Extended Health Care, Dental and Vision Care Sample Clauses

Extended Health Care, Dental and Vision Care. All employees as of October 1, 2006 can choose between Plan A or Plan B. Any employee that chooses Plan B cannot switch back to Plan A. All employees hired after October 1, 2006 will join Plan B when they become eligible. Dependents of married employees, as outlined in the Plan Document are covered under this provision. Plan A is the benefit plan in place at September 30, 2006. The following is a comparative outline of the two plans: PLAN A PLAN B MAJOR MEDICAL AND SUPPLEMENTAL HOSPITAL Deductible $25 annual No deductible Co-insurance 100%-drugs & hospital 80% other than drugs 80% - medical supplies & services 50% - vision Hospital semi-private to $55/day semi-private to $175/day Drugs Reimbursement Drug Card generic mandate generic mandate 80% of first $500/single 85% of first %500/single, effective October 1, 2013 80% of first $1000/family 85% of first $1000/family, effective October 1, 2013 100% coinsurance thereafter Subject to lifetime max $10,000 annual max $20,000 Anti-smoking $300 lifetime Anti-smoking $300 lifetime Drug Dispensing Fee N/A $6 limit per prescription Private Duty Nurse $5,000 lifetime $8,000 lifetime Chiropractor $7/visit to 20 visits/year $30/visit to max of $400 for Osteopath $7/visit to 20 visits/year all Paramedicals combined Speech therapist $7/visit to 20 visits/year Physiotherapist $7/visit to 20 visits/year Out-of-Country $100,000 lifetime/hosp $1,000,000 lifetime max $20,000 lifetime all other Travel assistance not covered 1-800 Emergency Medical Termination Retirement Age 65 or retirement, whichever comes earlier All premiums for the above benefits are 100% paid by the Company. DENTAL CARE Covered services are diagnostic services (routine examinations and x-rays), preventative services (cleaning, scaling (Plan A - limited to two units of cleaning and scaling with a six month recall and Plan B – limited to three units of cleaning and scaling with a six month recall) and fluoride applications), restorative services (fillings), and surgical services (extractions and necessary anesthesia), denture, denture repair and root canal services. PLAN A PLAN B Deductible $10 single, $20 family/year No Deductible Coinsurance 100% 90% Maximum $1500/year combined $2,000/year combined with dentures with dentures PLAN A PLAN B Dependent Ortho 50% 50% Maximum $2,000 lifetime $3,000 lifetime Eligible Fee Guide Two year lag current Termination Retirement Age 65 or retirement whichever comes earlier The premium cost will be shared between the Co...
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Related to Extended Health Care, Dental and Vision Care

  • Extended Health Care Benefits 12.02(a) The City will provide for all employees by contract through an insurer selected by the City an Extended Health Care Plan which will provide extended health care benefits. The City shall pay one hundred per cent (100%) of the premiums, which will include any premiums payable under The Health Insurance Act, R.S.O. 1990, as amended. Eligible Expenses (Benefit year January 1 – December 31)

  • Extended Health Care Plan (a) The Employer shall pay the monthly premium for regular employees entitled to coverage under a mutually acceptable Extended Health Care Plan.

  • Extended Health Care The Hospital shall contribute on behalf of each eligible employee seventy-five percent (75%) of the billed premium under the Extended Health Care Plan (Liberty Health $15-25 deductible plan including hearing aids with a maximum of $300.00 per person and vision care with a maximum of $150.00 every 24 months per person, or its equivalent) provided the balance of the monthly premium is paid by employees through payroll deduction. Any Hospital currently paying more than 75% of the premium shall continue to do so. The drug formulary shall be as defined by Liberty Health Formulary Three.

  • Extended Health Care Coverage A) The Employer shall pay one hundred percent (100%) of the monthly premiums for extended health care coverage for regular employees and their eligible dependents (including common-law spouses) under the Pacific Blue Cross Plan, or any other plan mutually acceptable to the Union and the Employer (See also Appendix “I”). The plan benefits shall be expanded to include:

  • Vision Care Effective July 1, 2000, the District shall provide all full-time employees and their dependents with Vision Service Plan (VSP) Plan C. This plan shall provide for a comprehensive exam and new lenses every 12 months, and new frames every 12 months. All other services will be pursuant to the standard VSP plan description, except that it will reimburse up to $50 for examinations by non-panel providers. There shall be a $10 annual deductible on materials only. In addition, the following vision plan enhancements shall take place effective July 1, 2000: $60 wholesale frame allowance; computer glasses; progressive lenses, tints, and UV coatings.

  • Covered Health Care Services We agree to provide coverage for medically necessary covered health care services listed in this agreement. If a service or category of service is not specifically listed as covered, it is not covered under this agreement. Only services that we have reviewed and determined are eligible for coverage under this agreement are covered. All other services are not covered. See Section 1.4 for how we identify new services and our guidelines for reviewing and making coverage determinations. We only cover a service listed in this agreement if it is medically necessary. We review medical necessity in accordance with our medical policies and related guidelines. The term medically necessary is defined in Section 8.0 - Glossary. It does not include all medically appropriate services. The amount of coverage we provide for each health care service differs according to whether or not the service is received: • as an inpatient; • as an outpatient; • in your home; • in a doctor’s office; or • from a pharmacy. Also coverage differs depending on whether: • the health care provider is a network provider or non-network provider; • deductibles (if any), copayments, or maximum benefit apply; • you have reached your plan year maximum out-of-pocket expense; • there are any exclusions from coverage that apply; or • our allowance for a covered health care service is less than the amount of your copayment and deductible (if any). In this case, you will be responsible to pay up to our allowance when services are rendered by a network provider. Please see the Summary of Medical Benefits to determine the benefit limits and amount that you pay for the covered health care services listed below. Please see the Summary of Pharmacy Benefits to determine the benefit limits and amount that you pay for prescription drug and diabetic equipment and supplies purchased at a pharmacy.

  • Health Care Benefits (a) Each regular full-time employee may elect coverage for himself and his eligible dependents* under one of the following health insurance plans:

  • Vision Care Plan The County agrees to provide a Vision Care Plan for all employees and dependents. The Plan will be the Vision Service Plan - Plan A with benefits at 12/12/24 month intervals and with twenty dollar ($20.00) deductible for examinations and twenty dollar ($20.00) deductible for materials. The County will fully pay the monthly premium for the employee and dependents and pick up inflationary costs during the term of the Agreement.

  • Child Care A. Employees employed as of March 1 who meet the following criteria shall be eligible for a lump sum payment each year. Eligible employees may apply for this payment between March 1 and April 15 of each year. Payment shall be made within thirty (30) days of receipt of the completed application. Any application received after April 15 will be considered on a case by case basis and shall not be arbitrarily rejected.

  • COVERED HEALTHCARE SERVICES This section describes covered healthcare services. This plan covers services only if they meet all of the following requirements: • Listed as a covered healthcare service in this section. The fact that a provider has prescribed or recommended a service, or that it is the only available treatment for an illness or injury does not mean it is a covered healthcare service under this plan. • Medically necessary, consistent with our medical policies and related guidelines at the time the services are provided. • Not listed in Exclusions Section. • Received while a member is enrolled in the plan. • Consistent with applicable state or federal law. We review medical necessity in accordance with our medical policies and related guidelines. Our medical policies can be found on our website. Our medical policies are written to help administer benefits for the purpose of claims payment. They are made available to you for informational purposes and are subject to change. Medical policies are not meant to be used as a guide for your medical treatment. Your medical treatment remains a decision made by you with your physician. If you have questions about our medical policies, please call Customer Service. When a new service or drug becomes available, when possible, we will review it within six (6) months of one of the events described below to determine whether the new service or drug will be covered: • the assignment of an American Medical Association (AMA) Current Procedural Terminology (CPT) code in the annual CPT publication; • final Food and Drug Administration (FDA) approval; • the assignment of processing codes other than CPT codes or approval by governing or regulatory bodies other than the FDA; • submission to us of a claim meeting the criteria above; and • generally, the first date an FDA approved prescription drug is available in pharmacies (for prescription drug coverage only). During the review period, new services and drugs are not covered. For all covered healthcare services, please see the Summary of Medical Benefits and the Summary of Pharmacy Benefits to determine the amount that you pay and any benefit limits.

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