RES-10239 Retiree Health Savings Plan Establishment Orange Fire Management AssociationRESOLUTION NO. 10239
A RESOLUTION OF THE CITY COUNCIL OF THE
CITY OF ORANGE ESTABLISHING A RETIREE
HEALTH SAVINGS PLAN FOR THE CITY OF
ORANGE - FIRE MANAGEMENT ASSOCIATION.
WHEREAS, the City of Orange (City)has employees rendering valuable services; and
WHEREAS, the establishment of a retiree health savings plan for such employees
serves the interests of the City by enabling it to provide reasonable security regarding such
employees' health needs during retirement, by providing increased flexibility in its personnel
management system and by assisting in the attraction and retention of competent personnel;
and
WHEREAS, the City has determined that the establishment of the retiree health
savings plan (the Plan) serves the above objectives and should be of no cost to the City.
NOW, THEREFORE BE IT RESOLVED, that the City Council of the City of
Orange adopts the plan in the form of ICMA Retirement Corporation's VantageCare
Retirement Health Savings program which includes the Employer VantageCare Retirement
Health Savings Plan Adoption Agreement which is attached hereto as Exhibit A.
BE IT FURTHER RESOLVED, that the assets of the Plan shall be held in the trust,
with the City serving as a trustee, for the exclusive benefit of Fire Management Association
Plan Participants and their beneficiaries, and the assets of the plan shall not be diverted to any
other purpose prior to the satisfaction of all liabilities of the Plan. The City has authorized the
Mayor to execute the Declaration of Trust of the City of Orange Integral Part Trust in the form
of the model trust made available by the ICMA Retirement Corporation. The City shall have
no tax liability to Plan Participants if any future determination is made that the Plan or any Plan
Participant is not exempt from federal ar state taxes.
BE IT FURTHER RESOLVED, that the Personnel Director shall be the coordinator
and contact for the Plan and shall receive necessary reports, notices, etc.
BE IT FURTHER RESOLVED, that the Mayor is authorized to execute all
documents necessary to implement the Plan.
ADOPTED this 27th day of November, 2007
t
roly .cche, Mayor rty of Orange
1
1'1C'I'EST:
Mary E urp , City C of Orange
I, MARY E. MURPHY, City Clerk of the City of Orange, California, do hereby certify
that the foregoing Resolution was duly and regularly adopted by the City Council of the City of
Orange at a regular meeting thereof held on the 27th day of November, 2007, by the following
vote:
AYES: COIJNCILMEMBERS: Smith, Cavecche, Dumitru, Bilodeau
NOES: COLTNCILMEMBERS: None
ABSENT: COUNCILMEMBERS: Murphy
ABSTAIN: COLTNCILMEMBERS: None
r
Mary E City er , ' Orange
2
EMPLOYER VANTAGECARE RETIREMENT HEALTH SAVINGS (RHS) PLAN
ADOPTION AGREEMENT
Plan Number: 8 a / Check one: New Plan Amendment to Existing Plan
Employer Retirement Health Savings Plan Name:
I. Employer Name: vry 4 7 l t/1 e ' w/• //l Gt'!R°L/i; C//
II. The Employer hereby attests that it is a unit of a state or local government or an agency or instrumentality of one
or more units of a state or local government.
III. Effective Date of the Plan: `
O
IV. The Employer intends to utilize the Trust to fund only welfarf benefits pursuant to the following welfare benefit
plan(s) established by the Employer: M oc w--lZ+.r-e la
V. Eligible Groups,Participation and Participant Eligibility Requirements
A. Eligible Groups
The following group or groups of Employees are eligible to pazticipate in the VantageCare Retirement Health Savings
Plan(check all applicable boxes):
All Employees
All Full-Time Employees
Non-Union Employees
Public Safety Employees—Police
Public Safety Employees—Firefighters
General Employees
Collectively-Bargained Employees(Specify unit(s))
Other(specify group(s)) 1 le /'I?a a m enf ,S.f U V''
The Employee group(s)specified must correspond to a group(s)of the same designation that is defined in the statutes,
ordinances,rules,regulations,personnel manuals or other documents or provisions in effect in the state or locality of
the Employer.
B. Participation
Mandatory Participation:All Employees in the covered group(s) are required to participate in
the Plan and shall receive contributions pursuant to Section VI.
If the Employer's underlying welfare benefit plan or funding under this VantageCare Retirement Healch Savings Plan is in
whole or parra non-collectively bargained,self-insured'plan,the nondiscrimination requitements afIntercial Rtiveriue Code,
IRC),Section 105(h)will apply. T,hese rulcs may impose,taxation on the,beqefits;recei by highly com ensated individuals, ;
if the Plan discriminates in favor of highly compensated individuals in tcrms of eligibdiry or benefits The Employer shouldf:_
discuss these rules with appropriate counseL
C. Participant Eligibility Requirements
1. Minimum service: The minimum period of service required for participation is(write N/A if an
Employee is eligible to participate or to elett to participate immediately upon employment).
2. Minimum age:The minimum age required for eligibility to participate is Nl (write N/A if no minimum
age is required).
VI.Contribution Sources and Amounts
A. Definition of Earnings
The definition of Earnings will apply to all RHS Contribution Features that reference"Earnings",including Direcc
Employer Contributions(Section VI.B.1.)and Mandatory Employee Compensation Contributions(Section VI.B.2.).
Definition of earnings:
B. Direct Employer Contributions and Mandatory Contributions
1. Direct Employer Contributions
The Employer shall contribute on behalf of each Participant
of Earnings
each Plan Year
A discretionary amount to be determined each Plan Year
Other(describe):
2. Mandatory Employee Compensation Contributions
The Employer will make mandatory contributions of Employee compensation as follows:
Reduction in Salary- of Earnings or$ will be contributed for the Plan Year.
Decreased Merit or Pay Plan Adjustment-All or a portion of the Employees' annual merit
or pay plan adjustment will be contributed as follows:
An Employee shall not have the right to discontinue or vary the rate of Mandatory Contributions of
Employee Compensation.
3. Mandatory Employee Leave Contributions
The Employer will make mandatory contributions of accrued leave as follows(provide formula for determining
Mandatory Employee Leave contributions):
Accrued Sick Leave 1 Y.GI q I b l C 4.S b u't 1
2 DQ i c 7 S'PiYJ r Csz
Accrued Vacation Leave UC' .P./i/b l G I 6 fi k O'
5 Ov fi K m S-a vi
Other(specify rype of leave)Accrued Leave
I rjl%a d a.Q a`I..er G.cur 9 f e,t Va-,U. r•.`"—
S A h-G?SY -o m .ii'I C..e
An Employee shall not have the right to discontinue or vary the rate of mandatory leave contributions.
C. Limits on Total Contributions(check one box)
The total contribution by the Employer on behalf of each Participant(including Direct Employer and
Mandatory Employee Contributions) for each Plan Year shall not exceed the following limit(s) below Limits
on individual contribution rypes are defined within the appropriate section above.
There is no Plan-defined limit on the percentage or dollar amount of earnings that may be conuibuted.
of earnings*
Definition of earnings: Same as Section VI.A.. Other
for the Plan year.
See Section V.B.for a discussion of nondiscrimination rules that may apply to non-collectively bargained self-insured Plans.
VII.Vesting for Direct Employer Contributions
A. Vesting Schedule(check one box)
The account is 100%vested at all times.
The following vesting schedule shall apply to Direct Employer Contributions as outlined in Section VI.B.1.:
Yeazs of Service Vesting
Completed Percentage
o o
B. The account will become 100%vested upon the death,disability,retirement*,or attainment of benefit
eligibility(as outlined in Section IX)by a Pazticipant.
Definition of retirement(check one box):
Recirement as defined in the primary retirement plan of the Employer
Sepazation from service
Other
C. Any period of service by a Participant prior to a rehire of the Participant by the Employer shall not count
toward the vesting schedule outlined in A above.
VIII.Forfeiture Provisions
Upon separation from the service of the Employer prior to attainment of benefit eligibility(as outlined in Section IX),or
upon reversion to the Trust of a Participant's account assets remaining upon the participant's death(as outlined in Section
XI),a Participant's non-vested funds shall(check one box):
Remain in the Trust to be reallocated among all remaining Employees participating in the Plan as Direct Employer
Contributions for the next and succeeding contribution cycle(s).
Remain in the Trust to be reallocated on an equal dollar basis among all Plan Participants.
Remain in the Trust to be reallocated among all Plan Participanu based upon Participant account balances.
Revert to the Employer.
IX.Eligibility Requirements to Receive Medica!Benefit Payments from the VantageCaze Retirement Health Savings Plan
A. A Participant is eligible to receive benefits:
At retirement only(also complete Section B.)
Definition of retirement:
Same as Section VII.B.
Other
At separation from service with the following restrictions
No restrictions
Other
At age only
At retirement and age also complete section B)
Definition of retirement:
Same as Section VII.B.
Other
At retirement or age
Definition of retirement:
Same as Section VII.B.
Other
Other, specified as follows (also complete Section B if applicable):
B. Termination prior to general benefit eligibility: In the case where the general benefit eligibility as outlined in
Section IX.A includes a retirement component,a Participant who separates from the setvice of the Employer
prior to retirement will be eligible to receive benefits:
Immediately upon sepazation from service.
At age
C. A Participant that becomes totally and permanently disabled
as defined by the Social Securiry Administration
as defined by the Employer's primary reurement plan
other
will become immediately eligible to receive medical benefit payments from his/her VantageCare Retirement Health
Savings Plan account.
D. Upon the death of the Participant,benefits shall become payable as outlined in Section XI.
B. No Surviving Spouse or Surviving Dependents
If there are no living spouse or dependents at the time of death of the Participant,the account will revert to the Plan to
be applied as specified in Section VIII.
XII.The Plan will operate according to the following provisions:
A. Employer Responsibilities
1. The Employer will submit all VantageCare Retirement Health Savings Plan contribution data via electronic submission.
2. The Employer will submit all VantageCare Retirement Health Savings Plan Participant status updates or personal
information updates via electronic submission. This includes but is not limited to termination notification and
benefit eligibility notification.
B. Participant account administration and asset-based fees will be paid through the redemption of Participant account
shares,unless agreed upon otherwise in the Administrative Services Agreement.
C. Assignment of benefits is not permitted. Benefits will be paid only to the Participant,his/her Survivors,the
Employer,or an insurance provider(as allowed by the claims administrator). Payments to an third-party payee
e.g.,medical service provider) are not permitted with the exception of reimbursement to the Employer or insurance
provider(as allowed by the claims administrator).
D. An eligible dependent is the Participant's lawful spouse and any other individual who is a person described in IRC
Section 152(a),as clarified by Internal Revenue Service Notice 2004-79.
E. The Employer will be responsible for withholding, reporting and remitting any applicable taxes for payments which
are deemed to be discriminatory under IRC Section 105(h),as outlined in the VantageCare Retirement Health
Savings Plan Employer Manual.
XIII.Employer Acknowledgements
A. The Employer hereby acknowledges it understands that failure to properly fill out this Employer VantageCare
Retirement Health Savings Plan Adoption Agreement may result in the loss of tax exemption of che Trust and/or loss
of tax-deferred status for Employer contributions.
B. Check this box if you are including supporting documents that include plan provisions.
EMPIAYER TU
y: Date:
Titl a V avecche a or
Attest• Date:
Title:Ntary E. Mlur Ci clerk
Accepted:VANTAGEPOINT TRANSFER AGENTS,LLC
1
Assistant Secretary
X. Permissible Medical Benefit Payments
Benefits eligible for reimbursement consist of:
All Medical Expenses eligible under IRC Section 213*other than direct long-term care expenses,and including
non-prescription medications allowed under IRS guidance.
The following Medical Expenses(select only the expenses you wish to cover under the VantageCare Retirement Health
Savings Plan):
Medical Insurance Premiums
Medical Out-of-Pocket Expenses*
Medicare Part B Insurance Premiums
Medicare Part D Insurance Premiums
Q Medicare Supplemental Insurance Premiums
Prescription Drug Insurance Premiums
COBRA Insurance Premiums
Dental Insurance Premiums
Dental Out-of-Pocket Expenses*
Vision Insurance Premiums
sion Out-of-Pocket Expenses*
Qualified Long-Term Care Insurance Premiums
Non-Prescription medications allowed under IRS guidance*
Other qualifying medical e cpenses(describe)*
See Section V.A.for a discussion of nondiscrimination rules which may apply to non-collectively bargained,self-insured Plans.
XI.Benefits After the Death of the Participant
In the event of a Participant's death,the following shall apply:
A. Surviving Spouse and/or Surviving Dependents
The surviving spouse and/or surviving eligible dependents(as defined in Seaion XII.D.)of th e deceased Participant aze
immediately eligible to maintain the account and utilize it to fund eligible medical benefiu specified in Section X ab ve.
Upon notification of a Participant's death,the Participant's account balance will be transferred inta the Vantagepoint
Money Market Fund*(or another fund selected by the Employer). The account balance may be reallocated by the
surviving spouse or dependents.
Please read the current[/antagepoint Mutual Funds prospectus carefully prinr to investing.An investment in this fund is neither
insured nor guaranteed and there can be no assuranc that the Fund will be able to maintain a stable net asset value of$1.00 per share.
T/antagepointMutual Funds are distributed by ICMA-RC Servica,LLC,a whally-owned broker-dealer af"zliate ofICMA Retiremen:
Corporation.Member NASD/SIPC.
If a Participant's accounc balance has not been fully utilized upon the death of the eligible spouse,the account balance
may continue to be utilized to pay benefits of eligible dependents.Upon the death of all eligible dependents,the
account will revert to the Plan to be applied as specified in Section VIII.