Feeling Secure. Medical Care Dental Care Voluntary Vision Care

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2 That s why at Town of Holly Springs we are committed to a comprehensive benefit program that helps our employees stay healthy, feel secure and maintain a work/life balance. Stay Healthy What s New for Medical Care Dental Care Voluntary Vision Care Feeling Secure Life and Accidental Death & Dismemberment Voluntary Life and Accidental Death & Dismemberment Voluntary Short and Long Term Disability Flexible Spending Account Wellness Program Decrease in the Premium Costs for Health New Primary Copay $30 New Specialist Copay $60 New Urgent Care Copay $60 New Benefit Virtual Visit $30 Copay No change to Dental Premiums with Delta Dental Change in contract if out of network provider files a claim, Delta will send payment back to Provider (called AOB assignment of benefits) No change to Vision Premiums New Life, Voluntary Life & Disability Carrier 2 Our insurance plans are designed to help you attain the health and dental services you need on a regular basis as well as to protect you against catastrophic financial loss in the event of a serious health condition, disability, or death. They represent a significant part of the total compensation package you have with Town of Holly Springs. Within this packet of materials is information that is pertinent to your benefits, so please take a few minutes to read over the information.

3 Refer to this list when you need to contact one of your benefit vendors. For general information contact Erika Phillips, (919) or Annmarie Forbis, (919) Your FIRST call should be to your DEDICATED Service Team YOUR SERVICE TEAM Banyan Consulting Group, Inc. // Allison Sabin // Client Care Advocate // (919) // Deborah Macik // Client Services Manager // (919) // MEDICAL..... pages 4-5 BlueCross BlueShield of NC // (877) // Customer Service (Claims, Benefit Questions & ID Cards) DENTAL page 6 Delta Dental // (800) // Customer Service VOLUNTARY VISION page 7 Eyemed // (888) // Customer Service LIFE & ACCIDENTAL DEATH & DISMEMBERMENT..... page 8 Mutual of Omaha - (800) Customer Service (ex: claims, benefit questions) VOLUNTARY LIFE & ACCIDENTAL DEATH & DISMEMBERMENT page 8 Mutual of Omaha - (800) Customer Service (ex: claims, benefit questions) VOLUNTARY SHORT & LONG TERM DISABILITY page 9 Mutual of Omaha - (800) Customer Service (ex: claims, benefit questions) FLEXIBLE SPENDING ACCOUNT..... page 10 P&A Group // (800) // Customer Service This Benefits at a Glance provides summary information about your benefits under Company benefit programs. In the event of any discrepancy between or among this summary, Summary Plan Descriptions, and Plan Documents, the Plan Documents control all benefit definitions and descriptions. 3

4 Provider: BCBSNC - Group #: *Note: Dependent children are eligible to be covered up to age 26, regardless of student or marital status. Blue Options PPO Plan Features In-Network Out-of-Network Deductible (per Benefit Period) Coinsurance (After Deductible) Total Out-of-Pocket (per Benefit Period) Includes Deductible, Coinsurance, copayment including Rx $1,750 Individual $3,500 Family 30% $4,750 Individual $9,500 Family $3,500 Individual $7,000 Family 60% $9,500 Individual $19,000 Family Preventive Care (Primary Preventive Diagnosis Only) Covered 100% Not Available Office Visit (Primary) $30 Copayment Deductible then 60% Office Visit (Specialist) $60 Copayment Deductible then 60% Virtual Visit $30 Copayment Deductible then 60% Urgent Care Visit $60 Copayment Emergency Room Visit $300 Copayment Ambulatory Surgical Center Deductible then 30% Deductible then 60% Inpatient Hospital Services Includes physician services, hospital and hospital-based services, and maternity delivery, prenatal and post-delivery care Outpatient Hospital Services Includes physician services, hospital and hospital-based services, hospital based clinics, outpatient diagnostic services Deductible then 30% Deductible then 60% Deductible then 30% Deductible then 60% Short-Term Rehabilitative Therapies: Physical/Occupational (Max 30 visits per benefit period) Speech Therapy (Max 30 visits per benefit period) $30 Primary Copay $60 Specialist Copay Deductible then 60% Skilled Nursing Facility (Max 60 days per benefit period) Deductible then 30% Deductible then 60% 4

5 Blue Options PPO Plan Features In-Network Out-of-Network Home Health Care, Durable Medical Equipment and Hospice Services Deductible then 30% Deductible then 60% Maternity (Includes Prenatal and Post-Delivery Care) Deductible then 30% Deductible then 60% Infertility Services (Combined In-Network and Out-of-Network Lifetime Maximum of 3 ovulation induction cycles, with or without insemination, per Member for Infertility services, provided in all places of service) Mental Health & Substance Abuse Services (Includes office visits, inpatient & outpatient services) $30 Primary Copayment $60 Specialist Copayment Deductible then 30% Hospital Services & Inpatient / Outpatient Professional Services $60 Office Visit Deductible then 30% Inpatient / Outpatient Deductible then 60% Deductible then 60% Prescription Drug Coverage (Mac B Pricing) Tier 1 (Generic) Tier 2 (Preferred Brand) Tier 3 (Non-Preferred Brand & Preferred Specialty Drugs Tier 4 (Nom-Preferred Specialty Drugs $10 Copay $45 Copay $60 Copay 25% ($50 min - $100 max) Unlimited lifetime maximum benefits per enrolled member. Deductible and coinsurance accumulation from July 1st through June 30th of each year. Employer Pays: Town of Holly Springs pays 100% of the employee only premium. You are responsible for any additional premium for covering dependents. Elections Employee Cost Employee Only $0.00 Payroll Deduction per Check (24x) Employee & Spouse $ Employee & Child(ren) $ Employee & Family $

6 Provider: Delta Dental - Group #: 1023 *Note: Dependent children are eligible to be covered up to age 26, regardless of student or marital status. Benefits You Receive: $50 Deductible per Member / $100 per Family per PLAN YEAR Deductible is waived for Preventive Services $1,500 Benefit Maximum per Member per PLAN YEAR Charges for Preventive Services will NOT count towards the plan year maximum, this allows the $1500 to be used for Basic and Major Services No Timely Enrollee or Late Entrant Waiting Periods Higher Benefits with Delta Dental Providers ( See your benefit booklet for limitations and exclusions Level of Service (Amount You Pay) Preventive Services 0% What is Covered? Exams, Cleanings, Fluoride, Space Maintainers, Emergency Palliative Treatment, Sealants, Brush Biopsy, Radiographs Basic Services Deductible then 20% Fillings, Crown Repair, Endodontic Services, Periodontic Services, Oral Surgery Services, Other Basic Services, Relines & Repairs Major Services Deductible then 20% Orthodontic Services 50% (Child to Age 19) Crowns, Inlays, Bridges, Implants, Dentures All Orthodontic Services subject to $1,000 Lifetime Maximum *Age Limits & Frequency Limitations Apply to Certain Service. Employer Pays: Town of Holly Springs pays 100% of the employee only dental premium. You are responsible for any additional premium for covering dependents. Elections Employee Cost Employee Only $0.00 Payroll Deduction per Check (24x) Employee & Spouse $15.70 Employee & Child(ren) $22.95 Employee & Family $

7 Voluntary Vision Provider: EyeMed - Group #: G Benefits You Receive: Voluntary Vision Plan Features Annual Vision Exam Every 12 Months In-Network $10 Copayment Up to $30 Out-of-Network LENSES: Single Bifocal Trifocal (additional copays for Lens Options) Every 12 Months $25 Copayment Up to $25 Up to $40 Up to $55 Standard Frames Every 24 Months $0 Copayment $130 Allowance + 20% off balance over allowance Up to $65 Contact Lens Fitting Exam Every 12 Months Contact Lenses (per pair): in lieu of all other lens and frame benefits Every 12 Months Standard: Up to $40 Premium: 10% off Retail Elective: Conventional - $130 Allowance + 15% over Allowance Disposable - $130 Allowance Medically Necessary: Paid In Full No Benefit Elective: Conventional - Up to $104 Disposable -Up to $104 Medically Necessary: Up to $200 Vision is offered on a voluntary basis. You are responsible for the full cost of the premium. Elections Employee Cost Employee Only $4.10 Payroll Deduction per Check (24x) Employee & Spouse $7.80 Employee & Child(ren) $8.19 Employee & Family $

8 Group Basic Life Insurance Provider: Mutual of Omaha Benefits You Receive: Town of Holly Springs provides full-time employees with 2x your annual salary to a maximum of $300,000 of group life and accidental death and dismemberment (AD&D). This benefit is provided at no cost to you. In the event of accidental death, the basic life insurance benefit is doubled. Note: Benefits reduces to 65% at Age 65 and to 50% at Age 70. Contact Human Resources to update your beneficiary information. Voluntary Life Insurance Provider: Mutual of Omaha Benefits You Receive: Employees who want to purchase additional Life Insurance have the opportunity to purchase at inexpensive group rates, through payroll deductions. If you enroll yourself, you may also enroll your dependents in this benefit. You can purchase coverage on yourself in $10,000 increments to a maximum of $500,000 (not to exceed 5x your base salary); $5,000 increments on spouse to a max of $300,000 (not to exceed 100% of employee s amount). You are guaranteed approval for $150,000 on yourself (capped at 5x salary) and $30,000 on spouse. You may also purchase coverage on your child(ren) in increment of $1,000 to a maximum of $10,000 ($2,000 is the minimum child benefit). If you go over these amounts (or are a late entrant, did not elect when you were originally eligible) you must answer health questions to prove evidence of insurability on any amount and can be declined. Spouse s rate is based off Spouse s age. Per $1,000 per Paycheck of Employee, Spouse and Child(ren) Life Insurance Coverage Age < EE & SP Life Rate Dependent Children $.035 $.040 $.050 $.080 $.120 $.200 $.360 $.655 $ $0.10 per $1,000. One premium regardless of number of children covered. 8

9 Group LTD and Voluntary STD: Provider: Mutual of Omaha Benefits You Receive: Town of Holly Springs provides full-time employees with long term disability income benefits. In the event you become disabled from a non work-related injury or sickness, disability income benefits are provided as a source of income. Note: Open Enrollment for Short Term Disability is this year only. This means that you can elect this benefit effective and not have to fill out medical questions. After this years open enrollment, if you do not elect this benefit, you will only be able to add it at future year s open enrollments but will be required to fill out medical questions and can be declined for benefits. Voluntary Short Term Disability Long Term Disability Benefits Begin 31st Day of Injury or Illness 181 st Day of Injury or Illness Benefits Payable Percentage of Income Replaced 22 Weeks 60% 60% Maximum Benefit $500 per Week $5,000 per Month Pre-Ex Limitation 3 / 6 3 / 12 Reducing Benefit Duration to Social Security Normal Retirement Age Town of Holly Springs pay 100% of the Long Term Disability premium. Short Term Disability is offered on a voluntary basis and you are responsible for the cost of the premium. The Monthly Rate for this benefit is $.40 per $10 Weekly Benefit. To calculate STD premium: Weekly Salary x.06 x.20 = per paycheck (2x/month) Example: $400 weekly salary: 400 x.06 = 24 X.20 = $4.80 per paycheck 9

10 Provider: P&A Group Benefits You Receive: FSAs provide you with an important tax advantage that can help you pay health care and dependent care expenses on a pre-tax basis. By anticipating your family s health care and dependent care costs for the next year, you can actually lower your taxable income. Health FSA Covers medical, dental & vision expenses that are only partially covered or not covered at all by your insurance, including insurance deductibles, insurances copayments & over-the-counter medications by prescription. You can contribute up to $2,600 on a pre-tax basis, but remember only up to $500 of FSA funds can roll over from year to year. If you make an election under the Health FSA, the amount that you elect will be immediately credited to the account in your name. Starting on the first day of the Plan Year, you will be entitled to be reimbursed for claims up to the entire elected amount at any time during the Plan Year, even if the total salary reduction contributions that you have made to your Health FSA are less than the total amount of claims that you have submitted. Individual Premium Reimbursement Account This account allows you to be reimbursed for individual accident/vision/dental premiums or disability premiums not provided by your employer. NOTE: If you use this pre-tax account to pay for the cost of your individual disability policy, the benefit you would receive will be taxed. The IRS will not allow you to use tax-free dollars and receive a tax-free benefit for the same expense. Dependent Care FSA This account covers amounts you pay to daycare centers, after school programs, babysitters, caregivers or elder care so that you and your spouse can work. Go to for the regulations and limitations. You can contribute up to $5,000 on a pre-tax basis. Adoption Assistance Account This account reimburses you for the reasonable and necessary expenses that you incur in the process of adopting an eligible child, including adoption agency fees, court costs and attorney fees. For more information contact Human Resources or P&A Group visit or call (800)

11 The Town of Holly Springs encourages all employees to take an active role in their health and work to improve the quality of life for both themselves and their families. To help with this effort the Town of Holly Springs tries to provide a varies of wellness programs throughout the year to focus on heightening health awareness and enhance preventive health strategies for all employees. Consider the following when thinking about wellness: Free Employee Gym Membership The Town provides a free, state of the art fitness center located at the Hunt Community Center for Town employees. The facility has universal weight equipment machines, aerobic equipment, a walking track and locker room facilities with showers. There are also employee groups that meet at lunch time to offer fitness classes. Nutritional Counseling Blue Cross Blue Shield of NC will cover nutritional counseling visits free with no copayment. Learn how to make healthy eating choices, pick out the best portion sizes, read food labels, choose healthy recipes and build a well-balanced meal plan. Use Urgent Care Centers for non-emergencies The emergency room should not be used for non-emergencies. Not only does a trip to the ER cost you a significant amount of money, but the wait time in an emergency room typically is several hours. In addition, use of the ER is analyzed in determining the Town s medical renewal rates. Use local Urgent Care Centers which are typically open later in the evening and on weekends if you are not able to see your primary care physician. OTHER BENEFIT PROGRAMS Save Money with Generic Prescription Drugs Make a habit of asking your physician or pharmacist if a generic option is available to you. Some generic drugs can cost 80% less than their brand-name counterpart. Take Care of Yourself Focus on building wellness. Take your medications as prescribed. Don t use tobacco products. Be active at least 30 minutes a day, five days a week. Eat well and with restraint. Visit your doctor for annual routine screenings and procedures. Find and Use a Primary Care Provider Make sure this provider is part of the BCBS Network. Talking about health concerns when they are small may spare you an expensive visit later. In addition, the cost to visit a primary care provider is significantly cheaper than a visit to an emergency room or urgent care. RelyMD Online urgent care benefit for Town employees and their dependents. It provides 24/7 access to boardcertified doctors for both children and adults. The web and mobile-based approach allows the patients to quickly obtain high-quality medical care via an internet connection or app on a smartphone or tablet. It is a time- and cost-effective alternative to emergency rooms and urgent care facilities where the visit can last for hours and often cost more than $1,

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16 Your Dedicated Service Team ALLISON SABIN Primary Client Care Advocate Service, Claims, Enrollment (919) office (919) fax TANYA PRITCHARD Client Care Advocate Service, Claims, Enrollment (919) office (919) fax ALICIA ALSHEHABI Client Care Advocate Service, Claims, Enrollment (919) office (919) fax DEBBIE MACIK Client Services Manager Service, Claims, Enrollment (919) office (919) fax BARBARA JOSSELYN Client Care Advocate Service, Claims, Enrollment (919) office (919) fax This Benefits at a Glance provides summary information about your benefits under the Company benefit programs. In the event of any discrepancy between or among this summary, Summary Plan Descriptions, and Plan Documents, the Plan Documents control all benefit definitions and descriptions. 16