(A) Policy statement. The board of trustees
authorizes all of the university's employee health care insurance programs.
This policy is intended to authorize participation in the medical, prescription
drug, dental and vision plan options for professional/administrative and other
non-bargaining employees of the university.
(B) Health care advisory committee. A health
care advisory committee ("HCAC") with representation from all bargaining units
and nonbargaining employees from each of the university divisions is
established in accordance with the HCAC September 2011 policy and guidelines.
The charge of the committee is to review and assess existing medical, dental,
prescription drug, and vision benefit plan options and other cost-controlling
measures.
(C) Plan design and
benefit levels.
(1) Bargaining unit employees
are eligible for medical, dental, prescription drug, and vision coverage in
accordance with the applicable collective bargaining agreement.
(2) Eligible employees who are not covered by
a collective bargaining agreement are eligible for medical, dental,
prescription drug, and vision coverage as identified in the
"Benefits" section on
employee benefits section of the office of human
resources website.
(D)
Premium sharing.
(1) Bargaining unit
employees who choose to enroll in the medical, prescription drug, dental or
vision plan will be required to contribute toward the cost of coverage in
accordance with the applicable collective bargaining agreement.
(2) Eligible employees who are not covered by
a collective bargaining agreement and who choose to enroll in the university's
health insurance plans will be required to share in the cost of coverage as
follows:
(a) Employees will contribute, via
payroll deduction, an aggregate
of fifteen per
cent
per cent of the funding
level
.
Funding rates will be established
for three tiers: the employee only, employee plus one dependent, and family
(employee plus two or more dependents) contracts. A flat percentage of salary
that is required for funding level to be reached will be identified each July
first
as recommended by the office of human
resources or negotiated through collective bargaining and approved by the board
of trustees. Annual funding level percentages
will be identified for the new plan year.
(b) Notwithstanding the foregoing
formula, employees shall pay no more or no less than the following percentages
of the funding rates effective July 1, 2017 through June 30,
2018:
(i) Minimum of ten per cent,
and
(ii) Maximum of twenty per
cent.
(c) Effective July 1, 2018 and
thereafter, employees will contribute via pay deduction fifteen per cent of the
cost of the employee only, employee plus one dependent, and family (employee
plus two or more dependents) of the full premium for fully insured components,
or for self-insured components, the established fully insured equivalent
rate.
(3) Payments shall be deducted in equal
amounts from each eligible participant's semimonthly paychecks.
(E) Working spouse/coordination of benefits.
(1)
As a condition
of eligibility for coverage under the university's group medical and/or
prescription drug plan (referred to as "university coverage"), if an employee's
spouse is eligible for
Working spouses of
university employees who have access to group medical and/or
prescription coverage which is sponsored, maintained and/or provided by the
spouse's current employer, former employer (if retirees), or business for
self-employed individuals other than sole proprietors, collectively or
individually, (referred to as
"employer
coverage
"),
the
spouse must
are required to enroll for
primary coverage at least
at the single coverage
in
his/her employer coverage
level unless
he/she is entitled to medicare as of January 1, 2015.
These spouses are only permitted to have secondary access to
university group medical and/or prescription drug plan (referred to as
university coverage). The use of the word
"spouse
" in
this policy refers to a legal spouse.
For purposes of this section, in instances where the spouse's
employer makes no monetary contribution for employer coverage, such plans will
not be considered to be employer coverage. This is intended to apply to
situations in which the spouse is a current employee in a business but not to
situations in which the spouse is a business owner, including partner of a
company and/or firm, is a self-employed individual (other than a sole
proprietor) in a business, or a retiree in a group medical and/or prescription
drug insurance plan.
(2)
The requirement of paragraph (E)(1) of this rule does not apply to any spouse
who works less than twenty-five hours per week and is required to pay more than
fifty
per cent
per
cent of the single premium
funding
rate or five hundred dollars per month, whichever is greater, in order to
participate in employer coverage.
(3) An employee's spouse who fails to enroll
in
their employer coverage, as outlined in this
paragraph,
shall be ineligible for
will remain on the university coverage
for secondary coverage.
(4)
Upon the
spouse's enrollment in employer coverage, that coverage will become the primary
plan and the university coverage will become the secondary plan, according to
the primary plan's coordination of benefits and participation rules.
Notwithstanding the foregoing, in
In the
event the spouse is a medicare beneficiary and medicare is secondary to the
university coverage and medicare is primary to the spouse's employer coverage,
the university coverage will be the primary coverage. Sections
3902.11 to
3902.14 of the Revised Code
shall govern the implementation and interpretation of these coordination of
benefits rules.
(F) Upon
becoming eligible, the employee's spouse must enroll in employer coverage
unless he/she is exempt from this requirement in accordance with the exemptions
stated in this policy.
(G) All
employees choosing to enroll, whose spouse participates in the university's
group medical and/or prescription drug insurance coverage, shall, upon request,
complete and submit to the plan a written certification verifying whether
his/her spouse is eligible for and enrolled in employer coverage. If any
employee fails to complete and submit the certification form during the annual
certification process, such employee's spouse will be removed
immediately from university coverage. Any
information not completed or provided on the certification form may be
requested from the employee.
(H) If
an employee submits false material information or fails to timely advise the
plan via the chief human resources officer
or
designee, of a change in the eligibility of the employee's spouse for
employer coverage within thirty days of notification of such eligibility, and
such false information or failure results in the provision of university
coverage to which the employee's spouse is not entitled, the employee's spouse
will be disenrolled from university coverage. Such disenrollment may be
retroactive to the date as of which the employee's spouse became ineligible for
plan coverage, as determined by the administrator for the university coverage.
The administrator shall provide at least thirty days advance
written notice of any proposed retroactive disenrollment. In the event of
retroactive disenrollment, the employee will be personally liable to the
applicable university coverage for reimbursement of benefits and expenses,
including attorney's fees and costs incurred by the university coverage as a
result of the false information or failure. Additionally, if the employee
submits false information in this context, the employee may be subject to
disciplinary action up to and including termination of employment.
(I) The details of the working
spouse limitations and coordination of benefits requirements are available
upon request from the human resource office
on the office of human resources website at employee
benefits.
(J) For purposes of
salary deduction toward insurance premium cost sharing, families in which both
spouses are employed by the university have the option either to be treated as
only one employee, employee plus one or family coverage, or to select
individual coverage and for each to pay the single salary share for
premium.
(K) If one spouse works
for the university and the other does not, the children
may remain on the university insurance. If both
spouses work for the university and choose employee plus one or family
coverage, the
higher paid
spouses will determine which employee pays for
the employee plus one or family coverage.
(L) An employee may opt out of health
insurance benefits (medical, prescription drug, dental and/or vision) coverage
upon submission of sufficient evidence, in accordance with the provisions of
this rule, of such coverage from another source.
