DENVER EMPLOYEES RETIREMENT PLAN RETIREE BENEFITS GUIDE

DENVER EMPLOYEES RETIREMENT PLAN 2018 RETIREE BENEFITS GUIDE

Table of Contents WELCOME LETTER 3 BENEFITS ELIGIBILITY AND ENROLLMENT 6 KEY TERMS 7 BENEFIT PLAN COSTS 8 MEDICAL PLANS 9 DENTAL PLANS 15 VISION PLAN 17 ADDITIONAL USEFUL INFORMATION 18 FREQUENTLY REQUESTED CONTACTS 19 This is a summary of s drafted in plain language to assist a retiree s understanding of what s are offered, and does not constitute a policy. Detailed provisions are contained in each provider s plan document. If there is a discrepancy between what is presented here and the official plan documents, the plan documents will govern. 2

A MESSAGE FROM THE DERP MEMBERSHIP SERVICES STAFF Dear Member: The annual insurance Open Enrollment period for the Denver Employees Retirement Plan (DERP) is quickly approaching. To help you prepare, DERP will once again hold an Open Enrollment Benefit Fair. This year s fair will be held on Monday, October 2, 2017 from 8 a.m. to 1 p.m. at the Denver Botanic Gardens. The DERP staff is excited to announce several enhancements to our Benefit Fair: Continental Breakfast and Social Event - Join the DERP staff and your fellow retirees for a complimentary light breakfast from 8 a.m. to 9 a.m. Please RSVP for this event by calling DERP at (303) 839-5419, no later than Thursday, September 28th. Flu Shots - Walgreens will have staff attending the Benefit Fair to provide flu shots to our retirees and their covered dependents who are covered on a medical insurance plan with Denver Health, Humana, or United Healthcare. If you or your dependents are enrolled in a medical plan with Denver Health, Humana, or United Healthcare, please be sure to bring your insurance ID card and get your flu shot at no charge. When you call DERP to RSVP for the Benefit Fair, please let us know if you also plan to get a flu shot. Unfortunately, Kaiser Permanente is not able to provide flu shots at our event to our Kaiser members and their dependents. Kaiser encourages its members to visit a Kaiser facility to receive their annual flu shot. Please speak with a Kaiser representative at the Benefit Fair if you have any questions about this. Members will have time to visit with our insurance carriers to ask questions regarding their s before and after the formal presentations. Insurance carriers will present information about their plans with a focus on wellness initiatives. The DERP Membership Services team will also be in attendance to answer questions and help members make changes to their insurance for the upcoming year. As was the case for 2017, DERP is pleased to announce that there are no plan design changes to any medical, dental, or vision plans for 2018. There are, however, premium increases for each of the medical plans. Please review the Benefits Guide for details on the monthly cost of each plan in 2018. The updated premiums will be deducted from your monthly retirement beginning January 1, 2018. Beginning October 1, 2017, those members wanting to make changes to insurance for 2018 may do so on-line via DERP s Member Self-Service Portal. Login to www.myderp.org, select the Insurance Enrollment link on the left hand side of the screen, and follow the instructions on the screens to make your insurance selections. Please note that you can make and submit your selections on-line only once during each annual Open Enrollment period. If you make changes on-line, submit them, and then change your mind about what you have selected, you will need to contact the Membership Services team and we will be happy to assist you with making any corrections. 3

A MESSAGE FROM THE DERP MEMBERSHIP SERVICES STAFF All insurance change requests for 2018 must be received by October 31, 2017. If you wish to remain on the plan(s) you are currently enrolled in, you do not need to take any action to continue your coverage. DERP has not yet been provided with the rates for the Kaiser Permanente plans located in California, Hawaii, Mid-Atlantic States, Northwest Oregon, and Southwest Washington. As soon as those rates are available, they will be posted on the DERP website, www.derp.org, and the rates will be mailed to those plans current subscribers. We hope that you find our new and improved Benefits Guide a valuable resource. Please keep this guide for the year, as it provides useful information about the insurance plans, as well as various contact information frequently requested by our members. Remember to RSVP by September 28th and let us know if you ll be joining us on October 2nd for breakfast, and if you want to receive a flu shot. The DERP Membership Services team is here to help you during this time. If you have any questions, please call the DERP office at (303) 839-5419 or email us at mbrsvs@derp.org. You can also schedule an appointment with a DERP Membership Services Representative to help you understand your insurance options so you can make the best decision for you and your dependents. Sincerely, DERP Membership Services 4

5 Notes:

Who is eligible to enroll in insurance through DERP? DERP recipients and their eligible dependents may enroll in medical, dental, and/or vision insurance with DERP. A recipient is someone receiving a monthly from DERP. The recipient must be enrolled in insurance in order for any dependents to be enrolled. If the recipient is enrolled, he/she may enroll the following dependents:»» Spouse, including those defined as common-law and same-sex legally married 03 Benefits Eligibility and Enrollment»» Children to age 26, regardless of student, marital, or tax-dependent status (including a stepchild, legally-adopted child, or a child for whom you are the legal guardian)»» Dependent children of any age who are physically or mentally unable to care for themselves When adding dependents, supporting documents are required to prove dependency. Acceptable dependent documentation includes:»» Spousal Verification Copy of a marriage certificate, common-law affidavit, or the first page of the most currently filed federal tax return will be accepted.»» Child Verification Copy of a certified birth certificate issued by the state, city, or county, Guardianship paperwork, adoption paperwork, or a letter from the child s physician indicating physical or mental incapacity will be accepted. When can I enroll, change plans, or add dependents? AT OPEN ENROLLMENT AS A NEW RETIREE DURING THE YEAR WHEN: During the annual open enrollment period each October. Any newly elected s or changes made to existing s during the open enrollment period become effective on January 1 of the following year. HOW: If you have computer access, you can log into your Member Self-Service Portal account at www.myderp.org, click on Insurance Enrollment and follow the steps to complete and submit any changes. WHEN: Within the first 30 days of receiving a monthly from DERP, members may elect to enroll in insurance. In most cases, insurance elections are effective when the monthly becomes effective. HOW: Insurance enrollment is typically part of the retirement application process. There is also an insurance enrollment form found at www.derp.org that can be completed and returned to the DERP office within 30 days of s commencement. WHEN: Within 30 days of a qualifying life event such as Medicare eligibility, marriage, divorce, or gain/loss of other coverage. HOW: If you experience a qualifying life event, please contact a DERP Membership Services Representative as soon as possible and within the 30-day qualification period. Our staff will work with you to get the proper paperwork and supporting documentation to process any insurance change due to a qualifying life event. If you do not have computer access, DERP staff can mail the appropriate form to you for completion. Completed forms must be returned to DERP no later than October 31. Forms can be returned via US Mail, fax, or scanned and emailed to the Membership Services staff. If you are adding insurance coverage anytime other than when first eligible or during the annual open enrollment period, the effective date of your insurance coverage through DERP must coincide with the end of your other coverage. WE ARE HERE TO HELP YOU ENROLL AND MAKE BENEFIT SELECTIONS THAT ARE RIGHT FOR YOU. w: www.myderp.org p: (303) 839-5419 e: mbrsvs@derp.org 6

04 Key Terms Coinsurance After you meet your deductible, you pay coinsurance, which is your share of the costs of a covered health care service. For example, if the health plan s allowed amount for lab work is $100 and your coinsurance is 20%, once you meet your deductible, you will pay 20% of $100, which is $20. The health plan will pay the remaining amount ($80). Copayment or copay A fixed dollar amount that you pay for a covered health service. Typically, your copay is due up front at the time of service. For example, DHMO members pay a copay for office visits and prescription drugs (not subject to the deductible). Deductible The amount that you must pay each calendar year for covered health services before the insurance plan will begin to pay. Medical Emergency A medical condition that requires immediate medical attention to prevent serious jeopardy to your health. Explanation of s (EOB) A statement from your health plan that lists the services you received and charges added toward your annual deductible and out-of-pocket maximum. An EOB is not a bill. Formulary Insurance Premium Reduction (IPR) Benefit Out-of-pocket maximum A list of covered prescription drugs. Also called preferred drug list. Includes both generic and brand-name drugs that you can receive through your medical plan. The amount DERP contributes toward insurance premiums. The IPR is based on a member s years of service and Medicare eligibility. If a member is not yet Medicare-eligible, DERP contributes $12.50 for each year of service, per month, toward premiums. For Medicare-eligible members, DERP contributes $6.25 for each year of service, per month, toward premiums. The most you will pay for covered health services during the calendar year. All copay, deductible, and coinsurance payments count toward the out-of-pocket maximum. Once you ve met your out-of-pocket maximum, your insurance plan will pay 100% of covered health services. PCP or Primary Care Physician The doctor who works with you and other doctors to provide, prescribe, approve, and coordinate your medical care and treatment. Our DHMO and HMO plans require you to see your PCP before you can see a specialist. Per occurrence deductible A fee Denver Health and UnitedHealthcare DHMO members pay for certain health services such as inpatient/ outpatient hospital services. Premium The amount that you pay out of your retirement in order to be enrolled in the medical, dental and/or vision insurance plans. Premiums are deducted on a post-tax basis. Preventive care Covered services that are intended to prevent disease or to identify disease while it is more easily treatable. Examples of preventive care services include screenings, check-ups and patient counseling to prevent illnesses, disease or other health problems. In-network preventive care is covered 100% by the medical plans. Specialist A doctor who has special training in a specific kind of medical care, such as a cardiologist or a neurologist. Members covered under DHMO or HMO plans will most likely have to receive referrals from PCP s to see a specialist. 7

Benefit Plan Costs Listed below are the monthly premiums for our insurance plans. The amount you pay for coverage is deducted from your retirement on a post-tax basis. These amounts do not include any Insurance Premium Reduction (IPR) that you may be entitled to receive from DERP. 05 Benefit Plan Costs NON-MEDICARE MEDICAL Member only Member + spouse Member + child(ren) Member + Family Denver Health Medical Plan HDHP $519.29 $1,142.43 $1,038.58 $1,661.72 Denver Health Medical Plan DHMO $693.78 $1,526.33 $1,387.57 $2,220.11 Kaiser Permanente Colorado HDHP $439.34 $966.55 $878.68 $1,405.68 Kaiser Permanente Colorado DHMO $544.68 $1,198.30 $1,089.36 $1,742.98 United Healthcare HDHP $684.26 $1,505.40 $1,368.55 $2,189.63 United Healthcare Navigate (Colorado only) $716.48 $1,576.27 $1,433.00 $2,293.14 MEDICARE MEDICAL Per Person Humana Medicare Advantage HMO $247.23 Humana Medicare Advantage PPO - Option M $300.25 Humana Medicare Advantage PPO - Option R $348.46 Kaiser Permanente Colorado Senior Advantage HMO $239.91 CIGNA DENTAL Member only Member + 1 dependent Member + 2 or more dependents Cigna DHMO $34.84 $70.08 $105.26 Cigna PPO Low $39.46 $78.19 $120.78 Cigna PPO High $51.58 $102.43 $158.36 DELTA DENTAL Member only Member + 1 dependent Member + 2 or more dependents Delta EPO $49.87 $92.61 $149.60 Delta PPO Low $43.25 $85.49 $132.30 Delta PPO High $58.01 $112.96 $179.12 VISION Member only Member + spouse Member + child(ren) Family VSP $4.97 $10.12 $9.33 $17.05 8

06 Medical Plans Comparing your medical plan options Non-Medicare Plans DERP offers six medical plan options through three carriers: Denver Health (DH), Kaiser Permanente (KP), and United Healthcare (UHC). All three carriers offer a high deductible health plan (HDHP) and a deductible HMO plan (DHMO). The main difference between an HDHP and a DHMO is how and when members pay for healthcare. Both HDHP and DHMO plans cover preventive care at 100%. With an HDHP, members will have a lower monthly premium and a higher deductible. HDHP enrollees will generally pay the full cost of all care until the annual deductible is reached. HDHP enrollees then pay coinsurance until the outof-pocket maximum is reached. HDHP enrollees can set up a health savings account (HSA) at a financial institution to help budget for out-of-pocket expenses. With a DHMO plan, members will have a higher monthly premium and a lower deductible. DHMO plan enrollees will pay for some services in the form of a copay and the full cost of other services until the annual deductible is reached. For deductible expenses, DHMO plan enrollees pay coinsurance after reaching the deductible. DHMO plan enrollees will continue to pay either copays or coinsurance until the out-of-pocket maximum is reached. Medicare Plans DERP offers four Medicare Advantage plans for our members and their dependents who are eligible for Medicare and are actively enrolled in Parts A and B of Medicare. We offer three plans with Humana and one plan with Kaiser Permanente. For all Medicare plans being offered, there are no changes in plan design from this year. The only thing changing is the premium you will pay each month. If you are enrolled in one of the Humana PPO plans, and you live in Colorado, Florida, or Arizona, you may want to consider switching to the Humana HMO plan. It s possible that your current primary care physician (PCP) is in the Humana HMO network. If so, the transition from the PPO to the HMO plan would be fairly seamless. Switching to the Humana HMO offers members a lower monthly premium and potential lower out-of-pocket expenses on items such as inpatient hospital stays, outpatient surgery, and prescription drugs. The Humana HMO is a traditional HMO plan where a member must select an in-network primary care physician (PCP) and that PCP works with you to handle your medical care. If you need to see specialists, then referrals from your PCP are required. If you want to see if the Humana HMO plan may work for you, please contact DERP Membership Services at (303) 839-5419 or Humana at (866) 396-8810. 9

2018 Denver Health Non-Medicare Plan Comparisons Annual Deductible DENVER HEALTH MEDICAL PLAN HDHP* DENVER HEALTH MEDICAL PLAN DHMO* Single $1,350 $500 Family $2,700 $1,500 Out-of-Pocket Maximum Single $2,700 per individual $3,000 per individual Family $5,400 per family $6,000 per family Preventive No Charge No Charge PCP Office Visit 10% after deductible $25 copay Specialist Office Visit 10% after deductible $50 copay Urgent Care 10% after deductible $75 copay Emergency Room 10% after deductible $300 copay Ambulance 10% after deductible 20% after deductible Inpatient Hospital 10% after deductible $150 and 20% coinsurance after deductible Physicians Fees for Surgical/Medical Services 10% after deductible 20% after deductible Outpatient Surgery 10% after deductible $150 and 20% coinsurance after deductible Lab and X-Ray 10% after deductible 20% after deductible MRI/CAT/CT/PET 10% after deductible $150 copay Mental Health/Substance Abuse Outpatient Services 10% after deductible $50 copay Physical, Occupational and Speech Therapy 10% after deductible; maximum of 20 visits per year $25 copay maximum of 20 visits per year Routine Vision Exams n/a $25 copay, one exam per 24 months Chiropractic 10% after deductible; maximum of 20 visits per year $50 copay maximum of 20 visits per year Durable Medical Equipment 10% after deductible; maximum of $ 2,000 per maximum of year $2,500 per year Oxygen and Oxygen Equipment Home Health Care Oxygen fully covered; 10% after deductible for equipment Fully covered for prescribed medically necessary services Oxygen fully covered; 20% after deductible for equipment maximum of 60 visits per year Hospice Care Fully covered 20% after deductible Skilled Nursing Facility Care Fully covered; maximum of 100 days per calendar year maximum of 60 days per year Hearing Aids $1,500 maximum every 5 years $2,500 maximum every five years Prescription Drugs 30 -day supply 30-day supply Generic $10 copay after deductible** $12 copay** Preferred Brand $15 copay after deductible** $40 copay** Non-Preferred Brand $30 copay after deductible** $50 copay** Prescription Drugs 90-day supply by mail 90-day supply by mail Generic $20 copay after deductible** $24 copay** Preferred Brand $30 copay after deductible** $80 copay** Non-Preferred Brand $60 copay after deductible** $100 copay** *NOTE: The Denver Health HDHP and DHMO plans also have s with its national Cofinity Network. The s are different than what is listed here. For detailed information on these coverages, please call our office and request a Denver Health brochure. **NOTE: The pharmacy copays for Denver Health are if you get your prescriptions filled at a Denver Health Pharmacy. If you get prescriptions filled at a Non-Denver Health Pharmacy, the copays are different. Please see DHMP brochure for details. To learn more about Denver Health visit www.denverhealthmedicalplan.org or call (303)602-2100. 10

2018 Kaiser Permanente Non-Medicare Plan Comparisons Annual Deductible KAISER PERMANENTE COLORADO HDHP KAISER PERMANENTE COLORADO DHMO Single $1,350 $500 Family $2,700 $1,500 Out-of-Pocket Maximum Single $2,700 per individual $3,000 per individual Family $5,400 per family $6,000 per family Preventive No Charge No Charge PCP Office Visit 20% after deductible $30 copay Specialist Office Visit 20% after deductible $50 copay Urgent Care 20% after deductible $75 copay Emergency Room 20% after deductible $200 copay Ambulance 20% after deductible 20% after deductible Inpatient Hospital 20% after deductible 20% after deductible Physicians Fees for Surgical/Medical Services 20% after deductible 20% after deductible Outpatient Surgery 20% after deductible 20% after deductible Lab and X-Ray 20% after deductible Lab: No Charge X-ray: 20% after deductible MRI/CAT/CT/PET 20% after deductible 20% after deductible Mental Health/Substance Abuse Outpatient Services 20% after deductible $30 copay Physical, Occupational and Speech Therapy maximum of 20 visits per year $30 copay maximum of 20 visits per year Routine Vision Exams 20% after deductible $30 copay per exam with Optometrist Chiropractic maximum of 20 visits per year $30 copay maximum of 20 visits per year Durable Medical Equipment 20% after deductible 20% after deductible Oxygen and Oxygen Equipment 20% after deductible 20% after deductible Home Health Care 20% after deductible 20% after deductible Hospice Care 20% after deductible No charge Skilled Nursing Facility Care maximum of 100 days per year maximum of 100 days per year Prescription Drugs 30 -day supply 30-day supply Generic $10 copay after deductible $20 copay Preferred Brand $35 copay after deductible $40 copay Non-Preferred Brand $60 copay after deductible $60 copay Prescription Drugs 90-day supply by mail 90-day supply by mail Generic 30$20 copay after deductible $40 copay Preferred Brand $70 copay after deductible $80 copay Non-Preferred Brand $120 copay after deductible $120 copay 11 To learn more about Kaiser Permanente visit my.kp.org/denvergov or call (303)338-4545.

2018 United Healthcare Non-Medicare Plan Comparisons Annual Deductible UNITED HEALTHCARE HDHP** UNITED HEALTHCARE NAVIGATE (COLORADO ONLY) Single $1,350 $500 Family $2,700 $1,500 Out-of-Pocket Maximum Single $2,700 per individual $3,000 per individual Family $5,400 per family $6,000 per family Preventive No Charge No Charge PCP Office Visit 20% after deductible $25 copay Specialist Office Visit 20% after deductible $50 copay Urgent Care 20% after deductible $75 copay Emergency Room 20% after deductible $300 copay Ambulance 20% after deductible 20% after deductible Inpatient Hospital 20% after deductible $150 and 20% coinsurance after deductible Physicians Fees for Surgical/Medical Services 20% after deductible 20% after deductible Outpatient Surgery 20% after deductible $75 and 20% coinsurance after deductible Lab and X-Ray 20% after deductible 20% after deductible MRI/CAT/CT/PET 20% after deductible $150 copay Mental Health/Substance Abuse Outpatient Services 20% after deductible $50 copay Physical, Occupational and Speech Therapy maximum of 20 visits per year $25 copay maximum of 20 visits per year Routine Vision Exams one exam per 24 months $25 copay, one exam per 24 months Chiropractic maximum of 20 visits per year $50 copay maximum of 20 visits per year Durable Medical Equipment 20% after deductible maximum of $2,500 per calendar year Oxygen and Oxygen Equipment See Durable Medical Equipment See Durable Medical Equipment Home Health Care maximum of 60 visits per year maximum of 60 visits per year Hospice Care 20% after deductible 20% after deductible Skilled Nursing Facility Care maximum of 60 visits per year maximum of 60 days per year Hearing Aids maximum of $2,500 maximum of $2,500 every three years every three years Prescription Drugs 30 -day supply 30-day supply Generic $10 copay after deductible $15 copay Preferred Brand $35 copay after deductible $45 copay Non-Preferred Brand $60 copay after deductible $60 copay Prescription Drugs 90-day supply by mail 90-day supply by mail Generic $25 copay after deductible $37.50 copay Preferred Brand $87.50 copay after deductible $112.50 copay Non-Preferred Brand $150 copay after deductible $150 copay **NOTE: The United Healthcare HDHP plan has a nationwide network as well as out-of-network s. The out-of-network s are different than what is listed here. For detailed information on these coverages, please call our office and request a United Healthcare brochure. To learn more about United Healthcare visit www.myuhc.com or call (800) 842-5520. 12

2018 Medicare Plan Summary HUMANA MEDICARE ADVANTAGE HMO* HUMANA MEDICARE ADVANTAGE PPO - OPTION M HUMANA MEDICARE ADVANTAGE PPO - OPTION R KAISER PERMANENTE COLORADO SENIOR ADVANTAGE HMO Annual Deductible N/A N/A $250 N/A Out-of-Pocket Maximum $3,000 $2,500 $3,500 $2,500 Preventive No Charge No Charge No Charge No Charge PCP Office Visit $15 copay $15 copay Deductible then $15 copay $15 copay Specialist Office Visit $30 copay $30 copay Deductible then $30 copay $30 copay Urgent Care $30 copay $30 copay $30 copay $30 copay Emergency Room $65 copay $65 copay $75 copay $65 copay Ambulance 20% coinsurance up to $500 per trip Inpatient Hospital $300 copay $300 copay $50 copay Deductible then $50 copay Deductible then $150 copay per day for days 1-5 20% coinsurance up to $500 per trip $300 copay Outpatient Surgery $150 copay $125 copay Deductible then $200 copay $150 copay Lab Services No Charge No Charge Deductible then fully covered No charge MRI/CAT/CT/PET $100 copay $50 copay Deductible then $50 copay $100 copay Mental Health/Substance Abuse Inpatient Services Mental Health/Substance Abuse Outpatient Services Physical, Occupational and Speech Therapy Vision Care Chiropractic $300 copay $300 copay Deductible then $150 copay per day for days 1-5 $300 copay $30 copay $30 copay Deductible then $50 copay $15 copay $30 copay $30 copay Deductible then $40 copay $15 copay $30 copay per exam; Medicare covered services only; no routine exams $15 copay maximum of 20 visits per year $30 copay per exam; Medicare covered services only; no routine exams Deductible then $30 copay per exam; Medicare covered services only; no routine exams $20 copay Deductible then $20 copay $15-$30 copay per exam; Up to $200 materials every 2 years $15 copay maximum of 20 visits per year Durable Medical Equipment No Charge No Charge Deductible then no charge No charge Oxygen No Charge No Charge Deductible then no charge No charge Home Health Care No Charge No Charge Deductible then no charge No charge Hospice Care Skilled Nursing Facility Care Hearing Benefits Covered through Original Medicare No Charge; maximum of 100 days per calendar year $30 copay; Medicare covered services only Covered through Original Medicare $0 copay days 1-20; $50 copay per day days 21-100 $15 - $30 copay; Medicare covered services only Covered through Original Medicare Deductible then $0 copay days 1-20; $50 copay per day days 21-100 Deductible then $30 copay; Medicare covered services only Hearing Aids N/A N/A N/A Covered through Original Medicare No charge; maximum of 100 days per calendar year $15 copay $500 credit per ear every 36 months Prescription Drugs 30-day supply 30-day supply 30-day supply 30-day supply Generic $20 copay see schedule on next page* $15 copay $15 copay Preferred Brand $40 copay see schedule on next page* $30 copay $40 copay Non-Preferred Brand $40 copay see schedule on next page* $50 copay $40 copay Specialty $60 copay see schedule on next page* $80 copay $40 copay Prescription Drugs 90-day supply by mail 90-day supply by mail 90-day supply by mail 90-day supply by mail Generic $40 copay see schedule on next page* $25 copay $30 copay Preferred Brand $80 copay see schedule on next page* $75 copay $80 copay Non-Preferred Brand $80 copay see schedule on next page* $125 copay $80 copay Specialty N/A N/A N/A N/A 13

*Humana PPO Low Rx Plan (Option M) This prescription drug plan has different costs based on what phase a member is in. Initial Coverage Limit (ICL) Phase A member will be in the ICL Phase until the drug cost (the amount the member pays plus the amount Humana pays) reaches $3,750 during the calendar year. 30-day supply 90-day supply by mail Generic $5 copay $10 copay Preferred Brand $15 copay $30 copay Non-Preferred Brand $25 copay $50 copay Specialty $40 copay N/A Coverage Gap Phase A member will be in the Coverage Gap Phase after the ICL Phase amount is met. A member will remain in the Coverage Gap Phase until the member s drug cost reaches $5,000 during the calendar year. NOTE: Please refer to the Humana Evidence of Coverage for details on the Coverage Gap Phase. 30-day supply 90-day supply by mail Generic $5 copay $10 copay Preferred Brand 35% coinsurance 35% coinsurance Non-Preferred Brand 35% coinsurance 35% coinsurance Specialty 35% coinsurance N/A Catastrophic Phase A member will be in the Catastrophic Phase when the member's total drug cost exceeds $5,000 during the calendar year and will remain in this phase for the rest of the calendar year. 30-day Supply 90-day Supply by Mail Greater of $3.35 for generic/multiple source drugs ($8.35 for all others) or 5% coinsurance Greater of $3.35 for generic/multiple source drugs ($8.35 for all others) or 5% coinsurance 14

07 Dental Plans DERP has dental plan offerings through both Cigna and Delta Dental. Each carrier provides our members and their dependents three different options of dental coverage. A summary of covered services is listed for each plan. For more detailed information regarding dental s, please call the DERP Membership Services team at (303) 839-5419 and we will send detailed dental information to you. FIND A DENTIST To learn if a dentist participates in a network covered by either Cigna or Delta Dental, you can search each carrier s website: Cigna: www.cigna.com and click on the Find a Doctor link or call Customer Service at (800)-244-6224. Delta Dental: www.deltadentalco.com and click on the Find a Dentist link or call Customer Relations at (800) 610-0201. ID CARDS Cigna does not send out ID cards to members. Delta Dental does send out ID cards to members. However, an ID card is not required when you visit the dentist. Your dental office can confirm your coverage directly with Cigna and Delta Dental. Annual Deductible CIGNA Dental Plan Summary CIGNA DHMO CIGNA PPO Low CIGNA PPO High In Network Out-of-network In Network Out-of-network Single N/A $25 $25 $25 $25 Family N/A $75 $75 $75 $75 Annual Maximum Benefit N/A $1,000 $1,000 $1,500 $1,500 Covered Providers CIGNA Dental Care HMO Providers CIGNA Dental PPO Network CIGNA Dental PPO Network CIGNA Dental PPO Network CIGNA Dental PPO Network Diagnostic & Preventive $0 to $240 copay No Charge No Charge No Charge No Charge Restorative (Fillings) $0 to $115 copay 30% after deductible; 30% after deductible*; maximum maximum * Crowns & Bridges $12 to $245 copay 50% after deductible*; maximum maximum * Endodontics (Root Canals) $12 to $245 copay 30% after deductible; 30% after deductible*; maximum maximum * Periodontics (Gum Treatment) $24 to $430 copay 30% after deductible; 30% after deductible*; maximum maximum * Prosthetics (Dentures) $14 to $425 copay 50% after deductible*; maximum maximum * Oral Surgery (Extractions) $8 to $185 copay 30% after deductible; 30% after deductible*; maximum maximum * Orthodontics (Braces) $50 to $1,584 copay for children (to age 19); $50 to $2,328 copay for adults 50 % after deductible; available only to children up to age 19; $1,000 lifetime maximum 50 % after deductible*; available only to children up to age 19; $1,000 lifetime maximum 50 % after deductible; available only to children up to age 19; $1,250 lifetime maximum 50 % after deductible; available only to children up to age 19; $1,250 lifetime maximum Anesthetics $73 to $190 copay 30% after deductible; 30% after deductible*; maximum maximum * Implants not covered 50% after deductible*; maximum maximum * *If you use an out-of-network provider, you may be balance billed by your dentist for any charges above Cigna s contracted PPO fee schedule. 15

Often all you will need is the group number for yourdental plan to provide to the dental office: COVERAGE VERIFICATION Every plan is different, so it is important Cigna Group Number (all 3 plans): 3175056 to understand the specifics of your dental s, especially what is and is not covered. Delta Dental EPO Group Number: 11356 If you think you may need treatment and want Delta Dental PPO Low Group Number: 11357 to find out what your costs will be, ask your dentist to submit a pre-treatment estimate, Delta Dental PPO High Group Number: 11358 allowing you to understand your full financial responsibility before committing to services. If you are enrolled in a Delta Dental plan, you can request a new ID card by logging into your Delta Dental account at www.deltadentalco.com or calling Customer Relations at (800) 610-0201. 07 Dental Plans DELTA Dental Plan Summary DELTA EPO DELTA PPO Low DELTA PPO High In Network Out-of-network In Network Out-of-network Annual Deductible Single N/A $25 $25 $25 $25 Family N/A $75 $75 $75 $75 Annual Maximum Benefit N/A $1,250 $1,250 $2,000 $2,000 Covered Providers DELTA Dental PPO Network-Colorado Residents Only DELTA Dental PPO Network-Nationwide DELTA Dental Premier Network-Nationwide DELTA Dental PPO Network-Nationwide DELTA Dental PPO Network-Nationwide Diagnostic & Preventive $0 to $10 copay deductible deductible deductible Restorative (Fillings) $21 to $73 copay 10% after deductible; Crowns & Bridges $0 to $295 copay 40% after deductible; Endodontics (Root Canals) $10 to $297 copay 10% after deductible; Periodontics (Gum Treatment) $23 to $284 copay 10% after deductible; Prosthetics (Dentures) $16 to $377 copay 40% after deductible; Oral Surgery (Extractions) $22 to $100 copay 10% after deductible; Orthodontics (Braces) $35 to $1,980 copay 50 % no deductible; $1,000 lifetime maximum 50 % no deductible; $1,000 lifetime maximum Anesthetics $8 to $56 copay 10% after deductible; Implants not covered up to annual maximum of $1,000 up to annual maximum of $1,000 of $1,000 up to annual maximum of $1,000 16

08 Vision Plan With VSP you will get a high level of care, including an annual exam designed to detect signs of health conditions like diabetes and high blood pressure. FIND A VISION PROVIDER Find a VSP provider at www.vsp.com or call (800) 877-7195. VSP Plan Summary In-network Out-of-network Comprehensive Exam Optometrist (OD) Covered in full after $10 copay $45 allowance *One exam per 12 months Standard Lenses (Per Pair) Single Vision Covered in full after $25 copay $30 allowance Bifocals Covered in full after $25 copay $50 allowance Trifocals Covered in full after $25 copay $65 allowance *One pair of lenses per 12 months Contact Lenses (Per Pair) Medically Necessary Covered in full $210 allowance Elective - (Cosmetic) $160 allowance $145 allowance Standard Contact Lens Fitting Fee Up to $60 copay Not covered Frames-Standard $160 allowance $70 allowance *One pair of frames per 24 months NOTE: Contact lenses are in lieu of eyeglass lenses and frames. VSP has special pricing for lasik surgery with participating centers, a savings that can add up to hundreds of dollars for VSP members. Visit vsp.com or call 800.877.7195 VSP does not provide ID cards. Your vision provider can verify your coverage directly with VSP. Visit www.vsp.com to find a provider 17

INSURANCE PREMIUM REDUCTION (IPR) BENEFIT The Insurance Premium Reduction (IPR) Benefit is a in which DERP contributes a portion of a member s monthly insurance premium, provided the member is enrolled in a group insurance offered by DERP. The monthly amount DERP contributes toward insurance is established by the Retirement Board based on credited service with the City/DHHA. Effective January 1, 2018, DERP will continue a monthly contribution of $6.25 for each year of credited service for Medicare-eligible members, and $12.50 for each year of credited service for members who are not yet Medicare-eligible. Surviving spouses and dependents who continue insurance coverage, but do not receive a monthly from DERP, must pay the full monthly premium. Persons in this category, or those whose retirement s are not large enough to pay their portion of the insurance premium, are required to have any remaining monthly premiums automatically deducted from a checking or savings account. FITNESS AND WELLNESS Fitness and wellness s have been proven to improve health and reduce health care costs. Studies show that having a relationship with a primary care physician and using preventive s such as annual physicals and appropriate immunizations typically results in better health outcomes. Be sure to take advantage of your preventive wellness s through your medical and dental insurance, as well as any valueadded s that your insurance may offer. If you are a Medicare member enrolled in one of our Medicare Advantage plans, consider utilizing your SilverSneakers s. With SilverSneakers, you receive a free basic fitness center membership at over 13,000 participating locations nationwide. You also have access to SilverSneakers classes, Senior Advisors, health education, and social activities. TRAVELING If you are traveling and have a medical emergency, all DERP medical plans cover your emergency and urgent care services at the in-network level, even if the facility is not part of your plan s network. If you are traveling and wish to receive nonemergency care (routine care), you should check with your medical plan first to determine if the cost of that care is covered by your plan. MOVING If you move, please notify DERP of your new address so that DERP can let the appropriate insurance carriers know your new information. You must notify DERP in writing or you can submit your address electronically via the Member Self-Service Portal at www.myderp.org. If you move outside of your plan s service area, your coverage must be cancelled. In most cases, you can continue to have insurance coverage with DERP, via an alternate carrier, by submitting your request within 30 days of your move date. CANCELLATION OF COVERAGE You may cancel coverage for yourself and/or any dependent at any time. Cancellations are effective the first of the month following receipt of the written request for cancellation. If you cancel coverage for you and/or your dependents during the year, you are allowed to re-enroll during the Open Enrollment period in October with a January 1 effective date. MEDICARE ELIGIBILITY When you become eligible for Medicare (for most, that is age 65), you are no longer eligible to be enrolled in one of DERP s pre-medicare medical plans. Instead, you become eligible to enroll in one of DERP s Medicare Advantage plans. Currently, DERP offers Medicare Advantage plans with Humana and Kaiser Permanente. Three months before your 65th birthday, DERP will send you a reminder letter about your Medicare eligibility. At this time, you should contact Social Security and enroll in Medicare Parts A and B. You must be continuously enrolled in Medicare Parts A and B in order to enroll in one of the Medicare Advantage plans offered by DERP. Once you have received your red, white, and blue Medicare card showing your entitlement to Parts A and B, you can make an appointment with the DERP Membership Services team to complete the application to enroll in a Medicare Advantage plan. This application must be completed prior to your effective date of enrollment. Medicare does not allow retroactive enrollments on Medicare Advantage plans. ACCESSING YOUR MEMBER SELF- SERVICE PORTAL ACCOUNT You can access useful information about your DERP account by securely logging into your Member Self-Service Portal account at www.myderp.org. If you haven t yet set up your online account, you will need your DERP ID to get started. This ID number is located on any documentation sent to you by DERP since August 2011. If you cannot locate your DERP ID, please call our office and we will provide that number to you. Once you are logged into your MSS Portal account, you can: Review messages sent by DERP Review and update your address Change your password RSVP for events, such as the Open Enrollment meeting Request a counseling session with the DERP Membership Services staff View and print direct deposit advices Review your beneficiary 09 Additional Useful Information Opt-in to electronic communications Review and update your direct deposit information Review and update your tax withholding preferences Review and update your insurance enrollment (update during the month of October only) View and print 1099-R tax forms 18

If you have any questions feel free to contact any of our providers directly. 10 RETIREE BENEFITS Denver Employees Retirement Plan Address: 777 Pearl St Denver, CO 80203 Ph: (303) 839-5419 Fx: (303) 839-9525 Email: mbrsvs@derp.org Web: www.derp.org MSS Portal: www.myderp.org MEDICAL Denver Health Medical Plan Ph: (303) 602-2100 Web: www.denverhealthmedicalplan.org Humana Ph: (866) 396-8810 Web: www.humana.com Group # s: varies by residence-see ID card Kaiser Permanente-Colorado Ph: (303) 338-3800 Web: www.kp.org Group # s: 0075 (Non-Medicare) 0090 (Medicare) United Healthcare Ph: (800) 842-5520 Web: www.myuhc.com Group #: 717340 Kaiser Permanente-California Ph: (800) 443-0815 Group # s: 52040 (Northern CA) 152053 (Southern CA) Kaiser Permanente-Hawaii Ph: (800) 805-2739 Group #: 3003 Kaiser Permanente-Mid-Atlantic States Ph: (888) 777-5536 Group #: 14774 Kaiser Permanente-NW Oregon/SW Washington Ph: (877) 221-8221 Group #: 4749 VISION VSP Ph: (800) 877-7195 Web: www.vsp.com Group #: 30050633 DENTAL Frequently Requested Contacts Cigna Dental Ph: (800) 244-6224 Web: www.cigna.com Group #: 3175056 Delta Dental Ph: (800) 610-0201 Web: www.deltadentalco.com Group # s: 11356 (EPO) 11357 (PPO Low) 11358 (PPO High) DEFERRED COMPENSATION TIAA Ph: (855) 259-4648 Web: www.tiaa.org SOCIAL SECURITY ADMINISTRATION & MEDICARE Social Security Administration (SSA) Ph: (800) 772-1213 Web: www.ssa.gov Centers for Medicare & Medicaid Services (CMS) Ph: (800) 633-4227 Web: www.cms.gov MISCELLANEOUS SilverSneakers Ph: (866) 584-7389 Web: www.silversneakers.com Denver Community Credit Union Ph: (303) 573-1170 Web: www.denvercommunity.coop Colorado Department of Public Health & Environment-Vital Records Ph: (303) 692-2200 Web: www.cdphe.state.co.us 19