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Home My WebLink About086 89 Œ: lIlt.d¡for]. q-~/-Jq EKS -5 , > STATE OF WASHINGTON COUNTY OF JEFFERSON In the matter of: ) ) ) ) ) ) ) RESOLUTION NO. 86-89 Initiating a County program designated as Employee Medical Expense Reimbursement Plan WHEREAS, Jefferson County is required to have a plan document to be in compliance with The Internal Revenue Code; and WHEREAS, a pl~ document h~ been drafted amending, in part, the Health Insurance Trust Fund established by Resolution Nö. 21-85; now, therefore, BE IT RESOLVED, by the Board of Jefferson County Commissioners that the amended Supplemental Reimbursement Plan is adopted in the form attached. BE IT FURTHER RESOLVED, that Resolution No. 21-85 is amended only in such parts as required by this Resolution and that all unamended parts survive and continue uninter- rupted. APPROVED this /8otrfuyof _¥ JEFFERSON COUNTY BOARD OF COMMISSIONERS , 1989. :---_.~.... -.' ""~\)j ~'~..~~' tD ;;:~, (",i...,."'. t. ".,,., ,,' "... .', ' . '," . i' ' ," ':_'i~ ., ,Wt _ '._ '*' .j . SEAi~~' ~~,:-- "-', . ' '" '" ' /- .-';', .1, ",~:../.-.)¡ "...~./ ~., :. 1.'¢'I\'i ,', .!: '_ -·~;-~r >~., ", -~. -.'... " '.....\,. ", ,,·r"' I' r'" '"", "" '.....,.' , .." . '",~.. \' i,.j ~ ' " ..,.'.'., ",'. " ".', ','.. - I . ·r, t ,,- "l 1 "', .. P¥. \ ,.., ".. ~ ..'~)t '4' ~, _' ¡t .: ,,' ,,'~," .~"....' 1.' , . ',", ¥":~ ~:-'~ ~. ,t ""¡' '" - .... . .. ~,,, ATIEST. ,~.:~ $1) Ii t. ~ :" /' ~~e¿M~ Clerk of the Board ~,~ eorge r , hairman ~ B. . rown, em er ~ \ _,_____"m~~ VDL t 5 T~ct £fr 4529 JEFFERSON COUNTY AMENDED SUPPLEMENTAL EMPWYEE MEDICAL EXPENSE REIMBURSEMENT PLAN It is in the best interest of the public and Jefferson County that the financial burden placed on County employees by medical expenses be reduced to an acceptable level. The County has adopted a comprehensive insurance program in an effort to shift the financial and administra- tive risk to a qualified and capable insurance company through the Washington Counties Insurance Fund ("WCIF'). Because WCIF benefits are less (by virtue of a higher deductible) than those previously enjoyed by employees, this supplemental reimbursement plan is adopted to prevent a reduction in benefits to County employees, This Plan was adopted by Resolution No, 21-85 on march 251985 and is amended as of the date of adoption below, SECTION I DEFINITIONS 1.1 Employer shall mean Jefferson County. ' 1.2 Employee shall mean a regular employee of the Employer who is eligible to participate in the Hospital- Medical Plan sponsored by the Employer. 13 Plan Administrator shall mean Jefferson County or such person or department as designated by the Board of County Commissioners. 1.4 Claim. shall mean that employee expense that is eligible for coverage under the Employer's WCIF policy but, for the operation of policy deductI'bles or co-payment requirements the employee expense is not eligJ.'ble for reimbursement through the Employer's WCIF policy, 1.5 Benefits shall be the amount of money to which an employee is entitled by virtue of this Plan, 1.6 Beneficiary shall be the recipient of benefits from this Plan. SECTION II ELIGIBILITY 2,1 Each employee who is eligible to participate in the group Hospital-Medical Plan of the Employer shall be eligJ.'ble to participate in this Plan, Elig¡.'bility is limited to employees who are working at least eighty (80) hours per month, Employees who's benefits are through a negotiated Union-Employer trust are not elig¡.'ble to participate in this Plan. SECTION III BENEFITS 3.1 Benefits under this Plan shall be payable to employees upon submission of an Explanationof Benefits (B.O.B.) provided by the WCIF Administrator, 3.2 The Plan Administrator shall make all benefit payments. Such payments shall be based on the E,O.B. submitted by employees and other relevant information. Supplemental Medical Plan Jefferson County Page 1 VOL 15 f~S~ dò 4530 3.3 The Plan Administrator shall make benefit payments or deny the claim no later than one hundred twenty (120) calendar days following the receipt of the E.O.B, from an employee and other supporting information from spousal coverage when appropriate. 3,4 Benefits payable under this Plan shall be: (a) The second $100.00 per person, or fraction thereof. of deductible amount not eligible for reim- bursement under the Employers Hospital-Medical Plan and not otherwise reimbursed to the employee or family unit. (b) The second $300.00 per family. or fraction thereof. of deductible amount not eligible for reim- bursement under the Employer's Hospital-Medical Plan and not otherwise reimbursed to the employee or family unit. (c) The employees share of any co-insurance required by the Employers Hospital-Medical Plan and not otherwise reimbursed to the employee or family unit. 3.5 Amounts not specified in Section 3,4 above and not payable (or reimbursable) under the Employer's Hospital-Medical Plan shall be an expense payable by the employee to the health care provider without reimbursement from Plan sponsored by the Employer, ' 3.6 The benefit of this Plan shall be limited to eligible E,O,B. amounts not reimbursed to an employee or family unit after all; Employer sponsored Hospital-Medical benefits, coordinated benefits from another employer or individual hospital-medical or supplemental benefits. subrogation of loss benefits. or as a result of a claim or tort by an employee or family unit. Benefits from this Plan will never be in excess of actual unreimbursed expenses of an employee or family unit. SECTION IV CLAIMS 4.1 No claim of benefits shall be recognized unless submitted by an employee (or employee's estate) to the Plan Administrator. 4,2 The Plan Administrator shall adopt such rules and forms necessary to effectuate the purposes of the Plan. Such rules. or changes thereto, shall be effective thirty (30) days after publication by the Plan Administrator to employees by any means reasonably certain to give notice to employees regarding rules and forms. 4.3 Claims shall be processed by the Plan Administrator in such fashion as the Plan Administrator deems appropriate. consistent with the provisions of the Plan. SECTION V OTHER PROVISION 5.1 The Board of County Commissioners may. in their sole discretion, amend this Plan, appoint or remove an administrator. seek legal or other assistance in interpreting or operating this Plan and may do such other actions relative to this Plan that åre not unlawful under the law of the United States or the State of Washington, This Plan is intended to be a permanent employee benefit. however. the Board of County Commissioners may at any time. without notice. terminate this Plan. Supplemental Medical Plan Jefferson County Page 2 vaL 15 rY~ 0(;' 4531 ''',j").~'-';,;:,¡:;, · . 5.2 A failure to enforce a Plan requirement or an increase or decrease of benefits through an act of omis- sion, misfeasance, fraud, or other method, i,e,: practice, shall not amend any provision of this Plan and shall not act to require a continuance of the referenced practice. 53 Employees who have submitted a claim, or who are refused an opportunity to submit a claim may ap- peal the action of the Plan Administrator as follows: 5.3.1 Within thirty (30) days of receipt of a rejected claim, including partial rejections, an employee desiring to appeal such rejection must file with the Plan Administrator a request for re-consideration clearly stating the action desired, the grounds justifying such action and why the rejection is in error. 53.2 Within sfx1:y (60) days of receipt by the Plan Administrator of a request for reconsideration the Plan Administrator shall answer the request stating; the grounds for continued rejection of the claim, pay- ment of thr claim, or a date upon which an answer will be made. 53.3 If the pIaxi Administrator rejects the claim following a request for re-consideration a written request may be m~de within thirty (30) days to the Board of County Commissioners, The request shall be made thr~ugh the Plan Administrator's office on a form provided. The Board of County Commis- sioners shall review the request and may make such inquires deemed necessary by the Board, The Board shall either approve the claim or reject it. Action by the Board of County Commissioners is final. I ! I , 5,4 This Plan is deemed to be in compliance with federal and state law. If one provision is found to be un- lawful the þalanceof this Plan shall survive and the unlawful provision remedied through amendment. Venue sha11 be in Jefferson County, Washington. 5.5 This Plank intended to be in compliance with those provisions of the D,S. Tax Code that permit this benefit to 1,>e free of income tax to the beneficiaries of the Plan, This amended PIatt shall be effective as of the Resolution date, and shall succeed without interruption to any prior plan, and shall be in effect until action of the Jefferson County Board of Commissioners terminates or amends this Plan. : , I Adopted by Resolution No. ! /1 this / 2'~ayof . ¥ , 1989. .~ /:;) \\" to~ /'~. "~.. . l;~j '\ .í~~~~~~~ \\ ; m ~ \~ ,þ1.) ~ VI ,,~ \' '1 . P t ~ ":, " - ~ '.; .. \! r ...'~ - '" ".' It.,..·:',... ,: 1l f -. .~~ . j '-'i't.;~...." ,; .. ,./~-: ~' "0, ¥~¡J'i t',\ ' ...., _._-..__....,.-t .~- JEFFERSON COUNTY BOARD OF COMMISSIONERS ~~~ George Bro hairman ATTEST: B'~ ~ ~ , itft)~ ~ e n, Memoer Supplemental Medical Plan Jefferson County Page 3 '..... II:" 15 rÞf:E r . 00 4532 'II .1 It EMPLOYEE RELATIONS SERVICES, INC. 10532 NE 68th Street, Suite 200 Kirkland, Washington 98033 (206) 822-9269 Fax (206) 827-6763 September 15, 1989 Robert R. Braun Jr. Board of County Commissioners Jefferson County P.O. Box 1220 Port Townsend, Wa. 98368 Re: Jefferson County - Commissioners Gentlemen, ~ æ ~'I ~4 n~J1,' 0:,;,' rrr , '" r:: n ¡/f ~, ¡i i¡ l' a~ -1..' .'~ '" c; ."C· ~ ~ ij- .. ....; - .Þ_. l' ~ ß f ,. t~ \. :". ~.J I '::' . ~ . _."r \..i "---' _1 ....i- r~,t .....;9",.,;'..,) JEFFEI1SChj ( , BOARD Or- cm,;~.nSSiC:j;':¡:¡S We have completed the review of the Supplemental Medical Plan Document and all parties agree it is ready for your adoption. If you agree please adopt the enclosed plan. RRB/js Enclosure CC: Mary Gaboury, w / enclosure '15" "'- Uti' - .-A533 . VúL ",/ JAti, . Ù L~