Article XI: Benefits
For information about benefit plans and eligibility prior to January 1, 2014, refer to Memorandum of Understanding VIII. There will be no change in eligibility or access to current health care plans from the date of ratification of this contract until December 31, 2013.
For the purpose of this Article, a benefits-eligible appointment must be confirmed by the appointing department.
Section A. Plan Year 2012 through Term of Agreement
1. Eligibility
a. GradCare Health Plan Coverage for all Employees on the Ann Arbor and Dearborn campuses: Effective January 1, 2014 and through the term of this Agreement, and consistent with the terms of the plan, all Employees on the Ann Arbor and Dearborn campuses appointed for a full “employment period” (as defined in Article X “Salaries”, Section A) are eligible to participate in the University’s GradCare Health Plan Coverage programs (GradCare and prescription drugs).
b. GradCare Health Plan Coverage for Employees on the Flint campus: Effective January 1, 2014 and through the term of this Agreement, and consistent with the terms of the plan, all Employees on the Flint campus with a one quarter (.25) or greater employment fraction for a full “employment period” (as defined in Article X, “Salaries”, Section A) are eligible to participate in the University’s GradCare Health Plan Coverage programs (GradCare and prescription drugs).
c. Non-Health Plan Eligibility: Effective January 1, 2012 and through the term of this Agreement, and consistent with the terms of each program or plan, all Employees with a one quarter (.25) or greater employment fraction for a full “employment period” (as defined in Article X, “Salaries”, Section A) in a term are eligible to participate in University, Optional and Dependent Life Insurance; Vision Plan; Legal Plan; Flexible Spending Accounts (Health and Dependent Care); Travel Accident Insurance; and Supplemental Retirement Plan.
2. Employer Contributions
University contributions toward all plans other than GradCare health insurance under this Article shall be in the same amount as that provided to the University’s regular non-bargained-for instructional staff for the coverage selected.
3. Health Plan Coverage Structure
The Health Plan Coverage (medical and prescription drug) as of January 1, 2012 will contain a 4-tier rate structure consisting of:
a. One adult;
b. One adult plus any number of children;
c. One adult plus one adult dependent (including an OQA);
d. One adult plus one adult dependent (including an OQA) plus any number of children.
4. Employer Contribution to Group Health Plan Coverage
a. As of the effective date of this Agreement and throughout the term of this Agreement, for individual Employee coverage (Tier I: one adult) , the Employer contribution toward the cost of the GradCare group health insurance plan premium will be 95% of the average premium cost of the two lowest-cost comprehensive plans available to all University employees. The Employer contribution toward the cost of group health insurance plan premiums for other tiers of coverage (those that include dependents, including OQAs) shall be the same contribution for the coverage for the Employee plus an additional contribution for covered dependents, calculated such that the Employer pays 85% of the aggregate premium cost for all covered individuals. The Employee will be responsible for any additional premium cost above the base Employer contribution rate toward the Employee’s plan of choice.
b. The University agrees that the co-pays in effect for Plan Year 2012 for the GradCare health plan coverage will not increase through plan year 2014. Thereafter, the co-pays for the GradCare health plan coverage shall be as provided by the Employer in the same manner and to the same extent as provided to the University’s regular non-bargained-for instruction staff enrolled in the U-M Premier Care Health Plan.
c. Effective January 1, 2012 through plan year 2014, the co-pay for office visits/urgent care shall be no more than $20 per visit, and for emergency room visits no more than $75 per visit. Thereafter, the co-pay for office visits/urgent care shall be as provided by the Employer in the same manner and to the same extent as provided to the University’s regular non-bargained-for instructional staff enrolled in the U-M Premier Care Health Plan.
d. Effective January 1, 2012, through plan year 2014, co-pays for the prescription drug plan shall be no more than:
Tier 1: $5.00 Tier 2: $15.00 Tier 3: $30.00
Thereafter, the co-pays for the prescription drug plan shall be as provided by the Employer in the same manner and to the same extent as provided to the University’s regular non-bargained-for instructional staff.
e. For the duration of the collective bargaining agreement, the annual maximum in prescription drug co-pays for any Employee is $2,500 per individual and $5,000 per family. This maximum does not apply to infertility medications and weight loss medications past the lifetime limits.
f. In the event of any substantive changes in coverage, the Union will be notified no later than 60 days prior to the effective date of change. Within a reasonable time, the Union may provide feedback to the Employer. The Employer will consider the feedback and respond to the Union.
5. Initiation of Coverage
a. Application Procedure: Application for Group Benefit programs must be made within thirty (30) days of the effective date of eligible employment or the date of notification described in Section B.5.c. below, whichever is later. Applicants enrolling past thirty (30) days of their eligibility date for the University Life and Optional Insurance plan must provide the Group Life Insurance Company with proof of insurability in order to be considered for coverage. Dependent Life Insurance for a spouse or OQA may be applied for any time and requires proof of insurability.
b. Newly-hired eligible Employees who do not either enroll in or waive medical insurance will be immediately enrolled in the GradCare medical insurance plan at the Tier I Level (one adult). Such newly-hired Employees will have thirty (30) days after employment begins to choose an alternative level if applicable.
c. Not later than the 30th day after employment begins, the University will notify an eligible Employee of the provisions of this Article including a reference to the time period requirement for application. In cases where an Employee misses the application deadline due to a lack of such notification, the University will enable the Employee to enroll in the GradCare and other benefits plans of his/her choice.
Section B. Dental Coverage
Newly hired eligible Employees who do not either enroll in or waive dental insurance will be immediately enrolled in Dental Option 1 at the Tier I Level (one adult).
The Employer will pay 100% of the premium for Dental Plan Option 1 for all eligible Employees. The Employer contribution for all other Options shall be in the same amount as that provided to the University’s non-bargained-for instructional staff for the coverage selected.
Section C. Summer Coverage
An Employee who is participating in the University Benefit plans during Term II, whether or not employed for IIIA and/or IIIB, and either:
1. has been re-employed under the terms of this Agreement for the following Term I, or
2. was employed during the previous Term I
may continue coverage during the months of May, June, July, and August, between Term II and Term I. The employing department will deliver confirmation of the Term I employment status to the Benefits Office by April 10.
An Employee who is not employed for Term II but is employed for Term IIIA and re-employed for the following Term I may continue coverage during the months of July and August between Term IIIA and Term I, by making arrangements through the Benefits Office by June 30, provided the initial employment and re-employment occur no later than the first day of Term IIIA. If employee contributions are required, the Employee will be billed monthly for the employee contributions for the months of May, June, July, and August. It is the Employee’s responsibility to provide current address information for billing purposes; if payment is not timely coverage will be cancelled.
Section D. Definition of “Other Qualified Adult”
If an Employee does not already cover a spouse in his/her U-M benefits plans, he/she may enroll one Other Qualified Adult (OQA) for benefit coverage if all of the following eligibility criteria are met:
1. The Employee is eligible for U-M benefits; and
2. The OQA, at the time of the requested enrollment, shares a primary residence with the Employee and has done so for the previous six (6) continuous months, other than as the Employee’s employee or tenant.
The following individuals are not eligible for participation in the OQA program if they are the Employee or the Employee’s spouse’s:
• Parents
• Parents’ other descendants (siblings, nieces, nephews)
• Grandparents and their descendants (aunts, uncles, cousins)
• Renters, boarders, tenants, employees
• Children or their descendants (children, grandchildren)
Dependent Children of an Other Qualified Adult
In addition to coverage for an OQA, the Employee may also elect coverage for the eligible child(ren) of an OQA. The dependent children of an OQA are eligible for coverage through the end of the month they turn age 26 (as of January 1, 2011).
Section E. Scope of Review
No matter concerning the above group benefit plans shall be subject to the Grievance and Arbitration Procedures, except for questions concerning compliance with the specific provision of this Article, and whether or not the Employee has coverage in accordance with the terms of the Plan. If, during the term of this Agreement, a federal or state law is enacted which requires the payment of taxes or premiums to either the federal or state government or another entity for hospital or medical benefits for Employees, the University may make such adjustments in the schedule of benefits provided by this Article to avoid duplication of benefits. In addition, any such taxes or premiums paid by the University shall be included in the total dollar limitations provided in this Article.
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