Common use of Duplicate Coverage Clause in Contracts

Duplicate Coverage. This subsection applies to married County employees, employees in domestic partnerships (as defined in Appendix B), and employees in parent-young adult dependent (YAD) relationships where the YAD employee is under age 26, when both parties are both employed by the County. The intent of this subsection is to limit County employees from both covering each other or having duplicate coverage within the same dental plan. Married County employees and employees in domestic partnerships who are both employed by the County, shall be entitled to one (1) choice from the following list of dental plan coverages: • Up to one (1) full family PPO plan together with up to one (1) PPO supplemental plan. • Up to one (1) full family PPO plan or Operating Engineers plan together with up to one (1) full family DHMO plan. • Up to one (1) full family DHMO plan. • Up to one (1) full family PPO plan or Operating Engineers plan. For County employees in a parent-YAD relationship, the YAD employee cannot have duplicate coverage within the same plan as the parent employee if the parent employee has the YAD employee on a family plan. Effect of Leave Without Pay and Re-Enrollment: Employees on leave without pay (including vacation purchase hours referenced in subsection 10.M. (Vacation Purchase Plan)) during a pay period that the semi-monthly premium is paid, who are on paid status less than fifty percent (50%) of the normal full-time biweekly pay period, shall be responsible for one hundred percent (100%) of the semi-monthly dental premium. Employees may elect to continue uninterrupted dental coverage for the duration of their leave without pay by paying 100% of their current plan’s dental premiums or enroll in and pay 100% of the premiums of a lower level of dental plan coverage while on leave without pay. Employees who elect to enroll in and pay for a lower level of dental plan coverage while on leave without pay shall maintain the same lower level of coverage through the duration of the Plan Year and may only restore to their prior level of coverage during Open Enrollment. Failure to pay for premiums will result in a lapse of coverage. Employees on leave without pay, who lose their dental plan coverage for a duration of three (3) months or less, will be able to re-enroll as a continuing member in the same plan under which they had coverage prior to the leave by completing the appropriate enrollment form within 30 calendar days of the date they return to work. The deductibles, maximums, and waiting period shall be applied as though the employee had been continuously enrolled. The effective date of coverage will be based on guidelines established by the County. Those employees whose dental plan coverage was allowed to lapse for a duration greater than three (3) months will be able to re-enroll within 30 calendar days of the date they return to work in the same manner as is allowed for new hires. Such employees will be subject to new deductibles, maximums, and waiting periods that are applicable to the plan year in which they reinstate. The effective date of coverage will be based on guidelines established by the County. Special Enrollment due to Change in Status. To make changes to employee benefits elections outside of the annual open enrollment period for a County-sponsored dental plan, employees must notify the Employee Benefits Center (EBC) within 30 days when they experience a qualifying event (e.g., marriage, adoption, loss of dental coverage by spouse/domestic partner, etc.) involving a change in status as defined by Internal Revenue Code Section 125. Open Enrollment. Eligible employees may choose from the dental plans offered by the County or the Operating Engineers Health and Welfare Trust and make benefits election changes during the County’s annual Open Enrollment period.

Duplicate Coverage. This subsection applies to married County employees, employees in domestic partnerships (as defined in Appendix B), and employees in parent-young adult dependent (YAD) relationships where the YAD employee is under age 26, 26 when both parties are both employed by the County. The intent of this subsection is to limit County employees from both covering each other or having duplicate coverage within the same dental medical plan. Married County employees and employees in domestic partnerships who are both employed by the County, shall be entitled to one (1) choice from the following list of dental medical plan coverages: • Up to one (1) full family PPO plan together with up to one (1) PPO supplemental HMO plan. • Up to one (1) full family PPO plan or Operating Engineers plan together with up to one (1) full family DHMO PPO/Indemnity plan. • Up to one (1) full family DHMO HMO plan with up to one (1) full family PPO/Indemnity plan. • Up to one (1) full family PPO HMO plan with up to one (1) full family alternative HMO plan. • Up to one (1) full family HMO plan with up to one (1) full family Operating Engineers – Health and Welfare Trust plan or alternative plan. • Up to one (1) full family PPO/Indemnity plan with up to one (1) full family Operating Engineers – Health and Welfare Trust plan or alternative plan. • Up to one (1) full family Operating Engineers – Health and Welfare Trust plan with up to one (1) full family Operating Engineers Trust alternative plan. For any County employees employee in a parent-YAD relationship, the YAD employee cannot have duplicate coverage within the same plan as the parent employee if employee. If the parent employee has the YAD employee on a family plan, the YAD employee cannot select individual coverage on the same HMO plan as the parent employee. Effect of Leave Without Pay and Re-Enrollment: . Employees on leave without pay (including vacation purchase hours referenced in subsection 10.M. (Vacation Purchase Plan)) during a pay period that the semi-monthly premium is paid, who are on paid status less than fifty percent shall have their County contribution towards the employee’s medical premium prorated as provided in 14.A.3. (50%) of the normal full-time biweekly pay period, shall be responsible for one hundred percent (100%) of the semi-monthly dental premiumProration). Employees may elect to continue uninterrupted dental medical coverage for the duration of their leave without pay by paying 100% of their current plan’s dental medical premiums or enroll in and pay 100% of the premiums of a lower level of dental medical plan coverage while on leave without pay. Employees who elect to enroll in and pay for a lower level of dental medical plan coverage while on leave without pay shall maintain the same lower level of coverage through the duration of the Plan Year and may only restore to their prior level of coverage medical plan during Open Enrollment. Failure to pay for premiums will result in a lapse of coverage. Employees Any employees who is on leave without pay, and who lose their dental loses his or her medical plan coverage for a duration of three (3) months or less, will be able to re-enroll as a continuing member in the same plan under which they had coverage prior to the leave by completing the appropriate enrollment form within 30 calendar days of the date they return to work. The deductibles, maximums, and waiting period shall be applied as though the employee had been continuously enrolled. The effective date of coverage will be based on guidelines established by the County. Those employees whose dental plan coverage was allowed to lapse for a duration greater than three (3) months will be able to re-enroll within 30 calendar days of the date they return to work in the same manner as is allowed for new hires. Such employees will be subject to new deductibles, maximums, and waiting periods that are applicable to the plan year in which they reinstate. The effective date of coverage will be based on guidelines established by the County. Special Enrollment due to Change in Status. To make changes to employee benefits elections outside of the annual open enrollment period for a County-sponsored dental plan, employees must notify the Employee Benefits Center (EBC) within 30 days when they experience a qualifying event (e.g., marriage, adoption, loss of dental coverage by spouse/domestic partner, etc.) involving a change in status as defined by Internal Revenue Code Section 125. Open Enrollment. Eligible employees may choose from the dental plans offered by the County or the Operating Engineers Health and Welfare Trust and make benefits election changes during the County’s annual Open Enrollment period.three

Duplicate Coverage. This subsection applies to married County employees, employees in domestic partnerships (as defined in Appendix BB – Domestic Partners), and employees in parent-young adult dependent (YAD) relationships where the YAD employee is under age 26, 26 when both parties are both employed by the County. The intent of this subsection is to limit County employees from both covering each other or having duplicate coverage within the same dental plan. Married County employees and employees in domestic partnerships who are both employed by the County, shall be entitled to one (1) choice from the following list of dental plan coverages: • Up to one (1) full family PPO plan together with up to one (1) PPO supplemental plan. ; • Up to one (1) full family PPO plan or Operating Engineers plan together with up to one (1) full family DHMO plan. ; • Up to one (1) full family DHMO plan. ; or • Up to one (1) full family PPO plan or Operating Engineers plan. For County employees in a parent-YAD relationship, the YAD employee cannot have duplicate coverage within the same plan as the parent employee if the parent employee has the YAD employee on a family plan. Effect of Leave Without Pay and Re-Enrollment: Employees on leave without pay (including vacation purchase hours referenced in subsection 10.M. (Vacation Purchase Plan)) during a pay period that the semi-monthly premium is paid, who are on paid status less than fifty percent (50%) of the normal full-time biweekly pay period, period due to leave without pay (including vacation purchase hours referenced in subsection 10.J. (Vacation Purchase Plan)) shall be responsible for one hundred percent (100%) of the semi-monthly dental premium. Employees may elect to continue uninterrupted dental coverage for the duration of their leave without pay by paying 100% of their current plan’s dental premiums or enroll in and pay 100% of the premiums of a lower level of dental plan coverage while on leave without pay. Employees who elect to enroll in and pay for a lower level of dental plan coverage while on leave without pay shall maintain the same lower level of coverage through the duration of the Plan Year and may only restore to their prior level of coverage during Open Enrollment. Failure to pay for premiums will result in a lapse of coverage. Employees on leave without pay, who lose their dental plan coverage for a duration of three (3) months or less, will be able to re-enroll as a continuing member in the same plan under which they had coverage prior to the leave without pay by completing the appropriate enrollment form within 30 thirty (30) calendar days of the date they return to work. The deductibles, maximums, and waiting period periods shall be applied as though the employee had been continuously enrolled. The effective date of coverage will be based on guidelines established by the County. Those employees whose dental plan coverage was allowed to lapse for a duration greater than three (3) months will be able to re-enroll within 30 thirty (30) calendar days of the date they return to work in the same manner as is allowed for new hires. Such employees will be subject to new deductibles, maximums, and waiting periods that are applicable to the plan year in which they reinstate. The effective date of coverage will be based on guidelines established by the County. Special Enrollment due to Change in Status. : To make changes to employee benefits elections outside of the annual open enrollment period for a County-sponsored dental plan, employees must notify the Employee Benefits Center EBC within thirty (EBC30) within 30 days when they experience of a qualifying event (e.g., marriage, adoption, loss of dental coverage by spouse/domestic partner, etc.) involving a change in status as defined by Internal Revenue Code Section 125. Open Enrollment. : Eligible employees may choose from the dental plans offered by the County or the Operating Engineers Health and Welfare Trust and make benefits election changes during the County’s annual Open Enrollment period.