2019 - 2023 SCLEMAMemorandum of Understanding: Article 5: Health and Welfare Benefits for Active Employees
What’s on this Page:
- 5.1 Active Employee Health Plans
- 5.2 Enrollment in County Offered Health (Medical, Dental, Vision, Life Insurance) Plans
- 5.2.1 County Offered Medical Plan(s)
- 5.2.2 Contributions Toward Medical Insurance for Active Employees
- 5.2.3 Dental Benefits
- 5.2.4 Vision Benefits
- 5.2.5 Life Insurance
- 5.2.6 Part-Time Employee – Health Plans
- 5.3 Employee Assistance Program
- 5.4 Long-Term Disability Program
- 5.4.1 Claims Disputes over LTD
- 5.5 Workers’ Compensation Claims Disputes
- 5.5.1 Workers’ Compensation Temporary Disability – Supplementing with Paid Leave
- 5.6 Medical, Dental & Vision Benefits – LWOP or Unpaid Absence
- 5.6.1 Health Benefits - Medical / Pregnancy Disability Leave
- 5.6.2 Continuation of Health Benefits Coverage
- 5.6.3 Part-Time Employees – Health Benefits During Leave of Absence
- 5.7 COBRA
- 5.8 Salary Enhancement Plans
- 5.9 Plan Documents and Other Controlling Documents
- 5.10 Health Reimbursement Arrangement (HRA) Contribution
5.1 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 5.2.6 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 registered domestic partner that has filed a Declaration of Domestic Partnership with the State of California, Secretary of State, as defined in Family Code Section 297 et seq; or
- An unmarried child up to age 26 or a disabled dependent child regardless of age.
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 retiree’s plan (i.e., an employee and his or her dependents cannot be covered by more than one County offered Health Plan.
5.2 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 open-enrollment period. Enrollment in vision and basic life insurance is automatic. Mid-year enrollment can only be permitted as allowed by IRC Sect 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 initial eligibility.
Health plan coverage is paid on a semi-monthly basis (24 payments per year).
5.2.1 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 bargaining units. The benefit provisions, co-payments and deductibles 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.
5.2.2 Contributions Toward Medical Insurance for Active Employees
Effective May 24, 2016 for coverage through June 30, 2016, the County shall contribute a flat dollar amount not to exceed $229.98 per pay period ($500 per month) toward the cost of any County offered medical plans 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).
- Effective the pay period beginning August 13, 2019, the County will 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).
Coverage Level Monthly Equivalent Semi-Monthly Equivalent Employee only $700 $350 Employee plus one $1,400 $742 Family $1,980 $990
- Effective the pay period beginning May 19, 2020, the County will 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).
Coverage Level Monthly Equivalent Semi-Monthly Equivalent Employee only $742 $371 Employee plus one $1,484 $742 Family $2,100 $1,050
- Effective the pay period beginning May 28, 2021, the County will 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).
Coverage Level Monthly Equivalent Semi-Monthly Equivalent Employee only $786 $393 Employee plus one $1,574 $787 Family $2,224 $1,112
- Effective the pay period beginning May 17, 2022, the County will 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).
Coverage Level Monthly Equivalent Semi-Monthly Equivalent 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 5.2.6.
5.2.3 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 is $13.04 semi-monthly ($26.09 per month). The semi-monthly deduction is effective the pay period beginning June 21, 2016 for coverage beginning July 1, 2016.
The County shall contribute to part-time employees on a pro-rated basis, in accordance with Section 5.2.6.
Effective the pay date of October 3, 2018, the employee contribution shall be suspended, resuming October 1, 2020.
5.2.4 Vision Benefits
The County offers vision benefits to full-time active employees and their eligible dependent(s) with no employee contribution. A computer vision care plan is included for the employee only.
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 5.2.6
Benefit provisions are outlined in the Summary Plan Description or Evidence of Coverage.
5.2.5 Life Insurance
The County provides to each eligible employee, at no expense to the employee, a basic term life insurance plan equivalent to two (2) times the employee’s annual salary (computed on the basis of multiplying the biweekly salary in effect at the time of death by 26.089) for an allocated full-time equivalent position of sixty hours or more (0.75 FTE or more). Enrollment in basic life insurance is automatic, based on eligibility.
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 supplemental life insurance for themselves at their own expense upon initial eligibility or during the annual open enrollment periods specified in Section 5.2. The employee may purchase supplemental coverage in increments one times (1X) to 4 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.
5.2.6 Part-Time Employee – Health Plans
- 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, plus eligible unpaid leaves as required by law such as FMLA and CFRA 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.
- A part-time employee covered under this MOU, whose allocated position is 0.75 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.
- Except for part-time (0.75 FTE+) employees referred to in this Section 5.2. 6(B), part-time employees shall not be eligible to participate in the County’s life insurance program.
5.3 Employee Assistance Program
The County provides an Employee Assistance Program (EAP) for all represented employees at no cost to the employee.
5.4 Long-Term Disability Program
Effective May 24, 2016, the County shall deduct from each member’s paycheck the amount of $11.31 per pay period for PORAC LTD coverage. The parties acknowledge that this results in an average per member cost savings to the County in excess of $60.00 per month. The County agrees to share in the cost savings with the members of SCLEMA only as long as it is cost neutral to the County on a going forward basis as follows:
- The County shall contribute $18.98 per pay period to each member’s Deferred Compensation Account (See Appendix C for calculations).
- The parties agree that this benefit does not increase the Long-Term Disability cost to the County for its members, now or in the future. Should PORAC increase the monthly LTD premium or the employer’s LTD costs increase above the rate used for the calculations in Appendix C, the deferred compensation contribution discussed in 5.4 A of this agreement shall be adjusted accordingly.
If the County’s cost for retirement on the increased deferred compensation contribution increases from the percentage in effect on 7/30/09, the amount of direct contribution by the County will decrease to preserve the cost neutral agreement between the parties.
5.4.1 Claims Disputes over LTD
The Provider (PORAC) claims dispute process is described in the Plan Document.
5.5 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 and may not be the subject of a grievance through this Memorandum.
5.5.1 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.
5.6 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 paid status to less than 50% of the employee’s allocated full-time equivalent 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 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 50% of the employee’s regular schedule in a pay period, the County will continue to pay its normal benefit contributions.
5.6.1 Health Benefits - 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 Section 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 5.6.1 (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 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%) of the allocated full-time equivalent in paid status, eligibility for a county contribution toward health benefits is regained. Active 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.
5.6.2 Continuation of Health Benefits Coverage
An employee who is entitled to continued benefit coverage as specified in Section 5.6 (Medical, Dental, & Vision Benefits - LWOP or Unpaid Absence) and 5.6.1 (Health Benefits - Medical / Pregnancy Disability Leave), must notify the Auditor-Controller-Treasurer-Tax Collector’s Office (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 due date, 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 Benefit Enrollment/Change form is received by the Human Resources Benefits Unit within 31 days of the return from leave.
5.6.3 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 Section 5.2.6 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 5.4 (Long-Term Disability).
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.
5.8 Salary Enhancement Plans
IRS Section 414(h)(2)
All employees who belong to the Sonoma County Employee’s 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
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 eligible medical expenses not reimbursed or covered under medical, dental and vision insurance plans. Such expenses include deductible, co-pays, and 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 the above 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 27 (Grievance Procedure) of the Memorandum.
5.9 Plan Documents and Other Controlling Documents
While mention may be made herein 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 Summary Plan Descriptions and evidence of coverages are available on the Sonoma County Human Resources web site. 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.
5.10 Health Reimbursement Arrangement (HRA) Contribution
Effective the pay period beginning on June 21, 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.
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 Section 6.3.
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.