A. Basic Group Insurance Plan: If an applicant is determined to be eligible for PSEBA benefits, the applicant will be eligible to receive continued health coverage consistent with the PSEBA under the village's basic group health insurance plan. The basic group health insurance plan shall be the least expensive health plan offered to village employees at the time PSEBA benefits are awarded as determined solely by the village from time to time. The basic group health insurance plan may change from time to time. A PSEBA beneficiary may choose to enroll in any other health insurance plan offered by the village different from the basic group health insurance plan, but shall pay the difference in insurance premium between the village's basic plan and the other plan. Failure of a 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 in the village's basic group health insurance plan, such as, but not limited to, dental, vision, life insurance, and the like. Individuals receiving benefits from the village under the PSEBA may only change from one health insurance plan to another during the village's open enrollment period.
B. Reduction Or Elimination Of PSEBA Benefits By Other Health Coverage: If a PSEBA beneficiary becomes eligible to receive health insurance benefits from any other source, including, but not limited to, Medicare, the PSEBA beneficiary's coverage may be reduced or eliminated as determined by the village consistent with PSEBA. Health insurance benefits payable from any other source will reduce the PSEBA benefits payable from the village. Receipt of health insurance benefits from other sources without notice to the village shall require the PSEBA beneficiary to reimburse the village for the value of those benefits. The PSEBA beneficiary shall notify the village when the PSEBA beneficiary becomes Medicare eligible regardless of the status of the enrollment period, so the village may assist with the transition to Medicare coverage and/or adjust health insurance benefits or PSEBA benefits accordingly.
C. Affidavit Of Continued PSEBA Eligibility: All recipients of PSEBA benefits from the village shall complete and return to the village administrator on an annual basis an affidavit verifying the recipient's continued eligibility for PSEBA benefits. The affidavit must be completed and returned to the village administrator within sixty (60) calendar days of written notice from the village. If the recipient does not complete and return the affidavit within the time required, the village administrator shall give the recipient an additional written notice providing an additional thirty (30) 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 village for premiums paid during the period the affidavit is due and not filed.
D. Disclosure Of Health Insurance Coverage: PSEBA beneficiaries have 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 village for duplicate coverage. If duplicate coverage has been received by a PSEBA beneficiary, further PSEBA benefits will be denied until the village has been fully reimbursed by the PSEBA beneficiary for what it would have been credited if it had known about other coverage. (Ord. 19-7, 3-5-2019)