MESA COUNTY GOVERNMENT - 2021 BENEFITS GUIDE

 
MESA COUNTY GOVERNMENT - 2021 BENEFITS GUIDE
MESA COUNTY GOVERNMENT
2021 BENEFITS GUIDE

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MESA COUNTY GOVERNMENT - 2021 BENEFITS GUIDE
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MESA COUNTY GOVERNMENT - 2021 BENEFITS GUIDE
TABLE OF CONTENTS
  4   New for 2021
  5   Enrollment Guidelines
  6   Benefit Contacts
  7   Glossary of Terms
  8   Premiums
  9   Medical Benefits
 10   myamberiben.com
 11   Ameriben’s Enhanced Customer Service
 12   VSP Exam Benefit
 13   Virtual Visits
 14   CHP Hotline-Precertification Requirements
 15   Triad EAP
 16   CHP Resources
 17   UNUM
 18   Travel Benefit
 19   GoodRx
 20   Dental Benefits Summary
 21   VSP Vision Benefits
 22   Vision Benefits Summary
 23   VSP Eyecare and Hearing Aids
 24   Flexible Spending Account
 28   Life & AD&D Insurance
 30   Voluntary Life & AD&D Insurance
 32   Long-Term Disability
 33   Additional Voluntary Benefits
 35   Retirement Benefits
 36   Important Notices
 37   Notice of Privacy Practices
 41   Marketplace Exchange Notice
 43   Children’s Health Insurance Program
 47   Medicare Part D Notice
474

This Benefits Guide is an overview of the benefits provided by Mesa County Government. It is not a Summary
Plan Description or Certificate of Insurance. If a question arises about the nature and extent of your benefits
under the plans and policies, or if there is a conflict between the informal language of this Benefits Guide
and the contracts, the Summary Plan Description and Certificates of Insurance will govern. Please note that
the benefits in your Benefits Guide are subject to change at any time. The Benefits Guide does not represent
a contractual obligation on the part of Mesa County Government.
This Benefits Guide is an overview of the benefits provided by Mesa County Government. It is
not a Summary Plan Description or Certificate of Insurance. If a question arises about the
nature and extent of your benefits under the plans and policies, or if there is a conflict between
the informal language of this Benefits Guide and the contracts, the Summary Plan Description
and Certificates of Insurance will govern. Please note that the benefits in your Benefits Guide
are subject to change at any time. The Benefits Guide does not represent a contractual
obligation on part of (CLIENT NAME).
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MESA COUNTY GOVERNMENT - 2021 BENEFITS GUIDE
New for 2021!

NEW MEDICAL PLAN TPA

For the 2021 plan year Mesa County Government has elected to change third
party administrators to Ameriben Health. The PPO Networks and the plan
design option remains the same. You will continue to access the CHP
Partners Hotline for provider searches, CHP Concierge, University of Utah
Health Care Connect program, and virtual visits through University of Utah.

NEW VISION EXAM BENEFIT THROUGH VSP

The routine vision exam is moving from the medical plan to VSP effective
1/1/2021. This benefit will be for members enrolled in the 2021 medical plan
but not enrolled in the 2021 voluntary VSP plan. Please see page 12 for more
details.

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MESA COUNTY GOVERNMENT - 2021 BENEFITS GUIDE
ENROLLMENT GUIDELINES
Welcome to the 2021 Benefits Guide for Mesa County Government. This Guide provides a quick
overview of the benefits program and helps to remove confusion that sometimes surrounds Employee
benefits. The benefits program was structured to provide comprehensive coverage for you and your
family. Benefit programs provide a financial safety net in the event of unexpected and potentially
catastrophic events.
ELIGIBILITY                                             QUALIFYING LIFE EVENTS
You are eligible to enroll in the medical benefits      Generally, you can only change your benefit
program if you are a full-time employee working         elections during the annual Open Enrollment
20 or more hours per week, or a temporary, non-         period. However, you may make changes during
seasonal employee working at least 30 hours per         the plan year if you have a qualifying event.
week. Medical, Dental, Vision, FSA, Basic
Lie/AD&D and LTD benefits for newly hired               Qualifying events include:
employees will take effect the first day of the
month following 30 days of qualified                    •   Marriage
employment. Voluntary life is effective the first of    •   Divorce
the month following 30 days of application if           •   Birth
dated prior to that date. Otherwise, it’s the first     •   Adoption
of the month following the date of signature (if        •   Death
signed within 30 days of eligibility). For benefits     •   Loss of Coverage
other than medical, Active at Work Provisions
apply, including Dependent Non-Confinement.             When you have a qualifying event, you have 31
                                                        days to complete and return a new
Your legal spouse and your married or unmarried         enrollment/change form for health, dental,
dependent children are eligible for medical             and/or vision coverage. You may be asked to
coverage if less than 26 years of age. Your             provide proof of the change and/or proof of
unmarried dependent children are eligible for           eligibility. (You have 60 days to complete and
dental and/or vision benefits if less than 26 years     return a new enrollment/change form after
of age. Disabled children over age 26 may be            coverage under Medicaid or CHIP terminates.)
eligible to continue benefits after approval of
necessary applications.                                 Available Benefits:
                                                        • Medical/Clinic
OPEN ENROLLMENT                                         • Flexible Spending Account (FSA)
Open enrollment for health, dental and vision is        • Dental
once a year and benefit elections will take effect      • Vision
January 1st. Participants may add or drop               • 401(a) Defined Contribution
coverage or make changes to their coverage at           • 457(b) Deferred Compensation
this time. Late entrants (employees or                  • Basic Life/Accidental Death & Dismemberment
dependents who apply for coverage more than               (AD&D)
31 days after the date of individual eligibility) are   • Supplemental Life Insurance
also provided an opportunity to enroll for              • Basic Voluntary Dependent Life Insurance
coverage during the plan’s open enrollment. The         • Long-Term Disability (LTD)
elections you make stay in effect the entire plan       • Accident/Critical Illness/Hospital
year, unless a qualifying life event occurs.              Indemnity/Legal/Identity Theft
                                                        • Sick Leave
                                                        • Vacation
                                                        • Employee Assistance Program (EAP)
                                                        • Social Security (FICA)

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MESA COUNTY GOVERNMENT - 2021 BENEFITS GUIDE
BENEFIT CONTACTS

Ameriben                            Medical                                (855) 401-8698
                                                                           www.myameriben.com

CHP Partners Hotline                Contact CHP Partners Hotline for       (877) 535-2295
                                    assistance in determining the          chp@gihosp.org
                                    appropriate facility or provider for
                                    Tier 1 services. Certain types of
                                    services may be paid at the Tier 1
                                    Network benefit level when
                                    performed at another Anthem
                                    ASO Network facility.
CHP Concierge                       Questions about CHP, CHP               (970) 644-4000
                                    Medical Clinic providers, hours
                                    and locations
University of Utah Health Care      Customer Service                       (801) 587-7219
Connect Program                                                            https://healthcare.Utah.edu/telehealth/
                                                                           virtual-visits/
Virtual Visits University of Utah   Virtual Visit Set-Up                   (844) 424-2172

Delta Dental                        Dental                                 www.customer_service@ddpco.com
                                    Group #12141                           (800) 610-0201

VSP                                 Vision                                 (800) 877-7195
                                                                            www.vsp.com

Rocky Mountain Reserve              Flexible Spending Account              (888) 722-1223
                                                                           www.rockymountainreserve.com

UNUM                                Life/AD&D Insurance, Voluntary         (800) 421-0344
                                    Life, & Long-Term Disability           www.unum.com

Mesa County Government              Brenda Moore                           (970) 244-1695
                                    HR Director                            Brenda.Moore@mesacounty.us

                                    Shelley Vehik                          970) 244-1847
                                    Senior Benefits Administrator          Shelley.Vehik@mesacounty.us

Novo Benefits                       Tre’ Bradley                           (970) 773-9145
                                    Associate Account Manager              tbradley@novobenefits.com

Novo Benefits                       Sharon Bacon                           (402) 802-9089
                                    Account Coordinator                    sbacon@novobenefits.com

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MESA COUNTY GOVERNMENT - 2021 BENEFITS GUIDE
GLOSSARY OF TERMS
The following terms will help you better understand your benefits.

Co-pay: A Copay is the portion of the Covered Expense that is your responsibility, as shown in the Medical
Schedule of Benefits. A Copay is applied for each occurrence of such covered medical service and is not
applied toward satisfaction of the Deductible.

Deductible: A Deductible is the total amount of eligible expenses as shown in the Medical Schedule of
Benefits, which must be Incurred by you during any Calendar Year before Covered Expenses are payable
under the Plan.

Coinsurance: Coinsurance is the percentage of eligible expenses the Plan and the Covered Person are
required to pay.

Out-of-Pocket Maximum (OOPM): An Out-of-Pocket Maximum is the maximum amount you and/or all of
your family members will pay for eligible expenses Incurred during a Calendar Year before the percentage
payable under the Plan increases to 100%.

PPO (Preferred Provider Organization): This type of plan utilizes network and non-network benefits.

In-Network: The Plan offers a broad network of providers and provides the highest level of benefits when
Covered Persons utilize “in-network” providers. These networks will be indicated on your Plan
identification card.

Out-of-Network: Any non-contracted providers. The services from these providers are subject to balance
billing, meaning members can be billed for the difference between the insurance carrier's fee schedule
and the billed charges.

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MESA COUNTY GOVERNMENT - 2021 BENEFITS GUIDE
PREMIUMS
Employee Contributions
Effective January 1, 2021

MEDICAL                     EMPLOYEE            COUNTY          % CONTRIBUTION             TOTAL

Single                       $43.00             $672.69                94%                $715.69
Employee + Spouse            $342.00            $1084.47               76%                $1426.47
Employee + Child(ren)        $228.00            $913.18                80%                $1141.18
Family                       $374.29            $1408.06               79%                $1782.35

DENTAL                      EMPLOYEE            COUNTY          % CONTRIBUTION             TOTAL

Single                       $32.53               $0.00                0%                  $32.53
Employee + Spouse            $68.30               $0.00                0%                  $68.30
Employee + Child(ren)        $55.29               $0.00                0%                  $55.29
Family                       $97.58               $0.00                0%                  $97.58

VISION                      EMPLOYEE            COUNTY          % CONTRIBUTION             TOTAL

Single                       $9.57                $0.00                0%                  $9.57
Employee + 1                 $16.99               $0.00                0%                  $16.99
Family                       $27.40               $0.00                0%                  $27.40

                                                                  Premium Paid by Employee
 VOLUNTARY SUPPLEMENTAL TERM LIFE
                Visit your enrollment portal at Mesa Wave to see your age banded rates.

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MESA COUNTY GOVERNMENT - 2021 BENEFITS GUIDE
MEDICAL BENEFITS
Mesa County Government offers medical benefits through Ameriben. This medical plan balances
affordability with the freedom to go outside the network. You may choose a participating or a non-
participating provider. Participating providers have agreed to provide services at a discounted fee.
For out-of-network care, you are responsible for charges above the in-network allowance for the
same services, in addition to the deductible and coinsurance. To find a participating provider, please
call the CHP Partners Hotline at 1-877-535-2295.

                                                           PPO Medical Plan
 Medical Benefits                             Tier 1                                    Tier 2                                Tier 3
                                Community Hospital & Community
                                    Hospital Owned Facilities;             Anthem BlueCross BlueShield
 Network                                                                                                            Non-Contracted Providers
                                  Canyon View Surgery Center;                  Contracted Providers
                                 University of Utah Health Center
 Deductible
                                  $1,250 Single / $2,500 Family             $1,250 Single/ $2,500 Family          $5,000 Single/ $10,000 Family
 Out-of-Pocket Maximum
                                  $5,000 Single/ $10,000 Family            $6,850 Single/ $13,700 Family                  No Maximum
 Preventive Care per
                                       Covered 100%, DW                          Covered 100%, DW                          Not Covered
 Schedule of Benefits
 Office Visit                       $10 copay for office visit.                                                    $60 copay for office visit. All
                                                                         $40 copay for office visit. All other
                                   All other services subject to                                                  other services 50%, deductible
                                                                        services subject to deductible + 20%
                                         deductible + 20%                                                                     waived
 Virtual Visits                              $0 Copay
                                                                                     Not Available                         Not Available
                                     University of Utah Only
 Specialist Office visit
                                    $45 copay for office visit.               $45 copay for office visit.           $60 copay for office visit.
                                   All other services subject to       All other services subject to deductible      All other services 50%,
                                       deductible then 20%                             then 20%                        deductible waived
 Outpatient Hospital                         20% AD                                    50% AD                                 50% AD
 Inpatient Hospital                          20% AD                                    50% AD                                 50% AD
 Emergency Room                $150 Copay per visit for facility and
                                physician services, then 20% after
                                                                                Same as in-network                     Same as in-network
                                 deductible for all other services.
                                    Copay waived if admitted
 Pharmacy Deductible             $150 Deductible Per Person               $150 Deductible Per Person                     Not Applicable
 Retail – 30 day supply
 Preventive RX Formulary            100% DW at Canyon View               Subject to copay and deductible
  Generic                         Lesser of $20 copay or 20%, AD          Lesser of $20 copay or 20%, AD                   Not Covered
  Formulary                       Lesser of $45 copay or 30%, AD          Lesser of $45 copay or 30%, AD                   Not covered
  Non-Formulary                   Lesser of $60 copay or 40%, AD          Lesser of $60 copay or 40% AD                    Not covered
 Specialty only through ESI    Lesser of 25% to a maximum of $500      Lesser of 25% to a maximum of $500                  Not covered
 Pharmacy Management                   per prescription, AD                    per prescription, AD
 Mail Order – 90 day supply
  Generic                       Lesser of $60 copay or 3 x 20% AD       Lesser of $60 copay or 3 x 20%, AD                 Not covered
  Preferred                    Lesser of $135 copay or 3 x 30% AD       Lesser of $135 copay or 3 x 30% AD                 Not covered
  Non-Preferred                Lesser of $180 copay or 3 x 40% AD       Lesser of $180 copay or 3 x 40% AD                 Not covered

  *Includes Deductible, Copays, & Rx                         AD – After Deductible                   DW – Deductible Waived

 *The above benefits are meant for illustrative purposes only and are only a brief look at your benefits. See your Plan Document for details on
 benefits, network utilization, limitations and exclusions. In the event of a discrepancy the Plan Document will prevail. The Plan Document is
 available via your Mesa Wave Portal. Printed documents are available upon request.

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MESA COUNTY GOVERNMENT - 2021 BENEFITS GUIDE
Introducing MyAmeriBen.com!
           MyAmeriBen is a tool designed to provide you quick and easy access to
       claims status, benefits, eligibility information, customer care, and much more.

Information you can access:
    Live Chat Features        Live online help to answer any questions 7:00 am – 6:00 pm MT

    Benefits & Claims         Check benefit information, eligibility, and claim status 24/7

    Important Links           Access other plan vendors such as HSA, PPO, and PBM

    ID Cards                  Electronic ID cards can be accessed and even emailed directly to
                              providers

    Health Risk               Complete the HRA to create a personalized wellness plan based
    Assessment                on your medical and lifestyle information

    Translator                Multiple languages can be utilized

                                                                                   ... and muchmore!
                                            NEED HELP?
         Customer Care Center is also available to help you, Monday-Friday, 7:00 AM to 6:00 PM MT      10
Introducing
          AmeriBen's Enhanced CustomerService!
                                                                   Navigating the healthcare labyrinth
                                                                  can be difficult. Allowus to guide your
                                                                    membersthrough the healthcare
                                                                     maze with confidence andcare.

                 YourMembersWill Appreciate the Additional Care They
                    Receive From AmeriBen Enhanced Customer Care
Benefits of Enhanced CustomerService                                    Optional ServicesAvailable
Youremployeesworkhardforyou.Allowustotakegoodcareof                     AmeriBenConsumerSupport
themwithourEnhancedCustomerServiceoption.Weprovide                      TheConsumerSupportteamwill assist memberswithfinding high-
assistance withschedulingdoctorvisits, coordinatingwithother            quality, low-costoptionsforprocedureslike MRIs,CTscans,total knee
programssuchaspharmacyorHSAbenefits,andmuchmore.                        replacements,total hipreplacements,andmore!Additionalfees may
Oneofthemostutilizedservicesis assistance findingahigh-                 apply.
quality,low-cost providerin themember'sarea.Thisservicecan
beusedforprimarycarephysiciansaswell asspecialists.                     Behavioral/CaseManagement
Representativeswill alsotakethetimetodiscuss availablecare
                                                                        AnAmeriBenregisterednursecasemanageris heretoprovidethe
resourcesdependingonsymptomsorneedsdiscussed.
                                                                        support membersneedthroughout illness, life-changing injury, or
Services Comparison                                                     behavioralhealthcrisis.Additionalfeesmayapply.

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                                                  CustomerCareRepresentativesAvailable            7:00am- 6:00pmMountainTime
Vision Benefits for Members Insured in Our 2021 Medical
    Plan and Not Enrolled in the 2021 Voluntary VSP Plan
Create an account on vsp.com to view your in-network coverage, find the VSP network doctor
who’s right for you, and discover savings with exclusive member extras. At your appointment,
just tell them you have VSP.
Maximize your coverage with bonus offers and additional savings that are exclusive to
Premier Program locations.

WellVision Exam            $20 Copay Every 12 Months
Glasses & Sunglasses 20% savings on complete pair of prescription glasses and sunglasses,
                     including lens enhancements, from any VSP Provider with 12 months
                     from your last WellVison Exam.
Contacts                   15% savings on a contact lens exam (fitting & evaluation)
Laser Vision               Average 15% off the regular price or 5% off the promotional price –
                           only available from contracted facilities

Coverage with a retail chain may be different or not apply. Log in to vsp.com to check your benefits for eligibility
                          and to confirm in-network locations based on your plan type.
 Plan Benefits are not available at Walmart, Sam’s Club, or Costco. VSP guarantees coverage from VSP network
                                                providers only.

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VIRTUAL VISITS
Online Acute Care through University of Utah
Mesa County-insured have access to virtual visits! If you have a minor illness, but you can’t make it to
a doctor, you can utilize online acute care!
If you are feeling sick and don’t want to leave the comfort of your home, you can speak face-to-face
with a University of Utah provider. You don’t need an appointment, just a Wi-Fi internet connection on
your smartphone, tablet or computer.
 • Available 9:00 a.m. - 8:00 p.m. 7 days a week.
 • Call from anywhere in Colorado or Utah.
 • Virtual Visits are covered with a $0 co-pay through your Mesa County insurance.

                                      To start your visit, please call
                                          (844) 424-2172
                                     *Save this number in your phone!

Symptoms Suitable for Virtual Visits
 •   Allergies
 •   Cough, cold and flu
 •   Eye infections
 •   Sore throat (adult patients only)
 •   Minor muscle or joint pain
     (adult patients only)
 •   Nausea, vomiting and diarrhea
 •   Sinus problems
 •   Skin issues
 •   Stomach and digestive issues
 •   Urinary track issues (adult patients only)
         And many more!

         Apple users will need to download the “UofU Health Virtual Care” app on the App Store
         prior to starting their visit. There is no app requirement for Androidusers.

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CHP HOTLINE
                   What procedures/services does Community Hospital offer?
                        What about labs, x-rays, mammograms, MRIs?
                    What services does Community Hospital not provide?
Our team will help you navigate the health care system and provide answers to your health plan questions.
Call the toll free number below to speak directly with the CHP Partners Hotline team member. Calls or
emails received by 5 p.m. will be returned by 5 p.m. the following business day. To best serve you, calls and
emails can be made to the hotline 24 hours a day, seven days a week. If a team member is not available at
the time of the call, please leave a message. All calls and emails will be returned in a timely manner.

PRE-CERTIFICATION
Contact CHP Partners Hotline at 1-877-535-2295 for assistance in determining
the appropriate facility or provider for services. Certain types of services may
                                                                                                                               61% OF THE TIME
also be paid at the in-network Tier 1 benefit level when performed at a                                                       MEMBERS SELF-REFER
University of Utah facility.                                                                                                    TO THE WRONG
                                                                                                                               SPECIALIST. CALL
Before you receive certain medical services or procedures, your health plan                                                    TODAY FOR HELP!
requires a doctor to confirm that these requested services are considered
medically necessary under your plan. This verification process is called "pre-
certification.“ Even if some services or therapies are performed in your
doctor's office, you may still need a pre-certification.

  SERVICES REQUIRING PRE-CERTIFICATION
  Inpatient Hospitalizations                                             Oncology Care & Services                                    Labor & Delivery
                                                                         (chemotherapy, radiation therapy, etc.)
  Colonoscopies other than at Grand Junction                             Out-Patient Surgeries other than Canyon View Surgery Center
  Endoscopy and Gastroenterology Associates of                           & Community Hospital
  Western Colorado.
  Services Community Hospital does not currently provide; however, with approval through the CHP Hotline, these
  services, if authorized by the third party administrator (TPA) as medically necessary and covered by the
  employer’s health plan, would be paid at the higher level benefit/in-network/Tier 1 for facilities in the
  employer’s selected provider network including University of Utah.
  •               Cardiac Catheterization
  •               Cardiothoracic Surgery
  •               Neonatal and Pediatric ICU
  •               Neurosurgery

*The above benefits are meant for illustrative purposes only and are only a brief look at your benefits. See your Certificate of Coverage or SBC for   14
details on benefits, network utilization, limitations and exclusions. In the event of a discrepancy the plan document will prevail. Plan Documents
are available via your Mesa Wave Portal. Printed documents are available upon request.
LIFESTYLE MODIFICATION
Outpatient Behavioral Health
                                             Our Behavioral Health Specialists can help you with:
                                              • Personal relationship problems
                                              • Anxiety and depression
                                              • Drug and alcohol interventions
                                              • Work stress
                                              • And more!
                                             Behavioral health services are available at no cost to you!
                                             To schedule an appointment, please call (970) 242-9026.
                                             Available to participants who see a CHP Medical
                                              Clinic Provider.

EAP Services
Triad EAP is a prepaid, confidential service offered by Mesa County. This
benefit is available to all Mesa County employees and extends to the
employee’s spouse and dependents under the age of 26. Five EAP
short-term, solution based counseling sessions are available at no cost
to you! This benefit includes legal and financial counseling.
Crisis counseling is available 24-hours a day, seven days a week.
Triad works with highly trained and qualified professionals who are experts in the fields such as
wellbeing, family matters, relationships, debt management, consumer rights, and much more.
For information regarding your benefits or to see a list of counselors, log in to www.triadeap.com.
Username: mesa / Password: county, or call (970) 242-9536 (local) or 877-679-1100 (toll free).

                                             Nutritional Education Services
                                             Nutritional education is available at no cost to you!
                                             Our dieticians can assist you with:
                                              • Weight loss
                                              • Medical nutrition therapy
                                              • And more!
                                             To schedule an appointment, please call 263-2664.
                                             *A referral from a CHP Medical Clinic Provider is required.

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                                                                                                           8
C H P Resources
Your CHP Resources
Utilize these resources to enhance wellness and navigate the healthcare system.

Navigation
Contact your CHP Coordinator by calling (970) 644-4000 or emailing chp@gjhosp.org.

                                  Your CHP Coordinator can help you with the following:
                                   •    Find a primary care provider
                                   •    Assist with the new patient process
                                   •    Find in-network health care services and facilities
                                   •    Specialist referrals/questions
                                   •    Narrow network exception process (CHP Hotline)
                                   •    Miscellaneous benefit questions

Health Coaching
Health coaching is a FREE personal approach to enhance wellness.
Through a series of interactions, your health coach will help you
determine health priorities, develop strategies and create a plan
of action for:
    • Nutrition and exercise evaluation/education
    • Chronic disease management
You can receive up to 12 free coaching visits a year!

                Can’t leave work? Crunched for time?
          We offer telephonic health coaching appointments!                 Danielle Wells, RN, CHWC
                                                                            Health Coach
                                                                            (970) 263-2639
                                                                            dwells@gjhosp.org

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Employee Assistance Program

 Help, when you need it most
 With your Employee Assistance Program and
 Work/Life Balance services, confidential assistance
 is as close as your phone or computer.

                                                                      Employee Assistance Program (EAP)
                                                                      Your EAP is designed to help you lead a happier and more productive life at home and at
 Always by your side                                                  work. Call for confidential access to a Licensed Professional Counselor* who can help you.
 • Expert support 24/7
 • Convenient website                                                       A Licensed Professional Counselor can help you with:
 • Short-term help                                                          • Stress, depression, anxiety                             • Family and parenting problems
 • Referrals for additional care                                            • Relationship issues, divorce                            • Anger, grief and loss
 • Monthly webinars                                                         • Job stress, work conflicts                              • And more
 • Medical Bill SaverTM
   —helps you save on medical bills
                                                                      Work/Life Balance
                                                                      You can also reach out to a specialist for help with balancing work and life issues. Just
 Who is covered?                                                      call and one of our Work/Life Specialists can answer your questions and help you find
 Unum’s EAP services                                                  resources in your community.
 are available to all
                                                                            Ask our Work/Life Specialists about:
 eligible employees, their spouses
                                                                            • Child care                     • Financial services, debt management, credit report issues
 or domestic partners, dependent
 children, parents and parents-in-law.                                      • Elder care                     • Even reducing your medical/dental bills!
                                                                            • Legal questions                • And more
                                                                            • Identity theft

                                                                      Help is easy to access:
                                                                      Online/phone support: Unlimited, confidential, 24/7.
                                                                      In-person: You can get up to 3 visits available at no additional cost to you with a
                                                                      Licensed Professional Counselor. Your counselor may refer you to resources in your
                                                                      community for ongoing support.

                                                                           Employee Assistance Program —Work/Life Balance

                                                                            Toll-free 24/7 access:                                                               Turn to us, when
                                                                            1-800-854-1446 (multi-lingual)                                                       you don’t know
                                                                            www.unum.com/lifebalance                                                             where to turn.

* The counselors must abide by federal regulations regarding duty to warn of harm to self or others. In   Services are not valid after coverage terminates. Please contact your Unum representative for details.
these instances, the consultant may be mandated to report a situation to the appropriate authority.       Insurance products are underwritten by the subsidiaries of Unum Group.
Unum’s Employee Assistance Program and Work/Life Balance services, provided by HealthAdvocate,            unum.com
are available with select Unum insurance offerings. Terms and availability of service are subject to      © 2018 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of
change. Service provider does not provide legal advice; please consult your attorney for guidance.        Unum Group and its insuring subsidiaries.
EN-2055 (5-18)             FOR EMPLOYEES
                                                                                                                                                                                                                   17
TRAVEL BENEFIT
  •      Call Anthem for pre-authorization of services/treatment by calling
         800-542-9402
  •      Travel Reimbursement related to travel to University of Utah for
         medical care.
                • Annual maximum benefit is $1,000
                • Eligible expenses are transportation, parking fees and tolls,
                    payable to the standard mileage rate per the IRS;
                • Lodging up to $150 per night
                • Inform Human Resources you are using this benefit when
                    your claim form is completed

  Retain travel receipts along with
  your Anthem Claim Form to HR:
  Attn: Brenda Moore or Shelley Vehik
  shelley.vehik@mesacounty.us
  brenda.moore@mesacounty.us

*This is a separate benefit from the Transplant Travel benefits provide under the Anthem benefits
explained in your Certificate of Insurance.
The above benefits are meant for illustrative purposes only and are only a brief look at your benefits. See your Certificate of Coverage for
details on benefits, network utilization, limitations and exclusions. In the event of a discrepancy the plan document will prevail.
Plan Documents are available via your Mesa Wave Portal. Printed documents are available upon request.                                 18
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                                                                                  19
Delta Dental PPO plus Premier
                                                               MESA COUNTY – Group # 12141
 MAXIMUM BENEFIT                                     $2,000 per member, per calendar year
 Calendar Year Maximum
 CALENDAR YEAR DEDUCTIBLE                            Individual Deductible – $50.00 Combination of in and out-of-network
 Applies to Basic and Major Services                 Family Deductible – $100.00 Combination of in and out-of-network
    PPO       PREMIER       NON-PAR
                                                  COVERED SERVICES                            BENEFIT INFORMATION (subject to Delta Dental guidelines)
  Dentist      Dentist       Dentist
 DIAGNOSTIC AND PREVENTIVE SERVICES
                                                                                Twice each in a calendar year. Two additional cleanings may be covered
                                         Oral Exams and Cleanings
                                                                                for those with a documented EBD condition.
                                                                                Once per tooth in a 36-month period for unrestored permanent
                                         Sealants
                                                                                molars, through age 14
                                         Bitewing X-Rays                        Once in a calendar year
  100%         100%          100%
                                         Full Mouth X-Rays                      Once in a 60-month period

                                         Fluoride                               Twice in a calendar year, through age 15
                                                                                One per quadrant, per lifetime to maintain space for eruption of
                                         Space Maintainers
                                                                                permanent posterior teeth, through age 13
 BASIC SERVICES
                                         Fillings (Composite or Amalgam)        Once per tooth in a 12-month period

                                         Simple Extractions
   80%          80%           80%
                                         Oral Surgery
                                         Endodontics

 MAJOR SERVICES
                                         Periodontics

                                         Crowns                                 Once per tooth in a 60-month period. Not a benefit under age 12.

   50%          50%           50%        Implants                               Once per tooth in a 60-month period. Not a benefit under age 16.

                                                                                Once in a 60-month period, only when existing prosthesis cannot be made
                                         Dentures, Bridges
                                                                                serviceable. Fixed bridges or removable partials are not a benefit under age
                                                                                16.
 ORTHODONTICS $2,000 lifetime maximum

   50%          50%           50%        For covered children to age 19

You are enrolled in a Delta Dental PPO plus Premier plan. You and your family members may visit any licensed dentist, but will enjoy the greatest out-of-
pocket savings if you see a Delta Dental PPO dentist. There are three levels of dentists to choose from.

PPO Dentist - Payment is based on the PPO dentist's allowable fee, or the actual fee charged, whichever is less.
Premier Dentist - Payment is based on the Premier Maximum Plan Allowance (MPA), or the fee actually charged, whichever is less.
Non-Participating Dentist - Payment is based on the non-participating Maximum Plan Allowance. Members are responsible for the difference between
the non-participating MPA and the full fee charged by the dentist. You will receive the best benefit by choosing a PPO dentist.

Open Enrollment applies. Members may add coverage once per year.

This is a brief description of services covered under your dental plan. Please refer to the Employee Benefit Booklet for full plan details. If differences
exist between this summary and the Employee Benefit Booklet, the Employee Benefit Booklet will govern.

                                                                                                                                                             20
A L O O K AT YO U R
  VSP VISION COVE R AGE

S E E H E A LT H Y A N D L I V E H A P P Y
WITH H E L P FROM MESA C O U N T Y
G O V E R N M E N T A N D VSP.

Enroll in VSP® Vision Care to get personalized care from a
VSP network doctor at low out-of-pocket costs.

VALUE A N D SAVINGS YOU LOVE.                                                               U s i n g your benefit is easy!
      Save on eyewear and eye care when you see a VSP network                               Create an account on v s p . c o m
      doctor. Plus, take advantage of Exclusive Member Extras                               to view your in-network
      for additional savings.                                                               coverage, find the VSP network
P R O V I D E R C H O I C E S Y O U WANT.                                                   doctor who’s right for you, and
           With an average of five VSP network doctors within six                           discover savings with exclusive
           miles of you, it’s easy to find a nearby in-network doctor                       member extras. At your
           or retail chain. Plus, maximize your coverage with bonus                         appointment, just tellthem you
           offers and additional savings that are exclusive to Premier                      have VSP.
           Program locations.
        Prefer to s h o p online? Use your vision benefits on
        Eyeconic®—the VSP preferred online retailer.
QUALITY VISION C A R E YOU NEED.
     You’ll get great care from a VSP network doctor, including
     a WellVision Exam®—a comprehensive exam designed to
     detect eye and health conditions.

                          G E T Y O U R P E R F E C T PA I R

  EXTRA $20 +                                                    UP
                                                                 TO   40%
               TO SPEND ON                                       SAVINGS ON L E N S
     F E AT U R E D FRAME BRANDS*                                 ENHANCEMENTS

      S E E MORE BRANDS AT V S P . C O M / OFF E R S .

                                                         Contact us: 8 0 0 . 877. 7195 or
                                                                    vsp.com

                                                                                                                                 21
22
VSP DISCOUNTS: EYE CARE & HEARING AIDS
 VSP Diabetic Eyecare Plus ®
 Available to Covered Persons who have been diagnosed with type 1 or type 2
 diabetes and specific ophthalmological conditions .The Program is intended
 to be a supplement to Covered Persons group medical plan. Providers will
 first submit a claim to Covered Persons group medical insurance plan, and
 then to VSP. Any amounts not paid by the medical plan will be considered for
 payment by VSP. Examples of symptoms which may result in a Covered
 Person seeking services under DEP Plus may include, but are not limited to:
 blurry vision, trouble focusing, transient loss of vision, “floating” spots.
 Examples of conditions which may require management under DEP Plus may
 include, but are not limited to: diabetic retinopathy, rubeosis, and diabetic
 macular edema.

TruHearing® is making hearing aids affordable by providing exclusive savings to all VSP® Vision Care members.
You can save up to $2,400 on a pair of hearing aids with TruHearing pricing. What’s more, your dependents
and even extended family members are eligible, too.

In addition to great pricing, TruHearing provides :      Plus, with TruHearing you’ll get:
• Three provider visits for fitting, adjustments, and    • Access to a national network of more than 4,500
   cleanings                                                licensed hearing aid professionals
• 45-day money back guarantee                            • Straightforward, nationally fixed pricing on a
• Three-year manufacturer’s warranty for repairs and        selection of more than 90 digital hearing aids in
   one-time loss and damage                                 400 styles
• 48 free batteries per hearing aid                      • Deep discounts on replacement batteries shipped
                                                            directly to your door

Best of all, if you already have a hearing aid benefit from your health plan or employer, you can combine it
with this program to maximize the benefit and reduce your out-of-pocket expense.

How it works
Call TruHearing. Call 877.396.7194. You and your family members must mention VSP.
Schedule exam. TruHearing will answer your questions and schedule a hearing exam with a local provider.
Attend appointment. The provider will make a recommendation, order the hearing aids through TruHearing
and fit them for you.

Learn more about this VSP Exclusive Member Extra at vsp.truhearing.com or, call 877.396.7194
with questions.

                                                                                                               23
Flexible Spending Account EnrollmentGuide

                                                   A health Flexible Spending Account (FSA) allows individuals to use pre-tax dollars to pay
                                                    for medical expenses not covered by insurance. A dependent care FSA, also known as a
                                                    Dependent Care Assistance Plan (DCAP) allows individuals to use pre-tax dollars for
W h a t is an FSA?                                daycare or dependent care expenses. The dependent care FSA (DCAP) cannot be used to
                                                    pay for medical expenses. Individuals elect to contribute a portion of their paychecks to
                                                             either a health FSA or dependent care FSA and save 25% to 40% in taxes.

 Know the Rules:
          Health (medical) FSA                         Health FSA and Dependent Care FSA                                           Dependent Care FSA
  Participants may claim and be paid out                Contributions are subject to the IRS “use-                     Participants may only be paid what they
  their entire annual election at any time.             it-or-lose-it” rule. However, for the health                   have contributed at any point in time.
                                                        FSA, your employer has adopted a provision
  Every expense must be substantiated.                  allowing up to a $500 carry         over of                    Participants must be ready to provide
  Participants must be able to provide                  unclaimed monies. Unclaimed monies not                         receipts for dependent care expenses.
  receipts, statements or bills for all                 carried over are forfeited at the end of the
  expenses if substantiation is requested.              plan year.
                                                                                                                       Dependent care expenses reimbursed by
  Documents must include the date, amount
  and description of the expense or service.            Elections cannot be changed during the                          the dependent care FSA may not be used
                                                        plan year, unless the participant has a                        to claim the day care credit.
                                                        change of status. IRS Regulations define a
  Only eligible expenses can be reimbursed.             change of status.
  Medical expenses are defined by IRS
  rules. Expenses generally include items               Expenses must be incurred by a
  and services for the diagnosis, cure,                 participant, spouse or eligible dependents
  mitigation, treatment, or prevention of               during the current plan year and while
  disease, or for the purpose of affecting              participating. Expenses are incurred when
  any structure or function of the body. See            the medical care is provided and not when
  IRS Publication 502.                                  the expense is billed, the bill is due or when
                                                        the bill ispaid.
  All over-the-counter drugs areeligible
  along with all menstrual care products.               Every employer sets the deadline when
                                                        claims and documentation must be
                                                        submitted after the end of the plan year. It
  Only “out-of-pocket” medical expenses                 is usually 60 or 90 days after the end of the
  are eligible for reimbursement. Medical               plan year.
  expenses covered by insurance or any
  other plan or program are not eligible for
  reimbursement.

  Expenses for personal use or
  cosmetic surgery are not eligible for
                                                                                             Tax Savings Examples:
  reimbursement. See IRS Publication 502.
                                                           Dave, a single taxpayer, earns $27,000/year and has eligible medical
  Medical expenses reimbursed under the                                          expenses of $1,200/year.
  health (medical) FSA may not be used to                  Dave's annual savings realized by participating in the FSA is $327 .
  claim a federal income tax deduction.

                                                            Michael and Sharon, working parents, earn a total of $48,000/year.
                                                             They have $5,000 in child care expenses and $1,000 per year in
                                                                                eligible medical expenses.
                                                            Their annual savings realized by participating in the FSA is $1,637 .

                                                                               Assumptions are based off of 15% Federal, 4.63% State, and 7.65% FICA tax
                                                                                                                                                               24

                        PO Box 631458 · Littleton, CO 80163 · (888) 722-1223 · fax (866) 557-0109 · https://www.RockyMountainReserve.com
Health Care Reform &
         EligibleExpenses                                                Over -the-Counter Items:

                                                                         Over-the-Counter Medicine and Drugs do not require a
                                                                         prescription to be eligible for reimbursement under the
                                                                         plan.

Common Eligible Medical Expenses:                                          Allergy medications
                                                                           Antacids
  Eyeglasses, eye exams, sunglasses                                        Anti-diarrhea medicine
  (prescription)                                                           Bug-bite medication
  Over-the-counter drugs                                                   Cold medicine
  Menstrual care products                                                  Cough drops and throat lozenges
  Eye surgery                                                              Diaper rash ointments
  Fertility enhancement                                                    Hemorrhoid medication
  HMO expenses                                                             Incontinence supplies
                                                                           Laxatives
  Hearing aids, batteries, and exams
  Hospital services                                                        Muscle/joint pain products/rubs
  Immunizations, vaccines, flu shots                                       Nicotine medications, gum,patch-es
  Laboratory fees                                                          Pain relievers
  LASIK eye surgery                                                        Sinus medications, nasal sprays, nasal strips
  Medicines (prescribed)                                                   Sleep aids
                                                                           Wart removal medication
  Obstetric services
  Optometrist
  Orthodontia                                     These are only examples and this list is not all-inclusive --
  Prescription drugs                                it only provides some of the more common expenses.
  Psychiatric care
                                                  Additional information is available in IRS Publication 502 and
  Psychologist
  Speech therapy                                     on our website: https://www.rockymountainreserve.com
  Stop smoking programs
  Surgery/operations
  Therapy                                                                Over-The-Counter Items:
  Vasectomy
  Wheelchair                                                               Band-aids/bandages
  X-rays                                                                   Cold/hot packs for injuries
Dual Purpose Expenses That Potentially Qualify:                            Condoms
                                                                           Contact lens solutions
The expense must be for a specific medical reason                          Diabetic supplies
and be accompanied by a prescription.                                      First aid kits
                                                                           Medical alert bracelets/necklaces
  Massage therapy                                                          Pregnancy test kits
  Vitamins                                                                 Thermometers
  Supplements
  Herbal supplements                                                     Dependent Care Eligible Expenses:
  Natural medicines
  Aromatherapy                                                             A dependent receiving care must be a child under
  Weight-loss program                                                      the age of 13, or a tax dependent unable to provide
  Health club dues                                                         for their own care, who resides with you. The care
                                                                           must be necessary for you or your spouse to be
Ineligible Expenses:                                                       gainfully employed or to go to school. Care may be
                                                                           provided by anyone other than your spouse or your
  Cosmetic surgery                                                         children under the age of 19. Expenses for schooling,
  Long term care                                                           kindergarten, over-night care, and nursing homes
  Hair transplant/re-growth                                                are not reimbursable. See IRS Publication 503.
  Maternity clothes                                                        The maximum you can elect, in a calendar year, is
  Nutritional supplements                                                  equal to the smallest of the following:
  Personal use items: such as toiletries,cotton                              $5,000 – Married and filing federal taxes jointly or
  swabs, toothbrush, toothpaste, facial care,                                a single parent
  shampoo                                                                    $2,500 – Married and filing separate federal tax
  Teeth whitening                                                            return
  Drunk drivingclasses                                                     The amount contributed year-to-date, is available
                                                                           for reimbursement.                                       25
Access to Your FSAMoney

                                                                  Access with a Debit Card
     Pay for Expenses w i t h a Deb it Card
                  Easy to use- the Benefits Card is a stored-value card that simplifies the process of paying for qualified expenses.
                  Restricted by merchant code (MCC) to healthcare-related merchants where MasterCard is accepted.
                  It pays directly at the point of sale - No waiting for reimbursement!
                  You can use it to pay for online mail-order prescriptions.
                  You must save all receipts and be prepared to provide receipts if they are requested.

    Save All Receipts For Purchases M a d e W i t h The Benefit Card
           Please r em em b er to keep receipts for all purchases made with th e Benefit Card. Per IRS regulations, Rocky M o u n tain Reserve
           may request itemized receipts to verify th e eligibility of purchases made with th e card.

                  All receipts or other proofs of purchase must include the date of service, name of provider, dollar amount, and a description of
                  the purchased service or product.
                  Any receipt that does not contain the detailed information described above is not acceptable. Credit card receipts and
                  canceled checks are not acceptable.
                  If the requested receipt is lost or otherwise unavailable, most providers can provide a detailed statement documenting FSA eligible
                  purchases. An Explanation of Benefits (EOB) is sufficient documentation to substantiate a transaction. Additional documentation
                  will be requested UNLESS the transaction matches a co-payment, a previously approved repetitive expense, or was at a merchant
                  that has installed the inventory information approval system referenced above.
                  If a receipt is requested, Rocky Mountain Reserve will email a request within hours. Participants can mail, fax, email, upload
                  the receipt online, or take a picture and submit it through the mobile app.

      N o Receipt Retailers

                  Some retailers have installed an inventory information approval system for most medical expenses and receipts will not be
                  requested. Below is a sample of some of the retailers who have installed the inventory information approval system:

                                1-800 Contacts                    Costco                            KingSoopers                      Safeway
                                Albertsons                        CVS                               Kroger                           Sam'sClub
                                City Market                       Drugstore.com                     Rite Aid                         Target

                             Submit Claims for Reimbursement
                                                                                     Submit Claims Through a Mobile Application
Take a picture of your receipt and submit it with your reimbursement request through the mobile application. You can also
   look up your account balance and recent transactions. Claims submitted through the mobile application receive high
   priority. To
                                                                        download the mobile application: Search for “RM R Benefits”

                                                                                                Submit Claims Through a W e b Portal
                                 Participants may file requests for reimbursement directly to Rocky Mountain Reserve through
                     https://www.rockymountainreserve.com . Claims submitted through the web portal receive high priority.

                                                                                                                  Submit Claims Manually
                                Participants may also file requests for reimbursement directly to RMR through fax, mail, or email.
             Fax: 866.557.0109                   E-mail: claims@rmrbenefits.com            Mail: PO Box 631458 Littleton, CO 80163
                                                                                                                                                     26
                                                       Claims are paid by direct deposit or check.
Online &MobileAccess
                                           www.rockymountainreserve.com

To Create Your Online Account:                                                  W i t h Online Access You Can:

  1                     Go to
              www.rockymountainreserve.com                                             Viewbalance
  2         Click on "Login/Register" in the top right-                                View transaction history
                           hand corner
                                                                                       Download statements
  3                                                                                    Submit claimsand upload
              Click on "Employee Registration"
                                                                                       receipts
 4       Username will be the name you use to log in for
             the web portal and mobile application.                                    View debit card receipt requests
 5       The password must contain at least 3 of these: special
                                                                                       and uploadreceipts
             character, number, upper or lower case letter

 6         For Employee ID Use SS# or other assigned
                         Employee ID.

  7        For Registration ID select “Card Number” which is your
            Benefits MasterCard. If you do not have a card, your
                  Employer will give you an Employer ID.

               Download the mobile application and gain real-time accessto your:
                                                   Flexible Spending Account (FSA)

                                      Search "RMR Benefits" on the app store                                                27

         PO Box 631458 · Littleton, CO 80163 · (888) 722-1223 · fax (866) 557-0109 · https://www.RockyMountainReserve.com
LIFE INSURANCE
Mesa County provides eligible employees (at no cost to the employee) Basic Life/AD&D coverage. All
regular full-time employees scheduled to work at least 20 hours each week in active employment in the
U.S. will be enrolled in the group Life/AD&D plan.

Life Insurance Amount
                                 $20,000

Reduction Schedule               Benefits are reduced to 65% at age 65; to 40% of the original amount at age 70,
                                 and to 25% of the original amount at age 75.

Accidental Death &
Dismemberment (AD&D)             Loss:                                       Amount of Additional Benefit Paid:
                                 Life                                        100%
Loss must occur while            One Limb                                    50%
insured and within 365 days      Speech & Hearing                            100%
after the accident is            Speech or Hearing                           50%
sustained                        Thumb & Index Finger of Same Hand           25%
                                 Quadriplegia                                100%
The total benefit paid for all   Paraplegia                                  75%
losses due to the same           Hemiplegia                                  50%
accident will not be more        Sight of One Eye                            50%
than 100%

                                 If you are certified as terminally ill with a life expectancy of 12 months or less, you
Accelerated Benefit
                                 may elect to receive a portion of your life insurance benefit up to 75% in advance.
                                 Upon death, your beneficiary will receive the balance of your benefit.
                                 Safe Driver Benefit (seatbelt & airbag)
                                 Dependent Education Benefit
                                 Child Care Benefit
Additional Benefits              Disappearance & Exposure
                                 Child Education
                                 Repatriation
                                 Portability

                                 $5,000 Spouse (no age reduction)
Basic Employee-Paid
                                 Child(ren) 14 days to 6 months - $1,000 / Age 19 or 26 if a full-time student -
Voluntary Dependent Life:        $2,500

*The above benefits are meant for illustrative purposes only and are only a brief look at your benefits. See your plan
document for details on benefits, limitations and exclusions. In the event of a discrepancy the plan document will prevail.
Certificate of Insurance is available via your Mesa Wave Portal. Printed documents are available upon request

                                                                                                                              28
Employer Paid Life/AD&D Insurance Continued...
Insured by Unum

                                Personalized financial counseling provides expert, objective financial counseling to
                                survivors and terminally ill employees at no cost. The financial consultants are
Life Planning Financial &
                                master level consultants that will not offer to sell any product or service. They will
Legal Resources
                                help develop strategies needed to protect resources, preserve current lifestyles,
                                and build future security.

                                If you become totally disabled for 6 months while insured, your life insurance will
Waiver of Premium               continue without payment to age 70 if the disability began prior to age 65. If total
                                disability ends, you may exercise the conversion privilege.

                                If your insurance terminates because you are no longer employed full-time, your
                                insurance may be converted to an individual life insurance policy if you apply and
Conversion
                                include payment of the first premium within 31 days of termination.
                                Conversion does not require proof of medical insurability.

                                To complement your Group Life Insurance coverage, you and your immediate
                                family have access to Emergency Travel Assistance administered by Assist America.
                                Emergency Travel Assistance offers you and your dependents worldwide medical,
                                travel, concierge and legal and financial assistance services, 24 hours a day, 365
                                days a year.

                                If you have a medical emergency while you are more than 100 miles away from
                                home, you don’t have to face it alone. With one phone call you can be connected
                                to Assist America’s staff of medically trained, multilingual professionals who can
                                advise you in a medical emergency, 24x7. No matter where you are in the world,
                                they will help you access or receive:
Travel Assistance Benefits
                                Pre-qualified, English-speaking professionals working in hospitals, pharmacies, and
                                dental offices; Medical consultation, evaluation and referral; Hospital admission,
                                critical care monitoring, emergency medical evacuation, transportation to return
                                home or to a rehabilitation facility, lost prescription assistance, legal and
                                interpreter services, and more.

                                Assist America pays for 100% of the services it arranges for and provides.

                                Your spouse and dependent children up to age 19 are also covered.

This is just a summary of your benefits. Please refer to your certificate booklet for a complete plan description. If
the terms of this summary differ from the Certificate, the Certificate will govern.

                                                                                                                         29
Voluntary Life and AD&D Insurance

                                 Employee: Up to 5 times earnings in increments of $10,000. Not to exceed $400,000.
                                 Spouse: Up to 100% of employee amount or $200,000, in increments of $5,000.
Coverage Amounts
(Term Life and AD&D)             Children: $10,000 of coverage if eligible. Maximum death benefit for a child between the ages
                                 of live birth and 6 months is $1,000.

Reduction Schedule
                                 Benefits are reduced to 65% at age 70, and to 50% of the original amount at age 75

                                 $200,000 for yourself and any amount of coverage up to $30,000 for your spouse.
Guarantee Issue                  Any Life insurance coverage over the Guarantee Issue amount(s) will be subject to
                                 evidence of insurability.

                                 Loss:                                   Amount of Benefit Paid:
Accidental Death &               Life                                    100%
Dismemberment (AD&D)             Both Hands                              100%
                                 Both Feet                               100%
                                 Sight of Both Eyes                      100%
The total benefit paid for all   One Hand & Sight of One Eye             100%
losses due to the same           One Foot & Sight of One Eye             100%
accident will not be more        Speech & Hearing                        100%
than 100%
                                 Other losses may be covered.

                                 Education Benefit: If you or your insured spouse die within 365 days of an accident,
                                 an additional benefit is paid to your dependent child(ren). Your child(ren) must be a
Additional AD&D                  full-time student beyond grade 12.
Benefits                         Seat Belt/Air Bag Benefit: If you or your insured dependent(s) die in a car accident and
                                 are wearing a properly fastened seat belt and/or are in a seat with an air bag, an
                                 amount will be paid in addition to the AD&D benefit.

*The above benefits are meant for illustrative purposes only and are only a brief look at your benefits. See your plan
document for details on benefits, limitations and exclusions. In the event of a discrepancy the plan document will prevail.
Certificate of Insurance is available via your Mesa Wave Portal. Printed documents are available upon request.

                                                                                                                                 30
Voluntary Life and AD&D Insurance Continued...
Insured by Unum

Each year you will be given the opportunity to change your Life and AD&D coverage, and may purchase additional life
insurance up to the guarantee issue amounts without evidence of insurability as long as you are already enrolled in the plan
(even at a minimum of $10,000).

If you waived coverage when you were first eligible and want to apply at a later date, all amounts are subject to evidence of
insurability – there is no guarantee issue available.

                                  If you become terminally ill and are not expected to live beyond a certain time
                                  period as stated in your certificate booklet, you may request up to 75% of your life
Accelerated Benefit               insurance amount up to $250,000, without fees or present value adjustments. A
                                  doctor must certify your condition in order to qualify for this benefit. Upon your
                                  death, the remaining benefit will be paid to your designated beneficiary(ies).

                                  Personalized financial counseling provides expert, objective financial counseling to survivors
                                  and terminally ill employees at no cost. The financial consultants are master level
                                  consultants that will not offer to sell any product or service. They will help develop
Life Planning Financial &
                                  strategies needed to protect resources, preserve current lifestyles, and build future
Legal Resources                   security.

                                  If you become disabled (as defined by your plan) and are no longer able to work, your
                                  premium payments may be waived during the period of disability.
Waiver of Premium

                                   If you retire, reduce your hours or leave your employer, you can take this coverage with
                                  you according to the terms outlined in the contract. However, if you have a medical
                                  condition which has a material effect on life expectancy, you will be ineligible to port your
Portability/Conversion            coverage. You may also have the option to convert your Term life coverage to an individual
                                  life insurance policy.

                                  Life benefits will not be paid for deaths caused by suicide in the first twenty-four
                                  months after your effective date of coverage.
Suicide Exclusion

This is just a summary of your benefits. Please refer to your certificate booklet for your complete plan description.
If the terms of this summary differ from the Certificate, the Certificate will govern.

                                                                                                                                   31
LONG-TERM DISABILITY INSURANCE

Monthly Benefit           60% of monthly earnings to a maximum benefit of $6,000, reduced by other income

Elimination Period        Benefits will begin after 180 days of disability
Benefit Duration          Your duration of benefits is based on your age when the disability occurs. Your LTD benefits are payable for
                          the period during which you continue to meet the definition of disability up to the Social Security Normal
                          Retirement Age. If your disability occurs on or after age 62, benefits would be paid for a reduced period of
                          time.
Disability Definition     You are disabled when Unum determines that:
                           • you are limited from performing the material and substantial duties of your regular occupation due to
                             your sickness or injury; and
                           • you have a 20% or more loss in weekly earnings due to the same sickness or injury.
                           • After benefits have been paid for 24 months, you are disabled when Unum determines that due to the
                             same sickness or injury, you are unable to perform the duties of any gainful occupation for which you
                             are reasonably fitted by education, training or experience.
                          You must be under the regular care of a physician in order to be considered disabled.
Gainful Occupation        Gainful occupation means an occupation that is or can be expected to provide you with an income within
                          12 months of your return to work that exceeds:
                            • 80% of your indexed monthly earnings, if you are working
                            • 60% of your indexed monthly earnings, if you are not working
Pre-Existing Conditions   If you received treatment 3 months prior to your effective date under this plan and are disabled from that
                          condition within the first 12 months, that disability will be excluded.
Rehabilitation and        Unum has a vocational Rehabilitation and Return to Work Assistance program available to assist you in
Return to Work            returning to work. We will make the final determination of your eligibility for participation in the program
Assistance                and will provide you with a written Rehabilitation and Return to Work Assistance plan developed
                          specifically for you. This program may include, but is not limited to the following benefits:
                            • coordination with your Employer to assist your return to work;
                            • adaptive equipment or job accommodations to allow you to work;
                            • vocational evaluation to determine how your disability may impact your employment options;
                            • job placement services;
                            • resume preparation;
                            • job seeking skills training; or
                            • education and retraining expenses for a new occupation.
                          If you are participating in a Rehabilitation and Return to Work Assistance program, we will also pay an
                          additional disability benefit of 10% of your gross disability payment to a maximum of $1,000 per month. In
                          addition, we will make monthly payments to you for 3 months following the date your disability ends, if we
                          determine you are no longer disabled while:
                            • you are participating in a Rehabilitation and Return to Work Assistance program; and
                            • you are not able to find employment.

Survivor Benefit          If you die after receiving benefits for 180 or more consecutive days, your eligible survivors will receive a
                          lump sum benefit equal to three months of your gross disability payment.

 This is just a summary of your benefit. Please refer to your certificate booklet for your complete plan description. If
 the terms of this summary differ from your Certificate, the Certificate will govern.

                                                                                                                                         32
ADDITIONAL VOLUNTARY BENEFITS
Aflac Group Accident Insurance                  Introducing added protection for life’s unexpected moments.
                                                If you’re like most people, you don’t budget for life’s
                                                unexpected moments. But at some point, you may make an
                                                unexpected trip to your local emergency room. And
                                                that could add a set of unexpected bills into the mix.
                                                That’s the benefit of the Aflac group Accident Advantage Plus
                                                plan.

                                                In the event of a covered accident, the plan pays cash
                                                benefits fast to help with the costs associated with out-of-
                                                pocket expenses and bills—expenses major medical may
                                                not take care of, including:
                                                • Ambulance rides.
                                                • Wheelchairs, crutches, and other medical appliances.
                                                • Emergency room visits.
                                                • Surgery and anesthesia.
                                                • Bandages, stitches, and casts.

Aflac Group Critical Illness Insurance          You can win the battle against a critical illness, but can you
                                                handle the added costs? A group critical illness plan helps
                                                prepare you for the added costs of battling a specific critical
                                                illness. The good news is that many people with a critical
                                                illness survive these life-threatening battles. Unfortunately,
                                                as the recovery process begins, people become aware of the
                                                medical bills that have piled up. Your recovery doesn’t have
                                                to be spoiled by medical bills. With this plan, our goal is to
                                                help you and your family cope with and recover from the
                                                financial stress of surviving a critical illness.

Aflac Hospital Indemnity Insurance              The average cost of a hospital stay is $10,000-and the
                                                average length of a stay is 4.8 days. Hospital indemnity
                                                insurance can help reduce costs by paying you or a covered
                                                dependent a benefit to help cover your deductible,
                                                coinsurance and other out-of-pocket costs due to a covered
                                                sickness or injury related hospitalization.

Legal Shield Legal Plan                         Imagine having access to top-rated legal professionals,
                                                without worrying about high hourly costs.
                                                • Protect your family
                                                • Save money and time
                                                • Enjoy peace of mind… for pennies a day!
                                                Preventive Law – Unlimited phone calls, letters and phone
                                                calls on your behalf, legal contract and document review, will
                                                preparation and annual updates, access to legal forms.
                                                Trial Defense – Defense of civil actions, pre-trial and trial
                                                assistance, coverage increases each year for the first 5 years.
                                                Family services, motor vehicle, IRS audit services, 25%
                                                member discount for services not covered on this plan.

This benefit summary was provided by Mesa County and Novo Benefits is not responsible for any discrepancies.      33
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