Spousal Coordination of Benefits Sample Clauses

Spousal Coordination of Benefits. Spouses of employees who work for an employer where insurance is available will be required to enroll in at least Single coverage through their employer. Xxxxxxx who retire after this date and who are eligible for health insurance through his/her retirement system or Medicare will be required to enroll in at least single coverage. The spouse can still be covered on the district’s policy as secondary. Spouses will be exempt from this requirement if: 1. The spouse’s employer does not offer medical coverage. 2. The spouse must pay more than 50% of the single premium of the most expensive plan offered by the Consortium.
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Spousal Coordination of Benefits. Spouses of employees who are eligible for medical insurance through their own employer by an employer-sponsored plan or a retiree eligible for medical insurance by a retirement system group health insurance plan are required to enroll in at least Single coverage through their employer or retirement system. Upon the spouse’s enrollment in any such employer or retirement plan sponsored group medical insurance coverage that coverage will become the primary payor of benefits and the coverage sponsored by the District will become the secondary payor of benefits. Spouses of the bargaining unit member affected by this change effective July 1, 2022 will remain under current coverage until the next open enrollment period provided by their employer if necessary. If the employee’s spouse has to wait for the next open enrollment, he/she will provide a letter from his/her spouse’s employer indicating the next open enrollment period. Employees affected by the spousal coordination of benefits clause are eligible for a forty percent (40%) reduction in monthly medical co-pays. The monthly co-pay reduction will be for those employees eligible for an employee+spouse plan who take the single plan and forty percent (40%) per month for those employees eligible for a family plan who take the employee+child(ren) plan.
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Spousal Coordination of Benefits. ⬩ Any spouse of an employee of the Versailles Exempted Village Schools (VEVSD) who is eligible or later becomes eligible for benefits under his or her employer’s Medical, Dental, Vision or retiree health insurance plan is required to enroll for at least single coverage in the plan offered by or through his or her employer. Xxxxxxx enrolled in their employer’s plan may be enrolled as a covered dependent for secondary coverage under VEVSD plans. ⬩ If the spouse is eligible for coverage and does not enroll, he or she is not eligible to be covered by the Versailles Exempted Village Schools health care benefit plan. This change in the health insurance plan policy became effective July 1, 2005 and is applicable to you if you currently cover your spouse under the plan and he or she is eligible for health care benefits (Medical, Dental, Vision) through his or her own employer. In order to certify that your spouse is or is not covered by a plan where he or she works, you must complete a Spousal Coordination of Benefits Policy Form if you are enrolled in the Versailles Exempted Village Schools’ Medical, Dental or Vision insurance plan for family coverage. Falsification of statements on this form regarding benefits information will be considered grounds for termination of your contract. Generally, the following waivers apply: ⬩ If none of the above group mentioned sponsored health care benefit plans are available to the spouse, he or she is exempt from this requirement. ⬩ Spouse is under sixty-five (65), retired and does not have access to the option to purchase group or system pooled and/or sponsored retiree health care coverage ⬩ Spouse is unemployed
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Spousal Coordination of Benefits. Spouses of employees are to obtain health insurance from their employers, as long as it is made available to them from their employer, or retirement system if they do not have to pay more than 50% of the premium. This shall become the spouses’ primary health insurance policy. The PCSD employee may choose to carry his/her spouse on a family policy, but the PCSD insurance becomes secondary in coverage. Employees whose spouse is retired and currently on the PCSD family plan prior to the effective date of this contract will be grandfathered. NOTE: This policy became effective on October 01, 2007. Employees must notify the treasurer’s office by August 20, of each school year, that the spouse has enrolled in his/her employer’s policy to be effective October 01, 2007.
Sample 1
Spousal Coordination of Benefits. 1. If the employee’s spouse is eligible in their employer’s group health insurance and/or prescription drug insurance, the spouse of the employee must enroll in said employer’s sponsored group insurance coverage(s). (Spouse available insurance). The employee’s spouse may enroll in single employer sponsored group insurance coverage, the spouse is not required to enroll in family coverage. 2. If the employee(s) spouse refuses to enroll in the employer’s group health insurance, the MOST employee will pay an additional two-hundred ($200) per month for family coverage through the district. 3. Upon the spouse’s enrollment in any such “spouse available group health insurance coverage”, that coverage will become the primary payer of the spouse’s benefits and the coverage sponsored by the Board will become the secondary payer of the spouse’s benefits. 4. Every employee whose spouse participates in the Board’s group health insurance coverage and/or prescription drug insurance coverage shall complete and submit to the Board, upon request, a written declaration verifying whether or not their spouse is eligible to participate in “spouse available group health insurance” sponsored by the spouse’s employer. 5. If an employee submits false information about their spouse’s “spouse available insurance” coverage, the employee may be subject to disciplinary action by the Board, up to and including termination of the employee. 6. If an employee and/or their spouse and/or the dependent(s) involuntarily lose insurance coverage from any other plan (e.g., Employer of spouse/dependent discontinues insurance coverage, spouse/dependent changes job and no longer has insurance benefits through the employer), that employee and/or spouse and/or dependent(s) are automatically eligible to enroll in the Board’s insurance coverage with no pre-existing condition exclusions or waiting period. 7. The Spousal Coordination of Benefits requirement does not apply to any spouse who works twenty (20) hours or less per week. 8. The Spousal Coordination of Benefits language only applies to a spouse who can take group health insurance coverage. The contract language does not apply to any spouse who works for an organization that does not offer a group health insurance plan.
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Spousal Coordination of Benefits. Spouses of employees are to obtain health
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Spousal Coordination of Benefits. Effective September 1, 2023, spousal healthcare coverage will only be extended to employees whose spouse is unable to obtain healthcare through their employer. In the event a spouse can obtain coverage through their employer, they are not eligible to be on the Saucon Valley plan.
Sample 1
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Related to Spousal Coordination of Benefits

  • Coordination of Benefits i. Delta Dental coordinates the dental Benefits under this dental plan with your benefits under any other group or pre-paid plan or insurance plan designed to fully integrate with other plans. If this plan is the “primary” plan, Delta Dental will not reduce Benefits. If this plan is the “secondary” plan, Delta Dental may reduce Benefits so that the total benefits paid or provided by all plans do not exceed 100% of total allowable expense. ii. How does Delta Dental determine which Plan is the “primary” plan? 1) The plan covering the Enrollee as an employee is primary over a plan covering the Enrollee as a dependent. 2) The plan covering the Enrollee as an employee is primary over a plan covering the insured person as a dependent; except that if the insured person is also a Medicare beneficiary, and as a result of the rule established by Title XVIII of the Social Security Act and implementing regulations, Medicare is: a) secondary to the plan covering the insured person as a dependent; and b) primary to the plan covering the insured person as other than a dependent (e.g. a retired employee), then the benefits of the plan covering the insured person as a dependent are determined before those of the plan covering that insured person as other than a dependent. 3) Except as stated in paragraph 4), when this plan and another plan cover the same child as a dependent of different persons, called parents: a) the benefits of the plan of the parent whose birthday falls earlier in a year are determined before those of the plan of the parent whose birthday falls later in that year; but b) if both parents have the same birthday, the benefits of the plan covering one parent longer are determined before those of the plan covering the other parent for a shorter period of time. c) However, if the other plan does not have the birthday rule described above, but instead has a rule based on the gender of the parent, and if, as a result, the plans do not agree on the order of benefits, the rule in the other plan determines the order of benefits. 4) In the case of a dependent child of legally separated or divorced parents, the plan covering the Enrollee as a dependent of the parent with legal custody or as a dependent of the custodial parent’s spouse (i.e. step-parent) will be primary over the plan covering the Enrollee as a dependent of the parent without legal custody. If there is a court decree establishing financial responsibility for the health care expenses with respect to the child, the benefits of a plan covering the child as a dependent of the parent with such financial responsibility will be determined before the benefits of any other policy covering the child as a dependent child. 5) If the specific terms of a court decree state that the parents will share joint custody without stating that one of the parents is responsible for the health care expenses of the child, the plans covering the child will follow the order of benefit determination rules outlined in paragraph 3). 6) The benefits of a plan covering an insured person as an employee who is neither laid-off nor retired are determined before those of a plan covering that insured person as a laid-off or retired employee. The same would hold true if an insured person is a dependent of a person covered as a retiree or an employee. If the other plan does not have this rule, and if, as a result, the plans do not agree on the order of benefits, this rule 6) is ignored. 7) If an insured person whose coverage is provided under a right of continuation pursuant to federal or state law also is covered under another plan, the following will be the order of benefit determination. a) First, the benefits of a plan covering the insured person as an employee (or as that insured person’s dependent). b) Second, the benefits under the continuation coverage. c) If the other plan does not have the rule described above, and if, as a result, the plans do not agree on the order of benefits, this rule 7) is ignored. 8) If none of the above rules determines the order of benefits, the benefits of the plan covering an employee longer are determined before those of the plan covering that insured person for the shorter term. 9) When determination cannot be made in accordance with the above for Pediatric Benefits, the benefits of a plan that is a medical plan covering dental as a benefit will be primary to a dental only plan.

  • Duration of Benefits Eligibility for Income Protection benefits will cease upon the earliest of the following dates: 1.09.01 the date the member is no longer disabled from performing the duties of their regular position, or any alternative employment made available to the member by the City. 1.09.02 the date the member's Income Protection benefits have been expended. 1.09.03 the date the member dies.

  • Payment of Benefits All or part of the contract benefits may be paid under one or more of the following: - a variable payment plan; - a fixed payment plan; or - in cash. The provisions and rate for variable and fixed payment plans are described in Section 11. Contract benefits may not be placed under a payment plan unless the plan would provide to each beneficiary a monthly income the initial amount of which is at least the minimum payment amount shown on page 4. A Withdrawal Charge will be deducted from contract benefits before their payment under certain conditions described in Section 7.3.

  • Termination of Benefits Except as provided in Section 2 above or as may be required by law, Executive’s participation in all employee benefit (pension and welfare) and compensation plans of the Company shall cease as of the Termination Date. Nothing contained herein shall limit or otherwise impair Executive’s right to receive pension or similar benefit payments that are vested as of the Termination Date under any applicable tax-qualified pension or other plans, pursuant to the terms of the applicable plan.

  • Retention of Benefits Union leave under the following four (4) sections will be unpaid. The Employer will maintain regular pay and xxxx the Union for the costs of the employee’s salary and benefits. If the Union member is part-time or casual, and the leave is greater than their normal work hours, the Employer will pay the employee for the full length of the leave requested by the Union. The Employer will xxxx the Union for these days as noted above. The Union will pay these invoices within twenty-eight (28) days. Union leave is not unpaid leave for the purposes of Article 22.02 [i.e. such leave will not affect the employee’s benefits, seniority or increment anniversary date].

  • Distribution of Benefits Members of this unit with at least one year of the service to the District may apply for a number of days consistent with a one-for-one match of their individual sick leave accumulation as of the end of the previous contract year brought forward to the year of the onset of disability. The combined benefit of accumulated personal sick leave and disability bank leave may not exceed one hundred-eighty days and may carry over from one contract year to another. Employees with less than one full year of service in the District will not be require to contribute one of their individual accumulated sick leave days to the disability bank. The Board reviews the right to request re-application and documentation from anyone requesting more than forty (40) days from the pool. Any benefits will be minus other insurance coverage (i.e. worker’s compensation, social security, etc.).

  • Limitation of Benefits (a) Anything in this Agreement to the contrary notwithstanding, in the event it shall be determined that any benefit, payment or distribution by the Company or any of its direct and/or indirect subsidiaries to or for the benefit of Employee (whether paid or payable or distributed or distributable pursuant to the terms of this Agreement or otherwise, but determined without regard to any additional payments required under this Section 18) (such benefits, payments or distributions are hereinafter referred to as “Payments”) would, if paid, be subject to the excise tax imposed by Section 4999 of the Code (the “Excise Tax”), then, prior to the making of any Payments to Employee, a calculation shall be made comparing (i) the net after-tax benefit to Employee of the Payments after payment by Employee of the Excise Tax, to (ii) the net after-tax benefit to Employee if the Payments had been limited to the extent necessary to avoid being subject to the Excise Tax. If the amount calculated under (i) above is less than the amount calculated under (ii) above, then the Payments shall be limited to the extent necessary to avoid being subject to the Excise Tax (the “Reduced Amount”). The reduction of the Payments due hereunder, if applicable, shall be made by first reducing cash Payments and then, to the extent necessary, reducing those Payments having the next highest ratio of Parachute Value to actual present value of such Payments as of the date of the change of control, as determined by the Determination Firm (as defined in Section 18(b) below). For purposes of this Section 18, present value shall be determined in accordance with Section 280G(d)(4) of the Code. For purposes of this Section 18, the “Parachute Value” of a Payment means the present value as of the date of the change of control of the portion of such Payment that constitutes a “parachute payment” under Section 280G(b)(2) of the Code, as determined by the Determination Firm for purposes of determining whether and to what extent the Excise Tax will apply to such Payment. (b) All determinations required to be made under this Section 18, including whether an Excise Tax would otherwise be imposed, whether the Payments shall be reduced, the amount of the Reduced Amount, and the assumptions to be used in arriving at such determinations, shall be made by an independent, nationally recognized accounting firm or compensation consulting firm mutually acceptable to the Company and Employee (the “Determination Firm”) which shall provide detailed supporting calculations both to the Company and Employee. All fees and expenses of the Determination Firm shall be borne solely by the Company. Any determination by the Determination Firm shall be binding upon the Company and Employee. As a result of the uncertainty in the application of Section 4999 of the Code at the time of the initial determination by the Determination Firm hereunder, it is possible that Payments hereunder will have been unnecessarily limited by this Section 18 (“Underpayment”), consistent with the calculations required to be made hereunder. The Determination Firm shall determine the amount of the Underpayment that has occurred and any such Underpayment shall be promptly paid by the Company to or for the benefit of Employee, but no later than March 15 of the year after the year in which the Underpayment is determined to exist, which is when the legally binding right to such Underpayment arises.

  • Continuation of Benefits (i) For a period of three years following the Termination of Employment (the “Benefit Continuation Period”), the Employee shall be treated as if Employee had continued to be an executive for all purposes under the Company’s health insurance plan and dental insurance plan; or if the Employee is prohibited from participating in such plans, the Company shall otherwise provide such benefits. Employee shall be responsible for any employee contributions for such insurance coverage. Following the Benefit Continuation Period, Employee shall be entitled to receive continuation coverage under Part 6 of Title I of ERISA (“COBRA Benefits”) by treating the end of this period as the applicable qualifying event (i.e., as a termination of employment) for purposes of ERISA Section 603(2)) and with the concurrent loss of coverage occurring on the same date, to the extent allowed by applicable law. (ii) For the Benefit Continuation Period, the Company shall maintain in force, at its expense, the Employee’s life insurance in effect under the Company’s voluntary life insurance benefit plan as of the Change-in-Control Date or as of the date of Termination of Employment, whichever coverage limits are greater. For purposes of clarification, the portion of the premiums in respect of such voluntary life insurance for which Employee and the Company are responsible, respectively, shall be the same as the portion for which the Company and Employee are responsible, respectively, immediately prior to the date of Termination of Employment or the Change-in-Control Date, as applicable. (iii) For the Benefit Continuation Period, the Company shall provide short-term and long-term disability insurance benefits to Employee equivalent to the coverage that the Employee would have had Employee remained employed under the disability insurance plans applicable to Employee on the date of Termination of Employment, or, at the Employee’s election, the plans applicable to Employee as of the Change-in-Control Date. Should Employee become disabled during such period, Employee shall be entitled to receive such benefits, and for such duration, as the applicable plan provides. For purposes of clarification, the portion of the premiums in respect of such short-term and long-term disability benefits for which Employee and the Company are responsible, respectively, shall be the same as the portion for which Employee and the Company are responsible, respectively, immediately prior to the date of Termination of Employment or the Change-in-Control Date, as applicable. (iv) Notwithstanding anything in this Agreement to the contrary, in no event shall the provision of in-kind benefits pursuant to this Section 3 during any taxable year of Employee affect the provision of in-kind benefits pursuant to this Section 3 in any other taxable year of Employee.

  • Extension of Benefits Upon termination of insurance, whether due to termination of eligibility, or termination of the Contract, an extension of benefits shall be provided for a period of no less than 30 days for completion of a dental procedure that was started before Your coverage ended.

  • Death Benefits Upon the Executive’s death during the Contract Period, the Executive’s estate shall not be entitled to any further benefits under this Agreement.

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