PPO Plan Clause Samples

PPO Plan. Effective July 1, 2016

PPO Plan. Single coverage deductible shall remain at $150.00. Prior to implementation of the Plan, the Township shall provide new benefit books and orientation during work hours. The Township shall provide at their cost, inoculations to prevent lyme disease upon approval and release by the appropriate State Regulatory Agency.

PPO Plan. Effective July 1, 2024 18% employee cost share For the HDHP/HSA plan, the following terms apply:

PPO Plan. This plan is the Blue Cross Blue Shield of Michigan's PPO Option. $20 co-pay for office/urgent care visits in a network physician's office. $250 single/$500 family calendar year deductible in network and $500 single/$1,000 family deductible out-of-network. $1,250 single/$2,500 family annual out of pocket max in-network and $3,500 single/$7,000 family out of pocket max out of network. When services are provided by a community provider, the provider pays eighty percent (80%) of the reasonable amount as determined by the carrier after deductibles and the participant is responsible for the remaining charges. If services are received from a provider who is not a member of the Plan network, the plan pays sixty percent (60%) of the reasonable amount as determined by the carrier and the participant is responsible for the remaining charges. Specific policy terms are those in the executed insurance contract with the carrier. Medical benefits shall be provided as agreed to by the University and the Association. Coverage information will be on file in University Human Resources and additional information will be provided by the medical carriers. The PPO plan described above is subject to specific carrier policy provisions and the Group Operating Agreements between Oakland University and the carrier.

PPO Plan. The Board will offer a PPO (Preferred Provider Organization) option. All benefits will be negotiated as a separate item and be outlined in the summary plan description which is posted on the district website and outlines the bargaining unit member’s percentage of coverage and co-pays not addressed within this Article. a. The bargaining unit members per pay contribution toward the cost of health insurance through the PPO shall be: 1) During FY22, the bargaining unit member shall pay no more than 14% of the COBRA rate for a Single, Employee Plus Children, Employee Plus Spouse, or Family plan. 2) During FY 23 increases in COBRA rates will be divided as follows: i. In the event the COBRA rate increases by 5% or less in one (1) year, the employee share of the COBRA rate will equal the employee share from FY 22 plus one percent (1%) of the COBRA rate. ii. In the event the COBRA rate increases by more than 5% in one (1) year, the Board will pay the dollar amount equal to the first 5% and the employee will pay the balance. The employee share will increase to reflect the new percentage plus 1% for the duration of this agreement. iii. The Board and Association further agree that, in the event that COBRA rates decrease during the life of this contract, the above formula will be utilized in the allocation contribution reduction by the first 5% decrease to the Board and the balance to the employee. 3) During FY 24 following, increases in COBRA rates will be divided as follows: i. In the event the COBRA rate increases by 5% or less in one (1) year, the Employee share of the COBRA rate will equal the Employee share from FY 23 plus one percent (1%) of the COBRA rate. ii. In the event the COBRA rate increases by more than 5% in one (1) year, the Board will pay the dollar amount equal to the first 5% and the employee will pay the balance. The employee share will increase to reflect the new percentage plus 1% for the duration of this agreement. iii. The Board and Association further agree that, in the event that COBRA rates decrease during the life of this contract, the above formula will be utilized in the allocation contribution reduction by the first 5% decrease to the Board and the balance to the employee.

PPO Plan. In addition to the coverage specified in the current plan, the employer will provide a PPO Plan each year of the Agreement with an in-network annual medical deductible of five hundred ($500) dollars for each covered individual in the plan and children under age twenty-six (26) years as defined in the ACA. Regular office visits with a primary care doctor will require a twenty dollars ($20) copay, while office visits for specialists will require a forty dollars ($40) copay. See the simplified chart below for a brief summary of these and other key medical benefit provisions. PPO Plan Medical Benefits: In Network Out of Network Deductibles $500 per person $1000/family $1,000 per person $3,000/family Coinsurance 0% 20% Coinsurance Out of Pocket Max n/a $2,000/$6,000 Emergency Room Copay $100 – waived if admitted OV Copay/Specialist Copay $20/$30 30% Urgent Care Copay $40 30% OOP MAX SINGLE: $3,675 OOP MAX FAMILY: $7,350

PPO Plan. The Cleveland Clinic System will be covered in-network with one or more Preferred Provider Organizations (PPO). The CCBDD may change the specifications to the following limits: a. In-Network:

PPO Plan. The member shall pay the first twenty percent (20%) of the insurance premium for single coverage. The Employer shall pay the remaining eighty percent (80%) of the insurance premium.

PPO Plan. Term of Contract -– Not to exceed 20% of the total PPO premium for whichever coverage is selected.