2021 Benefit Guide City of Lafayette_Final_202011251245526923

Plan Year 2021 INTRODUCTION The City of Lafayette Benefit Program is designed to give you flexibility and choice, allowing you to personalize your benefit program to best suit your needs and the needs of your dependents Reminder: Dependent coverage was extended to age 26 for both the Medical & Dental plans (in 2011) – regardless of the dependent’s marital status, financial dependence, student status or employment status The following benefit program is for all City of Lafayette eligible employees TABLE OF CONTENTS Medical Coverage Dental Coverage Vision Coverage 12 Flexible Spending Accounts 14 Life and Accidental Death & Dismemberment 18 Long-Term and Short-Term Disability 19 Employee Assistance Program 21 Travel and ID Theft Assistance 22 Legal Assistance 23 Wealth Building 24 Rates 26 Contact Information 29 Terms and Definitions 32 ELIGIBILITY Full-Time Employees Employees in positions designated as full-time who work a minimum of 40 hours per week are eligible for all full-time benefits Additionally, employees who work at least 1,560 hours per year are eligible for health insurance Part-Time Employees Employees working in those positions classified as Regular Part-Time are considered Part-Time Employees Regular Part ‐Time Employees may access the health insurance plan at their own cost No classification of part-time employee is eligible for dental, vision, life, LTD, STD, voluntary life, or AD&D benefits Employee Status Full-Time Part-Time Eligible 1st of month Following 30 days Medical Dental Voluntary Vision Group Life/AD&D Long-Term Disability Eligible 1st of month Following 30 days of service Not Eligible Voluntary Short-Term Disability Voluntary Life/AD&D Must be eligible for city health insurance to participate FSA Retirement Plan 401a (ICMA-RC) Deferred Compensation Plan (ICMA-RC) Fire and Police Pension Assoc (FPPA) Eligible 1st day of employment Not Eligible Eligible 1st of month following 30 days of service Eligible 1st day of employment Sworn Fire and Police personnel only Eligible 1st day of employment Not Eligible ELIGIBLE DEPENDENTS FOR MEDICAL, DENTAL & VISION Many of the benefit plans also offer coverage for eligible dependents Eligible dependents include: • Your common law spouse; • Your legal spouse, if not legally separated; • Your child, through the end of the month in which they reach age 26 This includes: – Your natural child; – Your stepchild; – An adopted child • Your dependent unmarried child of any age who becomes totally disabled before reaching the age limit for eligibility; • Your child, for whom a Qualified Medical Child Support Order (QMCSO) has been issued Note: It is your responsibility to notify Human Resources within 30 days of the qualifying event Failure to so may result in a loss of premiums paid for the dependent and/or financial responsibility for any claims incurred after the dependent became ineligible COVERAGE LEVELS You must be enrolled in order to enroll your dependents You may choose a different coverage level for Medical, Dental and/or Vision The coverage categories are: • Employee only, • Employee and spouse, • Employee and child(ren), • Family, or • Waived coverage WHEN IS MY COVERAGE EFFECTIVE? If you enroll during the annual enrollment period, the coverage you select will be effective January 1, 2021 provided you have met the eligibility requirements WHAT IF I CHOOSE NOT TO ENROLL NOW OR MISS THE OPEN ENROLLMENT PERIOD? If you choose not to enroll during open enrollment or your eligibility period, you will be required to wait until the next annual open enrollment unless you have a qualifying change of status as described below Qualifying Event: HIPAA Special Enrollment Rights/Change of Status for Which You May Make Changes to Your Elections You may only enroll, add family members, or cancel your elections during the annual enrollment period, or within 31 days of experiencing a qualifying life status change, including: • Marriage, death of spouse, divorce or legal separation • Birth, adoption, placement for adoption or death of a dependent • Termination or commencement of employment for you, spouse, or dependent • Relocation or increase in hours of employment by you or your spouse • Your dependent child satisfies or ceases to satisfy the requirements for coverage because of age • A change in the place of residence or work for you, your spouse, or dependent • You or your spouse experiences an open enrollment event If you or your dependents are eligible for premium assistance under Medicaid or CHIP, you may qualify for a Special Enrollment Opportunity You must request coverage within 60 days of being determined eligible for premium assistance If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage) However, you must request enrollment within 31 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage) Sortis Financial may request documentation regarding termination of or change in contributions for the other coverage medical Medical Coverage You may enroll in the HMO Plan 420P administered by Kaiser Permanente This plan requires members to see Kaiser Physicians exclusively Employees are required to enroll in the plan offered by the City; however, this requirement does not apply if the employee is covered under another health insurance plan Proof of paid premiums for other coverage is required, should the employee choose not to enroll in the City plan HEALTH ENROLLMENT TIPS To choose a coverage level and supplemental benefits that are best for you and your family, consider your choices and your prior and expected future medical needs: • What were your expenses this year? • Do you expect your medical expenses to increase next year in anticipation of surgery, chronic conditions, or childbirth? • How much are you willing to spend in premiums? • How much can you afford to pay out-of-pocket for medical expenses? KAISER HMO PLAN 420P Services In-Network Only Deductible Individual Family No Deductible No Deductible Individual Family $2,000 $4,500 Out of Pocket Maximum Preventive Care Children’s Services Adult’s Services $10 copay/visit $10 copay/visit Physician Services Routine Medical Office Visits Specialist Office Visit Diagnostic Lab/X-Ray Therapeutic X-Ray Imaging (CT/PET Scans, MRIs) $20 copay/visit $35 copay/visit Plan pays 100% $35 copay/visit $150 copay/procedure Prenatal Care Delivery & Inpatient Well Baby Care $0 copay/visit $750 copay/admission Inpatient Outpatient $750 copay/admission $150 copay/visit Maternity Hospital Facility Services Emergency Services Emergency Room Urgent Care Ambulance Prescription Drugs - Level of Coverage and Restrictions on Prescriptions Retail Generic Drugs Retail Preferred Brand Drugs Mail Order (90-day supply) Specialty Drugs $100 copay/visit, waived if admitted $100 copay/visit at ER $50 copay/visit at UC 20% coinsurance up to a max of $500/trip $15 copay $30 copay 2x retail copay 20% coinsurance to a max of $250/drug Other Mental Health Care Inpatient $750 copay/admission Services In-Network Only Alcohol & Substance Abuse Inpatient Outpatient $750 copay/admission $20 copay/visit Inpatient Outpatient $750 copay/admission $20 copay/visit Physical, Occupational & Speech Therapy Durable Medical Equipment Oxygen Play pays 80%; limited to $2,000 maximum/ calendar year Plan pays 80% Organ Transplants $750 copay/admission Home Health Care Plan pays 100% (for prescribed medically necessary part-time home health services; Not covered outside the Service Area) Hospice Care Skilled Nursing Facility Care (for up to 100 days per calendar year for prescribed skilled nursing facility services at approved skilled nursing facilities) Plan pays 100% Not covered outside the Service Area Plan pays 100% Not covered outside the Service Area Dental Care Not Covered Vision Care $20 copay/visit; no hardware Chiropractic Care Significant Additional Covered Services Not Covered See Colorado Health Benefit Plan Description Form Check out these new and expanded services from Kaiser Permanente! • Expanded primary and pediatric care hours to a.m.—7 p.m., Monday through Friday, and a.m.—noon on Saturdays • Same day/next day prescription drug delivery • Added more behavioral medicine specialists and expanded network of affiliated providers for increased access to mental health and wellness services • Contracted with DispatchHealth to provide in-home urgent care services in the Denver Metro Area • 24/7 on-demand phone and video provider visits available to members • Chat with a Doctor service hours extended to a.m.—10 p.m., days/week • Partnered with Rally Health to develop Total Health Assessment tool that helps you reach health goals through personalized summary and action plan • The myStrength app is available at no cost to all members—provides personalized, interactive well-being activities • The “Calm” app is now available to help members lower stress and reduce anxiety through meditation, mental resilience, and sleep dental supplementary EMPLOYEE ASSISTANCE PROGRAM GETTING SUPPORT SHOULD BE EASY Most of us have to face change, stress or a life-altering problem at some point Your company sponsored Employee Assistance Program is designed to provide counseling services, work-life assistance, legal and financial guidance to help handle concerns constructively, before they become major issues The service is confidential and provided at no charge to you and your dependents COMPASSIONATE SOLUTIONS FOR COMMON CHALLENGES From the everyday issues like job pressures, relationships, retirement planning or personal impact of grief, loss, or a disability, Guidance Resources can be your resource for professional support You and your family, including spouse and dependents, can access Guidance Resources; including five (5) face to face visits per year at no cost You also have access to three (3) face to face visits through Ability Assist Guidance Resources Confidential Counseling Financial Information and Resources Legal Support and Resources Work-Life Solutions Health Care Navigation This no-cost counseling service helps address stress, relationship and other personal issues you and your dependents may face It is staffed by GuidanceConsultants℠—highly trained master’s level clinicians who will listen to your concerns and refer you to in-person counseling and other resources for: • Job pressures • Work/school disagreements • Relationship/marital conflicts • Substance abuse • Stress, anxiety and depression • Child and elder care referral services Speak by phone with their Certified Public Accountants and Certified Financial Planners about a wide range of financial issues, including: • Managing a budget • Tax questions • Retirement • Saving for college • Getting out of debt • Estate planning Talk to their attorneys by phone If you require representation, they’ll refer you to a qualified attorney in your area for a free 30-minute consultation with a 25% reduction in customary legal fees thereafter • Debt and bankruptcy • Power of attorney • Guardianship • Divorce and family law • Buying a home • Landlord/tenant issues • Contracts Their Work-Life specialists will the research for you, providing qualified referrals and customized resources for: • Child and elder care • Pet care • College planning • Making major purchases • Moving and relocation • Home repair Employees covered under The Hartford’s disability insurance also have access to HealthChampion℠ This program provides confidential support for issues such as: • Explanation of health plan coverage • Understanding diagnosis and treatment options ã Claims review and fee negotiation GUIDANCERESOURCESđ ABILITY ASSIST® Solutions to the simple and complex aspects of life through confidential and professional EAP, work-life and behavioral health services Once you have used your face to face visits with GuidanceResources, you can all the number below to access additional visits with Ability Assist You must use your GuidanceResources visits first Call: 800-327-1850 | Online: guidanceresources.com Your Web ID: HLF902 22 Call: 800-964-3577 | Online: guidanceresources.com Your Web ID: HLF902 | Company Name Field: ABILI TRAVEL & ID THEFT ASSISTANCE As part of your employee benefits package, all full-time employees are eligible for Travel Assistance through The Hartford and Europ Assistance USA This is an employee benefit that includes travel, medical, and safety-related services while traveling These services are provided regardless if you’re traveling for business or leisure Travel Assistance and ID Theft Protection Services Emergency Medical Assistance • • • • • • • • • Medical referrals Medical monitoring Medical evacuation Repatriation Traveling companion assistance Dependent children assistance Visit by a family member or friend Emergency medical payments Return of mortal remains Pre-Trip Information • • • • Visa and passport requirements Inoculation and immunization requirements Foreign exchange rates Embassy and consular referrals Emergency Personal Services • • • • • Medication and eyeglass prescription assistance Emergency travel arrangements Emergency cash Locating lost items Bail advancement Identity Theft Assistance • • • • Prevention services -Education -Identity Theft Resolution Kit Detection Services -Fraud alert to three credit bureaus Resolution Guidance and Assistance -Credit information review -ID Theft Affidavit Assistance -Card replacement Personal Services -Translation -Emergency cash advance *Refer to the Hartford materials for details and limitations Have a serious medical emergency? Please obtain emergency medical services first (contact the local “911”), and then contact Europ Assistance USA to alert them to your situation Call: 1-800-243-6108 Collect from other locations: 202-828-5885 Fax: 202-331-1528 Travel Assistance Identification Number: GLD-09012 23 LEGAL ASSISTANCE As part of your employee benefits package, all full-time employees are eligible for Estate Guidance Will Preparation and Everest Funeral Planning Tools through the Hartford ESTATE GUIDANCE WILL PREPARATION SERVICES Create a simple will from the convenience of your desktop – at no cost Online assistance from licensed attorneys Additional estate planning services also available for purchase including living trusts and power of attorney Visit WWW.ESTATEGUIDANCE.COM/WILLS today Use this code: WILLHLF Then follow the easy steps below: Access The Hartford’s EstateGuidance® Will Services online Sign in to the secure site by entering the access code Follow the instructions and create your will Download the final will to your computer and print Obtain signatures and determine if your will should be notarized EVEREST – FUNERAL PLANNING TOOLS AND SERVICES Pre-Planning Services • 24/7 Advisor Planning Assistance • Online Funeral Planning Tools • Everest PriceFinder Research Reports • Detailed, local funeral home price comparisons At-Need Services • Negotiation assistance • Family assistance and plan implementation Find out more about The Hartford’s Funeral and Concierge Services by calling 1-866-854-5429 Or visit WWW.EVERESTFUNERAL.COM/HARTFORD and use this code: HFEVLC 24 WEALTH BUILDING Maybe you’re not thinking about future financial welfare yet, but there has never been a better time to start planning than right now! The City of Lafayette 401(a) savings plan is an employee retirement savings program that gives employees the ability to deduct pre-tax earnings from their paychecks to invest those earnings towards their own personal financial goals RETIREMENT PLAN (ICMA – RC) Full-time, non-commissioned employees are required to contribute 8% of their pre-tax compensation to a 401a retirement fund The City contributes 10.2% to this fund Employees may also contribute an additional post-tax 4% through payroll deduction Normal retirement age under this plan is 59 1/2 If a plan member terminates employment before reaching retirement, s/he is entitled to her/his vested benefits accumulated under the plan Employees who have years of service with the City are 100% vested (entitled to the entire amount in the fund) This benefit is in lieu of Social Security Employees are eligible to participate in the plan on the first day of employment as a full-time employee The plan includes several investment options from which to choose Employees may invest their contributions entirely into one fund or spread the investment among all options Investment options include a stable value fund, diversified bond fund, small cap growth and small cap balanced funds, moderate balanced funds, growth balanced funds, large company growth funds, and others FIRE AND POLICE PENSION ASSOCIATION Commissioned public safety employees belong to the Fire and Police Pension Association’s defined benefit plan Contributions depend on date of hire These employees also contribute to an ICMA-RC 401a plan for any overtime earnings, for which the employees’ and the City’s contribution rates are the same as detailed above DEFERRED COMPENSATION PLAN (ICMA – RC) The City offers a 457 deferred compensation plan where savings are tax deferred until the earnings are distributed Enrollment in the plan is mandatory in-lieu of social security for regular part-time employees, and is voluntary for full time employees ROTH INDIVIDUAL RETIREMENT ACCOUNT The City offers its employees an opportunity to enroll in a Roth IRA, a retirement account that is funded by after-tax contributions See Human Resources for more details 25 rates Medical Employee Only Rates $687.69 Employee + Spouse $1,409.70 Employee + Child(ren) $1,375.31 Family $1,987.36 Dental Employee Only Base Plan Rates Buy-Up Plan Rates $22.02 $40.98 Employee + Spouse $41.69 $77.24 Employee + Child(ren) $50.89 $90.24 Family $79.87 $144.68 Vision Employee Only Rates $12.14 Employee + Spouse $19.42 Employee + Child(ren) $19.83 Family $31.97 Voluntary Life Rates These rates are: • Unisex • Employee and Spouse • Guaranteed for One Year from the program effective date • Based on an employee’s current age • Shown as a monthly rate per $1,000 • AD&D Rates  Employee $0.04 Short-Term Disability Rates These rates are: • Unisex • Guaranteed for One Year from the program effective date • Based on an employee’s current age • Shown as a monthly rate per $10 of weekly benefit 27 Age Rates < 24 $0.075 25-29 $0.055 30-34 $0.06 35-39 $0.08 40-44 $0.13 45-49 $0.21 50-54 $0.33 55-59 $0.49 60-64 $0.64 65-69 $0.92 70-74 $1.55 75+ $4.22 Age Rates