Common use of Provisions of Coverage Clause in Contracts

Provisions of Coverage. Provisions of health care insurance program shall be detailed in master policies and contracts and shall include: a. Hospital room and board and miscellaneous costs b. Out-patient benefits c. Laboratory fees, diagnostic expenses and therapy treatments d. Maternity costs e. Surgical costs f. Major Medical coverage, lifetime maximum unlimited g. Co-pay for office visits: $10.00 per visit h. Prescription Coverage co-pay - $10.00 generic; $20.00 preferred brand on drug plan list and $35.00 for non preferred name brand drugs not listed. Mail order prescriptions are subject to the same co-pays for each category. i. Employees will not have the ability to submit prescription drug co-pays for reimbursement through Major Medical. j. Deductibles of $300.00 for single coverage and $600.00 for family coverage k. Out of network coverage percentage of 70%/30%

Provisions of Coverage. Provisions of health care insurance program shall be detailed in master policies and contracts and shall include: a. Hospital room and board and miscellaneous costs b. Out-patient benefits c. Laboratory fees, diagnostic expenses and therapy treatments d. Maternity costs e. Surgical costs f. Major Medical coverage, lifetime maximum unlimited g. Co-pay for office visits: $10.00 20.00 per visit h. Prescription Coverage co-pay - $10.00 generic; $20.00 preferred brand on drug plan list and $35.00 for non preferred name brand drugs not listed. Mail order prescriptions are subject to the same co-pays for each category. i. Employees will not have the ability to submit prescription drug co-pays for reimbursement through Major Medical. j. Deductibles of $300.00 for single coverage and $600.00 for family coverage k. Out of network coverage percentage of 70%/30%