Payment in Lieu of Health Care Coverage Clause Samples
The Payment in Lieu of Health Care Coverage clause allows employees to receive a monetary payment instead of enrolling in the employer-provided health insurance plan. Typically, this applies to employees who already have health coverage through another source, such as a spouse’s plan, and choose to opt out of the employer’s offering. This clause provides flexibility for employees while helping employers manage benefits costs by reducing the number of participants in their health plans.
Payment in Lieu of Health Care Coverage. A. Any bargaining unit member eligible for health care coverage who elects not to participate in The Plan shall receive an annual payment in lieu of insurance, provided that the bargaining unit member provides the District with a confirmation of health care coverage elsewhere. If four (4) or fewer members select payment in lieu of coverage, the annual payment shall be one thousand, five hundred dollars ($1,500). If five (5) members select payment in lieu of coverage, the annual payment shall be two thousand dollars ($2,000). If six
Payment in Lieu of Health Care Coverage. A. Any bargaining unit member eligible for health care coverage who elects not to participate in the Plan shall receive an annual payment of $1,500 in lieu of insurance, provided that the bargaining unit member provides the District with a confirmation of health care coverage elsewhere by September 30th.
B. The payment shall be made in the final payroll of the school year.
C. The annual payment shall be prorated for:
1. Bargaining unit members who terminate their service before the end of the school year
2. Bargaining unit members who re-enter the Plan once they have elected to receive the annual payment
3. Newly hired bargaining unit members whose effective date of employment occurs during the school year
D. If there are two bargaining unit members within the District who can be considered dependants of each other, according to the Plan, no buy-out provision payment will be made.
Payment in Lieu of Health Care Coverage. Employees who are eligible for health insurance coverage through the County and elect to NOT enroll in the group medical benefit plan because they are eligible for coverage under another qualified group medical benefit plan available to their spouse and/or eligible dependents will be eligible to receive additional monthly compensation based upon their health insurance coverage eligibility status. The amount of such compensation may be fixed by the Board of Commissioners, but shall not be less than $166.67 per month. Payments will be made once per month on the first paycheck in each month that the employee would otherwise be eligible for health insurance coverage. This amount will be pro-rated based on the number of hours the employee is regularly scheduled to work and the eligible months of service. An employee must provide proof of insurance coverage under a qualified group plan for the employee and eligible dependents as defined or required by the Affordable Care Act or implementing regulations and complete all forms or certifications required by the County and under the Affordable Care Act for such payments. It is agreed by the Parties that an employee will not be eligible for payment in lieu of health insurance if such payment would violate the Affordable Care Act or implementing regulations, or cause the Employer to be subject to penalty or fine. Should insurance coverage through the secondary source terminate for any reason, the employee should notify the County Administrator, or his or her designee, within thirty (30) days and re-enroll in the County health insurance program. Failure to timely notify the County may result in the ability to re-enroll being limited to the open-enrollment period. . Employees who are insured under a Grand Traverse County health insurance plan provided to their spouse are not eligible for this payment. The benefits provided under this section shall be secondary to any personal protection or personal injury benefits available from an insurer under a motor vehicle policy described in Section 500.3101(1) of the Michigan Compiled Laws. Eligibility and benefit provisions are provided subject to plan documents. The employee is obligated to pay any applicable cost share whether actively at work or on an approved leave. Failure to make the required cost share payment in a timely manner will result in loss of coverage.
Payment in Lieu of Health Care Coverage. Employees who are eligible for health insurance coverage through the County and elect to NOT enroll in the group medical benefit plan because they are eligible for coverage under another qualified group medical benefit plan available to their spouse and/or eligible dependents will be eligible to receive additional monthly compensation based upon their health insurance coverage eligibility status. The amount of such compensation may be fixed by the Board of Commissioners, but shall not be less than $166.67 per month. Payments will be made once per month on the first paycheck in each month that the employee would otherwise be eligible for health insurance coverage. This amount will be pro-rated based on the number of hours the employee is regularly scheduled to work and the eligible months of service. An employee must provide proof of insurance coverage under a qualified group plan for the employee and eligible dependents as defined or required by the Affordable Care Act or implementing regulations and complete all forms or certifications required by the County and under the Affordable Care Act of such payments. It is agreed by the Parties that an employee will not be eligible for payment in lieu of health insurance if such payment would violate the Affordable Care Act or implementing regulations, or cause the Employer to be subject to penalty or fine. Should insurance coverage through the secondary source terminate for any reason, the employee should notify the County Administrator, or his or her designee, within (30) days and re-enroll in the County health insurance program. Failure to timely notify the County may result in the ability to re-enroll being limited to the open-enrollment period. Employees who are insured under a Grand Traverse County health insurance plan provided to their spouse are not eligible for this payment.
Payment in Lieu of Health Care Coverage.
A. Any bargaining unit member eligible for health care coverage who elects not to participate in the Plan shall receive an annual payment in lieu of insurance as indicated on the chart below, provided that the bargaining unit member provides the District with a confirmation of health care coverage in a group health insurance plan or other plan which complies with the integration rules of the Affordable Care Act (i.e. not an individual health insurance plan that is obtained through the New York State of Health – Official Health Plan Marketplace) other than the District provided group health insurance plan.
B. The payment shall be made in the final payroll of the school year. The payment level will be determined based upon the number of teachers who have selected payment in lieu of coverage as of January 1st of each year. Proof of coverage must be submitted to the district within thirty (30) days of enrollment elsewhere.
C. The annual payment shall be prorated for:
1. Bargaining unit members who terminate their service before the end of the school year;
2. Bargaining unit members who re-enter the Plan once they have elected to receive the annual payment;
3. Newly hired bargaining unit members whose effective date of employment occurs during the school year.
D. If there are two (2) bargaining unit members within the District who can be considered dependents of each other, according to the Plan, no buy-out provision payment will be made.