Stipulations. The parties agree to the following stipulations: 1. Employees may elect this option at any time. 2. The supplemental pay will begin with the first pay date in the month that insurance coverage ceases. There will be no retroactive payments. 3. Employees may elect to reinstate their health insurance coverage and drop the supplemental pay plan at the annual health insurance open enrollment. If an employee wishes to reinstate their health insurance coverage at any other time, they may do so only if the reinstatement is due to loss of coverage as a result of the death of, divorce from, or loss of coverage due to the unemployment of the individual covering the employee under another plan. 4. Those persons who are eligible for hospital/medical insurance at the inception of this agreement but who have elected not to be insured by the Township plan because they are covered by another plan, will be eligible for this option. 5. In those cases where both a husband and wife work for the Township, one person may carry his/her spouse and dependents on the health insurance policy and the other person may elect the supplemental pay plan. 6. When an employee elects to drop his/her insurance coverage, he/she must drop it for him/her self and all dependents. (e.g. A parent cannot drop insurance for him/her self and retain coverage for his/her children). 7. The Provisions of this plan which pertain to adding or dropping insurance coverage are subject to the administrative rules of the insurance carriers for the Township. I hereby authorize the Charter Township of Clinton to cancel my group medical plan if I currently have group coverage and provide supplemental pay to me of $100 per pay in lieu of participation in any Township group medical plan. I affirm that I am covered by the health plan coverage offered through: I understand that by exercising the election to receive these payments, I will receive no benefits or payments as primary subscriber from any Township group medical plan. I understand that except in the case of death, divorce from, or lost of coverage due to the unemployment of the individual covering me under another plan, I will not be eligible for enrollment in any of Clinton Township’s group medical plans until the next open enrollment period. I understand that if I wish to enroll in any if Clinton Township’s group medical plans at a later date, I will be subject to that plan’s enrollment rules. NAME (PLEASE PRINT) SIGNATURE DATE DEPARTMENT NAME SOCIAL SECURITY NUMBER *If covered elsewhere, you must provide written proof of other coverage. A. OVERVIEW Effective April 1, 2001, any Captain who is a member of or promoted to the Clinton Township Police Captain’s bargaining group (hereinafter “Captains”) between April 1, 2001 and May 1, 2007 may at any time voluntarily elect to participate in the Clinton Township Police and Fire Retirement System Deferred Retirement Option Plan (hereinafter “DROP”) after attaining the minimum requirements for a normal service retirement/pension. Upon commencement of DROP participation, the Participant’s DROP Benefit shall be the dollar amount of the member’s monthly pension benefit computed by using the contractual guidelines and formula(s) that are in effect on the DROP date. During participation in the DROP, the Participant continues with full employment status and receives all future promotions and benefit/wage increases. The Participant’s DROP Benefit shall be credited monthly to the Participant’s DROP Account which shall be established within the Defined Benefit Plan of the Clinton Township Fire and Police Retirement System (the “Fire and Police Retirement System” or “Plan”). The Participant’s DROP Account shall be maintained and managed by the Board of Trustees of the Fire and Police Retirement System (the “Retirement Board”). Upon termination of employment, the retiree shall begin to receive payment(s) from his/her individual DROP Account as described herein. The DROP payment(s) are in addition to all other contractual pension benefits. The Participant is solely responsible for analyzing the tax consequences of participation in the DROP.
Appears in 1 contract
Sources: Collective Bargaining Agreement
Stipulations. The parties agree to the following stipulations:
1. Employees may elect this option at any timeopen enrollment.
2. The supplemental pay will begin with the first pay date in the month that insurance coverage ceases. There will be no retroactive payments.
3. Employees may elect to reinstate their health insurance coverage and drop the supplemental pay plan at the annual health insurance open enrollment. If an employee wishes to reinstate their health insurance coverage at any other time, they may do so only if the reinstatement is due to loss of coverage as a result of the death of, divorce from, or loss of coverage due to the unemployment of the individual covering the employee under another plan.
4. Those persons who are eligible for hospital/medical insurance at the inception of this agreement but who have elected not to be insured by the Township plan because they are covered by another plan, plan will be eligible for this option.
5. In those cases where both a husband and wife work for the Township, one person may carry his/her spouse and dependents on the health insurance policy and the other person may elect the supplemental pay plan.
6. When an employee elects to drop his/her insurance coverage, he/she must drop it for him/her self and all dependents. (e.g. A parent cannot drop insurance for him/her self and retain coverage for his/her children).
7. The Provisions of this plan which pertain to adding or dropping insurance coverage are subject to the administrative rules of the insurance carriers for the TownshipTownship and Section 125 of the Internal Revenue Code. I hereby authorize the Charter Township of Clinton to cancel my group medical plan if I currently have group coverage and provide supplemental pay to me of $100 per pay in lieu of participation in any Township group medical plan. I affirm that I am covered by the health plan coverage offered through: I understand that by exercising the election to receive these payments, I will receive no benefits or payments as primary subscriber from any Township group medical plan. I understand that except in the case of death, divorce from, or lost of coverage due to the unemployment of the individual covering me under another plan, I will not be eligible for enrollment in any of Clinton Township’s 's group medical plans until the next open enrollment period. I understand that if I wish to enroll in any if i f Clinton Township’s 's group medical plans at a later date, I will be subject to that plan’s plans enrollment rules. NAME Name (PLEASE PRINT) SIGNATURE DATE DEPARTMENT NAME SOCIAL SECURITY NUMBER *If covered elsewhere, you must provide written proof of other coverage.
A. OVERVIEW . BY: Please Print: LAST NAME FIRST NAME MIDDLE NAME CLASSIFICATION: TO: EMPLOYER Effective April 1I hereby request and authorize you to deduct from my earnings, 2001the current initiation fee being charged by AFSCME, any Captain who is Local Union # and effective the same date, to deduct from my earnings a member sufficient amount to provide for regular payment of or promoted the current rate of monthly union dues, as certified by the Union. The amount deducted shall be paid to the Clinton Township Police Captain’s bargaining group (hereinafter “Captains”) between April 1Treasurer of This is only a summary. If you want more detail about your coverage and costs, 2001 and May 1, 2007 may at any time voluntarily elect to participate you can get the complete terms in the Clinton Township Police policy or plan document by calling Human Resources at1-586-723-8072 Important Questions Answers Why this Matters: What is the overall deductible? $1,000person / $2,000 family Doesn’t apply to preventive care You must pay all the costs up to the deductibleamount before thisplan begins to pay for covered services you use. Check your policy or plan document to see when the deductiblestarts over (usually, but not always, January 1st). See the chart starting on page 2 for how much you pay for covered services after you meet the deductible. Are there other deductibles for specific services? There are deductibles for services received by out-of- network providers. $2,000person / $4,000family You must pay all of the costs for these services up to the specific deductible amount before this plan begins to pay for these services. Is there an out–of– pocket limit on my expenses? Yes. $3,000person / $6,000family for services received by in-network providers. The out-of-pocket limitis the most you could pay during a coverage period (usually one year) for your share of the cost of covered services. This limit helps you plan for health care expenses. Higher out-of-pocket limits exist for services received by out-of-network providers. What is not included in theout–of–pocket limit? Premiums, balance-billed charges, and Fire Retirement System Deferred Retirement Option Plan (hereinafter “DROP”) after attaining health care this plan doesn’t cover. Even though you pay these expenses, they don’t count toward the minimum requirements out-of-pocket limit. Is there an overall annual limit on what theplan pays? No. The chart starting on page 2 describes any limits on what the plan will pay for specific covered services, such as office visits. Does this plan use a network of providers? Yes. See ▇▇▇.▇▇▇▇▇.▇▇▇ for a normal list of participating providers. If you use an in-network doctor or other health care provider, thisplan will pay some or all of the costs of covered ▇▇▇▇▇▇▇▇.▇▇ aware, your in-network doctor or hospital may use an out-of-network provider for some services. Plans use the term in-network, preferred, or participatingfor providersin their network. See the chart starting on page 2 for how this plan pays different kinds of providers. Do I need a referral to see a specialist? No. You don’t need a referral to see a specialist. You can see the specialistyou choose without permission from this plan. Are there services this plan doesn’t cover? Yes. Some of the services thisplan doesn’t cover are listed on page 4. See your policy or plan document for additional information about excluded services. Copaymentsare fixed dollar amounts (for example, $10) you pay for covered health care, usually when you receive the service. Coinsuranceis your share of the costs of a covered service, calculated as a percent of the allowed amountfor the service. For example, if the plan’s allowed amountfor an overnight hospital stay is $1,000, your coinsurancepayment of 20% would be $200. This may change if you haven’t met your deductible. The amount the plan pays for covered services is based on the allowed amount. If an out-of-networkprovidercharges more than the allowed amount, you may have to pay the difference. For example, if an out-of-network hospital charges $1,500 for an overnight stay and the allowed amountis $1,000, you may have to pay the $500 difference. (This is called balance billing.) This plan may encourage you to use participating providersby charging you lower deductibles, copaymentsand coinsuranceamounts. Common Medical Event Services You May Need Your Cost If You Use a Participating Provider Your Cost If You Use a Non- Participating Provider Limitations & Exceptions If you visit a health care provider’s office or clinic Primary care visit to treat an injury or illness $30copay/visit 40% coinsurance Specialist visit $30copay/visit 40% coinsurance Other practitioner office visit $30 copay/visit 40% coinsurance Preventive care/screening/immunization No charge Not covered Not covered for non-BCBSM If you have a test Diagnostic test (x-ray, blood work) 20% coinsurance 40% coinsurance Payment increases for non-BCBSM Imaging (CT/PET scans, MRIs) 20% coinsurance 40% coinsurance Payment increases for non-BCBSM If you need drugs to treat your illness or condition More information about prescription drug coverageis available at ▇▇▇.▇▇▇▇▇.▇▇▇ Generic drugs $15 copay $15 copay + 25% Covers up to a 30-day supply (retail prescription); 31-90 day supply (mail order prescription) 2x copay Preferred brand drugs $30 copay $30 copay + 25% Covers up to a 30-day supply (retail prescription); 31-90 day supply (mail order prescription) 2x copay Non-preferred brand drugs $60 copay $60 copay + 25% Covers up to a 30-day supply (retail prescription); 31-90 day supply (mail order prescription) 2x copay Specialty drugs $60 copay Not covered Covers up to a 30-day supply (retail prescription); 31-90 day supply (mail order prescription) 2x copay If you have outpatient surgery Facility fee (e.g., ambulatory surgery center) 20% coinsurance 40% coinsurance Payment increases for non-BCBSM Physician/surgeon fees 20% coinsurance 40% coinsurance Payment increases for non-BCBSM If you need immediate medical attention Emergency room services $150 copay/visit $150 copay/visit Waived if admitted to hospital Emergency medical transportation 20% coinsurance 40% coinsurance Payment increases for non-BCBSM Urgent care $30 copay/visit 40% coinsurance Payment increases for non-BCBSM If you have a hospital stay Facility fee (e.g., hospital room) 20% coinsurance 40% coinsurance Payment increases for non-BCBSM Physician/surgeon fee 20% coinsurance 40%coinsurance Payment increases for non-BCBSM If you have mental health, behavioral health, or substance abuse needs Mental/Behavioral health outpatient services 20% coinsurance 40% coinsurance Payment increases for non-BCBSM Mental/Behavioral health inpatient services 20% coinsurance 40% coinsurance Payment increases for non-BCBSM Substance use disorder outpatient services 20% coinsurance 40% coinsurance Payment increases for non-BCBSM Substance use disorder inpatient services 20% coinsurance 40% coinsurance Payment increases for non-BCBSM If you are pregnant Prenatal and postnatal care 100% covered 40% coinsurance Payment increases for non-BCBSM Delivery and all inpatient services 20% coinsurance 40% coinsurance Payment increases for non-BCBSM If you need help recovering or have other special health needs Home health care 20% coinsurance 20% coinsurance Payment increases for non-BCBSM Rehabilitation services 20% coinsurance 40% coinsurance 60 visits per calendar year Habilitation services 20% coinsurance 40% coinsurance Payment increases for non-BCBSM Skilled nursing care 20% coinsurance 20% coinsurance 120 days per calendar year Durable medical equipment 20% coinsurance 20% coinsurance Hospice service retirement/pension100% covered 100% covered Four 90-day periods If your child needs dental or eye care Eye exam Not covered Not Covered Glasses Not covered Not Covered Dental check-up Not covered Not Covered Services Your Plan Does NOT Cover (This isn’t a complete list. Upon commencement Check your policy or plan document for otherexcluded services.) Cosmetic surgery Long-term care Routine eye care (Adult) Certain Experimental Medicine Non-emergency care when traveling outside the U.S. Elective procedures that are not medically necessary Organ transplants Chiropractic care Voluntary sterilization Federal and State laws may provide protections that allow you to keep this health insurance coverage as long as you pay your premium. There are exceptions, however, such as if: You commit fraud The insurer stops offering services in the State You move outside the coverage area For more information on your rights to continue coverage, contact the insurer at [contact number]. You may also contact your state insurance department at [insert applicable State Department of DROP participationInsurance contact information]. If you lose coverage under the plan, then, depending upon the circumstances, Federal and State laws may provide protections that allow you to keep health coverage. Any such rights may be OR limited in duration and will require you to pay a premium, which may be significantly higher than the premium you pay while covered under the plan. Other limitations on your rights to continue coverage may also apply. For more information on your rights to continue coverage, contact the plan at [contact number]. You may also contact your state insurance department, the Participant’s DROP Benefit shall be U.S. Department of Labor, Employee Benefits Security Administration at ▇-▇▇▇-▇▇▇-▇▇▇▇ or ▇▇▇.▇▇▇.▇▇▇/▇▇▇▇, or the dollar amount U.S. Department of the member’s monthly pension benefit computed by using the contractual guidelines Health and formula(s) that are in effect on the DROP date. During participation in the DROP, the Participant continues with full employment status and receives all future promotions and benefit/wage increases. The Participant’s DROP Benefit shall be credited monthly to the Participant’s DROP Account which shall be established within the Defined Benefit Plan of the Clinton Township Fire and Police Retirement System (the “Fire and Police Retirement System” Human Services at ▇-▇▇▇-▇▇▇-▇▇▇▇ ▇▇▇▇▇▇ or “Plan”). The Participant’s DROP Account shall be maintained and managed by the Board of Trustees of the Fire and Police Retirement System (the “Retirement Board”). Upon termination of employment, the retiree shall begin to receive payment(s) from his/her individual DROP Account as described herein. The DROP payment(s) are in addition to all other contractual pension benefits. The Participant is solely responsible for analyzing the tax consequences of participation in the DROP▇▇▇.▇▇▇▇▇.▇▇▇.▇▇▇.
Appears in 1 contract
Sources: Collective Bargaining Agreement
Stipulations. The parties agree to the following stipulations:
1. Employees may elect this option at any time.
2. The supplemental pay will begin with the first pay date in the month that insurance coverage ceases. There will be no retroactive payments.
3. Employees may elect to reinstate their health insurance coverage and drop the supplemental pay plan at the annual health insurance open enrollment. If an employee wishes to reinstate their health insurance coverage at any other time, they may do so only if the reinstatement is due to loss of coverage as a result of the death of, divorce from, or loss of coverage due to the unemployment of the individual covering the employee under another plan.
4. Those persons who are eligible for hospital/medical insurance at the inception of this agreement but who have elected not to be insured by the Township plan because they are covered by another plan, will be eligible for this option.
5. In those cases where both a husband and wife work for the Township, one person may carry his/her spouse and dependents on the health insurance policy and the other person may elect the supplemental pay plan.
6. When an employee elects to drop his/her insurance coverage, he/she must drop it for him/her self and all dependents. (e.g. A parent cannot drop insurance for him/her self and retain coverage for his/her children).
7. The Provisions of this plan which pertain to adding or dropping insurance coverage are subject to the administrative rules of the insurance carriers for the Township. WAIVER OF MEDICAL INSURANCE AND ELECTION OF SUPPLEMENTAL PAY IN LIEU OF PARTICIPATION IN GROUP MEDICAL INSURANCE I hereby authorize the Charter Township of Clinton to cancel my group medical plan if I currently have group coverage and provide supplemental pay to me of $100 100.00 per pay in lieu of participation in any Township group medical plan. I affirm that I am covered by the health plan coverage offered through: I understand that by exercising the election to receive these payments, I will receive no benefits or payments as primary subscriber from any Township group medical plan. I understand that except in the case of death, divorce from, or lost of coverage due to the unemployment of the individual covering me under another plan, I will not be eligible for enrollment in any of Clinton Township’s group medical plans until the next open enrollment period. I understand that if I wish to enroll in any if Clinton Township’s group medical plans at a later date, I will be subject to that plan’s enrollment rules. NAME (PLEASE PRINT) SIGNATURE DATE DEPARTMENT NAME SOCIAL SECURITY NUMBER *If covered elsewhere, you must provide written proof of other coverage.
A. OVERVIEW Effective April 1December 21, 20012000, any Captain employee who is a member of or promoted to the Clinton Township Police Captain’s Fire Chief, Deputy Fire Chief/Operations and Deputy Fire Chief/Administration bargaining group (hereinafter the “CaptainsFire and Chiefs”) between April 1, 2001 and May 1, 2007 may at any time voluntarily elect to participate in the Clinton Township Police and Fire Retirement System Deferred Retirement Option Plan (hereinafter “DROP”) after attaining the minimum requirements for a normal service retirement/pension. Upon commencement of DROP participation, the Participant’s DROP Benefit shall be the dollar amount of the member’s monthly pension benefit computed by using the contractual guidelines and formula(s) that are in effect on the DROP dateDate. During participation in the DROP, the Participant continues with will full employment status and receives all future promotions and benefit/wage increases. The Participant’s DROP Benefit shall be credited monthly to the Participant’s DROP Account which shall be established within the Defined Benefit Plan of the Clinton Township Fire and Police Retirement System (the “Fire and Police Retirement System” or “Plan”). The Participant’s DROP Account shall be maintained and managed by the Board of Trustees of the Fire and Police Retirement System (the “Retirement Board”). Upon termination of employment, the retiree shall begin to receive payment(s) from his/her individual DROP Account as described herein. The DROP payment(s) are in addition to all other contractual pension benefits. The Participant is solely responsible for analyzing the tax consequences of participation in the DROP.
Appears in 1 contract
Stipulations. The parties agree to the following stipulations:
1. Employees may elect this option at any time.
2. The supplemental pay will begin with the first pay date in the month that insurance coverage ceases. There will be no retroactive retro- active payments.
3. Employees may elect to reinstate their health insurance coverage and drop the supplemental pay plan at the annual health insurance open enrollment. If an employee wishes to reinstate their health insurance coverage at any other time, they may do so only if the reinstatement is due to loss of coverage as a result of the death of, divorce from, or loss of coverage due to the unemployment of the individual covering the employee under another plan.
4. Those persons who are eligible for hospital/medical insurance at the inception of this agreement Agreement but who have elected not to be insured by the Township plan because they are covered by another plan, will be eligible for this option.
5. In those cases where both a husband and wife work for the Township, one person may carry his/his or her spouse and dependents on the health insurance policy and the other person may elect the supplemental pay plan.
6. When an employee elects to drop his/his or her insurance coverage, he/he or she must drop it for him/her self herself and all dependents. (e.g. A parent cannot drop insurance for him/her self and retain coverage for his/his or her children).
7. The Provisions of this plan which pertain to adding or dropping insurance coverage coverages are subject to the administrative rules of the insurance carriers for the Township. I hereby authorize the Charter Township of Clinton to cancel my group medical plan if I currently have group coverage and provide supplemental pay to me of $100 per pay in lieu of participation in any Township group medical plan. I affirm that I am covered by the health plan coverage offered through: I understand that by exercising the election to receive these payments, I will receive no benefits or payments as primary subscriber from any Township group medical plan. I understand that except in the case of death, divorce from, or lost loss of coverage due to the unemployment of the individual covering me under another plan, I will not be eligible for enrollment in any of Clinton Township’s 's group medical plans until the next open enrollment period. I understand that if I wish to enroll in any if of Clinton Township’s 's group medical plans at a later date, I will be subject to that the plan’s 's enrollment rules. NAME Name (PLEASE PRINT) SIGNATURE DATE DEPARTMENT NAME SOCIAL SECURITY NUMBER ** If covered elsewhere, you must provide written proof of other coverage.
A. OVERVIEW Effective April 1, 2001, any Captain who is a member of or promoted to the Clinton Township Police Captain’s bargaining group (hereinafter “Captains”) between April 1, 2001 . Both parties hereby agree that Article XXVIII and May 1, 2007 may at any time voluntarily elect to participate in the Clinton Township Police and Fire Retirement System Deferred Retirement Option Plan (hereinafter “DROP”) after attaining the minimum requirements for a normal service retirement/pension. Upon commencement of DROP participation, the Participant’s DROP Benefit shall be the dollar amount Article XXIX of the member’s monthly pension benefit computed by using the contractual guidelines Collective Bargaining Agreement is clarified as followed: Employees being interviewed, solely for internal investigative purposes, and formula(s) that who are in effect on the DROP date. During participation in the DROP, the Participant continues with full employment status and receives all future promotions and benefit/wage increases. The Participant’s DROP Benefit shall be credited monthly ordered to the Participant’s DROP Account which shall be established within the Defined Benefit Plan of the Clinton Township Fire and Police Retirement System (the “Fire and Police Retirement System” or “Plan”). The Participant’s DROP Account shall be maintained and managed by the Board of Trustees of the Fire and Police Retirement System (the “Retirement Board”). Upon termination make a statement as a condition of employment, the retiree shall begin to receive payment(sonly be advised of their ▇▇▇▇▇▇▇ Rights. POLICE OFFICERS ASSOCIATION OF MICHIGAN CLINTON TOWNSHIP ▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇▇▇, Chief of Police CLINTON TOWNSHIP POLICE OFFICERS ASSOCIATION ▇▇▇▇▇▇▇ ▇▇▇▇▇, President The Summary of Benefits and Coverage (SBC) from his/her individual DROP Account as described hereindocument will help you choose a health plan. The DROP payment(sSBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) are in addition will be provided separately. This is only a summary. For more information about your coverage, or to all get a copy of the complete terms of coverage, go to ▇▇▇▇▇://▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇▇▇▇▇▇.▇▇▇ or call (▇▇▇) ▇▇▇-▇▇▇▇. For general definitions of common terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other contractual pension benefitsunderlined terms see the Glossary. The Participant is solely responsible for analyzing You can view the tax consequences of participation in the DROPGlossary at ▇▇▇.▇▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇-▇▇▇▇▇▇▇▇ or call Care Coordinators at (▇▇▇) ▇▇▇-▇▇▇▇ to request a copy.
Appears in 1 contract
Sources: Collective Bargaining Agreement
Stipulations. The parties agree to the following stipulations:
1. Employees may elect this option at any timeopen enrollment.
2. The supplemental pay will begin with the first pay date in the month that insurance coverage ceases. There will be no retroactive payments.
3. Employees may elect to reinstate their health insurance coverage and drop the supplemental pay plan at the annual health insurance open enrollment. If an employee wishes to reinstate their health insurance coverage at any other time, they may do so only if the reinstatement is due to loss of coverage as a result of the death of, divorce from, or loss of coverage due to the unemployment of the individual covering the employee under another plan.
4. Those persons who are eligible for hospital/medical insurance at the inception of this agreement but who have elected not to be insured by the Township plan because they are covered by another plan, will be eligible for this option.
5. In those cases where both a husband and wife work for the Township, one person may carry his/her spouse and dependents on the health insurance policy and the other person may elect the supplemental pay plan.
6. When an employee elects to drop his/her insurance coverage, he/she must drop it for him/her self and all dependents. (e.g. A parent cannot drop insurance for him/her self and retain coverage for his/her children).
7. The Provisions of this plan which pertain to adding or dropping insurance coverage are subject to the administrative rules of the insurance carriers for the TownshipTownship and Section 125 of the Internal Revenue Code. I hereby authorize the Charter Township of Clinton to cancel my group medical plan if I currently have group coverage and provide supplemental pay to me of $100 per pay in lieu of participation in any Township group medical plan. I affirm that I am covered by the health plan coverage offered through: I understand that by exercising the election to receive these payments, I will receive no benefits or payments as primary subscriber from any Township group medical plan. I understand that except in the case of death, divorce from, or lost loss of coverage due to the unemployment of the individual covering me under another plan, I will not be eligible for enrollment in any of Clinton Township’s group medical plans until the next open enrollment period. I understand that if I wish to enroll in any if of Clinton Township’s group medical plans at a later date, I will be subject to that plan’s enrollment rules. NAME (PLEASE PRINT) SIGNATURE DATE DEPARTMENT NAME SOCIAL SECURITY NUMBER *If covered elsewhere, you must provide written proof of other coverage.
A. OVERVIEW Effective April 1. This is only a summary. If you want more detail about your coverage and costs, 2001, any Captain who you can get the complete terms in the policy or plan document by calling Human Resources at1-586-723-8072 Important Questions Answers Why this Matters: What is a member of or promoted the overall deductible? $1,000person / $2,000 family Doesn’t apply to preventive care You must pay all the costs up to the Clinton Township Police Captaindeductibleamount before thisplan begins to pay for covered services you use. Check your policy or plan document to see when the deductiblestarts over (usually, but not always, January 1st). See the chart starting on page 2 for how much you pay for covered services after you meet the deductible. Are there other deductibles for specific services? There are deductibles for services received by out-of- network providers. $2,000person / $4,000family You must pay all of the costs for these services up to the specific deductible amount before this plan begins to pay for these services. Is there an out–of– pocket limit on my expenses? Yes. $3,000person / $6,000family for services received by in-network providers. The out-of-pocket limitis the most you could pay during a coverage period (usually one year) for your share of the cost of covered services. This limit helps you plan for health care expenses. Higher out-of-pocket limits exist for services received by out-of-network providers. What is not included in theout–of–pocket limit? Premiums, balance-billed charges, and health care this plan doesn’t cover. Even though you pay these expenses, they don’t count toward the out-of-pocket limit. Is there an overall annual limit on what theplan pays? No. The chart starting on page 2 describes any limits on what the plan will pay for specific covered services, such as office visits. Does this plan use a network of providers? Yes. See ▇▇▇.▇▇▇▇▇.▇▇▇ for a list of participating providers. If you use an in-network doctor or other health care provider, thisplan will pay some or all of the costs of covered ▇▇▇▇▇▇▇▇.▇▇ aware, your in-network doctor or hospital may use an out-of-network provider for some services. Plans use the term in-network, preferred, or participatingfor providersin their network. See the chart starting on page 2 for how this plan pays different kinds of providers. Do I need a referral to see a specialist? No. You don’t need a referral to see a specialist. You can see the specialistyou choose without permission from this plan. Are there services this plan doesn’t cover? Yes. Some of the services thisplan doesn’t cover are listed on page 4. See your policy or plan document for additional information about excluded services. Copaymentsare fixed dollar amounts (for example, $10) you pay for covered health care, usually when you receive the service. Coinsuranceis your share of the costs of a covered service, calculated as a percent of the allowed amountfor the service. For example, if the plan’s bargaining group allowed amountfor an overnight hospital stay is $1,000, your coinsurancepayment of 20% would be $200. This may change if you haven’t met your deductible. The amount the plan pays for covered services is based on the allowed amount. If an out-of-networkprovidercharges more than the allowed amount, you may have to pay the difference. For example, if an out-of-network hospital charges $1,500 for an overnight stay and the allowed amountis $1,000, you may have to pay the $500 difference. (hereinafter “Captains”This is called balance billing.) between April 1 This plan may encourage you to use participating providersby charging you lower deductibles, 2001 copaymentsand coinsuranceamounts. Common Medical Event Services You May Need Your Cost If You Use a Participating Provider Your Cost If You Use a Non- Participating Provider Limitations & Exceptions If you visit a health care provider’s office or clinic Primary care visit to treat an injury or illness $30copay/visit 40% coinsurance Specialist visit $30copay/visit 40% coinsurance Other practitioner office visit $30 copay/visit 40% coinsurance Preventive care/screening/immunization No charge Not covered Not covered for non-BCBSM If you have a test Diagnostic test (x-ray, blood work) 20% coinsurance 40% coinsurance Payment increases for non-BCBSM Imaging (CT/PET scans, MRIs) 20% coinsurance 40% coinsurance Payment increases for non-BCBSM If you need drugs to treat your illness or condition More information about prescription drug coverageis available at ▇▇▇.▇▇▇▇▇.▇▇▇ Generic drugs $15 copay $15 copay + 25% Covers up to a 30-day supply (retail prescription); 31-90 day supply (mail order prescription) 2x copay Preferred brand drugs $30 copay $30 copay + 25% Covers up to a 30-day supply (retail prescription); 31-90 day supply (mail order prescription) 2x copay Non-preferred brand drugs $60 copay $60 copay + 25% Covers up to a 30-day supply (retail prescription); 31-90 day supply (mail order prescription) 2x copay Specialty drugs $60 copay Not covered Covers up to a 30-day supply (retail prescription); 31-90 day supply (mail order prescription) 2x copay If you have outpatient surgery Facility fee (e.g., ambulatory surgery center) 20% coinsurance 40% coinsurance Payment increases for non-BCBSM Physician/surgeon fees 20% coinsurance 40% coinsurance Payment increases for non-BCBSM If you need immediate medical attention Emergency room services $150 copay/visit $150 copay/visit Waived if admitted to hospital Emergency medical transportation 20% coinsurance 40% coinsurance Payment increases for non-BCBSM Urgent care $30 copay/visit 40% coinsurance Payment increases for non-BCBSM If you have a hospital stay Facility fee (e.g., hospital room) 20% coinsurance 40% coinsurance Payment increases for non-BCBSM Physician/surgeon fee 20% coinsurance 40%coinsurance Payment increases for non-BCBSM If you have mental health, behavioral health, or substance abuse needs Mental/Behavioral health outpatient services 20% coinsurance 40% coinsurance Payment increases for non-BCBSM Mental/Behavioral health inpatient services 20% coinsurance 40% coinsurance Payment increases for non-BCBSM Substance use disorder outpatient services 20% coinsurance 40% coinsurance Payment increases for non-BCBSM Substance use disorder inpatient services 20% coinsurance 40% coinsurance Payment increases for non-BCBSM If you are pregnant Prenatal and May 1postnatal care 100% covered 40% coinsurance Payment increases for non-BCBSM Delivery and all inpatient services 20% coinsurance 40% coinsurance Payment increases for non-BCBSM If you need help recovering or have other special health needs Home health care 20% coinsurance 20% coinsurance Payment increases for non-BCBSM Rehabilitation services 20% coinsurance 40% coinsurance 60 visits per calendar year Habilitation services 20% coinsurance 40% coinsurance Payment increases for non-BCBSM Skilled nursing care 20% coinsurance 20% coinsurance 120 days per calendar year Durable medical equipment 20% coinsurance 20% coinsurance Hospice service 100% covered 100% covered Four 90-day periods If your child needs dental or eye care Eye exam Not covered Not Covered Glasses Not covered Not Covered Dental check-up Not covered Not Covered Services Your Plan Does NOT Cover (This isn’t a complete list. Check your policy or plan document for otherexcluded services.) Cosmetic surgery Long-term care Routine eye care (Adult) Certain Experimental Medicine Non-emergency care when traveling outside the U.S. Elective procedures that are not medically necessary Organ transplants Chiropractic care Voluntary sterilization Federal and State laws may provide protections that allow you to keep this health insurance coverage as long as you pay your premium. There are exceptions, 2007 may at any time voluntarily elect to participate however, such as if: You commit fraud The insurer stops offering services in the Clinton Township Police State You move outside the coverage area For more information on your rights to continue coverage, contact the insurer at [contact number]. You may also contact your state insurance department at [insert applicable State Department of Insurance contact information]. If you lose coverage under the plan, then, depending upon the circumstances, Federal and Fire Retirement System Deferred Retirement Option Plan (hereinafter “DROP”) after attaining State laws may provide protections that allow you to keep health coverage. Any such rights may be OR limited in duration and will require you to pay a premium, which may be significantly higher than the minimum requirements for a normal service retirement/pensionpremium you pay while covered under the plan. Upon commencement of DROP participationOther limitations on your rights to continue coverage may also apply. For more information on your rights to continue coverage, contact the plan at [contact number]. You may also contact your state insurance department, the Participant’s DROP Benefit shall be U.S. Department of Labor, Employee Benefits Security Administration at ▇-▇▇▇-▇▇▇-▇▇▇▇ or ▇▇▇.▇▇▇.▇▇▇/▇▇▇▇, or the dollar amount U.S. Department of the member’s monthly pension benefit computed by using the contractual guidelines Health and formula(s) that are in effect on the DROP date. During participation in the DROP, the Participant continues with full employment status and receives all future promotions and benefit/wage increases. The Participant’s DROP Benefit shall be credited monthly to the Participant’s DROP Account which shall be established within the Defined Benefit Plan of the Clinton Township Fire and Police Retirement System (the “Fire and Police Retirement System” Human Services at ▇-▇▇▇-▇▇▇-▇▇▇▇ ▇▇▇▇▇▇ or “Plan”). The Participant’s DROP Account shall be maintained and managed by the Board of Trustees of the Fire and Police Retirement System (the “Retirement Board”). Upon termination of employment, the retiree shall begin to receive payment(s) from his/her individual DROP Account as described herein. The DROP payment(s) are in addition to all other contractual pension benefits. The Participant is solely responsible for analyzing the tax consequences of participation in the DROP▇▇▇.▇▇▇▇▇.▇▇▇.▇▇▇.
Appears in 1 contract
Sources: Collective Bargaining Agreement
Stipulations. The parties agree to the following stipulations:
1. Employees may elect this option at any time.
2. The supplemental pay will begin with the first pay date in the month that insurance coverage ceases. There will be no retroactive payments.
3. Employees may elect to reinstate their health insurance coverage and drop the supplemental pay plan at the annual health insurance open enrollment. If an employee wishes to reinstate their health insurance coverage at any other time, they may do so only if the reinstatement is due to loss of coverage as a result of the death of, divorce from, or loss of coverage due to the unemployment of the individual covering the employee under another plan.
4. Those persons who are eligible for hospital/medical insurance at the inception of this agreement but who have elected not to be insured by the Township plan because they are covered by another plan, will be eligible for this option.
5. In those cases where both a husband and wife work for the Township, one person may carry his/her spouse and dependents on the health insurance policy and the other person may elect the supplemental pay plan.
6. When an employee elects to drop his/her insurance coverage, he/she must drop it for him/her self and all dependents. (e.g. A parent cannot drop insurance for him/her self and retain coverage for his/her children).
7. The Provisions of this plan which pertain to adding or dropping insurance coverage are subject to the administrative rules of the insurance carriers for the Township. WAIVER OF MEDICAL INSURANCE AND ELECTION OF SUPPLEMENTAL PAY IN LIEU OF PARTICIPATION IN GROUP MEDICAL INSURANCE I hereby authorize the Charter Township of Clinton to cancel my group medical plan if I currently have group coverage and provide supplemental pay to me of $100 100.00 per pay in lieu of participation in any Township group medical plan. I affirm that I am covered by the health plan coverage offered through: I understand that by exercising the election to receive these payments, I will receive no benefits or payments as primary subscriber from any Township group medical plan. I understand that except in the case of death, divorce from, or lost of coverage due to the unemployment of the individual covering me under another plan, I will not be eligible for enrollment in any of Clinton Township’s group medical plans until the next open enrollment period. I understand that if I wish to enroll in any if Clinton Township’s group medical plans at a later date, I will be subject to that plan’s enrollment rules. NAME (PLEASE PRINT) SIGNATURE DATE DEPARTMENT NAME SOCIAL SECURITY NUMBER *If covered elsewhere, you must provide written proof of other coverage.
A. OVERVIEW Effective April 1, 2001, any Captain who . Important Questions Answers Why this Matters: What is a member of or promoted the overall deductible? $500 person / $1,000 family Doesn’t apply to preventive care You must pay all the costs up to the Clinton Township Police Captain’s bargaining group deductible amount before this plan begins to pay for covered services you use. Check your policy or plan document to see when the deductible starts over (hereinafter “Captains”usually, but not always, January 1st). See the chart starting on page 2 for how much you pay for covered services after you meet the deductible. Are there other deductibles for specific services? There are deductibles for services received by out-of- network providers. $1,000 person / $2,000 family You must pay all of the costs for these services up to the specific deductible amount before this plan begins to pay for these services. Is there an out–of– pocket limit on my expenses? Yes. $2,000 person / $4,000 family for services received by in-network providers. The out-of-pocket limit is the most you could pay during a coverage period (usually one year) between April 1, 2001 and May 1, 2007 may at any time voluntarily elect to participate for your share of the cost of covered services. This limit helps you plan for health care expenses. Higher out-of-pocket limits exist for services received by out-of-network providers. What is not included in the Clinton Township Police out–of–pocket limit? Copays, Premiums, balance- billed charges, and Fire Retirement System Deferred Retirement Option Plan (hereinafter “DROP”) after attaining health care this plan doesn’t cover. Even though you pay these expenses, they don’t count toward the minimum requirements out-of-pocket limit. Total out-of-pocket limit including copays is $6,350 person / $12,700 family. Is there an overall annual limit on what the plan pays? No. The chart starting on page 2 describes any limits on what the plan will pay for specific covered services, such as office visits. Does this plan use a network of providers? Yes. See ▇▇▇.▇▇▇▇▇.▇▇▇ for a normal service retirement/pensionlist of participating providers. Upon commencement of DROP participationIf you use an in-network doctor or other health care provider, the Participant’s DROP Benefit shall be the dollar amount this plan will pay some or all of the membercosts of covered services. Be aware, your in-network doctor or hospital may use an out-of-network provider for some services. Plans use the term in-network, preferred, or participating for providers in their network. See the chart starting on page 2 for how this plan pays different kinds of providers. Do I need a referral to see a specialist? No. You don’t need a referral to see a specialist. You can see the specialist you choose without permission from this plan. Are there services this plan doesn’t cover? Yes. Some of the services this plan doesn’t cover are listed on page 4. See your policy or plan document for additional information about excluded services. • Copayments are fixed dollar amounts (for example, $10) you pay for covered health care, usually when you receive the service. • Coinsurance is your share of the costs of a covered service, calculated as a percent of the allowed amount for the service. For example, if the plan’s monthly pension benefit computed allowed amount for an overnight hospital stay is $1,000, your coinsurance payment of 20% would be $200. This may change if you haven’t met your deductible. • The amount the plan pays for covered services is based on the allowed amount. If an out-of-network provider charges more than the allowed amount, you may have to pay the difference. For example, if an out-of-network hospital charges $1,500 for an overnight stay and the allowed amount is $1,000, you may have to pay the $500 difference. (This is called balance billing.) • This plan may encourage you to use participating providers by using charging you lower deductibles, copayments and coinsurance amounts. Common Medical Event Services You May Need Your Cost If You Use a Participating Provider Your Cost If You Use a Non- Participating Provider Limitations & Exceptions If you visit a health care provider’s office or clinic Primary care visit to treat an injury or illness $20 copay/visit 40% coinsurance Specialist visit $20 copay/visit 40% coinsurance Other practitioner office visit $20 copay/visit 40% coinsurance Preventive care/screening/immunization No charge Not covered Not covered for non-BCBSM If you have a test Diagnostic test (x-ray, blood work) 20% coinsurance 40% coinsurance Payment increases for non-BCBSM Imaging (CT/PET scans, MRIs) 20% coinsurance 40% coinsurance Payment increases for non-BCBSM If you need drugs to treat your illness or condition More information about prescription drug coverage is available at ▇▇▇.▇▇▇▇▇.▇▇▇ Generic drugs $15 copay $15 copay + 25% Covers up to a 30-day supply (retail prescription); 31-90 day supply (mail order prescription) 2x copay Preferred brand drugs $30 copay $30 copay + 25% Covers up to a 30-day supply (retail prescription); 31-90 day supply (mail order prescription) 2x copay Non-preferred brand drugs $60 copay $60 copay + 25% Covers up to a 30-day supply (retail prescription); 31-90 day supply (mail order prescription) 2x copay Specialty drugs $60 copay Not covered Covers up to a 30-day supply (retail prescription); 31-90 day supply (mail order prescription) 2x copay If you have outpatient surgery Facility fee (e.g., ambulatory surgery center) 20% coinsurance 40% coinsurance Payment increases for non-BCBSM Physician/surgeon fees 20% coinsurance 40% coinsurance Payment increases for non-BCBSM If you need immediate medical attention Emergency room services $100 copay/visit $100 copay/visit Waived if admitted to hospital Emergency medical transportation 20% coinsurance 40% coinsurance Payment increases for non-BCBSM Urgent care $20 copay/visit 40% coinsurance Payment increases for non-BCBSM If you have a hospital stay Facility fee (e.g., hospital room) 20% coinsurance 40% coinsurance Payment increases for non-BCBSM Physician/surgeon fee 20% coinsurance 40% coinsurance Payment increases for non-BCBSM If you have mental health, behavioral health, or substance abuse needs Mental/Behavioral health outpatient services 20% coinsurance 40% coinsurance Payment increases for non-BCBSM Mental/Behavioral health inpatient services 20% coinsurance 40% coinsurance Payment increases for non-BCBSM Substance use disorder outpatient services 20% coinsurance 40% coinsurance Payment increases for non-BCBSM Substance use disorder inpatient services 20% coinsurance 40% coinsurance Payment increases for non-BCBSM If you are pregnant Prenatal and postnatal care 100% covered 40% coinsurance Payment increases for non-BCBSM Delivery and all inpatient services 20% coinsurance 40% coinsurance Payment increases for non-BCBSM If you need help recovering or have other special health needs Home health care 20% coinsurance 20% coinsurance Payment increases for non-BCBSM Rehabilitation services 20% coinsurance 40% coinsurance 60 visits per calendar year Habilitation services 20% coinsurance 40% coinsurance Payment increases for non-BCBSM Skilled nursing care 20% coinsurance 20% coinsurance 120 days per calendar year Durable medical equipment 20% coinsurance 20% coinsurance Hospice service 100% covered 100% covered Four 90-day periods If your child needs dental or eye care Eye exam Not covered Not Covered Glasses Not covered Not Covered Dental check-up Not covered Not Covered Services Your Plan Does NOT Cover (This isn’t a complete list. Check your policy or plan document for other excluded services.) • Cosmetic surgery • Certain Experimental Medicine • Long-term care • Non-emergency care when traveling outside the contractual guidelines and formula(sU.S. • Routine eye care (Adult) • Elective procedures that are in effect on the DROP date. During participation in the DROP, the Participant continues with full employment status and receives all future promotions and benefit/wage increases. The Participant’s DROP Benefit shall be credited monthly to the Participant’s DROP Account which shall be established within the Defined Benefit Plan of the Clinton Township Fire and Police Retirement System (the “Fire and Police Retirement System” or “Plan”). The Participant’s DROP Account shall be maintained and managed by the Board of Trustees of the Fire and Police Retirement System (the “Retirement Board”). Upon termination of employment, the retiree shall begin to receive payment(s) from his/her individual DROP Account as described herein. The DROP payment(s) are in addition to all other contractual pension benefits. The Participant is solely responsible for analyzing the tax consequences of participation in the DROP.not medically necessary • Voluntary sterilization • Chiropractic care • Organ transplants
Appears in 1 contract
Stipulations. The parties agree to the following stipulations:
1. Employees may elect this option at any time.
2. The supplemental pay will begin with the first pay date in the month that insurance coverage ceases. There will be no retroactive payments.
3. Employees may elect to reinstate their health insurance coverage and drop the supplemental pay plan at the annual health insurance open enrollment. If an employee wishes to reinstate their health insurance coverage at any other time, they may do so only if the reinstatement is due to loss of coverage as a result of the death of, divorce from, or loss of coverage due to the unemployment of the individual covering the employee under another plan.
4. Those persons who are eligible for hospital/medical insurance at the inception of this agreement but who have elected not to be insured by the Township plan because they are covered by another plan, will be eligible for this option.
5. In those cases where both a husband and husband-and-wife work for the Township, one person may carry his/her spouse and dependents on the health insurance policy and the other person may elect the supplemental pay plan.
6. When an employee elects to drop his/her insurance coverage, he/she must drop it for him/her self herself and all dependents. (e.g. e.g., A parent cannot drop insurance for him/her self herself and retain coverage for his/her children).
7. The Provisions of this plan which pertain to adding or dropping insurance coverage are subject to the administrative rules of the insurance carriers for the Township. WAIVER OF MEDICAL INSURANCE AND ELECTION OF SUPPLEMENTAL PAY IN LIEU OF PARTICIPATION IN GROUP MEDICAL INSURANCE I hereby authorize the Charter Township of Clinton to cancel my group medical plan if I currently have group coverage and provide supplemental pay to me of $100 100.00 per pay in lieu of participation in any Township group medical plan. I affirm that I am covered by the health plan coverage offered through: I understand that by exercising the election to receive these payments, I will receive no benefits or payments as primary subscriber from any Township group medical plan. I understand that except in the case of death, divorce from, or lost of coverage due to the unemployment of the individual covering me under another plan, I will not be eligible for enrollment in any of Clinton Township’s group medical plans until the next open enrollment period. I understand that if I wish to enroll in any if Clinton Township’s group medical plans at a later date, I will be subject to that plan’s enrollment rules. NAME (PLEASE PRINT) SIGNATURE DATE DEPARTMENT NAME SOCIAL SECURITY NUMBER *If covered elsewhere, you must provide written proof of other coverage.
A. OVERVIEW Effective April 1. Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2021 – 12/31/2021 Charter Township of Clinton Employee and Retiree Benefit Plan: ONTARIO 048 Coverage for: Single + Family | Plan Type: POS The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately. This is only a summary. For more information about your coverage, 2001, any Captain who is or to get a member of or promoted to the Clinton Township Police Captain’s bargaining group (hereinafter “Captains”) between April 1, 2001 and May 1, 2007 may at any time voluntarily elect to participate in the Clinton Township Police and Fire Retirement System Deferred Retirement Option Plan (hereinafter “DROP”) after attaining the minimum requirements for a normal service retirement/pension. Upon commencement of DROP participation, the Participant’s DROP Benefit shall be the dollar amount copy of the member’s monthly pension benefit computed by using complete terms of coverage, go to ▇▇▇▇▇://▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇▇▇▇▇▇.▇▇▇ or call (▇▇▇) ▇▇▇-▇▇▇▇. For general definitions of common terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other underlined terms see the contractual guidelines and formula(sGlossary. You can view the Glossary at ▇▇▇.▇▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇-▇▇▇▇▇▇▇▇ or call Care Coordinators at (▇▇▇) that are in effect on the DROP date. During participation in the DROP, the Participant continues with full employment status and receives all future promotions and benefit/wage increases. The Participant’s DROP Benefit shall be credited monthly ▇▇▇-▇▇▇▇ to the Participant’s DROP Account which shall be established within the Defined Benefit Plan of the Clinton Township Fire and Police Retirement System (the “Fire and Police Retirement System” or “Plan”). The Participant’s DROP Account shall be maintained and managed by the Board of Trustees of the Fire and Police Retirement System (the “Retirement Board”). Upon termination of employment, the retiree shall begin to receive payment(s) from his/her individual DROP Account as described herein. The DROP payment(s) are in addition to all other contractual pension benefits. The Participant is solely responsible for analyzing the tax consequences of participation in the DROPrequest a copy.
Appears in 1 contract
Sources: Contract Between the Charter Township of Clinton and the Clinton Township Deputy Fire Chiefs
Stipulations. The parties agree to the following stipulations:
1. Employees may elect this option at any timeopen enrollment.
2. The supplemental pay will begin with the first pay date in the month that insurance coverage ceases. There will be no retroactive payments.
3. Employees may elect to reinstate their health insurance coverage and drop the supplemental pay plan at the annual health insurance open enrollment. If an employee wishes to reinstate their health insurance coverage at any other time, they may do so only if the reinstatement is due to loss of coverage as a result of the death of, divorce from, or loss of coverage due to the unemployment of the individual covering the employee under another plan.
4. Those persons who are eligible for hospital/medical insurance at the inception of this agreement but who have elected not to be insured by the Township plan because they are covered by another plan, will be eligible for this option.
5. In those cases where both a husband and wife work for the Township, one person may carry his/her spouse and dependents on the health insurance policy and the other person may elect the supplemental pay plan.
6. When an employee elects to drop his/her insurance coverage, he/she must drop it for him/her self and all dependents. (e.g. A parent cannot drop insurance for him/her self and retain coverage for his/her children).
7. The Provisions of this plan which pertain to adding or dropping insurance coverage are subject to the administrative rules of the insurance carriers for the TownshipTownship and Section 125 of the Internal Revenue Code. I hereby authorize the Charter Township of Clinton to cancel my group medical plan if I currently have group coverage and provide supplemental pay to me of $100 per pay in lieu of participation in any Township group medical plan. I affirm that I am covered by the health plan coverage offered through: I understand that by exercising the election to receive these payments, I will receive no benefits or payments as primary subscriber from any Township group medical plan. I understand that except in the case of death, divorce from, or lost of coverage due to the unemployment of the individual covering me under another plan, I will not be eligible for enrollment in any of Clinton Township’s group medical plans until the next open enrollment period. I understand that if I wish to enroll in any if Clinton Township’s group medical plans at a later date, I will be subject to that plan’s enrollment rules. NAME (PLEASE PRINT) SIGNATURE DATE DEPARTMENT NAME SOCIAL SECURITY NUMBER *If covered elsewhere, you must provide written proof of other coverage.
A. OVERVIEW Effective April 1, 2001, any Captain who is a member of or promoted to the Clinton Township Police Captain’s bargaining group (hereinafter “Captains”) between April 1, 2001 and May 1, 2007 may at any time voluntarily elect to participate in the Clinton Township Police and Fire Retirement System Deferred Retirement Option Plan (hereinafter “DROP”) after attaining the minimum requirements for a normal service retirement/pension. Upon commencement of DROP participation, the Participant’s DROP Benefit shall be the dollar amount of the member’s monthly pension benefit computed by using the contractual guidelines and formula(s) that are in effect on the DROP date. During participation in the DROP, the Participant continues with full employment status and receives all future promotions and benefit/wage increases. The Participant’s DROP Benefit shall be credited monthly to the Participant’s DROP Account which shall be established within the Defined Benefit Plan of the Clinton Township Fire and Police Retirement System (the “Fire and Police Retirement System” or “Plan”). The Participant’s DROP Account shall be maintained and managed by the Board of Trustees of the Fire and Police Retirement System (the “Retirement Board”). Upon termination of employment, the retiree shall begin to receive payment(s) from his/her individual DROP Account as described herein. The DROP payment(s) are in addition to all other contractual pension benefits. The Participant is solely responsible for analyzing the tax consequences of participation in the DROP.
Appears in 1 contract
Sources: Collective Bargaining Agreement
Stipulations. The parties agree to the following stipulations:
1. Employees may elect this option at any timeopen enrollment.
2. The supplemental pay will begin with the first pay date in the month that insurance coverage ceases. There will be no retroactive payments.
3. Employees may elect to reinstate their health insurance coverage and drop the supplemental pay plan at the annual health insurance open enrollment. If an employee wishes to reinstate their health insurance coverage at any other time, they may do so only if the reinstatement is due to loss of coverage as a result of the death of, divorce from, or loss of coverage due to the unemployment of the individual covering the employee under another plan.
4. Those persons who are eligible for hospital/medical insurance at the inception of this agreement but who have elected not to be insured by the Township plan because they are covered by another plan, will be eligible for this option.
5. In those cases where both a husband and wife work for the Township, one person may carry his/her spouse and dependents on the health insurance policy and the other person may elect the supplemental pay plan.
6. When an employee elects to drop his/her insurance coverage, he/she must drop it for him/her self and all dependents. (e.g. A parent cannot drop insurance for him/her self and retain coverage for his/her children).
7. The Provisions of this plan which pertain to adding or dropping insurance coverage are subject to the administrative rules of the insurance carriers for the TownshipTownship and Section 125 of the Internal Revenue Code. I hereby authorize the Charter Township of Clinton to cancel my group medical plan if I currently have group coverage and provide supplemental pay to me of $100 per pay in lieu of participation in any Township group medical plan. I affirm that I am covered by the health plan coverage offered through: I understand that by exercising the election to receive these payments, I will receive no benefits or payments as primary subscriber from any Township group medical plan. I understand that except in the case of death, divorce from, or lost of coverage due to the unemployment of the individual covering me under another plan, I will not be eligible for enrollment in any of Clinton Township’s group medical plans until the next open enrollment period. I understand that if I wish to enroll in any if Clinton Township’s group medical plans at a later date, I will be subject to that plan’s enrollment rules. NAME (PLEASE PRINT) SIGNATURE DATE DEPARTMENT NAME SOCIAL SECURITY NUMBER *If covered elsewhere, you must provide written proof of other coverage.
A. OVERVIEW Effective April 1, 2001, any Captain who is a member of or promoted to the Clinton Township Police Captain’s bargaining group (hereinafter “Captains”) between April 1, 2001 and May 1, 2007 may at any time voluntarily elect to participate in the Clinton Township Police and Fire Retirement System Deferred Retirement Option Plan (hereinafter “DROP”) after attaining the minimum requirements for a normal service retirement/pension. Upon commencement of DROP participation, the Participant’s DROP Benefit shall be the dollar amount of the member’s monthly pension benefit computed by using the contractual guidelines and formula(s) that are in effect on the DROP date. During participation in the DROP, the Participant continues with full employment status and receives all future promotions and benefit/wage increases. The Participant’s DROP Benefit shall be credited monthly to the Participant’s DROP Account which shall be established within the Defined Benefit Plan of the Clinton Township Fire and Police Retirement System (the “Fire and Police Retirement System” or “Plan”). The Participant’s DROP Account shall be maintained and managed by the Board of Trustees of the Fire and Police Retirement System (the “Retirement Board”). Upon termination of employment, the retiree shall begin to receive payment(s) from his/her individual DROP Account as described herein. The DROP payment(s) are in addition to all other contractual pension benefits. The Participant is solely responsible for analyzing the tax consequences of participation in the DROP.
Appears in 1 contract
Sources: Collective Bargaining Agreement
Stipulations. The parties agree to the following stipulations:
1. Employees may elect this option at any time.
2. The supplemental pay will begin with the first pay date in the month that insurance coverage ceases. There will be no retroactive retro- active payments.
3. Employees may elect to reinstate their health insurance coverage and drop the supplemental pay plan at the annual health insurance open enrollment. If an employee wishes to reinstate their health insurance coverage at any other time, they may do so only if the reinstatement is due to loss of coverage as a result of the death of, divorce from, or loss of coverage due to the unemployment of the individual covering the employee under another plan.
4. Those persons who are eligible for hospital/medical insurance at the inception of this agreement Agreement but who have elected not to be insured by the Township plan because they are covered by another plan, will be eligible for this option.
5. In those cases where both a husband and wife work for the Township, one person may carry his/his or her spouse and dependents on the health insurance policy and the other person may elect the supplemental pay plan.
6. When an employee elects to drop his/his or her insurance coverage, he/he or she must drop it for him/her self herself and all dependents. (e.g. A parent cannot drop insurance for him/her self and retain coverage for his/his or her children).
7. The Provisions of this plan which pertain to adding or dropping insurance coverage coverages are subject to the administrative rules of the insurance carriers for the Township. I In hereby authorize the Charter Township of Clinton to cancel my group medical plan if I currently have group coverage and provide supplemental pay to me of $100 per pay in lieu of participation in any Township group medical plan. I affirm that I am covered by the health plan coverage offered through: I understand that by exercising the election to receive these payments, I will receive no benefits or payments as primary subscriber from any Township group medical plan. I understand that except in the case of death, divorce from, or lost loss of coverage due to the unemployment of the individual covering me under another plan, I will not be eligible for enrollment in any of Clinton Township’s group medical plans until the next open enrollment period. I understand that if I wish to enroll in any if of Clinton Township’s group medical plans at a later date, I will be subject to that the plan’s enrollment rules. NAME Name (PLEASE PRINT) SIGNATURE DATE DEPARTMENT NAME SOCIAL SECURITY NUMBER *NUMER * If covered elsewhere, you must provide written proof of other coverage.
A. OVERVIEW Effective April 1. Both parties hereby agree that Article XXXVIII and Article XXXIX of the Collective Bargaining Agreement is clarified as followed: Employees being interviewed, 2001solely for internal investigative purposes, and who are ordered to make a statement as a condition of employment, shall only be advised of their ▇▇▇▇▇▇▇ Rights. POLICE OFFICERS ASSOCIATION OF MICHIGAN CLINTON TOWNSHIP CLINTON TOWNSHIP POLICE OFFICES ASSOCIATION ▇▇▇▇▇▇ ▇▇▇▇▇▇▇, President Health Alliance Plan of Michigan Health Maintenance Organization (HMO) Plan Summary of Benefits for APPENDIX "C" Benefit Period: Calendar Year Annual Deductible None Co-insurance (amount member pays) None Annual Co-insurance Maximum NA Preventive Office Visit / Physical Exam Covered Well Baby Office Visit Covered Covered up to 24 months Routine Hearing Exam Covered Routine Eye Exam Covered Immunizations Covered Related Laboratory and Radiology Services Covered Pap Smears and Mammograms Covered Personal Care Physician Office Visit Covered Specialty Physician Office Visit Covered Gynecology Office Visit Covered Audiology Office Visit Covered Eye Exam Office Visit Covered Allergy Treatment and Injections Covered Laboratory and Radiology Services Covered Dialysis Covered Chemotherapy Covered Radiation Therapy Covered Outpatient Surgery Covered Chiropractic Office Visit and Related Services Not Covered Emergency Room Services Covered Urgent Care Facility Services Covered Emergency Ambulance Services Covered Emergency transport only Hospital Inpatient Stay in Semi-Private Room, Specialty Units as medically necessary, Physician Services, Surgery, Therapy, Laboratory, Radiology, Hospital Services and Supplies Covered Bariatric Surgery & Related Services $1,000 Copay One procedure per lifetime Initial Prenatal Office Visit Covered Subsequent Prenatal and Postnatal Office Visits Covered Labor, Delivery and Newborn Care Covered Inpatient Services Covered Outpatient Services Covered Inpatient Services Covered Outpatient Services Covered Home Health Care Covered See PT/OT/ST Coverage Hospice Care Covered Up to 210 days per lifetime Skilled Nursing Care Covered Covered for authorized services - Up to 730 days, renewable after 60 days Durable Medical Equipment; Prosthetic & Orthotics Covered Coverage provided for approved equipment based on HAP's guidelines Hearing Aid Hardware Covered Covered for authorized equipment Vision Hardware Covered One pair every 24 months, or 12 months with prescription change. The coverage is limited to STANDARD (basic) lenses and the amount is limited to $40 for frames. Contact lenses in place of eyeglasses are covered with a limitation of $80. Contact lense fitting is not covered Physical, Occupational, and Speech Therapy (PT/OT/ST) Covered Up to 60 combined visits per benefit period - May be rendered at home Voluntary Sterilizations Covered Voluntary Termination of Pregnancy Not Covered Infertility Services Covered Services for diagnosis, counseling, and treatment of anatomical disorders causing infertility in accordance with HAP’s benefit, referral and practice policies Assisted Reproductive Technologies Covered One attempt of artificial insemination per lifetime Pharmacy: Generic and Brand $2 Copay Retail: 35 day supply for non-maintenance drugs at one Copay; 35 day supply or 100 doses, whichever is greater, for eligible maintenance drugs at 1 Copay Mail Order: 90 day supply of non-maintenance drugs at 3 Copays less $5.00; 90 day supply of eligible maintenance drugs at 1 Copay * Hospital admissions require that HAP be notified within 48 hours of admission. Failure to notify HAP within 48 hours could result in a reduction of benefits, or nonpayment. * Students away at school are covered for acute illness and injury related services according to HAP criteria. Students away at school are not covered for routine physicals, non-emergency psychiatric care, elective surgeries, obstetrical care, sports medicine and vision care services while at school. * In cases of conflict between this summary and your HMO Subscriber Contract, the terms and conditions of the HMO Subscriber Contract govern. * Your employer may have determined that your benefit plan may or may not be grandfathered under health care reform legislation. If you have questions regarding grandfathering, please check with your employer. Rev 04/2011 APPENDIX "D" This is intended as an easy-to-read summary and provides only a general overview of your benefits. It is not a contract. Additional limitations and exclusions may apply to covered services. For a complete description of benefits, please see the applicable Blue Cross Blue Shield of Michigan certificates and riders. Payment amounts are based on the Blue Cross Blue Shield of Michigan approved amount, less any Captain who applicable deductible and/or copay amounts required by your plan. This coverage is provided pursuant to a member contract entered into in the state of or promoted Michigan and will be construed under the jurisdiction of and according to the Clinton Township Police Captain’s bargaining group (hereinafter “Captains”) between April 1, 2001 and May 1, 2007 may at any time voluntarily elect to participate in the Clinton Township Police and Fire Retirement System Deferred Retirement Option Plan (hereinafter “DROP”) after attaining the minimum requirements for a normal service retirement/pension. Upon commencement of DROP participation, the Participant’s DROP Benefit shall be the dollar amount laws of the state of Michigan. Deductibles None $250 for one member’s monthly pension benefit computed by using , $500 for the contractual guidelines family (when two or more members are covered under your contract) each calendar year Copays • $10 copay for office visits • $50 copay for emergency room visits $50 copay for emergency room visits • Fixed dollar copays • Percent copays 50% of approved amount for private duty nursing • 50% of approved amount for private duty nursing • 20% of approved amount for most other covered services See “Mental health care and formula(ssubstance abuse treatment” section for mental health and substance abuse percent copay amounts. See “Mental health care and substance abuse treatment” section for mental health and substance abuse percent copay amounts. Copay dollar maximums Not applicable $2,000 for one member, $4,000 for two or more members each calendar year • Percent copay maximums – includes general medical only – excludes fixed dollar copays and mental health care, substance abuse treatment and private duty nursing percent copays • For groups of 51 or more employees (including seasonal and part-time) that are in effect on the DROP date. During participation in the DROP, the Participant continues with full employment status and receives all future promotions and benefit/wage increases. The Participant’s DROP Benefit shall be credited monthly subject to the Participant’s DROP Account which shall be established within the Defined Benefit Plan MHP law, copays for mental health care and substance abuse treatment are subject to a separate copay maximum Not applicable $2,000 for one member, $4,000 for two or more members each calendar year Dollar maximums $1 million lifetime maximum per covered specified human organ transplant type and a separate $5 million lifetime maximum per member for all other covered services and as noted for individual services Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Clinton Township Fire Blue Cross and Police Retirement System Blue Shield Association. APPENDIX "D" Preventive care services – *Payment for preventive services is limited to a combined maximum of $500 per member per calendar year Health maintenance exam – includes chest x-ray, EKG and select lab procedures Covered – 100%*, one per calendar year Not covered Gynecological exam Covered – 100%*, one per calendar year Not covered Pap smear screening – laboratory and pathology services Covered – 100%*, one per calendar year Not covered Well-baby and child care Covered – 100%* • 6 visits, birth through 12 months • 6 visits, 13 months through 23 months • 2 visits, 24 months through 35 months • 2 visits, 36 months through 47 months • 1 visit per birth year, 48 months through age 15 Not covered Childhood immunizations as recommended by the Advisory Committee on Immunization Practices and the American Academy of Pediatrics Covered – 100%* Not covered Fecal occult blood screening Covered – 100%*, one per calendar year Not covered Flexible sigmoidoscopy exam Covered – 100%*, one per calendar year Not covered Prostate specific antigen (PSA) screening Covered – 100%*, one per calendar year Not covered Mammography screening Covered – 100% Covered – 80% after deductible One per calendar year, no age restrictions Office visits Covered – $10 copay per office visit Covered – 80% after deductible, must be medically necessary Outpatient and home medical care visits Covered – 100% Covered – 80% after deductible, must be medically necessary Office consultations Covered – $10 copay per office visit Covered – 80% after deductible, must be medically necessary Urgent care visits Covered – $10 copay per office visit Covered – 80% after deductible, must be medically necessary Hospital emergency room Covered – $50 copay per visit (copay waived if admitted or for an accidental injury) Covered – $50 copay per visit (copay waived if admitted or for an accidental injury) Ambulance services – must be medically necessary Covered – 100% Covered – 100% Laboratory and pathology services Covered – 100% Covered – 80% after deductible Diagnostic tests and x-rays Covered – 100% Covered – 80% after deductible Therapeutic radiology Covered – 100% Covered – 80% after deductible Prenatal and postnatal care Covered – 100% Covered – 80% after deductible Includes care provided by a certified nurse midwife Delivery and nursery care Covered – 100% Covered – 80% after deductible Includes delivery provided by a certified nurse midwife APPENDIX "D" Semiprivate room, inpatient physician care, general nursing care, hospital services and supplies Note: Nonemergency services must be rendered in a participating hospital. Covered – 100% Covered – 80% after deductible Inpatient consultations Covered – 100% Covered – 80% after deductible Chemotherapy Covered – 100% Covered – 80% after deductible Skilled nursing care Covered – 100% Covered – 100% Up to 120 days per member per calendar year Hospice care Covered – 100% Covered – 100% Up to 28 pre-hospice counseling visits before electing hospice services; when elected, four 90-day periods – provided through a participating hospice program only; limited to dollar maximum that is reviewed and adjusted periodically Home health care – must be medically necessary Covered – 100% Covered – 100% Home infusion therapy – must be medically necessary Covered – 100% Covered – 100% Surgery – includes related surgical services and medically necessary facility services by a participating ambulatory surgery facility Covered – 100% Covered – 80% after deductible Presurgical consultations Covered – 100% Covered – 80% after deductible Colonoscopy Covered – 100% Covered – 80% after deductible Voluntary sterilization Covered – 100% Covered – 80% after deductible Specified human organ transplants – in designated facilities only, when coordinated through the BCBSM Human Organ Transplant Program (800-242-3504) Covered – 100% Covered – in designated facilities only Limited to $1 million lifetime maximum per member per transplant type for transplant procedure(s) and related professional, hospital and pharmacy services Bone marrow transplants – when coordinated through the BCBSM Human Organ Transplant Program (800-242-3504) Covered – 100% Covered – 80% after deductible Specified oncology clinical trials Covered – 100% Covered – 80% after deductible Kidney, cornea and skin transplants Covered – 100% Covered – 80% after deductible APPENDIX "D" Note: If your employer has 51 or more employees (including seasonal and part-time) and is subject to the MHP law, covered mental health care and substance abuse treatment are subject to the following copays. Your copays for mental health care and substance abuse treatment are subject to a separate, combined annual copay dollar maximum. See “Fire Copay dollar maximums” section for these amounts. If you are employed by a union group with a collective bargaining agreement, please contact your employer to determine if this benefit level applies to you. Inpatient mental health care Covered – 100% Covered – 80% after deductible Inpatient substance abuse treatment Covered – 100% Covered – 80% after deductible Outpatient mental health care Covered – 100% Covered – 80% after deductible • Facility and Police Retirement System” clinic • Physician’s office Covered – 100% Covered – 80% after deductible Outpatient substance abuse treatment – in approved facilities only Covered – 100% Covered – 80% after deductible Outpatient Diabetes Management Program (ODMP) Covered – 100% Covered – 80% after deductible Allergy testing and therapy Covered – 100% Covered – 80% after deductible Chiropractic manipulation treatment and osteopathic manipulation treatment Covered – $10 copay per office visit Covered – 80% after deductible Outpatient physical, speech and occupational therapy Covered – 100% Covered – 80% after deductible Limited to a combined maximum of 60 visits per member per calendar year Durable medical equipment Covered – 100% Covered – 100% Prosthetic and orthotic appliances Covered – 100% Covered – 100% Private duty nursing Covered – 50% Covered – 50% APPENDIX "D" Note: The mail order pharmacy for specialty drugs is Option Care, an independent company. Specialty prescription drugs (such as Enbrel® and Humira® ) are used to treat complex conditions such as rheumatoid arthritis. These drugs require special handling, administration or “Plan”monitoring. Option Care will handle mail order prescriptions only for specialty drugs while many retail pharmacies will continue to dispense specialty drugs (check with your local pharmacy for availability). The Participant’s DROP Account shall Other mail order prescription medications can continue to be maintained and managed by the Board sent to Medco. (Medco is an independent company providing pharmacy benefit services for Blue members.) A list of Trustees specialty drugs is available on our Web site at ▇▇▇▇▇.▇▇▇. Log in under “I am a Member.” If you have any questions, please call Option Care customer service at ▇▇▇-▇▇▇-▇▇▇▇. Generic prescription drugs $10 copay for each drug $10 copay for each drug plus 25% of the Fire and Police Retirement System (BCBSM approved amount for the “Retirement Board”). Upon termination drug Prescribed over-the-counter drugs – when covered by BCBSM $10 copay for each drug $10 copay for each drug plus 25% of employment, the retiree shall begin to receive payment(s) from his/her individual DROP Account as described herein. The DROP payment(s) are in addition to all other contractual pension benefits. The Participant is solely responsible BCBSM approved amount for analyzing the tax consequences of participation in the DROP.dru
Appears in 1 contract
Sources: Collective Bargaining Agreement
Stipulations. The parties agree to the following stipulations:
1. Employees may elect this option at any timeopen enrollment.
2. The supplemental pay will begin with the first pay date in the month that insurance coverage ceases. There will be no retroactive payments.
3. Employees may elect to reinstate their health insurance coverage and drop the supplemental pay plan at the annual health insurance open enrollment. If an employee wishes to reinstate their health insurance coverage at any other time, they may do so only if the reinstatement is due to loss of coverage as a result of the death of, divorce from, or loss of coverage due to the unemployment of the individual covering the employee under another plan.
4. Those persons who are eligible for hospital/medical insurance at the inception of this agreement but who have elected not to be insured by the Township plan because they are covered by another plan, will be eligible for this option.
5. In those cases where both a husband and wife work for the Township, one person may carry his/her spouse and dependents on the health insurance policy and the other person may elect the supplemental pay plan.
6. When an employee elects to drop his/her insurance coverage, he/she must drop it for him/her self and all dependents. (e.g. A parent cannot drop insurance for him/her self and retain coverage for his/her children).
7. The Provisions of this plan which pertain to adding or dropping insurance coverage are subject to the administrative rules of the insurance carriers for the TownshipTownship and Section 125 of the Internal Revenue Code. I hereby authorize the Charter Township of Clinton to cancel my group medical plan if I currently have group coverage and provide supplemental pay to me of $100 per pay in lieu of participation in any Township group medical plan. I affirm that I am covered by the health plan coverage offered through: I understand that by exercising the election to receive these payments, I will receive no benefits or payments as primary subscriber from any Township group medical plan. I understand that except in the case of death, divorce from, or lost of coverage due to the unemployment of the individual covering me under another plan, I will not be eligible for enrollment in any of Clinton Township’s group medical plans until the next open enrollment period. I understand that if I wish to enroll in any if Clinton Township’s group medical plans at a later date, I will be subject to that plan’s enrollment rules. NAME (PLEASE PRINT) SIGNATURE DATE DEPARTMENT NAME SOCIAL SECURITY NUMBER *If covered elsewhere, you must provide written proof of other coverage.
A. OVERVIEW Effective April 1. The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately. This is only a summary. For more information about your coverage, 2001, any Captain who is or to get a member of or promoted to the Clinton Township Police Captain’s bargaining group (hereinafter “Captains”) between April 1, 2001 and May 1, 2007 may at any time voluntarily elect to participate in the Clinton Township Police and Fire Retirement System Deferred Retirement Option Plan (hereinafter “DROP”) after attaining the minimum requirements for a normal service retirement/pension. Upon commencement of DROP participation, the Participant’s DROP Benefit shall be the dollar amount copy of the member’s monthly pension benefit computed by using complete terms of coverage, go to ▇▇▇▇▇://▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇▇▇▇▇▇.▇▇▇ or call (▇▇▇) ▇▇▇-▇▇▇▇. For general definitions of common terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other underlined terms see the contractual guidelines and formula(sGlossary. You can view the Glossary at ▇▇▇.▇▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇-▇▇▇▇▇▇▇▇ or call Care Coordinators at (▇▇▇) that are in effect on the DROP date. During participation in the DROP, the Participant continues with full employment status and receives all future promotions and benefit/wage increases. The Participant’s DROP Benefit shall be credited monthly ▇▇▇-▇▇▇▇ to the Participant’s DROP Account which shall be established within the Defined Benefit Plan of the Clinton Township Fire and Police Retirement System (the “Fire and Police Retirement System” or “Plan”). The Participant’s DROP Account shall be maintained and managed by the Board of Trustees of the Fire and Police Retirement System (the “Retirement Board”). Upon termination of employment, the retiree shall begin to receive payment(s) from his/her individual DROP Account as described herein. The DROP payment(s) are in addition to all other contractual pension benefits. The Participant is solely responsible for analyzing the tax consequences of participation in the DROPrequest a copy.
Appears in 1 contract
Sources: Collective Bargaining Agreement
Stipulations. The parties agree to the following stipulations:
1. Employees may elect this option at any timeopen enrollment.
2. The supplemental pay will begin with the first pay date in the month that insurance coverage ceases. There will be no retroactive payments.
3. Employees may elect to reinstate their health insurance coverage and drop the supplemental pay plan at the annual health insurance open enrollment. If an employee wishes to reinstate their health insurance coverage at any other time, they may do so only if the reinstatement is due to loss of coverage as a result of the death of, divorce from, or loss of coverage due to the unemployment of the individual covering the employee under another plan.
4. Those persons who are eligible for hospital/medical insurance at the inception of this agreement but who have elected not to be insured by the Township plan because they are covered by another plan, will be eligible for this option.
5. In those cases where both a husband and husband-and-wife work for the Township, one person may carry his/her spouse and dependents on the health insurance policy and the other person may elect the supplemental pay plan.
6. When an employee elects to drop his/her insurance coverage, he/she must drop it for him/her self herself and all dependents. (e.g. e.g., A parent cannot drop insurance for him/her self herself and retain coverage for his/her children).
7. The Provisions of this plan which pertain to adding or dropping insurance coverage are subject to the administrative rules of the insurance carriers for the TownshipTownship and Section 125 of the Internal Revenue Code. I hereby authorize the Charter Township of Clinton to cancel my group medical plan if I currently have group coverage and provide supplemental pay to me of $100 per pay in lieu of participation in any Township group medical plan. I affirm that I am covered by the health plan coverage offered through: I understand that by exercising the election to receive these payments, I will receive no benefits or payments as primary subscriber from any Township group medical plan. I understand that except in the case of death, divorce from, or lost loss of coverage due to the unemployment of the individual covering me under another plan, I will not be eligible for enrollment in any of Clinton Township’s group medical plans until the next open enrollment period. I understand that if I wish to enroll in any if of Clinton Township’s group medical plans at a later date, I will be subject to that plan’s enrollment rules. NAME (PLEASE PRINT) SIGNATURE DATE DEPARTMENT NAME SOCIAL SECURITY NUMBER *If covered elsewhere, you must provide written proof of other coverage.
A. OVERVIEW Effective April 1. The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately. This is only a summary. For more information about your coverage, 2001, any Captain who is or to get a member of or promoted to the Clinton Township Police Captain’s bargaining group (hereinafter “Captains”) between April 1, 2001 and May 1, 2007 may at any time voluntarily elect to participate in the Clinton Township Police and Fire Retirement System Deferred Retirement Option Plan (hereinafter “DROP”) after attaining the minimum requirements for a normal service retirement/pension. Upon commencement of DROP participation, the Participant’s DROP Benefit shall be the dollar amount copy of the member’s monthly pension benefit computed by using complete terms of coverage, go to ▇▇▇▇▇://▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇▇▇▇▇▇.▇▇▇ or call (▇▇▇) ▇▇▇-▇▇▇▇. For general definitions of common terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other underlined terms see the contractual guidelines and formula(sGlossary. You can view the Glossary at ▇▇▇.▇▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇-▇▇▇▇▇▇▇▇ or call Care Coordinators at (▇▇▇) that are in effect on the DROP date. During participation in the DROP, the Participant continues with full employment status and receives all future promotions and benefit/wage increases. The Participant’s DROP Benefit shall be credited monthly ▇▇▇-▇▇▇▇ to the Participant’s DROP Account which shall be established within the Defined Benefit Plan of the Clinton Township Fire and Police Retirement System (the “Fire and Police Retirement System” or “Plan”). The Participant’s DROP Account shall be maintained and managed by the Board of Trustees of the Fire and Police Retirement System (the “Retirement Board”). Upon termination of employment, the retiree shall begin to receive payment(s) from his/her individual DROP Account as described herein. The DROP payment(s) are in addition to all other contractual pension benefits. The Participant is solely responsible for analyzing the tax consequences of participation in the DROPrequest a copy.
Appears in 1 contract
Sources: Collective Bargaining Agreement
Stipulations. The parties agree to the following stipulations:
1. Employees may elect this option at any timeopen enrollment.
2. The supplemental pay will begin with the first pay date in the month that insurance coverage ceases. There will be no retroactive payments.
3. Employees may elect to reinstate their health insurance coverage and drop the supplemental pay plan at the annual health insurance open enrollment. If an employee wishes to reinstate their health insurance coverage at any other time, they may do so only if the reinstatement is due to loss of coverage as a result of the death of, divorce from, or loss of coverage due to the unemployment of the individual covering the employee under another plan.
4. Those persons who are eligible for hospital/medical insurance at the inception of this agreement but who have elected not to be insured by the Township plan because they are covered by another plan, will be eligible for this option.
5. In those cases where both a husband and wife work for the Township, one person may carry his/her spouse and dependents on the health insurance policy and the other person may elect the supplemental pay plan.
6. When an employee elects to drop his/her insurance coverage, he/she must drop it for him/her self and all dependents. (e.g. A parent cannot drop insurance for him/her self and retain coverage for his/her children).
7. The Provisions of this plan which pertain to adding or dropping insurance coverage are subject to the administrative rules of the insurance carriers for the TownshipTownship and Section 125 of the Internal Revenue Code. I hereby authorize the Charter Township of Clinton to cancel my group medical plan if I currently have group coverage and provide supplemental pay to me of $100 per pay in lieu of participation in any Township group medical plan. I affirm that I am covered by the health plan coverage offered through: (Name of Company or Carrier) I understand that by exercising the election to receive these payments, I will receive no benefits or payments as primary subscriber from any Township group medical plan. I understand that except in the case of death, divorce from, or lost loss of coverage due to the unemployment of the individual covering me under another plan, I will not be eligible for enrollment in any of Clinton Township’s 's group medical plans until the next open enrollment period. I understand that if I wish to enroll in any if Clinton Township’s 's group medical plans at a later date, I will be subject to that plan’s 's enrollment rules. NAME Name (PLEASE PRINT) SIGNATURE DATE DEPARTMENT NAME SOCIAL SECURITY NUMBER *If covered elsewhere, you must provide written proof of other coverage.
A. OVERVIEW Effective April 1. This is only a summary. If you want more detail about your coverage and costs, 2001, any Captain who you can get the complete terms in the policy or plan document by calling Human Resources at1-586-723-8072 Important Questions Answers Why this Matters: What is a member of or promoted the overall deductible? $1,000person / $2,000 family Doesn’t apply to preventive care You must pay all the costs up to the Clinton Township Police Captaindeductibleamount before thisplan begins to pay for covered services you use. Check your policy or plan document to see when the deductiblestarts over (usually, but not always, January 1st). See the chart starting on page 2 for how much you pay for covered services after you meet the deductible. Are there other deductibles for specific services? There are deductibles for services received by out-of- network providers. $2,000person / $4,000family You must pay all of the costs for these services up to the specific deductible amount before this plan begins to pay for these services. Is there an out–of– pocket limit on my expenses? Yes. $3,000person / $6,000family for services received by in-network providers. The out-of-pocket limitis the most you could pay during a coverage period (usually one year) for your share of the cost of covered services. This limit helps you plan for health care expenses. Higher out-of-pocket limits exist for services received by out-of-network providers. What is not included in theout–of–pocket limit? Premiums, balance-billed charges, and health care this plan doesn’t cover. Even though you pay these expenses, they don’t count toward the out-of-pocket limit. Is there an overall annual limit on what theplan pays? No. The chart starting on page 2 describes any limits on what the plan will pay for specific covered services, such as office visits. Does this plan use a network of providers? Yes. See ▇▇▇.▇▇▇▇▇.▇▇▇ for a list of participating providers. If you use an in-network doctor or other health care provider, thisplan will pay some or all of the costs of covered ▇▇▇▇▇▇▇▇.▇▇ aware, your in-network doctor or hospital may use an out-of-network provider for some services. Plans use the term in-network, preferred, or participatingfor providersin their network. See the chart starting on page 2 for how this plan pays different kinds of providers. Do I need a referral to see a specialist? No. You don’t need a referral to see a specialist. You can see the specialistyou choose without permission from this plan. Are there services this plan doesn’t cover? Yes. Some of the services thisplan doesn’t cover are listed on page 4. See your policy or plan document for additional information about excluded services. Copaymentsare fixed dollar amounts (for example, $10) you pay for covered health care, usually when you receive the service. Coinsuranceis your share of the costs of a covered service, calculated as a percent of the allowed amountfor the service. For example, if the plan’s bargaining group allowed amountfor an overnight hospital stay is $1,000, your coinsurancepayment of 20% would be $200. This may change if you haven’t met your deductible. The amount the plan pays for covered services is based on the allowed amount. If an out-of-networkprovidercharges more than the allowed amount, you may have to pay the difference. For example, if an out-of-network hospital charges $1,500 for an overnight stay and the allowed amountis $1,000, you may have to pay the $500 difference. (hereinafter “Captains”This is called balance billing.) between April 1 This plan may encourage you to use participating providersby charging you lower deductibles, 2001 copaymentsand coinsuranceamounts. Common Medical Event Services You May Need Your Cost If You Use a Participating Provider Your Cost If You Use a Non- Participating Provider Limitations & Exceptions If you visit a health care provider’s office or clinic Primary care visit to treat an injury or illness $30copay/visit 40% coinsurance Specialist visit $30copay/visit 40% coinsurance Other practitioner office visit $30 copay/visit 40% coinsurance Preventive care/screening/immunization No charge Not covered Not covered for non-BCBSM If you have a test Diagnostic test (x-ray, blood work) 20% coinsurance 40% coinsurance Payment increases for non-BCBSM Imaging (CT/PET scans, MRIs) 20% coinsurance 40% coinsurance Payment increases for non-BCBSM If you need drugs to treat your illness or condition More information about prescription drug coverageis available at ▇▇▇.▇▇▇▇▇.▇▇▇ Generic drugs $15 copay $15 copay + 25% Covers up to a 30-day supply (retail prescription); 31-90 day supply (mail order prescription) 2x copay Preferred brand drugs $30 copay $30 copay + 25% Covers up to a 30-day supply (retail prescription); 31-90 day supply (mail order prescription) 2x copay Non-preferred brand drugs $60 copay $60 copay + 25% Covers up to a 30-day supply (retail prescription); 31-90 day supply (mail order prescription) 2x copay Specialty drugs $60 copay Not covered Covers up to a 30-day supply (retail prescription); 31-90 day supply (mail order prescription) 2x copay If you have outpatient surgery Facility fee (e.g., ambulatory surgery center) 20% coinsurance 40% coinsurance Payment increases for non-BCBSM Physician/surgeon fees 20% coinsurance 40% coinsurance Payment increases for non-BCBSM If you need immediate medical attention Emergency room services $150 copay/visit $150 copay/visit Waived if admitted to hospital Emergency medical transportation 20% coinsurance 40% coinsurance Payment increases for non-BCBSM Urgent care $30 copay/visit 40% coinsurance Payment increases for non-BCBSM If you have a hospital stay Facility fee (e.g., hospital room) 20% coinsurance 40% coinsurance Payment increases for non-BCBSM Physician/surgeon fee 20% coinsurance 40%coinsurance Payment increases for non-BCBSM If you have mental health, behavioral health, or substance abuse needs Mental/Behavioral health outpatient services 20% coinsurance 40% coinsurance Payment increases for non-BCBSM Mental/Behavioral health inpatient services 20% coinsurance 40% coinsurance Payment increases for non-BCBSM Substance use disorder outpatient services 20% coinsurance 40% coinsurance Payment increases for non-BCBSM Substance use disorder inpatient services 20% coinsurance 40% coinsurance Payment increases for non-BCBSM If you are pregnant Prenatal and May 1postnatal care 100% covered 40% coinsurance Payment increases for non-BCBSM Delivery and all inpatient services 20% coinsurance 40% coinsurance Payment increases for non-BCBSM If you need help recovering or have other special health needs Home health care 20% coinsurance 20% coinsurance Payment increases for non-BCBSM Rehabilitation services 20% coinsurance 40% coinsurance 60 visits per calendar year Habilitation services 20% coinsurance 40% coinsurance Payment increases for non-BCBSM Skilled nursing care 20% coinsurance 20% coinsurance 120 days per calendar year Durable medical equipment 20% coinsurance 20% coinsurance Hospice service 100% covered 100% covered Four 90-day periods If your child needs dental or eye care Eye exam Not covered Not Covered Glasses Not covered Not Covered Dental check-up Not covered Not Covered Services Your Plan Does NOT Cover (This isn’t a complete list. Check your policy or plan document for otherexcluded services.) Cosmetic surgery Long-term care Routine eye care (Adult) Certain Experimental Medicine Non-emergency care when traveling outside the U.S. Elective procedures that are not medically necessary Organ transplants Chiropractic care Voluntary sterilization Federal and State laws may provide protections that allow you to keep this health insurance coverage as long as you pay your premium. There are exceptions, 2007 may at any time voluntarily elect to participate however, such as if: You commit fraud The insurer stops offering services in the Clinton Township Police State You move outside the coverage area For more information on your rights to continue coverage, contact the insurer at [contact number]. You may also contact your state insurance department at [insert applicable State Department of Insurance contact information]. If you lose coverage under the plan, then, depending upon the circumstances, Federal and Fire Retirement System Deferred Retirement Option Plan (hereinafter “DROP”) after attaining State laws may provide protections that allow you to keep health coverage. Any such rights may be OR limited in duration and will require you to pay a premium, which may be significantly higher than the minimum requirements for a normal service retirement/pensionpremium you pay while covered under the plan. Upon commencement of DROP participationOther limitations on your rights to continue coverage may also apply. For more information on your rights to continue coverage, contact the plan at [contact number]. You may also contact your state insurance department, the Participant’s DROP Benefit shall be U.S. Department of Labor, Employee Benefits Security Administration at ▇-▇▇▇-▇▇▇-▇▇▇▇ or ▇▇▇.▇▇▇.▇▇▇/▇▇▇▇, or the dollar amount U.S. Department of the member’s monthly pension benefit computed by using the contractual guidelines Health and formula(s) that are in effect on the DROP date. During participation in the DROP, the Participant continues with full employment status and receives all future promotions and benefit/wage increases. The Participant’s DROP Benefit shall be credited monthly to the Participant’s DROP Account which shall be established within the Defined Benefit Plan of the Clinton Township Fire and Police Retirement System (the “Fire and Police Retirement System” Human Services at ▇-▇▇▇-▇▇▇-▇▇▇▇ ▇▇▇▇▇▇ or “Plan”). The Participant’s DROP Account shall be maintained and managed by the Board of Trustees of the Fire and Police Retirement System (the “Retirement Board”). Upon termination of employment, the retiree shall begin to receive payment(s) from his/her individual DROP Account as described herein. The DROP payment(s) are in addition to all other contractual pension benefits. The Participant is solely responsible for analyzing the tax consequences of participation in the DROP▇▇▇.▇▇▇▇▇.▇▇▇.▇▇▇.
Appears in 1 contract
Sources: Collective Bargaining Agreement
Stipulations. The parties agree to the following stipulations:
1. Employees may elect this option at any timeopen enrollment.
2. The supplemental pay will begin with the first pay date in the month that insurance coverage ceases. There will be no retroactive payments.
3. Employees may elect to reinstate their health insurance coverage and drop the supplemental pay plan at the annual health insurance open enrollment. If an employee wishes to reinstate their health insurance coverage at any other time, they may do so only if the reinstatement is due to loss of coverage as a result of the death of, divorce from, or loss of coverage due to the unemployment of the individual covering the employee under another plan.
4. Those persons who are eligible for hospital/medical insurance at the inception of this agreement but who have elected not to be insured by the Township plan because they are covered by another plan, will be eligible for this option.
5. In those cases where both a husband and wife work for the Township, one person may carry his/her spouse and dependents on the health insurance policy and the other person may elect the supplemental pay plan.
6. When an employee elects to drop his/her insurance coverage, he/she must drop it for him/her self and all dependents. (e.g. A parent cannot drop insurance for him/her self and retain coverage for his/her children).
7. The Provisions of this plan which pertain to adding or dropping insurance coverage are subject to the administrative rules of the insurance carriers for the TownshipTownship and Section 125 of the Internal Revenue Code. WAIVER OF MEDICAL INSURANCE AND I hereby authorize the Charter Township of Clinton to cancel my group medical plan if I currently have group coverage and provide supplemental pay to me of $100 per pay in lieu of participation in any Township group medical plan. I affirm that I am covered by the health plan coverage offered through: I understand that by exercising the election to receive these payments, I will receive no benefits or payments as primary subscriber from any Township group medical plan. I understand that except in the case of death, divorce from, or lost of coverage due to the unemployment of the individual covering me under another plan, I will not be eligible for enrollment in any of Clinton Township’s group medical plans until the next open enrollment period. I understand that if I wish to enroll in any if Clinton Township’s group medical plans at a later date, I will be subject to that plan’s enrollment rules. NAME (PLEASE PRINT) SIGNATURE DATE DEPARTMENT NAME SOCIAL SECURITY NUMBER ** If covered elsewhere, you must provide written proof of other coverage.
A. OVERVIEW Effective April 1. The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately. This is only a summary. For more information about your coverage, 2001, any Captain who is or to get a member of or promoted to the Clinton Township Police Captain’s bargaining group (hereinafter “Captains”) between April 1, 2001 and May 1, 2007 may at any time voluntarily elect to participate in the Clinton Township Police and Fire Retirement System Deferred Retirement Option Plan (hereinafter “DROP”) after attaining the minimum requirements for a normal service retirement/pension. Upon commencement of DROP participation, the Participant’s DROP Benefit shall be the dollar amount copy of the member’s monthly pension benefit computed by using complete terms of coverage, go to ▇▇▇▇▇://▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇▇▇▇▇▇.▇▇▇ or call (▇▇▇) ▇▇▇-▇▇▇▇. For general definitions of common terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other underlined terms see the contractual guidelines and formula(sGlossary. You can view the Glossary at ▇▇▇.▇▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇-▇▇▇▇▇▇▇▇ or call Care Coordinators at (▇▇▇) that are in effect on the DROP date. During participation in the DROP, the Participant continues with full employment status and receives all future promotions and benefit/wage increases. The Participant’s DROP Benefit shall be credited monthly ▇▇▇-▇▇▇▇ to the Participant’s DROP Account which shall be established within the Defined Benefit Plan of the Clinton Township Fire and Police Retirement System (the “Fire and Police Retirement System” or “Plan”). The Participant’s DROP Account shall be maintained and managed by the Board of Trustees of the Fire and Police Retirement System (the “Retirement Board”). Upon termination of employment, the retiree shall begin to receive payment(s) from his/her individual DROP Account as described herein. The DROP payment(s) are in addition to all other contractual pension benefits. The Participant is solely responsible for analyzing the tax consequences of participation in the DROPrequest a copy.
Appears in 1 contract
Sources: Collective Bargaining Agreement