Common use of Hospital-Surgical-Medical Benefits Clause in Contracts

Hospital-Surgical-Medical Benefits. a. It is expressly understood that the determination of the carrier or the decision to self-insure is the right of the board. b. New hires, hired directly from a contractor with whom Birmingham Public Schools has an existing contract with will receive health care benefits on their first day of employment, all other new hires will receive benefits on their 89th day of employment. c. The parties agree that the Board has no obligation to provide hospital-surgical-medical insurance coverage to either the spouse and/or dependents of an employee who are otherwise eligible to be covered by any such comparable insurance benefits elsewhere; for example, by virtue of the employment of the spouse. d. An employee who is laid off in accordance with Article 15, Section E, or who is on a leave of absence in accordance with Article 12, shall continue to have the Employer provide the hospitalization coverage provided in this Article for 90 days immediately following the month his/her layoff or leave of absence becomes effective. Thereafter, a laid off employee or an employee on a leave of absence who elects to have this coverage, will be required to elect coverage through COBRA and shall pay the total and current monthly premium for the additional time of his/her layoff or leave of absence to the districts third party administrator. If an employee is on sick leave because the employee is the victim of a serious injury, illness or disease, such as cancer, stroke, etc., the Employer may continue to provide this insurance coverage for a longer period than stated above at no cost to the employee. e. An employee whose weekly straight time work schedule is for less than twenty (20) hours per week shall, subject to all the conditions set forth herein, be eligible for hospitalization coverage by agreeing to pay one-half (1/2) the monthly premium for such coverage. Employees shall receive fully paid insurance that is set forth in A.1, above, by working 28 hours per week or more. Working 20 through 27 hours per week, the employee shall pay one quarter (1/4) the monthly premium for insurance. Working 19 hours or less per week, the employee shall pay one half (1/2) the monthly premium for insurance. Eligible twelve (12) month employees who choose health coverage, whose straight time hours are for 37.5 per week or more, shall have their health premium paid by the board. All such twelve (12) month employees whose straight time work schedules are for fewer than 37.5 hours per week but for more than 27 hours, shall pay one quarter (1/4) the monthly premium. f. The parties acknowledge that each employee is responsible for notifying the district when his or her spouse or a dependent, who is covered under the employee’s health plan or other benefits coverage with the district, is no longer his or her legal dependent and is no longer eligible for coverage under the plan. The employee must notify the employee benefits office in writing within thirty (30) calendar days who the ineligible dependent is, and must request the person’s immediate removal from coverage. Failure to provide such notice will result in the employee to become responsible for any premium difference that is paid from the time the person is no longer eligible until the employee notifies the district to discontinue coverage for the person. Where an employee must wait for a final court order or decree, the employee must notify the employee benefits office in writing within thirty (30) days of the final order or decree. g. The parties also acknowledge that if there is a question about whether a person is a legal dependent of the employee, the district shall have the right not to place the person on the employee’s coverage until the employee provides evidence of the person’s legal dependent status. The proof required will be a copy of the legal adoption papers, the court order requiring the employee to cover this person, or any other legal evidence that the district may require as proof of dependent status. Where more than one employee claims dependent status for the same person, the district shall not be obligated to place the person on any of these employees’ coverage, and shall place the person on coverage once the employees settle the legal dependency issue among themselves, and one of them presents the most recent legal proof that the person is that employee’s dependent. The district shall be held harmless, by the union and each employee, for any health or other benefits needs or bills for service(s) that the person incurs during any waiting period before one of the employees supplies the proper proof to obtain coverage for the person. h. The Employer may change to another carrier providing comparable benefits and coverages. i. The parties agree to participate on a committee that will consider hospitalization insurance costs, alternative coverages, variation in carriers and other matters.