§ 2-408. Insurance.

Each full-time City employee, elected official, full-time appointed official, and retiree will have the opportunity to participate in the various insurance programs offered by the City. State and federal laws give certain employees, spouses and dependent children the right to continue employer-sponsored health insurance benefits at group rates if they lose benefits because of certain qualifying events. The type of qualifying event determines who is qualified for continued coverage.

Health Insurance: Full-time employees who work a minimum of 1950 hours annually and elected officials who qualify for participation in the program in accordance with any eligibility criteria established by the selected carrier(s), shall be entitled to receive group health insurance coverage as determined and provided by the City. The City provides health insurance coverage for all full-time regular (non-seasonal) employees, full-time appointed officials, elected officials, their spouses, and/or their children in accordance with mandated employee contribution levels, as determined by the City Council. Specific information concerning coverage, limits, guidelines, and employee cost of insurance are subject to change on an annual basis. The employee premium contribution will be deducted from the employee's bi-weekly payroll check for a total of twenty-four (24) pay periods out of the annual twenty-six (26) pay periods.

A.

Employee Contribution Levels: The City will pay eighty percent (80%) of the applicable total monthly premium and the employee will be responsible for twenty percent (20%) of the applicable total monthly premium. In the event a husband and wife are both employed by the City, the individual first employed by the City will carry the dependent coverage. Dependent coverage shall be carried under only one (1) of the parent's policies.

B.

Deductible: It should be noted that certain deductible amounts, as established from time to time may need to be satisfied prior to receiving said benefits. Health insurance coverage terminates upon the employee's last day of employment with the City, unless the employee is eligible and elects to participate in insurance opportunities made available by federal law ("COBRA") or a health insurance program under Illinois law. The Public Health Services Act requires state and local governments to offer continuation coverage equivalent to COBRA requirements.

C.

Insurance Continuation: Any full-time employee who is unable to work and is under a physician's care for an illness or disability will continue to have his or her insurance premium paid by the City, excluding the employee's cost sharing portion of the premium, for a period of nine (9) months. If at that time, the employee is still unable to work and is under a physician's care for an illness or disability and the employee's employment with the City has not been terminated, the employee will have the option to continue the payment of the full insurance premium at his or her expense. If the employment is terminated prior to the expiration of nine (9) months, the employee shall thereafter have the option of continuing health insurance at his or her own expense to the extent provided by federal continuation requirements equivalent to COBRA or health insurance programs under Illinois law.

D.

COBRA: In April of 1986 the Federal Government passed legislation that requires employers with twenty (20) or more employees to provide for the continuation of their health care coverage under certain circumstances. This continuation is paid for by the employee and is to be continued at group rates in certain instances where coverage under the group plan would normally end. Group health plans maintained by a state or local government are subject to the same health continuation requirements that were added by COBRA to the Public Health Services Act.

E.

Retirees: Eligible employees who retire from City employment have the option of continuing on the group health plan as established by State Statute for the various fund participants or by COBRA with payment of insurance premiums being the sole responsibility of the individual retiree. Medicare eligible retirees are required to become Medicare primary, as soon as they become eligible for Medicare.

F.

Temporary Disability: Payment of insurance premiums for those employees who are temporarily disabled will be determined by the City Administrator on an individual basis.

G.

Health Savings Account Prorated Contribution: If an eligible employee experiences a qualifying event during any calendar year that the City Council has authorized the City to partially fund an employee's health savings account, then the employee's health savings account shall be funded on a prorated basis of the amount authorized by the City Council divided by 365 days. That amount will then be multiplied by the remaining days within the calendar year to determine the contribution amount. For example, if the City Council authorizes a $1,250 contribution for employee only coverage and a $2,500 contribution for employees who have more than employee only coverage and a single employee who was presently covered with employee only coverage gets married on November 15th, that employee would be eligible for $1,250 more divided by 365 (days of the calendar year) multiplied by 47 (the remaining days of the calendar year) which equals $160.96. This contribution will be made into the employee's health savings account within 30 calendar days after the City is notified of the qualifying event. The prorated contribution shall also apply to new hires. The date used to determine the prorated contribution for new hires shall be the date the employee is actively entered into the City's health insurance program.

The City reserves the right to seek health insurance quotes on an annual basis from multiple carriers and brokers. Pending the outcomes of these quotes, the health insurance carrier and/or the copayment requirements, prescription copayment requirements, deductible amounts, co-insurance amounts, employee premium contribution requirements, and the medical network are subject to change on an annual basis.

Health insurance benefits become effective on the first day of the next month following a thirty (30) day waiting period from the date of employment.

Dental Discount Plan: Full-time employees who qualify for participation are offered the opportunity to participate in an annual dental discount plan for the employee and the employee's family. The cost to participate is born 100% by the employee through an annual payroll check deduction. Said plan provides free initial examinations and a 25% to 35% savings on dental services.

Dental and Vision Insurance: Full-time employees and retirees who qualify for participation are offered the opportunity to participate in a voluntary dental and vision insurance program. The cost to participate is borne 100% by the employee or retiree through an annual payroll check deduction. Terms of the plan are subject to change on an annual basis.

Life Insurance: The City will pay the premium for a twenty thousand ($20,000) term life insurance policy for each full-time employee and elected official. The City will also pay the premium for a universal life insurance policy that is based upon gender and age at the time of eligible employment with the City. Each covered employee may also elect to purchase up to an additional fifty thousand dollars ($50,000) in life insurance at the employee's expense.

Flexible Spending Account: The City provides a voluntary flexible spending account option for full-time regular employees to assist the employee to meet his or her qualified health care costs. The City makes this opportunity available each year during the open enrollment period. The City reserves the right to establish both minimum and maximum amounts of required contributions to this account on an annual basis.

Supplemental Health Insurance Plans: The City reserves the right to review supplemental plans from time to time and may at the City's discretion continue to provide existing plans, add new plans, and/or discontinue supplemental insurance plans on an annual basis.

Waiver Incentive: Current and new employees who have dependents who qualify for family health insurance coverage and select employee-only coverage, or current and new employees who qualify for single health insurance coverage and decline coverage, shall receive a one thousand five hundred dollar ($1,500) annual payment per full policy year at the beginning of each policy year. To be eligible for reimbursement, dependents must be covered by a separate plan not affiliated with the City's health care plan. This election must be made within thirty (30) days for first employment (or the date the participant becomes eligible for coverage under the Medical Plan, if later) and before January 1 of each year thereafter. Once an election is made, it cannot be changed for the remainder of the calendar year unless the participant has a qualifying change in family status. In such case of a qualifying change during the calendar year, the City will make a prorated payment for the remainder of the policy year beginning the first of the next month or on the date the employee qualifies for coverage. Should the employee have a qualifying change in family status and elect employee or dependent coverage after receiving such payment, the employee shall reimburse the City on a prorated basis beginning the first of the next month for the remainder of the policy year. After notification by the health insurance provider of acceptance or reinstatement, this complete payment must be made to the City of Effingham. In the event of termination of employment other than a work related illness or injury, an employee shall be required to reimburse the City on a prorated basis for such payment. An employee electing to add or reinstate coverage will be subject to the health insurance provider's policy restrictions.

(Ord. No. 72-2011, § I(Exh. A), 12-20-2011; Ord. No. 3-2014, § II, 1-21-2014; Ord. No. 6-2015, § I, 3-17-2015)