City of Georgetown Employee Benefit Guide

Transcription

1 City of Georgetown Employee Benefit Guide October 1, 2007 December 31, 2008

2 Welcome Open enrollment will run August 1st through August 31st. The elections you make now will be effective October 1, 2007 and will last through December 31st, This is your opportunity to make changes to your benefits without needing a Qualifying Status change. You can: Enroll or Drop in the medical or vision plans Add, Change or Drop a dependent from your plan Enroll in the Flexible Spending Accounts (Health Care and Dependent Day Care) Add, Increase/Decrease, or Drop your Life Insurance and Short Term Disability coverage Participate in the Voluntary Benefit Plans Instructions: Use this guide and the enclosed benefit summaries to help you make your benefit selections. Once you have made your decision, complete the enclosed Employee Benefits Enrollment Form and any additional forms as required. Return your completed form to Human Resources no later than August 31st, Human Resources Staff Director Kevin Russell Administrative Assistant Elizabeth Jones HR Generalist (Benefits, Safety, EE Relations) Kelly Bressler HR Generalist (Staffing, Training, EE Relations) Rudy Villarreal Table of Contents What s New?...3 Medical.4 5 Dental...6 Vision 7 LTD & Life Insurance.8 STD & Voluntary Benefits.9 Retirement & EAP..10 FLEXTRA Health Savings Accounts (HSA).14 Contact Numbers..15 2

3 What s New? Universal Enrollment Form This year s form will again highlight your current elections in RED. Please circle your new elections. Make sure to indicate whether you want your premiums withheld on a pre or post tax basis. Also, be sure to verify your dependent information is accurate. Medical Options Effective October 1, 2007, The City of Georgetown will no longer offer Aetna Health Plans. However, through Humana s expanded provider network, employees and their eligible dependents can still access Aetna and S&W providers under the following Humana National Point of Service plans: Humana National Point of Service (NPOS) With this plan you are not required to select a Primary Care Physician (PCP), however, you are encouraged to do so to create that initial relationship between you and your doctor should a need arise. You also have the option of going directly to any network provider for covered services without a referral from your PCP. This includes all specialty providers. If network providers are not available, you have access to non network providers at a reduced benefit. Humana NPOS (HDHP) The Humana NPOS (HDHP) plan is essentially the same network and benefits as the regular plan EXCEPT that it has both an In Network and Out of Network high deductible. Enrollment in this plan qualifies the employee for a Health Savings Account (HSA). *Please refer to the Medical section of this handbook for revised plan designs. As a reminder, you still have the option of waiving medical coverage and receiving a monthly stipend of $100. Employees electing this benefit must provide proof of current medical insurance each year. Employee Assistance Program (EAP) The City of Georgetown recognizes the importance of having a successful EAP. Effective October 1, 2007, EAP services will be provided through MHNet. We will no longer offer services through Alliance Work Partners. For those employees and/or their dependents currently in session, MHNet will offer a transitional period. MHNet has provided leadership in the industry. Program benefits include 24 Hour Call Centers, Short Term counseling, up to 8 sessions; convenient counseling locations, and Work life Solutions, a program designed to assist you and your family members with legal and financial assistance, health and wellness programs and personal and professional development. Life Insurance/Accidental Death and Dismemberment (AD&D) Life Insurance will be provided by a new company The Standard at substantially reduced costs. The rates will still be blended to include AD&D. This is to ensure that employees are fully covered for an enhanced benefit. AD&D provides benefit payments in the event of loss of limb or eyesight. Short Term Disability Insurance Short Term Disability will also now be provided by The Standard at substantially reduced rates. Long Term Disability Insurance The City is please to announce that the Long Term Disability buy up will now be funded completely by the City. Employees will no longer have to pay for this option. 3

4 Medical You have the option to choose one of the following plans: Humana National Point of Service (NPOS) With this plan you are not required to select a Primary Care Physician (PCP), however, you are encouraged to do so to create that initial relationship between you and your doctor should a need arise. You also have the option of going directly to any network provider for covered services without a referral from your PCP. This includes all specialty providers. Humana NPOS (HDHP) The HPHP plan continues to offer you the option of choosing covered services in or out of network. Once the deductible is met, In Network services result in lower out of pocket costs due to deeper discounts, lower deductibles, and richer benefits. Out of Network services provide the flexibility to choose any licensed physician or hospital. The HDHP plan does require a high annual deductible per individual. You will either pay the total discounted amount until the deductible is met at which point insurance benefits will contribute. Employees selecting this plan qualify for an HSA. Features Humana National Point of Service In Network Out of Network In Network Humana NPOS (HDHP) Out of Network Annual $0/Individual $500/Individual $1,500/Individual $3,000/Individual Deductible $0/Family $1000/Family $3,000/Family $6,000/Family Annual Out of Pocket Maximum $2000/Individual* $4000/Family* $4000/Individual* $8000/Family* $2000/Individual* $4000/Family* $4000/Individual* $8000/Family* Co Insurance 100% 70% 100% after deduct. 70% after deduct. Office Visits $10 PCP* $25 specialist* 30% 100% after deduct. 70% after deduct. Hospital Care $150/day for first 5 days $150/day for first 5 days, plus 30%* 100% after deduct. 70% after deduct. Urgent Care $25 co pay, deductible waived* 30% 100% after deduct. 70% after deduct. Emergency Room $75 co pay $75 co pay Outpatient Surgery $100 30% 100% after deduct. 70% after deduct. 100% after deduct. 70% after deduct. Prescription Drugs $10 Generic* $30 Brand* $50 Non Covered at 70% of *submitted cost plus co pay 100% after deduct. 70% after deduct. Mail Order $20 Generic (Up to day supply) $60 Brand $100 Non N/A N/A N/A Amounts listed indicate patient responsibility. *New plan changes for FY 07/08 4

5 Medical Continued Benefit Rates NPOS Biweekly Employee Cost Monthly Employee Cost City s Monthly Contribution Total Monthly Premium Employee Only $ 0 $ 0 $ $ Employee + Child(ren) $ $ $ $ Single Parent Family* $ $ $ $ Employee + Spouse $ $ $ $ Employee + Family $ $ $ $ NPOS (HDHP) Biweekly Employee Cost Monthly Employee Cost City s Monthly Contribution Total Monthly Premium Employee Only $ 0 $ 0 $ $ Employee + Child(ren) $ $ $ $ Single Parent Family* $ 9.64 $ $ $ Employee + Spouse $ $ $ $ Employee + Family $ $ $ $ *Must complete a questionnaire (yellow) to determine if you are eligible for the City s health insurance family subsidy HUMANA Health is a state of complete physical, mental and social well being, and not merely the absence of disease or infirmity. ~World Health Organization,

6 Dental Dental insurance will continue to be offered under Aetna s Freedom of Choice Plan. This plan is unique in that it allows you to choose from either the Aetna dental network referred to as the DMO, or you can choose any licensed dentist for covered services under the PDN. You can also switch between the two plans at any time during the plan year, however, keep in mind that you must notify the plan prior to the 15 th of each month in order for your coverage to be effective the first of the coming month. Contact Member Services to make the switch. Freedom of Choice Features Aetna DMO plan Aetna PDN plan Annual Deductible None $50/Individual $150/Family Office Visit Co pay $5 None Preventive Care (exams, cleanings) Covered at 100% Covered at 100%, deductible waived Basic Care (fillings, $5 co pay, then 90% 80% after deductible extractions) Major Care (inlays, crowns) $5 co pay, then 60% 50% after deductible Orthodontia $2300 co pay (Adult and Child) No Lifetime Maximum Only children up to age 20 $1000 Lifetime Maximum Benefit Rates Aetna Freedom of Choice Plan Biweekly Employee Cost Monthly Employee Cost City s Monthly Contribution Total Monthly Premium Employee Only $ 0 $ 0 $ $ Employee + Child(ren) $ $ $ $ Employee + Spouse $ $ $ $ Employee + Family $ $ $ $

7 Vision Voluntary vision benefits will continue to be available through UHC Spectera. This plan gives you flexibility in choosing from a network provider for optimum coverage or selecting any private practice provider for a scheduled reimbursement amount. There are no ID cards for the vision plan. Contact Spectera s Customer Service department or log on to their website for assistance in locating a provider or verifying eligibility. Spectera Features In Network Provider Out of Network Provider Eye Exam (once every 12 months) $10 co pay Reimbursed up to $40 Eyeglass Lenses (once every 12 months) Eyeglass Frames $25 co pay*, then covered at 100% $25 co pay*, Single up to $40 Bifocal up to $60 Trifocal up to $80 (once every 12 months) Contact Lenses Medically Necessary then covered at 100% Reimbursed up to $45 $25 co pay, then covered at 100% Reimbursed up to $210 Elective Contact Lenses $25 co pay, then covered at 100% Reimbursed up to $105 All other elective contacts Covered up to $105 Reimbursed up to $105 Refractive Eye Surgery * Combined for lenses and frames Discount up to 15% w/ selected providers N/A Benefit Rates UHC Spectera Biweekly Employee Cost Monthly Employee Cost City s Monthly Contribution Total Monthly Premium Employee Only $ 4.36 $ 8.72 $ 0 $ 8.72 Employee + Child(ren) $ 9.59 $ $ 0 $ Employee + Spouse $ 9.15 $ $ 0 $ Employee + Family $ $ $ 0 $ Spectera

8 Long Term Disability (LTD) Long Term Disability pays you up to 60% of your monthly earnings if you are disabled for longer than 90 days and unable to fulfill your job duties. The City previously offered two options to the LTD benefit. The core plan provided LTD benefits to all regular full time employees at no cost, up to a maximum of five (5) years. In the past, you have had the opportunity to extend your LTD benefits by purchasing the buy up option. This option extended your LTD benefits up to the age of retirement (as determined by Social Security National Retirement Age). The cost of this benefit was based on your annual salary and your age. Beginning this year the City will now pay the full costs of the core plan AND the buy up option. Employees will no longer have to pay the additional casts. Life Insurance/Accidental Death & Dismemberment As a Texas Municipal Retirement System (TMRS) member you are automatically provided with life insurance in an amount equal to one times your annual average salary for the twelve months prior to the month of death. This year we will be changing from Assurant Employee Benefits as the provider of the Life Insurance and Accidental Death & dismemberment benefit to The Standard. This company will be providing the benefit at substantially reduced rates. You can also purchase additional Life Insurance with Accidental Death and Dismemberment (AD&D) through The Standard Insurance Company. All employees will be enrolling in Life Insurance with the new provider. If you are currently enrolled and would like to increase your life insurance you can do so at this time. Those employees wishing to increase their benefit will need to complete Evidence of Insurability. Any increase in your spouse s coverage will require Evidence of Insurability, regardless of the amount. Increases in child coverage does not require Evidence of Insurability. Your rate will change upon approval from the insurance company. Employees will still be able to enroll in up to 5 times their annual salary or $500,000 whichever is less. Spousal Insurance is limited to $125,000 or 1/2 of Employee s coverage, whichever is less. Child insurance coverage can be in any $1,000 increment from $1,000 to 10,000 and this insurance will cover all eligible children. 8

9 Voluntary Benefits Voluntary Short Term Disability This year we will be changing from Assurant Employee Benefits as the provider of the Short Term Disability benefit to The Standard. This company will be providing the benefit at substantially reduced rates. Short Term Disability pays you up to 60% of weekly earnings when unable to work for greater than 7 days due to a non work related injury or illness, including pregnancy. Premiums are paid post tax and benefits are not subject to federal income tax. This insurance can be beneficial to new hires who do not have sufficient benefit time to compensate them while out on leave or for those employees with low leave balances. To determine your semi monthly deduction, follow the example below. Employee Age Monthly Rate Per $10 of weekly benefit >= Example: Lucy is 29 years old. Annual salary = $25,000. Average weekly earnings = $ % of average weekly earnings = $289/10 = $28.90 Her monthly rate is.60 $28.90 *.60 = $17.34= Approximate monthly premium $17.34* 12 months = $ = Annual premium $ /24 semi-monthly deductions = $8.67semi-monthly deduction Voluntary Pre Paid Legal Plan The City will continue to offer voluntary benefits through Pre Paid Legal Plan. This plan is designed to meet the most common legal needs encountered by employees and their families. Plan benefits include preventive legal services, moving violation representation, pre trial and trial assistance, and IRS legal services. Voluntary AFLAC Plans The City will also continue to offer 3 voluntary insurance plans through AFLAC. Personal Accident Indemnity Plan Personal Cancer Indemnity Plan Personal Recovery Plus Plan benefits include payment to the insured when certain services are incurred, including annual wellness exams. 9

10 Retirement Programs TX Municipal Retirement System You will continue to contribute 7% of your pre tax earnings to TMRS. After 5 years of employment you are considered to be vested. Once you are vested, the City will match your contributions on a 2 to 1 basis. You are eligible to receive the match upon retirement, either at any age with 20 years of service or 60 years of age with 5 years of service. ICMA RC Deferred Compensation Plan Want to contribute more to your nest egg but unsure how? Our plan, managed by ICMA RC, allows you to contribute additional monies to a tax deferred retirement plan, up to $15,000 annually. You can choose between a percentage of your income or a flat amount. In addition, you select the funds in which you want to invest in. You can also join this plan at any time during the course of your employment. EAP Employee Assistance Program The City offers you and your dependents guidance and confidential counseling through MHNet Behavioral Health. Benefits Include: Up to eight (8) counseling sessions packages per family member, per problem, per year, for assessment, problem solving, and/or referrals. 24 Hour Call Center answered by a live counselor. Work life Solutions, a program designed to assist you and your family members with legal and financial assistance, health and wellness programs, and personal and professional development. Legal and Financial assistance Preventative health and complementary care coaching and education service. MHNet Behavioral Health 10

11 FLEXTRA Flexible Spending Accounts (FSA) The greatest benefit of FLEXTRA is that it reduces your reportable gross income to the IRS, thus, increasing your take home pay. FLEXTRA offers employees two ways to save money. 1) Employees can elect Premium Conversion Choice. This allows employees to pay for health, dental, and vision premiums with pre tax dollars. If you would like to have your health benefits withheld on a pretax basis, be sure to initial on the Employee Benefits Enrollment Form. See Example # 1. 2) Employees can also elect to participate in one or both of the Flexible Spending Accounts. An Unreimbursed Medical account allows you to set aside tax free dollars to pay for eligible health care expenses not covered by your plan. These can be incurred by yourself and/or your eligible dependents during the plan year. The maximum contribution is $5,000/year. See Example # 2 A Dependent Care account allows you to set aside tax free money to pay for dependent care expenses which enable you to work. The maximum contribution for the Dependent Care account is $5,000/year ($2,500 if married and filing separate income tax returns). See Example # 3 To sign up for the Flexible Spending Accounts, first decide how much money to set aside in the account for the plan year, October 1, 2007 February 28, 2009 (a 60 day grace period was adopted last year). Once you make your election it is set for the entire year so be sure to determine your expenses accordingly. Remember what you do not use, you lose so plan carefully. The pre authorized amount, determined by you, is taken out of your check before taxes and placed in your specially designated account. For reimbursement under the Health Care spending account, submit a Request for Reimbursement form with proof of payment and a dated receipt of services rendered to Human Resources. You will be reimbursed through your next payroll check. To get reimbursed under the Dependent Care spending account, you can choose one of the following two options: Option 1 For the Dependent Care account, submit a Request for Reimbursement form with proof of payment and a dated receipt of services rendered to Human Resources. Receipt must also include provider s name, address, phone number and Federal Tax ID number. Option 2 Enter into a contract with your day care provider for automatic payment to your provider and direct reimbursement through your paycheck. You will only be reimbursed for the current amount available in your account on your next payroll check. Note: Amounts reimbursed through either plan may not be used as a tax credit on your annual tax return. Example #1 Your bi weekly gross salary is $1,000. You have Emp. + Family coverage for Medical, Dental and Vision. You have elected to pay for your premiums pre tax. Medical Premium $ Dental Premium Vision Total Premiums $

12 FLEXTRA Here is a comparison of your paycheck with and without FLEXTRA. With Without FLEXTRA FLEXTRA Gross Pay $1, $1, Before Tax Premiums (with FLEX Taxable Pay $ $1, Social Security (7.65% of taxable Income Tax (assuming 15% tax After Tax Pay $ $ After Tax Premiums (without Take Home Pay $ $ Example # 2 Your bi weekly gross salary is $1, You have Employee + Child(ren) coverage for Medical, Dental and waived Vision. You elect to contribute $1,000/year for Health Care. Medical Premium $91.65 Dental Premium $14.40 Vision $0 Total Premiums $ With Without FLEXTRA FLEXTRA Gross Pay $1, $1, Before Tax Premiums (with Health Care (with FLEXTRA) Taxable Pay $ $1, Social Security (7.65% of taxable Income Tax (assuming 15% tax After Tax Pay $ $ After Tax Premiums (without Health Care (without FLEX Take Home Pay $ $

13 FLEXTRA Example # 3 Your bi weekly gross salary is $1, You have Employee Only coverage for Medical, Dental and Vision. You elect to contribute the max of $5000/year for Dependent Care. Medical Premium $0 Dental Premium $0 Vision $4.15 Total Premiums $4.15 With Without FLEXTRA FLEXTRA Gross Pay $1, $1, Before Tax Premiums Dependent Care Taxable Pay $ $1, Social Security (7.65% of taxable pay) Income Tax (assuming 15% tax bracket) After Tax Pay $ $ After Tax Premiums Dependent Care Take Home Pay $ $ How FLEXTRA Affects Income Tax and Social Security FLEXTRA affects your taxable earnings for both Federal income tax and Social Security. Since you do not pay income tax on the portion of your salary used to pay for benefits under FLEXTRA, you cannot claim those amounts on your Federal income tax return at the end of the year. Since you do not pay Social Security taxes on the portion of your salary used to pay for benefits under FLEX TRA, you participation may affect the benefits you and your family receive from Social Security when you retire. This difference is usually no more than a few dollars each month. Your retirement plan contributions are based on your gross salary (your pay before taxes are deducted) and not affected by FLEXTRA. If you are near retirement, you should talk with a tax advisor to determine what is best for you. 13

14 HDHP Health Savings Accounts (HSA) What is an HSA? An HSA is a tax free way to save and budget for healthcare expenses. * HSA contributions go in tax free, earn interest tax free, and can be used tax free for IRS approved expenses.* Your employer or anyone else can put money in your account, too. To put money in an HSA, you must be enrolled in a High Deductible Health Plan (HDHP) and you can t have coverage under any other non qualifying health plan. According to the IRS, an HSA compatible HDHP has certain features: 1. The minimum deductible and maximum out of pocket expense amounts are within a range the IRS sets. 2. All covered expenses, including prescriptions, have to apply to the same deductible and out of pocket maximum. Preventive services like yearly gynecological exams are an exception to this rule. Why might you want an HSA. The HSA lets you control how you save, invest, and use your healthcare dollars: Reduce your taxable income. You don t pay taxes on the money you put in your HSA, so you keep more of your paycheck.* By using tax free money instead of your take home pay, which you ve paid taxes on you re essentially getting a discount every time you use your HSA for eligible items. The money always belongs to you. Any money you put into the HSA, along with any contributions your employer makes, belongs to you even if you leave the company. Your account earns interest tax free. Money you put into an HSA earns interest a lot or a little, depending on the type of account you invest in and your balance. All the interest earned is tax free, too.* You control the money. You decide how to invest the funds, including any amounts your employer contributes. You can save the money for future needs. Even if you don t use a lot of healthcare services now, your HSA funds will be there if you need them in the future even after retirement. If you never need the money, it goes to your heirs. It s easy to use the funds. Humana gives you a debit card, the HumanaAccess Visa card, that lets you take money out of your HSA for medical expenses without the hassle of reimbursement forms. To sign up for the Health Savings Accounts, first decide how much money to set aside in the account for the plan year, October 1, 2007 December 31, Once you make your election it is set for the entire year so be sure to determine your expenses accordingly. The pre authorized amount, determined by you, is taken out of your check before taxes and placed in your specially designated account. Please see the enclosed documents for more information. 14

15 Benefit Contact Information D id you know that you can choose a provider...verify plan benefits request an ID card...switch from the DMO to PDN plan...file a claim just by making a phone call to your plan? Medical Hold onto this contact sheet for future use! BENEFIT PLAN PHONE WEBSITE Humana National Point of Service (NPOS) HUMANA Dental Aetna Freedom of Choice Vision UHC Spectera Employee Assistance Program (EAP) MHNet Behavioral Health Life Insurance/AD&D The Standard (888) General Questions Short Term Disability The Standard (888) General Questions Long Term Disability Assurant Employee Benefits General Questions Assurant Employee Benefits Claims Group Legal Plan Pre Paid Legal Services ext. 1 Cancer/Critical Illness Insurance AFLAC Personal Accident Insurance AFLAC Personal Recovery Plus Insurance AFLAC Retirement Programs TX Municipal Retirement System ICMA RC 457 plan

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