HomeMy WebLinkAbout2018-01 City of Auburn LEOFF Board
RESOLUTION 2018-01
A RESOLUTION OF THE CITY OF AUBURN LEOFF
BOARD AMENDING SECTIONS 1.01, 1.05, 8.02,
9.01, AND 9.02 OF THE BOARD'S POLICY AND
PROCEDURE MANUAL
THE LEOFF BOARD OF THE CITY OF AUBURN, WASHINGTON,
HEREBY RESOLVES as follows:
Section 1. That Policy secfion 1.01, Membership, be amended to read
as follows:
1.01 Membership
The Board shall consist of five (5) members, as follows:
A. Two (2) members of 4he City legislative body to be appointed
by the Mayor.
B. One (1) LEOFF 1 or LEOFF 2 firefghter elected by those
members subject to the jurisdiction of the Board, ' ��T
ast+ve-efi-reti+-e�#. Elections for fiPefigHter representative shall
be in even numbered years. .
C. One (1) LEOFF 1 or LEOFF 2 police officer to be elected by
those members subject to the jurisdiction of the Board, � c-��^„-rc
� �^'�.,^ ^� �^+ �^�' Elections for police officer representative
will be in odd numbered years.
D. One (1) member from the public at large who resides within
the City to be aPpointed by the other four (4) appointed
members.
E. If there are either no fire fighters or no Iaw enforcement
o�cers under the jurisdiction of the Board eligible to vote, fhe
eligible officers or fire fighters shall elect a second eligibl.e.
employee representative.
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Section 2. That Policy section 1.05, Elections, be amended to read as
follows:
1.05 Elections
At fhe first (15�) meeting of each year, the members shall elect from
among the members, a member to serve as Chairperson and a
member to serve as Chairperson pro tempore.
A. The election of a LEOFF firefighter representative shall be by
� secret ballot of all ^^+'��� ^^� �^}'��� LEOFF 1 firefigHter
personnel and shall be held every even numbered year. The
election of the LEOFF law enforcement officer representative
� shall be by secret ballot of all �^���i�e�LEOFF 1 law
enforcement personnel and shall be held in odd numbered
years. The name of the elected LEOFF law enforcement
officer and firefighter member shall be noted in the minutes of
the next regular meeting of the Board subsequent to the
election, along with the term for which elected. Each member
will hold office for a period of two (2) years, or as soon
thereafter as the successor is elected.
B. Election procedure for election by secret ballot shall be as
follows:
1. In October of each year, the Secretary to the LEOFF
Board shall prepare and mail forms for nomination of law
enforcement or firefighter representative to each actiVe
and retired law enforcement or firefighter personnel at
� their last address of record. Any a^' ���—�;;�
member, either LEOFF I or LEOFF II, wishing to run for
representatiVe must nominate themselves on the form
provided by the Secretary. Only those nomina4ing
themselves will be placed on the election ballot.
2. After the November meeting and upon receipt of
nominations, the Secretary shall prepare ballot packages
which shall contain: a) ballot, b) self-addressed pre-
stamped envelope for returning the ballot, c) a letter
sized envelope with no markings on it in which the
marked ballot is to be enclosed, and d) an information
sheet explaining who is running for the position and the
de.adline date by which the Secretary shall have to
receive all ballots. Ballots will be mailed those LEOFF
_ _
members subject to the jurisdiction of the Board-�€9€€
, �,.+„ ro+ .o,�
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3. The time between the mailing out of the ballot packets
until the deadline for receipt by the Secretary will in no
case be less than seven (7) but no more than ten (10)
business days as determined by the Chairperson.
4. All retumed ballots must be received by the Secretary
through the U.S. mail and must be postmarked by
midnight of the deadline date and mailed to the
Secretary.
5. The Secretary shall be custodian of all returned ballots
and shall keep them in a safe place and assure that they
remain unopened until authorized, in a locked box.
6. The ballots shall be opened by the Secretary and
� assistant Secretary and the results will then be
announced after the 3-day protest period by the
Chairperson and a certification of election results will be
sent to the respective department for posting. (Rev 5/94)
7. In fhe event that fhere are fhree (3) or more individuals
running for representative and one of the individuals does
not receive a simple majority of those voting, a run-off
election shall be scheduled between the two individuals
receiving the highest vote totals utilizing the same
process perthis section.
8. The election process shall be completed by December
31St of each election year.
9. All ballots shall be retained by the Secretary for one (1)
year. After 4he one-year period, the Secre,tary shall
prepare the ballots for destruction as authorized by the
State of Washington General Records Retention
Schedule & Destruction Authorization. (Rev 5/94)
10. Any discrepancies regarding the election process shall
be submitted in writing to the Secretary of the LEOFF
Board wi4hin three (3) calendar days following the
deadline date.
11. Candidates-elest shall take office at the regularly
scheduled meeting in January.
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12, In the event that there is only one person nominated for
police or fire representative, balloting will not be required
and the individual will be considered be elected. (Rev
12/7/92)
Section 3. That Policy section 8.02, Medical Services, be amended to
read as follows:
I8.02 Medical Services - General Guidelines
A. Where deemed necessary, the local Disability Board may
approve payment for any medical services which consfitute
preventative as opposed to curative services. Preventative
services are those which are meant to prevent future
occurrence of an illness, injury or disabling condition, as
opposed to curative services meant to restore health or cure
or correct an existing condition.
B. The Board will not consider any service of a cosmetic nature
or which is beyond that reasonably necessary to correct the
condition complained of to be a necessary medical service.
C. In the event the member has obtained medical services !
without obtaining prior approval of the board, the Board may �
authorize payment upon filing of such claim by the applicant.
D. Dental Expenses:
1. Dental charges incurred by a member who sustains an
accidental injury to his or her teeth shall be paid. For
purposes of this section, "accidental injury" does not
include inju.ry to a tooth or teeth caused by the act of
normal chewing or biting, or by the neglect of dental
hygiene.
2. No dental expenses incurred by a member for dental
services or work which is purely cosmetic in nature will
be approved or paid, except in unusual circumstances,
and then only with the prior written approval of the Board,
3. Denfal expenses incurred by a member for teeth
whitening will not b:e approved.
4. Dentures may be approved; however, prior authorization
by the Board is required. Dentures will be reimbursed to
� a maximum amount of$1,756.00 per plate.
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5. Dental implants may be approved; however, prior
authorization bv the Board is required. To receive pre-
authorization for an implant, the Board first must be
provided with a letter from the member's treatinq dentist
or physician statinq the reason the implant is medically
necessarv.
�6. Dental related expenses, not othervuise addressed in
Section 8.02(D) herein, up to an annual amount of
$1,200 will be coVe�ed. The annual term runs from
January 1 of each year to December 31 each year.
� &7. No payment will be authorize.d without proof that the
member has first swbmitted the claim for payment to the
member's outside dental insurance.
E. The Board will authorize fhe payment of the expense of an eye
exam by a licensed optometrist or licensed ophthalmologist.
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Medicare premiums supplementing other medical insurance
coverage are authorized for reimbursement upon receipt of
Form SSA-1099, Social Security Benefit Statement, showing
annual Medicare premiums paid for individual members. In
circumstanc.es where the member, and not Social Securiry,
pay some or all of the premium, proof of such payment shall
also be submitted.
The Board will not authorize payment for necessary medical
services where such expenses are, or would be, met by
Medicare, pursuant to RCW 41:26.150(2). Where the
expense of necessary medical services exceeds that which is
paid by Medicare, the Board may authorize the payment of
�k�e� excess which mav exist after coordination of benefits
with the provided medical insurance carrier.
The Board will authorize payment for Medicare premiums..
However, if, because an indiyidual delays signing up for
Medicare, the premiums are higher than they would be if the
individual signed up during the appropriate enrollment period,
the Board may not pay for the difference between the regular
premium and the more expensive premium.
G. Members possessing insurance benefits covering the expense
of necessary medical services which would otherwise be the.
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obiigation of the employer shali first present the claim to the
appropriate insurance carrier and only thereafter make claim
to the Board for those costs which are not paid by the insurer.
The Board will designate those services where this procedure
will not be followed.
H. Upon making payment for authorized medical services, the
employer shall be subrogated to all rights of the member
against any third party who may be held liable for the
member's injuries or for the payment of the costs of inedical
services in connection with a members sickness or disability.
Such subrogation shall be to the extent necessa.ry to recover
payments made by the employer.
Section 4. That Policy section 9.01, Medical Claims Procedure, be
amended to read as follows:
9.01 Medical Claim Procedure
A. Obtain prior LEOFF Board approval for any necessary medical
expense not coyered by insurance, Medicare or other similar
sources. All medical expenses incurred and claimed for
reimbursement by the member will be submitted through the
member's heal4h insurance provider(s) BEFORE the claim is
sent to the Board for approval. The medical expenses claim
submitted for reimbursement is to be that portion NOT covered
by the existing health insurance provider(s).
1. Each individual who has attained the age sixty-five (65)
shall either apply for Medicare within the initial elig'ibility
period or will provide a statement to the Board that they
are eligible for, and are taking advantage of, a special
en�ollment period. Members are advised to consult their
employer or personnel office reqardinq eliqibility for
Medicare health insurance coveraqe Parts A and B.
Medicare premiums supplementing other medical
insurance coverage are aufhorized for reimbursement
upon rec.eipt of Form SSA-1099, Social Security Benefit
Statement, showing annual Medicare premiums paid for
individual members. In circumstances where the
member, and not Social Security, pay some or all of the
premium, proof of such payment shall also be submitted.
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B. Process all medical expenses through the appropriate
insurance carriers. Members are aduised to consult first with
_ _
their health insurance providers or their employer/personnel
officer to lear'n wliat is or is not covered in existing health
insurance BEFORE. incurring treatment services. Elective
medical procedures, surgery and/or appliances/supplies may
not be covered by the health insurance provided by the
employer or authorized by the Board.
C. If the medical expense is not covered by insurance, a claim
can be submitted to the L_EOFF Board for payment. The
burden is upon the claimant to establish necessity of a
provided medical service and that the reasonableness of the
service charge in order for the Board to consider the claim for
payment.
D. Complete a Claim for Payment form and attach all explanation
of benefits insurance documentation forms showing the
amount fhey paid and/or rejected and any phy"sician
documentation necessary to support a claim.
�
E. Submit the claim with the above information to you� LEOFF
Representative by fhe last Tuesday of 4he month. LEQFF
Board agendas are prepared the last Wednesday of the month
and mailed to each Boa�d member at their last address of
record. Any claims sutimitted after that date will be held until
the next regularly scheduled LEOFF Board meefing, fhe first
Tuesday of each month.
F. If the LEOFF Board approves the claim for payment, the claim
will be processed according to established Finance
Department policies and procedures.
G. Claims which do not have complete doc.ume.ntation may be
tabled until the next LEOFF Board meeting or until the
required documentation is prodiiied so it is crucial to have the
required paperwork. Only those metlical services which are
deemed necessary shall be approved, unless the Board finds
the condition which has caused the need for such medical
service was caused or brought on by dissipation or abuse.
Determinations of dissipation or abuse and the necessity of
such medical services shall be determined by the Board after
considering the medical evaluafion of the Board's medical
advisor together with any other relevant evidence.
H. All claims for hearing aids must have prior authorization by the
LEOFF Board. Failure to obtain advance authorization may
result in only partial reimbursement or rejection of the claim at
the Boards discretion.
I. All claims, except prescription claims, co-pay claims and
Social Security Medicare Part B claims, shall be submitted to
the Board wifhin ninety (90) days of date processed/paid by
the insurance documentation. The Board will review the
_ _
submitted claim at the next full Board meeting. If all
documentation is submitted properly the BoarcJ will consider
reimbursement of expense.s. However, if for any reason, the
claim for paymenUreimbursement is insuffcient, at the
discretion of the Board, it may table the claim until the next
meeting or unt'il receipt of the requested documentation. The
claim may be tabled for three consecutive Board meetings. If,
after three (3) Board meetings #he Claimant has not provided
the Board with the requested documentation, #he claim for
paymenUreimbursement may be rejected, (Rev. 5/2008)
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J. Prescription claims and co-pay claims shall be submitted to
the Board within twelve (12) mon4hs from date of purchase.
(Rev. 5/2008)
K. All medical expenses a�e the rimember's responsib'ility to pay.
Claims for necessary medical services submitted to the Boarci
shall be reimbursed to the member in the amount approved by
the Board.
L. Upon making payment for authorized medical services, the
employer shall be subrogated to all rights of the member
against any third party who may be held liable for the
members injuries or for the payment of the costs of inedical
services in connection with a members sickness or disability.
Such subrogation shall be to the extent necessary fo recover
payments made by 4he employer.
M. The Board may approve a maximum one-time only $500
weight loss program fee if the member submits a description
of a physician monitored and p�escribed weight loss program
documenting a medical necessity of losing at least 60 pounds.
The Board will not consider payment or costs of food
supplem.e.nts/replacements.
N. All claims for durable medical eqUipment must have prior
authorization of the Board. The Board may approve self-help
or comfort items if, in the Bo.ard's sole discrefion, failure to
approve these items will result in the claimant going into a
nursing home; and the cost of the items is less cost of nursing
home care.
Section 5. That Policy section 9.02; Medical Claims for Corrective
Lenses and Frames, be amended to reatl as follows:
9.02 Medical Claims for Corrective Lenses and Frames
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Eye examinations for retire�-LEOFF I members are to be
charged to the Gity-contracte.d plan. The �eti�e�—LEOFF I
member may purchase from the optician or ophthalmologist of
his or her choice.
I The member shall forward a copy of the explanation of benefits
statement toqether with a completed Corrective Lenses and
Frames Worksheet to the LEOFF Boarci for consideration for
any lenses and frames expense. The LEOFF Board will
reimburse up to the amounts described below. The
reimbursement rates apply after all, if any, insurance coverages
have been applied. Any balance due after the LEOFF Board
reimbursement is the responsibility of the LEOFF I member.
� GB. Vision Benefits
Payments for eyeglasses and contact lenses, plus the
reasonable costs of necessary eye examination services of a
licensed ophthalmologist or optometrist, will be approved
pursuant to the authority granted to the Board under RCW
41.26.150, if eyeglasses are prescribed by an ophthalmologist
or optometrist.
Unless it is medically necessary for a member to have both
contacts and eyeglasses, the Board will approve payment for
either one pair of eyeglasses or for contact lenses, at the
member's option or as prescribed, to correct vision when
required for a new prescription in accordance with the
following schedule:
� 1. EYeglass_ Lenses. and Frames: $�9-99300.00
maximum per single set of frames and pair of lenses not more
than once e����., '.A,�'.,� "" � � « „ ^^'��per calendar
year. Lenses covered include single vision, bifocal, trifocal
and progressive lenses.
2. Second Pair: A second pair of monofocal (i.e.
computer) glasses shall be approved only if prescribed by a
ophthalmologist or licensed optometris.t. The maximum cost of
the second pai� shall not exceed $2-79:99300.00 pe.r single set
of frames and pair of lenses not more than once ;^ ��
ieaF{�4}£6^�c^ ",� ^^'h�every two Vears.
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3. Contact Lenses: Not to exceed $�59300.00
maximum during a calendar vear,
including disposable contact lense.s.
4. Reolacement: Claims for replacement pair of
eyeglass frames andlor lenses or contacts will be allowed if
proof of damage is provided and shown to have been incurred
in the perfortnance of a member's fire or law enforcement
duties. Only one replacement pair per year, due to accidental
damage, will be allowed, not to exceed the amount allowable
above.
5. Additional/Spare Pair: No reimbursement will b.e
made for a spare pair of glasses or contact lenses. (Re.y.
5/2008)
� 9C. Corrective Vision Su�qerv
The Board will reimburse fhe member the amount of $1,000
per eye for corrective vision surgery. If a member is
reimbursed the $1,000 per eye for the surgery, he or she will
not be reimbursed for eyeglasses or contact lenses during the
subsequent two calenda� years, unless eyeglasses or contact
lenses are medically necessary. (Rev. 7/2012)
Approved the 5�h day of June, 2018.
CITY OF AUBURN LEOFF BOARD
�
J M KELLY, Pol' Representative ST N SCH, Member-at-large
��,C/1 _..
BILL PETERSEN, Fire Representative UNFILLED, Councilmember
BOB BAGGE ouncilmember
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