Common use of Payment in Lieu of Insurance Coverage Clause in Contracts

Payment in Lieu of Insurance Coverage. 1. Any bargaining unit member currently covered under either the single or family coverage of the District’s insurance plan(s), or any newly hired employee who declares in writing to the Treasurer that he/she is covered under another insurance plan and/or elects not to be covered by the Board plan for the entire year may opt out of the Board plan(s) and shall be paid $1,500.00 for medical insurance, and/or $350 for dental insurance, and/or $100 for vision insurance (prorated for persons who have prorated insurance to the same percentage as paid by the Board for prorated insurance). This amount, less applicable payroll deductions, will be paid to eligible and qualifying individuals with the first pay in October the following year, through the Board’s qualified Section 125 Plan. 2. In order to elect any of these options and receive this additional compensation, an employee must have on file a form indicating his/her election. Once this election is made, it shall remain in effect and the employee shall not be entitled to receive the Board insurance coverage(s) that s/he elected not to receive for the duration of the one-year period, unless there is a qualifying event as described in paragraph 5., below. In the event of a change in the teacher’s circumstances after the election is made (other than a qualifying event), the teacher may elect to receive the insurance coverage after a three (3) month waiting period. They would forfeit all of the payment in lieu payments for that particular year. There shall be no pre-existing condition exclusion for any teacher who re-enters any of the insurance programs after originally electing not to participate in said programs. 3. For current employees with election forms already on file, no further action will be required in order to receive the in-lieu of payment(s). Current employees not presently participating in the opt-out payment may enroll during the open enrollment period (September 1st – September 21st each school year) by completing, signing and filing a form indicating this election with the Treasurer of the Board. It is the employee’s responsibility to get a waiver form (during open enrollment period) from the Treasurer’s office and return it by the designated date. Failure of current employees not already participating in payment in-lieu of insurance payment program to submit the required form by the designated date (end of business on the third Friday in September) shall result in a disqualification from payment of the opt-out amount. 4. At the discretion of the Board, teachers hired in any year after the September election date may be permitted to participate in the payment in lieu of insurance program and, if so, on a prorated basis. 5. Employees who are enrolled in the opt-out payment plan may opt back into Board-provided insurance coverage status only if there is a change in the employee's circumstances that, in accordance with IRC Section 125 regulations, permits the employee to change his/her election under that plan (e.g., divorce, death of spouse, change in employment status including employment status affecting a spouse or dependent, birth or adoption of a child, a child losing eligibility for coverage, a court order requiring coverage, or other enrollment rights consistent with federal law). 6. If both wife and husband are employed by the Board in any capacity in which both are entitled to receive Board paid family coverage of health, dental or vision, only family coverage shall be provided to only one spouse. The other spouse shall qualify for the payment in lieu of insurance coverage as provided in the paragraphs above. 7. If an employee selects payment in lieu of insurance as provided above, but leaves active pay status at any point prior to the end of the contract year, the employee will be paid a prorated amount based upon the proportional amount of time he/she was in active pay status for the contract year. 8. Employees interested in signing up for the “opt-out” payment must come to the Board and request the proper forms. No forms will be sent out on an annual basis. Benefit Period January 1st through December 31st Dependent Age 26; Removal upon End of Month Pre-Existing Condition Waiting Period Does Not Apply Blood Pint Deductible 0 pints Overall Annual Benefit Period Maximum Unlimited 3 month Deductible Carryover Does not Apply Benefit Period Deductible – Single/Family None None Inpatient Deductible per Admission – Single/Family None $250 per admission, to a family maximum of $750 per benefit period Coinsurance 100% 70% Coinsurance Out-of-Pocket Maximum (Excluding Deductible) – Single/Family None None Office Visit (Illness/Injury)1 $25 copay, then 100% $25 copay, then 70% Urgent Care Office Visit1 $25 copay, then 100% $25 copay, then 70% All Immunizations 100% Not Covered Allergy Testing and Treatments 100% 70% - Inpatient Not Covered – Outpatient Preventive Services, in accordance with state and federal law3 100% 70% Routine Physical Exam (Age 21 and over) (One exam per benefit period) 100% 70% Well Child Care Services including Exam, Routine Vision, Routine Hearing Exams, Well Child Care Immunizations and Laboratory Tests (To age 21) 100% 70% Routine Mammogram (One per benefit period) 100% 100% Routine Pap Test (One per benefit period) 100% 100% Routine EKG, Chest X-Ray, Complete Blood Count, Comprehensive Metabolic Panel, Urinalysis 100% 100% Routine Colonoscopy / Sigmoidoscopy 100% 100% Surgical Services 100% 70% Diagnostic Services 100% 100% Physical & Occupational Therapy (40 visits combined per benefit period then subject to medical review) $25 copay, then 100% $25 copay, then 70% Speech Therapy (10 visits per benefit period then subject to medical review) $25 copay, then 100% $25 copay, then 80% Chiropractic (20 visits per benefit period then subject to medical review) $25 copay, then 100% $25 copay, then 80% Cardiac Rehabilitation 100% 70%

Payment in Lieu of Insurance Coverage. 1. Any bargaining unit member currently An Employee, who was receiving Board covered medical and prescription insurances under either the single Section 1 or family coverage of the District’s insurance plan(s), or any newly hired an employee who declares was eligible for partial or full medical insurance coverage and who was receiving payment in writing to lieu of insurance coverage under Section 3, as of June 30, 2006 and any subsequent current employee who uses the Treasurer that he/she is covered under another healthcare insurance plan and/or elects as of June 30, 2006 or new employee may elect not to be covered by receive the Board plan for the entire year may opt out of the Board plan(s) Health Insurance coverage provided in Section 1 and shall be paid $1,500.00 for medical insurance, and/or $350 for dental insurance, and/or $100 for vision insurance (prorated for persons who have prorated insurance instead elect to the same percentage as paid by the Board for prorated insurance). This amountreceive additional compensation, less applicable payroll deductions, will be paid according to eligible and qualifying individuals with the first pay in October the following yeartable: 7+ hour employees $5000 (Family), through the Board’s qualified Section 125 Plan. 2. $1,500 (Single) 5 - 6.9 hour employees $2,500 (Family), $1,000 (Single) 4 - 4.9 hour employees $1,000 (Family), $350 (Single) In order to elect any of these options this option and receive this additional compensation, an the employee must have on must, by April 30th (June 15th in the first year of the contract), prior to the year for which they want to be paid, complete, sign and file with the Treasurer of the Board a form letter indicating his/her election. Payment will be made one year later in the following July (i.e. Notice June, 2019, payment July, 2020). Once this election is made, it shall remain in effect and the employee Employee shall not be entitled to receive the Board insurance coverage(s) that s/he elected not to receive coverage provided above for the duration of the one-year period, unless there is a qualifying event as described in paragraph 5., below. In the event of a change in the teacherEmployee’s circumstances (e.g., divorce, death of spouse, spouse loses insurance coverage) after the this election is made (other than a qualifying event)has been made, the teacher Employee may elect to receive the insurance coverage after a three (3) month waiting periodcoverage. They would forfeit all The employee must notify the Treasurer’s Office in writing of the payment change in lieu payments for that particular yearcircumstance. The employee must provide documentation of the change of circumstances at the time of notice. Coverage will commence within seven (7) days of the receipt of the notice in the Treasurer’s Office. There shall be no pre-existing condition exclusion for any teacher Employee who re-enters any of the insurance programs program provided above after originally electing not to participate in said programs. 3program. For current Newly hired employees with election forms already on filewho are eligible for healthcare benefits may, no further action will be required in order at the time of hire, elect not to receive the in-lieu of payment(s). Current employees not presently participating in the opt-out payment may enroll during the open enrollment period (September 1st – September 21st each school year) take health coverage by completing, signing submitting a letter and filing a form indicating this election it with the Treasurer of the Board. It is the employee’s responsibility to get a waiver form (during open enrollment period) from the Treasurer’s office and return it by the designated dateOffice. Failure of current employees not already participating in payment in-lieu of insurance payment program to submit the required form by the designated date (end of business on the third Friday in September) shall result in The newly hired employee would be eligible for a disqualification from payment prorated amount of the opt-above table based on their service (i.e. a new employee hired October 1st would work 9 out amount. 4. At the discretion of the Board12 months, teachers hired in any year after the September election date may be permitted to participate in the payment in lieu of insurance program 75% and, if sothey declined health insurance, on a prorated basis. 5. Employees who are enrolled they would receive 75% of the qualifying amount in the opt-out payment plan may opt back into Board-provided insurance coverage status only if there is a change in the employee's circumstances that, in accordance with IRC Section 125 regulations, permits the employee to change his/her election under that plan (e.g., divorce, death of spouse, change in employment status including employment status affecting a spouse or dependent, birth or adoption of a child, a child losing eligibility for coverage, a court order requiring coverage, or other enrollment rights consistent with federal lawJuly). 6. If both wife and husband are employed by the Board in any capacity in which both are entitled to receive Board paid family coverage of health, dental or vision, only family coverage shall be provided to only one spouse. The other spouse shall qualify for the payment in lieu of insurance coverage as provided in the paragraphs above. 7. If an employee selects payment in lieu of insurance as provided above, but leaves active pay status at any point prior to the end of the contract year, the employee will be paid a prorated amount based upon the proportional amount of time he/she was in active pay status for the contract year. 8. Employees interested in signing up for the “opt-out” payment must come to the Board and request the proper forms. No forms will be sent out on an annual basis. Benefit Period January 1st through December 31st Dependent Age 26; Removal upon End of Month Pre-Existing Condition Waiting Period Does Not Apply Blood Pint Deductible 0 pints Overall Annual Benefit Period Maximum Unlimited 3 month Deductible Carryover Does not Apply Benefit Period Deductible – Single/Family None None Inpatient Deductible per Admission – Single/Family None $250 per admission, to a family maximum of $750 per benefit period Coinsurance 100% 70% Coinsurance Out-of-Pocket Maximum (Excluding Deductible) – Single/Family None None Office Visit (Illness/Injury)1 $25 copay, then 100% $25 copay, then 70% Urgent Care Office Visit1 $25 copay, then 100% $25 copay, then 70% All Immunizations 100% Not Covered Allergy Testing and Treatments 100% 70% - Inpatient Not Covered – Outpatient Preventive Services, in accordance with state and federal law3 100% 70% Routine Physical Exam (Age 21 and over) (One exam per benefit period) 100% 70% Well Child Care Services including Exam, Routine Vision, Routine Hearing Exams, Well Child Care Immunizations and Laboratory Tests (To age 21) 100% 70% Routine Mammogram (One per benefit period) 100% 100% Routine Pap Test (One per benefit period) 100% 100% Routine EKG, Chest X-Ray, Complete Blood Count, Comprehensive Metabolic Panel, Urinalysis 100% 100% Routine Colonoscopy / Sigmoidoscopy 100% 100% Surgical Services 100% 70% Diagnostic Services 100% 100% Physical & Occupational Therapy (40 visits combined per benefit period then subject to medical review) $25 copay, then 100% $25 copay, then 70% Speech Therapy (10 visits per benefit period then subject to medical review) $25 copay, then 100% $25 copay, then 80% Chiropractic (20 visits per benefit period then subject to medical review) $25 copay, then 100% $25 copay, then 80% Cardiac Rehabilitation 100% 70%

Payment in Lieu of Insurance Coverage. 1. Any bargaining unit member currently covered under either the single or family coverage of the District’s insurance plan(s)a. An Employee, or any newly hired employee who declares in writing to the Treasurer that he/she is covered under another insurance plan and/or elects working forty (40) hours per week, may elect not to be covered by receive the Board plan for the entire year may opt out board insurance coverages provided above and instead elect to receive additional compensation of the Board plan(s$5,000 (family plan) and shall be paid or $1,500.00 for medical insurance, and/or $350 for dental insurance, and/or $100 for vision insurance 1,500 (prorated for persons who have prorated insurance to the same percentage as paid by the Board for prorated insurance). This amountsingle plan) per year, less applicable payroll deductions, will be paid to eligible and qualifying individuals with the first pay in October the following year, through the Board’s qualified Section 125 Plan. 2. b. An Employee, working less than forty (40) hours per week, may elect not to receive the board insurance coverages provided above and instead elect to receive additional compensation of $1,000. c. In order to elect any of these options this option and receive this additional compensation, an employee must have on the Employee must, by April 30 (June 15th prior to the start of the first year of the contract) prior to the year he/she elects not to receive medical and prescription coverage, complete, sign and file with the treasurer of the board a form indicating his/her electionelection for the upcoming school year. Once this election is made, it shall remain in effect and the employee Employee shall not be entitled to receive the Board insurance coverage(s) that s/he elected not to receive coverage provided above for the duration of the one-year period, unless there is a qualifying event as described in paragraph 5., below. In the event of a change in the teacherEmployee’s circumstances after the election is made (other than a “qualifying event)”, e.g., divorce, death of spouse, spouse loses insurance coverage) after this election has been made, the teacher Employee may elect to receive the insurance coverage after a three (3) month waiting period. They would forfeit all immediately notifying the Treasurer’s Office in writing of the change in his/her circumstances and is not eligible for any waiver payment in lieu payments for that particular year. There shall be no pre-existing condition exclusion for any teacher Employee who re-enters any of the insurance programs program, provided above, after originally electing not to participate in said programs. 3program. For current employees with Payment for this election forms already on file, no further action to waive medical and prescription benefits will be required made in order to receive July following the in-lieu of payment(s). Current employees not presently participating year in the opt-out payment may enroll during the open enrollment period (September 1st – September 21st each school year) by completing, signing and filing a form indicating this election with the Treasurer of the Board. It is the employee’s responsibility to get a waiver form (during open enrollment period) from the Treasurer’s office and return it by the designated date. Failure of current employees not already participating in payment in-lieu of insurance payment program to submit the required form by the designated date (end of business on the third Friday in September) shall result in a disqualification from payment of the opt-out amount. 4. At the discretion of the Board, teachers hired in any year after the September election date may be permitted to participate in the payment in lieu of insurance program and, if so, on a prorated basis. 5which benefits were waived. Employees who are enrolled in the opt-out payment married and both eligible for medical coverage under this plan are not entitled to this waiver and may opt back into Board-provided insurance coverage status have only if there is a change in the employee's circumstances that, in accordance with IRC Section 125 regulations, permits the employee to change his/her election under that plan (e.g., divorce, death of spouse, change in employment status including employment status affecting a spouse or dependent, birth or adoption of a child, a child losing eligibility for coverage, a court order requiring coverage, or other enrollment rights consistent with federal law)one family plan. 6. If both wife d. Newly hired Employees who are eligible for health care benefits may, at the time of hire, elect not to take health coverage by submitting a letter and husband are employed by filing it with the Board in any capacity in which both are entitled to receive Board paid family coverage of health, dental or vision, only family coverage shall be provided to only one spouseTreasurer’s Office. The other spouse shall qualify newly hired Employee would be eligible for the payment in lieu of insurance coverage as provided in the paragraphs above. 7. If an employee selects payment in lieu of insurance as provided above, but leaves active pay status at any point prior to the end of the contract year, the employee will be paid a prorated amount of their applicable waiver amount based upon on their service (i.e. a new Employee hired October 1st would work 9 out of 12 months, 75% and, if they declined health insurance, they would receive 75% of the proportional qualifying amount of time he/she was in active pay status for the contract yearJuly). 8. Employees interested in signing up for the “opt-out” payment must come to the Board and request the proper forms. No forms will be sent out on an annual basis. Benefit Period January 1st through December 31st Dependent Age 26; Removal upon End of Month Pre-Existing Condition Waiting Period Does Not Apply Blood Pint Deductible 0 pints Overall Annual Benefit Period Maximum Unlimited 3 month Deductible Carryover Does not Apply Benefit Period Deductible – Single/Family None None Inpatient Deductible per Admission – Single/Family None $250 per admission, to a family maximum of $750 per benefit period Coinsurance 100% 70% Coinsurance Out-of-Pocket Maximum (Excluding Deductible) – Single/Family None None Office Visit (Illness/Injury)1 $25 copay, then 100% $25 copay, then 70% Urgent Care Office Visit1 $25 copay, then 100% $25 copay, then 70% All Immunizations 100% Not Covered Allergy Testing and Treatments 100% 70% - Inpatient Not Covered – Outpatient Preventive Services, in accordance with state and federal law3 100% 70% Routine Physical Exam (Age 21 and over) (One exam per benefit period) 100% 70% Well Child Care Services including Exam, Routine Vision, Routine Hearing Exams, Well Child Care Immunizations and Laboratory Tests (To age 21) 100% 70% Routine Mammogram (One per benefit period) 100% 100% Routine Pap Test (One per benefit period) 100% 100% Routine EKG, Chest X-Ray, Complete Blood Count, Comprehensive Metabolic Panel, Urinalysis 100% 100% Routine Colonoscopy / Sigmoidoscopy 100% 100% Surgical Services 100% 70% Diagnostic Services 100% 100% Physical & Occupational Therapy (40 visits combined per benefit period then subject to medical review) $25 copay, then 100% $25 copay, then 70% Speech Therapy (10 visits per benefit period then subject to medical review) $25 copay, then 100% $25 copay, then 80% Chiropractic (20 visits per benefit period then subject to medical review) $25 copay, then 100% $25 copay, then 80% Cardiac Rehabilitation 100% 70%

Payment in Lieu of Insurance Coverage. 1. Any bargaining unit member currently An Employee, who was receiving Board covered medical and prescription insurances under either the single Section 1 or family coverage of the District’s insurance plan(s), or any newly hired an employee who declares was eligible for partial or full medical insurance coverage and who was receiving payment in writing to lieu of insurance coverage under Section 3, as of June 30, 2006 and any subsequent current employee who uses the Treasurer that he/she is covered under another healthcare insurance plan and/or elects as of June 30, 2006 or new employee may elect not to be covered by receive the Board plan for the entire year may opt out of the Board plan(s) Health Insurance coverage provided in Section 1 and shall be paid $1,500.00 for medical insurance, and/or $350 for dental insurance, and/or $100 for vision insurance (prorated for persons who have prorated insurance instead elect to the same percentage as paid by the Board for prorated insurance). This amountreceive additional compensation, less applicable payroll deductions, will be paid according to eligible and qualifying individuals with the first pay in October the following yeartable: 7+ hour employees $5000 (Family), through the Board’s qualified Section 125 Plan. 2. $1,500 (Single) 5 - 6.9 hour employees $2,500 (Family), $1,000 (Single) 4 - 4.9 hour employees $1,000 (Family), $350 (Single) In order to elect any of these options this option and receive this additional compensation, an the employee must have on must, by April 30th (June 15th in the first year of the contract), prior to the year for which they want to be paid, complete, sign and file with the Treasurer of the Board a form letter indicating his/her election. Payment will be made one year later in the following July (i.e. Notice June, 2014, payment July, 2015). Once this election is made, it shall remain in effect and the employee Employee shall not be entitled to receive the Board insurance coverage(s) that s/he elected not to receive coverage provided above for the duration of the one-year period, unless there is a qualifying event as described in paragraph 5., below. In the event of a change in the teacherEmployee’s circumstances (e.g., divorce, death of spouse, spouse loses insurance coverage) after the this election is made (other than a qualifying event)has been made, the teacher Employee may elect to receive the insurance coverage after a three (3) month waiting periodcoverage. They would forfeit all The employee must notify the Treasurer’s Office in writing of the payment change in lieu payments for that particular yearcircumstance. The employee must provide documentation of the change of circumstances at the time of notice. Coverage will commence within 7 days of the receipt of the notice in the Treasurer’s Office. There shall be no pre-existing condition exclusion for any teacher Employee who re-enters any of the insurance programs program provided above after originally electing not to participate in said programs. 3program. For current Newly hired employees with election forms already on filewho are eligible for healthcare benefits may, no further action will be required in order at the time of hire, elect not to receive the in-lieu of payment(s). Current employees not presently participating in the opt-out payment may enroll during the open enrollment period (September 1st – September 21st each school year) take health coverage by completing, signing submitting a letter and filing a form indicating this election it with the Treasurer of the Board. It is the employee’s responsibility to get a waiver form (during open enrollment period) from the Treasurer’s office and return it by the designated dateOffice. Failure of current employees not already participating in payment in-lieu of insurance payment program to submit the required form by the designated date (end of business on the third Friday in September) shall result in The newly hired employee would be eligible for a disqualification from payment prorated amount of the opt-above table based on their service (i.e. a new employee hired October 1st would work 9 out amount. 4. At the discretion of the Board12 months, teachers hired in any year after the September election date may be permitted to participate in the payment in lieu of insurance program 75% and, if sothey declined health insurance, on a prorated basis. 5. Employees who are enrolled they would receive 75% of the qualifying amount in the opt-out payment plan may opt back into Board-provided insurance coverage status only if there is a change in the employee's circumstances that, in accordance with IRC Section 125 regulations, permits the employee to change his/her election under that plan (e.g., divorce, death of spouse, change in employment status including employment status affecting a spouse or dependent, birth or adoption of a child, a child losing eligibility for coverage, a court order requiring coverage, or other enrollment rights consistent with federal lawJuly). 6. If both wife and husband are employed by the Board in any capacity in which both are entitled to receive Board paid family coverage of health, dental or vision, only family coverage shall be provided to only one spouse. The other spouse shall qualify for the payment in lieu of insurance coverage as provided in the paragraphs above. 7. If an employee selects payment in lieu of insurance as provided above, but leaves active pay status at any point prior to the end of the contract year, the employee will be paid a prorated amount based upon the proportional amount of time he/she was in active pay status for the contract year. 8. Employees interested in signing up for the “opt-out” payment must come to the Board and request the proper forms. No forms will be sent out on an annual basis. Benefit Period January 1st through December 31st Dependent Age 26; Removal upon End of Month Pre-Existing Condition Waiting Period Does Not Apply Blood Pint Deductible 0 pints Overall Annual Benefit Period Maximum Unlimited 3 month Deductible Carryover Does not Apply Benefit Period Deductible – Single/Family None None Inpatient Deductible per Admission – Single/Family None $250 per admission, to a family maximum of $750 per benefit period Coinsurance 100% 70% Coinsurance Out-of-Pocket Maximum (Excluding Deductible) – Single/Family None None Office Visit (Illness/Injury)1 $25 copay, then 100% $25 copay, then 70% Urgent Care Office Visit1 $25 copay, then 100% $25 copay, then 70% All Immunizations 100% Not Covered Allergy Testing and Treatments 100% 70% - Inpatient Not Covered – Outpatient Preventive Services, in accordance with state and federal law3 100% 70% Routine Physical Exam (Age 21 and over) (One exam per benefit period) 100% 70% Well Child Care Services including Exam, Routine Vision, Routine Hearing Exams, Well Child Care Immunizations and Laboratory Tests (To age 21) 100% 70% Routine Mammogram (One per benefit period) 100% 100% Routine Pap Test (One per benefit period) 100% 100% Routine EKG, Chest X-Ray, Complete Blood Count, Comprehensive Metabolic Panel, Urinalysis 100% 100% Routine Colonoscopy / Sigmoidoscopy 100% 100% Surgical Services 100% 70% Diagnostic Services 100% 100% Physical & Occupational Therapy (40 visits combined per benefit period then subject to medical review) $25 copay, then 100% $25 copay, then 70% Speech Therapy (10 visits per benefit period then subject to medical review) $25 copay, then 100% $25 copay, then 80% Chiropractic (20 visits per benefit period then subject to medical review) $25 copay, then 100% $25 copay, then 80% Cardiac Rehabilitation 100% 70%