fits in the Navitus retiree prescription plan before the change
in carriers was made. It was not until Navitus denied cover-
age for retired members’ prescriptions, which had previously
been approved by Horizon, that the union learned about the
changes.
Local 1860 filed a grievance and the dispute proceeded to
binding arbitration before a PERC-designated arbitrator. Both
the city and Local 1860 presented expert witnesses to testify
about the differences, or lack thereof, in the two prescription
plans.
During the hearing, the expert witness presented by Local
1860 testified that the Navitus plan was not at least equal or
even substantially similar to the Horizon plan. He testified
that the Navitus plan limited access or prevented access alto-
gether to certain prescribed drugs through the use of a formu-
lary list of prescription drugs that were not similarly limited or
inaccessible under the Horizon prescription plan. In addition,
the Navitus plan limited access to certain brand-name drugs
through a step therapy program that was also not part of the
Horizon plan.
The arbitrator agreed that the union met its burden to prove
that the Navitus prescription drug benefits plan for retirees
was not “substantially similar to and less than the benefits pro-
vided by Horizon.” He further agreed that the PERC designee’s
determination of the meaning of the contractual language in
the unfair practice case – that it must be “at least equal to” –
should be applied in this grievance arbitration. He credited
the union’s expert after noting that the city did not provide
any documentation concerning its coverage under Horizon
for the time period at issue in the arbitration. Because the
Navitus plan limited access to certain drugs, enforced restric-
tions on the availability of certain drugs and implemented a
step therapy program, the arbitrator agreed with the union’s
expert that the Navitus plan was not at least equal to the Hori-
zon plan. Accordingly, the arbitrator sustained the grievance
and ordered the city to restore the levels of benefits that were
available under the Horizon plan.
This opinion and award are examples of what PBA Locals
can do to protect retirees’ rights with the appropriate lan-
guage in agreements that protect the levels of benefits. The
principles of the award would also apply to medical benefits
in general and not just to prescription benefits. It is important
that you know what your agreement says about this issue. It
is true that PBA Locals do not have the authority to negotiate
benefits for current retirees, and there are limits to what can
be done in light of Chapter 78. But it is important to remem-
ber that PBA Locals do have the authority to enforce contrac-
tual language for retirees, and they should aggressively do so
in appropriate cases. Not all agreements have language which
protects the levels of benefits at the time of retirement. Some
agreements give an employer the right to change the levels of
retiree benefits whenever benefits change for active officers.
If you are faced with an employer’s decision to change ben-
efits for retirees, you should first review the language in your
agreements. If you have any questions, you should then speak
with your attorney or the NJ State PBA to determine if there is
a basis on which to contest the employer’s decision.
www.njcopsmagazine.com
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