2014
Employee
Benefits Guide
medical | dental | vision | life | disability & more
Eagle County’s 2014
Employee Benefit Guide
important information enclosed
Purpose
To enhance the quality of people’s lives
Mission
To be the model of excellence for mountain communities
Values
Passion
The commitment to never be satisfied and go beyond the best
Respect
The willingness to accept diversity and differences
Integrity
The responsibility to be honest and fair
Courage
The ability to do what’s right, even when it is unpopular
Engagement
01
Involving staff and the community
INTRODUCTION
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Eagle County recognize
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That is why all our full-tim
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eligible employees. Thes
all wellness.
in their health and over
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“B
In this
fit Program
ensive Employee Bene
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employees
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ovide all benefit eligible
• A description of Ea
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Ea
tices that
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• Important annual no
help employees manag
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• Important phone nu
ial Summary Plan
the full text of the offic
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be
each
Department.
For complete details of
unty Human Resources
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Descriptions available
, and
nefit enrollment options
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fits Guide to furth
ar.
Please review this Bene
rence throughout the ye
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please retain this Be
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man Resources Departm
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Ea
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th
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tance, contac
If you need further assis
Phone: 970.328.8790
eagleCounty.us /
berniece.gutierrez@
Email:
Resources
Eagle County Human
P.O. Box 850
500 Broadway
50
Eagle, CO 81631-08
s
.u
www.eagleCounty
ounty.us
lisa.ponder@eagleC
re
es to read this enti
ye
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Lastly, we enco
before you enroll!
Benefits Summary
TABLE OF CONTENTS
Health & Wellness
03
Dental and Vision Plan 04
Contribution Rates
05
Life Insurance/FSA 06
Disability/EAP 07
Care Advocacy
08
Retirement and more 09
Other Benefits 10
Holidays/Personal Leave
11
Important Notices 12-13
Medical Providers 14-15
FSA Worksheet 16
Notes 17
Important Contacts 18
02
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.
MEDICAL PLAN HIGHLIGHTS
Health & Wellness
Calendar Year Deductible
Individual/Family Maximum
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
Prescription Drugs (30 day supply)
Generic Copay
Preferred Brand Copay
Non-Preferred Brand
Mail-Order Drugs (90 day supply)
Generic Copay
Preferred Brand Copay
Non-Preferred Brand
03
Health & Wellness PPO
In-Network
Out-of-Network
$600/$1,200
$600/$1,200
$2,000/$3,500
$3,000/$6,000
80%
70%
$15 copay
($35 after 8 visits yr)
70% after deductible
100%
No coverage
80% after deductible
70% after deductible
80% after deductible
70% after deductible
80%, deductible waived
70% after deductible
80% after deductible
70% after deductible
80% after deductible
70% after deductible
$35 copay
70% after deductible
$0
$30
$60
No coverage
No coverage
$0
$60
No coverage
$120
No coverage
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.
GENERAL PROVISIONS
Calendar Year Deductible
Individual
Family
Calendar Year Maximum Benefit
Preventive Services (deductible waived)
Basic Services
Major Services
Orthodontic Services
Plan covers orthodontic services for eligible
children and adults. Lifetime maximum is
$1,000 per person
DENTAL PLAN
$50
$150
$1,500 per person
Plan pays 100%
80% after deductible
80% after deductible
50% after deductible
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.
GENERAL PROVISIONS
Benefit Amount
VISION PLAN
The plan will pay up to $400 per calendar year per
“Covered Person” for the following services and supplies, combined
Eye Exams - Limited to one (1) exam per calendar year
Prescription Lenses, Frames and Contact Lenses
Benefits
Corrective eye surgery, such as LASIK and PRK
Work-related, non-prescription sunglasses or safety goggles are covered up to $100 of the plan’s
$400 per Calendar Year maximum benefit
04
CONTRIBUTION RATES FOR 2014
Your monthly employee contribution rates are listed below:
Medical Contributions
PPO
w/Wellness
Health &
Wellness PPO
(rebate score 85+)
Employee Contribution Rates
Employee Only
$65
Employee + Spouse
$220
Employee + Child(ren)
$200
Family
$350
EE +EE
$130
EE+EE+Child(ren)
$265
Note: Dental contributions are included in medical contributions.
Vision Contributions
Employee Contribution Rates
Employee Only
Employee + Spouse
Employee + Child(ren)
Family
EE+EE
EE+EE+Child(ren)
05
$45
$180
$180
$310
$90
$225
CNIC Vision Plan
$0
$7.00
$7.00
$23.00
$0
$7.00
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
Annual gross pay between
$50,000 & $200,000
COMPANY PAID BENEFITS
$50,000 benefit minimum
$200,000 benefit maximum
Additional Life Insurance is available on a Voluntary Basis (Employee Paid). Please contact HR for additional information.
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 $2,500. 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
06
EMPLOYEE ASSISTANCE PROGRAM
For the many personal issues and concerns that arise in life, your Employee Assistance Program is available any time, 24 hours a day, seven days a week,
including holidays. It is a free and confidential service that will provide counseling, telephonic consultation, and support services for you and your family members. In addition to counseling services for issues like stress, relationships, depression, grief and loss, substance abuse, etc., they also provide
legal services, financial services and child care and elder care services. The County provides four free visits for each employee and their family members.
Hearing Aid Benefit
There is a $1,000 lifetime maximum benefit and it is covered under the Medical Benefit Plan.
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, after a 30 day waiting period.
COVERAGE TO AGE 65
ELIMINATION PERIOD
MAX WEEKLY BENEFIT
7 days
Replaces 60% of base weekly earnings up to $2,000 per week
Short Term Disability
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
Long Term Disability
07
ELIMINATION PERIOD
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
CARE ADVOCACY
COMPREHENSIVE SERVICE PACKAGE (Employer Paid)
Benefit Basics
Assists members with understanding benefits and what they cover. It is designed to broadly answer benefit questions.
Claims Assist
Provides expert assistance on issues such as claims, claim denials, out-of-pocket responsibilities, pre-authorizations, and questions on Explanation
of Benefits.
Care Choice
Offers assistance with coordination of care. Our healthcare professionals counsel member on medical needs and guide them when seeking help from
a physician-or after initial care.
Parent Care
Assists with care coordination of care. Select services include making arrangements for visiting nurses or personal care provider, hospice, home health,
or equipment.
Want to learn more?
Call 1-866-891-3306 or visit www.careadvocates.com
08
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.
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 2.46 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. Contact Human Resources for further details.
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.
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.
09
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 $17,500 (2013). Employees 50 years of age and older may contribute up to $35,000 (2013). These amounts may be adjusted
for 2014.
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.
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).
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.
10
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 years through the completion of year 2
12 days/3.70 hours per pay period
3 years through the completion of year 4
14 days/4.31 hours per pay period
5 years through the completion of year 9
17 days/5.23 hours per pay period
10+ years22 days/6.77 hours per pay period
Part-time employees accrue on a pro-rated basis. Leave accrual is capped at 176 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.
Service Recognition Program
Eagle County offers a service recognition program for 5, 10, 15, 20, 25 and 30 years of service.
11
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 provide
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.
12
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 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, 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 or by calling toll-free 1-866-444-EBSA (3272).
COLORADO-Medicaid
Medicaid Website: http://www.colorado.gov/ | Medicaid Phone (In state): 1-800-866-3513 | Medicaid Phone (Out of state): 1-800-221-3943
13
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
Edwards, CO 81632
970-328-1650
Edwards
Colorado Mountain Medical, P.C.
320 Beard Creek Road
Edwards, CO 81632
970-926-6340
Continued on the next page....
14
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 Blake
Glenwood Springs, CO 81601
970-945-8503
*Benefits are subject to eligibility requirements and are
subject to change. Contact Human Resources for details.
15
FLEXIBLE SPENDING ACCOUNT WORKSHEET
BENEFIT
YOUR
EXPENSES
EXPENSES FOR YOU
& DEPENDENTS
Deductibles and Coinsurance
$
$
Office Visit Co-Pays
$
$
Prescription Drug Co-Pays
$
$
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)
$
$
Christian Science Practitioner
$
$
Over the Counter Medication with physician’s prescription
Other (See IRS Publication 502 for Listing of Deductible Medical Expenses)
$
$
Eye Exams
$
$
Frames and Lenses
$
$
Contact Lenses, Cleaning Solutions and Supplies
$
$
Hearing Aids and Batteries
$
$
Radial Keratotomy Surgery to Correct Vision
$
$
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):
$
$
VISION AND HEARING CARE (not covered by insurance)
DENTAL EXPENSES (not covered by insurance)
16
Notes
17
CONTACT INFORMATION
If you have questions that are not answered in this booklet, please contact the appropriate carrier below.
BENEFIT
CONTACT
Medical
CNIC Health Plans
www.cnichs.com
(Account # 22204026)
(888) 426-7453
RX
RX-Total Script / Catamaran
www.catamaranrx.com
(800) 752-2211
Dental
Dental Health Plan
www.cnichs.com
(Account # 22204026)
(888) 426-7453
Vision
Vision Health Plan
www.cnichs.com
(Account # 22204026)
(888) 426-7453
Short Term Disability
CNIC Plans
www.cnichs.com
(Account # 22204026)
(888) 426-7453
Flexible Spending Accounts
Wage Works
www.wageworks.com
(877) WAGEWORKS
(924-3967)
Basic Life / AD&D
Lincoln Financial Group
www.lfg.com
(Account # 000010149432)
(800) 423-2765
Patient Advocacy
Care Advocates
(Account # CA1003)
(866) 891-3306
EAP
Colorado West Regional Health
Samaritan Counseling Center
Family Heritage Insurance
Jeff Cerovich
Eagle (970) 328-6969
Vail (970) 476-0930
Edwards (970) 926-8558
(970) 306-7050
www.familyheritagelife.com
Human Resources Department
Eagle County
berniece.gutierrez@eagleCounty.us
lisa.ponder@eagleCounty.us
(970) 328-8790
18
Choose your Benefits Wisely
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.
P.O. Box 850
500 Broadway
Eagle, Colorado 81631-0850
medical | dental | vision | life | disability & more
970-328-8600
info@eagleCounty.us
Apply yourself... and we all benefit