2018 - 2019 ESCMemorandum of Understanding: Article 9: Health and Welfare Benefits for Active Employees
What’s on this Page:
- 9.1 Active Employee Health Plan
- 9.2 Enrollment in County offered Health (Medical, Dental, Vision, Life Insurance) Plans
- 9.3 Employee Assistance Program
- 9.4 Malpractice Coverage
- 9.5 Short-Term Disability - Payroll Deduction
- 9.6 Long-Term Disability Program
- 9.7 Workers’ Compensation Claims Dispute
- 9.8 Health Benefits During Leaves of Absence – Non-Medical Leaves Without Pay
- 9.9 Medical / Pregnancy Disability Leave
- 9.10 Continuation of Health Benefits Coverage
- 9.11 Salary Enhancement Plans
- 9.12 Plan Documents and Other Controlling Documents
9.1 Active Employee Health Plan
Eligible employees are allowed to enroll themselves and their eligible spouse or domestic partner, and/or children in a County plan. An eligible employee is allowed 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 9.2.6 (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.
9.2 Enrollment in County Offered Health (Medical, Dental, Vision, Life Insurance) Plans
Election to enroll in a County offered health plan will take place within the first 31 days following date of hire to a 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 Code 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 September 13, 2016 for coverage beginning October 1, 2016, health plan coverage will be paid on a semi-monthly basis (24 payments per year).
9.2.1 County Offered Medical Plan(s)
The County will offer at least three medical plans including one HMO with a $10 co-pay and one plan providing out-of-network provider coverage. 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 listed below 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.
9.2.2 County Contribution toward Active Employee Medical Benefits
Effective the pay period beginning October 23, 2018, with the intent to have premiums paid in the pay period(s) required for coverage to be effective November 1, 2018, 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). The amounts listed below shall include the conversion of the current County HRA contributions for active employees in Section 9.2.7 to medical contributions.
|Employee plus one||$1,257||$628.50|
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 9.2.6 (Part Time Employees – Health Benefits).
9.2.3 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 is $13.04 per semi-monthly deduction. The semi-monthly deduction is effective the pay period beginning September 13, 2016 for coverage beginning October 1, 2016.
Effective the pay date of February 6, 2019, the employee contribution shall be suspended, resuming the pay date of June 12, 2019.
The County shall contribute to part-time eligible employees on a pro-rated basis, in accordance with Section 9.2.6 (Part Time Employees – Health Benefits).
9.2.4 Vision Benefits
The County offers vision benefits to full-time active employees and their dependent(s) with no employee contribution. The County offers computer vision care benefits to full-time active employees with no employee contribution. Benefits provisions, co-payments and deductibles are outlined in the Evidence of Coverage.
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 9.2.6.
9.2.5 Life Insurance
The County shall offer, at no expense to the employee, a basic term-life insurance plan in the amount of $25,000 for an allocated full-time equivalent position of sixty (60) hours or more (0.75 FTE or more). Enrollment in basic life insurance is automatic, based on eligibility.
Part-time employees who are allocated to less than a full-time equivalent position per pay period (less than sixty (60) hours or less than 0.75 FTE) may purchase life insurance 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 Schedule of Insurance or Group Insurance Policy.
Eligible employees may purchase additional life insurance coverage for themselves at their own expense upon initial eligibility or during the annual open enrollments period specified in Section 9.2. Employees may purchase supplemental coverage in increments one times (1X) to five times (5X) their base salary to a maximum of $500,000 (basic + supplemental), 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 during the April 2014 life insurance open enrollment period for coverage beginning June 1, 2014, members who make no changes to their supplemental coverage will automatically have their supplemental coverage amount adjusted from a multiple of the base $25,000 coverage to the nearest multiple their current base salary. Members will be responsible for paying any increased cost for the benefits. Increases to supplemental coverage beyond the amount automatically assigned by Hartford on June 1, 2014, will be subject to 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.
9.2.6 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 paid status hours in the pay period, excluding overtime and including any period of qualified FMLA and CFRA leaves without pay. Employees hired before April 1, 2010 will remain eligible to receive pro-rated benefits based on the paid status hours in the pay period.
9.2.7 Health Reimbursement Arrangement (HRA) Contribution
Effective the pay period beginning on September 13, 2016, the County shall cease contributions to the HRA account described in the section. Effective the pay period beginning September 13, 2016, the County will instead convert such HRA contributions into medical insurance premiums.
Effective through September 12, 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 9. 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 9.2.6.
Effective 5/12/2015 - 9/12/2016
|Employee plus 1||$0.66||$115.31|
|Employee plus 2||$2.47||$429.45|
Prior, unused 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 September 13, 2016, active employee post-tax medical premiums are not eligible for reimbursement.
Health benefits in this Article 9 are available only to active employees. When this MOU ends on March 26, 2018, the parties agree that the health benefits in this Article 9 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.
9.3 Employee Assistance Program
The County provides an Employee Assistance Program (EAP) for all employees during the term of the Memorandum.
9.4 Malpractice Coverage
All employees of the County who are engaged in patient care and covered by the County’s malpractice coverage shall continue to be covered for activities falling within the scope of their employment. Criminal or fraudulent conduct by the employee within the scope of their employment is specifically excluded. If the County should discontinue the malpractice coverage, the County agrees to meet and confer with the Union. This Section 9.4 is neither grievable nor arbitrable.
9.5 Short-Term Disability – Payroll Deduction
Employees who are ESC members may continue to purchase Short Term Disability (STD) Insurance coverage as may be offered by the (SEIU Local 1021) Union Insurance Services, at their own expense, through bi-weekly payroll deduction as long as they are members in good standing of ESC. Each employee is responsible for submitting to Union Insurance Services his/her own application for Short Term Disability Insurance and any subsequent material required by the insurance provider.
Upon request of the Union, the County will make a good faith effort to integrate any sick leave requested by an employee who is eligible to receive benefits under the Union’s short-term disability plan. The Union will cooperate fully with the County, but the County, reserves the right to conclude such an integration if it becomes unworkable or beyond the County’s resources available for payroll maintenance activities.
9.6 Long-Term Disability Program
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 the employee elects 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 an applicable income, such as short-term disability benefits, retirement benefits, Social Security, and Social Security Disability benefits, etc.
9.6.1 Long-Term Disability Claims Dispute
The LTD 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.
9.7 Workers' Compensation Claims Dispute
Any dispute by an employee over a claim processed through worker’s 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.
9.7.1 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 bi-weekly 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 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 any portion of absence from work due to industrial injury for which the employee uses previously earned vacation leave, sick leave, or compensatory time off.
9.8 Health Benefits During Leaves of Absence – Non-Medical Leaves Without Pay
If an employee is on an unpaid absence or goes on leave without pay, either of which reduces the employee’s time in paid 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 medical, dental, vision life insurance and LTD coverage. If an employee is on an unpaid absence or goes on leave without pay, either of which reduces the employee’s time in paid 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.
9.9 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 continued coverage through COBRA Continuation of Coverage, and the employee 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 13 pay period entitlement reduced for any pay period in which the employee is in paid status for at least 50% of the employee’s allocated full time equivalent as specified in this Section 9.9 (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 paid status hours fall below 50% of the allocated full-time equivalent. The County’s thirteen (13) pay period leave without pay benefit entitlement shall be coordinated with FMLA/CFRA/CPDL as provided in the County’s Medical Leave Policy and this MOU.
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 paid status, eligibility for a County contribution toward health benefits is regained. Benefit coverage begins the first of the following month.
9.10 Continuation of Health Benefits Coverage
An employee who is entitled to continued benefit coverage as specified in Section 9.9 (Medical / Pregnancy Disability Leave) and Section 9.8 (Health Benefits During Leaves of Absence-Non-Medical Leaves Without Pay) above, must notify the Auditor-Controller-Treasurer-Tax Collector (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 form signed by the employee and his/her appointing authority 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 last day of the pay period or the date specified in the notice, he/she will receive one 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 LTD coverage shall be terminated. Coverage will not be reinstated until the first of the month following the employee’s return to paid status.
9.10.1 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 pro-rated basis, as defined in Section 9.2.6 (Part Time Employees – Health Benefits). For pay periods with no paid status hours, the County contribution pro-ration shall be based on the employee’s FTE.
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.
9.11 Salary Enhancement Plans
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
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. Employees may set aside 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, will not be grievable or arbitrable.
9.12 Plan Documents and Other Controlling Documents
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.