300-32
EMPLOYEE HEALTH PROGRAM

Department: PERSONNEL

Effective Date:    10/18/93

Supersedes:    12/1/92

Staff Contact:    B. Nelson Glode

Approved by:    Earl Clymer

1.0 PURPOSE:

To establish procedures for the administration and eligibility of the employee health program as provided by the City of Renton Self-Funded Plan and Group Health Cooperative (GHC).

2.0 ORGANIZATIONS AFFECTED:

All departments/divisions.

3.0 REFERENCES:

3.1    Policy 330-11 - Types of Employees, Pay, Benefits & Retirement

3.2    Medical and dental contracts

3.3    Labor Agreements

4.0 POLICY:

It is the policy of the City of Renton that a consistent interpretation of eligibility for medical/dental coverage be applied to all employees within the City, and that standard procedures be initiated for the administration of the medical and dental programs.

5.0 DEFINITIONS:

5.1    Eligible Employee:

All regular employees of the City of Renton who are afforded medical/dental benefits under a labor agreement, or by the Renton City Council.

5.2    Dependent:

For the purpose of eligibility for coverage under the employee health program, a dependent shall be defined as an eligible employee's lawful spouse and unmarried dependent children, including step children, foster children, and legally adopted children, from birth to attainment of nineteenth (19) birthday, or attainment of twenty-third (23) birthday if attending an accredited school, college or university on a full-time basis. Dependents in the military service are not eligible.

5.3    Period of Coverage:

5.5.1    Coverage under the medical/dental plan begins on the first day of the month following employment.

5.5.2    Coverage is terminated as follows: (a) Group Health Cooperative coverage is terminated at the end of the month in which the employee leaves city service; (b) the City of Renton Self-Funded Medical and Dental plans terminate on the date the employee leaves city service.

6.0 PROCEDURE:

6.1    Enrollment:

During orientation in the Personnel office, the employee shall complete enrollment forms for coverage in the Self-Funded Dental plan and choose between the Self-Funded Medical Plan or Group Health Cooperative.

6.2    Program Change:

During designated open enrollment periods, employees shall complete enrollment forms provided by the Personnel office for the purpose of changing medical plans, if so desired.

6.2.1    Employees and their eligible dependents may switch from Group Health Cooperative to the City of Renton Self-Funded Plan or from the City of Renton Self-Funded Plan to GHC during the designated open enrollment period for coverage effective January 1.

6.2.2    Adding Dependents

Employees may, at any time, add an eligible dependent as defined in Section 5.2 by filing a completed enrollment with the Personnel office. Eligible dependents must be enrolled within 31 days in order to be covered without proof of good health except newly acquired dependents (including newborns) who must be enrolled within 60 days. Form should be completed in detail by providing full information on dependents to be covered.

6.2.3    Dropping Dependent Coverage:

Employees may drop a dependent at any time by filing the appropriate enrollment forms with the Personnel office.

6.3    Audit Responsibilities

6.3.1    It is the employee's responsibility to notify the Personnel office of a dependent's ineligibility due to divorce, age, marital or military status, or any other reason by updating medical and dental enrollments.

6.3.2    Employees are required to submit quarterly proof of dependents' school enrollment upon attainment of age nineteen (19) to the Personnel office. Payroll and Personnel will conduct periodic audits of the employee health program to assure contract compliance.

6.3.3    Once the ineligible status of a dependent is determined, his/her coverage will cease and the employee will be notified.

6.4    Continuation of Medical Coverage

Employees and eligible dependents are eligible for short-term, continued participation in the employee health program after termination, retirement, or other specific circumstances as legislated by the Consolidated Omnibus Budget Reconciliation Act (COBRA).

6.4.1    Employee Qualifying Events: Coverage may be continued for the employee and eligible dependents for a maximum of 18 months when employment is terminated (including retirement) or a reduction in working hours below the minimum requirement for medical benefits occurs.

6.4.1.1    In the event a non-represented employee becomes totally disabled a written request for employer-paid COBRA may be filed with the Personnel office. A physician's letter verifying the disability must accompany the request. Upon recommendation by the Personnel Director and approval by the Mayor, the employee portion of the COBRA premiums will be waived and coverage extended for a period of up to 12 months. For the remaining six (6) months of eligibility (6.4.1) the premium cost is borne by the employee.

6.4.2    Dependent Qualifying Events: Covered dependents may continue coverage for 36 months if they are no longer eligible for coverage due to death of the covered employee; divorce from a covered employee; when a child reaches age 19 and is not a full-time student, or when a full-time student reaches ages 23; when a covered child marries. Benefits will cease when the enrollee is entitled to Medicare, fails to make the required premium contributions, or the date the enrollee becomes covered under another plan.

6.4.3    Disabled Employee or Dependent: If the employee or dependent are totally disabled when the continuation of benefits end, benefits for the original disabling condition will continue for a period not to exceed 11 months, provided that the disability continues for that period of time. Only the condition which caused the disability will be covered, and evidence of disability must be submitted to the plan provider within 31 days after the continuation of benefits ends through a letter from the attending physician.

6.4.4    Employer/Employee Responsibilities: The City of Renton must notify the employee within 30 days of a qualifying employee event (see 6.4.1) regarding continuation of medical coverage benefits. It is the employee's or dependent's responsibility to notify the Personnel office within 60 days of that event if benefits are to be continued. It is the responsibility of the employee or dependent to notify the city in the case of a dependent qualifying event (see 6.4.2).

6.4.5    Premium Rates: The employee or eligible dependent is responsible for monthly premium payments. The premium rate will be the current rate plus a 2% administrative charge.

6.5    Conversion Privilege

Employees and their dependents may convert to an individual medical plan without providing evidence of insurability following termination from the City's employee health program depending upon the medical plan in which they are enrolled.

6.5.1    Group Health Cooperative: To qualify for the conversion privilege, enrollees must apply for coverage within 30 days of the last effective date of their group coverage. Conversion insurance may not be identical to the City's group plan.

6.5.2    City of Renton Self-Funded Plan: Conversion insurance is not available for the self-funded plan.

This policy is subject to modification in accordance with changes in statutory requirements or administrative agreements with health care providers or plan administrators.