2018 - 2019 SCLEAMemorandum of Understanding:   Article 18: Health and Welfare Benefits for Active Employees

Return to SCLEA 2018 - 2019 MOU Table of Contents

• 18.1 Active Employee Health Plans
• 18.2 Participation In County Offered Health (Medical, Dental, Vision, Life Insurance) Plans
  • 18.2.1 County Offered Medical Plan(s)
  • 18.2.2 County Contribution toward Active Employee Medical Benefits
  • 18.2.3 Dental Benefits
  • 18.2.4 Vision Benefits
  • 18.2.5 Life Insurance
  • 18.2.6 Part-Time Employees – Health Benefits
• 18.3 Employee Assistance Program
• 18.4 Long-Term Disability (LTD)
  • 18.4.1 Full-Time Employee Coverage
  • 18.4.2 Claims Disputes Over LTD – Full-Time Employees
  • 18.4.3 Part-Time Employee Coverage
  • 18.4.4 Long-Term Disability Claims Dispute – Part-Time Employees
• 18.5 Workers’ Compensation Claims Disputes
  • 18.5.1 Workers’ Compensation Temporary Disability – Supplementing With Paid Leave
• 18.6 Health Benefits During Leaves of Absence – Non-Medical Leaves Without Pay
  • 18.6.1 Medical / Pregnancy Disability Leave
  • 18.6.2 Continuation Of Health Benefits Coverage
• 18.7 COBRA
• 18.8 Salary Enhancement Plans
• 18.9 Plan Documents And Other Controlling Documents
• 18.10 Health And Welfare Benefits Health Care Reform Compliance Reopener

Read Next: Article 19: Medical Benefits for Future Retirees

An eligible employee and eligible dependent(s) (as defined below), are 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 18.2.6 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 participate in a County offered health plan will take place within the first 31 days following date of appointment to permanently allocated position of .49 FTE or greater or it shall 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 IRS 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  initial eligibility.

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

18.2.1 County Offered Medical Plans

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 the bargaining units. The benefit provisions, co-payments and deductibles of each plan are outlined in the Summary Plan Description or Evidence of Coverage.

Specific reference to a vendor does not obligate the County to continue to offer a medical plan offered by a specific vendor.  The County may change health insurance carrier(s) and/or network provider(s), provided the plan design(s) are substantially equivalent.

18.2.2 County Contribution Toward Active Employee Medical Benefits

Effective the pay period beginning September 11, 2018 for coverage beginning October 3, 2018, the County shall contribute up to a maximum of the following amounts based on level of coverage for employees enrolled in County–offered medical coverage for any eligible full-time regular employee and their eligible dependent(s).  

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 18.2.6.

18.2.3 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 shall be $13.04 bi-monthly ($26.08 per month).The County shall contribute to part-time eligible employees on a pro-rated basis, in accordance with Section 18.2.6.

Effective the pay date of October 3, 2018, and continuing beyond the term of this MOU extension, the employee contribution shall be suspended, resuming October 1, 2020. The suspension of the employee contribution is contingent on Union ratification of the successor MOU and approval by the Sonoma County Board of Supervisors on or before September 25, 2018.

18.2.4 Vision Benefits

The County provides vision benefits to full-time active employees and their dependent(s), and computer vision care benefits to full-time active employees, 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 18.2.8.  Benefit provisions, co-payments and deductibles are outlined in the Summary Plan Description or Evidence of Coverage. 

18.2.5 Life Insurance

The County provides a basic term-life insurance plan for an allocated full-time equivalent position of sixty (60) hours or more (.75 FTE or more) with no employee contribution. Effective May 24, 2016, the life insurance coverage amount will be an amount equal to one (1) times the employee’s base salary. Enrollment in basic life insurance is automatic, based on eligibility.  Part-time employees who are regularly scheduled to work less than sixty (60) hours per pay period may purchase coverage through payroll deduction.

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 additional life insurance coverage for themselves at their own expense upon initial eligibility or during the annual open enrollment periods specified in Section 18.2. Effective the first pay period following a special enrollment (June 21, 2016), 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 supplemental coverage purchased by the employee, in accordance with the insurance carrier’s policy. Members will be responsible for paying any increased cost for the benefits. 

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.

Effective June 21, 2016 members enrolled in supplemental coverage who make no changes to their supplemental coverage during open enrollment will automatically have their supplemental coverage amount adjusted to the nearest, lower, multiple of $10,000 below current coverage. Members will be responsible for paying any increased cost for the benefits.

18.2.6 Part-Time Employee – Health Benefits

Part-time employees in allocated positions of thirty-two (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 paid status hours in the pay period, excluding overtime.

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The County provides an enhanced Employee Assistance Program (EAP) for law enforcement employees.

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18.4.1 Full-Time Employee Coverage

The Association has elected to purchase Long-Term Disability benefits offered through PORAC as a part of Association membership.  This coverage is available only to full-time employees. Coverage for full-time employees is mandatory, based upon provider’s policy, and premiums will be paid by the employees through a payroll deduction on the first payroll of each month. An amount equivalent to the premium will be paid to the employee, up to $24.50 per month.

Should the Bargaining Unit elect for higher coverage than is currently offered, the higher coverage level will be mandatory for all full time Bargaining Unit members, and the employees will be responsible for any increase in premiums above $24.50 per month.

The insurance provider will be required to supply the County information on benefits paid to employees. Sick leave accruals may be used to supplement Long-Term Disability benefits according to the plan document.

The Association will provide to the Human Resources Department a monthly list of applicants and recipients, including a list of approvals and denials, and a copy of any changes to the LTD policy as the changes occur.  In addition, any separately purchased plan by the Association, shall comply with the County’s Transitional Duty Policy, including a requirement that benefits shall cease should an employee refuse a transitional duty assignment.

18.4.2 Claims Disputes Over LTD – Full-Time Employees

PORAC Plan: Employees shall utilize the appeal procedures in the PORAC plan for any dispute regarding claims under the plan described in Section 18.4.1.

18.4.3 Part-Time Employee Coverage

Because the Long-Term Disability benefit plan described in Section 18.4.1 is not available to part-time employees, the County shall provide and pay the premium for a Long-Term Disability (LTD) benefit as described in the applicable County plan document for part-time employees (0.4 FTE minimum) who meet the Plan eligibility requirements. The Plan document can be found at:

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

Benefit eligibility begins after 60 calendar days of disability. The benefit waiting period is the longer of 60 days, or the period the employee elects to receive paid leave. Employees eligible to received LTD benefits pursuant to this Section 18.4.3 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 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.

18.4.4 Long-Term Disability Claims Dispute – Part-Time Employees

The Provider claims dispute process for LTD benefits provided pursuant to Section 18.4.3 is described in the Summary Plan Description or Evidence of Coverage Document.  The County Human Resources Risk Management Division will assist employees with claims dispute processing. Related to the County’s outside LTD provider.

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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.

18.5.1 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 bi-weekly 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.

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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 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 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 paid status to not less than fifty percent (50%) of the employee’s allocated full-time equivalent (FTE) in a pay period, the County will continue to pay its normal benefit contributions.

18.6.1 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 (14^th) 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 (13^th) 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 (18.6.1) 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 18.6.1 (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 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%) 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..

18.6.2 Continuation Of Health Benefits Coverage

An employee, who is entitled to continued benefit coverage as specified in Section 18.6 (Health Benefits During Leaves of Absence – Non-Medical Leaves Without Pay and 18.6.1 Medical/Pregnancy Disability Leave) must notify the Auditor-Controller-Treasurer-Tax Collector (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. The employee must apply for a leave by completing a Leave of Absence Form.

If the Department authorizes the leave, the Department shall forward the completed Leave of Absence Form to the ACTTC’s Office. 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 continued 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 paid status

18.6.2.1 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 18.2.8.  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 18.4 (Long-Term Disability).

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The County provides continuation of health benefits at group rates plus two percent (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)

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 the law.

Dependent Care Assistance Program

The County provides a Dependent Care Assistance Program subject to the limitations and maximums as stipulated under law.

All of these plans will be administered by the County in accordance with applicable Federal and State laws as amended and, as such, will not be grievable or arbitrable.

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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.  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. Summary Plan Descriptions and evidence of coverages are available on-line at the following location:

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

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The County and the Association agree to a reopener to make necessary changes to health and welfare benefit eligibility and/or coverage options as required by the Patient Protection and Affordable Health Care Act (PPACA), commonly referred to as Health Care reform, or as required by similar subsequent statutes or regulations implemented during the term of this agreement.

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Effective June 21, 2016, the County ceased contributions to the Health Reimbursement Arrangement (HRA) contributions under this Section 18.11. Members 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.

Remaining Balances in the active HRA article 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 Article 19, Section 19.5.

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.

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