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January 1, 2016

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Eagle County’s 2016 Benefit

Enrollment Guide

important information enclosed

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TABLE OF CONTENTS

Introduction

Health

Patient

Dental

Vision

Rates 07

Life Insurance/Travel Connect Program 08

Employee Assistance Program (EAP) 09

Flexible Spending Accounts (FSA) 10

Worksheet 11

Short / Long Term Disability 12

Retirement and more...

Other

13

14

Leave

Medical Providers 16-17

Important Contacts 18

Important Notices 19-20

Notes 21-22

01

MISSION

Creating a Better Eagle County for All

VALUES

C

reativity

R

espect

E

ngagement

A

ccountability

T

eam

E

xcellence

INTRODUCTION

Eagle County recognizes the importance of providing a comprehensive benefits program. That is why all our full-time employees working 30 hours or more each week, are benefit eligible employees in addition to those that qualify through ACA. These benefits help provide employees and their family members opportunities to maintain their health and overall wellness.

In this “Benefit Guide” employees will be able to review:

• A description of Eagle County’s comprehensive Employee Benefit Program

• Important annual notices that Eagle County must provide all benefit eligible employees

• Important phone numbers and websites to help employees manage their benefits

For complete details of each benefit plan refer to the full text of the official Summary Plan Descriptions available through the Eagle County Human Resources

Department.

Please review this Benefits Guide to further understand your benefit enrollment options, and please retain this Benefits Guide for reference throughout the year.

If you need further assistance, contact the Eagle County Human Resources Department:

Phone: 970.328.8790

Eagle County Human Resources

P.O. Box 850

500 Broadway

Eagle, CO 81631-0850

Lastly, we encourage all employees to read this entire

Benefits Summary before you enroll!

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03

HEALTH & WELLNESS

Medical and dental insurance are combined in the cost of your benefits. Wellness exams are not subject to the deductible. Prescription coverage includes a mail-order prescription benefit.

Health & Wellness PPO

In-Network Out-of-Network

MEDICAL PLAN HIGHLIGHTS

Health & Wellness

Calendar Year Deductible

Individual/Family

Out-of-Pocket Maximum

Individual /Family

Coinsurance

Physician Office Visit

Preventive Care

In-Patient Hospital

Out-Patient Hospital

Lab / X-ray

Diagnostic Procedures

(MRI/CT/PET/High Tech Imagery)

Emergency Room

Urgent Care

Mammogram / Colonoscopy /

Sigmoioscopy

$600/$1,200

$3,000/$4,500

80%

$25

100%

80% after deductible

80% after deductible

80%, deductible waived

80% after deductible

80% after deductible

$35 copay

$600/$1,200

$4,000/$7,000

70%

70% after deductible

No coverage

70% after deductible

70% after deductible

70% after deductible

70% after deductible

70% after deductible

70% after deductible

100% 1 time per year - Diagnostic or preventative and no age restrictions

Prescription Drugs

(30 day supply)

Generic Copay

Preferred Brand Copay

Non-Preferred Brand

Kroger Mail-Order Drugs

(90 day supply)

Generic Copay

Preferred Brand Copay

Non-Preferred Brand

Prescription / Rx

Out-of-Pocket Maximum

$0

$30

$60

$0

$60

$120

$1,000 / $1,750

No coverage

No coverage

No coverage

No coverage

PATIENT CARE: Your Health Care Advocate!

Help Eagle County by engaging in the cost of healthcare and you can share in the savings!

Patient Care will:

• Help you find a doctor or hospital

• Answer questions about your benefits

• Resolve claims and billing issues

• Clarify the total and out-of-pocket costs for services

• Assist with prescription drugs

• Help you navigate health care reform

• Compare cost and quality of upcoming medical procedures

How much do the costs vary?

The Patient Care top 10 list:

1. Colonoscopy:

2. Mammogram:

3. MRI:

4. Ultrasound:

$950 - $8,550

$110 - $3,000

$325 - $7,300

$95 - $2,600

5. Delivery (routine): $6,700 - $25,550

6. Bone Density Test:

7. CT Scan:

8. X-ray:

9. Vasectomy:

10. Sleep Study:

$950 - $8,550

$200 - $7,800

$80 - $1,200

$1,200 - $7,900

$900 - $5,800

Get Rewarded!

Call Patient Care seven days before you schedule an elective procedure (mammogram, MRI, colonoscopy, etc.) and your Advocate will provide a cost comparison of up to three providers for your procedure. Choose a lower cost option and receive 20% of the savings .

Contact Patient Care at 866.253.2273 Monday - Friday 8am-9pm EST and Saturday 9am-2pm EST or for more information visit www.patientcare4u.com

.

04

YOUR DENTAL PLAN

This is a brief overview only and is not a complete list of your covered services. Please refer to your Summary Plan Description (SPD) for a detailed list.

Plan

Network

Calendar Year Maximum

Deductible / Family

Deductible Applies to

Covered Services

Diagnostic & Preventive

Oral Evaluation and cleanings, Fluoride, Sealants, Space Maintainers,

Bitewing x-rays, Full Mouth / Panoramic x-rays

Basic Services

Waiting Periods

Minor Restorative (fillings), Oral Surgery (extractions),

General Anesthesia (with oral surgery only)

Endodontics (root canal therapy), Periodontics (gum treatment)

Major Services

Waiting Periods

Crowns, Dentures, Partials, Bridges, Bridge/Denture Repair,

Denture Rebase/Reline

Orthodontics

Waiting Periods

Coinsurance

Age Limit

Lifetime Benefit Maximum

Single Choice Plan

Delta Dental PPO

SM

Plus Premier

Delta Dental PPO Delta Dental Premier® Out-of-Network

$1,500

$50 / $150

Basic and Major

100%

No Waiting Period

80%

No Waiting Period

80%

100%

No Waiting Period

80%

No Waiting Period

80%

No Waiting Period

50%

Children and Adults

$1,000

100%

No Waiting Period

80%

No Waiting Period

80%

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YOUR VISION PLAN

This is a brief overview only and is not a complete list of your covered services. Please refer to your Summary Plan Description (SPD) for a detailed list.

VSP Choice Plan

Exam Services

Lenses

Frame

• Comprehensive well vision exam covered in full after $10 copay

• Routine retinal screening covered after $39 copay

Glass or Plastic: Single Vision Covered-in-full after copay

Lined Bifocal Covered-in-full after copay

Lined Trifocal Covered-in-full after copay

Lenticular Covered-in-full after copay

• Frames covered-in-full after copay up to the retail allowance of $130.

• Frame allowance is guaranteed by a $50 wholesale allowance at VSP doctors, ensuring more than 13,000 frames are covered-in-full.

• Members who select a featured frame brand including Ann Klein, bebe®, Calvin Klein, Flexon,

Lacoste, Nike, Nine West, and more will receive an extra $20 towards their frame allowance.

• 20% off any amount above the retail frame allowance

• Members can choose from virtually any frame on the market.

• Prescription contact lens materials covered-in-full up to $130 retail allowance.

Elective Contact Lenses

(instead of lenses and frame)

Necessary Contact Lenses

(instead of lenses and frame)

• Covered-in-full after copay for members who have specific conditions at VSP doctors.

• Covered up to $20 after copay for members who have specific conditions at participating retail chains.

Out-of-Network Benefits subject to applicable copays

Exam

Lenses:

Single Vision

Lined Bifocal

Lined Trifocal

Lenticular

Reimbursed up to $45

Reimbursed up to $30

Reimbursed up to $50

Reimbursed up to $65

Reimbursed up to $100

06

CONTRIBUTION RATES FOR 2016

Your monthly employee contribution rates are listed below:

Medical & Dental Contributions

Employee Contribution Rates

Employee Only

Employee + Spouse

Employee + Child(ren)

Family

Note: Medical and Dental is a combined package.

Health &

Wellness PPO

$65

$240

$225

$370

Vision Contributions

Employee Contribution Rates

Employee Only

Employee + Spouse

Employee + Child(ren)

Family

VSP Vision Plan

$0

$7

$7

$23

PPO w/Wellness

(rebate score of 85+ each for employee and spouse)

$45

$200

$205

$330

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BASIC LIFE & ACCIDENTAL INSURANCE

As a full-time employee of Eagle County, you are eligible for a variety of company- sponsored benefit plans. Eagle County offers Basic Life and Accident

Insurance (also referred to as AD&D).

The Basic Life benefits are listed below based on your annual gross pay. The AD&D insurance is equal to the amount of life insurance coverage you have in the event of death due to an accident. The dismemberment coverage varies and is determined according to the extent of loss.

BASIC LIFE COVERAGE COMPANY PAID BENEFITS 2x Salary

Annual gross pay between

$50,000 & $200,000

$50,000 benefit minimum

$200,000 benefit maximum

Additional Life Insurance is available on a Voluntary Basis (Employee Paid).

VOLUNTARY LIFE & ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE

If you would like to supplement your Basic Life insurance, you may purchase additional coverage through Mutual of Omaha. When you enroll yourself

(and dependents), you pay the full cost through payroll deductions.

Employees currently enrolled in Voluntary Life may increase their elections by 2 increments ($10,000 each), up to the plan maximum of $200,000 at each open enrollment.

TRAVEL CONNECT PROGRAM

As an Eagle County Employee you are given the TravelConnect program, which focuses on travel, medical and safety-related services you may need while traveling. The TravelConnect benefit is provided at no additional cost to you and includes a wealth of services when traveling just 100 miles or more from home. Services are provided for both business and leisure travel. Whether you want the weather forecast for your destination or need emergency medical help halfway around the world, TravelConnect has the staff and resources to provide support 24 hours a day, seven days a week. To use

TravelConnect services, call 800 527-0218 or 410 453-6330, and provide them with ID number 322541.

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08

EMPLOYEE ASSISTANCE PROGRAM’s (EAP)

Mutual of Omaha

www.mutualofomaha.com

Mutual of Omaha’s EAP assists employees and their eligible dependents with personal or job-related concerns, including:

• Emotional well-being

• Family and relationships

• Legal and financial matters

• Healthy lifestyles

• Resources for:

• Financial tools & resources

• Substance abuse and other addictions

• Dependent and elder care assistance & referral services

• Access to a library of educational articles, handouts and resources via www.mutualofohmaha.com/eap.

• Work and life transitions

• Legal Assistance and financial services

• Online will preparation

• Legal library & online forms

• Telephonic financial consultation

Below is a small list of some of the EAP benefits provided for you:

• Unlimited telephone access to EAP professionals 24 hours a day, 7 days a week

• Telephone assistance and referral

• Service for employees and eligible dependents

• Robust network of licensed mental health professionals

• Four face-to-face sessions* with a counselor (per household per calendar year)

* Face-to-face visits can also be used towards legal consultations.

ADDITIONAL RESOURCES for EAP

Mind Springs Health

www.mindspringshealth.org

Here is a list of the core locations to further assist you. There are many more locations available, please see your HR representative for more information.

• Aspen: 970.920.5555

• Eagle: 970.328.6969

• Glenwood: 970.945.2583

• Vail: 970.476.0930

• Four face-to-face sessions with a counselor

Samaritan Counseling Center of the Rockies

www.samaritan-vail.org

• Samaritan Counseling Center: located in Edwards Co, 81632, 970.926.8558

• Four face-to-face sessions with a counselor.

What to Expect

You can trust your EAP professional to assess your needs and handle your concerns in a confidential, respectful manner. Our goal is to collaborate with you and find solutions that are responsive to your needs. Your EAP benefits are provided through your employer. There is no cost to you for utilizing EAP services. If additional services are needed, your EAP will help locate appropriate resources in your area.

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FLEXIBLE SPENDING ACCOUNTS

Eagle County offers Health and Dependent Care Flexible Spending Accounts (FSAs) which allows you to use tax-free dollars to reimburse yourself for a wide variety of health and/or dependent care expenses not covered through your other benefit plans. Eagle County is partnering with Wage Works to administer the health and dependent care spending accounts. Remember, carefully estimate expenses using the information provided on the enrollment form. The maximum annual contribution for the Health Care FSA is $2,550. You are able to rollover unused medical flex funds, up to $500, to be used in the next calendar year.

The maximum annual contribution for the Dependent Care FSA is $5,000 ($2,500 if you are married and filing a separate income tax return). Use the worksheet on page 16 to calculate your specific healthcare expenses. Additional benefits included in your FSA through Wage Works are listed below:

• Mobile application available (includes claims submission)

• Direct Deposit is available at no cost

• Account Summary Statements are available online

Automated Customer Service is available 24 hours a day, 7 days a week every day of the year. Agents are available 8:00 am - 8:00 pm EST.

(877) - WAGEWORKS

(924-3967)

Comprehensive Web Tools available www.wageworks.com

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FLEXIBLE SPENDING ACCOUNT WORKSHEET

BENEFIT

Deductibles and Coinsurance

Office Visit CoPays

Prescription Drug CoPays

Chiropractic Treatment/Acupuncture

Infertility Treatments

Birth Control Pills, Devices, and Surgical Procedures

Medical Equipment and Supplies

(Wheelchairs, Braces, Crutches, Oxygen, Etc.)

Transportation (mileage, lodging and meals if necessary to obtain health care) $

$

$

$

$

$

$

$

YOUR

EXPENSES

Christian Science Practitioner

Over the Counter Medication with physician’s prescription

Other (See IRS Publication 502 for Listing of Deductible Medical Expenses)

$

$

VISION AND HEARING CARE (not covered by insurance)

Eye Exams

Frames and Lenses

Contact Lenses, Cleaning Solutions and Supplies

Hearing Aids and Batteries

Radial Keratotomy Surgery to Correct Vision

DENTAL EXPENSES (not covered by insurance)

Deductibles and Coinsurance

Exams, Cleanings and X-rays

Fillings

Fluoride Treatments

Crowns, Bridges and Dentures

Orthodontia (Please see “Orthodontic Treatment” Worksheet

Other Eligible Dental Expenses (See IRS Publication 502)

TOTAL ESTIMATED UNINSURED MEDICAL EXPENSES (Sum of Your Expenses and Expenses for Your Spouse and Dependents):

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

EXPENSES FOR YOU

& DEPENDENTS

11

SHORT-TERM DISABILITY

Eagle County provides short-term disability coverage at 60% of the employee’s regular rate of pay for up to 26 weeks. Full-time employees are eligible for Short-Term Disability (STD) on the 1st day of the month coincident with or next following 1 year of employment.

COVERAGE TO AGE 65

Short Term Disability

ELIMINATION PERIOD

7 days

MAX WEEKLY BENEFIT

Replaces 60% of base weekly earnings up to $2,000 per week

LONG-TERM DISABILITY

Eagle County provides long-term disability coverage at 60% of the employee’s regular rate of pay after a six-month waiting period.

COVERAGE TO AGE 65 ELIMINATION PERIOD

Long Term Disability 180 days

MAX MONTHLY BENEFIT

60% of monthly salary to a maximum benefit of $5,000

Directors, Full-Time

Managers & Elected

Officials receive a maximum benefit of

$8,000

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RETIREMENT 401A

Eagle County is a member of Colorado County Officials & Employee Retirement Association (CCOERA). All full-time employees are required to participate as a condition of employment. Employees may choose to contribute 3%, 4%, 5% or 6%. The County will match the percentage you choose. Employees may self-direct their contributions into certain investments as allowed by CCOERA. Vesting occurs at 25% per year starting with your first year of contributing (i.e. 00/25/50/75/100%). Employees are totally vested after participating in the retirement plan for five years. Employees 55 years of age and older, as well as elected officials are always 100% vested in the County’s retirement plans.

ROTH (Roth 457b vs. traditional 457b)

What’s the difference?

With a traditional 457(b) plan, your contributions are made before taxes, so you save on your current tax bill. Contributions and earnings grow taxdeferred, and withdrawals at retirement are taxed at ordinary income tax rates. Benefit = up front tax savings and tax-deferred growth.

With a Roth 457(b) plan, your contributions are made on an after-tax basis; taxes on the contributed amount are paid up front and there is no current tax break. Contributions and earnings grow tax-free and can be withdrawn tax-free at retirement if certain conditions are met. Benefit = tax-free growth and distributions when you retire.

Is Roth right for you?

You have a decision to make. Your decision boils down to whether you want to contribute pretax or after-tax dollars, and that may depend on your goals and financial circumstances. If you expect your tax bracket to be lower in retirement than it is now, it may make sense to contribute to a traditional plan and take advantage of the tax break now. However, if you expect your tax bracket to be the same or higher in retirement, it may make sense to contribute to a Roth 457(b) and benefit from tax-free withdrawals later. You are eligible to contribute both Pre-Tax 457(b) and Roth 457(b).

ROTH 457b

• After-tax Contributions (taxes prepaid)

• Tax-free Investment Earnings

• Future Withdrawals are 100% Tax-free upon separation from employment, if held at least 5 yrs and to age 59 ½

TRADITIONAL PRE-TAX 457b

• Before-tax Contributions (taxes postponed)

• Tax-deferred Investment Earnings

• Future Withdrawals are Fully Taxable upon separation from employment

DEFERRED COMPENSATION 457b

Employees may participate in the 457b plan immediately upon hire. Employees may self-direct their contributions. Anyone under the age of 50 may contribute up to a total of $18,000 (2015). Employees 50 years of age and older may contribute up to an additional $6,000 catch-up amount. These amounts may be adjusted for 2016. Eagle County matches 2% of the employee contribution amount.

FMLA-FAMILY MEDICAL LEAVE

Under FMLA, eligible employee’s jobs and benefits are protected for up to 12 weeks for the birth and care of a newborn, serious health conditions of the employee, their spouse, child, parent or an adoption. Employees must use all available medical and personal leave time. As part of the 12 weeks once medical and personal leave has been exhausted, the remaining time of leave is unpaid.

13

MEDICAL LEAVE

Medical leave is available for regular employees working 20 hours or more per week for use when an employee is unable to perform his/her job duties for medical reasons, scheduled examinations, or to care for an injured or ill member of the family. Medical leave will be pro-rated according to FTE (fulltime equivalency) for part-time employees. Full-time employees accrue medical leave at 3.38 hours per pay period, up to a maximum of 320 hours.

FAMILY HERITAGE

Family Heritage is an industry-leading provider of life and supplemental health insurance products to families and businesses throughout America.

Family Heritage offers products that are in greater need now than ever, paying cash directly to families dealing with illness and accidents. They specialize in catastrophic coverage, so regardless of whether it is a policy for cancer; heart disease, heart attack or stroke; or accidental injury, Family Heritage is here to serve your needs. They also offer unique life insurance and additional coverage for intensive care unit confinements.

Many of the Family Heritage supplemental insurance policies include their flagship Return of Premium Benefit. If you keep your policy in force for a number of years as specified in your policy, and if you pay all your premiums, you will receive all your money back, minus the total amount of claims that have been paid to you.

WELLNESS

A $300 wellness benefit is available to employees for the purchase of wellness related expenses. This is a taxable benefit. An additional $150 benefit can be earned if a spouse also participates. Contact Human Resources for further details.

DISCOUNTED RECREATION CENTER PASSES

Eagle County has special discounted programs with the Gypsum Recreation Center and the Eagle Ranch Fitness Center.

DIRECT DEPOSIT

Employees may have their bi-weekly pay checks directly deposited into a maximum of three each checking and/or savings accounts at any bank of their choice.

EMPLOYEE VOLUNTEER PROGRAM

Eagle County Government wants to encourage and support our employees in their efforts to give back to the community. Full-time employees working

30 hours or more hours per week who have been employed for at least six months are eligible to receive up to eight hours per calendar year of paid leave for the purpose of volunteering. Part-time employees are eligible for up to four hours.

UNITED WAY

United Way Eagle River Valley provides support for those in need in our valley. This local support can make a big difference to our neighbors’ quality of life. Payroll deduction is available which makes it easy for employees interested in making a contribution.

EDUCATION

Eagle County University (ECU)

In conjunction with Colorado Mountain College and other professionals, we offer leadership, computer, business-related and other important courses to all employees to build their skills. We believe in learning and growing in your job and want to contribute to that growth. These courses are offered at the County campuses during work hours.

Tuition Reimbursement

Regular employees working at least 30 hours per week who are enrolled in a degree program, related to their employment, are eligible for tuition reimbursement up to $2,500 annually (books and additional fees must be covered by the employee).

Free Colorado Mountain College classes

Credit classes in the 100 and 200 levels offered at the Edwards campus are free to Eagle County employees (books and fees must be covered by the employee).

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HOLIDAYS

The Board of County Commissioners approves 11-12 holidays each year. Holiday pay for regular, part-time employees is pro-rated.

Personal Leave

Personal leave is provided for vacation or personal matters for regular employees working 20 or more hours per week. Full-time employees earn personal leave in accordance with the following schedule:

0

3

5

years through the completion of year 2

years through the completion of year 4

years through the completion of year 9

10+

12 days/3.70 hours per pay period

14 days/4.31 hours per pay period years

17 days/5.23 hours per pay period

22 days/6.77 hours per pay period

Part-time employees accrue on a pro-rated basis. Leave accrual is capped at 240 hours. Accrued personal leave is paid out to employees who leave the

County if they have been employed for at least three months.

Funeral Leave

The County offers Funeral Leave of 40 hours for immediate family. We also offer Funeral Leave of 8 hours for extended family or a personal friend.

ECO Free Bus Passes

Employees ride free of charge. Just like your employee ID, the employee bus pass is for your exclusive use and cannot be transferred or sold.

Service Recognition Program

Eagle County offers a service recognition program for 5, 10, 15, 20, 25, 30 and 35 years of service.

WORKERS COMPENSATION

The County is committed to a safe work environment for employees. Employees should report any unsafe practices or conditions to their supervisor.

If medical treatment for an on-the-job injury is needed, it must be obtained from one of the County’s designated physicians. If not, the employee may be responsible for the cost of medical treatment. If the injury requires immediate emergency treatment, employees and supervisors should utilize the nearest emergency facility or notify “911” for assistance.

DESIGNATED MEDICAL SERVICE PROVIDERS

Eagle

Eagle Valley Medical Center

0377 Sylvan Lake Rd., Suite 220

Eagle, CO 81631

970-328-1650

Colorado Mountain Medical, P.C.

320 Beard Creek Road

Eagle, CO 81631

970-328-1650

Edwards

Colorado Mountain Medical, P.C.

320 Beard Creek Road

Edwards, CO 81632

970-926-6340

Continued on the next page....

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ADDITIONAL DESIGNATED MEDICAL SERVICE PROVIDERS

Vail

Colorado Mountain Medical, P.C.

181 West Meadow Drive, #200

Vail, CO 81658

970-476-5695

Basalt/El Jebel

Glenwood Medical Associates

1905

Glenwood Springs, CO 81601

970-945-8503

*Benefits are subject to eligibility requirements and are

subject to change. Contact Human Resources for details.

CONTACT INFORMATION

If you have questions that are not answered in this booklet, please contact the appropriate carrier below.

BENEFIT

Medical

RX

Dental

Vision

Short-Term Disability

Long-Term Disability

Flexible Spending Accounts

Basic Life / AD&D

Patient Advocacy

Employee Assistance Program

United Way

Family Heritage Insurance

Human Resources Department

CONTACT

CNIC Health Plans (800) 426-7453 www.cnichs.com

(Account # 22204026)

Kroger Prescription Plans (800) 482-1285 www.kp-rx.com

Delta Dental Health Plan (800) 610-0201 www.deltadentalco.com

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

CNIC Plans (800) 426-7453 www.cnichs.com

(Account # 22204026)

Mutual of Omaha (800) 877-5176 www.mutualofomaha.com

Wage Works (877) WAGEWORKS www.wageworks.com

(924-3967)

Mutual of Omaha (800) 775-8805 www.mutualofomaha.com

(Account # 6988150)

Patient Care (866) 253-2273 www.patientcare4u.com

Mind Springs Health Eagle (970) 328-6969

Vail (970) 476-0930

Samaritan Counseling Center Edwards (970) 926-8558

Mutual of Omaha (800) 316-2796 www.mutualofomaha.com

www.unitedwayeagle.org

Jeff Cerovich (970) 306-7050 www.familyheritagelife.com

Eagle County (970) 328-8790

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IMPORTANT LEGAL NOTICES

Federal regulations require Eagle County to provide benefits-eligible employees with the following notices:

Private Health Information

A portion of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) addresses the protection of confidential health information. It applies to all health benefit plans. In short, the idea is to make sure that confidential health information that identifies (or could be used to identify) you is kept completely confidential. This individually identifiable health information is known as “protected health information” (PHI), and it will not be used or disclosed without your written authorization, except as described in the Plans HIPAA Privacy Notice or as otherwise permitted by federal and state health information privacy laws, A copy of the Plan’s Notice of Privacy Practices that describes the Plan’s policies, practices and your rights with respect to your PHI under HIPPM is available from your medical plan provider. For more information regarding this Notice, please contact Human Resources or the medical plan directly.

Women’s Health and Cancer Rights Act

On October 21, 1998, Congress passes a bill called the Women’s Health and Cancer Rights Act. This new law requires group health plans that provides coverage for mastectomy to provide coverage for certain reconstructive services. These services include:

• All stages of reconstruction of the breast on which the mastectomy was performed

• Surgery and reconstruction of the other breast to produce a symmetrical appearance

• Prostheses and treatment of physical complications resulting from mastectomy (including lymphedema)

In addition, the plan may not:

• Interfere with a woman’s rights under the plan to avoid these requirements

• Offer inducements to the health provider, or assess penalties against the health provider, in an attempt to interfere with the requirements of

the law.

This coverage will be provided in consultation with the attending physician and the patient, and will be subject to the same annual deductibles and coinsurance provisions that apply to the mastectomy. For more information, contact your medical plan provider.

Special Enrollment Rights

If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance coverage, you may be able to enroll yourself and your dependents in the Eagle County health plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing towards you or your dependents’ other coverage). However, you must request enrollment in writing within 30 days after you or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage). 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 in writing within 30 days after the marriage, birth, adoptions, or placement for adoption. For more information, contact Human Resources.

Notice of Prescription Drug Creditable Coverage

Eagle County provides a “Notice of Prescription Drug Creditable Coverage” to all Medicare-eligible participants on an annual basis. This notice states that under the Eagle County medical plan, you have prescription drug coverage that is, on average, as generous as the standard Medicare prescription Drug

Coverage. A copy of this notice is also available upon request from Human Resources.

Individual Coverage Mandate

Effective January 1, 2014, Federal law requires that you have Health Care coverage or you may be subject to an income tax penalty. You can enroll in

Eagle County’s health plan, or you may want to consider visiting www.healthcare.gov for information on health plans available through the Healthcare

Marketplace in your area.

Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and you are eligible for health coverage from your employer, your State may have a premium assistance program that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for these programs, but also have access to health insurance through their employer. If you or your children are not eligible for Medicaid or CHIP, you will not be eligible for these premium assistance programs. 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 at 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, as well as eligible under your employer plan, your employer must permit you to enroll in your employer plan if you are not already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, you can contact the Department of Labor electronically at www.askebsa.dol.gov

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COLORADO-Medicaid

Medicaid Website: http://www.colorado.gov/ | Medicaid Phone: 1-800-221-3943 | For all other states: (877) 267-2323, Ext. 61565

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Notes

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Choose your Benefits Wisely

Photo by Jack Affleck

P.O. Box 850

500 Broadway

Eagle, Colorado

81631-0850

970-328-8600

This booklet and the materials that accompany it are intended to provide only a general overview of the benefit programs for eligible Eagle County employees. This booklet is not a summary plan description and does not provide, nor is it intended to provide, complete details of any of the benefit plans. The plans are governed by legal plan documents and insurance contracts. If this booklet (and/or the materials that accompany it) and the plan documents or insurance contracts do not agree, the plan documents or the insurance contracts will rule. This brochure is not intended as a promise of continued benefits or employment. Eagle County reserves the right to change or end the plans at any time and for any reason.

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