2019 - 2023 SCDPDAAMemorandum of Understanding: Article 10: Health & Welfare Benefits for Active Employees
Return to SCDPDAA 2019 - 2023 MOU Table of Contents
- 10.1 Active Employee Health Plans
- 10.2 Enrollment in County Offered Health (Medical, Dental, Vision, Life Insurance) Plans
- 10.2.1 County Offered Medical Plan(s)
- 10.2.2 County Contributions Towards Active Employee Medical
- 10.2.3 Dental Benefits
- 10.2.4 Vision Benefits
- 10.2.5 Life Insurance
- 10.2.6 Part-Time Employees – Health Benefits
- 10.2.7 Health Reimbursement Arrangement (HRA) Contribution
- 10.3 Employee Assistance Program
- 10.4 Long-Term Disability Benefit
- 10.4.1 Long-Term Disability Claims Dispute
- 10.5 Workers' Compensation
- 10.5.1 Workers’ Compensation Claims Disputes
- 10.5.2 Workers’ Compensation Temporary Disability – Supplementing With Paid Leave
- 10.5.3 Leave Accrual While on Workers' Compensation Leave
- 10.6 Health Benefits During Medical / Pregnancy Disability Leave
- 10.7 Health Benefits During Leaves of Absence – Non-Medical Leaves Without Pay
- 10.8 Continuation of Employee Paid Health Benefits Coverage
- 10.9 Part-Time Employees – Health Benefits During Leave of Absence
- 10.10 COBRA Continuation Rates
- 10.11 Salary Enhancement Plans
- 10.11.1 IRS Section 414(h)(2)
- 10.11.2 IRS Section 125
- 10.11.2.1 Premium Conversion
- 10.11.2.2 Health Flexible Spending Account
- 10.11.2.3 Dependent Care Assistance Program
- 10.12 Benefits: Plan Documents and Other Controlling Documents
10.1 Active Employee Health Plans
An eligible employee is:
- A County of Sonoma probationary or regular full-time or probationary or regular part-time employee (refer to Section 10.2.6 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 domestic partner; or
- a child(ren) up to age 26 or a disabled dependent child regardless of age.
An eligible employee is allowed to only 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 (1) County offered health plan.
10.2 Enrollment in County Offered Health (Medical, Dental, Vision, Life Insurance) Plans
Election to enroll in the 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 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 date of hire or initial eligibility.
Health plan coverage will be paid on a semi-monthly basis (24 payments per year).
10.2.1 County Offered Medical Plans
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 listed above 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.
10.2.2 County Contributions towards Active Employee Medical
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 16, 2019, 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 | $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).
The County shall contribute to part-time eligible employees on a pro-rated basis, in accordance with Section 10.2.6.
10.2.3 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 Evidence of Coverage.
The employee contribution is $14.13 semi-monthly ($28.26 per month). The semi-monthly deduction is effective the pay period beginning May 10, 2016 for coverage beginning June 1, 2016.
Effective the pay date of November 14, 2018 and continuing through the term of this MOU, unless and until otherwise changed by agreement by the County and SCDPDAA, the employee contribution shall be suspended, resuming the pay date of September 2, 2020.
The County shall contribute to part-time eligible employees on a pro-rated basis, in accordance with Section 10.2.6.
10.2.4 Vision Benefits
The County provides vision benefits to full-time active employees and their dependent(s), and offers computer vision care benefits to full-time active employees, with no employee contribution.
The County will pay the total cost of the premium for vision benefits for full-time active employees.
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 10.2.6 (Part-Time Employees – Health Benefits).
Vision benefits provisions, co-payments and deductibles are outlined in the Evidence of Coverage.
10.2.5 Life Insurance
Basic Life
The County shall offer a basic term-life insurance plan in the following amount for an allocated full-time equivalent position of sixty (60) hours or more (0.75 FTE or more) with no employee contribution: two (2) times the annual salary computed on the basis of 26.089 times the bi-weekly salary in effect at the time of death. 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 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 annual enrollment periods specified in Section 10.2 (Enrollment in County Offered Health (Medical, Dental, Vision, Life Insurance) Plans). Employees may purchase supplemental coverage in increments one times (1X) to four times (4X) their 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 the 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.
10.2.6 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 paid status hours in the pay period, excluding overtime and including periods of qualified FMLA, CFRA and CDPL leaves without pay.
Part-time employees shall not be eligible to participate in the County’s life insurance program
10.2.7 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 dependents(s) as described in Internal Revenue code Sections 105 and 106.
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 11.
The County of Sonoma Health Reimbursement Arrangement (HRA) Plan Document will be amended to reflect 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.
10.3 Employee Assistance Program
The County will provide benefits under the Employee Assistance Program for all employees at no cost to the employee.
10.4 Long-Term Disability Benefit
The County shall provide and pay the premium for a Long-Term Disability (LTD) benefit as described in the applicable policy certificate for all full and part-time employees (0.40 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 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 sixtieth (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, social security and social security disability benefits, etc.
10.4.1 Long-Term Disability Claims Dispute
The claims dispute process is described in the Policy Certificate. The County Human Resources - Risk Management Division will assist employees with claims dispute processing.
10.5 Workers Compensation
10.5.1 Workers’ Compensation Claims Disputes
Any dispute by an employee over a claim processed through workers’ compensation shall be resolved solely through the appropriate appeal procedures of that system.
10.5.2 Workers’ Compensation Temporary Disability – Supplementing With Paid Leave
An employee 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 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.
10.5.3 Leave Accrual While on Workers Compensation Leave
An employee shall accrue vacation leave and sick leave only during the portion of absence from work due to industrial injury for which the employee uses previously earned vacation leave, sick leave or compensatory time off.
10.6 Health Benefits During 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 benefits 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 thirteenth (13th) pay period, 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 Section 10.6 shall not have the thirteen (13) pay period entitlement reduced for any pay period in which the employee is in paid status for at least fifty percent (50%) of the employee’s allocated full time equivalent as specified in this Section 10.6. 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 fifty percent (50%) of the allocated full-time equivalent.
The County’s thirteen (13) pay period Medical Leave without pay benefit entitlement shall run concurrently with Family Medical Leave Act (FMLA), California Family Rights Act (CFRA), and California Pregnancy Disability Leave (CPDL).
The employee’s entitlement to employee paid benefits continuation under COBRA 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.
10.7 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 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 premium(s), if the employee desires to continue 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 not less than fifty percent (50%) of the employee’s regular schedule in a pay period, the County will continue to pay its normal benefit contributions.
10.8 Continuation of Employee Paid Health Benefits Coverage
An employee, who is entitled to continued benefit coverage as specified in Section 10.6 or 10.7, must notify the Auditor-Controller-Treasurer-Tax Collector’s office (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.
A Request for Leave without Pay form signed by the employee and the Department Head 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, 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 medical, dental, vision, life insurance and long-term disability coverage shall be terminated. Coverage will not be reinstated until the 1st 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.
10.9 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 10.2.6. For pay periods with no paid 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 Section 10.4 (Long-Term Disability).
10.10 COBRA Continuation Rates
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 revision where applicable.
10.11 Salary Enhancement Plans
All of the following plans will be administered by the County in accordance with applicable Federal and State laws as amended and will not be grievable or arbitrable under Article 16, Grievance Procedure in this Memorandum or any County policy, rule or regulation.
10.11.1 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.
10.11.2 IRS Section 125
10.11.2.1 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.
10.11.2.2 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.
10.11.2.3 Dependent Care Assistance Program
The County provides a Dependent Care Assistance Program subject to the limitations and maximums as stipulated under law.
10.12 Benefits: 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 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.