Medical Disability Coverage Sample Clauses
The MEDICAL/DISABILITY COVERAGE clause defines the obligations and provisions related to providing medical and disability insurance or benefits for individuals covered under the agreement. Typically, this clause outlines the scope of coverage, eligibility requirements, and the types of medical or disability events that are included, such as illness, injury, or long-term disability. Its core function is to ensure that parties are protected against financial hardship resulting from health-related issues, thereby offering security and support in the event of medical emergencies or disabilities.
Medical Disability Coverage. Section 10.1 All eligible paraprofessionals shall be entitled to elect coverage for themselves and their dependents under the health insurance programs described below. Each shall be subject to the cost sharing provisions and other limitations or restrictions applicable to the medical program selected as set forth in the following sections.
1. The copay plan with coverage as follows:
a) Each paraprofessional shall receive medical insurance coverage for themselves and their dependents under the plan below: Office Visit $25 Specialty Office Visit $35 Inpatient Admission $200 Outpatient Surgery $150 Emergency Room $100 Urgent Care $25 High Cost Diagnostic* N/A OON Deductible 400/800/1200 OON Coinsurance 80%/20% OON Coins Max 1500/3000/4500 OON Out-of-Pocket Max 1900/3800/5700 RX Copay $10/25/40 RX Benefit Maximum Unlimited Mail Order Copays 2x RX Day Supply 30/90 RX Edits Qual/Safety Only
b) Anthem (Blue Cross/Blue Shield) full payment Dental Rider; including Riders A, B, C and D. Board of Education reserves the right to change the dental insurance carrier provided substantially equivalent coverage and network are provided.
c) Such coverage shall include vision benefits
2. Premium Contributions: The cost of coverage described in Section 10.1 shall be shared by the Board and paraprofessionals as follows for the duration of the agreement: Employee 10% 11% 12% Board 90% 89% 88%
Medical Disability Coverage. Section 10.1 Anthem (Blue Cross/Blue Shield) - CE
Section 10.2 Riders - CE
a. Reimbursement of Medicare premiums of eligible employees;
b. Anthem (Blue Cross/Blue Shield) High Option Plan or its equivalent and Anthem (Blue Cross/Blue Shield) 65 Plan 81 or its substantial equivalent for retirees and dependents (at no cost to the retiree). The provision set forth in Sections 10.2 (a) and (b) shall not apply to employees hired on or after July 1, 2017.
Medical Disability Coverage. Section 10.1 All eligible Paraeducators shall be entitled to elect coverage for themselves and their dependents under the health insurance programs described below. Each shall be subject to the cost sharing provisions and other limitations or restrictions applicable to the medical program selected as set forth in the following sections. Eligible employees, hired on or before June 30, 2022, may choose between the PPO, the HMO, or the HDHP/HSA Plan as set forth below. Effective July 1, 2022, eligible employees, hired on or after July 1, 2022, shall have access to the HDHP/HSA Plan only.
1. The copay plan with coverage as follows:
a) Each Paraeducator shall receive medical insurance coverage for themselves and their dependents under the plan below: Co-Pay Chart Office Visit $25 Specialty Office Visit $35 Inpatient Admission $200 Outpatient Surgery $150 Emergency Room $100 Urgent Care $25 High Cost Diagnostic* N/A OON Deductible 400/800/1200 OON Coinsurance 80%/20% OON Coins Max 1500/3000/4500 OON Out-of-Pocket Max 1900/3800/5700 RX Copay $10/25/40 RX Benefit Maximum Unlimited Mail Order Copays 2x RX Day Supply 30/90 RX Edits Qual/Safety Only
b) Anthem (Blue Cross/Blue Shield) full payment Dental Rider; including Riders A, B, C and D. Board of Education reserves the right to change the dental insurance carrier provided substantially equivalent coverage and network are provided.
c) Such coverage shall include vision benefits
2. High Deductible Health Plan/Health Savings Account (“HSA Plan”) The HSA plan shall include the following components: In-Network Out-of-Network Annual Deductible (individual/aggregate family) $2,000/4,000 Co-insurance N/A 20% after deductible up to co-insurance maximum Co-insurance Maximum (individual/aggregate family) N/A $3,000/6,000 Cost Share Maximum (individual/aggregate family) $5,000/10,000 Lifetime Maximum Unlimited Unlimited Preventive Care Deductible not applicable 20% co-insurance after deductible, subject to co- insurance limits Prescription Drug Coverage Treated as any other medical expense, subject to the post-deductible co-payments set forth below. Following exhaustion of the deductible, prescription drugs shall be subject to post-deductible co-payments of $0/15/30 (retail), and a two times co-payment for mail order. In each contract year, the Board will fund fifty percent (50%) of the applicable HSA deductible amount. One-half of the Board’s contribution toward the HSA plan deductible will be deposited into the HSA account...
Medical Disability Coverage. Section 10.1 All eligible paraprofessionals shall be entitled to elect coverage for themselves and their dependents under the health insurance programs described below. Each shall be subject to the cost sharing provisions and other limitations or restrictions applicable to the medical program selected as set forth in the following sections. Eligible employees, hired on or before June 30, 2022, may choose between the PPO, the HMO, or the HDHP/HSA Plan as set forth below. Effective July 1, 2022, eligible employees, hired on or after July 1, 2022, shall have access to the HDHP/HSA Plan only.
1. The copay plan with coverage as follows:
a) Each paraprofessional shall receive medical insurance coverage for themselves and their dependents under the plan below: Co-Pay Chart Office Visit $25 Specialty Office Visit $35 Inpatient Admission $200 Outpatient Surgery $150 Emergency Room $100 Urgent Care $25 High Cost Diagnostic* N/A OON Deductible 400/800/1200 OON Coinsurance 80%/20% OON Coins Max 1500/3000/4500 OON Out-of-Pocket Max 1900/3800/5700 RX Copay $10/25/40 RX Benefit Maximum Unlimited Mail Order Copays 2x RX Day Supply 30/90 RX Edits Qual/Safety Only
b) Anthem (Blue Cross/Blue Shield) full payment Dental Rider; including Riders A, B, C and D. Board of Education reserves the right to change the dental insurance carrier provided substantially equivalent coverage and network are provided.
c) Such coverage shall include vision benefits
2. High Deductible Health Plan/Health Savings Account (“HSA Plan”)
Medical Disability Coverage