Medical Hospitalization Other Insurance Protection Sample Clauses

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Medical Hospitalization Other Insurance Protection 

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• Health and Hospitalization Insurance Single Coverage: The School District shall contribute a sum not to exceed $284.00 per month toward the premium for individual coverage for each full-time employee employed by the School District who qualifies for and is enrolled in single coverage in the School District’s group health and hospitalization insurance plan. Any additional cost of the premium shall be borne by the employee and paid by payroll deduction.

• INSURANCE PROTECTION A. The Board shall provide MESSA Plan 1 or Plan 2 described below by making payment of insurance premiums for a full twelve (12) month period each year of this Agreement for the teacher and his/her eligible dependents as defined by MESSA, subject to the provisions below. B. Each teacher shall elect either Plan 1 or Plan 2, provided, however, that if a husband and wife are both members of the bargaining unit, one shall select Plan 1 and the other Plan 2. Part-time teachers shall receive the Plan 1 premium rate on a pro rata basis (e.g., a teacher employed for three days per week will receive three-fifths of the premium rate due to a full-time teacher eligible for the same coverage). Those part-time Teacher electing Plan 1 shall pay the difference between the prorated amount and the full cost of the appropriate health insurance by direct payment or payroll deduction. C. The employer shall pay 80% of the total cost of the MESSA medical premium and deductible. 100% of the non-medical benefits. Additionally, the Board agrees to maintain this 80/20 cost-sharing provision during the life of this Agreement. Employees shall contribute 20% of the medical premium and the annual deductible. Employer shall fund 100% of the MESSA ABC Plan 1 annual deductible (minus the employees 20% contribution) to the employees’ Health Equity (HEQ) Health Savings Account (HSA) for each plan year. Deposits would be made in quarterly installments beginning on January 1, then April 1, then July 1, and the last installment on October 1 of each year. The District will fund the balance of the deductible due ahead of schedule for any member who incurs significant medical claims prior to receiving all four quarterly deposits. For teachers hired after January 1, the Employer will fund a percentage of the MESSA ABC Plan I annual deductible to the employees’ Health Equity” (HEQ) Health Savings Account (HSA) for each plan year equal to the percentage of the calendar year they work. Employee contributions shall be payroll deducted. Payments will start with the first pay date after the open enrollment period ends. The annual payment amount will be distributed equally throughout the remainder of the payroll dates for the school year through a qualified Section 125 plan and shall not be subject to withholding. The Employer’s qualified Section 125 plan shall include any and all of the provisions necessary for pre-tax contributions to employees’ HSA accounts. In the event an employee is not qualified for a Health Savings Account for any of the months of the deductible plan year, the employer shall contribute the negotiated amount of funding as set forth in the agreement to either a Flexible Spending Account (“FSA”) or a 403(b). Affected employees shall notify the employer where to contribute the money on or before December 15 of each school year. Employees may contribute, through payroll deduction and electronic transfer additional money towards their HSA up to the maximum amounts allowed by Federal Law. The parties understand that in the event the minimum deductible necessary for a medical plan to comply with HSA eligibility is increased beyond the current deductible level in MESSA ABC Plan 1, the deductible (and the Employer’s funding of the deductible) will automatically adjust to meet the federal minimum requirement. D. Benefit Plan 1 Plan 2 1. Health Insurance MESSA ABC Plan 1 Deductible $1400/$2800 ABC Rx SO OL/OV/SV $0 Coinsurance 2. Long Term Disability MESSA Same as Plan 1 Coverage 66 2/3% of salary up to $7,500 monthly maximum 90 calendar days modified fill Pre-existing condition waiver Alcohol/drug (same as any other illness) Mental/Nervous (same as any other illness) Soc. Sec. Offset- Primary Own- Occupation 2 years COLA- No SS Freeze- Yes 3. Dental Insurance MESSA/Delta Dental Same as Plan 1 Coverage Diag & Prev – 80% Basic Services- 80% (X Rays) Major services 80% Annual Max- $1800 Orthodontics- 80% Lifetime Max- UCR Riders- 2 cleanings, AO 4. Life Insurance MESSA Negotiated Term Same as Plan 1 Life $45,000 with $45,000 AD&D, Waiver of Premium 5. Vision Insurance MESSA Vision Enhanced Same as Plan 1 6. Options Not Available Pursuant to the terms of the District’s Section 125 Plan, All teachers electing to take the Plan 2 option in lieu of medical insurance shall receive 80% of the amount of the single subscriber premium rate for the insurance plan provided to other members of the association. (prorated for part-time Teacher). Cash in lieu payments will start with the first pay date after the open enrollment period ends. The annual payment amount will be distributed equally throughout the remainder of the payroll dates for the school year. Any modifications of the Section 125 Plan which affect bargaining unit members will be subject to negotiations with the Association.

• Hospitalization Insurance A) Effective January 1, 2012, all eligible employees shall be enrolled into Blue Cross Blue Shield Community Blue 4 (CB4) medical plan with a closed formulary $5 generic/$40 preferred brand/$80 non-preferred brand prescription drug card. The CB4 medical plan shall include a $500 single/$1,000 couple/family first dollar deductible, after which coinsurance will be provided at 80% with an annual employee maximum co-insurance out of pocket at $1,500 single and $3,000 family. In accordance with Health Care Reform preventative care is covered 100%. Copays shall include $30 for office visits, $30 for urgent care, and $150 for emergency room visits. Effective July 1, 2019 the City will also provide Blue Cross Blue Shield Simply Blue PPO with a $5 generic/$40 preferred brand/$80 non-preferred prescription drug card as a voluntary option for employees. Effective January 1, 2012, the City shall establish a Cafeteria Plan Section 125 Flexible Spending Account (FSA) for qualified medical expenses compliant with all IRS regulations. Employees may elect to contribute into the FSA on a pre-tax basis up to a limit set by the employer in compliance with IRS regulations and Health Care Reform. Employees must establish their contributions each calendar year, and the amount may not be altered unless the employee experiences a qualifying event as defined by the IRS. The City shall not contribute into the employee’s FSA for calendar year 2011, 2012 or 2013. Effective with calendar year 2014 the City’s contribution into the FSA will be in accordance with Article IV Section 5. Qualified purchases during the calendar year using FSA funds must be submitted for reimbursement no later than the last day of February the following calendar year. Any money contributed into the FSA and not spent will be forfeited by the employee. Effective July 1, 2019 the FSA plan year shall be July through June to coincide with the medical plan year. Qualified purchases during the plan year using FSA funds must be submitted for reimbursement no later than the last day of September following the close of the plan year June 30th. Any money contributed into the FSA and not spent will be forfeited by the employee, except for the amount allowed by IRS regulations. The City reserves the right to self insure any and all medical insurance plans as described in this Collective Bargaining Agreement at the City’s sole discretion.

• Hospitalization In the event an employee is hospitalized overnight, the employee will have access to their EIB accrual at the first day of absence due to the hospitalization. Same day surgery, if requiring five (5) or more days of recovery, may also be paid from the employee’s EIB account.

• Income Protection Insurance The Employer shall provide Income Protection Insurance through an ETU nominated policy and scheme. It is agreed that the premium will be collected and administered by the “Protect” Severance Scheme at the same time as severance payments are made. Income protection will be paid for the employees and will be paid for all periods of authorised absence and cannot be on a pro-rata basis. It is agreed the Income Protection Insurance payments are paid on a monthly basis by the 14th day of each month. It is agreed that if the Employer has not made a valid or current insurance payment to “Protect”, the Employer shall be liable for any loss of earnings or benefits that would have otherwise been given to the employee. The rates of payment and cover shall be as follows: From 1/1/06 to 28/2/07* From 1/3/07 to 31/12/08* From 1/1/09* Tradesperson’s Premium $19.70 per week $20.90 per week $24.00 per week** Apprentice Premium $12.50 per week $13.50 per week $19.90 per week** * These rates are inclusive of GST and stamp duty. ** These are the premium rates and levels of cover that shall apply, unless reduced by the agreement of NECA and the ETU. It is the intention of NECA and the ETU to seek a lower premium. The premium rates and level of cover shall not exceed the amounts set out in the final column of the table above. The insurance benefits contained in this Policy will not be reduced during the life of this Agreement.

• Extended Health Care Benefits The City will provide for all employees by contract through an insurer selected by the City an Extended Health Care Plan which will provide extended health care benefits. The City shall pay one hundred per cent (100%) of the premiums, which will include any premiums payable under The Health Insurance Act, R.S.O. 1990, as amended.

• – DISABILITY INCOME PROTECTION PLAN i) The Disability Income Protection Plan of the designated employer will be in accordance with the collective agreement. ii) There will be no break in coverage and/or waiting period prior to being able to receive the Disability Income Protection Plan so long as the waiting period has already been served.

• Dental specific medications for dental purposes, including fluoride medications (except for children less than five years of age with a non-fluorinated water supply);

• Medical Examinations An employee may be required by the Employer, at the request of and at the expense of the Employer, to take a medical examination by a physician of the employee's choice. Employees may be required to take skin tests, x-ray examination, vaccination, inoculation and other immunization (with the exception of a rubella vaccination when the employee is of the opinion that a pregnancy is possible), unless the employee's physician has advised in writing that such a procedure may have an adverse affect on the employee's health.

• Health Care Benefits A. Each regular, full-time employee may elect coverage for himself and his eligible dependents* under one of the following health insurance plans: 1. Blue Cross/Blue Shield of Michigan Flexible Blue 3 with Flexible Blue Rx Prescription Drug Coverage with a Health Savings Account (hereinafter collectively referred to as the “H.S.A Plan”). The Employer shall pay for the illustrated premium cost of this coverage and make an annual contribution to each participating employee’s Health Savings Account in the amount of $500 for those selecting single coverage and $1,000 for those selecting Employee & Spouse, Employee Child(ren) or Family coverage, or the maximum annual amount the Employer is permitted to pay under Section 3 of the Publicly Funded Health Insurance Contribution Act, Public Act 152 of the Michigan Public Acts of 2011, whichever results in the lesser Employer contribution to the cost of such plan. Employees may, at their option, make additional contributions through bi-weekly pre-tax payroll deduction as permitted by applicable law. 2. Blue Cross/Blue Shield of Michigan Community Blue PPO Option 3 Revised Plan with Blue Preferred Rx Prescription Drug Coverage with a 50% co-pay ($5 floor and a $50 ceiling). Employees shall pay the difference between the illustrated premium cost of this coverage and the amount of the Employer’s total contribution towards the cost of coverage under the H.S.A. Plan as described in Section 1 (a) (1), for the same level of benefit (i.e. single, employee/spouse, employee/child(ren) and family), or pay the difference between the total cost of such coverage and the maximum annual amount the Employer is permitted to pay under Section 3 of the Publicly Funded Health Insurance Contribution Act, Public Act 152 of the Michigan Public Acts of 2011, whichever results in the greater employee contribution. 3. Blue Cross/Blue Shield of Michigan Community Blue PPO Option 6 Revised Plan with Blue Preferred Rx Prescription Drug Coverage with a 50% co-pay ($5 floor and a $50 ceiling). Employees shall pay the difference between the illustrated premium cost of this coverage and the amount of the Employer’s total contribution towards the cost of coverage under the H.S.A. Plan as described in Section 1 (a) (1), for the same level of benefit (i.e. single, employee/spouse, employee/child(ren) and family), or pay the difference between the total cost of such coverage and the maximum annual amount the Employer is permitted to pay under Section 3 of the Publicly Funded Health Insurance Contribution Act, Public Act 152 of the Michigan Public Acts of 2011, whichever results in the greater employee contribution. (a) All coverage under any of the foregoing plans shall be subject to such terms, conditions, exclusions, limitations, deductibles, co-payments premium cost-sharing, and other provisions of the plans. Coverage shall commence on the employee’s ninetieth (90th) day of continuous employment. The employee’s contribution to the cost of such coverage shall be payable on a bi-weekly basis through automatic payroll deduction. (b) To qualify for health care benefits as above described each employee must individually enroll and make proper application for such benefits at the Human Resources Department upon the commencement of his regular employment with the Employer. (c) Except as otherwise provided under the Family and Medical Leave Act, when on an authorized unpaid leave of absence of more than two weeks, the employee will be responsible for paying all his benefit costs for the period he is not on the active payroll. Proper application and arrangements for the payment of such continued benefits must be made at the Human Resources Department prior to the commencement of the leave. If such application and arrangements are not made as herein described, the employee's health care benefits shall automatically terminate upon the effective date of the unpaid leave of absence. (d) Except as otherwise provided under this Agreement and/or under COBRA, an employee's health care benefits shall terminate on the date the employee goes on a leave of absence for more than two weeks, terminates, retires or is laid off. Upon return from a leave of absence or layoff, an employee's health care benefits coverage shall be reinstated commencing with the employee's return. (e) An employee who is on layoff or leave of absence for more than two weeks or who terminates may elect under COBRA to continue the coverage herein provided at his own expense. (f) The Employer reserves the right to change a carrier(s), a plan(s), and/or the manner in which it provides the above benefits, provided that the benefits and conditions are equal to or better than the benefits and conditions outlined above. (g) To be eligible for health care benefits as provided above, an employee must document all coverage available to him under his spouse's medical plan and cooperate in the coordination of coverage to limit the Employer's expense. If an employee’s spouse or eligible dependent children work for an employer who provides medical coverage, they are required to elect medical coverage with their employer, so long as the spouse’s or monthly contribution to the premium does not exceed 20% of the total premium cost of said coverage. The Monroe County Plan shall provide secondary coverage. (h) Each employee is responsible for notifying the Human Resources Department of any change in his status, which might affect his insurance coverage or benefits, such as, marriage, divorce, births, adoptions, deaths, etc.