Common use of Hospitalization Insurance Clause in Contracts

Hospitalization Insurance. The Board shall make available health care benefits equal to or better than those previously adopted and as adjusted based on the negotiated contract for the years 2017-2018, 2018-2019, 2019-2020, and 2020-2021. Terms of coverage and benefit schedules are found in the Plan Document and Summary Plan Description for the Penn Manor School District Employee Healthcare Benefit Plan. The Board shall make available, through payroll deductions, coverage for members, members’ spouses, and members’ dependents as specified under The Patient Protection and Affordable Care Act. Monthly payroll deductions for healthcare: Calendar year basis 2018 2019 2020 2021 Single 2 Party Family 9% based upon 7/1/2017 Expected Floating Rate less dental deduction amount 9% based upon 7/1/2018 Expected Floating Rate less dental deduction amount 10% based upon 7/1/2019 Expected Floating Rate less dental deduction amount 10% based upon 7/1/2020 Expected Floating Rate less dental deduction amount The annual in-network deductible under the point of service plan will be as follows: Effective Date Individual Family January 1, 2018 $500 $1,000 Waived if Lancaster Regional/Heart Of Lancaster used January 1, 2019 $500 $1,000 Waived if Lancaster Regional/Heart Of Lancaster used January 1, 2020 $750 $1,500 Waived if Lancaster Regional/Heart Of Lancaster used January 1, 2021 $750 $1,500 Waived if Lancaster Regional/Heart Of Lancaster used The annual out-of-network deductible under the point of service plan will be as follows: Effective Date Individual Family January 1, 2018 $1,000 $2,000 January 1, 2019 $1,000 $2,000 January 1, 2020 $1,500 $3,000 January 1, 2021 $1,500 $3,000 Out-of-network co-insurance expense beyond the listed deductibles shall be paid at an 80% district/20% member rate subject to the usual and customary charge. The maximum out-of-pocket for combined in-network and out-of-network charges, which includes deductibles, medical co-pays, pharmacy co-pays, and amounts over reasonable and customary charges will be as follows: Effective Date Maximum out-of-pocket Individual Maximum out-of-pocket Family January 1, 2018 $4,000 $8,000 January 1, 2019 $4,000 $8,000 January 1, 2020 $6,350 $12,000 January 1, 2021 $6,350 $12,000 The doctor’s visit office co-pay under the current plan will be as follows: Primary Care Effective Date Physician Visit Specialist Visit January 1, 2018 $15 $40 January 1, 2019 $15 $40 January 1, 2020 $15 $45 January 1, 2021 $15 $45 Urgent Care and Emergency Room Co-pays: Effective Date Urgent Care Emergency Room January 1, 2018 $35 $100 January 1, 2019 $35 $100 January 1, 2020 $40 $100 January 1, 2021 $40 $100 In the event that a member has both an Urgent Care and Emergency Room visit for the same event, the member may submit receipts for reimbursement of $35 (2018-2019) and $40 (2020-2021) from the District.

Hospitalization Insurance. The Board shall make available health care benefits equal to or better than those previously adopted and as adjusted based on the negotiated contract for the years 20172022-20182023, 20182023-20192024, 20192024-20202025, and 20202025-20212026. Terms of coverage and benefit schedules are found in the Plan Document and Summary Plan Description for the Penn Manor School District Employee Healthcare Benefit Plan. The Board shall make available, through payroll deductions, coverage for members, members’ spouses, and members’ dependents as specified under The Patient Protection and Affordable Care Act. Monthly payroll deductions for healthcare: Calendar year basis 2018 2019 2020 2021 Single 1/1/2023-12/31/2026 No Wellness Single, 2 Party Party, Family 916% based upon 7/1/2017 the prior year’s Expected Floating Rate less dental deduction amount 9% based upon 7/1/2018 Expected Floating Rate less dental deduction amount 1/1/2023-12/31/2026 Wellness* 10% based upon 7/1/2019 the prior year’s Expected Floating Rate less dental deduction amount *In the event that a bargaining unit member submits a physician-verified Wellness Certification Form no later than the end of the annual open-enrollment period, the premium share will be a 10% contribution based upon 7/1/2020 Expected Floating Rate less dental deduction amount the prior year’s expected floating rate. The annual in-network deductible under the point of service plan will be as follows: Effective Date Individual Family January 1, 2018 $500 $1,000 Waived if Lancaster Regional/Heart Of Lancaster used January 1, 2019 $500 $1,000 Waived if Lancaster Regional/Heart Of Lancaster used January 1, 2020 2023 $750 $1,500 Waived if Lancaster Regional/Heart Of Lancaster UPMC Pinnacle Lititz used January 1, 2021 2024 $750 $1,500 Waived if Lancaster Regional/Heart Of Lancaster UPMC Pinnacle Lititz used January 1, 2025 $750 $1,500 Waived if UPMC Pinnacle Lititz used January 1, 2026 $750 $1,500 Waived if UPMC Pinnacle Lititz used The annual out-of-network deductible under the point of service plan will be as follows: Effective Date Individual Family January 1, 2018 $1,000 $2,000 January 1, 2019 $1,000 $2,000 January 1, 2020 2023 $1,500 $3,000 January 1, 2021 2024 $1,500 $3,000 January 1, 2025 $1,500 $3,000 January 1, 2026 $1,500 $3,000 Out-of-network co-insurance expense beyond the listed deductibles shall be paid at an 80% district/20% member rate subject to the usual and customary charge. The maximum out-of-pocket for combined in-network and out-of-network charges, which includes deductibles, medical co-pays, pharmacy co-pays, and amounts over reasonable and customary charges will be as follows: Effective Date Maximum out-of-pocket Individual Maximum out-of-pocket Family January 1, 2018 $4,000 $8,000 January 1, 2019 $4,000 $8,000 January 1, 2020 2023 $6,350 $12,000 January 1, 2021 2024 $6,350 $12,000 January 1, 2025 $6,350 $12,000 January 1, 2026 $6,350 $12,000 The doctor’s visit office co-pay under the current plan will be as follows: Effective Date Primary Care Effective Date Physician Visit Specialist Visit Visit* January 1, 2018 $15 $40 January 1, 2019 $15 $40 January 1, 2020 2023 $15 $45 January 1, 2021 2024 $15 $45 January 1, 2025 $15 $45 January 1, 2026 $15 $45 *Employees may request a consultation through Teledoc for dermatology services with no co-pay ($0). Urgent Care and Emergency Room Co-pays: Effective Date Urgent Care Emergency Room January 1, 2018 $35 $100 January 1, 2019 $35 $100 January 1, 2020 2023 $40 $100 January 1, 2021 2024 $40 $100 January 1, 2025 $40 $100 January 1, 2026 $40 $100 In the event that a member has both an Urgent Care and Emergency Room visit for the same event, the member may submit receipts for reimbursement of $35 (2018-2019) and $40 (2020-2021) from the District.

Hospitalization Insurance. The Board shall make available health care benefits equal to or better than those previously adopted and as adjusted based on the negotiated contract for the years 20172022-20182023, 20182023-20192024, 20192024-20202025, and 20202025-20212026. Terms of coverage and benefit schedules are found in the Plan Document and Summary Plan Description for the Penn Manor School District Employee Healthcare Benefit Plan. The Board shall make available, through payroll deductions, coverage for members, members’ spouses, and members’ dependents as specified under The Patient Protection and Affordable Care Act. Monthly payroll deductions for healthcare: Calendar year basis 2018 2019 2020 2021 Single 1/1/2023-12/31/2026 No Wellness 1/1/2023-12/31/2026 Wellness* Single, 2 Party Party, Family 916% based upon 7/1/2017 the prior year’s Expected Floating Rate less dental deduction amount 9% based upon 7/1/2018 Expected Floating Rate less dental deduction amount 10% based upon 7/1/2019 the prior year’s Expected Floating Rate less dental deduction amount *In the event that a bargaining unit member submits a physician-verified Wellness Certification Form no later than the end of the annual open-enrollment period, the premium share will be a 10% contribution based upon 7/1/2020 Expected Floating Rate less dental deduction amount the prior year’s expected floating rate. The annual in-network deductible under the point of service plan will be as follows: Effective Date Individual Family January 1, 2018 $500 $1,000 Waived if Lancaster Regional/Heart Of Lancaster used January 1, 2019 $500 $1,000 Waived if Lancaster Regional/Heart Of Lancaster used January 1, 2020 2023 $750 $1,500 Waived if Lancaster Regional/Heart Of Lancaster UPMC Pinnacle Lititz used January 1, 2021 2024 $750 $1,500 Waived if Lancaster Regional/Heart Of Lancaster UPMC Pinnacle Lititz used January 1, 2025 $750 $1,500 Waived if UPMC Pinnacle Lititz used January 1, 2026 $750 $1,500 Waived if UPMC Pinnacle Lititz used The annual out-of-network deductible under the point of service plan will be as follows: Effective Date Individual Family January 1, 2018 $1,000 $2,000 January 1, 2019 $1,000 $2,000 January 1, 2020 2023 $1,500 $3,000 January 1, 2021 2024 $1,500 $3,000 January 1, 2025 $1,500 $3,000 January 1, 2026 $1,500 $3,000 Out-of-network co-insurance expense beyond the listed deductibles shall be paid at an 80% district/20% member rate subject to the usual and customary charge. The maximum out-of-pocket for combined in-network and out-of-network charges, which includes deductibles, medical co-pays, pharmacy co-pays, and amounts over reasonable and customary charges will be as follows: Effective Date Maximum out-of-pocket Individual Maximum out-of-pocket Family January 1, 2018 $4,000 $8,000 January 1, 2019 $4,000 $8,000 January 1, 2020 2023 $6,350 $12,000 January 1, 2021 2024 $6,350 $12,000 January 1, 2025 $6,350 $12,000 January 1, 2026 $6,350 $12,000 The doctor’s visit office co-pay under the current plan will be as follows: Effective Date Primary Care Effective Date Physician Visit Specialist Visit Visit* January 1, 2018 $15 $40 January 1, 2019 $15 $40 January 1, 2020 2023 $15 $45 January 1, 2021 2024 $15 $45 January 1, 2025 $15 $45 January 1, 2026 $15 $45 *Employees may request a consultation through Teledoc for dermatology services with no co-pay ($0). Urgent Care and Emergency Room Co-pays: Effective Date Urgent Care Emergency Room January 1, 2018 $35 $100 January 1, 2019 $35 $100 January 1, 2020 2023 $40 $100 January 1, 2021 2024 $40 $100 January 1, 2025 $40 $100 January 1, 2026 $40 $100 In the event that a member has both an Urgent Care and Emergency Room visit for the same event, the member may submit receipts for reimbursement of $35 (2018-2019) and $40 (2020-2021) from the District.

Hospitalization Insurance. The Board shall make available health care benefits equal to or better than those previously adopted and as adjusted based on the negotiated contract for the years 2014-2015, 2015-2016 and 2016-2017-2018, 2018-2019, 2019-2020, and 2020-2021. Terms of coverage and benefit schedules are found in the Plan Document and Summary Plan Description for the Penn Manor School District Employee Healthcare Benefit Plan. The Board shall make available, through payroll deductions, coverage for members, members’ spouses, and members’ dependents as specified under The Patient Protection and Affordable Care Act. Monthly payroll deductions for healthcare: Calendar year basis 2018 2019 2020 2021 2015 2016 2017 Single 2 Party Family 97% based upon 7/1/2017 7/1/2014 Expected Floating Rate less dental deduction amount 8% based upon 7/1/2015 Expected Floating Rate less dental deduction amount 9% based upon 7/1/2018 Expected Floating Rate less dental deduction amount 10% based upon 7/1/2019 Expected Floating Rate less dental deduction amount 10% based upon 7/1/2020 7/1/2016 Expected Floating Rate less dental deduction amount The annual in-network deductible under the point of service plan will be as follows: Effective Date Individual Family January 1, 2018 2015 $500 400 $1,000 Waived if Lancaster Regional/Heart Of Lancaster used January 1, 2019 $500 $1,000 Waived if Lancaster Regional/Heart Of Lancaster used January 1, 2020 $750 $1,500 Waived if Lancaster Regional/Heart Of Lancaster used January 1, 2021 $750 $1,500 Waived if Lancaster Regional/Heart Of Lancaster used 800 The annual out-of-network deductible under the point of service plan will be as follows: Effective Date Individual Family January 1, 2018 2015 $1,000 800 $2,000 January 1, 2019 $1,000 $2,000 January 1, 2020 $1,500 $3,000 January 1, 2021 $1,500 $3,000 1,600 Out-of-network co-insurance expense beyond the listed deductibles shall be paid at an 80% district/20% member rate subject to the usual and customary charge. The maximum out-of-pocket for combined in-network and out-of-network charges, which includes deductibles, medical co-pays, pharmacy co-pays, and amounts over reasonable and customary charges will be as follows: Effective Date Maximum out-of-pocket Individual Maximum out-of-pocket Family January 1, 2018 2015 $2,000 $4,000 $8,000 January 1, 2019 $4,000 $8,000 January 1, 2020 $6,350 $12,000 January 1, 2021 $6,350 $12,000 The doctor’s visit office co-pay under the current plan will be as follows: Primary Care Effective Date Physician Visit Specialist Visit January 1, 2018 2015 $15 $40 January 1, 2019 $15 $40 January 1, 2020 $15 $45 January 1, 2021 $15 $45 Urgent Care and Emergency Room Co-pays: Effective Date Urgent Care Emergency Room January 1, 2018 2015 $35 $100 January 1, 2019 $35 $100 January 1, 2020 $40 $100 January 1, 2021 $40 25 $100 In the event that a member has both an Urgent Care and Emergency Room visit for the same event, the member may submit receipts for reimbursement of $35 (2018-2019) and $40 (2020-2021) 25 from the District.