Grievances and Appeals a. If you have questions about any pediatric dental services received, please first discuss the matter with your Dental Provider. However, if you continue to have concerns, please call Delta Dental’s Customer Service Center. You can also email questions by accessing the “Contact Us” section of the dental plan website at xxx.xxxxxxxxxxxxxx.xxx.
DISMISSAL, SUSPENSION AND DISCIPLINE 13 11.1 Procedure 13 11.2 Dismissal and Suspension 13 11.3 Burden of Proof 13 11.4 Right to Grieve Other Disciplinary Action 13 11.5 Personnel File 13 11.6 Right to Have Union Representative Present 14 11.7 Abandonment of Position 14 11.8 Probation 14 11.9 Employee Investigations 15 ARTICLE 12 - SENIORITY 15 12.1 Seniority Defined 15 12.2 Seniority List 16 12.3 Loss of Seniority 16 12.4 Re-Employment 17 12.5 Bridging of Service 17 12.6 Same Seniority 17 ARTICLE 13 - LAYOFF AND RECALL 17 13.1 Definition of a Layoff 17 13.2 Pre-Layoff Canvass 17 13.3 Layoff 18 13.4 Bumping 18 13.5 Recall 19 13.6 Advance Notice 19 13.7 Grievance on Layoffs and Recalls 19 13.8 Worksite Closure 19 ARTICLE 14 - HOURS OF WORK 20 14.1 Definitions 20 14.2 Hours of Work 20 14.3 Rest Periods 21 14.4 Meal Periods 22 14.5 Flextime 22 14.6 Staff Meetings 22 (ii) 14.7 Standby Provisions 22 14.8 Conversion of Hours 23 ARTICLE 15 - SHIFTS 23 15.1 Exchange of Shifts 23 15.2 Shortfall of Shifts 23 15.3 Short Changeover Premium 23 15.4 Split Shifts 23 15.5 Work Schedules 23 ARTICLE 16 - OVERTIME 24 16.1 Definitions 24 16.2 Overtime Entitlement 24 16.3 Recording of Overtime 24 16.4 Sharing of Overtime 24 16.5 Overtime Compensation 24 16.6 No Layoff to Compensate for Overtime 24 16.7 Right to Refuse Overtime 25 16.8 Callback Provisions 25 16.9 Rest Interval 25 16.10 Overtime for Part-Time Employees 25 16.11 Authorization and Application of Overtime 25 ARTICLE 17 - HOLIDAYS 26 17.1 Paid Holidays 26 17.2 Holiday Falling on Saturday or Sunday 26 17.3 Holiday Falling on a Day of Rest 26
Dismissal or Suspension Grievances (a) In the case of a dispute arising from an employee’s dismissal, the grievance may be filed directly at Step 3, within thirty (30) days of the date on which the dismissal occurred, or within thirty (30) days of the employee receiving notice of dismissal.
GRIEVANCES AND ARBITRATION Section 1. Having a desire to create and maintain labor relations harmony between them, the parties hereto agree that they will promptly attempt to adjust all disputes involving the interpretation, application or alleged violation of a specific provision of this Agreement. Addendum B, attached hereto, shall be utilized to resolve grievances.
Reconsiderations and Appeals If you experience a problem relating to an authorization review, benefit denial, or other aspect of this plan, we have internal and external procedures to help you resolve your issue. The following sections detail the processes and procedures for filing: • Administrative Appeals; • Medical Reconsiderations and Appeals (including expedited appeals); • Prescription Drug Appeals: and
Dismissal and Suspension Grievance All dismissals and suspensions will be subject to formal grievance procedure under Article 8. A copy of the written notice of dismissal or suspension shall be forwarded to the President of the Union within five (5) days of the action being taken.
Your Grievance and Appeals Rights If you have a complaint or are dissatisfied with a denial of coverage for claims under your plan, you may be able to appeal or file a grievance. For questions about your rights, this notice, or assistance, you can contact your state insurance department at (000) 000-0000 or by email at XxxxxxXxxXxxxxxx@xxxx.xx.xxx, the U.S. Department of Labor, Employee Benefits Security Administration at 0-000-000-0000 or xxx.xxx.xxx/xxxx, or the U.S. Department of Health and Human Services at 0-000-000-0000 x00000 or xxx.xxxxx.xxx.xxx. Does this Coverage Provide Minimum Essential Coverage? The Affordable Care Act requires most people to have health care coverage that qualifies as “minimum essential coverage.” This plan or policy does provide minimum essential coverage. Does this Coverage Meet the Minimum Value Standard? The Affordable Care Act establishes a minimum value standard of benefits of a health plan. The minimum value standard is 60% (actuarial value). This health coverage does meet the minimum value standard for the benefits it provides. Language Access Services: Para obtener asistencia en Español, llame al 0-000-000-0000. Kung kailangan ninyo ang tulong sa Tagalog tumawag sa 0-000-000-0000. 如果需要中文的帮助，请拨打这个号码 0-000-000-0000. Dinek'ehgo shika at'ohwol ninisingo, kwiijigo holne' 0-000-000-0000. ––––––––––––––––––––––To see examples of how this plan might cover costs for a sample medical situation, see the next page.–––––––––––––––––––––– About these Coverage Examples: These examples show how this plan might cover medical care in given situations. Use these examples to see, in general, how much financial protection a sample patient might get if they are covered under different plans. This is not a cost estimator. Don’t use these examples to estimate your actual costs under this plan. The actual care you receive will be different from these examples, and the cost of that care will also be different. See the next page for important information about these examples. Having a baby (normal delivery) ◼ Amount owed to providers: $7,540 ◼ Plan pays $7,490 ◼ Patient pays $50 Sample care costs: Hospital charges (mother) $2,700 Routine obstetric care $2,100 Hospital charges (baby) $900 Anesthesia $900 Laboratory tests $500 Prescriptions $200 Radiology $200 Vaccines, other preventive $40 Total $7,540 Patient pays: Deductibles $0 Copays $20 Coinsurance $0 Limits or exclusions $30 Total $50 Managing type 2 diabetes (routine maintenance of a well-controlled condition) ◼ Amount owed to providers: $5,400 ◼ Plan pays $4,760 ◼ Patient pays $640 Sample care costs: Prescriptions $2,900 Medical Equipment and Supplies $1,300 Office Visits and Procedures $700 Education $300 Laboratory tests $100 Vaccines, other preventive $100 Total $5,400 Patient pays: Deductibles $0 Copays $300 Coinsurance $300 Limits or exclusions $40 Total $640 These examples are based on coverage for an individual plan. Questions and answers about the Coverage Examples: What are some of the assumptions behind the Coverage Examples? • Costs don’t include premiums. • Sample care costs are based on national averages supplied by the U.S. Department of Health and Human Services, and aren’t specific to a particular geographic area or health plan. • The patient’s condition was not an excluded or preexisting condition. • All services and treatments started and ended in the same coverage period. • There are no other medical expenses for any member covered under this plan. • Out-of-pocket expenses are based only on treating the condition in the example. • The patient received all care from in- network providers. If the patient had received care from out-of-network providers, costs would have been higher. What does a Coverage Example show? For each treatment situation, the Coverage Example helps you see how deductibles, copayments, and coinsurance can add up. It also helps you see what expenses might be left up to you to pay because the service or treatment isn’t covered or payment is limited. Does the Coverage Example predict my own care needs?
Suspension and Dismissal In the event an Employee alleges dismissal or suspension without just cause, the Employee may commence a grievance at Step II. The grievance shall be filed within ten (10) days of the occurrence.
Resolution of Employee Dismissal or Suspension Disputes The following procedure shall be used for the resolution of disputes relating to the dismissal or suspension of an employee(s):
Certification of Funds; Budget and Fiscal Provisions; Termination in the Event of Non-Appropriation This Agreement is subject to the budget and fiscal provisions of the City’s Charter. Charges will accrue only after prior written authorization certified by the Controller, and the amount of City’s obligation hereunder shall not at any time exceed the amount certified for the purpose and period stated in such advance authorization. This Agreement will terminate without penalty, liability or expense of any kind to City at the end of any fiscal year if funds are not appropriated for the next succeeding fiscal year. If funds are appropriated for a portion of the fiscal year, this Agreement will terminate, without penalty, liability or expense of any kind at the end of the term for which funds are appropriated. City has no obligation to make appropriations for this Agreement in lieu of appropriations for new or other agreements. City budget decisions are subject to the discretion of the Mayor and the Board of Supervisors. Contractor’s assumption of risk of possible non-appropriation is part of the consideration for this Agreement. THIS SECTION CONTROLS AGAINST ANY AND ALL OTHER PROVISIONS OF THIS AGREEMENT.
