EMPLOYEE BENEFIT GUIDE - Your 2016 Plan Year: January 1, 2018 - December 31, 2018 - Teton County

 
EMPLOYEE BENEFIT GUIDE - Your 2016 Plan Year: January 1, 2018 - December 31, 2018 - Teton County
Important Benefit Information Enclosed
YOUR   2018
Your 2016
EMPLOYEE BENEFIT GUIDE
           Plan Year: January 1, 2018 – December 31, 2018
EMPLOYEE BENEFIT GUIDE - Your 2016 Plan Year: January 1, 2018 - December 31, 2018 - Teton County
Table of Contents

   Table of Contents                                                                          1

   Eligibility & Enrollment                                                                   2
   Health Insurance                                                                           3
   Health Savings Account (HSA)                                                               4
   Wellness Program                                                                           5
   Incentive Reimbursement Program                                                            6
   Zest Health - Concierge Service & Telemedicine                                             7-8
   Vision & Dental                                                                            9
   Dependent Care Flexible Spending Account (DCFSA) & Health Reimbursement Account            10
   (HRA)
   Basic Life and AD&D                                                                        11
   Supplemental Life and AD&D                                                                 12
   Long Term Disability                                                                       13
   Employee Assistance Program (EAP)                                                          14
   Voluntary Benefits                                                                         15
   Pension and Deferred Compensation Plans                                                    16-17
   Vacation, Sick & Holiday Leave                                                             18
   Teton County Employee Programs                                                             19
   Important Notices                                                                          20-21
   Questions & Contact Info                                                                   22

Teton County is pleased to offer you a selection of comprehensive, high quality employee benefits for
eligible employees and their dependents. Based on your personal needs, you have the choice of several
benefits to cover you and your family. Enclosed you will find a brief description of the options available, a
comparison of basic plan coverage and cost information.
We encourage you to read the entire enrollment guide before you enroll.
This is a summary of your County provided benefits only. Certain restrictions and exclusions apply. For
exact terms and conditions, please refer to your summary plan description. If information in this summary
differs from the legal contract, the legal contract is the ruling document. SPD’s are available from your
Human Resources Department.

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EMPLOYEE BENEFIT GUIDE - Your 2016 Plan Year: January 1, 2018 - December 31, 2018 - Teton County
Eligibility & Enrollment
    Teton County strives to provide a balanced, comprehensive benefits program for their employees.
    The Teton County Employee Benefits program offers you core benefits, such as Medical, Dental,
    Vision and Life insurance as well as voluntary & supplemental benefits that help maximize your
    coverage options.

    This booklet is designed to help you understand the coverages, premiums and options for this year.
    This is a reference for you and your family to make informed insurance decisions based on your
    specific needs. If you have questions please contact your Human Resources Department.
                                            Changes for 2018
      New Concierge Service – Zest & Telemedicine additional details on pages 7-8 of this brochure

    When Coverage Begins
     • Employees – 1st day of the month following date of hire. Must work 30 hours per week.
     • Elected Officials – 1st day of official service
    If you terminate employment or move to part-time status your coverage will terminate on the last
    day of the month that the change/termination occurs.

    Please note: It is important that you enroll in a timely manner. If you do not enroll within your first
    31 days of employment then you will not be eligible to enroll without a qualifying life event change
    until the next open enrollment period. Open enrollment is Nov 1 – Dec 15 each year for benefits
    beginning on January 1.

    Retirees - If your employment with Teton County terminates solely due to retirement you can
    continue coverage under the plan as a retiree if you:
           •     Are covered under the plan on the last day of full-time employment.
           •     Are at least 55 years of age on retirement date.
           •     Have completed a minimum of nine (9) years consecutive years of full -time service with
                 Teton County. Employees that worked 9 years are eligible for 5 years of coverage or until
                 age 65. Employees that worked more than 9 years are eligible for one additional year for
                 each 2 years over 9 you were employed.
           •     Pay a monthly contribution to the plan.
    Life Event Changes
    The following events allow you to change your benefits outside the open enrollment period:

                         •   You get married, divorced, or legally separated
                         •   You add a dependent child through birth, adoption, or change in custody
                         •   Your spouse or a dependent passes away
                         •   Your dependent loses coverage or gains other coverage
                         •   Your spouse loses or qualifies for coverage through his or her employer

    If you have a change in status, you must notify Human Resources to complete the necessary change
    forms within 31 days of the change. You will need to present documentation, such as a birth,
    marriage, or death certificate, or divorce decree.
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EMPLOYEE BENEFIT GUIDE - Your 2016 Plan Year: January 1, 2018 - December 31, 2018 - Teton County
Health Insurance
                 Benefits                                        In-Network
 Annual Deductible
                                    Single                          $2,400
                                    Family                          $4,800
 Out-of-Pocket Maximum
                                    Single                          $3,400
                                    Family                          $6,800
 Preventative Care                                              Covered 100%
 Office Visits                                                     20% AD
 Emergency Room                                                    20% AD
 Urgent Care                                                       20% AD
 Inpatient Hospital                                                20% AD
 (pre-certification required)
 Outpatient Hospital                                               20% AD
 Prescriptions - Retail Order (30 day supply)
 Tier 1 (Generic)                                                  20%   AD
 Tier 2 (Preferred Name Brand)                                     20%   AD**
 Tier 3 (Non-Preferred Name Brand)                                 20%   AD**
 Tier 4 (Specialty Drug)                                           20%   AD
 Prescriptions – Mail Order (90 day supply)
                   Tier 1                                          20% AD
                   Tier 2                                          20% AD
                   Tier 3                                          20% AD
 AD = After Deductible
** = Coverage for name brand drugs is only allowed when there is no generic available
Copayments, Coinsurance, Deductibles & Prescription Drug cost shares go towards the Out-of-
Pocket Maximums
                                                                           To locate coverage
Allegiance Tools and Resources                                            details, claims or for
 Look up Claims Status
                                                                          additional tools and
 See your Explanation of Benefit (EOB)
                                                                             resources from
 Review your Summary Plan Document
                                                                       Allegiance call 1-800-877-
 Locate Claims Forms
                                                                            1122 or log on to:
 Link to PPACA Covered Preventive Care List
                                                                       www.askallegiance.com
   www.uspreventiveservicestaskforce.org
               To locate an in-network provider near you visit the network websites at
                               www.1choice.com or www.mycigna.com
           This is a summary of benefits. Refer to your plan document for more details.             3
EMPLOYEE BENEFIT GUIDE - Your 2016 Plan Year: January 1, 2018 - December 31, 2018 - Teton County
Health Savings Account (HSA)

    What is a Health Savings Account (HSA)?
    An HSA is a type of bank account that you may set up and use to pay for eligible health care expenses
    with pre-tax payroll deductions. Employees are only eligible to enroll and contribute into an HSA
    account if the Qualified High Deductible Health Plan is elected. You may access funds via a debit card
    (if provided) or you will need to use a check to pay claims. Some accounts may qualify for interest. For
    more details please refer to your bank.

    To qualify for an HSA you:
    •Must be enrolled in a qualified High Deductible Health Plan (QHDHP)
    •Must not be covered by any other medical plan that is not an QHDHP (such as a spouse’s plan
    including the spouse’s FSA unless it is a limited purpose FSA)
    •Must not be entitled to benefits under Medicare
    •Must not have received VA benefits in the last 3 months

    The contributions from all sources may not exceed the annual maximum allowed or it will be subject
    to income tax. The maximum allowed annual contributions for 2018 are;
           •    Single: $3,450
           •    Family: $6,900

    If you are 55 and older you are allowed to contribute an additional $1000 each year.

    Teton County contributes the following amounts to your HSA account:
                 •    Single - $1,200 ($100 per month)
                 •    Family - $2,400 ($200 per month)
    Examples of Qualified Expenses:                                  Examples of Non-Qualified Expenses:
     •   Acupuncture                         •   Dental Care               •   Cosmetic Surgery
     •   Alcohol and Drug Rehab              •   Diabetic Supplies         •   Diapers
     •   Birth Control Medication            •   Eye exam and hardware     •   Exercise Equipment
     •   Blood Pressure Monitoring Devices   •   Hearing Aids              •   Hygiene Products
     •   Chiropractor                        •   Home Healthcare           •   Teeth Whitening
     •   Contact Lenses                      •   Medical Supplies          •   Health Club Dues
     •   Prescriptions                       •   Orthodontia               •   Nutritional Supplements
    For a comprehensive list of qualified expenses visit:
    http://www.hsacenter.com/what-is-an-hsa/qualified-medical-expenses/
    Your HSA account is governed by the IRS. Amounts used for non-qualified healthcare expenses are
    subject to income tax and a 20% penalty.

           This is a brief summary of your benefit . Please refer to plan summary for more details.
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EMPLOYEE BENEFIT GUIDE - Your 2016 Plan Year: January 1, 2018 - December 31, 2018 - Teton County
Wellness Program
                                    St. Johns Medical Center
                                    Wellness Blood Screenings

   Appointments must be made by calling 307-739-7531, SJMC Blood Lab
   Offered Year-Round
   Program offers deeply discounted prices
   Employees and their covered dependents will be required to pay the cost at the time of service
    and submit a claim form for reimbursement to Allegiance
   Vitamin D testing is not a covered service under Teton County’s Wellness Benefit
   Adults age 18 and older are eligible for the discounted pricing 1x during a 12 month period
   Results will be mailed to the patient and the patient’s physician upon request
   Interpretations will be offered during the annual Community Health Fair

Covered Services (must be received from St. John’s Medical Center):

             $35.00 - Blood Chemistry Profile: Screening for glucose, heart, liver, kidney
              and thyroid function – Fasting required.

             $10.00 – Hemogram: Complete blood count of red and white blood cells and
              platelets; screens for anemia & leukemia.

             $10.00 - HgbA1c: Measures blood sugar and control for the prior three months for
              diabetics and those with a family history.

             $20.00 – PSA Testing: Prostate screening for men.

             N/A - Vitamin D-25 Hydroxy: Screening is not covered under the county’s
              insurance plan. You will have to pay those fees independently.

           This is a brief summary of your benefit . Please refer to plan summary for more details.
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EMPLOYEE BENEFIT GUIDE - Your 2016 Plan Year: January 1, 2018 - December 31, 2018 - Teton County
Incentive Reimbursement Program
     Teton County Taxable Reimbursement Program                     Out-Patient       In-Patient
      SJMC: All outpatient surgical procedures (invasive
      procedure to repair or replace a body part) greater than           $250              -
      $2,500 for the facility billed charges
      Out-of-Area/Cigna: All outpatient procedures for facility
      billed charges of $5,000 and greater for out of Wyoming
      Hospitals and for any inpatient overnight stay per year per        $500            $2,000
      employee and/or dependent for a Hospital outside of
      Wyoming
      * No employee will receive greater than $500 for either themselves or their dependents in a
      calendar year for outpatient services, and no more than $2,000 for themselves or their
      dependents in a calendar year for inpatient services. Qualified employees must maintain
      employment and be considered an active, full time employee receiving a paycheck at time of
      disbursement.

                   Teton County is a self-funded plan and as such, has hired a third party
                 administrator (TPA), Allegiance to administer the medical and vision plan.

    Please Note:
     This program is Voluntary
     Benefits are paid After-Tax
     To receive reimbursement you must provide HR a completed Medical Incentive Reimbursement
      Form and an explanation of benefit (EOB). No diagnosis or other confidential information should
      be provided.
     HR will authorize and submit to payroll. The reimbursement will be included in the employee’s
      paycheck on the next pay cycle.

                                               Qualified

                    Local Network: First Choice of the Midwest – www.1choicem.com
                              National Network: Cigna – www.mycigna.com
    Please Note: Non-network provider services are covered at the same benefit level; however,
    amounts above the reasonable and customary charge for the area will be the members
    responsibility and are not applied to your deductible.

        This is a brief summary of your benefit . Please refer to plan summary for more details.
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EMPLOYEE BENEFIT GUIDE - Your 2016 Plan Year: January 1, 2018 - December 31, 2018 - Teton County
Zest Concierge Services

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EMPLOYEE BENEFIT GUIDE - Your 2016 Plan Year: January 1, 2018 - December 31, 2018 - Teton County
Telemedicine

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EMPLOYEE BENEFIT GUIDE - Your 2016 Plan Year: January 1, 2018 - December 31, 2018 - Teton County
Vision Coverage
VISION                                                                 In-Network
  Comprehensive exam
                                                        $25 copay, then covered 100% up to $200
  (every 12 months)
  * Materials – Glasses (frames Lenses)               Covered 100% up to $300 maximum combined
  every 24 months OR                                            benefit lenses & frames
  ** Contacts (every 12 months)                            Covered 100% up to $300 maximum
  * Excludes prescription sunglasses
  ** In lieu of eyeglass lens benefit
                                                                Submit claims to:
                                                      Allegiance Benefit Plan Management
                                                                   PO Box 3018
                                                         Missoula, Montana 59806-1269
                                                          Allegiance Customer Service:
                                                                 1-800-877-1122

                                   Dental Coverage

DENTAL                                                        In-Network            Out-of-Network
Annual Deductible                                                      $25 Person / $50 Family
Annual Benefit Maximum (including Preventative)                                 $1,500
Lifetime Ortho Maximum                                                          $1,000
Preventive and Diagnostic
                                                                Covered 100%               Covered 100%
(Deductible Does Not Apply)
Basic Services
                                                               Covered 80% AD            Covered 80% AD
(Fillings, Endodontics, Periodontics, Oral Surgery)
Major Restorative Services                (Crown,
                                                               Covered 50% AD            Covered 50% AD
bridges, dentures, implants)
Orthodontics – Dependent Child(ren) under age 19
                                                               Covered 50% AD            Covered 50% AD
(treatment must be on or after benefit effective date)
AD = After Deductible
                          Looking for a dentist?
 Visit www.deltadentalwy.org and search the “Premier” provider list or call
 1-800-735-3379 to find a provider, Monday through Thursday from 8:00am
               to 5:00pm., Friday from 8:00am to 4:00pm.
      This is a brief summary of your benefit . Please refer to plan summary for more details.            9
Dependent Care Flexible Spending Account
                       (DCFSA)
 What is a DCFSA?
 The County provides a Dependent Care Flexible Spending Account (DCFSA). When you enroll in DCFSA,
 the dollars you designate will be deducted from your paycheck on a pre-tax basis and credited to your
 FSA. You can use your DCFSA to be reimbursed for child or elder care expenses which enable you to
 work. This includes costs you incur for childcare for children under age 13 or adults living with you
 whom you claim as a tax dependent. By paying these expenses with pre-tax dollars, you will reduce
 your taxable income and take home a larger portion of your paycheck.

 PLEASE NOTE: you will need to submit claims and copies of your receipts to receive reimbursement.

                       2018 annual maximum contribution amount is:
                                 $5,000 – if married and filing jointly
                                  $2,500 – if filing Single

 These dollars do not rollover from year to year or from one employer to another; any unused portion
 at the end of the year will be forfeited.
                            REMEMBER – THIS IS USE IT OR LOSE IT

            Health Reimbursement Account (HRA)
 Health Reimbursement Account (for employees who are 65 years of age or older who are not eligible
 to contribute to an HSA)

 Teton County contributes the following:

            • $100 for single per month
            • $200 for family per month.

 PLEASE NOTE: This is an Employer owned account. Employees are not able to contribute to this
 account on a pre-tax basis.
                           REMEMBER – THIS IS USE IT OR LOSE IT
                               For claims or reimbursements call Allegiance at
                                               1-800-877-1122.

                                To enroll in the DCFSA or HRA please contact
                                               Human Resources

          This is a brief summary of your benefit . Please refer to plan summary for more details.
10
Basic Life and AD&D Benefits

Basic Life and AD&D
Teton County provides basic life coverage as well as Accidental Death and Dismemberment coverage
for all active, full-time employees working at least 30 or more hours per week. If you do not elect
coverage when you are first eligible you will be subject to medical underwriting.

Basic Life and AD&D Benefits
Employee                                                        $10,000
Spouse                                                           $2,000
Child (up to 19 yrs)                                             $1,000
Accidental Death (AD&D)                                         $10,000
Accelerated Death Benefit           If you are terminally ill, advance payout of 75% up to $250,000
                                65% of original benefit amount at age 65, 45% at age 70 &        30% at
Age Reduction
                                                                  age 75
                                   If your employment ends, you can apply for an individual policy
Conversion
                                            without evidence of insurability within 31 days.
Monthly Premium                                          100% Employer Paid

                                              Contact Us:
             https://dmswebintake.group.cigna.com/dmswebintake/LifeAccident/Initialform

                call 1-800-238-2125 Monday through Thursday from 8:00am to 5:00pm EST

         This is a brief summary of your benefit . Please refer to plan summary for more details.     11
Supplemental Life and AD&D Insurance

Supplemental Life Insurance and AD&D
Supplemental Life Insurance and AD&D is a voluntarily elected benefit. Supplemental Group Life and
AD&D insurance provides term life insurance at low rates. Current coverage includes financial
protection in the event you, your spouse and/or one of your dependents die while covered under this
benefit. If you do not elect coverage when you are first eligible you will be subject to proof of good
health.
                                   Supplemental Life and AD&D Benefits
                                                 Increments of $10,000 up to maximum of $100,000
 Employee
                                                          Guaranteed Issue – up to $100,000
                                           Increments of $5,000 up to $50,000 (the spouse amount cannot
 Spouse
                                                     exceed 50% of employee’s benefit amount)
                                         Increments of $5,000 up to $10,000 (age 15 days up to age 19 or age
 Dependent Children
                                                               25 if full-time student)
AD&D Benefits                                            Mirrors Supplemental Life Amount

                                                      How to figure out your monthly supplemental
       Life and AD&D Monthly rates per $1,000
                                                      life/AD&D premiums for Employee and/or Spouse
       Age           Cost for Employee and Spouses    coverage:
     Under 20                   $0.298
                                                                  Monthly            Benefits
      20-24                     $0.120                            Rate per              in
                                                        Age        $1,000     X      $1,000’s        =   Monthly Cost
      25-29                     $0.102
                                                        35         $.122      X        100           =       $12.20
      30-34                     $0.106
      35-39                     $0.122                How to figure out your per pay period premium for
                                                      Employee or Spouse coverage:
      40-44                     $0.180
                                                        Monthly            Number
      45-49                     $0.244                                        of             Number
                                                        Premiu             Months             of pay           Cost per
      50-54                     $0.385                    m          x     in year     ÷     periods     =     paycheck
      55-59                     $0.619                   $12.20      X       12        ÷        26       =      $5.63

      60-64                     $0.767
      65-69                     $1.118
      70-74                     $2.240
      75-79                     $4.487

  Child(ren) = $1.27 per $5,000 (regardless of # of
                     children)
                AD&D = $0.038 per $1,000

              This is a brief summary of your benefit . Please refer to plan summary for more details.
12
LTD Benefits

LTD Coverage
Teton County provides LTD coverage for all active, full-time employees working at least 30 hours per
week. If you elect coverage 50% of the cost is paid by Teton County.
                  Benefit                                             LTD
 Benefit Coverage amount                                             66.67%
 Maximum Payment Period                                             To age 65
 Benefits Begin                                         After 90 day elimination period
 Pre-Existing Condition                               12 months prior/12 months insured
 Maximum Benefit                                            Up to $5,000 per month
 Coverage Basis                                                 Own Occupation
 Monthly Premium                                               50% Employer Paid

  To calculate the cost of coverage, follow these steps:

  Step 1: Enter your gross or pre-tax monthly pay (not counting bonus or overtime).
  Please note this amount cannot exceed $8,333 $_________________________

  Step 2: Multiply gross pay (line 1) by $0.00341   $_________________________
  (this is your monthly premium)

  Step 3: Times your monthly premium by 12 months and divide by 26 pay periods. This is your per
  pay period cost. Divide this amount by 50% for your per pay period cost.

                                          $__________________________

     This is a brief summary of your benefit . Please refer to plan summary for more details.          13
Employee Assistance Program (EAP)

         Life. Just when you think you’ve got it figured out, along comes a challenge. Whether your
         needs are big or small, your Life Assistance & Work/Life Support Program is there for you. It can
         help you and your family find solutions and restore your peace of mind.

         What Can The EAP Do For Me?
                                                                                 Immediate assistance
                                                                                 with a 24 hour hotline
         When you call you’ll talk with a trained professional who will:
         • Ask about your situation
         • Help you clarify the problem                                             100% Confidential
         • Offer guidance and support                                                 No cost to you
         • Connect you with experts who can help with work-life issues
         • Refer you to a local EAP counselor for face-to-face sessions

         These confidential services are just a telephone call away for both you and your household
         members.
         The EAP Services Can Help With These, And Many More Issues:

              Life                 Work               Family             Legal             Money
                                                     Childcare           Estate
             Anxiety             Job Stress                                               Budgeting
                                                     resources          planning
             Stress           Communication          Parenting           Wills          Identity theft
                                Co-worker         Caring for older                         Debt
          Grief & Loss                                                Legal forms
                               relationships           adults                           management

                                                                          Call 800-538-3543
                                                                                  Or
                                                                        Visit their website at
                                                                     www.cignabehavioral.com/cgi

     9

14                     This is a summary of benefits. Refer to your plan document for more details.
Voluntary Insurance

                      15
Wyoming Retirement System - Benefits
 Wyoming Retirement System (WRS) is a defined benefit program for public employees in Wyoming.
 The active membership is comprised of school district employees, University and community college
 employees, state and local government employees, and various other political subdivisions in the
 State.

 WRS offers both a Pension and Deferred Compensation Plan to help you build a secure financial
 future:

 • PENSION – This benefit plan is designed to provide a monthly income for life and will continue
     to grow as long as you are working within the WRS. Your benefit is based on a formula involving
     your age at retirement, highest average salary, and years of service; it is not affected by
     investment gains or losses. Regular, full-time employees are eligible and automatically enrolled
     on date of hire. You become ‘vested’ after 48 months of service.

Pension Plan               Contributions                          Vesting       Eligibility
Public Plan                16.62% of Salary:                      48            •Age 60 with 4 years
Tier 1                     Employee = 8.25%                       Months        service, or
(Eligibility if hired      Employer = 8.37%
prior to 09/01/12)         (Teton County Contributes 13.94%                     •Upon meeting the
                           of employees total salary, leaving                   requirements of “rule of
                           employee to fund 2.68%)                              85” (age plus your years
                                                                                of service equal 85 or
                                                                                more)
Public Plan                16.62% of Salary:                      48            •Age 65 with 4 years
Tier 2                     Employee = 8.25%                       Months        service, or
(Eligibility if hired on   Employer = 8.37%
or after 09/01/12)         (Teton County Contributes 13.94%                     •Upon meeting the
                           of employees total salary, leaving                   requirements of “rule of
                           employee to fund 2.68%)                              85” (age plus your years
                                                                                of service equal 85 or
                                                                                more)
Fire Plan B                21.245% of salary:                     48            Age 50 with 4 years of
                           Employee = 9.245%                      Months        service
                           Employer = 12%
Law Enforcement            17.20% of salary:                      48            •Age 60 with 4 years of
                           Employee = 8.6%                        Months        service, or
                           Employer = 8.6%
                           (Teton County Contributes 11.25%                     •Any age with 20 years of
                           of employees total salary, leaving                   service
                           employee to fund 5.95%)

           This is a brief summary of your benefit . Please refer to plan summary for more details.
16
WRS – Deferred Compensation Plan
  This benefit plan helps you build your own retirement by investing pre-tax contributions through
   payroll deductions into the Plan. You decide where to invest your contributions by choosing from
   an offering of conservative to high-risk investment options. However, you cannot borrow, take
   loans, or close your account until your employment ends.

                              457 Deferred Compensation Plan
                                      Participation is Voluntary and you must complete an
                                      enrollment form.
Enrollment                            Minimum contribution per pay period is $20 but you can
                                      contribution any amount up to the IRS annual contribution
                                      limit of $18,000.

Eligibility                           Date of hire or at anytime during your employment.
                                      Voluntary – does not affect your pension benefit or
Contributions                         contributions to pension plan.
(pre-tax or after tax option)         You can increase, decrease, stop or restart contributions at
                                      anytime.
                                      If you are at least 50 years of age, you can contribute up to
Catch up Contributions                $6,000 per calendar year.

Each pension plan and the Deferred Compensation Plan has an associated handbook
                       to help you understand your benefits

                    WRS Benefit calculator and Plan Documents are
                      available at: http://retirement.state.wy.us

                                   For more information:
                                    Call: 1-307-777-7691                                              17
Vacation, Sick & Holiday Leave
               Teton County provides vacation and sick leave to regular full -time employees.
                      Leave benefits begin to accrue on the employee’s date of hire.

     Vacation:
     Vacation is accrued according to seniority, and the employee can accrue a maximum of 240
     hours. Any accrued vacation in excess of 240 hours will be forfeited. Vacation time may not be
     taken until it has been accrued. Fire/EMS shift personnel working a 24 day tour of duty accrue a
     maximum of 336 hours. Please reference Appendix C in the Employee Policies Manual and
     Handbook.

 Years of Service                              Hours Per Hours Per Fire/EMS Fire/EMS
                                                 Year    Pay Period Hours Per Hours Per
                                                                      Year    Pay Period
 Date of hire through four full years of        80 Hours          3.08        112 Hours         4.30
 service
 After completion of 4 full years of service    120 Hours         4.62        168 Hours         6.50
 After completion of 9 full years of service    160 Hours         6.15        224 Hours         8.60

     Sick Leave:
     Regular full-time Fire/EMS shift personnel earn sick leave at a rate of 8 hours per calendar month
     (3.70 hrs./pay period), and can accrue a maximum of 480 hours of sick leave. Sick leave may not
     be taken until it has been accrued. Any accrued sick leave in excess of 480 hours will be forfeited.
     Fire/EMS shift personnel working a 24 day tour of duty accrue 11.2 hours per calendar month
     (5.2hrs/pay period), or 134.4 hours per year and a maximum of 672 hours of sick leave.

     Holidays:
     •   New Years Day                     • Veteran’s Day
     •   Martin Luther King’s birthday     • Thanksgiving (4th Thursday & Friday in November)
     •   President’s Day                   • Christmas Eve (office closes at 12:00pm when it
     •   Memorial Day                        falls on Mon, Tues, Wed, or Thursday).
     •   Independence Day                  • Christmas Day
     •   Labor Day

18
Teton County Employee Programs

Recreation Center    Available at no charge to full time employees that work for
                     Teton County, Wyoming.
                     Please Note:
                     • Does not include classes or programs
                     • Spouse & dependents must pay to use the facility
                     • Employees must purchase an ID card for $10 or current price
                     • This is good for 24 months from date of purchase
                     • Must have proof of employment for your first visit (employee ID or
                       other form of identification)
  Town/County        The Town of Jackson has a workout area in the basement of the Town Hall
 Exercise Facility   Building.
                     • Available to employees, spouses & dependents from age 18-26.
                     • You are required to complete & sign an application and waiver and
                        obtain an electronic security card for access

Bus Pass Program     The County will reimburse you 50% of the cost of either a book of 10 rides
                     or a monthly pass. Please Note; The County can only reimburse up to $105
                     per month before it becomes taxable.
                     To obtain this benefit:
                     • complete a voucher
                     • attach your receipt
                     • sign the voucher on claimant line
                     • have supervisor sign it on the approval line
                     • Send completed voucher to: County Clerk’s Office

   Discounted        For year-round, full-time & part-time employees paid through the County
   Ski Passes        Clerk’s office.
                     • 20% off August pricing for JH Mountain Resort, Snowking Mountain
                       and Grand Targhee Resort
                     • No deadline to purchase discounted passes
                     • Tri-area sharable pass available during the ski season by RSVP through
                        County Administration office
                                                                                                  19
CHIP Notice
                   Medicaid and the Children’s Health Insurance Program (CHIP)
                  Offer Free Or Low-Cost Health Coverage To Children And Families

  If you are eligible for health coverage from your employer, but are unable to afford the premiums,
  some States have premium assistance programs that can help pay for coverage. These States use
  funds from their Medicaid or CHIP programs to help people who are eligible for employer-
  sponsored health coverage, but need assistance in paying their health premiums.

  If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed
  below, you can contact your State Medicaid or CHIP office to find out if premium assistance is
  available.

  If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any
  of your dependents might be eligible for either of these programs, you can contact your State
  Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to
  apply. If you qualify, you can ask the State if it has a program that might help you pay the premiums
  for an employer-sponsored plan.

  Once it is determined that you or your dependents are eligible for premium assistance under
  Medicaid or CHIP, your employer’s health plan is required to permit you and your dependents to
  enroll in the plan – as long as you and your dependents are eligible, but not already enrolled in the
  employer’s plan. This is called a “special enrollment” opportunity, and you must request coverage
  within 60 days of being determined eligible for premium assistance.
  You may also be eligible for assistance paying your employer health plan premiums. Contact your
                               State for further information on eligibility.
                                                              IDAHO – Medicaid and CHIP
                                          Medicaid Website: www.accesstohealthinsurance.idaho.gov
                                          Medicaid Phone: 1-800-926-2588
                                          CHIP Website: www.medicaid.idaho.gov
                                          CHIP Phone: 1-800-926-2588

                                                                 WYOMING - Medicaid
                                          Website: http://health.wyo.gov/healthcarefin/equalitycare
                                          Phone: 307-777-7531

                For more information on special enrollment rights, you can contact either:
        U.S. Department of Labor                        U.S. Department of Health and Human Services
 Employee Benefits Security Administration                Centers for Medicare & Medicaid Services
           www.dol.gov/ebsa                                           www.cms.hhs.gov
          1866-444-EBSA (3272)                                    1-877-267-2323 Ext. 61565

 Please Note: This is not an all-inclusive list of states, please contact Human Resources for a full copy of
                                                   the notice.
20
Employee Notice & Rights
                 HIPAA Privacy Notice
                 The Health Insurance Portability and Accountability Act (HIPAA) requires
                 employers to adhere to strict privacy guidelines and establishes employee’s rights
                 with regard to their personal health information. If you have any questions
                 regarding this federal regulation, please speak with your Human Resources
                 department.

                  Women's Health & Cancer Rights Act Annual Notice (WHCRA)
                  Did you know that your plan, as required by the Women’s Health and Cancer
                  Rights Act of 1998, provides benefits for mastectomy-related services including all
                  states of reconstruction and surgery to achieve symmetry between the breasts,
                  prostheses, and complications resulting from a mastectomy, including
                  lymphedema?
                  Call your Plan Administrator for more information

                 COBRA Rights
                 Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), federal law
                 makes it possible for certain employees and their eligible dependents to continue
                 participation in health care plans if coverage would have otherwise been
                 terminated.

                 Newborn’s and Mother’s Health Protection Act
                 The Newborn’s and Mother’s Heath Protection Act of 1996 (NMHPA) affects the
                 amount of time you and your newborn child are covered for a hospital stay
                 following childbirth. In general, health insurers and HMOs may not restrict
                 benefits for a hospital stay in connection with childbirth to less than 48 hours
                 following a vaginal delivery or 96 hours following a delivery by cesarean section. If
                 you deliver in the hospital, the 48 hour (or 96 hour) period starts at the time of
                 delivery. If you deliver somewhere other than the hospital and you are later
                 admitted to the hospital in connection with the childbirth, the period begins at the
                 time of admission. Also, a health insurer or HMO cannot require you or your
                 attending provider to obtain prior authorization for your delivery or show that the
                 48 hour (or 96 hour) stay is medically necessary. However, a health insurer or
                 HMO may require you to get prior authorization for any portion of stay after the
                 48 hours (or 96 hours).

Please contact your Human Resources Department for detailed information on these federal laws.

                                                                                                     21
Contact Page
 Provider                           Phone / E-Mail                 Website / Email

 Teton County Human Resources
 Julianne Fries, HR Director
 Laura Moyer, HR Generalist         Phone:    307-732-8483         hr@tetoncountywy.gov
 Hannah Lewis , HR Assistant
 Medical & Vision                   Phone:   800-877-1122
 Allegiance                         Fax:     406-532-4507 or       www.askallegiance.com
                                             866-201-0522
 Dental
 Delta Dental                       Phone:    800-735-3379         www.deltadentalwy.org
 Policy #: 70025
 Zest Health - Concierge Services                                  Mobile App – Refer to Apple & Android
 Health Advocate & Telemedicine     Phone:    866-333-4725
                                                                   stores to download
 Deductions & H.S.A Contributions
 Payroll Clerk or                   Phone:    307-732-8421
 Library Accounting Specialist      Phone:    307-733-2164 x 116
 Dependent Care Flexible Spending
 Account (DCFSA)                  Phone:     800-877-1122
                                                                   www.askallegiance.com
                                  Fax:       406-523-3149
 Allegiance
 Health Reimbursement Account
 (HRA)                              Phone:   800-877-1122
                                                                   www.askallegiance.com
                                    Fax:     406-523-3149
 Allegiance
 Life, AD&D & LTD Insurance                                        www.cigna.com
 Cigna Policy #OK 964217            Phone:   800-238-2125
                                                                   Email Life Applications
 Life Medical Underwriting          Fax:     800.440.0856
                                                                   https://dmswebintake.group.cigna.com
                                    Phone:   800-732-1603
                                                                   /dmswebintake/LifeAccident/Initialform
 Wyoming Retirement System
 (WRS)                              Phone:   307-777-7691          http://retirement.state.wy.us
                                    Fax:     307-777-5995          Email: pension@wyo.gov
 Defined Benefit Program
 WRS Deferred Compensation Plan     Phone:   307-777-7691          http://www.wrsdcp.com
                                    Fax:     307-777-3621          Email: 457pln@wyo.gov
 Voluntary Insurance
 Transamerica
 Darrell Rawlins                    Phone:    801-505-6480         drawlins@hayscompanies.com
 Hays Companies
 Phillip Aguillon                   Phone:    801-505-6513         paguillon@hayscompanies.com

22
We encourage you to read the entire enrollment guide before you enroll.

This benefit guide gives a brief description of what is in the official summary plan
documents for these plans. The benefits that you receive are based upon the
plan’s official documents, not this guide or any other written or oral statement. If
there is conflict between this guide and the official plan document, the official
plan documents will govern in all cases. Teton County reserves the right at any

                                                                                       Important Benefit Information Enclosed
time to change or terminate these plans.

 Your 2016
                                     Plan Year: January 1, 2017 – December 31, 2017

            2018 Employee Benefits Guide courtesy of Hays Companies
You can also read
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