Ordinance 2018-24: Reimbursement for Certain Medical for Calendar Year 2019

ORDINANCE NO. 2018-24

AN ORDINANCE AUTHORIZING THE REIMBURSEMENT OF CERTAIN MEDICAL SERVICES INCURRED BY FULL-TIME EMPLOYEES PARTICIPATING IN THE VILLAGE’S GROUP MEDICAL INSURANCE IN CALENDAR YEAR 2019, AND DECLARING THE SAME AN EMERGENCY

 

WHEREAS, the cost of medical insurance continues to increase each year and in an effort to curb those costs, the group medical insurance offered to full-time employees of the Village of Antwerp has been changed in recent years by increasing the maximum out-of-pocket in order to obtain a more affordable group medical insurance plan, and

 

WHEREAS, the Village Council has determined that this increase in the maximum out-of-pocket has created a potential significant monetary exposure to the full-time employees of the Village that participate in the group medical insurance plan, and

 

WHEREAS, in order to offset this exposure to some degree, Village Council hereby authorizes that a certain amount be budgeted for each full-time employee that participates in the group medical insurance plan and that a process be established by which such an employee may seek reimbursement of covered medical services in the event covered medical services exceed a certain amount, capped at the out-of-pocket maximum.

 

NOW THEREFORE, BE IT ORDAINED by the Council of the Village of Antwerp, Paulding County, Ohio:

 

Section 1.  Section 9.04 of the Village’s Personnel Manual provides that the Village shall provide group medical insurance for all full-time Employees in accordance with the Village’s current medical insurance contract and in accordance with ordinance(s) passed by Village Council.  In accordance with Section 9.04 of the Village’s Personnel Manual, Village Council hereby authorizes by ordinance that the 2019 budget include the potential reimbursement amounts per employee set forth in Sections 2 and 3 of this Ordinance, said funds to be available to full-time employees of the Village that participate in the Village’s group medical insurance and available only in calendar year 2019, and any funds not used for the purpose identified herein to be forfeited if such reimbursement is not sought and received no later than December 31, 2019.  This Ordinance only allows covered medical services to be subject to eligible reimbursements hereunder, which only includes medical services that are covered by the Village’s group medical insurance.

 

Section 2.  Each full-time employee that participates in the Village’s group medical insurance plan and that elects single coverage has a maximum out-of-pocket of $5,000.00 in accordance with the Village’s current medical insurance.  In order to assist full-time employees participating in the Village’s group medical insurance plan, employees with single coverage may be eligible for reimbursement of medical services covered by the Village’s group medical insurance plan when such employee has exceeded one-half (1/2) of the maximum out-of-pocket: $2,500.00 of the $5,000.00 maximum out-of-pocket for covered medical services.  Once an employee has exceeded one-half (1/2) of the maximum out-of-pocket, $2,500.00 of the maximum out-of-pocket of $5,000.00, the employee is eligible to request reimbursement for covered medical services in excess of $2,500.00 up to the $5,000.00 maximum out-of-pocket; that is, a potential reimbursement per full-time employee with single coverage of $2,500.00.

 

Section 3.  Each full-time employee that participates in the Village’s group medical insurance plan and that elects spouse or family coverage has a maximum out-of-pocket of $10,000.00 in accordance with the Village’s current medical insurance.  In order to assist full-time employees participating in the Village’s group medical insurance plan, employees with spouse or family coverage may be eligible for reimbursement of medical services covered by the Village’s group medical insurance plan when such employee has exceeded one-half (1/2) of the maximum out-of-pocket: $5,000.00 of the $10,000.00 maximum out-of-pocket for covered medical services.  Once an employee has exceeded one-half (1/2) of the maximum out-of-pocket, $5,000.00 of the maximum out-of-pocket of $10,000.00, the employee is eligible to request reimbursement for covered medical services in excess of $5,000.00 up to the $10,000.00 maximum out-of-pocket; that is, a potential reimbursement per full-time employee with spouse or family coverage of $5,000.00.

 

Section 4.  In order to obtain such reimbursements, the employee must submit receipts, invoices, and/or billing statements identifying the amounts for which reimbursement is being sought, redacting any and all personal and health information from such documentation, to the Village Fiscal Officer.  The Village Fiscal Officer is then authorized to contact the representative of the Village’s group medical insurance for the sole purpose of confirming that the employee has exceeded one-half (1/2) of the maximum out-of-pocket for the particular plan at issue. Once the Village Fiscal Officer is able to confirm that one-half (1/2) of the maximum out-of-pocket has been exceeded by the employee, the Village Fiscal Officer shall process the requested reimbursement on the next regular payroll as long as the documentation submitted by the employee and the confirmation required from the health insurance representative is received no later than five (5) business days prior to the date of processing the next regular payroll, or the  reimbursement will be processed for the next regular payroll thereafter.

 

Section 5.  All reimbursements made in accordance with this Ordinance shall be made payable to the requesting employee, processed through regular payroll, and subject to any and all applicable withholdings.  Employees who are not employed the full year will have this benefit only for covered medical services as set forth herein and that are requested for reimbursement during the term of such employee’s full-time employment with the Village.

 

Section 6.  All prior legislation, or any part thereof, which is inconsistent with this Ordinance is hereby repealed as to the inconsistent part thereof.

 

Section 7.  It is found and determined that all formal actions of the Council concerning and relating to the passage of this Ordinance were adopted in an open meeting of this Council, and that all deliberations of the Council and of any of its committees that resulted in such formal action, were in meetings open to the public, in compliance with all legal requirements including all lawful ordinances and any applicable provisions of Section 121.22 of the Ohio Revised Code.

 

Section 8.  This Ordinance is hereby declared to be an emergency measure necessary for the immediate preservation of the public health, safety and welfare of the Village and for the further reason that the potential reimbursement figures set forth herein must be included in the Village’s budget for calendar year 2019.  This Ordinance shall therefore take effect and be in full force and effect immediately after its passage and shall be available to full-time employees covered by the Village’s group medical insurance beginning January 1, 2019, and ending December 31, 2019.

 

 

Passed: ________________

_____________________________________

Ray DeLong,

Mayor of the Village of Antwerp

Attest:

 

__________________________

Aimee Lichty, Fiscal Officer

 

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