HomeMy WebLinkAboutResolution 3653 ICMA Vantage Care Health Plan
COMMISSION RESOLUTION NO. 3653
A RESOLUTION OF THE CITY COMMISSION OF THE CITY OF BOZEMAN,
MONTANA, ADOPTING THE ICMA
RETIREMENT CORPORATION'S
VANTAGECARE RETIREMENT HEALTH SAVINGS PROGRAM.
WHEREAS, the Employer has employees rendering valuable services; and
WHEREAS, the establishment of a retiree health savings plan for such employees serves the
interests of the Employer by enabling it to provide reasonable security regarding such employees' health
needs during retirement by providing increased flexibility in its personnel management system and by
assisting in the attraction and retention of competent personnel; and
WHEREAS, the Employer has determined that the establishment of the retiree heath savings
plan (the "Plan") serves the above objectives.
NOW, THEREFORE, BE IT RESOLVED by the City Commission of the City of Bozeman,
Montana:
Section 1
That the Employer hereby adopts the Plan in the form of the ICMA Retirement Corporatin's
VantageCare Retirement Health Savings program.
Section 2
That the assets of the Plan shall be held in trust, with the Employer serving as trustee, for the
exclusive benefit of Plan participants and their beneficiaries, and the assets of the Plan shall not be
diverted to any other purpose prior to the satisfaction of all liabilities of the Plan. The Employer has
executed the Declaration of Trust of the City of Bozeman Integral Part Trust in the form of the model trust
made available by the ICMA Retirement Corporation.
Section 3
That the Administrative Services Director shall be the coordinator and contact for the Plan and
shall receive necessary reports, notices, etc.
PASSED AND ADOPTED by the City Commission of the City of Bozeman, Montana, at a
regular session thereof held on the 2nd day of February 200 .
ATTEST:
~~J~
ROBIN L. SULL VAN
Clerk of the Commission
"
EMPLOYER VANTAGECARE RETIREMENT HEALTH
SAVINGS (RHS) PLAN ADOPTION AGREEMENT
Plan Number: 8
Employer Retirement Health Savings Plan Name: _______ ~~~,-----
I. Employer Name: - .,.,-.-- -~.,~.,--_.
State:
II. The Employer hereby attests that it is a unit of a state or local government or an agency or instrumentality of
one or more units of a state or local government.
III. The Effective Date of the Plan: ~'".,,.,~,~
IV. The Employer intends to utilize the Trust to fund only welfare benefits pursuant to the following welfare ben-
efit plan(s) established by the Employer:
-~~~,._---- --
-.
-',.' .~~~,.,. .,,~'.~----
V. Eligible Groups and Participant Eligibility Requirements
A. The following group or groups of Employees are eligible to participate in the VantageCare Retirement Health
Savings Plan:
.______ All Employees
_____ All Full-Time Employees
Non-Union Employees
~"-~~.~~._'. Public Safety Employees -- Police
",._,y,~..~..~ Public Safety Employees -- Firefighters
General Employees
Collectively-Bargained Employees (Specify unit)
Other (specify below)
-. ~---,~-~~'~
.',. ,~ ---
The group specified must correspond to a group of the same designation that is defined in the statutes, ordi-
nances, rules, regulations, personnel manuals or other material in effect in the state or locality of the Employer.
If this box is checked, in lieu of mandatoryparticipation~theEmployerprovides.f(.)r~one-timeirreVoca~
bleelection by eligible-Employees to partidpateinH.HS. Until such time-as the ele<:tionis macJe, the
Employee shall not participate in the Plan or receive contributions pursuanttogectip!1VI.
Newly eligible Employees shall be provided an election window of - days (110 morethan 60
calendar days) from the date of initial eligibilityduringwhichthey may make thet el ectlQn to participate.
Participation may begin no earlier than thecalenclarmonth following the endoftheeh:~c:tiOnwindow.
Ifthe Employee does not make the election in theyearofinitialeligibilitYI the election.tp participate may
be made in a later year. An annual election window of days (no !TIorethan60 calendar
days) shall be provided during which the electionmaybell1ade.The electionwil)dowshaHrun from
to (insert your-annualtim~frame fortheelectionwin?pwi.e.g,.October_1to
November 29). Participation may begin no earJiertl1anthecalendar year following theyearQfthe elec-
tion.
Once made, the election is irrevocable and maynotberevokedwhile the particiJ>8l1tisarnember of the
group covered by the RHS plan.
If the Employer's underlying welfare benefit plan or funding under this VantageCare Retirement Health Savings
Plan is in whole or part a non-collectively bargained. self-insured plan, the nondiscrimination requirements of
Internal Revenue Code (IRC) Section 105(h) will apply. These rules may impose taxation on the benefits received
11
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____._._n.
by highly compensated Employees if the Plan discriminates in favor of highly compensated Employees in terms
of eligibility or benefits. The Employer should discuss these rules with appropriate counsel.
B. Participant Eligibility
1. Minimum period of service required for participation is __ (write N/A if an Employee is eligible to partici-
pate or to elect to participate immediately upon employment).
2. Minimum age required for eligibility to participate is _ (write N/A if no minimum age is required).
VI.Contribution Sources and Amounts
A. Mandatory Contributions
o 1. Direct Employer Contributions
The Employer shall contribute on behalf of each Participant _% of earnings or $ for the Plan
Year.
Definition of earnings:
~.__._-
~."",
--
o 2. Mandatory Leave Contributions
The Employer will make mandatory contributions of leave as follows:
Accrued Sick Leave* n Yes n No
Accrued Vacation* o Yes 0 No
Other*' (describe) -~._- o Yes
CJ No
-)f Please provide the formula for determining the Accrued Leave contribution:
-..-
-.-... ,....~ .~-
An Employee shall not have the right to discontinue or vary the rate of annual leave contributions.
o 3. Mandatory Employee Compensation Contributions
The Employer will make mandatory contributions of Employee compensation as follows:
o Reduction in Salary - _% of earnings (as defined in VI.A.1.) or $ will be
contributed for the Plan Year.
o Decreased Merit or Pay Plan Adjustment - All or a portion of the Employees' annual merit
or pay plan adjustment will be contributed as follows:
---
.._-_.~--
An Employee shall not have the right to discontinue or vary the rate of mandatory contributions of
Employee compensation.
12
- -------------
---..--..--.-- -...-...-..----
B. Elective Contributions
1. Elective Pre-Tax Contributions
The Employer will permit each Erllployee to make the following elections to make pre-tax
contributions to the Plan:
o a. Irrevocable Election for Pre-Tax Contributions from Compensation: A one-time, irrevocable election of
the amount of Employer contributions of compensation made on his or her behalf.
The Employer limits the amount elected to either a fixed percentage or a range of percentages of an
Employee's earnings
__.m_____% of earnings (as defined in VI.A.1.) or up to _..~_ % of earnings (as defined in
VI.A.1) for the Plan Year,
Newly eligible Employees shall be provided an election window of days (no more than 60)
from the date of initial eligibility during which they may make the election to contribute. Contributions
may begin no earlier than the calendar month following the end of the election window.
If the Employee does not make the election in the year of initial eligibility, the election to contribute may
be made in a later year. An annual election window of __M._days (no more than 60) shall be
provided during which the election may be made. The election window shall run from ________ to
(insert your annual time frame for the election window). Contributions may begin no ear-
lier than the calendar year following the year of the election.
Once made, the election is irrevocable and may not be revoked.
o b. Irrevocable Election for Pre-Tax Contributions of Accrued Leave: A one-time, irrevocable election of
the amount of employer contributions of Employee accrued
o sick o vacation CJ other _n______
(describe) leave made on his or her behalf.
o Yes o No
The Employer limits the amount elected as shown below:
-~'..- ".,..- _.'.'.'"..'J.
...".,-....,..-.-----.---.---.
-_."~'." -..". "'.~,.,._.- _0' __.__...... -- .._,-"._-_.~.^-~-
"'--.-
Newly eligible Employees shall be provided an election window of days (no more than 60
calendar days) from the date of initial eligibility during which they may make the election to contribute.
Contributions may begin no earlier than the calendar month following the end of the election window.
If the Employee does not m<1ke the election in the year of initial eligibility, the election to contribute may
be made in a later year. An annual election window of _n. _ days (no more than 60 calendar
days) shall be provided during which the election may be made. The election window shall run from
-,,~_. _ to _._____ (insert your annual time frame for the election window), Contributions may
begin no earlier than the calendar year following the year of the election.
Once made, the election is irrevocable and may not be revoked.
o c. Annual Prospective Election for Pre-Tax Contributions of Leave: An annual, irrevocable election to
have his or her 0 sick 0 vacation 0 other ___"_ (describe) leave to be accrued in the next
calendar year contributed to the Plan on his or her behalf.
13
------ ----.---------...----- -----
-----.-.---.-.-.... --- -..--
---.---.,--,--..--.--..-.----
The Employer limits the amount elected as shown below:
._~,- ' , ' '" " .. "" :, , ,',::, ~,
,:: ~':,; :, i, " "j, , :,
";"'!""^
Contributions of future leave accruals will be remitted to thePlah ;' ::' ,,':' ,:' ~: ,,' ';, :, ,::;, "" , ':'"
',:' : ,: ",':: :"'::,~:"':/: :;:":': ':'\'
o as earned Oatthe end of the calendar year. .,":':,1':,:":,;":,:':':.":
;,:, ':,i
'.,':',':"','..',,: "",:":::,,,"":'"''''
:""""',,,' "':,"',"',
:'::,::""",::'::'.',:':,:,:,:,:",,':,i,,:,:.,:,,,,;"",:':'::"':":'::':'::":i::"'::::'''',:,:',:' ,
The' election.to..contributernust be made in the calendar year before the year in: Whrchcdrtributi()p'~<3r~!t:q:':
i:Jegin.Once made, the election shall apply to succeedingcalendaryears unless othervvis~I~Y'ise(1;(i)r> .. '., .
revoked by the Employee On an annual basis.
,:"'''",,,,,\''''''',,i,:''':'',,,,''''''''',':,' ':,,','i'n
, " ::, :,,' ':' t '': ' :'~:~' ,:': ',::,: , ' ':' : :" :':' ' : ' :, ~',', :,:',: ': ,,:':, , ><.. '
,:':'::' :
'''' ," ,,",',,'" ,':"':':"....,,
:;""" "',,' ,. ','" ',',' "" '"
An a nnualeJection. window'.of-----,days (no more than pO cal~rdardays)is ..providedduri hg>\lVtliCIi~li9ibi~:.
Employees may maketheelection to contribute, Theelecti~rr\IVindowshall runJ[()m.'~o" . . .
(insert your annualtimeframeforthe election window). .. ......
In adopting section a., b,and/orc, the:.Employer acknowledgestha~thelnternaIRevenue$ervi(;ehasn("}F.:. ..'
ruled on irrevocable electioncontri but Ions. in. an.. integral.paI'tJrust....ICMA~RChasobtai.lledtr~agVicf'ii().f.... ........
counsel that such contributions are allowable under the conditions outlined in thisAdoptionA~reerr1e'nt.The
Employer should discuss this issue withappropriatecounseJ;
2: Voluntary After- Tax Contribotidns
EachEmployee may contribute upto'_% of earnings (asdefinedInVLA1.lor $ . . . '.' .fprthePlanYearon
a voluntary after-tax basis; In no event may aggregate Employee voluntary after~taxcontributionsexceed25%
ortotal contributions in any Plan Year.
An Employee shall have the righltodiscontinue or vary the rate of elective afterctax contributions of Employee
earnings.
By adopting thissection, lheEmployer acknowledges thatlhelntemal Revenue Service hasdeclinedto"ruleon
Employee after tax contributions in an integral part trust. ICMARChasdbtained the advice of counsel that such
contributions are allowable in an insubstantial amount (i.e. no more than 25% of total contributions in any Plan
Year). The Employer should discuss this issue with appropriate counsel.
C. Limits on Total Contributions
The total contribution on behalf of each Participant (including both Mandatory and Elective
Contributions) for each Plan Year shall not exceed the following limit(s):
CJ % of earnings (as defined in VI.A.l.).
o $
o There is no Plan-defined limit on the percentage or dollar amount of earnings that may
be contributed.
Limits on individual contribution types are defined within the appropriate section above.
See Section V.A. for a discussion of nondiscrimination rules that may apply to non-collectively bargained self-
insured Plans.
14
---.....-.-...--..
VI" Vesting Schedule
A. The account is 100% vested at all times, unless specified otherwise in B. below.
B. The following vesting schedule applies to Direct Employer Contributions outlined in VI.A.1:
Yea rs of Specified
Service Percent
Completed Vesti ng
"'".-'~'-~,,~ .---_%
~%
%
%
%
%
%
%
%
C. The account will become 100% vested upon the death, disability, retirement, or attainment of
benefit eligibility by a Participant.
Definition of retirement:
D. Any period of service by a Participant prior to a rehire of the Participant by the Employer shall not
count toward the vesting schedule outlined in B. above.
VIII. Forfeiture Provisions
Upon separation from the service of the Employer or upon reversion to the Trust of a Participant's account
assets remaining upon the participant's death (as outlined in Section XI), a Participant's non-vested funds shall:
o Remain in the Trust to be reallocated among all Plan Participant's as Direct Employer Contributions for
the next and succeeding contribution cycle(s).
o Remain in the Trust to be reallocated on an equal dollar basis among all Plan Participants.
o Remain in the Trust to be reallocated among all Plan Participants based upon Participant account bal-
ances.
o Revert to the Employer.
In the case of separation from service, the Participant's non-vested funds shall be applied as shown above. In the
case of reversion due to the Participant's death under Section XI, the remaining account assets shall be applied
as shown above.
IX. Eligibility Requirements to Receive Medical Benefit Payments from the VantageCare Retirement Health
Savings Plan
A. A Participant is eligible to receive benefits:
At retirement only (as defined in Section VII.C.)
At separation from service with the following restrictions
At age only
____At retirement and age
At retirement or age
15
.--...--..--.....-..--.. .
B. Termination prior to general benefit eligibility: A Participant who separates from the service of the Employer
prior to attaining benefit eligibility as outlined in Section IX.A. or C. will be eligible to receive benefits:
D Immediately upon separation from service.
D At age
C. A Participant who dies or becomes totally and permanently disabled (as defined by the Social Security
Administration) will become immediately eligible to receive medical benefit payments from his/her VantageCare
Retirement Health Savings Plan account.
X. Permissible Medical Benefit Payments
Benefits eligible for payment consist of:
A. ~,,_.__..~AII Medical Expenses eligible under IRC Section 213* other than direct long-term care
expenses, OR
B. The following Medical Expenses (select only the expenses you wish to cover under the
VantageCare Retirement Health Savings Plan):
Medical Insurance Premiums
Medical Out-of~Pocket Expenses*
Medicare Part B Insurance Premiums
Medicare Supplement Insurance Premiums
COBRA Premiums
Dental Insurance Premiums
Dental Out-of-Pocket Expenses*
~_._Long Term Care Insurance Premiums
--- Other (Must be eligible under IRC Section 213)*
* See Section V.A. for a discussion of nondiscrimination rules which may apply to non-collectively bargained,
self-insured Plans.
XI. Death Benefit
In the event of a Participant's death, the following shall apply:
Account Transfer: The surviving spouse and/or surviving eligible dependents (as defined in Section XIII.F.) of the
deceased Participant are immediately eligible to maintain the account and utilize it to fund eligible medical bene-
fits specified in Section X above.
Upon notification of a Participant's death, the Participant's account balance will be transferred into the
Vantagepoint Money Market Fund*. The account balance may be reallocated by the surviving spouse or
dependents.
* Please read the current prospectus carefully prior to investing. An investment in this fund is neither insured
nor guaranteed and there can be no assurance that the Fund will be able to maintain a stable net asset value of
$1.00 per share. Vantagepoint Mutual Funds are distributed by ICMA-RC Services, LLC, a controlled affiliate of
ICMA Retirement Corporation. Member NASD/SIPC.
If a Participant's account balance has not been fully utilized upon the death of the eligible spouse, the account
balance may continue to be utilized to pay benefits of eligible dependents. Upon the death of all eligible depend-
ents, the balance will be available for medical benefits for the designated beneficiary of the last dependent or
spouse to die. Assets remaining upon the death of a designated beneficiary shall be available for medical bene-
fits of the beneficiary's designated beneficiary. If there is no living beneficiary(ies), the account will revert to the
Plan to be applied as specified in Section VIII.
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--.------.-
There will be no elective withholding of federal, state, or local taxes for medical benefit payments to the
Participant's spouse's or dependent's designated beneficiary(ies).
If there are no living spouse or dependents at the time of death of the Participant, the account will be available
for medical benefits for the designated beneficiary(ies) of the Participant. Assets remaining upon the death of all
designated beneficiaries shall be available for medical benefits of the beneficiary's beneficiary. If there is no liv-
ing beneficiary(ies), the account will revert to the Plan to be applied as specified in Section VIII.
There will be no elective withholding of federal, state, or local taxes for medical benefit payments to the
Participant's beneficiary(ies) or any beneficiary's beneficiary.
XII. De Minimis Accounts
Upon separation from the service of the Employer prior to a Participant becoming eligible for medical benefits
from a VantageCare Retirement Health Savings Plan account, Participant accounts that are considered de min-
imis as specified below will be paid to the Participant.
o The de minimis account value shall be $5,000 or less.
o The de minimis account value shall be $ (insert dollar amount between $0 and
$5,000) or less.
o The Plan shall not allow de minimis account distributions.
XIII. The Plan will operate according to the following provisions:
A. Employer Responsibilities
1. The Employer will submit all VantageCare Retirement Health Savings Plan contribution
data via electronic submission.
2. Participant status updates and/or changes or personal information updates and/or changes (Participants'
termination dates, Participants' benefit eligibility dates, etc.) will be provided via electronic submission.
B. Participant account administration fees will be paid through the redemption of Participant account shares,
unless agreed upon otherwise in the Administrative Services Agreement.
C. Employer plan fees will be paid by the Employer as outlined in the Administrative Services Agreement.
D. Assignment of benefits is not permitted.
E. Payments to an alternate payee (payee other than a Participant) are not permitted with the exception of reim-
bursement of health insurance premiums to the Employer.
F. An eligible dependent is the Participant's lawful spouse and any other individual who is a person described in
IRC Section 152(a).
G. The Employer will be responsible for withholding, reporting and remitting any applicable taxes, as outlined
in the VantageCare Retirement Health Savings Plan Employer Manual.
XIV. The Employer hereby acknowledges it understands that failure to properly fill out this Employer
VantageCare Retirement Health Savings Plan Adoption Agreement may result in the loss of tax exemption of the
Trust and/or loss of tax-deferred status for Employer contributions.
17
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EMPLOYER
By: ~._-~",.~."".",.~~~.
Title: -~~.,"."....~~.~"~~~~~,._,'--
Attest:
Accepted: Vantagepoint Transfer Agents, LLC
~ C2A..<. ~ J~
'"
Corporate Treasurer
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