Point of Service Plan Sample Clauses

Point of Service Plan. Effective January 1, 2017 the following shall be the Health Plan (Point of Service) offered to employees: Lifetime Benefit Maximum Unlimited Unlimited Unlimited Annual Deductible No deductible $250/person $1,000/person Out of Pocket Max $750 per person to $2,250 Family Max $1,500 per person to $4,500 Family Max $6000 per person to $18,000 Family Max Preventive Benefits No charge $25 copay Not covered Physician - Outpatient PCP $20 copay $25 copay 30% aft ded Physician - Outpatient Specialist $40 copay $50 copay 30% aft ded Physician - Inpatient 10% 20% aft ded 30% aft ded Hospital - Facility At SVMH: No charge (all other network facilities charged at Tier 2 level) 20% aft ded 30% aft ded Hospital - Professional 10% 20% aft ded 30% aft ded Mental Health / Substance Abuse - - - Outpatient (33 visits/CY) 10% 20% aft ded 30% aft ded Inpatient (30 days/CY) 10% 20% aft ded 30% aft ded Residential (60 days/CY) 10% 20% aft ded 30% aft ded Emergency Room $75 copay; copay waived if admitted Urgent Care At SVMH UCC only: $20 copay (all other network UCCs charged at Tier 2 level) 20 % aft ded 30% aft ded Ambulance 20% 20% aft ded 20% aft ded Prescription Drugs Generic-20% / Brand-20% / NonFormulary-20% 1. Deductibles and Out-of-Pocket Maximums will cross-accumulate: In- Network expenses (Tiers 1 and 2) will accumulate to Out-of-Network (Tier 3) and Out-of-Network expenses will accumulate to In-Network. Services not available at SVMH are payable at the Tier 1 level. 2. A dependent who receives medical services at a time the dependent is enrolled in a higher education institution located more than one hundred (100) miles from SVMH shall receive benefits at the Tier 1 level subject to the eligibility terms of the Plan Document.

Point of Service Plan. For members hired before September 1, 2015, the District will provide health insurance benefits as negotiated by the parties for eligible employees pursuant to the Syracuse City School District Health Benefits Program as set forth below.

Point of Service Plan. Provides employees with a choice each time there is a claim between receiving HMO style benefits or indemnity style benefits. HMO Style Benefits -- Benefits received from a Primary Care Physician or as a result of a referral from the Primary Care Physician are subject to a $5 copayment. Indemnity Style Benefits -- Benefits that are received without a referral from the employee's (or dependent's) Primary Care Physician are subject to an annual $250/person ($500/family) deductible, followed by 80% coverage for the next $5,000 of covered expenses per person ($1,000 per person in coinsurance payments). Prescription drugs are subject to a $10 copaypayment per 30 day supply of brand name drug, a $5 copayment per 30 day supply of generic drug, or a $5 copayment per 90 day supply of drugs ordered via mail order prescription service. Retirees under sixty-five (65) and their dependents will be covered by the same medical plan as active employees, described above, and the Company will pay the premium for Retirees and their dependents for the first year following retirement. After this first year, retirees and their dependents will be eligible to receive medical insurance benefits from the Unitil Retiree Trust. Active employees and retirees sixty-five (65) years or over will be covered by a supplement to Medicare Plan paid for by the Company. The eligible dependents (age 65 or over) of these active employees and retirees sixty-five (65) or over will also be covered by the Supplemental to Medical Plan with full premium paid for by the Company. The Company will pay the premium for the retirees and their dependents for the first year following retirement. After this first year, retirees and their dependents will be eligible to receive medical insurance benefits from the Unitil Retiree Trust.

Point of Service Plan. The POS plan design shall be comparable with the plan design of the Blue Cross/Blue Shield product known as Blue Choice I which was in place on June 30, 1997 with due regard for any changes or amendments thereto set forth herein. 1). Speech therapy, occupational therapy, physical therapy coverage in the plan shall be limited only by the PCP referrals and without other limits. 2). Up to ten (10) chiropractic visits per year before managed care reporting by the chiropractor begins.