Amendment to the Employee Health Benefit Plan for 2017 • 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, 2016, and
WHEREAS, Plan Sponsor wishes to amend the restated Plan; and
WHEREAS, authority to amend the Plan is granted therein.
NOW, THEREFORE, effective January 1, 2017, the Plan is amended as follows.
1. In every case where the word "immunization" is used to describe a benefit, it should be changed to
"vaccination."
2. Under BENEFIT LIMITS FOR ELIGIBLE EXPENSES/Preventive Services for Plan A and Plan B, the
second paragraph is amended to read:
These services include routine or periodic exams (including school enrollment exams, but excluding
sports exams), Vaccinations (including many childhood vaccines, age 60+ shingles vaccines and
some travel vaccines), pelvic exams, pap tests, labs or x-rays, annual dilated eye examinations for
diabetic retinopathy, routine vision screenings for disease or abnormality, routing hearing screenings,
routine mammograms, routine PSA tests, bone density tests, routine colorectal cancer examinations
and related lab tests and routine colonoscopies.
3. The following are added to the list of MEDICAL EXCLUSION:
Home traction devices
Charges billed by a chiropractor for blood tests or hair analysis.
4. Under ELIGIBLE PRESCRIPTION DRUG EXPENSES, #2 is amended to read:
Compound drugs when a commercially available dosage form of a Medically Necessary medication is
not available, all the ingredients of the compound drug are FDA approved and require a prescription
to dispense, and are not essentially the same as an FDA approved product from a drug manufacturer.
Non-FDA approved, non-proprietary, multisource ingredients that are vehicles essential for compound
administration may be covered.
5. Under ELIGIBLE DENTAL BENEFITS the PROSTHESIS REPLACEMENT RULE is amended to
read:
Replacement of, 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 six (6)
months prior to its replacement.
In all other respects the Plan remains unchanged.
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Health Plan Amendment
CITY OF CARMEL, INDIANA
By and through its Board of Public Works and Safety
es rainard Presiding Office Date
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Ma A urke, B rd Member Date
Lori Watso oard Member Date
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Christine S. Paul , Clerk-Treas Date
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