ARTICLE 43

Health Care Insurance

  1. Health Benefit Plans
    1. Effective January 15, 2016, or as soon as practicable thereafter, the District shall offer the following healthcare options for employees:
      1. A modified Personal Choice 20/30/70 medical plan with a prescription drug benefit program offering $10 Generic Formulary co-pay, $20 Brand Formulary co-pay, and $35 Non-Formulary co-pay (Core Plan);
      2. A modified Personal Choice 10/20/70 medical plan with a prescription drug benefit program offering $10 Generic Formulary co-pay, $20 Brand Formulary co-pay, and $35 Non-Formulary co-pay; and,
      3. The healthcare plan options listed in Section 3, below.
    2. Effective July 1, 2016, the District shall offer the following healthcare options for employees:
      1. A modified Personal Choice 20/30/70 medical plan with deductibles of $350/$500/$750 and with a prescription drug benefit program offering $10 Generic Formulary co-pay, $20 Brand Formulary co-pay, and $35 Non-Formulary co-pay (Core Plan);
      2. A modified Personal Choice 10/20/70 medical plan with a prescription drug benefit program offering $10 Generic Formulary co-pay, $20 Brand Formulary co-pay, and $35 Non-Formulary co-pay; and,
      3. The healthcare plan options listed in Section 3, below, through June 30, 2017, at which time these plans sunset and shall no longer be offered following expiration of the agreement or during any status quo period thereafter.
    3. The District agrees to offer the following healthcare options for employees during the term of this Contract and through June 30, 2017, at which time these plans sunset and shall no longer be offered following expiration of the agreement or during any status quo period thereafter:
      1. Independence Blue Cross Personal Choice 15 with a prescription drug benefit program offering $10 Generic Formulary co-pay, $20 Brand Formulary co-pay, and $35 Non-Formulary co-pay
      2. Independence Blue Cross Keystone HMO 2 with a prescription drug benefit program offering a $10 Generic Formulary co-pay, $20 Brand Formulary co-pay, and $35 Non-Formulary co-pay
      3. Independence Blue Cross Keystone HMO 2 with a prescription drug benefit program offering $2 Drug
      4. Keystone POS with a prescription drug benefit program offering a $10 Generic Formulary co-pay, $20 Brand Formulary co-pay, and $35 NonFormulary co-pay
      5. Keystone POS Direct C1F1O1 with a prescription drug benefit program offering a $10 Generic Formulary co-pay, $20 Brand Formulary co-pay, and $35 Non-Formulary co-pay
  2. Core Health Plan Defined
  3. Effective January 15, 2016, or as soon as practicable thereafter, the Core Health Plan shall be designated to be the modified Personal Choice 20/30/70 medical plan with a prescription drug benefit program offering $10 Generic Formulary co-pay, $20 Brand Formulary co-pay, and $35 Non-Formulary co-pay.

    Effective July 1, 2016, the Core Health Plan shall be designated as the modified Personal Choice 20/30/70 medical plan with deductibles of $350/$500/$750 and with a prescription drug benefit program offering $10 Generic Formulary co-pay, $20 Brand Formulary co-pay, and $35 Non-Formulary co-pay.

  4. Payment of Premiums for Health Benefit Plan(s)
    1. Employees who elect healthcare coverage shall contribute 2.4% of gross pay toward the cost of health care premiums for the 2015-2016 school year and 2.6% of gross pay for the 2016-2017 school year.
    2. Employees who enroll in a medical plan other than the Core Plan will be subject to a mandatory payroll deduction to cover any premium costs in excess of the premiums of the Core Plan for the equivalent coverage in addition to the 2.4% and 2.6% of gross pay. In all instances, the Board shall only pay the premium equivalent to the premium of the Core Plan minus 2.4% of gross salary in 2015- 2016 and 2.6% of gross salary in 2016-2017 for the selected level of coverage.
    3. Gross pay is defined as salary eligible for PSERS.
    4. Benefits contributions are retroactive to July 1, 2015.
  5. Manner of Payment of Employee Contributions
    The Association hereby agrees that the employee’s share of premium costs for a Health Benefit Plan option shall be paid through mandatory payroll deductions. Employees may elect to use pre-tax money by enrolling in the Medical Flexible Spending Account.
  6. One-time Health Care Payment
    In 2016-2017, employees who are eligible for District provided medical coverage, and elect such coverage as the primary subscriber, shall receive a cash bonus payment of $500, to be paid in two (2) installments on the second pay of January 2017 and the second pay in June 2017. Eligible employees who enroll in District provided medical coverage for a portion of the year shall be paid a pro-rated portion of the cash bonus.
  7. Change In Coverage
    Employees wishing insurance pursuant to this Article must complete benefit election forms and enrollment cards in the Human Resources Department upon employment or during the open enrollment period. Subsequent enrollment periods will occur during the months of May or June. New coverage will then be effective July 1. If the Bargaining Unit Employee elects to cover the Employee, Employee's spouse and/or one or more eligible dependents, the Employee, Employee's spouse and the Employee's eligible dependents must be covered under the same health benefit plan. For example, husband and wife both employed by District shall be entitled to have only one (1) health benefit plan with the District. Alternatively, Bargaining Unit Employees who are husband and wife employed by the District would be entitled to two (2) single coverages in the event that there are no other dependents involved.
  8. During the term of this Agreement or at any time after its expiration date until such time as a new Agreement is executed, should the calculated aggregate cost for any health benefit plans offered pursuant to the Agreement exceed any applicable threshold amount stated in the Patient Protection and Affordable Care Act, including all applicable regulations or guidance thereunder (or any other applicable federal or state legislation enacted hereafter) so as to subject the coverage provider to a tax or fee, the parties agree to address that issue as follows:
    1. The District shall notify the Association by at least January 1, 2017 that certain health benefit plan or plans that are offered pursuant to the Agreement are reasonably expected to be subject to the above-referenced tax or fee and what the District intends to do to eliminate or otherwise address the tax or fee;
    2. The Association and the District will have up to sixty (60) calendar days from the date of such notice to attempt to reach mutual agreement on the issue;
    3. If a mutual agreement is reached, that agreement shall become part of the Agreement and will supersede any affected provisions;
    4. If a mutual agreement is not reached within the sixty (60) calendar day period referenced in subsection 2., the following shall occur: (a) the District shall no longer offer the health benefit plan or plans subject to the tax or fees; (b) all employees, spouses and dependents enrolled in the health benefit plan or plans subject to the tax or fees shall no longer be entitled to remain in the health benefit plan or plans that are subject to the tax or fee; (c) and such individuals shall be entitled to enroll in an alternative health benefit plan selected by the District which is most analogous to the Core Plan offered in 2016-2017 that will not be subject to the tax or fee. Such changes shall become part of the Agreement and will not supersede any affected provisions.
    5. Notwithstanding the foregoing, existing employee premium share shall apply on the same basis as the eliminated health benefit plan(s). Grievances under this section shall be exclusively limited to whether the plan offered by the District is the most analogous without triggering the tax or fee threshold. In the event of a grievance under this section, this limited issue shall be submitted in an expedited fashion for an arbitrator to decide with the hearing to be held within fifteen (15) calendar days of submission. The award shall be issued within fourteen (14) calendar days of the close of the hearing.
  9. The Board shall provide the Delta Dental Plan, 100% Prevailing Fee, and the Delta Basic Dental Supplemental Program (including Oral Surgery, Prosthetics and Periodontics, but not including Orthodontics) for all employees and their eligible family members.
    1. The Delta Dental Supplemental Program shall be subject to the Usual and Customary Rate (U.C.R.) percentages maxima and restrictions of Delta Dental.
    2. The Board shall pay one hundred percent (100%) of the premium cost of this section.
    3. The annual maximum per person shall be Two Thousand ($2,000) dollars.
  10. The Board shall provide the Delta Dental Program of Orthodontics for employees under nineteen and eligible family members and shall pay one hundred percent (100%) of the premium cost thereof.
  11. The Board shall provide Independence Blue Cross Davis Vision Plan for employees and eligible members of employees' families and shall pay one hundred percent (100%) of the premium cost thereof.
  12. Employees wishing insurance under this Article must complete enrollment cards in the Human Resources Department upon employment, or during the open enrollment period (May and June of each year).
  13. The Board may provide equivalent programs for plans and programs covered under this Article or may decide to self-insure either as part of a consortium or as a single district.
  14. The Board shall fully fund a mutually acceptable Employee Assistance Program.
  15. The Labor Management Committee shall be continued to periodically review the costs, operations, and services of the various medical benefits programs.
  16. Support Staff
    To receive a full year benefits, employees must work a minimum of one-half of their regularly scheduled work year as defined in Article 27. Employees hired after June 30, 1992 who are regularly scheduled to work nine hundred (900) hours or more qualify for Health Care Insurance (medical, dental, vision) as covered in Article 27. All employees hired prior to June 30, 1992 working five hundred forty (540) hours shall retain full benefits under the contract.
  17. Professional Staff
    To receive a full year benefits, employees must work a minimum of half-time.