Source: https://mape.org/mapes-contract/article-20-insurance
Timestamp: 2020-01-26 21:32:18
Document Index: 100421219

Matched Legal Cases: ['§352', '§352', '§352', '§352', '§352', '§352', '§352', 'art 2017']

Article 20 -- Insurance | Minnesota Association of Professional Employees
Article 20 -- Insurance 2017-19 contract
Section 1. State Employee Group Insurance Program (SEGIP). During the life of this Agreement, the Employer agrees to offer a Group Insurance Program that includes health, dental, life, and disability coverages equivalent to existing coverages, subject to the provisions of this Article.
All insurance eligible employees will be provided with a Summary Plan Description (SPD) called “Your Employee Benefits”. Such SPD shall be provided no less than biennially and prior to the beginning of the insurance year. New insurance eligible employees shall receive a SPD within thirty (30) days of their date of eligibility.
Section 2. Eligibility for Group Participation. This section describes eligibility to participate in the Group Insurance Program.
A. Employees -- Basic Eligibility. Employees may participate in the Group Insurance Program if they are scheduled to work at least 1044 hours in any twelve consecutive months, except for: (1) emergency, or temporary classified, or intermittent employees; (2) student workers; and (3) interns.
B. Employees -- Special Eligibility. The following employees are also eligible to participate in the Group Insurance Program:
Spouse. The spouse of an eligible employee (if legally married under Minnesota law). For the purposes of health insurance coverage, if that spouse works full-time for an organization employing more than one hundred (100) people and elects to receive either credits or cash (1) in place of health insurance or health coverage or (2) in addition to a health plan with a seven hundred and fifty dollar ($750) or greater deductible through his/her employing organization, he/she is not eligible to be a covered dependent for the purposes of this Article. If both spouses work for the State or another organization participating in the State's Group Insurance Program, neither spouse may be covered as a dependent by the other, unless one spouse is not eligible for a full Employer Contribution as defined in Section 3A.
a. Health and Dental Coverage: A dependent child is an eligible employee’s child to age twenty-six (26).
b. Dependent Child: A “dependent child” includes an employee’s (1) biological child, (2) child legally adopted by or placed for adoption with the employee, (3) step-child, and (4) foster child who has been placed with the employee by an authorized placement agency or by a judgment, decree, or other court order. For a step-child to be considered a dependent child, the employee must be legally married to the child’s legal parent or legal guardian. An employee (or the employee’s spouse or jointly) must have permanent, full and sole legal and physical custody of the foster child.
c. Coverage Under Only One Plan: For purposes of (a) and (b) above, if the employee’s adult child (age eighteen (18) to twenty-six (26)) works for the State or another organization participating in the State’s Group Insurance Program, the child may not be covered as a dependent by the employee unless the child is not eligible for a full Employer Contribution as defined in Section 3A.
a. Is financially dependent upon the employee for principal support and maintenance and has resided with the employee continuously from birth, or
b. Resides with the employee and is dependent upon the employee for principal support and maintenance and is the child of the employee’s unmarried child (the parent) to age nineteen (19).
D. Continuation Coverage. Consistent with state and federal laws, certain employees, former employees, dependents, and former dependents may continue group health, dental, and/or life coverage at their own expense for a fixed length of time. As of the date of this Agreement, state and federal laws allow certain group coverages to be continued if they would otherwise terminate due to:
a. termination of employment (except for gross misconduct);
b. layoff;
c. reduction of hours to an ineligible status;
d. dependent child becoming ineligible due to change in age, student status, marital status, or financial support (in the case of a foster child or stepchild);
e. death of employee;
f. divorce or legal separation; or
g. a covered employee’s enrollment in Medicare.
Section 3. Eligibility for Employer Contribution. This section describes eligibility for an Employer Contribution toward the cost of coverage.
A. Full Employer Contribution -- Basic Eligibility. Employees covered by this Agreement who are scheduled to work at least seventy-five (75) percent of the time are eligible for the full Employer Contribution. This means:
B. Partial Employer Contribution -- Basic Eligibility. The following employees covered by this Agreement receive the full Employer Contribution for basic life coverage, and at the employee's option, a partial Employer Contribution for health and dental coverages if they are scheduled to work at least fifty (50) percent but less than seventy-five (75) percent of the time. This means:
C. Special Eligibility. The following employees also receive an Employer Contribution:
Work-related Injury/Disability. An employee who receives an Employer Contribution and who is off the State payroll due to a work-related injury or a work-related disability remains eligible for an Employer Contribution as long as such an employee receives workers' compensation payments. If such employee ceases to receive workers' compensation payments for the injury or disability and is granted a medical leave under Article 10, he/she shall be eligible for an Employer contribution during that leave.
a. Corrections Early Retirement Incentive Options. Any employee who is employed in a classification covered by the Correctional Employees Retirement Plan (M.S. §§352.91 and 352.911) shall be eligible to retire under one of the following Corrections Early Retirement Incentive programs if the conditions for eligibility as set forth in Section 3C4b below are met.
1) Pre-Fifty-Five Corrections Early Retirement Incentive. Any employee who attains the age of fifty (50) after the effective date and before the expiration date of the contract and who in the preceding three (3) years of his/her retirement is employed in a classification covered by the Correctional Employees Retirement Plan (M.S. §§352.91 and 352.911) and who retires at or after his/her fiftieth (50th) birthday but before his/her fifty-fifth (55th) birthday shall be entitled to participate in the Pre-Fifty-Five (55) Corrections Early Retirement Incentive in accordance with the provisions set forth in Section 3C4b below.
Notwithstanding any changes in coverage in accordance with this or a subsequent Agreement, the Employer contribution for health and dental insurance shall be equal to one hundred twenty (120) times the amount of the monthly Employer contribution applicable to that employee at the time of his/her retirement, divided by the number of months until the employee attains the age of sixty-five (65).
2) Post-Fifty-Five Corrections Early Retirement Incentive. Any employee who attains the age of fifty-five (55) after the effective date and before the expiration date of the contract and who in the preceding three (3) years of his/her retirement is employed in a classification covered by the Correctional Employees Retirement Plan (M.S. §§352.91 and 352.911) may opt during the pay period in which his/her fifty-fifth (55th) birthday occurs or any time thereafter until the employee attains the age of sixty-five (65) to participate in the Post-Fifty-Five Corrections Early Retirement Incentive in accordance with the provisions set forth in Section 3C4b below.
1) CERP Employees Who Are Covered By This Agreement Before December 1, 2007. CERP employees who are in a classification covered by this agreement before December 1, 2007 shall be subject to the following conditions for eligibility:
a) Employees exercising either of these options must be eligible for and receiving the Employer contribution for insurance coverage under the provisions of this Article.
b) Employees exercising either of these options shall be provided with the Employer contribution towards health and dental insurance which the employee was entitled to at the time of retirement or prior to going on an unpaid medical leave, whichever is sooner, subject to any changes in coverage in accordance with this or any subsequent agreement.
c) Employees eligible to receive an Employer contribution for health and dental coverage immediately prior to taking advantage of the Correctional Employees Retirement Plan (M.S. §§352.91 and 352.911) shall continue to receive an Employer contribution for themselves and their enrolled dependents until the employee attains the age of sixty-five (65).
d) An employee who retires with no Employer contribution for dependent coverage or who terminates dependent coverage following retirement may add a dependent in accordance with Section 5B1; however, that employee shall not subsequently be eligible for an Employer contribution for dependent coverage except when the dependent is the employee’s spouse and the spouse immediately at the time of their retirement is enrolled in SEGIP and is receiving an Employer contribution for health and dental insurance.
e) Receipt of the Corrections Early Retirement Incentive benefits is contingent upon completion of all the required forms and continued payment of the required premium by the employee.
f) Excluding those on military and medical leaves, employees who are at least fifty-five (55) years of age and are on an unpaid leave of absence of less than one (1) year during the year preceding their retirement must continue to pay the employer and employee contribution and be enrolled in the SEGIP program for their health and dental insurance.
g) Excluding those on military and medical leaves, employees who are at least fifty-five (55) years of age and are on an unpaid leave of absence in excess of one (1) year immediately prior to their retirement shall be subject to the provisions in Section 3C4b2) below.
2) Employees Who Are Covered By This Agreement On or After December 1, 2007. Employees who promote, demote, transfer, or who are appointed to a classification covered by this agreement on or after December 1, 2007 shall be subject to the conditions listed directly above in Section 3C4b1), and the additional conditions for eligibility listed below.
a) Employees must have a minimum cumulative total of ten (10) years of service in a classification covered by the Correctional Employees Retirement Plan (M.S. §§352.91 and 352.911) at the time of his/her date of retirement. Any time spent in a classification that is not covered under the Correctional Employees Retirement Plan (M.S. §§352.91 and 352.911) will not satisfy, and will not be combined with covered time to satisfy, the required time.
b) The employee must have been employed in a classification covered by the Correctional Employees Retirement Plan (M.S. §§352.91 and 352.911) for a minimum of five (5) years immediately preceding his/her date of retirement.
D. Maintaining Eligibility for Employer Contribution.
Section 4. Amount of Employer Contribution. The Employer Contribution amounts and rules in effect on June 30, 2017 will continue through December 31, 2017.
A. Contribution Formula -- Health Coverage.
Employee Coverage. For employee health coverage for the 2018 and 2019 plan years, the Employer contributes an amount equal to ninety-five percent (95%) of the employee-only premium of the Minnesota Advantage Health Plan (Advantage).
Dependent Coverage. For dependent health coverage for the 2018 and 2019 plan years, the Employer contributes an amount equal to eighty-five percent (85%) of the dependent premium of Advantage.
B. Contribution Formula -- Dental Coverage.
Employee Coverage. For employee dental coverage, the Employer contributes an amount equal to the lesser of ninety percent (90%) of the employee premium of the State Dental Plan, or the actual employee premium of the dental plan chosen by the employee. However, for calendar years beginning January 1, 2018, and January 1, 2019, the minimum employee contribution shall be thirteen dollars and fifty cents ($13.50) per month.
C. Contribution Formula -- Basic Life Coverage. For employee basic life coverage and accidental death and dismemberment coverage, the Employer contributes one-hundred percent (100%) of the cost.
Newly Hired Employees. All employees hired to an insurance eligible position must make their benefit elections by their initial effective date of coverage as defined in this Article, Section 5C. Insurance eligible employees will automatically be enrolled in basic life coverage. If employees eligible for a full Employer Contribution do not choose a health plan administrator and a primary care clinic by their initial effective date, and do not waive medical coverage, they will be enrolled in a Benefit Level Two clinic (or Level One, if available) that meets established access standards in the health plan with the largest number of Benefit Level One and Two clinics in the county of the employee’s residence at the beginning of the insurance year. If an employee does not choose a health plan administrator and primary care clinic by their initial effective date, but was previously covered as a dependent immediately prior to their initial effective date, they will be defaulted to the plan administrator and primary care clinic in which they were previously enrolled. If an employee who was re-hired after a previous separation period of 365 days or fewer does not choose a health plan administrator during open enrollment, that employee and any dependents will be defaulted to the plan administrator in which they had enrolled previously.
An employee may change his/her health or dental plan if the employee changes to a new permanent work or residence location and the employee's current plan is no longer available. If the employee has family coverage and if the new residence location is outside of the current plan’s service area, the employee shall be permitted to switch to a new plan administrator and new Benefit Level within thirty (30) days of the residence location change. The election change must be due to and correspond with the change in status. An employee who receives notification of a work location change between the end of an open enrollment period and the beginning of the next insurance year, may change his/her health or dental plan within thirty (30) days of the date of the relocation under the same provisions accorded during the last open enrollment period. An employee or retiree may also change health or dental plans in any other situation in which the Employer is required by the applicable federal or state law to allow a plan change.
B. When Coverage May be Changed or Cancelled.
a. A change in legal marital status, including marriage, death of a spouse, divorce, legal separation and annulment.
c. A change in employment status of the employee, or the employee’s or retiree’s spouse or dependent, including termination or commencement of employment, a strike or lockout, a commencement of or return from an unpaid leave of absence, a change in worksite, and a change in working conditions (including changing between part-time and full-time or hourly and salary) of the employee, the employee’s or retiree’s spouse or dependent which results in a change in the benefits they receive under a cafeteria plan or a health or dental plan.
d. A dependent ceasing to satisfy eligibility requirements for coverage due to attainment of age or otherwise no longer meets the eligibility requirements under Section 2C.
e. A change in the place of residence of the employee, retiree or their spouse or dependent.
f. Significant cost or coverage changes (including coverage curtailment and the addition of a benefit package).
h. Judgments, decrees or orders.
i. A change in coverage of a spouse or dependent under another Employer’s plan.
j. Open enrollment under the plan of another Employer.
k. Health Insurance Portability and Accountability Act (HIPAA) special enrollment rights for new dependents and in the case of loss of other insurance coverage.
l. A COBRA-qualifying event.
m. Loss of coverage under the group health plan of a governmental or educational institution (a State’s children’s health insurance program, medical care program of an Indian tribal government, State health benefits risk pool, or foreign government group health plan).
n. Entitlement to Medicare or Medicaid.
o. Any other situations in which the group health or dental plan is required by the applicable federal or state law to allow a change in coverage.
a. Basic Life. If an employee is not actively at work on the initial effective date of coverage, coverage will be effective on the first day of the employee’s return to work. The effective date of a change in coverage is not delayed in the event that, on the date the coverage change would be effective, an employee is on an unpaid leave of absence or layoff.
b. Medical and Dental. If an employee is not actively at work on the initial effective date of coverage due to a reason other than hospitalization or medical disability of the employee or dependent, medical and dental coverage will be effective on the first day of the employee’s return to work.
c. Optional Life and Disability Coverages. In order for coverage to become effective, the employee must be in active payroll status and not using sick leave on the first day following approval by the insurance company. If it is an open enrollment period, coverage may be applied for but will not become effective until the first day of the employee's return to work.
E. Coverage Selection Prior to Retirement. An employee who retires and is eligible to continue insurance coverage as a retiree may change his/her health or dental plan during the sixty (60) calendar day period immediately preceding the date of retirement. The employee may not add dependent coverage during this period. The change takes effect on the first day of the month following the date of retirement.
A. Employee and Family Health Coverage.
Coverage Under the Minnesota Advantage Health Plan. From July 1, 2017 through December 31, 2017, health coverage under the SEGIP will continue at the level in effect on June 30, 2015. Effective January 1, 2018, Advantage will cover eligible services subject to the copayments, deductibles and coinsurance coverage limits stated. Services provided through Advantage are subject to the managed care procedures and principles, including standards of medical necessity and appropriate practice, of the plan administrators. Coverage details are provided in the Advantage Summary of Benefits.
a. Benefit Options. Employees must elect a plan administrator and primary care clinic. Those elections will determine the Benefit Level through Advantage. Enrolled dependents must elect a primary care clinic that is available through the plan administrator chosen by the employee.
1) Plan Administrator. Employees must elect a plan administrator during their initial enrollment in Advantage and may change their plan administrator election only during the annual open enrollment and when permitted under Section 5. Dependents must be enrolled through the same plan administrator as the employee.
2) Benefit Level. The primary care clinics available through each plan administrator are assigned a Benefit Level. The Benefit Levels are outlined in the benefit chart below. Primary care clinics may be in different Benefit Levels for different plan administrators. Family members may be enrolled in clinics that are in different Benefits Levels. Employees and their dependents may change to clinics in different Benefit Levels during the annual open enrollment. Employees and their dependents may also elect to move to a clinic in a different Benefit Level within the same plan administrator up to two (2) additional times during the plan year. Unless the individual has a referral from his/her primary care clinic, there are no benefits for services received from providers in Benefit Levels that are different from that of the primary care clinic in which the individual has enrolled.
3) Primary Care Clinic. Employees and each of their covered dependents must individually elect a primary care clinic within the network of providers offered by the plan administrator chosen by the employee. Employees and their dependents may elect to change clinics within their clinic’s Benefit Level as often as the plan administrator permits and as outlined above.
4) Advantage Benefit Chart for Services Incurred During Plan Years 2018 and 2019.
Advantage Benefit Chart 2017-19
b. Office Visit Copayments. In each year of the Agreement, the level of the office visit copayment applicable to an employee and dependents is based upon whether the employee has completed the on-line Health Assessment during open enrollment, and has agreed to opt-in for health coaching.
Services received from, or authorized by, a primary care physician within the primary care clinic. Under Advantage, the health care services outlined in the benefits charts above shall be received from, or authorized by a primary care physician within the primary care clinic. Preventive care, as outlined in the Summary of Benefits, is covered at one hundred (100%) percent for services received from or authorized by the primary care clinic. The primary care clinic shall be selected from approved clinics in accordance with the Advantage administrative procedures. Unless otherwise specified in 6A2, services not received from, or authorized by, a primary care physician within the primary care clinic may not be covered. Unless the individual has a referral from his/her primary care clinic, there are no benefits for services received from providers in Benefit Levels that are different from that of the primary care clinic in which the individual has enrolled.
c. Services not requiring authorization by a primary care physician within the primary care clinic.
1) Eye Exams. Limited to one (1) routine examination per year for which no copay applies.
2) Outpatient emergency and urgicenter services within the service area. The emergency room copay applies to all outpatient emergency visits that do not result in hospital admission within twenty-four (24) hours. The urgicenter copay is the same as the primary care clinic office visit copay.
3) Emergency and urgently needed care outside the service area. Professional services of a physician, emergency room treatment, and inpatient hospital services are covered at eighty percent (80%) of the first two thousand dollars ($2,000) of the charges incurred per insurance year, and one-hundred percent (100%) thereafter. The maximum eligible out-of-pocket expense per individual per year for this benefit is four hundred dollars ($400). This benefit is not available when the member’s condition permits him or her to receive care within the network of the plan in which the individual is enrolled.
4) Ambulance. The deductible and coinsurance for services not subject to copays applies.
1) Copayments and annual out-of-pocket maximums.
Tier 1 copayment: Fourteen dollar ($14) copayment per prescription or refill for a Tier 1 drug dispensed in a thirty (30) day supply.
Tier 2 copayment: Twenty-five dollar ($25) copayment per prescription or refill for a Tier 2 drug dispensed in a thirty (30) day supply.
Tier 3 copayment: Fifty dollar ($50) copayment per prescription or refill for a Tier 3 drug dispensed in a thirty (30) day supply.
Out of pocket maximum: There is an annual maximum eligible out-of-pocket expense limit for prescription drugs of eight hundred dollars ($800) per person or one thousand six hundred dollars ($1,600) per family.
2) Insulin. Insulin will be treated as a prescription drug subject to a separate copay for each type prescribed.
3) Brand Name Drugs. If the subscriber chooses a brand name drug when a bioequivalent generic drug is available, the subscriber is required to pay the standard copayment plus the difference between the cost of the brand name drug and the generic. Amounts above the copay that an individual elects to pay for a brand name instead of a generic drug will not be credited toward the out-of-pocket maximum.
e. Special Service networks. The following services must be received from special service network providers in order to be covered. All terms and conditions outlined in the Summary of Benefits apply.
1) Mental health services – inpatient or outpatient.
2) Chemical dependency services – inpatient and outpatient.
3) Chiropractic services.
4) Transplant coverage.
5) Cardiac services.
6) Home infusion therapy.
7) Hospice.
f. Individuals whose permanent residence and principal work location are outside the State of Minnesota and outside of the service areas of the health plans participating in Advantage. If these individuals use the plan administrator’s national preferred provider organization in their area, services will be covered at Benefit Level Two. If a national preferred provider is not available in their area, services will be covered at Benefit Level Two through any other provider available in their area. If the national preferred provider organization is available but not used, benefits will be paid at the POS level described in paragraph “i” below. All terms and conditions outlined in the Summary of Benefits will apply.
g. Children living with an ex-spouse outside the service area of the employee’s plan administrator. Covered children living with former spouses outside the service area of the employee’s plan administrator, and enrolled under this provision as of December 31, 2003, will be covered at Benefit Level Two benefits. If available, services must be provided by providers in the plan administrator’s national preferred provider organization. If the national preferred provider organization is available but not used, benefits will be paid at the POS level described in paragraph “i” below.
h. Individuals whose permanent residence is outside the State of Minnesota and outside the service areas of the health plans participating in Advantage. (This category includes employees temporarily residing outside Minnesota on temporary assignment or paid leave (including spouses living out sabbatical leaves) and all dependent children (including college students) and of area.) The point of service (POS) benefit described below is available to these individuals. All terms and conditions outlined in the Summary of Benefits apply. This benefit is not available for services received within the service areas of the health plans participating in Advantage.
1) Deductible. There is a three hundred fifty dollar ($350) annual deductible per person, with a maximum deductible per family per year of seven hundred dollars ($700).
2) Coinsurance. After the deductible is satisfied, seventy percent (70%) coverage up to the plan out-of-pocket maximum designated below.
i. Lifetime maximums and non-prescription out-of-pocket maximums. Coverage under Advantage is not subject to a per person lifetime maximum.
In the first and second years of the contract, coverage under Advantage is subject to a plan year, non-prescription drug, out-of-pocket maximum of one thousand two hundred dollars ($1,200) per person or two thousand four hundred dollars ($2,400) per family for members whose primary care clinic is in Cost Level 1 or Cost Level 2; one thousand six hundred dollars ($1,600) per person or three thousand two hundred dollars ($3,200) per family for members whose primary care clinic is in Cost Level 3; and two thousand six hundred dollars ($2,600) per person or five thousand two hundred dollars ($5,200) per family for members whose primary care clinic is in Cost Level 4.
j. In-Network Convenience Clinics and Online Care. Services received at in-network convenience clinics and online care are not subject to a copayment in each year of the Agreement. First dollar deductibles are waived for convenience clinic and online care visits. (Note that prescriptions received as a result of a visit are subject to the drug copayment and out-of-pocket maximums described above at 6A2(4)e).)
Benefit Level Two Health Care Network Determination. Issues regarding the health care networks for the 2017 insurance year shall be negotiated in accordance with the following procedures:
a. At least twelve (12) weeks prior to the open enrollment period for the 2018 insurance year the Employer shall meet and confer with the Joint Labor/Management Committee on Health Plans in an attempt to reach agreement on the Benefit Level Two health care networks.
b. If no agreement is reached within five (5) working days, the Employer and the Joint Labor/Management Committee on behalf of all of the exclusive representatives shall submit a list of providers/provider groups in dispute to a mutually agreed upon neutral expert in health care delivery systems for final and binding resolution. The only providers/provider groups that may be submitted for resolution by this process are those for which, since the list for the 2017 insurance year was established, Benefit Level Two access has changed, or those that are intended to address specific problems caused by a reduction in Benefit Level Two access.
c. The decision of the neutral shall be issued within two (2) working days after the hearing.
a. Develop programs.
1) The Employer will develop and implement health promotion and health education programs, subject to the availability of resources. Each Appointing Authority will develop a health promotion and health education program consistent with the Minnesota Management & Budget policy. Upon request of any exclusive representative in an agency, the Appointing Authority shall jointly meet and confer with the exclusive representative(s) and may include other interested exclusive representatives. Agenda items shall include but are not limited to smoking cessation, weight loss, stress management, health education/self-care, and education on related benefits provided through the health plan administrators serving state employees.
2) Pilot Programs. The Employer may develop voluntary pilot programs to test the acceptability of various risk management programs. Incentives for participation in such programs may include limited short-term improvements to the benefits outlined in this Article. Implementation of such pilot programs is subject to the review and approval of the Joint Labor-Management Committee on Health Plans.
b. Health plan specification. The Employer will require health plans participating in the Group Insurance Program to develop and implement health promotion and health education programs for State employees and their dependents.
c. Employee participation. The Employer will assist employees' participation in health promotion and health education programs. Health promotion and health education programs that have been endorsed by the Employer (Minnesota Management & Budget) will be considered to be non-assigned job-related training pursuant to Administrative Procedure 21. Approval for this training is at the discretion of the Appointing Authority and is contingent upon meeting staffing needs in the employee's absence and the availability of funds. Employees are eligible for release time, tuition reimbursement, or a pro rata combination of both. Employees may be reimbursed for up to one hundred (100%) percent of tuition or registration costs upon successful completion of the program. Employees may be granted release time, including the travel time, in lieu of reimbursement.
d. Health promotion incentives. The Joint Labor-Management Committee on Health Plans shall develop a program which provides incentives for employees who participate in a health promotion program. The health promotion program shall emphasize the adoption and maintenance of more healthy lifestyle behaviors and shall encourage wiser usage of the health care system.
Post Retirement Health Care Benefit.
Employees who separate on or after January 1, 2008 from State service and who, at the time of separation are insurance eligible and entitled to immediately receive an annuity under a State retirement program, shall be entitled to a contribution of two hundred fifty dollars ($250) to the Minnesota State Retirement System’s (MSRS) Health Care Savings Plan. Employees who have a HCSP waiver on file shall receive a two hundred fifty dollars ($250) cash payment. If the employee separates due to death, the two hundred fifty dollars ($250) is paid in cash, not to the HCSP. An employee who becomes totally and permanently disabled on or after January 1, 2008, who receives a State disability benefit, and is eligible for a deferred annuity under a State retirement program is also eligible for the two hundred fifty dollar ($250) contribution to the MSRS Health Care Savings Plan. Employees are eligible for this benefit only once.
B. Employee Life Coverage.
Employee's Annual Base Group Life Insurance Accidental Death
Salary Coverage and Dismemberment
10,000 - $15,000 $15,000 $15,000
$15,001 - $20,000 $20,000 $20,000
$20,001 - $25,000 $25,000 $25,000
$25,001 - $30,000 $30,000 $30,000
$30,001 - $35,000 $35,000 $35,000
$35,001 - $40,000 $40,000 $40,000
$40,001 - $45,000 $45,000 $45,000
$45,001 - $50,000 $50,000 $50,000
$50,001 - $55,000 $55,000 $55,000
$55,001 - $60,000 $60,000 $60,000
$60,001 - $65,000 $65,000 $65,000
$65,001 - $70,000 $70,000 $70,000
$70,001 - $75,000 $75,000 $75,000
$75,001 - $80,000 $80,000 $80,000
$80,001 - $85,000 $85,000 $85,000
$85,001 - $90,000 $90,000 $90,000
Over $90,000 $95,000 $95,000
A. Employee and Family Dental Coverage.
a. Copayments. Effective January 1, 2018, the State Dental Plan will cover allowable charges for the following services subject to the copayments and coverage limits stated. Higher out-of-pocket costs apply to services obtained from dental care providers not in the State Dental Plan network. Services provided through the State Dental Plan are subject to the State Dental Plan's managed care procedures and principles, including standards of dental necessity and appropriate practice. The plan shall cover general cleaning two (2) times per plan year and special cleanings (root or deep cleaning) as prescribed by the dentist.
Service In-Network Out-of-Network
Diagnostic/Preventive 100% 50% after deductible
Fillings 80% after deductible 50% after deductible
Endodontics 80% after deductible 50% after deductible
Periodontics 80% after deductible 50% after deductible
Oral Surgery 80% after deductible 50% after deductible
Crowns 80% after deductible 50% after deductible
Implants 80% after deductible 50% after deductible
Prosthetics 80% after deductible 50% after deductible
Prosthetic Repairs 80% after deductible 50% after deductible
Orthodontics 80% after deductible 50% after deductible
b. Deductible. An annual deductible of fifty dollars ($50) per person and one hundred fifty dollars ($150) per family applies to State Dental Plan non-preventive services received from in-network providers. An annual deductible of one hundred twenty-five dollars ($125) per person applies to State Dental Plan services received from out-of-network providers. The deductible must be satisfied before coverage begins.
c. Annual maximums. State Dental Plan coverage is subject to a two thousand dollar ($2000) annual maximum benefit payable (excluding orthodontia) per person. "Annual" means per insurance year.
d. Orthodontia lifetime maximum. Orthodontia benefits are subject to a two thousand four hundred dollar ($2,400) lifetime maximum benefit.
B. Life Coverage.
Employee. An employee may purchase up to five hundred thousand dollars ($500,000) additional life insurance, in increments established by the Employer, subject to satisfactory evidence of insurability. A new employee may purchase up to two (2) times annual salary in optional employee life coverage by their initial effective date of coverage as defined in this Article, Section 5C without evidence of insurability. An employee who becomes eligible for insurance may purchase up to two (2) times annual salary in optional employee life coverage without evidence of insurability within thirty (30) days of the initial effective date as defined in this Article.
Spouse. An employee may purchase up to five hundred thousand dollars ($500,000) life insurance coverage for his/her spouse in increments established by the Employer, subject to satisfactory evidence of insurability. A new employee may purchase either five thousand dollars ($5,000) or ten thousand dollars ($10,000) in optional spouse life coverage by their initial effective date of coverage as defined in this Article, Section 5C without evidence of insurability. An employee who becomes eligible for insurance may purchase either five thousand dollars ($5,000) or ten thousand dollars ($10,000) in optional spouse coverage without evidence of insurability within thirty (30) days of the initial effective date as defined in this Article.
Children/Grandchildren. An employee may purchase life insurance in the amount of ten thousand dollars ($10,000) as a package for all eligible children/grandchildren (as defined in Section 2A2 and 2A3 of this Article). For a new employee, child/grandchild coverage requires evidence of insurability if application is made after the initial effective date of coverage as defined in this Article, Section 5C. An employee who becomes eligible for insurance may purchase child/grandchild coverage without evidence of insurability if application is made within thirty (30) days of the initial effective date as defined in this Article. Child/grandchild coverage commences fourteen (14) calendar days after birth.
C. Disability Coverage.
D. Accidental Death and Dismemberment Coverage. An employee may purchase accidental death and dismemberment coverage that provides principal sum benefits in amounts ranging from five thousand dollars ($5,000) to one hundred thousand dollars ($100,000). Payment is made only for accidental bodily injury or death and may vary, depending upon the extent of dismemberment. An employee may also purchase from five thousand dollars ($5,000) to twenty-five thousand dollars ($25,000) in coverage for his/her spouse, but not in excess of the amount carried by the employee.
E. Continuation of Optional Coverages During Unpaid Leave or Layoff. An employee who takes an unpaid leave of absence or who is laid off may discontinue premium payments on optional policies during the period of leave or layoff. If the employee returns within one (1) year, the employee shall be permitted to pick up all optionals held prior to the leave or layoff. For purposes of reinstating such optional coverages, the following limitations shall be applicable.
Book traversal links for Article 20 -- Insurance
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