MEDICAL CARE BENEFITS. The Board will provide without cost for active full-time employees, MESSA Medical Care Group Choices II insurance. PROVIDED, that such contribution shall not exceed that required for the coverage category, within which the employee is included, e.g., full family, two persons, one person family continuation or sponsored dependent. A member may elect to retain MESSA Medical Care Group Super Care I by assuming via a Section 125 Plan the cost difference between MESSA Medical Care Group Choices II $10/20 drug card rate and the MESSA Medical Care Group Super Care I $5/10 or $10/20 drug card rate. (see Letter of Agreement) The Board of Education will deduct any employee contributions through payroll deduction. The Board of Education will pay each full-time employee who waives coverage in the medical care program the sum of $250 per month as additional cash compensation. [Prorated payment will be made to less than full-time employees.] These waivers shall be made under the Flexible Benefit Plan established by the Board of Education under Internal Revenue Code Section 125. An employee may waive coverage or revoke a prior waiver only during the open enrollment period provided under the Plan or if the employee has a change in family status. The Board of Education will reimburse employees prescription co-pays that exceeds $250 per family, per fiscal year (July 1 through June 30). The employee must have receipts that must be submitted quarterly for reimbursement. (September 30, December 31, March 31, and June 30) (extended until August 31, 2008) A Health Insurance Committee will be formed to study health insurance options. The committee will be composed of eight (8) members - four (4) administrators, chosen by the Superintendent and four (4) teachers chosen by the President of EGREA.
MEDICAL CARE BENEFITS. 1. The Board will provide the MESSA “ABC” Plan 1 high deductible health care plan. The Board will cover the cost of the premiums towards the ABC Plan 1 premiums subject to the following cap amounts: Beginning July 1, 2015, $5,992.30 for single, $12,531.75 for 2-person and $16,342.66 for full family. On July 1 of each year of this agreement, the cap amount will be increased by the percentage increase in the statutory cap identified by the State Treasurer.
MEDICAL CARE BENEFITS. (a) Notwithstanding anything in this Agreement to the contrary, and in all events, until the last to die of you, your Spouse and your Children, the Company shall pay for all Medical Care and reimbursement for tax consequences as specified in this Section 6 for you, your Spouse and your Children, without reduction. The Company may arrange for a group or individual insurance policy to provide all or a portion of these Medical Care costs, however, in all events, the Company is obligated to ensure that payment for all Medical Care costs is made within 10 days of submittal to the Company for payment. The Company shall either pay all amounts directly to the provider of the Medical Care or reimburse you, your Spouse and your Children for such expenses incurred, whichever may be requested by you, your Spouse or your Children. Should the Company elect to provide insurance for any or all of the costs of Medical Care, the Company shall nevertheless provide 100% reimbursement of any expenses incurred by you, your Spouse and your Children that are not reimbursed by insurance or otherwise within 10 days after submittal of such expenses to the Company for payment.
MEDICAL CARE BENEFITS. (a) Notwithstanding anything in this Agreement to the contrary, from August 15, 2001 until the last to die of you, your Spouse and your Children, the Company shall pay for all Medical Care and Reimbursement for Tax Consequences as specified in Section 6 for you, your Spouse and your Children, without reduction, subject only to possible termination of Medical Care Benefits specified in Section 6 on the Termination Date but only if pursuant to the termination of your service prior to your death, Disability or a Change of Control and prior to August 16, 2006, by the Company for Cause pursuant to Section 4(a)(i) or by you for reason other than Good Reason pursuant to Section 4(b)(ii) or 4(d). The Company may arrange for a group or individual insurance policy to provide all or a portion of these Medical Care costs, however, in all events, the Company is obligated to ensure that payment for all Medical Care costs is made within 10 days of submittal to the Company for payment. The Company shall either pay all amounts directly to the provider of the Medical Care or reimburse you, your Spouse and your Children for such expenses incurred, whichever may be requested by you, your Spouse or your Children. Should the Company elect to provide insurance for any or all of the costs of Medical Care, the Company shall nevertheless provide 100% reimbursement of any expenses incurred by you, your Spouse and your Children that are not reimbursed by insurance or otherwise within 10 days after submittal of such expenses to the Company for payment.
MEDICAL CARE BENEFITS. 1. The Board will provide without cost for active full-time employees, MESSA Medical Care Group Choices II insurance. PROVIDED, that such contribution shall not exceed that required for the coverage category, within which the employee is included, e.g., full family, two persons, one person family continuation or sponsored dependent. A member may elect to retain MESSA Medical Care Group Super Care I by assuming via a Section 125 Plan the cost difference between MESSA Medical Care Group Choices II $10/20 drug card rate and the MESSA Medical Care Group Super Care I $5/10 or $10/20 drug card rate.
MEDICAL CARE BENEFITS. 1. The Board will provide the MESSA “ABC” Plan 1 high deductible health care plan. The Board will cover the cost of the premiums towards the ABC Plan 1 premiums subject to the following cap amounts: Beginning July 1, 2015, $5,992.30 for single, $12,531.75 for 2-person and $16,342.66 for full family. On July 1 of each year of this agreement, the cap amount will be increased by the percentage increase in the statutory cap identified by the State Treasurer. As of January 1, 2018, the Board & Association agree to offer a second MESSA medical care option ($1,350/$2,700 deductible, 10% coinsurance, ABC Rx). As of January 1, 2019, the Board and Association agree to offer a 3rd and/or 4th MESSA medical care plan to reduce bargaining unit employees’ out of pocket costs. If any of the MESSA plans offered are below the state’s maximum contribution cap for health insurance, the Board will provide the bargaining unit employees who choose said plan additional compensation or a contribution to the bargaining unit employee’s Health Savings Account in the amount the premium is below the allowable maximum contribution cap after deducting applicable state retirement and FICA costs on the contribution, effective in paychecks January 1st of each year.
MEDICAL CARE BENEFITS. For You and Your Dependents Pre-Admission Certification/Continued Stay Review Requirements Pre-Admission Certification (PAC) and Continued Stay Review (CSR) refer to the process used to certify the Medical Necessity and length of a Hospital Confinement when you or your Dependent requires treatment in a Hospital or Other Health Care Facility as a registered bed patient. PAC and CSR are performed through a utilization review program by a Review Organization with which CG has contracted. You or your Dependent should request PAC prior to any non-emergency treatment in a Hospital or Other Health Care Facility as described above. For an admission due to pregnancy, you should call the Review Organization by the end of the third month of pregnancy. CSR should be requested, prior to the end of the certified length of stay, for continued Hospital or Other Health Care Facility confinement. SAMPLE DOCUMENT Covered Expenses incurred for which benefits would otherwise be payable under this plan for Hospital or Other Health Care Facility charges listed below will be reduced by 50% for: Hospital or Other Health Care Facility charges for Bed and Board, for treatment listed above for which PAC was not performed. . Expenses incurred for which benefits would otherwise be payable under this plan will not include: . Hospital or Other Health Care Facility charges for Bed and Board, during a Hospital or Other Health Care Facility Confinement for which PAC is performed, which are made for any day in excess of the number of days certified through PAC or CSR; and any Hospital or Other Health Care Facility charges made during any Hospital or Other Health Care Facility Confinement as a registered bed patient: (a) for which PAC was performed; but (b) which was not certified as medically necessary. In any case, those expenses incurred for which payment is excluded by the terms set forth above will not be considered as expenses incurred for the purpose of any other part of this plan, except for the "Coordination of Benefits" section. Pre-authorization Requirement: Prior-authorization should be requested by you or your Dependent at least 14 days prior to the performance of diagnostic or surgical services performed at an Outpatient Surgical Facility and for magnetic resonance imaging. Amounts for expenses incurred, which would otherwise be payable under this plan, will be reduced to 50% for services described above for which pre-authorization was not obtained. POS-PAC(01) 1/05 How to File ...
