2019 - 2023 SCPDIAMemorandum of Understanding:   Article 15: Health and Welfare Benefits for Active Employees

Return to SCPDIA 2019 - 2023 MOU Table of Contents

• 15.1 Active Employee Health Plans
• 15.2 Participation in County offered Health (Medical, Dental, Vision, Life Insurance) Plans
  
  • 15.2.1 County Offered Medical Plans
  • 15.2.2 County Contribution Toward Medical Benefits for Active Employee
  • 15.2.3 Dental Benefits
  • 15.2.4 Vision Benefits
  • 15.2.5 Life Insurance
  • 15.2.6 Part-Time Employee Health Benefits
• 15.3 Employee Assistance Program
• 15.4 Long-Term Disability (LTD)
  
  • 15.4.1 Claims Disputes over LTD
• 15.5 Workers’ Compensation Claims Disputes
  
  • 15.5.1 Workers’ Compensation Temporary Disability – Supplementing with Paid Leave
• 15.6 Health Benefits During Leaves of Absence – Non-Medical Leaves Without Pay
  
  • 15.6.1 Medical / Pregnancy Disability Leave
  • 15.6.2 Continuation of Health Benefits Coverage
  • 15.6.2.1 Part-Time Employees – Health Benefits During Leave of Absence
• 15.7 COBRA
• 15.8 Salary Enhancement Plans
• 15.9 Plan Documents and Other Controlling Documents
• 15.10 Health And Welfare Benefits Health Care Reform Compliance Reopener
• 15.11 Health Reimbursement Arrangement Contribution

Read Next: Medical Benefits for Future Retirees

An eligible employee is:

• A County of Sonoma probationary or regular full-time or probationary or regular part-time employee (refer to Section 15.2.8 regarding plans offered and pro-ration of benefits for part-time employees).

Eligible employees may enroll eligible dependents. Eligible dependents are (as defined in each plan document/summary plan description):

• Either the employee’s spouse or registered domestic partner and has a Declaration of Domestic Partnership filed with the State of California, Secretary of State, as defined in California Family code Section 297 et. seq; or
• A child up to age 26 or a disabled dependent child regardless of age.

An eligible employee and eligible dependent(s) (as defined below), are 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).

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Election to participate in a County offered health plan is required within the first 31 days following date of appointment to permanently allocated position of .40 FTE or greater or it shall be made during an annual enrollment period.

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

Health plan coverage is paid on a semi-monthly basis (24 payments per year).

15.2.1 County Offered Medical Plans

The County will offer at least three medical plans: 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 the 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.

15.2.2 County Contribution Toward Medical for Active Employee Medical Benefits

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).

County Contribution - Plan Year 2019-2020

Effective the pay period beginning January 28, 2020, 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).

County Contribution – Plan Year 2020-2021

Effective the pay period beginning May 19, 2020, 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).

County Contribution – Plan Year 2021-2022

Effective the pay period beginning May 18, 2021, 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).

County Contribution – Plan Year 2022-2023

Effective the pay period beginning May 17, 2022, 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).

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 Employee 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). Benefit provisions, co-payments, and deductibles are outlined in the Summary Plan Description or Evidence of Coverage. The employee contribution(s) is:

The County shall contribute to part-time eligible employees on a pro-rated basis, in accordance with Section 15.2.6.

Effective the pay period of October 3, 2018,  the employee contributions shall be suspended, resuming October 1, 2020. 

15.2.4 Vision Benefits

The County provides vision benefits to full time active employees and their eligible dependent(s) and computer vision care benefits to full-time active employees, with no employee contribution. Part-time employees are automatically 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. Benefit provisions, co-payments, and deductibles are outlined in the Summary Plan Description or Evidence of Coverage.

15.2.5 Life Insurance

Basic Life

The County provides a basic term-life insurance plan for an allocated full-time equivalent position of sixty (60) hours or more (.75 FTE or more) with no employee contribution. The life insurance coverage amount is an amount equal to one (1) times the employee’s base salary. Enrollment in basic life insurance is automatic, based on eligibility.

Dependent Life

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 Summary Plan Description or Evidence of Coverage.

Supplemental Life

Eligible employees may purchase additional life insurance for themselves at their own expense upon initial eligibility or during the enrollment periods specified in Section 15.2 (Participation in County Offered Health (Medical, Dental, Vision, Life Insurance) Plans. Employees 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 supplemental coverage purchased by the employee, in accordance with the insurance carrier’s policy.  

Participating employees and the County are 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 will have to pay the rate of the higher age bracket beginning the January of the year in which the employee moves to the higher age bracket.

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15.2.6 Part-Time Employee 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. Employees working less than 32 hours bi-weekly and receiving benefits, prior to the implementation of the Human Resources Management System (HRMS), will be grandfathered and remain eligible to receive pro-rated benefits.

1. A part-time employee covered under this MOU, whose allocated position is .75 FTE or greater bi-weekly, shall receive medical, dental and vision coverage as if the part-time employee were a full-time employee. Said part-time employee shall receive life insurance and long-term disability insurance in accordance with the employee’s FTE.
2. Except for part-time (.75 FTE+) employees referred to in this Section 15.2.6(b) part-time employees shall not be eligible to participate in the County’s life insurance program.

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The County provides an Employee Assistance Program (EAP) for all represented employees at no cost to the employee.

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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 leaves. 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, as outlined in the Plan Document.

15.4.1 Claims Disputes over LTD

The claims dispute process is described in the Summary Plan Description or Evidence of Coverage. 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 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 allocated full-time equivalent (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 not less than fifty percent (50%) of the employee’s allocated full-time equivalent (FTE) in a pay period, the County will continue to pay its normal benefit contributions.

15.6.1 Medical / Pregnancy Disability Leave

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 continue coverage through COBRA Continuation of Coverage and is responsible for making a timely election and paying COBRA premiums by the due date. Prior to the exhaustion of the thirteen (13) pay periods, the County will provide reasonable advance 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 15.6.1 (Medical or 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 Family Medical Leave Act (FMLA), California Family Rights Act (CFRA), and California Pregnancy Disability Leave (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 at least 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 once a completed and signed Employee Benefits Enrollment / Change form is received by the Human Resources Benefits Unit within 31-days of the return from leave.

15.6.2 Continuation of Health Benefits Coverage

An employee who is entitled to continued benefit coverage as specified in 15.6 (Health Benefits During Leaves of Absence-Non-Medical Leaves Without Pay) and 15.6.1 (Health Benefits During Leaves of Absence-Non-Medical Leaves Without Pay) must notify the Auditor-Controller-Treasurer-Tax Collector (ACTTC), no later than five (5) County business days after the first (1st) day of the leave of absence, of the employee’s intent to continue insurance coverage. The employee must apply for a leave by completing a Leave of Absence Form.

If the Department authorizes the leave, the Department shall forward the completed Leave of Absence Form to the ACTTC’s Office. 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 last day of the pay period, 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 (1) reminder notice will be sent. If the employee fails to make proper payment within 30 days of the first due date, the employee’s continued medical, dental, vision, life insurance and LTD coverage shall be terminated. Coverage will not be reinstated until the 1st of the month following return to paid status once a completed and signed Employee Benefits Enrollment / Change form is received by the Human Resources Benefits Unit within 31-days of the return from leave.

15.6.2.1 Part-Time Employees – Health Benefits During Leave of Absence

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 15.2.8 (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)

All employees who belong to the Sonoma County Employees’ Retirement Association 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 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 (DCAP) subject to the limitations and maximums as stipulated under law.

All of these plans will be administered by the County in accordance with applicable Federal and State laws as amended and, as such, will not be subject to Article 28 (Grievance Procedure) of the Memorandum.

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While mention may be made in this MOU 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 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 administration, or network management. Summary Plan Descriptions and evidence of coverages are available on-line at the following location: 

https://sonomacounty.ca.gov/HR/Benefits/Benefit-Forms-and-Plan-Documents/

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The County and the Association agree to a reopener to make necessary changes to health and welfare benefit eligibility and/or coverage options as required by the Patient Protection and Affordable Health Care Act (PPACA), commonly referred to as Health Care reform, or as required by similar subsequent statutes or regulations implemented during the term of this agreement.

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Effective the pay period beginning on June 21, 2016, the County shall cease contributions to the HRA account described in this Section.

Remaining balances in the active HRA will continue to be available to Plan participants for reimbursement of eligible medical care expenses as incurred by an eligible employee/retiree or dependent(s) as defined under the Internal Revenue Code Sections 105 and 106. 

HRA contributions made pursuant to this article are separate and apart from HRA contributions and benefit eligibility criteria for Retiree Medical for employees hired on or after January 1, 2009 pursuant to Article 16, Section 16.3. 

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

The County of Sonoma has established an Active Health Reimbursement Arrangement (HRA) Plan Document which outlines the eligibility provisions of this plan pursuant to current IRS regulations and 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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