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City Council - 5889
RESOLUTION NO. 5889 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF HUNTINGTON BEACH APPROVING AND IMPLEMENTING THE MEMORANDUM OF UNDERSTANDING BETWEEN THE HUNTINGTON BEACH POLICE OFFICERS ' ASSOCIATION AND THE CITY OF HUNTINGTON BEACH FOR 1987-1990 The City Council of the City of Huntington Beach does resolve as follows: The Memorandum of Understanding between the City of Huntington Beach and the Huntington Beach Police Officers ' Association, dated June 9, 1988 , a copy of which is attached hereto and by reference made a part hereof, is hereby approved and ordered implemented in accordance with the terms and conditions thereof, and the City Administrator is authorized to execute this agreement . Such Memorandum of Understanding shall be effective for the term October 1, 1987, to September 30, 1990 . Mayor ATTEST: APVOVED AS TO FORM: L4 Z- City Clerk City Attorney APPROV AS TO ENT: APPROVED: Deputy ty dministr tor - City Administrator Chief of Police 5889 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 and PERS Pickup 3 Article 4 Salary Differentials 3 Article 5 Overtime and Stand By Pay 5 Article 6 Insurance 6 Article 7 Income Protection Plan 8 Article 8 Vision Care Plan 10 Article 9 Personnel Rules 10 Article 10 Retirement 11 Article 11 Police Education Incentive Plan 12 Article 12 Vacations 13 Article 13 Sick Leave 14 Article 14 Family Illness Leave 15 Article 15 Bereavement Leave 15 Article 16 Ten-Plan 15 Article 17 Uniforms 15 Article 18 Nurse Employees Certification 16 Article 19 Bilingual Pay 16 Article 20 Holidays 17 Article 21 Association Business 17 Article 22 Meal Allowance 17 Article 23 Weekend Military Drills 18 Article 24 Management Rights 18 Article 25 Term of Memorandum of Understanding 19 Article 26 City Council Approval 20 List of Exhibits: "A" Salary Schedule "B" Association Business - Department Regulations "C" Retiree Medical Plan "D" Senior Officer Program "E" Pay in Lieu of Compensatory Time "F" Employee Health Plan for Police Officers Assoc. "Gll Dental Plan Modifications i 5889 MEMORANDUM OF UNDERSTANDING Between THE CITY OF HUNTINGTON BEACH, CALIFORNIA (hereinafter called CITY) and THE HUNTINGTON BEACH POLICE OFFICERS ASSOCIATION (hereinafter called ASSOCIATION) PREAMBLE WHEREAS the designated representatives of the City of Huntington Beach and the Huntington Beach Police Officers association have met and conferred in good faith with respect to salaries, benefits and other terms and conditions of employment for the employees represented by the Association; NOW THEREFORE, this Memorandum of Understanding is made, to become effective October 1, 1987 and it is agreed as fo17ows: ARTICLE I REPRESENTATIONAL UNIT A. It is recognized that the Huntington Beach Police Officers 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 9 y Huntington Beach Police Department within the classification titles as outlined in Exhibit A attached hereto and incorporated herein. B. 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 the issue with all other bargaining units. The CITY hereby agrees not to propose a unit modification of the existing POLICE ASSOCIATION unit and that the existing POA unit is the appropriate unit to represent the classifications listed in Exhibit "A". 5889 • The proposed change to the Employer-Employee Relations Resolution is as follows: 7.3 Personnel Director Motion of Unit Modification - The Personnel Director may propose, during the same period for filling 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 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 o the composition of the appropriate unit or units, it shall give written notice of such determination to all affected employee organizations. _ 2 _ 5889 d) Any play who chooses to appeal froshe decision of the Personnel Commission is entitle to appeal in accordance with the provision of Section 14-4 of Resolution Number 3335. ARTICLE II EXISTING CONDITIONS OF EMPLOYMENT Except as expressly provided herein, the adoption of this Memorandum of Understanding shall not change existing terms and conditions of employment which have been established in prior Agreements between City and the Association. ARTICLE III SALARY SCHEDULES AND PERS PICKUP A. Employees shall be compensated at monthly salary rates by classification title and salary range during the term of this Agreement as set out in Exhibit A attached hereto and incorporated herein. B. Each non-sworn employee covered by this Agreement shall be reimbursed an amount equal to 71% of the employee's part of their PERS contribution. The above PERS pickup is not base salary but is done pursuant to Section 414(h)(2) of the Internal Revenue Code. C. Each sworn employee covered by this agreement shall be reimbursed an amount equal to 9% of the employees part of their PERS contribution. D. Effective upon implementation of this agreement each employee, eligible for service retirement, may have his/her PERS pickup reported as compensation for all or any part of the twenty four (24) month period prior to his/her service retirement date upon written request to the Finance Director. Such modified reporting shall be limited to a maximum period of twenty four (24) months preceding retirement. Requests for retroactivity, if permitted by PERS, will be decided on an individual basis and shall require the approval of the Personnel Director. ARTICLE IV SALARY DIFFERENTIALS A. 1. Employees assigned to duty as helicopter flight personnel shall receive $370 per month in addition to their applicable salary. 2. The Police Officer assigned as CHIEF PILOT shall receive $520.00 per month, including flight pay, in addition to his regular salary. 3 - 5889 • • B. Non-sworn members required to work on a regularly assigned shift that occurs between the hours of 4:00 P.M. and midnight, or midnight and 8:00 A.M., shall be paid a premium of five percent (5%) of the employee's base hourly rate for all work performed during said shift. 1. 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. 2. The shift differential provided by this Article for Communication Operators shall be effective the first pay period following the adoption of this MOU by the City Council. C. The Senior Officer Program is applicable to all officers as outlined in Exhibit "D". D. 1. Employees assigned to motorcycle duty shall receive a flat rate of $250 per month for hazardous duty pay. Effective October 1, 1988, such pay shall be $275.00 per month. Effective October 1, 1989, such pay shall be $300.00 per month. 2. In consideration of the motor officers receiving the foregoing compensatory duty pay and the right to drive their motorcycles to and from their residences to their places of work, the Association agrees that any time spent on maintenance and/or cleaning of motorcycles, as described below, while off duty and away from their place of employment is not considered to be time worked for the purpose of salary or overtime calculations. The Department shall supply necessary materials needed to perform the following duties: a. Keeping the assigned motorcycle cleaned and waxed. b. Keeping the drive chain properly lubricated and adjusted. C. Performing a daily check of the motorcycle fluid levels and tire pressure. d. Scheduling required routine services at specified mileage intervals with police motorcycle mechanics. 4 - 5889 ARTICLE V OVERTIME AND STAND BY PAY � A. Employees shall receive time and one half their salary rate for all time worked in excess of 40 hours during any given payroll week. 1. Compensatory Time - An employee may elect to receive compensatory book time in lieu of such overtime pay to a maximum of 120 hours. 2. Work Time - For the purpose of computing the 40 hour week the following shall be excluded in determining the eligibility for time and one half overtime pay: a) Sick leave b) Non Court Stand by Time. 3. Court Stand By Time - Employees required to be on stand by for a court appearance during other than their scheduled working hours shall receive a minimum of two hours straight time pay (including differentials in Article IV) for each morning and afternoon court session. 4. Court Appearance Time - Employees required to appear in court during other than their scheduled working hours shall receive a minimum of three hours pay at time and one half; provided, however, that, if such time overlaps with the employee's scheduled working hours said premium rate shall be limited to those hours occurring prior to or after the employee's scheduled work time. 5. Non-Court Stand By Time - An employee who is placed on stand by status by his supervisor shall receive four hours straight time pay for each 24 hour period of stand by status. 6. Call Back - Employees who are called back to work will be paid a minimum of two hours of pay at the rate of time and one half their regular hourly rate. 7. Pay in Lieu of Compensatory Time - In the months of December and April of each year, employees may, at their option, be paid for their compensatory time worked. Compensatory time is paid at the officer's straight time rate for the actual hours worked; not at the time and one half rate that compensatory time is earned. See Exhibit "E" for example and procedure. 5 - 5889 8. FTO Mensation - Officers who have Aessfully completed a POST Certified Field Training Officer course and have been designated field training officers, assigned to Traffic or Patrol Bureaus, shall be eligible for field training officer compensation. Compensation shall be five (5) hours of straight book time or straight time pay for each cumulative 40 hour block of actual field training. ARTICLE VI INSURANCE A. The CITY shall continue to provide group medical benefits to all employees with coverage and other benefits comparable to the group medical plan currently in effect. B. 1. POA and City insurance brokers to review the entire self administered Employee Health Plan within 90 days of adoption of the MOU by the City Council and prepare jointly agreeable bid specifications for quotation (if determined appropriate by the parties) by outside vendor bids and presentation to the City Council. 2. The City will pay medical claims under the Employee Health Plan within 30 days of the receipt of the claim or provide written notice to the claimant of the reason for delay. C. The elective surgeries listed in Exhibit F will require a second opinion from a list of authorized physicians. The CITY shall provide such list of physicians mutually agreeable to CITY and the ASSOCIATION. It is understood that should an employee or covered dependent elect a listed surgical procedure without a second opinion, such employee shall receive no benefit. The listed surgical procedures shall be considered elective unless the attending physician certifies that the procedure was performed on an emergency basis without reasonable time for a second opinion. D. The CITY will assume full payment 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. E. The CITY shall reimburse the dependent health insurance premium to a maximum of $400 a month for full family coverage for eligible employees. The employee shall pay for any premium in excess of $400 a month. If the maximum premium for coverage under the City's Employee - 6 - 5889 Health Plan, FHP, or Healthnet exceeds $400 on January 1, 1990, or any month thereafter during the term of this MOU, the parties agree to reopen the meet and confer process for the limited purpose of discussing the City's maximum contribution towards premiums. F. 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. Effective January 1, 1988, the Medical Insurance Plan shall be modified to increase the deductible from One Hundred Twenty Five ($125) to One Hundred Fifty Dollars ($150) per person; and the maximum deductible per family shall be increased from Three Hundred Seventy Five ($375) to Four Hundred ($400) per family during any period of benefit entitlement as described in the City's Employee Health Plan. 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 inoculations 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. 5. Chiropractic Treatment - Effective January 1, 1989, part X.C. of Exhibit "D" shall be modified to limit treatment to $1,000 per year or twenty-four (24) treatments per year, whichever is greater. G. Sworn personnel who have been placed on industrial disability retirement subsequent to January 31, 1974, shall be eligible to continue to participate in the existing group medical insurance plan at their own cost. Participation shall cease upon the earliest of the following: (1) the expiration of three calendar years following the date of the industrial disability retirement, or (2) the retirees obtaining eligibility for coverage under a comparable medical plan, or (3) eligibility to participate in any City sponsored retiree medical plan at retiree's own cost. Retirees who cease to participate may exercise any conversion privileges then in existence. 7 - 5889 H. Employees ell continue to be covered byental plan benefits equal to those currently being provided by the City as modified in Exhibit "G". I. City will provide $10,000.00 of term life insurance without evidence of insurability other than evidence of working a full time duty and an additional $10,000.00 policy requiring evidence of insurability, all at the employee's own cost. J. Upon retirement (whether service or disability) each employee shall have the following options in regards to medical insurance under CITY sponsored plans: 1. With no change in benefits, retirees can stay in the CITY's Employee Health Plan or an HMO plan offered by the CITY at the retiree's own expense for the maximum time period required by Federal Law (COBRA), or 2. Employees retiring after approval of this MOU may participate in the Retiree Medical Plan described in Exhibit C. Any employee who retired between October 1, 1987 and May 5, 1988 or on May 5, 1988 is reporting his/her PERS pickup as compensation pursuant to Article 3F, shall receive benefit payments under this retiree medical plan identical to benefit payments provided to employees retiring after 1011189. ARTICLE VII INCOME PROTECTION PLAN A. The existing long term disability program provided by the City shall remain in effect for all personnel. This program provides, for each incident, pay up to sixty calendar days at the employee's salary rate (excluding overtime but including any special pay in effect at the time of illness or injury). After the sixty calendar day period, the employee will be covered by an insurance plan paid for by the City which will provide 66-213 percent of the employee's salary rate (excluding overtime and any special pay) up to a maximum of $2,000.00 per month for all employees below the rank of Police Sergeant, effective January 1, 1986. The maximum benefits payable for Police Sergeant shall not exceed $2,600 per month, effective January 1, 1986. Effective October 1, 1989, the maximums shall be eliminated. _ 8 - 5889 Disability Disability Due D i y Due to Accident to illness First 60 days Regular Pay Regular Pay Next 24 months 66-2/3% of base pay Same up to maximum benefit of $2,000 per month (No maximum Effective 10-1-89) For Sergeants Same the maximum benefit is $2,600 (No maximum Effective 10-1-89) to age 65 66-2/3% up to maximum None benefit of $2,000 monthly (No maximum Effective 10-1-89) For Sergeants None the maximum benefit is $2,600 (No maximum Effective 10-1-89) 9 - 5889 • • B. Days and months refer to calendar days and months. Benefits under the Plan are integrated with Worker's Compensation, Social Security and other non-private program benefits to which the employee may be entitled. Disability is defined as the inability to perform all of the duties of regular occupation during two years and thereafter the inability to engage in any employment or occupation for which he is fitted by reason of education, training or experience. C. Rehabilitation benefits are provided in the event the individual, due to disability, must engage in other occupation. Plan will provide 66-2139 of difference between regular pay and pay of other occupation. D. Survivors benefit continues plan payment for three months beyond death. ARTICLE VIII VISION CARE PLAN The City shall implement a Vision Care Plan effective January 1, 1989 at an approximate composite cost of $12 per month per employee. ARTICLE IX 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. Closed 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 entry level 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 (15) days thereafter and shall cause notice to be served upon all interested parties. 10 - 5889 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 approved 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 a on by the Personnel Commission. The hearing officer shall hear the case and make recommended findings, conclus ions 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. ARTICLE X RETIREMENT A. The City will provide, for all safety personnel represented by the Association whose retirement is effective or whose death occurs after July 1, 1978, Public Employees Retirement System retirement benefits computed by utilizing the two percent at age fifty formula commonly referred to as the California Highway Patrol Retirement Plan. 11 - 5889 • • 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 at 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 #2) or one-half of the allowance (Option #3) is paid to the beneficiary for life.) ARTICLE XI POLICE EDUCATION INCENTIVE PLAN A. The Education Incentive Plan shall be continued for sworn personnel as follows: Cont. Education Monthly Education Maximum Years of College Units Amount Incentive Post College Training HBPD Required Monthly Effective Level Cert. Units Units Points Service Annually Amount 10-1-89 I Inter 30 20+ 10 1 6 83.31 100.00 II Inter 60 40+ 20 1 3 125.03 150.00 III Adv 90 60+ 30 2 3 166.67 200.00 IV Adv 120 0 3 3 250.00 300.00 V Adv 150 120+ 30 3 0 250.00 300.00 B. Stipulations 1. College major shall be Police Science, Criminology, Political Science, Sociology, Law, Business Administration, Public Administration, Psychology or closely similar field as approved by Chief of Police and Education Committee. 2. Initial eligibility must be approved by Chief of Police. An acceptable yearly performance evaluation, signed b Chief of Police, is P yP 9 y required. No incentive taken away without just cause. 3. Training points approved by POST may be substituted for college units, on the following schedule: 10 of 30, 20 of 60; 30 of 90. 4. Pay to be effective first month following approval. 5. After 120 units of B.A. POST approved training points may be substituted for college units without limit. 12 - 5889 6 • 6. Repeat college courses credited as determined by the college. 7. Repeat POST approved seminars, institutes, etc. credited as determined by the Chief of Police. 8. A11 college units require grade of "C" or better to qualify. 9. Obtaining transcripts or other acceptable documentation is employee responsibility. 10. Employee may choose between POST training points or college units where a choice is available. No change allowed once choice is made, no double credit allowed. ARTICLE XII VACATIONS A. Anniversary Date: For the purpose of computing vacation, an employee's anniversary date shall be the most recent date on which he commenced full-time, City employment. B. Annual Vacation: The purpose of annual vacation is to provide a rest period which will enable each employee to return to work physically and mentally refreshed. A11 permanent employees, whether full-time or part-time, shall be entitled to annual vacation with pay EXCEPT the following: 1. Employees who have not completed six (6) months continuous service with the City. 2. Employees who work less than fu11-time who are not permanent. 3. Employees on leave of absence. C. Vacation Allowance: 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 through the fourth year of continuous service vacation time will be accrued at the rate of 112 hours per year. 2. After fifth through ninth year of continuous service vacation time will be accrued at the rate of 136 hours per year. 3. For the tenth through fourteenth year of continuous service to the completion of fourteen years of continuous service vacation time will be accrued at the rate of 160 hours per year. 4. After fifteenth year and thereafter of continuous service vacation time will be accrued at the rate of 192 hours per year. 13 - 5889 6 • D. 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. E. Vacation - When Taken: No employee shall be permitted to take a vacation in excess of actual time earned and vacation shall not be accrued in excess of 320 hours. Vacations shall be taken only with permission of the department head; however, the department head shall schedule all vacations with due consideration for the wish of the employee and particular regard for the need of the department. F. Terminal Vacation Pay: An employee shall be paid for unused vacation upon termination of employment at which time such terminating employee shall receive compensation at his current salary rate for all unused, earned vacation to which he is entitled up to and including the effective date of his termination. G. Receipt of Vacation Pay: Upon two week written notification to the Finance Director, e l e entitled to receive his each employee ee shall b i p Y earned vacation pay, less deductions, in advance, prior to his regular scheduled annual vacation. Such advancements are limited to one during each employee's anniversary year. H. Pay in Lieu of Vacation: An employee may elect to take up to 80 hours of pay per year for accrued vacation in lieu of time off. Such pay may be reported to PERS as salary. It is the intent of the parties that employees will take vacation during the current year. ARTICLE XIII SICK LEAVE A. A17 sworn personnel and non sworn Personnel represented by the Association shall have a maximum of 60 calendar days sick leave per incident or illness. This leave shall not accumulate beyond the one year maximum and there shall be no pay off rights to unused leave upon termination of the employee from the City. B. All non-sworn personnel whose classifications were added to the police unit, shall have existing sick leave frozen as of June 30, 1976, at the rate in effect as of that date. Any payoff of such accumulated sick leave shall be in accordance with the provisions of Personnel Rule 14-8 as of June 30, 1976. - 14 - 5889 0 • C. If during the term of this Agreement the Chief of Police determines that an abuse of sick leave exists by employees in the Communication Operator classification, the short term sick leave plan formerly in effect for said employees under plan Memorandum of Understanding (Resolution 4925, Article XI, C) shall be reinstituted upon written direction of the Chief of Police. ARTICLE XIV FAMILY ILLNESS LEAVE Sick leave may be used for an absence due to illness of the employee's spouse or child when the employee's presence is required at home, provided that such absence shall be limited to five days per calendar year. ARTICLE XV BEREAVEMENT LEAVE Employees shall be entitled to bereavement leave not to exceed three working days per calendar year in instance of death in the immediate family. Immediate family is defined as father, mother, sister, brother, spouse or children of the employee. ARTICLE XVI TEN-PLAN A. The work schedule agreed to by the CITY and the ASSOCIATION during negotiations has been fully implemented and shall remain in effect during the life of this agreement unless changes are agreed to by the Association and the City. B. Effective January 1, 1984, all employees are entitled to work 4 days per week 10 hours each day, meal times to be included during the 10 hour shift. ARTICLE XVII UNIFORMS A. The CITY shall continue the Uniform Allowance in lieu of the CITY providing uniforms for employees represented by the ASSOCIATION. Such allowance shall be $500 per year increasing to $536 per year effective October 1, 1988, and further increasing to $572 per year effective October 1, 1989; payable quarterly to those employees on active duty during that quarter separately from payroll checks. It is the mutual intent of the parties that this allowance shall be utilized solely for the - 15 - 5889 purpose of replacing, repairing and maintaining uniforms and clothing worn in the line of duty. The CITY will continue to make initial issuance of required uniforms and replace uniforms and equipment damaged in the line of duty including safety equipment required by state law, City resolution or ordinance or order of the Chief. B. Batons, speed reloaders, SWAT uniforms and equipment and canine uniforms and equipment shall continue to be provided by the CITY. C. Motorcycle officers shall receive four pairs of britches at the time of assignment. After initial issue, replacement britches may be issued on recommendation of the Traffic Bureau Commander with approval of the Department Head. All replaced britches must be turned in when replaced. ARTICLE XVIII NURSE EMPLOYEES CERTIFICATION The City shall allow licensed nurse employees time off with pay to attend required courses necessary to maintain certification requirements. ARTICLE XIX BILINGUAL PAY A. Qualified employees who meet the criteria will be paid a monthly pay differential of fifty dollars ($50.00) for general qualifications and one hundred dollars ($100.00) for advanced qualifications. The Police Chief will have written and oral tests designed and administered to test for qualifications in either of the levels. The general pay level will cover the more routine foreign language requirements in filling out crime reports, interviewing suspects and witnesses, and responding to the public on matters relating to an incident or other police action. The advanced level requires written skills in the foreign language and an ability to converse regarding complex matters, court proceedings or other investigations requiring a proficient and broad knowledge of language including accent variations as used by different groups. B. The languages included will be Spanish, Vietnamese and sign language. C. Qualified employees authorized for either of the levels will be based on the following: 1. A need for the employee to use the language in the City to support the implementation of police operations. - 16 - 5889 • • 2. At the discretion of the Police Chief, he may limit the number of employees qualified in each category based on department needs. D. Successful completion of tests authorized by the Police Chief will be required to qualify for differential pay for any of the languages. Tests will be designed for the two levels. Retesting may be done on an annual basis. ARTICLE XX HOLIDAYS Employees represented by the Association and actively employed by the City, in addition to regular compensation, shall receive each month 1112 of the total holidays hours (80) earned for the year. They shall be entitled to an additional eight hours of pay at their regular rate for any day declared by the President of the United States to be a national holiday, or any day declared by the Governor of the State of California to be a state holiday, if such day is adopted by the City Council of the City of Huntington Beach as a special holiday for City employees (i.e. , day of mourning). ARTICLE XXI ASSOCIATION BUSINESS An allowance of 750 man-hours per year shall be established for the purpose of allowing authorized representatives of the Association to represent members of the Association in their employment relations. Such allowance may be utilized only by those persons authorized by the Board of Directors of the Association and such utilization shall be subject to the rules indicated in Exhibit B. Up to 200 hours per year of unused hours may be carried over to the subsequent year. ARTICLE XXII NEAL ALLOWANCE A. Per Diem - Effective December 24, 1983, employees shall be entitled to per diem under the following circumstances: 1. Personnel are on work assignments, attending seminars, meetings or training sessions which extend beyond their normal work hours or require lodging. Meetings which include a meal may be reimbursed at the actual cost of the meeting or meal. 2. Personnel are unexpectedly delayed or assigned at a location away from the City when the time extends beyond normal meal period. - 17 - 5889 0 3. When on assignment in excess of 25 mile radius beyond their normal work station. 4. Expenses other than those listed in a, b, or c may be considered for reimbursement (receipt required) at the discretion of the Division Commander. 5. Receipts are not required providing that the employee's expenses do not exceed the $35 limit and the expenses are in accordance with the above rules. B. Per Diem Schedule - $35 per 24 hour period or prorated as follows: a. Breakfast $6.00 b. Lunch 8.00 c. Dinner 16.00 d. Incidentals* 5.00 *i .e. ; tips, phone calls, snacks, coffee, etc. C. Mileage Allowance 1. The CITY shall reimburse employees for the use of personal automobiles at the rate of 26¢ per mile for all mileage reimbursable by POST. 2. All other mileage not reimbursable by POST shall be compensated at the rate of 23¢ per mile. ARTICLE XXIII WEEKEND MILITARY DRILLS The City shall continue to pay for weekend military drills for employees hired prior to July 1, 1988 and currently belonging to federal military reserve units. All other employees shall be granted rights in accordance with all applicable state and federal laws. ARTICLE XXIY MANAGEMENT RIGHTS Except as expressly abridged or modified herein, the Chief of Police retains all rights, powers and authority with respect to the management and direction of the performance of police 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 Chief of Police or the City the right to make unilateral changes in wages, hours, and terms and - 18 - 5889 conditions of employment. Such rights include, but are not limited to, consideration of the merits, necessity, 7eve7 or organization of police services, including establishing manning requirements, overtime assignments, number and location 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 XXY TERM OF MEMORANDUM OF UNDERSTANDING This Memorandum of Understanding shall be in effect for a term commencing on October 1, 1987, and ending at midnight on September 30, 1990 except as expressly provided herein, no further improvements or changes in the salaries and monetary benefits of the P 9 Y employees represented by the Association shall take effect during the term of this Agreement and the Association expressly waives any right to request any improvements or changes in salaries or monetary benefits for the employees represented by the Association which would take effect prior to September 30, 1990, and the City of Huntington Beach, through its representatives, shall not be required to meet and confer as to any such request. It is understood that the parties are continuing to meet and confer regarding non-monetary matters such as Personnel Rules, the department rules and manual , and any matters agreed upon resulting from such meeting and conferring will be the subject of a separate addendum to this Agreement. - 19 - 5889 ARTICLE XXVI CITY COUNCIL APPROVAL It is the understanding of the City and the Association that this Memorandum of Understanding is of no force or effect whatsoever unless and until adopted by Resolution of the City Council of the City of Huntington Beach. IN WITNESS WHEREOF, the parties hereto have executed this Memorandum of Understanding this 9th day of June 19$8. HUNTINGTON BEACH POLICE CITY OF HUNTINGTON BEACH OFFICERS ASSOCIATION �. By By 'Ci Administrator By G By e By By B i A min str ive Servi s By ..-- ----�. By Charles Goldstein Negotiator BY. 9 ..r APPROV D AS TQ;FORM: Gail Hutton Mark Reid City Attorney t Association Representative 0836z/sa 5889 - 20 - EXHIBIT A CITY OF HUNTINGTON BEACH POLICE OFFICERS ASSOCIATION SALARY SCHEDULE EFFECTIVE SEPTEMBER 30, 1989 JOB NO. TITLE RNG A B C D E 4334 Police Recruit 321 1874 1976 2085 2200 2321 4332 Police Officer 394 2697 2846 3002 3167 3340 4333 Police Officer Senior 406 2863 3021 3188 3363 3548 4338 Police Officer Chief Pilot 419 3056 3224 3401 3588 3786 4330 Identification Technician 417 3025 3191 3366 3552 3747 4331 Communications Supervisor 417 3025 3191 3366 3552 3747 3360 Police Sergeant 441 3411 3598 3796 4004 4224 3324 General Services Officer 414 2978 3143 3316 3498 3690 6370 Communications Operator 356 2233 2356 2486 2623 2766 6371 Communications Opers. Sr. 372 2416 2550 2690 2837 2993 4325 Detention Officer 364 2321 2449 2584 2727 2877 4324 Detention Officer Nurse 372 2416 2550 .2690 2837 2993 4326 Detention Officer Senior 380 2517 2655 2801 2955 3118 EFFECTIVE MARCH 31, 1990 JOB NO. TITLE RNG A B C D E 4334 Police Recruit 325 1912 2018 2129 2246 2369 4332 Police Officer 398 2753 2903 3063 3231 3409 4333 Police Officer Senior 410 2919 3080 3250 3429 3617 4338 Police Officer Chief Pilot 424 3132 3304 3486 3678 3881 4330 Identification Technician 421 3087 3257 3435 3624 3824 4331 Communications Supervisor 421 3087 3257 3435 3624 3824 3360 Police Sergeant 445 3477 3668 3869 4082 4307 3324 General Services Officer 418 3042 3208 3385 3571 3767 6370 Communications Operator 360 2279 2404 2536 2675 2822 6371 Communications Opers. Sr. 376 2467 2602 2746 2896 3056 4325 Detention Officer 368 2368 2498 2635 2780 2933 4324 Detention Officer Nurse 376 2467 2602 2746 2896 3056 4326 Detention Officer Senior 384 2567 2707 2857 3014 3181 1416X 5889 EXHIBIT A CITY OF HUNTINGTON BEACH POLICE OFFICERS ASSOCIATION SALARY SCHEDULE EFFECTIVE OCTOBER 1, 1988 JOB NO. TITLE RNG A B C D E 4334 Police Recruit 311 1782 1881 1985 2094 2208 4332 Police Officer 384 2567 2707 2857 3014 3181 4333 Police Officer Senior 396 2725 2874 3032 3198 3375 4338 Police Officer Chief Pilot 409 2907 3066 3234 3413 3600 4330 Identification Technician 407 2879 3037 3203 3380 3565 4331 Communications Supervisor 407 2879 3037 3203 3380 3565 3360 Police Sergeant 428 3195 3370 3555 3751 3957 3324 General Services Officer 404 2836 2992 3156 3330 3513 6370 Communications Operator 346 2122 2238 2361 2491 2628 6371 Communications Opers. Sr. 362 2300 2427 2560 2701 2850 4325 Detention Officer 354 2212 2333 2461 2597 2739 4324 Detention Officer Nurse 362 2300 2427 2560 2701 2850 4326 Detention Officer Senior 370 2392 2524 2662 2808 2962 EFFECTIVE APRIL 1, 1989 JOB NO. TITLE RNG A B C D E 4334 Police Recruit 315 1815 1915 2021 2132 2250 4332 Police Officer 388 2617 2761 2914 3073 3243 4333 Police Officer Senior 400 2780 2933 3094 3264 3444 4338 Police Officer Chief Pilot 413 2964 3127 3299 3481 3671 4330 Identification Technician 411 2935 3096 3266 3446 3635 4331 Communications Supervisor 411 2935 3096 3266 3446 3635 3360 Police Sergeant 432 3260 3439 3628 3827 4037 3324 General Services Officer 408 2891 3051 3219 3396 3583 6370 Communications Operator 350 2165 2285 2411 2543 2683 6371 Communications Opers. Sr. 366 2345 2473 2610 2754 2905 4325 Detention Officer 358 2255 2380 2510 2649 2794 4324 Detention Officer Nurse 366 2345 2473 2610 2754 2905 4326 Detention Officer Senior 374 2442 2576 2718 2867 3025 1416X 5889 EXHIBIT A CITY OF HUNTINGTON BEACH POLICE OFFICERS ASSOCIATION SALARY SCHEDULE EFFECTIVE OCTOBER 3, 1987 JOB NO. TITLE RNG A B C D E 4334 Police Recruit 301 1699 1792 1891 1995 2104 4332 Police Officer 374 2442 2576 2718 2867 3025 4333 Police Officer Senior 386 2591 2733 2884 3044 3212 4338 Police Officer Chief Pilot 399 2765 2917 3078 3248 3427 4330 Identification Technician 397 2737 2888 3047 3215 3392 4331 Communications Supervisor 397 2737 2888 3047 3215 3392 3360 Police Sergeant 414 2978 3143 3316 3498 3690 3324 General Services Officer 394 2697 2846 3002 3167 3340 6370 Communications Operator 336 2021 2132 2250 2373 2503 6371 Communications Oper. Sr. 352 2189 2309 2435 2569 2711 4325 Detention Officer 344 2099 2215 2337 2465 2600 4324 Detention Officer Nurse 352 2189 2309 2435 2569 2711 4326 Detention Officer Senior 360 2279 2404 2536 2675 2822 EFFECTIVE APRIL 2, 1988 JOB NO. TITLE RNG A B C D E 4334 Police Recruit 305 1732 1827 1927 2033 2146 4332 Police Officer 378 2493 2629 2773 2926 3087 4333 Police Officer Senior 390 2643 2789 2943 3104 3274 4338 Police Officer Chief Pilot 403 2822 2978 3141 3314 3496 4330 Identification Technician 401 2792 2947 3110 3281 3461 4331 Communications Supervisor 401 2792 2947 3110 3281 3461 3360 Police Sergeant 418 3042 3208 3385 3571 3767 3324 General Services Officer 398 2753 2888 3032 3198 3375 6370 Communications Operator 340 2059 2172 2291 2418 2551 6371 Communications Oper. Sr. 356 2233 2356 2486 2623 2766 4325 Detention Officer 348 2142 2260 2385 2517 2655 4324 Detention Officer Nurse 356 2233 2356 2486 2623 2766 4326 Detention Officer Senior 364 2321 2449 2584 2727 2877 1416X 5889 INTINI�T l`�T '. H F�_ LICE ' -'� «` -; ASSOCIATION POST OFFICE BOX 896, TII INTINCGTON BEACH, CALIFORNIA 92648 EXHIBIT B Page 1 of 2 1/16/86 EUTI-ELINES FOR _JU LIM OF JE .750-HOUR ASSOCIAT,IQm �AU IME A- ANY SUBSTANTIA_LTIME*** USED FOR THE H •B •P •0 •A• BUSINESS WHILE THE: MEMBER IS USING THAT TIME, IS ON A WORKING STATUS AND THIS TIME WILL BE DEDUCTED FROM THE 750-HOUR ASSOCIATION BANK, AS PEa moo SUBSTANTIAL TIME, BEING DEFINED AS THAT TIME IN EXCESS OF ONE HOUR AND WHERE THE ASSOCIATION MEMBER IS NOT AVAILABLE FOR DUTY UNTIL THE ASSOCIATION BUSINESS IS CONCLUDED- B . ANY ASSOCIATION . MEMBER DESIRING TO USE ASSOCIATION TIME, WHILE THEY ARE ON DUTY , SHALL OBTAIN PERMISSION FROM THEIR IMMEDIATE SUPERVISOR, THEN FROM THE PRESIDENT OF THE ASSOCIATION- IN THE EVENT TH r THE PRESIDENT OF THE ASSOCIATION IS NOT AVAILABLE TO GRANT PERMISSION, THE VICE-PRESIDENT WILL THEN HAVE THE RESPONSIBILITY TO MAKE THE APPROPRIATE DECISION - IF THE hSSOCI TIOM MEMBER ' S tF'MFf TsrE cllPFRVrSOF? Wt1.1 NOT GRANT THE PERSON WHO IS RLQUESTING TIME OFF THE ASSOCIATION BUSINESS, THEN THE. PRESIDENT SHALL Br IMMEDIATELY NOTIFIED BY THE MEMBER- IF THE BUSINESS, IS OF SUCH A NATURE THAT IT MAST BE CONDUCTED BY THAT PARTICULAR ASSOCIATION MEMBER, THEN THE PRESIDENT WILL TAKE THE MATTER TO THE DIVISION LEVEL AND EVERY EFFORT WILL BE MADE TO RESOLVE THE ISSUE- C . ANY MEMBER USING ASSOCIATION TIME, WHILE ON DUTY WILL SUBMITT AN INTER--DEPARTMENTAL COMMUNICATION MEMO AND AN OVER TIME REQUEST FORM TO THE PRESIDENT• THE MEMBER MUST WRITE ON TOP OF THE OVER TIME FORM- ASSOCIATION BANK 11K OFF• AND THE PAYROLL EXCEPTION FORM WILL BE SIGNED BY THE SUPERVISOR AND THE PRESIDENT OF THE P .O.A . OR HIS REPRESENTIVE• THE COMMUNIQUE WILL HAVE THE EXACT TIME AND THE DATE THAT WAS USED FOR THE ASSOCIATION BUSINESS,THE LOCATION WHERE THE BUSINESS WAS CONDUCTED* 5889 H�z NTIN GTON BEACH POLICE OFFICERS A SSOCI A TU ON -�$ • POcT OFFICE BOX 896, HUNTINC�TON REACH, CAI IFORNIA 91,649 EXHIBIT B Page 2 of 2 D . THOSE ASSOCIATON MEMBER THAT MAY USE THE 750-HOUR BANK TIME ARE 1 • PRESIDENT - H •B •P •O • A• ' • BOARD OF DIRECTORS 3 • MEMBERS ASSIGNED TO COMMITTEES DESIGNAITED BY THE PRESIDENT OR THE BOARD OF DIRECTORS• 4 . PORAC REPRESENTATIVE- S . ANY OTHER ASSOCIATION MEMBER DESIGNATED- E . ALL MEMOS AND OVER TIME REQUEST WILL BE FORWARDED, TO PAYROLL AND THE COPIES WILL BE SENT TO THE SECRETARY OF THE ASSOCIATION FOR ACCOUNTING PURPOSEES• CHIEF OF POLICE PRESIDENT O -B•P •O•A• 5889 . MEET AND CONFER • is it e POLICE ASSOCIATION RETIREE MEDICAL PLAN - CITY COUNTER PROPOSAL An employee who has retired from the City, shall be entitled to participate in the City-sponsored medical insurance plans and the City shall contribute toward monthly premiums for coverage and in an amount as specified in accordance with this Plan, provided: A. At the time of retirement the employee has a minimum of ten (10) years of service or is granted an industrial disability retirement; and B. At the time of retirement the employee is employed by the City; and C. Following official separation from the City the employee is granted a retirement allowance by the California Public Employees' Retirement System. The City's obligation to pay the monthly premium as indicated shall be modified downward or cease during the lifetime of the retiree upon the occurrence of any one of the following: A. During any period the retired employee is eligible to receive or receives health insurance coverage at the expense of another employer, the payment will be suspended. "Another employer" as used herein means private employer or public employer or the employer of a spouse. As a condition of being eligible to receive the premium contribution as set forth in this plan, the City shall have the right to require any retiree to annually certify that the retiree is not receiving or eligible to receive any such health insurance benefits from another employer. If it is later discovered that a misrepresentation has occurred, the retiree will be responsible for reimbursement of those amounts inappropriately expended and the retirees' eligibility to receive further benefits will cease. B. On the first of the month in which a retiree or dependent reaches age 65 or on the date the retiree or dependentcan first apply and become eligible, automatically or voluntarily, for medical coverage under Medicare (whether or not such application is made) the City's obligation to pay monthly premiums may be adjusted downward or eliminated. Benefit coverage at such age under City health plans shall be governed by plan documents for such plans. C. In the event the Federal Government or State Government mandates an employer-funded health plan or program for retirees, or mandates that the City make contributions toward a health plan (either private or public) for retirees, the City's contribution rate as set forth in this plan shall first be applied to that mandatory plan. If there is any excess, that excess may be applied toward the City medical plan as supplemental coverage provided the retired employee pays the balance necessary for such coverage, if any. D. In the event of the death of any employee, whether retired or not, the amount of the retiree medical premium benefit which the deceased employee was receiving at the time of his/her death or would be eligible to receive if he/she were retired based on the schedule below, shall be paid on behalf of the spouse or family for a period not to exceed twelve (12) months. 3745j 5889 . SCHEDULE OF BENEFITS . IR-rl r 7 I. Minimum Eligibility for Benefits - With the exception of an industrial 213 disability retirement, eligibility for benefits begins after an employee has completed ten (10) years of continuous service with the Huntington Beach Police Department. Said service must be continuous unless breaks are reinstated at the time of hire or rehire in accordance with the City's Personnel Rules. II. Disability Retirees - Industrial disability retirees with less than ten (10) years of service shall receive a maximum monthly payment toward the premium for health insurance of $40 for retirements after 10/1/87, $80 after 10/1/88 and $120.40 after 10/1/89. Payments shall be in accordance with the stipulations and conditions which exist for all other retirees. Payment shall not exceed dollar amount which is equal to the full cost of premium for employee only. III. All retirees including those retired as a result of disability whose number of years of service prior to retirement exceeds ten (10), shall be entitled to maximum monthly payment of premiums by the City as follows: Maximum Monthly Payment For Retirements After: Years of Service 10/1/87 10/1/88 10/1/89 10 $ 40 $ 80 $ 121 11 44 88 132 12 48 97 145 13 53 105 158 14 57 113 170 15 61 122 182 16 65 130 195 17 69 138 207 18 73 146 220 19 77 155 232 20 81 163 244 21 86 171 257 22 90 179 269 23 94 188 282 24 98 196 294 25 102 204 306 26 106 213 319 27 110 221 331 28 115 229 344 Note: The above payment amounts may be reduced each month as dependent eligibility ceases. However, the amount shall not be reduced if such reduction would cause insufficient funds needed to pay the full premium for the employee and the remaining dependents. In the event no reduction occurs and the remaining benefit payment is not sufficient to pay the premium amount for the employee and the then eligible dependents, said needed excess premium amount shall be paid by the employee. 3745j 5889 r 3249M CITY OF HUNTINGTON BEACH COMPARISON OF INDEMNITY PLANS (Reflects PERS 8/1/87 Changes) CURRENT PROPOSED CITY PLAN BENEFITS PERS MEDICAL - CWTO CITY PLAN EMPLOYEES RETIREES Inpatient Hospital 100% PPO Hospitals- after 100% - No deductible 100% - No 80% after Benefits deductible deductible deductible 60% Non PPO Hospitals - after deductible a 85% Non PPO Hospitals in areas without PPO Hospitals - after deductible Deductible $ 200 per person, $500 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 -irk prescription for non generic KX Major Medical 85% PPO doctor - after 80% after deductible 80 % after 80% after _ v deductible deductible deductible �O 60% Non PPO doctor - after u� y deductible 80% X-rays, lab, etc. - after \' deductible EXHIBIT "D" CITY OF HUNTINGTON BEACH SENIOR OFFICER PROGRAM Senior Police Officer is to be an official classification carrying a salary range of 6 percent above that of top step Police Officer, including Police Officers assigned to motorcycle duty. The criteria for achieving the Senior Police Officer classification is as follows: A. Five years continuous service with the Huntington Beach Police Department -and- B. Three years continuous service at E Step Police Officer -and- C. Possession of Advanced Post Certificate -and- D. Step 4 or 5 in Educational Incentive Program -and- E. Satisfactory performance evaluations as Police Officer. The number of Senior Officers shall be maintained at 35 percent of the total number of Police Officers within the Police Department. Once having met the qualifications for Senior Officer, selections will be made solely on the basis of seniority within the Huntington Beach Police Department. 5889 EXHIBIT "E" PAY IN LIEU OF COMPENSATORY TIME During the months of December and April of each year, all employees shall be allowed to receive pay for compensatory time which has been booked. Procedurally, all compensatory time will be booked based on the method earned, i .e. , straight time or time one half. The employee may choose the number and type of hours which will be paid. In the event an employee chooses to sell compensatory time which was booked at time and one half, the employee understands payment will only be made at straight time. Example: Compensatory Time Book Earned t i d On if a Straight Time Earned at Time an a Ha 9 12 Hours 8 Hours at Time & one half = 12 Hours booked. Paid 12 Hours at straight time If employee elects to sell this time, payment is made as follows: .8 Hours pay - 4 hours lost Hours Left - 0 .Hours Left - 0 5889 EXHIBIT F THE CITY OF HUNTINGTON BEACH EMPLOYEE HEALTH PLAN PLAN DOCUMENT May 1983 (Revised 4/87) 5889 TABLE OF* CONTENTS I . Definitions A. Calendar Year. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 B. Skilled Nursing Facility. . . . . . . 5 C. Effective Date. ■ . • . . . . . . ■ , . r .5 D. Family Members. . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . .5 E. Legally Operated Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . .5 F. Masculine Gender. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 G. Participant. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 H. Physician. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 I . Employee. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 J. Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 K. City. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 L. Retiree. . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 M. Accident. . . . . . . . . . . . . . . . . . . . . . « . . . . . . . . .6 N. Relative Vai.ue Studies. . . . . . . . . . . , . . . . . . . .6 O. Medically Necessary. . . . . . . . . . . . . . . . . . . . . . . . . . . .6 P. Usual Customary and Reasonable. . . . . . . . . . . . . . . . . . . . . .6 U. Second Surgical Opinion. . . . . . . . . . . . . . . . . . . . . « . . , . . . 6 II . Eligibility and Records A. Eligible Employees. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 B. Adding Family Members. . . . . . . , . . . . . , . . . . . . . . . 7 C. MEA. . . . . . . . . . . . . .,. . . . . . . . . . . . « . . . . . . . . . ..7 D. MEO/Non Repr•esented/PMA/FA/MOSA/POA. r . . . . . . . . . . . . . . . ..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 Ser•vices. . . . . . . . . . . . . . . . . . . . . . . . 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 Fore it Agency. . . . . . 12 F. Services and Supplies Not Provided For. . . . . . . . . . . . . . 12 G. Services and Supplies Not Connected with Illness. . . . 12 H. Treatment of Teeth. . . . . .. . . . . . . . . . . • 12 1 5889 I. Services and Supplies for Cosmetic Purposes. . . . . . . . . 12 J. Acts of War. . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . P12 K. Nursing Facilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 L. Custodial Care. . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . 13 M. Medicare. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 N. Sex Transformations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 0. Reversal of Steriliations. . . . . . . . . . . . . . . . . . . . . . . . 13 P. Charges in excess of UCR. . . . . . . . . . . . . . . . . . . . . . . . . 13 U. Experimental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 R. Pregnancy for dependent daughters. . . . . . . . . . . 13 S. Outpatient Psychiatric Care. . . . . . . . . . . . . . . . . . . . . . . . . 13 T. Supplies. . . . . . . . . . . . . . . a . . . . . . . . . . . . . . . . . . . . . . . . . 13 V. Coordination of Benefits A. Benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 B. Definitions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 C. Effect of Benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 D. Facility of Payment. . . . . . . . . . . . . . . . . . . . . 1'7 E. Right of Recovery. . . . . . . . . . . . . . . . 17 F. Right to Receive and Release Necessar•yInfvrmation. . 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 B. Elective Sur•gery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .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. . . . . . 0 . . . . . . . . .26 E. Accident Benefit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2'7 '. X. Ma,jor• Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2S XI. Terminal Benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32 XII . Fee Schedule. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33 XIII . Administration of the Plan A. Appointment of the Claims Administrator•. . . . . . . . . . . . . 41 B. Powers of the Claims Administrator. . . . . . . . . . . . . . . . . . 41 . , C. Claims Procedure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42 D. Appear 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 Per•son. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44 D. Governing Law. . . . . . . . . . . . . . 44 3 5889 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. 1 P.S.T. D. 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. "FamilyMember" shall be the souse of the Employee and P children from birth to nineteen (19) years . of age, 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 � P 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 hour•s .a day nursing service by registered, 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. J 5889 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 (S) 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. 0. "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 ar•e as listed: Cataract Surgery Varicose Vein Ligation Cholecystostomy Tonsillectomy & Adenoidectomy Hernia Repair• Knee Surgery (Men i sectomy ) Hysterectomy Hemorrhoidectomy L.aminectomy Dilation and Curettage Mastectomy Report of Deviated Septum (SMR ) Onychotomy Spinal Fusion Pr•ostatectomy 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 Administrator, 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 must 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 (6) months after the death of the employee 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 5889 NAME DEPENDENT COVERAGE 1 . Stephen Amebalo 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 Hildreth 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. Jarrett Webb None 20. Jack Weide Billie 21 . William Welch Marilyn, William, James, Jeffrey 2. They retired on or after 11/1/791 and a. Made application within 31 days of retiring, 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 retiree becomes an employee of the City of Huntington Beach and elects family coverage under the Employee Health Flan, 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. F. Family Members become ineligible under the following circumstances: 1 . When the Participant becomes ineligible. a. MEA - The date of. termination of coverage shall be one meek 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/ t 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 5889 Claims Administrator within fifteen days of the date on which the change in status occurs, apply for available Group Conversion Policies on the basis and at such subscription charges as ar•e 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 WIL.L. BE PAYABLE IN A HOSPITAL_ OR SKILLED NURSING FACILITY Benefits will be provided for expenses incurred .in any Legally Operated Hospital or• skilled nursing facility under the following conditions: A. Benefits shalt be provided for• expenses incur•r•ed 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. 8. 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 clays 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 inpatient bed care must be Medically Necessary and not capable of being performed on an outpatient basis. 11 5889 PART IV GENERAL L.IMI'TA'TIONS 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 L. 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 t❑ 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 sterilization 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 noncover•ed. R. Car•e 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, hum i d i fees, exercise equipment and supplies for• comfort, hygiene or• beautification, Educational services, nutritional counseling or• food supplements. 13 5889 PART V COORDINATION OF BENEFITS A. All of the benefits provided by the Plan are subject to the following provisions and limitation. D. 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: 1 . 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 incur-red 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 Eenefits 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; lor (3) this Document covers the Participant as the ch ild of a male Participant who has. been legally P 9 Y 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 j an Employee, and the other Plan has covered him for a longer period of time; or 15 5889 (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 period of time. 3. Effective Janaury 11 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 i amounts from any persons to, or for, or with respect to whom such payments were made, or- from any Insurance Company, or li 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 5889 PART VI CONVERSION PRIVILJ.-CaE 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 ar•e then in effect for such program, 1B PART' V I I GENERAL_ PROVISIONS A. This Document, and the individual applications of Employees shal.1 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,. G. 'rhis Medical Benefit Plan is not in lieu of and, does not affect any requirement for, or 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 or 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 care 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 care 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. 19 5889 T . Notice of Claim. Properly completed claim forms 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 VIIT 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 an 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•hoidectomy - surgical excision of hemorrhoids (piles). 5. Hernia repair repair• of an inguinal , femoral or umbical hernia. b. Hysterectomy - removal of the uterus (womb ). 7. Knee Surgery (Menisectomy ) - removal of meniscus cartilage of the knee, S. 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 tore or finger. 12. Prostatectomy -. excision of part or• all of the prostate gland. 13. Repair of deviated septum (SMR ) - sub-mucous resection - plastic 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. 8. The listed surgical procedures shall be considered elective unless the attending physician certifies that the procedure 21 5889 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 Board 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 50% 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 Pr•e 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. 100% of charges for• care in special treatment units licensed by the State, such as intensive care and coronary care units. 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 5889 eligible days of cure, EXCEPT THE ACQUISITION COSTS OF BLOOD AND BLOOD PLASMA AND THE CHARGES FOR EXPERIMENTAL OR INVESTIGATIVE PROCEDURES AND SERVICES. 5. Care 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 Nursing Facility a. Prior care in a Hospital is not required 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 are 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 for reduction of fractures and dislocations. b. Primary Surgeon: Benefits are determined by multiplying the number of Units specified for each pr•oc:edur e i n the Ca 1 i for•n i s 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 must 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 5889 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 per•for•med, 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 I . If the Participant or Family Member• is injured accidentally while covered under this Document, supplemental benefits up to $500.00 for• active Employees an.d $300.00 for• Retirees will be prowided .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 F•OR 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 5889 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: ForP g 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 Doc ument, 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 goad 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 5889 b. 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. I . Services and supplies furnished and billed by a 30 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. E. 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 meek 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 5889 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 extent 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• 3. 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) 1"0 determine the maximum allowance for any service, the Relative 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 Surg. Aries. ABDOMINAL Appendectomy 5. 8 5 Cholecystectomy 8.2 6 with common duct exploration 10.5 Colectomy, with anastamosis 12.0 6 with colostomy 13.5 6 Esophageal hiatus hernia repair, transabdominal 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 Hernioplastya Herniorrhaphy Herniotomy: 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 Labarotomy, exploratory, if done alone 6.5 5 Par•acentesis, 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 Thromboendarterectomy 15.0 6 Coronary artery bypass using saphenous vein on two arteries 32.0 15 on three or more arteries 38. 0 15 33 5889 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 tr•ansvenous electrodes 7. 0 b BONES, JOINTS AND RELATED STRUCTURES Arthr•oscopy of knee, with or without biopsy 4.0 3 Arthr•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 p � Joint replacement -• "total hip" replacement 26. 0 7 Scoliosis correction, Harrington rod technique 33.0 8 Spinal fusion (arthr•odesis) requiring iliac 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 Sur•g. Anes. modified radical , unilateral 10.5 4 radical , unilateral 12. 01 4 CHEST Bronchoscopy, diagnostic 2.4 5 with biopsy 3.2 5 with fore i gn body removal 3. 2 5 Diaphragmatic hernia repair transthoracic 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 lesion (s ) 12. 5 11 EAR, NOSE AND THROAT Adenoidectomy 1 .8 4 Antrum puncture with lavage, unilateral 0.25 4 bilateral . 4 4 Lar•yngoscopy, 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 4 extensive, requiring hospitalization 2. 7 4 Sinusotomy, maxillary, intranasal , unilateral 2.6 4 bilateral 38 4 Radical (Caldwelll -L.uc ), 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 21.4 4 35 5889 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 Chalazion, 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 Gland, 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 1.5.0 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 pro-x.i ma 1 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 age 12 and over 5. 8 3 36 UNITS Sur•g. Anes. Bi -malleolar 3. 2 3 "f`r• i --ma 1 l eo 1 ar• 4.0 3 Toe 0. 65 3 The amounts shown ar•e far• simple closed reductions. If the fracture requires an open operation, an additional allowance will be made. GYNECOLOGY AND OBSTETRICS Barthl i n `s cyst or abscess, incision mar•supialization 2.2 3 Cervix: Local exicision of lesion 0. 4 3 Cauterization, electro or cr•yocautery 0.4 0 Cesarean Section 7.9 6 Cystocel a repair 4.7 4 Dilation and curettage, diagnostic or therapeutic, non maternity 2. 7 3 for therapeutic abortion 3.7 3 Ectopic pregnancy, requiring salpingectomy or salpingostomy 8.3 6 Hysterectomy Abdominal , with or• without tubes 'and/or• ovaries 10.0 6 Vaginal , with cystocel e and/or• rectocele repair 1a. 5 Labparoscopy, diagnostic 3. 8 5 with biopsy 4.6 S Rectocel e repair• 3. 7 4 Tuba] 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 Circumcision, clamp procedure, newborn 0. 4 0 except newborn, hospital 1.2 3 Hydr•ocele, excision, if done alone, unilateral 4.6 3 37 5889 UNITS Surg.. Anes. bilateral 7. 1 3 Needle biopsy, prostate 1.0 3 Or•cn i opex:y, with or without hernia repair, unilateral 6.7 A. bilateral 10.5 4 Prostate, transur•ethr•a1 resection, including vasectomy, complete care 11 .5 5 Pr•ostatectomy, perineal , subtotal 11.5 6 perineal , radical 15. 0 b r•etr•opub i c 11 .5 6 suprapubic, one or two stages 11 .0 6 Var• icote1e, excision unilateral 4. 7 3 Vasectomy, unilateral or bilateral 2. 1 3 NERVOUS SYSTEM Brain cyst, neoplasm or abscess, excision: supratentor• ia1 20.0 11 Burr holes only for evacuation of e:x.tr-adur•a 1 or subdura 1 hematoma 14.0 9 Decompression and neurolysis of median nerve at carpal tunnel 5.0 3 Injection procedure for myel ogr•aphy 1 . 3 4 for discography 1.8 3 Lumbar laminectomy for herniated interver•tebral disc, unilateral , one inter-space 13.5 7 Spinal puncture, diagnostic 0. 4 0 RECTAL. Abscess, ischior•ectal and/or per• irectal , 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 spl en i s flexure 2.9 4 with one or more biopsies 3.3 4 Fissurectomy, if done alone 3. 1 3 Fistulectomy, or fistulotomoy, subcutaneous 1 .7 3 submuscular 5.6 3 Hemor•r•ho i d, enuc 1 ea t i on of external thrombotic 0.45 3 38 UNITS Surg. A►nes. 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 Para thyr•o i dec tomy or exploration of parathyroid 11.5 6 Thyr•oglossal duct, cyst or sinus, excision 7.2 5 .Thyroidectomy, subtotal or partial 8.9 6 total or complete 9.7 6 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 ful gur•at i on of local lesion, single, small , depending upon type of method and lesion 0.2 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 5889 UNITS Surg. Anes. with uretal 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 6 Pelviolithotomy with removal of calculus 11 .5 6 Ureter•ol i thotomy, 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 surgery for malignancies, neo- p lust 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. B. 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; G. 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; 5. To keep records regarding the administration of the Plan; 6. To furnish to City upon request such data with respect to the administrr•ation 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 Plan, 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 5889 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. references 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. D. Appeal Procedure In the event that the claim is denied and the claimant wishes 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. j 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 j time without liability whatsoever for such discontinuance or termination. E. 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 II' such modification, alteration or amendment which sLjbstantially 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 5889 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 workmanklike manner, nor shall it affect the City's rights to discipline, discharge, or take any other action with respect to an Employee. B. 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 Law The Plan shall be governed by and construed in accordance with 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 AMENDMENT NO. 1 THE CITY OF HUNTINGTON BEACH EMPLOYEE HEALTH PLAN PLAN DOCUMENT This Amendment No. I to the City of Huntington Beach Health Plan is to attached to and made part of this Employee Health Plan -- Plan Document effective as follows: As requested, the City of Huntington Beach Employee Health Plan document is hereby amended in its entirety, effective May 1 , 1983. CITY OF' HUNT I NGTON BEACH BY T I TL.E RISK MANAGER 45 5889 AMENDMENT NO 2 THE CITY OF HUNTINGTON BEACH EMPLOYEE HEALTH PLAN PLAN DOCUMENT This Amendment No. 2 to the City of Huntington Beach Employee Health Plan is to be attached to and made part of the Employee Health Plan Document effective January 1, 1985 as follows: 1984 MEDICARE -- DEFRA ENDORSEMENT The terms of the Medicare Provision shall not apply to certain actively employed Insured Employees covered under this Plan nor to their insured Dependents as shown below: 1 . Insured Employees will be covered under this Plan for their primary insurance coverage unless they elect, in writing, to have Medicare as their primary coverage. Any Insured employee who elects Medicare as primary coverage will not be covered for health benefits under this Plan,.. nor will their Dependents be covered under this Plan. 2. Spouses of actively employed Insured inployees under age 70 who are insured as Dependents under this Policy; and will be covered under this Plan for their primary insurance coverage unless they elect, in writing, to have Medicare as their primary coverage. Any spouse who elects Medicare as primary coverage will not be covered far health benefits under this Plan. 46 ?04 I /7 CITY OF HUNTINGT©N BEACH INTER-DEPARTMENT COMMUNICATION HUNPNGTON BEACH To POLICE OFFICERS From ROBERT J. FRANZ ASSOCIATION Deputy City Administrator Subject 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 a problem that has developed on the dental plan. The pre-paid dental plain 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. 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/l/88. 6. The above change in orthodontia coverage not to apply to any individual undergoing an orthodontia treatment plan on 1/1/88 until such treatment plan ceases. 5889 Res. No. 5889 STATE OF CALIFORNIA ) COUNTY OF ORANGE ) ss: CITY OF HUNTINGTON BEACH 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 more than a majority of all the members of said City Council at a regular meeting thereof held on the 20th day of June 19 88 by the following vote: AYES: Councilmen: Kelly, Green, Finley, Erskine, Mays, Winchell, Bannister NOES: Councilmen: None ABSENT: Councilmen: None City Clerk and ex-officio Clerk of the City Council of the City of Huntington Beach, California 5889