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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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