| 15. EMPLOYEE BENEFITS |
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| 15.1 |
Continue the current 125 plan (Flexible Spending Account) for premiums, out-of-pocket medical costs, and child care expenses. |
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| 15.2 |
Continue the current procedure whereby employees can elect not to be covered by one or more benefit programs. |
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| 15.3 |
Employee and retiree tenthly contributions shall be based on the three tiered rates (employee/retiree, two-party and family) as follows (except during the collective bargaining process as referenced in 15.5.6A4b):
Plans |
Lower Cost HMO |
Higher Cost HMO |
PPO |
Employee/Retiree Premium Contribution |
0% of premium |
5% of premium |
11% of premium |
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| 15.3.1 |
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Upon ratification, the following applies to newly hired, non-permanent unit members during their first two (2) full years (greater than 75%) of employment: Unit members shall be eligible for SAUSD paid contribution toward medical benefits at the cost of the lowest cost HMO; Unit members shall be permitted to purchase other SAUSD offered insurance plans at the difference between the cost of those plans and the lowest cost HMO. After the first two (2) full years (greater than 75%) of employment, unit members shall be eligible for SAUSD paid contributions toward Medical Benefits under 15.3 above. |
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| 15.4 |
In order to coordinate medical benefits when a member and spouse are both employees of the District and members of the same plan; one employee will have the contribution of the employee only rate and one will have the contribution of the 2 party or family rate. (See 15.3) |
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| 15.4.1 |
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If an employee and their spouse voluntarily choose not to coordinate benefits, one may decline coverage and the other employee’s contribution (dual/family coverage) shall be waived. |
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| 15.5 |
During the term of this Agreement, the District shall make available: |
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A. medical insurance
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B. dental insurance
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C. vision insurance
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D. mental health insurance
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E. life insurance
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F. retiree insurance
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| 15.5.1 |
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A Health Benefits Authority (HBA) shall be established to make decisions regarding: |
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A. medical insurance
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B. dental insurance
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C. vision insurance
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D. mental health insurance
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E. life insurance
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F. retiree insurance
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G. carriers/providers
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H. consultants
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| 15.5.2 |
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The District shall designate a separate health benefits sub-fund(s)/reserve fund(s) (67-69 and 71-71) for the purpose of all revenues, expenses, and reserves related to the health benefits programs listed in 15.5.1. |
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| 15.5.3 |
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Each year, no later than ninety (90) calendar days before the end of the health benefits plan year (i.e. March 30th of a fiscal health benefits plan year), an actuarial analysis shall be completed by the HBA’s health benefits consultant. The analysis shall reflect renewal rates/expected costs/savings based on a composite percentage increase/decrease per enrollee multiplied by the number of enrollees in the plan at the time of the actuarial analysis using current plan designs. Proposed provider increases/decreases shall be presented to the Health Benefits Authority on or before seventy-five (75) calendar days prior to the end of the health benefits plan year (i.e. April 15th of a fiscal health benefits plan year). |
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A. The annual actuarial analysis shall include the following elements
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1. Utilization
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2. Medical trend
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3. Experience
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4. SAUSD plan document
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B. If the District’s existing health benefits plan year’s per enrollee premium/costs is greater than the proposed premium/cost, the Health Benefits Authority shall address any excess health benefits funds (i.e. through plan modifications, etc.) prior to open enrollment. If those excess funds exceed the value of two (2) months of health benefits costs, then those excess funds over the value of the two (2) months shall be made available for health benefits related negotiations.
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C. If the District’s existing health benefits plan year’s per enrollee premium/costs level does not cover the proposed increase in premium/costs, the Health Benefits Authority shall, prior to open enrollment, take action to implement or change one or more of the following:
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1. Plan modifications
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2. Allocate excess funds from the health benefits sub-fund reserves to offset increased costs; the allocation shall not exceed 50% of the increased cost.
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D. In the event that plan modification(s) are insufficient to cover the entire increased premium/costs, the remaining increases/costs shall be referred to the Collective Bargaining process to determine how remaining increases/costs shall be allocated.
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E. The Health Benefits Authority may make health benefits plan design adjustments when needed during the health benefits plan year. Open enrollment opportunities shall be provided to allow unit members to change plans.
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| 15.5.4 |
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The Health Benefits Authority shall provide: |
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A. SAUSD Open Enrollment publication
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B. Summary Plan Description
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C. Evidence of Health Benefit Coverage
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D. Trainings on health benefits issues, trends, cost analysis, etc. shall be provided to the Health Benefits Authority. Release time shall be provided by the District.
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| 15.5.5 |
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The Health Benefits Authority shall have three (3) SAEA voting representatives, to be appointed by the SAEA President. |
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| 15.5.6 |
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The Health Benefits Authority Decision Making/Voting Process: |
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A. Consensus Decision Making Model
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1. Consensus building regarding the annual actuarial analysis and implementation of needed changes shall be used.
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2. Following consensus building, a vote shall be taken to implement the recommended changes. District and Labor shall have an equal one (1) District to one (1) SAEA vote.
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3. If the vote (15.5.5.A2) is 2 – 0, the recommended changes shall be implemented.
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4. If the vote (15.5.5.A2) is a 1 -1 tie:
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a. Either side may request mediation.
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b. If an agreement cannot be reached within one hundred-twenty (120) calendar days after the beginning of the new health benefits plan year (i.e. November 1st of the fiscal health benefits plan year), District and SAEA unit members/enrollees shall equally split SAEA’s proportion of the shortfall in health benefits funding retroactive to the first day of the new health benefits plan year District paying 50% of the shortfall; SAEA unit members/enrollees paying 50% of the shortfall). The 50%-50% shortfall split shall be applied to the unblended rate increases at the tier level. Rate increases that stay in effect may be referred to the Collective Bargaining process to determine how the increases shall be allocated.
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5. Meetings of the Health Benefits Authority shall be open and public, with agendas and minutes made available.
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6. Meetings shall be chaired by a voting member of the HBA. The chair shall be appointed and rotate annually between the District and each participating labor group. The District and each participating labor group shall appoint an Assistant Chair annually. SAEA shall appoint the chair for the 2010-2011 school year.
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7. Meetings shall be conducted using Robert’s Rules of Order and an annual review/training of Robert’s Rules of Order shall be held.
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8. To ensure order and efficiency, bylaws and/or standing rules shall be developed, adhered to, reviewed, and modified as needed.
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| 15.5.7 |
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The benefit plans provided during retirement will be the same as provided to active employees at the same time excluding life insurance, as is set forth in IN 6.2 and Appendix F. Retirees eligible for benefits shall sign the retiree benefit agreement with the District attached as Appendix G. |
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A. All unit members who are/have been hired after April 28, 1999 and have ten (10) or more years of SAUSD service are eligible for SAUSD provided retiree health and welfare benefits. These unit members shall be entitled to retiree benefits or coverage until the unit member reaches the age of Medicare eligibility.
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B. As of April 28, 2009, unit members with ten (10) or more years of full-time employment per Ed. Code in the District shall be covered by the terms of the 2007/2008 CBA.
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| 15.6 |
For the Group Health Plan, for employees hired after the effective date of the Agreement, deny coverage for pre-existing conditions until the first of the month following the completion of one year of employment. HIPA certification will waive the pre-existing condition(s). |
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| 15.7 |
Establish that eligibility for all dependent coverage on all plans to be as follows |
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| 15.7.1 |
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Any unmarried child under age nineteen (19) years (including a natural child, legally-adopted child, stepchild, or child under legal guardianship if actually living with employee in a regular parent-child relationship) but only if primarily dependent upon employee for support and while employee may claim such dependent as an exemption for Federal Income Tax purposes. |
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| 15.7.2 |
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A never married student age 19 through age 24 who is related to the employee as a natural or legally adopted child, a stepchild, or a child under legal guardianship. Such child must also be primarily dependent on the employee for financial support, and must be claimed by the employee as a dependent for Federal Income Tax purposes. The student must be able to provide proof acceptable to the District that he/she is in full-time attendance at one or a combination of qualified educational institutions. |
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A. As used herein, “full-time” attendance requires either a statement from a qualified educational institution that the student is accepted for the semester as “full-time” and/or at least 12 semester units as determined by college or university standards.
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B. A “qualified educational institution” includes high schools, junior colleges, or other two-year colleges, or universities or colleges granting four-year degrees or post-graduate degrees; proprietary school such as business colleges, professional schools, trade and technical schools which are established as other than evening schools exclusively.
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C. Cessation of full-time school attendance will terminate dependent status with respect to the student EXCEPT that: (a) if cessation is due to school vacation, dependent status will terminate on the date the school reconvenes if attendance does not resume, or (b) if cessation is due to graduation, dependent status will terminate at the end of the third calendar month following graduation.
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D. An eligible dependent does not include any dependent who is on active duty in a military service.
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| 15.7.3 |
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A handicapped child’s dependent status shall terminate solely by reason of his/her having attained age 19, if such child is related to the employee as a natural or legally adopted child, a stepchild, or a child under legal guardianship, and if: |
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A. The child is fully dependent upon the employee for support and maintenance.
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1. Within thirty-one (31) days after the child turns nineteen (19), proof of the child’s incapacity must be submitted to the Contract Administrator. Thereafter, continued proof of the disability may be required once per year.
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2. or these purposes, “handicapped” is defined as disabled and thus incapable of self-sustaining employment by reason of mental retardation or physical handicap. The District, at its expense, might require an independent medical or psychological verification.
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| 15.7.4 |
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A Dependent Status Report Committee shall be established consisting of two members of the Association and two representatives of the District. This committee shall review concerns and appeals in the matter of dependent eligibility and make recommendations to the District. |
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| 15.7.5 |
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A newborn child of the employee or employee’s spouse. Such newborn children automatically have coverage for the first thirty-one (31) days of life. Coverage after thirty-one (31) days is contingent upon the employee enrolling the newborn as a family dependent, and paying any premium or charges due and owing from the date of birth, within thirty-one (31) days following the birth. |
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| 15.7.6 |
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The following are not considered family dependents: |
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A. Foster Child, unless meeting requirements of 15.7.1,
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B. Grandchild, unless meeting requirements of 15.7.1,
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C. Any other person who does not meet the requirements of at least one of the categories in section 15.7.1 and 15.7.2 above.
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D. This language sunsets on June 30th, 2008.
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| 15.7.7 |
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The following are considered family dependents: |
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A. State Registered Domestic Partners
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| 15.8 |
When the choice of service providers is beyond the unit member’s control, non-PPO providers and hospitals shall be reimbursed at reasonable and customary rates. |
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| 15.9 |
All full-time home teachers (a full-time home teacher is one who teaches approximately five-hundred twenty-five (525) hours in a school year) shall receive the same benefits as any other unit member. |
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| 15.10 |
Any permanent, probationary, and temporary unit members employed on a contract full time shall receive the same benefits as any unit member. Unit members voluntarily reducing contract to less than full-time shall receive benefits only if they pay for the proportion of benefit costs equal to the proportion of the reduction of their contract. Unit members whose contracts are involuntarily reduced shall continue to receive full benefits. |
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A. Family coverage for surviving covered family members in the case of death of a unit member or retiree shall continue for a period of six (6) months beginning with the first of the month following the death of the unit member.
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| 15.11 |
A unit member on leave shall have the option to continue any health benefits negotiated in the Agreement at his/her own expense (see Article X, Section 10.4.12). |
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| 15.12 |
All costs for medical examination and tests required by the District shall be paid by the District. |
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| 15.13 |
The Health Benefits Authority shall review and study health benefits. |
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| 15.14 |
The Health Benefits Authority shall make available health benefits contracts with insurance carriers. |
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| 15.15 |
The Health Benefits Authority shall review benefits documents. |
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| 15.16 |
Daily administration of the health benefits program, and responsibility for implementing the direction of the Health Benefits Authority, shall be the responsibility of the District. All business correspondence, including claim waivers, formal proposals, bids, and correspondence shall be directed to the District for presentation as appropriate to the Health Benefits Authority. |
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| 15.17 |
Authority to enter into contracts with respect to the health benefits determined by the Health Benefits Authority shall rest with the District. |
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| 15.17.1 |
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The Health Benefits Authority shall be authorized to select consultants to be paid from budgeted health benefits funds. Labor shall have a health benefits consultant (chosen by Labor) to review the analysis presented by the HBA consultant, paid from the budgeted health benefits funds and not to exceed 20% of the expense of the consultant selected by the HBA. Contracts with firms or individuals shall be under the auspices of the District and shall require the approval of the Board of Education. |
