MISSION S 2017 Benefit Programs

Transcription

1 2017 Benefits Guide

2 MISSION S 2017 Benefit Programs The City of Mission is committed to providing you and your family access to competitive benefits at an affordable cost. Please take time to review this summary. Open Enrollment is your one opportunity each year to make changes to your benefit elections. Elections made during open enrollment became effective October 1, 2016, and remain in place throughout 2017, unless you experience a qualifying event that allows you to make changes midyear. Examples of qualifying events are marriage, divorce, and birth or adoption of a child. You have 30 days from the date of the qualifying event to make changes to your benefit elections. Changes must be consistent with the qualifying event. If you experience a qualifying event, please contact Brian Scott at (913) or bscott@missionks.org to discuss your options. TABLE OF CONTENTS Medical and Prescription Drug Plans...4 Dental...5 Vision Flexible Spending Accounts (FSA) AFLAC Retirement Plans Life and Disability...8 Voluntary Term Life Insurance...8 2

3 2017 Benefits Summary Medical/Prescription coverage is with Cigna effective October 1, The City of Mission Wellness program will continue through Dental Plan continues with Delta Dental of Kansas with no change to the plan design. Vision Plan will be with EyeMed effective January 1, Please see this guide for plan design. The City will continue to pay the cost of this benefit. Life & Disability The Standard will continue to administer these plans with no changes to plan design. Flexible Spending Account will continue to be administered by BASIC. AFLAC will continue to offer voluntary programs for you and your family. Voluntary Retirement Plans will continue to be offered through Great-West or ICMA-RC. Spouse and Child Optional Group Term Life will be offered through KPERS. Benefits are an integral part of the overall compensation package. Please take time to read this guide thoroughly. 3

4 Effective October 1, 2016 December 31, (888) MEDICAL PLAN CIGNA PPO Benefit Feature In Network Out of Network Deductible Individual $1,000 $3,000 Family $2,000 $6,000 Coinsurance 80% 50% In- and Out-of-Network Deductibles accumulate separately Out of Pocket Maximum* Individual $3,500 $12,000 Family $7,000 $24,000 Preventive Services 100% Deductible then 50% Physician Office Visits $25 Copay Deductible then 70% Specialist Office Visits $50 Copay Deductible then 70% Diagnostic Lab 100% after $20 Copay Deductible then 70% X-Ray 100% after $20 copay Deductible then 80% Complex Imaging Deductible then 80% Deductible then 50% Inpatient Hospital Deductible then 80% Deductible then 50% Outpatient Hospital Deductible then 80% Deductible then 50% Urgent Care $50 Copay Deductible then 70% Emergency Room $300 Copay then 80% Deductible then 80% Prescription Drugs Retail Copays Generic/Preferred Brand/Non-Preferred Brand $10/$45/$75 60% Mail Order Copays Generic/Preferred Brand/Non-Preferred Brand $20/$125/$215 60% Specialty Copays Generic/Preferred Brand/Non-Preferred Brand $10/$45/$75 60% To search for Cigna Providers Go to At the top right of page it says, Find a Doctor in a little orange box. Click there. In the middle of the page are four boxes. Click on the orange box that says, If your insurance plan is offered through work or school. You are now in the provider search engine. It says, Find a... and you can choose doctor, dentist, or hospital. You enter your location in the location box. Select the first option, which is Open Access Plus. *Medical and Rx copays and deductibles apply to the out-of-pocket maximum. CIGNA HEALTH INSURANCE PREMIUMS EFFECTIVE OCTOBER 1, 2016 THROUGH DECEMBER 31, 2017 Without Wellness Incentive Tier Level Total Monthly Premium Employer Contribution Monthly Employee Contribution Per Payroll (24) Employee Only $ $ $ $62.04 Employee + Spouse $1, $ $ $ Employee + Child(ren) $1, $ $ $ Employee + Family $1, $1, $ $

5 To locate Delta Dental providers: Visit the website at OR contact customer service at DENTAL There will be no plan design changes and Delta Dental will continue to administer the dental plan. Please remember that since the City of Mission uses a PPO Network, benefits differ between in-network and out-of-network providers. Utilizing providers in-network keeps your cost and the plan s cost down. This helps prevent future premium increases. Check the website if you have questions about a specific provider. Below is a brief summary of the dental benefits. Did You Know? Research suggests more than 90 percent of all systemic diseases including heart disease have oral symptoms. In addition, dentists can help patients with a history of heart disease by examining them for any signs of oral pain, infection, or inflammation. According to the Academy of General Dentistry, proper diagnosis and treatment of tooth and gum infections in some of these patients have led to a decrease in blood pressure medications, and improved health. Delta Dental of Kansas Plan Features In-Network Out-of-Network Annual Deductible Individual Family $50 $150 Annual Maximum $1,000 Preventive Services 100% 80% Basic Services 80% 60% Major Services 50% 40% Orthodontia 50% $1,000 Lifetime Benefit Maximum Balance Billing* Not Allowed Allowed *Based on the procedure, the insurance company allows in-network providers to charge a certain dollar amount. The benefit percentages are based on the allowed charges. If you go to a provider who is not in the network, the insurance company will base payment on what dentists charge on average. If that particular provider charges more than this amount, that provider reserves the right to charge you the difference. This would be in addition to the allowed amount. Dental Premium Rates (City pays 80% of premium/employee pays 20%) Tier Level Total Monthly Premium Employer Contribution Monthly Employee Contribution Per Payroll (24) Employee Only $31.20 $24.96 $6.24 $3.12 Employee + Family $91.25 $73.00 $18.25 $9.13 5

6 VISION The City will continue to offer vision coverage at no cost to you and your family, but it will be with EyeMed effective January 1, Please complete an EyeMed enrollment form and return it to Brian Scott. Additional discounts 40 % Complete pair of prescription eyeglasses 20 % OFF OFF Non-prescription sunglasses 20 % OFF Remaining balance beyond plan coverage These discounts are for in-network providers only Take a sneak peek before enrolling You re on the INSIGHT Network For a complete list of in-network providers near you, use our Enhanced Provider Locator on or call City of Mission SUMMARY OF BENEFITS Vision Care In-Network Out-of-Network Services Member Cost Reimbursement Exam With Dilation as Necessary $10 Co-pay Up to $40 Retinal Imaging Up to $39 N/A Frames $0 Co-pay; $150 allowance; 20% off balance over $150 Up to $105 Standard Plastic Lenses Single Vision $10 Co-pay Up to $30 Bifocal $10 Co-pay Up to $50 Trifocal $10 Co-pay Up to $70 Standard Progressive Lens $75 Co-pay Up to $50 Premium Progressive Lens $95 Co-pay - $120 Co-pay Tier 1 $95 Co-pay Up to $50 Tier 2 $105 Co-pay Up to $50 Tier 3 $120 Co-pay Up to $50 Tier 4 $75 Co-pay, 80% of charge less $120 allowance Up to $50 Lenticular $10 Co-pay Up to $70 Lens Options (paid by the member and added to the base price of the lens) UV Treatment $15 N/A Tint (Solid and Gradient) $15 N/A Standard Plastic Scratch Coating $15 N/A Standard Polycarbonate $40 N/A Standard Polycarbonate - Kids under 19 $40 N/A Standard Anti-Reflective Coating $45 N/A Premium Anti-Reflective Coating $57 - $68 N/A Tier 1 $57 N/A Tier 2 $68 N/A Tier 3 80% of charge N/A Photochromic/Transitions $75 N/A Polarized 20% off retail price N/A Other Add-Ons and Services 20% off retail price N/A Contact Lens Fit and Follow-Up (Contact lens fit and two follow up visits are available once a comprehensive eye exam has been completed) Standard Contact Lens Fit & Follow-Up Up to $55 N/A Premium Contact Lens Fit & Follow-Up 10% off retail N/A Contact Lenses Conventional $0 Co-pay; $150 allowance; 15% off balance over $150 Up to $150 Disposable $0 Co-pay; $150 allowance; plus balance over $150 Up to $150 Medically Necessary $0 Co-pay, Paid-in-Full Up to $210 Laser Vision Correction Lasik or PRK from U.S. Laser Network 15% off the retail price or 5% off the promotional price N/A Hearing Care Hearing Health Care from 40% off hearing exams and a low price guarantee N/A Amplifon Hearing Network on discounted hearing aids Frequency Examination Lenses or Contact Lenses Frame Once every 12 months Once every 12 months Once every 24 months For Lasik providers, call LASER6. Premium progressives and premium anti-reflective designations are subject to annual review by EyeMed s Medical Director and are subject to change based on market conditions. Premium progressives Fixed pricing and is reflective premiumof anti-reflective brands at the listed designations productare level subject. All providers to annual are review not required by EyeMed s to carry Medical all brands Director at all and levels. are subject Benefitsto are change not provided basedfrom on market services or materials conditions. arising Fixedfrom: pricing 1) Orthoptic is reflective or vision brands training, at subnormal the listed product vision aids level and. All anyproviders associated are supplemental not requiredtesting; to carry Aniseikonic all brands lenses; at all2) levels. Medical and/or surgical treatment of the eye, eyes or supporting structures; 3) Any eye or Vision Examination, or any corrective eyewear required by a Policyholder as a condition of employment; Safety eyewear; 4) Services provided as a result of any Workers Compensation law, or similar legislation, or required by any governmental agency or program whether federal, state or subdivisions thereof; 5) Plano (non-prescription) lenses; 6) Non-prescription sunglasses; 7) Two pair of glasses in lieu of bifocals; 8) Services or materials provided by any other group benefit plan providing vision care 9) Services rendered after the date an Insured Person ceases to be covered under the Policy, except when Vision Materials ordered before coverage ended are delivered, and the services rendered to the Insured Person are within 31 days from the date of such order. 10) Lost or broken lenses, frames, glasses, or contact lenses will not be replaced except in the next Benefit Frequency when Vision Materials would next become available. Benefits may not be combined with any discount, promotional offering, or other group benefit plans. Standard/Premium Progressive lens not covered-fund as a Bifocal lens. Standard Progressive lens covered-fund Premium Progressive as a Standard. Underwritten by Fidelity Security Life Insurance Company of Kansas City, Missouri, except in New York. The Certificate of Insurance is on file with your employer. Benefit allowance provides no remaining balance for future use within the same6benefit year. Fees charged for a non-insured benefit must be paid in full to the Provider. Such fees or materials are not covered. AH2015 BLM2015

7 What s in it for me? Options. It s simple really. We re dedicated to helping you see clearly and that s why we ve built a network that gives you lots of choices and flexibility. You can choose from thousands of independent and retail providers to find the one that best fits your needs and schedule. No matter which one you choose, our plan is designed to be easy-to-use and help you access the care you need. Welcome to EyeMed. Benefits Snapshot With EyeMed Out-of-Network Reimbursement Exam with dilation as necessary (Once every 12 months) Frames (Once every 24 months) $10 Co-pay Up to $40 $0 Co-pay; $150 allowance; 20% off balance over $150 Up to $105 Single Vision Lenses (Once every 12 months) Or Contacts (Once every 12 months) $10 Co-pay Up to $30 $0 Co-pay; $150 allowance; plus balance over $150 Up to $150 And now it s time for the breakdown... Here s an example of what you might pay for a pair of glasses with us vs. what you d pay without vision coverage. So, let s say you get an eye exam and choose a frame that costs $163 with single vision lenses that have UV and scratch protection. Now let s see the difference... With EyeMed Without Insurance** Exam $10 Co-pay Exam $106 85% SAVINGS with us * Frame $163 Frame $163 -$150 allowance $13 -$2.60 (20% discount off balance) $10.40 Lens $10 Co-pay Lens $78 $15 UV treatment add-on $23 UV treatment add-on +$15 Scratch coating add-on +$25 Scratch coating add-on $40 $126 Total $60.40 Total $395 Download the EyeMed Members App It s the easy way to view your ID card, see benefit details and find a provider near you. *This is a snapshot of your benefits. Actual savings will depend on provider, frame and lens selections. **Based on industry averages. 7

8 LIFE AND DISABILITY The Standard will continue to administer these important income protection benefits. As a reminder, beneficiary designations may be changed at any time throughout the year; however, open enrollment is a great time to ensure this information is up-to-date and reflects your current wishes. Basic Life and Accidental Death & Dismemberment (AD&D) As an employee of the City of Mission, in addition to the life insurance/death benefit offered through KPERS and KP&F, the City of Mission provides all employees with $20,000 Basic Life/AD&D insurance at no cost to you. VOLUNTARY TERM LIFE INSURANCE CHANGES WILL BE EFFECTIVE JANUARY 1, 2017 You also have the option to select additional benefits for you and your dependents. If you choose to elect additional coverage for yourself, you may then elect spouse and/or child coverage. If you are electing coverage for the first time or increasing coverage amounts, you will be required to complete a medical history questionnaire. Employee Coverage Available in increments of $10,000, up to five times your annual salary, not to exceed a maximum of $300,000. Age-based rates are in five-year increments based on your age each calendar year. Premiums adjust as you reach new age brackets. Spouse Coverage Available in $5,000 increments, up to $150,000 in coverage, or 50 percent of the amount you purchase for yourself. Rates for spouse coverage are based on the employee s age. Child Coverage h h $10,000 in life insurance for your dependent children. Includes unmarried child(ren) through age 20, or through age 24 h h if full-time student. $1.00 per month for $10,000 in coverage, regardless of the number of children you cover. Any increase you make to your Voluntary Life coverage will be subject to medical underwriting. No premiums will be deducted from your paycheck until the new amount has been approved. 8

9 FLEXIBLE SPENDING ACCOUNTS (FSA) The Section 125/Flexible Spending plan will continue to be administered by BASIC. The FSAs (Medical Reimbursement and Dependent Care) provide additional tax benefits by allowing you to set aside a certain amount of your paycheck on a pretax basis to pay for eligible expenses. Note Log on to to review claims and account balances Medical Reimbursement Account Used to pay for eligible expenses not covered under medical, dental, and vision plans. Examples include copays, deductibles, orthodontia expenses, prescription drug copays, and LASIK/laser eye surgery. The 2017 household contribution maximum is $2,600. Option to use debit card or submit claims via fax, mail, or online. You have until March 15, 2017, to incur and submit claims in order to use funds left over from the 2016 plan year. You can avoid forfeitures if you plan carefully, conservatively, and only for predictable expenses. Dependent Care Account Used to pay for day care for eligible dependents (including disabled adult children or legal spouse) that permit you to be gainfully employed. The 2017 household contribution maximum is $5,000. Reimbursement by fax, mail, or online. The IRS requires that you make your election decision before the new plan year begins each year or before your effective date, if you are newly eligible. The election decision remains in effect for the plan year, unless you have a qualifying life event. Over-the-Counter (OTC) Reimbursement Members can be reimbursed for certain OTC medications under these plans. However, OTC drugs, medicines, and biologicals (antibodies, enzymes, and hormones) require a written prescription or letter from a physician before reimbursement can be made. The following is a sample of OTC medications: Acid Controllers Allergy and Sinus Treatments Antibiotic Products Antidiarrheals Anti-gas Remedies Anti-itch and Insect Bite Remedies Antiparasitic Treatments Baby Rash Ointments/Creams Cold Sore Remedies Cough, Cold, and Flu Remedies Digestive Aids Feminine Anti-fungal/Anti-itch Hemorrhoidal Preparations Laxatives Motion Sickness Remedies Pain Relief Respiratory Treatments Sleep Aids and Sedatives *If you have funds left at the end of the plan year, you may continue to incur claims for expenses during the grace period. The grace period extends 2 1/2 months after the end of the plan year, during which time you can continue to incur claims and use up all amounts remaining in your Health FSA or Dependent Care FSA. 9

10 SAVE MONEY BY PARTICIPATING IN THE FSA Participating in the 125 plan will allow you to save on federal and state income taxes (in most states), Social Security taxes, and Medicare. The following is an example of the potential savings that could be realized by participating in the Flexible Spending Account. Without a Section 125 Cafeteria Plan With a Section 125 Cafeteria Plan Gross Taxable Income $30,000 Gross Taxable Income $30,000 Federal Income Taxes $3,745 Less Insurance Premiums $2,660 FICA Taxes $2,295 Less Out-of-Pocket Medical, Dental, and Vision Expenses $2,550 State Taxes $1,935 Net Taxable Income $24,790 Disposable Income $22,025 Federal Income Taxes $2,257 Less Insurance Premiums $2,660 FICA Taxes $1,702 Less Out-of-Pocket Medical, Dental, and Vision Expenses $2,500 State Taxes $1,435 NET TAKE-HOME PAY $16,865 NET TAKE-HOME PAY $19,396 We encourage you to take a few minutes to carefully review your explanation of benefits (EOB) statements and any out-of-pocket expenses you incurred for copays, deductibles, or coinsurance. Setting aside funds through the FSA is a smart way to reimburse yourself for qualified medical expenses each year. The total amount that you elect to set aside annually in the medical reimbursement account is available to you on January 1, 2017, regardless of the amount you have actually contributed to date. Estimate carefully, as you lose any funds you cannot use before March 15, However, for the dependent care account, the funds are only available to you after you set aside funds. Funds are reimbursed after they re expended. 10

11 AFLAC AFLAC representatives will be available during the open enrollment meetings to discuss the programs they offer in more detail. The following programs are available for you to consider: Accident Hospital Cancer Juvenile Life Specified Health (Heart Short-Term Disability Attack/Stroke) As a reminder, the short-term disability (STD) policy is guarantee issue, meaning you do not have to undergo a medical underwriting process to purchase. If you are interested in shortterm disability protection, AFLAC is your only source for this benefit. RETIREMENT PLANS The City offers all employees the opportunity to participate in voluntary 457 Deferred Compensation plans provided by Great- West or ICMA-RC. These are pretax contributions, and you can elect to participate or change your contribution amount at any time throughout the year. If you want more information on these plans or want to increase your contributions for 2017, please contact Brian Scott. Contribution limits for 2017 are as follows: Pretax employee elective deferrals to 401(k), 403(b), and 457(b) plans (without regard to catch-up contributions): Pretax employee catch-up contributions to (k), 403(b), and 457(b) plans: Special catch-up rules may apply to 457(b) plans 2017 Limit $18,000 $6,000 $3,000 Maximum annual contribution to defined contribution plans $54,000 11

12 CITY OF MISSION 6090 WOODSON MISSION, KS Brian Scott The descriptions of the benefits are not guarantees of current or future employment or benefits. If there is any conflict between this Guide and the official Plan Documents, the official documents will govern. g\city of mission\17\oe guide\17 oe guide_city of mission.indd:22512