Salary Resolution No. 95-0926 Revised December 2018 Section 14: Health and Welfare Benefits for Active Employees

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• 14.1 Active Employee Health Plans
• 14.2 Enrollment in County offered Health (Medical, Dental, Vision, Life Insurance) Plans
  
  • 14.2.1 County Offered Medical Plans
    • 14.2.2.1 County Contributions Toward Active Employee Medical Administrative Management and Department Heads
    • 14.2.2.2 County Contributions Toward Active Employee Medical - For Eligible Unrepresented Confidential (BU 0051) and Unrepresented (BU 0000) Full-Time and Part-Time Employees
  • 14.2.3 Dental Benefits
  • 14.2.4 Vision Benefits
  • 14.2.5 Life Insurance
  • 14.2.6 Part-Time Employees – Health Benefits
  • 14.2.7 Health Reimbursement Arrangement (HRA) Contribution
• 14.3 Health Reimbursement Arrangement (HRA) Contribution
• 14.4 Employee Assistance Program
• 14.5 Long-Term Disability
  
  • 14.5.1 Long-Term Disability Claims Dispute
• 14.6 Workers' Compensation Claims Disputes
  
  • 14.6.1 Workers’ Compensation Temporary Disability – Supplementing with Paid Leave
• 14.7 Medical/Pregnancy Disability Leave
  
  • 14.7.1 Health Benefits During Leaves of Absence – Non-Medical Leaves Without Pay
  • 14.7.2 Continuation of Health Benefits Coverage (Revised 3-19-13)
  • 14.7.3 Part-Time Employees – Health Benefits During Leave of Absence
  • 14.7.4 COBRA
• 14.8 Salary Enhancement Plans
• 14.9 Benefits: Plan Documents and Other Controlling Documents
• 14.10 Extra Help Employees – Applicable Benefits
• 14.11 Extra Help Employees - Medical Benefits
• 14.12 Extra Help Employees - Medical Benefits: Eligibility
• 14.13 Extra Help Employees - Contribution Rates for Medical Plan
• 14.14 Extra Help Employees: Continued Coverage and Conditions for Regaining Eligibility for Medical Plan
• 14.15 Extra Help Employees: Medical Plan - Dependent Coverage
• 14.16 Extra Help Employees: Enrollment in Medical Plan
• 14.17 Extra Help Employees: Medical Benefits & Family and Medical Leave Act (FMLA), California Family Rights Act (CFRA), or California Pregnancy Disability Leave (CPDL)

Read Next: Section 15: Medical Benefits for 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 / registered 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).

An eligible employee is:

• A County of Sonoma probationary or regular full-time or probationary or regular part-time employee (refer to Section 14.2.6 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 registered domestic partner and has a Declaration of Registered domestic partnership filed with the State of California as defined in California Family Code Section 297, et. seq; or 
• A child up to age 26 or a disabled dependent child regardless of age. 

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Election to enroll in the County offered health plan is required 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 date of hire or initial eligibility.   

14.2.1 County Offered Medical Plans

The County will offer at least the following medical plans, the County Health Plan PPO, County Health Plan EPO, and Kaiser HMO plan. The benefit provisions are outlined in the Summary Plan Description or Evidence of Coverage.

14.2.2.1 County Contributions Toward Active Employee Medical Administrative Management and Department Heads

Effective the pay period beginning January 15, 2019, with the intent to have premiums paid in the pay period(s) required for coverage to be effective February 1, 2019, the County shall contribute up to the maximum of the following amounts based on level of coverage for eligible full and part time employees and their eligible dependent(s) enrolled in a County-offered medical plan.

This is the full and total contribution amount the County will contribute toward medical benefits for active regular employees and their eligible dependent(s).

14.2.2.2 County Contributions Toward Active Employee Medical - For Eligible Unrepresented Confidential (BU 0051) and Unrepresented (BU 0000) Full-Time and Part-Time Employees

Effective the pay period beginning May 22, 2018, with the intent to have premiums paid in the pay period(s) required for coverage to be effective June 1, 2018, the County shall contribute up to maximum of the following amounts based on level of coverage for Unrepresented Confidential and Unrepresented employees enrolled in County-offered medical coverage for any eligible full-time and part-time employees 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 eligible dependent(s).  

The County shall contribute to part-time eligible employees on a pro-rated basis, in accordance with Section 14.2.6.

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14.2.3 Dental Benefits

(Amended 6/14/16, 7/10/18)

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).

Effective August 1, 2018, the employee contribution shall be suspended for a period of 22 months, resuming June 1, 2020.

The County shall contribute to part-time eligible employees on a pro-rated basis, in accordance with Section 14.2.6.

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

14.2.5 Life Insurance

(Amended 6/14/16)

The County provides a basic term-life insurance plan in the amounts specified below for an allocated full-time equivalent position of sixty (60) hours or more (0.75 FTE or more) with no employee contribution.  Enrollment in basic life insurance is automatic, based on eligibility.

Confidential Employees:

One and one half (1-1/2) time the annual salary computed on the basis of 26.089 times the bi-weekly salary in effect at the time of death. Administrative Management and Department / Agency Heads: 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. Unrepresented Employees: Ten thousand dollars ($10,000).

Unrepresented Employees:

Effective August 1, 2016, the life insurance coverage amount for Unrepresented employees will be in an amount equal to one  and one half (1-1/2) times their annual base salary. Enrollment in basic life insurance is automatic, based on eligibility.

Dependent Life Insurance:

Each eligible and enrolled employee may purchase through payroll deduction, dependent coverage of $5,000 for each eligible dependent. For all other plan benefits and provisions, refer to the insurance policy document. 

Supplemental Life Insurance:

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 14.2 (Enrollment in County Offered Health (Medical, Dental, Vision, Life Insurance) Plans). Confidential, Unrepresented, Administrative Management, and Department Head employees may purchase supplemental coverage in increments one times (1X) to four time (4X) the basic coverage to a maximum of $500,000, in accordance with the insurance carrier’s policy. Effective 7/19/2016 Unrepresented employees 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 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.

14.2.6  Part-Time Employee – Health Benefits

1. 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 pay status hours in the pay period, excluding overtime and including periods of qualified FMLA, CFRA and CDPL leaves without pay. 
2. A part-time Unrepresented Administrative Management, Unrepresented, or Confidential employee, whose allocated position is 0.75 FTE or greater biweekly, 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.
3. Except for part-time (0.75 FTE+) employees referred to in this Section 14.2.6(b), part-time employees shall not be eligible to participate in the County's life insurance program.

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(Amended 4/9/13, 3/15/16, 12/11/18)

Prior County contributions made pursuant to this section continue to be available to Plan participants for reimbursement of eligible medical care expenses as incurred by an eligible employee or dependents(s) as under Internal Revenue code Sections 105 and 106.  Effective July 1, 2016, employees will be able to access accumulated funds by submitting eligible expenses for reimbursement but may not use HRA funds to offset premium costs for County medical coverage.

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 Section 15.6.  Health benefits in this Section 14 are available only to active employees. 

Section 14.3 does not apply to Extra Help employees and unrepresented employees in the job classifications of: 0841 - Assistant Executive Officer LAFCO, 2537 - Forensic Psychiatrist, 2536 - Mental Health Physician, and 2535 - Public Health Physician

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The County provides an Employee Assistance Program (EAP) for all employees at no cost to the employee.

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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 (0.40 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 (60^th) 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.

14.5.1 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.

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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.

14.6.1 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 leaves 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. 

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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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 thirteenth (13th) 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 (14.7) shall not have the thirteen (13) pay period entitlement reduced for any pay period in which the employee is in pay status for at least fifty percent (50%) of the employee's allocated full time equivalent as specified in this Section 14.7 (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 pay 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 fifty percent (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.

14.7.1 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 pay 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 pay 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.

14.7.2  Continuation of Health Benefits Coverage (Revised 3-19-13)

An employee, who is entitled to continued benefit coverage as specified in Section 14.7 or 14.7.1, must notify the Auditor-Controller-Treasurer-Tax Collector’s office (ACTTC) no later than five (5) County business days after the first (1^st) 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 (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 1^st of the month following return to pay status.

14.7.3 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 14.2.6. For pay periods with no pay 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 14.5 (Long-Term Disability).

14.7.4 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 revision where applicable.

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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.

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While mention may be made in this resolution 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.

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Only benefits required by law and the following sections of Section 14 apply to Extra Help employees: Sections 14.4 (Employee Assistance Program), 14.9 (Plan Documents and Other Controlling Documents), 14.6 (Workers’ Comp-Claims Dispute), Sections 14.11 through 14.17 (Extra Help Employees – Medical Benefits).

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(Amended 3/15/16)

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 Section 14.2.1

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(Amended 3/15/16)

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
• Worked at least eighty (80) hours in the previous two (2) pay periods. 

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Effective with the first premium due, the County contribution shall be up to four hundred dollars ($400) per month.  

Pro-ration shall be as follows:

1. For each pay period in which the Extra Help employees work forty (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 twenty (20) but fewer than forty (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 twenty (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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An Extra Help employee who is enrolled in the medical plan who fails to work at least twenty (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 seven (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 (3) 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 annual 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 Auditor-Controller-Treasurer-Tax Collector’s (ACTTC) payroll division. The failure to pay premiums or the election to lapse or cancel coverage are not COBRA qualifying events.

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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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Approximately two (2) months prior to the anticipated eligibility date, the County shall provide enrollment materials to the employee. The employee then has twenty one (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.

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Eligible Extra Help employees who are off work on an FMLA or CFRA or CPDL qualifying leave shall receive a County contribution toward medical insurance equal to the average amount received in the two (2) pay periods immediately preceding the first (1^st) pay period of eligible leave. Employees must pay their share of the medical insurance premiums in order to maintain coverage and to continue to be eligible for a County contribution. Employees must file an Extra Help FMLA/CFRA/CPDL 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 (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 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 insurance shall be terminated. 

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