Plan Type. Combination Plan Type Option 1 (Retiree is Medicare eligible, but dependent(s) are not) Level of Coverage City Monthly Contribution Medicare Retiree+1 Basic Dependent $937.30 Medicare Retiree+2 or more Basic Dependents $1,321.01 Medicare Retiree+1 Medicare Dependent+1 or more Basic Dependent(s) $974.16
Plan Type. The Vendor (Health Plan) is approved to provide contracted services as the following health plan type as denoted by “X”: TABLE 1 Health Maintenance Organization (HMO) Fee- for-Service (FFS) Provider Service Network (PSN) Capitated PSN Specialty Health Plan for Children with Chronic Conditions Specialty Plan for Recipients Living with HIV/AIDS X
Plan Type. The Basic Separation Program provides severance benefits to eligible employees of the Company (and its subsidiaries). The Insured-Unfunded Plan also provides other employee benefits, the terms of which are described in separate summary plan descriptions. Plan Administrator: The Procter & Xxxxxx U.S. Business Services Company, c/o U.S. Benefits Manager, P&G Plaza, TE-3, Xxxxxxxxxx, XX 00000, [phone number].
Plan Type. The Iron Workers District Council of Southern Ohio & Vicinity Annuity Trust is a money purchase plan under Internal Revenue Code Section 401(a). 1-800-743-5274 Iron Workers District Council of Southern Ohio & Vicinity Annuity Trust Contract Number: MR 60359-001 DISTRIBUTION FORM • This form authorizes a distribution from the Iron Workers District Council of Southern Ohio & Vicinity Annuity Trust. • Participants must complete Sections 1 through 5 and return this form to the Iron Workers District Council of Southern Ohio & Vicinity. • If you are choosing a direct rollover to another qualified plan or IRA you must also complete Section #4. • If you are married your spouse must complete and enclose the Spousal Consent Form. • This form is not valid without your signature under Section #5 and the Fund Office’s countersignature.
Plan Type. Combination Plan Type Option 2 (Retiree is not Medicare eligible, but one or more dependent(s) are) Level of Coverage City Monthly Contribution Basic Retiree+1 Medicare Dependent $937.30 Basic Retiree+2 or more Medicare Dependents $1,235.10 Basic Retiree+1 Basic Dependent+1 or more Medicare Dependent(s) $1,321.01 Retiree contributions will vary based on future changes to health premiums and health plan selected. However, the City contribution shall be capped at the levels listed above. City contributions to medical premiums shall not exceed 100% of the premium cost for the applicable level of Kaiser coverage.
Plan Type. The Iron Workers District Council of Southern Ohio & Vicinity Annuity Trust is a money purchase plan under Internal Revenue Code Section 401(a). 1-800-743-5274 Iron Workers District Council of Southern Ohio & Vicinity Annuity Trust Contract Number: MR60359-001 BENEFICIARY AND ALTERNATE PAYEE DISTRIBUTION FORM • Use this form to request a distribution as a beneficiary following the death of the participant or as an alternate payee under a qualified domestic relations order. • Complete all of this form in ink and provide signatures where indicated. • To request a distribution as a participant following termination of employment, use the Distribution Form. • Your choices on this form may affect your taxes. You may wish to consult your own tax or financial advisor. • Please return completed form to the address below.
Plan Type. 1. The Managed Care Plan is approved to provide contracted services as denoted by "X" in Table 1, LTC Plan Type, below. TABLE LTC Plan Type Effective Date 08/0.1143'.4,•08/31118 C pitated Managed Care Plan Fee-for-Service (FFS) Managed Care Plan* LTC Exclusive Provider provider Service Organization Network (EPO) (LTC PSN) van age §0000r N0e4P1011 (MA SNP) LTC Provider Service Network (LTC PSN) X * FFS Managed Care Plans are capitated by the Agency for transportation only.
Plan Type. This defined contribution plan is established by the Company for the exclusive benefit of eligible employees and their beneficiaries. The Plan is intended to qualify and satisfy the requirements of the Internal Revenue Code Sections 401(a) and 501 and regulations promulgated under it. This plan is also intended to constitute a plan described in section 404(c) of the Employee Retirement Income Security Act (ERISA).
Plan Type. The scale of compensation as stated in the Compensation Table for Accidental Death and Permanent Disablement. The scale of compensation as stated in the Compensation Table for Broken / Fracture Bones. We will pay the amount specified in the Policy Schedule if the Insured Person is hospitalized for a minimum of twelve (12) continuous hours due to an Accident. The type of benefits as stated in the Wellness Health Screening and DOCTOR2U programme provisions in this Policy Rider 4 Funeral Expenses Reimbursement of expenses incurred per Accident up to the amount stated in the Optional Riders Section in the Policy Schedule. Rider 5 Medical Reimbursement due to Dengue or XXXX Xxxxx 6 Death due to Dengue, Japanese Encephalitis or Malaria We will pay the Insured’s legal representative the Sum Insured Person specified in the Policy Schedule in the event the Insured Person dies due to Dengue Fever, Japanese Encephalitis or Malaria.
Plan Type. The plan type is as designated in the adoption agreement.
