2020 County of Santa Barbara Employee Benefits Overview

 
2020 County of Santa Barbara Employee Benefits Overview
2020
                                          County of Santa Barbara
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                                      Employee Benefits Overview

                                                          County of Santa Barbara
                                                          Human Resources Department
                                                          One County. One Future.
2020 County of Santa Barbara Employee Benefits Overview
2020 County of Santa Barbara Employee Benefits Overview
TABLE OF CONTENTS
Benefits For The Way You Live ......................................................................................................................... 2
What’s New In 2020? ..................................................................................................................................... 3
Additional Benefits Programs .......................................................................................................................... 8
Open Enrollment Info .................................................................................................................................... 12
Join Us At A “Fun In The Sun” Benefits Fair...................................................................................................... 13
Who Can You Cover? .................................................................................................................................... 14
Making the Most of Your Benefits................................................................................................................... 15
Medical ..................................................................................................................................................... 16
Dental........................................................................................................................................................ 21
Vision ........................................................................................................................................................ 22
Cost of Coverage ......................................................................................................................................... 23
Life and Disability Insurance ......................................................................................................................... 25
Voluntary Accident and Critical Illness Insurance ............................................................................................. 28
Wellness Benefit At A Glance ........................................................................................................................ 29
Special Savings Accounts ............................................................................................................................. 30
Other Programs ........................................................................................................................................... 34
For Assistance ............................................................................................................................................ 36
Key Terms .................................................................................................................................................. 38
Important Plan Notices and Documents ........................................................................................................... 40
Appendix .................................................................................................................................................... 41
Notes......................................................................................................................................................... 42

    Medicare Part D Notice: If you and/or your dependents have Medicare or will
    become eligible for Medicare in the next 12 months, a federal law gives you more
    choices about your prescription drug coverage. Please refer to the Legal Notices
    posted on the County’s website, http://countyofsb.org/hr or contact Human
    Resources at 568.2818 or 568.2803 for more details.

                                                                               1
2020 County of Santa Barbara Employee Benefits Overview
BENEFITS FOR THE WAY YOU LIVE

The Santa Barbara County has a benefits program that provides you with the best coverage
that is simple and comprehensive. We offer programs that protect your health, your money,
your family and help you find balance between your concerns at work and at home. We also
know the value of understanding your coverage so that you know how to get care, when you
need it, at the lowest cost. With the tools and information in this booklet and related
resources, we hope to help you be well today and work towards a healthy and secure future.
The County understands that comparing benefit plans, features and costs can be complicated
The Employee Benefits Overview booklet provides information that will help simplify your
decision making process. It is a summary of your benefits and does not provide a complete
description of all benefit provisions. For more detailed information, please refer to your plan
benefit booklets or Evidence of Coverage (EOC) documents at the County’s website,
http://countyofsb.org/hr. The plan benefit booklets determine how all benefits are paid.

                 The benefits in this summary are effective:
                   January 1, 2020 - December 31, 2020

                 OPEN ENROLLMENT PERIOD:
               October 14 – November 1, 2019

                                               2
2020 County of Santa Barbara Employee Benefits Overview
What’s New In 2020?
BENEFITS COORDINATORS CORP (BCC) – New HSA Administrator
Effective January 1, the County of Santa Barbara will be moving the administration of the HSA
account to Benefit Coordinators Corporation (BCC , in order to better integrate your voluntary
special savings accounts. By moving from Sterling HSA to BCC’s My SmartCare HSA platform,
employees will find it easier to manage your HSA account and with less fees.
Employees who have a current account with Sterling HSA have several options for transition:
   1. You may keep your current Sterling HSA account. You will be responsible for a
      monthly administration fee from Sterling HSA for as long as your
      account is open. For 2020 County contributions and your personal
      contributions, you will need to open a new HSA account with BCC
      (Avidia Bank will be the custodian .
   2. You may transfer your Sterling HSA account balance to Avidia
      Bank. All employees who want to transfer their current HSA funds
      will need to fill out a HSA Transfer form. Instructions on how,
      when and where to send this form will be sent to you later this year
      by BCC and in email by the Benefits & Wellness Division.
      Remember that your Sterling HSA account must remain open until
      the last County HSA contribution for 2019 has been deposited.

                                       IMPORTANT
  During Open Enrollment – all current Blue Shield HDHP employees with an HSA
  account who want to continue with the HDHP in 2020 must:
      •   Login to the BenXcel Open Enrollment website, https://benxcel.net
      •   Re-enroll in the HSA account, it will not roll over for 2020

This year, you must login to the BenXcel portal and select the HSA amount that you want to
contribute for 2020. If you are not going to contribute anything in 2020, but only want the
County’s HSA contribution amount deposited into your new HSA account, you must still re-
enroll in the HSA and input “$0” as your contribution amount. Your current HSA
contribution amount will not roll over this year. You must re-enroll in the HSA account. If
you do not enroll in the HSA account, a new Avidia HSA account will NOT be opened and you
will not be able to receive the County and individual 2020 contribution.

                                              3
2020 County of Santa Barbara Employee Benefits Overview
NEW DIABETIC PROGRAM

Insulin medications are now available at no cost!
Rx ‘n Go has added insulin products to their drug list. You may now receive up to a 90-day
supply of insulin medications such as Humalog, Levemir and Novolog. Prodigy® diabetic test
strips and lancets can additionally be delivered to your home at no cost. The initial test strip
order includes a new free Prodigy® diabetic monitor.

What is Rx ‘n Go?

Rx ‘n Go is a voluntary mail order pharmacy benefit. All employees and covered dependents,
on a Blue Shield medical plan*, have the option to receive up to a 90-day supply of generic
prescription maintenance medications by mail at no cost to you.

What do I have to do?
   1. Go to www.rxngo.com and view all
      the available medication on the
      Rx ‘n Go drug list.
   2. Complete the Pharmacy Profile form
      online or by calling Rx ‘n Go.
   3. Mail the Pharmacy Profile form and
      original prescription(s) to Rx ‘n Go.
      Your physician my also fax, phone or
      E-Scribe your prescription.
   4. Receive your medication(s) by mail
      at your home.
   5. It’s that easy!
                                                                        Click on the picture and watch a video
                                                                        to learn more about Rx ‘n Go.

                 Questions? We are here to help at 888.697.9646.

   Over 1,200 free generic medications delivered to your home!*

   *Note: Due to IRS guideline on the HDHP, only preventive maintenance medications are available to you
   for free. Rx’ n Go has over 750 preventive medications on their drug list.

                                                     4
2020 County of Santa Barbara Employee Benefits Overview
LIMITED PURPOSE FSA (LPFSA) – Available To All HSA Members
The County will be offering a Limited Purpose FSA account to all employees that are enrolled
in the Blue Shield HDHP plan with a Health Savings Account (HSA. The Limited Purpose
FSA allows you to set aside pre-tax dollars for dental and vision expenses.

Why open a Limited-Purpose FSA?
   1. Contribute up to $2,700 in pre-tax dollars but remember that this is a “use it or lose
      it” account
   2. Use funds for dental and vision expenses only
   3. Continue to contribute to your HSA account. Keep your HSA funds when paying dental
      and vision expenses and use the Limited-Purpose FSA instead.
   4. Use for your dependent’s dental and vision expenses even though they are not enrolled
      in your HDHP plan. Must be claimed as dependents on your IRS taxes.
   5. Manage both your Limited-Purpose FSA and HSA account in ONE place – use BBC’s
      My Smartcare portal or app.

            If you have an HSA, you can open a LPFSA!

COUNTY ONSITE CLINICS – Blue Shield HDHP Copay for non-preventive
visits
Due to IRS regulations, County employees on the Blue Shield HDHP plan will have a $20
copayment for all non-preventive visits when using the County’s onsite clinics if they have not
met their yearly deductible. Once you have met your deductible, all services will be at no cost.
All preventive visits/services will remain at no cost. This copayment only affects employees on
the HDHP plan. IRS regulations state that you must pay a copayment for non-preventive
services until your deductible has been met.
Note that the $20 copayment for onsite clinic services will be a lower copayment than if you
would have a doctor’s visit using your Blue Shield benefits.
                                               5
2020 County of Santa Barbara Employee Benefits Overview
Express Scripts – Smart90 Program

What is the Smart 90 program?

This program is available to Express Scripts members on the Blue Shield Low EPO, High EPO
and PPO plans that are taking maintenance medication on a daily basis. Express Scripts now
gives you a choice on where to dispense a three month supply of your maintenance drugs. You
can:
   1. Fill your prescription through home delivery from the Express Scripts Pharmacy OR
   2. Fill your prescription at any CVS or Walgreens pharmacy

Relax with 90-say supplies.

                       Gets a 90-day                                      Gets a 30-day
                       supply, so                                         supply, so
                       he…                                                he…

  … keeps on track with his medicine                 … misses a dose since he forgot this month’s
                                                     refill
  …takes long hikes not worrying about running
  out of medication                                  …waits in line at the pharmacy every month
  …grabs dinner with friends with the money he       …possibly pays more than he needs to for his
  is saving                                          medicine
  …kicks back by the pool instead of making a        …makes time in his schedule to drive to the
  monthly pharmacy trip                              pharmacy month after month

The bottom line:
Be like Kyle – order a 90-day supply of your maintenance medication. Now you have two
convenient options through Smart90.

Learn how to be more like Kyle at express-scripts.com/KyleAndNick.

                                                 6
2020 County of Santa Barbara Employee Benefits Overview
MY SMARTCARE – BCC’s One Stop Shop For FSA / HSA / Commuter
Accounts
BCC has made it easier than ever to manage your FSA and HSA account(s). The My SmartCare
online portal and mobile app allows you to freely and securely access your BCC

Reimbursement accounts 24/7/365.

Why register with My SmartCare?
   •   Real time account balances
   •   Direct deposit management
   •   Claim status and tracking
   •   Transaction history and statements
   •   Electronic claims submission & uploads
   •   Manage your debit card
   •   Receive year end reminders
   •   Get notifications via email or text messages - your choice

            ASK EMMA!
            The industry’s first voice activated consumer
            funding account is now available on the My
            SmartCare mobile app!

                                               7
2020 County of Santa Barbara Employee Benefits Overview
Additional Benefits Programs
The Santa Barbara County offers a variety of free programs that are available to all members
and covered dependents in the Blue Shield plans. Take advantage of these different programs
that can help you stay healthy and save you money.

THE SMARTER VOLUNTARY SURGERY BENEFIT
Considering surgery? Carrum Health is your voluntary surgery benefit that allows employees
and their dependents to access top surgeons and hospitals across the country at no cost to
your, including travel*.

                          EXPLORE YOUR OPTIONS
                          A wide range of covered procedures at hospitals across
                          California that specialize in the care you need.

                          CHOOSE THE BEST
                          Pick from among our highly-qualified surgeons who have
                          performed hundreds of medical procedures on average.

                          WE’LL TAKE IT FROM HERE
                          Your travel will be fully-covered with a dedicated patient
                          care specialist to help guide you through every stop of the

PROCEDURES FULLY COVERED FOR YOU:

  LEARN MORE:
  CALL: 1.888.855.7806                                                       VISIT: CARRUM.ME/COSB
  TEXT: “COSB” TO 555888
  *Per IRS rules, a portion of the covered travel expenses will be reported as taxable income to the employee. Due to IRS regulations, on HSA plans
  the deductible applies but coinsurance is waived.

                                                                         8
SOLERA – Lifestyle Change Program
Blue Shield/EIA is offering a free comprehensive 16-week program which will help qualified
members lose weight, adopt healthy habits and significantly reduce their risk of developing
type 2 diabetes. You have a choice to do the program online or in-person, your choice.
What’s included in the program?
There are many versions of this program and depending if you want to do it online or in-
person, most programs include the following:
    •     16 weekly lessons, followed by monthly sessions for the rest of the year
    •     Lifestyle health coach to help set goals and keep you on track
    •     Small group for support and encouragement
    •     Helpful tools, like wireless scales and fitness trackers
What are some of the national programs available?
You may choose from an array of national programs like Weight Watchers, Retrofit or
HealthSlate.
What is the cost?
It’s free!
What do I do to find out if I qualify?
All you need to do is go to www.solera4me.com/eia and take a one minute quiz. If you are
identified as having a risk of developing type 2 diabetes, you will be able to enroll in one of
the various programs.

        Health Coaching       Weekly Lessons       Integrated devices      Group Support

                     Call Solera at 877.486.0141 if you have questions.

                                                  9
Connecting with a doctor within minutes is easy.

  1. Request a visit with a doctor 24 hours a day,
     365 days a year, by web, phone, or mobile app.

Want to see the doctor? Choose “video” as the method for your visit. Feeling camera shy? Choose
“phone”. Got a busy schedule? Select a time that’s best for you by choosing “schedule” instead of “as
soon as possible”.

  2. Talk to the doctor. Take as much time as you
     need…there’s no limits!

You will receive convenient, quality care from a variety of licensed healthcare providers.

           Physician                        Dermatologist                         Therapist
 FOR ISSUES LIKE:                   FOR ISSUES LIKE:                    FOR ISSUES LIKE:
 Cold & Flu symptoms                Skin infection                      Stress/anxiety
 Bronchitis                         Acne                                Depression
 Allergies                          Skin rash                           Domestic abuse
 Pink eye                           Abrasions                           Grief counseling
 Bladder infection                  Moles/warts                         Addiction

      3. If medically necessary, a prescription will be sent to
         the pharmacy of your choice. It’s that easy!

          Visit Teladoc.com/bsc and set up an account or call 1.800.835.2362
                                                   10
COUNTY ONSITE HEALTH CLINICS
The County of Santa Barbara has two employee health clinics for benefit eligible employees,
their spouses, registered domestic partners and dependent children age 16 and over.
Dependents must be enrolled in the County’s health plan in order to participate. After your
first visit, you will be required to schedule a follow-up visit to take a Health Risk Assessment
to ensure you are eligible to receive continued services through the clinic.

The clinic provides services for ongoing and
episodic illnesses such as:

              •   Minor illnesses
              •   Diabetic control
              •   Referral to specialist
              •   Blood pressure
              •   Cholesterol management
              •   Allergies
              •   Lab tests

                                        NEW FOR 2020
       Employees and their dependents on the Blue Shield HDHP plan, will have a
 copayment of $20 for all non-preventive services/visits at the onsite clinics due to IRS
 regulations. You must first meet your annual deductible before non-preventive services
  will be at no cost. All preventive visits and services will remain at no cost to you and
                                      your dependents.
 All services at the clinics are at no cost to employees and their dependents on the Low EPO,
                                     High EPO and PPO plans.

                                           LOCATIONS

                                                 427 Camino del Remedio
                  SANTA BARBARA                  805.681.4700 or Ext 4700
                                                 M - F: 7:30am - 4:00pm

                                                 500 West Forster Road
                  SANTA MARIA                    Behind BeWell offices
                                                 805.934.6107 or Ext 6107
                                                 M - F: 7:30am - 4:00pm

                                               11
Open Enrollment Info
Open Enrollment will take place from October 14– November 1, 2019. During this time, you
are able to enroll in new programs or make changes to your current benefits.

What should I do:
   1. If I like my current plan selections and do not want to change for 2020?
      You do not have to do anything. Your selections will automatically roll over with the
      exception of your Flexible Spending Account (FSA) and Health Savings Account
      enrollment.
   2. If I want to:

   •    Enroll in any of the County-sponsored plans and voluntary benefits for the first time;
   •    Change or cancel your plan choices; waiver must be supported by other group coverage
   •    Add or drop dependent coverage (Please Note: If you cancel a dependent’s coverage
        during Open Enrollment, that dependent is not eligible for COBRA);
   •    Add, change, or cancel your Optional Life, Critical Illness, Accident Plan, and/or
        Personal Accident Insurance;
   •    Participate for the first time or continue to participate in FSA Healthcare or Dependent
        Care or participate for the first time in an HSA for the 2020 plan year (Note: you cannot
        open an HSA account if you have an FSA. Your FSA account must have a $0 balance
        before you can open an HSA);
   •    Waive participation in County-sponsored medical and dental benefits; and/or
   •    Combined coverage with a spouse or registered domestic partner who is also a benefit-
        eligible County employee.

    Use the eBenefits website for ALL changes

You must go online to the County’s eBenefits website, https://benxcel.net, to make all plan
changes, dependent additions or deletions, HSA or FSA enrollment, address changes and
personal information updates.
If you need the Employee Guide to BenXcel, go to the County’s website at
http://countyofsb.org/hr, Employee Benefits link, and “Click” on the “Open Enrollment 2020
Benefit Year” link. This guide will help you establish a username and/or obtain your password.
Call BCC at 1.800.685.6100 if you need assistance with your account.

                       IMPORTANT DURING OPEN ENROLLMENT
       All current Blue Shield HDHP employees with an HSA account who want to
       continue with the Blue Shield HDHP in 2020 must:
          •   Login to the BenXcel Open Enrollment website, https://benxcel.net
          •   Re-enroll in the HSA account, it will not roll over for 2020

                                               12
Join Us At A “Fun In The Sun” Benefits Fair!
The County of Santa Barbara will be hosting a “Party” and would like to invite all
County employees to one of our Benefits Fairs. Join us in the festivities!

                                                                   Betteravia Parking Lot
 Santa Maria        October 15       10:30am – 2:00pm
                                                                  511 E. Lakeside Parkway

                                                                  Human Resources Bldg. -
Santa Barbara       October 16       10:30am – 2:00pm                  Parking Lot
                                                                   1226 Anacapa Street

                                                                  Veterans Memorial Bldg.
   Lompoc           October 17       12:30pm – 2:30pm
                                                                   100 E. Locust Avenue

Come have some fun and…
  •   Get free health screenings
  •   Enjoy interactive activities with a chance to win prizes
  •   Talk to our carriers, local vendors and County departments
  •   Obtain benefit information and giveaways
  •   Enjoy from a variety of delicious food samplings
  •   Have a cold refreshing Italian ice
  •   Register to WIN one of our many donated raffle prizes

                                                  JOIN
                                                   US!

Flu and pneumonia shots will be available at the Benefits Fairs. Bring your Express Scripts ID
card (Low EPO, High EPO or PPO plan) or Blue Shield ID card (HDHP) in order to get a free flu
or pneumonia vaccination. Note: FDA guidelines apply in order to receive a pneumonia vaccine.

                                             13
Who Can You Cover?
                                                                          child” (as defined in the Internal Revenue
                                                                          Code) of another individual.
                                                                    INELIGIBLE DEPENDENTS
                                                                    • Former spouse/registered domestic partner even
                                                                       if you are court ordered to provide the ex-
                                                                       spouse/former domestic partner with health
                                                                       coverage
                                                                    • Children age 26 or older
                                                                    • Children of former spouse or former registered
      WHO IS ELIGIBLE?                                                domestic partners
                                                                    • Disabled children over age 26 who were not
      A regular civil service employee working 20 or more
                                                                      enrolled prior to age 26
      hours per weeks is eligible for the benefits outlined
                                                                    • Relatives such as grandchildren, grandparents,
      in this overview. Your coverage for health and
                                                                      parents, aunts, uncles, nieces, nephews, etc.
      dental benefits will be effective on the first of
                                                                    • Foster children
      the month following your first pay period worked
                                                                    • Live-in boyfriend/girlfriend and his/her children
      prior to the first of the following month.
                                                                    DEPENDENT ELIGIBILITY DOCUMENTATION
      Extra-Help/Contractors on Payroll who have                    REQUIREMENTS
      currently enrolled in the County’s health insurance           If you are adding dependents (spouse and/or
      can make health insurance changes during Open                 dependent children) during Open Enrollment, the
      Enrollment.                                                   County requires that you verify your dependent’s
      ELIGIBLE DEPENDENTS                                           eligibility. You have until November 14, 2019 to
                                                                    fax the eligibility documentation* to SISCO at
      • Current legal spouse or registered domestic                 563.587.672. If documentation is not received by
        partner (same or opposite gender).                          November 14, 2019, your dependent(s) will not be
      • Children (including your domestic partner's                 added to your health plans for 2020.
        children):
                                                                    *A list of acceptable documentation that meet the
          o Must be under the age of 26 and not be                  County’s eligibility requirements can be found on
              eligible for medical coverage through his or          page 35 or at www.countyofsb.org/hr.
              her employer. They do not have to live with
                                                                    QUALIFYING LIFE EVENTS
            you or be enrolled in school. They can be
            married and/or living and working on their              Make sure to notify Human Resources if you have a
            own.                                                    qualifying life event and need to make a change
          o Eligible children include natural children,             (add or drop) to your coverage election. You have 31
            stepchildren, legally-adopted children, or              days to make your change. These changes include
            children who have been placed in your                   (but are not limited to):
            custody during the adoption process, and                • Birth or adoption of a baby or child
            physically or mentally handicapped children
                                                                    • Loss of other healthcare coverage, does not
            who depend on you for support, regardless of
                                                                        include private plans
              age.
                                                                    • Eligibility for new healthcare coverage
          o    A child of a covered domestic partner who
                                                                    • Marriage or Divorce
              satisfies the same conditions as listed above
                                                                    A list of qualifying events can be found in the Legal
              for natural children, stepchildren, or adopted
                                                                    Document posted on the County’s HR website.
              children, and in addition is not a “qualifying

The County has partnered with SISCO to assist in eligibility               Click on the icon to
verification. Please open all correspondence from SISCO. If                watch a video on
you do not respond to SISCO, your dependent will not have                  Qualifying Events.
benefits or may have their benefits terminated.
                                                               14
Making the Most of Your Benefits

WHEN TO USE THE ER                                          PREVENTIVE CARE SERVICES
The emergency room shouldn't be your first choice
                                                            Children:
unless there's a true emergency—a serious or life
threatening condition that requires immediate                  + Well-baby  care
attention or treatment that is only available at a             + Annual  physicals
hospital.                                                      + Immunizations
                                                               + Flu shots
WHEN TO USE URGENT CARE                                        + Medical/family history and physical exams
Urgent care is for serious symptoms, pain, or                  + Blood pressure checks
conditions that require immediate medical attention            + Vision screening
but are not severe or life-threatening and do not
require use of a hospital or ER. Urgent care
conditions include, but are not limited to: earache,        Women:
sore throat, rashes, sprains, flu, and fever up to             + Pap  tests
104°.                                                          + Mammograms
                                                               + Annual physicals
ONSITE EMPLOYEE CLINIC                                         + Immunizations
The Santa Barbara and Santa Maria clinics are open             + Flu shots
Monday to Friday from 7:30am – 4:00pm. See page
                                                               + Colonoscopy
7 for additional information.
                                                               + Blood pressure checks
                                                               + Cholesterol (total and HDL)
PREVENTIVE OR DIAGNOSTIC?
Preventive care is intended to prevent or detect            Men:
illness before you notice any symptoms. Diagnostic             + Colonoscopy
care treats or diagnoses a problem after you have              + Prostate cancer screening
had symptoms.                                                  + Annual physicals
Be sure to ask your doctor why a test or service is            + Immunizations

ordered. Many preventive services are covered at no            + Flu shots

out-of-pocket cost to you. The same test or service            + Blood pressure checks
can be preventive, diagnostic, or routine care for a           + Cholesterol (total and HDL)
chronic health condition. Depending on why it's
done, your share of the cost may change.
Whatever the reason, it's important to keep up with
recommended health screenings to avoid more
serious and costly health problems down the road.

                                                       15
Santa Barbara County Medical
                                This comparison chart shows a brief summary of the medical benefits available.

                                                            Blue Shield EPO                         Blue Shield EPO
                                                              Low Option                              High Option
How it Works                                    You must use a Blue Shield in-network PPO contracted provider or your care will
                                                not be covered. There are no Out-of-Network benefits with these plans, except in
                                                the case of an emergency.
Medical Plan
Annual Deductible                               $300 Individual/$600 Family              None
Lifetime Maximum                                Unlimited                                Unlimited
 Annual Co-pay (Out-of-Pocket                   $2,000 Individual/$4,000 Family          $1,500 Individual/$3,000 Family
maximum)
Hospital Care
Inpatient
      -    Physician                            No Charge*                               No Charge*
      -    Facility Services                    $500/ Admission + 20%*                   $300/ Admission + 20%*
Carrum Health                                   No Charge                                No Charge
Outpatient Surgery                              $500/ Admission + 20%*                   No Charge*
 Emergency Room Visit
      -    Not resulting in admission           $250 Co-pay (waived if admitted)         $150 Co-pay (waived if admitted)
      -    Resulting in hospital admission      $500/ Admission + 20%*                   $300/ Admission + 20%*
Physician Care
Office Visit                                    $25 Co-pay (not subject to deductible)   $20 Co-pay (not subject to deductible)
Specialist Visit                                $40 Co-pay (not subject to deductible)   $30 Co-pay (not subject to deductible)
Telemedicine                                    $25 Co-pay (Teladoc)                     $20 Co-pay (Teladoc)
Preventive Care/Annual Physical                 No Charge (not subject to deductible)    No Charge (not subject to deductible)
X-Ray. Lab & Pathology Services                 No Charge*                               No Charge*
CT/PET scans, MRIs, MRAs                        No Charge*                               No Charge*
Immunizations                                   No Charge                                No Charge
Outpatient Rehabilitation Therapy               $25 Co-pay, 26 visits/yr                 $20 Co-pay, 26 visits/yr**
      -    Physical, Speech, Occupational,      (not subject to deductible)              (not subject to deductible)
           Respiratory
Chiropractic Services                           Not Covered                              $20 Co-pay, 26 visits/yr**
Acupuncture Services                            Not Covered                              $20 Co-pay, 12 visits/yr
Mental Health/Substance Abuse
Inpatient - Mental Health                       $500/ Admission + 20%*                   $300/ Admission + 20%*
Outpatient - Mental Health                      $25/ visit (not subject to deductible)   $20/ visit (not subject to deductible)
Chem. Dependency Rehab - Outpatient             $25/ visit (not subject to deductible)   $20/ visit (not subject to deductible)
Detoxification - Inpatient (Detox Only)         $500/Admission + 20%*                    $300/ Admission + 20%*
Other
Ambulance - ER or authorized transport          $50 per transport*                       $50 per transport*
Prosthetics                                     20%*                                     No Charge*
Hearing Aid - max of $700 every 24 mths         No Charge*                               No Charge*
Durable Medical Equipment                       20%*                                     No Charge*
Home Healthcare Services                        20%*                                     20%*
Hospice                                         No Charge*                               No Charge*

  * After annual deductible.

  **Chiropractic visits per year are combined with Outpatient Rehabilitation Therapy.

                                                                    16
Benefits Summary Chart - Blue Shield Plans
   Refer to the carrier Evidence of Coverage (EOC) for detailed information on the plan.

                             Blue Shield                                                         Blue Shield
                                PPO                                                            HDHP Plan (PPO)
You may see any provider when you need care. You decide whether to see an in-network or an out-of-network provider each
time you need care. When you see in-network providers you typically pay less.
          In-Network                    Out-of-Network                     In-Network               Out-of-Network

$750 Ind / $2,250 Family              $750 Ind / $2,250 Family                             $1,500/ $3,000 (combined)
Unlimited                             Unlimited                                                     Unlimited
$4,750 Ind/ $10,250 Family            $6,750 / $14,250                                     $4,500 / $9,000 (combined)

20%*                                 40%*                                 20%*                              40%*
$250/ Admission + 20%*               40%*                                 20%*                              40%*
No Charge                            N/A                                  No Charge After Deductible        N/A
20%*                                 40%*                                 20%*                              40%*

$75/ visit + 20%*                    $75/ visit + 20%*                    20%*(waived if admitted)          20%*(waived if admitted)
$250/ Admission + 20%*               40%*                                 20%*                              40%*

$30 Co-pay                           40%*                                 20%*                              40%*
$30 Co-pay                           40%*                                 20%*                              40%*
$30 Co-pay (Teladoc)                 Not Covered                          $40 (Teladoc)                     Not Covered
No Charge                            40%*                                 No Charge                         40%*
20%*                                 40%*                                 No Charge*                        40%*
20%*                                 40%*                                 No Charge*                        40%*
No Charge                            40%*                                 No Charge                         40%*
20%*, 26 visits/ yr**                40%*, 26 visits/yr**                 20%*, 26 visits/ yr**             Not Covered

20%*, 26 visits/ yr**                Not Covered                          20%*, 26 visits/ yr**             Not Covered
20%*, 12 visits/ yr                  20%*, 12 visits/ yr                  20%*, 12 visits/ yr               20%*, 12 visits/ yr

$250/ Admission + 20%*               40%*                                 20%*                              40%*
$30/ visit                           40%*                                 20%*                              40%*
$30/ visit                           40%*                                 20%*                              40%*
$250/ Admission + 20%*               40%*                                 20%*                              40%*

20%*                                 20%*                                 20%*                              20%*
20%*                                 40%*                                 20%*                              40%*
20%*                                 20%*                                 20%*                              20%*
20%*                                 40%*                                 20%*                              40%*
20%*                                 Not Covered                          20%*                              Not Covered
No Charge*                           Not Covered                          No Charge*                        Not Covered

Note for Out-of-Network benefits - you is responsible for the applicable copayment/coinsurance plus any amount that exceeds Blue
Shield’s allowable amount. For inpatient hospitalization, maximum allowed amount per day is $600/day. For outpatient
surgery/services, labs and x-rays, maximum allowed per day is $350 per day. For MRI/CT/PET scans, the max allowed per admit is $800.
Charges over the allowable amount do not count toward the calendar year deductible or out-of-pocket maximum.

                                                                    17
Santa Barbara County Medical
                                        This comparison chart shows a brief summary of the medical benefits available.

                                                       Blue Shield EPO                               Blue Shield EPO
                                                         Low Option                                    High Option
 Other - Continued
 Pregnancy/Maternity Care                 No Charge*                                    No Charge*
 Family Planning
   - Counseling                           No Charge                                     No Charge
   - Tubal ligation                       No Charge                                     No Charge
   - Vasectomy                            $75 per Surgery*                              $75 per Surgery*
   - Infertility Services (Diagnosis      50% of allowed charges*                       50% of allowed charges*
     and treatment of causes only)
 Diabetes Care
 Devices and non-testing supplies         20%*                                          No Charge*
 Diabetes self-management training        $25 Co-pay                                    $20 Co-pay
 Rx’ n Go- device/test strips/lancets     No Charge                                     No Charge
 Care Outside of Service Area
 (benefits provided by the BlueCard
 Program, for out-of-state
 emergency and non-emergency
 care, are provided at the preferred
 level of the local Blue Plan
 allowable amount when you use a
 Blue Cross/Blue Shield provider)
 · Within US: BlueCard Program            See Applicable Benefit                        See Applicable Benefit
 · Outside US: BlueCard Worldwide         See Applicable Benefit                        See Applicable Benefit

                                          Express Scripts                               Express Scripts
 Prescription Drugs                       Annual Deductible for Brand Only:             Annual Deductible for Brand Only:
                                          $100 Ind / $300 Family***                     $25 Ind / $75 Family***

                                          Out-of-Pocket Maximum:                        Out-of-Pocket Maximum:
                                          $4,600 Ind / $9,200 Family                    $5,100 Ind / $10,200 Family

 Retail: Generic/Brand/Non-                $15 / $35/ $50 after annual deductible        $10 / $35/ $50 after annual deductible
 formulary                                (30-day supply)                               (30-day supply)

 Mail Order: Generic/Brand/Non-           $30 / $70 / $100 after annual deductible      $20 / $70/ $100 after annual deductible
 formulary                                (90-day supply)                               (90-day supply)

 Specialty Medications                    20% up to $100 max per script                 20% up to $100 max per script

 Rx’n Go- Generic Maintenance             $0 Co-pay for up to 90 day supply             $0 Co-pay for up to 90 day supply
 Medications via Mail Order
* After annual deductible.
*** The Pharmacy Deductible does not apply to the Medical Deductible. Generic medications are not subject to the Pharmacy
Deductible.

Pharmacy tip: Please read all mail from Express Scripts or Blue Shield since it will be a notice of a potential change to
prescription drug(s) that you are currently taking.
Find all benefit summaries at http://cosb.countyofsb.org/hr/. Please click on the “Employee Benefits” link.

                                                                 18
Benefits Summary Chart - Blue Shield Plans
Refer to the carrier Evidence of Coverage (EOC) for detailed information on the plan.

                      Blue Shield PPO                                               Blue Shield HDHP Plan (PPO)
         In-Network                      Out-of-Network                      In-Network                      Out-of-Network

20%*                              40%*                              20%*                             40%*

No Charge                         40%*                              No Charge                        40%*
No Charge                         40%*                              No Charge                        40%*
20%*                              40%*                              20%*                             40%*
50% of allowed charges*           Not Covered                       50% of allowed charges*          Not Covered

20%*                              40%*                              20%*                             40%*
$30 Co-pay                        40%*                              20%*                             40%*
No Charge                         N/A                               No Charge                        N/A

See Applicable Benefit            See Applicable Benefit            See Applicable Benefit           See Applicable Benefit
See Applicable Benefit            See Applicable Benefit            See Applicable Benefit           See Applicable Benefit
                     Express Scripts                                                         Blue Shield
              Annual Deductible for Brand Only:                      You must meet the annual deductible first before the noted
                  $25 Ind / $75 Family***                                          co-insurance amounts apply.

Out-of-Pocket Maximum:            No Limit                          Medical and Pharmacy have a combined Out-of-Pocket
$1,850 Ind / $2,950 Family                                          Maximum

$10 / $35/ $50 after annual       $10 / $35/ $50 after annual       20%* ( 30-day supply)            20%* ( 30-day supply)
deductible ( 30-day supply)       deductible ( 30-day supply)

$20 / $70/ $100 after annual      Not Covered                       20%* (90-day supply)             Not Covered
deductible ( 90-day supply)

 20% up to $100 max per           Not Covered                       20%* up to $100 max /            Not Covered
script                                                              script
$0 Co-pay for up to 90 days       N/A                               $0 Co-pay for Preventive         N/A
                                                                    generic medications
Note for Out-of-Network benefits - you is responsible for the applicable copayment/coinsurance plus any amount that exceeds Blue
Shield’s allowable amount. For inpatient hospitalization, maximum allowed amount per day is $600/day. For outpatient surgery/services,
labs and x-rays, maximum allowed per day is $350 per day. For MRI/CT/PET scans, the max allowed per admit is $800. Charges over the
allowable amount do not count toward the calendar year deductible or out-of-pocket maximum.

                                                      Click on the icon to watch a video
                                                      on Prescriptions Dos and Don’ts.

                                                              19
Kaiser Medical Plans

                                                           Kaiser HMO                          Kaiser HMO
                                                           Low Option                          High Option
Medical Plan
Annual Deductible                            None                                None
Lifetime Maximum                             Unlimited                           Unlimited
 Annual Co-pay (Out-of-Pocket                $1,500 Individual/$3,000 Family     $1,500 Individual/$3,000 Family
maximum)
Hospital Care
Inpatient Surgery                            $500 per admission                  $100 per admission
Outpatient Surgery                           $20 Co-pay per procedure            $15 Co-pay per procedure
Emergency Room Visit
      -    Not resulting in admission        $100 Co-pay                         $100 Co-pay
      -    Resulting in hospital admission   $500 hospital admission charge      $100 hospital admission charge
Physician Care
Office Visit                                 $20 Co-pay                          $15 Co-pay
Specialist Visit                             $20 Co-pay                          $15 Co-pay
Preventive Care/Annual Physical              No Charge                           No Charge
X-Ray. Lab & Pathology Services              No Charge                           No Charge
CT/PET scans, MRIs, MRAs                     No Charge                           No Charge
Immunizations                                No Charge                           No Charge
Chiropractic or Acupuncture Services         Not Covered                         Not Covered
Mental Health/Substance Abuse
Inpatient - Mental Health                    $500 per admission                  $100 per admission
Outpatient - Mental Health                   $20 Co-pay                          $15 Co-pay
Chem. Dependency Rehab - Outpatient          $20 Copay                           $15 Co-pay
Detoxification - Inpatient (Detox Only)      $500 per admission                  $100 per admission
Other
Ambulance                                    $50 per transport                   $50 per transport
Prosthetics                                  No Charge                           No Charge
Durable Medical Equipment                    No Charge                           No Charge
Home Healthcare Services                     No Charge (up to 100 visits)        No Charge (up to 100 visits)
Hospice                                      No Charge                           No Charge
Prescription Drugs                           $10 Co-pay Generic                  $10 Co-pay Generic
Retail:                                      $35 Co-pay Brand                    $30 Co-pay Brand
                                             No Non-Formulary Coverage           No Non-Formulary Coverage
                                             (30-day supply)                     (30-day supply)

Mail-Order:                                  $20 Co-pay Generic                  $20 Co-pay Generic
                                             $70 Co-pay Brand                    $65 Co-pay Brand
                                             No Non-Formulary Coverage           No Non-Formulary Coverage
                                             (100-day supply)                    (100-day supply)
                                             Specialty: 20% up to $150 max per   Specialty: 20% up to $150 max per
                                             script                              script

                                                              20
Dental
To enroll in a dental plan, you and your dependent(s) MUST be enrolled in one of the County’s medical
plans. Dependents may enroll in a medical plan without enrolling in a dental plan.

                             Delta Dental DHMO
                            DeltaCare USA (15A)                        Delta Dental PPO Plan – Self-Funded

                                   In-Network                          In-Network                   Out-Of-Network

   Calendar Year          $0                                           $50 Individual (combined in and out-of-network)
   Deductible
                          $0                                           $100 Family (combined in and out-of-network)

   Annual Plan
                          Unlimited                                       $1,500 (combined in and out-of-network)
   Maximum

   Waiting Period         None                                  None                         None

   Diagnostic and         Plan pays 100%                        Plan pays 100%               Plan pays 100%
   Preventive

   Basic Services

   Fillings               $8-$395 copay (varies by              Plan pays 80% after          Plan pays 80% after
                          service, see contract for fee         deductible                   deductible
                          schedule)

   Root Canals            $5-$395 copay (varies by              Plan pays 80% after          Plan pays 80% after
                          service, see contract for fee         deductible                   deductible
                          schedule)

   Periodontics           $8-$385 copay (varies by              Plan pays 80% after          Plan pays 80% after
                          service, see contract for fee         deductible                   deductible
                          schedule)

   Major Services         $15-$395 copay (varies by             Plan pays 60% after          Plan pays 60% after
                          service, see contract for fee         deductible                   deductible
                          schedule)

   Orthodontic Services

   Orthodontia

   Lifetime Maximum       N/A                                             $1,200 (combined in and out-of-network)

   Child                  $1,900                                Plan pays 60%                Plan pays 60%

   Adult                  $2,100                                Plan pays 60%                Plan pays 60%

For DHMO members: When first enrolling in a DHMO plan, you must choose a primary dentist. If you do not,
one will automatically be selected for you. To change your auto-assigned dentist, you will need to call Delta
Dental at 800.422.4234 after Open Enrollment with your selection.
The County has a special DHMO provider network with Delta Dental.
Go to www.deltadentalins.com/countyofsantabarbara for a full selection of DHMO providers. Use this website
when selecting a new primary dentist.

                                                          Click on the icon to watch a video
                                                          on Dental Insurance Tips.
                                                           21
Vision
The County of Santa Barbara offers you a vision plan through Vision Service Plan. You do not have to enroll in
the medical or dental plan in order to enroll in the Vision plan.

                                                 VSP – Choice Vision Plan (Voluntary)

                                          In-Network                               Out-Of-Network

    Examination

    Benefit                  $10 copay then plan pays 100%           Plan pays up to the $51 allowance

    Frequency                1 x every 12 months                     In-network limitations apply

    Materials                $10 copay (combined with                $10 copay (combined with examination)
                             examination) then 100%                  then 100% (see schedule below)

    Eyeglass Lenses

    Single Vision Lens       Plan pays 100% of basic lens            Up to $41 allowance

    Bifocal Lens             Plan pays 100% of basic lens            Up to $63 allowance

    Trifocal Lens            Plan pays 100% of basic lens            Up to $82 allowance
                             20% off all other lens options

    Frequency                1 x every 24 months or 1 every 12       In-network limitations apply
                             months if change in prescription

    Frames

    Benefit                  Up to $150 retail allowance, then 20%   Up to $70
                             off amount above the allowance

    Frequency                1 x every 24 months                     In-network limitations apply

    Contacts (Elective)

    Elective                 Up to $150 allowance (instead of        Up to $105 allowance (instead of
                             eyeglasses)                             eyeglasses)

    Medically Necessary      $10 copay                               Up to $302 allowance

    Frequency                1 x every 24 months                     1 x every 24 months

    Low Vision Benefit       $500 maximum benefit every two years    Not covered
                             (for severe vision problems)

    Laser Vision             15% fee discount                        Not covered
    Correction

    USING YOUR VSP BENEFIT IS EASY
•   Find a VSP doctor or print and ID card at
    www.vsp.com .
•   At your appointment, tell them you have VSP, no
    ID card is necessary.
•   Create an account online to review your benefits.

                                                              22
Cost of Coverage

The County of Santa Barbara pays for 100% of cost for basic Life, AD&D and LTD coverage.
All 2020 premiums are noted as twice-monthly premium amounts.

                                             Medical           County             Pre-Tax
                                             Premium         Contribution       Deductions*
 Blue Shield Low Option EPO Medical Plan

 Employee Only
                                              405.89          (405.89)              0.00
 With 1 Dependent
                                              748.89          (405.89)            343.00
 Two + Dependents
                                             1175.89          (405.89)            770.00
 Blue Shield High Option EPO Medical Plan

 Employee Only
                                              469.89          (405.89)             64.00
 With 1 Dependent
                                              868.39          (405.89)            462.50
 Two + Dependents
                                             1362.39          (405.89)            956.50
 Blue Shield PPO Medical Plan

 Employee Only
                                              618.89          (405.89)            213.00
 With 1 Dependent
                                             1142.39          (405.89)            736.50
 Two + Dependents
                                             1794.89          (405.89)            1389.00
 Blue Shield HDHP Medical Plan

 Employee Only
                                              353.89          (353.89)              0.00
 With 1 Dependent
                                              632.39          (353.89)            278.50
 Two + Dependents
                                              993.39          (353.89)            639.50
 Kaiser Low Option Medical Plan**

 Employee Only
                                              298.39          (298.39)              0.00
 With 1 Dependent
                                              558.89          (298.39)            260.50
 Two + Dependents
                                              847.89          (298.39)            549.50

                                                       23
Medical                County                   Pre-Tax
                                                          Premium              Contribution             Deductions*

 Kaiser High Option Medical Plan**

 Employee Only
                                                           309.89                (309.89)                    0.00
 With 1 Dependent
                                                           579.89                (309.89)                  270.00
 Two + Dependents
                                                           879.39                (309.89)                  569.50

                                                           Dental                County                   Pre-Tax
                                                          Premium              Contribution             Deductions*

 Delta Dental DHMO Dental Plan

 Employee Only
                                                            16.44                 (13.03)                    3.41
 With 1 Dependent
                                                            27.02                 (13.03)                   13.99
 Two + Dependents
                                                            41.03                 (13.03)                   28.00
 Delta Dental DPPO – County Self-Funded
 Dental Plan
 Employee Only
                                                            22.15                 (13.03)                    9.12
 With 1 Dependent
                                                            42.56                 (13.03)                   29.53
 Two + Dependents
                                                            65.51                 (13.03)                   52.48

                                                           Vision                County                   Pre-Tax
                                                          Premium              Contribution             Deductions*

 VSP Vision Plan

 Employee Only
                                                             3.18                   N/A                      3.18
 With 1 Dependent
                                                             4.57                   N/A                      4.57
 Two + Dependents
                                                             8.20                   N/A                      8.20

*Premium and County contribution rates in the document reflect a twice monthly deduction schedule taken over 24 pay periods. The first
deduction for the 2020 premiums will be taken in pay period 1 of 2020. There are two pay periods in 2020 in which no deduction is taken.

** Kaiser plans are limited to employees who reside in a Kaiser Southern California service area. Please go to www.kp.org to look up your zip
code and confirm that you live in the service area.

Please Note: Twice-monthly rates include $1.77 for Employee Assistance Plan (EAP) and CareCounsel Healthcare Assistance Plan. If
you and your spouse or domestic partner are both employees and want to combine the County’s contributions toward the cost of your
coverage, see the separate sheet online at the County’s website, http://cosb.countyofsb.org/hr/ under “Combined Coverage.”

The County’s benefits allowance amounts can be found at the County’s website, http://cosb.countyofsb.org/hr/.

                                                                    24
Life and Disability Insurance
If you have loved ones who depend on your income for support, having life and accidental death
insurance can help protect your family's financial security.

BASIC LIFE and AD&D
Basic Life Insurance pays your beneficiary a lump sum if you die. AD&D provides another layer of
benefits to either you or your beneficiary if you suffer from loss of a limb, speech, sight, or hearing, or
if you die in an accident. The cost of coverage is paid in full by the County of Santa Barbara.
Coverage is provided by Voya Financial.

   Eligible Group                                                   Basic Life and AD&D Amount

   Department Heads, Board of Supervisors and Elected               $50,000
   Officials

   Assistant Department Heads                                       $30,000

   Managers & Unrepresented Attorneys, Confidential                 $20,000
   Employees, and employees in job classes
   represented by:
        •   Deputy District Attorneys Association
        •   Civil Attorneys Association
        •   Deputy Sheriffs Association
        •   Engineers & Technicians Association
        •   SEIU Local 620 & 721
        •   Fire Fighters Locals 2046
        •   Probation Peace Officers Association
        •   Union of American Physicians & Dentists

Taxes: Due to IRS regulations, a life insurance benefit of $50,000 is considered a taxable benefit. You
will see the value of the benefit included in your taxable income on your paycheck and W-2.

BENEFICIARY REMINDER
Beneficiary means a person you name to receive death benefits.
You may name one or more beneficiaries. Make sure that you
have named a beneficiary for your basic life insurance. You may
change your beneficiary at any time. Note that some states
require a spouse be named as a beneficiary unless they sign a
waiver. Remember that a divorce or separation will not
automatically affect a beneficiary designation, so please review
you beneficiary election(s) to ensure it accurately reflects your
wishes.

                                                            25
LONG-TERM DISABILITY INSURANCE
Long-Term Disability coverage pays you a certain percentage of your income if you can't work because
an injury or illness prevents you from performing any of your job functions over a long time. It's
important to know that benefits are reduced by income from other benefits you might receive while
disabled, like Workers' Compensation and Social Security.
If you qualify, long-term disability benefits begin 60 after 60 days. The cost of coverage is paid in
full by the County of Santa Barbara. Coverage is provided by Voya Financial.

   Eligible Group:                                 Plan pays 60% of your basic monthly income
   Department Heads, Assistant Department          $9,000 is maximum amount
   Heads, Managers, Unrepresented
   Attorneys, Confidential Unrepresented           Benefits begin after 60 days of disability
   Employees, and employees represented
   by the Union of American Physicians, &          Social Security normal retirement age is maximum
   Dentists, Deputy District Attorneys             payment period*
   Association and Civil Attorneys
   Association.

   Eligible Group:                                 Plan pays 60% of your basic monthly income
   Employees in job classes represented by:        $3,600 is maximum amount
      •   Engineers & Technicians
          Association                              Benefits begin after 60 days of disability
      •   SEIU Local 620 & 721
                                                   Social Security normal retirement age is maximum
      •   Fire Fighters Locals 2046
                                                   payment period*
      •   Probation Peace Officers
          Association

*The age at which the disability begins may affect the duration of the benefits.

                                                   26
VOLUNTARY TERM LIFE INSURANCE
Voluntary Term Life Insurance allows you to purchase additional life insurance to protect your family's
financial security. Coverage is provided by Voya Financial.

   Employee Voluntary Term          Can elect from $10,000 to $500,000 in increments of
   Life Amount                      $10,000. Guaranteed issue amount is $300,000* or
                                    $150,000* for age 60 and over for new hires only.

   Spouse or Domestic Partner       Can elect from $10,000 to $500,000 in increments of $10,000
   Voluntary Term Life Amount       not to exceed 100% of Employee’s Supplemental Life Insurance
                                    amount. Guaranteed issue amount is $50,000.*

   Child(ren) Voluntary Term        Can elect $5,000 or $10,000 (from 6 months to age 26).
   Life Amount                      Guaranteed issue amount is $10,000.
Note: Married employees are not eligible for spouse coverage if the other spouse enrolls in Voluntary
Term Life Insurance.
*$20,000 of AD&D is included in this policy at no additional cost.

VOLUNTARY WHOLE LIFE INSURANCE
Whole Life insurance, through Manhattan Life, formerly Humana, provides you with additional financial
security and is designed to last through your retirement. A Facility Care Rider offers protection for Long
Term Care expenses.

   Employee Base Coverage           Guaranteed issue limit: up to $14/week.
                                    Coverage minimum is $2,500 to maximum of $125,000.

   Spouse Stand-alone               Guaranteed issue limit: $4/week to max of $15,000.
   Coverage                         Coverage minimum is $2,500 to maximum of $50,000.

   Child(ren) Stand-alone           Guaranteed issue limit: up to $10,000.
   Coverage                         Coverage minimum is $2,500 to maximum of $25,000.

The plan provides:
   •   An accelerated death benefit for terminal illness. It will pay when insured is diagnosed with a
       terminal illness with 6 months or less to live. Payment is 50% of face amount of base plan or
       $100,000.
   •   An accelerated benefit for terminal illness. Plan will pay lump sum of 50% of death benefit
       after diagnosis when life expectancy is 12 months or less.
   •   A facility care accelerated benefit rider. Provides monthly benefit for licensed adult day care
       facility or inpatient residential care for nursing home or assisted living facility.

         To enroll or for additional information, please call Farmington at 877.290.3931.

                                                   27
Voluntary Accident and Critical Illness Insurance
VOLUNTARY PERSONAL ACCIDENT                                  VOLUNTARY CRITICAL ILLNESS
Voluntary Personal Accident Insurance (PAI) is               Critical Illness Insurance is an affordable way to
offered by Voya Financial. Premiums are based on a           protect against the financial stress of a serious
flat rate per $1,000 for Employee only or Family             illness. It pays a lump-sum benefit if you are
(Spouse/Domestic Partner and Child). Evidence of             diagnosed with a covered illness or condition. This
Insurability (EOI) is not required.                          policy is in addition to your health coverage. You
                                                             may use this benefit to pay:
   Employee          Can elect from $25,000 to
                                                                 •   Medical expenses
   Voluntary         $500,000 in $25,000
   Personal          increments not to exceed 10                 •   Child care
   Accident          times annual salary                         •   Home health costs
                                                                 •   Mortgage payment/rent and home
   Family                •   Spouse/Domestic                         maintenance
   Voluntary                 Partner – see benefit
   Personal                  summary for details             This policy offers an annual Wellness benefit that
   Accident              •   Child (each) – see              provides a $200 reimbursement for covered
                             benefit summary for             health screenings.
                             details
                                                             Coverage is provided by Voya Financial.

Plan includes Travel Assistance, Day Care benefits,             Employee          Can elect from $5,000 to
Emergency Evacuation, Repatriation of Remains and               Voluntary         $30,000 in $5,000
a Seat Belt benefit.                                            Critical          increments. Guaranteed issue
                                                                Illness           amount is $30,000.

                                                                Spouse            Can elect from $5,000 to
VOLUNTARY ACCIDENT                                              Voluntary         $15,000 in $5,000
                                                                Critical          increments. Guaranteed issue
Voluntary Compass Accident Insurance is offered by              Illness           amount is $15,000.
Voya Financial. This policy helps you pay for the
out-of-pocket costs you may experience after an                 Child             Can elect $5,000 or
accident. The policy pays a lump sum amount                     Voluntary         $10,000. Guaranteed issue
depending on the type of injuries you have sustained            Critical          amount is $10,000.
                                                                Illness
such as broken bones, torn ligaments, burns, as well
as for expenses from hospitalizations, the ER, office
visits or physical therapy. You may use this amount
to pay for everyday living expenses or to pay
healthcare costs.
The policy also has an annual Wellness Benefit
that pays you $150 for completing a screening as
well as additional Wellness amounts for your
spouse and child(ren).

                                                        28
Wellness Benefit At A Glance
What is a Wellness Benefit?
A Wellness benefit is a rider that is included on your voluntary Accident and Critical Illness plan. It
provides an annual payment if you complete a preventive health screening test. You only need to
complete one preventive health screening test. This one test can be used for any or all three benefit
plans. The Accident and Critical Illness each has a Wellness benefit. Your spouse and/or dependents
covered under your plan also have a Wellness benefit.
What type of preventive health screening tests are eligible?
Preventive health screening tests include but are not limited to:
 Blood test for                Serum Protein                 Fasting blood glucose
                                                                                      Annual physical exam
 triglycerides                 Electrophoresis               test
                               Breast ultrasound,                                     CA 125 (ovarian
 Pap smear                                                   Thermography
                               sonogram, MRI                                          cancer)
 Sigmoidoscopy                 Chest x-ray                   PSA ( prostate cancer)   Tests for STIs
                                                                                      Ultrasounds for
 CEA (blood test for
                               Mammography                   Hearing test             abdominal aortic
 colon cancer)
                                                                                      aneurysms
 Bone marrow testing           Colonoscopy                   Routine eye exam         Hemoglobin A1C
                               CA 15-3 (breast
 Cholesterol test                                            Routine dental exam      Bone density
                               cancer)
 Hem occult stool              Stress test on bicycle        Well child/preventive    Electrocardiogram
 analysis                      or treadmill                  exam to age 18           (EKG)

How do I file a claim?
You can easily file a claim online.
   1. Go to voya.com/claims
   2. Scroll down to the “Have a Wellness Benefit Claim?” section and click the “Submit your claim”
       button.
   3. Check all products that apply – Accident, Critical Illness, Hospital Indemnity
   4. Click “Continue” and follow the screen prompts. Once all questions are answered, click
       “Submit”
Your Group Name is: County of Santa Barbara
Your Group Number is: 00684911

                    Click on the icon to view a video
                    on “How To File A Claim”.

                        Don’t forget to claim your Wellness dollars every year!
                  Make it a habit to do so right after your annual physical exam.
                                                        29
Special Savings Accounts
HEALTH SAVINGS ACCOUNT (HSA)
A Health Savings Account (HSA) is available to employees who participate in the Blue Shield
High Deductible Health Plan (HDHP). This is a tax-advantaged savings account that allows you
to save pre-tax dollars to pay for qualified health expenses. To open an HSA account or change
your contributions, you must go online to the County’s eBenefits website at
https://benxcel.net.

        Why should I have an HSA Account?
An HSA account is owned by you, goes with you if you leave
employment, is tax free and can be used for qualified
medical, dental and vision expenses.
The County makes a yearly contribution into your HSA
account to help fund your account. This amount is yours to
keep even though you may not use the entire contribution
amount during the year. Remember that the HSA account is
yours and you can take it with you if you decide to leave the
County.
Note: you are not eligible to elect an HSA if you are covered by another health plan, such as a
health plan sponsored by your spouse’s employer, Medicare, Tricare, or if an employee is
claimed as a dependent on another’s tax return.

                          HSA Contribution Limits for 2020

            Annual Single Contribution Maximum                     $3,550*

            Annual Family Contribution Maximum                     $7,100*
            Annual Catch-Up Contribution Maximum (for              $1,000
            HSA participants that are 55 years or older)

                            Want to learn more?
                            Click on the icon to watch a video
                            on how a High Deductible Health
                            Plan works alongside a Health
                            Savings Account.

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How does the County contribute to my HSA?
The County of Santa Barbara will make a yearly contribution into an employee’s Health
Savings Accounts (HSA) based on the schedule below.
For first time enrollees in the HDHP in 2020, the County will contribute half of its yearly
contribution amount in one lump sum in pay period 1 of 2020 to assist you with funding your
new Health Savings Account (HSA). On pay period 14 of 2020, the County will begin
depositing the remainder of the yearly contribution amount per the pay period schedule below.

         FOR EMPLOYEES CONTINUING ENROLLMENT IN A HDHP FOR 2020

                                                            2020 Yearly
                                                     County Contribution Amount
                                                       $1,200 ($46.15 per pay
                 Employee Only
                                                               period)
                                                       $1,800 ($69.23 per pay
                 Employee + Dependent(s)
                                                               period)
                 Two Married County Employees         $3,000 ($115.38 per pay
                 w combined coverage                          period)

                 FOR FIRST TIME NEW ENROLLEES IN A HDHP IN 2020
                           County Contribution         County Contribution       2020 Yearly
                             Amount on Pay             Amount Starting on     County Contribution
                            Period 1 of 2020         Pay Period 14 of 2020         Amount
                                                      $46.15 per pay period
 Employee Only                    $600                                              $1,200
                                                             ($600)
                                                     $69.23 per pay period
 Employee + Dependent(s)          $900                                              $1,800
                                                           ($900)
 Two Married County
                                                     $115.38 per pay period
 Employees w combined            $1500                                              $3,000
                                                           ($1,500)
 coverage

Note: the County contribution amount plus the amount that you will contribute should not
exceed the IRS contribution limits for 2020 noted on the previous page.

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FLEXIBLE SPENDING ACCOUNT (FSA)
The County of Santa Barbara offers you a Healthcare and/or Dependent Care Flexible Spending
Account (FSA) through Benefits Coordinator Corporation (BCC). You may participate in one or
both plans.

Healthcare FSA Account

This plan allows you to pay for eligible out-of-pocket healthcare expenses with pre-tax dollars.
Eligible expenses include medical, dental, or vision costs such as plan deductibles, copays,
coinsurance amounts, and other non-covered healthcare costs for you and your tax dependents.
For 2020, you can set aside up to $2,700.

Dependent Care FSA Account
This plan allows you to pay for eligible out-of-pocket dependent care expenses with pre-tax
dollars. Eligible expenses may include daycare centers, in-home child care, and before or after
school care for your dependent children under age 13. Other individuals may qualify if they are
considered your tax dependent and are incapable of self-care. It is important to note that you
can access money only after it is placed into your dependent care FSA account.
All caregivers must have a tax ID or Social Security number.
This information must be included on your federal tax return.
If you use the dependent care reimbursement account, the IRS
will not allow you to claim a dependent care credit for
reimbursed expenses. Consult your tax advisor to determine
whether you should enroll in this plan. For 2019, you can set
aside up to $5,000 per household for eligible dependent care
expenses.

IMPORTANT CONSIDERATIONS

• You must use all of your Healthcare FSA funds by March 15, 2021 or else you will lose them.
  The FSA plans have a Grace Period that allows you to continue to incur new claims up to
  03/15/21, with any remaining funds from your 2020 elected amount.
• Elections cannot be changed during the plan year, unless you have a qualified change in
  family status.
• FSA funds can be used for you, your spouse, and your tax dependents only.
• Claim forms may be found on the BCC website, https://benxcel.net.
• Stops on the last day of active employment.
• You must re-enroll every year during Open Enrollment. Your 2019 elected amount will
  not roll over for 2020.

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