Plan Year 2021 - Lafayette, CO
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Plan Year 2021 1
INTRODUCTION The City of Lafayette Benefit Program is designed to give you flexibility and choice, allowing you to personalize your benefit program to best suit your needs and the needs of your dependents. Reminder: Dependent coverage was extended to age 26 for both the Medical & Dental plans (in 2011) – regardless of the dependent’s marital status, financial dependence, student status or employment status. The following benefit program is for all City of Lafayette eligible employees. 1
TABLE OF CONTENTS Medical Coverage ............................................................................................................................. 5 Dental Coverage ............................................................................................................................... 9 Vision Coverage ............................................................................................................................. 12 Flexible Spending Accounts ............................................................................................................ 14 Life and Accidental Death & Dismemberment ............................................................................... 18 Long-Term and Short-Term Disability ............................................................................................ 19 Employee Assistance Program ....................................................................................................... 21 Travel and ID Theft Assistance ....................................................................................................... 22 Legal Assistance.............................................................................................................................. 23 Wealth Building .............................................................................................................................. 24 Rates ............................................................................................................................................... 26 Contact Information ....................................................................................................................... 29 Terms and Definitions .................................................................................................................... 32 2
ELIGIBILITY
Full-Time Employees
Employees in positions designated as full-time who work a minimum of 40 hours per week are eligible for all full-time
benefits. Additionally, employees who work at least 1,560 hours per year are eligible for health insurance.
Part-Time Employees
Employees working in those positions classified as Regular Part-Time are considered Part-Time Employees. Regular Part
‐Time Employees may access the health insurance plan at their own cost. No classification of part-time employee is eli-
gible for dental, vision, life, LTD, STD, voluntary life, or AD&D benefits.
Employee Status
Full-Time Part-Time
Medical Eligible 1st of month Following 30 days
Dental
Voluntary Vision
Group Life/AD&D
Eligible 1st of month Not Eligible
Long-Term Disability Following 30 days of service
Voluntary Short-Term Disability
Voluntary Life/AD&D
Must be eligible for city health insurance to
FSA
participate
Retirement Plan 401a (ICMA-RC) Eligible 1st day of employment Not Eligible
Eligible 1st of month following 30 days of Eligible 1st day of employment
Deferred Compensation Plan (ICMA-RC)
service
Sworn Fire and Police Not Eligible
Fire and Police Pension Assoc. (FPPA) personnel only. Eligible 1st day of employment
ELIGIBLE DEPENDENTS FOR MEDICAL, DENTAL & VISION
Many of the benefit plans also offer coverage for eligible dependents. Eligible dependents include:
• Your common law spouse;
• Your legal spouse, if not legally separated;
• Your child, through the end of the month in which they reach age 26. This includes:
– Your natural child;
– Your stepchild;
– An adopted child.
• Your dependent unmarried child of any age who becomes totally disabled before reaching the age limit for
eligibility;
• Your child, for whom a Qualified Medical Child Support Order (QMCSO) has been issued.
Note: It is your responsibility to notify Human Resources within 30 days of the qualifying event. Failure to do so may
result in a loss of premiums paid for the dependent and/or financial responsibility for any claims incurred after the
dependent became ineligible.
3
COVERAGE LEVELS You must be enrolled in order to enroll your dependents. You may choose a different coverage level for Medical, Dental and/or Vision. The coverage categories are: • Employee only, • Employee and spouse, • Employee and child(ren), • Family, or • Waived coverage. WHEN IS MY COVERAGE EFFECTIVE? If you enroll during the annual enrollment period, the coverage you select will be effective January 1, 2021 provided you have met the eligibility requirements. WHAT IF I CHOOSE NOT TO ENROLL NOW OR MISS THE OPEN ENROLLMENT PERIOD? If you choose not to enroll during open enrollment or your eligibility period, you will be required to wait until the next annual open enrollment unless you have a qualifying change of status as described below. Qualifying Event: HIPAA Special Enrollment Rights/Change of Status for Which You May Make Changes to Your Elections You may only enroll, add family members, or cancel your elections during the annual enrollment period, or within 31 days of experiencing a qualifying life status change, including: • Marriage, death of spouse, divorce or legal separation. • Birth, adoption, placement for adoption or death of a dependent. • Termination or commencement of employment for you, spouse, or dependent. • Relocation or increase in hours of employment by you or your spouse. • Your dependent child satisfies or ceases to satisfy the requirements for coverage because of age. • A change in the place of residence or work for you, your spouse, or dependent. • You or your spouse experiences an open enrollment event. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, you may qualify for a Special Enrollment Opportunity. You must request coverage within 60 days of being determined eligible for premium assistance. If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 31 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage). Sortis Financial may request documentation regarding termination of or change in contributions for the other coverage. 4
medical
Medical Coverage
You may enroll in the HMO Plan 420P administered by Kaiser Permanente. This plan requires members to see Kaiser
Physicians exclusively.
Employees are required to enroll in the plan offered by the City; however, this requirement does not apply if the
employee is covered under another health insurance plan. Proof of paid premiums for other coverage is required,
should the employee choose not to enroll in the City plan.
HEALTH ENROLLMENT TIPS
To choose a coverage level and supplemental benefits that are best for you and your family, consider your choices and
your prior and expected future medical needs:
• What were your expenses this year?
• Do you expect your medical expenses to increase next year in anticipation of surgery, chronic conditions, or
childbirth?
• How much are you willing to spend in premiums?
• How much can you afford to pay out-of-pocket for medical expenses?
6KAISER HMO PLAN 420P
Services In-Network Only
Deductible
Individual No Deductible
Family No Deductible
Out of Pocket Maximum
Individual $2,000
Family $4,500
Preventive Care
Children’s Services $10 copay/visit
Adult’s Services $10 copay/visit
Physician Services
Routine Medical Office Visits $20 copay/visit
Specialist Office Visit $35 copay/visit
Diagnostic Lab/X-Ray Plan pays 100%
Therapeutic X-Ray $35 copay/visit
Imaging (CT/PET Scans, MRIs) $150 copay/procedure
Maternity
Prenatal Care $0 copay/visit
Delivery & Inpatient Well Baby Care $750 copay/admission
Hospital Facility Services
Inpatient $750 copay/admission
Outpatient $150 copay/visit
Emergency Services
Emergency Room $100 copay/visit, waived if admitted
Urgent Care $100 copay/visit at ER
$50 copay/visit at UC
Ambulance 20% coinsurance up to a max of $500/trip
Prescription Drugs - Level of Coverage and Restrictions on Prescriptions
Retail Generic Drugs $15 copay
Retail Preferred Brand Drugs $30 copay
Mail Order (90-day supply) 2x retail copay
Specialty Drugs 20% coinsurance to a max of $250/drug
Other Mental Health Care
Inpatient $750 copay/admission
7Services In-Network Only
Alcohol & Substance Abuse
Inpatient $750 copay/admission
Outpatient $20 copay/visit
Physical, Occupational & Speech Therapy
Inpatient $750 copay/admission
Outpatient $20 copay/visit
Durable Medical Equipment Play pays 80%; limited to $2,000 maximum/
calendar year
Oxygen Plan pays 80%
Organ Transplants $750 copay/admission
Home Health Care Plan pays 100%
(for prescribed medically necessary part-time
home health services; Not covered outside the
Service Area)
Hospice Care Plan pays 100%
Not covered outside the Service Area
Skilled Nursing Facility Care Plan pays 100%
(for up to 100 days per calendar year for prescribed skilled nursing facility Not covered outside
services at approved skilled nursing facilities) the Service Area
Dental Care Not Covered
Vision Care $20 copay/visit; no hardware
Chiropractic Care Not Covered
Significant Additional Covered Services See Colorado Health Benefit Plan
Description Form
Check out these new and expanded services from Kaiser Permanente!
• Expanded primary and pediatric care hours to 7 a.m.—7 p.m., Monday through Friday, and 8 a.m.—noon on Saturdays
• Same day/next day prescription drug delivery
• Added more behavioral medicine specialists and expanded network of affiliated providers for increased access to
mental health and wellness services
• Contracted with DispatchHealth to provide in-home urgent care services in the Denver Metro Area
• 24/7 on-demand phone and video provider visits available to members
• Chat with a Doctor service hours extended to 6 a.m.—10 p.m., 7 days/week
• Partnered with Rally Health to develop Total Health Assessment tool that helps you reach health goals through
personalized summary and action plan
• The myStrength app is available at no cost to all members—provides personalized, interactive well-being activities
• The “Calm” app is now available to help members lower stress and reduce anxiety through meditation, mental
resilience, and sleep
8dental
DENTAL COVERAGE
Taking care of your teeth is an important part of your overall health. The City of Lafayette offers you and your eligible
dependents comprehensive dental coverage and services through Delta Dental of Colorado. There are two PPO plans
being offered with Delta Dental of Colorado:
• Base Plan PPO – This plan is replacing the EPO that was offered in the past. You must utilize Delta Dental PPO
dentists. This plan offers a lower annual benefit maximum with lower premiums. There is no out-of-network
coverage on this plan,
• Buy-Up Plan PPO – you must utilize Delta Dental PPO Premier dentists. While “Premier” dentists are considered in-
network, you will get the best benefit by seeing a “PPO” provider. This plan offers a higher annual benefit
maximum and includes both in– and out-of-network coverage.
Please refer to the Dental Benefits-At-A-Glance to review plan coverage.
HOW YOU CAN SAVE MONEY BY CHOOSING NETWORK DENTISTS
Through Delta Dental, you are provided with a network of dentists. Costs are generally lower when you use a network
dentist; however, you may go to any dentist you choose, in or out-of-network (only on the Buy-Up plan). Network
dentists have agreed to special rates for Delta Dental participants. If your PPO network dentist charges more for a
covered service, you will not be billed for the balance. However, if you see a Premier provider, they may balance bill
you, although it will still be a better benefit than going entirely out-of-network.
As an example: if the amount agreed upon through Delta Dental is $50 for a filling and your dentist normally charges
$60, you will not be responsible for the $10 difference if your dentist is in the Delta Dental PPO Network.
If your dentist is not in the Delta Dental network, he/she can bill you for the difference, which you will then be
obligated to pay. Your Explanation of Benefits (EOB) will explain the amount that is covered and how much you are
required to pay.
10DELTA DENTAL OF COLORADO
BASE PLAN BUY-UP PLAN BUY-UP PLAN
Services Delta Dental PPO Only Delta Dental PPO+Premier Delta Dental PPO+Premier
[In-Network Benefits Only] [In-Network] [Out-of-Network]
Deductible
Individual No deductible $50 $50
Family $150 $150
Preventive Services
100%, no deductible 100%, no deductible 100%, no deductible
(Routine exam, X-Rays)
Basic Services
50% after deductible 100% after deductible 80% after deductible
(Fillings, Extractions)
Major Services
50% after deductible 50% after deductible 50% after deductible
(Oral Surgery, Crowns, Root Canals)
Orthodontic Services
50%, no deductible 50%, no deductible 50%, no deductible
(Adult & Child)
Calendar Year Maximum Per Person $1,000 $1,500 $1,500
Orthodontic Lifetime Maximum $1,500 $1,500 $1,500
Periodontal & Endodontic Services Covered Basic Services Basic Services Basic Services
Under:
Dental insurance is often seen as unnecessary or a “luxury” item, when in reality, it’s just as important as your medical coverage.
People who see the dentist regularly have better dental outcomes.
11vision
VISION COVERAGE
City of Lafayette offers you and your eligible dependents vision coverage through VSP Vision Care. VSP includes a
network of participating eye care providers. Like the medical and dental benefits, you receive the maximum benefits
under the plan and pay less out of your pocket when you seek care from a network provider. You do have the option to
seek care out-of-network, but you will pay more out of your pocket for those services.
VSP VISION CARE
Services In-Network Out-Of-Network
Eye Exam
$20 Copay Reimburse up to $50
(once every 12 months)
Lenses
(once every 12 months)
Single Reimburse up to $50
Lined bifocal Reimburse up to $75
Lined trifocal Reimburse up to $100
Covered at 100%
Lenticular Reimburse up to $125
Standard progressive Reimburse up to $75
Anti-reflective coating No Coverage
Frames Up to a $130 retail allowance and 20% off
Reimburse up to $70
(once every 24 months) the cost difference
Contact Lenses $130 allowance; 15% off fitting and
Reimburse up to $105
(in lieu of lenses/frames) evaluation exam
Medically necessary
Plan pays 100% Reimburse up to $210
(every 12 months)
Elective Up to a $130 allowance Reimburse up to $105
13finances
FLEXIBLE SPENDING ACCOUNTS SAVE MONEY WITH A FSA Flexible Spending Accounts are like personal bank accounts in which you set aside a predetermined amount of your bi- weekly pay, before taxes, to cover certain expenses. If you know you will have to pay certain medical and dental deductibles, co-pays, commuting expenses or child care expenses, why not use Flex Spending Accounts to pay for these expenses with before-tax dollars? Just remember to budget carefully! Employees are able to contribute up to $2,750* per year in their health care flex spending account. There is a $5,000 annual limit for the dependent care flex spending account. In return for the tax savings, the IRS has set some strict rules around FSAs: Rule 1 – Use it or lose it Any money left in your FSA at the close of the plan year must be forfeited. You may also forfeit money in your account when your participation in your FSA ends. If your employment terminates, you may be eligible to choose to continue participation in your health care FSA under COBRA. Rule 2 – Separate plans Your FSA can only be used for specific expenses as determined by the IRS. If you have money left in your dependent care account, it cannot be used to pay for health care expenses. Likewise, any money left in health care cannot be used for dependent care expenses. Rule 3 – Irrevocability You cannot change the amount you contribute to the Health Care FSA and Dependent Care FSA until the next open enrollment, unless you experience a Qualified Life Event. THIS IS HOW YOU SAVE The FSA Plan lets you turn part of your pay into tax-free dollars to pay for eligible health care or dependent care expenses you incur during the Plan Year. Because FSA contributions and eligible spending withdrawals are not taxed, participating in the FSA decreases your taxable income while increasing your spending money for qualified expenses. *Pending IRS approval for 2021, subject to change 15
In the example below, this employee is married, has one child, earns $1,000 per paycheck and claims three exemptions
on their W-4.
Example without FSA Example with FSA
Gross Income $1,000.00 Gross Income $1,000.00
Health Ins. $125.00 Expenses per month
Childcare $200.00
Health Ins. $125.00
Health Expenses $25.00
New Taxable Income $875.00 New Taxable Income $650.00
Medicare Tax $9.43
Federal Tax $12.09
State Tax $6.50
Social Security Tax $40.30
Expenses per Month
Childcare $200.00
Health Expenses $25.00
Medicare Tax $12.69
Federal Tax $16.35
Social Security Tax $54.25
State Tax $9.00
Spendable Income $557.71 Spendable Income $581.68
Increased take home per paycheck: $23.97
To participate, you elect to have a portion of your pay deposited in a Health Care FSA and/or Dependent Care FSA. As
you incur eligible health care or dependent care expenses, you may submit claims for reimbursement from the
appropriate FSA to pay yourself back with pre-tax dollars. You may also use the debit card as described on the next
page.
16THE FSA DEBIT CARD
When you enroll in the Health Care Spending, Dependent Care or Transportation Account you will receive a debit card.
The card is a signature-based debit card that allows you to directly access flexible spending account funds. There is no
personal identification number (PIN) associated with the card so it cannot be used at ATM machines.
Benefits to You:
• Improved cash flow • Payment is made at the point of service directly from
• Your spouse may also receive a card your Flexible Spending Account, no need to file a claim
• Convenience for services
• You incur no out-of-pocket expenses at the time of
service or payment for over-the-counter medicines and
drugs
How it Works:
You present your card as payment when purchasing eligible medical expenses. The card is swiped by the provider,
sending the date, dollar amount and provider name to WageWorks.
IRS Regulations:
• The debit card is only to be used to pay for eligible • Food, personal use or cosmetic items are not eligible
IRS expenses. expenses and cannot be purchased using the debit
• The expense must be medically necessary and meet card.
the requirements for eligible expenses for the • Debit Cards may be used for dependent care expenses
Flexible Spending Account. if the provider accepts electronic payment from
MasterCard.
Documentation Requests:
Sometimes our administrator, WageWorks, requires additional information about a debit card expense to comply with
IRS regulations, so please hold on to all of your receipts. Our administrator will send you a request for documentation,
if required. You do not need to send in any additional documentation unless contacted by our administrator.
17HEALTH CARE FSA
What is a Health Care FSA?
You can use a Health Care FSA to reimburse yourself for eligible health care expenses that you incur for yourself and
your dependents.
• Claims deadline: Claims must be submitted by March 31st of the following year.
• Grace period: Employees may incur health and dependent care expenses through March 15th of the next year,
using the FSA grace period. Any expenses incurred through that point will be applied to the previous year, as long
as claims are submitted by March 31st.
UPDATES TO ELIGIBLE EXPENSES
Over-the-counter medications (no prescription needed) and menstrual products are now considered an eligible expense
for which you can use FSA dollars to purchase.
You may review the current listing of eligible and ineligible health care expenses by reviewing IRS Publications 502,
Medical and Dental Expenses, available online at http://www.irs.gov/pub/irs-pdf/p502.pdf.
Tip: Visit www.fsastore.com to view thousands of FSA-eligible over-the-counter products.
DEPENDENT CARE FSA
What is a Dependent Care FSA?
You can use a Dependent Care FSA to pay for eligible dependent care expenses (such as daycare) for your dependents
under age 13 or for an older disabled family member while you are working. If you are married, your spouse must be
working, looking for work, attending school full-time or be disabled.
You may review the current listing of eligible and ineligible health care expenses by reviewing IRS Publications 503,
Child and Dependent Care Expenses, available online at http://www.irs.gov/pub/irs-pdf/p503.pdf.
TRANSPORTATION FSA
What is a Transportation FSA?
Individuals who sign up for this plan will set aside pretax dollars to pay for work related transportation expenses.
• Participants will be issued a debit card (their medical spending or dependent care card serves triple duty).
• The debit card can be used to purchase RTD passes or punch cards online.
• Participants can use their debit card in a parking garage or for other parking services for their work related parking
expenses.
• Participants can only use the available balance in their account.
• An annual financial commitment is not required.
• Participants are allowed to make changes to their payroll deductions quarterly.
• Excess funds may be “rolled over” to the next plan year.
If members choose not to use the debit card, they can submit reimbursement requests for transportation expenses via
the WageWorks system. The IRS does not require a receipt.
You may review the current listing of Transportation expenses by reviewing IRS Publication 15-B, Fringe Benefits,
available online at http://www.irs.gov/pub/irs-pdf/p15b.pdf
18INCOME SECURITY
An important part of the benefit program offered to you by City of Lafayette is protection against loss of income
from unexpected occurrences. The City offers a variety of life insurance programs for eligible employees, along with
a comprehensive disability plan. The City offers this coverage through The Hartford.
EMPLOYER PAID EMPLOYEE TERM LIFE/AD&D
The City provides life insurance at 1x Annual Salary to a Maximum of $150,000 for all full-time employees. This
coverage includes Accidental Death and Dismemberment (AD&D) coverage equal to the amount of life insurance.
VOLUNTARY EMPLOYEE & FAMILY TERM LIFE/AD&D
Loss of a family member can place a significant financial burden on the rest of the family. That is why the protection
provided by Life and AD&D insurance is so important. When you enroll yourself and/or your dependents in this
benefit, you pay the full cost through payroll deductions.
During open enrollment you have the option to increase or decrease your coverage. Please request the change form
from your Human Resources Department. Coverage effective date is the date the employee completes all
underwriting requirements required by the company.
Coverage Options
Employee Spouse Child(ren)*
Insurance Amounts $10,000 increments $5,000 increments $1,000 increments
Guarantee Issue max for new hires
only ** Under age 70 $100,000; $30,000; spouses age 60+ are
$10,000
(Amount issued with no medical age 70-74 $20,000 not eligible for Guarantee Issue
questionnaire)
2.5 times the employees
$10,000
$300,000 annual salary.
Overall benefit maximum Cannot exceed spouse
Not to exceed 5x salary Cannot exceed 50% of the
amount
employees combined benefit
AD&D Benefit amount is the same as Life option
Employee Contribution 100% 100% 100%
* Child(ren)’s Eligibility: Dependent children from live birth to age 26 are eligible for coverage.
** Employees are able to increase coverage by $20,000 each open enrollment period with no medical questions asked until the
requested increase amount results in coverage above the guarantee amount; then a medical questionnaire will be required.
If you are electing coverage above the guarantee issue amounts noted, an Evidence of Insurability form (medical
questionnaire) must be completed by each applicant and submitted to Human Resources who will forward it to
Lincoln for approval. Coverage elected over the guarantee issue amount will not be established until approved by
the carrier.
19EMPLOYER PAID LONG-TERM DISABILITY
The City also provides your with Long-Term Disability insurance at no cost to you. You will be automatically enrolled
in this benefit. It is anticipated that employees will accrue and maintain a balance of sick leave to cover the two-
month period prior to receiving benefits under this plan. The policy benefit period extends to age 65 under certain
circumstances.
VOLUNTARY SHORT-TERM DISABILITY
Employees may purchase Short Term Disability insurance on a payroll deduction basis. This plan does have a pre-existing clause
(see benefit provisions). Partial disability is also included.
Long- and Short–Term Disability At-A-Glance
Plan Feature Short-Term Disability Long-Term Disability
Benefits begin on the 8th day for both accident
Elimination Period Benefits begin on the 61st day of disability
and illness.
Benefit 60% of pre-disability weekly earnings 60% of pre-disability monthly earnings
Maximum Benefit $1,000/week $6,000/month
Minimum Benefit $50 or 15% $100 or 10% of monthly earnings
Benefit Duration 8 weeks Up to Social Security Natural Retirement Age
Rates See table below N/A - Paid on your behalf by the City
20supplementary
EMPLOYEE ASSISTANCE PROGRAM
GETTING SUPPORT SHOULD BE EASY.
Most of us have to face change, stress or a life-altering problem at some point. Your company sponsored Employee Assistance Program is
designed to provide counseling services, work-life assistance, legal and financial guidance to help handle concerns constructively, before they
become major issues. The service is confidential and provided at no charge to you and your dependents.
COMPASSIONATE SOLUTIONS FOR COMMON CHALLENGES.
From the everyday issues like job pressures, relationships, retirement planning or personal impact of grief, loss, or a disability, Guidance
Resources can be your resource for professional support. You and your family, including spouse and dependents, can access Guidance
Resources; including five (5) face to face visits per year at no cost. You also have access to three (3) face to face visits through Ability Assist.
Guidance Resources
Confidential Counseling This no-cost counseling service helps address stress, relationship and other personal issues you and your
dependents may face. It is staffed by GuidanceConsultants℠—highly trained master’s level clinicians
who will listen to your concerns and refer you to in-person counseling and other resources for:
• Job pressures • Work/school disagreements
• Relationship/marital conflicts • Substance abuse
• Stress, anxiety and depression • Child and elder care referral services
Financial Information and Speak by phone with their Certified Public Accountants and Certified Financial Planners about a wide
Resources range of financial issues, including:
• Managing a budget • Tax questions
• Retirement • Saving for college
• Getting out of debt • Estate planning
Legal Support and Resources Talk to their attorneys by phone. If you require representation, they’ll refer you to a qualified attorney
in your area for a free 30-minute consultation with a 25% reduction in customary legal fees thereafter.
• Debt and bankruptcy • Power of attorney
• Guardianship • Divorce and family law
• Buying a home • Landlord/tenant issues
• Contracts
Work-Life Solutions Their Work-Life specialists will do the research for you, providing qualified referrals and customized
resources for:
• Child and elder care • Pet care
• College planning • Making major purchases
• Moving and relocation • Home repair
Health Care Navigation Employees covered under The Hartford’s disability insurance also have access to HealthChampion℠. This
program provides confidential support for issues such as:
• Explanation of health plan coverage
• Understanding diagnosis and treatment options
• Claims review and fee negotiation
GUIDANCERESOURCES® ABILITY ASSIST®
Solutions to the simple and complex aspects of life through Once you have used your 5 face to face visits with
confidential and professional EAP, work-life and behavioral health GuidanceResources, you can all the number below to access 3
services. additional visits with Ability Assist. You must use your
GuidanceResources visits first.
Call: 800-327-1850 | Online: guidanceresources.com
Your Web ID: HLF902 Call: 800-964-3577 | Online: guidanceresources.com
Your Web ID: HLF902 | Company Name Field: ABILI
22TRAVEL & ID THEFT ASSISTANCE
As part of your employee benefits package, all full-time employees are eligible for Travel Assistance through The
Hartford and Europ Assistance USA. This is an employee benefit that includes travel, medical, and safety-related
services while traveling. These services are provided regardless if you’re traveling for business or leisure.
Travel Assistance and ID Theft Protection Services
Emergency Medical Assistance Pre-Trip Information Emergency Personal Services Identity Theft Assistance
• Medical referrals • Visa and passport • Medication and eyeglass • Prevention services
• Medical monitoring requirements prescription assistance -Education
• Inoculation and • Emergency travel -Identity Theft
• Medical evacuation
immunization arrangements Resolution Kit
• Repatriation requirements • Emergency cash • Detection Services
• Traveling companion • Foreign exchange rates • Locating lost items -Fraud alert to three
assistance • Embassy and consular • Bail advancement credit bureaus
• Dependent children referrals • Resolution Guidance and
Assistance
assistance
-Credit information
• Visit by a family member or review
friend -ID Theft Affidavit
• Emergency medical Assistance
payments -Card replacement
• Personal Services
• Return of mortal remains
-Translation
-Emergency cash
advance
*Refer to the Hartford materials for details and limitations
Have a serious medical emergency? Please obtain emergency medical services first (contact the local “911”), and then
contact Europ Assistance USA to alert them to your situation.
Call: 1-800-243-6108 Collect from other locations: 202-828-5885 Fax: 202-331-1528
Travel Assistance Identification Number: GLD-09012
23LEGAL ASSISTANCE
As part of your employee benefits package, all full-time employees are eligible for Estate Guidance Will Preparation
and Everest Funeral Planning Tools through the Hartford.
ESTATE GUIDANCE WILL PREPARATION SERVICES
Create a simple will from the convenience of your desktop – at no cost
Online assistance from licensed attorneys
Additional estate planning services also available for purchase including living trusts and power of attorney
Visit WWW.ESTATEGUIDANCE.COM/WILLS today. Use this code: WILLHLF. Then follow the easy steps below:
1. Access The Hartford’s EstateGuidance® Will Services online.
2. Sign in to the secure site by entering the access code.
3. Follow the instructions and create your will.
4. Download the final will to your computer and print.
5. Obtain signatures and determine if your will should be notarized.
EVEREST – FUNERAL PLANNING TOOLS AND SERVICES
Pre-Planning Services
• 24/7 Advisor Planning Assistance
• Online Funeral Planning Tools
• Everest PriceFinder Research Reports
• Detailed, local funeral home price comparisons
At-Need Services
• Negotiation assistance
• Family assistance and plan implementation
Find out more about The Hartford’s Funeral and Concierge Services by calling 1-866-854-5429.
Or visit WWW.EVERESTFUNERAL.COM/HARTFORD and use this code: HFEVLC.
24WEALTH BUILDING Maybe you’re not thinking about future financial welfare yet, but there has never been a better time to start planning than right now! The City of Lafayette 401(a) savings plan is an employee retirement savings program that gives employees the ability to deduct pre-tax earnings from their paychecks to invest those earnings towards their own personal financial goals. RETIREMENT PLAN (ICMA – RC) Full-time, non-commissioned employees are required to contribute 8% of their pre-tax compensation to a 401a retirement fund. The City contributes 10.2% to this fund. Employees may also contribute an additional post-tax 4% through payroll deduction. Normal retirement age under this plan is 59 1/2. If a plan member terminates employment before reaching retirement, s/he is entitled to her/his vested benefits accumulated under the plan. Employees who have 5 years of service with the City are 100% vested (entitled to the entire amount in the fund). This benefit is in lieu of Social Security. Employees are eligible to participate in the plan on the first day of employment as a full-time employee. The plan includes several investment options from which to choose. Employees may invest their contributions entirely into one fund or spread the investment among all options. Investment options include a stable value fund, diversified bond fund, small cap growth and small cap balanced funds, moderate balanced funds, growth balanced funds, large company growth funds, and others. FIRE AND POLICE PENSION ASSOCIATION Commissioned public safety employees belong to the Fire and Police Pension Association’s defined benefit plan. Contributions depend on date of hire. These employees also contribute to an ICMA-RC 401a plan for any overtime earnings, for which the employees’ and the City’s contribution rates are the same as detailed above. DEFERRED COMPENSATION PLAN (ICMA – RC) The City offers a 457 deferred compensation plan where savings are tax deferred until the earnings are distributed. Enrollment in the plan is mandatory in-lieu of social security for regular part-time employees, and is voluntary for full time employees. ROTH INDIVIDUAL RETIREMENT ACCOUNT The City offers its employees an opportunity to enroll in a Roth IRA, a retirement account that is funded by after-tax contributions. See Human Resources for more details. 25
rates
Medical Rates
Employee Only $687.69
Employee + Spouse $1,409.70
Employee + Child(ren) $1,375.31
Family $1,987.36
Dental Base Plan Rates Buy-Up Plan Rates
Employee Only $22.02 $40.98
Employee + Spouse $41.69 $77.24
Employee + Child(ren) $50.89 $90.24
Family $79.87 $144.68
Vision Rates
Employee Only $12.14
Employee + Spouse $19.42
Employee + Child(ren) $19.83
Family $31.97
Voluntary Life Rates Age Rates
These rates are: < 24 $0.075
• Unisex 25-29 $0.055
• Employee and Spouse
30-34 $0.06
• Guaranteed for One Year from the program
effective date 35-39 $0.08
• Based on an employee’s current age 40-44 $0.13
• Shown as a monthly rate per $1,000 45-49 $0.21
• AD&D Rates
50-54 $0.33
Employee $0.04
55-59 $0.49
60-64 $0.64
65-69 $0.92
70-74 $1.55
75+ $4.22
Short-Term Disability Rates Age Rates
These rates are:CONTRIBUTION WORKSHEET
Use the below table to calculate coverage selections and contributions available through the Health Insurance
Reimbursement program.
Contributions Calculate your total contributions available to you based on which coverage level you select and if you
Employee Employee Monthly
Employee Family
+Spouse +Children Total
City’s Contribution $821.00 $1,552.00 $1,507.00 $2,112.00
Contributions Total
Health Benefits Calculate the total cost of your benefit selections
Employee Employee Monthly
Employee Family
+Spouse +Children Total
Health
Kaiser HMO $687.69 $1,409.70 $1,375.31 $1,987.36
Dental
PPO + $40.98 $77.24 $90.24 $144.68
PPO Only $22.02 $41.69 $50.89 $79.87
Vision $12.14 $19.42 $19.83 $31.97
Benefits Total
Additional Benefits
Employee Dependent Monthly Total
Voluntary Life Insurance $ $
Voluntary Short-Term Disability
Health Flexible Spending Account
Dependent Care Flexible Spending Account
Stable Direct Port
529 College $ $
457 - Deferred Comp (pre-tax)
After Tax 401 (up to 4% Compensation)
Helping Hands
Benefits Total
Total Subtract your Health Benefits & Additional Benefits amounts from your Contributions total to estimate your monthly
benefit cost.
Contributions Total
- Benefits Total Cost
Monthly Deduction
28contact
CONTACT INFORMATION Refer to this list when you need to contact one of your benefit vendors. For general information contact Human Resources. Medical Provider Name: Kaiser Permanente Group Address: PO Box 921010, Fort Worth, TX 76121-1010 Provider Phone Number: (303) 338-3800 Provider Web Address: www.kaiserpermanente.org Dental Provider Name: Delta Dental of Colorado Group Address: PO Box 173803, Denver, CO 80217-3803 Provider Phone Number: (303) 741-9305 Provider Web Address: www.deltadental.com Vision Provider Name: Vision Service Plan (VSP) Group Address: PO Box 997100, Sacramento, CA 95899-7100 Provider Phone Number: (303) 892-7763 Provider Web Address: www.vsp.com Flexible Spending Accounts (FSA) Provider Name: WageWorks (HealthEquity) Group Address: PO Box 14043, Lexington, KY 40512-4055 Provider Phone Number: (877) 924-3967 Provider Web Address: www.wageworks.com Life and Accidental Death & Dismemberment Provider Name: The Hartford Group Address: 1 Hartford Plaza, Hartford, CT 06155 Provider Phone Number: (800) 523-2233 Provider Web Address: www.thehartfordatwork.com 30
Employee Assistance Programs (EAP) Provider Name: ComPsych (through The Hartford) Provider Phone Number: (800) 327-1850 Provider Web Address: www.guidanceresources.com / Web ID: HLF902 Provider Name: Public Service EAP (Especially for Police and Firefighters) Provider Phone Number: (888) 327-1060 Provider Web Address: www.publicsafetyeap.com Travel Assistance & ID Theft Provider Name: Europ Assistance USA (through The Hartford) Provider Phone Number: (800) 243-6108 or collect from (202) 828-5885 ID Number: GLD-09012 Estate Guidance Provider Name: The Hartford Provider Contact: www.estateguidance.com/wills Code: WILLHLF Funeral Planning Provider Name: Everest (through The Hartford) Provider Phone Number: (866) 854-5429 Provider Web Address: www.everestfuneral.com/hartford ID Number: HFEVLC Retirement Savings Plan Provider Name: ICMA-RC Provider Phone Number: (800) 669-7400 Provider Name: FPPA Provider Phone Number: (303) 770-3772 31
terms&definitions
Copay – An arrangement where an individual pays a specified amount for various health care services and the health plan or insurance company pays the remainder. The individual must usually pay his or her share when services are rendered. The concept is similar to coinsurance, except that Copays are usually a set dollar amount (such as $20 per office visit), rather than a percentage of the charges. Deductible – A set dollar amount that a person must pay before insurance coverage for medical expenses can begin. They are usually charged on an annual basis. Coinsurance – The money that an individual is required to pay for services, after a deductible has been paid. It is often a specified percentage of the charges. For example, the employee pays 20 percent of the charges while the health plan pays 80 percent. Out-of-Pocket Maximum – The total amount paid each year by the member for Copays, deductible and coinsurance. After reaching the out-of-pocket maximum, the plan pays 100 percent of the allowable charges for covered services the rest of that calendar year. In-Network – Typically refers to physicians, hospitals or other health care providers who contract with the insurance plan (usually an HMO or PPO) to provide services to its members. Coverage for services received from in-network providers will typically be greater than for services received from out-of-network providers, depending on the plan. Out-of-Network – Typically refers to physicians, hospitals or other health care providers who do not contract with the insurance plan (usually an HMO or PPO) to provide services to its members. Depending upon the insurance plan, expenses incurred for services provided by out-of-network providers might not be covered, or coverage may be less than for in-network providers. Pre-Admission Certification – Also called “precertification” or “pre-admission review.” Approval granted by a case manager or insurance company representative (usually a nurse) for a person to be admitted to a hospital or inpatient facility before admittance. The goal is to ensure that individuals are not exposed to inappropriate health care services, or services that are not medically necessary. 33
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