Benefits Enrollment Guide - 2021-2022 City of Albemarle - Albemarle, NC
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2021-2022 Benefits Enrollment Guide City of Albemarle
TABLE OF CONTENTS
Package Overview 3
Open Enrollment 4
Beliefs and Values 7
Enrollment and Eligibility 8
When & Where to Get Services 10
Healthy Lifestyle – Wellness 11
Medical Plan 13
Telemedicine 20
Pharmacy 21
Dental Plan 23
Vision Plan 24
Health Savings Account 25
Flexible Spending Accounts 26
Life Insurance 27
The following descriptions of available benefit
Voluntary Insurance 28 elections options, are purely informational and
have been provided to you for illustrative purposes
Pension 29 only. Payment of benefits will vary from claim to
claim within a particular benefit option and will be
Retirement Savings Plan 32 paid at the sole discretion of the applicable
insurance provider for each benefit option. The
Other Benefits 33 terms and conditions of each applicable policy or
certificate of coverage will provide specific details
Time Away From Work Benefits 34 and will govern in all matters relating to each
particular benefit option described in this
Work-Life Balance – EAP 35 summary. In no case will any information in this
Contacts 36 summary amend, modify, expand, enhance,
improve or otherwise change any term, condition
Required Notices 37 or element of the policies or certificates of
coverage that govern the benefit options described
Glossary 43 in this summary.
Presented by:
2
PACKAGE OVERVIEW
The City of Albemarle is by definition, a community oriented organization. We pride ourselves on building
long-lasting relationships with our employees and the community that we serve. Our organizational
philosophy and how we do “business” is summarized on the next page. Please take time to read it whether
you are a new employee or a tenured one – it’s all important to us!
This guide provides a general overview of your benefit choices and requirements so you can select the
coverage that is right for you and your family. Our program offers a broad range of plan options and has
been carefully designed to meet the needs of our diverse workforce. With choice comes responsibility and
planning. In order to maximize your benefits and minimize your costs, please take the time to:
• Enroll on time.
• Read and understand each benefit offering.
• Ensure that you and your family are educated consumers of health care services.
• Plan thoughtfully regarding the level of health coverage necessary for you and your family.
Effective July 1, 2021:
Medical benefit plan
Flexible Spending Account
Limited Purpose Flexible Spending Account
Health Savings Account
Dental benefit plan
Vision benefit plan
Basic Life / AD&D plan
In the below chart, you will find information on eligibility and waiting periods for each of the
offered plans.
Plan Employment Status New Hire Waiting
Period
Medical, Prescription,
Dental, & Vision
Basic Life and AD&D Full-Time Employees 1st of the month
that work at least 30 following date of hire
Flexible Spending hours per week
Account (FSA)
Paid Holiday &
Vacation
Pension Plans See Pages 19-21
401(k) & NC 457 Full-Time and Part- First of the month
Retirement Savings Time having attained following 90 days
1,000 hours
The benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the
underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this
guide, the underlying insurance documents will govern in all cases.
3
Open Enrollment for 2021 is
Monday, May 24th – Friday, June 4th
You will have two options for enrollment this year:
Benefits call Center will be available Monday-Friday from 9 AM to 5 PM EST,
and until 7 PM on Tuesdays. Call 866-354-1327 to speak 1:1 with a benefits
counselor to enroll and answer any benefits related questions.
Self enroll for benefits at www.employeenavigator.com – create an account to
make benefit elections using the company identifier: ALBEMARLE.
IMPORTANT: You must either call the Benefits call center or
log into www.employeenavigator.com in order for your
benefits to remain active or make changes for July 1st 2021.
Enroll IN YOUR Benefits: One step at a time
The benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the
underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this
guide, the underlying insurance documents will govern in all cases.
4
The benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the
underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this
guide, the underlying insurance documents will govern in all cases.
5
The benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the
underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this
guide, the underlying insurance documents will govern in all cases.
6
CITY OF ALBEMARLE BELIEFS AND VALUES
At some point during your employment with The City of Albemarle, you will find yourself in the
role of either leader, facilitator, or implementing what needs to get done – each element being
critical to the City’s success. Our overall success depends on co-workers collectively moving the
organization towards our goals. Short and long term goals are often set for us, but there needs to
be a core set of principles and values to guide us.
Our Beliefs and Values:
• Humility and Respect – Use every opportunity to learn from the perspective, background and
experience of others. Treat everyone you encounter with humility and respect. It is the right thing to
do and will pay off for each of us in the long run.
• Integrity – A set of moral and ethical principles will guide us through all situations. Be fair and
consistent. By applying these core principles consistently, others will know that our actions and words
are synonymous.
• Honesty – Honesty is not a judgement call or a philosophical notion. It is just being honest. Abuse of
public trust has no place in our organization.
• Teamwork – What we do has meaning at every level and position. We are shaping a community that
affects lives. Teams are more creative, efficient and effective when there is a sense of purpose and
ownership from each team member. We have a commitment to each other and our community that
requires teamwork and it’s elements – respect, integrity, understanding and flexibility.
Things to Eliminate from our Things the City has a Low Tolerance for:
Environment • A lack of effort
• Failing to keep the greater good in mind • Failing to be respectful
• Failing to prepare or contribute • Deceitfulness / dishonesty
• A mindset of “That’s the way we’ve always done • A lack of caring
it”
What The City Expects:
• Be proud of this organization and your role in it
• Be the best
• Provide the best service
• Take Initiative
• Support your co-workers
• Enjoy your work
• Provide respectful feedback
• Be a good listener
7
ENROLLMENT AND ELIGIBILITY
Offering a comprehensive and competitive benefits package is one way we recognize your
contribution to the success of the organization and our role in helping you and your family to be
healthy, feel secure and maintain work/life balance. This enrollment guide has been designed to
provide you with information about the benefit choices available to you. Remember, open
enrollment is your only opportunity each year to make changes to your elections, unless you or
your family members experience an eligible "change in status."
How to Enroll in the Plans Change in Status
Read your materials and make sure you understand Generally, you may enroll in the plan, or make
all of the options available. changes to your benefits, when you are first
• Locate your enrollment/change forms. eligible. However, you can make changes/enroll
• Fill out any necessary personal information. during the plan year if you experience a change in
status. As with a new enrollee, you must submit
• Make your benefit choices. your paperwork within 30 days of the change or
• If you have questions or concerns, please you will be considered a late enrollee.
contact your HR department.
Examples of changes in status:
Whom Can You Add to Your Plan? • You get married, divorced or legally separated
Eligible: • You have a baby or adopt a child
• Legally married spouse • You or your spouse takes an unpaid leave of
• Natural or adopted children up to age 26, absence
regardless of student and marital status • You or your spouse has a change in
• Children under your legal guardianship employment status
• Stepchildren • Your spouse dies
• Children under a qualified medical child • You become eligible for or lose Medicaid
support order coverage
• Disabled children 19 years or older • Significant increase or decrease in plan
• Children placed in your physical custody for benefits or cost
adoption
Ineligible:
• Divorced or legally separated spouse
• Common law spouse, even if recognized by
your state
Open Enrollment is the only
• Domestic partners, unless your employer
states otherwise chance to make changes,
• Foster children unless you experience a
• Sisters, brothers, parents or in-laws, “change in status.”
grandchildren, etc.
8
Total Compensation with Employee Self Service
Offering a comprehensive and competitive benefits package is one way we recognize our
employee’s hard work. Log into Employee Self Service to learn more. You can review your benefits,
paychecks, tax information, available vacation and much more.
9
WHEN AND WHERE TO GET HEALTHCARE
Telemedicine – Available 24/7 via Phone/Mobile App through MD Live
• Video chat or telephone call with a certified medical physician that is available 24/7
• Can treat any acute care illnesses, including sore throat, ear infection, cough or cold
• Can send prescriptions to your preferred pharmacy at the end of the appointment
Primary Care Physician – By Appointment
• Helps you prevent disease and stay healthy
• Diagnose and treat a full range of health issues
• Refer you to the right care when you need a specialist
• Help with the healthcare needs of your whole family – creates a personal relationship with the member
• Costs less than emergency room or urgent care centers
Retail Health Clinics – Average Wait Time: 15 minutes
• Basic care from a nurse practitioner on a walk-in basis with extended hours
• Used for minor health concerns that need care quickly:
• Sore throats, ear infections, pink eye, skin rashes, bladder infections and physical exams.
• Find the Nearest Retail Health Clinic Locations:
• www.ccaclinics.org/membership/clinic-locations
• www.cvs.com/minuteclinic/clinic-locator
• www.walgreens.com/pharmacy/healthcare-clinic/locations
• www.riteaid.com/shop/info/pharmacy.services/rediclinic
Urgent Care Clinics – Average Wait Time: 15-45 minutes
• When your doctor is unavailable, get immediate quality care from a doctor on a walk-in basis with
extended hours
• For immediate attention for minor to moderate issues: Sports injuries, migraines, vomiting, sprains,
back pain, etc.
Emergency Room – Average Wait Time: 4 hours
• Care available 24/7 for severe emergencies from trained clinicians
• If you are facing an issue that threatens your life or health, never hesitate to go straight to the
emergency room or call 911.
Things to think about:
• Non-emergency care delivered in the ER costs 5 times more than in a doctor’s office or clinic – not
only does it cost more for you, but it also costs more to the City’s healthcare plan. This can negatively
impact the renewal premium for everyone on an annual basis.
• Patients, when possible, should be treated by their primary care physician for non-emergency
conditions in order to promote consistent, preventive and quality care.
• Use In-Network Providers when possible. In-Network care is covered at a higher percentage, which
means you’ll pay less out of pocket.
10HEALTHY LIFESTYLE – WELLNESS
There are many variables in our lives and in our world that we can’t control. We make choices everyday
about things we can control: what we eat, how much we move, and whether we use tobacco products.
These choices directly impact our health. While sometimes it’s hard to see the correlation, over time the
evidence is clear: health and quality of life is improved when we put the right food in our bodies, when we
move the way we’re supposed to move, and when we steer clear of tobacco – essentially when we take
care of ourselves and treat our bodies well. Although
that may sound easy, we know leading a healthy lifestyle can be anything but easy.
Blue Cross Blue Shield offers employees the opportunity to take a Health Risk Assessment (HRA) that will
evaluate employees current state of well-being in five areas: physical, emotional, social, financial and
spiritual. This assessment will help employees identify health risks and offer recommendations such as
programs for stress relief, fitness or better nutrition. To take the assessment, visit
www.BlueConnectNC.com and click on the ‘Wellness’ tab at the top of the page. This will take you to the
HRA page so that you can answer the questions and receive your results.
A first step in making better choices is “Knowing Your Numbers.” The chart below gives you key biometric
measures, a medical-based standard and a place to track your numbers. Once you know your numbers, you
can begin to work on improving your health.
Know Your Numbers
Biometric Measure National Standards What are your Numbers?
Cholesterol Ratio < 4.0 or 200 mg/dl
HDL Men: > 40
Women: > 50
Blood Pressure 130 / 80 mm HG
Fasting Blood Glucose < 100 mg/dl
Non-Fasting Blood < 140 mg/dl
Glucose
Waist Circumference Men: < 40 inches
Women: < 35 inches
Body Mass Index (BMI)
Underweight < 18.5
Healthy Weight = 18.5 – 24.9
Overweight =25 – 29.9
Obese > 30
Tobacco Use None
11HEALTHY LIFESTYLE – WELLNESS
Regular exercise is a key step in improving your numbers! Whether that’s walking in your
neighborhood, following a Couch to 5k exercise schedule, taking the stairs, or joining a gym, you
just have to get started with “one thing.”
It takes about six to eight weeks for form a habit, regardless of whether it is a healthy habit or one
that’s not so noble. While we are forming that new, healthy habit, many folks sabotage themselves
by being too aggressive in training, selecting the wrong training program, or not developing a plan
to maintain an exercise program.
First, visit your physician for a check-up. Be sure your body is ready for exercise, especially if you
haven’t exercised in a long time. Some of us have latent conditions which need to be addressed
before starting an exercise program. A smart plan is the best plan for improving your health.
Second, figure out where you are. Like setting the GPS in your car, before setting the course on
your destination, you need to know where you begin the journey. Don’t compare yourself to a
friend, significant other, co-worker or even the “you” you were 20 years ago in high school. Don’t
compare yourself to the “you” you will be, or want to be, in six months. Rather, honestly assess
how much exercise you have had in the last six months to a year. Recent athletic activity is a
precursor for selecting a proper training program. Your exercise plan should be the one that best
fits you and your goals, at the right pace and intensity.
Not using Tobacco is another key to your health, but quitting can be very challenging even for the
best of us. If you are a tobacco user, there are resources to help you quit.
Blue Cross Blue Shield of North Carolina offers a FREE program that will dramatically increase your
odds of quitting tobacco. As a BCBSNC member, you have 100% coverage for:
• Four telephone counseling sessions with QuitlineNC – a state-based tobacco cessation program
• Extra calls for members who are pregnant or have certain behavioral health conditions
• 12 weeks of nicotine patches and nicotine gum or lozenge through QuitlineNC
• Tobacco cessation screenings
• FDA-approved tobacco cessation drugs through your pharmacy benefit provider
QuitlineNC offers you:
• Confidential tobacco cessation counseling
• Highly trained, multilingual Quit Coaches
• 24/7 availability
• 93% satisfaction rating
Call QuitlineNC at 1-844-862-7848 to get started!
12MEDICAL PLAN
For this plan year, you have the option to select between 2 plan options. The following medical option is
a Traditional PPO plan. Refer to the carrier benefits summary for the exact benefit levels associated with
your plan choice. The City is paying 100% of the monthly premium for all employees.
Blue Cross Blue Shield of North Carolina
Name of Plan Blue Options
Type of Plan PPO Copay Plan
In Network Out of Network
Office Visits
(You Pay) (You Pay)
Preventive Covered at 100%, No Deductible Not Covered
Primary/Retail Clinic $20 Copay Deductible then 40%
Specialist $40 Copay Deductible then 40%
Telemedicine $5 Copay Not Available
Common Services
In-Patient Facility (You Pay) Deductible then 20% Deductible then 40%
Out-Patient Facility (You Pay) Deductible then 20% Deductible then 40%
Urgent Care $75 Copay
Emergency Room $150 Copay (if admitted, deductible/coinsurance applies)
Annual Deductible
Individual $500 $1,000
Family $1,000 $2,000
Coinsurance 20% 40%
Annual Out of Pocket
Individual $3,000 $6,000
Family $6,000 $12,000
Maximum Benefits Unlimited
Full Monthly Rate Bi-Weekly Rate
Employee Only $00.00 $00.00
Employee/Spouse $575.00 $287.50
Employee/Child(ren) $365.00 $182.50
Employee/Family $875.00 $437.50
The benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the
underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this
guide, the underlying insurance documents will govern in all cases.
13MEDICAL PLAN
For this plan year, you have the option to select between 2 plan options. The following medical option is
a HDHP or High Deductible Health plan. Refer to the carrier benefits summary for the exact benefit levels
associated with your plan choice. The City is paying 100% of the monthly premium for all employees.
Blue Cross Blue Shield of North Carolina
Name of Plan Blue Options
Type of Plan HDHP – High Deductible Health Plan
In Network Out of Network
Office Visits
(You Pay) (You Pay)
Preventive Covered at 100%, No Deductible Deductible then 70%
Primary/Retail Clinic Deductible then 20% Deductible then 50%
Specialist Deductible then 20% Deductible then 50%
Telemedicine Deductible then 20% Not Available
Common Services
In-Patient Facility (You Pay) Deductible then 20% Deductible then 50%
Out-Patient Facility (You Pay) Deductible then 20% Deductible then 50%
Urgent Care Deductible then 20% Deductible then 20%
Emergency Room Deductible then 20% Deductible then 20%
Annual Deductible (Embedded)
Individual $2,000 $4,000
Family $4,000 $8,000
Coinsurance 20% 50%
Annual Out of Pocket
Individual $4,000 $8,000
Family $8,000 $16,000
Maximum Benefits Unlimited
Full Monthly Rate Bi-Weekly Rate
Employee Only $00.00 $00.00
Employee/Spouse $506.52 $253.26
Employee/Child(ren) $324.85 $162.43
Employee/Family $781.45 $390.73
The benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the
underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this
guide, the underlying insurance documents will govern in all cases.
14What is a High Deductible Health Plan
• A High Deductible Health Plan (HDHP) is a health insurance plan that generally has a lower
monthly premium and a higher deductible than a traditional health plan.
• Members in a HDHP will pay for 100% of health care costs (preventive care is an exception)
until they reach the deductible amount. As a result, members become more selective on how
they spend their health care dollars. This plan encourages members to seek out better health
care options at more competitive prices.
• HDHPs allow you to use pre-tax dollars to pay for out-of-pocket health costs when paired with a
Health Spending Account (HSA).
High Deductible Concept with an HSA
• If you elect the High Deductible Health Plan (HDHP), you have the option to open a Health
Savings Account (HSA).
• An HDHP coupled with an HSA can help you take control of your healthcare expenses and save
for the future.
In order to contribute to an HSA:
• You must be enrolled in a qualified, high deductible health care plan
• You may not be covered under any other type of medical plan (such as a spouse’s plan)
• You may not be enrolled in Medicare
• You may not be claimed as a dependent on someone else’s tax return
The benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the
underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this
guide, the underlying insurance documents will govern in all cases.
15BLUE CROSS AND BLUE SHIELD RESOURCES
Blue Connect has all of your member resources packed into one site, www.BlueConnectNC.com.
Blue Connect is also available for your smartphone devices through a mobile app.
Through the mobile app, you are able to:
• See and share your digital Member ID card
• See the status of your open claims and your claims history
• Find doctors, hospitals and urgent care centers in your network
• Track your benefits, deductibles, out-of-pocket expenses and spending account balances
• Send secure messages to Customer Service and get answers to common questions using an
extensive list of FAQs
Blue Cross Blue Shield also offers the Nurse Support Program, which is a free program that is
offered to The City’s employees to complement the care that is already provided to you by your
primary care physician, specialists and other health care providers.
This program is tailored towards helping take the stress off of members that are managing:
• Complex health conditions
• Multiple health concerns
• Injuries sustained in accidents
• Disease-specific illnesses
• Short-term Disability
This program does not:
• Replace your current care
• Interfere with your normal schedule
• Cost anything extra
The benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the
underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this
guide, the underlying insurance documents will govern in all cases.
16BLUE CROSS AND BLUE SHIELD RESOURCES
Blue Cross Blue Shield provides additional programs for City of Albemarle employees to participate in to
lower medical costs. Diabetes is a chronic condition that can drive healthcare spending up for employees.
Blue Cross Blue Shield has implemented a program to help you save on diabetes supplies.
Diabetes Supplies Waiver
Managing diabetes can be a challenge both physically and financially. Blue Cross and Blue Shield of
North Carolina and the City of Albemarle want to bring you programs that make your healthcare
simple and affordable.
To help you take good care of your diabetes, BCBSNC will waive the deductible for diabetic supplies
and apply only the coinsurance – saving you money.
Enrolling in this program is as easy as visiting www.BlueCrossNC.com/DiabetesWaiver, logging into
Blue Connect and answering a few quick questions. It’s available to anyone covered by your plan,
but parents will need to log in to their children’s Blue Connect accounts to enroll them.
This program covers products bought through in-network durable medical equipment (DME)
providers – not pharmacies. That means things like test strips, needles, syringes, insulin pumps and
more are included in the deductible waiver. Continuous glucose monitors and supplies are not
included in the deductible waiver.
After signing up, the waiver is applied automatically in the claims process. You don’t need to do
anything else when buying the supplies. So it’s an easy way to save time and money.
If you need help finding an in-network DME provider or have questions about this benefit, please
call Blue Cross NC Customer Service at the number on the back of your ID card.
How to Enroll
1. Visit www.BlueCrossNC.com/DiabetesWaiver and log in to your Blue Connect account. If you’re
a parent enrolling a child, you must log in to the child’s Blue Connect account.
2. Answer the questions in the brief survey.
3. That’s it! You or your child are enrolled and don’t need to re-enroll. You’ll start saving
immediately!
The benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the
underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this
guide, the underlying insurance documents will govern in all cases.
17BLUE CROSS AND BLUE SHIELD RESOURCES
Tobacco Cessation with QuitlineNC
Dramatically increase your odds of quitting
tobacco – at no extra cost
Ready to get off tobacco for good? Get the support you need at no extra charge. As a Blue
Cross and Blue Shield member, you have 100% coverage for:
- Four telephone counseling sessions with QuitlineNC – a state-bases tobacco cessation
program
- Extra calls for teens, members who are pregnant or have certain behavioral health
conditions
- 12- weeks of nicotine patches and nicotine gum or lozenge through QuitlineNC2
- Tobacco cessation screenings
- FDA-approved tobacco cessation drugs through your pharmacy benefit provider
Tools you can use
Text2Quit:
Text tailored to your quitting plan along with coaching call and medication reminders,
games to manage urges, and mobile tracking of use, cost savings and other measures
Web Coaching:
Web application that integrates seamlessly with Quit Coach cessions and offers e-
learning tool, social support, and information about quitting.
Call QuitlineNC at 1-884-862-7848.
Your Quit Coach is ready to help you succeed
The benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the
underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this
guide, the underlying insurance documents will govern in all cases.
18BLUE CROSS AND BLUE SHIELD RESOURCES
Fitness and Wellness Discount Program
Keep your body – and budget - healthy
Staying healthy and active should be easy –
and affordable. That’s why Blue Cross and
Blue Shield of North Carolina offers
Blue365. It’s a simple way to save on
everything you need for a well-balanced
lifestyle.
How it works
Staying health With Blue365, you have two
ways to save. There are ongoing discounts,
which you can redeem anytime you like,
and limited-time offers. After you register,
simply visit the Blue365 website to start
saving.
Deals delivered to your inbox
Sign up to get deal alerts vis email, so you
can be the first to know about the latest
offers from Blue365. You won’t receive
any spam. And we only send out one deal
alert per week to help you keep your inbox
clutter-free.
Sign up to win
Every month, anyone who signs up on the
Blue365 will get an entry into a drawing for
a $25 retail gift certificate. Be sure to tell
any friends and family, who are also Blue
Cross and Blue Shield of North Carolina
members to sign up, so they have a chance
to win, too!
The benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the
underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this
guide, the underlying insurance documents will govern in all cases.
19TELEMEDICINE – MD LIVE
The City of Albemarle and Blue Cross Blue Shield offer
you the opportunity for easy, convenient care through a
telemedicine benefit, MD Live. This service allows you
to talk to doctors anytime, anywhere, at any time via
phone calls or video chat. This service is reserved for
acute care only.
$5 Copay
The benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the
underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this
guide, the underlying insurance documents will govern in all cases.
20PHARMACY
The City of Albemarle’s prescription drug program is administered by Prime Therapeutics. If you elect
medical coverage, prescription drugs are included. Prescriptions are the fastest growing healthcare cost
segment in the nation. Your pharmacy benefits includes specific clinical programs to ensure that you and
your family members have access to safe, appropriate and effective medications. You can do your part by
requesting the lowest cost drug available when you are at the pharmacy.
Pharmacy 30-Day Mail Order (90 Days)
Tier 1 $10 Copay $30 Copay
Tier 2 $10 Copay $30 Copay
Tier 3 Up to $100 Copay Up to $300
Tier 4 Up to $100 Copay Up to $300
Tier 5 – Specialty Up to $100 Copay Not Available
Prescription Info
Network & Formulary NetResults 5 Tier Commercial, Broad Plus Network Formulary
Dispense As Written (DAW) MAC B Pricing (Brand Penalty when Generic Equivalent is
available and Provider does not require Brand to be dispensed)
Mail Order Program
Home delivery is a convenient, reliable way to get your medications at lower prices than a retail pharmacy.
For those that take medications daily, this will ensure that you have enough medication to get you through
a long period of time. To participate in the Mail Order Program, order your prescriptions online or through
the mail. Most physicians can do it for you.
Option 1 – Online
• Visit BlueConnectNC.com to use your existing BCBSNC login or go directly to MyPrime.com
• Fill out the online form and Prime Therapeutics will take care of the rest
• Have your Blue Cross member ID ready as they will ask for that information
Option 2 – Through the Mail
• Talk to your doctor and ask for a prescription for a 30-day supply to fill at a retail pharmacy for
immediate use if needed AND a prescription for a 90-day supply of each of your maintenance
medications.
• Complete the Prime Mail order form from the website, and simply mail your completed form, your 90
day written prescription and your payment to Prime.
The benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the
underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this
guide, the underlying insurance documents will govern in all cases.
21PRESCRIPTION DRUG PROGRAMS
Copay Maximization -
This program utilizes coupons provided by the manufacturer to reduce the cost for eligible specialty medications
to $0 when dispensed at an AllianceRx Walgreens Prime Specialty Pharmacy. If your medication has a coupon
opportunity you will receive a letter from BCBS or you may reach out to BCBS customer service on the back of
your ID card prior to filling your prescription.
Prior Authorization
Certain drugs require additional information from your healthcare provider before your prescription can be filled,
This process is called Prior Authorization. If you receive a prescription for a medication that requires Prior
Authorization, your healthcare provider will need to provide information to Excellus/Express Scripts’ Prior
Authorization Department before your prescription can be filled and covered under the prescription drug plan.
NOTE: Prior Authorizations typically only last for 12 months, so some prescriptions will have to be re-authorized.
Step Therapy
Step Therapy helps you choose the most cost effective and appropriate medicine for certain medical conditions. A
First-Line therapy Is usually a generic drug in the same therapy class. If the first-line therapy does not work, the
next step is to try a Second-Line therapy, and then perhaps a Third-Line therapy. You may be subject to Step
Therapy guidelines if you are filling a prescription used to treat one of the following conditions: High Blood
Pressure, High Cholesterol, and GI Acid-Peptic disorders.
How to Save on Your Drug Cost?
• Be sure to use a pharmacy that is in-network. Most major pharmacies are in-network. Use your local pharmacy
for a 31-day supply or less. Simply show your ID card at the pharmacy.
• Use home deliver (mail order) for maintenance medications or long-standing prescriptions.
• Use Tier 1 and generic whenever possible. Generics are “copies” of brand drugs but are lower cost options.
• Discuss the preferred drug list (formulary) with your doctor. If a Tier 1 or generic drug is not an option, using
formulary drugs will save you money.
Mobile Apps for Prescription Savings
There are free mobile apps for your smartphone that will provide you with great savings opportunities on
prescriptions. These apps will compare drug prices in your area. Just simply provide the drug and quantity and it
compares the costs at different pharmacies. Rx Saver and GoodRx are two popular options.
The benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the
underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this
guide, the underlying insurance documents will govern in all cases.
22DENTAL PLAN
Dental benefits are administered through Guardian. The below chart
provides a summary of your benefits, but refer to the carrier benefits
summary for the exact benefit level associated with your plan. Benefits are
effective January 1st – December 31st.
Network DentalGuard DentalGuard Non-
(You Pay) (You Pay) Contracted
(You Pay)
Class Tier 1 – Gold Tier 2 – Silver Out of
Network
Preventive 0%, No Deductible
0%, No
Basic 20% 20%
Deductible
40%, No
Major Services 50% 50%
Deductible
Orthodontia 50% 50% 50%
Plan Details
Waived for Waived for Waived for
Deductible Preventive, Preventive Preventive
applies to Basic, and
Major
Orthodontics Children up to age 19
One can of soda is the (Children)
amount of sugar Deductible
recommended for Person -
Calendar Year
None $50 $50
three days for a child. Family - None $150 $150
Calendar Year
Sugary Sodas are a
Plan Maximums
major risk factor for Calendar Year $1,250
tooth decay* Max
Ortho Lifetime $1,000
*Source: American Dental Association (ADA)
Max
Coverage Tier Monthly Rate Bi-Weekly
Rate
EE Only $33.73 $16.87
EE + Spouse $70.24 $35.12
EE + Child(ren) $67.75 $33.88
EE + Family $116.38 $58.19
The benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the
underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this
guide, the underlying insurance documents will govern in all cases.
23VISION PLAN
Vision benefits are administered through Community Eye Care
(CEC). The below chart provides a summary of your benefits,
but refer to the carrier benefits summary for the exact benefit
level associated with your plan. Benefits are effective January
1st – December 31st.
Community Eye Care
Exam In Network
Frequency Once every 12 months
Copay $15 Copay
Lenses
Frequency Once every 12 months
Single $15 Copay
Bifocal $15 Copay
Trifocal $15 Copay
Contacts Lens $150 allowance
Fitting Up to $100
Evaluation Up to $80
Discount 10% off amount over $150
Frames Your eyes need a rest even while
you’re awake. Use the 20-20-20
Frequency Once every 12 months rule to reduce eyestrain. After
$150 allowance, 20% off amount over working for 20 minutes, look away
Frames
$150 about 20 feet in front of you for
Lasik 50% discount at Participating Providers about 20 seconds.*
Source: National Eye Institute
Coverage Tier Monthly Rate Bi-Weekly Rate https://nei.nih.gov/health/healthyeyes
EE Only $7.90 $3.95
EE + Spouse $14.52 $7.26
EE + Child(ren) $14.84 $7.42
EE + Family $23.61 $11.81
The benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the
underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this
guide, the underlying insurance documents will govern in all cases.
24Heath Savings Account
If you enroll in the High Deductible Health Plan How do I access the funds in my HSA?
(HDHP) , you can enroll in a Health Savings Account Your HSA is similar to a checking account. You are
(HSA) administered by Flores and Associates. responsible for ensuring the money is spent on
qualified purchases only and maintaining records to
What is a health savings account (HSA)? withstand IRS scrutiny. Payments can be made via
An HSA is a tax-advantaged personal savings check, ACH, online bill-pay, or debit card, depending
account that can be used to pay for medical, dental, on what is available to you.
vision and other qualified expenses now or later in What expenses are eligible for reimbursement?
life. To contribute to an HSA you must be enrolled
in a qualified high-deductible health plan (HDHP) Qualified medical expenses are those directly related
and your contributions are limited annually. The to the alleviation or prevention of physical or mental
funds can even be invested, making it a great illness. Amounts paid for over-the-counter drugs are
addition to your retirement portfolio. HSAs are
owned by individuals and never expire. Unlike not qualified medical expenses unless prescribed by a
flexible spending accounts (FSAs), all doctor. This requirement does not apply to expenses
remaining HSA funds roll over each year. such as insulin and diabetic supplies, bandages, band-
aids or contact lens supplies. Expenses generally can
Who is eligible to participate?
be for yourself, your spouse, or your dependent
In order to contribute, you must be enrolled in the children, regardless if they are covered by your health
UHC High Deductible Health Plan, not covered plan. HSA funds can be used to pay for qualified
under a secondary health insurance plan, not medical expenses such as:
enrolled in Medicare, and not another person’s
dependent. There are no eligibility requirements to For a complete list, visit irs.gov and search for
spend previously-contributed HSA funds. Publication 502, Medical and Dental Expenses.
- Medical Care - Vision
Why should I participate in an HSA? - Physicals - Deductible Payments
Funds contributed to an HSA are triple-tax- - Dental - Prescriptions
advantaged. - Chiropractic - Medical Equipment
1. Money goes in tax-free. The contribution is - Certain Healthcare Premiums
deposited into your HSA prior to taxes being applied (Cobra, LTC, Medicare A/B/C/D)
to your paycheck, making your savings immediate.
Save your receipts! Be sure to save all receipts for
2. Money comes out tax-free. Eligible healthcare your qualified medical expenses in the event that you
purchases can be made tax-free when you use your
HSA. Purchases can be made directly from your HSA are audited. With Flores and Associates, you can easily
account, either by using your benefits debit card, upload images of your receipts online at
ACH, online bill-pay, or check – or, you can pay out- www.flores247.com and organize them into folders.
of-pocket and then reimburse yourself from your
HSA. FLORES ONLINE SERVICES:
3. Earn interest, tax-free. The interest on HSA funds View online account balance and transaction
grows on a tax-free basis. And, unlike most savings information.
accounts, interest earned on an HSA is not Track expenses for tax reporting purposes.
considered taxable income when the funds are used
for eligible medical expenses. Print forms and documents relating to your
accounts.
How much can I contribute to my HSA? Find educational materials to help you
Employee Contribution: You are eligible to
contribute up to the 2021 IRS annual maximums: understand your HSA.
Individual: $3,600 Call our customer support any time with
Family: $7,200 questions and issues.
Individuals aged 55 and over may make an
additional $1,000 catch-up contributions.
For more detailed information visit
www.flores247.com or contact Flores at
800.532.3327
25FLEXIBLE SPENDING ACCOUNT
Who is Eligible and When
All Full-Time Employees working at least 30 hours each week. Please check with your HR
representative for specific eligibility requirements.
Benefits You Receive
FSAs provide you with an important tax advantage that can help you pay health care and dependent
care expenses on a pretax basis. By anticipating your family’s health care and dependent care costs for
the next year, you can actually lower your taxable income.
Health Care Reimbursement FSA
This program lets employees who are not enrolled in a Health Savings Account (HSA) pay for certain
IRS-approved medical care expenses and prescriptions not covered by their insurance plan with pretax
dollars. You can contribute a maximum of $2,750 per year pre-tax. There are limits on salary reduction
contributions to a health FSA offered under a cafeteria plan and is applicable to both grandfathered
and non-grandfathered health FSAs. This limit will be indexed for cost-of-living adjustments. Some
examples of eligible expenses include:
• Hearing services, including hearing aids and batteries
• Vision services, including contact lenses, contact lens solution, eye examinations and eyeglasses
• Dental services and orthodontia
• Chiropractic services
• Acupuncture
• Prescription contraceptives
Limited Purpose FSA
This program lets employees enrolled in a Health Savings Account (HSA) differ tax-free dollars for
reimbursement of eligible Dental and Vision expenses. Medical expenses are not eligible for
reimbursement under the Limited Purpose FSA. Some examples of eligible expenses include:
• Vision services, including contact lenses, contact lens solution, eye examinations and eyeglasses
• Dental services and orthodontia
Dependent Care FSA
The Dependent Care FSA lets employees use pretax dollars toward qualified dependent care such as
caring for children under the age 13 or caring for elders. The annual maximum amount you may
contribute to the Dependent Care FSA is $5,000 (or $2,500 if married and filing separately) per
calendar year. Examples include:
• The cost of child or adult dependent care
• The cost for an individual to provide care either in or out of your house
• Nursery schools and preschools (excluding kindergarten)
Important Dates
Flexible Spending Expense Incurred Submit Expenses for
Accounts Reimbursement
Healthcare July 1, 2021 – June 30, July 1, 2021 – August
2022 31, 2022
Dependent Care July 1, 2021 – June 30, July 1, 2021 – August
2021 31, 2022
26LIFE AND AD&D INSURANCE PLAN
The City of Albemarle provides employees with Basic Term Life insurance at no cost to
you! Please refer to the carrier benefit summary for plan details.
Lincoln Financial Group
Life Benefit $25,000
AD&D Benefit $25,000
35% at age 65
Age Reduction Additional 25% at age 70
Additional 15% at age 75
Please make sure that your beneficiary information is updated!
The benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from
the underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide,
the underlying insurance documents will govern in all cases.
27Colonial – Voluntary Benefits
Colonial Life will continue to offer a variety of voluntary
benefits to supplement your insurance needs for life’s
unexpected events.
The Following voluntary benefits are available:
Accident insurance helps offset unexpected medical expenses that can result from a covered
accidental injury.
Specified disease insurance can supplement your major medical coverage by providing a lump-
sum benefit that you can use to pay costs related to a covered illness.
Cancer Insurance helps offset covered out-of-pocket expenses related to cancer.
Disability insurance can replace a portion of your income to help make ends meet if you become
disabled from a covered accident or covered sickness.
Term life insurance offers a predictable to provide more coverage at more affordable prices
during high-need years.
Whole life insurance provides long-term protection that can build cash value
28PENSION – FIREFIGHTERS’ AND RESCUE SQUAD
The City of Albemarle participates in the Firefighters’ and Rescue Squad Workers’ Pension Fund
(FRSWPF). You can enroll as a member of the pension fund if you are an eligible firefighter or
rescue squad worker who meets the eligibility criteria.
Creditable Service – Creditable Service is defined as eligible service for any period during which
you paid and maintained contributions in the fund or for which you purchased service credit in the
fund. In certain instances you may purchase service credit. Please see your handbook for details.
ORBIT Secure Account – Orbit is a secure site that allows you to view your personal account
information, download forms and access other retirement resources 24/7/365. To access ORBIT, go
to www.MYNCRetirement.com, click on the ORBIT icon and follow the instructions to create a
USER ID and password.
Pension Fund Office: 3200 Atlantic Ave., Raleigh, NC 27604
For Complete details on the Pension Fund (FRSWPF), please reference the Fire and Rescue
Handbook available in Human Resources.
Firefighter Rescue Squad
• Age 18 • Age 18
• 36 hours of training annually • 36 hours of training annually
• Fire dept. files a roster • Squad is eligible for
annually with NC State membership in NC
Firemen’s Association by Jan Association of Rescue and
Enrollment Eligibility 31st of each year. Emergency Medical Services,
• Dept. is rated by Fire Inc.
Insurance Rating Bureau and • Squad files a roster annually
certified by Dept. of with the Association by
Insurance as not less than January 31st of each year,
Class “9S”
Complete Form 350 and mail to Pension Office.
Enrollment Your enrollment date is effective in the month in which the pension
fund receives both your application (Form 350) and first contribution.
Contributions
Employee $10 per Month
State Annual Appropriation State General Fund
Benefit Eligibility
Disability Retirement Age 55 and 10 years Creditable Service
Retirement Age 55 and 20 years Creditable Service
Benefit Amount $170 per Month (subject to updates)
29PENSION – LAW ENFORCEMENT OFFICER
The City of Albemarle participates in the Local Governmental Employees’ Retirement System (LGERS)
Pension Plan. As an eligible law enforcement officer you automatically participate in the plan.
Creditable Service – Creditable Service is the total of all service credit that counts towards retirement. It
includes membership service and may include prior service credit, sick leave credit, military service credit
and certain types of purchased service credit.
ORBIT Secure Account – Orbit is a secure site that allows you to view your personal account information,
download forms and access other retirement resources 24/7/365. To access ORBIT, go to
www.MYNCRetirement.com, click on the ORBIT icon and follow the instructions to create a USER ID and
password.
Pension Fund Office: 3200 Atlantic Ave., Raleigh, NC 27604
For Complete details on the LGERS Pension Fund, please reference the Law Enforcement Handbook
available in Human Resources.
Retirement Formula
Your Annual benefit =
1.85% of average final compensation x years and months of creditable service
Law Enforcement
A permanent, full-time law enforcement employee who:
1. Possesses the power of arrest
2. Has taken the law enforcement oath administered by the
Eligibility state.
3. Certified as a law enforcement officer or deputy Sheriff
under provisions of Chapter 17C or 17E of the General
Statutes.
Enrollment First of the month following 90 days.
Contributions
Employee 6% of salary Pre-Tax
Employer Actuarial Calculation
Vesting 5 years of Creditable Service
Retirement
Service – Unreduced Agee 55 and 5 years of Creditable Service or
30 years of Creditable Service at any age
Early – Reduced Age 50 and 15 years of Creditable Service or
Eff. 7/1/2019: 25 years of Creditable Service at any age and
complete 15 years of service as an officer.
30PENSION – ALL OTHER CITY EMPLOYEES
The City of Albemarle participates in the Local Governmental Employees’ Retirement System (LGERS)
Pension Plan. As an eligible city employee, you automatically participate in the plan.
Creditable Service – Creditable Service is the total of all service credit that counts towards retirement. It
includes membership service and may include prior service credit, sick leave credit, military service credit
and certain types of purchased service credit.
ORBIT Secure Account – Orbit is a secure site that allows you to view your personal account information,
download forms and access other retirement resources 24/7/365. To access ORBIT, go to
www.MYNCRetirement.com, click on the ORBIT icon and follow the instructions to create a USER ID and
password.
Pension Fund Office: 3200 Atlantic Ave., Raleigh, NC 27604
For Complete details on the LGERS Pension Fund, please reference the Law Enforcement Handbook
available in Human Resources.
Retirement Formula
Your Annual benefit =
1.85% of average final compensation x years and months of creditable service
City Employees
Employed in a regular position that requires at least 1,000 hours
Eligibility
of work in a calendar year
Enrollment First of the month following 90 days.
Contributions
Employee 6% of salary Pre-Tax
Employer Actuarial Calculation
Vesting 5 years of Creditable Service
Retirement
Service – Unreduced Age 65 and 5 years of Creditable Service, or
Age 60 and 25 years of Creditable Service, or
30 years of Creditable Service at any age
Early – Reduced Age 50 and 20 years of Creditable Service or
Age 60 and 5 years of Creditable Service
31RETIREMENT SAVINGS PLANS– 401(k) & NC457
The City of Albemarle participates in the North Carolina State 401(k) and NC457 Retirement Savings Plans
as a supplement to your Pension Plan. The Plans are administered by Prudential Retirement. These two
savings plans represent one of the best opportunities available for building your retirement nest egg.
Employees can make contributions either on a pre-tax or ROTH basis to either plan. Contributions on a pre-
tax basis reduces current federal, state, and Social Security taxes and are deferred until you are ready to
withdraw from the account. ROTH contributions are made after-tax. You may elect to contribute 1% to
100% of your pay.
Internal Revenue Service (IRS) regulations limit the annual amount of your salary deferral contributions. If
you meet a salary deferral contribution limit, you may continue to defer up to the catch-up contribution
limit if you are eligible (you must be age 50 or older by the end of the current calendar year).
IRS Contribution Limits 401(k)
2020Plan NC457 Plan
Eligibility (401(k) & NC 457) Full-time, part-time or
Members of LGERS
temporary
Contributions $19,500
Enrollment
Sworn LawCatch-Up
Enforcement(Age 50+)
Officer $6,500
Automatic
Must Elect
All Other City Employees Must Elect
Employee Contributions
Pre-Tax
1-100% of annual salary, up to IRS Maximums
ROTH (after-tax)
Special One-Time Per Year
Employer Contributions
Sworn Law Enforcement Officer 5% of Salary
N/A
All other City Employees N/A
Vesting Schedule
Employee Contributions 100% immediately 100% immediately
Employer
Sworn Law Enforcement Officer 100% after 5 years of N/A
Creditable Service
What’s the Difference?
• 401(k)
• Plans limit catch-up contributions to $1,000 annually
• Plans can assess up to a 10% early withdrawal penalty
• NC457
• Plans feature a double limit catch-up provision
• Plans do not assess an early withdrawal penalty to participants who take money out
before 59 ½ though the amount taken is still subject to normal income tax.
32OTHER BENEFITS
The City of Albemarle’s 2020 comprehensive benefits package also includes the following
benefits:
Leadership Training
A nine month Leadership Training Course is
available every year to qualified employees.
Classes are held monthly typically starting in
October and ending in June.
See Human Resources or your supervisor
about enrolling in this program.
Tuition Assistance
Courses:
The City supports continuing education
• Your Leadership Journey
through it’s Tuition Assistance Program. All full-
• Communicating for Leadership Success time employees who have completed their
• Making High Quality Decisions initial probation are eligible for tuition
• Sexual Harassment, Diversity & Ethics reimbursement.
• Planning & Managing Resources
• Navigating Beyond Conflict You may be reimbursed based on the
• Addressing Poor Performance guidelines outlined below:
• Embracing Change • The course is taken on your own time.
• Working as a High Performance Team • The course will improve your skills in your
current position or prepare you for a
promotional opportunity with the City.
Credit Union Membership • Pre-approval of course by your
As an employee of the City, you are eligible for Department Manger, subject to review by
membership in the North Carolina Local Human Resources Director and approval
Governmental Federal Credit Union. by the City Manager.
• Satisfactory completion of the course.
Grade “C” or higher.
Eligible Expenses include:
• Tuition
• Registration Fees
• Lab Fees
• Student Fees
33TIME AWAY FROM WORK BENEFITS
Paid Holidays Paid Vacation Policy
The City follows the holiday schedule as published Vacation is intended to be used for rest,
by the State of North Carolina for state employees. relaxation, school appointments, other personal
These holidays are typically: needs, or for observation of a religious holiday not
1. New Years Day (Jan.) covered under the paid holiday schedule.
2. Dr. Martin Luther King, Jr. (Feb)
3. Good Friday, Easter (March or April) Vacation should be requested in advance
in methods determined by the department
4. Memorial Day (May)
and approved by the supervisor.
5. Independence Day (July)
6. Labor Day (Sep)
7. Veteran’s Day (Nov) Paid Sick Leave
8. Thanksgiving Day (Nov) Sick leave is to be used for the following
9. Day after Thanksgiving Day (Nov) reasons: sickness, non-work injuries, first 7 days of
10. Christmas Eve (Dec) Worker’s Compensation, required physical or
dental exams or treatment, and/or when you are ill
11. Christmas Day (Dec)
and contagious.
12. Day after Christmas (Dec)
Sick leave accrues at a rate of approximately 1
To be eligible for holiday pay, employees must day per month of service or twelve days per year.
work the last scheduled work day immediately For Law enforcement and Fire & Rescue
preceding and the first scheduled day immediately employees, who do not work the standard 40
following the holiday unless approved by their hour week, their accrual is prorated per the
immediate supervisor. published formula
Public safety employees and/or those whose shift Complete details on Holidays, Vacation,
schedule requires that they work on any of the Sick Leave, and FMLA are provided in the
above days, will be granted these holidays on an City’s Employee Handbook.
alternate date and/or method.
Have questions? Contact your supervisor
Family Medical Leave (FMLA) or Human Resources.
The City grants up to 12 weeks of FMLA which may
be paid or unpaid or a combination of both. FMLA
is coordinated with the City’s sick and vacation
leave policies. Unpaid FMLA is granted once the
employee has exhausted all types of paid leave.
Paid Vacation Time
Years of
0-4 5-9 10-14 15-20 20+
Service
Days
10 12 15 18 21
Accrued/Yr.
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