Amendment to the 2018 City Employee Health Benefit Plan 2018 Health Plan Amendment
AMENDMENT TO THE CITY OF CARMEL
EMPLOYEE HEALTH BENEFIT PLAN
WHEREAS, the City of Carmel ("Plan Sponsor"), by action of its governing body, adopted the City of
Carmel Employee Health Benefit Plan (the "Plan") effective February 1, 1992, and subsequently modified
the Plan by a full restatement effective January 1, 2017; and
WHEREAS, authority to amend the Plan is granted therein; and
WHEREAS, Plan Sponsor wishes to amend the restated Plan.
NOW, THEREFORE, effective January 1, 2018, the Plan is amended as follows.
1. Under SCHEDULE OF MEDICAL BENEFITS (PLAN A), the following is added:
INFERTILITY TREATMENT 100% 100%
Deductible Applies: Yes Yes
Lifetime Maximum $5,000
2. Under SCHEDULE OF MEDICAL BENEFITS (PLAN B), the following is added:
INFERTILITY TREATMENT 80% 60%
Copay Applies: No No
Deductible Applies: Yes Yes
Lifetime Maximum $5,000
3. The following is added under DESCRIPTION OF MEDICAL BENEFITS:
INFERTILITY SERVICES
Charges for treatment of underlying medical conditions related to the inability to conceive.
Charges for infertility services, including artificial insemination, in vitro fertilization, gamete
intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT), subject to the limits shown in
the Schedule of Medical Benefits. The infertility benefit does not include surrogacy or fertility
medications.
4. Under MEDICAL EXCLUSIONS, #22 is amended to read as follows:
Charges for services and supplies for the purpose of achieving conception and/or pregnancy through
surrogacy or the use of fertility medications. See Infertility Services for eligible infertility expenses.
5. Under DESCRIPTION OF MEDICAL BENEFITS, the EMERGENCY ROOM benefit description is
amended to read as follows:
Charges for emergency treatment received in an emergency room. Non-emergency services
provided in an emergency room setting will not be considered eligible expenses.
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• 2018 Health Plan Amendment
6. The DENTAL SCHEDULE OF BENEFITS is amended to read as follows:
SCHEDULE OF DENTAL BENEFITS
(see Description of Dental Benefits for detailed explanation of the following provisions)
MAXIMUM BENEFITS:
Maximum Calendar Year Benefit per Participant(Non-Orthodontia) $2,500
Maximum Lifetime Benefit per Participant for Orthodontia $2,500
CALENDAR YEAR DEDUCTIBLES:
Basic and/or Major Services:
Individual Deductible $50
Family Deductible $100
(Deductible waived for Preventive and Orthodontia Services)
COINSURANCE PERCENTAGES:
Preventive Services 100%
Basic Services 80%
Major Services 50%
Orthodontia Services 50%
7. The following dental benefit is moved from MAJOR SERVICES TO BASIC SERVICES (benefit
increases from 50% to 80%).
Charges for restorations involving inlays and onlays, and gold, plastic or porcelain crowns, but only if
the tooth cannot be restored with a silver or amalgam filling.
8. The dental benefit is enhanced by Under ELIGIBLE DENTAL BENEFITS, the PROSTHESIS
REPLACEMENT RULE is amended to read as follows:
PROSTHESIS REPLACEMENT RULE
Replacement or additions to existing dentures or bridgework will be covered only if:
1. the replacement or addition of teeth is required to replace one (1) or more extracted teeth; or
2. the existing denture or bridgework cannot be made serviceable and was installed at least five (5)
years prior to its replacement.
In all other respects the Plan remains unchanged.
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2018 Health Plan Amendment
CITY OF CARMEL, INDIANA
By and through its Board of Public Works and Safety
mes Brainard, Presiding Officer
i
Date: -
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a Ann .urke, Boar Member
Date:
Lori Watson oard Member
Date: 5/r40// 7
ATTEST:_NA/RAO' M AI/, // t&ipk. ,
Christine Pauley, Clerk-Treasurer
Date: 6i/2-O//
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