Comprehensive Major Medical Health Insurance Sample Clauses
The Comprehensive Major Medical Health Insurance clause defines the requirement for an insurance policy that provides broad coverage for a wide range of medical expenses, including hospital stays, physician services, prescription drugs, and other necessary treatments. This type of clause typically outlines the minimum standards for coverage, such as deductibles, co-payments, and maximum benefit limits, ensuring that the insured party is protected against significant financial loss due to major health issues. Its core function is to guarantee that individuals or employees have access to extensive medical care while limiting their out-of-pocket costs, thereby addressing the risk of high medical expenses.
Comprehensive Major Medical Health Insurance. Section 1: The Board will provide any Teacher with a one-half (1/2) time contract or greater a comprehensive major medical plan which contains the following cost containment provisions:
(a) Out-patient Surgery
(b) Mandatory Pre-admissions Testing
(c) Mandatory Second Opinion Surgery
(d) Ambulatory Surgery
(e) Inpatient Concurrent Review
(f) A prescription card
Comprehensive Major Medical Health Insurance. Section 1: The Board will provide any Teacher with a one-half (1/2) time contract or greater a comprehensive major medical plan which contains the following cost containment provisions:
a) Out-patient Surgery
b) Mandatory Pre-admissions Testing
c) Mandatory Second Opinion Surgery
d) Ambulatory Surgery
e) Inpatient Concurrent Review
f) A prescription card
Section 2: Coverage for the comprehensive major medical insurance program will contain the benefit provisions set forth in Appendix IV. It will also include a full cost spousal surcharge for employees whose spouses are eligible for health coverage through their own employers. Additional information regarding this surcharge is set forth in Appendix IV. Teachers who are hired on or after November 20, 2017 are eligible to enroll in the Core Plan, the HSA Plan, or the Essential Plan only. The plan will pay one hundred percent (100%) of all eligible claims in excess of the annual deductible and coinsurance amount (excluding co-pays).
Section 3: The comprehensive major medical insurance program coverage and exceptions shall be set forth in a brochure and made available to all participants.
Section 4: Upon the death of an active or retired Teacher, the spouse shall be provided such access to health insurance as required by law.
Section 5: The plan will be administered by Anthem. A change in the third-party administration may occur at any time upon mutual agreement of the parties.
Section 6: The Board and the Association agree that SBCSC will not exceed limits imposed by I.C. 20-26-17. The Board and Association agree that an open enrollment period will be offered annually and will provide an opportunity to change between plans offered, except that following the close of the 2017 enrollment period, participants in the Core, HSA, or Essential Plans will not be permitted to select the Buy Up Plan. Within 14 days after open enrollment ends, the Corporation will provide to the Insurance Committee the expected cost for group health care, the Corporation’s contribution and the employee premium for each applicable plan and level of coverage. The Insurance Committee shall meet quarterly to review the premiums and to ensure there are no material errors in methodology and to monitor the services of Anthem. The parties agree that the group health insurance plan will be changed to avoid the “Cadillac Tax” under the Affordable Care Act. The Board and the Association shall bargain such changes and will execute a Memorandum of Un...