Contract Library
View text-only version of this page.

MnSCU-MSUAASF Master Agreement 1999-2001

ARTICLE 13 - INSURANCE

Section A. State ASF Member Group Insurance Program.

During the life of the 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 employees 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.

ASF Members - Basic Eligibility. An ASF Member may participate in the Group Insurance Program if he/she is employed on the basis of at least fifty percent (50%) of a nine (9) month or more appointment as defined in Article 11, Workload. An ASF Member hired on a temporary appointment during a fiscal year at fifty (50) percent time or greater should also be eligible for coverage if the president expects the appointment to continue beyond the current fiscal year at fifty (50) percent time or greater.
ASF Members - Special Eligibility. The following ASF Members are also eligible to participate in the Group Insurance Program:
1. ASF Members with a Work-related Injury/Disability. An ASF Member who was off the State payroll due to work-related injury or a work-related disability may continue to participate in the Group Insurance Program as long as such an ASF Member receives workers' compensation payments or while the workers' compensation claim is pending.
2. Totally Disabled ASF Members. Consistent with M.S. 62A.148, certain totally disabled ASF Members may continue to participate in the Group Insurance Program.
3. Retired ASF Members. An ASF Member who retires from MnSCU, is not eligible for regular (non-disability) Medicare coverage, has ten (10) or more years of allowable pension service, and is immediately eligible to receive 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.
  Consistent with M.S. 43A.27, Subdivision 3, a retired ASF 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 ASF Member may continue health and dental coverages through the Group Insurance Program provided the spouse was a dependent under the retired ASF Member's coverage at the time of the retiree's death and continues to make the required premium payment. Retiree coverage must be coordinated with Medicare.
Dependents. Eligible dependents for the purposes of this Article are as follows:
1. Spouse. The spouse of an eligible ASF 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) or greater deductible through his/her 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 C (1).
2. Children and Grandchildren. An eligible ASF 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 is chiefly dependent on the ASF 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 an ASF Member's: (1) biological child, (2) child legally adopted by or placed for adoption with the ASF Member, (3) foster child, and (4) step-child. To be considered a dependent child, a foster child must be dependent on the ASF Member for his/her principal support and maintenance and be placed by the court in the custody of the ASF Member. To be considered a dependent child, a step child must maintain residence with the ASF Member and be dependent upon the ASF Member for his/her principal support and maintenance.
  
  "Dependent Grandchild" includes an ASF Member's: (1) grandchild placed in the legal custody of the ASF Member, (2) grandchild legally adopted by the ASF Member or placed for adoption with the ASF Member, or (3) grandchild who is the dependent child of the ASF Member's unmarried dependent child. Under (1) and (3) above, the grandchild must be dependent upon the ASF Member for principal support and maintenance and live with the ASF 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 their eligible dependent children or grandchildren. This restriction also applies to two divorced, legally separated, or unmarried ASF Members who share legal responsibility for their eligible dependent children or grandchildren.
Continuation Coverage. Consistent with state and federal laws, certain ASF Members, former ASF 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 be terminated 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 ASF Member; or
6. divorce.

Section C. Eligibility for Employer Contribution.

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

Full Employer Contribution - Basic Eligibility. The following ASF Members covered by this Agreement receive the full Employer Contribution:
1. An ASF Member who is employed for at least 75% of nine (9) month or more appointment as defined in Article 11, Workload. A probationary ASF Member hired during a fiscal year for at least seventy five (75) percent time or greater. An ASF Member hired on a temporary appointment during a fiscal year at seventy five (75) percent time or greater should also be eligible if the president expects the appointment to continue beyond the current fiscal year at seventy five (75) percent time or greater.
Special Eligibility. The following ASF Members also receive an Employer Contribution:
1. ASF Members on layoff. An ASF 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 22, remains eligible for an Employer contribution and all other benefits provided under this Article for twelve (12) months from date of layoff.
2. Work-related Injury/Disability. An ASF 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 an ASF Member receives workers' compensation payments. If such ASF Member ceases to receive workers' compensation payments for the injury or disability and is granted a leave under Article 18, he/she shall be eligible for an Employer contribution during that leave.
3. Sabbatical leave. An ASF Member eligible for an Employer Contribution immediately prior to taking a sabbatical leave continues to receive the Employer Contribution during the sabbatical leave.
Maintaining Eligibility for Employer Contribution.
1. General. An ASF Member who receives a full Employer Contribution maintains that eligibility as long as the ASF Member meets the Employer Contribution 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 ASF Members who receive an Employer Contribution while on layoff as described in Section C(2)(a), or while eligible for workers' compensation payments as described in Section C(2)(b).
2. Unpaid Leave of Absence. If an ASF Member is on an unpaid leave of absence, then vacation leave, or sick leave cannot be used for the purpose of maintaining eligibility for an Employer Contribution by keeping the ASF Member on a State payroll for one (1) working day per pay period.
3. Academic Year Employment. If an ASF Member is employed on the basis of an academic year and such employment contemplates absences from the MnSCU payroll during the summer months or vacation periods scheduled by the Employer which occur during the regular school year, the ASF Member shall nonetheless remain eligible for an Employer Contribution, provided that the ASF Member appears on the regular payroll for at least one (1) working day in the payroll period immediately preceding such absences.
4. An ASF Member who is on an approved FMLA leave or on a voluntary reduction in hours as provided elsewhere in this agreement maintains eligibility for an Employer Contribution.

Section D. Amount of Employer Contribution.

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

Contribution Formula - Health Coverage.
1. ASF Member Coverage. For ASF Member health coverage, the Employer contributes an amount equal to the lesser of one hundred (100) percent of the ASF Member premium of the Low-Cost Health Plan, or the actual ASF Member-only premium of the health plan chosen by the ASF Member.
2. Dependent Coverage. For dependent health coverage, the Employer contributes an amount equal to the lesser of one hundred (100) percent of the dependent premium of the Low-Cost Health Plan, or the actual dependent premium of the health plan chosen by the ASF Member.
3. Low-Cost Health Plan. For the purposes of Section D(1), "Low-Cost Health Plan" means the health plan with: (1) the lowest family premium rate; and (2) operating in the county of the ASF Member's permanent work location county of residence for insurance year 2001; see Section D 1. (d) below; "Family premium" is the total of the ASF Member premium and the dependent premium.
  The Low-Cost Health Plan for each county for the 2000 insurance year is listed in Appendix A. 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 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 2000 insurance was negotiated, one 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. The decision of the neutral shall be issued within two working days after the hearing.
4. Location as the Basis for Employer Contribution. The Employer Contribution for each ASF Member is based on the ASF 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 employee's county of permanent residence (for Minnesota Residents) or the employee's county of work location (for Minnesota non-residents). If the health plan an ASF 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.
Contribution Formula - Dental Coverage.
1. ASF Member Coverage. For ASF Member dental coverage, the Employer contributes an amount equal to the lesser of one hundred (100) percent of the ASF Member premium of the State Dental Plan, or the actual ASF Member premium of the dental plan chosen by the ASF Member.
2. Dependent Coverage. For dependent dental coverage, the Employer contributes an amount equal to the lesser of fifty (50) percent of the dependent premium of the state Dental Plan, or the actual dependent premium of the dental plan chosen by the ASF Member.
Contribution Formula - Basic Life Coverage. For ASF Member basic life coverage and accidental death and dismemberment coverage, the Employer contributes one-hundred (100) percent of the cost.

Section E. Coverage Changes and Effective Dates.

When Coverage May Be Chosen. All ASF Members must make their choice of ASF Member 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 ASF Member will automatically be enrolled in basic life coverage. ASF 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. ASF Members who become eligible for a full employer contribution must make their choice of ASF Member 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 ASF Member's work location.
An ASF Member may change his/her health or dental plan if the ASF Member changes to a new permanent work location, and the ASF Member's current plan is not available at the new work location. An ASF 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.

An ASF Member and a retired employee may add dependent health or dental coverage following the birth of a child or dependent grandchild, or following the adoption of a child without regard to the thirty (30) day enrollment period.

In addition, an employee and a retired employee may add dependent health or dental coverage within thirty (30) days of the following events:
1. If an ASF Member or a retiree becomes married, the ASF Member or retiree may add his/her spouse and any dependent children/grandchildren.
2. If the ASF Member's spouse loses group health or dental coverage, the ASF 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.)
When Coverage May Be Canceled.
1. Dependent Coverage. An ASF 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 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 ASF Member or spouse; and
  - A significant change in 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 employee may also cancel employee coverage within sixty (60) days of when these same life events occurred.
3. Effective Date of Benefit Termination. Medical coverage termination will take effect on the first day of the month following the end of the pay period coinciding with or next following the date of the application to cancel coverage, or the loss of eligible employee or dependent status. All other benefit coverage terminations will take effect on the first day of the pay period coinciding with or next following the date of the application to cancel coverage, or the loss of eligible employee or dependent status.
Effective Date of Coverage.
1. Initial Effective Date. The initial effective date of coverage under the Group Insurance Program is the first day of the first payroll period beginning on or after the 28th calendar day following the ASF Member's first day of employment, re-employment, re-hire, or reinstatement with the State. An ASF Member must be actively at work on the initial effective date of coverage, except that an ASF 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 an ASF Member's dependent's coverage become effective before the ASF Member's coverage.
  If an employee is not actively at work due to employee or dependent health status or medical disability, medical and dental coverage will still take effect. (Life and disability coverage will be delayed until the employee returns to work.)
2. Delay in Coverage Effective Date.
  1. Basic Life. If an employee 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 employee's return to work. The effective date of a change in coverage is not delayed in the event that, on the date the coverage would be effective, an employee is on an unpaid leave of absence or layoff.
  2. Medical and Dental. If an employee is not actively at work on the initial effective date of coverage due to a reason other than hospitalization or medical disability of the employee or dependent, medical and dental coverage will be delayed until the first day of the pay period coinciding with or next following the employee'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, an ASF Member is on an unpaid leave of absence or layoff.
  3. Optional Life and Disability Coverages. In order for coverage to become effective, the ASF 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 ASF Member's return to work.
Open Enrollment.
1. 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 January 5, 2000. in the first year of this Agreement, and on January 3, 2001 in the second year of this Agreement.
2. Eligibility to Participate. An ASF Member eligible to participate in the State ASF Member Group Insurance Program, as described in Section B(1) and B(2), may participate in open enrollment. In as allowed in section 5(a) above, make certain changes: (1) former ASF Member or dependent on continuation coverage, as described in Section B(4), may change plans or add coverage for health and/or dental plans on the same basis as active ASF Members; and (2) an early retiree, prior to becoming eligible for Medicare, may change health and/or dental plans as agreed to for active ASF Members, but may not add dependent coverage.
3. Materials for ASF Member Choice. Each year prior to open enrollment, the Appointing Authority will give eligible ASF Members the information necessary to make open enrollment selections. ASF Members will be provided a statement of their current coverage each year of the contract.
Coverage Selection Prior to Retirement. An ASF Member who retires and is entitled to receive an annuity under a State retirement programs may change his/her health or dental plan during the sixty (60) calendar day period immediately preceding the date of retirement. The ASF 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.

ASF Member and Dependent Health Coverage.
1. Coverage Options. Eligible ASF Members may select coverage under any 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 Agreement upon approval of the Employer after consultation with 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 increase in co-payments, require appro 5 val of the Joint Labor/Management Committee on Health Plans. Coverage offered through the State Health Plan is determined by Section F(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 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 F(1)(b)(2), apply to the following service if not received from, or authorized by, a primary care physician in the primary care clinic.
    1. Inpatient hospital service. One hundred (100) percent coverage.
    2. Outpatient surgery center services. One hundred (100) percent coverage.
    3. Home health services. One hundred (100) percent coverage up to a maximum of five thousand dollars ($5,000) eligible expenses per person per year.
    4. X-rays and laboratory test. One hundred (100) percent coverage.
    5. Preventive care. One hundred (100) percent coverage.
    6. Physicians services. One hundred (100) percent coverage.
    7. Durable medical equipment. 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 F (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 F(1)(b)(1) which are not authorized by a primary care physician within the primary care clinic in the 2000 and 2001 insurance year.
    - 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 (70) percent coverage up to a maximum annual co-payment of:
    - three thousand dollars ($3,000) per person and six thousand dollars ($6,000) per family
    These deductibles and co-payments are separate from the deductibles and co-payments for authorized services under F(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 (100) percent coverage (up to 365 days for inpatient services.) No coverage for services obtained from out-of-network providers under SHPS. Out-of-network services are available under SHPPOS according to the terms of the Certificate of Coverage. In-network services need not be authorized by a primary care physician within the primary care clinic under either plan.
    2. Chemical dependency - inpatient and outpatient. One hundred (100) percent coverage (up to 365 days for inpatient services.) No coverage for services obtained from out-of-network providers under SHPS. Out-of-network services are available under SHPPOS according to the terms of the Certificate of Coverage. In-network services need not be authorized by a primary care physician within the primary care clinic under either plan.
    3. Chiropractic services. 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.
    4. Transplant coverage. The SHPPOS and SHPS shall provide transplant coverage, as specified in their respective Certificates of Coverage. No coverage for services obtained from out-of-network providers.
      Referrals for eligible transplant services must be authorized by a primary care physician within the primary care clinic.
    5. Cardiac Services. No coverage for non-emergency cardiac services obtained from out-of-network providers. Referrals for services must be authorized by a primary care physician within the primary care clinic.
    6. Home Infusion Therapy. The SHPPOS and SHPS shall provide Home Infusion Therapy coverage as specified their respective Certificates of Coverage. No coverage for services obtained from out-of-network providers. Referrals for eligible home infusion therapy services must be authorized by a primary care physician within the primary care clinic.
    7. Hospice Benefit. One hundred (100) percent coverage for services obtained from in-network providers. Seventy (70)percent coverage for services obtained from out-of-network providers under SHPPOS. Referrals for eligible hospice services must be authorized by a primary care physician with 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 co-pay 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.
        
        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) co-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.
  1. Grandfathered Diabetic Group. For insulin dependent diabetics who have been continuously enrolled in the State Health Plan since January 1, 1991 and who were identified as having used these supplies during the period January 1, 1991 through September 30, 1991, herein the "Grandfathered Diabetic Group", diabetic supplies are covered as follows:
    - Test tapes and syringes are covered at one-hundred (100) percent for the greater of a thirty-four (34) day supply or one-hundred (100) units when purchased with insulin.
      1. Eye Exams. SHPPOS and SHPS. On hundred (100) percent coverage. (Limited to one routine examination per year.)
      2. Outpatient emergency and urgicenter services within the area. 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.
      3. Emergency and urgently needed care outside the area (SHPPOS and SHPS). Professional services of a physician, emergency room treatment, and inpatient hospital services covered at eighty percent (80%) of the first two thousand dollars ($2000) 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. 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.)
  2. 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 (F(1)(b)(1), F(1)(b)(3) and F(1)(b)(4) combined. The lifetime maximum for services under F(1)(b)(2) is limited to five hundred thousand dollars ($500,000). The five hundred thousand dollar ($500,000) maximum which applies under F(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 an ASF Member has incurred on-the-job injury or an on-the-job disability and has filed a claim for worker's compensation, medical costs connected with the injury or disability shall be paid by the ASF Members health plan, pursuant to M.S. 176.191, Subdivision 3.
4. 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 ASF 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 ASF Member Relations policy. Upon request of any exclusive representative in an agency, the Appointing Authority shall meet and confer with the exclusive representative 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 provide through the State Health Plan and HMO plans.
  2. Health Plan Specification. The Employer will require health plans participating in the Group Insurance Program to develop and implement health promotion and health education programs for State ASF Members and their dependents.
  3. ASF Member Participation. The Employer will assist ASF Members' participation in health promotion and health education programs. Health promotion and health education programs that have been endorsed by the Employer (Department of ASF Member 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 ASF Member's absence and the availability of funds. ASF Members are eligible for release time, tuition reimbursement, or a pro rata combination of both. ASF Members may be reimbursed for up to one -hundred (100) percent of tuition or registration costs upon successful completion of the program. ASF 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 employees 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.

ASF Member and Family Dental Coverage.

Coverage Options. Eligible ASF 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 Joint Labor/Management Committee on Health Plans. Coverage offered through the State Dental Plan is determined by Section F(2)(b).

Coverage Under the State Dental Plan. The State Dental Plan will provide the following coverage:

Co-Payments. Effective January 5, 2000, the State Dental Plan will cover allowable charges for the following services subject to the copayments and coverage limits stated. Higher out-of-pocket costs apply to services obtained from dental care providers not in the State Dental Plan network. Services provided through the State Dental Plan are subject to the State Dental Plan's managed care procedures and principles, including standards of dental necessity and appropriate practice. The plan shall cover general cleaning two (2) times per 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.

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.
Annual maximums. State Dental Plan coverage is subject to a one-thousand dollar ($1,000) annual maximum payable (excluding orthodontia) per person. "Annual" means per insurance year.
Orthodontia lifetime maximum. Orthodontia benefits are available to eligible dependent children ages 8 through 18 subject to a two thousand eight hundred dollar ($2,800) lifetime maximum benefit.

ASF Member Life Coverage.

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 eligible ASF Members 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 accord with Internal Revenue Service regulations. An ASF Member 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.

ASF 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-$60,000	$60,000	$60,000
$60,001-$70,0000	$70,000	$70,000

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

Section G. Optional Coverages.

Life Coverage.
1. ASF Member. An ASF 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 ASF Member may purchase up to two (2) times annual salary or $200,000, whichever is less, in optional ASF Member life coverage within sixty (60) calendar days of hire without evidence of insurability.
2. An ASF Member may purchase up to five hundred thousand dollars ($500,000) life insurance coverage for his/her spouse in increments established by the Employer, subject to satisfactory evidence of insurability. A new ASF Member may purchase either $5,000 or $10,000 in optional spouse life coverage within sixty (60) calendar days of hire without evidence of insurability.
3. Children/Grandchildren. An ASF Member may purchase life insurance in the amount of $10,000 as a package for all eligible children/grandchildren (as defined in Section B(3)(b) 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.
4. Accelerated Life. The additional employee, 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 an ASF Member becomes totally disabled before age seventy (70), there shall be a waiver of premium for all life insurance coverage that the ASF Member had at the time of disability.
6. Paid up Life Policy. At age sixty-five (65) or the date of retirement, an ASF member who has carried optional ASF member life insurance for the five (5) consecutive years immediately preceding that date of the ASF member's retirement or age (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 ASF member life insurance in force during that five (5) year period. The ASF member's post-retirement death benefit shall be effective as of that date of the ASF member's retirement or the member age sixty-five (65), whichever is later. ASF Members who retire prior to age sixty-five (65) must be immediately eligible to receive a state retirement annuity and must continue their optional life insurance to age sixty-five (65) in order to remain eligible for the post-retirement death benefit.
  An ASF member who has carried optional spouse life insurance for the five consecutive years immediately preceding that date of the ASF 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 ASF member's retirement or spouse age sixty-five (65), whichever is later. The ASF member must continue the full amount of optional spouse life insurance to the date of the ASF 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.
Disability Coverage.
1. Short-term Disability Coverage. An ASF Member may purchase short-term disability coverage that provides benefits of from three hundred dollars ($300) to three five thousand dollars ($5,000) per month, up to two-thirds (2/3) of an ASF 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.
2. 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, an ASF 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 ASF Member's salary, commencing on the 181^st calendar 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 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 (15) percent of the amount purchased. The minimum benefit will not be reduced by any other wage replacement benefit. In the event that the ASF Member becomes totally disabled before age seventy (70), the premiums on this benefit shall be waived.
Accidental Death and Dismemberment Coverage. An ASF 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. An ASF 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 employee.
Continuation of Optional Coverages During Unpaid Leave of Layoff. An employee who takes an unpaid leave of absence or who is laid off may discontinue premium payments on optional policies during he 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.

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 or long-term disability coverage was discontinued, any such disability coverage shall exclude coverage for pre-existing conditions. For disability purposes, a pre-existing condition is defined as any disability which is caused by, or results from, any injury, sickness or pregnancy which occurred, was diagnosed, or for which medical care was received during the period of leave or layoff. In addition, any pre-existing condition limitations that would have been in effect under the policy but for the discontinuance of coverage shall continue to apply as provided in the policy.
The limitations set forth above do not apply to leaves that qualify under the Family and Medical Leave Act (FMLA).