CITY OF WHEAT RIDGE 2021 BENEFITS GUIDE

 
CITY OF WHEAT RIDGE 2021 BENEFITS GUIDE
CITY OF WHEAT RIDGE
2021 BENEFITS GUIDE
CITY OF WHEAT RIDGE 2021 BENEFITS GUIDE
2021 OVERVIEW

                     City of Wheat Ridge Benefits
                     Your 2021 Benefits Guide
                     BENEFITS DESIGNED TO SUPPORT YOU
                     At City of Wheat Ridge, we know our dedicated employees—YOU—are key to our overall success. As a
                     way to reward you for your hard work, we provide a benefits package that is designed to help you
                     reach your physical, financial, and mental health goals.
   CORE BENEFITS

                     2021 OVERVIEW
                     Benefit Eligibility / Overview . . . . . . . . . . . . . . . . . . . . . 2
                     Benefit Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
                     Medical Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
                     Comparing Medical Plans. . . . . . . . . . . . . . . . . . . . . . . . . 5

                     YOUR CORE BENEFITS
                     Medical Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
OTHER BENEFIT

                     Health & Flexible Spending Accounts. . . . . . . . . . . . . . . 7
                     Dental Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
   PLANS

                     Vision Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
                     Medical Premiums . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
                     Dental & Vision Premiums . . . . . . . . . . . . . . . . . . . . . . .11

                     OTHER BENEFIT PLANS
                     Retirement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   12
                     Life and Disability Insurance . . . . . . . . . . . . . . . . . . . . .            13
ADDITIONAL

                     Voluntary Life Insurance . . . . . . . . . . . . . . . . . . . . . . . .           14
 BENEFITS

                     Accident & Critical Illness Insurance . . . . . . . . . . . . . .                  15

                     ADDITIONAL BENEFITS
                     Employee Assistance Program . . . . . . . . . . . . . . . . . . .                  16
                     Personal Time Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . .        17
                     Wellness Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . .         18
                     What’s App’ening . . . . . . . . . . . . . . . . . . . . . . . . . . . . .         19
                     Legal Shield & ID Shield. . . . . . . . . . . . . . . . . . . . . . . . .          20
   ADDITIONAL INFO

                     2021 Payroll Calendar . . . . . . . . . . . . . . . . . . . . . . . . . .          21

                     ADDITIONAL INFORMATION
                     Resources and Contact Information . . . . . . . . . . . . . . . 22
                     Employee Notices . . . . . . . . . . . . . . . . . . . . . . . . . . . 23-29
CITY OF WHEAT RIDGE 2021 BENEFITS GUIDE
2021 OVERVIEW
Benefit Eligibility & Overview
Who is Eligible for Benefits?                                   Eligible Dependents:
•   City employee working 20 or more hours                      •    Spouse or Domestic Partner
    per week and classified as benefitted                       •    Children, spouse’s children, and adopted
    through the budget.                                              children-up to age 26
•   Part-time variable employees working an                     •    Unmarried dependents over age 26 who are
    average of 30 hours per week during the                          medically certified as disabled and
    City’s predetermined Affordable Care Act                         dependent upon you
    period.                                                     •    Legal custody of a child up to age 26
When can I enroll or change my benefit elections?
New Hire
The first 30 days of employment with the City as a new hire or re-hire. Benefit elections are effective the
first of the month following your date of hire.

Open Enrollment
During the annual open enrollment period each October. Any newly elected benefits or changes made to
existing benefits become effective on January 1st of the following year. This year’s Open Enrollment period
is October 19th – October 25th. This is an ACTIVE enrollment — everyone must participate!

Qualifying Event
A life change — like getting married or divorced, having a baby, adoption, losing health coverage, etc. —
that can make you eligible for a special enrollment period, allowing you to enroll in health insurance
outside the yearly Open Enrollment Period.

If you experience a qualifying life event, reach out to your HR Business Partner for information or for forms.
Any forms will need to be turned in within 30 days of your qualifying life event date. Supporting
documentation must also be provided as proof of any qualified life event.
                 Benefits                                                   Options

                                        •   Kaiser Deductible Coinsurance Plan (DHMO)
Medical Plans
                                        •   Kaiser High Deductible Healthcare Plan (HDHP)
                                        •   Delta Dental PPO Only
Dental Plans
                                        •   Delta Dental PPO Plus Premier

Vision Plan                             •   EyeMed

Health Savings Account                  •   Healthcare Spending Account

                                        •   Medical Flexible Spending Account
Flexible Spending Account               •   Dependent Care Account
                                        •   Limited Purpose Dental and Vision Flexible Spending Account
                                        •   Mandatory 401(a) Plan
Retirement                              •   457 (Post and Pre-tax)
                                        •   Roth IRA
                                        •   BDA Morneau Shepell & Associates
Employee Assistance Program
                                        •   Public Safety ESI
                                        •   Term Life Insurance
                                        •   Accidental Death and Dismemberment
Voluntary Insurance                     •   Accident Non-occupational Insurance
                                        •   Critical Illness Insurance
                                        •   Legal Shield & Identity Protection
                                        •   Recreation Center Discounts
                                        •   Monthly Healthcare Premium Savings
Wellness Programs
                                        •   Sonic Boom Medical Premium Reductions & Cash Incentive Program
                                        •   Free Wellness Sessions

IMA Benefits Guide | 2
CITY OF WHEAT RIDGE 2021 BENEFITS GUIDE
2021 OVERVIEW

                Benefit Information
                What’s New?
                Kaiser – premium decrease!
                The medical plans had an overall decrease to premiums for 2021! You will see a slight decrease
                in your premiums for 2021. Also, Kaiser will be issuing new ID cards for 2021, so please watch
                for those in your mailbox.
                Life and DI Carrier – carrier change!
                As of January 1, 2021, our Life and Disability carrier will be UNUM (previously Cigna).
                24HRFlex
                • 2021 Maximum FSA contributions will be released the end of October/Early November
                • 2021 HSA contribution limits have increased:
                       • Individual - $3,600
                       • Family - $7,200
                ICMA
                • Max contribution to 457 & Roth will be released in November. Stay Tuned!

                Don’t Forget:
                Wellness Sessions
                • Every employee receives 1 FREE session per year for EACH of the following: Massage, Reflexology,
                  Reiki, Personal Training, and Pilates Reformer
                        • All you must do is call the Recreation Center and schedule your sessions @ 303-231-1300
                           http://www.rootedinfun.com/233/Wellness
                EAP – {Employee Assistance Program} - Not just for employees!
                        • Family members can also use this tool! https://www.workhealthlife.com/
                        • Police Officers: https://www.theeap.com/public-safety-eap

                                                                                           IMA Benefits Guide | 3
CITY OF WHEAT RIDGE 2021 BENEFITS GUIDE
2021 OVERVIEW
Medical Information
Important Healthcare Terms & Definitions
Coinsurance - After you meet your deductible,      Premium - The amount that you pay out of
you pay coinsurance, which is your share of the    your paycheck in order to be enrolled in the
cost of a covered health care service. For         medical, dental and/or vision insurance plans.
example, if the plan’s allowed amount for lab      For medical and dental coverage, the monthly
work is $100 and your coinsurance is 20%, once     premium is deducted from the first two
you meet your deductible, you will pay 20% of      paychecks of the month.
$100, which is $20. The health plan will pay the
remaining amount ($80).                            Preventive Care - Covered services that are
                                                   intended to prevent disease or to identify
Copay - A fixed dollar amount that you pay for a   disease while it is more easily treatable.
covered health service. Typically, your Copay is   Examples of preventive care services include
due up front at the time of service.               screenings, check- ups and patient counseling
                                                   to prevent illnesses, disease or other health
Deductible - The amount that you must pay          problems. In-network preventive care is
each calendar year for covered health services     covered 100% by the medical plans.
before the insurance plan will begin to pay.
                                                   Plan Year – A 12-month period of benefits
Out-of-pocket maximum - The most you will          coverage under a group health plan. Our plan
pay for covered health services during the         year runs concurrent with a calendar year
calendar year. All Copay, deductible, and          meaning it starts January 1, 2021 and runs
coinsurance payments count toward the out-of-      through December 31, 2021. This is also when
pocket maximum. Once you’ve met your out-          deductibles reset and new contribution limits
of-pocket maximum, your insurance plan will        to 401k, FSA, and HSAs are changed.
pay 100% of covered health services.

 IMA Benefits Guide | 4
CITY OF WHEAT RIDGE 2021 BENEFITS GUIDE
2021 OVERVIEW

                Comparing Medical Plans
                    Premium: This is what you PAY NOW…..it comes out of your paycheck bi-weekly
                                   DHMO PLAN                                                   HDHP PLAN
                                      Higher Premiums                                                 Lower Premiums
                                Range from: $40.71 - $205.87                                    Range from: $11.56 - $105.23
                              *Bi-weekly rates for 40-hour status                             *Bi-weekly rates for 40-hour status
                                depending on enrollment tier                                    depending on enrollment tier

                    Plan Design: This is what you PAY LATER…..when you seek medical care
                     Copays apply to office visits ($30 PCP/$50                          Higher Deductible ($1,500 for individual/$3,000 for
                     Specialist), urgent care ($50) and prescription drugs               family) applies to all services except for preventive
                     – No deductible applies                                             care

                     Lower deductible ($500) for major medical services                  Preventive Care is covered at 100% with no
                     (i.e. inpatient & outpatient hospitalizations)                      deductible

                     Preventive Care is covered at 100% with no                          Non-embedded deductible – if you elect family
                     deductible                                                          coverage (EE + 1 or EE + Family) you will have to
                                                                                         meet entire family deductible of $3,000 before
                     Embedded deductible – if you elect family                           coinsurance will apply
                     coverage (EE+1, or EE+Family), you will not have to
                     meet entire family deductible before coinsurance
                     will apply. Deductible is applied on the individual
                     only, but capped at a total of $1,500 for the whole
                     family

                24 Hour Flex Spending/Savings Account Options:
                Options for out of pocket expenses at the doctor’s office or hospital
                Health Savings Account (HSA) pre-tax money set aside for known medical and other healthcare expenses (see IRS
                pub 502 for included expenses)
                •    Supplements a HDHP plan
                •    Money contributed to an HSA will roll over from year to year and the account is owned by you
                •    The account stays with you if you retire or leave the City
                •    The City contributes to your HSA
                •    If you participate in the High Deductible Health Plan, you may participate in the Limited Purpose Flexible Spending
                     Plan, which is for dental and vision expenses only
                •    Funds can be used during retirement

                Medical Flexible Spending Account (FSA) pre-tax money set aside for known medical, dental and vision expenses.
                •    Money may be used for expenses incurred in the calendar year or it will be forfeited - It’s a use-it or lose it plan
                •    The City does not contribute to the account
                •    You cannot change your contributions

                                                                                                               IMA Benefits Guide | 5
CITY OF WHEAT RIDGE 2021 BENEFITS GUIDE
Medical Insurance
   WEBSITE: www.kp.org
   Most Kaiser Permanente medical offices house primary care, laboratory, x-ray and pharmacy
   services under one roof, which means you can visit your physician and manage many of your other
   needs in a single trip. The Kaiser plans provide in-network coverage only (except in the case of a
   medical emergency).

   When enrolling in the Kaiser Permanente HDHP or DHMO plans, you must select a primary care

                                                                                                             CORE BENEFITS
   physician who is responsible for overseeing your health care. With 22 Kaiser Permanente medical
   offices across the Denver–Boulder area, it’s easy to find a doctor close to your home or workplace.

                                        High Deductible Health Plan
PLAN FEATURE                                                                           DHMO
                                             (HDHP) with HSA
                                             $1,500 Individual                   $500 Individual
Annual Deductible
                                              $3,000 Family                       $1,500 Family
                                             $3,000 Individual                   $3,000 Individual
Out of Pocket Maximum
                                              $6,000 Family                       $6,000 Family
Primary Office Visit                    You pay 10% after deductible                  $30 Copay

Specialist Office Visit                 You pay 10% after deductible                  $50 Copay

Preventive Care (including labs)                   No Charge                          No Charge
Urgent Care                             You pay 10% after deductible                  $50 Copay
Emergency Services                      You pay 10% after deductible         You pay 20% coinsurance
                                                                            X-Ray: 20% after deductible
Diagnostic Tests (X-ray & Lab)          You pay 10% after deductible
                                                                                  Lab: No charge
Advanced Imaging (MRI, CT, PET)         You pay 10% after deductible                 You pay 20%
Inpatient Mental Health                 You pay 10% after deductible                 You pay 20%
Outpatient Mental Health Facility       You pay 10% after deductible                  $30 Copay

PRESCRIPTION COVERAGE
                                             HDHP with HSA
Prescription Features                (*Copays apply after Deductible                   DHMO
                                     and Coinsurance have been met)

Type                                    Retail                 Mail         Retail                 Mail

Tier 1- Generic Drugs                 $20 Copay*           $40 Copay*     $15 Copay           $30 Copay

Tier 2 – Preferred Brand Drugs        $40 Copay*           $80 Copay*     $40 Copay           $80 Copay

Tier 3 – Non-Preferred Brand Drugs    $60 Copay*          $120 Copay*     $60 Copay           $120 Copay

                                      20% after            20% after
Tier 4 – Specialty Drugs                                                20% up to $250      20% up to $250
                                      deductible           deductible

   IMA Benefits Guide | 6
CITY OF WHEAT RIDGE 2021 BENEFITS GUIDE
Flexible Spending and Health Savings
                  Accounts
                  WEBSITE: http://24hourflex.com/employee-landing-page/log-in-to-employee-account/

                   Medical FSA
                                                                             Common Medical FSA Expenses
                   • A Health Care FSA is used to reimburse out-of-
                                                                             • Insurance: Copays, deductibles, and co-insurance
                     pocket medical expenses for you and your
                     dependents. This plan is only be to those on the        • Medical: Doctor fees, office visit charge, x-rays, lab
                     DHMO plan                                                 fees, medicines
CORE BENEFITS

                   • Max. annual contribution: $2,700 (2020 Limit)*          • Vision: Exams, frames, lenses, contact lenses, LASIK
                                                                               eye surgery
                   Limited Purpose FSA                                       • Dental: Exams, x-ray, orthodontia, dentures, fillings,
                   • A Limited Purpose FSA allows you to use pre-tax           retainers
                     dollars to pay for only Dental and Vision expenses      • Chiropractic / Acupuncture
                     for you and your dependents. This plan is only
                     available to those on the HDHP Medical Plan.

                   Dependent Care FSA                                        Common FSA Dependent Care Expenses
                   • A Dependent Care FSA allows you use pre-tax             • Daycare for a qualifying child 12 and under
                     dollars to pay for eligible, employment-related
                                                                             • Before-school and after-school care
                     dependent care expenses for your dependent
                     children 12 and under. You can also use this            • Expenses for preschool/nursery school
                     account to reimburse care for dependents who            • Extended day programs and summer day camps
                     are physically or mentally unable to care for           • Elder day care for a qualifying individual
                     themselves, such as adult children over 13, spouses,
                     parents, or grandparents
                   • Max. annual contribution: $5,000 (2021 limit)*
                                                                             Common Eligible HSA Expenses
                   Health Savings Account (HSA)                              • Insurance: Deductibles, co-insurance
                   • An HSA allows you to set aside money on a pre-tax       • Medical: Office visit charges, x-rays, lab fees
                     basis to pay for qualified medical expenses. You        • Vision: Vision exams, frames and lenses, contact
                     can only contribute to an HSA if you participate in       lenses, LASIK eye surgery
                     a High Deductible Health Plan (HDHP).
                                                                             • Prescription Medicines
                   • 2021 Maximum annual total contribution:
                                                                             • Dental: X-rays, fillings, caps, crowns, orthodontia
                     Individual $3,600 / Family $7,200
                                                                             • Chiropractic / Acupuncture
                   • Individuals age 55+ can add an additional $1,000
                     catch-up contribution each year
                   • Individuals 65+ cannot contribute to an HSA unless
                     they have declined all forms of Medicare coverage       HSA Employer Annual Contribution
                   THE CITY CONTRIBUTION                                     • Individual: $800
                   • The City HSA contribution is paid out twice annually    • Employee + One or Family: $1,100
                     (on the 1st paychecks in January and July). If you
                     are newly hired your first contribution will be pro-
                     rated based on your start date
                   • HDHP members must enroll in the HSA so the City
                     can deposit contributions
                   • 2021 contribution limits for FSA’s to be released the
                     beginning of November 2020

                See tax benefits for using an HSA, and different FSA’s: http://24hourflex.com/medical-fsa/
                                                                                                IMA Benefits Guide | 7
CITY OF WHEAT RIDGE 2021 BENEFITS GUIDE
Dental Insurance
                                           Plan Highlights
     PPO ONLY                                               PPO PLUS PREMIER
     •   Lower premiums                                     •   Higher premiums
     •   Discounts apply only to the PPO                    •   Discounts apply to PPO Network,

                                                                                                                   CORE BENEFITS
         Network                                                Premier, & Non-Participating Dentists
     •   Smaller discounts                                  •   Bigger discounts

          Benefit                            PPO Only                               PPO Plus Premier

                                                                            $50 Individual/$150 Family – Applies
                                               None
         Deductible                                                           only to Basic and Major Services

                                                                                   $1,500 PPO Network
     Maximum Benefit                    $1,000 PPO Network                   $1,000 outside of PPO Network

                               Plan pays 80% PPO Dentist 0% for              Plan pays 100% PPO Dentist 80%
                                        Premier Dentist                              Premier Dentist
        Preventative                0% Non-Participating Dentist                 80% Non-Participating Dentist

                               Plan pays 30% PPO Dentist 0% for               Plan pays 80% PPO Dentist 80%
                                        Premier Dentist                               Premier Dentist
       Basic Services
                                    0% Non-Participating Dentist                  80% Non-Participating Dentist

                               Plan pays 30% PPO Dentist 0% for              Plan pays 50% PPO Dentist 50%
                                        Premier Dentist                              Premier Dentist
       Major Services               0% Non-Participating Dentist                 50% Non-Participating Dentist

                               Plan pays 50% PPO Dentist 0% for             Plan pays 50% PPO Dentist 50%
                                        Premier Dentist                             Premier Dentist
  Orthodontics (Child and          0% Non-Participating Dentist                50% Non-Participating Dentist
Adult) Children up to age 19    Lifetime maximum of $1,000 Child           Lifetime maximum of $1,500 Child &
                                              Only                                       Adult

                See the Delta Dental schedule of benefits for detail on frequency of services allowed

                                WEBSITE: www.deltadentalco.com

    IMA Benefits Guide | 8
CITY OF WHEAT RIDGE 2021 BENEFITS GUIDE
Vision Insurance
                The City provides a supplemental plan at your cost for more extensive eye care coverage. The vision
                plan with EyeMed. EyeMed has a broad network of independent providers and nation retail chains as
                in-network providers including: Lens Crafters, Sears Optical, JC Penney Optical, Pearle Vision (most
                locations).

                WEBSITE: https://www.eyemedvisioncare.com/member/public/login.emvc

                                  Vision Care Services                              Eye Med Member Cost
CORE BENEFITS

                Eye Exam (Calendar Year)                                                    $10 Copay

                Standard Lenses:                                                            $10 Copay
                Single Vision                                                               $10 Copay
                Bifocal
                                                                                            $10 Copay
                Trifocal
                                                                                            $10 Copay

                Frames                                                     $120 allowance, 20% off retail price over $120

                Contact lenses:
                MedicallyNecessary                                                          Paid in Full

                Elective (Cosmetic)                                        $135 allowance, 15% off retail price over $135

                Laser Vision Correction:                                               15% off retail price or
                LASIK or PRK                                                         5% off promotional price

                Exam Frequency                                                              12 Months
                LensesFrequency                                                             12 Months
                Frames Frequency                                                            24 Months
                Contact Lenses                                                              12 Months

                                                                                                  IMA Benefits Guide | 9
Medical Premiums
Listed below are the bi-weekly pre-tax paycheck deductions. Deductions are taken from the first two
paychecks of each month. In months where there are three pay dates, the 3rd check will not have any
benefit premium deductions.

       *Medical Premiums listed do not reflect the $5.00 bi-weekly Wellness Premium Reduction.

                                                40 Hour Status
                     Employee Only                      Employee + 1                          Family

                                                                                                                 CORE BENEFITS
                 City Cost      Employee Cost      City Cost     Employee Cost    City Cost      Employee Cost
  HDHP           $230.11           $11.56          $458.96          $48.54        $628.25              $105.23
 DHMO            $242.99           $40.71          $481.80         $113.96        $655.15              $205.87
                                                35 Hour Status
                     Employee Only                      Employee + 1                          Family
                 City Cost      Employee Cost      City Cost     Employee Cost    City Cost      Employee Cost
  HDHP           $202.66           $39.01          $404.35         $103.15        $553.72              $179.76
 DHMO            $214.17           $69.53          $424.82         $170.94        $577.94              $283.08
                                                30 Hour Status
                     Employee Only                      Employee + 1                          Family
                 City Cost      Employee Cost      City Cost     Employee Cost    City Cost      Employee Cost
  HDHP           $175.21           $66.46          $349.75         $157.75        $479.18              $254.30
 DHMO            $185.34           $98.36          $367.84         $227.92        $500.74              $360.28
                                                25 Hour Status
                     Employee Only                      Employee + 1                          Family
                 City Cost      Employee Cost      City Cost     Employee Cost    City Cost      Employee Cost
  HDHP           $147.77           $93.90          $295.14         $212.36        $404.65              $328.83
 DHMO            $156.51          $127.19          $310.86         $284.90        $423.54              $437.48
                                                20 Hour Status
                     Employee Only                      Employee + 1                          Family
                 City Cost      Employee Cost      City Cost     Employee Cost    City Cost      Employee Cost
  HDHP           $120.32          $121.35          $240.54         $266.96        $330.11              $403.37
 DHMO            $127.68          $156.02          $253.88         $341.88        $346.34              $514.68

      IMA Benefits Guide | 10
Dental & Vision Premiums
                      Listed below are the bi-weekly pre-tax paycheck deductions for dental and vision. Deductions are taken
                      from the first two paychecks of each month. In months where there are three paychecks, the 3rd check
                      will not have any benefit premium deductions.

                                                              Dental Premiums
                                                                 40 Hour Status
CORE BENEFITS

                                         Employee Only                    Employee + 1                          Family
                                   City Cost    Employee Cost       City Cost   Employee Cost         City Cost    Employee Cost
                     PPO            $7.08            $0.86            $7.10           $8.30            $15.48              $18.10
                 PPO+Premier        $18.52           $1.93           $20.23           $18.07           $36.63              $32.74
                                                                 35 Hour Status
                                        Employee Only                     Employee + 1                            Family
                                   City Cost     Employee Cost      City Cost     Employee Cost       City Cost      Employee Cost
                     PPO            $6.12            $1.82            $6.06           $9.34            $13.22              $20.36
                 PPO+Premier        $16.35           $4.10           $17.97           $20.33           $32.54              $36.83
                                                                 30 Hour Status
                                        Employee Only                     Employee + 1                            Family
                                   City Cost     Employee Cost      City Cost     Employee Cost       City Cost      Employee Cost
                     PPO            $5.16            $2.78            $5.02           $10.38           $10.95              $22.63
                 PPO+Premier        $14.18           $6.27           $15.71           $22.59           $28.44              $40.93
                                                                 25 Hour Status
                                        Employee Only                     Employee + 1                            Family
                                   City Cost     Employee Cost      City Cost     Employee Cost       City Cost      Employee Cost
                     PPO            $4.19            $3.75            $3.99           $11.41           $8.69               $24.89
                 PPO+Premier        $12.01           $8.44           $13.45           $24.85           $24.35              $45.02
                                                                 20 Hour Status
                                        Employee Only                     Employee + 1                            Family
                                   City Cost     Employee Cost      City Cost     Employee Cost       City Cost      Employee Cost
                     PPO            $3.23            $4.71            $2.95           $12.45           $6.43               $27.15
                 PPO+Premier        $9.83            $10.62          $11.19           $27.11           $20.26              $49.11

                                                              Vision Premiums
                                        Employee Only                     Employee + 1                            Family
                                   City Cost     Employee Cost      City Cost     Employee Cost       City Cost      Employee Cost
                VSP Vision          $0.00            $3.73            $0.00           $7.07            $0.00               $10.36

                                                                                                       IMA Benefits Guide | 11
Retirement
 Website: http://www.icmarc.org/
 As a benefited City employee, you are automatically enrolled in the City of Wheat Ridge 401(a) Money
 Purchase Pension Plan through ICMA-RC. A 401(a) Money Purchase Pension Plan is a Defined
 Contribution plan that requires mandatory participation from all employees

 VESTING is a process used by many government agencies. It is the period of time by which an employee
 accrues non‐forfeitable rights over employer contributions. The City of Wheat Ridge vests employer
 contribution at a rate of 20% for every completed year of service.

                                 Employee                   City                       Vesting Period
                               Contribution             Contribution

  Employee                          4%                        6%                           5 years

  SwornEmployee                    10%                       11%                           7 years

                                                                                                                  OTHER BENEFIT
  Director                          4%                        7%                         Immediate

                                                                                                                     PLANS
VOLUNTARY RETIREMENT PLANS
Deferred Compensation (457) - A voluntary retirement savings plan allowing employees to contribute
additional funds for retirement, either on a pre-tax or post-tax (Roth) basis. You may defer up to $19,500 of
compensation for 2021. The limit on catch-up contributions for 2021 is $6,500 (over age50).

Roth IRA* - A voluntary retirement savings plan allowing employees to contribute to an Individual Roth IRA
via after-tax payroll deduction. For 2021, you may contribute up to $6,000 (under 50 years of age) or $7,000
total (over age50).

*New 2021 contribution limits for IRAs to be released in late October 2020

Tools & Calculators:
                                   Retirement Education Center:
                                              Click Here!

     IMA Benefits Guide | 12                                                            IMA Benefits Guide | 12
Life and Disability
                Website: https://unum.com/employees
                If you are not properly insured and experience an unexpected, short-term or long-term disability, it can
                have a significant impact on your financial situation. The City automatically provides you Basic Life and
                AD&D, Short-Term and Long-Term Disability insurance through Unum at no cost to you.

                BASIC SHORT-TERM DISABILITY INSURANCE
                Benefit Amount                               60% of pre-disability earnings
                Weekly Minimum Benefit                       $25 per week
                Weekly Maximum Benefit                       $1,000 per week
                Benefit Waiting Period for
                                                             30 days
                sickness and Accident
                Premiums Paid By                             City of Wheat Ridge

                BASIC LONG-TERM DISABILITY INSURANCE
                Benefit Amount                    60% of pre-disability earnings
OTHER BENEFIT

                                                             The greater of $100 or 10% of an employee’s gross
                Weekly Minimum Benefit
                                                             disability payment
   PLANS

                Monthly Maximum Benefit                      $6,000 per month
                Benefit Waiting Period                       90 days
                Premiums Paid By                             City of Wheat Ridge

                BASIC LIFE INSURANCE
                                                              1.5 X’s employee’s annual earnings up to $150,000
                Benefit Amount for Employee
                                                              max
                Benefit Amount for Employee                   $2,000 per dependent (spouse and children 6+ months)
                Dependents (i.e. Spouse, Children
                                                              $1,000 per child (age birth to 6 months old)
                etc.)
                Proof of Good Health                          Not required
                Age Restrictions                              Decrease in benefit at age 70 (reduced to 65%) and
                                                              age 75 (reduced to 50%)
                Conversion/Portability Option                 Conversion within 31 days of your termination of
                                                              employment
                Premiums Paid By                              City of Wheat Ridge
                Accidental Death &
                                                              Same as life benefit
                Dismemberment

                                                                                                      IMA Benefits Guide | 13
Voluntary Term Life Insurance
If you are seeking more life coverage, you can get additional life     Employee/Spouse
insurance for yourself, your spouse/domestic partner, and your                               Non-
                                                                       Monthly Cost per                  Smoker
children. Your spouse/domestic partner life voluntary election                              Smoker
                                                                         $1,000 Units
cannot exceed 100% of your voluntary Life Insurance benefits.
                                                                            Children         $0.20           n/a
Guaranteed Issue Amount (GI): is the amount of life insurance             Under Age 20       $0.050         $0.100
available to an employee without having to provide Evidence of
Insurability is only provided at the time of hire. Elections an            Age 20 – 24       $0.050         $0.100
employee makes outside of their first 31 days of employment will           Age 25 – 29       $0.050         $0.110
be subject to providing Evidence of Insurability.
                                                                           Age 30 – 34       $0.060         $0.160
PREMIUM EXAMPLE: If you are age 35 and your spouse is 34 and               Age 35 – 39       $0.080         $0.280
you want $100,000 of life insurance for you, $60,000 for your
                                                                           Age 40 – 44       $0.130         $0.240
spouse and $10,000 for your children, please see below for how to
calculate:                                                                 Age 45 – 49       $0.210         $0.680
                                                                           Age 50 – 54       $0.310         $0.960
Employee: 100 units (of $1,000) x $0 .080 = $8.00
Spouse: 60 units (of $1,000) x $0.060 = $3.60                              Age 55 – 59       $0.470         $1.490
Child(ren): 10 units (of $1,000) x $0.20 = $ 2.00                          Age 60 – 64       $0.790         $2.500
Total Monthly Premium: $13.60
                                                                           Age 65 – 69       $1.460         $3.230

                                                                                                                     OTHER BENEFIT
                                                                           Age 70 – 74       $2.120         $5.290

                                                                                                                        PLANS
      ADDITIONAL LIFE & AD&D INSURANCE – EMPLOYEE
      Benefit Election Units                         Amounts elected in units of $10,000
      Guarantee Issue Amount                         $150,000
      Maximum Benefit                                The lesser of 7 times annual earnings or $500,000
      Benefit Rounded to Next $1,000                 Yes
      Proof of Good Health                           Yes, for any amount over $150,000 and late applicants
      Age Restrictions                               Decrease in benefit at age 70 (reduced to 65%) and age 75
                                                     (reduced to 50%)
      Conversion/Portability Option                  Included
      Premiums Paid By                               Employee
      ADDITIONAL LIFE INSURANCE – SPOUSE
      Benefit Election Units                         Amounts elected in units of $10,000
      Guarantee Issue Amount                         $30,000
      Maximum Benefit                                $150,000
      ADDITIONAL LIFE INSURANCE – CHILD
      Benefit Election Units                         Amounts elected in units of $2,000
      Guarantee Issue Amount                         $10,000
      Maximum Benefit                                $10,000 (The maximum benefit for a Child less than 6
                                                     months old is $250)
        IMA Benefits Guide | 14
Accident & Critical Illness
                PROVIDED BY ALLSTATE
                No one plans on having an accident or a critical illness. That's why insurance like Accident & Critical
                Illness coverage can help you in the event you experience a major medical event.

                How does it work? When you’re injured or have a major medical event, you will receive a cash
                benefit based on the percentage payable for the condition. You then determine how to use that cash.

                If you’re on the HDHP plan, out-of-pocket costs and major medical costs can be expensive. These
                types of programs can help cover incurred expenses.

                VIDEO LINKS
                http://www.allstatevoluntary.com/videos/gvap2.htm
                http://www.allstatevoluntary.com/videos/gvcip.htm
                                              EXAMPLES OF ITEMS COVERED
                               CRITICAL ILLNESS                           Accidents
                                 Heart Attack                              Fractures
OTHER BENEFIT

                                    Stroke                                Dislocation
                                    Cancer                            Loss of extremities
   PLANS

                                   Paralysis                            Broken Tooth

                PER PAY PERIOD PREMIUMS FOR ACCIDENT INSURANCE
                        COVERAGE OPTIONS                             PLAN 1*                        PLAN 2
                 Employee (EE)                                        $4.37                       $6.23
                 Employee plus Spouse (EE+SP)                        $10.58                       $14.19
                 Employee plus Children (EE+CH)                      $13.30                       $17.39
                 Employee plus Family (F)                            $16.51                       $22.80
                *If you are on the HDHP medical plan, you are only able to choose Plan 1 because that’s the only HSA-
                compliant plan for both Accident & Critical Illness.

                PER PAY PERIOD PREMIUMS FOR CRITICAL ILLNESS INSURANCE
                                           Non-Tobacco                                          Tobacco
                                  Plan 1*                   Plan 2                 Plan 1*          Plan 2
                 AGES      EE or       EE+SP        EE or           EE+SP    EE or     EE+SP  EE or      EE+SP
                          EE+CH      or Family     EE+CH          or Family EE+CH or Family EE+CH Or Family
                 18-35      $3.71       $5.60         $6.37         $9.58     $5.75     $8.66 $10.44     $15.69
                 36-50      $8.62      $12.96        $16.19        $24.30    $14.25 $21.40    $27.43     $41.17
                 51-60     $17.87      $26.83        $34.69        $52.06    $29.69 $44.56    $58.32     $87.51
                 61-63     $28.05      $42.10        $55.04        $82.58    $43.14 $64.73    $85.22 $127.85
                 64+       $41.76      $62.67        $82.47        $123.73 $64.47 $96.74 $127.88 $191.85

                                                                                               IMA Benefits Guide | 15
Employee Assistance Program
The City offers you the access to an Employee Assistance Program through BDA, Morneau & Shepell.
The EAP offers confidential assistance to help you and your family meet the challenges that life, work
and relationships can bring. You can call, text, or email the EAP. They offer 6 face to face counseling
sessions and are available 24 hours a day/7 days a week via phone and web. Get help with:
• Depression
• Substance abuse
• Legal and financial concerns
• Marital or family difficulties
• Stress management/anxiety

The EAP also offers many types of resources for employees such as: childcare and eldercare search,
online legal forms, financial calculators, Self-Assessment & Questionnaires, and more. Go to the site
below to register or log-in to your account.

                                               BDA, MORNEAU & SHEPELL EAP PROGRAM
 Contact Phone Number                                             866-757-3271
 Website                                             https://www.workhealthlife.com/
 Company Name                                                   City of Wheat Ridge

Public Safety EAP
This EAP program is offered to our public safety personnel (sworn police officers and their families).
Public Safety EAP address specific stressors and issues that public safety personnel and their families face
every day. This EAP offers many of the same amenities that our other EAP offers such as counseling, legal
information, financial tools and calculators, child & elder care assistance.

                                                       PUBLIC SAFETY EAP PROGRAM
 Contact Phone Number                                              888-327-1060

                                                                                                               ADDITIONAL
 Website                                                 www.PublicSafetyEAP.com

                                                                                                                BENEFITS

                                           1st PD Chief’s Car

    IMA Benefits Guide | 16
Personal Time Off (PTO)
                A leave program is for employees to use for vacations, medical/dental appointments,
                personal business, childcare needs, bereavement, family emergencies, off-the-job injuries,
                incidental illness, etc. The number of PTO days earned per year (hours accrued each pay
                period) is dependent upon years of service and full-time/part-time status.

                                                                         Per Pay Period
                                        40 Hour            35 Hour            30 Hour           25 Hour           20 Hour
             Years of Service
                                         Status             Status             Status            Status            Status
             0 - 5 years                6.25hours           5.47 hours       4.69 hours        3.91 hours       3.13 hours

             6 - 10 years               7.25hours           6.34 hours       5.44 hours        4.53 hours       3.63 hours

             11 – 15 years              8.25hours           7.22 hours       6.19 hours        5.16 hours       4.13 hours

             16+ years                  9.25hours           8.09 hours       6.94 hours        5.78 hours       4.63 hours

                                                  2021 HOLIDAY SCHEDULE
                                               New Year’s Day         Friday, January 1
                                 Martin Luther King,Jr. Day           Monday, January 18
                                              Presidents’ Day         Monday, February 15

                                                Memorial Day          Monday, May 31

                                          Independence Day            Monday, July 5
ADDITIONAL
 BENEFITS

                                                      Labor Day       Monday, September 6

                                                 Veterans’ Day        Thursday, November11

                                            Thanksgiving Day          Thursday,November 25

                                Day after Thanksgiving Day            Friday, November 26

                                                ChristmasDay          Saturday, December 25

              NOTE: When a day recognized by the City as a holiday falls on Sunday, the following Monday is observed as
              the holiday. When a day recognized as a holiday by the City falls on Saturday, the preceding Friday is
              observed as the holiday.

                                                                                                IMA Benefits Guide | 17
Wellness Program
         The purpose of the City’s Wellness Program is to establish a work environment that promotes healthy
         lifestyles and enhances quality of life for all team members. Our overarching goal is to promote a
         culture of wellness.

         The Wellness Program year starts on Nov. 1, 2020 and goes through Oct. 31, 2021

         Benefits Available
             •   Cash incentive
             •   Access to Sonic Boom
                      •   Drop-in use at the Wheat Ridge Recreation Center
             •   Drop-in use at the outdoor pool in Anderson Park.
             •   1 free massage, 1 free reiki, 1 personal training session, & 1 Pilates reformer session
             •   50% off registration for team sports with 50% of employees on the roster
             •   Additional selection of programs/classes offered by the Recreation Division
             •   Note - Team members pay income tax on the value of Recreation passes, classes and programs

         What is Sonic Boom?
         https://app.sbwell.com
         Sonic Boom is an interactive online platform that promotes friendly competition, reliable wellness
         information, and enables personal accountability for wellness goals.

         Wellness Incentives
          There are two types of wellness incentives you can earn; medical premium reductions of $10.00
          monthly and a one-time annual incentive payment of up to $200.00.

                                                                                                               ADDITIONAL
                                                                                                                BENEFITS
          Step 1: Complete 2 of 5 offered premium reduction activities
          Step 2: Start earning prize points for completing different wellness activities
          For information and questions about the program, reach out to: wellness@ci.wheatridge.co.us

IMA Benefits Guide | 18
What’s App’ening?
             In today’s world, technology has improved the way we communicate and the way we consume our
             information. That same thing applies for the way we consume our benefits. Many of our vendors
             supply online mobile applications (apps) that can help you get quick access to your health, 401(a)/457,
             and wellness information. By downloading and registering with our benefit providers you can:
             • Get access to your health, dental, and vision card via their mobile application
             • Find a healthcare, dental, or vision provider near you
             • View your benefits and have access to calculators
             • For the EAP, the app gives you the ability to text or call from the Mobile app with the click or swipe
                 of the phone
             • Apps available include – Kaiser Permanente, Delta Dental, EyeMed, BDA, ESI Group, Sonic Boom,
                 24hour Flex, ICMA-RC, and Give-A-Wow (pictured below)

             TELEMEDICINE
             Can’t get to the Doctor due to your schedule? For non-urgent, non-life threatening, illnesses, there
ADDITIONAL

             are now ways to communicate with your Medical provider. There are options to do e-visits, phone
 BENEFITS

             calls with your Doctor, and even chat sessions (or instant messaging) with Kaiser Permanente
             Physicians. Most of these options are available by an easy click going through the KP mobile app or
             booking from our KP account online.

             WHAT’S AN E-VISIT?
             An e-visit lets you or someone you care for communicate more effectively with a doctor or other
             health care professional online. E-visits are for when a Kaiser Permanente member needs more than
             an answer to a question but don’t necessarily need or want to come in for a medical facility
             appointment.
             To schedule e-visits go to: www.kp.org/appointments

                                                                                              IMA Benefits Guide | 19
Legal Shield & ID Shield

                            ADDITIONAL
                             BENEFITS

IMA Benefits Guide | 20
2021 Payroll Calendar
                                    The City pays on a bi-weekly basis every other Friday and the pay is
                                    one week in arrears of the period being paid. For example, the January 22nd
                                    2021 paycheck would be for the prior two weeks, January 4th through
                  Pay Day
                                    January 15th. Months where there are 3 pay periods, the 3rd check will not
                                    have any benefit premium deductions. In 2021, April and October have 3
                                    pay periods.

                                    The City has 11 holidays. When a day recognized by the City as a holiday
                                    falls on Sunday, the following Monday is observed as the holiday. When a
                   Holiday
                                    day recognized as a holiday by the City falls on Saturday, the preceding Friday
                                    is observed as the holiday.

             Deadline for Payroll   Please have any payroll changes (i.e. Direct Deposit, W4, 457, IRA etc.) into
                  Changes           HR a week and a half before the payroll date.
ADDITIONAL
 BENEFITS

                                                                                       IMA Benefits Guide | 21
Resources and Contact Information
         Carrier                   Policy #                Contact Info                             Website
Kaiser Permanente:
High Deductible Health
                                   181-032                303-338-3800                            www.kp.org
Plan (HDHP)
Deductible/Coinsurance
                                   181-033                303-338-3800                            www.kp.org
Plan (DHMO)
Med. Advice Line, Appts &
                                                          303-338-4545
Urgent Care
Delta Dental of Colorado:
Delta Dental of CO PPO
                                     8342                 800-610-0201                      www.deltadentalco.com
Only Plan
Delta Dental of CO PPO +
                                        8343                  800-610-0201                     www.deltadentalco.com
Premier Plan
EyeMed Vision Coverage:
EyeMed                                9702580                 844-873-7853                        www.eyemed.com
 Life, AD&D and Disability:
Unum Life and AD&D                     955899
Unum Voluntary Life &
                                       955900                 866-679-3054                         www.unum.com
AD&D
Unum STD/LTD                           955899
HSA & FSA Carrier:
24 Hour Flex                                                  303-369-7886                       www.24hourflex.com
Retirement Plans
ICMA-RC
  •401(a)                                                                                          www.icmarc.org
                                                              800-669-7400                            Alicia Paige
  •Non-Sworn                          106604
                                                                                                  apaige@icmarc.org
  •Sworn                              106104
                                                                                                    833-646-0237
457                                    300187
IRA                                    705856
Employee Assistance Programs:
BDA, Morneau & Shepell         City of Wheat Ridge            866-757-3271                     www.workhealthlife.com
ESI Public Safety EAP (PD
                               City of Wheat Ridge            888-327-1060                    www.publicsafetyEAP.com
Only)
 Allstate – Accident and Critical Illness
 Accident
                                       30706                 (800)-521-3535                   www.allstatebenefits.com
 Critical Illness
 Identity Theft & Legal
 Legal Shield                         Please reach out your independent rep, Cheryl Garcia: Cheryl@thevoluntarybenefit.com
 ID Shield                                                www.LegalShield.com/info/CityofWheatRidge
Human Resources:                     Title                           Email                                  Phone

Michael Clasen                   HR Manager              mclasen@ci.wheatridge.co.us                    303-235-2887
                                                                                                                             ADDITIONAL INFO

Josh Neeble                 Sr. HR Business Partner      jneeble@ci.wheatridge.co.us                    303-235-2814

Millie Lewis                Sr. HR Business Partner       mlewis@ci.wheatridge.co.us                    303-235-2812

Christine Jones              HR Business Partner          cjones@ci.wheatridge.co.us                    303-235-2884

    IMA Benefits Guide | 22
Employee Benefit Notices

                  The following pages provide employee benefit plan notices. Please read them carefully as we generally provide
                  these once a year during annual open enrollment. You may see some of these notices in other documents as
                  well, but we consolidate the following notices here for your convenience:

                         • MEDICARE PART D PRESCRIPTION DRUG CREDITABILITY/NON-CREDITABILITY
                         • NON-GRANDFATHERED MEDICAL PLAN APPEALS PROCESSES
                         • WOMEN’S HEALTH AND CANCER RIGHTS ACT (WHCRA)
                         • PUBLIC HEALTH INSURANCE MARKETPLACE
                         • WELLNESS PLAN
                         • SPECIAL MEDICAL ENROLLMENT RIGHTS AND RESPONSIBILITIES UNDER HIPAA
                         • PREMIUM ASSISTANCE UNDER MEDICAID OR THE CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP)

                  Throughout these pages you are invited to contact HR for assistance. For any questions or requests you may have
                  about the pages below, including a request for a paper copy of this notice packet, contact human resources (HR)
                  at 303-235-2884 or hr@ci.wheatridge.co.us
                  Before we get into the notices, some basic rules governing our plan are summarized below:
                         • You may only enroll when first eligible or during our annual open enrollment each Fall.
                         • Your election is locked for the entire plan year, January 1 to December 31.
                         • You can generally submit an election change form within 30 days of a qualifying life event to request a
                         benefit change during the plan year. We may require substantiating documentation of the event, and we
                         may determine the event does not qualify to make the requested change.
                         • At any time, we may audit dependent status and require current substantiating documentation.
                         • Declining to enroll in coverage will require your signature each year.
                         • Please keep us informed of address or beneficiary changes.
                         • When first enrolling in health coverage, a general notice of rights and responsibilities to continue health
                         coverage under COBRA will be given to employees. It explains that when certain life events make an
                         enrolled individual no longer eligible to stay on the plan, coverage might be able to continue for a limited
                         time under COBRA so long as you or your spouse follow our procedures to notify us within 30 days of the
                         qualifying life event.
ADDITIONAL INFO

                         • Your rights and responsibilities under the FMLA and our company specific FMLA policies are discussed in
                         our employee handbook.

                         IMA Benefits Guide | 23
Employee Benefit Notices
MEDICARE PART D CREDITABILITY NOTICE
When you or a family member becomes eligible for Part D (Medicare’s prescription drug benefit), it is
important to understand when to enroll in Part D. You can wait as long as you maintain "creditable"
coverage (i.e., coverage which on average pays at least as well as Part D pays on average). But if you
do not have creditable coverage, you need to enroll in Part D at the earliest opportunity.

Below are highlights to note:
• A continuous break in creditable coverage of 63 or more days will trigger a late enrollment penalty
  payable for life.
• The longer you go without creditable coverage, the higher the penalty. For the rest of your life, you
  would be charged an additional 1% of Part D base premium for each month you are late.
• When creditable coverage ends, a special enrollment period of two (2) months may be provided to
  enroll in Part D (but note that this is only available when normal coverage ends, not when retiree or
  COBRA coverage ends).
• The Part D annual open enrollment occurs each year from October 15th through December 7th for
  coverage to begin January 1st.

The information below indicates whether prescription drug coverage under our plan is creditable.

                  CREDITABLE COVERAGE                                           NON-CREDITABLE COVERAGE
                       Kaiser HDHP
                                                                               None – both plans are creditable
                       Kaiser DHMO
        Anyone needing to learn more about Medicare should contact a Medicare-approved counselor in their state at
                                 https://www.medicare.gov/Contacts/#resources/ships.

NON-GRANDFATHERED MEDICAL PLAN APPEALS PROCESSES
Your medical plan booklet will explain how to appeal a claim denial through the plan, through a
government-authorized third party, and with the help of a consumer assistance office.

WOMEN’S HEALTH AND CANCER RIGHTS ACT (WHCRA)
Enrolled individuals may be entitled to certain benefits under the Women's Health and Cancer Rights
Act of 1998 (WHCRA). For 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 symmetrical appearance;
•   Prostheses; and
                                                                                                                     ADDITIONAL INFO

•   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 the medical plan. If you would like more information on
WHCRA benefits, please contact HR.

IMA Benefits Guide | 24
Public Health Insurance
                  Marketplace
                  For individuals needing to purchase health insurance on their own, the Affordable Care Act (ACA) created
                  a new public health insurance Marketplace. This website and call center helps individuals shop for
                  private health insurance, helps individuals enroll in Medicaid or the Children’s Health Insurance Program
                  (CHIP), and evaluates eligibility for new tax credits. Open enrollment for public Marketplace coverage
                  occurs each fall for coverage starting January 1, but special enrollment periods may be available for
                  certain life events. Learn more or request assistance at www.healthcare.gov.

                  Please note that insurance companies are not required to participate in the public Marketplace, so you
                  are unlikely to see all plans available in the community when shopping the public Marketplace.

                  The public Marketplace can help you determine whether you may be eligible for tax credits under section
                  36B of the Internal Revenue Code for Marketplace coverage. One tax credit can lower your monthly
                  premium, and the other can lower your cost sharing (such as your deductible). Since tax credits are
                  based on your projected household income and typically paid in advance to the insurance company,
                  there is a chance you may have to repay some or all tax credits on your tax return if your income for the
                  year ends up higher than anticipated. Tax credits are not available to those eligible for “affordable,
                  minimum value” medical coverage. “Minimum value” means our plan is intended to pay, on average, at
                  least 60% of the costs of medical care received. “Affordable” means our lowest-cost minimum value plan
                  costs you no more than 9.5% (indexed annually) of your household income to be enrolled in single (not
                  family) coverage.

                  Our plan is intended to be affordable and minimum value. As a result, if you or someone in your family
                  wanted to compare your health insurance options in the public Marketplace to the insurance offered
                  through us, you’ll need to remember that:
                  •     You might pay full retail price for public Marketplace insurance (without the new tax credits)

                          a)    You would no longer be paying for insurance on a pre-tax basis

                          b)    You would no longer have an employer contribution toward your insurance (note that
                                employer contributions are typically excludable from income for federal income tax)

                  •     You would navigate any questions you have directly with the insurance company you choose…HR
                        will not be able to assist you with your public Marketplace plan

                  •     Should you desire to come back to our plan in the future, you will either need to:

                          a)    experience a “qualifying event” recognized by our plan as a mid-year election change, or

                          b)    wait until our next annual open enrollment
ADDITIONAL INFO

                  IMA Benefits Guide | 25
Wellness Program
 We sponsor a voluntary wellness program for employees through Sonic Boom. The program is administered according to
 federal rules permitting employer-sponsored wellness programs that seek to improve employee health or prevent disease,
 including the Americans with Disabilities Act of 1990 (ADA), the Genetic Information Nondiscrimination Act of 2008 (GINA), and
 the Health Insurance Portability and Accountability Act (HIPAA), as applicable, among others.

 If you choose to participate in the wellness program, you may be asked to complete a voluntary health risk assessment that asks
 a series of questions about your health-related activities and behaviors and whether you have or had certain medical conditions
 (e.g., cancer, diabetes, or heart disease).

 However, employees who choose to participate in the wellness program will receive an incentive of $10.00 per month reduction
 of medical premium for completing any of the 6 gateway items as found in Sonic Boom. Although you are not required to
 complete the assessment or biometric screening, only employees who do so will receive the incentive.

 Additional incentives of up to $200 may be available for employees who participate in certain health-related activities as
 mentioned in Sonic Boom. If you are unable to participate in any of the health-related activities or achieve any of the health
 outcomes required to earn an incentive, you may be entitled to a reasonable accommodation or an alternative standard. You
 may request a reasonable accommodation or an alternative standard by contacting Josh Neeble at 303-235-2814.

 PROTECTIONS FROM DISCLOSURE OF MEDICAL INFORMATION

 We are required by law to maintain the privacy and security of your personally identifiable health information. Although the
 wellness program and City of Wheat Ridge may use aggregate information it collects to design a program based on identified
 health risks in the workplace, our wellness program will never disclose any of your personal information either publicly or to the
 employer, except as necessary to respond to a request from you for a reasonable accommodation needed to participate in the
 wellness program, or as expressly permitted by law. Medical information that personally identifies you that is provided in
 connection with the wellness program will not be provided to your supervisors or managers and may never be used to make
 decisions regarding your employment.

 Your health information will not be sold, exchanged, transferred, or otherwise disclosed except to the extent permitted by law
 to carry out specific activities related to the wellness program, and you will not be asked or required to waive the confidentiality
 of your health information as a condition of participating in the wellness program or receiving an incentive. Anyone who
 receives your information for purposes of providing you services as part of the wellness program will abide by the same
 confidentiality requirements.

 In addition, all medical information obtained through the wellness program will be maintained separate from your personnel
 records, information stored electronically will be encrypted, and no information you provide as part of the wellness program
 will be used in making any employment decision. Wheat Ridge does not have access to any of your personal health or medical
 information at any time. Appropriate precautions will be taken to avoid any data breach, and in the event a data breach occurs
 involving information you provide in connection with the wellness program, we will notify you immediately.

 You may not be discriminated against in employment because of the medical information you provide as part of participating in
 the wellness program, nor may you be subjected to retaliation if you choose not to participate.

 If you have questions or concerns regarding this notice, or about protections against discrimination and retaliation, please
 contact HR.

 WELLNESS PROGRAM DISCLOSURE
 Your health plan is committed to helping you achieve your best health. Rewards for participating in a wellness program are
 available to all employees. If you think you might be unable to meet a standard for a reward under this wellness program, you
 might qualify for an opportunity to earn the same reward by different means. Contact us at 303-235-2814 and we will work with
 you (and, if you wish, with your doctor) to find a wellness program with the same reward that is right for you considering your
 health status.                                                                                                                         ADDITIONAL INFO

IMA Benefits Guide | 26
Special Medical Enrollment
                  Rights and Responsibilities Under
                  HIPAA
                  When you are eligible to participate in our group medical plan, you may have to enroll and agree to
                  pay part of the premium through payroll deduction in order to participate.

                  A federal law called the Health Insurance Portability and Accountability Act (HIPAA) requires that we
                  notify you of your right to enroll in the plan under its "special enrollment provision" if you acquire a
                  new dependent, or if you decline coverage under this plan for yourself or an eligible dependent while
                  other coverage is in effect and later lose that other coverage for certain qualifying reasons.

                  SPECIAL ENROLLMENT PROVISION
                  •   Loss of Eligibility under Medicaid or a State Children's Health Insurance Program (CHIP). If you
                      decline enrollment for yourself or for an eligible dependent (including your spouse) while coverage
                      under Medicaid or CHIP is in effect, you may be able to enroll yourself and your dependents in this
                      plan if eligibility is lost for the other coverage. However, you must request enrollment within 60
                      days after the other coverage ends.
                  •   Loss of Eligibility for Other Coverage. If you decline enrollment for yourself or for an eligible
                      dependent (including your spouse) while other medical coverage is in effect, you may be able to
                      enroll yourself and your dependents in this plan if eligibility is lost for the other coverage (or if the
                      employer stops contributing toward it). However, you must request enrollment within 30 days
                      after the other coverage ends (or after the employer stops contributing toward it).
                  •   New Dependent by Marriage, Birth, Adoption, or Placement for Adoption. If you have a new
                      dependent as a result of marriage, birth, adoption, or placement with you for adoption, you may be
                      able to enroll yourself and your new dependents. However, you must request enrollment within
                      30 days after the marriage, birth, adoption, or placement for adoption.
                  •   Eligibility for Medicaid or CHIP State Premium Assistance Subsidy. If you or your dependents
                      (including your spouse) become eligible for a state premium assistance subsidy from Medicaid or
                      through CHIP with respect to coverage under this plan, you may be able to enroll yourself and your
                      dependents in this plan. However, you must request enrollment within 60 days after your or your
                      dependents' determination of eligibility for such assistance.

                  To request special enrollment or to obtain more information about the plan's special enrollment
                  provisions, contact HR.
ADDITIONAL INFO

                      IMA Benefits Guide | 27
Premium Assistance Under Medicaid or
   the Children’s Health Insurance Program
   (CHIP)
 If you or your children are eligible for Medicaid or CHIP and you’re 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, but 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 being
 determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact
 the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).

 If you live in one of the following states, you may be eligible for assistance paying your employer health plan
 premiums. The following list of states is current as of July 31, 2020. Contact your State for more information on
 eligibility.
                                                                                     COLORADO – HEALTH FIRST COLORADO (COLORADO’S MEDICAID
                          ALABAMA – MEDICAID
                                                                                              PROGRAM) & CHILD HEALTH PLAN PLUS (CHP+)
Website: http://myalhipp.com/                                                  Health First Colorado Website: https://www.healthfirstcolorado.com/
Phone: 1-855-692-5447                                                          Health First Colorado Member Contact Center: 1-800-221-3943/
                                                                               State Relay 711
                                                                               CHP+: https://www.colorado.gov/pacific/hcpf/child-health-plan-plus
                                                                               CHP+ Customer Service: 1-800-359-1991/ State Relay 711
                                                                               Health Insurance Buy-In Program (HIBI):
                                                                               https://www.colorado.gov/pacific/hcpf/health-insurance-buy-program
                                                                               HIBI Customer Service: 1-855-692-6442

                              ALASKA – MEDICAID                                                          FLORIDA – MEDICAID
The AK Health Insurance Premium Payment Program                                Website:
Website: http://myakhipp.com/                                                  https://www.flmedicaidtplrecovery.com/flmedicaidtplrecovery.com/hipp/in
Phone: 1-866-251-4861                                                          dex.html
Email: CustomerService@MyAKHIPP.com                                            Phone: 1-877-357-3268
Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx
                             ARKANSAS – MEDICAID                                                           GEORGIA – MEDICAID
Website: http://myarhipp.com/                                                  Website: https://medicaid.georgia.gov/health-insurance-premium-payment-
Phone: 1-855-MyARHIPP (855-692-7447)                                           program-hipp
                                                                               Phone: 678-564-1162 ext 2131
                        CALIFORNIA – MEDICAID                                                              INDIANA – MEDICAID
Website: https://www.dhcs.ca.gov/services/Pages/TPLRD_CAU_cont.aspx            Healthy Indiana Plan for low-income adults 19-64
Phone: 916-440-5676                                                            Website: http://www.in.gov/fssa/hip/
                                                                               Phone: 1-877-438-4479
                                                                               All other Medicaid
                                                                               Website: https://www.in.gov/medicaid/
                                                                               Phone 1-800-457-4584
                                                                                                                                                         ADDITIONAL INFO

                  IOWA – MEDICAID AND CHIP (HAWKI)                                                        MONTANA – MEDICAID
Medicaid Website: https://dhs.iowa.gov/ime/members                             Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP
Medicaid Phone: 1-800-338-8366                                                 Phone: 1-800-694-3084
Hawki Website: http://dhs.iowa.gov/Hawki
Hawki Phone: 1-800-257-8563
                            KANSAS – MEDICAID                                                          NEBRASKA – MEDICAID
Website: http://www.kdheks.gov/hcf/default.htm                                 Website: http://www.ACCESSNebraska.ne.gov
Phone: 1-800-792-4884                                                          Phone: 1-855-632-7633
                                                                               Lincoln: 402-473-7000
                                                                               Omaha: 402-595-1178
 IMA Benefits Guide | 28
CHIP Continued
                                                KENTUCKY – MEDICAID                                                    NEVADA – MEDICAID
                      Kentucky Integrated Health Insurance Premium Payment Program (KI-HIPP) Medicaid Website: http://dhcfp.nv.gov
                      Website: https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspx     Medicaid Phone: 1-800-992-0900
                      Phone: 1-855-459-6328
                      Email: KIHIPP.PROGRAM@ky.gov
                      KCHIP Website: https://kidshealth.ky.gov/Pages/index.aspx
                      Phone: 1-877-524-4718
                      Kentucky Medicaid Website: https://chfs.ky.gov

                                              LOUISIANA – MEDICAID                                                  NEW HAMPSHIRE – MEDICAID
                      Website: www.medicaid.la.gov or www.ldh.la.gov/lahipp                  Website: https://www.dhhs.nh.gov/oii/hipp.htm
                      Phone: 1-888-342-6207 (Medicaid hotline) or 1-855-618-5488 (LaHIPP)    Phone: 603-271-5218
                                                                                             Toll free number for the HIPP program: 1-800-852-3345, ext 5218
                                                  MAINE – MEDICAID                                               NEW JERSEY – MEDICAID AND CHIP
                      Enrollment Website: https://www.maine.gov/dhhs/ofi/applications-forms Medicaid Website:
                      Phone: 1-800-442-6003                                                  http://www.state.nj.us/humanservices/dmahs/clients/medicaid/
                      TTY: Maine relay 711                                                   Medicaid Phone: 609-631-2392
                      Private Health Insurance Premium Webpage:                              CHIP Website: http://www.njfamilycare.org/index.html
                      https://www.maine.gov/dhhs/ofi/applications-forms                      CHIP Phone: 1-800-701-0710
                      Phone: -800-977-6740.
                      TTY: Maine relay 711
                                        MASSACHUSETTS – MEDICAID AND CHIP                                              NEW YORK – MEDICAID
                      Website: http://www.mass.gov/eohhs/gov/departments/masshealth/         Website: https://www.health.ny.gov/health_care/medicaid/
                      Phone: 1-800-862-4840                                                  Phone: 1-800-541-2831
                                               MINNESOTA – MEDICAID                                                 NORTH CAROLINA – MEDICAID
                      Website: https://mn.gov/dhs/people-we-serve/children-and-              Website: https://medicaid.ncdhhs.gov/
                      families/health-care/health-care-programs/programs-and-services/other- Phone: 919-855-4100
                      insurance.jsp
                      Phone: 1-800-657-3739
                                                 MISSOURI – MEDICAID                                                 NORTH DAKOTA – MEDICAID
                      Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm         Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/
                      Phone: 573-751-2005                                                    Phone: 1-844-854-4825
                                          OKLAHOMA – MEDICAID AND CHIP                                               UTAH – MEDICAID AND CHIP
                      Website: http://www.insureoklahoma.org                                 Medicaid Website: https://medicaid.utah.gov/
                      Phone: 1-888-365-3742                                                  CHIP Website: http://health.utah.gov/chip
                                                                                             Phone: 1-877-543-7669
                                                 OREGON – MEDICAID                                                     VERMONT – MEDICAID
                      Website: http://healthcare.oregon.gov/Pages/index.aspx                 Website: http://www.greenmountaincare.org/
                      http://www.oregonhealthcare.gov/index-es.html                          Phone: 1-800-250-8427
                      Phone: 1-800-699-9075
                                              PENNSYLVANIA – MEDICAID                                              VIRGINIA – MEDICAID AND CHIP
                      Website:                                                               Website: https://www.coverva.org/hipp/
                      https://www.dhs.pa.gov/providers/Providers/Pages/Medical/HIPP-         Medicaid Phone: 1-800-432-5924 | CHIP Phone: 1-855-242-8282
                      Program.aspx
                      Phone: 1-800-692-7462
                                         RHODE ISLAND – MEDICAID AND CHIP                                             WASHINGTON – MEDICAID
                      Website: http://www.eohhs.ri.gov/                                      Website: https://www.hca.wa.gov/
                      Phone: 1-855-697-4347, or 401-462-0311 (Direct RIte Share Line)        Phone: 1-800-562-3022
                                            SOUTH CAROLINA – MEDICAID                                                WEST VIRGINIA – MEDICAID
                      Website: https://www.scdhhs.gov                                        Website: http://mywvhipp.com/
                      Phone: 1-888-549-0820                                                  Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)
                                              SOUTH DAKOTA – MEDICAID                                            WISCONSIN – MEDICAID AND CHIP
                      Website: http://dss.sd.gov                                             Website: https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm
                      Phone: 1-888-828-0059                                                  Phone: 1-800-362-3002
                                                  TEXAS – MEDICAID                                                     WYOMING – MEDICAID
                      Website: http://gethipptexas.com/                                      Website: https://health.wyo.gov/healthcarefin/medicaid/programs-and-
                      Phone: 1-800-440-0493                                                  eligibility/
                                                                                             Phone: 1-800-251-1269

                  •     To see if any other states have added a premium assistance program since July 31, 2020, or for more information on special enrollment
                        rights, contact either:
ADDITIONAL INFO

                  •     U.S. Department of Labor                                                       U.S. Department of Health and Human Services
                        Employee Benefits Security Administration                                      Centers for Medicare & Medicaid Services
                        www.dol.gov/agencies/ebsa                                                      www.cms.hhs.gov
                  •     1-866-444-EBSA (1-866-444-3272)                                                1-877-267-2323, Menu Option 4x Ext. 61565

                                    IMA Benefits Guide | 29
You can also read