Common use of Medical Plan Benefits Clause in Contracts

Medical Plan Benefits. The District’s medical and prescription drug plans are tied together. An employee electing coverage under the medical plan will automatically be afforded the same level or coverage under the prescription drug plan. Coverage under the prescription drug program will not be offered separately from the medical plan. The deductible amounts indicated in Appendix A will apply during a calendar year period (beginning January 1, 2020) and will apply separately to network and non-network services covered under the plan of benefits. For example, amounts paid by a plan participant toward satisfaction of the annual network deductible will not count against the annual non-network deductible, and amounts paid by a plan participant toward satisfaction of the annual non-network deductible will not count against the annual network deductible required under the plan. It is mutually understood that deductible amounts for all of calendar year 2019 will be administered in accordance with the health/prescription drug plan specifications appearing in the plan in effect from January 1, 2019 through June 30, 2019. The annual out-of-pocket limits indicated in Appendix A will apply during a calendar year period (beginning January 1, 2020) and will apply separately to network and non- network services covered under the plan of benefits. For example, amounts paid by a plan participant toward the satisfaction of the annual out-of-pocket limit, and amounts paid by a plan participant toward satisfaction of the annual non-network out-of-pocket limit will not count against the annual network out-of-pocket limit. It is mutually understood that out-of-pocket limits for all of calendar year 2019 will be administered in accordance with the health/prescription drug plan specifications appearing in the plan in effect from January 1, 2019 through June 30, 2019. It is further understood that an employee eligible to receive a 90-day supply of a maintenance drug by mail with an employee co-pay of twenty dollars ($20.00) may opt instead to have the prescription filled at a pharmacy instead of by mail, but the employee co-pay in such case will be sixty dollars ($60.00), not twenty dollars ($20.00). Coordination of benefit provisions also including dental and vision will be administered under standard non-duplication of benefit language, which prevents a covered person from receiving more in benefits under a combination of plans than would have been received under this plan alone had other coverage not been available.

Medical Plan Benefits. The District’s medical and prescription drug plans are tied togetherA Comprehensive Medical Benefit Plan with the following annual deductibles will be provided. An employee electing coverage under the medical plan will automatically be afforded the same level or coverage under the prescription drug plan. Coverage under the prescription drug program will not be offered separately from the medical plan. Network Deductible Non-Network Deductible Single $200.00 $500.00 Family $400.00 $1,500.00 The deductible amounts indicated in Appendix A above will apply during a calendar year period (beginning January 1, 2020) and will apply separately to network and non-network services covered under the plan of benefits. For example, amounts paid by a plan participant toward satisfaction of the annual network deductible will not count against the annual non-network deductible, and amounts paid by a plan participant toward satisfaction of the annual non-network deductible will not count against the annual network deductible required under the plan. It is mutually understood that Following satisfaction of the deductible amounts for all of calendar year 2019 shown above, generally, plan participants will be administered in accordance with required to pay a portion of covered expenses; however, the health/prescription drug portion of plan specifications appearing expenses payable by plan participants beyond the deductible will be subject to an annual out-of-pocket limit as shown in the following table: Network Out-of-Pocket Limit Non-Network Out-of-Pocket Limit Single $600.00 $1,500.00 Family $800.00 $3,000.00 The portion of covered plan expenses payable by participants beyond the deductible, except as noted below, will be 20% (subject to the annual network out-of-pocket limit) in effect from January 1the case of services rendered by a network provider. In the case of non-network care, 2019 through June 30, 2019the portion of covered plan expenses payable by participants beyond the deductible will equal 40% (subject to the annual non-network out-of pocket limit) of the reasonable and customary charge for such service. The annual out-of-pocket limits indicated in Appendix A above will apply during a calendar year period (beginning January 1, 2020) and will apply separately to network and non- network services covered under the plan of benefits. For example, amounts paid by a plan participant toward the satisfaction of the annual out-of-pocket limit, and amounts paid by a plan participant toward satisfaction of the annual non-network out-of-of pocket limit will not count against the annual network out-of-pocket limit. It is mutually understood that out-of-pocket limits for all of calendar year 2019 Certain services rendered by network providers will be administered in accordance with payable at 100% under the health/prescription drug plan. Charges for covered diagnostic testing performed by a network provider will be reimbursed at 100% by the plan specifications appearing in not subject to the network deductible. Charges for qualifying home health care and hospice care services rendered by a network provider will be covered at 100% under the plan without a deductible requirement. No coverage will be available under the plan in effect from January 1, 2019 through June 30, 2019. It is further understood that an employee eligible to receive a 90-day supply of a maintenance drug by mail with an employee co-pay of twenty dollars ($20.00) may opt instead to have the prescription filled at a pharmacy instead of by mail, but the employee co-pay in such case will be sixty dollars ($60.00), not twenty dollars ($20.00). Coordination of benefit provisions also including dental and vision will be administered under standard non-duplication of benefit language, which prevents a covered person from receiving more in benefits under a combination of plans than would have been received under this plan alone had other coverage not been available.of: