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MEO - Management Employees Organization - 2002-12-16
CITY OF HUNTINGTON MACH ,��� ��,�y,d04hS MEETING DATE: February 2, 2004 DEPARTMENT ID NUMBER: AS-04-002 Council/Agency Meeting Held: —4:2� Deferred/Continued to: pproved ❑ Conditionally Approved ❑ Denied % City CI r s S ' atur Council Meeting Date: February 2, 2004 Department ID Number: AS-04-002 SUBMITTED TO: HONORABLE MAYOR AND CITY COUNCIL SUBMITTED BY: RAY SILVER, CITY ADMINISTRATOR94/. a PREPARED BY: WILLIAM P. WORKMAN, ASSISTANT CITY ADMINISTRATOR CLAY MARTIN, DIRECTOR OF ADMINISTRATIVE SERVICES SUBJECT: ADOPT RESOLUTION APPROVING A SIDE LETTER TO THE MEMORANDUM OF UNDERSTANDING BETWEEN THE CITY AND THE HUNTINGTON BEACH �---MANAGEM.ENT-- EMPLOYEES' ORGANIZATION ��? S: /✓�.� �, �` �E,te,:e:nt:o:f Issue, Funding Source, Recommended Action, Alternative Action(s), Analysis, Environmental Status, Attachment(s) Statement of Issue: The city and Huntington Beach Management Employees' Organization have come to a side letter agreement regarding health insurance for calendar year 2004. Funding Source: Funding was adopted by the City Council with the adoption of Councilmember Coerper's December 15, 2003 H-Item titled, "H" Item for December 15,, 2003, City Council Meeting Approval of Funds to Pay Part of Employees Health Insurance Costs. The increase in total annual cost to implement the side letter agreement with the Huntington Beach Management Employees' Organization is approximately $45,300. The remainder of the funding is included in the Fiscal Year 2003/2004 budget. Recommended Action: Adopt Resolution No. -�?oQ- , a resolution of the City Council of Huntington Beach amending the Memorandum of Understanding between the City and the Huntington Beach Management Employees' Organization by adopting the side letter of agreement. Alternative Action(s): Reject the resolution and maintain the current health insurance plans and employer . , contributions. H:\RCA's\MEO Health Side Letter 2004.doc 4- 1/28/2004 10:50 AM F REQUEST FOR ACTION! MEETING DATE: February 2, 2004 DEPARTMENT ID NUMBER: AS-04-002 Analysis: Representatives of the city and the Huntington Beach Management Employees' Organization (MEO) have completed the meet and confer process on a side letter agreement for health insurance benefits for the 2004 calendar year. Health Insurance Effective April 1, 2004 the City Plan POS and Health Net HMO will no longer be available to MEO represented employees. Starting April 1, 2004 all MEO represented employees will begin utilizing either a Blue Shield PPO or HMO or a Kaiser Permanente HMO for medical insurance. The current dental and vision insurance plans remain in place. To assist employees in bridging the period between January 1, 2004 and March 31, 2004 (until the new medical plans are in place April 1, 2004) the city will increase the current medical insurance employer contributions by $93.88 per month in each category of coverage. Effective April 1, 2004 the city will return the medical insurance employer contribution to the 2003 rates and then add $37.72 per month to the 2003 health insurance employer contribution rates in each category of coverage. The current dental and vision insurance plans employer contributions remain in place. The side letter agreement does contain a clause, which may require the city to increase the maximum employer contribution to the same levels provided to another represented employee association in the city. The clause does expire on July 2, 2004. Depending on the category of coverage selected by each employee in the medical, dental, and vision insurance plans, employees will be up to $2,907.79 in calendar year 2004 for health insurance. Monthly Premiums January 1, 2004 through March 31, 2004. Monthly y City Health Delta Delta..VSP Premium Plan Net Dental Dental Vision POS HMO (PPO) (HMO) EE $48.1.40 $312.76 $51.18 $24.38 $18.07 EE + 1 951.96 685.31 97.86 41.46 18.07 EE + 2 or, more '' 1,165.54 903.25 138.83 63.40 18.07 H:\RCA's\MEO Health Side Letter 2004.doc 1/28/200410:50 AM REQUEST FOR ACTION MEETING DATE: February 2, 2004 DEPARTMENT ID NUMBER: AS-04-002 April 1, 2004 through December 31, 2004. Blue Shield Blue Shield Kaiser .Monthly Blue Shield Premium High Option Low. Option HMO Permanente 90/10 PPO'! 80/20 PPO HMO EE $366.21 $322.32 $253.46 $270.75 EE + 1 802.01 705.88 555.06 592.94 EE + 2 or more 1,047.37 921.84 724.87 779.76 Monthly Delta Delta VSP Premium Dental Dental Vision (PPO) (HMO) EE $51.18 $24.38 $18.07 EE + 1 - 97.86 41.46 18.07 EE + 2 or more 138.83 63.40 18.07 Employer Contribution January 1, 2004 through March 31, 2004. Monthly City Health Delta Delta VSP Employer, Plan Net Dental Dental Contribution ° POS HMO (PPO) (HMO) Vision EE $429.93 $330.19 $42.88 $23.00 $17.58 EE + 1 758.41 611.67 81.82 39.11 17.58 EE + 2 ,or more 907.50 776.34 116.36 59.81 17.58 April 1, 2004 through December 31, 2004. Monthly Blue Shield Blue Shield,glue Kaiser Employer High Option Low Option Shield Permane11 nte Contribution 90/10 PPO' 80/20 PPO HMO HMO EE $373.77 $373.77 $274.03 $274.03 EE,+ 1' 702.25 702.25 555.51 555.51 EE + 2 or more 851.34 851.34 720.18 720.18 H:\RCA's\MEO Health Side Letter 2004.doc 74- 1/28/2004 10:50 AM 3 REQUEST FOR ACTION MEETING DATE: February 2, 2004 DEPARTMENT ID NUMBER: AS-04-002 Monthly Delta Delta VSP Employer `.Dental Dental Contribution (PPO) (HMO) Vision EE $42.88 $23.00 $17.58 EE + 1: 81.82 39.11 17.58 EE +2 or more 116.36 59.81 17.58 Employee Contributions January 1, 2004 through March 31, 2004: Monthly City' Health Delta Delta VSP Employee Plan Net Dental Dental Contribution POS HMO (PPO) (HMO) Vision EE $51.47 $0.00 $8.30 $1.38 $0.49 EE + 1 193.55 73.64 16.04 2.35 0.49 EE + 2 or more 258.04 126.91 22.47 3.59 0.49 April 1, 2004 through December 31, 2004: Monthl Blue. Shield Blue Shield Blue Shield Kaiser Employee,:..- Low Option Permanente Contribution 90/1'0 PPO 80/20 PPO HMO HMO EE $0.00 $0.00 $0.00 $0.00 EE + 1: 99.76 3.63 0.00 37.43 EE + 2 or more 196.03 70.50 4.69 59.58 N�onthly Delta Delta VSP ..Employee Dental Dental Contribution (PPO) (HMO) Vision EE $8.30 $1.38 $0.49 EE:+ 1 16.04 2.35 0.49 . EE + 2 or more '' 22.47 3.59 0.49 H:\RCA's\MEO Health Side Letter 2004.doc ,6: 1/28/200410:50 AM REQUEST FOR ACTION MEETING DATE: February 2, 2004 DEPARTMENT ID NUMBER: AS-04-002 Post -Retirement Health Insurance The side letter agreement contains language modifying the city's current practice regarding employee's who retiree with less than ten years of service with the city and their participation in city sponsored medical insurance. The current practice is not to allow employees who retiree with less than ten years of service to the city to participate in city sponsored medical insurance. The new practice will allow these employees to participate with the retiree paying the full cost of the medical insurance coverage. The current Retiree Subsidy Medical Plan will continue without any changes for employees with more than ten years of service to the city. Starting April 1, 2004 the city will allow retirees over age sixty-five to participate in city sponsored medical insurance plans that are supplemental to Medicare. The retiree shall pay the full premium to participate in city sponsored medical insurance plans that are supplemental to Medicare for themselves or qualified dependents without any city subsidy. Retirees or qualified dependents, upon turning age 65, who choose not to participate in city sponsored medical insurance plans that are supplemental to Medicare permanently lose eligibility for this insurance. Health Insurance Contracts The contracts for Blue Shield and Kaiser Permanente to provide health insurance coverage should be before the City Council in March 2004. Attachment(s): RCA Author: William McReynolds H:\RCNs\MEO Health Side Letter 2004.doc 1/28/2004 5:18 PM ATTACHMENT #1 RESOLUTION NO. 0900 "- 7 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF HUNTINGTON BEACH AMENDING THE MEMORANDUM OF UNDERSTANDING BETWEEN THE CITY AND THE MANAGEMENT EMPLOYEES' ORGANIZATION, BY ADOPTING THE SIDE LETTER OF AGREEMENT WHEREAS, on December 16, 2002, the City Council of Huntington Beach adopted Resolution No. 2002-132 for the purpose of adopting the 2000/03 Memorandum of Understanding (MOU) between the City and the Management Employees' Organization (MEO); Subsequent to the adoption of the MOU, the City of Huntington Beach and the MEO agreed to changes, corrections, and clarifications to the MOU that are reflected in a Side Letter of Agreement between the City of Huntington Beach and the MEO ("Side Letter of Agreement") attached hereto as Exhibit A and incorporated herein by this reference. NOW THEREFORE, IT IS HEREBY RESOLVED by the City Council of the City of Huntington Beach as follows: Section 1. The Side Letter of Agreement attached hereto as Exhibit A is approved and adopted. Section 2. The Side Letter of Agreement amends the MOU between the City of Huntington Beach and the MEO. PASSED AND ADOPTED by the City Council of the City of Huntington Beach at a regular meeting thereof held on the 2nd day of February , 2004. ATTEST: City Clerk REVIEWED AND APPROVED: City Admi strator APPROVED AS TO FORM: City Attorney INITIAT Director o dministrative ervices 04reso/MEO side/128/04 __. _ - i �+ - Side Letter Agreement — Health and Other Insurance Benefits Between the City of Huntington Beach and the Huntington Beach Management Employees' Organization Effective: January 1; 2004 This is to memorialize an agreement between the City of Huntington Beach (City) and the Huntington Beach Management Employees' Organization (MEO) to reflect agreed upon changes, corrections or clarifications to Article X — Health and Other Insurance Benefits of the existing Memorandum -of - Understanding. All other terms and conditions of the 'Memorandum -of - Understanding remain in full force and effect. Both parties agree to continue the meet and confer process in good faith as required by the Meyers-Milias-Brown Act. The goal of the continued meet and confer process is a new Memorandum -of -Understanding between the City and the MEO. The subject of the continued meet and confer process shall be all issues between the parties concerning wages, hours, and other terms and conditions of employment. This agreement is to be incorporated into any future Memorandum -of - Understanding between the City and the MEO. Article X — Health and Other Insurance Benefits, Sections B.2, G and H shall now read: ARTICLE X — HEALTH AND OTHER INSURANCE BENEFITS B. Eligibility Criteria and Cost 2. Health and Other Insurance Benefit Premiums a. Year 2004 Employer Contribution, and Employee Contribution i. Monthly Premiums January 1, 2004 through March 31, 2004. Monthly City Health Delta Delta VSP Premium Plan Net Dental Dental .Vision POS HMO (PPO) (HMO) EE $481.40 $312.76 $51.18 $24.38 $18.07 EE + 1 951.96 685.31 97.86 41.46 18.07 EE + 2 or more 1,165.54 903.25 138.83 63.40 18.07 Effective April 1, 2004 the City Plan POS and Health Net HMO will not be available to MEO represented employees. April 1, 2004 through December 31, 2004. Monthly Blue Shield Blue Shield glue Shield Kaiser Premium High Option Low Option HMO Permanente 90110 PPO 80/20 PPO HMO EE $366.21 $322.32 $253.46 $270.75 EE,+ 1 802.01 705.88 555.06 592.94 EE + 2 or more 1,047.37 921.84 724.87 779.76 2 Month) y Delta Delta VSP Premium Dental Dental Vision (pPO) (HMO) EE $51.18 $24.38 $1.8.07 EE + 1 97.86 41.46 18.07 EE + 2 or more 138.83 63.40 18.07 ii. Employer Contribution The City's maximum monthly employer contribution for health and other insurance premiums are set forth in the charts below. With a written request from MEO, the City Administrator is authorized to modify the City's maximum monthly employer contribution (e.g. the "employer contribution" described below in the chart for April 1, 2004 through December 31, 2004), to reflect changes necessary to make the City's maximum monthly employer contribution the same as the "employer contribution" or "cap" provided to another represented employee association in the City. The change to the City's maximum monthly employer contribution for MEO will become effective the beginning of the pay period after the association's written proposal is received by the City Administrator's Office. The City Administrator's authorization to modify the City's maximum monthly employer contribution for MEO (described above) shall expire at 12:00 p.m. on Friday, July 2, 2004. January 1, 2004 through March 31, 2004. Monthly City Health Delta Delta VSP Employer Plan Net Dental Dental Contribution POS HMO (PPO) (HMO) Vision EE $429.93 $330.19 $42.88 $23.00 $17.58 EE + 1 758.41 611.67 81.82 39.11 17.58 EE + 2 or more 907*50 776.34 116.36 59.81 17.58 3 April 1, 2004 through December 31, 2004. Monthly Blue Shield Blue Shield Blue- Shield Kaiser Employer High Option Low Option Permanente Contribution 90/10 PPO 80/20 PPO HMO HMO EE $373.77 $373.7-7 $274.03 -$274.03 EE + 1 702.25 702.25 555.51 555.51 EE + 2 or more 851.34 851.34 720.18 720.18 Monthly Delta Delta VSP Employer Dental Dental Contribution (PPO) (HMO) Vision EE $42.88 $23.00 $17.58 EE + 1 81.82 39.11 17.58 EE + 2 or more 116.36 59.81 17.58 In no event shall the employee be entitled to the difference between the employer contribution and the premiums for insurance plan(s) selected by the employee. iii. Employee Contributions Employee contributions to health and other insurance plans will be taken on a pre-tax basis. The employee paid contributions translate to the following on a monthly basis: January 1, 2004 through March 31, 2004: Monthly City Health Delta Delta VSP Employee Plan Net Dental Dental Contribution POS HMO (PPO) (HMO) Vision EE $51.47 $0.00 $8.30 $1.38 $0.49 EE + 1 193.55 73.64 16.04 2.35 0.49 FEE + 2 or more 258.04 126.91 22.47 3.59 0.49 4 April 1, 2004 through December 31, 2004: Monthly Blue Shield Blue Shield Blue Shield Kaiser Employee High Option Low Option Permanente Contribution 90/10 PPO 80/20 PPO HMO HMO EE $0.00 $0.00 $0.00 $0.00 EE + 1 99.76 3.63 0.00 37.43 EE + 2 or more 196.03 70.50 4.69 59.58 Monthly Delta Delta VSP Employee Dental Dental Contribution (PPO) (HMO) Vision EE $8.30 $1.38 $0.49 EE + 1 16.04 2.35 0.49 EE + 2 or more 22.47 3.59 0.49 The employee paid contributions translate to the following on a bi-weekly (per paychecks basis: January 1, 2004 through March 31, 2004: Bi-Weekly City Health Delta Delta VSP Employee Plan Net Dental Dental Contribution POS HMO (PPO) (HMO) Vision EE $23.76 $0.00 $3.83 $0.64 $0.23 EE + 1 89.33 33.99 7.40 1.08 0.23 EE + 2 or more 119.10 58.57 10.37 1.66 0.23 April 1, 2004 through December 31, 2004: Bi-Weekly Blue Shield Blue Shield glue Shield Kaiser Employee High Option Low Option Permanente Contribution 90/10 PPO 80/20 PPO HMO HMO EE $0.00 $0.00 $0.00 $0.00 EE + 1 46.04 1.68 0.00 17.28 EE + 2 or more 90.48 32.54 2.16 27.50 11 Bi-Weekly Delta Delta VSP Employee Dental Dental Contribution (PPO) (HMO) Vision EE $3.83 $0.64 $0.23 EE + 1 7.40 1.08 0.23 EE + 2 or more 10.37 1.66 0.23 G. Retiree Medical Coverage for Retirees Not Eligible for the City Medical Retiree Subsidy Plan Employees who retire from the City after January 1, 2004 and are granted a retirement allowance by the California Public Employees' Retirement System and are not eligible for the City's Retiree Subsidy Medical Plan may choose to participate in City sponsored medical insurance plans until the first of the month in which they turn age sixty-five (65). The retiree shall pay the full premium for City sponsored medical insurance for themselves and/or qualified dependents without any City subsidy. Employees who_ retire from the City and receive a retirement allowance from the California Public Employees' Retirement System and are not eligible for the City's Retiree Subsidy Medical Plan and choose not to participate in City sponsored medical insurance upon retirement permanently lose eligibility for this insurance. However, if a retiree who is not eligible for the City's Retiree Subsidy Medical Plan chooses not to participate in city sponsored medical insurance plans because the retiree has access to other group medical insurance, and subsequently loses eligibility for that group medical insurance, the retiree and their qualified dependents will have access to city sponsored medical insurance plans reinstated. Eligibility for Retiree Medical Coverage terminates the. first of the month in which the retiree or qualified dependent turns age sixty-five (65). H. Post-65 Supplemental Medicare Coverage Retirees who are participating in the Retiree Subsidy Medical Plan as of January 1, 2004 and all future retirees who meet the criteria to participate in City sponsored medical insurance, with or without the Retiree Medical Subsidy Plan, may participate in City sponsored medical insurance plans that are supplemental to Medicare, after a contract is in place between the City and a health insurance provider. F A retiree or qualified dependent must choose to participate in City sponsored medical insurance plans that are supplemental to Medicare beginning the first of the month in which the retiree or qualified dependent turns age sixty-five (65). The retiree shall pay the .full premium to participate in ..City sponsored medical insurance plans that are supplemental to Medicare for themselves or qualified dependents without any City subsidy. Retirees or qualified dependents, upon turning age 65, who choose not to participate in City sponsored medical insurance plans that are supplemental to Medicare permanently lose eligibility for this insurance. In order to completely implement the terms and conditions of this agreement pertaining to the Article X — Health and Other Insurance Benefits, Sections I and J the City and MEO agree to meet and confer regarding changes to Article XI.A.2 and Exhibit E of the current Memorandum -of - Understanding. The City and MEO agree that the goal of the changes to Article XI.A.2 and Exhibit E of the current Memorandum -of -Understanding is to make. Article XI.A.2 and Exhibit E consistent with the language presented in this side letter. It is the understanding of the City of Huntington Beach and the Huntington Beach Management Employees' Organization that this side letter to the existing 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. 7 IN WITNESS WHEREOF, the parties hereto have executed this side letter to the Memorandum -of -Understanding this day of January, 2004. CITY OF HUNTINGTON PEAC &0 al William P. Workman Assistant City Admini trator Clay MaZu Directo dministrative Services ' 4e Steven M. Berliner Chief Negotiator APPROVED AS TO FORM: r. f` Jennifer McGrath City Attorney MANAGEMENT EMPLOYEES ORGANIZATION Eric R. Charlonne President Thernas P. Graham Vice -President APPROVED AS TO FORM: a s G. H er al Counsel 0 Res. No. 2004-7' STATE OF CALIFORNIA COUNTY OF ORANGE ) ss: CITY OF HUNTINGTON `BEACH ) 1, CONNIE BROCKWAY, 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 at least a majority of all the members of said City Council at an regular meeting thereof held on the 2nd day of February, 2004 by the following vote: AYES: Coerper, Hardy, Green, Boardman, Cook NOES: Sullivan ABSENT: Houchen ABSTAIN: None City Clerk and ex-officio erk of the City Council of the City of Huntington Beach, California ATTACHMENT #2 PPo-CP High January L °2004 Questions? Call 1-800-200-3242 Highlights: THIS MATRIX IS INTENDED TO BE USED TO HELP YOU COMPARE COVERAGE BENEFITS AND IS A SUMMARY ONLY. THE EVIDENCE OF COVERAGE AND PLAN CONTRACT SHOULD BE CONSULTED FOR A DETAILED DESCRIPTION OF COVERAGE BENEFITS AND LIMITATIONS. DEDUCTIBLES (all providers combined) Preferred Non -Preferred Benefits marked with an asterisk (*) are NOT subject to the calendar -year medical Providers' Providers' deductible. • Individual $500 • Family $1,000 Calendar -Year Copayment Maximum # • Individual $2,000 $10,000 • Family $4,000 $20,000 LIFETIME MAXIMUMS 0 • I I AA unlimited / 0 0 11 1 PROFESSIONAL SERVICES Physician services • Office visits and consultations $20/visit* 40%# • Specialist visits and consultations $20/visit* 40%# • Laboratory and X-rays $20/visit 40% • Mammogram and pap test or other FDA -approved cervical cancer screening tests $20/visit* 40% • Allergy testing or treatment 10% 40% • Diagnostic testing 10% 40% Preventive care • Annual routine physical exam Includes: eye/ear screening, immunizations, vaccinations No charge* 40% • Mammogram and pap test screening No charge* 40% or other FDA -approved cervical cancer screening tests • Laboratory No charge* 40% Well -baby care • Office visits and consultations Includes: eye/ear screening, immunizations, vaccinations $20/visit* Not covered • Laboratory $20/visit Not covered OUTPATIENT SERVICES • Outpatient surgery in hospital/facility 10% 40%2 • Outpatient treatment, renal dialysis and necessary supplies 10% 40%2# HOSPITALIZATION SERVICES • Inpatient visits and consultations 10% 40% • Surgeons and assistants, anesthesiologists, pathologists, radiologists 10% 40% • Semi -private room and board, medically necessary services 10% 40%2 (including subacute care) and supplies EMERGENCY HEALTH COVERAGE • Facility services (waived if admitted directly to the hospital as an inpatient) $50*# + 10%* • Emergency room physician services 10% 10% AMBULANCE SERVICES 20% 20% PRESCRIPTION DRUG COVERAGE A descri tion of your outpatient prescription drugg coverage is provided separately. �i this If you do not have the separate drug sheet that goes wit matrix, please contact your benetI s administrator. Preferred Non -Preferred DURABLE MEDICAL EQUIPMENT Providers' Providers' • Home medical equipment, prosthetics/orthotics 10% (Orthoses Only -Up to 40% (Orthoses Only -Up $2,000 per person per to $2,000 per person per year) year) MRSA Participating MHSA Non - Providers' Participating MENTAL HEALTH SERVICES (PSYCHIATRIC)3 Providers' • Inpatient services 10% 40%2 • Outpatient visits for severe mental health conditions $20/visit* 40%# • Outpatient visits for non -severe mental health conditions $20/visit # 40% (up to 30 visits per calendar year combined with outpatient chemical dependency visits)e CHEMICAL DEPENDENCY SERVICES (SUBSTANCE ABUSE) • Inpatient services for medical acute detoxification 10% 40% • Outpatient visits (up to 30 visits per calendar year combined with outpatient non -severe mental $20/visit# 40% health visits)' HOME HEALTH SERVICES (combined maximum of 100 preauthorized visits per calendar year) Preferred Non -Preferred Providers' Providers' • Home health and home infusion care (see "Outpatient Prescription Drug Coverage" for home 10% 10%4 self-administered injectables) HOSPICE • Routine home care and inpatient respite care No charge No Charge w/prior auth • 24 hour continuous home care and general inpatient care 10% 10% w/prior auth OTHER Alternative care6 • Chiropractic and acupuncture services (up to 20 visits, combined, per calendar year) 10% 40% Physical medicine • Office visits and related services (such as physical therapy and occupational therapy) 10% 40% Pregnancy and maternity • Prenatal and postnatal care • All necessary inpatient hospital services Family planning • Family planning counseling • Elective abortion, tubal ligation, vasectomy • Contraceptive devices and fitting Skilled nursing facility (SNF) services (up to 180 days per calendar year) • Semi -private accommodations —freestanding SNF • Semi -private accommodations — hospital SNF unit 10% 40% See "Hospitalization Services" See "Hospitalization Services" $20/visit* Not covered 10% Not covered $20/visit* 40%# 10% 40% 10% 40%2 Covered out-of-state benefits Benefits provided through BlueCard Program, for out-of-state 10% or $20 copay 40% emergency and non -emergency care, are provided at the preferred level of the local Blue Plan allowable amount when you use a Blue Cross/Blue Shield provider. Diabetes care • Equipment, devices and non -testing supplies (for testing supplies, please see "Outpatient 10% 40% Prescription Drug Coverage") • Self -management training and education $20/visit 40% Hearing aid services • Audiological evaluations $20/visit* 40%# • Hearing aid instrument and ancillary equipment 10% 40% (up to two hearing aids) ($1,000 maximum ($1,000 maximum every 24 months) every 24 months) Optional Benefits Optional dental, vision, inpatient substance abuse treatment, or infertility benefits are available. If your employer purchased any of these benefits, a description of the benefit is provided separately. Benefits are not subject to the calendar -year medical deductible. # Copayments and charges for services not included in the calculation of the member's calendar -year copayment maximum continue to be the member's responsibility after the calendar -year copayment maximum is reached. Deductible does not apply toward the calendar -year maximum. Please refer to the Evidence of Coverage, the Disclosure Form and the Group Health Service Contract for exact terms and conditions of coverage. 1 Member is responsible for copayment in addition to any charges above allowable amounts. The copayment percentage indicated is a percentage of allowable amounts. Preferred providers accept Blue Shield's allowable amount as full payment for covered services. Non -preferred providers can charge more than these amounts. When members use non -preferred providers, they must pay the applicable copayment plus any amount that exceeds Blue Shield's allowable amount. Charges above the allowable amount do not count toward the calendar -year deductible or copayment maximum. 2 The maximum allowed charges for non -emergency hospital services received from a non -preferred hospital is $600 per day. Members are responsible for 40 percent of this $600 per day, plus all charges in excess of $600. For physician services, members pay 40 percent of allowable amounts, plus all charges in excess of allowable amounts. 3 Mental health and chemical dependency services, other than medical acute detoxification, are accessed through the MHSA. Services for medical acute detoxification are accessed through Blue Shield using Blue Shield's preferred providers or non -preferred providers. For a listing of severe mental illnesses, including serious emotional disturbances of a child, and other benefit details, please refer to the Evidence of Coverage or plan contract. 4 Out -of -network home health care and home infusion services are not covered unless they are pre -authorized by Blue Shield. When these services are preauthorized, members pay 10 percent, the preferred provider level. 5 Covered hospice services received from any hospice agency must be pre -authorized by Blue Shield. If Blue Shield preauthorizes hospice services from a non -participating hospice agency, those hospice services will be reimbursed at participating hospice agency level. 6 All outpatient non -severe mental health, outpatient substance abuse, acupuncture and chiropractic visits accrue to the calendar -year visit maximum regardless of whether the plan deductible has been met. Benefits are subject to modification for subsequently enacted state or federal legislation. PPO CP High (8/03) THIS MAi RIX IS INTENDED TO BE USED TO HELP YOU COMPARE COVERAGE BENEFITS AND IS A SUMMARY ONLY. THE EVIDENCE OF COVERAGE, DISCLOSURE FORM AND PLAN CONTRACT SHOULD BE CONSULTED FOR A DETAILED DESCRIPTION OF COVERAGE BENEFITS AND LIMITATIONS. DEDUCTIBLES" (All providers combined) Preferred Non -Preferred Providers' Providers' Calendar -year medical deductible $500 individual/ $1,000 family Calendar -year copayment maximum# • Individual $3,000 $10,000 • Family $6,000 $20,000 LIFETIME MAXIMUMS unlimited • o 0 0.- ' PROFESSIONAL SERVICES Physician services • Physician and specialist office visits $20/visit" 40%* • Laboratory and X-rays $20/visit 40% • Allergy testing or treatment 20% 40% • Diagnostic testing 20% 40% Preventive care • Annual physical exam, eye/ear screenings and immunizations according to age No charge* 40% schedule • Laboratory, including mammogram and Pap test screening No charge* 40% or other FDA -approved cervical cancer screening tests Well -baby care • Office visits and consultations Includes: eye/ear screenings, immunizations, vaccinations $20/visit* Not covered • Laboratory $20/visit Not covered OUTPATIENT SERVICES • Outpatient surgery in hospital/facility 20% 40%2 • Outpatient treatment, renal dialysis and necessary supplies 20% 40%' HOSPITALIZATION SERVICES • Inpatient physician services (including pregnancy and maternity care) 20% 40%z • Semi -private room and board, medically necessary services 20% 40%2 and supplies Skilled nursing facility (SNF) servlceS3 (Up to 100 combined days per calendar year; semi -private accommodations) • Freestanding SNF 20% 40% • Hospital SNF unit 20% 40%2 EMERGENCY HEALTH COVERAGE • Facility services (The $50 copayment per emergency room visit is waived if the member is directly $50*# + 20%* admitted to the hospital for inpatient services) • Emergency room physician services 20% 20% AMBULANCE SERVICES 20% 20% PRESCRIPTION DRUG COVERAGE A description of your outpatient prescription drug coverage is provided separately. If you do not have the separate drug sheet that goes with this matrix, please contact your benefits administrator or call Customer Services at 800-200-3242. Preferred Non -Preferred DURABLE MEDICAL EQUIPMENT Providers' Providers' • Home medical equipment, prosthetics/orthotics 20% of allowable amount 40% of allowable amount (up to $2,000 maximum per (up to $2,000 maximum per calendar year) calendar year) MENTAL,,.HEALTH SERVICES (PSYCHIATRIC)4 • Inpatient' hospital facility services • Outpatient visits for severe mental health conditions • Outpatient visits for non -severe mental health conditions (Up to 30 visits per calendar year combined with outpatient chemical dependency visits)5 MHSA Participating Providers' 20% $20/visit" 20/visit# MHSA Non - Participating Providers' 40%Z 40%* 40% CHEMICAL DEPENDENCY SERVICES (SUBSTANCE ABUSE)" • Inpatient services for medical acute detoxification 20% 40% • Outpatient visits (Up to 30 visits per calendar year combined with outpatient non -severe mental $20/visit# 40% health visits) 5 HOME HEALTH SERVICES (Combined maximum of 100 prior authorized visits per calendar year) Preferred Non -Preferred Providers' Providers' • Home health and home infusion care (See "Prescription Drug Coverage" for home self- 20% 20% with prior administered injectables) authorization • Routine home care and inpatient respite care • 24 hour continuous home care and general inpatient care OTHER Alternative cares • Chiropractic and acupuncture services (up to 15 visits, combined, per calendar year) Physical medicine • Office visits and related services (such as physical therapy and occupational therapy) Family planning No charge 20% No charge, with prior authorization 20% with prior authorization 20% 40% 20% 40% • Family planning counseling $20/visit" Not covered • Elective abortion, tubal ligation, vasectomy 20% Not covered • Contraceptive devices and fitting $20/visit" 40%# Covered out -of -State benefits Benefits provided through BlueCard Program, for out-of-state 20% or $20 copay 40% emergency and non -emergency care, are provided at the preferred level of the local Blue Plan allowable amount when you use a Blue Cross/Blue Shield provider. Diabetes care • Equipment, devices and non -testing supplies (for testing supplies, please see "Prescription 20% 40% Drug Coverage") • Self -management training and education $20/visit 40% Hearing aid services • Audiological evaluations • Hearing aid instrument and ancillary equipment (up to two hearing aids) $20/visit' 40%# 20% 40% 1,000 maximum ($1,000 maximum fery 24 months) every 24 months) Optional Benefits Optional dental, vision, inpatient substance abuse treatment, or infertility benefits are available. If your employer purchased any of these benefits, a description of the benefit is provided separately. Footnotes Benefits are not subject to the calendar -year medical deductible. # Copayments and charges for services not included in the calculation of the member's calendar -year copayment maximum continue to be the member's responsibility after the calendar -year copayment maximum is reached. Deductible does not apply toward the calendar -year maximum. Please refer to the Evidence of Coverage, the Disclosure Form and the Group Health Service Contract for exact terms and conditions of coverage. 1 Member is responsible for copayment in addition to any charges above allowable amounts. The copayment percentage indicated is a percentage of allowable amounts. Preferred providers accept Blue Shield's allowable amount as full payment for covered services. Non -preferred providers can charge more than these amounts. When members use non -preferred providers, they must pay the applicable copayment plus any amount that exceeds Blue Shield's allowable amount. Charges above the allowable amount do not count toward the calendar -year deductible or copayment maximum. 2 The maximum allowed charges for non -emergency hospital services received from a non -preferred hospital is $600 per day. Members are responsible for 40% of this $600 per day, plus all charges in excess of $600. 3 Services may require prior authorization by Blue Shield. When these services are prior authorized, members pay the preferred or participating provider amount. 4 Mental health and chemical dependency services, other than medical acute detoxification, are accessed through the mental health services administrator (MHSA) - US Behavioral Health Plan, California (USBHPC) - using MHSA participating and non -participating providers. Services for medical acute detoxification are accessed through Blue Shield using Blue Shield's preferred providers or non -preferred providers. For a listing of severe mental illnesses, including serious emotional disturbances of a child, and other benefit details, please refer to the Evidence of Coverage or plan contract. 5 All outpatient non -severe mental health, outpatient substance abuse, acupuncture and chiropractic visits accrue to the calendar -year visit maximum regardless of whether the plan deductible has been met. Benefits are subject to modification for subsequently enacted state or federal legislation. PPO CP Low (8/03) Blue Shield of California An Independent Member of the Blue Shield Association Shield Spectrum PPO & PPO Outpatient Prescription Drug (For groups of 51 and above) Highlight: 3-Tier/Incentive Formulary THIS _,4UG SUMMARY IS INTENDED TO BE Plus Plans USED WITH THE SHIELD SPECTRUM PPO OR PPO PLUS PLANS UNIFORM HEALTH PLAN Coverage BENEFITS AND COVERAGE MATRIX. g THE EVIDENCE OF COVERAGE, DISCLOSURE FORMAND PLAN CONTRACT SHOULD BE CONSULTED FOR A DETAILED DESCRIPTION OF COVERAGE BENEFITS AND LIMITATIONS. No Calendar -Year Brand -Name Drug Deductible $5 Generic/$15 Formulary Brand-Name/$30 Non -Formulary Brand -Name Drugs — Retail Pharmacy $10 Generic/$25 Formulary Brand-Name/$45 Non -Formulary Brand -Name Drugs — Mail Service Covered Services Member G"opayment DEDUCTIBLES (Prescription drug coverage benefits are not subject to the medical plan deductible.) Calendar -year brand -name drug deductible PRESCRIPTION DRUG COVERAGE*0 (Including oral contraceptives, diaphragms, and covered diabetic drugs and testing supplies). — Retail prescriptions (For up to a 30-day supply) — Mail service prescriptions (For up to a 90-day supply) — Home self-administered injectable drugs (May require preauthorization from Blue Shield Pharmacy Services) None Participating Pharmacy $5 Generic $15 Formulary Brand $30 Non -Formulary Brand $10 Generic $25 Formulary Brand $45 Non -Formulary Brand 30% Non -Participating Pharmacy Member pays 25% of allowable amount plus a copayment of: $5 Generic $15 Formulary Brand $30 Non -Formulary Brand Not covered Not Covered * If the physician or member requests a brand -name drug and a generic drug equivalent is available, the member is responsible for paying the difference between the cost to Blue Shield of California of the brand -name drug and its generic drug equivalent, as well as the applicable formulary generic drug copayment. # Copayments and charges for services not included in the calculation of the member's calendar -year copayment maximum continue to be the member's responsibility after the calendar -year copayment maximum is reached. Please refer to the Evidence of Coverage, the Disclosure Form and the Group Health Service Contract for exact terms and conditions of coverage. Stretch Your Prescription Drug Dollar Even Further This benefit chart is just the beginning to making the most of your coverage. To help you get your money's worth, we have created many opportunities for you to save on costs wherever possible. Read on and learn about the unique resources we have to support you. Choose generic i,lptead of brand-namedrugs emu,- r We're driving the use of generics to help you get safe, affordable drugs at a time when prescription costs continue to grow. Increasing drug costs is one of the main reasons that overall healthcare coverage has become more expensive. But the use of generics can have a direct and indirect impact on keeping rates down. By choosing a proven generic over a brand -name drug, you can quickly lower your costs. Generics cost less than brand -name drugs so we can pass the savings on to you through affordable generic drug coverage. When you ask for a drug that is available as a generic you have a copayment that is significantly less than the copayment for the brand, and no deductible. Kri Choose generlonstea"f brand name drugs, continued You can trust generics to be equivalent to their brand -name counterpart. They must contain the same active ingredient and have approval from the U.S. Food and Drug Administration for meeting the same safety standards. About half the drugs on the market today are available in generic form. Your doctor can help you decide if a specific drug is right for you. At your next visit, let your doctor know you prefer generics and remember to bring a copy of your formulary. For a printed copy, call the customer service number on your Blue Shield ID card or download one from the "pharmacy" section of www.mylifepath.com. Use online Pharr► acy tools at" Myllfepath com " y .,..,; We created the "pharmacy' section of our Web site to give you access to resources to help you be informed and make cost -saving decisions. • ask the pharmacist — If you have clinical questions about prescription or over-the-counter drugs, you can use this feature to connect with the drug information pharmacists at the University of California, San Francisco. Simply submit your question using easy electronic forms. Within one to two business days, a clinical pharmacist will reply by e-mail with a link to a confidential response posted on the mylifepath site. Then, you have the option of saving the answer to a personal archive for later reference. • drug database & formulary — Use this feature to get information on our most current formulary list, generic alternatives that help you lower out-of-pocket costs and details about specific coverage restrictions. You can search by drug name, try browsing by first letter, or searching by medical condition or drug class. Plus, watch for the most recent changes to our formulary highlighted in our "Announcements" box. participating pharmacies — Using this feature, you can locate participating pharmacies for maximum coverage. Just enter a zip code or city and our new tool aggregates a list, across retail chains and independents, and serves it up on our site. S" up�for' our„ prescription mail servilS iu ,,,,.. , w a;. If you take a particular drug for a chronic condition such as diabetes or high blood pressure on an ongoing basis, going to the "pharmacy" at www.mylifepath.com can save you a trip - or several trips - to your local network pharmacy. Our plans offer coverage of a mail service benefit, available through Express Scripts. Members who take stabilized doses of long-term maintenance medications can order a mail service refill of up to a 90-day supply. After sending your initial maintenance drug prescription to Express Scripts, you can order refills via the "pharmacy" section of www.mylifepath.com. If you prefer to renew your prescription by phone, you can call Express Scripts at (800) 544-6962, or TTY (800) 972-4348 if you are hearing impaired. Allow up to 14 days for delivery, from the day you mail your initial prescription order or order a refill. If you don't have Internet access, call Customer Service at the number on your Blue Shield ID card to find out more about your drug benefits and get a mail service order form. Please note that injectable drugs other than insulin and drugs used for short-term conditions, such as migraine medications and antibiotics, are not covered by this mail service benefit. «Au (1 /04) Blue Shield of CMbrW, V. An Independent Member of the it ue Shield Assooat. THIS MATRIX IS INTENDED TO BE USED TO HELP YOU COMPARE COVERAGE BENEFITS AND IS A SUMMARY ONLY. THE EVIDENCE OF COVERAGE AND PLAN CONTRACT SHOULD BE CONSULTED FOR A DETAILED DESCRIPTION OF COVERAGE BENEFITS AND LIMITATIONS. Highlights: DEDUCTIBLES Calendar -year medical deductible None Calendar -year copayment maximum# (for many covered services) $1,000*per Individual $2,000* per Family LIFETIME MAXIMUMS PROFESSIONAL SERVICES Physician services — outpatient None • Personal Physician office visits and consultations $10/visit • Specialist visits and consultations (with an authorized referral) $10/visit • Obstetrical/Gynecological (OB/GYN) physician services $10/visit (A woman may self -refer to an OB/GYN or family practice physician in her Personal Physician's medical group or IPA for OB/GYN services.) • Allergy testing or treatment' $10/visit • Injectable medications administered during office visit (other than injectables for allergy) No charge Access+ Specialists" (self -referred office visits or consultations only)Z $30/VISIt Laboratory, X-ray and diagnostic tests No charge Preventive care • Scheduled routine physical exams $10/visit — Well -baby, child and adult exams according to age schedule — Annual gynecological exams (A woman may self -refer to an OB/GYN or family practice physician in her Personal Physician's medical group or IPA.) • Immunizations $10/visit • Vision eye refraction and hearing screenings up to age 18 $10/visit OUTPATIENT SERVICES Non -emergency • Outpatient surgery No charge • Outpatient treatment, renal dialysis and necessary supplies No charge HOSPITALIZATION SERVICES • Inpatient physician visits and consultations No charge • Surgeons and assistants, anesthesiologists, pathologists, radiologists No charge • Semi -private room and board, medically necessary services No charge and supplies, including subacute care EMERGENCY HEALTH COVERAGE (waived if admitted directly to the hospital as an inpatient) $25/visit AMBULANCE SERVICES No charge PRESCRIPTION DRUG COVERAGE A description of your outpatient prescription drug coverage is provided separately. If you do not have the separate drug sheet that goes with this matrix, please contact your benefits administrator. DURABLE MEDICAL EQUIPMENT • Home medical equipment, prosthetics/orthotics, oxygen, colostomy/ostomy supplies MENTAL HEALTH SERVICES (PSYCHIATRIC) Inpatient physician services Outpatient visits for severe mental health conditions Outpatient visits for non -severe mental health conditions (up to 30 visits per calendar year combined with outpatient chemical dependency visits) No charge No charge $10/visit $10/visit • visits) ERVICES (SUBSTANCE ABUSE)' al acute detoxification (up to 30 visits per calendar year combined with outpatient non -severe mental health No charge $10/visit HOME HEALTH SERVICES • Agency visits (up to 100 visits per calendar year) No charge • Medical supplies/IV solutions/home self-injectables from home infusion agency' No charge • Home self-injectables obtained from Blue Shield of California participating pharmacy $30 per prescription, up to a 30-day supply HOSPICE • Routine home care and inpatient respite care No charge • 24 hour continuous home care and general inpatient care No charge OTHER Pregnancy and maternity care • Prenatal and postnatal physician office visits No charge • All necessary inpatient hospital services No charge Family planning and infertility services • Family planning counseling $10/visit • Diagnosis and treatment of causes of infertility 50% of allowed charges • Tubal ligation 5' 6 and elective abortions $100 • Vasectomy $75 • Contraceptive devices and fitting $10/visit Rehabilitative therapy services — physical, speech, occupational and respiratory therapy • Outpatient visits $10/visit • In rehab unit of hospital No charge • In skilled nursing facility (SNF) rehab units No charqe Skilled nursing facility (SNF) services (up to 100 days per calendar year") No charge Urgent care outside service area (BlueCard Program) $50/visit Diabetes care • Equipment, devices and non -testing supplies (For testing supplies, please see "Outpatient Prescription Drug Coverage.") • Self -management training and education Hearing Aid Services • Audiological evaluations Hearing aid instrument and ancillary equipment (up to two hearing aids) 50% of allowed charges $10/visit No charge $1,000 maximum every 36 months Optional benefits Optional dental, vision, chiropractic, chiropractic and acupuncture, inpatient substance abuse treatment or infertility benefits are available. If your employer purchased any of these benefits, a description of the benefit is Provided seDarately. Copayments and charges for services not included in the calculation of the member's calendar -year copayment maximum continue to be the member's responsibility after the calendar -year copayment maximum is reached. Copayments for many covered services accrue to the calendar -year copayment maximum. Serum administered during the office visit is included. For serum purchased separately from the office visit, the member copayment is 50 percent of allowed charges. To use this option, members must select a Personal Physician who is affiliated with a medical group or IPA that is an Access+ provider group, which offers the Access+ Specialist feature. Members should then select a specialist within that medical group or IPA. Access+ Specialist visits for mental health or substance abuse services must be provided by a mental health services administrator's (MHSA) network participating provider. Access+ Specialist visits for mental health services for non -severe mental illness, or non -serious emotional disturbances of a child, or substance abuse will accrue toward the 20-visit per calendar -year maximum. In addition, all Access+ Specialist visits require a $30.00 member copayment per visit. Mental health and chemical dependency services, other than medical acute detoxification, are accessed through the MHSA using MHSA participating providers. Services for medical acute detoxification are accessed through Blue Shield using Blue Shield HMO providers. For a listing of severe mental illnesses, including serious emotional disturbances of a child, and other benefit details, please refer to the Evidence of Coverage or plan contract. In vitro fertilization, injectables for infertility, artificial insemination and GIFT are excluded. Copayment does not apply when performed in conjunction with delivery or abdominal surgery. Physician services copayment in the office or outpatient hospital facility only. If procedure is performed in an inpatient hospital facility setting, additional hospital services copayment will apply. Home self -injectable medications may require preauthorization by Blue Shield and must be obtained from home infusion agencies or Blue Shield participating pharmacies. Covered hospice services received from any hospice agency must be pre -authorized by Blue Shield. If Blue Shield preauthorizes hospice services from a non -participating hospice agency, those hospice services will be reimbursed at participating hospice agency level. Skilled nursing services are limited to 100 days during any calendar -year except when received through a hospice program provided by a participating hospice agency. This 100-day maximum on skilled nursing services is a combined maximum between hospital and skilled nursing facilities. Benefits are subject to modification for subsequently enacted state or federal legislation. Access+HMO CP10 (8/03) Blue Shield of Calif©rtua. An independent Member of the Blue 5h ekd Association Access+ HMOsM Outpatient Prescription Drug Coverage (For groups of 51 and above) Highlight: 3-Tier/Incentive Formulary THIS —AUG SUMMARY IS INTENDED TO BE 'w USED WITH THE ACCESS+ HMO OR ADDED ADVANTAGE POS PLANS UNIFORM HEALTH PLAN BENEFITS AND COVERAGE MATRIX. THE EVIDENCE OF COVERAGE, DISCLOSURE FORM AND PLAN CONTRACT SHOULD BE CONSULTED FOR A DETAILED DESCRIPTION OF COVERAGE BENEFITS AND LIMITATIONS. No Calendar -Year Brand -Name Drug Deductible $5 Generic/$15 Formulary Brand-Name/$30 Non -Formulary Brand -Name Drugs — Retail Pharmacy $10 Generic/$25 Formulary Brand-Name/$45 Non -Formulary Brand -Name Drugs — Mail Service DEDUCTIBLES (Prescription drug coverage benefits are not subject to the medical plan deductible.) Calendar -year brand -name drug deductible None PRESCRIPTION DRUG COVERAGE Participating Mail Service (Includes oral contraceptives, diaphragms, and covered diabetic drugs and testing supplies) Pharmacy Prescriptions (For up to a 30-day supply)° (For up to a 90-day supply)° — Generic drugs $5/prescription $10/prescription — Formulary brand -name drugs $15/prescription $25/prescription — Non -formulary brand -name drugs $30/prescription $45/prescription — Home self-administered injectable drugs (may require prior authorization from Blue Shield 20% Not covered Pharmacy Services) (Up to $100 copayment maximum per prescription) ` If the physician or member requests a brand -name drug and a generic drug equivalent is available, the member is responsible for paying the difference between the cost to Blue Shield of California of the brand -name drug and its generic drug equivalent, as well as the applicable formulary generic drug copayment. Drugs from non -participating pharmacies are not covered except in emergency and urgent situations. # Copayments and charges for services not included in the calculation of the member's calendar -year copayment maximum continue to be the members responsibility after the calendar -year copayment maximum is reached. Please refer to the Evidence of Coverage, the Disclosure Form and the Group Health Service Contract for exact terms and conditions of coverage. Stretch Your Prescription Drug Dollar Even Further This benefit chart is just the beginning to making the most of your coverage. To help you get your money's worth, we have created many opportunities for you to save on costs wherever possible. Read on and learn about the unique resources we have to support you. . Choose generi&rinstead of brand name drugs„ We're driving the use of generics to help you get safe, affordable drugs at a time when prescription costs continue to grow. Increasing drug costs is one of the main reasons that overall healthcare coverage has become more expensive. But the use of generics can have a direct and indirect impact on keeping rates down. By choosing a proven generic over a brand -name drug, you can quickly lower your costs. Generics cost less than brand -name drugs so we can pass the savings on to you through affordable generic drug coverage. When you ask for a drug that is available as a generic you have a copayment that is significantly less than the copayment for the brand, and no deductible. You can trust generics to provide a therapeutic equivalent to their brand -name counterpart. They must contain the same active ingredient and have approval from the U.S. Food and Drug Administration for meeting the same safety standards. About half the drugs on the market today are available in generic form. Your doctor can help you decide if a specific drug is right for you. At your next visit, let your doctor know you prefer generics and remember to bring a copy of your formulary. For a printed copy, call the customer service number on your Blue Shield ID card or download one from the "pharmacy" section of www.mylifepath.com. Use online pharmacy t"s at;Mylifepath came %s P.. We created the "pharmacy' section of our Web site to give you access to resources to help you be informed and make cost -saving decisions. ® ask the pharmacist — If you have clinical questions about prescription or over-the-counter drugs, you can use this feature to connect with the drug information pharmacists at the University of California, San Francisco. Simply submit your question using easy electronic forms. Within one to two business days, a clinical pharmacist will reply by e-mail with a link to a confidential response posted on the mylifepath site. Then, you have the option of saving the answer to a personal archive for later reference. ® drug database & formulary — Use this feature to get information on our most current formulary list, generic, alternatives that help you lower out-of-pocket costs and details about specific coverage restrictions. You can search by drug name, try browsing by first letter, or searching by medical condition or drug class. Plus, watch for the most recent changes to our formulary highlighted in our "Announcements" box. participating pharmacies — Using this feature, you can locate participating pharmacies for maximum coverage. Just enter a zip code or city and our new tool aggregates a list, across retail chains and independents, and serves it up on our site. ign 4-for our prescription mail'"seMe e�, 1. If you take a particular drug for a chronic condition such as diabetes or high blood pressure on an ongoing basis, going to the "pharmacy" at www.mylifepath.com can save you a trip - or several trips - to your local network pharmacy. Our plans offer coverage of a mail service benefit, available through Express Scripts. Members who take stabilized doses of long-term maintenance medications can order a mail service refill of up to a 90-day supply. After sending your initial maintenance drug prescription to Express Scripts, you can order refills via the "pharmacy" section of www.mylifepath.com. If you prefer to renew your prescription by phone, you can call Express Scripts at (800) 544-6962, or TTY (800) 972-4348 if you are hearing impaired. Allow up to 14 days for delivery, from the day you mail your initial prescription order or order a refill. If you don't have Internet access, call Member Service at the number on your Blue Shield ID card to find out more about your drug benefits and get a mail service order form. Please note that injectable drugs other than insulin and drugs used for short-term conditions, such as migraine medications and antibiotics, are not covered by this mail service benefit. ((A> (1 /04) (9. Blue Shield of Califon is An 1nsieoen0e.w Mermerof ;#ie Skw Shield Asso Ji ij- CITY OF HUNTINGTON BEACH Effective Date: 1/01/2004-12131/2004 Kaiser Permanente Southern California MEMBER SERVICES TELEPHONE 1-800-464-4000 WEB SITE org ANNUAL DEDUCTIBLE None MAXIMUM OUT-OF-POCKET $1,500 per member $3,000 per family unit two or more people) MAXIMUM LIFETIME BENEFIT None HOSPITAL CARE Room and Board, Surgeon, Physician visit $0 Copay per admission and Anesthesiologist All Inpatient services are included in 100 % Copay when authorized by a Plan physician OFFICE CARE Physician Visit, Routine Physical $10 Copay per visit Specialist Care $10 Copay per visit Outpatient Surgery $10 Copay per procedure Allergy Tests and Injections No charge Immunizations, Lab and X-ray 100 % Covered Mammography 100% Covered Vision Exams/Hearing Exams $10 Copay per exam, as needed Physical, Speech & Occupational Therapy Visit $10 Copay per visit. Benefits are limited to short-term therapy that can be expected to result in significant improvement of a members condition within a period of two months from the first date of treatment. EMERGENCYCARE In Area $50 Copay (waived if admitted) Out -of -Area $50 Copay (waived if admitted). Worldwide coverage for emergency services due to unforeseen illness. Limited tc emergency services required before the member's condition permits transfer of travel to the nearest Kaiser facility. Non -participating facility must notify health plan within 24 hours of hospitalization or as soon as reasonably possible. Follow-up care is not covered. Ambulance Service No charge per trip, when determined to meet the criteria that define an emergency MATERNITY Delivery/Nursery Care for Newborns $0 Copay per admission Pre -natal and Post -natal Visits No charge after confirmation of pregnancy and initial post-partum visit Well -Baby Care No charge (23 months or younger) PRESCRIPTION DRUGS Generic/Brand $5 copay for generic/$15 copay for brand per prescription for up to a 100-day supply in accordance with Health Plan formulary guidelines and when obtained at Plan pharmacies. Drugs for the treatment of sexual dysfunction are covered at 50 of charges with a maximum dosage limit of 27 doses for 100-day supply. Drugs for the treatment of infertility are covered at 50 % of charges as part of an approved treatment. MENTAL HEALTH Inpatient $0 Copay; Up to 30 days per calendar year. No days limit - AB88 Diagnosis' Outpatient $10 Copay per visit; Up to 20 visits per calendar year. No visit limit - AB88 Diagnosis* SUBSTANCE ABUSE Inpatient Detox: $0 Copay per admission Transitional Residential Recovery Service (TRRS) in a non -medical setting:$100 Copay per admission, up to 60 days per calendar year, but no more than 120 days in any 5 consecutive calendar year period. Outpatient Individual: $10 Copay per visit, Group: $5 Copay per visit; No outpatient visit limit. INFERTILITY SERVICES - Inpatient 50 % of member rate per admission for approved treatment Outpatient 50 % of member rate per visit for approved treatment DURABLE MEDICAL EQUIPMENT No charge PROSTHETICS & ORTHOTICS DIABETIC BENEFITS Insulin: $5 Co a for up to 100-daysupply; Testing Supplies: 80 % Covered up to 100-daysupply. HOME HEALTH 100 % Covered when prescribed by a plan physician within Service Area) SKILLED NURSING FACILITY SNF No Copay for up to 100 days per benefit period HOSPICE CARE 100 % Covered when selected as an alternative to traditional services and authorized by a Plan physician (within Service Area) for Traditional Plan member who are diagnosed with a terminal illness and who have a life expectancy of twelve months or less. OPTICAL Not Covered CHIROPRACTIC $10/visit; Up to 20 visits per calendar year HEARING AIDS $1000 Allowance; 1 device/ear; 2 device(s)/36 months Students to age 25 Covered Services and supplies described above are covered only if prescribed and authorized by a plan physician and received at a Plan facility inside the service area. 'AB88 (Mental Health Parity) Diagnosis: Schizophrenia. Schizoaffective disorder, Bipolar disorder (manic-depressive illness), Major depressive disorders, Panic disorder, Obsessive -compulsive disorder, Pervasive developmental disorder or autism, Anorexia nervosa, Bulimia nervosa, and Serious Emotional Disturbances (SED) when specific criteria are met. "Services covered are medically necessary diagnostic planning sevices for intently problems - Provider visit, diagnosis, and treatment (Inpatient and Outpatient fertility procedures. Infertility Treatment). Artificial insemination is covered except for donor semen and donor eggs and services related to their procurement and storage. All other services related to conception by artificial means are not covered. Such non -covered services include but are not limited to In Vitro Fertilization Ovum Transplants, Gamete Intrafalopian Transfer (GIFT) and Zygote Intrafallo ian Transfer (ZIFT). CONFIDENTIAL COMMUNICATION This transmission may contain'confidential information which is legally privileged or otherwide protected. This Information is Intended only for the use of the Individual or entity named above. If you are not the intended recipient, or the person responsible for receiving and/or delivering it to the Intended recipient, you are hereby notified that any disclosure, copying, distribution or use of any information contained in this transmittal is strictly prohibited. If you have received this transmission In error, please Immediately notify the sender by telephone and return the original transmission to the sender. Thank you. Grace Hong, Senior Sales Executive, license #-0007504 . Marlene Pocinich, Sales Associate, license #OB74585 City of Huntington Beach RCA ROUTING SHEET INITIATING DEPARTMENT: ADMINISTRATIVE SERVICES SUBJECT: ADOPT RESOLUTION APPROVING SIDE LETTER TO THE MEMORANDUM OF UNDERSTANDING BETWEEN THE CITY AND THE MANAGEMENT EMPLOYEES' ORGANIZATION COUNCIL MEETING DATE: February 2, 2004 RCA ATTACHMENTS STATUS Ordinance (w/exhibits & legislative draft if applicable) Not Applicable Resolution (w/exhibits & legislative draft if applicable) Attached Tract Map, Location Map and/or other Exhibits Not Applicable Contract/Agreement (w/exhibits if applicable) Signed in full by the City Attorney) Not Applicable Subleases, Third Party Agreements, etc. (Approved as to form by City Attorney) Not Applicable Certificates of Insurance (Approved by the City Attorney) Not Applicable Financial Impact Statement (Unbudget, over $5,000) Not Applicable Bonds (If applicable) Not Applicable Staff Report,(If applicable) Not Applicable Commission, Board or Committee Report (If applicable) Not Applicable Findings/Conditions for Approval and/or Denial Not Applicable EXPLANATION FOR MISSING ATTACHMENTS' EXPLANATION FOR RETURN OF ITEM: KUA Author: William McReynolds / 02, oZ, w CITY OF HUNTINGTON BEACH MEETING DATE: December 16, 2002 DEPARTMENT ID NUMBER: 02-057 Council/Agency Meeting Held:2- Deferred/Continued to:, �y x Approved ❑ Conditionally Approved ❑ Denied City Clerk's SignatLrre Council Meeting Date: December 16, 2002 Department ID Number: :02-057 CITY OF HUNTINGTON BEACH REQUEST FOR COUNCIL ACTION SUBMITTED TO: HONORABLE MAYOR AND CITY COUNCIL MEMBERS SUBMITTED BY: RAY SILVER, CITY ADMINISTRATORaa-' PREPARED BY: WILLIAM P. WORKMAN, ASSISTANT CITY ADMINISTRATOR / CLAY MARTIN, DIRECTOR OF ADMINISTRATIVE SERVICES (. SUBJECT: APPROVAL OF MEMORANDUM OF UNDERSTANDING BETW N THE CITY AND THE HUNTINGTON BEACH MANAGEMENT-,, EMPLOYEES ORGANIZATION 44 ..2.66,2- / 42 Statement of Issue, Funding Source, Recommended Action, Alternative Action(s), Analysis, Environmental Status, Attachment(s) Statement of Issue: Should the City and the Huntington Beach Management Employee's Organization enter into a new Memorandum of Understanding covering the period of December 21, 2002 through December 20, 2003? Funding Source: Funding is included in the Fiscal Year 2002/2003 budget. The total annual cost to implement the Memorandum of Understanding with the Huntington Beach Management Employee's Organization is $435,000. Recommended Action: Adopt Resolution No. .2e6a -l32 , a resolution of the City Council of Huntington Beach approving and implementing the Memorandum of Understanding between the Huntington Beach Management Employees' Organization (MEO) and the City of Huntington Beach for 12/21/02 through 12/20/03. Alternative Action(s): Reject the resolution and maintain the current salary Management Employee's Organization. and benefits of the Huntington Beach f— , 6 2003 MEO MOU.doc -1- 12/5/2002 11:07 AM REQUEST FOR COUNCIL ACTION MEETING DATE: December 16, 2002 DEPARTMENT ID NUMBER: 02-057 Analysis: Representatives of the City and the Huntington Beach Management Employee's Organization (MEO) have completed the meet and confer process with agreement on a new Memorandum -of -Understanding (MOU) for the period of December 21, 2002 through December 19, 2003. Proposed modified salary and benefit changes include the following: Salary Three percent (3%) salary increase effective December 21, 2002. As a point of reference the current Consumer Price Index for Urban Wage Earners and Clerical Workers averages 2.5% for the Los Angeles -Riverside -Orange County region. This is based on the period October 1, 2001 through September 30, 2002. Health Insurance Effective January 4, 2002 employees will share in the cost for 2003 medical, dental, and vision increases. Depending on the category of coverage selected by each employee in the medical, dental, and vision plans, employees will be contributing through a pre-tax payroll deduction between approximately $160.00 and $890.00 per year to offset the cost of 2003 health insurance increases. Pre -Retirement Death Benefits for Survivors Upon approval of the City Council, two amendments will be submitted to CalPERS having to do with survivors. The Pre -retirement Optional Settlement 2 Death Benefit provides the surviving spouse of a member eligible for retirement who dies before retiring the benefits that they would be eligible for if the member were to have already been retired. The Fourth Level of 1959 Survivors Benefit provides a monthly allowance to eligible survivors of members who died before retirement. This will bring the 1959 Survivor Benefit to just below the equivalent Social Security benefit. The Fourth Level of 1959 Survivors Benefit is separately funded with the CalPERS system and requires an employee contribution. A summary of these and other changes are included as Attachment #1. 2003 MEO MOU.doc -2- 12/5/2002 11:07 AM REQUEST FOR COUNCIL ACTION MEETING DATE: December 16, 2002 DEPARTMENT ID NUMBER: 02-057 Attachment(s): City Clerk's ..- NumberDescription Summary of salary and benefit changes Resolution to adopt Memorandum of Understanding, including Exhibit A, Memorandum of Understanding between the City of 2 Huntington Beach and the Huntington Beach Management Employee's Organization for December 21, 2002 through December 19, 2003 /LJo -Aoo.7 -- /3 Legislative Draft of the Memorandum of Understanding between the City of Huntington Beach and the Huntington Beach Management 3 Employee's Organization for December 21, 2003 through December 19, 2003 RCA Author: William McReynolds 2003 MEO MOU.doc -3- 12/5/2002 11:07 AM SUMMARY OF SALARY AND BENEFIT CHANGES FOR THE MANAGEMENT EMPLOYEE ORGANIZATION •'• Term • A one-year term from December 21, 2002 through December 19, 2003 ❖ Salary 3% increase effective December 21, 2002, (the first day of the pay period under the resolution). ❖ Health Year 2003 Premiums The City's contribution to medical, dental and vision shall be no more than the premium maximum for employee only, employee plus one, and employee plus two or more. ❖ Employee Cost Sharing of Benefits Year 2003 Starting January 4, 2003 employees will share in the city's total cost of providing benefits (medical, dental, vision, life, and accidental death & dismemberment) with a bi-weekly pre-tax payroll deduction in the amounts below based on the employee's category of the medical benefit. Employee Cost Pre -Tax Sharing Per Pay Annual Period EE $ 6.75 $ 175.50 EE + 1 14.00 364.00 EE + 2 or more 18.90 491.40 ❖ Joint Cafeteria Plan Study The city and two MEO employees will convene an ad -hoc committee to study a cafeteria plan for employee benefits. •'• Hours of Work Effective February 1, 2003, with supervisor and Department Head approval, MEO employees may flex regular scheduled start times between the hours of 7:00 a.m. to 9:00 a.m. Flex schedules shall not reduce service to the public, departmental effectiveness, productivity and/or efficiency as determined by the City Administrator or designee. Effective February 1, 2003, MEO employees will have the option of working a 5/40 or 9/80 work schedule with supervisor and Department Head approval. MEO employees assigned to the Police Department shall have the option of working the 4/10 work schedule with supervisor and Department Head approval. In order to maintain service to the public, departmental effectiveness, productivity and/or efficiency a Department Head may assign an employee a different work schedule that is in compliance with the requirements of the Fair Labor Standards Act (FLSA) with City Administrator approval. Page 1 SUMMARY OF SALARY AND BENEFIT CHANGES FOR THE MANAGEMENT EMPLOYEE ORGANIZATION •'• Retirement The city proposes amending its contract with California Public Employees Retirement System (CaIPERS) to provide the following pre -retirement death benefits, which are described by CaIPERS as follows: Pre -retirement Optional Settlement 2 Death Benefit The spouse of a deceased member, who was eligible to retire for service at the time of death, may elect to receive the Pre -Retirement Optional Settlement 2 Death Benefit in lieu of the lump sum Basic Death Benefit. The benefit is a monthly allowance equal to the amount the member would have received if the member had retired from service on the date of death and selected Option 2, the highest monthly allowance a member can leave a spouse. Fourth Level of 1959 Survivor Benefit The 1959 Survivor Benefit provides a monthly allowance to eligible survivors of members who were covered by this benefit program and died before retirement. This benefit coverage is available by contract amendment for those members who are not covered by federal Social Security with their employer. Covered members are required to pay a $2 monthly fee that is deducted from their salary specifically to fund the 1959 Survivor Benefit Program. Management Issues • Family Sick Leave — In Compliance with Law and Standardized • Increased Education Reimbursement • Remove language regarding retiree medical premiums paid by unused leave benefits • Roll Over lawsuits settled, delete language Page 2 RESOLUTION NO. 2002-132 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF HUNTINGTON BEACH APPROVING AND IMPLEMENTING THE MEMORANDUM OF UNDERSTANDING BETWEEN THE HUNTINGTON BEACH MANAGEMENT EMPLOYEES' ORGANIZATION (MEO) AND THE CITY OF HUNTINGTON BEACH FOR 12/21/02 THROUGH 12/19/03 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 Management Employees' Organization ("MEO"), a copy of which is attached hereto as EXHIBIT "A" 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 December 21, 2002, through December 19, 2003. PASSED AND ADOPTED by the City Council of the City of Huntington Beach at a regular meeting thereof held on the 36tb day of 002. —AZhdWA--1- ATTEST: City Clerk REVIEWED AND APPROVED: City Admini ator Mayor. APPROVED AS TO FORM: LC- -54� Cityorney ' 13I U'L tj AL INITIATED AND APPROVED: Director odministrative Services 01 reso/meo-emp/ 11 /13/02 EXHIBIT A Exhibit A to Res. No. 2002-132 MEO MOU TABLE OF CONTENTS, PREAMBLE.................................................................................................................................................................................3 ARTICLEI - TERM OF MOU...................................................................................................................................................3 ARTICLE II - REPRESENTATIONAL UNIT/CLASSIFICATIONS....................................................................................4 ARTICLE III - ARTICLE NUMBER RESERVED..................................................................................................................4 ARTICLE IV - EXISTING CONDITIONS OF EMPLOYMENT...........................................................................................4 ARTICLEV - SEVERABILITY.................................................................................................................................................4 ARTICLE VI - SALARY SCHEDULE ................... ..................... ......... .................. ......... ......... ......... ..............4 ARTICLEVII - SPECIAL PAY..................................................................................................................................................5 A. EDUCATIONAL TUITION.......................................................................................................................................................... 5 B. BILINGUAL PAY...................................................................................................................................................................... 6 ARTICLEVIII - UNIFORMS..................................................................................................................................................... 6 ARTICLE IX - HOURS OF WORK/OVERTIME/ADMINISTRATIVE LEAVE................................................................6 A. OVERTIME.............................................................................................................................................................................. 6 B. ADMINISTRATIVE LEAVE........................................................................................................................................................ 6 C. FLEX SCHEDULE AND HOURS OF WORK................................................................................................................................. 6 ARTICLE X - HEALTH AND OTHER INSURANCE BENEFITS........................................................................................8 A. B. 1. 2. 3. 4. C. D. E. 1. 2. 3. F. HEALTH: ........:.... .............. ..... .:.......... ................... ................................................................... 8 ELIGIBILITY CRITERIA AND COST ..... .....:..: ..... ............. .... ........... ........... .:.. .......... ............ .................... $ City Paid Medical, Dental and Vision Insurance —Employee and Dependents.............................................................. 8 Ci 's Contribution to Health Insurance Premiums........................................................................:................................ 8 a. Year 2003 Premiums...................................................................................................................................................................... 8 b. Future Premiums............................................................................................................................................................................. 8 MedicalCash-Out............................................................................................................................................................9 Section125 Plan.............................................................................................................................................................. 9 LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT......................................................................................................... 9 LONGTERM DISABILITY INSURANCE..................................................................................................................................... 9 MISCELLANEOUS.................................................................................................................................................................. 10 City Paid Premiums While On Medical Disability.........................................................................................................10 Insuance Benefits Advisory Committee..........................................................................................................................10 HealthPlan Over-Pavments...........................................................................................................................................10 a. Reduction of Employee's Bi-Monthly Salary Warrant................................................................................................................. 10 b. Notice of Ineligible Dependents................................................................................................................................................... 10 C. Twelve Month Recovery Period................................................................................................................................................... 10 JOINTCAFETERIA PLAN STUDY........................................................................................................................................... 10 ARTICLEXI - RETIREMENT BENEFITS............................................................................................................................I I A. BENEFITS.............................................................11 1. SelfFunded Supplemental Retirement Benefit........:...............................::.... ............I ......... .......,..... ::.......11' 2. Medical Insurance for Retirees';.:..,. .... .... .....:... ......... ... ... :...:..................................................................11- a. Medical Insurance Upon Retirement............................................:............................................................................................... 1 I b. Premiums Paid Upon Retirement By Use of Unused Sick Leave Benefits................................................................................... 12 B. PUBLIC EMPLOYEES' RETIREMENT SYSTEM REIMBURSEMENT AND REPORTING................................................................. 12 1. Employee's Contribution................................................................................................................................................12 2. Two Percent at Age 55 Formula....................................................................................................................................12 3. Pre -Retirement Optional Settlement 2 Death Benefit........................:............................................................................12 2003 MEO MOU Final i 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 MEO MOU TABLE OF CONTENTS 4. Fourth Level of 1959 Survivor Benefits..........................................................................................................................12 5. Review of Contract Amendment Cost Analysis...............................................................................................................12 ARTICLEXII - LEAVE BENEFITS........................................................................................................................................13 A. GENERAL LEAVE.................................................................................................................................................................. 13 1. Accrual...........................................................................................................................................................................13 2. fligib LtE and Approval.................................................................................................................................................13 3. Family Sick Leave..........................................................................................................................................................13 4. Conversion to Cash........................................................................................................................................................13 5. One Week Minimum Vacation Reguirement...................................................................................................................14 B. HOLIDAYS............................................................................................................................................................................ 14 C. SICK LEAVE.................................................................................................................................. .......14 D. BEREAVEMENT LEAVE... ......................... ...... ............. ............................................. ............... .................16 E. PATERNITY LEAVE ......... ......... ......... ......... ...................... ............................. ........ ... .......... .......... ....:....16 ARTICLEXIII - CITY RULES................................................................................................................................................16 ARTICLE XIV - MISCELLANEOUS......................................................................................................................................33 A. PHYSICAL EXAMINATION..................................................................................................................................................... 33 B. VEHICLE POLICY..................................................................................................................................................................33 C. DEFERRED COMPENSATION LOAN PROGRAM......................................................................................................................33 D. EMPLOYEE PERFORMANCE EVALUATIONS........................................................................................................................... 33 ARTICLE XV - CITY COUNCIL APPROVAL.....................................................................................................................34 EXHIBIT A - MEO SALARY SCHEDULE............................................................................................................................ 35 EXHIBIT B - DELTA DENTAL BROCHURE....................................................................................................................... 37 EXHIBIT C - DELTA CARE PLAN BROCHURE ............................................. .. ...38 EXHIBIT D - EMPLOYEE HEALTH PLAN BROCHURE ...::...... ...... ......... .......`.............:......:............... ............39 EXHIBIT E -RETIREE MEDICAL PLAN. .....:......... ..... ................ ........ .......... ...._.... ......................40 RETIREE SUBSIDY MEDICAL PLAN..................................................................................................................................40 SCHEDULEOF BENEFITS.....................................................................................................................................................41 A. Minimum Eligibility for Benefits.................................................................................................................................... 41 B. Disability Retirees..........................................................................................................................................................41 C. Maximum Monthly Subsidy Payments............................................................................................................................ 41 INDEMNITY HEALTH PLAN, EMPLOYEES/RETIREES.................................................................................................42 RETIREE SUBSIDY MEDICAL PLAN/MISCELLANEOUS PROVISIONS.....................................................................43 A. Eligibility........................................................................................................................................................................43 B. Bene ts...........................................................................................................................................................................44 C. Subsidies.........................................................................................................................................................................44 D. Medicare........................................................................................................................................................................ 45 E. Cancellation................................................................................................................................................................... 45 EXHIBIT F - VEHICLE USE/ASSIGNMENT........................................................................................................................47 EXHIBIT G - PHYSICAL EXAMINATION DESCRIPTION.............................................................................................. 48 EXHIBITH — 9/80 WORK SCHEDULE.................................................................................................................................49 EXHIBIT I — 4/10 WORK SCHEDULE................................................................................................................................... 52 2003 MEO MOU Final ii 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 MEMORANDUM OF UNDERSTANDING between THE CITY OF HUNTINGTON BEACH (Hereinafter called CITY) and THE HUNTINGTON BEACH MANAGEMENT EMPLOYEES' ORGANIZATION (Hereinafter called ASSOCIATION or MEO) PREAMBLE This Memorandum of Understanding is .entered into by and between the City of Huntington Beach, a Municipal Corporation of the State of California, herein called "City'; and the Huntington Beach Management Employees' Organization, a California Organization, herein called "Association". WHEREAS, pursuant to California law, the city, acting by and through its designated representatives, duly appointed by the governing body of said city, and the representatives of the Association, a duly recognized employee association have met and conferred in good faith and have fully communicated and exchanged information concerning wages, hours, and other terms and conditions of employment for the period December 21, 2002 through December 19, 2003. WHEREAS, except as otherwise expressly provided herein, all terms and conditions of this Agreement shall apply to.all employees represented by the Association, and WHEREAS, the representatives of the city and Association desire to reduce their agreements to writing, NOW THEREFORE, this Memorandum of Understanding (MOU) is made, to become effective December 21, 2002 and it is agreed as follows. ARTICLE I - TERM OF MOU This Agreement shall be in effect for a period of one (1) year commencing December 21, 2002, and ending midnight December 19, 2003. The City and the Association agree to exchange proposals regarding a successor Memorandum of Understanding (MOU) on or prior to August 4, 2003. 2003 MEO MOU Final 3 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 ARTICLE II - REPRESENTATIONAL UNIT/CLASSIFICATIONS It is recognized that Association is the employee association which has the right to meet and confer in good faith with the city on the behalf of employees whose classifications are listed in Exhibit A, attached hereto and incorporated by reference herein. ARTICLE III - ARTICLE NUMBER RESERVED ARTICLE IV - EXISTING CONDITIONS OF EMPLOYMENT Except as otherwise expressly provided herein, the adoption of this Memorandum of Understanding shall not change existing benefits and terms and conditions of employment which have been established in prior Memoranda of Understanding, and/or provided for in the Personnel and Departmental Rules of the City of Huntington Beach. ARTICLE V - SEVERABILITY If any section, subsection, sentence, clause, phrase or portion of this MOU or any additions or amendments thereof, or the application thereof to any person, is for any reason held to be invalid or unconstitutional by the decision of any court of competent jurisdiction, such decision shall not affect the validity of the remaining portions of this resolution or its application to other persons. The City Council hereby declares that it would have adopted this MOU and each section, subsection, sentence, clause,phrase or portion, and any additions or amendments thereof, irrespective of the fact that any one or more sections, subsections, sentences, clauses, phrases or portions, or the application thereof to any person, be declared invalid or unconstitutional. ARTICLE VI - SALARY SCHEDULE A. Salary Schedule 1. All MEO represented employees are required to utilize direct deposit of payroll checks. The city shall issue each employee direct deposit advice (payroll receipt) each pay period that details all income, withholdings and deductions. 2. Permanent employees shall be compensated at hourly salary rates by job type and pay grade including a three percent (3%) increase effective December 21, 2002 as set forth in Exhibit A attached hereto and incorporated. herein by this reference. 2003 MEO MOU Final 4 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 3. Marine Safety Chief The salary range of the Marine Safety Division Chief shall be a minimum of 18% above the Marine Safety Lieutenant but shall be no higher than 15% below the Deputy Director of Recreation/Beach Development. ARTICLE VII - SPECIAL PAY A. Educational Tuition: 1. Upon approval of the Department Head and the Human Resources Manager, permanent. employees may be compensated. for courses from accredited educational institutions. Tuition reimbursement shall be limited to job related courses or job related educational degree objectives and requires prior approval by the Department Head and Human Resources Manager. 2. Education costs shall be reimbursed to permanent employees on the basis of a full refund for tuition, books, parking (if a required fee) and any other required fees upon presentation of receipts. However, the maximum reimbursement shall be not more than one thousand five hundred dollars ($1,500) in any fiscal year period. 3. If a permanent employee was enrolled in a degree with approval from their Department Head and the Human Resources Manager prior to April 15, 2002. Education costs shall be paid to employees on the basis of full refund for tuition, fees, books and supplies; provided, however, that maximum reimbursement shall be at the rates currently in effect in the University of California System. Employee may be compensated for actual cost of tuition, books, fees, at accredited educational institutions that charge higher rates than the University of California, if it can be demonstrated by the employee that said educational institutional presents the only accredited course or program within a reasonable commuting distance of the employee. 4. Reimbursements shall be made when the employee presents proof to the Human Resources Manager that he/she has successfully completed the course with a grade of "C" or better; or a "Pass" if taken for credit. 5. The city and the Association agree to re -convene an "Education Committee" that will consist of two individuals from the city and two individuals from the Association to meet on the topic of tuition reimbursement. The committee will meet between July 1, 2003 and August 30, 2003.. The resulting committee report shall be a possible subject of negotiation in a successor MOU. 2003 MEO MOU Final 5 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 B. Bilingual Pay: Permanent employees who are required by their Department Head to use Spanish, Vietnamese, or Sign Language. skills as part of their job assignment, shall be paid an additional five -percent (5%) of their basic hourly rate in addition to their regular bi- weekly salary. Permanent employees may accept assignments utilizing bilingual skills in other languages on a short-term assignment with approval by the City Administrator. Such employees shall receive the additional five percent (5%) for every bi-weekly pay period that the assignment is in effect. In order to be eligible for said compensation, employee's language proficiency will be tested and certified by the Human Resources Manager or designee. ARTICLE Vill - UNIFORMS The city agrees to provide uniforms to employees on active duty who are required to wear uniforms to the same extent as in the past. ARTICLE IX - HOURS OF WORK/OVERTIME/ADMINISTRATIVE LEAVE It is the intent of the city to provide an opportunity for MEO employees to select a flex schedule and/or alternative work schedule that is consistent with the city's objective that such schedules shall not reduce service to the public, departmental effectiveness, prodductivity and/or efficiency as determined by the City Administrator or designee. A. Overtime: Employees represented herein shall not be eligible for paid overtime compensation. B. Administrative Leave: All unit employees shall be entitled to 40 hours of administrative leave upon working forty (40) additional hours above their regular work schedule per calendar year. Such employee may earn additional administrative leave, on an hour for hour basis, for hours worked in excess of seventy-five (75) in a calendar year. Time off for Police Department fitness programs and flexible scheduling that is agreed to between the employee and Department Head are exempt from the 75-hour provision. C. Flex Schedule and Hours of Work: Effective February 1, 2003, with supervisor and Department Head approval, MEO employees may flex regular scheduled start times between the hours of 7:00 a.m. to 9:00 a.m. Flex schedules shall not reduce service to the public, departmental effectiveness, productivity and/or efficiency as determined by the City Administrator or designee. 2003 MEO MOU Final 6 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 Effective February 1, 2003, MEO employees will have the option of working a 5/40 or 9/80 work schedule with supervisor and Department Head approval. MEO employees assigned the 4/10 work schedule shall retain the option of working the 4/10 work schedule with supervisor and Department Head approval. In order to maintain service to the public, departmental effectiveness, productivity and/or efficiency a Department Head may assign an employee a different work schedule that is in compliance with the requirements of the Fair Labor Standards Act (FLSA) with City Administrator approval. 1. 5/40 Work Schedule The 5/40 work schedule shall be defined as working five (5) eight (8) hour days Monday through Friday each week plus a one -hour lunch during each work shift, totaling a forty (40) hours work week. The assigned 5/40 work schedule must be in compliance with the requirements of FLSA and all other applicable laws. 2. 9/80 Work Schedule The 9/80 work schedule, as outlined in Exhibit H, shall be defined as working nine (9) days for eighty (80) hours in a two week pay period by working eight (8) days at nine (9) hours per day and working one (1) day for eight (8) hours (Friday), plus a one -hour lunch during each work shift, totaling forty (40) hours in each FLSA work week. The 9/80 work schedule shall not reduce service to the public, departmental effectiveness, productivity and/or efficiency as determined by the City Administrator or designee. 3 4/10 Work Schedule The 4/10 work schedule, as outlined in Exhibit I, shall be defined as working four (4) ten (10) hour days Monday through Thursday each week plus a one - hour lunch during each work shift, totaling a forty (40) hours work week. The assigned 4/10 work schedule must be in compliance with the requirements of FLSA and all other applicable laws. The 4/10 work schedule shall not reduce service to the public, departmental effectiveness, productivity and/or efficiency as determined by the City Administrator or designee. 12111 /02 9:01 AM Exhibit A to Res. No. 2002-132 ARTICLE X - HEALTH AND OTHER INSURANCE BENEFITS A. Health The city shall continue to make available group medical, dental and vision benefits to all MEO employees. B. Eligibility Criteria and Cost 1. City Paid Medical. Dental and Vision Insurance - Emdovee and Dependents The city will assume payment for employee and dependents medical, dental and vision insurance effective the first of the month following one complete calendar month of employment. 2. City's Contribution to Health Insurance Premiums a. Year 2003 Premiums The city "caps" its contributions for 2003 premiums at the level set forth in the chart below: Monthly City Paid Premium City Plan HMO Dental (PPO) Dental (PMI) Vision EE $336.05 $236.31 $42.88 $23.00 $17.58 EE + 1 664.53 517.79 81.82 39.11 17.58 EE + 2 or more 813.62 682.46 116.36 59.81 17.58 Effective January 4, 2003 employee bi-weekly payroll deduction contributions for 2003 premiums are set forth in the chart below: Bi-Weekly Dental Dental Employee Paid City Plan HMO (PPO) (PMI) Vision Premium EE $12.00 $5.95 $1.89 $0.00 $0.23 EE + 1 23.72 13.05 3.66 0.00 0.23 EE + 2 or more 29.04 17.20 5.12 0.00 0.23 b. Future Premiums The city "caps" its contributions toward monthly group medical, dental and vision plan premiums, by category (EE, EE +,1, and EE + 2 or more) and plan, at the year 2003 level. Until the City Council approves a successor to this Memorandum -of - Understanding, the city's 2003 contribution caps will remain in place 2003 MEO MOU Final 8 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 in 2004 and beyond, even if premium increases result in these additional costs being borne by the employee. 3. Medical Cash -Out If an employee is covered by a medical program outside of a city -provided program (evidence of which must be supplied to Administrative Services Department), they may elect to discontinue city medical coverage and receive ninety two dollars and thirty-one cents ($92.31) bi-weekly to deposit into their Deferred Compensation account or any other pre-tax program offered by the city. 4. Section 125 Plan This plan allows employees to use pre-tax salary to pay for regular child care, adult dependent care and/or medical expenses. C. Life and Accidental Death and Dismemberment Each employee shall be provided with $45,000 life insurance and $45,000 accidental death and dismemberment insurance paid for by the city. Each employee shall have the option, at his or her own expense, to purchase additional amounts of life insurance and accidental death and dismemberment insurance to the extent provided by the city's current providers. Evidence of insurability is contingent upon total participation in additional amounts. D. Long Term Disability Insurance This program provides, for each incident of illness or injury, a waiting period of thirty (30) calendar days, during which the employee may use accumulated sick leave, general leave pay, or the employee may elect to be in a non -pay status. Subsequent to the thirty (30) day waiting period, the employee will be covered by an insurance plan paid for by the city, providing 66 2/3 percent of the first $12,500 of the employee's basic monthly earnings. The maximum benefit period for disability due to accident or sickness shall be to age 65. Days and months refer to calendar days and months. Benefits under the plan are integrated with sick leave, Worker's Compensation, Social Security and other non - private program benefits to which the employee maybe 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." Rehabilitation benefits are provided in the event the individual, due to disability, must engage in another occupation. Survivor's benefits continues plan payment for three (3) months beyond death. A copy of the plan is on file in the Administrative Services Department. 2003 MEO MOU Final 9 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 E. Miscellaneous 1. City Paid Premiums While on Medical Disability When an employee is off work without pay for reason of medical disability, the city shall maintain the city paid employee's insurance premiums during the period the employee is in a non -pay status for the length of said leave, not to exceed twenty-four (24) months. 2. Insurance and Benefits Advisory Committee The city and the Association agree to participate in a citywide joint labor and management insurance and benefits .advisory committee to discuss and study issues relating to insurance and benefits available for employees. 3. Health Plan Over -Payments Unit members shall be responsible for accurately reporting the removal of ineligible dependents from health plan coverages. The city shall have the right to recover any premium paid by the city, including premiums to its self -insured plan, on behalf of ineligible dependents. Recovery of such over -payments shall be made as follows: a. Reduction of Employee's Bi- Weekly Salary Warrant The employee's bi-weekly salary warrant shall be reduced by one-half of the amount of the bi-weekly over -payment. Such reduction shall continue until the entire, amount of the over -payment is recovered. b. Notice of Ineligible Dependents The city shall use its best efforts to advise all unit members of their obligation to report changes in the status of dependents, which affect their eligibility. c. Twelve Month Recovery Period The city shall be entitled to recover a maximum of twelve (12) months of premium over -payments. Neither the employee nor the dependent shall be liable to the city other than as provided herein. F. Joint Cafeteria Plan Study The city and up to four MEO employees will convene an ad -hoc committee to study a cafeteria plan for employee benefits. The ad -hoc committee will finalize its report by June 30, 2003. The resulting report may have an effect on 2004 benefit costs. 2003 MEO MOU Final 10 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 ARTICLE XI - RETIREMENT BENEFITS A. Benefits 1. Self Funded Supplemental Retirement Benefit Employees hired prior to August 17, 1998 are eligible for the Self -Funded Supplemental Retirement Benefit, which provides that: a. In the event a member elects Option #2 (Section 21456) or Option #3 (Section 21457) 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 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 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.) b. Employees hired on or after August 17, 1998 shall not be eligible for this benefit referenced in A.1.a. herein above. 2. Medical Insurance for Retirees a. Medical Insurance Upon Retirement 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 any of the plans offered by the city, at the retiree's own expense, for the maximum time period required by Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) Federal Law, or 2) Retirees retiring after approval of this MOU may participate in the Retiree Medical Plan, attached hereto as Exhibit E, or the Health Maintenance Organization (HMO) Plan currently being offered to retirees at the retiree's own expense if the requirements set forth in Exhibit E are met, or if the retiree meets the eligibility requirements described in Exhibit E, the retiree may receive a subsidy from the city for retiree medical insurance pursuant to the schedule set forth in Exhibit E. 2003 MEO MOU Final 11 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 b. Premiums Paid Upon Retirement By Use of Unused Leave Benefits Employees electing to participate in the City's group health insurance program after retirement may cause the premiums to be paid by the City out of any available funds due and owing them under the terms of this agreement for unused sick leave and general leave benefits upon retirement. B. Public Employees' Retirement System Reimbursement and Reportinq 1. Employee's Contribution Each employee covered by this Agreement shall continue to be reimbursed once bi-weekly in an amount equal to 7% of the employee's base salary (9% for safety employees) as a pickup of the employee's contribution, or portion of such contribution, to the Public Employees' Retirement System. The above PERS pickup is not base salary but is done pursuant to Section 414(h)(2) of the Internal Revenue Code. 2. Two Percent at Age 55 Formula Unit employees shall be covered by the two percent at age 55 formula (2% @ 55) as identified in Section 21354. 3. Pre -Retirement Optional Settlement 2 Death Benefit The city will initiate the contract amendment process for the Pre -Retirement Optional Settlement 2 Death Benefit as identified in Section 21548 with CaIPERS within ten (10) business days of City Council ratification of all memoranda of understanding and/or other necessary agreements with all miscellaneous retirement plan employee associations and will adopt said amendment as soon as reasonably possible thereafter. 4. Fourth Level of 1959 Survivor Benefits The city will initiate the contract amendment process for the Fourth Level of the 1959 Survivor Benefit as identified in Section 21574 with CalPERS within ten (10) business days of City Council ratification of all memoranda of understanding and/or other necessary agreements with all miscellaneous retirement plan employee associations and will adopt said amendment as soon as reasonably possible thereafter. 5. Review of Contract Amendment Cost Analysis Upon receipt of the contract amendment cost analyses for the retirement formulas of 2.5%@55, 2.7%@55 and 3%@60 from CalPERS, (which have already been requested from CalPERS) the city and association shall jointly review the contract amendment cost analyses. This joint review shall not be a reopener nor shall it: commit the city to .make any amendments. to its contract with CalPERS. 2003 MEO MOU Final 12 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 ARTICLE XII - LEAVE BENEFITS A. General Leave 1. Accrual Employees accrue leave at the accrual rates outlined below. General leave may be used for any purpose, including vacation, sick leave, and personal leave. 2. Years of Service General Leave Allowance First through Fourth Year 176 Hours Fifth through Ninth Year 200 Hours Tenth through Fourteenth Year 224 Hours Fifteenth Year and Thereafter 256 Hours Eligibility and Approval General leave must be pre -approved except for illness, injury or family sickness, which may require a physician's statement for approval. Accrued general leave may not be taken prior to six (6) months' service except for illness, injury or family sickness. General leave accrued time is to be computed from hiring date anniversary. Members shall not be permitted to take general leave in excess of actual time earned. Members shall not accrue general leave in excess of six hundred hours (600). Employees may not use their general leave to advance their separation date on retirement or other separation from employment. 3. Family Sick Leave As required by law, employees will be allowed to use up to one-half of their annual General Leave accrual for family sick leave, pursuant to the provisions of California Labor Code Section 233. The city will provide family and medical care leave for eligible employees that meet all requirements of State and Federal law. Rights and obligations are set forth in the Department of Labor Regulations implementing the Family Medical Leave Act (FMLA), and the regulations of the California Fair Employment and Housing Commission implementing the California Family Rights Act (CFRA). 4. Conversion to Cash Once during each fiscal year, each employee shall have the option to convert into a cash payment or deferred compensation up to a total of one hundred twenty (120). hours of earned general leave benefits. .The employee shall give. two (2) weeks advance notice of his/her desire to exercise such option. 2003 MEO MOU Final 13 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 5. One Week Minimum Vacation Requirement The Deputy City Treasurer shall take a minimum of one week, (i.e., five consecutive work days) paid vacation each calendar year. B. Holidays The following are paid eight (8) hour holidays: 1. New Year's Day 2. Martin Luther King Jr., (third Monday in January) 3. Presidents Day (third Monday in February 4. Memorial Day (last Monday in May) 5. Independence Day (July 4) 6. Labor Day (first Monday in September) 7. Veteran's Day (November 11) 8. Thanksgiving Day (fourth Thursday in November) 9. The Friday after Thanksgiving 10. Christmas Day (December 25) Any day declared by the President of the United States to be a national holiday and adopted as an employee holiday by the City Council of Huntington Beach. Holidays which fall on Saturday shall be observed the preceding Friday, and those falling on Sunday shall be observed the following Monday. C. Sick Leave 1. Accrual — No employee shall accrue sick leave after December 24, 1999. 2. Credit —Employees assigned to MEO shall carry forward their sick leave balance and shall no longer accrue sick leave credit. 3. Usage — Employees may use accrued sick leave for the same purposes for which it was used prior to December 25, 1999. 4. Family Sick Leave — The city will provide family and medical care leave for eligible employees that meet all requirements of State and Federal law. Rights and obligations are set forth in the Department of Labor Regulations implementing the Family Medical Leave Act (FMLA), and the regulations of the California Fair - Employment and Housing Commission implementing the California Family Rights .Act (CFRA). 2003 MEO MOU Final 14 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 5. Pay Off At Termination a. Employees covered by this agreement and on the payroll on November 20, 1978 shall be entitled to the following sick leave payoff plan: At involuntary termination by reason of disability, or by death, or by retirement, employees shall be compensated at their then current rate of pay for seventy-five percent (75%) of all unused sick leave accumulated as of July 1, 1972, plus fifty percent (50%) of unused sick leave accumulated subsequent to July 1, 1972, up to a maximum of 720 hours of unused, accumulated sick leave, except as provided in paragraph 4 below. Upon termination for any other reason, employees shall be compensated at their then current rate of pay for fifty percent (50%) of all unused, accumulated sick leave, up to a maximum of 720 hours of such accumulated sick leave. b. Employees hired after November 20, 1978 shall be entitled to the following sick leave payoff plan: Upon termination, all employees shall be paid, at their then current salary rate, for twenty-five percent (25%) of unused, earned sick leave to 480 hours accrued, and for thirty-five percent (35%) of all unused, earned sick leave in excess of 480 hours, but not to exceed 720 hours, except as provided in paragraph 4 below. c. Except as provided in paragraph 4 below, no employee shall be paid at termination for more than 720 hours of unused, accumulated sick leave. However, employees may utilize accumulated sick leave on the basis of "last in, first out" meaning that sick leave accumulated in excess of the maximum for payoff may be utilized first for sick leave, as defined in Personnel Rule 18- 8. d. Employees who had unused, accumulated sick leave in excess of 720 hours as of July 5, 1980, shall be compensated for such excess sick leave remaining on termination under the formulas described in paragraphs 1 and 2 above. In no event shall any employee be compensated upon termination for any accumulated sick leave in excess of the "cap" established by this paragraph (i.e., 720 hours plus the amount over 720 hours existing on July 5, 1980). Employees may continue to utilize sick leave accrued after that date in excess of such "cap" on a "last in, first out basis. e. To the extent that any "capped" amount of excess sick leave over 720 hours is utilized, the maximum compensable amount shall be correspondingly reduced. (Example: Employee had 1,000 hours accumulated. Six months after July 5, 1980, employee has accumulated another 48 hours. Employee 2003 MEO MOU Final 15 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 is then sick for 120 hours. Employee's maximum sick leave "cap" for compensation at termination is now reduced by 72 hours to 928 hours.) f. Employees electing to participate in the City's group health insurance program after retirement may cause the premiums to be paid by the City out of any available funds due and owing them under the terms of this agreement for unused sick leave benefits upon retirement. D. Bereavement Leave Employees shall be entitled to bereavement leave not to exceed twenty-four (24) work hours in each instance of death in the immediate family. Immediate family is defined as father, mother, sister, brother, spouse, children, grandfather, grandmother,' stepfather, stepmother, step grandfather, step grandmother, grandchildren, stepsisters, stepbrothers, mother-in-law, father-in-law, son-in-law, daughter-in-law, brother-in-law, sister-in-law, stepchildren, or wards of which the employee is the legal guardian. E. Paternity Leave The city will provide family and medical care leave for eligible employees that meet all requirements of State and Federal law. Rights and obligations are set forth in the Department of Labor Regulations implementing the Family Medical Leave Act (FMLA), and the regulations of the California Fair Employment and Housing Commission implementing the California Family Rights Act (CFRA). ARTICLE X{II - CITY RULES A. 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 — Recruitment and Examination Procedure a) 5-4 — Order of Certification Whenever certification is to be made, the eligibility lists, if active and not exhausted shall be used in the following order: 1) Re-employment list 2) Promotional list 3) Employment List If fewer than five (5) names of persons willing to accept appointment are on the list from which certification is to be made, then additional eligibles shall be certified from the various lists next lower in order of preference until five (5) names are certified. If there are fewer than five (5) names on such lists, there shall be certified the number thereon. In such case, the appointing 2003 MEO MOU Final 16 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 authority may demand certification of five (5) names and examinations shall be conducted until five (5) names may be certified. In the event the appointing authority does not choose to appoint from the five (5) names certified, a new examination may be requested. In the event another examination is conducted, those names shall be merged with others already on the list in order of scores. b) 5-14 — Promotional Exams Promotional examinations may be conducted whenever, in the opinion of the Human Resources Manager, after consultation with the department head, the need of the service so requires; provided, however, a promotional examination may not be given unless there are two (2) or more candidates eligible. Only employees who meet the requirements for the vacant position may compete in promotional examinations. Promotional examinations may include any of the selection techniques, or any combination thereof, mentioned in Section 5-13. Additional factors including, but not limited to, performance rating and length of service may be considered. A promotional employment list shall be established after the administration of a promotional examination, and such list shall contain the name(s) of those that passed the examination. 2. Rule 7 — Discipline a) 7-2 — Causes for Discipline 12) Possession, use or sale of illegal narcotics or habit-forming` drugs, while on -duty or on city property. 14) Conviction of any felony or a misdemeanor with a job nexus. A plea or verdict of guilt, or a conviction following a plea of nolo contendere, is deemed to be a conviction within the meaning of this section. 15) Participating in an unlawful strike, work stoppage, slowdown, or using or attempting to use sick leave to accomplish the same purpose as a strike, work stoppage, or slowdown. 3. Rule 8 - Termination a) 8-1 — Medical Examination. Evaluation of Employee's Work Capacity. Demotion, Transfer or Termination of Appointment At any time a department head has reasonable cause to. believe that an employee may not be able to perform the duties of his/her position for physical or psychological reasons, such department head shall consult. with the Human Resources Manager regarding such belief. If the Human Resources Manager concurs, the department head may order the employee to submit to a medical or psychological examination. The 2003 MEO MOU Final 17 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 4. employee shall be offered the opportunity, in writing, to select from a panel of three to five physicians or psychologists to conduct the examination. The cost of such examination shall be paid by the city and, to the extent practicable, shall be scheduled during the work hours with no loss of pay. The department head shall review the medical or psychological report and shall consult with the Human Resources Manager regarding the physician's assessment of the employee's ability to perform the duties of his/her position. Any decision regarding such employee shall be made in accordance with the Americans with Disabilities Act. Notwithstanding any other provision of this rule, an employee being evaluated for medical or psychological fitness to perform the duties of his/her position may apply for another position in the competitive service for which he/she has qualified. If such employee is qualified and can perform the duties of a lower paying vacant position for which he/she has applied, he/she will be placed in such position, without competitive examination, subject to the approval of the department head. (The city and Association agree to meet biannually to discuss the 8-1 process). b) 8-3 — Layoff in Accordance with Length of Service The. city and the Association agree that the first sentence in Personnel Rule 8-3 shall be ; modified to read as follows: Layoff shall be ` made.. in accordance with the relative length of the last period of continuous service of the employees in the class of layoff, provided, however, that no permanent employee shall be laid off until all temporary, acting and probationary employees in the competitive service holding positions in the same class are first laid off. c) 8-11 — Re -Employment With the approval of Human Resources Manager, an employee who has resigned in good standing from the competitive service may be re- employed to his/her former position, if vacant, or to a vacant position in the same or comparable class within one (1) year from date of resignation in accordance with Rule 5-21. If such re-employment commences within ninety days of the effective date of resignation, the employee shall not be considered a new employee for vacation and seniority purposes. Rule 12 - Classification Plan a) 12-10 - Temporary Employees Employment on a basis other than permanent or probationary to a permanently budgeted position not to exceed 1000 hours in any twelve (12) month period. Employees occupying temporary positions shall not be 2003 MEO MOU Final 18 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 included in the competitive service and shall not be subject to these rules and regulations. 5. Rule 14 — Additional Pay and Pay Adjustments a) 14-6 — Salary Advancements to Meet Recruiting Problems or to Give Credit for Prior Service. Application for Other Advancements The Department Head, through the Human Resources Manager and with the approval of the City Administrator may make an appointment at any step above the minimum salary rate to classes or positions in order to meet recruiting problems to obtain a person who has extraordinary qualifications, or to give credit for prior city service in connection with appointments, promotions, reinstatements, transfers, reclassifications, or demotions. Salary adjustments within the salary range for the class, other than merit salary adjustments authorized by Section 14-1, may be approved by the City Administrator, upon recommendation of the department head through the Human Resources Manager. Such recommendation shall include the reason(s) for the adjustment, whether the advancement is to be permanent or temporary, and an effective date. 6. Rule 18 — Attendance and Leaves a) 18-16 — Industrial Accident Leave In -the event a permanent employee, who is a miscellaneous member of the Public Employees' Retirement System. (PERS), is itemporarily totally disabled as a result of an injury or illness arising out of and in the course of employment and covered by the State of California Workers' Compensation Insurance and Safety Act, resulting light duty assignments due to the injury or illness or absences from work shall be considered Industrial Accident Leave as that term is defined by this rule. A permanent employee eligible for Industrial Accident Leave shall receive compensation from the city in an amount equal to the employee's regular rate of salary during such period of temporary total disability. Benefits received under this rule shall be in lieu of statutory Workers' Compensation benefits. Industrial Accident Leave shall continue during all absences resulting from the injury or illness, including those absences attributable to doctor's appointments, therapy, or other follow-up medical visits, but in no case exceeding one year of accumulated absences attributable to the same injury or illness. In the event an employee is temporarily, totally disabled by coinciding qualifying injuries or illnesses, periods of absences shall be applied concurrently to all qualifying injuries or. illnesses. Industrial Accident Leave compensation shall begin on the first day an eligible employee is absent due to a qualifying injury or illness as defined 2003 MEO MOU Final 19 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 above. Industrial accident Leave compensation will terminate on the earliest of the following: 1) The date upon which the injury or illness giving rise to eligibility for compensation under this rule is declared permanent and stationary by a treating or examining physician; or 2) The date PERS approves an application for disability retirement benefits filed by the employee or by the city; or 3) The employee receives thirty (30) days advance notice and refuses to submit- to a medical examination ordered, by PERS pursuant to Government Section 21154 or otherwise refuses to cooperate with PERS in determining whether the employee is incapacitated for the performance of duty; or 4) The employee receiving Industrial Accident Leave Compensation applies for service -connected retirement benefits; or 5) The employment of the affected employee is otherwise separated. If an injured worker remains temporarily disabled after receiving one year of Industrial Accident Leave for accumulated absences or light duty work attributable to the same injury or illness, the employee will receive temporary total disability benefits as specified by the. State of California Workers' Compensation Insurance and Safety Act. Any period of time during which an employee is absent from work by reason of injury or illness for which he or she is entitled to receive Industrial Accident Leave compensation will not constitute a break in continuous service for the purposes of salary adjustments, sick leave, vacation accruals, and length of service computation. In the event an employee who is receiving or has received Industrial Accident Leave compensation makes a claim or initiates legal action against a third party for allegedly causing or contributing to the injury or illness resulting in the inability to work, the employee is required to notify in writing the City's Risk Management Division of the claim or commencement of such action within ten (10) days of the claim or such commencement. The city retains its rights of subrogation in all such instances. b) 18-19 — Maternity Leave The .city and the Association agree to modify the present Personnel Rule 18-19 MaternityLeave to read as follows: "A permanent employee shall be entitled to a leave of absence without pay due to inability to work due to pregnancy. The employee will be entitled to use available sick leave during this period. Said leave must be requested in writing from the Department 2003 MEO MOU Final 20 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 Head and must include written notification from the employees physician stating the last day the employee may work and the estimated duration of leave. The employee must obtain written authorization to return to work from the attending physician. Said authorization must be filed with the Department Head and the Human Resources Manager." c) 18-20 — Leave of Absence without Pay The city and the Association agree that the following sub -paragraph "C" shall be added to Personnel Rule 18-20. Leave of Absence without Pay: Leave of absence without pay, for medical disability reasons, shall be restricted to six (6) months. 7. Rule 19 — Grievance Procedure Non -Disciplinary Matters a) 19-5 Grievance Procedure The grievance procedure shall consist of the following steps, each of which must be completed prior to any request for further consideration of the matter unless otherwise provided herein: Step 1. Informal Discussion (optional) If an employee feels that he has a grievance, as defined in Section 19-2, he may request a meeting with his immediate supervisor within ten (10) days after the employee becomes aware or. reasonably should have become aware of the subject matter of the grievance. The immediate supervisor; within five (5) days of such request, shall meet with the employee when so requested and discuss the grievance in an effort to clarify the issue and work toward a cooperative settlement or resolution of the dispute. The immediate supervisor shall present, verbally or in writing, his decision to the employee within five (5) days from the time of the informal discussion. Step 2. Formal Procedure. Immediate Supervisor If the grievance is not settled through informal discussion, or if the employee elects not to invoke his right to informal discussion, the employee may formally submit a grievance to his immediate supervisor within five (5) days following the decision pursuant to informal discussion, or in the event the employee does not elect to invoke his right to informal discussion, within ten (10) days after the occurrence which gives rise to the grievance or after the employee becomes aware or reasonably should have been aware of he subject matter of the grievance_ Such submission shall be in writing,, stating the nature of the grievance and a suggested solution or requested remedy. Within five (5) days after receipt of the written grievance, the immediate supervisor shall meet with the employee. 2003 MEO MOU Final 21 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 Within five (5) days thereafter written decision shall be given the employee by the immediate supervisor. Step 3. Department Head In cases where the department head is not the immediate supervisor, if the grievance is not settled under Step 2, the grievance may be presented to the department head. The grievance shall be submitted within five (5) days after receipt of the written decision from Step 2. Within five (5) days after receipt of the written grievance, the department head, or his representative, shall meet with the employee and his immediate supervisor, if any. Within five (5) days thereafter written decision shall be given to the employee. 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 Human Resources Manager 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. The Human Resources Manager, 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 Human Resources Manager. Step 5 — Personnel Board Hearing Hearing. As soon as practicable thereafter, the Human Resources Manager shall set the matter for hearing before a hearing officer either selected by mutual, consent of the parties or from a list provided by the Personnel Commission. Ratification of the hearing officer selected by mutual consent of the parties, if from a list approved by the Personnel Commission, shall not require separate 2003 MEO MOU Final 22 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 approval or -ratification by the Personnel Commission. The hearing officer shall hear the case and make recommended findings, conclusions and decision in the form of a written report and recommendation to the Personnel Commission. In lieu of the hearing officer process, the Personnel Commission may agree to hear a case directly upon submission of the case by mutual consent of the parties. 8. Rule 20 —Disciplinary Procedure and Appeal a) 20-1 — Purpose The purpose of this rule is to provide a procedure for recommending and imposing discipline against city employees, and a means by which an employees may administratively appeal any such disciplinary action. b) 20-2 — Disciplinary Procedures 1) Notice of Proposed Adverse Action For disciplinary demotions, suspensions or dismissals, an employee shall be served a written Notice of Proposed Adverse Action by the employee's department head, or his/her designee, or by certified mail, prior to the proposed disciplinary action taking effect. The notice shall state the reasons for and charges upon which the proposed action. is based, and the effective date of the. action the right to respond and the employer's right to representation. A copy of all materials upon which the proposed action is based shall be attached to the notice. 2) Employee's Right to Respond The employee shall be given a minimum of ten (10) calendar days to respond orally and/or in writing to the charges upon which the proposed action is based. The employee's response shall be made to and/or before his/her department head. 3) Time Off The employee shall be given reasonable time off with pay to attend disciplinary meetings. 4) Final Notice of Decision After an employee has responded to or waived his/her right to respond to the proposed adverse action, the employee shall be served with a final Notice of Decision from his/her department head. The final written Notice of Decision shall state whether or not the proposed action shall be taken or modified, and the reasons therefore and effective date or the action. 2003 MEO MOU Final 23 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 c) 20-3 — Appeal to Personnel Commission Disciplinary action involving the termination, suspension, demotion or other reduction in pay may be appealed to the Personnel Commission for de novo hearing and final determination in accordance with the following procedure: 1) Request for Appeal Within five (5) days after the employee's receipt of a final Notice of Discipline, a written request for an appeal to the Personnel Commission shall be submitted to the Human Resources Manager. 2) Hearing As soon as practicable thereafter, the Human Resources Manager shall set the matter for hearing before a hearing officer. The hearing officer shall hear the case without the Board and shall make recommended findings, conclusions and decision in the form of a written report and recommendation to the Board. 3) Final Decision The Board shall consider the written report and recommendations of the hearing officer and after due deliberation in executive session, shall render a decision in the matter which shall be final and binding on all parties, and from which there shall be no further appeal. d) 20-4 — Supplemental Hearing by Personnel Board 1) The Board may, in its sole discretion, after it has received the written report and recommendation of the hearing officer, set the matter for private hearing for the purpose of receiving additional evidence or argument. In the event the Board sets a private hearing for such purposes, the Human Resources Manager shall give written notice to all parties concerned in such matter. 2) The Board, following a consideration of the hearing officer's written report and recommendation and deliberation thereon and any supplemental hearing before the Board, shall make findings, conclusions and decisions which shall be final and binding on all parties and from which there shall be no further appeal. e) 20-5 — Employee Status on Pending Appeal Notwithstanding the provisions of Rule 7, Section 7-4 (Suspension with Pay), the disciplinary action shall be effective pending an appeal to the Personnel Commission. 2003 MEO MOU Final 24 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 9. Rule 21 — Grievance Procedures - General a) 21-7 Hearing Officer 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. b) 21-12 Time. Extension of The city and the employee, or employee organization may, by mutual consent, extend the time period within which an act must occur in the processing of grievances: c) 21-13, Time Extension, Grievances The city and the employee, or employee organization may, by mutual consent, extend the time periods within which an act must occur in the processing of grievances. B. Employer -Employee Relations Resolution 1. Modification of Section 7 — Decertification and Modification a) b) The city and the Association desire to maintain labor stability within the representational unit to the greatest extent possible, consistent with the employee's right to select the representative of his or her own choosing. For these purposes, the parties agree that this Agreement shall act as a bar to appropriateness of this unit and the selection of the representative of this unit, except during the month of August prior to the expiration of this Agreement. Changes in bargaining unit shall not be effective until expiration of the MOU Except as may be determined by the Personnel Commission pursuant to the procedures outlined below. This provision shall modify and supersede the time limits, where inconsistent, contained in Section 7 of the current Employer -Employee Relations Resolution of the City of Huntington Beach. The city and the Association have agreed to a procedure whereby the city, by and through the Human Resources Manager, would be entitled to propose a Unit Modification. The Association and the city agree to jointly recommend a modification of the City of Huntington Beach Employer - Employee Relations Resolution (Resolution Number 3335) upon the city's having completed its obligation to meet and confer on this issue with all other bargaining units. The proposed changed to the Employer -Employee Relations Resolution is as follows: 2003 MEO MOU Final 25 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 7.3 Human Resources Manaqer Motion of Unit Modification - The Human Resources Manager may propose, during the same period for filing a petition for decertification, that an established unit be modified in accordance with the following procedure: 1. The Human Resources Manager shall give written notice of the proposed modification(s); to any affected employee organization and any affected employees. 2. The Personnel Commission shall hold a meeting concerning the proposed modification(s) at which time all affected employee organizations and employees shall be heard; 3. Thereafter, the Personnel Commission shall determine the composition of the appropriate unit or units and shall give written notice of such determination to the affected employee organizations and any affected employees. The City Administrator, employee organization or employee aggrieved by an appropriate unit determination of the Personnel Commission may, within ten (10) days of notice thereof, request a review of such determination by the City Council. Within thirty (30) days of receipt of a request to review a unit determination of the Personnel Commission the City Council shall review the matter. The.. City Council's decision shall be final. 4. Except as provided otherwise in this MOU, the salary, benefit and working conditions specified by this MOU shall be provided to employees in classifications listed in Exhibit A and have completed or are in the process of completing a probationary period in a permanent position in the competitive service in which the employee regularly works twenty hours or more per week. C. Rules Governing Layoff, Reduction in Lieu of Layoff and Re -Employ 1. Part 1 — Layoff Procedure a) General Provisions 1) Whenever it is necessary, because of lack of work or funds to reduce the staff of a city department, .employees may be laid off pursuant to these rules, 2) Whenever an employee is to be separated from the competitive service because the tasks assigned are to be eliminated or substantially changed due to management -initiated changes, including but not 2003 MEO MOU Final 26 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 limited to automation or other technological changes, it is the policy of the city that steps be taken by the Human Resources Division on an interdepartmental basis to assist such employee in locating, preparing to qualify for, and being placed in other positions in the competitive service. This shall not be construed as a restriction on the city government in effecting economies or in making organizational or other changes to increase efficiency. 3) A department shall reduce staff by identifying which positions within the department are to be eliminated. 4) The employee who has the least citywide service credit in the class within the department shall have citywide transfer rights in the class pursuant to Part 1, Section 3, Transfer or Reduction to Vacancies in Lieu of Layoffs, or within the occupational series pursuant to Part 2, Bumping Rights. 5) If a deadline within this procedure falls on a day that City Hall is closed, the deadline shall be the next day City Hall is open. b. Service Credit 1) Service credit means total time of full-time continuous service within the city at the time the layoff is initiated, including probation, paid leave or military leave. Permanent part-time employees earn service credit on a pro -rats basis. 2) Except as required by law, leaves of absence without pay shall not earn service credit. 3) As between two or more employees who have the same amount of service credit, the employee who has the least amount of service in class shall be deemed to be the least senior employee. c. Transfer or Reduction to Vacancies in Lieu of Layoff 1) In lieu of layoff, a transfer within class shall be offered to an employee(s) with the least amount of service credit in the class designated for staff reduction within a department subject to the following: a) The employee has the necessary qualifications to perform the duties of the position. b) The employee shall be given the opportunity, in order of service credit, to accept a transfer to a vacant position in the same class 2003 MEO MOU Final 27 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 within the city, provided the employee has the necessary qualifications to perform the duties of the position. c) If no position in the same class is vacant, the employee shall be given the opportunity, in order of service credit, to transfer to the position in the same class that is held by an incumbent in another department with the least amount of service credit whose position the employee has the necessary qualifications to perform. 2) If an employee(s) is not eligible for transfer within the employee's class, the employee shall be offered, in order of service credit, a reduction to. a vacant position in. the next lower class within the city in the. occupational series in lieu of layoff provided the employee has the necessary qualifications to perform the duties of the position. 3) If the employee refuses to accept a transfer or reduction pursuant to A. or B., above, the employee shall be laid off. d) If the employee(s) in the class with the least amount of service credit is in the position(s) to be eliminated or displaced by transfer, the employee shall be offered bumping rights, pursuant to Part 2, Service Credit. e) Any employee who takes a reduction to a position in a. lower class within the occupational series . in lieu of layoff, shall be placed on the reinstatement/reemployment list(s) pursuant to, Part & Reemployment. 2. Order of Layoff a) Prior to implementing a layoff, vacant positions that are authorized to be filled shall be identified by citywide occupational series. If the employee refuses to accept a position pursuant to Section 3., above, the employee shall be laid off. b) No promotional probationary employee or permanent employee within a class in the department shall be laid off until all temporary, nonpermanent part-time and non -promotional probationary employees in the class are laid off. Permanent employees whose positions have been eliminated may exercise citywide bumping rights to a lower class in the occupational series pursuant to Part 2. c) When a position in a class and/or occupational series is eliminated, any employee in the class who is on authorized leave of absence or is holding a temporary acting.position in. another class shall be included for determining order of service credit and be subject to these layoff procedures as if the employee was in his or her permanent position. 2003 MEO MOU Final 28 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 3. Notification of Employees a) The Human Resources Division shall give written notice of layoff to the employee by personal service or by sending it by certified mail to the last known mailing address at least fifteen (15) calendar days prior to the effective date of the layoff. Normally notices will be served on employees personally at work. b) Layoff notices may be initially issued to all employees who may be subject to layoff as a result of employees exercising voluntary reduction/bumping rights. c) The notice of layoff shall include the reason for the layoff, the effective date of the layoff, the employee's hire date and the employee's service credit ranking. The notice shall also include the employee's right to bump the person in a lower class with the least service credit within the occupational series. provided the employee possesses the necessary qualifications to successfully perform the duties in. the lower class and the employee has more service credit than the incumbent in the lower class. d) The written layoff notice given to an employee shall include notice that he or she has seven (7) calendar days from the date of personal service, or date of delivery of mail if certified, to notify the Human Resources Manager in writing if the employee intends to exercise the employee's bumping rights, if any, pursuant to Part 2, $umping Rights. e) Whenever practicable, any employee with the least amount of service credit in a lower class within an occupational series which is identified for work force reduction shall also be given written notice that such employee may be bumped pursuant to Part 2. This notice shall include the items referred to in C., above. f) If an employee disagrees with the city's computation of service credit or listed date of hire, the employee shall notify the Human Resources Manager as soon as possible but in no case later than five (5) calendar days after the personal service or certified mail delivery. Disputes regarding date of hire or service credit shall be jointly reviewed by the Human Resources Manager and the employee and/or the employee's representative as soon as possible, but in no case later than five (5) calendar days from the date the employee notifies the Human Resources Manager of the dispute. Within five (5) calendar days after the dispute is reviewed, the employee shall be notified in writing of the decision. 2003 MEO MOU Final 29 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 4. Part 2 — Bumping Rights a) Voluntary Reduction or Bumping in Lieu of Layoff 1) A promotional probationary employee or permanent employee who receives a layoff notice may request a reduction to a position in a lower class within the occupational series provided the employee possesses the necessary qualifications to perform the duties of the position. 2) Employees electing reduction under A above, shall be reduced to a position authorized to be filled in a lower class within the employee's occupational series. The employee may reduce to a lower class in his/her occupational series by: 1) filling a vacancy in that class, or 2) if no vacancy exists, displacing the employee in the class with the least service credit whose position the employee has the necessary qualifications to perform. A displaced employee shall have bumping rights. 3) An employee who receives a layoff notice must exercise bumping rights within seven (7) calendar days of receipt of the notice as specified in Part 1. Failure to respond within the time limit shall result in a reputable presumption that the employee does not intend to exercise any right of reduction or bumping to a lower class. The employee must carry the burden of proof to show that the employee's. failure to respond within the time limits was reasonable.. If the employee establishes that failure to respond within the time limit was reasonable, to the Human Resource Manager's satisfaction, the employee shall be permitted to exercise bumping rights but shall not be reinstated to a paid position until the employee to be bumped has vacated the position. If the employee disagrees with the Human Resource Manager decision, the employee may appeal pursuant to the provisions of Sections 3 and 4 below. b) Reinstate me nt/Re-employment Lists Any employee who takes a reduction to a position in a lower class within the occupational series in lieu of layoff shall be placed on tile reinstatement/re-employment list pursuant to Part 3, Re-employment. c) Qualifications Appeal Any employee who is denied a reduction to a position in a lower class within the occupational series on the basis that the employee does not possess the necessary qualifications to successfully perform the duties of the lower position may appeal the decision. The appeal shall be filed with the Human Resource Manager within five (5) calendar days of the employee's receipt of written notice of the decision and reason(s) for denial. 2003 MEO MOU Final 30 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 The employee's appeal shall be in writing and shall include supporting facts or documents supporting the appeal. d) Qualifications Appeal Hearing 1) Upon receipt of an appeal, the Human Resource Manager shall contact a mediator from the California State Mediation and Conciliation Service to schedule a hearing within two (2) weeks after receipt of the appeal. If the California State Mediation and Conciliation Service is not available within that time frame, the parties shall mutually select a person who is available within the time frame. If the California State Mediation and Conciliation Service and the person mutually selected are not available within tile time frame, the parties shall select the earliest date either is available to conduct the hearing. The parties shall split the cost, if any, of the hearing officer. In addition, the parties shall meet within three (3) workdays to attempt to resolve the dispute. If the dispute remains unresolved, the parties shall endeavor in good faith to submit to the hearing officer a statement of all agreed upon facts relevant to the hearing. 2) Appeal hearings shall be limited to two (2) hours, except as otherwise agreed by the parties or directed by the hearing officer. 3) The hearing officer shall attempt to resolve the disputeby mutual. agreement if. possible. If no agreement is reached, the hearing officer shall render a decision at the conclusion of the hearing which shall be final and binding 5. Part 3 — Re-employment a) Re-employment 1) Employees who are laid off or reduced to avoid layoff shall have their names placed upon a reemployment list, for each class in the occupational series, in seniority order at or below the level of the class from which laid off or reduced. 2) Names of persons placed on the reemployment lists shall remain on the list for two (2) years from the date of layoff or reduction. 3) Vacancies, shall be filled from the reemployment list for a class, starting at- tile top of the list, providing that the person meets the necessary qualifications for the position, 4) Names of persons are to be removed from the reemployment list for a class if on two (2) occasions they decline an offer of employment or on 2003 MEO MOU Final 31 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 two (2) occasions fail to respond to offers of employment in a particular class within five (5) calendar days of receipt of written notice of an offer. Any employee who is dismissed from the city service for cause shall have his or her name removed from all re-employment lists. 5) Re-employment lists shall be available to HBMEO and affected employees upon reasonable request, 6) Qualification appeals involving reemployment rights shall be resolved in the same manner as that identified in Part 2., Section 4. b) Status on Re-employment 1) Persons re-employed from layoff within a two (2) year period from the date of layoff shall receive the following considerations and benefits: a) Service credit held upon layoff shall be restored, but no credit shall be added for the period of layoff. b) Prior service credit shall be counted toward sick leave and vacation accruals. c) Employees may cash in sick leave upon layoff or at any time after layoff in the manner and amount set forth in existing Memoranda of Understanding for that employee's unit. Sick leave shall be paid to an employee when the reemployment list(s) expire(s), if not previously paid. d) Upon reinstatement the employee may have his or her sick leave re -credited by repayment to the city the cashed amount. Sick leave accumulation of less than 480 hours shall be restored upon reemployment. e) The employee shall be returned to the salary step of the classification held at the time of the layoff and credited with the time previously served at that step prior to being laid off. f) The probationary status of the employee shall resume if incomplete. 2) Employees who have been reduced in class to avoid layoff and are returned within two (2) years to their former class shall be placed at the salary step of the class they held at the time of reduction and have their merit increase eligibility date recalculated. 2003 MEO MOU Final 32 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 ARTICLE XIV - MISCELLANEOUS A. Physical Examination Employees covered by this agreement shall be provided, once every two years, with a city paid physical examination. Said exam shall be comprehensive in nature and shall include: 1. A complete medical history, physical exam, laboratory testing and review of results by a physician. (See Exhibit G, Physical Exam Description.) 2. A stress EKG will be provided for employees forty (40) years of age or older. No more than one-half of the eligible employees shall receive examinations in any one fiscal year. B. Vehicle Policy 1. Approval is required by the City Administrator or his designee for any city vehicle to be taken home by a MEO employee. 2. The auto allowance for qualifying employees shall be one hundred sixty one dollars and fifty-three cents ($161.53) bi-weekly. 3. No unit employee. shall have their automobile allowance eliminated until the city's Fleet Management Policy is re -negotiated. 4. Eligibility for automobile allowance shall be determined in accordance with the city's Fleet Management Program dated August, 1999. C. Deferred Compensation Loan Program Employees may borrow up to 50% of their deferred compensation funds for critical needs such as medical costs, college tuition, or purchase of a home. D. Employee Performance Evaluations The city and up to four MEO employees will convene an ad -hoc committee to study a new employee performance evaluation system. The ad -hoc committee will finalize its report by June 30, 2003. Nothing from said ad -hoc committee shall constitute a wavier by MEO or any of its represented employees of the right to dispute future performance evaluations. 2003 MEO MOU Final 33 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 ARTICLE XV - CITY COUNCIL APPROVAL It is the understanding of the city and the Association that this Memorandum of Understanding is of no force or effect unless and until adopted by resolution of the City Council of the City of Huntington Beach. IN WITNESS WHEROF, the parties hereto have executed this Memorandum of Understanding this 1j 1 day of December, 2002. CITY OF HUNTINGTON BEACH A Municipal Corporation Ray Silv6r / City Administr for f William P. Workma By; HUNTINGTON BEACH MANAGEMENT EMPLOYEES' ORGANIZATION By: L ustavo A. Duran, M O President By: .,� Shawna cone-Sehmidt, MEO Secretary By: �.xl�l By: Steven M. Berliner / Jam-es-89yf46, Negotiating Team Chief Negotiator APPROVED AS TO FORM Bjy#en�nifefM. By cGrath City Attorney APPROVED AS TO FORM mes G. H er, MEO Negotiator 2003 MEO MOU Final 34 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 ARTICLE XV - CITY COUNCIL APPROVAL It is the understanding of the city and the Association that this Memorandum of Understanding is of no force or effect unless and until adopted by resolution of the City Council of the City of Huntington Beach. IN WITNESS WHERF�OF. the parties hereto have executed this Memorandum of Understanding this __M day of December, 2002. CITY OF HUNTINGTON BEACH A Municipal Corporation By: Ray Sitv6r City Administrator ` By: William P. Workmant HUNTINGTON BEACH MANAGEMENT EMPLOYEES' ORGANIZATION ta' A. Duran, MEO President By: �_ PJ1� "4 Bever Braden, MEO Vioe-President. By: By.^.�-�( Clay Ma 7 ShawnKrone Schmidt, MEO Secretary DWec,Wfof administrative Services f BY: IBy: Steven M. Bediner /: James QY, Negotiating Team Chief Negotiator APPROVED AS TO FORM Br Jennife 11A. McGrath City Attorney APPROVED AS TO FORM mes G. H ' er. MEO Negotiator (7� ZM MW MOU Final 34 12/11/02 9.61 Alit Exhibit A to Res. No. 2002-132 EXHIBIT A CITY OF HUNTINGTON BEACH MANAGEMENT EMPLOYEES' ORGANIZATION SALARY SCHEDULE EFFECTIVE DECEMBER 21, 2002 0028 Accountant, Principal 532 30.97 32.67 34.47 36.37 38.37 0025 Administrative Analyst MEO 497 26.01 27.44 28.95 30.54 32.22 0084 Administrative Analyst, Principal MEO 544 32.88 34.69 36.6 38.61 40.73 0089 Administrative Analyst, Senior MEO 525 29.91 31.55 33.28 35.11 37.04 0132 Assistant City Clerk 124.86 26.23 27.67 29.19 30.8 0024 City Engineer 617 47.31 49.91 52.66 55.56 58.62 0069 Civil Engineer, Associate 542 32.56 34.35 36.24 38.23 40.33 0096 Civil Engineer, Principal 561 35.79 37.76 39.84 42.03 44.34 0092 Claims Supervisor 535 31.44 33.17 34.99 36.91 38.94 0471 Community Relations Officer 525 29.91 31.55 33.28 35.11 37.04 0097 Construction Manager 557 35.07 37 39.04 41.19 43.46 0085 Contract Administrator 525 29.91 31.55 33.28 35.11 37.04 0045 Criminalist Supervisor 549 33.71 35.56 37.52 39.58 41.76 0070 Criminalist, Chief 577 38.78 40.91 43.16 45.53 48.03 0253 Cultural Affairs Supervisor 480 23.9 25.21 26.6 28.06 29.6 0081 Deputy City Attorney 1 530 30.66 32.35 34.13 36.01 37.99 0080 Deputy City Attorney. I 1 567 36.88 38.91 41.05 43.31 45.69 0079 Deputy City Attorney III 595 42.4 44.73 147.19 49.79 52.53 0068 Deputy City Engineer 589 41.15 43.411 45.8 48.32 50.98 0090 Deputy City Treasurer 573 38 40.09 142.29 44.62 '47.07 0035 Deputy Director of Public Works 617 47.31 49.91 152.66 55.56 158.62 0027 Deputy Director of Recreation/Beach Development 607 45.01 47.49 50.1 52.86 155.77 0039 Economic Development Project Manager 548 33.54 35.38 37.33 39.38 41.55 0037 Economic Development Project Manager, Assistant 517 28.73 30.31 31.98 33.74 35.6 0474 Facilities, Development & Concession Manager 542 32.56 34.35 36.24 38.23 40.33 0131 Fire Med Coordinator 525 29.91 31.55 33.28 35.11 37.04 0130 Fire Protection Analyst 525 29.91 31.55 33.28 35.11 37.04 0184 GIS Manager 542 32.56 34.35 136.24 38.23 140.33 0023 Housing/Redevelopment Manager 568 37.07 39.11 41.26 43.53 45.92 0087 Information Systems Analyst V 556 34.9 36.82 38.85 40.99 43.24 0088 Information Systems Analyst, Principal 565 36.51 38.52 40.64 42.87 45.23 0038 Information Systems Manager 593 41.98 44.29 46.73 49.3 52.01 0199 1Information Systems Manager, Library 499 26.27 27.71 29.23 30.84 32.54 0067 Information Systems Manager, Police 574 38.18 40.28 42.5 44.84 147.31 0075 Inspection Manager 561 35.79 37.76 139.84 42.03 144.34 0076 Inspector Plb/Mech Principal. 514 28.3 29.861 31.5 33.23 135.06 0072 Inspector, Electrical Principal 514 28.3 29.861 31.5 33.23 35.06 0251 Investigator 497 26.01 27.44 128.95 30.54 32.22 0158 Landscape Architect 525 29.91 31.55 33.28 35.11 37.04 0095 Law Office Manager T 501 26.53 27.99 29.53 31.15 32.86 0077 Librarian, Senior 488 24.86 26.23 27.67 29.19 30.8 0066 Library Services Manager 546 33.2 35.03 36.96 38.99 41.13 2003 MEO MOU Final 35 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 Jain .T" .d Descri' ton y .. , Pa : Gcade . ` A B : C.. D E . 0030 Maintenance Operations Manager 571 37.63 39.7 141.88 44.18 46.61 0032 Marine Safety Division Chief 577 38.78 40.91 43.16 45.53 48.03 0441 Neighborhood Preservation Program Manager 568 37.07 39.11 41.26 43.53 45.92 0040 Park Tree Landscape Operations Manager 563 36.15 38.14 40.24 42.45 44.78 0098 JPermit & Plan Check Manager 570 37.44 39.5 41.67 43.96 46.38 0209 Plan Check & Permit Supervisor 526 30.06 31.71 33.45 35.29 37.23 0099 Plan Check Engineer 556 34.9 36.82 38.85 40.99 43.24 0071 Planner, Associate 517 28.73 30.31 31.98 33.74 35.6 0074 Planner, Principal 568 37.07 39.11 41.26 43.53 45.92 0036 Planner, Senior 548 33.54 35.38 37.33 39.38 41.55 0444 Planning Manager 578 38.96 41.1 43.36 45.75 48.27 0022 Police Communications Manager. 528 30.36 32.03 33.79 .35.65 37.61 0083 Purchasing & Central Services Manager 534 31.28 33 34.82 36.73 38.75 0043 Real Estate Services Manager 576 38.58 40.7 42.94 45.3 47.79 0093 Real Property Agent 548 33.54 35.38 37.33 39.38 41.55 0094 Records Admin Police 528 30.36 32.03 33.79 35.65 37.61 0000 Recreation, Human & Cultural Services, Superintendent 567 36.88 38.91 41.05 43.31 45.69 0457 Special Events Coordinator 480 23.9 25.21 j 26.6 28.06 29.6 0044 Supervisor, Beach Operations 527 30.21 31.87 33.62 35.47 37.42 0047 Supervisor, Building Maintenance 527 30.21 31.87 33.62 35.47 37.42 0073 Supervisor, Comb/Strctrl Insp 533 31.12 32.83 34.64 36.55 38.56 0473 Supervisor, Development & Petro -Chemical 529 30.51 32.19 33.96 35.83 37.8 0048 Supervisor, Mechanical Maintenance 527 30.21 31.87 33.62 35.47 37.42 0049 Supervisor, Park Maintenance 527 30.21 31.87 33.62 35.47 37A2 013.3 Supervisor, Parking & Camping Facilities 514 28.3 29.86 31.5 33.23 35.06 0046 Supervisor, Recreation Senior. 514 28.3 29.86 31.5 33.23 35.06 0050 Supervisor, Street & Sewer Maintenance 527 30.21 31.87 33.62 35.47 37A2 0051 Supervisor, Tree, Landscape, Pest Control 527 30.21 31.87 33.62 35.47 37.42 0052 Supervisor, Water Distribution 527 30.21 31.87 33.62 35.47 37.42 0053 ISupervisor, Water Production 527 30.21 31.87 33.62 35.47 37.42 0086 Systems Analyst 518 28.87 30.46 32.14 33.91 35.78 0034 Traffic Engineer, Associate 543 32.72 34.52 36.42 38.42 40.53 0033 Transportation Manager 586 40.55 42.78 45.13 47.61 50.23 0041 Water Operations Manager 591 41.57 43.86 46.27 48.81 51.49 EFFECTIVE DECEMBER 21, 2002 ob"f Desc» "f[orr = Pa ,.Grad 0032 IMarine Safety Division Chief 1 577 138.78 40.91 43.16 45.53 48.03 EFFECTIVE MARCH 29, 2003 ,y C , SD Ifi . 0032 Marine SafeV Division Chief 577 38.78 40:91 43.16 45.53 48.03 2003 MEO MOU Final 36 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 EXHIBIT B DELTA DENTAL PLAN BROCHURE A copy of the Delta Dental Plan Brochure may be obtained from the Administrative Services Department 2003 MEO MOU Final 37 12111102 9:01 AM Exhibit A to Res. No. 2002-132 EXHIBIT C DELTA DENTAL CARE PLAN BROCHURE A copy of the Delta Care Plan Brochure may be obtained from the Administrative Services Department 2003 MEO MOU Final 38 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 EXHIBIT D EMPLOYEE HEALTH PLAN BROCHURE A copy of the Employee Health Plan Brochure may be obtained from the Administrative Services Department 2003 MEO MOU Final 39 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 EXHIBIT E RETIREE SUBSIDY MEDICAL PLAN 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 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 continuous city 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: 1. 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 rightto 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 retiree's eligibility to receive further benefits will cease. 2. On the first of the month in which a retiree or dependent reaches age 65 or on the date the retiree or dependent can 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 age 65 under the city's medical plans shall be governed by applicable plan document. 3. In the event of the death of any employee, whether retired or not, the amount of the retiree medical insurance subsidy benefit which the deceased employee was. receiving at the time of his/her death would be eligible to receive if he/she were retired at the time of death, shall be paid on behalf of the spouse or family for a period not to exceed twelve (12) months. 2003 MEO MOU Final 40 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 SCHEDULE OF BENEFITS A. Minimum Eligibility for Benefits - With the exception of an industrial disability retirement, eligibility for benefits begin after an employee has completed ten (10) years of continuous service with the City of Huntington Beach. Said service must be continuous unless prior service is reinstated at the time of his/her rehire in accordance with the city's Personnel Rules. B. 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 $121. Payments shall be in accordance with the stipulations and conditions which exist for all retirees. Payment shall not exceed dollar. amount which is equal to the. full cost of premium for employee only. C. Maximum Monthly Subsidy Payments - 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 for each year of completed city service as follows: Maximum Monthly Payment for Retirements After: Years of Service Subsidy 10 . $ 121. 11 136. 12 151 13 166 14 181 15 196 16 211 17 226 18 241 19 256 20 271 21 286 22 300 23 315 24 330 25 344 Note: The above payment amounts may be reduced each month as dependent eligibility ceases due to death, divorce .or loss of dependent child status: 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 premium is not sufficient to pay the premium amount for the employee and the eligible dependents, said needed excess premium amount shall be paid by the employee. 2003 MEO MOU Final 41 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 INDEMNITY HEALTH PLAN, EMPLOYEES/RETIREES' Benefits City Plan - Employees City Plan - Subsidized Non -Subsidized Retirees Retirees COBRA -eligibles Deductible $250 per person $250 per person $500 per family $500 per family Maximum Out of.Pocket $2,000 per person $2,000 per person $4,000 per family $4,000 per family Co -Insurance PPO 90% of UCR 90% of UCR Non-PPO 70% of UCR 70% of UCR Note: Retirees who elect to participate in HMO shall be entitled to benefits of the program chosen. 2003 MEO MOU Final 42 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 RETIREE SUBSIDY MEDICAL PLAN/MISCELLANEOUS PROVISIONS A. Eligibility: 1. The effective start-up date of the Retiree Subsidy Medical Plan for the various employee groups shall be the first of the month following retirement date. 2. A retiree may change plans, add dependents, etc., during annual open enrollment. The Administrative Services Department shall notify covered retirees of this opportunity each year. 3. Years of service computed for the Retiree Subsidy Medical Plan are actual years of completed service with the City of Huntington Beach. 4. When a retiree is eligible for medical plan coverage at the expense of another employer due to post -retirement employment of the retiree or spouse of the retiree, the retiree and his/her spouse must take that coverage regardless of benefit level and shall be deleted from any City Plan coverage. Exceptions to this requirement are limited to the following: a. A retiree is not required to enroll in such "other" medical plan coverage if there is significant disparity between the benefits provided by the "other' medical plan and the Retiree Subsidy Medical Plan asdefined below. "Significant disparity" means coverage available, under the "other' medical plan is restrictive or limited in one or more of the following ways: 1) No in -patient hospitalization coverage. 2) No major medical benefits 3) Annual deductible is $1,000 or greater per person. 4) Major medical benefits are paid at 60% or less of covered expenses. b. The Risk Manager will have the authority to provide additional exceptions following review of the "other' medical plan policy. Exceptions will be made only if the "other' medical plan benefit provisions are comparable to the guidelines under B above. - c. Miscellaneous Provisions: 1. Benefits provided under the Retiree Subsidy Medical Plan will be coordinated with the "other" medical plan as the primary carrier. 2003 MEO MOU Final 43 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 2. The city shall have the right to require any retiree to provide a copy of the `other' medical plan policy for review by the Risk Manager. 5. When a retiree becomes eligible for the other group coverage and then becomes no longer eligible, he/she may have the subsidy reinstated and regain Retiree Subsidy Medical Plan coverage. 6. Dependents of a retiree may follow him/her into the Retiree 'Subsidy Medical Plan or they may choose to exercise COBRA rights along with the retiree. 7. When a retiree becomes 65 and has eligible dependents under 65, said dependents are eligible to exercise COBRA rights. 8. When a retiree is under 65 and his/her spouse is over 65, the spouse is not covered. B. Benefits: 1. Retiree Subsidy Medical Plan includes Managed Health Network (MHN), Prescription Card System (PCS), Orange County Foundation for Medical Care (OCFMC) and Medical Stop Loss insurance. 2. City Plans are the primary payer for active employees age 65 and over, with Medicare the secondary payer. Retirees age 65 and over have no City Plan options and are eligible only for Medicare. 3. Premium payments are to be received at least one month in advance of the coverage period. C. Subsidies: 1. The subsidy payments will pay for: a. Retiree Subsidy Medical Plan. c. Part A of Medicare for those retirees not eligible for paid Part A. 2. Subsidy payments will not pay for: a. Part B Medicare. b. Regular City Employee Indemnity Plan. c. Any other employee benefit plan. 2003 MEO MOU Final 44 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 d. Any other commercially available benefit plan. e. Medicare supplements D. Medicare: 1. All persons are eligible for Medicare coverage at age 65. Those with sufficient credit quarters of Social Security will receive Part A of Medicare at no cost. Those without sufficient credited quarters are still eligible for Medicare at age 65, but will have to pay for Part A of Medicare if the individual elects to take Medicare. In all cases, Part B of Medicare is paid for by the participant. 2. When a retiree and his/her spouse are both 65 or over, and neither is eligible for paid Part A of Medicare, the subsidy shall pay for Part A for each of them or the maximum subsidy, whichever is less. 3. When a retiree at age 65 is eligible for paid Part A of Medicare and his/her spouse is not eligible for paid Part A, the spouse shall not receive subsidy. When a retiree at age 65 is not eligible for paid Part A of Medicare and his/her spouse who is also age 65 is eligible for paid Part A of Medicare, the subsidy shall be for the retiree's Part A only. E. Cancellation: 1 For retirees/dependents eligible for paid Part A of Medicare, the following cancellation provisions apply: a. Coverage for a retiree under the Retiree Subsidy Medical Plan will be eliminated on the first day of the month in which the retiree reaches age 65. If such retiree was covering dependents under the Plan, dependents will be eligible for COBRA continuation benefits effective as of the retiree's 65th birthday. b. Dependent coverage will be eliminated upon whichever of the following occasions comes first: 1) After 36 months of COBRA continuation coverage, or 2) When the covered dependent reaches age 65 in the event such dependent reaches age 65 prior to the retiree reaching age 65. c. At age 65 retirees are eligible to make application for Medicare. Upon being considered "eligible to make application", whether or not application has been made for Medicare, the Retiree Subsidy Medical Plan will be eliminated. 2003 MEO MOU Final 45 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 2. See provisions under "Benefits", "Subsidies",' and "Medicare" for those retirees/dependents not eligible for paid Part A of Medicare. 3. Retiree Subsidy Medical Plan and COBRA participants shall be notified of non-payment of premium by means of a certified letter from Employee Benefits in accordance with provisions of the Memorandums of Understanding. 4. A retiree who fails to pay premiums due for coverage and is in arrears for sixty (60) days shall be terminated from the Plan and shall not have reinstatement rights. 2003 MEO MOU Final 46 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 EXHIBIT F VEHICLE USE ASSIGNMENT ADMINISTRATIVE REGULATION See Administrative Regulations 2003 MEO MOU Final 47 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 EXHIBIT G PHYSICAL EXAMINATION DESCRIPTION I. Complete Health History II. Complete Physical Examination by Physician III. Computer Printout: A. Physiological Tests: 1. Temperature 2. Height 3. Weight 4 Vision 5. Audiometry (Hearing Screening) 6. Blood Pressure 7. Pulse 8. Chest X-Ray 9. EKG 10. History 11. Tonometry (Glaucoma) for patients 35 and over. 12. Spirometry (Breathing) B. Laboratory Tests: 1. Blood Chemistry Screening Tests: SGPT Triglycerides SGOT Glucose Fasting LDH BUN Alk. Phosphatase Creatinine Total Bilirubin Uric Acid Total Protein Calcium Albumin -Serum Inorganic Phosphate Globulin Sodium Cholesterol Postassium 2. Complete Blood Count 3. Urinalysis 4. Stool Test for Blood 5. RPR 6. Pap Smear on Females 7. - ` HDL IV. Examination Findings: A. Consultation with Physician B. Written Report of Findings 2003 MEO MOU Final 48 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 EXHIBIT H - 9/80 WORK SCHEDULE This work schedule is known as the "9/80". The 9/80 work schedule is designed to be in compliance with the requirements of the Fair Labor Standards Act (FLSA) and all other applicable laws. In the event that there is a conflict with the current rules, practices and/or procedures regarding work schedules and leave plans, then the rules listed below shall govern. 9/80 WORK SCHEDULE DEFINED The 9/80 work schedule shall be defined as working nine (9) days for eighty (80) hours in a two week pay period by working eight (8) days at nine (9) hours per day and working one (1) day for eight (8) hours (Friday), with a one -hour lunch during each work shift, totaling forty (40) hours in each FLSA work week. The 9/80 work schedule shall not reduce service to. the public, departmental effectiveness, productivity and/or efficiency as determined by the City Administrator or designee. A. Forty (40) Hour FLSA Work Week — The actual FLSA work week is from Friday at mid - shift (p.m.) to Friday at mid -shift (a.m.). No employee working the 9/80 work schedule will be able to flex their Friday start time nor the time they take their lunch break, which will be from 12:00 p.m. to 1:00 p.m. on Fridays. All employee work shifts will start at 8:00 a.m. on their Friday worked. The start of the FLSA work week is 12:00 noon Friday. B. Two Week Pay Period — The pay period for employees starts Friday mid -shift (p.m.) and continues for fourteen (14) days until Friday mid -shift (a.m.). During this period, each week is made up of four (4) nine(9) hour work days (thirty-six (36) hours) and one (1)_ four (4) hour Friday and those hours equal forty (40) work hours in each work week (e.g. the Friday is split into four (4) hours for the a.m. shift, which is charged to work week one and four (4) hours for the p.m. shift, which is charged to work week two). C. A/B Schedules — To continue to provide service to the public every Friday, employees are to be divided between two schedules, known as the "A" schedule and the "B" schedule, based upon the departmental needs. For identification purposes, the "A" schedule shall be known as the schedule with a day off on the Friday in the middle of the pay period, or, "off on payday", the "B" schedule shall have the first Friday (p.m.) and the last Friday (a.m.) off, or "working on payday". An example is listed below: AM Py S y.. A Ntr. T _u, ..ill . F S . S. T W.:Th Schedule 4 4 - - 9 9 9 9 - - - - 9 9 9 9 4 4 B Schedule - - - - 9 9 9 9 4 4 - - 9 9 9 9 1 - - D. A/B Schedule Changes- FLSA non-exempt employees cannot change schedules without prior approval of their supervisor, Department Head, and the Human Resources ` Manager or designee. The purpose of this authorization is to ` review the impact on overtime. FLSA exempt employees may change A/B schedules at the beginning of any pay period with supervisor and Department Head approval. E. Emergencies — All employees on the 9/80 work schedule are subject to be called to work any time to meet any and all emergencies or unusual conditions which, in the 2003 MEO MOU Final 49 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 opinion of the City Administrator, Department Head or designee may require such service from any of said employees. OVERTIME DEFINED FLSA Non -Exempt Employees — All non-exempt employees under the 9/80 work schedule shall earn overtime for all hours worked after the first forty (40) hours in an FLSA work week (Friday 12:00:00 p.m. to Friday 11:59:59 a.m.) as required under FLSA. Employees are required to obtain supervisor authorization prior to working any overtime. 1. Overtime Compensation — As stated in Memorandum -of -Understanding 2.. Compensatory Time - As stated in Memorandum -of -Understanding LEAVE BENEFITS When an employee is off on a scheduled workday under the 9/80 work schedule, then nine (9) hours of eligible leave per workday shall be charged against the employee's leave balance or eight (8) hours shall be charged if the day off is a Friday. All leaves shall continue under the current accrual, eligibility, request and approval requirements. 1. General Leave — As stated in Memorandum -of -Understanding 2. Sick Leave — As stated in Memorandum -of -Understanding 3. Administrative Leave — As stated in Memorandum -of -Understanding 4. Executive Leave As stated in Memorandum -of -Understanding 5. Bereavement Leave — As stated in Memorandum -of -Understanding 6. Holidays - a. For a recognized city holiday, eight (8) hours, as stated in Section XII.B, are earned for each holiday. For the charging of hours on a scheduled holiday, the employee must use eight (8) hours of holiday time off and one (1) hour from the employees General Leave, Compensatory Time, Administrative Leave, or Executive Leave banks for a nine (9) hour workday charge or eight (8) hours holiday time off for a Friday. b. If a holiday falls on an FLSA non-exempt employee's Friday off, the employee must then take the work shift before or after the holiday off with supervisor and Department Head approval. If the employee cannot take the work shift before or after the holiday off the employee will be granted eight, (8) hours of general leave c. If a holiday falls on an FLSA exempt employee's Friday off, the employee must then take a work shift off within the same work week with supervisor and Department Head approval. FLSA exempt employees shall not be granted any administrative/general leave or any added compensation for not taking a work shift off on a scheduled holiday. 2003 MEO MOU Final 50 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 7. Jury Duty — The provisions of the Personnel Rules shall continue to apply, however, if an FLSA exempt employee is called to serve on jury duty during a normal Friday off, Saturday, or Sunday, or on a city holiday, then the jury duty shall be considered the same as having occurred during the employees day off work, therefore, the employee will receive no added compensation. 2003 MEO MOU Final 51 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 EXHIBIT I - 4/10 WORK SCHEDULE This work schedule is known as the "4/10". The 4/10 work schedule is designed to be in compliance with the requirements of the Fair Labor Standards Act (FLSA). In the event that there is a conflict with the current rules, practices and/or procedures regarding work schedules and leave plans, then the rules listed below shall govern. 4/10 WORK SCHEDULE DEFINED The 4/10 work schedule shall be defined as working eight (8) days for eighty (80) hours in a two week pay period by working eight (8) days (Monday through Thursday, Fridays off) at ten (10) hours per day, plus a one -hour lunch during each work shift, totaling forty (40) hours in each FLSA work, week. The 4/10 work schedule shall not reduce service to the public,. departmental. effectiveness, productivity and/or efficiency as determined by the City Administrator or designee. All employees on the 4/10 work schedule are subject to be called to work any time to meet any and all emergencies or unusual conditions which, in the opinion of the City Administrator, Department Head or designee may require such service from any of said employees. OVERTIME DEFINED FLSA Non -Exempt Employees — All non-exempt employees under the 4/10 work schedule shall earn overtime for all hours worked after the first forty (40) hours in an FLSA work week as required under FLSA. Employees are required to obtain supervisor authorization prior to working any overtime. 1. Overtime Compensation — As stated in Memorandum -of -Understanding 2. Compensatory Time — As stated in Memorandum -of -Understanding LEAVE BENEFITS When an employee is off on a scheduled workday under the 4/10 work schedule, then ten (10) hours of eligible leave per workday shall be charged against the employee's leave balance. All leaves shall continue under the current accrual, eligibility, request and approval requirements. 1. General Leave — As stated in Memorandum -of -Understanding 2. Sick Leave — As stated in Memorandum -of -Understanding 1 Administrative Leave — As stated in Memorandum -of -Understanding 4. Executive Leave — As stated in Memorandum -of -Understanding 5. Bereavement Leave - As stated in Memorandum -of -Understanding 2003 MEO MOU Final 52 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 6. Holidays - a. For a recognized city holiday, eight (8) hours, as stated in Section XII.B, are earned for each holiday. For the charging of hours on a scheduled holiday, the employee must use eight (8) hours of holiday time off and two (2) hour from the employees General Leave, Compensatory Time, Administrative Leave, or Executive Leave banks for a ten (10) hour workday. b. If a holiday falls on an FLSA non-exempt employee's Friday off, the employee must then take the work shift before or after the holiday off with supervisor and Department Head approval. If the employee cannot take the work shift before or after the holiday off the employee will be granted eight (8); hours of general. leave. c. If a holiday falls on an FLSA exempt employee's Friday off, the employee must then take a work shift off within the same work week with supervisor and Department Head approval. FLSA exempt employees shall not be granted any administrative/general leave or any added compensation for not taking a work shift off on a scheduled holiday. 7. Jury Duty — The provisions of the Personnel Rules shall continue to apply, however, if an FLSA exempt employee is called to serve on jury duty during a normal Friday off, Saturday, or Sunday, or on a city holiday, then the jury duty shall be considered the same as having occurred during the employees day off work, therefore, the employee will receive no added compensation. 2003 MEO MOU Final 53 12/11/02 9:01 AM Exhibit A to Res. No. 2002-132 Res. No. 2002-132 STATE OF CALIFORNIA COUNTY OF ORANGE ) ss: CITY OF HUNTINGTON BEACH ) 1, CONNIE BROCKWAY, 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 at least a majority of all the members of said City Council at an regular meeting thereof held on the 16th day of December, 2002 by the following vote: AYES: Coerper, Green, Cook, Houchen, Hardy NOES: Sullivan, Boardman ABSENT: None ABSTAIN: None City Clerk and ex-officio C rk of the City Council of the City of Huntington Beach, California MEO MOU TABLE OF CONTENTS PREAMBLE.................................................................................................................................................................................3 ARTICLEI - TERM OF MOU...................................................................................................................................................3 ARTICLE II - REPRESENTATIONAL UNIT/CLASSIFICATIONS....................................................................................4 ARTICLE III - ARTICLE NUMBER RESERVED..................................................................................................................4 ARTICLE IV - EXISTING CONDITIONS OF EMPLOYMENT...........................................................................................4 ARTICLEV - SEVERABILITY.................................................................................................................................................4 ARTICLEVI - SALARY SCHEDULE......................................................................................................................................4 ARTICLEVII - SPECIAL PAY..................................................................................................................................................5 A. EDUCATIONAL TUITION.......................................................................................................................................................... 5 B. BILINGUAL PAY...................................................................................................................................................................... 6 ARTICLEVIII - UNIFORMS.....................................................................................................................................................6 ARTICLE IX - HOURS OF WORK/OVERTIME/ADMINISTRATIVE LEAVE................................................................6 A. OVERTIME..............................................................................................................................................................................6 B. ADMINISTRATIVE LEAVE........................................................................................................................................................ 6 C. FLEX SCHEDULE AND HOURS OF WORK............................................................................................................................. 6 ARTICLE X - HEALTH AND OTHER INSURANCE BENEFITS........................................................................................8 A. HEALTH................................................................................................................................................................................. 8 4LAkdiea1 ............................................................................................................................................................................. 8 2, Dental...............................................................................................................................................................................8 3- Vision............................................................................................'....................................................................................8 B. ELIGIBILITY CRITERIA AND COST........................................................................................................................................... 8 1. City Paid Medical. Dental and Vision Insurance —Employee and Dependents............................................................. 8 2. !2bLLs Contribution to Health Insurance Premiums......................................................................................................... 8 a-. YeaF 200212fe .;UMS ........................... 8 a. Year 2003 Premiums..................................................................................................................................................................... 9 b. Future Premiums........................................................................................................................................................................ 10 3. Medical Cash-Out..........................................................................................................................................................10 4. Section 125 Plan............................................................................................................................................................10 C. LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT....................................................................................................... 10 D. LONG TERM DISABILITY INSURANCE................................................................................................................................... 10 E. MISCELLANEOUS..................................................................................................................................................................II 1. City Paid Premiums While On Medical Disability.........................................................................................................11 2. Insuance Benefits AdvisorX Committee..........................................................................................................................11 3. Health Plan Over-Payments........................................................................................................................................... II a. Reduction of Employee's Bi-Monthly Salary Warrant................................................................................................................. 11 b. Notice of Ineligible Dependents................................................................................................................................................... I 1 C. Twelve Month Recovery Period................................................................................................................................................... 11 F. JOINT CAFETERIA PLAN STUDY....................................................................................................................................... 11 ARTICLE XI - RETIREMENT BENEFITS............................................................................................................................13 A. BENEFITS............................................................................................................................................................................. 13 1. Self Funded Supplemental Retirement Beneft...............................................................................................................13 2. Medical Insurance for Retirees......................................................................................................................................13 a. Medical Insurance Upon Retirement............................................................................................................................................ 13 b. Premiums Paid Upon Retirement By Use of Unused Sick Leave Benefits................................................................................... 14 2003 MEO MOU Draft i 12/11/02 8:55 AM MEO MOU TABLE OF CONTENTS B. PUBLIC EMPLOYEES' RETIREMENT SYSTEM REIMBURSEMENT AND REPORTING ................................................................. 14 1. Employee's Contribution................................................................................................................................................14 2- Re�lleve..........................................................................................................................................................................14 2. Two Percent at APe 55 Formula...................................................................................................................................14 4- AERS Level a v.,...,iyer-. Bene a. ..................... . 14 3. Pre -Retirement Optional Settlement 2 Death Ben efzt..................................................................................................14 4. Fourth Level of 1959 Survivor Benelits.......................................................................................................................14 5. Review of Contract Amendment Cost Analysis............................................................................................................15 ARTICLE XII - LEAVE BENEFITS........................................................................................................................................15 A. GENERAL LEAVE.................................................................................................................................................................. 15 1. Accrual...........................................................................................................................................................................15 2. Elitibiliy and Approval.................................................................................................................................................15 3. Family Sick Leave.........................................................................................................................................................15 4. Conversion to Cash........................................................................................................................................................16 5. One Week Minimum Vacation Requirement...................................................................................................................16 B. HOLIDAYS............................................................................................................................................................................ 16 C. SICK LEAVE......................................................................................................................................................................... 16 D. BEREAVEMENT LEAVE......................................................................................................................................................... 18 E. PATERNITY LEAVE............................................................................................................................................................... 18 ARTICLE XIII - CITY RULES................................................................................................................................................19 ARTICLE XIV - MISCELLANEOUS........................................................... ................................. 36 A. PHYSICAL EXAMINATION..................................................................................................................................................... 36 B. VEHICLE POLICY..................................................................................................................................................................36 C. DEFERRED COMPENSATION LOAN PROGRAM......................................................................................................................36 D. EMPLOYEE PERFORMANCE EVALUATIONS....................................................................................................................... 36 ARTICLE XV - CITY COUNCIL APPROVAL .......................................... ............................................... 37 EXHIBIT A - MEO SALARY SCHEDULE............................................................................................................................38 EXHIBIT B - DELTA DENTAL BROCHURE.......................................................................................................................42 EXHIBIT C - DELTA CARE PLAN BROCHURE................................................................................................................43 EXHIBIT D - EMPLOYEE HEALTH PLAN BROCHURE..................................................................................................44 EXHIBIT E - RETIREE MEDICAL PLAN............................................................................................................................45 RETIREE SUBSIDY MEDICAL PLAN..................................................................................................................................45 SCHEDULEOF BENEFITS.....................................................................................................................................................46 A. Minimum Eligibility for Benefits.................................................................................................................................... 46 B. Disability Retirees.......................................................................................................................................................... 46 C. Maximum Monthly Subsidy Payments ............................................................................................................................ 46 INDEMNITY HEALTH PLAN, EMPLOYEES/RETIREES'................................................................................................47 RETIREE SUBSIDY MEDICAL PLAN/MISCELLANEOUS PROVISIONS .....................................................................48 A. Eligibility........................................................................................................................................................................48 B. Benefits ...........................................................................................................................................................................49 C. Subsidies.........................................................................................................................................................................49 D. Medicare........................................................................................................................................................................ 50 E. Cancellation................................................................................................................................................................... 50 EXHIBIT F - VEHICLE USE/ASSIGNMENT........................................................................................................................52 EXHIBIT G - PHYSICAL EXAMINATION DESCRIPTION.............................................................................................. 53 EXHIBIT H — 9/80 WORK SCHEDULE................................................................................................................................. 54 EXHIBIT I — 4/10 WORK SCHEDULE................................................................................................................................... 57 2003 MEO MOU Draft ii 12/11/02 8:55 AM MEMORANDUM OF UNDERSTANDING between THE CITY OF HUNTINGTON BEACH (Hereinafter called CITY) and THE HUNTINGTON BEACH MANAGEMENT EMPLOYEES' ORGANIZATION (Hereinafter called ASSOCIATION ORGAA17eTION or MEO) PREAMBLE This Memorandum of Understanding is entered into by and between the City of Huntington Beach, a Municipal Corporation of the State of California, herein called "City", and the Huntington Beach Management Employees' Organization, a California Organization, herein called "Association". WHEREAS, pursuant to California law, the city, acting by and through its designated representatives, duly appointed by the governing body of said city, and the representatives of the Association, a duly recognized employee association have met and conferred in good faith and have fully communicated and exchanged information concerning wages, hours, and other terms and conditions of employment for the period December 21, 2002 through December 19, 2003 DeG e22, 2001 through D8Gernber 20, 2(l�c WHEREAS, except as otherwise expressly provided herein, all terms and conditions of this Agreement shall apply to all employees represented by the Association, and WHEREAS, the representatives of the city and Association desire to reduce their agreements to writing, NOW THEREFORE, this Memorandum of Understanding (MOU) is made, to become effective December 21, 2002 DeGeFnbeF 22, 2001 and it is agreed as follows. ARTICLE I - TERM OF MOU This Agreement shall be in effect for a period of one (1) year commencing December 21, 2002, and ending midnight December 19, 2003. OeGembeF 22; 0c�,and —endin" midnight, rleGeme20_2002 The City and the Association agree to exchange proposals regarding a successor Memorandum of Understanding (MOU) on or prior to August 4, 2003 August 15, 2002. 2003 MEO MOU Draft 3 12/11/02 8:55 AM ARTICLE II - REPRESENTATIONAL UNIT/CLASSIFICATIONS It is recognized that Association is the employee association which has the right to meet and confer in good faith with the city on the behalf of employees whose classifications are listed in Exhibit A, attached hereto and incorporated by reference herein. ARTICLE III - ARTICLE NUMBER RESERVED ARTICLE IV - EXISTING CONDITIONS OF EMPLOYMENT Except as otherwise expressly provided herein, the adoption of this Memorandum of Understanding shall not change existing benefits and terms and conditions of employment which have been established in prior Memoranda of Understanding, and/or provided for in the Personnel and Departmental Rules of the City of Huntington Beach. ARTICLE V - SEVERABILITY If any section, subsection, sentence, clause, phrase or portion of this MOU or any additions or amendments thereof, or the application thereof to any person, is for any reason held to be invalid or unconstitutional by the decision of any court of competent jurisdiction, such decision shall not affect the validity of the remaining portions of this resolution or its application to other persons. The City Council hereby declares that it would have adopted this MOU and each section, subsection, sentence, clause, phrase or portion, and any additions or amendments thereof, irrespective of the fact that any one or more sections, subsections, sentences, clauses, phrases or portions, or the application thereof to any person, be declared invalid or unconstitutional. ARTICLE VI - SALARY SCHEDULE A. Salary Schedule 1. All MEO represented employees are ell be required to utilize direct deposit of payroll checks effes#+ve ApFil 26, 2002. The city shall issue each employee direct deposit advice (payroll receipt) each pay period that details all income, withholdings and deductions. 2. Permanent employees shall be compensated at hourly salary rates by job type and pay grade including a three percent (3%) increase effective December 21, 2002 MaFGh 2, 2as set forth in Exhibit A attached hereto and incorporated herein by this reference. 2003 MEO MOU Draft 4 12/11/02 8:55 AM 3. Marine Safety Chief The salary range of the Marine Safety Division Chief shall be a minimum of 18% above the Marine Safety Lieutenant but shall be no higher than 15% below the Deputy Director of Recreation/Beach Development DepaFtmont Deputy Direrte ARTICLE VII - SPECIAL PAY A. Educational Tuition: Upon approval of the Department Head and the Human Resources Manager Offieer, permanent employees may be compensated for courses from accredited educational institutions. Tuition reimbursement shall be limited to job related courses or job related educational degree objectives and requires prior approval by the Department Head and Human Resources Manager Officer. 2. Education costs shall be reimbursed to permanent employees on the basis of a full refund for tuition, books, parking (if a required fee) and any other required fees upon presentation of receipts. However, the maximum reimbursement shall be not more than one thousand five hundred dollars ($1,500) in any fiscal year period. 3. If a permanent employee was enrolled in a degree with approval from their Department Head and the Human Resources Manager O#1se prior to April 15, 2002. Education costs shall be paid to employees on the basis of full refund for tuition, fees, books and supplies; provided, however, that maximum reimbursement shall be at the rates currently in effect in the University of California System. Employee may be compensated for actual cost of tuition, books, fees, at accredited educational institutions that charge higher rates than the University of California, if it can be demonstrated by the employee that said educational institutional presents the only accredited course or program within a reasonable commuting distance of the employee. 4. Reimbursements shall be made when the employee presents proof to the Human Resources Manager Officer that he/she has successfully completed the course with a grade of "C" or better; or a "Pass" if taken for credit. 5. The city and the Association agree to re -convene an "Education Committee" that will consist of two individuals from the city and two individuals from the Association to meet on the topic of tuition reimbursement. The committee will meet between July 1, 2003 2-OQ and August 30, 2003 2-9Q. The resulting committee report shall be a possible subject of negotiation in a successor MOU. 2003 MEO MOU Draft 5 12/11/02 8:55 AM B. Bilingual Pax: Permanent employees who are required by their Department Head to use Spanish, Vietnamese, or Sign Language skills as part of their job assignment, -shall be paid an additional five -percent (5%) of their basic hourly rate in addition to their regular bi- weekly salary. Permanent employees may accept assignments utilizing bilingual skills in other languages on a short-term assignment with approval by the City Administrator. Such employees shall receive the additional five percent (5%) for every bi-weekly pay period that the assignment is in effect. In order to be eligible for said compensation, employee's language proficiency will be tested and certified by the Human Resources Manager O##ise or designee. ARTICLE VIII - UNIFORMS The city agrees to provide uniforms to employees on active duty who are required to wear uniforms to the same extent as in the past. ARTICLE IX - HOURS OF WORK/OVERTIME/ADMINISTRATIVE LEAVE It is the intent of the city to provide an opportunity for MEO employees to select a flex schedule and/or alternative work schedule that is consistent with the city's objective that such schedules shall not reduce service to the public, departmental effectiveness, productivity and/or efficiency as determined by the City Administrator or designee. A. Overtime: Employees represented herein shall not be eligible for paid overtime compensation. B. Administrative Leave: All unit employees shall be entitled to 40 hours of administrative leave upon working forty (40) additional hours above their regular work schedule per calendar year. Such employee may earn additional administrative leave, on an hour for hour basis, for hours worked in excess of seventy-five (75) in a calendar year. Time off for Police Department fitness programs and flexible scheduling that is agreed to between the employee and Department Head are exempt from the 75-hour provision. C. Flex Schedule and Hours of Work: Effective February 1, 2003, with supervisor and Department Head approval, MEO employees may flex regular scheduled start times between the hours of 7:00 a.m. to 9:00 a.m. Flex schedules shall not reduce service to the public, departmental effectiveness, productivity and/or efficiency as determined by the City Administrator or designee. 2003 MEO MOU Draft 6 12/11/02 8:55 AM Effective February 1, 2003, MEO employees will have the option of working a 5/40 or 9180 work schedule with supervisor and Department Head approval. MEO employees assigned the 4/10 work schedule shall retain the option of working the 4/10 work schedule with supervisor and Department Head approval. In order to maintain service to the public, departmental effectiveness, productivity and/or efficiency a Department Head may assign an employee a different work schedule that is in compliance with the requirements of the Fair Labor Standards Act (FLSA) with City Administrator approval. 1. 5/40 Work Schedule The 5/40 work schedule shall be defined as working five (5) eight (8) hour days Monday through Friday each week plus a one -hour lunch during each work shift, totaling a forty (40) hours work week. The assigned 5/40 work schedule must be in compliance with the requirements of FLSA and all other applicable laws. 2. 9/80 Work Schedule The 9/80 work schedule, as outlined in Exhibit H, shall be defined as working nine (9) days for eighty (80) hours in a two week pay period by working eight (8) days at nine (9) hours per day and working one (1) day for eight (8) hours (Friday), plus a one -hour lunch during each work shift, totaling forty (40) hours in each FLSA work week. The 9/80 work schedule shall not reduce service to the public, departmental effectiveness, productivity and/or efficiency as determined by the City Administrator or designee. 3. 4/10 Work Schedule The 4/10 work schedule, as outlined in Exhibit I, shall be defined as working four (4) ten (10) hour days Monday through Thursday each week plus a one -hour lunch during each work shift, totaling a forty (40) hours work week. The assigned 4/10 work schedule must be in compliance with the requirements of FLSA and all other applicable laws. The 4/10 work schedule shall not reduce service to the public, departmental effectiveness, productivity and/or efficiency as determined by the City Administrator or designee. 2003 MEO MOU Draft 7 12/11/02 8:55 AM ARTICLE X - HEALTH AND OTHER INSURANCE BENEFITS A. Health The city shall continue to make available group medical, dental and vision benefits to all MEO employees. ■. .. ■_ .. ..a- ■_ .. ..a- MR! ■ _ . .. I - B. Eligibility Criteria and Cost Citv Paid Medical. and Dental and Vision Insurance — Emolovee and Dependents The city will assume payment; subjerst to the limitationsset fGFth in AFtiGI8 X-13-2. for employee and dependents health and medical, dental and vision insurance effective the first of the month following one complete calendar month of employment. City's Contribution to Health Insurance Premiums .. .. ._ 2003 MEO MOU Draft 8 12/11/02 8:55 AM a. Year 2003 Premiums The city "caps" its contributions for 2003 premiums at the level set forth in the chart below: Monthly City City HMO Dental Dental Vision' Paid Premium Plan (PPO) (PMI) EE $336.05 $236.31 $42.88 $23.00 $17.58 EE + 1 664.53 517.79 81.82 39.11 17.58 EE + 2 or more 813.62 682.46 116.36 59.81 17.58 Effective January 4, 2003 employee biweekly payroll deduction contributions for 2003 premiums are set forth in the chart below: Bi-Weekly laity Dental Dental. Employee Paid Plan HMO (PPO) (PMI) Vision Premium EE $12.00 $5.95 $1.89 $0.00 $0.23 EE + 1 23.72 13.05 3.66 0.00 0.23 EE + 2 or more 29.04 17.20 5.12 0.00 0.23 2003 MEO MOU Draft 9 12/11/02 8:55 AM b. Future Premiums The city "caps" its contributions toward monthly group medical, dental and vision plan premiums, by category (EE, EE + 1, and EE + 2 or more) and plan, at the year 2003 level. Until the City Council approves a successor to this Memorandum -of - Understanding, the city's 2003 contribution caps will remain in place in 2004 and beyond, even if premium increases result in these additional costs being borne by the employee. 3. Medical Cash -Out If an employee is covered by a medical program outside of a city -provided program (evidence of which must be supplied to Administrative Services Department, Risk MaRagement Division), they may elect to discontinue city medical coverage and receive ninety two dollars and thirty-one cents ($92.31) bi- weekly to deposit into their Deferred Compensation account or any other pre-tax program offered by the city. 4. Section 125 Plan This plan allows employees to use pre-tax salary to pay for regular child care, adult dependent care and/or medical expenses. C. Life and Accidental Death and Dismemberment Each employee shall be provided with $45,000 life insurance and $45,000 accidental death and dismemberment insurance paid for by the city. Each employee shall have the option, at his or her own expense, to purchase additional amounts of life insurance and accidental death and dismemberment insurance to the extent provided by the city's current providers. Evidence of insurability is contingent upon total participation in additional amounts. D. Long Term Disability Insurance This program provides, for each incident of illness or injury, a waiting period of thirty (30) calendar days, during which the employee may use accumulated sick leave, general leave pay, or the employee may elect to be in a non -pay status. Subsequent to the thirty (30) day waiting period, the employee will be covered by an insurance plan paid for by the city, providing 66 2/3 percent of the first $12,500 of the employee's basic monthly earnings. The maximum benefit period for disability due to accident or sickness shall be to age 65. Days and months refer to calendar days and months. Benefits under the plan are integrated with sick leave, 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, 2003 MEO MOU Draft 10 12/11/02 8:55 AM and thereafter the inability to engage in any employment or occupation for which he is fitted by reason of education, training or experience." Rehabilitation benefits are provided in the event the individual, due to disability, must engage in another occupation. Survivor's benefits continues plan payment for three (3) months beyond death. A copy of the plan is on file in the Administrative Services Department. E. Miscellaneous 1. City Paid Premiums While on Medical Disability When an employee is off work without pay for reason of medical disability, the city shall maintain the city paid employee's insurance premiums during the period the employee is in a non -pay status for the length of said leave, not to exceed twenty-four (24) months. 2. Insurance and Benefits Adviso[y Committee The city and the Association agree to participate in a citywide joint labor and management insurance and benefits advisory committee to discuss and study issues relating to insurance and benefits available for employees. 3. Health Plan Over -Payments Unit members shall be responsible for accurately reporting the removal of ineligible dependents from health plan coverages. The city shall have the right to recover any premium paid by the city, including premiums to its self -insured plan, on behalf of ineligible dependents. Recovery of such over -payments shall be made as follows: a. Reduction of Employee's Bi- Weekly Salary Warrant The employee's bi-weekly salary warrant shall be reduced by one-half of the amount of the bi-weekly over -payment. Such reduction shall continue until the entire amount of the over -payment is recovered. b. Notice of Ineligible Dependents The city shall use its best efforts to advise all unit members of their obligation to report changes in the status of dependents, which affect their eligibility. c. Twelve Month Recovery Period The city shall be entitled to recover a maximum of twelve (12) months of premium over -payments. Neither the employee nor the dependent shall be liable to the city other than as provided herein. F. Joint Cafeteria Plan Study The city and up to four MEO employees will convene an ad -hoc committee to study a cafeteria plan for employee benefits. The ad -hoc committee will finalize its report by June 30, 2003. The resulting report may have an effect on 2004 benefit costs. 2003 MEO MOU Draft 11 12/11/02 8:55 AM 2003 MEO MOU Draft 12 12/11/02 8:55 AM ARTICLE XI - RETIREMENT BENEFITS A. Benefits Self Funded Supplemental Retirement Benefit Employees hired prior to August 17, 1998 are eligible for the Self -Funded Supplemental Retirement Benefit, which provides that: a. In the event a member elects Option #2 (Section 21456) or Option #3 (Section 21457) 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 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 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.) b. Employees hired on or after August 17, 1998 shall not be eligible for this benefit referenced in A.1.a. herein above. 2. Medical Insurance for Retirees a. Medical Insurance Upon Retirement 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 any of the plans offered by the city, at the retiree's own expense, for the maximum time period required by Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) Federal Law (COBRA), or 2) Retirees retiring after approval of this MOU may participate in the Retiree Medical Plan, attached hereto as Exhibit E, or the Health Maintenance Organization (HMO) Plan currently being offered to retirees at the retiree's own expense if the requirements set forth in Exhibit E are met, or if the retiree meets the based -upon -the eligibility requirements described in Exhibit E, the retiree may receive a subsidy from the city for retiree medical insurance pursuant to the schedule set forth in Exhibit E. 2003 MEO MOU Draft 13 12/11/02 8:55 AM b. Premiums Paid Upon Retirement By Use of Unused Leave Benefits Employees electing to participate in the City's group health insurance program after retirement may cause the premiums to be paid by the City out of any available funds due and owing them under the terms of this agreement for unused sick leave and general leave benefits upon retirement. B. Public Employees' Retirement System Reimbursement and Reporting Employee's Contribution Each employee covered by this Agreement shall continue to be reimbursed once bi-weekly in an amount equal to 7% of the employee's base salary (9% for safety employees) as a pickup of the employee's contribution, or portion of such contribution, to the Public Employees' Retirement System. The above PERS pickup is not base salary but is done pursuant to Section 414(h)(2) of the Internal Revenue Code. 2. Two Percent at Age 55 Formula Unit employees shall be covered by the two percent at age 55 formula (2% @ 55) as identified in Section 21354. 3. Pre -Retirement Optional Settlement 2 Death Benefit The city will initiate the contract amendment process for the Pre - Retirement Optional Settlement 2 Death Benefit as identified in Section 21548 with CaIPERS within ten (10) business days of City Council ratification of all memoranda of understanding and/or other necessary agreements with all miscellaneous retirement plan employee associations and will adopt said amendment as soon as reasonably possible thereafter. 4. Fourth Level of 1959 Survivor Benefits The city will initiate the contract amendment process for the Fourth Level of the 1959 Survivor Benefit as identified in Section 21574 with CaIPERS within ten (10) business days of City Council ratification of all memoranda of understanding and/or other necessary agreements with all miscellaneous retirement plan employee associations and will adopt said amendment as soon as reasonably possible thereafter. 2003 MEO MOU Draft 14 12/11/02 8:55 AM 5. Review of Contract Amendment Cost Analysis Upon receipt of the contract amendment cost analyses for the retirement formulas of 2.5%@55, 2.7%@55 and 3%@60 from CaIPERS, (which have already been requested from CaIPERS) the city and association shall jointly review the contract amendment cost analyses. This joint review shall not be a reopener nor shall it commit the city to make any amendments to its contract with CaIPERS. ARTICLE XII - LEAVE BENEFITS A. General Leave 1. Accrual Employees accrue leave at the accrual rates outlined below. General leave may be used for any purpose, including vacation, sick leave, and personal leave. 2. Eligibility and Approval General leave must be pre -approved except for illness, injury or family sickness, which may require a physician's statement for approval. Accrued general leave may not be taken prior to six (6) months' service except for illness, injury or family sickness. General leave accrued time is to be computed from hiring date anniversary. Members shall not be permitted to take general leave in excess of actual time earned. Members shall not accrue general leave in excess of six hundred hours (600). Employees may not use their general leave to advance their separation date on retirement or other separation from employment. 3. Family Sick Leave As required by law, employees will be allowed to use up to one-half of their annual General Leave accrual for family sick leave, pursuant to the provisions of California Labor Code Section 233. The city will provide family and medical care leave for eligible employees that meet all requirements of State and Federal law. Rights and obligations are set forth in the Department of Labor Regulations implementing the Family Medical Leave Act (FMLA), and the regulations of the California Fair Employment and Housing Commission implementing the California Family Rights Act (CFRA). 2003 MEO MOU Draft 15 121l 1102 8:55 AM 43-. Conversion to Cash Once during each fiscal year, each employee shall have the option to convert into a cash payment or deferred compensation up to a total of one hundred twenty (120) hours of earned general leave benefits. The employee shall give two (2) weeks advance notice of his/her desire to exercise such option. 54. One Week Minimum Vacation Requirement The Deputy City Treasurer shall take a minimum of one week, (i.e., five consecutive work days) paid vacation each calendar year. B. Holidays The following are paid eight (8) hour holidays: 1. New Year's Day 2. Martin Luther King Jr., (third Monday in January) 3. Presidents Day (third Monday in February 4. Memorial Day (last Monday in May) 5. Independence Day (July 4) 6. Labor Day (first Monday in September) 7. Veteran's Day (November 11) 8. Thanksgiving Day (fourth Thursday in November) 9. The Friday after Thanksgiving 10. Christmas Day (December 25) ii. Any day declared by the President of the United States to be a national holiday and adopted as an employee holiday by the City Council of Huntington Beach. Holidays which fall on Saturday shall be observed the preceding Friday, and those falling on Sunday shall be observed the following Monday. C. Sick Leave 1. Accrual — No employee shall accrue sick leave after December 24, 1999. 2. Credit —Employees assigned to MEO shall carry forward their sick leave balance and shall no longer accrue sick leave credit. 3. Usage — Employees may use accrued sick leave for the same purposes for which it was used prior to December 25, 1999. 4. Family Sick Leave — The city will provide family and medical care leave for eligible employees that meet all requirements of State and Federal law. 2003 MEO MOU Draft 16 12/11/02 8:55 AM Rights and obligations are set forth in the Department of Labor Regulations implementing the Family Medical Leave Act (FMLA), and the regulations of the California Fair Employment and Housing Commission implementing the California Family Rights Act (CFRA). 5. _Pay Off At Termination a. Employees covered by this agreement and on the payroll on November 20, 1978 shall be entitled to the following sick leave payoff plan: At involuntary termination by reason of disability, or by death, or by retirement, employees shall be compensated at their then current rate of pay for seventy-five percent (75%) of all unused sick leave accumulated as of July 1, 1972, plus fifty percent (50%) of unused sick leave accumulated subsequent to July 1, 1972, up to a maximum of 720 hours of unused, accumulated sick leave, except as provided in paragraph 4 below. Upon termination for any other reason, employees shall be compensated at their then current rate of pay for fifty percent (50%) of all unused, accumulated sick leave, up to a maximum of 720 hours of such accumulated sick leave. b. Employees hired after November 20, 1978 shall be entitled to the following sick leave payoff plan: Upon termination, all employees shall be paid, at their then current salary rate, for twenty-five percent (25%) of unused, earned sick leave to 480 hours accrued, and for thirty-five percent (35%) of all unused, earned sick leave in excess of 480 hours, but not to exceed 720 hours, except as provided in paragraph 4 below. c. Except as provided in paragraph 4 below, no employee shall be paid at termination for more than 720 hours of unused, accumulated sick leave. However, employees may utilize accumulated sick leave on the basis of "last in, first out" meaning that sick leave accumulated in excess of the maximum for payoff may be utilized first for sick leave, as defined in Personnel Rule 18- 8. d. Employees who had unused, accumulated sick leave in excess of 720 hours as of July 5, 1980, shall be compensated for such excess sick leave remaining on termination under the formulas described in paragraphs 1 and 2 above. In no event shall any employee be compensated upon termination 2003 MEO MOU Draft 17 12/11/02 8:55 AM for any accumulated sick leave in excess of the "cap" established by this paragraph (i.e., 720 hours plus the amount over 720 hours existing on July 5, 1980). Employees may continue to utilize sick leave accrued after that date in excess of such "cap" on a "last in, first out" basis. e. To the extent that any "capped" amount of excess sick leave over 720 hours is utilized, the maximum compensable amount shall be correspondingly reduced. (Example: Employee had 1,000 hours accumulated. Six months after July 5, 1980, employee has accumulated another 48 hours. Employee is then sick for 120 hours. Employee's maximum sick leave "cap" for compensation at termination is now reduced by 72 hours to 928 hours.) f. Employees electing to participate in the City's group health insurance program after retirement may cause the premiums to be paid by the City out of any available funds due and owing them under the terms of this agreement for unused sick leave benefits upon retirement. D. Bereavement Leave Employees shall be entitled to bereavement leave not to exceed twenty-four (24) work hours in each instance of death in the immediate family. Immediate family is defined as father, mother, sister, brother, spouse, children, grandfather, grandmother, stepfather, stepmother, step grandfather, step grandmother, grandchildren, stepsisters, stepbrothers, mother-in-law, father-in-law, son-in-law, daughter-in-law, brother-in-law, sister-in-law, stepchildren, or wards of which the employee is the legal guardian. E. Paternity Leave The city will provide family and medical care leave for eligible employees that meet all requirements of State and Federal law. Rights and obligations are set forth in the Department of Labor Regulations implementing the Family Medical Leave Act (FMLA), and the regulations of the California Fair Employment and Housing Commission implementing the California Family Rights Act (CFRA). 2003 MEO MOU Draft 18 12/11/02 8:55 AM ARTICLE XIII - CITY RULES A. 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 — Recruitment and Examination Procedure a) 5-4 — Order of Certification Whenever certification is to be made, the eligibility lists, if active and not exhausted shall be used in the following order: 1) Re-employment list 2) Promotional list 3) Employment List If fewer than five (5) names of persons willing to accept appointment are on the list from which certification is to be made, then additional eligibles shall be certified from the various lists next lower in order of preference until five (5) names are certified. If there are fewer than five (5) names on such lists, there shall be certified the number thereon. In such case, the appointing authority may demand certification of five (5) names and examinations shall be conducted until five (5) names may be certified. In the event the appointing authority does not choose to appoint from the five (5) names certified, a new examination may be requested. In the event another examination is conducted, those names shall be merged with others already on the list in order of scores. b) 5-14 — Promotional Exams Promotional examinations may be conducted whenever, in the opinion of the Human Resources Manager O€f+ser, after consultation with the department head, the need of the service so requires; provided, however, a promotional examination may not be given unless there are two (2) or more candidates eligible. Only employees who meet the requirements for the vacant position may compete in promotional examinations. Promotional examinations may include any of the selection techniques, or any combination thereof, mentioned in Section 5-13. Additional factors including, but not limited to, performance rating and length of service may be considered. A promotional employment list shall be established after, the administration of a promotional examination, and such list shall contain the name(s) of those that passed the examination. 2003 MEO MOU Draft 19 12/11/02 8:55 AM 2. Rule 7 — Discipline a) 7-2 — Causes for Discipline 12) Possession, use or sale of illegal narcotics or habit-forming drugs, while on -duty or on city property. 14) Conviction of any felony or a misdemeanor with a job nexus. A plea or verdict of guilt, or a conviction following a plea of nolo contendere, is deemed to be a conviction within the meaning of this section. 15) Participating in an unlawful strike, work stoppage, slowdown, or using or attempting to use sick leave to accomplish the same purpose as a strike, work stoppage, or slowdown. 3. Rule 8 — Termination a) 8-1 — Medical Examination. Evaluation of Employee's Work Capacity. Demotion. Transfer or Termination of Appointment At any time a department head has reasonable cause to believe that an employee may not be able to perform the duties of his/her position for physical or psychological reasons, such department head shall consult with the Human Resources Manager 9ffiseF regarding such belief. If the Human Resources Manager 8ffiser concurs, the department head may order the employee to submit to a medical or psychological examination. The employee shall be offered the opportunity, in writing, to select from a panel of three to five physicians or psychologists to conduct the examination. The cost of such examination shall be paid by the city and, to the extent practicable, shall be scheduled during the work hours with no loss of pay. The department head shall review the medical or psychological report and shall consult with the Human Resources Manager 9ffiser regarding the physician's assessment of the employee's ability to perform the duties of his/her position. Any decision regarding such employee shall be made in accordance with the Americans with Disabilities Act. Notwithstanding any other provision of this rule, an employee being evaluated for medical or psychological fitness to perform the duties of his/her position may apply for another position in the competitive service for which he/she has qualified. If such employee is qualified and can perform the duties of a lower paying vacant position for which he/she has applied, he/she will be placed in such position, without competitive examination, subject to the approval of the department head. 2003 MEO MOU Draft 20 12/11/02 8:55 AM (The city and Association agree to meet biannually to discuss the 8-1 process). b) 8-3 — Layoff in Accordance with Length of Service The city and the Association agree that the first sentence in Personnel Rule 8-3 shall be modified to read as follows: Layoff shall be made in accordance with the relative length of the last period of continuous service of the employees in the class of layoff, provided, however, that no permanent employee shall be laid off until all temporary, acting and probationary employees in the competitive service holding positions in the same class are first laid off. c) 8-11 — Re -Employment With the approval of Human Resources Manager O#1ser, an employee who has resigned in good standing from the competitive service may be re- employed to his/her former position, if vacant, or to a vacant position in the same or comparable class within one (1) year from date of resignation in accordance with Rule 5-21. If such re-employment commences within ninety days of the effective date of resignation, the employee shall not be considered a new employee for vacation and seniority purposes. 4. Rule 12 — Classification Plan a) 12-10 — Temporary Employees Employment on a basis other than permanent or probationary to a permanently budgeted position not to exceed 1000 hours in any twelve (12) month period. Employees occupying temporary positions shall not be included in the competitive service and shall not be subject to these rules and regulations. 5. Rule 14 — Additional Pay and Pay Adjustments a) 14-6 — Salary Advancements to Meet Recruiting Problems or to Give Credit for Prior Service. Application for Other Advancements The Department Head, through the Human Resources Manager Of#iser and with the approval of the City Administrator may make an appointment at any step above the minimum salary rate to classes or positions in order to meet recruiting problems to obtain a person who has extraordinary qualifications, or to give credit for prior city service in connection with appointments, promotions, reinstatements, transfers, reclassifications, or demotions. Salary adjustments within the salary range for the class, other than merit salary adjustments authorized by Section 14-1, may be approved by the City Administrator, upon recommendation of the department head through the Human Resources Manager Office . Such recommendation shall include the reason(s) for the adjustment, whether the advancement is to be permanent or temporary, and an effective date. 2003 MEO MOU Draft 21 12/11/02 8:55 AM 6. Rule 18 — Attendance and Leaves a) 18-16 — Industrial Accident Leave In the event a permanent employee, who is a miscellaneous member of the Public Employees' Retirement System (PERS), is temporarily totally disabled as a result of an injury or illness arising out of and in the course of employment and covered by the State of California Workers' Compensation Insurance and Safety Act, resulting light duty assignments due to the injury or illness or absences from work shall be considered Industrial Accident Leave as that term is defined by this rule. A permanent employee eligible for Industrial Accident Leave shall receive compensation from the city in an amount equal to the employee's regular rate of salary during such period of temporary total disability. Benefits received under this rule shall be in lieu of statutory Workers' Compensation benefits. Industrial Accident Leave shall continue during all absences resulting from the injury or illness, including those absences attributable to doctor's appointments, therapy, or other follow-up medical visits, but in no case exceeding one year of accumulated absences attributable to the same injury or illness. In the event an employee is temporarily, totally disabled by coinciding qualifying injuries or illnesses, periods of absences shall be applied concurrently to all qualifying injuries or illnesses. Industrial Accident Leave compensation shall begin on the first day an eligible employee is absent due to a qualifying injury or illness as defined above. Industrial accident Leave compensation will terminate on the earliest of the following: 1) The date upon which the injury or illness giving rise to eligibility for compensation under this rule is declared permanent and stationary by a treating or examining physician; or 2) The date PERS approves an application for disability retirement benefits filed by the employee or by the city; or 3) The employee receives thirty (30) days advance notice and refuses to submit to a medical examination ordered by PERS pursuant to Government Section 21154 or otherwise refuses to cooperate with PERS in determining whether the employee is incapacitated for the performance of duty; or 4) The employee receiving Industrial Accident Leave Compensation applies for service -connected retirement benefits; or 5) The employment of the affected employee is otherwise separated. 2003 MEO MOU Draft 22 12/11/02 8:55 AM If an injured worker remains temporarily disabled after receiving one year of Industrial Accident Leave for accumulated absences or light duty work attributable to the same injury or illness, the employee will receive temporary total disability benefits as specified by the State of California Workers' Compensation Insurance and Safety Act. Any period of time during which an employee is absent from work by reason of injury or illness for which he or she is entitled to receive Industrial Accident Leave compensation will not constitute a break in continuous service for the purposes of salary adjustments, sick leave, vacation accruals, and length of service computation. In the event an employee who is receiving or has received Industrial Accident Leave compensation makes a claim or initiates legal action against a third party for allegedly causing or contributing to the injury or illness resulting in the inability to work, the employee is required to notify in writing the City's Risk Management Division of the claim or commencement of such action within ten (10) days of the claim or such commencement. The city retains its rights of subrogation in all such instances. b) 18-19 — Maternity Leave The city and the Association agree to modify the present Personnel Rule 18-19 Maternity Leave to read as follows: "A permanent employee shall be entitled to a leave of absence without pay due to inability to work due to pregnancy. The employee will be entitled to use available sick leave during this period. Said leave must be requested in writing from the Department Head and must include written notification from the employees physician stating the last day the employee may work and the estimated duration of leave. The employee must obtain written authorization to return to work from the attending physician. Said authorization must be filed with the Department Head and the Human Resources Manager Officer." c) 18-20 — Leave of Absence without Pay The city and the Association agree that the following sub -paragraph "C" shall be added to Personnel Rule 18-20. Leave of Absence without Pay: Leave of absence without pay, for medical disability reasons, shall be restricted to six (6) months. 7. Rule 19 — Grievance Procedure Non -Disciplinary Matters a) 19-5 Grievance Procedure The grievance procedure shall consist of the following steps, each of which must be completed prior to any request for further consideration of the matter unless otherwise provided herein: 2003 MEO MOU Draft 23 12/11/02 8:55 AM Step 1. Informal Discussion (optional) If an employee feels that he has a grievance, as defined in Section 19-2, he may request a meeting with his immediate supervisor within ten (10) days after the employee becomes aware or reasonably should have become aware of the subject matter of the grievance. The immediate supervisor, within five (5) days of such request, shall meet with the employee when so requested and discuss the grievance in an effort to clarify the issue and work toward a cooperative settlement or resolution of the dispute. The immediate supervisor shall present, verbally or in writing, his decision to the employee within five (5) days from the time of the informal discussion. Step 2. Formal Procedure. Immediate Supervisor If the grievance is not settled through informal discussion, or if the employee elects not to invoke his right to informal discussion, the employee may formally submit a grievance to his immediate supervisor within five (5) days following the decision pursuant to informal discussion, or in the event the employee does not elect to invoke his right to informal discussion, within ten (10) days after the occurrence which gives rise to the grievance or after the employee becomes aware or reasonably should have been aware of the subject matter of the grievance. Such submission shall be in writing, stating the nature of the grievance and a suggested solution or requested remedy. Within five (5) days after receipt of the written grievance, the immediate supervisor shall meet with the employee. Within five (5) days thereafter written decision shall be given the employee by the immediate supervisor. Step 3. Department Head In cases where the department head is not the immediate supervisor, if the grievance is not settled under Step 2, the grievance may be presented to the department head. The grievance shall be submitted within five (5) days after receipt of the written decision from Step 2. Within five (5) days after receipt of the written grievance, the department head, or his representative, shall meet with the employee and his immediate supervisor, if any. Within five (5) days thereafter written decision shall be given to the employee. 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 2003 MEO MOU Draft 24 12/11/02 8:55 AM 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 Human Resources Manager 9#1&er 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. The Human Resources Manager 9ffiseF, 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 Human Resources Manager 8ffiser. Step 5 — Personnel Board Hearing Hearing. As soon as practicable thereafter, the Human Resources Manager 9ffiGer shall set the matter for hearing before a hearing officer either selected by mutual consent of the parties or from a list provided by the Personnel Commission. Ratification of the hearing officer selected by mutual consent of the parties, if from a list approved by the Personnel Commission, shall not require separate approval or -ratification by the Personnel Commission. The hearing officer shall hear the case and make recommended findings, conclusions and decision in the form of a written report and recommendation to the Personnel Commission. In lieu of the hearing officer process, the Personnel Commission may agree to hear a case directly upon submission of the case by mutual consent of the parties. 8. Rule 20 —Disciplinary Procedure and Appeal a) 20-1 — Purpose The purpose of this rule is to provide a procedure for recommending and imposing discipline against city employees, and a means by which an employees may administratively appeal any such disciplinary action. 2003 MEO MOU Draft 25 12/11/02 8:55 AM b) 20-2 — Disciplinary Procedures 1) Notice of Proposed Adverse Action For disciplinary demotions, suspensions or dismissals, an employee shall be served a written Notice of Proposed Adverse Action by the employee's department head, or his/her designee, or by certified mail, prior to the proposed disciplinary action taking effect. The notice shall state the reasons for and charges upon which the proposed action is based, and the effective date of the action the right to respond and the employer's right to representation. A copy of all materials upon which the proposed action is based shall be attached to the notice. 2) Employee's Right to Respond The employee shall be given a minimum of ten (10) calendar days to respond orally and/or in writing to the charges upon which the proposed action is based. The employee's response shall be made to and/or before his/her department head. 3) Time Off The employee shall be given reasonable time off with pay to attend disciplinary meetings. 4) Final Notice of Decision After an employee has responded to or waived his/her right to respond to the proposed adverse action, the employee shall be served with a final Notice of Decision from his/her department head. The final written Notice of Decision shall state whether or not the proposed action shall be taken or modified, and the reasons therefore and effective date or the action. c) 20-3 — Appeal to Personnel Commission Disciplinary action involving the termination, suspension, demotion or other reduction in pay may be appealed to the Personnel Commission for de novo hearing and final determination in accordance with the following procedure: 1) Request for Appeal Within five (5) days after the employee's receipt of a final Notice of Discipline, a written request for an appeal to the Personnel Commission shall be submitted to the Human Resources Manager Of#+ser. 2) Hearin 2003 MEO MOU Draft 26 12/11/02 8:55 AM As soon as practicable thereafter, the Human Resources Manager Officer shall set the matter for hearing before a hearing officer. The hearing officer shall hear the case without the Board and shall make recommended findings, conclusions and decision in the form of a written report and recommendation to the Board. 3) Final Decision The Board shall consider the written report and recommendations of the hearing officer and after due deliberation in executive session, shall render a decision in the matter which shall be final and binding on all parties, and from which there shall be no further appeal. d) 20-4 — Supplemental Hearing by Personnel Board 1) The Board may, in its sole discretion, after it has received the written report and recommendation of the hearing officer, set the matter for private hearing for the purpose of receiving additional evidence or argument. In the event the Board sets a private hearing for such purposes, the Human Resources Manager 9fF+cer shall give written notice to all parties concerned in such matter. 2) The Board, following a consideration of the hearing officer's written report and recommendation and deliberation thereon and any supplemental hearing before the Board, shall make findings, conclusions and decisions which shall be final and binding on all parties and from which there shall be no further appeal. e) 20-5 — Employee Status on Pending Appeal Notwithstanding the provisions of Rule 7, Section 7-4 (Suspension with Pay), the disciplinary action shall be effective pending an appeal to the Personnel Commission. 9. Rule 21 — Grievance Procedures - General a) 21-7 Hearing Officer 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. b) 21-12 Time. Extension of The city and the employee, or employee organization may, by mutual consent, extend the time period within which an act must occur in the processing of grievances. c) 21-13, Time Extension, Grievances 2003 MEO MOU Draft 27 12/11/02 8:55 AM The city and the employee, or employee organization may, by mutual consent, extend the time periods within which an act must occur in the processing of grievances. B. Employer -Employee Relations Resolution 1. Modification of Section 7 — Decertification and Modification a) The city and the Association desire to maintain labor stability within the representational unit to the greatest extent possible, consistent with the employee's right to select the representative of his or her own choosing. For these purposes, the parties agree that this Agreement shall act as a bar to appropriateness of this unit and the selection of the representative of this unit, except during the month of August prior to the expiration of this Agreement. Changes in bargaining unit shall not be effective until expiration of the MOU Except as may be determined by the Personnel Commission pursuant to the procedures outlined below. This provision shall modify and supersede the time limits, where inconsistent, contained in Section 7 of the current Employer -Employee Relations Resolution of the City of Huntington Beach. b) The city and the Association have agreed to a procedure whereby the city, by and through the Human Resources Manager Offfse , would be entitled to propose a Unit Modification. The Association and the city agree to jointly recommend a modification of the City of Huntington Beach Employer - Employee Relations Resolution (Resolution Number 3335) upon the city's having completed its obligation to meet and confer on this issue with all other bargaining units. The proposed changed to the Employer -Employee Relations Resolution is as follows: 7.3 Human Resources Manager O#+eer Motion of Unit Modification - The Human Resources Manager Officer may propose, during the same period for filing a petition for decertification, that an established unit be modified in accordance with the following procedure: The Human Resources Manager Officer shall give written notice of the proposed modification(s); to any affected employee organization and any affected employees. 2. The Personnel Commission shall hold a meeting concerning the proposed modification(s) at which time all affected employee organizations and employees shall be heard; 2003 MEO MOU Draft 28 12/11/02 8:55 AM 3. Thereafter, the Personnel Commission shall determine the composition of the appropriate unit or units and shall give written notice of such determination to the affected employee organizations and any affected employees. The City Administrator, employee organization or employee aggrieved by an appropriate unit determination of the Personnel Commission may, within ten (10) days of notice thereof, request a review of such determination by the City Council. Within thirty (30) days of receipt of a request to review a unit determination of the Personnel Commission the City Council shall review the matter. The City Council's decision shall be final. 4. Except as provided otherwise in this MOU, the salary, benefit and working conditions specified by this MOU shall be provided to employees in classifications listed in Exhibit A and have completed or are in the process of completing a probationary period in a permanent position in the competitive service in which the employee regularly works twenty hours or more per week. C. Rules Governing Layoff, Reduction in Lieu of Layoff and Re -Employment 1. Part 1 — Layoff Procedure a) General Provisions 1) Whenever it is necessary, because of lack of work or funds to reduce the staff of a city department, employees may be laid off pursuant to these rules. 2) Whenever an employee is to be separated from the competitive service because the tasks assigned are to be eliminated or substantially changed due to management -initiated changes, including but not limited to automation or other technological changes, it is the policy of the city that steps be taken by the Human Resources Division on an interdepartmental basis to assist such employee in locating, preparing to qualify for, and being placed in other positions in the competitive service. This shall not be construed as a restriction on the city government in effecting economies or in making organizational or other changes to increase efficiency. 3) A department shall reduce staff by identifying which positions within the department are to be eliminated. 4) The employee who has the least citywide service credit in the class within the department shall have citywide transfer rights in the class 2003 MEO MOU Draft 29 12/11/02 8:55 AM pursuant to Part 1, Section 3, Transfer or Reduction to Vacancies in Lieu of Layoffs, or within the occupational series pursuant to Part 2, Bumping Rights. 5) If a deadline within this procedure falls on a day that City Hall is closed, the deadline shall be the next day City Hall is open. b. Service Credit 1) Service credit means total time of full-time continuous service within the city at the time the layoff is initiated, including probation, paid leave or military leave. Permanent part-time employees earn service credit on a pro-rata basis. 2) Except as required by law, leaves of absence without pay shall not earn service credit. 3) As between two or more employees who have the same amount of service credit, the employee who has the least amount of service in class shall be deemed to be the least senior employee. c. Transfer or Reduction to Vacancies in Lieu of Layoff 1) In lieu of layoff, a transfer within class shall be offered to an employee(s) with the least amount of service credit in the class designated for staff reduction within a department subject to the following: a) The employee has the necessary qualifications to perform the duties of the position. b) The employee shall be given the opportunity, in order of service credit, to accept a transfer to a vacant position in the same class within the city, provided the employee has the necessary qualifications to perform the duties of the position. c) If no position in the same class is vacant, the employee shall be given the opportunity, in order of service credit, to transfer to the position in the same class that is held by an incumbent in another department with the least amount of service credit whose position the employee has the necessary qualifications to perform. 2) If an employee(s) is not eligible for transfer within the employee's class, the employee shall be offered, in order of service credit, a reduction to a vacant position in the next lower class within the city in the 2003 MEO MOU Draft 30 12/11/02 8:55 AM occupational series in lieu of layoff provided the employee has the necessary qualifications to perform the duties of the position. 3) If the employee refuses to accept a transfer or reduction pursuant to A. or B., above, the employee shall be laid off. d) If the employee(s) in the class with the least amount of service credit is in the position(s) to be eliminated or displaced by transfer, the employee shall be offered bumping rights, pursuant to Part 2, Service Credit. e) Any employee who takes a reduction to a position in a. lower class within the occupational series in lieu of layoff shall be placed on the reinstate ment/reemployment list(s) pursuant to Part 3., Reemployment. 2. Order of Layoff a) Prior to implementing a layoff, vacant positions that are authorized to be filled shall be identified by citywide occupational series. If the employee refuses to accept a position pursuant to Section 3., above, the employee shall be laid off. b) No promotional probationary employee or permanent employee within a class in the department shall be laid off until all temporary, nonpermanent part-time and non -promotional probationary employees in the class are laid off. Permanent employees whose positions have been eliminated may exercise citywide bumping rights to a lower class in the occupational series pursuant to Part 2. c) When a position in a class and/or occupational series is eliminated, any employee in the class who is on authorized leave of absence or is holding a temporary acting position in another class shall be included for determining order of service credit and be subject to these layoff procedures as if the employee was in his or her permanent position. 3. Notification of Employees a) The Human Resources Division shall give written notice of layoff to the employee by personal service or by sending it by certified mail to the last known mailing address at least fifteen (15) calendar days prior to the effective date of the layoff. Normally notices will be served on employees personally at work. b) Layoff notices to layoff as a rights. may be initially issued to all employees who may be subject result of employees exercising voluntary reduction/bumping 2003 MEO MOU Draft 31 12/11/02 8:55 AM c) The notice of layoff shall include the reason for the layoff, the effective date of the layoff, the employee's hire date and the employee's service credit ranking. The notice shall also include the employee's right to bump the person in a lower class with the least service credit within the occupational series provided the employee possesses the necessary qualifications to successfully perform the duties in. the lower class and the employee has more service credit than the incumbent in the lower class. d) The written layoff notice given to an employee shall include notice that he or she has seven (7) calendar days from the date of personal service, or date of delivery of mail if certified, to notify the Human Resources Manager 9ffiGer in writing if the employee intends to exercise the employee's bumping rights, if any, pursuant to Part 2, Bumping Rights. e) Whenever practicable, any employee with the least amount of service credit in a lower class within an occupational series which is identified for work force reduction shall also be given written notice that such employee may be bumped pursuant to Part 2. This notice shall include the items referred to in C., above. f) If an employee disagrees with the city's computation of service credit or listed date of hire, the employee shall notify the Human Resources Manager 9ffiGer as soon as possible but in no case later than five (5) calendar days after the personal service or certified mail delivery. Disputes regarding date of hire or service credit shall be jointly reviewed by the Human Resources Manager 8#iser and the employee and/or the employee's representative as soon as possible, but in no case later than five (5) calendar days from the date the employee notifies the Human Resources Manager 9ffiser of the dispute. Within five (5) calendar days after the dispute is reviewed, the employee shall be notified in writing of the decision. 2003 MEO MOU Draft 32 12/11/02 8:55 AM 4. Part 2 — Bumping Rights a) Voluntary Reduction or Bumping in Lieu of Layoff 1) A promotional probationary employee or permanent employee who receives a layoff notice may request a reduction to a position in a lower class within the occupational series provided the employee possesses the necessary qualifications to perform the duties of the position. 2) Employees electing reduction under A above, shall be reduced to a position authorized to be filled in a lower class within the employee's occupational series. The employee may reduce to a lower class in his/her occupational series by: 1) filling a vacancy in that class, or 2) if no vacancy exists, displacing the employee in the class with the least service credit whose position the employee has the necessary qualifications to perform. A displaced employee shall have bumping rights. 3) An employee who receives a layoff notice must exercise bumping rights within seven (7) calendar days of receipt of the notice as specified in Part 1. Failure to respond within the time limit shall result in a reputable presumption that the employee does not intend to exercise any right of reduction or bumping to a lower class. The employee must carry the burden of proof to show that the employee's failure to respond within the time limits was reasonable. If the employee establishes that failure to respond within the time limit was reasonable, to the Human Resource Manager's Qffi6eF6 satisfaction, the employee shall be permitted to exercise bumping rights but shall not be reinstated to a paid position until the employee to be bumped has vacated the position. If the employee disagrees with the Human Resource Manager 9#iser's decision, the employee may appeal pursuant to the provisions of Sections 3 and 4 below. b) Reinstate me nt/Re-employment Lists Any employee who takes a reduction to a position in a lower class within the occupational series in lieu of layoff shall be placed on tile reinstatement/re-employment list pursuant to Part 3, Re-employment. c) Qualifications Appeal Any employee who is denied a reduction to a position in a lower class within the occupational series on the basis that the employee does not possess the necessary qualifications to successfully perform the duties of the lower position may appeal the decision. The appeal shall be filed with the Human Resource Manager 9ffiGe within five (5) calendar days of the employee's receipt of written notice of the decision and reason(s) for denial. 2003 MEO MOU Draft 33 12/11/02 8:55 AM The employee's appeal shall be in writing and shall include supporting facts or documents supporting the appeal. d) Qualifications Appeal Hearing 1) Upon receipt of an appeal, the Human Resource Manager 9#fser shall contact a mediator from the California State Mediation and Conciliation Service to schedule a hearing within two (2) weeks after receipt of the appeal. If the California State Mediation and Conciliation Service is not available within that time frame, the parties shall mutually select a person who is available within the time frame. If the California State Mediation and Conciliation Service and the person mutually selected are not available within tile time frame, the parties shall select the earliest date either is available to conduct the hearing. The parties shall split the cost, if any, of the hearing officer. In addition, the parties shall meet within three (3) workdays to attempt to resolve the dispute. If the dispute remains unresolved, the parties shall endeavor in good faith to submit to the hearing officer a statement of all agreed upon facts relevant to the hearing. 2) Appeal hearings shall be limited to two (2) hours, except as otherwise agreed by the parties or directed by the hearing officer. 3) The hearing officer shall attempt to resolve the dispute by mutual agreement if possible. If no agreement is reached, the hearing officer shall render a decision at the conclusion of the hearing which shall be final and binding 5. Part 3 — Re-employment a) Re-employment 1) Employees who are laid off or reduced to avoid layoff shall have their names placed upon a reemployment list, for each class in the occupational series, in seniority order at or below the level of the class from which laid off or reduced. 2) Names of persons placed on the reemployment lists shall remain on the list for two (2) years from the date of layoff or reduction. 3) Vacancies shall be filled from the reemployment list for a class, starting at tile top of the list, providing that the person meets the necessary qualifications for tile position. 4) Names of persons are to be removed from the reemployment list for a class if on two (2) occasions they decline an offer of employment or on 2003 MEO MOU Draft 34 12/11/02 8:55 AM two (2) occasions fail to respond to offers of employment in a particular class within five (5) calendar days of receipt of written notice of an offer. Any employee who is dismissed from the city service for cause shall have his or her name removed from all re-employment lists. 5) Re-employment lists shall be available to HBMEO and affected employees upon reasonable request, 6) Qualification appeals involving reemployment rights shall be resolved in the same manner as that identified in Part 2., Section 4. b) Status on Re-employment 1) Persons re-employed from layoff within a two (2) year period from the date of layoff shall receive the following considerations and benefits: a) Service credit held upon layoff shall be restored, but no credit shall be added for the period of layoff. b) Prior service credit shall be counted toward sick leave and vacation accruals. c) Employees may cash in sick leave upon layoff or at any time after layoff in the manner and amount set forth in existing Memoranda of Understanding for that employee's unit. Sick leave shall be paid to an employee when the reemployment list(s) expire(s), if not previously paid. d) Upon reinstatement the employee may have his or her sick leave re -credited by repayment to the city the cashed amount. Sick leave accumulation of less than 480 hours shall be restored upon reemployment. e) The employee shall be returned to the salary step of the classification held at the time of the layoff and credited with the time previously served at that step prior to being laid off. f) The probationary status of the employee shall resume if incomplete. 2) Employees who have been reduced in class to avoid layoff and are returned within two (2) years to their former class shall be placed at the salary step of the class they held at the time of reduction and have their merit increase eligibility date recalculated. 2003 MEO MOU Draft 35 12/11/02 8:55 AM ARTICLE XIV - MISCELLANEOUS A. Physical Examination Employees covered by this agreement shall be provided, once every two years, with a city paid physical examination. Said exam shall be comprehensive in nature and shall include: 1. A complete medical history, physical exam, laboratory testing and review of results by a physician. (See Exhibit G, Physical Exam Description.) 2. A stress EKG will be provided for employees forty (40) years of age or older. No more than one-half of the eligible employees shall receive examinations in any one fiscal year. B. Vehicle Policv 1. Approval is required by the City Administrator or his designee for any city vehicle to be taken home by a MEO employee. 2. The auto allowance for qualifying employees shall be one hundred sixty one dollars and fifty-three cents ($161.53) bi-weekly. 3. No unit employee shall have their automobile allowance eliminated until the city's Fleet Management Policy is re -negotiated. 4. Eligibility for automobile allowance shall be determined in accordance with the city's Fleet Management Program dated August, 1999. C. Deferred Compensation Loan Program Employees may borrow up to 50% of their deferred compensation funds for critical needs such as medical costs, college tuition, or purchase of a home. D. Employee Performance Evaluations The city and up to four MEO employees will convene an ad -hoc committee to study a new employee performance evaluation system. The ad -hoc committee will finalize its report by June 30, 2003. Nothing from said ad -hoc committee shall constitute a wavier by MEO or any of its represented employees of the right to dispute future performance evaluations. 2003 MEO MOU Draft 36 12/11/02 8:55 AM ARTICLE XV - CITY COUNCIL APPROVAL It is the understanding of the city and the Association that this Memorandum of Understanding is of no force or effect 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 day of December, 2002. HUNTINGTON BEACH CITY OF HUNTINGTON BEACH MANAGEMENT EMPLOYEES' A Municipal Corporation ORGANIZATION By: By: Ray Silver Gustavo A. Duran, MEO President City Administrator By: By: William P. Workman Beverly Braden, MEO Vice -President Assistant City Administrator By: By: Clay Martin Shawna Krone -Schmidt, MEO Secretary Director of Administrative Services By: By: Steven M. Berliner James Jones, Negotiating Team Chief Negotiator am APPROVED AS TO FORM APPROVED AS TO FORM Jennifer M. McGrath City Attorney as James G. Harker, MEO Negotiator 2003 MEO MOU Draft 37 12/11/02 8:55 AM EXHIBIT A CITY OF HUNTINGTON BEACH MANAGEMENT EMPLOYEES' ORGANIZATION SALARY SCHEDULE EFFECTIVE DECEMBER 21, 2002 EFFECTIVE MARCH �.2 9 • 1 1 • • I • • ■ l I - -RIM I �� I • ® • • _ 1 • I ��� I • _ - • • - I I I I / • I •• _ _ 1 I - �� I"my-, I I I I VMS FIRM 2003 MEO MOU Draft 38 12/11/02 8:55 AM 28 Accountant, Principal 532 30.97 32.67 34.47 36.37 38.37 25 Administrative Analyst MEO 497 26.01 27.44 28.95 30.54 32.22 84 Administrative Analyst, Principal MEO 544 32.88 34.69 36.6 38.61 40.73 89 Administrative Analyst, Senior MEO 525 29.91 31.55 33.28 35.11 37.04 132 Assistant City Clerk 488 24.86 26.23 27.67 29.19 30.8 24 City Engineer 617 47.31 49.91 52.66 55.56 58.62 69 Civil Engineer, Associate 542 32.56 34.35 36.24 38.23 40.33 96 Civil Engineer, Principal 561 35.79 37.76 39.84 42.03 44.34 92 Claims Supervisor 535 31.44 33.17 34.99 36.91 38.94 471 Community Relations Officer 525 29.91 31.55 33.28 35.11 37.04 97 Construction Manager 557 35.07 37 39.04 41.19 43.46 85 Contract Administrator 525 29.91 31.55 33.28 35.11 37.04 45 Criminalist Supervisor 549 33.71 35.56 37.52 39.58 41.76 70 Criminalist, Chief 577 38.78 40.91 43.16 45.53 48.03 253 Cultural Affairs Supervisor 480 23.9 25.21 26.6 28.06 29.6 81 Deputy City Attorney 1 530 30.66 32.35 34.13 36.01 37.99 80 Deputy City Attorney II 567 136.88 38.91 41.05 43.31 45.69 79 Deputy City Attorney III 595 42.4 44.73 47.19 49.79 52.53 68 Deputy City Engineer 589 41.15 43.41 45.8 48.32 50.98 90 Deputy City Treasurer 573 38 40.09 42.29 44.62 47.07 35 Deputy Director of Public Works 617 47.31 49.91 52.66 55.56 58.62 27 Deputy Director of Recreation/Beach Development 607 45.01 47.49 50.1 52.86 55.77 39 lEconomic Development Project Manager 548 33.54 35.38 37.33 39.38 41.55 37 Economic Development Project Manager, Assistant 517 28.73 30.31 31.98 33.74 35.6 474 Facilities, Development & Concession Manager 542 32.56 34.35 36.24 38.23 40.33 131 Fire Med Coordinator 525 29.91 31.55 33.28 35.11 37.04 130 Fire Protection Analyst 525 29.91 31.55 33.28 35.11 37.04 184 GIS Manager 542 32.56 34.35 36.24 38.23 40.33 23 Housing/Redevelopment Manager 568 37.07 39.11 41.26 43.53 45.92 87 Information Systems Analyst V 556 34.9 36.82 38.85 40.99 43.24 88 Information Systems Analyst, Principal 565 36.51 38.52 40.64 42.87 45.23 38 Information Systems Manager 593 41.98 44.29 46.73 49.3 52.01 199 Information Systems Manager, Library 499 26.27 27.71 29.23 30.84 32.54 67 Information Systems Manager, Police 574 38.18 40.28 42.5 44.84 47.31 75 lInspection Manager 561 35.79 37.76 39.84 42.03 44.34 76 Inspector Plb/Mech Principal 514 28.3 29.86 31.5 33.23 35.06 72 Inspector, Electrical Principal 514 28.3 29.86 31.5 33.23 35.06 251 Investigator 497 26.01 27.44 28.95 30.54 32.22 158 Landsca a Architect 525 29.91 31.55 33.28 35.11 37.04 95 Law Office Manager T 501 26.53 27.99 29.53 31.15 32.86 77 Librarian, Senior 488 24.86 26.23 27.67 29.19 30.8 66 Library Services Manager 546 33.2 35.03 36.96 38.99 41.13 30 Maintenance Operations Manager 571 37.63 39.7 41.88 44.18 46.61 32 IMarine Safety Division Chief 577 38.78 40.91 43.16 45.53 48.03 441 Neighborhood Preservation Program Manager 568 37.07 39.11 41.26 43.53 45.92 40 Park Tree Landscape Operations Manager 563 36.15 38.14 40.24 42.45 44.78 98 Permit & Plan Check Manager 570 37.44 39.5 41.67 43.96 46.38 209 Plan Check & Permit Supervisor 526 130.06 31.71 33.45 135.29137.23 2003 MEO MOU Draft 40 12/11/02 8:55 AM 134woA -,ua 99 Plan Check Engineer 556 34.9 36.82 38.85 40.99 43.24 71 Planner, Associate 517 28.73 30.31 31.98 33.74 35.61 74 Planner, Principal 568 37.07 39.11 41.26 43.53 45.9� 36 Planner, Senior 548 33.54 35.38, 37.33 39.38 41.5� 444 Planning Manager 578 38.96 41.1 43.36 45.75 48.27 22 Police Communications Manager 528 30.36 32.03 33.79 35.65 37.67 83 Purchasing & Central Services Manager 534 31.28 33 34.82 36.73 38.75 43 Real Estate Services Manager 576 38.58 40.7 42.94 45.3 47.76 93 Real Property Agent 548 33.54 35.38 37.33 39.38 411.55 94 Records Admin Police 528 30.36 32.03 33.79 35.65 37.6� 0 Recreation, Human & Cultural Services, Superintendent 567 36.88 38.91 41.05 43.31 45.66 457 Special Events Coordinator 480 23.9 25.21 26.6 28.06 - 29.6,� 44 Supervisor, Beach Operations 527 30.21 131.87 33.62 35.47 37.42 47 Supervisor, Building Maintenance 527 30.21 31.87 33.62 35.47 37.42 73 Supervisor, Comb/Strctrl Ins p 533 31.12 32.83 34.64 36.55 38.56 473 Supervisor, Development & Petro -Chemical 529 30.51 32.19 33.96 35.83 37.8 48 Supervisor, Mechanical Maintenance 527 30.21 31.87 33.62 35.47 37.42 49 Supervisor, Park Maintenance 527 30.21 31.87 33.62 135.47 37.42 133 Supervisor, Parking & Camping Facilities 514 28.3 29.86 31.5 33.23 35.06 46 Supervisor, Recreation Senior 514 28.3 29.86 31.5 33.23 35.06 50 Supervisor, Street & Sewer Maintenance 527 30.21 31.87 33.62 35.47 37.42 51 Supervisor, Tree, Landscape, Pest Control 527 30.21 31.87 33.62 35.47 37.42 52 Supervisor, Water Distribution 527 30.21 31.87 33.62 35.47 37.42 53 Supervisor, Water Production 527 30.21 31.87 33.62 35.47 37.42 86 Systems Analyst 518 28.87 30.46 32.14 33.91 35.78 34 Traffic Engineer, Associate 543 32.72 34.52 36.42 38.42 40.53 33 Transportation Manager 586 40.55 42.78 45.13 47.61 50.23 41 Water Operations Manager 591 41.57 43.86 46.27 48.81 51.49 EFFECTIVE DECEMBER 21, 2002 0032 IMarine Safety Division Chief 1 577 38.78 40.91 43.16 45.53 48.03 EFFECTIVE MARCH 29,2003 F zs 0032 IMarine Safety Division Chief 1 577 138.78140.91 43.16145.53 48.03 2003 MEO MOU Draft 41 12/11/02 8:55 AM EXHIBIT B DELTA DENTAL PLAN BROCHURE A copy of the Delta Dental Plan Brochure may be obtained from the Administrative Services Department Risk MaRagervment Di ioinn 2003 MEO MOU Draft 42 12/11/02 8:55 AM EXHIBIT C DELTA DENTAL CARE PLAN BROCHURE A copy of the Delta Care Plan Brochure may be obtained from the Administrative Services Department Risk MaRanoment Divicinn 2003 MEO MOU Draft 43 12/11/02 8:55 AM EXHIBIT D EMPLOYEE HEALTH PLAN BROCHURE A copy of the Employee Health Plan Brochure may be obtained from the Administrative Services Department Disk Management Diioi - 2003 MEO MOU Draft 44 12/11/02 8:55 AM d DELTA DENTAL® Delta Dental Plan of California For Employees of CITY OF HUNTINGTON BEACH Group Number 4729 Combined Evidence of Coverage and Disclosure Form EXWt317 B - �lEo qOU USING THIS BOOKLET This booklet has been written with you in mind. It is designed to help you make the most of your Delta dental program. This combined Evidence of Coverage/Disclosure form discloses the terms and conditions of your coverage. The Combined Evidence of Coverage\Disclosure form should be read completely and carefully and individuals with special health care needs should read carefully those sections that apply to them (see CHOOSING YOUR DENTIST section). You have a right to review it prior to your enrollment. Please read the "DEFINITIONS" section. It will explain to you any words which have special or technical meanings under your group Contract. A copy of the Contract will be furnished upon request. Please read this summary of your dental Benefits carefully. Keep in mind that YOU means the ENROLLEES whom Delta covers. WE, US and OUR always refers to Delta Dental Plan of California (Delta). If you have any questions about your coverage that are not answered here, please check with your personnel office, or with Delta. DELTA DENTAL PLAN OF CALIFORNIA P.O. Box 7736 San Francisco, California 94120 For claims, eligibility and benefits inquiries, or additional information, call Delta's Customer and Member Service Department toll -free at: 1-888-335-8227. Or contact us on the Internet at: e-mail: cros@delta.org web site: www.deltadentalca.org A STATEMENT DESCRIBING OUR POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. This Combined Evidence of Coverage and Disclosure Form constitutes only a summary of the dental plan. The dental Contract must be consulted to determine the exact terms and conditions of coverage. TABLE OF CONTENTS DEFINITIONS.........................................................3 WHO IS COVERED?..............................................3 WHO ARE YOUR ELIGIBLE DEPENDENTS?......................................................4 ENROLLING YOUR DEPENDENTS....................4 COVERAGE COSTS..............................................4 WHEN YOU ARE NO LONGER COVERED..............................................................5 CANCELING THIS PROGRAM ...........................5 YOUR BENEFITS..................................................5 LIMITATIONS........................................................6 EXCLUSIONS/SERVICES WE DO NOTCOVER..........................................................8 DEDUCTIBLES......................................................9 COVERED FEES....................................................9 CHOOSING YOUR DENTIST...............................9 CONTINUITY OF CARE.....................................10 PUBLIC POLICY PARTICIPATION BY ENROLLEES..................................................10 SAVING MONEY ON YOUR DENTAL BILLS...................................................10 YOUR FIRST APPOINTMENT ...........................10 PREDETERMINATIONS..................................... I I PAYMENT............................................................11 IF YOU HAVE QUESTIONS ABOUT SERVICES FROM A DELTA DENTIST.............12 SECOND OPINIONS............................................12 ORGAN AND TISSUE DONATION...................12 COMPLAINT PROCEDURE, CLAIMS APPEAL AND ARBITRATION ...........................12 IF YOU HAVE ADDITIONAL COVERAGE..........................................................13 OPTIONAL CONTINUATION OF COVERAGE....................................................14 2 DEFINITIONS Certain words that you will see in this booklet have specific meanings. These definitions should make your dental program easier to understand. Attending Dentist's Statement - a form used by your dentist to request payment for dental treatment or predetermination for proposed dental treatment. Benefits - those dental services available under the Contract and which are described in this booklet. Contract - the written agreement between your employer or sponsoring group and Delta to provide dental Benefits. The Contract, together with this booklet, forms the terms and conditions of the Benefits you are provided. Covered Services - those dental services to which Delta will apply Benefit payments, according to the Contract. Delta Dentist - a Dentist who has a signed agreement with Delta or a Participating Plan, agreeing to provide services under the terms and conditions established by Delta or the Participating Plan. Dependent - a Primary Enrollee's Dependent who is eligible to enroll for Benefits in accordance with the conditions of eligibility outlined in this booklet. Effective Date - the date this program starts. Enrollee - a Primary Enrollee or Dependent enrolled to receive Benefits or a person who chooses to pay for OPTIONAL CONTINUATION OF COVERAGE. Maximum - the greatest dollar amount Delta will pay for covered procedures in any calendar year and lifetime for Orthodontic Benefits. Premiums - the money paid to Delta each month for you and your Dependents' dental coverage. Participating Plan — Delta and. any other member of the Delta Dental Plans Association with whom Delta contracts for assistance in administering your Benefits. Primary Enrollee - any group member or employee who is eligible to enroll for Benefits in accordance with the conditions of eligibility outlined in this booklet. Single Procedure - a dental procedure to which Delta has assigned a separate procedure number; for example, a three -surface amalgam restoration of one permanent tooth (procedure 02160) or a complete upper denture, including adjustments for a six- month period following installation (procedure 05110). Usual, Customary and Reasonable (UCR) - A Usual fee is the amount which an individual dentist regularly charges and receives for a given service or the fee actually charged, whichever is less. A Customary fee is within the range of Usual fees charged and received for a particular service by dentists of similar training in the same geographic area. A Reasonable fee schedule is reasonable if it is 'Usual and Customary. Additionally, a specific fee to a specific patient is Reasonable if it is justifiable considering special circumstances, or extraordinary difficulty, of the case in question. WHO IS COVERED? All present and future regular employees are required to enroll and will become eligible to receive Benefits on the first day of the month following 30 days of continuous employment. New Dependents should be enrolled as soon as they become Dependents, and they will then immediately be covered for dental Benefits. You are not eligible if you are not reporting to work on a regular basis and are not actively employed. Coverage resumes on the first day of the month after you return to active employment, report to work regularly and amounts due to Delta for coverage have been paid. But, coverage can continue without interruption if your employer continues to report you as a Primary Enrollee and amounts due Delta for your coverage continue to be paid. Family and Medical Leave Act of 1993 You can continue your coverage if you take a leave governed by the Family and Medical Leave Act of 1993. If you do not continue your coverage during the governed leave, it will be reinstated at the same Benefit level you received before your leave. Uniformed Services Employment and Re- employment Rights Act of 1994 You can continue coverage for up to 18 months, if you take a leave governed by the Uniformed Services Employment and Re-employment Rights Act of 1994. If you make this election, you must submit any Premiums necessary, which may include administrative costs, to your employer. If you do not continue your coverage during a military leave, it will be reinstated at the same Benefit level you received before your leave. WHO ARE YOUR ELIGIBLE DEPENDENTS? • Your legal spouse; • Your unmarried dependent children until their 19th birthday; Your unmarried dependent children until their 23rd birthday if enrolled full-time in an accredited school, college or university, or live at home and are dependent upon parent(s) for at least 50% of their support; • An unmarried dependent child aged 19 or older who is incapable of self-support because of a physical or mental handicap that occurred before he or she turned 19, if the child is mostly dependent on you for support. Proof of this handicap must be given to Delta or your employer within 31 days, if it is requested. Proof will not be required more than once a year after the child has reached age 21. "Dependent children" also means stepchildren, adopted children, children placed for adoption and foster children, provided that they are dependent upon you for support and maintenance. Dependent coverage is also extended to any child who is recognized under a Qualified Medical Child Support Order (QMCSO). No Dependent in the military service is eligible. ENROLLING YOUR DEPENDENTS A payroll deduction is required for your enrolled Dependents. Your group can only provide coverage for your Dependents if at least half of the Primary Enrollees who have Dependents enroll all of them in this program. Your Dependents must be enrolled when you first become eligible or on the first day of the month after they become Dependents. However, Dependents who are covered under another group dental program are not required to enroll under this Delta program. If the other coverage ends, the Dependents may enroll under this program within 30 days of the loss of the other coverage. Proof of prior coverage is required. Dependent children up to four years of age may be enrolled at the beginning of any Contract year including the Contract year immediately following their fourth birthday. If you drop coverage for your Dependents, you may not re -enroll them in this program. COVERAGE COSTS Your employer pays Delta monthly Premiums for coverage of you and your enrolled Dependents. 4 You do not pay for your own coverage but a payroll deduction is made for monthly Premiums required for your Dependent's coverage. The amount of Premiums may change at each renewal of the Contract between your employer and Delta. Premiums will not increase during the contract year unless new taxes or tax rates are imposed upon Delta for this program or unless there is an agreement between your employer and Delta to change the Premiums rate. WHEN YOU ARE NO LONGER COVERED If you stop working for your employer, your dental coverage will end on the last day of the month in which you stop working, unless you qualify for and pay for OPTIONAL CONTINUATION OF COVERAGE. Your. Dependents' coverage ends when yours does, or as soon as they are no longer Dependents, unless they choose to pay for OPTIONAL CONTINUATION OF COVERAGE. 2. When the Contract between Delta and your employer is discontinued or canceled, your coverage ends immediately. CANCELING THIS PROGRAM Delta may cancel this program only on an anniversary date (period after the program first takes effect or at the end of each renewal period thereafter), or any time your group does not make payment as required by the Contract. If you believe that this program has been terminated or not renewed due to your health status or requirements for health care services (or that of your Dependents), you may request a review by the California Director of the Department of Managed Health Care. If the Contract is terminated for any cause, Delta is not required to predetermine services beyond the termination date or to pay for services provided after the termination date, except for Single Procedures begun while the Contract was in effect which are otherwise Benefits under the Contract. If this program is canceled, you and your Dependents have no right to renewal or reinstatement of your Benefits. YOUR BENEFITS Your dental program covers several categories of Benefits, when the services are provided by a licensed dentist, and when they are necessary and customary under the generally accepted standards of dental practice. After you have satisfied any deductible requirements, Delta will provide payment for these services at the percentage indicated up to a Maximum of $1,000 for each Enrollee in each calendar year. Payment for Orthodontic Benefits for Enrollee is limited to a lifetime Maximum of $3,000. An agreement between your employer and Delta is required to change Benefits during the term of the contract. The following Benefits are limited to the applicable percentages of dentist's fees or allowances specified below. You are required to pay the balance of any such fee or allowance, known as the "patient copayment." If the dentist discounts, waives or rebates any portion of the patient copayment to the Enrollee, Delta only provides as Benefits the applicable allowances reduced by the amount that such fees or allowances are discounted, waived or rebated. I. DIAGNOSTIC AND PREVENTIVE BENEFITS - 85% Diagnostic - oral examinations (including initial examinations, periodic examinations and emergency examinations); x-rays; diagnostic casts; examination of biopsied tissue; palliative (emergency) treatment of dental pain; specialist consultation Preventive - prophylaxis (cleaning); fluoride treatment; space maintainers II. IV. BASIC BENEFITS - 85% Oral surgery - extractions and certain other surgical procedures, including pre- and post- operative care kv Restorative - amalgam, silicate or composite VI (resin) restorations (fillings) for treatment of carious lesions (visible destruction of hard tooth structure resulting from the process of dental decay) Endodontic - treatment of the tooth pulp Periodontic - treatment of gums and bones that support the teeth Sealants - topically applied acrylic, plastic or composite material used to seal developmental grooves and pits in teeth for the purpose of preventing dental decay Adjunctive General Services - general anesthesia; office visit for observation; office visit after regularly scheduled hours; therapeutic drug injection; treatment of post- surgical complications (unusual circumstances); limited occlusal adjustment CROWNS, JACKETS, INLAYS, ONLAYS AND CAST RESTORATION BENEFITS - 85% Crowns, Jackets, Inlays, Onlays and Cast Restorations are Benefits only if they are provided to treat cavities which cannot be restored with amalgam, silicate or direct composite (resin) restorations. PROSTHODONTIC BENEFITS - 60% Construction or repair of fixed bridges, partial dentures and complete dentures are Benefits if provided to replace missing, natural teeth. ORTHODONTIC BENEFITS - 60% Procedures using appliances or surgery to straighten or realign teeth, which otherwise would not function properly. DENTAL ACCIDENT BENEFITS - 100% Any services which would be covered under other Benefit categories (subject to the same limitations and exclusions) are covered instead by your dental accident coverage when they are provided for conditions caused directly by external, violent and accidental means. LIMITATIONS 1. Only the first two oral examinations, including office visits for observation and specialist consultations, or combination thereof, in a calendar year are Benefits while you are eligible under any Delta program. Oral examinations provided by a California dentist are Benefits only when the dentist is a Delta Dentist with an accepted fee on file with Delta. 2. Full -mouth x-rays are a Benefit once in a five-year period while you are eligible under any Delta program. 3. Bitewing x-rays are provided on request by the dentist, but no more than twice in any calendar year for children to age 18 or once in any calendar year for adults age 18 and over, while you are eligible under any Delta program. 4. Diagnostic casts are a Benefit only when made in connection with subsequent orthodontic treatment covered under this program. 5. Only the first two cleanings, fluoride treatments, or Single Procedures which include cleaning, or combination thereof, in a calendar year are Benefits while you are eligible under any Delta program. 6. Sealant Benefits include the application of sealants only to permanent first molars up to age nine and second molars up to age 14 if they are without caries (decay), or restoration on the occlusal surface. Sealant Benefits do not include the repair or replacement of a sealant on any tooth within three years of its application. 7. Direct composite (resin) restorations are Benefits on anterior teeth and the facial surface of bicuspids. Any other posterior direct composite (resin) restorations are optional services and Delta's payment is limited to the cost of the equivalent amalgam restorations. 8. Crowns, Jackets, Inlays, Onlays and Cast Restorations are Benefits on the same tooth only once every five years, while you are eligible under any Delta program, unless Delta determines that replacement is required because the restoration is unsatisfactory as a result or poor quality of care, or because the tooth involved has experienced extensive loss or changes to tooth structure or supporting tissues since the replacement of the restoration. 9. Prosthodontic appliances are Benefits only once every five years, while you are eligible under any Delta program, unless Delta determines that there has been such an extensive loss of remaining teeth or a change in supporting tissues that the existing appliance cannot be made satisfactory. Replacement of a prosthodontic appliance not provided under a Delta program will be made if it is unsatisfactory and cannot be made satisfactory. 10. Delta will pay its percentage of the dentist's fee for a standard partial or complete denture up to a maximum fee allowance. This fee allowance is the fee that would satisfy the majority of Delta's Dentists. A standard partial or complete denture is one made from accepted materials and by conventional methods. The maximum fee allowance is revised periodically, as dental fees change. If your dentist's accepted fee on file with Delta for a partial or complete denture is higher than this maximum allowance, you must pay that portion of his or her fee that exceeds Delta's allowance in addition to your portion of the allowance. 11. Implants (appliances inserted into bone or soft tissue in the jaw, usually to anchor a denture) are not covered by your program. However, if implants are provided along with a covered prosthodontic appliance, Delta will allow the cost of a standard partial or complete denture toward the cost of the implants and the prosthodontic appliances when the prosthetic appliance is completed. If Delta makes such an allowance, we will not pay for any replacement for five years following the completion of the service. „ 12. If you select a more expensive plan of treatment than is customarily provided, or specialized techniques, an allowance will be made for the least expensive, professionally acceptable, alternative treatment plan. Delta will pay the applicable percentage of the lesser fee for the customary or standard treatment and you are responsible for the remainder of the dentist's fee. For example: a crown where a silver filling would restore the tooth; or a precision denture where a standard denture would suffice. 13. If orthodontic treatment is begun before you become eligible for coverage, Delta's payments will begin with the first payment due to the dentist following your eligibility date. 3. Services for cosmetic purposes or for conditions that are a result of hereditary or developmental defects, such as cleft palate, upper and lower jaw malformations, congenitally missing teeth and teeth that are discolored or lacking enamel. 14. Delta's orthodontics payments will stop when the first payment is due to the dentist 4. following either a loss of eligibility, or if treatment is ended for any reason before it is completed. 15. X-rays and extractions that might be necessary for orthodontic treatment are not covered by Orthodontic Benefits, but may be covered under Diagnostic and Preventive or 5. Basic Benefits. 16. Delta will pay Dental Accident Benefits when services are provided within 180 days following the date of accident and shall not include any services for conditions caused by an accident occurring before your eligibility date. EXCLUSIONS/SERVICES WE DO NOT COVER Delta covers a wide variety of dental care expenses, but there are some services for which we do not provide Benefits. It is important for you to know what these services are before you visit your dentist. Delta does not provide benefits for:. Services for injuries covered by Workers' Compensation or Employer's Liability Laws. 2. Services which are provided to the Enrollee by any Federal or State Governmental Agency or are provided without cost to the Enrollee by any municipality, county or other political subdivision, except Medi-Cal benefits. 0 7. Services for restoring tooth structure lost from wear (abrasion, erosion, attrition, or abfraction), for rebuilding or maintaining chewing surfaces due to teeth out of alignment or occlusion, or for stabilizing the teeth. Examples of such treatment are equilibration and periodontal splinting. Any Single Procedure, bridge, denture or other prosthodontic service which was started before the Enrollee was covered by this program. Prescribed drugs, or applied therapeutic drugs, premedication or analgesia. Experimental procedures. 8. Charges by any hospital or other surgical or treatment facility and any additional fees charged by the Dentist for treatment in any such facility. 9. Anesthesia, except for general anesthesia given by a dentist for covered oral surgery procedures. 10. Grafting tissues from outside the mouth to tissues inside the mouth ("extraoral grafts"). 11. Implants (materials implanted into or on bone or soft tissue) or the repair or removal of implants, except as provided under LIMITATIONS. 12. Diagnosis or treatment by any method of any condition related to the temporomandibular (jaw) joints or associated muscles, nerves or tissues. 13. Replacement of existing restoration for any purpose other than active tooth decay. 14. Intravenous sedation, occlusal guards and complete occlusal adjustment. 15. Charges for replacement or repair of an orthodontic appliance paid in part or in full by this program. DEDUCTIBLES You must pay the first $25 of Covered Services for each Enrollee in your family in each calendar year, up to a limit of $75 per family. COVERED FEES It is to your advantage to select a dentist who is a Delta Dentist, since a lower percentage of the dentist's fees may be covered by this program if you select a dentist who is not a Delta Dentist. A list of Delta Dentists (see DEFINITIONS) is available in a directory at your group benefits office, or by calling 1-800-427-3237. Payment to a Delta Dentist will be based on the applicable percentage of the lesser of the Fee Actually Charged, or the accepted Usual, Customary and Reasonable Fee that the dentist has on file with Delta. Payment to a dentist located outside the United States will be based on the applicable percentage of the lesser of the Fee Actually Charged, or the fee which satisfies the majority of Delta's dentists. Payment to a dentist outside of California who agrees to be bound by Delta's rules in the administration of the program will be based on the applicable percentage of the lesser of the Fee Actually Charged or the Customary Fee for corresponding services for Delta Dentists in California. Payment to a California dentist, or an out-of-state dentist, who is not a Delta Dentist will be based on the applicable percentage of the lesser of the Fee Actually Charged, or the fee which satisfies the majority of Delta's Dentists. CHOOSING YOUR DENTIST PLEASE READ THE FOLLOWING INFORMATION SO YOU WILL KNOW FROM WHOM OR WHAT GROUP OF PROVIDERS HEALTH CARE MAY BE OBTAINED. More than 18,000 dentists in active practice in California are Delta Dentists. You are free to choose any dentist for treatment, but it is to your advantage to choose a Delta Dentist. This is because his or her fees are approved in advance by Delta. Delta Dentists have treatment forms on hand and will complete and submit the forms to Delta free of charge. If you go to a non -Delta Dentist, Delta cannot assure you what percentage of the charged fee may be covered. Claims for services from non -Delta Dentists may be submitted to Delta at the address listed on page 1. Dentists located outside the United States are not Delta Dentists. Claims submitted by out -of -country dentists are translated by Delta staff and the currency is converted to U.S. dollars. Claims submitted by out -of -country dentists for patients residing in California are referred to Delta's Quality Review department for processing Delta may require a clinical examination to determine the quality of the services provided, and Delta may decline to reimburse you for Benefits if the services are found to be unsatisfactory. A list of Delta Dentists can be obtained by calling 1-800-427-3237. This list will identify those dentists who can provide care for individuals who have mobility impairments or have special health 9 care needs. You can obtain specific information about Delta Dentists by using our web site — www.deltadentalca.org or calling the Delta Customer and Member Service Department at the number shown on page 1. A printed list of the Delta Dentists in your area is also available by calling 1-800-427-3237. Services may be obtained from any licensed dentist during normal office hours. Emergency services are available in most cases through an emergency telephone exchange maintained by the local dental society which is listed in the local telephone directory. Services from dental school clinics may be provided by students of dentistry or instructors who are not licensed by the state of California. Delta shares the public and professional concern about the possible spread of HIV and other infectious diseases in the dental office. However, Delta cannot ensure your dentist's use of precautions against the spread of such diseases, or compel your dentist to be tested for HIV or to disclose test results to Delta, or to you. Delta informs its panel dentists about the need for clinical precautions as recommended by recognized health authorities on this issue. If you should have questions about your dentist's health status or use of recommended clinical precautions, you should discuss them with your dentist. CONTINUITY OF CARE If you are undergoing a course of treatment and your dentist no longer is a Delta Dentist, you may continue to receive treatment from that dentist. PUBLIC POLICY PARTICIPATION BY ENROLLEES Delta's Board of Directors includes Enrollees who participate in establishing Delta's public policy regarding Enrollees through periodic review of Delta's Quality Assessment program reports and communication from Enrollees. Enrollees may submit any suggestions regarding Delta's public policy in writing to: Delta Dental Plan of California, Customer and Member Service Department, P. O. Box 7736, San Francisco, CA 94120. SAVING MONEY ON YOUR DENTAL BILLS You can keep your dental expenses down by practicing the following: Comparing the fees of different dentists; 2. Using a Delta Dentist; 3. Having your dentist obtain predetermination from Delta for any treatment over $300; 4. Visiting your dentist regularly for checkups; 5. Following your dentist's advice about regular brushing and flossing; 6. Avoiding putting off treatment until you have a major problem; and 7. By learning the facts about overbilling. Under this program, you must pay the dentist your copayment share (see YOUR BENEFITS). You may hear of some dentists who offer to accept insurance - payments as "full payment." You should know that these dentists may do so by overcharging your program and may do more work than you need, thereby increasing program costs. You can help keep your dental Benefits intact by avoiding such schemes. YOUR FIRST APPOINTMENT During your first appointment, be sure to give your dentist the following information: Your Delta group number (on the front of this booklet); 2. The employer's name; 10 3. Primary Enrollee's social security number (which must also be used by Dependents); 4. Primary Enrollee's date of birth; Any other dental coverage you may have. PREDETERMINATIONS After an examination, your dentist will talk to you about treatment you may need. The cost of treatment is something you may want to consider. If the service is extensive and involves crowns or bridges, or if the service will cost more than $300, we encourage you to ask your dentist to request a predetermination. A predetermination does not guarantee payment. It is an estimate of the amount Delta will pay if you are eligible and meet all the requirements of your program at the time the treatment you have planned is completed. In order to receive predetermination, your dentist must send an Attending Dentist's Statement to us listing the proposed treatment. Delta will send your dentist a Notice of Predetermination which estimates how much you will have to pay. After you review the estimate with your dentist and decide to go ahead with the treatment plan, your dentist returns the statement to us for payment when treatment has been completed. Computations are estimates only and are based on what would be payable on the date the Notice of Predetermination is issued if the patient is eligible. Payment will depend on the patient's eligibility and the remaining annual Maximum when completed services are submitted to Delta. Predetermining treatment helps prevent any misunderstanding about your financial responsibilities. If you have any concerns about the predetermination, let us know before treatment begins so your questions can be answered before you incur any charges. PAYMENT Delta will pay Delta Dentists directly. Our agreement with our Delta Dentists makes sure that you will not be responsible to the dentist for any money we owe. However, if for any reason we fail to pay a dentist who is not a Delta Dentist, you may be liable for that portion of the cost. If you have selected a non -Delta Dentist, Delta will pay you. Payments made to you are not assignable (in other words, we will not grant requests to pay non -Delta Dentists directly). Delta does not pay Delta Dentists any incentive as an inducement to deny, reduce, limit or delay any appropriate service. If you wish to know more about the method of reimbursement to Delta Dentists, you may call Delta's Customer and Member Service Department for more information. Payment for claims exceeding $500 for services provided by dentists located outside the United States may, at Delta's option, be conditioned upon a clinical evaluation at Delta's request (see Second Opinions). Delta will not pay Benefits for such services if they are found to be unsatisfactory. Payment for any Single Procedure which is a Covered Service will only be made upon completion of that procedure. Delta does not make or prorate payments for treatment in progress or incomplete procedures. The date the procedure is completed governs the calculation of any Deductible (and determines when a charge is made against any Maximum) under your program. If there is a difference between what your dentist is charging you and what Delta says your portion should be, or if you are not satisfied with the dental work you have received, contact Delta's Customer and Member Service Department. We may be able to help you resolve the situation. Delta may deny payment of any Attending Dentist's Statement for services submitted more than six months after the date the services were provided. If a claim is denied due to a Delta Dentist's failure to make a timely submission, you shall not be liable to 11 that dentist for the amount which would have been payable by Delta (unless you failed to advise the dentist of your eligibility at the time of treatment). The process Delta uses to determine or deny payment for services are distributed to all Delta Dentists. They describe in detail the dental procedures covered as Benefits, the conditions under which coverage is provided, and the limitations and exclusions applicable to the program. Claims are reviewed for eligibility and are paid according to these processing policies. Those claims which require additional review are evaluated by Delta's dentist consultants. If any claims are not covered, or if limitations or exclusions apply to services you have received from a Delta Dentist, you will be notified by an adjustment notice on the Notice of Payment or Action. You may contact Delta's Customer and Member Service Department for more information regarding Delta's processing policies. IF YOU HAVE QUESTIONS ABOUT SERVICES FROM A DELTA DENTIST If you have questions about the services you receive from a Delta Dentist, we recommend that you first discuss the matter with your dentist. If you continue to have concerns, call our Quality Review Department at 1-888-335-8227. If appropriate, Delta can arrange for you to be examined by one of our consulting dentists in your area. If the consultant recommends the work be replaced or corrected, Delta will intervene with the original dentist to either have the services replaced or corrected at no additional cost to you or obtain a refund. In the latter case, you are free to choose another dentist to receive your full Benefit. SECOND OPINIONS Delta obtains second opinions through Regional Consultant members of its Quality Review Committee who conduct clinical examinations, prepare objective reports of dental conditions, and evaluate treatment that is proposed or has been provided. Delta will authorize such an examination prior to treatment when necessary to make a Benefits determination in response to a request for a Predetermination of treatment cost by a dentist. Delta will also authorize a second opinion after treatment if an Enrollee has a complaint regarding the quality of care provided. Delta will notify the Enrollee and the treating dentist when a second opinion is necessary and appropriate, and direct the Enrollee to the Regional Consultant selected by Delta to perform the clinical examination. When Delta authorizes a second opinion through a Regional Consultant, we will pay for all charges. Enrollees may otherwise obtain second opinions about treatment from any dentist they choose, and claims for the examination or consultant may be submitted to Delta for payment. Delta will pay such claims in accordance with the Benefits of the program. This is only a summary of Delta's policy on second opinions. A copy of Delta's formal policy is available from Delta's Customer and Member Service Department upon request. ORGAN AND TISSUE DONATION Donating organ and tissue provides many societal benefits. Organ and tissue donation allows recipients of transplants to go on to lead fuller and more meaningful lives. Currently, the need for organ transplants far exceeds availability. If you are interested in organ donation, please speak to your physician. Organ donation begins at the hospital when a patient is pronounced brain dead and identified as a potential organ donor. An organ procurement organization will become involved to coordinate the activities. COMPLAINT PROCEDURE, CLAIMS APPEAL AND ARBITRATION If you have any questions about the services you receive from a Delta Dentist, we recommend that you first discuss the matter with your dentist. If you continue to have concerns, call our Quality Review Department at 1-888-335-8227. 12 We will provide notification if any dental services or claims are denied, in whole or in part, stating the specific reason or reasons for denial. If you have a question or complaint regarding eligibility, the denial of dental services or claims, the policies, procedures and operations of Delta, or the quality of dental services performed by a Delta Dentist, you may contact us at the telephone number shown on page 1. You have 60 days after you receive notice of denial to appeal. If you write, you must include the name of the patient, the group name and number, the Primary Enrollee's name and social security number or identification number and your telephone number on all correspondence. You should also include a copy of the treatment form, Notice of Payment and any other relevant information. Clearly explain your complaint and send it to us at the address shown on page 1. We will review your complaint and will resolve the matter within 30 days of receipt or inform you of the pending status of the complaint if more information or time is needed to resolve the matter. We will respond within three days of receipt to complaints involving severe pain and imminent and serious threat to a patient's health. The California Department of Managed Health Care is responsible for regulating health care service plans. The department has a toll -free number 1-888-HMO-2219 to receive complaints regarding health plans. The hearing and speech impaired may use the California Relay Service's toll -free telephone numbers 1-800-735-2929 (TTY) or 1-888-877-5378 (TTY) to contact the department. The department's Internet web site (http://www.hmohelp.ca.gov) has complaint forms and instructions online. If you have a grievance against the plan, you should first telephone the plan at 1-888-335-8227 and use the plan's grievance process before contacting the department. If you need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by the plan, or a grievance that has remained unresolved for more than 30 days, you may call the department for assistance. The plan's grievance process and the department's complaint review_ process are in addition to any other dispute resolution procedures that may be available to you, and your failure to use these processes does not preclude your use of any other remedy provided by law. Disputes relating to your plan, including claim denials, may be settled by arbitration if they cannot be settled by this complaint process. Arbitration will follow the Commercial Rules of the American Arbitration Association (AAA). You can begin this process by giving written notice to each party (for example, Delta and your dentist) with whom you want to arbitrate, explaining the dispute and the amount involved, if any, and the solution you wish. You must then file two copies of the notice with the Association's regional office in Los Angeles or San Francisco, along with the fee required by the Association. In the event of extreme hardship on the part of an Enrollee or subscriber, and upon an application for relief presented to the AAA, Delta shall assume all or a portion of the arbitration fees and expenses as determined by the AAA in accordance with procedures established and administered by the AAA. IF YOU HAVE ADDITIONAL COVERAGE It is to your advantage to let your dentist and Delta know if you have dental coverage in addition to this Delta program. Most dental carriers cooperate with one another to avoid duplicate payments, but still allow you to make use of both programs - sometimes paying 100% of your dental bill. For example, you might have some fillings which cost $100. If the primary carrier usually pays 80% for these services, it would pay $80. The secondary carrier might usually pay 50% for this service. In this case, since payment is not to exceed the entire fee charged, the secondary carrier pays the remaining $20 only. Since this method pays 100% of the bill, you have no out-of-pocket expense. Be sure to advise your dentist of all programs under which you have dental coverage and have him or her complete the dual coverage portion of the Attending Dentist's Statement, so that you will 13 receive all benefits to which you are entitled. For further information, contact the Delta Customer and Member Service Department at the number in the USING THIS BOOKLET section. OPTIONAL CONTINUATION OF COVERAGE (COBRA OR CAL -COBRA) The federal Consolidated Omnibus Budget Reconciliation Act (or COBRA, pertaining to certain employers having 20 or more employees) and the California Continuation Benefits Replacement Act (or Cal -COBRA, pertaining to employers with 2-19 employees), both required continued health care coverage be made available to "Qualified Beneficiaries" who lose health care coverage under the group plan as a result of a "Qualifying Event You or your Dependents may be entitled to continue coverage under this program, at the Qualified Beneficiary's expense, if certain conditions are met. The period of continued coverage depends on the Qualifying Event. DEFINITIONS The meaning of key terms used in this section are shown below. Qualified Beneficiary means: you and/or your Dependents who are enrolled in the Delta plan on the day before the Qualifying Event, or 2. a child who is born to or placed for adoption with you during the period of continued coverage, provided such child is enrolled within 30 days of birth or placement for adoption. Qualifying Event means any of the following events which, except for the election of this continued coverage, would result in a loss of coverage under the dental plan: Event 1. the termination of employment (other than termination for gross misconduct), or the reduction in work hours, by your employer; Event 2. your death; Event 3. your divorce or legal separation from your spouse; Event 4. your Dependents' loss of dependent status under the plan, and Event 5. as to your Dependents only, your entitlement to Medicare. You means the Primary Enrollee. PERIODS OF CONTINUED COVERAGE Qualified Beneficiaries may continue coverage for 18 months following the month in which Qualifying Event 1 occurs. This 18 month period can be extended for a total of 29 months, provided: 1. a determination is made under Title II or Title XVI of the Social Security Act that an individual is disabled on the date of the Qualifying Event or becomes disabled at any time during the first 60 days of continued coverage; and 2. notice of the determination is given to the employer during the initial 18 months of continued coverage and within 60 days of the date of the determination. This period of coverage will end on the first day of the month that begins more than 30 days after the date of the final determination that the disabled individual is no longer disabled. You must notify the employer within 30 days of any such determination. If, during the 18 months continuation period resulting from Qualifying Event 1, your Dependents, who are Qualified Beneficiaries, experience Qualifying Events 2, 3, 4, or 5, they may 14 choose to extend coverage for up to a total of 36 months (inclusive of the period continued under Qualifying Event 1). Your Dependents, who are Qualified Beneficiaries, may continue coverage for 36 months following the occurrence of Qualifying Events 2, 3, 4 or 5. Under federal COBRA law only, when an employer has filed for bankruptcy under Title II, United States Code, benefits may be substantially reduced or eliminated for retired employees and their Dependents, or the surviving spouse of a deceased retired employee. If this benefit reduction or elimination occurs within one year before or one year after the filing, it is considered a Qualifying Event. If you are the retiree, and you have lost coverage because of this Qualifying Event, you may choose to continue coverage until your death. Your Dependents who have lost coverage because of this Qualifying Event may choose to continue coverage for up to 36 months following your death. ELECTION OF CONTINUED COVERAGE Your employer will notify Delta in writing within 30 days of Qualifying Event 1. A Qualified Beneficiary must notify Delta in writing within 60 days of Qualifying Events 2, 3, 4, or 5 or within 60 days of receiving ,the election notice from the employer. Otherwise, the option of continued coverage will be lost. Within 14 days of receiving notice of a Qualified Event, Delta will provide a Qualified Beneficiary with the necessary benefits information, monthly Premiums charge, enrollment forms, and instructions to allow election of continued coverage. A Qualified Beneficiary will than have 60 days to give Delta written notice of the election to continue coverage. Failure to provide this written notice of election to Delta within 60 days will result in the loss of the right to continue coverage. A Qualified Beneficiary has 45 days from the written election of continued coverage to pay the initial Premiums to Delta, which includes the Premiums for each month since the loss of coverage. Failure to pay the required Premiums within the 45 days will result in the loss of the right to continue coverage, any Premiums received after that will be returned to the Qualified Beneficiary. CONTINUED COVERAGE BENEFITS The Benefits under the continued coverage will be the same as those provided to active employees and their Dependents who are still enrolled in the dental plan. If the employer changes the coverage for active employees, the continued coverage will change as well. Premiums will be adjusted to reflect the changes made. TERMINATION OF CONTINUED COVERAGE A Qualified Beneficiary's coverage will terminate at the end of the month in which any of the following events first occurs: 1. the allowable number of consecutive months of continued coverage is reached; 2. failure to pay the required Premiums in a timely manner; 3. the employer ceases to provide any group dental plan to its employees; 4. the individual first obtains coverage for dental Benefits, after the date of the election of continued coverage, under another group health plan (as an employee or Dependent) which does not contain or apply any exclusion or limitation with respect to any pre-existing condition of such a person, if that pre-existing condition is covered under this program; 5. entitlement to Medicare; or 6. the individual becomes eligible for coverage under the federal COBRA law. The employer shall notify Delta within 30 days 15 of the date when a Qualified Beneficiary becomes so eligible. Once continued coverage ends, it cannot be reinstated. TERMINATION OF THE EMPLOYER'S DENTAL CONTRACT If the dental Contract between the employer and Delta terminates prior to the time that the continuation coverage would otherwise terminate, the employer shall notify a Qualified Beneficiary under Cal -COBRA either 30 days prior to the termination or when all Enrollees are notified, whichever is later, of the ability to elect continuation coverage under the employer's subsequent dental plan, if any. The continuation coverage will be provided only for the balance of the period that a Qualified Beneficiary would have remained covered under the Delta program had such program with the former employer not terminated. The employer shall notify the successor plan in writing of the Qualified Beneficiaries receiving continuation coverage so they may be notified of how to continue coverage. The continuation coverage will terminate if a Qualified Beneficiary fails to comply with the requirements pertaining to enrollment in, and payment of Premiums to the new group benefit plan. OPEN ENROLLMENT CHANGE OF COVERAGE A Qualified Beneficiary under Cal -COBRA may elect to change continuation coverage during any subsequent open enrollment period, if the employer has contracted with another plan to provide coverage to its active employees. The continuation coverage under the other plan will be provided only for the balance of the period that a Qualified Beneficiary would have remained covered under the Delta program. 16 1,218 08/01 HSM d DELTACARE Dental HMO Program Administered by. Medical -Care, Inc. >wne Center Drive ;erritos, CA 90703 FX�IIBIT 0 DeltaCare is a dental program that provides you and your family with quality dental benefits at an affordable cost. The DeltaCare program is designed to encourage you and your family to visit the dentist regularly to maintain your dental health. To receive your DeltaCare benefits, you select a primary care network dentist when you enroll. The DeltaCare network consists of private practice dental offices that have been carefully screened for quality. QUALITY ✓ Extensive benefits for you and your family ✓ No restrictions on pre-existing conditions, except for work in progress ✓ Large, stable network of dentists, so you can enjoy a long-term relationship with your dentist. I ✓ No claim forms to complete ✓ Easy access to specialty care ✓ Expanded business hours for toll -free customer service, from 6:00 a.m. to 6:00 p.m., Pacific Time P_ IST St ✓ No deductibles or annual dollar maximum ✓ Out-of-pocket costs are clearly defined ✓ Out -of -area dental emergency coverage up to $100 each 12-month period • Eligibility for you and your family If you meet your group's eligibility requirements for dental coverage, you can enroll in the DeltaCare program. You may also enroll eligible dependents, including your lawful spouse and unmarried children (which includes stepchildren and legally adopted and foster children to the age limit specified by your group). Contact your benefits administrator if you have any questions. • Easy enrollment To enroll in the DeltaCare program, simply complete an enrollment form indicating your choice of dentist (from the list of network dental offices) and the name of your group. Return this form as directed by your benefits administrator. • How your DeltaCare program works Your selected primary care network dentist will take care of the dental care needs for your family. If you require treatment from a specialist, your primary care network dentist will handle the referral for you. After you have enrolled, you will receive a PMI membership card and an Evidence of Coverage that fully describes the covered benefits of your dental program. The membership card will have the telephone number and address of your network dentist. Simply call the dentist to make an appointment. Under the DeltaCare program, many services are covered at no cost, while others have copayments (fees you pay your network dentist) for certain procedures. See the "Description of Benefits and Copayments° for a list of your benefits. Please note: Dental services that are not performed by your network dentist must be prior authorized by PMI to be covered by your DeltaCare program. • Provisions for emergency care Under your DeltaCare program, you are covered for out -of -area dental emergencies (35 or more miles from your primary care networkdentist). Your program pays up to $100 for emergency dental expenses incurred in each 12-month period. ADA Enrollee ADA Enrollee Codes pays Codes Pays 2930,2931 Crown --prefabricated stainless steel-- primary/permanent........................................ No Cost 2950 Crown buildup (restorative material and pins) ........................ No Cost 2952 Cast post and core* (in addition to crown) ..................................... No Cost 2954 Prefabricated post and core (in addition to crown) ..................................... No Cost 5110,5120 Denture --complete maxillary or mandibular (upper or lower) ...................... No Cost 5130,5140 Immediate denture --maxillary or mandibular (upper or lower) ....................... No Cost 5213,5214 Denture --maxillary or mandibular (upper or lower) partial with metal lingual or palatal bar, clasps and acrylic saddles, and acrylic base or cast metal framework and teeth ..................... No Cost 5410 Adjust complete denture --maxillary .................... No Cost 5411 Adjust complete denture --mandibular ................ No Cost 5421 Adjust partial denture --maxillary ......................... No Cost 5422 Adjust partial denture --mandibular ..................... No Cost 5510 Repair broken complete denture base..No Cost 5520 Replace missing or broken teeth -- complete denture (per tooth) ......................... No Cost 5610 Repair resin denture base .................................. No Cost 5620 Repair cast framework ....................................... No Cost 5630 Repair or replace broken clasp .......................... No Cost 5640 Replace broken teeth (per tooth) ....................... No Cost 5650 Add tooth to existing partial denture ................... No Cost 5660 Add clasp to existing partial denture ................... No Cost 5730 Reline complete maxillary denture (chairside)...................................................... No Cost 5731 Reline complete mandibular denture (chairside)...................................................... No Cost 5740 Reline maxillary partial denture (chairside)...................................................... No Cost 5741 Reline mandibular partial denture (chairside)...................................................... No Cost 5710 Rebase complete maxillary denture ................... No Cost 5711 Rebase complete mandibular denture ............... No Cost 5720 Rebase maxillary partial denture ........................ No Cost 5721 Rebase mandibular partial denture .................... No Cost 5750 Reline complete maxillary denture (lab) ............. No Cost 5751 Reline complete mandibular denture (lab) .......... No Cost 5760 Reline maxillary partial denture (lab) .................. No Cost 5761 Reline mandibular partial denture (lab) .............. No Cost 5820 Interim partial denture (maxillary) ....................... No Cost 5821 Interim partial denture (mandibular) ................... No Cost 5850,5851 Tissue conditioning --per denture ........................ No Cost 6210 Pontic--cast high noble metal* ............................ No Cost 6211 Pontic--cast predominantly base metal ............... No Cost 6212 Pontic--cast noble metal ..................................... No Cost 6240 Pontic--porcelain fused to high noble metal*t ..... No Cost 6241 Pontic—porcelain fused to predominantly base metalt ............................ No Cost 6242 Pontic—porcelain fused to noble metalt ............. No Cost 6750 Crown --porcelain fused to high noble metal*t .... No Cost 6751 Crown --porcelain fused to predominantly base metalt ............................ No Cost 6752 Crown --porcelain fused to noble metalt ............. No Cost 6790 Crown --full cast high noble metal* ...................... No Cost 6791 Crown --full cast predominantly base metal ......... No Cost 6792 Crown --full cast noble metal ............................... No Cost 6930 Recement bridge (fixed partial denture) ............. No Cost 6940 Stress breaker, per unit (in addition to mixed partial denture, retainer) ...................... No Cost 6970 Cast post and core* (includes canal preparation) ........................... No Cost 6972 Prefabricated post and core buildup (including canal preparation, restorative material and any pins) .................. No Cost * Base or noble metal is the benefit High noble metal (precious), if used, will be charged to the enrollee at the additional laboratory cost of the high noble metal. This applies to crowns, bridges, cast and post cores, inlays and onaays. t Porcelain on molars is considered optional treatment VIL ENDODONTICS 3110,3120 Pulp capping (direct/indirect) .............................. No Cost 3220 Therapeutic pulpotomy (excluding final restoration) ........................... No Cost 3310 Root canal therapy --anterior (excluding final restoration) ............................ No Cost 3320 Root canal therapy --bicuspid (excluding final restoration) ............................ No Cost 3330 Root canal therapy --molar (excluding final restoration) ............................ No Cost 3410 Apicoectomy/periradicularsurgery--anterior....... No Cost 3421 Apicoectomy/periradicularsurgery-- bicuspid (first root) ......... :............................... No Cost 3425 Apicoectomy/periradicular surgery -- molar (first root) ............................................. No Cost 3426 Apicoectomy/periradicular surgery (each additional root) ........................ No Cost 3430 Retrograde filling, per root ................................. No Cost 3450 Root amputation, per root .................................. No Cost VIII. ADJUNCTIVE GENERAL SERVICES 9110 Palliative (emergency) treatment of dental pain.. No Cost 9211 Regional block anesthesia .................................. No Cost 9212 Trigeminal division block anesthesia .................. No Cost 9215 Local anesthesia ................................................ No Cost 9310 Consultation (diagnostic services provided by dentist or physician other than practitioner providing treatment) ....................................... No Cost 9440 Office visit after regularly scheduled hours ........... $ 20.00 0125 Failed appointment without 24 hour notification, per 15 minutes of appointment time ................ $10.00 IX. ORTHODONTICS Start-up fees (excluding records) ............................................. $250.00 Dependent children to age 19.................................................. $500.00 Adults and covered full-time students ....................................... $500.00 Any procedure not listed is available on a fee -for -service basis. 7MNS These services are performed as needed and deemed necessary by your attending DeltaCare network dentist subject to the limitations, exclusions and governing administrative policies of the program. ADA codes Enrolee Pays ADA Codes Enrolee ftys I. DIAGNOSTIC 7130 Root removal --exposed roots ............................. No Cost Office visit, per visit 7210 Surgical removal of erupted tooth ...................... No Cost (in addition to other services) ......................... No Cost 7220 Removal of impacted tooth --soft tissue .............. No Cost 0120 Periodic oral evaluation ...................................... No Cost 7230 Removal of impacted toothpartially bony ............ No Cost 0140 Limited oral evaluation —problem focused ........... No Cost 7240,7241 Removal of impacted tooth 0150 Comprehensive oral evaluation .......................... No Cost completely bony ............................................. No Cost 0160 Detailed and extensive oral evaluation 7250 Surgical removal of residual problem focused ............................................ No Cost tooth roots (cutting procedure) ....................... No Cost 0210 Intraoral radiographs- 7286 Biopsy of oral tissue --soft ................................... No Cost complete series (including bitewings) ............. No Cost 7310 Alveoloplastyin conjunction 0220,0230 Intraoral periapical film ....................................... No Cost with extractions, per quadrant ........................ No Cost 0240 Intraoral occlusal film .......................................... No Cost 7320 Alveoloplasty not in conjunction 0270, with extractions, per quadrant ........................ No Cost 0272,0274 Bitewing radiograph(s)....................................... No Cost 7470 Removal of exostosis-maxilla or mandible .......... No Cost 0330 Panoramic film ................................................... No Cost 7510 Incision and drainage of abscess-- intraoral soft tissue ......................................... No Cost It. PREVENTIVE 7960 Frenulectomy--(frenectomyorfrenotomy) 1110,1120 Prophylaxis (cleaning)--adulUchild separate procedure ....................................... No Cost 1 per 6 month period ..................................... No Cost 1201 Topical application of fluoride, V. PERIODONTICS including prophylaxis (to age 19) (includes preoperative and postoperative evaluations and treatment 1 per 6 month period ..................................... No Cost under local anesthetic) 1203 Topical application of fluoride, 4210 Gingivectomy or gingivoplasty, per quadrant....... No Cost excluding prophylaxis (to age 19) 4211 Gingivectomyor gingivoplasty, 1 per 6 month period ..................................... No Cost per tooth (fewer than six teeth) ...................... No Cost 1330 Oral hygiene instructions .................................... No Cost 4220 Gingival curettage surgical, per quadrant ........... No Cost 1351 Sealant, per tooth .............................................. No Cost 4240 Gingival flap procedures including 1510 Space maintainer--fixed—unilateral .................... No Cost root planing (per quadrant) ............................ No Cost 1515 Space maintainer--foxed--bilateral ...................... No Cost 4260 Osseous surgery, flap entry and closure, 1520 Space maintainer--removable--unilateral ........... No Cost per quadrant .................................................. No Cost 1525 Space maintainer--removable--bilateral ............. No Cost 4341 Periodontal scaling and root planing, 1550 Recementation of space maintainers ................. No Cost per quadrant .................................................. No Cost 4355 Full mouth debridement to enable III. RESTORATIVE (Fillings) comprehensive periodontal evaluation (Includes indirect pulp capping, bases, liners and acid etch procedures) and diagnosis ................................................. No Cost 2110 Amalgam --one surface, primary ......................... No Cost 4910 Periodontal maintenance 2120 Amalgam --two surfaces, primary ....................... No Cost (following active therapy) ................................ No Cost 2130 Amalgam --three surfaces, primary ..................... No Cost 2131 Amalgam --four or more surfaces, VI. PROSTHETICS primary ........................................................... No Cost (Crowns, bridges and dentures) 2140 Amalgam --one surface, permanent ................... No Cost 2510 Inlay --one surface --base metal noble ................. No Cost 2150 Amalgam --two surfaces, permanent .................. No Cost 2520,6520 Inlay --two surfaces --base metal noble ............... No Cost 2160 Amalgam --three surfaces, permanent ............... No Cost 2530,6530 Inlay --three or more surfaces- 2161 Amalgam-- base metal noble ............................................ No Cost four or more surfaces,, permanent ................. No Cost 2543,6543 Onlay--three surfaces --base metal noble ........... No Cost 2330 Resin --one surface anterior ............................... No Cost 2544,6544 Onlay--four or more surfaces-- 2331 Resin --two surface anterior ................................ No Cost base metal noble ............................................ No Cost 2332 Resin --three surface anterior ............................. No Cost 2710 Crown --resin (laboratory) .................................. No Cost 2335 Resin —four or more surfaces 2740 Crown—porcelain/ceramict................................ No Cost or involving incisal angle (anterior) ................. No Cost 2750 Crown --porcelain fused to high noble metal*t .... No Cost 2336 Composite resin crown, anterior --primary .......... No Cost 2751 Crown —porcelain fused to 2940 Sedative filling .................................................... No Cost predominantly base metalt ............................ No Cost 2951 Pin retention --per tooth, 2752 Crown --porcelain fused to noble metalt............. No Cost in addition to restoration ................................. No Cost 2790 Crown --full cast high noble metal*...................... No Cost 2791 Crown --full cast predominantly base metal ......... No Cost IV. ORAL SURGERY 2792 Crown --full cast noble metal ............................... No Cost (Includes preoperative and postoperative evaluations and treatment 2810 Crown--3/4 cast metal noble .............................. No Cost under local anesthetic) 2910 Recement inlay .................................................. No Cost 7110,7120 Single tooth extraction/each additional ............... No Cost 2920 Recement crown ................................................ No Cost 7WWS 1. Prophylaxis is limited to one treatment each six-month period (in- cludes periodontal maintenance following active therapy); 2. Full maxillary and/or mandibular dentures inlcuding immediate den- tures are not to exceed one each in any five year period from initial placement; 3. Partial dentures are not to be replaced within any five-year period from initial placement, unless necessary due to natural tooth loss where the addition or replacement of teeth to the existing partial is not feasible; 4. Crown(s) and bridges are not to be replaced within any five-year period from initial placement; 5. Denture relines are limited to one per denture during any 12 con- secutive months; 6. Periodontal treatments (root planing/subgingival curettage) are lim- ited to four quadrants during any 12 consecutive months; 7. Full mouth debridement (gross scale) is limited to one treatment dur- ing any 12 consecutive month period; 8. Bitewing x-rays are limited to not more than one series of four films in any six-month period; 9. Full mouth x-rays are limited to one set every 24 consecutive months; 10. Sealant benefits include the application of sealants only to permanent first and second molars with no decay, with no restorations and with the occlusal surface intact, for first molars up to age nine and second molars up to age fourteen. Sealant benefits do not include the repair or replacement of a sealant on any tooth within three years of its application. • Exclusions The following services are not covered benefits of this program: 1. General anesthesia and the services of a special anesthesiologist; 2. Cosmetic dental care; 3. Dental conditions arising out of and due to enrollee's employment or for which Workers' Compensation is payable. Services which are provided to the enrollee by State government or agency thereof or are provided without cost to the enrollee by any municipality, county or other subdivision, except as provided in Section 1373(a) of the Cali- fornia Health and Safety Code; 4. Treatment required by reason of war; 5. Dental services performed in a hospital and related hospital fees; 6. Treatment of fractures and dislocations; 7. Loss or theft of fixed and removable prosthetics (crowns, bridges, full or partial dentures), 8. Dental expenses incurred in connection with any dental procedures started after termination of eligibility for coverage; 9. Any service that is not specifically listed as a covered expense; 10. Dental expenses incurred in connection with any dental procedure started prior to enrollee's eligibility with the DeltaCare program. Ex- ample: teeth prepared for crowns, root canals in progress, orthodon- tic treatment; 11. Congenital malformations (e.g., congenitally missing teeth, supernumerary); 12. Cysts and malignancies; 13. Dispensing of drugs not normally supplied in a dental office; 14. Accidental injury. Accidental injury is defined as damage to the hard and soft tissues of the oral cavity resulting from forces external to the mouth. Damages to the hard and soft tissues of the oral cavity from normal masticatory (chewing) function will be covered at the normal schedule of benefits; 15. Cases which, in the professional judgment of the attending dentist, a satisfactory result cannot be obtained, or where the prognosis is poor or guarded; 16. Dental services received from any dental office other than the assigned DeltaCare office, unless expressly authorized in writing by DeltaCare or as cited under "Provisions for Emergency Care"; 17. Prophylactic removal of impactions (asymptomatic/nonpathological); 18. "Specialist consultations" for noncovered benefits; 19. Implant placement or removal, appliances placed on or services associated with implants, including but not limited to prophylaxis and periodontal treatment. 20. Crown lengthening procedures. • Summary of Orthodontic Limitations and Exclusions The program provides coverage for orthodontic treatment plans provided through DeltaCare Network orthodontists. The start-up fees and the cost to the enrollee forthetreatment plan are listed in the Description of Benefits and Copayments, subject to the following: 1. Orthodontic treatment must be provided by DeltaCare orthodontist. 2. Plan benefits cover 24 months of usual and customary orthodontic treatment. 3. Should an enrollee's coverage be canceled or terminated for any reason, and at the time of cancellation or termination be receiving any orthodontic treatment, the enrollee and not DeltaCare will be responsible for payment of balance due for treatment provided after cancellation or termination. In such a case the enrollee's payment shall be based on a maximum of $2,300 for dependent children to age 19 and $2,500 for coveredfull time students and adults. The amount will be prorated over the number of months to completion of the treatment and, will be payable bythe enrollee on such terms and conditions as are arranged between the enrollee and the orthodontist. Start-up fees are included in these amounts. 4. Start-up fees cover the initial examination, diagnosis, consultation and the retention phase of treatment of up to two years maximum. This includes initial construction, placement and adjustments to retainers and office visits for a maximum period of two years. The following services are not covered 1. Pre, mid -and post- treatment records which include cephalometric x- rays, tracings, photographs and study models; 2. Lost, stolen or broken orthodontic appliances, functional appliances, headgear, retainers and expansion appliances; 3. Retreatment of orthodontic cases; 4. Treatment that extends more than 24 months from the point of banding dentition will besubject to an office visit charge at orthodontist's usual, customary and reasonable fee; 5. Treatment in progress at inception of eligibility; 6. Transfer after banding has been initiated. • What is PMI? PMI is a dental HMO that has administered DeltaCare programs for nearly 30 years. PMI contracts with network dentists, works with your group to design your benefits program and handles all customer service inquiries. Today, more than a million enrollees are covered by DeltaCare programs. • What is the difference between PMI and Delta? PMI administers DeltaCare dental HMO programs and is an affiliate of Delta Dental Plan of California. • How do I know if my dentist is a PMI dentist? When you enroll in DeltaCare, you select a primary care dentist from the list of DeltaCare network dentists. With more than 2,500 general and specialist dentists, the DeltaCare network is one of the largest in California. • My dentist is a Delta dentist but is not on the list of DeltaCare network dentists. Can I still receive treatment from this dentist? No, you must receive treatment from your selected DeltaCare network dentist. Please note that Delta dentists are not necessarily DeltaCare dentists. • How do I know DeltaCare dentists provide quality care? DeltaCare dentists are reviewed for quality, availability and safety before joining the network. PMI maintains quality standards by visiting each network dental office every three months. • Do my family members receive treatment from the same DeltaCare network dentist? Yes, you and all eligible dependents receive care from the same primary care network dentist. DENTAL HEALTH PLAN An Affiliate of Dclw Dcntaf Plan of Glifornia If you have any questions or need additional information, call or write to: PMI Dental Health Plan 12898 Towne Center Drive Cerritos, CA 90703 (800) 422-4234 or visit our website at www.deltadentalca.org Note: THIS IS ONLY A BRIEF SUMMARY OF THE PLAN. The Group Dental Service Contract must be consulted to determine the exact terms and conditions of coverage. An Evidence of Coverage will be sent to you upon enrollment. If you wish to review an Evidence of Coverage prior to enrollment, you may request a copy by calling PMI's Customer Relations Department at (800) 422-4234. • How long does it take to get an appointment with a DeltaCare dentist? Two to four weeks is a reasonable amount of time to wait for a routine, non -urgent appointment. If you require a specific time, you may have to wait longer. In addition, most DeltaCare dentists are in private group practices, which means greater appointment availability and extended office hours. • 1 have a pre-existing dental condition. Can I still join DeltaCare? Yes, treatment for pre-existing conditions such as extracted teeth is not excluded under the DeltaCare program. However, benefits are not provided for any dental treatment started before joining the program (that is, work in progress, such as preparations for crowns, root canals, impressions for dentures and orthodontic treatment). • How does the DeltaCare program encourage preventive care? Your DeltaCare program is designed to encourage regular visits to the dentist by having no copayments (fees you pay to the network dentist) on most diagnostic and preventive services. See the enclosed "Description of Benefits and Copayments." • Does my DeltaCare program cover specialists' services? Yes. Your primary care network dentist will coordinate your specialty care needs with an approved network specialist. There is no additional charge to you for receiving care from a specialist. If there's no network specialist within your service area, PMI will authorize a referral to an out -of -network specialist at no extra cost, other than the applicable copayment. If you or your dependent is assigned to a dental school clinic for specialty services, those services may be provided by a dentist, a dental student, a clinician or a dental instructor. • Can I change my primary care network dentist? Yes. You may change network dentists by notifying PMI either by phone or in writing, or by visiting our website (www.deltadentalca.orQ). If you contact us by the 21 st of the month, the change will become effective the first of the following month. • What if I have questions about my DeltaCare program? Call PMI Customer Relations at (800) 422-4234. We have multilingual representatives available from 5 a.m. to 6 p.m., Monday through Friday. Our Customer Relations representatives have worked in dental offices and can answer benefits questions, as well as arrange office transfers and urgent care referrals. 09/01 SCCA700 HUNTINGTON BEACH MEMBERSHIP HANDBOOK FXkIUIT-t) 4C-D ►400 EMPLOYEE HEALTH PLAN This booklet provides a brief description of the important features of your health insurance coverage. It is not a contract and only the provisions of the Plan Document will control. Payments under this plan are based on Usual, Customary and Reasonable charges. Revised April 2001 Termination of Coverage TABLE OF CONTENTS Coverage will terminate for an employee on the last day of the month in which employment terminates. Coverage for a dependent will cease on Highlights of the Employee Health Plan 1 the earliest of the following: CoPayment and Benefit Percentages 2 • Last day of the month in which the employee's coverage termi- nates Definitions 3 • Date the dependent enters active service with the armed forces • Date the dependent ceases to be an eligible dependent Persons Covered and Effective Dates 6 . For a dependent spouse, on the date of divorce Preferred Provider and Exclusive Provider Organization 7 • For dependent child/children, the date of the child's marriage or attainment of the maximum age limit of 25. Deductibles and Out of Pocket Expenses 8 Covered Medical Expenses 10 Continuation of Benefits Prescriptions 12 If a covered employee ceases active employment due to an authorized Chiropractic and Physical Therapy 12 leave of absence, participation may be continued under COBRA or Family and Medical Leave Act (FMLA). Please refer any questions regarding the continuation of health insurance coverage to the Employee Benefits Divi- sion of the City of Huntington Beach. Well Baby Care 12 General Exclusions and Limitations 13 When You Have a Claim 15 Claims Payment and Appeals 15 Coordination with Other Plans 16 Termination of Coverage 17 17 Coordination with Other Plans The Employee Health Plan contains a provision to prevent double pay- ment for covered expenses. This provision works by coordinating the benefits under this Plan with other similar plans under which a person is covered, so the total benefits available will not exceed one hundred per- cent of allowable expenses. This provision is commonly called "Coordination of Benefits". When a claim is made, the primary plan (as described below) pays its benefits without regard to any other plans. The secondary plans adjust their benefits so that the total benefits available will not exceed the allow- able expenses. No plan pays more than it would otherwise pay without this coordination provision. A plan without a coordination of benefits provision is always the primary plan. If all plans have such a provision: (1) the plan covering the patient directly (e.g., employee or retiree), rather than as a dependent, is primary and the others secondary: (2) if a child is covered under both parents' plans, the parent whose birthday falls earlier in the year is primary, or, if both parents have the same birthday, the plan covering the parent longer is primary, but when the parents are separated or divorced, their plans pay in this order: (a) the plan of the parent with custody of the child; (b) the plan of the parent not having custody of the child (c) the plan of the spouse of the parent with custody of the child; , and (d) the plan of the spouse of the parent not having custody of the child. When the order of benefits is not determined by the preceding paragraphs, the benefits of the plan covering the person as an employee who is actively employed (neither laid off nor retired), are determined before those of a plan covering a person who is inactive. If the other plan does not have this provision and, as a result, the plans do not agree on the order of benefits, this provision is ignored. If none of the preceding provisions determine the order of benefits, the benefits of the plan that covered a person longer are determined first. If none of the preceding provisions of this section make it able to deter- mine which plan is primary, the allowable expenses shall be shared equally between the plans. Highlights of the Employee Health Plan The Employee Health Plan was created for the purpose of providing medi- cal benefits for eligible employees and their eligible dependents. This section is intended only as a brief summary of the Plan's benefits. All maximums are per person unless specifically noted as per family. Please refer to the subsequent sections for a more detailed description of covered expenses and benefits exclusions and limitations. Eligible Employees A permanent City employee Eligibility Date (See Persons Covered and Effective Dates section for enrollment details and effective dates) Open Enrollment The open enrollment period is the month of November. Coverage for a participant enrolling during Open Enrollment will be effective Jan. 1. Lifetime Maximum Benefit The lifetime maximum benefit is $1,000,000. This is the absolute limit on what the Plan will pay for each participant's covered expenses. Calendar Year Maximum Benefit The calendar year maximum benefits listed below are the limits on what this Plan will pay for each participant's covered expenses in a calendar year for the corresponding type of benefit: Mental/Emotional Disorder and or Substance Abuse: Administered by Managed Health Network. No benefits available through the Employee Health Plan. Refer to MHN brochures for further informa- tion. Inpatient Hospitalization 100 days (during each period of disability) Chiropractic Care $2,000 or 24 visits (whichever occurs first) Wellness Benefit $200 per year 16 Deductible: Per Person $250 Per Family $500 Out of Pocket: Per Person $2,000 Per Family $4,000 (Deductibles and Out of Pocket apply per calendar year) NOTE: The out of pocket expenses do not include any charges that ex- ceed Usual, Customary and Reasonable rates, any expenses for treatment of a mental/emotional disorder andlor substance abuse, charges for pre- scription drugs or the EPO copayments. Copayment and Benefit Percentage Benefits Description EPO% PPO% Non PPO% Annual Deductible None $250/$500 $250/$500 Office Visits $5 copay 90% 70% UCR Wellness No charge $200 max $200 max Inpatient $150 copay 90% 70% Hospitalization (day 1-4) then 100% Emergency Services $5 copay 90% 70% Outpatient Services $5 copay 90% 70% Durable Medical $5 copay 90% 70% Equipment Prescription -pharmacy $5 generic/$8 brand Prescription —mail order $4 generic/$6 brand When you have a Claim Before submitting a claim for medical expenses, review this brochure and the bills you have accumulated. Be sure you are submitted itemized bills for which benefits are payable. Save all of your bills, including those being accumulated to satisfy a de- ductible. In most instances they will serve as evidence of your claim. Submit the original bill, not a copy. Each bill must be complete and item- ized and should show the patient's full name, date or dates of service, na- ture of the illness or injury, and type of service provided. Claim forms are available in the Risk Management office. A separate claim form is re- quired for each family member. Please mail all completed forms to: City of Huntington Beach Employee Health Plan Risk Management Division 2000 Main Street Huntington Beach, CA 92648 All claims must be received no later than 12 months from the date of ser- vice. Claims submitted after this time period will be rejected. Claims Payment and Appeals Notice of Decision A notice of decision will be sent to you within 30 days after receipt of a properly completed claim. If there is some reason your claim cannot be processed within that time, you will be given notice of the reason for the delay. Claim Appeal Procedure If your claim is denied in whole or in part, you and your physician will be provided with written notification explaining the reason. If you have rea- son to believe that the denial of your claim was not correct under the terms of the Plan Document, a request for review must be made within 60 days from the notice of the claim denial. The claim, as well as all supporting documentation, will be submitted to Medical Review for review by physi- cians at the Foundation for Medical Care. You and your provider will be notified in writing of the claim decision as soon as possible but not later than 120 days after receipt of the request. 15 2 5. Any illness or injury due to war, declared or undeclared, or any act of war is excluded 6. Any means of artificial fertilization, including but not limited to artificial insemination, in -vitro fertilization or gamete intra- fallopian transfer 7. Reversing prior surgical sterilization procedures 8. Any charges for weight control or weight reduction program 9. No benefits will be provided for any condition of pregnancy for dependent daughters. 10. Sales tax on prescription drugs or on any other covered item 11. No benefits will be provided for any mental health care. Mental health services are provided by Managed Health Network 12. Treatment, services, equipment, new technology, drugs, proce- dures or supplies considered experimental or investigational at the time the procedure is performed or service or supply is pro- vided 13. Air conditioners, dehumidifiers, air purifiers, arch supports, cor- rective or orthopedic shoes, heating pads, hot water bottles, home enema equipment, etc. are not covered. 14. Any items for which the participant is not legally required to pay, or for which a charge would not have been made if the participant did not have this coverage. 15. Benefits available under the Plan may be reduced or eliminated based upon the coordination of benefits or subrogation rules. 16. Charges for failure to keep a scheduled visit, completion of claim forms or providing supplemental information. 17. Charges for vitamins (except pre -natal vitamins), minerals, nutri- tional or food supplements or any other over the counter item. 18. Any charges not listed in `Covered Expenses" 19. Nursing Facility. Any services furnished by an institution which is primarily a place of rest, a place for the aged, a nursing or con- valescent home or any institution of like character, unless other- wise specifically provided for herein. 20. Smoking cessation program. 14 Definitions Calendar Year A period of twelve months commencing January 1 and ending December 31 of the same year. Custodial Care Means services or supplies for persons who are physically or mentally dis- abled but who are not currently receiving medical, surgical or psychiatric treatment to reduce their disability and to enable them to live without cus- todial care. Emereencv A sudden, unexpected, acute illness or injury that, without immediate medical treatment, could result in death or cause impairment to bodily functions. Extended Care or Skilled NursingFacility A licensed facility operating pursuant to law which is primarily engaged in providing skilled nursing care on an inpatient basis during the convales- cent state of illness or injury under 24 hours a day supervision of a physi- cian or registered graduate nurse. Such a facility must maintain complete medical records on each patient and have established methods and proce- dures for the dispensing and administering of drugs. In no event shall the term include a facility that is primarily: • A rest home, retirement home or home for the aged • A school or similar institution • Engaged in the care and treatment of substance abuse, or of mentally ill or senile persons • Engaged in custodial care Hos ital An institution operated pursuant to law that is accredited by the appropri- ate national regulatory body for hospital accreditation. It must be primar- ily engaged in providing medical, diagnostic and surgical facilities for the care and treatment of sick and injured individuals on an inpatient basis. It must also provide such facilities under the supervision of a staff of physi- cians and with 24 hour a day nursing services by registered graduate nurses. The definition of hospital shall not include any institution or part thereof which is used principally as a rest facility, extended care facility, nursing facility or facility for the aged. Inpatient A person who is confined in a hospital as a registered bed patient and who is charged at least one day's room and board by the hospital. Medical Necessary or Medical Necessity Describes medical treatment that: • Is appropriate and consistent with the diagnosis • Is in accordance with accepted medical standards, it would not have been omitted without adversely affecting the patient's condition or the quality of medical care rendered • Is not primarily custodial care Mental Health Disorder Any disorder characterized by abnormal functioning of the mind or emotions and in which psychological, intellectual, emotional or behav- ioral disturbances are the dominate features. Mental health disorders include mental disorders, mental illnesses, psychiatric illnesses, mental conditions and psychiatric conditions, whether organic or non -organic, whether biological, non -biological, genetic, chemical, or non -chemical origin, and irrespective of cause, basis or inducement. Nurse A licensed Registered Nurse (R.N.) or licensed Practical Nurse (LPN) or licensed Vocational Nurse (LVN) who does not live with the patient and is not a member of the family. Outpatient A person who is not admitted as an inpatient but who receives medical care. Outpatient Surgery Surgery performed on an outpatient basis at a hospital, ambulatory sur- gical facility, or physician's office. An ambulatory surgical facility is defined as a licensed, specialized facility, within or outside the hospital facility that meets the following criteria: Is established, equipped and operated in accordance with the applicable state laws and is primarily for the purpose of per- forming surgical procedures Is operated under the supervision of a Medical Doctor (M.D.) who is devoted full time to such supervision Requires, in all cases other than those requiring only local infiltration anesthetics, that a licensed anesthesiologist admin- ister the anesthetics and remain present through the surgery. Ph iys cian A duly licensed Doctor of Medicine (M.D.), Osteopath, Podiatrist, Chi- ropractor or any other practitioner providing a covered service and act- ing within the scope of his/her license. 4 General Exclusions and Limitations Benefits for the following shall not be covered: Occupational Injuries or Illnesses. Any illness or injury arising out of, or in the course of, employment is excluded. Unnecessa!y Services or Supplies. Any services or supplies not rea- sonably necessary for the medical care of the participant's illness or injury are excluded. Weekend Admissions. If admitted to the hospital on a Friday, Satur- day or Sunday, charges for these days will be excluded unless admit- ted due to an emergency or if surgery is performed within 24 hours. Excess of Usual. Customary and Reasonable. The portion of any charge for any services or supplies in excess of the reasonable and customary charge is excluded. Mouth and Teeth Conditions. Treatment on or to the teeth, extraction of teeth, treatment of dental abscesses or granuloma, dental examina- tion or treatment of gingival tissues other than for tumors is excluded. Hearing Aids. Examinations to determine the need for, or the proper adjustment of hearing aids, are excluded. Vision Care. Physicians services in connection with eye refractions or any other examinations to determine the need for, or the proper ad- justment of, eyeglasses or contact lenses are excluded. Radial keratot- omy, Lasik and similar procedures are also excluded. Cosmetic Surgery. Charges in connection with cosmetic surgery are excluded unless performed for the correction of functional disorders as a result of accidental injury occurring while the individuals are covered. Other General Exclusions: 1. Hospital admissions primarily for diagnostic study when in- patient care would not otherwise have been required. 2. Custodial care 3. Personal or convenience items 4. Services or supplies not connected with the care and treat- ment of an actual illness, disease or injury 13 Prescriptions All prescription drug payments shall be made through the Advance Prescrip- tion Card Service (PCS) and shall be on the basis of a copayment by the par- ticipant of $5 for each generic drug prescription or $8 for each brand name drug prescription. No payments for any prescription drug shall be made through the Employee Health Plan. Prescription drugs are available by mail order at a cost of $4 for generic and $6 for brand name prescriptions. Claims forms are available in the Risk Management Office. Chiropractic and Physical Therapy Guidelines Benefits are provided as follows: 3 times a week for the first month 2 times a week for the second month Once a week for the third month 2 times a month for fourth month and thereafter These guidelines may be modified on an individual case -by -case basis pur- suant to the recommendation of our Medical Advisor. Chiropractic Limitations Benefits will be provided to a maximum of 24 treatments per year or $2,000, whichever occurs first. Said limits are per person and commence January 1 of each year. Preventive Medical Care Benefits will be provided up to $200 per person for preventive medical care per year. This care shall include preventive medical options such as an an- nual physical exam, PAP tests, flu shots, chest x-rays, EKG, PSA and other diagnostic tests if certified by the physician that such procedures are in- cluded under a routine physical examination and are not in connection with the diagnosis or treatment of any illness or disease. Well Baby Exams Three well baby examinations for an infant for the first year of life will be allowed subject to the $200 maximum benefit. All innoculations for infants/ children will be provided and coverage is not limited to the $200 maximum benefit. 12 Plan Administrator The Risk Management Division is the Plan Administrator for purposes of this Plan's claims administration. Retiree Any retired employee of the City who (a) has retired on a service or dis- ability retirement and (2) is not eligible for Medicare, and (3) has not at- tained age 65. Usual, Customary and Reasonable Charges made for medical services or supplies essential to the care of the participant will be considered reasonable and customary if they are the amount normally charged by the provider for similar services and supplies and do not exceed the amount ordinary charged by most providers of com- parable services and supplies in the geographic area where the services or supplies are received. Whether charges are reasonable and customary shall be determined by the Plan Administrator or its agent in its sole dis- cretion by use of any customary or accepted method. In determining whether charges are reasonable and customary, the Plan Administrator will give due consideration to the nature and severity of the condition be- ing treated and any medical complications or unusual circumstances that require additional time, skill or expertise. Persons Covered and Effective Date 11. Speech therapy by a qualified speech therapist. The therapy must be to restore or rehabilitate speech loss due an illness or in - Those eligible are: jury, or due to surgery for an illness or injury. If speech loss is due to a congenital anomaly, surgery to correct the anomaly must • All permanent employees and their spouses have been performed prior to therapy. • Their unmarried children to age 19 12. Elective surgery for sterilization, including tubal ligation and va- • Unmarried children from age 19 to 25 if a) A full time student, or sectomy. 13. Medical supplies necessary for treatment including but not lim- (b) Lives at home and is dependent upon his/her ited to, an electronic heart pacemaker, surgical dressings, casts, parent for at least 50% of his/her support splints, and crutches. 14. Surgeon's fees for the performance of surgical procedures, in - New permanent employees are eligible to participate in the Employee cluding necessary related postoperative care by a physician, sub - Health Plan on the first of the month following 30 days from the date of ject to the reasonable and customary fees in the area. hire. 15. Wellness care (see Highlights section for details) 16. Chiropractic and Physical Therapy subject to Plan limitations Effective Date of Dependent Coverage 17. Occupational Therapy performed by a licensed occupational Check with the Human Resources Division when you want to enroll a new therapist and ordered by a physician. It must be considered pro - spouse or new child. Appropriate forms must be completed within 60 gressive therapy, not maintenance therapy, and must not be per - days of marriage, birth of a child or when the employee becomes legally formed for the purpose of vocational rehabilitation. Covered ex - responsible for an adopted child. Dependent coverage will be effective on penses do not include either recreational programs or supplies the date of marriage, date of birth or the newborn child or the date of used in occupational therapy. adoption or the date of placement of an adopted child in your home. 18. Emergency services. In the event of emergency services, the Plan will pay at the PPO rate for Non PPO providers. Emergency Change in Family Status service is defined as follows: services which are immediately Once you are enrolled in the Employee Health Plan, you must notify the required to treat a sudden serious and unexpected illness or in - Plan Administrator or Human Resources Division within 60 days of any jury, including services to alleviate pain associated with sudden, family status change, such as a newborn baby, or when you no longer need serious and unexpected illness and/or injury. a certain family member covered, or when a family member is no longer eligible as defined by this Plan. Notice to Employees Waiving Coverage If you decide to decline coverage under this Plan for yourself or your Eli- gible Dependents for whatever reason, you must execute a waiver of cov- erage on a form provided by the Human Resources Division at the time coverage is declined, and return such form to Human Resources. If you are declining enrollment for yourself or your Eligible Dependents because of other health insurance coverage, you may, in the future, be able to enroll yourself or your Eligible Dependents in the Plan, provided that you request enrollment within thirty (30) days after your other coverage ends. 6 11 Covered Medical Expenses List of Covered Medical Expenses The following expenses are covered by the Plan. Reimbursement is based upon the lifetime maximum and calendar year limits, benefit percentages and other limitations previously described in the Highlights section. 1. Charges for services and supplies used in the administration of anesthesia, when not duplicated in the hospital charges. 2. Transportation by a professional ambulance service to a local hospital or convalescent facility for inpatient care, if medically necessary, or to the nearest hospital for emergency care. Ex- penses for transportation by air will be covered only if an air am- bulance is medically necessary. The first $50 of charges will be paid at 100%. 3. Rental or durable medical equipment when such equipment is deemed medically necessary, including, but not limited to, a wheelchair, hospital bed, respirator, and equipment for the ad- ministration of oxygen. Such equipment may be purchased, if, in the judgment of the Plan Administrator, purchase of the equip- ment would be less expensive than rental or the equipment is not available for rental. 4. Hospital room and board, at the semi -private hospital room and board rate. If medical necessity requires an intensive care or in- termediate care unit, the Plan will cover the room and board rate charged by the hospital. 5. Other hospital services and supplies furnished by the hospital for medical care during confinement, exclusive of physician's and other professional services. 6. Radiology (x-rays) and laboratory charges in connection with treatment of an illness or injury. 7. Outpatient surgery charges for necessary services and supplies for surgical procedures performed on an outpatient basis at a hos- pital, ambulatory surgical facility, or physician's office, provided that benefits for such charges would be payable if the procedure were performed during a hospital confinement. 8. Physician's fees for medical care and treatment of an illness or injury covered under the terms of this Plan 9. Prescription drugs necessary for the treatment of an illness or in- jury, if obtainable only on a physician's written prescription and dispensed by a licensed pharmacist. 10. X-ray and, radium treatments, and treatments with other radioac- tive substances. Preferred Provider Organization (PPO) Exclusive Provider Organization (EPO) The Preferred Provider Organization (PPO) and Exclusive Provider Or- ganization (EPO) is a statewide network of physicians, hospitals and other health care providers established specifically to provide comprehensive medical service to Plan participants at reduced rates. As a participant in the Plan, you will receive a directory of providers that belong to the PPO and EPO networks. If you choose the PPO/EPO option, please follow the procedures for its use carefully. If your doctor refers you to another provider, make sure that the new provider is also an EPO or PPO before services are rendered. The copayments and applicable benefit percentages are shown in the Highlights section. If you go to a PPO provider, do not pay for services at the time of your visit. PPO providers are required to submit their medical bills to the Employee Health Plan first. The Employee Health Plan will then calculate the Usual, Customary and Reasonable (UCR) rate and then issue an Explanation of Benefits (EOB) to the PPO and the participant. The PPO provider will then issue a statement to the participant for the co - payment and deductible if applicable. If you go to an EPO, the provider may request payment of the $5 copay at the time of your visit. You are not responsible for any other charges other than the $5 copay. If you are admitted to a hospital, your copay will be $150 per day to a maximum of $600 per period of hospitalization. 10 7 Deductibles and Out of Pocket Expenses Family Out of Pocket Expense Deductibles and out of pocket expenses represent the portion that the par- If the dollar amount of the family out of pocket expense amount, shown in ticipant pays for covered expenses. This section generally describes these the Highlights section, is satisfied by the combined covered expenses ap- plied to the individual out of pocket expense amount of several covered cost sharing provisions of the Plan, family members, no additional out of pocket expense amount is required Calendar Year Deductible to be satisfied by the covered persons of that family for the remainder of The calendar year deductible is the amount of covered expenses incurred the calendar year. Once a covered family member has satisfied the individ- by a participant during a calendar year for which no benefits will be paid. ual out of pocket expense amount no additional covered expenses for that After you, or a covered dependent, has satisfied the calendar year deducti- person will be counted towards the family out of pocket expense amount. ble, the Plan pays a certain percentage of the covered expenses for that individual during the rest of the calendar year. Deductible accumulation period is January 1 through December 31. Family Calendar Year Deductible If the dollar amount of the family calendar year deductible, shown in the Highlights section, is satisfied by the combined covered expenses applied to the individual deductibles of several covered family members, no addi- tional calendar year deductible amount is required to be satisfied by the covered persons of that family for the remainder of the calendar year. Once a covered family member has satisfied the individual deductible, no additional covered expenses for that person will be counted toward the family deductible. Three Month Carryover Any covered expenses incurred in the last three months of the calendar year that are used to satisfy the calendar year deductible for that year will be applied towards to deductible for the following year. Out of Pocket Expenses Out of pocket expense is the amount of covered expenses you must pay after the satisfaction of the calendar year deductible before certain benefits begin to be paid at 100%. If, during the calendar year, your out of pocket expenses satisfy the out of pocket expense amount, the rate of payment for certain covered charges will be increased to a full one hundred percent (100%). The one hundred percent (1001/6) will continue until the end of that calendar year. You must satisfy your deductible plus your out of pocket amount before these benefits will be paid at 100%. In no event will this provision apply to the deductible, any expenses for treatment of a mental/emotional disorder and/or substance abuse, charges for prescription drugs, charges that exceed Usual, Customary and Reason- able charges, or the EPO copayments. LL Ln Ch m in o in a� . a� 0 E CD TABLE OF CONTENTS PART1- DEFINITIONS...........................................................................................................1 A. "CALENDAR YEAR"............................................................................................................... 1 B. "SKILLED NURSING FACILITY"................................................................................................ 1 C. "EFFECTIVE DATE"............................................................................................................... 1 D. "FAMILY MEMBER"................................................................................................................ 1 E. "LEGALLY OPERATED HOSPITAL".......................................................................................... 1 F. "MASCULINE GENDER"....................................................................................................... 1 G. "PARTICIPANT"...........................................................................................................I. .... 2 H. "PHYSICIAN" OR "SURGEON"................................................................................................ 2 1. "EMPLOYEE".......................................................................................................................... 2 J. "PLAN"........................................................................................................................ ..... 2 K. "CITY".................................................................................................................................. 2 L. "RETIREE"............................................................................................................................ 2 M. "ACCIDENT"......................................................................................................................... 2 N. "RELATIVE VALUE STUDIES (RVS),'....................................................................................... 2 O. "MEDICALLY NECESSARY".................................................................................................... 2 P. "USUAL, CUSTOMARY AND REASONABLE (UCR) CHARGE" ..................................................... 2 Q. "SECOND SURGICAL OPINION".............................................................................................. 3 R. "PPO OR PPO PROVIDER"................................................................................................... 3 S. "NON-PPO PROVIDER"......................................................................................................... 3 T. "SUBSIDIZED RETIREE"......................................................................................................... 3 U. "CLAIMS ADMINISTRATOR".................................................................................................... 3 V. "CUSTODIAL CARE".............................................................................................................. 3 W. "MENTAL OR NERVOUS DISORDERS"..................................................................................... 3 X. "TOTALLY DISABLED"............................................................................................................ 4 Y. "UTILIZATION REVIEW".......................................................................................................... 4 Z. "UTILIZATION REVIEW ORGANIZATION"................................................................................... 4 AA. "HOSPITAL PRE -ADMISSION NOTIFICATION"......................................................................... 4 BB. "MEDICAL REVIEW ADVISERS"............................................................................................ 4 CC. "SUBSTANCE ABUSE"........................................................................................................ 4 PART II - ELIGIBILITY AND RECORDS................................................................................. 4 A. ELIGIBLE PARTICIPANTS......................................................................................................... 4 B. ADDING FAMILY MEMBERS..................................................................................................... 4 C. PRE-EXISTING CONDITIONS.................................................................................................... 5 D. RETIREES............................................................................................................................. 5 E. FAMILY MEMBERS BECOMING INELIGIBLE............................................................................. 6 F. BENEFIT BOOKLET................................................................................................................. 6 PART III - CONDITIONS UNDER WHICH BENEFITS WILL BE PAYABLE IN A HOSPITAL OR SKILLED NURSING FACILITY......................................................................................... 6 A. CARE FOR ILLNESS OR ACCIDENT........................................................................................... 7 B. BED CARE............................................................................................................................ 7 C. EFFECTIVE DATE................................................................................................................... 7 TABLE OF CONTENTS D. IDENTIFICATION CARD............................................................................................................ 7 E. DAYS OF CARE...................................................................................................................... 7 F. MEDICALLY NECESSARY SERVICES......................................................................................... 7 PART1V - EXCLUSIONS.........................................................................................................7 A. DIAGNOSTIC STUDY............................................................................................................... 7 B. RECOVERABLE BENEFITS.......................................................................................................7 C. SERVICES/SUPPLIES..............................................................................................................8 D. NO CHARGE SERVICES/SUPPLIES........................................................................................... 8 E. UNITED STATES FEDERAL OR FOREIGN GOVERNMENT AGENCY ................................................ 8 F. SERVICES SUPPLIES NOT SPECIFIED HEREIN........................................................................... 8 G. CARE AND TREATMENT OF ACTUAL ILLNESS/INJURY................................................................ 8 H. TREATMENT TO THE TEETH/EYES/EARS.................................................................................. 8 1. COSMETIC........................................................................................................................... 8 J. ACTS OF WAR........................................................................................................................ 8 K. NURSING FACILITIES.............................................................................................................. 8 L. CUSTODIAL CARE................................................................................................................. 8 M. MEDICARE............................................................................................................................8 N. SEX TRANSFORMATIONS........................................................................................................ 9 O. RECONSTRUCTION OF STERILIZATION PROCEDURE.................................................................. 9 P. CHARGES IN EXCESS OF UCR................................................................................................ 9 Q. EXPERIMENTAL..................................................................................................................... 9 R. PREGNANCY FOR DEPENDENT DAUGHTERS............................................................................. 9 S. OUTPATIENT PSYCHIATRIC CARE............................................................................................ 9 T. SUPPLIES............................................................................................................................. 9 U. WEIGHT CONTROL.................................................................................................................9 V. SERVICES PROVIDED BY MEMBERS OF HOUSEHOLD................................................................ 9 W. UNKEPT APPOINTMENTS....................................................................................................... 9 X. FALSE STATEMENTS.........................................................................................................10 Y. SERVICES OR SUPPLIES.......................................................................................................10 Z. TREATMENT BY OTHER THAN A LICENSED PHYSICIAN.............................................................10 AA. DISCOUNTS THROUGH ANOTHER PLAN...............................................................................10 BB. RESIDENTS/INTERNS.........................................................................................................10 CC. INJURY INCURRED DURING COMMISSION OF A CRIME...........................................................10 DD. IRS REGULATIONS............................................................................................................10 EE. HYPNOSIS.........................................................................................................................10 FF. DIGESTIVE AIDS, VITAMINS, SUPPLEMENTS.........................................................................10 GG. SMOKING CESSATION........................................................................................................10 HH. SPAS OR SWIMMING POOLS..............................................................................................10 11. MANAGED HEALTH NETWORK...............................................................................................10 PART V - COORDINATION OF BENEFITS..........................................................................11 A. BENEFITS............................................................................................................................11 B. DEFINITIONS........................................................................................................................11 1. "CLAIMS DETERMINATION PERIOD"....................................................................................11 2. "COVERED INDIVIDUAL"....................................................................................................11 TABLE OF CONTENTS 3. "COVERED SERVICES...................................................................................................... 11 4. "THIS DOCUMENT............................................................................................................. 11 5. "PLAN"...........................................................................................................................11 C. EFFECT ON BENEFITS.......................................................................................................... 11 D. FACILITY OF PAYMENT......................................................................................................... 13 E. RIGHT OF RECOVERY........................................................................................................... 13 F. RIGHT TO RECEIVE AND RELEASE NECESSARY INFORMATION.................................................13 PART VI - CONTINUATION BENEFIT..................................................................................14 PART VIl - GENERAL PROVISIONS....................................................................................15 A. PLAN DOCUMENT................................................................................................................ 15 B. WORKER'S COMPENSATION INSURANCE............................................................................... 15 C. CHIROPRACTOR OR PSYCHOLOGIST...................................................................................... 15 D. CHARTER............................................................................................................................ 15 E. EMPLOYER RESPONSIBILITY FOR FURNISHING HOSPITAL CARE .............................................. 16 F. DUPLICATE COVERAGE........................................................................................................ 16 1. NOTICE OF CLAIM.................................................................................................................. 16 J. PRESCRIPTIONS................................................................................................................... 16 G. NON TRANSFERABLE BENEFITS........................................................................................... 16 H. LIMITATION OF LIABILITY....................................................................................................... 16 PART VIII - SECOND OPINION SURGICAL PROGRAM.....................................................17 A. DEFINTION, EFFECTIVE 1-1-84................................................:............................................ 17 B. ELECTIVE SURGERY............................................................................................................ 17 C. BOARD CERTIFIED............................................................................................................... 17 D. SECOND OPINION FEES PAID BY PLAN.................................................................................. 18 E. COVERAGE BY EMPLOYEE ORGANIZATION............................................................................. 18 PART1X - BASIC BENEFITS................................................................................................18 A. DEFINITION.......................................................................................................................... 18 B. SUBSTANCE ABUSE TREATMENT.......................................................................................... 18 C. OUT -PATIENT PRE -HOSPITAL ADMISSION TESTING................................................................ 18 D. OUT -PATIENT SURGERY...................................................................................................... 18 E. BASIC PROFESSIONAL BENEFITS.......................................................................................... 19 F. AMBULANCE BENEFIT.......................................................................................................... 20 G. PREVENTATIVE MEDICAL CARE............................................................................................ 20 PARTX - MAJOR MEDICAL................................................................................................ 21 A. DEFINITION.......................................................................................................................... 21 B. SPECIAL CONDITIONS IN REGARD TO HOSPITAL BENEFITS...................................................... 23 C. BENEFITS FOR SERVICES AND SUPPLIES IN ELIGIBLE SKILLED NURSING FACILITIES ................. 24 D. CARE FOR CONDITIONS OF PREGNANCY................................................................................ 25 E. CHIROPRACTIC AND PHYSICAL THERAPY GUIDELINES............................................................ 25 F. TREATMENT BY CALIFORNIA LICENSED CERTIFIED ACUPUNCTURIST ........................................ 25 G. SUBSIDIZED RETIREE BENEFITS........................................................................................... 25 H. MUNICIPAL EMPLOYEES ASSOCIATION(MEA) ....................................................................... 25 TABLE OF CONTENTS PART XI - RETIREE SUBSIDY MEDICAL PLAN..................................................................25 A. ELIGIBILITY..........................................................................................................................25 B. SCHEDULE OF BENEFITS...................................................................................................... 26 C. BENEFIT SUMMARY.............................................................................................................. 29 D. MISCELLANEOUS PROVISIONS / ELIGIBILITY........................................................................... 29 BENEFITS............................................................................................................................. 31 SUBSIDIES............................................................................................................................ 31 MEDICARE............................................................................................................................ 31 CANCELLATION..................................................................................................................... 32 PART XII - TERMINAL BENEFITS........................................................................................ 32 A. BENEFIT CONTINUANCE AT TIME OF TERMINATION OF EMPLOYMENT ....................................... 33 B. TERMINAL BENEFITS FOR TOTAL DISABILITY.......................................................................... 33 C. DEFINITION OF TOTAL DISABILITY.......................................................................................... 33 D. EXCLUSION OF TERMINAL BENEFITS..................................................................................... 33 PART XIII - ADMINISTRATION OF THE PLAN....................................................................33 A. APPOINTMENT OF THE CLAIMS ADMINISTRATOR..................................................................... 33 B. POWERS OF THE CLAIMS ADMINISTRATOR............................................................................. 33 C. CLAIMS PROCEDURE............................................................................................................ 34 D. APPEAL PROCEDURE........................................................................................................... 34 E. LIMITATION OF LIABILITY....................................................................................................... 35 PART XIV - DURATION AND AMENDMENT OF THE PLAN.............:.................................35 A. PERMANENCE OF THE PLAN.................................................................................................. 35 B. RIGHT TO AMEND................................................................................................................. 35 C. SEVERABILITY..................................................................................................................... 35 PART XV - ADMINISTRATIVE PROVISIONS....................................................................... 36 A. MANAGEMENT RIGHTS......................................................................................................... 36 B. PARTICIPANT'S RESPONSIBILITIES......................................................................................... 36 C. MISSING PERSON................................................................................................................36 D. GOVERNING LAW.................................................................................................................36 AMENDMENTNO. 1.............................................................................................................37 AMENDMENTNO. 2.............................................................................................................38 AMENDMENTNO. 3.............................................................................................................39 AMENDMENTNO.4.............................................................................................................40 AMENDMENTNO. 5.............................................................................................................41 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. PART I - DEFINITIONS A. "Calendar Year" - Is the twelve-month period commencing January 1 st of each year at 12:01 A.M., Pacific Standard Time. B. "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. "Effective Date" - Is the date on which this Document becomes effective. D. "Family Member" - Shall be the spouse of the Employee and children from birth to nineteen (19) years of age, provided such children are unmarried, and dependent upon the Employee for support and maintenance. Refer to Part II, Eligibility and Records, Section E for further clarification. The term "children" shall include natural children, legally adopted children, and stepchildren. E. "Legally Operated Hospital" - Is an institution operated in accordance with the laws of the jurisdiction in which it is located pertaining to institutions identified as hospitals and which, for compensation from its patients and on an inpatient basis, is primarily engaged in providing diagnostic and therapeutic facilities for surgical and medical diagnosis, treatment and care of injured and sick persons by or under the supervision of a staff of licensed physicians or surgeons, and which continuously provides 24 hours a day nursing service by 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. "Masculine Gender" - Includes the feminine in context. G. "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. 0011662.01 4- 04/24/95 8:49 AM EMPLOYEE HEALTH PLAN DOCUMENT H. "Physician" or "Surgeon" - Is one who is duly licensed (1) to prescribe and administer drugs, and (2) to perform surgery within the scope of his license. Physicians include Acupuncturists, Chiropractors, and Physical Therapists when acting within the scope of their license. 1. "Employee" - Means all permanent employees of the City of Huntington Beach working at least 20 hours per week. J. "Plan" - Means Huntington Beach Employee Health Plan. K. "City" - Means City of Huntington Beach. L. `Retiree" - Means any retired Employee of the City who (1) has retired on a service or disability retirement, and (2) is not eligible for Medicare, and (3) has not attained age 65. M. "Accident" - Means a sudden, unexpected and unplanned event occurring by chance which is caused by an independent external force and which results in definite physical trauma. N. `Relative Value Studies (RVS)" - Is a listing of medical and surgical procedures published by the California Medical Association with "Units" assigned to each procedure in accordance with various medical criteria. The City provides benefits which are valued by assigning a monetary value to the RVS Unit for covered procedures. O. "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. 0011662.01 -2- 04/24/95 8:49 AIM EMPLOYEE HEALTH PLAN DOCUMENT Q. "Second Surgical Opinion" - Means certain surgical procedures done on an elective basis shall be mandated to have a second surgical opinion in order to be payable at normal plan benefits, as specified in this Plan Document. These surgical procedures are as listed: Cataract Surgery Varicose Vein Ligation Cholecystostomy Tonsillectomy & Adenoidectomy Hernia Repair Knee Surgery (Menisectomy) Hysterectomy Hemorrhoidectomy Laminectomy Dilation and Curettage Mastectomy Repair of Deviated Septum Onychotomy Spinal Fusion Prostatectomy R. "PPO or PPO Provider" - A doctor or other health care professional or hospital who belong to the Orange County Foundation Preferred Provider Organization (OCPPO) or similar organization if OCPPO is replaced. S. "Non-PPO Provider" - A doctor, hospital, or other health care professional not belonging to the Orange County Preferred Provider Organization. T. "Subsidized Retiree" - A subsidized retiree is an employee, who, at the time of retirement has a minimum of ten years of continuous City service or is granted an industrial disability retirement and elects to participate in the Retiree Subsidy Medical Plan. U. "Claims Administrator" - Means the person(s) with whom the City has contracted to provide the services described in Section XIII. V. "Custodial Care" - Means services or supplies provided for persons who are physically or mentally disabled but who are not currently receiving medical, surgical or psychiatric treatment to reduce their disability and to enable them to live without Custodial Care W. "Mental or Nervous Disorders" - Are those conditions listed in the International Classification of Diseases in the section on Mental Disorders (Diagnostic Codes 290-319), including drug or alcohol intoxification or dependence and learning problems. These disorders may be of physical or functional etiology. X. `Totally Disabled" - Is physically prevented from engaging in his or her regular or customary occupation. A Dependent is Totally Disabled if prevented solely because of Sickness or Injury, from engaging in substantially all of the normal activities of an individual of similar age. Certification of Total Disability must be made by a Physician. 0011662.01 -3- 04/24/95 8:49 AM EMPLOYEE HEALTH PLAN DOCUMENT Y. "Utilization Review" - Means systematically evaluating the appropriateness and necessity of medical care. Utilization Review consists of, but is not limited to: 1. Pre -certifying the appropriateness and necessity of non -emergency confinements; 2. Reviewing, on a concurrent basis, the continued appropriateness and necessity of confinement or home health care; 3. Determining the necessity of second opinions for Elective Surgical Operations; and 4. Providing case management services. Z. "Utilization Review Organization" - Means the organization that conducts Utilization Review for the Plan. AA. "Hospital Pre -Admission Notification" - Means complying with all the rules set forth by the Utilization Review Organization. BB. "Medical Review Advisers" - Means the consultants of employees hired by the Utilization Review Organization or Claim Administrator to provide advise as to whether services are Medically Necessary. CC. "Substance Abuse" - Means conditions listed in the International Classification of Diseases as alcoholic psychoses, drug psychoses, alcohol dependence syndrome, drug dependence or non-dependent abuse of drugs (Diagnostic Codes 291 through 292.9 and 303 through 305.9). PART II - ELIGIBILITY AND RECORDS A. Eligible Participants - Shall be all permanent Employees and Retirees. B. Adding Family Members - 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 except during open enrollment. 0011662.01 -4- 04/24/95 8:49 AM EMPLOYEE HEALTH PLAN DOCUMENT C. Pre -Existing Conditions - The Medical Plan shall exclude coverage of pre-existing medical conditions of new employees and dependents, except under the following conditions: 1. 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. 2. A pre-existing condition of the employee is covered after the employee completes six month of continuous employment. 3. 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. D. Retirees - All Retirees and their eligible Dependents shall be covered if: 1. They were approved for coverage and covered by the prior plan on October 31, 1979. 2. They retired on or after 11 /1 /79, 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 cost, 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 Plan, the retiree can elect to cancel his insurance coverage and be insured as a dependent of his spouse. Upon the spouse's termination of City insurance benefits, the retiree can, without evidence of insurability, become reinstated to the Employee Health Plan at his own cost. E. Family Members Becoming Ineligible - Family members become ineligible under the following circumstances: 1. When the Participant becomes ineligible. 2. When a child attains the age of nineteen years, or 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 here under shall continue while he remains in such status 0011662.01 -5- 04/24/95 8:49 AM EMPLOYEE HEALTH PLAN DOCUMENT until he attains age twenty-three; Effective 1-1-86 the definition of dependent child is changed to require that children between the ages of nineteen to twenty-three be either: 1) A full time student or 2) Lives at home and are dependent on the parent/employee for more than fifty percent (50%) of his/her support. b. In respect to an unmarried child attaining the age of nineteen years, or twenty-three years when qualifying as set forth in Paragraph a. above, should he at such time be incapable of self-sustaining employment by reason of mental retardation or physical handicap and continue to be dependent upon his parent(s) to the extent of not less than fifty percent of his subsistence and support, his eligibility for benefits hereunder shall continue regardless of his age while he remains in such status. Evidence of such incapacity and dependency shall be required within thirty-one days of the dependent's attainment of age nineteen years or twenty-three years whichever is applicable, and periodically thereafter as may be required by the Claims Administrator, but not more frequently than annually after a two-year period following such dependent's attainment of the aforementioned age limitation. Determination of eligibility by the Claims Administrator shall be conclusive. 3. A spouse upon entry of final decree of divorce or annulment. F. Benefit Booklet - 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. PART III - CONDITIONS UNDER WHICH BENEFITS WILL 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. Care for Illness or Accident - Benefits shall be provided for expenses incurred in connection with illness or accident, but limited to those expenses billed by the Hospital or Skilled Nursing Facility which are necessary for treatment of the condition requiring such care. B. Bed Care - The attending Physician or Surgeon must certify that bed care is Medically Necessary. C. Effective Date - Admission must occur on or after the Participant's or Family Member's Effective Date hereunder. D. Identification Card - 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 0011662.01 -6- 04/24/95 8:49 AM EMPLOYEE. HEALTH PLAN DOCUMENT beyond the control of the patient, benefits will be allowed only if claim is made within ninety days from date of admission or thirty days from date of discharge, whichever is later, accompanied by a receipted bill and such supporting statements as are necessary to establish the claim. E. Days of Care - Days of care under the above provisions shall be counted against total days of care available under this Document. F. Medically Necessary Services - Services for inpatient bed care must be Medically Necessary and not capable of being performed on an outpatient basis. PART IV - EXCLUSIONS Benefits shall not be provided for: A. Diagnostic Study - Admissions primarily for diagnostic study when inpatient bed care would not otherwise have been required, unless otherwise specified herein. B. Recoverable Benefits - 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/Supplies - Services or supplies for which the participant or family member is not legally required to pay. D. No Charge Services/Supplies - Services or supplies for which no charge is made. E. United States Federal or Foreign Government Agency - Care or treatment obtained from, or for which payment is made by, any United States Federal or foreign government agency. F. Services Supplies not Specified Herein - Services or supplies not specifically provided for herein. G. Care and Treatment of Actual Illness/Injury - Services or supplies not connected with care and treatment of an actual illness, disease or injury. H. Treatment to the Teeth/Eyes/Ears - Treatment on or to the teeth, extraction of teeth, treatment of dental abscess or granuloma, dental examinations, or treatment of gingival tisues (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. 0011662.01 -7- 04/24/95 8:49 AM EMPLOYEE HEALTH PLAN DOCUMENT 1. Cosmetic - 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. I Acts of War - 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. Nursing Facilities - 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. L. Custodial Care. M. Medicare - Any services or supplies payable by Medicare, whether or not claim for such Medicare benefits is made. On the first of the month in which the Participant or eligible dependent who becomes age 65 or on the date the Participant can first apply and become eligible for any type of Medicare coverage (whether or not such application is made), benefits under this Document will be modified and reduced so as to supplement Medicare coverage. N. Sex Transformations - 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. O. Reconstruction of Sterilization Procedure - Reconstruction of prior surgical sterilization procedures. P. Charges in Excess of UCR - 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 non -covered therapy will be considered non -covered. R. 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. Supplies - Orthopedic Shoes (except when joined to braces) or shoe inserts, air purifiers, air conditioners, humidifiers, exercise equipment and supplies for comfort, 0011662.01 -a- 04/24/95 8:49 AM EMPLOYEE HEALTH PLAN DOCUMENT hygiene or beautification, educational services, nutritional counseling or food supplements. U. Weight Control - Any charges for weight control or weight reduction procedures. V. Services Provided by Members of Household - Charges for services furnished by Immediate Relatives or members of the patient's household. W. Unkept Appointments - Charges for unkept appointments, completion of claim forms or providing supplementary information or interviews in which the patient is not seen. X. False Statements - Services payable by reason of any false statement. Y. Services or Supplies - Services or supplies that were incurred prior to the date the Employee or Dependent became covered or after termination of coverage, except as otherwise specified. Z. Treatment by Other Than a Licensed Physician - Treatment by anyone except a Physician acting within the scope of his or her license. AA. Discounts Through Another Plan - PPO discounts through another plan. BB. Residents/Interns - Residents or interns of a Hospital. CC. Injury Incurred During Commission of a Crime - Treatment for any injury incurred in the commission of a crime. DD. IRS Regulations - Services not deductible under Section 213 of the Internal Revenue Code. EE. Hypnosis. FF. Digestive Aids, Vitamins, Supplements - Digestive aids, vitamins, laetrile, or mineral supplements, whether taken orally or injected, regardless of whether they are prescribed by a physician. GG. Smoking Cessation - Smoking cessation programs. HH. Spas Or Swimming Pools. 11. Managed Health Network - Inpatient mental health care and substance abuse/detoxification will be provided by Managed Health Network, effective March 1, 1994. This applies to POA/PMA/MEO/MEA/NA/MSOA employees. 0011662.01 -9- 04/24/95 8:49 AM EMPLOYEE HEALTH PLAN DOCUMENT PART V - COORDINATION OF BENEFITS A. Benefits - All of the benefits provided by the Plan are subject to the following provisions and limitation. B. Definitions: 1. "Claims Determination Period" - Is a period beginning with any January 1st and ending at 12 o'clock midnight on the next succeeding December 31 st, 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 benefits that would be payable under this Document in the absence of this provision for the allowable expenses incurred during such claim determination period shall be reduced to the extent necessary so that the sum of (a) such reduced benefits and (b) all the benefits payable for such allowable expenses under all other Plans shall not exceed one hundred percent of Covered Services under all Plans. 2. The services due or the benefits payable under this Document shall be reduced in accordance with the foregoing Subsection I. When the covered individual's other Plan: a. Does not contain a Coordination of Benefits provision. 0011662.01 -10- 04/24/95 8:49 AM 3 EMPLOYEE HEALTH PLAN DOCUMENT b. The other Plan has a Coordination of Benefits provision similar to this, and 1) this Document covers the individual as a dependent while the other Plan covers him as an Employee; or 2) this Document covers the Participant as the child of a female Participant while the other Plan covers him as the child of a male Employee; or 3) this Document covers the Participant as the child of a male Participant who has been legally separated or divorced from the mother while the other Plan covers him as the child of the employed mother, except that if valid evidence is submitted establishing that the natural father has legal custody of the dependent child, then in such case the order of benefits determination shall be reversed; or 4) this Document covers the individual as a dependent child of a male Participant who has been divorced from the subsequently remarried mother while the other Plan covers him as the dependent step -child of the Employee step -father except that if valid evidence is submitted establishing that the natural father has legal custody of the dependent child, then in such case the order of benefits determination shall be reversed; or 5) this Document covers the individual as a Participant while the other Plan covers him as an Employee, and the other Plan has covered him for a longer period of time; or 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. Effective January 1, 1987 the Department of Insurance has implemented new Order of Benefit Determination rules called the Birthday Rule. a. Except for cases of dependent children of divorced or separated parents, the health plan of the person whose birthday (month and day, not year) falls earlier in the calendar year will pay first and the plan of the other person covering the dependent will be the secondary payer. b. If persons with the two plans covering the same dependents have the same birthday, the plan of the person which has had coverage longer is the primary payer. c. If one of the two plans has not adopted the Birthday Rule (such as if one plan is in another state) the rules of the plan without the Birthday Rule will determine which plan is primary and which is secondary. d. The divorced/separated parent rule specifies that the health plan of the parent with court ordered financial responsibility is not established the plan of the parent with custody is the primary payer. 0011662.01 -11- 04/24/95 8:49 AM EMPLOYEE HEALTH PLAN DOCUMENT 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 each service rendered shall be deemed to be both a covered service and a benefit paid. The reasonable cash value of any services provided to the covered individual by any service organization shall be deemed an expense incurred by said individual, and the liability of the Claims Administrator under this Document will be reduced accordingly. D. Facility of Payment - Whenever payments which should have been made under this Document in accordance herewith have been made under any other Plans, the Claims Administrator shall have the right, -exercisable alone and in its sole discretion, to pay over to any organizations making such other payments, any amounts it shall determine to be warranted in order to satisfy the intent of this provision. Any amounts so paid shall be deemed to be benefits paid under this Document and to the extent of such payments, the Claims Administrator shall be fully discharged from liability under this Document. E. Right of Recovery - Whenever payments for covered services have been made by the Claims Administrator and said payments exceed the maximum amount of payment necessary to satisfy the intent of this provision, irrespective of to whom paid, the Claim Administrator shall have the right to recover such excessive amounts from any persons to, or for, or with respect to whom such payments were made, or from any Insurance Company, or any other organizations or persons. F. Right 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. PART VI - CONTINUATION BENEFIT In accordance with the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), continuation benefits will be offered to Participants who experience a qualifying event. 0011662.01 _12_ 04/24/95 8:49 AM EMPLOYEE HEALTH PLAN DOCUMENT The following will be considered qualifying events for the purposes of determining eligibility for continuation benefits due to loss of health care coverage: A. Termination of employment (except for gross misconduct); B. Reduction of work hours; C. Death of Employee or Retiree; D. Divorce or legal separation of Employee or Retiree; E. Dependent child ceasing to be eligible; or F. Bankruptcy proceedings, but only with respect to Retirees. A qualified beneficiary is a Participant who was covered for medical benefits on the date of the qualifying event who, because of the qualifying event, would no longer be covered for benefits as specified by the Plan. If a qualifying event occurs, this Plan will be offered to the qualified beneficiary(ies) until the earliest of the following dates: A. Eighteen (18) months from the date of qualifying events (a) or (b), except this period may be extended for an additional eleven (11) months if the qualified beneficiary notifies the Personnel Division that the Social Security Administration has determined that the qualified beneficiary was disabled as of the date • of the qualifying event. Such notice must be received within sixty (60) days of the date of determination and before the expiration of the initial eighteen (18) month period. The qualified beneficiary is responsible for notifying the Personnel Division within thirty (30) days of the date of any final determination that they are no longer disabled; B. Thirty-six (36) months from the date of qualifying event (c), (d), or (e); C. The end of the period for which contributions were made; D. The date the qualified beneficiary(ies) first becomes covered under another group health plan or entitled to Medicare, except that if the other group health plan excludes or limits a pre-existing condition of the qualified beneficiary, coverage may be continued during the first eighteen (18) months of entitlement to Medicare due to end -stage renal disease; E. The date the City no longer provides group health coverage to any of its Employees; or F. In the case of a bankruptcy proceeding, the date of death of the qualified beneficiary, or in the care of the surviving spouse or dependent children, thirty-six (36) months after the date of death. 0011662.01 -13- 04/24/95 8:49 AM EMPLOYEE HEALTH PLAN DOCUMENT The qualified beneficiary(ies) electing coverage are responsible for the payment of contributions, plus any additional amounts permitted by law. The qualified - beneficiary(ies) must enroll for continuation benefits within sixty (60) days of notification. The qualified beneficiary(ies) will be allowed forty-five (45) days from the date of enrollment to submit payment for all contributions due. Thereafter, the qualified beneficiary(ies) will be allowed a thirty (30) day grace period in which to submit contributions. PART VII - GENERAL PROVISIONS A. Plan Document - This Document, and the individual applications of Employees shall constitute the entire Agreement between the parties and all statements made by the City or by any individual Participant shall, in the absence of fraud, be deemed representations and not warranties, and no such statement shall be used in defense to a claim under this Agreement unless it is contained in a written application. B. Worker's Compensation Insurance - This Medical Benefit Plan is not in lieu of and does not affect any requirement for, or coverage by Workers' Compensation Insurance. C. Chiropractor or Psychologist - 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. Charter - 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. Employer Responsibility for Furnishing Hospital Care - The Employer and Claims Administrator shall not be responsible for the furnishing of hospital care nor for the quality thereof. F. Duplicate Coverage - 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 usual, reasonable, and customary medical expenses incurred. 1. 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 rendered. The Claims 0011662.01 -14- 04/24/95 8:49 AIM EMPLOYEE HEALTH PLAN DOCUMENT Administrator is not liable for payment of the benefits if claims are not filed within this time period. J. Prescriptions - All prescription drug payments shall be made through the Prescription Card Service and shall be on the basis of a co -payment by the employee of $5 for each generic drug prescription or $8 for each non -generic drug prescription. No payments for any prescription drug shall be made through the Employee Medical Plan. Effective January 1, 1992 the dispensing limit has been changed from 100 days to 34 days for prescriptions. A 90 day supply will be allowed for mail order prescriptions only: POA/M EO/M EA/P MA/NA/M SOA: Effective January 1, 1994 the mail order drug co -payment shall be $4 for generic and $6 for non -generic prescriptions per 30 day supply. G. Non Transferable Benefits - No person other than the Participant or Family Member is entitled to receive benefits to be furnished by the Claims Administrator under this Document. Such right to hospital care or other benefits is not transferable. H. Limitation of Liability - The hospitals (or Skilled Nursing Facilities) 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. PART Vill - SECOND OPINION SURGICAL PROGRAM A. Defintion, 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. Hemorrhoidectomy - surgical excision of hemorrhoids (piles). 5. Hernia repair - repair of an inguinal, femoral or umbical hernia. 6. Hysterectomy - removal of the uterus. 7. Knee Surgery (Menisectomy) - removal of meniscus cartilage of the knee. 0011662.01 -15- 04/24/95 8:49 AM EMPLOYEE HEALTH PLAN DOCUMENT 8. Laminectomy - surgery on the spinal canal through the vertebral arch. 9. Varicose Vein Ligation - repair of varicose vein. 10. Mastectomy - surgical removal of the breast. 11. Onychotomy - surgical removal of the nail of a toe or finger. 12. Prostatectomy - excision of part or all of the prostate gland. 13. Repair of deviated septum (SMR) - sub -mucous resection - 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. B. Elective Surgery - 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. C. Board Certified - The second opinion will be rendered by a physician who is a qualified Board Certified surgeon in the same specialty as the original surgeon. D. Second Opinion Fees Paid by Plan - The second surgical opinion fees will be paid in full by the Employee Health Plan subject to UCR. 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. 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. 0011662-01 -16- 04/24/95 8:49 AM EMPLOYEE HEALTH PLAN DOCUMENT PART IX - BASIC BENEFITS A. Definition - The term "Basic Benefit" as used herein means only those services and supplies listed below. These services are not subject to a deductible and payment shall be based upon charges not exceeding the Usual, customary and Reasonable charges for such services. B. Substance Abuse Treatment: 1. Benefits will be provided for 5 days of in patient detoxification with a life time maximum benefit of $10,000. 2. POA/PMA/MEO/MEA/NA/MSOA: Effective March 1, 1994 this benefit will be provided by Managed Health Network. C. Out -Patient Pre -Hospital Admission Testing - For required medical testing done on an out -patient basis prior to admission to a hospital, benefits will be provided at 100% of Usual, Customary and Reasonable charges. No basic benefits for subsidized retirees. 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 hospital under this Plan Document, AND THE PHYSICIAN'S CHARGES FOR THE SURGICAL PROCEDURE, benefits will be provided at 100% of Usual, Customary, and Reasonable charges. No basic benefits for subsidized retirees. POA/PMA/MEA/MEO/NA/MSOA: Effective January 1, 1994, benefits will be paid at 100% of usual, customary and reasonable charges for PPO providers. Covered expenses include anesthesia, outpatient surgery, facility use, surgeon and pre -admission. Plan will pay 70% of usual, reasonable and customary charges after the deductible is met for non-PPO providers. E. 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. The Unit Value used in calculating Basic Professional Benefits for Surgical Services and Doctor Visits in the Hospital is: $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. 0011662.01 -17- 04/24/95 8:49 AM EMPLOYEE HEALTH PLAN DOCUMENT b. Primary Surgeon: Benefits are determined by multiplying the number of Units specified for each procedure in the California Relative Value Studies - Fifth Edition by the designated Unit Value. c. Assistant Surgeon: If a benefit is paid to the Primary Surgeon and scope of surgery customarily requires an Assistant Surgeon, benefits will be provided for one Assistant Surgeon who is not a hospital intern, resident or house officer. The benefit is 20% of the amount paid to the Primary Surgeon, or one Unit - whichever is greater. d. Benefits for Surgical Services are subject to these conditions and limitations: 1) The service must be performed by a licensed Physician. 2) The service 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 Family Member is entitled to hospital care and surgical benefits hereunder, the plan shall pay for services of professional anesthetist, in accordance with the Anesthesia Units listed in the California Relative Value Studies - Fifth Edition and at the Unit Value designated in Document. b. The Units appearing in the Anesthesia column represent basic values. To these will be added Time Units, representing the actual time spent administering the anesthetic. Time Units are based on one Unit for each quarter-hour or major part thereof. 3. Physician Visits in the Hospital a. When a Participant or Family Member receives covered care in a Legally Operated Hospital or Skilled Nursing Facility as a result of illness or injury and no surgery is performed, payment toward the cost of visits by the attending Physician shall be: . 0011662.01 -18- 04/24/95 8:49 AM EMPLOYEE HEALTH PLAN DOCUMENT 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. Up to .37 Units will be allowed per bedside consultation for a maximum of one such consultation per admission. F. Ambulance Benefit - 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. G. Preventative Medical Care: 1. Benefits will be provided up to $200 per person per year for preventative medical care. Such care shall include such usual preventative medical options as an every other year physical exam for adults, yearly PAP tests for females, flu shots, chest x-rays, EKG and other diagnostic lab tests if certified by the physician that such procedures are included under a routine physical examination and is not. in connection with the diagnosis or treatment of any illness, disease or accidental bodily injury. Three well baby exams for an infant for the first year of life will be allowed subject to the $200 maximum benefit. All inoculations for infants/children will be provided and coverage is'not limited to the $200 maximum benefit. PART X - MAJOR MEDICAL A. Definition - 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. 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. 0011662.01 -19- 04/24/95 8:49 AM EMPLOYEE HEALTH PLAN DOCUMENT 3. After the deductible has been met, benefits shall be paid at 90% of usual, customary and reasonable charges for PPO's and 80% for non-PPO's. P OA/P MA/M EA/M E O/NA/M S OA: Effective January 1, 1994, benefits shall be paid at the rate of 90% for PPO's and 70% for non-PPO's of usual, customary and reasonable charges after the deductible has been met. However, in the event of emergency services, the plan will pay 90% of usual, customary and reasonable charges for non PPO's. Emergency services is defined as follows: services which are immediately required to treat a sudden I serious and unexpected illness or injury, including services to alleviate pain associated with sudden, serious and unexpected illness and/or injury. 4. 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 Accident, 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 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. Effective 1-1-88, the individual deductible had been increase to $150 and to $400 per family. Deductibles are calculated on a calendar ear basis. Effective 1-1-90 the individual deductibles is $150 a person and $450 per family. Effective 1-1-90, the deductible for subsidized retirees is $200 a person or $500 per family. 5. Stop -Loss: a. When expenses incurred by the participant or family member for covered services and supplies exceeds the deductible amount, benefits will be provided at 70% of usual, customary, and reasonable charges (90% if PPO provider is used). Once the out-of-pocket expense of $1,000 per individual or $2,000 per family is exceeded - during the calendar year, 100% of covered services and supplies will be covered during the remainder of the calendar year. Only the cost 0011662.01 -20- 04/24/95 8:49 AM EMPLOYEE HEALTH PLAN DOCUMENT of eligible services and supplies can be used to satisfy the out-of- pocket limit. The maximum out-of-pocket expense for subsidized retirees is $1,500 a person or $3,000 per family. b. Mental Disorders: For in -patient psychiatric care benefits will be provided at 50% of Usual, Customary and Reasonable Charges. No stop -loss or 100% benefit will apply. c. POA/PMA/MEA/MEO/NA/MSOA Effective March 1, 1994, all in -patient psychiatric care benefits will be provided by Managed Health Network at 50% of usual, customary and reasonable charges. No stop loss or 100% benefit will apply. 6. The Participant or Family Member who has received at least $1,000.00 of benefits hereunder may apply for reinstatement of maximum benefits by furnishing evidence of good health satisfactory to Claims Administrator. However, notwithstanding the above, the Participant or Family Member who has incurred expense hereunder which has been charged against the aggregate maximum of $1,000,000.00 shall automatically have reinstated toward such maximum as of the last day of each Calendar Year an amount of up to $1,000.00. 7. 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. 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 0011662.01 -21- 04/24/95 8:49 AM EMPLOYEE HEALTH PLAN DOCUMENT 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. j. Blood transfusions, including cost of blood and blood plasma. k. Services and supplies furnished and billed by a Legally Operated Hospital, excepts 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. B. Special Conditions in Regard to Hospital Benefits: 1. Hospital Pre -admission Notification a. A hospital pre -admission notification to the Orange County Medical Review (OCMR) shall be required prior -to hospital admittance for non - emergencies. b. If the required notification is not given to OCMR, the benefit entitlement will be subject to a $100 deductible against the charges for hospital costs. 2. Room Accommodations - Benefits will be provided as follows: a. 90% of charges for a room of two or more beds for a PPO, 80% for a non-PPO provider. b. 90% for PPO, 80% for non-PPO 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. d. POA/MEO/MEA/PMA/NA/MSOA: Effective January 1, 1994 benefits will be paid at the rate of 90% for PPO and 70% for non-PPO 3. 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 will be provided at 90% for PPO or 80% for non PPO charges during eligible days of care, except the acquisition costs of blood and blood plasma and the charges for experimental or investigative procedures and services. 0011662.01 -22- 04/24/95 8:49 AM EMPLOYEE HEALTH PLAN DOCUMENT b. POA/MEO/MEA/PMA/NA/MSOA: Effective January 1, 1994 benefits will be paid at the rate of 90% for PPO and 70% for non-PPO providers. C. Benefits for Services and Supplies in Eligible Skilled Nursing Facilities: 1. Days of Inpatient Care a. Covered inpatient services of a 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 re -admission are 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. c. Prior care in a hospital is not required before being eligible for care in a Skilled Nursing Facility. d. Admissions or continued stays for custodial or domiciliary care are not covered. D. Care for Conditions of Pregnancy: Benefits will be provided for Normal Delivery, Cesarean Section and other Complications of Pregnancy for active Employees and their spouse. 2. No benefits will be provided dependent daughters. E. Chiropractic and Physical Therapy Guidelines: Benefits will be provided as follows: 3 times a week for the first month of treatment 2 times a week for the second month of treatment 1 time a week for the third month of treatment 2 times a month for the fourth month and thereafter 2. Chiropractic Limits - Benefits are provided under Major Medical to a maximum of 24 treatments per year or $2,000.00 whichever occurs first. Said limits are per person and commence January 1 of each year. 3. These guidelines may be modified on an individual case -by -case basis pursuant to the recommendation of the Medical Review Advisor. F. Treatment by California Licensed Certified Acupuncturist - Will be covered to the extent that treatment is for pain associated with injury or illness. G. Subsidized Retiree Benefits - All eligible major medical expenses and hospital benefits for subsidized retirees will be paid at 80% of UCR. 0011662.01 -23- 04/24/95 8:49 AM EMPLOYEE HEALTH PLAN DOCUMENT H. Municipal Employees Association (MEA) - Effective January 1, 1995, all eligible major medical expenses and hospital benefits for subsidized retirees will be paid at 70% of usual, customary and reasonable. PART XI - RETIREE SUBSIDY MEDICAL PLAN A. Eligibility - 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 in an amount as specified in accordance with this Plan, provided: At the time of retirement the employee has a minimum of ten (10) years of continuous City service or is granted as industrial disability retirement; and 2. At the time of retirement, the employee is employed by the City; and 3. 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 dependent can 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 age 65 under the City's medical plans shall be governed by applicable plan document. 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 the 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. 0011662.01 -24- 04/24/95 8:49 AM EMPLOYEE HEALTH PLAN DOCUMENT d. In the event of the death of any employee, whether retired or not, the amount of the retiree medical insurance subsidy benefit which the deceased employee was receiving at the time of his/her death would be eligible to receive if he/she were retired at the time of death, shall be paid on behalf of the spouse or family for a period not to exceed twelve (12) months. B. Schedule of Benefits: 1. Minimum Eligibility for Benefits - With the exception of an industrial disability retirement, eligibility for benefits begins after an employee has completed ten (10) years of continuous service with the City of Huntington Beach. Said service must be continuous unless prior service is reinstated at the time of his/her rehire in accordance with the City's Personnel Rules. 2. 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 $121 after 10/1 /89. Payments shall be in accordance with the stipulations and conditions which exist for all retirees. Payment shall not exceed dollar amount which is equal to the full cost of premium for employee only. 0011662.01 -25- 04/24/95 8:49 AM EMPLOYEE HEALTH PLAN DOCUMENT 3. 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 for each year of completed City service as follows: Maximum Monthly Payment for Retirements After: Note: The above payment amounts may be reduced each month as dependent eligibility ceases due to death, divorce or loss of dependent child status. 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 premium is not sufficient to pay the premium amount for the employee and the eligible dependents, said needed excess premium amount shall be paid by the employee. 0011662.01 -26- 04/24/95 6:49 AM EMPLOYEE HEALTH PLAN DOCUMENT Note: Retirees who elect to participate in Health Net or Family Health Plan (FHP) shall be entitled to benefits of the program chosen. C. Benefit Summary, effective January 1, 1995: Inpatient Hospital Deductible Per Person 90% - (PPO) of UCR after deductible 70% (Non-PPO) of UCR after deductible FA: 80% for Non-PPO $150 / $450 80% of UCR after deductible MEA: 70% of UCR after deductible $200 / $500 Maximum Out of Pocket Expenses $1,000 / $2,000 $1,500 / $3,000 (Excludes Deductible) Accident Benefit Prescription Drugs Deductible Generic /Non Generic Major Medical None (Covered Same as Other Expenses) PCs $5 / $8 90% (PPO) of UCR after deductible 70% (Non-PPO) of UCR after deductible FA: 80% for Non-PPO None (Covered Same as Other Expenses) PCs $5 / $8 80% of UCR after deductible MEA: 70% of UCR after deductible D. Miscellaneous Provisions / Eligibility: 1. The effective start-up date of the Retiree Subsidy Medical Plan (80% Plan) for the various employee groups shall be the first of the month following retirement date. 2. A retiree may change plans, add dependents, etc., during annual open enrollment. Personnel shall notify covered retirees of this opportunity each year. 0011662.01 -27- 04/24/95 8:49 AM EMPLOYEE HEALTH PLAN DOCUMENT 3. Years of service computed for the Retiree Subsidy Medical Plan are actual years of completed service with the City of Huntington Beach. 4. When a retiree is eligible for medical plan coverage at the expense of another employer due to post -retirement employment of the retiree or spouse of the retiree, the retiree and his/her spouse must take that coverage regardless of benefit level and shall be deleted from any City Plan coverage. Exceptions to this requirement are limited to the following: a. A retiree is not required to enroll in such 'other" medical plan coverage if there is significant disparity between the benefits provided by the 'other" medical plan and the Retiree Subsidy Medical Plan as defined below. "Significant disparity" means coverage available under the 'other" medical plan is restrictive or limited in one or more of the following ways: 1) No inpatient hospitalization coverage. 2) No major medical benefits. 3) Annual deductible is $1,000 or greater per person. 4) Major medical benefits are paid at 60% or less of covered expenses. b. The Risk Manager will have the authority to provide additional exceptions following review of the - 'other" medical plan benefit provisions are comparable to the guidelines under "B" above. c. Miscellaneous Provisions: 1) Benefits provided under the Retiree Subsidy Medical Plan will be coordinated with the 'other" medical plan as the primary carrier 2) The City shall have the right to require any retiree to provide a copy of the 'other" medical plan policy for review by the Risk Manager. 5. When a retiree becomes eligible for other group coverage and then becomes no longer eligible, he/she may have the subsidy reinstated and regain Retiree Subsidy Medical Plan coverage. 6. Dependents of a retiree may follow him/her into the Retiree Subsidy Medical Plan or they may choose to exercise COBRA rights along with the retiree. 7. When a retiree becomes 65 and has eligible dependents under 65, said dependents are eligible to exercise COBRA rights. 8. When a retiree is under 65 and his/her spouse is over 65, the spouse is not covered. 0011662.01 -28- 04/24/95 8:49 AM EMPLOYEE HEALTH PLAN DOCUMENT Benefits: 1. Retiree Subsidy Medical Plan includes Managed Health Network (MHN), Prescription Card System (PCS), Orange County Preferred Provider Organization (OCPPO) and Medical Stop Loss insurance. 2. City Plans are the primary payer for active employees age 65 and over, with Medicare the secondary payer. Retirees age 65 and over have no City Plan options and are eligible only for Medicare. 3. Premium payments are to be received at least one month in advance of the coverage period. Subsidies: 1. The subsidy payments will pay for: a. Retiree Subsidy Medical Plan b. Health Net c. Family Health Plan (FHP) d. Part A of Medicare for those retirees not eligible for paid Part A 2. Subsidy payments will not pay for: . a. Part B Medicare b. Regular City Employee Indemnity Plan c. Any other employee benefit plan d. Any other commercially available benefit plan. e. Medicare supplements 3. Employees who retire on or after the following dates shall be eligible for the subsidy based on years of completed service with the City: October 1, 1987 - MEO, MEA, POA, MSOA, FA, PMA July 1, 1988 - Non -Represented Retirees who retire prior to the above dates are not eligible for any subsidy benefit. Medicare: 1. All persons are eligible for Medicare coverage at age 65. Those with sufficient credited quarters of Social Security will receive Part A of - Medicare at no cost. Those without sufficient credited quarters are still eligible for Medicare at age 65, but will have to pay for Part A of Medicare if 0011662.01 -29- 04/24/95 8:49 AM EMPLOYEE HEALTH PLAN DOCUMENT the individual elects to take Medicare. In all cases Part B of Medicare is paid for by the participant. 2. When a retiree and his/her spouse are both age 65 or over, and neither is eligible for paid Part A of Medicare, the subsidy shall pay for Part A for each of them or the maximum subsidy, whichever is less. 3. When a retiree at age 65 is eligible for paid Part A of Medicare and his/her spouse is not eligible for paid Part A, the spouse shall not receive subsidy. When a retiree at age 65 is not eligible for paid Part A of Medicare and his/her spouse who is also age 65 is eligible for paid Part A of Medicare, the subsidy shall be for the retiree's Part A only. Cancellation: 1. For retirees/dependents eligible for paid Part A of Medicare, the following cancellation provisions apply: a. Coverage for a retiree under the Retiree Subsidy Medical Plan will be eliminated on the first day of the month in which the retiree reaches age 65. If such retiree was covering dependents under the Plan, dependents will be eligible for COBRA continuation benefits effective as of the retiree's 65th birthday. b. Dependent coverage will be eliminated upon the whichever of the following occasions come first: 1) After 36 months of COBRA continuation coverage, or 2) When the covered dependent reaches age 65 in the event such dependent reaches age 65 prior to the retiree reaching age 65. c. At age 65 retirees are eligible to make application for Medicare. Upon being considered "eligible to make application", whether or not application has been made for Medicare, the Retiree Subsidy Medical Plan will be eliminated. 2. See provisions under "Benefits", "Subsidies", and "Medicare" for those retirees/dependents not eligible for paid Part A of Medicare. 3. Retiree Subsidy Medical Plan and COBRA participants shall be notified of non-payment of premium by means of a certified letter from Personnel in accordance with provisions of the Memorandums of Understanding. 4. A retiree who fails to pay premiums due for coverage and is in arrears for sixty (60) days shall be terminated from the Plan and shall not have reinstatement rights. PART XII - TERMINAL BENEFITS A. Benefit Continuance at Time of Termination of Employment - 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 0011862.01 -30- 04/24/95 8:49 AM EMPLOYEE HEALTH PLAN DOCUMENT 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 - 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. Definition of Total Disability - For the purposes of this benefit, the Employee shall be considered totally disabled 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. Exclusion of Terminal Benefits - 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. 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: 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; 0011662.01 -31- 04/24/95 8:49 AM EMPLOYEE HEALTH PLAN DOCUMENT 2. To find facts and make determinations as to the rights of any Participant applying for or receiving benefits under the Plan and to afford any such Participant dissatisfied with any such finding or determination the right to a hearing thereon; 3. To make benefit payments directly to Participants and/or their assignees entitled to benefits under the Plan; 4. To obtain from the City, Participants and others, such information as shall be necessary for the proper administration of the Plan; 5. To keep records regarding the administration of the Plan; 6. To furnish to City upon request such data with respect to the administration of the Plan as is reasonable and appropriate; and 7. To collect, evaluate, analyze and prepare statistical and other data with respect to the administration of the Plan. The Claims Administrator shall have no power to add to or subtract from or to modify any of the provisions of the 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 retroactive adjustment in any other case. 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 may 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 no 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. 0011662.01 -32- 04/24/95 8:49 AM EMPLOYEE HEALTH PLAN DOCUMENT In the event the claimant is dissatisfied 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 Administrator'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 further appeals. E. Limitation of Liability - The Claims Administrator shall be entitled to rely upon information from any source in good faith to be correct. PART XIV - DURATION AND AMENDMENT OF THE PLAN A. Permanence of the Plan - The Plan shall continue in full force and effect unless terminated, modified, altered or amended by the City as provided in the article. Although the City has established the Plan with the bona fide intention and expectation that it will be able to make contributions indefinitely, nevertheless the City is not and shall not be under any obligation or liability whatsoever to maintain the Plan for any given length of time. The City may, in its sole and absolute discretion, discontinue or terminate the Plan in accordance with its provisions at any time without liability whatsoever for such discontinuance or termination. B. Right to Amend - The City reserves the right at any time and from time to time to modify, alter, or amend, in whole or in part, any or all of the provisions of the Plan, provided, however, that no such modifications, alteration or amendment which substantially increases the duties, obligations or liabilities shall be made without the consent of the appropriate party. Notwithstanding the foregoing, any modification, alteration or amendment of the Plan may be made retroactive to the Effective Date if necessary or appropriate for the Plan. C. Severability - If any provision of the Plan is held invalid or unenforceable, its invalidity or unenforceability will not affect any other provisions of the Plan, and the Plan will be construed and enforced if such provision had not been included. PART XV - ADMINISTRATIVE PROVISIONS A. Management Rights - 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 workmanlike 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 0011662.01 -33- 04/24/95 8:49 AM EMPLOYEE HEALTH PLAN DOCUMENT 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 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. 0011662.01 -34- 04/24/95 8:49 AM EMPLOYEE HEALTH PLAN DOCUMENT AMENDMENT NO. 1 THE CITY OF HUNTINGTON BEACH EMPLOYEE HEALTH PLAN PLAN DOCUMENT This Amendment No. 1 to the City of Huntington Beach Health Plan is to be 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 HUNTINGTON BEACH Signature: Typed Name: Karen S. Foster Typed Title: Risk Manager 0011662.01 -35- 04/24/95 8:49 AM EMPLOYEE HEALTH PLAN DOCUMENT 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: A. 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. B. Spouses of actively employed Insured employees 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 for health benefits under this Plan. CITY OF HUNTINGTON BEACH Signature: `'L /� Typed Name: Karen S. Foster Typed Title: Risk Manager 0011662.01 -36- 04/24/95 8:49 AM EMPLOYEE HEALTH PLAN DOCUMENT AMENDMENT NO. 3 RETIREES MEDICAL INSURANCE SUBSIDY BENEFIT (RMIS) Eligible retirees may receive a subsidy for payment of medical insurance premiums. The eligibility requirements and monthly subsidy amounts are available in the Personnel Division. The modification in coverage for the Retiree Medical Insurance subsidy is as follows: Annual deduction for retiree/family $200/$500 Major medical stop loss level $5,000.00 Basic in -patient benefits after deductible 80% Outpatient surgery and pre -admission testing after deductible 80% Accident benefit after deductible 80% Surgery and anesthetics after deductible 80% CITY OF HUNTINGTON BEACH Signature: "f 1/ / / Typed Name: Karen S. Foster Typed Title: Risk Manager 0011662.01 -37- 04/24/95 8:49 AM EMPLOYEE HEALTH PLAN DOCUMENT AMENDMENT NO.4 This amendment No. 4 effective July 1,1993 is hereby adopted. A. Part II.0 page 5 is amended to comply with all the provisions of California AB 1672 as it applies to this self -funded plan. AB1672 states (among other items) the following: Pre-existing conditions are not to be denied, excluded or limited for more than 6 months after the effective date of that person's coverage under the plan. This plan will credit the time the person was covered under qualifying prior coverage but only if the previous coverage was continuous to a date not more than 30 days before the effective date of the new coverage. However, if: an individual's employment has ended; and he lost his group health coverage as a result of termination of employment; or his employer's contribution towards health coverage terminated; then the insurer offering the new group health plan must credit the time the individual was covered under the previous group health plan, but only if the previous coverage was continuous to a date not more than 90 days before the effective date of the new coverage. an eligible employee or a dependent who is a "Late Enrollee" may be excluded from a policy/plan for a maximum of 12 months. The term "Late Enrollee" is defined in AB1672 to exclude a person: who gave a written statement stating that he was declining coverage initially because he was covered under another employer's plan and who later requests coverage within 30 days of termination of coverage under the prior plan; for whom a court has ordered that coverage be provided for a spouse or minor child under a covered employee's health benefit plan and the request for coverage is made within 30 days after the issuance of the court order. 3. Part X Major Medical B. 1. This paragraph is eliminated. There is no 100 day limitation on inpatient hospital care. CITY OF HUNTINGTON BEACH i Signature: Typed Name: Karen S. Foster Typed Title: Risk Manager 0011662.01 -38- 04/24/95 8:49 AM EMPLOYEE HEALTH PLAN DOCUMENT AMENDMENT NO. 5 CITY OF HUNTINGTON BEACH EMPLOYEES AND RETIREES INDEMNITY HEALTH PLAN Effective January 1, 1995, coverage is amended as follows: Inpatient Hospital I 90% - (PPO) of UCR after deductible 70% (Non-PPO) of UCR after deductible FA: 80% for Non-PPO after deductible Deductible Per Person/Maximum I $150 / $450 Per Family Maximum Out of Pocket I $1,0001$2,000 Expenses (Excludes Deductible) 80% of UCR after deductible MEA: 70% of UCR after deductible $200 / $500 $1,500 / $3,000 Accident Benefit None None (Medical) (Covered Same as Other (Covered Same as Other Expenses) Expenses) Prescription Drugs PCs PCs Deductible Generic /Non $5 / $8 I Generic Major Medical I 90% (PPO) of UCR after deductible 70% (Non PPO) of UCR after deductible FA: 80% for Non-PPO after deductible In 80% of UCR after deductible MEA: 70% of UCR after deductible CITY OF HUNTINGTON BEACH Signature: �_ l Typed Name: Karen S. Foster Typed Title: Risk Manager 0011662.01 -39- 04/24/95 8:49 AM EXHIBIT E RETIREE SUBSIDY MEDICAL PLAN 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 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 continuous city 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: 1. 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 retiree's eligibility to receive further benefits will cease. 2. On the first of the month in which a retiree or dependent reaches age 65 or on the date the retiree or dependent can 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 age 65 under the city's medical plans shall be governed by applicable plan document. 3. In the event of the death of any employee, whether retired or not, the amount of the retiree medical insurance subsidy benefit which the deceased employee was receiving at the time of his/her death would be eligible to receive if he/she were retired at the time of death, shall be paid on behalf of the spouse or family for a period not to exceed twelve (12) months. 2003 MEO MOU Draft 45 12/11/02 8:55 AM SCHEDULE OF BENEFITS A. Minimum Eligibility for Benefits - With the exception of an industrial disability retirement, eligibility for benefits begin after an employee has completed ten (10) years of continuous service with the City of Huntington Beach. Said service must be continuous unless prior service is reinstated at the time of his/her rehire in accordance with the city's Personnel Rules. B. 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 $121. Payments shall be in accordance with the stipulations and conditions which exist for all retirees. Payment shall not exceed dollar amount which is equal to the full cost of premium for employee only. C. _Maximum Monthly Subsidy Payments - 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 for each year of completed city service as follows: Maximum Monthly Payment for Retirements After: Years of Service Subsidy 10 $ 121 11 136 12 151 13 166 14 181 15 196 16 211 17 226 18 241 19 256 20 271 21 286 22 300 23 315 24 330 25 344 Note: The above payment amounts may be reduced each month as dependent eligibility ceases due to death, divorce or loss of dependent child status. 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 premium is not sufficient to pay the premium amount for the employee and the eligible dependents, said needed excess premium amount shall be paid by the employee. 2003 MEO MOU Draft 46 12/11/02 8:55 AM INDEMNITY HEALTH PLAN, EMPLOYEES/RETIREES' YEAR 2003 YEAR 2002 �- Gity P1aR F=FnPll0yeec rr NOR Subsidized Refireec Benefits l GOB A_eligic.hle �T Benefits City Plan - Employees City Plan - Subsidized Non -Subsidized Retirees Retirees COBRA -eligibles Deductible $250 per person $250 per person $500 per family $500 per family Maximum Out of Pocket $2,000 per person $2,000 per person $4,000 per family $4,000 per family Co -Insurance PPO 90% of UCR 90% of UCR Non-PPO 50% of UCR 50% of UCR Note: Retirees who elect to participate in HMO Health a shall be entitled to benefits of the program chosen. This summary has been used to list only those benefit provisions that differ between active and subsidized Retiree Plans. Currently, there are no differences, however, this exhibit is not intended to require that future changes to active employee benefits be applied to retirees as well. The Employee Health Plan Document should be consulted for detailed questions about specific benefits. Benefits are subject to modification through the meet and confer process. 2003 MEO MOU Draft 47 12/11/02 8:55 AM RETIREE SUBSIDY MEDICAL PLAN/MISCELLANEOUS PROVISIONS A. Eligibility: 1. The effective start-up date of the Retiree Subsidy Medical Plan for the various employee groups shall be the first of the month following retirement date. 2. A retiree may change plans, add dependents, etc., during annual open enrollment. The Administrative Services Department Empleyee BeRefits shall notify covered retirees of this opportunity each year. 3. Years of service computed for the Retiree Subsidy Medical Plan are actual years of completed service with the City of Huntington Beach. 4. When a retiree is eligible for medical plan coverage at the expense of another employer due to post -retirement employment of the retiree or spouse of the retiree, the retiree and his/her spouse must take that coverage regardless of benefit level and shall be deleted from any City Plan coverage. Exceptions to this requirement are limited to the following: a. A retiree is not required to enroll in such "other" medical plan coverage if there is significant disparity between the benefits provided by the "other" medical plan and the Retiree Subsidy Medical Plan as defined below. "Significant disparity" means coverage available under the "other' medical plan is restrictive or limited in one or more of the following ways: 1) No in -patient hospitalization coverage. 2) No major medical benefits 3) Annual deductible is $1,000 or greater per person. 4) Major medical benefits are paid at 60% or less of covered expenses. b. The Risk Manager will have the authority to provide additional exceptions following review of the "other" medical plan policy. Exceptions will be made only if the "other' medical plan benefit provisions are comparable to the guidelines under B above. c. Miscellaneous Provisions: 1. Benefits provided under the Retiree Subsidy Medical Plan will be coordinated with the `other' medical plan as the primary carrier. 2003 MEO MOU Draft 48 12/11/02 8:55 AM 2. The city shall have the right to require any retiree to provide a copy of the "other" medical plan policy for review by the Risk Manager. 5. When a retiree becomes eligible for the other group coverage and then becomes no longer eligible, he/she may have the subsidy reinstated and regain Retiree Subsidy Medical Plan coverage. 6. Dependents of a retiree may follow him/her into the Retiree Subsidy Medical Plan or they may choose to exercise COBRA rights along with the retiree. 7. When a retiree becomes 65 and has eligible dependents under 65, said dependents are eligible to exercise COBRA rights. 8. When a retiree is under 65 and his/her spouse is over 65, the spouse is not covered. B. Benefits: 1. Retiree Subsidy Medical Plan includes Managed Health Network (MHN), Prescription Card System (PCS), Orange County Foundation for Medical Care (OCFMC) and Medical Stop Loss insurance. 2. City Plans are the primary payer for active employees age 65 and over, with Medicare the secondary payer. Retirees age 65 and over have no City Plan options and are eligible only for Medicare. 3. Premium payments are to be received at least one month in advance of the coverage period. C. Subsidies: 1. The subsidy payments will pay for: a. Retiree Subsidy Medical Plan. b. HMO HealtheZ. c. Part A of Medicare for those retirees not eligible for paid Part A. 2. Subsidy payments will not pay for: a. Part B Medicare. b. Regular City Employee Indemnity Plan. c. Any other employee benefit plan. 2003 MEO MOU Draft 49 12/11/02 8:55 AM d. Any other commercially available benefit plan. e. Medicare supplements D. Medicare: 1. All persons are eligible for Medicare coverage at age 65. Those with sufficient credit quarters of Social Security will receive Part A of Medicare at no cost. Those without sufficient credited quarters are still eligible for Medicare at age 65, but will have to pay for Part A of Medicare if the individual elects to take Medicare. In all cases, Part B of Medicare is paid for by the participant. 2. When a retiree and his/her spouse are both 65 or over, and neither is eligible for paid Part A of Medicare, the subsidy shall pay for Part A for each of them or the maximum subsidy, whichever is less. 3. When a retiree at age 65 is eligible for paid Part A of Medicare and his/her spouse is not eligible for paid Part A, the spouse shall not receive subsidy. When a retiree at age 65 is not eligible for paid Part A of Medicare and his/her spouse who is also age 65 is eligible for paid Part A of Medicare, the subsidy shall be for the retiree's Part A only. E. Cancellation: 1. For retirees/dependents eligible for paid Part A of Medicare, the following cancellation provisions apply: a. Coverage for a retiree under the Retiree Subsidy Medical Plan will be eliminated on the first day of the month in which the retiree reaches age 65. If such retiree was covering dependents under the Plan, dependents will be eligible for COBRA continuation benefits effective as of the retiree's 65th birthday. b. Dependent coverage will be eliminated upon whichever of the following occasions comes first: 1) After 36 months of COBRA continuation coverage, or 2) When the covered dependent reaches age 65 in the event such dependent reaches age 65 prior to the retiree reaching age 65. c. At age 65 retirees are eligible to make application for Medicare. Upon being considered "eligible to make application", whether or not application has been made for Medicare, the Retiree Subsidy Medical Plan will be eliminated. 2003 MEO MOU Draft 50 12/11/02 8:55 AM 2. See provisions under "Benefits", "Subsidies", and "Medicare" for those retirees/dependents not eligible for paid Part A of Medicare. 3. Retiree Subsidy Medical Plan and COBRA participants shall be notified of non-payment of premium by means of a certified letter from Employee Benefits in accordance with provisions of the Memorandums of Understanding. 4. A retiree who fails to pay premiums due for coverage and is in arrears for sixty (60) days shall be terminated from the Plan and shall not have reinstatement rights. 2003 MEO MOU Draft 51 12/11/02 8:55 AM EXHIBIT F VEHICLE USE ASSIGNMENT ADMINISTRATIVE REGULATION See Administrative Regulations 2003 MEO MOU Draft 52 12/11/02 8:55 AM -ADMINISTRATIVE REGULATION - Office of the City Administrator �( I Number. 604 1� Sections: 1-13 Q 14M V Effective Date: April, 1996 SUBJECT: City Vehicle Use/Assignment 1. Purpose. The purpose of this regulation is to establish and implement City policies and procedures relative to the assignment, utilization and control of City -owned vehicles as transportation for employees while engaged in official City business, to establish reimbursement procedures for privately -owned vehicles used for City business and to clarify the City's responsibility for damage and/or liability for private vehicles used on official City business. 2. Authority. Section 401, Huntington Beach City Charter. 3. Scope. This regulation covers the use of City and private vehicles for conducting official City business and shall be applicable to all City departments and employees. 4. Policy. 4.1 When necessary during the course of an employee's official duties, transportation shall be provided by the City. In the event no City vehicle is available, the employee may use his personal vehicle with the approval of his/her department head. 4.2 Employees authorized to drive either their own or a City -owned vehicle on official business must possess a valid California driver license for the class of vehicle they will be operating. 4.3 The transportation method authorized will be that which is in the best interests of the City. 4.4 City -owned vehicles shall only be used for official City business. 4.5 City -owned vehicles shall not be driven to and kept at the employee's home or any location other than the regular work location or Corporation Yard, except as provided by this regulation. 4.6 No City owned vehicle will be driven outside the boundaries of Los Angeles, Riverside and Orange Counties without prior approval of the Department Head. 4.7 All City vehicles shall be fueled and maintained at the City Yard or other City facility, as applicable, except in cases of emergency. 0011756.01 Cityr of Huntington Beach EMIET 'P - 49) f aJ- 04/05/96 2:35 PM ADMINISTRATIVE REGULATION - Office of the City Administrator 4.8 The general program set forth in this regulation will be implemented by the City Administrator and administered by the department heads in accordance with the regulations herein established. It is the responsibility of each department head to enforce the provisions of this regulation as it relates to the employees of his/her department. 5. Vehicle Use Assignments. 5.1 Category A - Permanent Assignment: Upon approval of the City Administrator and Department Head, assigned City vehicles may be taken home by employees whose residence is within twenty-five (25) miles of City Hall for the uses as described below: 5.1.1 Executive Use: Includes the City Administrator and Department Heads. 5.1.2 Other Designated Management Positions: In addition to the Executive Use positions, certain other employees in management positions may be assigned a City vehicle if they meet the following criteria: A. They have received a permanent or probationary appointment to the management position, or are serving in an acting capacity in a management position in excess of sixty days, and B. Assignment is approved by the City Administrator, and C. There is a higher than normal need for incumbents to return to duty in the evenings and normal days off (more that 3 times per month), and D. There is a need to have a vehicle available for City business purposes on a constant and regular basis, and E. In addition, such employees must meet one of the following criteria: 1. Have routine and recurring duties to perform after or outside of normal working hours which require a return to work from home, or 2. Be subject to call out during non -duty hours for emergencies or meetings if the actual frequency of emergency calls and the importance of response times to emergencies can be documented and justify the assignment of vehicle; or 3. Mileage driven on official City business exceeds an average of 300 miles per month, or 0011 156.01 City of Huntington Beach�.�1 . 04/05/96 2:35 PM -2- ADMINISTRATIVE REGULATION Office of the City Administrator 4. Regularly and frequently supervise subordinates in the field and conduct City business in the field, outside of normal working hours, or 5. Duties require the employee to be away from his or her base work station greater than 50% of his or her working time, on an average. 5.1.3 Emergency Response Units: A. Employees who are required to respond more than once per week on an. average without delay in order to protect the public health, safety and property- B. Employees who are required to cant' special emergency equipment in their vehicles which must be utilized on a regular and frequent basis. (A radio or car phone in and of itself does not constitute special emergency equipment). 5.1.4 Exhibit A is a list of authorized "Category A" Assignments where the employee has an option of an auto allowance or vehicle assignment. 5.2 Category B - Non -Permanent Assignment: City vehicles which are not to be taken home may be assigned to an employee by a Department Head based on meeting one of the following criteria: 5.2.1 Monthly mileage driven exceeds an average of 300 miles per month and the vehicle is used for the purpose of supervision or inspection in the field, or 5.2.2 Duties require the employee to be away from his or her work station greater than 50% of his or her working time on an average. 5.3 Category C - Departmental Pool Vehicles 5.3.1 Departmental pool vehicles will be available for employees who require transportation to perform official City business but do not meet the criteria for an assigned City vehicle under "Category A or B" above. Such pool vehicles shall be used in accordance with departmental policies which shall provide for the assignment of responsibility for the maintenance of the necessary records with respect to check in, check out, general purpose of use and other relevant matters related to the use of pool vehicles. 5.4 Temporary Assignment. The City Administrator's approval is required for temporary assignment of a vehicle to an employee if the vehicle is to be taken home by the employee. 1W 0011756.01 t City of Huntington Beach -3- 04/05/96 2:35 PM ADMINISTRATIVE REGULATION--� Office of the City Administrator r 6. Vehicle Maintenance. 6.1 City owned pool vehicles or other vehicles assigned as provided by this regulation shall be maintained in a clean. and safe manner by the Public Works Department, or other Department as applicable, on a regular schedule administered by the applicable department. The department providing this maintenance service shall schedule required maintenance and perform safety and operational inspections as part of such regular service. At the time a major tune-up is performed on a City owned vehicle, a diagnostic and overall maintenance report shall be prepared by the Manager of Vehicle Maintenance and sent to the appropriate Department Head. In addition, an annual review will be made by the Public Works Director in February of each year to determine the continuing suitability with respect to cleanliness and safety. 6.2 Each department shall have a plan for daily pre -operational safety and preventative maintenance inspection of the vehicle under its jurisdiction. This shall include inspection, reporting of malfunctions and a procedure for ensuring correction of routine, as well as critical safety and maintenance operational problems. 6.3 It shall be the responsibility of each employee using a pool vehicle or other vehicle assigned as provided by this regulation to perform the required inspection and reporting procedure. 7. Reimbursement for Use of Personal Vehicles 7.1 Executive Use. The City Administrator and Department Heads may, at their option, receive an automobile allowance as established by Resolution of the City Council in lieu of the assignment of a City vehicle pursuant to Section 5.1 herein. Administrative Regulation 407 - Auto Allowance, provides the procedures and requirements for selection of the Auto Allowance option. 7.2 Division Heads and employees represented by MEO who are assigned a City vehicle pursuant to Section 5.1.2 and 5.1.3 (Category A) herein may be eligible to receive an auto allowance in lieu of such assignment. Administrative Regulation 407 - Auto Allowance, provides the procedures and requirements for selection of the Auto Allowance option. 7.3 Mileage Reimbursement. Employees, upon authorization of their department head, may use their own vehicles on official City business and shall be reimbursed at the rate of 270 per mile driven on official City business. 7.3.1 Employees shall submit monthly claims for reimbursement to the Director of Finance through their Department Head on forms prescribed by the Director of Finance. 7.3.2 Employees shall not be reimbursed for commuting to and from work, except that employees who are required to attend scheduled meetings outside 0011756.01 City of Huntington Beachl -4- 04/05/96 2:35 PM ADMINISTRATIVE REGULATION - Office of the City Administrator of nominal working hours may be reimbursed for mileage required for use of personal vehicles when authorized by the department head. 7.3.3 The mileage reimbursement covers fuel, oil, tires, maintenance, depreciation, insurance and all other costs of owning and maintaining an automobile. 7.4 Safety Inspections. The Traffic Bureau of the Police Department will perform annual safety inspections of personal vehicles for which employees receive an auto allowance or mileage reimbursement, utilizing the form attached as Exhibit B. 8. Vehicle Use Committee. The Vehicle Use Committee shall review and make recommendations to the City Administrator with respect to all vehicle assignments. 9. Composition of Vehicle Use Committee. Public Works Director, Deputy City Administrator/Administrative Services and the Director of Community Services. 10. Vehicle Assignment Review. A. During the month of February of each year, departments which have assigned City -owned vehicles to employees or have authorized auto allowances for employees shall review such assignments. A report of these assignments will be prepared containing the following information: Department and division, employee name and classification, employee address, justification for assignment, justification for driving vehicle home (if applicable), average monthly business mileage, average monthly personal mileage (includes mileage to and from home), radio equipped (yes or no), special emergency equipment. This report will be forwarded to the Vehicle Use Committee prior to March 1 of each year. B. Whenever a vacancy occurs in a position previously assigned a vehicle or an auto allowance pursuant to this Administrative Regulation, such assignment or auto allowance shall be reviewed by the committee prior to recruitment/appointment to fill the vacancy. C. Annually by February 1 each department head shall review their respective departments pool car needs and shall prepare the necessary budget request for consideration if pool car needs are not being adequately served by the departments existing pool cars. 11. Insurance Requirements. Private vehicles used on City business shall be insured by the individual employee by vehicle liability insurance at least equal to the minimum requirement of the California Vehicle Code. Such requirements currently are: 11.1 $15,000 for single injury or death. 0011756.01 City of Huntington Beach -5- 04/05/96 2:35 PM ADMINISTRATIVE REGULATION Office of the City Administrator r 11.2 $30,000 for multiple injury or death. 11.3 $5,000 for property damage. Employees who do not meet the above requirements shall not be permitted to use private vehicles on City business until such requirements are met. 12. City Liability on Use of Private Vehicle. Should an employee be injured in an accident while driving a privately owned vehicle on official City business, he/she will be covered under the City's worker's compensation policy. There is no City coverage for damage to the privately owned vehicles. Should an employee be on official City business in a privately owned vehicle and it involved in an accident and he/she is not at fault, the City will reimburse him/her for any property damage loss incurred because of a policy deductible not to exceed $250. 13. Other Administrative Regulations which include provisions relating to vehicle usage: A.R. SUBJECT 407 Auto Allowance 601 Car Pool Operation 602 Vehicle Exterior Finish Maintenance 603 Criteria for the Purchase of City Vehicles 0011156.01 City of Huntington Beach �': 04/05/96 2:35 PM ADMINISTRATIVE REGULATION Office of the City Administrator EXHIBIT "A" CURRENT AUTHORIZATIONS CITY VEHICLE OR AUTO ALLOWANCE City Administrator All Appointed and Elected Department Heads Administration Assistant City Administrator Deputy City Administrator Fire Division Chief (2) Fire Protection Analyst Public Works City Engineer Traffic Engineer Supt. Parks, Trees & Landscape Water Operations Manager Supv. Water Production Supv. Mechanical Maintenance Dep. Director Recreation Beach Supv. Park Maintenance Supv. Tree, Land. Pest Construction Manager Maintenance Operations Manager Supervisor Water Distribution Community Development Building Safety Director Police Captains (4) Lieutenants (11 positions) Information Systems Manager Chief Criminalist Police Records Administrator Community Services Marine Safety Captain Supv. Parking/Camping Facility Supv. Street/Sewer Maint. Supt. Rec./Human Svcs Beach Operations Supervisor Recreation Supv. Sr. (2) Arts & Cultural Affairs Manager Note: The following classifications are not authorized to have an auto allowance, or City vehicle on a take-home basis. The incumbents in these classifications as of November 1, 1989 are, however, receiving auto allowance and will be allowed to continue receiving an auto allowance during their employment with the City. Department Classification Administrative Services Finance Director Community Development Planning Director 1W 0011756.01 City of Huntington Beach _7_ 04/05/96 2:35 PM 0011756.01 ADMINISTRATIVE REGULATION Office of the City Administrator EXHIBIT B CITY OF HUNTINGTON BEACH Safety Inspection Form Privately Owned Vehicles Used for City Business Name Address: Vehicle Make Year: Body Type: Drivers License #: Class: Working Order Glass Brakes Tires Lighting Devi ces Steering/Suspension Seat Belts Mirrors Comments - Details on Items Needing Repair. Inspector's Signature Date and Details of Repairs Made: Inspector's Signature Risk Management October, 1989 ,A City of Huntington Beach -8- 04/05/96 2:35 PM Plate # Needs Attention Date: Date: EXHIBIT G PHYSICAL EXAMINATION DESCRIPTION I. Complete Health History II. Complete Physical Examination by Physician III. Computer Printout: A. Physiological Tests: 1. Temperature 2. Height 3. Weight 4. Vision 5. Audiometry (Hearing Screening) 6. Blood Pressure 7. Pulse 8. Chest X-Ray 9. EKG 10. History 11. Tonometry (Glaucoma) for patients 35 and over. 12. Spirometry (Breathing) B. Laboratory Tests: 1. Blood Chemistry Screening Tests: SGPT Triglycerides SGOT Glucose Fasting LDH BUN Alk. Phosphatase Creatinine Total Bilirubin Uric Acid Total Protein Calcium Albumin -Serum Inorganic Phosphate Globulin Sodium Cholesterol Postassium 2. Complete Blood Count 3. Urinalysis 4. Stool Test for Blood 5. RPR 6. Pap Smear on Females 7. HDL IV. Examination Findings: A. Consultation with Physician B. Written Report of Findings 2003 MEO MOU Draft 53 12/11/02 8:55 AM EXHIBIT H - 9180 WORK SCHEDULE This work schedule is known as the 119/80". The 9/80 work schedule is designed to be in compliance with the requirements of the Fair Labor Standards Act (FLSA) and all other applicable laws. In the event that there is a conflict with the current rules, practices and/or procedures regarding work schedules and leave plans, then the rules listed below shall govern. 9180 WORK SCHEDULE DEFINED The 9/80 work schedule shall be defined as working nine (9) days for eighty (80) hours in a two week pay period by working eight (8) days at nine (9) hours per day and working one (1) day for eight (8) hours (Friday), with a one -hour lunch during each work shift, totaling forty (40) hours in each FLSA work week. The 9/80 work schedule shall not reduce service to the public, departmental effectiveness, productivity and/or efficiency as determined by the City Administrator or designee. A. Forty (40) Hour FLSA Work Week — The actual FLSA work week is from Friday at mid -shift (p.m.) to Friday at mid -shift (a.m.). No employee working the 9/80 work schedule will be able to flex their Friday start time nor the time they take their lunch break, which will be from 12:00 p.m. to 1:00 p.m. on Fridays. All employee work shifts will start at 8:00 a.m. on their Friday worked. The start of the FLSA work week- is 12:00 noon Friday. B. Two Week Pay Period — The pay period for employees starts Friday mid -shift (p.m.) and continues for fourteen (14) days until Friday mid -shift (a.m.). During this period, each week is made up of four (4) nine (9) hour work days (thirty-six (36) hours) and one (1) four (4) hour Friday and those hours equal forty (40) work hours in each work week (e.g. the Friday is split into four (4) hours for the a.m. shift, which is charged to work week one and four (4) hours for the p.m. shift, which is charged to work week two). C. A/B Schedules — To continue to provide service to the public every Friday, employees are to be divided between two schedules, known as the "A" schedule and the "B" schedule, based upon the departmental needs. For identification purposes, the "A" schedule shall be known as the schedule with a day off on the Friday in the middle of the pay period, or, "off on payday", the "B" schedule shall have the first Friday (p.m.) and the last Friday. (a.m.) off, or "working on payday". An example is listed below: D. A/B Schedule Changes — FLSA non-exempt employees cannot change schedules without prior approval of their supervisor, Department Head, and the Human Resources Manager or designee. The purpose of this authorization is to review 2003 MEO MOU Draft 54 12/11/02 8:55 AM the impact on overtime. FLSA exempt employees may change A/B schedules at the beginning of any pay period with supervisor and Department Head approval. E. Emergencies — All employees on the 9/80 work schedule are subject to be called to work any time to meet any and all emergencies or unusual conditions which, in the opinion of the City Administrator, Department Head or designee may require such service from any of said employees. OVERTIME DEFINED FLSA Non -Exempt Employees — All non-exempt employees under the 9/80 work schedule shall earn overtime for all hours worked after the first forty (40) hours in an FLSA work week (Friday 12:00:00 p.m. to Friday 11:59:59 a.m.) as required under FLSA. Employees are required to obtain supervisor authorization prior to working any overtime. 1. Overtime Compensation — As stated in Memorandum -of -Understanding 2. Compensatory Time — As stated in Memorandum -of -Understanding LEAVE BENEFITS When an employee is off on a scheduled workday under the 9/80 work schedule, then nine (9) hours of eligible leave per workday shall be charged against the employee's leave balance or eight (8) hours shall be charged if the day off is a Friday. All leaves shall continue under the current accrual, eligibility, request and approval requirements. 1. General Leave — As stated in Memorandum -of -Understanding 2. Sick Leave — As stated in Memorandum -of -Understanding 3. Administrative Leave — As stated in Memorandum -of -Understanding 4. Executive Leave — As stated in Memorandum -of -Understanding 5. Bereavement Leave — As stated in Memorandum -of -Understanding 6. Holidays - a. For a recognized city holiday, eight (8) hours, as stated in Section XII.B, are earned for each holiday. For the charging of hours on a scheduled holiday, the employee must use eight (8) hours of holiday time off and one (1) hour from the employees General Leave, Compensatory Time, Administrative Leave, or Executive Leave banks for a nine (9) hour workday charge or eight (8) hours holiday time off for a Friday. b. If a holiday falls on an FLSA non-exempt employee's Friday off, the employee must then take the work shift before or after the holiday off with supervisor and Department Head approval. If the employee cannot take the 2003 MEO MOU Draft 55 12/11/02 8:55 AM work shift before or after the holiday off the employee will be granted eight (8) hours of general leave. c. If a holiday falls on an FLSA exempt employee's Friday off, the employee must then take a work shift off within the same work week with supervisor and Department Head approval. FLSA exempt employees shall not be granted any administrative/general leave or any added compensation for not taking a work shift off on a scheduled holiday. 7. Jury Duty — The provisions of the Personnel Rules shall continue to apply, however, if an FLSA exempt employee is called to serve on jury duty during a normal Friday off, Saturday, or Sunday, or on a city holiday, then the jury duty shall be considered the same as having occurred during the employees day off work, therefore, the employee will receive no added compensation. 2003 MEO MOU Draft 56 12/11/02 8:55 AM EXHIBIT I - 4/10 WORK SCHEDULE This work schedule is known as the "4/10". The 4/10 work schedule is designed to be in compliance with the requirements of the Fair Labor Standards Act (FLSA). In the event that there is a conflict with the current rules, practices and/or procedures regarding work schedules and leave plans, then the rules listed below shall govern. 4/10 WORK SCHEDULE DEFINED The 4/10 work schedule shall be defined as working eight (8) days for eighty (80) hours in a two week pay period by working eight (8) days (Monday through Thursday, Fridays off) at ten (10) hours per day, plus a one -hour lunch during each work shift, totaling forty (40) hours in each FLSA work week. The 4/10 work schedule shall not reduce service to the public, departmental effectiveness, productivity and/or efficiency as determined by the City Administrator or designee. All employees on the 4/10 work schedule are subject to be called to work any time to meet any and all emergencies or unusual- conditions which, in the opinion of the City Administrator, Department Head or designee may require such service from any of said employees. OVERTIME DEFINED FLSA Non -Exempt Employees — All non-exempt employees under the 4/10 work schedule shall earn overtime for all hours worked after the first forty (40) hours in an FLSA work week as required under FLSA. Employees are required to obtain supervisor authorization prior to working any overtime. 1. Overtime Compensation — As stated in Memorandum -of -Understanding 2. Compensatory Time — As stated in Memorandum -of -Understanding LEAVE BENEFITS When an employee is off on a scheduled workday under the 4110 work schedule, then ten (10) hours of eligible leave per workday shall be charged against the employee's leave balance. All leaves shall continue under the current accrual, eligibility, request and approval requirements. 1. General Leave — As stated in Memorandum -of -Understanding 2. Sick Leave — As stated in Memorandum -of -Understanding 3. Administrative Leave — As stated in Memorandum -of -Understanding 4. Executive Leave — As stated in Memorandum -of -Understanding 5. Bereavement Leave — As stated in Memorandum -of -Understanding 2003 MEO MOU Draft 57 12/11/02 8:55 AM 6. Holidays - a. For a recognized city holiday, eight (8) hours, as stated in Section XI1.13, are earned for each holiday. For the charging of hours on a scheduled holiday, the employee must use eight (8) hours of holiday time off and two (2) hour from the employees General Leave, Compensatory Time, Administrative Leave, or Executive Leave banks for a ten (10) hour workday. b. If a holiday falls on an FLSA non-exempt employee's Friday off, the employee must then take the work shift before or after the holiday off with supervisor and Department Head approval. If the employee cannot take the work shift before or after the holiday off the employee will be granted eight (8) hours of general leave. c. If a holiday falls on an FLSA exempt employee's Friday off, the employee must then take a work shift off within the same work week with supervisor and Department Head approval. FLSA exempt employees shall not be granted any administrative/general leave or any added compensation for not taking a work shift off on a scheduled holiday. 7. Jury Duty — The provisions of the Personnel Rules shall continue to apply, however, if an FLSA exempt employee is called to serve on jury duty during a normal Friday off, Saturday, or Sunday, or on a city holiday, then the jury duty shall be considered the same as having occurred during the employees day off work, therefore, the employee will receive no added compensation. 2003 MEO MOU Draft 58 12/11/02 8:55 AM RCA ROUTING SHEET INITIATING DEPARTMENT: ADMINISTRATIVE SERVICES SUBJECT: APPROVAL OF MEMORANDUM OF UNDERSTANDING BETWEEN THE CITY AND THE HUNTINGTON BEACH MANAGEMENT EMPLOYEES ORGANIZATION COUNCIL MEETING DATE: I December 16, 2002 RCA ATTACHMENTS STATUS Ordinance (w/exhibits & legislative draft if applicable Not Applicable Resolution (w/exhibits & legislative draft if applicable) Attached Tract Map, Location Map and/or other Exhibits Not Applicable Contract/Agreement (w/exhibits if applicable) (Signed in full by the City Attorne Not Applicable Subleases, Third Party Agreements, etc. (Approved as to form by City Attome Not Applicable Certificates of Insurance (Approved by the City Attorney) Not Applicable Financial Impact Statement (Unbudget, over $5,000) Not Applicable Bonds (If applicable) Not Applicable Staff Report (If applicable) Not Applicable Commission, Board or Committee Report (If applicable) Not Applicable Findings/Conditions for Approval and/or Denial Not Applicable REVIEWED Administrative Staff Assistant City Administrator (Initial) City Administrator (Initial) City Clerk FKC:A Author: William McReynolds LH CITY OF HUNTINGTON BEACH INTER -DEPARTMENT COMMUNICATION HUNTINGTON BEACH Connie Brockway, City Clerk Office of the City Clerk Liz Ehring, Deputy City Clerk II 4To: Date: Meeting Date: f Agenda Item: Proposed City Council Agenda Items: The City Clerk's Office/City Administrator's Office must return your agenda item due to the following requirements that have not been met. When your Agenda Item is ready to resubmit, please return to: Elaine Kuhnke, Management Assistant, Administration 1. Signature(s) Needed A On RCA B On Agreement C Other 2. Attachments A Missing B Not identified C Other 3. Exhibits A Missing B Not identified C Other 4. Insurance Certificate (Proof Of Insurance) A Not attached B Not approved by City Attorney's Office C Signed form notifying City Clerk that department will be responsible for obtaining insurance certificate on this item. (See form attached) 5. Wording On Request For Council Action (RCA) Unclear A Recommended Action on RCA not complete B Clarification needed on RCA C Other 6. City Attorney Approval Required 7. Agreement Needs To Be Changed AI Page No. 8. Other [� S G:agenda/misdreaform