Common use of Medical, Dental and Vision Insurance Clause in Contracts

Medical, Dental and Vision Insurance. A. A new employee may enroll within sixty (60) days of employment, however, employees must complete thirty (30) days of employment to be eligible for the Employer’s portion listed below. B. Major Medical The Employer shall offer three (3) Major Medical Insurance Policies consistent with the following: ▪ $500 Individual/$1,000 Family Deductible ▪ Coinsurance is 80% Board paid in-network and 60% Board paid out-of- network ▪ Maximum co-insurance out-of-pocket per year for in-network is $1,000 single and $2,000 family ▪ Maximum out-of-pocket per year in-network is $1,500 single and $3,000 family ▪ Maximum medical co-pay out-of-pocket per year in-network is $1,000 single and $2,000 family ▪ Maximum out-of-pocket per year out-of-network is $2,500 single and $5,000 family ▪ $75 employee co-pay then plan pays 100% for ER visits ▪ Covered prescription drugs will be subject to the following co-pays: Mail (90-Day) Retail (30-day) Generic $25.00 $10.00 Formulary $87.50 $35.00 Non-formulary/Brand $150.00 $60.00 ▪ Specialty Drugs 20% of cost to a maximum of $150.00 ▪ Maximum annual prescription drug co-pays is $3,100 single and $6,200 family ▪ Compound prescriptions are subject to the same co-pay as noted above, however, the plan cost of the prescription is limited to a maximum of $500 per prescription. The employee will pay any cost over the maximum. ▪ $1,000 Individual/$2,000 Family Deductible ▪ Coinsurance is 80% Board paid in-network and 60% Board paid out-of- network ▪ Maximum co-insurance out-of-pocket per year in-network is $1,500 single and $3,000 family ▪ Maximum out-of-pocket per year in-network is $2,500 single and $5,000 family. ▪ Maximum medical co-pay out-of-pocket per year in-network is $1,500 single and $3,000 family ▪ Maximum out-of-pocket per year out-of-network is $3,500 single and $7,000 family. ▪ $150 employee co-pay then plan pays 100% for ER visits ▪ Covered prescription drugs will be subject to the following co-pays: Mail (90-Day) Retail (30-day) Generic $25.00 $10.00 Formulary $87.50 $35.00 Non-formulary/Brand $150.00 $60.00 ▪ Specialty Drugs 20% of cost to a maximum of $150.00 ▪ Maximum annual prescription drug co-pays is $3,100 single and $6,200 family ▪ Compound prescriptions are subject to the same co-pay as noted above, however, the plan cost of the prescription is limited to a maximum of $500 per prescription. The employee will pay any cost over the maximum. ▪ $3,000 Individual/$6,000 Family Deductible ▪ Coinsurance after deductible met is 100% Board paid in-network and 60% Board paid out-of-network ▪ After the deductible is met, maximum co-insurance out-of-pocket per year in-network is $0 single and $0 family ▪ Maximum out-of-pocket per year in-network is $3,000 single and $6,000 family ▪ Maximum post deductible copays (ER/Prescription) out-of-pocket per year for in-network deductible is $4,100 single and $8,200 family ▪ Maximum out-of-pocket per year out-of-network is $6,850 single and $13,700 family ▪ Employee is responsible for opening their own Health Savings Account (HSA) and providing the direct deposit information to the Treasurer’s Office prior to the first scheduled deposit ▪ After deductible the following copays apply: $200 for ER visits Mail (90-Day) Retail (30-day) Generic $0.00 $0.00 Formulary $75.00 $25.00 Non-formulary/Brand $150.00 $50.00 ▪ Specialty Drugs 20% of cost to a maximum of $150.00 ▪ Compound prescriptions are subject to the same co-pay as noted above, however, the plan cost of the prescription is limited to a maximum of $500 per prescription. The employee will pay any cost over the maximum. C. Employee premiums under any plan Board Contribution Rate

Medical, Dental and Vision Insurance. A. A new employee may enroll within sixty (60) days of employment, however, employees must complete thirty (30) days of employment to be eligible for the Employer’s portion listed below. B. Major Medical The Employer shall offer three (3) Major Medical Insurance Policies consistent with the following: ▪  $500 Individual/$1,000 Family Deductible ▪  Coinsurance is 80% Board paid in-network and 60% Board paid out-of- network ▪  Maximum co-insurance out-of-pocket per year for in-network is $1,000 single and $2,000 family ▪  Maximum out-of-pocket per year in-network is $1,500 single and $3,000 family ▪  Maximum medical co-pay out-of-pocket per year in-network is $1,000 single and $2,000 family ▪  Maximum out-of-pocket per year out-of-network is $2,500 single and $5,000 family ▪  $75 employee co-pay then plan pays 100% for ER visits ▪  Covered prescription drugs will be subject to the following co-pays: Mail (90-Day) Retail (30-day) Generic $25.00 $10.00 Formulary $87.50 $35.00 Non-formulary/Brand $150.00 $60.00 ▪  Specialty Drugs 20% of cost to a maximum of $150.00 ▪  Maximum annual prescription drug co-pays is $3,100 single and $6,200 family ▪  Compound prescriptions are subject to the same co-pay as noted above, however, the plan cost of the prescription is limited to a maximum of $500 per prescription. The employee will pay any cost over the maximum. ▪  $1,000 Individual/$2,000 Family Deductible ▪  Coinsurance is 80% Board paid in-network and 60% Board paid out-of- network ▪  Maximum co-insurance out-of-pocket per year in-network is $1,500 single and $3,000 family ▪  Maximum out-of-pocket per year in-network is $2,500 single and $5,000 family. ▪  Maximum medical co-pay out-of-pocket per year in-network is $1,500 single and $3,000 family ▪  Maximum out-of-pocket per year out-of-network is $3,500 single and $7,000 family. ▪  $150 employee co-pay then plan pays 100% for ER visits ▪  Covered prescription drugs will be subject to the following co-pays: Mail (90-Day) Retail (30-day) Generic $25.00 $10.00 Formulary $87.50 $35.00 Non-formulary/Brand $150.00 $60.00 ▪  Specialty Drugs 20% of cost to a maximum of $150.00 ▪  Maximum annual prescription drug co-pays is $3,100 single and $6,200 family ▪  Compound prescriptions are subject to the same co-pay as noted above, however, the plan cost of the prescription is limited to a maximum of $500 per prescription. The employee will pay any cost over the maximum. ▪  $3,000 Individual/$6,000 Family Deductible ▪  Coinsurance after deductible met is 100% Board paid in-network and 60% Board paid out-of-network ▪  After the deductible is met, maximum co-insurance out-of-pocket per year in-network is $0 single and $0 family ▪  Maximum out-of-pocket per year in-network is $3,000 single and $6,000 family ▪  Maximum post deductible copays (ER/Prescription) out-of-pocket per year for in-network deductible is $4,100 single and $8,200 family ▪  Maximum out-of-pocket per year out-of-network is $6,850 single and $13,700 family ▪  Employee is responsible for opening their own Health Savings Account (HSA) and providing the direct deposit information to the Treasurer’s Office prior to the first scheduled deposit ▪  After deductible the following copays apply: $200 for ER visits Mail (90-Day) Retail (30-day) Generic $0.00 $0.00 Formulary $75.00 $25.00 Non-formulary/Brand $150.00 $50.00 ▪  Specialty Drugs 20% of cost to a maximum of $150.00 ▪  Compound prescriptions are subject to the same co-pay as noted above, however, the plan cost of the prescription is limited to a maximum of $500 per prescription. The employee will pay any cost over the maximum. C. Employee premiums under any plan Board Contribution Rate

Medical, Dental and Vision Insurance. A. A new employee may enroll within sixty (60) days of employment, however, employees must complete thirty (30) days of employment to be eligible for the Employer’s portion listed below.below.‌ B. Major Medical The Employer shall offer three (3) Major Medical Insurance Policies consistent with the following: ▪ $500 Individual/$1,000 Family Deductible ▪ Coinsurance is 80% Board paid in-network and 60% Board paid out-of- network ▪ Maximum co-insurance out-of-pocket per year for in-network is $1,000 single and $2,000 family ▪ Maximum out-of-pocket per year in-network is $1,500 single and $3,000 family ▪ Maximum medical co-pay out-of-pocket per year in-network is $1,000 single and $2,000 family ▪ Maximum out-of-pocket per year out-of-network is $2,500 single and $5,000 family ▪ $75 employee co-pay then plan pays 100% for ER visits ▪ Covered prescription drugs will be subject to the following co-pays: Mail (90-Day) Retail (30-day) Generic $25.00 $10.00 Formulary $87.50 $35.00 Non-formulary/Brand $150.00 $60.00 ▪ Specialty Drugs 20% of cost to a maximum of $150.00 ▪ Maximum annual prescription drug co-pays is $3,100 single and $6,200 family ▪ Compound prescriptions are subject to the same co-pay as noted above, however, the plan cost of the prescription is limited to a maximum of $500 per prescription. The employee will pay any cost over the maximum. ▪ $1,000 Individual/$2,000 Family Deductible ▪ Coinsurance is 80% Board paid in-network and 60% Board paid out-of- network ▪ Maximum co-insurance out-of-pocket per year in-network is $1,500 single and $3,000 family ▪ Maximum out-of-pocket per year in-network is $2,500 single and $5,000 family. ▪ Maximum medical co-pay out-of-pocket per year in-network is $1,500 single and $3,000 family ▪ Maximum out-of-pocket per year out-of-network is $3,500 single and $7,000 family. ▪ $150 employee co-pay then plan pays 100% for ER visits ▪ Covered prescription drugs will be subject to the following co-pays: Mail (90-Day) Retail (30-day) Generic $25.00 $10.00 Formulary $87.50 $35.00 Non-formulary/Brand $150.00 $60.00 ▪ Specialty Drugs 20% of cost to a maximum of $150.00 ▪ Maximum annual prescription drug co-pays is $3,100 single and $6,200 family ▪ Compound prescriptions are subject to the same co-pay as noted above, however, the plan cost of the prescription is limited to a maximum of $500 per prescription. The employee will pay any cost over the maximum. ▪ $3,000 Individual/$6,000 Family Deductible ▪ Coinsurance after deductible met is 100% Board paid in-network and 60% Board paid out-of-network ▪ After the deductible is met, maximum co-insurance out-of-pocket per year in-network is $0 single and $0 family ▪ Maximum out-of-pocket per year in-network is $3,000 single and $6,000 family ▪ Maximum post deductible copays (ER/Prescription) out-of-pocket per year for in-network deductible is $4,100 single and $8,200 family ▪ Maximum out-of-pocket per year out-of-network is $6,850 single and $13,700 family ▪ Employee is responsible for opening their own Health Savings Account (HSA) and providing the direct deposit information to the Treasurer’s Office prior to the first scheduled deposit ▪ After deductible the following copays apply: $200 for ER visits Mail (90-Day) Retail (30-day) Generic $0.00 $0.00 Formulary $75.00 $25.00 Non-formulary/Brand $150.00 $50.00 ▪ Specialty Drugs 20% of cost to a maximum of $150.00 ▪ Compound prescriptions are subject to the same co-pay as noted above, however, the plan cost of the prescription is limited to a maximum of $500 per prescription. The employee will pay any cost over the maximum. C. Employee premiums under any plan Board Contribution Rate