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(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) or other age as determined by applicable state or federal law. Spouses who are both employed by the City must jointly elect only one coverage. 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 has health care coverage through a different employer, the spouse must enroll in his/her employer's plan. Dependents shall be covered as provided by the "Birthday Rule". Coordination of benefits shall be provided so that coverage is extended to the spouse and dependents that is not provided by the other employer's plan. In cases of demonstrated hardship due to excessive co-premiums (i.e. 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 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).
(iii) There shall be one hundred dollar ($100.00) 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.
(iv) As a condition of continued coverage under the terms of this section, covered employees shall, beginning the first full pay period in January, 2013, be responsible for premium payments in accordance with the following schedule: Single employees receiving coverage under this section shall pay a monthly premium of forty-eight dollars ($48) per month; a single employee with one (1) dependent (e.g. "single + 1" coverage) shall pay a monthly premium of eighty dollars ($80) per month; an employee with more than one dependent (e.g. family coverage) shall pay a monthly premium of ninety-two dollars ($92) per month. Any employee eligible to receive coverage may waive such coverage.
Effective the first full pay period in June, 2013 the monthly premiums will be increased as follows: Single employees receiving coverage under this section shall pay a monthly premium of seventy-one dollars ($71) per month; a single employee with one (1) dependent shall pay a monthly premium of one hundred twenty dollars ($120) per month; an employee with more than one dependent (e.g. family coverage) shall pay a monthly premium of one hundred twenty-nine dollars ($129) per month.
Effective the first full pay period in June, 2014 the monthly premiums will be increased as follows: Single employees receiving coverage under this section shall pay a monthly premium of ninety-four dollars ($94) per month; a single employee with one (1) dependent shall pay a monthly premium of one hundred sixty dollars ($160) per month; an employee with more than one dependent (e.g. family coverage) shall pay a monthly premium of one hundred sixty six dollars ($166) per month.
The co-premium payments will be made by payroll deduction on a pre-tax basis. Spouses who are both employed by the City of Toledo will only pay one co-premium payment based on the level of coverage selected. The "Birthday Rule" and the spousal exclusion language in subsection (a) of this section continue to apply to coverage options.
(d) Medical providers shall be restricted to those hospitals, physicians, and other care providers designated in the plan as developed by the City.
(e) 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 physician's office, including physical examinations and family planning, shall be subject to a ten dollar ($10.00) 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 (e)(i) and (iii) will be made for the first one hundred twenty-five dollars ($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 ten dollar ($10.00) office visit co-pay before the 80%/20% co-payment formula is applied.
(f) 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.
(g) The City shall provide a prescriptive drug purchase program with a deductible of twenty percent (20%) of the cost for each brand name prescription, up to a maximum deductible of eight dollars ($8.00), and a two dollar ($2.00) deductible for generic drug prescriptions. This program will include a generic drug substitution option. 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.
(h) The City shall provide a vision care plan, which will contain a deductible plan. The City may select a carrier or become a self insurer as it deems necessary.
(a) The City shall continue to participate in the Public Employees Retirement System of Ohio as provided in the Ohio Revised Code.
(b) As long as the City participates in a pension "pick-up" plan in accordance with Internal Revenue Service regulations and Ohio Attorney General opinions, as permitted by law State and Federal Income Taxes on employee pension contributions by the Judges, Clerk of Court, and all Court employees may be deferred.
(c) Effective with the first full pay period of January 2013, the City will pay five percent (5.0%) of the employee's pension contribution and the employee shall be responsible for the remaining percentage (employee contribution increased from 1.5% to 5.0%). In the first full pay period of January, 2013, those employees receiving a reduction in pension pickup will receive a separate one time lump sum payment in the amount of six hundred and twenty-six dollars ($626). In the first full pay period of July, 2013, those employees receiving a reduction in pension pickup will receive a separate one time lump sum payment in the amount of six hundred and twenty four dollars ($624). Those employees unaffected by the pension pickup reduction are not eligible to receive the lump sum payments. Those permanent employees who are less than full-time employees who are affected by the pension pick-up reduction specified in paragraphs (c) through (e) will receive lump sum payments calculated on a pro-rata basis that is based upon actual hours worked during the previous calendar year.
(d) Effective with the first full pay period of March 2013, the City will pay two percent (2.0%) of the employee's pension contribution and the employee shall be responsible for the remaining percentage (employee contribution increased from 5.0% to 8.0%).
(e) Effective with the first full pay period of March 2014, the City will pay zero percent (0%) of the employee's pension contribution and the employee shall be responsible for the remaining percentage (employee contribution increased from 8.0% to 10%).
(f) In the event that the employee share of the pension payment increases due to a change in law or regulation, the employee shall be responsible for paying the entire amount of the increased employee contribution.
(g) Employees who were hired or reinstated after January 1, 2012, shall be required to pay the entire employee share of their pension and, furthermore, shall not receive any lump sum payments contained in this section.
(h) Except for the one time lump sum payments to those affected employees whose PERS pick-up is being reduced, employees who are eligible to have the City pick up a percentage of their employee share of pension are prohibited from receiving the payment specified in paragraphs (c) through (e) directly. The payments will be to each employee's individual P.E.R.S. account.
(i) Effective the first full pay period of March 2014, and pursuant to paragraph (e), the city's pension pick-up referred to in this article will terminate, and the City will no longer implement or participate in any pension pick-up plan.
The City shall provide an employee purchase plan whereby authorized employees will be able to purchase personal protective equipment (shoes, glasses), including prescriptive lenses, through a City program. The purchase program shall make these items available to the employee at forty (40%) percent of the cost with the City paying the remaining sixty (60%) percent. The Court Administrator shall determine which employees will be authorized to purchase equipment through this program.
The City shall continue to make available to an employee of the Toledo Municipal Court Judges' Division, after the employee has completed the probationary period, an opportunity to participate through payroll deduction in a Deferred Compensation Plan (Section 401-K or Section 457 Plan) developed and administered by a provider designated by the City.
Reimbursement of up to two hundred fifty dollars ($250.00) per year shall be made for the costs of an annual physical examination that are not covered by the employee's health care plan. To be reimbursed, charges must be from a physician or hospital as part of a routine physical. Documentation confirming the expenses as out of pocket shall be required.
ECONOMIC FRINGE BENEFITS
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