AELE LAW LIBRARY OF CASE SUMMARIES:
Employment & Labor Law for Public Safety Agencies


Back to list of subjects             Back to Legal Publications Menu

Health Insurance & Benefits

     City employee recovers payment for the two hours of work time lost to take a mammogram. N.Y. Civil Service Law §159-b/c provides that employees are entitled to up to four hours leave annually to have a mammogram or prostate cancer screening. Moran v. City of Saratoga Springs, #45-1-2008-0150, 2008 N.Y. Misc. Lexis 4605 (Sup. Saratoga Co.).
     Arbitrator sustains the termination of a municipal employee that intentionally delayed providing notification of his divorce to management so that his ex-wife could continue to access his health insurance coverage; when confronted, the grievant was not honest or forthcoming. City of Eugene and AFSCME L-1724, 124 LA (BNA) 1724 (Henner, 2008).
     The Office of Personnel Management now authorizes insurance carriers participating in federal employees health benefits plans to reimburse physicians who screen their patients for substance use behavior (alcohol, illicit drugs, and prescription drug abuse) and to provide intervention programs. Office of Natl. Drug Control Policy News Release (4-7-2008).
     The mere fact that a county sheriff has chosen to participate in a group health plan managed by a city does not make the city the "employer" of county correctional officers. City of Boston and AFSCME C-93, #MUP-03-3880 (Mass. Emp. Rel. Bd. 2008).
     Eighth Circuit overturns a city's unilateral discontinuance of health insurance premium payments for retired public employees as required by a bargaining agreement; Art. I §10 of the U.S. Constitution prohibits the impairment of contracts. AFGE L-2957 v. City of Benton, Ark, #07-1589, 2008 U.S. App. Lexis 1416 (8th Cir.).
     Arbitrator finds that management violated the bargaining agreement by unilaterally adding a spousal surcharge or additional payment for health coverage. City of Painesville and IBEW L-673, 123 LA (BNA) 1563, FMCS Case #06/58893 (Cohen, 2007).
     Arbitrator holds that management violated the bargaining agreement by charging higher medical co-payments without improving the coverage. Hamilton Co. Sheriff's Dept. and FOP Ohio, FMCS Case #06/00964, 123 LA (BNA) 851 (Dissen, 2007).
     Massachusetts appellate court concludes that it was lawful for a town to fire an at-will animal-control officer after she requested enrollment in the town's health insurance plan. "Mere eligibility for the insurance does not in any way protect the employment status of a town employee." Parker v. Town of North Brookfield, #06-P-167, 68 Mass. App. Ct. 235, 861 N.E.2d 770, 25 IER Cases (BNA) 1283, 2007 Mass. App. Lexis 157.
     Arbitrator rejects a grievance that the county deducted too much for medical insurance; "for at least fifteen years prior to the instant grievance, the county has administered the opt-out provision in precisely the same fashion." Cuyahoga Co. and Ohio PBA, FMCS Case #050926/59407, 122 LA (BNA) 1808 (Ruben, 2006). [N/R]
     A police officer, who was injured in an automobile accident, was entitled to retain money paid to him under an underinsured motorist claim. Although the village paid his medical claims, it was not entitled to a lien on his insurance recovery. Musgrove v. Amer. Prot. Insur. Co., #12865/04, 2006 NY Slip Op 6566, 2006 N.Y. App. Div. Lexis 10877 (2006). {N/R}
     Appellate court holds that a city did not violate the Equal Protection Clause when it denied a retired firefighter's claim for health benefits. Sellars v. City of Gary, #05-3858, 453 F.3d 848, 2006 U.S. App. Lexis 16965- (7th Cir. 2006). {N/R}
     Employee's claim that the group health insurance policy provided by a public employer did not cover in vitro fertilization, does not establish a prima facie case of disability discrimination. Knight v. Hayward Sch. Dist., #A106449, 132 Cal.App.4th 121, 33 Cal.Rptr.3d 287, 2005 Cal. App. Lexis 1339 (1st Dist. 2005). {N/R}
     Seventh Circuit holds that the due process rights of retired officers were not violated when the county required retired sheriff's deputies to pay higher health care premiums than required by currently employed deputies. Germano v. Winnebago County, #04-3319, 2005 U.S. App. Lexis 6075 (7th Cir. 2005). {N/R}
     Arbitrator holds that management did not violate the bargaining agreement when it stopped paying for health insurance for a pregnant police officer who was on FMLA leave, and ineligible for group coverage. Vil. of Huntley, IL and Metrop. Alliance of Police C-207, 120 LA (BNA) 949, FMCS #040218/03758-A (Cox, 2004). {N/R}
     Arbitrator holds that management did not violate the bargaining agreement by requiring new enrollees in the health plan to document the status of persons they claim as dependents. Enrollment procedures are an administrative matter and the process does not confer a benefit on employees. Milwaukee Bd. of Sch. v. Teachers Educ. Assn., 120 LA (BNA) 279 (Winton 2004). {N/R}
    Arbitrator holds that management violated the bargaining agreement by unilaterally imposing deductibles on employee medical benefits. The terms "deductible" and "coinsurance" are not interchangeable. City of Middletown and IAFF L-336, 120 LA (BNA) 8, AAA Case #52-390-00845-03 (Braverman, 2004). {N/R}
     EEOC approves a final regulation that allows employers to reduce or end health benefits when a retiree becomes eligible for Medicare or under a comparable state retiree health plan, without violating the Age Discrimination in Employment Act. Age Discrimination in Employment Act: Retiree Health Benefits, 29 CFR Parts 1625 & 1627, RIN 3046-AA72, 72 (40) U.S. Law Week 2640 (2004). {N/R}
     Employers will be able to reduce or eliminate retired workers' health benefits after they qualify for Medicare, under a revised Rule of the Equal Employment Opportunity Commission. U.S. E.E.O.C. Notice of Proposed Rulemaking: Age Discrimination in Employment Act -- Retiree Health Benefits, 68 (134) Fed. Reg. 41542 (July 14, 2003). [2004 FP Jun]
     Arbitrator holds that a county did not violate the collective-bargaining agreement when it negotiated a new health plan. Some employees were disadvantaged by the changes, and others benefited. Clark County [Ohio] Sheriff and FOP, 118 LA (BNA) 1493, FMCS #02/04119 (Graham, 2003). {N/R}
     Arbitrator holds that a sheriff's dept. violated the bargaining contract when it unilaterally changed the health insurance plan, based on the recommendations of a cost containment board. Lucas County Sheriff's Office and Ohio PBA, 118 LA (BNA) 929, FMCS Case #03/06631 (Coyne, 2003). {N/R}
     Arbitrator rules that management violated the bargaining contract by changing the health insurance carrier, increasing firefighter co-pay costs. City of Glenpool, Okla. and IAFF L-2990, 118 LA (BNA) 761, FMCS Case #020827/15296-8 (Neas, 2003). {N/R}
     Supreme Court declines to review an en banc appellate decision that held, 9-to-3, that the government was not obligated to honor medical claims of veterans that had enlisted with a promise of lifetime medical benefits. Schism v. U.S., #99-1402, 316 F.3d 1259 (Fed. Cir., en banc 2002); cert. den. #02-1226, 2003 U.S. Lexis 4404, 71 Law Week 3750 (2003). {N/R}
     Federal appeals court splits 9-to-4 to deny VA hospital benefits to retired service personnel who enlisted between 1941 and 1956, even though they were told by military recruiters they would receive free lifetime health care if they stayed in the service 20 years. In 1995 the Pentagon ended those benefits for veterans over 65 because they are eligible for Medicare. The majority found that the recruiters had no authority to make those promises. Schism v. U.S., #99-1402, 2002 U.S. App. Lexis 23769 (en banc, Fed.Cir. 2002). {N/R}
     Arbitrator sustains a grievance that a new health plan, which allowed the employer's premium payments to remain constant, but caused employees' out-of-pocket expenses to skyrocket, was not an equivalent program. Coles County 911 Board and IL FOP Labor Council, FMCS Case #010502/10114-A, 117 LA (BNA) 462 (Petersen, 2002). {N/R}
     Arbitrator holds that a Township violated the bargaining agreement when it raised drug prescription costs from three dollars to $15 per prescription for generics and $30 for brand name drugs. Olmstead Twp. and Frat. Order of Police, 117 LA (BNA) 540, FMCS Case #00120/00854-6 (Van Pelt, 2002). [2002 FP Dec]
     Arbitrator holds that a city did not violate the CBA when it increased fees for ER visits and changed the payment system for prescription drugs. "Substantially similar benefits" should refer to changes that apply to a plan as a whole, and not to minor provisions. Elk Grove Village and Prof. Firefighters L-2340, 117 LA (BNA) 152 (Nathan, 2002). {N/R}
     Arbitrator rules that a city did not violate the bargaining agreement when it had to replace the dental coverage with a more expensive policy, which required a worker co-payment. The contract was silent on dental plan coverage. Oklahoma City and FOP L-123, FMCS #01/05071, 116 LA (BNA) 1502 (Moreland, 2002). [N/R]
     An employer complies with its duty under COBRA, 29 U.S. Code §1161-1169, by sending a letter to an individual's last known address by certified mail, even when the employer knows that the individual did not actually receive the letter. Degruise v. Sprint, #00-31320, 279 F.3d 333, 2002 U.S. App. Lexis 1116 (5th Cir. 2002). [N/R]
     Federal court in Seattle orders an employer to cover the cost of prescription contraceptives in its insurance plan. Erickson v. The Bartell Drug Co., #C00-1213L, 141 F.Supp.2d 1266, 85 FEP Cases (BNA) 1569, 2001 U.S. Dist. Lexis 7550 (W.D. Wash. 2001). [2001 FP 120]
     City, for valid financial reasons, could not unilaterally change the benefits paid on its health plan, where the bargaining agreement prohibited a reduction of benefits. Arbitrator holds that past practices were not controlling. Norman (City of) and FOP L-122, FMCS #00/15703-8, 115 LA (BNA) 827 (McReynolds, 2001). [2001 FP 83]
     Arbitrator finds that management violated the bargaining agreement when it adopted new health plan that increased the employee co-pay from $10 to $15. Muskegon (County of) and AFSCME C-25, L-570, AAA # 54-390-00712-00, 115 LA (BNA) 1239 (McDonald, 2001). {N/R}
     Wisconsin arbitrator holds that a town violated the bargaining contract, which provided that management could change insurance carriers provided that benefits remained equivalent. Oconomowoc (Town of) and Wis. Prof. Police Assn., Grievances #98-311 and 00-220, 115 LA (BNA) 169 (Petersen, 2000). [2001 FP 83-4]
     EEOC holds, in two cases, employers violated Title VII and the PDA by not providing prescription benefits to women for contraceptives. www.eeoc.gov/docs/decision-contraception.html [2001 FP 24-5]
     Federal workers now allowed 4 hours time off for some health screenings. White House Executive Dept. Memorandum, “Preventive Health Services at the Federal Workplace” (Jan. 4, 2001). [2001 FP 25]
     Health plan that excludes infertility treatments does not violate the ADA or PDA. Krauel v. Iowa Med. Ctr., 915 F.Supp. 102; 69 FEP Cases (BNA) 182 (D.Iowa 1995). [1996 FP 88]
     Federal appeals court holds that ERISA does not prevent an employer from reducing the maximum benefits for AIDS related illnesses from $1 million to $5,000. McGann v. H&H Music, 946 F.2d 401 (5th Cir. 1991); cert.den. 113 S.Ct. 482 (1992). {N/R}
     Township that agreed to pay retired employees’ medical insurance could not unilaterally terminate obligation. Newport Twp. v. Margalis, 532 A.2d 1263 (Pa. Cmwlth. 1987).
     Recipient of medical benefits was entitled to due process before termination; commission of a felony did not eliminate these rights. Knudson v. City of Ellensburg, 832 F.2d 1142 (9th Cir. 1987).
     COBRA's Public Health Amendments requires state and local governments to continue health insurance to former employees, their ex- spouses, and certain dependents under specified conditions. Consol. Omnibus Budget Reconcil. Act, P.L. 99-272 Sec. 10003 (April 7, 1986).
     City could not require married employees to be covered under same health policy if issuance of second policy increased benefits. Fraternal Order of Police v. City of Columbus, 24 Ohio App. 157, 493 N.E.2d 983 (Ohio App.).
     Domestic Partners: See topic by that name, with several cases relating to health insurance.

Back to list of subjects             Back to Legal Publications Menu