§ 37.30 COORDINATION OF BENEFITS.

   (A)   Intent. The city intends that this chapter shall provide each retiree with payment for health care expenses incurred by the retiree, as provided in this chapter and/or insurance agreement. The city does not intend that payment under this chapter shall exceed the amount of the expenses incurred. For this reason, this chapter coordinates benefits with other insurance policies according to industry standards and applicable laws. If a participant becomes eligible for Medicare, plan benefits for such participant will be adjusted to reflect Medicare as primary coverage.

   (B)   Reimbursement. If an expense is paid under this chapter by the Plan Administrator on behalf of a retiree and such expense subsequently is paid from any other source, in whole or in part, the retiree shall remit to this chapter an amount equal to the duplicated benefits. In addition, the Plan Administrator may reimburse any other plan, person or entity that has paid an expense on behalf of a retiree which expense was payable under this chapter. In such event, this chapter, Plan Administrator and/or the insurance carrier shall be relieved of all further responsibility with respect to that expense.

   (C)    Subrogation. In the event any payment is made by the fund under this chapter, this chapter shall be subrogated and shall succeed to the rights of any retiree against any other plan, person or entity for recovery of health care expenses for which such other plan, person or entity legally is liable. All amounts so recovered, by settlement, judgment or otherwise shall be paid to the fund. Retirees shall furnish such information, execute and deliver such assignments, documents or other instruments and take whatever steps are necessary to secure the rights of this chapter. Retirees shall take no action to prejudice the rights and interests of this chapter hereunder.

   (D)   Effect of exclusions. The provisions of this section shall not be construed to create any independent right to payment of any benefit under this plan. Any exclusion or limitation contained in this chapter and/or insurance agreement shall supersede any provision of this section regarding coordination of benefits.

(Ord. 886, passed 11-11-02)

§ 37.31 PLAN ADMINISTRATION - CITY DUTIES.

   (A)   The city shall be responsible for complying with the code's reporting and disclosure requirements and for the purpose of fulfilling such other plan administrative functions as are not specifically assigned to the Plan Administrator and/or insurance carrier. The city may employ a Plan Administrator and/or insurance carrier who will be responsible for the interpretation and administration of this chapter including the payment of health care claims under this chapter.

   (B)   The city shall be responsible for the performance of its duties as employer and plan sponsor under applicable Internal Revenue Code sections. The city may delegate all or any part of its plan administration responsibilities. Any such delegation shall be done in writing.

   (C)   The city may employ one or more persons to render advice with regard to any responsibility such fiduciary has under this chapter. Any fiduciary, agent, representative or other person performing services to or for this chapter shall be entitled to reasonable compensation for services rendered, unless such person is employed by the city and already receives full pay from the city, and to reimbursement or expenses properly and actually incurred.

   (D)   In administering this chapter, the city shall be entitled to the extent permitted by law to rely conclusively on all tables, valuations, certificates, opinions and reports which are furnished by or in accordance with the instructions of accountants, counsel or other experts employed or engaged by the city. All actions taken in a good faith reliance on advice from such advisors are conclusive and binding upon all persons.

   (E)   The city shall furnish the Plan Administrator and/or insurance carrier, while this chapter is in effect, any information as may be required at intervals and in the form prescribed by the Plan Administrator and/or insurance carrier for the enrollment of retirees for coverage under this chapter and for the processing of terminations or other changes in coverage of retirees and also shall furnish to the Plan Administrator and/or insurance carrier such other information required for the administration of this chapter.

(Ord. 886, passed 11-11-02)

§ 37.32 PLAN ADMINISTRATION - INSURANCE CARRIER DUTIES.

   Each insurance carrier shall have the responsibility for interpreting and administering their respective insurance agreement and for processing and paying benefit claims thereunder and shall provide the city with such information as the city may deem necessary to permit the timely filing of all reports required by law. The insurance carrier also shall provide a description of the benefits provided under their respective insurance agreement directly to the retirees or to the city for distribution to retirees.

(Ord. 886, passed 11-11-02)

§ 37.33 PLAN ADMINISTRATION - PLAN ADMINISTRATOR DUTIES.

   The Plan Administrator shall have the responsibility for interpreting and administering this chapter and for processing and paying benefit claims thereunder. The Plan Administrator shall exercise his or her authority in a non-discriminatory manner so that all persons similarly situated shall receive substantially the same treatment. The Plan Administrator shall maintain the appropriate records and accounts necessary in the administration of this chapter and shall provide the trustees with such information necessary to permit the timely filing of all reports required by applicable laws or regulations governing the fund.

(Ord. 886, passed 11-11-02)

§ 37.34 PLAN ADMINISTRATION - CITY MANAGER'S DUTIES.

   The City Manager shall be vested with the authority to render decisions regarding participation in this chapter. Such authority shall be specifically limited by:

   (A)   The eligibility requirements of § 37.21 or as otherwise provided for in this chapter; and

   (B)   The city's ability to obtain coverage under this chapter and/or from the applicable insurance carrier.

(Ord. 886, passed 11-11-02)

§ 37.35 HEALTH CARE BENEFITS, CLAIMS PROCEDURES.

   A claim for benefits under this chapter must be submitted in writing to the Plan Administrator and/or insurance carrier in accordance with procedures established by the Plan Administrator or this chapter and/or insurance carrier.

(Ord. 886, passed 11-11-02)