GUIDE TO FY 2015 OPEN ENROLLMENT PERIOD

Transcription

1 GUIDE TO FY 2015 OPEN ENROLLMENT PERIOD Open Enrllment begins n May 9, 2014 and ends May 23, This is generally yur nly pprtunity t enrll in, change r drp yur health, dental, visin, lng term disability plan cverage r t enrll in the sick leave bank. Additinally, yu may enrll in the City-spnsred Flexible Spending Accunt (FSA) prgram, administered by PayFlex, fr the full plan year beginning July 1, 2014.

2 Open Enrllment Guide What d I d if I m satisfied with all f my current benefit plan chices? If yu are satisfied with yur current health and lng-term disability insurance, yu need d nthing mre and yur current benefits will be cntinued fr the FY 2015 Plan Year. Nte that yu must reenrll in the Flexible Spending Accunt if yu want t participate, even if yu enrlled last December fr the six-mnth plan frm January 1, 2014 t June 30, Als, due t a change in the City s dental prvider, yu will need t enrll in the new Aetna dental plan. Can I drp r cancel my benefits plans at any time during the plan year? If yu want t cancel r change cverage, yu must d s during Open Enrllment. Per Sectin 125 f the Internal Revenue Cde, changing benefits paid with pre-tax dllars health, dental, visin, FSAs - during the plan year is nt permitted, unless a qualifying event ccurs. (See Cmmn Health Insurance Terms defined belw). The Lng-Term Disability plan may be changed during the plan year. At Twn Hall meetings, the City Manager said a new health plan with n deductibles wuld be ffered. Can I chse a n-deductible plan? Yes. There are tw Kaiser HMO plans ffered. One is the deductible DHMO and the ther is the n deductible HMO. Cverage is identical in the tw plans. The differences in the plans are: 1) the DHMO has a $400 (Individual) r $800 (EE+1 r Family) deductible and the HMO des nt; and, 2) the DHMO premium is the same as last year while the premium fr the new n deductible HMO was set by Kaiser Underwriting and is higher than the n deductible DHMO premium. What shuld I d if I m cnsidering a change t my benefits plan? Review the letter yu received frm Human Resurces that includes yur current enrllment infrmatin, this Guide t FY 2015 Open Enrllment, and benefit enrllment infrmatin. Plan t visit ne f the 10 n-site meetings scheduled t be held thrughut the City during Open Enrllment s representatives frm the insurance prviders can answer yur persnal, unique questins/cncerns. A schedule f dates/times is included in the next sectin f this Guide. Visit the Open Enrllment and Benefits infrmatin pages n AlexNet. Where can I find benefit enrllment frms? Benefit enrllment frms are available frm 3 surces: AlexNet Department Human Resurces Liaisns. A cmplete list f Liaisns and their cntact infrmatin is in the Frms Sectin f this Guide. Liaisns will have a pdf. packet f enrllment frms and ther t either r print fr thse needing frms. 1 P age

3 The Human Resurces Department, Rm 2500, City Hall. Remember: If yu are enrlling in a Flexible Spending Accunt (FSA), yu must enrll n line at the PayFlex website Yu may nt enrll using a paper enrllment frm. If I want t make a change, what benefit plan chices can I make during Open Enrllment? Health Insurance Plans: Yu may enrll, change, r drp yur health insurance cverage. 4 Plans are available in FY 2015 with 3 tier ptins: Emplyee, Emplyee + 1, and Family: Kaiser Permanente deductible DHMO Kaiser Permanente standard HMO (n deductible) (NEW) United Healthcare Chice Plan (EPO) United Healthcare Chice Plus Plan (POS) Cmplete an enrllment frm if yu wish t change plans. Aetna Dental Insurance Plans (New): Yu may enrll in the new dental plan. 2 Plans are available in FY 2015 with 3 tier ptins: Emplyee, Emplyee + 1, and Family: DHMO Plan DPPO Plan Cmplete an enrllment frm if yu wish t elect cverage. Aetna Visin Insurance Plan (New): Yu may enrll in the new visin plan. 1 plan is available in FY 2015 with 3 tier ptins: Emplyee, Emplyee + 1, and Family. Cmplete an enrllment frm if yu wish t elect cverage. PayFlex Flexible Spending Accunt (FSA) (Full Plan Year): Yu may enrll in the FSA fr the plan year July 1, 2014 t June 30, FY 2015 Healthcare pretax cntributin limit is $2500 and the Dependent Care limit is $5000 per husehld per family. Enrll nline via the PayFlex HealthHub website: ( Enrllment instructins and further benefit details will be distributed at the infrmatinal meetings and are als psted n AlexNet. See Frms sectin f this guide fr ther surces f this infrmatin. Participants will receive a PayFlex debit card fr use in paying fr eligible healthcare expenses (e.g., annual deductibles, cpays, etc.) at pint f sale in lieu f submitting paper claims. The Standard Lng Term Disability Plan: 2 P age

4 Upgrade frm 120-day waiting perid t 90-day waiting perid. Cmplete a LTD enrllment frm. The Sick Leave Bank: T enrll, emplyees must dnate 8 hurs f annual leave (prrated fr regular part-time emplyees) t jin. Cmplete a Sick Leave Bank enrllment frm. Nte: Emplyees may receive up t 160 hurs (4 frty-hur weeks) frm the Bank in the frm f a grant fr Family Medical Leave Act (FMLA) qualifying events in a rlling 12-mnth perid. Are there any special prvisins fr retirees? Yes. Only retirees wh are nt nw eligible fr Medicare may change health plans r tiers during this Open Enrllment. As f January 1, 2014, Medicare-eligible retirees became ineligible t participate in the plans ffered here. When they becme Medicare-eligible, retirees must either enrll in ne f the City-spnsred Medicare plans r participate in the Retiree Health Reimbursement Prgram. What is the deadline t make a change t my benefits plans? The Open Enrllment perid is Friday, May 9 thrugh Friday, May 23, If yu decide t enrll, change r drp plans r tiers, etc., yu must cmplete the apprpriate enrllment frm(s) and return t Human Resurces n later than 4:30 pm n Friday, May 23 s it is prcessed timely. Additinally, yu must cmplete nline FSA enrllment by that time as well. Wh can help me if I still have questins r need assistance with my chices? Visit ne f the 10 n-site meetings scheduled t be held thrughut the City during Open Enrllment (see next page fr schedule) s the representatives f the insurance carriers can answer yur persnal, unique questins/cncerns. Cntact the HR Benefits Team Mnday-Friday, 8:00AM 5:00PM at Are there any changes t the health care plans that I shuld knw abut? Yes, per the Affrdable Care Act, the fllwing changes have been made t the City-spnsred United Healthcare health plans effective July 1, 2014; (1) Emergency Rm cpay must apply t Out-f-Pcket (OOP) Medical Maximum, (2) Prescriptin drugs will have a separate OOP Maximum equal t the Medical OOP Maximum, and (3) the $10,000 per year travel maximum fr transplants has been eliminated. 3 P age

5 Wh is eligible t enrll in City-spnsred benefit prgrams? Eligible Emplyees: Full-time, regular Regular, part-time wh wrk at least 10 hurs per week Eligible Dependents: Eligible Spuses: An individual wh, tgether with the benefitted eligible emplyee has entered int a marriage with a persn f the ppsite sex that is fficially recgnized by the United States gvernment fr federal incme tax purpses, r a marriage r civil unin with a persn f the same sex that is recgnized by a U.S. state, territry r a freign gvernment. The emplyee and the eligible spuse are able t attest that their marriage has nt been disslved r ended by divrce. Eligible Dmestic Partner: An individual f any sex wh, tgether with the benefitted eligible emplyee, meets all f the fllwing criteria: Is in a relatinship f mutual supprt, caring, and cmmitment with the emplyee, in which bth intend t remain. Has been sharing a primary residence as dmestic partner with the emplyee fr at least six cntinuus mnths unless residing in different gegraphical areas n a temprary basis. Is nt currently married t, nr part f a civil unin r dmestic partnership, with anyne else, and whse emplyee dmestic partner can attest t the same. Has nt been in a marriage with the benefitted emplyee within the last three years. Is at least 18 years f age r an emancipated minr. Is nt the emplyee's parent, child, sibling, grandparent, grandchild r any bld relatin that wuld bar marriage in the State f Virginia. Shares jint respnsibility fr ne anther s cmmn welfare and basic needs fr at least six cntinuus mnths, as evidenced by at least tw (2) f the fllwing fr the emplyee and eligible same/ppsite-sex dmestic partner: named parents in a c-parenting r adptin agreement jint mrtgage, lease, r title jint wnership f mtr vehicle r bank accunt r credit card accunt designatin f dmestic partner as a primary beneficiary f emplyee's life insurance, retirement benefits, r will assignment f a Durable Pwer f Attrney r Health Care Prxy t ne anther. Eligible Dependent Child(ren): The benefitted eligible emplyee's dependent child(ren) must satisfy the fllwing requirements in rder t be eligible t participate: The eligible dependent must have ne f the fllwing relatinships with the benefitted eligible emplyee: 4 P age

6 bilgical child; child f an eligible spuse r eligible dmestic partner; child fr whm the benefitted eligible emplyee, eligible spuse r eligible dmestic partner has either legal custdy, r has been appinted legal guardian; r adpted child r a child wh has been placed with the benefitted eligible emplyee, eligible spuse r eligible dmestic partner fr adptin. The eligible dependent must satisfy the criteria in either (1) r (2) belw: is yunger than age 26 and nt eligible fr cverage as an emplyee r spuse under anther emplyer-spnsred health plan r is unmarried, is r becmes disabled befre age 26 as certified by a City health plan, and qualifies as a tax dependent f the benefitted eligible emplyee, eligible spuse r eligible dmestic partner. Cnsult the eligibility guidelines fund n the Benefits Page f AlexNet fr further details. 5 P age

7 Open Enrllment On-Site Meetings OPEN ENROLLMENT Friday, May 9 thrugh May 23, 2014 This is the ne pprtunity during the year t review and discuss plan benefits with representatives frm the Cityspnsred benefits prviders. The meeting dates, times and lcatins are listed belw as infrmatin s please plan t attend ne f the sessins t help yu make well-infrmed healthcare decisins fr yu and yur families. Please nte that a representative frm Pay Flex will be available t answer yur FSA questins at the Annual Health Fair n May 15. A representative frm The Standard, the City s Life and Lng-Term Disability carrier, will be available at the Annual Health Fair as well. DATE TIME LOCATION Friday, May 9 6:00 a.m. - 9:00 a.m. Sheriff s Office 2003 Mill Rad Mnday, May 12 9:00 a.m. - 11:00 a.m. The Lee Center 108 Jeffersn Street (Cnference Rm) Mnday May 12 1:00 p.m. - 3:00 p.m. Public Safety (Plice) 3600 Wheeler Ave (Cmmunity Rm) Tuesday, May 13 1:00 p.m. - 4:00 p.m. Beatley Central Library 5005 Duke Street Wednesday, May 14 6:30 a.m. 9:30 a.m. T&ES 2900 B Business Center Drive Thursday, May 15 9:00 a.m. 3:00 p.m. Health, Wellness and Benefits Fair (Active Emplyees Charles Hustn Recreatin Center & Retirees) 901 Wythe Street Mnday, May 19 10:00 a.m. 1:00 p.m. The Lee Center (Retirees Only) 1108 Jeffersn Street (Cnf. Rm 2) Tuesday, May 20 12:30 p.m. - 2:00 p.m. Dept. f Cmmunity & Human Services 2525 Mt. Vernn Avenue Atrium Cnference Rm Wednesday, May 21 7:00 a.m. - 10:00 a.m. Public Safety (Fire) 900 Secnd Street (2 nd Flr) Thursday, May 22 1:00 p.m. -4:00p.m City Hall 301 King Street (Rm 2000) 6 P age

8 Cmmn Health Insurance Terms COMMON HEALTH INSURANCE TERMS DEFINED Cpayment (cpay): This is a specific amunt yu pay when yu receive certain cvered services r prescriptins. Cpayments vary depending n the plan and the service. In-Netwrk cpays are fixed amunts yu pay fr cvered services t prviders wh cntract with yur health insurance plan and are usually less than ut-f-netwrk cpays. Out-f-Netwrk cpays are fixed amunts yu pay fr cvered services frm prviders wh d nt cntract with yur health insurance plan and are usually mre than in-netwrk cpays. Deductible: A fixed amunt yu pay ut f pcket befre a health insurance plan begins t cver yur health care csts. Emergency Rm: Typically, emergency rm services include all services prvided when a patient visits an emergency rm fr an emergency cnditin. An emergency cnditin is any medical cnditin f recent nset and severity, including but nt limited t severe pain, that wuld lead a prudent laypersn, pssessing an average knwledge f medicine and health, t believe that his r her cnditin, sickness, r injury is f such a nature that failure t btain immediate medical care culd result in placing the patient's health in serius jepardy, serius impairment t bdily functins, r serius dysfunctin f a bdily rgan r part. Exclusive Prvider Organizatin (EPO): EPO members d nt have a primary care dctr and may see specialists withut referrals. These plans may limit cverage t prviders inside their netwrks. A netwrk is a list f dctrs, hspitals, and ther health care prviders that prvide medical care t members f a specific health plan. If yu use a dctr r facility that is nt in the EPO s netwrk, yu may have t pay the full cst f the services prvided. Health Maintenance Organizatin (HMO): HMO members usually have a primary care dctr and must get referrals t see specialists. These plans may limit cverage t prviders inside their netwrks. A netwrk is a list f dctrs, hspitals, and ther health care prviders that prvide medical care t members f a specific health plan. If yu use a dctr r facility that is nt in the HMO s netwrk, yu may have t pay the full cst f the services prvided. Out-Of-Pcket Maximum (Csts): The mst yu pay in a plan year befre yur health insurance plan begins t pay 100% f the allwed amunt. This limit never includes yur premium and the design f a healthcare plan will determine if all, sme, r nne f yur cpays, deductibles, c-insurance, etc. cunt twards the limit. Pint-f-Service Plan (POS): These insurance plans give yu a chice f getting care within r utside f a prvider netwrk. With POS plans, yu may use ut-f-netwrk prviders and facilities, but yu ll have t pay mre than if yu use in-netwrk nes. Members can visit any in-netwrk prvider withut a referral, but yu may need ne t visit a prvider ut-f-netwrk. Premium: The fixed amunt that yu will pay every mnth fr health insurance cverage usually deducted frm yur biweekly paychecks. Preventive Care: Medical care rendered nt fr a specific cmplaint, but fcused n preventin and earlydetectin f disease. Specified by yur plan, preventive care generally includes screening exams, rutine preventive physical exams fr adults and children, prenatal care, and vaccines (immunizatins). 7 P age

9 Cmmn Health Insurance Terms Primary Care Physician (PCP): A patient may be required t chse a primary care physician (PCP). A primary care physician usually serves as a patient's main healthcare prvider. The PCP serves as a first pint f cntact fr healthcare and may refer a patient t specialists fr additinal services. Qualifying Event: A qualifying event is an event that results in the pprtunity t make changes t ne's enrllment in emplyer-spnsred benefits fr which a qualified beneficiary (emplyee and the dependents) is eligible fr COBRA benefits. Examples f qualifying events are the birth f a child, marriage, the end f emplyment, a reductin in wrking hurs f the emplyee, divrce frm the emplyee, etc. A full list f qualifying events is available in the Human Resurces Department. Urgent Care: Care fr an illness, injury r cnditin serius enugh that a reasnable persn wuld seek care right away, but nt s severe as t require emergency rm care. 8 P age

10 Health Insurance Individual DHMO HMO Chice EPO (In Plan Cverage Only) Chice Plus POS (In Plan r ut f Plan Cverage) Mnthly $95.98 $ $ $ Bi-Weekly* $47.99 $84.58 $57.50 $ Emplyee + One Family FULL-TIME EMPLOYEES Mnthly FY 2015 Health Insurance Premiums Effective July 1, 2014 thrugh June 30, 2015 KAISER EMPLOYEE COST United Health Care EMPLOYEE COST Mnthly $ $ $ $ Bi-Weekly* $95.98 $ $ $ Mnthly $ $ $ $ Bi-Weekly* $ $ $ $ *Bi-Week ly payments are fr 24 pay perids. Premium payments are nt deducted fr tw pay perids per year. Individual Emplyee + One Family DHMO PART-TIME EMPLOYEES Mnthly FY 2015 Health Insurance Premiums Effective July 1, 2014 thrugh June 30, 2015 KAISER HMO EMPLOYEE COST Chice EPO (In Plan Cverage Only) United Health Care Chice Plus POS (In Plan r ut f Plan Cverage) EMPLOYEE COST Mnthly $ $ $ $ Bi-Weekly* $ $ $ $ Mnthly $ $ $ $ Bi-Weekly* $ $ $ $ Mnthly $ $ $ $1, Bi-Weekly* $ $ $ $ *Bi-Week ly payments are fr 24 pay perids. Premium payments are nt deducted fr tw pay perids per year. 9 P age

11 Health Insurance Health Insurance Mnthly FY 2015 Health Insurance Premiums Effective July 1, 2014 thrugh June 30, 2015 DHMO NON-MEDICARE RETIREES KAISER TOTAL COST HMO Chice EPO (In Plan Cverage Only) United Health Care Chice Plus POS (In Plan r ut f Plan Cverage) TOTAL COST Individual Mnthly $ $ $ $ Emplyee + One Mnthly $ $1, $1, $1, Family Mnthly $1, $1, $1, $2, Retirees receive a City f Alexandria health care reimbursement f up t $260 per mnth. Mnthly FY 2015 Health Insurance Premiums Effective July 1, 2014 thrugh June 30, 2015 DHMO KAISER HMO EMPLOYEE COST COBRA Chice EPO (In Plan Cverage Only) United Health Care Chice Plus POS (In Plan r ut f Plan Cverage) EMPLOYEE COST Individual Mnthly $ $ $ $ Emplyee + One Mnthly $1, $1, $1, $1, Family Mnthly $1, $1, $1, $2, P age

12 Health Insurance FY 2015 COMPARISON OF HEALTH INSURANCE PLAN FEATURES (Fr Perid July 1, 2014 thrugh June 30, 2015) T help in yur review f key benefits included in each f the plans, please see the cmparisn chart belw: Cvered Benefits Kaiser DHMO Kaiser Standard HMO (New) Deductible Out-f-Pcket Maximum Primary Care Office Visit fr Illness $400 Individual $800 Family* $2200 Individual $6400 Family $15 Cpay $0 Cpay fr Children under age 5 Nne $3500 Individual $9400 Family $15 Cpay $0 Cpay fr Children under age 5 United Healthcare United Healthcare Chice Plus (POS) Chice (EPO) In-Netwrk Out-f-Netwrk $400 Individual $400 Individual $800 Individual $800 Family* $800 Family* $1600 Family* $3175 Individual $3175 Individual $3175 Individual $6350 Family $6350 Family $9525 Family $15 Cpayment $15 Cpayment 80% cinsurance Specialist Office Visit $25 Cpay $25 Cpay $25 Cpayment $25 Cpayment 80% Cinsurance fr Illness X-ray, Lab, and $0 Cpay $0 Cpay 100% 100% 80% Cinsurance Diagnstics (Outpatient) X-ray, Lab, and Majr $75 Cpay $75 Cpay $100 Cpayment $100 Cpayment 80% Cinsurance Diagnstics (CT, PET, MRI, MRA and Nuclear Medicine (Outpatient) per service per service Inpatient $500 Cpay $500 Cpay $500 Cpayment $500 Cpayment 80% Cinsurance Hspitalizatin per admit per admit Emergency Rm Cpay $150 Cpay** $150 Cpay** $150 Cpayment per visit** $150 Cpayment per visit** $150 Cpayment per visit** Urgent Care Cpay $25 Cpay $25 Cpay $25 Cpayment $25 Cpayment 80% Cinsurance Mental Health and Substance Abuse Services- Inpatient/Intermediate $500 Cpay $500 Cpay $500 Cpayment per admit $500 Cpayment per admit $500 Cpayment per admit, 80% Cinsurance Mental Health and Substance Abuse Services- Outpatient Pregnancy/Maternity Services $15 Cpay Individual $7 Cpay Grup $15 Initial visit, then $0 cpay $15 Cpay Individual $7 Cpay Grup $15 Initial visit, then $0 cpay $15 Cpayment $15 Cpayment 80% Cinsurance Depending upn where the Cvered Service is prvided, benefits will be the same as thse stated under each Cvered Service categry Depending upn where the Cvered Service is prvided, benefits will be the same as thse stated under each Cvered Service categry Depending upn where the Cvered Service is prvided, benefits will be the same as thse stated under each Cvered Service categry, 80% Cinsurance Preventive Care Well Child Care Cvered in full Cvered in full Cvered in full Cvered in full 80% Cinsurance Adult Physical Exam Cvered in full Cvered in full Cvered in full Cvered in full 80% Cinsurance Rutine GYN Visit Cvered in full Cvered in full Cvered in full Cvered in full 80% Cinsurance Mammgram Cvered in full Cvered in full Cvered in full Cvered in full 80% Cinsurance 11 P age

13 Health Insurance FY 2015 COMPARISON OF HEALTH INSURANCE PLAN FEATURES CONTINUED (Fr Perid July 1, 2014 thrugh June 30, 2015) Cvered Benefits Kaiser DHMO Kaiser HMO (New) Preventive Care Cancer Screening (Pap Test, Prstate) Prescriptin Drug Cverage Generic Brand (Lwest-Cst) Preferred Brand (Mid-Range Cst) Nn-Preferred Brand (Highest Cst) United Healthcare Chice (EPO) United Healthcare Chice Plus (POS) In-Netwrk Out-f-Netwrk Cvered in full Cvered in full Cvered in full Cvered in full 80% Cinsurance $15 Medical Center, $25 Participating Cmmunity Pharmacy $30 Medical Center $40 Participating Cmmunity Pharmacy $50 Medical Center $55 Participating Cmmunity Pharmacy Mail Order Generic: $15 Preferred: $30 Nn-Preferred: $50 Rx Out-f-Pcket Maximum * Includes Emplyee + 1 **Waived if admitted $15 Medical Center, $25 Participating Cmmunity Pharmacy $30 Medical Center $40 Participating Cmmunity Pharmacy $50 Medical Center $55 Participating Cmmunity Pharmacy Generic: $15 Preferred: $30 Nn-Preferred: $50 $15 Cpayment $15 Cpayment 80% Cinsurance $30 Cpayment $30 Cpayment 80% Cinsurance $50 Cpayment $50 Cpayment 80% Cinsurance Mandatry mail rder after 3 rd fill at retail Nt Applicable Nt Applicable $3175 Individual $6350 Family Mandatry mail rder after 3 rd fill at retail $3175 Individual $6350 Family Mandatry mail rder after 3 rd fill at retail $3175 Individual $9525 Family 12 P age

14 Dental Insurance AETNA DENTAL (New) After an exhaustive RFP cmpetitive bid prcess, the City has named Aetna Dental as its prvider f vluntary dental benefits. These rates are ver 20% lwer than thse f the previus prvider. AETNA DENTAL PLANS (Bi-Weekly Emplyee Csts) Cverage Tier DMO DPPO Individual Only $7.41 $14.24 Individual + One $12.36 $26.60 Family $16.68 $40.39 Enrllment frms and a benefits descriptin will be distributed at the infrmatinal meetings and are als psted n AlexNet. See the Frms sectin f this Guide belw fr ther ways t get enrllment frms. Visin Insurance AETNA VISION (New) AETNA VISION PLAN Cverage Tier Bi-Weekly Emplyee Csts Individual Only $4.75 Individual + One $9.01 Family $13.24 Enrllment frms and a benefits descriptin will be distributed at the infrmatinal meetings and are als psted n AlexNet. See the Frms sectin f this Guide belw fr ther ways t get enrllment frms. 13 P age

15 Flexible Spending Accunt (FSA) FLEXIBLE SPENDING ACCOUNT (FSA) This is the first fiscal year where the start f the City s health insurance plan year (July 1) is aligned with the start f the Flexible Spending Accunt (FSA) plan year. As a result, emplyees can set aside mney frm their paychecks (n a pretax basis) t use fr eligible ut-f-pcket expenses. The City s FSA is administered by PayFlex and there are tw types f FSAs available t emplyees: health care and dependent care. Health Care FSA: This accunt reimburses fr varius eligible health care expenses such as medical, dental, visin, hearing, and prescriptin drug expenses. The FSA funds can als pay fr deductibles and cpays. Dependent Care FSA: This accunt reimburses fr eligible child and adult care expenses. Such expenses include day care, befre and after schl care, nursery schl, pre-schl and summer day camp. Each FSA participant will be issued a PayFlex debit card, an accunt card that can be used t pay fr eligible health care expenses. When the card is used, the funds are autmatically debited frm the participant s accunt. This year s enrllment int the FSA will be cnducted n-line via the PayFlex website, Enrllment instructins and further benefit details will be distributed at the infrmatinal meetings and are als psted n AlexNet. See Frms sectin f this guide fr ther surces f this infrmatin. Lng Term Disability LONG TERM DISABILITY (LTD) The City prvides lng-term disability insurance thrugh the Standard Insurance Cmpany. Each year during Open Enrllment, emplyees can make changes t the disability waiting perid befre LTD benefits begin. The basic benefit has a 120-day waiting perid and is paid by the City. Fr an increased premium equal t.10% f insured earnings, emplyees can select a 90-day waiting perid. Enrllment frms are psted n AlexNet. See the Frms sectin f this Guide belw fr ther ways t get enrllment frms. Fr additinal infrmatin, please cntact a member f the Benefits Team at P age

16 Sick Leave Bank SICK LEAVE BANK T enrll, regular emplyees must dnate 8 hurs f annual leave (prrated fr regular, part-time emplyees). Emplyees may receive up t 160 hurs (4 frty-hur weeks) frm the Sick Leave Bank in the frm f a grant fr Family Medical Leave Act (FMLA) qualifying events in a rlling 12-mnth perid. The 160 hurs are prrated fr regular, part-time emplyees. Please nte, nce yu have enrlled, yu cntinue t participate until yu ntify Human Resurces that yu n lnger wish t participate. T learn mre abut the Sick Leave Bank, please read the Sick Leave Bank plicy n the Human Resurces hme page n AlexNet (Sick Leave Bank Plicy). Fr questins n the enrllment prcess r t btain an enrllment frm, please visit AlexNet Sick Leave Bank FAQs and Sick Leave Bank Enrllment Frm. Enrllment frms are psted n AlexNet. See the Frms sectin f this Guide belw fr ther ways t get enrllment frms. Other Useful Open Enrllment Infrmatin HEALTH CARE REFORM As required under the Patient Prtectin and Affrdable Care Act f 2010, the Summary f Benefits Cverage (SBC) fr each f the 3 health plans must be made available t all benefitted emplyees thrugh the City. These dcuments as well as updated FY 2014 Grup Insurance Summary Descriptins will sn be psted n AlexNet fr yur review. Als, this legislatin mandates that dependents can cntinue health cverage n their parent s health plan up t age 26. Yur dependent child must be less than 26 years f age and ineligible fr health cverage thrugh his/her emplyer. If yu have questins r need additinal infrmatin, please cntact a member f the Benefits Team at QUALIFYING EVENTS Emplyees are respnsible fr ntifying the Benefits Team f any changes in their dependents status (Divrce, Birth, Legal Adptin, Legal Guardianship, Death, Eligible Dependent s lss f health cverage). This qualifying event allws emplyees t change tiers, but nt plans, even after pen enrllment has ended. If yu have any questins r cncerns regarding yur dependent enrllments and eligibility requirements, please cntact the Benefits Divisin at fr assistance. 15 P age

17 Other Useful Open Enrllment Infrmatin REMOTELY ACCESSING INFORMATION AND FORMS FROM HOME AlexNet is available frm utside the City's institutinal netwrk (I-Net). While yu are lgged int AlexNet remtely, yur sessin will be encrypted in the same manner as an nline stre r yur bank's Web site. This means that yu can access yur cnfidential pay and benefits infrmatin in the privacy f yur hme. In rder t prtect the security f the City's netwrk, yu must meet certain anti-virus and system requirements. Yu may view r print ut the list f requirements and a step-by-step guide by visiting the fllwing web address n AlexNet: Otherwise, yu may access the AlexNet Remte Access gateway frm the fllwing web address: Nte: Emplyees with newer Windws 8 cmputers at hme will nt be able t access AlexNet remtely. ITS will be scheduling an update t allw Windws 8 authenticatin in the near future. Annual Open Enrllment Ntices WOMEN S HEALTH AND CANCER RIGHTS ACT D yu knw that yur plan, as required by the Wmen s Health and Cancer Rights Act f 1998, prvides benefits fr mastectmy-related services including all stages f recnstructin and surgery t achieve symmetry between the breasts, prstheses, and cmplicatins resulting frm a mastectmy, including lymphedema? Call a member f yur Human Resurces Benefits Team at fr mre infrmatin. PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDREN S HEALTH INSURANCE PROGRAM (CHIP) If yu r yur children are eligible fr Medicaid r CHIP and yu are eligible fr health cverage frm yur emplyer, yur State may have a premium assistance prgram that can help pay fr cverage. These States use funds frm their Medicaid r CHIP prgrams t help peple wh are eligible fr these prgrams, but als have access t health insurance thrugh their emplyer. If yu r yur children are nt eligible fr Medicaid r CHIP, yu will nt be eligible fr these premium assistance prgrams. If yu r yur dependents are already enrlled in Medicaid r CHIP and yu live in a State listed belw, yu can cntact yur State Medicaid r CHIP ffice t find ut if premium assistance is available. If yu r yur dependents are NOT currently enrlled in Medicaid r CHIP, and yu think yu r any f yur dependents might be eligible fr either f these prgrams, yu can cntact yur State Medicaid r CHIP ffice r dial KIDS NOW r t find ut hw t apply. If yu qualify, yu can ask the State if it has a prgram that might help yu pay the premiums fr an emplyer-spnsred plan. 16 Page

18 Annual Open Enrllment Ntices Once it is determined that yu r yur dependents are eligible fr premium assistance under Medicaid r CHIP, as well as eligible under yur emplyer plan, yur emplyer must permit yu t enrll in yur emplyer plan if yu are nt already enrlled. This is called a special enrllment pprtunity, and yu must request cverage within 60 days f being determined eligible fr premium assistance. If yu have questins abut enrlling in yur emplyer plan, yu can cntact the Department f Labr electrnically at r by calling tll-free EBSA (3272). If yu live in ne f the fllwing States, yu may be eligible fr assistance paying yur emplyer health plan premiums. The fllwing list f States is current as f January 31, Yu shuld cntact yur State fr further infrmatin n eligibility Nrth Carlina Medicaid PENNSYLVANIA Medicaid Website: Website: Phne: Phne: Pennsylvania Medicaid Virginia Medicaid and CHIP Website: Website: Phne: Medicaid Phne: CHIP Website: CHIP Phne: West Virginia Medicaid Website: Phne: , HMS Third Party Liability NEWBORNS AND MOTHERS HEALTH PROTECTION ACT Grup health plans and health insurance issuers generally may nt, under federal law, restrict benefits fr any hspital length f stay in cnnectin with childbirth fr the mther r newbrn child t less than 48 hurs fllwing a vaginal delivery, r less than 96 hurs fllwing a cesarean sectin. Hwever, federal law generally des nt prhibit the mther's r newbrn's attending prvider, after cnsulting with the mther, frm discharging the mther r her newbrn earlier than 48 hurs (r 96 hurs as applicable). In any case, plans and issuers may nt, under federal law, require that a prvider btain authrizatin frm the plan r the issuer fr prescribing a length f stay nt in excess f 48 hurs (r 96 hurs). HIPAA NOTICE OF SPECIAL ENROLLMENT RIGHTS If yu are declining enrllment fr yurself r yur dependents (including yur spuse) because f ther health insurance r grup health plan cverage, yu may be able t enrll yurself and yur dependents in ne f the City-spnsred health insurance plans if yu r yur dependents lse eligibility fr that ther cverage (r if the emplyer stps cntributing tward yur r yur dependents ther cverage). Hwever, yu must request enrllment within 30 days r any lnger perid that applies under the plan] after yur r yur dependents ther cverage ends (r after the emplyer stps cntributing tward the ther cverage). In additin, if yu have a new dependent as a result f marriage, birth, adptin, r placement fr adptin, yu may be able t enrll yurself and yur dependents. Hwever, yu must request enrllment within [insert 30 days r any lnger perid that applies under the plan] after the marriage, birth, adptin, r placement fr adptin. T request special enrllment r btain mre infrmatin, cntact the City f Alexandria Benefits Team at (703) P age

19 Annual Open Enrllment Ntices MEDICARE PART D CREDITABLE COVERAGE NOTICE: The City is required t prvide yu with this Medicare ntificatin. Imprtant Ntice frm the City f Alexandria Abut Yur Prescriptin Drug Cverage and Medicare Medicare Part D ntices f creditable r nn-creditable cverage must be prvided t Medicare-eligible individuals prir t Nvember 15 f each year. Please read this ntice carefully and keep it where yu can find it. This ntice has infrmatin abut yur current prescriptin drug cverage with the City f Alexandria and abut yur ptins under Medicare s prescriptin drug cverage. This infrmatin can help yu decide whether r nt yu want t jin a Medicare drug plan. If yu are cnsidering jining, yu shuld cmpare yur current cverage, including which drugs are cvered at what cst, with the cverage and csts f the plans ffering Medicare prescriptin drug cverage in yur area. Infrmatin abut where yu can get help t make decisins abut yur prescriptin drug cverage is at the end f this ntice. There are tw imprtant things yu need t knw abut yur current cverage and Medicare s prescriptin drug cverage: 1. Medicare prescriptin drug cverage became available in 2006 t everyne with Medicare. Yu can get this cverage if yu jin a Medicare Prescriptin Drug Plan r jin a Medicare Advantage Plan (like an HMO r PPO) that ffers prescriptin drug cverage. All Medicare drug plans prvide at least a standard level f cverage set by Medicare. Sme plans may als ffer mre cverage fr a higher mnthly premium. 2. The City f Alexandria has determined that the prescriptin drug cverage ffered by the Kaiser Permanente Medicare Plus and United Healthcare Medicare Advantage Plans are, n average fr all plan participants, expected t pay ut as much as standard Medicare prescriptin drug cverage pays and is therefre cnsidered Creditable Cverage. Because yur existing cverage is Creditable Cverage, yu can keep this cverage and nt pay a higher premium (a penalty) if yu later decide t jin a Medicare drug plan. When Can Yu Jin A Medicare Drug Plan? Yu can jin a Medicare drug plan when yu first becme eligible fr Medicare and each year frm Octber 15th t December 7th. Hwever, if yu lse yur current creditable prescriptin drug cverage, thrugh n fault f yur wn, yu will als be eligible fr a tw (2) mnth Special Enrllment Perid (SEP) t jin a Medicare drug plan. What Happens T Yur Current Cverage If Yu Decide t Jin A Medicare Drug Plan? If yu are currently a Kaiser Permanente member and yu decide t jin a Medicare drug plan, yu will be disenrlled altgether frm yur current Kaiser cverage. Yu and yur cvered dependents will n lnger be eligible t participate in the City s health benefit. If yu are currently a United HealthCare member and yu decide t jin a Medicare drug plan, yu will n lnger be eligible fr the prescriptin drug benefit prvided by United HealthCare. 18 P age

20 Annual Open Enrllment Ntices When Will Yu Pay A Higher Premium (Penalty) T Jin A Medicare Drug Plan? Yu shuld als knw that if yu drp r lse yur current cverage with [Insert Name f Entity] and dn t jin a Medicare drug plan within 63 cntinuus days after yur current cverage ends, yu may pay a higher premium (a penalty) t jin a Medicare drug plan later. If yu g 63 cntinuus days r lnger withut creditable prescriptin drug cverage, yur mnthly premium may g up by at least 1% f the Medicare base beneficiary premium per mnth fr every mnth that yu did nt have that cverage. Fr example, if yu g nineteen mnths withut creditable cverage, yur premium may cnsistently be at least 19% higher than the Medicare base beneficiary premium. Yu may have t pay this higher premium (a penalty) as lng as yu have Medicare prescriptin drug cverage. In additin, yu may have t wait until the fllwing Nvember t jin. Fr Mre Infrmatin Abut This Ntice Or Yur Current Prescriptin Drug Cverage Yu can cntact a member f the Benefits Team at NOTE: Yu will get this ntice each year. Yu will als get it befre the next perid yu can jin a Medicare drug plan, and if this cverage thrugh the City f Alexandria changes. Yu als may request a cpy f this ntice at any time. Fr Mre Infrmatin Abut Yur Optins Under Medicare Prescriptin Drug Cverage Mre detailed infrmatin abut Medicare plans that ffer prescriptin drug cverage is in the Medicare & Yu handbk. Yu ll get a cpy f the handbk in the mail every year frm Medicare. Yu may als be cntacted directly by Medicare drug plans. Fr mre infrmatin abut Medicare prescriptin drug cverage: Visit Call yur State Health Insurance Assistance Prgram (see the inside back cver f yur cpy f the Medicare & Yu handbk fr their telephne number) fr persnalized help Call MEDICARE ( ). TTY users shuld call If yu have limited incme and resurces, extra help paying fr Medicare prescriptin drug cverage is available. Fr infrmatin abut this extra help, visit Scial Security n the web at r call them at (TTY ). May 1, 2014 City f Alexandria, Virginia 301 King Street, Suite 2510 Alexandria, VA Remember: Keep this Creditable Cverage ntice. If yu decide t jin ne f the Medicare drug plans, yu may be required t prvide a cpy f this ntice when yu jin t shw whether r nt yu have maintained creditable cverage and, therefre, whether r nt yu are required t pay a higher premium (a penalty). 19 P age