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Group Benefits
Group Medical Insurance January 1, 2009 Group Medical Insurance for Radiological Physician Associates, Inc. is a PPO Plan with Coventry Health & Life Insurance Company. Employees meeting weekly work-hour requirements established by RPA, Inc., are covered, effective with date of employment. Enrollment must occur within 30 days of the date of employment. Further, changes and/or additions of coverage for new dependents (such as marriage, birth or adoption of children) can be effective upon the date of the occurrence; but again, enrollment for these new dependents must occur within 30 days of the happening. Employees can elect dependent coverage. Dependent children will be covered to age 20 for unmarried children or to age 26 if a full-time, unmarried student. Maternity benefits are covered the same as for sickness, and standard "well baby care" exists. Obstetrical care does not include services for childbirth performed in a covered individual's home. The annual cash deductible for this plan is $5,000 per covered person, for up to two (2) family members. However, Radiological Physician Associates, Inc. has funded a Health Reimbursement Arrangement plan that reimburses the employee 80% (or $4,000) of the $5,000 annual deductible. This leaves a $1,000 out-of-pocket expense for the year. NOTE: There may be different co-payments for some types of coverage, based on provisions of the plan. The limit on out-of-pocket expense per covered person each benefit year is $5,000. The limit of out-of-pocket expense per covered family each benefit year is $10,000. Lifetime payment limit for most sickness or injury is $2,000,000. NOTE: Some provisions have benefit year or treatment period limits.
Group Life Insurance Group Life Insurance and Accidental Death and Dismemberment Insurance are provided by RPA through UNUM Life Insurance Company. Employees meeting weekly work-hour requirements established by RPA, Inc., are covered with date of employment. Enrollment must occur within 30 days of date of employment. Premium rates are calculated on the basis of 100% participation. The premium is based on average age of the group, and thus the rate per thousand benefit is the same amount for all employees. The amount issued per employee is calculated as follows. All Employees @ 3 times basic annual earnings to maximum of $315,000 Note: Original amount in force prior to age 70 reduces to 65% at age 70 and 50% at age 75. Each insured names beneficiary of proceeds. Coverage terminates upon the date of termination of employment. Conversion rights exist for a limited period of time from that date. Group Long Term Disability Income This benefit is provided through a group policy with Unum Life Insurance Company. Employees meeting weekly work-hour requirements established by RPA, Inc., are covered, effective with date of employment. Enrollment must occur within 30 days of date of employment. Benefits are payable after an elimination period of 180 days. Benefits are payable for a maximum benefit period to age 65. Maximum benefits available are calculated @ 50 % of a calendar year W-2 income to a maximum monthly benefit payable of $20,000/month. NOTE: New employee's benefit is calculated using "average monthly earnings as figured for the period of employment if no W-2 form is available when disabled." Definition of disability uses a regular occupation type of definition wherein a physician's "regular occupation" means the specialty on the practice of medicine being practiced just prior to date of disability. Benefits can be payable for total disability when "the insured cannot perform each of the material duties of regular occupation." Partial benefits could be payable if not totally disabled and income has decreased by at least 20%. Preexisting conditions do exist for sickness or accident (such as diagnostic measures, treatment, consultation, care, etc.) occurring in the 6 months prior to effective date of coverage. Preexisting conditions, however, are covered either after 12 consecutive months of no medical treatment or a disability begins after the first 24 months of coverage. Coverage will cease upon the date that employment is terminated, If an employee has been insured for 12 consecutive months before his policy is terminated, some limited rights of conversion exist. Return to Top |
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