[R.O. 2007 § 125.055; Ord. No. 3215 § 1, 3-23-2000; Ord. No. 3357 §§ 1 — 2, 12-14-2000; Ord. No. 3509 § 1, 8-23-2001; Ord. No. 4936 § 1, 12-13-2007; Ord. No. 7478, 7-22-2021; Ord. No. 7513, 9-23-2021]
A. The City Administrator is hereby directed to implement amendments to the City of St. Peters Health Plan as it may be stated and restated from time to time and described in health plan booklets (the "plan"), and its dental insurance policy consistent with and substantially containing the following provisions set forth below for all eligible employees, their eligible spouses and dependents and eligible retired employees and their eligible spouses and eligible dependents. The amendments to the plan and/or insurance policies set forth below shall be effective October 1, 2018, for all persons who are eligible employees, their eligible spouses and eligible dependents on that date and thereafter. Except as otherwise provided herein, the amendments and provisions described below apply to all retired employees of the City, and their eligible spouses, who previously retired, or retire, on or after January 1, 2001.
B. Such plan and/or policy amendments shall include in substance the following:
ELIGIBLE DEPENDENTA natural or adopted child or children, whether legitimate or illegitimate, including any stepchild claimable by the eligible employee on his or her Federal tax returns at the time of enrollment, who is no more than twenty-five (25) years of age, or as may otherwise be defined in the plan.
ELIGIBLE EMPLOYEE(a) An employee of the City who is designated to be a regular, full-time City employee who is routinely scheduled to work at his or her job at least forty (40) hours per week, and (b) all elected officials of the City who elect to be a subscriber or participant in the plan.
PARTICIPANTAn eligible employee and his or her eligible spouse and eligible dependents under the plan or retired employee and eligible spouse and eligible dependents who are properly enrolled in the plan.
RETIRED EMPLOYEEAn eligible employee who has retired directly from employment with the City or has died while employed by the City, and who (a) has accrued at least five (5) years of service with the City prior to retirement or death; (b) who has attained at least age fifty-five (55) [age fifty (50) if a City Police Officer] or whose combination of age and years of service with the City equals at least eighty (80) at retirement or death; and (c) had elected to be a subscriber or participant in the plan at the time of his or her retirement from the City or death. Employees who terminate from employment with the City prior to their having attained the aforementioned age requirement or service requirement but who thereafter meet that requirement and begin to receive pension or retirement benefit payments shall not be eligible to participate in this plan or the Medicare supplemental policy described in Subsection
(D)(2) below.
C. Termination Of Participant Or Subscriber Coverage.
1. Subject to an eligible employee, surviving eligible spouse or surviving eligible dependent's continuation of coverage rights as provided by law and the plan, a plan participant will lose coverage under the plan on the earliest of the dates described below:
a. The last day of the month in which an employee participant ceases to perform work for the City or, if earlier, the date on which such an individual otherwise ceases to be an eligible employee under the terms of the plan. In the case of an employee participant who ceases to perform work because of:
(1) Approved leave of absence, the employee's coverage may continue under the plan for such periods as may be consistent with City policies and procedures or until his/her employment is actually terminated by the City;
(2) Total and permanent disability (as determined pursuant to the City's group long-term disability plan or the LAGERS retirement plan) coverage will continue for the employee participant until he or she attains age sixty-five (65), provided, however, that the employee participant:
(a) Had completed sixty (60) or more months of work with the City at the time he or she became totally and permanently disabled; and
(b) He or she was determined to be entitled to receive disability income benefits under the group long-term disability benefit plan maintained by the City or the LAGERS retirement plan and continues to receive those benefits;
(3) Retirement, a retired employee may elect to continue coverage under this plan in accordance with the rules provided below;
b. If an employee participant fails to timely make any required participant contribution, and thereafter fails to timely make such contribution within thirty (30) days of delivery of notice of the failure to pay any required participant contribution, the last day of the period for which the last participant contribution received was applied;
c. The date on which the plan is terminated by the City;
d. The date on which the plan is amended to eliminate participation of an eligible employee or participant; or
e. The date on which a participant ceases to be an eligible employee or eligible to otherwise be a participant.
2. As of the date a participant's coverage terminates in accordance with the above provisions, such an individual will no longer be entitled to receive any benefit under the plan; however, claims for covered medical expenses as limited by the provisions hereof, which are incurred before the date on which the participant loses coverage, but which have not yet been submitted to the Plan Administrator, and those which have been submitted, but are not yet paid, may be paid to or on behalf of the participant after the date on which his/her coverage under the plan ceases.
D. Retiree Coverage. A retired employee may continue to participate in the plan or obtain post-retirement medical coverage under the Medicare supplemental policy described below, as follows:
1. Application For Retired Employees, Eligible Spouses and Eligible Dependents.
a. Participation in the plan, or the Medicare supplemental policy described below, as a retired employee is voluntary and contributory. If a retired employee wishes to obtain post-retirement medical coverage under the plan or Medicare supplemental policy, then within thirty-one (31) days from the date of a retired employee's termination of employment, he or she must complete and return to the Plan Administrator an enrollment form whereby the retired employee elects to participate in the plan's post-retirement medical coverage or the Medicare supplemental plan. At the time of tendering the enrollment form, the retired employee also must pay any contribution required of the retired employee for his or her first month of plan participation.
b. The eligible spouse and eligible dependents of a retired employee may participate as covered person (as defined in the plan) in post-retirement medical coverage provided by the plan, or Medicare supplemental policy described below, provided that the eligible spouse must be the legal spouse of the retired employee on the retired employee's date of retirement and who has been legally married to the retired employee for at least two (2) full years prior to the date of the employee's retirement. If a retired employee wishes to enroll his or her eligible spouse and/or one (1) or more eligible dependents for such post-retirement medical coverage, then he or she must do so by completing the appropriate enrollment process and tendering any contribution required for plan coverage of the eligible spouse and/or eligible dependents within the same period as described in Subsection
(D)(1)(a) above. Notwithstanding the foregoing, if the eligible spouse and eligible dependents, if any, of a retired employee that retires on or after July 22, 2021, are provided coverage as a named subscriber, insured, enrollee, or covered person under any group or individual health benefit plan at the time of the employee's retirement, the retired employee may defer enrollment of his or her eligible spouse and eligible dependents for such post-retirement medical coverage until such time as the eligible spouse or eligible dependents lose coverage as a named subscriber, insured, enrollee, or covered person under any group or individual health benefit plan for any reason except the non-payment of premiums.
(1) The surviving eligible spouse and surviving eligible dependents of a retired employee may participate as covered person (as defined in the plan) in post-retirement medical coverage provided by the plan, or Medicare supplemental policy described below, provided that the surviving eligible spouse must be the legal spouse of the retired employee on the retired employee's date of death and who has been legally married to the retired employee for at least two (2) full years prior to the date of the employee's death. If a surviving eligible spouse or any surviving eligible dependent wishes to enroll for such post-retirement medical coverage, then he or she must do so by completing the appropriate enrollment process and tendering any contribution required for plan coverage of the eligible spouse and/or eligible dependents within the same period as described in Subsection
(D)(1)(a) above. Notwithstanding the foregoing, if the surviving eligible spouse and surviving eligible dependents, if any, of a retired employee that dies on or after July 22, 2021, are provided coverage as a named subscriber, insured, enrollee, or covered person under any group or individual health benefit plan at the time of the retired employee's death, the surviving eligible spouse and any surviving eligible dependent may defer enrollment for such post-retirement medical coverage until such time as the surviving eligible spouse or surviving eligible dependents lose coverage as a named subscriber, insured, enrollee, or covered person under any group or individual health benefit plan for any reason except the non-payment of premiums.
c. Unless eligible for deferral under Subsection
(D)(1)(b) of this Section, if a retired employee, surviving eligible spouse or surviving eligible dependent fails to enroll, or a retired employee fails to enroll his or her eligible spouse or eligible dependents, within the thirty-one-day period, provided his or her coverage under the plan shall terminate as of the date determined under the plan, and he/she shall no longer be eligible to participate as a retired employee, surviving eligible spouse or surviving eligible dependent either under the plan or the Medical supplemental policy described below. He or she may be eligible to continue plan participation for a limited period pursuant to the plan's continuation of coverage provisions for non-retired employees.
d. If at any time a retired employee, or his or her eligible spouse or eligible dependents covered by the plan or Medicare supplemental policy, ends plan participation in the plan's post-retirement medical coverage or in the Medicare supplemental policy described below, then neither that retired employee or his or her eligible spouse or eligible dependents whose participation ended may reenroll in the plan or Medicare supplemental policy.
Notwithstanding the foregoing, if a retired employee, his or her eligible spouse, or his or her surviving eligible spouse who would otherwise be eligible to enroll in the Medicare supplemental policy described below instead enrolls in a Medicare replacement plan, such as a Medicare Complete or Medicare Choice program, instead of the Medicare supplemental policy, such retired employee and his or her eligible spouse, or his or her surviving eligible spouse may anytime thereafter elect to enroll in the Medicare supplemental policy offered hereunder.
e. Effective January 1, 2008, retired employees who retire after having attained eligibility for Medicare may enroll in a Medicare supplemental policy, to be provided pursuant to this Code, within the same period and pursuant to the same method as specified in Subsection
(D)(1)(a) and
(b) above.
2. Post-Retirement Medical Benefits And Exclusions. The benefits available under the plan or the Medicare supplemental policy described below to a retired employee participant, eligible spouse and eligible dependents, if any, shall be those benefits and coverages described in this plan at the time the medical expense is incurred for which a benefit is claimed under the plan or the Medicare supplemental policy with the following exceptions:
a. Medicare Eligibility. Effective January 1, 2008:
(1) Retired employees who retired prior to January 1, 2008, and their eligible spouses who are covered by the plan on January 1, 2008; and
(2) Employees of the City who retire on or after January 1, 2008, and become retired employees, as well as their eligible spouses, who are or become eligible for Medicare, i.e., by reason of having attained age sixty-five (65), having become disabled for social security purposes or otherwise, as well as employees of the City who retire after attaining age sixty-five (65), will not be entitled to participate in the plan or receive any benefits or coverage under it.
b. Medicare Supplemental Policy. Effective January 1, 2008:
(1) Retired employees who retired prior to January 1, 2008, and their eligible spouses who are covered by the plan on January 1, 2008; and
(2) Employees of the City who retire on or after January 1, 2008, and become retired employees, as well as their eligible spouses who are or become eligible for Medicare, i.e., by reason of having attained age sixty-five (65), having become disabled for Social Security purposes or otherwise, as well as employees of the City who retire after attaining age sixty-five (65), will be provided post-retirement medical benefits by the City pursuant to a separate Medicare supplemental insurance policy to be procured by the City in such amount and of such type as the City determines, from time to time, to be appropriate instead of coverage under the plan.
c. Pre-Medicare Eligibility. Effective October 1, 2008, for retired employees and their eligible spouses who have not yet attained Medicare eligibility, the provisions of this plan applicable to those retired employees and their eligible spouses will be amended to reflect the specific schedule of benefits as attached to the plan from time to time. Notwithstanding any other provisions of the plan as it may apply to retired employees and their eligible spouses, the provisions of that schedule of benefits shall supersede all conflicting plan provisions and replace the plan's schedule of benefits which is applicable to non-retired employees.
d. Provisions Of The Plan Not Applicable To Retired Employees. The following provisions of the plan are not applicable or available to retired employees or are modified as follows:
(1) Maximum Plan Benefits. Accumulated usage under, or expenses applicable toward, lifetime or annual maximum benefits, out-of-pocket maximum expenses or deductibles or limitations are not reset upon termination of employment from the City. Rather, such amounts which have been accumulated or which were applicable toward such limitations, maximums or deductibles continue while a person is entitled to receive post-retirement medical coverage under the plan as a retired employee or enrolled eligible spouse or enrolled eligible dependent.
(2) Termination Of Coverage And Reenrollment. Upon an employee's retirement from the City, coverage under the plan ends. A retired employee, his or her otherwise eligible spouse, and his or her eligible dependents may then continue coverage under the plan, or the Medicare supplemental policy described below, upon reenrollment as described in Subsection
(D)(1) above.
(3) Dependents. Retired employees that retired prior to October 1, 2018, are not eligible to add or retain any dependents to this plan nor are coverage or benefits provided under this plan to dependents other than the eligible spouse of a retired employee who is appropriately enrolled and maintained as a covered person as provided in Subsection
(D)(1) above.
(4) Special Enrollment. The special enrollment period and rules of Section 4 of the plan are not applicable to retired employees. Subject to the retired employee enrolling pursuant to the provisions of subsection
(D)(1)(a) of this Section, benefits under this plan may be provided to, an eligible spouse and eligible dependents of the retired employee pursuant to Subsection
(D)(1)(a) or
(b).
(5) Continuation Of Coverage. The continuation of coverage provisions of Section 8 of the plan under COBRA do not apply to retired employees, their eligible spouses or their eligible dependents who elect to continue participation as a retired employee under this Code Section
125.055. At retirement, a retired employee has the option to elect the continuation of coverage provisions of COBRA under Section 8 of the plan and to pay the full plan premium for such coverage or to elect continuation under this plan as provided under this Section
125.055. If a retired employee elects continued coverage under this plan as a retiree, then the retired employee (and his or her eligible spouse and eligible dependents if he or she so elects) will have no further rights to COBRA continuation.
3. Retired Employee Premiums/Contributions. Except as specifically provided below and as a condition to obtaining post-retirement medical coverage under the plan or the Medicare supplemental policy described above, all retired employees, surviving eligible spouses and surviving eligible dependents shall make such premium payments and shall pay such contributions as may be established from time to time by the City and as specified below. The monthly premium contribution rate per retired employee, and per covered eligible spouse and eligible dependents, will equal a percentage of the estimated monthly insurance policy or contract premium cost, or self-funded plan estimated monthly cost, as determined by the City and as specified below:
| Retired Employee Years of Service at Retirement | Percentage of Monthly Premium or Plan Cost to Be Paid by Retired Employee Contribution | Percentage of Monthly Premium or Plan Cost to Be Paid by City Contribution |
|---|
3% per year of service City contribution | 5 | 90% | 10% |
6 | 87% | 13% |
7 | 84% | 16% |
8 | 81% | 19% |
9 | 78% | 22% |
10 | 75% | 25% |
3 1/2% per year of service City contribution | 11 | 71.5% | 28.5% |
12 | 68% | 32% |
13 | 64.5% | 35.5% |
14 | 61% | 39% |
15 | 57.5% | 42.5% |
4% per year of service City contribution | 16 | 53.5% | 46.5% |
17 | 49.5% | 50.5% |
18 | 45.5% | 54.5% |
19 | 41.5% | 58.5% |
20 | 37.5% | 62.5% |
4.5% per year of service City contribution | 21 | 33% | 67% |
22 | 28.5% | 71.5% |
23 | 24% | 76% |
24 | 19.5% | 80.5% |
25 | 15% | 85% |
5% per year of service City contribution | 26 | 10% | 90% |
27 | 5% | 95% |
28 | 0% | 100% |
a. Employees who retire with twenty-eight (28) years of service or more with the City shall make no monthly contribution, and the City shall pay one hundred percent (100%) of the premium costs for coverage for the retired employee and his or her eligible spouse under the plan and/or Medicare supplemental policy.
Notwithstanding the foregoing, for those retired employees who provided the City twenty-two (22) years of service and, consistent with the policy of the City in place at the time of their retirement, paid one hundred percent (100%) of the retired employee and their eligible spouse's contribution costs, the City shall pay one hundred percent (100%) of a retired employee participant's and their eligible spouse's contribution.
b. The amount of plan cost or premium and the amount to be charged for participation shall be determined annually, or at such other times as the City may determine, based on the City's actual costs, level of service, premium rates and such other factors as the City determines appropriate including, but not limited to, costs of excess coverage, administration, Medicare supplemental policies.
c. The premium contribution for the eligible spouse of a retired employee will be an amount equal to the appropriate percentage, as determined above, of the applicable premium cost assessed by the City for the retired employee or eligible spouse. Payment of the full amount of the monthly premium contribution for the eligible dependents of a retired employee will be the sole responsibility of the retired employee or, if coverage is elected under subsection
(D)(1)(b)(1), the surviving eligible spouse or the surviving eligible dependent.
d. Retired employees and their covered eligible spouses and eligible dependents, if any, shall make monthly premium contributions to the City of St. Peters on or before the first day of the month for which coverage under the plan or the Medicare supplemental policy is to be provided. Premium and contribution billings will not be sent to retired employees. The City will send a contribution collection (delinquency) notice if required contributions are not received on a timely basis. If required contributions are not made within thirty (30) days of the date on which a contribution delinquency notice is sent, coverage under the plan or Medicare supplemental policy will be terminated.
4. Termination Of Post-Retirement Medical Coverage. Post-retirement medical coverage under the plan, and Medicare supplemental policy purchased by the City, shall terminate for a retired employee participant and his or her covered eligible spouse and eligible dependents on the earliest to occur of the following dates:
a. The later of the date of such retired employee participant's death, his or her covered eligible spouse's death, or each of his or her eligible dependents' deaths;
b. If a retired employee participant, surviving eligible spouse participant, or surviving eligible dependent participant fails to timely make any required contribution, and thereafter fails to make such contribution within thirty (30) days of issuance of notice of the failure to pay any required participant contribution, the last day of the period to which the last participant contribution received was applied;
c. The date on which the plan, and/or the Medicare supplemental policy maintained under it, is terminated by the City;
d. The date on which the plan or this Code is amended to eliminate participation of a retired employee participant or covered eligible spouses or eligible dependents; or
e. The date on which a participant ceases to be an eligible retired employee, eligible spouse of a retired employee, eligible dependent of a retired employee, or to otherwise be eligible as a participant.
5. Funding, Benefit Limitations And Payment Responsibility. As of January 1, 2008, the City of St. Peters is responsible for payment of post-retirement medical benefits due under the plan for retired employees and for the premiums for the Medicare supplemental policy, less contributions made by retired employees. It is the intention of the City of St. Peters to establish a separate, stand-alone trust for future funding of post-retirement medical benefits under this plan and the Medicare supplemental policy for retired employees and their eligible spouses and eligible dependents.
a. In the event that the City does create and fund a trust for payment of post-retirement medical expenses for retired employees, then all expenses under the plan incurred for retired employees, their eligible spouses and their eligible dependents, as well as premiums to be paid for the Medicare supplemental policy, less all retired employee contributions, will be paid through that trust and after the date that such trust is established, will not be paid by the City. The amount of benefits for retired employees to be paid thereafter under this plan and premiums to be paid under the Medicare supplemental plan shall be paid from the trust.
b. After creation of such trust, plan benefits and premiums under the Medicare supplemental plan, less contributions by retired employees, will be provided only to the extent of the value of assets held by the trust. To the extent trust assets are insufficient to pay for plan benefits for retired employees, their eligible spouses, or their eligible dependents or coverage under the plan or premiums under the Medicare supplemental policy, the City shall have no further responsibility for their payment.
c. If the assets held by the trust are exhausted, benefits will no longer be provided under the plan for retired employees, their eligible spouses or their eligible dependents, and premiums will no longer be paid for the Medicare supplemental policy.
d. The amount and level of funding for the trust, if any, will be determined by the City's Board of Aldermen in its judgment and discretion pursuant to the City budgetary process. The City has no obligation to make any specific amount of contributions or payments to the trust or to make contributions sufficient to fund benefits or coverage under this plan or the Medicare supplemental plan.
E. Amendment, Termination And Application. Notwithstanding any other provision of this Section, the City reserves the right to modify or terminate at any time the provisions of the plan or this Code applicable to retired employee participants, spouses and their eligible dependents. In addition, the provisions of this Section
125.055 of the Code will apply to all retired employees, including those who do not participate in and have coverage under the plan but who, for instance, may be covered by, or attempt to become covered by, the Medicare supplemental policy.