Outpatient Surgery. A $100 single and $200 family combined annual deductible will apply to Outpatient Surgery after which 100% Coverage will apply.
Outpatient Surgery. Any absence for which the District is required to provide a reasonable accommodation
Outpatient Surgery. Discipline issued to employees under the Sick Day Policy carries over from fiscal year to fiscal year. However, if an employee goes twelve (12) consecutive months without incurring any discipline under the Sick Day Policy, the disciplines he or she has will be removed from consideration; and the employee will start over on progressive discipline. Any District authorized exceptions would be in writing and available for the Union President to review.
Outpatient Surgery. Procedures including all routine Medical Services required during the 12 Outpatient Visit including but not limited to all medical supplies, central service items, and nursing 13 support or care.
Outpatient Surgery. 100% Coverage
Outpatient Surgery. Case Rates ------------------- Arthroscopies $[ ** ] Laparoscopic Procedures $[ ** ] Lithotripsy $[ ** ] Fractures of Hips and Pelvis $[ ** ] Cardiac Pacemaker Device Replacement $[ ** ] Inguinal Hernia $[ ** ] Breast Biopsy w/ or w/o Localization $[ ** ] Cataract w/IOI $[ ** ] Cataract w/Lens $[ ** ] Bunionectomy $[ ** ] Other Outpatient Surgical Procedures [ ** ] ATTACHMENT A4-1 HOSPITAL SERVICES VALUATION SCHEDULE ST JUDE MEDICAL CENTER PROSPECT MEDICAL GROUP PAGE 2 Exclusions: (Reimbursed Separately) --------------------------------- Excluded from Case Rates and/or per diems Prosthesis/Implants/DME/Chole-K/ [ ** ] Pacemakers/Valves/Balloon Catheters/ DCA cutting Devices/Imaging Catheters Emergency Room: $0-$300 in Gross Charges [ ** ] $301 and greater [ ** ] Risk Pool Distribution: St. Jude Medical Center [ ** ] Prospect Medical Group [ ** ] Limited Downside Risk-Prospect Med Group [ ** ] St. Jude Medical Center Stop Loss Reinsurance [ ** ] BED DAYS BONUS SCHEDULE Bed Days/Thousand: Total member months Bonus ------------------ ------ 1,200 or greater [ ** ] 1,000 to 1,199 [ ** ] 951 to 999 [ ** ] 900 to 950 [ ** ] 850 to 899 [ ** ] 800 to 849 [ ** ] 700 to 799 [ ** ] 600 to 699 [ ** ] Under 600 [ ** ] 41a ATTACHMENT B SECURE HORIZONS MEDICAL AND HOSPITAL SUBSCRIBERS AGREEMENT Secure Horizons Medical and Hospital Subscriber Agreement is available upon request. A summary of the Schedule of Benefits is attached. ATTACHMENT C COMPENSATION CAPITATION PAYMENTS - PacifiCare shall make monthly Capitation Payments to IPA based on the number of Subscribers eligible to receive Medical Services from IPA.
Outpatient Surgery. Eligible employees will receive their regular pay for the winter break if they work their assigned work hours as scheduled. To be eligible to receive their regular pay over the winter break, employees who are assigned to work more than four (4) hours each work day at the start of the school year may not be absent from work for more than the equivalent of three (3) work days between the start of the school year through the start of winter break. To be eligible to receive their regular pay over the winter break, employees who are assigned to work four (4) hours or fewer each work day at the start of the school year may not be absent from work for more than the equivalent of one (1) work day from the start of the school year through the start of winter break. Eligible employees will receive their regular pay for the spring break if they work their assigned work hours as scheduled. To be eligible to receive their regular pay over the spring break, employees who are assigned to work more than four (4) hours each work day at the start of winter break may not be absent from work for more than the equivalent of three (3) work days between the start of winter break through the start of spring break. To be eligible to receive their regular pay over spring break, employees who are assigned to work four (4) hours or fewer each work day at the start of winter break may not be absent from work for more than the equivalent of one
Outpatient Surgery. Employees who have accrued in excess of fifteen (15) sick days may use any such excess sick days during the winter break period and during spring break period (i.e., Special Holiday). Employees who choose to apply their excess sick days to winter and/or spring break must submit a written request to their supervisor in advance of the break period. Discipline issued to employees under the Sick Day Policy carries over from school year to school year. However, if an employee goes 75 work days without incurring any discipline, he/she shall have one occurrence removed from consideration. Thereafter, for each successive 75 work day period which passes without the occurrence of any discipline, an additional occurrence shall be removed from consideration. In the event twelve (12) consecutive months pass without incurring any discipline under the Sick Day Policy, all the disciplines he/she has will be removed from consideration, and the employee will start over on progressive discipline. Any District-authorized exceptions shall be in writing and available for the Union to review.
Outpatient Surgery. Outpatient X-Ray & Diagnostic Testing: $700 maximum per Plan Year at 100% after deductible; coinsurance applies at PPO & Non- Supplemental Accident: $500 maximum per accident for charges incurred within 90 days; includes initial visit.
Outpatient Surgery. Outpatient surgery may be performed in an Acute Care Hospital or Ambulatory Surgical Facility. Benefits for Ambulatory Surgical Facilities include those outpatient surgeries that, in the judgment of the Provider, are nonlife threatening, can be provided in a facility other than an Acute Care Hospital, and are performed at an Ambulatory Surgical Facility by a duly licensed associated Physician or allied health professional practicing within the scope of his/her licensure and specialty. Outpatient surgeries performed in an Acute Care Hospital may be subject to higher Cost Sharing Amounts.
