Exhibit 10(jj)
EX-10.JJ 7 o67673exv10wjj.htm EXHIBIT 10(JJ) exv10wjj
Exhibit 10(jj)
Effective January 1, 2011
CHIEF EXECUTIVE OFFICER
MAJOR MEDICAL & DENTAL BENEFITS
Benefits include all medical, dental and vision expenses covered under (i) the PCS U.S. Flexible Benefits Plan (the Plan) and (ii) a company-provided fully-insured wrap around policy that reimburses the chief executive officer for certain out-of-pocket expenses that exceed the reimbursed costs under the Plan.
Individual Deductible Amount | $250 | |
Family Deductible Amount | $500 | |
Annual Out of Pocket Maximum | $1,250 individual | |
$2,500 family | ||
Percentage Reimbursements | 90% | |
Office Visits | ||
Primary Doctor | $15 Copay | |
Specialist | $15 Copay | |
Emergency Room | $150 Copay | |
Urgent Care | $50 Copay | |
MEDICAL | ||
Maximum Aggregate per Individual | None | |
Maximum Medical Travel Amount (per Individual) | None | |
Preventive & Wellness | 100% | |
DENTAL | ||
Maximum Dental Amount per Individual | $8,000 per calendar year | |
OTHER SPECIFIC LIMITS & MAXIMUMS ARE LISTED BELOW: | ||
STANDARD COVERED EXPENSES | ||
Maximum Nursing Services Amount | Subject to medical necessity | |
HOSPITAL COVERED EXPENSES | ||
Hospital Daily Amount (private room) | 90% after deductible | |
PRESCRIPTION DRUG COVERED EXPENSES | $10/$20 copay | |
PARAMEDICAL COVERED EXPENSES | ||
Chiropractic Services | Subject to medical necessity | |
Physiotherapist Services | Subject to medical necessity | |
Acupuncturist Services | Only when used for anesthesia | |
Podiatrist Services | Subject to medical necessity | |
Speech Therapist Services | Subject to medical necessity | |
EXTRACARE COVERED EXPENSES | ||
Convalescent Hospital Daily Amount | 90% after deductible | |
Maximum Number of Days of Convalescent Hospital Confinement | Subject to medical necessity | |
Maximum Visits to Psychologist or Social Worker | Subject to medical necessity | |
Maximum Eye Examination Amount | Reasonable and customary | |
Once every 12 months | ||
Eyeglass, Frame or Contact Lens Amount | $1,000 per 24 consecutive months |