PLAN SPECIFICS Sample Clauses

PLAN SPECIFICS. Traditional Plan, Annual Deductible, Individual $150 Traditional Plan, Annual Deductible, Family $300 HMO Deductible $ 0 Physician Office Visit PCP $ 10 Physician Office Visit, Specialist $ 15 Outpatient Surgery Co-pay $ 50 Emergency Room Co-pay $ 25 Diagnostic Co-pay $ 30 Home Health Co-pay $ 10 Skilled Nursing Facility 100% Coverage, 60 Days per Calendar Year Durable Medical Equipment 80% Coverage up to $5000 per Calendar Year Prescription Drugs Retail 30 Days $5 Generic, $20 Brand Prescription Drugs Mail Order 90 Days $10 Generic, $40 Brand Annual Out-of-Pocket Maximum/ $750 Individual, $1500 Family Individual Prescription Drugs then 100% coverage District will make the above Blue Cross/Blue Shield Medical and Dental Group Rate available to all part-time employees at employees' expense. Those part-time employees who initiate such coverage must do so in accordance with the requirements established by the Business Office. The existing Traditional and HMO plans will remain the same for the duration of the contract. Member will contribute the following per pay for said coverage: CONTRIBUTION PER PAY Single $20 Single and Child $25 Husband and Wife $30 Family $35 Any employee hired after June 30, 2021 will be placed on the Core HMO Plan. This will be the only plan available to those hires.