contribution rates.

  • Medical Verification The Town may require medical verification of an employee’s absence if the Town perceives the employee is abusing sick leave or has used an excessive amount of sick leave. The Town may require medical verification of an employee’s absence to verify that the employee is able to return to work with or without restrictions.

  • Durable Medical Equipment (DME), Medical Supplies, Prosthetic Devices, Enteral Formula or Food, and Hair Prosthesis (Wigs) This plan covers durable medical equipment and supplies, prosthetic devices and enteral formula or food as described in this section. DME is equipment which: • can withstand repeated use; • is primarily and customarily used to serve a medical purpose; • is not useful to a person in the absence of an illness or injury; and • is for use in the home. DME includes supplies necessary for the effective use of the equipment. This plan covers the following DME: • wheelchairs, hospital beds, and other DME items used only for medical treatment; and • replacement of purchased equipment which is needed due to a change in your medical condition or if the device is not functional, no longer under warranty, or cannot be repaired. DME may be classified as a rental item or a purchased item. In most cases, this plan only pays for a rental DME up to our allowance for a purchased DME. Repairs and supplies for rental DME are included in the rental allowance. Medical supplies are consumable supplies that are disposable and not intended for re- use. Medical supplies require an order by a physician and must be essential for the care or treatment of an illness, injury, or congenital defect. Covered medical supplies include: • essential accessories such as hoses, tubes and mouthpieces for use with medically necessary DME (these accessories are included as part of the rental allowance for rented DME); • catheters, colostomy and ileostomy supplies, irrigation trays and surgical dressings; and • respiratory therapy equipment. This plan covers diabetic equipment and supplies for the treatment of diabetes in accordance with R.I. General Law §27-20-30. Covered diabetic equipment and supplies include: • therapeutic or molded shoes and inserts for custom-molded shoes for the prevention of amputation; • blood glucose monitors including those with special features for the legally blind, external insulin infusion pumps and accessories, insulin infusion devices and injection aids; and • lancets and test strips for glucose monitors including those with special features for the legally blind, and infusion sets for external insulin pumps. The amount you pay differs based on whether the equipment and supplies are bought from a durable medical equipment provider or from a pharmacy. See the Summary of Pharmacy Benefits and the Summary of Medical Benefits for details. Coverage for some diabetic equipment and supplies may only be available from either a DME provider or from a pharmacy. Visit our website to determine if this is applicable or call our Customer Service Department. Prosthetic devices replace or substitute all or part of an internal body part, including contiguous tissue, or replace all or part of the function of a permanently inoperative or malfunctioning body part and alleviate functional loss or impairment due to an illness, injury or congenital defect. Prosthetic devices do not include dental prosthetics. This plan covers the following prosthetic devices as required under R.I. General Law § 27-20-52: • prosthetic appliances such as artificial limbs, breasts, larynxes and eyes; • replacement or adjustment of prosthetic appliances if there is a change in your medical condition or if the device is not functional, no longer under warranty and cannot be repaired; • devices, accessories, batteries and supplies necessary for prosthetic devices; • orthopedic braces except corrective shoes and orthotic devices used in connection with footwear; and • breast prosthesis following a mastectomy, in accordance with the Women’s Health and Cancer Rights Act of 1998 and R.I. General Law 27-20-29. The prosthetic device must be ordered or provided by a physician, or by a provider under the direction of a physician. When you are prescribed a prosthetic device as an inpatient and it is billed by a provider other than the hospital where you are an inpatient, the outpatient benefit limit will apply. Enteral formula or food is nutrition that is absorbed through the intestinal tract, whether delivered through a feeding tube or taken orally. Enteral nutrition is covered when it is the sole source of nutrition and prescribed by the physician for home use. In accordance with R.I. General Law §27-20-56, this plan covers enteral formula taken orally for the treatment of: • malabsorption caused by Crohn’s Disease; • ulcerative colitis; • gastroesophageal reflux; • chronic intestinal pseudo obstruction; and • inherited diseases of amino acids and organic acids. Food products modified to be low protein are covered for the treatment of inherited diseases of amino acids and organic acids. Preauthorization may be required. The amount that you pay may differ depending on whether the nutrition is delivered through a feeding tube or taken orally. When enteral formula is delivered through a feeding tube, associated supplies are also covered. This plan covers hair prosthetics (wigs) worn for hair loss suffered as a result of cancer treatment in accordance with R.I. General Law § 27-20-54 and subject to the benefit limit and copayment listed in the Summary of Medical Benefits. This plan will reimburse the lesser of the provider’s charge or the benefit limit shown in the Summary of Medical Benefits. If the provider’s charge is more than the benefit limit, you are responsible for paying any difference. This plan covers Early Intervention Services in accordance with R.I. General Law §27- 20-50. Early Intervention Services are educational, developmental, health, and social services provided to children from birth to thirty-six (36) months. The child must be certified by the Rhode Island Department of Human Services (DHS) to enroll in an approved Early Intervention Services program. Services must be provided by a licensed Early Intervention provider and rendered to a Rhode Island resident. Members not living in Rhode Island may seek services from the state in which they reside; however, those services are not covered under this plan. Early Intervention Services as defined by DHS include but are not limited to the following: • speech and language therapy; • physical and occupational therapy; • evaluation; • case management; • nutrition; • service plan development and review; • nursing services; and • assistive technology services and devices.

  • Medical Plans The Employer will maintain the current health (including vision) and dental insurance programs and practices. For Calendar Years 2022 — 2023, the Employer shall contribute 80% of the premium charge for PPO plans, 85% of premium for the EPO plan, 85% of premium for the IHM plan, 80% for the prescription drug plan and 50% for the dental plan.

  • Medical and Dental If an employee is not actively at work on the initial effective date of coverage due to a reason other than hospitalization or medical disability of the employee or dependent, medical and dental coverage will be effective on the first day of the employee’s return to work. The effective date of a change in coverage is not delayed in the event that, on the date the coverage change would be effective, an employee is on an unpaid leave of absence or layoff.

  • Medical Examination Where the Employer requires an employee to submit to a medical examination or medical interview, it shall be at the Employer's expense and on the Employer's time.

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