Benefit Limitations. Your Covered Benefits may have specific limitations or requirements and are listed under the specific benefit section of this document: • Some Benefits may be subject to dollar amount and/or visit limitations. • Benefits may be excluded if the services are provided by Out-of-network Practitioners/Providers. • Some Benefits may be subject to Prior Authorization. Refer to your Summary of Benefits and Coverage and the Benefits Section for details about these limitations. Major Disasters In the event of any major disaster, epidemic or other circumstances beyond our control, we shall render or attempt to arrange Covered Benefits with In-network Practitioners/Providers insofar as practical, according to our best judgment, and within the limitations of facilities and personnel as are then available. However, no liability or obligation shall result from nor shall be incurred for the delay or failure to provide any such service due to the lack of available facilities or personnel if such lack is the result of such disaster, epidemic or other circumstances beyond our control, and if we have made a good-faith effort to provide or arrange for the provision of such services. Such circumstances include complete or partial disruption of facilities, war, act(s) of terrorism, riot, civil insurrection, disability of a significant part of a Hospital, our personnel or In-network Practitioners/Providers or similar causes. This provision does not impose any limitation on the availability of Coverage for services provided by Out-of-network Practitioners/Providers. Presbyterian Insurance Company, Inc. (PIC) Continuation If you are Covered by our continuation policy and are also Covered by another group medical plan you shall receive our benefits to the extent that we are the secondary payer of all eligible charges, subject to the terms, conditions and limitations of this Agreement.
Benefit Limitations. This benefit has one or more exclusions as specified in the Exclusions Section. You have the option to purchase up to a 90-day supply of Prescription Drugs/Medications. Under the up to a 90-day at Retail Pharmacy benefit, Preferred Generic, Non-Preferred Generic, Preferred Brand and Non-Preferred Drugs can be obtained from an In-network Pharmacy. If you chose the 90 days at retail option, you will be charged on copayment per 30-day supply up to a maximum of a 90-day supply. Some medications may qualify for third-party copayment assistance programs which could lower your out-of-pocket costs for those products. For any such medication where third-party copayment assistance is used (Discount Cards or Prescription Drug Savings Cards), the Member shall not receive credit toward their maximum out-of-pocket or deductible for any copayment or coinsurance amounts that are applied to a manufacturer coupon or rebate. Self-Administered Specialty Pharmaceuticals Self-Administered Specialty Pharmaceuticals are self-administered, meaning they are administered by the patient, a family member or care-giver. Specialty Pharmaceuticals are often used to treat complex chronic, rare diseases and/or life-threatening conditions. Most Specialty Pharmaceuticals require Prior Authorization and must be obtained through the specialty pharmacy network. Specialty Pharmaceuticals are often high cost, typically greater than $600 for up to a 30-day supply. Specialty Pharmaceuticals are not available through the retail or mail order option and are limited to a 30-day supply. Certain Specialty Pharmaceuticals may have additional day supply limitations. For a complete list of these drugs, please see the Specialty Pharmaceutical listing at xxxx://xxxx.xxx.xxx/idc/groups/public/documents/communication/pel_00000000.pdf. You can call our Presbyterian Customer Service Center, Monday through Friday from 7 a.m. to 6 p.m. at (000) 000-0000 or 0-000-000-0000. Hearing impaired users may call TTY 711. A Medical Drug is any drug administered by a Healthcare Professional and is typically given in the member's home, physician’s office, freestanding (ambulatory) infusion suite, or outpatient facility. Medical Drugs may require a Prior Authorization and some must be obtained through the specialty network. These drugs may be subject to a separate Copayment/Coinsurance to a maximum as outlined in your Summary of Benefits and Coverage.
Benefit Limitations. Full-time temporary employees shall be entitled to all the benefits of this Agreement, except that full-time temporary employees:
Benefit Limitations i) will conclude their probationary periods after having worked the equivalent hours as described for the probationary period.
Benefit Limitations. Full-time regular employees shall be entitled to all benefits of this Agreement except as limited during the probationary period. During the probationary period full-time regular employees shall not be eligible for coverage under the Dental Plan and the Long Term Disability Plan, but shall receive coverage under the B.C. Medical Plan, the Extended Health Benefits Plan and the Group Insurance Plan. Upon completion of the probationary period, a full-time regular employee will be credited with service back to the date of hire for the purpose of determining all the benefits under this Agreement. Except as provided for in 6.04(a) ii), by agreement with the Union the Corporation may hire a temporary employee to fill a full-time regular position as defined above. A full-time temporary employee who is successful in securing a regular position while a temporary employee shall have the term of employment since her/his last date of hire as a temporary employee applied towards the waiting periods for all welfare benefit plans. Those who have served the required waiting periods will be immediately eligible for coverage under those welfare benefit plans provided to full-time regular employees.
Benefit Limitations. Unless otherwise specifically agreed by the Union, part-time temporary employees will be paid an hourly rate which will be 108% of the hourly rate which is at the mid-point of the salary range for the appropriate classification. The enhanced rate shall be in lieu of all other benefits except that any benefit required by law will be in addition to the enhanced rate. Part-time temporary employees will receive 10.8% of gross earnings at termination in lieu of holiday pay as set out in Article 16 and in lieu of vacation entitlements.
Benefit Limitations. In accordance with Article 4.03, the employee i) shall not attain seniority until completion of the probationary period.
Benefit Limitations. Notwithstanding anything contained in this letter agreement to the contrary, to the extent that any payment or distribution of any type to you or for you by the Company, a Company affiliate, any person who acquires ownership or effective control of the Company or ownership of a substantial portion of the Company’s assets (within the meaning of Section 280G of Code and regulations thereunder), or any affiliate of such person, whether paid or payable or distributed or distributable pursuant to the terms of this letter agreement or otherwise (including, without limitation, any accelerated vesting, or payment of stock options or other awards) (collectively, the “Total Payments”) is or will be subject to the excise tax imposed under Section 4999 of the Code (the “Excise Tax”), then the Total Payments will be reduced (but not below zero) so that the maximum amount of the Total Payments (after reduction) will be one dollar ($1) less than the amount that would cause the Total Payments to be subject to the Excise Tax; provided that such reduction to the Total Payments will be made only if the total after-tax benefit to you is greater after giving effect to such reduction than if no such reduction had been
Benefit Limitations. On-call employees do not qualify for Group Insurance Plan.
