Common use of Employee Costs Clause in Contracts

Employee Costs. A. Regardless of the plan, employees will pay fifteen percent (15%) of the premium and the Employer will pay eighty-five percent (85%) of the premium; however, for any alternative plans offered pursuant to Section 20.04 (A), the employees’ premium share will be determined by the Director of DAS, but will not exceed fifteen percent (15%) of the premium. For an HMO health plan, the Employer will pay the lesser of 1) eighty-five percent (85%) of the HMO single and family rates or 2) eighty-five percent (85%) of the Ohio Med PPO single and family rates. In the fall of 2006 and 2007 employees enrolled in a self-funded health plan (Ohio Med and any other self-funded plans) will receive a one (1) month rate holiday and will make no premium payment in each of those months. The State will deduct the employee’s monthly share of the health care premium twice a month or bi-weekly as determined by the Employer. B. The Employer's premium share of eighty-five (85%) shall be paid only on behalf of the following employees: (1) Full-time employees. (2) For part-time employees (including established-term appointments (ETA’s) employees (unless modified by agency-specific agreement) according to the schedule in 20.05(C), provided that all part-time employees who were grandparented under the provisions of the previous Agreements shall continue to have premiums paid pursuant to those provisions. C. The Employer's premium share for all part-time employees shall be paid as follows: (1) The Employer shall pay no share of the premium for part-time employees who are in active pay status an average of less than forty (40) hours in a bi-weekly pay period. However, such employees shall have the option of self-paying the entire health plan premium. (2) The Employer shall pay fifty percent (50%) of the premium for part-time employees who are in active pay status an average of forty (40) hours or more but less than sixty (60) hours in a bi- weekly pay period. (3) The Employer shall pay seventy-five percent (75%) of the premium for part-time employees who are in active pay status an average of sixty (60) hours or more but less than eighty (80) hours in a bi- weekly pay period. (4) The Employer shall pay eighty-five (85%) of the premium for part- time employees who are in active pay status an average of eighty (80) hours or more in a bi-weekly pay period. Average hours in active pay status beginning with the pay period shall be calculated semi-annually on the basis of the thirteen (13) pay periods, which start with the pay period that includes January 1 or July 1, respectively. For newly hired part-time employees, estimated scheduled hours shall determine the Employer contribution toward the premium cost for the first six (6) months of employment. However, if an employee has been in active pay status during at least six bi-weekly pay periods at the time that a pay period including January 1 or July 1, commences, calculations for the Employer contribution toward the premium cost shall be based upon the employee's average hours in active pay status for the number of weeks the employee worked. Employees subject to the pro-rated Employer health plan premium share under this subsection shall be advised in writing regarding the amount of the Employer's share which applies to them. Such information shall be provided to said employees as soon as practicable after the pay periods including January 1 and July 1 of each year. An Employee who declined enrollment in a health plan because he/she was not eligible to receive any Employer contribution pursuant to this Section, and who after a semi-annual calculation of average hours would otherwise become eligible to receive some Employer contribution, may enroll in a health plan within forty-five (45) days from the annual calculation date. Employer payments for premium costs under this Article shall continue during unpaid family leaves granted pursuant to Section 31.01, provided the employee continues to contribute his/her share of the premium. D. Except as provided for in Section 20.04 (A), employee co-insurance shall not exceed twenty percent (20%) of the paid charges for covered network services. In health plans which offer to employees the option of using a network or a non-network provider or facility, employee co- insurance when using a non-network provider or facility shall not exceed forty percent (40%) of the plan’s reimbursement rate for non- network providers. The non-network provider may bill the participant the balance between what is charged and what the plan allows. In health plans which do not have network providers and/or network facilities, employee co- insurance shall not exceed thirty percent (30%) of paid charges when using a service type (i.e., providers or facilities) for which a network option does not exist. E. Except as provided for Section 20.04 (A), employee out-of-pocket maximums for a benefit period shall not exceed $1,000 for single coverage and $2,000 for family coverage when using covered network services. In health plans which offer to employees the option of using a network or non-network provider or facility, employee out-of-pocket maximums for a benefit period shall not exceed a combined total of $2,000 for single coverage and $4,000 for family coverage for covered services in any instance. In health plans which do not have network providers and/or network facilities, employee out-of-pocket maximums for a benefit period shall not exceed $1,000 for a single coverage and $2,000 for family coverage for covered services for use of a service type (i.e., providers or facilities) for which a network option does not exist.

Employee Costs. A. Regardless of the plan, employees will pay ten percent (10%) of the premium, provided however, that for an HMO health plan the Employer will pay the lesser of 1) ninety percent (90%) of the statewide HMO single and family average rates or 2) 90% of the Ohio Med PPO single and family rates. Effective July 1, 2005, employees will pay fifteen percent (15%) of the premium and the Employer will pay eighty-five percent (85%) of the premium; , provided however, that for any alternative plans offered pursuant to Section 20.04 (A), the employees’ premium share will be determined by the Director of DAS, but will not exceed fifteen percent (15%) of the premium. For an HMO health plan, the Employer will pay the lesser of 1) eighty-five percent (85%) of the statewide HMO single and family average rates or 2) eighty-five percent (85%) of the Ohio Med PPO single and family rates. In Effective November 1st of 2003 the fall of 2006 and 2007 employees enrolled in a self-funded health plan (Ohio Med and any other self-funded plans) will receive a one (1) month rate holiday and will make no premium payment in each of those months. The State will deduct commence the process of deducting the employee’s monthly share of the health care premium twice a month or bi-weekly as determined by month. The first half of the Employeremployee’s share of the monthly premium will be deducted from the first paycheck that the employee receives in a month. The remaining balance of the employee’s share of the monthly premium will be deducted from the second paycheck that the employee receives in a month. B. The Employer's premium share of ninety percent (90%) (eighty-five percent (85%) beginning July 1, 2005) shall be paid only on behalf of the following employees: (1) Full-time employees. (2) For part-time employees (including established-established term appointments (ETA’s) employees (unless modified by agency-specific agreementregular and established term irregular employees) according to the schedule in 20.05(C), provided that all part-time employees who were grandparented under the provisions of the previous Agreements shall continue to have premiums paid pursuant to those provisions. C. The Employer's premium share for all part-time employees shall be paid as follows: (1) The Employer shall pay no share of the premium for part-time employees who are in active pay status an average of less than forty (40) hours in a bi-weekly pay period. However, such employees shall have the option of self-paying the entire health plan premium. (2) The Employer shall pay fifty percent (50%) of the premium for part-time employees who are in active pay status an average of forty (40) hours or more but less than sixty (60) hours in a bi- bi-weekly pay period. (3) The Employer shall pay seventy-five percent (75%) of the premium for part-time employees who are in active pay status an average of sixty (60) hours or more but less than eighty (80) hours in a bi- bi-weekly pay period. (4) The Employer shall pay ninety percent (90%) of the premium for part-time employees who are in active pay status an average of eighty (80) hours or more in a bi-weekly pay period. Effective July 1, 2005, the Employer shall pay eighty-five percent (85%) of the premium for part- part-time employees who are in active pay status an average of eighty (80) hours or more in a bi-weekly pay period. Average hours in active pay status beginning with the pay period shall be calculated semi-annually on the basis of the thirteen (13) pay periods, which start with the pay period that includes January 1 or July 1, respectively. For newly hired part-time employees, estimated scheduled hours shall determine the Employer contribution toward the premium cost for the first six (6) months of employment. However, if an employee has been in active pay status during at least six bi-weekly pay periods at the time that a pay period including January 1 or July 1, commences, calculations for the Employer contribution toward the premium cost shall be based upon the employee's average hours in active pay status for the number of weeks the employee worked. Employees subject to the pro-rated Employer health plan premium share under this subsection shall be advised in writing regarding the amount of the Employer's share which applies to them. Such information shall be provided to said employees as soon as practicable after the pay periods including January 1 and July 1 of each year. An Employee who declined enrollment in a health plan because he/she was not eligible to receive any Employer contribution pursuant to this Section, and who after a semi-annual calculation of average hours would otherwise become eligible to receive some Employer contribution, may enroll in a health plan within forty-five (45) days from the annual calculation date. Employer payments for premium costs under this Article shall continue during unpaid family leaves granted pursuant to Section 31.01, provided the employee continues to contribute his/her share of the premium. D. Except as provided for in Section 20.04 (A)Regardless of the plan, employee co-insurance payments shall not exceed twenty percent (20%) of the paid charges for covered network services. In health plans which offer to employees the option of using a network or a non-non- network provider or facility, employee co- insurance co-payments when using a non-network provider or facility shall not exceed forty percent (40%) of the plan’s reimbursement rate for non- network providers. The non-network provider may bill the participant the balance between what is charged and what the plan allowspaid charges. In health plans which do not have network providers and/or network facilities, employee co- insurance co-payments shall not exceed thirty percent (30%) of paid charges when using a service type (i.e., providers or facilities) for which a network option does not exist. E. Except as provided for Section 20.04 (A)Regardless of the plan, employee out-of-pocket maximums for a benefit period shall not exceed $1,000 for single coverage and $2,000 for family coverage when using covered network services. In health plans which offer to employees the option of using a network or non-network provider or facility, employee out-of-pocket maximums for a benefit period shall not exceed a combined total of $2,000 for single coverage and $4,000 for family coverage for covered services in any instance. In health plans which do not have network providers and/or network facilities, employee out-of-pocket maximums for a benefit period shall not exceed $1,000 for a single coverage and $2,000 for family coverage for covered services for use of a service type (i.e., providers or facilities) for which a network option does not exist.

Employee Costs. A. Regardless of the plan, employees will pay ten percent (10%) of the premium, provided however, that for an HMO health plan the Employer will pay the lesser of 1) ninety percent (90%) of the statewide HMO single and family average rates or 2) 90% of the Ohio Med PPO single and family rates. Effective July 1, 2005, employees will pay fifteen percent (15%) of the premium and the Employer will pay eighty-five percent (85%) of the premium; , provided however, that for any alternative plans offered pursuant to Section 20.04 (A), the employees’ premium share will be determined by the Director of DAS, but will not exceed fifteen percent (15%) of the premium. For an HMO health plan, the Employer will pay the lesser of 1) eighty-five percent (85%) of the statewide HMO single and family average rates or 2) eighty-five percent (85%) of the Ohio Med PPO single and family rates. In Effective November 1st of 2003 the fall of 2006 and 2007 employees enrolled in a self-funded health plan (Ohio Med and any other self-funded plans) will receive a one (1) month rate holiday and will make no premium payment in each of those months. The State will deduct commence the process of deducting the employee’s monthly share of the health care premium twice a month or bi-weekly as determined by month. The first half of the Employeremployee’s share of the monthly premium will be deducted from the first paycheck that the employee receives in a month. The remaining balance of the employee’s share of the monthly premium will be deducted from the second paycheck that the employee receives in a month. B. The Employer's premium share of ninety percent (90%) (eighty-five percent (85%) beginning July 1, 2005) shall be paid only on behalf of the following employees: (1) Full-time employees. (2) For part-time employees (including established-established term appointments (ETA’s) employees (unless modified by agency-specific agreementregular and established term irregular employees) according to the schedule in 20.05(C), provided that all part-time employees who were grandparented under the provisions of the previous Agreements shall continue to have premiums premiu ms paid pursuant to those provisions. C. The Employer's premium share for all part-time employees shall be paid as follows: (1) The Employer shall pay no share of the premium for part-time employees who are in active pay status an average of less than forty (40) hours in a bi-weekly pay period. However, such employees shall have the option of self-paying the entire health plan premium. (2) The Employer shall pay fifty percent (50%) of the premium for part-time employees who are in active pay status an average of forty (40) hours or more but less than sixty (60) hours in a bi- bi-weekly pay period. (3) The Employer shall pay seventy-five percent (75%) of the premium for part-time part -time employees who are in active pay status an average of sixty (60) hours or more but less than eighty (80) hours in a bi- bi-weekly pay period. (4) The Employer shall pay ninety percent (90%) of the premium for part-time employees who are in active pay status an average of eighty (80) hours or more in a bi-weekly pay period. Effective July 1, 2005, the Employer shall pay eighty-five percent (85%) of the premium for part- part-time employees who are in active pay status an average of eighty (80) hours or more in a bi-weekly pay period. Average hours in active pay status beginning with the pay period shall be calculated semi-annually semi -annually on the basis of the thirteen (13) pay periods, which start with the pay period that includes January 1 or July 1, respectively. For newly hired part-time employees, estimated scheduled hours shall determine the Employer contribution toward the premium cost for the first six (6) months of employment. However, if an employee has been in active pay status during at least six bi-weekly pay periods at the time that a pay period including January 1 or July 1, commences, calculations for the Employer contribution toward the premium cost shall be based upon the employee's average hours in active pay status for the number of weeks the employee worked. Employees subject to the pro-rated Employer health plan premium share under this subsection shall be advised in writing regarding the amount of the Employer's share which applies to them. Such information shall be provided to said employees as soon as practicable after the pay periods including January 1 and July 1 of each year. An Employee who declined enrollment in a health plan because he/she was not eligible to receive any Employer contribution pursuant to this Section, and who after a semi-annual calculation of average hours would otherwise become eligible to receive some Employer contribution, may enroll in a health plan within forty-five (45) days from the annual calculation date. Employer payments for premium costs under this Article shall continue during unpaid family leaves granted pursuant to Section 31.01, provided the employee continues to contribute his/her share of the premium. D. Except as provided for in Section 20.04 (A)Regardless of the plan, employee co-insurance payments shall not exceed twenty percent (20%) of the paid charges for covered network services. In health plans which offer to employees the option of using a network or a non-non- network provider or facility, employee co- insurance co-payments when using a non-network provider or facility shall not exceed forty percent (40%) of the plan’s reimbursement rate for non- network providers. The non-network provider may bill the participant the balance between what is charged and what the plan allowspaid charges. In health plans which do not have network providers and/or network facilities, employee co- insurance co-payments shall not exceed thirty percent (30%) of paid charges when using a service type (i.e., providers or facilities) for which a network option does not exist. E. Except as provided for Section 20.04 (A)Regardless of the plan, employee out-of-pocket maximums for a benefit period shall not exceed $1,000 for single coverage and $2,000 for family coverage when using covered network services. In health plans which offer to employees the option of using a network or non-network provider or facility, employee out-of-pocket maximums for a benefit period shall not exceed a combined total of $2,000 for single coverage and $4,000 for family coverage for covered services in any instance. In health plans which do not have network providers and/or network facilities, employee out-of-pocket maximums for a benefit period shall not exceed $1,000 for a single coverage and $2,000 for family coverage for covered services for use of a service type (i.e., providers or facilities) for which a network option does not exist.

Employee Costs. A. Regardless of the plan, employees eEmployees will pay fifteen percent (15%) of the health care premium and the Employer will pay eighty-five percent (85%) of the health care premium; however, for any alternative plans offered pursuant to Section 20.04 (A), the employees’ premium share will be determined by the Director of DAS, but will not exceed fifteen percent (15%) of the premium. For an HMO health plan, the Employer will pay the lesser of 1) eighty-five percent (85%) of the HMO single and family rates or 2) eighty-five percent (85%) of the Ohio Med PPO single and family rates. Employees who include a spouse as a dependent for healthcare coverage shall pay a surchage of $12.50 per month in addition to the family premium. In the fall of 2006 and 2007 employees enrolled in a self-funded health plan (Ohio Med and any other self-funded plans) will receive a one (1) month rate holiday and will make no premium payment in each of those months. The State will deduct the employee’s monthly share of the health care premium twice a month or bi-weekly as determined by the Employer. B. The Employer's ’s premium share of eighty-five (85%) shall be paid only on behalf of the following employees: (1) Full-time employees. (2) For part-time employees (including established-term appointments (ETA’s) employees (unless modified by agency-specific agreement) according to the schedule in 20.05(C), provided that all part-time employees who were grandparented grand- parented under the provisions of the previous Agreements shall continue to have premiums paid pursuant to those provisions. C. The Employer's ’s premium share for all part-time employees shall be paid as follows: (1) The Employer shall pay no share of the premium for part-time employees who are in active pay status an average of less than forty (40) hours in a bi-weekly pay period. However, such employees shall have the option of self-paying the entire health plan premium. (2) The Employer shall pay fifty percent (50%) of the premium for part-time employees who are in active pay status an average of forty (40) hours or more but less than sixty (60) hours in a bi- weekly biweekly pay period. (3) The Employer shall pay seventy-five percent (75%) of the premium for part-time employees who are in active pay status an average of sixty (60) hours or more but less than eighty (80) hours in a bi- weekly biweekly pay period. (4) The Employer shall pay eighty-five (85%) of the premium for part- part-time employees who are in active pay status an average of eighty (80) hours or more in a bi-weekly pay period. Average hours in active pay status beginning with the pay period shall be calculated semi-annually on the basis of the thirteen (13) pay periods, which start with the pay period that includes January 1 or July 1, respectively. For newly hired part-time employees, estimated scheduled hours shall determine the Employer contribution toward the premium cost for the first six (6) months of employment. However, if an employee has been in active pay status during at least six bi-weekly pay periods at the time that a pay period including January 1 or July 1, commences, calculations for the Employer contribution toward the premium cost shall be based upon the employee's ’s average hours in active pay status for the number of weeks the employee worked. Employees subject to the pro-rated Employer health plan premium share under this subsection shall be advised in writing regarding the amount of the Employer's ’s share which applies to them. Such information shall be provided to said employees as soon as practicable after the pay periods including January 1 and July 1 of each year. Employees moving from a full-time position to a part-time position are immediately subject to the pro-rated premium based on the projected number of hours they are scheduled to work. An Employee who declined enrollment in a health plan because he/she was not eligible to receive any Employer contribution pursuant to this Section, and who after a semi-annual calculation of average hours would otherwise become eligible to receive some Employer contribution, may enroll in a health plan within forty-five (45) days from the annual calculation date. Employer payments for premium costs under this Article shall continue during unpaid family leaves granted pursuant to Section 31.01, provided the employee continues to contribute his/her share of the premium. D. Except as provided for in Section 20.04 (A), employee co-insurance shall not exceed twenty percent (20%) of the paid charges for covered network services. In health plans which offer to employees the option of using a network or a non-network provider or facility, employee co- insurance when using a non-network provider or facility shall not exceed forty percent (40%) of the plan’s reimbursement rate for non- network providers. The non-network provider may bill the participant the balance between what is charged and what the plan allows. In health plans which do not have network providers and/or network facilities, employee co- insurance shall not exceed thirty percent (30%) of paid charges when using a service type (i.e., providers or facilities) for which a network option does not exist. E. Except as provided for Section 20.04 (A), employee out-of-pocket maximums for a benefit period shall not exceed $1,000 for single coverage and $2,000 for family coverage when using covered network services. In health plans which offer to employees the option of using a network or non-network provider or facility, employee out-of-pocket maximums for a benefit period shall not exceed a combined total of $2,000 for single coverage and $4,000 for family coverage for covered services in any instance. In health plans which do not have network providers and/or network facilities, employee out-of-pocket maximums for a benefit period shall not exceed $1,000 for a single coverage and $2,000 for family coverage for covered services for use of a service type (i.e., providers or facilities) for which a network option does not exist.five