(a) Self-insurance. There is established a self- insurance program for the City for the purpose of establishing comprehensive medical insurance for qualified City employees and Carmel-Clay Park Board employees.
(`91 Code, § 2-57) (Ord. D-1040, 12-20-93; Ord. D-1900, 8-4-08)
(b) Employee insurance. The City will offer one or more plans of medical, dental and/or vision insurance to its eligible employees. All full-time employees, including conditional and probationary employees, and elected officials shall be eligible for such insurance coverage after 30 days of employment with the City. For the purposes of health insurance eligibility only, full time shall mean an employee who is regularly scheduled to work thirty (30) or more hours per week. Details regarding medical insurance are set forth in the City of Carmel Employee Health Benefit Plan, as amended from time to time.
(c) Insurance premiums. The City shall contribute no less than 75% of the premiums for single and family coverage, the actual amount to be determined annually during the budget process, depending on the plan selected by an employee. For members of the Common Council, the City shall contribute exactly 75% of the total premium. Employees will be informed of the City's contribution level no later than November 15 of each year, to be effective the following January 1.
(d) Parks employees. Full-time employees of the Carmel-Clay Parks Board shall also be eligible for coverage under the City’s medical, dental and vision plans, on the same terms and conditions as City employees. The insurance provider, or third party administrator in the event the City is self-insured, shall agree in writing on all new plan inception dates and plan renewal dates that Parks employees are included in such coverage. The Parks Board shall make the employer contribution for its employees.
(e) Retiree insurance. For full-time employees hired before October 3, 2016: The City shall contribute 50% of the monthly employee-spouse premium for retirees who have 20 years of active service with the City, plus an additional 1% for each additional six months of service, up to a maximum of 75% of the employee only or employee-spouse premium, as applicable, provided that the City’s insurance premium contribution shall not exceed $900 per month or $10,800 per year. If the retiree is not married but has dependent children, an equivalent dollar amount will be applied to the employee-child(ren) premium. If the retiree has a spouse, whether or not the spouse is on the City’s plan, coverage for other eligible dependents may be continued at the retiree’s expense. Coverage will end when the retiree and/or spouse and dependent(s) age
out of the Plan, or, in the case of a qualified disabled dependent child, when both parents have aged out of the plan. Employees hired on or after October 3, 2016 will not be eligible for this benefit.
(f) Insurance for individuals who die in the line of duty. For an employee who dies in the line of duty, the City will contribute 100% of the monthly spouse and dependent (if applicable) medical and dental premiums as long as the wife and dependents are in the plan. The surviving spouse may remain in the plan for the remainder of his or her lifetime, or, when the spouse becomes eligible for Medicare the City may, in its sole discretion, elect to pay for a supplemental insurance plan that offers coverage equal to or better than the City plan. Coverage for other dependents will end when they age out of the plan, or in the case of a qualified disabled dependent child, when the spouse is no longer in the plan.
A death must be clearly, directly, substantially and causally related to the employee’s official job duties to be deemed “in the line of duty.” For a sworn police officer or firefighter, this determination shall be made by the Indiana Public Retirement System (“INPRS”). For civilian employees, this determination shall be made at the sole discretion of the City.
(g) Insurance for individuals who suffer from a catastrophic physical personal injury. For a police officer or firefighter who suffers from a catastrophic physical personal injury, the City will contribute 100% of the monthly employee medical and dental premiums until the employee becomes eligible for Medicare. The City will contribute 100% of the spouse and dependent (if applicable) medical and dental premiums until those individuals age out of the plan, or, in the case of a qualified disabled dependent child, when both parents have aged out of the plan.
A catastrophic physical personal injury is a permanent and total impairment that is the direct result of a physical injury that:
(1) occurs in the line of duty; and
(2) permanently prevents the police officer or firefighter from performing any gainful work.
The determination that a police officer or firefighter suffers from a catastrophic physical personal injury will be made solely by INPRS.
(h) Insurance for other disabled individuals. A disabled individual (a “Medical Retiree”) must qualify for an INPRS disability benefit based on a line-of-duty or duty-based illness or injury before he or she becomes eligible for a City benefit under this section. For qualifying Medical Retirees, the City will contribute to monthly premium payments according to the following schedule:
(1) For an initial period of two (2) years from the date of disability the City will pay one hundred percent (100%) of the Medical Retiree’s medical and dental premiums. All percentages in this section include premiums for the Medical Retiree and eligible family members, including spouses and dependents acquired after the disability date.
(2) No less than two (2) months prior to the two (2) year anniversary of the disability date, the Medical Retiree will meet with a Medical Review Committee (the “Committee”), in person or virtually, to determine the need for additional premium assistance. The Review Committee may end premium contributions after two (2) years or continue them at a fifty percent (50%) or one hundred percent (100%) level for an additional two (2) years. The 50% level will be subject to the same monthly maximum imposed on retirees with twenty (20) or more years of service.
(3) No less than two (2) months prior to the four (4) year anniversary of the disability date, the Medical Retiree will again meet with the Committee, in person or virtually, for a final determination. The Review Committee may end premium contributions after four (4) years or continue them at a fifty percent (50%) or one hundred percent (100%) level, which decision will remain valid until the Medical Retiree and his or her family members age out of the Plan, or until INPRS determines the Medical Retiree is no longer disabled. An eligible disabled dependent may remain on the plan as long as at least one parent is on the plan. The 50% level will be subject to the same monthly maximum imposed on retirees with twenty (20) or more years of service.
(4) The Committee shall be comprised of nine (9) members and one alternate, as follows:
a. two (2) police officers elected from within their ranks, who may not also serve on the Department’s Pension Committee;
b. two (2) firefighters elected from within their ranks, who may not also serve on the Department’s Pension Committee;
c. one (1) upper level management employee selected by the police and fire chiefs;
d. two (2) civilian employees nominated by their directors and selected by the Director of Human Resources;
e. one (1) civilian management employee nominated by his or her director and selected by the Director of Human Resources; and
f. the Director of Human Resources, who shall chair the Committee.
g. An alternate shall be named by the Corporation Counsel, but shall not be a member of the Corporation Counsel’s staff. The alternate shall sit in on all fact-finding meetings and deliberations, but shall not vote unless another committee member is absent, recuses himself or herself or is recused at the Medical Retiree’s request.
(5) The Medical Retiree shall be entitled to request any one (1) member of the committee be recused, with or without cause.
(6) Deliberations may be held in-person or virtually. The committee’s decisions shall be made by a vote requiring a simple majority of members present. In case of a tie, the Director of Human Resources shall make the final determination.
(7) The committee’s decisions are final, unless a petition for reconsideration is granted (see (8) below). The committee’s decision shall be communicated to the Medical Retiree in writing by the Director of Human Resources within two (2) weeks after the meeting with the Medical Retiree.
(8) Each Committee member shall sign a confidentiality agreement, pledging not to reveal medical, financial or other personal information of the Medical Retiree. Members will be subject to disciplinary action for breaching the agreement.
(9) The Committee shall be authorized to consider the Medical Retiree’s medical condition, preparation for different careers, employment status, family status and other relevant factors in reaching a decision. The Committee may end premium contributions without further consideration for a Medical Retiree who refuses to provide information as requested.
(10) The Committee’s decision may be invalidated, and premium contributions terminated, at any time it can be shown the Medical Retiree has withheld relevant information or provided incomplete or false information.
(11) If benefits are reduced or terminated, the Medical Retiree can petition for reconsideration of the decision if his or her circumstances materially change. The petition shall be made in writing to the Director of Human Resources and shall include a description of the changes that the Medical Retiree believes merit further review. The Director of Human Resources will decide whether to grant a petition for reconsideration and inform the Medical Retiree of the decision in writing.
(12) This section (h) applies to Medical Retirees whose final determination is made after July 31, 2020. Those Medical Retirees whose determinations were made on or before July 31, 2020, will continue to receive benefits provided under previous guidelines.
(i) Summary only. The benefits described in sections (e) through (h) are a summary only. Complete details regarding insurance benefits for employees who retire or who die or are disabled in the line of duty are set forth in the City of Carmel Guidelines For Payment Of Retiree Insurance Premiums and Guidelines for Payment of Premiums For Individuals Who Die Or Who Are Disabled In The Line Of Duty, as amended from time to time.
(j) Coordination of benefits. An employee or family member who qualifies for an employer contribution based on years of service and death or disability shall receive the greater of the benefits described in sections (e) through (h) above for which he or she is eligible.
(k) Eligibility. Eligibility for the Plan is determined solely by the provisions of the Plan. Sections (e) through (h) above pertain only to premium contributions and not to Plan eligibility.
(l) City as sole beneficiary. Benefits under this section will be paid only to the City of Carmel Employee Health Benefit Plan or its successor plan. The only exception shall be if the City purchases a supplemental insurance plan for a survivor who is eligible for Medicare benefits, as described in section (f) above.
(`91 Code, § 2-38) (Ord. D-826, § 2-38, 8-17-92; Ord. D-1348-98, 1-26-98; Ord. D-1377-98, 8-17-98; Ord. D-1541-01, § I, 11-19-01; Ord. D-1643-03, § 1, 8-18-03; Ord. D-1838-06, As Amended, 12-18-06; Ord. D-1900-08, 8-4-08; Ord. D-1920-08, § 2, 12-15-08; Ord. D-2038-11, As Amended, 6-6-11;Ord. D-2050-11, 9-19-11; Ord. D-2067-11, 11-7-11; Ord. D-2123-13, 2-4-13; Ord. D-2210-15, 4-20-15; Ord. D-2324-16, 10-17-16; Ord. D-2490-19, 10-21-19; Ord. D-2540-20, As Amended, § 2, 2-15-21)