Preferred Provider Organization Access Sample Clauses

Preferred Provider Organization Access. (PPO). The Preferred Provider Organization distinguishes between network and non-network providers with network providers having contracts with the PPO. The participant may elect to use non- network providers, in which case an annual deductible of $200 per person and $400 per family applies. Once the deductible is met, the plan pays 70% and the participant pays 30% of eligible non-network expenses to an out-of-pocket limit, including the deductible, of $1,100 per person and $2,200 per family each calendar year. Effective January 1, 2003, once the deductible is met, the plan pays 80% and the participant pays 20% of eligible non-network expenses to an out-of-pocket limit, including the deductible, of $1,100 per person and $2,200 per family each calendar year. Effective February 1, 2002, prescription drugs (including female contraceptives) are covered with a $5.00 co-payment for each generic prescription and a $8.00 co-payment for each non- generic prescription. Effective January 1, 2003, the University will provide mail order prescription access on the same basis as provided to other University employees. The employee co- payment for prescription drugs will be $5.00 for each generic prescription, $8.00 for each non-generic prescription and $15.00 for each non-formulary, non-generic or non-formulary, generic prescription. A $10.00 co-payment will be required for each in- panel office visit/medical treatment received by PPO participants. Effective January 1, 2003, bargaining unit members shall make the following monthly pre-tax contributions for the PPO: Single $11.26 Double $22.52 Family $31.19 Effective January 1, 2004, bargaining unit members shall make the following monthly pre-tax contributions for the PPO: Single $22.52 Double $45.04 Family $59.72
Sample 1
AutoNDA by SimpleDocs
Preferred Provider Organization Access. (PPO). The Preferred Provider Organization distinguishes between network and non-network providers with network providers having contracts with the PPO. The participant may elect to use non-network providers, in which case the annual deductible of $200 per person and $400 per family applies. Once the deductible is met, the plan pays 80% and the participant pays 20% of eligible non-network expenses to an out-of-pocket limit, including the deductible, of $1,100 per person and $2,200 per family each calendar year. The University will provide mail order prescription access. Co- payments for mail order prescriptions, ninety (90) day supply, will be $16.00 for each generic, $30.00 for each brand/non-generic and $60.00 for each non-formulary, non- generic or non-formulary, generic. The employee co- payment for prescription drugs will be $8.00 for each generic prescription, $15.00 for each brand/non-generic prescription and $30.00 for each non-formulary, non- generic or non-formulary, generic prescription. A $15.00 co-payment will be required for each in-panel office visit/medical treatment received by PPO participants. A $75.00 co-payment will be required for each emergency room visit. Effective January 1, 2004, Bargaining Unit members shall make the following monthly pre-tax contributions for the PPO: Single $22.52 Double $45.04 Family $59.72 Effective January 1, 2005, bargaining unit members shall make the following monthly pre-tax contributions for the PPO: Single $24.77 Double $49.54 Family $66.69 Effective January 1, 2006, Bargaining Unit members shall have their monthly pre-tax contributions for the PPO adjusted by a percentage equivalent to the percentage increase or decrease of the university’s costs of the plan for the AAUP group for 2005 as compared to 2004. Effective January 1, 2007, Bargaining Unit members shall have their monthly pre-tax contributions for the PPO adjusted by a percentage equivalent to the percentage increase or decrease of the university’s costs of the plan for the AAUP group for 2006 as compared to 2005.
Sample 1

Related to Preferred Provider Organization Access

  • Preferred Provider - Prescription Drugs The Board shall provide, through the Xxxxx County Council of Governments, a preferred provider drug program that, if the employee chooses to utilize, will include the following:

  • Contractor Certification regarding Business with Certain Countries and Organizations Pursuant to Subchapter F, Chapter 2252, Texas Government Code], Contractor certifies Contractor is not engaged in business with Iran, Sudan, or a foreign terrorist organization. Contractor acknowledges this Agreement may be terminated and payment withheld if this certification is inaccurate.

  • Provider Selection To the extent applicable to Provider in performance of the Agreement, Provider shall comply with 42 CFR 438.214, as may be amended from time to time, which includes, but is not limited to the selection and retention of providers, credentialing and recredentialing requirements and nondiscrimination. If Subcontractor and/or Health Plan delegate credentialing to Provider, Subcontractor and/or Health Plan will provide monitoring and oversight and Provider shall ensure that all licensed medical professionals are credentialed in accordance with Health Plan’s and the State Contract’s credentialing requirements.

  • Training Designation Type Code Select and insert the appropriate training credit designation type code: Code Short Description Long Description (If Applicable) 01 Undergraduate Credit N/A 02 Graduate Credit N/A 03 Continuing Education Unit N/A 04 Post Graduate Credit N/A 05 N/A N/A

  • Association Access Employees shall have the right at any time to have the assistance of a paid representative of the Association on all matters related to employee and Employer relations. The paid representative of the Association shall have access to the Employer's premises in order to provide the required assistance. Employees involved in such discussions or investigations of grievances shall not absent themselves from their work, except with the permission from their supervisor and such permission will not be unreasonably withheld.

  • Five-Tier Copayment Structure This prescription drug plan formulary has a five-tiered copayment structure. The copayment for a prescription drug will vary by tier. The tier placement of a prescription drug on our formulary is subject to change. For more information about our formulary, and to see the tier placement of a particular prescription drug, visit our website or call our Customer Service Department. Below indicates the tier structure for this plan and the amount that you are responsible to pay. You will be responsible for paying the lowest cost of either your copayment, the retail cost of the drug, or the pharmacy allowance. We reserve the right not to accept manufacturer coupons, discount plan payments or other cost share assistance program payments for prescription drug copayments and/or deductibles. Insulin Prescription Drugs In accordance with RIGL § 27-20.8-3, copayments for insulin prescription drugs will not exceed $40 for each thirty-day supply and are not subject to a deductible. Summary of Pharmacy Benefits Covered Benefits Network Pharmacy Non-network Pharmacy (+) Preauthorization is required for thisservice. Please see Preauthorization in Section 3 for more information. You Pay You Pay Prescription Drugs, other than Specialty Prescription Drugs, and Diabetic Equipment and Supplies (which includes Glucometers, Test Strips, Lancet and Lancet Devices, Needles and Syringes, and Miscellaneous Supplies, calibration fluid): When purchased at a Retail Pharmacy: For maintenance and non-maintenance prescription drugs, a copayment applies for each 30-day period (or portion thereof) within the prescribeddosing period. Prorated copayments for a shorter supply periodmay apply for network pharmacy only. See Prescription Drug section for details. For tiers 1, 2, and 3: Up to a 90-day supply of maintenance and non-maintenance prescription drugs is available at certain network retail pharmacies and a 365-day supply for contraceptive prescription drugs is available at all network pharmacies. A copayment will apply for each 30-day supply. For more information about pharmacies offering this option, visit our website. Tier 1: $10 Not Covered Tier 2: $30 Not Covered Tier 3: $50 Not Covered Tier 4: $75 Not Covered Tier 5: See specialty prescription drug section below. Not Covered When purchased at a Mail Order Pharmacy: Up to a 90-day supply of maintenance and non- maintenance prescription drugs. Tier 1: $25 Not Covered Tier 2: $75 Not Covered Tier 3: $125 Not Covered Tier 4: $225 Not Covered Tier 5: See specialty prescription drug section below. Not Covered

  • Certification Regarding Business with Certain Countries and Organizations Pursuant to Subchapter F, Chapter 2252, Texas Government Code, PROVIDER certifies it is not engaged in business with Iran, Sudan, or a foreign terrorist organization. PROVIDER acknowledges this Purchase Order may be terminated if this certification is or becomes inaccurate.

  • SPECIALIZED JOB CLASSES Where there is a particular specialized job class in which the pay rate is below the local market value assessment of that job class, the parties may use existing means under the collective agreement to adjust compensation for that job class.

  • Information Access Each Party (“Disclosing Party”) shall make available to another Party (“Requesting Party”) information that is in the possession of the Disclosing Party and is necessary in order for the Requesting Party to: (i) verify the costs incurred by the Disclosing Party for which the Requesting Party is responsible under this Agreement; and (ii) carry out its obligations and responsibilities under this Agreement. The Parties shall not use such information for purposes other than those set forth in this Article 25.1 of this Agreement and to enforce their rights under this Agreement.

  • FUND TRANSFER FACILITIES VIA TBS The Account Holder may apply, in accordance with the Bank’s prescribed procedure then prevailing and the Bank may, in its reasonable discretion, permit the Account Holder to operate such fund transfer facilities via the TBS, including without limitation, GIRO or direct debit banking system as may be made available by the Bank from time to time. The Account Holder acknowledges that the operation of such fund transfer facilities shall be subject to the relevant terms and conditions governing such facilities.

Time is Money Join Law Insider Premium to draft better contracts faster.