It shall be the sole responsibility and obligation of the employee to perform the following in order to avail himself/herself of the benefits of this program:
(A) Notify the city, in writing, of the intent to retire and claim eligibility in the program at least 30 days in advance of separation from the city. This notice shall include the employee’s current and intended address after retirement, if different, and the name of the dependents, if the employee is entitled to dependent coverage.
(B) Execute program forms created by city, which may contain information requested by the health insurance provider.
(C) Execute an affidavit agreeing that he/she will notify the city, in writing, if in the future he/she is reemployed and is eligible to receive substantially the same health insurance coverage from the new employer.
(Ord. 990, passed 4-15-92; Am. Ord. 1024, passed 2-17-93)