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HomeMy WebLinkAboutORD-2004-106 - Benefits for Domestic Partners - Implementation and Personnel Ordinance RevisionsORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: October 5, 2004 Action Agenda Item No. SUBJECT: Benefits for Domestic Partners — Implementation and Personnel Ordinance Revisions DEPARTMENT: Personnel ATTACHMENT(S): 1 — Draft Personnel Ordinance Revisions 2 - Declaration of Domestic Partner Status PUBLIC HEARING: (Y /N) No INFORMATION CONTACT: Elaine Holmes, Personnel Director, Extension 2550 TELEPHONE NUMBERS: Hillsborough 732 -8181 Chapel Hill 968 -4501 Durham 688 -7331 Mebane 336 -227 -2031 PURPOSE: To consider and adopt the implementing policy to provide County employee benefits for domestic partners effective January 1, 2005. BACKGROUND: At the Board of Commissioners' September 21, 2004, the Board adopted benefits for domestic partners and the implementing policy in principal and -asked that staff bring this agenda item back to the October 5, 2004 Board meeting with clarification as to the meaning of some of the language included in the North Carolina Association of County Commissioners Health Insurance Trust policy requirements. This information is provided below under "NCACC Health Insurance Trust Language Clarifications." This follows the Board of Commissioners' decision at its November 2003 employee pay and benefits work session to provide benefits for domestic partners with the County's health insurance renewal effective January 1, 2005. The approved 2004 -05 budget included funds ($10,500) to implement this coverage. This agenda abstract provides for the Board's consideration the implementing policy to make this coverage effective January 1, 2005. This implementing policy includes the definition of domestic partner, the benefits to be provided with such coverage and the necessary Personnel Ordinance revisions. Staff will offer this coverage during the upcoming benefits open enrollment period for 2005 scheduled to begin in mid - October. Domestic Partner Definition The County's health insurance provider — the North Carolina Association of County Commissioners Health Insurance Trust — requires that the County apply its definition of domestic partner in making health insurance available for domestic partners. This is the definition proposed below. The Health Insurance Trust does not specify whether such benefits should be limited to persons of the same gender or may be offered to both persons of the same or opposite gender. The proposed definition below provides for coverage for both persons of the same or opposite gender. As incorporated in the Attachment 1 Personnel Ordinance revision, the proposed definition of domestic partner is as follows: Domestic Partner — A person of the same or opposite gender, not related by blood to the . employee, who is not legally married to any other person, and who shares the following with the employee: 1) an exclusive, committed relationship as provided in the Declaration of Domestic Partnership statement, 2) a residence, and 3) responsibility for each other's common welfare and financial obligations. To qualify for Domestic Partner coverage (under the provisions of the County's health insurance plan), the employee and his or her Domestic Partner must meet all of the following criteria and sign a Declaration of Domestic Partnership (Attachment 2) attesting that they are: • At least 18 years old and mentally competent to consent to a civil contract, • Not acting under force or duress, • Not related by blood, • Not legally married to any other person and not engaged in another domestic partner relationship, • Are engaged in a committed relationship of mutual caring and support that has existed for at least 12 consecutive months, • Currently reside together and intend to do so permanently, • Responsible for each other's common welfare and either. ✓ Are jointly responsible for their assets and debts as provided by applicable law, or ✓ Have executed a written agreement or civil contract which defines their domestic partner relationship and their liabilities with respect to their assets and debts. • Not Medicare eligible. To document the domestic partner relationship, the County's health insurance provider requires two forms of proof along with the Declaration. Acceptable forms of such documentation include Birth Certificates, Drive's license or state - issued Identification Card, Common Will, Joint Bank or Credit Accounts, Life Insurance Policy designating the Domestic Partner as a beneficiary or the like. NCACC Health Insurance Trust Language Clarifications In follow up to the September 21 Board discussion, the Health Trust confirmed again that it does require that the County use its specific language in defining domestic partner status and in its Declaration of Domestic Partner Status form. In follow up to the Board's questions at the September 21 meeting, the Trust provided the following clarifications as to the meaning of its language: • Birth Certificate — The Trust representative acknowledged this document does not establish a domestic partner relationship but is here for the purpose of establishing that the two partners are not related by blood as in a parent and child and for use to verify identity. • Drivers License — The Trust advises this is used to determine that the partner is at least age 18 or older, to verify identify and also may be used to show that the two partners share a common address. • Common Will — This could be used to demonstrate a domestic partner relationship by showing that the two partners are each other's beneficiaries. Joint Bank or Credit Accounts — This could be used to show that the partners share financial resources or responsibility. The Board also has asked about the Trust language as to being jointly responsible for "assets and debts as provided by applicable law." The Trust advises that this means, for example, that if a house is jointly owned that this is reflected on the deed for the property or if a mortgage is jointly held that this is reflected on the mortgage documents. In documenting domestic partner relationships, staff plans to work individually with any employee interested in this coverage to ask what documentation they may be able to provide and as necessary to review any questions or issues with the Health Trust. Staff understands from the Trust that Orange County is the first County in the Trust to offer Domestic Partner coverage and the Trust recognizes that it may require some discussion as necessary to address specific situations. Benefits Offered It is proposed that domestic partner coverage include the following benefits. These parallel those that would be available for an employee's spouse. • Dependent health insurance • Dependent dental insurance • Dependent life insurance • Dependent COBRA coverage for continuation of health and dental insurance • Dependent retiree health insurance • Dependent Employee Assistance Program coverage • Funeral Leave • Sick Leave to care for family members • Shared Leave • Family leave of absence (comparable to that required under the Federal Family and Medical Leave Act) The Attachment 1 Personnel Ordinance revisions provides ,for the necessary changes to the County's Personnel Ordinance to implement the above coverage. Estimated Employee Participation For purposes of estimating costs, staff estimated that up to about one percent of employees might decide to participate in domestic partner coverage. This is based on participation rates 4 for other employers and represents about seven to eight employees. Participation is impacted by such factors as: • Whether County domestic partner benefits cover same sex partners only or also cover opposite sex partners. • The criteria used to establish domestic partner eligibility. • Employee willingness to disclose information about a domestic partner relationship. • Tax consequences of participation. Tax Issue The Federal Internal Revenue Code does not recognize a domestic partner as a dependent. This means that the employee will be required to pay taxes on the "fair market value" of any contribution the County and the employee make for domestic partner coverage for that employee. Estimated Cost The County cost for domestic partner coverage will be the cost of dependent coverage for any domestic partners enrolled in the health insurance plan. If seven employees elected to participate in domestic partner coverage, the estimated annual County cost will be about $17,000 for the County's dependent health insurance contribution. There is no additional health insurance surcharge for offering domestic partner coverage so the cost is that for the dependent coverage only. FINANCIAL IMPACT: With the adoption of the 2004 -2005 budget, the Board provided funding of $10,500 for implementation of domestic partner coverage effective January 1, 2005. The projected cost of the coverage effective January 1 for 2004 -05 is about $10,000 if seven employees enroll. RECOMMENDATION(S): The Manager recommends that the Board: • Approve the implementation of benefits for domestic partners as provided under `Benefits Offered" above. • Adopt the Attachment 1 Personnel Ordinance revisions effective January 1, 2005. 5 Attachment 1 Draft Personnel Ordinance Revisions To Implement Benefits For Domestic Partners (Changes shown in bold type) Article I - The Personnel Organization 4. D Definitions 4.11 Domestic Partner — A person of the same or opposite gender, not related by blood to the employee, who is not legally married to the employee or anyone else, and who shares the following with the employee: 1) an exclusive, committed relationship as provided in the Declaration of Domestic Partnership statement, 2) a residence, and 3) responsibility for each other's common welfare and financial obligations. Note: To qualify for Domestic Partner coverage, the employee and his or her Domestic Partner must meet all of the following criteria and must sign the North Carolina Association of County Commissioners' Risk Management Pool's Declaration of Domestic Partner status attesting that they are: • At least 18 years old and mentally competent to consent to a civil contract, • Not acting under force or duress, • Not legally married to any other person and not engaged in another domestic partner relationship, • Not related by blood, • Engaged in an exclusive, committed relationship that has existed for at least 12 consecutive months, • Currently reside together and intend to do so permanently, • Responsible for each other's common welfare and either: ✓ Are jointly responsible for their assets and debts as provided by applicable law, or ✓ Have executed a written agreement or civil contract which defines their domestic partner relationship and their liabilities with respect to their assets and debts. • Not Medicare eligible. Two forms of proof, documenting the Domestic Partner relationship, must be provided with the Declaration. Acceptable forms of documentation include Birth Certificate, Driver's License, or state - issued Identification Card, Common Will, Joint Bank or Credit Accounts, Life Insurance Policy designating the Domestic Partner as a named beneficiary. 6 Attachment 1 4.17 Immediate Family - wife, husband, domestic partner as defined in the Ordinance, father, mother, daughter, son, grandparent, grandchildren, brother, sister. (Also included are step, foster or in -law relationships.) Article IV — Employee Benefits 6.2 Using Sick Leave Sick Leave may be used for: - Physical or mental illness or injury which prevents the employee from performing the usual duties, including a pregnancy - related disability. -Care of an ill member of the employee's immediate family. For this purpose, immediate family is defined as the employee's spouse, parent, of child, or domestic partner as defined in this Ordinance. - Medical or dental appointments, including those necessary for the care of a member of the employee's immediate family. - Appointments with the Employee Assistance Program provider. 7.0 Health Insurance It is the policy of Orange County to provide permanent employees both full -time and part-time (regularly scheduled at least 20 hours each workweek) with group health insurance. The cost to the employee for group health insurance is determined each year. Employees also have the option, at additional expense, to cover the employee's spouse, dependent child(ren), domestic partner as defined in this Ordinance and /or family. 7.3 COBRA Coverage Under the Consolidated Omnibus Reconciliation Act (COBRA), Orange County continues health care coverage to persons who would otherwise lose coverage under a health care plan due to specific events provided the employee, covered spouse, domestic partner as defined in this Ordinance, and /or dependent child agrees to pay, and pays, the cost of this coverage. 7.3.1 When coverage ceases due to termination or reduction in hours of employment, the employee, covered spouse, domestic partner, and /or dependent child is entitled to up to 18 months of coverage. 7.3.2 If the employee, covered spouse, domestic partner, or dependent child is determined disabled under Social Security at the time of termination or reduction in hours, he or she is entitled to purchase coverage for up to 29 months. 7 Attachment 1 7.3.3 The spouse, domestic partner, or dependent child of an employee is entitled to up to 36 months of coverage if any of the following occurs: -Death of the covered employee - Divorce or legal separation of the covered employee from the employee's spouse or termination of a domestic partner relationship -A covered employee- becomes entitled to Medicare benefits -A covered dependent is no longer a dependent. 22.0 Shared Leave 22.2 Eligibility 22.2.1 Any permanent employee with one year of Orange County service as a permanent employee is eligible to donate or request leave. 22.2.2 Following are situations wherein an employee can request to participate in the Shared Leave program upon documentation of the need for leave by a physician: An employee who is unable to work due to a serious health condition. This includes an employee who is unable to work due to pregnancy related disability. An employee who needs to be away from work to care for a member of the employee's immediate family (spouse, domestic partner as defined in this Ordinance, child, or parent) who has a serious health condition. I. Declaration We, North Carolina Association of County Commissioners Risk Management Pools Attachment BOARD OF TRUSTEES POLICY STATEMENT Declaration of Domestic Partner Status (employee), and (Domestic Partner) each certify and declare that we are each other's sole Domestic Partners as set out below: A. We are both at least eighteen (18) years old and mentally competent to consent to a civil contract; and B. We are not acting under force or duress; and C. Neither of us is married to or legally separated from any other person and neither of us is engaged in another domestic partnership; and D. We are not related by blood; and E. We have been engaged in a committed relationship of mutual caring and support for at least 12 consecutive months; and F. We currently reside together and intend to do so permanently; and G. We are jointly responsible for each other's common welfare; and either. 1. We are jointly responsible for our assets and debts as provided by applicable law; or 2. We have executed a written agreement or civil contract, which defines our domestic partnership and our liabilities with respect to our assets and debts. (Orange County Administrative Note: The Orange County Personnel Department will review the documentation provided by the employee to determine whether or not it provides sufficient documentation of an eligible domestic partner relationship. If not, Personnel will ask the employee to provide additional documentation as necessary.) II. Termination of Domestic Partnership A. The above named employee has an obligation to ensure that the employer receives a written notice of Declaration of Termination of Domestic Partnership if there is any change in the domestic partnership status that makes this Declaration invalid or erroneous. Notice shall be provided by the employee to the Human Resources Department within thirty -one (31) days of such change. B. The above named understand that termination of benefit coverage obtained as a result of this Declaration will be effective on the last day of the month during which the domestic partnership ends or at such time as coverage terminates in accordance with the terms and conditions of applicable policies. Receipt by the employer of a Declaration of Termination of Domestic Partnership from the employee shall be deemed conclusive evidence of the termination of the domestic partnership status for purposes of this benefit. In the event that more than one such Declaration of Termination of Domestic Partnership is provided with conflicting dates of termination 9 of the domestic partnership, the employer shall rely on the document with the earlier date. Ill. Acknowledgments A. The above named understand that a civil action may be brought against one or both for any losses (including attorney's fees and costs) due to any false statement contained in this Declaration or for failure to notify the employer of changed circumstances as required in Section II, above. The undersigned employee further understands that falsification of information in this Declaration or failure to notify the employer of changed circumstances pursuant to Section II, above, may lead to disciplinary action, including discharge from employment. B. The above named have provided information in this Declaration for use by the employer for the sole purpose of determining our eligibility for certain health insurance benefits. We understand and agree that the employer is not legally required to extend such benefits to domestic partners and that my employer may change or terminate these benefits in its discretion without consent of any employee or group of employees. C. The above named understand that the information provided in this Declaration will be treated as confidential but will be subject to disclosure: 1. Upon the express written authorization of the undersigned or 2. If otherwise required by law. D. The above named understand that this Declaration may have legal implication relating, for example, to our ownership of property or to taxability of benefits provided. We understand that before signing this Declaration we should seek competent legal and tax advice concerning such matters. We acknowledge that the employer has provided us with no advice in this regard. We affirm, under penalty of perjury, that the statements in this Declaration are true and correct. Employee Printed name: . Domestic Partner Printed name: Date of birth Date Date of birth Date NCACC Group Benefits Pool Page 2 of 2 Declaration of Domestic Partnership Adopted by the Board of Trustees January 2, 2001 Commissioner Halkiotis sai d th t th' th St t t .4; ' a is year e a e is s a ing something new in that it is no longer buying school buses outright, but doing three -year leases. He predicts that at the end of the three -year trial period, the cost will be put back on the counties. Commissioner Halkiotis said that he hopes the Board will discuss Amendment One, before the November election. He is hearing that it has the potential of taking away monies from county government in anticipated new revenues that will accrue from additional housing stocks in property taxes. He would like to have a presentation on this from the County Commissioners' Association. John Link said that he has asked Economic Development Director Dianne Reid to give a presentation on this Amendment One. This report will be at the next meeting. Chair Jacobs said that he understands that in November the Board will receive a report on the minority business policy, which has been in effect since 1990. Chair Jacobs said that the Board would get a report at the next meeting from the Library Task Force. He said that the task force has worked very hard to listen to concerns of residents of Hillsborough and also to assure them that the branch library would probably be more than 7,000 square feet. Commissioner Carey said asked if a preliminary report could be given to them before they meet with Durham Tech and Chair Jacobs said yes. 4. County Manager's Report John Link said that the only topic he had planned to bring forward was the flu season presentation and that Rosemary Summers just presented it. 5. Items for Decision -- Consent Agenda A motion was made by Commissioner Halkiotis, seconded by Commissioner Carey to approve those items on the consent agenda as stated below: a. Minutes The Board approved the minutes for June 21 and August 17, 23, 31 of 2004 as submitted by the Clerk to the Board. b. Appointments — None c. Property Tax Releases The Board adopted a resolution, which is incorporated by reference, to release property values related to two (2) requests for property tax releases in accordance with N.C. General Statute 105 -381. d. Property Value Changes The Board adopted the resolution, which is incorporated by reference, approving value changes made in property values after the 2004 Board of Equalization and Review has adjourned. e. Applications for Property Tax Exemption The Board approved three (3) untimely applications for granting exempt status from ad Val Orem taxation for the 2004 tax year. f. Board of Commissioners Meeting Calendar for Year 2005 This item was removed and placed at the end of the consent agenda for separate consideration. gL Benefits for Domestic Partners — Implementation and Personnel Ordinance Revisions The Board approved the implementation of benefits for domestic partners as provided under "Benefits Offered" and adopted the Attachment 1 Personnel Ordinance revisions effective January 1, 2005. ORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: September 21, 2004 D /v -- ago i o 6 Action Agenda Item No. 5— SUBJECT: Benefits for Domestic Partners — Implementation and Personnel Ordinance Revisions DEPARTMENT: Personnel PUBLIC HEARING: (Y /N) No ATTACHMENT(S): 1 — Draft Personnel Ordinance Revisions 2 - Declaration of Domestic Partner INFORMATION CONTACT: Elaine Holmes, Personnel Director, Extension 2550 Status TELEPHONE NUMBERS: Hillsborough 732 -8181 Chapel Hill 968 -4501 Durham 688 -7331 Mebane 336- 227 -2031 PURPOSE: To consider and adopt the implementing policy to provide County employee benefits for domestic partners effective January 1, 2005. BACKGROUND: At the Board of Commissioners' November 2003 employee pay and benefits work session, the Board decided to provide benefits for domestic partners with the County's health insurance renewal effective January 1, 2005. The approved 2004 -05 budget included funds ($10,500) to implement this coverage. This agenda abstract provides for the Board's consideration the implementing policy to make this coverage effective January 1, 2005. This implementing policy includes the definition of domestic partner, the benefits to be provided with such coverage and the necessary Personnel Ordinance revisions. With the Board's adoption of the implementing policy, staff will offer this coverage during the upcoming benefits open enrollment period for 2005 scheduled to begin in mid - October. Domestic Partner Definition The County's health insurance provider — the North Carolina Association of County Commissioners Health Insurance Trust — requires that the County apply its definition of domestic partner in making health insurance available for domestic partners. This is the definition proposed below. The Health Insurance Trust does not specify whether such benefits should be limited to persons of the same gender or may be offered to both persons of the same or opposite gender. The proposed definition below provides for coverage for both persons of the same or opposite gender. As incorporated in the Attachment 1 Personnel Ordinance revision, the proposed definition of domestic partner is as follows: Domestic Partner -- A person of the same or opposite gender, not related by blood to the employee, who is not legally married to any other person, and who shares the following with the employee: 1) an exclusive, committed relationship as provided in the Declaration of Domestic Partnership statement, 2) a residence, and 3) responsibility for each other's common welfare and financial obligations. To qualify for Domestic Partner coverage (under the provisions of the County's health insurance plan), the employee and his or her Domestic Partner must meet all of the following criteria and sign a Declaration of Domestic Partnership (Attachment 2) attesting that they are: • At least 18 years old and mentally competent to consent to a civil contract, • Not acting under force or duress, • Not related by blood, • Not legally married to any other person and not engaged in another domestic partner relationship, • Are engaged in a committed relationship of mutual caring and support that has existed for at least 12 consecutive months, • Currently reside together and intend to do so permanently, • Responsible for each other's common welfare and either: ✓ Are jointly responsible for their assets and debts as provided by applicable law, or ✓ Have executed a written agreement or civil contract which defines their domestic partner relationship and their liabilities with respect to their assets and debts. • Not Medicare eligible. To document the domestic partner relationship, the County's health insurance provider requires two forms of proof along with the Declaration. Acceptable forms of such documentation include Birth Certificates, Driver's license or state - issued Identification Card, Common Will, Joint Bank or Credit Accounts, Life Insurance Policy designating the Domestic Partner as a beneficiary or the like. Benefits Offered It is proposed that domestic partner coverage include the following benefits. These parallel those that would be available for an employee's spouse. • Dependent health insurance • Dependent dental insurance • Dependent life insurance • Dependent COBRA coverage for continuation of health and dental insurance • Dependent retiree health insurance • Dependent Employee Assistance Program coverage • Funeral Leave • Sick Leave to care for family members • Shared Leave 3 • Family leave of absence (comparable to that required under the Federal Family and Medical Leave Act) The Attachment 1 Personnel Ordinance revisions provides for the necessary changes to the County's Personnel Ordinance to implement the above coverage. Estimated Employee Participation For purposes of estimating costs, staff estimated that up to about one percent of employees might decide to participate in domestic partner coverage. This is based on participation rates for other employers and represents about seven to eight employees. Participation is impacted by such factors as: • Whether County domestic partner benefits cover same sex partners only or also cover opposite sex partners. • The criteria used to establish domestic partner eligibility. • Employee willingness to disclose information about a domestic partner relationship. • Tax consequences of participation. Tax Issue The Federal Internal Revenue Code does not recognize a domestic partner as a dependent. This means that the employee will be required to pay taxes on the "fair market value" of any contribution the County and the employee make for domestic partner coverage for that employee. Estimated Cost The County cost for domestic partner coverage will be the cost of dependent coverage for any domestic partners enrolled in the health insurance plan. If seven employees elected to participate in domestic partner coverage, the estimated annual County cost will be about $17,000 for the County's dependent health insurance contribution. There is no additional health insurance surcharge for offering domestic partner coverage so the cost is that for the dependent coverage only. FINANCIAL IMPACT: With the adoption of the 2004 -2005 budget, the Board provided funding of $10,500 for implementation of domestic partner coverage effective January 1, 2005. The projected cost of the coverage effective January 1 for 2004 -05 is about $10,000 if seven employees enroll. RECOMMENDATION(S): The Manager recommends that the Board: • Approve the implementation of benefits for domestic partners as provided under "Benefits Offered" above. • Adopt the Attachment 1 Personnel Ordinance revisions effective January 1, 2005. 4 Attachment 1 Draft Personnel Ordinance Revisions To Implement Benefits For Domestic Partners (Changes shown in bold type) Article i - The Personnel Organization 4.0 Definitions 4.11 Domestic Partner— A person of the same or opposite gender, not related by blood to the employee, who is not legally married to the employee or anyone else, and who shares the following with the employee: 1) an exclusive, committed relationship as provided in the Declaration of Domestic Partnership statement, 2) a residence, and 3) responsibility for each other's common welfare and financial obligations. Note: To qualify for Domestic Partner coverage, the employee and his or her Domestic Partner must meet all of the following criteria and must sign the Declaration of Domestic Partnership attesting that they are: • At least 18 years old and mentally competent to consent to a civil contract • Not acting under force or duress, • Not legally married to any other person and not engaged in another domestic partner relationship, • Not related by blood, • Engaged in an exclusive, committed relationship that has existed for at least 12 consecutive months, • Responsible for each other's common welfare and either: ✓ Are jointly responsible for their assets and debts as provided by applicable law, or ✓ Have executed a written agreement or civil contract which defines their domestic partner relationship and their liabilities with respect to their assets and debts. • Not Medicare eligible. Two forms of proof, documenting the Domestic Partner relationship, must be provided with the Declaration. Acceptable forms of documentation include Birth Certificate, Driver's License, or state - issued Identification Card, Common Will, Joint Bank or Credit Accounts, Life Insurance Policy designating the Domestic Partner as a named beneficiary. 4.17 Immediate Family - wife, husband, domestic partner as defined in policy, father, mother, daughter, son, grandparent; grandchildren, brother, sister. (Also included are step, foster or in -law relationships.) 5 Attachment 1 Article IV — Employee Benefits 6.2 Using Sick Leave Sick Leave may be used for: - Physical or mental illness or injury which prevents the employee from performing the usual duties, including a pregnancy - related disability. -Care of an ill member of the employee's immediate family. For this purpose, immediate family is defined as the employee's spouse, parent, eF child, or domestic partner as defined in policy. - Medical or dental appointments, including those necessary for the care of a member of the employee's immediate family. - Appointments with the Employee Assistance Program provider. 7.0 Health Insurance It is the policy of Orange County to provide permanent employees both full -time and part-time (regularly scheduled at least 20 hours each workweek) with group health insurance. The cost to the employee for group health insurance is determined each year. Employees also have the option, at additional expense, to cover the employee's spouse, dependent child(ren), domestic partner as defined in policy and /or family. 7.3 COBRA Coverage Under the Consolidated Omnibus Reconciliation Act (COBRA), Orange County continues health care coverage to persons who would otherwise lose coverage under a health care plan due to specific events provided the employee, covered spouse, domestic partner as defined in policy, and /or dependent child agrees to pay, and pays, the cost of this coverage. 7.3.1 When coverage ceases due to termination or reduction in hours of employment, the employee, covered spouse, domestic partner, and /or - dependent child is entitled to up to 18 months of coverage. 7.3.2 If the employee, covered spouse, domestic partner, or dependent child is determined disabled under Social Security at the time of termination or reduction in hours, he or she is entitled to purchase coverage for up to 29 months. 7.3.3 The spouse, domestic partner, or dependent child of an employee is entitled to up to 36 months of coverage if any of the following occurs: -Death of the covered employee 6 Attachment 1 - Divorce or legal separation of the covered employee from the employee's spouse or termination of a domestic partner relationship -A covered employee- becomes entitled to Medicare benefits -A covered dependent is no longer a dependent. 22.0 Shared Leave 22.2 Eligibility 22.2.1 Any permanent employee with one year of Orange County service as a permanent employee is eligible to donate or request leave. 22.2.2 Following are situations wherein an employee can request.to participate in the Shared Leave program upon documentation of the need for leave by a physician: An employee who is unable to work due to a serious health condition. This includes an employee who is unable to work due to pregnancy related disability. An employee who needs to be away from work to care for a member of the employee's immediate family (spouse, domestic partner as defined in policy, child, or parent) who has a serious health condition. I. Declaration We, North Carolina Association of County Commissioners Risk Management Pools Attachment BOARD OF TRUSTEES POLICY STATEMENT Declaration of Domestic Partner Status (employee), and (Domestic Partner) each certify and declare that we are each other's sole Domestic Partners as set out below: (Domestic Partner), each certify and declare that we are each other's sole Domestic Partners as set out below. A. We are both at least eighteen (18) years old and mentally competent to consent to a civil contract; and B. We are not acting under force or duress; and C. Neither of us is married to or legally separated from any other person and neither of us is engaged in another domestic partnership; and D. We are not related by blood; and E. We have been engaged in a committed relationship of mutual caring and support for at least 12 consecutive months; and F. We currently reside together and intend to do so permanently; and G. We are jointly responsible for each other's common welfare; and either: We are jointly responsible for our assets and debts as provided by applicable law; or 2. We have executed a written agreement or civil contract, which defines our domestic partnership and our liabilities with respect to our assets and debts. II. Termination of Domestic Partnership A. The above named employee has an obligation to ensure that the employer receives a written notice of Declaration of Termination of Domestic Partnership if there is any change in the domestic partnership status that makes this Declaration invalid or erroneous. Notice shall be provided by the employee to the Human Resources Department within thirty -one (31) days of such change. B. The above named understand that termination of benefit coverage obtained as a result of this Declaration will be effective on the last day of the month during which the domestic partnership ends or at such time as coverage terminates in accordance with the terms and conditions of applicable policies. Receipt by the employer of a Declaration of Termination of Domestic Partnership from the employee shall be NCACC Group Benefits Pool Page 1 of 2 Declaration of Domestic Partnership Mooted by the Board of Trustees January 2. 2001 deemed conclusive evidence of the termination of the domestic partnership status for purposes of this benefit. In the event that more than one such Declaration of Termination of Domestic Partnership is provided with conflicting dates of termination of the domestic partnership, the employer shall rely on the document with the earlier date. Ill. Acknowledgments A. The above named understand that a civil action may be brought against one or both for any losses (including attorney's fees and costs) due to any false statement contained in this Declaration or for failure to notify the employer of changed circumstances as required in Section II, above. The undersigned employee further understands that falsification of information in this Declaration or failure to notify the employer of changed circumstances pursuant to Section II, above, may lead to disciplinary action, including discharge from employment. B. The above named have provided information in this Declaration for use by the employer for the sole purpose of determining our eligibility for certain health insurance benefits. We understand and agree that the employer is not legally required to extend such benefits to domestic partners and that my employer may change or terminate these benefits in its discretion without consent of any employee or group of employees. C. The above named understand that the information provided in this Declaration will be treated as confidential but will be subject to disclosure: 1. Upon the express written authorization of the undersigned or 2. If otherwise required by law. D. The above named understand that this Declaration, may have legal implication relating, for example, to our ownership of property or, to taxability of benefits provided. We understand that before signing this Declaration we should seek competent legal and tax advice concerning such matters. We acknowledge that the employer has provided us with no advice in this regard. We affirm, under penalty of perjury, that the statements in this Declaration are true and correct. Employee Printed name: Domestic Partner Printed name: Declaration of Domestic Partnership Adopted by the Board of Trustees January 2. 2001 Date of birth Date Date of birth Date N °nom - �d d. Benefits for Domestic Partners — Implementation and Personnel Ordinance Revisions The Board considered implementing policy and personnel ordinance revisions for County employee benefits for domestic partners effective January 1, 2005. Commissioner Gordon said that there were several things that were not clear in the ordinance. She made reference to page four where it talks about demonstrating each one's common welfare and she read: "Two forms of proof documenting the domestic partner relationship must be provided with the declaration. Acceptable forms of documentation include...... She said that three of the things listed do not seem to have anything to do with the relationship. She suggested striking out birth certificate, driver's license, or state - issued identification card, since it does not document the domestic partner relationship. Elaine Holmes said that the Health Insurance Trust prescribed this definition to them. Her understanding is that the birth certificate requirement is to make sure that the partners are not blood related. She can explore this further with the Trust. Commissioner Gordon said that there are a lot of loose ends. Commissioner Gordon asked about the statement, "responsible for each other's common welfare," and "are jointly responsible for their assets and debts as provided by applicable law." She asked what applicable law was. Geof Gledhill said that normally people that are not married or not related are not responsible for assets and debts. Relationships can be created by contract or will or by power of attorney. He thinks this is what it is talking about. Commissioner Gordon asked for clarification on this. Elaine Holmes will be bringing this back for a second reading on October 51h, so the clarification will be brought back at that time. John Link said that they will pursue these questions and he will bring back what the Trust requires. Ultimately, it is the Trust's program. A motion was made by Chair Jacobs, seconded by Commissioner Carey to approve the revisions in principle and have it come back on October 5th with further clarification. Geof Gledhill said that this would still require approval of the ordinance. John Link recommended voting for this in principle and for the motion to indicate that the Board intends to fully pursue this as a benefit. VOTE: UNANIMOUS k. Voluntary Agricultural District Designation — Walters Propertv The Board considered an application from Carl and Elizabeth Walters for certification as qualifying farmland and designation of 173 acres as an addition to their Voluntary Agricultural District. Commissioner Gordon highlighted that the Walters family has put a tremendous number of acres of their property into the voluntary agricultural districts. Dave Stancil said that the total for the Walters family would be 378 acres. This also pushes the County over the 2,000 -acre mark. A motion was made by Commissioner Gordon, seconded by Commissioner Halkiotis to approve the application from Carl and Elizabeth Walters for certification as qualifying farmland and designation of 173 acres as an addition to their Voluntary Agricultural District. VOTE: UNANIMOUS 6. Resolutions or Proclamations a. Resolution Requesting Congress and the President of the United States of America to Reauthorize the Assault Weapon Ban