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(a) Employees of the City of Toledo are engaged in the performance and delivery of vital services to our community. In order to ensure the efficient delivery of these services, good attendance on the part of the City's employees is necessary. Moreover, recurring and excessive absenteeism is disruptive to the City's operations, costly to the City and its residents, and detrimental to the morale and efforts of employees who maintain a good work record. Therefore, it is the intent of the parties: (1) to work toward programs and understandings that will reduce absenteeism; (2) to encourage and recognize good attendance on the part of employees; and (3) to cooperate in correcting excessive absenteeism on the part of employees.
(b) This provision in no way detracts from the City's right to investigate illnesses or to bring charges against any employee for abuse of sick leave or for single instances of unexcused absence.
(a) Employees injured in the course of and arising out of their employment under such circumstances as would cause such injury or disability to be compensable under the Worker's Compensation Laws of the State of Ohio will be eligible to participate in the City's injury pay program. The Cost Containment Committee referenced below will select the program physician(s) and medical facilities from submitted proposals.
(1) Employees sustaining a work related injury that requires medical attention at a medical treatment facility (i.e., sprains, simple fractures, etc.) will be transported to and treated by a program physician or medical facility. The program physician, along with rendering a diagnosis and prognosis, will determine if the employee is capable of returning to regular duties, whether a transitional work assignment is appropriate, and the necessary rehabilitation plan to be followed; this plan will include the duration of any transitional work assignment not to exceed ninety (90) calendar days and indicate any physical therapy the injured employee may require. The program physician(s) may require follow-up medical evaluations.
(2) Employees sustaining a work related emergency/trauma injury (i.e., life threatening, severe body injury) may be treated at any medical treatment facility to which emergency medical personnel transport them. The employee will subsequently be examined by the program physician. The designated program physician will determine if the employee is capable of returning to regular duties or if a transitional work assignment is appropriate and the necessary rehabilitation plan to be followed; this opinion will include the duration of any transitional work assignment not to exceed thirty (30) calendar days and indicate any physical therapy the injured employee may require. The program physician(s) may require follow-up medical evaluations.
(3) An employee may, after the initial evaluation by the program physician, elect to continue treatment with their personal physician provided the program physician's recommendations are followed. The employee will sign any necessary waivers to allow their personal physicians to release information to the program physician. The employee's personal physician will be the physician of record for Workers' Compensation purposes.
(b) Upon the program physician's determination that an injury requires the employee to be off work, wherein the employee reports said injury within twenty-four (24) hours of the incident of illness or injury, paid leave shall be granted by the Department of Human Resources for up to sixty (60) days.
Should such disability exceed sixty (60) calendar days, the Director of Human Resources, on application therefor and proof of continued disability, may extend the period during which such person is carried on the regular payroll. The length of such extended period or periods shall not exceed two (2) years.
Injury pay extension requests, accompanied by a “Statement of Attending Physician” setting forth the illness or injury and the need for additional time, must be presented to the Director of Human Resources no later than one (1) week after the expiration of the original sixty (60) day disability period. If the above requirements are not fulfilled, the request for injury pay extension may not be considered.
(c) Workers' Compensation: At the expiration of the injury leave granted, if the employee is still unable to return to work, the employee may elect in writing to use accumulated sick and other accrued time. If the employee is still unable to return to work, payment of normal wages will be stopped and the Industrial Commission will be requested to begin weekly payment under the provisions of the Workers' Compensation Act.
(d) If the opinion of the employee's treating physician conflicts with that of the program physician and such opinion is presented to the City in seven (7) calendar days of the program physician's evaluation, and if the physicians cannot agree after consultation, the employee will be referred for a third opinion. The Cost Containment Committee referenced below will establish a panel of occupational health specialists for third opinions. The third opinion shall be determinative of the employee's injury pay status under the contract and shall not be subject to further appeal or review. If the third opinion is consistent with the program physician's plan and the employee fails to abide by the rehabilitation plan, or if the employee enters and later drops out of the plan, then the City can recoup injury pay advanced from the employee's sick time accumulation. If the employee does not have a sufficient sick time balance, the City shall recoup the injury pay by reducing future sick leave earnings by one-half until the injury pay is fully recouped.
(e) Employees who sustain injuries in the course of and arising out of their employment under such circumstances as would cause such injury or disability to be compensable under the Worker's Compensation Laws of the State of Ohio who choose not to be evaluated by the program physician or who choose not to follow that physician's recommended program and go only to the physician of their choice are not entitled to any paid injury leave benefits contained in this collective bargaining agreement. Notice of intent not to participate in the City's injury program must be given within three (3) work days of the injury. Any and all work- related injury claims will be processed through and conform with the Workers' Compensation Act.
(f) False Claim: The City reserves the right to recoup benefit payments to any employee who is guilty of submitting a false claim, or abuse of the privileges covered in this Section, or working for another employer while on injury leave, and may take disciplinary action.
(g) An employee working in a transitional work assignment will be compensated at their regular rate of pay. The employee will not be entitled to bid rights, overtime, etc., since the employee is not fit to perform all of the duties of the classification. With regard to the rights of other employees, the employee in the transitional assignment will be deemed not to be working out of classification.
Transitional work assignments will be identified by the Department of Human Resources in consultation with those divisions who have appropriate tasks available. The currently available assignments and the tasks involved in each division will be provided in writing to the Union. No transitional work assignment shall be made to a task which has not been identified in writing to the Union, except by mutual agreement. Addition ally, it is not the intent of the parties to supplement the workforce in classifications where there has been a reduction due to unfilled vacancies, layoff or attrition.
In order to identify tasks within each division which may be appropriate for transitional work assignments, the Union will designate a divisional transitional work coordinator to interface with the Department of Human Resources. The divisional transitional work coordinator, divisional safety committee, and Human Resources will work to further identify appropriate transitional work tasks within each division. Human Resources and the divisional transitional work coordinator, in consultation with the manager/division head, will, on a case-by case basis, consult regarding placement of employees in appropriate transitional work assignments. Medical issues involving an employee’s ability to perform duties will be determined by the Program physician.
If issues regarding availability of transitional work assignments cannot be resolved at the divisional level, the matter shall be brought to the Chief Operating Officer or his/her designee for final determination, subject to arbitration under Section 2115.23, “Arbitration” and 2117.23, “Arbitration”.
It is not the intent of this section to allow divisions to provide transitional work above that identified nor is a division required to provide transitional work where no such appropriate tasks have been identified and recognized.
(h) An employee whose treating physician has declared the employee to be “maximum medically improved” (M.M.I.) using the tie-breaking feature in part (d) of this section, shall have the right to fill a position according to the following priorities:
(1) Return to the same job as long as it does not violate their physical restrictions;
(2) Return to the same job with reasonable accommodations for their physical restrictions;
(3) Return to a vacant position in the same salary group for which he/she qualifies that does not violate their physical restrictions;
(4) Return to a vacant position in a lower salary group for which he/she qualifies.
In the event that an employee cannot be returned to work in their regular job or alternate position, or is applying for a P.E.R.S. disability retirement, if the employee has followed the injury pay program the City will continue injury leave pay for a period of forty-five (45) days. After forty-five (45) days, the employee may use any sick and/or vacation time that they have accrued. The Department of Human Resources will continue to review the vacancy list every two weeks for a position which the employee would qualify. Where appropriate, if the employee qualifies for Bureau of Workers' Compensation rehabilitation the City will cooperate with the Bureau in allowing on the job training to help qualify the injured worker for a position.
(i) With the intent of this injury program being to minimize time away from work and return the healthy employee to active employment as soon as possible, the Joint Labor-Management Health and Safety Committee (Section 2115.85) will also serve as a cost containment committee for Workers' Compensation.
A regular full-time employee of the City shall be given Bonus Days provided the employee has earned sick pay benefits in the previous year, in accordance with the Bonus Day Table set forth below. For the purpose of bonus vacation, unpaid sick days taken will be applied in the same manner as paid sick days.
BONUS DAYS CANCELLATION TABLE | |||||||||||
SICK DAYS TAKEN | |||||||||||
MONTHS WORKED | SICK DAYS TAKEN | ||||||||||
0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 910 | ||
12 | 5 | 5 | 5 | 4½ | 4 | 3½ | 3 | 2 | l | ½0 | |
11 | 4½ | 4½ | 4½ | 4 | 3½ | 3 | 2½ | 1½ | ½ | 0 | |
10 | 4 | 4 | 4 | 3½ | 3 | 2½ | 2 | 1 | 0 | ||
9 | 3½ | 3½ | 3½ | 3 | 2½ | 2 | 1½ | ½ | 0 | ||
8 | 3 | 3 | 3 | 2½ | 2 | 1½ | 1 | 0 | |||
7 | 2½ | 2½ | 2½ | 2 | 1½ | 1 | ½ | 0 | |||
6 | 2 | 2 | 2 | 1½ | 1 | ½ | 0 | ||||
5 | 1½ | 1½ | 1½ | 1 | ½ | 0 | |||||
4 | 1 | 1 | 1 | ½ | 0 | ||||||
3 | ½ | ½ | ½ | 0 | |||||||
The parties agree that employees shall continue to be covered by the AFSCME Health and Welfare Plan, which includes, (1) life insurance, (2) hearing care plan, and (3) an increase of $5.25 for the vision care plan. The cost of this plan shall be borne by the City, provided that the total cost shall not exceed twenty dollars ($20.00) per employee, per month during the life of this agreement. The increase in cost and coverage from Vision Level I to Vision Level II shall only become effective when the terms of the Memorandum of Understanding between the City of Toledo and AFSCME Local 7, Reverse "Me Too" Health Care Changes, are met.
(a) GENERAL PROVISIONS: The City shall continue to provide hospital, medical, surgical, major medical, outpatient diagnostic laboratory services, prescription drug, dental care and benefits under the terms and conditions set forth below.
(i) Coverage shall be provided to each employee, each employee's spouse and all unmarried dependent members of the employee's family to age twenty-three (23). Spouses who are both employed by the City must jointly elect only one coverage: Traditional or HMO. A new election may occur after an open enrollment due to circumstances such as layoff or other separation of one of the spouses, death, or divorce. Where spouses who are both employed have dependents from prior marriages for whose hospitalization coverage they are responsible they shall be exempt from this joint election requirement. Where the spouse of a City employee is employed by a different employer and he or she desires to waive his or her employer's plan in favor of City coverage, the City is not obligated to place the spouse on the City's plan. In cases of demonstrated hardship due to excessive co- premiums (e.g., 40% co-premiums or premium payments equaling 30% or more of earnings), special consideration will occur.
(ii) Coverage for this purpose shall be furnished through the insurance carrier(s) selected exclusively by the City on a fair fee basis until such time as some other insurer may be selected or the City determines that it would be in its best interest to self insure these benefits.
(b) The following health care cost containment procedures shall be effective for all employees:
(i) Second surgical opinions, pre-admission notification or certification, emergency care limitations, post-admission concurrent review, outpatient surgery, continued treatment and technological review, medical case management, planned discharge, and other procedures as may be established under the medical review programs established by the City shall be followed. Failure to follow the procedures shall result in only eighty percent (80%) coverage for necessary care.
(ii) Full-time employees covered by another health care program due to marriage or other reasons may waive their City of Toledo coverage and receive twenty-five thousand dollars ($25,000.00) in additional life insurance coverage. This shall also be extended to those employees whose spouses are also employed by the City.
(iii) Coverage for nervous and mental treatment is limited as follows. Inpatient care shall be maintained at a maximum of thirty-one (31) days per calendar year. Outpatient coverage shall be expanded to a maximum of twenty-two (22) visits per year at fifty percent (50%) co-insurance.
(iv) Coverage for drug and alcoholism treatment is limited as follows. Inpatient care shall be maintained at a maximum of thirty-one (31) days per calendar year. Coverage is limited to a maximum of twenty-five thousand dollars ($25,000.00) lifetime benefits for all inpatient and outpatient care. Inpatient coverage shall be at one hundred percent (100%) for an individual's first admission, seventy-five percent (75%) for a second admission, and fifty percent (50%) for a third admission. No coverage shall be provided beyond three (3) admissions per lifetime or thirty-one (31) days per calendar year. Outpatient coverage shall be expanded to a maximum of two thousand five hundred dollars ($2,500.00) per calendar year at fifty percent (50%) co-insurance. Employees using drug and alcoholism treatment benefits must use the City employee assistance program.
(v) The panel of providers, and/or Preferred Provider Organization (P.P.O.), selected by the City for managing and providing nervous and mental, drug and alcohol treatment must be utilized. The City will request proposals toward a managed care plan for this purpose with an effective date of June 1, 1999. The Union shall have a seat on the selection committee, but the right of final selection is reserved to the City. The Schedule of Benefits in effect as of February 9, 1999 shall be maintained, without additional co-pays or deductibles.
(c) The following cost sharing plan and cost coverage restrictions shall be effective for all employees:
(i) There shall be a five hundred dollar ($500.00) annual per person maximum on chiropractic care and a one thousand three hundred dollar ($1,300.00) annual per person maximum on physical therapy, both subject to the major medical deductible ($100/individual and $200/family) and co-insurance (80%/20%).
(ii) Major medical benefits shall be paid to a lifetime maximum of one million dollars ($1,000,000.00) per person with a one hundred dollar ($100.00)/individual and two hundred dollar ($200.00) family deductible and 80%/20% co-payment; provided that coverage for nervous and mental, drug and alcoholism treatment is limited per paragraph (b)(iii) and (iv).
(iii) There shall be a sixty-five dollar ($65.00) co-pay for all emergency room visits, which shall be waived if the individual is admitted or if the visit is between the hours of 8:00 p.m. and 9:00 a.m., or on a Saturday after 12:00 Noon, or on a Sunday.
(d) Effective June 1, 1994 the availability of a Health Maintenance Organization (HMO) and preferred provider Organization (PPO) shall be discontinued. All employees including those in the Traditional Plan, shall thereafter be enrolled in the Consortium Plan. Consortium Plan coverage and benefits shall be at the Traditional Plan levels as of June 30, 1993 except as otherwise provided here or in the plan document. Consortium Plan Medical Providers shall be restricted to those hospitals, physicians, and other care providers designated in the plan as developed by the City in conjunction with the Cost Containment Committee. It is understood that the City is currently utilizing the hospital and ancillary providers panels through the Cooperative Health Network (CHN). It is further understood that the CHN physicians' panel may be implemented by the City without further consultation with the cost containment committee. However, the schedule of benefits shall not be diminished.
(e) The cost containment committee shall be formed from among representatives of the various Bargaining Units and representatives of the City and shall be maintained. The committee shall develop other cost containment measures, which shall include:
1. Enhanced managed care, such as pre-certification, concurrent review, and utilization review;
2. Changed coverage or benefits, such as increased deductibles, limitations on coverage, and contributions from employees;
3. Increased claims control, such as coordination of benefits, subrogation, worker's compensation deferral, patient audits, and claims audits;
4. Alternate delivery systems, such as preferred provider organizations for specific benefits and direct provider negotiations; and,
5. Development of a participative employee plan by which employees will be encouraged to contain costs, audit bills, correct lifestyles, maintain wellness, and undertake other cost saving measures.
The committee shall meet regularly, on at least a monthly basis, and attendance shall be required. Actions taken in the absence of a bargaining unit representative shall be binding upon that bargaining unit.
The committee shall develop annual goals, objectives, and timetables directly aimed at reducing health care costs. Sub- committees may be formed as deemed necessary by the co- chairpersons to study issues, develop reasonable solutions, and report back to the committee. Goals and objectives not met within established timeframes shall be critically reviewed by the committee. If the City, in its sole discretion, is dissatisfied with progress in meeting goals and objectives or with the committee's action or inaction on 1, 3, 4, and/or 5 measures listed above, the City may take such actions as it deems necessary to exact cost containment. Changes in measure 2 must be by agreement of the parties.
(f) The Union releases the City from any obligation to expend monies currently in the healthcare savings fund created pursuant to former paragraph (g) of this section on future cost increases or for wellness programming. The Union further releases the City from any obligation to consult with the cost containment committee relative to the transfer or expenditure of those funds.
(g) Coverage for well baby care, pap tests, and office visits shall be offered to all employees enrolled under conventional coverage as follows:
(i) well baby care limited to routine examinations and immunizations for an infant until the infant's 1st birthday;
(ii) pap tests as well as office fee will be paid in full once every twelve (12) months;
(iii) office visits for routine wellness, services and treatment of illness or injury rendered in the physicians office, including physical examinations and family planning shall be subject to a fifteen dollar ($15.00) co-payment, which shall be counted toward the individual's major medical deductible;
Fees that the physician charges for the services under paragraphs (i), (ii), and (iii) shall be paid on the same basis as other covered services (e.g. Usual, customary, and reasonable). Payment for services under Part (g)(i) and (iii) will be made for the first one hundred twenty-five ($125.00) per single contract or three hundred dollars ($300.00) per family per calendar year collectively for well baby care (after the federally specified limits have been met) and for office visits. The ten dollar ($10.00) office visit co-pay shall not be counted toward the $125/300 limits. After deductibles are reached, payment shall then be under the major medical plan; provided, however, that the bill shall be reduced by the fifteen dollar ($15.00) office visit co-pay before the 80%/20% co- payment formula is applied.
(h) The City shall continue to provide a major dental program which provides the following:
Type A Services: Preventative 100%
Type B Services: Major and minor restorative 80%
Type C Services: Orthodontia 60%
Deductible for Type B Services: $50.00 per person per year maximum payment of $1,000.00 per year.
Maximum lifetime benefit for Type C Services for any covered person $1,000.00. Coverage limited to dependent children under age 19.
This program shall continue in effect for the duration of this agreement.
(i) The City shall provide a three tier closed formulary prescriptive drug purchase program with a co-payment structure of a six dollar ($6.00) co-payment Tier 1 drugs (generic); a fifteen dollar ($15.00) co-payment for Tier 2 drugs (preferred brand name drugs); and a thirty dollar ($30.00) co-payment for Tier 3 (non- preferred brand name drugs). This program will include a generic drug substitution option. The city shall select the provider for the formulary drug program who shall group drugs according to determination made by the providers therapeutic committee as it deems necessary. The City may select an alternative carrier at its option.
The City may implement managed care for the prescriptive drug program. This would allow for an evaluation of the interaction of an individual's different prescriptions on a voluntary basis. Recommendations could then be made to the individual and his/her physician for more effective drug therapy.
The coverages herein for dental and prescription drug shall be under either an individual or family contract as may be appropriate. The selection of the insurance carrier to provide the coverages herein is the exclusive right of the City.
(j) A reopener over the terms of this section may occur upon ten (10) days notice by the City if the City's percentage rise in medical services costs in the year 2000 is more than seven percent (7%) greater than the industry actuarial trend for Northwest Ohio. The base cost for this purpose will be the average annual full-time equivalent employee cost for medical services for the combined calendar years 1998 and 1999. In calculating the City's percentage rise, claims for an individual that total more than twenty-five thousand dollars ($25,000.00) shall be excluded from consideration from both the base cost and the year 2000 cost. If agreement cannot be reached within thirty (30) days after commencement of the reopener, the parties shall select an arbitrator using the selection procedure set forth in section 2115.23, "Arbitration". The arbitrator shall conduct a hearing and render a decision following the provisions of the Ohio Public Employee Collective Bargaining Law at Section 4117.14(G), notwithstanding the provisions of 4117.14(D)(1).
In consideration for the right to reopen on this basis during the term of the 1999 Collective Bargaining Agreement, the City shall not exercise its rights under Paragraph (e) above to take such actions as it deems necessary to exact cost containment through measures 1, 3, 4, and/or 5. The existence of this reopener provision, or this clause of that provision, does not prevent the parties from agreeing through the cost containment committee or otherwise to cost containment measures during the term of this agreement.
(k) Starting on April 1, 2010, the City will deduct by monthly payroll deduction from each employee an amount for their health care coverage in accordance with the following schedule based on their respective salary level and type of healthcare coverage selected.
Annual Salary Single Plan Single+1 Family
Below $30,000 $35.00 $55.00 $75.00
$30,001 to $50,000 $70.00 $90.00 $110.00
$50,001 to $70,000 $105.00 $125.00 $145.00
$70,001 and above $140.00 $160.00 $180.00
(Ord. 105-10. Passed 3-30-10.)
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