Employee Benefit Summary Guide

Transcription

1 Employee Benefit Summary Guide

2 Table of Contents Introductory Letter...2 About Your Benefits Important Benefit Rules & Recommendations...5 Dependent Audit Information Benefit Enrollment System Quick Guide (WORKTERRA) Important Contact Information...14 Health and Dental Rate Sheet...15 Core Health Plan Highlights (BCBSNC) Basic Health Plan Highlights (BCBSNC) Dental Plan (Delta Dental) Vision Plan (Superior Vision)...26 Employee Assistance Plan (ComPsych) Basic & Supplemental Term Life Insurance & AD&D Benefits (RSLI) Short Term Disability (RSLI) Long Term Disability (RSLI) Flexible Spending Accounts (FSA) (Laymon Group) Healthcare Reimbursement Arrangement (HRA) (Laymon Group) Worksite Benefits (Transamerica) Critical Illness, Cancer, Accident, Hospital Indemnity, & Whole Life Insurance Legal Plan (Hyatt/MetLaw)...44 Auto and Home Insurance (Liberty Mutual)...45 Long Term Care Insurance (New York Life) Time Off Benefits Retirement Benefits COBRA Continuation Benefits (P & A Group) About This Guide and Key Terms...56 Notice of Privacy Information Practices

3 July 2015 Dear City Employee: We d like to welcome you to the start of another open enrollment season. It is our pleasure to provide you with this important resource regarding your benefits at the City of Durham. This guide has all of the information you will need for open enrollment and throughout the year so that you can make educated decisions that are right for you and your family. Open Enrollment is a great time to review your existing benefit plans, evaluate any anticipated needs, learn more about your benefits and make adjustments for the upcoming year. Your benefits make up an important part of your total compensation. The City of Durham offers a comprehensive benefits package for our employees and their eligible dependents. Our benefits program provides a flexible approach to certain City benefits, allowing you to select coverage that best meets your needs. We have placed a major focus on enhancements to the City s Wellness program in order to create a culture of wellness. The plan design continues our effort to be more involved in your health care decisions, to take advantage of preventive health care options, and to adopt a healthy lifestyle. We encourage you to continue getting the most from your healthcare benefits by expanding your awareness, attending education sessions, reading articles and special announcements about health programs that may be useful to you and your family. The City s 2015 annual OPEN ENROLLMENT period will occur July 6, July 30, There are several changes to the benefits offering this year, therefore everyone will be required to log into the automated open enrollment tool, Workterra, to select their benefits. Remember, annual enrollment is the only chance you have each year to adjust your benefits, except for qualifying events or when court ordered. Your benefit plan changes must be completed and submitted no later than 5:00 PM Thursday, July 30, Please enroll online at for health, dental, vision, life, long term disability, short term disability, Hyatt Legal Plans and flexible spending accounts. For voluntary benefits with Transamerica, Liberty Mutual and New York Life you will be able to meet with enrollment counselors for assistance. The schedule of site locations and times can be found on CODI. We look forward to working with you! Human Resources Department 2

4 Choosing Your Benefits About Your Benefits Some benefits such as basic life insurance are automatic. You don t have to choose them because the City of Durham pays the entire cost. The benefits that you pay for, you must actively choose. Your portion of the cost is automatically taken out of your paycheck. There are two ways that the premiums can be deducted from your paycheck: PRE-TAX premiums are collected for Medical, Dental, Vision, Pre-Paid Legal, and Flexible Spending Accounts. POST-TAX premiums are collected for the following optional benefit plans: Short-Term Disability, Long- Term Disability, Long-Term Care, and Supplemental and Dependent Life Insurance. Making Changes Employee benefit elections must be made before the start of each plan year during open enrollment or as part of the new hire benefits enrollment process. In 2016, the City of Durham will be changing the benefit year to coincide with the City of Durham s fiscal year. The benefit year will end on June 30, Generally, you can only change your benefits choices during the annual open enrollment period. However, you can change your applicable benefit plans during the year if you have a qualifying event. A list of qualifying events follows: Marriage Divorce or legal separation Addition of Certified Dependent Birth, adoption, or placement for adoption of an eligible child Death of spouse or covered child Change in spouse s or certified partner s work status that affects benefits eligibility (e.g., starting a new job, leaving a job, or leave of absence) A significant change in spouse s or certified partner s health coverage attributable to your spouse s or certified partner s employment (e.g., open enrollment of spouse) A change in your child s eligibility for benefits Becoming eligible for Medicare or Medicaid Commencement of or returning from an unpaid leave for employee/spouse If you have a qualifying event, you must notify the Benefits Team in Human Resources with the appropriate paperwork within 30 days. Depending on the type of change, you may need to provide proof of the change (e.g., a copy of a marriage license or birth certificate). If you do not notify Human Resources within 30 days, you will have to wait until the next annual enrollment period to make benefits changes unless you have another family status change. 3

5 Any changes you make to your benefits choices must be directly related to the family status change. Financial hardship is not a change in life status that qualifies for changing or stopping contributions for your insurance coverage or Flexible Spending Account. The IRS has strict regulations regarding changes to insurance coverage and Flexible Spending Account plans that allow payroll deductions on a pre-tax basis. Once you have elected your coverage and contribution amounts, you cannot start, change, or cancel them during the benefit period unless you have a qualifying change in your life status. The new insurance medical and dental premium deduction will appear on your second August 2015 paycheck. All other deductions for the plan years, if you choose to participate, will begin on your first September 2015 paycheck. When Coverage Ends Health and dental benefits will end according to your termination date. If you terminate on or before the 15 th of the month, health and dental benefits will terminate at the end of the current month. If you terminate on or after the 16 th of the month, health and dental benefits will end on the last day of the following month. Disability and life insurance benefits will end on the date of termination. Flex spending will end on the date of termination. All claims filed must have a date of service before the termination date and must be submitted within 90 days of the termination date. Transamerica, Colonial, New York Life Long Term Care, Liberty Mutual, Hyatt/MetLaw Legal, the City paid Reliance Standard basic life insurance and supplemental policies are portable. If employees wish to continue coverage following termination, it is their responsibility to contact the carrier. If you have a covered dependent, the dependent s coverage will end on the last day of the month in which the dependent s 26th birthday falls unless that dependent is unmarried, and mentally or physically handicapped, and incapable of self-support. Eligibility for Healthcare Benefits All full time and specified part-time or temporary-with-benefits employees (not all benefits may apply to temporary-with-benefits employees) are eligible for medical coverage beginning on the first day of month following date of employment. You may also enroll eligible dependents, which include your: spouse; certified dependent (same-sex or opposite-sex partners) *; natural children, step children, adopted children, and children of certified dependents (up to age 26); court ordered children (up to age 26); and unmarried children who are mentally or physically handicapped and incapable of self-support, regardless of age. Contact HR Connect for Questions at *Required documentation must be submitted per policy HRM 510 4

6 Important Benefit Rules & Recommendations Each employee is responsible for insuring that benefit deductions are correct for the coverage enrolled. Each employee should carefully review deductions for accuracy and report any errors to Human Resources immediately. The City of Durham will refund a maximum of thirty (30) days deductions in the event that deductions are inaccurate. There can be no changes, other than those defined as qualifying event changes, after Open Enrollment ends. Qualifying events are as follows: Marriage Divorce or legal separation Addition of Certified Dependent Birth, adoption, or placement for adoption of an eligible child Death of spouse or covered child Change in spouse s or certified partner s work status that affects benefits eligibility (e.g., starting a new job, leaving a job, or leave of absence) A significant change in spouse s or certified partner s health coverage attributable to your spouse s or certified partner s employment (e.g., open enrollment of spouse) Change in your child s eligibility for benefits Becoming eligible for Medicare or Medicaid Commencement of or returning from an unpaid leave for employee/spouse Family status changes must be made within thirty (30) days of the event constituting the change. Employees must provide appropriate documentation of the change within the thirty (30) day period. Employee family status changes occurring outside the open enrollment period may only be made within a plan tier, i.e. from Employee to Employee/Spouse. An employee may not make a change from plan to plan, i.e. from Core to Basic. 5

7 Memorandum CITY OF DURHAM Date: July 2, 2015 To: From: Re: City Employees Germaine Brewington, Department of Audit Services Director City of Durham Benefits Verification Performance Audit We are all aware of how important it is to have adequate healthcare coverage, and how expensive paying for healthcare can be for you and for the City of Durham. Over the years, the City has worked hard to provide you and your dependents with quality health benefits. As part of this goal, this year the Audit Services staff will conduct a dependent verification audit. The purpose of this audit is to ensure that each spouse and dependent enrolled for Health and Dental benefits through the City is accurately listed and eligible for coverage. We are confident this process will ensure that eligible dependents are covered in a fair and equitable manner. All employees who are covering a spouse or other dependents will be required to participate. In the very near future enrollment for the plan year beginning September 2015 will open. All employees who will be electing to cover a spouse/dependent should gather and review documents during the open enrollment period (July 2015) to ensure that you have the appropriate documents to verify eligibility for your dependents/spouse. The definition of eligibility is attached. The documents that will be used to verify eligibility are also included in the attachments. In September, a sample of employees will be selected from the total pool of all employees that are covering a spouse/dependent on their health benefits. Selected employees will be asked to provide documentation to support eligibility. Please look at the attached timeline for more details regarding this process; and your role in the process. Claiming someone on your benefits who does not qualify as an eligible dependent is a violation of the City s Ethics Policy and could lead to sanctions up to and including termination and repayment of claims. It is important for you to know that the documents examined will be used solely to verify that dependent eligibility has been satisfied based on the rules stated in the Benefits Summary Guide that will be forthcoming. The Audit Services Department staff will take all necessary precautions to maintain the confidentially of this information. If you have any questions please do not hesitate to me or call me at x cc: Thomas J. Bonfield, City Manager Regina Youngblood, Director, Department of Human Resources Durham Where Great Things Happen 6

8 Memorandum CITY OF DURHAM Dependent Verification Summary Timeline Date July 2015 July 2015 September 2015 September/October 2015 November 2015 Action Item Initial notification letter sent to all employees. Open enrollment period (All employees that are covering a spouse/dependent should gather and review their relevant documents to support eligibility). Sample of employees selected. Employees will be notified via a letter. Audit field work will be conducted. Audit report will be shared. Durham Where Great Things Happen 7

9 Eligible Dependents and Required Documentation for Health and Dental Insurance Dependent Type Definition Required Verification Documents Spouse An individual to whom you are legally married Government Issued Marriage Certificate and page one of your Federal Tax Return filed within the last 2 years OR Government Issued Marriage Certificate and Proof of Joint Ownership Issued within the last 6 Months OR Government Issued Marriage Certificate ONLY if Married in the Current Calendar Year Certified Dependent An individual that has reached the age of 18, is not married to anyone else, and who lives in a long term relationship of indefinite duration with a City of Durham employee, with the exclusive mutual commitment in which they share the necessities of life and are financially interdependent. See policy HRM for full definition. Biological child A notarized copy of the Application and Affidavit to Designate Certified Dependent and the enrollment application forms as required by policy HRM Natural Child (up to age 26) Government Issued Birth Certificate that names the parents of child Step Child A child of one s spouse Government Issued Birth Certificate that names the (up to age 26) parents of child and Government Issued Marriage Certificate of Employee and Spouse and page one of your Federal Tax Return filed within last 2 years OR Government Issued Birth Certificate that names the parents of child and Government Issued Marriage Certificate of Employee and Spouse and Proof of Joint Ownership Issued within last 6 Months OR Government Issued Birth Certificate that names the parents of child and Government Issued Marriage Certificate ONLY if Married in the Current Calendar Year Child of Certified Biological child of Certified Dependent Government Issued Birth Certificate that names the Dependent parents of child and an Application and Affidavit to Designate certified Dependent on file with the City of Durham Disabled Child A biological child, step child, or adopted Government Issued Birth Certificate that names the child that has been medically certified as parents of child and page one of your Federal Tax disabled Return filed within last 2 years and proof of medical disability Adopted Child A child that has been legally adopted Adoption Certificate and page one of your Federal through the judicial process Tax Return filed within last 2 Years OR Official Adoption Placement Agreement and Signed Petition for Adoption Court Ordered Child A child that the City of Durham is required Documents noted above for natural child, step-child, to cover under the insurance as disabled child or adopted child OR a copy of the mandated by State or Federal regulations court order stating that the employer is required to provide insurance to the child Federal Tax Return Only submit first page and black out all social security numbers and financial information Proof of Joint Ownership Mortgage or rental agreement in both names, bank account or credit card statement 8

10 CITY OF DURHAM Human Resources Department 101 CITY HALL PLAZA DURHAM, NC F DEPENDENT ELIGIBLE REVIEW FREQUENTLY ASKED QUESTIONS 1. Why is the City of Durham conducting this verification review? Your health insurance is a valuable benefit, but also a costly one. It becomes more costly to you and the city when ineligible dependents are covered. The review is to ensure that only eligible dependents are covered under your benefits. This will help us control costs and ensure regulatory compliance. 2. Why am I being required to submit verification of my family members but my coworker is not? The initial group of employees selected to submit verification of family members is a sample of all employees with dependents covered under the City s health plan. Based on the outcome of the initial review, the City of Durham will decide whether to expand the review to all employees with covered dependents. 3. What types of dependents are being verified? Spouses, certified dependents and children. 4. Who does the City of Durham consider an eligible dependent? Spouse; Certified dependent (same-sex or opposite-sex partners);* Children (eligible for coverage until age 26, regardless of any, or a combination of any, of the following factors: financial dependency, residency with parent, student status, employment and marital status) o your natural children; o your spouses or certified dependent s natural children o your legally adopted children; o unmarried children who are mentally or physically handicapped and incapable of selfsupport, regardless of age; and o children who are the subject of a Qualified Medical Child Support Order. *required documentation must be submitted per policy HRM-510 Definitions of dependents and documentation requirements can be found on the Human Resources CODI site under Verification Review. The document is titled Eligible Dependents and Required Documentation for Health and Dental Insurance 5. What happens if I do not respond to the verification request? If you do not respond, your dependents will be removed from coverage. Durham Where Great Things Happen 9

11 CITY OF DURHAM Human Resources Department 101 CITY HALL PLAZA DURHAM, NC F If my dependents are removed from coverage, why aren t they being offered COBRA? Termination of a dependent who was not eligible for coverage is not considered a COBRA Qualifying Event. Therefore, the dependent is not eligible for COBRA coverage. 7. What if my child s birth certificate says Do not copy. For the purpose of the review, a scanned copy will be acceptable. 8. What if my child s birth certificate does not show the names of the parents. Most states offer both a short and a long form of a child s birth certificate. The long form includes the parents names and is the only birth certificate that will be accepted. 9. What if my child s birth certificate has my previous last name and not my current last name. Will the City of Durham require any additional documentation to verify our relationship? Not at this time. The City of Durham will review the documentation submitted, and will contact you within 10 business days if additional information is needed. 10. Where can I get a copy of my child s birth certificate or my marriage license? The North Carolina Department of health and Human Services Division of Public Health Vital Records Unit can assist you with this. Be sure to ask for the long Form which includes the parents names. They can be contacted at or If you would like to request a birth certificate online, most states refer people to VitalCheck, a private company, is not affiliated with the State of North Carolina, and additional fees are charged as well as any applicable state fees. Phone and online orders: call (toll-free). Average processing time is 5-7 business days. 11. I cannot find the birth certificate of one of my three children. I have requested a copy, but it will not arrive before the deadline. I have documentation for the other two children. What should I do? The City of Durham would prefer that all documents be submitted at the same time; however, we understand there may be times when that is not possible. If you are unable to obtain documentation for one of your dependents before the deadline, you should submit the documentation for the remaining dependents to ensure their coverage will continue. Only the dependent without documentation will be dropped from coverage. Once you obtain the documentation, submit the forms to the Audit Services Department and the dependents insurance will be retroactively reinstated once the forms have been validated. Durham Where Great Things Happen 10

12 CITY OF DURHAM Human Resources Department 101 CITY HALL PLAZA DURHAM, NC F My dependent documentation was issued in a foreign country and is not in English. Do I need to provide a copy of the document translated into English for it to be acceptable? Yes. Any document provided as proof of eligibility that is in a foreign language must be completely translated into English and should be certified with a letter of accuracy from the translator. If you do not have a translation and you wish to submit a copy of the foreign document, the City will try to provide a translation. If the City is unable to translate, you will be responsible for providing an acceptable English translation. 13. I am recently married and my spouse isn t listed on my tax return. How do I show we are married? If you have been married for less than one year, the City of Durham will accept a marriage license as verification, and you do not need to submit a tax return. 14. I have been married for many years. Why can t you just accept a copy of my marriage license? The purpose of the audit is to ensure that only eligible dependents are covered by the plan. A marriage license, along with a copy of page one of your most recent tax return, ensures that you are covering a current spouse and not a former spouse. Former spouses are not eligible to participate in the health and dental plans. 15. My spouse and I file our taxes separately. What should I send? A copy of both your and your spouse s most recent tax return. 16. My divorce decree states that I must provide health insurance for my ex-spouse, can I cover them under the City of Durham s health plan? No. An ex-spouse is not an eligible dependent for City of Durham coverage. Durham Where Great Things Happen 11

13 City of Durham Enrollment System Quick Guide Sign In Instructions WORKTERRA Website: Type the following address into your web browser: You should see the WorkTerra login page pictured below. Enter Username: Your Username will be your full Last Name followed by your full First Name and then the last 4 digits of your Social Security number without any spaces. For example, John Smith s Social Security Number is His Username is: smithjohn6789 Initial Password: Your password will be your full Date of Birth in MMDDYYYY format. For example, if your Date of Birth is: July 9, 1983 Then your password is: Company Name: Enter City of Durham Sign In: Click the Sign In button. Help: If you need assistance signing in, please contact City of Durham Human Resources Department. Legal Agreement & Welcome Page Read the Employee Usage Agreement and click Continue at the bottom of the page. Read the Legal Agreement and click Continue at the bottom of the page. Read the Welcome message and click Continue at the bottom of the page. 12

14 City of Durham Enrollment System Quick Guide Change Password The first time you sign in to WORKTERRA, you will be required to create a new password. You will see the WORKTERRA password change page pictured below. Secret Questions: For additional security and password recovery, you will select secret questions and enter your answers. Select 2 Secret Questions from the dropdown lists and enter your Secret Answers. New Password: Read the password rules at the top of the screen. Enter your new password. Enter your password again to confirm. Passwords are case sensitive. Click on the Save and Continue button. Demographic Information and Benefit Elections Step by step instructions are available in the forms library in WORKTERRA, on the City s Human Resources intranet site, and from your Department Liaison. The following general instructions will help you navigate WORKTERRA and successfully complete your enrollment. Do not use your internet browser back and forward buttons. If you do, WORKTERRA s security features will log you out and you will have to sign in again. Demographic information marked with a red asterisk is mandatory. To enroll in a benefit, select the names of your family members to be covered by clicking the radio button next to each family member s name. Then click the Enroll button. After you make your enrollment selection for each plan, you automatically advance to the next enrollment option. Your enrollment is not finished until you click the Finish button on the bottom of the Confirmation page. It is strongly recommended that you print a copy for your records. You may sign in to WORKTERRA to change your enrollment selections during open enrollment or to view your prior confirmed enrollments. 13

15 Important Contact Information Benefit Questions If you have questions about any of your benefits, please contact the company that handles the plan administration for the City. If you still have questions, or need more information about any other benefit plans, please contact your Human Resources Team for assistance. They will be happy to assist you. Below is a list of companies, the plans they administer and their contact information. Company Phone Number Website Blue Cross/Blue Shield of NC Colonial Products Delta Dental ICMA (Deferred Compensation) Laymon Group (Flex Spending Accounts and HRA) Liberty Mutual Service: x Claims: MetLaw/Hyatt Legal Nationwide (Deferred Compensation) New York Life Enrollment & Service: Claims: NC Retirement System NC Supplemental Retirement (k) P & A Group (COBRA) Reliance Standard (Life Insurance, STD, & LTD) Superior Vision Transamerica Products Service: Claims: X2 14

16 City of Durham 2015/2016 Health and Dental Insurance Rate Sheet Monthly Employee/City Contributions Wellness Rate Core Plan Total City City Employee Cost Cost % Cost Employee $ $ % $33.48 Emp/Spouse $1, $ % $ Emp/Child(ren) $ $ % $ Family $1, $1, % $ Wellness Rate Basic Plan Employee $ $ % $0.00 Emp/Spouse $ $ % $ Emp/Child(ren) $ $ % $96.55 Family $1, $1, % $ Non Wellness Rate Core Plan Employee $ $ % $53.48 Emp/Spouse $1, $ % $ Emp/Child(ren) $ $ % $ Family $1, $1, % $ Non Wellness Rate Basic Plan Employee $ $ % $20.00 Emp/Spouse $ $ % $ Emp/Child(ren) $ $ % $ Family $1, $1, % $ Dental Rate Plan Total City City Employee Cost Cost % Cost Employee $45.32 $ % $14.95 Employee/Spouse $78.17 $ % $32.83 Employee/Child(ren) $78.63 $ % $33.02 Family $ $ % $

17 City of Durham Core PPO Plan Effective Date: 09/01/ /30/

18 Blue Options SM Benefit Highlights (PPO) Physician Office Services (See Outpatient Hospital Services for outpatient clinic In-network Out-of-network 1 or hospital-based services.) Office Visit Includes Office Surgery, Consultation, X-rays, Lab and benefit period maximum of 4 office visits for the assessment of obesity in and out of network. Primary Care Provider $20 copayment 70% after deductible Specialist $40 copayment 70% after deductible Preventive Care Routine Examinations, Well-Child Care, Well-Baby Care, Immunizations, Well- Woman Care, colorectal screening, bone mass measurement, newborn hearing screening, routine eye exam and prostate specific antigen tests (PSAs). Primary Care Provider 100% Not Available* Specialist 100% Not Available* Outpatient Clinic 100% Not Available* *Colorectal screening, bone mass measurement, newborn hearing screening, prostate specific antigen tests (PSAs) and certain well woman care like gynecological exams, cervical cancer screening, ovarian cancer screening and screening mammograms are covered Out-of-network. Therapies Short-Term Rehabilitative Therapies (Maximums apply to Home, Office and Outpatient Settings): Physical/Occupational: 30 visits per Benefit Period Speech Therapy: 30 visits per Benefit Period Primary Care $20 copayment 70% after deductible Specialist $40 copayment 70% after deductible Urgent Care Centers and Emergency Room Urgent Care Centers $20 copayment $20 copayment Emergency Room Visit (Inpatient Hospital benefits apply if admitted. If held for $300 copayment $300 copayment Observation, Outpatient benefits apply. See Inpatient and Outpatient Hospital Services ) Ambulatory Surgical Center 80% after deductible 70% after deductible Inpatient and Outpatient Hospital Services Hospital and Hospital Based Services 80% after deductible 70% after deductible Outpatient Clinic Services 80% after deductible 70% after deductible Professional Services 80% after deductible 70% after deductible Hospital and Professional Outpatient Labs and Mammograms with surgery or other services 80% after deductible 70% after deductible Outpatient Labs and Mammograms without surgery or other services 100% 70% after deductible Outpatient X-rays, ultrasounds, and other diagnostic tests, such as 80% after deductible 70% after deductible EEG s and EKG s CT scans, MRI s, MRA s and PET scans in any location, including 80% after deductible 70% after deductible physician s office Other Services Skilled Nursing Facility (60 days per Benefit Period) 80% after deductible 70% after deductible Home Health Care, Ambulance, 80% after deductible 70% after deductible Durable Medical Equipment and Hospice Maternity Maternity Delivery includes Prenatal and Post-delivery care Hospital Services (Delivery) 80% after deductible 70% after deductible Professional Services (Delivery) 80% after deductible 70% after deductible Transplants Hospital Services 80% after deductible 70% after deductible Professional Services 80% after deductible 70% after deductible 17 Page 2

19 Blue Options SM Benefit Highlights (PPO) Infertility Services Limit of 3 ovulation induction cycles without insemination Primary Care Provider $20 copayment 70% after deductible Specialist $40 copayment 70% after deductible Hospital Services 80% after deductible 70% after deductible Inpatient and Outpatient Professional Services 80% after deductible 70% after deductible Vision (Routine Eye Exams) 100% Not Available Lifetime Maximum, Deductibles & Coinsurance Maximums In-network Out-of-network 1 The following Deductibles and Coinsurance and Medical Office Copays apply towards the Out-of-Pocket limit. Lifetime Benefit Maximum Deductibles Unlimited Unlimited Individual (per Benefit Period) $750 $1,500 Family (per Benefit Period) Out-of-Pocket Limits Individual - Medical (per Benefit Period) $1,500 $2,750 $3,000 $5,500 Individual - Rx (per Benefit Period) Family - Medical (per Benefit Period) Family - Rx (per Benefit Period) $1,500 $5,500 $3,000 $3,000 $11,000 $6,000 Mental Health and Substance Abuse Services *Inpatient/Outpatient Certification is required. Call Magellan Behavioral Health at Mental Health Services Office Visits Inpatient Hospital Outpatient Hospital Substance Abuse Services Office Visit Inpatient Hospital Outpatient Hospital Prescription Drugs Up to 31 day supply day supply is two copayments. Infertility Drugs up to $5000. MAC B Pricing, Brand Penalty. Rx Copays do not apply towards the Out-of-Pocket Limit. $40 copayment 100% 100% $40 copayment 100% 100% 70% after deductible 70% after deductible 70% after deductible 70% after deductible 70% after deductible 70% after deductible Tier 1 (Generic) $0 copayment Copayment + charge over In-network allowed amount Tier 2 (Preferred Brand) $30 copayment Copayment + charge over In-network allowed amount Tier 3 (Brand) $45 copayment Copayment + charge over In-network allowed amount Diabetic Supplies 100% 100% Spacers and Peak Flow Meters 100% 100% Medco Mail Order - 90 day supply: Tier 1 (Generic) Tier 2 (Preferred Brand) Tier 3 (Brand) Diabetic Supplies Spacers and Peak Flow Meters $0 copayment $60 Copayment $90 copayment 100% 100% Not Available Not Available Not Available Not Available Not Available 18 Page 3

20 ADDITIONAL INFORMATION ABOUT BLUE OPTIONS FROM BCBSNC Benefit Period The period of time, usually 12 months as stated in the group contract, during which charges for covered services provided to a member must be incurred in order to be eligible for payment by BCBSNC. A charge shall be considered incurred on the date the service or supply was provided to a member. Allowed Amount The charge that BCBSNC determines using a methodology that is applied to comparable providers for similar services under a similar health benefit plan. Coinsurance Maximum The dollar amount of coinsurance a member must pay prior to BCBSNC paying 100% for certain services. NOTE: In some plans, there is no coinsurance maximum; members are responsible for coinsurance once the deductible has been met. Day and Visit Maximums All day and visit maximums are on a combined In- and Out-of Network basis. Utilization Management To make sure you have access to high quality, cost-effective health care, we manage utilization through a variety of programs including certification, transplant management, concurrent and retrospective review and care management. If you have a concern regarding the final determination of your care, you have the right to appeal the decision. If you would like a copy of a benefit booklet providing more information about our Utilization Management programs, call the toll free number listed in your information packet. Certification Certification is a program designed to make sure that your care is given in a cost effective setting and efficient manner. If you need to be hospitalized, you must obtain certification. Non-emergency and non-maternity hospital admissions must be certified prior to the hospitalization. If the admission is not certified, a penalty will be applied. For maternity admissions, your provider is not required to obtain certification from BCBSNC for prescribing a length of stay up to 48 hours for a normal vaginal delivery, or up to 96 hours for delivery by cesarean section. You or your provider must request certification for coverage for additional days, which will be given by BCBSNC, if medically necessary. All inpatient and certain outpatient Mental Health and Substance Abuse services must be certified in advance by Magellan Behavioral Health. Office visits do not require certification. In-network providers are responsible for obtaining certifications. The member will bear no financial penalties if the in-network provider fails to obtain the appropriate authorization. The member is responsible for obtaining certification for services rendered by an out-of-network provider. Obtaining certification for Mental Health and Substance Abuse services is the member s responsibility. Health and Wellness Program Because we want to help you stay healthy, we offer a variety of wellness benefits and services. You can take advantage of HealthLine Blue, our 24-hour health information service, a health topics library, asthma and diabetes management and a prenatal program. You will also receive Active Blue, our health magazine and have access to online health and wellness information at With our program you can get health advice anytime you need it, so you can learn how to take charge of your health. What Is Not Covered? The following are summaries of some of the coverage restrictions. A full explanation and listing of restrictions will be found in your benefit booklet. Your health benefit plan does not cover services, supplies, drugs or charges that are: Not medically necessary For injury or illness resulting from an act of war For personal hygiene and convenience items For inpatient admissions that are primarily for diagnostic studies For palliative or cosmetic foot care For investigative or experimental purposes For hearing aids or tinnitus maskers For cosmetic services or cosmetic surgery For custodial care, domiciliary care or rest cures For treatment of obesity, except for surgical treatment of morbid obesity, or as specifically covered by your health benefit plan For reversal of sterilization For treatment of sexual dysfunction not related to organic disease For conception by artificial means For self-injectable drugs in the provider's office A waiting period for coverage of pre-existing conditions may apply to your coverage. BCBSNC defines pre-existing conditions as those conditions for which medical advice, diagnosis, care or treatment was received or recommended within 6 months of the date that your [BCBSNC] coverage begins. You may receive credit toward the 12-month waiting period if your enrollment date is within 63 days of the termination of your previous health coverage. The benefit highlights is a summary of Blue Options benefits. This is meant only to be a summary. Final interpretation and a complete listing of benefits and what is not covered are found in and governed by the group contract and benefit booklet. You may preview the benefit booklet by requesting a copy of the Blue Options benefit booklet from BCBSNC Customer Services., SM Registration and Service marks of the Blue Cross and Blue Shield Association. An Independent Licensee of the Blue Cross and Blue Shield Association Page 4 19

21 City of Durham Basic PPO Plan Effective Date: 09/01/ /30/

22 Blue Options SM Benefit Highlights (PPO) Physician Office Services (See Outpatient Hospital Services for outpatient clinic In-network Out-of-network 1 or hospital-based services.) Office Visit Includes Office Surgery, Consultation, X-rays, Lab and benefit period maximum of 4 office visits for the assessment of obesity in and out of network. Primary Care Provider $25 copayment 70% after deductible Specialist $50 copayment 70% after deductible Preventive Care Routine Examinations, Well-Child Care, Well-Baby Care, Immunizations, Well- Woman Care, colorectal screening, bone mass measurement, newborn hearing screening, routine eye exam and prostate specific antigen tests (PSAs). Primary Care Provider 100% Not Available* Specialist 100% Not Available* Outpatient Clinic 100% Not Available* *Colorectal screening, bone mass measurement, newborn hearing screening, prostate specific antigen tests (PSAs) and certain well woman care like gynecological exams, cervical cancer screening, ovarian cancer screening and screening mammograms are covered Out-of-network. Therapies Short-Term Rehabilitative Therapies (Maximums apply to Home, Office and Outpatient Settings): Physical/Occupational: 30 visits per Benefit Period Speech Therapy: 30 visits per Benefit Period Primary Care $25 copayment 70% after deductible Specialist $50 copayment 70% after deductible Urgent Care Centers and Emergency Room Urgent Care Centers $25 copayment $25 copayment Emergency Room Visit (Inpatient Hospital benefits apply if admitted. If held for $300 copayment $300 copayment Observation, Outpatient benefits apply. See Inpatient and Outpatient Hospital Services ) Ambulatory Surgical Center 80% after deductible 70% after deductible Inpatient and Outpatient Hospital Services Hospital and Hospital Based Services 80% after deductible 70% after deductible Outpatient Clinic Services 80% after deductible 70% after deductible Professional Services 80% after deductible 70% after deductible Hospital and Professional Outpatient Labs and Mammograms with surgery or other services 80% after deductible 70% after deductible Outpatient Labs and Mammograms without surgery or other services 100% 70% after deductible Outpatient X-rays, ultrasounds, and other diagnostic tests, such as 80% after deductible 70% after deductible EEG s and EKG s CT scans, MRI s, MRA s and PET scans in any location, including 80% after deductible 70% after deductible physician s office Other Services Skilled Nursing Facility (60 days per Benefit Period) 80% after deductible 70% after deductible Home Health Care, Ambulance, Durable Medical Equipment and Hospice 80% after deductible 70% after deductible Maternity Maternity Delivery includes Prenatal and Post-delivery care Hospital Services (Delivery) 80% after deductible 70% after deductible Professional Services (Delivery) 80% after deductible 70% after deductible Transplants Hospital Services 80% after deductible 70% after deductible Professional Services 80% after deductible 70% after deductible 21 Page 2

23 Blue Options SM Benefit Highlights (PPO) Infertility Services Limit of 3 ovulation Induction cycles without insemination. Primary Care Provider $25 copayment 70% after deductible Specialist $50 copayment 70% after deductible Hospital Services 80% after deductible 70% after deductible Inpatient and Outpatient Professional Services 80% after deductible 70% after deductible Vision (Routine Eye Exam) 100% Not Available Lifetime Maximum, Deductibles & Coinsurance Maximums In-network Out-of-network 1 The following Deductibles and Coinsurance and Medical Office Copays apply towards the Out-of- Pocket Limit. Lifetime Benefit Maximum Deductibles Unlimited Unlimited Individual (per Benefit Period) $1,500 $3,000 Family (per Benefit Period) $3,000 $6,000 Out-of Pocket Limits Individual - Medical (per Benefit Period) Individual - Rx (per Benefit Period) Family - Medical (per Benefit Period) Family - Rx (per Benefit Period) $4,500 $2,000 $9,000 $4,000 $9,000 $4,000 $15,000 $8,000 Mental Health and Substance Abuse Services *Inpatient/Outpatient Certification is required. Call Magellan Behavioral Health at Mental Health Services Office Visits $50 copayment Inpatient Hospital 100% Outpatient Hospital 100% 70% after deductible 70% after deductible 70% after deductible Substance Abuse Services Office Visit Inpatient Hospital Outpatient Hospital Prescription Drugs Up to 31 day supply day supply is two copayments. Infertility Drugs up to $5000. MAC B Pricing, Brand Penalty. Rx Copays do not apply to the Out-of-Pocket Limit. $50 copayment 100% 100% 70% after deductible 70% after deductible 70% after deductible Tier 1 (Generic) $0 copayment Copayment + charge over In-network allowed amount Tier 2 (Preferred Brand) $35 copayment Copayment + charge over In-network allowed amount Tier 3 (Brand) $50 copayment Copayment + charge over In-network allowed amount Diabetic Supplies 100% 100% Spacers and Peak Flow Meters 100% 100% Medco Mail Order - 90 day supply: Tier 1 (Generic) Tier 2 (Preferred Brand) Tier 3 (Brand) Diabetic Supplies Spacers and Peak Flow Meters $0 copayment $70 Copayment $100 copayment 100% 100% Not Available Not Available Not Available Not Available Not Available 22 Page 3

24 ADDITIONAL INFORMATION ABOUT BLUE OPTIONS FROM BCBSNC Benefit Period The period of time, usually 12 months as stated in the group contract, during which charges for covered services provided to a member must be incurred in order to be eligible for payment by BCBSNC. A charge shall be considered incurred on the date the service or supply was provided to a member. Allowed Amount The charge that BCBSNC determines using a methodology that is applied to comparable providers for similar services under a similar health benefit plan. Coinsurance Maximum The dollar amount of coinsurance a member must pay prior to BCBSNC paying 100% for certain services. NOTE: In some plans, there is no coinsurance maximum; members are responsible for coinsurance once the deductible has been met. Day and Visit Maximums All day and visit maximums are on a combined In- and Out-of Network basis. Utilization Management To make sure you have access to high quality, cost-effective health care, we manage utilization through a variety of programs including certification, transplant management, concurrent and retrospective review and care management. If you have a concern regarding the final determination of your care, you have the right to appeal the decision. If you would like a copy of a benefit booklet providing more information about our Utilization Management programs, call the toll free number listed in your information packet. Certification Certification is a program designed to make sure that your care is given in a cost effective setting and efficient manner. If you need to be hospitalized, you must obtain certification. Non-emergency and non-maternity hospital admissions must be certified prior to the hospitalization. If the admission is not certified, a penalty will be applied. For maternity admissions, your provider is not required to obtain certification from BCBSNC for prescribing a length of stay up to 48 hours for a normal vaginal delivery, or up to 96 hours for delivery by cesarean section. You or your provider must request certification for coverage for additional days, which will be given by BCBSNC, if medically necessary. All inpatient and certain outpatient Mental Health and Substance Abuse services must be certified in advance by Magellan Behavioral Health. Office visits do not require certification. In-network providers are responsible for obtaining certifications. The member will bear no financial penalties if the in-network provider fails to obtain the appropriate authorization. The member is responsible for obtaining certification for services rendered by an out-of-network provider. Obtaining certification for Mental Health and Substance Abuse services is the member s responsibility. Health and Wellness Program Because we want to help you stay healthy, we offer a variety of wellness benefits and services. You can take advantage of HealthLine Blue, our 24-hour health information service, a health topics library, asthma and diabetes management and a prenatal program. You will also receive Active Blue, our health magazine and have access to online health and wellness information at With our program you can get health advice anytime you need it, so you can learn how to take charge of your health. What Is Not Covered? The following are summaries of some of the coverage restrictions. A full explanation and listing of restrictions will be found in your benefit booklet. Your health benefit plan does not cover services, supplies, drugs or charges that are: Not medically necessary For injury or illness resulting from an act of war For personal hygiene and convenience items For inpatient admissions that are primarily for diagnostic studies For palliative or cosmetic foot care For investigative or experimental purposes For hearing aids or tinnitus maskers For cosmetic services or cosmetic surgery For custodial care, domiciliary care or rest cures For treatment of obesity, except for surgical treatment of morbid obesity, or as specifically covered by your health benefit plan For reversal of sterilization For treatment of sexual dysfunction not related to organic disease For conception by artificial means For self-injectable drugs in the provider's office A waiting period for coverage of pre-existing conditions may apply to your coverage. BCBSNC defines pre-existing conditions as those conditions for which medical advice, diagnosis, care or treatment was received or recommended within 6 months of the date that your [BCBSNC] coverage begins. You may receive credit toward the 12-month waiting period if your enrollment date is within 63 days of the termination of your previous health coverage. The benefit highlights is a summary of Blue Options benefits. This is meant only to be a summary. Final interpretation and a complete listing of benefits and what is not covered are found in and governed by the group contract and benefit booklet. You may preview the benefit booklet by requesting a copy of the Blue Options benefit booklet from BCBSNC Customer Services., SM Registration and Service marks of the Blue Cross and Blue Shield Association. An Independent Licensee of the Blue Cross and Blue Shield Association Page 4 23

25 Delta Dental PPO plus Premier Benefits at a Glance City of Durham We are pleased to announce City of Durham has chosen Delta Dental of North Carolina as your new dental provider! You will be covered under two of the nation s largest dental networks Delta Dental PPO SM and Delta Dental Premier. You can still see your current dentist; however, if they are not in our networks, you may pay more. You are likely to save more money by visiting a dentist who is in one of these networks. You can check for network dentists by visiting Delta Dental s website at or by calling Delta Dental s Customer Service Center. Customer Service is available Monday to Friday from 8:30 a.m. until 8:00 p.m. (Eastern Time) to help you. Covered Services: Delta Dental PPO Dentist Delta Dental Premier Dentist Diagnostic & Preventative Diagnostic and Preventative Services exams, cleanings, fluoride, sealants, and X-rays, 100% 100% 100% Emergency Palliative Treatment temporarily relieve pain 100% 100% 100% Brush Biopsy detect oral cancer 100% 100% 100% Basic Services Space Maintainers appliances to prevent tooth movement 80% 80% 80% Minor Restorative Services fillings and crown repair 80% 80% 80% Endodontic Services root canals 80% 80% 80% Oral Surgery Services extractions and dental surgery 80% 80% 80% Other Basic Services miscellaneous services 80% 80% 80% Major Services Relines and Repairs repairs to bridges, implants, and Out-of-Network Dentist* 50% 50% 50% dentures Periodontic Services treatment for gum disease 50% 50% 50% Major Restorative Services crowns 50% 50% 50% Prosthodontic Services bridges, implants, and dentures 50% 50% 50% Orthodontic Services Orthodontic Services braces (No age limit) 50% 50% 50% *When you receive services from an out of network dentist, the percentages above indicate the portion of Delta Dental s Nonparticipating Dentist Fee that will be paid for those services. The amount may be less than what your dentist charges and you are responsible for the difference. Maximum Payment - $3,000 per person total per benefit year. Orthodontic services have a $1,500 per person total lifetime maximum. Deductible - $50 deductible per person total per benefit year with a maximum deductible of $150 per family per benefit year on all services except diagnostic and preventative, emergency palliative treatment, and brush biopsy. Customer Service:

26 Are there any new benefits? Brush biopsies to detect oral cancer will be covered. Implants to replace missing teeth will also be a covered service. Delta Dental will be paying Out-of-Network providers directly for services. What are the benefits of network providers? Delta Dental PPO and Delta Dental Premier Dentists Submits claims for you Only charges you for your copayment and deductible, if any. Out-of-pocket costs are likely lower Out-of-Network Dentists May require you to submit your own claims May charge you the full cost for the service Will receive payment directly from Delta Dental How can I find a network dentist? How can I find out if my dentist is in the network? You can find network dentists by visiting our website at or by calling Delta Dental s Customer Service department at (800) Participating dentists are in one of two networks. Delta Dental PPO has the biggest discounts and Delta Dental Premier is also discounted, but not as much as the Delta Dental PPO. If you choose a Delta Dental PPO dentist, you will pay the least out-of-pocket and your Maximum Payment will last longer. Will Delta Dental recruit my dentist if I ask? You can ask us to recruit your dentist if they are not in one of our networks by calling Customer Service or by completing the Refer Your Dentist form on the website. What if I am in orthodontic treatment? Have your orthodontist submit a new treatment plan to Delta Dental. We will work with them to set up payment for the remaining treatment based on how much you have already used. Where do I send claims? For services on or after September 1, 2015, either you or your dentists should send your claims to Delta Dental: Delta Dental PO Box 9085 Farmington Hills, MI Have Questions? Please call Delta Dental s Customer Service Department at ADULT CLEANING CROWN NOTE: Payment examples are just to demonstrate savings. Fees vary by location and dentist. Delta Dental PPO Dentist Customer Service: Delta Dental Premier Dentist Out-Of-Network Dentist Dentist Charges: $80.00 $80.00 $80.00 What Delta Dental Accepts: $54.00 $77.00 $63.00 Coverage Level: 100% 100% 100% Amount Delta Dental Pays: $54.00 $77.00 $63.00 AMOUNT YOU PAY: $0.00 $0.00 $17.00 Dentist Charges: $ $ $ What Delta Dental Accepts: $ $ $ Coverage Level: 50% 50% 50% Amount Delta Dental Pays: $ $ $ AMOUNT YOU PAY: $ $ $578.00

27 Vision Plan Benefits for City of Durham Co-Pays Monthly Premiums Services/Frequency Exam $10 Emp. only $8.37 Exam 1 per plan year Materials $10 Emp. + spouse $16.74 Frame 1 per plan year (applies to frame and lenses) Contact Lens Fitting $10 Emp. + child(ren) $19.00 Contact Lens Fitting 1 per plan year (standard & specialty) Emp. + family $29.35 Lenses 1 pair per plan year Benefits Superior Vision Services, Inc. P.O. Box 967 Rancho Cordova, CA SuperiorVision.com The Superior Vision Plan is underwritten by National Guardian Life Insurance Company. National Guardian Life Insurance Company is not affiliated with The Guardian Life Insurance Company of America, AKA The Guardian or Guardian Life NVIGRP BSv4/NC 26 Contact Lenses In-Network Out-of-Network Exam (Ophthalmologist) (Co-pay applies) Covered in full Up to $44 retail Exam (Optometrist) (Co-pay applies) Covered in full Up to $39 retail Frames (Copay Applies) $150 retail allowance Up to $60 retail Contact Lens Fitting(standard 2 ) (Co-pay applies) Covered in full Not covered Contact Lens Fitting(specialty 2 ) (Co-pay applies) $50 retail allowance Not covered Lenses (standard) per pair (Co-pay applies) Single Vision Covered in full Up to $26 retail Bifocal Covered in full Up to $34 retail Trifocal Covered in full Up to $50 retail Progressive lens upgrade See description 3 Up to $50 retail Contact Lenses 4 $150 retail allowance Up to $100 retail 1 allowance per plan year Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements 1 Materials co-pay applies to lenses and frames only, not contact lenses 2 See your benefits materials for definitions of standard and specialty contact lens fittings 3 Covered to provider s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co-pay 4 Contact lenses are in lieu of eyeglass lenses and frames benefit Discount Features Look for providers in the Provider Directory who accept discounts, as some do not; please verify their services and discounts (range from 10%-30%) prior to service as they vary. Discounts on Covered Materials Frames: Lens options: Progressives: 20% off amount over allowance 20% off retail 20% off amount over retail lined trifocal lens, including lens options The following options have out-of-pocket maximums 5 on standard (not premium, brand, or progressive) lenses. Maximum Member Out-of-Pocket Single Vision Bifocal & Trifocal Scratch coat $13 $13 Ultraviolet coat $15 $15 Tints, solid or gradients $25 $25 Anti-reflective coat $50 $50 Polycarbonate $40 20% off retail High index 1.6 $55 20% off retail Photochromics $80 20% off retail Discounts on Non-Covered Exam and Materials Exams, frames, and prescription lenses: Lens options, contacts, other prescription materials: Disposable contact lenses: 30% off retail 20% off retail 10% off retail 5 Discounts and maximums may vary by lens type. Please check with your provider.. SuperiorVision.com Customer Service Network: Superior National Refractive Surgery Superior Vision has a nationwide network of refractive surgeons and leading LASIK networks who offer members a discount. These discounts range from 15%-50%, and are the best possible discounts available to Superior Vision. The Plan discount features are not insurance. All allowances are retail; the member is responsible for paying the provider directly for all non-covered items and/or any amount over the allowances, minus available discounts. These are not covered by the plan. Discounts are subject to change without notice. Disclaimer: All final determinations of benefits, administrative duties, and definitions are governed by the Certificate of Insurance for your vision plan. Please check with your Human Resources department if you have any questions. North Carolina residents: Please contact our customer service department if you are unable to secure a timely (at least 30 days) appointment with your provider or need assistance finding a provider within a reasonable distance (30 miles) of your residence. Adjustments to your benefits may be available.

28 Call ComPsych GuidanceResources anytime for confidential assistance. Call: TDD: Go online: guidanceresources.com Your company Web ID: DURHAMEAP Personal issues, planning for life events or simply managing daily life can affect your work, health and family. ComPsych GuidanceResources provides support, resources and information for personal and work-life issues. GuidanceResources is company-sponsored, confidential and provided at no charge to you and your dependents. This flyer explains how GuidanceResources can help you and your family deal with everyday challenges. Confidential Counseling Someone to talk to. This no-cost counseling service helps you address stress, relationship and other personal issues you and your family may face. It is staffed by GuidanceConsultants SM highly trained master s and doctoral level clinicians who will listen to your concerns and quickly refer you to in-person counseling and other resources for: Stress, anxiety and depression Job pressures Relationship/marital conflicts Grief and loss Problems with children Substance abuse Financial Information and Resources Discover your best options. Speak by phone with our Certified Public Accountants and Certified Financial Planners on a wide range of financial issues, including: Getting out of debt Retirement planning Credit card or loan problems Estate planning Tax questions Saving for college Legal Support and Resources Expert info when you need it. Talk to our attorneys by phone. If you require representation, we ll refer you to a qualified attorney in your area for a free 30-minute consultation with a 25% reduction in customary legal fees thereafter. Call about: Divorce and family law Real estate transactions Debt and bankruptcy Civil and criminal actions Landlord/tenant issues Contracts Work-Life Solutions Delegate your to-do list. Our Work-Life specialists will do the research for you, providing qualified referrals and customized resources for: Child and elder care College planning Moving and relocation Pet care Making major purchases Home repair GuidanceResources Online Knowledge at your fingertips. GuidanceResources Online is your one stop for expert information on the issues that matter most to you... relationships, work, school, children, wellness, legal, financial, free time and more. Timely articles, HelpSheets SM, tutorials, streaming videos and self-assessments Ask the Expert personal responses to your questions Child care, elder care, attorney and financial planner searches Just call or click to access your services. Copyright 2011 ComPsych Corporation. All rights reserved. This document is the confidential and proprietary information of ComPsych Corporation. To view the ComPsych HIPAA privacy notice, please go to 27

29 GuidanceResources Guide to Using GuidanceResources Online First-time users, follow these simple instructions and start exploring the resources offered to you on GuidanceResources Online. 1. Go to guidanceresources.com to reach the website. 2. Once on the guidanceresources.com home page, click the blue link at the bottom right of the page that states I am a first-time user. 3. You will then be asked to enter your Company/Organization Web ID. Your Company/Organization Web ID: You will then be asked to enter a User Name and Password. Both can be anything you would like them to be but should be something you will remember. The User Name (often your name) must be at least six characters long and should have no spaces (for example: joesmith). The Security Question is meant to prompt you if you forget your password. You must select the button verifying that you are at least 13 years of age, as required by federal law. Make sure that you complete all fields that have red asterisks, as these are required fields. When you ve finished, click the Submit button at the bottom of the page. 4. On the next page, you will be asked to provide some demographic information. All of the fields are optional. Be sure to read the Terms of Use and click inside the check box to indicate your agreement to those terms. When you ve finished, click the Submit button at the bottom of the page. 5. You should now be on the website. DURHAMEAP For Future Log-ins You will NOT have to enter all of the demographic information again. You will only need to remember your User Name and Password. When you get to step 2 above, instead of clicking on the first-time user link, go to the Login section and enter your User Name and Password and click the login button. This will take you directly to GuidanceResources Online. If you have any problems registering or logging into GuidanceResources Online, Member Services at memberservices@compsych.com. Copyright 2012 ComPsych Corporation. All rights reserved. 28

30 Group Basic Life and AD&D, ELIGIBILITY Employees: Each Active, Full-time employee working 30 or more hours per week, except any person working on a temporary or seasonal basis. Dependents: You must be insured in order for Dependents to be covered. Dependents are: Are covered to 26 *natural and adopted children; stepchildren and foster children in your custody. limit does not apply to handicapped children. A person may not have coverage as both an Employee and Dependent. Only one insured spouse may cover Dependent children. BENEFIT AMOUNT Basic Life & AD&D 1 times Earnings, rounded to the next higher $1,000, subject to a maximum of $250,000 Supplemental Life & AD&D Choose from a minimum of $10,000 to a maximum of $500,000 in $10,000 increments Amounts of life insurance equal to $150,000 or more may be subject to an earnings cap. Dependent Life & AD&D Spouse Choose from a minimum of $10,000 to a maximum of $500,000 in $10,000 increments (spouse amount may not exceed 100% of employee amount) Dependent Child(ren) From: $2,500 To: $10,000 (up to age 26) GUARANTEED ISSUE (INITIAL ELIGIBILITY PERIOD ONLY) Employee: $200,000 Spouse: $50,000 Child: all child amounts are guaranteed issue CONTRIBUTION REQUIREMENTS Basic Life & AD&D: Coverage is 100% employer paid. Supplemental Life & AD&D: Coverage is 100% employee paid. Spouse: Coverage is 100% employee paid. Dependent Child(ren): Coverage is 100% employee paid. City of Durham RATE See attached Rate Sheet. FEATURES Living Benefit Rider (expressed as Accelerated Death Benefit in some states and Imminent Death Benefit in PA) Portability Waiver of Premium with Critical Illness Bereavement Counseling Service Reduction 35% at % at 75 AD&D SCHEDULE For Accidental Loss of: Life 100% Both hands or both feet 100% Sight of both eyes 100% One hand and one foot 100% One hand and sight of one eye 100% One foot and sight of one eye 100% Speech and hearing 100% One hand or One foot 50% Sight of one eye 50% Speech or Hearing 50% EXCLUSIONS Amount Payable: AD&D EXCLUSIONS: AD&D benefits will not be payable for a loss: caused by suicide or intentionally self-inflicted injuries; caused by or resulting from war or any act of war, declared or undeclared; to which sickness, disease or myocardial infarction, including medical or surgical treatment thereof, is a contributing factor; sustained during an insured s commission or attempted commission of an assault or felony; to which the insured s acute or chronic intoxication is a contributing factor; or to which the insured s voluntary consumption of an illegal or controlled substance or a non-prescribed narcotic or drug is a contributing factor. For a comprehensive list of exclusions and limitations, please refer to the Certificate of Insurance. The Certificate also provides all requirements necessary to be eligible for coverage and benefits. This Plan Highlights is a brief description of the key features of the RSL insurance plan. The availability of the benefits and features described may vary by state. It is not a certificate of insurance or evidence of coverage. Insurance is provided under group policy form LRS-6422, et al. 29

31 Employee Monthly Premiums Benefit Amount Reliance Standard Life Insurance Supplemental Life & AD&D Insurance $10,000 $0.95 $0.95 $1.15 $1.45 $2.15 $3.25 $5.05 $7.75 $11.85 $16.75 $20.75 $20.75 $20.75 $20,000 $1.90 $1.90 $2.30 $2.90 $4.30 $6.50 $10.10 $15.50 $23.70 $33.50 $41.50 $41.50 $41.50 $30,000 $2.85 $2.85 $3.45 $4.35 $6.45 $9.75 $15.15 $23.25 $35.55 $50.25 $62.25 $62.25 $62.25 $40,000 $3.80 $3.80 $4.60 $5.80 $8.60 $13.00 $20.20 $31.00 $47.40 $67.00 $83.00 $83.00 $83.00 $50,000 $4.75 $4.75 $5.75 $7.25 $10.75 $16.25 $25.25 $38.75 $59.25 $83.75 $ $ $ $60,000 $5.70 $5.70 $6.90 $8.70 $12.90 $19.50 $30.30 $46.50 $71.10 $ $ $ $ $70,000 $6.65 $6.65 $8.05 $10.15 $15.05 $22.75 $35.35 $54.25 $82.95 $ $ $ $ $80,000 $7.60 $7.60 $9.20 $11.60 $17.20 $26.00 $40.40 $62.00 $94.80 $ $ $ $ $90,000 $8.55 $8.55 $10.35 $13.05 $19.35 $29.25 $45.45 $69.75 $ $ $ $ $ $100,000 $9.50 $9.50 $11.50 $14.50 $21.50 $32.50 $50.50 $77.50 $ $ $ $ $ $110,000 $10.45 $10.45 $12.65 $15.95 $23.65 $35.75 $55.55 $85.25 $ $ $ $ $ $120,000 $11.40 $11.40 $13.80 $17.40 $25.80 $39.00 $60.60 $93.00 $ $ $ $ $ $130,000 $12.35 $12.35 $14.95 $18.85 $27.95 $42.25 $65.65 $ $ $ $ $ $ $140,000 $13.30 $13.90 $16.10 $20.30 $30.10 $45.50 $70.70 $ $ $ $ $ $ $150,000 $14.25 $14.25 $17.25 $21.75 $32.25 $48.75 $75.75 $ $ $ $ $ $ $160,000 $15.20 $15.20 $18.40 $23.20 $34.40 $52.00 $80.80 $ $ $ $ $ $ $170,000 $16.15 $16.15 $19.55 $24.65 $36.55 $55.25 $85.85 $ $ $ $ $ $ $180,000 $17.10 $17.10 $20.70 $26.10 $38.70 $58.50 $90.90 $ $ $ $ $ $ $190,000 $18.05 $18.05 $21.85 $27.55 $40.85 $61.75 $95.95 $ $ $ $ $ $ $200,000 $19.00 $19.00 $23.00 $29.00 $43.00 $65.00 $ $ $ $ $ $ $ Spouse Monthly Premiums Benefit Amount $10,000 $0.60 $0.60 $0.80 $1.10 $1.80 $2.90 $4.70 $7.40 $11.50 $16.40 $20.40 $20.40 $20.40 $20,000 $1.20 $1.20 $1.60 $2.20 $3.60 $5.80 $9.40 $14.80 $23.00 $32.80 $40.80 $40.80 $40.80 $30,000 $1.80 $1.80 $2.40 $3.30 $5.40 $8.70 $14.10 $22.20 $34.50 $49.20 $61.20 $61.20 $61.20 $40,000 $2.40 $2.40 $3.20 $4.40 $7.20 $11.60 $18.80 $29.60 $46.00 $65.60 $81.60 $81.60 $81.60 $50,000 $3.00 $3.00 $4.00 $5.50 $9.00 $14.50 $23.50 $37.00 $57.50 $82.00 $ $ $ $60,000 $3.60 $3.60 $4.80 $6.60 $10.80 $17.40 $28.20 $44.40 $69.00 $98.40 $ $ $ $70,000 $4.20 $4.20 $5.60 $7.70 $12.60 $20.30 $32.90 $51.80 $80.50 $ $ $ $ $80,000 $4.80 $4.80 $6.40 $8.80 $14.40 $23.20 $37.60 $59.20 $92.00 $ $ $ $ $90,000 $5.40 $5.40 $7.20 $9.90 $16.20 $26.10 $42.30 $66.60 $ $ $ $ $ $100,000 $6.00 $6.00 $8.00 $11.00 $18.00 $29.00 $47.00 $74.00 $ $ $ $ $ Employee and Spouse rates change as age increases from one age bracket to the next. Dependent Children Premiums Benefit Monthly Premium $2,500 $0.78 $5,000 $1.56 $7,500 $2.34 $10,000 $3.12 All children in the family are covered for the one rate above

32 Plan Highlights Voluntary Group Short Term Disability Insurance City of Durham- Option 1 (14-Day EP) COVERAGE Disability income protection insurance provides a benefit for short term disability resulting from a covered injury or sickness. Benefits begin at the end of the elimination period and continue while you are disabled up to the maximum benefit duration. ELIGIBILITY Each Active, Full-time employee working 30 or more hours per week, except any person working on a temporary or seasonal basis. BENEFIT AMOUNT You may elect a weekly benefit in increments of $100, from a minimum of $100 up to a maximum benefit of $2,500 per week, not to exceed 60% of your covered earnings (rounded to the next lower increment). DAY BENEFITS BEGIN Injury (accident): Benefits begin on the 14th consecutive day of disability; Sickness (illness): Benefits begin on the 14th consecutive day of disability; or the day following the number of accumulated sick days applicable to the employee. MAXIMUM BENEFIT DURATION Benefits for one period of disability, will be paid up to a maximum of 13 weeks. CONTRIBUTION REQUIREMENTS Coverage is 100% employee paid. RATES See attached Rate Sheet. FEATURES Maternity covered as any other illness Non-occupational coverage LIMITATIONS Pre-Existing Condition Limitation 3/12 Please note- pre-ex limitations also apply to benefit increases EXCLUSIONS Benefits will not be payable for any disability caused by: an intentionally self-inflicted injury; an act of war (declared or undeclared); commission of a felony; sickness covered by workers compensation or other workers disability law; injury occurring out of or in the course of work for wage or profit. For a comprehensive list of exclusions, limitations, and any applicable benefit offsets, please refer to the Certificate of Insurance. The Certificate also provides all requirements necessary to be eligible for coverage and benefits. This Plan Highlights is a brief description of the key features of the RSL insurance plan. The availability of the benefits and features described may vary by state. It is not a certificate of insurance or evidence of coverage. Insurance is provided under group policy form LRS-6451, et al. 31

33 Plan Highlights Voluntary Group Short Term Disability Insurance City of Durham- Option 2 (30-Day EP) COVERAGE Disability income protection insurance provides a benefit for short term disability resulting from a covered injury or sickness. Benefits begin at the end of the elimination period and continue while you are disabled up to the maximum benefit duration. ELIGIBILITY Each Active, Full-time employee working 30 or more hours per week, except any person working on a temporary or seasonal basis. BENEFIT AMOUNT You may elect a weekly benefit in increments of $100, from a minimum of $100 up to a maximum benefit of $2,500 per week, not to exceed 60% of your covered earnings (rounded to the next lower increment). DAY BENEFITS BEGIN Injury (accident): Benefits begin on the 30th consecutive day of disability; Sickness (illness): Benefits begin on the 30th consecutive day of disability; or the day following the number of accumulated sick days applicable to the employee. MAXIMUM BENEFIT DURATION Benefits for one period of disability, will be paid up to a maximum of 13 weeks. CONTRIBUTION REQUIREMENTS Coverage is 100% employee paid. RATES See attached Rate Sheet. FEATURES Maternity covered as any other illness Non-occupational coverage LIMITATIONS Pre-Existing Condition Limitation 3/12 Please note- pre-ex limitations also apply to benefit increases EXCLUSIONS Benefits will not be payable for any disability caused by: an intentionally self-inflicted injury; an act of war (declared or undeclared); commission of a felony; sickness covered by workers compensation or other workers disability law; injury occurring out of or in the course of work for wage or profit. For a comprehensive list of exclusions, limitations, and any applicable benefit offsets, please refer to the Certificate of Insurance. The Certificate also provides all requirements necessary to be eligible for coverage and benefits. This Plan Highlights is a brief description of the key features of the RSL insurance plan. The availability of the benefits and features described may vary by state. It is not a certificate of insurance or evidence of coverage. Insurance is provided under group policy form LRS-6451, et al. 32

34 Reliance Standard Life Insurance Short Term Disability Insurance (STD) Monthly Premiums City of Durham Option 1 (14-Day EP) Minimum Annual Weekly Benefit Salary Required < $17,333 $200 $8.80 $9.40 $8.60 $8.20 $8.80 $9.60 $11.40 $14.80 $18.00 $20.40 $22,333 $300 $13.20 $14.10 $12.90 $12.30 $13.20 $14.40 $17.10 $22.20 $27.00 $30.60 $27,333 $400 $17.60 $18.80 $17.20 $16.40 $17.60 $19.20 $22.80 $29.60 $36.00 $40.80 $32,333 $500 $22.00 $23.50 $21.50 $20.50 $22.00 $24.00 $28.50 $37.00 $45.00 $51.00 $37,333 $600 $26.40 $28.20 $25.80 $24.60 $26.40 $28.80 $34.20 $44.40 $54.00 $61.20 $42,333 $700 $30.80 $32.90 $30.10 $28.70 $30.80 $33.60 $39.90 $51.80 $63.00 $71.40 $47,333 $800 $35.20 $37.60 $34.40 $32.80 $35.20 $38.40 $45.60 $59.20 $72.00 $81.60 $52,333 $900 $39.60 $42.30 $38.70 $36.90 $39.60 $43.20 $51.30 $66.60 $81.00 $91.80 $57,333 $1,000 $44.00 $47.00 $43.00 $41.00 $44.00 $48.00 $57.00 $74.00 $90.00 $ $62,333 $1,100 $48.40 $51.70 $47.30 $45.10 $48.40 $52.80 $62.70 $81.40 $99.00 $ $67,333 $1,200 $52.80 $56.40 $51.60 $49.20 $52.80 $57.60 $68.40 $88.80 $ $ $72,333 $1,300 $57.20 $61.10 $55.90 $53.30 $57.20 $62.40 $74.10 $96.20 $ $ $77,333 $1,400 $61.60 $65.80 $60.20 $57.40 $61.60 $67.20 $79.80 $ $ $ $82,333 $1,500 $66.00 $70.50 $64.50 $61.50 $66.00 $72.00 $85.50 $ $ $ $87,333 $1,600 $70.40 $75.20 $68.80 $65.60 $70.40 $76.80 $91.20 $ $ $ $92,333 $1,700 $74.80 $79.90 $73.10 $69.70 $74.80 $81.60 $96.90 $ $ $ $97,333 $1,800 $79.20 $84.60 $77.40 $73.80 $79.20 $86.40 $ $ $ $ $102,333 $1,900 $83.60 $89.30 $81.70 $77.90 $83.60 $91.20 $ $ $ $ $112,333 $2,000 $88.00 $94.00 $86.00 $82.00 $88.00 $96.00 $ $ $ $ $122,333 $2,100 $92.40 $98.70 $90.30 $86.10 $92.40 $ $ $ $ $ $132,333 $2,200 $96.80 $ $94.60 $90.20 $96.80 $ $ $ $ $ $142,333 $2,300 $ $ $98.90 $94.30 $ $ $ $ $ $ $152,333 $2,400 $ $ $ $98.40 $ $ $ $ $ $ $162,333 $2,500 $ $ $ $ $ $ $ $ $ $ Option 2 (30-Day EP) Minimum Annual Weekly Benefit Salary Required < $17,333 $200 $5.00 $5.60 $5.20 $5.20 $5.80 $6.80 $8.80 $10.80 $12.40 $12.80 $22,333 $300 $7.50 $8.40 $7.80 $7.80 $8.70 $10.20 $13.20 $16.20 $18.60 $19.20 $27,333 $400 $10.00 $11.20 $10.40 $10.40 $11.60 $13.60 $17.60 $21.60 $24.80 $25.60 $32,333 $500 $12.50 $14.00 $13.00 $13.00 $14.50 $17.00 $22.00 $27.00 $31.00 $32.00 $37,333 $600 $15.00 $16.80 $15.60 $15.60 $17.40 $20.40 $26.40 $32.40 $37.20 $38.40 $42,333 $700 $17.50 $19.60 $18.20 $18.20 $20.30 $23.80 $30.80 $37.80 $43.40 $44.80 $47,333 $800 $20.00 $22.40 $20.80 $20.80 $23.20 $27.20 $35.20 $43.20 $49.60 $51.20 $52,333 $900 $22.50 $25.20 $23.40 $23.40 $26.10 $30.60 $39.60 $48.60 $55.80 $57.60 $57,333 $1,000 $25.00 $28.00 $26.00 $26.00 $29.00 $34.00 $44.00 $54.00 $62.00 $64.00 $62,333 $1,100 $27.50 $30.80 $28.60 $28.60 $31.90 $37.40 $48.40 $59.40 $68.20 $70.40 $67,333 $1,200 $30.00 $33.60 $31.20 $31.20 $34.80 $40.80 $52.80 $64.80 $74.40 $76.80 $72,333 $1,300 $32.50 $36.40 $33.80 $33.80 $37.70 $44.20 $57.20 $70.20 $80.60 $83.20 $77,333 $1,400 $35.00 $39.20 $36.40 $36.40 $40.60 $47.60 $61.60 $75.60 $86.80 $89.60 $82,333 $1,500 $37.50 $42.00 $39.00 $39.00 $43.50 $51.00 $66.00 $81.00 $93.00 $96.00 $87,333 $1,600 $40.00 $44.80 $41.60 $41.60 $46.40 $54.40 $70.40 $86.40 $99.20 $ $92,333 $1,700 $42.50 $47.60 $44.20 $44.20 $49.30 $57.80 $74.80 $91.80 $ $ $97,333 $1,800 $45.00 $50.40 $46.80 $46.80 $52.20 $61.20 $79.20 $97.20 $ $ $102,333 $1,900 $47.50 $53.20 $49.40 $49.40 $55.10 $64.60 $83.60 $ $ $ $112,333 $2,000 $50.00 $56.00 $52.00 $52.00 $58.00 $68.00 $88.00 $ $ $ $122,333 $2,100 $52.50 $58.80 $54.60 $54.60 $60.90 $71.40 $92.40 $ $ $ $132,333 $2,200 $55.00 $61.60 $57.20 $57.20 $63.80 $74.80 $96.80 $ $ $ $142,333 $2,300 $57.50 $64.40 $59.80 $59.80 $66.70 $78.20 $ $ $ $ $152,333 $2,400 $60.00 $67.20 $62.40 $62.40 $69.60 $81.60 $ $ $ $ $162,333 $2,500 $62.50 $70.00 $65.00 $65.00 $72.50 $85.00 $ $ $ $

35 Plan Highlights Voluntary Group Long Term Disability Insurance City of Durham Option 1- (Benefit to 65) COVERAGE Disability income protection insurance provides a benefit for long term disability resulting from a covered injury or sickness. Benefits begin at the end of the elimination period and continue while you are disabled up to the maximum benefit duration. ELIGIBILITY Each Active, Full-time employee working 30 or more hours per week, except any person working on a temporary or seasonal basis. BENEFIT AMOUNT The monthly benefit is an amount equal to 60% of covered earnings, up to a maximum benefit of $6,000 per month. ELIMINATION PERIOD 90 consecutive days of total disability MAXIMUM BENEFIT DURATION Benefits will not extend beyond the longer of: Social Security Normal Retirement or Duration of Benefits below: at Disablement Duration of Benefits 61 or less to age ½ years 63 3 years 64 2 ½ years 65 2 years 66 1 ¾ years 67 1 ½ years 68 1 ¼ years 69 or more 1 year CONTRIBUTION REQUIREMENTS Coverage is 100% employee paid. RATES See attached Rate Sheet. FEATURES Cost of Living Freeze provision Own Occupation Coverage 24 months Survivor Benefit 3 months Work Incentive & Child Care provisions LIMITATIONS Mental/Nervous Illness Limitation 24 Months outpatient Pre-Existing Condition Limitation 3/12 Please note- pre-ex limitations also apply to benefit increases EXCLUSIONS Benefits will not be payable for any disability caused by: an intentionally self-inflicted injury; an act of war (declared or undeclared); commission of a felony;alcoholism or drug addiction; injury or sickness occurring while confined in any penal or correctional institution. For a comprehensive list of exclusions, limitations, and any applicable benefit offsets, please refer to the Certificate of Insurance. The Certificate also provides all requirements necessary to be eligible for coverage and benefits. This Plan Highlights is a brief description of the key features of the RSL insurance plan. The availability of the benefits and features described may vary by state. It is not a certificate of insurance or evidence of coverage. Insurance is provided under group policy form LRS-6564, et al. 34

36 Plan Highlights Voluntary Group Long Term Disability Insurance City of Durham Option 2- (Two Year Benefit Period) COVERAGE Disability income protection insurance provides a benefit for long term disability resulting from a covered injury or sickness. Benefits begin at the end of the elimination period and continue while you are disabled up to the maximum benefit duration. ELIGIBILITY Each Active, Full-time employee working 30 or more hours per week, except any person working on a temporary or seasonal basis. BENEFIT AMOUNT The monthly benefit is an amount equal to 60% of covered earnings, up to a maximum benefit of $6,000 per month. ELIMINATION PERIOD 90 consecutive days of total disability MAXIMUM BENEFIT DURATION Benefits will not extend beyond the longer of: Social Security Normal Retirement or Duration of Benefits below: at Disablement Duration of Benefits 65 or less 2 years /4 years /2 years /4 years 69 and older 1 year CONTRIBUTION REQUIREMENTS Coverage is 100% employee paid. RATES See attached Rate Sheet. FEATURES Cost of Living Freeze provision Own Occupation Coverage 24 months Survivor Benefit 3 months Work Incentive & Child Care provisions LIMITATIONS Mental/Nervous Illness Limitation 24 Months outpatient Pre-Existing Condition Limitation 3/12 Please note- pre-ex limitations also apply to benefit increases EXCLUSIONS Benefits will not be payable for any disability caused by: an intentionally self-inflicted injury; an act of war (declared or undeclared); commission of a felony;alcoholism or drug addiction; injury or sickness occurring while confined in any penal or correctional institution. For a comprehensive list of exclusions, limitations, and any applicable benefit offsets, please refer to the Certificate of Insurance. The Certificate also provides all requirements necessary to be eligible for coverage and benefits. This Plan Highlights is a brief description of the key features of the RSL insurance plan. The availability of the benefits and features described may vary by state. It is not a certificate of insurance or evidence of coverage. Insurance is provided under group policy form LRS-6564, et al. 35

37 Reliance Standard Life Insurance Long Term Disability Insurance (LTD) Monthly Premiums City of Durham Annual Salary Monthly Benefit <24 Option 1 (Benefit to 65) $15,000 $750 $2.93 $3.04 $3.83 $4.84 $6.53 $9.11 $12.04 $15.98 $27.00 $20,000 $1,000 $3.90 $4.05 $5.10 $6.45 $8.70 $12.15 $16.05 $21.30 $36.00 $25,000 $1,250 $4.88 $5.06 $6.38 $8.06 $10.88 $15.19 $20.06 $26.63 $45.00 $30,000 $1,500 $5.85 $6.08 $7.65 $9.68 $13.05 $18.23 $24.08 $31.95 $54.00 $35,000 $1,750 $6.83 $7.09 $8.93 $11.29 $15.23 $21.26 $28.09 $37.28 $63.00 $40,000 $2,000 $7.80 $8.10 $10.20 $12.90 $17.40 $24.30 $32.10 $42.60 $72.00 $45,000 $2,250 $8.78 $9.11 $11.48 $14.51 $19.58 $27.34 $36.11 $47.93 $81.00 $50,000 $2,500 $9.75 $10.13 $12.75 $16.13 $21.75 $30.38 $40.13 $53.25 $90.00 $55,000 $2,750 $10.73 $11.14 $14.03 $17.74 $23.93 $33.41 $44.14 $58.58 $99.00 $60,000 $3,000 $11.70 $12.15 $15.30 $19.35 $26.10 $36.45 $48.15 $63.90 $ $65,000 $3,250 $12.68 $13.16 $16.58 $20.96 $28.28 $39.49 $52.16 $69.23 $ $70,000 $3,500 $13.65 $14.18 $17.85 $22.58 $30.45 $42.53 $56.18 $74.55 $ $75,000 $3,750 $14.63 $15.19 $19.13 $24.19 $32.63 $45.56 $60.19 $79.88 $ $80,000 $4,000 $15.60 $16.20 $20.40 $25.80 $34.80 $48.60 $64.20 $85.20 $ $85,000 $4,250 $16.58 $17.21 $21.68 $27.41 $36.98 $51.64 $68.21 $90.53 $ $90,000 $4,500 $17.55 $18.23 $22.95 $29.03 $39.15 $54.68 $72.23 $95.85 $ $95,000 $4,750 $18.53 $19.24 $24.23 $30.64 $41.33 $57.71 $76.24 $ $ $100,000 $5,000 $19.50 $20.25 $25.50 $32.25 $43.50 $60.75 $80.25 $ $ $110,000 $5,500 $21.45 $22.28 $28.05 $35.48 $47.85 $66.83 $88.28 $ $ $120,000 $6,000 $23.40 $24.30 $30.60 $38.70 $52.20 $72.90 $96.30 $ $ Annual Salary Monthly Benefit <24 Option 2 (Two Year Benefit Period) $15,000 $750 $0.90 $1.01 $1.13 $1.58 $2.03 $2.93 $3.83 $4.95 $8.44 $20,000 $1,000 $1.20 $1.35 $1.50 $2.10 $2.70 $3.90 $5.10 $6.60 $11.25 $25,000 $1,250 $1.50 $1.69 $1.88 $2.63 $3.38 $4.88 $6.38 $8.25 $14.06 $30,000 $1,500 $1.80 $2.03 $2.25 $3.15 $4.05 $5.85 $7.65 $9.90 $16.88 $35,000 $1,750 $2.10 $2.36 $2.63 $3.68 $4.73 $6.83 $8.93 $11.55 $19.69 $40,000 $2,000 $2.40 $2.70 $3.00 $4.20 $5.40 $7.80 $10.20 $13.20 $22.50 $45,000 $2,250 $2.70 $3.04 $3.38 $4.73 $6.08 $8.78 $11.48 $14.85 $25.31 $50,000 $2,500 $3.00 $3.38 $3.75 $5.25 $6.75 $9.75 $12.75 $16.50 $28.13 $55,000 $2,750 $3.30 $3.71 $4.13 $5.78 $7.43 $10.73 $14.03 $18.15 $30.94 $60,000 $3,000 $3.60 $4.05 $4.50 $6.30 $8.10 $11.70 $15.30 $19.80 $33.75 $65,000 $3,250 $3.90 $4.39 $4.88 $6.83 $8.78 $12.68 $16.58 $21.45 $36.56 $70,000 $3,500 $4.20 $4.73 $5.25 $7.35 $9.45 $13.65 $17.85 $23.10 $39.38 $75,000 $3,750 $4.50 $5.06 $5.63 $7.88 $10.13 $14.63 $19.13 $24.75 $42.19 $80,000 $4,000 $4.80 $5.40 $6.00 $8.40 $10.80 $15.60 $20.40 $26.40 $45.00 $85,000 $4,250 $5.10 $5.74 $6.38 $8.93 $11.48 $16.58 $21.68 $28.05 $47.81 $90,000 $4,500 $5.40 $6.08 $6.75 $9.45 $12.15 $17.55 $22.95 $29.70 $50.63 $95,000 $4,750 $5.70 $6.41 $7.13 $9.98 $12.83 $18.53 $24.23 $31.35 $53.44 $100,000 $5,000 $6.00 $6.75 $7.50 $10.50 $13.50 $19.50 $25.50 $33.00 $56.25 $110,000 $5,500 $6.60 $7.43 $8.25 $11.55 $14.85 $21.45 $28.05 $36.30 $61.88 $120,000 $6,000 $7.20 $8.10 $9.00 $12.60 $16.20 $23.40 $30.60 $39.60 $

38 KNOW YOUR BENEFITS. Brought to you by the insurance professionals at Laymon Group. Flexible Spending Accounts The example that follows illustrates how an FSA can save money. * Assumes standard deductions and four exemptions ** Varies, assumes 3 percent This example is for illustrative purposes only. Every situation varies and it is recommended you consult a tax advisor for all tax advice. Bob and Jane s combined gross income is $30,000. They have two children and file their income taxes jointly. Since Bob and Jane expect to spend $2,000 in adult orthodontia and $3,000 for day care in the next plan year, they decide to direct a total of $5,000 (both contributing the maximum amount of $2,500) into their FSAs. (See table) Information for City of Durham Employees Flexible spending accounts, or FSAs, provide you with an important tax advantage that can help you pay health care and dependent care expenses on a pretax basis. By anticipating your family s health care and dependent care costs for the next plan year, you can lower your taxable income. Essentially, the Internal Revenue Service (IRS) set up FSAs as a means to provide a tax break to employees and their employers. As an employee, you agree to set aside a portion of your pretax salary in an account, and that money is deducted from your paycheck over the course of the year. The amount you contribute to the FSA is not subject to social security (FICA), federal, state or local income taxes effectively adjusting your annual taxable salary. The taxes you pay each paycheck and collectively each plan year can be reduced significantly, depending on your tax bracket. As a result of the personal tax savings you incur, your spendable income will increase. Without FSA With FSA Gross Income $30,000 $30,000 FSA Contributions $0 -$5,000 Gross Income $30,000 $25,000 Estimated Taxes Federal -$2,550* -$1,776* State -$900** -$750** FICA -$2,295 $1,913 After-Tax Earnings $24,255 $20,561 Eligible out-of-pocket -$5,000 $0 and dependent care expenses Remaining spendable $19,255 $20,561 income Spendable income -- $1,306 increase * Assumes standard deductions and four exemptions ** Varies, assumes 3 percent This example is for illustrative purposes only. Every situation varies and it is recommended you consult a tax advisor for all tax advice. This Know Your Benefits article is provided by Laymon Group and is to be used for informational purposes only and is not intended to replace the advice of an insurance professional. 37

39 City of Durham Flexible Spending Accounts The Health Care Reimbursement FSA The health care reimbursement FSA lets you pay for certain IRS-approved medical care expenses not covered by your insurance plan with pretax dollars. For example, cash that you now spend on deductibles, copayments or other out-ofpocket medical expenses can instead be placed in the health care reimbursement FSA pretax. The annual maximum contribution to the health care reimbursement FSA is $2,083. The Dependent Care FSA The Dependent Care FSA lets you use pretax dollars toward qualified dependent care. The annual maximum amount you may contribute is $4,167 (or $2, if married and filing separately) per calendar year. If you elect to contribute to the dependent care FSA, you may be reimbursed for: The cost of child or adult dependent care The cost for an individual to provide care either in or out of your house Nursery schools and preschools (excluding kindergarten) Health FSAs employ a use-it-or-lose-it model. If you do not use the funds that you contribute to your FSA within the end of the year, you will have to forfeit those funds. Eligible Expenses Eligible health care expenses for the health care reimbursement FSA include more than just your deductible and copayments. You can also reimburse items such as prescription drugs, dental expenses, eye glasses and contacts, certain medical equipment and many more items. For more information about eligible medical expenses, please refer to IRS Publication 502, Medical and Dental Expenses, available at Over-the-counter drugs used to be eligible expenses, but a law effective Jan. 1, 2011, only allows claims for over-the-counter medication or drug expenses (other than insulin) to be reimbursed if the patient has a prescription. This new rule does not apply to items for medical care that are not considered medication or drugs. Equipment such as crutches, supplies such as bandages and diagnostic devices such as blood sugar test kits still qualify for reimbursement without a prescription. KNOW YOUR BENEFITS. Flexible Spending Accounts administered by Laymon Group Giles Avenue, Suite 102 Wilmington, NC Phone: Fax: flexdepartment@laymongroup.com Eligible Expenses In order for dependent care services to be eligible, they must be for the care of a tax-dependent child under age 13 who lives with you, or a tax-dependent parent, spouse or child who lives with you and is incapable of caring for himself or herself. The care must be needed so that you and your spouse (if applicable) can go to work. Care must be given during normal working hours (instances such as Saturday night babysitting does not qualify) and cannot be provided by another of your dependents. Is the FSA program right for me? City of Durham s flexible spending accounts are beneficial for anyone who has out-of-pocket medical, dental, vision, hearing or dependent care expenses beyond what his or her insurance plan covers. It s easy to determine if an FSA will save you money. At enrollment time, you will need to determine your annual election amount. Estimate the expenses that you know will occur during the year. These include out-of-pocket expenses for yourself and anyone claimed as a dependent on your taxes. If you had $100 or more in recurring or predictable expenses, the accounts can help you stretch your dollars. How do the accounts work? If you decide to enroll in one or both of the accounts, your contributions are taken out of each paycheck before taxes in equal installments throughout the plan year. The City of Durham plan year runs from 9/1 to 8/31. For the plan year beginning 9/1/15, there will be a short plan year that will end 6/30/16. These dollars are then placed into your FSA. When you have an eligible health care or dependent care expense, you must submit a claim form along with an itemized receipt to be reimbursed from your account. The health care reimbursement FSA will reimburse you for the full amount of your annual election (less any reimbursement already received), at any time during the plan year, regardless of the amount actually in your account. The dependent care FSA will only reimburse you for the amount that is in your account at the time you make a claim. 38

40 KNOW YOUR HRA BENEFITS. Brought to you by the insurance professionals at Laymon Group Health Reimbursement Arrangement (HRA) Information for City of Durham Employees What is a Health Reimbursement Arrangement? A Health Reimbursement Arrangement (HRA) is an employer-funded account that is designed to reimburse employees for qualified medical expenses that are paid outof-pocket towards the BCBS medical deductible. The City of Durham HRA reimburses employees up to $250 per household each plan year (9/1-8/31). There will be a short plan year for the period beginning 9/1/15. It will only run until 6/30/16 Contributions to an HRA Your employer funds the account, so it costs you nothing out-of-pocket. What is covered under the HRA? Expenses that apply to your Blue Cross Blue Shield medical deductible. This can include: *Inpatient Hospital *Outpatient Hospital *Diagnostic Testing *Durable Medical Equipment *Skilled Nursing Reimbursements under an HRA can be made to the following persons: 1. Current full time employees 2. Retirees who continue their BCBS health coverage 3. Spouses and dependents of those employees Eligibility Requirements: Eligibility is contingent upon completion of the BCBS Health Risk Appraisal between 9/1/15 and 12/31/15. **Immediately upon completion of assessment, print a copy of the confirmation page and keep it for your records. If you make an HRA claim in the first 4 months of the plan year, you will be asked to send a copy of this confirmation with your claim to assist in expediting your reimbursement. Are my benefits taxable? The HRA plan is intended to meet certain requirements of existing federal tax laws, under which the benefits that you receive under the HRA Plan are not taxable to you. Your employer cannot guarantee the tax treatment to any given participant, since individual circumstances may produce differing results. What is the difference between an HRA and FSA? HRAs are employer-funded, which means your employer determines the amount that goes into the HRA account. FSAs can be funded by employee and employer contributions. FSA contributions are deducted from your salary on a pre-tax basis. You determine how much to contribute to your FSA account. What does the IRS require me to report on my taxes concerning my HRA? Nothing. Your HRA is a health benefit. This Know Your Benefits article is provided by Laymon Group and is to be used for informational purposes only and is not intended to replace the advice of an insurance professional. 39

41 Understanding a Health Reimbursement Arrangement Understanding a Health Reimbursement Arrangement Claim Submission Procedure: 1. After you have incurred an eligible medical Claim Submission Procedure: expense, wait for BCBS to send you an 1. After you have incurred an eligible medical Explanation of Benefits. The EOB breaks down expense, wait for BCBS to send you an the cost Explanation between of the Benefits. insurance The carrier EOB breaks and the down insured. the It cost will between mailed the to insurance you automatically carrier and the for every insured. service incurred It will be mailed toward to your deductible. automatically for **A reimbursement every service incurred can not toward be issued your unless deductible. the EOB submitted **A reimbursement with your can claim not shows be issued an unless amount the satisfied EOB in submitted the deductible with your column. claim shows an amount satisfied in the deductible column. 2. Complete the Laymon Group HRA Reimbursement 2. Complete the Request Laymon Form. Group You HRA can obtain one at: Reimbursement Request Form. ( Forms You & can Docs obtain one at: ( Forms & Docs Client Specific Forms City of Durham Client Specific Forms City of Durham HRA Claim Form ). **Read instructions HRA Claim Form ). **Read instructions thoroughly thoroughly and complete and complete ALL ALL fields. fields. When does the reimbursement claim have to be submitted? When does the reimbursement Claims claim have for eligible to be submitted? expenses incurred during Claims the for current eligible expenses plan year incurred can be submitted during the at current any time plan during year can the be plan year. submitted at any time during the plan The year. deadline for submission is 90 days The deadline following for the submission end of the is plan 90 year. days following After 11/30/16, the end claims of the plan for the City year. of After Durham s 11/30/16, claims for the Healthcare City of Durham s Reimbursement Arrangement Healthcare Reimbursement are no longer eligible for reimbursement. Arrangement are no longer eligible for reimbursement. 3. Submit 3. Submit your claim your claim to Laymon to Laymon Group Group for for reimbursement. reimbursement. Submission Submission should should include include a a completed completed claim claim form, form, BCBS BCBS Explanation of of Benefits, Benefits, and a and copy a copy of the of confirmation the of of Health Health Appraisal Appraisal completion (if submitting (if prior prior to 1/1/16). to 1/1/16). *Claims *Claims can be can submitted be submitted to the to Laymon the Laymon Group Group via via postal mail, , or fax. postal mail, , or fax. Follow Up: Follow If anything Up: is missing, incomplete, or your If anything reimbursement is missing, request incomplete, is found or to your be reimbursement ineligible, you request will receive is found a Claim to be Action ineligible, Notification you will form receive in the a mail. Claim This Action will give Notification detail regarding form the what, mail. if anything, This will needs give to be detail corrected regarding prior what, to if resubmission. anything, needs to be corrected prior to resubmission. HRA Plan adminstered by Laymon Group Giles Avenue, Suite 102 Wilmington, NC Phone: Fax: Fax: hradepartment@laymongroup.com hradepartment@laymongroup.com 40

42 Benefits Open Enrollment July 6th - July 30th Policies underwritten by Transamerica Life Insurance Company, Cedar Rapids, Iowa. This is your opportunity to apply for additional insurance to supplement your core benefits. These insurance policies can help protect your financial future. Enroll today! CriticalAssistance Advance SM - critical illness insurance Policy form series CPCI0400 and CCCI0400. Critical illness insurance is designed to come to the rescue of those budget-conscious families by helping pay the costs associated with the initial occurrence of a heart attack, stroke, cancer or other serious illness as defined in the policy. You choose your benefit amount. Benefits are also available for your spouse and eligible children. Their benefit amount will be 50% of your elected benefit. It pays a lump sum benefit equal to the amount you choose multiplied by the applicable percentage shown in the Schedule of Benefits upon the occurrence of a covered critical illness within each category. If the benefit payment is less than 100% of the selected benefit amount, the policy pays another lump sum benefit amount upon the diagnosis of a different type of critical illness within the same category up to the limit per category. There is a lifetime maximum of three times the benefit amount you choose. CancerSelect Plus - cancer-only insurance Policy form series CPCAN200 and CCCAN200. Anyone can develop cancer, but can you help protect yourself and your family from the out-of-pocket costs associated with cancer treatment? Good medical coverage helps, but is it enough? CancerSelect Plus is designed to provide you and your eligible family members with benefits for costs associated with cancer treatment. Coverage is 100% portable. Benefits are paid directly to you -- or anyone you choose. CancerSelect Plus offers benefits for Hospital Benefits, Cancer Maintenance Therapy, Wellness and Miscellaneous Benefits, Surgery Benefits, Radiation and Chemotherapy Benefits. AccidentAdvance - accident-only insurance Policy form series CPACC100 and CCACC100. Accidents are a part of everyday life, but are you prepared for the added financial burden? If you have a serious accident, you ll want extra cash to help pay your increased expenses. Accident insurance pays benefits you can use for medical bills and other out-of-pocket expenses or for any other purpose, including paying your mortgage or other bills. Your medical coverage may not take care of all of the added expenses you ll have after an accident. You ll want your family protected. This policy helps provide protection for you and your insured family every day of the year for covered accidents. These benefits are paid directly to you, not to your doctor or hospital. You can use this money for anything you need. The extra cash can really help you and your family during a difficult time. This flier is not complete unless it is presented with consumer brochures that include the full list of limitations and exclusions for the policies listed. This is a brief summary of benefits. Forms and form numbers may vary. Coverage may not be available in all jurisdictions. Limitations and exclusions apply. Refer to the policy, certificate and riders for complete details. Up to date information regarding our compensation practices can be found in the Disclosures section of our website at: CHOEMMP(CoD)

43 Benefits Open Enrollment July 6th - July 30th Policies underwritten by Transamerica Life Insurance Company, Cedar Rapids, Iowa. This is your opportunity to apply for additional insurance to supplement your core benefits. These insurance policies can help protect your financial future. Enroll today! Trans$ure SM - whole life insurance Policy form series CPWL0100 and CCWL0100 Now without a medical exam you can buy interest sensitive whole life insurance coverage and build cash value with a guaranteed 4% interest rate. You can help protect yourself and eligible members of your family, all with the convenience of payroll deduction. You ll be able to keep your coverage and take it with you if you ever leave the company. Here s another plus: if you buy this policy and continue to pay the monthly cost, after 15 years or at age 65, whichever is later, you ll have a paid-up life insurance policy for half of the benefit amount that s yours to keep. In addition to your coverage, you can buy whole life policies for your spouse and each eligible child and grandchild. Or you could choose to attach a term life insurance rider to your policy or your spouse s to add extra coverage for your children. Hospital Select SM II - Hospital Indemnity Insurance Recovering from a serious illness or accident is difficult enough without having to worry about the added financial stress of being in the hospital. You can help protect yourself with a product that pays benefits for expenses that arise if you or a covered family member end up in the hospital. It s called Hospital Select II, hospital indemnity insurance. The base policy pays a specified amount for each day a covered person is confined to the hospital, up to specified maximum limits. You can use hospital indemnity insurance benefits to defray the expenses major medical insurance doesn t cover like deductibles, co-pays or co-insurance amounts. Benefits can also be used for non-medical expenses such as your rent or mortgage, car payment, groceries, or child care. This flier is not complete unless it is presented with consumer brochures that include the full list of limitations and exclusions for the policies listed. This is a brief summary of benefits. Forms and form numbers may vary. Coverage may not be available in all jurisdictions. Limitations and exclusions apply. Refer to the policy, certificate and riders for complete details. Up to date information regarding our compensation practices can be found in the Disclosures section of our website at: 42

44 TRANSAMERICA EMPLOYEE BENEFITS CLAIMS-EXPRESS Transamerica Customer Service: (888) or File Claims Quick and Easy File TransConnect, Short-Term Disability and Cancer, Critical Illness and Accident Wellness Claims online. Transamerica s claim filing process is a snap! Customers can submit claims online, phone or fax for TransConnect and Short-Term Disability benefits along with wellness claims for cancer, critical illness and accident benefits. How to File Claims Online Customers register at then complete the online form and upload documentation to support their requests. Following submission, customers may view the status, review the submitted claim form and documentation. Once the claim is processed, the Explanation of Benefits (EOB) statement will be available online as well. How to File a Claim by Phone or Fax Contact the Transamerica Claims Customer Service Department at (800) and press 2 or fax directly to the Claims Department at (866) The following information must be provided: + Insured s name/ policy number + Covered person s name, date of birth and relationship to insured + Doctor and facility name, address and phone number + Name of test/procedure + Date of test/procedure + (Fax only) Provider s billing statement, which includes the test/procedure and the date it was performed File Claims for Other Products Claims for other products may be completed by downloading the respective claim form at Once the proper documentation is received, the claim will be processed. QUESTIONS ABOUT CLAIMS Call the Claims Customer Service Department at (800) and press 2. EBD HOWL

45 MetLaw SPONSOR NAME Smart. Simple. Affordable. City of Durham Telephone & Office Consultations MetLaw provides you with telephone and office consultations for an unlimited number of matters with the attorney of your choice. During the consultation, the attorney will review the law, discuss your rights and responsibilities, explore your options and recommend a course of action. Legal Representation Estate Planning Money Matters Real Estate Matters Elder Law Matters Simple Wills Complex Wills Revocable Trusts Irrevocable Trusts Powers of Attorney (healthcare, financial, childcare) Healthcare Proxies Living Wills Codicils Personal Bankruptcy/Wage Earner Plan Debt Collection Defense Foreclosure Defense Repossession Defense Garnishment Defense Identity Theft Defense Tax Collection Defense Negotiations with Creditors Tax Audit Representation (Municipal, State, Federal) Sale, Purchase or Refinancing of primary, second or vacation home Home Equity Loans for primary, second or vacation home Eviction & Tenant Problems (for tenant) Security Deposit Assistance (for tenant) Boundary or Title Disputes Property Tax Assessments Zoning Applications Consultation & Document Review for issues related to your parents: Medicare Medicaid Prescription Plans Nursing Home Agreements Leases Notes Deeds Wills Powers of Attorney Family Law Traffic Offenses* Document Preparation Immigration Assistance Adoption & Legitimization Guardianship Conservatorship Name Change Prenuptial Agreement Protection from Domestic Violence Defense of Traffic Tickets (excludes DUI) Driving Privileges Restoration (includes License Suspension due to DUI) Affidavits Deeds Demand Letters Mortgages Promissory Notes Review of Any Personal Legal Document Advice & Consultation Review of Immigration Documents Preparation of Affidavits Preparation of Powers of Attorney Juvenile Matters Consumer Protection Defense of Civil Lawsuits Personal Property Protection Juvenile Court Defense (includes Criminal Matters) Parental Responsibility Matters Disputes over Consumer Goods & Services Small Claims Assistance Civil Litigation Defense Incompetency Defense Administrative Hearings School Hearings Pet Liabilities Consultation & Document Review for personal property issues Assistance for disputes over goods & services For More Information: Visit info.legalplans.com and enter access code GETLAW or call our Client Service Center at (Monday Friday, 8 am to 7 pm EST/EDT). $18.00 per month covers employee, spouse and dependents The cost is automatically deducted from your paycheck. Additional Plan Features Reduced Fees Network attorneys provide representation for personal injury, probate & estate administration matters at reduced fees. E-Services Family Matters ** Available for an additional fee. Separate plan for parents of participants for estate planning documents. Attorney Locator; Law Firm E-Panel ; Free, downloadable legal documents; Life Guide; Links to financial planning, insurance & work/life matters resources Group Legal Plans and Family Matters are provided by Hyatt Legal Plans, Inc., a MetLife company, Cleveland, Ohio. In certain states, group legal plans and Family Matters are provided through insurance coverage underwritten by Metropolitan Property and Casualty Company and Affiliates, Warwick, Rhode Island. Please contact Hyatt Legal Plans for complete details on covered services including trials. No service, including advice and consultations, will be provided for: 1) employment-related matters, including company or statutory benefits; 2) matters involving the company, MetLife and affiliates, and Plan Attorneys; 3) matters in which there is a conflict of interest between the employee and spouse or dependents in which case services are excluded for the spouse and dependents; 4) appeals and class actions; 5) farm matters, business or investment matters, matters involving property held for investment or rental, or issues when the Participant is the landlord; 6) patent, trademark and copyright matters; 7) costs or fines; 8) frivolous or unethical matters; 9) matters for which an attorney-client relationship exists prior to the Participant becoming eligible for plan benefits. For all other personal legal matters, an advice and consultation benefit is provided. Additional representation is also included for certain matters listed above under Legal Representation. *Not available in all states. **For Family Matters, different terms and exclusions apply. L [exp0815][All States][DC] 44