APPENDIX I

BLUE SHIELD INDEMNITY PLAN

AS OF JULY 1, 2004

The current indemnity plan shall not be modified except as follows:

1. The major medical deductible under the present indemnity plan for active employees shall be $500 per person per calendar year, and $1500 per family per calendar year, with a maximum of three (3) deductibles per family per calendar year.   This deductible shall apply to FACULTY MEMBERS who retire, and receive coverage under the present indemnity plan. 

2. Major medical out-of-state claims will be processed up to twice the rate of in-state major medical reimbursement.

3. Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD) claims will be processed as mental health claims when provided and billed by a psychiatric provider.

4. Outpatient spinal manipulation visits will be limited to thirty (30) each per calendar year.

5. Outpatient physical therapy visits will be unlimited.

6. The major medical lifetime maximum for each FACULTY MEMBER shall be

$1,075,000.

7. The indemnity plan shall include a pre-certification provision, which shall consist

of the following conditions:

a. Emergency care is excluded from the provision;

b. The quality of medical care shall not be adversely affected;

c. Notification burdens for pre-certification shall not fall on the FACULTY MEMBER;

d. Appeals for denied medical coverage or any breakdown in procedures must be handled or corrected in an objective and timely fashion without harm to the FACULTY MEMBER.

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APSCUF DATE STATE SYSTEM DATE