M.
III
VIA EMAIL ONLY Chairpersons General Committees of Adjustment United Transportation Union Railroads in the United States
March 1, 2010
Re: Employee H&W Contribution -NRC/UTU Health & Welfare Plan and
Dear Sirs and Brothers:
Railroad Employees National Health & Welfare Plan (GA-23000)
www.utu.org
Over the past two (2) years the Cooperating Railway Labor Organizations sub-committee has had discussions with the NRLC in an effort to reach agreed-upon questions and answers illustrating the circumstances under which the railroads are required to make monthly payments to the above referenced health and welfare plans and under which the covered employees are required to make contributions.
While NRLC did not want to execute a formal question and answer document, they were willing to co-issue a document that would serve as "guidelines" on which the parties have agreement, but without prejudice to any position or rights that either party may now have, or had at any time in the past, regarding the interpretation or application of any collective bargaining agreement provision relating to any matter addressed by the guidelines.
Attached you will find a copy of any exchange of correspondence between CRLO Chairman R. A. Scardelletti and NRLC Chairman A. K. Gradia, along with the "Consolidated Cost-Sharing Guidelines With Examples Of Their Application".
The guidelines should serve to answer most questions you may receive from the membership regarding their required cost-sharing and please do not hesitate to contact this office should issues arise.
Attachment
cc: International Officers (via email) State Legislative Directors (via email) Field Supervisors (via email) Designated Legal Counsel (via email)
Fraternally yours,
/44:~.;' M. B. Futhey, Jr. International President
Goperating
RilWay
]jbOr Organizations
Health and Welfare Committee
3 Research Place Rockville, MD 20850 301-948-4910
R. A. Scardelletti Chairman
W. D. Pickett Vice Chairman
G. J. Francisco, Jr. Treasurer
American Train Dispatchers Association
Brotherhood of Locomotive Engineers & Trainmen Division IBT
Brotherhood of Maintenance of Way Employes Division IBT
Brotherhood of Railroad Signalmen
International Association of Machinists and Aerospace Workers
Sheet Metal Workers' International Association
International Brotherhood of Boilermakers & Blacksmiths
International Brotherhood of Electrical Workers
SEIUlNational Conference of Firemen & Oilers
Transport Workers Union
Transportation Communications Union
United Transportation Union
February 9, 2010 VIA FACSIMILE
TO: ALL CRLO Chiefs
Dear Sirs and Brothers:
This is in further reference to communications regarding the {(Consolidated Cost-Sharing Instructions" and my request for a formal agreement between the Cooperating Railway Labor Organizations and the National Railway Labor Conference.
In response to my August 7, 2009 request, A. Kenneth Gradia,Chairman National Railway Labor Conference provided a counter-proposal on October 22, 2009, wherein he stated that the cost-sharing instructions could be used as a guideline without the need of a formally signed document between the parties.
Attached is a copy of an email sent to the Labor Subcommittee members from former CRLO Administrator Nick Stewart, relaying the Carrier's counter-proposal. Subsequent to that email, one organization voiced some concern to Nick Stewart, to which he provided an appropriate response. Since that time, this office has not received any further communications from any other organization or subcommittee member.
As a result of no further comments, I will respond to Mr. Gradia's October 22, 2009 letter that we should bring this matter to a conclusion. In doing so, I will advise that the document represents the objective views of the matters noted therein. They are set forth without prejudice to any position or rights that either party may now have,orhad at any time in the past, regarding the interpretation or application of any collective bargaining agreement provision relating to any matter addressed by this guidance.
Attachment
In solidarity,
/~~. Robert A. Scardelletti CRLO Chairman
Conboy, Ellen
Subject: FW: Consolidated Cost-Sharing Guidelines Attachments: Ken_CostShareLetter_10222009.pdf; CRLO Cost Share Instructions (10-16-09).pdf
Importance: High
From: Stewart, Nick Sent: Friday, October 23, 2009 12: 15 PM To: Bill Bohne ([email protected]); Bill Hildenbrand; Cook, Dan; Dan Hamilton ([email protected]); Don Griffin; Frank May; Fred Fink; Jeff Weisbarth; John Slatery; Leo McCann ([email protected]); Michael Williams ([email protected]); Oathout, Russell; Thomas Fisher; Walt Barrows Subject: FW: Consolidated Cost-Sharing Guidelines Importance: High
Greetings:
At long last, we have a response from the NRLC regarding the consolidated cost-sharing instructions.
As you will see from NRLC Chairman Ken Gradia's cover letter, the NRLC does not want to execute the
instructions in the form of an ([agreement" for reasons he explains therein. However, the NRLC is willing to co
issue the document as {{Consolidated Cost Sharing Guidelines/' albeit with a disclaimer.
Ellen and I spent the morning going over the NRLC document word by word, and we did not find any material
changes from our original proposal. In some instances, the intent of our language has been condensed, but
the CRLO scenarios and interpretations are all there as we presented them. In short, we found no surprises.
While the NRLC's response is not exactly what we asked for, suffice it to say that we are far better off now
than we were two years ago when we started this project. We now have a working set of guidelines that the
railroads have agreed to, and which we can distribute as we see fit. For that, I want to congratulate the
committee that has worked so hard on this for so many months, both individually and through meetings and
conference calls. I also want to thank CRLO Chairman Scardelletti for his aggressive pursuit of this matter with the Chairman of the NRLC.
In solidarity,
Nick Stewart
CRLO Administrator
1
NATIONAL RAILWAY LABOR CONFERENCE 1901 L STREET, N.W., WASHINGTON, D.C. 20036/ AREA CODE: 202-862-7200 FAX: 202-467-5892
JEFFREY F. ROGERS Vice Chairman
Robert A. Scardelletti CRLO Chairman 3 Research Place Rockville, MD 20850
Dear Mr. Scardelletti:
A. KENNETH GRADIA Chairman
JOANNA L. MOORHEAD General Counsel
JOHNF. HENNECKE Director of Labor Relations
October 22,2009
By letter dated August 7, 2009, you sent me a paper entitled "Consolidated Cost-Sharing Instructions". That paper was essentially a CRLO revision of the response that we made earlier in the year of a Question and Answer document that Mr. Stewart of your office sent to me setting forth the CRLO's views as to when a carrier contribution to the Railroad Employees National Health and Welfare Plan and, accordingly, an employee cost-sharing contribution, was required.
We have now completed our review of that paper and enclose with this letter a revised version of that document for your consideration. We would be happy to discuss any of the revisions we have proposed with such CRLO representatives as you may designate.
In your August 7 letter, you proposed that the carriers and the labor organizations agree to formally and jointly adopt whatever text emerges from our exchange once completed. We think a different approach would better and more promptly effectuate what I believe to be our mutual objective-the amelioration of the confusion and uncertainty to which you refer in the penultimate paragraph of your August 7 letter.
As you will see from the title of the enclosed revision, we think the principles and examples set forth in the document should comprise a set of "Guidelines" for carrier use and guidance that would help achieve that goal on a going-forward basis. As we noted in our response to Mr. Stewart last March, the positions articulated in the revised document represent current carrier views regarding the matters addressed therein. They are set forth without prejudice to any position or rights that any carrier may now have, or had at any time in the past,
-2 -
regarding the interpretation or application of any collective bargaining agreement provision relating to any matter addressed by this guidance. A process requiring "formal" and 'joint" adoption of the document would, in our view, materially delay and complicate our efforts to address the problems you have identified with no assurance of mutual resolution.
We look forward to hearing your views on our revision.
Sincerely yours,
A. Kenneth Gradia
Enclosure
CONSOLIDATED COST-SHARING GUIDELINES WITH EXAMPLES OF THEIR APPLICATION
Employee cost-sharing is required for each month that a carrier is required to make a
contribution to the Railroad Employees National Health and Welfare Plan (the "Plan")
on the employee's behalf for foreign-to-occupation health benefit coverage for
himself/herself and/or his/her dependents.
General Principles
1. A carrier is required to make a Plan contribution regarding an employee (thus
triggering an employee cost-sharing contribution) for each calendar month
immediately following a calendar month in which the employee rendered the
Requisite Amount of Compensated Service or received the Requisite Amount of
Vacation Payor a combination of both. A carrier is also required to make a
Plan contribution when the "Opportunity Rule" applies and an employee is
treated as if he/she had rendered the Requisite Amount of Compensated
Service. See General Principle 5.
2. The Requisite Amount of Compensated Service is compensated service
rendered for an aggregate of at least seven calendar days during a calendar
month if the employee is covered under the Plan pursuant to a collective
bargaining agreement that provides for such a "seven-day" rule; otherwise, the
Requisite Amount of Compensated Service is compensated service rendered
for at least one day during the month.
3. The Requisite Amount of Vacation Pay is vacation pay received for an
aggregate of at least seven calendar days during a calendar month if the
employee is covered under the Plan pursuant to a collective bargaining
agreement that provides for such a "seven-day" rule; otherwise, the Requisite
Amount of Vacation Pay is vacation pay received for at least one day during the
month. This General Principle is subject to the following exceptions:
a) Vacation pay received by a furloughed employee after the start of his/her
furlough will not be considered vacation pay for purposes of determining
Plan coverage or required carrier or employee cost-sharing contributions.
b) Vacation pay received by an employee after termination of his/her
employment relationship (i.e., resignation, dismissal and retirement) will
not be considered vacation pay for purposes of determining Plan
coverage or required carrier or employee cost-sharing contributions.
c) Vacation pay received by an employee while covered by the Plan as a
disabled employee will be considered vacation pay for purposes of
determining Plan coverage but not for purposes of determining carrier or
employee cost-sharing contributions.
2
4. Where the seven-day rule applies, an employee continues to be covered by the
Plan during any calendar month by virtue of rendering compensated service or
receiving vacation pay in the immediately preceding month only if he/she
rendered compensated service on, or received vacation pay for, an aggregate
of at least seven calendar days during such preceding month.
5. If an employee returns to work from furlough, suspension, dismissal or disability
(including pregnancy), or commences work as a new hire, at a time during a
month when there is not an opportunity to render compensated service on at
least seven calendar days during that month, the employee will be deemed to
have satisfied the seven-day rule, provided that he/she is available to work, or
actually works, every available work opportunity during that month. Carriers
refer to this principle as the "Opportunity Rule." It does not apply to an
employee who will be covered by the Plan during the immediately following
month under any of the Plan's extended coverage provisions, such as furlough,
suspension, dismissal, disability, etc.
6. For all unions that have agreed to the seven-day rule, except for the BLET and
the UTU (including Yardmasters), where the regular work day consists of more
than eight hours, each such day actually worked or for which vacation pay is
received is treated as one and a fraction days, i.e., a regular assignment of ten
hours is treated as 1.25 calendar days for purposes of determining whether or
not the seven-day rule has been satisfied.
3
7. Compensated service includes time actually worked and time that the carrier
has customarily treated as if it were time actually worked. In addition,
compensated service includes days of FMLA leave unless the employee is
covered by the Plan during the immediately following month for any reason
other than rendering the Requisite Amount of Compensated Service or
receiving the Requisite Amount of Vacation Pay, or a combination of both,
during the current month (i.e., coverage during the immediately following month
by reason of furlough, dismissal, suspension, etc.).
8. Where an employee has coverage in the immediately succeeding month by
reason of any of the extended coverage provisions of the Plan, no carrier or
employee cost-sharing contributions are required for that month unless the
employee rendered the Requisite Amount of Compensated Service or received
the Requisite Amount of Vacation Pay, or a combination of both, in the current
month or experienced a situation where the "Opportunity Rule" (see General
Principle 5) was applicable for the current month.
Side Letters of the 1996 National Agreements confirm understandings with respect to
application of the seven-calendar-day-per-month requirement for benefit coverage and
also impact when coverage is established.
Assumptions
The specific rules set forth below incorporate the following assumptions:
a) Newly hired employees are not subject to any waiting period.
4
b) References to "vacation pay," "vacation" and the like mean days
for which the employee received vacation pay.
c) All employees are subject to the seven-day rule.
d) Unless specified otherwise, all vacation pay was received prior to
furlough, retirement, dismissal or disability, as the case may be.
e) In cases where the employee returns to work from furlough,
suspension, dismissal or di"sability when less than seven calendar
days remain in the month, the employee is available to work, or
actually works, every available opportunity during that month.
f) All disabled employees have provided satisfactory proof of
disability_ Unless specified otherwise, disabled employees are
continuously disabled and have retained their employment
relationship.
g) In cases where a disabled employee received vacation pay after
becoming disabled, the vacation pay was received in the same
year as the disability began.
5
Examples
1. New Hire
a. Employee hires out January 27 and works all the remaining days in
January - coverage begins February 1, and cost-sharing and carrier
contributions are required for February because the employee was
treated as if he/she rendered the Requisite Amount of Compensated
Service in January pursuant to the "Opportunity Rule." See General
Principle 5.
b. Employee hires out January 3 and works at least seven days in January
- coverage begins February 1. Cost-sharing and carrier contributions
are required for February as the employee rendered the Requisite
Amount of Compensated Service in January.
2. Furloughed Employee
a. Employee is furloughed January 15 after working seven days in January
and remains furloughed through May - has coverage through May.
Cost-sharing and carrier contributions are required for February as the
employee rendered the Requisite Amount of Compensated Service in
January. No cost-sharing and carrier contributions are required for
March-May.
b. Employee is furloughed January 5 after working three days in January
and remains furloughed through May - has coverage through May. No
6
cost-sharing and carrier contributions are required for February, since in
January employee did not render the Requisite Amount of Compensated
Service or receive the Requisite Amount of Vacation Payor a
combination of both. See General Principle 8. No cost-sharing and
carrier contributions are required for March-May.
c. (i) Employee is furloughed January 15 after working seven days in
January - would (if he/she remained furloughed) have coverage through
May. However, employee returns to work on March 29 (prior to end of
4th month) and works all available work opportunities through the end of
the month. Cost-sharing and carrier contributions are required for
February as the employee rendered the Requisite Amount of
Compensated Service in January. Employee will have coverage in
March as a result of the furlough until his/her furlough ends and, since
he/she rendered compensated service by working in March, for the rest
of that month. The employee will also have coverage in April pursuant to
the "Opportunity Rule. 1T See General Principle 5 and Assumption e.
(ii) In Example (i) above, no cost-sharing or carrier contributions are
required for March as employee did not render the Requisite Amount of
Compensated Service or receive the Requisite Amount of Vacation Pay
or a combination of both in February. The employee will have coverage
in April, and carrier and employee cost-sharing contributions are required
for April, because the employee was treated as if he/she rendered the
7
Requisite Amount of Compensated Service in March pursuant to the
"Opportunity Rule. n See General Principle 5 and Assumption e.
d. (i) Employee is furloughed January 5 after working three days in
January - would (if he/she remained furloughed) have coverage through
May. However, employee returns to work on March 29 (prior to end of
4th month) and works all available work opportunities through the end of
the month. The employee will have coverage in April, and carrier and
employee cost-sharing contributions are required for April, because the
employee was treated as if he/she rendered the Requisite Amount of
Compensated Service pursuant to the "Opportunity Rule. n See General
Principle 5 and Assumption e.
e.
(ii) In Example (i) above, cost-sharing and carrier contributions are
not required for February or March as employee did not render the
Requisite Amount of Compensated Service or receive the Requisite
Amount of Vacation Payor a combination of both in January or February,
respectively.
(i) Employee is furloughed January 15 after working seven days in
January and, because he/she remains furloughed through May, has
coverage through that month. The employee returns to work June 15
(after end of 4th month) and renders the Requisite Amount of
Compensated Service in June. Coverage will begin again July 1. The
employee will not have coverage in June.
8
f.
(ii) In Example (i) above, cost-sharing and carrier contributions are
required for February as employee rendered the Requisite Amount of
Compensated Service in January. No cost-sharing and carrier
contributions are required for March-June.
(iii) In Example (i) above, cost-sharing and carrier contributions are
required for July as the employee rendered the Requisite Amount of
Compensated Service in June.
(i) Employee is furloughed January 15 after working seven days in
January and, because he/she remains furloughed through May, has
coverage through that month. The employee returns to work June 28
(after end of 4th month) and works all available work opportunities
through the end of the month. Coverage for the employee will begin July
1 because he/she was treated as if he/she rendered the Requisite
Amount of Compensated Service in June pursuant to the "Opportunity
Rule." See General Principles 5 & 8 and Assumption e. The employee
will not have coverage in June.
(ii) In Example (i) above, cost-sharing and carrier contributions are
required for February as the employee rendered the Requisite Amount of
Compensated Service in January. No cost-sharing and carrier
contributions are required for March-June.
(iii) In Example (i) above, cost-sharing and carrier contributions are
required for July because the employee was treated as if he/she
9
rendered the Requisite Amount of Compensated Service in June
pursuant to the "Opportunity Rule." See General Principles 5 & 8 and
Assumption e.
g. (i) If during any period of furlough an employee renders at least one
day of compensated service, the furlough period will be extended four (4)
months from the month in which the employee rendered such
compensated service. For example, an employee last works January 15
after working seven days in January, coverage would (if he/she remains
furloughed) continue through May. However, the employee returns to
work in March and renders one day of compensated service and is again
furloughed and remains furloughed through July, coverage would
continue through July.
(ii) In Example (i) above, cost-sharing and carrier contributions are
required for February as the employee rendered the Requisite Amount of
Compensated Service in January. No cost-sharing and carrier
contributions are required for March-July. See General Principles 5 & 8.
h. (i) Employee works seven days in January and receives one day of
vacation pay in February. Employee is then furloughed later in February
and remains furloughed. The employee would have coverage through
June.
10
i.
(ii) In Example (i) above, cost-sharing and carrier contributions are
required for February as the employee rendered the Requisite Amount of
Compensated Service in January.
(iii) In Example (i) above, no cost-sharing and carrier contributions are
required for March-June. See General Principles 5 & 8.
(i) Employee is furloughed December 24 after working 20 days in
December and remains furloughed. The employee would have coverage
through April. In January the employee is paid for the January 1 holiday.
The receipt of holiday pay in January does not count as compensated
service and therefore, does not extend coverage. The employee's
coverage would still terminate in April. See General Principles 5 & 8.
(ii) In Example (i) above, cost-sharing and carrier contributions are
required for January as the employee rendered the Requisite Amount of
Compensated Service in December. Cost-sharing and carrier
contributions are not required for February. See General Principles 5 &
8.
3. Suspended Employee
a. Employee is suspended January 15 after working seven days in January
and remains suspended through May - has coverage through May.
Cost-sharing and carrier contributions are required for February as the
employee rendered the Requisite Amount of Compensated Service in
11
January. No cost-sharing and carrier contributions are required for
March-May.
b. Employee is suspended January 5 after working three days in January
and remains suspended through May - has coverage through May. No
cost-sharing and carrier contributions are required for February, since in
January employee did not render the Requisite Amount of Compensated
Service or receive the Requisite Amount of Vacation Payor a
combination of both. See General Principles 5 & 8. No cost-sharing and
carrier contributions are required for March-May.
c. (i) Employee is suspended January 15 after working seven days in
January - would (if he/she remained suspended) have coverage through
May. However, employee returns to work on March 29 (prior to end of
4th month) and works all available work opportunities through the end of
the month. The employee will have coverage in March until his/her
suspension ends and, since he/she rendered compensated service by
working in March, for the rest of that month.
(ii) In Example (i) above, cost-sharing and carrier contributions are
required for February as employee rendered the Requisite Amount of
Compensated Service in January. No cost-sharing and carrier
contributions are required for March as no days were worked in
February.
12
d.
Carrier and employee cost-sharing contributions are required for April
because the employee was treated as if he/she rendered the Requisite
Amount of Compensated Service in March pursuant to the "Opportunity
Rule." See General Principles 5 & 8 and Assumption e.
(i) Employee is suspended January 5 after working three days in
January - would (if he/she remained suspended) have coverage through
May. However, the employee returns to work on March 15 (prior to end
of 4th month) and works at least seven days in March. The employee will
have coverage in March until his/her suspension ends and, since he/she
rendered compensated service by working in March, for the rest of that
month.
(ii) In Example (i) above, cost-sharing and carrier contributions are
not required for February as in January employee did not render the
Requisite Amount of Compensated Service or receive the Requisite
Amount of Vacation Payor a combination of both. No cost-sharing or
carrier contributions are required for March as no days were worked in
February. Cost-sharing and carrier contributions are required for April as
seven days were worked in March. See General Principles 5 & 8.
e. (i) Employee is suspended January 15 after working seven days in
January - would (if he/she remained suspended) have coverage through
May. However, the employee returns to work June 28 (after end of 4th
month) and works all available work opportunities through the end of the
13
f.
month. The employee will have coverage again beginning July 1
because he/she was treated as if he/she rendered the Requisite Amount
of Compensated Service in June pursuant to the "Opportunity Rule."
See General Principles 5 & 8 and Assumption e. The employee will not
have coverage in June.
(ii) In Example (i) above, cost-sharing and carrier contributions are
required for February as the employee rendered the Requisite Amount of
Compensated Service in January. No cost-sharing and carrier
contributions are required for March-June.
(iii) In Example (i) above, cost-sharing and carrier contributions are
required for July because the employee was treated as if he/she
rendered the Requisite Amount of Compensated Service in June
pursuant to the "Opportunity Rule." See General Principles 5 & 8 and
Assumption e.
(i) Employee is suspended on January 15 - would (if he/she remains
suspended) have coverage through May. Employee receives two days
of vacation in April and remains suspended. The receipt of such
vacation pay extends coverage through August.
(ii) In Example (I) above, cost-sharing and carrier contributions are
required for February if in January the employee rendered the Requisite
Amount of Compensated Service or received the Requisite Amount of
Vacation Pay, or a combination of both. If in January the employee did
14
not render the Requisite Amount of Compensated Service or receive the
Requisite Amount of Vacation Pay, or a combination of both, no cost
sharing and carrier contributions are required for February. See General
Principles 5 & 8.
(iii) In Example (i) above, the receipt of any vacation in April triggers
an extension of benefits through August. No cost-sharing or carrier
contributions are required for May because two days of vacation does
not constitute the Requisite Amount of Vacation Pay. See General
Principles 5 & 8.
g. If an employee is awarded full back pay for all time lost as a result of
suspension, coverage will be provided as if he/she had not been
suspended. All cost-sharing and carrier contributions would then be
required for retroactive months on the same basis as would have been
required of an active employee.
4. Dismissed Employee
a. Employee is dismissed January 15 after working seven days in January
- would (if he/she remains dismissed) have coverage through May.
Cost-sharing and carrier contributions are required for February as the
employee rendered the Requisite Amount of Compensated Service in
January. No cost-sharing and carrier contributions are required for
March-May.
15
b. Employee is dismissed January 5 after working three days in January -
would (if he/she remains dismissed) have coverage through May. No
cost-sharing and carrier contribution are required for February, since in
January, employee did not render the Requisite Amount of Compensated
Service or receive the Requisite Amount of Vacation Payor a
combination of both. See General Principles 5 & 8. No cost-sharing and
carrier contributions are required for March-May.
c. (i) Employee is dismissed January 15 after working seven days in
January - would (if he/she remained dismissed) have coverage through
May. However, the employee returns to work on March 29 (prior to end
of 4th month) and works all available work opportunities through the end
of the month. The employee will have coverage in March until his/her
dismissal ends and, since he/she rendered compensated service by
working in March, for the rest of that month.
(ii) In Example (i) above, cost-sharing and carrier contributions are
required for February as seven days worked in January. No cost-sharing
and carrier contributions are required for March as no days were worked
in February. Cost-sharing and carrier contributions are required for April
because the employee was treated as if he/she rendered the Requisite
Amount of Compensated Service in March pursuant to the "Opportunity
Rule." See General Principles 5 & 8 and Assumption e.
16
d. (i) Employee is dismissed January 5 after working three days in
January - would (if he/she remained dismissed) have coverage through
May. However, the employee returns to work on March 15 (prior to end
of 4th month) and works at least seven days in March. The employee will
have coverage in March until his/her dismissal ends and, since he/she
rendered compensated service by working in March, for the rest of that
month.
(ii) In Example (i) above, no cost-sharing and carrier contributions are
required for February or March, since the employee did not render the
Requisite Amount of Compensated Service or receive the Requisite
Amount of Vacation Payor a combination of both, in January or
February. Cost-sharing and carrier contributions are required for April as
employee rendered the Requisite Amount of Compensated Service in
March. See General Principles 5 & 8.
e. (i) Employee is dismissed January 15 after working seven days in
January - would (if he/she remained dismissed) have coverage through
May. However, the employee returns to work June 28 (after end of 4th
month) and works all available work opportunities through the end of the
month. Coverage for the employee will begin July 1 because he/she was
treated as if he/she rendered the Requisite Amount of Compensated
Service in June pursuant to the "Opportunity Rule." See General
Principles 5 & 8 and Assumption e. The employee will not have coverage
in June.
17
(ii) In Example (i) above, cost-sharing and carrier contributions are
required for February as the employee rendered the Requisite Amount of
Compensated Service in January. No cost-sharing and carrier
contribution are required for March-June.
(iii) In Example (i) above, cost-sharing and carrier contributions are
required for July because the employee was treated as if he/she
rendered the Requisite Amount of Compensated Service in June
pursuant to the "Opportunity Rule." See General Principles 5 & 8 and
Assumption e.
f. (i) Employee works seven days in January, receives one day of
vacation on February 1 and is then dismissed on February 2 - would (if
he/she remains dismissed) have coverage through June.
(ii) In Example (i) above, cost-sharing and carrier contributions are
required for February as employee rendered the Requisite Amount of
Compensated Service in January.
(iii) In Example (i) above, no cost-sharing and carrier contributions are
required for March as the employee did not render the Requisite Amount
of Compensated Service or receive the Requisite Amount of Vacation
Payor a combination of both in February. No cost-sharing or carrier
contributions are required for April-June. See General Principles 5 & 8.
18
g. (i) Employee is dismissed on January 15 after working seven days in
January - would (if he/she remains dismissed) have coverage through
May. Employee, while covered under the Plan as a dismissed
employee r receives two weeks of vacation pay in March.
(ii) In Example (i) above, cost-sharing and carrier contributions are
required for February as the employee rendered the Requisite Amount of
Compensated Service in January. See General Principles 5 & 8.
(iii) In Example (i) above, vacation paid after the dismissal date is not
considered vacation pay for purposes of determining Plan coverage or
required employee cost-sharing and carrier contributions and, therefore,
does not extend the period of coverage beyond Mayor trigger a cost
sharing or carrier contribution for April. See General Principle 3(b).
h. If an employee is awarded full back pay for all time lost as a result of
dismissal, coverage will be provided as if he/she had not been
dismissed. All cost-sharing and carrier contributions would then be
required for retroactive months on the same basis as would have been
required of an active employee.
5. Disabled Employee
a. (i) Employee becomes disabled January 15 after working seven days
in January - would (if he/she remains continuously disabled) have
coverage for employee benefits through the end of the 2nd calendar year
19
b.
c.
following the year in which the employee last rendered compensated
service or received vacation pay.
(ii) In Example (i) above, cost-sharing and carrier contributions are
required for February as the employee rendered the Requisite Amount of
Compensated Service in January. No cost-sharing and carrier
contributions are required for the remaining months of coverage for
employee benefits by reason of disability.
(i) Employee becomes disabled January 5 after working three days
in January - would (if he/she remains continuously disabled) have
coverage for employee benefits through the end of the 2nd calendar year
following the year in which the employee last rendered compensated
service or received vacation pay.
(ii) In Example (i) above, no cost-sharing and carrier contributions are
required for February as in January the employee did not render the
Requisite Amount of Compensated Service or receive the Requisite
Amount of Vacation Pay, or a combination of both. No cost-sharing and
carrier contributions are required for the remaining months of coverage
for employee benefits by reason of disability.
(i) Employee becomes disabled January 15 after working seven days
in January - would (if he/she remains continuously disabled) have
coverage for employee benefits through the end of the 2nd calendar year
following the year in which the employee last rendered compensated
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d.
service or received vacation pay. Cost-sharing and carrier contributions
are required for February.
(ii) In Example (i) above, however, employee returns to work before
the end of the 2nd calendar year. Coverage by reason of disability will
continue until the end of the month in which the employee's disability
ends. Coverage as a returning employee will begin on the first day of the
next month, and cost-sharing and carrier contributions will be required for
that month, if the employee rendered the Requisite Amount of
Compensated Service, or the "Opportunity Rule" applied, in the month in
which he/she returned to work. See General Principles 5 & 8 and
Assumption e. No cost-sharing or carrier contribution is required for the
month in which the employee returns to work since he/she did not render
the Requisite Amount of Compensated Service or receive the Requisite
Amount of Vacation Pay, or a combination of both, in the prior month.
For example, employee returns and works seven days in June - he/she
has coverage in July. No carrier or cost-sharing contributions are
required for June as no days were worked in May, but carrier and cost
sharing contributions are required for July since the employee rendered
the Requisite Amount of Compensated Service in June. See General
Principal 5.
(i) Employee becomes disabled January 5 after working three days
in January - would (if he/she remains continuously disabled) have
coverage for employee benefits through the end of the 2nd calendar year
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e.
following the year in which the employee last rendered compensated
service or received vacation pay. Cost-sharing and carrier contributions
are not required for February as in January the employee did not render
the Requisite Amount of Compensated Service or receive the Requisite
Amount of Vacation Pay, or a combination of both. See General
Principles 5 & 8.
(ii) In Example (i) above, however, employee returns to work before
the end of the 2nd calendar year. Coverage by reason of disability will
continue until the end of the month in which the employee's disability
ends. Coverage as a returning employee will begin on the first day of the
next month, and carrier and cost-sharing contribution will be required for
that month, if the employee rendered the Requisite Amount of
Compensated Service, or the "Opportunity Rule" applied, in the month in
which he/she returned to work. For example, employee returns on
June 29, coverage begins July 1, no cost-sharing or carrier contribution
is required for June as no days worked in May but cost-sharing and
carrier contributions are required for July because the employee was
treated as if he/she rendered the Requested Amount of Compensated
Service in June pursuant to the "Opportunity Rule." See General
Principles 5 & 8 and Assumption e.
(i) Employee becomes disabled January 5 after working three days
in January - would (if he/she remains continuously disabled) have
coverage for employee benefits through the end of the 2nd calendar year
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following the year in which the employee last rendered compensated
service or received vacation pay. Employee receives one day of
vacation in immediately subsequent year.
Oi) In Example 0) above, cost-sharing and carrier contributions are
not required for February as in January the employee did not render the
Requisite Amount of Compensated Service or receive the Requisite
Amount of Vacation Pay, or a combination of both. No cost-sharing or
carrier contributions are required for remaining period of coverage for
employee benefits by reason of disability. Receipt of vacation thereafter
will not require a cost-sharing or carrier contribution but coverage will be
extended from the receipt of any vacation. Coverage will extend· through
the end of the second calendar year following the year in which the
employee received vacation pay. See General Principle 3( c) and
Assumption f.
6. Retired Employees
a. Employee retires January 5 after working three days in January,
coverage is provided until the end of February. Cost-sharing and carrier
contributions are not required for February as in January the employee
did not render the Requisite Amount of Compensated Service or receive
the Requisite Amount of Vacation Pay, or a combination of both.
b. Employee retires January 15 after working seven days in January,
coverage is provided until the end of February. Cost-sharing and carrier
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contributions are required for February as employee rendered the
Requisite Amount of Compensated Service worked in January.
7. Leave of Absence
a. Employee takes leave of absence January 5. Coverage would be
provided in January, and cost-sharing and carrier contributions would be
required for January, only if the employee rendered the Requisite
Amount of Compensated Service or received the Requisite Amount of
Vacation Pay, or a combination of both, in December. In such a case,
coverage would terminate on January 31. No coverage is provided to
the employee in February as the employee did not render the Requisite
Amount of Compensated Service or receive the Requisite Amount of
Vacation Pay, or a combination of both, in January. No cost-sharing or
carrier contributions are required for February.
b. Employee takes leave of absence January 15 after working seven days
in January. Coverage is provided until the end of the month following the
month in which the employee last rendered the Requisite Amount of
Compensated Service or received the Requisite Amount of Vacation
Payor a combination of both. Coverage is provided to the employee
through February as the employee rendered the Requisite Amount of
Compensated Service in January. Cost-sharing and carrier contributions
are required for February.
8. Family or Medical Leave (FMLA)
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Any day of FMLA leave taken in a month immediately preceding a month during
which the employee has Plan coverage by virtue of any of the extended
coverage provisions of the Plan (usually disability where the employee takes
FMLA for his/her own disability) is not counted as a day of compensated
service. All other days of FMLA leave are counted as days of compensated
service. Accordingly, if the employee has rendered the Requisite Amount of
Compensated Service or received the Requisite Amount of Vacation Pay, or a
combination of both, during June (including days of FMLA leave where the
employee does not have coverage in July under any of the Plan's extended
coverage provisions), carrier and employee cost-sharing contributions would be
required, and the employee would be covered, in July. If the employee has
coverage in July by reason of a Plan extended coverage provision, (e.g.,
disability), FMLA leave in June is not counted as compensated service. Thus,
unless the employee has rendered the Requisite Amount of Compensated
Service (not including his/her FMLA leave) or received the Requisite Amount of
Vacation Pay, or a combination of both, in June, no cost-sharing or carrier
contributions are required in July.
g. Death of Employee
Cost-sharing and carrier contributions are not required in the month following
the employee's death unless the employee rendered the Requisite Amount of
Compensated Service or received the Requisite Amount of Vacation Pay, or a
combination of both, in the month in which he/she died.
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10. Dismissed or Retired Employee
In cases of dismissal or retirement where there's an insufficient amount in the
employee's next paycheck to pay any cost-sharing contribution then due from
the employee, the excess of the unpaid employee contribution over the amount
of the employee's pay available to satisfy his/her contribution obligation will be
deemed in arrears and deducted from compensation of any sort subsequently
payable to the employee. No other efforts are made to collect the unpaid
employee contribution.
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