Transcription
Exhibit ACITY OF PORTLAND EMPLOYEE BENEFITS PROGRAMAs Amended and Restated July 1, 2022
Exhibit ACITY OF PORTLAND EMPLOYEE BENEFITS PROGRAMTable of ContentsPageCHAPTER 1. INTRODUCTION .11.011.021.031.041.05Establishment . 1Purpose and Status of Plan. 1Plan Limitations . 1Administrator . 2Plan Notification . 2CHAPTER 2. DEFINITIONS 252.262.272.282.29ACA . 3Administrator . 3Adverse Benefit Determination. 3Annual Enrollment Period or Annual Enrollment. 3Beneficiary . 3Benefit . 3Benefit Election Forms . 4Cafeteria Plan . 4Casual Employee . 4Change in Status . 4City . 4Claimant . 4COBRA . 4COBRA Group Health Plan . 4Code. 4Component Plan . 4Council . 4Dependent . 5Dependent Care Account . 5Dependent Care Flexible Spending Account or DFSA . 5Dependent Care Expenses . 5Dependent Care Service Provider . 5Domestic Partner. 5Effective Date . 6Eligible Casual Employee . 6Eligible Employee . 6Employee . 6Employee Contribution . 7Employer Contribution . 7i
Exhibit ACITY OF PORTLAND EMPLOYEE BENEFITS 02.412.422.432.442.452.462.472.482.49FMLA . 7FMLA Group Health Plan . 7Full-time Employee. 7Health Plan Benefits . 7HIPAA . 7HIPAA Group Health Plan . 8Medical Expenses . 8Healthcare Flexible Spending Account or HFSA . 8HFSA Account . 8Participant . 8Part-time Employee. 8Plan . 8Plan Year . 8Premium Payment Benefit . 8PHS Act . 8Qualified Beneficiary . 8Qualified Benefits . 9Qualifying Event . 9Qualifying Individual . 9Related Document . 92.502.512.522.532.542.55Seasonal Maintenance Worker . 9Seasonal Park Ranger . 9Spouse . 9Salary Reduction Agreement . 9Third Party Administrator. 10USERRA . 10CHAPTER 3. ELIGIBILITY AND PARTICIPATION .113.013.023.033.043.053.063.073.08General . 11Initial Eligibility . 11Commencement of Participation . 11On-Going Eligibility . 11Termination . 14Reinstatement of Participation . 14Qualifying Leave Under FMLA . 15Unclaimed Benefits . 15CHAPTER 4. METHOD AND TIMING OF ELECTIONS .164.014.02Employee Elections . 16Mid-Plan Year Election Changes for Qualified Benefits . 16ii
Exhibit ACITY OF PORTLAND EMPLOYEE BENEFITS PROGRAMCHAPTER 5. BENEFITS OFFERED AND FUNDING .215.015.025.035.045.05Benefits Offered Under the Cafeteria Plan . 21Other Benefits Offered Under the Plan . 21Funding . 21Required and Default Benefits . 22Plan Benefits . 24CHAPTER 6. PREMIUM PAYMENT BENEFIT.256.016.026.036.046.05Benefits. 25Funding . 25Elections . 25Default Benefits . 25Claims Procedure. 25CHAPTER 7. DEPENDENT CARE ASSISTANCE PLAN .267.017.027.037.047.057.067.07Purpose. 26Eligibility and Enrollment . 26Establishing an Account; Payment of Expenses . 26Benefits. 26Forfeiture . 27Funding . 28Claims Procedure. 28CHAPTER 8. HEALTHCARE FLEXIBLE SPENDING ACCOUNT .308.018.028.038.048.058.068.07Purpose. 30Eligibility and Enrollment . 30Establishing an Account; Payment of Expenses . 31Benefits. 31Forfeiture . 31Funding . 32Claims Procedure. 32CHAPTER 9. HEALTH PLAN BENEFITS .349.019.029.039.049.059.069.079.089.09General . 34Coordination of Benefits (“COB”) . 34Coordination of Benefit – Payment of Claims . 36Leave Provisions . 38Continuation of Benefit Coverage . 39Continuation of Coverage: “COBRA Provisions” . 41Federal Health Insurance Exchange . 41Washington State Health Insurance Exchange. 42Medical and Behavioral Health Management Services. 42iii
Exhibit ACITY OF PORTLAND EMPLOYEE BENEFITS 0Acts of Third Parties . 42Extension of Hospitalization Benefits . 44Federal Newborns’ and Mothers’ Health Protection Act of 1996. 44Federal Women’s Health and Cancer Rights Act of 1998 . 44Genetic Information and Nondiscrimination Act of 2008 (“GINA”) . 45Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of2008 . 45ACA Group Market (Insurance) Reforms . 45Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and EconomicSecurity Act. 46National Medical Support Notice . 46Health Care Outcomes . 46Responsibility for Health Care . 46CHAPTER 10. HIPAA PRIVACY .1010.11Health Insurance Portability and Accountability Act . 47Permitted Disclosure of Enrollment/Disenrollment Information . 47Permitted Uses and Disclosure of Summary Health Information . 47Permitted and Required Uses and Disclosure of PHI . 47Conditions of Disclosure for Plan Administration Purposes. 48Adequate Separation Between HIPAA Group Health Plans and Plan Sponsor .49Certification of Plan Sponsor . 49HIPAA Security Rule . 49Health Information Technology for Economic and Clinical Health Act . 49Nondisclosure of Genetic Information for Underwriting Purposes . 49HIPAA Notice of Privacy Practices . 50CHAPTER 11. AMENDMENT AND TERMINATION .5111.01 Amendment and Termination . 5111.02 Authority of Administrator . 5111.03 Effect of Termination . 51CHAPTER 12. MISCELLANEOUS trator . 52Indemnification . 52Insurers . 52Third Party Administrator Responsibilities. 52Nondiscrimination . 52Payment . 53Complete Statement of Plan . 53Plan Records . 53iv
Exhibit ACITY OF PORTLAND EMPLOYEE BENEFITS n Interpretation . 54Mistake of Fact . 54Physical Examination and Autopsy . 54No Guarantee of Tax Consequences . 54Notices . 54Limitations of Rights . 54Quality of Services . 55Nonalienation of Benefits. 55No Vested Rights . 56Conflict with Employee Benefit Laws or Regulations . 56Right to Receive and Release Necessary Information . 56Information to be Furnished . 56Fraud. 56No Waiver or Estoppel . 56Headings and Number . 56Severability . 56Governing Law and Venue . 57Legal Process . 57APPENDIX A COMPONENT PLAN INFORMATION .58v
Exhibit AChapter 1.Introduction1.01EstablishmentThe City of Portland (the “City”) established the City’s Employee Benefits Program (the “Plan”) toprovide health and welfare benefits to eligible employees and their eligible dependents. The Plan ishereby amended and restated effective of July 1, 2022 (the “Effective Date”). The terms of this Plansupersede any prior oral or written versions of the Plan.1.02Purpose and Status of PlanThe Plan is designed to permit an Eligible Employee to elect various Benefits and to pay for thoseBenefits with a combination of Employer Contributions and Employee Contributions. EmployeeContributions may be paid on a pre-tax salary reduction basis under the Cafeteria Plan or with after-taxdeductions, as permitted under the Code and the applicable Component Plan.The Plan shall be interpreted and administered in accordance with the following intent:(a)The Cafeteria Plan is intended to be a cafeteria plan that qualifies under CodeSection 125 and shall be interpreted to accomplish that objective.(b)The Premium Payment Benefit is intended to qualify as a salary reduction plan underCode Section 125 to permit Participants to pay their share of the rates or premiums for their Health PlanBenefits on a pre-tax basis.(c)The Healthcare Flexible Spending Account (HFSA) is intended to qualify as a “selfinsured medical reimbursement plan” under the Code, and the Medical Expenses reimbursed thereunderare intended to be eligible for exclusion from Participants’ gross income under Code Sections 105(b) and106.(d)The Dependent Care Flexible Spending Account (DFSA) is intended to qualify as a“dependent care assistance plan” under the Code, and the Dependent Care Expenses reimbursedthereunder are intended to be eligible for exclusion from Participants’ gross income under Code Section129(a).(e)Although reprinted within this document, the Premium Payment Benefit, the HFSA, andthe DFSA are separate plans for purposes of administration and all reporting and nondiscriminationrequirements imposed by Code Sections 105(h), 125, and 129. The HFSA is also a separate plan forpurposes of the provisions of COBRA, as applicable to government plans by the Public Health ServicesAct (“PHS Act”).(f)The Plan includes and encompasses each Component Plan, and the terms of eachComponent Plan and Related Documents are hereby incorporated into the Plan by reference. The Planas set forth herein, together with all Component Plans and Related Documents, constitutes the writtenplan document for the Plan.(g)The provisions of the Plan as restated herein shall amend and supersede in their entiretythe prior provisions of the Plan. All Benefits payable before the Effective Date shall be made inaccordance with the Plan provisions then in effect.1.03Plan Limitations(a)Nothing contained in the Plan or any of its Component Plans shall be deemed to give anyEmployee the right to be retained in the service of the City or to interfere with the right of the City toChapter 11Introduction
Exhibit Adischarge any Employee at any time, regardless of the effect which such discharge shall have upon suchEmployee as a Participant under the Plan.(b)The City does not guarantee Benefits payable under any insurance policy or other similarcontract described or referred to herein, and any Benefits thereunder shall be the exclusive responsibilityof the insurer or other entity that is required to provide such Benefits under such policy or contract.1.04AdministratorThe Plan and its Component Plans shall be administered by the Administrator described inSection 2.02. The Administrator shall have responsibility for the general operation of the Plan and itsComponent Plans and shall have the power and duty to decide all questions arising in connection with theadministration, interpretation, and application of the Plan and its Component Plans and shall take allactions and make all decisions that shall be necessary to carry out the provisions of the Plan and itsComponent Plans, including, but not limited to:Plan;(a)Determining an Employee’s eligibility to participate in any Benefits authorized by the(b)Promulgating rules of procedure and keeping records necessary for the proper andefficient administration of the Plan;(c)Advising the insurers and Third Party Administrators with respect to Participants and withrespect to contributions made on behalf of Participants;(d)Furnishing the Council, Participants, and insurers with information they may require;(e)Engaging the services of such agents as the Administrator may deem advisable to assistwith or perform the Administrator’s duties;(f)Consulting with the City attorney with respect to the meaning or construction of the Planand its Component Plans and the Administrator’s duties thereunder; and(g)Assuming responsibility for all applicable reporting and disclosure requirements andengaging the service of agents to assist with reporting and disclosure requirements.The Administrator will be deemed to have properly exercised such discretionary authority, unlessthe Administrator has abused their discretion hereunder by acting arbitrarily and capriciously.1.05Plan NotificationReasonable notification of the availability and terms of the Plan and its Component Plans shall beprovided to all Eligible Employees by the Administrator.Chapter 12Introduction
Exhibit AChapter 2.DefinitionsThe following terms, as used in the Plan, shall have the meanings set forth below in this Chapter2, unless a clearly different meaning is required by the context in which the term is used:2.01ACA“ACA” means the Patient Protection and Affordable Care Act enacted on March 23, 2010, asamended by the Health Care and Education Reconciliation Act enacted on March 30, 2010.2.02Administrator“Administrator” means the Manager, Benefits of the City of Portland.2.03Adverse Benefit Determination“Adverse Benefit Determination” means any denial, reduction, or termination of, or a failure toprovide or make payment (in whole or in part) for, a Benefit, including any denial, reduction, termination,or failure to provide or make payment that is based on a determination of a Claimant’s eligibility toparticipate in the Plan, and including a denial, reduction, or termination of, or a failure to provide or makepayment (in whole or in part) for, a Benefit resulting from the application of any utilization review, as wellas a failure to cover an item or service for which Benefits are otherwise provided because it is determinedto be experimental or investigational or not medically necessary or appropriate.2.04Annual Enrollment Period or Annual Enrollment“Annual Enrollment Period” or “Annual Enrollment” means the period immediately preceding theperiod of Benefit coverage, as designated by the Administrator, during which an Eligible Employee mayfile or amend their Benefit Election Form.2.05Beneficiary“Beneficiary” means the person designated as a Participant’s beneficiary with respect to anyapplicable Benefit.2.06Benefit“Benefit” means each of the following benefits that are provided to Participants and Dependentsunder the Plan, as described in the applicable Component Plan and Related Document:(a)Cafeteria Plan Benefits:1.2.3.(b)Health Plan Benefits:1.2.3.(c)Medical (including prescription medication) benefits;Dental benefits; andVision benefits.Other Benefits:1.2.3.4.Chapter 2Premium Payment Benefit;Dependent Care Flexible Spending Account (DFSA); andHealthcare Flexible Spending Account (HFSA).Long-term disability benefits;Short-term disability benefits;Employee assistance program benefits;Basic and supplemental life insurance; and3Definitions
Exhibit A5
The City of Portland (the "City") established the City's Employee Benefits Program (the "Plan") to provide health and welfare benefits to eligible employees and their eligible dependent s. The Plan is hereby amended and restated effective of July 1, 2022 (the "Effective Date"). The terms of this Plan
