Plan Type. Combination Plan Type Option 1 (Retiree is Medicare eligible, but dependent(s) are not) Level of Coverage City Monthly Contribution Medicare Retiree+1 Basic Dependent $937.30 Medicare Retiree+2 or more Basic Dependents $1,321.01 Medicare Retiree+1 Medicare Dependent+1 or more Basic Dependent(s) $974.16
Plan Type. The Vendor (Health Plan) is approved to provide contracted services as the following health plan type as denoted by “X”: TABLE 1 Health Maintenance Organization (HMO) Fee- for-Service (FFS) Provider Service Network (PSN) Capitated PSN Specialty Health Plan for Children with Chronic Conditions Specialty Plan for Recipients Living with HIV/AIDS X
Plan Type. The Basic Separation Program provides severance benefits to eligible employees of the Company (and its subsidiaries). The Insured-Unfunded Plan also provides other employee benefits, the terms of which are described in separate summary plan descriptions. Plan Administrator: The Procter & Xxxxxx U.S. Business Services Company, c/o U.S. Benefits Manager, P&G Plaza, TE-3, Xxxxxxxxxx, XX 00000, [phone].
Plan Type. Combination Plan Type Option 2 (Retiree is not Medicare eligible, but one or more dependent(s) are) Level of Coverage City Monthly Contribution Basic Retiree+1 Medicare Dependent $937.30 Basic Retiree+2 or more Medicare Dependents $1,235.10 Basic Retiree+1 Basic Dependent+1 or more Medicare Dependent(s) $1,321.01 Retiree contributions will vary based on future changes to health premiums and health plan selected. However, the City contribution shall be capped at the levels listed above. City contributions to medical premiums shall not exceed 100% of the premium cost for the applicable level of Kaiser coverage.
Plan Type. The Iron Workers District Council of Southern Ohio & Vicinity Annuity Trust is a money purchase plan under Internal Revenue Code Section 401(a). 1-800-743-5274 Iron Workers District Council of Southern Ohio & Vicinity Annuity Trust Contract Number: MR 60359-001 DISTRIBUTION FORM • This form authorizes a distribution from the Iron Workers District Council of Southern Ohio & Vicinity Annuity Trust. • Participants must complete Sections 1 through 5 and return this form to the Iron Workers District Council of Southern Ohio & Vicinity. • If you are choosing a direct rollover to another qualified plan or IRA you must also complete Section #4. • If you are married your spouse must complete and enclose the Spousal Consent Form. • This form is not valid without your signature under Section #5 and the Fund Office’s countersignature.
Plan Type. The Iron Workers District Council of Southern Ohio & Vicinity Annuity Trust is a money purchase plan under Internal Revenue Code Section 401(a). 1-800-743-5274 Iron Workers District Council of Southern Ohio & Vicinity Annuity Trust Contract Number: MR60359-001 BENEFICIARY AND ALTERNATE PAYEE DISTRIBUTION FORM • Use this form to request a distribution as a beneficiary following the death of the participant or as an alternate payee under a qualified domestic relations order. • Complete all of this form in ink and provide signatures where indicated. • To request a distribution as a participant following termination of employment, use the Distribution Form. • Your choices on this form may affect your taxes. You may wish to consult your own tax or financial advisor. • Please return completed form to the address below.
Plan Type. 1. The Managed Care Plan is approved to provide contracted services as denoted by "X" in Table 1, LTC Plan Type, below. TABLE LTC Plan Type Effective Date 08/0.1143'.4,•08/31118 C pitated Managed Care Plan Fee-for-Service (FFS) Managed Care Plan* LTC Exclusive Provider provider Service Organization Network (EPO) (LTC PSN) van age §0000r N0e4P1011 (MA SNP) LTC Provider Service Network (LTC PSN) X * FFS Managed Care Plans are capitated by the Agency for transportation only.
Plan Type. For the 2024-2025 school years and to be determined for the 2025-2026 school year, the School District shall use the Educators Health Alliance (EHA) health and dental insurance Blue Preferred $650 Deductible $2,500 Deductible Dual Choice Plan with Employee PPO -.80% A & B, with 50% C coverage at the premium cost established annually by the EHA for the 2024-2025 fiscal years. New employees are not covered by Health Insurance until September 1. If hired after the start of the school year, coverage begins on the first day of the month following employment.
Plan Type. For the 2013-14 school year the School District shall use the Educators Health Alliance (EHA) health and dental insurance Blue Preferred $500 Deductible /$1,650 Deductible Dual Choice Plan with Employee PPO -.80% A & B, with 50% C coverage at the premium cost established annually by the EHA for the 2013-2014 fiscal year.
Plan Type. For the 2021-22 school year the School District shall provide and pay 100% of the cost to all 1.0 full time equivalency (FTE) teachers, the Educators Health Alliance (EHA) health and dental insurance Blue Preferred $1050 Deductible or the $2500 Deductible (Dual Choice, PPO, $1050 or $2500 deductible) plan with Employee (self-only) PPO -.80% A & B, with 50% C coverage at the premium cost established annually by the EHA for the 2021-2022 fiscal year; the School District’s contribution toward the premium cost of health and dental insurance coverage and the fringe benefit stipend shall be prorated for teachers with an FTE (full-time-equivalency) of less than 1.0 on the basis of such FTE.
