All of the benefits provided by the City are subject to the terms of the relevant insurance policies. The City has the right to change benefits and policies from time to time. In an effort to create informed, responsible consumers of the insurance benefits, the City may work with an Employee Benefit Committee to further this cause.
Upon written application, group medical insurance coverage is available to all regular employees. The Basic Plan is designated as the City's basic health plan.
The City will pay a portion of the cost of the health insurance plan for individual employee coverage. If desired, employees may extend coverage to their families; the City will pay a portion of the cost of the total health insurance plan for dependent coverage on a monthly basis as approved by the City Council.
Application for these benefits must be made within thirty (30) days from the date of employment or during an annual open enrollment period.
Upon written application, group dental insurance coverage is available to all regular employees.
Application for these benefits must be made within thirty (30) days from the date of employment or during and annual open enrollment period.
The City will pay all or a portion of the cost of the total dental insurance plan for individual employee coverage. If desired, employees may extend coverage to their families by paying the dental insurance plan dependent coverage portion.
Upon written application, group life insurance with accidental death and dismemberment coverage may be available to all regular employees with additional voluntary coverage available for employee purchase.
8.4.0 Health and Dental Insurance Program for Retired Employees
Employees who retire may continue their health and dental insurance at their expense. This benefit will be administered in a manner as set forth in Administrative Directive 2-20, Continued Benefits for Retired Personnel.
8.5.0 Employee Assistance Program
The City has made arrangements with Family Services (www.fsslc.org) whereby employees and/or their family members can receive counseling. A family member is defined as a spouse, child or parents. The first 12 sessions will be paid for entirely by the City. The City will pay 75% of the next 12 sessions. Thereafter, should counseling continue past 24 sessions, the City will pay 50%. The employee will be charged for the portion of the fee the City does not pay (i.e., 25% and 50%) on the basis of ability to pay. When a period of time has elapsed between counseling sessions, Family Services will make the determination on whether or not it is a new event or a continuation of a previous event for billing purposes.
Other types of programs may also be available. To find out about any additional programs, the Director of Human Resources should be contacted. (See Admin. Dir. 2-2, Alcohol and Drug Policy for CDL Holders and Admin. Dir. 2-3, Alcohol and Drugs)
8.6.0 Flexible Spending - FLEX
All full-time and regular part-time employees are allowed to participate in the FLEX PLAN. The Internal Revenue Code Section 125 permits employees to take advantage of current tax laws, while providing some flexibility in benefit selections.
The City will provide between $150-$200 under the Think Healthy Wellness Program per flex plan year for each regular employee to be used for unreimbursed medical expenses only. Regular part-time employees will receive a pro-rated amount to be used for unreimbursed medical expenses. Employees must qualify to earn these Think Healthy contributions annually. Employees will be allowed to make additional contributions to cover reimbursement (before-tax dollars) in the following areas:
· Medical insurance premium
· Dental insurance premium
· IMRF Voluntary Life insurance premium
· Certain AFLAC premiums
· Vision care (examination, prescription glasses)
· Hearing care (examination and aid)
· Prescription drugs
· Day care services ($5,000 annual maximum)
· Medical and dental care deductibles
· Unreimbursed medical and dental expenses
Should an employee choose, the Think Healthy City contribution may be placed in a deferred compensation program. Employees must insure they do not exceed the maximum allowable contribution amount by use of the Think Healthy dollars in this manner.
Whichever option chosen, employees will have to participate in the Think Healthy program in order to receive the City's contribution by choosing from a list of healthy options and program offerings during the year. This will be explained each year prior to the time to sign up for the flex plan.
The flex plan runs from January 1 through December 31 of each year. Every eligible employee, whether they receive the City contribution or not, will be asked to make an election to participate in this program in November through an online enrollment process. Those choosing to participate will have their elected amount withheld through payroll deductions based on 26 pay periods.
All funds contributed to the flex account must be used within the year in which they are pledged. Employees have 90 days following the end of the plan year to submit charges to the flex account, however, the charges must have been incurred during the plan year and must be received by the plan administrator with appropriate documentation before the end of this 90-day period. Between $50 and $500 of unused funds may be rolled into the following year. Other unused funds are not reimbursable to the employee, but will be used for employee benefits or functions, including the Think Healthy Program.
8.7.0 Continuation of Benefits
The right to COBRA Continuation Coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended (COBRA). COBRA Continuation Coverage can become available to employees when an employee would otherwise would lose group health coverage. It also can become available to other members of the employee’s family who are covered under the Plan when they otherwise would lose their group health coverage. The entire cost (plus a reasonable administration fee) must be paid by the person. Coverage will end in certain instances, including if the employee or dependents fail to make timely payment of premiums. Employees covered by the City’s insurance have a right to choose this continuation coverage if they lose their group health coverage because of a reduction in hours of employment or the termination of employment for reasons other than gross misconduct.
A covered spouse has the right to choose continuation coverage if he/she loses group health coverage for any of the following reasons:
Employee’s hours of employment are reduced;
Employee’s employment ends for any reason other than his or her gross misconduct;
Employee becomes entitled to Medicare benefits (under Part A, Part B, or both); or
Employee and spouse become divorced or legally separated.
In the case of the dependent child of an employee, he/she has the right to continuation coverage if group health coverage is lost for any of the following reasons:
The parent-Covered Employee dies;
The parent-Covered Employee’s hours of employment are reduced;
The parent-Covered Employee’s employment ends for any reason other than his or her gross misconduct;
The parent-Covered Employee becomes entitled to Medicare benefits (Part A, Part B, or both);
The parents become divorced or legally separated; or
The child stops being eligible for coverage under the plan as a “dependent child.”
Under the law, employees or a covered dependent has the responsibility to notify the Human Resources Department in the event of divorce, legal separation, or a child losing dependent status within 60 days of any of the above-named actions or the day coverage would end under the plan because of the action, whichever is later. They will then be advised of their or their dependent’s responsibilities relative to continuation of coverage. Under the law, the employee and/or dependent has at least 60 days from the date of employer notification or the date they would have lost coverage because of the event to let Human Resources know that they want continuation coverage.
Any children born or adopted during COBRA coverage are qualified beneficiaries and, as such, have the same rights as employees. Consequently, COBRA participants may change their coverage status upon the birth or adoption of a child.
If continuation of coverage is not chosen, the group health insurance coverage will terminate. If they choose continuation coverage, the City is required to give coverage which, as of the time coverage is being provided, is identical to the coverage provided under the plan to similarly situated employees or family members. The law requires that employees be afforded the opportunity to maintain continuation coverage for 36 months unless group health coverage is lost because of a termination of employment or reduction in hours. In that case, the required continuation coverage period is 18 months. However, the law also provides that continuation coverage may be cut short for any of the following reasons:
The Employer no longer provides group health coverage to any of its employees.
The premium for continuation coverage is not paid.
They become covered under another group health plan as an employee or otherwise.
They become eligible for Medicare Part A or Part B, whichever comes first.
Persons with COBRA continuation health coverage as a result of termination of employment (or reduction in hours) and who are disabled under the Social Security Act at the time of the qualifying event can extend the continuation period from 18 months to 29 months. To be eligible for this extension, the qualified beneficiary must notify the Human Resources Department before the end of the initial 18 months of COBRA coverage and within 60 days of receiving notice from Social Security. In the event certification of disability under the Social Security Administration takes place for any qualified beneficiary at the time or within 60 days of the time COBRA coverage begins, coverage may be continued for 29 months. If the individual entitled to the disability extension has non-disabled family members who are entitled to COBRA continuation coverage, the non-disabled family members are also entitled to the 29-month extended period of coverage. The maximum premium for the additional 11 months of coverage is 150% of the cost of coverage rather than the 102% rate set for the initial 18 months.
8.8.0 HIPPA Privacy Rule
The City complies with the HIPPA Privacy Rules in dealing with your personal health information (PHI). (See Admin. Dir. Section 7)