CITY OF PLANT CITY PLAN YEAR 10/01/17-9/30/18 EMPLOYEE BENEFITS ENROLLMENT GUIDE

Transcription

1 CITY OF PLANT CITY PLAN YEAR 10/01/17-9/30/18 EMPLOYEE BENEFITS ENROLLMENT GUIDE

2 INTRODUCTION The City of Plant City is committed to providing you and your family comprehensive insurance coverage options at the most affordable costs available in today s challenging market. The Cafeteria Plan, established by the City as allowed by Section 125, Internal Revenue Code, gives employees the flexibility to choose the insurance benefits they determine to be best for their families on a pre-tax basis. Those choices include the following: Medical Insurance Dental Insurance Vision Care Insurance Long Term Disability Insurance Cancer/Intensive Care Insurance Basic/Supplemental Life Insurance Dependent Life Accidental Death & Disability Insurance Other available non-cafeteria benefits include Credit Union and Deferred Compensation. The City provides a spending account to each eligible employee to assist in the purchase of the benefits listed above. Employees may purchase as many benefits as desired however; any cost for benefits that exceed the spending account will be deducted from the employee's pay on a pre-tax basis. Benefits dollars in the spending account must be allocated first to basic life and to single medical coverage, if the employee does not have proof of coverage under another group plan, following which, any surplus may be allocated by the employee for dependent medical, or a variety of other benefits. The employee may supplement the City's contributions through salary redirection (pre-tax) to pay for additional benefits not covered by the City's contribution.

3 MAKING YOUR YEAR 17/18 BENEFITS CHOICES Due to the rising costs of changes in the healthcare system, the medical plan premium rates shown on the following pages reflect an increase over current rates for Standard, HMO I and HMO II plans. The new premiums are effective with October 2017 payroll deductions. Making your health care selections for is an important decision. Before you decide, here are some questions and answers that may assist you. When does Cafeteria Plan 17/18 take effect? The benefits you select at re-enrollment take effect on October 1, New premium deductions begin with the first pay day of October. Which City employees are eligible for benefits? All regular full-time employees (other than temporary employees) scheduled to work 30 or more hours per week are eligible for all the benefits described here. When I am first hired by the City, how soon am I eligible for benefits? New employees are covered on the first day of the month following 30 continuous calendar days of employment. Must I apply for benefits, or will I get them automatically? You must apply for benefits to receive them. New employees must submit an application during their first 30 days of employment. Employees who fail to apply during their first 30 days must wait until the annual re-enrollment period for the next year and are subject to denial of coverage based on medical exam results. Continuing employees must renew their benefits elections annually during open enrollment period. How do I apply for benefits? New employees apply at the Human Resources Department during the first 30 days of employment. Current employees must re-elect their benefits during the re-enrollment period. Because family and financial circumstances change from year to year, you should review your coverage each year before reenrollment to be certain your choices are still best for your current circumstances, and to update dependent or beneficiary changes. Can I add or drop benefits during the year? The same law that permits payment of the benefits on a pre-tax basis also requires that the agreement stay in effect without changes for a full year, unless there is an An eligible family status change that significantly impacts one or more of your coverage choices. The benefit change you wish to make must be consistent with the family status change that has occurred and must be made within 30 days of the eligible event. Eligible changes are listed below. What happens to my benefits if I leave my employment with the City? City benefits end when employment terminates. However, you may choose to continue Medical, Dental and Vision coverage at your own expense for 102% of the actual total cost as provided under federal law (COBRA). Other benefits may be applied for directly from each insurance company. See the Human Resources Department for more information.

4 YOUR BENEFIT ELECTIONS STAY IN EFFECT FOR THE PLAN YEAR The elections you make now will remain in effect through September 30, It is important that you make your decisions carefully because once the selections are made, you cannot stop or change your coverage during the plan year unless there is a family status change as explained below. This restriction is imposed by the same law that permits pre-tax premium deductions. Approved Family Status Changes Χ Χ Χ Χ marriage, divorce or legal separation birth or adoption of an eligible dependent death or loss of custody of a dependent significant change in a dependent's health insurance coverage Remember, if a dependent spouse or child becomes ineligible as a dependent during the plan year, it is your responsibility to contact Human Resources and make the necessary changes; within 30 days of the event. The law further requires that any change an employee makes must be consistent with the event. For example, if the reason is marriage, one could change from single to employee and spouse coverage, but could not change from the HMO I plan to the HMO II plan. Benefits at Termination COBRA The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) is a federal law requiring employers to offer continuation coverage to employees and dependents who would otherwise lose group health, vision and dental plan coverage because of certain qualifying events. A qualified beneficiary is an individual who, on the day before a qualifying event, is covered by a group health plan maintained by the employer and who on that day has coverage because he or she is either the covered employee, spouse or dependent of a covered employee. Termination of employment for any reason (except gross misconduct) or reduction in hours to fewer than the number required for plan participation are both examples of qualifying events that trigger COBRA eligibility. HIPAA The Health Insurance Portability and Accountability Act of 1996 (HIPAA): limits exclusions for preexisting medical conditions; provides credit for prior health coverage and a process for transmitting certificates and other information concerning prior coverage to a new group health plan or issuer; allows you to enroll for health coverage when you lose other health coverage or have a new dependent; prohibits discrimination in enrollment and premiums against you and your dependents based on health status; and/or guarantees availability of health insurance based upon Florida s regulation of health insurance.

5 MEDICAL CARE BENEFITS The City offers a comprehensive package of services and programs through United Healthcare. These are designed to give you and your family the tools necessary to manage your preventive care and medical treatment needs. Three levels of traditional HMO options are available for your consideration. Be sure to examine all the details explained in the United Healthcare package provided to you. MONTHLY PREMIUM RATES STANDARD HMO HMO I HMO II Employee Only $ $ $ Employee & Spouse $ $ $ Employee & Children $ $ $ Family $ $ $

6 LIFE INSURANCE Life insurance is an important benefit and a major feature of the Cafeteria Plan for all employees. Each employee must purchase a basic amount of life insurance and accidental death and dismemberment coverage of $10,000. The City also offers you the ability to purchase additional coverage through the optional life insurance plan. Term life insurance provides a lump sum to your beneficiary if you die. Your beneficiary is the person or persons you name to receive the benefit in the event of your death. How Much You Can Purchase You must purchase $10,000 of Basic Life/AD & D for $3.10/month and new enrollees may purchase up to $200,000 in increments of $10,000 of optional life insurance, subject to carrier limitations and/or physical exam. Life insurance rates for optional additional coverage are $.29 per $1,000 ($2.90/$10,000). The amount of life insurance you elect will be paid to your beneficiary, if you die while covered by the plan. Optional Life Insurance * Death Monthly Death Monthly Benefit Premium Benefit Premium $10,000 $2.90 $110,000 $31.90 $20,000 $5.80 $120,000 $34.80 $30,000 $8.70 $130,000 $37.70 $40,000 $11.60 $140,000 $40.60 $50,000 $14.50 $150,000 $43.50 $60,000 $17.40 $160,000 $46.40 $70,000 $20.30 $170,000 $49.30 $80,000 $23.20 $180,000 $52.20 $90,000 $26.10 $190,000 $55.10 $100,000 $29.00 $200,000 $58.00 Dependent Life Insurance * One low monthly rate covers your spouse and eligible children. Dependent Classification Benefit Family Rate Spouse $5, $1.26 Infant, 7 days to 6 months $1, Child, 6 months to 19 years ** $2, ** Dependent life coverage also applies to all unmarried, full-time students under 24 years of age. Any increase after the initial (original enrollment) eligibility period will be subject to Evidence of Insurability and Underwriting approval.

7 DENTAL PLANS You have a choice of an HMO or PPO plan, both covered by Humana. The HMO Plan The HMO Dental Plan is similar to a medical plan HMO and offers the most cost-effective way to receive dental care. You select your dentist from a group of participating dentists. For treatment to be covered, you must use a participating dentist. Many dental services are covered at no charge to you, such as routine check-ups and x-ray. Other general dental services require out-of-pocket co-payments, but are limited to network negotiated rates. If you need specialty care you can either: * have your general dentist refer you (or you may self-refer) to a participating specialist and receive services at a reduced charge of 20% off the specialist's usual fee, or * contact Humana Member Services at and a representative will advise you of a local general dentist who will perform a specialty procedure. In this case, you pay only the $15 co-payment listed in the Humana brochure. Monthly Costs Employee Employee + Employee+ Only One Family $15.22 $29.66 $42.96 The PPO Plan The PPO Plan is a plan that provides out of network coverage. It covers a fixed percentage per procedure for dental services provided by any general dentist, in or out of the network. For a list of covered services and the maximum benefits paid, see the Humana Plan brochure in your enrollment package. Monthly Costs Employee Only Employee + One Employee + Family $20.14 $39.14 $65.73

8 VISIONCARE PLAN The Visioncare Plan features a dual option to provide professional vision care that best suits your needs. Use a network doctor for maximum benefits or a non-participating provider at reduced coverage. Plan benefits include periodic eye exams, lenses and frames. This vision care program assures the finest quality professional care and materials at a uniform cost. What Are The Benefits? 1. VISION EXAMINATION: A complete analysis of the eyes and related structures to determine the presence of vision problems or other abnormalities. 2. LENSES: Your doctor will order your lenses from an approved optical laboratory. The plan fully covers any lenses you need for your visual welfare, as determined by your network doctor. The doctor will also verify the accuracy of your finished lenses. 3. FRAMES: The plan offers a wide selection of frames. However, if you select a frame that costs more than the amount allowed by your plan, there will be an additional charge. 4. CONTACT LENSES: Contact lenses are allowed under the program in either of these instances: 1) following cataract surgery; or 2) when visual acuity cannot be corrected to 20/70 in the better eye except by their use. However, if you choose contact lenses instead of the glasses available under this program, an allowance of $ will be made in addition to coverage of the cost of the exam. When you select a doctor from the network list, this plan covers the visual care described (examination, professional services, lenses and frames) at no expense to you except a deductible of $10.00 for the vision examination and $15.00 for any prescribed materials. Any additional care, service and/or materials not covered by this plan may be arranged between you and the doctor. Read the plan brochure for more details. VISIONCARE Monthly Costs Employee Only Employee + One Employee + Family $5.20 $10.40 $19.35

9 UNUM LONG TERM DISABILITY INSURANCE This plan covers you for an illness or an accident that leaves you unable to work for an extended time and is available to all active, full-time employees working 30 hours or more per week. *Your Benefit: Benefit Begins: Benefit Duration: Other Plan Features: Covers 50% of your monthly earnings up to a $3,000 monthly maximum benefit. After 3 months of disability. While disabled, up to 5 years. Own occupation coverage for 2 years. Minimum monthly benefit of $100. Mental & nervous and drug & alcohol limitation: 2 years. 6/12 Pre-existing condition exclusion. Waiver of premium. Individual guaranteed renewable conversion privilege. The above illustrates the primary features of the plan. For further plan details, refer to the policy/certificate. Cost Summary Your Age Rates based on Covered Earnings Your Age Rates based on Covered Earnings How to calculate your benefit and cost *Your Benefit: X.50 = monthly earnings benefit monthly benefit * (not to exceed $6,000) percentage (not to exceed $3,000) * Benefit will be reduced by other income, including any Social Security and Workers= Compensation benefits you are eligible to receive. Your Cost: X = monthly earnings rate cost per month (not to exceed $6,000)

10 CANCER/ACCIDENT INSURANCE AFLAC Insurance Cancer and accident insurance is offered through AFLAC. The monthly premiums for new enrollees are as follows: Employee Husband One Parent Family Only and Wife Family Cancer Accident - Office Personnel Accident - Labor Force SUMMARY The City of Plant City provides a number of other benefits in addition to those outlined in this guide. Retirement Plan, uniforms, safety equipment, Medicare contribution, unemployment compensation, Social Security, Worker s Compensation, and other benefits add up to a value equal to almost 40% of your salary. Human Resources staff will be happy to discuss these benefits with you. The City of Plant City is committed to offering you a comprehensive benefit program that offers you choice, flexibility and tax advantages. It is a program that is continually reviewed to ensure that the benefits offered provide the protection you need at an affordable cost. The City is taking steps to control health care costs. However, you must do your part, too. Schedule yourself and your dependents for regular check-ups. Use your plan wisely, practice preventive medicine and, most important, know what your health care options are.

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