contribution of $125 montly for a single plan and $250 monthly for 2-person or
family plan for each full month remaining in that fiscal year.
d.__ Annual disbursement of HSA contribution in two (2) installments (July and October)
— The Board’s contribution will be distributed in two (2) installments, one on or
about July 1 and one on or about October 1, provided however that if an employee
is required to pay more towards his/her deductible than the initial 50%
contribution, upon presentation of suitable documentation, the City will contribute
the reraaining 50% before October 1.
Healthtasurance
The-District shail provide upen the request-etan-administrates,the-benctits-cfar-individust
tve-sersen-o-foricovemasuaderene—otthefolleunna-plens offered bu the Mead of
Education-ora-com parable plas-as-determined by the Baard:
a}_—_aint-eftersise-Bloa:
6}——__HIMO-Plan;or
e}—___Anadditione| plan-made available threughthe Board with baneit-levelsand premiue—
———_«estshoring-determined bythe Bese.
Healthcare plan-optiontareat-thegele discretion ofthe Beard-andthe Beard reserves the right
te-change- o-heath-insurance-comicanreviging semearable.bemeatits, Fhe District chal baue tha
night te-provide-_precseriptonbenoits threuch-2teparatc—srovider managed-bu.2-skopmacy
benefits menagen
Amy adminisiete:requesting—tinitial_ membersstio—in—e—plen—may_enterduring acpected
enrolliment-_paried._Any eligible-administrater-dasiting-to-celoct-a-different-plan-may make such
achenge-cnldudagtieareuscaretiment peciedecagualhing vert
The-group_health-iacuranee-of-any adminitratertorminatiag-employment-with the District-for
whateverreasen—racignation—retirement—tayeff—discharge-or-uapaid_leave-of-absence-other
than-cickteave—shall-oxpire-on-the-last-day of the-monthfollowing the meath the-administeator
terminetesempleymenbwiththe > otc
Fhe—Distrist-chail-contibute-70%-af the. premiumforapointeflrerice plan_and-2054-al-ihe
premiumforontiVie-slten—Alplans-effereq-bu the distctshallhave-thefelowineca-pouc ane
deductibles:
b} One-Hundred Dollars ($100.00) per-emergency ream visit:
€}_Twe-Hundred—-ifty Dallars{$250.00} perpersen, Five-Hundred—Doltars($500.00}-per
twa-person/Familyinpatient/Outpatient- Facility Deduetible:
d}—Three+{3} Tier Pharmacy Benefit-of $5595 (55/30/70 mailorder,
Specific provisions of each plan, including pharmacy benefits, will be provided to each employee
at the time of hire, upon request, or in advance of any changes to the benefits provided by a
plan.
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