Open Enrollment is the time of the year you can make Benefit changes. Open Enrollment for 2015 begins February 16 and ends February 27, 2015.

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1 Benefits Line is your guide to the health and wellness programs offered to employees of the City of St. Petersburg. Benefits Line contains the information you need to make an informed decision about your benefits. Open Enrollment is the time of the year you can make Benefit changes. Open Enrollment for 2015 begins February 16 and ends February 27, 2015.

2 Inside Benefits Line Benefits Line is a summary of the City of St. Petersburg s group insurance benefits available to eligible employees. Review this information carefully in order to make an informed decision about your benefits. Open enrollment information is distributed via , interoffice mail, bulletin board postings and the City s Intranet. Benefits Division staff will be available to answer questions during Open Enrollment Help Sessions (see schedule below) and assist in completing your enrollment. Topic Open Enrollment Schedule of Events and Important Requirements for Enrollment Inside cover What s New for Employee Health and Wellness Center 1-2 Employee Assistance & Wellness Program 2 HIPAA 2 UnitedHealthcare Group Health Plans Highlights 3 Important Notice Regarding Laboratory Tests 3 HDP Basic Highlights 4 Choice HDP with Health Reimbursement Account Highlights 5 Choice Plan Highlights (EPO) 6 Choice Plus Plan Highlights (PPO) 7 Prescription Drug Benefits 8 UnitedHealthcare & You 9 MetLife Dental Plans - Employee Paid 10 Humana/CompBenefits Vision Plans - Employee Paid 11 Basic Life Insurance - City Paid 11 Supplemental Life Insurance - Employee Paid 12 Supplemental AD&D Plans & Rates 13 Flexible Spending Accounts 14 If You Are Retiring Soon 15 Frequently Asked Questions & COBRA Contact Information 18 Open Enrollment Help Sessions Page Location Date Time MSC Conference Room 800 February a.m. to 1 p.m. Water Resources Operations Bldg. Muster Area February 18 7 a.m. to 11 a.m. Sanitation Operations Bldg. Break Room February 19 1:30 to 5 p.m. Fire Headquarters 1st Floor Classroom February 20 9 a.m. to Noon Police Training Bldg. Classroom A and Computer Lab B February 20 1:30 to 4 p.m. Requirements for Enrollment 4 A valid Social Security Number must be entered in Oracle Self-Service for each covered dependent. 4 If you wish to start or continue a Flexible Spending Account election, you MUST enroll via Oracle Self-Service. 4 All changes and new elections must be entered into Oracle Self-Service no later than February 27, If you newly elect group health coverage for a child age 26 or over, you must complete the Dependent Child Age 26 or Over Application for Coverage form. A separate form for each child is required. 4 Any required documents must be submitted to the Benefits Division by March 6, 2015.

3 City of St. Petersburg What s New for ) Effective April 1, 2015, an employee classified as Full-time Temporary Short or in any Part-time status who meets the definition of a full-time employee will be eligible to participate in one of the City s group health plans. See the document Determination of Full-time Status for Group Health Coverage on the Intranet or call the Benefits Division at for more details. 2) HDP Basic Group Health Plan A full coverage plan with a high deductible, see page 4. 3) Choice and Choice Plus Plans increase in Annual Out-of-Pocket Maximum Choice from $2,500/$5,000 to $3,000/$6,000 Choice Plus from $1,500/$3,000 to $3,000/$6,000 4) Choice, Choice Plus and Choice HDP addition of a fourth tier of medications and a $200/$400 annual deductible for Tier 2, 3 or 4 prescriptions. The City, in partnership with Bayfront Health, provides employees with primary care services at the Health and Wellness Center. Dr. Israel Wojnowich and his staff offer primary care services, chronic disease management and episodic illness treatment, along with other services. The Center will provide monthly tracking and monitoring of your progress and provide opportunities to participate in programs to assist with your wellness goals. Benefits to utilizing the Wellness Center include: 4 4 High Quality Healthcare provided by a Board-Certified Family Practice Physician 4 4 No Co-pay if covered by City medical insurance No Co-pay for Prescriptions dispensed at the Center, if covered by City medical insurance Details on the City Policy Regarding Time Off for Use of Wellness Center can be found on the Intranet under the Health and Wellness Center tab. Spouses and dependents over age 14 and covered by the City s medical insurance may utilize the services of the Center. Secure, Private, HIPAA Compliant page 1

4 The City of St. Petersburg Health and Welless Center is located at 603 7th Street South, Suite 350, St. Petersburg, FL Phone: for appointment Hours of Operation: Monday, Wednesday and Friday 7 a.m. to 5 p.m. Tuesday and Thursday 10 a.m. to 7 p.m. For additional information visit the City Intranet and go to the Health and Wellness Center link. Wellness Portal A web-based tool providing health and wellness resources, plus online coaching. Go to cosp wellness.mycernerwellness.com. For more details contact stacie.lehmann@stpete.org. Wellness Program The City of St. Petersburg offers numerous programs and events to help employees meet health and wellness goals. The Wellness Office works with the Employee Health and Wellness Center to provide and support programs that will benefit your well-being. We encourage you to find the wellness opportunity that is right for you. Program updates and links to useful information are distributed to employees via , print and on the Intranet. Resources include: l Wellness Corner on the Intranet with links and other wellness information l Workshops and Seminars l Blood Drives and Screenings l Special Programs, Events and Initiatives Employee Assistance Program The City s benefit program includes services provided by ComPsych. ComPsych services include short term counseling, finding legal and financial assistance and a variety of other resources to help employees achieve a work/life balance. The City pays the premium for this plan; ComPsych doesn t charge you for services and does not report to the City that you or a family member has used any of its services. To use the plan, call or visit ComPsych online at guidanceresources.com, using Company Web ID: STPETE to set up your personal user account. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 provides protection from pre-existing conditions limitations for employees and their dependents when moving from job to job. Health plans must provide proof or certification of the dates of their most recent period of creditable coverage. Certificates provide proof of coverage for the receiving plan and are issued: when the employee or dependent loses coverage-whether or not coverage continues under COBRA; when the individual loses coverage under COBRA; or upon request within 24 months of the loss of coverage. When signing up for a new health plan, submit your certification of health care coverage from your previous plan and keep copies for your records. HIPAA includes privacy standards for handling protected health information, prohibiting insurance carriers from discussing health information with third parties without approval of the member. If you have issues with the insurance carrier, other than enrollment or deductions, contact United s Member Services at If the issue cannot be resolved, call to speak with our UHC on-site representative. The City's HIPAA Privacy Policies and Procedures can be found on the Intranet under Benefit News. page 2

5 UnitedHealthcare Group Health Plans Highlights City of St. Petersburg Employees have four group health plans from which to choose. All plans are open access referrals to specialists are not required. 1) HDP Basic 4 In-and out-of-network providers available. 4 Offers lowest premium with higher first dollar costs. 2) United Choice HDP Plan with Health Reimbursement Account 4 In-and out-of-network providers available. 4 Offers lower premium with higher first dollar costs. City funded Health Reimbursement Account for qualified members. See the flyer Understanding the Choice HDP Plan for details. 3) United Choice Plan (EPO) 4 All providers must be in the UnitedHealthcare network. 4) United Choice Plus Plan (PPO) 4 In and out-of-network providers available. Additional Services Provided with All Plans l Nurseline Services: Connects you with a registered nurse 24 hours a day, 7 days a week to obtain assistance on a wide range of health care questions and concerns. Call: l Convenience Care Clinics: Walk-in clinics are located at some CVS and Walgreens stores to provide care (including writing prescriptions) for common illnesses and non-urgent medical care. The fee is the same as your primary care physician co-pay. l Health4Me smart phone application Important Notice Regarding Laboratory Tests All laboratory tests must be done at a LabCorp facility. LabCorp is the only laboratory contracted with UnitedHealthcare. To find a facility go to To find UHC network providers: 1) Visit (you do not need a user name or password). l Health Assessment Questionnaire, Wellness Programs and Tools, myhealthcare Cost Estimator and more at l UHC Premium Program identifies network physicians and hospitals who demonstrate adherence to quality and cost efficiency standards based on evidence-based medicine. A premium-designated doctor or hospital will have a Tier 1 designation in the provider directory at myuhc.com. Co-pays will be lower than for other specialists. 2) In Links and Tools click on Find a Physician, Laboratory or Facility. 3) Select your plan from the dropdown box. 4) Select Search for a Facility, then click Continue. 5) Enter any optional search information, click Continue to display data found. page 3

6 New for 2015 HDP Basic Highlights This is a full coverage plan with in and out-of-network benefits. The deductible is higher and the premiums are lower than the other plans. You must meet the full deductible before the HDP Basic pays any benefits. The cost of services from in-network providers is at the contracted rate. You Pay In-Network Benefits Out-of-Network Benefits Annual Deductibles $5,000 Individual $10,000 Family $15,000 Individual $30,000 Family Co-insurance 0% 30% Hospital 100% after deductible 100% after deductible and co-insurance Emergency Room 100% after deductible 100% after deductible and co-insurance Urgent Care Center 100% after deductible 100% after deductible and co-insurance Physician: Office 100% after deductible 100% after deductible and co-insurance Physician: In-Hospital 100% after deductible 100% after deductible and co-insurance Annual preventure care $0 Rehabilitation Service 100% after deductible 100% after deductible and co-insurance (Physical Therapy, Chiropractic, etc.) Outpatient Surgery 100% after deductible 100% after deductible and co-insurance Hospital or Free Standing Facility Annual $5,000 Individual $10,000 Family $15,000 Individual $30,000 Family Out-of-Pocket Limit Total out-of-pocket maximum includes Total out-of-pocket maximum includes deductible deductible Prescription Drugs 100% after deductible 100% after deductible and co-insurance See the Benefit Summary in your enrollment packet for more complete information Active Employees Group Health Plan Rates HDP Basic Effective April 1, 2015 Total Cost City Cost Employee Deductions COBRA Benefit Plan Monthly Monthly Monthly Bi-weekly Weekly Monthly 24 per year 48 per year Single $ $ $ $52.42 $26.21 $ Two person $ $ $ $ $56.35 $ Family $1, $ $ $ $74.17 $1, page 4

7 Choice HDP Highlights City of St. Petersburg This is a full coverage plan with a higher deductible and lower premium than the Choice and Choice Plus plans. The City will contribute up to $700 for the employee (and up to an additional $450 for a spouse or covered child, if primary) to a Health Reimbursement Account to help you pay deductible costs, if certain requirements are met. See the flyer Understanding the Choice HDP Plan for details. You Pay In-Network Benefits Out-of-Network Benefits Annual Deductibles $1,750 Individual $3,500 Family $3,500 Individual $7,000 Family Excludes co-pays Excludes co-pays Co-insurance 10% 30% Hospital $300 co-pay/day (first 5 days per admission) $300 co-pay/day (first 5 days per plus 10% co-insurance and deductible admission) plus 30% co-insurance and deductible Emergency Room $250 co-payment per visit and deductible $250 co-payment per visit and deductible Urgent Care Center $50 and deductible 30% and deductible Physician: Office Annual Preventive Care Visit $0 Primary Care $25 co-pay per visit *Premium Specialist $35 co-pay per visit 30% and deductible Non-Premium Specialist $45 co-pay per visit Physician: In-Hospital 10% and deductible 30% and deductible Rehabilitation Service $35 co-pay per visit limit 60 visits 30% and deductible 60 days each (Physical Therapy, each type of service, multiple visits per day type of service, multiple visits per day Chiropractic, etc.) Outpatient Surgery 10% and deductible 30% and deductible Hospital or Free Standing Facility Annual $3,500 Individual $7,000 Family $7,000 Individual $14,000 Family Out-of-Pocket Limit Total out-of-pocket maximum includes Total out-of-pocket maximum includes deductible and co-pay deductible and co-pay NEW FOR 2015 $15 co-pay generic $35 co-pay brand $15 co-pay generic $35 co-pay Prescription Drugs $50 co-pay non-preferred generic brand $50 co-pay non-preferred Tier 2, 3 and 4 drugs have a and brand 25% specialty (30 day supply), generic and brand 25% specialty $200/$400 deductible. Mail order is 3 co-pays for 90 day supply. (30 day supply), plus any difference Accumulates to Annual between network and non-network Out-of-Pocket charges. Mail order not covered. See the Benefit Summary in your enrollment packet for more complete information *Premium Specialist is noted by Tier 1 designation for quality and efficient care at myuhc.com Active Employees Group Health Plan Rates Choice HDP Effective April 1, 2015 Total Cost City Cost Employee Deductions COBRA Benefit Plan Monthly Monthly Monthly Bi-weekly Weekly Monthly 24 per year 48 per year Single $ $ $ $66.02 $33.01 $ Two person $1, $ $ $ $70.97 $1, Family $1, $1, $ $ $93.42 $1, page 5

8 Choice Plan Highlights (EPO) In-Network Benefits ONLY Effective: April 1, 2015 You Pay Annual Deductibles Hospital Emergency Room Urgent Care Center Physician: Office $500 Individual $1,000 Family Excludes co-pays $300 co-pay/day (first 3 days per admission) and plan year deductible $250 co-pay per visit and plan year deductible $50 and deductible Annual Preventive Care Visit $0 Primary Care $20 co-pay per visit *Premium Specialist $30 co-pay per visit Non-Premium Specialist $40 co-pay per visit Physician: In-Hospital 0% Rehabilitation Service (Physical Therapy, Chiropractic, etc.) Outpatient Surgery Hospital or Free Standing Facility New for 2015 Annual Out-of-Pocket Limit $30 co-pay per visit limit 60 visits each type of service, multiple visits /day Plan pays 100% after deductible $3,000 Individual $6,000 Family Total out-of-pocket maximum includes deductible and co-pay Prescription Drugs $15 co-pay generic $35 co-pay preferred brand $50 co-pay Tier 2, 3 and 4 drugs have a non-preferred brand 25% specialty (30 day supply); Mail order $200/$400 deductible. 3 co-pays for 90-day supply. Accumulates to Annual Out-of-Pocket See the Benefit Summary in your enrollment packet for more complete information *Premium Specialist is noted by Tier 1 designation for quality and efficient care at Active Employees Group Health Plan Rates Choice (EPO) Effective April 1, 2015 Total Cost City Cost Employee Deductions COBRA Benefit Plan Monthly Monthly Monthly Bi-weekly Weekly Monthly 24 per year 48 per year Single $ $ $ $76.66 $38.33 $ Two person $1, $ $ $ $82.41 $1, Family $1, $1, $ $ $ $1, page 6

9 Choice Plus Plan Highlights (PPO) In-and Out-of-Network Benefits Effective: April 1, 2015 You Pay In-Network Benefits Out-of-Network Benefits Annual Deductibles $500 Individual $1,000 Family $1,000 Individual $2,000 Family Excludes co-pays Excludes co-pays Hospital $300 co-pay/day (first 3 days per admission) $300 co-pay/day (first 3 days per then 10% co-insurance and deductible admission) then 30% co-insurance and deductible Emergency Room $250 co-payment per visit and deductible $250 co-payment per visit and deductible Urgent Care Center $50 and deductible 30% and deductible Physician: Office Annual Preventive Care Visit $0 Primary Care $25 co-pay per visit *Premium Specialist $35 co-pay per visit Non-Premium Specialist $45 co-pay per visit 30% and deductible Physician: In-Hospital 10% and deductible 30% and deductible Rehabilitation Service $35 co-pay per visit limit 60 visits 30% and deductible 60 days each (Physical Therapy, each type of service, multiple visits per day type of service, multiple visits per day Chiropractic, etc.) Outpatient Surgery 10% and deductible 30% and deductible Hospital or Free Standing Facility New for 2015 Annual $3,000 Individual $6,000 Family $6,000 Individual $12,000 Family Out-of-Pocket Limit Total out-of-pocket maximum includes Total out-of-pocket maximum includes deductible and co-pay deductible and co-pay Prescription Drugs $15 co-pay generic $35 co-pay brand $15 co-pay generic $35 co-pay Tier 2, 3 and 4 drugs have a $50 co-pay non-preferred generic brand $50 co-pay non-preferred $200/$400 deductible. and brand 25% specialty generic and brand 25% specialty Accumulates to Annual (30 day supply) Mail order is 3 co-pays for (30 day supply) plus any difference Out-of-Pocket 90 day supply. between network and non-network charges. Mail order not covered. See the Benefit Summary in your enrollment packet for more complete information *Premium Specialist is noted by Tier 1 designation for quality and efficient care at myuhc.com Active Employees Group Health Plan Rates Choice Plus (PPO) Effective April 1, 2015 Total Cost City Cost Employee Deductions COBRA Benefit Plan Monthly Monthly Monthly Bi-weekly Weekly Monthly 24 per year 48 per year Single $ $ $ $84.85 $42.42 $ Two person $1, $1, $ $ $85.70 $1, Family $1, $1, $ $ $ $1, page 7

10 City of St. Petersburg Prescription Drug Benefits Mail Service The UnitedHealthcare s Group Pharmacy Management Company, OptumRx, administers the pharmacy benefit and develops the prescription drug list ( PDL ). The PDL is comprised of FDA approved generic and brand name medications categorized in four tiers. Tier placement is managed to provide the safest, most appropriate and lowest cost drug choices. The full PDL list can be reviewed at OPTUMRx Mail Service Pharmacy makes it convenient to fill maintenance medications taken daily. Receive a 90-day supply of maintenance medications sent directly to your home; shipping is free. Your doctor s office calls in a new or renewing 90-day prescription to (Monday to Friday, 6 a.m. to 6 p.m. PST). To begin mail order: 1) Call , 24 hours a day, 7 days a week and OPTUMRx will request a new prescription from your doctor; or 2) Order by mail by completing a prescription order form (available on the City s Intranet under Benefits Forms or in the Benefits Office) and returning it to OPTUMRx with payment and prescription(s); or 3) Your doctor s office calls in a new or renewing 90-day prescription to (Monday to Friday, 6 a.m. to 6 p.m. PST). Specialty Pharmacy Specialty medications are critical to improving the health and lives of individuals and are also some of the most expensive medications being used today. The UnitedHeathcare pharmacy benefit requires that certain medications be filled at a designated page 8 Specialty Pharmacy. A reminder notice will be sent if your prescription requires use of the Specialty Pharmacy to receive coverage for that medication. Medications are delivered directly to your home and shipping is free.

11 UnitedHealthcare & You What is the difference between In-and Out-of-Network? In-Network Out-of-Network You pay a lower co-insurance percentage, provider charges are based on the discounted rates UHC negotiates with in-network providers. You pay prescription co-pays or co-insurance based on the applicable drug tier. Your deductible and out-of-pocket maximum is lower in-network. No claim forms. You pay a higher percentage of co-insurance coverage based on reasonable and customary charges. * In general, you will have higher out-of-pocket costs when you use out-of-network providers. You pay prescription co-pays or co-insurance based on the drug tier, plus any difference between network and non-network charges. Your deductible and out-of-pocket maximum is higher. You may have to pay 100% of the cost up-front and file claims for reimbursement. *Understanding Reasonable and Customary (R&C) Charges Reasonable and customary charges are the amounts UHC considers appropriate for a health care expense. R&C is based on the typical rate charged for a specific service within a provider s zip code. R&C charges are sometimes referred to as usual and customary charges or allowed amounts. How do I know if my doctor is in the UnitedHealthcare network? 1) Log on to the internet and visit (you do not need a user name or password). 2) In Links and Tools click on Find a Physician, Laboratory or Facility. 3) Select plan: Either "UnitedHealthcare Choice" or "UnitedHealthcare Choice Plus" which includes Choice HDP and HDP Basic. 4) Enter any optional search information; click Continue for specialists to display. 5) Specialists that have achieved the Premium Specialist Tier 1 designation will have a lower co-pay than non-premium specialists. What should I know about choosing care outside the UHC network? If you enroll in the Choice Plus, Choice HDP or HDP Basic and choose to receive care from a non-network doctor, facility or laboratory, it is recommended you: Understand your UnitedHealthcare benefits. Check your benefit plan documents to confirm that you have non-network benefits and understand the details of your non-network benefits, including your deductibles and co-insurance. Understand what you might have to pay. Ask the doctor or facility about their billed charges for the services you need. Check your benefit plan and estimate the costs on myuhc.com or call the member number on the back of your health plan ID card to have a customer care professional help you estimate how much UnitedHealthcare will pay. Some services require you to notify UHC first in order to receive non-network benefits. NOTE: Out-of-network benefits are not available if you are enrolled in the Choice Plan. (see page 6) page 9

12 MetLife Dental Plans - Employee Paid The City provides a choice between two MetLife dental plans: The MET 3773 DHMO or the MetLife PPO. MET 3773 DHMO MetLife PPO l Must receive services from participating general dentists and specialists. l Covered members select the dentist of their choice from a list of participating general dentists. l No deductibles, claim forms, maximum level of benefits or waiting periods. l After a $5 office visit co-pay, most preventive and diagnostic services are no charge, including routine exams, semi-annual routine cleanings, x-rays, silver fillings, and non-surgical extractions. l Co-pay schedule applies to specialty benefits and includes lab fees. l General dentist referral to participating specialists, if necessary. Orthodontia benefits are available for both adults and children. l To order a DHMO card by phone: Dial , press 1 and then select 1 again. Enter Social Security number then press #. Press 1 to confirm employee name. Press 3 to have a DHMO ID card mailed to the employee. l Choose any provider, in or out-of-network. Utilize a network provider for higher percentage of benefits covered by the plan. l You or your dentist will file a claim form and be reimbursed for services according to the PPO schedule. l A deductible of $50 annually, maximum $150 per family applies to basic and major services, in-network and out-of-network. l Annual maximum benefit is $5,000 per covered member. Orthodontia benefits are offered for children up to 19 years of age with an annual maximum benefit of $1000. l In-network preventive services are covered 100%, basic services are reimbursed at 85% and major services at 55%. l Out-of-network preventive services are reimbursed at 90%, basic services at 70% and major services at 50%. Plan Summaries and directories are located on the City s Intranet in the Benefits section or in the Benefits Division Office. Specific questions regarding the plans and an up-to-date provider locator may be obtained from MetLife Member Services at If you elect group dental, children are eligible for coverage through end of calendar year in which they turn 26, regardless of student status. Dental Insurance Rates Effective April 1, 2015 Total Cost Employee Deductions COBRA MET 3773 DHMO Monthly Bi-weekly Weekly Monthly Single $15.62 $7.81 $3.91 $15.93 Two person $27.32 $13.66 $6.83 $27.87 Family $42.95 $21.48 $10.74 $43.81 MetLife PPO Single $24.62 $12.31 $6.16 $25.11 Two person $52.18 $26.09 $13.05 $53.22 Family $80.56 $40.28 $20.14 $82.17 page 10

13 Humana/CompBenefits Vision Plans - Employee Paid NOTE: There is no change in coverage or rates for Basic High Option l Covered members may get one eyeglass or contact lens exam each year with no co-pay required. l Covered members receive a 20% discount on lenses and frames at participating providers. l Offers an enhanced plan which includes one eye exam for a $10 co-pay. l $15 co-pay for single vision, bifocal or trifocal lenses with a maximum $15 co-pay for basic and designer frames up to a $50 wholesale allowance or a $135 annual allowance for contact lenses. Please see the Vision Plan summaries and provider directories for additional information. Both plans require the use of network providers. Plan Summaries and directories are located on the City s Intranet in the Benefits section or in the Benefits Division Office. Questions regarding the plans may be directed to CompBenefits Member Services at or Vision Insurance Rates Effective April 1, 2015 Total Cost Employee Deductions COBRA Basic Monthly Bi-weekly Weekly Monthly Single $.95 $.48 $.24 $.97 Two person $1.43 $.72 $.36 $1.46 Family $2.38 $1.19 $.60 $2.43 High Option Single $5.92 $2.96 $1.48 $6.04 Two person $11.80 $5.90 $2.95 $12.04 Family $15.78 $7.89 $3.95 $16.10 Basic Life Insurance - City Paid All eligible full-time employees are provided with Term Life and Accidental Death and Dismemberment (AD&D) Insurance provided by The Standard Life Insurance Company and paid for by the City of St. Petersburg. You should designate a beneficiary using Oracle Self-Service. Benefit Classes Active Classified Employees (other than below) $10,000 Professionals $20,000 Amount of Insurance Firefighters, Firefighter/Paramedics, Fire Lieutenants SPAFF Plan Fire Captain, Fire District Chief, Police Sergeant, 1 X Annual Salary (to the nearest $1,000) Police Lieutenant, Police Officers, Forensics Services Technicians & Latent Print Examiners Administrative Management $100,000 Elected Officials $100,000 page 11

14 Supplemental Life Insurance - Employee Paid If you enroll during your initial eligibility period, you do not need to submit an Evidence of Insurability form. If you enroll after your initial eligibility or want to increase coverage, you must complete an Evidence of Insurability form (available on the City s Intranet in the Benefits section) and submit to The Standard for approval. Standard makes all determinations. Approval is not guaranteed. Because Supplemental Life Insurance coverage levels depend on your base annual salary, if your salary increases to the next salary range, your coverage and premiums will automatically increase as well. Premiums may be waived in the event of a disability retirement. For new, full-time employees, coverage becomes effective the first of the month nearest 60 days after full-time employment. Coverage elected during the open enrollment period becomes effective on April 1 or the date the Evidence of Insurability form, if required, is approved by the Standard Life Insurance Company, whichever is later. Be sure to designate a beneficiary in Oracle Self-Service. You may change your beneficiary designation at any time. For questions on enrollment, contact the Benefits Division at Supplemental Life Insurance Effective April 1, 2015 REDUCED RATES FOR SPOUSE COVERAGE The Standard Life Insurance Company offers three levels of supplemental life insurance coverage. Employees may choose to cover their spouses and children only if they elect coverage for themselves. Spouses may be covered for $10,000, $25,000 or $50,000 as long as the coverage of the employee is at least twice the spouse s coverage. Unmarried dependent children up to age 20 (age 25 if enrolled as full-time student at accredited school or college, over age 20 if disabled) may be insured for $5,000 or $10,000. An employee, spouse or dependent child who is a full-time member of the armed forces is not eligible for this coverage. Salary Range in dollars Low Option Coverage Low Option Monthly Cost Mid Option Coverage Mid Option Monthly Cost High Option Coverage High Option Monthly Cost $15,000-19,999 $15,000 $5.06 $30,000 $10.11 $45,000 $15.17 $20,000-24,999 $20,000 $6.74 $40,000 $13.48 $60,000 $20.22 $25,000-29,999 $25,000 $8.43 $50,000 $16.85 $75,000 $25.28 $30,000-34,999 $30,000 $10.11 $60,000 $20.22 $90,000 $30.33 $35,000-39,999 $35,000 $11.80 $70,000 $23.59 $105,000 $35.39 $40,000-44,999 $40,000 $13.48 $80,000 $26.96 $120,000 $40.44 $45,000 - $49,999 $45,000 $15.17 $90,000 $30.33 $135,000 $45.50 $50,000 or more $50,000 $16.85 $100,000 $33.70 $150,000 $50.55 Spouse $10,000 $2.58 $25,000 $6.45 $50,000 $12.90 Child $5,000 $0.70 n/a n/a $10,000 $1.40 page 12

15 Supplemental Accidental Death and Dismemberment (AD&D) - Employee Paid The Standard Life Insurance Company plan allows you to purchase coverage from $25,000 to $300,000 (up to a maximum of 10 times your annual salary). AD&D will pay benefits in the event of accidental death, paralysis, dismemberment, loss of eyesight, loss of speech, or loss of hearing due to an accident. See the plan summary on City Intranet or in the Benefits Division Office for complete information regarding this program. Evidence of Insurability is not required no matter when you enroll. Coverage for Eligible Dependents/Children Under the family plan option, you may insure your spouse and/or dependent children. Unmarried children: 1) through age 20 2) through age 25 if enrolled as a full-time student at an accredited educational institution 3) over age 20 if disabled An employee, spouse, or dependent child who is a full-time member of the armed forces is not eligible for this coverage. If covered as an employee, you cannot be covered as a spouse of another employee. Family Plan Coverage Amounts If you choose this coverage, family members are covered by the policy as follows: l Spouse only: 50% of the employee amount l l Child(ren) only: 10% of the employee amount for each child, not to exceed $25,000. Spouse and child(ren): Spouse 40% of the employee amount; Child(ren) 5% of the employee amount for each child not to exceed $25,000. Effective Date For new employees, coverage is effective the first of the month nearest 60 days after employment. Coverage elected during annual open enrollment will be effective April 1, The plan summary, located on the City s Intranet under Human Resources/Benefits/Life Insurance, has a complete description of benefits, limitations, exclusions and costs. Supplemental Accidental Death and Dismemberment Effective April 1, 2015 RATES Coverage Amount Employee Only Monthly Cost Family Plan Monthly Cost $25,000 $0.58 $0.88 $50,000 $1.15 $1.75 $75,000 $1.73 $2.63 $100,000 $2.30 $3.50 $125,000 $2.88 $4.38 $150,000 $3.45 $5.25 $175,000 $4.03 $6.13 $200,000 $4.60 $7.00 $225,000 $5.18 $7.88 $250,000 $5.75 $8.75 $275,000 $6.33 $9.63 $300,000 $6.90 $10.50 page 13

16 City of St. Petersburg Flexible Spending Accounts (FSA) Flexible Spending Accounts for health care and/or dependent care allow you to set aside payroll dollars on a pre-tax basis to spend those dollars for qualified health or dependent care expenses. At enrollment, enter an annual amount for Health Care ($300-$2,500) and/or Dependent Care ($600$5,000). If you want a specific amount deducted per pay period, multiply it by 52 if paid weekly or 26 if paid bi-weekly to obtain the annual amount. Flexible Spending Accounts must be elected annually using Oracle Self-Service. Claims for services provided between April 1, 2015 and March 31, 2016 must be submitted to UnitedHealthcare by May 15, Claim form can be found on the City Intranet under Benefits, in the Benefits Office and at Health Care Accounts Employees enrolling in the Health Care FSA receive two debit MasterCards to be used for eligible health expenses which include co-pays to health care providers, prescriptions and other approved health care expenses (examples can be found at myuhc.com or on the City Intranet). The Health Care FSA has an auto-pay function which you may unselect at myuhc.com. Requests for reimbursement may be submitted to United using claim forms. Debit card purchases and claims may be submitted prior to deductions being taken from your paycheck. Debit MasterCard activation and usage instructions come to you from UnitedHealthcare. If you had a FSA debit card during the 2014 plan year, retain the card if re-enrolling; it will be reloaded with the amount of your 2015 election. Unspent health care FSA balances, up to a maximum of $500, will be carried forward to the next year (amounts above $500 are forfeited at the end of the plan year). Dependent Care Accounts Eligible dependent care expenses include preschool, day care and some before and after school care expenses. Private school tuition is not eligible for reimbursement. Payroll deductions must be taken prior to requesting a reimbursement. The debit MasterCard will not be issued for Dependent Care accounts. DON T FORGET! Flexible Spending Account enrollments do not renew automatically. You must re-enroll in Oracle SelfService to continue FSA for the 2015 plan year. page 14

17 If You Are Retiring Soon If you are planning to retire between April 1, 2015 and March 31, 2016, this open enrollment period is your last chance to select the benefit plans you ll be taking into retirement. NOTE: Generally, retirees do not have open enrollment periods: but may make changes if they have a qualifying life event. It is important for a retiree or covered dependent to enroll in Medicare Parts A & B at the time they first become eligible. Currently, retiree premiums differ for health and life insurance, but are the same for the dental, vision, and AD&D plans. Call the Benefits Division at for rates. Frequently Asked Questions What is Open Enrollment and when are changes effective? Open Enrollment is when you can make changes to your group insurance coverage for the upcoming benefits year (April 1, 2015 to March 31, 2016). During Open Enrollment you may: What will I need to enroll? l Your Oracle ID and Password are required. If you do not know your password and have a City address, go to the Oracle E-Business Suite Login page and click on the Login Assistance link and follow the prompts. A new password will be ed to you. If you do not have a City address, call the ICS Help Desk at ext: 7200 ( ) and request your Oracle password be reset. They must speak to you, the employee, who must provide the last four digits of your Social Security number and the month and day of your birth for identity verification. You must make selections from a City computer. 1) Enroll, if you previously waived coverage; 2) Cancel coverage; 3) Add or remove dependents; 4) Change coverage level for Supplemental Life and/or Accidental Death and Dismemberment insurance. Submit Evidence of Insurability form to The Standard to request an increase in Supplemental Life coverage. l l Name, date of birth and Social Security Number must be provided for all dependents A Social Security Number must be provided for all dependents and required documentation must be submitted to the Benefits Office by March 6, Be sure your address, marital status and contact information and beneficiaries are up to date. You may change personal information and beneficiary designations at any time during the year, not just during Open Enrollment. You must make your selections in Oracle Self-Service prior to the close of business on February 27, Any required documentation must be received in the Benefits Division Office by March 6, Coverage enrollments and changes will be effective April 1, UnitedHealthcare will send new group health insurance cards to the home address of record prior to the coverage effective date. Changes cannot be made between Open Enrollment periods unless you have a Qualifying Life Event (see page 16). I am a new enrollee, what do I do? Collect the required information: Social Security Numbers, birth dates and names of all dependents along with your Oracle password. Use Oracle Self- Service to check benefit choices before the end of the enrollment period (within 30 days of your date of hire for new employees) and submit any required documentation to the Benefits Division Office on the 4th floor of the MSC building. For new employees, coverage elected becomes effective on the first of the month nearest 60 days after employment. Don t want to participate in a plan? Choose decline coverage in Oracle Self-Service. page 15

18 What if I don t want to make changes to my current coverage or covered dependents? No action is required to keep your current medical, dental or vision coverage. If you have a Flexible Spending Account (FSA) and wish to participate in 2015 or you wish to enroll in FSA for the first time, you must enroll via Oracle Self-Service. What documentation will be required to add dependents? Eligible dependents are a legal spouse, Same Sex Domestic Partner, and natural, adopted or stepchildren (under the age of 30 for medical; under age 26 for dental and/or vision). 1) Children: Verification of natural children must indicate you as the parent of the child. For step-children, verification must indicate your spouse as the child s parent. A birth certificate (not Birth Registration Card), child support court order, court-certified guardianship papers, etc. may be used. Verification of adopted/foster children must be by official court documents indicating the child has been placed in your home. 2) Spouse: An official marriage certificate must be provided to the Benefits Division to enroll your spouse. 3) Same Sex Domestic Partner: Contact the Benefits Division for more information and forms. Social Security Numbers must be input via Oracle Self-Service for all dependents. If you elect coverage for a child age 26 or over you must complete the Dependent Child Age 26 or Over-Application for Coverage form. A separate form for each child is required. What is the cost of health benefits and how do I pay for my benefits? Premium costs for all plans can be found in Benefits Line: pages 4 through 7 for medical, page 10 for dental, page 11 for vision; and pages 12 and 13 for life insurance and AD&D. With the City's Premium Payment Plan some of these costs are paid with pre-tax dollars (except for coverage of non-qualifying dependents). The amount of premiums will reduce your taxable income. (Pre-tax deductions will also decrease your salary amount used for Social Security benefit calculations). NOTE: If paid bi-weekly, deductions will be for 24 pay periods per year. If you are paid weekly, there will be 48 deductions per year. Exception: Flexible Spending Account deductions are deducted each pay period. The Premium Payment Plan is automatic when you enroll in the City s group insurance plans. If you do not wish premium deductions to be made pre-tax, call the Benefits Office at The Internal Revenue Code requires that coverage selected remain in effect for the full plan year; however, you may make changes to group insurance coverage if you have a Qualifying Life Event. What is a Qualifying Life Event? l In the event of marriage, death, divorce, legal separation, or annulment, you may add or delete a spouse. NOTE: Former spouses must be removed from the plan within 31 days of the date the divorce is final. l Birth, adoption, placement for adoption, or death of a dependent. l Changes in your, your spouse s or a dependent s employment if the change results in a loss of coverage for one of you. l A dependent satisfying or ceasing to satisfy a plan s eligibility requirements. NOTE: Ineligible dependents must be removed from the plan within 31 days of the date they become ineligible. l A change in work schedule resulting in a decrease or increase in hours of employment by you, your spouse or dependent, including a switch between part-time and full-time; a strike or lockout; or the beginning of or return from an unpaid leave of absence. Frequently Asked Questions continued on page 17 page 16

19 Frequently Asked Questions continued from page 16 In order to make any change you must first update information in Oracle Self-Service, then notify and provide appropriate documentation to the Benefits Division within 31 days of the Qualifying Life Event. If you have questions or need to confirm changes to your coverage, call City s plans. The election period ends 60 days from the later of the date coverage would otherwise terminate or you are notified of your continuation rights by United. If you have questions about continuation coverage, contact the Benefits Division at You must be enrolled in a plan in order for dependents to be enrolled in the same plan. If you have a Qualifying Life Event you may: 1) Enroll in a group insurance plan; 2) Change your coverage level; 3) Cancel your coverage for yourself and/or your dependents; 4) Switch from one Supplemental Life Insurance plan to another with Evidence of Insurability if increasing coverage; 5) Cancel your Supplemental Life Insurance coverage. COBRA Eligibility If a Qualifying Life Event occurs that causes you or a dependent to lose coverage under any of the City s plans, the Consolidated Omnibus Budget Reconciliation Act allows you to continue the coverage you had immediately before the Qualifying Life Event occurred. A COBRA Qualifying Life Event is any of the following causing you or a dependent to lose coverage under any of the City s plans: a covered employee s death; divorce or legal separation; termination of employment for any reason other than gross misconduct; reduction in hours to fewer than the number required for plan participation; a covered child s loss of dependent status under a plan. UnitedHealthcare will send notification of your continuation rights to your address of record. You have 60 days to determine whether you wish to continue your coverage(s) through any of the page 17

20 Contact Information The Florida Relay Service is a link for individuals who are deaf, hard of hearing, deaf/blind or have speech disabilities. Florida Relay Service uses specialized equipment to communicate with others using standard telephone equipment. Dial 711, toll free, and a relay operator will answer your call. Contact information and links to the carrier web sites are below. Plan information and links can also be found in the Benefits section on the City s Intranet. For questions concerning the health plans, please contact: l l l l For Health Plan questions contact: On-site United Representative located in MSC at or UnitedHealthcare Customer Service at or visit For Dental Plan questions contact: MetLife GET-MET8 ( ) M-F 6 a.m. to 11 p.m. EST or visit or For Vision Plan questions contact: CompBenefits or visit For Supplemental Life Insurance or Accidental Death & Dismemberment policy questions contact: The Standard or visit Mail any required Evidence of Insurability forms to: The Standard Insurance Company Medical Underwriting 900 S.W. Fifth Avenue Portland, OR l For Employee Assistance Program (EAP) contact: ComPsych at (TDD: ) or go online at guidanceresources.com. Company Web ID: STPETE For questions regarding group insurance premiums or deductions, please call the Human Resources Department Benefits Division Enrollment Hotline at Remember! Open Enrollment is the only time to make changes in your benefit plans unless you have a Qualifying Life Event. Open Enrollment is February 16 through February 27, You must make all selections in Oracle Self-Service by February 27, 2015, and you must submit all required documents to the Benefits Division by the March 6, 2015 deadline for enrollment to be effective. This guide is a summary and is not intended to describe the benefit plans. Benefit plans are governed by the applicable plan documents of each plan and anything in this summary that is inconsistent with the plan documents shall be superseded by and governed by the plan documents as well as the rules and regulations of the City of St. Petersburg. page 18