2018 - 2019 SEIUMemorandum of Understanding:  Article 12: Health and Welfare Benefits for Active Employees

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What’s on this Page

• 12.1 Active Employee Health Plans
• 12.2 Enrollment in County offered Health (Medical, Dental, Vision, Life Insurance) Plans
  • 12.2.1 County Offered Medical Plan(s)
  • 12.2.2 County Contribution toward Active Employee Medical Benefits
  • 12.2.3 Dental Benefits
  • 12.2.4 Vision Benefits
  • 12.2.5 Life Insurance
  • 12.2.6 Part-Time Employees – Health Benefits
  • 12.2.7 Health Reimbursement Arrangement (HRA) Contribution
• 12.3 Employee Assistance Program
• 12.4 Malpractice Coverage
• 12.5 Short-Term Disability
• 12.6 Long-Term Disability
  • 12.6.1 Long-Term Disability Claims Dispute
• 12.7 Workers’ Compensation Claims Dispute
  • 12.7.1 Workers’ Compensation Temporary Disability – Supplementing With Paid Leave
• 12.8 Medical, Dental, & Vision Benefits – LWOP or Unpaid Absence
• 12.9 Medical, Dental, & Vision Benefits – Medical or Pregnancy Disability
• 12.10 Continuation of Health Benefits Coverage
  • 12.10.1 Part-Time Employees – Health Benefits during Leave of Absence
  • 12.10.2 COBRA
• 12.11 Salary Enhancement Plans
• 12.12 Extra Help Employees
  • 12.12.1 Extra Help Employees – Medical Benefits
  • 12.12.2 Medical Benefits – Extra Help Employees: Eligibility
  • 12.12.3 Extra Help Employees: Contribution for Medical Plan
  • 12.12.4 Extra Help Employees: Continued Coverage and Conditions for Regaining Eligibility for Medical Plan
  • 12.12.5 Extra Help Employees: Medical Plan – Dependent Coverage
  • 12.12.6 Extra Help Employees: Enrollment in Medical Plan
  • 12.12.7 Extra Help Employees: Medical Benefits & Family and Medical Leave Act (FMLA), California Family Rights Act (CFRA), or California Pregnancy Disability Leave (CPDL)
• 12.13 Plan Documents and Other Controlling Documents
• 12.14 Labor Management Meetings – Health Benefits

Read Next: Article 13: 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 Section 12.2.6 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 hire to 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 Section 125 or as required by HIPAA or other applicable regulations.

The effective date of benefits will be the first of the month following enrollment.

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

12.2.1 County Offered Medical Plan(s)

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 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.

12.2.2 County Contribution toward Active Employee Medical Benefits

Effective the pay period beginning July 3, 2018, with the intent to have premiums paid for the pay check on July 25, 2018, 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).   

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 12.2.6.

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12.2.3 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 $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 August 1, 2018 and continuing beyond the term of this MOU extension, unless and until otherwise changed by agreement by the County and SEIU, the employee contribution shall be suspended, resuming June 1, 2020.

The County shall contribute to part-time eligible employees on a pro-rated basis in accordance with Section 12.2.6.

12.2.4 Vision Benefits

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

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 12.2.6. Benefits provisions, co-payments and deductibles are outlined in the Evidence of Coverage.

12.2.5 Life Insurance

The County shall offer a basic term life insurance plan in the amount of $10,000 for an allocated full-time equivalent position of sixty hours or more (0.75 FTE or more) with no employee contribution.

The life insurance coverage amount for employees in the 0001, 0005, 0010, 0025, 0080, and 0095 bargaining units will be in an amount equal to one (1) times their annual base salary. 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. Benefits 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 enrollment periods specified in Section 12.2. The employee may purchase supplemental coverage in increments one times (1X) to four times (4X) the basic coverage to a maximum of $500,000, in accordance with the insurance carrier’s policy.

The employee may purchase supplemental coverage in increments of $10,000, not to exceed the maximum of $500,000, which includes the County paid basic term life insurance plan and additional life insurance coverage purchased by the employee 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.

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12.2.6 Part-Time Employees – Health Benefits

Part-time employees in allocated positions of 32 hours or more biweekly (.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 and including periods of qualified FMLA and CFRA leaves without pay.

12.2.7 Health Reimbursement Arrangement (HRA) Contribution

Effective the pay period beginning on May 10, 2016, the County shall cease contributions to the HRA account described in the section. Effective the pay period beginning May 10, 2016, the County will instead convert such HRA contributions into medical insurance premiums.

Between March 1, 2016 and May 9, 2016, all eligible full and part- time employees as defined in Article 3.2, 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 herein. 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 pay 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 12.2.6.

Effective 5/12/2015 - 5/9/2016:

County contributions pursuant to this article will be available to Plan participants for reimbursement of eligible medical care expenses as incurred by an eligible employee 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 Article 13.3. The parties agree that the health benefits in this Article 12 are available only to active employees. When this MOU ends on February 28, 2018, the parties agree that the health benefits in this Article 12 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 prior to the effective date of Section 12.2.7.

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The County provides an Employee Assistance Program to assist employees who are experiencing unusual stress which may be affecting the employee’s job performance.

Upon Union request, the County will meet and confer with the Union regarding any substantive changes to the Employee Assistance Program.

Effective June 1, 2016, the Employee Assistance Program will be enhanced to six (6) face-to-face clinical consultations per incident per benefit period.

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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 shall meet and confer with the Union. In accordance with existing practice, this Section 12.4 is neither grievable nor arbitrable.

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SEIU makes available an optional short-term disability benefit program with premiums fully paid by the employee.  The County shall deduct applicable premiums for coverage through payroll deductions. 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 and its insurance carrier as requested to 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.

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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 Plan document can be found at:

http://sonomacounty.ca.gov/HR/Disability-Management/Long-Term-Disability/

The benefit waiting period is the longer of 60 days, or the period you elect to receive paid leave. Employees eligible to received 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 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.

12.6.1 Long-Term Disability Claims Dispute

The 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.

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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.

12.7.1 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 biweekly base salary as follows:

• All sick leaves 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.

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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 regular work schedule 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 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.

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When an employee exhausts all but 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, the HRA described in Section 12.2.7, and LTD benefits for a period not to exceed 13 pay periods per disability. Beginning with the 14th pay period, the employee will be entitled to continued coverage through COBRA Continuation of Coverage and is responsible for making a timely election and paying the COBRA premiums by the due date. Prior to the exhaustion of the 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 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 pay status for at least 50% of the employee’s allocated full-time equivalent as specified in this Section 12.9 (Medical or Pregnancy Disability Leave). If the employee returns to medical or pregnancy disability leave without pay for the same condition, the 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 50% of the allocated full-time equivalent. The County’s 13 pay period leave without pay benefit entitlement shall run concurrent with FMLA/CFRA/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 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.

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An employee who is entitled to continued benefit coverage as specified in Section 12.8 (Medical, Dental & Vision Benefits – LWOP or Unpaid Absence), Subsection 17.12.1 (Leaves – Stipend Education Leave – Health Benefit Continuation), and/or Section 12.9 (Medical, Dental & Vision Benefits - Medical or Pregnancy Disability) above, must notify the 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 Without Pay 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, 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 1st of the month following return to pay status.

12.10.1 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 prorated basis, as defined in Section 12.2.6. For pay periods  with  no  pay  status  hours, proration shall be based on the employee’s FTE or the average pay status hours in the 6 pay periods preceding the first day of leave without pay, whichever is greater. Part-time employees shall be entitled to participate in long-term disability as specified in Section 12.6 (Long-Term Disability).

12.10.2 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 where applicable.

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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:

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 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, will not be grievable or arbitrable.

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Only benefits required by law and the following sections of Article 12 apply to Extra Help employees: 12.4 (Malpractice Coverage), 12.7 (Workers’ Comp-Claims dispute), 12.10.2 (COBRA), Sections 12.12.1 through 12.12.7 (Extra Help Employees – Medical Benefits), 12.13 (Plan Documents and Other Controlling Documents).

12.12.1 Extra Help Employees – Medical Benefits

Extra Help employees shall have access to a medical plan.

The County will offer all available health plans, excluding the County EPO and County PPO plans, to eligible Extra Help employees and their eligible dependent(s) as is provided to regular employees as described in Article 12.2.1.

12.12.2 Medical Benefits – Extra Help Employees: Eligibility

Employees who meet the following criteria will be eligible to begin payroll deductions once both criteria are met:

• Must generally be scheduled to work at least forty (40) hours per pay period, and
• Worked at least 80 hours in the previous two (2) pay periods.

Once an employee has been deemed eligible based on the above criteria, employees shall not be dis-enrolled for no longer meeting the criteria.

12.12.3 Extra Help Employees: Contribution For Medical Plan

Effective with the first premium due, the County contribution shall be up to $400 per month.

Pro-ration shall be as follows:

1. For each pay period in which the Extra Help employee works 40 or more hours, the full County contribution will be paid.
2. For each pay period in which the Extra Help employee works more than 20 but fewer than 40 hours, the above amounts shall be prorated in proportion to the number of hours worked in the pay period.
3. For each pay period in which the Extra Help employee works fewer than 20 hours, no County contribution will be made.
4. Premiums for the plan will be paid in advance on the first two pay dates of the month prior to the coverage effective date and on the first two pay dates of every month thereafter. When payment has been made in full, coverage will take effect on the first of the month following payment and shall end on the last day of the same month. Coverage will be month to month and is dependent on full payment of premiums and subject to continued eligibility.

The employee premiums shall be paid through pre-tax payroll deduction as allowed by IRS Code Section 125.

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12.12.4 Extra Help Employees: Continued Coverage And Conditions For Regaining Eligibility For Medical Plan

An Extra Help employee who is enrolled in the medical plan who fails to work at least 20 hours in any pay period in which a premium deduction was due, will be eligible to contribute toward the medical coverage by paying the full amount of the premiums by payroll deduction if sufficient funds are available to fully cover the deduction. Premium payments not paid by payroll deduction will be due in the ACTTC’s Payroll Office by the last day of the pay period in which there were insufficient hours worked. A $25 late fee will apply for each payment not received by the due date.

Premium payments not paid by payroll deduction but paid directly to the ACTTC’s Office may be continued for a maximum of three (3) months or upon the exhaustion of any approved CPDL, CFRA, or FMLA benefit period, whichever is later.

1. Employees who choose to pay timely premiums directly to the ACTTC’s Office by cash or check without a lapse in coverage shall resume premium payment by payroll deduction on the first available pay date following their last cash premium payment without a lapse in coverage.
2. Employees who choose to lapse their coverage during a period of absence may do so by notifying the ACTTC’s Payroll Office in writing  no later than 7 days after the premium due date. Coverage will be lost for the months not paid. Premium payment by payroll deduction shall restart on the first pay date of a month with sufficient funds to cover the cost of premiums due and shall continue until discontinued by a written cancellation notice, non-payment of premiums, a temporary lapse in coverage in accordance with this Section, or separation from employment. Coverage will not restart until a full month’s premiums are paid in full.
3. Employees may choose to cancel their coverage by completing the appropriate forms.
4. Employees who fail to make any of the above elections or who fail to pay premiums when due shall receive one notice of payment due and shall have their coverage canceled for failure to respond.
5. The County reserves the right to cancel an employee’s active coverage if the employee lapses coverage more than three times, or a similar frequency that is determined to be an administrative burden.

Employees who choose option (c) or are canceled under item (d) or (e) must wait until the next open enrollment period to re-enroll.

An employee who loses coverage under this Section may be eligible to elect COBRA continuation of coverage if he or she is no longer eligible to pay premiums directly to the ACTTC’s payroll division.

The failure to pay premiums or the election to lapse or cancel coverage are not COBRA qualifying events.

12.12.5 Extra Help Employees: Medical Plan – Dependent Coverage

Covered employees may purchase dependent coverage for eligible dependents at their own expense through pre-tax payroll deduction as allowed by IRS Code Section 125.

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12.12.6 Extra Help Employees: Enrollment In Medical Plan

Approximately 2 months prior to the anticipated eligibility date, the County shall provide enrollment materials to the employee. The employee then has 21 calendar days to complete and submit the enrollment forms. If coverage is waived upon initial eligibility, election to participate in the medical plan can only be made during an annual open enrollment period designated by the County or as required by law.

12.12.7 Extra Help Employees: Medical Benefits and Family and Medical Leave Act (FMLA), California Family Rights Act (CFRA), or California Pregnancy Disability Leave (CPDL)

Eligible Extra Help employees who are off work on an FMLA or CFRA qualifying leave shall receive a County contribution toward medical insurance equal to the average amount received in the two pay periods immediately preceding the first pay period of eligible leave. Employees must pay their share of the medical benefits in order to maintain coverage and to continue to be eligible for a County contribution. Employees must file an Extra Help FMLA/CFRA Request for Leave form along with appropriate medical documentation with their department. Upon approval, the leave form signed by the employee and his/her appointing authority shall be forwarded to the ACTTC’s office.

An employee who is eligible for this continued benefit shall notify the ACTTC’s payroll division of the employee’s intent to continue insurance coverage no later than five (5) County business days after the first day of the leave.

To ensure 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 for which premiums were due. If the employee fails to pay the premium by the last day of the pay period, 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 continued medical insurance shall be terminated

Premium deductions will not be restarted until the 1st of the month following return to a regular schedule of 40 or more hours biweekly, with coverage reinstated the first of the month following payment of a full months premiums.

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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. Plan documents are available on line at the following location:

http://sonomacounty.ca.gov/HR/Benefits/Benefit-Forms-and-Plan-Documents/

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.

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Through the term of this Memorandum, upon Union request, the County and representatives of the Union, not to exceed four (4) in number, shall meet quarterly at mutually agreed upon times at the County to discuss informational matters of mutual concern relating to the County Health Plan and other health benefit related benefits. More frequent meetings may be held upon mutual agreement. If a meeting occurs during an employee union representative’s regular work schedule, the employee can attend without loss of regular pay and benefits. Items and information to be discussed at each meeting shall be subject to advance mutual agreement. The parties acknowledge that these meetings and this provision shall not be subject to Article 21 (Grievance Procedure), to meet and confer requirements of the County Employee Relations Policy and Section 3505 of the Government Code.

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