15.1 Continue the current 125 plan (Flexible Spending Account) for premiums, out-of-pocket
medical costs, and child care expenses.
15.2 Continue the current procedure whereby employees can elect not to be covered by one or
more benefit programs.
15.3 Employee and retiree tenthly contributions shall be based on the three tiered rates
(employee/retiree, two-party and family) as follows:
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)
15.5.1 Benefit plans as described in Appendix F including:
A. medical insurance
B. dental insurance
C. vision insurance
D. mental health insurance
E. life insurance
F. retiree insurance
15.5.2 SAUSD Open Enrollment publication
15.5.3 Summary Plan Description
15.5.4 Evidence of Health Benefit Coverage
15.5.5 The benefit plans provided during retirement will be the same as provided to
active employees at that 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.
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.
B. As of April 28, 2009, unit member 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.
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).
15.7 Establish that eligibility for all dependent coverage on all plans to be as follows:
15.7.1 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.
15.7.2 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.
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.
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.
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.
D. An eligible dependent does not include any dependent who is on active
duty in a military service.
15.7.3 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:
A. The child is fully dependent upon the employee for support and maintenance.
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.
2. For 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.
15.7.4 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.
15.7.5 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.
15.7.6 The following are not considered family dependents:
A. Foster Child, unless meeting requirements of 15.7.1,
B. Grandchild, unless meeting requirements of 15.7.1,
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.
D. This language sunsets on June 30th, 2008.
15.7.7 The following are considered family dependents:
A. State Registered Domestic Partners
.
15.7.8 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.
15.7.9 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.
15.7.10 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.
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.
15.7.11 A unit member on leave shall have the option to continue any health and dental, vision, and life insurance benefits negotiated in the Agreement at his/her own
expense (see Article X, Section 10.4.12).
15.7.12 All costs for medical examination and tests required by the District shall be paid
by the District.
15.7.13 The parties agree to a committee to review and study health benefits and retirement incentive programs. Group Health Care Plans are subject to revisions
through the bargaining process in this Agreement with consideration of District
benefits committee recommendations.
15.7.14 Upon request, the association shall be provided copies of master contracts with
insurance carriers.
15.7.15 The Association shall be given the opportunity to proofread insurance brochures
if the District is given such an opportunity.
15.7.16 The Health Benefits Committee shall obtain bids for health and welfare benefits from providers including a provider of SAEA’s choice..
