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During the life of this Agreement, the Employer agrees to offer a Group Insurance Program that includes medical, dental, life with matching accidental death and dismemberment, and disability coverages.
The UPlan will make a UPlan Summary describing these coverages available to all insurance eligible employees. The UPlan Summary shall be provided no less than biennially and prior to the beginning of the insurance year. New insurance eligible employees shall receive a UPlan Summary within thirty (30) days of their enrollment in the plan.
This section describes eligibility to participate in the Group Insurance Program.
Employees may participate in the University of Minnesota Employee Insurance Plan if they are scheduled to work at the University with an appointment of at least fifty percent (50%) time and lasting at least three (3) months in duration.
The following employees are also eligible to participate in the Group Insurance Program.
Eligible dependents for the purposes of this Article are as follows:
The spouse of an eligible employee (if not legally separated). For the purposes of medical coverage, if that spouse works full time for an employer other than the University and elects to receive either credits or cash (1) in place of medical coverage; or (2) in addition to a medical plan with seven hundred fifty dollar ($750) or greater deductible through his/her employing organization, s/he is not eligible to be a covered dependent under medical coverage for the purposes of this Article. If both spouses work for the University, one employee may elect family coverage and cover the other employee as a dependent.
For purposes of medical, dental and optional coverages, to the extent possible the registered same-sex Domestic Partner of an eligible employee, who meets the criteria in the University’s Domestic Partner Registration process, shall be offered the same coverage as an employee’s Spouse.
An eligible employee's unmarried or married dependent children and unmarried dependent grandchildren: (1) through age twenty-five (25) or (2) a handicapped child or grandchild, regardless of age or marital status, who is incapable of self-sustaining employment by reason of mental retardation, mental illness or physical disability and is chiefly dependent on the employee for support. The handicapped dependent shall be eligible to continue coverage as long as s/he continues to be handicapped and dependent, unless coverage terminates under the contract. Children or grandchildren of current employees who become handicapped after they are no longer eligible dependents under (1) above do not become eligible dependents due to their change in health status. Handicapped children or grandchildren of a newly hired University employee will be considered eligible dependents if there has been no break in coverage between the employee’s coverage through the previous employer and the coverage under the UPlan.
"Dependent Child" includes an employee's unmarried or married: (1) biological child, (2) child legally adopted by or placed for adoption with the employee, (3) foster child, (4) stepchild, and (5) dependent child of the employee’s registered same-sex Domestic Partner. To be considered a dependent child, a foster child must be dependent on the employee for his/her principal support and maintenance and be placed by the court in the custody of the employee. To be considered a dependent child, a stepchild or dependent child of a registered same-sex Domestic Partner must maintain residence with the employee and be dependent upon the employee for his/her principal support and maintenance.
"Dependent Grandchild" includes an employee's: (1) grandchild placed in the legal custody of the employee, (2) grandchild legally adopted by the employee or placed for adoption with the employee, or (3) grandchild who is the dependent child of the employee's unmarried dependent child. Under (1) and (3) above, the grandchild must be dependent upon the employee for principal support and maintenance.
If both spouses or registered same-sex Domestic Partners work for the University, either spouse or registered same-sex Domestic Partner, but not both, may cover their eligible dependent children or grandchildren. This restriction also applies to two divorced, legally separated, unmarried or registered same-sex Domestic Partner employees whose partnership has been terminated who share legal responsibility for their eligible dependent children or grandchildren.
Consistent with state and federal laws, certain employees, former employees, dependents, and former dependents may continue group medical, 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:
This section describes eligibility for an Employer Contribution toward the cost of coverage.
The following employees covered by this Agreement receive the full Employer Contribution:
The following employees shall also receive an Employer Contribution:
For employees eligible for an Employer Contribution as described in Section 3, the Employer Contribution amounts and rules in effect on June 30, 2013, will continue through the 2013 insurance contract year. The amount of the Employer Contribution will be determined as follows beginning on the first day of the 2014 insurance contract year. For purposes of this Article, the 2014 insurance contract year shall be the period beginning January 1, 2014 and ending December 31, 2014.
For employee basic life coverage with matching accidental death and dismemberment coverage, the employer contributes one hundred percent (100%) of the cost.
All employees must make their choice of employee medical and dental plans and choice of family coverage (if applicable) within thirty (30) calendar days of the date of initial employment in an insurance eligible position. The employee will automatically be enrolled in the basic life insurance coverage. Employees who become eligible for a full employer contribution must make their choice of employee or family medical and/or dental coverage within thirty (30) calendar days of becoming eligible. Employees who do not make an election within this period will have no coverage, and may not elect coverage until the next open enrollment period.
An employee may change his or her medical or dental plan during the year if the employee changes to a new permanent residence or work location, and as a result of this change, the employee’s current plan is no longer available. When an employee receives notification of a work location change between the end of an open enrollment period and the beginning of the next insurance year, the employee may change her or his medical 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 a retired employee, may also add dependent medical or dental coverage following the birth of a child or dependent grandchild, or following the adoption of a child without regard to the 30 day enrollment period. In addition, an employee or a retired employee may add family health or dental coverage within thirty (30) days of the following event:
The initial effective date of coverage under the Group Insurance Program is the first day of the month following the first day of employment. An employee must be actively at work on the initial effective date of coverage or the effective date will be delayed until the first day of the pay period the employee is actively at work. In no event shall an employee's family coverage become effective before the employee's coverage.
If an employee is not actively at work due to employee or dependent health status or medical disability, medical and dental coverage will still take effect. (Life and disability coverage will be delayed until the employee returns to work.)
If an employee is on paid leave on the date University paid life insurance benefits would otherwise increase, the employee will receive the increased life insurance coverage on that date.
An employee who retires and meets eligibility criteria under Section 2.3 may change his/her medical 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 beginning after the date of retirement.
The employee who has elected no coverage may not add coverage during this period. The retiring employee may only carry into retirement coverage in effect on the date of retirement.
Eligible employees may select coverage under any one of the UPlan medical options offered by the Employer, for employees in that zone. Coverage offered through these plans is subject to change during the life of this Agreement upon approval of the employer after consultation with the Union.
From July 1, 2013 through December 31, 2013 coverage under the current UPlan will continue at the level in effect on June 30, 2013.
In Network and Out of Network: 100% coverage after a $100 copay. The copay is waived if the patient is admitted within 24 hours.
In network and Out of Network: 100% coverage after a $25 office visit copay.
100% coverage for covered Inpatient services at network hospitals, including medical, mental health, and chemical dependency treatment, after a $100 per person and a $200 per family combined annual deductible.
Preventive care: 100% coverage. Preventive services include, but are not restricted to routine physical exams, routine gynecological exams, routine hearing exams, routine eye exams, and immunizations.
A $100 single and $200 family combined annual deductible will apply to lab/diagnostic testing after which 100% coverage will apply. A $50 copay will apply to CT and MRI scans.
A $100 single and $200 family combined annual deductible will apply to Outpatient Surgery after which 100% Coverage will apply.
Outpatient mental health and chemical dependency treatment; chiropractic care; physical, speech and occupational therapy; home health care: 100% coverage for covered services after a $25 copay per visit.
80% coverage, including hearing aids.
Eligible diabetic supplies, including test strips and syringes, are covered under the pharmacy benefit and will count toward the pharmacy out-of-pocket maximum. Diabetic monitors are covered at 80% as part of the pharmacy benefit and will count toward the pharmacy out-of-pocket maximum.
Eligible ambulance expenses are covered at 80%, including ground or air transport as medically necessary.
Covered for Medical Base Plan with $600 deductible and 70% coinsurance up to the annual out-of-pocket maximum. Pre-arranged services while outside the area are covered as if in-network.
Deductibles: $100 per person and $200 per family, applicable to all items without a copay.
Annual Maximum: Annual out of pocket maximum of $2500 per person or $4000 per family. The prescription out of pocket maximum is separate.
Life time Maximum: The UPlan medical lifetime maximum will be unlimited for each member.
If an employee has filed a claim for worker’s compensation, and if a dispute exists as to whether the employee’s injury or disability is work-related, coverage will be provided pursuant to M.S. 176.191, Subdivision 3.
For the 2014 insurance year, eligible employees may select coverage under any one of the UPlan dental options offered by the employer for employees in that zone.
Copayments. Effective with the 2014 insurance contract year, the Base Dental Plan will cover allowable charges for the following services subject to the copayments and coverage limits stated. Services provided through the UPlan are subject to the 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.
|Oral Surgery|| |
|Prosthetic Repairs|| |
*Please refer to your certificate of coverage for information regarding age limitations for dependent orthodontic care.
The employer agrees to provide and pay for the following term life coverage, with matching accidental death and dismemberment coverage, for all employees eligible for an Employer Contribution, as described in Section 3. The basic life insurance amount is 115% of the employee’s annual salary, subject to a $200,000 maximum. Basic Life and Accidental Death and Dismemberment coverage is provided regardless of the employee’s health history.
There is a reduction schedule in basic life if the employee is age 67 or older. At age 67 the amount is reduced to 65%; at age 70 it is reduced to 50%; and at age 75 the life insurance amount is reduced to 25% of the original benefit.
Any premium paid by the University in excess of fifty thousand dollars ($50,000) coverage is subject to a tax liability in accord with Internal Revenue Service regulations. An employee may decline coverage in excess of fifty thousand dollars ($50,000) by filing a waiver in accord with Department of Employee Benefits procedures. The basic life insurance policy will include an accelerated benefits agreement providing for payment of benefits prior to death if the insured has a terminal condition.
An employee who becomes totally disabled before age 70 shall be eligible to apply for the extended benefit provisions of the life insurance policy until age 70.
See Section C.1. for reduction schedule.
Employees who were disabled prior to July 1, 1983, and who have continuously received benefits shall continue to receive such benefits under the terms of the policy in effect prior to July 1, 1983.
Employees who retire on or after July 1, 1985, and who have twenty (20) years of service as of 12/31/02, shall be entitled to a five hundred dollar ($500) death benefit payable to a beneficiary designated by the 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 three (3) times annual salary or $500,000, whichever is less, in optional employee life coverage within sixty (60) calendar days of hire or the date of first becoming eligible, without evidence of insurability.
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 within sixty (60) calendar days of hire without evidence of insurability.
An employee may purchase up to five hundred thousand dollars ($500,000) life insurance coverage for his/her registered same sex Domestic Partner in increments established by the employer, subject to satisfactory evidence of insurability. A new employee may purchase either five thousand ($5,000) or ten thousand dollars ($10,000) in optional coverage within sixty (60) calendar days of hire without evidence of insurability.
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 2C of this Article). Child/grandchild coverage requires evidence of insurability if application is made after the first sixty (60) calendar days of employment or initial eligibility. Child/grandchild coverage commences fourteen (14) calendar days after birth.
The additional employee, spouse and child life insurance policies will include an accelerated benefits agreement providing for payment of benefits prior to death if the insured has a terminal condition.
An employee who becomes totally disabled before age 70 shall be eligible to apply for the extended benefit provisions of the life insurance policy until age 70.
An employee may purchase short-term disability coverage that provides benefits of from three hundred dollars ($300) to five thousand dollars ($5,000) per month, but no more than two-thirds (2/3) of an employee's salary, for up to one hundred eighty (180) calendar days during total disability due to a non-occupational accident or a non-occupational sickness. Benefits are paid from the first day of a disabling injury or from the eighth day of a disabling sickness. Coverage applied for within sixty (60) days of hire or becoming insurance eligible does not require evidence of insurability.
New employees may enroll in long-term disability insurance within sixty (60) days of employment or insurance eligibility. The terms are the same as for employees who wish to add/increase during the annual open enrollment. During open enrollment only, an employee may purchase long-term disability coverage that provides benefits of from three hundred dollars ($300) to five thousand dollars ($5,000) per month, based on the employee's salary, commencing on the 181st calendar day of total disability, and not subject to evidence of insurability but with a limited term pre-existing condition exclusion. Employees should be aware that other wage replacement benefits, as described in the certificate of coverage (i.e., Social Security Disability, Minnesota State Retirement Disability, etc.), may result in a reduction of the monthly benefit levels purchased. In any event, the minimum is the greater of three hundred dollars ($300) or fifteen percent (15%) of the amount purchased. The minimum benefit will not be reduced by any other wage replacement benefits. In the event that the employee becomes totally disabled before age seventy (70), the premiums on this coverage shall be waived according to the certificate of coverage.
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, and applies within two weeks of returning to work, the employee shall be permitted to pick up all optional coverages held prior to the leave or layoff. For purposes of reinstating such optional coverages, the following limitations shall be applicable:
For the first 24 months long-term disability coverage after such a period of leave or layoff during which long-term disability coverage was discontinued, any such disability coverage shall exclude coverage for certain pre-existing conditions. For disability purposes, a pre-existing condition is defined as any disability which is caused by, or results from, any injury, sickness or pregnancy which occurred, was diagnosed, or for which medical care was received during the period of leave or layoff. In addition, any pre-existing condition limitations that would have been in effect under the policy but for the discontinuance of coverage shall continue to apply as provided in the policy.
The limitations set forth above do not apply to leaves that qualify under the Family Medical Leave Act (FMLA).
Upon request of the Union, the employer shall meet and confer on health promotion and education issues. Agenda items shall include but are not limited to smoking cessation, weight loss, stress management, health education/self care, employee participation in programs, and education on related benefits provided through the plans.