PPO. Employees may enroll in the PPO program (or its successor), subject to the enrollment rules of the carrier but provided there shall be no pre-existing condition limitation. The annual date for rate changes is October 1. Those individual/small group instruction teachers who elect coverage shall be provided the benefit level that is in effect at the time of their election. The benefits shall be as follows in accordance with the Summary Chart in Appendix (TBD): $20.00–70% out of network Emergency room co-pay: $ 50.00 $1,000.00 Family Non-network: $2,000.00–Single $4,000.00 – Family
PPO. The City shall provide hospitalization and major PPO medical coverage with a deductible of $250.00 per person to a maximum of $500.00 per family. Out of network deductibles shall be $500.00 single/$1000.00 family. Office visit co-pay of $20.00 for in network and paid at 70% for out of network. Healthcare expenses will be paid at 90% in network with a maximum out of pocket at $750 single/$1500 family per year. Out of network expenses will be paid at 70% up to a maximum out of pocket expense of $1500 single/$3,000 family per year. Prescription drug plan available at $10.00 for generic drug, $30.00 brand formulary and $50.00 brand non-formulary. Mail in drug plan, cost for a 90 day supply at the same rate as that of the 30 day prescription. The City shall continue to provide the AFSCME, Ohio Council 8 Health and Welfare Plan. The City shall pay the cost of such coverage not to exceed $47.50 per employee. In patient hospital in network paid at 90% after deductible and out of network hospital paid at 70% after deductible, until maximum out of pocket expense is made. Emergency room co-pay of $50.00 in network and 70% for out of network after deductible. Urgent Care co-pay of $25.00 in network and 70% out of network after deductible.
PPO. 38.021 The Board shall provide PPO insurance coverage which meets or exceeds the specifications below for each teacher in the bargaining unit, now or hereinafter employed, and his or her eligible dependents. Eighty-eight (88) percent of the cost of the premium shall be paid by the Board. Twelve (12) percent of the cost of the premium shall be paid by the employee. The employee’s share of the premium shall be paid through a Section 125 plan. Effective August 1, 2018 Eighty-seven (87) percent of the cost of the premium shall be paid by the Board. Thirteen (13) percent of the cost of the premium shall be paid by the employee. The employee’s share of the premium shall be paid through a Section 125 plan. Effective August 1, 2019 Eighty-six (86) percent of the cost of the premium shall be paid by the Board. Fourteen (14) percent of the cost of the premium shall be paid by the employee. The employee’s share of the premium shall be paid through a Section 125 plan. Effective August 1, 2020 Eighty-five (85) percent of the cost of the premium shall be paid by the Board. Fifteen (15) percent of the cost of the premium shall be paid by the employee. The employee’s share of the premium shall be paid through a Section 125 plan. Employees who work less than full-time shall contribute fifty (50) percent of the cost of the premium (for .5 teacher) or twenty-five (25) percent of the cost of the premium (for .75 teacher).
PPO. For the life of the Agreement, the Company would offer the PPO plan as an option. Medical In-Network Out-of-Network Calendar Year Deductible $600 / $1,800 $1,800 / $3,600 Company Funded HRA N/A N/A Coinsurance 80% 60% Out-of-Pocket Maximum $3,000 / $6,000 No Max. PCP Copay $35 Ded. and Coin. Specialist Copay $40 Ded. and Coin Emergency Room $125 copay plus Ded. and Coin. $125 copay plus Ded. and Coin. Urgent Care $35 Ded. and Coin Preventive Care 100% Ded. and Coin • In the final month of the agreement, employees will pay no more than 25% of the cost for a PPO plan. • During 2022 through 2025, the Company and the Union may reach mutual agreement on changes in plan design (items above) in an effort to curb increases to employee’s weekly contribution while maintaining total net cost. • Spousal Surcharge – If members choose to elect spousal coverage for a spouse who is eligible for coverage under his or her employer’s health plan, they will pay an additional $25 per week.
PPO. Employees may enroll in the PPO program (or its successor), subject to the enrollment rules of the carrier but provided there shall be no pre-existing condition limitation. Employees shall pay 13% for such coverage, including prescription drug coverage and dental coverage, of the premium rates in effect in each benefit year. The employee contribution shall be 15% in the fall of 2015. The annual date for rate changes is October 1st.
PPO. 38.021 The Board shall provide PPO insurance coverage which meets or exceeds the specifications below for each teacher in the bargaining unit, now or hereinafter employed, and his or her eligible dependents. Eighty-eight (88) percent of the cost of the premium shall be paid by the Board. Twelve (12) percent of the cost of the premium shall be paid by the employee. The employee’s share of the premium shall be paid through a Section 125 plan. Employees hired on or after August 1, 2007 and who work less than full-time shall contribute fifty (50) percent of the cost of the premium (for .5 teacher) or twenty-five (25) percent of the cost of the premium (for .75 teacher).
PPO. Effective September 1, 2008, each eligible employee with PPO single coverage shall have deducted in each payroll period $39.53 from his/her payroll check; for an eligible employee with PPO dependent coverage, the amount shall be $49.53. Effective the first full pay period on or after January 1, 2009, each eligible employee with PPO coverage shall have deducted in each payroll period $41.61 from his/her payroll check; for an eligible employee with PPO dependent coverage, the amount shall be $52.62. Effective the first full pay period on of after January 1, 2010, each eligible employee with PPO single coverage shall have deducted in each payroll period $44.16 from his/her payroll check; for an eligible employee with PPO dependent coverage, the amount shall be $55.85.
PPO. All teams must submit a team photo no later than 48hrs after their third game – failure to do so will result in a automatic league point deduction. PP1 All Team managers must commit to providing electronic player photographs of their players by a date defined by BBAXN League Administrators (minimum of 3 weeks notice will be given). This is used to facilitate thrown out players, Most Valuable Player and Top Point Scorer table.
PPO. The penalty for failure to call for preadmission approval prior to an inpatient hospital stay under the PPO is $350.00. For employees in the PPO, the following will apply: • The annual deductible will be $350.00 per individual, the annual deductible for Employee + 1 will be $700.00 and the maximum annual deductible per family will be $1,050.00. • Coinsurance will be 85% of eligible charges after the annual deductible has been met. • A $100.00 co-payment for the emergency room per visit will be required. The co- payment is waived if the patient is admitted from the emergency room. • A Prescription Drug Step Therapy and Prior Authorization program will be utilized. • The annual out-of-pocket expense limit is $1,500.00 per individual, $3,000.00 for Employee + 1 and a maximum of $4,000.00 per family for in-network providers. The annual out-of-pocket expense limit is $3,000.00 per individual, $6,000.00 for Employee + 1 and a maximum of $9,000.00 per family for out-of-network providers. • Coverage for outpatient surgery will be as follows: In-network (PPO) 85% Out-of-network 70% of Usual and Customary The District offers a Wellness Benefit, including Preventative Care Services to all employees and eligible dependents enrolled in the Blue Cross Blue Shield Participating Provider Organization (PPO). This benefit will encourage employees and eligible dependents to seek the preventative care and diagnostic services identified below with the goal of providing for the early diagnosis of illness which can be beneficial in controlling long term health care costs. • Routine Lab Work • Routine X-rays • Hearing Screenings • Routine Sleep Study • Routine EKG • Routine Ovarian Cancer Lab/X-ray • Routine Colorectal Lab/X-ray The Wellness Benefit will be covered at 100% of the eligible charge and the annual deductible will not apply. Covered employees and dependents must use a Participating Provider to receive the maximum benefit coverage.
