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HomeMy WebLinkAbout2018-2019 Employee Benefits HUMAN RESOURCES 1225 MAIN STREET ■ SEBASTIAN, FLORIDA 32958 TELEPHONE (772) 388-8222 ■ FAX (772) 388-8249 www.cityofsebastian.org All, Insurance Open Enrollment is right around the corner. Insurance changes can be made by signing into BenTek (https://www.mybentek.com/sebastian/) from Wednesday, August 22nd to Wednesday August 29th at 5:00 PM. The annual Open Enrollment Meeting date is Thursday, August 23rd. There are 3 different meeting times: 10:00 am – 11:30 am; 2:00 pm – 3:30 pm; 5:30 pm – 7:00 pm. Due to early voting in the Council Chambers, the meetings will be at the Police Department in the Briefing Room. You may invite your spouse/significant other. Please attend one of the 3 meetings. Please mark your calendar. The City has decided to remain with Florida Blue for Medical insurance, Humana for Dental and Vision insurance and Lincoln Financial for Life Insurance. The City has also decided to add an additional Dental Plan. Employees will now have the option to choose from between two Dental Plans, the normal $1,000 Calendar Year Maximum per member or the Buy-up Plan of $1,500 Calendar Year Maximum. There is an additional fee for the $1,500 Maximum. (See below.) As was expected, Medical and Dental Insurance rates did increase this year and even though the City will be paying a majority of the increase a small percentage of the increase will be passed on to the employee. Remember, last year’s increase was not passed on. The amount on the HRA cards will remain the same; $2,500 for employee and $5,000 for employee plus spouse/domestic partner, children, or family. The new Insurance Rates will be follows: Florida Blue Current Rate As of October 1, 2018 Employee $25.00 ($12.50/pay) $25.00 ($12.50/pay) Employee & Spouse/ Domestic Partner $294.32 ($147.16/pay) $309.04 ($154.52/pay) Employee & Children $184.44 ($92.22/pay) $193.66 ($96.83/pay) Family $445.14 ($222.57/pay) $467.40 ($233.70/pay) Human Dental Current Rate As of October 1, 2018 As of October 1, 2018 Maximum $1,000 Maximum $1,500 Employee $0 $0 $5.81 ($2.91/pay) Employee & Spouse/ Domestic Partner $12.70 ($6.36/pay) $13.96 ($6.98/pay) $25.70 ($12.85/pay) Employee & Children $22.09 ($11.05) $24.28 ($12.14/pay) $40.40 ($20.20/pay) Family $34.79 ($17.39/pay) $38.22 ($19.11/pay) $60.26 ($30.13/pay) Last, remember to review beneficiaries. If you were married, divorced, had a child, or some other event, you may want to review your beneficiaries (Primary and Contingent) for Life Insurance, Pension and Retirement Plans. If you would like to change your beneficiary, please see me for the appropriate form(s). If you have any questions, please see me. Cindy Watson, HR Director | 2018 2019 EMPLOYEE BENEFIT HIGHLIGHTS || City of Sebastian 2018-2019 Contact Information Cynthia WatsonPhone: (772) 388-8222 Human Resources HR ManagerEmail: cwatson@cityofsebastian.org (888) 5-BenTek (523-6835) BenTek Supportwww.mybentek.com/sebastian Email: support@mybentek.com Customer Service: (800) 345-3885 Medical Insurance Florida Blue Prescription Drug Coverage Customer Service: (888) 849-7865 Alliance Rx Walgreens Prime & Mail-Order Program Customer Service: (888) 537-3539 Health Reimbursement Account Customer Service: (800) 233-4013 Dental Insurance Humana www.humana.com Customer Service: (866) 537-0229 Vision Insurance Humana www.humana.com Customer Service: (888) 537-3539 Flexible Spending Accounts Customer Service: (800) 423-2765 Basic Life and AD&D Insurance Lincoln Financial Group www.lfg.com Customer Service: (800) 423-2765 Voluntary Life and AD&D Insurance Lincoln Financial Group www.lfg.com Customer Service: (800) 423-2765 Long Term Disability Insurance Lincoln Financial Group www.lfg.com Customer Service: (855) 327-4463 Employee Assistance Program Lincoln Financial Group www.guidanceresources.com Customer Service: (800) 521-3535 Supplemental Insurance AllstateCell: (954) 609-4924 Customer Service: (800) 356-5297 Agent: Dixie Kuehn Legal Insurance US Legal Services www.uslegalservices.net © 2016, Gehring Group, Inc., All Rights Reserved || City of Sebastian 2018-2019 Table of Contents Introduction 1 1 Group Insurance Eligibility 2 Qualifying Events and IRS Code Section 125 3 Medical Insurance 4 Group Insurance Premiums 4 4 Other Available Plan Resources 4 Florida Blue HRA BlueOptions 5190/5191 Plan At-A-Glance 5 Health Reimbursement Account 6 Dental Insurance 7 Humana Dental PPO Base Plan At-A-Glance 8 Humana Dental PPO Buy-Up Plan At-A-Glance 10 Vision Insurance 11 Humana Vision 130 Plan At-A-Glance 12 Flexible Spending Accounts 13-14 Employee Assistance Program 15 Basic Life and AD&D Insurance 15 Voluntary Life and AD&D Insurance 16 Long Term Disability 17 Supplemental Insurance 17 Legal & Identity Protection Plans 18 Retirement Plans 18 19 Leave Policies 19 Notes 20 The City of Sebastian reserves the right to amend, modify or terminate the plan at any time. This booklet should not be construed as a guarantee of employment. © 2016, Gehring Group, Inc., All Rights Reserved || City of Sebastian 2018-2019 New Hire Orientation, or Qualifying Events. Accessible 24 hours a day, throughout the year, employee may log dependent(s). Employee has access to important forms and carrier Introduction links, can report qualifying life events and review and make changes further explanation or needs assistance regarding claims processing, please subject to change contingent upon availability of funds. Log on to www.mybentek.com/sebastian Sign in using a previously created username and password or click "Create an Account" to set up a username and password. If employee has forgotten username and/or password, click on the link “Forgot Username/Password” and follow the instructions. Once logged on, navigate to the menu in order to review For technical issues directly related to using the EBC, please call (888) 5-BenTek (523-6835) or email BenTek Support at support@mybentek.com, Monday through Friday, during regular business hours, 8:30am - 5:00pm. www.mybentek.com/sebastian Please Note: Link must be addressed exactly as written. Due to security reasons, the website cannot be accessed by Google or other search engines. 1 © 2016, Gehring Group, Inc., All Rights Reserved || City of Sebastian 2018-2019 Group Insurance Eligibility The City's group insurance plan year is Dependent Age Requirements October 1 through September 30. Medical Coverage: A dependent child may be covered through the end of the calendar year in which the child turns age 26. An over- age dependent may continue to be covered on the medical plan to Employee Eligibility the end of the calendar year in which the child reaches age 30, if the Employees are eligible to participate in the City’s insurance plans if they are dependent meets the following requirements: full-time employees working a minimum of 40 hours per week. Part-time • Unmarried with no dependents; and employees working a minimum of 30 hours per week may participate in the • A Florida resident, or full-time or part-time student; and • Otherwise uninsured; and following 60 days of employment. For example, if an employee is hired on April • Social Security Act, unless the child is disabled. Dental and Vision Coverage: A dependent child may be covered Termination through the end of the calendar year in which the child turns age 26. If an employee separates employment from the City, insurance will continue through the end of month in which separation occurred. COBRA continuation of coverage may be available as applicable by law. Disabled Dependents Coverage for an unmarried dependent child may be continued beyond age 26 if: Dependent Eligibility • The dependent is physically or mentally disabled and incapable of dependent child(ren) of the participant or spouse/domestic partner. The term self-sustaining employment (prior to age 26); and “child” includes any of the following: • Primarily dependent upon the employee for support; and • The dependent is otherwise eligible for coverage under the group • A natural child medical plan; and • A stepchild • The dependent has been continuously insured; and • A legally adopted child • Coverage with the City began prior to age 26. • A newborn child (up to the age of 18 months old) of a covered dependent (Florida) Proof of disability will be required upon request, including a medical examination, no more than once per year. Please contact Human Resources if • A child for whom legal guardianship has been awarded to the participant or the participant’s spouse/domestic partner. Taxable Dependents Employee covering adult child(ren) under employee's medical insurance plan may continue to have the related coverage premiums payroll deducted on a pre-tax basis through the end of the calendar year in which the dependent child reaches age 26. Beginning January 1 of the calendar year in which the dependent child reaches age 27 through the end of the calendar year in which the dependent child reaches age 30, imputed income must be reported on the employee’s W-2 for that entire tax year. Imputed income is the dollar value of insurance coverage attributable to covering the adult dependent child. Note: There is no imputed income if adult dependent child is eligible to be claimed as a dependent for Federal income tax purposes on the employee’s tax return. Contact Human Resources for further details if covering an adult dependent child who will turn 27 any time during the upcoming calendar year or for more information. 2 © 2016, Gehring Group, Inc., All Rights Reserved || City of Sebastian 2018-2019 Group Insurance Eligibility (Continued) Domestic Partner Coverage guidelines state that employee may not receive a tax advantage on any portion of premiums paid related to domestic partner coverage. Employees insuring domestic partners and/or child dependent(s) of a domestic partner are required to pay imputed income tax on subsidy amounts and should consult a tax advisor. Please contact Human Resources for more information. Qualifying Events and IRS Code Section 125 IRS Code Section 125 Premiums for medical, dental, vision insurance, contributions to Flexible Spending Accounts (FSA), and/or certain supplemental policies are deducted IMPORTANT NOTES through a Cafeteria Plan established under Section 125 of the Internal Revenue Code and are pre-taxed to the extent permitted. Under Section 125, changes to If employee experiences a qualifying event, Human Resources must be contacted within 30 days of the qualifying event to make the appropriate changes to employee's coverage. Beyond 30 days, Qualifying Event and the request to make a change is made within 30 days of requests will be denied and employee may be responsible, both legally the qualifying event. employee or dependent who continues to be enrolled but no longer Under certain circumstances, employee may be allowed to make changes spouse or dependent’s coverage eligibility. An “eligible” qualifying event is determined by the Internal Revenue Code, Section 125. Any requested changes Cancellations will be processed at the end of the month. In the event must be consistent with and due to the Qualifying Event. of death, coverage terminates the date following the death. Employee Examples of Qualifying Events: may be required to furnish valid documentation supporting a change in status or “Qualifying Event.” • Employee gets married or divorced • Birth of a child • Employee gains legal custody or adopts a child • Employee's spouse and/or other dependent(s) die(s) • Employee, employee's spouse or dependent(s) terminate or start employment • An increase or decrease in employee's work hours causes eligibility or ineligibility • A covered dependent no longer meets eligibility criteria for coverage • A child gains or loses coverage with an ex-spouse • Change of coverage under an employer’s plan • Gain or loss of Medicare coverage • Losing eligibility for coverage under a State Medicaid or CHIP 3 © 2016, Gehring Group, Inc., All Rights Reserved || City of Sebastian 2018-2019 Medical Insurance Other Available Plan Resources employees. The costs per pay period for coverage are listed in the premium and discounts through value added programs. For more details regarding other page. For more detailed information about the medical plan, please refer to (SBC) document or contact Florida Blue's customer service. Blue365 Florida Blue’s customer service. discounted products and services at participating providers. Members can Medical Insurance Florida Blue HRA BlueOptions 5190/5191 Plan (800) 345-3885. 24 Payroll Deductions - Per Pay Period Cost Fitness club Elder care advisory Tier of CoverageSemi-Monthly Monthly memberships, exercise services Employee Only$12.50$25.00 footwear and apparel Hotel rooms and travel Employee + Spouse$154.52$309.04 Vision care, glasses, information and contact lenses Weight loss Employee + Child(ren)$96.83$193.66 Hearing care and aidsmanagement Employee + Family$233.70$467.40 Alternative medicine Florida Blue The Florida Blue Mobile App Florida Blue’s mobile website can be accessed from any smartphone or download the app from the iPhone® or Android™ with just a tap! Group Insurance Premiums Visit the smartphone’s app store and search for Florida Blue or visit coverage, shall pay $25.00 per month. The City pays 100% of the premium disability group insurance coverages. The City also pays 100% of the cost for A for the Medical Plan is provided as a supplement to this booklet being distributed to new hires and existing employees employee and dependent(s). during Open Enrollment. The summary is an important item in understanding the or is available as follows: From: Human Resources Address: 1225 Main Street The City provides an “opt out” program for all eligible employees who elect Sebastian, FL 32958 Phone: (772) 388-8222 proof of other medical insurance coverage in order to qualify for this program. Email: cwatson@cityofsebastian.org Qualifying employee will receive a taxable payment of $75 semi-monthly (24 At Website URL: www.cityofsebastian.org pay periods) for this waiver. www.mybentek.com/sebastian The SBC is only a summary of the plan’s coverage. A copy of the plan document, policy, and obtained by contacting Human Resources. Human Resources at (772) 388-8222. 4 © 2016, Gehring Group, Inc., All Rights Reserved || City of Sebastian 2018-2019 Florida Blue HRA BlueOptions 5190/5191 Plan At-A-Glance NetworkBlueOptions Plan Year Deductible (PYD)*In-NetworkOut-of-Network** Single$1,500$3,000 Family$3,000$6,000 Coinsurance Locate a Provider Member Responsibility 20%40% To search for a participating provider, contact Florida Blue’s customer service Plan Year Out-of-Pocket Limit Single$4,500$9,000 completing the necessary search criteria, select BlueOptions network. $6,850 Per Person$18,000 Per Person Family $9,000 Per Family$18,000 Per Family What Applies to the Out-of-Pocket Limit?Deductible, Coinsurance, Copays and Rx Physician Services Primary Care Physician (PCP) 20% After PYD40% After PYD Plan References 20% After PYD40% After PYD *Deductible is shared for all individuals Non-Hospital Services; Freestanding Facility of the family. Clinical Lab (Blood Work)***0% After PYD40% After PYD **Out-Of-Network Balance Billing: For information regarding out-of- X-rays 20% After PYD40% After PYD network balance billing that may be Advanced Imaging (MRI, PET, CT) 20% After PYD40% After PYD charged by out of network providers, Outpatient Surgery in Surgical Center 20% After PYD40% After PYD and Coverage document. Physician Services at Surgical Center 20% After PYD40% After PYD Urgent Care (Per Visit)20% After PYD20% After PYD ***Quest is the preferred lab for blood work through Florida Blue. When using Hospital Services they are contracted with Florida Blue’s Option 2: Option 1: $500 PAD**** + BlueOptions network. Inpatient Hospital (Per Admission)25% After PYD Per Person 20% After PYD40% Deductible After PYD 20% After PYD Per Family ****PAD: Per Admission Deductible Option 1: Option 2: Outpatient Hospital 40% After PYD 20% After PYD25% After PYD Physician Services at Hospital 20% After PYD20% After In-Network PYD Emergency Room (Per Visit)20% After PYD20% After PYD Mental Health/Alcohol & Substance Abuse Inpatient (Per Admission; Prior Authorization May Be Required)20% After PYD20% After In-Network PYD Outpatient (Per Admission; Prior Authorization May Be Required)20% After PYD40% After PYD Prescription Drugs (Rx) Generic$10 Retail Copay After PYD50% After In-Network PYD Preferred Brand$30 Retail Copay After PYD50% After In-Network PYD Non-Preferred Brand$50 Retail Copay After PYD50% After In-Network PYD Mail Order Drug (90 Day Supply)2.5x Retail Copays After PYD50% After In-Network PYD 5 © 2016, Gehring Group, Inc., All Rights Reserved || City of Sebastian 2018-2019 Health Reimbursement Account HRA Funding AllotmentFile a Claim HRA Funding for 2018-2019 is as follows:Debit Card Each employee will be provided with a debit card to use for payment of out-of- • $2,500 for Employee only pocket medical expenses. This may prevent the employee from having to pay • $5,000 for Family Coverage • No rollover of unused funds, “Use it or lose it.” required to submit documentation of any expenses that do not match a copay Retain Receipts During the year, employee should keep all receipts and documentation for Paper Claim prescriptions and medical related expenses if needed to verify a claim for received. Claim forms can be submitted via fax to (904) 880-2830, which is indicated on the claims form, or via mail to address listed below. How to Check Available HRA Balance Claims Mailing Address Balance, activity and account history is available anytime online at PO Box 56828, Jacksonville, FL 32241 (888) 537-3539. Expenses Eligible for Reimbursement Employee may request reimbursement of expenses for employee or covered dependent(s). Eligible expenses must be necessary for the diagnosis, (September 30, 2019), or 30 days from the date employee Cosmetic expenses are not eligible for reimbursement. Reimbursement checks will be issued to employee throughout the year for incurred expenses up to participating during the plan year. reimbursement checks direct deposited into employee's bank account. For 6 © 2016, Gehring Group, Inc., All Rights Reserved || City of Sebastian 2018-2019 Dental Insurance Humana Dental PPO Base Plan employees. The costs per pay period for coverage are listed in the premium participating Humana PPO/Traditional Preferred network provider. Humana page. For more detailed information about the dental plan, please refer to the reimburses out-of-network services based on what it determines is the Usual, carrier’s summary plan document or contact Humana’s customer service. area. If services are received from an out-of-network dentist, the member may Dental Insurance – Humana Dental PPO Base Plan 24 Payroll Deductions - Per Pay Period Cost Humana UCR and the amount charged by the out-of-network dental provider. Tier of CoverageSemi-Monthly Monthly This is known as balance billing. Balance billing is in addition to any applicable Employee Only$0.00$0.00 plan deductible or coinsurance responsibility. Employee + Spouse$6.98$13.96 Calendar Year Deductible Employee + Child(ren)$12.14$24.28 The Humana Dental PPO plan requires a $50 individual or a $150 family Employee + Family$19.11$38.22 deductible to be met for in-network or out-of-network services before most services. in-network and out-of-network providers. It is also an open-access plan which allows for services to be received from any dental provider without having to select a Primary Dental Provider (PDP) or obtain a referral to a specialist. covered member is $1,000 for in-network and out-of-network services The network of participating dental providers the plan utilizes is the Humana combined. Diagnostic and preventative services do not accumulate towards PPO/Traditional Preferred network. These participating dental providers have contractually agreed to accept Humana’s contracted fee or “allowed amount.” will be responsible for future charges until next calendar year. This fee is the maximum amount a Humana dental provider can charge a member for a service. The member is responsible for a Calendar Year Deductible Humana | Customer Service: (800) 233-4013 | www.humana.com (CYD) and then coinsurance based on the plan’s charge limitations. 7 © 2016, Gehring Group, Inc., All Rights Reserved || City of Sebastian 2018-2019 Humana Dental PPO Base Plan At-A-Glance NetworkPPO/Traditional Preferred Calendar Year Deductible (CYD)In-NetworkOut-of-Network* Locate a Provider Per Member$50 To search for a participating provider, Per Family$150 contact Humana's customer service Waived for Class I Services?Yes or visit www.humana.com. When completing the necessary search criteria, select PPO/Traditional Preferred network. Per Member$1,000 Class I Services: Diagnostic & Preventive Care Routine Oral Evaluation (2 Per Calendar Year) Plan Pays: 100% Routine Cleanings (2 Per Calendar Year) Plan Pays: 100% Deductible Waived Deductible Waived Bitewing X-rays** (Subject to Balance Billing) Plan References Complete X-rays (1 Set Every 5 Years) *Out-Of-Network Balance Billing: For information regarding out-of- Class II Services: Basic Restorative Care network balance billing that may be Fillings (Amalgam; one (1) per tooth every two (2) years) charged by an out-of-network provider for services rendered, please refer to the Fillings (Composite for Anterior/Front Teeth)Plan Pays: 80% Plan Pays: 80% After CYD After CYD previous page. Simple Extractions (Subject to Balance Billing) Oral Surgery year age 10 and older. Class III Services: Major Restorative Care Periodontal Services Endodontics (Root Canal Therapy) Plan Pays: 50% Plan Pays: 50% Crowns After CYD After CYD (Subject to Balance Billing) Bridges Important Notes Dentures • Each covered member may receive Class IV Services: Orthodontia up to two (2) routine cleanings per calendar year under the preventive Lifetime Maximum$1,000 • Waiting periods and age limitations Plan Pays: 50% (Dependent Children through Age 18)Plan Pays: 50% may apply for some services. (Subject to Balance Billing) • If treatment is going to exceed $300, a pre-treatment plan is recommended. • The above summary is provided as a convenient reference. Additional charges may apply. For a full listing of covered services, exclusions, and stipulations, refer to the carrier’s summary plan document or contact Humana's customer service for 8 © 2016, Gehring Group, Inc., All Rights Reserved || City of Sebastian 2018-2019 Dental Insurance Humana Dental PPO Buy-Up Plan employees. The costs per pay period for coverage are listed in the premium participating Humana PPO/Traditional Preferred network provider. Humana page. For more detailed information about the dental plan, please refer to the reimburses out-of-network services based on what it determines is the Usual, carrier’s summary plan document or contact Humana’s customer service. area. If services are received from an out-of-network dentist, the member may Dental Insurance – Humana Dental PPO Buy-Up Plan 24 Payroll Deductions - Per Pay Period Cost Humana UCR and the amount charged by the out-of-network dental provider. Tier of CoverageSemi-Monthly Monthly This is known as balance billing. Balance billing is in addition to any applicable Employee Only$2.91$5.81 plan deductible or coinsurance responsibility. Employee + Spouse$12.85$25.70 Calendar Year Deductible Employee + Child(ren)$20.20$40.40 The Humana Dental PPO plan requires a $50 individual or a $150 family Employee + Family$30.13$60.26 deductible to be met for in-network or out-of-network services before most services. from in-network and out-of-network providers. It is also an open-access plan which allows for services to be received from any dental provider without having to select a Primary Dental Provider (PDP) or obtain a referral to a covered member is $1,500 for in-network and out-of-network services specialist. The network of participating dental providers the plan utilizes is combined. Diagnostic and preventative services do not accumulate towards the Humana PPO/Traditional Preferred network. These participating dental providers have contractually agreed to accept Humana’s contracted fee or will be responsible for future charges until next calendar year. “allowed amount.” This fee is the maximum amount a Humana dental provider can charge a member for a service. The member is responsible for a Calendar Humana | Customer Service: (800) 233-4013 | www.humana.com Year Deductible (CYD) and then coinsurance based on the plan’s charge limitations. 9 © 2016, Gehring Group, Inc., All Rights Reserved || City of Sebastian 2018-2019 Humana Dental PPO Buy-Up Plan At-A-Glance NetworkPPO/Traditional Preferred Calendar Year Deductible (CYD)In-NetworkOut-of-Network* Locate a Provider Per Member$50 To search for a participating provider, Per Family$150 contact Humana's customer service Waived for Class I Services?Yes or visit www.humana.com. When completing the necessary search criteria, select PPO/Traditional Preferred network. Per Member$1,500 Class I Services: Diagnostic & Preventive Care Routine Oral Evaluation (2 Per Calendar Year) Plan Pays: 100% Routine Cleanings (2 Per Calendar Year) Plan Pays: 100% Deductible Waived Deductible Waived Bitewing X-rays** (Subject to Balance Billing) Plan References Complete X-rays (1 Set Every 5 Years) *Out-Of-Network Balance Billing: For information regarding out-of- Class II Services: Basic Restorative Care network balance billing that may be Fillings (Amalgam; one (1) per tooth every two (2) years) charged by an out-of-network provider Plan Pays: 80% for services rendered, please refer to the Fillings (Composite for Anterior/Front Teeth) Plan Pays: 80% After CYD After CYD Simple Extractions (Subject to Balance Billing) previous page. Oral Surgery Class III Services: Major Restorative Care year age 10 and older. Periodontal Services Endodontics (Root Canal Therapy) Plan Pays: 50% Plan Pays: 50% Crowns After CYD After CYD (Subject to Balance Billing) Bridges Dentures Important Notes • Each covered member may receive Class IV Services: Orthodontia up to two (2) routine cleanings per Lifetime Maximum$1,000 calendar year under the preventive Plan Pays: 50% • Waiting periods and age limitations (Dependent Children through Age 18)Plan Pays: 50% (Subject to Balance Billing) may apply for some services. • If treatment is going to exceed $300, a pre-treatment plan is recommended. • The above summary is provided as a convenient reference. Additional charges may apply. For a full listing of covered services, exclusions, and stipulations, refer to the carrier’s summary plan document or contact Humana's customer service for 10 © 2016, Gehring Group, Inc., All Rights Reserved || City of Sebastian 2018-2019 Vision Insurance Humana Vision 130 Plan The costs per pay period for coverage are listed in the premium table below Employee and covered dependent(s) may also choose to receive services from vision providers who do not participate in the Humana Insight network. more detailed information about the vision plan, please refer to the carrier’s When going out of network, the provider will require payment at the time of summary plan document or contact Humana’s customer service. appointment. Humana will then reimburse based on the plan’s out-of-network reimbursement schedule upon receipt of proof of services rendered. Vision Insurance – Humana Vision 130 Plan Calendar Year Deductible 24 Payroll Deductions - Per Pay Period Cost There is no calendar year deductible. Tier of CoverageSemi-Monthly Monthly Employee Only$0.00$0.00 Calendar Year Out-of-Pocket Maximum Employee + Family$1.79$3.58 maximums for certain services. Humana | Customer Service: (866) 537-0229 | www.humanavisioncare.com care, including eye exams, eyeglasses (lenses and frames) or contact lenses. To schedule an appointment, covered employee and dependent(s) can select any network provider who participates in the Humana Insight network. At the time of service, routine vision examinations and basic optical needs will be covered are additional costs if chosen at the time of the appointment. 11 © 2016, Gehring Group, Inc., All Rights Reserved || City of Sebastian 2018-2019 Humana Vision 130 Plan At-A-Glance NetworkInsight ServicesIn-NetworkOut-of-Network Eye Exam$10 CopayUp To $30 Reimbursement Plan Reimburses Member Material$15 Copay Based on Type of Service Locate a Provider Retinal Imaging Up to $39 CopayNot Covered To search for a participating provider, Frequency of Services Per Calendar Year contact Humana’s customer service or visit www.humanavisioncare.com. Examination 12 Months When completing the necessary search criteria, select Humana Insight Lenses 12 Months network. Frames 24 Months Contact Lenses 12 Months Lenses Single$15 CopayUp To $25 Reimbursement Plan References Bifocal$15 CopayUp To $40 Reimbursement *Contact lenses are in lieu of spectacle Trifocal$15 CopayUp To $60 Reimbursement lenses and a frame. Frames Up to $130 Retail Allowance, Allowance Up To $65 Reimbursement Contact Lenses*Important Notes • Member options, such as LASIK, UV Non-Elective (Medically Necessary)No ChargeUp To $200 Reimbursement coating, progressive lenses, etc. are not Up to $130 Allowance, covered in full, but may be available at Elective Up To $104 Reimbursement a discount. Fit and Follow Up Up to $55 AllowanceNot Covered 12 © 2016, Gehring Group, Inc., All Rights Reserved || City of Sebastian 2018-2019 Flexible Spending Accounts employee to set aside money from employee's paycheck for reimbursement of health care and day care expenses they regularly pay. The amount set aside is not taxed and is automatically deducted from the employee’s paycheck and deposited into the FSA. During the year, employee has access to this account for reimbursement of some expenses not covered by insurance. Participation in an FSA allows for substantial tax savings and an increase in spending power. Participating employee must re-elect the dollar amount to be deducted each plan year. There are two (2) types of FSAs: Health Care FSADependent Care FSA This account allows participants to set aside up to an annual This account allows participants to set aside up to an annual maximum of $5,000 if single maximum of $2,650. This money will not be taxable income wide variety of eligible medical expenses that generate and before/after school care for eligible children and dependent adults. out-of-pocket costs. Participating employee can also receive Please note that if a family’s income is over $20,000, this reimbursement option will reimbursement for expenses related to dental and vision likely save participants more money than the dependent day care tax credit taken on a tax return. To qualify, dependents must be: Examples of common expenses that qualify for • A child under the age of 13, or reimbursement are listed below. • A child, spouse or other dependent that is physically or mentally incapable of self-care and spends at least eight (8) hours a day in the participant’s household. Please Note: The entire Health Care FSA election is available for use on Please Note: Unlike the Health Care FSA, reimbursement is only up to the amount that has been deducted from the participant’s paycheck for the Dependent Care FSA. Ambulance Service Experimental Medical Treatment Nursing Services Chiropractic Care Corrective Eyeglasses And Contact Lenses Optometrist Fees Dental and Orthodontic FeesHearing Aids and ExamsPrescription Drugs Diagnostic Tests/Health ScreeningsInjections and VaccinationsSunscreen SPF 15 or Greater LASIK SurgeryWheelchairs Drug Addiction/Alcoholism TreatmentMental Health Care 13 © 2016, Gehring Group, Inc., All Rights Reserved || City of Sebastian 2018-2019 Flexible Spending Accounts (Continued) FSA Guidelines • Employee may rollover $500 of unused Health Care FSA funds into HERE’S HOW IT WORKS! the next plan year after a plan year ends and all claims have been Employee earning $30,000 elects to place $1,000 into a Health • The Health Care FSA has a run out period at the end of the plan year Care FSA. The payroll deduction is $41.66 based on a 24 pay period (90 days) to submit reimbursement on eligible expenses incurred schedule. As a result, the insurance premiums and health care during the period of coverage within the plan year (October 1 – expenses are paid with tax-free dollars, giving the employee a tax September 30). savings of $227. • exception of the $500 rollover for the Health Care FSA, all unused With a Health Without a Health funds will be forfeited and not be returned. Care FSACare FSA • Employee can enroll in either or both of the FSAs only during the Salary$30,000$30,000 Open Enrollment period, a Qualifying Event, or New Hire Eligibility FSA Contribution- $1,000- $0 period. Taxable Pay$29,000$30,000 • Money cannot be transferred between FSAs. Estimated Tax - $6,568- $6,795 22.65% = 15% + 7.65% FICA • Reimbursed expenses cannot be deducted for income tax purposes. After Tax Expenses- $0- $1,000 • Employee and dependent(s) cannot be reimbursed for services not Spendable Income$22,432$22,205 received. • Tax Savings $227 any other compensation for expenses reimbursed through an FSA. • Domestic Partners are not eligible as Federal law does not recognize Filing a Claim Please Note: Be conservative when estimating health care and/or dependent care expenses. IRS regulations state that any unused funds remaining in an FSA, Claim Form A completed claim form along with a copy of the receipt as proof of the or carried forward to the next plan year, with the exception of the $500 rollover expense can be submitted by mail or fax. The IRS requires FSA participants to that may be allowed for the Health Care FSA. This rule is known as “use it maintain complete documentation, including copies of receipts for reimbursed or lose it”. expenses, for a minimum of one (1) year. Debit Card FSA participants will automatically receive a debit card for payment of eligible Claims Mailing Address | P.O. Box 56828 | Jacksonville, FL 33421 Claims Fax | (904) 880-2830 the point of sale versus paying out-of-pocket and requesting reimbursement. The debit card is accepted at a number of medical providers and facilities, and | Customer Service: (888) 537-3539 documentation for expenses paid with a debit card. Failure to provide supporting documentation when requested, may result in suspension of the card and account until funds are substantiated or refunded back to the City. card for use next year. Additional or replacement cards may be requested, however, a small $5 fee may apply. 14 © 2016, Gehring Group, Inc., All Rights Reserved || City of Sebastian 2018-2019 Employee Assistance ProgramBasic Life and AD&D Insurance Basic Term Life Insurance provides at no cost, a comprehensive Employee Assistance Program (EAP) The City provides Basic Term Life insurance to all eligible full-time employees working a minimum of 30 hours per week, at no cost, through Lincoln Financial each family member access to licensed mental health professionals through Accidental Death & Dismemberment Insurance locate the best professional help for a particular problem, and decide upon a Also, at no cost to employee, the City provides Accidental Death & Dismemberment (AD&D) insurance, which pays in addition to the Basic Term What is an Employee Assistance Program (EAP)? Age Reduction Schedule members/domestic partners free and convenient access to a range of › › includes six (6) face-to-face visits with a specialist, per person, per issue, per Life Insurance Imputed Income The IRS requires that the imputed cost of employer paid employee life counseling services on issues such as: insurance, in excess of $50,000, must be included in income and is subject to Child Care ResourcesWork Related Issues Social Security and Medicare taxes. Legal ResourcesAdult & Elder Care Assistance Grief and BereavementFinancial Resources Stress ManagementFamily and/or Marriage Issues through BenTek. Depression and AnxietySubstance Abuse Lincoln Financial Group | Customer Service: (800) 423-2765 | www.lfg.com in the EAP is a direct result of a Management Referral (a referral initiated by a supervisor or manager), we will ask permission to communicate certain aspects of the employee’s care (attendance at sessions, adherence to treatment plans, etc.) to the referring supervisor/manager. The referring supervisor will not, The supervisor will only receive reports on whether the referred employee is complying with the prescribed treatment plan. Lincoln Financial Group Customer Service: (855) 327-4463 | www.guidanceresources.com 15 © 2016, Gehring Group, Inc., All Rights Reserved || City of Sebastian 2018-2019 Voluntary Life and AD&D Insurance Voluntary Employee Life and AD&D Insurance Voluntary Life and AD&D Insurance Rate Table Monthly Premium Eligible employee may elect to purchase additional Life and AD&D insurance on a voluntary basis through Lincoln Financial Group. This coverage may be Age Bracket Employee/Spouse purchased in addition to the Basic Term Life and AD&D coverage. Voluntary Life (Based On Employee Age) Under Age 30$0.13 30 - 34$0.17 35 - 39$0.20 New Hires may purchase Voluntary Employee Life insurance without 40 - 44$0.30 having to go through Medical Underwriting, also known as Evidence 45 - 49$0.46 of Insurability (EOI), up to the Guaranteed Issue amount of 50 - 54$0.71 $100,000. 55 - 59$1.17 60 - 64$1.21 • Units can be purchased in increments of $10,000 to the maximum 65 - 69$2.64 70 - 74$4.31 • 75 +$7.13 › › Voluntary Dependent Child(ren) Life Insurance Voluntary Spouse Life and AD&D Insurance • Employee must participate in the Voluntary Employee Life plan for dependent child(ren) to participate. • Dependent child(ren), 14 days old up to six (6) months of age, may New Hires may purchase Voluntary Spouse Life insurance without having to go through Medical Underwriting, also known as Evidence of Insurability (EOI), up to the Guaranteed Issue amount of • Dependent child(ren), six (6) months old up to age 19 (or age 25 if a $30,000. up to a maximum amount of $10,000. Lincoln Financial Group | Customer Service: (800) 423-2765 | www.lfg.com • Employee must participate in the Voluntary Employee Life plan for spouse to participate. • Units can be purchased in increments of $5,000 to a maximum of $250,000 not to exceed 50% of the employee’s Voluntary Life coverage amount. • schedule: › › • Spouse life insurance rate is based on employee age. 16 © 2016, Gehring Group, Inc., All Rights Reserved || City of Sebastian 2018-2019 Long Term DisabilitySupplemental Insurance The City provides Long Term Disability (LTD) insurance at no cost to employee, who has completed one (1) year of service, through Lincoln Financial Group.be purchased separately on a voluntary basis and premiums paid by payroll deduction. Allstate pays money directly to employees, regardless of what disabled due to an illness or non-work related injury.other insurance plans they may have. To learn more about these Allstate plans and/or to schedule a personal appointment, contact the local Allstate agent. Details regarding available Allstate plans and services are also available online • Available Allstate plans include coverages for: • Employee must be disabled for 90 consecutive days prior to Group Critical Illness Insurance period). Group Accident Insurance • Group Voluntary Disability Insurance • Cancer Insurance time of disability. Allstate | Customer Service: (888) 546-3193 • Lincoln Financial Group | Customer Service: (800) 423-2765 | www.lfg.com 17 © 2016, Gehring Group, Inc., All Rights Reserved || City of Sebastian 2018-2019 Legal & Identity Protection PlansRetirement Plans insurance program provided by U.S. Legal Services. By enrolling in the Family The Chapter 185 Pension Plan is available only for full-time permanent sworn Defender plan, participants will have direct access to attorneys who will provide services for a variety of situations that include: information regarding contributions to the plan. DivorceName Changes Child Custody & Criminal Defense Sebastian. For additional information, refer to the Plan documents. Support Adoption Wills & Living Trusts CWA/ITU Negotiated Pension Plan Civil Litigation Real Estate The employees covered by the PEA Union bargaining Unit are eligible for Bankruptcy Contract Review plan. The City contributes to the plan for each regular full-time employee The cost to the employee to participate in this legal plan is $16.90 per month for covered under the bargaining unit. employee only coverage or $21.50 per month for family coverage (dependents and face-to-face consultations with the attorney, and much more. with the City of Sebastian. For additional information, refer to the Plan documents. Identity Theft Protection Identity Defender can be added to the legal insurance plan for $9.95 per Tax Deferred Individual Pension Plans All employees of the City of Sebastian are eligible to participate in the ICMA (457) Deferred Compensation Plan. All exempt management personnel Protection Experts available to assist with identity theft matters 24/7. Experts participate in a 401A Plan. A representative of ICMA periodically visits the complete all paperwork and make all calls to ensure your identity is restored. Members have access to an online dashboard and mobile app for continuous monitoring and alerts. Covered identity services include, but are not limited to: IRA and Roth IRA Plans. Employee contributions can be made through payroll deduction. Advanced Fraud MonitoringStolen Funds Reimbursement Change of Address MonitoringIdentity Theft Insurance ($1 million)* Credit & Debit Card MonitoringIdentity Restoration* Dark Web Monitoring*Credit Monitoring Fraud Alert RemindersMobile App Medical ID Fraud ProtectionTwo Adults & Unlimited Dependent Children Smart SSN Tracker* Covered** Lost Wallet *Covered for dependents under ChildWatch **Dependents must be under 26 years old and live in the policy holder’s residence. To learn about the plan, please contact the City’s U.S. Legal Services’ representative, Dixie Kuehn, using the contact information provided below. U.S. Legal Services | www.uslegalservices.net 18 © 2016, Gehring Group, Inc., All Rights Reserved || City of Sebastian 2018-2019 Probationary Period All regular full-time and part-time employees are on a six (6) month introductory period from date of hire. Direct Deposit Employees may have paycheck directly deposited to any bank, savings and loan or credit union which is ACH approved. Supplemental Insurance Upon employment with the City and during Open Enrollment for insurance, representatives of Allstate will meet with employees to discuss various types of supplemental insurances that may be purchased on a voluntary basis at employee cost. Supplemental Insurance premium payments may be payroll deducted. Leave Policies Paid HolidaysPersonal Leave The holidays celebrated by the City of Sebastian on an annual basis are Regular full-time employees are entitled to personal leave. Request for provided below.personal leave is subject to Department Head approval. Please refer to the • New Year’s Day• Veteran’s Day • Martin Luther King, Jr. Day• Thanksgiving Day Bereavement Leave • President’s Day• Day After Thanksgiving Bereavement Leave is available for employees to arrange and/or attend the • Memorial Day • Christmas Eve Day funeral of an immediate family member. Please refer to the appropriate • Independence Day• Christmas Day • Labor Day newspaper, obituary). Annual Leave Annual leave accrues at the rate of 10 days per year for full-time employees Jury Duty and at a pro-rated rate for regular part-time employees. The rate increases Supervisor. Employees of the City will receive their normal earnings while leave is subject to Department Head approval. serving jury duty. Please refer to the appropriate bargaining agreements for Sick Leave Sick leave begins accruing from date of hire. New employees may not use sick Regular Part-Time Employee 19 © 2016, Gehring Group, Inc., All Rights Reserved || City of Sebastian 2018-2019 Notes 20 © 2016, Gehring Group, Inc., All Rights Reserved 4200 Northcorp Parkway, Suite 185 Palm Beach Gardens, Florida 33410 Toll Free: (800) 244-3696 | Fax: (561) 626-6970 www.gehringgroup.com FINAL © 2016, Gehring Group, Inc., All Rights Reserved