Subd. 1. Employees - Basic Eligibility.

Employees may participate in the Group Insurance Program if they are employed on the basis of at least fifty percent (50%) of a full-time work assignment, as defined in Article 14. Coverage will terminate at the end of the payroll period of the effective date of resignation, termination or non-renewal.

Subd. 2. Employees - Special Eligibility.

The following employees are also eligible to participate in the Group Insurance Program.

1. Employees with a Work-related Injury/Disability. An employee who was off the payroll due to a work-related injury or a work-related disability may continue to participate in the Group Insurance Program as long as such employee receives workers' compensation payments or while the workers' compensation claim is pending.
2. Totally Disabled Employees. Consistent with Minnesota Statute 62A.148, certain totally disabled employees may continue to participate in the Group Insurance Program.
3. Retired Employees. An employee who retires from State service, is not eligible for regular (non-disability) Medicare coverage, has five (5) or more years of allowable pension service, and meets the age or length of service requirements of TRA or MSRS (thirty (30) years service, no age limit; or fifty five (55) years of age, not less than three (3) years of service; or Rule of Ninety (90), and is entitled at the time of retirement to immediately receive a retirement benefit under Minnesota Statute 354B or an annuity under a retirement program, may continue to participate in the health and dental coverages offered through the Group Insurance Program. Pension service includes service from K-12, Joint Vocational, or Intermediate District.

   Consistent with Minnesota Statute 43A.27, Subd. 3, a retired employee who receives a retirement benefit under Minnesota Statute 354B or an annuity under a retirement program may continue to participate in the health and dental coverages offered through the Group Insurance Program. A spouse of a deceased retired faculty member may continue health and dental coverages through the Group Insurance Program provided the spouse was a 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 will be coordinated with Medicare.

4. Summer Coverage - Temporary Employees. An employee 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 Employer by May 31 of each year that the employee will be rehired in an insurance eligible position for the subsequent fall semester.
5. Sabbatical Leave. For the duration of this agreement, an employee who is eligible to participate in the Group Insurance Program immediately prior to taking a sabbatical leave continues that eligibility during the sabbatical leave.
6. Employees on Unpaid Leaves of Absence. An employee 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.

Subd. 3. Dependents.

Eligible dependent for the purpose of this Article are as follows:

1. Spouse. The spouse of an eligible employee (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 dollars ($750) or greater deductible through his/her employing organization, he/she is not eligible to be a covered dependent for the purposes of this Attachment. 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. (a.)
2. Children and Grandchildren. An eligible employee'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 employee 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 an employee's (1) biological child, (2) child legally adopted by or placed for adoption with the employee, (3) foster child, and (4) step child. To be considered a dependent child, a foster child must be dependent on the employee for his/her principal support and maintenance and be placed by the court in the custody of the employee. To be considered a dependent child, a step child must maintain residence with the employee and be dependent upon the employee for his/her principal support and maintenance.

   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 and grandchildren. This restriction also applies to two divorced, legally separated, or unmarried employees who share legal responsibility for their eligible dependent children or grandchildren.

Subd. 4. Continuation Coverage.

Consistent with state and federal laws, certain employees, former employees, 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 allowed certain group coverage's to be continued if they would otherwise terminate due to:

• termination of employment (except for gross misconduct);
• layoff;
• reduction of hours to an ineligible status;
• 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);
• death of employee; or
• divorce

Subd. 1. Full Employer Contribution - Basic Eligibility.

The following employees covered by this Agreement receive the full Employer Contribution:

1. Employees who are appointed for at least seventy five percent (75%) of a full-time assignment receive the full Employer contribution.

Subd. 2. Partial Employer Contribution - Basic Eligibility.

The following employees covered by this Agreement receive the full Employer Contribution for basic life coverage, and at the employee's option, a partial Employer Contribution for health and dental coverage. The partial Employer Contribution for health and dental coverage is fifty percent (50%) of the full Employer Contribution.

1. Part-time Employees. Employees who hold part-time appointment of at least fifty percent (50%) of a full-time assignment but less than seventy five percent (75%) of a full-time assignment.

Subd. 3. Special Eligibility.

The following employees also receive an Employer Contribution:

1. Employees On Layoff. An employee who receives an Employer contribution, who has three (3) or more years of continuous service, and who has been placed on layoff, remains eligible for an Employer contribution and all other benefits provided by this Master Agreement for a period of six (6) months from the date of layoff.
2. Work-related Injury/Disability. An employee 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 employee receives workers' compensation payments. If such employee ceases to receive workers' compensation payments for the injury or disability and is granted a disability leave under provision(s) of the applicable Master Agreement, s/he shall be eligible for an Employer Contribution during that leave.
3. Summer Coverage - Temporary Employees. An employee on a temporary assignment who is eligible for an Employer contribution continues to receive the Employer contribution during the summer if notice has been received from the Employer by May 31 of each year that the employee will be rehired in an insurance eligible position for the subsequent fall semester.
4. Sabbatical Leave. For the duration of this Agreement, an employee who is eligible for an Employer contribution immediately prior to taking a sabbatical leave continues that eligibility during the sabbatical leave.

Subd. 4. Maintaining Eligibility for Employer Contribution.

1. General. An employee who receives a full or partial Employer Contribution maintains that eligibility as long as the employee 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 employees who receive an Employer Contribution while eligible for workers' compensation payments as described in Section 3., Subd. 3., (b.).
2. Unpaid Leave of Absence. If an employee is on an unpaid leave of absence, then vacation leave, compensatory time, or sick leave cannot be used for the purpose of maintaining eligibility for an Employer Contribution by keeping the employee on a State payroll for one (1) working day per pay period.
3. Academic Year Employment. When employees are employed on a basis of an academic year and such employee contemplates absence from the State payroll during the summer months or vacation periods scheduled by the Appointing Authority which occur during the regular school year, the employee shall nonetheless remain eligible for an Employer Contribution, provided that the employee appears on the regular payroll for at least one (1) working day in the payroll immediately preceding such absences.
4. An employee who is on an approved FMLA qualifying leave as provided elsewhere in this agreement maintains eligibility for an Employer Contribution.

Subd. 1. Contribution Formula - Health Coverage.

1. Employee Coverage. For employee health coverage, the Employer contributes an amount equal to the lesser of one hundred percent (100%) of the employee-only premium of the Low-Cost Health Plan, or the actual employee-only premium of the health plan chosen by the employee.
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 employee.
3. Low-Cost Health Plan. For the purposes of Section 4., Subd. 1. "Low-Cost Health Plan" means the health plan with: (1) the lowest family premium rate: and (2) operating in the county of the employee's permanent work location; county of residence for Insurance year 2001; See Section 4, Subd. (e.) below. "Family premium" is the total of the employee premium and the dependent premium.

   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.

4. 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 or more of the following has occurred:
      • changes in the network of one or more of the plan offered;
      • changes in premium amounts affecting which plan is low cost;
      • 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 (1/2) of the fees and expenses of the neutral shall be paid by the Employer and one-half (1/2) 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 employee is based on the employee'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 permanent work location (for Minnesota non-residents). If the health plan an employee is enrolled in is not available at the permanent work location, then the Employer Contribution changes to the amount in effect at the permanent work location.

Subd. 2. Contribution Formula - Dental Coverage.

1. Employee Coverage. For employee dental coverage, the Employer contributes an amount equal to the lesser of one hundred percent (100%) of the employment premium of the State Dental Plan, or the actual employee premium of the dental plan chosen by the employee.
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 employee.

Subd. 3. Contribution Formula - Basic Life Coverage.

For employee 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.

All employees must make their choice of plans and choice of employee health and dental plans and dependent coverage (if applicable) within sixty (60) calendar days of the date of initial appointment to an insurance eligible position. When health and dental coverage are elected, the employee will automatically be enrolled in basic life coverage. Employees eligible for a partial Employer contribution may elect health and dental coverage within sixty (60) calendar days of initial employment or during an open enrollment period. Employees who become eligible for a full Employer contribution must make their choice of employee health and dental plans and dependent coverage within sixty (60) calendar days of becoming eligible or be enrolled in the low cost in the county of the employee's work location.

Subd. 2. 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 employees' first day of employment, re-employment, re-hire, or reinstatement with the State. An employee must be actively at work on the initial effective date of coverage, except that an employee 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 employee's dependents coverage become effective before the employee's coverage.

Subd. 3. Changing Coverage - All Employees.

An employee may change his/her health or dental plan if the employee changes to a new permanent work location, and the employee's current plan is not available at the new work location. An employee who receives notification of a work location change between the end of their initial enrollment period and the beginning of the next insurance year, may change his/her health or dental plan within thirty (30) calendar days of the date of the relocation under the same provisions accorded during the last open enrollment period.

An employee and a retired employee 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.

An employee and a retired employee may add dependent health or dental coverage within thirty (30) calendar days after the following events:

1. If an employee or a retiree becomes married, the employee or retiree may also add his/her spouse and any dependent children/grandchildren.
2. If the employee's spouse loses group health or dental coverage, the employee 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. 4. When Coverage May Be Canceled.

1. An employee may cancel dependent health or 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 an Employer or spouse; and
   • a significant change of spousal insurance coverage (cost of coverage is not a significant change).
2. 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.
3. A part-time employee may also cancel employee coverage within sixty (60) days of when one of these same life events occurred.
4. 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 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 dependent status.

Subd. 5. Effective Date of Coverage.

1. 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 employee's first day of employment, re-employment, re-hire, or reinstatement with the State. An employee must be actively at work on the initial effective date of coverage, except that an employee 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 employee's dependent's coverage become effective before the employee'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.)

Subd. 6. 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 change 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 employee is on an unpaid leave of absence or layoff.

3. Optional Life and Disability Coverages. In order for coverage to become effective, the employee must be active in 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 employee's return to work.

Subd. 7. Open Enrollment.

1. Frequency and Duration. There shall be an open enrollment period for health coverage in each year of this Collective Bargaining Agreement, and for dental coverage in the first year of this Collective Bargaining Agreement. Open enrollment periods shall last a minimum of thirty (30) calendar days. Open enrollment changes become effective on January 5, 2000 in the first year of this Agreement, and on January 3, 2001 in the second year of this Agreement.
2. Eligibility to Participate. An employee eligible to participate in the State Employee Group Insurance Program, as described in Section 2., Subd. 1. and Subd. 2, may participate in open enrollment. In addition, a person in the following categories may as allowed in Section 5., Subd. 5. (a.) above, make certain changes. (1) a former employee or dependent on continuation coverage, as described in Section 2., Subd. 4., may change plans or add coverage for health and/or dental plans on the same basis as active employees; and (2) an early retiree, prior to becoming eligible for Medicare, may change health and/or dental plans as agreed to for active employees, but may not add dependent coverage.
3. Materials for Employee Choice. Each year prior to open enrollment, the Appointing Authority will give eligible employee the information necessary to make open enrollment selections. Employees will be provided a statement of his/her current coverage each year of the contract.

Subd. 8. Coverage Selection Prior to Retirement.

An employee who retires and is entitled to receive an annuity under a State retirement program may change his/her health or dental plan during the sixty (60) calendar day period immediately preceding the date of retirement. The employee 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. Employee and Family Health Coverage.

1. Coverage Options. Eligible employees 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 Agreement 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 Collective Bargaining Agreement, including increases in co-payments, requires 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.

      • Inpatient hospital services. One hundred percent (100%) coverage.
      • Outpatient surgery center services. One hundred percent (100%) coverage.
      • Home health services. One hundred percent (100%) coverage up to a maximum of five thousand ($5,000) eligible expenses per person per year.
      • X-rays and laboratory tests. One hundred (100%) percent coverage.
      • Preventive care. One hundred percent (100%) coverage.
      • Physicians services. One hundred percent (100%) coverage.
      • 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 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.) (2.) which are not authorized by a primary care physician within the primary care clinic in the 2000 and 2001 insurance years:

      • there is a three hundred fifty dollars ($350) deductible per person with a maximum deductible per family of seven hundred dollars ($700).

        After deductible is satisfied, seventy percent (70%) 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 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 three hundred and sixty five (365) days for inpatient services). No coverage for services obtained from out-of-network providers under SHPS. Out-of-network services are available under SHPPOS according to the terms of the Certificate of Coverage. In-Network Services need not be authorized by a primary 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 physician within the primary care clinic under either plan.
      3. Chiropractic services. One hundred percent (100%) coverage. No coverage for services obtained from out-of-network providers. Services need not be authorized by a primary care physician within the primary care clinic.
      4. Transplant coverage. SHPPOS and SHPS shall provide transplant coverage as specified in their respective Certificate 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. SHPPOS and SHPS shall provide Home Infusion Therapy coverage as specified in their respective Certificates of Coverage. No coverage for services obtained from out-of-network providers. Referrals for eligible 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 dollars ($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. Eye exams. SHPPOS and SHPS. One hundred percent (100%) coverage. (Limited to one routine examination per year.)
      3. Outpatient emergency and urgicenter services within the area. SHPPOS and SHPS. Thirty dollars ($30) co-payment per visit for outpatient emergency visits and fifteen dollar ($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.
      4. 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.
      5. 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.)
         1. 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) except for services not authorized by a primary care physician within the primary care clinic (SHPPOS) where the five hundred thousand dollar ($500,000) lifetime maximum remains. The lifetime maximum for services under Section 6., Subd. 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., Subd. 1. (b.)(2.)is part of, and not in addition to, the two million dollar ($2,000,000) lifetime plan maximum.
      6. Coordination with Workers' Compensation. When an employee has incurred an 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 employee's health plan, pursuant to M.S. 176.191, Subd. 3.
      7. 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 employees and their dependents to maintain and enhance their health, and to make appropriate use of the health care system. To work toward these goals:
         1. Develop Programs. The Employer will develop and implement health promotion and health education programs, subject to the availability of resources. Each Appointing Authority will develop a health promotion and health education program consistent with the Department of Employee Relations policy. Upon request of any exclusive representative in an agency, the Appointing Authority shall jointly meet and confer with the exclusive representative(s) and may include other interested exclusive representatives.
            
            Agenda items shall include but not be 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 State employees and their dependents.
         3. Employee Participation. The Employer will assist employees' 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 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 employee's absence and the availability of funds. Employees are eligible for release time, tuition reimbursement, or a pro rata combination of both. Employees may be reimbursed for up to one hundred percent (100%) of tuition or registration costs upon successful completion of the program. Employees 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.

Subd. 2. Employee and Family Dental Coverage.

1. Coverage Options. Eligible employees may select coverage under any one of the dental plans offered by the Employer, including health maintenance organization plans, the State Dental Plan, or other dental plans. Coverage offered through health maintenance organization plans is subject to change during the life of this Agreement upon action of the health maintenance organization and approval of the Employer after consultation with the Joint Labor-Management Committee on Health Plans. However, actuarial reduction 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.B2.
2. Coverage Under the State Dental Plan. The State Dental Plan will provide the following coverage:
   1. Co-payment. 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 practice.
      
      The plan shall cover general cleaning two (2) times per plan year and special cleanings (root or deep cleaning) as prescribed by the dentist.
      
      

      Service	In-Network	Out-of-Network
      Diagnostic/Preventative	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 ($1,000) 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. Employee 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 employees eligible for an 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.
   
   

   Employee'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
   over $50,000	$70,000	$70,000

   
   
2. Extended Benefits. An employee who becomes totally disabled before age 70 shall be eligible for the extended benefit provisions of the life insurance policy until age 70. Current recipients of extended life insurance shall continue to receive such benefits consistent with applicable statutes.
3. Additional Death Benefit. Employees who retire on or after July 1, 1995, shall be entitled to a five hundred dollar ($500) death benefit payable to a beneficiary designated by the employee, if at the time of death the employee is entitled to an annuity under a State retirement program. A five hundred ($500) cash death benefit shall also be payable to the designated beneficiary of an employee who becomes totally and permanently disabled on or after July 1, 1995, 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.

Subd. 1. Eligibility During Unpaid Leaves or Layoff.

An employee who takes an unpaid leave of absence or who is laid off may discontinue premium payments on optional policies during the period of leave or layoff. If the employee returns within one (1) year, the employee shall be permitted to pick up all optionals held prior to the leave or layoff. For purposes of reinstating such optional coverages, the following limitations shall be applicable.

1. For the first twenty four (24) months of short-term and /or long-term disability coverage after such a period of leave or layoff, any such disability coverage shall exclude coverage for certain pre-existing conditions. For disability purposes, a pre-existing condition is defined as any disability which is caused by, or results from, any injury, sickness or pregnancy which occurred, was diagnosed, or for which medical care was received during the period of leave or layoff. In addition, any pre-existing condition limitations that would have been in effect under the policy but for the discontinuance of coverage shall continue to apply as provided in the policy.
2. For the first twenty four (24) months of optional life coverage after such a period of leave or layoff, any such optional life coverage shall exclude coverage for certain pre-existing conditions. For optional life purposes, any death which is caused by, or results from any injury or sickness which occurred, was diagnosed, or for which medical care was received during the period of leave or layoff shall be excluded from coverage for such twenty four (24) month period.
   
   The limitations set forth in (a.) and (b.) above do not apply to Family Medical Leave Act (FMLA) leaves.

Subd. 2. Regular Eligibility for Life and Disability Coverage - Evidence of insurance may be required.

The following optional life and disability coverages may be available with evidence of insurability. Each of the following requires evidence of insurability unless otherwise indicated.

1. Life Coverage.
   1. Employee. An employee may purchase a combined total of 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 employee hired on or after July 1, 1995, may purchase up to two (2) times annual salary or two hundred thousand dollars ($200,000), whichever is less, in optional employee life coverage within sixty (60) calendar days of hire without evidence of insurability.
   2. Spouse. An employee 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 employee hired on or after July 1,1995 may purchase either five thousand dollars ($5,000) or ten thousand dollars ($10,000) in optional spouse life coverage within sixty (60) calendar days of hire without evidence of insurability.
   3. Children/Grandchildren. An employee may purchase life insurance in the amount of ten thousand dollars ($10,000) as a package for all eligible children/grandchildren (as defined in Section 2., Subd. 3. of this Attachment). Child/grandchild coverage for new employees hired on or after July 1, 1995, 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 employee becomes totally disabled after the effective date of insurance coverage provided by this agreement but before age seventy (70), there shall be a waiver of premium for all life insurance coverage that the employee had at the time of disability.
   6. Paid Up Life Policy. At age sixty five (65) or the date of retirement, an employee who has carried optional employee life insurance for the five (5) consecutive years immediately preceding the date of the employee's retirement or age sixty five (65), which ever is later, shall receive a post-retirement paid-up insurance policy in an amount equal to fifteen percent (15%) of the smallest amount of optional employee life insurance in force during that five (5) year period. The employee's post-retirement death benefit shall be effective as of the date of the employee's retirement or the date the employee reaches age sixty five (65), whichever is later. Employees who retire prior to age sixty five (65) must be immediately eligible to receive a state retirement annuity and must continue their employee life insurance to age sixty five (65) in order to remain eligible for the employee post-retirement death benefit.
      
      An employee who has carried optional spouse life insurance for the five (5) consecutive years immediately preceding the date of the employee's retirement or spouse age sixty five (65), whichever is later, shall receive a post-retirement paid-up life insurance policy in an amount equal tofifteen percent (15%) of the smallest amount of optional spouse life insurance in force during that five (5) year period. The spouse post-retirement death benefit shall be effective as of the date of the employee's retirement or the date the spouse reaches age sixty five (65) whichever is later. The employee must continue the full amount of optional spouse life insurance to the date of the employee's retirement or spouse age sixty five (65), whichever is later, in order to remain eligible for the spouse post-retirement death benefit.
      
      Each policy remains separate and distinct, and amounts may not be combined for the purpose of increasing the amount of a single policy.

    

2. Disability Coverage
   1. Short-term Disability Coverage. Subject to evidence of good health, an employee may purchase short-term disability coverage that provides benefits of from three hundred dollars ($300) to five thousand dollars ($5,000) per month, up to two thirds (2/3) of an employee'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. Employees hired on or after July 1, 1995 may purchase coverage without providing evidence of good health if coverage is purchased within the first sixty (60) days of their insurance eligibility.
      
      
   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 employee 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 employee's salary, commencing on the 181st calendar day of total disability, with a limited term pre-existing exclusion. Employees hired on or after July 1, 1995 may enroll within the first sixty (60) days of their employment or their insurance eligibility. In the event that the employee becomes totally disabled before age seventy (70), the premiums on this benefit shall be waived. Employees should be aware that other wage replacement benefits as described in the certificate of coverage (i.e., Social Security Disability, Minnesota State Retirement Disability, etc.) may result in a reduction of the monthly benefit levels purchased.
      
      
   3. Limited Term Pre-existing Exclusion. Pre-existing medical conditions are excluded from coverage during the first twenty four (24) months of long-term disability coverage. 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 12 months prior to the effective date of your long-term disability coverage.
      
      
   4. Accidental Death and Dismemberment Coverage. For employees hired on or after July 1, 1995, an employee may purchase accidental death and dismemberment coverage that provides principal sum benefits in amount ranging from five thousand dollars ($5,000) to one hundred thousand dollars ($100,000), with evidence of insurability. Payment is made only for accidental bodily injury or death and may vary, depending upon the extent of dismemberment. An employee 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.