Copayments, Coinsurance and Discount Sample Clauses

Related to Copayments, Coinsurance and Discount

Copayment A fixed amount You pay directly to a Provider for a Covered Service when You receive the service. The amount can vary by the type of Covered Service. Cost-Sharing: Amounts You must pay for Covered Services, expressed as Copayments, Deductibles and/or Coinsurance. Cover, Covered or Covered Services: The Medically Necessary services paid for, arranged, or authorized for You by Us under the terms and conditions of this Contract. Deductible: The amount You owe before We begin to pay for Covered Services. The Deductible applies before any Copayments or Coinsurance are applied. The Deductible may not apply to all Covered Services. You may also have a Deductible that applies to a specific Covered Service that You owe before We begin to pay for a particular Covered Service. Dependents: The Subscriber’s Spouse and Children. Emergency Dental Care: Emergency dental treatment required to alleviate pain and suffering caused by dental disease or trauma. Refer to the Pediatric Dental Care and Adult Dental Care sections of this Contract for details.
Copayments Effective January 1, 2019, the State Dental Plan will cover allowable charges for the following services subject to the copayments and coverage limits stated. Higher out-of-pocket costs apply to services obtained from dental care providers not in the State Dental Plan network. Services provided through the State Dental Plan are subject to the State Dental Plan's managed care procedures and principles, including standards of dental necessity and appropriate practice. The plan shall cover general cleaning two (2) times per plan year and special cleanings (root or deep cleaning) as prescribed by the dentist. Service In-Network Out-of-Network Diagnostic/Preventive 100% 50% after deductible Fillings 80% after deductible 50% after deductible Endodontics 80% after deductible 50% after deductible Periodontics 80% after deductible 50% after deductible Oral Surgery 80% after deductible 50% after deductible Crowns 80% after deductible 50% after deductible Implants 80% after deductible 50% after deductible Prosthetics 80% after deductible 50% after deductible Prosthetic Repairs 80% after deductible 50% after deductible Orthodontics* 80% after deductible 50% after deductible
MAINTENANCE OF CLASSROOM CONTROL AND DISCIPLINE A. When, in the judgment of a teacher, a student is, by behavior, seriously disrupting the instructional program to the detriment of other students, the teacher may exclude the student temporarily from the classroom and refer the student to the building administrator for appropriate intervention. At the request of the referring teacher, an administrator will communicate the status of a disciplinary action within two (2) work days of the request.
Basic Life and Accidental Death and Dismemberment Coverage The Employer agrees to provide and pay for the following term life coverage and accidental death and dismemberment coverage for all supervisors eligible for an Employer Contribution, as described in Section 3. Any premium paid by the State in excess of fifty thousand dollars ($50,000) coverage is subject to a tax liability in accord with Internal Revenue Service regulations. A supervisor may decline coverage in excess of fifty thousand dollars ($50,000) by filing a waiver in accord with Minnesota Management & Budget procedures. The basic life insurance policy will include an accelerated benefits agreement providing for payment of benefits prior to death if the insured has a terminal condition. Supervisors’ Annual Base Salary Group Life Insurance Coverage Accidental Death and Dismemberment Principal Sum $10,000 - $15,000 $15,000 $15,000 $15,001 - $20,000 $20,000 $20,000 $20,001 - $25,000 $25,000 $25,000 $25,001 - $30,000 $30,000 $30,000 $30,001 - $35,000 $35,000 $35,000 $35,001 - $40,000 $40,000 $40,000 $40,001 - $45,000 $45,000 $45,000 $45,001 - $50,000 $50,000 $50,000 $50,001 - $55,000 $55,000 $55,000 $55,001 - $60,000 $60,000 $60,000 $60,001 - $65,000 $65,000 $65,000 $65,001 - $70,000 $70,000 $70,000 $70,001 - $75,000 $75,000 $75,000 $75,001 - $80,000 $80,000 $80,000 $80,001 - $85,000 $85,000 $85,000 $85,001 - $90,000 $90,000 $90,000 Over $90,000 $95,000 $95,000
Office Visit Copayments In each year of the Agreement, the level of the office visit copayment applicable to an employee and dependents is based upon whether the employee has completed the on-line Health Assessment during open enrollment and has agreed to opt-in for health coaching.
Coinsurance After the deductible is satisfied, seventy percent (70%) coverage up to the plan out-of-pocket maximum designated below.
Optional Life and Disability Coverages In order for coverage to become effective, the employee must be in active payroll status and not using sick leave on the first day following approval by the insurance company. If it is an open enrollment period, coverage may be applied for but will not become effective until the first day of the employee's return to work.
’ Compensation Insurance and Disability Benefits Requirements Sections 57 and 220 of the New York State Workers’ Compensation Law require the heads of all municipal and state entities to ensure that businesses applying for contracts have appropriate workers’ compensation and disability benefits insurance coverage. These requirements apply to both original contracts and renewals. Failure to provide proper proof of such coverage or a legal exemption will result in a rejection of any contract renewal. Proof of workers’ compensation and disability benefits coverage, or proof of exemption must be submitted to OGS at the time of policy renewal, contract renewal and upon request. Proof of compliance must be submitted on one of the following forms designated by the New York State Workers’ Compensation Board. An XXXXX form is not acceptable proof of New York State workers’ compensation or disability benefits insurance coverage. Proof of Compliance with Workers’ Compensation Coverage Requirements:
Life Insurance and Accidental Death and Dismemberment The Board shall provide without cost to the employee’s life insurance and accidental death and dismemberment insurance in the amount of $35,000.
Accidental Death and Dismemberment Insurance The plan provides accidental death and dismemberment insurance coverage in an amount equal to your basic group life insurance (two times your current annual salary). Coverage is provided 24 hours per day, anywhere in the world, for any accident resulting in death, dismemberment, paralysis, loss of use, or loss of speech or hearing. If you sustain an injury caused by an accident occurring while the policy is in force which results in one of the following losses, within 365 days of the accident, the benefit shown will be paid to you. In the case of accidental death, the benefit will be paid to the beneficiary you have named to receive your group life insurance benefits. Benefits are payable in accordance with the following schedule: Schedule of Benefits 100% of Principal Sum For Loss of: · Life · Both Hands or Both Feet · Entire Sight of Both Eyes · One Hand and One Foot · One Hand and Entire Sight of One Eye · One Foot and Entire Sight of One Eye · Speech and Hearing in Both Ears · Use of Both Arms or Both Legs or Both Hands · Quadriplegia (total paralysis of both upper and lower limbs) · Paraplegia (total paralysis of both lower limbs) · Hemiplegia (total paralysis of upper and lower limbs of one side of the body) 75% of Principal Sum For Loss of: · One Arm or One Leg · Use of One Arm or One Leg 66 2/3% of Principal Sum For Loss of: · One Hand or One Foot · Entire Sight of One Eye · Speech or Hearing in Both Ears · Use of One Hand or One Foot 33 1/3% of Principal Sum of Loss of: · Thumb and Index Finger of One Hand · Four Fingers of One Hand