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Several members have reported problems with insurance claims being denied by the administrator due to their definition of what constitutes an emergent care injury / illness. If you have a problem with billing, or any other problem involving the health insurance plan, please e-mail Bob Graff at the bottom of this page and then contact Jackie Hendershot in personnel.
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Reminder: If you are injured on duty the facility and Physician you seek treatment from are YOUR CHOICE. No one can force you to be treated by any physician against your wishes.
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AGREEMENT FOR JOINT LABOR/MANAGEMENT
HEALTH CARE PLANNING COMMITTEE
CITY OF ROCK ISLAND
WHEREAS, the City of Rock Island offers a program of group health care coverage to its employees and retirees and their dependents through a self-funded arrangement; and
WHEREAS, a consensus has been reached among the City Council of the City of Rock Island, the exclusive representatives of the City employees pursuant to the Illinois Public Labor Relations Act, City employees not so represented by an exclusive representative, and the retired City employees who participate in the City of Rock Island Employee Health Benefit Plan, and the Administration of the City, that a Joint Labor/Management Health Care Planning Committee appears to be the most effective option for dealing with the problem of maintaining quality health care while controlling costs.
NOW, THEREFORE, IT IS AGREED BETWEEN AND AMONG THE PARTIES TO THIS AGREEMENT AS FOLLOWS:
1. The parties to this Agreement are as follows:
City of Rock Island
American Federation of State, County, and Municipal Employees Local #988, Chapter B (AFSCME B)
American Federation of State, County, and Municipal Employees Local 988, Chapter A (AFSCME A)
Fraternal Order of Police Lodge #57 (FOP)
Command Officers Association (COA)
International Association of Fire Fighters Local 26(IAFF)
United Auto Workers Local 2282 (UAW)
2. Each of the parties hereby agrees to the Health Benefit Plan attached hereto and incorporated herein as Appendix 1.
3. The plan as described in Appendix 1 shall continue in force as the City of Rock Island Health Benefit Plan for a period of two years from April 1, 2003 unless modified as provided in Paragraph 4. It is understood and agreed that if any provision of the Plan is or shall be prohibited or limited by law or any modification be required by law, the necessary revisions to the Plan shall be made as required by law.
4. The provisions of the Plan as described in Appendix 1 may be modified only upon the consensus agreement of all of the members per Section 7 of this agreement of the Health Care Planning Committee and approved, if necessary (i.e. budget and contract approval), by the City Council of the City of Rock Island. For purposes of this agreement, consensus shall mean the general agreement of each member of the Committee. Although the Committee does not typically “vote” on items, each member has the right to raise an objection to any proposal. Until an objector has removed his/her objection and agreed that the proposal, while perhaps not ideal in the opinion of the objector, is the best overall for the plan, the proposal shall not be approved.
5. Each of the parties has full authority of its governing board, its membership, or whatever group or subgroup within its structure has the ultimate authority to enter into this Agreement. Each of the parties represents to each of the other parties as an inducement to enter into this Agreement that it has such authority and that it intends to and does bind itself and each of its members to the terms of the Agreement. For the two year period, this Committee shall be the exclusive forum for dealing with non-work related health care issues and during the two year period each of the parties waives any rights to bargain over the subject of health care or health insurance or to impose other terms or to strike or arbitrate concerning other terms for health care coverage or benefits.
The parties agree that should any dispute concerning the interpretation or application of this Agreement arise between any two or more of them which cannot be resolved after good faith efforts, it shall be submitted to binding arbitration pursuant to the terms of the Uniform Arbitration Act (710 ILCS 5/1 et seq.). It is understood that this provision for arbitration shall not apply to operation of the Plan itself or to any individual claims or disputes under the Plan.
To select an arbitrator, the parties in dispute, by joint letter, shall request that the Federal Mediation and Conciliation Service (FMCS) submit a panel list of seven (7) arbitrators, all with National Academy of Arbitrators (NAA) credentials. The representatives of the parties shall meet within ten (10) days of their receipt of this list from FMCS and engage in a mutual striking process to select an arbitrator. Each party shall have the right to reject one entire list, provided such rejection occurs within five (5) days of the receipt of the list. The parties shall alternately strike a name from the list until there is one name remaining, with the order of striking to be determined by coin toss. The arbitrator shall be notified of his/her selection by joint letter, requesting that a hearing be scheduled in Rock Island, Illinois, on mutually agreed dates, subject to the reasonable availability of the parties and their representatives.
Both parties agree to attempt to arrive at a joint stipulation of the facts and issues as outlined to be submitted to the arbitrator. Both parties have the right to request the arbitrator to require the presence of witnesses and/or reasonable documents. Employees of the City called to testify at the arbitration shall be released from duty for such purposes without loss of pay or benefits. The arbitrator shall have no authority to amend, modify, nullify, ignore, add or subtract from the provisions of this Agreement. The arbitrator shall consider and decide the issue(s) presented and fashion an appropriate remedy. The arbitrator’s decision shall be rendered and delivered in writing to the parties within thirty (30) days of the close of the hearings or the submission of post-hearing briefs, whichever is later. Post-hearing briefs shall be filed simultaneously by the parties on the date established by the arbitrator. Fees and expenses of the arbitrator, the cost of the hearing room, and the cost of a court reporter to provide a written transcript for the arbitrator shall be shared equally by the parties. If either party desires a verbatim record of the proceedings, it shall pay for the cost of its copy.
6. The parties to this Agreement, in consideration of their mutual undertakings and obligations, mutually agree for the two year period that this Agreement represents a collectively bargained agreement between and among all of the parties and that no provisions concerning this plan shall be raised as an issue in any other collective bargaining agreement, contract or negotiations between those exclusive representatives and the City of Rock Island. It is further understood and agreed that this Agreement does not represent a collectively bargained agreement between the City of Rock Island and its non-represented employees nor between the City of Rock Island and the retired employees of the City, either individually or collectively, nor does it represent any undertaking to bargain with any exclusive representative concerning insurance, health care, or any other benefit or provision with the retirees who are or were members of any bargaining unit.
7. The Health Care Planning Committee shall be composed of the regular members appointed by the parties as follows:
A. The City Council shall appoint two regular members of the Committee from its membership as representatives of management.
B. The City Manager shall appoint three regular members of the Committee as representatives of management.
C. The AFSCME A, AFSCME B, COA, FOP, and IAFF unions shall each appoint three regular members of the Committee as representatives of these bodies.
D. The UAW shall appoint two regular members of the Committee as its representatives.
E. The Parks Director shall appoint two regular members of the Committee as representatives of its department and its non-represented employees.
Recognizing the need for stability in the Committee, each of the parties and participating groups agree insofar as it is practical to maintain the same representatives on the Committee for the term of this Agreement. If it becomes necessary to replace one of its previously designated representatives, such party or group will notify the co-chairs of the Committee in writing as soon as practical and not less than five (5) days prior to any regular Committee meeting.
8. Two retirees of the City shall be selected to serve as ex-officio members of the Committee and provide input and perspective from retirees. The Committee may decide to continue retiree participation at the conclusion of each plan year. Retirees serving on the Committee shall be selected by the Committee annually. The two retired representatives shall be from separate bargaining or non-affiliated groups.
9. The Committee shall determine its own internal structure, including arrangement for subcommittees and co-chairing of the Committee and subcommittees. Both Labor and Management shall be represented by co-chairs and within the membership of all subcommittees. The co-chair representing Labor shall alternate every plan year according to the following schedule, with the current Labor Co-Chair’s term set by the Committee:
AFSCME A
FOP Lodge #57
IAFF Local #26
Parks Department
AFSCME B
UAW Local #2282
This list shall be repeated in the same order once it is exhausted.
10. The Committee shall meet on a regular basis not less than quarterly and more frequently if needs require. Additional meetings may be called as necessary at the direction of the co-chairs. Additional meetings shall be called upon demand of any three of the parties to this agreement submitted in writing to the co-chairs. Meetings shall be called with a minimum of 10 working days notice to the members. Working days shall be defined as days that the Rock Island City Hall is open for business. In order for a quorum to be present at a regular meeting, at least 51% of the overall Committee membership shall be in attendance. If an emergency meeting is necessary in the opinion of the co-chairs, the 10 day notice requirement can be waived. However, in order for a quorum to be determined to be present at an emergency meeting, at least 1 member from each represented bargaining unit and 1 member appointed by city management shall be in attendance.
11. Employees who are on-duty shall be granted time off work to attend Committee and sub-committee meetings and be paid at the appropriate rate when attending said meetings. There shall be no compensation paid by the City for attendance at meetings when employees are not on-duty.
12. The Department of Personnel shall serve as staff to the Health Care Planning Committee.
13. The parties agree that for the term of this agreement, the existing fund balance in the City Health Insurance Fund shall be utilized in an effort to control costs for all parties to the plan. In accordance with City financial policies, the goal is to maintain a minimum balance in the fund of three (3) months of self-insured expenses. Each year, based upon the projection of expenses, the minimum balance of the fund shall be calculated. The Affordability Subcommittee will make financial recommendations during the premium renewal period to keep reserves sufficient to ensure revenues sufficient to maintain the fund balance. The subcommittee will also meet with the City Council and recommend options to increase revenues for the fund balance in an attempt to decrease premiums and make insurance more affordable for employees and retirees of the City of Rock Island.
A. The total amount shall be divided into fifths, representing a five (5) year plan for a phased reduction in the fund balance.
B. One fifth of the total amount (representing the first year of the five (5) year reduction) shall be utilized to reduce costs by reducing premiums paid into the fund by all plan participants, including the City, employees and retirees.
C. For the City, employees, and retirees under the age of 65, the fund balance shall be utilized as a straight percentage reduction in the premiums to be paid.
D. Each year, the calculation of the three (3) month fund balance and the five (5) year phased reduction in the fund balance shall be recomputed, resulted in a “rolling” five (5) year phased reduction.
14. The parties agree that the importance of a strong program to improve health and promote wellness of plan participants cannot be underestimated in providing for a high quality of life for plan participants as well as controlling costs in the long-term for the plan. Accordingly, the Committee agrees that it will set aside funds each year in its planning for health plan expenses to provide for a pro-active Wellness program.
15. In the event that, after reasonable effort, the Health Care Planning Committee is unable to reach agreement on the health care plan, the Health Care Planning Committee may be dissolved upon three or more parties to the agreement providing written notice of intent to withdraw from participation to the Committee Co-Chairs. Should fewer than three parties to the agreement request to dissolve the Committee, the Committee shall continue with full participation from all parties to the agreement. In the event that such a dissolution occurs, any party to this agreement may demand to bargain over the issue of health insurance. Until the outcome of such negotiations is determined, the plan shall remain unchanged as of the date of dissolution.
16. It is understood and agreed that the City of Rock Island, being a municipal corporation, this Agreement and all actions, procedures and processes under this Agreement are subject to all of the statutes and ordinances governing the conduct of municipalities, including but not limited to, requirements for bidding and contracting for the provisions of goods and services and compliance with all legal provisions for equal employment opportunity and affirmative action applicable to the City or any other party.
APPENDIX 1 TO CITY OF ROCK ISLAND AGREEMENT FOR JOINT
LABOR/MANAGEMENT HEALTH CARE PLANNING COMMITTEE
I. Purpose
The purpose of Appendix 1 is to provide a comprehensive summary of the City of Rock Island Employee Health Benefit Plan administered by the Health Care Planning Committee in accordance with the Agreement for Joint Labor/Management Health Care Planning Committee this appendix is attached to.
This appendix summarizes administration policies, coverages, benefit levels, and premiums available as a part of the Employee Health Benefit Plan (the Plan), providing information on each provision of the plan available to plan participants as well as expressing the policies by which the plan is administered by the Health Care Planning Committee.
II. Summary of Plan Administration Policies
Eligible employees, retired employees, and their eligible dependents shall be provided medical insurance benefits under the Plan according to the provisions below.
A. Eligibility
Active employees (on probationary or permanent status and working a minimum of thirty (30) hours weekly) and their eligible dependents shall be eligible for benefits under the health plan. Temporary or part-time employees working less than 30 hours weekly shall not be eligible for benefits under the health plan. Coverage for new employees and their eligible dependents will be effective on the first of the month after 30 days of employment with the City.
B. Health Care, Prescription Drug Plan and Vision Plan Premiums
1. Payments by City/Employee
The City of Rock Island’s monthly payment towards an eligible employee’s health insurance premium for single, employee/spouse (double), employee/child(ren), and family coverage shall be 70 percent of the total premium. The employee shall pay the remaining 30 percent of the premium via payroll deduction.
2. Both Working Provision
In the event a City employee is married to another City employee and both are eligible for health insurance coverage, the following premium options shall apply:
Option A: Each employee may elect to have single coverage with no dependent care coverage. The City would pay 70 percent of the total premium for each employee towards the cost of single coverage. The balance of the premium payment shall be paid by each employee via payroll deduction.
Option B: One of the employees may elect employee and spouse coverage with his/her spouse listed as dependent. The City will pay an amount equal to 70% of the total monthly single premium plus 70% of the remaining premium owed after subtracting the 70% of the single premium. The balance of the premium payment shall be paid by each employee via payroll deduction, with half of the amount of the premium due from the employee and spouse taken from each employee’s paycheck.
Option C: One of the employees may elect family coverage with his/her spouse and children listed as dependents. The City would pay an amount equal to 70 percent of the total monthly single premium plus 70 percent of the family premium owed after subtracting the total single premium.
3. City of Rock Island retirees will be allowed to continue participating in the health care plan provided they meet the eligibility provisions.
a. Retirees Less than 65 years Old and Eligible Dependents
Employees who are vested in their pension plan
and are eligible to receive paid pension benefits or have twenty (20) years of
service or are eligible for a disability pension shall be allowed to
continue membership in the plan upon separation from employment with the
City. Eligible dependents, if any, shall also be allowed to continue
participation on the plan in conformance with the summary plan descriptions of
the various plan offerings at the time of retirement. Said continued
participation in the plan for retirees and eligible dependents shall be
allowed as follows:
1. Retirees may elect at the time of retirement to continue membership in the plan without interruption upon separation from employment with the City.
2. Retirees not electing to continue their membership in the health plan at the time of separation shall permanently forfeit their right to re-enroll, with the following exceptions:
I. the retiree returns to active employment with the City as specified under Section II(A) above, or
ii. the retiree presents a certificate of continued coverage from a former health insurance provider in conformance with the Health Insurance Portability and Accountability Act of 1996 documenting proof of continued health insurance coverage for the appropriate time periods as required by the act.
iii. should the retiree choose to remain on the plan but becomes eligible for other group health insurance, the retiree may continue on the plan with the understanding that the plan will serve as the secondary provider of health coverage for the retiree. The other health coverage for the retiree shall be considered primary. The full amount of the premium will continue to be due from any retiree who elects this option.
Retirees shall be responsible for payment of the full cost of their health insurance premium under the health plan. The total premium due from retirees in this category shall be determined after the calculation of the premiums for the year in accord with Section 12 of the Joint Administration Agreement regarding the use of fund balance to reduce premiums.
b. Retirees 65 and over
Employees who retire at the age of 65 or over or retirees on the plan in conformance with Section B(3) above shall be provided with Medicare Supplement coverage rather than the existing plan for active employees, retirees under the age of 65, and their eligible dependents. This Medicare Supplement plan includes a prescription drug program similar to that provided for active employees and retirees under the age of 65. Continued participation in the plan for Medicare eligible retirees shall be in conformance with Section a(2) above.
In accordance with Section 13 (D) of the Joint Administration Agreement, the premium charged to retirees and their eligible dependents for participation in the Medicare Supplement plan shall be equivalent to the standard premium charged for Medicare Supplement participants between the ages of 65 and 69, regardless of the age of the participant. In addition, per Section 13(D) of the Joint Administration Agreement, there shall be no additional charge for the prescription drug program benefit.
C. Dental Plan Premiums
Active employees, retirees under the age of 65, and their eligible dependents shall be offered the opportunity to participate in a voluntary dental insurance benefit plan. Participation in this plan shall be completely voluntary by the employee with the full payment of premiums required by the employee. Premium rates will be determined by the annual level of participation in the program.
D. Dependent Eligibility
Eligible dependents of employees shall be insured under the plan provided the employee elects the additional dependent coverage; that the employee completes the necessary enrollment forms; and that the employee authorizes the appropriate payroll deductions for payment of the necessary premiums.
E. On-the-Job Disability Leave Premium Payments
Employees who are disabled as a result of an on-the-job injury shall be required to continue to pay their share of the insurance premium for single or family coverage. Employees who are disabled for more than one year as a result of an on-the-job injury shall be required to pay their entire insurance premium beginning with the first month following one year from the date the employee is disabled.
F. Unpaid Leave Premium Payments
Employees who are on any type of approved, unpaid leave which exceeds 30 calendar days shall be responsible for the full payment of their health insurance premium for the duration of their leave, except as provided by the Family and Medical Leave Act.
G. Failure to Make Payments on Premiums
Employees, who fail, for any reason to make the proper payments for their portion of the health insurance premium shall forfeit their health benefits under the Plan.
H. Continued Participation at Termination
Employees who voluntarily or involuntarily end their employment with the City and who do not qualify for continued participation in the plan under Sections II(B)(2)(3) and II(B)(2)(4) above are eligible for continued health care coverage under COBRA. The specific time period for continued participation shall be in conformance with COBRA. The full amount of the premium and a 2% administration fee shall be charged to any employee electing continued coverage under COBRA. The former employee shall pay the full premium in advance each month in order to continue participation.
I. Plan Booklet
Benefits provided under the various options that make up the Plan shall be published in booklet form and shall be made available to all employees. The booklet(s) shall also include information regarding the filing and processing of claims, enrollment procedures and policies, procedures for adding or deleting coverage for dependents, as well as other information concerning the administration and operation of the Plan.
III. COVERAGE SUMMARY
1. Options--The plan includes several options for active employees and retirees under the age of 65 in the Quad Cities to choose from, including:
A. Coverage categories-a. Employee,
b. Employee and spouse,
c. Employee and child(ren) with no spouse, and
d. Family (spouse and children)
B. Health Care Plan- a. Partially self-insured Standard Plan administered by Employee Benefits Corp. (HCH Administration).
C. Dental- Employees may elect whether or not to participate in a voluntary dental insurance program offered by Delta Dental.
2. Vision Care-- Included as part of the standard benefit package for active employees, retirees under the age of 65 in the Quad Cities area, and their eligible dependents is a vision care plan provided by Outlook Vision Services.
3. Medicare Supplement-- Retirees and their eligible dependents who are Medicare eligible are able to participate in a Medicare Supplement plan through American Association of Retired Persons (AARP). The benefits for those covered in the Medicare Supplement Plan are Plan F. Although retirees in excess of 79 years of age are included in the Plan B Medicare Supplement Plan, AARP is responsible for payment of the additional benefits necessary to ensure that those older retirees are afforded the same benefits as are available to those on the Plan F Medicare Supplement plan.
4. Retirees Under 65 Out of the Quad City Area-- Retirees and their eligible dependents who are under the age of 65 and reside away from the Quad City area are eligible for participation in the Beechstreet Plan. This plan provides benefits similar to those formerly offered by the City to all employees, with an annual deductible and a standard 90/10 co-pay for most claims.
5. Medicare Supplement Plan Prescription Drug Program-- Retirees and their eligible dependents who are on the Medicare Supplement plan and retirees under the age of 65 and out of the Quad City area have prescription drug benefits equivalent to active employees, retirees under the age of 65 and their eligible dependents in the Quad City area. These drug benefits are administered Walgreens Health Initiatives on a self-funded basis by the City.
Attachments--
1. Standard Plan Summary Plan Description
2. Outlook Vision Services Sponsor Agreement
3. Delta Dental Insurance Summary Plan Description
4. Medicare Supplement Plan F Benefits Listing
5. City of Rock Island Premium Listing for All Premium Categories for April 1, 2004-March 31, 2005.