(A) Purpose.
(1) The general purpose of this policy is to establish the process for application for health insurance benefits pursuant to the Public Safety Employee Benefits Act ("PSEBA") (ILCS Ch. 820, Act 320, §§ 1 et seq.). This policy is established in recognition of the Village of Orland Hills' ("village") obligations under state law to provide health insurance benefits to its public safety employees who qualify for, and are determined to be eligible to receive, certain health insurance benefits from the village.
(2) Any full time police officer who after November 14, 1997 suffers a catastrophic injury or the eligible family members of a police officer who is killed in the line of duty may apply for health insurance benefits under PSEBA by sending a letter of request for benefits to the village as provided in division (B)(2) below.
(B) Administrative process. The following procedure is established to determine eligibility for PSEBA benefits:
(1) Application form. The applicant shall submit an application on a form provided by the village.
(2) Time period for submission of application. The application for PSEBA benefits must be submitted by personal delivery or certified mail to the village, within one year after the date on which the police officer allegedly suffered a catastrophic injury or was killed in the line of duty. The Administrator will review the application when all of the required documentation has been received by the village.
(3) Matters pending before the Village Police Pension Board. In the event that a timely application for pension benefits has been filed with the Police Pension Board, the following rules shall govern the submission of a PSEBA application:
(a) The submission deadline for the PSEBA application form shall be extended to the date that is 60 days after the date of any final ruling by Police Pension Board concerning any duty related disability.
(b) The applicant shall be responsible for submitting all transcripts and exhibits from the Police Pension Board hearing that resulted in the award of a duty related disability pension.
(4) Processing of application by Village Administrator. Upon receipt of a timely, complete and executed application form, the Administrator shall review the application and engage in such additional fact finding as the Administrator deems necessary to evaluate the application.
(a) If fact finding is determined to be necessary or appropriate, the applicant shall fully cooperate in such fact finding activity.
(b) If the applicant refuses or otherwise fails to fully cooperate, then a reminder notice shall be sent to the applicant explaining the duty of full cooperation in the fact finding process.
(c) The applicant fails to cooperate as requested within 21 days after receipt of such notice, then the application for benefits shall be deemed withdrawn and waived.
(5) Determination of eligibility. The determination shall be based on the application and evidence provided by the applicant to the Administrator as well as such additional fact finding undertaken by the Administrator.
(6) Village Administrator's determination. Within 60 days following receipt of the PSEBA application and all related evidence, the Administrator shall advise the applicant, in writing, of one of the following final determinations:
(a) The village approves the application and awards health insurance benefits; or
(b) The village denies the application and refuses to provide health insurance benefits.
(7) Reconsideration of Village Administrator's determination. In the event the Administrator denies a PSEBA application, the applicant will be afforded an opportunity to present any additional arguments, evidence or testimony to Administrator within 30 days of the Administrator's initial determination.
(C) Health insurance benefits. If an applicant is awarded health insurance benefits, the following provisions apply:
(1) Village insurance plan. If the village approves the application and awards health insurance benefits, the village's basic health insurance plan will be the only plan offered. If the applicant chooses to enroll in any other plan offered by the village, the applicant must pay the difference in insurance premiums.
(2) Other health insurance benefits.
(a) According to state law, health insurance benefits payable by any other source will reduce the benefits payable from the village. Each applicant will be required to sign an affidavit attesting to the fact that they are not eligible for insurance benefits from any other source.
(b) It is the responsibility of the applicant and/or benefit recipient to notify the village within 30 days of any changes to other sources of health insurance benefits. Receipt of benefits in violation of this provision will require reimbursement to the village of any benefits received. The village reserves the right on an annual basis to have the applicant and/or any benefit recipient provide another affidavit affirming whether other health insurance is available or payable to the applicant and/or any benefit recipient.
(Ord. 2011-013, passed 12-7-11)