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MnSCU-IFO Master Agreement 1995-1997
ARTICLE 14 - Insurance
Section A. State Employee Group Insurance Program. During the life of this Agreement, the Employer agrees to offer a Group Insurance Program that includes health, dental, life, and disability coverages equivalent to existing coverages, subject to the provisions of this Article.
All insurance eligible employees 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 employee shall receive a Summary Plan Description within thirty (30) days of their date of eligibility.
Section B. Eligibility for Group Participation. This Section describes eligibility to participate in the Group Insurance Program.
Subd. 1. Faculty Members-Basic Eligibility. A faculty member may participate in the Group Insurance Program if he/she is employed on the basis of at least fifty percent (50%) of a full-time work assignment for a regular academic year. Coverage will terminate at the end of the payroll period of the effective date of resignation, termination or non-renewal. However, a fixed-term faculty member will cease to be covered at the expiration date of his/her appointment, unless notice is provided by the President by May 1 of each year that the faculty member will be rehired. Faculty members who meet the eligibility requirements and are non-renewed effective with the end of the academic year shall continue to participate in the Group Insurance Program and receive Employer premium contributions at the contractually specified rates until the beginning of the subsequent academic year.
Subd. 2. Faculty Members-Special Eligibility. The following faculty members are also eligible to participate in the Group Insurance Program:
a. Faculty Members with Work-related Injury/Disability. A faculty member 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 faculty member receives workers' compensation payments or while the workers' compensation claim is pending.
b. Totally Disabled Faculty Members. Consistent with Minnesota Statutes 62A.148, certain totally disabled faculty members may continue to participate in the Group Insurance Program.
c. Early Retirement. A faculty member who retires from State service, is not eligible for regular (non-disability) Medicare coverage, has ten (10) 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 at his/her own expense.
Consistent with Minnesota Statutes 43A.27, Subd. 3., a retired faculty member 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 at his/her own expense. Retiree coverage must be coordinated with Medicare.
d. Sabbatical Leave. A faculty member eligible to participate in the Group Insurance Program immediately prior to taking a sabbatical leave continues that eligibility during the sabbatical leave.
Subd. 3. Dependents. Eligible dependents for purposes of this Article are as follows:
a. Spouse. The spouse of an eligible faculty member (if not legally separated). For the purposes of health insurance coverage, if that spouse works full-time for an organization employing more than one hundred (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, he/she is not eligible to be a covered dependent for purposes of this Article. 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 Subd. 3.a.
b. Children and Grandchildren. An eligible faculty member'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 if chiefly dependent on the faculty member for support. The handicapped dependent shall be eligible for coverage as long as she/he continues to be handicapped and dependent, unless coverage terminates under the contract.
"Dependent Child" includes a faculty member's: (1) biological child, (2) child legally adopted by or placed for adoption with the faculty member, (3) foster child, and (4) stepchild. To be considered a dependent child, a foster child must be dependent on the faculty member for his/her principal support and maintenance and be placed by the court in the custody of the faculty member. To be considered a dependent child, a stepchild must maintain residence with the faculty member and be dependent upon the faculty member for his/her principal support and maintenance.
"Dependent Grandchild" includes a faculty member's: (1) grandchild placed in the legal custody of the faculty member, (2) grandchild legally adopted by the faculty member or placed for adoption with the faculty member, or (3) grandchild who is the dependent child of the faculty member's unmarried dependent child. Under (1) and (3) above, the grandchild must be dependent upon the faculty member for principal support and maintenance and live with the faculty member.
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 eligible dependent children or grandchildren. This restriction also applies to two divorced, legally separated, or unmarried faculty members/employees who share legal responsibility for their eligible dependent children or grandchildren.
Subd. 4. Continuation of Coverage. Consistent with state and federal laws, certain faculty members, former faculty members, 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 Agreement, state and federal laws allow certain group coverages to be continued if they would otherwise terminate due to:
a. Termination of employment (except for gross misconduct);
b. Layoff;
c. Reduction of hours to an ineligible status;
d. 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):
e. Death of faculty member; or
f. Divorce.
Section C. Eligibility for Employer Contribution. This Section describes eligibility for an Employer contribution toward the cost of coverage.
Subd. 1. Full Employer Contribution - Basic Eligibility. Faculty members covered by this Agreement and appointed for at least seventy-five percent (75%) of the full-time work assignment load for a regular academic year receive the full Employer contribution. The seventy-five percent (75%) minimum requirement can be satisfied by: (1) a one hundred sixty-eight (168) duty-day contract at seventy-five percent (75%) load; (2) a contract for seventy-five percent (75%) of the 168 duty-days at full load; (3) some equivalent combination.
A faculty member initially hired during the academic year on a tenured appointment or a probationary appointment may receive the full Employer contribution if the appointment is for minimum of a seventy-five percent (75%) load for the duration of that appointment.
Subd. 2. Special Eligibility. The following faculty members also receive an Employer contribution:
a. Faculty Members on Layoff. An eligible tenured faculty member who receives an Employer contribution, who has three (3) or more years of continuous service, and who has been laid off pursuant to the provisions of Article 23 remains eligible for an Employer contribution and all other benefits provided under this Article for twelve (12) consecutive months from the date of layoff.
b. Work-Related Injury/Disability. A faculty member 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 faculty member receives workers' compensation payments. If such faculty member ceases to receive workers' compensation payments for the injury or disability and is granted a disability leave under Article 17, he/she shall be eligible for an Employer contribution during that leave.
c. Sabbatical Leave. A faculty member eligible for an Employer contribution immediately prior to taking a sabbatical leave continues to receive the Employer contribution during the sabbatical leave.
d. Faculty members participating in phased retirement shall be eligible for Employer-paid benefits in accordance with Minnesota Statutes 354.66 at the same rate as if they were employed full-time.
Subd. 3. Maintaining Eligibility for Employer Contribution.
a. General. A faculty member who is eligible for the Employer contribution maintains that eligibility as long as the faculty member meets the Employer determination eligibility requirements and appears on a State payroll for at least one (1) full working day during each payroll period. This requirement does not apply to faculty members who receive an Employer contribution while on layoff as described in Section C, Subd. 2.a., or while eligible for workers' compensation payments as described in Section C, Subd. 2.b.
b. Unpaid Leave of Absence. If a faculty member is on an unpaid leave of absence, then sick leave cannot be used for the purpose of maintaining eligibility for an Employer contribution by keeping the faculty member on a State payroll for one working day per pay period.
c. A faculty member on an approved Family Medical Leave Act (FMLA) leave or on a Voluntary Reduction in Hours as provided elsewhere in this Agreement maintains eligibility.
Section D. Amount of Employer Contribution. For faculty members eligible for an Employer contribution as described in Section C, the amount of the Employer contribution will be determined as follows beginning on December 24, 1997. The Employer contribution amounts and rules in effect on June 30, 1997, will continue through December 23, 1997.
Subd. 1. Contribution Formula-Health Coverage.
a. Faculty Member Coverage. For faculty member health coverage, the Employer contributes an amount equal to the lesser of one hundred percent (100%) of the faculty member premium of the Low Cost Health Plan, or the actual faculty member premium of the health plan chosen by the faculty member.
b. Dependent Coverage. For dependent health coverage, the Employer contributes an amount equal to the lesser of one hundred percent (100%) of the dependent premium of the Low Cost Health Plan, or the actual dependent premium of the health plan chosen by the faculty member.
c. Low Cost Health Plan. For purposes of Section D, Subd. 1., "lowest cost carrier" means the health plan: (1) with the lowest family premium rate, and (2) operating in the county of the faculty member's permanent work location. "Family premium" is the total of the faculty member premium and the dependent premium.
The Low-Cost Health Plan for each county for the 1998 insurance year is listed in Appendix D. During the 1998 insurance year, the list may be changed only if the low-cost carrier no longer operates in a county.
Low-Cost Health Plan Determination 1999. The list for the 1999 insurance year shall be established in accordance with the following procedures:
1. At least twelve (12) weeks prior to the open enrollment period for the 1999 insurance year, the Employer shall meet and confer with the Joint Labor/Management Committee on Health Plans in an attempt to reach agreement on the low-cost carrier for each county.
2. If no agreement is reached within five (5) working days, the Employer and the Joint Labor/Management Committee on behalf of all of the exclusive representatives shall submit counties in dispute to a mutually agreed-upon neutral expert in health care delivery systems for final and binding resolution. The only counties that may be submitted for resolution by this process are those in which, since the list for the 1998 insurance year was negotiated, one or more of the following has occurred:
changes in the network of one or more of the plans offered;
changes in the premium amounts affecting which plan is low cost;
the addition or deletion of carriers affecting which plan is low cost.
Absent agreement on a neutral expert, the parties shall select an arbitrator from a list of five (5) arbitrators supplied by the Bureau of Mediation Services. The parties shall flip a coin to determine who strikes first. One-half (.50) of the fees and expenses of the neutral shall be paid by the Employer and one-half (.50) by the exclusive representatives. The parties shall select a neutral within five (5) working days after no agreement is reached, and a hearing shall be held within fourteen (14) working days of the selection of the neutral.
3. The decision of the neutral shall be issued within two (2) working days after the hearing.
d. Faculty Member Work Location. The Employer contribution for each faculty member is based on the faculty member's permanent work location on the effective date of each new insurance year. If the health plan a faculty member 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.
Subd. 2. Contribution Formula-Dental Coverage.
a. Faculty Member Coverage. For faculty member dental coverage, the Employer contributes an amount equal to the lesser of one hundred percent (100%) of the faculty member premium of the State Dental Plan, or the actual faculty member premium of the dental plan chosen by the faculty member.
b. 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 faculty member.
Subd. 3. Contribution Formula-Basic Life Coverage. For faculty members' basic life coverage and accidental death and dismemberment coverage, the Employer contributes one hundred percent (100%) of the cost.
Section E. Coverage Changes and Effective Dates.
Subd. 1. When Coverage May be Chosen. All faculty members must make their 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 employee will automatically be enrolled in basic life coverage. Employees 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. Employees who become eligible for a full employer contribution must make their choice of employee 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 employee's work location.
A faculty member may change his/her health or dental plan if the faculty member changes to a new permanent work location, and the faculty member's current plan is not available at the new work location. A faculty member 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) days of the date of the relocation under the same provisions accorded during the last open enrollment period.
A faculty member may add dependent health or dental coverage following the birth of a child or dependent grandchild, or following the adoption of a child.
In addition, an employee may add dependent or dental coverage within thirty (30) days of the following events:
1. If a faculty member becomes married, the faculty member may add his/her spouse and any dependent children/grandchildren.
2. If the faculty member's spouse loses group health or dental coverage, the faculty member may add his/her spouse and any dependent children/grandchildren.
3. When a faculty member acquires his/her first dependent child, grandchild, or step child, the faculty member may add dependent coverage to cover both the child and the faculty member's spouse.
Subd. 2. When Coverage May Be Canceled.
1. Dependent coverage. An employee may cancel dependent health or dependent dental coverage outside the open enrollment only in the case of certain life events that are consistent with the request 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 an employee 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 canceled during the open enrollment period that applies to each type of plan for any reason.
Cancellation 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 dependent status.
2. Employee Coverage. A part-time employee may also cancel employee coverage within sixty (60) days of when one of these same life events occurred.
Subd. 3. 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 twenty-eighth (28) calendar day following the faculty member's first day of employment, reemployment, rehire, or reinstatement with the State. A faculty member must be actively at work on the initial effective date of coverage, except that a faculty member 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 faculty member's dependent's coverage become effective before the faculty member's coverage.
Subd. 4. Delay in Coverage Effective Date.
a. Health, Dental, and Basic Life. Except for dependent coverage for newborn children,
handicapped dependents as defined in Minnesota Statutes 62A.14 and 62A.141, and children placed for the purposes of adoption, the effective date of initial coverage or a change in coverage is delayed in the event that, on the date coverage would otherwise be effective, a faculty member or his/her dependent is hospitalized. Initial coverage for a newborn child is not affected by the child's hospitalization. In all other cases, coverage does not begin or change until the beginning of the first payroll period following the faculty member's or dependent's hospital discharge. However, initial faculty member-only coverage may begin if the faculty member's dependent is hospitalized.
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 faculty member is on an unpaid leave of absence or layoff.
b. Optional Life and Disability Coverages. In order for coverage to become effective, the faculty member 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 faculty member's return to work.
Subd. 5. Open Enrollment.
a. Frequency and Duration. There shall be an open enrollment period for health coverage in each year of this Agreement, and for dental coverage in the first year of this Agreement. Open enrollment periods shall commence on a mutually acceptable date and last a minimum of thirty (30) calendar days. Open enrollment changes become effective on December 24,1997, in the first year of this Agreement, January 6, 1999 in the second year of this Agreement.
b. Eligibility to Participate. A faculty member eligible to participate in the Group Insurance Program, as described in Section B., Subd. 1. and Section B., Subd. 2., may participate in open enrollment. In addition, a person in the following categories may, as allowed in Section E., Subd. 5.a. above, make certain changes: (1) a former employee or dependent on continuation coverage, as described in Section B., Subd. 4., may change plans or add coverage for health and/or dental plans on the same basis as active employees; and (2) an early retiree, prior to becoming eligible for Medicare, may change health and/or dental plans as agreed to for active employees, but may not add dependent coverage.
c. Materials for Faculty Member Choice. Each year prior to open enrollment the Appointing Authority will give eligible faculty members the information necessary to make open enrollment selections. Employees will be provided a statement of their current coverage each year of the contract.
Subd. 6. Coverage Selection Prior to Retirement. A faculty member 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 faculty member 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 F. Basic Coverages.
Subd. 1. Faculty Member and Dependent Health Coverage.
a. Coverage Options. Eligible faculty members must select coverage under one of the health plans offered by the Employer, including health maintenance organization plans, the State Health Plan, or other health plans. Coverage offered through health maintenance organization plans is subject to change during the life of this Agreement upon action of the health maintenance organization and approval of the Employer after consultation with the Joint Labor/Management Committee on Health Plans. However, actuarial reductions in the level of HMO coverages effective during the term of this Agreement, including increases in copayments, require approval of the Joint Labor/Management Committee on Health Plans. Coverage offered through the State Health Plan is determined by Section F, Subd. 1.b.
b. Coverage Under the State Health Plan. From July 1, 1997, through December 23, 1997, 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, 1997. Effective December 24, 1997, 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.
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 Section F., Subd. 1.b.3. apply to the following services if not received from, or authorized by, a primary care physician within the primary care clinic.
a. Inpatient hospital services. One hundred percent (100%) coverage.
b. Outpatient surgery center services. One hundred percent (100%) coverage.
c. Outpatient health services. One hundred percent (100%) coverage up to a maximum of five thousand dollars ($5,000) eligible expenses per person per year.
d. X-rays and laboratory tests. One hundred percent (100%) coverage.
e. Preventive Care. One hundred percent (100%) coverage.
f. Physicians services. One hundred percent (100%) coverage.
g. Durable medical equipment. Eighty percent (80%) coverage.
2. Services not authorized by a primary care physician within the primary care clinic.
Coverage under Section F, Subd. 1.b.2. 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 Section F, Subd. 1.b.1. which are not authorized by a primary care physician within the primary care clinic in the 1998 and 1999 insurance years:
Three hundred fifty dollar ($350) deductible per person with a maximum deductible per family per year of seven hundred dollars ($700).
After deductible is satisfied, seventy percent (70%) coverage up to a maximum annual copayment of:
Three thousand dollars ($3,000) per person and six thousand dollars ($6,000) per family.
The deductibles and copayments are separate from deductibles and copayments for authorized services under Section F, Subd. 1.b.1.
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.
a. Mental health services - inpatient and outpatient. One hundred percent coverage (up to three hundred sixty-five (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. Services need not be authorized by a primary physician within the primary care clinic.
b. Chemical dependency services - inpatient and outpatient. One hundred percent (100%) coverage (up to three hundred sixty-five (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. Services need not be authorized by a primary care physician within the primary care clinic.
c. Chiropractic services. One hundred percent (100%) 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.
d. 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.
e. 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.
f. 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 infusions therapy services must be authorized by a primary care physician within the primary care clinic.
g. Hospice Benefit. One hundred percent (100%) coverage for services obtained from in-network providers. Seventy percent (70%) coverage for services obtained from out-of-network providers under SHPPOS.
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.
a. 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.
1. SHPS. Prescription drugs. For the 1998 and 1999 insurance years:
- eight dollar copayment per prescription or refill for a formulary drug dispensed in a thirty-four (34) day supply.
- all diabetic supplies, including test tapes and syringes, are covered under the durable medical equipment benefit at eighty percent (80%) and are not subject to the thirty-four (34) day or one hundred (100) unit dispensing limitation.
2. SHPPOS. For the 1998 and 1999 insurance years:
- eight dollar ($8) copayment per prescription or refill for a formulary drug dispensed in a thirty four (34) day supply, or a one hundred (100) day supply for approved maintenance drugs;
- fourteen dollar ($14) copayment for non-formulary drugs; one hundred (100) percent coverage after copayment.
- A prescription for a non-formulary drug will be treated as a formulary if the physician has written Dispense as Written (DAW) on the prescription.
b. Diabetic Supplies.
1. Beginning with the 1992 plan year, any diabetics not included in the "Grandfathered Diabetic Group" described in paragraph "(2)" below will have diabetic supplies covered as follows:
- All diabetic supplies, other than test tapes and syringes, are covered under the durable medical equipment benefit at eighty percent (80%) and are not subject to the thirty-four (34) day or one hundred (100) unit dispensing limitation.
- Test tapes and syringes: an eight dollar ($8) copayment for a thirty-four (34) day supply of each.
2. 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 percent (100%) for the greater of a thirty-four (34) day supply or one hundred units when purchased with insulin.
- All other diabetic supplies, including test tapes and syringes not dispensed with the purchase of insulin, are covered under the durable medical equipment benefit at eighty percent (80%) and are not subject to the thirty-four (34) day or one hundred (100) unit dispensing limitation.
c. Eye exams. SHPPOS and SHPS. One hundred percent (100%) coverage (limited to one routine examination per year.)
d. 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.
e. Ambulance. SHPPOS and SHPS. Eighty percent (80%) 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. 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 Section F., Subd. 1.b.1., b.3. and b.4. combined. The lifetime maximum for services under Section F, Subd. 1.b.2. is limited to five hundred thousand dollars ($500,000) The five hundred thousand dollar ($500,000) maximum is part of, and not in addition to, the two million dollar ($2,000,000) lifetime plan maximum.
a. Coordination with Workers' Compensation. When a faculty member 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 faculty member's health plan, pursuant to Minnesota Statutes 176.191, Subd. 3.
b. Health Promotion and Health Education. Both parties to this Agreement recognize the value and importance of health promotion and health education programs. Such programs can assist faculty members 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 Employer 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. Upon request of any exclusive representative in an agency, the Appointing Authority shall jointly meet and confer with the exclusive representative(s) and may include other interested exclusive representatives. Discussion 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 faculty members and their dependents.
3. Faculty member participation. The Employer will assist faculty members' 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 faculty member's absence and the availability of funds. Faculty members are eligible for release time, tuition reimbursement, or a pro rata combination of both. Faculty members may be reimbursed for up to one hundred percent (100%) of tuition or registration costs upon successful completion of the program. Faculty members may be granted release time, including the travel time, in lieu of reimbursement.
4. Health Promotion Incentives. The Joint Labor-Management Committee on Health Plans shall develop a program which provides incentives for faculty 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.
a. Healthcare Delivery Strategy. The Joint Labor Management Committee on Health Plans shall review the performance of the managed competition strategy in promoting the goals of health care cost containment, access to care, and quality of care. The Committee shall consider other strategies for financing and delivering health care to state employees and their dependents, including the care system competition strategy implemented by the Buyers' Health Care Action Group. The Committee shall complete its work by December 1998, so that any changes to the insurance offering may be bargained by Plan Year 2000-2001.
b. Employer Medical Contribution Study. The Joint Labor Management Committee on Health Plans shall meet and confer regarding the administrative and economic feasibility of using the primary care clinic chosen by the employee as the basis of the Employer Contribution. If the Joint Labor Management Committee is able to agree on a methodology, this may be implemented for Plan Year 1999.
Subd. 2. Faculty Member and Dependent Dental Coverage.
a. Coverage Options. Eligible faculty members 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. Coverage offered through health maintenance organization plans is subject to change during the life of this Agreement upon action of the health maintenance organization and approval of the Employer after consultation with the Joint Labor/Management Committee on Health Plans. However, actuarial reductions in the level of HMO coverages effective during the term of this Agreement, including increases in copayments, require approval of the Joint Labor/Management Committee on Health Plans. Coverage offered through the State Dental Plan is determined by Section F., Subd. 2.b.
b. Coverage Under the State Dental Plan. The State Dental Plan will provide the following coverage:
1. Copayments. Effective December 24, 1997, 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 limitations for dependent orthodontic care.
2. Deductible. An annual deductible of one hundred dollars ($100) 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 maximum. State Dental Plan coverage is subject to a one thousand dollar ($1,000) annual maximum in eligible expenses per person. Annual means per insurance year.
Subd. 3. Faculty Member Life Coverage.
a. Basic Life and Accidental Death and Dismemberment Coverage. The Employer agrees to provide and pay for the following term life coverage and accidental death and dismemberment coverage for all faculty members eligible for an Employer contribution as described in Section C. Any premium paid by the State in excess of fifty thousand dollars ($50,000) coverage is subject to a tax liability in accordance with Internal Revenue Service regulations. A faculty member may decline coverage in excess of fifty thousand dollars ($50,000) by filing a waiver in accordance with Department of Finance procedures (also see Appendix F).
Faculty Member's
Annual Base Salary
Group Life Insurance Coverage Accidental Death and Dismemberment
Principal Sum
$20,000 or less $20,000 $20,000 $20,001 - $30,000 $30,000 $30,000 $30,001 - $40,000 $40,000 $40,000 $40,001 - $50,000 $50,000 $50,000 $50,001- $55,000 $55,000 $55,000 $55,001 - $60,000 $60,000 $60,000 $60,001 - $65,000 $65,000 $65,000 $65,001 - $70,000 $70,000 $70,000 Over $70,000 $75,000 $75,000
b. Extended Benefits. A faculty member who becomes totally disabled before age 70 shall be eligible for the extended benefit provisions of the life insurance policy until age 70. Current recipients of extended life insurance shall continue to receive such benefits under the terms of the policy in effect prior to July 1, 1983.
c. Additional Death Benefit. Faculty members retiring on or after July 1, 1981, shall be entitled to a five hundred dollar ($500) death benefit payable to a beneficiary designated by the faculty member, if at the time of death the faculty member 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 faculty member who becomes totally and permanently disabled on or after July 1, 1983, 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 G. Optional Coverages. An employee who takes an unpaid leave of absence or who is laid off may discontinue premium payments on optional policies during the period of leave or layoff, if the employee returns within one (1) year, the employee 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.
1. For the first 24 months of short-term and/or long-term disability coverage after such a period or layoff, 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.
2. For the first 24 months of optional life coverage after such a period of leave or layoff, any such optional life coverage shall exclude coverage for certain pre-existing conditions. For optional life purposes, any death which is caused by, or results from any injury or sickness which occurred, was diagnosed, or for which medical care was received during the period of leave or layoff shall be excluded from coverage for such 24-month period.
The limitations set forth in 1, and 2, above do not apply to the Family Medical Leave Act (FMLA) leaves.
Subd. 1. Life Coverage.
a. Faculty Member. A faculty member may purchase up to three hundred thousand dollars ($300,000) additional life insurance, in increments established by the Employer, subject to satisfactory evidence of insurability. A new faculty member 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.
b. Spouse. A faculty member may purchase up to three hundred thousand dollars ($300,000) of life insurance coverage for his/her spouse, in increments established by the Employer, subject to satisfactory evidence of insurability. A new faculty member 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.
c. Children/Grandchildren. A faculty member 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 B., Subd. 3., of this Article). 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.
d. Waiver of Premium. In the event a faculty member becomes totally disabled before age seventy (70), there shall be a waiver of premium for all life insurance coverage that the faculty member had at the time of disability.
e. Paid-up Life Policy. At age sixty-five (65) or the date of retirement, an employee who has carried optional employee life insurance for the five consecutive years immediately preceding the date of the employee'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 ten (10) percent of the smallest amount of optional employee life insurance in force during that five (5) year period. The employee's post-retirement death benefit shall be effective as of the date of the employee's retirement or the employee age sixty-five (65), whichever is later. Employees who retire prior to age sixty-five (65) must be immediately eligible to receive a state retirement annuity and must continue their optional employee life insurance to age sixty-five (65) in order to remain eligible for the employee post-retirement death benefit.
An employee who has carried optional spouse life insurance for five (5) consecutive years immediately preceding the date of the employee'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 ten percent (10%) 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 employee's retirement or spouse age sixty-five (65), whichever is later. The employee must continue the full amount of optional spouse life insurance to the date of the employee'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.
Subd. 2. Disability Coverage.
a. Short-term Disability Coverage. A faculty member may purchase short-term disability coverage that provides benefits of from three hundred dollars ($300) to three thousand dollars ($3,000) per month, up to two-thirds (2/3) of a faculty member's salary, for up to one hundred eighty (180) calendar days during total disability due to a non-occupational accident or a non-occupational sickness. Benefits are paid from the first day of a disabling injury or from the eighth day of a disabling sickness. Coverage applied for within sixty (60) calendar days of hire or becoming insurance eligible does not require evidence of insurability.
b. Long-term Disability Coverage. New employees may enroll in long-term disability insurance within sixty (60) days of employment or insurance eligibility. The terms are the same as for employees who wish to add/increase during the annual open enrollment. During open enrollment only, a faculty member may purchase long-term disability coverage that provides benefits of from two hundred dollars ($200) to four thousand dollars ($4,000) per month, based on the faculty member's salary, commencing on the one hundred eighty-one (181st) day of total disability, and not subject to evidence of insurability but with a limited pre-existing condition exclusion. Employees should be aware that other wage replacement benefits, as described in the certificate of coverage (i.e., Social Security Disability, Minnesota State Retirement Disability, etc,), may result in a reduction of the monthly benefit levels purchased. In the event that the faculty member becomes totally disabled before age seventy (70), the premiums on this benefit shall be waived.
Subd. 3. Accidental Death and Dismemberment Coverage. A faculty member 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 faculty member 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 faculty member.