Common use of Health Insurance Program Clause in Contracts

Health Insurance Program. Effective January 1, 2006, the EMPLOYER will offer the following health insurance programs for eligible full-time employees and legal dependents. Option 1: BCBSM-POS: Blue Choice Certificate, POS DR 250/500, POS CR 80/20, POS AA, POS OV 20, POS ET 50 Prescription drug coverage will be provided by the EMPLOYER through a pharmacy benefits manager. Prescription Drug Plan 1: Prescription drug copayments for generic drugs will be $0.00. Prescription drug copayments for brand drugs will be based on a formulary. Brands listed under “Generic Copay” heading will have a $0.00 copay. Formulary brand copay will be 20%, but not more than $35.00. Non formulary brand copay will 25%, but not less than $25.00 and not more than $45.00. Maximum out-of-pocket expenses for drugs for each health care plan participant contract will be $1,100.00 per year. Coverage for mail order will also be provided, and a 90-day supply of any properly prescribed drug will only be available through mail order. A 90-day supply of designated maintenance drugs shall also be available at retail pharmacies. The formulary and list of medications available in 90-day quantities at retail pharmacies shall be subject to periodic review and revision. Option 2: PHP Plus (Point-of-Service) Plan 00000-000-000 Prescription drug coverage will be provided by the EMPLOYER through a pharmacy benefits manager. Prescription Drug Plan 1: Prescription drug copayments for generic drugs will be $0.00. Prescription drug copayments for brand drugs will be based on a formulary. Brands listed under “Generic Copay” heading will have a $0.00 copay. Formulary brand copay will be 20%, but not more than $35.00. Non formulary brand copay will 25%, but not less than $25.00 and not more than $45.00. Maximum out-of-pocket expenses for drugs for each health care plan participant contract will be $1,100.00 per year. Coverage for mail order will also be provided, and a 90-day supply of any properly prescribed drug will only be available through mail order. A 90-day supply of designated maintenance drugs shall also be available at retail pharmacies. The formulary and list of medications available in 90-day quantities at retail pharmacies shall be subject to periodic review and revision. Option 3: Health Advantage - High Plan Prescription drug coverage will be provided by the EMPLOYER through a pharmacy benefits manager. Prescription Drug Plan 1: Prescription drug copayments for generic drugs will be $0.00. Prescription drug copayments for brand drugs will be based on a formulary. Brands listed under “Generic Copay” heading will have a $0.00 copay. Formulary brand copay will be 20%, but not more than $35.00. Non formulary brand copay will be 25%, but not less than $25.00 and not more than $45.00. Maximum out-of-pocket expenses for drugs for each health care plan participant contract will be $1,100.00 per year. Coverage for mail order will also be provided, and a 90-day supply of any properly prescribed drug will be available through mail order for a single month copay. A 90-day supply of designated maintenance drugs shall also be available at retail pharmacies for a single month copay. The formulary and list of medications available in 90-day quantities at retail pharmacies shall be subject to periodic review and revision. Option 4: Health Advantage - Low Plan Prescription Drug Plan 3: Prescription drug coverage will be provided by the EMPLOYER through a pharmacy benefits manager. Generic drugs shall have a $2.00 copay. Prescription drug copayments for brand drugs will be based on a formulary. Brands listed under “Generic Copay” heading will have a $2.00 copay. Formulary brand copay will be 25%, but not less than $15.00 and not more than $35.00. Non formulary brand copay will be 25%, but not less than $25.00 and not more than $45.00. Maximum out-of-pocket expenses for drugs for each health care plan participant contract will be $1,100.00 per year. Coverage for mail order will also be provided, and a 90-day supply of any properly prescribed drug will be available through mail order for a single month copay. A 90-day supply of designated maintenance drugs shall also be available at retail pharmacies for a single month copay. The formulary and list of medications available in 90-day quantities at retail pharmacies shall be subject to periodic review and revision Prescription drug copayments will be $2.00 for generic drugs, 25% for brand drugs, with a minimum of $15.00 and a maximum of $35.00. Maximum out-of-pocket expenses for drugs for each health care plan participant contract will be $1,100.00 per year. Coverage for mail order will also be provided and a 90-day supply of a maintenance drug will only be available through mail order. Option 5: PHP HMO Only Plan 30407 Prescription Drug Plan 3: Prescription drug coverage will be provided by the EMPLOYER through a pharmacy benefits manager. Generic drugs shall have a $2.00 copay. Prescription drug copayments for brand drugs will be based on a formulary. Brands listed under “Generic Copay” heading will have a $2.00 copay. Formulary brand copay will be 25%, but not less than $15.00 and not more than $35.00. Non formulary brand copay will be 25%, but not less than $25.00 and not more than $45.00. Maximum out-of-pocket expenses for drugs for each health care plan participant contract will be $1,100.00 per year. Coverage for mail order will also be provided, and a 90-day supply of any properly prescribed drug will be available through mail order for a single month copay. A 90-day supply of designated maintenance drugs shall also be available at retail pharmacies for a single month copay. The formulary and list of medications available in 90-day quantities at retail pharmacies shall be subject to periodic review and revision Prescription drug copayments will be $2.00 for generic drugs, 25% for brand drugs, with a minimum of $15.00 and a maximum of $35.00. Maximum out-of-pocket expenses for drugs for each health care plan participant contract will be $1,100.00 per year. Coverage for mail order will also be provided and a 90-day supply of a maintenance drug will only be available through mail order.

Health Insurance Program. Effective January 1, 2006, the EMPLOYER will offer the following health insurance programs for eligible full-time employees and legal dependents. Option 1: BCBSM-POS: Blue Choice Certificate, POS DR 250/500, POS CR 80/20, POS AA, POS OV 20, POS ET 50 Prescription drug coverage will be provided by the EMPLOYER through a pharmacy benefits manager. Prescription Drug Plan 1: Prescription drug copayments for generic drugs will be $0.00. Prescription drug copayments for brand drugs will be based on a formulary. Brands listed under “Generic Copay” heading will have a $0.00 copay. Formulary brand copay will be 20%, but not more than $35.00. Non formulary brand copay will 25%, but not less than $25.00 and not more than $45.00. Maximum out-of-pocket expenses for drugs for each health care plan participant contract will be $1,100.00 per year. Coverage for mail order will also be provided, and a 90-day supply of any properly prescribed drug will only be available through mail order. A 90-day supply of designated maintenance drugs shall also be available at retail pharmacies. The formulary and list of medications available in 90-day quantities at retail pharmacies shall be subject to periodic review and revision. Option 2: PHP Plus (Point-of-Service) Plan 00000-000-000 Prescription drug coverage will be provided by the EMPLOYER through a pharmacy benefits manager. Prescription Drug Plan 1: Prescription drug copayments for generic drugs will be $0.00. Prescription drug copayments for brand drugs will be based on a formulary. Brands listed under “Generic Copay” heading will have a $0.00 copay. Formulary brand copay will be 20%, but not more than $35.00. Non formulary brand copay will 25%, but not less than $25.00 and not more than $45.00. Maximum out-of-pocket expenses for drugs for each health care plan participant contract will be $1,100.00 per year. Coverage for mail order will also be provided, and a 90-day supply of any properly prescribed drug will only be available through mail order. A 90-day supply of designated maintenance drugs shall also be available at retail pharmacies. The formulary and list of medications available in 90-day quantities at retail pharmacies shall be subject to periodic review and revision. Option 3: Health Advantage - High Plan Prescription drug coverage will be provided by the EMPLOYER through a pharmacy benefits manager. Prescription Drug Plan 1: Prescription drug copayments for generic drugs will be $0.00. Prescription drug copayments for brand drugs will be based on a formulary. Brands listed under “Generic Copay” heading will have a $0.00 copay. Formulary brand copay will be 20%, but not more than $35.00. Non formulary brand copay will be 25%, but not less than $25.00 and not more than $45.00. Maximum out-of-pocket expenses for drugs for each health care plan participant contract will be $1,100.00 per year. Coverage for mail order will also be provided, and a 90-day supply of any properly prescribed drug will be available through mail order for a single month copay. A 90-day supply of designated maintenance drugs shall also be available at retail pharmacies for a single month copay. The formulary and list of medications available in 90-day quantities at retail pharmacies shall be subject to periodic review and revision. Option 4: Health Advantage - Low Plan Prescription Drug Plan 3: Prescription drug coverage will be provided by the EMPLOYER through a pharmacy benefits manager. Generic drugs shall have a $2.00 copay. Prescription drug copayments for brand drugs will be based on a formulary. Brands listed under “Generic Copay” heading will have a $2.00 copay. Formulary brand copay will be 25%, but not less than $15.00 and not more than $35.00. Non formulary brand copay will be 25%, but not less than $25.00 and not more than $45.00. Maximum out-of-pocket expenses for drugs for each health care plan participant contract will be $1,100.00 per year. Coverage for mail order will also be provided, and a 90-90- day supply of any properly prescribed drug will be available through mail order for a single month copay. A 90-day supply of designated maintenance drugs shall also be available at retail pharmacies for a single month copay. The formulary and list of medications available in 90-day quantities at retail pharmacies shall be subject to periodic review and revision Prescription drug copayments will be $2.00 for generic drugs, 25% for brand drugs, with a minimum of $15.00 and a maximum of $35.00. Maximum out-of-pocket expenses for drugs for each health care plan participant contract will be $1,100.00 per year. Coverage for mail order will also be provided and a 90-90- day supply of a maintenance drug will only be available through mail order. Option 5: PHP HMO Only Plan 30407 Prescription Drug Plan 3: Prescription drug coverage will be provided by the EMPLOYER through a pharmacy benefits manager. Generic drugs shall have a $2.00 copay. Prescription drug copayments for brand drugs will be based on a formulary. Brands listed under “Generic Copay” heading will have a $2.00 copay. Formulary brand copay will be 25%, but not less than $15.00 and not more than $35.00. Non formulary brand copay will be 25%, but not less than $25.00 and not more than $45.00. Maximum out-of-pocket expenses for drugs for each health care plan participant contract will be $1,100.00 per year. Coverage for mail order will also be provided, and a 90-90- day supply of any properly prescribed drug will be available through mail order for a single month copay. A 90-day supply of designated maintenance drugs shall also be available at retail pharmacies for a single month copay. The formulary and list of medications available in 90-day quantities at retail pharmacies shall be subject to periodic review and revision Prescription drug copayments will be $2.00 for generic drugs, 25% for brand drugs, with a minimum of $15.00 and a maximum of $35.00. Maximum out-of-pocket expenses for drugs for each health care plan participant contract will be $1,100.00 per year. Coverage for mail order will also be provided and a 90-90- day supply of a maintenance drug will only be available through mail order.

Health Insurance Program. Effective January 1, 20062007, the EMPLOYER Employer will offer the following health insurance programs for eligible full-time employees and legal dependents. Option 1: BCBSM-POS: Blue Choice Certificate, POS DR 250/500, POS CR 80/20, POS AA, POS OV 20, POS ET 50 Prescription drug coverage will be provided by the EMPLOYER through a pharmacy benefits manager. Prescription Drug Plan 1: Prescription drug copayments for generic drugs will be $0.00. Prescription drug copayments for brand drugs will be based on a formulary. Brands listed under “Generic Copay” heading will have a $0.00 copay. Formulary brand copay will be 20%, but not more than $35.0040.00. Non formulary brand copay will 25%, but not less than $25.00 and not more than $45.0050.00. Maximum out-of-pocket expenses for drugs for each health care plan participant contract will be $1,100.00 1,200.00 per year. Coverage for mail order will also be provided, and a 90-day supply of any properly prescribed drug will only be available through mail order. A 90-day supply of designated maintenance drugs shall also be available at retail pharmacies. The formulary and list of medications available in 90-day quantities at retail pharmacies shall be subject to periodic review and revision. There will be step therapy provisions for stated classes of medications beginning with stomach acid reducers and allergy medications. A grandfather clause will be included in the step therapy program. Option 2: PHP Plus (Point-of-Service) Plan 00000-000-000 Prescription drug coverage will be provided by the EMPLOYER through a pharmacy benefits manager. Prescription Drug Plan 1: Prescription drug copayments for generic drugs will be $0.00. Prescription drug copayments for brand drugs will be based on a formulary. Brands listed under “Generic Copay” heading will have a $0.00 copay. Formulary brand copay will be 20%, but not more than $35.0040.00. Non formulary brand copay will be 25%, but not less than $25.00 and not more than $45.0050.00. Maximum out-of-pocket expenses for drugs for each health care plan participant contract will be $1,100.00 1,200.00 per year. Coverage for mail order will also be provided, and a 90-day supply of any properly prescribed drug will only be available through mail order. A 90-day supply of designated maintenance drugs shall also be available at retail pharmacies. The formulary and list of medications available in 90-day quantities at retail pharmacies shall be subject to periodic review and revision. There will be step therapy provisions for stated classes of medications beginning with stomach acid reducers and allergy medications. A grandfather clause will be included in the step therapy program. Option 3: McLaren Health Advantage - Plan-High Plan 100274,A100,A039 Prescription drug coverage will be provided by the EMPLOYER through a pharmacy benefits manager. Prescription Drug Plan 1: Prescription drug copayments for generic drugs will be $0.00. Prescription drug copayments for brand drugs will be based on a formulary. Brands listed under “Generic Copay” heading will have a $0.00 copay. Formulary brand copay will be 20%, but not more than $35.0040.00. Non formulary brand copay will be 25%, but not less than $25.00 and not more than $45.0050.00. Maximum out-of-pocket expenses for drugs for each health care plan participant contract will be $1,100.00 1,200.00 per year. Coverage for mail order will also be provided, and a 90-day supply of any properly prescribed drug will only be available through mail order. A 90-day supply of designated maintenance drugs shall also be available at retail pharmacies. The formulary and list of medications available in 90-day quantities at retail pharmacies shall be subject to periodic review and revision. There will be step therapy provisions for stated classes of medications beginning with stomach acid reducers and allergy medications. A grandfather clause will be included in the step therapy program. Option 4: McLaren Health Plan-Low Plan 100274, A100, A040 Prescription Drug Plan 3: Prescription drug coverage will be provided by the EMPLOYER through a pharmacy benefits manager. Generic drugs shall have a $2.00 copay. Prescription drug copayments for brand drugs will be based on a formulary. Brands listed under “Generic Copay” heading will have a $2.00 copay. Formulary brand copay will be 25%, but not less than $15.00 and not more than $40.00. Non formulary brand copay will be 25%, but not less than $25.00 and not more than $50.00. Maximum out-of-pocket expenses for drugs for each health care plan contract will be $1,200.00 per year. Coverage for mail order will also be provided, and a 90-day supply of any properly prescribed drug will be available through mail order for a single month copay. A 90-day supply of designated maintenance drugs shall also be available at retail pharmacies for a single month copay. The formulary and list of medications available in 90-day quantities at retail pharmacies shall be subject to periodic review and revision. Prescription drug copayments will be $2.00 for generic drugs, 25% for brand drugs, with a minimum of $15.00 and a maximum of $35.00. Maximum out-of- pocket expenses for drugs for each health care plan contract will be $1,200.00 per year. Coverage for mail order will also be provided and a 90-day supply of a maintenance drug will only be available through mail order. There will be step therapy provisions for stated classes of medications beginning with stomach acid reducers and allergy medications. A grandfather clause will be included in the step therapy program. Option 45: Health Advantage - Low PHP HMO Only Plan L00002480 SubGroup1010 Prescription Drug Plan 3: Prescription drug coverage will be provided by the EMPLOYER through a pharmacy benefits manager. Generic drugs shall have a $2.00 copay. Prescription drug copayments for brand drugs will be based on a formulary. Brands listed under “Generic Copay” heading will have a $2.00 copay. Formulary brand copay will be 25%, but not less than $15.00 and not more than $35.0040.00. Non formulary brand copay will be 25%, but not less than $25.00 and not more than $45.0050.00. Maximum out-of-pocket expenses for drugs for each health care plan participant contract will be $1,100.00 1,200.00 per year. Coverage for mail order will also be provided, and a 90-day supply of any properly prescribed drug will be available through mail order for a single month copay. A 90-day supply of designated maintenance drugs shall also be available at retail pharmacies for a single month copay. The formulary and list of medications available in 90-day quantities at retail pharmacies shall be subject to periodic review and revision revision. Prescription drug copayments will be $2.00 for generic drugs, 25% for brand drugs, with a minimum of $15.00 and a maximum of $35.00. Maximum out-of-of- pocket expenses for drugs for each health care plan participant contract will be $1,100.00 1,200.00 per year. Coverage for mail order will also be provided and a 90-day supply of a maintenance drug will only be available through mail order. Option 5: PHP HMO Only Plan 30407 Prescription Drug Plan 3: Prescription drug coverage There will be provided by the EMPLOYER through a pharmacy benefits managerstep therapy provisions for stated classes of medications beginning with stomach acid reducers and allergy medications. Generic drugs shall have a $2.00 copay. Prescription drug copayments for brand drugs A grandfather clause will be based on a formulary. Brands listed under “Generic Copay” heading will have a $2.00 copay. Formulary brand copay will be 25%, but not less than $15.00 and not more than $35.00. Non formulary brand copay will be 25%, but not less than $25.00 and not more than $45.00. Maximum out-of-pocket expenses for drugs for each health care plan participant contract will be $1,100.00 per year. Coverage for mail order will also be provided, and a 90-day supply of any properly prescribed drug will be available through mail order for a single month copay. A 90-day supply of designated maintenance drugs shall also be available at retail pharmacies for a single month copay. The formulary and list of medications available included in 90-day quantities at retail pharmacies shall be subject to periodic review and revision Prescription drug copayments will be $2.00 for generic drugs, 25% for brand drugs, with a minimum of $15.00 and a maximum of $35.00. Maximum out-of-pocket expenses for drugs for each health care plan participant contract will be $1,100.00 per year. Coverage for mail order will also be provided and a 90-day supply of a maintenance drug will only be available through mail orderthe step therapy program.