2003 AGN DEC 16 I10 - Laserfiche WebLink

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Exhibit A Years of Service Percentage of Cafeteria Dollars City -Paid Premium 5 30% $274.50 10 40% $366.00 15 50% $457.50 20 60% $549.00 25 70% $640.50 30 80% $732.00 2. The retiree may use the allotted dollar amount to purchase medical insurance for himself or herself and their legal dependents. The percentage is based on the monthly Cafeteria Plan allowance for active city employees. The dollar amount may fluctuate in future years based on the Cafeteria Plan allowance determined by City Council However, the dollar amount will never go below the amount the employee will receive when he/she retires 3. In the event the retiree, and/or dependent, premium exceeds the allowance amount per the above schedule/formula, the retiree shall be billed for and must pay the excess/difference on a monthly basis. If the retiree fails to remit payment within 60 days after the billing date, enrollment in the city's plan shall be permanently cancelled for the retiree and any related spouse and dependents. 4. In the event the retiree moves out of state to an area where the city's health insurance carriers do not provide coverage, the retiree must show proof of health insurance coverage and payment of monthly premiums before reimbursement, subject to the aforementioned formula limits. 5. If the premium cost is less than the amount allocated by the formula, the retiree will not receive the difference. Additionally, there is no opt -out money paid to the retiree. 6. In the event that the city reduces the cafeteria plan allowance, retirees will not receive an amount of premium dollars that is less than their allowance at the time of the reduction. 7. The retiree will provide the city with all documentation required for any qualifying event, in a timely manner, but never beyond thirty (30) days of said event. *Dependents are defined as spouse and/or any qualified legal dependent. Surviving Spouse and Dependent Coverage In The Event Of Death of the Retiree: 1. In the event of the death of the retiree who is survived by a spouse or legal dependent, enrolled in a city health insurance plan at the time of the retiree's death, the city shall continue to provide health coverage subject to the aforementioned schedule/formula, subject to other terms and conditions that apply to the Medicare age excess billing, relocation, premiums, etc. Page 2 of 9