Basic Medical - Health - Hospitalization Sample Clauses

Basic Medical - Health - Hospitalization. Full-time employees, their spouses, and dependent children are eligible for medical insurance on the first day of the month following official hire date. Optional benefits will be provided under the Classified Flexible Compensation Program (see program booklet for details). Effective January 1, 2016: For each eligible employee who elects to receive medical coverage from the College, the College will pay for the actual premium cost and/or illustrated rate cost for such medical coverage up to the hard cap threshold as determined by the State of Michigan on an annual basis. As an illustration, the current (2017) hard cap thresholds are: Single $6,344.80 2-Person $13,268.93 Family $17,304.02 By law, these amounts are subject to annual adjustment by the State for each calendar year (January 1st – December 31st). The annual hard cap amounts as established by the State will be accounted for by the College during the health insurance open enrollment period provided for employees. Notwithstanding this provision, the College’s Board of Trustees for the length of this agreement retains its right to elect any option (i.e. 80%/20%) provided under Michigan law relative to employer medical insurance coverage contributions on an annual basis. The medical plan options will include at least two PPO plan options (ex. MESSA-administered BCBS medical plan with $500/$1,000 deductible and MESSA-administered BCBS medical plan with $300/$600 deductible) and at least one high-deductible (HSA-eligible) plan option (ex. MESSA- administered BCBS medical plan with $1,300/$2,600 deductible). Summary Plan Descriptions for each medical coverage plan offered by the College will be provided to existing employees during the annual health insurance open enrollment period and to new employees upon hire. At any point during the term of this Agreement, the College may seek quotes from reliable medical carriers/providers for the existing deductible, co-pay, co-insurance and/or prescription drug card levels or alternative medical coverage plan designs. Upon request, representatives for the Union agree to meet with the College to review and discuss these quotes with the understanding that any change(s) in benefit level(s) is/are subject to negotiation by the parties. OPT OUT - $1,000 Cash Payment Annually
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Basic Medical - Health - Hospitalization. Full-time employees, their spouses, and dependent children are eligible for medical insurance on the first day of the month following official hire date. Optional benefits will be provided under the Classified Flexible Compensation Program (see program booklet for details). Cost sharing in the amount of 20% of health care premium is required of all covered employees in the bargaining unit who are subject to cost sharing through December 31, 2015. Effective July 1, 2015 through December 31, 2015: Select Choice – HMO 20% of premium Deductible 0 Co-insurance 0 Office visit $10 Prescription $5/$10/$10 PPO Plan (in-network) 20% of premium Deductible $500/$1,000 Co-insurance 90/10, limit of $1,000/$2,000 Office visit $15 Prescription $10/$20/$40 PPO Plan (in-network) 20% of premium Deductible $100/$200 Co-insurance 0 Office visit $15 Prescription $10/$20/$40 OPT OUT $1,000 Cash Refund Effective January 1, 2016: For each eligible employee who elects to receive medical coverage from the College, the College will pay for the actual premium cost and/or illustrated rate cost for such medical coverage up to the hard cap threshold as determined by the State of Michigan on an annual basis. As an illustration, the current (2015) hard cap thresholds are: Single $5,992.30 2-Person $12,531.75 Family $16,342.66 By law, these amounts are subject to annual adjustment by the State for each calendar year (January 1st – December 31st). The annual hard cap amounts as established by the State will be accounted for by the College during the health insurance open enrollment period provided for employees. Notwithstanding this provision, the College’s Board of Trustees for the length of this agreement retains its right to elect any option (i.e. 80%/20%) provided under Michigan law relative to employer medical insurance coverage contributions on an annual basis. The medical plan options will include at least two PPO plan options (ex. MESSA-administered BCBS medical plan with $500/$1,000 deductible and MESSA-administered BCBS medical plan with $300/$600 deductible) and at least one high-deductible (HSA-eligible) plan option (ex. MESSA-administered BCBS medical plan with $1,300/$2,600 deductible). Summary Plan Descriptions for each medical coverage plan offered by the College will be provided to existing employees during the annual health insurance open enrollment period and to new employees upon hire. At any point during the term of this Agreement, the College may seek quotes from reliab...
Sample 1
Basic Medical - Health - Hospitalization. ‌ Full-time employees, their spouses, and dependent children are eligible for medical insurance on the first day of the month following official hire date. For each eligible employee who elects to receive medical coverage from the College, the College will pay for the actual premium cost and/or illustrated rate cost for such medical coverage up to the hard cap threshold as determined by the State of Michigan on an annual basis. For each part-time employee meeting the standard for employer subsidized medical coverage as required under the Affordable Care Act and who elects to receive such medical coverage from the College, The College will pay up to the actual premium cost and/or illustrated rate cost for such medical coverage, up to the hard cap threshold as determined by the state of Michigan on an annual basis, for the employee only/single level of coverage. By law, these amounts are subject to annual adjustment by the State for each calendar year (January 1st – December 31st). The annual hard cap amounts as established by the State will be accounted for by the College during the health insurance open enrollment period provided for employees. Notwithstanding this provision, the College’s Board of Trustees for the length of this Agreement retains its right to elect any option (i.e. 80%/20%) provided under Michigan law relative to employer medical insurance coverage contributions on an annual basis. The medical plan options will include at least two PPO plan options and at least one high-deductible (HSA-eligible) plan option. Summary Plan Descriptions for each medical coverage plan offered by the College will be provided to existing employees during the annual health insurance open enrollment period and to new employees upon hire. At any point during the term of this Agreement, the College may seek quotes from reliable medical carriers/providers for the existing deductible, co-pay, co-insurance and/or prescription drug card levels or alternative medical coverage plan designs. Upon request, representatives for the Union agree to meet with the College to review and discuss these quotes with the understanding that any change(s) in benefit level(s) is/are subject to negotiation by the parties.
Sample 1
Basic Medical - Health - Hospitalization. Full-time employees, their spouses, and dependent children are eligible for medical insurance on the first day of the month following official hire date. Optional benefits will be provided under the Maintenance Flexible Compensation Program (see program booklet for details). Employee costs/refunds as follows: The following plans will continue through December 31, 2014 with 20% cost sharing. PPO $100/200 Deductible in-network $15 Office Visit Co-pay $10/20 Prescription Co-pay $25 Emergency Room Co-pay 10% of Premium Cost Share PPO Option 1 $15 Office Visit Co-pay 30% Prescription Co-pay $25 Emergency Room Co-pay $600 refund HAP $10 Office Visit Co-pay $5/$10 Prescription Co-pay $25 Emergency Room Co-pay 10% of Premium Cost Share BCN $10 Office Visit Co-pay $5/$10 Prescription Co-pay $25 Emergency Room Co-pay 10% of Premium Cost Share OPT OUT $1000 Cash Refund Effective January 1, 2015: Aetna Select-Open Access 20% of premium Deductible 0 Co-insurance 0 Office visit $10 Prescription $5/$10/$10 PPO A Plan (in-network) 20% of premium Deductible $500/$1,000 Co-insurance 90/10, limit of $1,000/$2,000 Office visit $15 Prescription $10/$20/$40 PPO B Plan (in-network) 20% of premium Deductible $100/$200 Co-insurance 0 Office visit $15 Prescription $10/$20/$40 Note: Failure to maintain current cost sharing payments while on a leave of absence (i.e., short-term disability, long-term disability, workers’ compensation, etc.) will result in termination of health insurance.
Sample 1

Related to Basic Medical - Health - Hospitalization

  • Clinical Management for Behavioral Health Services (CMBHS) System The CMBHS is the official record of documentation by System Agency. Grantee shall:

  • Mental Health Services This agreement covers medically necessary services for the treatment of mental health disorders in a general or specialty hospital or outpatient facilities that are: • reviewed and approved by us; and • licensed under the laws of the State of Rhode Island or by the state in which the facility is located as a general or specialty hospital or outpatient facility. We review network and non-network programs, hospitals and inpatient facilities, and the specific services provided to decide whether a preauthorization, hospital or inpatient facility, or specific services rendered meets our program requirements, content and criteria. If our program content and criteria are not met, the services are not covered under this agreement. Our program content and criteria are defined below.

  • HEALTH PROGRAM 3701 Health examinations required by the Employer shall be provided by the Employer and shall be at the expense of the Employer. 3702 Time off without loss of regular pay shall be allowed at a time determined by the Employer for such medical examinations and laboratory tests, provided that these are performed on the Employer’s premises, or at a facility designated by the Employer. 3703 With the approval of the Employer, a nurse may choose to be examined by a physician of her/his own choice, at her/his own expense, as long as the Employer receives a statement as to the fitness of the nurse from the physician. 3704 Time off for medical and dental examinations and/or treatments may be granted and such time off, including necessary travel time, shall be chargeable against accumulated income protection benefits.

  • Behavioral Health Services Behavioral health services include the evaluation, management, and treatment for a mental health or substance use disorder condition. For the purpose of this plan, substance use disorder does not include addiction to or abuse of tobacco and/or caffeine. Mental health or substance use disorders are those that are listed in the most updated volume of either: • the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association; or • the International Classification of Disease Manual (ICD) published by the World Health Organization. This plan provides parity in benefits for behavioral healthcare services. Please see Section 10 for additional information regarding behavioral healthcare parity. Inpatient This plan covers behavioral health services if you are inpatient at a general or specialty hospital. See Inpatient Services in Section 3 for additional information. Residential Treatment Facility This plan covers services at behavioral health residential treatment facilities, which provide: • clinical treatment; • medication evaluation management; and • 24-hour on site availability of health professional staff, as required by licensing regulations. Intermediate Care Services This plan covers intermediate care services, which are facility-based programs that are: • more intensive than traditional outpatient services; • less intensive than 24-hour inpatient hospital or residential treatment facility services; and • used as a step down from a higher level of care; or • used a step-up from standard care level of care. Intermediate care services include the following: • Partial Hospital Program (PHP) – PHPs are structured and medically supervised day, evening, or nighttime treatment programs providing individualized treatment plans. A PHP typically runs for five hours a day, five days per week. • Intensive Outpatient Program (IOP) – An IOP provides substantial clinical support for patients who are either in transition from a higher level of care or at risk for admission to a higher level of care. An IOP typically runs for three hours per day, three days per week.

  • Orthodontics We Cover orthodontics used to help restore oral structures to health and function and to treat serious medical conditions such as: cleft palate and cleft lip; maxillary/mandibular micrognathia (underdeveloped upper or lower jaw); extreme mandibular prognathism; severe asymmetry (craniofacial anomalies); ankylosis of the temporomandibular joint; and other significant skeletal dysplasias. Procedures include but are not limited to: • Rapid Palatal Expansion (RPE); • Placement of component parts (e.g. brackets, bands); • Interceptive orthodontic treatment; • Comprehensive orthodontic treatment (during which orthodontic appliances are placed for active treatment and periodically adjusted); • Removable appliance therapy; and • Orthodontic retention (removal of appliances, construction and placement of retainers).

  • Mental Health The parties recognize the importance of supporting and promoting a psychologically healthy workplace and as such will adhere to all applicable statutes, policy, guidelines and regulations pertaining to the promotion of mental health.

  • EMPLOYEE HEALTH CARE 233. Pursuant to the Charter, the City contributes whatever rate is applicable per month directly into the City Health Service System for each employee who is a member of the Health Service System. Subsequent City contributions will be set pursuant to the Charter.

  • Behavioral Health Behavioral health services, with the exception of Medicaid Rehabilitation Option (MRO) and 1915(i) services, are a covered benefit under the Hoosier Healthwise program. The Contractor shall be responsible for managing and reimbursing all such services in accordance with the requirements in this section. In furnishing behavioral health benefits, including any applicable utilization restrictions, the Contractor shall comply with the Mental Health Parity and Additions Equity Act (MHPAEA). This includes, but is not limited to:  Ensuring medical management techniques applied to mental health or substance use disorder benefits are comparable to and applied no more stringently than the medical management techniques that are applied to medical and surgical benefits.  Ensuring compliance with MHPAEA for any benefits offered by the Contractor to members beyond those otherwise specified in this Scope of Work.  Making the criteria for medical necessity determinations for mental health or substance use disorder benefits available to any current or potential members, or contracting provider upon request.  Providing the reason for any denial of reimbursement or payment with respect to mental health or substance use disorder benefits to members.  Providing out-of-network coverage for mental health or substance use disorder benefits when made available for medical and surgical benefits. The Contractor shall assure that behavioral health services are integrated with physical care services, and that behavioral health services are provided as part of the treatment continuum of care. The Contractor shall develop protocols to:  Provide care that addresses the needs of members in an integrated way, with attention to the physical health and chronic disease contributions to behavioral health;  Provide a written plan and evidence of ongoing, increased communication between the PMP, the Contractor and the behavioral health care provider; and  Coordinate management of utilization of behavioral health care services with MRO and 1915(i) services and services for physical health.

  • MEDICALLY FRAGILE STUDENTS 1. If a teacher will be providing instructional or other services to a medically fragile student, the teacher or another adult who will be present when the instruction or other services are being provided will be advised of the steps to be taken in the event an emergency arises relating to the student's medical condition.

  • Community Mental Health Center Services Assertive Community Treatment Staffing Full Time Equivalents Community Mental Health Center March 2021 December 2020 Nurse Masters Level Clinician/or Functional Support Worker Peer Specialist Total (Excluding Psychiatry) Psychiatrist/Nurse Practitioner Total (Excluding Psychiatry) Psychiatrist/Nurse Practitioner 01 Northern Human Services - Wolfeboro 1.00 0.00 0.00 0.57 6.81 0.27 8.27 0.25 01 Northern Human Services - Berlin 0.34 0.31 0.00 0.00 3.94 0.14 4.17 0.14 01 Northern Human Services - Littleton 0.00 0.14 0.00 0.00 3.28 0.29 3.31 0.29 02 West Central Behavioral Health 0.60 1.00 0.00 0.00 5.40 0.30 5.90 0.30 03 Lakes Region Mental Health Center 1.00 1.00 0.00 1.00 5.00 0.40 7.00 0.38 04 Riverbend Community Mental Health Center 0.50 1.00 6.90 1.00 10.40 0.50 10.50 0.50 05 Monadnock Family Services 1.91 2.53 0.00 1.12 11.17 0.66 10.32 0.62 06 Greater Nashua Mental Health 1 1.00 1.00 3.00 1.00 7.65 0.15 8.50 0.15 06 Greater Nashua Mental Health 2 1.00 1.00 4.00 1.00 8.65 0.15 8.50 0.15 07 Mental Health Center of Greater Manchester-CTT 1.33 10.64 2.00 0.00 19.95 1.17 21.61 1.21 07 Mental Health Center of Greater Manchester-MCST 1.33 9.31 3.33 1.33 19.95 1.17 25.27 1.21 08 Seacoast Mental Health Center 1.00 1.10 5.00 1.00 10.10 0.60 10.10 0.60 09 Community Partners 0.50 0.00 3.40 0.88 7.28 0.70 7.41 0.70 10 Center for Life Management 1.00 0.00 2.28 1.00 6.71 0.46 6.57 0.46 Total 12.51 29.03 29.91 9.33 126.29 6.96 137.43 6.96 2b. Community Mental Health Center Services: Assertive Community Treatment Staffing Competencies Community Mental Health Center Substance Use Disorder Treatment Housing Assistance Supported Employment March 2021 December 2020 March 2021 December 2020 March 2021 December 2020 01 Northern Human Services - Wolfeboro 1.27 1.27 5.81 6.30 0.00 0.40 01 Northern Human Services - Berlin 0.74 0.74 3.29 3.29 0.00 0.23 01 Northern Human Services - Littleton 1.43 1.29 2.14 2.14 1.00 1.00 02 West Central Behavioral Health 0.20 0.20 4.00 0.40 0.60 0.60 03 Lakes Region Mental Health Center 1.00 3.00 5.00 7.00 2.00 2.00 04 Riverbend Community Mental Health Center 0.50 0.50 9.40 9.50 0.50 0.50 05 Monadnock Family Services 1.69 1.62 4.56 4.48 0.95 1.18 06 Greater Nashua Mental Health 1 6.15 7.15 5.50 6.50 1.50 1.50 06 Greater Nashua Mental Health 2 5.15 5.15 6.50 6.50 0.50 0.50 07 Mental Health Center of Greater Manchester-CCT 14.47 15.84 13.96 15.62 2.66 2.66 07 Mental Health Center of Greater Manchester-MCST 6.49 7.86 15.29 19.28 1.33 2.66 08 Seacoast Mental Health Center 2.00 2.00 5.00 5.00 1.00 1.00 09 Community Partners 1.20 1.20 4.50 4.50 1.00 1.00 10 Center for Life Management 2.14 2.14 5.42 5.28 0.29 0.29 Total 44.43 49.96 90.37 99.39 13.33 15.52 Revisions to Prior Period: None. Data Source: Bureau of Mental Health CMHC ACT Staffing Census Based on CMHC self-report. Notes: Data compiled 04/26/2021. For 2b: the Staff Competency values reflect the sum of FTEs trained to provide each service type. These numbers are not a reflection of the services delivered, but rather the quantity of staff available to provide each service. If staff are trained to provide multiple service types, their entire FTE value is credited to each service type.

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