Common use of Rural Subsidy Program Clause in Contracts

Rural Subsidy Program. The State and the Union agree that in those areas/counties which CalPERS has defined as “rural” because no CalPERS HMO plan is available for enrollment in the area, Unit 18 members who are enrolled in a CalPERS-sponsored PPO plan shall be eligible for the Rural Health Care Equity Program (RHCEP). Unit 18 members enrolled in a CalPERS-contracted HMO plan will not be eligible for the RHCEP. The parties agree that in those areas/counties which CalPERS has defined as rural, Unit 18 members shall be eligible for the following Rural Subsidy Program, replacing the previous RHCEP. The program shall operate as follows: A. The State shall pay $100 per month to each eligible Unit 18 member (employee) as a subsidy of the higher health care expenses of PPO plan members. In addition; B. The “available pool” is defined as any Bargaining Unit 18 money remaining, as of January 1, 2005, in the RHCEP fund as described in Section 7.3 of the previous Unit 18 contract (July 3, 2001 through January 2, 2004). The available pool shall be used for reimbursement of deductible and co-insurance expenses up to $1500 per fiscal year incurred by the eligible Unit 18 member. C. Members are required to submit an RHCEP claim form along with a copy of their Explanation of Benefits document in order to receive reimbursement of deductible and co-insurance expenses from the available pool. D. Reimbursement from the available pool shall continue until the available pool is exhausted. Claims up to $1500 per eligible member shall be processed on a “first come” basis. E. For eligible expenses incurred in excess of $1500, claims will be held until the close of the fiscal year. At that time, these excess claims shall be paid on a pro-rated basis to Unit 18 members until the funds in the available pool are exhausted. F. Upon exhaustion of the available pool the State shall pay $125 per month to each eligible Unit 18 member as a subsidy for the higher health care expenses of PPO plan members G. The program shall be administered by the Department of Personnel Administration. H. The CalPERS Board shall determine the rural areas for each subsequent year at the same meeting when the board approves premiums for HMOs. I. Enrollment for the rural subsidy shall be automatic, based on the employee’s residence address and health plan choice as maintained by the State Controller’s Office. J. It is the responsibility of the employee to establish and maintain accurate address and health plan information in order to receive the rural subsidy.