CITY OF WHEAT RIDGE 2021 BENEFITS GUIDE
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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
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
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
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
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
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
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
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
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 | 9Medical 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 | 10Dental & 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 | 11Retirement
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 | 12Life 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 | 13Voluntary 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 | 14Accident & 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 | 15Employee 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 | 16Personal 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 | 17Wellness 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 | 18What’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 | 19Legal Shield & ID Shield
ADDITIONAL
BENEFITS
IMA Benefits Guide | 202021 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 | 21Resources 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 | 22Employee 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 | 23Employee 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 | 24Public 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 | 25Wellness 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 | 27Premium 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 | 28CHIP 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 | 29You can also read
