Common use of Health Insurance Plans Clause in Contracts

Health Insurance Plans. The following are summaries of the provisions of the HMO, PPO, dental and vision insurance plans in effect as of the ratification date of this Agreement. Actual implementation of said plans with respect to bargaining unit employees will occur as soon as feasible following employee ratification and Board approval of this Agreement; until such implementation, the health insurance coverage previously in effect shall be maintained. Before implementing a reduction in benefits, the Board will notify the Union and shall bargain with the Union in good faith over the reduction or change. In any event, (a) the percentage of applicable premium cost to be contributed by eligible employees shall not be increased during the life of this Agreement without the consent of the Union, and (b) there shall be no reduction in benefits prior to June 1, 2015. In the event that the Board implements a reduction in benefits (other than as set forth in Section VI below) after bargaining to impasse with the Union, then, upon statutory notice to the Board, the Union shall have the right to strike over the issue, the provisions of Article XV of this Agreement to the contrary notwithstanding. HMO (HEALTH MAINTENANCE ORGANIZATION) PLAN* Annual Copay Limit $1,500/individual $3,000/family Preventive Care and Physician Services (Office Visit and diagnostic Tests) Primary Care Physicians $25 copay per visit Specialist Physician $35 copay per visit Hospital Services $500 copay Emergency Room $200 copay per visit Other Medical Services (e.g. physical therapy) $15 copay per visit Prescription Drugs Retail (30 day supply) Generic $20 copay Brand Formulary** $30 copay Brand Non-Formulary** $45 copay Mail Order (90 day supply) 2 times retail copays * If a discrepancy exists between this summary and the plan document, the plan document will govern. ** If a brand name drug is chosen when a generic equivalent is available, the member pays the cost difference between the brand and generic drugs plus the copay. PPO (PREFERRED PROVIDER ORGANIZATION) PLAN* PPO (In-Network) Non-PPO (Out-of-Network) Annual Deductible $900/individual $1,000/individual $900/family $3000/family Actual Out-of-Pocket Limit $2,500/individual (including deductible) $3,000/individual (including deductible) $4,000/family (including deductible) $9,000/family (including deductible Physician Services Benefit (after deductible) 80% and $10/$20 copay (PCP/Specialist) 70% Hospital Services Benefit (after deductible) 80% and $100 copay 70% Emergency Room $175 copay per visit $100 copay per visit Prescription Drugs Retail (30 day supply) Generic $10 copay Reimbursed 75% of network rate less copay Brand Formulary $20 copay Reimbursed 75% of network rate less copay Brand Non-formulary** $40 copay Reimbursed 75% of network rate less copay Mail Order (90 day supply) 2 times retail copays Not applicable * If a discrepancy exists between this summary and the plan document, the plan document will govern. ** If a brand non-formulary drug is chosen when a generic equivalent is available, the member pays the cost difference between the brand and generic drugs plus the copay. *** Brand non-formulary drugs are not available through mail order. DENTAL PLAN* Annual Benefit Limit $1,500/individual Annual Deductible $10/individual Preventative Services Benefit (exams, cleanings, and bitewing X-rays every 6 months) 100%** Basic Services Benefit (amalgam and resin fillings) 80%** Major Services Benefit (crowns, root canals, extractions, periodontal treatments, dentures) 80%** Orthodontia Lifetime Benefit (dependent child only) $2,000 (50% payment up to $2,000) * If a discrepancy exists between this summary and the plan document, the plan document will govern. ** Reimbursement up to usual and customary allowance. VISION PLAN* Benefit Frequency Calendar Year Copay Network Provider Coverage Out-of-Network Reimbursement Exam 12 months 100% Up to $35 allowance Lenses (prescription only) 12 months $10 100% for single vision, lined bifocal lenses, lined trifocal lenses and tints Single vision up to $30 allowance Lined bifocal up to $40 allowance Lined trifocal up to $50allowance Frame (prescription eyewear only) 24 months Up to $120 allowance Up to $40 allowance Contact Lenses in 12 months lieu of glasses None Up to $300 allowance Up to $105 allowance If a discrepancy exists between this summary and the plan document, the plan document will govern.

Appears in 2 contracts

Samples: Collective Bargaining Agreement, Collective Bargaining Agreement

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Health Insurance Plans. The following are summaries of the provisions of the HMO, PPO, dental and vision insurance plans in effect as of the ratification date of this Agreement. Actual implementation of said plans with respect to bargaining unit employees will occur as soon as feasible following employee ratification and Board approval of this Agreement; Agreement; until such implementation, the health insurance coverage previously in effect shall be maintained. Before implementing a reduction in benefits, the Board will notify the Union and shall bargain with the Union in good faith over the reduction or change. In any event, (a) the percentage of applicable premium cost to be contributed by eligible employees shall not be increased during the life of this Agreement without the consent of the Union, and (b) there shall be no reduction in benefits prior to June 1, 20152008. In the event that the Board implements a reduction in benefits (other than as set forth in Section VI below) after bargaining to impasse with the Union, then, upon statutory notice to the Board, the Union shall have the right to strike over the issue, the provisions of Article XV of this Agreement to the contrary notwithstanding. HMO (HEALTH MAINTENANCE ORGANIZATIONHealth Maintenance Organization) PLANPlan* Annual Copay Limit $1,500/individual $3,000/family Preventive Care and Physician Services (Office Visit and diagnostic Diagnostic Tests) Primary Care Physicians Physician Specialist Physician $25 10 copay per visit Specialist Physician $35 15 copay per visit Hospital Services $500 copay Emergency Room $200 100 copay per visit Other Medical Services (e.g. physical therapy) $15 copay per visit Prescription Drugs Retail (30 day supply) Generic $20 copay Brand Formulary** $30 copay Brand Non-Formulary** $45 copay Mail Order (90 day supply) $10 copay $20 copay $40 copay 2 times retail copays * If a discrepancy exists between this summary and the plan document, the plan document will govern. ** If a brand name drug is chosen when a generic equivalent is available, the member pays the cost difference between the brand and generic drugs plus the copay. PPO (PREFERRED PROVIDER ORGANIZATIONPreferred Provider Organization) PLANPlan* PPO (In-Network) Non-PPO (Out-of-Network) Annual Deductible $900/individual $1,000300/individual $900/family $3000/family Actual (3 individual deductibles) Annual Out-of-Pocket Limit $2,500/individual (including deductible) $3,0002,000/individual (including deductible) $4,000/family (including deductible) $1,000/individual Deductible per Covered Person $3,000/individual (including deductible) $9,000/family (including deductible deductible) Lifetime Maximum $1,500,000 Physician Services Benefit (after deductible) 8085% and $10/$20 copay (PCP/Specialist) 70% Hospital Services Benefit (after deductible) 8085% and $100 copay 70% Emergency Room $175 100 copay per visit $100 copay per visit Prescription Drugs Retail (30 day supply) Generic $10 copay Reimbursed 75% of network rate less copay Brand Formulary $20 copay Reimbursed 75% of network rate less copay Brand Non-formularyFormulary** $40 copay Reimbursed 75% of network rate less copay Mail Order (90 day supply) )*** 2 times retail copays Not applicable Applicable * If a discrepancy exists between this summary and the plan document, the plan document will govern. ** If a brand non-formulary drug is chosen when a generic equivalent is available, the member pays the cost difference between the brand and generic drugs plus the copay. *** Brand non-formulary drugs are not available through mail order. DENTAL PLANDental Plan* Annual Benefit Limit $1,500/individual Annual Deductible $10/individual Preventative Preventive Services Benefit (exams, cleanings, and bitewing X-rays every 6 months) 100%** Basic Services Benefit (amalgam and resin fillings) 80%** Major Services Benefit (crowns, root canals, extractions, periodontal treatments, dentures) 80%** Orthodontia Lifetime Benefit (dependent child only) $2,000 (50% payment up to $2,000) * If a discrepancy exists between this summary and the plan document, the plan document will govern. ** Reimbursement up to usual and customary allowance. VISION PLANVision Plan* Benefit Frequency Calendar Year Copay Network Provider Coverage Out-of-Network Reimbursement Exam 12 months $10 100% Up to $35 allowance Lenses (prescription only) 12 months $10 100% for single vision, lined bifocal lenses, lined trifocal lenses and tints Single vision up to $30 allowance Lined bifocal up to $40 allowance Lined trifocal up to $50allowance 50 allowance Frame (prescription eyewear only) 24 months Up to $120 allowance Up to $40 allowance Contact Lenses in 12 months lieu of glasses 12 months None Up to $300 allowance Up to $105 allowance * If a discrepancy exists between this summary and the plan document, the plan document will govern.

Appears in 1 contract

Samples: Collective Bargaining Agreement

Health Insurance Plans. The following are summaries of the provisions of the HMO, PPO, dental and vision insurance plans in effect as of the ratification date of this Agreement. Actual implementation of said plans with respect to bargaining unit employees will occur as soon as feasible following employee ratification and Board approval of this Agreement; until such implementation, the health insurance coverage previously in effect shall be maintained. Before implementing a reduction in benefits, the Board will notify the Union and shall bargain with the Union in good faith over the reduction or change. In any event, (a) the percentage of applicable premium cost to be contributed by eligible employees shall not be increased during the life of this Agreement without the consent of the Union, and (b) there shall be no reduction in benefits prior to June 1, 2015. In the event that the Board implements a reduction in benefits (other than as set forth in Section VI below) after bargaining to impasse with the Union, then, upon statutory notice to the Board, the Union shall have the right to strike over the issue, the provisions of Article XV of this Agreement to the contrary notwithstanding. HMO (HEALTH MAINTENANCE ORGANIZATION) PLAN* Annual Copay Limit $1,500/individual $3,000/family Preventive Care and Physician Services (Office Visit and diagnostic Tests) Primary Care Physicians $25 copay per visit Specialist Physician $35 copay per visit Hospital Services $500 copay Emergency Room $200 copay per visit Other Medical Services (e.g. physical therapy) $15 copay per visit Prescription Drugs Retail (30 day supply) Generic $20 copay Brand Formulary** $30 copay Brand Non-Formulary** $45 copay Mail Order (90 day supply) 2 times retail copays * If a discrepancy exists between this summary and the plan document, the plan document will govern. ** If a brand name drug is chosen when a generic equivalent is available, the member pays the cost difference between the brand and generic drugs plus the copay. PPO (PREFERRED PROVIDER ORGANIZATION) PLAN* PPO (In-Network) Non-PPO (Out-of-Network) Annual Deductible $900/individual $1,000/individual $900/family $3000/family Actual Out-of-Pocket Limit $2,500/individual (including deductible) $3,000/individual (including deductible) $4,000/family (including deductible) $9,000/family (including deductible Physician Services Benefit (after deductible) 80% and $10/$20 copay (PCP/Specialist) 70% Hospital Services Benefit (after deductible) 80% and $100 copay 70% Emergency Room $175 copay per visit $100 copay per visit Prescription Drugs Retail (30 day supply) Generic $10 copay Reimbursed 75% of network rate less copay Brand Formulary $20 copay Reimbursed 75% of network rate less copay Brand Non-formulary** $40 copay Reimbursed 75% of network rate less copay Mail Order (90 day supply) 2 times retail copays Not applicable * If a discrepancy exists between this summary and the plan document, the plan document will govern. ** If a brand non-formulary drug is chosen when a generic equivalent is available, the member pays the cost difference between the brand and generic drugs plus the copay. *** Brand non-formulary drugs are not available through mail order. DENTAL PLAN* Annual Benefit Limit $1,500/individual Annual Deductible $10/individual Preventative Services Benefit (exams, cleanings, and bitewing X-rays every 6 months) 100%** Basic Services Benefit (amalgam and resin fillings) 80%** Major Services Benefit (crowns, root canals, extractions, periodontal treatments, dentures) 80%** Orthodontia Lifetime Benefit (dependent child only) $2,000 (50% payment up to $2,000) * If a discrepancy exists between this summary and the plan document, the plan document will govern. ** Reimbursement up to usual and customary allowance. VISION PLAN* Benefit Frequency Calendar Year Copay Network Provider Coverage Out-of-Network Reimbursement Exam 12 months 100% Up to $35 allowance Lenses (prescription only) 12 months $10 100% for single vision, lined bifocal lenses, lined trifocal lenses and tints Single vision up to $30 allowance Lined bifocal up to $40 allowance Lined trifocal up to $50allowance 50 allowance Frame (prescription eyewear only) 24 months Up to $120 allowance Up to $40 allowance Contact Lenses in 12 months lieu of glasses None Up to $300 allowance Up to $105 allowance If a discrepancy exists between this summary and the plan document, the plan document will govern.

Appears in 1 contract

Samples: Collective Bargaining Agreement

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Health Insurance Plans. The following are summaries of the provisions of the HMO, PPO, dental and vision insurance plans in effect as of the ratification date of this Agreement. Actual implementation of said plans with respect to bargaining unit employees will occur as soon as feasible following employee ratification and Board approval of this Agreement; until such implementation, the health insurance coverage previously in effect shall be maintained. Before implementing a reduction in benefits, the Board will notify the Union and shall bargain with the Union in good faith over the reduction or change. In any event, (a) the percentage of applicable premium cost to be contributed by eligible employees shall not be increased during the life of this Agreement without the consent of the Union, and (b) there shall be no reduction in benefits prior to June 1, 2015. In the event that the Board implements a reduction in benefits (other than as set forth in Section VI below) after bargaining to impasse with the Union, then, upon statutory notice to the Board, the Union shall have the right to strike over the issue, the provisions of Article XV of this Agreement to the contrary notwithstanding. HMO (HEALTH MAINTENANCE ORGANIZATION) PLAN* Annual Copay Limit $1,500/individual $3,000/family Preventive Care and Physician Services (Office Visit and diagnostic Tests) Primary Care Physicians $25 copay per visit Specialist Physician $35 copay per visit Hospital Services $500 copay Emergency Room $200 copay per visit Other Medical Services (e.g. physical therapy) $15 copay per visit Prescription Drugs Retail (30 day supply) Generic $20 copay Brand Formulary** $30 copay Brand Non-Formulary** $45 copay Mail Order (90 day supply) 2 times retail copays * If a discrepancy exists between this summary and the plan document, the plan document will govern. ** If a brand name drug is chosen when a generic equivalent is available, the member pays the cost difference between the brand and generic drugs plus the copay. PPO (PREFERRED PROVIDER ORGANIZATION) PLAN* PPO (In-Network) Non-PPO (Out-of-Network) Annual Deductible $900/individual $1,000/individual $900/family $3000/family Actual Out-of-Pocket Limit $2,500/individual (including deductible) $3,000/individual (including deductible) $4,000/family (including deductible) $9,000/family (including deductible Physician Services Benefit (after deductible) 80% and $10/$20 copay (PCP/Specialist) 70% Hospital Services Benefit (after deductible) 80% and $100 copay 70% Emergency Room $175 copay per visit $100 copay per visit Prescription Drugs Retail (30 day supply) Generic $10 copay Reimbursed 75% of network rate less copay Brand Formulary $20 copay Reimbursed 75% of network rate less copay Brand Non-formulary** $40 copay Reimbursed 75% of network rate less copay Mail Order (90 day supply) 2 times retail copays Not applicable * If a discrepancy exists between this summary and the plan document, the plan document will govern. ** If a brand non-formulary drug is chosen when a generic equivalent is available, the member pays the cost difference between the brand and generic drugs plus the copay. *** Brand non-formulary drugs are not available through mail order. DENTAL PLAN* Annual Benefit Limit $1,500/individual Annual Deductible $10/individual Preventative Services Benefit (exams, cleanings, and bitewing X-rays every 6 months) 100%** Basic Services Benefit (amalgam and resin fillings) 80%** Major Services Benefit (crowns, root canals, extractions, periodontal treatments, dentures) 80%** Orthodontia Lifetime Benefit (dependent child only) $2,000 (50% payment up to $2,000) * If a discrepancy exists between this summary and the plan document, the plan document will govern. ** Reimbursement up to usual and customary allowance. VISION PLAN* Benefit Frequency Calendar Year Copay Network Provider Coverage Out-of-Network Reimbursement Exam 12 months 100% Up to $35 allowance Lenses (prescription only) 12 months $10 100% for single vision, lined bifocal lenses, lined trifocal lenses and tints Single vision up to $30 allowance Lined allowanceLined bifocal up to $40 allowance Lined allowanceLined trifocal up to $50allowance Frame (prescription eyewear only) 24 months Up to $120 allowance Up to $40 allowance Contact Lenses in 12 months lieu of glasses None Up to $300 allowance Up to $105 allowance If a discrepancy exists between this summary and the plan document, the plan document will govern.

Appears in 1 contract

Samples: Collective Bargaining Agreement

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