ARTICLE 14

Insurance

Section A. State Employee Group Insurance Program (“SEGIP”). During the life of this Agreement, the Employer agrees to offer a Group Insurance Program that includes health, dental, life, and disability coverages equivalent to existing coverages, subject to the provisions of this article.

All insurance eligible employees will be provided with a Summary Plan Description (“SPD”) “Your Employee Benefits”. Such SPD shall be provided no less than biennially and prior to the beginning of the insurance year. New insurance eligible employees shall receive a SPD within thirty (30) days of their date of eligibility.

Section B. Eligibility for Group Participation. This section describes eligibility to participate in the Group Insurance Program.

Subd. 1. Faculty Members - Basic Eligibility. A faculty member may participate in the Group Insurance Program if he/she is employed on the basis of at least fifty percent (50%) of a full-time work assignment for a regular academic year. If an insurance eligible faculty member’s last scheduled day of work (excluding termination for cause) is at the end of the academic year or later, coverage will cease at the completion of the payroll period in which the succeeding academic year commences. If an insurance eligible faculty member is terminated for cause or his/her last scheduled day of work is before the end of the academic year, coverage will cease at the end of the payroll period in which the separation or termination date occurs.

Subd. 2. Faculty Members - Special Eligibility. The following faculty members are also eligible to participate in the Group Insurance Program:

a. Faculty Members with Work-related Injury/Disability. A faculty member who was off the State payroll due to a work-related injury or a work-related disability may continue to participate in the Group Insurance Program as long as such a faculty member receives workers’ compensation payments or while the workers’ compensation claim is pending.

b. Totally Disabled Faculty Members. Consistent with Minnesota Statutes §62A.148, certain totally disabled faculty members may continue to participate in the Group Insurance Program.

c. Early Retirement. A faculty member who retires from State service, is not eligible for regular (non-disability) Medicare coverage, has five (5) or more years of allowable pension service, and is immediately eligible to receive a retirement benefit under Chapter 354B or an annuity under a State retirement program may continue to participate in the health and dental coverages offered through the Group Insurance Program at his/her own expense.

Consistent with Minnesota Statutes §43A.27, Subd. 3., a retired faculty member who receives a retirement benefit under Chapter 354B or an annuity under a State retirement program may continue to participate in the health and dental coverages offered through the Group Insurance Program at his/her own expense. A spouse of a deceased retired faculty member may continue health and dental coverages through the Group Insurance Program provided the spouse was dependent under the retired member’s coverage at the time of the retiree’s death and continues to make the required premium payments. Retiree coverage must be coordinated with Medicare.

d. Sabbatical Leave. A faculty member eligible to participate in the Group Insurance Program immediately prior to taking a sabbatical leave continues that eligibility during the sabbatical leave.

e. Adjunct faculty with multiple appointments. An adjunct faculty member holding separate appointments at different MnSCU institutions shall have such assignments combined for purposes of determining eligibility under Article 14. To be eligible for this benefit, such adjunct faculty members must report any multiple appointments to the human resource office at each reporting institution.

Subd. 3. Dependents. Eligible dependents for purposes of this article are as follows:

a. Spouse. The spouse of an eligible faculty member (if not legally separated). For the purposes of health insurance coverage, if that spouse works full-time for an organization employing more than one hundred (100) people and elects to receive either credits or cash: (1) in place of health insurance or health coverage, or (2) in addition to a health plan with a seven hundred and fifty dollar ($750) or greater deductible through his/her employing organization, he/she is not eligible to be a covered dependent for purposes of this article. If both spouses work for the State or another organization participating in the State’s Group Insurance Program, neither spouse may be covered as a dependent by the other unless one spouse is not eligible for a full Employer Contribution as defined in Subd. 3.a.

b. Children and Grandchildren. An eligible faculty member’s unmarried dependent children and unmarried dependent grandchildren: (1) through age eighteen (18); or (2) through age twenty-four (24) if the child or grandchild is a full-time student at an accredited educational institution; or (3) a child or grandchild, regardless of age or marital status who is incapable of self-sustaining employment by reason of mental retardation, mental illness or physical disability and if chiefly dependent on the faculty member for support. The handicapped dependent shall be eligible for coverage as long as she/he continues to be handicapped and dependent, unless coverage terminates under the contract. Children or grandchildren who become handicapped after they are no longer eligible dependents under (1) and (2) above may not be considered eligible dependents unless they are continuing coverage as a dependent through the employee’s prior employer.

“Dependent Child” includes a faculty member’s: (1) biological child, (2) child legally adopted by or placed for adoption with the faculty member, (3) foster child, and (4) stepchild. To be considered a dependent child, a foster child must be dependent on the faculty member for his/her principal support and maintenance and be placed by the court in the custody of the faculty member. To be considered a dependent child, a stepchild must maintain residence with the faculty member and be dependent upon the faculty member for his/her principal support and maintenance.

“Dependent Grandchild” includes a faculty member’s: (1) grandchild placed in the legal custody of the faculty member, (2) grandchild legally adopted by the faculty member or placed for adoption with the faculty member, or (3) grandchild who is the dependent child of the faculty member’s unmarried dependent child. Under (1) and (3) above, the grandchild must be dependent upon the faculty member for principal support and maintenance and live with the faculty member.

If both spouses work for the State or another organization participating in the State’s Group Insurance Program, either spouse, but not both, may cover their eligible dependent children or grandchildren. This restriction also applies to two divorced, legally separated, or unmarried faculty members/employees who share legal responsibility for their eligible dependent children or grandchildren.

Subd. 4. Continuation of Coverage. Consistent with state and federal laws, certain faculty members, former faculty members, dependents, and former dependents may continue group health, dental, and/or life coverage at their own expense for a fixed length of time. As of the date of this Agreement, state and federal laws allow certain group coverages to be continued if they would otherwise terminate due to:

a. Termination of employment (except for gross misconduct);

b. Layoff;

c. Reduction of hours to an ineligible status;

d. Dependent child becoming ineligible due to change in age, student status, marital status, or financial support (in the case of a foster child or stepchild);

e. Death of faculty member;

f. Divorce or legal separation;

g. Covered employee’s entitlement to or enrollment in Medicare.

Section C. Eligibility for Employer Contribution. This section describes eligibility for an Employer Contribution toward the cost of coverage.

Subd. 1. Full Employer Contribution - Basic Eligibility. Faculty members covered by this Agreement and appointed for at least seventy-five percent (75%) of the full-time work assignment load for a regular academic year receive the full Employer Contribution. The seventy-five percent (75%) minimum requirement can be satisfied by: (1) a one hundred sixty-eight (168) duty-day contract at seventy-five percent (75%) load; (2) a contract for seventy-five percent (75%) of the 168 duty days at full load; (3) some equivalent combination.

A faculty member initially hired during the academic year on a tenured appointment or a probationary appointment may receive the full Employer Contribution if the appointment is for a minimum of a seventy-five percent (75%) load for the duration of that appointment. A faculty member who, due to a change in assignment during the academic year, becomes eligible under this subdivision for an Employer Contribution shall be eligible on a prospective basis.

Subd. 2. Partial Employer Contribution - Basic Eligibility. Faculty members covered by this Agreement, who hold part-time appointments and who work at least fifty percent (50%), but less than seventy-five percent (75%), of the full-time work assignment load for a regular academic year, receive the full Employer Contribution for basic life coverage, and at the employee's option, a partial Employer Contribution for health and dental coverages. The partial Employer Contribution for health and dental coverages is seventy-five percent (75%) of the full Employer Contribution for both employee only and dependent coverage. A faculty member who, due to a change in assignment during the academic year, becomes eligible under this subdivision for a partial Employer Contribution shall be eligible to participate in the group insurance program on a prospective basis.

Subd. 3. Special Eligibility. The following faculty members also receive an Employer Contribution:

a. Faculty Members on Layoff. An eligible tenured faculty member who receives an Employer Contribution, who has three (3) or more years of continuous service, and who has been laid off pursuant to the provisions of Article 23 remains eligible for an Employer Contribution and all other benefits provided under this article for twelve (12) consecutive months from the date of layoff.

b. Work-Related Injury/Disability. A faculty member who receives an Employer Contribution and who is off the State payroll due to a work-related injury or a work-related disability remains eligible for an Employer Contribution as long as such faculty member receives workers’ compensation payments. If such faculty member ceases to receive workers’ compensation payments for the injury or disability and is granted a disability leave under Article 17, he/she shall be eligible for an Employer Contribution during that leave.

c. Sabbatical or Educational Leave. A faculty member eligible to participate in the Group Insurance Program immediately prior to taking a sabbatical leave, or an educational leave pursuant to Article 18, continues that eligibility during the sabbatical or educational leave.

d. Faculty members participating in phased retirement shall be eligible for Employer-paid benefits in accordance with Minnesota Statutes §354.66 at the same rate as if they were employed full-time.

e. Faculty members participating in the Annuitant Employment Program (AEP) shall be eligible for Employer-paid benefits in accordance with Minnesota Statutes §§136F.48 and 354.445 at the same rate as if they were employed full-time.

Subd. 4. Maintaining Eligibility for Employer Contribution.

General. A faculty member who is eligible for the Employer Contribution maintains that eligibility as long as the faculty member meets the Employer Contribution eligibility requirements and appears on a State payroll for at least one (1) full working day during each payroll period. This requirement does not apply to faculty members who receive an Employer Contribution while on layoff as described in Section C, Subd. 3.a, or while eligible for workers’ compensation payments as described in Section C, Subd. 3.b.

a. General. A faculty member who is eligible for the Employer Contribution maintains that eligibility as long as the faculty member meets the Employer Contribution eligibility requirements and appears on a State payroll for at least one (1) full working day during each payroll period. This requirement does not apply to faculty members who receive an Employer Contribution while on layoff as described in Section C, Subd. 3.a, or while eligible for workers’ compensation payments as described in Section C, Subd. 3.b.

b. Unpaid Leave of Absence. If a faculty member is on an unpaid leave of absence, then sick leave cannot be used for the purpose of maintaining eligibility for an Employer Contribution by keeping the faculty member on a State payroll for one working day per pay period.

c. A faculty member on an approved Family Medical Leave Act (FMLA) leave or on a voluntary reduction in hours as provided elsewhere in this Agreement maintains eligibility for an Employer Contribution.

Section D. Amount of Employer Contribution. For faculty members eligible for an Employer Contribution as described in Section C, the amount of the Employer Contribution will be determined as follows beginning on January 1, 2008. The Employer Contribution amounts and rules in effect on June 30, 2007, will continue through December 31, 2007.

Subd. 1. Contribution Formula - Health Coverage.

a. Faculty Member Coverage. For faculty member health coverage, the Employer contributes an amount equal to one hundred percent (100%) of the faculty member premium of the Minnesota Advantage Health Plan (Advantage).

b. Dependent Coverage. For dependent health coverage for the 2008 and 2009 plan years, the Employer contributes an amount equal to eighty five percent (85%) of the dependent premium of Advantage.

Subd. 2. Contribution Formula - Dental Coverage.

a. Faculty Member Coverage. For faculty member dental coverage, the Employer contributes an amount equal to the lesser of ninety percent (90%) of the faculty member premium of the State Dental Plan, or the actual faculty member premium of the dental plan chosen by the faculty member. However, for calendar years beginning January 1, 2008, and January 1, 2009, the minimum employee contribution shall be five dollars ($5.00) per month.

b. Dependent Coverage. For dependent dental coverage, the Employer contributes an amount equal to the lesser of fifty percent (50%) of the dependent premium of the State Dental Plan, or the actual dependent premium of the dental plan chosen by the faculty member.

Subd. 3. Contribution Formula - Basic Life Coverage. For faculty members’ basic life coverage and accidental death and dismemberment coverage, the Employer contributes one hundred percent (100%) of the cost.

Section E. Coverage Changes and Effective Dates.

Subd. 1. When Coverage May be Chosen.

a. Newly Hired Employees. All faculty members hired to an insurance eligible position must make benefit elections by their initial effective date of coverage as defined in this article, Section E, Sub. 3. Insurance eligible employees will automatically be enrolled in basic life coverage. If faculty members eligible for a full Employer Contribution do not choose a health plan administrator and a primary care clinic by their initial effective date, they will be enrolled in a Benefit Level Two clinic (or Level One, if available) that meets established access standards in the health plan with the largest number of Benefit Level One and Two clinics in the county of the faculty member’s residence at the beginning of the insurance year.

b. Eligibility Changes. Faculty members who become eligible for a full Employer Contribution must make their benefit elections within thirty (30) calendar days of becoming eligible. If employees do not choose a health plan administrator and primary care clinic within this thirty (30) day time frame, they will be enrolled in a Benefit Level Two clinic (or Level One, if available) that meets established access standards in the health plan with the largest number of Benefit Level One and Two clinics in the county of the employee’s residence at the beginning of the insurance year.

If employees who become eligible for a partial Employer Contribution choose to enroll in insurance, they must do so within thirty (30) days of becoming eligible or during open enrollment.

A faculty member may change his/her health or dental plan if the faculty member changes to a new permanent work or residence location, and the faculty member’s current plan is no longer available. If the faculty member has family coverage and if the new residence location is outside of the current plan’s service area, the employee shall be permitted to switch to a new plan administrator and new Benefit Level within thirty (30) days of the residence location change. The election change must be due to and correspond with the change in status. A faculty member who receives notification of a work location change between the end of an open enrollment period and the beginning of the next insurance year may change his/her health or dental plan within thirty (30) days of the date of the relocation under the same provisions accorded during the last open enrollment period.

A faculty member may also change health or dental plans in any other situation in which the Employer is required by applicable federal or state laws to allow a plan change.

Subd. 2. When Coverage May be Changed or Cancelled.

a. Changes Due to a Life Event. After the initial enrollment period and outside of any open enrollment period an employee may elect to change health or dental coverage (including adding or canceling coverage) and any applicable employee contributions in the following situations (as long as allowed under the applicable provisions, regulations, and rules of the federal and state law in effect at the beginning of the plan year).

The request to change coverage must be consistent with a change in status that qualifies as a life event, and does not include changing health or dental plans, which may only be done under the terms of Section E, Subd. 1, above. Any election to add coverage must be made within thirty (30) days following the event, and any election to cancel coverage must be made within sixty (60) days following the event. (An employee and a retired employee may add dependent health or dental coverage following the birth of a child or dependent grandchild, or following the adoption of a child, without regard to the thirty (30) day limit.) These life events (for both employees and retirees) are:

1. A change in legal marital status, including marriage, death of a spouse, divorce, legal separation and annulment.

2. A change in number of dependents, including birth, death, adoption, and placement for

adoption.

3. A change in employment status of the employee, or the employee’s or retiree’s spouse or dependent, including termination or commencement of employment, a strike or lockout, a commencement of or return from an unpaid leave of absence, a change in worksite, and a change in working conditions (including changing between part-time and full-time or hourly and salary) of the employee, the employee’s or retiree’s spouse or dependent which results in a change in the benefits they receive under a cafeteria plan or a health or dental plan.

4. A dependent ceasing to satisfy eligibility requirements for coverage due to attainment of age, student status, marital status, or other similar circumstances.

5. A change in the place of residence of the employee, retiree or their spouse or dependent.

6. Significant cost or coverage changes (including coverage curtailment and the addition of a benefit package).

7. Family Medical Leave Act (FMLA) leave.

8. Judgments, decrees or orders.

9. A change in coverage of a spouse or dependent under another employer’s plan.

10. Open enrollment under the plan of another employer.

11. Health Insurance Portability and Accountability Act (HIPAA) special enrollment rights for new dependents and in the case of loss of other insurance coverage.

12. A COBRA-qualifying event.

13. Loss of coverage under the group health plan of a governmental or educational institution (a state’s children’s health insurance program, medical care program of an Indian tribal government, State health benefits risk pool, or foreign government group health plan).

14. Entitlement to Medicare or Medicaid.

15. Any other situations in which the group health or dental plan is required by the applicable federal or state law to allow a change in coverage.

b. Canceling Dependent Coverage During Open Enrollment. In addition to the above situations, dependent health or dependent dental coverage may also be canceled for any reason during the open enrollment period that applies to each type of plan (as long as allowed under the applicable provisions, regulations and rules of the federal and state law in effect at the beginning of the plan year).

c. Canceling Employee Coverage. A part-time employee may also cancel employee coverage within sixty (60) days of when one of these same life events occurred.

d. Effective Date of Benefit Termination. Medical, dental and life coverage termination will take effect on the first of the month following the loss of eligible employee or dependent status. Disability benefit coverage terminations will take effect on the day following loss of eligible employee or dependent status.

Subd. 3. Effective Date of Coverage.

a. Initial Effective Date. The initial effective date of coverage under the Group Insurance Program is the thirty-fifth day following the faculty member’s first day of employment, reemployment, rehire, or reinstatement with the State. The initial effective date of coverage for an employee whose eligibility has changed is the date of the change. A faculty member must be actively at work on the initial effective date of coverage, except that a faculty member who is on paid leave on the date State-paid life insurance benefits increase is also entitled to the increased life insurance coverage. In no event shall a faculty member’s dependent’s coverage become effective before the faculty member’s coverage

If an employee is not actively at work due to employee or dependent health status or medical disability, medical and dental coverage will still take effect. (Life and disability coverage will be delayed until the employee returns to work.)

b. Delay in Coverage Effective Date.

1. Basic Life. If a faculty member is not actively at work on the initial effective date of coverage, coverage will be effective on the first day of the faculty member’s return to work. The effective date of a change in coverage is not delayed in the event that, on the date the coverage change would be effective, a faculty member is on an unpaid leave of absence or layoff.

2. Medical and Dental. If a faculty member is not actively at work on the initial effective date of coverage due to a reason other than hospitalization or medical disability of the faculty member or dependent, medical and dental coverage will be effective on the first day of the faculty member’s return to work.

The effective date of a change in coverage is not delayed in the event that, on the date the coverage change would be effective, a faculty member is on an unpaid leave of absence or layoff.

3. Optional Life and Disability Coverages. In order for coverage to become effective, the faculty member must be in active payroll status and not using sick leave on the first day following approval by the insurance company. If it is an open enrollment period, coverage may be applied for but will not become effective until the first day of the faculty member’s return to work.

Subd. 4. Open Enrollment.

a. Frequency and Duration. There shall be an open enrollment period for health coverage in each year of this Agreement, and for dental coverage in the first year of this Agreement. Each year of the Agreement, all employees shall have the option to complete a Health Assessment. Open enrollment periods shall last a minimum of fourteen (14) calendar days in each year of the Agreement. Open enrollment changes become effective on January 1 of each year of this Agreement.

b. Eligibility to Participate. A faculty member eligible to participate in the Group Insurance Program, as described in Section B, Subd. 1. and Section B, Subd. 2., may participate in open enrollment. In addition, a person in the following categories may, as allowed in Section E, Subd. 4.a above, make certain changes: (1) a former employee or dependent on continuation coverage, as described in Section B, Subd. 4, may change plans or add coverage for health and/or dental plans on the same basis as active employees; and (2) an early retiree, prior to becoming eligible for Medicare, may change health and/or dental plans as agreed to for active employees, but may not add dependent coverage.

c. Materials for Faculty Member Choice. Each year prior to open enrollment the appointing authority will give eligible faculty members the information necessary to make open enrollment selections. Employees will be provided a statement of their current coverage each year of the contract.

Subd. 5. Coverage Selection Prior to Retirement. A faculty member who retires and is entitled to receive an annuity under a State retirement program may change his/her health or dental plan during the sixty (60) calendar day period immediately preceding the date of retirement. The faculty member may not add dependent coverage during this period. The change takes effect on the first day of the month following the date of retirement.

Section F. Basic Coverages.

Subd. 1. Faculty Member and Family Health Coverage.

a. Minnesota Advantage Health Plan (Advantage). The health coverage portion of the State Employee Group Insurance Program is provided through the Minnesota Advantage Health Plan (Advantage), a self-insured health plan offering four (4) Benefit Level options. Provider networks and claim administration are provided by multiple plan administrators. Coverage offered through Advantage is determined by Section F, Subd. 1, paragraph b below.

b. Coverage under the Minnesota Advantage Health Plan (Advantage). From July 1, 2007 through December 31, 2007, health coverage under the SEGIP will continue at the level in effect on June 30, 2007. Effective January 1, 2008, Advantage will cover eligible services subject to the copayments, deductibles and coinsurance coverage limits stated. Services provided through Advantage are subject to the managed care procedures and principles, including standards of medical necessity and appropriate practice of the plan administrators. Coverage details are provided in the Advantage Summary of Benefits.

1. Benefit Options. Employees must elect a plan administrator and primary care clinic. Those elections will determine the Benefit Level through Advantage. Enrolled dependents must elect a primary care clinic that is available through the plan administrator chosen by the employee.

I. Plan Administrator. Employees must elect a plan administrator during their initial enrollment in Advantage and may change their plan administrator election only during the annual open enrollment and when permitted under Section E. Dependents must be enrolled through the same plan administrator as the employee.

II. Benefit Level. The primary care clinics available through each plan administrator are assigned a Benefit Level. The Benefit Levels are outlined in the benefit chart below. Primary care clinics may be in different Benefit Levels for different plan administrators. Family members may be enrolled in clinics that are in different Benefit Levels. Employees and their dependents may change to clinics in different Benefit Levels during the annual open enrollment. Employees and their dependents may also elect to move to a clinic in a different Benefit Level within the same plan administrator up to two (2) additional times during the plan year. Unless the individual has a referral from his/her primary care clinic, there are no benefits for services received from providers in Benefit Levels that are different from that of the primary care clinic in which the individual has enrolled.

III. Primary Care Clinic. Employees and each of their covered dependents must individually elect a primary care clinic within the network of providers offered by the plan administrator chosen by the employee. Employees and their dependents may elect to change clinics within their clinic’s Benefit Level as often as the plan administrator permits and as outlined above.

IV. Advantage Benefit Chart for Services Incurred During Plan Year 2008 and 2009.

2008 and 2009 Benefit Provision	Benefit Level 1 The member pays:	Benefit Level 2 The member pays:	Benefit Level 3 The member pays:	Benefit Level 4 The member pays:
Deductible for all services except drugs and preventive care (S/F)	$50/100	$140/280	$350/700	$600/1200
Office visit copay/urgent care (copay waived for preventive services) 1) Having taken Health Assessment and opted in for Health Coaching 2) Not having taken Health Assessment or not having opted-in for Health Coaching	1) $17 2) $22	1) $22 2) $27	1) $27 2) $32	1) $37 2) $42
Convenience Clinic (deductible waived)	$10	$10	$10	$10
Emergency room Copay	$75	$75	$75	N/A – subject to Deductible and 25% Coinsurance to OOP maximum
Facility copays · Per inpatient Admission · Per outpatient Surgery	$85 $55	$180 $110	$450 $220	N/A—subject to Deductible and 25% Coinsurance to OOP maximum N/A—subject to Deductible and 30% Coinsurance to OOP maximum
Coinsurance for MRI/CT scan services	5%	5%	10%	N/A—subject to Deductible and 30% Coinsurance to OOP maximum
Coinsurance for services NOT subject to copays	5% (100% coverage after payment of deductible)	5% (100% coverage after payment of deductible)	10% (90% coverage after payment of deductible)	30% for all services to OOP maximum after deductible.
Coinsurance for durable medical equipment	20% (80% coverage after payment of 20% coinsurance)	20% (80% coverage after payment of 20% coinsurance)	20% (80% coverage after payment of 20% coinsurance)	30% for all services to OOP maximum after deductible.
Copay for three tier prescription drug Plan	Tier 1: $10 Tier 2: $16 Tier 3: $36	Tier 1: $10 Tier 2: $16 Tier 3: $36	Tier 1: $10 Tier 2: $16 Tier 3: $36	Tier 1: $10 Tier 2: $16 Tier 3: $36
Maximum drug out-of-pocket limit (S/F)	$800/$1,600	$800/$1,600	$800/$1,600	$800/$1,600
Maximum non-drug Out-of-pocket limit (S/F)	$1,100/$2,200	$1,100/$2,200	$1,100/$2,200	$1,100/$2,200

2. Office Visit Copayments. In each year of the Agreement, the level of the office visit copayment applicable to an employee and dependents is based upon whether the employee has completed the on-line Health Assessment during open enrollment, and has agreed to opt-in for Health Coaching.

3. Services received from, or authorized by, a primary care physician within the primary care clinic. Under Advantage, the health care services outlined in the benefits charts above shall be received from, or authorized by a primary care physician within the primary care clinic. Preventive care, as outlined in the Summary of Benefits, is covered at one hundred percent (100%) for services received from or authorized by the primary care clinic. The primary care clinic shall be selected from approved clinics in accordance with the Advantage administrative procedures. Unless otherwise specified in paragraph 4) below, services not received from, or authorized by, a primary care physician within the primary care clinic may not be covered. Unless the individual has a referral from his/her primary care clinic, there are no benefits for services received from providers in Benefit Levels that are different from that of the primary care clinic in which the individual has enrolled.

4. Services not requiring authorization by a primary care physician within the primary care clinic.

I. Eye Exams. Limited to one (1) routine examination per year for which no copay applies.

II. Outpatient emergency and urgicenter services within the service area. The emergency room copay applies to all outpatient emergency visits that do not result in hospital admission within twenty-four (24) hours. The urgicenter copay is the same as the primary care clinic office visit copay.

III. Emergency and urgently needed care outside the service area. Professional services of a physician, emergency room treatment, and inpatient hospital services are covered at eighty percent (80%) of the first two thousand dollars ($2,000) of the charges incurred per insurance year, and one hundred percent (100%) thereafter. The maximum eligible out-of-pocket expense per individual per year for this benefit is four hundred dollars ($400). This benefit is not available when the member’s condition permits him/her to receive care within the network of the plan in which the individual is enrolled.

IV. Ambulance. The deductible and coinsurance for services not subject to copays applies.

5. Prescription drugs.

I. Copayments and annual out-of-pocket maximums.

For each year of the contract:

Tier 1 copayment: Ten dollar ($10) copayment per prescription or refill for a Tier 1 drug dispensed in a thirty (30) day supply.

Tier 2 copayment: Sixteen dollar ($16) copayment per prescription or refill for a Tier 2 drug dispensed in a thirty (30) day supply.

Tier 3 copayment: Thirty-six dollar ($36) copayment per prescription or refill for a Tier 3 drug dispensed in a thirty (30) day supply.

Out-of-pocket maximum: There is an annual maximum eligible out-of-pocket expense limit for prescription drugs of eight hundred dollars ($800) per person or one thousand six hundred dollars ($1,600) per family.

II. Insulin. Insulin will be treated as a prescription drug subject to a separate copay for each type prescribed.

III. Brand Name Drugs. If the subscriber chooses a brand name drug when a bioequivalent generic drug is available, the subscriber is required to pay the standard copayment plus the difference between the cost of the brand name drug and the generic. Amounts above the copay that an individual elects to pay for a brand name instead of a generic drug will not be credited toward the out-of-pocket maximum.

IV. Special Coverage for “Grandparented Diabetic Group”. For insulin dependent diabetics who have been continuously enrolled for health coverage insured or administered by Blue Cross Blue Shield through the SEGIP since January 1, 1991, and who were identified as having used these supplies during the period from January 1, 1991, through September 30, 1991, (herein the “Grandparented Diabetic Group”), diabetic supplies are covered as follows:

-Test tapes and syringes are covered at one hundred percent (100%) for the greater of a thirty (30) day supply or one hundred (100%) units when purchased with insulin.

V. Special Coverage for Nicotine Replacement Therapies. There will be no copayment for formulary nicotine replacement therapies for employees and dependents who take the Health Assessment, opt-in for Coaching, and are engaged in a plan-sponsored smoking cessation program, or other program as documented by the Health Coach.

6. Special Service Networks. The following services must be received from special service network providers in order to be covered. All terms and conditions outlined in the Summary of Benefits apply.

I. Mental health services - inpatient or outpatient.

II. Chemical dependency services - inpatient or outpatient.

III. Chiropractic services.

IV. Transplant coverage.

V. Cardiac services.

VI. Home infusion therapy.

VII. Hospice.

7. Individuals whose permanent residence and principal work location are outside the State of Minnesota and outside of the service areas of the health plans participating in Advantage. If these individuals use the plan administrator’s national preferred provider organization in their area, services will be covered at Benefit Level Two. If a national preferred provider is not available in their area, services will be covered at Benefit Level Two through any other provider available in their area. If the national preferred provider organization is available but not used, benefits will be paid at the POS level described in paragraph 9 below. All terms and conditions outlined in the Summary of Benefits will apply.

8. Children living with an ex-spouse outside the service area of the employee’s plan administrator. Covered children living with former spouses outside the service area of the employee’s plan administrator and enrolled under this provision as of December 31, 2003, will be covered at Benefit Level Two benefits. If available, services must be provided by providers in the plan administrator’s national preferred provider organization. If the national preferred provider organization is available but not used, benefits will be paid at the POS level described in paragraph 9 below.

9. Individuals whose permanent residence is outside the State of Minnesota and outside the service areas of the health plans participating in Advantage. (This category includes employees temporarily residing outside Minnesota on temporary assignment or paid leave (including sabbatical leaves) and all dependent children (including college students) and spouses living out of area.) The point of service (POS) benefit described below is available to these individuals. All terms and conditions outlined in the Summary of Benefits apply. This benefit is not available for services received within the service areas of the health plans participating in Advantage.

I. Deductible. There is a three hundred fifty dollar ($350) annual deductible per person with a maximum deductible per family per year of seven hundred dollars ($700).

II. Coinsurance. After the deductible is satisfied, seventy percent (70%) coverage up to the plan out-of-pocket maximum designated below.

10. Lifetime maximums and non-prescription out-of-pocket maximums. Coverage under Advantage is not subject to a per person lifetime maximum. Coverage under Advantage is subject to a plan year, non-prescription drug, out-of-pocket maximum of one thousand one hundred dollars ($1,100) per person or two thousand two hundred dollars ($2,200) per family.

11. Convenience Clinics. Services rendered at Convenience Clinics are subject to a ten dollar ($10) copayment in each year of the Agreement. First dollar deductibles are waived for Convenience Clinic visits. (Note the prescriptions received as a result of a visit are subject to the drug copayment maximums as described above at Section F, Subd. 1 b. 5.)

c. Benefit Level Two Health Care Network Determination.

Issues regarding the health care networks for the 2009 insurance year shall be negotiated in accordance with the following procedures:

1. At least twelve (12) weeks prior to the open enrollment period for the 2009 insurance year the Employer shall meet and confer with the Joint Labor/Management Committee on Health Plans in an attempt to reach agreement on the Benefit Level Two health care networks.

2. If no agreement is reached within five (5) working days, the Employer and the Joint Labor-Management Committee on behalf of all of the exclusive representatives shall submit a list of providers/provider groups in dispute to a mutually agreed upon neutral expert in health care delivery systems for final and binding resolution. The only providers/provider groups that may be submitted for resolution by this process are those for which, since the list for the 2008 insurance year was established, Benefit Level Two access has changed, or those that are intended to address specific problems caused by a reduction in Benefit Level Two access.

Absent agreement on a neutral expert, the parties shall select an arbitrator from a list of five (5) arbitrators supplied by the Bureau of Mediation Services. The parties shall flip a coin to determine who strikes first. One-half (1/2) of the fees and expenses of the neutral shall be paid by the Employer and one-half (1/2) by the exclusive representatives. The parties shall select a neutral within five (5) working days after no agreement is reached, and a hearing shall be held within fourteen (14) working days of the selection of the neutral.

3. The decision of the neutral shall be issued within two (2) working days after the hearing.

d. Coordination with Workers’ Compensation. When an employee has incurred an on-the-job injury or an on-the-job disability and has filed a claim for workers’ compensation, medical costs connected with the injury or disability shall be paid by the employee’s health plan, pursuant to Minnesota Statutes §176.191, Subd. 3.

e. Health Promotion and Health Education. Both parties to this Agreement recognize the value and importance of health promotion and health education programs. Such programs can assist employees and their dependents to maintain and enhance their health, and to make appropriate use of the health care system. To work toward these goals:

1. Develop programs.

I. The Employer will develop and implement health promotion and health education programs, subject to the availability of resources. Each appointment authority will develop a health promotion and health education program consistent with the Department of Employee Relations policy. Upon request of any exclusive representative in an agency, the appointing authority shall jointly meet and confer with the exclusive representative(s) and may include other interested exclusive representatives. Agenda items shall include but are not limited to smoking cessation, weight loss, stress management, health education/self-care, and education on related benefits provided through the health plan administrators serving state employees.

II. Pilot Programs. The Employer may develop voluntary pilot programs to test the acceptability of various risk management programs. Incentives for participation in such programs may include limited short-term improvements to the benefits outlined in this article. Implementation of such pilot programs is subject to the review and approval of the Joint Labor-Management Committee on Health Plans.

2. Health Plan specification. The Employer will require health plans participating in the Group Insurance Program to develop and implement health promotion and health education programs for State employees and their dependents.

3. Employee participation. The Employer will assist employees’ participation in health promotion and health education programs. Health promotion and health education programs that have been endorsed by the Employer (Department of Employee Relations) will be considered to be non-assigned job-related training pursuant to Administrative Procedure 21. Approval for this training is at the discretion of the appointing authority and is contingent upon meeting staffing needs in the employee’s absence and the availability of funds. Employees are eligible for release time, tuition reimbursement, or a pro rata combination of both. Employees may be reimbursed for up to one hundred percent (100%) of tuition or registration costs upon successful completion of the program. Employees may be granted release time, including the travel time, in lieu of reimbursement.

4. Health Promotion Incentives. The Joint Labor-Management Committee on Health Plans shall develop a program which provides incentives for employees who participate in a health promotion program. The health promotion program shall emphasize the adoption and maintenance of more healthy lifestyle behaviors and shall encourage wiser usage of the health care system.

f. Post Retirement Health Care Benefit. Employees who retire on or after January 1, 2008, shall be entitled to a contribution of two hundred fifty dollars ($250) to the Minnesota State Retirement System (MSRS) Health Care Savings Plan, if at the time of retirement the employee is entitled to either a) an annuity under a State retirement program, or b) receive a retirement benefit under Minnesota Statutes §354B. An employee who becomes totally and permanently disabled on or after January 1, 2008, who received a State disability benefit, and is eligible for a deferred benefit under a State retirement program is also eligible for the two hundred fifty dollar ($250) contribution to the MSRS Health Care Savings Plan. Employees are eligible for this benefit only once.

Subd. 2. Employee Life Coverage.

a. Basic Life and Accidental Death and Dismemberment Coverage. The Employer agrees to provide and pay for the following term life coverage and accidental death and dismemberment coverage for all faculty members eligible for an Employer Contribution as described in Section C. Any premium paid by the State in excess of fifty thousand dollars ($50,000) coverage is subject to a tax liability in accordance with Internal Revenue Service regulations. A faculty member may decline coverage in excess of fifty thousand dollars ($50,000) by filing a waiver in accordance with Department of Finance procedures (also see Appendix F). The basic life insurance policy will include an accelerated benefits agreement providing for payment of benefits prior to death if the insured has a terminal condition.

Faculty Member's Annual Base Salary	Group Life Insurance Coverage	Accidental Death and Dismemberment Principal Sum
$20,000 or less	$20,000	$20,000
$20,001 - $30,000	$30,000	$30,000
$30,001 - $40,000	$40,000	$40,000
$40,001 - $50,000	$50,000	$50,000
$50,001- $55,000	$55,000	$55,000
$55,001 - $60,000	$60,000	$60,000
$60,001 - $65,000	$65,000	$65,000
$65,001 - $70,000	$70,000	$70,000
$70,001-$75,000 $75,001 - $80,000 $80,001 - $85,000 $85,001 - $90,000 Over $90,000	$75,000 $80,000 $85,000 $90,000 $95,000	$75,000 $80,000 $85,000 $90,000 $95,000

b. Extended Benefits. A faculty member who becomes totally disabled before age 70 shall be eligible for the extended benefit provisions of the life insurance policy until age 70. Employees who were disabled prior to July 1, 1983 and who have continuously received benefits shall continue to receive such benefits under the terms of the policy in effect prior to July 1, 1983.

c. Additional Death Benefit. Faculty members who retire between July 1, 1981, and December 31, 2007, shall be entitled to a five hundred dollar ($500) death benefit payable to a beneficiary designated by the faculty member, if at the time of death the faculty member is entitled to an annuity under a State retirement program. A five hundred dollar ($500) cash death benefit shall also be payable to the designated beneficiary of a faculty member who becomes totally and permanently disabled between July 1, 1983, and December 31, 2007, and who at the time of death is receiving a State disability benefit and is eligible for a deferred annuity under a State retirement program.

Section G. Optional Coverages.

Subd. 1. Employee and Family Dental Coverage.

a. Coverage Options. Eligible faculty members may select coverage under any one of the dental plans offered by the Employer, including health maintenance organization plans, the State Dental Plan, or other dental plans. Coverage offered through health maintenance organization plans is subject to change during the life of this Agreement upon action of the health maintenance organization and approval of the Employer after consultation with the Joint Labor-Management Committee on Health Plans. However, actuarial reductions in the level of HMO coverages effective during the term of this Agreement, including increases in copayments, require approval of the Joint Labor-Management Committee on Health Plans. Coverage offered through the State Dental Plan is determined by Section G, Subd. 1.b.

b. Coverage Under the State Dental Plan. The State Dental Plan will provide the following coverage:

1. Copayments. Effective January 1, 2008, the State Dental Plan will cover allowable charges for the following services subject to the copayments and coverage limits stated. Higher out-of-pocket costs apply to services obtained from dental care providers not in the State Dental Plan network. Services provided through the State Dental Plan are subject to the State Dental Plan’s managed care procedures and principles, including standards of dental necessity and appropriate practice. The plan shall cover general cleaning two (2) times per plan year and special cleanings (root or deep cleaning) as prescribed by the dentist.

Service	In-Network	Out-of-Network
Diagnostic/Preventive	100%	50% after deductible
Fillings	60% after deductible	50% after deductible
Endodontics	60% after deductible	50% after deductible
Periodontics	60% after deductible	50% after deductible
Oral Surgery	60% after deductible	50% after deductible
Crowns	60% after deductible	50% after deductible
Prosthetics	50% after deductible	50% after deductible
Prosthetic Repairs	50% after deductible	50% after deductible
Orthodontics*	50% after deductible	50% after deductible

* Please refer to your certificate of coverage for information regarding age

limitations for dependent orthodontic care.

2. Deductible. An annual deductible of fifty dollars ($50) and one hundred fifty dollars ($150) per family applies to State Dental Plan non-preventive services received from in-network providers. An annual deductible of one hundred twenty-five dollars ($125) per person applies to State Dental Plan services received from out of network providers. The deductible must be satisfied before coverage begins.

3. Annual maximum. State Dental Plan coverage is subject to a one thousand dollar ($1,000) annual maximum benefit payable (excluding orthodontia) per person. “Annual” means per insurance year.

4. Orthodontia lifetime maximum. Orthodontia benefits are available to eligible dependent children ages eight (8) through eighteen (18) subject to a two thousand four hundred dollar ($2,400) lifetime maximum benefit.

Subd. 2. Life Coverage.

a. Faculty Member. A faculty member may purchase up to five hundred thousand dollars ($500,000) additional life insurance, in increments established by the Employer, subject to satisfactory evidence of insurability. A new faculty member may purchase up to two (2) times annual salary in optional employee life coverage by their initial effective date of coverage as defined in this article, Section E, Subd. 3 without evidence of insurability. An employee who becomes eligible for insurance may purchase up to two (2) times annual salary in optional employee life coverage without evidence of insurability within thirty (30) days of the initial effective date as defined in this article.

b. Spouse. A faculty member may purchase up to five hundred thousand dollars ($500,000) of life insurance coverage for his/her spouse, in increments established by the Employer, subject to satisfactory evidence of insurability. A new faculty member may purchase either five thousand dollars ($5,000) or ten thousand dollars ($10,000) in optional spouse life coverage by their initial effective date of coverage as defined in this article, Section E, Subd. 3, without evidence of insurability. An employee who becomes eligible for insurance may purchase either five thousand dollars ($5,000) or ten thousand dollars ($10,000) in optional spouse coverage without evidence of insurability within thirty (30) days of the initial effective date as defined in this article.

c. Children/Grandchildren. A faculty member may purchase life insurance in the amount of ten thousand dollars ($10,000) as a package for all eligible children/grandchildren (as defined in Section B., Subd. 3, of this article). For a new employee, child/grandchild coverage requires evidence of insurability if application is made after the initial effective date of coverage as defined in this article, Section E, Subd. 3. An employee who becomes eligible for insurance may purchase child/grandchild coverage without evidence of insurability if application is made within thirty (30) days of the initial effective date as defined in this article. Child/grandchild coverage commences fourteen (14) calendar days after birth.

d. Accelerated Life. The additional employee, spouse and child life insurance polices will include an accelerated benefits agreement providing for payment of benefits prior to death if the insured has a terminal condition.

e. Waiver of Premium. In the event a faculty member becomes totally disabled before age seventy (70), there shall be a waiver of premium for all life insurance coverage that the faculty member had at the time of disability.

f. Paid-up Life Policy. At age sixty-five (65) or the date of retirement, an employee who has carried optional employee life insurance for the five consecutive years immediately preceding the date of the employee's retirement or age sixty-five (65), whichever is later, shall receive a post-retirement paid-up life insurance policy in an amount equal to fifteen percent (15%) of the smallest amount of optional employee life insurance in force during that five (5) year period. The employee's post-retirement death benefit shall be effective as of the date of the employee's retirement or the employee age sixty-five (65), whichever is later. Employees who retire prior to age sixty-five (65) must be immediately eligible to receive a State retirement annuity and must continue their optional employee life insurance to age sixty-five (65) in order to remain eligible for the employee post-retirement death benefit.

An employee who has carried optional spouse life insurance for five (5) consecutive years immediately preceding the date of the employee's retirement or spouse age sixty-five (65), whichever is later, shall receive a post retirement paid-up life insurance policy in an amount equal to fifteen percent (15%) of the smallest amount of optional spouse life insurance in force during that five (5) year period. The spouse post-retirement death benefit shall be effective as of the date of the employee's retirement or spouse age sixty-five (65), whichever is later. The employee must continue the full amount of optional spouse life insurance to the date of the employee's retirement or spouse age sixty-five (65), whichever is later, in order to remain eligible for the spouse post-retirement death benefit.

Each policy remains separate and distinct, and amounts may not be combined for the purpose of increasing the amount of a single policy.

Subd. 3. Disability Coverage.

a. Short-term Disability Coverage. A faculty member may purchase short-term disability coverage that provides benefits from three hundred dollars ($300) to five thousand dollars ($5,000) per month, up to two-thirds (2/3) of a faculty member’s salary, for up to one hundred eighty (180) calendar days during total disability due to a non-occupational accident or a non-occupational sickness. Benefits are paid from the first day of a disabling injury or from the eighth day of a disabling sickness. For a new employee, coverage applied for by the initial effective date of coverage as defined in this article, Section E, Subd. 3. does not require evidence of insurability. For an employee who becomes eligible for insurance, coverage applied for within thirty (30) days of the initial effective date does not require evidence of insurability.

b. Long-term Disability Coverage. New employees may enroll in long-term disability insurance by their initial effective date of coverage. Employees who become eligible for insurance may enroll in long-term disability insurance within thirty (30) days of their initial effective date as defined in this article, Section E, Subd. 3. The terms are the same as for employees who wish to add/increase during the annual open enrollment. During open enrollment only, a faculty member may purchase long-term disability coverage that provides benefits from three hundred dollars ($300) to seven thousand dollars ($7,000) per month, based on the faculty member’s salary, commencing on the one hundred eighty-one (181st) day of total disability, and not subject to evidence of insurability but with a limited pre-existing condition exclusion. Employees should be aware that other wage replacement benefits, as described in the certificate of coverage (i.e., Social Security Disability, Minnesota State Retirement Disability, etc.), may result in a reduction of the monthly benefit levels purchased. In any event, the minimum is the greater of three hundred dollars ($300) or fifteen percent (15%) of the amount purchased. The minimum benefit will not be reduced by any other wage replacement benefit. In the event that the faculty member becomes totally disabled before age seventy (70), the premiums on this benefit shall be waived.

Subd. 4. Accidental Death and Dismemberment Coverage. A faculty member may purchase accidental death and dismemberment coverage that provides principal sum benefits in amounts ranging from five thousand dollars ($5,000) to one hundred thousand dollars ($100,000). Payment is made only for accidental bodily injury or death and may vary, depending upon the extent of dismemberment. A faculty member may also purchase from five thousand dollars ($5,000) to twenty-five thousand dollars ($25,000) in coverage for his/her spouse but not in excess of the amount carried by the faculty member.

Subd. 5. Continuation of Optional Coverages During Unpaid Leave or Layoff. An employee who takes an unpaid leave of absence or who is laid off may discontinue premium payments on optional policies during the period of leave or layoff. If the employee returns within one (1) year, the employee shall be permitted to pick up all optionals held prior to the leave or layoff. For purposes of reinstating such optional coverages, the following limitations shall be applicable.

For the first twenty-four (24) months of short-term and/or long-term disability coverage after such a period of leave or layoff during which short-term or long-term disability coverage was discontinued, any such disability coverage shall exclude coverage for pre-existing conditions. For disability purposes, a pre-existing condition is defined as any disability which is caused by, or results from, any injury, sickness or pregnancy which occurred, was diagnosed, or for which medical care was received during the period of leave or layoff. In addition, any pre-existing condition limitations that would have been in effect under the policy but for the discontinuance of coverage shall continue to apply as provided in the policy.

The limitations set forth above do not apply to leaves that qualify under the Family Medical Leave Act (FMLA).