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APPENDIX B - Insurance

Section 1. Manager Group Insurance Program.

During the life of this Plan, the Employer shall provide a Group Insurance Program that includes health, dental, life, and disability coverages equivalent to existing coverages, subject to the provisions of this Chapter.

All insurance eligible managers will be provided with a Summary Plan Description describing these coverages. Such Summary Plan Description shall be provided no less than biennially and prior to the beginning of the insurance year. New insurance eligible managers shall receive a Summary Plan Description within thirty (30) days of their date of eligibility.

Section 2. Eligibility for Group Participation.

This section describes eligibility to participate in the Group Insurance Program.

1. Managers - Basic Eligibility. Managers may participate in the Group Insurance Program if they are scheduled to work at least 1044 hours in any twelve consecutive months, except for: emergency, temporary, and intermittent managers.
2. Managers - Special Eligibility. The following managers are also eligible to participate in the Group Insurance Program:
   1. Managers with a Work-related Injury/Disability. A manager who was off the State payroll due to a work-related injury or a work-related disability may continue to participate in the Group Insurance Program as long as such a manager receives workers' compensation payments or while the workers' compensation claim is pending.
   2. Totally Disabled Managers. Consistent with M.S. 62A.148, certain totally disabled managers may continue to participate in the Group Insurance Program.
   3. Retired Managers. A manager who retires from State service, is not eligible for regular (non-disability) Medicare coverage, has five (5) or more years of allowable pension service, and is entitled at the time of retirement to immediately receive an annuity under a State retirement program, may continue to participate in the health and dental coverages offered through the Group Insurance Program.

      Consistent with M.S. 43A.27, subdivision 3, a retired manager from State service who receives an annuity under a State retirement program may continue to participate in the health and dental coverages offered through the Group Insurance Program. Retiree coverage must be coordinated with Medicare.

3. Dependents. Eligible dependents for the purposes of this Chapter are as follows:
   1. Spouse. The spouse of an eligible manager (if not legally separated). For the purpose of health insurance coverage, if that spouse works full-time for an organization employing more than 100 people and elects to receive either credits or cash (1) in place of health insurance or health coverage or (2) in addition to a health plan with a seven hundred and fifty dollar ($750) or greater deductible through his/her employing organization, s/he is not eligible to be a covered dependent for the purposes of this Chapter. If both spouses work for the State or another organization participating in the State's Group Insurance Program, neither spouse may be covered as a dependent by the other, unless one spouse is not eligible for a full Employer Contribution as defined in Section 3A.
   2. Children and Grandchildren.An eligible manager's unmarried dependent children and unmarried dependent grandchildren: (1) through age eighteen (18); or (2) through age twenty-four (24) if the child or grandchild is a full-time student at an accredited educational institution; or (3) a child or grandchild, regardless of age or marital status, who is incapable of self-sustaining employment by reason of mental retardation, mental illness or physical disability and is chiefly dependent on the manager for support. The handicapped dependent shall be eligible for coverage as long as s/he continues to be handicapped and dependent, unless coverage terminates under the contract.

      "Dependent Child" includes a manager's: (1) biological child, (2) child legally adopted by or placed for adoption with the manager, (3) foster child, and (4) step-child. To be considered a dependent child, a foster child must be dependent on the manager for his/her principal support and maintenance and be placed by the court in the custody of the manager. To be considered a dependent child, a step-child must maintain residence with the manager and be dependent upon the manager for his/her principal support and maintenance.

      "Dependent Grandchild" includes a manager's: (1) grandchild placed in the legal custody of the manager, (2) grandchild legally adopted by the manager or placed for adoption with the manager, or (3) grandchild who is the dependent child of the manager's unmarried dependent child. Under (1) and (3) above, the grandchild must be dependent upon the manager for principal support and maintenance and live with the manager.

      If both spouses work for the State or another organization participating in the State's Group Insurance Program, either spouse, but not both, may cover their eligible dependent children or grandchildren. This restriction also applies to two divorced, legally separated, or unmarried managers who share legal responsibility for their eligible dependent children or grandchildren.

4. Continuation Coverage. Consistent with state and federal laws, certain managers, former managers, dependents, and former dependents may continue group health, dental, and/or life coverage at their own expense for a fixed length of time. As of the date of this Plan, state and federal laws allow certain group coverages to be continued if they would otherwise terminate due to:
   1. termination of employment (except for gross misconduct);
   2. layoff;
   3. reduction of hours to an ineligible status;
   4. dependent child becoming ineligible due to change in age, student status, marital status, or financial support (in the case of a foster child or stepchild);
   5. death of manager; or
   6. divorce.

Section 3. Eligibility for Employer Contribution.

This section describes eligibility for an Employer Contribution toward the cost of coverage.

1. Full Employer Contribution - Basic Eligibility. The following managers covered by this Plan receive the full Employer Contribution:
   1. Managers who are scheduled to work at least forty (40) hours weekly for a period of nine (9) months or more in any twelve (12) consecutive months.
   2. Managers who are scheduled to work at least sixty (60) hours per pay period for twelve (12) consecutive months, but excluding part-time or seasonal managers serving on less than a seventy-five (75) percent basis.
2. Partial Employer Contribution - Basic Eligibility. The following managers covered by this Plan receive the full Employer Contribution for basic life coverage, and at the manager's option, a partial Employer Contribution for health and dental coverages. The partial Employer Contribution for health and dental coverages is seventy-five (75) percent of the full Employer Contribution for both employee only and dependent coverage.
   1. Part-time Managers.Managers who hold part-time, unlimited appointments and who work at least fifty (50) percent of the time but less than seventy-five (75) percent of the time.
   2. Seasonal Managers. Seasonal managers who are scheduled to work at least 1044 hours over a period of any twelve (12) consecutive months.
3. Special Eligibility. The following managers also receive an Employer Contribution:
   1. Managers on Layoff. A classified manager who receives an Employer Contribution, who has three (3) or more years of continuous service, and who has been laid off, remains eligible for an Employer Contribution and all other benefits provided
   2. Work-related Injury/Disability. A manager who receives an Employer Contribution and who is off the State payroll due to a work-related injury or a work-related disability remains eligible for an Employer Contribution as long as such a manager receives workers' compensation payments. If such manager ceases to receive workers' compensation payments for the injury or disability and is granted a disability leave under Chapter 6, s/he shall be eligible for an Employer Contribution during that leave.
4. Maintaining Eligibility for Employer Contribution.
   1. General. A manager who receives a full or partial Employer Contribution maintains that eligibility as long as the manager meets the Employer Contribution eligibility requirements, and appears on a State payroll for at least one full working day during each payroll period. This requirement does not apply to managers who receive an Employer Contribution while on layoff as described in Section 3C2, or while eligible for workers' compensation payments as described in Section 3C3.
   2. Unpaid Leave of Absence. If a manager is on an unpaid leave of absence, then vacation leave, compensatory time, or sick leave cannot be used for the purpose of maintaining eligibility for an Employer Contribution by keeping the manager on a State payroll for one (1) working day per pay period.
   3. School Year Employment. If a manager is employed on the basis of a school year and such employment contemplates absences from the State payroll during the summer months or vacation periods scheduled by the Appointing Authority which occur during the regular school year, the manager shall nonetheless remain eligible for an Employer Contribution, provided that the manager appears on the regular payroll for at least one working day in the payroll period immediately preceding such absences.
   4. A manager who is on an approved FMLA leave or on a salary savings leave as provided elsewhere in this plan maintains eligibility for an Employer contribution.

Section 4. Amount of Employer Contribution.

For managers eligible for an Employer Contribution as described in Section 3, the amount of the Employer Contribution will be determined as follows beginning on January 5, 2000. The Employer Contribution amounts and rules in effect on June 30, 1999 will continue through January 4, 2000.

1. Contribution Formula - Health Coverage.
   1. Manager Coverage. For manager health coverage, the Employer contributes an amount equal to the lesser of one hundred (100) percent of the manager-only premium of the Low-Cost Health Plan, or the actual manager-only premium of the health plan chosen by the manager.
   2. Dependent Coverage. For dependent health coverage, the Employer contributes an amount equal to the lesser of ninety (90) percent of the dependent premium of the Low-Cost Health Plan, or the actual dependent premium of the health plan chosen by the manager.
   3. Low-Cost Health Plan. For the purposes of Section 4A, "Low-Cost Health Plan" means the health plan with: (1) the lowest family premium rate; and (2) operating in the county of the manager's permanent work location; county of residence for insurance year 2001; see Section 4A4 below. "Family premium" is the total of the manager premium and the dependent premium.

      The Low-Cost Health Plan for each county for the 2000 insurance year is listed in Appendix I. During the 2000 insurance year, the list may be changed only if the Low-Cost Health Plan no longer operates in a county.

   4. Location as the Basis for Employer Contribution. The Employer Contribution for each manager is based on the manager's permanent work location on the effective date of the 2000 insurance year. For the 2001 insurance year, the Employer contribution will be based on the manager’s county of permanent residence (for Minnesota residents) or the manager’s county of permanent work location (for Minnesota non-residents). If the health plan a manager is enrolled in is not available at the new permanent work location, then the Employer Contribution changes to the amount in effect at the new permanent work location.
2. Contribution Formula - Dental Coverage.
   1. Manager Coverage. For manager dental coverage, the Employer contributes an amount equal to the lesser of one hundred (100) percent of the manager premium of the State Dental Plan, or the actual manager premium of the dental plan chosen by the manager.
   2. Dependent Coverage. For dependent dental coverage, the Employer contributes an amount equal to the lesser of fifty (50) percent of the dependent premium of the State Dental Plan, or the actual dependent premium of the dental plan chosen by the manager.
3. Contribution Formula - Basic Life Coverage. For manager basic life coverage and accidental death and dismemberment coverage, the Employer contributes one-hundred (100) percent of the cost.

Section 5. Coverage Changes and Effective Dates.

1. When Coverage May Be Chosen. A manager must make his/her choice of employee health and dental plans and choice of dependent coverage (if applicable) within sixty (60) calendar days of the date of initial appointment to an insurance-eligible position. When health and dental coverage are elected, the manager will automatically be enrolled in basic life coverage. Managers eligible for a partial employer contribution may elect health and dental coverage within sixty (60) calendar days of initial employment or during an open enrollment period. Managers who become eligible for a full employer contribution must make their choice of manager-only health and dental plans and dependent coverage within sixty (60) calendar days of becoming eligible or be enrolled in the low-cost plan in the county of the manager's work location. A manager may change his/her health or dental plan if the manager changes to a new permanent work location, and the manager's current plan is not available at the new work location.

   A manager who receives notification of a work location change between the end of an open enrollment period and the beginning of the next insurance year, may change his/her health or dental plan within thirty (30) calendar days of the date of the relocation under the same provisions accorded during the last open enrollment period. A manager and a retired manager may add dependent health or dental coverage following the birth of a child or dependent grandchild, or following the adoption of a child without regard to the thirty (30) day enrollment period. In addition, a manager and a retired manager may add dependent health or dental coverage within thirty (30) days of the following events:

   1. If a manager or retired manager becomes married, the manager or retiree may add his/her spouse and any dependent children/grandchildren.
   2. If the manager's spouse loses group health or dental coverage, the manager may add his/her spouse and any dependent children/grandchildren.
   3. If the retiree’s spouse involuntarily loses group health or dental coverage, the retiree may add his/her spouse and any dependent children/grandchildren. (Spouse’s loss of coverage due to his/her retirement would be considered involuntary.)
2. When Coverage May Be Cancelled.
   1. Dependent Coverage. A manager may cancel dependent health or dependent dental coverage outside of open enrollment only in the case of certain life events that are consistent with the request to cancel coverage. The request to cancel coverage must be made within sixty (60) days of the event. Life events include, but are not limited to:
      • loss of dependent status of a sole dependent;
      • death of a sole dependent;
      • divorce;
      • change in employment condition of a manager or spouse; and
      • a significant change of spousal insurance coverage (cost of coverage is not a significant change).
      Dependent health or dependent dental coverage may also be cancelled during the open enrollment period that applies to each type of plan for any reason.
   2. Manager-only Coverage. A part-time manager may also cancel manager-only coverage within sixty (60) days of when one of these same life events occurred.
   3. Effective Date of Benefit Termination. Medical coverage termination will take effect on the first of the month following the end of the pay period coinciding with or next following the date of the application to cancel coverage, or the loss of eligible employee or dependent status.

      All other benefit coverage terminations will take effect on the first day of the pay period coinciding with or next following the date of the application to cancel coverage, or the loss of eligible employee or dependent status.

3. Effective Date of Coverage.
   1. Initial Effective Date. The initial effective date of coverage under the Group Insurance Program is the first day of the first payroll period beginning on or after the 28th calendar day following the manager's first day of employment, re-employment, re-hire, or reinstatement with the State. A manager must be actively at work on the initial effective date of coverage, except that a manager who is on paid leave on the date State-paid life insurance benefits increase is also entitled to the increased life insurance coverage. In no event shall a manager's dependent's coverage become effective before the manager's coverage.

      If a manager is not actively at work due to manager or dependent health status or medical disability, medical and dental coverage will still take effect. (Life and disability coverage will be delayed until the manager returns to work.)

   2. Delay in Coverage Effective Date.
      1. Basic Life. If a manager is not actively at work on the initial effective date of coverage, coverage will be delayed until the first day of the pay period coinciding with or next following the manager’s return to work. The effective date of a change in coverage is not delayed in the event that, on the date the coverage change would be effective, a manager is on an unpaid leave of absence or layoff.
      2. Medical and Dental. If a manager is not actively at work on the initial effective date of coverage due to a reason other than hospitalization or medical disability of the manager or dependent, medical and dental coverage will be delayed until the first day of the pay period coinciding with or next following the manager’s return to work.

         The effective date of a change in coverage is not delayed in the event that, on the date the coverage change would be effective, a manager is on an unpaid leave of absence or layoff.

      3. Optional Life and Disability Coverages. In order for coverage to become effective, the manager must be in active payroll status and not using sick leave on the first day of the pay period coinciding with or next following approval by the insurance company. If it is an open enrollment period, coverage may be applied for but will not become effective until the first day of the pay period coinciding with or next following the manager's return to work.
4. Open Enrollment.
   1. Frequency and Duration. There shall be an open enrollment period for health coverage in each year of this Plan, and for dental coverage in the first year of this Plan. Open enrollment periods shall last a minimum of thirty (30) calendar days. Open enrollment changes become effective on January 5, 2000 in the first year of this Plan, and on January 3, 2001 in the second year of this Plan.
   2. Eligibility to Participate. A manager eligible to participate in the State Employee Group Insurance Program, as described in Section 2A and 2B, may participate in open enrollment. In addition, a person in the following categories may, as allowed in Section 5E1 above, make certain changes: (1) a former manager or dependent on continuation coverage, as described in Section 2D, may change plans or add coverage for health and/or dental plans on the same basis as active managers; and (2) an early retiree, prior to becoming eligible for Medicare, may change health and/or dental plans as agreed to for active managers, but may not add dependent coverage.
   3. Materials for Manager Choice. Each year prior to open enrollment, the Appointing Authority will give eligible managers the information necessary to make open enrollment selections. Managers will be provided a statement of their current coverage each year of the plan.
   4. Coverage Selection Prior to Retirement. A manager who retires and is entitled to receive an annuity under a State retirement program may change his/her health or dental plan during the sixty (60) calendar day period immediately preceding the date of retirement. The manager may not add dependent coverage during this period. The change takes effect on the first day of the first pay period beginning after the date of retirement.

Section 6. Basic Coverages.

1. Manager and Dependent Health Coverage.
1. Coverage Options. Eligible managers must select coverage under one of the health plans offered by the Employer, including the State Health Plan, or other health plans.
2. Coverage Under the State Health Plan. From July 1, 1999 through January 4, 2000, coverage under the State Health Plan Point of Service and State Health Plan Select (hereinafter referred to as SHPPOS and SHPS, respectively) will continue at the level in effect on June 30, 1999. Effective January 5, 2000, SHPPOS and SHPS will cover allowable charges for the following eligible services subject to the copayments and coverage limits stated. Services provided through both plans are subject to their managed care procedures and principles, including standards of medical necessity and appropriate practice. Effective January 5, 2000, all other plans providing services to state employees will have the same coverages as the SHPS.
   1. Services received from, or authorized by, a primary care physician within the primary care clinic. State Health Plan Point of Service (SHPPOS) and State Health Plan Select (SHPS).
      
      The following health care services under SHPPOS and SHPS shall be received from, or authorized by, a primary care physician within the primary care clinic. The primary care clinic shall be selected from approved clinics in accordance with SHPPOS and SHPS administrative procedures. Higher out-of-pocket costs as described in 6A2b apply to the following services if not received from, or authorized by, a primary care physician within the primary care clinic.
      1. Inpatient hospital services. One hundred (100) percent coverage.
      2. Outpatient surgery center services. One hundred (100) percent coverage.
      3. Home health services. One hundred (100) percent coverage up to a maximum of five thousand dollars ($5,000) eligible expenses per person per year.
      4. X-rays and laboratory tests. One hundred (100) percent coverage.
      5. Preventive care. One hundred (100) percent coverage.
      6. Physicians services. One hundred (100) percent coverage.
      7. Durable medical equipment. Eighty (80) percent coverage.
      • All diabetic supplies, including test tapes and syringes, are covered under durable medical equipment
   2. Services not authorized by a primary care physician within the primary care clinic. Coverage under this section 6A2b is only available to individuals who elect SHPPOS coverage, and then only under the terms and conditions outlined in the Certificate of Coverage.&
      
      For services under 6A2a which are not authorized by a primary care physician within the primary care clinic in the 2000 and 2001 insurance years:
      • there is a three hundred fifty dollar ($350) deductible per person with a maximum deductible per family of seven hundred dollars ($700).
      After deductible is satisfied, seventy (70) percent coverage up to a maximum annual copayment of:
      • three thousand dollars ($3,000) per person and six thousand dollars ($6,000) per family.
      These deductibles and copayments are separate from the deductibles and copayments for authorized services under Section 6A2a.
   3. Special service networks (applies to SHPPOS and SHPS). The following services must be received from Special Service network providers in order to be covered.
      1. Mental health services - inpatient and outpatient. One hundred (100) percent coverage (up to 365 days for inpatient services). No coverage for services obtained from out-of-network providers under SHPS. Out-of-network services are available under SHPPOS according to the terms of the Certificate of Coverage. In-network services need not be authorized by a primary care physician within the primary care clinic under either plan.
      2. Chemical dependency services - inpatient and outpatient. One hundred (100) percent coverage (up to 365 days for inpatient services). No coverage for services obtained from out-of-network providers under SHPS. Out-of-network services are available under SHPPOS according to the terms of the Certificate of Coverage. In-network services need not be authorized by a primary care physician within the primary care
      3. Chiropractic services. One hundred (100) percent coverage. No coverage for services obtained from out-of-network providers. Services need not be authorized by a primary care physician within the primary care clinic. Coverage shall be provided for a minimum of twenty (20) services or twenty-one (21) calendar days, whichever is greater, per incident.
      4. Transplant coverage. The SHPPOS and SHPS shall provide transplant coverage, as specified in their respective Certificates of Coverage. No coverage for services obtained from out-of-network providers.
         
         Referrals for eligible transplant services must be authorized by a primary care physician within the primary care clinic.
      5. Cardiac services. No coverage for non-emergency cardiac services obtained from out-of-network providers. Referrals for services must be authorized by a primary care physician within the primary care clinic.
      6. Home Infusion Therapy. The SHPPOS and SHPS shall provide Home Infusion Therapy coverage as specified in their respective Certificates of Coverage. No coverage for services obtained from out-of-network providers. Referrals for eligible Home Infusion Therapy services must be authorized by a primary care physician within the primary care clinic.
      7. Hospice Benefit. One hundred (100) percent coverage for services obtained from in-network providers. Seventy (70) percent coverage for services obtained from out-of-network providers under SHPPOS. Referrals for eligible hospice services must be authorized by a primary care physician within the primary care network.
   4. Services not requiring authorization by a primary care physician within the primary care clinic.
      
      The following services do not require authorization by a primary care physician within the primary care clinic in order to be covered.
      1. Prescription drugs.
         • Insulin will be treated as a prescription drug subject to a separate copay for each type prescribed.
         • If the subscriber chooses a brand name drug when a bioequivalent generic drug is available, the subscriber is required to pay the standard copayment plus the difference between the cost of the brand name drug and the generic. Amounts above the copay that an individual elects to pay for a brand name instead of a generic drug will not be credited toward the out-of-pocket maximum.
         1. SHPS. Prescription Drugs. For the 2000 and 2001 insurance years:
         • ten dollar ($10) copayment per prescription or refill for a generic formulary drug dispensed in a thirty-four (34) day supply.
         • twenty-one dollar ($21) payment per prescription or refill for a non-formulary drug dispensed in a thirty-four (34) day supply.
         • annual maximum eligible out of pocket expense for prescription drugs of two hundred dollars ($200) per person or four hundred dollars ($400) per family.
         2. Grandfathered Diabetic Group. For insulin dependent diabetics who have been continuously enrolled in the State Health Plan since January 1, 1991 and who were identified as having used these supplies during the period January 1, 1991 through September 30, 1991, (hereinafter the "Grandfathered Diabetic Group") diabetic supplies are covered as follows:
            • Test tapes and syringes are covered at one hundred (100) percent for the greater of a thirty-four (34) day supply or one hundred (100) units when purchased with insulin.
      2. Eye exams. SHPPOS and SHPS. One hundred (100) percent coverage. (Limited to one routine examination per year.)
      3. Outpatient emergency and urgicenter services. SHPPOS and SHPS. Thirty dollar ($30) copayment per visit for outpatient emergency visits and fifteen dollar ($15) copayment per visit for urgicenter visits that do not result in hospital admission within twenty-four (24) hours; one hundred (100) percent coverage thereafter.
      4. Ambulance. SHPPOS and SHPS. Eighty (80) percent coverage for eligible expenses. (Air ambulance paid to ground ambulance coverage limit only, unless ordered "first response" or if air ambulance is the only medically acceptable means of transport as certified by the attending physician.)
   5. Emergency and urgently needed care outside the network (SHPPOS and SHPS). Professional services of a physician, emergency room treatment, and inpatient hospital services covered at eighty percent (80%) of the first two thousand dollars ($2,000) and one hundred percent (100%) thereafter of the charges incurred per insurance year. The maximum eligible out-of-pocket expense per individual per year for this benefit is four hundred dollars ($400). This benefit is not available when the member’s condition permits him or her to receive care within the network of the plan in which the individual is enrolled.
   6. Lifetime maximum. SHPPOS and SHPS. Coverage under the State Health Plan is subject to a per-person lifetime maximum. The lifetime maximum is two million dollars ($2,000,000) for services under 6A2a, 6A2c and 6A2d combined. The lifetime maximum for services under 6A2b is limited to five hundred thousand dollars ($500,000). The five hundred thousand dollar ($500,000) maximum which applies under 6A2b is part of, and not in addition to, the two million dollar ($2,000,000) lifetime plan maximum.
3. Coordination with Workers' Compensation. When a manager has incurred an on-the-job injury or an on-the-job disability and has filed a claim for workers' compensation, medical costs connected with the injury or disability shall be paid by the manager's health plan, pursuant to M.S. 176.191, subdivision 3.
4. Health Promotion and Health Education. The Employer recognizes the value and importance of health promotion and health education programs. Such programs can assist managers and their dependents to maintain and enhance their health, and to make appropriate use of the health care system. To work toward these goals:
   1. Develop Programs. The Department of Employee Relations will develop and implement health promotion and health education programs, subject to the availability of resources. Each Appointing Authority will develop a health promotion and health education program consistent with the Department of Employee Relations policy. Program topics shall include but are not limited to smoking cessation, weight loss, stress management, health education/self-care, and education on related benefits provided through the State Health Plan and HMO plans.
   2. Health Plan Specification. The Employer will require health plans participating in the Group Insurance Program to develop and implement health promotion and health education programs for State managers and their dependents.
   3. Manager Participation. The Employer will assist managers' participation in health promotion and health education programs. Health promotion and health education programs that have been endorsed by the Employer (Department of Employee Relations) will be considered to be non-assigned job-related training pursuant to Administrative Procedure 21B. Approval for this training is at the discretion of the Appointing Authority and is contingent upon meeting staffing needs in the manager's absence and the availability of funds. Managers are eligible for release time, tuition reimbursement, or a prorata combination of both. Managers may be reimbursed for up to one hundred (100) percent of tuition or registration costs upon successful completion of the program.
   4. Health Promotion Incentives. The Joint Labor-Management Committee on Health Plans shall develop a program which provides incentives for managers who participate in a health promotion program. The health promotion program shall emphasize the adoption and maintenance of more healthy lifestyle behaviors and shall encourage wiser usage of the health care system.
2. Manager and Family Dental Coverage.
   1. Coverage Options. Eligible managers may select coverage under any one of the dental plans offered by the Employer, including health maintenance organization plans, the State Dental Plan, or other dental plans.
   2. Coverage Under the State Dental Plan. The State Dental Plan will provide the following coverage:
   1. Copayments. Effective January 5, 2000, the State Dental Plan will cover allowable charges for the following services subject to the copayments and coverage limits stated. Higher out-of-pocket costs apply to services obtained from dental care providers not in the State Dental Plan network. Services provided through the State Dental Plan are subject to the State Dental Plan's managed care procedures and principles, including standards of dental necessity and appropriate practice. The plan shall cover general cleaning two (2) times per plan year and special cleanings (root or deep cleaning) as prescribed by the dentist.

      Service	In-Network	Out-of-Network
      Diagnostic/Preventive	100%	50%
      Fillings	80%	50%
      Endodontics	80%	50%
      Periodontics	80%	50%
      Oral Surgery	80%	50%
      Crowns	80%	50%
      Prosthetics	50%	None
      Prosthetic Repairs	50%	None
      Orthodontics*	80%	50%

      *Please refer to your Certificate of Coverage for information regarding age limitation for dependent orthodontic care.

   2. Deductible. An annual deductible of one hundred twenty-five dollars ($125) per person applies to State Dental Plan basic and special services received from out of network providers. The deductible must be satisfied before coverage begins.
   3. Annual Maximums. State Dental Plan coverage is subject to a one thousand dollar ($1,000) annual maximum benefit payable (excluding orthodontia) per person. "Annual" means per insurance year.
   4. Orthodontia Lifetime Maximum. Orthodontia benefits are available to eligible dependent children ages 8 through 18 subject to a two thousand eight hundred dollar ($2,800) lifetime maximum benefit.
3. Income Protection Plan.
   1. Basic Managerial Life, Accidental Death and Dismemberment (AD&D) Coverage, and Disability Insurance. The Employer agrees to provide and pay for the following coverage in either Plan A or Plan B for all managers eligible for a full or partial Employer Contribution, as described in Section 3. Any premium paid by the State in excess of fifty thousand dollars ($50,000) coverage is subject to a tax liability in accord with Internal Revenue Service regulations. A manager may decline coverage in excess of fifty thousand dollars ($50,000) by filing a waiver in accord with Department of Finance procedures. The basic life insurance policy will include an accelerated benefits agreement providing for payment of benefits prior to death if the insured has a terminal condition.

      Managers select coverage under either Plan A or Plan B below. Both plans provide employer paid life and AD&D coverage. Plan A also includes employer paid disability coverage.

      Plan A

      Employer paid life and AD&D coverage equal to one and one-half times annual salary and disability insurance with a one hundred and fifty (150) calendar day elimination period.

      Managers may elect to purchase shorter elimination periods for disability insurance of thirty (30), sixty (60), ninety (90) or one hundred and twenty (120) days.

      The disability benefit, after the elimination period, is sixty (60) percent of a manager's salary to a maximum of $5,000/month.

      Plan B

      Employer paid life and AD&D coverage equal to two times annual salary.

      Managers may elect to purchase disability insurance at the manager's own expense. Managers may elect to purchase shorter elimination periods of thirty (30), sixty (60), ninety (90), one hundred and twenty (120) or one hundred and fifty (150) days.

      The disability benefit, after the elimination period, is sixty (60) percent of a manager's salary to a maximum of $5,000/month.

      Disability insurance elimination periods. Elimination periods can be changed once a year. The Group Benefits Plan brochure for the Managers Income Protection Plan contains information on when changes require evidence of insurability.

   
   
   
   2. Extended Benefits. A manager who becomes totally disabled before age 70 shall be eligible for the extended benefit provisions of the life insurance policy until age 70. Employees who were disabled prior to July 1, 1983 and who have continuously received benefits shall continue to receive such benefits under the terms of the policy in effect prior to July 1, 1983.
   3. Additional Death Benefit. Managers who retire on or after July 1, 1985, shall be entitled to a five hundred dollar ($500) death benefit payable to a beneficiary designated by the manager, if at the time of death the manager is entitled to an annuity under a State retirement program. A five hundred dollar ($500) cash death benefit shall also be payable to the designated beneficiary of a manager who becomes totally and permanently disabled on or after July 1, 1985, and who at the time of death is receiving a State disability benefit and is eligible for a deferred annuity under a State retirement program.

Section 7. Optional Coverages.

1. Life Coverage.
1. Manager. A manager may purchase up to five hundred thousand dollars ($500,000) additional life insurance, in increments established by the Employer, subject to satisfactory evidence of insurability. Upon initial appointment to state service, a new manager may purchase up to two (2) times annual salary or two hundred thousand dollars ($200,000), whichever is less, in optional employee life coverage within sixty (60) calendar days of hire without evidence of insurability.
2. Spouse. A manager may purchase up to five hundred thousand dollars ($500,000) life insurance coverage for his/her spouse, in increments established by the Employer, subject to satisfactory evidence of insurability. Upon initial appointment to state service, a new manager may purchase either five thousand dollars ($5,000) or ten thousand dollars ($10,000) in optional spouse life coverage within sixty (60) calendar days of hire without evidence of insurability.
3. Children/Grandchildren. A manager may purchase life insurance in the amount of ten thousand dollars ($10,000) as a package for all eligible children/grandchildren (as defined in Section 2C of this Chapter). Child/grandchild coverage requires evidence of insurability if application is made after the first sixty (60) calendar days of employment. Child/grandchild coverage commences fourteen (14) calendar days after birth.
4. Accelerated Life. The additional manager, spouse and child life insurance policies will include an accelerated benefits agreement providing for payment of benefits prior to death if the insured has a terminal condition.
5. Waiver of Premium. In the event a manager becomes totally disabled before age seventy (70), there shall be a waiver of premium for all life insurance coverage that the manager had at the time of disability.
6. Paid Up Life Policy. At age sixty-five (65) or the date of retirement, a manager who has carried optional life insurance for the five (5) consecutive years immediately preceding the date of the manager’s retirement or age sixty-five (65), whichever is later, shall receive a post-retirement paid-up life insurance policy in an amount equal to fifteen (15) percent of the smallest amount of optional manager life insurance in force during that five (5) year period. The manager’s post-retirement death benefit shall be effective as of the date of the manager’s retirement or the manager age sixty-five (65), whichever is later. Managers who retire prior to age sixty-five (65) must be immediately eligible to receive a state retirement annuity and must continue their optional manager life insurance to age sixty-five (65) in order to remain eligible for the manager post-retirement death benefit.



A manager who has carried optional spouse life insurance for the five (5) consecutive years immediately preceding the date of the manager’s retirement or spouse age sixty-five (65), whichever is later, shall receive a post-retirement paid-up life insurance policy in an amount equal to fifteen (15) percent of the smallest amount of optional spouse life insurance in force during that five (5) year period. The spouse post-retirement death benefit shall be effective as of the date of the manager’s retirement or spouse age sixty-five (65), whichever is later. The manager must continue the full amount of optional spouse life insurance to the date of the manager’s retirement or spouse age sixty-five (65), whichever is later, in order to remain eligible for the spouse post-retirement death benefit.

Each policy remains separate and distinct, and amounts may not be combined for the purpose of increasing the amount of a single policy.

2. Disability Coverage.
1. Short-term Disability Coverage. An employee who carries short-term disability and is promoted to a managerial position may continue the coverage in force at that time. The manager may decrease or cancel the coverage, but may not increase the coverage.
2. Long-term Disability Coverage. An employee who is promoted to a managerial position is eligible for long-term disability coverage only through the Income Protection Plan.
3. Accidental Death and Dismemberment Coverage. A manager may purchase accidental death and dismemberment coverage that provides principal sum benefits in amounts ranging from five thousand dollars ($5,000) to one hundred thousand dollars ($100,000). Payment is made only for accidental bodily injury or death and may vary, depending upon the extent of dismemberment. A manager may also purchase from five thousand dollars ($5,000) to twenty five thousand dollars ($25,000) in coverage for his/her spouse, but not in excess of the amount carried by the manager.
4. Continuation of Optional Coverages During Unpaid Leave or Layoff. A manager who takes an unpaid leave of absence or who is laid off may discontinue premium payments on short-term disability and optional employee, spouse and child life policies during the period of leave or layoff. If the manager returns within one (1) year, the manager shall be permitted to pick up all optionals held prior to the leave or layoff. For purposes of reinstating such optional coverages, the following limitations shall be applicable.



For the first twenty-four (24) months of short-term disability coverage after such a period of leave or layoff during which short-term or long-term disability coverage was discontinued, any such disability coverage shall exclude coverage for certain pre-existing conditions. For disability purposes, a pre-existing condition is defined as any disability which is caused by, or results from, any injury, sickness or pregnancy which occurred, was diagnosed, or for which medical care was received during the period of leave or layoff. In addition, any pre-existing condition limitations that would have been in effect under the policy but for the discontinuance of coverage shall continue to apply as provided in the policy.

The limitations set forth above do not apply to Family Medical Leave Act (FMLA) leaves.