Article 58Group Insurance
A player’s enrolled dependents (including a child born to the player’s wife within ten months after the player’s death) shall continue to be entitled to continuing family medical, vision and dental coverage, as follows:
Section 1. Maintenance
The current terms of the NFL Player Insurance Plan (“Insurance Plan”) shall remain in effect, except as amended below, and all past and future amendments thereto as adopted in accordance with the terms of that Plan, are incorporated by reference and made a part of this Agreement; provided, however, that the terms used in such Plan and the definitions of such terms are applicable only to such Plan and shall have no applicability to this Agreement unless the context of this Agreement specifically mandates the use of such terms. The Plan will be continued and maintained in full force and effect during the term of this Agreement and must at all times comply with the terms of this Article. Under the Plan, players will receive group insurance benefits, consisting of life insurance, medical, dental, and vision benefits, as follows:(a)
Life Insurance. The Insurance Plan shall be amended effective September 1, 2020 to increase the life insurance coverage as follows:
Credited Seasons Life Insurance Coverage 0-1 $1,000,000 2 $1,200,000 3 $1,400,000 4 $1,600,000 5 $1,800,000 6+ $2,000,000(b)
Medical. Each player will continue to be required to pay an annual deductible of $850 per individual per plan year and $1700 per family per plan year with maximum out-of-pocket expenses of $2000 (including the deductible) for each covered individual. In addition:(b)(1)
the co-insurance paid by a covered individual for services rendered by outof-network providers will continue to be 30% of covered charges; and(b)(2)
the amount paid by a covered individual for non-compliance with pre-certification and emergency admission procedures will continue to be $500 and the reimbursement paid to the covered individual for such services shall be reduced by 50%; and(b)(3)
a prescription drug card will continue to be provided to covered individuals with a three-tier, $15/$25/$50 co-pay.(b)(4)
One physical per year for the covered player and his spouse will continue to be covered.(c)
Dental. Usual, customary and reasonable (“UCR”) dental expenses for all players and their eligible dependents will continue to be reimbursed to players pursuant to the following schedule: (1) Preventive care paid at 100% of UCR, (2) General services paid at 85% of UCR, and (3) Major services paid at 50% of UCR. Each player will continue to be required to pay an annual deductible of $50 per individual per plan year and $100 per family per plan year. The maximum benefit payable will continue to be $2,000 per covered individual per plan year.(d)
Vision. Effective September 1, 2020, the Insurance Plan shall be amended to add a vision benefit for players and their eligible dependents to provide vision benefits to cover some or all of the cost of exams, corrective lenses, frames and contact lenses.(e)
Period of Benefits. Subject to the extension provided in Section 2, players will continue to receive the benefits provided in this Article through the end of the Plan Year in which they are released or otherwise sever employment. Players vested due to their Credited Seasons under the Retirement Plan who are released or otherwise sever employment after May 1 in a calendar year will continue to receive the benefits provided under this section until the first regular season game of the season that begins in the following calendar year. Group benefits are guaranteed during the term of this Agreement unless required to be modified by law. The Insurance Plan shall terminate as to all players as of the last day of the 2030 League Year unless continued under future collective bargaining agreements. If the Insurance Plan is not continued, Claims for services received but not submitted prior to the end of the 2030 League Year shall be paid in accordance with the terms of the Insurance Plan in effect prior to the termination.(f)
Family Medical, Vision and Dental Coverage for Deceased Players.(f)(1)
for the dependents of a player on the Active, Inactive, Reserve/Injured, Reserve/PUP, or Practice Squad roster at the time of the player’s death, coverage will continue for the length of time the player would have been covered had his contract been terminated on the date of his death for any reason other than death;(f)(2)
for dependents of a player who was receiving coverage under this Article at the time of his death, coverage will continue for the remaining length of time that the player would have been eligible under such Section had his death not occurred.(g)
Coverage for Players Receiving Injury Settlements. Section 2.1 of the Plan shall continue to provide that a player who was on a Qualifying List at any time during the preseason shall be eligible for Comprehensive Medical, Vision, and Dental Benefits in the immediately following season if he is paid all or part of his salary for such season pursuant to an Injury Settlement Waiver or an Injury Grievance, as such terms are defined in the CBA, and shall be regarded as being released in that season for purposes of determining the date his eligibility terminates under Section 2.3 and his right to extended coverage, if any, begins, provided, however, that coverage under the Plan will not be provided retroactively for any period of time it was not then available. In addition, the definition of “Continuing Veteran” shall continue to require that a player be regarded as a vested player only if he has earned three or more Credited Seasons.
Section 2. Extended Post-Career Medical, Vision And Dental Benefits
The medical, dental, and vision benefits described in Section 1 of this Article will continue, subject to limitations described in Section 3 below, as follows;(a)
Players vested due to their Credited Seasons under the Retirement Plan who are released or otherwise sever employment at any time on or after the first regular season game, and prior to the expiration or termination of this Agreement, will continue to receive the benefits described in Subsections 1(b), 1(c) and 1(d) above through the end of the Plan Year in which such release or severance occurs and for the following sixty (60) month period.(b)
All rights under federal law of the players and their spouses and dependents to elect COBRA continuation coverage will commence upon the expiration or termination of the period in which the benefits described above are provided, as if such additional benefits had not been provided.(c)
Players vested due to their Credited Seasons under the Retirement Plan who have completed their eligibility under this Section and under COBRA shall have the option, at the expiration of COBRA, to continue insurance coverage on the same terms as if COBRA had not expired (at their own expense) for the duration of this Agreement provided that no break in coverage occurs after the player’s last Player Contract is terminated or expires. Each such player also will have the right to waive coverage under COBRA and elect coverage instead under the lower cost option provided under the Plan.
Section 3. Limitations And Rules For Extended Insurance
Certain limitations and rules for the benefits described in Section 2 above will apply as follows:(a)
The benefits described in Sections 2(a)(i) and 2(a)(iii) above will terminate immediately upon the expiration or termination of this Agreement consistent with Section 1(e) above, for individuals eligible for benefits under this Section, including, without limitation, those who have already been released or otherwise severed employment at the time of such expiration or termination.(b)
Players eligible for coverage under Section 2 above are not obligated to enroll in any other health plan or program for health services offered by an employer.
Section 4. NFL Designated Hospital Network(a)
The Plan Administrator shall establish a program in all NFL markets wherein eligible players who no longer have insurance coverage under the NFL Player Insurance Plan may, at no cost to the player, receive from participating medical providers who have contracted with the Plan Administrator, or its authorized representative, defined medical care that may consist of such services as annual physicals, preventative care, mental health care, orthopedic out-patient services, or other services as provided for in such medical provider contracts.(b)
Any player who was eligible for continuation coverage under Section 2(a)(i) above and who is not age 65 or older shall be eligible to participate in the program established in any NFL Market described in this Section 4 on the later of the expiration of his continuation coverage under Section 2(a)(i) or the date this program is established.(c)
The Plan Administrator shall establish the program described in Section 4(a) to be effective on or before September 1, 2021, but any failure to establish such program in one or more NFL Market(s) by this date, or any later date, shall not be a breach of this Agreement or give rise to any liability or other obligation on the part of the Plan, the Plan Administrator, the Management Council or the NFL so long as the Plan Administrator is making all best efforts to establish such program in the relevant NFL Market(s).(d)
The Plan Administrator shall make best efforts to expand some or all of the coverage under this Section 4 to include spouses and dependents of participating players.(e)
The Plan Administrator shall make best efforts to establish by the beginning of the 2022 Plan Year a defined health screening program for spouses of participating players.(f)
The Plan Administrator shall make best efforts to expand the services provided under this Section 4 to include certain surgical procedures.(g)
The agreement by the Plan Administrator in subsection 4(a) of this Article 58 shall create no additional obligation on the part of the Management Council or the NFL to provide medical coverage to Former Players except as otherwise provided for in this Agreement.(h)
The agreement by the Plan Administrator in Section 1 of this Article 58 to establish the described program therein shall create no additional obligation on the part of the Management Council or the NFL to provide medical coverage to any player except as otherwise provided for in this Agreement.(i)
The Plan shall be amended to incorporate the terms of the NFL Health System Network Program when the Program is first established.(j)
The Program described in this Section 4 will terminate immediately upon the expiration or termination of this Agreement consistent with Section 1(e) above.
Section 5. Administration
The Management Council will continue to administer the Plan. The parties each shall continue to have the right to appoint two (2) trustees for the Plan. In the event of a tie vote by the trustees in any appeal, the matter will be referred to the Benefits Arbitrator under Article 64. The NFLPA will continue to have the right to veto for cause any insurance company or other entity selected by the NFL or the Management Council to provide benefits under this Article. Reasons justifying such a veto for cause include, but are not limited to, excessive cost, poor service, or insufficient financial reserves. Upon request by the NFLPA, the Management Council will promptly provide the NFLPA with any document or other information relating to group insurance, including materials relating to experience and costs. The Management Council shall not change any benefit provided under this Article 58 without the consent of the NFLPA.