Common use of Health Maintenance Organization Clause in Contracts

Health Maintenance Organization. Oakland and the Association may agree to participate in or dissociate from federally qualified Health Maintenance Organization (HMO) plans as alternatives to the health care coverage provided above. In calendar year 2016 two outcome based HMO plans are to be offered: Priority Health’s Health by Choice HMO, and BCN’s Healthy Blue Living HMO, or essentially similar plans. Both of these HMO plans will offer two levels of benefits – Enhanced and Standard. The chart below contains the key features of these two HMO plans. A summary chart of these plans is also provided in Appendix M, for informational purposes, only (and shall not be the basis of a grievance). Additional information, including how members qualify for the level of coverage, will be provided in the annual open enrollment materials that are distributed to each eligible faculty member. Both of these HMO plans shall contain riders for Other Eligible Adults including Dependent Children of Other Eligible Adults. Enhanced Standard Deductible (Single/Family) $0 $200/$400 Co-Insurance N/A 80%/20% Out-of-Pocket Max (including deductible) N/A $2,000/$4,000 Office/Urgent Care Co-Pay $20 $30 *Prescription Co-Pay Generic $7 $10 Preferred Brand Name $15 $20 Non-Preferred Brand Name $30 $50 *The Priority Health Standard Prescription co-pay matches the Enhanced Prescription co-pay. The True Out-of-Pocket Maximum (which includes the deductible, coinsurance and flat dollar copays, as required by the Affordable Care Act) is set by the Federal government. Information about Plan benefits, plan design and open enrollment materials may be obtained from the Benefit and Compensation Services office and available on- line at the website, and will be provided by the medical carriers. All benefits of the HMO plans are subject to specific HMO policy provisions and the Group Operating Agreements between Oakland and the HMO.

Health Maintenance Organization. Oakland and the Association may agree to participate in or dissociate from federally qualified Health Maintenance Organization (HMO) plans as alternatives to the health care coverage provided above. In calendar year 2016 two outcome based HMO plans are to be offered: Priority Health’s Health by Choice HMO, and BCN’s Healthy Blue Living HMO, or essentially similar plans. Both of these HMO plans will offer two levels of benefits – Enhanced and Standard. The chart below contains the key features of these two HMO plans. A summary chart of these plans is also provided in Appendix M, for informational purposes, only (and shall not be the basis of a grievance). Additional information, including how members qualify for the level of coverage, will be provided in the annual open enrollment materials that are distributed to each eligible faculty member. Both of these HMO plans shall contain riders for Other Eligible Adults including Dependent Children of Other Eligible Adults. Enhanced Standard Deductible (Single/Family) $0 $200/$400 Co-Insurance N/A 80%/20% Out-of-Pocket Max (including deductible) N/A $2,000/$4,000 2,200/$4,400 Office/Urgent Care Co-Pay $20 $30 *Prescription Co-Pay Generic $7 $10 Preferred Brand Name $15 $20 Non-Preferred Brand Name $30 $50 *The Priority Health Standard Prescription co-pay matches the Enhanced Prescription co-pay. The True Out-of-Pocket Maximum (which includes the deductible, coinsurance and flat dollar copays, as required by the Affordable Care Act) is set by the Federal government. Information about Plan benefits, plan design and open enrollment materials may be obtained from the Benefit and Compensation Services office and available on- line at the website, and will be provided by the medical carriers. All benefits of the HMO plans are subject to specific HMO policy provisions and the Group Operating Agreements between Oakland and the HMO.