New Employee/ Benefit Book 2022 - City of Hays
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2022 New Employee/ Benefit Book More information can be found at haysusa.com/newemployee
TABLE OF CONTENTS
Welcome......................................................................................................................................... 3
Contacts ......................................................................................................................................... 3
Cheat Sheet .................................................................................................................................... 4
Probationary Period ........................................................................................................................ 5
I-9/W-4/K-4 ..................................................................................................................................... 5
Pay Days ........................................................................................................................................ 5
Pay Increases ................................................................................................................................. 5
Direct Deposit ................................................................................................................................. 6
Holidays & Paid Time Off (PTO) ..................................................................................................... 6
Lunch Breaks/Breaks...................................................................................................................... 7
Employee Intranet .......................................................................................................................... 7
Hours of Work/Alternative Work Schedule...................................................................................... 7
City Personnel Manual, Pay Plan, and More .................................................................................. 7
Code of Ethics/Drug Testing ........................................................................................................... 7
uAttend Timekeeping ...................................................................................................................... 8
KPERS/KP&F (retirement) .............................................................................................................. 9
Short Term Disability ...................................................................................................................... 9
Longevity Bonus ............................................................................................................................. 9
Qualifying Event ............................................................................................................................. 10
Important Health Insurance Documents ......................................................................................... 10
Health Insurance Plan Options and Premiums ............................................................................... 11
BCBS Preferred Network, Prescriptions, Online Access & Preventative Services ......................... 12
Telemedicine .................................................................................................................................. 12
Dental Insurance Plan and Premiums ............................................................................................ 13
Vision Plan Options and Premiums ................................................................................................ 14
Health Savings Account.................................................................................................................. 16
AFLAC ............................................................................................................................................ 17
HSA vs FSA .................................................................................................................................... 18
Golf Course Fees Payroll Deduction............................................................................................... 19
AirMedCare .................................................................................................................................... 19
Gym Memberships.......................................................................................................................... 19
Employee Assistance Program (EAP) ............................................................................................ 20
KPERS 457 Plan ............................................................................................................................ 21
United Way of Ellis County ............................................................................................................. 21
Legal Notices .................................................................................................................................. 22
Continuation of Health Plan Coverage (COBRA) ...................................................................... 22
Notice of Special Enrollment Provisions ................................................................................... 22
Special Rules for Mothers and Newborns ................................................................................ 22
HIPAA Privacy ........................................................................................................................... 22
Women’s Health and Cancer Rights Act of 1998 ...................................................................... 23
Health Insurance Marketplace Coverage Options & Your Health Coverage ............................. 23
Prescription Drug Coverage & Medicare ................................................................................... 25
Premium Assistance Under Medicaid and CHIP ....................................................................... 26
Family Medical Leave Act (FMLA) ............................................................................................. 27
USERRA ................................................................................................................................... 27
More information can be found at haysusa.com/newemployee 2
WELCOME TO THE CITY OF HAYS
Welcome to the City of Hays! We are excited that you have decided to join our team of amazing em-
ployees. You will meet with Human Resources (HR) on your first day to complete new employee pa-
perwork. This includes government mandated forms, benefit elections, and other general infor-
mation. All this information may seem overwhelming at the time.
In order to help prepare you, please review all the information in advance of your first day. You will
not need to print or complete any of the paperwork ahead of time as you will do this with the HR staff
on your first day. This will allow you to see what type of decisions you will be asked to make and will
allow you to review the information with other individuals who may help make your selections. If you
have any questions, feel free to bring them with you on your first day or email HR at
hr@haysusa.com.
CONTACT INFORMATION
Contact Website/Email Phone
Blue Cross Blue Shield of Kansas
bcbsks.com 800.432.3990
(Medical & Rx)
Delta Dental of Kansas deltadentalks.com 800.234.3375
Vision Care Direct visioncaredirect.com 877.488.8900
aflac.com
AFLAC—Randy Weber
randy_weber@us.aflac.com 785.639.3825
AFLAC—Flexible Spending Accounts takecarewageworks.com 800.950.0105
(Medical & Daycare) randy_weber@us.aflac.com 785.639.3825
KPERS kpers.org 888.275.5737
kpers457.org
457 Plan—Joe Hillebrand, CRC 785.213.7175
joseph.hillebrand@empower-retirement.com
EAP (Company Code: Hays) ndbh.com 800.624.5544
airmedcarenetwork.com 833.965.0334
AirMedCare—Nate Brown
Nate.brown@airmedcarenetwork.com 785.216.9087
Human Resources hr@haysusa.com 785.628.7320
Erin Giebler—Director of HR egiebler@haysusa.com Fax:
Madi Ginther—HR Generalist mginther@haysusa.com 785.628.7323
More information can be found at haysusa.com/newemployee 3
CHEAT SHEET
This booklet goes in depth into your employment benefits with the City of Hays. Additional infor-
mation can be found at www.haysusa.com/newemployee. Carefully review all information. This is a
quick overview of all the documents/decisions you will be required to make when you meet with HR.
Required Information
• I-9 Acceptable Documents (Must be original and be provided within 3 days of hire date)
• W-4 & K-4 must be filled out. Review the form before your first day so you are familiar with the
form. HR is not able to provide you with any tax advice.
• Direct Deposit—Bring routing number(s) and account number(s) as well as the email address
you would like to receive your pay stub at.
• Insurances—Bring social security numbers, birthdays, and marriage date of anyone who would
be included on your insurance options.
• Beneficiaries —Bring social security numbers and birthdays of anyone who you would like to list
as a beneficiary on your retirement plan.
• Emergency Contact—Bring at least one phone number for an emergency contact. Additional
contacts are allowed and encouraged.
Eligibility Date
• PTO—Start accruing PTO after 3 months of employment
• Longevity Bonus—Paid a longevity bonus annually after 5 years of employment
• Health Insurance—First of the month following a 60 day waiting period
• Dental Insurance—First of the month following a 60 day waiting period
• Vision Plan—First of the month following a 60 day waiting period
• Short Term Disability—First of the month following a 90 day waiting period
• Retirement—Begin contribution right away. Vesting in KPERS 5 years and KP&F 15 Years
• AFLAC—First of the month after your hire date
The information in this booklet is intended to summarize the benefits offered in language that is clear and
easy to understand. Every effort has been made to ensure that this information is accurate. This booklet is not
intended to replace the Personnel Manual or legal plan document (Benefit Description), which contains the
complete provisions of a program. In case of any discrepancy between this booklet and the Personnel Manual
or legal plan document, the Personnel Manual and legal plan document will govern in all cases.
More information can be found at haysusa.com/newemployee 4PROBATIONARY PERIOD
All new hires must complete a probationary period. This gives the supervisor an opportunity to ob-
serve the employee in order to determine whether or not the employee is capable of handling the
responsibilities and duties of the job in a satisfactory manner. See more in our Personnel Manual.
I-9 (EMPLOYMENT ELIGIBILITY VERIFICATION)
The Federal Government requires all U.S. employers to complete an I-9 for each employee they hire
in order to verify the employee is authorized to work in the United States. This form requires the
employee to provide acceptable documents to HR within three days of employment. These
documents must be originals (no copies or faxes allowed) and they must be unexpired. A list of the
acceptable documents can be found with the I-9 Form. Find more information about the I-9 on the
USCIS website.
W-4 (FEDERAL TAX WITHHOLDING FORM)
This government mandated form lets HR know how much you want withheld from your paycheck for
federal taxes. Note that if you have too much tax withheld, you will receive a refund when you file
your tax return. If you have too little tax withheld, you will owe tax when you file your tax return. This
forms remains in effect until the you provide HR with an updated one. You may update this form
whenever you feel it is necessary. Instructions on how to complete the W-4 can be found on the IRS
website or W-4 Form.
K-4 (STATE TAX WITHHOLDING FORM)
This form will let HR know how much Kansas income tax should be withheld from your pay. This
form remains in effect until you provide HR with an updated one. You may update this form whenev-
er you feel it is necessary. This form has a different set of instructions than the W-4. Your K-4 may
also differ from what you claim on your W-4. Instructions on how to complete the K-4 can be found
on the K-4 Form.
PAY DAYS
Employees are paid bi-weekly on Fridays (or the day before if Friday falls on a holiday). The
paycheck provided on the Friday is always for the two weeks prior to the week of payday. Typically
there are 26 payrolls per year.
PAY INCREASES
The City of Hays uses a Step Plan for employee raises. Employees will receive a 2% step annually
based on their anniversary date as long a they have not reached the top of the pay scale.
(Anniversary dates may change when promotions are provided). The pay steps can be found online.
More information can be found at haysusa.com/newemployee 5DIRECT DEPOSIT FORM
Employees can choose to receive a paper check or have it directly deposited into their bank account
(the preferred method). Pay stubs are sent by emails for those who elect direct deposit.
Employees can also choose to have some of their check paid into another account; for example, an
employee may want $40 per check put into their savings account.
In order to set any direct deposit up, employees would need to provide their Bank’s routing number
(s) and their account number(s). Employees may change their Direct Deposit at anytime by coming
into HR’s office. (We do not allow for Direct Deposit Forms to be done through emails.)
HOLIDAYS
The City of Hays celebrates nine holidays: New Years Day, Memorial Day, Independence Day, La-
bor Day, Veterans Day, Thanksgiving, the Day After Thanksgiving, Christmas Eve, and Christmas.
Shift work employees will always celebrate the holiday on the day. Other employees will celebrate it
on the Friday before or Monday after if the Holiday is on the weekend. Any non-exempt employee
working a holiday is compensated extra. (Paid 1.5x their wage for working + 1x their wage for the
holiday celebrated = 2.5x total). Shift workers who are not scheduled to work on the holiday will re-
ceive their normal shift hours on that day as pay called “Holiday Regular Day Off”. Holiday Celebrat-
ed counts as time worked for OT purposes.
PAID TIME OFF (PTO)
New employees will begin accruing PTO after a three month waiting period. PTO is accrued bi-
weekly and may not be taken until it has been accrued. Employees are allowed to keep up to the
max amount listed below. At no time will employees be able to accrue more than the max. Besides
the max, there is no carry over limit. PTO counts as time worked for OT purposes.
Months of Bi-Weekly Annual Fire Bi- Fire Annual
Max Fire Max
Service Accrual Accrual Weekly Accrual
4-47 5.9 153.4 192.4 8.3 215.8 265.2
48-107 6.5 169 208 9.1 236.6 288.6
108-167 7.1 184.6 223.6 9.9 257.4 312
168-227 7.8 202.8 241.8 10.9 283.4 338
228+ 8.4 218.4 257.4 11.8 306.8 361.4
More information can be found at haysusa.com/newemployee 6LUNCH BREAKS / BREAKS
Each employee must follow their department’s policies on Lunch. If an employee takes a working
lunch, which means the lunch break is less than 20 minutes, it must be taken onsite at a location de-
termined by your supervisor. Typically lunches need to be packed and brought with you to the job
site. If a lunch break is longer than 20 minutes, employees must clock out. All lunch break times will
be determined by your department head or their designee.
Employees will be provided up to 15 minutes of paid break time for each 4 hours an employee works
if the work load allows for the break. Break times will be determined by their department head or de-
signee. Break times cannot be added together to make a longer break. If leaving the work site on
your break, you must punch out. HR will add the time back as long as your break did not exceed al-
lotted time.
EMPLOYEE INTRANET
Employees have access to the Employee Intranet. This provides employees with more information
about policies, benefits, IT information, and an employee directory. Once employees sign up, email
hr@haysusa.com so the employee can be granted access to the intranet.
HOURS OF WORK/ALTERNATIVE WORK SCHEDULE
Employees shall work a schedule to be assigned by the department head. Business hours are Mon-
day—Thursday 7:30—5:30 and Friday 7:30—11:30. All other departments may set their working
hours to best utilize their staff and work load while limiting overtime. Eligible employees may request
an Alternative Work Schedule (AWS) when wanting to routinely deviate from their department’s typi-
cal work hours. All AWS must be approved by the department head and may be revoked at anytime.
Employees may request to flex their time in a given week for the one-time occurrences like doctor’s
appointments, child’s sporting events, etc. A supervisor may require the use of flex time in order to
control overtime costs. The department head has the final approval of all flex time. (AWS and flex
time may not be available in all positions.)
CITY’S PERSONNEL MANUAL, PAY PLAN
The City’s Personnel Manual, pay plan, and more can be found online at www.haysusa.com/
employment.
CODE OF ETHICS / DRUG TESTING
All employees are required to abide by the City’s Code of Ethics and are subject to alcohol and drug
testing. These policies may be viewed in the Personnel Manual.
More information can be found at haysusa.com/newemployee 7UATTEND - TIMEKEEPING
Employees are required to keep the times they performed any work for the City of Hays. To do this,
the City uses a system called uAttend for employees to punch in/out, enter Vacations, Holidays, and
Notes. All non-exempt employees are required to punch in/out. After each pay period, all employees
must approve their timecards following their departments specific guidelines. Exempt employees
must follow the guidelines set by their department head.
What do I need to do?
Before any work is performed (during or after normal working hours), employees will be required to
punch in. When employees stop working (unpaid lunch breaks, PTO, end of the day, etc), employ-
ees must punch out.
While each employee should punch in and out before and after their work, HR understands there will
be times employees forget. Employees will be able to manually update their timecard though this
should be the exception, not the norm.
Employees will be responsible for watching their overtime to make sure they do not work any unau-
thorized overtime. Any usage of unauthorized overtime or performing work that is not included on
the timecard may lead to disciplinary action. Any time an employee feels they were not paid correct-
ly, it needs to be reported to HR immediately after discovery.
Calculating Time Worked
To use this system, punch in and punch out and it will automatically calculate your time worked. It is
set to follow the Fair Labor Standards Act (FLSA) rounding rule. Employee time from 1 to 7 minutes
will be rounded down to the next quarter hour and employee time from 8 to 14 minutes will be round-
ed up to the next quarter hour.
Benefit Leave
Employees will enter their benefit leave using the following codes:
· VAC = PTO
· HOL = Holiday Celebrated
· SIC = Family Medical Leave PTO (Must notify HR if using this.)
· OTH = Short Term Disability, Time without Pay, Holiday Regular Day Off, Disciplinary Suspension,
Worker’s Compensation (Need an explanation in the notes)
Holiday Celebrated
Holiday Celebrated will need to be manually added to your timecard. If you work a holiday, it will au-
tomatically be put in the OT2 code. For employees who get paid for a holiday that falls on their regu-
lar day off, they will need to add those hours to your timecard using the Benefit Leave code OTH
and put a note stating what those hours are “Holiday – Reg Day Off”.
How To Use It
Timeclocks—Available at select locations.
Smartphone App—Download uAttend app, use Company Code: 92316
Internet Browser—https://v2trackmytime.com/haysusa (If it ever asks for an email address enter
hr@haysusa.com).
User Name: First initial followed by last name (jsmith)
Password: Employee Number
Find more (including step-by-step instructions) at www.haysusa.com/newemployee.
More information can be found at haysusa.com/newemployee 8KPERS/KP&F
Throughout your career, you make contributions to the Retirement System. We invest the money
and pay you interest. Your employer also helps funds the system. When you retire, the Retirement
System pays you a guaranteed monthly benefit for life.
KP&F Tier II (Police and Fire Employees)
• Vested after 15 Years
• Employees Contribute 7.15% of each check to KP&F
• Employees are provided Retirement Benefits, Disability Benefits, and Death Benefits
KPERS
• Vested after 5 Years
• Employees Contribute 6% of each check to KPERS
• Employees are provided Retirement Benefits, Disability Benefits, and Life Insurance (1.5x salary)
• There are three tiers: KPERS 1 (those hired before 7/2009), KPERS 2 (those hired between
7/2009 & 12/2014), and KPERS 3 (those hired after 1/2015
Optional Group Life Insurance
• Employees may purchase additional life insurance on themselves, spouse, and/or child(ren)
• Cost is based on age and amount elected and paid monthly through payroll deduction
• Employees may get guaranteed coverage when they sign up as a new employee (within 31 days
of hire date), during a qualifying event (within 31 days of qualifying event) or during open enroll-
ment. Coverage may also be sought at anytime with proof of good health.
Online Account Access
• Sign up to track your membership and plan for retirement with your KPERS online account.
Find out more at kpers.org.
SHORT TERM DISABILITY
All full time employees are provided with short term disability insurance at no cost to the employee
the first of the month following a 90 day waiting period. This is meant to help cover an employee who
may be off work due to medical reasons. (This benefit is for the employee’s medical reason only, not
their spouse or kids.) There is a 14 day waiting period (which would be covered by an employee’s
PTO if available), then the employee will receive 70% of their wages until they return to work or up to
the max listed in the plan document. At no time will the City allow an employee use PTO and Short
Term Disability at the same time. See the plan document at www.haysusa.com/newemployee.
Any employee planning on missing more than 14 days of work due to a medical condition must noti-
fy HR as soon as feasible.
LONGEVITY BONUS
Full time employees are eligible for a Longevity Bonus after 5 years of employment. Employees are
paid at the following rate: 5 years—9 years - 2%; 10 years—14 years - 3%; and 15+ years - 4%.
Longevity is paid at the end of the year, usually on the same day as the last paycheck of the year.
Longevity on overtime is paid as it is accrued.
More information can be found at haysusa.com/newemployee 9QUALIFYING EVENT
Life is full of changes; expected and unexpected. Generally, you may change your benefit elections
only during the open enrollment period. However, you may change your benefit elections during the
year if you experience a qualifying event, including but not limited to:
• Marriage
• Divorce
• Birth or adoption
• Death of your spouse or dependent child
• Change in employment status of employee, spouse, or dependent child that causes a change
in eligibility for other coverage
• Entitlement to Medicare and Medicaid
PLEASE NOTE:
You must notify Human Resources within 30 days of the qualifying event, even if you do not
plan on making any benefit changes. If you do not contact Human Resources within 30 days of
the qualified event, you may have to wait until the next open enrollment period to make changes
(unless you experience another qualifying event).
IMPORTANT HEALTH INSURANCE DOCUMENTS
As part of the Affordable Care Act, the federal government requires group health plans and health
insurance issuers offering group and individual coverage to provide consumers two key documents.
These documents provide consumers information needed to compare coverage options in different
types of plans.
• Summary of Benefits and Coverage SBC – The SBC summarizes the key features of a health
plan, such as the covered benefits, cost-sharing provisions and coverage limitations. SBCs in-
clude a new, standardized plan comparison tool called “coverage examples,” similar to the Nutri-
tion Facts label required for packaged foods.
• Uniform Glossary – This glossary of terms, written in plain language, helps consumers under-
stand some of the most common but confusing jargon used in health insurance.
The SBC is not a guideline or example. It must be replicated using the exact wording, format and
layout as set forth by the U.S. Department of Health and Human Services. Both of these forms are
the direct result of model forms created through a public process led by the National Association of
Insurance Commissioners (NAIC) and several representatives of insurers, health care professionals,
consumer advocacy groups and others.
The Summary of Benefits and Coverage and Uniformed Glossary can be found at
www.haysusa.com/newemployee.
More information can be found at haysusa.com/newemployee 10HEALTH INSURANCE
The City of Hays will use Blue Cross Blue Shield of Kansas (BCBSKS) for their Health Insurance in
2022. Beginning January 1, 2022, a generic mandatory program will apply to prescription benefits.
Visit bcbsks.com/prescription-drugs/generic-drugs to find out more about this program.
Benefit HDHP Base Plan Premium Plan
Plan Deductible** $3,000/$6,000 $2,500/$5,000 $1,500/$3,000
Co-insurance** $0/$0 $2,000/$4,000 (40%) $1,000/$2,000 (20%)
$30/$60 (up to 5 Vis-
Primary Care Office Visit/Specialist Deductible $25/$50
its per Person)
Preventative Services Paid 100% Paid 100% Paid 100%
100% up to $300
Outpatient Lab/X-Ray Services Deductible 40% after Deductible then Deductible and
Co-Insurance
Surgery Deductible 40% after Deductible 20% after Deductible
Inpatient Hospital Care (Room &
Deductible 40% after Deductible 20% after Deductible
board, maternity care, x-ray, labs, etc)
Inpatient Mental Illness Services & Al-
cohol or Chemical Dependency Treat- Deductible 40% after Deductible 20% after Deductible
ment
Ambulance/Emergency Transportation Deductible 40% after Deductible 20% after Deductible
40% after $250 Co- 20% after $250 Co-
ER Deductible
Pay & Deductible Pay & Deductible
Accidental Injury Deductible 40% after Deductible 20% after Deductible
Prescription Drugs Co-Pays Deductible then: .
Tier 1 (Generic) $15 $15 $15
Tier 2 (Preferred Formulary Brands) $50 $50 $50
Tier 3 (Non-Preferred Brands) $75 $75 $75
Tier 4 (Preferred Specialty) $150 $150 $150
Tier 5 (Non-Preferred Specialty) 20% up to $250 20% up to $250 20% up to $250
Bi-Weekly Employee Costs
Single $14.01 $24.20 $52.60
Employee/Spouse $30.08 $51.97 $112.96
Employee/Children $28.36 $48.98 $106.46
Family $44.43 $76.75 $166.82
Max Out of Pocket—Including deducti-
bles, co-insurance, & premiums. Does
not include co-pays.
Single $3,364.26 $5,129.20 $3,867.60
Employee/Spouse $6,782.08 $10,351.22 $7,936.96
Employee/Children $6,737.36 $10,273.48 $7,767.96
Family $7,155.18 $10,995.50 $9,337.32
**These rates are based on In-Network expenses. Please refer to the policy for full benefit details.
The summary of benefits & glossary of terms can be found
at www.haysusa.com/newemployee
More information can be found at haysusa.com/newemployee 11BCBSKS PREFERRED NETWORK
Make sure you check your medical provider before you go to an appointment to make sure they are
in network. Otherwise you will pay a higher deductible & co-insurance. To see if your provider is on
the preferred network, you can either call the number on the back of your insurance card or go to
bcbsks.com/find-a-doctor/ & put XSB in the “Already a Member” box.
BCBSKS PRESCRIPTIONS
The easiest way to find out what tier your medication will be classified under BCBS is to go to
bcbsks.com and log into BlueAccess. You would then click on “Find Drugs (Formulary)”. Type in the
medicine you are wanting to check. Once you have it pulled up, under the bold information that tells
the dosing, you will see if it says “Generic for...covered, on drug list”. That would be Tier 1. If it
doesn’t say generic instead just “covered, on drug list” it is Tier 2. If it says Covered, Not on drug list
then it is Tier 3. If, on the right hand side (before the pricing), it says specialty then it is a specialty
drug. You would then look to see if it says “on drug list” Tier 4 or “covered, not on drug list” for Tier 5.
You may also find information without logging in by going to myprime.com/en/forms.html.
Generic Mandatory Drug Program
Beginning January 1, 2022, a generic mandatory program will apply to prescription benefits. If you
purchase a brand-name drug which has an available generic equivalent, you will be responsible for
the difference in the allowable charge for the generic versus the brand. This additional cost will be in
addition to the copay for the requested brand-name drug. If your prescriber determines that the
brand-name drug must be dispensed at the pharmacy, you will not be responsible for the difference
in cost between the brand and generic products. Your prescriber must include this information on the
prescription which is sent to your pharmacy. Find out more at bcbsks.com/prescription-drugs/generic
-drugs.
BCBS ONLINE ACCESS
For online access to your health insurance and resources to enhance your membership with
BCBSKS, you will want to establish a BlueAccess account. Follow the steps below to get your ac-
count set-up.
1. Go to bcbsks.com/blueaccess and click “Member Login”
2. Click “Sign Up”.
3. Read the user agreement, check “I Agree”, select “continue”.
4. Create your profile. (Have your ID card handy.)
PREVENTATIVE SERVICES
Preventative services can be received without any cost-sharing, meaning you will not pay deducti-
bles, copays or coinsurance. Preventative services must be provided by an eligible contracting pro-
vider as outlined in the health plan. Preventative services are subject to change. To see the full list
of covered preventative services, please visit bcbsks.com/aca. For additional information on health
care reform and preventative services, please visit healthcare.gov.
TELEMEDICINE
Telemedicine is an alternative to in-person visits. It allows health care professionals to evaluate, di-
agnose and treat patients at a distance via secure video/audio connections. Blue Cross Blue Shield
has partnered with Amwell so you can have a virtual doctor’s visit from your smartphone or computer
– right when you need it. Great for common conditions like Cold/Flu, Fever, Rash, Sinus Infection,
Pink Eye, Ear Infection, etc. They also provide behavioral health services. Doctors may provide pre-
scriptions when needed. To register download the Amwell app, visit bcbsks.com/telemed or call
844.733.3627. Cost is processed based on your BCBS plan design. Often telemedicine is cheaper
than in-person doctor visits for members who do not have a co-pay for doctor visits.
More information can be found at haysusa.com/newemployee 12DENTAL INSURANCE
The City of Hays will use Delta Dental as our dental Insurance provider for 2022. To save the most
money, you must go to an in-network provider. See if your dentist is in network at deltadentalks.com.
Maximum Benefit Per Person
$1,500
(annually)
100% Paid (No Deductible)** Oral Evaluation (2x per year)
Bitewing X-Rays (2x per year for under 18 years old and 1x per
year for 18 years old and older)
Full Mouth or panoramic X-Rays (1x per 5 years)
Prophylaxis (Cleanings)
Topical Fluoride (2x per year for under 19 years old)
Space Maintainers (under 14 years old for premature loss of
molars)
Sealants (1x per lifetime per tooth for under 16 years old)
Deductible $50 per person up to $150
80% (After Deductible)** Ancillary (1x per year)
Oral Surgery
Regular Restorative (Cavities)
Endodontics (Root Canal)
Periodontics (Surgical and Non-Surgical)
50% (After Deductible)** Special Restorative (Crowns)
Prosthodontics (Bridges, Dentures, Implants)
Orthodontics No Coverage (May use HSA or Flex Spending Account)
Right Start 4 Kids (RS4K): Children, 12 years old and under, receive coverage at 100% for all ser-
vices covered under the plan. Not subject to deductible, but plans’ annual maximum and fre-
quencies/limitations apply.
Bi-Weekly Employee Costs
Single $17.07
Employee/Spouse $33.80
Employee/Children $33.79
Family $57.46
**These rates are based on In-Network expenses. Please refer to the policy for full benefit details.
More information can be found at haysusa.com/newemployee 13VISION PLAN
The City of Hays will use Vision Plan through Vision Care Direct in 2022 with for eye exam and/or
material coverage. There are many options employees may choose, so review each option carefully.
Employees may enroll in more than one plan. To get the most out of your benefit, see a Vision Care
Direct provider. To locate a Vision Care Direct provider in your area go to
VisionCareDirect.com. (See next page for premiums.)
Open Access
Plan Includes (Using an In- Member
Description of Allowance Maximum (Non-
Network Provider) Responsibility
Network Provider)
Exam (Not applicable on Materials Only PK Plans)
Comprehensive eye-health
vision examination
100% after exam fee $15 Exam Fee Up to $50
includes refraction &
dilation if indicated*
In the event that a member has an eye exam in-
cluded with another plan, Vision Care Direct al-
lows the exam reimbursement to be used for oth-
er services or materials in lieu of a Vision Care No Open Access
Flexible Exam Option
Direct eye exam. An explanation will be provided Option
to you by your provider at time of service regard-
ing to the amount and how it was applied to your
additional services or materials.
Materials (Not Applicable on Exam Only Plan)
100% for glass or plastic
(CR-39) for single vision, Up to Maximum
Spectacle Lens* $15 Material Fee
bifocal, trifocal (FT25-28 or Listed:
lenticular) after material fee Single: $50
Progressive Lens*- Up to the retail price of Bifocal: $75
All Non-Platinum standard trifocal lens Overage Trifocal: $100
complete plans regardless of Rx Lenticular: $100
Progressive Lens*- All $180 progressive lens Progressive: $100
Overage
Platinum Plans allowance
100% for Dependent
No Open Access
Polycarbonate for Kids* children up to age 18 after $25 Material Fee
Option
material fee
Contact Lens* - In lieu of
Fitting fees and
frames and spectacle lens Elective: Selected Allowance
overage above Up to $80
(including multi-focal Medically necessary: $250
allowance
contacts)
Any frame from provider’s Overage above
Frame Allowance* Up to $60
inventory allowance
Specialty Plan Variations
Members pay differ-
Lenses included as indicated ence in retail price
Same as
RX Sunwear PK Plan* above. 100% tint on plastic for Polarized, glass
spectacle lens
lens tints, or photo-
chromic, plus $15
*There is an 11-month waiting period between each eye exam and glasses purchases.
More information can be found at haysusa.com/newemployee 14VISION PLAN
General Limitations & Exclusions
The vision plan is designed for routine eye care & materials expense incurred while the membership
is in force. Plan allowances cannot be combined with any other discounts, promotional offers or other
advertised specials including, but not limited to, discounts, coupons, or two-for-one materials spe-
cials offered by the providers at their individual offices. Members must choose between using their
Vision Care Direct allowances or the provider’s special offers. Unused allowances do not roll over
into next allowance period. We do not provide allowances for the following: 1) Services & Materials
not included on Allowance Summary including cosmetic items & add-ons; 2) Orthoptics or vision
training & any associated supplemental testing; 3) Subnormal vision aids, non-prescription or anisei-
konia lenses; 4) Contact lenses for cosmetic enhancement such as changing eye color except as in-
cluded in the Allowance Summary; 5) Oversized 61 & above lens or lenses; 6) Medical or surgical
treatment of the eyes; 7) Any injury or illness covered by Worker’s Compensation or similar law; 8)
Two pairs of glasses in lieu of bifocals, trifocals, or progressives; 9) Care for services or materials
received while traveling in a foreign country without a detailed receipt in English; 10) Charges in-
curred after membership ends.
Frame/Contact Emp./ Emp./
Emp. Emp. + 1 Family Emp. Emp. + 1 Family
Lens Allowance Deps. Deps.
Platinum Complete Plan—12 month Platinum Material Only Plan—12
exam, lens, & frame benefit (Includes month lens & frame benefit (Includes
$180 progressive lens allowance) $180 progressive lens allowance)
$100/$105 $6.02 $9.63 $11.10 $18.89 $4.31 $6.90 $7.97 $13.54
$130/$130 $7.05 $11.29 $13.02 $22.14 $5.35 $8.57 $9.88 $16.80
$160/$160 $8.10 $12.95 $14.94 $25.40 $6.39 $10.23 $11.80 $20.06
$200/$200 $9.48 $15.17 $17.49 $29.75 $7.77 $12.44 $14.35 $24.41
Gold Complete Plan—12 month exam, Gold Material Only Plan—12 month
lens, & frame benefit lens & frame benefit
$100/$105 $5.25 $8.40 $9.69 $16.48 $3.54 $5.68 $6.54 $11.13
$130/$130 $6.29 $10.06 $11.61 $19.74 $4.59 $7.34 $8.46 $14.39
$160/$160 $7.33 $11.72 $13.52 $23.00 $5.62 $9.00 $10.38 $17.66
$200/$200 $8.71 $13.94 $16.08 $27.35 $7.01 $11.22 $12.94 $22.00
Silver PK Plan—12 month exam & lens, Rx Sunwear—12 month lens & frame
24 month frame benefit benefit
$100/$105 $4.68 $7.50 $8.64 $14.07 $3.83 $6.13 $7.07 $12.03
$130/$130 $5.20 $8.33 $9.60 $16.33 $4.86 $7.79 $8.99 $15.29
$160/$160 $5.72 $9.16 $10.56 $17.96 $5.91 $9.45 $10.90 $18.54
$200/$200 $6.42 $10.26 $11.56 $20.13 $7.29 $11.67 $13.46 $22.89
Exam Only Plan—12 month exam
$1.70 $2.72 $3.14 $5.34
More information can be found at haysusa.com/newemployee 15HEALTH SAVINGS ACCOUNT (HSA)
A Health Savings Account (HSA) is a plan designed to help you help pay your deductible of a High
Deductible Health Plan (HDHP) by allowing you to set aside money to pay for out-of-pocket medical
expenses. You set aside money on a pre-tax basis—this means as long as you use the money for
eligible expenses, you won’t pay income taxes on it. Unlike a healthcare flexible spending account
(FSA), HSA’s are employee-owned, meaning you take the HSA with you if you change employers
and any unused funds rollover to the following year.
You may be Eligible for a HSA if:
• You are covered by a High Deductible Health Plan (HDHP)
• You are not covered under another medical plan that is not a HDHP
• You are not enrolled in Medicare benefits
• You cannot be claimed on another person’s tax return
• You are not contributing to or have access to funds in a healthcare FSA through a spouse
Payroll Deduction
Contributing funds lowers your taxable income and allows you to build a nest egg for future
healthcare expenses. The amount you elect to contribute to your HSA will be payroll deducted and
deposited into the HSA account that you open. You may open a HSA account at any financial insti-
tute that offers this specialized account. The amount of payroll deduction can be changed during the
year by completing a new HSA deduction form available from HR. HSA funds cannot be used in ad-
vance like FSA funds are. You will be allowed to use only the amount available in your HSA account.
CARES Act Change
HSA can be used for even more since the CARES Act added Over the Counter (OTC) medicines
without a prescription and feminine care products to the list of eligible medical expenses.
To find out more about HSAs, please view Publication 969 on the IRS website (irs.gov).
2022 HSA Maximum Annual Contributions: Individual—$3,650; Family—$7,300, Catch-Up (for
employees over age 55) - $1,000. (Your maximum contribution may be different due to mid-year
changes. See IRS Publication 969 to see how this may affect you.)
More information can be found at haysusa.com/newemployee 16AFLAC & FLEXIBLE SPENDING ACCOUNTS (FSA)
AFLAC is supplemental insurance that provides an additional level of financial protection by provid-
ing cash to help with expenses health insurance doesn't cover like deductibles and copayments. The
plans offered include: Accident, Cancer, Critical Illness, and Hospital. Plan designs and premiums
may vary. Contact our AFLAC representative, Randy Weber, to discuss the plan options.
AFLAC also offers Flexible Spending Accounts. A Flexible Spending Account (FSA) lets you set
aside money from your paycheck on a pretax basis to use for eligible out-of-pocket expens-
es. There are three types of FSAs:
Health Care FSA – You can use this account to pay for eligible medical, dental, vision, hearing
and prescription drug expenses for you, your spouse, and your eligible tax dependents. The en-
tire amount you set aside is available to use on the first day of your plan year.
Dependent Care FSA – You can use this account to pay for eligible child and adult care expens-
es like day care, before and after school care, nursery school, preschool, and summer day
camp.
Limited Purpose FSA – You can generally use this account to pay for eligible dental and vision
expenses. You can enroll in this account, if you have or plan on opening a Health Savings Ac-
count (HSA). The entire amount you set aside is available to use on the first day of your plan
year.
Remember:
• Eligible expense must be incurred within the plan year (Jan 1 - Dec 31).
• The Healthcare and Limited Purpose FSA allows participants to carry over $500 into the next
year. If you have a FSA and money left over, it will automatically be rolled over to the following
year. If you plan on contributing to an HSA the following year, this rollover may make you ineligi-
ble for an HSA. Please visit with the AFLAC rep to get the money left over to rollover into a Lim-
ited Purpose FSA.
• Any unused funds over the $500 at the end of the plan year will be forfeited. Also called “Use it or
Lose it”.
• The contribution elections made will remain in effect until the end of the plan year unless a quali-
fying event occurs.
More information can be found at haysusa.com/newemployee 17HSA VS HEALTHCARE FSA
Funding predictable healthcare ex-
Funding lifetime of healthcare ex-
GENERAL penses in the current year with pre-
penses with pre-tax dollars.
tax dollars.
Owned by the employee. Keeps
Owned by the City. Ends when your
the HSA after the end of employ- CONTROL
employment ends.
ment.
Employees may adjust contribu-
Annual elections. Changes may only
tions throughout the year up to the CONTRIBUTIONS
be made due to a qualifying event.
IRS limit.
IRS Limit of $3,650 for Single Plan
and $7,300 for Family plan as well CONTRIBUTION
IRS Limit of $2,750
as an additional $1,000 for employ- LIMITS
ees over 55.
Must be paired with a qualified HEALTH PLAN
Can be paired with any health plan.
HDHP. ELIGIBILITY
Funds available once they have FUND All funds available on day one of the
been contributed. AVAILABILITY plan year.
Distributions for eligible expenses,
Distributions for eligible expenses and
investments returns, and contribu- TAX SAVINGS
contributions are tax-free.
tions are tax-free.
All funds carry over to the next plan Up to $500 may carry over to the next
CARRYOVER
year. year.
INVESTMENT
Yes No
CAPABILITY
IRS; Publication 969 MORE INFO IRS; Publication 969
More information can be found at haysusa.com/newemployee 18GOLF MEMBERSHIP
Non-seasonal City employees can elect to pay for golf membership at Fort Hays Municipal Golf
Course through payroll deduction. This allows employees to pay for theirs &/or their family’s golf
membership dues bi-weekly instead of a one-time lump sum. The bi-weekly amount is figured by tak-
ing your total membership costs divided by the number of payroll deductions left in the payroll year.
Employees wishing to take advantage of this will need to go to Fort Hays Golf Course & fill out a
membership card & when asked for payment, tell them you are a City of Hays employee & would like
to pay for membership through payroll deduction. They will provide you with a
form which will allow the City to deduct your membership costs equally through-
out the remaining payrolls. If you leave employment with the City of Hays before
paying off the membership fees, the remaining amount will be taken out of your
final paycheck. Remember you must renew your membership & payroll de-
duction each year.
AIRMEDCARE NETWARK MEMBERSHIP
EagleMed & many other Emergency Air Transportation companies have started the
AirMedCare network membership. The participating providers of the AirMedCare
Network provide air ambulance service that can help reduce time to the appropriate
trauma center. When you become a member, you will have no out-of-pocket flight
expenses if you are flown by one of their participating providers. With the City’s
membership with the Chamber of Commerce, employees & their household may sign
up for a 1-year membership for $65/year. To learn more, call Membership Sales Manager, Nate
Brown, at 785.216.9087 or visit AirMedCareNetwork.com. This is not a benefit offered by the City of
Hays & is not available as payroll deduction. Employees who would like to learn more or enroll would
need to deal directly with the AirMedCare Network. The enrollment form can be found at
haysusa.com/openenrollment.
GYM MEMBERSHIP DISCOUNTS
HRC Fitness: Single—$25.00; Family (up to 4)—$48.00; Student/Senior—
$23.00
Munsch Fitness: Single—$34.95
Must have 10 employees signed up for membership to get this rate.
The Center for Health Improvement: Single—$54.45; Spouse—$50.00; Family (Primary/Spouse/2
Dependents)—$125.00; Child—$20.00 (Age 13-21. Must be claimed on Primary’s taxes)
Must have 18 employees sign up for membership to get these rates (the City currently DOES NOT meet this require-
ment). Enrollment fees are waived if a one-year agreement is signed. HR has a limited number of guest passes for The
Center if anyone would like to try it before signing up. (One guess pass per employee per year.)
More information can be found at haysusa.com/newemployee 19EMPLOYEE ASSISTANCE PROGRAM (EAP)
The City of Hays offers all full-time employees and their families,
the Employee Assistance Program at no cost. Their website,
www.ndbh.com (password: Hays) is full of articles, videos, self-
assessments and planners to help you balance your work and
family life, support your emotional wellbeing and promote person-
al growth. To find out more about the free benefit, watch a pre-recorded webinar at http://
ndbh.adobeconnect.com/pbrwafj17gol/.
Your Benefits
To help you balance home & work, the EAP is provided to assist with:
• Workplace Conflicts
• Interpersonal Difficulties
• Marriage and Family Concerns
• Stress Management
• Emotional Upsets
• Financial Matters
• Alcohol & Drug Problems
You can depend on the expertise of New Directions Employee Assistance Program. When you call,
our licensed EAP professionals will help you resolve problems & offer you any needed referrals to
community & treatment resources.
They are here for YOU to help you find that balance between work & home so necessary to quality
living, yet so difficult to achieve without help. Call us, 24 hours a day, 365 days a year. Your con-
cerns will be treated with confidentiality consistent with all state & federal mandates. To schedule an
appointment, call 800-624-5544.
Legal Consultation
Most people don’t know where to turn with legal problems. Selecting an attorney is often an intimidat-
ing prospect. What will it cost? How should the choice be made?
Employees receive the benefits of a legal referral program that offers a 30 minute consultation with
an attorney, by telephone or in person. Ongoing consultation with the attorney is available. With one
quick phone call, employees can discover what steps to take when faced with a legal problem.
Financial & Credit Information/Referral
Changes in finances & accumulating debt can create great stress for anyone. Employees facing this
challenge can call our EAP counselors for support & the resources needed to settle financial issues.
Employees will receive referral to a credit consultant, when appropriate, combined with emotional
support & motivation to take control of finances. Call us for both the referral & a face-to-face appoint-
ment.
Family Resource Services
Childcare: Finding quality childcare is a big job. Sometimes the process is frustrating. At other times,
dealing with a child’s separation anxiety -- or yours -- can interfere with work performance. You can't
work well when you are worried about a child’s wellbeing.
Employees can call for referral to childcare resources or use the Balanced Life directories to find a
childcare provider by following this link to Personal Directions. Employees can call for referral to
childcare resources. We also provide support & strategies to reduce a child's reaction to separation
from a parent, making the transition from home to a sitter a comfortable one for all.
Eldercare: Caring for an aging parent can create work distractions & disruptions. Employees who
must find care for an elderly dependent can call New Directions for information, resources & support.
Available resources include transportation, physician, day-care, community programs & housing op-
tions.
More information can be found at haysusa.com/newemployee 20KPERS 457 PLAN
Saving through the optional KPERS 457 (deferred compensation)
Plan is a simple way to help supplement your KPERS/KP&F and
Social Security benefits. It can help you bridge the gap between
your financial goals and your destination in retirement. You can choose to pay taxes on your contri-
butions now (Roth) or when you take money out (Pre-Tax) or both. For the most part, the plan oper-
ates similarly to a 401(k) or 403(b) plan most people are familiar with. The key difference is that, un-
like with a 401(k) plan, there is no 10% early withdrawal tax penalty (although the withdrawal is sub-
ject to ordinary income taxation).
Your KPERS 457 offers a range of professionally screened investment options. If you would like
help managing your account, KPERS 457 offers Online Advice provided by Advised Assets Group,
LLC. This service is designed to help you choose specific investments based on your person goals
and financial situation—at no additional cost to you.
Take advantage of several innovative resources, tools, and calculators on kpers457.org. You may
also enroll or make changes online at kpers457.org.
2022 Contribution Limits: $20,500, additional $6,500 if over age 50
Contact Person: Joe Hillebrand, joseph.hillebrand@empower-retirement.com, 785.213.7175
UNITED WAY OF ELLIS COUNTY
United Way of Ellis County supports 16 partner agencies in the county. At United Way, they focus on
creating lasting impacts and encouraging a strong foundation in education, health, and finance. Be-
cause of their funding request and reporting requirements, 100% of the funds collected stay within
the county. Where the funds go is decided by the CARE Council, who is made up of citizens within
Ellis County. Even the smallest contributions can change the community.
Employees who wish to contribute have many different ways to give to United Way of Ellis County.
1. Payroll Deduction (Super Easy!)
2. Donate directly on their website at liveunited.us.
3. Set up automatic withdrawals from your bank account.
4. Round Up Giving: Rounds up your bank/credit card to the nearest dollar to a set amount monthly.
5. AmazonSmile: While shopping Amazon, select United Way of Ellis County as your favorite chari-
ty.
Any employees currently doing payroll deduction for United Way will continue to have their donation
collected through payroll deduction and given to United Way. Any employee wanting to cancel,
make changes or start payroll deduction for United Way of Ellis County should contact HR or
complete the Open Enrollment Form.
Visit liveunited.us/campaign for more information about the United Way campaign
More information can be found at haysusa.com/newemployee 21LEGAL NOTICES
CONTINUATION OF HEALTH PLAN COVERAGE
A federal law, commonly referred to as COBRA (for Consolidated Omnibus Budget Reconciliation
Act) gives you and your covered dependents the right to continue health plan coverage in certain
circumstances when it would otherwise end. These include termination of employment or reduction
in hours causing loss of plan eligibility of the covered employee, as well as for covered dependents,
the death of the covered employee, a divorce or legal separation from the covered employee, or
ceasing to be an eligible dependent child of the employee.
IT IS VERY IMPORTANT THAT YOU NOTIFY HUMAN RESOURCES IF YOU EXPERIENCE A DI-
VORCE/LEGAL SEPARATION OR HAVE A DEPENDENT WHO NO LONGER MEETS THE ELI-
GIBILITY RULES OF THE PLAN.
If you do not notify Human Resources of one of these events within 60 days, your covered depend-
ents will lose the right to continue their coverage under COBRA. More details are available in the
COBRA notification material on the City’s Intranet Web Page.
NOTICE OF SPECIAL ENROLLMENT PROVISIONS
If you are declining enrollment for yourself or your dependents (including your spouse) because of
other health plan coverage, you may, in the future, be able to enroll yourself and/or your dependents
in this plan, provided that you request enrollment within 30 days after you or your dependents lose
eligibility for that other coverage (or employer contributions toward that coverage end). In addition, if
you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you
may be able to enroll yourself and your dependents, provided that you request enrollment within 30
days after the marriage, birth, adoption, or placement for adoption. To request special enrollment,
contact the Human Resources Department.
SPECIAL RULES FOR MOTHERS & NEWBORNS
Group health plans and health insurance issuers generally may not, under Federal Law, restrict ben-
efits for any hospital length of stay in connection with childbirth for the mother or newborn child to
less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section.
However, Federal law generally does not prohibit the mother’s or newborn’s attending provider, after
consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96
hours as applicable). In any case, plans and issuers may not, under Federal law require that a pro-
vider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in
excess of 48 hours or (96 hours).
HIPAA PRIVACY
The City’s Medical Plan is required by law to take reasonable steps to ensure the privacy of your
personally identifiable health information and to inform you about the uses of protected health infor-
mation (PHI) and your privacy rights. PHI use and disclosure by the City’s Medical Plan is regulated
by federal law known as HIPAA (the Health Insurance Portability and Accountability Act). A copy
may be found within the City’s Personnel Manual.
More information can be found at haysusa.com/newemployee 22LEGAL NOTICES
WOMEN’S HEALTH & CANCER RIGHTS ACT OF 1998
If you had or are scheduled to have a mastectomy, you may be entitled to certain benefits under the
Women’s Health and Cancer Rights of 1998. For individuals receiving mastectomy-related benefits,
coverage will be provided in a manner determined, in consultation with attending physician and the
patient, for:
1. All stages of reconstruction of the breast on which the mastectomy was performed;
2. Surgery and reconstruction of the other breast to produce a symmetrical appearance;
3. Prostheses; and
4. Treatment of physical complications during all stages of the mastectomy, including lymphedemas.
These benefits will be provided, subject to the same deductible, copays, and coinsurance applicable
to other medical and surgical benefits under the plan.
HEALTH INSURANCE MARKETPLACE COVERAGE OPTIONS & YOUR HEALTH COVERAGE
PART A: GENERAL INFORMATION
When key parts of the health care law took effect in 2014, there was a new way to buy health insur-
ance: the Health Insurance Marketplace. To assist you as you evaluate options for you and your
family, this notice provides some basic information about the new Marketplace and employment
based health coverage offered by your employer.
WHAT IS THE HEALTH INSURANCE MARKETPLACE?
The Marketplace is designed to help you find health insurance that meets your needs and fits your
budget. The Marketplace offers "one-stop shopping" to find and compare private health insurance
options. You may also be eligible for a tax credit that lowers your monthly premium right away. Open
enrollment for health insurance coverage through the Marketplace begins in October for coverage
starting as early as January 1.
CAN I SAVE MONEY ON MY HEALTH INSURANCE PREMIUMS IN THE MARKETPLACE?
You may qualify to save money and lower your monthly premium, but only if your employer does not
offer coverage, or offers coverage that doesn't meet certain standards. The savings on your premi-
um that you're eligible for depends on your household income.
DOES EMPLOYER HEALTH COVERAGE AFFECT ELIGIBILITY FOR PREMIUM SAVINGS
THROUGH THE MARKETPLACE?
Yes. If you have an offer of health coverage from your employer that meets certain standards, you
will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer's
health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a re-
duction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer
coverage that meets certain standards.
If the cost of a plan from your employer that would cover you (and not any other members of your
family) is more than 9.83% (subject to change by federal government) of your household income for
the year, or if the coverage your employer provides does not meet the "minimum value" standard set
by the Affordable Care Act, you may be eligible for a tax credit.1
1
An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total
allowed benefit costs covered by the plan is no less than 60 percent of such costs.
More information can be found at haysusa.com/newemployee 23You can also read
