Common use of HMO Plan Clause in Contracts

HMO Plan. The City shall offer an HMO plan, which will be the same plan that is offered to the City’s non-represented employees as of the effective date of this Agreement. The City can change the HMO plan from time-to-time, consistent with Article 18, Section A, as long as such changes apply equally to FOP employees as they are applied to the non-represented employees. All changes will be communicated during Open Enrollment for the upcoming insurance plan year and will be effective no sooner than January 1 of the first plan year after which the changes are communicated. Deductible: • Single $2,500 • Family $5,000 Out-of-Pocket: • Single $2,750 (includes deductible) • Family $6,850 (includes deductible) Emergency Room copay – Deductible applies, then 100% • Deductible applies, then 100% • The High Deductible Health Plan shall have associated with it a Health Savings Account (HSA). To the extent permitted by IRS regulations, employer contributions to the HSA shall be 50% of the deductibles for single and family coverage • Pursuant to the above formula, the City will make the following HSA contributions annually on behalf of current employees who enroll in the HDHP plan (not retirees) o $1,250 for employees with single coverage o $2,500 for employees with family coverage • In 2018 only, any current employee (not retirees) who enrolls in the HDHP Plan will receive a one-time cash payment as follows: o $500 for single coverage o $1,000 for family coverage o Employees can voluntarily elect to put this money into their HSA account. Subject to IRS rules, such voluntary contributions may be entitled to special tax treatment. Any employee who receives the bonus payment must remain in the HDHP plan for 36 months. If the employee opts out of the HDHP having participated in the plan less than 36 months, he will be required to repay the bonus via payroll deduction. Deductible:  Single $2,000 Out-of-Pocket:  Single $2,500 Emergency Room copay - $100 Chiropractic Services unlimited Pharmacy 30 day supply – local 90 day supply – mail order Generic $25 Generic $25 Formulary $50 Formulary $50 Namebrand $75 Namebrand $75 Mandatory mail order on maintenance drugs (90 day maximum fill). Retail fill (30 days maximum fill) allowed up to 3 months, then must go under mail order or pay the full retail price. If physician allows generic substitution, and individual requests name brand, then the charge will be the $75 name brand fill co-pay PLUS the cost difference between the generic drug to the name brand drug. If the total number of “in-network” providers decrease by 1/3rd or greater, then the Union may re-open negotiations for network benefits under the City’s Insurance Plan. Negotiations will be conducted in accordance with the IPLRA as interpreted under law.

HMO Plan. The City shall offer an HMO plan, which will be the same plan that is offered to the City’s non-non- represented employees as of the effective date of this Agreement. The City can change the HMO plan from time-to-time, consistent with Article 18, Section A, as long as such changes apply equally to FOP employees as they are applied to the non-represented employees. All changes will be communicated during Open Enrollment for the upcoming insurance plan year and will be effective no sooner than January 1 of the first plan year after which the changes are communicated. Deductible: •  Single $2,500 •  Family $5,000 Out-of-Pocket: •  Single $2,750 (includes deductible) •  Family $6,850 (includes deductible) Emergency Room copay – Deductible applies, then 100% •  Deductible applies, then 100% •  The High Deductible Health Plan shall have associated with it a Health Savings Account (HSA). To the extent permitted by IRS regulations, employer contributions to the HSA shall be 50% of the deductibles for single and family coverage •  Pursuant to the above formula, the City will make the following HSA contributions annually on behalf of current employees who enroll in the HDHP plan (not retirees) o $1,250 for employees with single coverage o $2,500 for employees with family coverage •  In 2018 only, any current employee (not retirees) who enrolls in the HDHP Plan will receive a one-time cash payment as follows: o $500 for single coverage o $1,000 for family coverage o Employees can voluntarily elect to put this money into their HSA account. Subject to IRS rules, such voluntary contributions may be entitled to special tax treatment. Any employee who receives the bonus payment must remain in the HDHP plan for 36 months. If the employee opts out of the HDHP having participated in the plan less than 36 months, he will be required to repay the bonus via payroll deduction. Deductible:  Single $2,000 Out-of-Pocket:  Single $2,500 Emergency Room copay - $100 Chiropractic Services unlimited Pharmacy 30 day supply – local 90 day supply – mail order Generic $25 Generic $25 Formulary $50 Formulary $50 Namebrand $75 Namebrand $75 Mandatory mail order on maintenance drugs (90 day maximum fill). Retail fill (30 days maximum fill) allowed up to 3 months, then must go under mail order or pay the full retail price. If physician allows generic substitution, and individual requests name brand, then the charge will be the $75 name brand fill co-pay PLUS the cost difference between the generic drug to the name brand drug. If the total number of “in-network” providers decrease by 1/3rd or greater, then the Union may re-open negotiations for network benefits under the City’s Insurance Plan. Negotiations will be conducted in accordance with the IPLRA as interpreted under law.