(a) Effective January 1, 2003, the City's monthly contribution to the Toledo Firefighters Local 92 Trust Fund shall be six hundred seventy dollars ($670.00) per employee covered by this agreement.
(b) Beginning January l, 2004, the Per Employee Per Month (PEPM) contribution shall be the same as the City's 2003 annual average, as determined in paragraph (c) below, for all employees covered in the City of Toledo, Ohio Employee Health Benefit Plan document and monthly administrative costs that are incurred maintaining health care for members of the City as a whole, as set forth in paragraph (c) of this Section. The City's 2003 annual average shall include payments to the Teamsters Union Local 20 Health and Welfare Plan and Trust for City of Toledo employees in the Teamsters' Local 20 bargaining unit.
(c) The computation shall be made in the following manner: City costs paid during the prior City calendar fiscal year shall be added together and divided by the average number of "employee months" for that year.
"City costs paid" shall be actual costs paid by the City for all those covered under the City of Toledo, Ohio Employee Health Benefit Plan, both exempt and non-exempt, as reflected by disbursement records maintained by the Finance Department for the following:
- Prescriptive drug plan paid claims ( formerly AmeriSource and now Total Script)
- Prescriptive drug plan credits
- Third party Administrator (TPA) claims paid (medical and dental) (currently E-V Benefits)
- TPA credits (medical and dental)
- Vision care payments for exempt (currently VSP)
- Cobra credits
- AFSCME Health & Welfare Plan payments
- Police vision care payments
- Stop loss premiums (paid to E-V Benefits with administrative fee) (currently Lincoln)
- Stop loss credits
- Prescriptive drug plan fees (included in plan paid claims) [AmeriSource and Total Script]
- Prescriptive drug plan fees [AmeriSource and Total Script]
- TPA administrative fees (medical and dental, exclusive of on-site representative) (E-V Benefits)
- Preferred provider organization fees (formerly CN and now WLEC)
- Teamsters Union Local 20 Health and Welfare Plan and Trust
- Overhead/miscellaneous costs (at a fixed rate of $4.50 PEMP for 2003, $5.00 effective 1/1/04 and $5.50 effective 1/1/05)
It is recognized that providers for City plan services may change from time to time. Where a change occurs, the payments made to both providers of a given service shall be included in the City cost calculation for that year.
"Employee Months" shall be as reported by the third party administrator for medical coverage plus the employee months reported on Teamsters billings. It is recognized that City employees in the Teamsters' Local 20 Bargaining Unit are currently covered by the Teamsters Union Local 20 Health and Welfare Plan and Trust for healthcare purposes. Payments by the City to the Teamsters' trust shall be included in the calculation of the "City costs". If the Teamsters join the City plan, then payments to the Teamsters' trust made during the year that occurs shall be included in the calculation of the "City costs" for that year. The Employee Months reported on Teamsters' billings shall also be included. Thereafter, the Teamsters' costs and employee months shall be included under the City plan.
(d) The amount computed pursuant to paragraph (c) shall then serve as the PEPM to be paid to the trust fund for the next twelve month period.
In the event the 2003 PEPM "All City" cost paid to the fund is lower than the actual "All City" PEPM cost, to be computed by February 28, 2004, in accordance with paragraph (c) above, the City shall pay a lump sum amount to the fund by March 15, 2004. The lump sum amount shall be the difference between the 2003 PEPM paid to the fund and the actual "All City" cost. The lump sum payment is intended to catch the fund up with the total dollar amount it would have received had the actual PEPM "All City" cost numbers been available in 2003. Interest, as determined by Star Ohio Bank on the month the actual PEPM amount should have been paid, shall be added to the lump sum catch up amount. The lump sum plus interest payment shall be retroactive to 1/1/03. If there is an overpayment to the fund in 2003, the fund shall not be required to pay back the overpayment.
At the end of each year thereafter, the payment shall be adjusted based upon the City's experience, as computed above, for the preceding calendar fiscal year. The foregoing formula shall be used to address any underpayment or overpayment to the fund in 2004 and 2005. If the new rate is greater than the prior 12 month rate, then a lump sum payment of the difference shall be made to the fund. The repayment shall be retroactive to January 1, 2004 or January 1, 2005. If the new rate is less than the prior 12 month rate, then the overpay-ment shall be deducted on a proportional basis from the next three months' payments to the fund. If there is an overpayment for the year 2004, no deduction from payments to the fund shall occur until commencing in October, 2005 and only after the grievance procedure process below has been exhausted. In the event that the fund is overpaid as defined above, there will be no unilateral change for the City's contribution rate until the grievance procedure below has been exhausted.
(e) Local 92 and Firefighters' Health and Welfare Trust Fund will be allowed complete access to any and all material used in computing the average monthly cost. If there is disagreement as to the amount, the grievance procedure will be used to reach a solution using expedited arbitration. A panel of three (3) arbitrators selected by the parties, and identified by side letter, shall alternate in serving as the arbitrator. A hearing shall be conducted within thirty (30) days of the Union notifying the City that there is a dispute over the calculation. Briefs shall be submitted within three (3) weeks of the hearing. The decision shall be due within three (3) weeks thereafter. There will be no unilateral change for the City's contribution rate. On a quarterly basis, within thirty (30) days of the end of the quarter, the City shall, within ten (10) days of receipt, provide to the fund payment information for all items listed in paragraph (c) and access to copies of E-V Benefits City cost reports.
(f) The City shall make the monthly Trust Fund payment on the first day of banking each month. Failure to make payment within seven (7) days of the due date will cause the City to forfeit the administrative fee exclusion specified in paragraph (D) for that month. Failure to make payment within fifteen (15) days of the due date will result in a ten per cent (10%) interest charge on the payment due.
(g) The City's contributions to the Trust Fund shall be limited to the amounts set forth herein as determined through the calculations set forth herein; said amounts may be used by the Fund to purchase whatever health care benefits they will buy.
(h) Effective January 1, 1991, the Trust Fund Administrator shall be released on a full-time basis.
(i) In the event that at any time while this agreement is in effect, the Toledo Firefighters Health and Welfare Trust Fund ceases operations, the City must, beginning on the first day of the month following such cessation, and through the duration of this agreement, provide all Toledo firefighters with health care benefits as then provided under the City plan for members of the Toledo Police Patrol Officers Association. The fund shall provide notice to the City of such cessation sixty (60) days in advance of when assumption of health care coverage is to occur.
(Ord. 594-06. Passed 8-22-06.)