(A) Definitions. For the purpose of this section, the following definitions shall apply unless the context clearly indicates or requires a different meaning.
CITY. The incorporated City of Winchester, Indiana.
CITY INSURANCE. Individual or family group medical insurance benefits made available by the city to all full-time city employees.
DEPENDENT. A natural child, stepchild, or adopted child of a public safety employee who:
(a) Is less than 26 years; or
(b) Is 26 years of age or older and physically or mentally disabled as defined by the disability guidelines established by the Social Security Administration.
EMPLOYEE SPOUSE. A retired city employee's spouse or elected city official's spouse where the retired employee or elected city official has elected to have his or her spouse covered under city insurance at the time the employee retires.
PUBLIC SAFETY EMPLOYEE. A full time city firefighter and/or city police officer.
PUBLIC SAFETY SURVIVING SPOUSE. A surviving spouse of a public safety employee who died while in active service or after retirement.
RETIRED CITY EMPLOYEE. An employee or elected city official who:
(a) Leaves employment with the city after June 30, 1986;
(b) Will have reached 55 years of age on or before the employee's retirement date, but who will not be eligible on that date for Medicare coverage as prescribed by 42 U.S.C. 1395, et seq.;
(c) Will 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; and
(d) Will have completed at least 15 years of participation in the retirement plan of which the employee is a member on or before the employee's retirement date.
RETIRED PUBLIC SAFETY EMPLOYEE. A full time city firefighter and/or city police officer who:
(a) Has retired as a firefighter and/or police officer; or
(b) Is a public safety employee who is receiving disability benefits under I.C. 36-8-6, 36-8-7, 36-8-7.5, 36-8-8, or 36-8-10.
SURVIVING SPOUSE. A retired city employee's spouse or elected city official's spouse who has paid the amount the retired city employee or elected city official would have been required to pay for city insurance coverage; and
(a) Is not eligible for Medicare coverage as prescribed by 42 U.S.C. 1395 et seq.;
(b) Has not survived his or her city employee spouse or elected city official spouse for more than two years; and
(c) Has not remarried.
(B) Benefits.
(1) A retired city employee shall pay a percentage determined under division (B)(6) of this section of the retired city employee's city insurance premium if the retired city employee elects single coverage benefits. If the retired city employee elects family coverage benefits, the city shall pay an amount equal to what it would have paid if retired city employee had elected single coverage benefits. The retired city employee must file a written request with the city requesting retiree insurance benefits within 90 days after his or her retirement date or the enactment of this section. When a retired city employee becomes eligible for Medicare coverage, as prescribed by 42 U.S.C. 1395 et seq., the retired city employee's eligibility for participation in city insurance shall automatically terminate.
(2) The employee spouse may be eligible to be covered under city insurance if the retired city employee files a written request with the city requesting insurance benefits for said spouse within 90 days after his or her retirement date or the enactment of this section. The employee spouse shall pay 100% of the city insurance premium. An employee spouse's coverage shall terminate when the employee's spouse becomes eligible for Medicare as prescribed by 42 U.S.C. 1395 et seq.
(3) A retired public safety employee shall pay a percentage determined under division (B)(6) of this section of the retired public safety employee's city insurance premium if the retired public safety employee elects single coverage benefits. If a retired public safety employee elects family coverage benefits, the city shall pay an amount equal to what it would have paid if retired public safety employee had elected single coverage benefits. The retired public safety employee must file a written requesting insurance benefits within 90 days after his or her retirement date or the enactment of this section. When a retired public safety employee becomes eligible for Medicare coverage, as prescribed by 42 U.S.C. 1395 et seq., the retired public safety employee's eligibility for participation in city insurance shall automatically terminate.
(4) A retired public safety employee may elect to have his or her spouse and/or dependents covered under city insurance, if such request is in writing and submitted to the city within 90 days from the date of retirement or when the retired public safety employee begins receiving disability benefits. The spouse and/or dependents shall pay 100% of the city insurance premium. A dependant's coverage shall terminate when the dependent becomes eligible for Medicare, as prescribed by 42 U.S.C. 1395 et seq., when the dependent fails to meet the definition of a dependent, or when health insurance becomes available to the dependent through employment. A spouse's coverage shall terminate when the spouse is eligible for Medicare as prescribed by 42 U.S.C. 1395 et seq.
(5) The surviving spouse or public safety surviving spouse shall be eligible for insurance coverage if said spouse pays the amount the retired city employee or retired public safety employee would have been required to pay for the coverage selected by the surviving spouse or public safety surviving spouse. The surviving spouse or public safety employee spouse must file a written request with the city requesting insurance benefits within 90 days after the death of the retired city employee or retired public safety employee or the enactment of this section. If the city pays any portion of the premium for the surviving spouse or public safety surviving spouse, that payment would be subject to any limitations imposed pursuant to division (B)(6) of this section. The surviving spouse's eligibility for participation shall terminate if any of the following events occur: the surviving spouse remarries; two years after the date of death of the retired city employee; the city terminates the health insurance program; or the surviving spouse becomes eligible for Medicare as prescribed by 42 U.S.C. 1395 et seq.
The public safety surviving spouse's eligibility for participation shall terminate if any of the following events shall occur: the public safety surviving spouse remarries; insurance becomes available to the public safety surviving spouse through employment; the city terminates the health insurance program; or the public safety surviving spouse becomes eligible for Medicare as prescribed by 42 U.S.C. 1395 et seq.
(6) To be eligible for the city to pay any portion of the retired employee's premium, said employee must have retired on or after January 1, 1998. To receive payment of 100% of his or her health insurance premiums upon retirement, the retired employee's years of service and age when added together must total at least 85, but the employee shall pay at least a minimum of $1 per year. If an employee retires after 20 years of consecutive service but his or her years of service when combined with his/her age is less than 85, then the city will pay a percentage of his or her health insurance. The percentage that the city will pay for health insurance coverage for retired employees will be calculated according to the following formula: Actual years of service divided by the sum of 85 minus retired employee's current age. There shall be a lifetime cap of premium payments paid by the city on behalf of any employee of $30,000. The city insurance premium shall be established by the Clerk's office each year within 30 days of the renewal of the city insurance.
(C) Additional insurance.
(1) The city shall establish an additional health insurance benefit program for those retired city employees and retired public safety employees and their spouses, who have qualified for Medicare coverage.
(2) Retired city employees, retired public safety employees and their spouses must qualify for the additional health insurance program which is offered through the city and must comply with any and all requirements of said program.
(3) The city shall pay insurance premiums for the retired city employees and retired public safety employees if said employee elects the single coverage benefits of the additional health insurance program pursuant to a percentage determined under (B)(6) of the section. The city shall not pay a premium for any spouse, surviving spouse or any other dependant of the retired city employee or retired public safety employee. If the retired city employee or retired public safety employee elects any coverage other than the single benefits coverage offered through the city, the city shall pay an amount equal to what it would have paid if retired city employee or retired public safety employee had elected single coverage benefits. A retired city employee or retired public safety employee must file a written request for additional health insurance within 90 days after the retired city employee or retired public safety employee qualifies for Medicare.
(4) The city shall not self-insure the additional health insurance program and shall contract with an independent organization to provide said insurance.
(D) Payments.
(1) Any individual who receives benefits under this section shall be responsible for payment of any balance of his or her monthly city insurance premium.
(2) If any individual fails to deliver to the Clerk-Treasurer his or her portion of the monthly city insurance premium on or before the first day of every month, the city may terminate the individual's city insurance coverage after notice and a hearing before the Board of Public Works and Safety ("the Board"). The Board, at its sole discretion, may allow that individual to continue receiving city insurance coverage if that individual makes the delinquent payment in the manner required by the Board, it being understood that the insurance carrier might have a grace period for late payment.
(Ord. 2004-12, passed 6-21-04; Am. Ord. 2019-5, passed 3-13-19)