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HomeMy WebLinkAbout2020-2021 - Employee Benefit HighlightsCity of Sebastian I Employee Benefit Highlights 2020-2021 Contact Information ............................................................................................................................................................................................ Human Resources Cynthia Watson . Phone: (772) 388-8222 HR Manager Email: cwatson@cityofsebastian.org ................ (888) 5-Bentek (523-6835) Online Benefit Enrollment Bentek Support www.mybentek.com/sebastian ................. ........................................................................ Email: support@mybentek.com ........................................... ......... Medical Insurance Florida Blue Customer Service: (800) 345-3885 www.floridablue.com .................... Prescription Drug Coverage Alliance RxWalgreens Prime Customer Service: (888) 849-7865 & Mail -Order Program www.floridablue.com EM Health Reimbursement Account BenefitsWorkshop Customer Service: (888) 537-3539 .................................. www.benefitsworkshop.com/sebastian _ Dental Insurance Humana Customer Service: (800) 233-4013 ..... ....... . www.humana.com ® Vision Insurance Humana Customer Service: (866) 537-0229 www.humana.com is Flexible Spending Accounts BenefitsWorkshop Customer Service: (888) 537-3539 .................... www.benefitsworkshop.com/sebastian Basic Life and AD&D Insurance Lincoln Financial Group Customer Service: (800) 423-2765 040 www.lfg.com for Voluntary Life and AD&D Insurance Lincoln Financial Group Customer Service: (800) 423-2765 ..... .................................................................................................. www.lfg.com .. -- Long Term Disability Insurance Lincoln Financial Group Customer Service: (800) 423-2765 www.lfg.com Employee Assistance Program Lincoln Financial Group Customer Service: (855) 327-4463 www.guidanceresources.com Agent: Artie Hoffman I Cell: (954) 609-4924 Supplemental Insurance Allstate Email: benefitsuniverse@gmail.com Customer Service: (800) 521-3535 www.allstatebenefits.com/mybenefits Agent: Dixie Kuehn I Cell: (321) 403-0156 Legal Insurance US Legal Services Email: dixiekuehn@cfl.rr.com Customer Service: (800) 356-5297 www.uslegalservices.net Table of Contents Introduction Online Benefit Enrollment Group Insurance Eligibility Qualifying Events and Section 125 Summary of Benefits and Coverage Medical Insurance Group Insurance Premiums Opt Out Benefit Other Available Plan Resources Telehealth Florida Blue HRA BlueOptions 5190/5191 Plan At-A-Glan Health Reimbursement Account Dental Insurance Humana Dental PPO Base Plan At -A -Glance Humana Dental PPO Buy -Up Plan At -A -Glance Vision Insurance Humana Vision 130 Plan At -A -Glance Flexible Spending Accounts Employee Assistance Program Basic Life and AD&D Insurance Voluntary Life and AD&D Insurance Long Term Disability Supplemental Insurance Legal & Identity Protection Plans Retirement Plans Miscellaneous Benefits Leave Policies Notes 1 1 2 3 3 4 4 4 4 4 ce 5 6 7 8 10 11 12 13-14 15 15 16 17 17 18 18 19 19 20 This booklet is merely a summary of employee benefits. For a full description, refer to the plan document. Where conflict exists between this summary and the plan document, the plan document controls. The City of Sebastian reserves the right to amend, modify or terminate the plan at anytime. This booklet should not be construed as a guarantee of employment. c;lCity of Sebastian I Employee Benefit Highlights 2020-2021 CITY OF __.�PASTIA:, 4i I—IOM E OF PELICAN ISLAND Introduction The City of Sebastian provides group insurance benefits to eligible employees. The Employee Benefit Highlights Booklet provides a general summary of the benefit options as a convenient reference. Please refer to the City's Personnel Policies and/or Certificates of Coverage for detailed descriptions of all available employee benefit programs and stipulations therein. If an employee requires further explanation or needs assistance regarding claims processing, please refer to the customer service phone numbers under each benefit description heading or contact Human Resources for further information. Benefits are subject to change contingent upon availability of funds. Online Benefit Enrollment The City provides employees with an online benefits enrollment platform through Bentek's Employee Benefits Center (EBC). The EBC provides benefit -eligible employees the ability to select or change insurance benefits online during the annual Open Enrollment Period, New Hire Orientation, or for Qualifying Life Events. Accessible 24 hours a day, throughout the year, employee may log in and review comprehensive information regarding benefit plans, and view and print an outline of benefit elections for employee and dependent(s). Employee also has access to important forms and carrier links, can report qualifying life events and review and make changes to Life insurance beneficiary designations. .O. O i O BOO® ©_a -- 44 To Access the Employee Benefits Center: ............................................................................... ✓ 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 using the Launchpad to review current enrollment, learn about benefit options, and make any benefit changes or update beneficiary designations. 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. To access Employee Benefits Center online, log on to: www.mybentek.com/sebastian Please Note: Link must be addressed exactly as written. Due to security reasons, the website cannot be accessed by 600gle or othersearch engines. 4 City of Sebastian I Employee Benefit Highlights 1 2020-2021 Group Insurance Eligibility The 0ity'6 9rour w6uranoe clan year 16 n Datolber I through Sertember 30. Employee Eligibility Employees are eligible to participate in the City's insurance plans if they are full-time employees working a minimum of 40 hours per week. Part-time employees working a minimum of 30 hours per week may participate in the City's medical plan only. Coverage will be effective the first of the month following 60 days of employment. For example, if an employee is hired on April 11, then the effective date of coverage will be July 1. Separation of Employment 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. Dependent Eligibility A dependent is defined as the legal spouse/domestic partner and/or dependent child(ren) of the participant or spouse/domestic partner. The term "child" includes any of the following: • A natural child • A stepchild A legally adopted child • A newborn child (up to the age of 18 months old) of a covered dependent (Florida) • A child for whom legal guardianship has been awarded to the participant or the participant's spouse/domestic partner. Dependent Age Requirements 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 the end of the calendar year in which the child reaches age 30, if the dependent meets the following requirements: • Unmarried with no dependents; and • A Florida resident, or full-time or part-time student; and • Otherwise uninsured; and • Not entitled to Medicare benefits under Title XVIII of the Social Security Act, unless the child is disabled. Dental and Vision Coverage: A dependent child may be covered through the end of the calendar year in which the child turns age 26. Disabled Dependents Coverageforan unmarried dependentchild may be continued beyond age 26 if: • The dependent is physically or mentally disabled and incapable of self-sustaining employment (prior to age 26); and • Primarily dependent upon the employee for support; and • The dependent is otherwise eligible for coverage under the group medical plan; and • The dependent has been continuously insured; and • Coverage with the City began prior to age 26. Proof of disability will be required upon request, including a medical examination, no more than once per year. Please contact Human Resources if further clarification is needed. 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. Domestic Partner Coverage Domestic partners may be eligible to participate in the City's group insurance plans if the partner is officially registered as a domestic partner with the City. The IRS 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. OV City of Sebastian I Employee Benefit Highlights 2020-2021 • Qualifying Events and Section 125 Section 125 of the Internal Revenue Code Premiums for medical, dental, vision insurance, contributions to Flexible Spending Accounts (FSA), and/or certain supplemental policies are deducted 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 an employee's pre-tax benefits can be made ONLY during the Open Enrollment period unless the employee or qualified dependent(s) experience(s) a Qualifying Event and the request to make a change is made within 30 days of the Qualifying Event. Under certain circumstances, employee may be allowed to make changes to benefit elections during the plan year, if the event affects the employee, spouse or dependent's coverage eligibility. An "eligible"Qualifying Event is determined by Section 125 of the Internal Revenue Code. Any requested changes must be consistent with and due to the Qualifying Event. Examples of Qualifying Events: • 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) • Loss or gain of coverage due to employee, employee's spouse and/or dependent(s) termination or start of 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 other parent or legal guardian • Change of coverage under an employer's plan • Gain or loss of Medicare coverage • Losing or becoming eligible for coverage under a State Medicaid or CHIP (including Florida Kid Care) program (60 day notification period) I IMPORTANT NOTES • ............................................................................... 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, requests will be denied and employee may be responsible, both legally and financially, for any claim and/or expense incurred as a result of employee or dependent who continues to be enrolled but no longer meets eligibility requirements. If approved, changes will be effective on the date of the Qualifying Event or the first of the month following the Qualifying Event. Newborns are effective on the date of birth. Cancellations will be processed at the end of the month. In the event of death, coverage terminates the date following the death. Employee may be required to furnish valid documentation supporting a change in status or"Qualifying Event." Summary of Benefits and Coverage A Summary of Benefits & Coverage (SBC) for the Medical Plan is provided as a supplement to this booklet being distributed to new hires and existing employees during the Open Enrollment period. The summary is an important item in understanding the employee's benefit options. Afree papercopy of the SBC document may be requested or is available as follows: ............................................................................... From: Human Resources Address: 1225 Main Street Sebastian, FL 32958 Phone: (772)388-8222 Email: cwatson@cityofsebastian.org Website URL: www.cityofsebastian.org www.mybentek.com/sebastian The SBC is only a summary of the plan's coverage. A copy of the plan document, policy, or certificate of coverage should be consulted to determine the governing contractual provisions of the coverage. A copy of the group certificate of coverage can be reviewed and obtained by contacting Human Resources. If there are questions about the plan offerings or coverage options, please contact Human Resources at (772) 388-8222. ft City of Sebastian I Employee Benefit Highlights 2020-2021 co Medical Insurance The City offers medical insurance through Florida Blue to benefit -eligible employees. The costs per pay period for coverage are listed in the premium table below and a brief summary of benefits is provided on the following page. For more detailed information about the medical plan, please refer to the carrier's Summary of Benefits and Coverage (SBC) document or contact Florida Blue's customer service. Medical Insurance Florida Blue HRA BlueOptions 5190/5191 Plan 24 Payroll Deductions - Per Pay Period Cost Employee Only $12.50 $25.00 Employee + Spouse $152.52 $305.04 Employee + Child(ren) $99.73 $199.46 Employee + Family $236.59 $473.18 Other Available Plan Resources Florida Blue offers all enrolled employees and dependents additional services and discounts through value added programs. For more details regarding other available plan resources, please refer to the Summary of Benefits and Coverage (SBC) document or contact Florida Blue's customer service at (800) 345-3885. BIue365 BIue365 is provided automatically at no additional cost and offers access to discounted products and services at participating providers. Members can log on to www.floridablue.com to learn more about these programs or call (800)345-3885. ✓ Fitness club ✓ Alternative medicine memberships, exercise ✓ Elder care advisory footwear and apparel services ✓ Vision care, glasses, and ✓ Hotel rooms and travel contact lenses information ✓ Hearing care and aids ✓ Weight loss management Florida Blue I Customer Service: (800) 345-3885 1 www.floridablue.com The Florida Blue Mobile App Group Insurance Premiums All benefit -eligible employees who participate in the group medical insurance coverage, shall pay $25.00 per month. The City pays 100% of the premium cost for all benefit -eligible employees for dental, vision, life and long term disability group insurance coverages. The City also pays 100% of the cost for an Employee Assistance Program which is provided to all benefit -eligible employee and dependent(s). Opt Out Benefit The City provides an "opt out" program for all eligible employees who elect not to take the medical insurance offered by the City. Employee must provide proof of other medical insurance coverage in order to qualify for this program. Qualifying employee will receive a taxable payment of $75 semi-monthly (24 pay periods) for this waiver. Florida Blue's mobile website can be accessed from any smartphone or download the app from the iPhone° or Android TM with just a tap! Visit the smartphone's app store and search for Florida Blue or visit http://apps.floridablue.com. Telehealth Florida Blue provides access to telehealth services as part of the medical plan. Teladoc is a convenient phone and video consultation company that provides immediate medical assistance for many conditions. The benefit is provided to all enrolled members. Registration is required and should be completed ahead of time. This program allows members 24 hours a day, seven (7) days a week on -demand access to affordable medical care via phone and online video consultations when needing immediate care for non - emergency medical issues. Telehealth should be considered when employee's primary care doctor is unavailable, after-hours or on holidays for non -emergency needs. Many urgent care ailments can be treated with telehealth, such as: ✓ Sore Throat ✓ Fever ✓ Rash ✓ Headache ✓ Cold And Flu ✓ Acne ✓ Stomachache ✓ Allergies ✓ UTIs And More Telehealth doctors do not replace employee's primary care physician but may be a convenient alternative for urgent care and ER visits. For further information please contact Teladoc. Teladoc I Customer Service: (800) 835-2362 1 www.teladoc.com 0 Locate a Provider To search for a participating provider, contact Florida Blue's customer service or visit www.floridablue.com. When completing the necessary search criteria, select BlueOptions network. Plan References *Deductible is shared for all individuals of the family. "Out -Of -Network Balance Billing: For information regarding out -of - network balance billing that may be charged by out -of -network providers, please refer to the Summary of Benefits and Coverage (SB() document. ***Quest is the preferred lab for bloodwork through Florida Blue. When using a lab other than Quest please confirm they are contracted with Florida Blue's BlueOptions network. City of Sebastian I Employee Benefit Highlights 2020-2021 Florida Blue HRA BlueOptions 5190/5191 Plan At -A -Glance Plan Year Deductible (PYD)* Single Family Coinsurance Member Responsibility Plan Year Out -of -Pocket Limit Single Family What Applies to the Out -of -Pocket Limit? Physician Services Primary Care Physician (P(P) Office Visit Specialist Office Visit Telehealth Services Non -Hospital Services; Freestanding Facility Clinical Lab (Bloodwork)*** X-rays Advanced Imaging (MRI, PET (T) Outpatient Surgery in Surgical Center Physician Services at Surgical Center Urgent Care (Per Visit) Hospital Services ****PAD: PerAdmission Deductible Inpatient Hospital (PerAdmission) Outpatient Hospital Physician Services at Hospital Emergency Room (Per Visit) Mental Health/Alcohol & Substance Abuse Inpatient (PerAdmission; Prior Authorization May Be Required) Outpatient (PerAdmission; Prior Authorization May Be Required) Prescription Drugs (Rx) Generic Preferred Brand Non -Preferred Brand Mail Order Drug (90DaySupply) In -Network $1,500 $3,000 20% Out -of -Network** $3,000 $6,000 40% $4,500 $9,000 $6,850 Per Person $18,000 Per Person $9,000 Per Family $18,000 Per Family Deductible, Coinsurance, Copays and Rx 20% After PYD 20% After PYD 20% After PYD 0% After PYD 20% After PYD 20% After PYD 20% After PYD 20% After PYD 20% After PYD Option 1: Option 2: 20% After PYD 25%After PYD Option 1: Option 2: 20% After PYD 25%After PYD 20% After PYD 20% After PYD 20% After PYD 20% After PYD $10 Retail Copay After PYD $30 Retail Copay After PYD $50 Retail Copay After PYD 2.5x Retail Copays After PYD 40% After PYD 40% After PYD 40% After PYD 40% After PYD 40% After PYD 40% After PYD 40% After PYD 40% After PYD 20% After PYD $500 PAD**** + 40% After PYD 40% After PYD 20% After In -Network PYD 20% After PYD 20% After In -Network PYD 40% After PYD 50%After In -Network PYD 50%After In -Network PYD 50%After In -Network PYD 50%After In -Network PYD Health Reimbursement Account The City provides employees who participate in the Florida Blue HRA BlueOptions 5190/5191 Plan, a Health Reimbursement Account (HRA) through BenefitsWorkshop. HRA monies are funded by the City and can be used for any qualified medical expenses such as deductibles, coinsurance and copayments for physician services, hospital services, prescription drugs, etc. The HRA monies provide tax-free funds to cover qualified out-of-pocket expenses incurred under the medical plan. Please Note: The HRA funds are allocated specifically for medical plan expenses ONLY and cannot be used for other IRS 213.d expenses such as dental or vision. HRA Funding Allotment HRA Funding for 2020-2021 is as follows: • $2,500 for Employee only • $5,000 for Family Coverage • No rollover of unused funds Retain Receipts During the year, employee should keep all receipts and documentation for prescriptions and medical related expenses if needed to verify a claim for BenefitsWorkshop or for IRS taxes. If asked to produce documentation, a valid Explanation of Benefits (EOB) and receipt of payment for the services rendered will be sufficient. How to Check Available HRA Balance Balance, activity and account history is available anytime online at www.benefitsworkshop.com/sebastian or by calling BenefitsWorkshop at (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, treatment, cure, mitigation or prevention of a specific medical condition. Cosmetic expenses are not eligible for reimbursement. Reimbursement checks will be issued to employee throughout the year for incurred expenses up to the maximum annual benefit amount. Employee has the option to have reimbursement checks direct deposited into employee's bank account. For more information regarding eligible expenses, visit BenefitsWorkshop online at www.benefitsworkshop.com/sebastian. File a Claim Debit Card Each employee will be provided with a debit card to use for payment of out-of- pocket medical expenses. This may prevent the employee from having to pay an expense first and then seek reimbursement. However, employee may be required to submit documentation of any expenses that do not match a charge associated with a specific service under the plan. Paper Claim Employee may submit claim forms to BenefitsWorkshop and must include a copy of carrier's Explanation of Benefits or receipts for eligible medical services 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. Claims Mailing Address PO Box 56828, Jacksonville, FL 32241 BenefitsWorkshop Customer Service: (888) 537-3539 1 www.benefitsworkshop.com/sebastian All claims must be filed within 90 days after the plan year ends (September 30, 2021), or 30 days from the date employee becomes ineligible to file for expenses incurred while participating during the plan year. Dental Insurance Humana Dental PPO Base Plan The City offers dental insurance through Humana to benefit -eligible employees. The costs per pay period for coverage are listed in the premium table below and a brief summary of benefits is provided on the following page. For more detailed information about the dental plan, please refer to the carrier's summary plan document or contact Humana's customer service. Dental Insurance — Humana Dental PPO Base Plan 24 Payroll Deductions - Per Pay Period Cost Employee Only $0.00 $0.00 Employee + Spouse $8.21 $16.42 Employee + Child(ren) $14.28 $28.56 Employee + Family $22.48 $44.96 In -Network Benefits The Humana Dental PPO Base plan provides benefits for services received 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 specialist. The network of participating dental providers the plan utilizes is the Humana PPO/Traditional Preferred network. These participating dental providers have contractually agreed to accept Humana's contracted fee or"allowed amount" This fee is the maximum amount a Humana dental provider can charge a member for a service. The member is responsible fora CalendarYear Deductible (CYD) and then coinsurance based on the plan's charge limitations. City of Sebastian I Employee Benefit Highlights 2020-2021 Out -of -Network Benefits Out -of -network benefits are used when member receives services by a non- participating Humana PPO/Traditional Preferred network provider. Humana reimburses out -of -network services based on what it determines is the Usual, Customary & Reasonable (UCR) charge.The UCR is defined as the most common charge for a particular dental procedure performed in a specific geographic area. If services are received from an out -of -network dentist, the member may be responsible for balance billing. Balance billing is the difference between the Humana UCR and the amount charged by the out -of -network dental provider. This is known as balance billing. Balance billing is in addition to any applicable plan deductible or coinsurance responsibility. Calendar Year Deductible The Humana Dental PPO Base plan requires a $50 individual or a $150 family deductible to be met for in -network or out -of -network services before most benefits will begin. The deductible is waived for preventive and orthodontia services. Calendar Year Benefit Maximum The maximum benefit (coinsurance) the Humana Dental PPO Base plan will pay for each covered member is $1,000 for in -network and out -of -network services combined. Diagnostic and preventive services do not accumulate towards the benefit maximum. Once the plan's benefit maximum is met, the member will be responsible for future charges until next calendar year. Humana I Customer Service: (800) 233-4013 1 www.humana.com City of Sebastian I Employee Benefit Highlights 2020-2021 col Humana Dental PPO Base Plan At -A -Glance Calendar Year Deductible (CYD) In -Network Out -of -Network* Per Member $50 Per Family $150 Waived for Class I Services? Yes Calendar Year Benefit Maximum Per Member $1,000 Class I Services: Diagnostic & Preventive Care Routine Oral Evaluation (2 Per Calendar Year) Routine Cleanings (2 Per Calendar Year) Plan Pays:100% Plan Pays:100% BitewingX-rays" Deductible Waived Deductible Waived (Subject to Balance Billing) Complete X-rays (1 Set Every 5 Years) Class II Services: Basic Restorative Care Fillings (Amalgam, one (1) per tooth every two (2) years) Fillings ositeforAnterior/Front Teeth) Plan Pas 80% 9 p Plan Pays: 80% y Simple Extractions After CYD After CYD (Subject to Balance Billing) Oral Surgery Class III Services: Major Restorative Care Periodontal Services Endodontics (Root Canal Therapy) o Plan Pays:50% Plan Pays: 50% Crowns After CYD After CYD Bridges (Subject to Balance Billing) Dentures Class IV Services: Orthodontia Lifetime Maximum $1,000 Benefit (Dependent Children through Age 18) Plan Pays:50% Plan Pays:50% (Subject to Balance Billing) 0 Locate a Provider To search for a participating provider, contact Humana's customer service or visit www.humana.com. When completing the necessary search criteria, select PPO/Traditional Preferred network. Plan References *Out -Of -Network Balance Billing: For information regarding out -of - network balance billing that maybe charged by an out -of -network provider, please refer to the Out -of -Network Benefits section on the previous page. . "Bitewing X-rays: Two (2) films per year under age 10. Four (4) films per year age 10 and older. Important Notes • Each covered member may receive up to two (2) routine cleanings per calendar year under the preventive benefit. • Waiting periods and age limitations may apply for some services. • If treatment is going to exceed $300, a pre-treatment plan is recommended. • The above summaryis provided as a convenient reference. Additional charges may apply. Fora full listing of covered services, exclusions, and stipulations, refer to the carrier's summary plan document or contact Human's customer service for details specific to a procedure. Dental Insurance Humana Dental PPO Buy -Up Plan The City offers dental insurance through Humana to benefit -eligible employees. The costs per pay period for coverage are listed in the premium table below and a brief summary of benefits is provided on the following page. For more detailed information about the dental plan, please refer to the carrier's summary plan document or contact Humana's customer service. Dental Insurance — Humana Dental PPO Buy -Up Plan 24 Payroll Deductions - Per Pay Period Cost Employee Only $3.42 $6.84 Employee + Spouse $15.11 $30.22 Employee + Child(ren) $23.76 $47.52 Employee + Family $35.44 $70.88 In -Network Benefits The Humana Dental PPO Buy -Up plan provides benefits for services received 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 specialist. The network of participating dental providers the plan utilizes is the Humana PPO/Traditional Preferred network. These participating dental providers have contractually agreed to accept Humana's contracted fee or "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 Year Deductible (CYD) and then coinsurance based on the plan's charge limitations. City of Sebastian I Employee Benefit Highlights 2020-2021 Out -of -Network Benefits Out -of -network benefits are used when member receives services by a non- participating Humana PPO/Traditional Preferred network provider. Humana reimburses out -of -network services based on what it determines is the Usual, Customary & Reasonable (UCR) charge.The UCR is defined as the most common charge for a particular dental procedure performed in a specific geographic area. If services are received from an out -of -network dentist, the member may be responsible for balance billing. Balance billing is the difference between the Humana UCR and the amount charged by the out -of -network dental provider. This is known as balance billing. Balance billing is in addition to any applicable plan deductible or coinsurance responsibility. Calendar Year Deductible The Humana Dental PPO Buy -Up plan requires a $50 individual or $150family deductible to be met for in -network or out -of -network services before most benefits will begin. The deductible is waived for preventive and orthodontia services. Calendar Year Benefit Maximum The maximum benefit (coinsurance) the Humana Dental PPO Buy -Up plan will pay for each covered member is $1,500 for in -network and out -of -network services combined. Diagnostic and preventive services do not accumulate towards the benefit maximum. Once the plan's benefit maximum is met, the member will be responsible for future charges until next calendar year. Humana I Customer Service: (800) 233-4013 1 www.humana.com City of Sebastian I Employee Benefit Highlights 2020-2021 01 Humana Dental PPO Buy -Up Plan At -A -Glance Calendar Year Deductible (CYD) In -Network Out -of -Network* Per Member $50 Per Family $150 Waived for Class I Services? Yes Calendar Year Benefit Maximum Per Member $1,500 Class I Services: Diagnostic & Preventive Care Routine Oral Evaluation (2 Per Calendar Year) Routine Cleanings (2 Per Calendar Year) Plan Pays:100% Plan Pays:100% BitewingX-rays** Deductible Waived Deductible Waived (Subject to Balance Billing) Complete X-rays (1 Set Every 5 Years) Class II Services: Basic Restorative Care Fillings (Amalgam, one (1) per tooth every two (2) years) Fillings ositeforAnterior/Front Teeth) Plan Pas 80% 9 p Plan Pays: 80% y Simple Extractions After CYD After CYD (Subject to Balance Billing) Oral Surgery Class III Services: Major Restorative Care Periodontal Services Endodontics (Root Canal Therapy) o Plan Pays:50% Plan Pays: 50% Crowns After CYD After CYD Bridges (Subject to Balance Billing) Dentures Class IV Services: Orthodontia Lifetime Maximum $1,000 Benefit (Dependent Children through Age 18) Plan Pays:50% Plan Pays:50% (Subject to Balance Billing) 0 Locate a Provider To search for a participating provider, contact Humana's customer service or visit www.humana.com. When completing the necessary search criteria, select PPO/Traditional Preferred network. Plan References *Out -Of -Network Balance Billing: For information regarding out -of - network balance billing thatmay be charged by an out -of -network provider, please refer to the Out -of -Network Benefits section on the previous page. **Bitewing X-rays: Two (2) films per year under age 10. Four (4) films per year age 10 and older. Important Notes • Each covered member may receive up to two (2) routine cleanings per calendar year under the preventive benefit. • Waiting periods and age limitations 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 Human's customer service for details specific to a procedure. Vision Insurance Humana Vision 130 Plan The City offers vision insurance through Humana to benefit -eligible employees. The costs per pay period for coverage are listed in the premium table below and a brief summary of benefits is provided on the following page. For more detailed information about the vision plan, please refer to the carrier's summary plan document or contact Humana's customer service. Vision Insurance — Humana Vision 130 Plan 24 Payroll Deductions - Per Pay Period Cost Employee Only $0.00 $0.00 Employee + Family $1.88 $3.76 In -Network Benefits The vision plan offers employee and dependent(s) coverage for routine eye 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 as shown on the plan's schedule of benefits. Cosmetic services and upgrades are additional costs if chosen at the time of the appointment. City of Sebastian I Employee Benefit Highlights 2020-2021 Out -of -Network Benefits Employee and covered dependent(s) may also choose to receive services from vision providers who do not participate in the Humana Insight network. When going out of network, the provider will require payment at the time of appointment. Humana will then reimburse based on the plan's out -of -network reimbursement schedule upon receipt of proof of services rendered. Calendar Year Deductible There is no calendar year deductible. Calendar Year Out -of -Pocket Maximum There is no out-of-pocket maximum. However, there are benefit reimbursement maximums for certain services. Humana I Customer Service: (866) 537-0229 1 www.humana.com 44 Humana Vision 130 Plan At -A -Glance Services In -Network Out -of -Network Eye Exam $10 Copay Up To $30 Reimbursement Contact Lens Exam (If Different Than Eye Exam) Up to $55 Allowance Not Covered Material $15 Copay Reimbursement Based on Type of Service Retinal Imaging Up to $39 Copay Not Covered Frequency of Services Per Calendar Year Examination 12 Months Lenses 12 Months Frames 24 Months Contact Lenses 12 Months Lenses Single $15 Copay Up To $25 Reimbursement Bifocal $15 Copay Up To $40 Reimbursement Trifocal $15 Copay Up To $60 Reimbursement Frames Allowance Up to $130 Retail Allowance Plus U To $65 Reimbursement p 20%Off Balance Over $130 Contact Lenses* Non -Elective (Medically Necessary) No Charge Up To $200 Reimbursement Conventional Up to $130 Allowance Up to $104 Reimbursement Elective Plus 15% Off Balance Over $130 Disposable Up to $130 Allowance Up to $104 Reimbursement 0 Locate a Provider To search for a participating provider, contact Humana's customer service or visit www.humana.com. When completing the necessary search criteria, select Humana Insight network. 0 Plan References *Contact lenses are in lieu ofspectacle lenses and a frame. 0 Important Notes Member options, such as LASIK, UV coating, progressive lenses, etc. are not covered in full, but may be available at a discount. 000000 rS City of Sebastian I Employee Benefit Highlights 2020-2021 Flexible Spending Accounts The City offers Flexible Spending Accounts (FSA) administered through BenefitsWorkshop. The FSA plan year is from October 1 through September 30. If employee or family member(s) has predictable health care or work -related day care expenses, then employee may benefit from participating in an FSA. An FSA allows 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: This account allows participants to set aside up to an annual maximum of $2,750. This money will not be taxable income to the participant and can be used to offset the cost of a wide variety of eligible medical expenses that generate out-of-pocket costs. Participating employee can also receive reimbursement for expenses related to dental and vision care (that are not classified as cosmetic). Examples of common expenses that qualify for reimbursement are listed below. This account allows participants to set aside up to an annual maximum of $5,000 if single or married and file a joint tax return ($2,500 if married and file a separate tax return) for work -related day care expenses. Qualified expenses include day care centers, preschool, and before/after school care for eligible children and dependent adults. Please note that if a family's income is over $20,000, this reimbursement option will likely save participants more money than the dependent day care tax credit taken on a tax return. To qualify, dependents must be: • A child under the age of 13, or 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. A sample list of qualified expenses eligible for reimbursement include, but not limited to, the following: ✓ Prescription/Over-the-Counter Medications ✓ Menstrual Products ✓ Ambulance Service ✓ Chiropractic Care ✓ Dental and Orthodontic Fees ✓ Diagnostic Tests/Health Screenings ✓ Physician Fees and Office Visits ✓ Drug Addiction/Alcoholism Treatment ✓ Experimental Medical Treatment ✓ Corrective Eyeglasses and Contact Lenses ✓ Hearing Aids and Exams ✓ Injections and Vaccinations ✓ LASIKSurgery ✓ Mental Health Care ✓ Nursing Services ✓ Optometrist Fees ✓ Sunscreen SPF 15 or Greater ✓ Wheelchairs Log on to http:llwww.irs.gov/publicationslp502lindex.htmI for additional details regarding qualified and non -qualified expenses. Flexible Spending Accounts (Continued) FSA Guidelines • Employee may rollover $550 of unused Health Care FSA funds into the next plan year after a plan year ends and all claims have been filed. Dependent Care funds cannot be carried over. • The Health Care FSA has a run out period at the end of the plan year (90 days) to submit reimbursement on eligible expenses incurred during the period of coverage within the plan year (October 1 — September 30). • When a plan year ends and all claims have been filed, with the exception of the $550 rollover for the Health Care FSA, all unused funds will be forfeited and not returned. • Employee can enroll in an FSA only during the Open Enrollment period, a Qualifying Event, or New Hire Eligibility period. • Money cannot be transferred between FSAs. • Reimbursed expenses cannot be deducted for income tax purposes. • Employee and dependent(s) cannot be reimbursed for services not received. • Employee and dependent(s) cannot receive insurance benefits or any other compensation for expenses reimbursed through an FSA. • Domestic Partners are not eligible as Federal law does not recognize them as a qualified dependent. Filing a Claim Claim Form A completed claim form along with a copy of the receipt as proof of the expense can be submitted by mail or fax. The IRS requires FSA participants to maintain complete documentation, including copies of receiptsfor reimbursed expenses, for a minimum of one (1) year. Debit Card FSA participants will automatically receive a debit card for payment of eligible expenses. With the card, most qualified services and products can be paid at 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 most pharmacy retail outlets. BenefitsWorkshop may request supporting 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. This card will not expire at the end of the benefit year. Please keep the issued card for use next year. Additional or replacement cards may be requested, however, a small $5 fee may apply. HERE'S HOW IT WORKS! Employee earning $30,000 elects to place $1,000 into a Health Care FSA. The payroll deduction is $41.66 based on a 24 pay period schedule. As a result, the insurance premiums and health care expenses are paid with tax-free dollars, giving the employee a tax savings of $227. With a Health Without a Health Care FSA Care FSA Salary $30,000 $30,000 FSA Contribution - $1,000 - $0 Taxable Pay $29,000 $30,000 Estimated Tax $6,568 $6,795 22.65% = 15% + 7.65% FICA After Tax Expenses - $0 - $1,000 Spendable Income $22,432 $22,205 Tax Savings $227 Please Note: Be conservative when estimating health care and/or dependent care expenses. IRS regulations state thatany unused funds remaining in an FSA, after a plan year ends and after all claims have been filed, cannot be returned or carried forward to the next plan year, with the exception of the $550 rollover that may be allowed for the Health Care FSA. This rule is known as "use -it or lose -it.' Claims Mailing Address I P.O. Box 56828 1 Jacksonville, FL 33421 Claims Fax 1 (904) 880-2830 BenefitsWorkshop I Customer Service: (888) 537-3539 Fax: (904) 880-2830 1 www.benefitsworkshop.com/sebastian ' City of Sebastian I Employee Benefit Highlights 2020-2021 Employee Assistance Program The City cares about the well-being of all employees on and off the job and provides at no cost, a comprehensive Employee Assistance Program (EAP) through Lincoln Financial Group. EAP offers employee and each family member access to licensed mental health professionals through a confidential program protected by State and Federal laws. EAP is available to help employee gain a better understanding of problems that affect them, locate the best professional help for a particular problem, and decide upon a plan of action. EAP counselors are professionally trained and certified in their fields and available 24 hours a day, seven (7) days a week. What is an Employee Assistance Program (EAP)? An Employee Assistance Program offers covered employees and family members/domestic partners free and convenient access to a range of confidential and professional services to help address a variety of problems that may negatively affect employee or family member's well-being. Coverage includes six (6) face-to-face visits with a specialist, per person, per issue, per year, telephonic consultation, online material/tools and webinars. EAP offers counseling services on issues such as: ✓ Child Care Resources ✓ Work Related Issues ✓ Legal Resources ✓ Adult & Elder Care Assistance ✓ Grief and Bereavement ✓ Financial Resources ✓ Stress Management ✓ Family and/or Marriage Issues ✓ Depression and Anxiety ✓ Substance Abuse Are Services Confidential? Yes. Receipt of EAP Services is completely confidential. If, however, participation 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/manager will not, however, receive specific information regarding the referred employee's case. The supervisor/manager will only receive reports on whether the referred employee is complying with the prescribed treatment plan. Lincoln Financial Group Customer Service: (855) 327-4463 1 www.guidanceresources.com Organization Web ID: Lincoln Basic Life and AUD Insurance Basic Term Life Insurance The City provides Basic Term Life insurance to all eligible full-time employees working a minimum of 30 hours perweek, at no cost, through Lincoln Financial Group. All full-time employees receive a flat benefit amount of $15,000. Accidental Death & Dismemberment Insurance Also, at no cost to employee, the City provides Accidental Death & Dismemberment (AD&D) insurance, which pays in addition to the Basic Term Life benefit when death occurs as a result of an accident. The AD&D benefit amount equals the BasicTerm Life benefit, partial benefit may also be payable. Age Reduction Schedule Benefit amounts are subject to the following age reduction schedule: • Reduces by 35% of the benefit amount at age 65 Reduces by 60% of the benefit amount at age 80 Life Insurance Imputed Income The IRS requires that the imputed cost of employer paid employee life insurance, in excess of $50,000, must be included in income and is subject to Social Security and Medicare taxes. Always remember to keep beneficiary information updated. Beneficiary information may be updated at any time through Bentek. Lincoln Financial Group I Customer Service: (800) 423-2765 1 www.lfg.com Voluntary Life and AUD Insurance Voluntary Employee Life and ADO Insurance Eligible employee may elect to purchase additional Life and ADO insurance on a voluntary basis through Lincoln Financial Group. This coverage may be purchased in addition to the BasicTerm Life and ADO coverage. Voluntary Life insurance offers coverage for employee, spouse and/or child(ren) at different benefit levels. New Hires may purchase Voluntary Employee Life insurance without being subject to Medical Underwriting, also known as Evidence of Insurability (E01), up to the Guaranteed Issue amount of $100,000. • Units can be purchased in increments of $10,000 to the maximum of $500,000, or up to a maximum of five (5) times annual salary. • Benefit amounts are subject to the following age reduction schedule: Reduces by 35% of the benefit amount at age 65 Reduces by 60% of the benefit amount at age 80 • Benefits terminate at retirement. • Monthly Premium Calculation: Elected coverage - $1,000 x Employee rate (see rate table) x 12 months _ 24 annual deductions = per pay premium. Voluntary Spouse Life and AD&D Insurance New Hires may purchase Voluntary Spouse Life insurance without being subject to Medical Underwriting, also known as Evidence of Insurability (E01), up to the Guaranteed Issue amount of $30,000. • 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. • Benefit amounts are subject to the following age reduction schedule: > Reduces by 35% of the benefit amount at age 65 > Reduces by 60% of the benefit amount at age 80 • Spouse life insurance rate is based on employee age. Voluntary Life and AD&D Insurance Rate Table Monthly Premium Under Age 30 $0.13 30 - 34 $0.17 35 - 39 $0.20 40 - 44 $0.30 45 - 49 $0.46 50 - 54 $0.71 55 - 59 $1.17 60-64 $1.21 65 - 69 $2.64 70 - 74 $4.31 75 + $7.13 Please Note. Spouse coverage terminates at employee retirement. Voluntary Dependent Child(ren) Life 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 be covered for a benefit amount of $250. • Dependent child(ren), six (6) months old up to age 19 (or age 25 if a full-time student), may be covered for a minimum benefit of $5,000 up to a maximum amount of $10,000. Always remember to keep beneficiary information updated. Beneficiary information may be updated at any time through Bentek. Lincoln Financial Group I Customer Service: (800) 423-2765 1 www.lfg.com D�;) City of Sebastian I Employee Benefit Highlights 2020-2021 Long Term Disability 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. The LTD benefit pays a percentage of monthly earnings if employee becomes disabled due to an illness or non -work related injury. Long Term Disability (LTD) Benefits • LTD provides a benefit of 60% of employee's monthly earnings up to a benefit maximum of $5,000 per month. • Employee must be disabled for 90 consecutive days prior to becoming eligible for LTD benefits (known as the elimination period). • Benefit payments will commence on the 91 st day of disability. • The maximum benefit period is determined based on age at the time of disability. • Benefits maybe reduced by other income. Lincoln Financial Group I Customer Service: (800) 423-2765 1 www.lfg.com Supplemental Insurance Allstate offers a variety of voluntary supplemental insurance plans that may be purchased separately on a voluntary basis and premiums paid by payroll deduction. Allstate pays money directly to employees, regardless of what 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 at www.allstatebenefits.com/mybenefits. Available Allstate plans include coverages for: ✓ Group Critical Illness Insurance ✓ Group Accident Insurance ✓ Group Voluntary Disability Insurance ✓ Cancer Insurance Allstate I Customer Service: (888) 546-3193 www.allstatebenefits.com/mybenefits Agent: Artie Hoffman I Cell: (954) 609-4924 Email: artiehoffman@bellsouth.net 4 7 Legal & Identity Protection Plans U.S. Legal Services — Family Defender Plan The City offers employees the opportunity to participate in a voluntary legal insurance program provided by U.S. Legal Services. By enrolling in the Family Defender plan, participants will have direct access to attorneys who will provide services for a variety of situations that include: ✓ Divorce ✓ Criminal Defense ✓ Child Custody & Support ✓ TrafficTickets ✓ Adoption ✓ Wills & Living Trusts ✓ Civil Litigation ✓ Real Estate ✓ Bankruptcy ✓ Contract Review ✓ Name Changes The cost to the employeeto participate in this legal plan is $16.90 per month for employee only coverage or $21.50 per month for family coverage (dependents up to age 18, or 23 if a full time college student). Plan benefits include phone and face-to-face consultations with the attorney, and much more. U.S. Legal Services — Identity Theft Protection Identity Defender can be added to the legal insurance plan for $9.95 per month. With the Identity Defender Plan, employee and family members can fight back against stolen identity and can restore good credit and stolen funds. Certified Protection Experts available to assist with identity theft matters 24/7. Experts complete all paperwork and make all calls to ensure 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: ✓ Advanced Fraud Monitoring ✓ Stolen Funds Reimbursement ✓ Change of Address Monitoring ✓ Identity Theft Insurance ✓ Credit & Debit Card Monitoring ($1 million)* ✓ Dark Web Monitoring* ✓ Identity Restoration* ✓ Fraud Alert Reminders ✓ Credit Monitoring ✓ Medical ID Fraud Protection ✓ Mobile App ✓ Smart SSN Tracker* ✓ Two Adults & Unlimited ✓ Lost Wallet Dependent Children Covered** *Covered for dependents under ChildWatch **Dependents must be under26 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 I Customer Service: (800) 356-5297 www.uslegalservices.net Agent: Dixie Kuehn I Cell: (321) 403-0156 Email: dixiekuehn@cfl.rr.com Retirement Plans Chapter 185 Pension Plan - Sworn Police Officers The Chapter 185 Pension Plan is available only for full-time permanent sworn Officers of the City. It is a defined benefit plan. Contact Human Resources for information regarding contributions to the plan. The Officer becomes vested in this Plan after 10 years of service with the City of Sebastian. For additional information, refer to the Plan documents. CWA/ITU Negotiated Pension Plan The employees covered by the PEA Union bargaining Unit are eligible for coverage in the CWA/ITU Negotiated Pension Plan. This is a defined benefit plan. The City contributes to the plan for each regular full-time employee covered under the bargaining unit. The employee becomes vested in the plan after five (5) years of employment with the City of Sebastian. For additional information, refer to the Plan documents. 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 participate in a 401A Plan. A representative of ICMA periodically visits the City at which time employees can make an appointment to discuss financial planning via the programs offered by ICMA; i.e. Deferred Compensation Plan, IRA and Roth IRA Plans. Employee contributions can be made through payroll deduction. I :-ii City of Sebastian I Employee Benefit Highlights 2020-2021 Miscellaneous Benefits Probationary Period All regular full-time and part-time employees are on a six (6) month introductory period from date of hire. Sworn Police Officers and 911 Emergency Dispatch Technicians are on a 12 month introductory probationary 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 Enrollmentfor insurance, representatives of Allstate will meet with employees to discuss various types ofsupplemental insurances that may be purchased on a voluntary basis at employee cost. Supplemental Insurance premium payments may be payroll deducted. Leave Policies Paid Holidays The holidays celebrated by the City of Sebastian on an annual basis are provided below. • New Year's Day • Martin Luther King, Jr. Day • President's Day • Memorial Day • Independence Day • Labor Day Annual Leave • Veteran's Day • Thanksgiving Day • Day After Thanksgiving • Christmas Eve Day • Christmas Day Annual leave accrues at the rate of 10 days per year for full-time employees and at a pro -rated rate for regular part-time employees. The rate increases with every five (5) years of continuous service with the City. Request for annual leave is subject to Department Head approval. Sick Leave Sick leave begins accruing from date of hire. New employees may not use sick leave during their first 60 days of employment. Please refer to the appropriate bargaining agreements for specifics. Personal Leave Regular full-time employees are entitled to personal leave. Request for personal leave is subject to Department Head approval. Please refer to the appropriate bargaining agreements for specifics. Bereavement Leave Bereavement Leave is available for employees to arrange and/or attend the funeral of an immediate family member. Please refer to the appropriate collective bargaining agreement for specifics. Leave is to be approved by the Supervisor upon proof of death of a family member (i.e. death certificate, newspaper, obituary). Jury Duty Employees are required to bring notification of request for jury duty to the Supervisor. Employees of the City will receive their normal earnings while serving jury duty. Please refer to the appropriate bargaining agreements for specifics. Regular Part -Time Employee Regular part-time employees receive pro -rated benefits based on 40 hours of service per pay period or as specified in the collective bargaining agreement.