FINANCE COMMITTE Packet 09172024CITY OF MUSKEGO
FINANCE COMMITTEE AGENDA
09/17/2024
5:30 PM
Muskego City Hall, W182 S8200 Racine Avenue
CALL TO ORDER
PLEDGE OF ALLEGIANCE
ROLL CALL
PUBLIC MEETING NOTICE
APPROVAL OF MINUTES
Finance Committee Minutes - August 27, 2024
FCM.2024.08.27 DRAFT.docx
LICENSE APPROVALS
i"PSC4 of
KEGO
Recommend Approval of "Class B" Liquor License for S&K Coffee (d/b/a Vintage Grounds) located
at S74W16825 Janesville Road
NEW BUSINESS
Recommend Approval of a Resolution of Eligibility for Exemption from the County Library Tax Levy
for 2025
County Library Tax Exemption Letter to Municipalities. pdf
Recommend Approval of a Resolution for Inclusion Under the Income Continuation Insurance Plan
et2129_O.pdf
ICI Memo - 2024.pdf
VOUCHER APPROVAL (Due to rescheduled Common Council meeting, there are no voucher
approvals.)
FINANCE DIRECTOR'S REPORT
COMMUNICATIONS AND ANY OTHER BUSINESS AS AUTHORIZED BY LAW
ADJOURNMENT
NOTICE
IT IS POSSIBLE THAT MEMBERS OF AND POSSIBLY A QUORUM OF MEMBERS OF OTHER GOVERNMENTAL BODIES OF THE
MUNICIPALITY MAY BE IN ATTENDANCE AT THE ABOVE -STATED MEETING TO GATHER INFORMATION; NO ACTION WILL BE TAKEN
BY ANY GOVERNMENTAL BODY AT THE ABOVE -STATED MEETING OTHER THAN THE GOVERNMENTAL BODY SPECIFICALLY
REFERRED TO ABOVE IN THIS NOTICE.
ALSO, UPON REASONABLE NOTICE, EFFORTS WILL BE MADE TO ACCOMMODATE THE NEEDS OF DISABLED INDIVIDUALS
THROUGH APPROPRIATE AIDS AND SERVICES. FOR ADDITIONAL INFORMATION OR TO REQUEST THIS SERVICE, CONTACT
MUSKEGO CITY HALL, (262) 679-4100.
CITY OF MUSKEGO
FINANCE COMMITTEE MINUTES C4 W
August 27, 2024 I AIUSKEGO5:55 PM
Muskego City Hall, W182 S8200 Racine Avenue 1
UNAPPROVED
CALL TO ORDER
Mayor Petfalski called the meeting to order at 5:55 pm.
PLEDGE OF ALLEGIANCE
Those present recited the Pledge of Allegiance.
ROLL CALL
Present: Mayor Petfalski, Alderperson Wolfe, Alderperson Schroeder, Alderperson Madden
Also present: Alderperson Hammel, Alderperson Decker, Alderperson Schwer, Alderperson Kubacki;
City Attorney Warchol, Public Works and Development Director Kroeger, Planning Manager
Trzebiatowski, and Assistant Deputy -Clerk Treasurer Crisp
PUBLIC MEETING NOTICE
Assistant Deputy -Clerk Treasurer Crisp stated that the meeting was noticed in accordance with the
open meeting law on Friday, August 23, 2024.
APPROVAL OF MINUTES
Finance Committee Minutes - July 23, 2024
FCM.2024.07.23 DRAFT.docx
Moved by Alderperson Madden; seconded by Alderperson Wolfe to Approve.
Motion Passed: 3 - 0
Voting For: Alderperson Wolfe, Alderperson Schroeder, Alderperson Madden
Voting Against: None
LICENSE APPROVALS
Recommend Approval of Outside Dance Permit for Eagle Trace Brewing Company LLC (dba Eagle Park
Brewing & Distilling Corp) located at S64W 15640 Commerce Center Parkway for the following dates:
--September 6 & 7, 2024 from 10 am to 10:30 pm (Octoberfest)
--April 18, 2025 from 4 pm to 10 pm (Joint Beer Fest Pre -Party)
--April 19, 2025 from 11 am to 8 pm (Joint Beer Fest)
Moved by Alderperson Wolfe; seconded by Alderperson Madden to Recommend for Approval.
Motion Passed: 3 - 0
Voting For: Alderperson Wolfe, Alderperson Schroeder, Alderperson Madden
Voting Against: None
NEW BUSINESS
Recommend Approval of Bond Reduction for DCEN, LLC
Finance Memo - DCEN, LLC Bond reduction.docx
LOC2-DenoonCountry_Final.pdf
Moved by Alderperson Madden; seconded by Alderperson Schroeder to Recommend for Approval.
Motion Passed: 3 - 0
Voting For: Alderperson Wolfe, Alderperson Schroeder, Alderperson Madden
Voting Against: None
3
Finance Committee Minutes — August 27, 2024
Page 12
Recommend Approval of Letter of Credit Reduction (Peach Lane LLC - Twin Silos Subdivision)
Common Council - Twin Silos LOC Reduction 1.docx
LOC-TwinSilosMNP.pdf
Moved by Alderperson Madden; seconded by Alderperson Schroeder to Recommend for Approval.
Motion Passed: 3 - 0
Voting For: Alderperson Wolfe, Alderperson Schroeder, Alderperson Madden
Voting Against: None
VOUCHER APPROVAL
Recommend Approval of Utility Vouchers in the amount of $192,938.37.
Vouchers - Total Sheet.pdf
Vouchers - Alpha Report.pdf
Moved by Alderperson Schroeder, seconded by Alderperson Wolfe to Recommend for Approval.
Motion Passed: 3 - 0
Voting For: Alderperson Wolfe, Alderperson Schroeder, Alderperson Madden
Voting Against: None
Recommend Approval of General Fund Vouchers in the amount of $1,411,133.28.
Vouchers - Total Sheet.pdf
Vouchers - Alpha Report.pdf
Moved by Alderperson Schroeder; seconded by Alderperson Madden to Recommend for Approval.
Motion Passed: 3 - 0
Voting For: Alderperson Wolfe, Alderperson Schroeder, Alderperson Madden
Voting Against: None
Recommend Approval of Wire Transfers for Payroll/Invoice Transmittals in the amount of $453,517.61.
Vouchers - Total Sheet.pdf
Vouchers - Alpha Report.pdf
Moved by Alderperson Schroeder, seconded by Alderperson Wolfe to Recommend for Approval.
Motion Passed: 3 - 0
Voting For: Alderperson Wolfe, Alderperson Schroeder, Alderperson Madden
Voting Against: None
FINANCE DIRECTOR'S REPORT
None
COMMUNICATIONS AND ANY OTHER BUSINESS AS AUTHORIZED BY LAW
None
ADJOURNMENT
Moved by Alderperson Madden; seconded by Alderperson Schroeder to Adjourn at 5:59 pm.
Motion Passed: 3 - 0
Voting For: Alderperson Wolfe, Alderperson Schroeder, Alderperson Madden
Voting Against: None
Minutes recorded and transcribed by Assistant Deputy Clerk -Treasurer Crisp.
4
Bridges
�1
LIBRARY SYSTEM
Bringing libraries together
741 N. Grand Ave., #210
Waukesha, WI 53186
P 262.896.8080
W bridges Iibra rysystem.org
To: Chief Elected Officials/Administrators in Municipalities with Libraries, Library Directors
From: Karol Kennedy, Bridges Library System Director
Re: Waukesha County Library Tax Exemption Notice
Date: August 19, 2024
Annually, Waukesha County sets a special levy for library services. The funds are distributed to public
libraries to compensate them for use by non-residents of their communities. State law (ss. 43.64(2)
Wisc. Statutes) provides that municipalities with libraries may avoid double taxation and exempt
themselves from this special levy if they meet certain conditions:
• Exempting library municipalities must levy and expend an amount equal to or greater than the
mill rate set by Waukesha County in the preceding year with the exception of joint libraries
whose participating municipalities have an alternate option for exempting which is to levy and
expend an amount not less than the average of the previous 3 years (ss.43.64 (2)(c)).
• Exempting library communities are required to provide written notification to the county
annually.
• The County Code requires that the notification be from the local governing body rather than
from the clerk alone.
• The County Code also requires a deadline of September 30 so that the County Executive Budget
available to supervisors and the general public can properly reflect the county library taxation
levels in the Adopted Budget in November.
• Exempting communities must also have a library that meets or exceeds minimum service levels
and quality assurance standards (included in the Waukesha County Library Services Plan and
formally adopted by the Waukesha County Board of Supervisors in 2022) which are certified by
the library board. (The libraries have already received their standards certification letters.)
If you would like to exempt your municipality from the Waukesha County library tax, the form (on page
2), Request for Exemption from Waukesha County Library Levy 2024 Tax for 2025 Purposes must be
completed, approved by the municipality's governing body, signed, and returned to Bridges Library
System no later than September 30, 2024. A copy of your adopted municipal ordinance or resolution
certifying that your library appropriation meets or exceeds the requirements is also required. Email
submission is acceptable as long as the form includes the actual signature.
Thank you for providing library services to our citizens. Strong libraries build strong communities and
your commitment to support your library is vital and valued!
Request for Exemption from Waukesha County Library Levy
2024 Tax for 2025 Purposes
Name of Community:
Name of library:
We recognize that, pursuant to 43.64 of Wisconsin Statutes, to obtain an exemption from the 2024 county
library levy for 2025 purposes, the municipality must certify that during budget year 2025, its library will be
provided and be allowed to expend no less than the county library tax rate in the prior year, $0.201553
per $1,000 Equalized Value.
In the case of a joint library, an alternate exemption option exists pursuant to ss 43.64 (2) (c). Under this
language, each participating municipality in the joint library has the option to certify that during its budget
year 2025, the library will be provided and allowed to expend no less than the average of the funding levels
of the previous 3 years.
We further recognize that, pursuant to state law, listed funding must be only from municipal sources, not the
entire library budget. Reported amounts must exclude fines, fees, and other revenues. Capital expenditures
are excluded as well.
I am authorized to certify that the governing body of the municipality has enacted an ordinance or resolution
pledging that it will appropriate and allow the library to expend no less than a rate of $0.201553 per $1,000
of the actual state Equalized Value amount for the community that was published by the state on August 15,
2024 or, in the case of a joint library whose municipality may choose this option, that the participating
municipality will appropriate and allow the library to expend no less than the average of the funding levels of
the previous 3 years.
The community meets its requirement stated above and is therefore eligible for exemption from the 2024
Waukesha County library levy.
Name and Title of Person filling out this form:
Signature
Date
This form, along with a copy of the municipal resolution/ordinance, must be filed no later than
September 30, 2024.
Send to:
Bridges Library System
741 N. Grand Avenue, Suite 210
Waukesha, WI 53186
Or email to kkennedv@bridgeslibrarVsystem.org
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50-
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� I MA
LOCAL GOVERNMENT EMPLOYEES
What is an Income Continuation Insurance (ICI) Benefit? ..............................
2
Howdo I Enroll?............................................................................................
2
Coverage.......................................................................................................
3
How Much Are the Premiums?.......................................................................
4
Pregnancy.....................................................................................................
4
Filing a Disability Claim with the ICI Program .................................................
5
When Will My Benefit Start?..........................................................................
6
How Much Will I Receive?..............................................................................
7
Participant's Responsibilities While Receiving the Benefit .............................
9
Returningto Work...........................................................................................
10
When Will my Benefit End?............................................................................
11
Definitions......................................................................................................
12
ContactUs....................................................................................................
12
ETF has made every effort to ensure that this brochure is current and accurate.
However, changes in the law or processes since the last revision to this brochure
may mean that some details are not current. Visit etf.wi.gov to view the most current
version of this document. Please contact ETF if you have any questions about a
particular topic in this brochure.
ETF complies with applicable federal civil rights laws and does not discriminate
on the basis of race, color, national origin, age, disability or sex in the provision
of programs, services or employment. For more information please view ETF's
Nondiscrimination and Language Access (ET-8108) available at etf.wi.gov. To
request this information in another format, call 1-877-533-5020 (toll free). We will try
to find another way to get the information to you in a usable form.
1
8
The Income Continuation Insurance (ICI) benefit is
a voluntary "income replacement" benefit payable if
you become disabled. This insurance is available to
all local government employees whose employers
have elected to participate. The ICI program is
authorized by Wisconsin Statute § 40.62 and is
funded by premium contributions. ETF contracts
with an external company (the plan administrator)
to issue eligibility determinations and process
individual claims. See the Contact Us section for
their information.
ICI benefits provide up to 75% of your average
monthly earnings based on your previous calendar
year earnings rounded to the next highest $1,000
and divided by 12. For newly hired employees, your
estimated annual earnings are rounded to the next
highest $1,000 and divided by 12. Earnings up to
a maximum of $120,000 per year are covered. The
maximum benefit is $7,500 per month.
Option 1: Initial Enrollment
You may enroll by completing the Income
Continuation Insurance Application (ET-2366)
and returning it to your payroll/personnel office
within 30 days of hire (or within 30 days of
becoming a WRS-participating employee, if you
were not considered a participating employee at
the time you were initially hired).
If you are employed at more than one WRS employer,
you must file an enrollment application for each
position held.
ICI provides replacement income for short- and
long-term disabilities. The benefit usually lasts until
you are no longer disabled or you reach age 65 (with
some exceptions), whichever is sooner.
Note: Please see page 3 for information on benefit
durations for pregnancies.
Before the benefit starts, you must serve an
elimination period (also called a waiting period;
see the Definitions section). You may select an
elimination period of up to 180 days. You must be
completely off work during this time.
ICI benefits will not duplicate benefits available
from other Wisconsin Retirement System (WRS)
programs, the Social Security Administration, workers'
compensation, unemployment compensation or
certain other sources. You will be required to repay
duplicate benefits back to the ICI program.
Option 2: Evidence of Insurability
If you do not enroll under option 1, you may enroll at
anytime in the future if you are medically insurable.
An ICI Application and Evidence of Insurability (ET-
2308) form is available at etf.wi.gov or by contacting
the Department of Employee Trust Funds.
This form asks you to answer questions concerning
your past and present health. Approval/denial of
your evidence of insurability (EOI) application will be
based on this medical information.
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Coverage During Leave of Absence
Your coverage may be continued while on temporary
layoff or an approved leave of absence by paying
premiums in advance.
The maximum time ICI coverage can be continued
on an approved leave of absence is 36 months,
except that an insured employee on union leave
or military leave may continue to be insured for the
duration of that leave.
You are required to pay the entire premium due
(employee and employer portion). Payments
must be received by your payroll/personnel office
so that there is no lapse in coverage.
If you allow your coverage to lapse while you are on
leave of absence, coverage may be reinstated with
the same elimination period and without furnishing
evidence of insurability if you submit a new Income
Continuation Insurance Application (ET-2366) to
your employer within 30 days of resuming active
employment. Coverage will be effective the first
of the month that first occurs during the 30-day
enrollment period.
Termination of Coverage
ICI coverage ends on the date you resign, retire, are
dismissed, or die, whichever occurs first. If coverage
ends, a full month's premium is due for any month or
portion of a month for which earnings are paid. If your
The ICI program provides limited coverage for
pregnancies. As with any disability claim, you must
serve your elimination period prior to receiving an
ICI benefit. Your ICI benefit for a normal, vaginal
delivery will end 6 weeks after the date of delivery
(8 weeks for an uncomplicated cesarean delivery).
These time periods are standard durations used in
the disability industry.
employer withdraws from the program, coverage shall
terminate at the end of the calendar year.
Note: If you are disabled under the terms of the plan
at the time coverage terminates, you will continue to
be eligible to receive benefits as long as you remain
disabled, up to the maximum duration of benefits as
explained in the When Will My Benefit End? section.
Disabilities Not Covered
Benefit payments are not available for a disability
that begins prior to the effective date of coverage or
a disability that is:
• The direct result of war, declared or undeclared.
The act of war shall be determined by the Group
Insurance Board. (Note: Although ICI benefits
are not payable for disabilities caused by acts of
war, you may have — or develop — a medical
condition unrelated to war service that may
qualify you for ICI benefits.)
• The direct or indirect result of intentional self-
inflicted injury for monetary gain.
• The direct or indirect result of participation in the
commission of a crime other than a misdemeanor.
• The direct or indirect result from cosmetic
surgery, except for complications thereof.
A condition which is present but not disabling prior
to the effective date of coverage is not excluded
from benefits.
However, if you have complications prior to or after
delivery, ICI benefits may be paid longer, depending
on whether the complication is considered
disabling.
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Premium Rates
Note: The Local ICI program is currently under a
premium holiday.
Monthly premiums are based on:
1. Your previous calendar year earnings, as
reported to the WRS (or your estimated annual
earnings, if applicable), rounded to the next
higher $1,000.
2. Your selected elimination period.
Annual Premium Adjustment
Effective every April 1, your employer will adjust
your premium based on changes to your previous
year's earnings. If you were either a new hire, were
on an unpaid leave of absence, or had a permanent
change in your percentage of appointment in the
previous calendar year, your earnings for ICI premium
purposes will not be adjusted until the next annual
review when a full calendar year of WRS-reportable
earnings is available (for a new hire or someone on
an unpaid leave) or you've worked a full calendar year
at your new percentage of appointment.
Premium Change Based on Change in Appointment
Employers must adjust premiums when an
employee's percentage of appointment is
permanently changed. In these situations, the
employer determines the premium rate by estimating
earnings for the following 12 months and rounding up
to the next higher $1,000. These estimated annual
earnings are used as a basis for coverage until, at
the time of the annual adjustment, a full calendar
year of WRS-reportable earnings is available (for a
new hire or someone on an unpaid leave) or you've
worked a full calendar year at your new percentage
of appointment.
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How to File a Claim
Contact the plan administrator to file a claim. See
the Contact Us section of this brochure). Telephone
filing is encouraged.
1. File your claim as soon as possible after your
last day worked.
You may file a claim up to 30 days
before your anticipated last day worked
in cases of impending childbirth or
scheduled surgery.
A claim will not be approved if received
more than 12 months after your last day
in pay status.
The effective date of your benefit can be
no earlier than 90 days before your claim
is filed. If you wait to file a claim, you could
miss out on some benefits.
2. The plan administrator will send you an
introductory packet. Complete and return
the medical release form and the repayment
agreement.
3. A licensed physician will be required to
submit medical information concerning your
disability to the plan administrator.
A licensed physician as defined in the ICI
plan includes a medical doctor, doctor of
osteopathy, surgeon, podiatrist, dentist,
or nurse practitioner licensed to practice
by a state within the United States. This
also includes a physician's assistant or
psychologist who is acting within the
lawful scope of his or her license and
performs a service that is supervised
by a licensed medical doctor, doctor of
osteopathy, or surgeon.
For a short-term disability (a disability
lasting 12 months or less), a physician
must certify that you are not able to
perform the duties of your position.
Note: If your physician states that you
can return to work if the employer makes
reasonable accommodations for your
disability, and if your employer agrees to
make those accommodations, your claim
will be denied.
For a long-term disability (a disability
lasting longer than 12 months), a physician
must certify that you are not able to
engage in any substantial gainful activity
(see Definitions) for which you are
reasonably qualified, with due regard to
your education, training, and experience.
4. The plan administrator will periodically contact
your physician to receive updated information on
your disability and expected return -to -work date.
You will be responsible for costs associated with
the medical exams.
5. Your employer must complete the employment
statement that comes from the plan administrator.
6. After contacting your physician and employer,
the plan administrator will determine whether
you should be approved for the benefit.
If you are approved, you will receive a letter from
the plan administrator describing how much your
benefit will be and when it will start. If you are
denied, you will receive a letter from the plan
administrator stating the reasons for the denial.
Administrative Review Process
If you do not agree with a decision made by the
administrative personnel, you have the right to
request that they reconsider the determination. A
written request for reconsideration must be received
by the plan administrator within 90 days of the date
of the determination letter.
With the reconsideration request, you must
specifically state how you believe the plan
administrator erred in interpreting the plan
provisions.
You must provide the plan administrator with
all documentation, including medical records
relevant to the claimed disability and your
position regarding the determination.
After reviewing all of the new and original
information, the plan administrator will send you
a letter with the reconsidered decision.
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If you do not agree with the decision at the
If you do not agree with the Departmental
reconsideration level of the appeal process,
Determination, and you wish to pursue the matter
you have the right to request a departmental
further, you may request an appeal to the Group
determination from ETF. Your written request must
Insurance Board. You must request the appeal
be received by ETF within 90 days of the date of
in writing. The written appeal request must be
the reconsideration letter.
received by the Appeals Coordinator within 90 days
of the date of the notice. The Appeals Coordinator
If you request a Departmental Determination,
will provide you with a booklet covering the appeals
ETF will determine whether the plan administrator
process and time frames.
erred in its decision. ETF relies upon the medical
records/notes and the review performed by the plan
administrator's medical consultants to make
a determination.
Your ICI benefit will begin after you serve your
selected elimination period. Employees have
an elimination period of 30, 60, 90, 120, or 180
calendar days.
The elimination period begins on the first full day
that you are continuously and completely absent
from work due to disability. If you return to work
during your elimination period, even to perform
incidental work at your employer's request,
your elimination period will be extended. Before
performing any work during your elimination
period, you should talk to the plan administrator.
Sick leave, vacation, holiday, and compensatory
time do not need to be exhausted before ICI
benefit payments can begin. However, use of
leave time after your elimination period is satisfied
will delay the start of your ICI benefits or reduce
the amount of benefits you receive, as benefits
are reduced at the rate of 100% for payments you
receive for leave time.
Example 1:
You satisfy your elimination period on March 1,
but you continue to use some form of leave time
to stay in full pay status with your employer. Your
ICI benefit will not start until you are no longer in
full pay status.
Example 2:
You satisfy your elimination period on March 1,
but you continue to use two hours of sick leave
per day to stay in partial pay status with your
employer. Your ICI benefit will be reduced by the
amount you receive from your employer for leave
time paid.
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Benefit Amount
The ICI benefit is calculated by multiplying your
average monthly earnings from the previous year
by 75%. A maximum of $120,000 in annual earnings
are covered, resulting in a maximum benefit of
$7,500 per month.
For disabilities lasting longer than 12 months, a
supplement of $75 per month is added to the normal
benefit amount.
Offsets/Reductions
ICI benefits will not duplicate other income sources
available to you, but rather will supplement these
income sources to provide a specified level of
disability income. Therefore, your ICI benefit will be
reduced by income received from sources including,
but not limited to:
• Social Security based on your work record
(regular or disability)*
• Unemployment compensation.
• Workers' compensation (except permanent
disability awards).
• WRS benefits (retirement, disability retirement,
or separation).
• Any employer sponsored/sanctioned salary
continuation plan.
• Earnings, including self-employment.
• Duty disability.
In addition, your benefit will be reduced at the rate
of 100% for any vacation, sick leave, holiday, or
compensation pay you receive after your ICI benefit
effective date.
If you receive a monthly retirement benefit from
the WRS, your ICI will be reduced by the largest
retirement benefit amount you are eligible to receive,
even if you choose an option that pays a reduced
benefit. If you take a separation or lump -sum benefit,
your ICI benefit will be reduced by an equivalent
monthly amount.
If you receive income from any of the above
sources, it is important not to spend it until the ICI
amount to be repaid is provided to you by the plan
administrator. You will be required to repay any
benefits you receive, or are eligible to receive, that
cover the same time period as your ICI benefits.
You must also apply for all other benefits that you
might be eligible to receive. If you fail to do this, your
ICI benefit will be reduced by the largest benefit
amount you could receive from another source.
If you are approved to return to part-time
employment with your prior employer, your benefit
will be reduced (offset) at the rate of 75% of
your earnings. If medical evidence indicates you
are capable of working part-time but you do not
return to work, your benefit will be reduced by an
estimated earnings offset. See the Returning to
Work section of this brochure for more information.
When Social Security benefits have been
initially denied, you are required to pursue the
appeal through the hearing level.
The ICI program does not require you to
obtain an attorney to assist you in obtaining
Social Security benefits. However, if you do
decide to obtain an attorney and you win
your appeal, the ICI program will not consider
the attorney fees as a reduction to the ICI
benefit if the Social Security Administration
(SSA) approves the amount to be paid to the
attorney. Documentation of SSA approval of
such fees must be provided to the ICI plan.
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Payment Dates
Benefits are paid monthly at the beginning of the
month for the previous benefit month (i.e. January
benefits are paid February 1).
Waiver of Premium
ICI premiums are waived effective the first of the
month following the date ICI benefits begin.
Note: If benefits begin on the first day of a month, the
premium waiver begins on the same day.
The waiver of premium remains in effect for as
long as you continue to be eligible for benefits. If
benefits are terminated because you returned to
full-time employment with a state employer, premium
payments will resume.
If you choose to remain on a leave of absence after
your disability ceases and have not terminated
employment, you must immediately make
arrangements for payment of the ICI premium
through your employer. Otherwise, coverage will
terminate and can only be reinstated after you return
to work and reapply for coverage.
Taxable Benefits
A portion or all of your ICI benefit may be taxable
income to you. As the percentage of the total
premium paid by your employer as a fringe benefit
increases, there is a corresponding increase in the
percentage of benefits that is considered taxable
income. The taxable portion is based on an average
of the premium percentage paid by the employer over
the three years prior to the year in which ICI benefits
are first paid.
However, due to changes in the tax laws and the
interpretation of the revenue code, you should
consult both state and federal tax authorities
for answers to any specific questions you have
concerning the exclusion or inclusion of such benefit
payments as taxable income.
The plan administrator will automatically withhold
federal income tax from the taxable portion of a
benefit. The amount of federal income tax withheld
will equal the deduction for a single person with zero
exemptions. If you wish to change the amount of
federal tax withheld, you may submit Form W-4S or
W-4 (available from the IRS) to the plan administrator.
Wisconsin state income tax will only be withheld from
a taxable ICI benefit if you submit the Wisconsin
Withholding Exemption Form WT-4. It is available
from the Wisconsin Department of Revenue.
FICA: Social Security regulations provide that any
income received from a sickness or disability plan
during the first six months of a disability is subject
to withholding for Social Security contributions if
the employer has paid a portion of the premiums.
The percent of the benefit subject to Social Security
contributions equals the percent of the gross
premium paid by the state. Any ICI benefits you
receive during the first six months of disability will
reflect this deduction for Social Security contributions
unless your WRS employment is terminated and you
are approved for disability retirement benefits.
Annual Tax Documents
The plan administrator will send you tax forms annually.
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Annual Statement of Earnings
After the first year of ICI benefits, you will be required
to complete and return to ETF the ICI Annual
Income Certification (DTPA-5905) on which you will
report all earnings for the prior calendar year. The
plan administrator normally sends this form out on
February 1.
Medical Reports to Substantiate Disability
Your physician and the plan administrator will work
together to determine how often your physician
should follow up with you to certify that you are still
disabled. The plan administrator will periodically ask
your physician to complete supplemental medical
forms. Cost for medical exams and copies of the
medical records are your responsibility.
Failure to Comply
Benefits may be suspended or terminated if you fail
to provide required information within 60 days of the
date of the initial request or if you do not otherwise
cooperate in meeting the program requirements.
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You may return to work with your prior WRS
employer given your physician's release to return to
work and your employer's ability to accommodate
any restrictions imposed. Earnings paid when you
return to work less than full-time will be offset at 75%
(see example below). Earnings include pay for days
taken as vacation, holiday, or compensation time.
Paid sick leave will be offset at 100%.
Your part-time earnings will be offset based on the
date of your earnings check. For example, your
earnings check dated July 1 will be offset from the
ICI benefit check dated August 1 (which covers the
month of July).
If you are receiving long-term ICI benefits, you will
be required to provide objective medical evidence
(see Definitions) on a quarterly basis to continue to
substantiate the disability.
If your physician releases you to return to work,
but you choose not to, or you return to work but
do not work the number of hours your physician
released you to return, your ICI benefit will either be
terminated or it will be offset (reduced) by estimated
earnings. The estimated earnings offset will be
calculated by multiplying your number of hours you
were released to work by the hourly rate of pay.
If you are unable to work the number of hours your
physician released you to work because of your
medical condition, you should contact your physician
immediately to discuss your inability to work those
hours. Your physician will need to amend your
restrictions. For benefit payment purposes, it is
extremely important that your medical records reflect
the amount and type of work you are able to perform.
Rehabilitative Training
If you have a rehabilitation plan that was
approved by the Wisconsin Division of Vocational
Rehabilitation (DVR), you need to contact the plan
administrator and provide them with a copy of your
approved plan. You will need to sign a release
allowing the ICI program access to your pre -
approved plan.
As an incentive to return to work, only 75% of
earnings from approved rehabilitative employment
may apply to the reduction of your ICI benefits.
Earnings from non -approved rehabilitative
employment will reduce your ICI benefit amount
dollar -for -dollar (100%). The offset for the
rehabilitative earnings are based on the date of the
earnings check. See example below.
denetit reauction aue to earninas trom
Monthly income continuation benefit
Less: earnings with prior employer
Offset reduced to 75%
Net monthly income continuation benefit
Plus: earnings
Total monthly income
part-time return to worK.
$2,812.50
$1,000.00
x 75% - 750.00
$2,062.50
+ 1,000.00
$3,062.50
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`I N
Your ICI benefit will end on the earliest of the
following dates:
• When you reach age 65. However, if your first
day of disability is after your 60th birthday,
benefits will be payable for a period of 5 years
from your date of disablement. See table at
right.
• When medical evidence shows that you are
capable of performing the duties of your
position (or of any position if you've had a long-
term disability, i.e. over 12 months).
When you die. The ICI program does not have
a death benefit.
Termination of employment does not affect the
continued payment of your ICI benefits. Your
benefits will not end until you meet one of the
criteria above.
Maximum
Age at Disablement
Duration of Benefits
From Date of Disablement
On or before
To age 65
60th birthday
After 60th birthday
5 years
Date of Disability —The day after your last day
worked or the date your physician indicates that your
medical condition meets the program's disability
definition, whichever is later.
Elimination Period —This is the number of calendar
days in which you must be completely off work in
order to receive ICI benefits. Employees may select
an elimination period up to 180 days.
Objective Medical Evidence —Test results such
as blood tests, MRI, CAT scan, X-rays, etc. and
physician's notes of regular visits recording the
physician's observations of disabling symptoms
and conditions.
The physician's opinion may rely in part on records
of care provided by other medical professionals
under the supervision of a physician, including but
not limited to physician's assistants, midwives,
psychologists and psychotherapists (MMSW).
The actual certification of disability must come from
the licensed medical doctor, doctor of osteopathy,
surgeon, podiatrist, dentist or nurse practitioner.
Contacting ETF
See the back cover for ETF contact information.
Plan Administrator —External company contracted
by the Department of Employee Trust Funds to issue
eligibility determinations and process individual
claims. This is also sometimes referred to as a third -
party administrator.
Regular Care and Attendance —Planned program
of observation and treatment requiring personal
attendance by a physician.
Substantial Gainful Activity —Gross earnings that
are equal to or greater than the gross ICI benefit for
the same period of time.
Totally Disabled —The ICI program has two
definitions of disability depending on the duration of
the disability:
Short-term Disability —the first 12 months
of disability, while you are under the regular
care and attendance of a physician, and your
disability makes you unable to perform your job.
Long-term Disability —after the first 12 months
of disability, while you are under the regular
care and attendance of a physician, and your
disability makes you unable to engage in any
substantial gainful activity for which you are
reasonably qualified.
Contacting the plan administrator: The Hartford
Phone
Toll Free: 1-800-960-0052
Fax: 1-833-357-5153
Mail
The Hartford
P.O. Box 14869
Lexington, KY 40512-4869
Email
ICIQuestions@thehartford.com
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Contact ETF
etf.wi.gov
Find ETF-administered benefits information, forms, brochures, benefit calculators,
educational offerings and other online resources. Stay connected with:
Q ETF E-Mail Updates
@wi_etf
1-877-533-5020
to7.00 a.m. to 5:00 p.m. (CST), Monday -Friday
Benefit specialists are available to answer questions.
Wisconsin Relay: 711
d PO Box 7931
Madison, WI 53707-7931
Write ETF or return forms.
tf
JSIN DEPARTMENT
OF EMPLOYEE TRUST FUNDS
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n Cdj eF
AUSKEGO
Memo
From: Kate Croteau, Human Resources Director
To: Mayor and Common Council
Subject: Income Continuation Insurance
Date: August 30, 2024
Background
I am writing to recommend implementation of a new employee benefit through our pension program,
ETF, called Income Continuation Insurance (ICI). ICI is a program that replaces up to 75% of a
subscriber's (pension eligible employee's) annual WRS earnings up to $120,000 annually in the event of
short or long-term disability. The program is funded by premium contributions from both employers and
employees, however, the program has been on premium waiver for many years. The premium waiver is
currently funded through surplus funds that have been earmarked for the premium holiday.
In order to participate in this program, the City has to enact a resolution which outlines when our
participation in the program would begin and what elimination period we would select. My
recommendation would include having the program begin January 1, 2025 with a 30-day elimination
period since the program is currently on a premium holiday. An elimination period is the timeframe a
subscriber would have to wait until benefits would begin. The ETF allows for elimination period options
up to a 180-day waiting period.
In order to participate in the program at least 65% of eligible employees (approximately 75 employees)
must participate or the resolution becomes void. I plan to roll this out as a new benefit during our 2025
insurance open enrollment process which typically takes place at the beginning of November.
Employees have the opportunity to enroll within a 30-day window. After the 30-day window, employees
can only join the program if they go through an evidence of insurability process.
Recommendation
Overall, I see this as a great benefit to our employees with currently no cost to them or the City. I
recommend passing the attached resolution and implementing the program effective January 1, 2025.
For additional detail on the program, please also see the attached Income Continuation Insurance Guide
from ETF.
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