(A) (1) All full-time employees and their eligible dependents, as defined by the major medical insurance policy adopted by the town, will become eligible for medical benefits on the first day of employment on which the insurance company then providing coverage will accept the employee and his or her eligible dependents into the plan coverage. The town will pay the premium, with the exception of $0.10 per month, which is to be paid by each covered employee, for a major medical insurance policy with an insurance company, to be selected at the discretion of the Town Council, which will cover eligible medical expenses, as defined by the major medical insurance policy, on behalf of each eligible employee. In addition, the town will pay 80% of the premium on behalf of the employee's eligible dependents, if they elect coverage. The cost to the employee shall be assessed through payroll deduction.
(2) The major medical insurance coverage will contain a deductible per employee and their eligible dependents. The employee shall be responsible for the deductible expense per person covered.
(B) Definitions. For the purpose of this section, the following definitions shall apply to the administration of the Town Medical Insurance Plan unless the context clearly indicates or requires a different meaning.
COVERED EMPLOYEE. An individual who is (or was) provided coverage under a group health plan by virtue of the individual's employment or previous employment with the town.
GROUP HEALTH PLAN. The major medical insurance coverage maintained by the town from time to time and as defined in the Internal Revenue Code of 1986 Sec. 162(i)(3).
PREMIUM COSTS. The premium costs shall be equal to the actual premium cost to the town on behalf of similarly situated plan participants, who have not suffered a qualifying event, or have not retired. The Town Council may assess an additional 2% of the actual cost to cover the administrative cost of processing the qualified beneficiaries' election. In the event a qualified beneficiary is determined under Title II or XVI of the Social Security Act to have been disabled at the time of the qualifying event, the town may assess an additional 50% of the actual cost to cover the administrative costs of processing the qualified beneficiaries election to maintain coverage after the 18th month of coverage.
QUALIFIED BENEFICIARY. The covered employee, the spouse of a covered employee, or the dependent child of a covered employee.
RETIRED EMPLOYEE. A former employee who qualifies for a benefit under IC 5-10.3-8 et seq. (PERF).
RETIREMENT DATE. The date that the employee has chosen to receive retirement benefits from the employee's retirement fund.
(C) (1) The town shall provide to each retired employee the same Group Health Plan coverage which is available to active employees if the retired employee pays the premium costs for the coverage which premium shall be equal to the premium paid on behalf of active employees, if the retired employee files a written request for coverage within 90 days after the employee's retirement date and if the retired employee meets the following requirements:
(a) The retired employee's retirement date is after June 30, 1986;
(b) The retired employee shall have reached 55 years of age on or before the employee's retirement date but shall not be eligible on that date for medicare coverage as prescribed by 42 USC 1395 et seq.;
(c) The retired employee shall have completed 20 years of creditable employment with a public employer on or before the employee's retirement date, ten years of which must have been completed immediately preceding the retirement date;
(d) The retired employee has completed at least 15 years of participation in the Public Employer's Retirement Fund.
(2) The retired employee's eligibility to continue participation in the Town's Group Health Plan shall terminate when the employee becomes eligible for medicare coverage as prescribed by 42 USC 1395 et seq., or when the town terminates the Group Health Plan on behalf of all employees.
(3) Eligible retired employees may elect at the time the employee retires to have the employee's spouse covered on the employee's retirement if the appropriate premium cost is paid. The spouse's eligibility is not affected by the death of the retired employee. The surviving spouse's eligibility terminates upon the happening of the earliest of any one of the following events:
(a) The spouse becomes eligible for medicare coverage under 42 USC 1395 et seq.
(b) The town terminates the Group Health Plan for all town employees.
(c) Two years after the date of the employee's death.
(d) The date of the spouse's remarriage.
(4) The retired employee may assign a part of his or her retirement benefits to the town to cover the premium costs of the continuation coverage.
(D) (1) The town shall provide to each qualified beneficiary the right to elect continued coverage under the Group Health Plan upon the happening of any one of the following qualifying events:
(a) Death of the covered employee;
(b) Termination (other than by reason of such employee's gross misconduct) or reduction of hours of the covered employee's employment;
(c) The divorce or legal separation of the covered employee from the employee's spouse;
(d) The covered employee becoming entitled to benefits under medicare;
(e) A dependent child ceasing to be a dependent child under the generally applicable requirements of the plan.
(2) The continuation coverage is conditioned upon payment of the applicable premium cost by the qualified beneficiary.
(3) The coverage must extend for the period of time beginning on the date of the qualifying event and ending not earlier than the earliest of the following;
(a) In the case of a qualifying event relating to termination and/or reduction of hours the date which is 18 months after the date of the qualifying event except that if the qualified beneficiary is determined under Title II or XVI of the Social Security Act to have been disabled at the time of the qualifying event, the date is 29 months so long as the qualified beneficiary has provided notice of such determination of disability before the end of the initial 18 months as provided hereinafter.
(b) In the case of a qualified beneficiary who is disabled at the time of a qualifying event coverage will terminate in the month which begins more than 30 days after the date of final determination under Title II or XVI of the Social Security Act, that the qualified beneficiary is no longer disabled.
(c) In the case of any other qualifying event not relating to termination or reduction of hours, the date which is 36 months after the date of the qualifying event;
(d) The date on which the employer ceases to provide any Group Health Plan to any employee;
(e) The date on which the coverage ceases under the plan by reason of a failure to maketimely payment of any premium required under the plan with respect to the qualified beneficiary;
(f) The date on which the qualified beneficiary first becomes, after the date of the election, a covered employee under any other group health plan which does not contain any exclusion or limitation with respect to any preexisting condition of such beneficiary, or entitled to Medicare benefits (except that dependents of the qualified beneficiary shall be entitled to continued coverage for a period of 36 months from the date the qualified beneficiary became entitled to Medicare benefits or the qualifying event, whichever is earlier).
(g) In the case of an individual who is a qualified beneficiary by reason of being the spouse of a covered employee, the date upon which the qualified beneficiary remarries and becomes covered under a separate group health plan which does not contain any exclusion or limitation with respect to any pre-existing condition.
(4) The employees shall have the right to elect continuation coverage within a 60-day period after the qualifying event. Any qualified beneficiary electing coverage must pay the premium costs as defined herein and the premiums may be paid in monthly installments commencing not earlier than 45 days after the date on which the qualified beneficiary made the initial election.
(5) Conversion option. Any conversion option contained in any group health insurance plan maintained by the town from time to time shall also be made available to qualified beneficiaries at such time as the period of continuation coverage expires.
(6) Notice requirement. Each covered employee or qualified beneficiary is responsible for notifying the Clerk-Treasurer in the event of any of the following qualifying events:
(a) Divorce or legal separation of the covered employee from the employee's spouse;
(b) A dependent child ceasing to be a dependent child under the generally applicable requirements of the plan; or
(c) The determination under Title II or XVI of the Social Security Act that the qualified beneficiary is disabled within 60 days after the date of the determination and within 30 days after the date of a final determination under such titles that the qualified beneficiary is no longer disabled.
(E) Wellness program.
(1) The town shall reimburse to the employee and their dependents up to $100 annually for routine physical exams, including mammograms, routine pediatric care and immunizations, and any other routine diagnostic exam prescribed by a physician.
(2) The employee shall present a paid receipt for such exam and will be reimbursed through the State Board of Accounts claim procedure.
('80 Code, § 2.02.040 C.) (Am. Ord. 1988-25, passed 9-26-88; Am. Ord. 1990-8, passed 3-26-90; Am. Ord. 1992-21, passed - -92; Am. Ord. 1992-24, passed 12-14-92; Am. Ord. 2014-12, passed 7-14-14)
Cross-reference:
Fee schedule, see § 11.006