Medical and Pharmacy Coverage Clause Samples
The Medical and Pharmacy Coverage clause defines the scope and terms under which medical and prescription drug benefits are provided to eligible individuals. It typically outlines what types of medical services, treatments, and medications are covered, any exclusions or limitations, and the process for accessing these benefits, such as required copayments or prior authorizations. This clause ensures that all parties understand the extent of healthcare coverage available, helping to prevent disputes and clarify financial responsibilities related to medical and pharmacy expenses.
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.
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 Coverage. The 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 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:
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 ...