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                                                                                                                                Appendix 2

 

Dental Benefits for Employees and Dependents

 

 

Maximum Benefit per Calendar Year

(Class I, II  and III Dental Services Only)........... $  1,000

 

Orthodontic Limit, Lifetime Maximum

(for Class IV Dental Services) ....................... $    750

 

Individual Deductible Amount ....... ................. $     50

 

Family Deductible Amount ............................. $    100

 

The Deductible does not apply to Class IV (Orthodontic)

Dental Services.

 

The Maximum Payment for each Dental Service will be the percentage of the Covered Dental Expense incurred for that service as shown below:

 

         Dental Service                    Payable At

            Class I   .....................   100%

            Class II  .....................    75%

            Class III .....................    50%

            Class IV  .....................    50%

      

                                      Appendix 3

 

Summary of Retirement Medical Plan Options

 

Benefits at retirement are based upon the employee's age and service.  The employee may elect one of the following coverages for himself and any family member presently enrolled in an NJTRO plan.

 

I.  Basic Early Retirement Plan

 

Cost: Employer Paid

 

Eligibility: Employee must be 61 years old with 30 or more years of service at date of retirement.

 

Deductible: $100 per individual per calendar year.

 

Plan Pays: 80% of reasonable and customary charges for eligible medical                                     expenses.

 

           65% of reasonable and customary charges for mental or nervous                                    disorders.

 

Maximum Lifetime Benefit: $75,000

 

Covered Expenses: 1.) Hospital

                  2.) Physicians' and Nurses' Services

                  3.) Radiation Therapy

                  4.) Anesthesia

                  5.) Medical Supplies

                  6.) Prescription Drugs

 

II.  Enriched Early Retirement Plan

 

Cost: Employee pays the Enriched portion only.  Balance paid by Employer.

 

Eligibility: Employee must be 61 years old with 30 or more years of service at date of retirement.  Eligible employees must enroll within 30 days of termination of coverage under the health and welfare program provided to active employees.

 

Deductible: $100 per individual per calendar year.

 

Plan Pays: 80% of reasonable and customary charges for eligible medical                                     expenses until an employee reaches an out-of-pocket maximum of $1000                                per year, then the Plan pays 100%.

 

           65% of reasonable and customary charges for mental or nervous disorders.

 

Maximum Lifetime Benefit:  $250,000

 

Covered Expenses: 1.) Hospital

                  2.) Physicians' and Nurses' Services.

                  3.) Radiation Therapy

                  4.) Anesthesia

                  5.) Medical Supplies

                  6.) Prescription Drugs

 

III.  Medicare Supplement Plan

 

Cost: Employee pays entire Premium.

 

Eligibility: Employee must be 65 years old.

 

Deductible: $50 per individual per calendar year.

 

Plan Pays: 1.) Hospital Inpatient

 

Medicare Supplement Plan (Hospital inpatient pays for Medicare Part A                               deductible)

 

           2.) Major Medical Expenses

 

Medicare Supplement Plan (Surgical & Medical insurance) covers the          Medicare deductible and 80% of reasonable and customary charges.

 

Maximum Lifetime Benefit:  $100,000 per person

 

Covered Expenses: 1.) Hospital Medicare Part A Deductible

                  2.) Medicare Part B Deductible

                  3.) Ambulatory Surgical Center

                  4.) Physicians, Psychologists, or Licensed Nurses

                  5.) Radiation

                  6.) Anesthesia

                  7.) Medical Supplies

                  8.) Prescription Drugs

                  9.) Licensed Ambulance Service

                  10.) Outpatient Mental Illness

                     Appendix 3a

                                              

Health and Welfare cost containment changes:

 

 

All hospital admissions require pre‑certification. Room and board charges will be paid at 100% when pre‑certified. If the pre‑certification process is not followed, a 35% penalty will be imposed on hospital room and board charges.

 

Managed Second Surgical Opinion required for designated elective surgeries. Failure to comply with the procedures shall result in a 50% penalty on the surgeon's fee.

 

Mammography to be eligible under Major Medical.

 

The Mental/Nervous/Substance Abuse benefit shall be as follows:

 

Network Benefits                        Case Management referral to specific provider required for

                        defined program of treatment

 

         In‑patient Hospital                                                    100% up to 60 days/year

 

In‑patient Medical                                                     100% up to 60 days/year

 

Intensive Outpatient                            $5 per visit co‑pay 2-programs/year limit, 40-visits/year maximum.

 

Out‑patient                                          $0 co‑pay for first three (3) visits

                                                            $5 co‑pay for group sessions

                                                            $15 co‑pay for individual sessions

                                                            60 visits/year maximum

 

Employee/Dependent

Voluntary Treatment                        Unless specifically requested by the individual seeking treatment, NJ

                                                          Transit’s Employee Assistance Program (EAP) will not have knowledge

                                                          and will not participate in such cases

 

Network Substance

Abuse/Mental/Nervous

Annual Limit                                        $25,000

 

Special Cost Containment Provisions

 

Duplication of payments for medical expenses arising out of an automobile accident is not permitted. Once an Insurance Provider is selected to provide primary coverage, the other Provider Plan will automatically be designated as secondary provider through coordination of benefits between the two plans. The subrogation rights of each plan provider shall apply.

 

 

 

 

 

Enrollment Eligibility

 

New employees become eligible for all hospital, medical, and vision plans and life insurance the first of the month after completing 90 days of service.

An employee may be either a subscriber or a dependent in NJ TRANSIT health plans. Children may be enrolled only once in NJ Transit’s health plans.

 

Coverage for all plans and all conditions will terminate on the first of the month according to the following schedule:

 

Category                                                                        Effective

After full‑time student's

23rd birthday                                                                 1 st of year

 

Furlough w/less than one (1) full year of service          1st of month after 1 full month

 

Resignation                            1st of month

 

Leave of Absence/Termination                                      3 full months

 

Prescription  Drug Card

 

Increase current $4.50 pharmacy co‑pay to $6.00 and current $2.50 mail order co-pay to $4.00.

 

                                                                      Appendix 4

Injury Benefits - Off-Track Vehicles

 

(a.) Where engineers/assistant engineers sustain personal injuries or death while riding in, boarding, or alighting from all-track vehicles authorized by the Corporation and are:

 

(1.) deadheading under orders or;

 

            (2.) being transported at Corporation expense;

 

the Corporation shall provide and pay such engineers/assistant engineers, or their personal representative, the applicable amounts set forth in paragraph (b) below, subject to the provisions of other paragraphs in this article.

 

(b.) In the event that any one of the losses enumerated in subparagraphs (1), (2), and (3) below results from an injury sustained directly from an accident covered in paragraph (a) and independently of all other causes and such loss occurs or commences within the time limits set forth in subparagraphs (1), (2) and (3) below, the Corporation shall provide, subject to the terms and conditions herein contained, and less any amounts payable under Group Policy Contract GA-23000 of the Travelers Insurance Company or any other medical or insurance policy or plan paid for in its entirety by the Corporation, the following benefits:

 

(1.) Accidental Death or Dismemberment

 

The Corporation shall provide for loss of life or dismemberment occurring within 120 days after date of an accident covered in paragraph (a):

 

Loss of Life                           $  150,000

Loss of Both Hands                        150,000

Loss of Both Feet                         150,000

Loss of Sight of Both Eyes                150,000

Loss of One Hand and One Foot             150,000

Loss of One Hand and Sight of One Eye     150,000

Loss of One Foot and Sight of One Eye     150,000

Loss of One Hand and One Foot or Sight

  of One Eye                               75,000

 

"Loss" shall mean, with regard to hands and feet, dismemberment by severance through or above wrist or ankle joints; with regard to eyes, entire and irrevocable loss of sight.

 

No more than $150,000 shall be paid under this paragraph to any one employee or his personal representative as a result of any one accident.

 

(2.) Medical and Hospital Care

 

The Corporation shall provide payment for the actual expense of medical and hospital care commencing within 120 days after an accident covered under paragraph (a) of injuries incurred as a result of such accident, subject to limitations of $3,000 for any engineer or assistant engineer for any one accident, less any amounts payable under Group Policy Contract GA-23000 of the Travelers Insurance Company or under any other medical or insurance policy or plan paid for in its entirety by the Corporation.

 

(3.) Time Loss

 

The Corporation shall provide an engineer who is injured as a result of an accident covered under paragraph (a) hereof and who is unable to work as a result thereof commencing within 30 days after such accidents 80% of the engineer's/assistant engineer's basic full-time weekly compensation from the Corporation for time actually lost, subject to a maximum payment of $150.00 per week for time lost during a period of 156 continuous weeks following such accident provided, however, that such weekly payment shall be reduced by such amounts as the engineer is entitled to receive as sickness benefits under provisions of the Railroad Unemployment Insurance Act.

 

(4.) Aggregate Limit

 

The aggregate amount of payments to be made hereunder is limited to $1,000,000 for any one accident and the Corporation shall not be liable for any amount in excess of $1,000,000 for any one accident irrespective of the number of injuries or deaths which occur in or as a result of such accident.  If the aggregate amount of payments otherwise payable hereunder exceeds the aggregate limit herein provided, the Corporation shall not be required to pay as respects each separate employee a greater proportion of such payments than the aggregate limit set forth herein bears to the aggregate amount of all such payments.

 

(c.) Payment in Case of Accidental Death

 

Payment of the applicable amount for accidental death shall be made to the engineer's/assistant engineer's personal representative for the benefit of the persons designated in, and according to the apportionment required by the Federal Employers Liability Act (45 U.S.C. 51 et seq., as amended),or if no such person survives the engineers/assistant engineers, for the benefit of his estate.

 

      (d.) Exclusions:

 

Benefits provided under paragraph (b) shall not be payable  for or under any of the following conditions:

 

(1.) Intentionally self-inflicted injuries; suicide or any attempt thereat, while sane or insane.

 

            (2.) Declared or undeclared war or any act thereof.

 

            (3.) Illness, disease, or any bacterial infection other than bacterial infection occurring in consequence of an accidental cut or wound.

           

            (4.) Accident occurring while the employee driver is under the influence of alcohol or drugs, or an employee passenger who is under the influence of alcohol or drugs who in any way contributes to the cause of the accident.

 

            (5.) While an employee is a driver or an occupant of any conveyance engaged in any race or speed test.

 

            (6.) While an engineer/assistant engineer is commuting to and/or from his residence or place of business.

 

(e.) Offset:

 

It is intended that this article is to provide a guaranteed recovery by an engineer/assistant engineer or his personal representative under the circumstances described, and that receipt of payment thereunder shall not bar the engineer/assistant engineer or his personal representative from pursuing any remedy under the Federal Employers Liability Act or any other law; provide, however, that any amount received by such engineer/assistant engineer or his personal representative under this article may be applied as an offset by the Corporation against any recovery so obtained.

 

      (f.) Subrogation:

 

The Corporation shall be subrogated to any right or recovery an engineer/assistant engineer or his personal representative may have against any party for loss to the extent that the Corporation has made payments pursuant to this article.

 

      It is understood that no benefits or payments will be due or payable to any engineer/assistant engineer or his personal representative unless such engineer/assistant engineer, or his personal representative, as the case may be, stipulates as follows:

 

      "In consideration of the payment of any of the benefits provided in Rule - 6 of this Agreement of January 1, 1983 (engineer/assistant engineer or personal representative)

agrees to be governed by all of the conditions and provisions said and set forth by Article G-m-18."

 

 

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