Common use of Maintenance of Benefits/Open Enrollment Clause in Contracts

Maintenance of Benefits/Open Enrollment. Except as provided in this article, the benefits under the University’s group health plan shall remain equivalent to or better than those provided in the certificates that are in place in Appendix D of this Agreement. Members of the bargaining unit will annually have the right to choose to enroll in the plan during the open enrollment period established by the Administration. 1. Working Spouse Coverage Obligations a. As a condition of eligibility for coverage under the University’s group medical and/or prescription drug plan(s) (“University Coverage”), if an employee’s spouse is eligible for group medical and/or prescription drug coverage sponsored, maintained, and/or provided by the spouse’s current employer, former employer (for retirees), or business for self-employed individuals (other than sole proprietors) (collectively or individually, “Employer Coverage”), the spouse must enroll for at least single coverage in their Employer Coverage unless they are entitled to Medicare. For purposes of this section, in instances where the spouse’s employer makes no monetary contribution for Employer Coverage, such plans will not be considered to be Employer Coverage. This is intended to apply to situations in which the spouse is a current employee in a business, but not to situations in which the spouse is a business owner, including partner of a company and/or firm, is a self-employed individual (other than a sole proprietor) in a business, or retiree in a group medical and/or prescription drug insurance plan. b. The requirement of subsection (a) does not apply to any spouse who works less than 25 hours per week AND is required to pay more than 50% of the single premium funding rate OR $500 per month, whichever is greater, in order to participate in Employer Coverage. c. An employee’s spouse who fails to enroll in Employer Coverage, as outlined above, shall be ineligible for University Coverage. d. Upon the spouse’s enrollment in Employer Coverage, that coverage will become the primary plan and the University Coverage will become the secondary plan according to the primary plan’s coordination of benefits and participation rules. Notwithstanding the foregoing, in the event the spouse is a Medicare beneficiary and (i) Medicare is secondary to the University Coverage, and (ii) Medicare is primary to the spouse’s Employer Coverage, the University Coverage will be the primary coverage. The rules of O.R.C. §§3902.11 to 3902.14 shall govern the implementation and interpretation of these coordination of benefits rules. 2. It is the employee’s responsibility to advise the Plan via the University’s Human Resources Office immediately (and not later than thirty (30) calendar days after any change in eligibility) if the employee’s spouse becomes eligible to participate in Employer Coverage. Upon becoming eligible, the employee’s spouse must enroll in Employer Coverage unless they are exempt from this requirement in accordance with the exemptions stated in this section. 3. Every bargaining unit member whose spouse participates in the University’s group medical and/or prescription drug insurance coverage shall complete and submit to the Plan, upon request, a written certification verifying whether their spouse is eligible for and enrolled in Employer Coverage. If any bargaining unit member fails to complete and submit the certification during the annual certification process, such bargaining unit member’s spouse will be removed immediately from University Coverage. Any information not completed or provided on the certification form may be requested from the employee. 4. If a bargaining unit member submits false material information or fails to timely advise the Plan via the Chief Human Resources Officer of a change in the eligibility of the employee’s spouse for Employer Coverage within thirty (30) calendar days of notification of such eligibility, and such false information or failure results in the provision of University Coverage to which the employee’s spouse is not entitled, the employee’s spouse will be disenrolled from University Coverage. Such disenrollment may be retroactive to the date as of which the employee’s spouse became ineligible for plan coverage, as determined by the administrator for the University Coverage. The administrator shall provide at least thirty (30) calendar days advance written notice of any proposed retroactive disenrollment. In the event of retroactive disenrollment, the bargaining unit member will be personally liable to the applicable University Coverage for reimbursement of benefits and expenses, including attorneys’ fees and costs, incurred by the University Coverage as a result of the false information or failure. Additionally, if the bargaining unit member submits false information in this context, the employee may be subject to disciplinary action, up to and including termination of employment. 5. The details of the working spouse limitations and coordination of benefits requirements are available upon request from the Human Resources Office. 6. For purposes of salary deduction toward premium cost sharing, families in which both spouses are employed by YSU have the option either to be treated as only one employee, employee plus one, or family, or to select individual coverage and for each to pay the single salary share of the premium. 7. If one spouse works for YSU and the other does not, the children remain on the YSU insurance. If both spouses work for the University, in the case of family coverage, the higher-paid employee pays for the employee plus one (1) or family coverage. 8. An employee may opt out of health insurance benefits (medical, prescription drug, dental and/or vision) coverage.

Maintenance of Benefits/Open Enrollment. Except as provided in this article, the benefits under the University’s group health plan shall remain equivalent to or better than those provided in the certificates that are in place in Appendix D G of this Agreement. Members of the bargaining unit will annually have the right to choose to enroll in the plan during the open enrollment period established by the Administration.University. C) Working Spouse/Coordination of Benefits:‌ 1. Working Spouse Coverage Obligations a. As a condition of eligibility for coverage under the University’s group medical and/or and r prescription drug plan(s) (“University Coverage”), if an employee’s spouse is eligible for group medical and/or and prescription drug coverage sponsored, maintained, maintained and/or provided by the spouse’s current employer, former employer (for retirees), or business for self-self- employed individuals (other than sole proprietors) (collectively or individually, “Employer Coverage”), the spouse must enroll for at least single coverage in their Employer Coverage unless they are entitled to Medicare. For purposes of this section, in instances where the spouse’s employer makes no monetary contribution for Employer Coverage, such plans will not be considered to be Employer Coverage. This is intended to apply to situations in which the spouse is a current employee in a business, but not to situations in which the spouse is a business owner, including partner of a company and/or firm, is a self-employed individual (other than a sole proprietor) in a business, or retiree in a group medical and/or and prescription drug insurance plan. b. The requirement of subsection (a) does not apply to any spouse who works less than 25 hours per week AND is required to pay more than 50% of the single premium funding rate OR $500 300 per month, whichever is greater, in order to participate in Employer Coverage. c. An employee’s spouse who fails to enroll in Employer Coverage, as outlined above, shall be ineligible for University Coverage. d. Upon the spouse’s enrollment in Employer Coverage, that coverage will become the primary plan and the University Coverage will become the secondary plan according to the primary plan’s coordination of benefits and participation rules. Notwithstanding the foregoing, in the event the spouse is a Medicare beneficiary and (i) Medicare is secondary to the University Coverage, and (ii) Medicare is primary to the spouse’s Employer Coverage, the University Coverage will be the primary coverage. The rules of O.R.C. §§§ 3902.11 to 3902.14 shall govern the implementation and interpretation of these coordination of benefits rules. 2. It is the employee’s responsibility to advise the Plan via the University’s Human Resources Office immediately (and not later than thirty (30) calendar days after any change in eligibility) if the employee’s spouse becomes eligible to participate in Employer Coverage. Upon becoming eligible, the employee’s spouse must enroll in Employer Coverage unless they are exempt from this requirement in accordance with the exemptions stated in this section. 3. Every bargaining unit member whose spouse participates in the University’s group medical and/or prescription drug insurance coverage shall complete and submit to the Plan, upon request, a written certification verifying whether their spouse is eligible for and enrolled in Employer Coverage. If any bargaining unit member fails to complete and submit the certification during the annual certification process, such bargaining unit member’s spouse will be removed immediately from University Coverage. Any information not completed or provided on the certification form may be requested from the employee. 4. If a bargaining unit member submits false material information or fails to timely advise the Plan via the Chief Human Resources Officer of a change in the eligibility of the employee’s spouse for Employer Coverage within thirty (30) calendar days of notification of such eligibility, and such false information or failure results in the provision of University Coverage to which the employee’s spouse is not entitled, the employee’s spouse will be disenrolled from University Coverage. Such disenrollment may be retroactive to the date as of which the employee’s spouse became ineligible for plan coverage, as determined by the administrator for the University Coverage. The administrator shall provide at least thirty (30) calendar days advance written notice of any proposed retroactive disenrollment. In the event of retroactive disenrollment, the bargaining unit member will be personally liable to the applicable University Coverage for reimbursement of benefits and expenses, including attorneys’ fees and costs, incurred by the University Coverage as a result of the false information or failure. Additionally, if the bargaining unit member submits false information in this context, the employee may be subject to disciplinary action, up to and including termination of employment. 5. The details of the working spouse limitations and coordination of benefits requirements are available upon request from the Human Resources Office. 6. For purposes of salary deduction toward premium cost sharing, families in which both spouses are employed by YSU have the option either to be treated as only one employee, employee plus one, or family, or to select individual coverage and for each to pay the single salary share of the premium. 7. If one spouse works for YSU and the other does not, the children remain on the YSU insurance. If both spouses work for the University, in the case of family coverage, the higher-paid employee pays for the employee plus one (1) or family coverage. 8. An employee may opt out of health insurance benefits (medical, prescription drug, dental and/or vision) coverage.