CCR1989057.
COMMON COUNCIL - CITY OF MUSKEG0
RESOLUTION #57-89
AUTHORIZING EXECUTION OF "PREMIUM ONLY"
CAFETERIA PLAN
WHEREAS, it is the desire of the City to reward its employees for
which provides favorable tax benefits to such employees, and
service rendered to the City by the adoption of a cafeteria plan
WHEREAS, the Common Council has considered the features of the
City of Muskego "Premium Only Plan", which when executed and
carried out, will satisfactorily provide the desired benefits to
employees of the City, and
WHEREAS, it is believed that the adoption of said Plan is in the
mutual interest of the employees and the City.
NOW, THEREFORE, BE IT RESOLVED that the Common Council of the
City of Muskego, upon the recommendation of the Finance
Committee, does hereby adopt the City of Muskego "Premium Only
Plan" and does hereby authorize the Mayor and Clerk to execute
of said Plan.
said Plan and related documents necessary for the implementation
BE IT FURTHER RESOLVED that the Mayor and Clerk shall be
designated as Co-Administrators of the Plan.
March 1, 1989.
BE IT FURTHER RESOLVED that the Plan shall be effective beginning
DATED THIS 28th DAY OF February , 1989.
FINANCE COMMITTEE
Ald. Mitchel Penovich
A
ATTEST :
City Clerk
CI!l'Y OF MUSKEGO PREMIUM ONLY PLAN
SUMMARY PLAN DESCRIPTION
1/20/89
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EFFECTIVE DATE
The plan is effective as of March 1, 1989. A plan year
begins on January 1 and ends on December 31st of each
year.
PLAN ADMINISTRATOR
The Plan is administered by:
City of Muskego
W182 58200 Racine Avenue
Muskego, WI 53150
The person at the City to contact regarding questions and
claims is the City Clerk at the above address (phone:
(414) 679-4100).
PLAN SPONSOR
This plan is maintained by City of Muskego
PIAN NAME
City of Muskego Premium Only Plan.
LEGAL STATUS
This Plan is designed to constitute a "cafeteria plan"
under Internal Revenue Code section 125, as amended. Its
purpose is to provide Employees a means of paying their
share of medical and dental coverage premiums in a
tax-effective manner.
NO SEPARATE TRUST FUND
This is not a trusteed plan nor do any separate assets
exist outside of the general assets of the City of
Muskego.
ELIGIBLE EMPLOYEES
The following persons are eligible to participate in the
Plan: any individual who is employed by the City, provided
City's medical or dental plans which requires an insurance
that such Employee receives coverage under one of the
contribution from the Employee. Such eligible Employees
who are employed by the City on the Effective Date of the
plan will be eligible to participate in the plan as of the
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Effective Date. New employees and tbose who become eligi-
ble after the Effective Date will be eligible to partici-
pate on the first day of the first month in which such
dental plans which requires an insurance contribution from
Employee is covered under one of the City's medical or
the Employee. Eligible Employees who do not already par-
ticipate may apply to participate during annual open
enrollment periods.
There are no service or age requirements other than those
contained, if any, under the applicable medical plan
selected by the Employee.
VIII. ELECTION PROCEDURE
Initial Negative Enrollment Period:
An Employee who, on the Effective Date, is already covered
under one of the City's medical or dental plans pursuant
miums will be deemed to be an automatic Participant under
to a payroll deduction for that Employee's portion of pre-
this Plan and will be deemed to have authorized a salary
conversion election in the same amount as is being cur-
rently withheld from such Employee's salary. The City has
provided an initial open enrollment period prior to the
Effective Date of this Plan to provide Employees the abil-
ity to elect out of this Plan if they choose to do so.
Salary Conversion Elections:
During December of each year, Employees will be able to
elect to convert part of their salary to Premium Dollars
or to change or revoke their current elections for the
subsequent plan year. Premium Dollars will be applied by
the City toward the payment of the Employee's share of
premiums/costs of medical or dental coverage. The elec-
tion will be executed on a written form provided by the
Administrator.
Salary Conversion Elections of New Employees:
will be entitled to elect to convert a portion of their
New Employees will be provided with election forms and
salaries to Premium Dollars. The election period for such
new Employees will be specified by the Administrator but
will extend no later than the beginning of the first pay
period for which the Employee's election will apply.
IX. FAILURE TO ELECT AND ELECTIONS FOR SUBSEQUENT PLAN YEARS
If an Employee is not an immediate Participant pursuant to
the initial negative enrollment and has not executed an
election to participate in this Plan, then such Employee
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will not become a Participant. .. Nevertheless, such
Employee will be allowed to execute election forms during
subsequent open enrollment periods.
If a Participant who has filed an election does not change
or revoke such election during any subsequent open enroll-
ment period, such election will continue in effect.
Between the time the election is effective and the end of
vocable except for a change in such election made on
the plan year to which it applies, such election is irre-
account of and consistent with a change in the
Participant's family status (e.g., marriage, divorce,
death of a spouse or child, birth or adoption of a child,
and termination of a spouse's employment).
X. RECORDS
Records pertaining to the Plan will be kept by the City on
a calendar year basis. Records pertaining to individual
salary conversion elections and premium payments with
respect to individual Participants will be available for
inspection upon request.
XI. CLAIMS PROCEDURE
or participation in the Plan, you may file a written claim
If you have any claim with respect to payment of premiums
with the Administrator, specifying the nature of the claim
and the benefit or remedy sought. The Administrator must
then, within thirty (30) days provide you with a written
tutes a denial of the claim, the following: specific rea-
response to your claim including, if the response consti-
on which the denial is based: a description of any addi-
sons for the denial; specific reference to Plan provisions
tional information or material necessary for you to per-
fect your claim; and the steps to be taken if you wish to
appeal the Administrator's decision. The claims procedure
is spelled out in further detail in the Plan document
itself.
XII. TAX BENEFITS TO YOU
The salary conversion election will reduce your gross tax-
able income for Federal and State income tax purposes and
for purposes of social security (FICA) tax withholding.
your salary (the salary conversion amount) from taxable
This is achieved by your election to convert a portion of
wages to non-taxable City contributions toward your health
or dental care. As a result, payment of your share of
premiums for your medical or dental coverage pursuant to
the Plan will occur on a "before-tax" basis. Thus, an
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Employee participating in the Plan should be subject to a
deduction was made on an "after-tax" basis. This has the
reduced payroll tax than would have applied if the payroll
result of lowering the cost to the Employee of his or her
Actual savings will vary among Employees, however, due to
insurance co-payment when compared to the after-tax cost.
differences in income, withholding exemptions, marital
status and other factors.
XIII. PLAN DOCUMENT WILL CONTROL
The explanation contained in this Summary Plan Description
is intended only as a summary of the Plan's highlights and
is not the complete Plan document. In the event of any
inconsistencies between this explanation and the actual
wish to read the actual Plan, a copy is available for
Plan provisions, the actual Plan shall govern. If you
inspection upon request to the City Clerk during regular
working hours.
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