Comprehensive Major Medical. The City shall maintain preferred provider organization(s) (PPO) for both medical and prescription drug services.
Comprehensive Major Medical. Continuation of 18 existing plan without modification of benefits, except as noted. 19 20 (a) Effective January 1, 2016, $300/$600 deductible; 20% co- 21 insurance; $1,000 individual/$2,000 family per year out-of- 22 pocket limit (in addition to deductible). 24 (b) Effective January 1, 2016, $500/$1,000 deductible; 40% co- 25 insurance; $5,000 individual/$10,000 family per year out-of- 26 pocket limit (in addition to deductible).
Comprehensive Major Medical. (1) A $200 annual deductible with an 80/20 percent co-insurance of the next $1,500 of reasonable charges or $300, for a total out-of-pocket maximum of $500 per single contract per year.
Comprehensive Major Medical. If the employee and/or dependent receive services from a preferred provider (PPO), reimbursements will remain at the current eighty/twenty percent (80/20%) coinsurance and will be subject to the single and family deductibles and out-of- pocket maximums listed in Appendix D. The reimbursement rate will be determined based on reasonable charges, not usual, customary and reasonable. Deductibles, Out-of-Pocket Maximums and visit limits will fully reset on January 1st of each year.
Comprehensive Major Medical. This section has been superseded and replaced by the parties' December 13, 2018 Memorandum of Understanding (MOU). With respect to insurance (Topics 1-4), the MOU remains in effect for Benefit Year 2020. Pursuant to Article 19, Section 1, the topic of insurance is subject to reopening for Benefit Year 2021.
Comprehensive Major Medical. This plan includes a mandatory hospital pre-admission certification requirement which must be followed to prevent a reduction in benefits payable by the plan. Failure to contact the medical review organization as specified in this pre-admission certification requirement will result in a $200 reduction in benefits payable for hospital expenses incurred during a non-certified hospital confinement. This plan will pay, after satisfaction of the specified deductible amount, the benefit percentage indicated in the schedule of benefits, subject to the specified maximums. The plan provides for a preferred provider organization (network provider) as recommended by the insurance committee to the board of education. Overall Annual Maximum Unlimited Calendar Year Deductible Amount ................................................................................. Network ndividual $300 ....................................................................................................................Family $600 Non-Network ndividual $600 .................................................................................................................Family $1,200 Coinsurance (Paid by the Plan) Network 80% of the allowed amount Non-Network 60% of allowed amount Coinsurance Maximum Network ndividual $1,000 .................................................................................................................Family $2,000 Non-Network ndividual $4,000 .................................................................................................................Family $8,000 Network/Non-Network Integration – Costs incurred for a non-network provider will only apply to the non-network deductible, coinsurance limits and vice versa. When admitted to an In-Network Hospital all services administered by the facility and physicians attached to that facility shall be paid according to the In-Network schedule of benefits. Out-of-Pocket Maximum (Includes coinsurance paid by the employee, medical copayments and the calendar year deductible amount) Network Individual Family $3,000 $6,000 Non-Network Individual Family Unlimited Unlimited Benefit Limits & Maximums (subject to Overall Annual Maximum) Spinal Manipulation Treatment 20 visits per Calendar Year Treatment of Infertility -------------------------- No coverage for treatment of infertility. Coverage will include tests and treatment necessary to determine diagnosis of infertility. Outpatient Occupational & Physical Thera...
Comprehensive Major Medical. The Board of School Trustees will provide to eligible employees on a voluntary basis a medical insurance program. Following are the required annual employee contributions Employee’s will see a modest 3% increase to their contribution levels. Employees who were eligible for insurance prior to 2006 and enrolled prior to 2012: Grandfathered Employees (20-40 hrs) 2022 Contributions Plan A Single $ 1,213 Family $ 3,514 Plan B Single $ 176 Family $ 742 The following are required annual contributions to the medical insurance plans offered for employees currently working twenty to thirty-nine (20-39) hours or more per week. Employees Enrolled After 1-1 2012 (30+ hrs per week) 2022 Contributions Plan B Single $ 1,436 Family $ 3,830 Employees Enrolled After 1-1-2012 (20-29 hrs per week) 2022 Contributions Plan B Single $ 3,586 Family $ 9,578
Comprehensive Major Medical. ACTIVE EMPLOYEES AND ELIGIBLE DEPENDENTS Comprehensive major medical benefits including hospital, surgical, medical, laboratory, X-ray and ancillary services for each full-time permanent employee and eligible dependents described below, who has been in the employ of the Authority continuously for not less than three (3) months, while necessarily confined in a hospital, as defined in the master policy, because of bodily injuries, sickness or disease and on the advice and under the care of a licensed physician or surgeon, providing eighty (80) percent of full payment of the usual and customary cost of a semi-private hospital room; eighty (80) percent of full payment of the usual and customary cost for services rendered and hospital supplies furnished by the hospital and not included in the hospital room charges; full hospital benefits paid in accordance with above for maternity; provided in all of the above situations the employee or dependent fully complies with the Utilization Review Program (pre- certification, continued stay, utilization review, discharge planning and for surgical procedures in which a second opinion was obtained or waived); eighty (80) percent of full payment for usual and customary cost of emergency hospital out-patient services incurred within seventy-two (72) hours on account of accidental bodily injuries; payment of medical expense incurred by the employee for any treatment rendered to the employee by the attending licensed physician while so confined, but not in excess of (a) eighty (80) percent of usual and customary charges for one
Comprehensive Major Medical. Lifetime 5 maximum of one million dollars ($1,000,000). Continuation 6 of existing plan without modification of benefits, except as 7 noted. 9 (a) Preferred Provider - $200/$400 deductible; 20% co- 10 insurance; $500 individual/$1,000 family per year out- 11 of- pocket limit (in addition to deductible). 12 13 (b) Out-of-Network Provider - $400/$800 deductible; 14 40% co-insurance; $3,000 individual/$6,000 family 15 per year out-of-pocket limit (in addition to deductible). 16
Comprehensive Major Medical. (1) Weight loss schedule limited to examination charges only. Food supplements in the treatment of obesity are excluded.
