CITY OF DECATUR Employee Benefits Enrollment Guide

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Sophia Robertson
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2 Welcome to Open Enrollment for your 2019 Benefits! Elections you make during open enrollment will become effective January 1, The City of Decatur offers you and your eligible family members a comprehensive and valuable benefits program. We encourage you to take the time to educate yourself about your options and choose the best coverage for you and your family. Page 2

Who is eligible? If you are a full-time employee (working 30 or more hours per week) you are eligible to enroll in the benefits described in this guide.

Benefits for eligible employees and enrolled dependents become effective on the first day of the month following 30 days of full-time employment.

Once you have made your elections, you will not be able to change them until the next open enrollment period unless you have a qualified change in status.

3 Who is eligible? If you are a full-time employee (working 30 or more hours per week) you are eligible to enroll in the benefits described in this guide. Employees may also enroll their qualified dependents (children up to age 26). Benefits for eligible employees and enrolled dependents become effective on the first day of the month following 30 days of full-time employment. How to Enroll The first step is to review your current benefit elections. Verify your personal information and make any changes if necessary. Make your benefit elections. Once you have made your elections, you will not be able to change them until the next open enrollment period unless you have a qualified change in status. When to Enroll New Online Enrollment The open enrollment period runs from November 22 through December 21. The benefits you elect during open enrollment will be effective from January 1, 2019 through December 31, Partipants may enroll in the Council Chambers at City Hall 8:00 a.m. until 5:00 p.m. Tuesday November 27, 2018 thru Monday December 3, Enrollment forms must be completed by December 3, 2018 by 5:00 PM.. How to Make Changes Unless you have a qualified change in status, you cannot make changes to the benefits you elect until the next open enrollment period. Qualified changes in status include: marriage, divorce, legal separation, domestic partnership status change, birth or adoption of a child, change in child s dependent status, death of spouse, child or other qualified dependent, change in residence due to an employment transfer for you, your spouse or domestic partner, commencement or termination of adoption proceedings, or change in spouse s or domestic partner s benefits or employment status. Design Zywave, Inc. All rights reserved.

What s New for 2019 Medical Renewing with Blue Cross Blue Shield of Texas Voluntary Dental Moving to Blue Cross Blue Shield of Texas Voluntary Vision Renewing with Superior Vision Long Term

4 What s New for 2019 Medical Renewing with Blue Cross Blue Shield of Texas Voluntary Dental Moving to Blue Cross Blue Shield of Texas Voluntary Vision Renewing with Superior Vision Long Term Disability Renewing with Dearborn National Employee and Dependent Voluntary Life/AD&D Renewing with Dearborn National - no open enrollment for this coverage New Benefits Formerly Freshbenies Benefit FSA Renewing with TASC LifeWorks EAP New Employee Assistance Program HR Connection online enrollment for employee elections Page 4

5 Medical and Prescription Drugs-Blue Cross Blue Shield of TX The following chart compares benefits that will take effect January 1, Find a Provider at or call Services Base Plan Blue Cross MTBCP608 HSA Buy-Up Plan 1 Blue Cross MTBCP813 PPO Buy-Up Plan 2 Blue Cross MTBEA813 EPO Physician Visit 100% after deductible $45/$90 Copay HMO $45/$90 Copay In Network Only Deductible - Individual - Family $5,000 $10,000 $5,000 $14,700 $5,000 $14,700 Hospitalization 100% after Deductible 70% after Deductible 70% after Deductible Preventive Care 100% 100% 100% Emergency Room 100% after deductible $500 Copay plus 30% coinsurance $500 Copay plus 30% coinsurance Urgent Care 100% after deductible $75 Copay, No deductible $75 Copay, No deductible Out-of-Pocket Max - Individual - Family $ 5,000 $10,000 $5,600 $14,700 $5,600 $14,700 Prescription Drugs -Preferred Generic -Non Preferred Generic -Preferred Brand -Non Preferred Brand -Preferred Specialty -NonPreferred Specialty 100% after deductible $0 $10 $50 $100 $150 $250 $0 $10 $50 $100 $150 $250 Lower Copay Applies to Preferred Network Pharmacies. EPO - Buy-Up Plan 2 provides in network benefits only. (Texas only, referral required) PPO- both Base and Buy-up Plan 1 provides in and out of network benefits. If you currently participate in FSA you may not open an HSA. Page 5

6 Your Cost beginning January 1, 2019 The City of Decatur contributes 100% to the Employee-Only cost for the Base Plan. Employee s may choose one of the Buy-Up Plans and pay the difference in the Base and the Buy-Up Plans. Employees are eligible to enroll qualified Spouses and Dependent Children and the City will contribute $1500 single or $3000 family for the HSA plan. ($ per quarter single or $750 per quarter family)the cost will be deducted via payroll deduction on a pre-tax basis. The City has a semi-monthly payroll and deducts insurance premiums 2 pay periods per month. You must be actively enrolled in the City of Decatur s group HDHP HSA and complete the HSA Payroll Deductions form in order to receive quarterly employer contribution on 1/15, 4/15, and 10/15. The form must be turned in to Payroll at least two weeks before the pay period for these dates. NO CHANGE IN COST FOR 2019 EMPLOYEE SEMI-MONTHLY DEDUCTIONS (EFFECTIVE 1/1/18) Base Plan MTBCP608 HSA Employee Only Employee & Spouse Employee & Children Employee & Family $0 $75.84 $24.70 $ Buy-Up Plan 1 MTBCP813 PPO Buy-Up Plan 2 MTBEA813 EPO $57.77 $ $ $ $26.92 $ $ $ Health Savings Accounts (HSA) If you participate in the high-deductible health plan, you can set aside money in a Health Savings Account (HSA) before taxes are deducted to pay for eligible medical, dental and vision expenses. An HSA is similar to a flexible spending account in that you are eligible to pay for health care expenses with pre-tax dollars. There are several advantages of an HSA. For instance, money in an HSA can be invested much like 401(k) funds are invested. Unused money in an HSA account is not forfeited at the end of the year and is carried forward. Also, your HSA account is yours to keep which means that you can take it with you if you change jobs or retire. If you have any money remaining in your HSA after your retirement, you may withdraw the money as cash. The maximum amount that you can contribute (including employe r contribution) to an HSA is $3,500 in 2019 for individual coverage and $7,000 in 2019 for family coverage. Additionally, if you are age 55 or older, you may make an additional catch - up contribution of $1,000. Health Care and Dependent Care Flexible Spending Accounts (FSA) Employees and dependents that elect the HSA and elect to open an HSA are not eligible to use remaining FSA funds and current FSA payroll deductions will continue through December 31, You may continue Dependent Care if you select HSA. Page 6

7 The City of Decatur provides you the opportunity to pay for out-of-pocket medical, dental, vision and dependent care expenses with pre-tax dollars through Flexible Spending Accounts. You must enroll/re-enroll in the plan to participate for the plan year January 1, 2019 to December 31, You can save approximately 25 percent of each dollar spent on these expenses when you participate in a FSA. A health care FSA is used to reimburse out-of-pocket medical expenses incurred by you and your dependents. A dependent care FSA is used to reimburse expenses related to care of eligible dependents while you and your spouse work. Contributions to your FSA come out of your paycheck before any taxes are taken out. This means that you don t pay federal income tax, Social Security taxes, or state and local income taxes on the portion of your paycheck you contribute to your FSA. You should contribute the amount of money you expect to pay out of pocket for eligible expenses for the plan period. If you do not use the money you contributed it will not be refunded to you or carried forward to a future plan year. This is the use-it-orlose-it rule. The maximum that you can contribute to the Health Care Flexible Spending account is set by your employer. The maximum FSA contribution for medical reimbursement is $2650. The maximum that you can contribute to the Dependent Care Flexible Spending Account is $5,000 if you are a single employee or married filing jointly, or $2,500 if you are married and filing separately. The following example shows how you can save money with a flexible spending account. Bob and Jane s combined gross income is $30,000. They have two children and file their income taxes jointly. Since Bob and Jane expect to spend $2,000 in adult orthodontia and $3,300 for day care next plan year, they decide to direct a total of $5,300 into their FSAs. Without FSAs With FSAs Gross income: $30,000 $30,000 FSA contributions: 0-5,000 Gross income: 30,000 25,000 Estimated taxes: Federal -2,550* -1,776* State -900** -750** FICA -2,295-1,913 After-tax earnings: 24,255 20,314 Eligible out-of-pocket Medical and dependent care expenses: -5,000 0 Remaining spendable income: $19,255 $20,561 Spendable income increase: $1,306 *Assumes standard deductions and four exemptions. ** Varies, assume 3percent. The example above is for illustrative purposes only. Every situation varies and we recommend that you consult a tax advisor for all tax advice. Page 7

8 Voluntary Dental-Blue Cross Blue Shield of Texas The City of Decatur offers eligible full-time employees a comprehensive Voluntary Dental plan. Employees are responsible for 100% of all premiums. Find a Provider at or call Services Preventive Services Amount You Pay Exams, cleanings, x-rays Covered 100% (2 per benefit period) Deductible Applies to basic and major services only $50/$150 Basic Services Fillings, simple extractions, periodontics, endodontics Covered 80% Major Services Restorative services, crowns Covered 50% Annual Maximum Child Orthodontics Deductions-2 paychecks per month $1,500 Annual Maximum Plan benefit 50% $1,500 Lifetime Maximum Waiting Period-None Employee-Only: $18.33 Employee & Spouse: $36.67 Employee & Child(ren): $45.51 Family: $70.11 Voluntary Vision-Superior Vision As part of the comprehensive benefit program the City of Decatur offers eligible full-time employees a Voluntary Vision plan. Employees are responsible for 100% of all premiums. Cost of the plan will be made on pre-tax basis via payroll deduction. Find a Provider at or call Services Eye Exam Materials/Eyewear Standard Corrective Lenses *Single *Lined Bifocal *Lined Trifocal Contact Lenses Frame Allowance Contact Lens Allowance Deductions-2 paychecks per month Page 8 Amount You Pay $10 Copay $25 Copay Once each 12 months Once each 12 months $125 Allowance once each 24 months $150 Allowance - once each 12 months Employee-Only: $2.30 Employee & Spouse: $4.66 Employee & Child $4.63 Family $7.10

9 Long Term Disability-Dearborn National The City of Decatur provides full-time employees a benefit to secure your income while out of work from an unexpected injury or illness. The benefit provides 60% of base salary to a maximum of $6,000 monthly. There is an elimination period of 90-days and the benefit continues until your Social Security Normal Retirement Age. The City pays the full cost of this benefit. or call ENHANCED PRODUCT SERVICES INCLUDED WITH LONG TERM DISABILITY: 24 hour telephonic support for behavioral health issues provided by masters degree clinicians at no charge. Provides caller with assessment, counseling and referral advice for face-to-face counseling. Up to 3 face-to-face counseling sessions per year to address appropriate behavioral health issues. Guidance Resources Online is a secure, password-protected interactive Web site that contains selfassessments, search tools, extensive content on personal health and powerful tools to help with personal, relational, legal, health and financial concerns. The service is free of charge to employees and their families and is available 24 hours a day, 7 days a week. Long Term Disability Benefits Begin Benefits Payable Percentage of Income Replaced Maximum Benefit 90 Day Elimination Period Up to $6,000 per month 60% SSNRA Page 9

10 Voluntary Life Insurance-Dearborn National Full-Time Employees are eligible to purchase g roup life insurance. W hen you enroll yourself and/or your dependents in this benefit, you pay the full cost through semi -monthly payroll deductions. You can purchase coverage on yourself in $10,000, and your spouse, in $5,000 increments. Maximum coverage f or employee is $500,000 and spouse maximum is $250,000. Amounts above the Guarantee Issue will require medical history to be completed. Employees must enroll in order to add Spouse or Child(ren). Dearborn Voluntary Life/ADD is not a true open enrollment for employees who are currently enrolled in Voluntary life/add. Those employees can increase their coverage by $10,000 each annual enrollment without an Evidence of Insurability (EOI) if they do not exceed the Guaranteed Issue Amount $50,000. If they are not currently enrolled, then the EOI is required for even $10,000 since they are considered a late entrant. Any spouse/child increase in coverage requires EOI. Guarantee Issue Amounts: Employee- $100,000 Spouse- $30,000 Children- $10,000 when first eligible. Monthly Cost for Each $1,000 of EMPLOYEE Life & AD&D Insurance Coverage Age < Life AD&D Dependent Children Birth to 14 days $ days to age 26- $10,000 Cost Per $1,000 is $.197 or $1.97 per $10,000 Monthly Cost for Each $1,000 of SPOUSE Life & AD&D Insurance Coverage Age < Life AD&D Dependent Children Birth to 14 days $ days to age 26- $10,000 Cost Per $1,000 is $.197 or $1.97 per $10,000 Page 10

11 New Benefits Card The City of Decatur has elected to provide the Ne w B e n efits (fo rm erl y Fre s hb e ni e s) Prepaid Benefits Card to all Full-Time employees. The City pays the full cost of this benefit. Employees will have Access to the following services: Page 11

12 LifeWorks Employee Assistance Program Page 12

13 Required Notices COBRA Under the Federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) you and your eligible dependents are entitled to continue your group health benefits coverage (medical, dental, and vision) under the City of Decatur s plan after you have left employment with the agency. If you wish to elect COBRA coverage, you have 60 days from the date you receive notice to make an election. You have 45 days after electing coverage to pay the initial premium. HIPAA Privacy Notice This notice describes how medical information may be used and disclosed and how you can access this information. Please review it carefully. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) imposes numerous requirements on employer health plans concerning the use and disclosure of individual health information. This information known as protected health information (PHI), includes virtually all individually identifiable health information held by a health plan whether received in writing, in an electric medium or as oral communication. This notice describes the privacy practices of the Employee Benefits Plan (referred to in this notice as the Plan), sponsored by City of Decatur hereinafter referred to as the plan sponsor. The Plan is required by law to maintain the privacy of your health information and to provide you with this notice of the Plans legal duties and privacy practices with respect to your health information. It is important to note that these rules apply to the Plan, not the plan sponsor as an employer. You have the right to inspect and copy protected health information which is maintained by and for the Plan for enrollment, payment, claims, and case management. If you feel that protected health information about you is incorrect or incomplete, you may ask the Human Resource Department to amend the information. For a full copy of the Notice of Privacy Practices describing how protected health information about you may be used and disclosed and how you can get access to the information, contact the Human Resources Department. Women s Health and Cancer Rights Act of 1998 As Specified in the Women s Health and Cancer Rights Act, a plan participant or beneficiary who elects breast reconstruction relating to a mastectomy is also entitled to the following benefits: All stages of reconstruction of the breast on which the mastectomy was performed; surgery and reconstruction of the other breast to produce a symmetrical appearance; and prostheses and treatment of physical complications of the mastectomy, including lymphedema. Health plans must determine the manner of coverage in consultation with the attending physician and the patient. Coverage for breast reconstruction and related services may be subject to deductibles and coinsurance amounts that are consistent with those that apply to other benefits under the plan. Newborns and Mothers Health Protection Act Group health plans and health insurance issuers generally may not, under federal law, restrict for any hospital length of stay relating to childbirth for the mother or newborn child less than 48 hours following a vaginal delivery or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother s or newborn s attending provider, after consulting the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 as applicable). In any case, plans and issuers may not. under federal law, Page 13

14 require that a provider obtain authorization from the Plan or the Issuer for prescribing a length of stay not more than 48 hours (or 96 hours). Premium Assistance Under Medicaid and the Children s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you are also eligible for health insurance coverage from your employer, your state may have a premium assistance program that can help pay for coverage. These states use funds from their Medicaid or CHIP programs to help people who are eligible for these programs, but also have access to health insurance through their employer. If you or your children are not eligible for Medicaid or CHIP, you will not be eligible for these premium assistance programs. If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs, you can contact your state Medicaid or CHIP office or dial KIDS-NOW or to find out how to apply. If you qualify, you can ask the state if it has a program that might help you pay the premiums for an employer-sponsored plan. If it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, your employer must permit you to enroll in your employer plan if you are not already enrolled. This is called a Special Enrollment opportunity, and you MUST request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, you can contact the Department of Labor electronically at or by calling EBSA (3272). Your Prescription Drug Coverage and Medicare This notice has information about your current prescription drug coverage with City of Decatur and your options under Medicare s prescription drug coverage. If neither you nor any of your covered dependents are eligible for or have Medicare, this notice does not apply to you, as the case may be. Please note that later notices might supersede this notice. 1. Medicare prescription drug coverage became available in 2016 to everyone with Medicare. You can get this coverage through a Medicare Prescription Drug Plan or a Medicare Advantage Plan that offers prescription drug coverage. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. 2. Tawakoni Building Center has determined that the prescription drug coverage offered by the Tawakoni Building Center medical plan option(s) is, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage pays and is considered Credible Coverage. Because your existing coverage is, on average, at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to enroll in a Medicare prescription drug plan, as long as you later enroll within specific time periods. Availability of Summary Health Care Benefits Information To help you make an informed choice and verify your benefits, the Summary of Benefits and Coverage (SBC) is available, which summarizes essential information about your health coverage option(s) in a standard format. A copy is available by contacting the Human Resources Department. **This employee enrollment guide is designed to serve as an overview only. Final determination will be determined by the insurance carrier certificates of coverage** Page 14

A Guide to Your Benefits 2019

A Guide to Your Benefits 2019 Lamers Bus Lines, Inc. offers a comprehensive suite of benefits to promote health and financial security for you and your family. This booklet provides you with a summary