Option 1: Physician Open Access (POA) Sample Clauses

Option 1: Physician Open Access (POA). The POA gives you “open access” to the doctor (or hospital) of your choice, without requiring a referral. Each time you need care, you decide which type of doctor to see and whether to receive services from an in-network provider (one who participates in the plan network) or from an out- of-network provider. Even though you may seek care from any provider, it’s still important to review the extensive network of participating hospitals, doctors, and other providers. That’s because more of your out- of-pocket costs are covered when you use an in-network provider. You’re free to receive care from any network provider to qualify for in-network benefits. When you do, office visits are covered at 100% after a co-payment. Preventive Care Office Visits are covered at 100%. Prescription drugs are covered at 100% after a co-payment that is determined based upon whether the drug is filled with a generic, preferred brand name, or non-preferred brand name. You can receive up to a 30-day supply through a retail pharmacy, and a 90-day supply through the mail-order program. Most other services are subject to an annual deductible, coinsurance, and an out-of-pocket maximum. Listed below is a summary of some fees for commonly used services from network providers. Through After 12/31/2124 12/31/2124 Preventive Care Office Visit $-0- $-0- Office Visits (PCP) $35 $3545 Office Visits (Specialist) $100/50 $100/50 110/55 Cardiac Rehabilitation $-0- $-0- Physical Therapy Office Visit $50 $5055 Chiropractic Office Visit $50 $5055 Allergy Shots Office Visit office visit office visit Prescription Drugs Retail (30-day supply) $10/5060/120130 $10/60/130 Mail Order (90-day supply) $20/100110/240250 $20/110/250 X-rays, Labs, Diagnostics 20%; after deductible 20%; after deductible Emergency Room 20%; after deductible 20%; after deductible Inpatient Hospital Stay 20%; after deductible 20%; after deductible Outpatient Surgery 20%; after deductible 20%; after deductible Here is how your share of the cost for care is determined for those services where coinsurance applies. (Co-payments for office visits and prescription drugs do not count toward the annual deductible and out-of-pocket maximum.) Unless specifically stated above, you need to meet the annual deductible. For in-network care, the annual deductible is: Per Person $600 $800 $600 $800 $800 $1,200 $800 $1,200 Maximum Per Family $1,200 $1,600 $1,200 $1,600 $1,600 $2,400 $1,600 $2,400 Once you meet the annual deductible, you will begin t...
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Option 1: Physician Open Access (POA). The option gives you “open access” to the doctor (or hospital) of your choice, without requiring a referral. Each time you need care, you decide which type of doctor to see and whether to receive services from an in-network provider (one who participates in the plan network) or from an out-of- network provider. Even though you may seek care from any provider, it’s still important to review the extensive network of participating hospitals, doctors, and other providers. That’s because more of your out-of- pocket costs are covered when you use an in-network provider. You’re free to receive care from any network provider to qualify for in-network benefits. When you do, office visits and preventive care (including Mammograms, annual physicals, and immunizations) are covered at 100% after a $15 co-payment. Prescription drugs are covered at 100% after a co-payment that is determined based upon whether the drug is filled with a generic, preferred brand name, or non-preferred brand name. You can receive up to a 30-day supply through a retail pharmacy, and a 90-day supply through the mail-order program. Most other services are subject to an annual deductible, coinsurance, and an out-of-pocket maximum. Listed below is a summary of some fees for commonly used services from network providers. Preventive Care Office Visit $15 Office Visits (PCP or Specialist) $15 Physical Therapy Office Visit $15 Chiropractic Office Visit $15 Allergy Shots Office Visit $15 Prescription Drugs Retail (30-day supply) $10/20/35 Mail Order (90-day supply) $20/40/70 X-rays, Labs, Diagnostics 15%; no deductible Emergency Room 15%; after deductible Inpatient Hospital Stay 15%; after deductible Outpatient Surgery 15%; after deductible Here is how your share of the cost for care is determined for those services where coinsurance applies. (Co-payments for office visits and prescription drugs do not count toward the annual deductible and out-of-pocket maximum.) Unless specifically stated above, you need to meet the annual deductible. For in-network care, the annual deductible is: Per Person $100 $150 $200 $250 Maximum Per Family $200 $300 $400 $500 Once you meet the annual deductible, you will begin to pay a percentage of covered services. After your deductible and share of coinsurance reaches the out-of-pocket maximum, then the plan pays the remainder of covered services (excluding co-payments) for the rest of the year. This means the plan pays 100% of the usual, customary and reasonable costs for...
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Related to Option 1: Physician Open Access (POA)

  • Physician Visits This plan covers the services of a physician or other provider in charge of your medical care while you are inpatient in a general or specialty hospital.

  • STATEWIDE ACHIEVEMENT TESTING When CONTRACTOR is a NPS, per implementation of Senate Bill 484, CONTRACTOR shall administer all Statewide assessments within the California Assessment of Student Performance and Progress (“CAASPP”), Desired Results Developmental Profile (“DRDP”), California Alternative Assessment (“CAA”), achievement and abilities tests (using LEA-authorized assessment instruments), the Fitness Gram, , the English Language Proficiency Assessments for California (“ELPAC”), and as appropriate to the student, and mandated by LEA pursuant to LEA and state and federal guidelines. CONTRACTOR is subject to the alternative accountability system developed pursuant to Education Code section 52052, in the same manner as public schools. Each LEA student placed with CONTRACTOR by the LEA shall be tested by qualified staff of CONTRACTOR in accordance with that accountability program. ▇▇▇ shall provide test administration training to CONTRACTOR’S qualified staff. CONTRACTOR shall attend LEA test training and comply with completion of all coding requirements as required by ▇▇▇.

  • Reporting of Total Compensation of Subrecipient Executives 1. Applicability and what to report. Unless you are exempt as provided in paragraph d. of this award term, for each first-tier subrecipient under this award, you shall report the names and total compensation of each of the subrecipient's five most highly compensated executives for the subrecipient's preceding completed fiscal year, if-- i. in the subrecipient's preceding fiscal year, the subrecipient received-- (A) 80 percent or more of its annual gross revenues from Federal procurement contracts (and subcontracts) and Federal financial assistance subject to the Transparency Act, as defined at 2 CFR 170.320 (and subawards); and (B) $25,000,000 or more in annual gross revenues from Federal procurement contracts (and subcontracts), and Federal financial assistance subject to the Transparency Act (and subawards); and ii. The public does not have access to information about the compensation of the executives through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986. (To determine if the public has access to the compensation information, see the U.S. Security and Exchange Commission total compensation filings at ▇▇▇▇://▇▇▇.▇▇▇.▇▇▇/answers/execomp.htm.) 2. Where and when to report. You must report subrecipient executive total compensation described in paragraph c.1. of this award term: i. To the recipient. ii. By the end of the month following the month during which you make the subaward. For example, if a subaward is obligated on any date during the month of October of a given year (i.e., between October 1 and 31), you must report any required compensation information of the subrecipient by November 30 of that year.

  • PROFESSIONAL DEVELOPMENT AND EDUCATIONAL IMPROVEMENT A. Both the Board and the Association encourage teachers to seek professional improvement. In order to assist teachers in extending and improving their skills the following plan will be implemented. B. All Teachers will be encouraged to earn a Masters degree or coursework toward additional certification that is in the field of education and within a teacher's discipline, or in an area that is beneficial to the school. C. The Board will pay teacher's expenses for undergraduate and/or graduate credits, specialty and additional endorsements under the following conditions. 1. In allocating budgeted funds priority will be given to the teachers in a “masters” program and those teachers who need to complete coursework for certification. 2. All courses must be approved, in advance, by the Superintendent. Courses for recertification purposes must be approved in advance by the certification committee and the superintendent. The teacher shall receive a written reply from the Superintendent within ten (10) days of application for course approval (See Appendix D). 3. Each teacher will be eligible for up to six (6) semester hours of credit or, if enrolled in a matriculated, organized program, 12 semester hours of credit for undergraduate will be paid if part of a graduate program or graduate courses per contract year. The Superintendent reserves the right to request intent to take courses prior to final budget preparation. Failure to communicate such intent at the time of the Superintendent’s request may jeopardize course reimbursement due to a lack of funding. 4. The administration will pay in advance the cost of the course. Presentation of evidence of satisfactory completion of the course (A grade of B or better) is the responsibility of the teacher. In the event the course is not completed or not completed satisfactorily, the teacher will refund the payment received in advance and in accordance with Appendix D – attached. 5. Teachers who resign shall not be eligible for reimbursement after the date of resignation Teachers who have been reimbursed for any course work toward securing a masters within the last two (2) years of employment shall be required to continue their service to RSU # 78 for an additional two (2) years (twenty-four months) or will be required to reimburse the district the cost associated with Masters courses taken prior to departing, Such reimbursement to the district shall be remitted via payroll deductions as arranged between the District and employee, unless the failure to continue employment is due to illness, disability, death, or reduction of position. 6. Reimbursement will only be for tuition and fees. It will not include reimbursement for mileage, books and other expenses unless the teacher is required to take the course by the administration.

  • Contract for Professional Services of Physicians, Optometrists, and Registered Nurses In accordance with Senate Bill 799, Acts 2021, 87th Leg., R.S., if Texas Government Code, Section 2254.008(a)(2) is applicable to this Contract, Contractor affirms that it possesses the necessary occupational licenses and experience.