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Negotiations: Article 26, Medical, Dental and Vision Insurance

Wright State University Chapter

American Association of University Professors

MOU? CBA? RCM? NTE? TET?

What are all these acronyms? See this guide.

AAUP-WSU submitted the proposal shown in the left column of the table below at the April 2 negotiating session. On April 16, the administration countered as shown in the right column of the table. Reports about the status of this article will be found below the article itself.

See our CBA Negotiations page for a roster of the AAUP-WSU negotiating team, brief reports about each Monday's negotiation session, and an article-by-article summary table with links to detailed information about each individual article that either the administration or AAUP-WSU proposes to include in the CBA.

Article 26

Medical, Dental and Vision Insurance

AAUP-WSU Proposal of April 2

Administration Proposal of April 16

Changes are relative to the current TET CBA. The proposed language below would appear in both the TET and NTE CBAs.

26.1 For the duration of this Agreement, the University will provide Bargaining Unit Faculty Members with medical insurance, a prescription drug benefit, dental insurance, and vision insurance.

26.1.1 Through December 31, 2014, those plans and the benefits they provide will be substantially the same as those available to Bargaining Unit Faculty as of January 1, 2014. Through December 31, 2014, the monthly premiums paid by TET Bargaining Unit Faculty will be as those specified in the October 12, 2011 – June 30, 2014 CBA for TET faculty; and the monthly premiums paid by NTE Bargaining Unit Faculty will be same as those they paid effective January 1, 2014. However, the following improvement will be effective upon execution of this agreement:

When a Member receives medical services at an in-network hospital, the Member shall not be responsible for paying higher costs (co-pays, deductibles, etc.) if the Member receives services from an out-of-network provider (e.g., an out-of-network physician) while receiving services at the in-network hospital. The only exception to the foregoing is when the Member explicitly and knowingly chooses an out-of-network provider from whom to receive a service at the in-network hospital.

26.1.2 Effective January 1, 2015, the University will offer three choices for medical insurance, all of which will include prescription drug benefits, specifically two PPO plans and one HDHP plan:

  1. one PPO with substantially the same level of benefits as Anthem’s “Blue Access® (PPO)–90/10 Plan” as of January 1, 2014, but with the improvements described in 26.1.3.1 and 26.1.3.2 below;
  2. one PPO with substantially the same level of benefits as Anthem’s “Blue Access® (PPO)–80/20 Plan” as of January 1, 2014, but with the improvements described in 26.1.3.1 and 26.1.3.3 below;
  3. one HDHP with substantially the same level of benefits as Anthem’s “Lumenos Health Savings Accounts Option 6 – HDHP” as of January 1, 2014, but with the improvements described in 26.1.3.1 below

26.1.3.1 When a Member receives medical services at an in-network hospital, the Member shall not be responsible for paying higher costs (co-pays, deductibles, etc.) if the Member receives services from an out-of-network provider (e.g., an out-of-network physician) while receiving services at the in-network hospital. The only exception to the foregoing is when the Member explicitly and knowingly chooses an out-of-network provider from whom to receive a service at the in-network hospital.

26.1.3.2 For the plan listed under 26.1.2 A:

  • The in-network deductible shall be $75 (single) and $125 (family).
  • The in-network out-of-pocket limit shall be $500 (single) and $1,000 (family).
  • The copay for physician home and office services provided by a Specialty Care Physician shall be $20.
  • The in-network co-insurance shall be 95% (paid by the plan) and 5% (paid by the Member).

26.1.3.3 For the plan listed under 26.1.2 B:

  • The in-network deductible shall be $125 (single) and $250 (family).
  • The in-network out-of-pocket limit shall be $1,250 (single) and $2,500 (family).
  • The copay for physician home and office services provided by a Specialty Care Physician shall be $25.
  • The in-network co-insurance shall be 85% (paid by the plan) and 15% (paid by the Member).

provided June 30, 2011 and as specified in the Summary Plan Description or Certificate Booklets and amendatory documents provided to the University by the insurance carriers

These benefits are summarized in Appendix E.

26.1.41 If a member elects coverage under the HDHP for the upcoming calendar year and the member has a health care flexible spending account (FSA) (see Sections 31.3 and 31.3.1), the member must have a zero balance in his or her health care FSA by December 15 of the current year. If any funds are in a Member’s health care FSA as of December 15, that member will be dis-enrolled from the HDHP and remain in his or her current health care plan for the upcoming calendar year.

26.1.5 Effective January 1, 2015, the University will continue to offer dental insurance and vision insurance with substantially the same level of benefits as were provided to Bargaining Unit Faculty on January 1, 2014, but with the following improvements to the dental coverage:

  • When provided by a Delta PPO Option Dentist or a Delta Premier Dentist, charges for provided by exams, emergency palliative treatment, prophylaxes (cleanings), X-rays, and sealants (to age 9 on first molars; to age 14 on second molars) shall not contribute toward the maximum annual benefit.
  • The maximum annual benefit per patient for services other than orthodontic services is $1,500.
  • The maximum lifetime benefit for orthodontic treatment for a child is $1,500.

26.2 In 20152, 20163, and 20174, for Members electing coverage under the HDHP, the University will make the following contributions to a Health Savings Account (HSA).

Employee Only

$1,2501400

Employee and One Dependent

$2,4002600

Employee and Two or More Dependents

$2,6503000

26.3.1 Monthly premiums for Members in the in the Tenure-Eligible and Tenured Bargaining Unit

The monthly premium contribution to be paid by a Bargaining Unit Faculty Members shall be as shown in the table below. These premiums cover medical (incorporating prescription drugs) and dental and vision insurance. Years marked in the table areThese premiums shall apply during the calendar years (January 1 through December 31) 2015, 2016, and 2017. The salary ranges are for academic years. Bargaining Unit Faculty with fiscal year salaries will have their salaries adjusted by taking 9/11ths of their fiscal year salary for purposes of determining their premium contribution using the table below.

 

Salary band

$30,000 - $49,999

$50,000-$74,999

$75,000-$99,999

>$100,000

2015

26.1.2 A

Single

 $99

 $116

 $133

 $151

EE+1

 $184

 $221

 $257

 $293

EE+2

 $258

 $311

 $363

 $416

26.1.2 B

Single

 $58

 $75

 $92

 $109

EE+1

 $119

 $156

 $201

 $229

EE+2

 $175

 $227

 $280

 $332

26.1.2 C

Single

 $41

 $53

 $65

 $77

EE+1

 $85

 $110

 $141

 $161

EE+2

 $126

 $162

 $198

 $234

2016

26.1.2 A

Single

 $101

 $118

 $136

 $154

EE+1

 $188

 $225

 $262

 $299

EE+2

 $263

 $317

 $370

 $424

26.1.2 B

Single

 $59

 $76

 $94

 $112

EE+1

 $122

 $159

 $205

 $233

EE+2

 $178

 $232

 $285

 $339

26.1.2 C

Single

 $42

 $54

 $66

 $79

EE+1

 $87

 $112

 $144

 $165

EE+2

 $128

 $165

 $202

 $239

2017

26.1.2 A

Single

 $103

 $121

 $139

 $157

EE+1

 $191

 $230

 $268

 $305

EE+2

 $269

 $323

 $378

 $432

26.1.2 B

Single

 $60

 $78

 $96

 $114

EE+1

 $124

 $162

 $209

 $238

EE+2

 $182

 $236

 $291

 $346

26.1.2 C

Single

 $43

 $55

 $68

 $80

EE+1

 $88

 $115

 $147

 $168

EE+2

 $131

 $168

 $206

 $244

Pursuant to Ohio House Bill 1, a Member who chooses to cover an adult child (or children) from age of 26 and up to the end of the month the child turns age 28 shall pay the following additional monthly premium contribution per covered adult child; these additional monthly premium contributions shall be paid during the calendar years (January 1 through December 31) 2015, 2016, and 2017:

 

26.1.2 A

26.1.2 B

26.1.2 C

2015

 $247

 $243

 $226

2016

 $252

 $248

 $231

2017

 $257

 $253

 $236

26.4 Eligible dependents for purposes of health care coverage are the Member’s spouse; the Member’s domestic partner; the unmarried child including a stepchild or adopted child of the Member, of the Member’s spouse or domestic partner, or for whom the Member, the Member’s spouse or the Member’s domestic partner is the legal guardian. Determination of dependent eligibility shall be consistent with criteria used beginning January 2007.

26.5 The University will offer each Bargaining Unit Faculty Member the option to enroll in the National Ear Care Plan, or an equivalent plan if available, providing an annual hearing screening and discounts on the cost of hearing aids and certain hearing testing. The Bargaining Unit Faculty Member will pay any enrollment fee for the Plan.

26.6 The University is committed to providing adequate service for faculty through the adopted health care coverage. An individual in Human Resources will be responsible for assisting Bargaining Unit Faculty in any claims disputes or for obtaining coverage from the designated carriers.

26.7 If the University is considering a change in carriers, the AAUP-WSU will be given an opportunity to suggest criteria for RFPs. In the event that the University solicits RFPs, the AAUP-WSU will be given an opportunity to recommend to the University which proposals should be accepted or rejected. The AAUP-WSU acknowledges that such decisions are often made in a very short time frame and agrees to respond promptly with its recommendations so that the University’s processes are not delayed.

26.8 Before implementing a wellness plan, the University will negotiate with AAUP-WSU the provisions of the plan and its availability to Bargaining Unit Faculty Members and their eligible dependents.

Changes are relative to the AAUP proposal dated March 28, 2014 (submitted April 2)

26.1 For the duration of this Agreement, the University will provide Bargaining Unit Faculty Members with medical insurance, a prescription drug benefit, dental insurance, and vision insurance.

26.1.1 Through December 31, 2014, those plans and the benefits they provide will be substantially the same as those available to Bargaining Unit Faculty as of January 1, 2014. Through December 31, 2014, the monthly premiums paid by TET Bargaining Unit Faculty will be as those specified in the October 12, 2011 – June 30, 2014 CBA for TET faculty; and the monthly premiums paid by NTE Bargaining Unit Faculty will be same as those they paid effective January 1, 2014. However, the following improvement will be effective upon execution of this agreement:

When a Member receives medical services at an in-network hospital, the Member shall not be responsible for paying higher costs (co-pays, deductibles, etc.) if the Member receives services from an out-of-network provider (e.g., an out-of-network physician) while receiving services at the in-network hospital. The only exception to the foregoing is when the Member explicitly and knowingly chooses an out-of-network provider from whom to receive a service at the in-network hospital.

26.1.2 Effective January 1, 2015, the University will offer three choices for medical insurance, all of which will include prescription drug benefits, specifically two PPO plans and one HDHP plan:

A. one PPO with substantially the same level of benefits as Anthem’s “Blue Access® (PPO)–90/10 Plan” as of January 1, 2014, but with the changesimprovements described in 26.1.3.1 and 26.1.3.2  below;

B. one PPO with substantially the same level of benefits as Anthem’s “Blue Access® (PPO)–80/20 Plan” as of January 1, 2014, but with the chagngesimprovements described in 26.1.3.21 and 26.1.3.3 below;

C. one HDHP with substantially the same level of benefits as Anthem’s “Lumenos Health Savings Accounts Option 6 – HDHP” as of January 1, 2014, but with the change described in 26.1.3.3 below.., but with the improvements described in 26.1.3.1 below

26.1.3.1 When a Member receives medical services at an in-network hospital, the Member shall not be responsible for paying higher costs (co-pays, deductibles, etc.) if the Member receives services from an out-of-network provider (e.g., an out-of-network physician) while receiving services at the in-network hospital. The only exception to the foregoing is when the Member explicitly and knowingly chooses an out-of-network provider from whom to receive a service at the in-network hospital.

26.1.3.12 For the plan listed under 26.1.2 A:

  • The in-network medical deductible shall be $50025075 (single) and $7501,000125 (family).
  • The in-network out-of-pocket medical limit shall be $21,500500 (single) and $54,0001,000 (family).
  • The in-network out-of-pocket pharmacy limit shall be $32,3500 (single) and $4,6,700 (family).
  • The copay for a physician office visithome and office services will be $20.
  • The copay for provided by a Specialistty office visit will be $30.Care Physician shall be $20.
  • The in-network co-insurance shall be 9590% (paid by the plan) and 510% (paid by the Member).

26.1.3.23 For the plan listed under 26.1.2 B:

  • The in-network medical deductible shall be $1251,0500 (single) and $25021,0500 (family).
  • The in-network medical out-of-pocket limit shall be $43,0001,250 (single) and $8,0002,500 (family).
  • The in-network pharmacy out-of-pocket limit shall be $2,3500 (single) and $4,7600 (family).
  • The copay for a physician office visit home and office services provided by a Specialty Care Physician shall be $25.will be $30.
  • The copay for a Specialist office visit will be $40.
  • The in-network co-insurance shall be 8580% (paid by the plan) and 1520% (paid by the Member).

26.1.3.3 For the plan listed under 26.1.2 B:

  • The in-network pharmacy out-of-pocket limit shall be $2,300 (single) and $4,600 (family).

These benefits are summarized in Appendix E.

26.1.4 Through December 31, 2014, iIf a member elects coverage under the HDHP for the upcoming calendar year and the member has a health care flexible spending account (FSA) (see Sections 31.3 and 31.3.1), the member must have a zero balance in his or her health care FSA by December 15 of the current year. If any funds are in a Member’s health care FSA as of December 15, that member will be dis-enrolled from the HDHP and remain in his or her current health care plan for the upcoming calendar year.

Effective January 1, 2015, if a member elects coverage under the HDHP for the upcoming calendar year and the member has a healath care flexible spending account (FSA), the member must elect not to carry any balance up to $500 over into the following year.

26.1.5 Effective January 1, 2015, the University will continue to offer dental insurance and vision insurance with substantially the same level of benefits as were provided to Bargaining Unit Faculty on January 1, 2014, but with the following improvements to the dental coverage:.

·         When provided by a Delta PPO Option Dentist or a Delta Premier Dentist, charges for provided by exams, emergency palliative treatment, prophylaxes (cleanings), X-rays, and sealants (to age 9 on first molars; to age 14 on second molars) shall not contribute toward the maximum annual benefit.

·         The maximum annual benefit per patient for services other than orthodontic services is $1,500.

·         The maximum lifetime benefit for orthodontic treatment for a child is $1,500.

26.2 In 2015, 2016, and 2017, for Members electing coverage under the HDHP, the University will make the following annual contributions to a Health Savings Account (HSA). The amounts are pro-rated for those members who initiate and terminate the HDHP during the calendar year.

26.2.1A                       2015

Employee Only

$1,250

Employee and One Dependent

$2,400

Employee and Two or More Dependents

$2,650

   

26.2.2A                       2016

Employee Only

$1,125

Employee and One Dependent

$2,200

Employee and Two or More Dependents

$2,300

   

26.2.3A                       2017

Employee Only

$1,000

Employee and One Dependent

$2,000

Employee and Two or More Dependents

$2,000

   

26.3.1  Monthly premiums for Members in the in the Tenure-Eligible and Tenured Bargaining Unit

The monthly premium contribution to be paid by a Bargaining Unit Faculty Members shall be as shown in the table below. There are three separate se premiums covering medical (incorporating prescription drugs),  and dental, and vision insurance. These premiums shall apply during the calendar years (January 1 through December 31) 2015, 2016, and 2017. The salary ranges are for academic fiscal years. Bargaining Unit Faculty with fiscal academic year salaries will have their salaries adjusted by taking 11/99/11ths of their academicfiscal year salary for purposes of determining their premium contribution using the table below.

   
NTE
NTE
NTE
TET
 

Salary band

$30,000 - < $49,999

$50,000-$74,999

> $75,000-$99,999

>$100,000

Medical (incorporating pharmacy)

2015

26.1.2 A

Single

 $99109

 $116129

 $133149

 $151134

EE+1

 $184202

 $221245

 $257287

 $293291

EE+2

 $258278

 $311339

 $363400

 $416378

26.1.2 B

Single

 $5861

 $7581

 $92101

 $109111

EE+1

 $119127

 $156169

 $201222

 $229244

EE+2

 $175182

 $227243

 $280303

 $332315

26.1.2 C

Single

 $4142

 $5356

 $6569

 $7775

EE+1

 $8587

 $110116

 $141153

 $161164

EE+2

 $126125

 $162167

 $198209

 $234211

2016

26.1.2 A

Single

 $101117

 $118139

 $136161

 $154145

EE+1

 $188223

 $225269

 $262316

 $299321

EE+2

 $263312

 $317380

 $370448

 $424424

26.1.2 B

Single

 $5966

 $7687

 $94109

 $112120

EE+1

 $122140

 $159186

 $205244

 $233268

EE+2

 $178203

 $232272

 $285340

 $339352

26.1.2 C

Single

 $4245

 $5460

 $6675

 $7981

EE+1

 $8796

 $112128

 $144168

 $165181

EE+2

 $128140

 $165187

 $202234

 $239236

2017

26.1.2 A

Single

 $103124

 $121148

 $139171

 $157154

EE+1

 $191240

 $230291

 $268341

 $305346

EE+2

 $269343

 $323418

 $378493

 $432466

26.1.2 B

Single

 $6070

 $7892

 $96116

 $114127

EE+1

 $124151

 $162201

 $209264

 $238289

EE+2

 $182224

 $236299

 $291374

 $346388

26.1.2 C

Single

 $4348

 $5564

 $6880

 $8085

EE+1

 $88104

 $115138

 $147181

 $168195

EE+2

 $131154

 $168205

 $206257

 $244259

Dental-NTE & TET

26.1.5

2015

2016

2017

Single

 $4.44

 $4.80

 $5.09

 

EE+1

 $8.36

 $9.19

 $9.93

 

EE+2

 $15.80

 $17.70

 $19.47

 

Vision-NTE & TET

 

2015

2016

2017

Single

 $1.03

 $1.12

 $1.18

 

EE+1

 $2.11

 $2.32

 $2.50

 

EE+2

 $3.51

 $3.93

 $4.33

 

Pursuant to Ohio House Bill 1, a Member who chooses to cover an unmarried adult child (or children) from age of 26 and up to the end of the month the child turns age 28 shall pay the following additional after-tax monthly premium contribution per covered adult child; these additional after-tax monthly premium contributions shall be paid during the calendar years (January 1 through December 31) 2015, 2016, and 2017:

 

26.1.2 A

26.1.2 B

26.1.2 C

2015

 $247271

 $243267

 $226249

2016

 $252298

 $248293

 $231274

2017

 $257322

 $253317

 $236295

 

 

Dental

Vision

2015

 $31.07

 $6.91

2016

 $34.18

$7.60

2017

 $36.91

 $8.21

 

 

 

26.4 Eligible dependents for purposes of health care coverage are the Member’s spouse; the Member’s registered domestic partner; the unmarried child including a stepchild or adopted child of the Member, of the Member’s spouse or registered domestic partner, or for whom the Member, the Member’s spouse or the Member’s registered domestic partner is the legal guardian. Determination of dependent eligibility shall be consistent with criteria used beginning January 2007.

26.6 The University is committed to providing problem solving support adequate services for faculty through the adopted health care coverage. If a situation occurs, the member should contact the dedicated Anthem service representative via the phone numbers listed on the back of their insurance card. If further assistance is still needed, the WSU’s benefits consultants, Horan and Associate, is available to assist. And, if still unresolved, aAn individual in member of the Human Resources Benefit team will assist with next steps.be responsible for assisting Bargaining Unit Faculty in any claims disputes or for obtaining coverage from the designated carriers.

26.7 If the University is considering a change in carriers, the AAUP-WSU will be given an opportunity to suggest criteria for RFPs. In the event that the University solicits RFPs, the AAUP-WSU will be given an opportunity to recommend to the University which proposals should be accepted or rejected. The AAUP-WSU acknowledges that such decisions are often made in a very short time frame and agrees to respond promptly with its recommendations so that the University’s processes are not delayed. 

26.8 Before implementing a wellness plan, the University will negotiate with AAUP-WSU the provisions of the plan and its availability to Bargaining Unit Faculty Members and their eligible dependents.

Status of Negotiations about the Above Article

June 24, 2014

The administration put forward a counterproposal in response to our June 20 offering.

Among the objectionable features of this counter, we find that it

Regarding the latter bullet, the administration stated that it had arrived at the proposed 3.1% summer tax by computing the total annual medical insurance premiums paid by all bargaining unit faculty divided by the total annual base salaries for all bargaining unit faculty.

In reaction, our team stated that we could possibly accept a system in which bargaining unit faculty would pay their full medical insurance premiums as a fixed percentage of their WSU income, but only if the following three features are adopted. First, the fixed percentage would have to be calculated by using all full-time faculty, including administrators like the President, the Provost, Deans, and Chairs, and also medical school faculty; second, the salaries to be totaled would have to include all compensation from WSU (including stipends, deferred compensation, and so forth), not just base salaries; and third, the fixed percentage would have to be levied as the charge for medical insurance premiums on all full-time faculty, and the charge would, for each individual, be levied on all compensation from WSU. We noted in particular that now, the highest salary band on the sliding scale of monthly premiums begins at $100 thousand, thus implying that an administrator making (say) $500 thousand per year pays the same medical insurance premiums as a BUFM making $100 thousand; whereas under our proposal, the administrator would pay five times as much as the BUFM.

Our reaction seemed to dampen the administration's enthusiasm for its second bullet above.

See also the administration's counterproposals of June 24 for Article 23 (Compensation), one for the NTE and one for the TET CBA.

June 20, 2014

Our negotiating team submitted a counterproposal that would apply to all BUFMs in both the NTE and TET Bargaining units. In it, we accepted the health care plans now available to the other WSU employees, improved to protect an insured person who (for example) receives care at an in-network hospital but while there also from out-of-network provider. We retained the same monthly premiums in both our original proposal and our April 28 counterproposal, save only that fiscal year appointees would pay premiums based upon their fiscal year base salary rather than 9/11 of same (see 26.3.1). Regarding dental coverage, we continued to press for an additional improvement (not charging routine cleanings and the like against the annual limit on covered expenses; see the first bullet under 26.1.5).

In response to a question from the administration, we stated that we did not agree to pay monthly premiums in years two and three dependent upon the claims reported for the previous fiscal year.

We expect to receive a response to our counterproposal (and to our June 20 counterproposals for Article 23 (Compensation) at a negotiating session set for Tuesday, June 24.

May 30, 2014

The administration submitted this counterproposal. It features three plans like those now available to non-AAUP-represented employees (see 26.1.2 A, B, and C), but with out-of-pocket maximums in the two PPO plans (A and B) doubled from their present amounts and lowered administration contributions to the HSA (plan C).

The administration did agree to our proposal to protect an insured person who (for example) receives care at an in-network hospital but while there also from out-of-network anesthetist, radiologist, etc.; see the indented paragraph in 26.1.1 and also section 26.1.3.

The administration did agree to some improvements in dental benefits; see 26.1.5, and compare with our Section 26.1.5 in the left column of the table above.

The administration calls for premium increases in the second and third years (calendar years 2016 and 2017) that are not specified but instead dependent upon the claims reported for the previous fiscal year. Our team pointed out that the medical care cost data thus far provided by the administration was highly suspect, one of the reasons why we do not look favorably upon this premium increase scheme.

The administration's administration's counterproposal continues to feature un-bundled medical, dental, and vision benefits, and it continues to charge premiums to BUFMs on academic year appointments as if their salaries were scaled upward by a factor of 11/9, in effect assuming that each such BUFM teaches eight hours in each summer (more than the administration is obligated to offer and certainly more than is actually taught by the vast majority).

Our team asked the administration if it had "costed out" its counterproposal -- that is, if it had determined the salary-cut equivalent of its proposal (reducing coverage and increasing premiums). It was unable to answer that question at the May 30 session, which one takes as a "no".

April 28, 2014

Our team put forth this counterproposal. We noted that it differs only in two ways from our original (dated March 28, submitted at the April 2 session): in the co-insurance rates for the two PPOs.

April 16, 2014

The administration submitted the counterproposal shown in the right column of the table above. Briefly put, it is dramatically worse than our proposal and, in combination with the administration's proposal for Article 23 (Compensation), would yield a real pay decrease over the term of the new CBAs.

April 2, 2014

In submitting the proposal in the left column above (intended for both the NTE and TET CBAs), our team noted that all BUFMs would pay medical premiums on a sliding (salary-dependent) scale, as is now the case for NTE BUFMs and was formerly the case for TET BUFMs. Our team pointed out a number of improvements we specify in comparison to the insurance plans now applicable to employees not represented by AAUP-WSU. The plans and improvements therein are specified in sections 26.1.2 - 26.1.3.3. We also specify improvements in the current dental plan (26.1.5).


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