Common use of Medical Benefit Design In-Network Clause in Contracts

Medical Benefit Design In-Network. [NOTE – all charts have been updated to accurately reflect the 2019 medical plans] In-Network Plan Feature Health Reimbursement (HRA) Medical Plan Health Savings (HSA) Medical Plan Annual deductible $1,150 per person $2,300 max per family $1,500 employee only $3,000 if covering dependents Annual out-of-pocket maximum (with deductible) $3,300 per person $6,600 max per family $3,000 employee only$6,000 if covering dependents Preventive Care No charge No charge Primary Care Provider visits (non-preventive) $20 copay 10% after deductible Specialist visits (non- preventive) Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Lab and x-ray 20% after deductible 20% after deductible Alternative care (chiropractic, acupuncture) 20% after deductible Combined 12 visit limit per calendar year; all therapies Tier I, Tier II: 20% after deductibleCombined 12 visit limit per calendar year; all therapies Naturopathy Covered as Specialist Covered as Specialist Outpatient behavioral health care providers No charge No charge after deductible Outpatient hospital/surgery facility fees (except hospice, rehab) Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible Inpatient hospital facility fees, including behavioral health Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible Hospital physician fees Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Emergency room (waived if admitted) $250 copay 20% after deductible Urgent Care professional fees Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Maternity Pre-natal as Preventive Care Tier I, Tier II: No Charge Tier I, Tier II: No Charge Delivery and Post-natal Provider Care Tier I, Tier II: No Charge Tier I: 10% after deductible Tier II: 20% after deductible Maternity Hospital Stay and Routine Nursery Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible

Appears in 2 contracts

Samples: Agreement, Agreement

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Medical Benefit Design In-Network. 2 [NOTE – all charts have been updated to accurately reflect the 2019 medical plans] In-Network Plan Feature Health Reimbursement (HRA) Medical Plan Health Savings (HSA) Medical Plan Annual deductible $1,150 1,150.00 per person person. $2,300 2,300.00 max per family $1,500 1,500..00 per employee only $3,000 only.$3,000.00 if covering dependents Annual out-of-pocket maximum (with deductible) $3,300 3,300.00 per person $6,600 6,600.00 max per family $3,000 3,000.00 per employee only$6,000 only $6,000.00 if covering dependents Preventive Care No charge No charge Primary Care Provider visits (non-preventive) PCP: $20 20.00 copay PCP: 10% after deductible Specialist visits (non- preventive) Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10I:10% after deductible Tier II: 20% after deductible Lab and x-ray 20% after deductible 20% after deductible Alternative care (chiropractic, acupuncture) 20% after deductible Combined 12 visit limit per calendar year; all therapies Tier I, Tier II: combined 20% after deductibleCombined deductible Combined 12 visit limit per calendar year; all therapies combined Naturopathy Covered as Specialist Covered as Specialist Outpatient behavioral health care providers No charge No charge after deductible Outpatient hospital/surgery facility fees (except hospice, rehab) Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible Inpatient hospital facility fees, including behavioral health Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible Hospital physician fees Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10I:10% after deductible Tier II: 20% after deductible Emergency room $250.00 copay (waived if admitted) $250 copay 20% after deductible Urgent Care professional fees Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Maternity Pre-natal as Preventive Care Tier I, Tier II: No Charge Tier I, Tier II: No Charge Delivery and Post-natal Provider Care Tier I, Tier II: No Charge Tier I: 10% after deductible Tier II: 20% after deductible Maternity Hospital Stay and Routine Nursery Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductibledeductible Plan Provision EPO Medical Plan Portland metro area only Annual Deductible $300.00 per person $900.00 max per family Annual Out-of-Pocket Maximum $2,500.00 per person $7,500.00 max per family Preventive Care No charge Primary Care Office Visit $20.00 copay Specialist Office Visit $40.00 copay X-ray and Laboratory 20% after deductible In-patient hospital facility fees 20% after deductible Hospital physician fees 20% after deductible Outpatient hospital/surgery facility fees 20% after deductible Emergency Room (in- network and out-of- network) $250.00 copay, waived if admitted Outpatient behavioral health 0% Express Care Virtual $0 Express Care Clinics $10.00 copay Urgent care $60.00 copay

Appears in 2 contracts

Samples: Collective Bargaining Agreement, Collective Bargaining Agreement

Medical Benefit Design In-Network. 15 [NOTE – all charts have been updated to accurately reflect the 2019 2017 medical plans] In-Network Plan Feature Health Reimbursement (HRA) Medical Plan Health Savings (HSA) Medical Plan Annual deductible $1,150 per person $2,300 max per family $1,500 employee only $3,000 if covering dependents Annual out-of-pocket maximum (with does not include deductible) $3,300 2,150 per person $6,600 max 4,300 per family $1,500 employee only $3,000 employee only$6,000 if covering dependents Preventive Care No charge Charge No charge Charge Primary Care Provider visits (non-preventive) PCP: $20 copay PCP: 10% after deductible Specialist visits (non- preventive) Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Lab and x-ray 20% after deductible 20% after deductible Alternative care (chiropractic, acupuncture) 20% after deductible Combined 12 visit limit per calendar year; all therapies year Tier I1, Tier II2: 20% after deductibleCombined deductible Combined 12 visit limit per calendar year; all therapies year Naturopathy Covered as Specialist Covered as Specialist Outpatient behavioral health care providers No charge No charge Charge Tier I: 10% after deductible Tier II: 20% after deductible Outpatient hospital/surgery facility fees (except hospice, rehab) Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible Inpatient hospital facility fees, including behavioral health Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible Hospital physician fees Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Emergency room $250 copay (waived if admitted) $250 copay 20% after deductible Urgent Care professional fees Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Maternity Pre-natal as Preventive Care Tier I1, Tier II2: No Charge Tier I1, Tier II: 2:No Charge Delivery Delivery, and Post-natal Provider Care Tier I1, Tier II: 2:No Charge Tier I1: 10% after deductible Tier II2: 20% after deductible Maternity Hospital Stay and Routine Nursery Tier I1: 10% after deductible Tier II2: 25% after deductible Tier ITier: 10% after deductible Tier II2: 25% after deductible

Appears in 1 contract

Samples: Collective Bargaining Agreement

Medical Benefit Design In-Network. [NOTE – all charts have been updated to accurately reflect the 2019 2015 medical plans] In-Network Plan Feature Health Reimbursement (HRA) Medical Plan Health Savings (HSA) Medical Plan Annual deductible $1,150 per person $2,300 max per family $1,500 employee only $3,000 if covering dependents Annual out-of-pocket maximum (with does not include deductible) $3,300 2,150 per person $6,600 max 4,300 per family $1,500 employee only $3,000 employee only$6,000 if covering dependents Preventive Care No charge Charge No charge Charge Primary Care Provider visits (non-preventive) PCP: $20 copay 10% after deductible Specialist visits (non- preventive) Tier ISpecialist: PH&S employed: 10% after deductible Tier IIOther in-network: 20% after deductible Tier IPCP: 10% after deductible Tier IISpecialist: PH&S employed: 10% after deductible Other in-network: 20% after deductible Lab and x-ray 20% after deductible 20% after deductible Alternative care (chiropractic, acupuncture) 20% after deductible Combined 12 visit limit per calendar year; all therapies Tier I, Tier II: year 20% after deductibleCombined deductible Combined 12 visit limit per calendar year; all therapies year Naturopathy Covered as Specialist Covered as Specialist Outpatient behavioral health care providers No charge No charge Charge 20% after deductible Outpatient hospital/surgery facility fees (except hospice, rehab) Tier IPH&S: 10% after deductible Tier IIOther in-network: 25% after deductible Tier IPH&S: 10% after deductible Tier IIOther in-network: 25% after deductible Inpatient hospital facility fees, including behavioral health Tier IPH&S: 10% after deductible Tier IIOther in-network: 25% after deductible Tier IPH&S: 10% after deductible Tier IIOther in-network: 25% after deductible Hospital physician fees Tier IPH&S: 10% after deductible Tier IIOther in-network: 20% after deductible Tier IPH&S: 10% after deductible Tier IIOther in-network: 20% after deductible Emergency room $250 copay (waived if admitted) $250 copay 20% after deductible Urgent Care professional fees Tier IPH&S: 10% after deductible Tier IIOther in-network: 20% after deductible Tier IPH&S: 10% after deductible Tier IIOther in-network: 20% after deductible Maternity Preventive Care No Charge No Charge Pre-natal as Preventive Care Tier Inatal, Tier II: No Charge Tier IDelivery, Tier II: No Charge Delivery and Post-natal Provider Care Tier I, Tier II: No Charge Tier INo Charge (Delivery/Post- Natal: 10% after deductible Tier II: 20% after deductible Same as hospital stay) Maternity Hospital Stay and Routine Nursery Tier IPH&S: 10% after deductible Tier IIOther in-network: 25% after deductible Tier IPH&S: 10% after deductible Tier IIOther in-network: 25% after deductible

Appears in 1 contract

Samples: Agreement

Medical Benefit Design In-Network. [NOTE – all charts have been updated to accurately reflect the 2019 2017 medical plans] In-Network Plan Feature Health Reimbursement (HRA) Medical Plan Health Savings (HSA) Medical Plan Annual deductible $1,150 per person $2,300 max per family $1,500 employee only $3,000 if covering dependents Annual out-of-pocket maximum (with does not include deductible) $3,300 2,150 per person $6,600 max 4,300 per family $1,500 employee only $3,000 employee only$6,000 if covering dependents Preventive Care No charge Charge No charge Charge Primary Care Provider visits (non-preventive) PCP: $20 copay PCP: 10% after deductible Specialist visits (non- preventive) Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Lab and x-ray 20% after deductible 20% after deductible Alternative care (chiropractic, acupuncture) 20% after deductible Combined 12 visit limit per calendar year; all therapies year Tier I1, Tier II2: 20% after deductibleCombined deductible Combined 12 visit limit per calendar year; all therapies year Naturopathy Covered as Specialist Covered as Specialist Outpatient behavioral health care providers No charge No charge Charge Tier I: 10% after deductible Tier II: 20% after deductible Outpatient Tier I: 10% after deductible Tier I: 10% after deductible hospital/surgery facility fees (except hospice, rehab) Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible Inpatient hospital facility fees, including behavioral health Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible Hospital physician fees Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Emergency room $250 copay (waived if admitted) $250 copay 20% after deductible Urgent Care professional fees Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Maternity Pre-natal as Preventive Care Tier I1, Tier II2: No Charge Tier I1, Tier II: 2:No Charge Delivery Delivery, and Post-natal Provider Care Tier I1, Tier II: 2:No Charge Tier I1: 10% after deductible Tier II2: 20% after deductible Maternity Hospital Stay and Routine Nursery Tier I1: 10% after deductible Tier II2: 25% after deductible Tier ITier: 10% after deductible Tier II2: 25% after deductible

Appears in 1 contract

Samples: Collective Bargaining Agreement

Medical Benefit Design In-Network. [NOTE – all charts have been updated to accurately reflect the 2019 medical plans] In-Network Plan Feature Health Reimbursement (HRA) Medical Plan Health Savings (HSA) Medical Plan Annual deductible $1,150 per person $2,300 max per family $1,500 employee only $3,000 if covering dependents Annual out-of-pocket maximum (with does not include deductible) $3,300 2,150 per person $6,600 max 4,300 per family $1,500 employee only $3,000 employee only$6,000 if covering dependents Preventive Care No charge Charge No charge Charge Primary Care Provider visits (non-preventive) PCP: $20 copay 10% after deductible Specialist visits (non- preventive) Tier I: 10% after deductible Tier IISpecialist: 20% after deductible Tier Ideductible**** After deductible: PCP: 10% after deductible Tier IISpecialist: 20% after deductible Lab and x-ray 20% after deductible 20% after deductible Alternative care (chiropractic, acupuncture, naturopathy.) 20% after deductible Combined 12 visit $1,500 limit per calendar year; all therapies Tier I, Tier II: *** 20% after deductibleCombined 12 visit deductible $1,500 limit per calendar year; all therapies Naturopathy Covered as Specialist Covered as Specialist Outpatient behavioral year Behavioral health care providers No charge No charge Charge 20% after deductible Outpatient hospital/surgery facility fees (except hospice, rehab) Tier IPH&S: 10% after deductible Tier IIOther in-network: 25% after deductible Tier IPH&S: 10% after deductible Tier IIOther in-network: 25% after deductible Inpatient hospital facility fees, including behavioral health Tier IPH&S: 10% after deductible Tier IIOther in-network: 25% after deductible Tier IPH&S: 10% after deductible Tier IIOther in-network: 25% after deductible Hospital physician fees Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Emergency room $250 copay (waived if admitted) $250 copay 20% after deductible Urgent Care professional fees Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Page 1 of 11 Date Accepted / / Accepted by XXX Accepted by Employer Maternity Preventive Care No Charge No charge Pre-natal as Preventive Care Tier Inatal, Tier II: No Charge Tier IDelivery, Tier II: No Charge Delivery and Post-natal Provider Care Tier I, Tier II: No Charge Tier I: 10% after deductible Tier II: 20% after deductible No Charge Maternity Hospital Stay and Routine Nursery Tier IPH&S: 10% after deductible Tier IIOther in-network: 25% after deductible Tier IPH&S: 10% after deductible Tier IIOther in-network: 25% after deductibledeductible 2 ** These need to be updated to match announced 2013 benefits.

Appears in 1 contract

Samples: cdn.ymaws.com

Medical Benefit Design In-Network. 12 [NOTE – all charts have been updated to accurately reflect the 2019 medical plans] In-Network Plan Feature Health Reimbursement (HRA) Medical Plan Health Savings (HSA) Medical Plan Annual deductible $1,150 per person $2,300 max per family $1,500 employee only $3,000 if covering dependents Annual out-of-pocket maximum (with deductible) $3,300 per person $6,600 max per family $3,000 employee only$6,000 if covering dependents Preventive Care No charge No charge Primary Care Provider visits (non-preventive) $20 copay 10% after deductible Specialist visits (non- preventive) Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Lab and x-ray 20% after deductible 20% after deductible Alternative care (chiropractic, acupuncture) 20% after deductible Combined 12 visit limit per calendar year; all therapies Tier I, Tier II: 20% after deductibleCombined deductible Combined 12 visit limit per calendar year; all therapies Naturopathy Covered as Specialist Covered as Specialist Outpatient behavioral health care providers No charge No charge after deductible Outpatient hospital/surgery Tier I: 10% after deductible Tier I: 10% after deductible facility fees (except hospice, rehab) Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible Inpatient hospital facility fees, including behavioral health Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible Hospital physician fees Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Emergency room (waived if admitted) $250 copay 20% after deductible Urgent Care professional fees Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Maternity Pre-natal as Preventive Care Tier I, Tier II: No Charge Tier I, Tier II: No Charge Delivery and Post-natal Provider Care Tier I, Tier II: No Charge Tier I: 10% after deductible Tier II: 20% after deductible Maternity Hospital Stay and Routine Nursery Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible

Appears in 1 contract

Samples: Agreement

Medical Benefit Design In-Network. [NOTE – all charts have been updated to accurately reflect the 2019 medical plans] In-Network Plan Feature Health Reimbursement (HRA) Medical Plan Health Savings (HSA) Medical Plan Annual deductible $1,150 per person $2,300 max per family $1,500 employee only $3,000 if covering dependents Annual out-of-pocket maximum (with does not include deductible) $3,300 2,150 per person $6,600 max 4,300 per family $1,500 employee only $3,000 employee only$6,000 if covering dependents Preventive Care No charge Charge No charge Charge Primary Care Provider visits (non-preventive) PCP: $20 copay 10% after deductible Specialist visits (non- preventive) Tier ISpecialist: PH&S employed: 10% after deductible Tier IIOther in-network: 20% after deductible Tier IPCP: 10% after deductible Tier IISpecialist: PH&S employed: 10% after deductible Other in-network: 20% after deductible Lab and x-ray 20% after deductible 20% after deductible Alternative care (chiropractic, acupuncture) 20% after deductible Combined 12 visit limit per calendar year; all therapies Tier I, Tier II: year 20% after deductibleCombined deductible Combined 12 visit limit per calendar year; all therapies year Naturopathy Covered as Specialist Covered as Specialist Outpatient behavioral health care providers No charge No charge Charge 20% after deductible Outpatient hospital/surgery facility fees (except hospice, rehab) Tier IPH&S: 10% after deductible Tier IIOther in-network: 25% after deductible Tier IPH&S: 10% after deductible Tier IIOther in-network: 25% after deductible Inpatient hospital facility fees, including behavioral health Tier IPH&S: 10% after deductible Tier IIOther in-network: 25% after deductible Tier IPH&S: 10% after deductible Tier IIOther in-network: 25% after deductible Hospital physician fees Tier IPH&S: 10% after deductible Tier IIOther in-network: 20% after deductible Tier IPH&S: 10% after deductible Tier IIOther in-network: 20% after deductible Emergency room $250 copay (waived if admitted) $250 copay 20% after deductible Urgent Care professional fees Tier IPH&S: 10% after deductible Tier IIOther in-network: 20% after deductible Tier IPH&S: 10% after deductible Tier IIOther in-network: 20% after deductible Maternity Preventive Care No Charge No Charge Pre-natal as Preventive Care Tier Inatal, Tier II: No Charge Tier IDelivery, Tier II: No Charge Delivery and Post-natal Provider Care Tier I, Tier II: No Charge Tier INo Charge (Delivery/Post- Natal: 10% after deductible Tier II: 20% after deductible Same as hospital stay) Maternity Hospital Stay and Routine Nursery Tier IPH&S: 10% after deductible Tier IIOther in-network: 25% after deductible Tier IPH&S: 10% after deductible Tier IIOther in-network: 25% after deductible

Appears in 1 contract

Samples: Professional Agreement

Medical Benefit Design In-Network. [NOTE – all charts have been updated to accurately reflect the 2019 2017 medical plans] In-Network Plan Feature Health Reimbursement (HRA) Medical Plan Health Savings (HSA) Medical Plan Annual deductible $1,150 per person $2,300 max per family $1,500 employee only $3,000 if covering dependents Annual out-of-pocket maximum (with does not include deductible) $3,300 2,150 per person $6,600 max 4,300 per family $1,500 employee only $3,000 employee only$6,000 if covering dependents Preventive Care No charge Charge No charge Charge Primary Care Provider visits (non-preventive) PCP: $20 copay Specialist: PH&S employed: 10% after deductible Other in-network: 20% after deductible PCP: 10% after deductible Specialist: PH&S employed: 10% after deductible Other in-network: 20% after deductible Specialist visits (non- preventive) Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Lab and x-ray 20% after deductible 20% after deductible Alternative care (chiropractic, acupuncture) 20% after deductible Combined 12 visit limit per calendar year; all therapies year Tier I, Tier II: 20% after deductibleCombined deductible Combined 12 visit limit per calendar year; all therapies year Naturopathy Covered as Specialist Covered as Specialist Outpatient behavioral health care providers No charge No charge Charge 20% after deductibleTier I: 10% after deductible Tier II: 20% after deductible Outpatient hospital/surgery facility fees (except hospice, rehab) Tier PH&STier I: 10% after deductible Tier Other in-networkTier II: 25% after deductible Tier PH&STier I: 10% after deductible Tier Other in-networkTier II: 25% after deductible Inpatient hospital facility fees, including behavioral health Tier PH&STier I: 10% after deductible Tier Other in-networkTier II: 25% after deductible Tier PH&STier I: 10% after deductible Tier Other in-networkTier II: 25% after deductible Hospital physician fees Tier PH&STier I: 10% after PH&STier I: 10% after deductible Tier Other in-networkTier II: 20% after deductible Tier I: 10% after deductible Tier Other in-networkTier II: 20% after deductible Emergency room $250 copay (waived if admitted) $250 copay 20% after deductible Urgent Care professional fees Tier PH&STier I: 10% after deductible Tier Other in-networkTier II: 20% after deductible Tier PH&STier I: 10% after deductible Tier Other in-networkTier II: 20% after deductible Maternity Pre-natal as Preventive Care Tier I, Tier II: No Charge Tier I, Tier II: No Charge Delivery Pre-natal, Delivery, and Post-natal Provider Care Tier I, Tier II: No Charge Tier No Charge (Delivery/Post- Natal: Same as hospital stay)Tier I: 10% after deductible Tier II: 20% after deductible Maternity Hospital Stay and Routine Nursery Tier IIPH&S: 10% after deductible Tier IIIIOther in-network: 25% after deductible Tier IIPH&S: 10% after deductible Tier IIIIOther in-network: 25% after deductible

Appears in 1 contract

Samples: Agreement

Medical Benefit Design In-Network. [NOTE – all charts have been updated to accurately reflect the 2019 medical plans] In-Network Plan Feature Health Reimbursement (HRA) Medical Plan Health Savings (HSA) Medical Plan Annual deductible $1,150 per person $2,300 max per family $1,500 employee only $3,000 if covering dependents Annual out-of-pocket maximum (with does not include deductible) $3,300 2,150 per person $6,600 max 4,300 per family $1,500 employee only $3,000 employee only$6,000 if covering dependents Preventive Care No charge Charge No charge Charge Primary Care Provider visits (non-preventive) PCP: $20 copay 10% after deductible Specialist visits (non- preventive) Tier I: 10% after deductible Tier IISpecialist: 20% after deductible Tier IAfter deductible: PCP: 10% after deductible Tier IISpecialist: 20% after deductible Lab and x-ray 20% after deductible 20% after deductible Alternative care (chiropractic, acupuncture) 20% after deductible Combined 12 visit limit per calendar year; all therapies Tier I, Tier II: year 20% after deductibleCombined deductible Combined 12 visit limit per calendar year; all therapies year Naturopathy Covered as Specialist Covered as Specialist Outpatient behavioral Behavioral health care providers No charge No charge Charge 20% after deductible Outpatient hospital/surgery facility fees (except hospice, rehab) Tier IPH&S: 10% after deductible Tier IIOther in-network: 25% after deductible Tier IPH&S: 10% after deductible Tier IIOther in-network: 25% after deductible Inpatient hospital facility fees, including behavioral health Tier IPH&S: 10% after deductible Tier IIOther in-network: 25% after deductible Tier IPH&S: 10% after deductible Tier IIOther in-network: 25% after deductible Hospital physician fees Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Emergency room $250 copay (waived if admitted) $250 copay 20% after deductible Urgent Care professional fees Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Maternity Preventive Care No Charge No charge Pre-natal as Preventive Care Tier Inatal, Tier II: No Charge Tier IDelivery, Tier II: No Charge Delivery and Post-Post- natal Provider Care Tier I, Tier II: No Charge Tier INo Charge (Delivery/Post-Natal: 10% after deductible Tier II: 20% after deductible same as hospital stay) Maternity Hospital Stay and Routine Nursery Tier IPH&S: 10% after deductible Tier IIOther in-network: 25% after deductible Tier IPH&S: 10% after deductible Tier IIOther in-network: 25% after deductibledeductible 8 Medical Premiums 9 The following are the premium contribution for the nurses for each pay period for 10 a total of twenty four (24) pay periods for the year. Level of Benefit Health Reimbursement Medical Plan Health Savings Medical Plan Full Time 0000 0000 0000 2015 Employee Only $11.50 5% of premium $0.00 $0.00 Employee and child(ren) $22.50 8% of premium $21.00 15% of premium Employee and Spouse/Partner $30.50 8% of premium $35.50 15% of premium Employee and Family $42.00 8% of premium $57.00 15% of premium Part Time 0000 0000 0000 2015 Employee Only $24.00 10% of premium $24.00 10% of premium Employee and child(ren) $42.50 13% of premium $52.50 20% of premium Employee and Spouse/Partner $55.00 13% of premium $71.50 20% of premium Employee and Family $73.50 13% of premium $100.00 20% of premium

Appears in 1 contract

Samples: 1 Agreement

Medical Benefit Design In-Network. 2 [NOTE – all charts have been updated to accurately reflect the 2019 2024 medical plans] In-Network Plan Feature Health Reimbursement (HRA) Medical Plan Health Savings (HSA) Medical Plan Annual deductible $1,150 1,150.00 per person person. $2,300 2,300.00 max per family $1,500 1,600.00 per employee only $3,000 3,200.00 if covering dependents Annual out-of-pocket maximum (with deductible) $3,300 3,300.00 per person $6,600 6,600.00 max per family $3,000 3,000.00 per employee only$6,000 only $6,000.00 if covering dependents Preventive Care No charge No charge Primary Care Provider visits (non-preventive) PCP: $20 20.00 copay PCP: 10% after deductible Specialist visits (non- preventive) Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10I:10% after deductible Tier II: 20% after deductible Lab and x-ray Tier I: 10% after deductible Tier II: 20% after deductible Tier I:10% after deductible Tier II: 20% after deductible Alternative care (chiropractic, acupuncture) 20% after deductible Combined 12 visit limit per calendar year; all therapies Tier I, Tier II: combined 20% after deductibleCombined deductible Combined 12 visit limit per calendar year; all therapies combined Naturopathy Covered as Specialist Covered as Specialist Outpatient behavioral health care providers No charge No charge after deductible Outpatient hospital/surgery facility fees (except hospice, rehab) Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible Inpatient hospital facility fees, including behavioral health Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible Hospital physician fees Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10I:10% after deductible Tier II: 20% after deductible Emergency room $250.00 copay (waived if admitted) $250 copay 20% after deductible (waved if admitted) Urgent Care professional fees Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Maternity Pre-natal as Preventive Care Tier I, Tier II: No Charge Tier I, Tier II: No Charge Delivery and Post-natal Provider Care Tier I, Tier II: No Charge Tier I: 10% after deductible Tier II: 20% after deductible Maternity Hospital Stay and Routine Nursery Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductibledeductible Plan Provision EPO Medical Plan Portland metro area only Annual Deductible $300.00 per person $900.00 max per family Annual Out-of-Pocket Maximum $2,500.00 per person $6,000.00 max per family Preventive Care No charge Primary Care Office Visit $20.00 copay Specialist Office Visit $40.00 copay X-ray and Laboratory 20% after deductible In-patient hospital facility fees 20% after deductible Hospital physician fees 20% after deductible Outpatient hospital/surgery facility fees 20% after deductible Emergency Room (in- network and out-of- network) $250.00 copay, waived if admitted Outpatient behavioral health 0% Express Care Virtual $0 Express Care Clinics $10.00 copay Urgent care $60.00 copay 1 No PCP referral required for specialist care

Appears in 1 contract

Samples: Collective Bargaining Agreement

Medical Benefit Design In-Network. [NOTE – all charts have been updated to accurately reflect the 2019 20172019 medical plans] In-Network Plan Feature Health Reimbursement (HRA) Medical Plan Health Savings (HSA) Medical Plan Annual deductible $1,150 per person $2,300 max per family $1,500 employee only $3,000 if covering dependents Annual out-of-pocket maximum (with does not includewith deductible) $3,300 2,150 per person $43,300 per person $6,600 max per family $3,000 1,5003,000 employee only$6,000 only $3$6,000 if covering dependents Preventive Care No charge No charge Primary Care Provider visits (non-preventive) PCP: $20 copay PCP: 10% after deductible Specialist visits (non- preventive) Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Lab and x-ray 20% after deductible 20% after deductible Alternative care (chiropractic, acupuncture) 20% after deductible Combined 12 visit limit per calendar year; all therapies combined Tier I, Tier II: 20% after deductibleCombined 12 visit limit per calendar year; all therapies combined Naturopathy Covered as Specialist Covered as Specialist Outpatient behavioral health care providers No charge No Chargecharge Tier I: 10% after deductible Tier II: 20%No charge after deductible Outpatient hospital/surgery facility fees (except hospice, rehab) Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible Inpatient hospital facility fees, including behavioral health Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible Hospital physician fees Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Emergency room (waived if admitted) $250 copay (waived if admitted) 20% after deductible Urgent Care professional fees Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Maternity Pre-natal as Preventive Care Tier I, Tier II: No Charge Tier I, Tier II: No Charge Delivery and Post-natal Provider Care Tier I, Tier II: No Charge Tier I: 10% after deductible Tier II: 20% after deductible Maternity Hospital Stay and Routine Nursery Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductibledeductible Plan Provision EPO Medical Plan – Portland metro area only Annual Deductible $300 per person $900 max per family Annual Out-of Pocket Maximum $2,500 per person $7,500 max per family Preventive Care No charge Primary Care Office Visit $20 copay Specialist Office Visit $40 copay1 X-ray and Laboratory 20% after deductible In-patient hospital facility fees 20% after deductible Hospital physician fees 20% after deductible Outpatient hospital/surgery facility fees 20% after deductible Emergency Room (in- network and out-of- network) $250 copay, waived if admitted Outpatient behavioral health 0% Express Care Virtual $0 Express Care Clinics $10 copay Urgent care $60 copay 1 No PCP referral required for specialist care

Appears in 1 contract

Samples: Providence Portland Medical Center – Ona Redline Tentative Agreement Agreement

Medical Benefit Design In-Network. 14 [NOTE – all charts have been updated to accurately reflect the 2019 2017 medical plans] In-Network Plan Feature Health Reimbursement (HRA) Medical Plan Health Savings (HSA) Medical Plan Annual deductible $1,150 per person $2,300 max per family $1,500 employee only $3,000 if covering dependents Annual out-of-pocket maximum (with does not include deductible) $3,300 2,150 per person $6,600 max 4,300 per family $1,500 employee only $3,000 employee only$6,000 if covering dependents Preventive Care No charge Charge No charge Charge Primary Care Provider visits (non-preventive) PCP: $20 copay PCP: 10% after deductible Specialist visits (non- preventive) Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Lab and x-ray 20% after deductible 20% after deductible Alternative care (chiropractic, acupuncture) 20% after deductible Combined 12 visit limit per calendar year; all therapies year Tier I, Tier II: 20% after deductibleCombined deductible Combined 12 visit limit per calendar year; all therapies year Naturopathy Covered as Specialist Covered as Specialist Outpatient behavioral health care providers No charge No charge Charge Tier I: 10% after deductible Tier II: 20% after deductible Outpatient hospital/surgery facility fees (except hospice, rehab) Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible Inpatient hospital facility fees, including behavioral health Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible Hospital physician fees Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Emergency room $250 copay (waived if admitted) $250 copay 20% after deductible Urgent Care professional fees Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Maternity Pre-natal as Preventive Care Tier I, Tier II: No Charge Tier I, Tier II: No Charge Delivery and Post-natal Natal Provider Care Tier I, Tier II: No Charge Tier I: 10% after deductible Tier II: 20% after deductible Maternity Hospital Stay and Routine Nursery Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible

Appears in 1 contract

Samples: Agreement

Medical Benefit Design In-Network. 15 [NOTE – all charts have been beenwill be updated to accurately reflect the 2019 2024 16 medical plans] In-Network Plan Feature Health Reimbursement (HRA) Medical Plan Health Savings (HSA) Medical Plan Annual deductible $1,150 per person $2,300 max per family $1,500 employee only $3,000 if covering dependents Annual out-of-pocket maximum (with deductible) $3,300 per person $6,600 max per family $3,000 employee only$6,000 if covering dependents Preventive Care No charge No charge Primary Care Provider visits (non-preventive) $20 copay 10% after deductible Specialist visits (non- preventive) Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Lab and x-ray 20% after deductible 20% after deductible Alternative care (chiropractic, acupuncture) 20% after deductible Combined 12 visit limit per calendar year; all therapies Tier I, Tier II: combined 20% after deductibleCombined deductible Combined 12 visit limit per calendar year; all therapies therapiescombined Naturopathy Covered as Specialist Covered as Specialist Outpatient behavioral health care providers No charge No charge after deductible Outpatient hospital/surgery facility fees (except hospice, rehab) Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible Inpatient hospital facility fees, including behavioral health Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible Hospital physician fees Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Emergency room $250 copay (waived if admitted) $250 copay 20% after deductible Urgent Care professional fees Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Maternity Pre-natal as Preventive Care Tier I, Tier II: No Charge Tier I, Tier II: No Charge Delivery and Post-natal Provider Care Tier I, Tier II: No Charge Tier I: 10% after deductible Tier II: 20% after deductible Maternity Hospital Stay and Routine Nursery Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductibledeductible Plan Provision EPO Medical Plan – Portland metro area only Annual Deductible $300 per person $900 max per family Annual Out-of-Pocket Maximum $2,500 per person $7,500 max per family Preventive Care No charge Primary Care Office Visit $20 copay Specialist Office Visit $40 copay1 X-ray and Laboratory 20% after deductible In-patient hospital facility fees 20% after deductible Hospital physician fees 20% after deductible Outpatient hospital/surgery facility fees 20% after deductible Emergency Room (in- network and out-of- network) $250 copay, waived if admitted Outpatient behavioral health 0% Express Care Virtual $0 Express Care Clinics $10 copay Urgent care $60 copay

Appears in 1 contract

Samples: Agreement

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Medical Benefit Design In-Network. 13 [NOTE – all charts have been updated to accurately reflect the 2019 2017 medical plans] In-Network Plan Feature Health Reimbursement (HRA) Medical Plan Health Savings (HSA) Medical Plan Annual deductible $1,150 per person $2,300 max per family $1,500 employee only $3,000 if covering dependents Annual out-of-pocket maximum (with does not include deductible) $3,300 2,150 per person $6,600 max 4,300 per family $1,500 employee only $3,000 employee only$6,000 if covering dependents Preventive Care No charge Charge No charge Charge Primary Care Provider visits (non-preventive) PCP: $20 copay PCP: 10% after deductible Specialist visits (non- preventive) Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Lab and x-ray 20% after deductible 20% after deductible Alternative care (chiropractic, acupuncture) 20% after deductible Combined 12 visit limit per calendar year; all therapies Tier I, Tier II: year 20% after deductibleCombined deductible Combined 12 visit limit per calendar year; all therapies year Naturopathy Covered as Specialist Covered as Specialist 20% after deductible 20% after deductible Outpatient behavioral health care providers No charge No charge Charge Tier I: 10% after deductible Tier II: 20% after deductible Outpatient hospital/surgery facility fees (except hospice, rehab) Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible Inpatient hospital facility fees, including behavioral health Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible Hospital physician fees Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Emergency room Employer covers 100% after $250 copay (copay waived if admitted) $250 copay 20% after deductible Urgent Care professional fees Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Maternity Pre-natal as Preventive Care Tier I, Tier II: No Charge Tier I, Tier II: No Charge Delivery Delivery, and Post-natal Post- Natal Provider Care Tier I, Tier II: No Charge Tier I: 10% after deductible Tier II: 20% after deductible N Maternity Hospital Stay and Routine Nursery Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible

Appears in 1 contract

Samples: Professional Agreement

Medical Benefit Design In-Network. 14 [NOTE – all charts have been updated to accurately reflect the 2019 medical plans] In-Network Plan Feature Health Reimbursement (HRA) Medical Plan Health Savings (HSA) Medical Plan Annual deductible $1,150 per person $2,300 max per family $1,500 employee only $3,000 if covering dependents Annual out-of-pocket maximum (with deductible) $3,300 per person $6,600 max per family $3,000 employee only$6,000 if covering dependents Preventive Care No charge No charge Primary Care Provider visits (non-preventive) $20 copay 10% after deductible Specialist visits (non- preventive) Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Lab and x-ray 20% after deductible 20% after deductible Alternative care (chiropractic, acupuncture) 20% after deductible Combined 12 visit limit per calendar year; all therapies Tier I, Tier II: combined 20% after deductibleCombined deductible Combined 12 visit limit per calendar year; all therapies therapiescombined Naturopathy Covered as Specialist Covered as Specialist Outpatient behavioral health care providers No charge No charge after deductible Outpatient hospital/surgery facility fees (except hospice, rehab) Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible Inpatient hospital facility fees, including behavioral health Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible Hospital physician fees Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Emergency room $250 copay (waived if admitted) $250 copay 20% after deductible Urgent Care professional fees Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Maternity Pre-natal as Preventive Care Tier I, Tier II: No Charge Tier I, Tier II: No Charge Delivery and Post-natal Provider Care Tier I, Tier II: No Charge Tier I: 10% after deductible Tier II: 20% after deductible Maternity Hospital Stay and Routine Nursery Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductibledeductible Plan Provision EPO Medical Plan – Portland metro area only Annual Deductible $300 per person $900 max per family Annual Out-of-Pocket Maximum $2,500 per person $7,500 max per family Preventive Care No charge Primary Care Office Visit $20 copay Specialist Office Visit $40 copay1 X-ray and Laboratory 20% after deductible In-patient hospital facility fees 20% after deductible Hospital physician fees 20% after deductible Outpatient hospital/surgery facility fees 20% after deductible Emergency Room (in- network and out-of- network) $250 copay, waived if admitted Outpatient behavioral health 0% Express Care Virtual $0 Express Care Clinics $10 copay Urgent care $60 copay

Appears in 1 contract

Samples: Agreement

Medical Benefit Design In-Network. 14 [NOTE – all charts have been updated to accurately reflect the 2019 medical plans] In-Network Plan Feature Health Reimbursement (HRA) Medical Plan Health Savings (HSA) Medical Plan Annual deductible $1,150 per person $2,300 max per family $1,500 employee only $3,000 if covering dependents Annual out-of-pocket maximum (with deductible) $3,300 per person $6,600 max per family $3,000 employee only$6,000 if covering dependents Preventive Care No charge No charge Primary Care Provider visits (non-preventive) $20 copay 10% after deductible Specialist visits (non- preventive) Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Lab and x-ray 20% after deductible 20% after deductible Alternative care (chiropractic, acupuncture) 20% after deductible Combined 12 visit limit per calendar year; all therapies Tier I, Tier II: combined 20% after deductibleCombined deductible Combined 12 visit limit per calendar year; all therapies combined Naturopathy Covered as Specialist Covered as Specialist Outpatient behavioral health care providers No charge No charge after deductible Outpatient hospital/surgery facility fees (except hospice, rehab) Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible Inpatient hospital facility fees, including behavioral health Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible Hospital physician fees Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Emergency room $250 copay (waived if admitted) $250 copay 20% after deductible Urgent Care professional fees Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Maternity Pre-natal as Preventive Care Tier I, Tier II: No Charge Tier I, Tier II: No Charge Delivery and Post-natal Provider Care Tier I, Tier II: No Charge Tier I: 10% after deductible Tier II: 20% after deductible Maternity Hospital Stay and Routine Nursery Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductibledeductible Plan Provision EPO Medical Plan – Portland metro area only Annual Deductible $300 per person $900 max per family Annual Out-of-Pocket Maximum $2,500 per person $7,500 max per family Preventive Care No charge Primary Care Office Visit $20 copay Specialist Office Visit $40 copay1 X-ray and Laboratory 20% after deductible In-patient hospital facility fees 20% after deductible Hospital physician fees 20% after deductible Outpatient hospital/surgery facility fees 20% after deductible Emergency Room (in- network and out-of- network) $250 copay, waived if admitted Outpatient behavioral health 0% Express Care Virtual $0 Express Care Clinics $10 copay Urgent care $60 copay

Appears in 1 contract

Samples: Agreement

Medical Benefit Design In-Network. [27 NOTE – all charts have been will be accurately updated to accurately reflect the 2019 medical plans] current plan year. In-Network Plan Feature Health Reimbursement (HRA) Medical Plan Health Savings (HSA) Medical Plan Annual deductible Deductible $1,150 per person $2,300 max per family $1,500 employee only $3,000 if covering dependents In-Network Plan Feature Health Reimbursement (HRA) Medical Plan Health Savings (HSA) Medical Plan Annual outOut-ofOf-pocket maximum Pocket Maximum (with deductibleDeductible) $3,300 per person $6,600 max per family $3,000 employee only$6,000 only $6,000 if covering dependents Preventive Care No charge No charge Primary Care Provider visits Visits (nonNon-preventivePreventive) PCP: $20 copay PCP: 10% after deductible Specialist visits Visits (non- preventiveNon- Preventive) Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Lab and xX-ray Ray 20% after deductible 20% after deductible Alternative care Care (chiropracticChiropractic, acupunctureAcupuncture) 20% after deductible Combined 12 visit limit per calendar year; all therapies Tier I, Tier II: 20% after deductibleCombined deductible Combined 12 visit limit per calendar year; all therapies therapiescombined Naturopathy Covered as Specialist Covered as Specialist Outpatient behavioral health care providers Behavioral Health Care Providers No charge No charge after deductible Outpatient hospitalHospital/surgery facility fees Surgery Facility Fees (except hospiceExcept Hospice, rehabRehab) Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible Inpatient hospital facility feesHospital Facility Fees, including behavioral health Including Behavioral Health Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible Hospital physician fees Physician Fees Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Emergency room Room $250 copay (waived if admitted) $250 copay 20% after deductible In-Network Plan Health Reimbursement Health Savings (HSA) Feature (HRA) Medical Plan Medical Plan Urgent Care professional fees Professional Fees Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Maternity Pre-natal Natal as Preventive Care Tier I, Tier II: No Charge Tier I, Tier II: No Charge Delivery and Post-natal Natal Provider Care Tier I, Tier II: No Charge Tier I: 10% after deductible Tier II: 20% after deductible Maternity Hospital Stay and And Routine Nursery Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductibledeductible Plan Provision EPO Medical Plan – Portland metro area only Annual Deductible $300 per person $900 max per family Annual Out-Of Pocket Maximum $2,500 per person $7,500 max per family Preventive Care No charge Primary Care Office Visit $20 copay Specialist Office Visit $40 copay1 X-Ray and Laboratory 20% after deductible In-Patient Hospital Facility Fees 20% after deductible Hospital Physician Fees 20% after deductible Outpatient Hospital/Surgery Facility Fees 20% after deductible Emergency Room (In-Network And Out-Of-Network) $250 copay, waived if admitted Outpatient Behavioral Health 0% Express Care Virtual $0 Express Care Clinics $10 copay Plan Provision EPO Medical Plan – Portland metro area only Urgent Care $60 copay

Appears in 1 contract

Samples: Professional Agreement

Medical Benefit Design In-Network. [NOTE – all charts have been updated to accurately reflect the 2019 20172019 medical plans] In-Network Plan Feature Health Reimbursement (HRA) Medical Plan Health Savings (HSA) Medical Plan Annual deductible $1,150 per person $2,300 max per family $1,500 employee only $3,000 if covering dependents Annual out-of-pocket maximum (with does not includewith deductible) $3,300 2,150 per person $43,300 per person $6,600 max per family $3,000 1,5003,000 employee only$6,000 only $3$6,000 if covering dependents Preventive Care No charge No charge Primary Care Provider visits (non-preventive) PCP: $20 copay PCP: 10% after deductible Specialist visits (non- preventive) Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Lab and x-ray 20% after deductible 20% after deductible Alternative care (chiropractic, acupuncture) 20% after deductible Combined 12 visit limit per calendar year; all therapies combined Tier I, Tier II: 20% after deductibleCombined deductible Combined 12 visit limit per calendar year; all therapies combined Naturopathy Covered as Specialist Covered as Specialist Outpatient behavioral health care providers No charge No Chargecharge Tier I: 10% after deductible Tier II: 20%No charge after deductible Outpatient hospital/surgery facility fees (except hospice, rehab) Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible Inpatient hospital facility fees, including behavioral health Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible Hospital physician fees Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Emergency room (waived if admitted) $250 copay (waived if admitted) 20% after deductible Urgent Care professional fees Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Maternity Pre-natal as Preventive Care Tier I, Tier II: No Charge Tier I, Tier II: No Charge Delivery and Post-natal Provider Care Tier I, Tier II: No Charge Tier I: 10% after deductible Tier II: 20% after deductible Maternity Hospital Stay and Routine Nursery Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductibledeductible Plan Provision EPO Medical Plan – Portland metro area only Annual Deductible $300 per person $900 max per family Annual Out-of Pocket Maximum $2,500 per person $7,500 max per family Preventive Care No charge Primary Care Office Visit $20 copay Specialist Office Visit $40 copay1 X-ray and Laboratory 20% after deductible In-patient hospital facility fees 20% after deductible Hospital physician fees 20% after deductible Outpatient hospital/surgery facility fees 20% after deductible Emergency Room (in- network and out-of- network) $250 copay, waived if admitted Outpatient behavioral health 0% Express Care Virtual $0 Express Care Clinics $10 copay Urgent care $60 copay 1 No PCP referral required for specialist care

Appears in 1 contract

Samples: Providence Portland Medical Center – Ona Redline Tentative Agreement Agreement

Medical Benefit Design In-Network. 10 [NOTE – all charts have been updated to accurately reflect the 2019 medical plans] In-Network Plan Feature Health Reimbursement (HRA) Medical Plan Health Savings (HSA) Medical Plan Annual deductible $1,150 per person $2,300 max per family $1,500 employee only $3,000 if covering dependents Annual out-of-pocket maximum (with deductible) $3,300 per person $6,600 max per family $3,000 employee only$6,000 if covering dependents Preventive Care No charge No charge Primary Care Provider visits (non-preventive) $20 copay 10% after deductible Specialist visits (non- preventive) Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Lab and x-ray 20% after deductible 20% after deductible Alternative care (chiropractic, acupuncture) 20% after deductible Combined 12 visit limit per calendar year; all therapies Tier I, Tier II: 20% after deductibleCombined deductible Combined 12 visit limit per calendar year; all therapies combined Naturopathy Covered as Specialist Covered as Specialist Outpatient behavioral health care providers No charge No charge after deductible Outpatient hospital/surgery facility fees (except hospice, rehab) Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible Inpatient hospital facility fees, including behavioral health Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible Hospital physician fees Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Emergency room $250 copay (waived if admitted) $250 copay 20% after deductible Urgent Care professional fees Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Maternity Pre-natal as Preventive Care Tier I, Tier II: No Charge Tier I, Tier II: No Charge Delivery and Post-natal Provider Care Tier I, Tier II: No Charge Tier I: 10% after deductible Tier II: 20% after deductible Maternity Hospital Stay and Routine Nursery Tier I: 10% after deductible Tier II: 25% after deductible Tier I: 10% after deductible Tier II: 25% after deductible

Appears in 1 contract

Samples: Agreement

Medical Benefit Design In-Network. [NOTE – all charts have been updated to accurately reflect the 2019 2017 medical plans] In-Network Plan Feature Health Reimbursement (HRA) Medical Plan Health Savings (HSA) Medical Plan Annual deductible $1,150 per person $2,300 max per family $1,500 employee only $3,000 if covering dependents Annual out-of-pocket maximum (with does not include deductible) $3,300 2,150 per person $6,600 max 4,300 per family $1,500 employee only $3,000 employee only$6,000 if covering dependents Preventive Care No charge Charge No charge Charge Primary Care Provider visits (non-preventive) PCP: $20 copay Specialist: PH&S employed: 10% after deductible Other in-network: 20% after deductible PCP: 10% after deductible Specialist: PH&S employed: 10% after deductible Other in-network: 20% after deductible Specialist visits (non- preventive) Tier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier II: 20% after deductible Lab and x-ray 20% after deductible 20% after deductible Alternative care (chiropractic, acupuncture) 20% after deductible Combined 12 visit limit per calendar year; all therapies year Tier I, Tier II: 20% after deductibleCombined deductible Combined 12 visit limit per calendar year; all therapies year Naturopathy Covered 20% after deductibleCovered as Specialist Covered 20% after deductibleCovered as Specialist Outpatient behavioral health care providers No charge No charge Charge Tier I: 10% after deductible Tier II: 20% after deductible 20% after deductible Outpatient hospital/surgery facility fees (except hospice, rehab) Tier PH&STier I: 10% after deductible Tier Other in-networkTier II: 25% after deductible Tier PH&STier I: 10% after deductible Tier Other in-networkTier II: 25% after deductible Inpatient hospital facility fees, including behavioral health Tier PH&STier I: 10% after deductible Tier Other in-networkTier II: 25% after deductible Tier PH&STier I: 10% after deductible Tier Other in-networkTier II: 25% after deductible Hospital physician fees Tier PH&STier I: 10% after deductible Tier Other in-networkTier II: 20% after deductible Tier PH&STier I: 10% after deductible Tier Other in-networkTier II: 20% after deductible Emergency room Employer covers 100% after $250 copay (copay waived if admitted) $250 copay 20% after deductible Urgent Care professional fees Tier PH&STier I: 10% after deductible Other in-networkTier II: 20% after deductible PH&STier I: 10% after deductible Tier II: 20% after deductible Tier I: 10% after deductible Tier IIIIOther in-network: 20% after deductible Maternity Pre-natal as Preventive Care Tier I, Tier II: No Charge Tier I, Tier II: No Charge Delivery Pre-natal, Delivery, and Post-natal Provider Care Tier I, Tier II: No Charge Tier I: 10% after deductible Tier II: 20% after deductible Care No Charge (Delivery/Post- Natal: Same as hospital stay) Maternity Hospital Stay and Routine Nursery Tier PH&STier I: 10% after deductible Tier Other in-networkTier II: 25% after deductible Tier PH&STier I: 10% after deductible Tier Other in-networkTier II: 25% after deductible

Appears in 1 contract

Samples: Letter of Agreement

Medical Benefit Design In-Network. [NOTE – all charts have been updated to accurately reflect the 2019 2015 2017 medical plans] In-Network Plan Feature Health Reimbursement (HRA) Medical Plan Health Savings (HSA) Medical Plan Annual deductible $1,150 per person $2,300 max per family $1,500 employee only $3,000 if covering dependents Annual out-of-pocket maximum (with does not include deductible) $3,300 2,150 per person $6,600 max 4,300 per family $1,500 employee only $3,000 employee only$6,000 if covering dependents Preventive Care No charge Charge No charge Charge Primary Care Provider visits (non-preventive) PCP: $20 copay 10% after deductible Specialist visits (non- preventive) Tier ISpecialist: PCP: 10% after deductible Tier IISpecialist: Specialist PH&S employedTier 1I: 10% after deductible Other in-networkTier 2II: 20% after deductible Tier IPH&S employedTier I1: 10% after deductible Tier IIOther in-networkTier II2: 20% after deductible Lab and x-ray 20% after deductible 20% after deductible Alternative care (chiropractic, acupuncture) 20% after deductible Combined 12 visit limit per calendar year; all therapies year Tier I1, Tier II2: 20% after deductibleCombined deductible Combined 12 visit limit per calendar year; all therapies year Naturopathy Covered as Specialist Covered as Specialist Outpatient behavioral No Charge 20% after deductible health care providers No charge No charge Tier 1I: 10% after deductible Tier II2: 20% after deductible Outpatient hospital/surgery facility fees (except hospice, rehab) Tier IPH&STier 1I: 10% after deductible Tier IIOther in-networkTier 2II: 25% after deductible Tier IPH&STier 1I: 10% after deductible Tier IIOther in-networkTier 2II: 25% after deductible Inpatient hospital facility fees, including behavioral health Tier IPH&STier 1I: 10% after deductible Tier IIOther in-networkTier 2II: 25% after deductible Tier IPH&STier 1I: 10% after deductible Tier IIOther in-networkTier 2II: 25% after deductible Hospital physician fees Tier IPH&STier 1I: 10% after deductible Tier IIOther in-networkTier 2II: 20% after deductible Tier IPH&STier 1I: 10% after deductible Tier IIOther in-networkTier 2II: 20% after deductible Emergency room $250 copay (waived if admitted) $250 copay 20% after deductible Urgent Care professional fees Tier IPH&STier 1I: 10% after deductible Tier II2IIOther in-network: 20% after deductible Tier IPH&STier 1I: 10% after deductible Tier IIOther in-networkTier 2II: 20% after deductible Maternity Pre-natal as Preventive Care Tier I1, Tier II2: No Charge Tier I1, Tier II: 2:No Charge Delivery Pre-natal, Delivery, and Post-natal Provider Care Tier I1, Tier II: 2:No Charge No Charge (Delivery/Post- Natal: Same as hospital stay) Tier I1: 10% after deductible Tier II2: 20% after deductible Maternity Hospital Stay and Routine Nursery Tier IPH&STier 1: 10% after deductible Tier IIOther in-networkTier 2: 25% after deductible Tier IPH&STier: 10% after deductible Tier IIOther in-networkTier 2: 25% after deductible

Appears in 1 contract

Samples: Agreement

Medical Benefit Design In-Network. 14 [NOTE – all charts have been updated to accurately reflect the 2019 2017 medical plans] In-Network Plan Feature Health Reimbursement (HRA) Medical Plan Health Savings (HSA) Medical Plan Annual deductible $1,150 per person $2,300 max per family $1,500 employee only $3,000 if covering dependents Annual out-of-pocket maximum (with does not include deductible) $3,300 2,150 per person $6,600 max 4,300 per family $1,500 employee only $3,000 employee only$6,000 if covering dependents Preventive Care No charge Charge No charge Charge Primary Care Provider visits (non-preventive) PCP: $20 copay PCP: 10% after deductible Specialist visits (non- preventive) Tier Specialist: PTier I: 10% after deductible Tier OTier II: 20% after deductible Tier PTier I: 10% after deductible Tier OTier II: 20% after deductible Lab and x-ray 20% after deductible Tier I, Tier II: 20% after deductible Alternative care (chiropractic, acupuncture) 20% after deductible Combined 12 visit limit per calendar year; all therapies year Tier I, Tier II: 20% after deductibleCombined deductible Combined 12 visit limit per calendar year; all therapies year Naturopathy Covered as Specialist Covered as Specialist Outpatient behavioral health care providers No charge No charge Charge Tier I: 10% after deductible Tier II: 20% after deductible Outpatient P Tier I: 10% after deductible P Tier I: 10% after deductible hospital/surgery facility fees (except hospice, rehab) Tier I: 10% after deductible O Tier II: 25% after deductible Tier I: 10% after deductible O Tier II: 25% after deductible Inpatient hospital facility fees, including behavioral health P Tier I: 10% after deductible O Tier II: 25% after deductible P Tier I: 10% after deductible O Tier II: 25% after deductible Hospital physician fees P Tier I: 10% after deductible O Tier II: 20% after deductible P Tier I: 10% after deductible O Tier II: 20% after deductible Emergency room $250 copay (waived if admitted) $250 copay 20% after deductible Urgent Care professional fees P Tier I: 10% after deductible O Tier II: 20% after deductible P Tier I: 10% after deductible O Tier II: 20% after deductible Maternity Pre-natal as Preventive Care Tier I, Tier II: No Charge Tier I, Tier II: No Charge Delivery and Post-natal Provider Care Tier I, Tier II: No Charge N Tier I: 10% after deductible Tier II: 20% after deductible Maternity Hospital Stay and Routine Nursery P Tier I: 10% after deductible O Tier II: 25% after deductible P Tier I: 10% after deductible O Tier II: 25% after deductible

Appears in 1 contract

Samples: Agreement

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