APPENDIX F
MEDICAL PLAN AGREEMENT
BETWEEN
SOUTHERN CALIFORNIA GAS
COMPANY
AND
UTILITY WORKERS
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
IN WITNESS WHEREOF, the parties hereto have
executed this Agreement on the
1st day of January 2001.
Director
of Human Resources
Michael
E. Shurley
Labor Relations Manager
For UTILITY WORKERS
OF
For UTILITY WORKERS
Dennis
C. Zukowski
President,
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
This
Agreement sets forth the terms and conditions of Medical, Dental and Vision
Benefits for
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
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.
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
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
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
The
Medical Plan basic provisions regarding prescription drug coverage are agreed
to as provided in the Summary of Medical Plan Provisions attached hereto.
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
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
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
|
|
Tier 1 In Network
(a) |
Tier
2 In Network
|
Tier
3 Out of Network
|
General
|
|||
|
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 |
|
|
|
|
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) |
|
|
|
Other Services
|
|||
|
Diagnostic x-ray and lab |
100% |
80% |
70% after deductible |
|
Chiropractic Services |
Not |
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 |
||
|
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
|
|
|
|
|
$10 copay/visit |
$35 copay/visit |
Not |
|
|
Well Child Care |
$10 copay/visit |
$35 copay/visit |
Not |
|
Mammography |
$10 copay/visit |
$35 copay/visit |
Not |
|
Immunization |
$10 copay |
$35 copay |
Not |
(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.
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
Emergency Room 75% after deductible
Prescription Drugs $10 for generic
$15 for brand
$25
for non-formulary
* If hospitalization and surgery are not pre-authorized, benefits are reduced to
50% coverage after annual deductible.
Out of Area Plan
|
|
PPO Network
Provider
|
Out of Network Provider
|
Choice of Doctor
|
Your choice of PPO doctor |
Any doctor you wish |
|
|