benefits employee guide 2020
Table of Contents Table of Contents............................................................................................................................................................................... 2 City of Pearland Holiday Calendar .................................................................................................................................................... 3 Take Care of Your Tomorrow!............................................................................................................................................................ 4 Benefits Resource List ...................................................................................................................................................................... 5 Registering and Enrolling on Benefit Connector .............................................................................................................................. 6 Online Enrollment Instructions ......................................................................................................................................................... 7 Eligiblity .............................................................................................................................................................................................. 8 Medical Benefits ................................................................................................................................................................................ 9 Wellness Instructions ...................................................................................................................................................................... 10 Wellness Instructions – Form ......................................................................................................................................................... 11 Generic Drugs: Questions and Answers ......................................................................................................................................... 12 OneRx ............................................................................................................................................................................................... 13 Health Savings Account (HSA) ........................................................................................................................................................ 14 Health Savings Account (HSA) continued ....................................................................................................................................... 15 Urgent Care vs. Emergency Rooms................................................................................................................................................. 16 Surprise Medical Bills...................................................................................................................................................................... 17 Dental Benefits ................................................................................................................................................................................ 18 Vision Benefits ................................................................................................................................................................................. 19 Basic Life & AD&D Benefits ............................................................................................................................................................ 20 How Much Life Insurance Do You Need? ....................................................................................................................................... 21 Voluntary Life & AD&D Benefits...................................................................................................................................................... 22 Disability Insurance ......................................................................................................................................................................... 23 Employee Assistance Program (EAP) .............................................................................................................................................. 24 Flexible Spending Account .............................................................................................................................................................. 25 Limited Flexible Spending Account................................................................................................................................................. 26 Medical Eligible Expenses for HSA or FSA...................................................................................................................................... 27 Aflac Short Term Disability/Whole Life Insurance ......................................................................................................................... 28 Aflac Accident Plan/Hospital Indemnity Plan................................................................................................................................. 29 Aflac Critical Illness Plan ................................................................................................................................................................. 30 Aflac Enrollment & Claim Filing....................................................................................................................................................... 31 LegalShield ...................................................................................................................................................................................... 32 IDShield............................................................................................................................................................................................ 33 Gym Membership ............................................................................................................................................................................ 34 What Constitutes a Qualifying Life Event? ..................................................................................................................................... 35 Glossary of Health Coverage & Medical Terms.............................................................................................................................. 36 Glossary of Health Coverage & Medical Terms (continued) .......................................................................................................... 37 Glossary of Health Coverage & Medical Terms (continued) .......................................................................................................... 38 Glossary of Health Coverage & Medical Terms (continued) .......................................................................................................... 39
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City of Pearland Holiday Calendar
The holiday schedule that the City of Pearland will observe is as follows: Thanksgiving Holidays Thursday, November 26, 2020 Friday, November 27, 2020 Christmas Eve Thursday, December 24, 2020 Christmas Day Friday, December 25, 2020
New Year’s Day (2021)
Friday, January 1, 2021
Martin Luther King, Jr. Day
Monday, January 18, 2021
Good Friday
Friday, April 2, 2021
Memorial Day
Monday, May 31, 2021
Monday, July 5, 2021 (observed)
Independence Day
Labor Day/ September 11 th Memorial Holiday * Thanksgiving Holidays
Monday, September 6, 2021
Thursday, November 25, 2021 Friday, November 26, 2021
Thursday, December 23, 2021 (observed)
Christmas Eve
Friday, December 24, 2021 (observed)
Christmas Day
Friday, December 31, 2021 (observed)
New Year’s Day (2022)
Designated Holidays
2 used at the employees’ choice with approval
* The City has designated the Labor Day holiday as the September 11 th Memorial holiday for firefighters in accordance with Section 142.0013 (c) of the Local Government Code. or all other employees, Labor Day holiday is unchanged. All City employees have the same number of holidays on the same days; with this one exception.
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Take Care of Your Tomorrow! Personal needs greatly influence the choices we make every day. Young or older, single or married, our needs differ. That’s why the City of Pearland wants to provide you with the freedom to select quality benefit options that work best for you. It is important that you take an opportunity to review all of your plan options in detail. You will need to carefully consider each benefit option, its cost and value to you and whether it is appropriate for your personal needs. By taking the time to examine all of your options, you will ensure that your benefits meet those needs throughout the plan year.
The City of Pearland values our employees and recognizes the importance of offering benefits that enhance people’s lives. With that in mind, we have good news for 2020!
Quick Response (QR) CODES! You will see these weird looking squares within your benefit guide called QR Codes.
Each of these codes store and transmit data, and you can use them by scanning them with your mobile device if you download a QR Reader from your app store such as the Apple App Store or Android Market.
Please Keep This Guide It is a valuable resource for you throughout the year.
Your Pearland HR Team
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Benefits Resource List
For more information on the wide range of the City of Pearland’s benefits, programs and tools, contact the following resources:
If You Have Questions About KELSEY CARE MEDICAL COVERAGE Directories of network providers, claims status or pre-notification CIGNA MEDICAL COVERAGE Directories of network providers, claims status or pre-notification
Contact
By Phone
On the Internet
Kelsey Seybold
www.kelsey-seybold.com My Appointments, get lab results, email physician
713-442-0427
Cigna
800-244-6224
www.cigna.com
DENTAL COVERAGE
Cigna
800-244-6224
www.cigna.com
VISION COVERAGE
UNUM (AlwaysCare)
800-275-8686
www.alwayscarebenefits.com
LIFE INSURANCE
Symetra
800-796-3872
www.symetra.com
DISABILITY INSURANCE
Symetra
800-796-3872
www.symetra.com
EMPLOYEE ASSISTANCE PROGRAM
Alliance Work Partners
800-343-3822
www.alliancewp.com
HEALTH CARE & DEPENDENT CARE SPENDING ACCOUNTS
Cigna
800-244-6224
www.cigna.com
AFLAC COVERAGE - VOLUNTARY
Aflac
800-433-3036
www.aflac.com
LEGAL PROTECTION COVERAGE
LegalShield 888-807-0407 www.benefits.legalshield.com/cityofpearland.com
IDENTITY THEFT PROTECTION
LegalShield 888-807-0407 www.benefits.legalshield.com/cityofpearland.com
**For assistance during Open Enrollment please call 1-800-244-6224 to speak to a Cigna representative**
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Registering and Enrolling on Benefit Connector
Step 1 Log on to: https://cityofpearland.benefitconnector.com/ or with your mobile device use the following QR Code.
Step 2 If you have never accessed the site, you must register. • From the log in screen, click ' register ' to begin registration process.
Step 3 • Enter the Registration Information - Last Name, Date of Birth, Last 4-Digits of SS#.
• Click 'Next' to continue.
Step 4 • Make note of your Login/Username
• Select and answer a Secret Question
• Create and verify a Password. Password strength is displayed as password is developed.
• Click 'Next' to continue.
Be sure to remember your Login/Username and Password for future access to Benefit Connector. If you forget your Password, it can be reset it by following the instructions for 'Forgot Login/Password' in the log in box.
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Online Enrollment Instructions
Step 1: Register/ Log Into Benefit Connector
Go to: https://cityofpearland.benefitconnector.com/ 1. Upon logging into the site above for the first time, you must register in order to set up an account. 2. Click "Register" and answer all questions in order to move forward. 3. Select a Secret Question and Answer as well as a Password. The system will auto-generate your Username for you. 4. You will receive a "Completed" message once the Username and Password have been created and the registration process is complete. 5. Log into the site using the information you just set up. READ AND ACCEPT THE DISCLAIMER TO CONTINUE.
Step 2: Verify Employee Information and Family Members
1. Click the "Start Enrollment" button on the top left of the screen. 2. A Help screen will pop up to assist you in moving from screen-to-screen, just in case you need assistance completing your enrollment. 3. Verify "My Info" and update, if necessary. (If no updates or changes are allowed through the online site, please notify your HR Department immediately of the requested change .) 4. Verify/ Add dependents (spouse and/or children) on this screen. Please add anyone who will be enrolling for Insurance coverage on this screen to avoid any delay or missing data needed for the enrollment process.
Step 3: Completing Enrollment
1) Click on "Make Election", starting with the first benefit option, until all have a Check Mark inside each large box. a) Electing Coverage: i) Check the plan you want. ii) Select Dependents to be covered. iii) Click Save and Exit. b) Waiving Coverage: i) Check "Waive/ Opt Out" if you choose to not elect the benefit. ii) Provide a "Reason for Waiver" under Step 2. iii) Click Save. c) Now you will see a check mark next to the benefit you have completed. You MUST click on each benefit option until all boxes are checked. 2) Once all boxes have been checked, a "View Confirmation" button will appear at the top of the screen. 3) Click this button, and you can print/ save your enrollment confirmation at this point. Important Notes: • You do not have the option to waive Basic Life or Long Term Disability (LTD). These benefits are 100% paid by your Employer. You will be required to add a beneficiary for Basic Life. View the Benefit Confirmation Statement. Verify that all elections are correct, all dependents are listed, and the Coverage column is correct. Retain copy of Benefit Confirmation Statement for your records.
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Eligiblity
If you are a full-time employee who regularly works a minimum of 30 or more hours per week, you are eligible to participate in The City of Pearland’s benefit plans.
Dependent Eligibility Who can you cover on your benefit plans?
You may cover your spouse or civil union partner on our medical, dental, vision, and life insurance plans. If your spouse or civil union partner is a benefit eligible employee at the City of Pearland, you may not cover him/her under spouse life insurance. Your domestic partner & partner in common law marriage is also eligible for coverage. Children’s eligibility varies by plan.
Medical Insurance: A child may be covered under our medical plan through the end of the month during which he/she reaches age 26. Student status does not affect eligibility for medical coverage.
Dental, Vision, and Life Insurance: A child may be covered under our Dental, Vision, and Life plans through the end of the month during which he/she reaches age 26. Student status does not affect eligibility for these coverages.
Flexible Spending Accounts: Claims incurred by you, your spouse, and qualifying child are reimbursable under an FSA. Per federal tax law, claims incurred by an employee’s civil union partner or that partner’s children are not eligible for reimbursement through the employee’s health care or dependent care flexible spending accounts.
You must cover yourself on any plans that you wish to enroll a dependent(s) in. See the Summary Plan Descriptions for more information about dependents and their eligibility.
Dependent Verification Required Documentation will be required to enroll a dependent in medical, dental or vision coverage. Verification of a dependent can range from a copy of a birth certificate, copy of a marriage license, or a copy of your most recent tax return proving the dependent relationship.
You are unable to make changes to your benefit selections during the Plan Year unless you have a Qualifying Life Event, such as marriage, birth of a child or adoption of a child. Refer to page 34 of this book for a list of Qualifying Events. You have 30 days from the event date to notify HR.
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Medical Benefits
Effective October 1, 2020 Here is a snapshot of the coverage offered through the 2020-2021 medical plans.
BENEFITS – Kelsey & Cigna
Kelsey 90
Kelsey 80
HSA Plan
$2,800 Individual / $5,000 Family $5,000 Individual / $10,000 Family Includes Deductible $4,000 Individual / $8,000 Family $8,000 Individual / $16,000 Family
Deductible
Network
None
None
Non-Network
N/A
N/A
Out-of-Pocket Maximum
$2,000 Individual / $4,000 Family
$3,000 Individual / $6,000 Family
Network
Non-Network
N/A 90% N/A
N/A 80% N/A
Co-insurance
Network
80% 60%
Non-Network
Lifetime Maximum
Unlimited You Pay
Unlimited You Pay
Unlimited You Pay
Office Visit
Network
$25 PCP / $50 Spec
$25 PCP / $50 Spec
Deductible/ 20% Deductible/ 40%
Non-Network
N/A
N/A
Wellness Visit
Network
$0 Copay
$0 Copay
$0 Copay
Non-Network
N/A
N/A
Deductible/ 40%
In-Patient & Out-Patient Hospital
Network
10% N/A
20% N/A
Deductible/ 20% Deductible/ 40% Deductible/ 20% Deductible/ 40% Deductible/ 20% Deductible/ 40% Deductible Then $10/$40/$80/$150 Deductible Then $20/$80/$160/$300 Open Access PPO
Non-Network
Urgent Care
Network
$75 Copay
$75 Copay
Non-Network
N/A
N/A
Emergency Room
Network
$200 Copay
$200 Copay
Non-Network Generic/Brand/ Non-Formulary
N/A
N/A
Prescriptions
$10/$40/$80/$150
$10/$40/$80/$150
Mail Order (90 Days)
$20/$80/$160/$300
$20/$80/$160/$300
Network
Kelsey Care Network
Kelsey Care Network
NOTE: This is a brief summary and not intended to be a contract.
Medical Costs Per Pay Period Employee Only
Kelsey 90
Kelsey 80
HSA Plan
Wellness $11.00 $148.50 $111.00 $237.00
Non-Wellness
Wellness
Non-Wellness
Wellness $19.50 $166.00 $131.00 $245.00
Non-Wellness
$36.00 $173.50 $136.00 $262.00
$0.00
$25.00 $151.00 $116.50 $231.00
$44.50 $191.00 $156.00 $270.00
Employee & Spouse Employee & Children Employee & Family
$126.00 $91.50 $206.00
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Wellness Instructions
Effective October 1, 2020 all employees and spouses on the City’s medical insurance plan must complete an Annual Physical and the Personal Health Assessment before August 31, 2021 to receive the wellness discount rates for the next fiscal year. For those employees who have Employee Only or Employee & Children medical coverage, you will have to complete an annual physical and the personal health assessment for them to receive the wellness discount. Annual physicals and the personal health assessment will count towards the wellness discount. Please use the Wellness Screening form found in this guide to report your annual physical. The Wellness Screening form can be found on www.mycigna.com under the “Incentive and Awards” tab, on your City’s Benefit page and in Human Resources. To complete the personal health assessment, log onto mycigna.com, click on the “My Wellness” tab and select ‘My Health Assessment”. Once complete, you’ll receive a confirmation email.
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Wellness Instructions – Form
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Generic Drugs: Questions and Answers
What are generic drugs? A generic drug is identical -- or bioequivalent -- to a brand name drug in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use. Although generic drugs are chemically identical to their branded
counterparts, they are typically sold at substantial discounts from the branded price. According to the Congressional Budget Office, generic drugs save consumers an estimated $8 to $10 billion a year at retail pharmacies. Even more billions are saved when hospitals use generics. Are generic drugs as effective as brand-name drugs? Yes. A generic drug is the same as a brand-name drug in dosage, safety, strength, quality, the way it works, the way it is taken and the way it should be used. FDA requires generic drugs have the same high quality, strength, purity and stability as brand-name drugs.
For more information about Generic Drugs visit https://www.accessdata.fda.gov/scripts/cder/daf/ or use your QR Scanner.
Not every brand-name drug has a generic drug. When new drugs are first made they have drug patents. Most drug patents are protected for 20 years. The patent,
which protects the company that made the drug first, doesn't allow anyone else to make and sell the drug. When the patent expires, other drug companies can start selling a generic version of the drug. But, first, they must test the drug and the FDA must approve it. Creating a drug costs lots of money. Since generic drug makers do not develop a drug from scratch, the costs to bring the drug to market are less; therefore, generic drugs are usually less expensive than brand-name drugs. But, generic drug makers must show that their product performs in the same way as the brand-name drug. How are generic drugs approved? Drug companies must submit an abbreviated new drug application (ANDA) for approval to market a generic product. The Drug Price Competition and Patent Term Restoration Act of 1984, more commonly known as the Hatch-Waxman Act, made ANDAs possible by creating a compromise in the drug industry. Generic drug companies gained greater access to the market for prescription drugs, and innovator companies gained restoration of patent life of their products lost during FDA's approval process. New drugs, like other new products, are developed under patent protection. The patent protects the investment in the drug's development by giving the company the sole right to sell the drug while the patent is in effect. When patents or other periods of exclusivity expire, manufacturers can apply to the FDA to sell generic versions. The ANDA process does not require the drug sponsor to repeat costly animal and clinical research on ingredients or dosage forms already approved for safety and effectiveness. This applies to drugs first marketed after 1962. What standards do generic drugs have to meet? Health professionals and consumers can be assured that FDA approved generic drugs have met the same rigid standards as the innovator drug. To gain FDA approval, a generic drug must: • contain the same active ingredients as the innovator drug(inactive ingredients may vary) • be identical in strength, dosage form, and route of administration • have the same use indications • be bioequivalent • meet the same batch requirements for identity, strength, purity, and quality • be manufactured under the same strict standards of FDA's good manufacturing practice regulations required for innovator products
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OneRx The OneRx application is a free downloadable app for your smart phone to have instant access to current discounts and coupons for your prescriptions. Know out-of-pocket costs in real time • Employees save money by seeing their personalized out-of- pocket for a drug being
prescribed at local pharmacies including any special coupons or discounts you can use.
Be alerted to insurance restrictions • Know if step therapy or a prior
authorization is required before you try to fill the prescription.
Stay up to date on coverage and savings • Track all medications automatically; be kept up to date on the prescription drug list
status and all available savings. The average savings for using the OneRx app is $750!
Visit www.onerx.com or scan the QR Code for additional details about OneRx.
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Health Savings Account (HSA)
WHAT IS A HEALTH SAVINGS ACCOUNT (HSA)? An HSA is an individually-owned, personal health care savings account that you can use to pay out-of-pocket health care expenses with pre-tax dollars. Your contributions are tax-free, and the money remains in the account for you to spend on eligible expenses no matter where you work or how long it stays in the account.
2020 IRS CONTRIBUTION MAXIMUMS
An HDHP generally costs less than what traditional health care coverage costs, so the money that you save on insurance premiums can therefore be put into the Health Savings Account.
COVERAGE LEVEL
Employee Only
$3,550
YOUR HSA IS AN INDIVIDUALLY OWNED ACCOUNT • You own and administer your HSA.
Employee + Spouse Employee + Child(ren) Family Catch-Up Contribution (Individuals 55 or Older)
$7,100
• You determine how much you will contribute to your account and when to use the money to pay for eligible health care expenses.
$1,000
For more information on HSA Accounts visit https://www.irs.gov/pub/irs-pdf/p969.pdf or scan the QR Code with your phone. YOU ARE ELIGIBLE TO OPEN AND FUND AN HSA IF YOU MEET ALL OF THE CRITERIA BELOW: • You are enrolled in a HDHP/HSA plan. • You are not covered by another health plan (unless it is an HSA-qualified plan), healthcare FSA (including a spouse’s healthcare FSA), or health reimbursement arrangement. • You are not eligible to be claimed as a dependent on someone else’s tax return. • You are not enrolled in Medicare or TRICARE for Life. WHAT IS A HIGH DEDUCTIBLE HEALTH PLAN (HDHP)? You must have an HDHP if you want to open an HSA or keep contributing to an existing HSA. The HDHP is usually a less expensive health insurance plan that generally doesn’t pay for the first several thousand dollars of health care expenses (i.e., your “deductible”) but will generally cover you after that. Of course, your HSA is available to help you pay for the expenses your plan does not cover. • You can change your contribution during the plan year without a qualifying event (allowed one time per month). • Like a bank account, you must maintain a balance in order to pay for eligible healthcare expenses. • Keep all receipts for tax documentation. • An HSA allows you to save and “roll over” money from year to year. • The money in the account is always yours, even if you change health plans or jobs. • There are no vesting requirements or forfeiture provisions.
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Health Savings Account (HSA) continued
HSA ADVANTAGES AND HOW DOES THE HSA PLAN WORK? 1. The contributions are made to the HSA by the City of Pearland. The City of Pearland’s 2020 contribution is $500 for single coverage for the year and $1,000 for Employee & Spouse/Child(ren) or Family. You can also elect at Open Enrollment to make your own additional contribution to the HSA which would be taken out of your paycheck on a pre- tax basis. That money is available to pay for the qualifying medical expenses throughout the year. 2. When you need medical care and visit the doctor, emergency room or hospital, you will be responsible for the full cost of the visit (minus any network discounts). You can use the HSA account funds to pay for that visit at the time of the service, you can reimburse yourself at the end of the year or you can choose to pay for the visit out of pocket and let the HSA funds grow. 3. Unused HSA contributions carry over from year to year and remain in the HSA for the following year’s medical expenses. CHANGES TO YOUR HSA WHEN YOU REACH 65 At age 65, you can take penalty-free distributions from the HSA for any reason. However, in order to be both tax-free and penalty-free the distribution must be for a qualified medical expense. Withdrawals made for other purposes will be subject to ordinary income taxes. HEALTH INSURANCE PREMIUMS At age 65, you can use your HSA to pay for Medicare parts A, B, D and Medicare HMO premiums tax-free and penalty- free. You cannot use your HSA to pay for Medigap insurance premiums. If your Medicare premium is automatically deducted from your Social Security check, you simplify reimburse yourself directly from your HSA for the Medicare premiums paid from your Social Security payment. CONTINUED ELIGIBILITY FOR AN HSA Most Americans become eligible for Medicare at age 65. Americans that begin receiving Social Security benefits prior to age 65 are automatically enrolled in Medicare at age 65. Participation in any type of Medicare (Part A, Part B, Part C - Medicare Advantage Plans, Part D, and Medicare Supplement Insurance -Medigap), makes you ineligible to contribute to an HSA. However, you can continue to use your HSA for qualified medical expenses and for other expenses for as long as you have funds in your HSA. LOSS OF ELIGIBILITY IN MONTH YOU TURN 65. You lose eligibility as of the first day of the month you turn 65 and enroll in Medicare. STOPPING MEDICARE TO RECLAIM HSA ELIGIBILITY If you signed up for Medicare Part A and now want to decline it, you can do so by contacting the Social Security Administration. Assuming you have not begun receiving Social Security checks this will reestablish your eligibility for an HSA. If you have applied for or have begun receiving Social Security, you cannot opt out of Medicare Part A without paying the government back all the money you received from Social Security payments plus paying the government back for any money Medicare spent on your medical claims. This action will also stop future Social Security payments (until you reapply and start this cycle over again). SPOUSE UNDER AGE 65 If your spouse is under age 65 that may provide an avenue for continued HSA contributions. An employer; however, cannot make HSA contributions into the HSA of an employee’s spouse.
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Urgent Care vs. Emergency Rooms Healthcare consumers must educate themselves to recognize the differences between an urgent care facility, emergency rooms and freestanding emergency rooms. Understanding their differences could save you as a consumer thousands of dollars.
Whenever you feel bad or have a child who is under the weather all you want is for yourself or them to feel better. You should take into consideration the severity of the situation, the ER wait time and the hefty bill you will receive. Actually, visiting an urgent care may be a better choice as wait times may be shorter and more affordable. A majority of Urgent Care Clinics accept insurance and are
open all week long, including nights, weekends and holidays. Additionally, instead of having to wait in a waiting room to be seen, some Urgent Care Clinics allow you to call in advance and wait in the comfort of your home until a room becomes available.
Urgent care centers are equipped to handle non-life threatening situations, and many have attending doctors and nurses who have access to x-rays and labs onsite. Most urgent care centers are open late and on weekends and holidays.
Choosing an urgent care center over the ER can save you time and money: •Average time of an ER visit: 4 hours •Average cost of an ER visit: $1,757 •Average cost of an urgent care center visit: $162
Visit an urgent care center for these common conditions: •Flu and cold / High fevers
•Coughs and sore throat
•Cuts and severe scrapes
•Broken bones
•Vomiting, diarrhea, stomach pain
•High fevers
Emergency Rooms
Emergency rooms are meant for true medical emergencies and can handle trauma, x-rays, surgical procedures and other life threatening situations.
Most hospitals have an emergency room that’s open 24 hours a day, 7 days a week. If you have a true emergency, go to your nearest emergency room or call 911.
Visit an emergency room if you experience:
•Allergic reactions
•Broken bones
•Chest pain
•Constant vomiting
•Continuous bleeding
•Severe shortness of breath
•Deep wounds
•Weakness or pain in a leg or arm
•Head injuries / Unconsciousness
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Surprise Medical Bills “Surprise medical bill” is a term commonly used to describe charges arising when an insured individual inadvertently receives care from an out-of-network provider. This situation could arise in an emergency when the patient has no ability to select the emergency room, treating physicians, or ambulance providers. Surprise medical bills might also
arise when a patient receives planned care from an in-network provider (often, a hospital or ambulatory care facility), but other treating providers brought in to participate in the patient’s care are not in the same network. These can include anesthesiologists, radiologists, pathologists, surgical assistants, and others. In some cases, entire departments within an in-network facility may be operated by subcontractors who don’t participate in the same network. In these non-emergency situations, too, the in-network provider or facility generally arranges for the other treating providers, not the patient.
I GOT A SURPRISE BILL. WHAT CAN I DO ABOUT IT?
• Call the doctor or provider that sent the bill and discuss your concerns. In most cases, Texas law requires providers to provide an itemized bill on request, so review the charges carefully. Some providers might accept a lower payment. • For planned procedures, find out in advance whether your providers are contracted with your health plan. This is especially important in the case of facility-based providers, such as radiologists, anesthesiologists, pathologists, and neonatologists. Even if a hospital is in your health plan's network, some doctors who provide services there might not be. • Call your health plan to make sure the services you will get are covered under your policy. If the services are not covered, you will have to pay the charges. • Texas law gives patients the right to request estimates of charges. Doctors and other providers and health plans have 10 days to give you the estimates, so you won't be able to get them in cases of emergencies. Some providers and health plans also have cost information on their websites. • If there aren’t any contracted providers available, your health plan might be able to work out a discounted payment. You also might be able to ask your doctor or provider if they’ll accept payment options in advance. In some cases, the health plan may be required to make sure you aren’t balance billed.
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Dental Benefits
Effective October 1, 2020
Here is a snapshot of the coverage offered through the 2020-2021 dental plans.
BENEFITS - Cigna
DMO
PPO
Type I – Preventive Services Oral examinations (2 Per Year)
X-rays
100%
$5 Copay/ 100%
Cleanings (2 Per Year) Type II – Basic Services Fillings
Extractions
$50 Deductible/ 80%
$5 Copay/ 100%
Root Canal Type III – Major Services Crowns
Removable / fixed bridge-work Partial or complete dentures Type IV - Orthodontia Adult & Child / Child Only
$50 Deductible/ 50%
$5 Copay/ 60%
Adult & Child
Child up to Age 19 Only
$2,400
50%
Annual Deductible Individual
$50
$0 $0
Family
$150
Annual Maximums Dental Annual Maximum
$1,500 $1,500
None None
Orthodontia Lifetime Maximum Network Website www.cigna.com
Cigna PPO Network
Cigna DMO Network
NOTE: This is a brief summary and not intended to be a contract.
DMO $0.00 $4.44 $6.64 $12.23
Dental Costs – Per Pay Period
PPO $0.00
Employee Only
Employee & Spouse Employee & Children Employee & Family
$11.75 $18.44 $29.56
*Employees may not change plans mid-year without a Qualifying Life Event.
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Vision Benefits
Effective October 1, 2020
This is a snapshot of the coverage offered through the 2020-2021 Vision plans.
BENEFITS
UNUM (AlwaysCare)
Eye Exam
Network
$0 Copay
Non-Network
Up to $40 Reimbursement
Frames/ Lens Single Vision
Network
$20 Copay
Non-Network
Up to $40 Reimbursement
Bifocal Lenses
Network
$20 Copay
Non-Network
Up to $60 Reimbursement
Trifocal Lenses
Network
$20 Copay
Non-Network
Up to $80 Reimbursement
Frames
Network
$150 Allowance
Non-Network
Up To $50 Reimbursement
Contacts *In Lieu of Glasses Network
Medically Necessary
$0 Copay/Covered in Full
Elective
$160 Allowance
Non-Network
Medically Necessary
Up to $210 Reimbursement Up to $160 Reimbursement
Elective
Exam Frequency Lens Frequency Frames Frequency Network Website
12 Months 12 Months 24 Months
www.alwaysassist.com
First Look/AlwaysCare Network
NOTE: This is a brief summary and not intended to be a contract.
Vision Costs Employee Only Employee +1
Per Pay Period
$1.85 $3.43 $5.04
Employee +2 or More
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Basic Life & AD&D Benefits Effective October 1, 2020
The City of Pearland provides Basic Life and AD&D (Accidental Death and Dismemberment) insurance for you as a full-time employee at no additional cost. If you would like to purchase additional life insurance for yourself and/or your dependents, please see the Voluntary Life Insurance page for more information. BENEFICIARY INFORMATION Remember, it is important to designate beneficiaries for all of your insurance policies that require them. If you don’t, laws may cause death benefits to be distributed differently than you had planned resulting in additional taxes and may unnecessarily delay the process of finalizing payment to your loved ones. You should regularly review and, if necessary, update your beneficiary designations. You can update your beneficiary at any time by submitting a new beneficiary form to HR.
BASIC LIFE/AD&D BENEFITS
Symetra
Class 1: Employees earning $50,000 or less annually = $50,000 Class 2: All other employees = 1 X BAE to $175,000
Employee Basic Life & AD&D Schedule Waiver of Premium For Total Disability
Included to age 65 75% of Life Benefit
Accelerated Death Benefit
Conversion Portability
Included Included
NOTE: This is a brief summary and not intended to be a contract.
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How Much Life Insurance Do You Need? If you’re going to achieve all your goals, such as sending your kids to college, retiring in comfort and leaving a legacy, you will need to save and invest throughout your lifetime. But to really complete your financial picture, you’ll also need to add one more element: protection. And that means you’ll require adequate life insurance for your situation. However, your need for insurance will vary at different times of your life — so you’ll want to recognize these changing needs and be prepared to act. When you’re a young adult, and you’re single, life insurance will probably not be that big of a priority. And even married couples without children typically have little need for life insurance; if both spouses contribute equally to household finances, and you don’t own a home, the death of one spouse will generally not be financially catastrophic for the other.
But once you buy a home, things change. Even if you and your spouse are both working, the financial burden of a mortgage may be too much for the surviving spouse. So, to enable the survivor to continue living in the home, you might consider purchasing enough life insurance to at least cover the mortgage.
When you have children, your life insurance needs will typically increase greatly. In fact, it’s a good idea for both parents to carry enough life insurance to pay off a mortgage and raise and educate the children, because the surviving parent’s income may be insufficient for these needs. How much insurance do you need? You might hear of a “formula,” such as buying an amount equal to seven to ten times your annual income, but this is a rough guideline, at best. You might want to work with a financial professional to weigh various factors – number and ages of children, size of mortgage, current income of you and your spouse, and so on – to determine both the amount of coverage and the type of insurance (“term” or “permanent”) appropriate for your situation. Once you’ve reached the “empty nest” stage, and your kids are grown and living on their own, you may need to re- evaluate your insurance needs. You might be able to lower your coverage, but if you still have a mortgage, you probably would want to keep enough insurance to pay it off. After you retire, you may have either paid off your mortgage or moved into a condominium or apartment, so you may require even less life insurance than before. But it's also possible that your need for life insurance will remain strong. For example, the proceeds of a life insurance policy can be used to pay your final expenses or to replace any income lost to your spouse as a result of your death (e.g., from a pension or Social Security.) Life insurance can also be used in your estate plans to help leave the legacy you desire.
As we’ve seen, insurance can be important at every stage of your life. You’ll help yourself – and your loved ones – by getting the coverage you need when you need it.
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Voluntary Life & AD&D Benefits
Effective October 1, 2020
VOLUNTARY LIFE BENEFITS PAID BY EMPLOYEE
Symetra
Employee Life Amount
Increments of $10,000 $170,000 to Age 69 $50,000 Age 70 and older
Employee Guarantee Issue Amount
Employee Maximum Amount
3X Base Annual Salary to $300,000
Waiver of Premium For Total Disability
Included
Accelerated Death Benefit
75% to $500,000
To 65% @ Age 65 To 50% @ Age 70, Terminates at Retirement
Employee Age Reduction Schedule
$5,000 Increments to a Maximum Amount of 50% of the Employee Amount or $150,000
Spouse Life Amount
Spouse Guarantee Issue Amount
$50,000
Live Birth to 14 Days Old = $250 15 Days Old to Age 25 = $10,000
Dependent Child(ren) Life Amount
Conversion
Included
Suicide Clause
24 Months
AGE RATED PREMIUMS (Rates based on Employee or Spouse)
With AD&D
Without AD&D (Rate Per $1,000)
(Rate Per $1,000)
Accidental Death & Dismemberment (AD&D) Rate:
$0.045 $0.115 $0.155 $0.175 $0.185 $0.245 $0.355 $0.665 $1.065 $1.475 $2.585 $4.245 $7.175
$0.00 $0.07 $0.11 $0.13 $0.14 $0.20 $0.31 $0.62 $1.02 $1.43 $2.54 $4.20 $7.13
Life Rate: Up to 24
25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79
Dependent Child(ren) Premium Per $1,000
N/A
$.20
NOTE: This is a brief summary and not intended to be a contract. Guarantee issue Amounts listed are only available to new hires and their spouses. All other eligible employees and spouses will be required to submit Evidence of Insurability for any new coverage amount or increase in coverage amount, except as noted.
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Disability Insurance
Effective October 1, 2020 The City of Pearland provides full-time employees with long-term disability income benefits. The cost for this coverage is paid in full by your employer. In the event you become disabled from a non-work-related injury or sickness, disability income benefits are provided as a source of income.
LONG TERM DISABILITY BENEFITS
Symetra
Monthly Percentage
50%
Monthly Maximum Benefit
$6,000
Definition of Disability Elimination Period Benefit Duration Definition of Earnings
2 Years Own Occupation
90 Days
Social Security Normal Retirement Age
Base Annual Earnings 3 Month Lump Sum
Survivor Benefit
Pre-existing Limitation
3 / 12
Mental Nervous Limitations Drug & Alcohol Limitations Self-Reported Limitations
24 Months per Disability 24 Months per Disability
24 Months
NOTE: This is a brief summary and not intended to be a contract.
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Employee Assistance Program (EAP)
Effective October 1, 2020 The Employee Assistance Program (EAP) can help you resolve problems that affect your personal life or job performance. The Employee Assistance Program (EAP) is offered to all employees and immediate family members through Alliance Work Partners. The EAP is paid for by the City of Pearland. It is a completely confidential counseling program that covers issues such as:
Legal / Financial Depression / Stress Drug / Alcohol Abuse Emotional Problems Financial Pressures
• • • • • • • •
Grief Issues
Family / Relationship Problems
Other Personal Concerns
EAP offers up to six (6) sessions per issue, per year for face-to-face or telephonic counseling for short term problem resolution. Staff members are available 24 hours a day, 7 days a week, every day of the year by calling 1-800-343-3822. Staff members are highly trained professionals with experience in family, personal, work related and substance abuse issues.
For online access, please visit www.alliancewp.com.
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Flexible Spending Account
Effective October 1, 2020 A Flexible Spending Account, or FSA, lets you set aside pre-tax money from your paychecks to spend on out-of- pocket healthcare expenses (i.e. co-pays, deductibles, over-the-counter items, etc.). Money that goes into an FSA is pre-tax, so by anticipating your family’s health care and dependent care costs for the next year, you can actually lower your taxable income. Health Care Reimbursement FSA This program lets employees pay for certain IRS-approved medical care expenses not covered by their insurance plan with pre-tax dollars. The annual maximum amount you may contribute to the Health Care Reimbursement FSA is $2,750. Some examples include: Deductible, Prescriptions & Doctor Visit Co-Payments Over-the-Counter Medicines with a Prescription Vision services, including Lasik Eye Surgery, Glasses & Contacts
Hearing services, including hearing aids and batteries Orthodontics, Dental deductibles and coinsurance Acupuncture Dependent Care FSA – Access To Amount Contributed Year To Date Only
The Dependent Care FSA allows employees to use pre-tax dollars towards qualified dependent care for children under the age 13 or caring for elders. The annual maximum amount you may contribute to the Dependent Care FSA is $5,000 for 2020, (or $2,500 if married and filing separately). Examples include: 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) FSA Smart Tips Cover any significant medical expenses early in the year using your FSA. You’ll spend the remainder of the year paying yourself back with the regular payroll deductions. Save your receipts as proof of purchase in order to be reimbursed for your health care expenses from your FSA. So if you are making purchases that are eligible for reimbursement, you’ll want to keep them separate from other items. Take advantage of the pre-tax savings and use your FSA dollars. Remember, unused money in an FSA at the end of the year is lost.
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Limited Flexible Spending Account
Effective October 1, 2020
*For HSA Plan Participant Use Only
If you participate in the City of Pearland Health Plan High Deductible Health Plan and participate in a health savings account, you can only enroll in the limited purpose health care FSA, not the standard health care FSA. The limited purpose health care FSA allows you to reimburse yourself for eligible dental and vision expenses. Dental and vision expenses are also eligible under your health savings account, but you cannot claim the same expenses on both accounts. You cannot submit medical, prescription drug, or over-the-counter medication expenses to your limited purpose health care FSA for reimbursement — those expenses are eligible only for reimbursement from your health savings account.
Can you use your HSA?
Can you use your limited purpose health care FSA?
If you have both an HSA and a limited purpose health care FSA…
Medical expenses you incur, such as your deductible and coinsurance costs
Yes
No
Prescription drug expenses you incur
Yes
No
No. Some over-the-counter medications for dental care and vision may be eligible for reimbursement.
Yes, with doctor's prescription
Over-the-counter (OTC) medication expenses
Dental expenses, such as visits to the dentist and orthodontia (unreimbursed expenses only)
Yes
Yes
Vision expenses, such as eyeglasses and contact lenses. If enrolled in the Vision Benefits, these would be expenses remaining out of your pocket after the Vision benefit is paid.
Yes
Yes
IRS limitations on flexible spending accounts
• Expenses reimbursed from an FSA cannot be claimed as a medical expense on your tax return. • Only expenses actually incurred during the calendar year are eligible for reimbursement. Expenses incurred before or after the eligibility period are not eligible, regardless of when you paid for the expenses. FSAs may not reimburse for future or projected expenses. • If you do not use all the pre-tax dollars in your flexible spending account, you forfeit the amount left over. That's an Internal Revenue Service requirement.
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