HEALTH & WELLNESS BENEFITS SUMMARY. January 1, 2013 to December 31, 2013

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1 HEALTH & WELLNESS BENEFITS SUMMARY January 1, 2013 to December 31,

Notice of Privacy Practices City of Georgetown understands that information about you and your health is personal and we are committed to protecting this information.

The Notice of Privacy Practices also describes your rights and our obligations regarding the use and disclosure of this information.

2 Notice of Privacy Practices City of Georgetown understands that information about you and your health is personal and we are committed to protecting this information. City of Georgetown maintains a Notice of Privacy Practices that explains how we may disclose your health information. The Notice of Privacy Practices also describes your rights and our obligations regarding the use and disclosure of this information. Plans at a Glance This brochure is intended to provide a convenient summary of benefit plans. It is not intended to be a legal document. If there are any inconsistencies between the information in this brochure and the plan Summary of Benefit documents or contracts, the plan documents and contracts will prevail. 2

Table of Contents Customer Service 2 Carrier Information 3 Important Information 4 Things to Remember 5

100/70/50 Plan 12-18 Aetna Texas Savings Plus 3000 90% HSA Plan 19-25 HSA Information 26-29 Aetna Extras

Assurant Voluntary Short-Term Disability (STD) 42-43 Assurant Long-Term Disability (LTD) 44-45 Employee

you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a

3 Table of Contents Customer Service 2 Carrier Information 3 Important Information 4 Things to Remember 5 Eligibility and Enrollment 6 Terms and Descriptions 7 Rates and Premiums 8-11 Aetna Texas Savings Plus /70/50 Plan Aetna Texas Savings Plus % HSA Plan HSA Information Aetna Extras Whiteglove Housecall Health MetLife Dental Block Vision 39 Assurant Voluntary Life Assurant Voluntary Short-Term Disability (STD) Assurant Long-Term Disability (LTD) Employee Assistance Program Explanation of Benefits 48 Medicare D Notice CHIPRA Notice 52 Cobra 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 prescription drug coverage. Please see pages for more details. 3

The BeneTex Group, A Division of Gallagher Benefit Services, Inc. We are here to help! The BeneTex Group/City of Georgetown are here to act as a liaison in your dealings with insurance carriers.

4 The BeneTex Group, A Division of Gallagher Benefit Services, Inc. We are here to help! The BeneTex Group/City of Georgetown are here to act as a liaison in your dealings with insurance carriers. If you are having problems getting claims paid or have questions regarding your coverage, let us deal with the insurance company for you. Please contact anyone listed below with questions regarding your employee benefits package. The BeneTex Group Monday thru Friday 9:00 a.m. to 5:00 pm Phone (Main number) Fax: Account Manager Account Manager Benefit Specialist Unit Manager (Claims) City of Georgetown Kevin Russell Director of HR & Civil Service Kevin.Russell@georgetown.org Sandra Quintanilla Cell sandra_quintanilla@ajg.com Jennifer McDonald jennifer_mcdonald@ajg.com Sherrie Johnson sherrie_johnson@ajg.com Civil Service; Policy Interpretation; Exit Interviews; Compensation Reviews City of Georgetown (continued) Laura Maloy Assistant HR Director Laura.Maloy@georgetown.org Elizabeth Jones HR Generalist Elizabeth.Jones@georgetown.org Rudy Villarreal HR Generalist Rudy.Villarreal@georgetown.org Carina Reason HR Generalist Carina.Reason@georgetown.org Employee Relations: Finance Administration, Management Services; Compensation Benefits & COBRA Coverage, ICMA Flexible Spending Accounts/Health Savings Account; FMLA Requests; City-Wide Wellness Program Employee Relations: Police & Fire Departments; Civil Service Program Administration Employee Relations: Community Services, Community Development; Job Audit / Position Upgrades & Job Descriptions PAFs / Salary Ranges / Pay Grades; Training Needs; Job Postings / Employment Advertising; Employee Evaluations; TMRS Employee Relations: GUS; City Claims Processing; Workers Compensation; City-Wide Safety Program Cynthia Nguyen Administrative Assistant III (HR Main Phone Line) Cynthia.Nguyen@georgetown.org Celina Morales Administrative Assistant I (HR Main Phone Line) Celina.Morales@georgetown.org Application Processing; Employment Verifications; Review of Employee Files; Safety Glasses The following pages give a brief description of the benefit plans, eligibility requirements and the specific benefits available to you. City of Georgetown provides several categories of benefits from which employees may choose to participate: Healthcare. Medical, Dental, Vision Life Insurance. Voluntary Life and AD&D Disability. Voluntary Short-Term Disability STD) and Long-Term Disability (LTD) Insurance Additional Benefits. Employee Assistance Program 2

5 Benefit Plans & Carrier Contacts New employees of City of Georgetown are eligible for benefits on the 1st of the month following date of hire. The following benefits are offered through Aetna: Medical Plans and Prescription Drugs Customer Service Provider Listing The following benefits are offered through MetLife: Dental Customer Service The following benefits are offered through Block Vision: Vision Customer Service The following benefits are offered through Assurant: Voluntary Life & AD&D, Voluntary STD, and LTD Customer Service Provider Listing The following benefits are offered through Alliance: Employee Assistance Program Customer Service The following benefits are offered through Allstate: Allstate Ancillary Products Cancer/Critical Illness/Off Job Accident Michaela Castro Walter Sprang The following benefits are offered through IDTSOA: ID Theft Coverage/Legal Shield Coverage Customer Service Provider Listing

6 Important Information Benefit Choices That Fit Your Needs Your benefit selections are a reflection of your lifestyle. When making your selections, it is important to determine which benefit plans are most appropriate for you and your family. To do this, consider the following: How much will my monthly employee contributions be? How often will I use the plan? care needs do I or my family have? Where will my children receive the best coverage? Do they have special health care needs, for example a newborn baby who will need routine exams and immunizations? Do I have preferred doctors and/or hospitals? Am I willing to pay more to use them if they are not in the network? Will I have significant out-of-pocket expenses that could be paid through a flexible spending account? Contributing to Your Benefits City of Georgetown pays a portion of your medical and dental premiums, and all of your long-term disability premiums. You are responsible for your vision, STD and supplemental life coverage. Changing Your Benefit Elections Outside of Open Enrollment You may change your benefit elections once a year during the annual open enrollment period. The only other time you may change your elections is if you have a change in family status or qualify for a HIPAA special enrollment provision. Special Enrollment Provisions-HIPAA Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), a special enrollment period for medical insurance may be available if you lose medical coverage under certain conditions or when you acquire a new dependent by marriage, birth, or adoption. If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance coverage, you may in the future be able to enroll yourself or your dependents in this plan, provided that you request enrollment within 31 days after your other coverage ends. In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents, provided that you request enrollment within 31 days after the marriage, birth, adoption, or placement for adoption. HEALTH CARE COVERAGES City of Georgetown provides you and your eligible dependents with health care options. When you enroll, you may select medical, dental or vision coverage. Medical Coverage City of Georgetown allows you to choose from two medical plans: a PPO medical plan offered by Aetna. A Preferred Provider Organization (PPO) offers a combination of in and out-of-network providers. In-network doctors and facilities have agreed to offer services at reduced, contracted fees. Members have the ability to see out-of-network providers at a much higher cost-share. A HDHP-HSA plan is a tax-favored account used in conjunction with a qualifying health plan. The HSA plan offers lower premiums vs. traditional PPO plans. Restrictions To receive in-network benefits, you must use Aetna Choice Open Access Network of physicians and facilities. Out-of-Pocket Costs There are annual deductibles, co-pays and coinsurance. If you visit facilities and providers within the network, you will typically benefit from lower costs. 4

7 Things to Remember Be sure that all providers (doctors, labs, x-rays, etc.) participate in-network for the best coverage. The choices you make now will remain in effect until the next open enrollment period, unless you experience a family status change. This book highlights some of the main features of your benefit programs, but does not include all plan rules, features, limitations or exclusions. The terms of your benefit plans are governed by legal documents, including insurance contracts. Should there be any inconsistencies between this book and the legal plan documents, the plan documents are the final authority. City of Georgetown reserves the right to change or discontinue its benefit plans at any time. Pre-Existing Condition Limitation Notice Pre-Existing Condition Limitations do not apply to current City of Georgetown employees who have been enrolled on the health plan for 12 months. They also do not apply to pregnancy and children up to age 19. mastectomy to provide coverage for certain reconstructive services. This law also requires that written notice of the availability of the coverage be delivered to all plan participants upon enrollment and annually thereafter. This language serves to fulfill that requirement for this year. These services include: Reconstruction of the breast upon which the mastectomy has been performed; Surgery/reconstruction of the other breast to produce a symmetrical appearance; Prostheses; and Treatment for physical complications during all stages of mastectomy, including lymph edemas. In addition, the plan may not: Offer inducements to the healthcare provider, or assess penalties against the provider, in an attempt to interfere with the requirements of the law. However, the plan may apply deductibles, coinsurance, and co-payments consistent with other coverage provided by the plan. 5

8 Eligibility & Enrollment You are eligible if you are a regular full-time employee regularly scheduled to work at least 30 hours a week. Individuals may make changes or add dependents without having to provide proof of insurability during the open enrollment period. Open enrollment applies to Medical, Dental, Vision, Life/AD&D, Voluntary Life, Short- Term Disability, and Long-Term Disability. Some of these may be subject to medical underwriting. The open enrollment period is the only time employees may enroll in the above listed coverage without the occurrence of a qualifying event (see definition below). You and/or your dependents will receive a HIPAA Certificate of Creditable Coverage at termination from your previous carrier to provide proof of prior coverage. Making Enrollment Changes During the Year In most cases, your benefit elections will remain in effect for the entire plan year (January 1, 2013 thru December 31, 2013). During the annual enrollment period you have the opportunity to review your benefit elections and make changes for the coming year. You may only make changes to your elections during the year if you have one of the following status changes: Marriage, divorce or legal separation; Gain or loss of an eligible dependent for reasons such as birth, adoption, court order, disability, death, reaching the dependent child age limit; Significant changes in employment or employer-sponsored benefit coverage that affect Your benefit change must be consistent with your change in family status. IRS regulations require that for enrollment due to the qualifying events above, change forms must be submitted to your benefits office within 30 days of that qualifying event. Beginning April 1, 2009 group health plans must permit employees and their dependents coverage under two scenarios: loss of eligibility. The employee or dependent becomes eligible for group health plan premium assistance Employees have 60 days from the time of either of these two events to submit change forms to their plan sponsor. Contact your Human Resources office for these forms. 6

Reasonable & Customary (R&C) and/or Usual & Customary (U&C) When using out-of-network providers for medical or dental or benefits, payments from insurance carriers are based on what is considered

9 Reasonable & Customary (R&C) and/or Usual & Customary (U&C) When using out-of-network providers for medical or dental or benefits, payments from insurance carriers are based on what is considered reasonable. Everything not included as member is not credited for any of these expenses towards their deductible or coinsurance maximums. Benefit Payments For benefits received in the Network, you are responsible only for your co-payment or deductible amount and coinsurance. Your provider will file the claim. Benefits for Non- Network visits are payable on a reimbursement basis only. You can be subject to additional charges over the reasonable and customary allowed amount. Co-payment Terms & Descriptions Co-payments for office visits and prescription drugs do not count toward the deductible or out-of-pocket maximum. Calendar Year Deductible/Out-of-Pocket Maximum Expenses incurred towards your deductible and your out-of-pocket maximum are credited on a calendar year basis. A calendar year is January 1st - December 31st. Your deductible and out-of-pocket maximum will restart January 1st each year, regardless of the expenses you incurred in the prior calendar year or when your annual open enrollment period occurs. Your children are eligible for coverage on your medical plan until the age of 26, regardless of marital, student or financial status. Unmarried children are eligible for dental and life plans until the age of 25. 7

10 Rates & Premiums Texas Savings Plus 3000 Regular Employees Type of Coverage Total Premium Employer Pays Employee Pays Employee $ $ $0 Employee & Spouse $ $ $ Employee & Child(ren) $ $ $68.80 Employee & Family $1, $ $ Texas Savings Plus 3000 Retired Employees Type of Coverage Total Premium Employer Pays Employee Pays Employee $ $0 $ Employee & Spouse $ $0 $ Employee & Child(ren) $ $0 $ Employee & Family $1, $0 $1, Texas Savings Plus 3000 HSA Regular Employees Type of Coverage Total Premium Employer Pays Employee Pays Employee $ $ $0 Employee & Spouse $ $ $ Employee & Child(ren) $ $ $24.70 Employee & Family $1, $ $ Texas Savings Plus 3000 HSA Retired Employees Type of Coverage Total Premium Employer Pays Employee Pays Employee $ $0 $ Employee & Spouse $ $0 $ Employee & Child(ren) $ $0 $ Employee & Family $1, $0 $1,

11 Rates & Premiums MetLife Dental Plan Regular Employees Type of Coverage Total Premium Employer Pays Employee Pays Employee $31.82 $31.82 $0 Employee & Spouse $65.34 $46.82 $18.52 Employee & Child(ren) $68.70 $46.82 $21.88 Employee & Family $97.72 $51.82 $45.90 MetLife Dental Plan Retired Employees Type of Coverage Total Premium Employer Pays Employee Pays Employee $31.82 $0 $31.82 Employee & Spouse $65.34 $0 $65.34 Employee & Child(ren) $68.70 $0 $68.70 Employee & Family $97.72 $0 $97.72 Block Vision Plan Regular Employees Type of Coverage Total Premium Employer Pays Employee Pays Employee $6.66 $0 $6.66 Employee & Spouse $11.36 $0 $11.36 Employee & Child(ren) $12.00 $0 $12.00 Employee & Family $18.00 $0 $18.00 Block Vision Plan Retired Employees Type of Coverage Total Premium Employer Pays Employee Pays Employee $6.66 $0 $6.66 Employee & Spouse $11.36 $0 $11.36 Employee & Child(ren) $12.00 $0 $12.00 Employee & Family $18.00 $0 $

12 Voluntary Life & AD&D Monthly Premiums 10

13 Rates & Premiums Voluntary STD Monthly Premium Deductions Voluntary LTD Monthly Premium Deductions This plan is 100% Employer-paid 11

14 Aetna Texas Savings Plus 3000 TIER 1: TIER 2 : TIER 3: 12

15 Aetna Texas Savings Plus

16 Aetna Texas Savings Plus

17 Aetna Texas Savings Plus

18 Aetna Texas Savings Plus

19 Aetna Texas Savings Plus

20 Aetna Texas Savings Plus

21 Aetna Texas Savings Plus 3000 HSA 19

22 Aetna Texas Savings Plus 3000 HSA 20

23 Aetna Texas Savings Plus 3000 HSA 21

24 Aetna Texas Savings Plus 3000 HSA 22

25 Aetna Texas Savings Plus 3000 HSA 23

26 Aetna Texas Savings Plus 3000 HSA 24

Description Provided by Benefit Assurant Employee Benefits Eligibility All full-time active employees working 30 or more hours per week.

27 Long-Term Disability (LTD) Aetna Texas Savings Plus 3000 HSA A Long-Term Disability policy is also available for eligible employees. Long-term disability is intended to help continue your income if you become unable to work due to illness or injury. Description Provided by Benefit Assurant Employee Benefits Eligibility All full-time active employees working 30 or more hours per week. Maximum benefit amount 60% of basic covered monthly pay up to a maximum of $8,000 per month. Elimination period 90 days Maximum benefit duration For disabilities occurring before age 60, Social Security Normal Retirement Age This plan summary is provided to help you understand your insurance coverage. If the terms of this plan summary and the policy differ, the policy will govern. 25

WHAT IS AN HDHP? A High-Deductible Health Plan (HDHP) is a major medical health insurance plan that has a lower premium than traditional health plans.

28 WHAT IS AN HDHP? A High-Deductible Health Plan (HDHP) is a major medical health insurance plan that has a lower premium than traditional health plans. Your HDHP: Is a major-medical health plan that is HSA-compatible. That means it can be used with a health savings account. Has a higher annual deductible with lower monthly premiums paycheck and more to add to your HSA. Covers 100% of preventive care, including annual physicals, immunizations, well-woman and well-child exams, and more all without having to meet your deductible. Provides coverage for health screenings, such as blood pressure, cholesterol, diabetes, vision, hearing and more. 26

29 WHAT IS AN HSA? A Health Savings Account (HSA), is a unique tax-advantaged account that you can use to pay for current or future health- A tax-advantaged savings account that you use to pay for eligible medical expenses as well as deductibles, coinsurance, prescriptions, vision and dental care. Unused funds that will roll over year to year Potential to build more savings through investing. You can choose from a variety of HSA self-directed investment options with no minimum balance required. Additional retirement savings. After age 65, funds can be withdrawn for any purpose without penalty. 27

An HSA provides triple tax savings by reducing your Fed- Contributions to your HSA can be made with pre-tax dollars, which reduces your

30 HOW DOES A HDHP & HSA WORK? While paying lower premiums for your HDHP, you can put those savings into your HSA. You can use your HSA funds to pay for eligible healthcare expenses until you meet your annual deductible. An HSA provides triple tax savings by reducing your Fed- Contributions to your HSA can be made with pre-tax dollars, which reduces your taxable income Any after-tax contributions that you make to y our HSA are tax deductible. HSA funds earn interest tax free and when used for eligible healthcare expenses are also free from tax. 28

2016 Open Enrollment Presentation

2016 Open Enrollment Presentation Agenda Provider Changes Open Enrollment Information Compass Professional Health Services Explanation of each benefit plan Health Savings Accounts (HSA) Premiums Gallagher