Subd. 1. Faculty Members -- Basic Eligibility.

A faculty member may participate in the group insurance program if he/she:

1. Holds a temporary full-time or an unlimited appointment with annual guarantee of at least twelve (12) semester credits or its equivalent: or
2. Holds a temporary part-time appointment and meets the following conditions:
   1. Initial qualification requires an appointment totaling at least six (6) credits per semester over two (2) consecutive academic year semesters. Such eligibility starts at the beginning of the second semester.
   2. Once qualified, the faculty member remains qualified for each semester in which he/her appointment equals at least six (6) credits.
   3. When the faculty member's semester appointment drops below six (6) credits, insurance eligibility will cancel for that semester, but will be reinstated when the semester appointment returns to at least six (6) credits.
   4. Once a break in service (defined as no assignments for one (1) full academic year) occurs (excluding summer session) initial qualification in Subd. 1.B.1. above must be re-met.

Subd. 2. Faculty Members -- Special Eligibility.

The following faculty members are also eligible to participate in the group insurance program:

1. Faculty members with a work-related injury/disability. A faculty member who was off the state payroll due to a work-related injury or 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.
2. Totally disabled faculty members. Consistent with M.S. 62A.148, certain totally disabled faculty members may continue to participate in the group insurance program.
3. Retired faculty members. 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.

   Consistent with M.S. 43A.27, Subd. 3., a retired faculty member who receives a retirement benefit under Chapter 354B or 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. A spouse of a deceased retired faculty member may continue health and dental coverages through the Group Insurance Program provided the spouse was dependent under the retired member's coverage at the time of the retiree's death and continues to make the required premium payments. Retiree coverage must be coordinated with Medicare.

4. Summer Coverage - Unlimited Faculty. A faculty member who submits a resignation but has completed the academic year and is enrolled in the group insurance program continues that eligibility and the employer contribution through the summer. This paragraph shall not apply to those faculty members who retire; however, faculty members who elect early retirement continue to be provided with the provisions of Article 14, Section 2. This paragraph does not change current practice relative to the provisions of Article 14, Section 2.
5. Summer Coverage - Temporary Faculty. A faculty member on a temporary appointment who is eligible to participate in the group insurance program continues that eligibility during the summer if notice has been received from the college president (provost) or designee by May 31 of each year that the faculty member will be re-hired in an insurance-eligible position (at least six (6) credits or its equivalent) for the subsequent fall term.
6. 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.
7. Faculty Members on Layoff. A faculty member who is eligible to participate in the group insurance program immediately prior to being placed on layoff continues that eligibility during the recall period.
8. Faculty Members on Unpaid Leave of Absence. A faculty member who is eligible to participate in the group insurance program immediately prior to taking an unpaid leave of absence continues that eligibility during the unpaid leave of absence at own expense.

Subd. 3. Dependents.

Eligible dependents for the purposes of this article are as follows:

1. 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 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 ($750.00) or greater deductible through employing organization, he/she is not eligible to be a covered dependent for the 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 Section 3. Subd. 1.
2. 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 s/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) step-child. To be considered a dependent child, a foster child must be dependent on the faculty member for principal support and maintenance and be placed by the court in the custody of the faculty member. To be considered a dependent child, a step-child must maintain residence with the faculty member and be dependent on the faculty member for 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 on 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 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 own expense for a fixed length of time. As of the date of this contract, state and federal laws allow certain group coverages to be continued if it 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 faculty member; or
6. divorce.

Subd. 1. Full Employer Contribution -- Basic Eligibility.

Faculty members covered by this contract and appointed for at least seventy-five percent (75%) of the full-time work assignment load for the academic year receive the full employer contribution.

Subd. 2. Partial Employer Contribution -- Basic Eligibility.

The following faculty member covered by this contract receive the full employer contribution for basic life coverage, and at the faculty member's option, a partial employer contribution for health and dental coverages. The partial employer contribution for health and dental coverages is fifty percent (50%) of the full employer contribution.

1. A faculty member who holds an unlimited appointment and works twelve (12) credits or more or its equivalent per academic year but less than seventy-five percent (75%) of a full-time work assignment load.
2. A faculty member who holds a temporary part-time appointment and meets the following conditions:
   1. Initial qualification requires an appointment totaling at least six (6) credits per semester over two (2) consecutive academic year semesters. Such eligibility starts at the beginning of the second semester.
   2. Once qualified, the faculty member remains qualified for each semester in which he/her appointment equals at least six (6) credits.
   3. When the faculty member's semester appointment drops below six (6) credits, insurance eligibility will cancel for that semester, but will be reinstated when the semester appointment returns to at least six (6) credits.
   4. Once a break in service (defined as no assignments for one (1) full academic year) occurs (excluding summer session) initial qualification in Subd. 2.B.1. above must be re-met.

Subd. 3. Special Eligibility.

The following faculty members also receive an employer contribution:

1. Faculty Members on Layoff. A faculty member 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 under this Article for twelve (12) months from the date of layoff.
2. 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 a 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 13, Section 1. Subd. 3. s/he shall be eligible for an employer contribution during that leave.
3. Summer Coverage - Unlimited Faculty. A faculty member who submits a resignation but has completed the academic year and is enrolled in the group insurance program continues that eligibility and the employer contribution through the summer. This paragraph shall not apply to those faculty members who retire; however, faculty members who elect early retirement continue to be provided with the provisions of Article 14, Section 2. This paragraph does not change current practice relative to the provisions of Article 14, Section 2.
4. Summer Coverage - Temporary Faculty. A faculty member on a temporary appointment who is eligible for an employer contribution continues to receive the employer contribution during the summer if notice has been received from the college president (provost) or designee by May 31^st of each year that the faculty member will be re-hired in an insurance-eligible position (at least six (6) credits or its equivalent) for the subsequent fall term.
5. 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.

Subd. 4. Maintaining Eligibility for Employer Contribution.

1. General. A faculty member who receives a full or partial employer contribution maintains that eligibility as long as the faculty member 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 faculty members who receive an employer contribution while on layoff as described above.
2. Unpaid Leave of Absence. If a faculty member is on an unpaid leave of absence, then 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. For a faculty member returning from an approved unpaid leave of absence of less than a full academic year, the employer contribution shall resume immediately following the end of the last quarter of the leave.
3. Academic Year Employment. If a faculty member is employed on the basis of an academic year and such employment contemplates absences from the state payroll during the summer months, the faculty member shall nonetheless remain eligible for an employer contribution, provided that the faculty member appears on the regular payroll for at least one (1) working day in the payroll period immediately preceding such absences, except as noted in Subd.4.B. above.
4. A faculty member who is on an approved FMLA leave maintains eligibility for an employer contribution.

Subd. 1. Contribution Formula -- Health Coverage.

1. 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.
2. Dependent Coverage. For dependent health coverage, the Employer contributes an amount equal to the lesser of ninety percent (90%) of the dependent premium of the low-cost health plan, or the actual dependent premium of the health plan chosen by the faculty member.
3. Low-Cost Health Plan. For the purposes of Section 4. Subd. 1.A., "low-cost health plan" means the health plan with: (1) the lowest family premium rate; and (2) operating in the county of the faculty member's permanent work location.; county of residence for insurance year 2001; see Section 4. 1.E. below. "Family premium" is the total of the faculty member premium and the dependent premium.
4. The low-cost health plan for each county for the 2000 insurance year is listed in Appendix B. During the 2000 insurance year, the list may be changed only if the low-cost health plan no longer operates in a county.

   Low-Cost Health Plan Determination 2001. The list for the 2001 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 2001 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 health plan 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 2000 insurance year was negotiated, one (1) or more of the following has occurred:
      1. changes in the network of one or more of the plans offered;
      2. changes in premium amounts affecting which plan is low-cost;
      3. the addition or deletion of carriers affecting which plan is low-cost.
   3. 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 (½) of the fees and expenses of the neutral shall be paid by the Employer and one-half (½) 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.
   4. The decision of the neutral shall be issued within two (2) working days after the hearing.
5. Location as the Basis for Employer Contribution. The employer contribution for each faculty member is based on the faculty member'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 faculty member's county of permanent residence (for Minnesota residents) or the faculty member's county of permanent work location (for Minnesota non-residents). 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.

1. 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.
2. Dependent Coverage. For dependent dental coverage, the Employer contributes an amount equal to the lesser of fifty percent (50%) 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 member basic life coverage and accidental death and dismemberment coverage, the Employer contributes one hundred percent (100%) of the cost.

Subd. 1. When Coverage May Be Chosen.

A faculty member must make choice of 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 faculty member will automatically be enrolled in basic life coverage. Faculty members 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. Faculty members 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 faculty member'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 and a retired faculty member may also 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 faculty member and a retired faculty member may add dependent health or dental coverage within thirty (30) days of the following events:

1. If a faculty member or a retiree becomes married, the faculty member or retiree may add 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. 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.)

Subd. 2. When Coverage May Be Canceled.

1. Dependent Coverage. A faculty member 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 faculty member 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.

2. Employee Coverage. A part-time faculty member may also cancel employee coverage within sixty (60) days of when one of these same 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 application to cancel coverage, or the loss of eligible faculty member 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 faculty member or dependent status.

Subd. 3. Effective Date of Coverage.

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 28^th calendar day following the faculty member's first day of employment, re-employment, re-hire, 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.

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

Subd. 4. Delay in Coverage Effective Date.

1. Basic Life. If a faculty member 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 faculty member'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 faculty member is on an unpaid leave of absence or layoff.
2. Medical and Dental and Basic Life. If a faculty member is not actively at work on the initial effective date of coverage due to a reason other than hospitalization or medical disability of the faculty member or dependent, medical and dental coverage will be delayed until the first day of the pay period coinciding with or next following the faculty member'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 faculty member is on an unpaid leave of absence or layoff.

3. 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.

1. Frequency and Duration. There shall be an open enrollment period for health coverage in each year of this contract, and for dental coverage in the first year of this contract. Open enrollment changes become effective on January 5, 2000, in the first year of this contract, and on January 3, 2001, in the second year of this contract.
2. Eligibility to Participate. A faculty member eligible to participate in the group insurance program, as described in Section 2. above, may participate in open enrollment. In addition, a person in the following categories may as allowed in Section 5. Subd. 4.A. above, make certain changes: (1) a former faculty member or dependent on continuation coverage, as described in Section 2. Subd. D., may change plans or add coverage for health and/or dental plans on the same basis as active faculty members; and (2) an early retiree, prior to becoming eligible for Medicare, may change health and/or dental plans as agreed to for active faculty members, but may not add dependent coverage.
3. Materials for Faculty Member Choice. Each year prior to open enrollment, the college will give eligible faculty members the information necessary to make open enrollment selections. Faculty members will be provided a statement of their current coverage each year of this 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 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.

Subd. 1. Faculty Member and Dependent Health Coverage.

1. Coverage Options. Eligible faculty members may select coverage under one of the health plans offered by the Employer, including, the state health plan, or other health plans. Coverage offered through these plans is subject to change during the life of this contract upon approval of the Employer after consultation with the Joint Labor/Management Committee on Health Plans. However, actuarial reductions in the level of the other plan coverages effective during the term of this Agreement, including increases in co-payments, require approval of the Joint Labor/Management Committee on Health Plans. Coverage offered through the state health plan is determined by Section 6. Subd. 1.B.
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 co-payments 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 Section 6. Subd. 1.B.2. 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 percent (100%)coverage.
      2. Outpatient surgery center services. One hundred percent (100%)coverage.
      3. Home health services. One hundred percent (100%) coverage up to a maximum of five thousand ($5,000) eligible expenses per person per year.
      4. X-rays and laboratory tests. One hundred percent (100%) coverage.
      5. Preventative Care. One hundred percent (100%) coverage.
      6. Physicians services. One hundred percent (100%) coverage.
      7. Durable medical equipment. Eighty percent (80%) 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 (Section 6, 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 6, Subd. 1.B.1. which are not authorized by a primary care physician within the primary care clinic in the 2000 and 2001 insurance years:

      1. there is a 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 co-payment of:
      2. three thousand dollars ($3000) per person and six thousand dollars ($6000) per family.

      These deductibles and co-payments are separate from the deductibles and co-payments for authorized services under Section 6, 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.
      1. Mental health services - inpatient and outpatient. One hundred percent (100%) 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 percent (100%) 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.
      3. Chiropractic services. One hundred percent (100%). 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 the 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 the 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 percent (100%) coverage for services obtained from in-network providers. Seventy percent (70%) 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 clinic.
   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 co-pay for each type prescribed.
         • If the subscriber chooses a brand name drug when a bio-equivalent generic drug is available, the subscriber is required to pay the standard co-payment 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 and SHPPOS. Prescription Drugs: For the 2000 and 2001 insurance years:
              • ten dollar ($10) co-payment per prescription or refill for a 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. Grandparented Diabetic Group.
         1. 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, (herein the "Grandparented 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 (100) units when purchased with insulin.
            1. Eye exams. SHPPOS and SHPS. One hundred percent (100%) coverage. (Limited to one (1) routine examination per year).
            2. Outpatient emergency and urgicenter services within the area. SHPPOS and SHPS. Thirty dollar ($30) co-payment per visit for outpatient emergency visits and fifteen ($15) co-payment per visit for urgicenter visits that do not result in hospital admission within twenty four (24) hours; one hundred percent (100%) coverage thereafter.
            3. Emergency and urgently needed care outside the area. (SHPPOS and SHP) 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.
            4. 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 6. 1.B.1., 1.B.3. and 1.B.4. combined. The lifetime maximum for services under Section 6.1.B.2. is limited to five hundred thousand dollars ($500,000). The five hundred thousand dollar ($500,000) maximum which applies under Section 6.1.B.2. 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 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 M.S. 176.191. Subd. 3.
4. Health promotion and health education. Both parties to this contract 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. The Employer will develop a health promotion and health education program consistent with the Department of Employee Relations policy. Upon request of the Association, the Employer shall meet and confer with the Association, 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 specifications. 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 21.B. Approval for this training is at the discretion of the college, 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 members 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.

Subd. 2. Faculty Member and Dependent Dental Coverage.

1. 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 contract 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 co-payments, require approval of the Joint Labor/Management Committee on Health Plans. Coverage offered through the state dental plan is determined by Section 6. Subd. 2.B.
2. Coverage under the State Dental Plan. The state dental plan will provide the following coverage:
   1. Co-payments. Effective January 5, 2000, the state dental plan will cover allowable charges for the following services subject to the co-payments 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 practices. The plan shall cover general cleaning two (2) times per plan year and special cleanings (root or deep cleaning) as prescribed by the dentist.

      Co-payments

      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 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 ($1000) annual maximum in benefits payable (excluding orthodontia) per person. "Annual" means per insurance year.
   4. Orthodontia Lifetime Maximum. Orthodontia benefits are available to eligible dependent children ages eight (8) through eighteen (18) subject to a two thousand eight hundred dollar ($2,800) lifetime maximum benefit.

Subd. 3. Faculty Member Life Coverage

1. 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 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. An employee 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.
   
   

   Faculty Member's Annual Base Salary	Group Life Insurance Coverage	Accidental Death and Dismemberment Principal Sum
   0 - $20,000	$30,000	$30,000
   $20,001-$30,000	$40,000	$40,000
   $30,001-$40,000	$50,000	$50,000
   $40,001-$50,000	$60,000	$60,000
   $50,001-$60,000	$70,000	$70,000
   Over $60,000	$75,000	$75,000

   
   
2. Extended Benefits. A faculty member who becomes totally disabled before age seventy (70) shall be eligible for the extended benefit provision of the life insurance policy until age seventy (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.

Subd. 1. Life Coverage.

1. Faculty Member. A faculty member 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. A new faculty member may purchase up to two times the value of their annual salary or $200,000, whichever is less, in optional life coverage within sixty (60) days of hire without evidence of insurability.
2. Spouse. A faculty member may purchase up to five hundred thousand dollars ($500,000) life insurance coverage for spouse in increments established by the Employer,, subject to satisfactory evidence of insurability. A new faculty member may purchase five thousand dollars $5,000 or ten thousand dollars $10,000 in optional spouse life coverage within sixty (60) days of hire without evidence of insurability.
3. Children/Grandchildren. A faculty member may purchase life insurance of ten thousand dollars ($10,000) for all eligible children/grandchildren (as defined in Section 2. Subd. 3. of this Article). Child/grandchild coverage requires evidence of insurability if application is made after the first sixty (60) days of employment. Child/grandchild coverage commences fourteen (14) days after birth.
4. Accelerated Life. The additional employees, 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 of 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 has at the time of disability.
6. Paid Up Life Policy. At age sixty five (65) or the date of retirement, a faculty member who has carried optional employee life insurance for the five (5) consecutive years immediately preceding the date of the faculty member'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 employee life insurance in force during that five (5) year period. The faculty member's post-retirement death benefit shall be effective as of the date of the faculty member's retirement or the faculty member age sixty five (65), whichever is later. Faculty members 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.

   A faculty member who has carried optional spouse life insurance for the five (5) consecutive years immediately preceding the date of the faculty member'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 faculty member's retirement or spouse age sixty five (65), whichever is later. The faculty member must continue the full amount of optional spouse life insurance to the date of the faculty member'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.

1. Short-term disability coverage. A faculty member may purchase short-term disability coverage that provides benefits from three hundred dollars ($300) to five thousand dollars ($5,000) per month, up to two-thirds (2/3) of a faculty member's salary, for up to 180 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.
2. Long-term Disability Coverage. New faculty members may enroll in long-term disability insurance within sixty (60) days of employment or insurance eligibility. The terms are the same as for faculty members 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 five thousand dollars ($5,000) per month, based on the faculty member's salary, commencing on the 181st calendar day of total disability, and not subject to evidence of insurability but with a limited term pre-existing condition exclusion. Faculty members should be aware that other wage replacement benefits, as described in the certificate of coverage, (i.e. Social Security Disability, Minnesota State Teacher's Retirement Disability, etc.) may result in a reduction of the monthly benefit levels purchased. In any event, the minimum is the greater of three hundred dollars ($300) or fifteen percent (15%) of the amount purchased. The minimum benefit will not be reduced by any other wage replacement benefits. When an eligible faculty member has elected to take the state's long term disability coverage, the state shall contribute one half ( ½) toward the premium or $5.90 bi-weekly, whichever is less.
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 $5,000 to $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 to twenty five thousand dollars ($5,000 to $25,000) in coverage for spouse, but not in excess of the amount carried by the faculty member.
4. Continuation of Optional Coverages During Unpaid Leave or Layoff. A faculty member 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 faculty member returns with one (1) year, the faculty member 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. p> For the first twenty four (24) months of short-term and/or long-term disability coverage after such a period of leave or layoff during which short-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 int eh policy.

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