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.
(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:
A.
Purpose. The purpose of this section is to establish procedures for
the handling of insurance claims against the Borough.
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.
