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EB-3 Rev. 6 Enrollment in City Group Health PlanCITY OF DELRAY BEACH ADMINISTRATIVE POLICIES AND PROCEDURES DEPARTMENT: SUBJECT: REVISION: APPROVED BY: Human Resources Enrollment in City Group Health Plan POLICY NUMBER:EB-3 SUPERSEDES:Rev.5 EFFECTIVE DATE: Terrence R.Moore,City Manager PURPOSE The purpose of this directive is to establish policies and procedures for enrollment in the City's group health insurance program and to establish City policy regarding dependent health insurance coverage. POLICY All full-time employees are provided with the opportunity to enroll in group health insurance.Employees shall also be offered the option of purchasing group health insurance for their dependents.Health insurance coverage will become effective for the employee and his/her dependents thirty (30)calendar days after the employee's date of hire,on his/her 31°day of employment.The new employee must opt for dependent coverage within the 30-day period prior to his/her coverage effective date.For example,if the employee's date of hire is January 7th,coverage would become effective on February 6, Group health coverage for an employee and all insured dependent(s)will terminate on the last day of the month in which the employee terminates employment.For example,if an employee terminates employment on December 11",his/her coverage will continue through December 31,with January 1° being the first day without group coverage. Dependent Eligibility for Health Insurance: A.Eligible Dependents include: 1.Spouse.The employee's lawful spouse as determined by the laws of the state where the covered employee resides. 2.Domestic partner.To be eligible for domestic partner coverage,the employee must submit the following documents to Employee Benefits: •Domestic Partnership Certificate of Registration issued by the Palm Beach County Clerk and Comptroller's Office or County of residence,where available;and •Certification of Dependent Children of a Domestic Partnership;and •Agreement to notify the City of the termination of the Domestic Partnership. Enrollment in City Group Health Plan EB-3 Rev.6 Page 2 of 4 The completed documents must be submitted at the time of enrollment.A covered employee may elect coverage for employee's qualifying domestic partner and eligible dependent(s)of the domestic partnership.IRS guidelines state the employee may not receive a tax advantage on any portion of premium paid,related to domestic partner coverage. Employee insuring a domestic partner and/or child dependent(s)of a domestic partner will see the insurance premium deductions on a post-tax basis and any amount subsidized by the City will be reported as "imputed income"to the employee.Employee may contact Employee Benefits for further details and rates if the employee is covering a domestic partner at any time during the upcoming plan year. 3.Dependent Child(ren):Any of the employee's unmarried children under the age of 19 years, for whom the employee provides primary support and maintenance,and claims as a dependent on IRS tax submissions within the meaning of the IRS Code Section 152(a) including: •natural child who lives with you;or •stepchild who lives with you;or •legally adopted child or child placed in anticipation for adoption who lives with a covered employee (the term placed for adoption means the assumption and retention by the employee of a legal obligation for total or partial support of the child in anticipation of adoption of the child and the child must be available for adoption and the legal adoption process must have commenced);or •child who qualifies for benefits under a Qualified Medical Child Support Order;or •child who lives with a covered employee,for whom a covered employee has legal guardianship under a court order. 4.Other:A child born to an insured dependent of a covered employee until such child is 18 months old,or as stipulated in the current Summary Plan Descriptions for the applicable insurance plans. 5.Over age Child/Student Status:A covered employee's unmarried child will continue to be eligible until the end of the calendar year in which the child reaches age 26,provided that the child is both primarily supported by the covered employee and either living in the covered employees'household or enrolled as a full-time or part-time student,or as stipulated in the current Summary Plan Descriptions for the applicable insurance plans. Such proof may be required at least once each year until the end of the calendar year in which the child attains age 26. 6.Over age Child/Disabled Status:A covered employee's unmarried child who has attained age 26 or more years will continue to be eligible,if the child is primarily supported by the covered employee and is incapable of self-sustaining employment or self-sufficiency by reason of mental or physical handicap,or as stipulated in the current Summary Plan Descriptions for applicable insurance plans.Proof that the child is and has continued to be mentally or physically handicapped may be required if a related claim is denied. Enrollment in City Group Health Plan EB-3 Rev.6 Page 3 of 4 B.Coverage of a Dependent Child ends at the end of the calendar year in which that child: •reaches his/her 19th or 26th birthday,whichever is applicable;and •voluntarily or involuntarily terminates full-time or part-time attendance at a high school,college,university,or graduates;or •marries;or •enters military or similar service anywhere;or •as stipulated in the Summary Plan Descriptions for applicable insurance PROCEDURE 1.New Employees A New employees will meet with the Employee Benefits Department during orientation to receive information concerning the benefit package.The Benefits Manager or designee will ensure that the new employee completes an enrollment form which provides employee and dependent information.Copies of the form will be retained in the employee's benefit file. B.The Employee Benefits Department will provide employees with a copy of the Employee Benefits Guide which contains website information for the group health plan and a listing of physicians, hospitals and pharmacies that are members of the plan. C.The Employee Benefits Department will enter benefit premium deductions into the payroll system. 2.Adding,Deleting or Changing Dependent Coverage: A covered employee may elect,delete,or change coverage for his/her eligible dependents on: •the day of enrollment eligibility for the covered employee;or •the day an eligible dependent is acquired by birth,adoption or placement for adoption; •during an annual open enrollment period;or •the first of the month concurrent with or following the date of marriage or other applicable Qualifying Event.(see Qualifying Events for Pre-tax Benefits). 3.Medicare Supplement Reimbursement and Coverage of Eligible Dependents A Covered employee may elect to discontinue City Sponsored Group coverage once the covered employee becomes Medicare eligible,and elects Medicare Coverage and supplemental coverage that is comparable to the City Sponsored Group Coverage. B.The City will agree to reimburse the cost of comparable Medicare Supplement plans for the covered employee,provided that those plans do not exceed the cost of City Sponsored Group Coverage. C.If the covered employee also has an eligible covered dependent(s)at the time of discontinuation of the City Sponsored Group Coverage,the following option is available: Enrollment in City Group Health Plan EB-3 Rev.6 Page 4 of 4 •The covered employee may forego reimbursement of the cost of comparable Medicare Supplement plans and the eligible covered dependent(s)may remain on the City Sponsored Group Plan. Current and standard active employee coverage rates will apply. 4.Spouses of Retired Employees or Surviving Spouses of Deceased Retired Employees: Spouses of retired City employees and surviving spouses of deceased retired City employees, who have not remarried,shall have the opportunity to continue uninterrupted coverage on the City's Group Health Plan by paying the appropriate monthly premium,providing that such coverage has not been discontinued prior to election.The rates for coverage will be equal to related active employee rates for single and dependent coverage. 5.Qualifying Events for Pre-tax Benefits: A.The IRS regulations for mid-year (i.e.outside of an open enrollment period)restrict any changes to pre-tax coverage unless a Qualifying Event has occurred that supports such a change.Applicable Qualifying Events include: • • • • change in legal marital status (marriage,divorce,death of a spouse);or change in number of dependents (birth,adoption,placement for adoption); change in employment status (start or termination of employment by covered employee or spouse);or change in individual's eligibility for Medicare or Medicaid .