2019 - 2023 ESCMemorandum of Understanding: Article 9: Health and Welfare Benefits for Active Employees
Return to ESC 2019 - 2023 MOU Table of Contents
What’s on this Page:
- 9.1 Active Employee Health Plan
- 9.2 Enrollment in County Offered Health (Medical, Dental, Vision, Life Insurance) Plans
- 9.2.1 County Offered Medical Plan(s)
- 9.2.2 County Contribution Toward Active Employee Medical Benefits
- 9.2.3 Dental Benefits
- 9.2.4 Vision Benefits
- 9.2.5 Life Insurance
- 9.2.6 Part-Time Employees: Health Benefits
- 9.2.7 Health Reimbursement Arrangement (HRA) Contribution
- 9.3 Employee Assistance Program
- 9.4 Malpractice Coverage
- 9.5 Short-Term Disability - Payroll Deduction
- 9.6 Long-Term Disability Program
- 9.6.1 Long-Term Disability Claims Dispute
- 9.7 Workers’ Compensation Claims Dispute
- 9.7.1 Workers' Compensation Temporary Disability - Supplementing With Paid Leave
- 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
- 9.10.1 Part-Time Employees: Health Benefits During Leave of Absence
- 9.10.2 COBRA
- 9.11 Salary Enhancement Plans
- 9.12 Plan Documents and Other Controlling Documents
9.1 Active Employee 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 Employee – Health Benefits), 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):
- The employee’s spouse; or
- The employee’s domestic partner; or
- A child up to age 26 or a disabled dependent child regardless of age.
Eligible employees are allowed to enroll themselves and their eligible dependents 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’s spouse or domestic partner is also an eligible employee,each eligible dependent will be allowed to enroll as a dependent on only one employee or retirees’ plan (i.e., an employee and their dependents cannot be covered by more than one County offered health plan).
9.2 Enrollment in County Offered Health (Medical, Dental, Vision, Life Insurance) Plans
Election to enroll in a County offered health plan is required 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 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.
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 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
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).
| Per Month | Semi-Monthly | |
|---|---|---|
| Employee only | $629 | $314.50 |
| Employee plus one | $1,257 | $628.50 |
| Family | $1,779 | $889.50 |
County Contribution-Plan Year 2019-2020
Effective the pay period beginning July 30, 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 |
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).
| Per Month | Semi-Monthly | |
|---|---|---|
| Employee only | $742 | $371 |
| Employee plus one | $1,484 | $742 |
| Family | $2,100 | $1,050 |
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).
| Per Month | Semi-Monthly | |
|---|---|---|
| Employee only | $786 | $393 |
| Employee plus one | $1,574 | $787 |
| Family | $2,224 | $1,112 |
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).
| 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).
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.
9.2.4 Vision Benefits
The County offers vision benefits to full-time active employees and their eligible 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 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 9.2.6.
9.2.5 Life Insurance
Basic Life
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.
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 Schedule of Insurance or Group Insurance Policy.
Supplemental Life
Eligible employees may purchase additional life insurance coverage for themselves at their own expense upon initial eligibility or during the enrollment periods 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.
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
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 eligible dependents(s) as described in Internal Revenue Code Sections 105 and 106.
The County of Sonoma Health Reimbursement Arrangement (HRA) Plan Document will be amended to reflect HRA contributions 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 at no cost to the employee.
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 purchase Short Term Disability (STD) Insurance coverage as may be offered through the Union, 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 the vendor designated by the Union their 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 policy certificate to all full and part-time employees (0.4 FTE minimum) who meet the eligibility requirements. Enrollment in the Long-Term Disability benefit is automatic. 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 Policy Certificate. 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/CDPL 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 once a completed and signed Employee Benefit Enrollment/Change form is received by Human Resources Benefits Unit within 31 days of the return from leave.
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 once a completed and signed Employee Benefit Enrollment/Change form is received by Human Resources Benefits Unit within 31 days of the return from leave.
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.
9.10.2 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.
9.11 Salary Enhancement Plans
IRS Section 414(h)(2)
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. 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.