City of Delray Beach Employee Benefits Handbook 2015

Transcription

CITY OF
Delray Beach
2015 | 2016
Employee Benefit
Guide
IMPORTANT CONTACT INFORMATION
City of Delray Beach
Contact Name
Contact Information
Human Resources
Sue Radig,
Benefits Manager
Phone: (561) 243-7154
Email: [email protected]
Medical Insurance
Cigna
Phone: (800) 244-6224
www.mycigna.com
Prescription Drug Coverage
& Mail-Order Program
Cigna Home Delivery Pharmacy
Phone: (800) 835-3784
www.mycigna.com
Dental Insurance
Humana
Phone: (800) 342-5209
www.mycompbenefits.com
Vision Insurance
Humana
Phone: (800) 537-0229
www.mycompbenefits.com
Flexible Spending Accounts (FSA)
TASC
Phone: (800) 422-4661
www.tasconline.com
Employee Assistance Program (EAP)
Cigna Employee Assistance Program
(CAP)
Phone: (888) 371-1125
www.cignabehavioral.com
Basic Life and AD&D Insurance
Minnesota Life
Phone: (800) 392-7295
www.ochsinc.com
Voluntary Life and AD&D Insurance
Minnesota Life
Phone: (800) 392-7295
www.ochsinc.com
Long Term Disability Insurance
Cigna
Phone: (800) 732-1603
www.cigna.com
Allstate
Phone: (800) 521-3535
www.allstatebenefits.com
Trustmark
Phone: (800) 918-8877
www.trustmarksolutions.com
Legal Insurance
Legal Club of America
Phone: (800) 305-6816
www.legalclub.com
Pet Insurance
Pet Assure
Phone: (888) 789-7387
www.petassure.com
Employee Health Center
The City of Delray Beach
Medical Center
Phone: (561) 243-7612
www.delraycare.com
BenTek Online Enrollment
BenTek Technical Support
Email: [email protected]
Phone: (888) 5-BenTek (523-6835)
www.mybentek.com/delraybeach
Supplemental Insurance
CITY OF DELRAY BEACH — 2015-2016 EMPLOYEE BENEFIT GUIDE
Table of Contents
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Notices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Online Benefit Enrollment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Medical Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Group Insurance Eligibility. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-4
Qualifying Events and IRS Code Section 125. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Employee Health and Wellness Center. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Wellness Incentive Program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Medical Insurance Premiums. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-8
Other Available Plan Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
How to Locate A Provider . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Medical Insurance: Cigna HMO Core Plan At-A-Glance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Medical Insurance: Cigna HMO Buy Up Plan At-A-Glance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Medical Insurance: Cigna Open Access Choice Fund Plan (with HRA) At-A-Glance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Health Reimbursement Account . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Dental Insurance: Humana DHMO CS150 Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Dental Insurance: Humana DHMO CS150 Plan At-A-Glance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Dental Insurance: Humana DHMO Advantage Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Dental Insurance: Humana DHMO Advantage Plan At-A-Glance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Dental Insurance: Humana PPO Low Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Dental Insurance: Humana PPO Low Plan At-A-Glance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Dental Insurance: Humana PPO High Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Dental Insurance: Humana PPO High Plan At-A-Glance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Vision Insurance: Humana VisionCare Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Vision Insurance: Humana VisionCare Plan At-A-Glance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Flexible Spending Accounts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23-24
Employee Assistance Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Basic Life and AD&D Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Voluntary and AD&D Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Long Term Disability Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Voluntary Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Supplemental Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-29
Legal Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Pet Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30-32
Introduction
The City of Delray Beach provides employees with a comprehensive compensation package which includes group insurance benefits.
This Employee Benefit Guide provides a general summary of the group insurance options available to full-time employees. Please refer to
the City of Delray Beach Administrative Policies and Procedures, applicable Contracts and the individual plan. If you have any questions
concerning the coverage provided by the plan or need assistance regarding claims processing, please refer to the customer service phone
numbers under each benefit description heading or contact the City’s Benefits Manager using the contact information provided.
Notices
COBRA Continuation of Medical Coverage Benefits
Medicare Part D Creditable Coverage
Under the Consolidated Omnibus Budget Reconciliation
Act (COBRA), employees and/or dependents may be able
to continue their enrollment in certain health plans such as
medical, if such coverage is terminated or changed due to a
qualifying event.
The City’s prescription drug coverage is considered Creditable
Coverage under Medicare Part D. If you or your dependents
currently are or will be eligible for Medicare, you may obtain
more information by requesting a Medicare Part D Disclosure
of Creditable Coverage Notice.
More information is available about the above notices by contacting the Benefits Manager.
Online Benefit Enrollment
BenTek
Technical Support - Email: [email protected]
Technical Support - Phone: (888) 5-BenTek (523-6835)
NEW Online Benefit Enrollment with BenTek!
The City of Delray Beach is putting you in charge of your benefit enrollment. All benefit eligible employees are provided access
to electronic enrollment through the BenTek Employee Benefit Center (EBC). The EBC provides you the ability to make your group
benefit elections online for the annual open enrollment, new hire enrollment and to make any changes to your coverage election
due to a qualifying life event.
The BenTek EBC is accessible 24 hours a day during the open enrollment. Information about all of your employee benefit options,
premiums and carrier contact information is available to help you make informed decisions. You may also log on to the EBC any
time to review your benefit elections, access carrier contact information, review and update your life insurance beneficiaries and
report any qualifying life events that impact your benefit coverage needs.
To access the Employee Benefit Center:
•• Log on to https://www.mybentek.com/delraybeach
•• First Time User? Click on First Time User to create your confidential user profile, including your user name and password.
•• Enter the BenTek EBC to review your current benefit elections, learn about your benefit options and make any new elections
or changes in your elections.
••
You may also review your life insurance beneficiary designation(s) and make any necessary changes.
Once you have completed your review and made any changes, you will be able to print your enrollment confirmation statement
reflecting your benefit elections for you and your family, including your life insurance beneficiary designations.
Having trouble with the BenTek Employee Benefit Center?
Please contact BenTek Support at [email protected] or call 888-5-BenTek (888-523-6835) Monday through Friday, during
regular business hours.
To access your group insurance benefits online, log on to the EBC at www.mybentek.com/delraybeach
1
All benefits in this booklet are subject to change. This is an Employee Benefits Highlights Summary and not a contract. All benefits are subject to the provisions and exclusions of the master contract.
Medical Insurance
Summary of Benefits and Coverage
A Summary of Benefits & Coverage (SBC) for each Medical Plan Option is provided as a
supplement to this booklet which is being distributed to new hires and existing employees
during open enrollment. These summaries are an important item in understanding your
benefit options. A copy of the SBC documents are also available as follows:
From:
Human Resources
Address:
100 NW 1st Avenue
Delray Beach, FL 33444
Phone:
561-243-7154
Email:
[email protected]
Through the Benefits Resource Center – BenTek: www.mybentek.com/delraybeach
The SBC is only a summary of the plan’s coverage. A copy of the plan document, policy,
or certificate of coverage should be consulted to determine the governing contractual
provisions of the coverage. A copy of the actual group certificate of coverage can be
reviewed and obtained by contacting the Benefits Manager Unit or at the following web
address: www.mybentek.com/delraybeach.
If you have any questions about the plan offerings or coverage options, please contact the
Benefits Manager at 561-243-7154.
2
Group Insurance Eligibility
The City of Delray Beach’s group insurance plan year is June 1st through May 31st.
Employee Eligibility
Employees are eligible to participate in the City’s insurance plans if they are full-time employees working a minimum of 40 hours
per week. Coverage will become effective 30 days after your hire date, making coverage active on the 31st day of employment.
For example: If you are hired on April 15th, your coverage will be effective on May 16th. If you separate employment from the
City, insurance will continue through the end of the month in which the separation occurred. COBRA continuation of coverage
may be available as applicable by law.
Dependent Eligibility
A dependent is defined as the legal spouse, domestic partner and/or dependent child(ren) of the participant spouse or domestic
partner. Dependent children may be covered through the end of the calendar year in which the child reaches age 26 for medical
and dental; or to age 18 for vision coverage (or to age 25, if certain requirements are met).The term “child” includes any of the
following:
••
A natural child
••
A foster child
••
A stepchild
••
••
A legally adopted child
A newborn (up to age 18 months) of
a covered dependent (Florida)
••
A child for whom legal guardianship has been
awarded to the participant or the participant’s
spouse/domestic partner
Dependent Eligibility Age Requirements
Eligibility requirements for Over-age Dependents have been eliminated for group medical insurance. Dependents may be
covered by the medical and dental plans through the end of the calendar year in which the child turns age 26.
Medical coverage may also continue to the end of the calendar year in which the dependent reaches the age of 30, if the
dependent is:
•• Unmarried with no dependents; AND
•• A Florida resident, or full-time or part-time student; AND
•• Otherwise uninsured; AND
•• Not entitled to Medicare benefits under Title XVIII of the Social Security Act, unless the child is handicapped.
Disabled Dependents
Coverage for an unmarried dependent child may be continued beyond age 26 if:
1. The dependent is physically or mentally disabled and incapable of self-sustaining employment; AND
2. The dependent is otherwise eligible for coverage under the group medical plan; AND
3. The dependent has been continuously insured; AND
4. Coverage began prior to the age of 19.
Proof of disability will be required upon request. Please contact the Benefits Manager if further clarification is required.
Taxable Dependents
Employees covering adult children under their medical insurance plan may continue to have the related coverage premiums payroll
deducted on a pre-tax basis through the end of the calendar year in which the child reaches age 26. Beginning January 1st of the
calendar year in which the child reaches age 27 through the end of the calendar year in which the child reaches age 30, imputed
income for the value of the applicable adult child’s coverage for the coverage period must be reported on the employee’s W-2.
Imputed income is the dollar value of insurance coverage attributable to covering the adult child. There is no imputed income if an
adult child is eligible to be claimed as a dependent for federal income tax purposes on the employees tax return. Check with the
Benefits Manager for further details if you are covering an adult child who will turn 27 any time in the upcoming calendar year, a
signed Over Age Dependent Affidavit may be required in order to continue coverage.
3
Group Insurance Eligibility (continued)
Domestic Partner
Domestic partners are eligible to participate in the City’s group insurance plans. To be eligible for domestic partner coverage, the
employee must submit the following documents to the Benefits Manager:
•• Domestic Partnership Certificate of Registration issued by the Palm Beach County Clerk and Comptroller’s Office or County
of residence, where available; and
•• Certification of Dependent Children of a Domestic Partnership; and
•• Agreement to notify the City of the termination of the Domestic Partnership.
These completed documents must be submitted at the time of enrollment. A covered employee may elect coverage for his/her qualifying
domestic partner and eligible dependents of the domestic partnership beginning the first of the month following the date of registration. IRS
guidelines state that an employee may not receive a tax advantage on any portion of premium paid, related to domestic partner coverage.
Employees insuring domestic partners and/or child dependents of a domestic partner will see the insurance premium deductions on a
post-tax basis and any amount subsidized by the employer will be reported as “imputed income” to the employee. You may contact the
Benefits Manager for further details and rates if you are covering a domestic partner at any time during the upcoming plan year.
Qualifying Events and IRS Code Section 125
IRS Code Section 125
Premiums for medical, dental, vision insurance, certain supplemental policies and contributions to FSA accounts (Health Care and Dependent
Care FSAs) are deducted through a Cafeteria Plan established under Section 125 of the Internal Revenue Code (IRC) and are pre-tax to the
extent permitted. Under Section 125, changes to your pre-tax benefits can be made ONLY during the Open Enrollment period unless you or
your qualified dependents experience a qualifying event and the request to make a change is made within 30 days of the qualifying event.
Under certain circumstances, you may be allowed to make changes to your benefits elections during the plan year, if the event
affects your own, your spouse’s, or your dependent’s coverage eligibility. An “eligible” qualifying event is determined by the
Internal Revenue Service (IRS) Code, Section 125.
Examples of Qualifying Events
••
••
••
••
••
••
••
••
••
••
••
••
You get married or divorced
Birth of a child
You gain legal custody or adopt a child
Your spouse and/or other dependent(s) die(s)
You, your spouse, or dependent(s) terminate or start employment
An increase or decrease in your work hours causes eligibility or ineligibility
Change of coverage under another employer’s plan
A covered dependent no longer meets eligibility criteria for coverage
A child gains or loses coverage with an ex-spouse
Gain or loss of Medicare coverage
Losing eligibility for coverage under a State Medicaid or CHIP (including Florida Kid Care) program (60 day notification period)
Becoming eligible for State premium assistance under Medicaid or CHIP (60 day notification period)
Please note: The forming of a Domestic Partnership, in and of itself, is not considered a qualifying event
IMPORTANT
If you experience a qualifying event, you must contact the Benefits Manager within 30 days of the qualifying
event to make the appropriate changes to your coverage. Beyond 30 days, requests will be denied and the
employee may be responsible both legally and financially for any claim and/or expense incurred as a result of the
employee or a dependent who continues to be enrolled but no longer meets eligibility requirements. If approved,
changes will take place on the first of the month following the latter of the qualifying event or the date of written
request for change in coverage, except for newborns which are effective on the date of birth. Any cancellations
will be processed at the end of the month, except coverage ends on the date of death. You will be required to
furnish valid documentation supporting a change in status or “Qualifying Event.”
4
Employee Health and Wellness Center
City of Delray Beach Medical Center
525 NE 3rd Avenue
Delray Beach, FL 33444
To schedule an appointment
please call: (561) 243-7613
www.delraycare.com
Employee Health and Wellness Center
The Employee Health and Wellness Center is available to all employees and dependents (spouses, domestic partners,
and child(ren) 2 years and over) enrolled in a City medical plan.
Your participation is completely voluntary and private so you can be sure that your medical information will not be shared with
your employer. The Employee Health and Wellness Center can serve you in several ways to help lower your out of pocket costs
and improve your health such as short wait times to be seen by the doctor, no co-pays or deductibles. All services and generic
prescription medications received at the Employee Health and Wellness Center are provided at no charge.
The Employee Health and Wellness Center provides the care you and your family need for all non-emergency illnesses, at no cost
to you for the visit.
Available Services include:
99 Primary Care
99 Well Woman Visits
99 Prescription Dispensing
99 School Physicals
99 Annual Adult Physicals
99
99
99
99
99
Labs Performed On-site
ECG’s
Health Risk Assessments
Maintenance Drugs
Acute Illness
To schedule an appointment visit www.delraycare.com or call (561) 243-7613.
The Employee Health and Wellness Center hours of operation are:
HOURS OF OPERATION
5
Monday
9:00 a.m. – 5:00 p.m.
Thursday
11:00 a.m. – 5:00 p.m.
Tuesday
10:00 a.m. – 6:00 p.m.
Friday
8:00 a.m. – 12:00 p.m.
Wednesday
9:00 a.m. – 5:00 p.m.
Wellness Incentive Program
The City is committed to encouraging healthy behaviors. Therefore the City offers employees enrolled in one of the Cigna
medical plans an opportunity to earn monetary rewards to reduce your monthly insurance premiums. Employees enrolled in the
Cigna Open Access Choice Fund Plan have an opportunity to earn additional contributions into an HRA.
In order to receive any Wellness Incentives from the City, both the Employee and the Insured Spouse must participate
in the Program(s) being chosen!
Cigna HMO Core and Cigna HMO Buy Up Plans (not available for employee only coverage on the HMO
Core plan)
Employees enrolled in either the Cigna HMO Core (with dependent coverage) or Buy Up Plan will have the opportunity for
a reduced discount on the medical insurance premium payroll deduction by completing a biometric screening and nicotine
screening through the City’s Employee Health and Wellness Center.
To complete this program:
1. The employee and the covered spouse will need to either call the City’s Employee Health and Wellness Center at
(561) 243-7612 or log into the City’s Portal at www.delraycare.com and schedule a wellness appointment.
2. The employee and covered spouse will both need to complete a biometric screening. The appointment will include a finger
stick and immediate review of the results.
•• A nicotine screening will take place when you have your biometric screening completed at the Employee Health and
Wellness Center. Employees and covered spouses who are tobacco users will have the opportunity to qualify for this portion
of the incentive by participating in a 6 week smoking cessation program held at the Employee Health and Wellness Center
and ESD Training Room.
•• Based on the findings of the Health Screening, you or the covered spouse may be educated on additional coaching
opportunities and programs that are available to help you improve your health.
3. To receive the Wellness Incentive, employees and covered spouses must also complete the Cigna Health Risk Assessment
questionnaire by logging into mycigna.com and selecting “Take my health assessment” on the right side of the screen.
Cigna Open Access Choice Fund Plan
When you enroll in the Cigna Open Access Choice Fund Plan, participation in the Wellness Incentive Program gives you the
opportunity to earn HRA funds, on top of the HRA funds the City provides annually. The City will award you an additional $250
for employee only coverage or $500 if you and your insured spouse participate in our Wellness Incentive Program. In order to
receive a discount on your medical insurance premium payroll deductions you, and if applicable, your covered spouse, will be
required to complete a nicotine screening through the City’s Employee Health Center.
To complete this program:
1. The employee and the covered spouse will need to either call the City’s Employee Health and Wellness Center at
(561) 243-7612 or log into the City’s Portal at www.delraycare.com and schedule a wellness appointment.
2. The employee and covered spouse will both need to complete a biometric screening. The appointment will include a finger
stick and immediate review of the results.
•• A nicotine screening will take place when you have your biometric screening completed at the Employee Health and
Wellness Center. Employees and covered spouses who are tobacco users will have the opportunity to qualify for this portion
of the incentive by participating in a 6 week smoking cessation program held at the Employee Health and Wellness Center
and ESD Training Room.
•• Based on the findings of the Health Screening, you or the covered spouse may be educated on additional coaching
opportunities and programs that are available to help you improve your health.
3. To receive the Wellness Incentive, employees and covered spouses must also complete the Cigna Health Risk Assessment
questionnaire by logging into mycigna.com and selecting “Take my health assessment” on the right side of the screen.
Please remember that in order to receive any Wellness Incentives from the City, both employees and covered spouses must participate
in order for the program to be considered complete. If an employee or covered spouse decide to not participate in the Wellness
Incentive Program, the medical insurance premium cost will be higher than those who choose to participate.
For additional information concerning the Wellness Incentive Program, please contact the Benefits Manager.
6
Medical Insurance Premiums
The Summary of Benefits and Coverage (SBC), provided in addition to this Employee Benefits Guide, is your primary source of information
regarding your Cigna medical plans. The information contained in this Booklet regarding your medical plans is intended to supplement your SBC
and accompanying definitions. If any information in this booklet unintentionally conflicts with the SBC or accompanying definitions, the SBC
information prevails. If you have any additional questions regarding the plan please contact Cigna’s Customer Service at (800) 244-6224.
The City of Delray Beach provides medical insurance through Cigna to benefit eligible employees. The costs per pay period for
coverage are listed in the premium tables below. For information about your medical plan please refer to the Summary of
Benefits and Coverage (SBC) provided.
Medical Insurance – Cigna Core HMO Plan
26 Payroll Deductions
With
Completed
Incentive / NonTobacco User
With
Completed
Incentive /
Tobacco User
Without
Completed
Without
Completed
Incentive /
Tobacco User
$0.00
$0.00
$0.00
$0.00
$100.71
$125.90
$115.82
$144.78
Employee + Child(ren)
$80.66
$100.83
$92.76
$115.95
Employee + Family
$170.88
$213.60
$196.51
$245.64
Plan Type
Employee Only
Employee + Spouse
Medical Insurance – Cigna Buy Up HMO Plan
Plan Type
With
Completed
With
Completed
Incentive /
Tobacco User
Without
Completed
Without
Completed
Incentive /
Tobacco User
Employee Only
$33.45
$41.82
$38.47
$48.09
Employee + Spouse
$210.07
$262.59
$241.58
$301.98
$177.97
$222.47
$204.67
$255.84
Employee + Family
$322.48
$403.10
$370.85
$463.56
Other Available Plan Resources
Cigna offers to all enrolled members and dependents additional services and discounts through value added programs. For more
details regarding other available plan resources, please refer to your Summary of Benefits and Coverage (SBC).
24 Hour Help Information Hotline (800) CIGNA-24
The Cigna 24-Hour Health Information Line provides you access to helpful, reliable information and assistance from qualified
health information nurses on a wide range of health topics 24 hours a day, any day of the year. Not sure what to do when your
child has a fever in the middle of the night? Have you injured yourself and are not sure if you should seek treatment or go see a
doctor? There are over 1,000 topics in the Health Information Library that include FREE audio, video and printed information on
aging, women’s health, nutrition, surgery and specific medical conditions to help you weigh the risks and advantages of treatment
options. The call is FREE and is strictly confidential.
Healthy Rewards (800) 870-3470
Cigna’s Healthy Rewards is provided to you automatically at no additional cost and offers access to discounted health and wellness
programs at participating providers. Members can log on to www.mycigna.com and select Healthy Rewards to learn more about
these programs or call (800) 870-3470.
•• Vision Care
•• Hearing Care
•• Lasik Vision Correction Services
•• Tobacco Cessation
•• Fitness Club Discounts
•• Alternative Medicine
•• Nutrition Discounts
7
Medical Insurance Premiums (continued)
Medical Insurance – Cigna Open Access Choice Fund Plan (Salary Under $35,000)
Plan Type
With
Completed
With
Completed
Incentive /
Tobacco User
Without
Completed
Without
Completed
Incentive /
Tobacco User
Employee Only
$12.65
$15.81
$12.65
$15.81
Employee + Spouse
$67.23
$90.29
$67.23
$90.29
$50.30
$69.13
$50.30
$69.13
Employee + Family
$100.61
$138.26
$100.61
$138.26
Medical Insurance – Cigna Open Access Choice Fund Plan (Salary $35,000 to $50,000)
With
Completed
With
Completed
Incentive /
Tobacco User
Without
Completed
Without
Completed
Incentive /
Tobacco User
Employee Only
$12.65
$15.81
$12.65
$15.81
Employee + Spouse
$79.73
$102.79
$79.73
$102.79
Plan Type
$62.80
$81.63
$62.80
$81.63
Employee + Family
$125.61
$163.26
$125.61
$163.26
Medical Insurance – Cigna Open Access Choice Fund Plan (Salary Above $50,000)
With
Completed
With
Completed
Incentive /
Tobacco User
Without
Completed
Without
Completed
Incentive /
Tobacco User
$12.65
$15.81
$12.65
$15.81
Employee + Spouse
$92.23
$115.29
$92.23
$115.29
$75.30
$94.13
$75.30
$94.13
Employee + Family
$150.61
$188.26
$150.61
$188.26
Plan Type
Employee Only
How to Locate A Provider
To search for a participating provider, contact Customer Service or visit Cigna online at www.cigna.com. Click the “Find a Doctor”
tab, then under “Choose a Directory,” select “If your insurance plan is offered through work or school... Find a Doctor or Dentist
using this Directory. ”Under “Select a plan,” click “pick” and choose “Open Access Plus, OA Plus, Choice Fund OA Plus” for
the Choice Fund Plan or “HMO/Network - Cigna HealthCare Seamless Network - Florida” for the Core/BuyUp HMO plans, then
“Select.” Complete the additional Search Criteria and “Search.”
Please Note: When seeking care from a specialist for any of the plans offered you can maximize your savings by selecting a
Cigna Care Network (CCN) provider. You can identify Cigna Care Network specialist by the Cigna Care Designation symbol when
searching for network providers.
8
Medical Insurance: Cigna HMO Core Plan At-A-Glance
Network
HMO/Seamless Network
Plan Year Deductible (PYD)
In Network
Single
$1,500
Family
$3,000
Coinsurance
In Network
Member Responsibility
30% After PYD
Plan Year Out-of-Pocket Limit
In Network
Single
$5,000
Family
$10,000
What Applies to the Out-of-Pocket Limit?
Deductible, Coinsurance, Copays and Rx
Physician Services
In Network
Primary Physician Office Visit
$45 Copay
CCN Specialist Office Visit**
$65 Copay
Non-CCN Specialist Office Visit
$85 Copay
Diagnostic Services
In Network
Clinical Lab (Blood Work) at Independent Facility
No Charge
X-rays at Independent Facility
No Charge
Advanced Imaging (MRI, PET, CT) at Outpatient Facility
Hospital Services
30% After PYD
In Network
Inpatient
30% After PYD
Outpatient Facility
30% After PYD
Physician Services at Hospital or Outpatient Facility
30% After PYD
Emergency Room (Waived if Admitted)**
$500 Copay
Urgent Care Facility**
$75 Copay
Mental Health / Alcohol & Substance Abuse
In Network
Inpatient
30% After PYD
Outpatient Facility
No Charge
Prescription Drugs (Rx)
In Network
Generic - Tier 1
$30 Copay
Preferred Brand Name - Tier 2
$55 Copay
Non-Preferred Brand Name - Tier 3
$80 Copay
Mail-Order Drug (90 Day Supply)
2 Copays
Please Note the Following:
•• Services received by providers or facilities not in the Cigna HMO/Seamless Network will not be covered.
•• CCN** - Cigna Care Network: May provide a higher level of network benefits if services are received from a CCN designated provider.
•• PYD - Plan Year Deductible: Plan Benefits and accumulators are per plan year (June 1st - May 31st).
•• Prior authorizations may be required before certain services can be received. If prior authorization is required and not obtained
prior to receiving the services, the claim could be denied and all charges will be your responsibility.
9
Medical Insurance: Cigna HMO Buy Up Plan At-A-Glance
Network
HMO/Seamless Network
In Network
Single
$750
Family
$1,500
Coinsurance
In Network
20% After PYD
In Network
Single
$3,500
Family
$7,000
Physician Services
In Network
$40 Copay
$60 Copay
$80 Copay
Diagnostic Services
In Network
No Charge
No Charge
Hospital Services
20% After PYD
In Network
Inpatient
20% After PYD
Outpatient Facility
20% After PYD
Physician Services at Hospital or Outpatient Facility
20% After PYD
Emergency Room (Waived if Admitted)**
$300 Copay
Urgent Care Facility**
$75 Copay
In Network
Inpatient
20% After PYD
Outpatient Facility
No Charge
In Network
Generic - Tier 1
$20 Copay
$45 Copay
$65 Copay
2 Copays
•• Services received by providers or facilities not in the Cigna HMO/Seamless Network will not be covered.
10
Medical Insurance: Cigna Open Access Choice Fund Plan (with HRA) At-A-Glance
Network
Open Access
Single
Family
In Network
Out of Network
$1,500
$3,000
$3,000
$6,000
In Network
Out of Network
10%
40%
In Network
Out of Network
Single
$4,750
$9,500
Family
$9,500
$19,000
Coinsurance
Physician Services
In Network
10% After PYD
10% After PYD
20% After PYD
Diagnostic Services
Out of Network*
40% After PYD
In Network
Out of Network*
40% After PYD
10% After PYD
40% After PYD**
Hospital Services
In Network
Inpatient
10% After PYD
Outpatient Facility
10% After PYD
Physician Services at Hospital or Outpatient Facility**
10% After PYD
Emergency Room
Outpatient Facility
20% After PYD
10% After PYD
Urgent Care Facility
Inpatient
Out of Network*
10% After PYD
10% After PYD
In Network
Out of Network*
10% After PYD
40% After PYD
In Network
Out of Network*
Generic - Tier 1
30% After PYD
40% After PYD
50% After PYD
Cost of One Fill
Not Covered
*Out-Of-Network Balance Billing
For information regarding Out-of-Network Balance Billing that may be charged by an out-of-network provider for services rendered,
please refer to the Out-of-Network Benefits section on the Summary of Benefits and Coverage (SBC).
11
Health Reimbursement Account
The Summary of Benefits and Coverage (SBC), provided in addition to this Employee Benefit Guide, is your primary source of information
regarding your Cigna medical plan. The information contained in this Booklet regarding your medical plan is intended to supplement your SBC and
accompanying definitions. If any information in this booklet unintentionally conflicts with the SBC or accompanying definitions, the SBC information
prevails. If you have any additional questions regarding the plan, please contact Cigna’s Customer Service at (800) 244-6224 or the Benefits Manager.
Cigna
Customer Service: (800) 244-6224
www.cigna.com
The City provides employees enrolled in the Cigna Open Access Choice Fund Plan with a Health Reimbursement Account (HRA). The City’s
HRA benefits are administered by Cigna. The HRA allocations are not taxable to the employee and can be used to offset the cost of a wide
variety of health related expenses incurred by you and your covered dependents under the Cigna Open Access Choice Fund Plan. These
funds can only be used for expenses incurred during the 2015/2016 plan year. Please Note: The HRA funds are allocated specifically for
medical plan expenses ONLY and cannot be used for other IRS 213.d expenses such as dental or vision.
2015-2016 Funding:
••
The City will fund $500 for Employee Only coverage or $1000 for employees with Family coverage. Funds not used in any given plan
year, up to $500, can be rolled over to the next plan year period, up to an accumulated cap of $1,000 for employee only and $2,000 for
employees with family. This is in addition to any awarded Wellness Incentive monies earned.
••
You have an opportunity earn additional monies to be placed in your HRA by participating in the City’s Wellness Initiative Program.
The City will award an additional $250 for Employee Only coverage or an additional $500 if the employee and the covered
spouse both participate in the Wellness Initiative Program (for more details on the Wellness Initiative Program please see page 6).
HRA Funding Allotment
1. Eligible medical expenses under an HRA plan include deductibles, coinsurances, and pharmacies.
2. HRA money is not paid out when the member leaves employment.
3. HRA money can transfer when the eligible member transitions from an active employee to a retiree and remains covered by
the employer’s health plan.
4. The City’s HRA may be used in conjunction with a Flexible Spending Account (FSA). The HRA will be established to cover
eligible expenses automatically. A member cannot get reimbursed for the same eligible expenses under the HRA and FSA.
Please Note: The Plan Year Deductibles exceed the HRA funding amounts. Members will be responsible for any amount over the HRA
funding until the Plan Year Deductible and Out-of-Pocket Limit have been met for the plan year.
What is the difference between an HRA and an FSA?
Health Reimbursement Account (HRA)
•• Employer Funded Account
•• Enrollment is automatic if enrolled in the Open Access
Choice Fund medical plan
•• Funds are used for eligible medical expenses for you and
your dependents who are enrolled in the medical plan
•• Unused funds accumulate and roll over year to year
Flexible Spending Accounts (FSA)
•• Employee Funded Account
•• You must enroll annually
•• Funds are used for eligible medical, dental, vision & dependent care for you and your qualified dependents
•• Unused funds will be forfeited at the end of the plan year
(once the filing deadlines have expired).
Do I still need to keep my receipts?
Yes. During the year, you should keep all receipts and documentation for prescriptions and medical related expenses for all transactions so
that you have them if needed to verify a claim for Cigna or for IRS taxes. If asked to produce documentation, a valid Explanation of Benefits
(EOB) and receipt of payment for the services rendered will be sufficient.
How to File a Claim
Employees may submit claim forms to Cigna with an Explanation of Benefits form from the insurance carrier or receipts for eligible medical services
throughout the plan year. Claim forms can be submitted via fax or mail, which is indicated on the claims form, or electronically at mycigna.com.
12
Dental Insurance: Humana DHMO CS150 Plan
Humana/CompBenefits
www.compbenefits.com
The City offers insurance through Humana. A brief description of
the DHMO CS150 Plan is provided below and the employee costs
per pay period are shown on the premium table to the right. A
summary of benefits is provided on the following page. For detailed
coverages, exclusions and stipulations, please refer to the carrier’s
benefit summary or contact Humana’s Customer Service.
Dental Insurance – Humana DHMO CS150 Plan
Tier of Coverage
Employee Cost
Employee Only
$7.38
Employee + 1 Dependent
$14.03
In-Network Benefits
Employee + 2 Or More Dependents
$18.54
The DHMO CS150 plan is an “in-network” only plan that requires
you to select a Primary Dental Provider in order to receive services. You can select any participating dentist in the plans network.
This dental plan utilizes the CompBenefits DHMO CS150 Network.
The DHMO CS150 plan’s schedule of benefits is set forth by the Patient Charge Schedule (fee schedule), which is highlighted on
the following page. Please refer to your plan’s certificate of coverage for a detailed listing of charges and what is covered.
Out-of-Network Benefits
The DHMO CS150 plan does not cover any services rendered by out-of-network facilities or providers.
How to Locate a Provider
To search for a participating dental provider, call Customer Service or visit www.compbenefits.com. Click the “Providers/Search”
tab and you can either log into your mycompbenefits.com account or under Plan Type Options, select “DHMO Plans.” Then
complete the search criteria and click “Submit.”
Calendar Year Deductible
There is no Calendar Year Deductible that needs to be met on this plan.
Calendar Year Benefit Maximum
This plan is not subject to any benefit maximums.
•• Each covered family member may receive up to 2 FREE cleanings per calendar year (1 every 6 months) covered under the
preventative benefit. Members can also receive an additional cleaning at the charge of a copay.
•• Should you need to see a specialist under this plan (Oral Surgeon, Periodontist, Orthodontist, etc.), you must be referred by your
Primary Dental Provider.
•• Prior authorization is not required for specialty referrals for Endodontic and Pediatric Services.
•• Waiting periods and age limitations may apply for some services.
13
Dental Insurance: Humana DHMO CS150 Plan At-A-Glance
Network
CompBenefits DHMO CS150
Calendar Year Deductible (CYD)
In Network Only
Per Member
None
Per Family
None
Calendar Year Maximum
None
Class I Services: Diagnostic & Preventative
In Network
Code
Office Visit
$5 Copay
9430
Emergency Care to Relieve Pain (During Regular Hours)
$20 Copay
9999
Routine Oral Exam (1 Every 6 Months)
No Charge
0120
Routine Cleanings (1 Every 6 Months)
No Charge
1110/20
Bitewing X-rays (1 Every 6 Months)
No Charge
0274
Complete X-rays
No Charge
0330
Sealants - Per Tooth
$10 Copay
1351
Fluoride Treatments (To Age 16 Every 6 Months)
No Charge
1203
Class II Services: Basic Restorative
In Network
Code
Fillings (Amalgam; 3 Surfaces)
No Charge
2140
Fillings (Composite; 3 Surfaces, Anterior)
$50 Copay
2332
Fillings (Composite; 3 Surfaces, Posterior)
$100 Copay
2393
No Charge
7140
Root Canal Therapy (Molar)*
$250 Copay
3330
Surgical Removal of Tooth
$40 Copay
7210
Full Mouth Debridement (Deep Cleaning)
$45 Copay
4355
Class III Services: Major Restorative
In Network
Code
Bridges (Porcelain Fused to Noble Metal)**
$280 Copay
6242
Crowns (Porcelain Fused to High Noble Metal)**
$280 Copay
6750
$330 Copay + Lab
5110/20
In Network
Code
Benefit — Child to age 19
$1,800
8070/8080
Benefit — Adults and Dependent Children (Age 19 and Over)
$2,000
8090
Records/Treatment Planning
$250 Copay
8070/80/90
Retention
$450 Copay
8680
Extractions (Erupted Tooth or Exposed Root)
Dentures
Class IV Services: Orthodontia
* Excluding Final Restoration
** Copays for these services do not include the additional cost of precious (High Noble) and semi-precious (Noble) metal. The
additional cost of precious metal shall not exceed $125 per unit and $75 per unit for semi-precious metal.
•• You must receive services from facilities and providers in the CompBenefits DHMO CS150 Network for benefits to be covered.
•• Unlisted covered dental care services may be available at the participating dentist usual fee, less 20%. Not all dentists perform
all services.
The above summary has been provided as a convenient reference. For a full listing of covered services,
exclusions and stipulations please see the plan’s Schedule of Benefits or contact Humana/CompBenefits
Customer Service.
14
Dental Insurance: Humana DHMO Advantage Plan
Humana/CompBenefits
The City offers dental insurance through Humana. A brief description
of the DHMO Advantage Plan is provided below and the employee
costs per pay period are shown on the premium table to the right. A
summary of benefits is provided on the following page. For detailed
coverages, exclusions and stipulations, please refer to the carrier’s
benefit summary or contact Humana’s Customer Service.
Dental Insurance – Humana DHMO Advantage Plan
Tier of Coverage
Employee Only
Employee Cost
$7.71
$14.80
In-Network Benefits
$24.47
The DHMO Advantage plan is an “in-network” only plan that is
“Open Access” and does not require a Primary Dental Provider to be selected prior to receiving services. You can select any
participating dentist in the network to receive services from. This dental plan utilizes the CompBenefits DHMO Advantage
Network.
The DHMO Advantage plan’s schedule of benefits is set forth by the Patient Charge Schedule (fee schedule), which is highlighted
on the following page. Please refer to your plan’s certificate of coverage for a detailed listing of charges and what is covered.
The DHMO Advantage plan does not cover any services rendered by out-of-network facilities or providers.
tab and you can either log into your mycompbenefits.com account or under Plan Type Options, select “DHMO Plans.” Then
complete the search criteria and click “Submit.”
There is no Calendar Year Deductible that needs to be met on this plan.
This plan is not subject to any benefit maximums.
•• Each covered family member may receive up to 2 FREE cleanings per year covered under the preventative benefit. Members can
also receive an additional cleaning at the charge of a copay.
•• Should you need to see a specialist under this plan (Oral Surgeon, Periodontist, Orthodontist, etc.), you must be referred by your
Primary Dental Provider.
•• Prior authorization is not required for specialty referrals for Endodontic and Pediatric Services.
•• Waiting periods and age limitations may apply for some services.
15
Dental Insurance: Humana DHMO Advantage Plan At-A-Glance
Network
CompBenefits DHMO Advantage
In Network Only
Per Member
None
Per Family
None
Calendar Year Maximum
None
In Network
Code
$10
9430
No Charge
0120
No Charge
1110/20
Bitewing X-rays (2 Every 12 Months)
No Charge
0274
Complete X-rays (Every 3 Years)
No Charge
0210
Sealants (1 Per Tooth; Child to Age 13)
No Charge
1351
Fluoride Treatments
No Charge
1203
In Network
Code
Fillings (Amalgam; 3 Surfaces)
$37 Copay
2160
Fillings (Composite; 3 Surfaces, Anterior)
$38 Copay
2332
Fillings (Composite; 3 Surfaces, Posterior)
$46 Copay
2393
Extractions (Erupted Tooth or Exposed Root)
$26 Copay
7140
Root Canal Therapy (Molar)*
$199 Copay
3330
Surgical Removal of Tooth
$43 Copay
7210
Full Mouth Debridement (Deep Cleaning)
$21 Copay
4355
In Network
Code
Bridges (Porcelain Fused to Noble Metal; 1 Every 5 Years)
$415 Copay
6242
Crowns (Porcelain Fused to High Noble Metal; 1 Every 5 Years)
$486 Copay
6750
Dentures (1 Every 5 Years)
$642 Copay
5110/20
Class IV Services: Orthodontia
In Network
Code
Benefit — Child to age 19
$2,100
8070/8080
Benefit — Adults and Dependent Children (Age 19 and Over)
$2,300
8090
Records/Treatment Planning
$250 Copay
8070/80/90
Retention
$450 Copay
8680
Office Visit
* Excluding Final Restoration
•• You must receive services from facilities and providers in the CompBenefits DHMO Advantage Network for benefits to be covered.
•• Unlisted covered dental care services may be available at the participating dentist usual fee, less 20%. Not all dentists perform
all services.
Customer Service.
16
Dental Insurance: Humana PPO Low Plan
Humana/CompBenefits
Dental Insurance – Humana PPO Low Plan
of the PPO Low Plan is provided below and the premium payroll
deductions are shown on the table to the right. A summary of
benefits is provided on the following page. For detailed coverages,
exclusions and stipulations, please refer to the carrier’s benefit
summary or contact Humana’s Customer Service.
Tier of Coverage
In-Network Benefits
Employee Cost
Employee Only
$14.17
$27.17
$44.34
The PPO Low plan is “open access” and allows you to receive
services from any dental provider without selecting a Primary Dental Provider (PDP) and does not require referrals to specialists.
The network of participating dental providers the plan utilizes is the CompBenefits PPO Network. The PPO plan provides
benefits for services received from in-network and out-of-network providers. You are responsible for a Calendar Year Deductible
(CYD) and then coinsurance based on the plan’s Usual, Customary and Reasonable (UCR) charge limitations.
Providers who do not contract with insurance carriers because they do not accept their discounted rates are referred to as “nonparticipating” or “out of network.” Understanding how your insurance company pays for out-of-network services is important
because you will usually pay more.
The insurance company processes charges based on what it determines the “Usual, Customary and Reasonable (UCR)” charge
is for a specific service. UCR or the “allowed amount” can be defined as the most common charge for a particular dental or
medical procedure performed in a specific geographic area. Since there is no contract in place between the insurance company
and out-of-network provider, the dentist may charge an amount higher than the UCR. The difference between the UCR amount
and the dentist’s higher charge is called “balance billing.” Balance billing is in addition to your deductible and coinsurance
responsibility.
tab and you can either log into your mycompbenefits.com account or under Plan Type Options, select “PPO Plans.” Then complete
the search criteria and click “Submit.”
The PPO Low plan requires a $50 individual and $150 family in- or out-of-network deductible to be met before most benefits will
begin. The deductible is waived for preventive services.
The maximum benefit the PPO Low plan will pay for each covered member is $1,000 for in- and out-of-network services combined
per Calendar Year. Diagnostic and preventive services accumulate towards the Benefit Maximum.
•• Each covered family member may receive up to 2 FREE cleanings per Calendar Year under the Preventive Benefit.
•• Waiting periods and age limitations for certain services may apply.
17
Dental Insurance: Humana PPO Low Plan At-A-Glance
Network
CompBenefits PPO
In Network
Out of Network
Per Member
$50
Per Family
$150
Waived for Class I Services
Yes
In Network
Per Member
Out of Network
$1,000
In Network
Out of Network*
Plan Pays: 100%
Deductible Waived
Plan Pays: 100%
Deductible Waived
(Subject to Balance Billing)
In Network
Out of Network*
Plan Pays: 80% After CYD
In Network
Out of Network*
Bitewing X-rays
Complete X-rays (1 every 3 years)
Fillings (Amalgam and Composite)
Simple Extractions
Non-Surgical Periodontics
Surgical Periodontics
Endodontics (Root Canal Therapy)
Oral Surgery
Local Anesthesia (Limitations Apply)
Crowns
Dentures
Bridges
For information regarding out-of-network balance billing that may be charged by an out-of-network provider for services rendered,
please refer to the Out-of-Network Benefits section on the previous page.
Customer Service.
18
Dental Insurance: Humana PPO High Plan
Humana/CompBenefits
Dental Insurance – Humana PPO High Plan
of the PPO High Plan is provided below and the premium payroll
deductions are shown on the table to the right. A summary of
benefits is provided on the following page. For detailed coverages,
exclusions and stipulations, please refer to the carrier’s benefit
summary or contact Humana’s Customer Service.
Tier of Coverage
In-Network Benefits
Employee Cost
Employee Only
$15.59
$29.89
$48.78
The PPO High plan is “open access” and allows you to receive
services from any dental provider without selecting a Primary Dental Provider (PDP) and does not require referrals to specialists.
The network of participating dental providers the plan utilizes is the CompBenefits PPO Network. The PPO plan provides
benefits for services received from in-network and out-of-network providers. You are responsible for a Calendar Year Deductible
(CYD) and then coinsurance based on the plan’s Usual, Customary and Reasonable (UCR) charge limitations.
Providers who do not contract with insurance carriers because they do not accept their discounted rates are referred to as “nonparticipating” or “out of network.” Understanding how your insurance company pays for out-of-network services is important
because you will usually pay more.
The insurance company processes charges based on what it determines the “Usual, Customary and Reasonable (UCR)” charge
is for a specific service. UCR or the “allowed amount” can be defined as the most common charge for a particular dental or
medical procedure performed in a specific geographic area. Since there is no contract in place between the insurance company
and out-of-network provider, the dentist may charge an amount higher than the UCR. The difference between the UCR amount
and the dentist’s higher charge is called “balance billing.” Balance billing is in addition to your deductible and coinsurance
responsibility.
tab and you can either log into your mycompbenefits.com account or under Plan Type Options, select “PPO Plans.” Then complete
the search criteria and click “Submit.”
The PPO High plan requires a $50 individual and $150 family in- or out-of-network deductible to be met before most benefits will
begin. The deductible is waived for preventive services.
The maximum benefit the PPO High plan will pay for each covered member is $1,000 for in- and out-of-network services combined
per Calendar Year. Diagnostic and preventive services accumulate towards the Benefit Maximum.
•• Each covered family member may receive up to 2 FREE cleanings per Calendar Year under the Preventive Benefit.
•• Waiting periods and age limitations for certain services may apply.
19
Dental Insurance: Humana PPO High Plan At-A-Glance
Network
CompBenefits PPO
In Network
Out of Network
Per Member
$50
Per Family
$150
Waived for Class I Services
Yes
In Network
Per Member
Out of Network
$1,500
In Network
Out of Network*
Plan Pays: 100%
Deductible Waived
Plan Pays: 100%
Deductible Waived
In Network
Out of Network*
In Network
Out of Network*
Bitewing X-rays
Complete X-rays (1 every 3 years)
Fillings (Amalgam and Composite)
Simple Extractions
Non-Surgical Periodontics
Surgical Periodontics
Endodontics (Root Canal Therapy)
Oral Surgery
Local Anesthesia (Limitations Apply)
Crowns
Dentures
Bridges
For information regarding out-of-network balance billing that may be charged by an out-of-network provider for services rendered,
please refer to the Out-of-Network Benefits section on the previous page.
Customer Service.
20
Vision Insurance: Humana VisionCare Plan
Humana/CompBenefits
The City offers vision insurance through Humana. A brief
description of the VisionCare Plan is provided below. A
summary of the plan’s schedule of benefits is provided on the
following page and the cost per pay period are provided in
the premium table to the right. For details regarding the entire
plan’s coverages, exclusions and stipulations, please refer to the
carrier’s benefit summary or please contact Humana’s Customer
Service.
Vision Insurance – Humana VisionCare Plan
Tier of Coverage
Employee Cost
Employee Only
$2.27
$4.42
Employee + 2 or more Dependents
$6.34
In-Network Benefits
Receiving services from a provider that participates in the CompBenefits VisionCare Plan Network offers you and your covered
dependents with coverage for routine eye care, including eye exams, eyeglasses (lenses and frames) or contact lenses with a cost
of a copay. At the time of service, routine vision examinations and basic optical needs will be covered as shown on the plan’s
schedule of benefits. Cosmetic services and upgrades will be additional if chosen at the time of your appointment.
Out of Network Benefits
Covered members may also choose to receive services from vision providers that do not participate in the CompBenefit VisionCare
Plan network. If so, the cost of the services received would be paid to that provider at the time of the scheduled appointment.
Humana will then reimburse the covered members based on the plan’s out-of-network reimbursement schedule upon receipt of
proof of services rendered.
To search for a participating provider, call Customer Service or go to www.compbenefits.com. Click on the “Providers/Search” tab
and then on the right side column click “Find Vision Providers.” You can either log on to your mycompbenefits.com account or
select the “VisionCare Plan” link. Complete the search criteria and click “Submit.”
There is no Calendar Year Deductible.
Calendar Year Out-of-Pocket Maximum
There is no Out-of-Pocket Maximum. However, there are benefit reimbursement maximums for certain services per year.
•• Member options, such as Lasik, UV coating, progressive lenses, etc. are not covered in full, but may be available at a discount.
•• Limitations and exclusions may apply for certain services.
21
Vision Insurance: Humana VisionCare Plan At-A-Glance
Services
In Network
Out of Network
Eye Exam
$10 Copay
Up to $35 Reimbursement
Materials
$15 Copay
Reimbursement is based on type of
service
Frequency of Services
In Network
Out of Network
Examination
12 Months
Lenses
12 Months
Frames
24 Months
Contact Lenses
12 Months
Lenses
In Network
Single
Out of Network
No Charge After Applicable
Exam/Materials Copy
Bifocal
Trifocal
Frames
In Network
Out of Network
$40 Wholesale Allowance
Contact Lenses*
In Network
Out of Network
Non-Elective (Medically Necessary)
No Charge
Elective (Fitting, Follow-up & Lenses)
$135 Allowance
Basic, Preferred or Non-Preferred
*Contact lenses are in lieu of spectacle lenses and a frame.
22
Flexible Spending Accounts
TASC
www.tasconline.com
Claims Mailing Address:
Fax: (608) 663-2754
The City of Delray Beach offers Flexible Spending Accounts (FSA) administered through TASC.
If you have predictable medical expenses for yourself or your family, such as deductibles and copays, or any work-related day care
expenses, FSAs may be right for you. FSAs allow you to set aside money for reimbursement of medical and day care expenses you
regularly pay. The amount you set aside is not taxed and is automatically deducted from your paycheck and deposited into the FSA.
During the year, you have access to this account for reimbursement of some expenses that are not covered by insurance. An FSA not
only results in a substantial tax savings, it also increases your spending power. There are two types of FSAs:
Health Care Reimbursement Account
Dependent Care Reimbursement Account
This account allows you to set aside up to an annual
maximum of $2,550. This money will not be taxable
income to you and can be used to offset the cost of a
wide variety of eligible medical expenses that generate
out-of-pocket costs for you or your qualified dependents.
Employees can also receive reimbursement for expenses
related to dental and vision care (that are not classified
as cosmetic).
This account allows you to set aside up to an annual maximum of $5,000
($2,500 if you file a separate tax return) for work-related day care expenses.
Qualified expenses include adult and child day care centers, preschool, and
before/after school care for eligible children and adults.
Examples of common expenses that qualify for
reimbursement are listed below.
*NOTE: The entire Health Care FSA election is
available to you on the first day coverage is effective.
Please note that if your family’s annual income is over $20,000, this
reimbursement option will most likely save you more money than the dependent
care tax credit you take on your tax return. To qualify, your dependent must be:
••
a child under the age of 13, or
••
a child, spouse or other dependent that is physically or mentally incapable
of self-care and spends at least 8 hours a day in your household.
*NOTE: Unlike the Health Care FSA, you will only be reimbursed up to the
amount that has been deducted from your paycheck for Dependent Care
expenses.
A sample list of qualified expenses eligible for reimbursement include, but are not limited to, the following:
••
••
••
••
••
••
Ambulance service
Chiropractic care
Dental fees/Orthodontic fees
Diagnostic tests/Health screenings
Doctor fees
Drug addiction/Alcoholism treatment
••
••
••
••
••
••
Experimental medical treatment
Eyeglasses/Contact lenses (corrective)
Hearing aids and exams
Injections & vaccinations
Lasik surgery
Mental healthcare
••
••
••
••
••
••
Nursing services
Optometrist fees
Physician office visits
Prescription drugs
Medically Necessary Sunscreen
Wheelchairs
Log on to http://www.irs.gov/publications/p502/index.html for additional details regarding qualified and non-qualified expenses.
23
Flexible Spending Accounts (continued)
FSA Guidelines
••
••
••
••
••
••
••
••
••
••
••
Healthcare Reimbursement Accounts allow you to carry over up to $500 of unused funds from your Healthcare FSA account
into the next plan year after a plan year ends and all claims have been filed. Dependent Care funds CANNOT be carried over.
Healthcare Reimbursement Accounts allow a run out period at the end of the plan year (2.5 months) to submit for
reimbursement on eligible expenses incurred during your period of coverage within the plan year (June 1st - May 31st).
Dependent Care Reimbursement Accounts allow a grace at the end of the plan year (2.5 months). The grace period
allows additional time to incur claims and use any unused funds on eligible expenses after the plan year ends. Once
the grace period ends any unused funds still remaining in the account will be forfeited. Healthcare Reimbursement
Accounts DO NOT have a grace period.
After a plan year ends and all claims have been filed, any unused funds cannot be returned to you or carried
forward to the next plan year, with the exception of the $500 carry over that may be allowed for the Healthcare
Reimbursement Account.
You can enroll in either or both FSAs during open enrollment period, a qualifying event or new hire eligibility only.
You cannot transfer money between FSAs.
You cannot pay a dependent care expense from your Health Care FSA or vice versa.
You cannot deduct reimbursed expenses for income tax purposes.
You cannot be reimbursed for a service which you have not received.
You cannot receive insurance benefits or any other compensation for expenses which are reimbursed through your FSAs.
Domestic Partners are not eligible as federal law does not recognize them as a qualified dependent.
Here’s How It Works
An employee earning $30,000 elects to place $1,000 into their FSA Health Care Savings Account, with payroll deductions being
$38.46 based on a 26 pay period schedule. As a result, the insurance premiums and health care expenses are paid with tax-free
dollars, giving the employee a tax savings of $227.
With the Plan
Salary
$30,000
Without the Plan
$30,000
FSA Contribution
- $1,000
- $0
Taxable pay
$29,000
$30,000
Estimated Tax
22.65% = 15% + 7.65% FICA
- $6,568
- $6,795
After Tax Expenses
- $0
- $1,000
Spendable Income
$22,432
$22,205
Tax Savings
$227
NOTE: Be conservative when estimating your medical and/or dependent care expenses. IRS regulations state that any
unused funds which remain in your FSA after a plan year ends and after all claims have been filed, cannot be returned
to you or carried forward to the next plan year, with the exception of the $500 carry over that may be allowed for the
Healthcare Reimbursement FSA. This is known as the “USE IT OR LOSE IT” rule.
Filing a Claim
To file a claim, you must submit your completed claim form and include a copy of the receipt as proof of the expense. Once
completed, you may submit your claim either by mail or fax. The IRS requires FSA participants to maintain complete documentation,
including keeping copies of receipts for reimbursed expenses, for a minimum of one year.
Debit Card
FSA participants will receive a debit card for payment of eligible expenses. The debit card allows participants to pay for most
qualified services and products at the point of sale versus paying out of pocket and requesting reimbursement. The debit card is
accepted at a number of medical providers and facilities and most pharmacy retail outlets.
24
Employee Assistance Program
Cigna Employee Assistance Program (EAP)
www.cignabehavioral.com
Employer ID: cityofdelraybeach
The City provides through Cigna, at no cost to all eligible employees, an Employee Assistance Program (EAP) for you and your
household. The EAP is strictly confidential and provides professional counseling 24/7 for handling life’s demands. The EAP allows
you or a household family member to call and request a referral up to 5 face-to-face visits with a counselor.
Get phone support by calling for advice or a referral to a service in your community on topics such as:
••
Legal Consultation – Receive a 30-minute free consultation.
••
Parenting – Receive guidance on child development, sibling rivalry, separation anxiety, and much more.
••
Senior Care – Learn about challenges and solutions associated with caring for an aging loved one.
••
Child Care – Whether you need care all day or just after school, find a place that’s right for your family.
••
Pet Care – From grooming to boarding to veterinary services, find what you need to care for your pet.
The EAP also provides Online Support for topics like:
••
Parenting – Adoption, child care, developmental stages, kid’s well-being, education.
••
Aging – Adults with disabilities, aging well, planning for the future, U.S. systems for the elderly, housing options, home care,
health, caregivers, grief & loss.
••
Balancing – Personal growth, communication, families, relationship, grief & loss, mental health, addiction & recovery.
••
Thriving – Health tools, live healthy, healthy eating, medical care, infant & toddler health, child health, adolescent health,
women’s health, men’s health, senior health, health challenges.
••
Working – Accomplished employee, effective manager, career development, training & development, workplace
productivity, workplace diversity, workplace safety, managing stress.
••
Living – Consumer tips, home improvement, home buying or selling, moving, financial, legal, legal ready docs, errands
online, safety, pets, travel & leisure time, fraud & theft.
Please Note: This program is strictly confidential. There is no information shared with your employer.
Are your services confidential?
Yes. Receipt of EAP services is completely confidential. If, however, participation in the EAP is the direct result of a Management
Referral (a referral initiated by a supervisor or manager), we will ask permission to communicate certain aspects of the employee’s
care (attendance at sessions, adherence to treatment plans, etc.) to the referring supervisor/manager. The referring supervisor will
not, however, receive specific information regarding the referred employee’s case. The supervisor will only receive reports on
whether the referred employee is complying with the prescribed treatment plan.
25
Basic Life and AD&D Insurance
Minnesota Life
www.ochsinc.com
Basic Term Life
The City provides basic life insurance coverage through Minnesota Life at no cost to you. The life insurance benefit amount is
determined by class as follows:
Class
Class Description
Benefit Amount
Class 1
City Manager, Assistant City Managers, City Attorney & Department Heads
$150,000
Class 2
Assistant Department Heads, Police Legal Advisors, Assistant City Attorney,
Division Heads, Battalion Chiefs and Police Lieutenants all earning
$75,000 or more annually
$100,000
Class 3
Assistant Department Heads, Police Legal Advisors, Assistant City Attorney,
Division Heads, Battalion Chiefs and Police Lieutenants all earning less
than $75,000 annually
$75,000
Class 4
P.B.A. employees who are subject to a collective bargaining agreement
$50,000
Class 5
I.A.F.F. employees who are subject to a collective bargaining agreement
$50,000
Class 6
S.E.I.U. employees who are subject to a collective bargaining agreement
earning $25,000 or more annually
$50,000
Class 7
S.E.I.U. employees who are subject to a collective bargaining agreement
earning less than $25,000
$50,000
Class 8
Employees earning $60,000 or more annually, excluding employees in the
above classes
$75,000
Class 9
Employees earning between $40,000 and less than $60,000 annually,
excluding employees in the above classes
$60,000
Class 10
Employees earning less than $40,000 annually, excluding employees in the
above classes
$50,000
The Basic Term Life Insurance benefit is subject to an age reduction schedule that reduces the benefit given, as the employee ages.
The reduction schedule is as follows:
At age 65 the benefit will reduce to 65% of the original amount
Accidental Death & Dismemberment
Also at no cost to the employee, the City provides Accidental Death & Dismemberment (AD&D) insurance, which pays in addition
to the Basic Life benefit when death occurs as a result of an accident. The AD&D benefit amount equals the Basic Term Life benefit.
Always remember to keep your beneficiary forms updated. You may update
your beneficiary information at anytime by logging onto BenTek’s Employee Benefits Center at
www.mybentek.com/delraybeach or by contacting the Benefits Manager.
26
Voluntary and AD&D Life Insurance
Minnesota Life
www.ochsinc.com
Voluntary Employee Life and AD&D Insurance
Eligible employees may elect to purchase additional life insurance on a voluntary basis through Minnesota Life. This coverage may
be purchased in addition to the Basic Term Life and AD&D coverages. Voluntary Life Insurance offers coverage for yourself, spouse
or child(ren) at different benefit levels.
New Hires can purchase voluntary employee life insurance without having to go through Medical
Underwriting, also known as Evidence of Insurability (EOI), up to the Guaranteed Issue amount of
up to $200,000.
••
••
••
••
Units can be purchased in increments of one, up to five times, your annual earnings with a maximum of $500,000.
Benefit amounts are subject to the following age reduction schedule as the employee ages:
Rates are subject to increase annually and are based on the employees age bracket.
Group coverage with the City will end upon termination.
Voluntary Spouse Life Insurance
New Hires can purchase voluntary spouse life insurance without
having to go through Medical Underwriting, also known as
Evidence of Insurability (EOI), up to the Guaranteed Issue
amount of $30,000.
••
••
••
••
Employees must participate in the voluntary plan for spouse to participate.
Units can be purchased in increments of $5,000, not to exceed a maximum of $200,000,
however coverage cannot exceed the employee’s Voluntary Life coverage amount.
Evidence of Insurability (EOI) Forms will be required for approval of coverage over the
guaranteed issue amount or if elected after initially being eligible to participate.
Benefit amounts are subject to the following age reduction schedule as the employee ages.
The reduction schedule is as follows:
Dependent Child(ren) Life Insurance
••
••
••
Employees must participate in voluntary plan for dependent children to participate.
For eligible unmarried children, from 6 months up to age 19 or 25 if a full-tme student,
you can elect coverage of $10,000.
Child(ren) from 14 days to 6 months may be covered for a reduced benefit of $1,000.
Voluntary Life
Monthly Rates
Age Bracket
(Based on
Employee
Age)
Employee /
Spouse
per $1,000
< 34
$0.07
35-39
$0.13
40-44
$0.20
45-49
$0.33
50-54
$0.53
55-59
$0.86
60-64
$1.12
65-69
$1.76
70+
$3.11
Always remember to keep your beneficiary forms updated. You may update
your beneficiary information at anytime by logging onto BenTek’s Employee Benefits Center at
www.mybentek.com/delraybeach or by contacting the Benefits Manager.
27
Long Term Disability Insurance
Cigna
www.cigna.com
The City provides Long Term Disability (LTD) insurance to all eligible employees at no cost through Cigna. The LTD pays you a
percentage of your weekly earnings if you become disabled due to an illness or non-work related injury.
LTD Plan Summary
••
••
••
••
••
••
••
The LTD program offers a benefit of 60% of your monthly earnings, subject to a maximum of $5,000 per month.
An employee must be disabled for 60 days prior to becoming eligible for benefits (known as the elimination period).
Benefit payments will commence on the 61st day of your disability.
If you return to work on a part-time basis, you may continue to be eligible for partial benefits.
Periodic evaluations will occur at the discretion of the Cigna.
The employee may receive benefits for up to 24 months if they are unable to return to their own occupation.
After 24 months, if the employee can return to any occupation in which they are suitably trained, educated, and capable of
performing, the employee must return to that occupation.
Voluntary Benefits
The City offers employees a chance to purchase voluntary products through payroll deductions. While the City does not pay any
portion of these premiums, it does save you the extra time and energy of maintaining outside coverage without the hassle of mailing
the premiums. Most important, these products are portable. You can take them with you if you leave employment with the City.
Supplemental Insurance
Allstate
Claims: (800) 348-4489
www.allstatebenefits.com
Allstate offers voluntary supplemental insurance plans that may be purchased separately on a voluntary basis and premiums paid
by payroll deduction. Allstate pays money directly to you, regardless of what other insurance plans you may have. To learn more
about these Allstate plans and/or to schedule a personal appointment, contact your local Allstate agent.
Available plans include:
•• Group Accident Plan
•• Group Supplemental Health Insurance
28
Supplemental Insurance (continued)
Trustmark
Claims: (877) 201-9373
www.trustmarksolutions.com
Trustmark offers voluntary supplemental insurance plans that may be purchased separately on a voluntary basis and premiums paid
by payroll deduction. To learn more about these Trustmark plans and/or to schedule a personal appointment, contact your local
Trustmark agent.
Available plans include:
•• Disability Income Insurance
•• Critical Illness
•• Universal Life Insurance
Legal Insurance
Legal Club of America
www.legalclub.com
City employees have the opportunity to enroll in a voluntary pre-paid legal program provided by Legal Club of America. By
enrolling in this plan, a participant will have direct access to attorneys who will provide legal assistance, 24 hours a day, 7 days a
week, for a variety of situations that include:
•• Free & Discounted Legal Care
•• Financial Education & Credit
•• Identity Theft Solutions
Counseling
•• Tax Preparation & Advice
•• Life Events™ Counseling
The cost to the employee to participate in this legal plan is $14 per month. This includes coverage for the entire household
including your spouse, domestic partners, dependent children under age 25 and any dependent individual living in the plan
member’s home, such as a parent or grandparent, regardless of the number of eligible dependents enrolled in the plan.
Pet Insurance
Pet Assure
www.petassure.com
The City provides employees the opportunity to purchase pet insurance on a voluntary basis through Pet Assure. Participating Pet
Assure Providers offer a 25% savings on all medical care provided in the office. This includes the office visit, exam, shots, surgery,
x-rays and any other procedures the vet does. Check www.petassure.com for a complete list of providers near you. Pet Assure is
not insurance, therefore there are no exclusions. You can enroll any pet, any breed, any age and in any health condition; you can
even enroll pets with pre-existing and hereditary conditions. Also, included at no additional cost is Pet Assure’s 24/7/365 lost pet
recovery service that helps thousands of lost pets reunite with their families. Employees will also receive additional savings on
pet products and services at thousands of participating pet merchants, including everyday basics like food, treats, medications,
supplies, and grooming. This policy can be purchased for $9 per month, regardless of how many covered pets. For additional
information contact Pet Assure’s Customer Services.
29
Notes
Use this section to make notes regarding your personal benefit plans or to keep track of important information such as doctor’s
names and addresses or prescription medications.
30
Notes
31
Notes
32
11505 Fairchild Gardens Ave., Suite 202
Palm Beach Gardens, Florida 33410
Toll Free: (800) 244-3696; Fax: (561) 626-6970
www.gehringgroup.com
FINAL Revised - Last Modified:
April 21, 2015 3:57 PM

City of Delray Beach Employee Benefits Handbook 2015

Transcription

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