Upon qualification for PSEBA benefits, the applicant shall be entitled to the city’s basic group health insurance plan. Basic group health insurance plan shall mean the lowest-cost plan available to the city. The basic group health insurance plan may change from time to time. An applicant may choose to enroll in any other health insurance plan offered by the city different from the basic group health insurance plan, but shall pay the difference in insurance premium between the city’s basic plan and the other plan. Failure of the PSEBA beneficiary to timely pay the premium’s non-basic level coverage shall result in coverage in the basic plan. PSEBA benefits do not include benefits not provided under the city’s basic group health insurance plan such as, but not limited to, disability benefits, life insurance, dental or vision benefits, etc.
(A) Open enrollment. Individuals receiving benefits under PSEBA will only be able to change from one plan to another during the city’s open enrollment period.
(B) Other benefits. Health insurance benefits payable from any other source will reduce the benefits payable from the city. Each applicant shall sign an affidavit attesting that the applicant is not eligible for insurance benefits from any other source, unless there is another source. If there is another source, the applicant shall notify the city of that source no later than five business days from that source becoming available to the applicant or the applicant’s beneficiaries. The city reserves the right on an annual basis to have the benefit recipient provide another affidavit affirming whether other health insurance is available or payable to the applicant, his/her spouse and/or his/her qualifying dependent children. The affidavit must be completed and returned to the city within 30 calendar days of written notice from the city. If the recipient does not complete and return the affidavit within the time required, the city shall give the recipient an additional written notice providing an additional 15 calendar days for the recipient to complete and return the affidavit. Failure to return the affidavit within the time required shall result in the recipient incurring responsibility for reimbursing the city for premiums paid during the period the affidavit is due and not filed.
(C) Disclosure of health insurance coverage. The applicant has an ongoing obligation and shall update health insurance coverage information provided and failure to do so may result in the denial of benefits and/or reimbursement to the city for duplicate coverage. If duplicate coverage has been received by a PSEBA beneficiary, further PSEBA benefits will be denied until the city has been fully reimbursed by the PSEBA beneficiary for what it would have been credited if it had known about other coverage.
(D) Reimbursement. Receipt of health insurance benefits from other sources without notice to the city shall require the applicant to reimburse the city for the value of those benefits.
(E) Medicare eligibility. The applicant shall notify the city when the applicant becomes Medicare eligible regardless of the status of the enrollment period, so the city may assist with the transition to Medicare coverage and/or adjust health insurance benefits or PSEBA benefits accordingly.
(Ord. 8310, passed 3-18-2019)