2018 - 2019 Local 39Memorandum of Understanding:  Article 15: Health and Welfare Benefits for Active Employees

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What’s on this Page

• 15.1 Active Employee Health Plans
• 15.2 Enrollment in County Offered Health (Medical, Dental, Vision, Life Insurance) Plans
  
  • 15.2.1 County Offered Medical Plan(s)
  • 15.2.2 County Contribution Toward Active Employee Medical Benefits
  • 15.2.3 Dental Benefits
  • 15.2.4 Vision Benefits
  • 15.2.5 Life Insurance
  • 15.2.6 Part-Time Employees – Health Benefits
  • 15.2.7 Health Reimbursement Arrangement (HRA) Contribution
• 15.3 Employee Assistance Program
• 15.4 Long-Term Disability
  
  • 15.4.1 Long-Term Disability – Claim Disputes
• 15.5 Workers' Compensation Claims Disputes
  
  • 15.5.1 Workers' Compensation Temporary Disability – Supplementing with Paid Leave
• 15.6 Medical/Dental/Vision Benefits During Leaves of Absence – Non-Medical Leaves Without Pay
• 15.7 Medical/Pregnancy Disability Leave
• 15.8 Continuation Of Health Benefits Coverage
• 15.9 Part-Time Employees-Health Benefits During Leave of Absence
• 15.10 COBRA
• 15.11 Salary Enhancement Plans
• 15.12 Plan Documents And Other Controlling Documents
• 15.13 Affordable Care Act Reopener

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Read Next: Article 16: Medical Benefits for Future Retirees

An eligible employee is allowed only to enroll either as a single subscriber in a County offered medical, dental, vision plan, and/or dependent life insurance, or as the dependent spouse/domestic partner of another eligible County employee/retiree, but not both.

If an employee is also eligible to cover their dependent child/children, each child will be allowed to enroll as a dependent on only one employee or retirees’ plan (i.e., an employee and his or her dependents cannot be covered by more than one County offered health plan).

An eligible employee is:

• A County of Sonoma probationary or regular full-time or probationary or regular part-time employee (Refer to Section 15.2.6 (Part-Time Employees – Health Benefits) regarding plans offered and pro-ration of benefits for part-time employees).
• An eligible dependent is (as defined in each plan document/summary plan description):
  • Either the employee’s spouse or domestic partner; or
  • A child based on your plan’s age limits or a disabled dependent child regardless of age.

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Election to enroll in a County offered health plan will take place within the first 31 days following date of hire to permanently allocated position of .40 FTE or greater or it will be made during an annual open-enrollment period.  Enrollment in vision and basic life insurance is automatic.  Mid-year enrollment can only be permitted as allowed by IRS Section 125 or as required by HIPAA or other applicable regulations.

The effective date of benefits will be the first of the month following date of hire or initial eligibility.

Effective the pay period beginning July 19, 2016 for coverage beginning August 1, 2016, health plan coverage will be paid on a semi-monthly basis (24 payments per year).

15.2.1  County Offered Medical Plan(s)

The County will offer at least three medical plans, the County Health Plan PPO, County Health Plan EPO, and Kaiser HMO ($10 co-pay) Plan.  The benefit provisions, co-payments, and deductibles of each plan are outlined in Summary Plan Description or Evidence of Coverage. 

Specific reference to a vendor does not obligate the County to continue to offer a medical plan offered by a specific vendor.  The County may change health insurance carrier(s) and/or network provider(s), provided the plan design(s) are substantially equivalent.

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15.2.2  County Contribution Toward Active Employee Medical Benefits

Effective July 19, 2016, for coverage through July 31, 2016 the County shall contribute a flat dollar amount not to exceed $229.98 biweekly ($500 per month) toward the cost of any County offered medical plans for any eligible full-time regular employee and their eligible dependent(s).

This is the full and total contribution amount the County will contribute toward medical benefits for active regular employees and their dependent(s).

Effective the pay period beginning July 19, 2016, with the intent to have premiums paid in the pay period(s) required for coverage to be effective August 1, 2016, the County shall contribute up to maximum of the following amounts based on level of coverage for employees enrolled in County-offered medical coverage for any eligible full-time regular employee and their eligible dependent(s). The amounts listed below shall include the conversion of the current County HRA contributions for active employees in Section 15.2.7 to medical contributions.

This is the full and total contribution amount the County will contribute toward medical benefits for active regular employees and their dependent(s).

Effective the pay period beginning May 23, 2017, with the intent to have premiums paid in the pay period(s) required for coverage to be effective June 1, 2017, the County shall contribute up to a maximum of the following amounts based on the level of coverage for employees enrolled in County-offered medical coverage for any eligible full-time regular employee and their eligible dependent(s).

This is the full and total contribution amount the County will contribute toward medical benefits for active regular employees and their dependent(s).

The County shall contribute to part-time eligible employees on a pro-rated basis, in accordance with Section 15.2.6 (Part-Time Employees – Health Benefits).

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15.2.3  Dental Benefits

The County offers dental and orthodontic benefits to full and part-time regular employees and their eligible dependent(s Benefits, provisions, co-payments, and deductibles are outlined in the Evidence of Coverage.

The employee contribution shall be $13.04 semi-monthly ($26.09 per month). The semi-monthly deduction is effective the pay period beginning July 19, 2016 for coverage beginning August 1, 2016.

The County shall contribute to part-time eligible employees on a pro-rated basis, in accordance with Section 15.2.6 (Part-Time Employees – Health Benefits).

15.2.4  Vision Benefits

The County offers vision benefits to full-time active employees and their dependent(s) with no employee contribution.  A computer vision care plan is included for the employee only.

Part-time employees will automatically be enrolled in the vision benefit and the County shall contribute to part-time eligible employees on a pro-rated basis, in accordance with Section 15.2.6 (Part-Time Employees – Health Benefits).

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15.2.5  Life Insurance

The County shall offer a basic term-life insurance plan in the amount of $20,000 for an allocated full-time equivalent position of sixty (60) hours or more (0.75 FTE or more) with no employee contribution. Enrollment in basic life insurance is automatic, based on eligibility.

Effective August 1, 2016, the life insurance coverage amount for employees will be in an amount equal to one (1) times their annual base salary.  Enrollment in basic life insurance is automatic, based on eligibility.

Each eligible and enrolled employee may purchase, through payroll deduction, dependent coverage of $5,000 for each eligible dependent.  Benefit provisions are outlined in the Schedule of Insurance or Group Insurance Policy. Eligible employees may purchase additional life insurance for themselves at their own expense upon initial eligibility or during the annual enrollment period specified in Section 15.2 (Enrollment in County Offered Health (Medical, Dental, Vision, Life Insurance) Plans).  The employee may purchase supplemental coverage in increments of one times (1X) to four times (4X) the basic coverage to a maximum of $500,000, in accordance with the insurance carrier’s policy.  Participating employees and the County will be required to follow the insurance company’s contracted requirements with respect to maximum amounts and the necessity for evidence of insurability in order to be eligible to receive the benefit as may be amended from time to time and may be based on actual participation by County employees in the program.  An employee enrolled in supplemental coverage who moves from one age bracket to the next higher bracket will have to pay the rate of the higher age bracket beginning the January of the year the employee moves to the higher age bracket.

Effective August 1, 2016, the employee may purchase supplemental coverage in increments of $10,000 not to exceed the maximum of $500,000 which includes the County paid basic term life insurance plan and additional life insurance coverage purchased by the employee, in accordance with the insurance carrier’s policy.

15.2.6  Part-Time Employees – Health Benefits

Part-time employees in allocated positions of thirty-two (32) hours or more biweekly (0.40 FTE minimum) shall be eligible to participate in the County’s medical, dental, and vision plans and the County’s contribution toward their premiums shall be pro-rated. Pro-ration shall be based on the number of pay status hours in the pay period, excluding overtime and including periods of qualified FMLA and CFRA leaves without pay.

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15.2.7  Health Reimbursement Arrangement (HRA) Contribution

Effective the pay period beginning on July 19, 2016, the County shall cease contribution to the HRA account described in this section. Effective the pay period beginning July 19, 2016, the County will instead convert such HRA contribution into medical insurance premiums as described in 15.2.2.

Between July 1, 2016 and July 18, 2016, all eligible full and part time employees enrolled in a County sponsored medical plan will receive a contribution into a Health Reimbursement Arrangement (HRA) and can participate in the HRA plan based on County medical plan enrollment as described in this Article 15. Eligible employees who waive medical coverage and are not enrolled in a County sponsored medical plan will not receive a contribution into the HRA.

The County will contribute the amount specified in the table below, per paid status hour to a maximum of 80 hours per biweekly pay period.  The County will contribute to eligible part-time employees on a pro-rated basis, in accordance with Section 15.2.6.

Effective 6/9/2015 - ­7/18/2016

County contributions pursuant to this section will be available to Plan participants for reimbursement of eligible medical care expenses incurred by an eligible employee or dependents(s) as described in Internal Revenue code Sections 105 and 106. Effective August 1, 2016, active employee post-tax medical premiums are not eligible for reimbursement.

HRA contributions made pursuant to this section are separate and apart from HRA contributions and benefit eligibility for Retiree Medical for employees hired on or after January 1, 2009, pursuant to Article 16.  Health benefits in this Article 15 are available only to active employees. When this MOU ends on July 1, 2018, the parties agree that the health benefits in this Article 15 are subject to negotiations for a successor MOU.

The County of Sonoma Health Reimbursement Arrangement (HRA) Plan Document will be amended to reflect the above HRA contribution and benefit eligibility criteria for active employees.

The County makes no representations or warranties in regard to the tax treatment of the HRA, including whether any portion of the HRA is taxable by the Internal Revenue Service or the Franchise Tax Board.

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The County shall continue the current level of benefits under the Employee Assistance Program for all employees represented under this MOU for the term of this Memorandum.

Effective July 1, 2016, the Employee Assistance Program will be enhanced to six (6) face-to-face clinical consultations per incident per benefit period.

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The County shall provide and pay the premium for a Long-Term Disability (LTD) benefit as described in the applicable plan document to all full and part‑time employees (0.4 FTE minimum) who meet the eligibility requirements.  The benefit waiting period is the longer of 60 days, or the period you elect to receive paid leave. Employees  eligible to receive LTD benefits are not required to exhaust sick leave before receiving LTD benefits, but an employee who chooses to use sick leave or other  paid leave after the 60th day of disability is not eligible to receive any LTD benefits until the employee stops using paid leave.  LTD benefits cannot be supplemented with any paid leave. LTD benefits will be offset by any applicable income, such as, short-term disability benefits, retirement benefits, Social Security and Social Security Disability benefits.

15.4.1  Long-Term Disability – Claim Disputes

The claims dispute process is described in the Summary Plan Description or Evidence of Coverage. The County Human Resources - Risk Management Division will assist employees with claims dispute processing.

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Any dispute by an employee over a claim processed through workers’ compensation shall be resolved solely through the appropriate appeal procedures of that system and may not be the subject of a grievance through this Memorandum.

15.5.1  Workers’ Compensation Temporary Disability – Supplementing with Paid Leave

An employee not entitled to the benefits of Labor Code Section 4850 who is absent from work by reasons of industrial injury compensable by temporary disability, shall supplement such compensation with enough paid leaves to increase his/her gross earnings to equal his/her regular biweekly base salary as follows:

• All sick leave shall be taken until the remaining sick leave balance is forty (40) hours or less.
• Once the sick leave balance is forty (40) hours or less, the employee may elect to supplement by taking any combination of the remaining sick leave, vacation, and or compensatory time off up to his/her base salary.
• Employees whose sick leave balance is forty (40) hours or less may also elect not to supplement at all.

An employee shall accrue vacation leave and sick leave only during such portion of absence from work due to industrial injury for which the employee uses previously earned vacation leave, sick leave, or compensatory time off.

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If an employee is on an unpaid absence or goes on leave without pay, either of which reduces the employee's time in pay status to less than fifty percent (50%) of the employee's FTE in a pay period, the County will cease to pay its normal benefit contributions.  The employee must pay the total benefit premiums if the employee desires to continue any coverage.  If an employee is on an unpaid absence or goes on leave without pay, either of which reduces the employee's time in pay status to no less than fifty percent (50%) of the employee's FTE in a pay period, the County will continue to pay its normal benefit contributions.

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When an employee exhausts all but forty (40) hours of sick leave and goes on medical or pregnancy disability leave without pay, the County will make its normal contribution to the employee's medical, dental, vision care, life insurance and LTD benefits for a period not to exceed thirteen (13) pay periods per disability.  Beginning with the fourteenth (14th) pay period, the employee will be entitled to continued coverage through COBRA Continuation of Coverage and is responsible for making a timely election and paying the COBRA premiums by the due date.  Prior to the exhaustion of the thirteen (13) pay periods the County will provide reasonable notice of the employee's obligations regarding the opportunity to continue employee‑paid benefits.

An employee who returns to work from medical or pregnancy disability leave without pay prior to the exhaustion of the thirteen (13) pay periods of entitlement under this Article shall not have the thirteen (13) pay period entitlement reduced for any pay period in which the employee is in pay status for at least fifty percent (50%) of the employee’s allocated full-time equivalent as specified in this Section 15.7 (Medical/Pregnancy Disability Leave).

If the employee returns to medical or pregnancy disability leave without pay for the same condition, the thirteen (13) pay period time frame will continue where it left off and will be reduced only for those pay periods when the employee’s pay status hours fall below fifty percent (50%) of the allocated full-time equivalent.  The County’s thirteen (13) pay period leave without pay benefit entitlement shall run concurrent with FMLA/CFRA/CPDL.

The employee's entitlement under COBRA law begins when the employee is no longer eligible for a County contribution toward medical benefits.  When the employee returns to fifty percent (50%) allocated full time equivalent in pay status, eligibility for a County contribution toward health benefits is regained.  Benefit coverage begins the first of the following month.

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An employee who is entitled to continued benefit coverage as specified in Section 15.6 (Health Benefits During Leaves of Absence - Non-Medical Leaves Without Pay) and Section 15.7 (Medical/Pregnancy Disability Leave) above, must notify the ACTTC no later than five (5) County business days after the first day of the leave of absence, of the employee's intent to continue insurance coverage.  A request for Leave of Absence (without pay) form signed by the employee and his/her Department shall be forwarded to the ACTTC’s office when leave is authorized.

To assure continued insurance coverage, premiums shall be paid by the employee to the ACTTC’s office no later than the last day of the pay period or the date specified in the notice.  If the employee fails to pay the premium by the due date, he/she will receive one (1) reminder notice.  In order to prevent a lapse in coverage due to non-payment, the employee shall pay a $25.00 late charge in addition to the premium amount due by the date specified in the reminder notice. Only one reminder notice will be sent.  If the employee fails to make proper payment within 30 days of the first due date, the employee's medical, dental, vision, life insurance, and Long Term Disability coverage shall be terminated.  Coverage will not be reinstated until the first of the month following return to pay status.

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Part-time employees shall be eligible to participate in the medical benefit plans and/or the dental plans on a prorated basis, as defined in Section 15.2.6 (Part-Time Employees-Health Benefits).  For pay periods with no pay status hours, pro-ration shall be based on the employee’s FTE.

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The County provides continuation of health benefits at group rates plus 2% as required by the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986, including any applicable subsequent amendments or revisions where applicable.

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IRS Section 414(h)(2)

All employees who belong to the retirement system shall have their wages adjusted according to Section 414(h)(2) of the Internal Revenue Code which has the effect of deferring Federal and State income taxes on the employee's retirement contributions.

IRS Section 125

Premium Conversion

The County shall continue, under IRS Code Section 125, to administer a Health Care Premium Conversion Plan that allows eligible employees to make their required contributions towards health premiums with pre‑tax dollars through payroll deduction. The County will make no contribution to this plan, however it will bear the cost of administering this benefit.

Health Flexible Spending Account

The County provides a Health Care Flexible Spending Account (FSA) to enable eligible employees to set aside pre‑tax dollars for reimbursement of employee's qualified medical expenses not reimbursed by the employee's health insurance plan and will be provided to the maximum amount stipulated in the Plan and consistent with the law.

Dependent Care Assistance Program

The County provides a Dependent Care Assistance Program subject to the limitations and maximums as stipulated under law.

All of the above plans will be administered by the County in accordance with applicable Federal and State laws as amended and, as such, will not be grievable or arbitrable.

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While mention may be made in this Memorandum of various provisions of benefit programs, specific details of benefits (including disputes and/or appeals) provided under County offered health plans, shall be governed solely by the various plan documents or insurance contracts and/or policies maintained by the County. The County will bear no responsibility for resolving disputes/appeals between an employee and a contracted health plan vendor. Within this section, vendor refers to insurance company, Knox-Keene organizations licensed in the state of California to provide health benefits, benefits administration, or network management.

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The parties agree to reopen Article 15, entitled “Health and Welfare Benefits for Active Employees”, to meet and confer over any changes or impacts to the County’s obligations under Article 15, presented by implementation of the Affordable Care Act (ACA).

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