Hospitalization and Medical Insurance. 1. Upon submission of a written application and acceptance by the carrier, the BOARD will provide for all teachers employed for more than half-time (1/2), subject to limitations expressed in, Article VIII, Section 12, and their eligible dependents health insurance benefits that comply with the hard cap limitations of Section 3 of 2011 Public Act 152 (MCL 15.563) or the 80/20 percentage requirements of Section 4 of 2011 Public Act 152 (MCL 15.564). Employees will be able to choose from a high deductible health plan (with the option of contributing to a health savings account) or co-pay based health plans offered by the district health insurance provider as outlined below:
a. Lake Shore ABC Plan 1 w/0% ABC Rx
b. Lake Shore ABC Plan 1 w/0% 3-Tier Rx MM
c. Lake Shore ABC Plan 2 w/20% ABC Rx
d. Lake Shore CHOICES $500/$1,000 w/20% 3-TIER Rx Detailed information on current MESSA BCBS health plans can be found at xxxxx://xxxxxxxxxxxxx.xxxxxx.xxx/health.html.
2. To be eligible for the above coverage, teachers must be able to meet the “at work” requirement with Lake Shore Public Schools before the above benefits are effective. Employees working less than a full contract year shall have benefits terminated on the first day of the month following termination of employment.
3. It is the teacher's responsibility to report to the Department of Employee Services any changes in family status within thirty (30) days of such change.
4. The BOARD shall offer to its teachers a Section 125 Flexible Benefits program. This program may provide employees with alternative health care programs, supplemental coverage at the employee’s expense, and the opportunity to participate in flexible spending accounts.
5. Teachers having access to alternative health care coverage may annually refrain from participating in any of the district's hospitalization insurance programs in which case the employee shall receive a payment-in-lieu-of coverage according to the following:
Hospitalization and Medical Insurance. Health and Dental insurance coverage as determined by the Board of Trustees shall be provided for each employee. This plan shall be known as the “Base Plan.” Insurance benefits, deductibles, and Township contributions to a Health Savings Account will be the same as it is for all other Township employees.
Hospitalization and Medical Insurance. A. The HESE Wellness and optional HDHP Medical Plans shall be available for all employees.
1. The insurance premium for teachers will be a percentage of the premium costs for hospitalization and medical insurance for single and family coverage as listed below for the duration of this agreement. Employee Contributions for Insurance: Subject to the following caps: Family Medical 2016-17 15% not to exceed $170.00/month 2017-18 15% not to exceed $181.00/month 2018-19 15% not to exceed $193.00/month Single Medical 2016-17 15% not to exceed $76.00/month 2017-18 15% not to exceed $82.00/month 2018-19 15% not to exceed $88.00/month High Deductible Plan: 2016-19 5%
2. Provided a summary of the Plan Document is available, said document shall be included as a Schedule of Benefits and attached to this Agreement as Xxxxxxxx X-0, X-0, X-0, X-0.
0. In the event the Board receives a medical, dental, vision, and/or prescription “premium holiday(s)” from its insurance carrier or provider, the member shall also receive a “premium holiday(s)” in an amount equal to their contribution.
4. Retire-rehire teachers are not eligible for “premium holiday(s).”
B. Section 125 (Flex Save) Plan Teachers shall have an IRS Section 125 flexible spending account established for them on an annual basis. The flexible spending account shall be in the amount of $500 contributed by the Board for families and $250 for singles with the Board matching teacher contributions dollar for dollar for an additional $500 for families and $250 for singles.
C. Section 125 Plan
1. The Board shall provide to teachers Flexible Spending Accounts (FSAs) or a Section 125 Plan, according to Federal Law. The FSAs will have a third-party administrator selected and paid by the Board.
2. Teachers are permitted to participate in the Section 125 Plan on a voluntary basis in accordance with Federal law.
3. Each year on January 1, up to $500 of all remaining money in each teacher’s FSA shall be carried over into the new year.
4. In the event a Rif’d teacher returns to employment or a new hire is employed after the enrollment period and/or after the availability date of January 1, such teacher shall have his/her monies stated in 13.01 prorated on the remaining calendar days in the plan year and made available within ten (10) calendar days of reinstatement or hire.
Hospitalization and Medical Insurance. The district contributions identified in this Section are based on insurance rates for the plan years 2022 and 2023, and shall be paid on behalf of eligible teachers enrolled in a School District sponsored hospitalization and medical insurance plan.
a) The School District contribution for those electing a Single coverage plan will be equal to 100% of the monthly premium amount for Plan C Single, or
b) The School District contribution for those electing an E+1 coverage plan will be equal to 75% of the monthly premium amount for Plan C E+1, or
c) The School District contribution for those electing a Family coverage plan will be equal to 65% of the monthly premium amount for Plan C Family. In the event that the District contribution exceeds the premium cost, teachers will be reimbursed, in the form of salary on a monthly basis, for the difference between 1) the actual premium amount for those teachers electing coverage or the Plan C single premium amount for those electing no coverage and 2) the monthly amounts listed above. Monthly reimbursement will be estimated until such time as the actual premiums are known and can be calculated by the payroll manager. The Association will hold the School District harmless and indemnify the School District for any and all suits, claims, damages, judgments and other forms of liability which any person may have or claim to have arising out of or by reason of the School District's contribution toward dependent or family hospitalization and medical insurance premiums.
Hospitalization and Medical Insurance.
31.1 Providing Insurance Major medical insurance, dental insurance, and a prescription drug card will be provided to bargaining unit members as follows:
(a) Major medical insurance and a prescription drug card will include $1000 single and $2000 family deductible plan and a drug card plan.
(b) Dental insurance will be provided through the City’s self-insured plan. Dental coverage is being provided at the same level of benefits as was provided through the 2015-2017 contract. The Employer shall offer group medical, dental, and prescription drug insurance coverage. It is agreed and understood that the schedule of benefits for employees shall be as set forth in the health plan offered by the City, including all conditions and payments specified or required by individual carriers/providers of the health insurance plan. It is further agreed and understood that during the term of this Agreement, individual carriers/providers may, through no fault of the City, Union, or employees, cease coverage. The Union will be provided notice at least 30 days prior to implementation of proposed changes or revisions to the insurance coverage. The City agrees to meet with the Union and its representatives to discuss the proposed changes and revisions and to receive any recommendations or alternatives the Union may present. It is further agreed and understood that the Employer may modify the terms of the insurance coverage and may reduce coverage levels if such reductions are made to maintain or reduce costs. Additionally, it is agreed and understood that during the term of this Agreement, specific carriers/providers under the plan may unilaterally institute or modify payments or conditions which modifications will be required for subscription to the plan provided by that carrier/provider.
Hospitalization and Medical Insurance. 1) Upon submission of a written application and acceptance by the carrier, the BOARD will provide for all teachers employed for more than half-time (1/2), subject to limitations expressed in, Article VIII, Section 12, and their eligible dependents as defined by the Internal Revenue Service the following options:
2) To be eligible for the above coverage, teachers must be able to meet the “at work” requirement with Lake Shore Public Schools before the above benefits are effective. Employees working less than a full contract year shall have benefits terminated on the first day of the month following termination of employment.
3) It is the teacher's responsibility to report to the Department of Human Resources any changes in family status within thirty (30) days of such change.
4) The BOARD shall offer to its teachers a Section 125 Flexible Benefits program. This program may provide employees with alternative health care programs, supplemental coverage at the employees expense, and the opportunity to participate in flexible spending accounts. Employees shall be offered monetary incentives to change or drop designated insurance programs. The terms and conditions of the Flexible Benefits program shall be approved by the district's Benefits Committee which shall be comprised of representatives from each bargaining unit. Neither the Flexible Benefits program or the Benefits Committee has the authority to change negotiated core benefits.
5) Teachers having access to alternative health care coverage may annually refrain from participating in any of the district's hospitalization insurance programs in which case the employee shall receive a payment-in-lieu-of coverage of $1,100 annually.
Hospitalization and Medical Insurance. Coverage shall be as determined by the Health Benefit Task Force. The employee portion of premium is as determined by Public Act 152 except that the employee portion of premium for less than full-time employees is calculated as follows:
1. A less than full-time employee who elects coverage for him/herself and his/her eligible dependents must pay, in addition to the full-time employee premium contribution, a prorated amount of the College’s premium contribution based on their benefit eligibility factor in effect at the time of application for the benefit, with the balance of the premium being paid by the College. If an employee’s BEF (percentage of full time hours worked) is .80 or greater, the employee is treated as a full-time employee and will not be required to pay anything in addition to the full-time premium. If an employee’s BEF is less than .80, their additional premium portion will be calculated as follows, (.80 – BEF) x College’s premium contribution. Part-time employee with single coverage BEF = .70 Full-time employee bi-weekly premium contribution = $102.91 College’s bi-weekly premium contribution = $211.54 Employee’s additional bi-weekly premium calculation (.80 - .70) = .10 .10 x $211.54 = $21.15 Employee’s total bi-weekly premium amount $102.91 + $21.15 = $124.06 The less than full-time employee’s portion of the premium may be adjusted at the beginning of each fiscal year if the benefit eligibility factor changes and/or when the premium rate changes for the rest of the bargaining unit. (See Article 16, Section C for benefit eligibility factor calculation rules).
2. Consistent with state and federal laws, particularly HIPAA, the College will not have access to individual medical records of employees through its hospitalization and medical insurance programs although it will have access to aggregate or consolidated data. Violations of this provision of this Agreement must be processed under HIPAA’s procedures and are not subject to the grievance process.
Hospitalization and Medical Insurance a. Effective July 1, 2016, each full time employee may select one of the options contained in Appendix H.
b. The Board may offer other health care options. It is understood the determination of carrier or decision to self-insure is the right of the Board.
c. Options "in lieu of" medical coverage:
1) An election of $500.00 per year cash (prorated the first year dependent on date of hire) which can be redirected to a board-approved tax deferred annuity (TDA) and/or board-paid variable options. The TDA payment will be made directly to the carrier at the end of each December.
2. To be eligible for hospitalization insurance the employee must be working except as covered in Article VII.K.5.
3. In the event of any violation of the no strike provision, this provision shall be immediately terminated and discontinued and the Board shall be reimbursed by the individual for any premium paid but unused.
4. Part-time employees will receive a prorated share. A full time employee shall be interpreted to be those who work thirty-eight (38) weeks or more, and those who work at least five (5) hours per day, five (5) days per week. The District will count all district employment (i.e., hall monitor, bus aide, etc.) towards qualifying for full-time status for health insurance. Part-time employees hired before July 1, 2008 must work a minimum of fifteen (15) hours per week to qualify for the insurance program. Employees hired on or after July 1, 2008 must work twenty (20) hours per week to qualify for the insurance program. Subsidization on a fifty percent (50%) basis will be allowed for employees who work fifteen (15) hours per week (twenty hours if hired on or after July 1, 2008), but less than twenty-five (25) hours per week. Above benefits will be provided to all regular, full time and part- time employees, for the full calendar year, except those employees who terminate their employment. Their insurance benefits will end at the close of the month in which they terminate.
5. In the event of the death of an employee, her/his health insurance coverage will remain in force for her/his dependents for an additional six (6) months.
Hospitalization and Medical Insurance. For the length of the Agreement, all eligible employees shall be provided the HSA- Flexible Blue II with riders. (See Appendix B, Correction, Should be: See Schedule Notations). The District shall fully fund the high deductible cost of the plan.
Hospitalization and Medical Insurance. Upon submission of a written application, the BOARD shall provide, at BOARD expense, full hospitalization and medical insurance for each eligible employee who has successfully completed his/her probationary period and their eligible spouse and dependent(s) (see Article III, Section1.) Such insurance shall be provided as follows: Blue Cross/Blue Shield Blue Preferred Plan (PPO). Blue Cross/Blue Shield Blue Preferred Plan (PPO): Comprehensive Hospital, Semi-Private Room, SAT2, Trust 15, Plus 15, D45NM, PSG-1, ML, FAERC, PPNV-1, CNM, RAPS-2, BMT, HMN, XTMJ, PTB, COB- 3, Master Medical Option 1, MMC-POV, MCXTMJ, MMC-PTB, ICMP, Preferred RX Prescription Drugs with a $10.00 Generic/$20.00 Brand Name with MOPD, EBMT, TSA, PTFS, PTS, and HCB-1, XVA2. Should at some future date the BOARD decide to investigate other heath insurance carriers, self-funding and/or third party administrators in order to provide the same or better coverage to employees as described (A), (B) and (C) above, the UNION shall be allowed representation on the committee convened by the BOARD to study such alternatives. Once the BOARD makes a choice as to another carrier or third party administrator, or to use self-funding for any of its health care programs, Article VII, Section 6 shall be reopened for negotiations. Employees working less than a full contract year have benefits terminated on the first day of the month following termination of employment. It is the employee‟s responsibility to report to the Personnel Office any changes in family status within thirty (30) days of such change. The employee shall be responsible for any overpayment of premiums made by the BOARD in his/her behalf for failure to comply with this provision. For those employees so electing the BOARD shall pay the full premium, under the same conditions as in (1) above for the BC/BS Blue Care Network – HMO or equivalent. The election may be made or changed during the enrollment period. The use of the PPO program is contingent upon both LSASA and contract personnel also utilizing the PPO as their core medical insurance coverage. Employees having access to alternative health care coverage may annually refrain from participating in any of the District‟s hospitalization programs and receive an annual rebate of $1,100.00 (in-lieu-of-coverage). This option will not apply if the alternate coverage is through a spouse also employed by the District.
