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Section 1. 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 access to an electronic summary of benefits
(SOB) or certificate of coverage (COC) for each insurance product. These documents shall be
provided no less than biennially and prior to the beginning of the insurance year.
Section 2. Eligibility for Group Participation.
This section describes eligibility to participate in the Group Insurance Program.
A. Employees - Basic Eligibility. Employees may participate in the Group Insurance Program if
they are scheduled to work at least 1044 hours in any twelve consecutive months, except for:
- (1) emergency, or temporary classified, or intermittent employees;
- (2) student workers; and
- (3) interns.
B. Employees - Special Eligibility. The following employees are also eligible to participate in the
Group Insurance Program:
- 1. DNR Employees. An employee of the Department of Natural Resources may meet the basic eligibility requirement for participation in the Group Insurance Program based on a combination of seasonal and temporary project employment. Eligibility commences after completion of three (3) years of continuous service in which the basic eligibility requirements are met; continues until the employee completes a year in which the basic eligibility requirements are not met; and commences again after the employee meets or is anticipated to meet the basic eligibility requirements in one (1) year.
- 2. Employees with a Work-related Injury/Disability. An employee 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 an employee receives workers' compensation payments or while the workers' compensation claim is pending.
- 3. Totally Disabled Employees. Consistent with Minn. Stat. § 62A.148, certain totally disabled employees may continue to participate in the Group Insurance Program.
- 4. Separated Employees Under Minn. Stat. § 43A.27. Pursuant to Minn. Stat. § 43A.27, Subdivision 3a(1), an employee who separates or retires from State service and who, at the time of separation has five (5) or more years of allowable pension service and is entitled to immediately receive an annuity under a State retirement program and, who is not eligible for regular (non-disability) Medicare coverage, may continue to participate in the health and dental coverages offered through the Group Insurance Program.
Consistent with Minn. Stat. § 43A.27, Subdivision 3a(2), an employee who separates or
retires from State service and who, at the time of separation is at least fifty (50) years of
age and at least fifteen (15) years of State service may continue to participate in the health
and dental coverages offered through the Group Insurance Program. Retiree coverage
must be coordinated with Medicare.
C. Dependents. Eligible dependents for the purposes of this Article are as follows:
- 1. Spouse. The spouse of an eligible employee (if legally married under Minnesota law). 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 (1) elects to receive either credits or cash in place of health insurance or health coverage or towards some other benefit in place of health insurance, then they are not eligible for the comparable coverage or insurance under this Article; or (2) is enrolled in a high deductible medical insurance plan (as defined by the IRS) that includes a contribution to a health savings account (HSA) through their employing organization, then they are not eligible for medical coverage under this Article.
When both spouses work for the State or another organization participating in the State
Employee Group Insurance Program, a spouse may be covered as a dependent by the other
but when covered as a dependent they may not carry their own coverage (members may
only be covered once).
- 2. Children.
- a. Health and Dental Coverage: A dependent child is an eligible employee’s child to age twenty-six (26).
- b. Dependent Child: A “dependent child” includes an employee’s (1) biological child, (2) child legally adopted by or placed for adoption with the employee, (3) step-child, and (4) foster child who has been placed with the employee by an authorized placement agency or by a judgment, decree, or other court order. For a step-child to be considered a dependent child, the employee must be legally married to the child’s legal parent or legal guardian. An employee (or the employee’s spouse or jointly) must have permanent, full and sole legal and physical custody of the foster child.
- c. Coverage Under Only One Plan: For purposes of (a) and (b) above, if the employee’s adult child (age 18 to 26) works for the State or another organization participating in the State’s Group Insurance Program, the child may not be covered as a dependent by the employee unless the child is not eligible for a full Employer Contribution as defined in Section 3A.
Effective January 1, 2015 for purposes of (a) and (b) above, if the employee’s adult child
(age 18 to 26) works for the State or another organization participating in the State’s Group
Insurance Program, the child may be covered as a dependent by the employee.
- 3. Grandchildren. A dependent grandchild is an eligible employee’s unmarried dependent grandchild who:
- a. Is financially dependent upon the employee for principal support and maintenance and has resided with the employee continuously from birth, or
- b. Resides with the employee and is dependent upon the employee for principal support and maintenance and is the child of the employee’s unmarried child (the parent) to age nineteen (19).
If a grandchild is legally adopted or placed in the legal custody of the grandparent, they are
covered as a dependent child under Section 2C (2) and (4).
- 4. Child with a Disability. A dependent child with a disability is an eligible employee’s child or grandchild regardless of marital status, who was covered and then disabled prior to the limiting age or any other limiting term required for dependent coverage and who continues to be incapable of self-sustaining employment by reason of developmental disability, mental illness or disorder, or physical disability, and is chiefly dependent upon the employee for support and maintenance, provided proof of such incapacity and dependency must be furnished to the health carrier by the employee or enrollee within thirty one (31) days of the child’s attainment of the limiting age or any other limiting term required for dependent coverage. The dependent with a disability is eligible to continue coverage as long as they continue to be disabled and dependent, unless coverage terminates under the contract.
- 5. Qualified Medical Child Support Order. A child who would otherwise meet the eligibility requirements and is required to be covered by a Qualified Medical Child Support Order (QMCSO) is considered an eligible dependent.
- 6. Child Coverage Limited to Coverage Under One Employee. 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 the eligible dependent children or grandchildren. This restriction also applies to two divorced, legally separated, or unmarried employees who share legal responsibility for their eligible dependent children or grandchildren.
D. Continuation Coverage. Consistent with state and federal laws, certain employees, former
employees, 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 employee, or
- f. divorce or legal separation, or
- g. a covered employee’s enrollment in Medicare
Section 3. Eligibility for Employer Contribution.
This section describes eligibility for an Employer Contribution toward the cost of coverage.
A. Full Employer Contribution - Basic Eligibility. Employees covered by this Agreement who are
scheduled to work at least seventy-five (75) percent of the time are eligible for the full
Employer Contribution. This means:
- 1. Employees who are scheduled to work at least eighty (80) hours per pay period for a period of nine (9) months or more in any twelve (12) consecutive months.
- 2. Employees who are scheduled to work at least sixty (60) hours per pay period for twelve (12) consecutive months, but excluding part-time or seasonal employees serving on less than a seventy-five (75) percent basis.
B. Special Eligibility. The following employees also receive an Employer Contribution:
- 1. DNR Employees. An employee of the Department of Natural Resources may meet the basic requirements for a full or partial Employer Contribution based on a combination of seasonal and temporary project employment, as described in Section 2B1.
- 2. Employees on Layoff. A classified employee who receives an Employer Contribution, who has three (3) or more years of continuous service, and who has been laid off, remains eligible for an Employer Contribution and all other benefits provided under this Article for an extended benefit eligibility period of six (6) months from the date of layoff.
- The calculation in determining the six (6) month duration of eligibility for an employer contribution begins on the date the employee is permanently laid off or accepts an appointment in lieu of layoff without a break in service with a lesser employer-paid insurance contribution than the employee was receiving in the appointment from which the layoff occurred and is no longer actively employed in the appointment from which the layoff occurred.
- In the event the employee, while on permanent layoff, is rehired to any state job classification with a lesser employer-paid insurance contribution than the employee is receiving under the six (6) months of insurance continuation, the employee shall continue to receive the employer contribution toward the employer-paid insurance for the duration of the six (6) months.
- However, notwithstanding the paragraph above, in the event the employee successfully claims another state job in any agency and classification which is insurance eligible without a break in service, and is subsequently non-certified or involuntarily separated, the six (6) month duration for the employer contribution toward insurance benefits will begin at the time the employee is non-certified or otherwise involuntarily separated and is no longer actively employed by the Employer.
- In no event shall an extended benefit eligibility period be longer than a total of six (6) months. Further, an employee must be receiving an Employer Contribution under Section 3 (A) at the time of layoff in order to be eligible for the six (6) months continuation of insurance.
- 3. Work-related Injury/Disability. An employee 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 an employee receives workers' compensation payments. If such employee ceases to receive workers' compensation payments for the injury or disability and is granted a medical leave under Article 14, they shall be eligible for an Employer contribution during that leave.
C. Maintaining Eligibility for Employer Contribution.
- 1. General. An employee who receives a full or partial Employer Contribution maintains that eligibility as long as the employee 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 employees who receive an Employer Contribution while on layoff as described in Section 3B2, or while eligible for workers' compensation payments as described in Section 3B3.
- 2. Unpaid Leave of Absence. If an employee is on an unpaid leave of absence, then vacation leave, compensatory time, or sick leave cannot be used for the purpose of maintaining eligibility for an Employer Contribution by keeping the employee on a State payroll for one (1) working day per pay period.
- 3. School Year Employment. If an employee is employed on the basis of a school year and such employment contemplates absences from the State payroll during the summer months or vacation periods scheduled by the Appointing Authority which occur during the regular school year, the employee shall nonetheless remain eligible for an Employer Contribution, provided that the employee appears on the regular payroll for at least one (1) working day in the payroll period immediately preceding such absences.
- 4. Special Leaves. An employee who is on an approved FMLA leave or on a Voluntary Reduction in Hours as provided elsewhere in this Agreement maintains eligibility for an Employer Contribution.
Section 4. Amount of Employer Contribution.
The Employer Contribution amounts and rules in effect on June 30, 2021 will continue through
December 31, 2021.
A. Contribution Formula - Health Coverage.
- 1. Employee Coverage. For employee health coverage for the 2022 and 2023 plan years, the Employer contributes an amount equal to ninety-five percent (95%) of the employee-only premium of the Minnesota Advantage Health Plan (Advantage.)
- 2. Dependent Coverage. For dependent health coverage for the 2022 and 2023 plan years, the Employer contributes an amount equal to eighty-five (85) percent of the dependent premium of Advantage.
B. Contribution Formula - Dental Coverage.
- 1. Employee Coverage. For employee dental coverage, the Employer contributes an amount equal to the lesser of ninety (90) percent of the employee premium of the State Dental Plan, or the actual employee premium of the dental plan chosen by the employee. However, for calendar years beginning January 1, 2019, the minimum employee contribution shall be thirteen dollars and fifty cents ($13.50) per month.
- 2. Dependent Coverage. For dependent dental coverage, the Employer contributes an amount equal to the lesser of fifty (50) percent of the dependent premium of the State Dental Plan, or the actual dependent premium of the dental plan chosen by the employee.
C. Contribution Formula - Basic Life Coverage. For employee basic life coverage and accidental
death and dismemberment coverage, the Employer contributes one-hundred (100) percent of
the cost.
Section 5. Coverage Changes and Effective Dates.
A. When Coverage May Be Chosen.
- 1. Newly Hired Employees. All employees hired to an insurance eligible position must make their benefit elections by their initial effective date of coverage as defined in this Article, Section 5C. Insurance eligible employees will automatically be enrolled in basic life coverage. If employees eligible for a full Employer Contribution do not choose a health plan administrator and a primary care clinic by their initial effective date, and do not waive medical coverage, 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 an employee does not choose a health plan administrator and primary care clinic by their initial effective date, but was previously covered as a dependent immediately prior to their initial effective date, they will be defaulted to the plan administrator and primary care clinic in which they were previously enrolled.
- 2. Eligibility Changes. Employees 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 a primary care clinic and do not waive coverage within this thirty (30) day timeframe, 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.
- An employee may change their health or dental plan if the employee changes to a new permanent work or residence location, and the employee's current plan is no longer available. If the employee 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. An employee 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 their 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. An employee or retiree may also change health or dental plans in any other situation in which the employer is required by applicable federal or state law to allow a plan change.
- 3. Waiving Medical Coverage. Effective July 1, 2017 employees may choose to waive medical coverage. If an employee is eligible for the full employer contribution and desires to waive medical coverage, the employee must submit a Waiver of Medical Coverage form and provide proof of other coverage by the end of the employee’s enrollment period. If an employee does not submit the form and proof by the end of the employee’s enrollment period, the employee will be enrolled in medical coverage, with the next opportunity to waive coverage during Open Enrollment or upon a permitted Qualified Life Event. If an employee waives medical coverage, the employee can elect it again during the next Open Enrollment or midyear upon a permitted Qualified Life Event.
B. When Coverage May be Changed or Cancelled.
- 1. 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 5A 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:
- a. A change in legal marital status, including marriage, death of a spouse, divorce, legal separation and annulment.
- b. A change in number of dependents, including birth, death, adoption, and placement for adoption.
- c. 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.
- d. A dependent ceasing to satisfy eligibility requirements for coverage due to attainment of age or otherwise no longer meets the eligibility requirements under Section 2C.
- e. A change in the place of residence of the employee, retiree or their spouse, or dependent that is not in the health plan administrator’s service area.
- f. Significant cost or coverage changes (including coverage curtailment and the addition of a benefit package).
- g. Family Medical Leave Act (FMLA) leave.
- h. Judgments, decrees or orders.
- i. A change in coverage of a spouse or dependent under another Employer’s plan.
- j. Open enrollment under the plan of another Employer.
- k. Health Insurance Portability and Accountability Act (HIPAA) special enrollment rights for new dependents and in the case of loss of other insurance coverage.
- l. A COBRA-qualifying event.
- m. 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).
- n. Entitlement to Medicare or Medicaid.
- o. 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.
- 2. Canceling Dependent Coverage During Open Enrollment. In addition to the above situations, dependent health or dependent dental coverage may also be cancelled 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).
- 3. Canceling Employee Coverage. A part-time employee may also cancel employee coverage within sixty (60) days of when one of the life events set forth above occurs.
- 4. 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 status.
C. Effective Date of Coverage.
- 1. Initial Effective Date. The initial effective date of coverage under the Group Insurance Program is the thirtieth (30th) day following the employee's first day of employment, 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. An employee must be actively at work on the initial effective date of coverage, except that an employee 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 an employee's dependent's coverage become effective before the employee'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.)
- 2. Delay in Coverage Effective Date.
- a. Basic Life. If an employee is not actively at work on the initial effective date of coverage, coverage will be effective on the first day of the employee’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, an employee is on an unpaid leave of absence or layoff.
- b. Medical and Dental. If an employee is not actively at work on the initial effective date of coverage due to a reason other than hospitalization or medical disability of the employee or dependent, medical and dental coverage will be effective on the first day of the employee’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, an employee is on an unpaid leave of absence or layoff.
- c. Optional Life and Disability Coverages. In order for coverage to become effective, the employee 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 employee's return to work.
D. Open Enrollment.
- 1. 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. Dental coverage will be offered during the 2023 plan year Open Enrollment. 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. Subject to a timely contract settlement, the Employer shall make open enrollment materials available to employees at least fourteen (14) days prior to the start of the open enrollment period.
- 2. Eligibility to Participate. An employee eligible to participate in the State Employee Group Insurance Program, as described in Sections 2A and 2B, may participate in open enrollment. In addition, a person in the following categories may, as allowed in section 5D1 above, make certain changes: (1) a former employee or dependent on continuation coverage, as described in Section 2D, 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.
- 3. Materials for Employee Choice. Each year prior to open enrollment, the Appointing Authority will give eligible employees the information necessary to make open enrollment selections. Employees will be provided a statement of their current coverage each year of the contract.
E. Coverage Selection Prior to Retirement. An employee who retires and is eligible to continue
insurance coverage as a retiree may change their health or dental plan during the sixty (60)
calendar day period immediately preceding the date of retirement. The employee 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 6. Basic Coverages.
A. Employee and Family Health Coverage.
- 1. 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 6A2.
- 2. Coverage Under the Minnesota Advantage Health Plan. From July 1, 2021 through December 31, 2021, health coverage under the SEGIP will continue at the level in effect on June 30, 2021. Effective January 1, 2022, 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.
- a. 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.
- 1) 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 5. Dependents must be enrolled through the same plan administrator as the employee.
- 2) 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 Benefits 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 their 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.
- 3) 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.
[SEE NOTE 1 AT END OF ARTICLE FOR FULL TABLE]
- b. Incentive. Employees will receive a $70 first-dollar credit to their individual deductible (regardless of whether the employee is enrolled in single or family coverage), conditional upon completion of qualifying activities in the State of Wellbeing program by the deadline.
- c. 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 (100) percent 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 6A2, 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 their 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.
- d. Services not requiring authorization by a primary care physician within the primary care clinic.
- 1) Eye Exams. Limited to one (1) routine examination per year for which no copay applies. Eye injury or illness at an in-network provider will be covered as an office visit based on the benefit level in which the individual is enrolled.
- 2) 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.
- 3) 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 them to receive care within the network of the plan in which the individual is enrolled.
- 4) Ambulance. The deductible and coinsurance for services not subject to copays applies.
- e. Prescription drugs.
- 1) Copayments and annual out-of-pocket maximums. For the first and second year of the contract:
- Tier 1 copayment: Eighteen dollar ($18) copayment per prescription or refill for a Tier 1 drug dispensed in a thirty (30) day supply.
- Tier 2 copayment: Thirty dollar ($30) copayment per prescription or refill for a
- Tier 2 drug dispensed in a thirty (30) day supply.
- Tier 3 copayment: Fifty-five dollar ($55) 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 one thousand and fifty dollars ($1,050) per person or two thousand one hundred dollars ($2,100) per family.
- 2) Insulin. Insulin will be treated as a prescription drug subject to a separate copay for each type prescribed.
- 3) 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.
- f. 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.
- 1) Mental health services – inpatient or outpatient
- 2) Chemical dependency services – inpatient and outpatient
- 3) Chiropractic services
- 4) Transplant coverage
- 5) Cardiac services
- 6) Home infusion therapy
- 7) Hospice
- g. 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 “i” below. All terms and conditions outlined in the Summary of Benefits will apply.
- h. 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 “i” below.
- i. 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.
- 1) 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).
- 2) Coinsurance. After the deductible is satisfied, seventy percent (70%) coverage up to the plan out-of-pocket maximum designated below.
- j. Lifetime maximums and non-prescription out-of-pocket maximums. Coverage under Advantage is not subject to a per person lifetime maximum. In the first and second years of the contract, coverage under Advantage is subject to a plan year, non-prescription drug, out-of-pocket maximum of one thousand seven hundred dollars ($1,700) per person or three thousand four hundred dollars ($3,400) per family for members whose primary care clinic is in Cost Level 1 or Cost Level 2; two thousand four hundred dollars ($2,400) per person or four thousand eight hundred dollars ($4,800) per family for members whose primary care clinic is in Cost Level 3; and three thousand six hundred dollars ($3,600) per person or seven thousand two hundred dollars ($7,200) per family for members whose primary care clinic is in Cost Level 4.
- k. In-Network Convenience Clinics and Online Care. Services received at in-network convenience clinics and online care are not subject to a copayment in each year of the Agreement. First dollar deductibles are waived for convenience clinic and online care visits. (Note that prescriptions received as a result of a visit are subject to the drug copayment and out-of-pocket maximums described above at 6A2(4)e).)
- 3. Benefit Level Two Health Care Network Determination. Issues regarding the health care networks for the 2022 insurance year shall be negotiated in accordance with the following procedures:
- a. At least twelve (12) weeks prior to the open enrollment period for the 2022 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.
- b. 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 2021 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.
- c. The decision of the neutral shall be issued within two (2) working days after the hearing.
- 4. Coordination with Workers' Compensation. When an employee has incurred an on-thejob 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 Minn. Stat. § 176.191, Subdivision 3.
- 5. 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:
- a. Develop programs.
- 1) Policy. The Employer will develop and implement health promotion, health education programs, and other programs mutually agreed upon with the Joint Labor Management Committee on Health Plans, subject to the availability of resources. Each Appointing Authority will develop a health promotion and health education program consistent with the Minnesota Management and Budget 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.
- 2) Pilot Programs. The Employer may develop voluntary pilot programs to test the acceptability of various risk management programs, programs that seek to control costs, programs that streamline the delivery of services, or that enhance services to members. Incentives for participation in such programs may include 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.
- b. 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.
- c. 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 (Minnesota Management and Budget) 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 (100) percent 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.
- d. 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.
- 6. Post Retirement Health Care Benefit. Employees who separate from State service and who, at the time of separation are insurance eligible and entitled to immediately receive an annuity under a State retirement program shall be entitled to a contribution of two hundred fifty dollars ($250) to the Minnesota State Retirement System’s (MSRS) Health Care Savings Plan. If the employee separates due to death, the two hundred fifty dollar ($250) is paid in cash, not to the HCSP. Employees who have a HCSP waiver on file shall receive a two hundred fifty dollar ($250) cash payment. An employee who becomes totally and permanently disabled who receives a State disability benefit, and is eligible for a deferred annuity 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.
- 7. Temporary plan changes due to a state or national emergency. SEGIP and the unions recognize that certain natural disasters and other major emergencies may disrupt or seriously threaten to disrupt the State of Minnesota at a time when employees are especially needed to provide services. If the State or a federal government agency declares a state of emergency or otherwise invokes emergency authority by declaration, rules, regulations or similar official statements, the terms of the programs administered by SEGIP may be changed for the period of the declared emergency and for up to a 30 day run-out period.
- These changes may include changes to programs administered by SEGIP including but not limited to, benefit design, enrollment and eligibility, billing, and administration as well as waiver of out-of-network restrictions, changes to out of pocket costs, extension of time frames for enrollment and billing, and other protocols reasonably required to provide Members with access to benefits.
- These changes must be agreed to by both SEGIP and the Joint Labor Management Committee. Nothing in this provision prohibits SEGIP from making changes authorized or required under another authority including but not limited to a state or federal law, regulation, order, or rule without union agreement.
B. Employee Life Coverage.
- 1. 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 employees eligible for an Employer Contribution, as described in Section 3. Any premium paid by the State in excess of fifty thousand dollars ($50,000) coverage is subject to a tax liability in accord with Internal Revenue Service regulations. An employee may decline coverage in excess of fifty thousand dollars ($50,000) by filing a waiver in accord with Minnesota Management and Budget procedures. 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.
[SEE NOTE 2 AT END OF ARTICLE FOR FULL TABLE]
- 2. Extended Benefits. An employee 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.
Section 7. Optional Coverages.
A. Employee and Family Dental Coverage.
- 1. Coverage Options. Eligible employees 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 7A2.
- 2. Coverage Under the State Dental Plan. The State Dental Plan will provide the following coverage:
- a. Copayments. Effective January 1, 2019, 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.
[SEE NOTE 3 AT END OF ARTICLE FOR FULL TABLE]
- b. Deductible. An annual deductible of fifty dollars ($50) per person 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.
- c. Annual maximums. State Dental Plan coverage is subject to a two thousand dollar ($2,000) annual maximum benefit payable (excluding orthodontia and preventive services) per person. "Annual" means per insurance year.
- d. Orthodontia lifetime maximum. Orthodontia benefits are subject to a three-thousanddollar ($3,000) lifetime maximum benefit.
B. Life Coverage.
- 1. Employee. An employee 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 employee 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 5C without evidence of insurability. An individual may only be covered on one state sponsored life coverage policy. A retired employee who returns to state service with optional employee life coverage in place or who has already received a paid-up benefit is not eligible for optional employee life coverage. 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.
- 2. Spouse. An employee may purchase up to five hundred thousand dollars ($500,000) life insurance coverage for their spouse in increments established by the Employer, subject to satisfactory evidence of insurability. An individual may only be covered on one state sponsored life coverage policy. A retired employee who returns to state services with optional spouse life coverage in place or who has already received a paid-up benefit is not eligible for optional spouse life coverage. A new employee 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 5C of hire 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.
- 3. Children/Grandchildren. An employee 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 2A2 and 2A3 of this Article). An individual may only be covered on one policy, by one employee participating in the State Employee Group Insurance Program. 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 5C. 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 immediately from the moment of birth up to age twenty-six (26).
- 4. Accelerated Life. The additional employee, spouse and child life insurance policies will include an accelerated benefits agreement providing for payment of benefits prior to death if the insured has a terminal condition.
- 5. Waiver of Premium. In the event an employee becomes totally disabled before age seventy (70), there shall be a waiver of premium for all life insurance coverage that the employee had at the time of disability.
- 6. 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 (5) consecutive years immediately preceding the date of the employee’s retirement or age sixty-five (65), whichever is later, (15) percent 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 the five (5) consecutive years immediately preceding the date of the employee’s retirement or spouse age sixtyfive (65), whichever is later, shall receive a post-retirement paid-up life insurance policy in an amount equal to fifteen (15) percent 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 sixtyfive (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.
C. Disability Coverage.
- 1. Short-term Disability Coverage. An employee may purchase short-term disability coverage that provides benefits of from three hundred dollars ($300) to five thousand dollars ($5,000) per month, up to two-thirds (2/3) of an employee's salary, for up to one hundred eighty (180) days during total disability due to a non occupational accident or a nonoccupational 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 5C 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. An employee who is insurance eligible and moves from a temporary position to a permanent position will be allowed to enroll in short-term disability coverage within thirty (30) days of the event without providing evidence of insurability. A short-term disability open enrollment will be offered every five (5) years.
- 2. 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 5C. An employee who is insurance eligible and moves from a temporary position to a permanent position will be allowed to enroll in long-term disability coverage within thirty (30) days of the event without providing evidence of insurability. The terms are the same as for employees who wish to
add/increase during the annual open enrollment. During open enrollment only, an employee may purchase long-term disability coverage that provides benefits of from three hundred dollars ($300) to seven thousand dollars ($7,000) per month, based on the employee's salary, commencing on the 181st calendar day of total disability, and not subject to evidence of insurability but with a limited term 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 (15) percent of the amount purchased. The minimum benefit will not be reduced by any other wage replacement benefit. In the event that the employee becomes totally disabled before age seventy (70), the premiums on this benefit shall be waived.
D. Accidental Death and Dismemberment Coverage. An employee may purchase accidental
death and dismemberment coverage that provides principal sum benefits in amounts ranging
from five thousand dollars ($5,000) to two hundred thousand dollars ($200,000). Payment is
made only for accidental bodily injury or death and may vary, depending upon the extent of
dismemberment. An employee may also purchase from five thousand dollars ($5,000) to
twenty-five thousand dollars ($25,000) in coverage for their spouse, but not in excess of the
amount carried by the employee.
E. Vision Coverage. A fully employee paid vision benefit will be available beginning January 1,
2021 subject to agreement by the subcommittee of the Joint Labor Management Insurance
Committee to the benefit set determined through the state’s Request for Proposal (RFP)
process.
F. 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 long-term disability coverage after such a period of
leave or layoff during which long-term disability coverage was discontinued, any such disability
coverage shall exclude coverage for pre-existing conditions. For disability purposes, a preexisting 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).[2]
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