APPENDIX F

 

 

 

 

 

MEDICAL PLAN AGREEMENT

 

 

 

 

 

BETWEEN

 

 

 

 

SOUTHERN CALIFORNIA GAS COMPANY

 

 

 

AND

 

 

 

UTILITY WORKERS UNION OF AMERICA, AFL-CIO

INTERNATIONAL CHEMICAL WORKERS UNION COUNCIL,
 UFCW, AFL-CIO

 

 

 

 

2001

 

 

 

 


MEDICAL DENTAL AND VISION

BENEFIT AGREEMENT

 

 

 

 

This Agreement, made and entered into at Los Angeles California, as of January 1, 2001, by and between Southern California Gas Company, a California corporation, with its principal place of business at 555 West Fifth Street, in said City and State, party of the first part, hereinafter referred to as the “Company,” and the Utility Workers Union of America, AFL-CIO, and International Chemical Workers Council, UFCW, AFL-CIO, parties of the second part, hereinafter referred to as the Union.”

 

 

WITNESSETH:

 

That it is the intent and purpose of the parties hereto to incorporate herein the provisions of the Company’s Medical, Dental and Vision Plan, hereinafter referred to as the “Plan,” and that this Agreement, arrived at through the process of collective bargaining in the manner provided by law, represents the determination of all issues pertaining directly or indirectly to the subject of Medical, Dental and Vision Benefits for employees covered by this Agreement, and sets forth herein the agreement relating to such benefits to be observed between the parties hereto and that said parties to this Agreement, acting through their respective duly authorized representatives, promise and agree as follows:

 

The provisions of this Agreement shall apply to all employees who are covered by that certain Agreement between the parties hereto dated April 1, 2000, covering rates of pay, hours of work and conditions of employment, or by said Agreement as it may be subsequently modified, or by any superseding agreement.


IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the
1st day of January 2001.


 

 

For SOUTHERN CALIFORNIA GAS COMPANY


 

J. B. Lane

Director of Human Resources


 

Michael E. Shurley
Labor Relations Manager


 

For UTILITY WORKERS UNION

     OF AMERICA, AFL-CIO


For UTILITY WORKERS UNION OF AMERICA, AFL-CIO, and INTERNATIONAL CHEMICAL WORKERS UNION COUNCIL, UFCW, AFL-CIO, JOINTLY


 

Dennis C. Zukowski

President, Local 483, UWUA, AFL-CIO


Bernardo R. Garcia

National Representative, UWUA, AFL-CIO


 

Dan Kyle

President, Local 522, UWUA, AFL-CIO


John Lewis

Representative, ICWUC, AFL-CIO


 

Beatty G. Henson

President, Local 132, UWUA, AFL-CIO


 

Michael L. Bowling

President, Local 17O, UWUA, AFL-CIO


 

Robert Gonzalez

President, Local 47, ICWUC, AFL-CIO


 

James T. O'Donnell

President, Local 78, ICWUC, AFL-CIO


 

JoAnn C. Rizzi

President, Local 350, ICWUC, AFL-CIO

 

Raquel G. Looney

President, Local 995, ICWUC, AFL-CIO

 


MEDICAL, DENTAL AND VISION BENEFITS AGREEMENT

 

 

This Agreement sets forth the terms and conditions of Medical, Dental and Vision Benefits for January 1, 2001 through December 31, 2002. 

 

HMOs:

 

All eligible employees shall be entitled to choose from those among the following four HMOs which have coverage in their geographic area:  Blue Cross of California CaliforniaCare, PacifiCare, Kaiser,  and Maxicare.  The minimum monthly employee contribution for the lowest cost HMO shall be $5.00 for the employee only, $15.00 for the employee plus one dependent, and $25.00 for the employee plus two or more dependents.  The other HMOs will have premiums using the minimum contribution as a baseline.  That is, the monthly employee contribution shall be $5.00 for employee only plus the amount by which the premium of their HMO exceeds the lowest cost HMO, $15.00 for employee plus one dependent plus the amount by which the premium of their HMO exceeds the lowest cost HMO and $25.00 for employee plus two or more dependents plus the amount by which the premium for their HMO exceeds the lowest cost HMO.  The lowest cost HMO will be established annually by the Company after the annual renewal process.  No HMO with fewer than 200 enrollees will be considered the lowest cost HMO for purposes of setting HMO contributions.  The basic coverage and base costs of HMO coverage are set forth in the attached Summary of Medical Plan Provisions.  Those basic provisions, as described by the HMO’s own summary plan descriptions, may be modified from time to time by the specific HMO to meet legal requirements, or as designated by law, or annually to meet business requirements.  If not specified by the HMO, the Company may not modify the provisions within this Agreement.

 

Medical Plan Options - General:

 

For employees in the Blue Cross network service area, the Company, in addition to offering HMOs, shall offer the following options:  the Blue Cross of California Triple Option Point of Service Plan (Triple Option Plan) and a Safety Net Plan.  Other than required employee contributions, co-pays, and deductibles, as applicable, the Company agrees to pay the full cost of medical plans.  The basic provisions of the medical plans are agreed to as provided in the Summary of Medical Plan Provisions attached hereto.

 

Representatives from the Company and the Union agree to meet per the letter of agreement dated March 9, 1994 to discuss problems and issues related to the delivery of medical care in the Triple Option Plan.

 

 

 

 

Out of Area Plan:

 

The Company shall pay the cost, other than employee contributions, co-insurance and deductibles, for a PPO/indemnity-type plan or the Safety Net Plan in areas not served by an HMO or the Triple Option Plan Network.  The basic terms of the Out-of-Area Plan are agreed to be as stated in the Summary of Medical Plan Provisions attached hereto.  The monthly employee contributions shall be $30.00 for the employee only, $60.00 for employee plus one dependent, and $90.00 for employee plus two or more dependents.   HMO or Triple Option Plan options shall replace this plan immediately when a network expands to these areas, subject to an employee’s 30-day election rights.

 

For retirees in the Blythe and Needles areas, the Company, in addition to offering HMOs shall offer the Out of Area and Safety Net plans with provisions as agreed to as stated in the Summary of Medical Plan Provisions attached hereto.  The retiree contributions shall be as stated in the Summary of Medical Plan Provisions attached hereto.

 

Expansion of HMO and Triple Option Plan Networks

 

It is understood by the Union and Company that the HMOs and Triple Option Plan Networks may expand to service areas not presently covered.  In the event that the network expands into an area covered by the Out of Area Plan, such that instead of zero primary care physicians in the area there one or more primary care physicians, the employee shall have thirty days in which to elect one of the Triple Option, Safety Net or HMO plans.

 

Married Employees:

 

If two Company employees are married to one another they may enroll individually, or one may enroll as the dependent of the other, whichever is financially beneficial for the employees. For instance, two married employees who have no covered children and elect the low cost HMO would have a $10.00 monthly contribution rather than the $15.00 monthly contribution applicable to an employee plus one dependent.  However, if one employee enrolls as employee plus one and the other employee declines coverage, the employee declining coverage will receive a $50 flex credit as described below.

 

Domestic Partners:

 

Domestic Partners of employees will be eligible for dependent coverage under the Medical, Dental and Vision Plans. Domestic Partners are defined as “two adults of the same or opposite sex who have chosen to share their lives in an intimate and committed relationship, reside together, and share a mutual obligation of support for the basic necessities of life”.  Employees must complete and sign an affidavit affirming the relationship. 

 

An affidavit is also required in the event the domestic partner relationship terminates.  An employee cannot file another affidavit of domestic partnership until at least 12 months after a statement of termination of domestic partnership is filed.  Employee contribution amounts will be the same as for current dependent coverage.  Employees are subject to any imputed income tax as a result of covering a domestic partner.

 

Declining Medical Coverage:

 

An employee who can show proof of coverage under another medical plan or who signs a medical health coverage declination statement may elect not to be covered by any Company medical plan.  A flex credit of $50 a month will be provided.  This credit can be used to offset the cost of other benefits or will be provided as additional income subject to all regular payroll taxes.

 

Medical Plan - Mental Health:

 

For employees enrolled in any Blue Cross of California plan, the Medical Plan basic provisions regarding mental health coverage are agreed to as provided in the following summary or as prescribed by law when applicable:

 

Benefits                                                   Coverage:

 

Choice of therapist and hospital               Choice between network or non-network provider

 

Annual Maximum Benefits                        Network:

                                                                        60 inpatient days

                                                                        50 outpatient visits

                                                                  Non-network:

12 acute care days

                                                                        25 outpatient visits

 

Lifetime Benefits                                       100 acute care days

 

Inpatient Treatment (Hospital)                  Network:  90% coverage

Non-network:  50% usual and customary charges

 

Alternate Inpatient Treatment                    Same as inpatient treatment if pre-certified

 

Outpatient Treatment                                Network:  $15 co-pay per visit

                                                                  Non-network:  50% usual and customary charges up to $25 per visit

 


Medical Plan - Prescription  Drugs:

 

The Medical Plan basic provisions regarding prescription drug coverage are agreed to as provided in the Summary of Medical Plan Provisions attached hereto.

 

Medical Plan - Employee Contributions:

 

Employee contributions under the medical plan are agreed to as provided in the Summary of Employee Monthly Contributions attached hereto.

 

Retirees:

 

Represented employees under 65 who retire, and their eligible dependents, shall have the same medical and dental plan options as active employees.

 

Dental Coverage:

 

The Company shall offer Delta Dental in addition to the Safeguard Dental Plan.  The basic provisions of the dental plans are agreed to as provided in Summary of Dental Plan Provisions attached hereto.

 

The Company will pay the full cost of the SafeGuard Dental plan for all coverage levels (Employee only, Employee plus one dependent, Employee plus two or more dependents) and will contribute an equal amount toward the Delta plan.  Employees will pay the amount that exceeds the cost of the equivalent SafeGuard coverage.

 

For employees who waive dental coverage a flex credit of $6 a month will be provided.  This credit can be used to offset the cost of other benefits or will be provided as additional income subject to all regular payroll taxes.

 

Vision Coverage:

 

The Company will offer the Vision Service Plan in addition to the Safeguard Vision Plan.  The basic provisions of the vision plans are agreed to as provided in the Summary of Vision Benefits attached hereto.  The Company shall pay the full premium for employee coverage; employees pay the full premium for dependent coverage.

 

For employees who waive vision coverage a flex credit of $1.50 a month will be provided.  This credit can be used to offset the cost of other benefits or will be provided as additional income subject to all regular payroll taxes.


Summary of Medical Plan Provisions

 

 

Triple Option Plan

 

Tier 1 In Network (a)

Tier 2 In Network

Tier 3 Out of Network

General Coverage

Annual Deductible Individual

None

None

$300

               Family

None

None

$750

Inpatient hospital deductible

$100/day; first 2 days

$100/day; first 2 days

Annual deductibles apply

Out of Pocket Max. Individual

N/A

N/A

$4,300

                                Family

N/A

N/A

$10,000

Pre-certification, continued stay, second surgical opinion

 

 

If not preauthorized, benefits are reduced to 50% coverage after annual deductible

Co-Insurance

100%

80%

70%, after annual deductible

Maximum Lifetime Benefit

Unlimited

Unlimited

$1,000,000

Hospital Services (inpatient)

Room and board medical (semi-private room), intensive care

100%

80%

70% after deductible

Other hospital charges

100%

80%

70% after deductible

Hospital Services (outpatient)

Surgery (services and supplies)

100%

80%

70% after deductible

Emergency Room

100%

80%

70% after deductible

Diagnostic x-ray and lab

100%

80%

70% after deductible

 

 

(a) All services provided through Primary Care Physician (PCP).


Triple Option Plan (continued)

Physician’s Services

Surgeon

100%

80%

70% after deductible

Second Surgical Opinion

100% after $10 copay

100% after $35 copay

70% after deductible

Assistant Surgeon and

Anesthesiologist

100%

80%

70% after deductible

Physician hospital visits

100%

80%

70% after deductible

Physician home or office visits

$10 co-pay/visit

$35 co-pay/visit

70% after deductible

Emergency Room Treatment for emergency care

 

(non-emergency care is covered as out of network)

 

$25 copay if authorized within 48 hours.  Copay waived if admitted.

 

$25 copay if authorized within 48 hours.  If admitted, copay applies to hospital deductible

 

70% after deductible

Other Services

Diagnostic x-ray and lab

100%

80%

70% after deductible

Chiropractic Services

Not Covered

80% up to $28/visit and 25 visit maximum per year

70% after ded. up to $28/visit and 25 visit maximum per year

Prescription Drugs

$10 for generic

$15 for brand when generic is not available (b)

$25 for non-formulary drugs

30-day supply

 

Mail Order Prescriptions

Two times the applicable copay shown above for a 90 day supply.  No coverage for brand if generic is available unless doctor indicates do not substitute.

Preventive Care

 

 

 

Physical

$10 copay/visit

$35 copay/visit

Not Covered

Well Child Care

$10 copay/visit

$35 copay/visit

Not Covered

Mammography

$10 copay/visit

$35 copay/visit

Not Covered

Immunization

$10 copay

$35 copay

Not Covered

 (b) If generic exists and patient demands brand, co-pay is $10 plus the difference in cost between brand and generic.

 

Note:  Coordination of Benefits (COB) provision is “non-duplication”; maximum payment will be the Plan payment in absence of other coverage.


SUMMARY OF MEDICAL PLAN PROVISIONS

 

Safety Net Plan

 

Annual Deductible    Individual                                   $1,000

Family                                      $2,000

 

Co-Insurance                                                               75%

 

Out-of-Pocket Max                                                   $4000

                                                                 

Lifetime Maximum                                                    $1,000,000

 

Hospital                                                                  75% after deductible*

 

Physician                                                                75% after deductible

 

Routine Exams                                                        Not Covered

 

Emergency Room                                                    75% after deductible

 

Prescription Drugs                                             $10 for generic

$15 for brand

                                                      $25 for non-formulary

 

 

Mail Order Drugs                                                               Two times the applicable copay for a 90 day supply

 

 

                              * If hospitalization and surgery are not pre-authorized, benefits are reduced to

                                      50% coverage after annual deductible.

                                   

                                   


 

 

Summary of Medical Plan Provisions

 

Out of Area Plan

 

PPO Network Provider

Out of Network Provider

Choice of Doctor

Your choice of PPO doctor

Any doctor you wish