2021 Benefits Guide Plan Year January 1, 2021 through December 31, 2021 - Littleton CO

 
2021 Benefits Guide Plan Year January 1, 2021 through December 31, 2021 - Littleton CO
2021 Benefits Guide

                     Plan Year January 1, 2021 through December 31, 2021

Revised 09.28.2020
2021 Benefits Guide Plan Year January 1, 2021 through December 31, 2021 - Littleton CO
The City of Littleton is pleased to provide you with benefit offerings to help you take care of your well-being
now and into the future. We want each and every participant to receive the highest quality health coverage at
the most affordable price possible.

This booklet provides a high-level overview of the plans. More information about our plan is available in your
full plan description or by contacting HR.

Table of Contents
Benefit Program Overview ............................................................................................................................. 3
Benefit Eligibility ............................................................................................................................................ 4
Enrollment Instructions ................................................................................................................................. 6
Medical Plan .................................................................................................................................................. 9
Medical Plan Costs ........................................................................................................................................11
Cost Savings Resources ................................................................................................................................ 12
Prescriptions ................................................................................................................................................ 13
City of Littleton Employee Wellness Clinic .................................................................................................... 15
Dental Plan ...................................................................................................................................................17
Dental Plan Costs ......................................................................................................................................... 18
Vision Plan ................................................................................................................................................... 19
Vision Plan Costs .................................................................................................................................................. 20
Life Insurance ...............................................................................................................................................21
Voluntary Life/AD&D ................................................................................................................................... 22
Disability Insurance...................................................................................................................................... 23
Employee Assistance Program ..................................................................................................................... 24
Tax Savings Programs ...................................................................................................................................25
Legal Shield................................................................................................................................................... 26
Time-Off Benefits .......................................................................................................................................... 27
Retirement Plans ......................................................................................................................................... 30
Tuition Reimbursement ............................................................................................................................... 32
Wellness Program ........................................................................................................................................ 32
Plan Contacts ............................................................................................................................................... 33
Important Plan Notices and Documents ....................................................................................................... 34
2021 Benefits Guide Plan Year January 1, 2021 through December 31, 2021 - Littleton CO
Benefit Program Overview
                            Contact Human Resources for Help
                            City of Littleton – Human Resources
                            (303) 795-3857
                            HR@littletongov.org

                                BENEFIT OFFERINGS
MEDICAL                   Cigna LocalPlus Plan
                          Medical plan includes:
                             - $500 deductible for in-network providers
                             - $25 copays for visits to PCP and $50 copay for visits to specialists
                             - 80% coinsurance for other services
                             - (Copays/coinsurance shown are for in-network providers)
DENTAL                    Delta Dental PPO plan:
                             - Preventative care covered at 100%
                             - $50 deductible for other services
VISION                    The VSP network for vision care, including a $10 copay for in-network
                          exams and allowances for glasses or contacts
BASIC LIFE & ACCIDENTAL   1.5 x your annual salary, up to $250,000 of coverage for both life and
DEATH & DISMEMBERMENT     accidental death & dismemberment (AD&D).

SHORT-TERM AND LONG-      Benefit varies based on years of service. (see pg. 23 for details)
TERM DISABILITY
VOLUNTARY BENEFIT         Employees may choose to purchase voluntary benefits through convenient
OPTIONS                   payroll deduction:
                              - Employee & Dependent Supplemental Life Insurance
                              - Flexible Spending Accounts
EMPLOYEE ASSISTANCE       Regular full and part-time employees and their dependents (living in their
PROGRAM                   household) are eligible for 5 free sessions per incident, per person, per
                          calendar year.
RETIREMENT PLANS          General Employee Retirement Plan
                          Police Employee Pension Plan
                          Deferred Compensation Plan
PAID HOLIDAYS             The city observes 9.5 paid holidays per year

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2021 Benefits Guide Plan Year January 1, 2021 through December 31, 2021 - Littleton CO
Benefit Eligibility
    The City of Littleton allows employees to participate in the plans if they meet the minimum service hour
    requirements, as outlined in the table below, and are a regular employee. *
       BENEFIT                                                                  Part-Time Rate                      Full-Time Rate
                                                                             Service Requirement                 Service Requirement
       Medical                                                               20+ hours per week                  30+ hours per week
       Dental, Vision, Life, AD&D, Long-Term Disability                      20+ hours per week                  30+ hours per week
       Voluntary Benefits through Voya                                       20+ hours per week                  30+ hours per week
       Employee Assistance Program                                                   All full-time and part-time employees

    *If you are a temporary employee working 30 hours or more, you may be eligible for medical benefits due to provisions of the Affordable Care
    Act (healthcare reform). Please see Human Resources if you have any questions.

    Eligible dependents*
              •    Legal spouse (same or opposite sex)
              •    Civil union partner
              •    Common-law spouse
              •    Child(ren) to the age of 26 — married and unmarried- biological, legally adopted, or legal custody
              •    Stepchild(ren) to the age of 26 — the employee must be married to the child’s parent

    Eligibility Documents Required
    Proof of eligibility is required for all dependents covered on the City’s insurance. Acceptable documentation
    includes:

              •    Marriage certificates for spouses
              •    Civil union certificate for civil union partner
              •    Birth certificates or proof of legal guardianship for children
              •    Affidavit for common-law spouses

*Domestic partners verified prior to December 31, 2019 are still considered eligible dependents.

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2021 Benefits Guide Plan Year January 1, 2021 through December 31, 2021 - Littleton CO
When you can enroll
You can enroll in benefits as a new hire, during our annual enrollment period or if you experience a qualifying
life event. New hires or employees who have a change in employment status that makes them eligible for
benefits must enroll within 30 days of their hire date or eligibility date. Coverage is effective on the first of the
month following their date of hire or eligibility.

Changing your benefits
Outside of open enrollment, you may be able to add or remove dependents or change benefit options if
you experience a qualifying life event. A qualifying life event is a change in your family status or employment
that affects your benefits eligibility. Examples include:

        •   Marriage or divorce
        •   Birth, adoption, death of a dependent
        •   A dependent child is no longer eligible because they have reached age 26
        •   Change in the employment of an employee or an employee’s spouse that affects benefit eligibility

It is the employee’s responsibility to submit the appropriate paperwork to Human Resources within 30 days of
the event. If this deadline is missed, the employee must wait until the next open enrollment period to make
changes.

       To request a benefits change, notify Human Resources within 30 days of the qualifying life event.
       Change requests submitted after 30 days cannot be accepted. You will need to provide proof of
       the event, such as a marriage license or birth certificate.

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2021 Benefits Guide Plan Year January 1, 2021 through December 31, 2021 - Littleton CO
Online Enrollment Instructions- Sage Employee Self-Service
The City of Littleton uses Sage Employee Self Service to make the benefits enrollment process easy
and convenient.

Beginning Tuesday, October 27, 2020, Employee Self Service will enable you to enter, customize,
validate, and confirm your benefits selection and dependent information online.

                             2020 Open Enrollment
          Enroll online from Tuesday, October 27, 2020 through Monday, November 9,
                                             2020

Selecting Your Benefits Online is Simple!

Just follow these step-by-step instructions.

Log onto SAGE Employee Self Service at

https://benefits.littletongov.org/sagebenefits/default.aspx

Review Message Center and Enter Open Enrollment

There will be Open Enrollment Notifications on the left of the screen click “Open Enrollment”

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2021 Benefits Guide Plan Year January 1, 2021 through December 31, 2021 - Littleton CO
Online Enrollment Instructions- Sage Employee Self-Service

Once you have started the Open Enrollment Session

You will notice your enrollment status will show “Incomplete” (you must re-elect your benefits)

To navigate to each page use the arrows at the top of the page on the right.

Adding or Editing Dependents

    §   If you do not see your dependents listed under “Dependents” you can add or edit by clicking
        the plus sign
             o If you would also like them to be a beneficiary, select “Both” as the type of dependent.
             o You must select the coverage tier AND check the box next to the Dependents name
                to elect coverage.
             o Important: If you are choosing to cover a dependent (Spouse/Child(ren)), you must
                select the correct tier (Employee + spouse, EE+Child(ren), or Family) AND choose the
                dependents that are to be covered

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2021 Benefits Guide Plan Year January 1, 2021 through December 31, 2021 - Littleton CO
Understanding Flexible Spending Elections
You must select or waive the Flex Spending Account

   §   Note: When entering an annual amount, do not use dollar signs, commas, or decimals.

Reviewing and Confirming

   §   Print a copy for your records

IMPORTANT: Submitting your Benefit Elections
   §   You must change select “I’M FINISHED”
   §   Enter your ESS Username
   §   Enter your ESS Password
   §   Enter your Social Security number (WITH DASHES) ie. 211-11-1111
   §   Click Done
           o You should receive a “Congratulations” email instantly showing you successfully
               completed Open Enrollment.

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2021 Benefits Guide Plan Year January 1, 2021 through December 31, 2021 - Littleton CO
Your Medical Plan
The City of Littleton offers one medical plan through the Cigna LocalPlus network. Your plan includes free
preventive care from in-network providers to ensure that you are staying healthy. The medical plan provides
in- and out-of-network benefits, providing you the freedom to choose a provider. However, you will maximize
the plan benefits and pay less out of your pocket when you choose an in-network provider. Your plan provides
a large network of doctors, hospitals, and labs.

Your Plan offers

             • Online tools and health resources to make managing your care and coverage easier
             • 24/7 access to a Cigna AmWell or MDLIVE doctors for confidential, expert answers to your
               health questions
             • Access to Cigna mobile app to find network doctors, compare cost information, order
               prescriptions, and more.
             • Cigna Cancer Support for patients and families
             • 90-Day Prescription Refills on maintenance medications with Cigna 90 Now.
Make sure you choose a doctor that is in the LocalPlus Network to get the most out of your benefits!

             • Go to myCigna.com and sign in with your user ID and passcode. (If you’re not already
               registered for myCigna.com, click on “Register Now” to sign up)
             • Click on the “Find a Doctor” tab
             • Enter the requested details for your search
             • Click on “Search” to see all the doctors and hospitals in the LocalPlus Network. (If there is no
               LocalPlus Network in your search area, you’ll see a link to our Away From Home Care
               Network)

With these benefits, you can be confident you are getting the best value for your health care and coverage
dollars. Please visit www.mycigna.com and don’t forget to register for access to many member resources and
tools that are also available on the mobile app.

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2021 Benefits Guide Plan Year January 1, 2021 through December 31, 2021 - Littleton CO
Cigna LocalPlus
                            The table below summarizes the key features of the medical plan. The coinsurance
                            amounts listed reflect the amount you pay. Please refer to the official plan
                            documents for additional information on coverage and exclusions.

                                     In-Network                               Out-of-Network
Annual Deductible
Individual                                   $500                                    $1000
Two Person/Family                          $1000                                     $2000

Annual Out-of-Pocket Max
Individual                                $4,000                                    $10,000
Two Person/Family                         $8,000                                    $20,000

Preventive Services                  Plan pays 100%                              Plan pays 50%
Office Visit

Primary Provider                        $25 copay                              50% Coinsurance
Specialist                              $50 copay                              50% Coinsurance

Urgent Care                             $50 copay                                  $50 copay

Emergency Room               Plan pays 80% after deductible            Plan pays 80% after deductible

Lab and X-ray                Plan pays 80% after deductible            Plan pays 50% after deductible

Inpatient Hospitalization    Plan pays 80% after deductible            Plan pays 50% after deductible

Outpatient Surgery           Plan pays 80% after deductible            Plan pays 50% after deductible

                                        10
Medical Plan Costs
Listed below are the biweekly costs for medical insurance. The amount you pay for coverage is deducted from
your paycheck on a pre-tax basis.

                                  Full-Time Biweekly Medical Costs

     Coverage Level                    Full-Time Rate                             Full-Time Rate
                                    Employee Medical Cost                        City Medical Cost
  Employee Only                               $34.23                                   $308.04
  Employee + Spouse                           $140.16                                  $560.62
  Employee + Child(ren)                       $130.06                                  $520.24
  Employee + Family                           $200.22                                  $800.89

                                 Part-Time Biweekly Medical Costs

     Coverage Level                    Part-Time Rate                             Part-Time Rate
                                    Employee Medical Cost                        City Medical Cost
  Employee Only                               $136.90                                  $205.36
  Employee + Spouse                           $350.39                                  $350.39
  Employee + Child(ren)                       $325.14                                  $325.16
  Employee + Family                           $500.56                                  $500.56

                                                        11
Cost Saving Resources
Chat with a Doctor at Home, Work or on the Go

Cigna Telehealth Connection lets you get the care you need – including most prescriptions – for a wide range
of minor conditions. Now you can connect with a board-certified doctor via secure video chat or phone,
without leaving your home or office. When, where, and how it works best for you!

24/7 Medical Advice

    •   Televisits with AmWell and MDLIVE can be a cost-effective alternative to a convenience care clinic or
        urgent care center and cost less than going to the emergency room.
    •   Connect with a board-certified doctor via secure video or chat or phone, without leaving your home.
                • Choose when: Day or night, weekdays, weekends, and holidays.
                • Choose where: Home, work, or on the go.
                • Choose how: Phone or video chat.
                • Choose who: AmWell or MDLIVE doctors.
    •   You can speak with a doctor for help with:

                     Sore Throat                       Fever                          Rash
                      Headache                      Cold & Flu                        Acne
                    Stomachache                      Allergies                  UTI’s and more…

    •   The cost of a phone or online visit is the same or less than with your primary care provider.
    •   The telehealth services are only available for minor, non-life-threatening conditions. In an
        emergency, dial 911 or go to the nearest hospital.

        Register for one or both today so you’ll be ready to use a telehealth service
        when and where you need it.
                         AmWellforCigna.com*                             MDLIVEforCigna.com*
                           855-667-9722                                     888-726-3171

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Prescriptions
90 Day Prescription Refills, More Choice

Your plan includes a new maintenance medication program called Cigna 90 Now. Maintenance medications
are taken regularly, over time, to treat ongoing health conditions. Cigna 90 Now offers you more choice in
how and where you can fill your prescriptions.

Choose What Works Best For You

       •   If you choose to fill your prescription in a 90-day supply, you have to use a 90-day retail pharmacy
           in your plan’s network, or Cigna Home Delivery Pharmacy
       •   If you choose to fill your prescription in a 30-day supply, you can use any retail pharmacy in your
           plan’s network.

Where You Can Fill a 90-day Prescription

       •   With Cigna 90 Now, your plan offers a retail pharmacy network that gives you more choices in
           where you can fill your 90-day prescriptions.
       •   There are thousands of retail pharmacies in your network. They include local pharmacies, grocery
           stores, retail chains, and wholesale warehouse stores – all places where you already shop.
       •   If you prefer the convenience of having your medications delivered to your home, you can also use
           Cigna Home Delivery Pharmacy to fill your prescriptions.

Cigna Home Delivery Pharmacy

       •   The Cigna Home Delivery Pharmacy will deliver your medication to you at the location of your
           choice with free shipping included every time.

       For More Information About Your Pharmacy Network, You Can Go To
        Cigna 90 Now Pharmacy Network:            Cigna.com/Rx90network
        Cigna Home Delivery Pharmacy:             Cigna.com/home-delivery-pharmacy or 800-285-4812

                                                      13
Prescriptions – Specialty Medications
Under your Cigna prescription drug plan, you and your dependents can fill one prescription at a retail pharmacy.
After that, your specialty medications will only be covered when you use Cigna Specialty Pharmacy Services.
These prescriptions can be delivered to your home.

Ordering Your Specialty Medications
Contact Cigna at 800-351-3606. Give the representative your medication, doctor’s information, and payment
information. Cigna will then contact your doctor and coordinate any necessary benefit approvals. You can also
log in to myCigna.com and visit the Cigna Home Pharmacy page for more information. You can see the real-
time pricing of medications.

More Than Just Your Medication

        •   24/7 access to customer service and pharmacists to help answer any questions
        •   Free standard shipping anywhere in the U.S.
        •   Condition-specific support and therapy management
        •   Convenient delivery right to your door or preferred location
        •   Helpful coaching and reminder services
        •   Supplies like tape, bandages, sharps collectors, swabs, etc.
        •   Access to educational materials and more
        •   Discreet packaging at no additional cost to protect quality and privacy
        •   Financial assistance may be available for costly medications

For More Information About Your Specialty Medications, You Can Go To
        Cigna Specialty Pharmacy Services:         800-351-3606
        Cigna Home Delivery Pharmacy:              Cigna.com/home-delivery-pharmacy

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City of Littleton Employee Wellness Clinic by CareHere
CareHere offers a City of Littleton Employee Wellness clinic. It is free to employees, their spouses, and
dependents, two years of age and older who are covered by the City of Littleton’s health plan.

Primary Care

You can get care for your sore throat, a cold, or the flu, and help with high blood pressure or diabetes. Your
City of Littleton Employee Wellness clinic will treat both acute and chronic conditions, all at no cost to you.

The City of Littleton Employee Wellness clinic will dispense dozens of select generic medications and also
provide annual physicals, health coaching, lab work, and much more.

Benefits

    •   No deductibles or co-pays for visits
    •   No cost for on-site labs
    •   No cost for available generic medications
    •   Short or no time in a waiting room
    •   Schedule appointments online, on your smartphone or tablet, or by calling the 24/7 helpline
    •   Private and secure records will not be shared with your employer or anyone else without your
        permission

Location

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16
Dental
Did you know that regular dental checkups keep your smile bright and also help keep your whole body healthy?
Many people believe that they need to see a dentist only if they are in pain or when something is wrong, but
regular dental visits can contribute to a lifetime of good oral health. Our dental coverage provides cleanings,
exams, and x-rays. If there’s a problem, your plan helps with the cost of dental work.

The City of Littleton offers a dental plan through Delta Dental. The PPO Plan provides a lower benefit level for
a lower monthly premium. You may visit any dentist; however, you receive the greatest benefits when you visit
in-network dentists. To find a provider call 1-800-610-0201 or go to www.deltadental.com.

                                                              PPO Plan
                                          In-Network                                 Out-Of-Network
                                  Delta PPO and Premiere Dentist
 Calendar Year Deductible                                              $50
 Individual/Family                                                    $150
 Annual Plan Maximum                                          $2,000 per person

 Diagnostic & Preventive                               Plan pays 100% (deductible waived)

 Basic Services                                          Plan pays 100% after deductible

                       Fillings                          Plan pays 100% after deductible

                  Root Canals                            Plan pays 100% after deductible

              Periodontics                               Plan pays 100% after deductible

 Major Services                                           Plan pays 50% after deductible

 Orthodontic Services                 Plan Pays 50% ($1800 lifetime max per person – children to age 24 only)

                                                         17
Dental Plan Costs
Listed below are the biweekly costs for dental insurance. The amount you pay for coverage is deducted from
your paycheck on a pre-tax basis.

                                  Full-Time Biweekly Dental Costs

     Coverage Level                    Full-Time Rate                             Full-Time Rate
                                     Employee Dental Cost                        City Dental Cost
  Employee Only                                 $0                                     $19.04
  Employee + Spouse                           $18.82                                   $21.17
  Employee + Child(ren)                       $26.44                                   $21.17
  Employee + Family                           $45.49                                   $21.17

                                  Part-Time Biweekly Dental Costs

     Coverage Level                    Part-Time Rate                            Part-Time Rate
                                     Employee Dental Cost                        City Dental Cost
  Employee Only                                $5.71                                   $13.33
  Employee + Spouse                           $25.99                                   $13.99
  Employee + Child(ren)                       $30.94                                   $16.66
  Employee + Family                           $49.99                                   $16.66

                                                       18
Vision
Vision coverage helps with the cost of eyeglasses or contacts. But even if you don’t need vision correction, an
annual eye exam checks the health of your eyes and can even detect more serious health issues such as
diabetes, high blood pressure, high cholesterol, and thyroid disease.
Our vision plan uses the VSP network of providers. It covers an exam and lenses every 12 months and covers
eyeglass frames every 24 months. You can search for a doctor online at www.vsp.com or by calling
1 (800) 216-6248.

                                                   VSP Vision Care Plan
                                                In-Network                        Out-Of-Network

 Examination (Every
 12 Months)                                       $10 Copay                             Up to $50

 Spectacle Lenses (Every
 12 Months)

                              Single              $25 Copay                             Up to $50
                              Bifocal             $25 Copay                             Up to $75

                             Trifocal             $25 Copay                            Up to $100
 Frames                                 $130 Allowance; then 20% off
 (Every 24 Months)                              balance over $130                       Up to $70
 Contacts
 Instead of Glasses (Every
 12 Months)                                    $130 Allowance                           Up to $60

                                                       19
Vision Plan Costs
Listed below are the biweekly costs for vision insurance. The amount you pay for coverage is deducted from
your paycheck on a pre-tax basis.

                                   Full-Time Biweekly Vision Costs

     Coverage Level                    Full-Time Rate                             Full-Time Rate
                                     Employee Vision Cost                         City Vision Cost
  Employee Only                                 $0                                      $4.38
  Employee + Spouse                            $2.62                                    $4.38
  Employee + Child(ren)                        $2.78                                    $4.37
  Employee + Family                            $7.14                                    $4.38

                                  Part-Time Biweekly Vision Costs

      Coverage Level                   Part-Time Rate                             Part-Time Rate
                                     Employee Vision Cost                         City Vision Cost
  Employee Only                               $1.31                                     $3.06
  Employee + Spouse                           $3.55                                     $3.45
  Employee + Child(ren)                       $3.70                                     $3.45
  Employee + Family                           $8.07                                     $3.45

                                                       20
Life Insurance
Life insurance can fill a number of financial gaps for a family recovering from the death of a loved one. Without
enough life insurance, many families have to reduce their standard of living after the loss of an income. Consider
your current and future financial needs when evaluating how much coverage you need. The most common short
and long-term financial needs include:

    •   Medical bills and funeral expenses
    •   Living expenses for the surviving family (housing, food, clothing, utilities, etc.)
    •   Large expenses, e.g., college education, or home mortgage
    •   Taxes and debts that need to be settled.

Basic Life and AD&D
Basic Life Insurance pays your beneficiary a lump sum if you die. AD&D (Accidental Death & Dismemberment)
provides another layer of benefits to either you or your beneficiary if you suffer certain injuries or death from an
accident. The City of Littleton pays 100% of the premium for basic life and AD&D.

2021 Voya Financial LIFE and AD&D
 Basic Life and AD&D Amount            Employee: 1.5 x employee annual earnings, up to $250,000

                Make sure that you have named a beneficiary for your life insurance benefit
                and update it if your family or marital status changes.

                                                        21
Voluntary Life and AD&D
You may supplement your basic life and AD&D coverage with voluntary coverage through Voya Financial. If you are
a new employee enrolling when you first become eligible, you will be guaranteed $100,000 of coverage up to 3
times your annual earnings for yourself without having to submit a medical questionnaire.

You may purchase life insurance in the following coverage amounts:

2021 Voya FINANCIAL VOLUNTARY LIFE and AD&D
 Voluntary Life and AD&D           Employee: A maximum of $500,000 or 5 x earnings,
 Amounts                                      in increments of $10,000
                                   Spouse: A maximum of $50,000, in increments of $5,000, may not exceed
                                   50% of the employee’s voluntary life amount
                                   Child(ren): $10,000

Contact HR for rates on voluntary life insurance

               Make sure that you have named a beneficiary for your life insurance benefit
               and update it if your family or marital status changes.

                                                    22
Disability Insurance
Disability insurance replaces part of your pay while you are unable to work so you have a continuing income for
living expenses.

2021 Voya Financial Short-Term Disability
Should you become disabled, short-term disability (STD) may provide you 60% of your pre-disability salary up to
$3,500 per week. STD is available after a 2-week waiting period of the time of disability. The City of Littleton pays
100% of the premium for short-term disability insurance.

  Benefit Amount                       60% of weekly pre-disability earnings

  Maximum Benefit                      $3,500 per week

  Elimination Benefit                  14 days Accident or Illness

  Benefit Duration                     11 weeks

2021 Voya Financial Long-Term Disability
If you are unable to work for longer than ninety days, long-term disability (LTD) coverage replaces part of your
monthly income. Payments may be reduced by state, federal, or private disability benefits you receive while
disabled. The City of Littleton pays 100% of the premium for long-term disability insurance.

                                  General Government Benefit                    Commissioned Police Eligible
                                                                                  for Normal Retirement

  Monthly benefit       60% of salary, up to a maximum of                  40% of salary, up to a maximum of
                        $6,000                                             $2,000

  Benefits begin        90 days after injury or illness                    180 days after injury or illness

  Effective date        Date of hire                                       Date of hire

  Maximum               Later of 65 or Social Security Normal              Later of 65 or Social Security Normal
  payment period        Retirement Age                                     Retirement Age

                                                          23
Employee Assistance Program
Regular full and part-time employees and their dependents (living in their household) are eligible for five (5)
free sessions per incident, per person, per calendar year.

Everyone has been affected by personal problems at some time in is his/her life. These problems may affect
personal happiness and create disruption in job performance. Because the City of Littleton values its employees
and the work they perform, we have provided an Employee Assistance Program (EAP) through Mines and
Associates. The EAP provides assessment referral, focused therapy and coaching for employees and their
household members in dealing with such issues as:

          Abuse                       Anxiety                      Career                   Depression

    Child & Eldercare          Death, Grief & Dying          Financial Problems          Mood Disorders

 Drug/Alcohol Concerns            Eating Disorders                 Stress             Supervisory Resources

     Legal Referrals           Marital & Relationship           Psychological                 Sexual

      Work-Related              Wellness Coaching

The use of the Employee Assistance Program is strictly confidential. Your contact with the EAP and your counselor
will not be discussed within the organization in any way without your written permission. There will be no
information in your personnel file pertaining to the use of the EAP. The EAP offices are located away from the
workplace to provide as much privacy as possible.

Additionally, supervisors have access to unlimited workplace consultation regarding work performance issues.

For more information, please contact Mines and Associates at (303) 832-1068 or by visiting their website at
www.minesandassociates.com

               You also have 24/7 access to a ComPsych Guidance Resources program that offers someone
               to talk to and resources to consult whenever and wherever you need them.

               Call: 877-533-2363 (max. 3 calls per issue) Online: guidanceresources.com (Web ID: My5848i)

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Tax Savings Programs
Flexible Spending Accounts
The City of Littleton offers two flexible spending account (FSA) options – the Heath Care FSA – which allows you to
pay eligible health care and dependent care expenses with pre-tax dollars. The FSAs are administered by
24HourFlex. Log into your account at www.24HOURFLEX.com to: view your account balance(s), calculate tax
savings, view eligible expenses, download forms, view transaction history, and more. You will receive a 24HourFlex
stored value VISA card, which can be used to pay for eligible health care at the point of service. If you do not use
your card or if you have dependent care expenses to be reimbursed, submit a claim form and a bill or itemized
receipt from the provider to 24HourFlex.

Health Care FSA
The health care FSA through 24HourFlex allows you to set aside money from your paycheck on a pre-tax basis
(before income taxes are withheld) to pay for eligible out-of-pocket expenses, such as deductibles, copays, and
other health-related expenses, that are not paid by the medical, dental, or vision plans. Over-the-counter (OTC)
medication is not eligible for reimbursement without a prescription.

The health care FSA maximum contribution is $2,750 for the 2021 plan year.

Dependent Care FSA
The Dependent Care FSA allows you to set aside money from your paycheck on a pre-tax basis for daycare expenses
to allow you and your spouse to work or attend school full-time. Eligible dependents are children under 13 years
of age, or a child over 13, spouse, or elderly parent residing in your house which is physically or mentally unable
to care for himself or herself. Examples of eligible expenses are daycare facility fees, before-and-after- school
care, and in-home babysitting fees (income must be reported by your care provider).

The dependent care FSA maximum contribution is $5,000 for the 2021 plan year.

Estimate carefully! Any balance remaining in your Health Care Reimbursement Account at the end of the plan year
up to $500 will be carried forward and used to fund your account in the next plan year. This carryover amount does
not apply to the Dependent Care FSA. Any remaining balances, at the end of the plan year, will be forfeited.

                  The biggest deduction from your paycheck is likely federal income tax. Why not take a
                  bite out of taxes while participating in these programs which you pay for with pre-tax
                  dollars?

                                                       25
Legal Services
LegalShield/IDShield
The City of Littleton offers access to LegalShield (www.legalshield.com/info/littletonco) to help you with
frustrating legal endeavors.

LegalShield covers various legal needs that you may have.

                                  Services Provided with LegalShield
   Preventative Legal Services                             Motor Vehicle Services
       • Legal consultation and advice                         • Legal expenses from traffic violations
       • Will preparation                                      • Driver’s license assistance
   Trial Defense Legal Services                            IRS Audit Legal Services
       • Up to 60 hours of attorney time if you are            • Up to 50 hours of attorney time if you
            a named defendant in a civil or job related            receive a written notice of an IRS
            criminal action.                                       audit.

IDShield covers various identity security needs that you may have, including:

                                    Services Provided with IDShield
   Privacy Monitoring                                      Security Monitoring
       • Comprehensive identity protection                      • Monitors SSN, credit cards, and bank
       • Monitors your name, SSN and other                         accounts
           numbers                                              • Quarterly credit score tracking
   Consultation                                            Full-Service Restoration
       • 24/7/365 live support                                  • Complete identity recovery services

                         Plans                                            Bi-Weekly Rates
                  LegalShield Legal Plan                                          $7.27
        LegalShield Legal plus IDShield Individual                               $11.40
          LegalShield Legal plus IDShield Family                                 $14.17
                 IDShield Full Individual                                         $4.13
                   IDShield Full Family                                           $8.75

                                                          26
Time-Off Benefits
The City observes the following holidays*:

                                       2021 Holiday Schedule
 New Year’s Day                                          January 1, 2021
 Martin Luther King Jr. Day                              January 18, 2021
 President’s Day                                         February 15, 2021
 Memorial Day                                            May 31, 2021
 Independence Day                                        July 5, 2021 (observance)
 Labor Day                                               September 6, 2021
 Thanksgiving Day                                        November 25, 2021
 Day after Thanksgiving                                  November 26, 2021
 Christmas Eve Afternoon                                 December 23, 2021 (close at 12:00 PM)
 Christmas  Day                                          Decemberfull-time
*The holidays listed above are fully paid for general government    24, 2021employees.
                                                                             (observance)

For general government part-time employees (20+ hours per week), the above holidays are prorated at the
following levels:

                                      Paid Hours Per Holiday
                            Weekly Hours Worked          Paid Hours Per Holiday
                                       20                              4
                                       24                              5
                                       28                              6
                                       32                              7

*Commissioned police officers, detectives, corporals, sergeants, and emergency services dispatchers are
granted additional vacation hours in lieu of paid holidays.

Floating Holidays
General government regular Full-Time employees and emergency service dispatchers receive 40 hours
annually of floating holiday. General government regular part-time employees of 20 hours or more are
eligible for 12 annually of floating holiday. At the end of each calendar year, and at the time of termination
from employment, unused floating holiday hours will be forfeited.

                                                       27
Time-Off Benefits (cont.)
Vacation Leave Policy*
Employees receive paid vacation leave on an annual basis at the following schedule.

                                  Part-Time Employees 2021 Vacation
         Benefit Level                     20 hour          24 hour       28 hour         32 hour
         Date of Hire to 5 yrs.                64             77              90             103
         5 yrs. Up to 10 yrs.                  76             92             107             122
         10 yrs. Up to 15 yrs.                 84            101             118             135
         15 yrs. Up to 20 yrs.                 96            116             135             154
         Over 20 yrs.                         104            125             146             167
                                  Vacation Carry Over: Up to 100 hours

                             Full-Time Employees 2021 Vacation
                                       General                        Commissioned Police Officers,
             Benefit Level           Government       Dispatch           Corporals, & Sergeants
         Date of Hire to 5 yrs.           128               204                     230
         5 yrs. Up to 10 yrs.             152               228                     246
         10 yrs. Up to 15 yrs.            168               244                     270
         15 yrs. Up to 20 yrs.            192               268                     286
         Over 20 yrs.                     208               284                     306
                                         Max 200 hours
          Vacation Carryover                                                 Max 150 hours

                                                       28
Time-Off Benefits (cont.)
Sick Leave Policy*

Full-time regular employees earn eight hours of sick leave accrual per month. There is no carry over limit from
year to year.

Part-time regular employees of 20 or more hours per week earn sick leave on a monthly basis at the following schedule:

                 Part-Time Employees Sick Hours Earned Per Month
                       Weekly Hours Worked                       Paid Hours Earned
                                  20                                       4
                                  24                                       5
                                  28                                       6
                                  32                                       7

Temporary, seasonal, and variable hour employees will accrue sick leave at one hour of paid sick leave for
every 30 hours worked, up to a maximum of 48 hours/year.

Flexible Schedules
Certain employees may be eligible for flexible scheduling arrangements, including compressed workweeks,
early or late start times, and telecommuting. Flexible scheduling arrangements are at the discretion of the
Department Director/Chief or City Manager.

*The City evaluates holiday, vacation, and sick time off benefits on an ongoing basis should any changes
happen to the accruals, employees will be notified.

                                                      29
Retirement Plans
457 Deferred Compensation Plan
The City of Littleton offers employees with a regular part-time or full-time status of 20 hours per week or more
to elect to participate in the 457 Deferred Compensation Plan. The employee can elect contribution amounts
and make investment selections. The contributions can be made up to the IRS maximum contribution amount
($19,500 in 2021). Employees 50 or older can contribute an additional $6,500 per year as a designated “catch-
up” provision.

Employees are eligible for this plan on their date of hire.

The City of Littleton will provide employees with a match on voluntary elected contributions. The match is up to
2% for general government and police employees hired before 10/14/18 that elected to stay with IMCA. The
employer voluntary match for the police plan is contributed in the employee’s 401(a) vesting schedule. The
employer voluntary match for the general government plans is contributed to the employee’s 457 plan.*

All employees are immediately fully vested in the employer’s contribution to the 457 plan.

*In 2020, the city match to the 457-retirement plan was suspended for full-time
employees through 2021.

                                                         30
Retirement Plans (cont.)
General Employee Retirement Plan 401a
The City of Littleton offers regular full-time status employees of 40 hours or more per week a retirement/401(a)
plan. Employees are fully vested in the employer’s contributions to the 401(a) after five years of employment
or age 55.

Employees are eligible for this plan on their date of hire.

The chart below details the specific contribution schedule.

 General Employee Retirement Plan/401(a) and FPPA Contributions
                                                            2021 Mandatory                        City of Littleton
              Employee Classification
                                                          Employee Contribution                    Contribution
 401(a) – General Government Employees                             5%                                    7%
 401(a) – Commissioned Police Personnel –
                                                                     10%                                10%*
 Hired before 10/14/18 and did not elect FPPA
 FPPA Defined Benefit Plan –
                                                                    11.5%                                8%
 Commissioned Police Personnel – Hired
 on or after 10/14/18
 FPPA Defined Benefit Plan –
                                                                    11.5%                                12%
 Commissioned Police Personnel – Hired
 before 10/14/18

*This number can go up to 12% if police personnel have elected to contribute to the 457 plan. The city matches up to 2%
on this election and it is deposited into the police personnel's 401(a) plan. *In 2020, the city match to the 457-retirement
plan was suspended through 2021.

Roth Individual Retirement Account
The City of Littleton offers employees with a regular part-time or full-time status of 20 hours per week or more
to elect to participate in a Roth Individual Retirement Account. The employee can elect contribution amounts
and make investment selections. The contributions can be made up to the IRS maximum contribution amount
of $6,000 per year after-tax for employees under the age of 50 and $7,000 per year after-tax for employees
over the age of 50. There are no city contributions.

Employees are eligible for this plan on their date of hire.

                                                            31
Tuition Reimbursement
The City of Littleton offers tuition reimbursement to regular full-time employees (40 hours or more per week)
when funding is available. Eligible courses for advanced degrees and education related to an employee’s
position with the City. Reimbursements will be approved within the program’s criteria on a first-come-first-
served basis when funding is available up to $3,000 annually.

*In 2020, this program has been suspended through 2021.

Wellness Program

The City’s wellness program is designed to promote and improve health and well-being in the lives of City
employees through health education and wellness programs. Our goal is to establish a work environment that
promotes a healthy lifestyle both at work and at home. Our wellness program is focused on preventative health
care, health education, and fostering healthy lifestyles.

Employees and spouses are invited to participate in a variety of health programs that can earn individuals up to
$300 per year or $600 per household, per year! Our easy to use program offers cash incentives for completing
wellness goals such as an annual physical, telephonic coaching, and other preventative exams.

In addition, we offer an array of health programs for all employees. Contact Human Resources for more information!

                                                      32
Plan Contacts
      Plan type                 Provider                Phone                    Web                 Policy #
City of Littleton Human       City of Littleton     303-795-3857       HR@littletongov.org          N/A
Resources

Medical                       Cigna                 1 (800) 244-6224   www.mycigna.com              3332146

City of Littleton Employee    CareHere              (877) 423-1330     www.carehere.com             N/A
Wellness Clinic

Dental PPO                    Delta Dental          1 (800) 610-0201   www.deltadentalco.com        1235
                              Insurance Company

Vision                        Vision Service Plan   1 (800) 216-6248   www.vsp.com                  12198600

Life and AD&D                 Voya Financial        1 (800) 955-7736   www.voya.com                 696692

Voluntary Life and AD&D
Short Term Disability (STD)   Voya Financial        1 (800) 423-2765   www.voya.com                 696692
Long Term Disability (LTD)
FSA Administration            24HourFlex            (800) 651-4855     www.24HourFlex.com           N/A
                                                                       Email: Info@24HourFlex.com

EAP                           Mines & Associates    (800) 873-7138     www.minesandassociates.com   8963

CompPsych Guidance            Voya                  (877) 533-2363     www.guidanceresources.com    Web ID:My5848i

FPPA                          Fire and Police       (800) 332-3772     www.fppaco.org               N/A
                              Pension Association

401(a) Retirement Plan        ICMA-RC               (800) 669-7400     www.icmarc.org               GG # 107464
                                                                                                    Police # 107465

457 Deferred Comp             ICMA-RC               (800) 669-7400     www.icmarc.org               300177

                                                            33
Important plan notices & documents
Summary Plan Descriptions
The legal document for describing benefits provided under the plan as well as plan rights and obligations to
participants and beneficiaries. Please contact HR for your Summary Plan Description.

Summary of Benefits and Coverage
A summary document that presents each of our benefit plan features in a standardized format. Please contact
HR for your Summary of Benefits and Coverage.

Medical Continuation Information
Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), employees may continue medical and/or
dental coverage at their own expense. In addition, spouses, domestic partners and dependents (called Qualified
Beneficiaries) may also continue medical and/or dental coverage at their own expense.

What is COBRA Continuation Coverage?
COBRA continuation coverage is a continuation of Plan coverage when coverage would otherwise end because
of a life event known as a “qualifying event.” Specific qualifying events are listed later in this notice. After a
qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.”
You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan
is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation
coverage must pay for COBRA continuation coverage.

If you are an employee, you will become a qualified beneficiary if you lose your coverage under the Plan
because either one of the following qualifying events happens:

     •   Your hours of employment are reduced, and you are no longer eligible for coverage, or
     •   Your employment ends for any reason other than your gross misconduct;
     •   Your spouse dies;
     •   Your spouse’s hours of employment are reduced and he or she is no longer eligible for coverage;
     •   Your spouse’s employment ends for any reason other than his or her gross misconduct;
     •   Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or you become
         divorced or legally separated from your spouse.

                                                       34
Medical Continuation Information (cont.)
Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because any
of the following qualifying events happens:

     • The parent-employee dies;
     • The parent-employee’s hours of employment are reduced and he or she is no longer eligible for
        coverage;
     • The parent-employee’s employment ends for any reason other than his or her gross misconduct;
     • The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both);
     • The parents become divorced or legally separated; or
     • The child stops being eligible for coverage under the plan as a “dependent child.”
When is COBRA Coverage Available?

The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has
been notified that a qualifying event has occurred. When the qualifying event is the end of employment or
reduction of hours of employment, death of the employee, or commencement of a proceeding in bankruptcy
with respect to the City of Littleton, the employer will notify the insurance provider of the qualifying event.

You Must Give Notice of Some Qualifying Events

For the other qualifying events (employee becoming entitled to Medicare benefits, divorce or legal separation
of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you
must notify human resources within 60 days after the qualifying event occurs.
How is COBRA Coverage Provided?

Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage
will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right
to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf
of their spouses, and parents may elect COBRA continuation coverage on behalf of their children. All COBRA
notices and enrollment information is sent directly from 24hr Flex.

Additional information regarding COBRA benefits, including the length of COBRA coverage, is available on NiC
(or in the Human Resources office).

                                                       35
Medicare Part D Notice of Creditable Coverage
Important Notice from the City of Littleton, about your Prescription Drug Coverage and
Medicare
Please read this notice carefully and keep it where you can find it. This notice has information about your current
prescription drug coverage with the City of Littleton, and about your options under Medicare’s prescription drug
coverage. This information can help you decide whether or not you want to join a Medicare drug Plan. If you are
considering joining, you should compare your current coverage, including which drugs are covered at what cost,
with the coverage and costs of the Plans offering Medicare prescription drug coverage in your area. Information
about where you can get help to make decisions about your prescription drug coverage is at the end of this
notice.

There are two important things you need to know about your current coverage and Medicare’s prescription
drug coverage:

1.   Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this
     coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or
     PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of
     coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.

2.   The City of Littleton has determined that the prescription drug coverage offered by Cigna is, on average
     for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage
     pays and is therefore considered Creditable Coverage. Because your existing coverage is Credible
     Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join
     a Medicare drug plan.

When Can You Join a Medicare Drug Plan?

You can join a Medicare drug plan when you first become eligible for Medicare and each year from October
15th to December 7th.

However, if you lose your current creditable prescription drug coverage, through no fault of your own, you
will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.

                                                        36
Medicare Part D Notice of Creditable Coverage (Cont.)
What Happens To Your Current Coverage If You Decide to Join a Medicare Drug Plan?

If you decide to join a Medicare drug plan, your City of Littleton coverage will not be affected. See below for
more information about what happens to your current coverage if you join a Medicare drug plan.

Since the existing prescription drug coverage under Cigna is creditable (e.g., as good as Medicare
coverage), you can retain your existing prescription drug coverage and choose not to enroll in a Part D plan;
or you can enroll in a Part D plan as a supplement to, or in lieu of, your existing prescription drug coverage.

If you do decide to join a Medicare drug plan and drop your coverage through the City of Littleton, be aware
that you and your dependents can only get this coverage back.

When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?

You should also know that if you drop or lose your current coverage with The City of Littleton and don’t join a
Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher
premium (a penalty) to join a Medicare drug plan later.

If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium
may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did
not have that coverage. For example, if you go nineteen months without creditable coverage, your premium
may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this
higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have
to wait until the following October to join.

For More Information About This Notice Or Your Current Prescription Drug Coverage…

Contact the person listed below for further information at (303) 795-3857. NOTE: You’ll get this notice each
year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through
The City of Littleton changes. You also may request a copy of this notice at any time.

For More Information About Your Options Under Medicare Prescription Drug Coverage…

More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare &
You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be
contacted directly by Medicare drug plans.

                                                        37
Medicare Part D Notice of Creditable Coverage (Cont.)
For more information about Medicare prescription drug coverage:

• Visit www.medicare.gov

• Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare
& You” handbook for their telephone number) for personalized help.

• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

If you have limited income and resources, extra help paying for Medicare prescription drug coverage is
available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or
call them at 1-800-772-1213 (TTY 1-800-325-0778).

 Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans,
 you may be required to provide a copy of this notice when you join to show whether or not you have
 maintained creditable coverage and, therefore, whether or not you are required to pay a higher
 premium (a penalty).

Availability of Privacy Practices Notice
We maintain the HIPAA Notice of Privacy Practices for describing how health information about you may be
used and disclosed. You may obtain a copy of the Notice of Privacy Practices by contacting the plan
administrator.

                                                       38
Women’s Health and Cancer Rights Act
If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s
Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits,
coverage will be provided in a manner determined in consultation with the attending physician and the
patient, for:

●   All stages of reconstruction of the breast on which the mastectomy was performed;
●   Surgery and reconstruction of the other breast to produce a symmetricalappearance;
●   Prostheses; and
●   Treatment of physical complications of the mastectomy, including lymphedema.

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical
and surgical benefits provided under this plan. If you would like more information on WHCRA benefits, call
your plan administrator.

Newborns’ and Mothers’ Health Protection Act
Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any
hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours
following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally
does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from
discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and
issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance
issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). If you would like more information
on maternity benefits, call your plan administrator at (303) 795-3857.

HIPAA Notice of Special Enrollment Rights
If you decline enrollment in City of Littleton health plan for you or your dependents (including your spouse)
because of other health insurance or group health plan coverage, you or your dependents may be able to
enroll in City of Littleton health plan without waiting for the next open enrollment period if you:

●   Lose other health insurance or group health plan coverage. You must request enrollment within 30 days
    after the loss of other coverage.

●   Gain a new dependent as a result of marriage, birth, adoption, or placement for adoption. You must
    request health plan enrollment within 30 days after the marriage, birth, adoption, or placement for
    adoption.

                                                        39
HIPAA Notice of Special Enrollment Rights (Cont.)
 ●   Lose Medicaid or Children’s Health Insurance Program (CHIP) coverage because you are no longer eligible.
     You must request medical plan enrollment within 60 days after the loss of such coverage.

 If you request a change due to a special enrollment event within the 30-day timeframe, coverage will be
 effective the date of birth, adoption, or placement for adoption. For all other events, coverage will be
 effective the first of the month following your request for enrollment. In addition, you may enroll in The City of
 Littleton’s health plan if you become eligible for a state premium assistance program under Medicaid or CHIP.
 You must request enrollment within 60 days after you gain eligibility for medical plan coverage. If you request
 this change, coverage will be effective the first of the month following your request for enrollment. Specific
 restrictions may apply, depending on federal and state law.

 Note: If your dependent becomes eligible for a special enrollment right, you may add the dependent to your
 current coverage or change to another health plan.

 Premium Assistance Under Medicaid and the Children's
 Health Insurance Program

 If you or your children are eligible for Medicaid or CHIP and you are eligible for health coverage from your
 employer, your State may have a premium assistance program that can help pay for coverage, using funds
 from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t
 be eligible for these premium assistance programs. Still, you may be able to buy individual insurance
 coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.

 If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact
 your State Medicaid or CHIP office to find out if premium assistance is available.

 If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your
 dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-
 877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your State if it has a
 program that might help you pay the premiums for an employer-sponsored plan.

 If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under
 your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled.
 This is called a “special enrollment” opportunity, and you must request coverage within 60 days of

                                                         40
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