TABLE OF CONTENTS PAGE. Summary of Benefits 9 Introduction to the Blue Shield Trio HMO Health Plan 15 How to Use This Health Plan 15 Selecting a Primary Care Physician 15 Primary Care Physician Relationship 16 Role of the Primary Care Physician 16 Obstetrical/Gynecological (OB/GYN) Physician Services 16 Referral to Specialty Services 16 Role of the Medical Group or IPA 17 Changing Primary Care Physicians or Designated Medical Group or IPA 17 Trio+ Specialist 18 Trio+ Satisfaction 18 Mental Health and Substance Use Disorder Services 18 Continuity of Care 19 Second Medical Opinion 20 Urgent Services 20 Emergency Services 21 Claims for Emergency and Urgent Services 21 NurseHelp 24/7 sm 21 Life Referrals 24/7 22 Blue Shield Online 22 Health Education and Health Promotion Services 22 Timely Access to Care 22 Cost Sharing 22 Limitation of Liability 24 Out-of-Area Services 24 Inter-Plan Arrangements 24 BlueCard Program 24 Blue Shield Global Core 25 Utilization Management 26 Principal Benefits and Coverages (Covered Services) 26 Allergy Testing and Treatment Benefits 26 Ambulance Benefits 27 Ambulatory Surgery Center Benefits 27 Clinical Trial for Treatment of Cancer or Life-Threatening Conditions Benefits 27 Diabetes Care Benefits 28 Durable Medical Equipment Benefits 28 Emergency Room Benefits 29 Family Planning and Infertility Benefits 29 Home Health Care Benefits 30 Home Infusion and Home Injectable Therapy Benefits 30 Hospice Program Benefits 31 Hospital Benefits (Facility Services) 32 Medical Treatment of the Teeth, Gums, or Jaw Joints and Jaw Bones Benefits 33 Mental Health and Substance Use Disorder Benefits 34 Orthotics Benefits 35 Outpatient X-Ray, Pathology and Laboratory 35 PKU Related Formulas and Special Food Products Benefits 35 Podiatric Benefits 36 Pregnancy and Maternity Care Benefits 36 Preventive Health Benefits 36 Professional (Physician) Benefits 37 Prosthetic Appliances Benefits 38 Reconstructive Surgery Benefits 38 Rehabilitative and Habilitative Services Benefits (Physical, Occupational and Respiratory Therapy) 38 Skilled Nursing Facility Benefits 39 Speech Therapy Benefits (Rehabilitative and Habilitative Services) 39 Transplant Benefits 39 Urgent Services Benefits 40 Principal Limitations, Exceptions, Exclusions and Reductions 40 General Exclusions and Limitations 40 Medical Necessity Exclusion 43 Table of Contents Page Limitations for Duplicate Coverage 43 Exception for Other Coverage 44 Claims Review 44 Reductions - Third Party Liability 44 Coordination of Be...
TABLE OF CONTENTS PAGE. I Recognition and Scope of Agreement 1 II NJ Department of Personnel 2 III Grievance Procedure 3-7 IV Association Business 8-9 V Bulletin Boards and Access 10 VI Health and Safety 11 VII Insurance 12 VIII Personal Days 13 IX Clothing 14 X Overtime 15-16 XI Union Security 17 XII Discipline 18 XIII Discrimination or Coercion 19 XIV Equipment 20 XV Transfer and Reassignment 21 XVI Out of Title Work 22 XVIII Vacations 24 XIX Longevity 25 XX Holidays 26 XXI Sick Leave 27 XXII Management Rights 28 XXIII Strike Clause-Slow Down-Work Action 29 XXIV Severability 30 XXV Conformity of Township Code 31 XXVI Maintenance of Benefits 32 XXVII Retirement Benefit 33 XXVII Labor Management and Increment Review 34 RECOGNITION AND SCOPE OF AGREEMENT
TABLE OF CONTENTS PAGE. Section 1. Certain Definitions 4 Section 2. Appointment of Rights Agent 8 Section 3. Issue of Right Certificates 8 Section 4. Form of Right Certificates 9 Section 5. Countersignature and Registration 10 Section 6. Transfer, Split Up, Combination and Exchange of Right Certificates; Mutilated, Destroyed, Lost or Stolen Right Certificates 10 Section 7. Exercise of Rights, Purchase Price; Expiration Date of Rights 11 Section 8. Cancellation and Destruction of Right Certificates 12 Section 9. Availability of Shares of Preferred Stock 12 Section 10. Preferred Stock Record Date 13
TABLE OF CONTENTS PAGE. ARTICLE I THE MERGER 2 1.1 The Merger 2 1.2 Effect of Merger 3 1.3 Certificate of Incorporation and By-Laws 3 1.4 Effective Time of Merger 3 1.5 ERS Directors and Officers 3 1.6 Taking of Necessary Action; Further Action 3
TABLE OF CONTENTS PAGE. ARTICLE 1
TABLE OF CONTENTS PAGE. Resignation and Reinstatement 16 Xxxxxx and Reemployment 17 Severance Pay 20 Holidays 20 Election Days 21 Vacations 22 Sick Leave 23 Catastrophic Leave 25 Leaves of Absence 26 Disability Leave 27 Parental Leave 29 Military Leaves of Absence 29 Attendance in Court 29 Educational Leave 30 Absence Without Leave 30 Hospitalization and Medical Care 31 Dental Care 34 Vision Care 34 Change in Employee Benefit Plans 34 Benefit Booklets 35 Life Insurance 35 Long Term Disability Insurance 35 State Disability Insurance 36 Promotion 36 Career Mobility 37 Part-Time Positions Which Become Full-Time 39 Table of Contents Page Geographical Displacement 39 Change of Assigned Duties 39 Pay for Work-Out-Of-Classification 40 Probationary Period 41 Performance Evaluations 42 Dismissal, Non-Punitive Discipline or Demotion for Cause 43 Grievances 43 Loss of Compensation 47 Personnel Files 47 Committees 48 Employee Assistance Committee 48 Affirmative Action Advisory Committee 48 Central Safety Committee 48 Deferred Compensation Committee 48 V.D.T 48 Separability of Provisions 49 Past Practices and Existing Memoranda of Understanding 49 Retirement Plans 49 Contracting Out 51 Term of Agreement 51 Table of Contents Page Benefits Summary 55 EXHIBIT A Accounting and Administrative Unit 57 EXHIBIT B Appraisal Unit 64 EXHIBIT C Office and Technical Services Unit 66 EXHIBIT D Library Unit 73 EXHIBIT E Engineering Unit 75 EXHIBIT F Career Opportunities Program 77
TABLE OF CONTENTS PAGE. 1. Title 1
TABLE OF CONTENTS PAGE. 1 Recognition 1 2 Definitions 1 3 Physical Examinations 1 4 Homebound Teaching 1 5 Summer School 2 6 Purchase of Protective Clothing 2 7 Grievance Procedure 2 8 Worker’s Compensation 4 9 Liability Insurance 4 10 Medical Health Insurance Benefits 5 11 Dental Health Insurance Benefits 7 12 Life Insurance 7
TABLE OF CONTENTS PAGE. Article I
TABLE OF CONTENTS PAGE. ARTICLE I DEFINITIONS 1 1.1 Account Balance 1 1.2 Adoption Date 1 1.3 Annual Compensation 1 1.4 Annual Valuation Date 1 1.5 Authorized Leaves of Absence 1 1.6 Beneficiary 1 1.7 Board 1 1.8 Break in Service 2 1.9 Code 2 1.10 Company 2 1.11 Effective Date 2 1.12 Eligible Participant 2 1.13 Employee 2 1.14 Employer 2 1.15 Employer Contribution Account 2 1.16 Employer Stock 3 1.17 Employment 3 1.18 ERISA 3 1.19 ESOP Committee 3 1.20 Fiduciaries 3 1.21 FMLA Leave 3 1.22 Hour of Service 3 1.23 Normal Retirement Date 5 1.24 Participant 5 1.25 Plan 5 1.26 Plan Administrator 5 1.27 Plan Year 5 1.28 Qualified Election Period 5 1.29 Service 5 1.30 Trust (or Trust Fund) 5 1.31 Trustee 5 1.32 Year of Service 5 ARTICLE II PARTICIPATION AND SERVICE 6 2.1 Participation 6 2.2 Service 7 2.3 Effect of Break in Service 7 2.4 Inactive Account Status 8 2.5 Transfers of Employment Among Employers 9 2.6 Election Not to Participate 9 Table of Contents Page (continued)
