When You Have More Than One Plan with BCBSRI If you are covered under more than one plan with us, you are entitled to covered benefits under both plans. If one plan has a benefit that the other(s) does not, you are entitled to coverage under the plan that has the benefit. The total payments you receive will never be more than the total allowable expense for the services you receive.
Teaching Staff Assigned to More Than One Building Each Educator who is assigned to more than one building will be evaluated by the appropriate administrator where the individual is assigned most of the time. The principal of each building in which the Educator serves must review and sign the evaluation, and may add written comments. In cases where there is no predominate assignment, the superintendent will determine who the primary evaluator will be.
Family Illness The start of a family leave for a serious health condition of a family member shall begin on the date requested by the employee or designated by Management.
Industrial Accident or Illness Leave 7.6.1 All unit members shall receive sixty (60) days’ leave with pay in any one fiscal year for an industrial accident or illness. An industrial accident or illness is defined as one where the unit member becomes ill or is injured while he/she is serving the District, and, the accident or illness is reported to the District’s Self-Insurance Program in accordance with District regulations, and, the District Self-Insurance Program accepts responsibility for the treatment of the unit member.
Statement of Grievance The grievance shall contain a statement of:
Management Grievance The Employer may initiate a grievance at Step 3 of the grievance procedure by the Employer or designate presenting the grievance to the President of the Union or designate. Time limits and process are identical to a union grievance.
Child Coverage Limited to Coverage Under One Employee If both spouses work for the State or another organization participating in the State’s Group Insurance Program, either spouse, but not both, may cover the eligible dependent children or grandchildren. This restriction also applies to two divorced, legally separated, or unmarried employees who share legal responsibility for their eligible dependent children or grandchildren.
When You Are Covered by More Than One Insurer A healthcare coverage plan is considered the primary plan and its benefits will be paid first if: • the plan does not use similar COB rules to determine coverage; or • the plan does not have a COB provision; or • The plan has similar the COB rules and is determined to be primary under the order of benefit determination rules described below. Benefits under another plan include all benefits that would be paid if claims had been initially submitted under that plan. The following factors are used to determine which plan is primary and which plan is secondary: • if you are the main subscriber or a dependent; • if you are married, which spouse was born earlier in the year; • the length of time each spouse has been covered under the plan; • if a parental custody or divorce decree applies; or • if Medicare is your other coverage then Medicare guidelines will apply. These factors make up the order of benefit determination rules, described in greater detail below:
Family Illness Leave An employee will be granted leave of absence for up to five (5) days per year without loss of pay or benefits for family illness. Additional family illness leave may be granted by the employer.
