Explanation
This ordinance amends the Management Compensation Plan by updating Section 5, Classifications and Assigned Rates of Pay, as a result of Civil Service Commission action by assigning or adjusting pay grades assigned to new or existing classifications. Additionally, there are proposed amendments to several sections of the MCP.
Emergency action is proposed in order to immediately effect the Civil Service Commission's actions and to ensure proper levels of compensation.
There is no immediate fiscal impact.
Title
To amend the Management Compensation Plan, Ordinance No. 2944-99, as amended, by enacting various sections within Section 5(E); and by amending certain sections within Sections 4, 5, 6, 7, 10, 12, 14, 15 and 16; and to declare an emergency.
Body
WHEREAS, the Civil Service Commission created and amended or abolished several classifications; and
WHEREAS, it is necessary to assign pay grades to the newly created classifications and adjust pay grades where appropriate; and
WHEREAS, it is necessary to amend various sections within the Management Compensation Plan to reflect current operations; and
WHEREAS, it is necessary to amend various other sections within the Management Compensation Plan; and
WHEREAS, it is immediately necessary to amend the Management Compensation Plan thereby preserving the public health, peace, property, safety and welfare; Now, Therefore,
BE IT ORDAINED BY THE COUNCIL OF THE CITY OF COLUMBUS:
SECTION 1. That Section 4 of Ordinance No. 2944-99 is amended as shown in Attachment A attached hereto.
SECTION 2. That existing Section 5(C) of Ordinance No. 2944-99, as amended, be amended as follows:
(C) Part-time, Seasonal, Emergency and Confidential Classifications. Any part-time (averaging less than twenty hours' work per week), emergency, seasonal, or confidential employees in classifications listed in Appendix A of the collective bargaining contract between the City of Columbus and American Federal of State, County and Municipal Employees, Local 1632, and Local 2191, April 1, 2002 - March 31, 2005, will be covered by this Management Compensation Plan. Further, the classifications listed in Appendix A may be used for employees who do not meet the definition of a public employee pursuant to Section 4117.01 of the Ohio Revised Code, or who are (1) employees of the Human Resources Department; (2) employees of the Civil Service Commission; (3) confidential secretaries of the Appointing Authorities; (4) employees working less than 1040 hours per calendar year; or (5) employees in temporary/emergency status as defined by the Civil Service Commission.
SECTION 3. That Sections 5(E)-D129, 5(E)-P078 and 5(E)-P080 of Ordinance No. 2944-99, as amended, be enacted to read as follows:
Ord. Class
Sec. Code Class Title Grade
5(E)-
D129 0109 Deputy Chief of Staff (U) 98
5(E)-
P078 3780 Parks Management Coordinator 94
5(E)-
P080 1204 Parks Planning Coordinator 93
SECTION 4. That Sections 5(E)-A070 and 5(E)-P339 of Ordinance No. 2944-99, as amended, be amended to read as follows:
Ord. Class
Sec. Code Class Title Grade
5(D)-
M038 0780 Management Analyst II* 91
5(E)-
P339 1792 Property Maintenance Inspection Manager 92
SECTION 5. That existing Section 6 of Ordinance No. 2944-99, as amended, be amended to read as follows:
SECTION 6. ADMINISTRATION OF PAY PLAN.
(A) Salary Determination. Salaries shall be set within the assigned pay grade, within the discretion of the Appointing Authority, considering the skills, experience and other qualifications of an employee. Guidelines for administration of these pay grades will be developed by the Director of Human Resources. Subject to City Council appropriation, the Finance Director will determine and establish available monies for performance increases for overtime-eligible and overtime-exempt employees.
(B) Pay Rates Established. Employees whose classes are assigned a variable hourly rate shall be paid at the minimum hourly or bi-weekly salary rate established for that grade, pay range or at an hourly or bi-weekly salary rate authorized, as provided in the MCP policy and in Subsection (C) and (D) below.
(C ) Step X. Step X is a compensation mechanism used to accommodate a specific set of circumstances in which an employee's pay rate may exceed pay grade maximum. The Director of Human Resources must approve an employee's pay rate moving to Step X. Use of Step X is limited to the following situations:
(1) A pay grade assignment is changed as the result of market analysis by the Department of Human Resources, and current pay rates exceed the new pay grade maximum.
(2) Positions reclassified by Civil Service Commission action that result in the incumbent(s)' current pay rate(s) exceeding the new pay grade maximum.
(3) An employee who moves into MCP as a result of the position being determined to be exempt from bargaining, and whose pay rate exceeds the new pay grade maximum in MCP.
(4) Employees whose pay rates were higher than their new pay range maximum at the time of the 2001 new pay structure implementation.
Employees whose hourly rate exceeds the maximum in grade (Step X) and those employees who are paid at the maximum of a grade may, at the discretion of the Appointing Authority, receive a lump sum payment in lieu of a pay rate increase. The lump sum payment may not exceed the maximum percentage increase to which other eligible employees in the same classification would be entitled.
(D) Pay Rates in Range 30 and Above and Variable Hourly Rates.
(1) Performance Increases. All increases in pay shall be made only with the approval of the Appointing Authority and shall be on the basis of performance. If an overtime-eligible employee has reached the highest hourly wage rate in the highest pay range assigned to his/her classification, the Appointing Authority may, if the employee is otherwise deserving of a performance increase, give a bonus in the amount of up to $500 (not a salary increase), less taxes and deductions, to the employee. This bonus shall be payable no more than once a year. Employees will not be eligible for this bonus if they have received an across-the-board increase for the year.
(2) Appointing Authority Discretion. Notwithstanding any other provisions of Section 6(A) through (F) of this Management Compensation Plan, the salaries paid to employees may be at any rate within the pay assigned to the pay range or variable hourly rates for each position as determined by the Appointing Authority. Subsequent changes in pay may be made to any rate within the pay range or variable hourly rates for these positions and shall be effective at the beginning of the next pay period following submission of a personnel transaction form by the Appointing Authority to the Civil Service Commission.
(E) Additional City Employment.
(1) Any employee who simultaneously works in or occupies more than one position is not entitled to and shall not receive compensation, nor any other benefits or privileges allowed for employees by the City, for more than one position, unless otherwise provided herein.
(2) Any employee who seeks or obtains additional City employment beyond his/her present appointment, shall first obtain, in writing, the approval of the Appointing Authority of his/her present position. Such written approval must be filed with the employee's personnel file. Failure to obtain written permission shall subject the employee to possible disciplinary action. In such cases where total City employment exceeds forty (40) hours in a workweek, the overtime provisions of Section 8 of this Ordinance shall apply.
(3) Upon approval of additional employment with the City, the Appointing Authority for an employee's present position shall, at that time, determine in writing whether the employee shall be entitled and shall receive additional vacation and sick leave benefits pursuant to the provisions of this Ordinance. In no event shall the employee receive injury leave or insurance coverage beyond that provided for an employee occupying only one position.
(F) Additional Compensation Benefits. Except as provided in Section 7(C) of this Management Compensation Plan, no employee shall receive, and the City Treasurer shall not draw any checks, or any additional compensation in any form, sick and injury leave, vacation, insurance coverage and any and all other benefits and privileges, for any employee who substitutes or acts for another in the position of another, other than the position to which he or she was appointed pursuant to the Ohio Constitution, City Charter provisions, and the Rules and Regulations of the Civil Service Commission. No Appointing Authority shall appoint any person or submit any personnel action form contrary to said constitution, charter and rules and regulations and the provisions of this Ordinance.
(G) Payroll Deductions. Payroll deductions shall be governed first by the ability of the City Auditor's payroll system to handle them, and secondly, upon a determination by City Officials of the type of payroll deductions which are to be offered to employees and also based upon which ones will benefit the largest number of employees. Deductions or withholdings, except where demanded or required by law, must be agreed to in writing by the employee with the specific reason stated in writing and filed with the Appointing Authority.
(H) City Council Authorization Required. Neither the Civil Service Commission nor the City Auditor shall approve and/or pay any pay rate based on the assignment of any class to a pay range/grade not specifically authorized by City Council, except as provided in Section 7(C).
(I) Salaried Employees. Employees permanently assigned to full-time job classifications listed in Section 5(E) (operational) are paid on a bi-weekly salary basis. Salaried employees are paid a bi-weekly salary based on a minimum of two forty (40) hour workweeks. Pursuant to principles of public accountability, those salaried employees covered by leave programs (i.e., sick, vacation, and personal), who absent themselves from the workplace for personal reasons, sickness, or accident, and who have exhausted their leave, will have their salary reduced accordingly. [29 CFR 541.5(d)]
Additional detail regarding deductions is as follows:
(1) Deductions from a salaried employee's salary may be made for any
workweek in which the salaried employee performs no work.
(2) Disciplinary suspensions must be of no less than five (5) work days except in the case of infractions of safety rules of major significance. Safety rules of major significance include only those relating to the prevention of serious danger to property or other employees.
(3) Deductions made from a salaried employee's salary for absences will be made on a proportionate basis from the employee's bi-weekly salary for the time the employee is absent.
SECTION 6. That existing Sections 7(E), (F), and (H) of Ordinance No. 2944-99, as amended, be amended to read as follows:
(E) Tuition Reimbursement. All full-time employees with one (1) or more years of continuous active service shall be eligible for reimbursement of instructional fees and associated fees of up to two thousand two hundred dollars ($2200) per calendar year for undergraduate studies or up to two thousand eight hundred dollars ($2800) per calendar year for graduate studies voluntarily undertaken by them. The tuition reimbursement program shall be subject to the following conditions:
(1) No employee on an unpaid leave of absence, unauthorized leave of absence, disability leave, injury leave or workers' compensation may apply for tuition reimbursement.
(2) All courses must be taken at times other than scheduled working hours. All scheduled hours for courses of instruction must be filed with the Appointing Authority or designee and with the Department of Human Resources. There must be a correlation between the employee's duties and responsibilities and the courses taken or the degree program pursued. All scheduled times of courses must be approved by the Appointing Authority or designee. Any situation which, in the discretion of the Appointing Authority or designee, would require an employee's presence on the job shall take complete and final precedence over any time scheduled for courses.
(3) Institutions must be located or courses of instruction given within Franklin County or adjoining counties. Courses must be taken at accredited colleges, universities, technical and business institutes or at their established extension centers. Courses taken via the Internet may be approved by the Human Resources Department provided the institution meets criteria similar to that for residential education programs. Correspondence courses, seminars, conferences and workshops are not included.
(4) The Department of Human Resources shall determine the approved institutions for which reimbursement for instructional fees and associated fees (general and laboratory) may be made under this Section. Only those institutions approved by the Department of Human Resources shall establish eligibility of the employee to receive reimbursement. Additional institutions may be added by forwarding an application for reimbursement to the Department of Human Resources. Application for approval of institutions and courses must be made to Human Resources not more than thirty (30) days or less than ten (10) days prior to the first day of the scheduled course(s).
(5) Any financial assistance from any governmental or private agency available to an employee, whether or not applied for and regardless of when such assistance may have been received, shall be deducted in the entire amount from the full tuition reimbursement the employee is eligible for under this Section. If an employee's tuition is fully covered by another governmental or private agency, then the employee is not entitled to payment from the City.
(6) Reimbursement for instructional fees and associated general and laboratory fees will be made when the employee satisfactorily completes a course and presents an official certificate or its equivalent and an original receipt of payment or unpaid bill from the institution confirming completion of the approved course.
(7) No reimbursement will be granted for books, paper, supplies of whatever nature, transportation, meals, or any other expense connected with any course except the cost of instructional fees and associated fees.
(8) Any employee participating in the tuition reimbursement program who resigns or retires or is discharged for cause must repay the tuition reimbursement paid by the City for undergraduate courses taken less than two years prior to the date of termination or discharge and for graduate courses taken less than three years prior to the date of termination or discharge. If necessary, this amount will be deducted from the employee's terminal leave pay or final paycheck. Employees who are separated from the City involuntarily, e.g., laid off, or through no fault of their own, during the time periods set forth above will not be required to reimburse the City.
(9) The administration of the tuition reimbursement program will require the Director of Human Resources or designee to be responsible for establishing rules, devising forms and keeping records for the program.
(F) Pre-Tax Dependent Care Program. In accordance with Section 129 of the Internal Revenue Code, the City established a pre-tax dependent care program whereby employees may set aside, on a pre-tax basis, the amount of money needed to pay for dependent (IRS defined) care. Said Program will be administered by the Department of Human Resources.
(H) Adoption Assistance. The City established an Adoption Assistance Program (September 1, 1994) whereby employees in full-time, non-seasonal classifications with at least one (1) year of continuous City service, may be eligible for adoption assistance up to $2,500 per adopted child. Adoption of a "special needs" child may provide for assistance up to $3,500. A "special needs" child is defined as a child qualified with special needs as described by each state agency under Title IV-E Program.
Assistance will be on a reimbursement basis for specific adoption-related expenses. The following items will be considered for reimbursement:
Licensed adoption agency fees (including fees for placement and parental counseling).
State-required "pre-placement home study" and "post placement supervision" program.
Charges for temporary foster care before placement. The foster care must be provided by an approved or licensed agency and will be limited to thirty (30) days.
Charges for domestic transportation to obtain physical custody of the adoptive child. Transportation charges must be reasonable and be for both the adoptive parents and the adoptive child.
Financial assistance payments will be made after the adoption is finalized. A written request for reimbursement must be submitted to the Director of Human Resources along with the itemized bills. Written requests must be made within ninety (90) days after adoption is finalized. Final assistance payments will be made directly to the employee. The Department of Human Resources may request additional documentation regarding itemized bills.
SECTION 7. That existing Section 10(A) of Ordinance No. 2944-99, as amended, be amended by deleting paragraph 4.
SECTION 8. That existing Section 12(H) of Ordinance No. 2944-99, as amended, be amended as follows:
(H) Vacation Leave for Certain City Officials. Effective with the passage of this Ordinance and notwithstanding the other provisions of Section 12, Department Directors, employees classified as Executive Assistant to the Mayor (U), Deputy Chief of Staff (U), Senior Executive Assistant (U), Department Assistant Director (U), Community Relations Commission Executive Director (U), Equal Business Opportunity Commission Executive Director (U), Department Deputy Director (U), and Deputy Director (Chief Negotiator) (U), may be granted vacation leave with pay at the discretion of the Mayor but may not accumulate any vacation leave during the term of employment in one or more of these positions. The City Clerk (U), Executive Assistant to the City Council President (U), and the City Treasurer (U) may be granted vacation leave with pay at the discretion of the President of the City Council but may not accumulate vacation leave during the term of employment in one or more of these positions. The Civil Service Commission Executive Director (U) may be granted vacation leave with pay at the discretion of the Civil Service Commission but may not accumulate vacation leave during the term of employment in this position. Excepting and providing that in the event Department Directors, employees classified as Executive Assistant to the Mayor (U), Senior Executive Assistant (U), Department Assistant Director (U), Community Relations Commission Executive Director (U), Equal Business Opportunity Commission Executive Director (U), Department Deputy Director (U), and Deputy Director (Chief Negotiator) (U), die while in office, vacation leave may, at the discretion of the Mayor, be accrued pursuant to the provisions of this Ordinance and payable upon death, and further excepting and providing that in the event that the City Clerk (U), Executive Assistant to the City Council President (U), or City Treasurer (U) dies while in office, vacation leave may, at the discretion of the President of City Council, be accrued pursuant to the provisions of this Ordinance and payable upon death. Also, further excepting and providing that in the event that the Civil Service Executive Director (U) dies while in office, vacation leave may, at the discretion of the Civil Service Commission, be accrued pursuant to the provisions of this Ordinance and payable upon death.
SECTION 9. That existing Sections 14(C) and (T) of Ordinance No. 2944-99, as amended, be amended as follows:
(C) Sick Leave Reciprocity.
(1) During January 2000 and each subsequent year, each employee shall be paid, at his/her regular straight-time hourly rate in effect on December 31 of the preceding year, for any unused sick leave hours awarded during the preceding calendar year, up to a maximum of 72 hours, on a one-for-one basis, or at the employee's option, may carry over any unused sick leave hours to the next year. No interest is planned or to be paid by the City on this account.
Any disallowal of sick leave credit by the Appointing Authority as provided for in Subsection (A), and any hours paid on the pre-1985 sick leave bank (old bank), disability or injury leave will be considered as hours of sick leave taken during the year for the purpose of computing paid sick leave hours available to an employee under the reciprocity plan.
(2) During January of each year, each employee shall be paid, at his/her regular straight-time hourly rate in effect on December 31 of the previous year, for any unused sick leave hours awarded during the preceding calendar year, up to a maximum of seventy-two (72) hours, on a one-for-one basis, or at the employee's option, may carry over any unused sick leave hours to the next year. No interest is planned or to be paid by the City on this account.
(3) Effect on Unused Sick Leave. The number of reciprocity hours paid each employee will be subtracted from the total accrued unused sick leave. The remainder of the unused sick leave will be carried forward each year as the current sick leave account.
(4) An employee who is eligible to participate in the provisions of this Subsection (C) is limited to and must elect only one of the following options:
(a) Not to participate in any of the provisions.
(b) To participate solely in the provisions of Paragraphs (1), (2), and (3) of this Subsection (C).
(T) Sick Leave for Certain City Officials. Effective upon passage of this Ordinance and notwithstanding the other provisions of this section, Department Directors, employees classified as Executive Assistant to the Mayor (U), Deputy Chief of Staff (U), Senior Executive Assistant (U), Department Assistant Director (U), Community Relations Commission Executive Director (U), Equal Business Opportunity Commission Executive Director (U), Department Deputy Director (U), and Deputy Director (Chief Negotiator) (U), may be granted sick leave with pay at the discretion of the Mayor but may not accumulate any sick leave during the term of employment in one or more of these positions. The City Clerk (U), Executive Assistant to the City Council President (U), and the City Treasurer (U) may be granted sick leave with pay at the discretion of the President of the City Council but may not accumulate sick leave during the term of employment in one or more of these positions or be paid for any sick leave not taken during the term of employment in one or more of these positions. The Civil Service Commission Executive Director (U) may be granted sick leave with pay at the discretion of the Civil Service Commission but may not accumulate sick leave during the term of employment in this position or be paid for any sick leave not taken during the term of employment in this position. Excepting and providing that in the event a Department Director, employees classified as Executive Assistant to the Mayor (U), Senior Executive Assistant (U), Department Assistant Director (U), Community Relations Commission Executive Director (U), Equal Business Opportunity Commission Executive Director (U), Department Deputy Director (U), and Deputy Director (Chief Negotiator) (U), dies while in office, sick leave may, at the discretion of the Mayor, be accrued pursuant to the provisions of this Ordinance and payable upon death, and further excepting and providing that in the event the City Clerk (U), Executive Assistant to the City Council President (U), or City Treasurer (U) dies while in office, sick leave may, at the discretion of the President of City Council, be accrued pursuant to the provisions of this Ordinance and payable upon death. Also, further excepting and providing that in the event the Civil Service Commission Executive Director (U) dies while in office, sick leave may, at the discretion of the Civil Service Commission be accrued pursuant to the provisions of this Ordinance and payable upon death.
SECTION 10. That existing Section 15(A) of Ordinance No. 2944-99, as amended, be amended as follows:
(A) Disability Program Eligibility. The City will provide, at no cost to employees, a disability program covering full-time employees for non-work related illnesses and injuries. Employees must complete one (1) year of continuous City service before qualifying for disability; such benefits will become available at the first of the month following completion of one (1) year of continuous service. This program shall provide for payment to the employee from the twelfth (12th) day of accident or illness for employees in classifications listed in Sections 5(C), (D) and (E) of this ordinance, for a maximum of twenty-six (26) weeks per disability within a 365 day period, at eighty-one percent (81%) of the employee's standard gross wages after applicable federal, state and local flat tax rates and applicable Medicare charge(s) are deducted. The employee may, if he/she so desires, elect to use all, or part of, his/her accumulated but unused sick leave in order to make up any difference between one hundred percent (100%) of his/her gross wages and the amount which he/she receives under the disability program, provided that all new (current year) sick leave accruals are exhausted before an employee may use the available balance in his/her Old Sick Leave Bank. If an employee exhausts all sick leave benefits, other approved leave may be granted by the AppointingAuthority. During the period in which an employee receives such payments, he/she shall suffer no reduction in paid sick leave entitlement set forth in Section 14 of this Ordinance, as applicable. If, while receiving such payments, the employee performs work for the City or another employer, the amount of payment under the disability program, shall be reduced by the compensation which he/she receives during that time period. The proper forms must be submitted to the City no later than forty-five (45) days from the commencement of the disability.
SECTION 11. That existing Section 16(A) of Ordinance 2944-99, as amended, be amended to read as follows:
(A) Health Insurance. The City shall provide comprehensive major medical, dental, vision care, and prescription drug benefits for all full-time employees, as detailed below, for both the employee and family coverage. Such major medical, dental, vision care and prescription drug benefits will be available beginning the first of the month following the date of hire. Life insurance is effective the first of the month following the date of hire. This coverage shall also comply with all pertinent state and federal statues, including the Health Insurance Portability and Accountability Act (HIPAA) and the Newborns' andMothers' Health Protection Act of 1996. The benefits set forth in this Ordinance shall take effect within ninety (90) days of the effective date of this Ordinance, unless otherwise specified.
The following benefits are in effect and remain unchanged unless otherwise indicated:
(1) COMPREHENSIVE MAJOR MEDICAL
(A) Inpatient alcohol or drug treatment (substance abuse) limited to one confinement per calendar year, per individual, with no more than thirty-five (35) calendar days per confinement.
(B) Inpatient psychiatric treatment limited to a sixty (60) day maximum per calendar year.
(C) Effective January 1, 2003, outpatient alcohol or drug treatment (substance abuse) payments limited to a fifty percent (50%) co-payment, applied to a total of twenty-five (25) visits per calendar year per individual when provided by a non-network provider.
Effective January 1, 2003, outpatient alcohol or drug treatment (substance abuse) payments will continue to be limited to a total of twenty-five (25) visits per calendar year when provided by a network provider. An office co-pay for the visit will apply as specified in Section 16(A)(2)(D).
(D) Effective January 1, 2003, outpatient psychiatric payments limited to a sixty/forty percent (60/40%) co-pay, applied to a total of twenty-five (25) visits per calendar year when provided by a non-network provider.
Effective January 1, 2003, outpatient psychiatric payments will continue to be limited to a total of twenty-five (25) visits per calendar year when provided by a network provider. An office co-pay for the visit will apply as specified in Section 16(A)(2)(D).
(E) Weight loss schedule limited to examination charges only. Food supplement in the treatment of obesity are excluded.
(F) Services rendered by a Hospice Care program will be covered up to a maximum of sixty (60) days. Covered services include those services for which an employee is eligible during a hospital admission.
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(G) A mental ealth/substance abuse case management benefit is offered whereby an eligible participant may elect to exchange unused mental health or substance abuse inpatient days for other needed mental health or substance abuse benefits as determined medically necessary by the plan administrator. The medical necessity and exchange rate shall be determined by the plan administrator.
(2) Effective January 1, 2003, the following deductibles, coinsurance, office visit co-pays, and out-of-pocket maximums will apply. All other benefits remain the same unless otherwise noted:
(A) A two-hundred dollar ($200.00) annual deductible with an eighty/twenty percent (80/20%) coinsurance of the next fifteen hundred dollars ($1,500.00) in reasonable charges or three hundred dollars ($300.00), for a total out-of-pocket maximum of five hundred dollars ($500.00) per single contract year.
(B) A four hundred dollar ($400.00) annua family deductible with an eighty/twenty percent (80/20%) coinsurance of the next two thousand dollars ($2,000.00) of reasonable charges or four hured dollars ($400.00) for a total out-of-pocket maximum of eight hundred dollars ($800.00) per family contract year.
(C) Effective with office visits occurring on or after January 1, 2003, the plan will cover routine physicals, exams, immunizations and diagnostic tests subject to an annual maximum of one hundred fifty dollars ($150.00) per individual for covered persons age 9 and over with a three hundred dollar ($300.00) family maximum. An office visit co-pay shall apply as specified in Section 16(A)(2)(D). Stress tests are payable only if the plan administrator determines that they are medically necessary. House Bill 478 provides coverage for eligible dependents from birth to age 9.
(D) Effective with office visits occurring on or after January 1, 2003, physician office visits will be subject to a fifteen dollar ($15.00) co-pay per in-network primary care physician visit (including family, general, internal, pediatrician, and OB/GYN physicians); the fifteen dollar ($15.00) co-pay will apply to out-patient psychiatric and substance abuse doctors' office visits subject to the limits specified in Section 16(A)(1)(C) and (D). Eligible services, which shall include diagnostic, surgical and/or specialty services, routine mammograms and routine prostate/colon rectal cancer tests subject to the limits specified in Section 16(A)(2)(E) provided in the network physician's office and billed by that office shall be covered at one hundred percent (100%) after office visit co-pay.
(E) Specialty care physician office visits will be subject to a twenty-five dollar ($25.00) co-pay per in-network specialist visit. Eligible services, which shall include diagnostic, surgical and/or specialty services, routine mammograms and routine prostate/colon rectal cancer tests subject to the limits specified in Section 16(A)(2)(I) provided in the network physician's office and billed by that office shall be covered at one hundred percent (100%) after office visit co-pay.
(F) The office co-pay does not apply to the annual deductible; however, office co-pays will apply to the annual out-of-pocket maximum. Care rendered by non-network providers shall be subject to the annual deductible, co-insurance, out-of-pocket maximum, and twenty percent (20%) penalty as specified in Section 16(A)(2)(P).
(G) Temporomandibular joint pain dysfunction, syndrome or disease or any related conditions collectively referred to as "TMJ" or "TMD" will be covered on the basis of medical necessity, up to a lifetime maximum of $200.00. This limit does not apply to surgical services on the jaw hinge.
(H) For new hires and eligible dependents, a pre-existing condition clause will apply. In the event medical care or consultation is sought or received within six (6) months prior to the employee's effective date of hire the medical condition will not be payable for twelve (12) months from the effective date with the City. A new employee may reduce his/her twelve (12) month waiting period for a pre-existing condition by submitting a Certificate of Creditable Coverage from a prior health insurer, in conformity with the Health Insurance Portability and Accountability Act (HIPAA).
(I) Provide coverage for routine mammograms up to a maximum of eighty-five dollars ($85.00) according to the following frequency:
§ one baseline exam for women 35-39 years old;
§ one exam every two years for women age 40-49;
§ one exam every year for women 50 and over.
(J) Provide coverage for routine prostate/colon rectal cancer tests for men age 40-49 up to a maximum of sixty-five dollars ($65.00). For men age 50 and over, one sigmoidoscopy exam and/or PSA blood test will be covered up to a maximum of eighty-five dollars ($85.00).
(K) Cover well baby immunizations up to twenty-four (24) months of age, subject to current routine office visit provisions.
(L) Physical therapy, occupational therapy, and/or chiropractic visits will be covered up to a combined annual maximum for thirty (30) visits per person, based on medical necessity.
(M) Prescription drug deductible charges are not payable under this medical contract.
(N) The City will provide the following minimum coverage for maternity benefits: At least forty-eight (48) hours of inpatient hospital care following a normal vaginal delivery; and at least ninety-six (96) hours of inpatient hospital care following a caesarean section; and physician directed aftercare. These minimum stay requirements are not applicable if the mother and her health care provider mutually agree that the mother and her child may be discharged earlier.
(O) Well baby care from birth to age 1 including immunizations, exams, and routine diagnostic services are payable under the program up to a five hundred dollar ($500.00) maximum payment for each eligible dependent, subject to the deductible, coinsurance and reasonable charge provisions.
Well child care from age 1 up to age 9 including immunizations, exams, and routine diagnostic services are payable under the program up to a one hundred-fifty dollar ($150.00) annual maximum payment for each eligible dependent, subject to the deductible, coinsurance and reasonable charge provisions.
(P) Medical PPO
If an employee and/or dependent receives services from a preferred provider organization (PPO), reimbursements remain at the current eighty/twenty percent (80/20%) coinsurance. If the participating providers are not used, coinsurance reduces to sixty/forty percent (60/40%). The additional twenty percent (20%) coinsurance is the employee's responsibility and not subject to the out-of-pocket maximum. Any PPO network modifications will apply.
(Q) Any reference to UCR in this Ordinance or related documents shall be replaced by the words "reasonable charges".
SECTION 11. That existing Sections 4, 5(C), 5(E)-A070, 5(E)-L105, 5(E)-P339, 5(E)-T042, 5(E)-T102, 5(E)-T115, 5(G)-C110, 5(G)-C135, 5(G)-C155, 5(G)-C350, 6, 7(E), 7(F), 7(H), 10(A), 12(H), 14(C), 14(T), 15(A), and 16(A) of Ordinance No. 2944-99, as amended, are hereby repealed.
SECTION 12. That for reasons stated in the preamble hereto, which is hereby made a part hereof, this ordinance is hereby declared to be an emergency measure and shall take effect and be in full force from and after approval by the Mayor, or ten days after passage if the Mayor neither approves nor vetoes the same.