Coverage and Benefits Clause Samples

Coverage and Benefits. Benefits – Extended Health Benefit and Dental Plans will benchmark to the Industry Pattern in the PPWC Health and Welfare Trust. Adjustments will come into effect the date of ratification of our new Labour Agreement (September 24, 2019). Future adjustments will come into effect on the date that changes are applied in the PPWC Health & Welfare Trust. In the event that Drug Cards are included in the Joint Labour Agreement settlement and applied in the H&W Trust, it will be adopted in our EHB Plan. Summer Students covered under this agreement are not eligible for coverage under Exhibit B Welfare Plan.

Coverage and Benefits. This agreement covers the BBSD device loaned to the student and any temporary devices loaned to a student, not including daily loaners, against some incidents of accidental damage. The following items are NOT covered: • A device that is lost or stolen. • Damage caused by negligence including, but not limited to leaving it outside in an automobile, immersion in liquid, any type of damage caused by food or liquid, damage caused by pets, rough/inappropriate handling, etc. • Intentional misuse of one’s own or a peer’s device • More than one accidental incident, including more than one broken screen or accessory • Loss of power adapter/cord It is agreed and understood that: • It will be the right of the principal or his/her designee to determine if damages were due to negligence or accidental in nature. • The principal reserves the right to determine the cost of repair/replacement and to assess such charges. Students must clear all device fees before participating in school-related events, including attendance at sports, dances, and graduation. Students will not be issued a new device until all fees are satisfied. • The principal will review all damages determined to be from misuse or negligence and will assess student’s continued privilege of taking the device to and from school. Effective and Expiration This coverage is effective from the date this form and payment are received by the school through the date when the device is to be returned in good working condition to the school or at least by the end of the current school year. Premium The current total premium cost is $30 paid annually. The premium for students that qualify for free and reduced lunch is $15 (per student) paid annually. Partial semesters/years are not refundable. The current replacement costs for devices not covered under this insurance plan is: • Charger - $30.00 • Screen damage - $50.00 • Chromebook - $225.00 • Surface Laptop - $248.00

Coverage and Benefits a) Group Term Life Insurance

Coverage and Benefits. A. Group Term Life Insurance The Welfare Plan will include Group Term Life Insurance coverage in accordance with the Table. Benefits will be payable as a result of death from any cause on a twenty- four (24) hour coverage basis. B. Accidental Death or Dismemberment Insurance In addition to the above Group Term Life Insurance coverage the Welfare Plan will include Accidental Death Insurance as out-lined in the Table on a twenty-four (24) hour coverage basis. Accidental Death and Dismemberment coverage Schedule to reflect current insurance carriers’ benefit levels. Provide coverage for quadriplegia, paraplegia and hemiplegia at 200%. C. Non-occupational Accident and Sickness Insurance The Welfare Plan will include Non-Occupational Accident and Sickness Insurance that will provide a benefit of sixty percent (60%) of the employee’s regular job rate to the maximums in the following table. Effective Date Benefit Maximum May 1, 2012 $845.00 per week May 1, 2013 $845.00 per week May 1, 2014 $845.00 per week May 1, 2015 $860.00 per week May 1, 2016 $880.00 per week Note: The increases effective May 1, 2010 and May 1, 2011 reflect the May 1, 2009 benefit being increased in accordance with the general wage increases effective on those dates. Weekly Indemnity (WI) benefits will be payable beginning with the first day of disability caused by non-occupational accident and beginning with the fourth day of disability caused by non-occupational sickness, except that in those cases of non-occupational sickness, which results in the claimant being hospitalized as a bed patient, and in those cases where surgery is performed which necessitates loss of time from work, the said Weekly Indemnity benefits will be payable beginning with the first day of sickness. Benefits will be payable for a maximum of fifty-two (52) weeks during any one period of disability. Only one (1) waiting period will be required for serious illnesses which require kidney dialysis, chemotherapy, radiation or other similar recurring treatments. This will provide benefits, after the initial waiting period, for any subsequent lost time. Weekly Indemnity benefits which begin prior to age 65 will continue until the employee has received at least fifteen

Coverage and Benefits. Injuries on or After 1 July 2015 7.1 Those workers who are injured on or after 1 July 2015 in circumstances where the worker: (a) Is temporarily or permanently incapacitated for work as a result of a physical or psychological injury sustained when he or she was on duty or lawfully exercising the duties of a worker in their employment; and (b) The injury – i. Resulted from conduct directed at the worker that constitutes a criminal offence; or ii. Occurred as a direct and immediate result of conduct that constitutes a criminal offence in the course of the workers employment or conduct that appears to be criminal; or iii. Occurred as a direct and immediate result of conduct that constitutes a criminal offence; or iv. Occurred in other circumstances where the worker is placed in a dangerous situation in the course of, or as a consequence of, acting in, or engaging in, their duties or position excluding psychological injury other than that caused as a consequence of a specific incident or incidents. (c) Has an accepted claim pursuant to the Return to Work Act 2014; and (d) Has had their individual entitlements exhausted pursuant to the Return to Work Act 2014; and (e) Has not been assessed as having a 30% or more Whole Person Impairment (WPI); and (f) Has not made a return to work within the meaning of the Return to Work Act 2014; will be provided on the following basis: 7.2 In the case of medical expenses, ongoing cover for such expenses as are reasonably and necessarily incurred as a direct result of such accepted claim (other than those already covered by the Employer); or 7.3 A redemption of medical expenses referred to in 7.2. 7.4 In the case of financial support: (a) A top-up payment to achieve 80% notional weekly earnings or 80% of the difference between actual earnings and notional weekly earnings until retirement or return to work, subject to a work capacity review as per the Workers Rehabilitation and Compensation Act 1986 and meeting the mutual obligations set out in this policy; or (b) A redemption of 7.4(a).

Coverage and Benefits for Retiree Health Care Benefits will mirror the plan design of existing active employee health care benefits (i.e., retiree benefits change when active employee benefits change). The retiree will pay only that amount of premium above the “hard cap” amount as published by the State in regard to Public Act 152. In no event shall prescription drug coverage for retirees exceed that offered to active employees. 1. The Township shall terminate the participation TPOAM members in the MERS Health Care Savings Plan effective as soon as possible. If an employee terminates employment prior to the ten (10) year vesting period, the previously contributed Employer’ s contribution on behalf of the employee shall be forfeited and the forfeited funds shall be rolled over into the Township's retiree health funding vehicle. 2. Those employees that contributed 1% of their base salary to the program shall remain with the MERS Health Care Savings Plan until the employee separates employment from Pittsfield Charter Township.

Coverage and Benefits. Effective January 1, 2020, the District implemented the State’s mandatory insurance program administered by the Washington Health Care Authority through the School Employees Benefits Board (SEBB). The District shall pay the full portion of the employer contribution as adopted in the School Employees Health Care Coalition agreement for all employees who meet the HCA’s eligibility requirements.

Coverage and Benefits for Retiree Health Care Benefits will mirror the plan design of existing active employee health care benefits (i.e., retiree benefits change when active employee benefits change). In no event shall prescription drug coverage for retirees exceed that offered to active employees. 1. The Township shall terminate the participation TPOAM members in the MERS Health Care Savings Plan effective as soon as possible. If an employee terminates employment prior to the ten (10) year vesting period, the previously contributed Employer's contribution on behalf of the employee shall be forfeited and the forfeited funds shall be rolled over into the Township's retiree health funding vehicle. 2. Those employees that contributed 1% of their base salary to the program shall remain with the MERS Health Care Savings Plan until the employee separates employment from Pittsfield Charter Township.

Coverage and Benefits. ENT & Allergy Health Services does not verify coverage or benefits (what your plan covers); this is the patient’s responsibility. We strongly urge you to verify coverage and benefits. The codes that pertain to your services will be marked below. Some questions you may want to ask are: 95115 - 95117 Injection 95165 ▇▇▇▇▇▇▇ (▇▇▇▇▇, ▇▇▇▇▇▇, ▇▇▇.) ▇▇▇▇▇ – 95146 – 95147 95148 - 95148 Antigen (stinging insect) ICD-10 Codes Description