Township of Ocean, NJ Article VII Health Insurance

§ 57-34 Health insurance benefits.

A. The Township currently provides all regular full-time employees and other officials certain health benefits. In view of the fact that health insurance premiums can often rise dramatically, the Township Committee reserves the right to change, amend, delete, require cost sharing, decrease or increase the amount of and types of certain health benefits provided to its employees. At this time, the Township provides to each eligible full-time employee and official, and to that individual's immediate family (spouse and children), comprehensive hospital-physician coverage. All such individuals have an option to select HMO coverage from U.S. Healthcare, as an alternative to the current standard health benefit package offered by the municipality. This option may be exercised only during the open enrollment period as established by the Ocean/Monmouth Regional Employee Benefits Fund. Employees are required to review and be fully familiar with the health benefits package currently in place in the municipality at all times. The Township Clerk maintains all information with respect to health benefits provided to employees; however, it is not the responsibility of the Township Clerk or the Township's governing body to personally advise each and every employee of any changes made with respect thereto. It is the responsibility of the employee to be fully familiar with all such coverages.

B. In the event of any cost increase to the municipality due to an employee's voluntary selection of the U.S. Healthcare HMO, the employee will be responsible for any increased cost through payroll deductions. This means that if HMO coverage is more expensive to the municipality than the total current coverage provided in the health plan to all other employees, the difference will be paid by the Township employee through payroll deduction in his or her biweekly payroll. Those employees who select the HMO will be responsible for all copays associated with the HMO.

C. The Township currently provides certain vision care for eligible individuals up to maximum amount of $150 per calendar year. The individual may use this benefit for any member of his or her immediate family. "Immediate family" means the spouse of an individual, and/or the minor child of the individual, or child of an individual who is over 18 years of age, but under 23 years of age, who is currently residing in the individual's home.

D. The Township also currently provides to all eligible individuals group dental coverage with various deductibles relating to individuals and/or families. The definitions for family coverage are the same as those with respect to vision care.

E. The Township currently provides a prescription plan for eligible individuals which includes individual and/or family coverage as defined in this section. Current coverage provides for prescription card service requiring minimal copays for employees. It is anticipated that the minimal copay will increase in the near future.

F. All municipal employees are required to participate in the Public Employee Retirement System (PERS) in accordance with requirements set forth by said system, both statutory and administratively. The system is regulated by the state of New Jersey, and the Township's Chief Financial Officer shall be the liaison between the employees and the PERS system. All employees are directed to be familiar with their pension plan, as it is their responsibility to insure appropriate contributions into the system so that they will be eligible to receive benefits therefrom in the future.

G. In the event the Township employs both a husband and wife, one individual will be designated and entitled to full family coverage, and one will be designated and entitled to single coverage for all health insurance coverage. In the event the spouse of any employee has other valid and collectable insurance similar to that provided by the municipality, the Township will only be responsible to provide the employee single coverage and not family coverage. It shall be the obligation of the Township employee to make this determination and to so notify the Township Clerk and Committee member in charge of personnel. In the event the employee fails to so notify the municipality or falsely reports the requested information, the employee will be charged the cost incurred by the municipality in providing such family coverage when same was not required for the period of time during which the employee failed to notify the municipality. Said employee shall also be subject to disciplinary proceedings. This obligation of the employee shall continue during all times of employment with the municipality and any subsequent changes in benefits provided to him/her or his/her spouse which would result in the municipality being required to provide only single coverage, must be reported within 30 days of receipt by said employee.

§ 57-35 Health benefits selection program.

[Amended by Ord. No. 2002-35; Ord. No. 2003-2]

A. Establishment of a Health Benefits Selection and Buyback Program. The Health Benefits Selection and Buyback Program allows an eligible individual to voluntarily select health benefits that best suit his/her individual need by voluntarily declining certain or all of the health benefits accorded that individual as provided by the Township. For those benefits that the individual declines, he/she shall be compensated according to this policy.

B. Coverage. This policy covers all employees and officials who are eligible to receive health benefits.

C. Procedure.

(1) Selection.

(a) An employee or official who is entitled to family coverage may amend their coverage as follows:

[1] Decline all coverage;

[2] Reduce from family coverage to single coverage;

[3] Decline medical benefits (must provide documentation demonstrating coverage elsewhere);

[4] Decline dental coverage only;

[5] Decline prescription coverage only;

[6] Decline any combination of coverage types listed above.

(b) An employee or official who is entitled to single coverage may amend their coverage as follows:

[1] Decline all coverage;

[2] Decline medical benefits (must provide documentation demonstrating coverage elsewhere);

[3] Decline dental coverage only;

[4] Decline prescription coverage only;

[5] Decline any combination of coverage types listed above.

(2) Proof of other medical coverage. Participants who decline medical (hospitalization) coverage must provide written documentation as described by the Township to prove that he/she is covered elsewhere. No employee or official will be allowed to decline this coverage without proof of other coverage.

(3) Payment in lieu of benefits.

(a) For those individuals who wish to participate in the buyback program, said individuals shall receive payment for each option declined, for each quarter of the calendar year. Such quarterly payments will be made no later than the 10th day of the month following the end of the quarter; i.e., April 10, July 10, October 10 and January 10 of the following year. All payments to the individual shall be for the preceding three months. All such payments in lieu of benefits are taxable under federal and state regulations, (including Federal Wage Tax, FICA, State Income Tax, State Unemployment Tax and State Disability Insurance). Taxes will be deducted in accordance with the employee's form on file at the time of enrollment. Payment in lieu of benefits shall have no effect on pension deductions or calculations.

(b) Amount of payment. Any individual who declines any coverage set forth above, or any combination of coverages, resulting in savings to the municipality for the cost of such benefits, shall be entitled to be paid 50% of the savings, up to maximum of $5,000 incurred by the municipality. Such payments shall be made quarterly to said employee as set forth above (Example: if an employee is eligible for, but declines, family coverage and retains only single coverage, at a resulting savings of $5,000 in healthcare costs to the municipality in any particular calendar year, said individual shall be entitled to 50% of such savings, payments totaling $2,500 for the year in question, i.e., $625 per quarter. All employees hired by the Township subsequent to October 1, 2002 and choose to utilize the buyback program will be kept at their buyback rate with a maximum buyback of $5,000. All employees who are in the employ of the Township on or before September 30, 2002 shall be entitled to be paid 50% of the saving which the municipality may receive.

(4) Enrollment in the program. Any individual who wishes to participate in the Health Benefit Selection and Buyback Program shall do so to be effective May 1 and November 1 of each year. The individual must notify the Township in writing no later than the preceding April 1 or October 1 of his or her intention to participate.

(5) Emergency enrollment. If an individual chooses to decline certain benefits based upon spouse coverage and the spouse coverage is later eliminated, or in the case of a plan change from single to family due to marriage or divorce, the individual may do so at any time during the year with a thirty-day notice to the municipality. A fifteen-day emergency enrollment, or enrollment to the first day of the following month, may be allowed under extreme hardship. The Township Committee shall determine, in a case-by-case basis, whether there exists an extreme hardship. If an individual changes their benefits plan, their quarterly payment shall be amended accordingly on pro rata basis.

(6) Preexisting conditions. Preexisting conditions shall be covered in accordance with the benefit plan at the time of enrollment.

(7) Carriage of deductible. When any individual reduces his/her coverage and subsequently thereafter during an enrollment period adds back to the coverage, he or she will not be able to receive credit for, and carry, the deductibles, if any, that were met earlier in the year.

(8) Special enrollment period for 1999. A special enrollment period for 1999 will allow employees to enroll effective October 1, 1999, for the months of October, November and December 1999. Such enrollment shall be on prorated basis for calendar year 1999. Any payment to be made by the municipality with respect hereto, shall be made by January 10, 2000.

§ 57-36 Retirement insurance benefits.

[Added by Ord. No. 2007-36; amended 12-8-2011; 6-4-2012 by Ord. No. 2012-11; 10-11-2012 by Ord. No. 2012-21; 9-27-2018 by Ord. No. 2018-14]

The Township of Ocean shall assume the cost of insurance coverage for those employees, in the same manner for which benefits are provided to regular full-time employees, who meet the following criteria:

A. With respect to employees hired prior to July 1, 2018, the Township of Ocean shall assume the cost of insurance coverage for those employees and their spouse in the same manner for which such benefits are provided to regular full-time Township employees who retire after 25 years or more of service credit in the State Pension System and a period of at least 25 years of employment with the Township of Ocean or for those employees who have retired and reached the age of 65 years of age with 25 years or more of service credit in a state or local administered retired system and a period of 25 years with the employer at the time of retirement.

B. With respect to employees hired subsequent to July 1, 2018, the Township of Ocean shall only assume the cost of insurance coverage for the individual employee, and not their spouse or dependents, who retires after 25 years or more of service credit in the State Pension System and a period of at least 25 years of employment with the Township of Ocean or for those employees who have retired and reached the age of 65 years of age with 25 years or more of service credit in a state or local administered retired system and a period of 25 years with the employer at the time of retirement.

C. Those employees who retire with 25 years or more service credit in the state pension system and a period of at least 25 years of employment with the Township of Ocean and/or the former Ocean Township Municipal Utilities Authority are included within the terms of this section.

D. Employees of the Township with 25 years or more of credit in the state pension system may be eligible to include any years of service in the Armed Forces of the United States to be counted toward his/her 25 years of service with the Township in the same manner as he/she may receive credit for such military service under the state pension system in order to meet the 25 years of employment with the municipality.