2008 EMPLOYEE BENEFITS GUIDE TABLE OF CONTENTS Introduction ................................................................ 1 Semi-Monthly Rates .................................................. 2 Helpful Definitions ................................................... 3 Medical Benefits ....................................................... 4 Bexar County is pleased to provide you with a comprehensive benefits program for 2008. Your participation will help safeguard the health care and financial needs of you and your family. Employee Assistance Program ............................... 6 Prescription Drug Benefits....................................... 7 Preventative Care ....................................................... 8 Wellness ....................................................................... 8 Virgin HealthMiles Program .................................. 8 Dental Benefits ........................................................... 9 This booklet will assist you in making benefit decisions that will best fit your needs. It is not intended as a complete description of the provisions of the benefit plans, but as a guide to help you in making the benefit choices that are best for you and your family. If any discrepancy exists between this guide and the official plan documents, the plan documents will govern. Vision Benefits ......................................................... 11 Life Insurance – Minnesota Life .......................... 12 UNUM………………………………………………14 Short Term & Long Term Disability Critical Illness Personal Accident Cancer Legal Access Plans .................................................. 17 AFLAC – Hospital Intensive Care ........................ 18 For additional information, visit the Planning & Resource Management website Benefits page at www.bexar.org/PRM/EmployeeBenefits.html Colonial – Medical Bridge .................................... 18 Flexible Spending Accounts .................................. 19 Retirement/Deferred Compensation .................... 22 or Important Notices…………………………………23 http://intra/PRM/EmployeeBenefits.html Contact Information ............................................... 27 For plan year January 1, 2008 through December 31, 2008. Introduction Who is Eligible? Enrollment Changes during the year Regular full-time employees of Bexar County who work at least 32 hours per week are eligible to participate in the Employee Benefits Programs. Your benefit elections will remain in effect for the entire plan year (January 1-December 31). You may only make changes to your elections during the year if you have one of the following status changes: Marriage or divorce Death of spouse or dependent Birth or adoption Spouse loses or gains employment Spouse loses existing insurance through no fault of his/her own Court Order Spouse receives a significant change in the health insurance premium or benefits of his/her group plan Spouse’s group plan open enrollment Retirement Leave without Pay Active Duty Military Leave Eligible Dependents Your spouse as defined and recognized by the law of the State of Texas. Un-married, financially dependent child(ren), including: Child(ren) for which you are the biological Mother or Father Legally adopted child(ren) Child(ren) placed with you pending formal adoption Stepchild(ren) Child(ren) or grandchild(ren) under age 25, not working full-time, for whom you are the legal guardian and claim as legal dependent(s) on your income tax return. (Full-time college student status is no longer an eligibility requirement.) Your Benefits – Your Responsibility! If you and your spouse, child or dependent are both employed by Bexar County, only one of you may elect benefits on your dependents: children and eligible grandchild(ren). Duplicate coverage of dependents is not permitted. Effective dates of coverage: Annual Enrollment – January 1, 2008 New Hire – first of the month following 30 days of employment You must submit a Status Change form within the 30-day deadline. You have 30 days from the date of a status change to complete an enrollment change form and return it to Human Resources. If you do not notify Human Resources, you and/or your dependents must wait until the next annual enrollment period to make a change to your benefit elections. You will be asked to provide written documentation of any status change. For Annual Enrollment: 1 Enrollment forms are due to Human Resources no later than November 19, 2007. Employee Semi-Monthly Rates Effective January 1, 2008 $ Employees NOT covered by the Collective Bargaining Agreement Employee Only Employee + 1 Employee + 2 or more Employees covered by the Collective Bargaining Agreement Employee Only Employee + 1 Employee + 2 or more All Employees Employee Only Employee + 1 Employee + 2 or more All Employees Employee Only Employee + One Employee + Family EPO Premium PPO Base PPO $51.16 $102.31 $166.25 $33.06 $66.12 $107.44 $24.07 $48.13 $78.22 EPO Premium PPO Base PPO $46.14 $92.7 $149.94 $29.82 $59.63 $96.90 $21.71 $43.41 $70.55 QCD Base Plan (Red) QCD Premium Plan (White) QCD Indemnity Plan (Blue) $0 $4 $6 $9.84 $21.03 $31.89 $12.36 $26.38 $44.38 QCD/Avesis Vision Plan UNUM Short Term & Long Term Disability Critical Illness Personal Accident Cancer $ 3.18 $5.48 $8.98 AFLAC Personal Hospital Intensive Care Legal Access Plans Colonial Medical Bridge Minnesota Life (additional Group Term Life for the Employee, Spouse and child(ren)) Rates vary based on age, salary as of 01-01-08 and coverage amount Employee Only Employee + Family $4.35 $8.77 Employee Only Employee + Family $7.00 $7.00 Rates vary based on coverage amount Rates vary based on age as of 01-01-08 and coverage amount 2 Helpful Definitions Calendar Year – January 1 through December 31 of each year. Case management – The process of assessing whether an alternative plan of care would more effectively provide medically necessary health care services in an appropriate setting. Coinsurance – The percent of eligible charges that the plan or member pays. Co-payment (medical) – The amount to be paid by you for each applicable medical service. Copayments for covered services are not applied to your deductible. Deductible – The amount you pay each calendar year before the plan begins to pay covered health care expenses. Emergency – An acute, sudden onset of a sickness or bodily injury which is life threatening or will significantly worsen without immediate medical or surgical treatment. Network Benefits – The benefits applicable for the covered services of a network provider. Non-Network Benefits – The benefits applicable for the covered services of a non-network provider. Using Network Providers makes GOOD FINANCIAL SENSE! Out-of-Pocket Maximum – The most a covered person can pay in deductibles and coinsurance in a calendar year for covered health care expenses (excluding reductions for provider contracts and usual and customary guidelines and copays). Pre-Certification – The process of assessing the medical necessity, appropriateness, or proposed nonemergency hospital admission, surgical procedure, outpatient care, or other health care services. Pre-determination of benefits – A review by the Plan Manager of a qualified practitioner's treatment plan, specific diagnostic and procedure codes and expected charges prior to rendering services. Pre-Existing Condition – A physical or mental condition for which you have received medical attention (medical attention includes, but is not limited to: services or care) during the six month period immediately prior to the enrollment date of your medical coverage under the Plan. Preexisting conditions are covered after the end of a period of twelve months after the enrollment date (first day of coverage or, if there is a waiting period, the first day of the waiting period). Preexisting condition limitations will be waived or reduced for pre-existing conditions that were satisfied under previous creditable coverage. Usual and Customary Rates – Non-network health plan expenses are considered for reimbursement at usual and customary (U&C) rates. U&C rates are determined to be the prevailing charge made for a service by a similar provider in the same geographic area. Charges above U&C are not covered by the plan and are the responsibility of the participant. 3 Medical Plan Benefits Your Medical Plans provides you and your eligible dependents with coverage for a wide range of health, wellness and medical services. For the first time in four years, employees will have a slight increase in their premium, while Bexar County will continue to pay approximately 80% of the total premium. In addition to your share of the premium cost, you are also responsible for being a wise consumer of medical services, for making responsible health care decisions. Bexar County offers many training classes, health fairs and wellness programs, including a full wellness initiative which includes a health risk assessment, screenings, health coaches and disease management for serious and chronic health conditions. Also offered for 2008 will be the addition of the Virgin HealthMiles Program, allowing employees to earn up to $400 in incentives for reaching certain goals. By sharing the responsibility and the cost for your health care, everyone works together to ensure quality medical care that is necessary and cost-effective is received by all. Preferred Provider Organization (PPO) Plans Bexar County offers two PPO plans. With a PPO plan, you may select any provider to receive care. Receiving care from a network provider will provide you with greater coverage and less out of pocket expenses. Both plans offer a convenient physician office visit co-pay, however, are not applied to the deductible. Premium PPO Plan covers medical expenses at 90% in-network and at 70% out-of-network once you have met an individual deductible of $400 in-network; $600 out-of-network. Base PPO Plan covers medical expenses at 80% in-network and at 60% out-of-network once you have met an individual deductible of $1,000 in-network; $2000 out-of-network. Premium & Base PPO Plans In-Network Care: Once you have met your deductible, a higher percentage of the cost of services is paid when you use network physicians. Your deductible is also lower if you use network services. You are responsible for verifying that any services a physician refers you to, such as other specialists, labs, hospitals and home health agencies are also in network. Claims are generally filed for you through the network. Out-of-Network Care: You can seek care from out-of-network providers, but a smaller percentage of the total cost is paid. The deductible is also higher if you use out-of-network services and you must file your own claims. In addition, you are responsible for any charges over reasonable and customary amounts. Exclusive Provider Organization (EPO) Plan This EPO Plan is much like an HMO; however, with an EPO Plan, you may select any affiliated physician, hospital and facility using the Humana National EPO directory. An EPO Plan, like an HMO, does not offer Out-of-Network benefits, except in certain emergency situations. All plans will remain the same, however, will have an inclusion of a mental health provider network, CorpHealth. Humana, Inc. will continue to be the claims administrator and continue utilizing the Humana, Inc. Provider Network for all other medical conditions. To verify that your physician or medical facility is in network, call 1-800-626-2698 or go online to www.myhumana.com. 4 Medical Plan Benefits Calendar Year Deductible In-Network Individual Family Out-of-Network Individual Family Annual Out-of-Pocket Maximum In-Network Individual Family Out-of-Network Individual Family Coinsurance In-Network Out-of-Network Copays Primary Care Physician Specialist Urgent Care Emergency Room Hospital Services Inpatient In-Network Out-of-Network Outpatient In-Network Out-of-Network Premium PPO Base PPO EPO $400 $800 $1,000 $2,000 None None $600 $1,200 $2,000 $4,000 None None $1,200 $2,400 $3,000 $6,000 $1,200 $2,500 $3,000 $6,000 $6,000 $12,000 None None 90% 70% 80% 60% 100% No Coverage $20 $20 $30 $30 90% after plan deductible 90% after plan deductible 80% after plan deductible 80% after plan deductible $20 $20 $50 $150 90% after plan deductible $500 copay then 70% after plan deductible 80% after plan deductible $500 copay, then 60% after plan deductible $250 copay per admission No coverage 90% after plan deductible 70% after plan deductible 80% after plan deductible $500 per admission then 60% after plan deductible 100% 5 No Coverage MENTAL HEALTH BENEFITS Premium PPO Base PPO Inpatient Benefits In-Network 90% after plan deductible 45 day maximum 80% after plan deductible 45 day maximum EPO 100% 45 day maximum No Coverage Out-of-Network OutPatient Benefits In-Network Out-of-Network 70% after plan deductible 45 day maximum 60% after plan deductible 45 day maximum $20 co-pay 52 visit maximum $30 co-pay 52 visit maximum $20 co-pay 52 visit maximum 70% after plan deductible 52 visit maximum 60% after plan deductible 52 visit maximum No Coverage Employee Assistance Program The County provides counseling and referral services to employees and their family members through an outside contractor. There is no cost to the employees and all services are confidential, even if you don't enroll in a Bexar County Medical Plan. To access services, call 615-8880 twenty-four (24) hours a day Monday thru Friday. Services are available during work hours, after work hours and between 8:00 A.M. and 12:00 P.M. on Saturdays. Deer Oaks EAP Services offers Bexar County Employees and Dependents the following: 6 Short term counseling session to include: o Individual Counseling o Family Counseling o Marital Counseling o Telephone Counseling 6 Counseling session with unlimited reasons: o Example Reason 1: 6 sessions for Stress/Anxiety o Example Reason 2: 6 sessions for Marital problems Interactive Website: (contact HR Central for access details) Internet Counseling: email us at eap@deeroaks.com to chat with a counselor and provide guidance and advice on your area of concern. Telephone Counseling and Teen Hotline: 800-396-2467 Local #: 615-8880 Toll Free#: 800-396-2467 6 Prescription Drug Benefits Prescription Drugs are covered under the medical plans if prescribed for the treatment of a covered medical condition. Prescription Drug Benefits Premium PPO Base PPO EPO Generic Brand w/ Generic Equivalent Retail (30 day supply) $10.00 $10.00 $10.00 plus difference $10.00 plus difference $10.00 $10.00 plus difference between brand & generic between brand & generic between brand & generic Formulary $25.00 $25.00 Non-Formulary $40.00 $40.00 Mail Order or Retail (90 day supply) Generic $25.00 $25.00 Brand w/ Generic Equivalent $25.00 plus difference $25.00 plus difference Formulary Non-Formulary NON-NETWORK PHARMACY $15.00 $25.00 $25.00 $25.00 plus difference between brand & generic between brand & generic between brand & generic $62.50 $100 Co-pay + 30% $62.50 $100 Co-pay + 30% $37.50 $62.50 No Coverage Pharmacy Helpful Definitions Brand Name Medicine – A medication that is manufactured and distributed by only one pharmaceutical manufacturer. Copayment (Prescription Drug Copay) – The amount to be paid by you toward the cost of each separate prescription order or refill of a covered drug when dispensed by a pharmacy. Dispensing Limit – The monthly drug dosage limit and/or the number of months the drug usage is needed to treat a particular condition. Drug List (Formulary) – A list of prescription drugs, medicines, medications and supplies approved by Humana, which identifies drugs as Level 1, 2, or 3. Generic Medication – A medication that is manufactured, distributed and available from several pharmaceutical manufacturers and identified by the chemical name. Level 1 Drug – A category of generic drugs, medicines, or medications on the Humana drug list. Level 2 Drug – A category of brand name drugs medicines or medications on the Humana drug list. Level 3 Drug – A category of generic or brand name drugs, medicines or medications not on the Humana drug list. 7 Preventive Care The calendar year maximum for preventive care benefits is $500. This includes services such as: Preventive Screenings Well Woman Exams Annual Physicals Immunizations Childhood immunizations (to age 7) do not have an annual limit These charges will incur an office visit co-pay and are not subject to your deductible, however, any charges exceeding the annual limit will be covered according to the provisions of your elected medical plan. Note: If your physician submits a claim for any of these procedures using any code other than a preventive procedure, benefits will be paid under the regular provisions of your elected medical plan and would not considered under the preventive care benefits. These benefits are provided to Employees and covered dependents to detect health problems as early as possible. Each benefit is provided on a “per calendar year” basis. Wellness A newly added benefit for employees and covered dependents is the Humana Wellness Plus Program. This program offers tailored health coaching and targets six key areas of wellness: Weight Management Physical Activity Smoking Cessation Nutrition Stress Management Back Care Additionally, covered members have access to Humana’s Core Wellness Program which offers well resources through MyHumana at www.myhumana.com, the on-line Humana Health Assessment, targeted mailing and telephone reminders for preventive care, and the Wellness Calendar program. HealthMiles HealthMiles by Virgin Life Care offers a first-of-its-kind physical activity incentive and rewards program to promote and motivate employees covered in either of the Bexar County Medical Plans, to increase their activity level and physical fitness. Employees are given a pedometer that tracks activity with time and date stamps which can be uploaded and tracked, all while earning HealthMiles for effort, measurements, and achievement. These miles are redeemable at more than 50 national retailers, encouraging employees to walk, dance, or run their way to valuable merchandise, up to $400 annually. 8 Dental Benefits Bexar County will once again offer 3 dental options with QCD of America. By enrolling in a QCD Red or White Dental Programs, you will automatically receive discounted vision care benefits under QCD AVESIS Simple Savings Plan. Details for of these benefits can be obtained by contacting QCD or visiting the QCD website at www.qcdofamerica.com or www.avesis.com for vision benefits. If you don't enroll in a Bexar County Medical Plan, you and your eligible dependents may still enroll in a QCD Dental Program to receive dental care benefits. Enroll in the QCD Dental Program of your choice by completing an enrollment form. Calendar Year Deductible Individual Family Calendar Year Maximum Per Covered Member Preventive Services – Class I Waiting Period Office Visit Routine Exams/Cleanings/ X-Rays/Sealants/Fluoride Basic Services – Class II Waiting Period Fillings/Extractions Major Services – Class III Waiting Period Crowns/Bridges/Dentures/Root Canals/Periodontal/Oral Surgery Orthodontia Waiting Period Lifetime Maximum Coverage Base (RED) Dental Plan* Premium (White) Dental Plan** Indemnity (BLUE) Dental Plan No deductible No deductible $ 50 $150 $50 $150 No maximum $1,500 $1,000 None No charge See Reduced Fee Schedule (Approx. 50% savings) None No charge In-network 100% *** In-Network Reimbursed per schedule Out-Of-Network None None See Reduced Fee Schedule (Approx. 50% savings) 3 Months 100% *** In-Network Reimbursed per schedule Out-Of-Network 3 Months 80% of Usual & Customary Rate None See Reduced Fee Schedule (Approx. 50% savings) 12 Months 100% *** In-Network Reimbursed per schedule Out-Of-Network 12 Months 50% of Usual & Customary Rate None None—Adult & Children 12 Months 12 Months $1,000 – Children only $1,000 – Children only Use any dentist, however greater reimbursement with a network dentist. Use any dentist 100% of Usual & Customary Rate Special Program Features Discount Dental Program with a network dentist. 9 * QCD “RED” Program is a managed cost dental benefit program. The member pays at the time of service according to the QCD Schedule of Program Fees. ** QCD “WHITE” Program – Member pays a QCD Provider at the time of service according to the QCD Schedule of Program Fees, then submits a copy of the paid receipt for reimbursement. Claims are paid in approximately 6-10 business days. Out-of-network insurance reimbursements are set per the schedule and represent approximately 50% coverage. *** QCD “WHITE” Program reimburses the member for any service performed by a QCD General Dentist and listed by ADA code on the RED Schedule of Program Fees at 100% (after deductibles). Some fees are additional and are not reimbursed. Your benefits will go further by utilizing a Network Dentist! 10 Vision Plan Each eligible employee may elect to participate in the QCD/AVESIS Vision Program. You choose the level of coverage appropriate for you and your family’s needs and you pay the full cost of the coverage. You can receive services from one of Avesis’ eye care professionals, or choose to receive care outside of the Avesis network. To find an Avesis provider, call 1-800828-9341 or visit the Avesis web site at www.avesis.com . Type of Service Examination: (Once every 12 months) Frames: (Once every 24 months) Lenses: (Once every 12 months) Contacts: (Once every 12 months) Laser Vision Correction Avesis Participating Provider Non-Participating Provider A comprehensive vision examination is provided by a network optometrist or ophthalmologist after a $10 copayment. Dilation may be covered in certain conditions. After an additional $10 copayment, $35 wholesale allowance (approximate retail of $75 to $100) If prescribed, a pair of standard single vision or standard lined multifocal lenses is covered with the $10 frame copayment. Progressive Lenses – 20% off retail, minus $50 allowance Specialty Lenses – 20% off retail minus the corresponding standard lens plan payment. If medically necessary covered in full, in lieu of frame and spectacle lenses. If elective, a$110 allowance, in lieu of frame and spectacle lenses, after the Avesis Preferred Pricing Discount has been applied. The contact lens allowance may be used all at once or throughout the plan year as needed and may be applied to contact lenses and/or professional services. Participating Providers have been contracted to provide discounts for Lasik surgery. Call (888)314-4619. Reimbursed up to $35, member must pay provider in full, then submit a claim to Avesis for reimbursement. Reimbursed up to $45, member must pay provider in full, then submit a claim to Avesis for reimbursement Reimbursed up to: Single Vision: $25 Bifocal: $40 Trifocal: $50 Lenticular: $80 Progressive: $40 Specialty: corresponding standard lens plan payment. Reimbursed up to: Medically Necessary Contacts: $250 Elective Contacts: $110 No coverage Other Options – Should you choose other options not covered by the program, you will be able to purchase these options or additional purchases on an unlimited basis at 20% off retail if you use a network provider. 11 Life Insurance – Minnesota Life Basic Life Insurance In order to protect your family’s security, Bexar County provides Basic Term Life Insurance and Accidental Death & Dismemberment (AD&D) coverage at 1 times the employee’s salary up to $250,000. This coverage is provided at no cost to employees. Supplemental Term Life Insurance If you want a greater level of protection, Supplemental Life coverage is available to purchase. Life doesn’t always bring us what we expect. It helps to know that financial security is available for your family…even if you aren’t. But not everyone has the same need for protection. That’s why Bexar County provides you with the opportunity to elect Supplemental Life Insurance for yourself as well as for your family. Annual Enrollment: You may newly elect your current coverage for yourself, your spouse, or your child(ren), but you will have to provide evidence of good health by submitting a health questionnaire to Minnesota Life for approval. If you or your spouse is currently enrolled, you may increase your coverage for an additional $10,000 without having to submit a health questionnaire with your application. New Hires: Employee and their dependents are eligible to enroll up to the Guarantee Issue. If your desired level of coverage is more than the Guarantee Issue, a health questionnaire will have to be completed and submitted to Minnesota Life for approval. Group Term Life and AD&D Insurance Highlights: Employees may elect Life/AD&D amounts in $10,000 increments from $10,000 to $250,000 Up to $250,000 of employee life/AD&D is guaranteed – no evidence of insurability is required – if elected within 31 days of initial eligibility. Employee must complete Evidence of Insurability if coverage is elected or increased after initial eligibility. Waiver of Premium--waives premium for disabilities prior to age 60; continues to earlier of retirement, age 65, or recovery; nine month waiting period before premiums are waived. Accelerated Benefit--pays up to 100% of the face value in lieu of death benefit if insured’s life expectancy is 12 months or less Accidental Death & Dismemberment--coverage matches life amount, with benefit schedule for dismemberment; terminates at age 70 Life amounts reduce to 65% at age 65; 50% at age 70; and 25% at age 75 Employees can convert to an individual policy if they leave County employment Up to $30,000 of spouse life/AD&D is guaranteed – no evidence of insurability is required – if elected within 31 days of initial eligibility (Evidence of Insurability for coverage over $30,000 for spouse will be required). Spouse life coverage may be elected in increments of $10,000 to a maximum of $120,000 or 50% of the employee’s amount of coverage Child life coverage may be elected in increments of $2,000 to a maximum of $10,000. All child life is guaranteed if elected within 31 days of initial eligibility. Child Definition: Age 14 days to 19 years or up to age 23 if a full-time student. (Children 14 days to 6 months are covered at 10% of the elected amount.) 12 Rates: Employee & Spouse Life/AD&D: Age Under 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 and older Employee Life and AD&D Spouse Life Rate / $10,000 / Pay Period Rate / $10,000 / Pay Period $ .45 $ .30 .50 .35 .60 .45 .65 .50 .70 .55 1.00 .85 1.40 1.25 2.50 2.35 3.80 3.65 7.15 7.00 11.50 11.35 Child Life: $0.26 / per $2,000 of elected coverage (one premium covers all eligible children in the family) For You For Your Spouse For Your Child(ren) You must purchase coverage on yourself to purchase it for your family You must purchase coverage on yourself to purchase it for your family You must purchase coverage on yourself to purchase it for your family Amount of Coverage Amount of Coverage Amount of Coverage From $10,000 to $250,000 $10,000 increments From $10,000 to 50% of employee’s coverage up to $120,000 in $10,000 increments Dependent Coverage is available for children under age 19 up to $10,000 in increments of $2,000 Guarantee Issue is $250,000 Guarantee Issue is $30,000 Guarantee Issue is $10,000 13 UNUM Short and Long Term Disability Insurance Highlights: Unum’s Short and Long Term Disability Income Protection insurance replaces a portion of your income if you are unable to work due to a covered accident or illness. That means you have money coming into you at the time you need it most. Annual Enrollment: You may newly elect coverage for yourself, however, evidence of good health must be submitted to UNUM for approval by completing a required health questionnaire with your application. New Hires: Employees are eligible to enroll without providing evidence of good health, however, must elect coverage within their first 30 days of employment. Long Term Disability Plan: 90- day elimination period – you must be disabled 90 days prior to becoming eligible for a benefit The Plan pays 60% of your base Bexar County monthly salary to a maximum monthly benefit of $5,000. Minimum benefit is the greater of 10% of your base monthly salary, or $100 Benefits are payable up to age 65 3- month lump sum benefit is payable if you die while disabled Pre-existing conditions apply. Short and Long Term Disability Plan: 14- Day elimination period – you must be disabled for 14 days prior to becoming eligible for a benefit. The Short Term Disability plan pays 60% of your base Bexar County weekly salary to a maximum weekly benefit of $1,000. After 11 weeks of Short-Term Disability benefits, Long Term Disability will begin to pay 60% of your base Bexar County monthly salary to a maximum monthly benefit of $5,000. Benefit duration is 11 weeks for Short Term Disability, and up to age 65 for Long Term Disability 3- month lump sum benefit is payable if you die while disabled No pre-existing conditions apply for STD, however, do apply for LTD. Rates Vary Based on Salary and Age as of January 1st of each year Short Term Disability Rates Per $100 of covered salary AGE RATE Long Term Disability Rates Per $100 of covered salary AGE RATE < 25 Years 25 – 29 30 – 34 35 – 39 40 – 44 45 – 49 50 – 54 55 – 59 60 – 64 65 – 69 70 + < 25 Years 25 – 29 30 – 34 35 – 39 40 – 44 45 – 49 50 – 54 55 – 59 60 – 64 65 – 69 70 + $.55 $.61 $.53 $.47 $.47 $.48 $.57 $.72 $.87 $.98 $.98 14 $.20 $.26 $.41 $.59 $.76 $1.06 $1.44 $1.81 $1.81 $2.28 $2.88 Critical Illness Insurance Highlights: Unum’s Voluntary Workplace Benefits (VWB)--Critical Illness Insurance can help supplement major medical coverage and group disability plans by helping employees pay the direct/indirect costs associated with a critical illness or event. PLAN FEATURES: Voluntary, individual coverage for employees with multiple family coverage options available; A lump sum benefit is paid, upon first diagnosis of a covered critical illness or event; Coverage is guaranteed renewable as long as premiums are paid and until the benefit amount is paid in full; Premiums are paid through payroll deduction; The policy is individually owned, which means employees can take their policy with them if they retire or leave the company. Health screening benefit writer available. Base Plan Unum’s Specified Critical Illness benefit pays a lump sum benefit, when an insured is first diagnosed with one of the noted critical illnesses. Employees may choose a benefit amount from $5,000 to $50,000. Dependent coverage available as a rider to the employee policy. o Spouse - $5,000 to $30,000 o Children - $5,000 to $10,000 Base plan can provide a single pay out up to 100% of the policy benefit amount. Up to 100% of the benefit amount 100% 100% 100% 100% 100% 25% Base Specified Critical Illness Heart Attack Stroke1 Major Organ Transplant2 Permanent Paralysis3 End-stage Renal(Kidney) Failure Coronary Artery Bypass Surgery4 Enhanced Plan Base Specified Critical Illness Employees may choose to add an additional Specified Critical Illness benefit for all insureds covered by a critical illness policy or rider. Benefit amount will equal that of the Base Plan for each covered insured. The Enhanced option can pay: 1) Up to 100% of the benefit amount for the illnesses and events listed under the Base Plan ~plus~ 2) Up to 100% of the benefit amount for The Additional Specified Critical Illnesses Up to 100% of the benefit amount ~plus~ Additional Specified Critical Illnesses5 Cancer Carcinoma in Situ4 Up to 100% of the benefit amount 100% 25% 1 Evidence of persistent neurological deficits confirmed by a neurologist at least 30 days after the event 2 Undergoing surgery as a recipient of a human heart, lung, liver, kidney, or pancreas 3 Complete and permanent loss of the use of two or more limbs for continuous 180 days as a result of a covered accident 4 Limited to one pay out per lifetime for each covered insured; child coverage payable at 100% 5 Insureds may be eligible for coverage 30 days after the effective date of coverage 15 Personal Accident Insurance Highlights: Unum’s Voluntary Workplace Benefits (VWB) Accident Insurance covers a wide variety of injuries and accident related expenses, such as hospitalization, physical therapy, hospital intensive care, transportation and lodging, associated with the loss of income due to a covered on or off-job accident. PLAN FEATURES Accident/Injury Benefit Amount Accident/Injury Accidental death (Plans 1 & 2 only) employee spouse child(ren) $25,000 $10,000 $5,000 Accidental Death-Common Carrier employee spouse child(ren) $50,000 $20,000 $10,000 Doctor's office initial visit $50 Emergency Room Treatment (includes X-rays) $150 Eye Injury requires surgery or removal of foreign body $200 Follow-up treatment for accident initial follow-up visit $50 Fractures open up to $5,000 closed up to $2,500 chips 25% of closed amount Hospital admission (per admission) $750 (Plan 3 - $250) Hospital confinement (per day up to 365 days) $200 (Plan 3 - $100) Hospital intensive care unit (per day up to 15 days) $400 (Plan 3 - $200) Knee cartilage (torn) $500 Exploratory $100 Laceration $25-$400 Lodging (per night up to 30 days) $100 Loss of finger, toe, hand, foot or sight of an eye Ambulance air Appliance $100 $500 $100 Blood, Plasma, platelets $300 Burns Flat amount for 2nd degree for 36% or more of body $750 3rd degree 9-34 sq. in. $1,500 3rd degree 35 or more sq. in. $10,000 skin grafts 25% of burn benefit Catastrophic accident (loss of use of sight, hearing, speech, arms or legs - Plans 1 & 2 only)* employee <65 years $100,000 spouse or child <65 years $50,000 age 65-69 Amount reduced to 50% age 70+ Amount reduced to 50% Concussion Dental work, emergency extraction crown Dislocations open up to closed up to $100 $50 $150 $4,000 $2,000 Loss of both hands, feet, sight or both eyes or any combination of two or more losses Benefit Amount $15,000 Loss of one hand, foot or sight in one eye $7,500 Loss of two or more fingers, toes or any combination of two or more losses $1,500 Loss of one finger or toe Physical therapy (6 treatments) Prosthetic device or artificial limb One more than one Ruptured disc $400 Surgery benefit (open abdominal, thoracic) exploratory Tendon/ligament and rotator cuff repair of one repair of more than one exploratory only Transportation (100+ miles up to 3 trips) 16 $750 $25 per treatment $500 $1,000 $1,000 $100 $400 $600 $100 $300 Cancer Insurance Highlights: Unum offers a Voluntary Workplace Benefit (VWB) Cancer Insurance as an individual or family policy that can provide benefits for employees and their families should cancer occur. PLAN FEATURES: Covers a wide range of costs for care, treatments and other expenses related to cancer. Benefits are paid directly to the owner and pays in addition to other health insurance, and are payable 30 days after the effective date of the policy. This applies to benefits payable from the base policy and all riders. Coverage options are available for employee, spouse and children. A Waiver of Premium provision is automatically included in the policy Premiums are paid through payroll deduction. The policy is individually owned, which means employees can take their policy with them if they retire or leave the County. Legal Access Plans Legal Plan Highlights ½ Hour Consultation (In Person, Telephonic or Online) Guaranteed Plan Rates (Up to 25% Reduction from Normal Rate) Dispute Resolution Calls/Letters (Up to 3 Separate Matters Per Year) Legal Document Review/Writing (Up to 5 Documents of 6 Pages Per Member Per Year) Small Claims Court Preparation Wills and/or Trusts Domestic Relations (Up to 25% Reduction from Normal Rate) Real Estate (Up to 25% Reduction from Normal Rate) Business Matters (Up to 25% Reduction from Normal Rate) Bankruptcy (Up to 25% Reduction from Normal Rate) Court Trials/Judicial/Administrative Proceedings (Up to 25% Reduction from Normal Rate) Guaranteed Discounted Contingency Fee Domestic Violence 24-Hour Interactive Website Access Financial Counseling/Planning Services Estate Planning and Financial Planning Seminars 17 AFLAC Personal Hospital Intensive Care Insurance Highlights Daily Hospital Intensive Care Unit Benefit Daily Sub-Acute Intensive Care Unit Benefit Human Organ Transplant Ambulance Benefit $ 600 per day (Days 1-7) $ 1,000 per day (Days 8-15) $ 250 per day (up to 15 days) $25,000 per occurrence Up to $250 (air $2,000) This coverage requires additional enrollment forms which can be obtain by contacting our local AFLAC Representative, Jim McNeel at 210-826-6412. Colonial Medical Bridge Highlights Colonial’s Medical Bridge insurance policy provides an employee with benefits for hospital confinement or outpatient surgery to assist against unexpected costs and out-of-pocket medical expenses associated with hospital confinement and outpatient surgeries. Special Features Benefits are paid in a lump sum, directly to you, in addition to other insurance; Coverage is guaranteed renewable and portable. This coverage requires additional enrollment forms which can be obtain by contacting Colonial customer service at 210-492-0000. 18 Flexible LifeSpending InsuranceAccounts – MetLife(FSA) Healthcare Daycare Transportation All Bexar County employees may contribute to either of the three Flexible Spending Accounts offered. Contributions are made through payroll deductions with before-tax dollars. When you contribute beforetax dollars, you decrease your taxable income and, thereby, increase your take-home pay. How Can A Spending Account Help Me? Your Flex accounts offer tax savings by allowing you to pay for qualifying out-of-pocket expenses with before-tax dollars. Without a Flex account, you would still pay for these expenses, but you would do so using money remaining in your paycheck after taxes are deducted. For example: Tax Savings Example *Actual savings will vary, based on your individual tax situation With Flex Account Gross Salary Health & Day Care Expenses/ Parking & Mass Transit (before-tax) Taxable Income Tax (17.65%) Net Salary Health / Day Care (after-tax) Take-Home Pay Your Tax Savings Without Flex Account $40,000 $40,000 $5,600 N/A $34,400 $40,000 $6,072 $7,060 $28,328 $32,940 N/A $5,600 $28,328 $27,340 $988 N/A You may submit claims for reimbursement throughout the plan year. Charges incurred after your termination date or for services received after you are no longer enrolled in the FSA will be denied. It is important that you estimate your anticipated medical expenses carefully as any amounts left in your account at the end of the year will be forfeited. 19 Health Care FSA Using pre-tax payroll contributions, you can receive reimbursement from your Health Care Spending Account for eligible medical, dental, vision and hearing expenses incurred by you or an eligible dependent, as long as the expenses are not covered or reimbursed by other plans. The maximum amount that you may contribute to your Health Care Spending Account is $4,800. You can use this account for health care related expenses such as: Out-of-pocket deductibles, co-insurance, co-payments and prescription charges. Medical, dental, and vision care expenses which are not reimbursable by insurance. Cost of Over-the-Counter Drugs with receipt showing Name of Drug and Cost Weight loss programs undertaken at a physician’s direction to treat an existing disease. Hearing examinations and hearing aids. Accessing your Health Care FSA Using your Health Care FSA is easy! You will receive a Humana Access Visa card in the mail. This special type of card gives the ability to pay for certain eligible expenses and co-pays at the time of service. When this card is used, you may be asked to submit a receipt for services provided or an Explanation of Benefits per IRS regulations! Many over the counter medicines may be purchased at Walgreen’s’ utilizing your Humana Access Visa Card. While Humana attempts to verify expenses automatically, there are many times they cannot. The IRS does require proof that the expense is for a qualified expense, therefore you will be asked to substantiate the expense by submitting an explanation of benefits or receipt. BEST PRACTICE: Send a copy of your Explanation of Benefits or your receipt to Humana FSA as soon as possible! You may also submit an FSA reimbursement claim form for expenses not eligible for use with your Access Visa card. Dependent Care FSA Bexar County offers an opportunity for you to save money on day care for eligible dependents through the Dependent Care Spending Account. You decide how much to contribute, up to $5,000 per year per household combined. To be eligible to use the account, you (and your spouse, if married) must both work outside the home. You may claim dependent care expenses for a dependent that lives with you and relies on you for more than half of his or her financial support. You must claim the person as a dependent on your federal income tax return. In addition to staying within these guidelines, you will also need to provide your dependent care provider’s name, address, and Social Security number or tax identification number. 20 What Care is Covered? You may only be reimbursed for day care that enables you to work, not occasional baby sitters. If you are married, your spouse must also work, be a full-time student or be disabled. Eligible care includes care in: Day Care Centers, Baby-sitter (not occasional baby sitting), nurse or any other dependent care services provided inside or outside your home. Before-school and after-school care up to the age of 13. Special education schools. Nurse or caregiver for an incapacitated adult who lives with you at least eight hours per day. You may be reimbursed for care provided by a relative, as long as the person is not your spouse, child under age 19, or someone you claim as a dependent on your federal income tax return. Transportation FSA Bexar County employees may elect to set aside a certain amount of their pre-tax salary to cover qualified costs incurred in commuting to work. The employee will designate an amount (up to $105 per month) for mass transit expenses and a separate amount (up to $215 per month) for parking expenses - these accounts must be kept separate, and funds cannot be transferred between accounts (i.e. funds designated for parking cannot be used to pay for mass transit). Employees who have their parking expenses paid or reimbursed by the County may not participate in pre-tax parking. Employees that have a CONTRACT with Bexar County to park in the County Garage must enroll in order to have their parking fee deductions “pre-taxed” from their payroll checks. Your current election DOES automatically carry forward! Employees parking in the Bexar County Parking Garage: Your Signature on the TRANSPORTATION FOR PRE-TAX REIMBURSEMENT ENROLLMENT FORM automatically authorizes your “Transportation” deduction. If you have a parking change and would like to change or cancel your elected deduction, you must sign a “Cancellation” form to avoid non-reimbursable deductions. VIA Free Ride Program County employees will continue to ride a VIA bus for free. Rides are free for regular scheduled bus service by showing your Bexar County ID card. All are encouraged to take advantage of this program to save your dollars and assist with traffic congestion and the environment. Van Pool Program The Van Pool program provides a $25.00 monthly subsidy to County employees who participate in the Van Pool service. In van pooling, at least 6 people share the ride to work, while splitting the cost of the van rental and fuel. One member of the group drives and is required to maintain the van in return for riding free. VIA will work with the County to form van pools of interested employees who share a similar daily commute. 21 Retirement/Deferred Compensation Texas County and District Retirement System (TCDRS) All employees, except temporary employees, are automatically enrolled in this retirement benefit. Your deposits currently get matching credits in a ratio of 2:1, or $2.00 for every $1.00 deposited. Plan Provisions Employee Deposit Rate – 7% Current County Matching Ratio – 2 to 1 Vesting Requirements – 8 Years Service Retirement Eligibilities – o Age 60 with 8 years of service o Any age with 20 years of service o Rule of 75 (age + years of service = 75) For additional personal account information, please call 1-800-823-7782, or visit the TCDRS website at www.tcdrs.org Section 457 Deferred Compensation Members can enroll at any time of the year Nationwide Retirement Solutions Customer Service Paula Nemec 1-877-677-3678 (210) 867-3282 American General - AIG (VALIC) Customer Service Ben Brakelock 1-800-892-5558 (210) 415-5722 ICMA-RC District Office Pete Mayberry 1-888-803-2722 (210) 658-0422 ING (Aetna) Shane Pfeffer (210) 979-8277 22 Important Notices Notice of HIPAA Special Enrollment Rights and Pre-existing Condition Exclusions The Health Insurance Portability and Accountability Act (HIPAA) is a Federal Law which requires notification about two important provisions in our health insurance plan. The first is your right to enroll in the plan under the “special enrollment provision”. Second, this notice advises of the plan’s pre-existing exclusion rules that may temporarily exclude coverage for certain pre-existing conditions that you or your family may have. I. SPECIAL ENROLLMENT RIGHTS PROVISION Rule #1 – Loss of Coverage: If you are declining enrollment for yourself or any eligible dependents, due to the existence of other healthcare coverage at the time of your initial eligibility, and that coverage is later lost, you “may” be able to enroll yourself and any eligible dependents, whose coverage terminates for a qualifying reason. Should loss of coverage occur, your request for enrollment must be submitted within 31 days of the effective date of the loss of other coverage. All requests must be submitted in writing with appropriate supporting documentation attached. Any changes may be subject to the pre-existing condition limitation listed in this notice. Rule #2 – Marriage, Birth or Adoption. If you acquire a new dependent as a result of marriage, birth, adoption or placement for adoption, you “may” be able to enroll yourself and your newly eligible dependents. Your request for enrollment must be submitted within 31 days of the effective date of marriage, birth, adoption, placement for adoption, or assuming custody of a child/children. All requests must be submitted in writing with appropriate supporting documentation attached. Any changes may be subject to the pre-existing condition limitation listed in this notice. Important Warning If you decline initial enrollment for you or your eligible dependents, please complete the “Waiver of Health Coverage Form”. This form is processed in place of the medical plan enrollment form. This will prevent your benefits from being defaulted to no coverage due to non-receipt of your written notification. Completion of the Waiver of Health Coverage Form waives only your Medical coverage while allowing you continued enrollment eligibility in your optional benefits. If you would like more information about the plan’s special enrollment provisions, please refer to the plan’s Summary Plan Description available in the Human Resources office or on the Planning and Resource Management intranet website. If you have any additional questions regarding this notice, feel free to contact Human Resources at 335-2545 or Heritage Plaza Building, 400 S. Main, 1st Floor, San Antonio, Texas 78204. II. PRE-EXISTING CONDITION PROVISIONS Pre-existing Condition Defined. A pre-existing condition is any condition (whether physical or mental), regardless of the cause of the condition, for which medical advice, diagnosis, care or treatment was 23 recommended or received within the 6-month period ending on your enrollment date. (For new hires that are hired into a benefits eligible job, the 6-month period ends on the date of hire). How to Show Us That You Had Creditable Coverage Before Joining our Plan. In order for the 12-month preexisting condition exclusion to be shortened as described above, you must show the Plan Manager, Humana, Inc. that you had prior creditable coverage. Documentation required to demonstrate whether you had other creditable coverage, should be provide to the Plan Manager with a “certificate of creditable coverage” from your prior employer’s health plan or your individual health plan carrier. Other forms of evidence of coverage may also be accepted. Most group health plans, health insurers, and HMO’s automatically furnish these certificates to the individuals when coverage is lost. In addition, all plans, insurers and HMO’s are required to provide these certificates upon request. This certificate will indicate how long coverage was effective under your prior plan, and when coverage ended. You have the right to request a certificate from a prior plan, insurer, HMO, or other entity through which you had creditable coverage. If, after making reasonable efforts, you have difficulty getting a certificate from your prior plan, insurer or HMO or other entity through which you had creditable coverage, please contact us at 335-2545, and we will attempt to assist you. If a certificate is unavailable, you have the right to prove creditable coverage through other forms of evidence. Each HIPAA certificate (certificate of creditable coverage) will be reviewed by the Plan Manager who (with the assistance of the prior plan administrator or insurer) will determine its authenticity. Submission of a fraudulent HIPAA certificate would be considered a federal health care crime under HIPAA and may be punishable by fine and/or imprisonment. After the Plan Manager receives your certificate(s) or other evidence of coverage, a determination will be made on whether, and for how long, our plan’s pre-existing condition period will apply. If it is determined that our plan’s pre-existing condition period will apply, the plan manager will inform you of that period. 24 Notice of Privacy Practices This notice describes the medical information practices of the Bexar County group health plans and that of any third party that assists in the administration of Plan claims as well as describes how medical information about you may be disclosed and how you can access this information. Information about you and your health is personal and Bexar County is committed to protecting that information. A record of the health care claims reimbursed under the Plans may be created for Plan administration purposes. This notice applies to all of the medical records we maintain. Your doctor or health care provider may have different policies or notices regarding their use and disclosure. We are required by law to: Make sure that medical information that identifies you is kept private; Notify you of our legal duties and privacy practices with respect to medical information about you; and Follow the terms of the notice that is currently in effect. How We May Use and Disclose Medical Information About You The following categories describe different ways that we use and disclose medical information. For Payment – To determine eligibility for Plan benefits, to facilitate payment for the treatment services you receive from health care providers, to determine benefit responsibility under the plan, or to coordinate Plan coverage. For Health Care Options – This may be necessary for Plan Administration such as cost management, business management and general administrative activities. As Required by Law – As required by federal, state or local law. To Avert a Serious Threat to Health or Safety. We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat. Special Situations Disclosure to Health Plan Sponsor – Medical information may be shared with another health plan maintained by Bexar County as well as Bexar County personnel for purposes of facilitating claims payments or benefits administration. Organ and Tissue Donation – If you are an organ donor, we may release medical information to organizations to facilitate organ or tissue donation and transplantation. Military and Veterans – If you are a member of the armed forces, we may release medical information required by military command authorities. 25 Worker’s Compensation – We may disclose medical information for workers’ compensation or similar programs. Public Health Risks – We may disclose medical information for public health activities. Health Oversight Activities – We may disclose medical information to a health oversight agency for activities authorized by law. Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. A request for confidential communications must be in writing to Bexar County Human Resources, Attn: Benefits Administrator and should specify how and where you wish to be contacted. All reasonable requests will be accommodated. Other Uses of Medical Information Any uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. Changes to This Notice We reserve the right to change this notice at anytime and will be effective for medical information on file as well as any future information we may receive. Complaints Complaint regarding any Bexar County Plans must be submitted in writing to: Bexar County Human Resources, Attn: Benefits Administrator. You will not be penalized for filing a complaint. 26 Contact Information Plan All Bexar County Benefits Bexar County Medical Plans (Administered by: Humana) QCD Dental Avesis Employee Assistance Program (EAP) Contact Phone Number Human Resources 210- 335-2545 Member Services Claims Customer Service Humana Beginnings Disease Management & Nurse Advisor Health Miles Program Pre-Certification Pharmacy Mail Order Mental Health Services Flexible Spending Accounts Websites http://intra/PRM/EmployeeBe nefits 800-626-2694 888-357-6767 888-847-9960 800-622-9529 866-852-6898 800-523-0023 800-379-0092 888-357-6767 800-604-6228 920-632-9200 (fax) Doris Hurtado 800-229-0304 ext 20 Customer Service 800-828-9341 Dear Oaks 210-615-8880 800-396-2467 Group Term Life & AD&D Minnesota Life #33424 800-843-8358 Optional Life Minnesota Life #33375 800-843-8358 www.myhumana.com www.qcdofamerica.com www.avesis.com www.deeroaks.com User Name & Password: bxco AFLAC Personal Intensive Care Insurance Jim McNeel 210-826-6412 Customer Service 800-992-3522 www.aflac.com Colonial Medical Bridge Customer Service 800-325-4368 www.coloniallife.com Kevin Buske 800-562-2929 www.legalaccessplans.com Jerry Ray 713-706-4723 www.unumprovident.com UNUM Critical Illness UNUM Personal Accident UNUM Cancer Benefit Alliance 800-543-8686 Customer Service 210-493-5433 www.unumprovident.com TCDRS Customer Service 800-823-7782 www.tcdrs.org Nationwide Customer Service 877-677-3678 Paula Nemec 210-867-3282 www.nationwide.com American General-AIG (Valic) Customer Service 800-448-2542 Ben Brakelock 210-415-5722 www.aigvalic.com Legal Access Plans UNUM Short & Long Term Disability ING (Aetna) ICMA Shane Pfeffer 210-979-8277 www.ingfa.com Customer Service 800-326-7272 Pete Mayberry 210-658-0422 www.imarc.com 27 This benefit booklet summarizes the provisions of your Employee benefits offered by Bexar County effective January 1, 2008. Complete details of each plan are included in the official plan documents and contracts. If there is a difference between this book and the documents or contracts, then the documents and contracts will govern. Benefits described in this book may be changed at any time and do not represent a contractual obligation. Bexar County Planning & Resource Management Human Resources November 2007 28