ARTICLE
XIII
DISABILITY
INSURANCE, HEALTH INSURANCE AND RETIREMENT
SECTION 1. The employer shall provide and pay 100% of the cost of New York State Disability Insurance for all employees covered under the agreement in addition to the employees’ existing sick leave benefits.
In an instance where an employee wants to diminish the loss of sick leave, such employee shall turn over to the employer, the weekly disability check and in return, the employer shall credit the employee with that portion of the sick leave used in each week which is paid for by the employee’s disability check; this buy-back becomes available for a separate illness.
SECTION 2. HEALTH INSURANCE - The County will provide for a health, dental and vision care plan providing benefits in accordance with the carrier contracts and the applicable schedules therein.
Health Insurance
Buy Out:
- Candidate must demonstrate and maintain adequate coverage with another Health Insurance Program
- Employee withdraws for one year
- Selection must occur at annual enrollment period (October); participants must renew buy out on annual basis
- Payment of $l,000 annually - $250 paid at end of each quarter
The parties agree that the County shall have the right to substitute through a carrier of their choice (or become self - insured) for the health insurance coverage indicated in the paragraphs above. In doing so, however, the County will provide CSEA with at least 90 days notice of the effective date of such change. The CSEA will have the right to review and study the benefits of said proposed plan to insure that it is at least comparable to the benefits of the plan in effect at the time of said change.
CLARIFICATION:
- Pre-Certification and Concurrent Review of Hospital Stays
- Mandatory Second Surgical Opinion Program
- Targeted Out-patient Surgery Program
Specifically as Per Model:
Room & Board ---------------- Same as current plan with a pre-admission review program for all (non-emergency) hospital admissions
Ambulatory Surgery ---------- Paid at 100% if done on an out-patient basis. If in-patient surgery certified by physician, paid at 80%;otherwise 50%
Second Surgical Opinion ----- Opinion paid at 100% for certain mandated procedures. If second opinion is not obtained, surgery paid at 50%
Deductible ---------------------- $150 per individual $450 per family
Coinsurance
-------------------- 80% of R &
C: maximum out of pocket $500/$1500 plus deductible —
Maximum Benefit ------------- $1,000,000 per lifetime
MCC provides managed mental health
services for indemnity participants; MCC also provides Employee Assistance
Program for County employees. Employees hired on or after
SECTION 3. While an employee is on an unpaid leave of absence, such employee shall be allowed to continue health insurance coverage with the employer at the employee’s expense.
When an employee is on compensation leave, the employer shall continue the payment of the employee’s total premium, both individual and dependent coverage. Reimbursement to the County of the payment for dependent coverage shall be made by the employee on demand.
SECTION 4. RETIREMENT - The County agrees to provide the retirement plans and related death benefits and sick leave options heretofore in effect as provided for by the New York State Retirement and Social Security Law.
The benefits available under the above State retirement plans and options are summarized in Schedule "D", it being understood that the County’s sole obligation is to make the required contributions to the applicable State plans and options. For full particulars consult with the New York State Department of Audit and Control.