City of McKinney Employee Benefits Guide

Transcription

2017
City of McKinney
Employee
Benefits Guide
Table of Contents
Welcome1
Eligibility2
Enrollment/Changes3
Summary of Benefit Options4
Health Insurance Costs5
Medical & Prescription Drug Plans6
Compass Professional Healthcare Services6
Medical Plan Benefits7
Prescription Drug Coverage8-9
Dental Plan Highlights10
Vision Plan Highlights11
Flexible Spending Accounts12
Life Insurance13
Long Term Disability14
AFLAC15-16
LegalShield17
Wellness Program18
Employee Assistance Program19
Retirement Programs20
Leave & Additional Benefits21-22
Family Medical Leave Act23-24
Notice of Privacy Practices25-27
Important Notices28
Important Contacts29
City of McKinney Employee Benefits Guide
WELCOME
The City of McKinney is pleased to offer you a comprehensive benefits package. This guide is designed to assist you and your
family in making the choices that best meet your needs.
This enrollment guide provides you with information about the following benefit plans available to you and your family:
medical/prescription, dental, vision, term life insurance/AD&D, long term disability, flexible spending accounts and other
supplemental plans.
Other city benefits, such as holiday pay, vacation and sick leave, are mentioned in this guide for your information only. No
enrollment is required for these benefits. However, you should refer to the relevant city policy for more information regarding
eligibility and usage.
Note: This guide is only a summary of employee benefits currently offered by the City of McKinney. In all events, the terms of the
various benefit plans, as set forth in their respective plan documents govern, and as a result, no statements made outside of the
plan documents, whether verbal or written, change or modify the terms of the plans. The City of McKinney reserves the right to
modify or eliminate any benefit plan at any time.
What’s new for 2017
No More Co-Pays for In/Outpatient Hospital Visits
The health plan will eliminate copays for inpatient and outpatient hospital visits. Currently, an in-network visit to the hospital
requires either a $50 or $300 copay, plus deductible and coinsurance. Only the deductible and coinsurance will apply to these
visits starting in 2017. Copays for urgent care and emergency room visits will still apply.
Over the Counter Drugs (OTC)
OTC drugs will no longer be covered under the health plan, even if prescribed by a physician. However, these medications can
still be reimbursed under the health FSA, with a doctor’s prescription.
McKinney Preferred Network
Due to the elimination of hospital copays for services other than emergency or urgent care, the McKinney Preferred Provider
Network will be cut back to two providers:
• LegacyER & Urgent Care
• OccumedPlus McKinney
Medical claims for all other facilities will be paid on an “in-network” or “out-of-network” basis, depending on the facility’s
affiliation with the Cigna OAP network.
New Wellness Program
Employees may sign up for one of the new wellness program options when they enroll for 2017 benefits online:
1. Healthy Goals – earn up to $600 Wellness Dollars by completing an HRA, biometric screen and other wellness activities.
2. Healthy Lifestyle – get a paid monthly membership to the new Apex Centre ($500 annual value) and earn an additional $100
Wellness Dollars by completing an HRA and biometric screen.
For more information on the wellness program, see page 18 or visit www.thecityinsider.org
2017 City of McKinney Human Resources Department • 972-547-7560 • www.thecityinsider.org
1
ELIGIBILITY FOR BENEFITS
Employee Eligibility
Regular full-time employees are eligible to participate in the medical, dental, vision, life, disability, flexible spending (medical or
dependent care) and supplemental plans. Certain variable hour employees determined to be working an average of at least 30
hours per week may qualify for coverage under some plans.
Dependent Eligibility
Dependents eligible for coverage in City of McKinney benefit plans include:
• Your legal spouse
• Your dependent children up to age 26 (includes stepchildren, legally adopted children, or children placed with you for adoption)
• Your dependent child, regardless of age, provided he or she is incapable of self-support due to a mental or physical disability
and is chiefly dependent on you for support and maintenance. Proof of incapacity must be furnished upon request.
Dependent Children Turning Age 26
If your adult child becomes ineligible for benefits due to turning age 26, it is your responsibility to notify the Human Resources
Department (HR) within 30 days of the child’s 26th birth date to cancel benefits for that child. If the child needs to remain on a
plan to due mental/physical disability, as described above, you will need to contact HR to request continued enrollment for the
child. Proof of the child’s incapacity for self-support must be furnished.
Divorce
If you divorce your spouse, it is your responsibility to notify HR within 30 days of the effective date of the divorce. A copy of the
divorce decree showing the effective date will need to be submitted to HR. You should also request to drop your former spouse
from your benefits via Benefit Solver at www.benefitsolver.com.
2
ENROLLMENT/CHANGES
How to Enroll
Enroll for benefits online through Benefit Solver: www.benefitsolver.com.
Register with Benefit Solver using your date of birth, social security number and the company code “mckinney” (without the
quotes). You will need to either select or waive (decline) each benefit option offered.
Be sure to have social security numbers and birth dates for any eligible dependent(s) that you plan to enroll. You cannot enroll
your dependent(s) without this information.
Documentation for Dependent Eligibility
If you are adding a dependent for the first time, you will be required to provide proof of dependent status to HR prior to the
enrollment deadline (e.g. a marriage license to prove a spouse or a birth certificate to prove a dependent child).
Evidence of Insurability (EOI) or Statement of Health (SOH) Forms
If you choose to increase or elect optional life insurance or long-term disability benefits after your initial enrollment period or in
excess of a non-medical maximum, you will need to complete an evidence of insurability (EOI) or statement of health form (SOH)
for review. The EOI or SOH form must be submitted to HR no later than the enrollment deadline. Coverage will not take effect
until the form is approved by the insurance company.
When Coverage is Effective
Provided that all enrollment requirements are completed on time, coverage is generally effective as follows:
• New Hire – First of the month following 28 days of employment
• Annual Enrollment – January 1
• Qualifying Event – First of the month following approval of the change; date of the event for birth or adoption
Change Requests
Once an enrollment period closes, you cannot make any changes to your benefits until the next enrollment period unless you
experience a Qualifying Event. You must request a change due to a Qualifying Event within 30 days of the event. However, if
you or your dependents lose coverage or become eligible for premium assistance under Medicaid or CHIP, you have up to 60
days from the date you lost or gained eligibility to request enrollment in the city’s health plan. Any change requested must
be consistent with the Qualifying Event. Except in cases of birth or adoption, changes generally become effective the first of
the month following the date the request (with supporting documentation) is approved. Approved enrollment due to birth or
adoption becomes effective as of the date of the event.
Log in to Benefit Solver www.benefitsolver.com to submit your change request under Life Events. Submit supporting
documentation (marriage license, birth certificate, etc.) to HR when you make your request on Benefit Solver. Contact HR at 972547-7560 for assistance.
Qualifying Events include:
1. Change in legal marital status due to marriage, death of a
spouse or divorce
6. Change in residence of employee, spouse or dependent to
a location outside of the employer’s network service area
2. Change in number of dependents due to birth, adoption,
placement for adoption, or death of a dependent
7. Changes which cause a dependent to become eligible or
ineligible for coverage
3. Change in employment status of employee, spouse or
dependent due to termination or start of employment,
beginning or end of unpaid leave of absence, including
under the Family and Medical Leave Act (FMLA)
8. Court Order mandating a change in coverage to cover
a dependent
9. Medicare or Medicaid Eligibility/Entitlement
4. Changes in employment status of employee, spouse or
dependent resulting in eligibility or ineligibility for coverage
5. Changes in coverage of spouse or dependent under another
employer’s plan
3
SUMMARY OF BENEFIT PLAN OPTIONS
The following benefit plans are available for enrollment. Enrollment is online through Benefit Solver for all options except for
AFLAC and the 457 Deferred Compensation Plans. To enroll in AFLAC or one of the 457 Deferred Compensation Plans, contact
the plan representative identified on the contact list.
This chart summarizes who pays for coverage under each plan elected (you and/or the City) and whether your payments are
made as before or after-tax deductions. Payroll deductions to pay for benefits are taken 24 times per year, unless special
circumstances apply.
BENEFIT PLAN
PAID BY CITY
PAID BY YOU
Medical & Prescription Drug
X
X
Before Tax
Dental
X
X
Before Tax
Vision
X
Before Tax
Flexible Spending Accounts (FSAs)
X
Before Tax
Basic Life and AD&D
X
Basic Long Term Disability
No Cost
X
Supplemental Life/AD&D Buy-up1
HOW YOU PAY
X
After Tax
No Cost
X
After Tax
457 Deferred Compensation1
X
Before Tax
Aflac1
X
Depends on
Plan Option
Legal Shield1
X
After Tax
Supplemental Long Term Disability1
Basic LTD
You may elect, change or waive enrollment in the following plans at any time during the year; you do not need to wait for Open Enrollment or
have a qualifying event: Supplemental life and LTD(Buy-up), 457 Deferred Compensation, Aflac (after-tax options) and Legal Shield.
1
4
HEALTH INSURANCE COSTS
Employees and the City of McKinney share the cost of medical and dental benefits. Employee contributions for benefits are
deducted from the first two paychecks each month, for a total of 24 benefits deductions per year.
MEDICAL PLAN
CITY CARE
Higher Deductible ($1,200)
Tier
CITY CARE PLUS
Lower Deductible ($500)
Per Month
Per Pay Period
Per Month
Per Pay Period
Employee Only
$35
$17.50
$100
$50
Employee & Spouse
$260
$130
$370
$185
Employee & Child(ren)
$220
$110
$330
$165
Employee & Family
$360
$180
$510
$255
DENTAL PLAN
Tier
Per Month
Per Pay Period
Employee Only
$12
$6
Employee & Spouse
$25
$12.50
$28
$14
Employee & Family
$36
$18
Per Month
Per Pay Period
Employee Only
$4.62
$2.31
Employee & Spouse
$8.34
$4.17
$8.80
$4.40
Employee & Family
$13.08
$6.54
VISION PLAN
Tier
5
MEDICAL & PRESCRIPTION DRUG PLANS
City of McKinney offers two PPO medical plan options: City Care and City Care Plus. Both medical plans are administered by
Allegiance (a CIGNA Company), but utilize the CIGNA Open Access Plus (OAP) network. Cigna providers are contracted to
limit their charges for services. Out-of-network providers may charge more and may balance bill for charges above the plan’s
“maximum eligible expense” limit. Prescription drug coverage provided by Maxor Plus is included with enrollment in either
medical plan.
Verification of Benefits
If you are enrolled in one of the city’s medical plans, you should tell your medical provider that your benefits are verified and paid
by Allegiance, but that your plan uses the doctors and hospitals on the CIGNA Open Access Plus network.
Visit the Allegiance website to search for network providers or to verify whether your provider is “in-network.” Always ask your
health care provider to confirm CIGNA OAP network affiliation before receiving service.
Allegiance Contact Information
24 hour verification of coverage: 1-406-523-3199
Customer Service: 1-855-999-1054
Website: askallegiance.com/mckinney/
Plan # 2001065
Maxor Contact Information
Customer Service: 1-800-687-0707
Website: maxorplus.com
COMPASS PROFESSIONAL HEALTHCARE SERVICES
Compass Professional Healthcare Services (Compass) is a healthcare advisor service that is available to anyone enrolled in the
city’s health plan. The Compass Health Pro consultant can assist you with —
• Finding a doctor and setting up appointments
• Comparing cost of services
• Understanding your medical bills
• Understanding your health plan
Compass Contact Information
Customer Service: 1-800-513-1667 Ext. 411
Health Pro: Ryan Hrbacek
Email: [email protected]
Website: compassphs.com
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MEDICAL PLAN BENEFITS
Except for benefits for emergency/urgent care services, benefits for health care services obtained out of network are generally
subject to higher out-of-pocket costs to you. It is recommended that covered health care services be obtained from a network
provider whenever possible to assure the highest level of benefits under the plan. Below is a short summary of plan benefits. For
complete details, refer to the medical plan document, which may be found on the intranet.
CITY CARE
CITY CARE PLUS
Annual deductible (In Network): $1200 individual/$2400 family
Out of pocket maximum (In-network): $5200 employee/$10,400 family
COVERAGE
CITY CARE
IN NETWORK
Preventative Care 100%, no deductible
CITY CARE
OUT OF NETWORK
$500 individual/$1000 family
$3000 employee/$6000 family
CITY CARE PLUS
IN NETWORK
CITY CARE PLUS
OUT OF NETWORK
50% after deductible
100%, no deductible
$25 Copay
Same as PCP
Specialty Care Office Visit $40 Copay
$40 Copay
Chiropractor
$25 Copay
(limit 30 visits/year)
$25 Copay
Other Professional Provider
80%, after deductible
Services (In or Out Patient)
80%, after deductible
• During Office
Visit: 100%, no
deductible
• Facility Services
or Independent
Diagnostic Services
Facility (other
(Lab & X-Ray, other than
than Emergency
Advanced Imaging)
Room): 100%, no
deductible
• Emergency Room:
80%, no deductible
• During Office
Visit: 50%, after
deductible
or Independent
Facility (other
than Emergency
Room): 50%, after
deductible
• Emergency Room:
80%, no deductible
• During Office
Visit: 100%, no
deductible
or Independent
Facility (other
than Emergency
Room): 100%, no
deductible
• Emergency Room:
80%, no deductible
• During Office
Visit: 50%, after
deductible
or Independent
Facility (other
than Emergency
Room): 50%, after
deductible
• Emergency Room:
80%, no deductible
Primary Care (PCP) Office Visit $25 Copay
Walk-in Retail Clinic Same as PCP
• Emergency Room & • Emergency Room & • Emergency Room & • Emergency Room &
Urgent Care: 80%,
Urgent Care: 80%,
Urgent Care: 80%,
Urgent Care: 80%,
Advanced Radiology Imaging
no deductible
no deductible
no deductible
no deductible
(MRI, MRA, CAT scan, PET • All other locations:
• All other locations:
scan, etc.)
80% after
50% after
80% after
50% after
deductible
deductible
deductible
deductible
• Inpatient: 80% after • Inpatient: 50% after • Inpatient: 80% after • Inpatient: 50% after
deductible
deductible
deductible
deductible
Hospital • Outpatient: 80%
• Outpatient: 50%
• Outpatient: 80%
• Outpatient: 50%
after deductible
after deductible
after deductible
after deductible
Urgent Care
$50 Copay, then
100% coverage
Copay, then
Emergency Room* $100
80% coverage
$50 Copay, then
100% coverage
$50 Copay, then
100% coverage
$50 Copay, then
100% coverage
$100 Copay, then
80% coverage
$100 Copay, then
80% coverage
$100 Copay, then
80% coverage
• OCCUMED PLUS MCKINNEY: $10 Copay | Urgent care services for adults and children age
10+, M-F 8am - 5pm, 130 S. Central Expressway, McKinney, TX 75070
McKinney Preferred Network • LEGACY ER & URGENT CARE*: Urgent care services between the hours of 7 a.m. and 9
p.m. Monday – Sunday: $10 Copay; Emergency services (24 hrs.): $100 Copay, then 80%
coverage. For locations and information: www.legacyer.com. Cost of service depends on the
type of services needed.
*If the emergency visit is found not to be a true emergency as defined by the plan, benefits will be payable at 80%, after the deductible.
Find in-network providers at askallegiance.com/mckinney
7
PRESCRIPTION DRUG COVERAGE
Prescription drug coverage provided by Maxor Plus is included with enrollment in either medical plan. Your Allegiance ID card
will act as your Maxor Plus ID card as well.
Formulary
Pharmacy benefits are based on the MaxorPlus Preferred Drug Formulary. The formulary is a list of medications to be used as a
guide for physicians when prescribing. For the most up-to-date formulary, visit www.maxorplus.com.
The formulary options are:
• Generic - Any covered generic prescription drug. All generic drugs within your evidence of coverage are covered even if they are
not listed.
• Preferred Brand - Any covered prescription brand name drug listed on the formulary.
• Non-Preferred Brand - Any prescription brand name drug not listed on the formulary or is listed on the formulary and has a
generic equivalent listed beside the brand name.
As brand name medications become available generically, only the generic will be considered formulary. We encourage you to
visit with your physician or pharmacist about your formulary list to determine if a generic or a preferred brand medication is
appropriate for you.
Retail/Mail Order/Specialty
When you need prescriptions, you can purchase them through a participating retail pharmacy. For medications you need on
an ongoing basis, purchase through the mail order program is recommended. Specialty drugs generally must be purchased
through the Maxor Specialty Pharmacy to be covered.
Retail
To receive the highest level of benefits at a retail outlet, use one of the participating pharmacies such as:
COSTCO PHARMACY
KMART PHARMACY
TOM THUMB
CVS PHARMACY
KROGER PHARMACY
UNITED SUPERMARKET PHARMACY
DRUG EMPORIUM
SAM’S CLUB PHARMACY*
WALGREENS
H-E-B PHARMACY
SAV-ON PHARMACY
WAL-MART PHARMACY*
*Use Walmart or Sam’s Club for lower copays on generic drugs.
Mail Order Prescription
Maxor Mail Order Pharmacy offers a convenient, cost effective way to order prescribed long-term, maintenance medications for
direct delivery to your home. Medications obtained through mail order are limited to a 90-day supply. In order to maximize your
savings, please ask your doctor to write your prescription for a 90-day supply with refills up to one year.
Complete the order form when requesting a new prescription through Maxor Mail Order Pharmacy. Once Maxor Mail Order
has your original prescription, refills can easily be obtained by mail, by calling 1-800-687-8629, or online at www.maxorplus.com.
Specialty Drugs
Specialty drugs are often injectable drugs, other than insulin, but can include other generic or non-generic drugs classified by
the plan as “specialty drugs.” Unless an exception applies, only your first prescription may be obtained from a retail pharmacy.
Thereafter, refills must be obtained from the Maxor Specialty Pharmacy.
Find in-network providers at maxor.com
8
PRESCRIPTION DRUG COVERAGE
PRESCRIPTION COPAY AMOUNTS – RETAIL
COPAY PER PRESCRIPTION 1-34 DAY SUPPLY
Drug Type
Wal-Mart or Sam’s Club Pharmacy
Other Participating Pharmacy
Generic
$5
$10
Preferred Brand
$30
$30
Non-Preferred Brand
$60
$60
PRESCRIPTION COPAY AMOUNTS – MAIL ORDER
COPAY PER PRESCRIPTION Up to
Drug Type Wal-Mart or Sam’s Club Pharmacy (in-store)
90 DAY SUPPLY
Maxor Mail Order
Generic
$15
$20
Preferred Brand
$90
$60
Non-Preferred Brand
$180
$120
Specialty Medications: 10% with a minimum copay of $75 and a maximum copay of $200.
Maximum Out-of-Pocket: $1,400 per individual/$2,800 per family, per calendar year.
If a member requests a brand name drug when a generic equivalent exists, the member will pay the difference
between the brand and the generic medication in addition to the applicable brand copay.
Find in-network providers at maxor.com
9
MCKINNEY DENTAL PLAN HIGHLIGHTS
The dental plan provides benefits for typical dental expenses such as cleanings, X-rays, fillings and orthodontia. The dental plan
is administered by Allegiance (a CIGNA company), but utilizes the CIGNA dental network. Members may use any dental provider,
but will benefit from lower out-of-pocket costs when using a CIGNA network provider. CIGNA providers are contracted to limit
their charges for services. Out-of-network providers may charge more and may balance bill for charges above the plan’s “usual,
customary, and reasonable” limit.
DENTAL PLAN BENEFITS
Annual Dental Deductible
Lifetime Orthodontia Deductible
Annual Dental Maximum Benefit
Lifetime Orthodontia Maximum Benefit
Preventive Care (exams, routine cleanings, X-rays)
Basic Care (fillings, repairs, most extractions)
Major Care (crowns, bridges, dentures)
Orthodontia Benefits
10
$50 Individual/$150 Family
$50
$1,500
$1,500
100% (Deductible waived)
80%
50%
50%
To lifetime maximum child or adult.
MCKINNEY VISION PLAN HIGHLIGHTS
The vision benefit is designed to cover the cost of an annual eye exam and one pair of glasses with plastic lenses per year from
in-network providers. Certain upgrades/options, like polycarbonate lenses or anti-reflective coatings, may also be purchased from
network providers at a discount. Contact lenses may be purchased in lieu of glasses.
You can access care through either Davis Vision’s network of independent, private practice doctors (optometrists and
ophthalmologists) or select retail partners in the network. You may also be reimbursed for a portion of out-of-network expenses.
If you choose an out-of-network provider, you must pay the provider directly for all charges and then submit a claim for
reimbursement.
VISION PLAN
Service/Material
Benefit
In-Network
Out-of-Network
Eye Exam
Covered in full once per calendar year
after a $10 copay
$35
Eyeglasses
Standard Plastic Lenses
Covered in full once per calendar year
after a $15 copay
Single vision $25
Bifocal $40
Trifocal $50
Lenticular $80
Davis Vision’s Collection
(available at most
independent providers)
Frames
Any frame from Provider
$125 allowance , plus
20% off balance*
Any Visionworks
store frame
$175 allowance, plus
20% off balance*
Contact Lenses
Evaluation, fitting
and follow-up
Contact Lenses
(in lieu of glasses)
Covered in full
$45
Once per calendar year
With Davis Vision’s Contact
Lens Collection
Covered in full
With Non Collection
Contacts
15% discount*
Not covered
Davis Vision’s Contact Lens
Collection
Covered in full
Not covered
Other provider supplied
contact lenses
$130 allowance, plus
15% off balance*
$130
(available at most
independent providers)
*Additional discounts not applicable at Wal-Mart, Sam’s Club or Costco.
For more information about Davis Vision, visit www.davisvision.com or call 1-877-923-2847
11
FLEXIBLE SPENDING ACCOUNTS
A flexible spending account (FSA) is an account you can use to be reimbursed for certain out-of-pocket expenses related to
health care or dependent care (daycare) services. The City of McKinney offers both the Health FSA and the Dependent Care FSA
options. These accounts are separately funded by a fixed amount deducted from your pay on a pre-tax basis, the first two pay
checks each month. The FSA plan year runs on a calendar year basis, January – December, with a grace period through March
15. Any money left in the account at the close of the plan year is forfeited.
Participation is optional, but once elected, it cannot be changed unless you experience a qualifying event, such as marriage, divorce,
birth of a child, etc. Changes due to qualifying events must be requested within 30 days of the event, unless the change is related
to a gain or loss of Medicaid eligibility. For changes due to Medicaid eligibility, requests must be made within 60 days of the event.
Change requests must be initiated via Benefit Solver, in consultation with HR. Supporting documentation will be required.
Health FSA
The Health FSA may be used to pay for eligible out-of-pocket medical expenses incurred by you and your dependents.
Contribution Limits: $100 - $2,550 annually
Examples of Eligible Expenses:
• Prescription drugs
• Copays
• Other out-of-pocket costs for medical, dental and vision
• Deductibles
services not paid by insurance
Over-the-counter (OTC) drugs and medicines are not reimbursable through your flex account unless prescribed
by a medical practitioner.
Eligible health FSA expenses include those defined by IRS Code, Section 213(d). See www.allegianceflexadvantage.com for
a more complete list.
Dependent Care FSA
The Dependent Care FSA may be used for daycare expenses you incur for the following dependents:
• Your children that live with you and are 12 years of age or younger
• Your tax dependents incapable of self-care that reside in your home at least eight (8) hours per day.
Reimbursements are only available for dependent care that is necessary for you and your spouse to remain gainfully employed
or for you to remain gainfully employed while your spouse maintains full-time student status. Of course, single parents are also
eligible for reimbursements.
Contribution Limits:
The maximum amount you can elect to contribute is the smallest of the following:
• $5,000 – per couple if married and filing federal taxes jointly
• $2,500 – if married and filing a separate federal tax return
• Your spouse’s annual earned income
Examples of Eligible Expenses: • Day Care Centers
• Elder Care
• Day Camps
• Preschool
• After School Care
• Nanny / Au Pair
Examples of Ineligible Expenses:
• Meals
• Overnight Camps
• Diapers
• Education Expenses, including Kindergarten
• Incidental fees, such as activity fees and field trips
Reimbursement
Allegiance administers both the Health FSA and the Dependent Care FSA. You can mail, fax (toll free) or scan and send your
claims electronically through www.askallegiance.com or the Allegiance Advantage Mobile App. You may receive reimbursement
through check or direct deposit. Debit cards are available for immediate reimbursement of health care expenses, subject to
substantiation. Direct deposit is recommended for reimbursement of daycare expenses.
The full balance of your annual Health FSA election is available at all times while you are contributing to the account. For
example, if you have elected to contribute $1,200/year, but have only contributed $100 in January and have submitted no claims
so far, you could still be reimbursed for a $1,200 claim in February.
Dependent Care FSA reimbursements are limited to the balance in your account when the claim is submitted.
Eligible expenses must be incurred no later than March 15 following the end of the plan year, and claims for reimbursement
must be submitted by March 31.
12
LIFE INSURANCE
Basic Life & AD&D Insurance Coverage
The City of McKinney automatically provides basic term life and accidental death and dismemberment (AD&D) insurance
coverage to all regular full-time employees at no cost to the employee. The life insurance plan pays a benefit of $50,000 to the
employee’s designated beneficiary. The AD&D plan also provides a $50,000 benefit in the event of death due to an accident.
Benefits for other losses/injuries due to an accident, are based on a percentage of the full death benefit. Benefits reduce to 65%
at age 70 and to 50% at age 75. Coverage is provided by MetLife.
Supplemental Life and AD&D Insurance
Regular full-time employees may elect to purchase supplemental life and AD&D insurance coverage in addition to the basic
city-paid coverage. Employees pay the full cost of these benefits through post-tax payroll deductions. Premiums for both the
employee and the spouse are based on the employee’s age. Children must be unmarried and under age 26 for coverage.
Evidence of insurability (EOI) is required for coverage elections above the “non-medical maximum.” Any purchase or increase
in benefits beyond the initial eligibility period is also subject to submission of EOI. Contact HR or visit the intranet to locate the
MetLife “Statement of Health” form required for benefit elections requiring EOI.
BASIC LIFE & AD&D COVERAGE
Type of Coverage
Benefit Amounts –
Life and AD&D
Employee Increments of $10,000
Non-Medical
Maximum
Overall Maximum
Benefit
Employee
Contribution
$100,000
5 x Basic Annual
Earnings to
$500,000
100%
Spouse*
Increments of $5,000
$25,000
$250,000
100%
Child(ren)*
Flat amount: $1,000,
$2,000, $4,000, $5,000
or $10,000
$10,000
$10,000
100%
*Spouse amount cannot exceed 50% of the employee’s supplemental benefit. Child amount cannot exceed spouse amount.
For more information about this benefit, visit the Intranet or contact HR.
SUPPLEMENTAL LIFE/AD&D (METLIFE)
Employee Age
Employee / Spouse* – Cost Per $1000 Coverage
Under 30
$0.071
30-34
$0.074
35-34
$0.085
40-44
$0.113
45-49
$0.162
50-54
$0.239
55-59
$0.357
60-64
$0.516
65-69
$0.921
70+
$1.715
Child(ren)
$0.283
*Spouse rates are based on the employee’s age.
13
LONG TERM DISABILITY
Basic LTD
The City of McKinney automatically provides basic Long Term Disability (LTD) insurance coverage to regular full-time employees
at no cost to the employee. Basic LTD coverage provides income protection by replacing a percentage of pay if an employee is
unable to work for more than 180 days due to an illness or injury.
Monthly benefits generally equate to 60% of basic pre-disability earnings up to a maximum of $5,000. Benefits are subject to
reductions due to income from other sources, such as sick leave, salary continuation, workers’ compensation or Social Security.
LTD Buy-Up (optional)
Employees may enhance their basic LTD coverage by “buying up” to a benefit that would pay 66.67% of their basic pre-disability
earnings, up to a maximum of $7,500 per month. Buy-up is optional, but is paid entirely by the employee through post-tax
payroll deductions. Premiums for buy-up are based on age. Evidence of Insurability (EOI) is required for enrollment beyond the
initial eligibility period.
EXAMPLE: Employee is age 47 as of 1/1/17 and makes $62,000 per year. Buy-up premium rate is .35% of covered payroll.
Determine Basic Benefit:
Step 1. Calculate monthly salary: $62,000/12 = $5,167
Step 2. Calculate basic benefit: $5,167 x .60 = $3,100 monthly benefit
Determine Total Benefit (with Buy-Up) and Cost:
Step 1. Calculate monthly salary: $62,000/12 = $5,167
Step 2. Calculate total benefit (basic plus buy-up): $5,167 x .6667 = $3,444 TOTAL monthly benefit available
($3,100 from basic plan, and $344 from buy-up)
Step 3. Calculate employee cost: $5,167 x .35% (.0035) = $18.08 per month in premium
For more information about this benefit, visit the intranet or contact HR.
LONG TERM DISABILITY BUY-UP (KANSAS CITY LIFE)
Employee Age
14
Rate as a % of Covered Payroll
Under 30
0.20%
30-34
0.19%
35-34
0.24%
40-44
0.29%
45-49
0.35%
50-54
0.40%
55-59
0.46%
60-64
0.50%
65-69
0.56%
70+
0.62%
AFLAC
Aflac offers voluntary supplemental insurance plans that you may purchase to supplement your other benefits. You may reach
out to Donna Polser, our Aflac Agent, at 214-726-6406 or via e-mail at [email protected] with any questions. The
Aflac brochures can be viewed under the “reference center” tab at benefitsolver.com. Current Aflac policyholders may access
their specific policy information online via aflac.com. At the top right, click on log-in/register, click individual and follow the
instructions. Please e-mail Donna should you need your policy number prior to setting up your Aflac online account.
Aflac does not coordinate benefits with your health insurance nor does your health insurance coordinate benefits with Aflac.
The following is a brief summary of benefits that you may elect to own:
Aflac Accident Advantage: 24/7 Accident - Option 3
The plan has the following accident benefits for: Accident Treatment, Accident Follow-up treatment, Major Diagnostic
and Imaging Exams, Initial Accident Hospitalization, Accident Hospital Confinement, Intensive Care Unit Confinement,
Ambulance, Appliances Benefit, Rehabilitation Facility Benefit, Accident Specific-Sum Injuries Benefit, Accidental -Death
Benefit, Wellness Benefit, Transportation and Lodging Benefit and many other accident benefits.
Aflac Short Term Disability
You may elect to own the Short Term Disability, which will help bridge, the 6-month gap until your employer’s long-term
disability begins. Consider protecting one of the most valuable assets you have: your ability to provide an income for you
and your family in the event of an illness or off-the-job injury disability.
Aflac Cancer Care - Classic
As good as your major medical is, it still doesn’t pay for the out-of-pocket expenses incurred during a major illness
such as Cancer. The following are just a few of the many benefits paid directly to you under the plan: Initial Diagnosis,
Hospital Confinement, Skin Cancer Surgery, Radiation Therapy, Chemotherapy, Bone Marrow Transplantation, Stem Cell
Transplantation, Experimental Treatment Benefit, Transportation Benefit, Lodging Benefit, NCI evaluation/consultation,
Extended Care Facility and Hospice Care.
Aflac Plus Rider (Optional Lump Sum Critical Illness Rider)
The plan has a Tier One Critical Illness Event Benefit that covers 15 events such as heart attack and stroke, and a
Subsequent Benefit for a recurrence of the same or a new occurrence. Tier Two Critical Illness Event Benefit and a Coronary
Artery Bypass Graft Surgery Benefit. This rider can be added to either the Aflac Accident Advantage or the Aflac Hospital
Advantage or the Aflac Short Term Disability plan.
Aflac Critical Care Protection Option 1
Provides benefits for 10 specified health events including Heart Attack, Stroke and Coronary Artery Bypass Surgery. The
plan includes a first occurrence benefit, subsequent specified health event benefit, hospital confinement benefit ambulance
benefit, continuing care benefit, transportation benefit, lodging benefit and waiver of premium benefit.
Aflac Hospital Advantage - Preferred
This plan has benefits for Hospital Confinement, Rehabilitation Facility, Hospital Short Stay, Waiver of Premium, Hospital
Emergency Room, Physician Visits, Medical Imaging and Diagnostic, Ambulance, Surgical, Invasive Diagnostic Exams , Daily
Hospital Confinement and Hospital Intensive Care Unit Confinement.
Aflac Dental Insurance
Freedom to choose your own dentist without restriction. No deductibles. Benefits are paid regardless of any other plan.
Aflac Life Solutions
Term Life and Whole life plans are available.
15
AFLAC
Agent: Donna Polser
Number: 214-726-6406 Email: [email protected]
Semi-Monthly Payroll Deductions
24 Deductions per Year
AFLAC PREMIUMS
• Individual Employee $13.46
• Primary & Spouse (Employee & Spouse) $17.94
AFLAC Accident Advantage Option 3
• One parent family $20.87
• Two Parent Family $26.26
Aflac Short-Term Disability
To obtain a quote based upon your hourly rate of pay/salary and age, please
email Donna your information so she may provide you your Disability quote.
Aflac Cancer Care - Classic 18-75 Base
IDR $500
DCR
SDR
Individual (Employee) / One Parent Family $15.86
$2.93
$0.46
$0.46
Primary & Spouse / Two Parent Family $26.98
$6.50
$0.46
$0.85
IDR = Optional Initial Diagnosis Rider accruing $500 per year to diagnosis benefit
DCR = Optional Dependent Child Rider increase child diagnosis to $10,000 benefit
SDR = Optional Specified Disease Rider
Aflac Plus Rider
18-29
30-39
40-49
50-70
Individual (Employee) $1.56
$2.21
$3.77
$6.44
(Optional Lump Sum Critical Illness Benefit Rider)
Primary & Spouse (Employee & Spouse) $2.93
$4.36
$7.15
$12.29
One Parent Family $3.12
$3.38
$4.55
$6.63
Two Parent Family $3.77
$4.88
$7.35
$12.35
Aflac Critical Care Protection Option 1 18-35
36-45
46-55
56-70
$7.28
$10.14
$13.65
$11.18
$16.77
$24.57
$7.54
$10.47
$13.98
$12.35
$18.20
$26.26
Option 2 18-75
Option 3 18-75
Option 4 18-75
$19.83
$23.40
$28.21
$31.79
$38.42
$47.19
$28.99
$33.02
$37.96
$36.21
$42.77
$49.79
Dental
Level1
Level 2
Orthodontic
Cosmetic
$19.18
$11.83
$12.81
$37.57
$12.94
$12.81
$37.31
$12.94
$12.81
$56.10
$12.94
$12.81
Aflac Hospital Advantage - Preferred
Option 1 18-75
Aflac Life Solutions: Agent will quote. Based upon age tobacco/non-tobacco use and face dollar amount.
16
LEGALSHIELD
LegalShield protection plans provide affordable access to legal services related to family, auto, financial, home and estate
matters and more. Some of the services available include:
• Unlimited personal or business advice : 24/7 access to qualified attorneys within eight hours of your initial phone call to Ross
and Matthews, LegalShield’s provider Texas law firm.
• Will and trust preparation
• Letters and phone calls on your behalf
• Legal document review
• Trial defense hours
• Video law library
• Forms service center
• LegalShield Member Perks (savings on product categories: savings over $2,000/yr.)
LegalShield Identity Theft Plans provide services to help prevent and resolve issues related to identity theft. Benefits include:
• Credit report and personal credit score
• Continuous monitoring with safety alerts
• Identity consultation and restoration services through LegalShield’s partner, Kroll Security.
LEGAL SHIELD & IDENTITY THEFT SHIELD
Option
Per Pay Period
Legal Shield
$7.98
Identity Theft Shield
$6.47
Identity Theft Shield w/Children’s Safeguard*
$6.98
Legal Shield & Identity Shield
$12.95
Legal Shield & Identity Shield w/Children’s Safeguard*
$13.45
*Additional Approx $.50/Pay Period to add children under the age of 18 to the ID Theft Shield coverage.
17
WELLNESS PROGRAM
The Choice is Up to You!
Beginning in 2017, the City of McKinney’s Wellness Program will offer new incentives* and online tools to encourage healthy
habits and inspire participants to take charge of their wellbeing. The program is open to any full-time employee and is
completely voluntary. To participate, employees may elect one of two plan options during benefits enrollment. Once the election
is made, it cannot be changed until the next benefits enrollment opportunity. Participation will be tracked by Circle Wellness
(third party administrator), who will receive the required documentation to validate the completion of activities and assure the
privacy and security of individual health data. City employees will not receive medical information.
Option 1 – Healthy Goals
Participants can earn up to $600 Wellness Dollars for completing the three activities below by December 1, 2017. Wellness
Dollars earned in 2017 will be paid out in a lump-sum payment in January of 2018.
Activity 1. Health Risk Assessment (HRA) and Annual Biometric Screen - $100
• Both the HRA and Biometric Screen are required for any other reward payout.
• Biometric screen may be completed at an annual screening event sponsored by the city or through the participant’s
doctor (validated by an official copy of screening results and/or a form signed by doctor). Biometric screens must include
the items listed in Activity 2: waist measure, glucose, blood pressure, HDL cholesterol and triglycerides.
Activity 2. Meeting 3 of 5 Biometric Goals - $250
• Validated by an official copy of the biometric screen results. Participants who do not meet at least three goals may still
earn the reward if they also complete the Annual Preventive Care Exam.
1) Waist measure: 2) Fasting glucose: 3) Blood pressure: 4) HDL cholesterol: 5) Triglycerides: men ≤ 40” / women ≤ 35” ≤ 100 ≤ 130/85 men ≥ 40 / women ≥ 50 ≤ 150 Activity 3. Annual Preventive Care Exam - $250
• Validated either by Allegiance medical claim (if enrolled in the health plan) or by a form signed by the doctor.
Option 2 – Healthy Lifestyle
Participants electing this option will receive a monthly, employee-only membership to the new McKinney aquatics and fitness
facility, Apex Centre, valued at $41.67/month, $500 annually. Memberships will be effective January 1, 2017, or the month
following initial enrollment, and will be paid by the city for the duration of calendar year or until the end of the month in which
the participant terminates employment. Participants would also have the option to “buy up” to a family membership, by having
an additional $16.66/month ($200/year) deducted from their paychecks. Employees terminating employment would need to
reinstate their Apex Centre memberships on an individual basis to continue using the facility.
Participants may also earn $100 Wellness Dollars for completing both the Health Risk Assessment (HRA) and an Annual
Biometric Screen. The $100 lump-sum payout would occur in January of 2018.
*Wellness Dollars and Apex Centre membership are taxable benefits.
18
EMPLOYEE ASSISTANCE PROGRAM (EAP)
Deer Oaks EAP is a free service that provides a variety of counseling, referral and consultation services to assist you and your
family in resolving work/life issues in order to live happier, healthier, more balanced lives. All employees and their household
members are eligible to access the EAP, including former employees within six (6) months of separation. These services are
completely confidential and can be easily accessed by calling the toll-free Helpline: 866-327-2400.
How can the EAP help?
A trained counselor is available 24/7, 365 days per year to help you and your family cope with problems such as—
• Stress, tension, anxiety
• Depression, grief
• Anger management
• Marital/family problems
• Drug/alcohol use
• Coping with illness
• Parent/child problems
• Work-related difficulties
• Interpersonal problems with co-workers and supervisors
Participants are eligible for up to six (6) face-to-face counseling sessions per issue, per calendar year. Telephonic counseling may
be available at the request of the participant.
What other services does the EAP offer in addition to counseling?
Advantage Legal Assist: Free 30-minute telephonic consultation with a plan attorney; free 30-minute in-person consultation;
25% discount on hourly attorney fees if representation is required; unlimited online access to a wealth of educational legal
resources, links, tools and forms; interactive online Simple Will preparation; access to state agencies to obtain birth certificates
and other records.
Advantage Financial Assist: Unlimited telephonic consultation with a financial counselor qualified to advise on a range of
financial issues such as bankruptcy prevention, debt reduction and financial planning; supporting educational materials
available; credit report review by a financial counselor and tips for improvement; objective, pressure-free advice; unlimited online
access to a wealth of educational financial resources, links, tools and forms (i.e. tax guides, financial calculators, etc.).
Interactive Online Simple Will Preparation: Create a legally-binding simple state specific will at no cost through a step by step
online “interview process.” Access this service through www.deeroakseap.com/member-login/.
Credit Monitoring: Free credit reports and credit monitoring available via the legal/financial center.
ID Recovery: Free 30-minute telephonic consultation with an Identity Recovery Professional; customized action plan and
consultation; ongoing ID recovery guidance available as needed; free ID monitoring service.
Online Tools & Resources: Log on to deeroakseap.com/member-login/ to access an extensive topical library containing health
and wellness articles, child and elder care resources, work/life balance resources and webinars.
Username: mckinneytexas Password: mckinneytexas
19
RETIREMENT PROGRAMS
Required Plan – Texas Municipal Retirement System (TMRS)
Employees who normally work at least 1000 hours per year are required to contribute 7% of gross pay each paycheck. Deposits
are credited with interest each year. City of McKinney matches member deposits and interest at retirement at a rate of 2 to 1.
The city match is combined with member deposits and interest to calculate retirement benefits. Member deposits are deducted
from pay before taxes, so participants are not taxed on deposits or interest credits until they receive them from TMRS as a
benefit payment. By law, members cannot borrow from their TMRS accounts, nor can they use it as collateral for a loan.
Members may retire when they have at least five (5) years of service credit and are at least age 60. They may also retire at any
age with 20 years of service credit.
Employees who leave the city before they are vested (5 years) may request a refund or rollover of their deposits and interest, but
will not receive any city matching funds. Employees who are not vested and do not apply for a refund or rollover, may leave their
funds with TMRS for up to five years and continue to earn interest.
TMRS members may view and print annual statements, run retirement estimates and update your address on the website at
www.tmrs.com, click on MyTMRS to register. Please contact HR to update your beneficiary information. The city also participates
in Social Security.
Optional Plans – 457(b) Deferred Compensation
The City of McKinney sponsors two 457(b) deferred compensation plans to supplement retirement savings: ICMA and
Nationwide. Participation is optional and both plans are fully funded by employee contributions. The city does not make a
contribution to either plan. Employees may contribute up to $18,000 annually (2016) (or $24,000 if age 50 or older) on a pretax
basis. Contributions and earnings on investments are not taxed until withdrawn from the participant’s account. Account values
will fluctuate based on the performance of investment options selected.
Enroll in ICMA or Nationwide 457 plans online or by contacting one of the plan representatives on the contact list:
ICMA: icmarc.com
Nationwide: nrsforu.com
For more information about retirement, visit www.thecityinsider.org
20
LEAVE & ADDITIONAL BENEFITS
Regular FULL TIME employees only
Benefit
Summary
Vacation time is accrued monthly. It begins accruing at the start of employment, and may be used
after six months of service. The rate of vacation accrual shall be stair-stepped in order to reward
longevity, per the annual vacation accrual schedules below:
Vacation
Years of Service
Regular Full-Time
Sworn Police* & Fire
Non-Shift
Fire Shift
0 – 2 years
80 hrs.
120 hrs.
180 hrs.
2+ years
120 hrs.
120 hrs.
180 hrs.
10+ years
152 hrs.
152 hrs.
228 hrs.
20+ years
200 hrs.
200 hrs.
300 hrs.
Maximum Annual Carryover: 300 hours for Regular, Sworn Police & Fire Non-Shift; 450 hours for Fire Shift.
*For the purpose of vacation accrual, Public Safety Communications employees are included under Sworn Police.
Sick Leave
Regular full-time employees and fire non-shift employees shall accrue sick leave at a rate of 11.37 hours
per month. Firefighters assigned to a 56 hour work week shall accrue 15.4 hours per month of sick leave.
Sick leave accrual is not limited or capped. Sick leave can be used if the employee or a member of their
immediate family is ill or injured, for doctor visits for the employee or their immediate family, or in the event
of the death of an immediate family member. All regular, full-time employees are eligible to accrue sick time
from their first day of employment. Sick leave is available for use after six months of service.
Compensatory Time
Compensatory (comp) time may accrue in lieu of overtime pay for regular full-time, non-exempt employees
at the rate of one and one-half hours for every hour worked in excess of the standard 40 hour work week
(employees who do not work a standard 40 hour work week will accrue comp time based on FLSA standards
for their work cycle). Employees assigned to a standard 40 hour work week may accrue up to 80 hours of
comp time. Employees assigned to a 56 hour work week may accrue up to 120 hours of comp time. Exempt
employees may accrue comp time at straight time per hours worked in excess of the standard 40 hour work
week (max 40 hours).
Catastrophic Leave
This policy was established to allow employees to donate vacation leave to fellow employees who have
exhausted all paid leave as a result of a non-job related catastrophic (life threatening) injury or illness to
oneself or a member of his/her family. In order to apply for this program, it is required that the employee
donate a minimum of eight vacation hours every two years.
The city provides nine (9) paid holidays per calendar year. They are:
Holidays
Longevity Pay
Tuition Assistance
Program
• New Year’s Day
• Martin Luther King Day
• Memorial Day
• Independence Day
• Labor Day
• Thanksgiving Day and the following Friday
• Christmas Eve and Christmas Day
Each employee receives $5 per month of service to a maximum of $1,200. Payments are distributed
annually.
All regular full-time employees are eligible to participate in the program at the start of employment.
Employees may apply for reimbursement based on the current Tuition Reimbursement Schedule. At the time
of application, reimbursement will be based on the availability of funds in the city’s operating budget of the
fiscal year of course completion. Please review the Tuition Assistance Policy for further information, eligibility
and rules.
21
LEAVE & ADDITIONAL BENEFITS
Regular PART-TIME employees (15+ hours/week)
Benefit
Vacation
Sick Leave
Holidays
22
Summary
Regular part-time employees scheduled to work at least 15 hours per week accrue vacation leave
at a rate of 3.33 hours per month and may use it after six months of service. Unused vacation
accrual, as of December 31, will not carry over to the next calendar year.
Regular part-time employees scheduled to work at least 15 hours per week accrue 5.68 hours of
sick leave per month and may use it after six months of service. Unused sick leave accrual, as of
December 31, will not carry over to the next calendar year.
Regular part-time employees scheduled to work at least 15 hours per week will be paid 4 hours of
holiday time for each city holiday.
FAMILY & MEDICAL LEAVE ACT (FMLA)
The Family & Medical Leave Act of 1993 (the “Act”) entitles employees to twelve weeks of unpaid, job-protected leave for certain
family and medical reasons.
Employees are eligible for family/medical care leave (“FMLA Leave”) if they have been employed for at least 12 months by the
City of McKinney and have at least 1,250 hours of service in the previous 12 months.
An employee who has/will be absent from work for surgery or for more than three (3) consecutive work days for medical
reasons (36 hours for Fire shift employees) should contact HR as soon as possible to determine whether the absence should
be designated as FMLA Leave.
An unpaid leave will be granted for any of the following reasons:
• To care for the employee’s child after birth, placement for adoption or foster care (the right to leave for the birth or
placement of a son or daughter expires 12 months after the birth or placement with the employee, and must be taken in a
continuous block of leave unless the city agrees to allow intermittent leave).
• To care for the employee’s spouse, son or daughter or parent who has a serious health condition.
• For a serious health condition (as that term is defined by the Act) that makes the employee unable to perform the employee’s
job including work related illness or injuries.
• Any qualifying exigency arising out of the fact that the employee’s spouse, son, daughter, or parent is a military member on
covered active duty.
• To care for a current service member or veteran with a serious injury or illness if the employee is the spouse, son, daughter,
parent, or “next of kin” of the current service member or veteran (military caregiver leave).
Employees are entitled to a total of 12 workweeks of FMLA Leave in a rolling 12-month period. This means that the amount
of current FMLA Leave and any FMLA Leave taken within the previous 12 months may not exceed 12 workweeks total, unless
military caregiver leave also applies. Employees are not entitled to 12 workweeks for each situation that would otherwise qualify
for FMLA Leave.
An eligible employee who is the spouse, son, daughter, parent, or “next of kin” of a current service member or veteran with a
serious injury or illness may take up to a total of 26 workweeks of unpaid leave during a “single 12-month period” to provide
care for the service member or veteran. In the case of military caregiver leave, an eligible employee’s FMLA Leave entitlement is
limited to a total of 26 workweeks of FMLA Leave for any qualifying reason.
If both spouses are working for the City of McKinney, their total leave in any 12-month period may be limited to 12 weeks if the
leave is taken for the birth or adoption of a child or to care for a sick parent. Care for parents-in-law is not covered by the FMLA.
Requesting FMLA Leave
To request FMLA Leave when the need for leave is foreseeable, the employee should notify his/her supervisor and HR at least
30 days in advance or as soon as possible. If the need for FMLA Leave is unforeseeable, the employee should notify his/her
supervisor and HR as soon as he/she becomes aware of the need.
HR may request the following from the employee:
• A written request indicating the dates and the reason for the leave
• Certification from a health care provider to support a request for leave due to the serious health condition of the employee,
family member or covered service member
• Regular reports from the employee regarding his/her leave status and anticipated return-to-work date
• Documentation from the military certifying that the military member is on covered active duty (or has been notified of an
impending call to covered active duty)
• A return-to-work release from the employee’s doctor
• To undergo a fitness-for-duty test prior to returning to work (if needed)
23
FAMILY & MEDICAL LEAVE ACT (FMLA)
Intermittent FMLA Leave
When medically necessary, an employee may be granted leave intermittently or on a reduced work schedule in accordance with
the Act. Employees should consult HR to determine when they are eligible for such intermittent leave or reduced work schedule.
To accommodate such intermittent leave or reduced work schedule, the City of McKinney may transfer the employee to another
position of equivalent pay and benefits. In the case of a child’s birth, adoption or placement into an employee’s home, leave may
be taken intermittently or on a reduced schedule only by approval of the Department Director and HR.
If an employee needs leave intermittently or on a reduced leave schedule for planned medical treatment, then the employee
must make a reasonable effort to schedule the treatment so as not to unduly disrupt departmental operations. If the need for
intermittent leave is unforeseeable, the employee must make a reasonable effort to notify his/her immediate supervisor and
the Human Resources Department at least one hour prior to the start of a scheduled shift (or per departmental procedures)
that he/she is going to be absent from work due to a reason related to the approved intermittent FMLA Leave.
Other Requirements
The City of McKinney may require additional and/or periodic verification of the medical condition and/or the need for leave. Any
misrepresentation made to obtain or continue leave is grounds for immediate termination.
If an employee has health coverage through the City of McKinney, the employee’s benefits will be continued while on leave,
provided the employee continues to pay his/her portion of the cost. The employee must repay the City of McKinney for the city’s
portion of premiums during an unpaid leave if the following conditions occur:
• The employee fails to return from leave after entitlement has expired.
• The employee fails to return to work for a reason other than:
(1) The continuation, recurrence, or onset of a serious health condition that would entitle the employee to leave or
(2) Other circumstances beyond the employee’s control.
Accrued paid time, including sick, vacation, holiday and comp time, will run concurrently with all FMLA Leave.
Accrued paid time must be exhausted prior to taking an unpaid leave.
With limited exceptions under the Act, upon return from an FMLA Leave, the employee will return to his/her regular job or an
equivalent position with equivalent pay, benefits and other terms and conditions of employment.
24
NOTICE OF PRIVACY PRACTICES
The City of McKinney is required by law to maintain the privacy of your protected health information and to provide you with
notice of its legal duties and privacy practices with regard to your protected health information. As your group health plan,
the City of McKinney must use and disclose protected health information in order to pay benefits to you and your health care
providers. The City of McKinney uses physical, electronic, and procedural safeguards to protect your personal information from
being used or disclosed inappropriately. This notice describes how medical information about you may be used, disclosed and
how you can get access to this information. Please review it carefully.
Frequently Asked Questions
1. What is protected health information?
Protected health information is individually identifiable health
information that is transmitted or maintained in writing,
electronically, orally or by any other means. It includes
information created or received by the City of McKinney that
identifies a person and relates to the person’s participation in
the plan, the person’s physical or mental health, the provision
of health care services to that person or the payment of health
care services received by the person.
2. How does the City of McKinney use and disclose protected
health information?
The most common use of protected health information by the
City of McKinney is for treatment, payment, and health care
operations. The City of McKinney also may disclose protected
health information to health care providers, other health
plans, and health care clearinghouses for treatment, payment,
and health care operations. (Health care clearinghouses are
organizations that assist in electronic claims transactions.)
The City of McKinney may also disclose protected health
information to a business associate if the business associate
needs the information to perform treatment, payment or health
care operations on the City of McKinney’s behalf. Health care
providers, other health plans, health care clearinghouses and
the City of McKinney’s business associates are all required to
maintain the privacy and confidentiality of the protected health
information they receive from the City of McKinney. All uses and
disclosures of protected health information made by the City of
McKinney for treatment, payment and health care operations
are kept to the minimum necessary to accomplish the intended
purpose.
3. What are treatment, payment and health care operations?
Treatment is the provision, coordination, or management of
health care and related services. An example of a disclosure of
protected health information for treatment is when your family
doctor refers you to a specialist.
Payment includes City of McKinney activities such as billing,
claims management, subrogation, plan reimbursement, reviews
for medical necessity and appropriateness of care, utilization
review, and pre-certification of health care services. For example,
the City of McKinney may tell a doctor whether you are eligible
for coverage and what percentage of the bill the City of
McKinney will pay.
Heath care operations include quality assessment and
improvement, reviewing competence or qualifications of health
care professionals, underwriting and other activities necessary
to create or renew health plans. It also includes disease
management, case management, conducting or arranging
for medical review, legal services, auditing functions including
fraud and abuse compliance programs, business planning and
development, business management and general administrative
activities. For example, the City of McKinney may use
information from your claims to contact you about treatment
alternatives or other health-related benefits and services that
may be of interest to you.
4. How else does the City of McKinney use and disclose
protected health information?
The City of McKinney may use or disclose protected health
information, when permitted or required by law, as follows:
• Directly to you or your personal representative. A personal
representative is a person who has legal authority to make
health care decisions on your behalf. In the case of a child
under 18 years of age, a personal representative may be a
person who has durable power of attorney to make health
care decisions in the event you are incapacitated.
• To the Secretary of the U.S. Department of Health and Human
Services to investigate or determine the City of McKinney’s
compliance with privacy regulations.
• To your family member, other relative, close personal friend or
other person identified by you that is directly involved in your
care. Such disclosures will be limited to information relevant
to the person’s involvement in your care and, except in the
case of an emergency or your incapacity, you will be given an
opportunity to agree or object to the disclosure.
• For public health activities.
• To report suspected abuse, neglect or domestic violence to
public authorities.
• To a public oversight agency.
• When required for judicial or administrative proceedings.
• When required for law enforcement purposes.
• To organ procurement organizations or other organizations to
facilitate organ, eye, or tissue donation or transplantation.
• To a coroner or medical examiner for the purpose of
identifying a deceased person, determining a cause of death
or other duties required by law.
• To a funeral director when permitted by law and when
necessary for the funeral director to carry out his/her duties
with respect to the deceased person.
• To avert serious threat to health or safety.
• For specialized governmental functions, as required by law.
• When otherwise required by law.
• Information that has been de-identified. This means that all
individual identifiers have been removed and it is reasonable to
believe that the organization receiving the information will not
be able to identify the person to whom the information belongs.
25
5. Can I keep the City of McKinney from using or disclosing my
protected health information for any of these purposes?
9. Can I review my protected health information maintained by
the City of McKinney?
You have the right to make a written request that the City of
McKinney not use or disclose your protected health information
for certain purposes, unless the use or disclosure is required by
law. However, since most of the uses and disclosures made by
the City of McKinney are necessary to administer your health
plan, the City of McKinney does not have to agree to your
request.
You may make a written request to inspect, at the City of
McKinney offices, your enrollment, payment, billing, claims and
case or medical management records maintained by the City of
McKinney. You also may request paper copies of your records.
If you request paper copies, the City of McKinney may change a
reasonable, cost-based fee for the copies. Requests to view your
protected health information should be made in writing to:
6. Are there any other circumstances when the City of
McKinney may use or disclose protected health information?
The City of McKinney may not use or disclose your protected
health information for any purpose not included in this
notice, unless the City of McKinney first receives your written
authorization. To be valid, an authorization must include: the
name of the person or organization making the disclosure, the
name of the person or organization receiving the disclosure,
specifics on the information that may be disclosed, the purpose
of the disclosure, and an end date or end event. You may revoke
any authorization that you make. A revocation must be made
in writing and will not apply to any information disclosed before
the City of McKinney was acting as your group health plan.
7. Will Allegiance (a Cigna company) disclose my protected
health information to my employer?
The City of McKinney health plan is administered by Allegiance
(a Cigna company). However, the City of McKinney is prohibited
from using or disclosing any protected health information
for employment-related activities, if the protected health
information was received or created while the City of McKinney
was acting as your group health plan.
8. Can I find out if my protected health information has been
disclosed to anyone?
You may make a written request to the City of McKinney’s
Privacy Officer for an accounting of any disclosures of your
protected health information made during the six years prior
to receipt of your request. The accounting will not include
any disclosures made for treatment, payment, or health care
operations; any disclosures made directly to you; any disclosures
made based upon your written authorization; or any disclosures
reported on a previous accounting.
Generally, the accounting will be provided within 60 days of
the date the City of McKinney receives your written request.
However, the City of McKinney is allowed an additional 30 days if
the City of McKinney notifies you, in writing, of the reason for the
delay and notifies you of the date by which you can expect the
accounting.
If you request more than one accounting in a 12-month period,
the City of McKinney may charge a reasonable, cost-based fee
for each additional accounting.
The City of McKinney will inform you promptly if a breach occurs
that may have compromised the privacy or security of your
information.
26
City of McKinney
Benefits Administrator
P.O. Box 517
McKinney, TX 75070
10. If I review my protected health information and find errors,
how do I get my records corrected?
You may request that the City of McKinney amend any of
your protected health information that the City of McKinney
maintains. All requests for amendment must be made to the
City of McKinney’s Privacy Officer, must be in writing and include
a reason for the amendment. Please be aware that the City of
McKinney can amend only the information that it creates. If
your request is to amend information that the City of McKinney
did not create, the City of McKinney will need a statement from
the individual or organization that created the information
explaining an error was made. For example, if you requested
a claim be amended because the diagnosis was incorrect, the
City of McKinney will amend the claim if the City of McKinney
made an error in the data entry of the diagnosis. However, if
your health care provider submitted the wrong diagnosis to the
City of McKinney, the City of McKinney cannot amend the claim
without a statement from your health care provider that the
diagnosis is incorrect.
The City of McKinney has 60 days after it receives your request
to respond. If the City of McKinney is not able to respond, it is
allowed one 30-day extension. If the City of McKinney denies
your request, either in part or in whole, the City of McKinney
will send you a written explanation for the denial. You may
then submit a written statement disagreeing with the City of
McKinney’s denial and have that statement included in any
further disclosures.
11. I’m covered as a dependent and do not want anything
that includes my protected health information mailed to the
covered person’s address. Will you do that?
If mailing communications to the covered employee’s
address could place you in danger, the City of McKinney
will accommodate your request to receive communications
of protected health information by alternative means or at
alternative locations. Your request must be reasonable, be
in writing, specify an alternative address or other method of
contact and include a statement that sending communications
to the covered employee’s address could place you in danger.
12. If I believe my privacy rights have been violated, how do I
make a complaint?
If you believe your privacy rights have been violated, you may
make a complaint to the City of McKinney at:
In writing:
City of McKinney
P.O. Box 517
McKinney, TX 75070
Or call: 972-547-7560
17. Who can I contact for more information on my privacy
rights?
Write to:
City of McKinney
P.O. Box 517
McKinney, TX 75070
Or call: 972-547-7560
Also, you may file a complaint with the U.S. Department of
Health and Human Services at:
U.S. Department of Health and Human Services
Hubert H. Humphrey Building
200 Independence Avenue, S.W.
Washington, D.C. 20201
The City of McKinney will not retaliate against you for filing a
complaint.
13. When are the privacy practices described in this notice
effective?
This privacy notice has an effective date of January 1, 2016.
14. Can the City of McKinney change its privacy practices?
The City of McKinney is required by law to abide by the terms
of the privacy notice currently in effect. The City of McKinney
reserves the right to change its privacy practices and to apply
the changes to any protected health information the City of
McKinney received or maintained prior to the effective date
of the change. The City of McKinney will distribute any revised
notice of privacy practices. The City of McKinney will distribute
the notice to covered employees before the effective date
of any changes. Also, the City of McKinney will maintain its
current privacy notice on its website at: www.mckinneytexas.
org and www.thecityinsider.org.
15. What happens to my protected health information when I
leave the plan?
The City of McKinney is required to maintain your records for
at least six years after you leave the City of McKinney’s group
health plan. However, the City of McKinney will continue to
maintain the privacy and confidentiality of your protected
health information even after you leave the plan.
16. How can I get a paper copy of this notice?
To request that the City of McKinney mail you a paper copy of
this notice, call 972- 547-7560.
27
IMPORTANT NOTICES
SPECIAL ENROLLMENT NOTICE
If you are declining enrollment in the health plan for yourself or your dependents (including your spouse) because of other health
insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your
dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other
coverage). However, you must request enrollment within 30 days after your or your dependents’ other coverage ends (or after
the employer stops contributing toward the other coverage).
In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to
enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or
placement for adoption.
Finally, if you or a dependent loses coverage under a State Children’s Health Insurance Program (CHIP) or Medicaid, or
becomes eligible to receive premium assistance under those programs for group health plan coverage, you may be able to
enroll yourself and your dependents. However, you must request enrollment within 60 days of losing eligibility for coverage or
becoming eligible for premium assistance.
To request special enrollment or obtain more information, contact HR at 972-547-7560.
CONTINUATION OF HEALTH COVERAGE / COBRA
Health plan coverage ends on the last day of the month in which employment ends or you or your dependent(s) are no longer
eligible for coverage. If you wish to continue your health insurance coverage, you may do so through COBRA by completing an
election form and paying the appropriate premiums.
COBRA allows you to continue your coverage in most cases if—
• Your employment ends – up to 18 months
• You become disabled under Social Security – up to 29 months
• In the event of your death or divorce, spouse and/or dependents can continue coverage – up to 36 months
• Cease to qualify as an eligible dependent (for example, a dependent child turns age 26) – up to 36 months
WOMEN’S HEALTH AND CANCER RIGHTS
If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and
Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a
manner determined in consultation with the attending physician and the patient, for:
• All stages of reconstruction of the breast on which the mastectomy was performed;
• Surgery and reconstruction of the other breast to produce a symmetrical appearance;
• Prostheses; and
• Treatment of physical complications of the mastectomy, including lymphedema.
These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical
benefits provided under this plan. If you would like more information on WHCRA benefits, call HR at 972-547-7560 or your
medical plan administrator.
28
IMPORTANT CONTACTS
Medical Administrator – Allegiance
Medical PPO Network – CIGNA OAP
1-855-999-1054
askallegiance.com/mckinney
Prescription Drug – Maxor Plus
1-800-687-0707
maxorplus.com
Dental Administrator – Allegiance
Dental PPO Network – CIGNA DPPO
1-855-999-1054
askallegiance.com/mckinney
Vision – Davis Vision
1-877-923-2847
davisvision.com
Client Code: 3893
Flexible Spending Account – Allegiance
1-855-999-1054
askallegiance.com
Mobile App – Allegiance Advantage
Life & AD&D Insurance – MetLife
1-800-638-6420
Long-Term Disability – Kansas City Life
800-627-3660
Compass Professional Health Services
Health Pro: Ryan Hrbacek
800-513-1667
Ext.411
[email protected]
compassphs.com
Supplemental Insurance – Aflac
Agent: Donna Polser
214-726-6406
[email protected]
Legal Services – Legal Shield
Agent: Clint Scofield
1-800-654-7757
214-542-0778
[email protected]
legalshield.com
Mobile Apps – Legal Shield & IDShield
Texas Municipal Retirement System (TMRS)
1-800-924-8677
tmrs.com
ICMA-RC 457 Deferred Compensation Plan
Agent: Eunice Brogdon
1-800-669-7400
877-313-8316
icmarc.com
[email protected]
Nationwide 457 Deferred Compensation Plan
Agent: Michelle Diaz
1-877-677-3678
214-914-0401
nrsforu.com
[email protected]
Employee Assistance Program (EAP) – Deer Oaks
1-866-327-2400
deeroakseap.com
UserID/Password: mckinneytexas
Benefits Enrollment – Benefit Solver
City of McKinney – HR Department
City of McKinney intranet
benefitsolver.com
972-547-7561
[email protected]
thecityinsider.org
Username/Password: same as city
network login
29

City of McKinney Employee Benefits Guide

Transcription

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