ARTICLE 22 INSURANCE

Exeter-West Greenwich School District

A. Healthcare Insurance. The Committee shall provide all members of the bargaining unit with the following health insurance coverage options:

1. Preferred Provider Organization (PPO). The Committee shall maintain a PPO plan for members of the bargaining unit who selected this option prior to January 1, 2019. The PPO plan shall contain in- and out-of-network benefits. Unless contrary to R.I.G.L. § 28- 7-49, the PPO plan’s network shall not contain less than ninety percent (90%) participation by Rhode Island physicians and include the following acute care facilities (or their successors): Bradley Hospital; Butler Hospital; Hasbro Children’s Hospital; Kent Hospital; Miriam Hospital; Rhode Island Hospital; Roger Williams Hospital; South County Hospital Healthcare System; Women and Infants Hospital. A summary of benefits for said PPO plan shall be available through the District’s Director of Administration.

2. Indemnity Plan. The Committee shall cease to offer an Indemnity Plan to any new hires or former hires not currently enrolled in said plan upon ratification of this Agreement. All bargaining unit members currently enrolled in an Indemnity Plan shall contribute as follows: Bargaining unit members hired after 7/1/98 shall pay one-hundred percent (100%) of the additional cost of the Indemnity Plan. Bargaining unit members hired before 7/1/98 shall pay twenty percent (20%) of the additional cost of the Indemnity plan.

3. a. High Deductible Health Plan/Health Savings Account. the Committee shall provide employees a high-deductible health plan (“HDHP”) option, with the same benefits, levels of coverage, and limitations as provided in the PPO, in conjunction with portable, individual Health Savings Accounts (“HSA”), pursuant to changes in the Internal Revenue Code made possible by the Medicare Modernization Act of 2003. Effective for all employees hired for the 2019-2020 school year and beyond, the HDHP option shall be the standard health insurance plan offered to members of the bargaining unit. New employees shall be provided with the Preferred Provider Organization (PPO) plan with co-shares and co-pays consistent with this agreement until January 1st of the first year of employment. At that time, new employees shall convert to the HDHP HSA plan.

b. Employees opting for an HDHP/HSA family plan will have an annual deductible of $6,000. The Committee shall deposit $2,000 on January 1, 2023 and on January 1, 2024 into the employee’s HSA. The employee may elect to contribute, by payroll deduction on a pre-tax basis or by lump sum, the remaining deductible for family medical coverage, as provided in this Section A. Once the Committee’s contribution is exhausted, the employee shall be responsible for the remainder of the deductible before the Committee assumes any and all additional healthcare costs incurred consistent with the health plan offered to other employees. This shall include, but is not limited to, office visits, emergency room fees, prescription deductibles, etc. Once the deductible of $6,000 is met, the Committee shall provide 100% coverage for services in-network / 60% coverage for services out-of network. The Committee shall pay the following service charges and fees accrued through the HDHP/HSA: Account Setup Fee and the HSA Administrator Monthly Fee. The district shall deposit the proportional dollar amount into the employee’s HSA account equivalent to the FTE status of the part time teacher. For example, if the employee is .8 FTE during the 2019-2020 school year, the district shall deposit .8 X $3,000 into the employee’s account. The teacher is responsible for the remainder of the deductible. Additionally, the part time teacher shall be responsible to pay the percentage of the premium which is equal to the difference between 1.0 FTE and his FTE. A .8 FTE teacher will pay .2 of the premium.

1 An HSA is a financial account that an employee can use to accumulate tax-free funds to pay for current and future qualified health-care expenses. Under these plans, individuals or families participate in high deductible consumer- driven health plans (“CDHPs”). Employees may contribute pre-tax dollars into their individual HSAs to pay for medical expenses up to the deductible amount.

c. Employees opting for an HDHP/HSA individual plan will have an annual deductible of $3,000. The Committee shall deposit $1,000 on January 1, 2023 and on January 1, 2024 into the employee’s employee may elect to contribute, by payroll deduction on a pre-tax basis or by lump sum, the remaining deductible for individual medical coverage, as provided in this Section A. Once the Committee’s contribution is exhausted, the employee shall be responsible for the remainder of the deductible before the Committee assumes any and all additional healthcare costs incurred consistent with the health plan offered to other employees. This shall include, but is not limited to, office visits, emergency room fees, prescription deductibles, etc. Once the deductible of $3,000 is met, the Committee shall provide 100% coverage for services in-network / 60% coverage for services out-of­ network. The Committee shall pay the following service charges and fees accrued through the HDHP/HSA: Account Setup Fee and the HSA Administrator Monthly Fee. The district shall deposit the proportional dollar amount into the employee’s HSA account equivalent to the FTE status of the part time teacher. The teacher is responsible for the remainder of the deductible. Additionally, the part time teacher shall be responsible to pay the percentage of the premium which is equal to the difference between 1.0 FTE and his FTE.  A .8 FTE teacher will pay .2 of the premium.

d. Employees opting for the HSA individual or family plan will be offered the same negotiated prescription rates from the healthcare provider as those under the plan referenced above; however, employees will be responsible for the full cost of prescription drugs until the annual deductible is met. Thereafter, the prescriptions are paid by the Committee as part of the 100% co-insurance.

e. The employee’s election of an HDHP/HSA for the following year shall be made on or before December 31st and said election shall remain irrevocable.

f. Should the provision of HDHP/HSAs be discontinued due to regulatory or legislative action, members will be offered the same health insurance coverage available to members under this Agreement, under the terms herein.

B. Employee Healthcare Insurance Contributions.

1.For the term of this Agreement, each active employee with PPO or Indemnity plan coverage shall pay 20% of the premium costs for healthcare insurance by payroll deduction The contribution for employees with the HSA plan is specified in subsection A.3.b. and c. (above).

2. Except as provided in Article 23.C, retirees shall not make any contribution toward healthcare insurance provided through this Agreement.

3. Each employee shall sign a payroll deduction authorization as may be required by the Director of Administration to satisfy the above-referenced cost-sharing obligations.

4. The PPO plan will include the following: $20 point-of-service co-payments for office visits to primary care physicians; $30 point-of-service co-payments for office visits to specialists; $50 point-of-service co-payments for urgent-care visits; and, $150 point-of- service co-payments for emergency room visits each occurrence. Point-of-service co- payments shall not be increased without approval of the Association.

5. The prescription coverage for PPO plans shall include a four-tier prescription drug program at the rates of $10/$35/$60/$100. The mail-order Rx program will be available for all eligible prescriptions at 1 copay per 90 days.

Tier co-payments shall not be increased without approval of the Association.

6. Healthcare coverage shall be prorated for part-time teachers and teachers who are on unpaid maternity or parental leave. Healthcare shall be prorated proportionate to the portion of the school year for which the teacher is being paid. Teachers on maternity or parental leave shall receive paid healthcare as provided in Article 18.

A part time teacher who maintains the PPO will contribute to their healthcare premium in the following manner: ((Cost of Plan * FTE status) * Contractual Co-Share % of the premium) + [Cost of the plan * (1.0 - FTE status)]. Example: A 0.8 FTE teacher would pay for family plan including dental (Using $28,000 as the Cost of the Plan and 18% co- share as an example): (28,000 x 0.8 x .18) + (28,000 x .2) = 4,032 + 5,600 = $9,632

C. Dental Insurance. The Committee shall provide each employee with a dental plan with substantially equivalent benefits and network to those existing on the date of execution of this Agreement. A summary of benefits for said dental plan shall be appended hereto and incorporated herein. Additionally, a summary description of said dental plan shall be available through the District’s Director of Administration. For the term of this agreement, the Committee shall provide dental insurance of $1,800 annual maximum per calendar year per member for each member and his family, as he may elect. Employees shall contribute by payroll deduction 20% of the annual premium cost.

D. Change in Health or Dental Insurer. The Committee reserves the right to change health or dental insurance plan providers, subject to the following conditions. Prior to any change in health or dental insurance plan providers, the Committee shall:

1. Provide the Association with actuarial certification that any and all proposed modified benefit limit(s) or proposed modified level(s) of coverage is (are) actuarially equivalent to or greater than the existing benefit limits or the existing levels of coverage. “Actuarial equivalence” means that two or more benefit plans provide the same expected value of benefits in total (as determined through generally accepted actuarial principles), though the specific benefits within those plans may differ. The actuarial analysis to determine actuarial equivalence will take into account the net value of all benefits including deductibles, coinsurance, and out-of-pocket maximums.

2. Demonstrate to the Association that the network for the plan or plans under consideration is (are) substantially equivalent or better in terms of providers. The demonstration shall consist of an analysis of the utilization and availability of network access to the benefits under subsection D.1 (above). Unless contrary to R.I.G.L. § 28-7-49, no consideration shall be given to any health or dental insurance plan provider with less than ninety percent (90%) participation by Rhode Island physicians. Further, unless contrary to R.I.G.L. § 28-7-49, no consideration shall be given to any health or dental insurance plan provider, the network of which does not include the following acute care facilities (or their successors) at the time coverage commences: Bradley Hospital, Butler Hospital, Hasbro Children’s Hospital, Kent Hospital, Miriam Hospital, Rhode Island Hospital, Roger Williams Hospital, South County Hospital Healthcare System and Women and Infants Hospital.

Should a dispute arise in connection with a proposed change in health or dental insurance plan providers under this article, the Committee or the Association may resolve said dispute either- through declaratory and injunctive relief litigation in the Superior Court of the State of Rhode Island or through arbitration in  accordance with the Expedited Labor Arbitration Procedures of the American Arbitration Association’s Labor Arbitration Rules. Nothing herein shall be construed to limit or abridge the rights of the Committee and Association to seek post-arbitration relief in the Superior Court pursuant to R.I.G.L. § 28-9-1 et seq. No change in health or dental insurance plans shall be made pending conclusion of Superior Court litigation or arbitration, unless otherwise ordered by the Superior Court.

E. Hold Harmless/Change in Healthcare Insurer.

In the event the Committee elects to change healthcare insurance coverage as provided herein, it shall reimburse a covered individual whose primary care physician does not participate in the network of the selected healthcare  insurer for any out-of-network  costs incurred for services provided in the subscriber agreement. For purposes of this article, the term primary care physician shall include the following categories:

1. internal medicine;
2. family practice;
3. general practice;
4. pediatrics; and
5. obstetrics and gynecology/primary care.

For purposes of this article, a covered individual must have a relationship with a primary care physician at least thirty (30) days before the date the Committee changes health insurance coverage to qualify for Committee reimbursement. In addition, the Committee shall reimburse a covered individual for out-of-network costs incurred for treatment provided by a physician and/or other healthcare service provider (e.g. counselor) with whom ongoing treatment had been initiated at least thirty (30) days prior to the date the Committee changes health insurance coverage. A “relationship” with either a primary physician or specialists shall be sufficiently demonstrated by (1) prior or current treatment by the same individual (2) a referral from the member or covered family member’s current primary physician, or (3) an appointment scheduled with the physician or specialist in question.

The reimbursement obligations of the Committee as set forth above are expressly limited to a period of twelve (12) months.

F. Other Insurance.

1. Liability Insurance. Liability insurance in the amount of $500,000 each occurrence. Teachers’ participation in athletics or intramurals is also covered with this same amount.

2. Term Life Insurance. The Committee will provide maximum fifty-five thousand dollars ($55,000) term life insurance for all members of the bargaining unit with the provision that upon termination of employment, the insured person may convert his term insurance to an individual policy.

3. Workers’ Compensation. The Committee shall maintain Workers’ Compensation coverage.

G. Employee Healthcare Waiver.

1. If a teacher elects not to receive health insurance, he or she shall receive $1,500.00.

The teacher shall notify the District’s Director of Administration in writing prior to September that he does not wish the healthcare insurance and/or dental coverage. The payment shall be made on the last day of the school year. If during the school year the teacher requires healthcare insurance coverage as a result of a spouse becoming unemployed or for any other reasons beyond the teacher’s control, the teacher shall notify the school department in writing. The Committee shall reinstate the coverage as of the beginning of the month following said notification.

2. If said teacher has provided notification in time for the Committee to reinstate the coverage, and the Committee fails to do so through negligence, the Committee accepts responsibility for the payment of all medical costs incurred by the teacher and/or their immediate family.

H. Committee-Association Healthcare Advisory Committee.

There shall be established a joint Committee-Association healthcare advisory committee comprised of two (2) members designated by the Committee and two (2) members designated by the Association’s president. The Advisory Committee’s role, which is purely advisory, shall include: reviewing the mix of health and dental benefits made available to the membership; exploring cost- savings measures, benefit enhancements, and alternative plans and insurers; meeting with representatives of healthcare insurance providers; assisting the Committee, as requested, in coordinating healthcare insurance educational seminars or forums for members of the bargaining unit; and, making non-binding reports or recommendations with respect to healthcare insurance to the Committee and Association. It is expressly understood that any advisory reports or recommendations of the committee established in this section shall not supplant the obligations of the Committee and Association to engage in collective bargaining.

I. General Provisions on Healthcare Insurance.

1. Selection of the HDHP/HSA plan by members eligible to maintain PPO coverage per Article 22.A.1 shall be solely at the determination of the employee, subject to the terms and conditions contained in this Agreement.

2. Employee contributions toward healthcare insurance shall be made on a pre-tax basis as permitted by law.

3. Coverage will be available to domestic partners who certify by affidavit that they satisfy the indicia and requirements of domestic partners as set forth in R.I.G.L. § 36-12-1(3) and to civil union partners (as provided for, and in accordance with, Rhode Island’s Civil Unions act, R.I.G.L. § 15-3.1-1 et seq.).

4. The Committee shall provide a minimum of sixty (60) days’ notice to the members of the bargaining unit of a change in health care insurer.