2019 - 2023 DSA Memorandum of Understanding: Article 18: Health and Welfare Benefits for Active Employees

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What’s on this Page

• 18.1 Active Employee Health Plans
• 18.2 Enrollment in County Offered Health (Medical, Dental, Vision, Life Insurance) Plans
  
  • 18.2.1 County Offered Medical Plan(s)
  • 18.2.2 County Contributions Toward Active Employee Medical Benefits
  • 18.2.3 Dental Benefits
  • 18.2.4 Vision Benefits
  • 18.2.5 Life Insurance
  • 18.2.6 Part-Time Employee – Health Plans
• 18.3 Employee Assistance Program
• 18.4 Long-Term Disability (LTD)
  
  • 18.4.1 Claims Disputes Over LTD
• 18.5 Workers' Compensation Claims Disputes
  
  • 18.5.1 Workers’ Compensation Temporary Disability – Supplementing With Paid Leave
• 18.6 Medical / Pregnancy Disability Leave
  
  • 18.6.1 Medical, Dental & Vision Benefits – LWOP or Unpaid Absence
  • 18.6.2 Continuation of Health Benefits Coverage
  • 18.6.3 Part-Time Employees – Health Benefits during Leave of Absence
  • 18.6.4 COBRA
• 18.7 Salary Enhancement Plans
• 18.8 Plan Documents and Other Controlling Documents
• 18.9 Health Reimbursement Arrangement (HRA) Contribution

Read Next: Article 19: 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 Article 18.2.6 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 appointment to a permanently allocated position of .40 FTE or greater or it shall 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 IRC Section 125 or as required by HIPAA or other applicable regulations.

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

Health plan coverage will be paid on bi-monthly basis (24 payments per year).

18.2.1 County Offered Medical Plan(s)

The County will offer at least one HMO plan and one plan permitting out-of-network provider coverage. No changes to existing medical plans will be made without completion of meet and confer with the Bargaining Units. 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.

18.2.2 County Contributions Toward Active Employee Medical Benefits.

1. Effective the pay period beginning August 14, 2018, for the pay date of September 5, 2018, the County shall contribute up to a 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).
   

   	per month	bi-monthly
   Employee only	$629	$314.50
   Employee plus one	$1,257	$628.50
   Family	$1,779	$889.50

2. Effective the pay period beginning May 21, 2019, the County shall contribute up to a 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).
   

   	per month	semi-monthly
   Employee only	$700	$350
   Employee plus one	$1,400	$700
   Family	$1,980	$990

3. Effective the pay period beginning May 19, 2020, the County shall contribute up to a 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).
   

   	per month	semi-monthly
   Employee only	$742	$371
   Employee plus one	$1,484	$742
   Family	$2,100	$1,050

4. Effective the pay period beginning May 18, 2021, the County shall contribute up to a 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).
   

   	per month	semi-monthly
   Employee only	$786	$393
   Employee plus one	$1,574	$787
   Family	$2,224	$1,112

5. Effective the pay period beginning May 17, 2022, the County shall contribute up to a 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).
   

   	per month	semi-monthly
   Employee only	$834	$417
   Employee plus one	$1,668	$834
   Family	$2,358	$1,179

   
   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 Article 18.6.3.

18.2.3 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 shall be $14.13 bi-monthly ($28.26 per month).

Effective the pay date of September 5, 2018 and continuing beyond the term of this MOU extension, the employee contribution shall be suspended, resuming July 1, 2020. The suspension of the employee contribution is contingent on Union ratification of the successor MOU and approval by the Sonoma County Board of Supervisors on or before August 28, 2018.

The County shall contribute to part-time eligible employees on a pro-rated basis, in accordance with Article 18.2.6.

18.2.4 Vision Benefits

The County provides vision benefits to full-time active employees and their dependent(s), and computer vision care benefits to full-time active employees, with no employee contribution.

Part-time employees will be enrolled automatically in the vision benefit and the County shall contribute to part-time eligible employees on a pro-rated basis, in accordance with Article 18.2.6.

Benefit provisions, co-payments and deductibles are outlined in the Summary Plan Description or Evidence of Coverage.

18.2.5 Life Insurance

The County provides a basic term life insurance plan in the amount of $25,000 for an allocated full-time equivalent position of sixty hours or more (0.75 FTE or more) with no employee contribution. Enrollment in basic life insurance is automatic, based on eligibility. Part-time employees who are regularly scheduled to work less than 60 hours per pay period may purchase coverage through payroll deduction.

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. Eligible employees may purchase additional life insurance coverage for themselves at their own expense upon initial eligibility during the annual open enrollment periods specified in Article 18.2. 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 in which the employee moves to the higher age bracket.

18.2.6 Part-Time Employee – Health Plans

Part-time employees in allocated positions of 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 in allocated positions of fewer than 32 hours biweekly and receiving health benefits prior to June 1, 2010 will be grandfathered and remain eligible to receive pro-rated benefits.

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The County provides an enhanced Employee Assistance Program (EAP) for law enforcement employees.

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The Association has elected to purchase Long Term Disability (LTD) benefits offered through PORAC as a part of Association membership. Coverage is mandatory, based upon provider’s policy, and premiums will be paid by the employees through payroll deduction on the first payroll of each month. The County will reimburse up to $32.00 per month of the premium.

Should the Bargaining Unit elect for higher coverage than is currently offered, the higher coverage level will be mandatory for all Bargaining Unit members, and employees will be responsible for any increase in premiums above $32.00 per month.

The insurance provider will be required to supply the County information on benefits paid to employees. Sick leave accruals may be used to supplement long-term disability benefits according to the plan document.

The Association will provide to the Human Resources Department a copy of any changes to the LTD policy as the changes occur.

18.4.1 Claims Disputes Over LTD

Employees shall utilize the appeal procedures in the PORAC plan for any dispute regarding claims under this plan.

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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.

18.5.1 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 40 hours or less.
• Once the sick leave balance is 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 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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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 Article 18.6 (Medical/Pregnancy Disability Leave). If the employee returns to medical or pregnancy 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 Medical 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 Benefit Enrollment / Change form is received by the Human Resources Benefits Unit within 31-days of the return from leave.

18.6.1 Medical, Dental & Vision Benefits – LWOP or Unpaid Absence

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 50% of the employee's allocated full-time equivalent position in a pay period, the County will cease to pay its normal benefit contributions. The employee must pay the total health plan premium(s), 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 50% of the employee's regular schedule in a pay period, the County will continue to pay its normal benefit contributions.

18.6.2 Continuation of Health Benefits Coverage

An employee, who is entitled to continued benefit coverage as specified in Article 18.6 (Medical /Pregnancy Disability Leave and 18.6.1 (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 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 pay status once a completed and signed Employee Benefit Enrollment/Change form is received by the Human Resources Benefits Unit within 31-days of the return from leave.

18.6.3 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 Article 18.2.6. For pay periods with no pay status hours, pro-ration shall be based on the employee’s FTE. Part-time employees shall be entitled to participate in long-term disability as specified in Article 18.4 (Long-Term Disability).

18.6.4 COBRA

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 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, are not subject to Article 30 (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, benefits administration, or network management. Summary Plan Descriptions and evidence of coverages are available on-line on the County’s Human Resources webpage.

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Effective the pay period beginning May 10, 2016, the County ceased contributions to the Active 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 Internal Revenue Code Sections 105 and 106.

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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