HomeMy WebLinkAboutCity Council - 5840 RESOLUTION NO. 5840
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF
HUNTINGTON BEACH APPROVING AND IMPLEMENTING
THE MEMORANDUM OF UNDERSTANDING WITH THE
HUNTINGTON BEACH MUNICIPAL EMPLOYEES'
ASSOCIATION
The City Council of the City of Huntington Beach does hereby resolve as follows:
The Memorandum of Understanding between the City of Huntington Beach and the
Huntington Beach Municipal Employees' Association, effective June 27, 1987 through
June 30, 1988 a copy of which is attached hereto and by reference made a part hereof, is
hereby approved, adopted and ordered implemented in accordance with the terms and
conditions thereof.
PASSED AND ADOPTED by the City Council of the City of Huntington Beach at a
regular meeting thereof held on the 19t.h day of January , 1988.
ATTEST:
City Clerk Mayor
REVIEWED AND APPROVED: APPROVED AS TO FORM:
ity Administrator 6;� 14 City Attorney
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INITIAT AND APPR ED:
C
9Ad ive ervices
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MEA MOU
TABLE OF CONTENTS
TITLE PAGE
Table of Contents i
Preamble 1
Article 1 Representational Unit 1
Article 2 Existing Conditions of Employment 3
Article 3 Salary Schedules 3
Article 4 PERS & Retirement Medical Insurance Plan 3
Article 5 Insurance 4
Article 6 Vacations and Holidays 7
Article 7 Overtime Pay & Compensatory Time 8
Article 8 Education Pay Plan 9
Article 9 Uniform and Safety Shoes 9
Article 10 Bereavement Leave 9
Article 11 Shift Differential 9
Article 12 Standyby and Call Back Pay 10
Article 13 Tool Replacement 10
Article 14 Grievances 10
Article 15 Disability Insurance Payments 10
Article 16 Promotions 11
Article 17 Leadworker 11
Article 18 Vehicle Use 11
Article 19 Sick Leave Payoff 11
Article 20 Hours of Work Study 11
Article 21 Personnel Rules 12
Article 22 Family Sick Leave 13
Article 23 Temporary Upgrade Pay 13
Article 24 Association Business 14
Article 25 Mid-Year Salary Review 14
Article 26 Bilingual Pay 14
Article 27 Maternity Leave 14
Article 28 Medical Leave of Absence 15
Article 29 Layoff Rules 15
Article 30 Copies of MOU 15
Article 31 Management Rights 15
Article 32 Term of Memorandum of Understanding 16
Article 33 Severability and Savings of Intent 16
Article 34 City Council Approval 17
Exhibit A - Salary Schedule - Effective 06/27/87
Exhibit B - MEA Exempt Classes
Exhibit C - Employee Health Plan - Synopsis of Modifications
Exhibit D - Employee Health Plan
Exhibit E - PMI Dental Plan
Exhibit F - Retiree Medical Program
Exhibit G - Uniform Policy
Exhibit H - Vehicle Use Policy
Exhibit I - City Sponsored Indemnity Plan (Delta), City Sponsored Pre-Paid Plan (PMI)
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MEMORANDUM OF UNDERSTANDING
Between
THE CITY OF HUNTINGTON BEACH, CALIFORNIA
(hereinafter called CITY)
and
THE HUNTINGTON BEACH MUNICIPAL EMPLOYEES' ASSOCIATION
(hereinafter called ASSOCIATION or MEA)
PREAMBLE
WHEREAS, pursuant to California law, the CITY, acting by and through its
designated representatives, duly appointed by the governing body of said CITY, and the
representatives of the ASSOCIATION, a duly recognized employee association, have met
and conferred in good faith and have fully communicated and exchanged information
concerning wages, hours, and other terms and conditions of employment for the fiscal
years 1987/88; and
WHEREAS, except as otherwise expressly provided herein, all terms and conditions of
this agreement shall apply to all employees represented by the ASSOCIATION; and
WHEREAS, the representatives of the CITY and the ASSOCIATION desire to reduce
their agreements to writing,
NOW THEREFORE, this Memorandum of Understanding is made to become effective
June 27, 1987 and it is agreed as follows:
ARTICLE 1
REPRESENTATIONAL UNIT
A. It is recognized that the ASSOCIATION is the employee organization which has
the right to meet and confer in good faith with the CITY on behalf of employees of the
CITY within those class titles set out in Exhibit "A" attached hereto and incorporated
herein. Additionally, the representation unit shall include all non-safety,
non-management classifications which are created after execution of this agreement and
are not included in another representation unit or determined in accordance with the
Employer-Employee relations Resolution to be more appropriately designated as non
associated classifications.
B. The CITY shall send the ASSOCIATION a copy of each new job description
approved for classifications within the representation unit.
C. The CITY and the ASSOCIATION desire to maintain labor stability within the
representational unit to the greatest extent possible, consistent with the employee's right
to select the representative of his or her own choosing. For these purposes, the parties
agree that this Agreement shall act as a bar to appropriateness this unit and the selection
of the representative of this unit, except during the month of February prior to the
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expiration of this Agreement. Changes in bargaining unit shall not be effective until the
expiration of the MOU. This provision shall modify and supersede the time limits, where
inconsistent, contained in Section 7 of the current Employer-Employee Relations
Resolution of the City of Huntington Beach.
D. The CITY and the ASSOCIATION have agreed to a procedure whereby the CITY,
by and through the Personnel Director, would be entitled to propose a Unit Modification.
The ASSOCIATION and the CITY agree to jointly recommend a modification of the City
of Huntington Beach Employer-Employee Relations Resolution (Resolution Number 3335)
upon the CITY's having completed its obligation to meet and confer on this issue with all
other bargaining units.
The proposed change to the Employer-Employee Relations Resolution as follows:
7-3. Personnel Director Motion of Unit Modification - The Personnel Director
may propose, during the same period for filing a Petition for Decertification, that an
established Unit be modified in accordance with the following procedure:
a) The Personnel Director shall give written notice of the proposed Unit
Modification of Modifications to all employee organizations that may be affected by the
proposed change. Said written notification shall contain the Personnel Director's
rationale for the proposed change including all information which justifies the change
pursuant to the criteria established in Section 6-5 for Appropriateness of Units.
Additionally, the Personnel Director shall provide all affected employee organizations
with all correspondence, memoranda, and other documents which relate to any input
regarding the Unit Modification which may have been received by the CITY or from
affected employees and/or sent by the CITY to affected employees;
b) Following receipt of the Personnel Director's Proposal for Unit Modification
any affected employee organization shall be afforded not less than thirty (30) days to
receive input from its members regarding the proposed change and to formulate a written
and/or oral response to the Motion for Unit Modification to the Personnel Commission;
c) The Personnel Commission shall conduct a noticed Public Hearing regarding
the Motion for Unit Modification at which time all affected employee organizations and
other interested parties shall be heard. The Personnel Commission shall make a
determination regarding the proposed Unit Modification which determination may include
a granting of the motion, a denying of the motion, or other appropriate orders relating to
the appropriate creation of Bargaining Units. Following the Personnel Commission's
determination of the composition of the appropriate Unit or Units, it shall give written
notice of such determination to all affected employee organizations;
d) Any party who chooses to appeal from the decision of the Personnel
Commission is entitled to appeal in accordance with the provision of Section 14-4 of
Resolution Number 3335.
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ARTICLE 2
EXISTING CONDITIONS OF EMPLOYMENT
Except as expressly provided herein, the adoption of this Memorandum of
Understanding shall not change existing benefits, and terms and conditions of employment
which have been established in prior Memoranda of Understanding, and/or provided for in
the Personnel Rules of the City of Huntington Beach.
ARTICLE 3
SALARY SCHEDULE
Effective June 27, 1987, employees shall be compensated at monthly salary rates by
classification title and salary range for the pay period commencing June 29, 1985 as set
forth in Exhibit "A" attached hereto and incorporated herein by this reference.
ARTICLE 4
PUBLIC EMPLOYEES' RETIREMENT SYSTEM AND
RETIREMENT MEDICAL INSURANCE PLAN
A. Each employee covered by this Agreement shall be reimbursed an amount equal to
seven percent (7%) of the employee's base salary as a pickup of the employee's
contribution to the Public Employees' Retirement System. The above PERS pickup is not
base salary, but is done pursuant to Section 414(h)(2) of the Internal Revenue Code.
B. In the event a member elects Option #2 (Section 21333) or Option #3
(Section 21334) of the Public Employees' Retirement law, the CITY shall pay the
difference between such elected option and the unmodified allowance which the member
would have received for his or her life alone. This payment shall be made only to the
member, shall be payable by the CITY during the life of the member, and upon that
member's death, the CITY's obligation shall cease. The method of funding this benefit
shall be the sole discretion of the CITY. This benefit is vested for employees covered by
this Agreement (Note: The options provide that the allowance is payable to the member
until his or her death, and then either the entire allowance [Option #21 or one-half of the
allowance [Option #31 is paid to the beneficiary for life.)
C. The CITY and the ASSOCIATION agree to continue the existing funding
mechanism whereby employees may set aside funds which, at retirement, may be used for
funding their medical insurance premiums. The parties agree to utilize the existing
Deferred Compensation Plan as said funding mechanism. Any employee who contributes
one dollar ($1.00) or more per pay period to his or her deferred compensation account
shall receive an employer contribution to the employee's deferred compensation account
in the amount of five dollars and fifty cents ($5.50) per pay period.
D. Each employee, eligible for service retirement, may have his/her PERS pickup
reported as compensation for all or any part of the twelve month period prior to his/her
service retirement date upon written request to the Finance Director. Such modified
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reporting shall be limited to a maximum period of twenty-four months preceding
retirement pursuant to Government Code Section 20022. Requests for retroactivity, if
permitted by PERS, will be decided on an individual basis and shall require the approval of
the Personnel Director.
ARTICLE 5
INSURANCE
A. The CITY shall continue to provide group medical benefits to all employees with
coverage and other benefits comparable to the group medical plans currently in effect.
The coverage and benefits provided under the CITY Self-Insured and Self-Administered
Indemnity Plan (hereinafter called "the Plan") shall be as provided in the Employee Health
Plan Document, attached hereto and by this reference incorporated herein as Exhibit "D".
B. The CITY shall pay for dependent health insurance effective the first of the
month following the month during which the employee completes one (1) year of full-time,
continuous service with the CITY, except that an employee working half-time must
complete two (2) years, and a three-quarter time employee must complete eighteen (18)
months of continuous service before the CITY shall make such payments as set forth
above. Permanent part-time employees of more than half time employment whose status
cannot be precisely characterized as "half-time" or "three quarter-time" shall be eligible
for CITY payment of dependent health insurance upon completion of two thousand eighty
(2,080) hours of continuous service with the CITY. For purposes of determining
continuous service, there shall be no accrual of hours for the period of time an employee
is on a non-pay status for a complete pay period. The CITY's financial obligation to each
employee for payment of medical insurance premiums shall not exceed Four Hundred
Dollars ($400) per month.
C. 1. Effective January 1, 1988, the maximum out of pocket expense for covered
expenses shall be $550 per person per year after the deductible has been met.
2. Chiropractic Treatment - Effective January 1, 1988 shall be limited to $1,000
per year or twenty-four (24) treatments per calender year, whichever is greater.
3. Effective January 1, 1988, there shall be a benefit not to exceed $200 per
person per year for preventive medical care expenses. Such care shall not be subject to
annual deductibles or co-payment provisions of the plan and shall include preventive
medical care expenses such as, but not limited to, an every-other-year physical exam for
adults, yearly PAP test for females, all innoculations for children, three exams for an
infant in the first year of life, flu shots, chest x-rays, EKG and other diagnostic lab tests.
4. The CITY shall implement a Substance Abuse Treatment Program with five
days of in-patient care for detoxification with a lifetime maximum benefit of $10,000.
D. The CITY and the ASSOCIATION shall jointly engage in appropriate planning for
the addition of vision care benefits in order to form an objective and reliable cost impact
study in conjunction with the medical program.
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E. The CITY shall provide for each employee, at CITY's cost, $10,000 of life
insurance with coverage comparable to the Standard Insurance Company Plan in effect on
July 5, 1980. Said insurance shall contain provisions for optional supplemental coverage
at the employee's cost. Effective April 1, 1988 the CITY provided insurance shall be
increased from $10,000 to $25,000.
F. The CITY shall provide for each employee at the CITY's expense a long-term
disability insurance plan comparable to the Group Disability Insurance Plan in effect on
July 5, 1980. The parties agree to exclude the first year of job related illness or injury
from coverage on condition that the plan provides for a coordination with sick leave,
vacations and holidays which is satisfactory to the ASSOCIATION.
G. The CITY shall provide for each employee at the CITY's expense dental insurance
coverage comparable to PMI Plan CXP-203 outlined in Exhibit "E" attached hereto and
incorporated herein by this reference. Upon completion of one (1) continuous year of
service (as defined in Article 5.13 above), the CITY shall pay for dependent dental
insurance, provided the employee has covered, at his or her own expense, their dependents
under the CITY plan for a period of six (6) months prior thereto. The plan shall be
modified as described in Exhibit "I".
H. Nothing in this Article shall be deemed to restrict the CITY's right to change
insurance carriers or self-fund should circumstances warrant. CITY shall, however, notify
the ASSOCIATION of any proposed change, and allow the ASSOCIATION an opportunity to
review any proposed change and make recommendations to the CITY.
1. Nothing in this Article shall be deemed to obligate the CITY to improve the
benefits outlined in this Article.
J. Upon retirement (whether service or disability connected), each employee shall be
entitled to participate fully, along with their dependents, in the group medical insurance
program maintained by the CITY with respect to employees represented by the
ASSOCIATION at the CITY's group premium rate. Retired employees exercising this
option shall cause the premiums to be paid by the CITY out of any available funds due and
owing them for unused sick leave benefits upon retirement, as provided in Article 20;
provided, however, that whenever any such retired employee does not have any such
available funds with which to cause the premiums to be paid, he or she shall have the
opportunity to provide the CITY with sufficient funds to pay the premiums. Retired
employees shall be entitled to the minimum benefits as specified by COBRA (Federal
Law). At retirement, the sick leave hours remaining shall be converted to a dollar figure,
as provided in Article 21, and an estimate shall be provided by the CITY to the retired
employee as to the approximate number of months the group insurance can be paid by
such sick leave dollars.
The CITY shall notify any retired employee whose funds available for unused sick
leave benefits are about to be exhausted of such fact in writing by certified mail, return
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receipt requested, at the retired employee's most recent address of record with the CITY
no later than three (3) months prior to the date upon which there will not be sufficient
I
funds to pay premiums. It shall be the individual retiree's responsibility either to insure
that there are sufficient sick leave dollars available to pay premiums or to make premium
payments at least one (1) month in advance to continue the group insurance in effect. If,
following exhaustion of sick leave funds, a retired employee fails to provide the CITY
with sufficient additional funds to pay premiums, the CITY shall have the right to notify
said retired employee in the manner prescribed above that it intends to cause his or her
coverage to be terminated for non-payment of premiums, and the further right to
terminate such coverage if such default has not been cured within thirty (30) days
following receipt of such notice. Any retired employee electing to obtain such medical
insurance coverage after retirement shall have the further option to terminate such
coverage following the provision of thirty (30) days written notice to the CITY, whereupon
any funds due and owing him or her for unused sick leave benefits that have not been
exhausted to pay these health insurance premiums shall be paid in a lump sum to the
retired employee within thirty (30) days following receipt by the CITY of such notice;
provided, however, that once such retired employee elects to terminate such coverage, he
or shall shall be precluded from securing it at a later date at the group rate. It is
understood that such retiree coverage shall be made available during the term of this
Agreement at no increased cost to the CITY.
K. As an alternative to the benefit described in Article 5-J above, the CITY will
provide a financial contribution towards the cost of retiree medical premiums as
described in Exhibit "F", subject to agreement on the language. The CITY proposes to
reopen the meet and confer process on this issue only in the event a different plan is
approved for other bargaining units in the CITY. The language of this Plan is subject to
approval by the City Attorney and the MEA Attorney, and the plan will not be effective
until its language is approved by the City Attorney and the MEA Attorney.
ARTICLE 6
VACATION - HOLIDAY
A. Permanent employees in CITY service, having an average work week of forty (40)
hours, shall accrue annual vacations with pay in accordance with the following:
1. For the first four (4) years of continuous service, vacation time shall be
accrued at the rate of 112 hours per year.
2. After four (4) years of continuous service to the completion of nine (9)
years of continuous service, vacation shall be accrued at the rate of 136 hours per year.
3. After nine (9) years of continuous service to the completion of fourteen
(14) years of continuous service, vacation time shall be accrued at the rate of 160 hours
per year.
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4. After fourteen (14) years of continuous service, vacation time shall be
accrued at the rate of 192 hours per year.
B. No vacation may be taken until the completion of six (6) months of service.
Permanent, part-time employees assigned a work schedule of less than 2,080 and more
than 1,040 hours per year shall receive vacation in one-half the amounts set forth above.
C. Upon one-week written notification to the Finance Director, each employee shall
be entitled to receive his or her earned vacation pay, less deductions, in advance, prior to
his or her regularly scheduled annual vacation. Such advancement shall be limited to one
(1) during each employee's anniversary year.
D. Once during each fiscal year, each employee shall have the option to convert into
a cash payment or deferred compensation up to a total of eighty (80) hours of vacation
benefits. Such pay may be reported to PERS as salary. The employee shall give two (2)
weeks advance notice of his or her desire to exercise such option.
E. The limit on vacation accumulation shall be three hundred (300) hours, provided
the CITY notifies the employee and his or her Department Head upon accumulation of two
hundred seventy (270) hours and again at least two (2) payroll periods prior to reaching
said three hundred (300) hour limit of his or her option under sub-paragraph D above.
F. All unit employees shall have the following legal holidays with pay:
1. New Year's Day
2. Martin Luther King Day (third Monday in January)
3. Washington's Birthday (third Monday in February)
4. Memorial Day (last Monday in May)
5. Independence Day (July 4)
6. Labor Day (first Monday in September)
7. Veteran's Day (November 9, 1987)
8. Thanksgiving Day (fourth Thursday in November)
9. The Friday after Thanksgiving
10. Christmas Day (December 25)
11. Any day declared by the President of the United States to be a national
Holiday by the Governor of the State of California to be a or state holiday and adopted as
an employee holiday by the City Council of Huntington Beach.
Holidays which fall on Sunday shall be observed the following Monday, and those
falling on Saturday shall be observed the preceding Friday.
Employees who are required to work on a legal holiday designated above, shall be
compensated at the rate of time and one-half the hourly rate exclusive of any other
premiums for all hours worked on said holiday.
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ARTICLE 7
OVERTIME PAY AND COMPENSATORY TIME
A. Employees who work in excess of forty (40) hours per week shall be compensated
at the rate of time and one-half the hourly rate exclusive of any other premiums for all
hours worked in excess of forty (40) hours in a given payroll week. Any time off in the
form of sick leave during any payroll week does not constitute hours worked and such time
shall not be counted toward calculation of hours worked.
B. Exempt employees shall have the option of designating up to sixty (60) overtime
hours per year to be paid in compensatory time at the time and one-half rate. The
scheduling of compensatory time taken shall be approved by the employee's department
head or supervisor.
C. "Fair Labor Standards Act" - The City and the ASSOCIATION agree that
employees covered by this agreement, and defined as "non-exempt" employees under the
Fair Labor Standards Act, shall be subject to the provisions of the Act, as interpreted and
administered by regulations of the U. S. Department of Labor. The minimum wage,
calculation of overtime compensation, definition of hours worked shall meet the
requirements of the Act. It is also understood that the City may establish a work period
for each covered employee which meets the requirements of the Act and which will not
result in overtime compensation as part of a normal work schedule. It shall remain the
policy of the City that overtime is to be used only as needed or under emergency
conditions as approved by the City Administrator.
D. Employees in classifications listed in Exhibit "B" attached hereto and incorporated
herein by this reference shall be defined as "exempt" employees who are not subject to
the provisions of the Fair Labor Standards Act.
ARTICLE 8
EDUCATION PAY PLAN
A. Employees hired prior to January 1, 1979, shall continue to receive Educational
Incentive Pay for units earned under the previous Plan so long as they remain employed
with the CITY.
B. All employees shall be eligible for reimbursement of tuition only at the authorized
rate under the California State University System upon the request of the employee and
approval of the Department Head and the Personnel Manager; and on condition that the
employee complete the course with a passing grade and submit his or her grade card and
tuition receipt.
ARTICLE 9
UNIFORM AND SAFETY SHOES
There shall be, and the parties shall abide by, a uniform and safety shoe policy as set
forth in Exhibit "G", a copy of which is attached hereto and incorporated herein by this
reference.
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EXHIBIT F
CITY OF HUNTINGTON BEACH
RETIREE MEDICAL PROGRAM
MEET AND CONFER
MUNICIPAL EMPLOYEES ASSOCIATION
Following is a description of a City proposed alternative to the PERS Medical
Program for City of Huntington Beach retiree medical coverage.
Applies only to future retirees. A two-tier City Plan. Will be administered under
the umbrella of the City Self Insured Medical Program. One level of coverage will apply
to employees and a different level of coverage would apply to employees retiring
January 1, 1988 or later. The benefits for retirees will be generally the same as the
current City program with the main differences described in the attachment. Benefits for
employees (prior to retirement) would remain essentially as currently provided with
changes as agreed to during current meet and confer sessions with the Association and
with the addition of a prescription drug card with separate deductibles of $4 for generic
and $6 for non-generic prescriptions. The Retiree Medical Plan would provide the
following financial contributions by the City towards retiree medical premium costs:
I. City Payment of Retiree Medical Premiums - The City would pay a portion of the
retiree's medical premium based on years of service as follows:
Years With City City Payment of Premium
5 - 10 Years Service $10 Per Month
11 - 20 Years Service $25 Per Month
20 Years or More $50 Per Month
II. Medical Insurance Retirement Fund - Two accounts would be established for each
participating employee in a newly created Medical Insurance Retirement Fund.
One account would be the "employee contribution" account and the other the "city
contribution" account.
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EXHIBIT F
(Continued)
A. City Contribution - The City would contribute $12 per payday to the "city
contribution" account for any employee who contributes at least $6 per payday
to the "employee contribution" account. Vesting rights for the funds (plus
interest) in the City Contribution account ($12 per payday) would be based on
years of service as follows:
1. 50% vested for 0 - 10 years service
2. 75% vested at 11 years service
3. 100% vested at 20 years service
B. Employee Contribution - Employees would be required to contribute a
minimum of $6 per payday in order to participate in the Fund. Employees
could contribute additional amounts to the employee contribution account at
their option. Such additional contributions could be from the following:
1. Payroll deduction
2. Conversion of vacation hours
3. Conversion of a portion of sick leave hours
4. Other - per mutual agreement
The Fund would be administered by the City in a separate fund and all administrative
costs would be paid from the fund.
The plan details will be further discussed with the MEA prior to implementation. The
financial contributions by the City will be effective January 1, 1988.
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ARTICLE 10
BEREAVEMENT LEAVE
Employees shall be entitled to bereavement leave not to exceed (3) work shift days
per calendar year in each instance of death in the immediate family. Immediate family is
defined as father, mother, sister, brother, spouse, children, stepfather, stepmother,
stepsisters, stepbrothers, mother-in-law, father-in-law, brother-in-law, sister-in-law,
stepchildren, grandparents, grandchildren, son-in-law, and daughter-in-law.
ARTICLE 11
SHIFT DIFFERENTIAL
A. Employees required to work on a regularly assigned shift that occurs between the
hours of 4:00 P.M. and midnight, shall be paid a premium equal to five percent (5%) of the
employee's base hourly rate for all work performed during said shift.
B. Employees required to work on a regularly assigned shift that occurs between
midnight and 8:00 A.M. shall be paid a premium equal to ten (10%) percent of the
employee's base hourly rate.
C. Employees will be considered as assigned to the afternoon shift (4:00 P.M. to
midnight) or the night shift (midnight to 8:00 A.M.) when five (5) or more hours of their
regularly assigned shifts occur in the afternoon or night shift as defined herein.
ARTICLE 12
STANDBY AND CALL BACK PAY
A. An employee who is placed on standby status by his or her supervisor shall receive
four (4) hours straight time pay for each twenty-four (24) hour period on such standby
status.
B. The CITY will reimburse employees called back to work a minimum of two (2)
hours of pay at the rate of one and one-half time (1 1/2) his or her regularly hourly rate.
C. A supervisor shall notify an employee, in advance, of the need of work overtime.
Where overtime is worked as an extension of the work day, it shall not be considered call
back. While overtime may be required to be worked, it is the City's policy to discourage
the working of overtime, and to provide reasonable notification to an employee should
overtime be required.
ARTICLE 13
TOOL REPLACEMENT
Those employees who are required to furnish their own personal tools for use on the
job, shall be reimbursed by the CITY for said tools that are lost, stolen or broken when in
use on the job. Replacement of such personal tools or reimbursement to the employee
shall be limited to $250 per employee and subject to approval by the supervisor. It is
understood that the employee has the responsibility to exercise care and diligence in
preventing the loss, theft and breakage of his or her personal tools and that the CITY may
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require a written report of when, where and how tools were either lost, stolen or broken
while in use on the job in order for the employee to be eligible for reimbursement.
ARTICLE 14
GRIEVANCES
Any grievance as defined and described in Rules 19 and 20 of the CITY Personnel
Rules (Resolution No. 3960), shall be settled in accordance with the procedures set forth
in said Rules except that the parties to the grievance may, by mutual agreement, submit
the grievance to a neutral arbitrator whose decision shall be final and binding on the
parties. The arbitrator shall be selected by the parties from listings of and pursuant to
the rules of the American Arbitration ASSOCIATION. This procedure, if adopted by the
parties, shall be in lieu of Step 5 of Rule 19, or Step 4 of Rule 20, and the fees charged by
the arbitrator or hearing officer and court reporter shall be paid by the party which is not
the prevailing party.
ARTICLE 15
DISABILITY INSURANCE PAYMENTS
When the CITY grants an employee leave without pay for reason of medical
disability, the CITY shall maintain the employees' insurance premiums for the time the
employee is in a non-pay status for the length of said leave not to exceed twenty-four (24)
months. The CITY shall provide timely written notification of employee rights under this
Article and the Long Term Disability Plan and will assist the employee in processing LTD
claims so that undue delay in receiving LTD payments is avoided.
ARTICLE 16
PROMOTIONS
A. When promotions are to be made, and two or more employees are found to be
equal as a result of promotional examinations conducted by the CITY, the employee with
the greatest length of service with the CITY shall receive the promotion.
B. Upon promotion, an employee shall be compensated at the same step in the salary
range for his or her new classification, subject to the following provisions:
1) Except for the provisions of sub-paragraphs 2) and 3) below, no employee
shall receive greater than a ten percent (10%) increase upon promotion.
2) If "A" STEP of the classification upon promotion is greater than 10%
increase, the employee shall be compensated at "A" STEP upon promotion.
3) If the employee would be eligible for a step increase within 11 months of
the date of promotion in his or her classification before promotion, then the Personnel
Manager may authorize an increase greater than ten percent (10%) upon promotion.
ARTICLE 17
LEADWORKER
Any employee classified as "Leadworker" shall receive sixteen (16) ranges on the
"Universal Salary Schedule" above the highest classification which is assigned to the
Leadworker to lead.
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ARTICLE 18
VEHICLE USE
The CITY Vehicle Use Policy shall be as indicated in the document attached hereto
and by this reference incorporated herein as Exhibit "G".
ARTICLE 19
SICK LEAVE PAYOFF
Upon termination, all employees shall be paid, at their current salary rate, for
twenty-five percent (25%) of unused, earned sick leave from 480 hours through 720 hours,
and for fifty percent (50%) of all unused, earned sick leave in excess of 720 hours.
ARTICLE 19
HOURS OF WORK STUDY
The parties agree to continue to study the issue of hours of work during the term of
the Agreement through a Joint ASSOCIATION1City Study Committee (with equal number
of representatives). Upon approval by the City Administrator, implementation of any
alternative hours of work may be accomplished on a city-wide, department-wide or
individual work unit basis. Meetings of the Joint Committee may be called by either the
Chief ASSOCIATION representative or the Chief City Representative. The City shall
notify the ASSOCIATION and employees at least 30 days prior to any modification of
alternative schedules of hours of work in order to discuss any modification of alternative
schedules of hours of work before they are implemented by the City.
ARTICLE 20
PERSONNEL RULES
The City and the ASSOCIATION agree to implement the following rules and accordingly
revise the Personnel Rules as described herein:
1. Rule 5-20 - Duration of Employment Lists - Employment lists shall remain in
effect for one (1) year from the date of the last examination, unless sooner exhausted.
Promotional lists and entry level employment lists may be extended prior to expiration
date by the Personnel Director when requested by the Department Head, for additional
periods but in no event shall an employment list remain in effect for more than two (2)
years. Names placed on such lists shall be merged with others already on the list in order
of scores.
2. Rule 19-5, Step 4 - City Administrator - If the grievance is not settled under
Step 3, the grievance may be presented to the City Administrator in accordance with the
following procedure: Within fifteen (15) days after the time the decision is rendered
under Step 3 above, a written statement of the grievance shall be filed with the Personnel
Director who shall act as hearing officer and shall set the matter for hearing within
fifteen 05) days thereafter and shall cause notice to be served upon all interested parties.
-11-
1306X
5840
The Personnel Director, or his representative, shall hear the matter de
novo and shall make recommended findings, conclusions and decision in the form of a
written report and recommendation to the City Administrator within five (5) days
following such hearing. The City Administrator may, in his discretion, receive additional
evidence or argument by setting the matter for hearing within ten (10) days following his
receipt of such report and causing notice of such hearing to be served upon all interested
parties.
Within five (5) days after receipt of report, or the hearing provided for
above, if such hearing is set by the City Administrator, the City Administrator shall make
written decision and cause such to be served upon the employee or employee organization
and the Personnel Director.
3. Rule 19-5(b) - Hearing - As soon as practicable thereafter, the Personnel
Director shall set the matter for hearing before a hearing officer either selected by
mutual consent of the parties or from a list provided by the Personnel Commission.
Ratification of the hearing officer selected by mutual consent of the parties, if from a
list approved by the Personnel Commission, shall not require separate approval or
ratification by the Personnel Commission. The hearing officer shall hear the case and
make recommended findings, conclusions and decision in the form of a written report and
recommendation to the Personnel Commission. In lieu of the hearing officer process, the
Personnel Commission may agree to hear a case directly upon submission of the case by
mutual consent of the parties.
4. Rule 21-7 - Hearing Officers - The hearing officer provided for in Rules
19 and 20 shall be from a list provided by the Personnel Commission or one selected by
mutual consent of the parties.
5. Rule 21-11 - Time. Computation of. The period of time in which any act
must occur, as provided in these rules, shall be computed by excluding the first and
including the last day of such period, and in the event the last day falls on a Saturday,
Sunday or legal holiday, such acts may be accomplished on the next succeeding working
day.
As used in Rules 19 and 10, all references to days shall be interpreted to
mean calendar days.
The City and the employee, or employee organization may, by mutual
consent, extend the time period within which an act must occur in the processing of
grievances.
ARTICLE 21
FAMILY SICK LEAVE
The parties agree to modify Section 18-8(d) of the Personnel Rules to provide: When
an employee is required at home, not to exceed, unless approved by the Department Head,
a total of five (5) days in anycalendar year, to attend upon his/her ill or injured spouse,
child, stepchild, or parent.
-12-
1306X
ARTICLE 22
TEMPORARY UPGRADE PAY
If an employee is formally assigned to work in a higher classification on a temporary
basis but for greater than four (4) weeks, then the employee shall be compensated for any
hours worked in excess of four (4) weeks, in the higher classification, in the same manner
provided in Article 16-B.
ARTICLE 23
ASSOCIATION BUSINESS
An allowance of 50 hours per year shall be established for the purpose of allowing
duly authorized representatives of the ASSOCIATION to conduct lawful ASSOCIATION
activities.
ARTICLE 24
MID-YEAR SALARY REVIEW
The following classifications will be included in the City's annual mid-year salary
review: Accountant, Shift Supervisor, Sr. Outreach Workers, Leadworker - Paint Division,
and hazard duty pay for sewer workers and chemical application workers. While not being
a meet and confer process subject to impasse resolution under the City's Employee
Relations Resolution, this shall be a bilateral process and, after the parties have reviewed
and analyzed data at a mutually set meeting(s) called for this purpose, approved salary
changes for the above classifications shall be effective March 1, 1988.
ARTICLE 25
BILINGUAL PAY
Employees who are required by their Department Head to use their bilingual abilities
as part of their job assignment shall be paid an additional five percent (5%) over their
regular monthly salary. Employees who are required by their Department Head to utilize
the bilingual skills may be required to be tested and certified by the Personnel Manager as
to their language proficiency in order to be eligible for said compensation.
ARTICLE 26
MATERNITY LEAVE
The CITY and the ASSOCIATION agree to modify the present Personnel Rule 18-19
Maternity Leave to read as follows: "An employee shall be entitled to a leave of absence
without pay due to inability to work due to pregnancy. The employee will be entitled to
use available sick leave during this period. Said leave must be requested in writing from
the Department Head and must include written notification from the employee's physician
stating the last day the employee may work and the estimated duration of leave. The
employee must obtain written authorization to return to work from the attending
physician. Said authorization must be filed with the Department Head and the Personnel
Manager."
1306X -13- 5840
ARTICLE 27
MEDICAL LEAVE OF ABSENCE
The CITY and the ASSOCIATION agree that the following sub-paragraph "C" shall be
added to Personnel Rule 18-20. Leave of Absence Without Pay: Leave of absence without
pay, for medical disability reasons, shall be restricted to six (6) months.
ARTICLE 28
LAYOFF RULES
The CITY and the ASSOCIATION agree that the first sentence in Personnel Rule 8-3
shall be modified to read as follows: Layoff shall be made in accordance with the relative
length of the last period of continuous service of the employees in the class of layoff,
provided, however, that no permanent employee shall be laid off until all temporary,
acting and probationary employees in the competitive service holding positions in the
same class in the same department are first laid off.
ARTICLE 29
COPIES OF M.O.U.
The CITY agrees to print this Memorandum of Understanding for each employee in
the bargaining unit including all Exhibits except Exhibit "D" on or before February 1, 1988.
ARTICLE 30
MANAGEMENT RIGHTS
Except as expressly abridged or modified herein, the CITY retains all rights, powers
and authority with respect to the management and direction of the performance of CITY
services and the work forces performing such services, provided that nothing herein shall
change the CITY's obligation to meet and confer as to the effects of any such
management decision upon wages, hours and terms and conditions of employment or be
construed as granting the CITY the right to make unilateral changes in wages, hours and
terms and conditions of employment. Such rights include, but are not limited to,
consideration of the merits, necessity, level or organization of CITY services, including
establishing of work stations, nature of work to be performed, contracting for any work or
operation, reasonable employee performance standards, including reasonable work and
safety rules and regulations in order to maintain the efficiency and economy desirable for
the performance of CITY services.
ARTICLE 31
TERM OF MEMORANDUM OF UNDERSTANDING
A. This Memorandum of Understanding shall be in effect for a term commencing
at 12:01 A.M., June 27, 1987 and ending at midnight on June 30, 1988.
B. This Agreement constitutes the entire agreement of the parties with respect to
improvements or changes in the salaries and monetary benefits for employees represented
by the ASSOCIATION for the duration of this Agreement.
-14-
1306X 5840
C. Resolution No. 5455 has been the subject of litigation in Orange County
Superior Court Case No. 44-18-25 and Fourth District Court of Appeals Case No.
G002811. In the meeting and conferring to reach this agreement, the City and the
ASSOCIATION have not intended to resolve the pending appeal in the aforementioned
litigation or the wages and other terms and conditions of employment which were
implemented for fiscal year 1984/85, including, but not limited to medical benefits and
wages contained in Article 3 and 5. By entering into this agreement, the ASSOCIATION
and the CITY agree that nothing contained herein shall be construed as a waiver by either
party of their right to meet and confer over the issues in dispute from the 1984/85
impasse as they may affect fiscal year 1984/85 or thereafter; nor prevent any court from
awarding any remedy in the above entitled litigation. This provision shall apply also to
the effective date of the Police Records Technician wage increase, but not to the issue of
the Police Records Technician inequity.
ARTICLE 32
SEVERABILITY AND SAVINGS OF INTENT
A. If any article, sub-article, sentence, clause, phrase or portion of this
Agreement, or the application thereof to any person, is for any reason held to be invalid
or unenforceable by the decision of any court of competent jurisdiction, such decision
shall not affect the validity of the remaining portions of this Agreement or its application
to other persons.
B. The CITY and the ASSOCIATION hereby agree that in the event any state or
federal legislative, executive or administrative provision purports to nullify or otherwise
adversely affect the wages, hours and other terms and conditions of employment
contained in this Agreement or similarly purports to restrict the ability of the parties to
negotiate a successor agreement, the CITY and the ASSOCIATION shall, without
prejudice to either party's judicial remedies, endeavor to agree to alternative contractual
provisions which are not adversely affected by said legislative, executive or
administrative provision.
5840
-15-
1306X
ARTICLE 33
CITY COUNCIL APPROVAL
It is the intent of CITY and ASSOCIATION that this Memorandum of Understanding
represents an "Agreement" between the undersigned within the meaning of Section 8-2 of
the Huntington Beach Employer-Employee Relations Resolution; however, this
Memorandum of Understanding is of no force or effect whatsoever unless adopted by
resolution of the City Council of the City of Huntington Beach.
DATED: ��,^ , 1988
HUNTINGTON BEACH MUNICIPAL
EMPLOYEES' ASSOCIATION
APPROVED AS TO CONTENT: (ASSOCIATION OR MEA)
By: /
XOC�F-
City Administrat
B
e
v y.
Chief o in str ive Services
By:
Charles Goldstein, City Negotiator
APPROVED AS TO FORM: APPROVED AS TO FORM AND CONTENT:
City Attorney m s Harker, Attorney for the M.E.A.
-16- 5840
1306X
MEA MOU
TABLE OF CONTENTS
TITLE PAGE
Table of Contents i
Preamble 1
Article 1 Representational Unit I
Article 2 Existing Conditions of Employment 3
Article 3 Salary Schedules 3
Article 4 PERS & Retirement Medical Insurance Plan 3
Article 5 Insurance 4
Article 6 Vacations and Holidays 7
Article 7 Overtime Pay & Compensatory Time 8
Article 8 Education Pay Plan 9
Article 9 Uniform and Safety Shoes 9
Article 10 Bereavement Leave 9
Article 11 Shift Differential 9
Article 12 Standyby and Call Back Pay 10
Article 13 Tool Replacement 10
Article 14 Grievances 10
Article 15 Disability Insurance Payments 10
Article 16 Promotions 11
Article 17 Leadworker 11
Article 18 Vehicle Use I1
Article 19 Sick Leave Payoff 11
Article 20 Hours of Work Study 11
Article 21 Personnel Rules 12
Article 22 Family Sick Leave 13
Article 23 Temporary Upgrade Pay 13
Article 24 Association Business 14
Article 25 Mid-Year Salary Review 14
Article 26 Bilingual Pay 14
Article 27 Maternity Leave 14
Article 28 Medical Leave of Absence 15
Article 29 Layoff Rules 15
Article 30 Copies of MOU 15
Article 31 Management Rights 15
Article 32 Term of Memorandum of Understanding 16
Article 33 Severability and Savings of Intent 16
Article 34 City Council Approval 17
Exhibit A - Salary Schedule - Effective 06/27/87
Exhibit B - MEA Exempt Classes
Exhibit C - Employee Health Plan - Synopsis of Modifications
Exhibit D - Employee Health Plan
Exhibit E - PMI Dental Plan
Exhibit F - Retiree Medical Program
Exhibit G - Uniform Policy
Exhibit H - Vehicle Use Policy
Exhibit I - City Sponsored Indemnity Plan (Delta), City Sponsored Pre-Paid Plan (PMI)
5840
`* EXHIBI City of Hunti� Beach
MUNICIPAL EMPLOYEES ASSOCIATION
SALARY SCHEDULE
Effective 06/27/87
J03 CODE J03 TITLE J08 RNG STEP A STEP E STEP C STEP D STEP E CMP C0 R E M A R K S
* * t MISCELLANEOUS EI+PLCYEE ASS * * +
to43 ACCOUNTANT 373 2428 2562 27C2 2851 3009 5
6010 ACCT TECH I 269 1449 1529 1612 1700 1794 5
6611 ACCT TECH II 279 1517 16C0 1688 1782 1881 5
6612 ACCT TECH II1 299 1683 1775 1872 1974 2083 5
6613 ACCT TECH IV S19 1855 1957 2064 2177 2297 5
5648 ADMIN AIDE I 325 1912 2018 2129 2246 2369 5
1651 ADMIN AIDE 11 351 2177 2297 2423 2557 2.697 5
6615 ADMIN ASST (DIV) 299 1683 1775 1872 1974 2083 5
3647 ASSIST CORN TECH 289 1598 1687 1778 1875 1979 1
6663 ASST CIV OEF CRD 298 1674 1766 1863 1966 2073 5
1691 AUDIO VISUAL CRD 314 1808 19C7 2012 2123 2239 5
9617 AUTO 'BODY WKR NPR 320 1865 1967 2075 2189 2309 1
7641 . AUTO BODY WORKER 341 2070 2184 2304 2430 2564 1
7649 AUTORTO IRRIG WKR 314 1808 1907 2012 2123 2239 1
8634 BLDG MAIN -SVC YRK 314 1808 19C7 2012 2123 2239 1
3620 BLDG MAINT TECH 378 2493 2629 2773 2926 3087 1
3621 BLDG RNT TEC ASST 356 2233 2356 2486 2623 2766 1
Y628 BLOCK^lIASONRY'WKR 341 2070 2184 2304 2430 2564 1
1644 BUYER 367 2356 2486 2623 2766 2919 5
$645 BUYER ASSISTANT 1� 314 ' 1808 19c7 2012 2123 2239 5
_-7623 _..__._.CARPENTER.. _' . .341 _ --2070 - 2184 2304 2630 2564 1 -
fso15 CARPENTER HELPER 308 1758 1855 1957 2064 2177 1
7661 CHERICAL APPLICAT 325 1912 2018 2129 2246 2369 1
1642 CHIEF COIMINALIST 445 3477 3668 3869 4082 4307 `4
3600 CIV CMECK INV 301 1699 1792 1891 1995 2104 5
1631 CIVIL'ENGR'ASST 404 2836 2992 3156 3330 3513 5
6651 ----_ CLERK--__,.._---- -. . 241__ 1253 - 1323 _1395 .._,_..__..1472 . . _. .-1'553 - ----__ S --
6688 CLERK COURT LIAIS 288 1591 1678 1770 1867 1969 5
6079 CLERK LIBRARY 259 1378 1454 1534 1619 1707 5
6679 -._ CLE11C"_LL99ARY_SR 279 1517 1600 1688 1782 1881 5 -
6650 CLERK SENIOR 259 1378 1454 1534 1619 1707 5.
6639 CLERK STENO 269 1449 1529 1612 1700 1794 5
6646 CLERK fYPIST 247 1295 1366 1440 1520 1603 5
6645 CLERK TYPIST SR 20 �1420 1498 1581 1667 1759 5
5623 C04M CNTR LOR SR 313 1799 1898 2002 2113 2229 5
1678 COMNUNICTNS ADM 445 3477 3668 3869 4082 4307 5
3661 COMPTR OPTS SUPV 388 2617 2761 2914 3073 3243 5
3655 COMPUT OPER AIDE 288 1591 1678 1770 1867 1969 5
3648 COMPUTER OPER SR 52J 1865 1967 2075 2189 2309 5
3649 COMPUTER OPERATOR 302 1707 1801 19CC 2004 2115 5
7629 CONCRETE FINISHER 135 2011 2122 2238 2361 2491 1
F627 CONST E MAINT WKR 346 2122 2238 2361 2491 2628 1
�
6620 C04ST PERM AIDE 278 1511 1595 1683 1775 1872 5
-�b /o28 CONTRACT ADMIN 409 2907 3066 3234 3413 3600 5
0 2681 CREW LDR BCH MNT 383 2555 2695 2844 3000 3165 1
2673 CREW LOR BLDG MNT 388 2617 2761 2914 3073 3243 1
2670 CREW LOR ELEC MNT 388 2617 2761 2914 3073 3243 1
EXHIB
MUNICIPAL EMPLOYEES ASSOCIATION
SALARY SCHEDULE
Effective 06/27/87
J09 CODE : JOS TITLE J09 'RNG STEP A S1EP E STEP C STEP 0 STEP E CNP CO R E M A R K S
2672 C&EY LOR MECH NNT 388 2617 2761 2914 3073 3243 1
2678 CREW LOR MET OPTS r 383 2555 2655 2844 3000 3165 1
2671 CREW LOR PAINT 388 2617 2761 2914 3073 3243 1
2686 CREW LOR PARK NNT 383 _ 2555 2695 2844 3000 3165 1
2677 CREW LDR SEYR NNT 383 2555 2695 2844 3000 3165 1
2676 City LOR ST LDSCP 383 2555 2695 2844 3000 3165 1
2682 CREW LDR ST NNT 363 2555 2695 2844 3000 3165 1
2675 CREW LDR ST TREES 383 2555 2695 2844 3000 3165 1
R 2664 CREW LOR MAT DIST $83 2555 2695 2844 3000 3165 !
2665_�._._. _ CREW LDA YA.T-_PROP— 383--_ 25-55,. 2695 _. 2844 3000_ 3165 _._ T.
2680 CREWLDR TRAFFIC 388 2617 2761 2914 3073 3243 1
2674 CREYLDR TRF SGNLS 388 2617 2761 2914 3073 3243 1 -
1476 _ C41RE-PEV.ENT-_SPEC .__-.___ __.... . 319_ 1855._. 1957 2064 _ 2177_ 2297 5
1679 CRININALIST I 356- 2233 2356 2486 2623 2766 ; A
1680 CRININALIST II 396 2725 2874 3032 3193 3375 4
43:E� C+l�ETQlIB!£_� :. _ _ 233_--.�.___ 14 --- - 1.558' �- 1643_ _._. 1733�._- ..._._1829 -__ 1
2a 6643 DATA CONTROL CLK 278 1511 1595 1683 1775
13
2604 DEP CITY CLERK II 341 2070 2124 2304 2430 2564 5
' _ AS _ 319_ _._.�_____1855 1957 2064 2177 2297 5
3650 OUPUT EtUitikK 242 �624.: " 1714 1a0a 19�7 2011- 5—_. .___
. ,_�....__,.,.._OE _..C_ITY _TRE
OPER 288 1591 1679 1770 1867 1969 1
27i'
84E_Cr_R1 PA _MK11� _. �.. 325_ 1912 _..-2018 -= .... 2129 - - 2246 2-169_ 1
7
e! 17 ELECT TRAF SIGUL - 356 2233 2356 2486 .2623 �27b6
ei 7622 ELECTRICIAN 356 2233 2356 2486 2623 2766 1
-ENri- TECH- I _._ _-_ _._. _331__. _.:._, 1971_- 2C80_ ---_ . 2194 2316 -----__2442 1
3627- ENGINEERING AIDE 335 201! 21Z2 2238 2361 2491 _..•.-S_ .._ �_.____
3631 E4696 TECH It 351 2177 2297 2423 2557 2697 1 -
ti�;_363�.._`__.__EN4RG._T_ECR_Li3._ _.2914 _ .3073 32�43 _ 7
---'-3087
_
' 1660 ENYIRON OFFICR 378 2493 2629 2773 2926 -__3087 5
7655 EQUIP MAINT SPEC 367 2356 2486 2623 2766 2919 1
74 3 _. -._ EGJIP,_OP -HVY OUTY_ 341- 2070 2184 _ _2304 2430_ 2564 1
7644 EQUIP OPERATOR 325 1912 2C18 2129 2246 2369 1
8618 EQUIP SUPRT COORD 341 2070 2184 2304 2430 2564 1
�.-..._ 863$ FAC NAINT YRKR_ 303 1716 1810 1908 2014 2125 1
5631 FIELD SERVICE OFF 335 2011 2122 2238 2361 2491 1
5640 FIREE EDUCAT SPEC 349 2156 2274 2399 2531 2669 5
8633 GROUN.DSMORKER 283 1546 le31 1721 1817 1917 1
7613 HELICOPTER TECH 434 2836 - 2992 3156 3330 3513 1
7669 M20 STSTN TCH III 353 2198 2319 2447 2583 2725 1
7668 N20 SYSTNS-_TCH II 333 1992 21C1 2217 2338 2467 1
7667 N20 SYSTNS TECH I 320 1865 1967 2075 2189 2309 1
3602 IDENTIF TECH II 346 2122 2238 2361 2491 2628 4
3601 IDENTIFICAT TECH1 316 1825 1926 2031 2142 2260 S
3665 INFO SPEC I 314 1808 19C7 2012 2123 2239 5
-3666 INFO SPEC II 361 2288 2415 2548 2688 2836 5
cn 3674 INSP ELECT SR 378 2493 2629 2773 2926 3087 1
0 3642 INSP LANDSCAPING 367 2356 2486 2623 2766 2919 1
3650 INSP LICENSE 331 1971 2C80 2194 2316 2442 1
3675 INSP PLB 9 NEC SR 378 2493 2629 2773 2926 3087 1
EXHIBIM
MUNICIPAL EMPLOYEES ASSOCIATION
SALARY SCHEDULE
Effective 06/27/87
J08 CODE JOB TITLE JOd RN6 STEP A STEP B STEP C STEP 0 STEP E CMP CO R E M A R K S
3677 INSP PLB R MECH 356 2233 2356 2486 2623 2766 1
3622 INSP PUB WKR SR 378 2493 2629 2773 2926 3087 1
3623 INSP PUB WRKS TRN 356 2233 2356 2486 2623 2766 1
3673 INSP STRUCT SR 378 2493 2629 2773 2926 3067 1
3640 INSP WATER SERV 367 2356_ 2486_ 2623.._ 2766 2919 1
3670 INSPECTOR ELECT 356 2233 2356 2486 2623 2766 7
3672 INSPECTOR STRUCT 356 2233 2356 2486 2623 2766 7
6644 INVENTORY- CLERK 259 1378 1454 1534 1619 1701 S
3634 LAND USE TECH 367 2356 2486 2623 2766 2919 S
-- 3606 LANDSCAPE ARCHIT : 400 2780 _ 2933� 3094 3264 3444 7
7652 LArJOSCAPER . 303 1716 1810 1905 - 2014 2125 ___1.. Y
7678 LDOKR HYD 9 VALVS 336 2021 2132 2250 2373 2503 1
7673 LDWKR H2O SYSTEMS 369 2378 2508 2647 2792 2947 1
7682 LDWKR NEC-"NVY OTT 369 2378 2508 264f 2792 2947 1_ _
9692 LOWKR TRAFIC STP 341 2070 2184 t 2304 2430 2564 1
768l- L99KA VAT MTR RPR 336 2021 2132 : 2250,- 2373 2503' 1
______ __.._.
69 0 " --__-_._L D i K R H T R C 0115 T_.. :--_33 7_��..._�7i3Z]a s•....."".._`���'8Z�3'�"`.�___2'f86-_`�`._,�:_._ - -
_.______ _ -_
7692 LDi1KR/SERVS REP 357 2245 2368 2498 2635 2780 7
7691 LEADWKR BLDG MNT 367 2356 2486 2623 2766 2919 1
--8689 LEADWKR CHEN APPL {, 341 , 2070
Y684 LEADWKR CONCRETE 35t 2245 . 2366 2498,;: 2635 2780 1
;., 7680 LEADWK& ELECT ---._ _ . i 3T2y -. 2416. 2550`. 2690. 23837. 29 3 1
8682 LEADWKR LANDSCAPE
7684 LEADWKR PAINTER 357 2245 2368 2498 2635 2780 1
8684 LEADWKR SEWER 341 2070 2184 2304 2430 2564 1
r - --8686 LEADWKR STREET_ _ , 357 -22�S T` 2368Y 2498_._ - 2635--' 2780 -.._- 4 -
7688 LEADWKR WATER 341 2070 2184 2304 2430 2564 1
8685 LEADYORKER MECH 357 2243 2368 : _ 2498 _2635 2780 1
— - 1649 - LlaRARIAN_ -___ .._.. . 33 2 i 2123 2 38" 2361_
5634 LIaRARY ASST I 314 1808 1907 2012 2123 2239 6
8636 MAINT SVR WKR 314 1808 1907 2012 2123 2239 1
- 8631 MAINT WKR SR 303 - 1716.. _- 1810 _ 1908-. . _.. 2014 . 2125 1
8638 MAINT WORKER 288 1591 1678 1770 1867 1969 1
0665 MAINTLREPR SUPV 402 + 2808 2962 3125 3297 3479 5
7635 MECH HEAVY DUTY 353 2198` -2319- 2447_ 2583_ 2725 - 1
7619 MECH HELICOPTER 341 2070 2184 2304 2430 2564 1
8627 MECH SEWER PUMPS 320 1865 1967 2075 2189 2309 1
7639 MECH SWR PUMPS SR 325 1912 2018 2129 2246 2369 1
8620 MECHANIC 320 1865 1967 2075 2189 2309 1
7636 MECHANIC SR 341 2070 2184 2304 2430 2564 1
8621 MECHANIC Y 356 2233 2356 2486 2623 2766 1
8642, METER READER 298 1674 1766 1863 1966 2073 1
8641 METER READER SR 314 1808 19C7 2012 2123 2239 1
7648 METER REPAIR WKR 320 1865 1967 2075 2189 2309 1
7650 METER RPR WRKR"Y" 325 1912 2C18 2129 2246 2369 1
Ul 6652 NEBRHO WTCH SPEC 288 1591 108 1770 1867 1969 5
00 662E OFFICE COORD-LEGL 305 1732 1827 1927 2033 2146 5
-p 5671 OUTREACH ASST 167 0874 C922 0972 1026 1083 5
O 7624 PAINTER 341 2070 2184 2304 2430 2564 1
. .ti EXHIB
M(JNICIPAL EMPLOYEES ASSOCIATION
SALARY SCHEDULE
Effective 06/27/87
JOB CODE JOB TITtE JOB RNG STEP A STEP E STEP C STEP D STEP E CMP Co R E M A R K S
3629 PARK MTR REPR T£C 336 2021 2132 2250 2373 2503 7
5660 PARK NATURALIST 361 2288 2415 2548 2688 2836 7
7620 PHOTOMLT06RAPHER 345 2109 2226 2349 2477 2614 1
2683 PK/CMP FACL SUPV 383 255S 2695 2844 3000 3165 5
5642 PKG CONTROL OFFIC 288 1591 1678 17T0. 1867 1969 1
8639 PKG/CAM ATTU 288 1591 1678 1770 1867 1969 1
3651 PLAN CHECK COORD 321 1874 1976 2085 2200 2321 5
-; 3 62 6 PLAN' CNCCXER SR 388 2617 2761 2914 3073 3243 5'
1604 PLAN/RESCN COORD 367 2356 2486 2623 2766 2919 i
163t PLANNER ASSISTANT 378 2493 2629 2773 2926 3087 S
3634 -- - PLA NNE R7RRAFTIN6 -- _ 325------ -- .._19f2 _ __. 2C18 __-._2129--- 2246 _ 2369 5_.
2637 PLANNING AI'S 362 2300 2427 2560 2701 2850 S
3671 PLM CH PUS WKS SR 399 27.65 2917 3078 3248 3427 5
m___PlU11SER; --- - ` .. . .35T 2t77~' 2297 2423 _ - -2557 2697 1
660 POL RECRS.TCN III 282 1539 1624 1714, 1808 1907 S
6601°. POL RECSS' TECO-t _-. 25r;.. 1364 1439 151$ 1602 1690 ,k._.S- t.�
6602P .._
OL REl`p3�ECM II 'r273 fi47T 1558 - - 161,3-_--. ..1733_ _._._ 1829 � S_
6656 POLICE CLERK SPEC 278 1511 1595 1683 1775 1872 5
6654 POLICE CLERK SR 269 1449 1529 1612 1700 1794 S
365i lOIIt�PN�3ii1!l►ftf� 3Si�"
__.2T7T _. -2297 2421- ZSST- 2697
667?�; PRINCIP k9841 CLK {. 298 1674 1766 1863 1966 2073 5
361 PRINT INS'CO6210(; �' 335; . . . 2011 2122 2238 61 2441 1
36 PROGRAMNER� 36$ 23b$ 2498__---._ 2635_-_ 8Q. 2933 5_._
1653 PROGRAMMER SR 388 2617 2761 2914 3073 3243 S
1654 PROGRAMMER/ANALYS 405 2851 3007 3172 3347 3531 S
2011"_._-- 1122 ,_ 2238.__ 2361. 2491 :_..1
5639' PROPERTY OFFICER 320 1865 1967 2075 2189 2309 5
E 3601 PURCHASING TECH . 278 1511 1595 1683. 1T7S 1872 S
w
• 1656 REJ1l ESTATE ANAL - 3-?`9` -�23D3- _2789__ . 2941 3103_�.__---.5.w---_.____�____,:.�_.
5636 R£C LOR SR 346 2122 2238 2361 2491 2628 7
Z650 RECORDS ADMIN 390 2643 2789 2943 3104 3274 S
5607 - -RECORDS COORD __..- _ 340 2059 2172 2291 2418 2551 S_
2627 REDEVELOPMT ANAL 378 2493 2629 2773 2926 3087 S
C 6635 SECRETARY 239 1598 1687 17T8 1875 1979 S
6632 -_ - SECRETARY A DM IN 309 • 176E _. 1863 1966 2073 2187 5 _
6614 SECRETARY DIVISN 299 1683 1775 1872 1974 2083 S
6633 SECRETARY LEGAL 309 1766 1863 1966 2073 2187 5
6636 SECRETARY TYPIST 279 1517 1600 1688 1782 1881 S
6634 SECRTRY LEGAL SR 318 - 1844 1945 2052 2165 2285 S
6637 SECTY LEG TYPIST 298 1674 1766 1863 1966 2073 S
__--- - 5630 SERVI CE OFF/ALARM 335 2011 2122 2238---- 2361 2491- -- 1
5632 SERVICE OFFICER 335 2011 2122 2238 2361 2491 1
3644 SERVICE REP Y 320 1865 1967 2075 2189 2309 1
7646 SERVICE WORKER 320 1865 1967 2075 2189 2309 1
Ln 6604 SHIFT SUPERVISOR 298 1674 1766 1863 1966 2073 5
0-P 5670 SR OUTREACH CRO 346 2122 2238 2361 2491 2628 7
p 8624 STOREKEEPER 320 1865 1967 2075- 2189 2309 1
0653 SUPV SYS t PRMG 425 3149 9323 3505 3697 3900 5
7603 SURPLUS EXP€DITOR 279 1517 1600 1688 1782 1881 1
r EXHIBI7M
MUNICIPAL EMPLOYEES ASSOCIATION
SALARY SCHEDULE
Effective 06/27/87
JOB CODE JOB TITLE JOB RNG _ STEP A - _STEP_. E -__ STEP C STEP 0 STEP E CNP CD R E P A R K S
3678 TECH PER t tN INF' . 321 1874 _ . 1976 1 2085 2200 2321 5
8629 TIRE SERVICE WKR 314 1808 1907 2012 2123 2239 1
7645 TRAF STRPNG EQ OP 32S 1912 2018 2129 2246 2369 1
1659_.-___._._ tREE...aR:I_N_.AERtA4:___... 323 _- _ _141.2 _ 24��------- .__ __:224.6__ 2369 1
8623 WAREHOUSEKEEPER 330 1962 2070 2184 2304 7430 1
7647 WATER NTR RPR WKR 320 1865 1967 2075 2189 2309 1
_._3643_ ,WAT ER..QT_L TEtH. ._ _ _._ _ . .. 335. .2D1.1__. 2122_ - -.�_2238� . 2361_ 2491 7 -
2689 WATER %UAL COORD 383 2555 2695 2af4 3000 3165 1-
' � 3690 WORD PROC COOR9 345 2109 2226 2349 2477 2614 5
• ._.._ _. 6663� �_..___ wait e,-.PRO_CESSoR—__._ _.. _-.._. 2bc�._. _` 1�13 : ti91 ;� 1'�.7_.�._. - --16S9__. 17S1_:__ S
'E) 6684 WORD PROCESSOR SR 278 1511 1545 1683 1775 1872 S
5624 Cultural Affairs Sup. 351 2177 2297 2423 2557 2697 _
3663 Claims Examiner Sr. 376 2467 2602 2746 2896 3056
2679 Leadworker Park Facility 3659*' 2335 2463 2598 2740 2891
xdw
t
EXHIBIT B
M.E.A. EXEMPT CLASSIFICATIONS
Payroll Job Code File
Effective June 27, 1987
JOB CODE CLASSIFICATION RANGE SALARY
1642 Chief Criminalist 445 3477 - 4307
1678 Communications Adm. 445 3477 - 4307
0653 Supervisor Systems & Program 425 3149 - 3900
1628 Contract Administrator 409 2907 - 3600
1631 Civil Engineer Assistant 404 2836 - 3513
0665 Maint. & Repro. Supervisor 402 2808 - 3479
1680 Criminalist II 396 2725 - 3375
2650 Records Administrator 390 2643 - 3274
2673 Crewleader Bldg. Maint. 388 2617 - 3243
2670 Crewleader Elect. Maint. 388 2617 - 3243
2672 Crewleader Mech. Maint. 388 2617 - 3243
2671 Crewleader Paint 388 2617 - 3243
2680 Crewleader Traffic 388 2617 - 3243
2674 Crewleader Traffic Signals 388 2617 - 3243
1653 Programmer Senior 388 2617 - 3243
2681 Crewleader Beach Maint. 383 2555 - 3165
2678 Crewleader Met. Opts. 383 2555 - 3165
2686 Crewleader Park Maint. 383 2555 - 3165
2677 Crewleader Sewer Maint. 383 2555 - 3165
2676 Crewleader Street Land. 383 2555 - 3165
2682 Crewleader Street Maint. 383 2555 - 3165
2675 Crewleader Street Trees 383 2555 - 3165
2684 Crewleader Water Dist. 383 2555 - 3165
2688 Crewleader Water Prod. 383 2555 - 3165
2689 Water Quality Coordinator 383 2555 - 3165
2683 Park/Camp Facility Supervisor 383 2555 - 3165
1656 Real Estate Analyst 379 2505 - 3103
2627 Redevelopment Analyst 378 2493 - 3087
1637 Planner Assistant 378 2493 - 3087
1643 Accountant 373 2428 - 3009
1644 Buyer 367 2356 - 2919
1604 Plan/Research Coordinator 367 2356 - 2919
2679 Leadworker Park Facility 365 2335 - 2891
2637 Planning Aide 362 2300 - 2850
1679 Criminalist I 356 2233 - 2766
1651 Admin. Aide II 351 2177 - 2697
1649 Librarian 335 2011 - 2491
1676 Crime Prevention Specialist 319 1855 - 2297
0585X
5840
EXHIBIT C
EMPLOYEE HEALTH PLAN
SYNOPSIS OF MODIFICATIONS
The Employee Health Plan has been modified to include the following:
1. The initial cost of medical services covered by the Plan which are fully paid
for by the employee, (commonly referred to as "the Deductible"), shall be
One Hundred Fifty Dollars ($150) per person and Four Hundred Dollars
($400) per family.
2. Hospital admissions shall require prior notice by the employee and approval
for said admission by the Insurance and Benefits Division, except in the case
of emergencies as defined in the Employee Health Plan document.
3. The definition of a "dependent child" shall be changed so as to require that
children ages nineteen (19) to twenty-three (23); a) be either a full time
student, or b) live at home and be dependent on the parent/employee for
more than fifty percent (50%) of his/her support.
4. The date of termination of coverage under the medical plan shall be changed
to one (1) week after an employee's separation from City service.
5. Dependents of a deceased employee or a deceased retiree shall remain
eligible for participation in the medical plan for a maximum of six (6)
months after the death of the employee or retiree.
6. Eligibility for participation by employees in the City's medical plans shall
not terminate on account of the age of the plan participant.
7. An annual financial report prepared in accordance with generally accepted
accounting principals shall be provided by the City to the Association.
Copies of the Medical Plan Document may be obtained from the Insurance and Benefits
Office, City of Huntington Beach.
0619X
5840
EXHIBIT "Dn
i
THE CITY OF HUNTINGTON BEACH
EMPLOYEE HEALTH PLAN
PLAN DOCUMENT
May 1983
(Revised 4/87)
5840
TABLE OF' CONTENTS
I Definitions
A. Calendar Year. . . . . . . . . . . . . . . . . . . . . . . . . . .5
B. Skilled Nursing Facility. . . • Y . . . . .
C. Effective Date• . • • ■ . . . . . . . . • . . . . • ■ . . . . Y .5
D. Family Members. . . . . . . . . . . . . . . • . . • . . . . . . . • . . . . . . . . . ,
E. Legally Operated Hospital . . . . . . . . . . . . . . . . . . . . . . . . . .5
F. Masculine Gender. . . . . . . . . . a . . . . . . . . . . . . . a . . . . . . . . . . . . 5
G. Participant. .. . . . . . • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
H. Physician. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
I . Employee. . . . . . . . . . . . • . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
J. Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
K. City. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
L. Retiree. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
M. Accident. . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . 6
N. Relative Value Studies. . . . . . . . . . . . . . . . . . . . . . .6
O. Medically Necessary. . . * . . . . . . . . . . . . . . . . . . . . .. . . . . . . .6
P. Usual Customary and Reasonable. . . . . . . . . . . . . . . . . . . • . . .6
Q. Second Surgical Opinion. . . . . . . . . . . . . . . . . . . . . . .6
II Eligibility and Records
A. Eligible Employees. . . . . . . . . . . • . . . . . Y . Y.• . . . . . . • Y . .7
B. Adding Family Members. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
C. MEA. . a . . . . . Y . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . .7
D. MEO/Non Repr•esented/PMA/FA/MOSA/POA. . . . . . . . . . . . . . . .7
E. Retirees and Their Eligible Dependents. .. . . . . . . . . . . . . 7
F. Family Members Becoming Ineligible. . . . . . . . . . . . . . . . . . .9
G. Benefit Booklet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
III. Conditions Under Which Care Will Be Furnished
in a Hospital or Skilled Nursing Facility
A. Care for Illness or Accident. . . . . . . . . . . . . . . . . . . . 11
B. Bed Care. . . . . . . . .. . . . . . 11
C. Effective.Date. . . . . . . . . . . . . . . . . . . . 11
D. ID Card. . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . 11
E. Days of Care. . . . .. . . . . . . . . • . . . . . . . . . . . . . . 11
F'. Medically Necessary Services. . . . . . . . . . . . . . . . . . . . 11
IV. General Limitations
A. Admission for Diagnostic Study, . . . . . . . . . . . . . . . 12.
B. Workers' Compensation. . . . . . . . . . . . . . . . . . . . . . . 12
C. Services or Supplies not Legally Required to Pay. . . . 12
D. Services or Supplies at No Charge. . . ., . . . . . . . . . . . . . . 12
E. Care or Treatment from U.S. or F'or•e i�n Agency. . . . . . . 12
F. Services and Supplies Not Provided For. . . . . . . . . . . . . . 12
G. Services and Supplies Not Connected with Illness. . . . 12
H. Treatment of Teeth. . . . . . . . . . . . . . . I. . . . . . . . . . . • 12
1
5840
I . Services and Supplies for Cosmetic Purposes. . . . . . . . 12
J. Acts of War. . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . .-12
K. Nursing Facilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
L. Custodial Care. . . . . . . . . . . . . . . . . . . . . . . . . . 13
M. Medicare. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
N. Sex Transformations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
0. Reversal of Sterili ations. . . . . . . . . . . . . . . . . . . . . . . . . . 13
P. Charges in excess of UCR. . . . . . . . . . . . . . . . . . . . . . . . . . . 13
0. Experimental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
R. Pregnancy for dependent daughters. . . . . . . . . . . . . . . . . 13
S. Outpatient Psychiatric Care. . . . . . . . . . . . . . . . . . . . . . 13
'r. Supplies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . 13
V. Coordination of Benefits
A. Benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
S. Definitions. . . . . . . . . . . . . . . . . . . . . 14
C. Effect of Benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . 14
D. Facility of Payment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1'7
E. Right of Recovery. . . . . . . . �
. . . . . . . . . . . . . . . . . 17
F. Right to Receive and Release NecessaryInformation. . 17 .
VI . Conversion Privilege. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
VII . General Provisions
A. Plan Document. . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . 19
B. Workers' Compensation insurance. . . . . . . . . . . . . . . . . . . . . 19
C. Chiropractic or Psychologist. . . .. . . . . . . . . . . . . . . . . . . 19
D. Charter. . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . 19
E. Employer Responsibility for Furnishing
Hospital Care. . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . 19
F. Duplicate Coverage. . . . . . . . . . ... . . . . . . . . . 19
G. Eligibility to Receive Hospital Care. . . . . . . . . . . . . . . . 19
H. Hospital and Skilled Nursing Facilities. . . . . . . . . . . . . 19
I . Notice of Claim. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
VIII. Second Surgical Opinion
A. Definition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
8. Elective Surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
C. Board Certified Surgeon. . . . . . . . . . . . . . . . . . . . . . . . . . .22
D. Second Opinion Fees Paid by Plan. . . . . . . . , . . . . . . . . . .22
E. Coverage by Employee Organization. . . . . . . . . .22
IX. Basic Benefits
A. Benefits for Services and Supplies in
Hospitals and Skilled Nursing Facilities. . . . . . . . . . . .23
B. Total Days of Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
C. Basic Professional Benefits. . . . . . . . . . . . . . . . . . . . . . . .24
D. Care for Conditions of Pregnancy. . . . . . . . . . . . . . . . . . .26
E. Accident Benefit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
2
X. Major, Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
XI . Terminal Benefits. . . . . . . . . . . . . ...32
XII . Fee Schedule. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
XIII. Administration of the Plan
A. Appointment of the Claims Administrator . . . . . . . . . . 41
B. Powers of the Claims Administrator. . . . . . . . . . . . . . . . . . 41 ,
C. Claims Procedure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42.
D. Appeal Procedure. . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . .42
E. Limitation of Liability. . . . . . . . . . . . . . . . . . . . . . . , . . . . .42
XIV. Duration and Amendment of the Plan
A. Permanence of the Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
B. Right to Amend. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43,
XV. Administrative Provisions
A. _ No Limitation of Management Rights. . . . . . . . . . . . . . . . . .44
B. Participant 's Responsibilities. . . . . . . . . . . . . . . . . . . . . . 44
C. Missing Person. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
D. Governing Law. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
3
5840
CITY OF HUNTINGTON BEACH
EMPLOYEE HEALTH PLAN DOCUMENT
Nothing contained in this Document shall in any manner• restrict
or• interfere with the right of any individual entitled to service
and care to select the Hospital , Skilled Nursing Facility or• to
make a free choice of his attending physician or surgeon who
shall be holder of a valid and unrevoked physician 's or• surgeon 's
certificate and who is a member• of, or acceptable to, the
attending staff and Board of Directors of the facility in which
services are to be provided and rendered.
Payment of benef.its herein shall not be construed as regulating
the fee which a physician or surgeon may charge for his services
or• as attempting to evaluate his services.
4
PART I
DEFINITIONS
A. A "Calendar Year" is the twelve-month period commencing
January 1st of each year at 12:,01 A.M. , P.S. T.
S. A "Skilled Nursing Facility" means an institution which (1 )
provides skilled nursing care under 24 hour supervision of a
doctor or graduate registered nurse, (2) has available at all
times the services of a doctor who is a staff member of a
hospital , (3) provides 24 hours a day nursing service by a
graduate registered nurse on duty at least 8 hours per day,
and (4) maintains a daily medical record for each patient.
It shall specifically exclude any institution which is
primarily a place of rest, a place for the aged or a facility
operated by the Federal Government or any agency thereof.
C. The "Effective Date" is the date on which this Document
becomes effective.
D. "Family Member" shall be the spouse of the Employee and
children from, birth to nineteen (19) years of a,ge,. provided
such children are unmarried,, and dependent upon the Employee
for support and maintenance. Refer to Part II, Eligibility
and Records, Section D for further clarification. The term
"children" shall include natural children, legally adopted
children, and stepchildren.
E. A "Legally Operated Hospital" is an institution operated in
accordance with the laws of the Jurisdiction in which it is
located pertaining to institutions identified as hospitals
and which, for compensation from its patients and on an
inpatient basis, is primarily engaged in providing diagnostic
and therapeutic facilities for surgical and medical
diagnosis, treatment and care of injured and sick persons by
or under the supervision of a staff of licensed physicians or
surgeons, and which continuously provides 24 hours .a day
nursing service by reg i ster•ed., graduate nurses. It shall
specifically exclude care provided by any institution or any
affiliate or unit of a legally operated hospital which is
primarily a place of rest, a place for the aged, a nursing or
convalescent home, or a facility operated by the Federal
Government or any agency thereof.
F. The "Masculine Gender" includes the. feminine_ in context.
G. The "Participant" is the eligible employee or retired
employee .of the City whose Enrollment Form has been accepted
by the Claims , Administrator in accordance with the enrollment
regulations of this Document and in whose, name the City's
Identification Card is issued.
S
5840
H. A "Physician" or "Surgeon" is one who is duly licensed (1 ) to
prescribe and adminster drugs, and (2 ) to perform surgery
within the scope of his license.
I . "Employee" means all full -time, permanent employees of the
City of Huntington Beach working at least 20 hours per week.
J. "Plan" means Huntington Beach Employee Health Plan.
K. "City" means City of Huntington Beach.
L. "Retiree" means any retired Employee of the City who ( 1 ) has
retired on a service or, disability retirement, and (2) is not
eligible for Medicare, and (3) has not attained age 65.
M. "Accident" means a sudden, unexpected and unplanned event
occurring by chance which is caused by an independent
external force and which results in definite physical trauma.
N. "Relative Value Studies" (RVS ) . is a listing of medical and
surgical procedures published by the California Medical
Association with "Units" assigned to each procedure in
accordance with various medical criteria. The City provides
benefits which are valued by assigning a monetary value to
the RVS .Unit for covered procedures.
0. "Medically Necessary" services and/or, supplies are services
or supplies which the Claims Administrator's medical advisors
determine to be reasonably necessary and which are provided
in accordance with local community standards for care and
treatment of the illness or injury involved. The Plan will
provide benefits only for these services and supplies which
are determined to have been medically necessary at the. time
P. "Usual , Customary and Reasonable (UCR ) . Charge" is the amount
charged or the amount the Claims Administrator determines to
be the prevailing charge within the general area in which the
service was provided, whichever is the lesser.
Q. "Second Surgical Opinion" means certain surgical procedures
done on an elective basis shall be mandated to have a second
surgical opinion in order to be payable at normal plan
benefits, as specified in this Plan Document These surgical
procedures are as listed:
Cataract Surgery Varicose Vein Ligation
Cholecystostomy Tonsillectomy & Adenoidectomy
Hernia Repair Knee Surgery (Menisectomy )
Hysterectomy Hemorrhoider_tomy
L.aminectomy Dilation and Curettage
Mastectomy Report of Deviated Septum (SMR )
Onychotomy Spinal Fusion
Prostatectomy
6
PART II
ELIGIBILITY AND RECORDS
A. Eligible Participants shall be all permanent Employees
and Retirees.
B. The Participants may add, upon notice to the Claims
Adrn i n i stra tor•, other eligible Family Members, subject to
enrollment regulations in effect with the City. Immediate
coverage will be provided from and after the moment of birth
for each newborn child of a Participant covered by a
"Participant and one or more dependent" type coverage without
requiring evidence of insurability. Extension of coverage
for any condition commencing beyond thirty-one days from the
date of birth of a newborn child of a Participant covered
under a "Participant and one dependent" type coverage shall
be contingent upon application to the Claims Administrator by
the Participant in respect to each newborn child provided
such application is made within sixty days from date of birth
of a child in accordance with the enrollment regulations. An
application for coverage for a new spouse or new child roust
be completed within sixty days of marriage. An individual
who fails to enroll when first eligible must submit
satisfactory evidence of good health when the application for
enrollment is made.
C. MEA - Dependents of a deceased employee or a deceased retiree
shall remain eligible for participation in the medical plan
for a maximum of six (b) months after the death of the
ern,p 1 oyes or retiree.
D. MEO/Non Represented/PMA/FA/MSOA/POA - The Medical Plan shall
exclude coverage of pre-existing medical conditions of new
employees and dependents, except under the following
conditions:
a. The employee or. dependent is free from treatment for the
pre-existing condition for three months after the
effective date of coverage under the plan.
b. A pre-existing condition of the employee is covered after•
the employee completes six month of continuous
employment.
C. A pre-existing condition of any dependent who has been
enrolled on the plan is covered after the employee
completes twelve months of continuous service.
E. All Retirees and their eligible Dependents shall be covered
if:
1 . They were approved for coverage and ,covered by he prior
plan on October 31, 1979. These Retirees are as follows:
7
5U 0
NAME: DEPENDENT COVERAGE
1 . Stephen Arebalo Mary
2. Robert Baker• Linda, Stacie, Renee,
Robert
3. William Bruce Joanna
4. Ruth Burns None
5. Brander Castle None
6. Kier-an Chuba None
7. Helen Cowling None
8. Annabelle Cresswell None
9. Dola Dodd None
10. Richard Farrell H i l dr•eth
11 . Eddie Groom Violet
12. Virginia Kirkmeyer None
13. Fred Loya Jeannita, Michael , Lisa,
Robert Show, Matthew
Julian
14. Harold Mays None
15. Donald Moore Gertrude
16. John Sarver• Diane, Jay, Marc
17. Walter Sawyer Reeta, Jeffrey, Wendy
18. Donald Tryon Marilyn, David, Michael ,
Jennifer
19. Jar•r•ett Webb None
20. Jack Weide Billie
21 . William Welch Marilyn, William, James,
Jeffrey
2. They retired on or after 11/1/799 and
a. Made application within 31 days of r•etir• ing, and
b. Paid. a quarterly premium, as determined by the City
in advance. Retirees must continue to pay the
quarterly premium monthly cast, as determined by the
City, in advance to maintain coverage.
3. On the first of the month in which the retiree reached
age 65 or on the date the retiree can first apply and
become eligible for medical coverage under• Medicare
(whether or• not such application is made ) , benefits under•
this Document will be terminated.
4. Effective 1-1-86 if the spouse of an industrial
disability r.•etir•ee becomes an employee of the City of
Huntington Beach and elects family coverage under the
Employee Health Plan, the retiree can elect to cancel his
insurance coverage and be insured as a dependent . of his
spouse. Upon the spouse's termination of City insurance
benefits, the retiree can, without evidence of
insurability, become reinstated to the Employee Health
Plan at his own cost.
8
F. Family Members become ineligible under the following
circumstances:
1 . When the Participant becomes ineligible.
a. MEA - The date o.f. termination of coverage shall be
one week after an employee's separation from City
service.
2. When a child attains the age of nineteen years, or upon
upon prior marriage, except that:
a. In respect to an unmarried child attaining the age of
nineteen years, should he continue to be dependent
upon his parent (s) to the extent of not less than
fifty percent of his subsistence and support, his
eligibility for benefits hereunder shall continue
while he remains in such status until he attains age
twenty--•three,
Effective 1-•1-86 the definition of dependent child is
changed to require that children between the ages of
nineteen to twenty-three be either:
1 ) A full time student or
2 ) Lives at home and are dependent on the parent/
employee for more than fifty percent (50% ) of
his/her support.
b. In respect to an unmarried child attaining the age of
nineteen years, or twenty-three years when qualifying
as set forth in Paragraph a. above, should he at such
time be incapable of self-sustaining employment by
reason of mental retardation or physical handicap and
continue to be dependent upon his parent (s ) to the
extent of not less than fifty percent of his
subsistence and support, his eligibility for benefits
hereunder shall continue regardless of his age while
he remains in such status. Evidence of such
incapacity and dependency shall be required within
thirty-one days of the dependent's attainment of age
nineteen years or ; twenty--three years whichever is
applicable, and periodically thereafter as may be
required by the Claims Administrator, but not more
frequently than annually after a two-year period
following such dependent 's attainment of the
aforementioned age ] imitation. Determination of
eligibility by the Claims Administrator shall be
. conclusive.
3. A spouse upon entry of final decree of divorce or
annulment. The child, or spouse upon entry of final
decree of divorce or annulment, may, upon notice to the
9
5840
Claims Administrator wi
thin fifteen days of the dot y h e on
which the change in status occurs, apply for available
Group Conversion Policies on the basis and at such
subscription charges as are then in effect for such
categories.
G. The Claims Administrator shall issue for delivery to each
Participant an individual benefit booklet, setting forth a
statement of benefits to which the Participant and his
eligible Family Members are entitled, and an Identification
Card.
10
PART III
CONDITIONS UNDER WHICH BENEFITS WILL BE PAYABLE
IN A HOSPITAL OR SKILLED NURSING FACILITY
Benef its will be provided for• expenses incurred in any Legally
Operated Hospital or• skilled nursing facility under the following
conditions:
A. Benefits shall be provided for• expenses incurred in
connection with illness or accident, but limited to those
expenses billed by the Hospital or Skilled Nursing Facility
which are necessary for• treatment of the condition requiring
such care.
B. The attending Physician or• Surgeon must certify that bed care
is Medically Necessary,
C. Admission must occur• on or after• the Participant 's or• Family
Member•'s Effective Date hereunder.
D. The Participant 's Identification Card must` be presented at
time of admission or during the confinement stay. If such is
not done because of factors beyond the control of the
patient, benefits will be allowed only if claim is made
within ninety days from date of admission or• thirty days from
date of discharge, whichever is later•, accompanied by a
r•eceipted bill and such supporting statements as are
necessary to establish the claim.
E. Days of care under. : the above provisions shall be counted
against total days of care available under this Document.
F. Services for• i npat i ent bed care must be Medically Necessary
and not capable of being performed on an outpatient basis.
11
5840
PAR 1 IV
GENERAL LIMITATIONS
Benefits shall not be provided for:
A. Admissions primarily for diagnostic study when inpatient 'bed
care would not otherwise have been required, unless otherwise
specified herein.
B. Any condition for which benefits of any nature are recovered
or found to be recoverable, whether by adjudication or
settlement, under any Workers' Compensation or Occupational
Disease Law, even though the Participant or Family. Member-
fails to claim his rights to such benefits.
C. Services or supplies for which the Participant or• Family
Member is not legally required to pay.
D. Services or supplies for which no charge is made.
E. Care or treatment obtained from, or for• which payment is made
by, any United States Federal or foreign government agency.
F. Services or. supplies not specifically provided for herein.
G. Services or• supplies not connected with care and treatment of
an actual illness, disease or injury.
H. Treatment on or to the teeth, extraction of teeth, treatment
of dental abscess or granuloma, dental examinations, or
treatment of gingival tissues (gums ) other than for tumors;
eye glasses, eye refractions, eye examinations for the
correction of vision or fitting of glasses; or the furnishing
or replacement. of hearing aids, except as specifically
provided for under Major Medical if such benefits are
included in this Document.
I . Services or supplies for cosmetic purposes, unless performed
for correction of functional disorders or as a result of
accidental injury occurring while the individual is covered
hereunder.
J. Conditions caused by or arising out of an act of war•, armed
invasion or aggression, or any illness or injury occurring
after the Effective Date of this Document and caused by
atomic explosion or other release of nuclear energy, whether
or not the result of war.
K. Any services furnished by an institution which is primarily a
place of rest, a place for the aged, a nursing or•
convalescent home or any institution of like character,
unless otherwise specifically provided for herein.
12
I
1 . Custodial care.
M. Any services or supplies payable by Medicare, whether or not
claim for such Medicare benefits is made. On the first of
the month in which the Participant or eligible dependent who
becomes age 65 or on the date the Participant can first
apply and become eligible for any type of Medicare coverage
(whether or not such application is made) , benefits under
this Document will be modified and reduced so as to
supplement Medicare coverage.
N. Any procedure or treatment designed to . alter physical
characteristics of the Participant to those of the opposite
sex, and any other treatment or studies related to sex
transformations.
0. Reconstruction of prior surgical stem• i 1 i zat i on procedures.
P. That portion of charges in excess of Usual , Customary and
Reasonable Charges, as determined by the Claims
Administrator.
Q. Experimental : Experimental or investigative therapy,
including any type of therapy not generally recognized as of
value by the medical community and its societies, as
determined by the Claims Administrator in the reasonable
exercise of its discretion, is not covered; all other
charges, as for office visits or laboratory procedures,
incurred in conjunction with noncovered therapy will be
considered noncovered.
R. Care for Conditions of Pregnancy for Dependent daughters. No
benefits will be provided for any condition of pregnancy for
dependent daughters.
S. Outpatient Psychiatric Care. No benefits will be provided For
any psychiatric services performed on an outpatient basis.
T. Orthopedic shoes (except when ,joined to braces ) or shoe
inserts, air purifiers, air conditioners, humidifers,
exercise equipment and supplies for comfort, hygiene or
beautification, Educational services, nutritional counseling
or food supplements.
13
5840
PART V
COORDINATION OF BENEFITS
A. All of the benefits provided by the Plan are subject to the
following provisions and limitation.
B. Definitions:
1 . "Claims Determination Period" is a period beginning with
any January 1st and ending at 12 o'clock midnight on the
next succeeding December 31st, or that portion of such
period during which the covered individual was covered
under this Document. However, should this document
specify a benefit year which does not coincide with the
standard calendar year, then the "claim determination
period will coincide with, and run concurrently with,
the stated benefit year or portion of such benefit year
during which the covered individual was covered under
this document.
2. "Covered Individual " means the Participant or Family
Member eligible for covered services under this Document.
3. "Covered Services means any necessary, reasonable and
. customary item of hospital or medical expense incurred,
where at least a portion of said ,incurred expense is
covered under one or more of the Plans covering the
person for whom claim is made or service rendered.. To
the extent legally possible, "covered services" shall be
synonymous with allowable expense.
4. "This Document" shall have the same meaning as Plan
5. "Plan" . means any plan, contract or policy providing
benefits or services for- or by reason of hospital ,
surgical , or- medical care or treatment, which benefits
or services are provided by (a ) group, (b ) group hospital
or medical services organization, group practice, or
other type of group service prepayment coverage, (c ) any
group coverage under labor management trusteed plans,
union welfare plans, employer organization plans, or
employee benefit organization plans, (d ) any coverage
under any governmental program., or any coverage required
or provided by any statute "other than individual
policies or contracts" , (e) any group student coverage
provided, or sponsored, by a school or other educational
institution.
C. Effect on Benefits:
I . For any claims determination period to which this
provision is applicable, the services due and the
14
benefits that would be payable under this Document in the
absence of this provision for the allowable expenses
incurred during such claim determination period shall be
reduced to the extent necessary so that the sum of (a )
.such reduced benefits and (b ) all the benefits payable
for such allowable expenses under all other Plans shall
not exceed one hundred percent of Covered Services under
all Plans.
2. The services due or the benefits payable under this
Document shall be reduced in accordance with the
foregoing Subsection I . when the covered individual 's
other Plan.
a. does not contain a Coordination of Benefits provision
similar to this, or
b. the other Plan has a Coordination of Benefits
provision similar to this, and
( 1 ) this Document covers the individual as a
dependent while the other Plan covers him as an
.Employee; or
(2 ) this Document covers the Participant as the
child of a female Participant while the other
Plan covers him as the child of a male Employee•,
or
(3) this Document covers the Participant as the
child of a male Participant who has. been legally
separated or divorced from the mother- while the
other Plan covers him as the child of the
employed mother, except that if valid evidence
is submitted establishing that the natural
father has legal custody of the dependent child,
then in such case the order of benefits
determination shall be reversed; or
(4 ) this Document covers the individual as a
dependent child of a male Participant who has
been divorced from the subsequently remarried
mother while the other Plan covers him as the
dependent step-child of the Employee step-
father except that if valid evidence is
submitted establishing that the natural father
has legal custody of the dependent child, then
in such case the order of benefits determination
shall be reversed; or
(5 ) this Document covers the individual as a
Participant while the other Plan covers him as
an Employee, and the other Plan has covered him
for a longer period of time; or
15
5840
(6) this Document covers the individual as a
dependent of a Participant while the other Plan
covers him as a dependent of the same Employee,
and the other Plan has covered him for a longer-
per i od of t i me.
3. Effective Janaury 1 , 1987 the Department of Insurance has
implemented new Order of Benefit Determination rules
called the Birthday Rule.
a. Except for cases of dependent children of divorced or
separated parents, the health plan of the person
whose birthday (month and day, not year ) falls
earlier in the calendar year will pay first and the
plan of the other person covering the dependent will
be the secondary payer.
b. If persons with the two plans covering the same
dependents have the same birthday, the plan of the
person which has had coverage longer is the primary
payer.
C. If one of the two plans has not adopted the Birthday
Rule (such as if one plan is in another state) the
rules of the plan without the Birthday Rule will
determine which plan is primary and which is
secondary.
d. The divorced/separated parent rule specifies that the
health plan of the parent with court ordered
financial responsibility is not established the plan
of the parent with custody is the primary payer.
e. The retiree rule specifies that when a retired
employee has two health plans because of coverage
under a retirement health plan and as an active
worker covered by another health plan, the plan
covering the individual as an active employee will
pay first and the plan of the company from which the
worker is retired will pay second.
4. The Claims Administrator shall not be required to
determine the existence of any Plan or the benefits
payable under any Plan, when computing the services or
benefits due any covered individual under this Document.
The services due or the benefits payable under this
.Document shall be affected only to the extend that other
Plan information is supplied by the covered individual ,
any supplier of covered services hereunder, or any other
organization or person.
5. When a Plan provides benefits in the form of services
rather than cash payments, the reasonable cash value of
16
each service rendered shall be deemed to be both a
covered service and a benefit paid, The reasonable cash
value of any services provided to the covered individual
by any service organization shall be deemed an expense
incurred by said individual , and the liability of the
Claims Administrator under this Document will be reduced
accordingly.
D. Facility of Payment:
Whenever payments which should have been made under this
Document in . accordance herewith have been made under any
other• Plans, the Claims Administrator shall have the right,
exercisable alone and in its sole discretion, to pay over to
any organizations making such other payments, any amounts it
shall determine to be warranted in order to satisfy the
intent of this provision. Any amounts so paid shall be
deemed to be benefits paid under this Document and to the
extent of such payments, the Claims Administrator shall be
fully discharged from liability under this Document.
E. Right of Recovery
Whenever payments for covered services have been made by the
Claims Administrator and said payments exceed the maximum
amount of payment necessary . to satisfy the intent of this
provision, irrespective of to whom paid, the Claim
Administrator shall have the right to recover such excessive
amounts from any persons to, or for, or with respect to whom
such payments were made, or from any Insurance Company, or
any other organizations or persons.
F. Rights to Receive and Release Necessary Information:
For the purpose of implementing this provision and in the
interest thereof, the Claims Administrator• may release or
obtain any information deemed to be necessary with respect
to any person claiming benefits under• this Document. Such
information may be released or obtained without the consent
of, or notice to, the covered individual or any other person
or organization.
17
5840
PART VI
CONVERSION PR I V I I....CGE
A. When the Participant or Family Member ceases to be eligible
for coverage hereunder, coverage shall terminate
automatically without notice; however, such Participant or
Family Members shall be entitled, upon written notice to the
Claims Administrator within 31 days from the date that
eligibility ceases, to make application for a Group
Conversion Policy on the basis and at such premiums as are
then in effect for such program.
18
PART' V I I
GENERAL PROVISIONS
A. This Document, and the individual applications of Employees
shall constitute the entire Agreement between the parties and ,
all statements made by the City or by any individual
Participant shall , in the absence of fraud, be deemed
representations and not warranties, and no such statement
shall be used . in defense to a claim under this Agreement
unless it is contained in a written application.
B. 'This Medical Benefit Plan is not in lieu of and does not
affect any requirement for, o • coverage by Workers'
Compensation Insurance.
C. Subject to the conditions and limitations set forth herein,
if the Participant or Family Member• uses the services of a
licensed chiropractor or psychologist performed within the
scope of his license;, and payment for such services would
have been provided by this . Document if performed by a
Physician. or Surgeon, then such services shall be treated
as though they had been performed by a Physician or Surgeon
for the purposes of determining benefits hereunder.
D. None of the terms dr provisions of the charter, constitution
of by-laws of the Claims Administrator shall form a part of
this Document or• be used in the defense of any suit hereunder
unless the same is set forth in full herein.
E. The Employer and Claims Administrator shall not be
responsible for the furnishing of hospital; cure nor for the
quality thereof.
F. If the Participant or Family Member has duplicate coverage
with the Claims Administrator, benefits shall be limited to
an aggregate amount paid not to exceed 100% of the necessary,
reasonable, and customary medical expenses incurred.
G. No person other than the Participant or Family Member is
entitled to receive hospital cure or other benefits to be
furnished by the Claims Administrator under this Document.
Such right to hospital care or other benefits is not
transferable.
H. The hospitals (or Skilled Nursing Facilities if such benefits
are included in this Document) furnishing care or other
benefits, to the Participant and Family Member and the Claims
Administrator shall not be liable for any claim, or demand on
account of damages arising out of or in any manner connected
with any injuries suffered by the Participant or Family
Member while receiving care in any hospital or Skilled
Nursing Facility.
ty
5840
T . Notice of Claim. Properly completed claim form, itemizing
the service received and the charges must be sent to the
Claims Administrator by the Participant or the provider of
service. These claim forms must be received by the Claims
Administrator• within 12 months of the date services are
received. The Claims Administrator is not liable for
payment of the benefits if claims ar•e not filed within this
time period.
20
PART VIII
SECOND OPINION SURGICAL PROGRAM
A. Effective 1-1-84 certain surgical procedures done on an
elective basis shall be mandated to have a second surgical
opinion in order to qualify as a covered benefit. The
surgical procedures which would require a second opinion
if done on art elective basis are as listed below:
1 . Cataract Surgery excision of a diseased lens of the
eye.
2. Cholecystostomy - cutting into and draining of the
gallbladder through abdominal wall .
3. Dilation and Curettage -- expansion of cervix and
scraping of uterine cavity.
4. Hemor•r•ho i dectomy - surgical excision of hemorrhoids
(piles).
D. Hernia 'repair repair of an inguinal , femoral or
umb i ca l hernia.
b. Hysterectomy removal of the uterus (womb ).
7. Knee Surgery (Menisectomy) - removal of meniscus
cartilage of the knee.
8. Laminectomy - surgery on the spinal canal through the
vertebral arch.
9. Varicose Vein Ligation - repair of varicose vein.
10. Mastectomy - surgical removal of the breast.
11. Onychotomy - surgical removal of the nail of. a toe or
finger.
12.. Prostatectomy -. excision of part or all of the prostate
gland.
13. Repair of deviated septum (SMR ) -•• sub-mucous resection -
plast`ic surgical procedure to straighten nose.
14. Spinal fusion -• surgical fusion of two or more vertebrae.
15. Tonsillectomy and/or Adenoidectomy - surgical removal of
tonsils and/or adenoids.
B. The listed surgical procedures shall be considered elective
unless the attending physician certifies that the procedure
21
5840
was performed on an emergency basis without reasonable time
for a second opinion.
C. The second opinion will be rendered by a physician who is a
qualified Eoar•d Certified surgeon in the same speciality as
the original surgeon.
D. The second surgical opinion fees will be paid in full by the
Employee Health Plan subject to U. C.R.
E. Coverage by Employee Organization
1 . MEO/Non Represented:
Should an employee or• covered dependent elect a listed
surgical procedure without a second opinion or contrary
to the recommendation of a second or• third opinion, the
benefit charge will be reimbursed at 00% of the normal
benefits payable.
2. POA/MEA/PMA/FA/MSOA:
Should an employee or• covered dependent elect a listed
surgical procedure without obtaining a second opinion
no benefit will be payable.
3. FA/MSOA:
Once a second opinion is obtained and the individual
elects to have the surgery, the normal benefit will be
paid irrespective of the content of the second opinion.
22
PART IX
BASIC BENEFITS
A. BENEFITS FOR SERVICES AND SUPPLIES IN HOSPITALS AND ELIGIBLE
SKILLED NURSING FACILITIES.
1 . Days of Inpatient Care
a. Covered inpatient services or Skilled Nursing
Facility will be paid up to an aggregate of 100 days
during each Period of Disability.
b. A Period of Disability is a continuous inpatient stay
or a series of stays where dates of discharge and
readmission ar•e separated by less than 28 days.
However•, if inpatient care is required because of an
Accident within the 28-day period, a new Period of
Disability begins.
2. Hospital Pre Admission Notification
a. A hospital pre-admission notification to the Orange
County Medical Review (OCMR ) shall be required prior•
to hospital admittance for• non emergencies.
b. If the required notification is not given to OCMR,
the benefit entitlement will be subject to a $100
deductible against the charges for hospital costs.
3. Room Accommodations
Except when care is for• Mental Disorders, benefits will
be provided as follows;
a. 100% of charges for a room of two or more beds.
b. 1007 of charges for care in special treatment units
licensed by the State, such as intensive care and
coronary care un i ts.
C. If a private room is used, benefits will be
equivalent to 100% of the Contracting Hospital 's or
Skilled Nursing Facility's most prevalent charge for
a two-bed room.
4. Other Inpatient Services:
a. When furnished and billed by the Hospital , or• Skilled
Nursing Facility, all services and supplies Medically
Necessary for• treatment of the illness or• injury
requiring the covered confinement EXCEPT MENTAL
DISORDERS will. be provided at 100% of charges during
23
5840
eligible days of care, EXCEPT THE ACQUISITION COSTS
OF BLOOD AND BLOOD PLASMA AND THE CHARGES FOR
EXPERIMENTAL OR INVESTIGATIVE PROCEDURES AND
SERVICES.
5. Car•e for Mental Disorders
a. When care is for Mental Disorders, benefits as
described for Room Accomadations and Other Inpatient
Services will be provided at 50% of the Hospital 's or•
Skilled Nursing Facility's charges.
b. Skilled Nur•si.ng Facility
a. Prior care in a Hospital is not r•equ i red. before being
eligible for care in a Skilled Nursing Facility.
b. ADMISSIONS OR CONTINUED STAYS FOR CUSTODIAL OR
DOMICILIARY CARE ARE NOT COVERED.
7. Outpatient, Hospital Benefits
Benefits will be provided for 100% of the Hospital 's
charges for• services and supplies in connection with:
a. Surgery requiring use of operating facilities, and
the physician 's charges for the surgical procedure.
b. Treatment of an accidental injury within 72 hours of
the Accident, including necessary X-rays and
laboratory tests, and the physician's charges for•
professional services.
C. Usual , Customary and Reasonable Charges for required
medical testing done on an out patient basis prior to
admission to a hospital .
B. TOTAL DAYS OF CARE
Days of care provided in any facility shall be counted
against total days of care available under this Document.
C. BASIC PROFESSIONAL BENEFITS
Basic Professional Benefits are provided when they ar•e
Medically Necessary. These benefits are based on the
California Relative Value Studies -• Fifth Edition. A
representative sample of those Studies, with surgical
procedures and assigned Units, is included in this Document.
Professional procedures not listed in this Document may also
be covered. The Unit Value used in calculating Basic
Professional Benefits for Surgical Services, Professional
Anesthetist Benefits and Doctor Visits in the Hospital is:
24
$65.00 Per Unit
1. Benefits for Surgical Services
a. Surgical Services are defined as Medically Necessary
operative and cutting procedures for treatment of
diseases and injuries, and f-or reduction of fractures
and dislocations.
b. Primary Surgeon: Benefits are determined by
multiplying the number of Units specified for each
procedure in the California Relative Value Studies
Fifth Edition by the designated Unit Value..
C. Assistant Surgeon: If a benefit is paid to the
Primary . Surgeon and scope of surgery customarily
requires an Assistant. Surgeon, benefits will be
provided for one Assistant Surgeon who is not a
hospital intern, resident or house officer. The
benefit is 20% of the amount paid to the Primary
Surgeon, or one Unit - whichever is greater.
d. Benefits for Surgical Services are subject to these
conditions and limitations:
(1 ) The service must be performed by a licensed
Physician.
(2) The service mush be performed on or after- the
Participant's or Family Member's Effective Date
of coverage under this Document. However, if
the Member is already hospitalized prior to the
Effective Date, benefits for surgical services
will not be provided until after the Member is
discharged from that hospital .
(3 ) If more than one surgical service is performed
during one operative session in the same
operative area, payment will be made only for
the major procedure.
(4) If more than one surgical service is performed
during the same operative session in different
operative areas, maximum payment is made for the
major procedure, plus one-half the allowance for
the minor procedure which provides the next
greatest allowance. However, the total benefit
for the Primary Surgeon under these
circumstances shall not exceed 24.62 Units.
2. Professional Anesthetist Benefit
a. When the Participant or Famility Member is entitled
to hospital care and surgical benefits hereunder, the
25
5840
plan shall pay for services of professional
anesthetist, in accordance with the Anesthesia Units
listed in the California Relative Value Studies -
Fifth Edition and at the Unit Value designated in
Document.
b. The Units appearing in the Anesthesia column
represent basic values. To these will be added Time
Units, representing the actual time spent
administering the anesthetic. Time Units are based
on one Unit for each quarter-hour or major part
thereof.
3. Physician Visits in the Hospital
a. When a Participant or Family Member receives. covered
care in a Legally Operated Hospital or Skilled
Nursing Facility as a result of illness or injury and
no surgery is performed, payment toward the cost of
visits by the attending Physican shall be:
( 1 ) Up to .37 Units for the first visit during
eligible confinement, and . 123 Units for one
visit a day thereafter during the Period of
Disability.
b. Benefits will be provided for consultation services
by a Physician (EXCEPT STAFF CONSULTATIONS REQUIRED
BY HOSPITAL REGULATIONS) , if the Member is
hospitalized and the condition requires special skill
or knowledge for diagnosis and treatment.
( 1 ) Up to 37 Units will be allowed per bedside
consultation for a maximum of one such
consultation per admission.
4. Ambulance Benefit
a. Benefits will be provided for expense incurred by the
Participant or Family Member for necessary use of
local. surface ambulance service for- transportation to
or from the Legally Operated Hospital (or Skilled
Nursing Facility if that benefit in included in this
Document ) up to $50 for each covered inpatient
admission or conditions for which outpatient services
are payable.
D. CARE FOR CONDITIONS OF PREGNANCY
1 . Basic Benefits will be provided for Normal Delivery,
Cesarean Section and other Complications of Pregnancy for.
active employees and their spouse. Only complications of
pregnancy will be provided for Retirees and their spouse.
26
2. Hospital charges for routine nursery care of the Newborn
will be covered if the mother is the Subscriber or
spouse.
3. No benefits will be provided for dependent daughters.
E. ACCIDENT .BENEFIT
1 . If the Participant or Family Member is injured
accidentally while covered under this Document,
supplemental benefits up to $500. 00 for active Employees
anal $300.00 for Retirees will be provided for any one
Accident to pay Usual , Customary and Reasonable Charges
for the following services INCURRED WITHIN 90 DAYS OF THE
ACCIDENT, when these services are not covered in full by
other Basic Benefits.
a. Professional medical or surgical treatment by a
licensed Physician.
b Necessary services furnished and billed by a Legally
Operated Hospital , except for blood and blood plasma
and personal expenses.
C. Services of a Registered Nurse not related to the
Member by blood or marriage.
d. X-rays and laboratory examinations.
LIMITATIONS OF ACCIDENT BENEFIT
THIS BENEFIT WILL. NOT BE: PROVIDED FOR ANY INJURIES ARISING OUT OF'
OR IN THE COURSE OF EMPLOYMENT; PTOMAINE POISONING, DISEASE OR
INFECTION (EXCEPT INFECTION OCCURRING FROM AN ACCIDENTAL CUT OR
WOUND); EYE REFRACTIONS OR FITTING OF EYEGLASSES; OR AN
INTENTIONALLY SELF-INFLICTED INJURY.
27
5340
PART' X
MAJOR MEDICAL
A. The term "Major Medical " as used herein means only those
services and supplies listed below, and only to the extent
that they are not provided elsewhere herein. Services and
supplies . when provided or billed by any hospital or any
Skilled Nursing Facility, nursing or convalescent home in
connection with bed-patient care, shall be specifically
excluded. To be eligible for Major Medical , it will be
necessary that such be furnished while the patient is
covered hereunder in connection with diagnosis or treatment
of any illness, disease or accidental bodily injury, and be
authorized by a licensed Physician or Surgeon and for only
as long as such authorization is given. Upon receipt of due
notice and proof that the Participant or Family Member shall
have incurred expense for Major Medical , benefits will be
provided as follows:
1 Such expense must be incurred on or after the
Participant 's or Family Member's Effective Date of
coverage hereunder, or, in the event such person is
already hospitalized prior to such Effective Date, such
expense must be incurred subsequent to the date of
discharge from the hospital. An expense will be
considered to have been incurred on the date that the
individual receives the services for which the charge
is made.
2. Payment for such services shall be based upon charges not
exceeding the Usual , Customary and Reasonable Charges for-
such services in the community.
3. The Participant or Family Member will be responsible for
the first $100. 00 of expense incurred in each calendar
year for Major• Medical after becoming eligible for
benefits hereunder. However, no family shall be required
to satisfy more than an aggregate maximum deductible of
$300 during any one Calendar Year. Any expense for Major
Medical incurred in connection with an illness, disease
or injury during the last calendar quarter of any year
and applied against such deductible amount for that year
shall be carried forward to apply against the deductible
amount for the ensuing year. Also, if the Participant
and/or• one or more Family Members shall suffer a bodily
injury as a result of the same Accident, the aggregate
deductible amount applicable to all said persons, in
connection with total expense for Major Medical incurred
for such Accidet, shall be $100.00 for that year in which
the accident occurs. Separate deductibles will be
required for other• than the first year unless such
accident occurs during the last calendar quarter of the
year. In this event, the above stated provision
28
relating to the carrying forward of expense incurred to
the ensuing year will apply, and moreover, the provision
relating to the aggregate deductible amount applicable to
all said persons will also apply for the ensuing year.
Effective 1-1-85, the individual deductible had been
increased to $125 and to $375 per family. Deductibles
are calculated on a calendar year basis.
4. Stop-Loss
a. Other than Mental Disorders: When expense incurred
by the Participant or Family Member for Covered
Services and Supplies, EXCEPT FOR MENTAL DISORDERS,
exceeds the Deductible Amount, benefits will be
provided at 80% of Usual , Customary and Reasonable
Charges for those Covered Services and Supplies which
exceed the Deductible Amount until total paid Major
Medical benefits during the Calendar Year reach
$1 ,600. For the remainder of the Calendar Year,
benefits will be provided at 100% of Usual , Customary
and Reasonable Charges for Covered Services and
Supplies.
b. Mental Disorders: For in-patient psychiatric care
benefits will be provided at 50% of Usual , Customary
and Reasonable Charges.
C. Out-Patient Pre-Hospital Admission Testing: For
required medical testing done on an out-patient basis
prior to admission to a hospital , benefits will be
provided at 100% of Usual , Customary and Reasonable
charges.
d. Out-Patient Surgery: For surgery requiring the use
of hospital surgical facilities, surgical centers or
other- surgical facilities affiliated with an
accredited hospital which satisfies the definition of
hospital under this Plan Document, AND THE
PHYSICIAN'S CHARGES FOR THE SURGICAL PROCEDURE,
benefits will be provided at 100% of Usual , Customary
and Reasonable charges.
5. The Participant or Family Member who has received at
least $1 ,000.00 of benefits hereunder may apply for
reinstatement of maximum benefits by furnishing evidence
of good health satisfactory to Claims Administrator.
However-, notwithstanding the above, the Participant or
Family Member who has incurred expense hereunder which
has been charged against the aggregate maximum of
$1 ,000,000.00 shall automatically have reinstated toward
such maximum as of the last day of each Calendar Year an
amount of up to $1 ,000.00.
29
5840
6. Eligible services and supplies are:
a. Professional services rendered by a licensed
Physician or Surgeon.
b. Professional services rendered by a licensed
Physician or Surgeon or doctor of dental surgery for
treatment of a fractured jaw or other accidental
injury to natural teeth, providing that injury occurs
while the patient is covered hereunder. Such
services will be covered only during the six month
period immediately following the date of injury.
C. Professional nursing services of a registered
graduate nurse, other than one who ordinarily resides
in the Participant 's home or who is related to the
Participant by blood or marriage.
d. Administration of anesthesia by an anesthetist.
e. X-ray, radium and radioactive isotope therapy.
f. Services of a licensed physician or surgeon, or a
registered physical therapist, in connection with
physical therapy treatments, other than one who
ordinarily resides in the Participant 's home or who
is related to the Participant by blood or marriage.
g. Diagnostic X-ray and laboratory tests for treatment
of illness or Accident
h. Services of a licensed ambulance company for- local
ambulance services to or from a hospital or Skilled
Nursing Facility.
i . Drugs or medicines directly related to treatment of
an illness or injury, including contraceptives, which
require a written prescription and dispensed by a
licensed pharmacist or licensed Physician or Surgeon.
j. Artificial limbs or eyes, casts, splints, trusses,
braces, crutches, including rental of wheelchair,
hospital --type bed or iron lung required for treatment
up to a maximum charge of not to exceed the purchase
price of the equipment used. These supplies will be
limited to those reasonable required by standard
treatment practices for illness, disease or injury
occurring while the patient is covered hereunder.
Convenience or comfort items are not covered.
k. Blood transfusions, including cost of blood and blood
plasma.
1 . Services and supplies furnished and billed by a
30
�I
Legally Operated Hospital , except personal services
such as charges for radio, telephone, television and
the like, and private room charges exceeding the most
prevalent rate of the hospital for semi -private (two-
bed ) accommodations.
7. If these services and supplies are furnished by a
Hospital , the Claims Administrator reserves the right to
make payment directly to the hospital for• any eligible
charges.
B. Care for• Conditions of Pregnancy
1 . Benefits will be provided for Normal Delivery, Cesarean
Section and other• Complications of Pregnancy for• active
Employees and their• spouse. Only complications of
pregnancy will be provided for• Retirees.
2. No benefits will be provided for dependent daughters.
C. Chiropractic and Physical Therapy Guidelines
1 . Benefits will be provided as follows.
3 times a week for the first month of treatment
2 times a week for• the second month of treatment
1 time a week for• the third month of treatment
time a month for the fourth month and thereafter
2. These guidelines my be modified on an individual case by
case basis pursuant to .the recommendation of the Medical
Advisor.
D. Treatment by a California licensed certified .acupuncturist
will be covered to the extent that treatment is for pain
associated with injury or• illness.
31
5840
PART XI
TERMINAL BENEFITS
A. Should a Participant or Family Member be totally disabled at
the date of termination .of coverage and be under treatment of
a Physician, the services and benefits set forth in this
Document shall be furnished to the e::,:tent such services and
benefits relate directly to the condition causing such total
disability and for• 'no other condition, illness, disease or-
injury. Terminal Benefits shall be provided only when
written certification of the total disability and the cause
thereof has .been furnished by the attending Physician within
90 days from the date coverage is terminated under this
Document. Proof of continuation of total disability shall be
furnished to the Claims Administrator not less frequently
than 90-day intervals during the period that terminal
benefits are available.
B. Terminal benefits for total disability shall be provided:
1 . Up to a maximum period of 12 consecutive months, or
2. Until the maximum amount of benefits has been paid, or
S. Until the total disability ends, whichever occurs first.
C. For the purposes of this benefit, the Employee shall be
considered totally disaled when, as a result of bodily injury
or disease, such Employee is unable to engage in any
employment or occupation for which he or she is or becomes
qualified by reason of education, training or experience and
not, in fact, engaged in any employment or occupation for
wage .or profit. A Family Member shall be considered totally
disabled when such Member is prevented from performing all
regular and customary activities usual for a person of that
age and family status.
D. Terminal Benefits for total disability shall not be provided
if the Participant is required to pay the whole or any part
of the subscription charges required under the terms of this
Document and such Participant ceases to pay such premiums
while this Document is in effect.
32
PART XII
FEE SCHEDULE
FEE SCHEDULE (RV 74)
To determine the maximum 'allowance for any service, the Ref at i ve
Value Units indicated below will be multiplied by the value of
each Unit as previously designated.
The Units appearing in the Anesthesia column represent basic
values. To these will be added Time Units representing the
actual time spent administering the anesthesia. Time Units will
be based on one Unit for each quarter hour or major part thereof.
UNITS
Sur•g. Anes.
ABDOMINAL_
Appendectomy 5.8 5
Cholecystectomy 8.2 6
with common duct exploration 10.5 7
Colectomy, with anastamosis 12.0 6
with colostomy 13.5 6
Esophageal hiatus hernia
repair, transabdom i na l 11. 5 7
Esophagogastroduodenoscopy 2.9 4
with biopsy 3. 3 4
Gastrectomy, subtotal 12.0 7
total 16. 5 7
Gastrorrhaphy suture of
perforated gastric ulcer,
wound or injury 8. 3 6
Her•n i op 1 asty Her•n i or•rhaphy
Her•niotomy: Inguinal ,
unilateral over age 12 5.6 4
bilateral over age 12 8. 3 4
Umbilical , age two to 12 years 4.8 4
age 12 and over 5.5 4
Labar•otomy, exploratory,
if done alone 6.5 ;
Paracentesis, initial 0.5 0
Splenectomy 10. 0 7
BLOOD VESSELS AND HEART
Aorto--femoral bypass graft,
unilateral 16.5 12
bilateral 20.0 12
Carotid Thromboendarter•ectomy 15.0 6
Coronary artery bypass using
saphenous vein on two arteries 32.0 1
on three or more arteries 38.0 15
33
5840
UNITS
Surg. Anes.
Injection of sclerosing solution
into vein of leg, one 0. 15 0
two or more injections, same leg 0.25 O
Ligation, division and complete
stripping of long and short
saphenous veins
unilateral 5.0 3
bilateral 7.5 3
Permanent pacemaker insertion
with transvenous electrodes 7.0 6
BONES, JOINTS AND RELATED STRUCTURES
Arthr•oscopy of knee, with or
without biopsy 4.0 3
Ar•thr•oscopy of knee of
biopsy only 6.7 3
with ,Joint exploration for
removal of loose bodies 7.3 3
for excision of semi -lunar
cartilage (meniscectomy) 8.9 3
Arthrotomy of wrist for
biopsy only 3.6 3
with ,join exploration for
removal of loose bodies 4. 1 3
for synovectomy 5.8 3
Excision, wrist ganglion 2.7
Excision, Morton' , Neur•oma,
single 2.3 3
multiple, same foot 3.3 3
Joint replacement -- "total hip"
replacement 26. 0 7
Scoliosis correction,
Harrington rod technique 33.0 8
Spinal fusion (arthrodesis)
requiring i 1 i ac or other
autogenous bone graft. 18.5 7
BREAST
Excision of cyst or other
benign tumor., unilateral 2.9 3
bilateral 4. 0 3
Incisional biopsy of breast 2.3 3
Mastectomy
partial , unilateral 3.9 3
bilateral 5. 2 3
simple, complete, unilateral 5.2 4
bilateral 7. 7 4
34
UNITS
Surg. Antis.
modified radical , unilateral 10.5 4
radical , unilateral 12. 0 4
CHEST
Br•onchoscopy, diagnostic 2. 4 5
with biopsy 3.2 5
with. foreign body removal 3.2 5
Diaphragmatic hernia repair
tr•ansthorac i c 11 .0 12
Lobectomy, total or• segmental 15.5 11
Needle biopsy, lung or pleura 0.65 0
Pneumonectomy 18. 0 11
Throacentesis 0.45 0
Thoracoscopy, diagnostic, with or
without biopsy 2.4 4
Thoractomy, limited with
biopsy of lung or pleura 5.5 11
major with exploration and biopsy 7. 1 11
Wedge resection of enucleation
of lesions) 12. 5 11
EAR, NOSE AND THROAT
Adenoidectomy 1 .8 4
Antrum puncture with lavage,
unilateral 0. 25 4
bilateral . 4 4
Laryngoscopy, direct, diagnostic
(except newborn ) 1 .9 4
with biopsy 2.7 4
with removal of tumor• 3.8 4
Nasal polyp, excision, single 1 .0 A.
extensive, requiring hospitalization 2. 7 4
Sinusotomy, maxillary,
intranasal , unilateral 2.6 4
bilateral 3.8 4
Radical (Caldwelll-Luc ) ,
unilateral 7.7 4
bilateral 11.5 4
Stapedectomy, with
reestablishment of ossicular•
continuity 13.0 5
Submucous resection, nasal
septum 5.0 4
Tonsillectomy and adenoidectomy,
under• 12 years 2.4 4
35 ,
5840
UNITS
Surg. Anes.
over 12 years 2. 7 4
Tracheostomy 3. 1 6
Tympanoplasty without
mastoidectomy .13..0 5
EYE
Cataract removal , unilateral 11 .0 8
Chalaaion, excision, single 0.65 4
multiple, same lid 0.85 4
multiple, different lids 0.9 4
Corneal ulcer-, cautery 0. 8 4
Dacryocryoeystorninostomy 7.8 4
Lacrimal Grand, excision 6. 7 4
Nasolacrimal duct stenosis,
probing, unilateral 0.35 4
Pterygium, excision, without
graft 3.4 4
Retinal detachment, repair by
sc l er•a l buckling 15. 0 8
Prophylaxis, cryotherapy
or laser 5.8 4
Strabismus correction, one
or both eyes, one or two
muscle procedure 7.9 4
FRACTURES (SIMPLE, CLOSED REDUCTION)
Clavicle 1 .8 3
Femur, shaft 5. 3 3
proximal end 6.3 3
Finger 1 . 1 3
Forearm:
Radius, distal (Collies type )
under- age 12 2.0 3
age 12 and over 2. 7 3
Radius, shaft, under age 12 2.5 3
age 12 and over 2.9 3
Radius and ulna, shaft,
under age 12 3.3 3
age 12 and over 4.0 3
Legs:
Tibia, distal 2.3 3
Tibial , shft, under age 12 3.3 3
age 12 and over 4.0 3
Tibia and fibula, shaft
under age 12 4.2 3
I
age 12 and over 5. 8 3
36
LINITS
Surg. Anes.
--ma11eoIar 3. 2 .3
Tr• i -•ma l 1 eo l ar• 4.0 3
Toe 0. 65 3
The amounts shown are for• simple closed reductions.
If the fracture requires an open operation, an additional
allowance will be made.
GYNECOLOGY AND OBSTETRICS
Barthlin 's cyst or abscess,
incision 0-.6 3
mar•sup i al i zat i on 2.2 3
Cervix: Local exicision of lesion 0. 4 3
Cauterization, electro or
cr•yocautery 0.4 0
Cesarean Section 7. 9 6
C:ystoce 1 e repair 4•.7 4
Dilation and curettage,
diagnostic or therapeutic,
non maternity 2. 7 3
for• therapeutic abortion 3.7 3
Ec topic pregnancy, requiring
salpingectomy or
salpingostomy 8.3 6
Hysterectomy
Abdominal , with or• without
tubes 'and/or ovaries 10.0 6
Vaginal , with cystocele
and/or• rectocele repair 10.5 5
Labparoscopy, diagnostic 3. 8 5
with biopsy 4.6 5
Rectracel a repair• 3. 7 4
Tubal ligation, abdominal
or• vaginal approach 5.6 5
after• delivery, same
hospitalization 4.3 5
by laparoscopy 4.6
Vaginal repair, including
cystocele and rectocele 6.4 4
MALE GENITAL SYSTEM
C i r•cumc i s ion, clamp procedure,
newborn 0.4 0
except newborn, hospital 1.2 3
Hydr•ocele, excision, if done alone,
unilateral 4.6 3
37
5840
UNITS
Surg. Anes.
bilateral 7. 1 3
Needle biopsy, prostate 1.0 3
Orcn i opex:y, with or without
hernia repair, unilateral 6.7 4
bilateral 10.5 4
Prostate, tr•ansur•ethral
resection, including
vasectomy, complete care 11.5
Prostatectomy, perineal ,
subtotal 11 .5 6
perineal , radical 15. 0 6
r•etr•opub i c 11 .5 6
suprapub i c, one or two
stages 11 . 0 6
Var• i cocel e, e::<:c i s i on unilateral 4. 7 3
Vasectomy, unilateral or bilateral 2. 1 3
NERVOUS SYSTEM
Brain cyst, neoplasm or abscess,
excision: supratentorial 20. 0 11
Burr holes only for evacuation of
e:x:tradura l or subdura l hematoma 14.0 9
Decompression and neurolysis of
median nerve at carpal tunnel 5.0 3
Injection procedure for myel ography 1 .3 4
for discography 1.8 3
Lumbar l am i nectomy for herniated
inter•ver•tebr•al disc, unilateral ,
one interspace 13.5 7
Spinal puncture, diagnostic 0. 4 0
RECTAL.
Abscess, . ischior•ectal and/or
per• i r•ec to 1 , incision and drainage 1. 4 3
perianal , incision and drainage . 0.35 3
Colonoscopy, beyond splenic flexure 4.2 4
with one or more biopsies 4.6 4
Colonoscopy, beyond 25 centimeters
and below sp1enic flexure 2.9 4
with one or more biopsies 3.3 4
F i ssur•ectomy, if done a'l one 3. 1 3
Fistulectomy, or fistulotomoy,
subcutaneous 1 .7 3
submuscular• 5.6 3
Hemorrhoid, enuc 1 eat i on of
external thrombotic 0.45 3
38
UNITS
Surg. Anes.
Hemorrhoidectomy, internal and
external 4.5 3
Proctectomy, complete, combined
abdominoperineal , one or two stages 15. 5 7
Proctosignmoidoscopy, diagnostic 0. 4 4
with biopsy 0. 75 4
THYROID
Adenoma, excision 6.2 5
Parathyroidectomy or exploration of
parathyroid 11.5 6
Thyroglossal duct, cyst or sinus,
excision 7.2 5
Thyroidectomy, subtotal or partial 8. 9 6
total or complete 97 b
TUMORS AND CYSTS
Parotid tumor, removal , superficial 3.8 4
Parotid gland excision, total , with
preservation of facial nerve 11.0 6
Pilonidal cyst or sinus, excision,
simple 1.3 4
extensive 4. 6 4
Skin lesions (surgical allowances
include local anesthesia )
Benign lesions of skin and excision,
single,. depending on size and area 0. 4 to
0.8 3
Cauterization or fulguration of
local lesion, single, small ,
depending upon type of method
and lesion 02 to
0.35 3
Malignant lesions (e.g. Basal cell
carcinoma ), excision, single, depending
on size and area 0. 8 to
2.7 3
Sebaceous cyst, incision and drainage,
excision: refer• to benign lesions 0.45 3
Skin tags, excision,
multiple up to 15, any area 0.3 3
URINARY SYSTEM
Cystoscopy, office, diagnostic 0.65 0
39
5840
UNITS
Surg. Anes.
with ur•eta 1 catheterization 0.9 0
hospital 1 .2 3
with ureteral catheterization 2. 1 3
with removal of stone from
bladder or urethra 2. 3 3
Nephr•ec tomy 11 .5 E,
Pel v i of i thotomy with removal
of calculus 11 .5 b
Ureter•ol i thotorny, upper• or•
lower third of ureter 11 .5 5
middle third of ureter• 10.5 5
X-RAY OR RADIUM THERAPY
X-ray or• radium therapy in lieu
of sur•ger•y for• malignancies, neo-
p last i c disease or• fore postoperative
care for• malignancies..
Pre Treatment Allowance:
Superficial or• low voltage 2.0
Supervoltage including cobalt
sources 5.0
40
PART XIII
ADMINISTRATION OF THE PLAN
A. Appointment of the Claims Administrator
The City shall appoint a Claims Administrator who shall
handle claims under Plan in accordance with its terms. The
person, persons or entity serving as Administrator shall
serve at the pleasure of the City.
S. Powers of the Claims Administrator•
The Claims Administrator shall have such powers as necessary
for the proper• handling of claims for benefits under the
Plan, including, but not limited to, the following:
1 . To prescribe procedures to be followed by participants in
filing applications for benefits and for furnishing
evidence necessary to establish their rights to benefits
under the Plan;
2. To find facts and make determinations as to the rights of
any Participant applying for or receiving benefits under
the Plan and to afford any such Participant dissatisfied
with any such finding or determination the right to a
hearing thereon;
3. To make benefit payments directly to Participants and/or
their assignees entitled to benefits under the Plan;
4. To obtain from the City, Participants and others, such
information as shall be necessary for the proper
administration of the Plan;
i
O. To keep records regarding the administration. of the Plan;
6. To furnish to City upon request such data with respect to
the administration of the Plan as is reasonable and
appropriate; and
7. To collect, evaluate, analyze and prepare statistical and
other data with respect to the administration of the
Plan.
The Claims Administrator• shall have no power to add to or
subtract from or to modify any of the provisions of the flan,
to change or add .to any benefit provided by the Plan, or to
waive or fail to apply any requirements of eligibility for a
benefit under the Plan.
No determination of the Claims Administrator in one case
shall create a basis for retoractive adjustment in any other
case.
41
5840
C. Claims Procedure
The Claims Administrator shall be required to give written
notice to any Participant who makes a claim for the
commencement or continuation of benefits under the Plan which
claim is denied Such notice shall be sent to the
Participant 's last known address. The notice shall be send
forth the specific reason or reasons for the denial of the
claim and shall include a specific reference or. r•eferences
to pertinent Plan provisions upon which the denial is based,
a description of any additional material or information
necessary for the claimant to perfect his claim, which
description shall indicate why such material or information
is needed, and an explanation of the Plan's claims review
procedure.
0. Appeal Procedure
In the event that the claim is denied and the claimant lushes
to appeal his claim's denial , he or his duly authorized
representative shall file a written request for a review,
which request must ,be made within 60 days of the receipt by
the claimant of the notice of his claim's denial . The
claimant or his representative my review pertinent documents
relating to the claim and its denial and may submit issues
and comments in writing to the Administrator who shall make
a decision on the merits of the claim as 'soon as practicable
but not later than 120 days after receipt of a request for
review. The decision on review shall be in writing and
shall include specific reasons therefore and specific
references to the pertinent Plan provisions on which the
decision is based.
In the event the claimant is dissatisifed with the
Administrator 's final decision, the claimant may request that
the claim file be sent to the City's Medical Review Advisors.
The claimant shall indicate in writing the reason or reasons
for disagreement with the Admd i n i str•ator• 's decision and shall
submit such written materials to the Administrator. The
entire file shall be transmitted to the Medical Review
Advisors by the Administrator along with any additional
written materials submitted. by the claimant. The Medical
Review Advisors shall review the file and render a written
decision on the claim to the claimant and the Administrator
and there shall be no futher• appeals,
E. Limitation of Liability
The Claims Administrator shall be entitled to rely upon
. information from any source in good faith to be correct.
42
PART XIV
DURATION AND AMENDMENT OF THE PLAN
A. Permanence of the Plan
The Plan shall continue in full force and effect unless
terminated, modified, altered or• amended by the City as
provided in the article.
Although the City has established the Plan with the bona fide
intention and expectation that it will be able to make
contributions indefinitely, nevertheless the City is not and
shall not be under• any obligation or• liability whatsoever to
maintain the Plan for• any given length of time. The City
may, in its sole and absolute discretion, discontinue or•
terminate the Plan in accordance with its provisions at any
time without liability whatsoever• for• such discontinuance or
termination.
B. Right to Amend
The City reserves the right at any time and from time to time
to modify, alter•, or amend, in whole or• in part, .any or• all
of the provisions of the Plan, provided, however, that no
such modification, alteration or• amendment which
substantially increases the duties, obligations or•
liabilities shall be made without the consent of the
appropriate party. Notwithstanding the foregoing, any
modification, alteration or• amendment of the Plan may be made
retroactive to the Effective Date if necessary or• appropriate
for the Plan.
43
5840
PART XV
ADMINISTRATIVE PROVISIONS
A. No Limitation of Management Rights
Participation in the Plan shall not lessen or otherwise
affect the responsibility of an Employee to perform fully
his duties in a satisfactory and wor•kmanklike manner, nor
shall it affect the City's rights to discipline, discharge,
or take any other action with respect to an Employee.
G. Participant 's Responsibilities
Each Participant shall be responsible for providing the
Claims Administrator with his current address. Any notices
required or permitted to be given hereunder shall be deemed
given if directed to such address and mailed by regular
United States mail . Neither the Claims Administrator nor the
City shall have any obligation or duty to locate a
Participant. In the event a Participant becomes entitled to
a payment under the Plan and such payment cannot be made ( i )
because the current address referred to above is incorrect,
( ii ) because such Participant fails to respond to the notice
sent to the current address referred to above, ( iii ) because
of conflicting claims to such payment, or ( iv ) because of any
other reason, the amount of such payment, if and when made,
shall be that determined under the provisions of the Plan
without interest thereon.
C. Missing Person
If , within five years after any amount becomes payable
hereunder to a Participant the same shall not have been
claimed, provided due and proper care shall have been
exercised by the Claims Administrator in attempting to make
such payment, the amount thereof shall be forfeited and shall
cease to be a liability to the City.
D. 'Governing L.a►ai
The Plan shall be governed by and construed in accordance
►=pith the federal laws governing employee benefit plans, and
in accordance with the laws of the State of California where
such laws are not in conflict with the aforementioned federal
laws.
I
44
ad*
00
L0
t y
ADVANTAGES - HOW IT WORKS ' {
�'� I WHO ARE PM{ MEMBERS {
` NO CLAIM FARMS—The dental location When you enroll in PMI,select a Participating ;
YOU choose provides all dental services.No Dental Group from the list of officesenclosed; i People`lust like yourself. Many employers, PREPAID
claiim,farms are needed. This location is now the center for air of your unions and organizations throughout Califw
dental needs. nia now make PMI available to their employ-
0 NO DEDUCTIBLES—In our plan there are { ees. Some of these companies, unions and DENTAL CARE
After you have enrolled,you will receive from { organizations are: /� A■R
no rtequfred deductibles,so)sour benefits PMI a brochure that fully describes the benefits
begin immediately! of your dental planes ureliasa PMI membership } 1. Rohr Industries,Inc. PROGRAM
card. This card will have the address and tele- 1 2. San Diego State College
• NO DOLLAR LIMIT OF DENTAL phone number of your PMI pane.dentist.You I 3, Aerojet-General Corporation
BENEFITS--No annual maximum. simply call to make an appointment to receive { 4. McDonnell Douglas Corporation PROVIDED THROUGH
all necessary dental care covered by the plan. 5. Lockheed Corporation
` NO PRE-EXISTING CONDITIONS Remember to always contact your selected 6. California State University
RESTRICTED—These conditions are not dental provider.DENTAL SERVICES WHICH 7. State of California
excluded in a PMI plan.Exception; ARE NOT PERFORMED OR AUTHORIZED 8. FMC t
/nprtoceas w0tiodontia. BY PMI WILL NOT BE COVERED BY PMI. 9. Hydraulic Research {
Changes in dental facilities can only be done j 1 , ROLM Corporation
at an annual o 11 Weber Aircraft S PMI
re QUALITY REVIEW OF DENTAL pen enrollment period, unless
PROVIDER—On-aft audit of participating authorized by PMI for good reason.The trans- i
dental location to insure that certain fer would then take effect on the first of the I
W month following written notification from
_ standards tit quality ere rnaimarrred. the subscriber.
E" sP£c1ALTY sERVICEs—PMi offers
WHO CAN JOIN t
W services in an dental specialties.These Eligibility for the benefits of this program have If you have any quest or
irtCkrde periockrnUcs(treatment!of diseased need additional information,Call
been established for employees of the City of
gums and bone),endociontim(root canal Huntington Beach. TOLL FREE FOR
W itrerapy),end oral surgery procedures. If you meet your company's eligibility (800)422-4234 No.Calif.
requirements for dental coverage you can join (800)325.4529 So.Calif. ELIGIBLE EMPLOYEES
• ORTHODONTIA—Available et a greatly PMI.You can also enroll your eligible dependeMs, i or
reduced tee lawful spouse and unmarried dependent children OF
(including stepchildren and legally adopted { (213)493.6661
• EMERGENCY SERVICES—As a member children)except any children 19 years of age or or write CITY OF
over who are in full-time employment. PMI I
you are eligible for emergency treatment. HUNTINGTON BEACH
CaN your selected participating dental since sere are no bereft for serener anesthesia or for routine 5122 Kate118 Ave.,Suits 206
provider to receive the necessary dental proceduresdoreoutsdeyourassgnedpanetafttce,tamve Los Alamitos,CA 90720-2804
Cara.Members are also covered for with members with unique physical or simotional conditions
should contact PMI for specific in6miabon on benefit MUNICIPAL EMPLOYEES ASSOCIATION
out-of-area dental emergencies This limitations before deciding whether to enroll in the Pill POLE pFRCERS ASSOCtXT1ON
program wo pay dental expenses incurred Program i
UP 10 a maximum of$10D.00 during each 12 Conditions which might prevent utduation of Pmi dental : POLICE MANAGEMENT ASSOCIATION
calendarmor#hs. "Out of Area"means 35 benefits would include
miles or more from your PM/dentist's office. 1..physical or emotional resistance or energy to all
commonly utilized local anesthetics. i
2.extremely contagious diseases which might endanger d
the staff and patents of a typical general denestry iffkC
and NOTE
3, seve.medical problems which would make dental This is only a brief summary of the.plan.The health Plan SUMMARY PLAN DESCRIPTION
+ therapy at a typical general dentistry Olt"unwise. contract must be consulted to determine the exact terms and
conditions of coverage.An Evidence of Coverage will be sent
to you upon receipt of your enrollment card
fl/ail ,�st t
i
i
I-
0
00
d-
to
DESCRIPTION OF BENEFITS Culture canal No Cost SUMMARY OF LIMITATIONS
DENTAL'HEALTH PLAN Roe canal therapy(per.canal} .No Cost"
Afrdrrted.ith ikhs 0."RM, AND CO-PAYMENTS Roc amputation . .i No cost I.Prophylaxis limited to 2 treatments in my 12
These services are performed as needed and deemed 'm and filling canal ... No Cost coruscubw moons.
T
Apicoactomry on separate appointment No Cost ,
necessary by your attending PMI P"Demo subject to REST(WT1VE DEKMTRY 2.Full upper and/or fewer dentures are not to aimeed
The eaalusbnm limitations and governing administrative Amalgam Restorations Primary Teeth one each any eo consecutive months from the lots
procedures of the plan. Cavities involving 1 tooth surface ..........No Cost filet made under"plan.Replacement we be
mum Cavities iriwtvmg 2 tootle surfaces ...:....tks Cost provided by PLO bran existing tfershure a bridge
A NEW APPROACH VISITS AND DIAGNOSTIC PAYS i!�n9 3 or mare torts surmoea No cost a o„y it K is unsatisfactory«nil rx+„h>Qa be mile
T O DENTAL CARE Oral � f)non/ Ifice vast ..No Cost Amalgam Restorations Permanent Teti, satisfactory by ewher MUM or repair.
Emergency treatment,palliative No Cos Cavities wwotvahp 1 tooth surfer .No Cast
Specialist consultation ...No Cost Cavities involving 2 tooth surfaces ...... No Coat , s Partial dentures we not to be^>r> witfniti any
vrafity testa.. .......... No Cost Cavities irWvng 3 or mare tooth surfaces..,No Cast eo consecutive month period unless necessary due
PROPHYLAXIS AND FLUORIDE TREAIVEMS Silicate,Acrylic,Plastic Restorations to natural tooth loss where the addition or
PM I offers you an alternative way to P'ophylexis_2 treatments No Cost SAsc� ceiment min No Cost replacement d ttseth to the eadating partial is not
per any 12 month period..: g :N Cal
provide you and your family's dental Topical Fkxxide-to age 18 only..............No cost Pn build-up...................
care needs— economically and con- ROENMENOLOOY C"� No Cost +'Denture refines Ifmitsd '° the during any re
venlentl
y Full mouth x-rays or Panorex nc wth mites No Cost consecutive months.
Add Single -gry 2 yes•• ..No CCost A lain .No Cost &Five periodontal treatments during any 12
x-ray Porcelain
wan metal. .No Cost consecutive months.
• As a member of PMI, you will .......No Cost
up to and including 13 f lms ....No Cost Gob unsay o 314 crown .No Cost & aim-wing x-rays smiled to not more Man one aeries
_ receive coordinated, continuous and Bse•wnng x-rays-not more Man 1 series st.tin sleet(primary) .No Cost of 4 films In any sk month period.
^ accessible dental care in a manner of 4 films in any six morns period ......No Cost stainless a"(permanent) .No Coe
'O hntra-oral,occlusal view, Removable acrylic space mtamtarner No coot 7. Full mouth x taya limited Io one ea every 24
that is personal,warm and efficient. maxifary or mandibular. .. .......No Cost Fixed fir post ,band ripe ,No t;� consecutive .
rE•+ Extractions uR� i Dowel
uildd-up. No Cost S. Fixed bridges wa be towered only when a partial
PMI has contracted with a network of
r local a esthet � ) ..No Coe PROSTHETCS txresc tf Nporiy reatoe the owe.
'-" private dental offices throughout the surgcel extractions No cost PoMica
x O state of California. As a member of (sutures).``° ._No Cost Tru pon!x type... No Cost
WPMI you select from any of these 11"Removed d tooth lit tissue) ..No Coat Porcelain pper to tal gold........ .......:No Cost
dental locations and go to the office for Removal of towh(Partially bony) ,No Cosh Dentures
d bot
h oth(completely bony) .No Cost denture all of your dental care needs. This of ofal tissues .. .No Coe Mandibular re .No�' SUMMARY OF EXCLUSIONS
network of dental offices is composed Amo ry edentulous per quadrant No coat Partial uppernower(each) ..... ........No cost
Of ' established dental grOUps—not Alveolectionny
Palista aid ridge extension per arch ..N C Stress breakers,per unit .No Cod I.Coamoft dental tom•
clinics. We have found that most Mandibular fond........ .....No Coe Tom+'aria pas unit .:, too rose 2.Any condmori ll rwhich benatits are recovered o
Denture and partial adjustments No'Cwt
people feel more secure and comfor• FLocal nesthabcs.. :. No Cost Denture and partial repairs .:: No Cost under any Worker's compensation or
table if the same dentist continues t0 anal eanesthesiathetics.rot extractions o.. end......No Cow Addng 'to existing partial or denture .No Cost °°eupaaonal disease law.to the extent of was
only when for necessary.. No Coat Ofhce refine .. No Cat benefits (exoept " regular benefits will be
•. . Laboratory refine No Coe Pv*AdW it PMtreat them personally. PERIODONTICS 2r Tissue conditioning.2 per denture............No Cost Compensation or otheir ry� a
Emergency triantnnent(periodontal abscess Recerr atio n
f-after reading the following material acute per,odwnntis,etc.)..... ....No Cost Inlay .... . No Coe 3. Hospital charges of any kind.
you'decide that the PMI dental plan is Subgingival wmetage, Crown.. .No cost
for you—fill out the enclosed enrol• (ram ptann9 Per quadrant) •. st Bridge .......... ....... ..........No Cost
4.Major surgery d hacures and dislocations,
Gngiv�omy.per quadrant..............
No Co
No Cost ORTHODONTIA(excludingp$M.00 start-up Nei)) G Loss or theft of dentures a bridgework.
Iment card and join thousands of Gangnrectomy,per tooth Fhb banded case Includes adult coverage)...s500.0
satisfied PMI members. ((�lt r�ri 6 } No Cost G. Lost,sbkn.or fi n orthodontic appliances
osseous or muootlingsvei surgery. FAILURE TO CANM APPOINTMENT ;t0A0"
per Quadrant ....No Cost (24 tour prior notification).................
ENOODONTICZ EMERGENCY VISIT
Pulp capping.............................No Cost After normal via"hours ....... $20.00
Pulpo err a rs weave uo"
vitalPutt .. .. No Cost -PAN www rnb potomy ...
NO cost
Temporary flitting with CaOH... .....No Cast Ms'Pamir"not rare isrwNede on r kabrrvMcr toe.
CITY OF HUNTINGTON BEACH 3561 j
COMPARISON OF INDEMNITY PLANS
(Reflects PERS 8/1/87 Changes)
CURRENT PROPOSED CITY PLAN
BENEFITS PERS MEDICAL - CWO CITY PLAN EMPLOYEES RETIREES
Inpatient Hospital 100% PPO Hospitals- after 100% - No deductible 100% - No 80% after
deductible deductible deductible
60% Non PPO Hospitals - after
deductible
85% Non PPO Hospitals in areas
without PPO Hospitals - after
deductible
Deductible $200 per person, $500 per family $125 per person, $150/$400 $200/500
maximum $375 family maximum
Maximum Out of $2,000 (may be higher - policy $400 $550 $1,000
Pocket Employee unclear)
Expense (Excludes
Deductible)
Accident Benefit None (covered same as other $500 $500 None
Medical expenses) (Covered
same as
other
expenses)
Prescription Drugs Additional deductibles as follows: 80% after normal PCs PCs
$4 deductible per prescription ($125/375) deductible $4 - $6 $4 - $6
for generic, $6 deductible per
prescription for non generic
Major Medical 85% PPO doctor - after 80% after deductible 80% after 80% after
deductible deductible deductible
60% Non PPO doctor - after
deductible
� 80% X-rays, lab, etc.- after
C) deductible
EXHIBIT "G"
UNIFORM POLICY
A. General - The City, in accordance with agreements now established, shall furnish
uniforms to those personnel designated by the various department heads as required
to wear a standard uniform for appearance, uniformity and public recognition
purposes, in the procedures and guidelines set forth hereinafter.
B. Affected Personnel - All employees categorized as field working assignees shall
wear a standard City adopted uniform. Color selection is a light blue shirt and dark
blue trousers with appurtenances as described below. Each Department Head shall
determine which group of employees must wear a uniform.
C. Basic Uniform Components and Standard Allowances:
1. Black safety toe shoes or boots as each assignment dictates.
a) Two pair per year.
b) Boots will be black, heavy duty and laced.
c) Damaged shoes shall be turned into operating supervisor who shall
authorize replacement or repair.
2. Five short-sleeved shirts (light blue) the first year, three the second
year, and then alternate five uniforms with three uniforms in subsequent
years.
3. Five trousers per year (dark blue) the first year, three the second year
and then alternate five trousers with three trousers in subsequent years;
trousers are to have no cuffs.
4. Dark blue jacket with removable liner, one per year.
5. Four City departmental patches.
6. Absolutely no allowance will be made for socks, underwear, etc.
7. Hard hats, foul weather gear, and steel-toed rubber boots to be furnished
each employee with supervisor designated need.
8. Special hazard gloves shall be furnished with supervisor designated need.
9. Safety glasses and face shields shall be furnished with supervisor
designated need.
10. Special uniforms shall be furnished.
11. Ear protectors, arm and shin guards, steel shoe caps, wood heat resistant
soles, and other safety regulated equipment shall be furnished to
supervisor designated employees.
12. R-1 safety vests shall be furnished all employees having occasion to work
within travelways.
5840
EXHIBIT "G"
(Continued)
D. Employee Responsibilities:
1. To wear complete uniforms at all times.
2. To wear clean uniform.
3. To wash and provide minimum repair; i.e., buttons, small tears, etc.
4. To provide any alterations necessary including sewing on of City patches.
5. To not wear for other than City duties or work.
6. To notify supervisor of need to replace due to disrepair or severe
staining producing an undesirable appearance.
7. To turn in all patches upon termination prior to receiving final check.
8. To turn in all uniforms upon termination.
9. To turn in all safety equipment upon termination.
10. To wear all safety equipment prescribed by the City safety officer and
supervisor of the division.
E. City Responsibilities:
1. To furnish funding for the agreed to uniform allowances.
2. To allow department heads to authorize additions to the basic allowances
due to severity of work assignments and frequency of wearing out.
3. To provide and maintain one or more retail clothing outlets for the
various allotments. City reserves the right to name vendor.
4. To make arrangements for the standard allotments to be of first line
quality work clothing.
5. To maintain records of purchases. Forms for uniform requests will be
provided by the Director of Finance.
6. To establish an expedient procedure for reimbursement to employees for
uniforms purchased by employees.
F. Department Head Responsibilities:
1. To direct and assure employee compliance with attire rules.
2. To inspect clothing requested to be replaced.
3. To determine wear frequencies for employees having needs additional to
basic allotment.
-2-
0621X/
5840
EXHIBIT "G"
(Continued)
4. To insist on replacements of deteriorated clothing with special attention to
safety equipment and apparel.
5. To enforce q disciplinary program for repeated violations of employee
regulations relative to cleanliness, uniform attire, or safety requirements.
6. To demand and confirm receipt of turn in required equipment upon
termination.
G. Purchases and Exceptions:
1. Clothing shall be purchased at only those outlets as directed by City, unless
prior approval is obtained due to size, out of stock, or special type of clothing
problems which exist.
2. Shoes or boots shall be purchased through standard outlets designated unless
last creates discomfort or injury risk.
3. Safety glasses must be purchased only through designated outlet for City
specified amount of dollars, with employee paying the cost for the
examination by a private optometrist to obtain a prescription and cost of
cosmetic lenses and frames.
4. All safety and foul weather gear shall be purchased by the City.
5. Uniform appearance:
a) Patch to be worn above left shirt or jacket pocket.
b) Pants to have no cuff.
c) Worn with pride in appearance to public; i.e., shirt buttoned, shirt tail
tucked in, etc.
6. Exceptions at discretion of Department Heads:
a) Supervisors need not wear uniform; however, in so electing, must pay for
their own clothing.
b) Employees who have foot deformities or conditions which do not allow
wearing of safety-toed shoes shall wear external caps affording equal
protection.
c) Additional patches shall be furnished to equip the special clothing over
the basic allotments.
7. Disposition of Turned in Clothing - The City shall determine a procedure as
to disposition of turned in clothing.
-3-
0621X/
5840
EXHIBIT "H"
VEHICLE USE POLICY
SECTION 1: PURPOSE
The purpose of these regulations is to establish and implement City policies and
procedures relative to the assignment, utilization and control of City-owned vehicles as
transportation for employees who engaged in official City business, to establish
reimbursement procedures for privately-owned vehicles used for City business and to
clarify the City's responsibility for damage and/or liability for private vehicles used on
official City business.
SECTION 2: SCOPE
These regulations cover the use of City and private vehicles for conducting official City
business and shall be applicable to all City departments and employees.
SECTION 3: POLICIES
When necessary during the course of an employee's official duties, transportation or
reimbursement therefor shall be provided by the City. In the event no City vehicle is
available, the employee may use his personal vehicle with the approval of his department
head. Employees authorized to drive either their own or a City-owned vehicle on official
business must possess a valid California driver's license for the class of vehicle they will
be operating. The transportation method authorized will be determined in terms of the
best interests of the City. The general program set forth in this regulation will be
implemented by the City Administrator's Office upon approval of the City Council and
administered by the department heads in accordance with the policies herein established.
It is the responsibility of each department head to enforce the provisions of this
regulation as it relates to the employees of his/her department.
City-owned vehicles shall only be used for official City business. City-owned vehicles
shall not be driven to and kept at the employee's home or any location other than the
regular work location or Corporation Yard, except as provided by this regulation.
SECTION 4: VEHICLE USE CRITERIA
I. Assigned Vehicles:
A. Assigned City Vehicles may be taken home by employees whose residence
is within ten (10) miles of City Hall for the uses as described below:
1. Executive use includes the City Administrator, Assistant City
Administrator and Department Heads.
2. Emergency Response Units:
a. Employees who are required to respond more than once per
week on an average without delay in order to protect the public
health, safety and property.
5840
EXHIBIT "H"
(Continued)
b. Employees who are required to carry special emergency
equipment in their vehicles which must be utilized on a regular
and frequent basis. (A radio in and of itself does not constitute
special emergency equipment.)
3. Continuous use outside of regular working hours:
Employees who are called back on an unscheduled basis to perform
official city business outside of regular working hours more than once
per week on an average and who meet one of the following criteria:
a. Mileage driven on official City business exceeds an average of
500 miles per month, or
b. Who regularly and frequently supervises subordinates or
conducts inspections in the field, or
C. Whose duties require the employee to be away from his or her
base work station greater than 50% of his or her working time,
on an average.
B. City vehicles which shall not be taken home may be assigned based on
meeting one of the following criteria:
1. Monthly mileage driven exceeds an average of 500 miles per month
and the vehicle is used for the purpose of supervision or inspection in
the field, or
2. Duties require the employee to be away from his or her work station
greater than 50% of his or her working time on an average.
II. Reimbursement of Use of Personal Vehicles
A. Executive Use. The City Administrator, Assistant City Administrator and
Department Heads may, at their option, receive the automobile allowance
as established by Resolution.
B. Mileage Reimbursement. Employees, upon authorization of their
department head, may use their own vehicles on official City business and
shall be reimbursed at the rate of 230 per mile driven on official City
business.
1. Employees shall submit monthly claims for reimbursement to the
Finance Director through their Department Head on forms prescribed
by the Finance Director.
2. Employees shall not be reimbursed for commuting to and from work
g
except that employees who are required to attend scheduled meetings
outside of normal working hours may be reimbursed for mileage
required.
-2-
0355X
5840
EXHIBIT "H"
(Continued)
SECTION 5: INSURANCE REQUIREMENTS
All privately-owned vehicles authorized to be used on official City business shall be
insured by the individual employee in the minimum amount of $50,000 public liability for
any one person and $100,000 public liability for all persons, any one accident. They must
also be insured for $25,000 property damage and $15,000 for any one uninsured motorist
and $30,000 for all uninsured motorists any one accident. A current certificate of
insurance must be filed with the Finance Director.
Employee private vehicle information shall be reviewed and updated annually by the
respective departments. The record maintained should contain the following current
information.
- Name of employee - Operator's license
- Insurance company - Driver's license expiration date
- Insurance policy No. - Insurance expiration date
- Amount of coverage
It shall be the department head's responsibility to insure that no privately-owned vehicle
is operated on City business without insurance coverage and a valid operator's license as
required by this regulation.
Clarification on City Liability on Use of Private Vehicle
In the event of damage to private vehicles while on City business where a third party is
negligent, the employee should collect damages (including insurance deductibles) from the
third party. Where the employee is negligent, the City cannot be held liable for damages
to his automobile, but the City can be held responsible for liability to third parties. The
City shall be responsible to such employee for the first $100 of comprehensive and/or
collision damages suffered by such employee to the extent that such employee's personal
automobile insurance policy does not cover such first $100 damage. The employee's
insurance policy is considered as the primary coverage, and the City liability begins after
the limitations of the employee's coverage is exhausted.
In the event a City employee's personal vehicle is damaged due to accident/collision while
being used for official City business and the employee is deprived the use thereof, the
City shall furnish such employee with a vehicle during such time as is reasonably required
to repair said employee's vehicle.
-3-
0355X
5840
EXHIBIT I
CITY OF HUNTINGTON BEACH
Inter-Department Communication
To: MUNICIPAL EMPLOYEES From: ROBERT J. FRANZ
ASSOCIATION Deputy City Administrator
Re: DENTAL COVERAGE Date: SEPTEMBER 30, 1987
City Sponsored Indemnity Plan (Delta)
City Sponsored Pre-Paid Plan (PMI)
As you know, we have two dental plans; an indemnity plan (any dentist) and a pre-paid plan
(panel dentists). Employees may choose either of the plans. Roughly 50% of the employees
are in each plan.
We wish to review with the Association two problems that have developed on the dental
plans.
Problem 1 - For many years the carrier for both the indemnity plan and the pre-paid plan
has been Private Medical Care on P.M.I. Last year Delta Dental, the nation's largest dental
carrier, purchased P.M.I. and has a result, Delta Dental replaced P.M.I. as the indemnity
plan dental carrier.
There were several advantages to the City on the change. Coverage would essentially be
the same, there would be better service, and in the area of orthodontia, we would no longer
be confined to using the P.M.I. designated orthodontists.
Delta, however, could not use the exact P.M.I. wording describing the orthodontia benefit
(due to their agreement with participating dentists).
P.M.I. Orthodontia Benefit:
Up to $1,100 out of pocket expense to the employee
Delta agreed to the following:
60% of expenses to $3,000. Also if any current
covered individual undergoing orthodontia treatment
would receive less than under the prior plan, it is
agreed, on a case by case basis, that Delta will
remedy. Eventually, however, this will be the new
benefit.
Problem 2 - Having to do with the P.M.I. orthodontia benefit.
The pre-paid dental plan insured by P.M.I. goes back ten years. Pre-paid dental plans were
in the infancy and the City's plan was one of the first such plans adopted.
P.M.I. in preparing the original contract years ago, neglected to spell out the usual and
customary restrictions on orthodontia; the two main restrictions being that the orthodontia
coverage does not include so called "start-up costs" of $250 and coverage ceases after
24 month treatment plan.
This original contract omission has caused constant problems over the years since the City's
contract said one thing and the P.M.I. contract with their panel orthodontist said another.
Recently, P.M.I. prepared a new contract to replace the old contract so as to up-date all the
benefit changes, which also would facilitate preparation of employee booklets, etc.
5840
As part of the new contract, the orthodontia restrictions described above were included.
This might be construed as a reduction in benefits, and therefore, we have been able to get
P.M.I. to agree to the following benefit increases:
1. Coverage for general anesthesia is added at no cost for extractions when
medically necessary; (prior to this was no coverage for general anesthesia).
2. Coverage for dowel posts and pin build-ups included at no cost.
3. Decrease the limitation on crowns, partials, and dentures five years to three
years.
4. The present emergency benefit for out-of-area treatment is increased from $50
to $100.
5. The effective date of the orthodontia limitations and the above improvements to
be 1/1/88.
6. The above change in orthodontia coverage not to apply to any individual
undergoing an orthodontia treatment plan on l/1/88 until such treatment plan
ceases.
3422j
5840
RESOLUTION NO. 5840
STATE OF CALIFORNIA )
COUNTY OF ORANGE ) ss:
CITY OF HUNTINGTON )
I, ALICIA M. WENTWORTH, the duly elected, qualified City Clerk of the City of
Huntington Beach, and ex-officio Clerk of the City Council of said City, do hereby certify
that the whole number of members of the City Council of the City of Huntington Beach is
seven; that the foregoing resolution was passed and adopted by the affirmative vote of a
majority of all the members of said City Council at a regular meeting thereof held on
the 19th day of January , 1988, by the following vote:
AYES: Council Members:
Kelly, Green, Finley, Erskine, Mays, Winchell, Bannister
NOES: Council Members:
None
ABSENT: Council Members:
None
City Clerk and ex-officio Clerk of
the City Council of the City of
Huntington Beach, California
5840