Common use of Health Benefit Program Clause in Contracts

Health Benefit Program. A. The County will provide a Health Benefit Program that includes the following coverages: 1. A Hospitalization/Surgical Medical Benefit Program subject to a One Hundred ($100.00) Dollar Co- Payment that applies to each hospital admission up to a maximum of two (2) hospital admissions per calendar year per family. 2. An unlimited maximum on Major Medical coverage after an initial $200.00 individual Deductible/ $400.00. Aggregate Deductible with 80% Co-Insurance up to $2,500.00. 3. An eye care coverage plan for all employees and their dependents covered under this Agreement. 4. A Prescription Insurance Plan for all employees and their dependents with an $8.00 co-pay for non- formulary or non-generic drugs. A $4.00 co-pay for formulary drugs or an alternate zero (0) co-pay for Generic Drugs. Effective January 1, 2006, the co- pays will increase to $10.00 for non-formulary and $6 for formulary. Effective January 1, 2007, the co-pays will increase to $12 for non-formulary and $8 for formulary. Employees may order prescriptions by mail where the prescriptions are repetitive maintenance medications that have been taken by the employee for sixty (60) days and have been designated as repetitive maintenance medications by the County. Mail order prescriptions shall include a $12.00 co-pay with a $6.00 alternate co-pay for Formulary drugs or an alternate zero (0) co-pay for Generic Drugs for a ninety (90) day supply. Effective Jan.1, 2006, these co-pays shall increase to $14.00 and $8.00. Effective January 1, 2007, the co-pays shall increase to $16.00 and $10.00. 5. A disability coverage insurance plan with benefits of $150.00 per week for a period of twenty-six weeks will be provided. Coverage under this program will begin when the employee exhausts all accrued sick time and/or has completed an eight (8) scheduled workday waiting period. Employees will only be entitled to this $150.00 amount for an aggregate total of 26 weeks for the life of this agreement. Thereafter, they will only be entitled to the $90.00 per week for thirteen

Health Benefit Program. A. The County will provide a Health Benefit Program that which includes the following coverages: 1. A. A Hospitalization/Surgical Medical Benefit Program Plan subject to a One Hundred ($100.00) Dollar Co- Payment that co-payment which applies to each hospital admission up to a maximum of two (2) hospital admissions per calendar year per family. 2. B. An unlimited maximum on Major Medical coverage after an initial $200.00 individual Deductible/ $400.00. Aggregate Deductible deductible/$400.00 aggregate deductible with 80% Coco-Insurance insurance up to $2,500.00. 3. C. An eye care coverage plan for all employees Employees and their dependents covered under this Agreement. 4. D. A Prescription Insurance Plan for all employees Employees and their dependents with an $8.00 co-pay for non- non-formulary or non-generic drugs. A $4.00 co-pay for formulary drugs or an alternate zero (0) co-pay for Generic Drugsgeneric drugs. Effective January July 1, 20062005, the co- co-pays will increase to $10.00 for non-formulary and $6 for formulary. Effective January 1, 2007, the co-pays will increase to $12 for non-formulary and $8 for formulary. Employees may order prescriptions by mail where the prescriptions are repetitive maintenance medications that which have been taken by the employee Employee for sixty (60) days and have been designated as repetitive maintenance medications by the County. Mail order prescriptions shall include a $12.00 co-pay with a $6.00 alternate co-pay for Formulary formulary drugs or an alternate zero (0) co-co- pay for Generic Drugs generic drugs for a ninety (90) day supply. Effective Jan.1July 1, 20062005, these co-pays shall increase to $14.00 and $8.00. Effective January 1, 2007, 2007 the co-pays shall increase to $16.00 and $10.00. 5. E. A disability coverage insurance plan with benefits of $150.00 per week for a period of twenty-six weeks (26) will be provided. Coverage under this program will begin when the employee Employee exhausts all accrued sick time and/or has completed an eight (8) scheduled workday waiting period. Employees will only be entitled to this $150.00 amount for an aggregate total of 26 twenty-six (26) weeks for the life of this agreementAgreement. Thereafter, they will only be entitled to the $90.00 per week for thirteenthirteen (13) weeks. Benefits available to Employees under this plan shall be denied and shall at any time be denied or discontinued by the County in any of the following events: 1. It finds said Employee unreasonably refuses, prevents or hinders medical examinations from time-to-time as the County may require. 2. Employee is found not to be disabled as herein provided. 3. Employee is found to be employed for wage, profit or gain for any employer other than the County. 4. Employee resigns or is terminated for cause. 5. No Employee shall receive benefits hereunder if his disability shall be found to be a result of any of the following causes: (a) Chronic alcoholism or use of stimulants, drugs or narcotics, except as prescribed by a Physician, or as specifically mandated under the A.D.A. (b) Committing unlawful acts. (c) Being engaged in some other business or occupation for profit. F. Life Insurance coverage for each Employee in the amount of $5,000.00. The County reserves the right to implement a self-insurance plan for both its current life and disability programs provided that it provides the same level of benefits to its employees. G. A full Family Dental Care Plan with a maximum coverage of $1,500.00 per covered family member per year. H. In order to contain the rising costs of Health Benefits, anytime within the life of this agreement the current employee co-payments toward emergency room treatments may be increased to a ceiling of $50.00. For employees enrolled in the alternate Plan, doctor’s office visits may be increased to a ceiling of $20.00. For employees enrolled in the basic plan, doctor’s office visits may be increased to a ceiling of $10.00. I. Upon retirement, the County shall continue the hospitalization and life insurance program for retiring employees with twenty-five (25) years of service with the County of Cape May until the death of the Employee, including where applicable, dependent coverage. Coverages provided to retiring employees shall be subject to the same provisions, including but not limited to co-payments required from active Employees. For current retirees and eligible dependents over the age of 65 years, the County reserves the right to offer the current and/or additional supplements to Medicare A & B. If a retiree and/or their dependents elect to select Medicare A & B with a County authorized supplemental insurance program, the County will reimburse the individual, after proof of coverage for the cost of Medicare B and the cost of any supplemental plan authorized and offered by the County. If possible, the County will attempt to directly pay the supplemental insurer for the costs to the retiree and eligible dependents. If the retiree selects this option, it is understood that Medicare B will be used as the primary insurance. For all employees retiring after December 31, 2004, the County reserves the right to require eligible individuals to carry Medicare A and B as its primary insurance. The costs of Medicare Part B will be reimbursed by the County. In lieu of the county’s group plan for active employees, the County also reserves the right to offer a supplemental plan to these retirees if it determines that it will contain the overall health benefit cost increases. It is understood that any changes to the plan will continue to provide a level of coverage that is on balance appreciably comparable to the current coverage. The opt-out amount for active and retired Employees will be $1,500.00 per year. 1. For purposes of the determination of which spouse will be covered and which spouse will be receiving the $1,500.00 in lieu of coverage payment (whether active or retired), the Employee or retiree who has the first birth date in the year will be designated the policyholder and the Employee or retiree with the second birth date in the year will receive the opt-out payment. 2. Upon death or divorce of either spouse, the opt-out provision of the policy will cease and they will revert to their own policies. X. In the event of death of a full-time Employee of the County, whether active or retired (if the Employee was receiving coverage as per the provisions of the Agreement), the Employee’s spouse and dependents (if eligible to receive coverage under the County’s policy) shall be covered by the County’s hospitalization premium as set forth herein. Such coverage shall be based upon the Deceased Employee’s length of service with the County immediately prior to death as follows: 1. Employees with more than five (5) years and less than ten (10) years of service -- Spouse/family would have one (1) additional year of coverage. 2. Employees with more than ten (10) years of service, but less than twenty-five (25) years of service -- two (2) years of additional coverage. 3. Active and retired Employees with twenty-five (25) or more years of service -- three (3) years of additional coverage. It is agreed, however, that should a spouse remarry, such coverage shall cease immediately. K. On or about December 1 of each year, the County shall inform Employees of the County's Basic Standard Health Benefit Program and Alternate Choices to be provided and/or made available to employees for the next calendar year. If the Employee selects to be covered under the County's Basic Standard Health Benefit Program, then such plan will be provided to the Employee and his/her dependents without charge. In the event an Employee selects an Alternate Choice Plan, then in such event the Employee shall pay $20.00 per month for individual only coverage and $30.00 per month for individual/dependent coverage. Payment for such charges shall be by way of payroll deduction and each Employee must sign any necessary payroll authorization form in order to effectuate coverage under an Alternate Choice Plan. The County will continue to offer an Alternative Choice Plan for all its existing employees as well as continue to pay the current premium for individual and dependent coverage. An employee who selects this plan will continue to pay $20.00 per month for individual only coverage and $30.00 per month for individual/dependent coverage as long as the current (Year 2004) rate stays the same. The employee will be responsible for any increases in premiums to a ceiling of $40 per month for individual only coverage and $50 per month for individual/dependent coverage. The County agrees to pay any premium rate increases above this ceiling amount of employee contributions. During the month of December of each year, Employees may choose to change from one plan to another, but must have necessary forms in to the Human Resources Department no later than December 15th of each year. Effective July 1, 2005 the County will only pay the premium amount of the Basic Standard Health Benefit Program for all new employees for the first five years of their employment with the County. If any new employee wishes to enroll in the Alternate Plan, he/she will be responsible for the full cost of the Plan above the amount allocated for the Basic Plan for this period of time. L. Employees who can certify other health care coverage may elect to opt-out of coverage and receive a payment of $1,500.00 per annum pro-rated for the period of time each calendar year that coverage does not apply to the Employee. Checks for opting out will be issued on or about December 1st of each year. M. The County will pay an Employee, who opts out of Health Benefit coverage but wishes to retain the prescription plan, $1,000.00 per annum pro-rated for the period of time each calendar year that the County coverage does not apply to the Employee. N. In the event a husband and a wife are both employed by the County, Health Care Insurance coverages provided hereunder shall be afforded to only one (1) designated spouse with the other spouse covered as a family member. The in lieu of coverage amount will be $1,500.00. The non-designated spouse shall receive a payment of $1,500.00 per annum in lieu of coverage. Checks for this payment will be issued on or about December 1st of each calendar year. In the event the designated covered spouse dies, terminates employment or should the marriage be dissolved by divorce, the non-designated spouse shall once again become covered and the $1,500.00 payment shall be pro-rated. For purposes of the determination which spouse will be covered and which spouse will be receiving the $1,500.00 in lieu of coverage payment, the Employee who has the first birth date in the year will be designated the policyholder and the Employee with the second birth date in the year will receive the opt-out payment. O. Employees who do not work a minimum of thirty-five (35) hours per week shall not be covered by the County's Health Benefit Program set forth above. However, all current Employees receiving health benefits with less than the thirty-five (35) hour requirement will be “grandfathered” and continue to be covered by the County Health Benefits. P. The County reserves the right to review and change the Health Benefit Insurance Coverage set forth above or to implement a Cape May County Self-Insured Health Benefit Plan during this contract as long as the level of coverage provided is on balance appreciably comparable to the current coverages. Q. In the event an Employee undertakes drug or alcohol rehabilitation under the County's Health Care Benefit Plan, the Employee may apply for a leave of absence and such leave will not be unreasonably denied.

Health Benefit Program. A. The County will provide a Health Benefit Program that which includes the following coverages: 1. A. A Hospitalization/Surgical Medical Benefit Program Plan subject to a One Hundred ($100.00) Dollar Co- Payment that co-payment which applies to each hospital admission up to a maximum of two (2) hospital admissions per calendar year per family. 2. B. An unlimited maximum on Major Medical coverage after an initial $200.00 individual Deductible/ $400.00. Aggregate Deductible deductible/$400.00 aggregate deductible with 80% Coco-Insurance insurance up to $2,500.00. 3. C. An eye care coverage plan for all employees Employees and their dependents covered under this Agreement. 4. D. A Prescription Insurance Plan for all employees Employees and their dependents with an $8.00 co-pay for non- non-formulary or non-generic drugs. A $4.00 co-pay for formulary drugs or an alternate zero (0) co-pay for Generic Drugsgeneric drugs. Effective January July 1, 20062005, the co- co-pays will increase to $10.00 for non-formulary and $6 for formulary. Effective January 1, 2007, the co-pays will increase to $12 for non-formulary and $8 for formulary. Employees may order prescriptions by mail where the prescriptions are repetitive maintenance medications that which have been taken by the employee Employee for sixty (60) days and have been designated as repetitive maintenance medications by the County. Mail order prescriptions shall include a $12.00 co-pay with a $6.00 alternate co-co- pay for Formulary formulary drugs or an alternate zero (0) co-pay for Generic Drugs generic drugs for a ninety (90) day supply. Effective Jan.1July 1, 20062005, these co-pays shall increase to $14.00 and $8.00. Effective January 1, 2007, 2007 the co-pays shall increase to $16.00 and $10.00. 5. E. A disability coverage insurance plan with benefits of $150.00 per week for a period of twenty-twenty- six weeks (26) will be provided. Coverage under this program will begin when the employee Employee exhausts all accrued sick time and/or has completed an eight (8) scheduled workday waiting period. Employees will only be entitled to this $150.00 amount for an aggregate total of 26 twenty-six (26) weeks for the life of this agreementAgreement. Thereafter, they will only be entitled to the $90.00 per week for thirteenthirteen (13) weeks. Benefits available to Employees under this plan shall be denied and shall at any time be denied or discontinued by the County in any of the following events: 1. It finds said Employee unreasonably refuses, prevents or hinders medical examinations from time-to-time as the County may require. 2. Employee is found not to be disabled as herein provided. 3. Employee is found to be employed for wage, profit or gain for any employer other than the County. 4. Employee resigns or is terminated for cause. 5. No Employee shall receive benefits hereunder if his disability shall be found to be a result of any of the following causes: (a) Chronic alcoholism or use of stimulants, drugs or narcotics, except as prescribed by a Physician, or as specifically mandated under the A.D.A. (b) Committing unlawful acts. (c) Being engaged in some other business or occupation for profit. F. Life Insurance coverage for each Employee in the amount of $5,000.00. The County reserves the right to implement a self-insurance plan for both its current life and disability programs provided that it provides the same level of benefits to its employees. G. A full Family Dental Care Plan with a maximum coverage of $1,500.00 per covered family member per year. H. In order to contain the rising costs of Health Benefits, anytime within the life of this agreement the current employee co-payments toward emergency room treatments may be increased to a ceiling of $50.00. For employees enrolled in the alternate Plan, doctor’s office visits may be increased to a ceiling of $20.00. For employees enrolled in the basic plan, doctor’s office visits may be increased to a ceiling of $10.00. I. Upon retirement, the County shall continue the hospitalization and life insurance program for retiring employees with twenty-five (25) years of service with the County of Cape May until the death of the Employee, including where applicable, dependent coverage. Coverages provided to retiring employees shall be subject to the same provisions, including but not limited to co-payments required from active Employees. For current retirees and eligible dependents over the age of 65 years, the County reserves the right to offer the current and/or additional supplements to Medicare A & B. If a retiree and/or their dependents elect to select Medicare A & B with a County authorized supplemental insurance program, the County will reimburse the individual, after proof of coverage for the cost of Medicare B and the cost of any supplemental plan authorized and offered by the County. If possible, the County will attempt to directly pay the supplemental insurer for the costs to the retiree and eligible dependents. If the retiree selects this option, it is understood that Medicare B will be used as the primary insurance. For all employees retiring after December 31, 2004, the County reserves the right to require eligible individuals to carry Medicare A and B as its primary insurance. The costs of Medicare Part B will be reimbursed by the County. In lieu of the county’s group plan for active employees, the County also reserves the right to offer a supplemental plan to these retirees if it determines that it will contain the overall health benefit cost increases. It is understood that any changes to the plan will continue to provide a level of coverage that is on balance appreciably comparable to the current coverage. The opt-out amount for active and retired Employees will be $1,500.00 per year. 1. For purposes of the determination of which spouse will be covered and which spouse will be receiving the $1,500.00 in lieu of coverage payment (whether active or retired), the Employee or retiree who has the first birth date in the year will be designated the policyholder and the Employee or retiree with the second birth date in the year will receive the opt-out payment. 2. Upon death or divorce of either spouse, the opt-out provision of the policy will cease and they will revert to their own policies. X. In the event of death of a full-time Employee of the County, whether active or retired (if the Employee was receiving coverage as per the provisions of the Agreement), the Employee’s spouse and dependents (if eligible to receive coverage under the County’s policy) shall be covered by the County’s hospitalization premium as set forth herein. Such coverage shall be based upon the Deceased Employee’s length of service with the County immediately prior to death as follows: 1. Employees with more than five (5) years and less than ten (10) years of service -- Spouse/family would have one (1) additional year of coverage. 2. Employees with more than ten (10) years of service, but less than twenty-five (25) years of service -- two (2) years of additional coverage. 3. Active and retired Employees with twenty-five (25) or more years of service -- three (3) years of additional coverage. It is agreed, however, that should a spouse remarry, such coverage shall cease immediately. K. On or about December 1 of each year, the County shall inform Employees of the County's Basic Standard Health Benefit Program and Alternate Choices to be provided and/or made available to employees for the next calendar year. If the Employee selects to be covered under the County's Basic Standard Health Benefit Program, then such plan will be provided to the Employee and his/her dependents without charge. In the event an Employee selects an Alternate Choice Plan, then in such event the Employee shall pay $20.00 per month for individual only coverage and $30.00 per month for individual/dependent coverage. Payment for such charges shall be by way of payroll deduction and each Employee must sign any necessary payroll authorization form in order to effectuate coverage under an Alternate Choice Plan. The County will continue to offer an Alternative Choice Plan for all its existing employees as well as continue to pay the current premium for individual and dependent coverage. An employee who selects this plan will continue to pay $20.00 per month for individual only coverage and $30.00 per month for individual/dependent coverage as long as the current (Year 2004) rate stays the same. The employee will be responsible for any increases in premiums to a ceiling of $40 per month for individual only coverage and $50 per month for individual/dependent coverage. The County agrees to pay any premium rate increases above this ceiling amount of employee contributions. During the month of December of each year, Employees may choose to change from one plan to another, but must have necessary forms in to the Human Resources Department no later than December 15th of each year. Effective July 1, 2005 the County will only pay the premium amount of the Basic Standard Health Benefit Program for all new employees for the first five years of their employment with the County. If any new employee wishes to enroll in the Alternate Plan, he/she will be responsible for the full cost of the Plan above the amount allocated for the Basic Plan for this period of time. L. Employees who can certify other health care coverage may elect to opt-out of coverage and receive a payment of $1,500.00 per annum pro-rated for the period of time each calendar year that coverage does not apply to the Employee. Checks for opting out will be issued on or about December 1st of each year. M. The County will pay an Employee, who opts out of Health Benefit coverage but wishes to retain the prescription plan, $1,000.00 per annum pro-rated for the period of time each calendar year that the County coverage does not apply to the Employee. N. In the event a husband and a wife are both employed by the County, Health Care Insurance coverages provided hereunder shall be afforded to only one (1) designated spouse with the other spouse covered as a family member. The in lieu of coverage amount will be $1,500.00. The non-designated spouse shall receive a payment of $1,500.00 per annum in lieu of coverage. Checks for this payment will be issued on or about December 1st of each calendar year. In the event the designated covered spouse dies, terminates employment or should the marriage be dissolved by divorce, the non-designated spouse shall once again become covered and the $1,500.00 payment shall be pro-rated. For purposes of the determination which spouse will be covered and which spouse will be receiving the $1,500.00 in lieu of coverage payment, the Employee who has the first birth date in the year will be designated the policyholder and the Employee with the second birth date in the year will receive the opt-out payment. O. Employees who do not work a minimum of thirty-five (35) hours per week shall not be covered by the County's Health Benefit Program set forth above. However, all current Employees receiving health benefits with less than the thirty-five (35) hour requirement will be “grandfathered” and continue to be covered by the County Health Benefits. P. The County reserves the right to review and change the Health Benefit Insurance Coverage set forth above or to implement a Cape May County Self-Insured Health Benefit Plan during this contract as long as the level of coverage provided is on balance appreciably comparable to the current coverages. Q. In the event an Employee undertakes drug or alcohol rehabilitation under the County's Health Care Benefit Plan, the Employee may apply for a leave of absence and such leave will not be unreasonably denied.