[Amended 2-2-1993 by Ord. No. 5622-93; 7-18-2000 by Ord. No. 6149-00; 5-1-2001 by Ord. No. 6194-01; 5-18-2004 by Ord. No. 6406-04; 12-31-2010 by Ord. No. 6916-10; 12-3-2013 by Ord. No. 7129-13; 3-3-2015 by Ord. No. 7206-15; 12-19-2017 by Ord. No. 7420-17; 4-17-2018 by Ord. No. 7443-18; 1-21-2020 by Ord. No. 7559-20; 2-7-2023 by Ord. No. 7793-23; 2-4-2997 by Ord. No. 5865-97]
A. Hospitalization and medical coverage. Effective January 1, 2026, the City shall provide to all full-time employees and those employees who work 30 hours per week covered hereunder and to their eligible dependents, except as modified herein, the Blue Cross/Blue Shield medical and hospitalization plans known as the Preferred Provider Option ("PPO") Plan, the Direct Access ("DA") Plan and the Omina Plan, which covered employees may select from during the period of open enrollment. Copies of all policies affecting the employees covered by this agreement shall be on file and available for inspection at the office of the City Clerk of the City of Clifton.
B. Conditions. The following conditions shall apply to the hospitalization and medical coverage provided by the City:
(1) Deductibles: The employer shall have the right to implement up to a $200 deductible for individual subscribers and up to a $400 deductible for family subscribers enrolled in the PPO and a $150 deductible for individual subscribers and up to a $300 deductible for family subscribers enrolled in the DA plan. Omnia Plan deductibles will be based upon the Tier Assignment of the provider or facility. Tier 1 deductible is $0; Tier 2 is a $1,500 deductible for individual subscribers and a $3,000 deductible for family subscribers enrolled in the Omnia Plan.
(2) Physician co-pays: The PPO physician visit co-pay shall be $25 per visit. The DA physician visit co-pay shall be $10 per visit. Omnia Plan co-pays will be based upon the Tier Assignment of the provider. The co-pay is $5 per visit for Tier 1 providers and $10 per visit for Tier 2 providers. There is no co-pay for Tier 1 inpatient admissions and a $150 co-pay for Tier 2 inpatient admissions, other than hospice.
(3) Prescription drug co-pays: The City will continue to provide, at no cost to the employee, except as modified herein, a prescription drug plan with no less coverage than the one presently in force, for the term of this agreement. For the purpose of the City providing prescription coverage to employees, the co-pay for each prescription for nongeneric drugs shall be $25. There shall be no co-pay for generic prescriptions.
(4) Employee contributions: All employees will pay a contribution to health insurance premiums, including prescription and dental, based upon pensionable base salary in accordance with the provisions of P.L. 2010, c. 2 and P.L. 2011, c. 78 which are incorporated by reference as if set forth herein at length.
(5) Dependent coverage: All health insurance coverage hereinabove in Subsection
A are hereby extended to cover, to the extent hereinafter more particularly set forth, all dependent members of the immediate families of all of the employees of the City of Clifton. Such insurance coverage shall be extended to cover, through the end of the calendar year during which each attains his or her 26th birthday, all of the dependent members of the immediate families of the City's employees who are full-time students at a recognized, certified, secondary school or institution of higher learning pursuing a prescribed course of study at any school or institution for which course credits are given or who are "disabled" within the meaning of that term as defined by applicable New Jersey State law.
C. Dental coverage. The City will continue to provide, at no cost to the employee, except as modified herein, a group dental plan with no less coverage than the one presently in force, including orthodontic benefits, for the term of this agreement.
D. Life insurance. The City will provide a $20,000 life insurance policy for all employees covered by this agreement up to the age of 70. For employees age 70 and older, said insurance shall be in the amount of $2,500, and a $1,000 policy shall be provided to all retired employees for the first 10 years of retirement only.
E. Retiree coverage.
(1) Insurance coverage, as set forth in Subsections
A and
C herein, except as modified herein, shall be extended to cover employees who retire from the City of Clifton in accordance with the terms and conditions of the Public Employees Retirement System and N.J.S.A. 40A:10-23. Effective January 1, 2020, the PPO plan will no longer be available to retirees after they reach age 65, or the earliest Medicare eligibility age. After January 1, 2023, retirees who reach age 65, or the earliest Medicare eligibility age, that select Medicare primary with the Direct Access Plan or the Omnia Plan as secondary insurance shall receive 10 years of benefits from the date of retirement. Employees who reach age 65, or the earliest Medicare eligibility age, that select the Braven/HBCBS Medicare Advantage Plan, shall receive lifetime health benefits. Retiree coverage is subject to the terms and conditions set forth.
(2) For any such employee to be qualified for retirement benefits under this section, he or she shall have retired in compliance with the requirements of the Public Employees Retirement System and N.J.S.A. 40A:10-23. Retirees must also meet the eligibility requirements of applicable ordinances and applicable New Jersey Statutes, including, but not limited to, N.J.S.A. 40A:10-21.1, in order to qualify to receive health benefits in retirement. However, any retired employee otherwise qualified for such coverage in accordance with the terms of this paragraph shall not qualify while (a) he or she is employed on a regular basis, and (b) where such employment provides health insurance coverage not less than those specified in Subsections
A and
C herein.
(3) Any employee who has retired in accordance with the Public Employees Retirement System that is entitled to receive coverage beyond the age of 65 years under this section, will be entitled to receive coverage beyond the age of 65, with the provision that the City's health insurance plan shall be secondary insurance to Medicare Parts A and B for employees and their spouses beyond the age of 65. Any employee eligible for Medicare Part A or B shall enroll in same as outlined in Subsection
H below.
(4) Effective January 1, 2026, employees eligible for retirement in accordance with the Public Employees Retirement System shall only be eligible for health insurance coverage in retirement after reaching 20 years of employment with the City of Clifton, in addition to meeting all other statutory requirements.
(5) Any employee qualifying for the above coverage who has reached the age of 65 and elected to receive Direct Access or Omnia will be eligible to continue to receive said insurance benefits by paying City the annual premium for such insurance coverage after the expiration of the ten-year period of retiree medical benefits outlined above. Said benefits shall be secondary to Medicare Part A and B benefits.
(6) Retiree and member health benefit contributions shall be governed by the terms and rates set by New Jersey Statutes including N.J.S.A. 40A:10-21.1 and N.J.S.A. 52:14-17.28, et seq., (P.L. 2011, Chapter 78) as may be amended or modified by any applicable judicial ruling or legislation.
F. Temporary disability insurance.
All confidential employees shall be covered by a temporary disability insurance plan provided by the City. Said plan shall require the City and the employee to each pay 50% of the premium cost. Said plan requires that, to be eligible, an employee must exhaust all accumulated sick leave, plus all other requirements set forth by the plan. The obligated premium cost to eligible confidential employees shall be no more than the premium cost obligation would be under the New Jersey State Disability Plan.
G. Changes in plans or carriers. The City may, at its option, change the Horizon Blue Cross/Blue Shield Preferred Provider Option Plan and/or carriers so long as the coverage provided is substantially similar.
H. Medicare premiums. Confidential employees and their spouse, if applicable, shall continue to be responsible for payment of the costs of their Medicare premiums upon attaining Medicare eligibility, and shall be required to enroll in both Medicare Part A and Medicare Part B and to pay the full amount of the premiums for both. Upon such enrollment in Medicare the City's medical plan will become secondary to Medicare. Should an eligible employee or spouse fail to enroll in both Medicare Part A and Medicare Part B, the employee's (or spouse's) medical plan benefits through the City's medical plan shall be reduced by the amount that Medicare would have paid had the member enrolled.
I. Health insurance opt-out. Confidential employees that receive the City's health insurance coverage shall be eligible for an opt-out bonus when they waive the City's health insurance coverage subject to the following procedures and limitations:
(1) Employees who have other available health insurance, other than through another City employee, will have the opportunity during the annual open enrollment period in June of each year to elect to waive the City's health insurance coverage effective on July 1 of that year.
(2) Any employee who waives health insurance coverage as provided for above shall be entitled to an opt-out bonus of 25% of the net savings to the City on account of the waiver, or $5,000, whichever is less. The waiver terms are fully set forth in the City of Clifton Policy for Waiver of Health Insurance Coverage Sharing of Premium Savings.
(3) This opt out bonus shall be paid in 24 equal semimonthly installments annually.
(4) If the employee is terminated or leaves employment with the City for any reason after becoming entitled to the opt-out bonus, the employee's entitlement to continue receiving installments pursuant to Subsection
I(3) above shall cease upon the effective date of the employee's termination or last date of employment with the City. The employee's last installment of the opt-out bonus, therefore, shall be prorated based upon the employee's last date of employment with the City.
(5) To be eligible for the opt-out bonus, the employee must provide proof of alternative health insurance coverage for the employee, and, if applicable, for any eligible dependents.
(6) An employee who has waived the City's health insurance coverage during the annual open enrollment period may opt back in upon 30 days' written notice to the City. The written notice must set forth the changed circumstances that now require the employee to receive health insurance coverage through the City in accordance with the terms of the agreement. The employee's entitlement to installments toward the opt-out bonus shall cease upon the effective date that the employee's City-provided health insurance coverage is reinstated. Any employee who opts back in after receiving the opt-out bonus installments must reimburse the City for the pro-rata share of the opt-out bonus to which the employee is no longer entitled.
J. Optional life insurance. The City shall provide optional life insurance coverage for all employees, except seasonal part-time employees. Said life insurance coverage shall be provided, at the option of each employee, with 75% of the cost of the same being paid by the respective employee. Coverage under said life insurance protection shall be in accordance with the schedule for coverage provided under the existing group life insurance plan maintained by the City.
K. Changes in state law. In the event that during the term of this agreement any state law is amended which would conflict with the provisions of this article, the provisions of such statute shall control and this agreement shall be considered amended to conform thereto.