Section 107-776; Ord. 19336; Amending the City of Columbia Employee Health Care Plan and the City of Columbia Employee Dental Plan


Ordinance No. 19336                            Council Bill No. B 493-06 A

     AN ORDINANCE

amending the City of Columbia Employee Health Care Plan and the City of Columbia Employee Dental Plan; and fixing the time when this ordinance shall become effective.

BE IT ORDAINED BY THE COUNCIL OF THE CITY OF COLUMBIA, MISSOURI, AS FOLLOWS:

    SECTION 1.    The City of Columbia Employee Health Care Plan is amended as follows:

Material to be deleted in strikeout; material to be added underlined.


    a.    Article III, Coverage and Contributions, is amended to read as follows:

        . . .

2.     CHANGING YOUR ENROLLMENT.  You have the opportunity to add, change or drop your Medical Plan coverage effective each January 1st.  To do so, you must file your election change by the preceding December 1st.  You cannot change your coverage status at any other time unless you experience a change in status as described below:

. . .

    G.    Your work hours change and you gain or lose eligibility for coverage as a result of a change in your work hours.

     H.    In the case of adding a domestic partner, within 30 days of the date that said partner has shared the same regular and permanent residence with     employee for a period of at least six months; or, if residency requirement has already been met, then if domestic partner also meets applicable conditions of items A, B, D, E or G, as outlined above.

. . .

13.     PREMIUM CONTRIBUTIONS.  The City shall determine the cost of coverage and the portion of the cost of coverage which the City will pay for eligible employees.  Your contributions toward the cost of this coverage, if any, will be deducted from your pay and are subject to change.

    The plan is designed to offer an employee additional tax advantages by providing that the employer’ s share of the premium is paid with before-tax dollars as permitted by Section 125 of the Internal Revenue Code.  Any premium costs for the coverage you elect will be deducted on a pre-tax basis through our tax savings plan unless you specifically authorize the deduction to be made after-tax.  This means that the amount credited to your premium payment account will normally not be included in your federal or state taxable income or subject to FICA (Social Security) taxation.  By becoming a participant in the tax savings plan, you agree to have a portion of your earnings credited to your premium payment for health coverage.  Section 125 of the Internal Revenue Code does not allow insurance premiums for a domestic partner to be included in the tax savings plan; the City will deduct these insurance premiums on an after-tax basis.

b.    The Schedule of Benefits in Article IV is amended by substituting Exhibit A for the corresponding provisions in the current plan.

c.    Article VIII, Definitions, is amended to read as follows:

        . . .

4.     DEPENDENT means any person who is related to a covered enrollee as follows:

    A.    an eligible child;

    B.    the spouse (unless legally separated) of an eligible or disabled or retired employee; or

    C.    a surviving dependent of an eligible employee. ; or

     D.    the domestic partner of an eligible or disabled or retired employee.

        . . .

7a.    DOMESTIC PARTNER, means a person who has resided together with an employee of the City for at least six months and each intend for the person to continue to reside with the employee and share the common necessities of life.  Domestic partners must be at least 18 years of age, mentally competent to contract, and not related by blood to the employee closer than would bar marriage in the State of Missouri.  Neither the employee nor the domestic partner may be married to any person.  The employee and domestic partner must file a joint affidavit with the City stating their intention to be domestic partners and either may end such relationship at any time.  Once established, the City will consider such relationship in existence until notified by the employee in writing that it has been terminated.  An employee may only claim one domestic partnership at a time and, upon termination of such relationship, may not claim a new domestic partnership until six months after notice to the City of the termination of the previous domestic partnership.

        . . .

        8.     ELIGIBLE CHILD means any person who:

        . . .

E.    has not reached the last day of the calendar year in which his 23 rd birthday occurs; OR is a disabled child (see definition of “Disabled Child”).; OR

F.    meets the requirements of C, D and E and is the child of a domestic partner of the employee when the employee currently is standing “in loco parentis” to the child.

        . . .

14a.    IN LOCO PARENTIS means “in place of a parent” and describes the relationship that occurs when an employee has assumed day-to-day responsibilities to care for and financially support a child when the employee otherwise has no biological or legal relationship to the child. The “in loco parentis” relationship ends upon the death of the employee or the termination of the domestic partnership between the employee and the child’ s parent.

        . . .

    d.    A new Article IX is added to read as follows:

                             ARTICLE IX

                     PROVISION OF PROTECTED HEALTH
                       INFORMATION TO PLAN SPONSOR

1.    PERMITTED DISCLOSURES OF PROTECTED HEALTH INFORMATION.

Unless otherwise permitted by law, and subject to obtaining written certification pursuant to Section 4, on and after the date this Plan is required to comply with the provisions governing the use and disclosure of protected health information pursuant to the administrative simplification provisions of the Health Insurance Portability and Accountability Act of 1996, a Component Plan that is a Health Plan as defined in 45 CFR §160.103, (or a health insurance issuer or HMO with respect to such Health Plan) may disclose Protected Heath Information (as defined in 45 CFR §164.501) to the Plan Sponsor only for the purpose of enabling the Plan Sponsor to perform administrative functions related to the treatment, payment and health care operations of such Health Plan as defined in 45 CFR §164.501.  

In no event shall the Plan Sponsor be permitted to use or disclose Protected Health Information in a manner that is inconsistent with 45 CFR §164.504(f).

2.    CONDITIONS OF DISCLOSURE.  The Plan Sponsor agrees that with respect to any Protected Health Information disclosed to it by a Health Plan (or a health insurance issuer or HMO with respect to the Plan) that it shall:

A.    Not use or further disclose the Protected Health Information other than as permitted or required by the Health Plan or as required by law.

B.    Ensure that any agents, including a subcontractor, to whom it provides Protected Health Information received from a Health Plan agree to the same restrictions and conditions that apply to the Plan Sponsor with respect to Protected Health Information.

C.    Not use or disclose the Protected Health Information for employment-related actions and decisions or in connection with any other benefit or employee benefit plan of the Plan Sponsor.

D.    Report to a Health Plan any use or disclosure of the information that is     inconsistent with the uses or disclosures provided for of which it becomes     aware.

E.    Make available Protected Health Information in accordance with 45 CFR     §164.524.

F.    Make available Protected Health Information for amendment and incorporate any amendments to Protected Health Information in accordance     with 45 CFR §164.526.

G.    Make available the information required to provide an accounting of disclosures in accordance with 45 CFR §164.528.

H.    Make its internal practices, books, and records relating to the use and disclosure of Protected Health Information received from a Health Plan available to the Secretary of Health and Human Services for purposes of determining compliance by the Health Plan with subpart E of 45 CFR §164.

I.    If feasible, return or destroy all Protected Health Information received from a Health Plan that the Plan Sponsor still maintains in any form and retain no copies of such information when no longer needed for the purpose for which disclosure was made, except that, if such return or destruction is not feasible, limit further uses and disclosures to those purposes that make the return or destruction of the information infeasible.

J.    Ensure that the adequate separation between a Health Plan and Plan Sponsor, required in 45 CFR §504(f)(2)(iii), is satisfied.

3.    SEPARATION BETWEEN HEALTH PLAN AND PLAN SPONSOR.  To satisfy the requirements of Section 2.J. above, the following conditions shall apply:

A.    Only the following employees, or classes of employees, or other persons under control of the Plan Sponsor, shall be given access to the Protected Health Information to be disclosed:

     City of Columbia Human Resources Department staff members designated by the Director of Human Resources, Plan Administrator.

B.    The access to and use of Protected Health Information by the individuals described in Section 3.A. above shall be restricted to the plan administration functions that the Plan Sponsor performs for a Health Plan.

C.    An individual described in Section 3.A. above who fails to comply with the provisions of the plan document relating to the use and disclosure of Protected Health Information shall be subject to disciplinary action under the Plan Sponsor's established policies and procedures.

4.    CERTIFICATION BY PLAN SPONSOR.  A Health Plan (or a health insurance issuer or HMO with respect to such Health Plan) shall disclose Protected Health Information to the Plan Sponsor only upon the receipt of a certification by the Plan Sponsor that the plan document has been amended to incorporate the provisions of 45 CFR §164.504(f)(2)(ii), and that the Plan Sponsor agrees to the conditions of disclosure set forth in Section 2.  A Health Plan shall not disclose and may not permit a health insurance issuer or HMO to disclose Protected Health Information to the Plan Sponsor as otherwise permitted herein unless the statement required by 45 CFR §164.520(b)(1)(iii)(C) is included in the appropriate notice.

    SECTION 2.    The City of Columbia Employee Dental Plan is amended as follows:

Material to be deleted in strikeout; material to be added underlined.

    a.    Article III, Coverage and Contributions, is amended to read as follows:

        . . .

2.     CHANGING YOUR ENROLLMENT.  You have the opportunity to add, change or drop your Dental plan coverage effective each January 1st. To do so, you must file your election change by the preceding December 1st.  You cannot change your coverage status at any other time unless you experience a change in status as described below:

. . .

G.    Your work hours change and you gain or lose eligibility for coverage as a result of a change in your work hours.
H.    In the case of adding a domestic partner, within 30 days of the date that said partner has shared the same regular and permanent residence with     employee for a period of at least six months; or, if residency requirement has already been met, then if domestic partner also meets applicable conditions of items outlined above.

. . .

13.     PREMIUM CONTRIBUTIONS.  The City shall determine the cost of coverage and the portion of the cost of coverage which the City will pay for eligible employees.  Your contributions toward the cost of this coverage, if any, will be deducted from your pay and are subject to change.

The plan is designed to offer an employee additional tax advantages by providing that the employee's share of the premium is paid with beforetax dollars as permitted by Section 125 of the Internal Revenue Code.  Any premium costs for the coverage you elect will be deducted on a pretax basis through our tax savings plan unless you specifically authorize the deduction to be made aftertax.  This means that the amount credited to your premium payment account will normally not be included in your federal or state taxable income or subject to FICA (Social Security) taxation.  By becoming a participant in the tax savings plan, you agree to have a portion of your earnings credited to your premium payment for health coverage.  Section 125 of the Internal Revenue Code does not allow insurance premiums for a domestic partner to be included in the tax savings plan; the City will deduct these insurance premiums on an after-tax basis.

b.    Article VIII, Definitions, is amended to read as follows:

    . . .

5.     DEPENDENT means any person who is related to a covered enrollee as follows:

    A.    an eligible child;

    B.    the spouse (unless legally separated) of an eligible or disabled or retired employee; or

    C.    a surviving dependent of an eligible employee. ; or

         D.    the domestic partner of an eligible or disabled or retired employee.

        . . .

7a.    DOMESTIC PARTNER, means a person who has resided together with an employee of the City for at least six months and each intend for the person to continue to reside with the employee and share the common necessities of life.  Domestic partners must be at least 18 years of age, mentally competent to contract, and not related by blood to the employee closer than would bar marriage in the State of Missouri.  Neither the employee nor the domestic partner may be married to any person.  The employee and domestic partner must file a joint affidavit with the City stating their intention to be domestic partners and either may end such relationship at any time.  Once established, the City will consider such relationship in existence until notified by the employee in writing that it has been terminated.  An employee may only claim one domestic partnership at a time and, upon termination of such relationship, may not claim a new domestic partnership until six months after notice to the City of the termination of the previous domestic partnership.

        8.     ELIGIBLE CHILD means any person who:

        . . .

E.    has not reached the last day of the calendar year in which his 23 rd birthday occurs; OR is a disabled child (see definition of “Disabled Child”).; OR

F.    meets the requirements of C, D and E and is the child of a domestic partner of the employee when the employee currently is standing “in loco parentis” to the child.

        . . .

13a.    IN LOCO PARENTIS means “in place of a parent” and describes the relationship that occurs when an employee has assumed day-to-day responsibilities to care for and financially support a child when the employee otherwise has no biological or legal relationship to the child. The “in loco parentis” relationship ends upon the death of the employee or the termination of the domestic partnership between the employee and the child’ s parent.

        . . .
    c.    A new Article IX is added to read as follows:

                             ARTICLE IX

                     PROVISION OF PROTECTED HEALTH
                        INFORMATION TO PLAN SPONSOR

1.    PERMITTED DISCLOSURES OF PROTECTED HEALTH INFORMATION.

Unless otherwise permitted by law, and subject to obtaining written certification pursuant to Section 4, on and after the date this Plan is required to comply with the provisions governing the use and disclosure of protected health information pursuant to the administrative simplification provisions of the Health Insurance Portability and Accountability Act of 1996, a Component Plan that is a Health Plan as defined in 45 CFR §160.103, (or a health insurance issuer or HMO with respect to such Health Plan) may disclose Protected Heath Information (as defined in 45 CFR §164.501) to the Plan Sponsor only for the purpose of enabling the Plan Sponsor to perform administrative functions related to the treatment, payment and health care operations of such Health Plan as defined in 45 CFR §164.501.  

In no event shall the Plan Sponsor be permitted to use or disclose Protected Health Information in a manner that is inconsistent with 45 CFR §164.504(f).

2.    CONDITIONS OF DISCLOSURE.  The Plan Sponsor agrees that with respect to any Protected Health Information disclosed to it by a Health Plan (or a health insurance issuer or HMO with respect to the Plan) that it shall:

A.    Not use or further disclose the Protected Health Information other than as permitted or required by the Health Plan or as required by law.

B.    Ensure that any agents, including a subcontractor, to whom it provides Protected Health Information received from a Health Plan agree to the same restrictions and conditions that apply to the Plan Sponsor with respect to Protected Health Information.

C.    Not use or disclose the Protected Health Information for employment-related actions and decisions or in connection with any other benefit or employee benefit plan of the Plan Sponsor.

D.    Report to a Health Plan any use or disclosure of the information that is     inconsistent with the uses or disclosures provided for of which it becomes     aware.

E.    Make available Protected Health Information in accordance with 45 CFR     §164.524.

F.    Make available Protected Health Information for amendment and incorporate any amendments to Protected Health Information in accordance     with 45 CFR §164.526.

G.    Make available the information required to provide an accounting of disclosures in accordance with 45 CFR §164.528.

H.    Make its internal practices, books, and records relating to the use and disclosure of Protected Health Information received from a Health Plan available to the Secretary of Health and Human Services for purposes of determining compliance by the Health Plan with subpart E of 45 CFR §164.

I.    If feasible, return or destroy all Protected Health Information received from a Health Plan that the Plan Sponsor still maintains in any form and retain no copies of such information when no longer needed for the purpose for which disclosure was made, except that, if such return or destruction is not feasible, limit further uses and disclosures to those purposes that make the return or destruction of the information infeasible.

J.    Ensure that the adequate separation between a Health Plan and Plan Sponsor, required in 45 CFR §504(f)(2)(iii), is satisfied.

3.    SEPARATION BETWEEN HEALTH PLAN AND PLAN SPONSOR.  To satisfy the requirements of Section 2.J. above, the following conditions shall apply:

A.    Only the following employees, or classes of employees, or other persons under control of the Plan Sponsor, shall be given access to the Protected Health Information to be disclosed:
     City of Columbia Human Resources Department staff members designated by the Director of Human Resources, Plan Administrator.

B.    The access to and use of Protected Health Information by the individuals described in Section 3.A. above shall be restricted to the plan administration functions that the Plan Sponsor performs for a Health Plan.

C.    An individual described in Section 3.A. above who fails to comply with the provisions of the plan document relating to the use and disclosure of Protected Health Information shall be subject to disciplinary action under the Plan Sponsor's established policies and procedures.

4.    CERTIFICATION BY PLAN SPONSOR.  A Health Plan (or a health insurance issuer or HMO with respect to such Health Plan) shall disclose Protected Health Information to the Plan Sponsor only upon the receipt of a certification by the Plan Sponsor that the plan document has been amended to incorporate the provisions of 45 CFR §164.504(f)(2)(ii), and that the Plan Sponsor agrees to the conditions of disclosure set forth in Section 2.  A Health Plan shall not disclose and may not permit a health insurance issuer or HMO to disclose Protected Health Information to the Plan Sponsor as otherwise permitted herein unless the statement required by 45 CFR §164.520(b)(1)(iii)(C) is included in the appropriate notice.

    SECTION 3.    The amendments set forth in this ordinance pertaining to domestic partners shall be in full force and effect from and after February 1, 2007; all other provisions of this ordinance shall be in full force and effect from and after January 1, 2007.

    PASSED this 18th day of December, 2006.