Benefits Resource Guide Overview January 1, December 31, 2017

Transcription

1 Benefits Resource Guide Overview January 1, December 31, 2017 Our Commitment to You Part of the County s commitment to you is a comprehensive, flexible benefits program that allows you to choose the benefit coverage that meets your needs. Learning About Your Benefits As you read this Guide, you will learn about the op ons available to you and your family. You will also be given addi onal informa on from the benefit providers, and you can visit the Risk Management sec on of the County s website for more informa on. We encourage you to read all of the material available to you and ask ques ons of our Risk Management Division in order to make the enrollment decisions that meets your needs. Making Your Choices Along with this Resource Guide, you will also receive an enrollment packet that gives you a summary of the steps you need to take to enroll and begin your benefits. The Risk Management Office is Ready to Help As you re making decisions about coverage, or using your benefits during the year, the Risk Management staff is here to help. We re available Monday through Friday, from 8:00 am to 5:00 pm. Give Us A Call (530) Stop By Our Office 330 Fair Lane, Placerville, CA Or riskmanagement@edcgov.us

2 MESSAGE FROM THE COUNTY OF EL DORADO Welcome Welcome to the 2017 Employee Benefits Guide, your single source document for the informa on you need to make informed decisions about your benefits for yourself and your family. The 2017 Employee Benefits Guide is intended to be a summary of some of the benefits offered to you and your family including: health insurance, dental insurance, vision insurance, life insurance, long term disability insurance, and flexible spending accounts. Addi onal informa on and forms about these employee benefits and others are available online at The benefits described herein are offered to eligible employees of the County of El Dorado. All benefits are subject to change and there is no guarantee that these benefits will be con nued indefinitely. The descrip ons are very general and are not intended to provide complete details about any or all plans. Exact specifica ons for all plans are provided in the official Plan Documents, copies of which are available at Thank you, The Risk Management Team (a division of Human Resources) PAGE 2

3 TABLE OF CONTENTS What s Inside Message from the County... 2 Enrolling in Benefits... 4 Eligibility... 6 Medical Benefits Overview Dental Plan Highlights Vision Plan Highlights Employee Assistance Program Flexible Spending Accounts Health Savings Account (HSA) Disability Life Insurance Re rement Plan COBRA Con nua on Coverage This package of material will give you informa on about the benefits which are available to you. Please read the informa on carefully. To help you make important decisions about your benefits, Risk Management is available to answer any ques ons you may have. Helpful Hints... Read through this guide to familiarize yourself with your benefit op ons. Think about your current benefit plans. Are they s ll working for you? Have you experienced any changes or do you an cipate any that might make a different plan more suitable? Gather addi onal informa on. Use the websites and the phone numbers in the back of this guide to see which doctors and other healthcare providers you can use under the different plan choices. If you have dependents on your plan that live out of state, check on provisions for coverage of members away from home. Required Federal No ces Important No ce about Your Prescrip on Drug Coverage and Medicare Important Contact Informa on Health Plan Contribu on Rates... If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a Federal law gives you more choices about your prescrip on drug coverage. Please see pages for more details. IMPORTANT NOTICE The informa on in this brochure is a general outline of the benefits offered under the County of El Dorado s benefits program. This brochure may not include all relevant limita ons and condi ons. Specific details and limita ons are provided in the plan documents, which may include a Summary Plan Descrip on (SPD), Evidence of Coverage (EOC), and/or insurance policies. The plan documents contain the relevant plan provisions. If the informa on in this brochure differs from the plan documents, the plan documents will prevail. PAGE 3

4 ENROLLING IN YOUR BENEFITS This chart is a brief overview of your County-sponsored coverage options. Read more about each benefit on the following pages of this guide. MEDICAL (including prescription drugs) Blue Shield PPOs (all locations) Kaiser Permanente HMOs (Placerville and west only, based on your home or work Zip Code) OE3 Health Trust Plans* (for members of the Corrections and Trades & Crafts bargaining units only) Decline Coverage for Medical, Dental, and Vision plans DENTAL Automatic when enrolled in County medical Delta Dental PPO+Premier for all medical plans VISION Automatic when enrolled in County medical Vision Service Plan (VSP) Choice for all medical plans Employee Assistance Program No cost to you Automatic for employees and dependents Flexible Spending Accounts (FSAs) Health Savings Account (HSA) Health Care Reimbursement Account (HCRA) Dependent Care Reimbursement Account (DCRA) Health Savings Account (must be enrolled in an ABHP medical plan) Disability Coverage No cost to you Long-Term Disability Coverage Basic and Voluntary Life Insurance Basic coverage paid by the County is provided for most employees. Voluntary employee paid coverage is available to all eligible employees. Retirement Coverage Pension plan, deferred compensation program and retiree health benefit contributions are available to most employees. Note: Employees in the CA, CC, CO, EL, MA, SA, SM, UD and UM bargaining units receive credits each year as part of their pay. Credits that are not used for benefits can often be paid as taxable income. Proof of other coverage is required if cash is received instead of medical benefits. *Employees represented by Operating Engineers Union Local 3 have the option of enrolling in either the County program outlined above or medical, dental, and vision benefits provided by the Operating Engineers Trust Fund program. For more information, contact Risk Management. PAGE 4

5 ENROLLING IN YOUR BENEFITS HOW TO ENROLL WORKTERRA is the County of El Dorado s online employee benefit administra on tool to assist you with your benefit choices and enrollment. The site offers a central loca on for you to access Summary Plan Descrip ons and other informa on on the benefits that the County of El Dorado offers to their employees. The site can be accessed through the County of El Dorado s intranet Page or by going to You may access the site using the following: Sign On: 1. User ID: Complete last name followed by the last four digits of your Social Security Number For example, if your Last name is Test and the last 4 of your SSN is 6456 your User ID is: test6456 (not case sensi ve) 2. Password: Full Date of Birth without dashes (Ini al password) For example, if your date of birth is March 9, 1980 your password would be Company Name: El Dorado (not case sensi ve) If you do not remember your log in, click on the Forgot your User Name or Password? Link or contact EBS Customer Service at (888) Monday Friday 8 am to 5 pm PST. PAGE 5

6 ELIGIBILITY Who is eligible to enroll in the benefit program? Employees scheduled to work at least 32 hours each bi weekly pay period are generally eligible for benefits. What is the effec ve date of coverage? The first day of the month following date of hire or qualifying event. Can I enroll my dependents? Your current spouse, or registered domes c partner. Your natural children, stepchildren, domes c partner s children and adopted children. In addi on, such children must be: under age 26 Your disabled children age 26 or older. Such disabled children must meet the same condi ons as listed above for natural children, stepchildren, domes c partner s children, adopted children, and in addi on are physically or mentally disabled on the date coverage would otherwise end because of age and con nue to be disabled. A child for whom you are required to provide benefits by a court order, who sa sfies the same condi ons as listed above for natural children, stepchildren, domes c partner s children and adopted children. What is the defini on of domes c partner? Domes c partner is defined as the employee s same sex domes c partner under a legally registered and valid domes c partnership or one that meets certain requirements and provides an affidavit of domes c partnership. How do I add and exclude dependents? Newly acquired dependents may be added to the plan during the year by submi ng the informa on to Risk Management via WORKTERRA and providing verifica on documents within 30 days of their eligibility. If you do not add dependents within the 30 day period and do not qualify for a special enrollment, they will not be eligible to enroll un l the next open enrollment period with coverage taking effect January 1. When can I make changes to my benefit elec ons? Other than during the annual open enrollment period, you may not change your coverage unless you qualify for a special enrollment. In addi on, if you are declining enrollment for you or your dependents (including your spouse) because of other group medical coverage, you may in the future be able to enroll yourself or your dependents in this plan, provided that you qualify for a special enrollment. PAGE 6

7 WHEN YOU CAN MAKE CHANGES TO YOUR BENEFITS Other than during annual open enrollment, you may only make changes to your benefit elec ons if you experience a qualifying event or qualify for a special enrollment. If you qualify for a mid year benefit change, you may be required to submit proof of the change or evidence of prior coverage. QUALIFYING EVENTS INCLUDE: Change in legal marital status, including marriage, divorce, legal separa on, annulment, and death of a spouse. Change in number of dependents, including birth, adop on, placement for adop on, or death of a dependent child. Change in employment status that affects benefit eligibility, including the start or termina on of employment by you, your spouse, or your dependent child. Change in work schedule, including an increase or decrease in hours of employment by you, your spouse, or your dependent child, including a switch between part me and full me employment that affects eligibility for benefits. Change in a child's dependent status, either newly sa sfying the requirements for dependent child status or ceasing to sa sfy them. Change in place of residence or worksite, including a change that affects the accessibility of network providers. Change in your health coverage or your spouse's coverage a ributable to your spouse's employment. Change in an individual's eligibility for Medicare or Medicaid. A court order resul ng from a divorce, legal separa on, annulment, or change in legal custody (including a Qualified Medical Child Support Order) requiring coverage for your child. An event that is a special enrollment under the Health Insurance Portability and Accountability Act (HIPAA) including acquisi on of a new dependent by marriage, birth or adop on, or loss of coverage under another health insurance plan. An event that is allowed under the Children's Health Insurance Program (CHIP) Reauthoriza on Act. Under provisions of the Act, employees have 60 days a er the following events to request enrollment: Employee or dependent loses eligibility for Medicaid (known as Medi Cal in CA) or CHIP (known as Healthy Families in CA). Employee or dependent becomes eligible to par cipate in a premium assistance program under Medicaid or CHIP. Two rules apply to making changes to your benefits during the year: Any change you make must be consistent with the change in status, AND You must make the change within 30 days of the date the event occurs. PAGE 7

8 WHEN YOUR BENEFITS TERMINATE When Your Benefits Terminate Insurance benefits will terminate on the last day of the month in which the termina on occurs. (re rement, unpaid absence or FMLA exhaus ng). When termina ng, the employee must work at least one full schedule day in the month to get coverage for that month. Employees who terminate due to a medical condi on / exhaus on of leave should contact Risk Management. COBRA, if elected, will be effec ve the first of the month following date of termina on. Benefits during the Family and Medical Leave (FMLA) and California Family Rights Act (CFRA) An employee who qualifies for and is taking Family Medical Leave will be allowed to con nue par cipa ng in any health and welfare benefit plan in which he/she was enrolled before the first day of leave (for a maximum of 12 work weeks) at the level and under the same condi ons of coverage as if the employee had con nued in employment for the dura on of such leave. The County will con nue to make the same premium contribu ons as if the employee had con nued working. The con nued par cipa on in health benefits begins on the date leave first begins under the Family and Medical Leave Act (e.g. for pregnancy disability leaves) or under the Family and Medical Leave Act/CFRA (e.g. for all other family care and medical leaves). In some instances, the County may recover premiums it paid to maintain health coverage for you if you fail to return to work following pregnancy disability leave/fmla leave. An employee s use of family/medical leave will not result in the loss of any employment benefit that the employee earned before using family/medical leave. All employees must no fy their department as soon as possible when reques ng FMLA for their own illness or for caring for a family member. PAGE 8

9 MEDICARE AND THE ACTIVE WORKER If you are an ac ve employee and have reached the age of 65, you may be wondering about Medicare. You should receive an advisory no ce from Medicare about 4 months before your 65th birthday for your ini al enrollment period. Here is some informa on that you should know about your Medicare op ons when working beyond age 65: You may not enroll in a Medicare Supplemental plan un l you re re or are otherwise not eligible for the group plan. You have the op on of enrolling in Medicare Part B (medical) coverage at your cost. If you do so, your Group Health medical plan remains your primary and Part B (which does have a fee involved) would coordinate as secondary coverage to your Group Health medical plan. When you reach age 65, you must complete the Group Health Cer fica on of Medicare Status form to report either your enrollment in Medicare Part B or your deferment un l re rement. Once you re re, you must sign up for Part B with Medicare during the eight months following the month that your group health plan coverage or employment ended (whichever is first), also known as the Special Enrollment Period. If you choose to defer Part B, please be aware that there may be a 10% federal surcharge added to the monthly premium for every 12 month period that you were qualified to sign up for Medicare but did not enroll. Upon re rement, you will be transferred to the Medicare plan, assuming that you meet other eligibility requirements. For addi onal informa on on Medicare and your related benefit op ons, contact Risk Management at (530) or go to This informa on also applies to any dependents enrolled on your plan. PAGE 9

10 MEDICAL BENEFITS OVERVIEW The County s medical benefits are designed to help maintain wellness and protect you and your family from major financial hardship in the event of illness or injury. The County offers a choice of medical plans through Blue Shield of CA and Kaiser Permanente. Blue Shield of CA PPO a Preferred Provider Organiza on (PPO) is a plan that allows you to seek care from any provider, but offers significant savings if you choose a Blue Shield network provider. The plan benefit is generally a percentage of the allowed cost for a service a er you have sa sfied the deduc ble. Staying in network ensures you re charged the lowest amount your plan offers, but knowing you can go out network, if you wish, gives you that added flexibility. Blue Shield of CA ABHP (Account Based Health Plan) ABHP is a PPO plan with a higher deduc ble. It uses the PPO network descrip on above but coverage is different and this plan allows an employee to make contribu ons to a Health Savings Account (HSA). Unused por ons of the account roll over to the next plan year and if you separate from the organiza on the account belongs to the account holder/ employee to use toward qualified medical expenses. These accounts are governed by IRS Code 502. Kaiser Permanente HMO a Health Maintenance Organiza on (HMO) in which pa ents seek medical care within the plan s own facili es. Under this plan, most services and medicines are covered with a small co payment. You select your doctor, or Primary Care Provider (PCP), from the staff at a local Kaiser Permanente facility. All of your care is provided at a Kaiser facility. Services outside of a Kaiser facility are not covered except if it is a life threatening emergency. Kaiser Permanente ABHP (Account Based Health Plan) With Kaiser s Account Based Health Plan, you ll pay full charges for most services including prescrip on drugs un l you reach your deduc ble. Then you ll start paying copays for most services covered by your plan un l the annual out ofpocket maximum is met for the rest of the calendar year. You select your doctor, or Primary Care Provider (PCP), from the staff at a local Kaiser Permanente facility. All of your care is provided at a Kaiser facility. Services outside of a Kaiser facility are not covered except if it is a life threatening emergency. The summaries in the following pages is for informational purpose only. It does not amend, extend, or alter the current policy in any way. In the event information in this summary differs from the Plan Documents, the Plan Documents will prevail. PAGE 10

11 MEDICAL BENEFITS OVERVIEW Blue Shield of CA Customer Service: (855) Hours: 7:00 a.m. to 7:00 p.m. M-F Website: Blue Shield PPO $200 (Standard) Calendar Year Deduc ble (Individual / Family) Calendar Year Out of Pocket Maximum (Individual / Family) IN NETWORK OUT OF NETWORK $200/$400 $1,200/ $2,400 Physician Care Primary Physician Office Visit 20% 40% Specialist Office Visit 20% 40% Preven ve Care No Charge 40% Most Lab and X Ray 20% 40% MRI, CT and PET 20% 40% 1 Chiroprac c (30 visits per Member per Calendar Year) $10 per visit 50% Hospital Care Urgent Care 20% 40% Emergency Room $50 deduc ble + 20% (copay waived if admi ed) Inpa ent 20% 40% Outpa ent 10% 40% Prescrip on Drugs Tier 1 / Tier 2/ Tier 3 Retail Par cipa ng Pharmacy (up to a 34 day supply) Mail Order (up to a 90 day supply) $10 / $15 / $30 $10 / $15 / $30 Not Covered PAGE 11

12 MEDICAL BENEFITS OVERVIEW Blue Shield of CA Account Based Health Plan : The County of El Dorado offers you two innova ve plan op ons from Blue Shield of CA called Account Based Health Plans (ABHP). These consumerdriven health plans are designed to educate you about health care decisions and empower you to take control of your health, as well as the dollars you spend on your care. These Account Based Health Plans have features similar to the Blue Shield PPO Plan such as visi ng any doctor even a specialist without a referral, choosing from a large network of providers for greater savings. Or go out of network and share more of the cost. These Account Based Health Plans are different from the tradi onal PPO in that you pay the annual deduc ble amount before coverage begins for all services with the excep on of preven ve care services (which is covered at 100%). Once you have sa sfied your annual deduc ble your tradi onal health coverage kicks in. You pay the appropriate coinsurance for covered services, up to the annual out of pocket maximum. You pay applicable copays for prescrip on drugs a er you have sa sfied your annual deduc ble (January 1, 2017 December 31, 2017). Finally, premiums can be substan ally lower. BLUE SHIELD PPO $1300 ABHP IN NETWORK OUT OF NETWORK Calendar Year Deduc ble (Individual / Family) (Accumula ve; applies to medical and $1,300 / $2,600 prescrip on benefits) Deduc ble Note: Deduc ble must be met before coinsurance applies Calendar Year Out of Pocket Maximum (Individual / Family) $2,500 / $5,000 $5,000 / $6,000 (Includes Deduc ble) Coinsurance change from last year Preven ve Care No Charge (Adults & Children) (not subject to deduc ble) 50% Office Visit 30% 50% Hospitaliza on 20% 50% Pregnancy and Maternity 20% 50% Outpa ent Surgery 20% 50% Emergency Room $ % (copay waived if admi ed) Urgent Care 20% 50% Most Lab & X ray 20% 50% Durable Medical Equipment 50% 50% Prescrip on Drugs * Tier 1 Generic Drugs Tier 2 Formulary Brand Name Drugs Tier 3 Non Formulary Brand Name Drugs Mail Order 90 day supply $10 a er deduc ble $15 a er deduc ble $30 a er deduc ble $10/$15/$30 $ % (copay waived if admi ed) $10 a er deduc ble $15 a er deduc ble $30 a er deduc ble Not Covered *Please note: Blue Shield of California Account Based Health Plan Rx is administered by Blue Shield of CA PAGE 12

13 MEDICAL BENEFITS OVERVIEW Calendar Year Deduc ble (Individual / Family) (Accumula ve; applies to medical and prescrip on benefits) Deduc ble Note: Calendar Year Out of Pocket Maximum (Individual / Family) (Includes Deduc ble) BLUE SHIELD PPO $2000 ABHP IN NETWORK OUT OF NETWORK $2,000 / $6,000 Deduc ble must be met before coinsurance applies $6,450 / $12,900 $12,700 / $38,100 Preven ve Care No Charge (Adults & Children) (not subject to deduc ble) Not Covered Office Visit 30% 50% Hospitaliza on 30% 50% Pregnancy and Maternity 30% 50% Outpa ent Surgery 30% 50% up to $350 per day Emergency Room 30% 30% Urgent Care 30% 50% Most Lab & X ray 30% 50% Durable Medical Equipment 30% 50% Prescrip on Drugs * Tier 1 Generic Drugs Tier 2 Formulary Brand Name Drugs Tier 3 Non Formulary Brand Name Drugs Mail Order 90 day supply 30% a er deduc ble 30% a er deduc ble 30% a er deduc ble 30% a er deduc ble Not Covered Not Covered Not Covered Not Covered *Please note: Blue Shield of California Account Based Health Plan Rx is administered by Blue Shield of CA 24/7 online access You have convenient 24 hour access to informa on about your health benefits at blueshieldca.com. Here you can find a wide range of resources in one centralized loca on, including: Medical benefits Log in to get informa on about your PPO plan s features and benefits, view claim status, print Blue Shield member ID cards, and more. Find a Provider Search for doctors, hospitals, and urgent care centers easily. NurseHelp 24/7 SM Get health advice from a registered nurse day or night. Programs and services Find informa on on programs and services including prenatal and condi on management. PAGE 13

14 MEDICAL BENEFITS OVERVIEW Express Scripts (ESI): Your plan covers a broad range of medica ons that fall into three categories. Generic Medica ons (Tier 1) May cost you less than plan preferred and nonpreferred medica ons. Plan preferred medica ons (Tier 2) A broad list that includes more than 1,800 brandname drugs. Drugs on this list may cost you less than non preferred medica ons. Non preferred medica ons (Tier 3) Brand name drugs that are not included on the plan preferred list. You may pay the most toward the cost of these drugs. Express Scripts is available on the Blue Shield PPO 200 plan only. PAGE 14

15 MEDICAL PLAN HIGHLIGHTS Calendar Year Deductible (Individual / Family) Calendar Year Out of Pocket Maximum (Individual / Family) Kaiser HMO Kaiser HMO ABHP IN NETWORK ONLY IN NETWORK ONLY None $1,300 / $2,600 $1,500 / $3,000 $2,600 / $5,200 Physician Care Primary Physician Office Visit $15 / Visit $30 after deductible Kaiser Permanente s Customer Service: (800) Specialist Office Visit $15 / Visit $30 after deductible Preventive Care No Charge No Charge Most Lab and X Ray No Charge $30 after deductible/ per encounter MRI, CT and PET No Charge $50 after deductible/ per procedure Most Physical Therapy $15 / Visit $30 after deductible Hospital Care Urgent Care $15 Copay $30 after deductible Emergency Room Inpatient Outpatient $50 Copay (waived if admitted) No Copay $15 per procedure $100 after deductible (waived if admitted) $250/admission after deductible $150/procedure after deductible Prescription Drugs Tier 1 / Tier 2 Tier 1 / Tier 2 Retail Participating Pharmacy Mail Order (up to a 100 day supply) $15/$30 For each 30 day prescription $15/30 $30/$60 for a 90 day supply $10 after deductible $30 after deductible Kaiser Permanente Plans are available to employees west of Camino only (based on work zip code). If you choose Kaiser based on your work zip code, limita ons to your benefits may apply. See plan for details. Kaiser members must receive services from a Kaiser Facility. Out of network benefits are not available under the Kaiser HMO Plan PAGE 15

16 DENTAL PLAN HIGHLIGHTS Save money with a Delta Dental PPO den st. Our PPO network den sts accept reduced fees for covered services they provide you, so you ll usually pay the least when you visit a PPO network den st. This also ensures Delta Dental PPO den sts won t balance bill you the difference between the contracted amount and their usual fee. Calendar Year Deduc ble Individual/Family Maximum Annual Benefit (per member) Preven ve Services (deduc ble waived) Oral Exams Cleaning every 6 months Sealants Fluoride treatment Dental PPO + Premier In Network $50 / $150 Out Of Network $1,600 $1, % (No charge; no deduc ble) 100% (No charge of usual, customary and reasonable charge; no deduc ble) Delta Dental of California 100 First St. San Francisco, CA Customer Service Claims Address P.O. Box Sacramento, CA deltadentalins.com Basic Services Amalgam Fillings Simple Extrac ons Oral Surgery Endodon cs Periodon cs Major Services Surgical Extrac ons Bridgework Dentures Crowns 20% Deduc ble applies 40% Deduc ble applies 20% charge of usual, customary and reasonable charge; Deduc ble applies 40% charge of usual, customary and reasonable charge; Deduc ble applies * Limita ons or wai ng periods may apply for some benefits; some services may be excluded from your plan. Reimbursement is based on Delta Dental maximum contract allowances and not necessarily each den st s submi ed fees. ** Reimbursement is based on PPO contracted fees for PPO den sts, Premier contracted fees for Premier den sts and program allowance for non Delta Dental den sts. When you enroll in any County sponsored medical plan, you have dental coverage through Delta Dental. You may use any den st at any me, but if you use a Delta den st you will save money on your share of the expenses. PAGE 16

17 VISION PLAN HIGHLIGHTS VSP provides par cipants with access to a large network of vision care providers. To locate a network provider visit If you decide not to see a VSP doctor, the plan co pay s ll applies. This choice is yours either way, your VSP benefits are a tremendous part of your overall benefits package. There are no ID cards necessary for this plan. VSP Vision Choice Network (Par cipant Share of Cost) Vision Plan Highlights In Network Out of Network Type of Service Copay Plan Pays Eye examina on (Once Every 12 Months) Standard Lenses (Once Every 24 Months) Single Bifocal Trifocal Frame (Once Every 24 Months) Contact Lenses (Once Every 24 Months, in Lieu of Eyeglasses) Elec ve $25 1 Up to $45 Copay combined with exam $115 Allowance + 20% Off the Amount Over the Allowance Medically Necessary is Covered in full. $105 Allowance Up to $30 Up to $50 Up to $65 Up to $70 Up to $105 1 Sheriffs have a $10 Exam and Materials copay *No lined lenses are not a covered benefit under this plan. When requested, the lenses will be covered up to the value of the lined lenses and you will pay the addi onal cost. ** When you choose contacts instead of glasses, your $ allowance applies to the cost of your contacts and the contact lens exam (fi ng and evalua on). This exam is in addi on to your vision exam to ensure proper fit of contacts. When you enroll in any County sponsored medical plan, you have vision coverage through VSP. You may use most eye doctors, but if you use a VSP provider you will save money on your share of the expenses. PAGE 17

18 FLEXIBLE SPENDING ARRANGEMENT (FSA) A Flexible Spending Arrangement (FSA) allows you to pay for eligible healthcare and dependent care expenses using tax free dollars. When you par cipate in an FSA plan via salary reduc on, you reduce your federal, FICA, social security, Medicare (and in some cases, state) taxes and increases take home pay. The money that is deposited into your FSA comes straight out of your gross pay, therefore reducing your taxes. The County offers two types of FSAs Health Care Reimbursement Account (HCRA) and a Dependent Care Reimbursement Account (DCRA): HEALTH CARE REIMBURSEMENT ACCOUNT (HCRA): This plan allows you set aside pre tax dollars to help pay for certain out of pocket health care expenses. Contribu ons are elected annually and can range from $100 $2,500 per year. This plan offers a benefit debit card for your convenience. HCRA Eligible Expenses (per Sec on 502 of the IRS code): Medical expenses; co pays, co insurance, and deduc bles Dental expenses; exams, cleanings, X rays, and braces Vision expenses; exams, contact lenses and supplies, eyeglasses, and laser eye surgery Professional services; chiropractor and acupuncture Prescrip on drugs and insulin NOTE: If you are eligible for a Health Savings Account (HSA), regardless if you elect to par cipate, you cannot par cipate in an HCRA. DEPENDENT CARE REIMBURSEMENT ACCOUNT (DCRA): This plan allows you to set aside pre tax dollars that can be used to help pay for dependent care services for eligible dependents. The maximum amount you can contribute to this plan annually is $5,000 (if you are married but filing separately, federal regula ons limit the use of a Dependent Care FSA to $2,500 each year). If you claim the dependent care credit on your tax return or collect compensa on through your DCRA, you must report the name, address, and tax payer iden fica on number of each dependent care provider. DCRA Eligible Expenses (per Sec on 503 of the IRS Code): Care for your child who is under age 13 before and a er school care Baby si ng and nanny expenses Daycare, nursery school, and preschool Summer day camp Care for a rela ve who is physically or mentally incapable of self care and lives in your home THE USE IT OR LOSE IT RULE: This rule states that if you contribute your pre tax dollars to an FSA and then do not use all of the dollars you deposit, you will lose the remaining balance in the account at the end of the plan year, with the excep on of the HCRA where $500 can roll over to the following year. For this reason, it is essen al that you plan ahead before deciding how much to contribute to your two FSA accounts and that you put in those dollars you are confident you will use. PAGE 18

19 HEALTH SAVINGS ACCOUNT Discover an easy, hassle free health savings account (HSA) and discover the best way to save for health care, and a great way to save on taxes. What is a Health Savings Account (HSA)? An HSA is a tax free savings account that works with a qualified health plan to help you pay for the cost of out of pocket health care and prescrip on medica on expenses such as: Medical expenses; co pays, co insurance, and deduc bles Dental expenses; exams, cleanings, X rays, and braces Vision expenses; exams, contact lenses and supplies, eyeglasses, and laser eye surgery Professional services; chiropractor and acupuncture Prescrip on drugs and insulin You can take the money you would have paid for higher health insurance premiums and use it to pay for qualified medical expenses or save it and let it grow! What s more: Your HSA money is yours, ALWAYS! You won t lose it if you don t spend it, change jobs, re re or change health plans. You never pay taxes on withdrawals for qualified medical expenses. Your money earns interest and you don t pay taxes on the interest earned. Your contribu ons are tax free and reduce your overall taxable income. You can change your contribu on to the HSA any me during the year. Who is Eligible for an HSA? Anyone mee ng the following requirements is eligible for an HSA: Is enrolled in County of El Dorado s qualified ABHP medical plan, Is not covered under another medical plan that is not HSA compa ble, Is not enrolled in Medicare, Is not eligible to be claimed on another person s tax return, Is not ac ve in the military, and Is a U.S. resident. Individual HSA Contribu on Limit Family HSA Contribu on Limit 2017 $3, $6,650 Catch Up HSA Contribu on Limit For par cipants age 55 or older $1,000 You are allowed to contribute the en re year s limit when you first become eligible for the HSA (even if that is in December); however, you must remain eligible for at least 12 months a er that date, or you will be subject to taxes and penal es on the amount you contributed. PAGE 19

20 EMPLOYEE ASSISTANCE PROGRAM About the Employee Assistance Program The Employee Assistance Program (EAP) from MHN is designed to help with short term counseling needs. It offers quick and easy access to confiden al, professional assistance and resources to assist employees address difficul es related to emo onal concerns, rela onships, substance abuse, legal and financial concerns. If it is determined that you need or your family members need more than the 5 face to face sessions that you are eligible for, the EAP will help coordinate your needs under your medical plan. All services are confiden al and in accordance with professional ethics and federal and state laws. Use of the EAP is strictly voluntary. Example of problems the EAP can help resolve are: marital and family conflict stress and anxiety alcohol and drug abuse grief and loss depression physical abuse Ea ng disorders representa on or prepara on service). Pre Re rement Planning Guidance for planning a quality re rement (does not include investment, tax or legal advice). Organizing Life s Affairs Help organizing records and vital documents and with arranging final details for a loved one. Concierge Services Referrals for everyday errands, travel, event planning and more (does not cover the cost, nor guarantee delivery, of services). Legal Services Telephonic or face to face legal consulta ons for issues rela ng to civil, consumer, personal and family law, financial ma ers, business law, real estate, criminal ma ers, the IRS and estate planning (excluding disputes or ac ons between members and their employer or MHN). Work & Life Services: Depending on your plan, telephonic consulta on may be available for: Child and Eldercare Assistance Help accessing available community and financial resources and referrals to pre screened providers for childcare, eldercare and more. We ll help iden fy needs and search our extensive directories to find the right care. You may also be en tled to help with adop on, paren ng skills, child development, special needs, emergency care, reloca on services and educa onal issues. Access MHN website at: Enter your company Web ID: eldorado Or call toll-free at (800) Financial Issues Budge ng, credit and financial guidance (tax or investment advice, loans and bill payments not included). Federal Tax Assistance Help with IRS audits and unfiled or past due tax returns (not a tax PAGE 20

21 DISABILITY BENEFITS As you work for the County, you accumulate paid sick leave that you can take as needed to care for yourself or family members due to illness. Depending on your labor agreement, some employees can convert accumulated sick leave into cash upon separa on with the County. In addi on to sick leave, you are covered by the following three programs: State Disability Insurance (SDI)* If you become disabled due to an off the job accident or illness, State Disability Insurance (SDI) provides you with limited protec on against lost wages. Typically, a er a wai ng period you can obtain a por on of your regular salary, subject certain limita ons. Paid Family Leave (PFL)* If you are absent from work due to a qualifying family member s illness or injury, you may be en tled to Paid Family Leave. Typically, a er a wai ng period you can obtain a por on of your regular salary, subject certain limita ons. SDI and PFL benefits are payable by the Employment Development Department (EDD) and only for specified periods of me. For more informa on on these programs, refer the SDI/PFL pamphlet available from Risk Management or contact EDD at BE.THERE or at Long Term Disability Insurance (LTD)* All County employees regularly scheduled to work 60 or more hours per bi weekly pay period are covered by a County paid Long Term Disability insurance policy through Lincoln Financial. Benefit up to 66.67% of your salary, subject to policy limita ons, are paid for a prolonged disability. Benefits can be payable as long as you are disabled (generally up to age 65). More informa on is found online at and is also available from Risk Management. Note: Should you become disabled, any benefits received through the LTD plan will be considered taxable income, and you'll have to pay income tax on all of your benefit. Workers Compensa on Coverage If you are injured or become ill due to your job, Workers Compensa on provides payment for medical treatment as well as par al wage loss benefits. Workers Compensa on benefits are regulated by State Law. If you have a non emergency work related illness or injury, call Company Nurse at (877) who will then direct you to treatment. Your supervisor will provide you with a claim form to be completed and returned to Risk Management. For more informa on, read the pamphlet tled Facts About Workers Compensa on, available from Risk Management. *does not apply to members of the Deputy Sheriff s Associa on bargaining unit. Please contact your union for more details PAGE 21

22 BASIC LIFE / ACCIDENTAL DEATH & DISMEMBERMENT Basic Life / AD&D Benefits Benefits Basic Life / AD&D Class 1 Class 2 Class 3 Class 4 Benefits (for both Life and AD&D) Benefit Reduc on Elected Officials (EL) and Unrepresented Department Heads (UD) Bargaining Units CC, CA, MA, SM and UM Confiden al Employees (CO) Bargaining Units CR, GE, PL, SU, PR and TC Class 1 $60,000 Class 2 $40,000 Class 3 $30,000 Class 4 $20,000 Benefit reduces to 65% at age 70 (Terminates at re rement) Choosing a Beneficiary When you enroll for benefits be sure to choose a beneficiary for your life insurance. The online enrollment form includes a sec on for beneficiaries. If you choose voluntary life insurance coverage for your family, you will be the beneficiary for your spouse and/or children. Please remember to update your Beneficiary informa on whenever there is a family status change. PAGE 22

23 VOLUNTARY LIFE You make a great investment in your family. You spend me with them. You care for them. You work for them. And if you re not there for them, you want your family protected. What would happen if you were no longer there to protect them yourself? Lincoln Financial s Voluntary life insurance is a simple, easy way to help protect your loved ones. It gives you the opportunity to apply for the amount of protec on you need for yourself and your family. Please remember to update your Beneficiary informa on whenever there is a family status change. Note: The value of any life insurance coverage in excess of $50,000 and premiums for Domes c Partner coverage may be subject to imputed income. Voluntary Life Benefits Eligibility Employee Benefits All benefit eligible employees Life Maximum $500,000 Elec on Op ons Increments of $10,000 Minimum $10,000 Guaranteed Issue Amount (for ini al offering) Spouse Benefits $250,000 Maximum $500,000 Elec on Op ons Increments of $10,000 Minimum $10,000 Guaranteed Issue Amount $50,000 Dependent Child(ren) Benefits Child(ren) between live birth to age 21 (to 26 if FT Student) $10,000 Guaranteed Issue Amount $10,000 Benefits Reduc on Employee Accelerated Death Benefit At age 70, 35% of original benefit At age 75, an addi onal 15% of original benefit 75% of Life benefit before age 65 subject to a maximum of $500,000 if life expectancy is 6 months or less. PAGE 23

24 RETIREMENT PROGRAMS Overview The County offers you several ways to plan for a secure financial future. Regular employees are eligible to par cipate in the CalPERS defined benefit pension plan, as well as a tax advantaged savings account called a deferred compensa on plan, which is similar to a 401(k) plan. You may also be eligible for County contribu ons toward re ree health care coverage. CalPERS Defined Benefit Pension Plan This plan provides a monthly pension at re rement, based on a set formula. While the formula differs depending on your job classifica on and bargaining unit, you generally receive a benefit based on your eligible service and final compensa on. You must have at least five years of service at re rement to qualify for a pension. Human Resources Personnel Division can give you more informa on, including details about the formula that applies to you, and whether you need to contribute to the plan. There are various op ons for pension payments, some providing a benefits to a survivor. You also have choices about when the benefit starts, which can be as early as age 50. Your monthly benefit amount is adjusted based on your choice. change the amount you are contribu ng or how your money is invested by comple ng a change form. To par cipate in either the Deferred Compensa on program (CalPERs or Na onwide), you must complete an enrollment form. More informa on is available from the Auditor Controller s Payroll office, including booklets and enrollment and change forms. Please visit the Employee Resources sec on of the EDCnet to set up appointments with financial advisors from CalPERS or Na onwide. Health Benefit Contribu on Program for Re rees Re ree medical coverage is provided per the terms of the appropriate Memorandum of Understanding (MOU) for represented employees, or the Salary & Benefits Resolu on for non represented employees. New employees are not eligible for County contribu ons towards re ree medical coverage, but may purchase re ree medical coverage at their own cost. The eligibility cutoff dates for County contribu ons towards re ree medical varies by bargaining unit. Please contact Risk Management with any ques ons regarding eligibility. Deferred Compensa on Programs (457 Plan) The County offers regular employees the opportunity to set aside part of their income each year into a personal tax advantaged savings account. This type of plan is similar to a 401(k) plan, but is offered for public employees under IRS Code sec on 457. Contribu ons are made through payroll contribu ons that are not taxed un l they are taken out of the plan, usually at re rement. Certain employees may be eligible for County contribu ons to their account, as set out in their Memorandum of Understanding (MOU). You can choose to set up your account through either CalPERS or Na onwide. Both administrators offer a wide selec on of investment funds. You can easily PAGE 24

25 COBRA COBRA Con nua on Coverage Under a federal law known as the Consolidated Omnibus Budget Reconcilia on Act (COBRA) you and your qualified dependents are en tled to con nue medical and dental coverage under certain circumstances when coverage would otherwise end, provided you pay the applicable rate. Qualified dependents include your dependents that are covered under the El Dorado County Health Plan at the me your coverage would end for one of the reasons described below. Qualified dependents also include your newly adopted or newborn children that you enroll for COBRA coverage. You and your qualified dependents may elect to con nue Plan coverage for up to 18 months if your coverage ends because: Your employment ends for any reason, or You have a reduc on in hours. Plan coverage may be con nued by your qualified dependents for up to 36 months if coverage ends because of one of the following events: Your death, Your divorce (but not termina on of a Registered Domes c Partnership), or Your child no longer qualified for dependent coverage under the terms of the Plan. If you or Your Dependent Becomes Disabled You or your qualified dependents may extend COBRA coverage from 18 months to 29 months if, within the first 60 days of your COBRA coverage, you or your qualified dependents become disabled as determined by Social Security. You must no fy the County that you qualify for the extension within 60 days of the date you or your dependent is declared disabled by Social Security, but not later than 18 months from the date you or your dependent ini ally become eligible for COBRA coverage. Your extended COBRA coverage based on disability will terminate if Social Security determines that you are no longer disabled. Extended COBRA Coverage If your qualified dependents elect COBRA coverage because your employment ends or your hours are reduced, they will be en tled to addi onal coverage, up to a total of 36, if during the first 18 months: You die, You divorce your spouse, or Your child no longer qualifies for dependent coverage under the terms of the medical, or dental plans. To qualify for the extended COBRA coverage, it is your responsibility, or your dependent s responsibility, to no fy the County within 60 days of the date of any of these events. If you fail to no fy the County within the 60 days, the County will not be obligated to offer the addi onal COBRA coverage. When COBRA Coverage Ends COBRA con nua on coverage will stop before the end of the indicated me period if: You or your dependent becomes covered under any other group medical plan, unless the other has a pre exis ng condi on exclusion or limita on that affects your or your dependent s coverage, You or your dependent becomes en tled to Medicare, You fail to make the required payments on me, The County terminates all of its group health plans, or You or your dependent is on a disability extension, and Social Security determines that you or your dependent is no longer disabled. COBRA coverage can be voluntarily terminated at any me by sending a wri en request to the County Risk Management offices. Benefits Provided Through COBRA Coverage While you are enrolled in COBRA, your benefit coverage will be the same as the coverage for ac ve employees. Therefore, if there any changes to the Plan for ac ve employees, including a change in the cost, your benefits will also change. Elec ng COBRA Coverage When any of the events described on the preceding page occur, Employee Benefit Specialists (EBS) will send you an elec on form and detailed informa on about your rights under COBRA, including the cost of coverage and payment method. You or your qualified dependents must elect COBRA coverage within 60 days a er your coverage under the County Plan ends, or the date you receive the elec on form, whichever is later. For more informa on, contact EBS (888) PAGE 25

26 Required Federal Notices Notice of Availability of HIPAA Notice The Federal Health Insurance Portability and Accountability Act (HIPAA) requires that we periodically remind you of your right to receive a copy of the Insurance Carriers HIPAA Privacy Notices. You can request copies of the Privacy Notices by contacting the El Dorado County at 330 Fair Lane, Placerville, CA HIPAA Notice of Special Enrollment Rights for Medical/Health Plan Coverage If you decline enrollment in the El Dorado County s health plan for you or your dependents (including your spouse) because of other health insurance or group health plan coverage, you or your dependents may be able to enroll in the El Dorado County s health plan without waiting for the next open enrollment period if you: Lose other health insurance or group health plan coverage. You must request enrollment within [30/31] days after the loss of other coverage. Gain a new dependent as a result of marriage, birth, adoption, or placement for adoption. You must request [medical plan OR health plan] enrollment within [30/31] days after the marriage, birth, adoption, or placement for adoption. Lose Medicaid or Children s Health Insurance Program (CHIP) coverage because you are no longer eligible. You must request medical plan enrollment within 60 days after the loss of such coverage. If you request a change due to a special enrollment event within the [30/31] day timeframe, coverage will be effective the date of birth, adoption or placement for adoption. For all other events, coverage will be effective the first of the month following your request for enrollment. In addition, you may enroll in the MCDH medical plan if you become eligible for a state premium assistance program under Medicaid or CHIP. You must request enrollment within 60 days after you gain eligibility for medical plan coverage. If you request this change, coverage will be effective the first of the month following your request for enrollment. Specific restrictions may apply, depending on federal and state law. Note: If your dependent becomes eligible for a special enrollment rights, you may add the dependent to your current coverage or change to another health plan.

27 Required Federal Notices The Women s Health and Cancer Rights Act The Women s Health and Cancer Rights Act (WHCRA) requires employer groups to notify participants and beneficiaries of the group health plan, of their rights to mastectomy benefits under the plan. Participants and beneficiaries have rights for coverage to be provided in a manner determined in consultation with the attending Physician for: 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; Prostheses; and Treatment of physical complications of the mastectomy, including lymphedema. These benefits are subject to the same deductible and co-payments applicable to other medical and surgical procedures provided under this plan. You can contact your health plan s Member Services for more information. Newborns and Mothers Health Protection Act Notice Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to 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 with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). If you would like more information on maternity benefits, call your plan administrator. Michelle s Law Notice Extended dependent medical coverage during student medical leaves The El Dorado County plans may extend medical coverage for dependent children if they lose eligibility for coverage because of a medically necessary leave of absence from school. Coverage may continue for up to a year, unless your child s eligibility would end earlier for another reason. Extended coverage is available if a child s leave of absence from school or change in school enrollment status (for example, switching from full-time to part-time status) starts while the child has a serious illness or injury, is medically necessary and otherwise causes eligibility for student coverage under the plan to end. Written certification from the child s physician stating that the child suffers from a serious illness or injury and the leave of absence is medically necessary may be required. If your child will lose eligibility for coverage because of a medically necessary leave of absence from school and you want his or her coverage to be extended, Contact the El Dorado County as soon as the need for the leave is recognized. In addition, contact your child s health plan to see if any state laws requiring extended coverage may apply to his or her benefits.

28 Required Federal Notices 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 re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren t eligible for Medicaid or CHIP, you won t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available. 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, contact your State Medicaid or CHIP office or dial KIDS NOW or insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren t 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, contact the Department of Labor at askebsa.dol.gov or call EBSA (3272). If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of January 31, Contact your State for more information on eligibility ALABAMA Medicaid Website: Phone: ALASKA Medicaid Website: Phone (Outside of Anchorage): Phone (Anchorage): GEORGIA Medicaid Website: - Click on Programs, then Medicaid, then Health Insurance Premium Payment (HIPP) Phone: INDIANA Medicaid Website: Phone:

29 COLORADO Medicaid Medicaid Website: Medicaid Customer Contact Center: FLORIDA Medicaid Website: Phone: KENTUCKY Medicaid IOWA Medicaid Website: Phone: KANSAS Medicaid Website: Phone: NEW HAMPSHIRE Medicaid Website: Phone: LOUISIANA Medicaid Website: Phone: NEW JERSEY Medicaid and CHIP Website: Phone: MAINE Medicaid Medicaid Website: dmahs/clients/medicaid/ Medicaid Phone: CHIP Website: CHIP Phone: NEW YORK Medicaid Website: Phone: TTY MASSACHUSETTS Medicaid and CHIP Website: Phone: NORTH CAROLINA Medicaid Website: Phone: MINNESOTA Medicaid Website: Phone: NORTH DAKOTA Medicaid Website: Click on Health Care, then Medical Assistance Website:

30 Phone: Phone: MISSOURI Medicaid OKLAHOMA Medicaid and CHIP Website: Phone: MONTANA Medicaid Website: Phone: OREGON Medicaid Website: Phone: Website: Phone: NEBRASKA Medicaid PENNSYLVANIA Medicaid Website: Phone: NEVADA Medicaid Website: Phone: RHODE ISLAND Medicaid Medicaid Website: Medicaid Phone: SOUTH CAROLINA Medicaid Website: Phone: VIRGINIA Medicaid and CHIP Website: Phone: SOUTH DAKOTA - Medicaid Medicaid Website: cfm Medicaid Phone: CHIP Website: cfm CHIP Phone: WASHINGTON Medicaid

31 Website: Phone: TEXAS Medicaid Website: Phone: ext WEST VIRGINIA Medicaid Website: Phone: UTAH Medicaid and CHIP Website: Phone: , HMS Third Party Liability WISCONSIN Medicaid and CHIP Website: Medicaid: CHIP: Phone: VERMONT Medicaid Website: dhs.wisconsin.gov/badgercareplus/p htm Phone: WYOMING Medicaid Website: Phone: Website: Phone: To see if any other states have added a premium assistance program since January 31, 2015, or for more information on special enrollment rights, contact either: U.S. Department of Labor Employee Benefits Security Administration U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services EBSA (3272) , Menu Option 4, Ext OMB Control Number (expires 10/31/2016)

32 Required Federal Notices Medicare Part D Notice Important Notice from El Dorado County About Your Prescription Drug Coverage and Medicare Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with El Dorado County and about your options under Medicare s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. There are two important things you need to know about your current coverage and Medicare s prescription drug coverage: 1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare 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. El Dorado County has determined that the prescription drug coverage offered by Express Scripts is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan. When Can You Join A Medicare Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.

33 What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan? If you decide to join a Medicare drug plan, your El Dorado County coverage will be affected. See below for more information about what happens to your current coverage if you join a Medicare drug plan. Since the existing prescription drug coverage under Blue Shield of California, Express Scripts, Kaiser Permanente or United Healthcare is creditable (e.g., as good as Medicare coverage), you can retain your existing prescription drug coverage and choose not to enroll in a Part D plan; or you can enroll in a Part D plan as a supplement to, or in lieu of, your existing prescription drug coverage. If you do decide to join a Medicare drug plan and drop your El Dorado County s prescription drug coverage, be aware that you and your dependents may not be able to get this coverage back. When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan? You should also know that if you drop or lose your current coverage with El Dorado County and don t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join. For More Information About This Notice Or Your Current Prescription Drug Coverage Contact El Dorado County listed below for further information. NOTE: You ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through El Dorado County changes. You also may request a copy of this notice at any time. For More Information About Your Options Under Medicare Prescription Drug Coverage More detailed information about Medicare plans that offer prescription drug coverage is in the Medicare & You handbook. You ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans.

34 For more information about Medicare prescription drug coverage: Visit medicare.gov Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the Medicare & You handbook for their telephone number) for personalized help Call 800-MEDICARE ( ). TTY users should call If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at socialsecurity.gov, or call them at (TTY ). Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty). Date: January 1, 2017 Name of Entity/Sender: El Dorado County Contact: Heather Evans, Risk Management Address: 330 Fair Lane, Placerville, CA Phone Number: (530)

35 Key Terms MEDICAL/GENERAL TERMS Allowable Charge Balance Billing Coinsurance Copay Explanation of Benefits (EOB) Family Deductible Individual Deductible In-Network Out-of-Network Out-of-Pocket Maximum Preventive Care The negotiated amount that in-network providers have agreed to accept as full payment. A practice where out-of-network providers bill a member for charges that exceed the plan's allowable charge. The percentage cost share between the insurance carrier and a member. The dollar amount a member must pay directly to a provider at the time of service. The statement you receive from the insurance carrier that details how much the provider billed, how much the plan paid (if any) and how much you owe (if any). In general, you should not pay your provider until you have received this except for copays. The maximum dollar amount any one family will pay out in individual deductibles in a year. The dollar amount a member must pay each year before the plan will pay benefits for certain services. Services received from providers (doctors, hospitals, etc.) who have agreed to limit their fees for health plan members to a negotiated allowable charge. Services received from providers (doctors, hospitals, etc.) who have not agreed to limit their fees to a negotiated allowable charge. Out-of-network benefits are usually lower and additional balance billing charges will apply whenever the provider charges more than the plan's allowable charge. That maximum amount that you will pay each year for covered services. A routine exam - usually yearly that may include a physical exam, immunizations and tests for cancer. PRESCRIPTION DRUG TERMS Brand Prescription Drug Dispense as Written (DAW) Maintenance Medications Non-Preferred Brand Drug A drug which is produced and distributed under patent protection with a trademarked name from a single drug manufacturer. A generic drug may be available if the patent has expired. A prescription that does not allow for substitution of an equivalent generic or similar brand drug. Medications taken on a regular basis for an ongoing condition. Examples of maintenance medications include oral contraceptives, blood pressure medication and asthma medications. A brand drug for which alternatives are available from either the insurance carrier's preferred brand drug or generic drug list. There is generally a higher copayment for a non-preferred brand drug.

36 Preferred Brand Drug Specialty Pharmacy Step Therapy A brand drug that an insurance carrier has selected for its preferred drug list. Preferred drugs are generally chosen based on a combination of their clinical effectiveness and their cost. Provide special drugs that are used to treat complex conditions such as multiple sclerosis, cancer and HIV/AIDS. The practice of beginning drug therapy for a medical condition with the most cost effective and safest drug therapy and progressing to other more costly or risky therapy, only if necessary. DENTAL TERMS Basic Services Diagnostic and Preventive Services Endodontics Implants Major Services Orthodontia Periodontics Pre-Treatment Estimate Basic services generally include coverage for fillings and oral surgery. Diagnostic and preventive services generally include services such as routine cleanings, oral exams, x-rays, sealants and fluoride treatments. Most plans limit the frequency of preventive exams and cleanings to two times a year. Commonly known as root canal therapy. Dental implants are surgically implanted replacements for the natural tooth root of missing teeth. Many dental plans do not cover implants. Generally include coverage for restorative dental work such as crowns, bridges, dentures, inlays and onlays. A benefit that is offered under some dental plans. It generally includes services for the treatment of alignment of the teeth. Orthodontia services are typically limited to a lifetime maximum. The diagnosis and treatment of gum disease. An estimate that the insurance company provides detailing how much they will pay for treatment. A pre-treatment estimate is not a guarantee of payment.

37 Member Services Express Scripts Prescription Drugs Websites Member Services Website Blue Shield PPO Plans Kaiser Permanente HMO Plans IMPORTANT CONTACT INFORMATION (855) (800) (800) Member Services Website Member Services Website Delta Dental Plan VSP Vision Plan (800) (800) Lincoln Financial - Life and Disability Insurance Member Services Website (800) Flexible Spending Accounts (HCRA and DCRA) Employee Benefit Specialists Website Bank of America Website Managed Health Network (MHN) Website OE3 Health Trust SDI/ California Paid Leave CalPERS (457 Retirement Plan) Nationwide ACO (457 Retirement Plan) Health Savings Accounts (HSA) MHN Employee Assistance Program Other Important Numbers (888) (866) bensol/logindisplay.jsp (800) (access code: eldorado) (800) (877) BE-THERE ( (800) ( (877) ( El Dorado County Contacts Risk Management Auditor-Controller s Office Benefits Website Address (530) (530) riskmanagement@edcgov.us

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39 HEALTH PLAN CONTRIBUTION RATES For employees in Local 1, OE3 and Probation (GE, PL, SU, TC, PR & CR) Effective January 1, 2017 Contributions are deducted over 24 pay periods FULL TIME 64+ HOURS (PER PAY PERIOD) PART TIME HOURS (PER PAY PERIOD) PART TIME HOURS (PER PAY PERIOD) EE ONLY EE+1 FAMILY EE ONLY EE+1 FAMILY EE ONLY EE+1 FAMILY Blue Shield PPO $1300 ABHP $ $ $1, $ $ $1, $ $ $1, EDC Admin Fee $9.49 $18.98 $28.47 $9.49 $18.98 $28.47 $9.49 $18.98 $28.47 Total $ $ $1, $ $ $1, $ $ $1, Employer $ $ $ $ $ $ $ $ $ Employee $90.29 $ $ $ $ $ $ $ $ EE ONLY EE+1 FAMILY EE ONLY EE+1 FAMILY EE ONLY EE+1 FAMILY Blue Shield PPO $200 $ $1, $1, $ $1, $1, $ $1, $1, EDC Admin Fee $9.49 $18.98 $28.47 $9.49 $18.98 $28.47 $9.49 $18.98 $28.47 Total $ $1, $1, $ $1, $1, $ $1, $1, Employer $ $ $1, $ $ $ $ $ $ Employee $ $ $ $ $ $ $ $ $ EE ONLY EE+1 FAMILY EE ONLY EE+1 FAMILY EE ONLY EE+1 FAMILY Kaiser HMO $ $ $ $ $ $ $ $ $ EDC Admin Fee $9.49 $18.98 $28.47 $9.49 $18.98 $28.47 $9.49 $18.98 $28.47 Total $ $ $ $ $ $ $ $ $ Employer $ $ $ $ $ $ $ $ $ Employee $66.08 $ $ $ $ $ $ $ $ EE ONLY EE+1 FAMILY EE ONLY EE+1 FAMILY EE ONLY EE+1 FAMILY Kaiser HMO $1300 ABHP $ $ $ $ $ $ $ $ $ EDC Admin Fee $9.49 $18.98 $28.47 $9.49 $18.98 $28.47 $9.49 $18.98 $28.47 Total $ $ $ $ $ $ $ $ $ Employer $ $ $ $ $ $ $ $ $ Employee $54.59 $ $ $ $ $ $ $ $ THESE RATES DO NOT INCLUDE THE RATES FOR THE MANDATORY VISION AND DENTAL PLANS. PLEASE SEE THE DENTAL AND VISION RATE CARD FOR THOSE RATES.

40 HEALTH PLAN CONTRIBUTION RATES For employees in bargaining units CA, CC & MA Effective January 1, 2017 Contributions are deducted over 24 pay periods FULL TIME 64+ HOURS PART TIME HOURS PART TIME HOURS (PER PAY PERIOD) (PER PAY PERIOD) (PER PAY PERIOD) EE ONLY EE+1 FAMILY EE ONLY EE+1 FAMILY EE ONLY EE+1 FAMILY Blue Shield PPO $1300 ABHP $ $ $1, $ $ $1, $ $ $1, EDC Admin Fee $9.49 $18.98 $28.47 $9.49 $18.98 $28.47 $9.49 $18.98 $28.47 Total $ $ $1, $ $ $1, $ $ $1, Employer $ $ $ $ $ $ $ $ $ Employee $ $ $ $ $ $ $ $ $ EE ONLY EE+1 FAMILY EE ONLY EE+1 FAMILY EE ONLY EE+1 FAMILY Blue Shield PPO $200 $ $1, $1, $ $1, $1, $ $1, $1, EDC Admin Fee $9.49 $18.98 $28.47 $9.49 $18.98 $28.47 $9.49 $18.98 $28.47 Total $ $1, $1, $ $1, $1, $ $1, $1, Employer $ $ $ $ $ $ $ $ $ Employee $ $ $ $ $ $ $ $ $ EE ONLY EE+1 FAMILY EE ONLY EE+1 FAMILY EE ONLY EE+1 FAMILY Kaiser HMO $ $ $ $ $ $ $ $ $ EDC Admin Fee $9.49 $18.98 $28.47 $9.49 $18.98 $28.47 $9.49 $18.98 $28.47 Total $ $ $ $ $ $ $ $ $ Employer $ $ $ $ $ $ $ $ $ Employee $ $ $ $ $ $ $ $ $ EE ONLY EE+1 FAMILY EE ONLY EE+1 FAMILY EE ONLY EE+1 FAMILY Kaiser HMO $1300 ABHP $ $ $ $ $ $ $ $ $ EDC Admin Fee $9.49 $18.98 $28.47 $9.49 $18.98 $28.47 $9.49 $18.98 $28.47 Total $ $ $ $ $ $ $ $ $ Employer $ $ $ $ $ $ $88.72 $ $ Employee $95.54 $ $ $ $ $ $ $ $ NOTE: Employees receive $6,000 over 24 pay periods in Optional Benefit credits, which can be used to offset employee contributions. (24 pay periods at $250 each) NOTE: Employees receive $4,500 over 24 pay periods in Optional Benefit credits, which can be used to offset employee contributions. (24 pay periods at $188 each) THESE RATES DO NOT INCLUDE THE RATES FOR THE MANDATORY VISION AND DENTAL PLANS. PLEASE SEE THE DENTAL AND VISION RATE CARD FOR THOSE RATES. NOTE: Employees receive $3,000 over 24 pay periods in Optional Benefit credits, which can be used to offset employee contributions. (24 pay periods at $125 each)

41 HEALTH PLAN CONTRIBUTION RATES For employees in bargaining units SA Effective January 1, 2017 Contributions are deducted over 24 pay periods FULL TIME 64+ HOURS EE ONLY EE+1 FAMILY Blue Shield PPO $1300 ABHP $ $ $1, EDC Admin Fee $9.49 $18.98 $28.47 Total $ $ $1, Employer $ $ $ Employee $ $ $ EE ONLY EE+1 FAMILY Blue Shield PPO $200 $ $1, $1, EDC Admin Fee $9.49 $18.98 $28.47 Total $ $1, $1, Employer $ $ $ Employee $ $ $ EE ONLY EE+1 FAMILY Kaiser HMO $ $ $ EDC Admin Fee $9.49 $18.98 $28.47 Total $ $ $ Employer $ $ $ Employee $ $ $ EE ONLY EE+1 FAMILY Kaiser HMO $1300 ABHP $ $ $ EDC Admin Fee $9.49 $18.98 $28.47 Total $ $ $ Employer $ $ $ Employee $95.54 $ $ NOTE: Employees receive $4,108 over 24 pay periods in Optional Benefit credits, which can be used to offset employee contributions. (24 pay periods at $ each) THESE RATES DO NOT INCLUDE THE RATES FOR THE MANDATORY VISION AND DENTAL PLANS.

42 HEALTH PLAN CONTRIBUTION RATES For employees in bargaining units CO, EL, SM, UM & UD Effective January 1, 2017 Contributions are deducted over 24 pay periods FULL TIME 64+ HOURS PART TIME HOURS PART TIME HOURS (PER PAY PERIOD) (PER PAY PERIOD) (PER PAY PERIOD) EE ONLY EE+1 FAMILY EE ONLY EE+1 FAMILY EE ONLY EE+1 FAMILY Blue Shield PPO $1300 ABHP $ $ $1, $ $ $1, $ $ $1, EDC Admin Fee $9.49 $18.98 $28.47 $9.49 $18.98 $28.47 $9.49 $18.98 $28.47 Total $ $ $1, $ $ $1, $ $ $1, Employer $ $ $ $ $ $ $ $ $ Employee $ $ $ $ $ $ $ $ $ EE ONLY EE+1 FAMILY EE ONLY EE+1 FAMILY EE ONLY EE+1 FAMILY Blue Shield PPO $200 $ $1, $1, $ $1, $1, $ $1, $1, EDC Admin Fee $9.49 $18.98 $28.47 $9.49 $18.98 $28.47 $9.49 $18.98 $28.47 Total $ $1, $1, $ $1, $1, $ $1, $1, Employer $ $ $ $ $ $ $ $ $ Employee $ $ $ $ $ $ $ $ $ EE ONLY EE+1 FAMILY EE ONLY EE+1 FAMILY EE ONLY EE+1 FAMILY Kaiser HMO $ $ $ $ $ $ $ $ $ EDC Admin Fee $9.49 $18.98 $28.47 $9.49 $18.98 $28.47 $9.49 $18.98 $28.47 Total $ $ $ $ $ $ $ $ $ Employer $ $ $ $ $ $ $ $ $ Employee $ $ $ $ $ $ $ $ $ EE ONLY EE+1 FAMILY EE ONLY EE+1 FAMILY EE ONLY EE+1 FAMILY Kaiser HMO $1300 ABHP $ $ $ $ $ $ $ $ $ EDC Admin Fee $9.49 $18.98 $28.47 $9.49 $18.98 $28.47 $9.49 $18.98 $28.47 Total $ $ $ $ $ $ $ $ $ Employer $ $ $ $ $ $ $90.72 $ $ Employee $91.54 $ $ $ $ $ $ $ $ NOTE: Employees receive $6,000 over 24 pay periods in Optional Benefit credits, which can be used to offset employee contributions. (24 pay periods at $250 each) NOTE: Employees receive $4,500 over 24 pay periods in Optional Benefit credits, which can be used to offset employee contributions. (24 pay periods at $188 each) THESE RATES DO NOT INCLUDE THE RATES FOR THE MANDATORY VISION AND DENTAL PLANS. PLEASE SEE THE DENTAL AND VISION RATE CARD FOR THOSE RATES. NOTE: Employees receive $3,000 over 24 pay periods in Optional Benefit credits, which can be used to offset employee contributions. (24 pay periods at $125 each)

43 ACA COMPLIANT PLAN* Effective January 1, 2017 Contributions are deducted over 24 pay periods EE ONLY EE+1 FAMILY Blue Shield PPO $2000 ABHP $ $ $ EDC Admin Fee $9.49 $18.98 $28.47 Total $ $ $1, Employer $ $ $ Employee $45.66 $ $ THESE RATES DO NOT INCLUDE THE RATES FOR THE MANDATORY VISION AND DENTAL PLANS. PLEASE SEE THE DENTAL AND VISION RATE CARD FOR THOSE RATES. *THIS IS A COUNTY SPONSORED HEALTH PLAN THAT MEETS BOTH THE MINIMUM ESSENTIAL COVERAGE (MEC) AND AFFORDABILITY REQUIREMENTS OF THE AFFORDABLE CARE ACT (ACA)

44 DENTAL & VISION CONTRIBUTION RATES Effective January 1, 2017 Contributions are deducted over 24 pay periods Participation in the Dental and Vision plans is mandatory when participating in a County sponsored health plan. FULL TIME 64+ HOURS (PER PAY PERIOD) (PER PAY PERIOD) (PER PAY PERIOD) For employees in Local 1, OE3 For employees in Local 1, OE3 For employees in Local 1, OE3 and Probation and Probation and Probation EE ONLY EE+1 FAMILY EE ONLY EE+1 FAMILY EE ONLY EE+1 FAMILY DELTA DENTAL PPO+PREMIER $27.14 $48.85 $67.85 $27.14 $48.85 $67.85 $27.14 $48.85 $67.85 VSP CHOICE $2.29 $4.58 $7.37 $2.29 $4.58 $7.37 $2.29 $4.58 $7.37 Total $29.43 $53.43 $75.22 $29.43 $53.43 $75.22 $29.43 $53.43 $75.22 Employer $23.55 $42.75 $60.18 $17.66 $32.06 $45.14 $11.78 $21.38 $30.09 Employee $5.88 $10.68 $15.04 $11.77 $21.37 $30.08 $17.65 $32.05 $45.13 For employees in bargaining For employees in bargaining For employees in bargaining units CA, CC & MA units CA, CC & MA units CA, CC & MA EE ONLY EE+1 FAMILY EE ONLY EE+1 FAMILY EE ONLY EE+1 FAMILY DELTA DENTAL PPO+PREMIER $27.14 $48.85 $67.85 $27.14 $48.85 $67.85 $27.14 $48.85 $67.85 VSP CHOICE $2.29 $4.58 $7.37 $2.29 $4.58 $7.37 $2.29 $4.58 $7.37 Total $29.43 $53.43 $75.22 $29.43 $53.43 $75.22 $29.43 $53.43 $75.22 Employer $19.13 $34.73 $48.90 $14.35 $26.05 $36.68 $9.57 $17.37 $24.45 Employee $10.30 $18.70 $26.32 $15.08 $27.38 $38.54 $19.86 $36.06 $50.77 NOTE: Employees receive $6,000 over 24 pay periods in Optional Benefit credits, which can be used to offset employee contributions. (24 pay periods at $250 each) For employees in bargaining unit SA EE ONLY EE+1 FAMILY DELTA DENTAL PPO+PREMIER $27.14 $48.85 $67.85 VSP CHOICE $2.29 $4.58 $7.37 Total $29.43 $53.43 $75.22 Employer $19.13 $34.73 $48.90 Employee $10.30 $18.70 $26.32 NOTE: Employees receive $4,108 over 24 pay periods in Optional Benefit credits, which can be used to offset employee contributions. (24 pay periods at $ each) For employees in bargaining units PART TIME HOURS PART TIME HOURS CO, EL, SM, UM & UD CO, EL, SM, UM & UD CO, EL, SM, UM & UD EE ONLY EE+1 FAMILY EE ONLY EE+1 FAMILY EE ONLY EE+1 FAMILY DELTA DENTAL PPO+PREMIER $27.14 $48.85 $67.85 $27.14 $48.85 $67.85 $27.14 $48.85 $67.85 VSP CHOICE $2.29 $4.58 $7.37 $2.29 $4.58 $7.37 $2.29 $4.58 $7.37 Total $29.43 $53.43 $75.22 $29.43 $53.43 $75.22 $29.43 $53.43 $75.22 Employer $19.01 $34.48 $48.50 $14.26 $25.86 $36.38 $9.51 $17.24 $24.25 Employee $10.42 $18.95 $26.72 $15.17 $27.57 $38.84 $19.92 $36.19 $50.97 NOTE: Employees receive $6,000 over 24 pay periods in Optional Benefit credits, which can be used to offset employee contributions. (24 pay periods at $250 each) NOTE: Employees receive $4,500 over 24 pay periods in Optional Benefit credits, which can be used to offset employee contributions. (24 pay periods at $188 each) For employees in bargaining units NOTE: Employees receive $4,500 over 24 pay periods in Optional Benefit credits, which can be used to offset employee contributions. (24 pay periods at $188 each) NOTE: Employees receive $3,000 over 24 pay periods in Optional Benefit credits, which can be used to offset employee contributions. (24 pay periods at $125 each) For employees in bargaining units NOTE: Employees receive $3,000 over 24 pay periods in Optional Benefit credits, which can be used to offset employee contributions. (24 pay periods at $125 each)

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