Common use of Duplicate Coverage Clause in Contracts

Duplicate Coverage. This subsection applies to married County employees, employees in domestic partnerships (as defined in Appendix B), and employees in parent-young adult dependent (YAD) relationships where the YAD employee is under age 26 when both parties are employed by the County. The intent of this subsection is to limit County employees from both covering each other or having duplicate coverage within the same medical plan. Married County employees and employees in domestic partnerships who are both employed by the County, shall be entitled to one (1) choice from the following list of medical plan coverages: • Up to one (1) full family HMO plan. • Up to one (1) full family PPO/Indemnity plan. • Up to one (1) full family HMO plan with up to one (1) full family PPO/Indemnity plan. • Up to one (1) full family HMO plan with up to one (1) full family alternative HMO plan. • Up to one (1) full family HMO plan with up to one (1) full family Operating Engineers – Health and Welfare Trust plan or alternative plan. • Up to one (1) full family PPO/Indemnity plan with up to one (1) full family Operating Engineers – Health and Welfare Trust plan or alternative plan. • Up to one (1) full family Operating Engineers – Health and Welfare Trust plan with up to one (1) full family Operating Engineers Trust alternative plan. For any County employee in a parent-YAD relationship, the YAD employee cannot have duplicate coverage within the same plan as the parent employee. If the parent employee has the YAD employee on a family plan, the YAD employee cannot select individual coverage on the same HMO plan as the parent employee. Effect of Leave Without Pay and Re-Enrollment. Employees on leave without pay (including vacation purchase hours referenced in subsection 10.M. (Vacation Purchase Plan)) during a pay period that the semi-monthly premium is paid shall have their County contribution towards the employee’s medical premium prorated as provided in 14.A.3. (Proration). Employees may elect to continue uninterrupted medical coverage for the duration of their leave without pay by paying 100% of their current plan’s medical premiums or enroll in and pay 100% of the premiums of a lower level of medical plan coverage while on leave without pay. Employees who elect to enroll in and pay for a lower level of medical plan coverage while on leave without pay shall maintain the same lower level of coverage through the duration of the Plan Year and may only restore to their prior level of coverage medical plan during Open Enrollment. Failure to pay for premiums will result in a lapse of coverage. Any employees who is on leave without pay, and who loses his or her medical plan coverage for a duration of three

Duplicate Coverage. This subsection applies to married County employees, employees in domestic partnerships (as defined in Appendix B), and employees in parent-young adult dependent (YAD) relationships where the YAD employee is under age 26 26, when both parties are both employed by the County. The intent of this subsection is to limit County employees from both covering each other or having duplicate coverage within the same medical dental plan. Married County employees and employees in domestic partnerships who are both employed by the County, shall be entitled to one (1) choice from the following list of medical dental plan coverages: • Up to one (1) full family HMO PPO plan together with up to one (1) PPO supplemental plan. • Up to one (1) full family PPO/Indemnity PPO plan or Operating Engineers plan together with up to one (1) full family DHMO plan. • Up to one (1) full family HMO plan with up to one (1) full family PPO/Indemnity DHMO plan. • Up to one (1) full family HMO PPO plan with up to one (1) full family alternative HMO plan. • Up to one (1) full family HMO plan with up to one (1) full family or Operating Engineers – Health and Welfare Trust plan or alternative plan. • Up to one (1) full family PPO/Indemnity plan with up to one (1) full family Operating Engineers – Health and Welfare Trust plan or alternative plan. • Up to one (1) full family Operating Engineers – Health and Welfare Trust plan with up to one (1) full family Operating Engineers Trust alternative plan. For any County employee employees in a parent-YAD relationship, the YAD employee cannot have duplicate coverage within the same plan as the parent employee. If employee if the parent employee has the YAD employee on a family plan, the YAD employee cannot select individual coverage on the same HMO plan as the parent employee. Effect of Leave Without Pay and Re-Enrollment. : Employees on leave without pay (including vacation purchase hours referenced in subsection 10.M. (Vacation Purchase Plan)) during a pay period that the semi-monthly premium is paid, who are on paid status less than fifty percent (50%) of the normal full-time biweekly pay period, shall have their County contribution towards be responsible for one hundred percent (100%) of the employee’s medical premium prorated as provided in 14.A.3. (Proration)semi-monthly dental premium. Employees may elect to continue uninterrupted medical dental coverage for the duration of their leave without pay by paying 100% of their current plan’s medical dental premiums or enroll in and pay 100% of the premiums of a lower level of medical dental plan coverage while on leave without pay. Employees who elect to enroll in and pay for a lower level of medical dental plan coverage while on leave without pay shall maintain the same lower level of coverage through the duration of the Plan Year and may only restore to their prior level of coverage medical plan during Open Enrollment. Failure to pay for premiums will result in a lapse of coverage. Any employees who is Employees on leave without pay, and who loses his or her medical lose their dental plan coverage for a duration of threethree (3) months or less, will be able to re-enroll as a continuing member in the same plan under which they had coverage prior to the leave by completing the appropriate enrollment form within 30 calendar days of the date they return to work. The deductibles, maximums, and waiting period shall be applied as though the employee had been continuously enrolled. The effective date of coverage will be based on guidelines established by the County. Those employees whose dental plan coverage was allowed to lapse for a duration greater than three (3) months will be able to re-enroll within 30 calendar days of the date they return to work in the same manner as is allowed for new hires. Such employees will be subject to new deductibles, maximums, and waiting periods that are applicable to the plan year in which they reinstate. The effective date of coverage will be based on guidelines established by the County. Special Enrollment due to Change in Status. To make changes to employee benefits elections outside of the annual open enrollment period for a County-sponsored dental plan, employees must notify the Employee Benefits Center (EBC) within 30 days when they experience a qualifying event (e.g., marriage, adoption, loss of dental coverage by spouse/domestic partner, etc.) involving a change in status as defined by Internal Revenue Code Section 125. Open Enrollment. Eligible employees may choose from the dental plans offered by the County or the Operating Engineers Health and Welfare Trust and make benefits election changes during the County’s annual Open Enrollment period.