Common use of Employee Benefit Clause in Contracts

Employee Benefit. Trust Fund (medical hardware not covered by faculty member’s medical insurance): 5.1.9.1 The District will reimburse any unpaid balance of eligible claims for medical hardware, provided the unpaid balance is not part of the member’s required annual deductible or doctor office visit co-pay. 5.1.9.2 Eligible claims will be subject to the following maximums: 1. One claim per year. 2. Three claims maximum while in the program. a. No more than $2,000 per claim or $5,000 total benefit per family from the program. 5.1.9.3 Valid claims for Medical Hardware must meet all the following criteria: 1. Prescribed by a health care provider. 2. Of no further use when medical need ends. 3. Usable only by the patient-. 4. Not for environmental control. 5. Not for exercise. 6. Manufactured specifically for medical use. 5.1.9.4 A request for claim payment for medical hardware (as defined above) must be initially submitted to the medical insurance provider. Following claim validation by the medical insurance provider, the faculty member may submit the claim to the Business Office for payment of the amount not covered by medical insurance (excluding the annual deductible and/or co-pay, which always remains the responsibility of the faculty member). 5.1.9.5 Coverage is provided for: 1. Faculty members (while employed) and their eligible spouse or domestic partner and dependents during such employment; and 2. Retired faculty members (who are retirees of STRS or PERS, and who participate in the District’s Retirement Benefits as described in Article VI) and their spouses or domestic partners. Definitions of spouse or domestic partner and dependent are the same as for other medical benefits.