A. 
Purpose. The purpose of this section is to establish procedures for the administration and eligibility of the employee insurance programs.
B. 
Health insurance.
(1) 
Health benefits will be provided through the Borough's insurance carrier under the terms and conditions of the applicable plan. Eligibility for benefits is determined through the carrier and subject to the thresholds of the Affordable Care Act. The employee shall contribute towards the cost of the health/prescription coverage as required by New Jersey law. That contribution shall never be less than the 6% of dependent cost.
(2) 
Post-retirement medical/prescription benefits.
(a) 
Upon retirement, after 20 years of employment with the Borough and 25 years of creditable service with the state-administered pension or 15 years of employment with the Borough and obtaining the age of 62 or older, all full-time employees, along with their spouse of record at the time of retirement, will be eligible for benefits as follows:
[1] 
Following retirement and until Medicare eligibility, the retiree (and their spouse of record at the time of retirement, along with eligible dependents) will be on the Borough's health care plan, except the retiree shall contribute towards the cost of the health/prescription coverage as required by New Jersey law. The premium copayment will be frozen at the percentage in effect at the time of retirement of the employee, except that in no event will the percentage be less than New Jersey statutory minimums. That contribution shall never be less than the 6% of dependent cost. Following Medicare eligibility, the retiree shall be responsible for all applicable Medicare costs, expenses, and premiums charged to the retiree, spouse and/or any eligible dependents. The Borough's health care plan will be secondary to Medicare. As to the Borough's secondary coverage, the retiree shall be subject to the same conditions as above for contributions to health care costs, subject to any applicable statutory restrictions.
[2] 
Retirees shall pay the medical and prescription copayments that are designated by the Borough's health insurance carrier.
(3) 
Waiver of benefits. The employer shall make payments to eligible employees who agree in writing to waive their medical benefits, pursuant to a cafeteria plan authorized by Section 125 of the Internal Revenue Code. The following terms shall apply:
(a) 
In order to be eligible, employees must show proof of other current medical coverage through a spouse's employer or other source annually.
(b) 
Employees shall be permitted to re-enroll during any subsequent open-enrollment period or upon showing loss of alternative coverage.
(c) 
Payments shall be made on a monthly basis so long as the waiver remains in effect, beginning with the month in which the benefit ceases. Payments shall be made in accordance with the amounts set forth in the salary ordinance and will be based on the type of coverage to which the employee would otherwise have been entitled.
A. 
Employees may be eligible for benefits under COBRA on retirement or separation under the terms and conditions set by COBRA regulations. Employees with questions about COBRA eligibility should contact the Administrator.
B. 
Statement of policy.
(1) 
Employee and/or dependent medical coverage under the current plan may cease as a result of one of the following events:
(a) 
Termination of employment.
(b) 
Change to nonparticipating employment status.
(c) 
Divorce or legal separation.
(d) 
Dependent child became ineligible (attained age 23).
(2) 
Employees or dependents may elect to continue medical coverage beyond the date that it would otherwise terminate by:
(a) 
Participating in the group medical coverage plan under the criteria outlined below:
[1] 
Rights of an employee. Employees presently covered by the insurance plan may continue this coverage for up to 18 months from the date that employment terminates or status changed to a nonparticipating (noninsured) employment status, provided that the employee pays the full cost of premium and any administrative fee (up to 2%) that may be imposed.
[2] 
Rights of a spouse of an employee. The spouse of an employee covered by the medical plan has the right to continue coverage if the employee was terminated or changed to nonparticipating employment status or if a divorce or legal court-decreed separation from the employee took place. Coverage under these circumstances may continue for a period up to 36 months, provided that the spouse pays the premium in full and any administrative fee (up to 2%) that may be imposed.
[3] 
Rights of child(ren). Dependent children of an employee covered by the medical plan have the right to continue coverage if group health coverage under the medical plan is lost because of termination of a parent's employment or change to nonparticipating employment status; parents' divorce or legal court-decreed separation; or the dependent ceases to be a "dependent child" under the medical plan (attains age 23). Coverage under these circumstances may continue for a period up to 36 months, provided that the spouse pays the premium in full and any administrative fee (up to 2%) that may be imposed.
(3) 
Election.
(a) 
If an employee or eligible spouse or dependent does not elect to continue coverage, group health insurance will end as scheduled under the plan.
(b) 
If an employee elects to continue group medical coverage, the employee or eligible spouse or dependent is responsible for paying the entire cost. This cost will be subject to periodic rate changes.
(c) 
Continued coverage may be terminated earlier than the eighteen- or thirty-six-month period if group medical plans for all other employees are terminated, or if the employee or eligible spouse or dependent:
[1] 
Fails to remit the required monthly payments within 31 days of the due date;
[2] 
Becomes eligible under any other group medical plan;
[3] 
For a covered spouse: remarries and becomes eligible to be covered under a group medical plan; or
[4] 
Becomes eligible for Medicare.
A. 
Purpose. The purpose of this section is to establish procedures for the handling of insurance claims against the Borough.
B. 
Statement of policy.
(1) 
No employee will discuss matters involving claims against the Borough.
(2) 
All questions pertaining to claims shall be referred to the Borough Administrator.
(3) 
Claims for damages presented to the Borough shall be referred to the Borough Clerk for filing.
C. 
Responsibilities.
(1) 
All Borough employees must notify their supervisor in the case of incidents involving potential claims within one day of the occurrence. The supervisor must report, in writing, to the Borough Administrator within three days of the occurrence. Items reported should include any property damage occurring during work for the Borough, no matter how small.
(2) 
The Borough Clerk is responsible for accepting service of process of complaints against the Borough and its employees, officers and officials. All damage claims against the Borough shall be received by the JIF Claims Coordinator.
(3) 
The Borough Administrator shall:
(a) 
Ensure that any applicable provisions of state law are met and see that all claims for damages accurately locate and describe the defect or act that caused the injury, reasonably describe the injury and state the time when it occurred, contain the item of damages claimed and are verified by the claimant or a relative of the claimant, attorney or agent of the claimant.
(b) 
Refer the claim to the carrier within five working days and provide an informational report to the Borough Council on claim status.
(c) 
Recommend action to the Borough Council within 30 days of receipt regarding claims which fall below deductible limits of existing policies or which are not covered under existing policies.