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CONTINGENT CATEGORY II – EMPLOYMENT CONTRACT EXEMPT AND NON EXEMPT EMPL CLASS 22 & 35 Please return the completed contract form, a copy of the completed Benefits Calculation Worksheet, and completed hire packet to: HR Benefits - 620 W. Lexington Street, 3rd Floor, (410) 706-2616 Please Complete and Obtain Appropriate Approvals; White out is not permitted on this form.PLEASE PROVIDE A COPY OF THIS CONTRACT TO EMPLOYEE; HIRING AUTHORITY TO RETAIN COPYPurpose of Contingent Category II Employment Contract:Initial Hire FORMCHECKBOX Contract Renewal FORMCHECKBOX Contract Amendment FORMCHECKBOX Contingent Category II employees are (1) subject to the terms and conditions of this written contract, which is not to exceed twelve months and is to be no less than six months; (2) subject to University of Maryland, Baltimore and University System of Maryland policies; (3) considered a non-regular employee; and (4) required to work a minimum of 40 hours bi-weekly (20 hours per week).Requesting Department InformationDepartment Code: FORMTEXT ?????School/Admin Dept. Name: FORMTEXT ?????Initiator Name: FORMTEXT ?????Contact Phone: FORMTEXT ????? Supervisor Name: FORMTEXT ?????Supervisor Job Title: FORMTEXT ?????Location of Work: FORMTEXT ?????Department Contact: FORMTEXT ?????SECTION 1 - Contingent Category II Employee InformationEmployee Name: FORMTEXT ?????Employee ID: FORMTEXT ?????Non-Exempt FORMCHECKBOX Exempt FORMCHECKBOX Job Title: FORMTEXT ?????Job Code: FORMTEXT ????? Full-Time FORMCHECKBOX Part-Time FORMCHECKBOX Effective Begin Date: FORMTEXT ?????Hours per Week: FORMTEXT ?????FTE: FORMTEXT ?????Effective End Date: FORMTEXT ????? SECTION 2 – Compensation Contingent Category II employees may be eligible for Cost of Living Increases and Merit Increases as determined by the school or department and granted by the State of Maryland. Updates to COLA and Merit increases may be adjusted on a contract to contract basis with no mid-contract amendments.Cost of Living and Merit increases incorporated, if granted by State, during the duration of the contract?If yes, use compensation rate code ANNLEL. If no, use compensation rate code ANNLIN.Yes (ANNLEL) FORMCHECKBOX No (ANNLIN) FORMCHECKBOX Base Salary (Annual)$ FORMTEXT ?????SECTION 3 – BenefitsContingent Category II employees working 30 or more hours per week are eligible to enroll in medical and prescription benefits through the state of Maryland Department of Budget Management (DBM) on a post-tax basis with a 75% state subsidy. Contingent II employees working less than 30 hours per week may be eligible to receive up to 75% assistance from the employee’s department, if offered. Contingent II employees working 20-40 hours per week may be eligible for up to 75% assistance for dental coverage from the employee’s department, if offered.Any assistance from UMB is payable bi-weekly. New employees have 60 days from date of hire to enroll in benefits. Contingent II employees may participate in the life insurance, and accidental death and dismemberment by paying the full premium on a post-tax basis. Contingent II employees are also eligible to participate and can enroll at any time in the supplemental retirement program (401k, 403b, 457 and Roth plans available) which will be withheld from pay.What is the employee’s regular work schedule (for ACA purposes)? Less than 30 hours/week FORMCHECKBOX More than 30 hours/week FORMCHECKBOX What benefit assistance is offered by the Department, if any? Medical* FORMCHECKBOX Prescription* FORMCHECKBOX Dental FORMCHECKBOX None FORMCHECKBOX (*CII working <30 hrs/Wk)BenefitState Subsidy (%)UMB Benefit Assistance (%)Employee Benefit Responsibility (%)Monthly paid by Employee to DBMContract Assistance Paid by Employer (Annual)1. Medical Benefit FORMTEXT ?????% FORMTEXT ?????% FORMTEXT ?????%$ FORMTEXT ?????$ FORMTEXT ?????2. Prescription Benefit FORMTEXT ?????% FORMTEXT ?????% FORMTEXT ?????%$ FORMTEXT ?????$ FORMTEXT ?????3. Dental Benefit0% FORMTEXT ?????% FORMTEXT ?????%$ FORMTEXT ?????$ FORMTEXT ?????4. Base Salary $ FORMTEXT ?????5. Total Compensation (1+2+3+4)$ FORMTEXT ?????$ FORMTEXT ?????Department - If the employee is working an average of 30 hours/week or more, the State Subsidy will be 75% for Medical and Prescription Benefits. The UMB department may provide up to 75% for Dental only. If the employee is working an average of less than 30 hours/week, they are ineligible for the State Subsidy. If the UMB department is offering assistance, they may provide up to 75% for Medical, Prescription, and Dental. Use the benefits calculation worksheet to determine the monthly amount paid by employee to DBM.SECTION 4 - EMPLOYEE ACKNOWLEDGEMENT OF COMPENSATION AND BENEFIT ASSISTANCEI ________ (EMPLOYEE INTIALS) on __/__/__(DATE) understand that my Base Salary is displayed Section 2. I understand that if I receive healthcare assistance from the University as set forth in Section 3, that I will be obligated to enroll in those plans at the coverage levels for which I am receiving assistance (full extent of obligations and responsibilities are available under UMB Policy VII-1.40(A)). I further understand that I will be responsible for making monthly payments to the Department of Budget and Management (DBM) for the full cost of these benefits programs. These monthly premiums are paid on a post-tax basis. Failure to pay insurance premiums for which you are receiving assistance from UMB, may result in disciplinary action up to, and including termination. I understand that I must send a check and coupon, or electronically submit my monthly premium to DBM. () for my elected benefit coverage. I acknowledge responsibility for repayment of a debt to the University if I fail to make timely premium payments to DBM while receiving healthcare assistance from my department. The University reserves the right to withhold all, or a portion, of any earned regular annual and/or holiday leave balances and/or any paycheck owed to me for the purposes of repayment of any debt balance. Benefit plan and coverage levels may only be changed during Open Enrollment or the occurrence of a qualifying life event change. I also understand that I am fully responsible for any premiums for life insurance, and accidental death and dismemberment by paying the full premium on a post-tax basis. SECTION 5 – Leave Package Contingent Category II employees are eligible for the following leave package. Leave days shall be pro-rated for contracts less than one year and/or for less than full-time employment. A termination with a negative leave balance will result in a reimbursement of leave taken to the employer.Category DaysHoursLeave balances do not roll over from one contract to another. Regular, Sick, and Personal leave will be made available at the beginning of a contract or extension and will managed on a “use or lose” basis. Holiday leave will accrue throughout the contract period. Conversion to a regular position will result in a zero leave balance.Regular Annual1080Sick Annual540Personal Annual324Holidays Annual864Total26208SECTION 6 – Conditions of Employment I ________ (EMPLOYEE INTIALS) on __/__/__(DATE) am subject to all applicable rules, policies and procedures of the department/administrative unit, the University of Maryland, Baltimore, the University System of Maryland, and the State of Maryland. The Board of Regents policies with respect to contractual employees shall prevail over any conflicting policies and procedures issued by any component of the University.SECTION 7 – Termination of Contract1. The number of calendar days prior written notice either party may give to the other party to terminate this contract is 14 days. 2.The University of Maryland, Baltimore may terminate this Contract immediately “for or without cause” in the event of breach of this Contract or any condition of employment by the employee.3.Notice of termination from the University of Maryland, Baltimore shall be deemed received by the employee upon delivery to the employee’s workplace. Notice of termination from the employee to the University of Maryland, Baltimore shall be deemed received by the University upon delivery to the Office of Human Resource Services or to the employee’s department administrator as its representative.4.Upon the termination of this Contract, the Contingent Category II employee shall not be compensated for unused leave.SECTION 8 – DisputesThe employee may not use the formal University grievance policies and procedures to dispute or question any action of the University of Maryland, Baltimore or any of its personnel with respect to the employee’s employment by the University of Maryland, Baltimore. Any dispute between the employee and the University of Maryland, Baltimore shall be referred to the department’s Human Resources Representative for resolution. In the event that no resolution is reached, the dispute shall be resolved by an authorized representative of the University of Maryland, Baltimore, Office of Human Resource Services, whose decision shall be final and binding upon the employee and the University of Maryland Baltimore.SECTION 9 – Dual Employment within the University Systems of Maryland or other Maryland State Agencies.The employee shall notify the employer of dual employment within other USM Institutions and/or MD State Agencies. If my dual employment status changes after this contract is signed, I must notify my employer immediately in order to maintain this contract as valid.As of today’s date I am also employed within another USM Institution or MD State Agency: Yes: FORMCHECKBOX / No: FORMCHECKBOX Employee’s Initials: FORMTEXT ?????If yes, please list the USM Institutions and/or MD State Agencies below and initial here: FORMTEXT ?????Employer ________________________ Hours/week _________ Employment Status*_______Contract begin:__/__/__ Contract end:__/__/__Employer ________________________ Hours/week _________ Employment Status*_______Contract begin:__/__/__ Contract end:__/__/__Employer ________________________ Hours/week _________ Employment Status*_______Contract begin:__/__/__ Contract end:__/__/__Employer ________________________ Hours/week _________ Employment Status*_______Contract begin:__/__/__ Contract end:__/__/__* C= Staff Contractual; R= Regular Staff f/t or p/t; F= Regular faculty; AF = Adjunct FacultySECTION 10 – Execution of Contract (Please read and initial appropriate sections before signing below.)In witness whereof, the University of Maryland, Baltimore and the employee execute this Contract. Employee – Please ensure that you have read the Acknowledgement of Compensation and Health Benefit Assistance very thoroughly. It informs you of your responsibilities regarding the health benefit assistance payments.Hiring Authority/Department – Has the responsibility to monitor the monthly payments of health assistance subsidy by the employee of this contract and will contact the Office of Human Resource Services if payments are not made.Employee Name – Printed NameSignatureDateDean/VP - Printed NameSignatureDate(Electronic approval done in ePAF)Reviewed by Human Resources Representative DateHealth and Prescription Drug CoverageThe State of Maryland will offer subsidized health and prescription drug benefit coverage for contractual employees (and their dependents) who have a current employment contract and are scheduled to regularly work 30 or more hours a week (or an average 130 hours per month or faculty teaching 9 credits or more a semester).? The employee will be responsible for paying 25% of the premiums for medical and prescription coverage for themselves and any eligible dependents enrolled. The State of Maryland will subsidize the remaining 75% of the benefit premiums for these benefits.? Monthly direct pay billing from DBM will reflect the remaining 25%. Contingent II employees may be eligible for additional assistance from their department.Other Benefit CoverageContractual Contingent I and Contingent II employees who have a current employment contract and work 30 or more hours a week (or an average of 130 hours per month or faculty teaching 9 credits or more a semester) may also elect to enroll in dental coverage, life insurance and accidental death and dismemberment insurance, but will be responsible to pay the full premium for these benefits.? Contingent II employees may be eligible for additional assistance for dental coverage from their department.Contractual Contingent I and Contingent II Employees Working Less than 30 Hours per WeekIf you are a contractual Contingent I or Contingent II employee working less than 30 hours per week (or less than an average of 130 hours per month), you may participate in the State of Maryland Benefit Plans at the full premium amount (no State subsidy). Contingent II employees who work more than 20 hours but less than 30 hours per week may continue to receive assistance from your department.? ?Contractual Contingent I and Contingent II Employee EnrollmentsIf you are newly eligible for State subsidized healthcare, please visit the Benefits website to view all of the highlights of the benefits available and instruction on how to enroll. Benefits for all contractual employees are post tax. Please contact the Benefits Office if you have further questions – HRBenefits@umaryland.edu. I acknowledge that I have received and read this notice regarding my benefits.__________________________________________ ____________________________________ _______________________Printed Employee Name Employee Signature Date ................
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