Employee
Benefits Guide
2013
Dear Seattle Housing Authority Employee,
As a regularly appointed employee, the Seattle Housing Authority (SHA) offers you a benefit package that
helps provide for you and your family’s health care, disability and survivor needs. It is a priority to offer choices
to help you address your unique financial needs.
This benefits guide includes information to guide you in choosing the insurance coverages that best fit your
needs. You will find information on employee benefits, answers to commonly asked questions, and important
deadlines for new employees. This booklet also covers other work/life programs that are designed to help you
manage your life and promote a satisfying and productive relationship between you and SHA.
Seattle Housing Authority is subject to the City of Seattle’s eligibility rules and regulations for the benefits that
we receive through them, such as medical, dental, vision, Accidental Death & Dismemberment, Basic and
Supplemental Life insurance, and Basic & Supplemental Long Term Disability. Any request from an employee
that is outside the guidelines set by the City of Seattle requires written approval from them.
The City of Seattle intends to continue these plans indefinitely but reserves the right to amend or terminate
them at anytime in whole or part, for any reason, according to the amendment and termination procedures
described in the legal documents. This booklet does not create a contract of employment with Seattle Housing
Authority or its employees.
Please note: We’ve made every attempt to ensure the accuracy of this information. If there is any discrepancy
between this booklet, the insurance contracts, other legal documents, or the terms of an authorized collective
bargaining agreement, the contracts, legal documents and applicable collective bargaining agreements will
always govern.
Human Resources
Page 2
TABLE OF CONTENTS
EMPLOYEE RESPONSIBILITIES ......................... 4
VISION COVERAGE ............................................... 32
Vision Service Plan (VSP) .................................... 32
ELIGIBILITY AND COVERAGE INFORMATION .. 5
ELIGIBILITY FOR REGULAR EMPLOYEES ........ 6
Eligible Family Members ..................................... 6
New Employee Enrollment.................................. 7
When New Employee Coverage Begins ............. 7
Can I Enroll My Family Members? ...................... 8
How Do I Disenroll My Family Members? ........... 8
Changing Your Benefits ...................................... 9
When Coverage Ends....................................... 10
How To Continue Coverage.............................. 10
PAYING FOR BENEFITS .................................... 11
BENEFITS AND FINANCIAL PLANNING........... 12
MEDICAL PLAN OPTIONS................................. 13
How To Choose a Medical Plan ........................ 13
Preventive Plan ................................................ 14
Traditional Plan................................................. 14
GHC Standard Plan .......................................... 15
GHC Deductible Plan........................................ 15
MEDICAL PLAN COMPARISON EXAMPLES .... 16
PAYING OUT-OF-NETWORK CLAIMS .............. 16
OPTIONAL INSURANCE........................................ 34
AD&D ................................................................... 35
Basic Long Term Disability ................................... 37
Supplemental LTD ................................................ 37
Group Term Life (GTL) Insurance ......................... 38
Basic Life Insurance ............................................. 38
Limited Basic Life Insurance ................................. 38
Supplemental Life Insurance ................................ 41
HAIG Free Life Insurance ..................................... 43
Long Term Care ................................................... 44
Health Care FSA Account ..................................... 45
Dependent Care FSA Account .............................. 45
WORK LIFE PROGRAMS
Guaranteed Educations Tuition (GET) .................. 46
Commute Trip Reduction Program ....................... 47
Employee Assistance Program ............................. 48
RETIREMENT ......................................................... 49
Public Employees Retirement System (PERS) ..... 49
Deferred Compensation Savings Plan .................. 49
LEAVE BENEFITS.................................................. 50
Vacation ............................................................... 50
Sick Leave ............................................................ 51
Other Leave Benefits ............................................ 51
2012 MEDICAL BENEFITS HIGHLIGHTS .......... 17
GLOSSARY ............................................................ 54
HEALTH CARE PREMIUMS ............................... 24
Taxable Benefit Amount – (With WDS) ............. 24
Taxable Benefit Amount – (with DHS) .............. 25
WHO TO CONTACT IF YOU HAVE QUESTIONS .. 55
SCHEDULE OF DEDUCTIONS .............................. 56
PRESCRIPTION DRUG COVERAGE ................. 26
Preventive And Traditional Plans (Aetna) ......... 26
GHC Plans ....................................................... 26
DENTAL PLAN OPTIONS .................................. 28
Washington Dental Service............................... 28
Dental Health Services ..................................... 29
Dental Plan Comparison ................................... 30
Page 3
Employee Responsibilities
Employees are responsible for making benefits elections or changes by their due dates including Open
Enrollment. They must notify Human Resources at (206) 615-3328 of any family or employment status
changes that impact benefits such as marriage, divorce, a new or terminated domestic partnership, a birth or
adoption, a leave of absence, or a death in the family.
New employee? You are responsible for making your benefits elections within 31 days of your date of hire.
Adding a new family member to your health care coverage and Flexible Spending Account? Contact Human
Resources at (206) 615-3328 within 31 days of marriage or a new domestic partnership. You have 60 days
from the effective date to notify your representative of a birth or adoption.
Dropping a family member from your health care coverage and Flexible Spending Account? Contact Human
Resources at (206) 615-3328, if you are dropping a family member or an adult child who will be obtaining other
health care coverage through their own full-time employment.
Planning a leave of absence? Contact Human Resources at (206) 615-3328 about how it could affect your
SHA benefits.
Designating or changing your beneficiary?
· Life, Accidental Death & Dismemberment insurance, HAIG life insurance and last paycheck, contact
Human Resources at (206) 615-3328
· Retirement – contact the WA State Retirement at (800) 547-6657
· WA State Deferred Compensation – contact (800) 423-1524.
Moving? Contact Human Resources at (206) 615-3321.
To change your benefits, submit SHA Benefits Election form during fall Open Enrollment to
make benefits elections for the following year.
Page 4
Eligibility and Coverage Information
Seattle Housing Authority (SHA) provides employees and their families a range of benefit options to support
individual financial planning.
Medical - SHA offers regular employees and their dependents a choice among four healthcare plans: City of
Seattle Preventive (Aetna), City of Seattle Traditional (Aetna), Group Health Standard and Group Health
Deductible.
Dental - SHA offers dental coverage through Washington Dental Service and Dental Health Services.
Vision - SHA offers Basic and Buy-Up Vision plans through Vision Service Plan.
Life Insurance & Long-Term Disability (LTD) - SHA offers Basic Long-Term Disability insurance and shares
the cost of Group Term Life insurance, both of which can be supplemented by the employee.
Accidental Death & Dismemberment (AD&D) - SHA offers an employee-paid group AD&D insurance plan.
Flexible Spending Accounts (FSAs) - Employees can pay for employment-related dependent care costs
and/or eligible health care expenses with up to $2,500.00 for the health care account or $5,000 for the
dependent care account per year in pre-tax dollars.
HAIG Free Life Insurance – The Housing Authority Insurance Group (HAIG) is offering free life insurance
($5,000.00) to SHA employees. This policy is underwritten by Guardian Life Insurance Company of America
and subject to certain conditions and restrictions.
Long-Term Care (LTC) Insurance - SHA offers an employee-paid LTC program with guaranteed acceptance
for new employees. New employees have 31 days from the first of the month following their date of hire to
sign up for Long Term Care Insurance. Under the LTC, new employees may either elect guaranteed coverage
at the time of hire, or higher coverage which will need medical underwriting and approval. Employees can
enroll under the LTC any time after the 31 days of new hire and are subject to underwriting approval.
Retirement (PERS) - Most SHA employees are members of the Public Employees Retirement System (PERS)
administered by the Washington Department of Retirement Systems (DRS). Membership is defined by
Washington State statutes, and is mandatory if you are hired into an “eligible” position.
Deferred Compensation - SHA offers a tax deferred savings plan through the State of Washington which
allows employees to save pre-tax dollars to supplement retirement funds.
Guaranteed Education Tuition - In order to help families prepare for future college costs, the 1997
Washington State Legislature created the Guaranteed Education Tuition (GET) Program. GET allows families
to purchase college tuition now for use in the future, giving families peace of mind about their children’s future
education.
Employee Assistance Program (EAP) - SHA provides a professional, confidential counseling service to
assist employees with personal or work-related problems.
Page 5
Eligibility and Coverage Information
Eligibility for
Regular
Employees
If you are a regularly appointed employee in a full- or part-time position (scheduled to
work at least 80 hours per month), you are eligible to participate in the medical, dental,
vision, life, AD&D, LTD, HAIG Free Life insurance, FSA, deferred compensation, LTC
and EAP plans.
Eligible Family
Members
The following family members are eligible to participate in the medical, dental, vision,
supplemental life insurance, accident coverage, LTC insurance and EAP programs:
Spouse or domestic partner – an Affidavit of Marriage/Domestic Partnership or
Certificate of State Registered Domestic partnership must be filed with Human
Resources to cover your spouse or domestic partner.
Children – your children, and your spouse’s or domestic partner’s children. Please
check child eligibility requirements below.
Child Eligibility
Plan
Medical, Dental, Vision,
and Flexible Spending
Account
Age
Up to age 26 (through
age 25) unless they
have access to
coverage through their
own employment
Up to age 21 (through
age 20) or
Other
Do not have to be:
-married
-live with you
-be dependent on you
for support
AD&D
Up to age 26 (through
age 25)
Long-Term Care
Age 18 and Older
Must be primarily
dependent on employee
for support
N/A
Supplemental GTL
Coverage may continue for a handicapped/incapacitated child if the child becomes
disabled prior to the limiting age, provided that proof of his or her fully
handicapped/incapacitated status has been documented by a physician.
Page 6
Eligibility and Coverage Information
New Employee
Enrollment
If you are a newly hired employee, you must enroll in/apply for medical, dental, vision,
life, AD&D and/or supplemental Long Term Care (LTD) coverage within 31 days of your
hire date. If you miss the deadline, you must wait for the next Open Enrollment period,
except for Long Term Care (LTC). You can enroll under LTC anytime. For guaranteed
acceptance into the Long-Term Care Program, you must enroll within 31 days.
If you do not enroll in life or LTC insurance when first eligible, you will be required to
complete a Medical History Statement or Evidence of Insurability for the insurance
carrier, and you are not guaranteed coverage as you are when first eligible.
Supplemental disability has longer a preexisting condition exclusion period if you apply at
a later date.
When New
Employee
Coverage
Begins
You must enroll within 31 days of hire. Coverage begins for you and your eligible
family members on your first day of employment if that date is:
 the first calendar day of the month designated as an SHA business day, or
 the first calendar day of the month designated or recognized as the first working
day for the shift to which you are assigned, whichever is later.
If your employment begins after this date, your coverage will begin the following month.
What if I miss the enrollment deadline?
If you fail to enroll within 31 days of your hire date, you will not be able to enroll in a
medical plan until the next Open Enrollment period (or within 31 days of a change in
family status). However, you will automatically be enrolled for dental and basic vision
coverage. Your dental coverage will default to the Washington Dental Service plan.
You also will need to meet additional requirements to be eligible for Life Insurance and
Long-Term Disability Insurance (LTD) coverage. You will be required to submit a Medical
History Statement and have it approved by the insurance company in order to be eligible
for Life Insurance coverage. You will have an additional waiting period for LTD.
Page 7
Eligibility and Coverage Information
Can I enroll my
family
members?
The following family members are eligible for coverage:
 Your spouse or domestic partner;
 Your birth or adopted children, or children placed for adoption;
 Children of your domestic partner who live with you;
 Stepchildren who live with you; or
 Any child for whom you are legal guardian, or for whom coverage is required by a
Qualified Medical Child Support Order.
Children may be covered on the following plans; see page 3 for detailed eligibility
requirements for children.









AD&D (family coverage)
Group Health Cooperative plans
Preventive Plan (Aetna)
Traditional Plan (Aetna)
Washington Dental Service
Dental Health Services
Vision Service Plan
Supplemental Group Term Life Insurance
Long Term Care
Coverage may continue after age 25 for a handicapped/incapacitated child if the child
becomes disabled prior to the limiting age, provided that proof of fully
handicapped/incapacitated status has been documented by a physician.
Contact Maria Sahagun in Human Resources at (206) 615-3328 if you have questions.
How do I
disenroll my
family
members?
If you need to remove a family member from coverage outside of Open Enrollment,
submit a completed SHA Benefit Election Form to Human Resources.
If you end your spouse or domestic partner’s coverage due to a termination of the
marriage/partnership, submit a completed Statement of Termination of Marriage/
Domestic Partnership form or a Notice of Termination of State Registered Domestic
Partnership within 31 days of the divorce or domestic partnership termination. You cannot
file a new Affidavit until 90 days have elapsed from the termination of the prior
marriage/partnership, unless the termination was due to the spouse or domestic partner's
death or if the domestic partnership was certified with the State of Washington.
Page 8
Eligibility and Coverage Information
Changing Your
Benefits
There are two opportunities to change your benefit choices:
 Open Enrollment
 Mid-year, if you have a change in family or job status.
Open Enrollment
Open Enrollment is held once each year in the fall for the upcoming calendar
year. During Open Enrollment, you can change your benefits plans, add and
drop family members, and add or drop coverages. If you make changes during
Open Enrollment, your new coverage is effective on January 1 of the new (next)
plan year. Increases in your Life insurance coverage are subject to the approval
of your Medical History Statement by the life insurance carrier.
Open Enrollment is also the time to enroll in the Flexible Spending Account
program (Health Care and Dependent Care). You must re-enroll every year, even
if you had an account the previous year.
Life Events that Affect Your Benefits
You must enroll a new spouse or domestic partner within 31 days of your
marriage, or establishment of a domestic partnership. You have 60 days to add a
child acquired through birth, adoption, placement for adoption, legal guardianship,
marriage or domestic partnership. If you miss the deadline, you can only add
family members during the annual fall Open Enrollment period.
If you have a change in family status, you may be able to make a related change
to your benefits. Here are several examples. Contact Human Resources at 6153328 if any of the following occur.
 You adopt a child. You may add coverage for that child (you may not add






coverage for your other children at that time).
Your child loses coverage under your spouse’s coverage. You may add this
child to your plan.
You get married, or form a domestic partnership. You may enroll your new
spouse, or domestic partner and his/her eligible children.
Your spouse, or domestic partner loses coverage due to termination of
employment, change in employment status, or beginning an unpaid leave of
absence. You may add your spouse or partner to the plan.
Your spouse or domestic partner gains coverage due to start of
employment, change in employment status, or ending an unpaid leave of
absence. You may drop your spouse or partner from the plan.
You get divorced, separate, or dissolve a domestic partnership. You may
drop the spouse or domestic partner from the plan.
Your child no longer meets the age requirements for medical/dental/vision.
Your child will be dropped from coverage.
Page 9
Eligibility and Coverage Information
Your medical/dental/vision, Basic and Supplemental Long-Term Disability, Basic and
When
Coverage Ends Supplemental Life, AD&D and Long Term care coverages end on the last day of the
calendar month in which:
 You are no longer eligible,
 You resign, retire, are laid off, or are terminated,
 You stop making any required payment.
Your medical, dental and vision coverages will also end on the day the plan terminates,
or if you die (your family members’ coverage will end on the last day of the calendar
month in which you die).
How to
Continue
Coverage
To help you maintain health coverage, Congress passed the Consolidated Omnibus
Reconciliation Act (COBRA) in 1986. Under COBRA, you are eligible to purchase
continuing medical only, dental/vision only, or medical/dental/vision coverage under
certain circumstances when your SHA group health plan coverage ends.
If you are an SHA employee and have SHA medical, dental and vision coverage, you and
your covered family members have the right to elect COBRA continuation coverage for
up to 18 months if your coverage is lost because of one of these qualifying events:


Your employment ends for a reason other than gross misconduct,
Your work hours are reduced to the point where you no longer are eligible for
benefits.
The 18-month COBRA continuation period may be extended to 29 months if you or a
family member (who is a qualified beneficiary) is disabled according to Social Security at
the time of one of the above qualifying events. This 11-month extension is available to all
qualified beneficiaries who lose coverage due to termination of employment or a
reduction of hours.
Covered family members have the right to choose COBRA continuation coverage for up
to 36 months if coverage is lost for any of these qualifying events:



Death of the employee,
Divorce or legal separation of the employee and spouse or dissolution of the
domestic partnership, or
A child loses coverage (turns 26 and/or obtains a full-time job with access to health
care insurance.
The Life, AD&D, and disability plans have conversion options. You can continue your
Long-Term Care coverage by completing the Election To Continue Your Long Term Care
Insurance Coverage form which is available in Human Resources.
Page 10
Paying for Benefits
Medical
If you elect medical coverage, SHA pays most of the premium for you and your eligible
enrolled family members. The amount you pay depends on which plan you select, and
whether you cover a spouse or domestic partner.
Payroll
Deductions
Medical premiums are deducted each month on a pre-tax basis. Pre-tax deductions are
exempt from Social Security taxes. This may slightly reduce your future Social Security
benefits, but most people find that ongoing tax savings outweigh a future reduction in
Social Security benefits, if any. If this is a concern for you, discuss it with your financial
advisor. (Premium amounts paid for a domestic partner cannot be taken on a pre-tax
basis if your partner is not a dependent on your IRS tax form.)
Your share of the cost for your medical premium is taken in equal amounts from the first
and second paychecks of the month during the month of coverage on a pre-tax basis.
For example, premium deductions taken from your March paychecks provide for March
coverage.
Dental and the Basic Vision plans are fully paid by SHA for most employees. You can
elect a Buy-Up Vision plan; you pay the premium for you and your eligible family
members. The premium is deducted pre-tax in equal amounts from the first and second
paychecks of the month.
Life Insurance
Your basic and supplemental after-tax premium deductions are taken from your first
paycheck of the month for the current month’s coverage.
Supplemental Long-Term Disability
Your Supplemental LTD after-tax premium deduction is taken from your first paycheck of
the month for the current month’s coverage. The amount you pay for Supplemental LTD
coverage may vary each month because it is a percentage of your monthly earnings.
Accidental Death and Dismemberment
Your AD&D after-tax premium deduction is taken from your first paycheck of the month
for that month’s coverage.
Long-Term Care
Your LTC after-tax premium deduction is taken on the second paycheck of the month for
the next month’s coverage.
Flexible Spending Accounts (Health Care & Dependent Care)
Your FSA pre-tax deduction is taken every paycheck.
Page 11
Benefits and Financial Planning
Because everyone’s medical and financial situations are different, SHA offers a variety of plans to help protect
employees and their families from the financial hardship that unusual medical expenses can bring. The plans
are designed to cover much of the cost of medically necessary health care services. However, employees still
bear a portion of their medical service costs in the form of premiums, deductibles, copayments, and
coinsurance.
Since health care costs may be unanticipated, it makes sense to plan in advance, and save for your out-ofpocket costs. If you can accurately anticipate some medical, dental and/or vision expenses for the following
year – such as prescriptions, glasses, orthodontia, office visit copays and deductibles the Health Care FSA is a
tool to support your financial planning and maximize the value you get for dollars spent on health care. You
can elect the Health Care FSA during Open Enrollment to set aside pre-tax dollars to pay for eligible out-ofpocket medical expenses for you and your family. Here are additional ways to cut costs and save money.

Quit smoking and encourage your family to quit.

Be more active and eat nutrient dense food. Many diseases and conditions are preventable, and
healthy behavior reduces your future health care costs and enhances your life now.

Go to check ups and screenings. Have regularly scheduled physical examinations by your doctor,
dentist, eye doctor, etc. Take advantage of free medical screenings, flu shots and go to SHA’s
wellness fair and City’s benefits fairs.

Choose the best health plan for you and your family. There is more to selecting a good health plan than
just the payroll deduction. If you are shopping for a health plan, compare the premiums along with what
is and is not covered by the various plans.

Stay within the network. Look for doctors and health care providers that are within the plan’s network.
If you participate in an Aetna plan and require a specialist, make sure you use an Aexcel specialist,
which will save you 10%.

Review medical bills carefully. Billing errors can cost you hundreds or even thousands of dollars.
Contact the billing office if there is an error or you do not understand your bill. You may be able to
negotiate fees and bills that you feel are too high.
Page 12
Medical Plan Options
Medical Plans
SHA offers four different medical plans:




City of Seattle Preventive Plan
City of Seattle Traditional Plan
Group Health Cooperative Standard Plan
Group Health Cooperative Deductible Plan
How to Choose Plan features, coverages and costs vary. The City’s self-insured plans offer an unlimited
a Medical Plan choice of doctors; coverage is higher if you use doctors in the Aetna network. The Group
Health Cooperative (GHC) plans require that you use the GHC network of doctors,
clinics, hospitals and pharmacies, but offer a higher level of coverage.
Plans offering higher coverage (City Preventive and Group Health Standard) have lower
copays but higher monthly premiums. Plans with larger annual deductibles have lower or
no monthly premiums (City Traditional and Group Health Deductible).
When making your decisions, you should consider cost, choice, and coverage. Here are
some questions to ask yourself:

Do you want a plan that allows you to choose any doctor, hospital or clinic (City
self-insured plans), or are you willing to stay within a network (GHC) and receive a
higher level of coverage?

Would you rather pay higher monthly premiums to have a small annual deductible
(City Preventive Plan), or no annual deductible (GHC Standard Plan), and smaller
copays?

Would you rather pay lower or no monthly premiums, and have higher coinsurance
and deductibles (GHC Deductible and City Traditional plans)?
The following very brief description of the plans may help you make these choices.
New Employees: Remember - You have 31 days from your hire date to enroll in the
medical, dental, vision and most optional insurance plans.
Page 13
Medical Plan Options
City of Seattle
Self-insured
Plans
The City has two self-insured plans — the Preventive Plan and the Traditional Plan.
The plans use the Aetna provider network, and Aetna administers the claims.
Preventive Plan
This plan has a $100 annual deductible per person ($300 per family) and a $15 copay
for all office visits except preventive care (which is covered at 100%). The deductible
applies to most services except where a copay applies. Most other services are
covered at 90% after a copay if you use an Aetna network provider.
Traditional Plan
This plan has a $400 annual deductible per person ($1,200 per family). Most services
are covered at 80% if you use an Aetna network provider. Most preventive care is not
covered.
What If I Don’t
Use the Aetna
Network?
Both of the City’s self-insured plans include the Aetna network of doctors; however,
you choose whether to use a network or non-network provider when you require care.
If you choose a doctor who is not in the network, you will pay a higher percentage of
the cost of the visit. Another issue to keep in mind is that prices charged by a nonnetwork provider are often higher than those charged by a network provider. If you use
a non-network provider, you will pay 40% of the network cost for a service, and your
doctor may charge you an additional amount over the established network price.
Aetna’s Aexcel
Network
Aetna has a special sub-network, called the Aexcel network, which consists of doctors
who specialize in the following areas: cardiology, cardiothoracic surgery,
gastroenterology, general surgery, obstetrics/ gynecology, orthopedics, otolaryngology,
neurology, neurosurgery, plastic surgery, vascular surgery and urology. Doctors were
selected for this special network because they meet screening criteria in the areas of
experience, performance, effectiveness and efficiency. If you need care in one of
these areas and you do not choose a doctor from the Aexcel network to provide that
care, you will pay 10% higher coinsurance. You do not need a referral to see a
specialist.
Aetna Navigator
Aetna’s member website is called Aetna Navigator. Through the site
(AetnaNavigator.com) you can locate detailed claim information, review your benefits,
request changes, find service providers, and email member services.
Simple Steps to
a Healthier Life
Traditional and Preventive plan members have access to a health risk assessment –
Simple Steps to a Healthier Life. Following completion of a questionnaire, you will
receive a health report and a personal action plan along with access to healthy living
programs.
Page 14
Medical Plan Options
Health Care Options
Group Health
Cooperative
Group Health Cooperative (GHC) is a health maintenance organization which provides
an integrated system of health care services. All services are delivered in GHC clinics,
hospitals and pharmacies. You must use GHC providers and facilities unless a GHC
doctor refers you elsewhere. You do not need a physician’s referral to see most GHC
specialists.
The City offers two plans through Group Health Cooperative.
GHC Standard This is a managed care plan with no deductible and an office copay of $15. Most
services are covered at 100% after payment of a copay. Preventive care is covered.
Plan
GHC
Deductible
Plan
This is a managed care plan with a $200 annual deductible per person ($600 per family)
and a $15 office copay. The deductible does not apply to ambulance service,
prescription drugs, durable medical equipment and preventive visits (preventive visits do
have a copay). After the deductible is satisfied, most services are covered at 100% after
the copayment.
My Group
Health
The health care website is My Group Health at GHC.org. Members can request
appointments and exchange emails with their provider, view their online medical record,
refill prescriptions online, and view lab and test reports. The provider and facilitator
directory, and drug formulary are all accessible online.
Health Profile
The plan has a health risk assessment called Health Profile. Members complete the
profile online and receive a report and personalized action plan. Free healthy lifestyle
coaching is available.
Page 15
Medical Plan Comparison Examples
The following table compares the plans in four different scenarios where employees would use services: a
routine physical exam, a regular office visit (such as for an illness), outpatient treatment at a hospital, and
surgery performed by a specialist. Costs for each service are compared by plan. For a more complete
summary of benefits by plan, see the table that follows this example.
PREVENTIVE PLAN
TRADITIONAL PLAN
GROUP HEALTH
COOPERATIVE
In-network
Out-ofnetwork
In-network
Out-ofnetwork
GHC
Deductible
Plan
GHC
Standard
Plan
$100
$450
$400
$1,000
$200
None
$300
$1,350
$1,200
$3,000
$600
None
Paid at 100%
Paid at 60%
after satisfaction of
deductible for
mammogram
and ob/gyn
exams only.
Paid at 80%
after
satisfaction of
deductible for
mammogram
only. No other
preventive care
covered.
Paid at 60%
after
satisfaction of
deductible for
mammogram
only. No other
preventive care
covered.
Paid at 100%
after $15 copay
and satisfaction
of deductible
(copay applies
to deductible)
Paid at 100%
after $15
copay
Office visit
Paid at 100%
after $15 copay
Paid at 60%
after
satisfaction of
deductible
Paid at 80%
after
satisfaction of
deductible
Paid at 60%
after
satisfaction of
deductible
Outpatient
treatment at a
hospital
Physician
charges paid at
100% after $15
co-pay. After
satisfaction of
deductible,
other charges
paid at 90%.
After
satisfaction of
deductible,
physician and
other charges
paid at 60%.
After
satisfaction of
deductible,
physician and
other charges
paid at 80%.
After
satisfaction of
deductible,
physician and
other charges
paid at 60%
Individual
deductible
Family
deductible
Routine
physical
exam
Inpatient
Surgery
performed by
a specialist in
one of the 12
Aexcel
specialty
areas
Aexcel
specialist:
Paid at 90%
after $200
inpatient copay
Non-Aexcel
specialist:
Paid at 80%
after $200
inpatient copay
Paid at 60%
after $200
inpatient copay
and satisfaction
of deductible.
Aexcel
specialist:
Paid at 80%
after $200
copay.
Non-Aexcel
Paid at 70%
after $200
copay.
Paid at 60%
after $200
inpatient copay
and satisfaction
of deductible.
Paid at 100%
after $15 copay
and satisfaction
of deductible
(copay applies
to deductible)
After
satisfaction of
deductible and
$15 copay
(copay applies
to the
deductible),
physician and
other charges
paid at 100%.
Paid at 100%
after
satisfaction of
deductible.
Paid at 100%
after $15
copay
Paid at 100%
after $15
copay.
Paid at 100%
after $200
inpatient
copay
Page 16
2013 Medical Benefits Highlights
The purpose of this document is to help you make decisions; it is not a contract. Details are provided in medical plan booklet which can be found in Ourhouse
http://ourhouse/Dept-HR/HR-Pages/HR-Benefits/HR-Ben-RA-RM-Insurance.htm
Group Health Cooperative (GHC)*
Standard Plan
Deductible Plan
City of Seattle Traditional Plan*
Aetna In-Network
Out-of-Network
City of Seattle Preventive Plan*
Aetna In-Network
Out-of-Network
Deductible (per calendar year)
No Deductible
$200 per person
$400 per person
$1,000 per person
$100 per person
$450 per person
$600 per family
$1,200 per family
$3,000 per family
$300 per family
$1,350 per family
Deductible applies as noted
Deductible applies to most services, except as noted.
Deductible applies to most services, except as noted.
except for prescriptions,
Deductible does not apply for prescriptions or when the
Deductible does not apply for prescriptions or when the
preventive visits, ambulance,
Inpatient co-pay or emergency room co-pay applies.
Inpatient co-pay or emergency room co-pay applies.
and durable medical
equipment.
Annual Out of Pocket Maximum (OOP Max) Excludes deductible, if applicable. Aetna Copays do not apply towards OOP Max.
$2,000 per person
$2,000 per person
$1,000 per person
$2,000 per person**
$2,000 per person
$3,000 per person*
$4,000 per family
$6,000 per family
$3,000 per family
$6,000 per family*
$4,000 per family
$6,000 per family*
Hospital Copay
$200 per admission
Deductible applies
$200 copay per admission
$200 copay per admission $200 copay per admission
$200 copay per admission
Hospital Pre-admission Authorization
Except for maternity or emergency admissions,
Except for maternity or emergency admissions, your
Except for maternity or emergency admissions, your
must be authorized by GHC
physician must contact Aetna prior to your admission.
physician must contact Aetna prior to your admission
Member responsible for obtaining precertification of out-of- Member responsible for obtaining precertification of out-ofnetwork care.
network care.
Choice of Providers
Aetna contracted providers.
Any licensed, qualified
Aetna contracted providers.
Any licensed, qualified
All care and services must be approved and/or provided
No primary care physician
provider of your choice.
No primary care physician
provider of your choice.
by GHC or GHC designated providers.
selection or referrals required. Expenses paid based on
selection or referrals required. Expenses paid based on
Members may self-refer to most GHC specialists.
Aexcel*** specialists must be recognized charges*. You Aexcel** specialists must be recognized charges*. You
used in designated specialty pay the difference between used in designated specialty pay the difference between
areas to receive the maximum recognized and billed
areas to receive the maximum recognized and billed
benefit.
charges.
benefit.
charges.
COVERED EXPENSES
Acupuncture
$15 copay for up to 8 visits
per condition per year selfreferred. Additional visits
when approved by plan.
$15 copay for up to 8 visits per
condition per year selfreferred. Additional visits
when approved by plan.
Deductible applies.
Alcohol/Drug Abuse Treatment
Inpatient: Paid at 100% after Inpatient: Paid at 100% after
$200 copay
deductible
Outpatient: Paid at 100%
Outpatient: Paid at 100%
after $15 copay
after $15 co-pay. Deductible
applies.
Contraceptives
For contraceptive drugs and devices,
see Prescription Drug benefit
Durable Medical Equipment
Paid at 80%
Paid at 80%
Paid at 80%
Paid at 60%
Maximum of 12 visits per calendar year in- and
out-of-network combined.
Inpatient: Paid at 80% after
$200 copay
Outpatient: Paid at 80%
All acupuncture services are subject to ongoing review and
approval by Aetna for medical necessity.
Inpatient: Paid at 60% after Inpatient: Paid at 90% after
Inpatient: Paid at 60% after
$200 copay
$200 copay
$200 copay
Outpatient: Paid at 60%
Outpatient: Paid at 100% after Outpatient: Paid at 60%
$15 copay
IUDs and Depo Provera covered as medical benefits.
See Prescription Drug benefit.
Paid at 80%
Paid at 100% after $15 copay Paid at 60%
Paid at 60%
IUDs and Depo Provera covered as medical benefits.
See Prescription Drug benefit.
Paid at 90%
Paid at 60%
Page 17
Group Health Cooperative (GHC)*
Standard Plan
Deductible Plan
Emergency Medical Care
 Urgent Care Clinic
Paid at 100% after $15
copay
$15 copay. Deductible
applies.
City of Seattle Traditional Plan*
Aetna In-Network
Out-of-Network
Paid at 80%
Paid at 60%
 Emergency Room (copays waived if admitted)
GHC facility: $100 copay
GHC facility: $100 copay
Paid at 80% after $150 copay Paid at 80% after $150
Non-GHC facility: $150
Non-GHC facility: $150 copay.
copay.
copay
Deductible applies
If non-emergency, paid at
60% after copay.
 Ambulance
Paid at 80%.
Paid at 80%.
Paid at 80% when medically necessary.
GHC-initiated nonGHC-initiated non-emergency
Non-emergency transportation must be approved in
emergency transfers are paid transfers are paid at 100%
advance
at 100%
by Aetna.
Gender Reassignment Services
Covered as any other service; Covered as any other service; Covered as any other
Covered as any other
copays/coinsurance depend copays/coinsurance depend service; copays/coinsurance service; copays/coinsurance
on type and location of
on type and location of
depend on type and location depend on type and location
service provided.
service provided.
of service provided.
of service provided.
Hearing Aids (per ear, every 36 months)
Up to $1,000
Up to $1,000
Up to $1,000
Up to $1,000
In-network coinsurance applies whether purchased in- or
out-of-network. Deductible does not apply.
Home Health Care
Paid at 100% when
authorized.
No visit limit.
Hospital Inpatient
Paid at 100% after $200
copay per admission
Paid at 100% when
authorized.
No visit limit.
Paid at 80%
Paid at 60%
Maximum benefit of 130 visits per calendar year
for in- and out-of-network combined
Paid at 100% after deductible. Paid at 80% after $200 copay. Paid at 60% after $200
Physician services paid at
copay
70%
if Aexcel** specialist not
used in specialty areas.
Hospital Outpatient
Paid at 100% after $15 copay $15 copay. Deductible applies. Paid at 80% after deductible.
Physician services paid at
70%
if Aexcel** specialist is not
used in specialty areas.
Hospice
Paid at 100% when
Paid at 100% when authorized Paid at 80%
authorized
Maternity Care (delivery & related hospital)
Paid at 100% after $200
Deductible applies.
copay
City of Seattle Preventive Plan*
Aetna In-Network
Out-of-Network
Paid at 100% after $15
Paid at 60%
copay (no fee for preventive
care)
Paid at 90% after $150 copay Paid at 90% after $150
copay.
If non-emergency, paid at
60% after copay.
Paid at 90% when medically necessary.
Non-emergency transportation must be approved in
advance
by Aetna.
Covered as any other service;
copays/coinsurance depend
on type and location of service
provided.
Covered as any other
service; copays/coinsurance
depend on type and location
of service provided.
Up to $1,000
Up to $1,000
In-network coinsurance applies whether purchased in- or
out-of-network. Deductible does not apply.
Paid at 90%
Paid at 60%
Maximum benefit of 130 visits per calendar year
for in- and out-of-network combined
Paid at 90% after $200 copay. Paid at 60% after $200
Physician services paid at
copay
80%
if Aexcel** specialist not used
in specialty areas.
Paid at 60% after
satisfaction of deductible
Paid at 90% after deductible.
Physician services paid at
80%
if Aexcel** specialist is not
used in specialty areas.
Paid at 60% after
satisfaction of deductible
Paid at 60%
Paid at 90%
Not covered
Paid at 80% after $200 copay Paid at 60% after $200
copay
Paid at 90% after $200 copay Paid at 60% after $200
copay
Page 18
Group Health Cooperative (GHC)*
Standard Plan
Deductible Plan
City of Seattle Traditional Plan*
Aetna In-Network
Out-of-Network
Maternity Care (prenatal and postpartum)
Paid at 100% after $15 copay $15 copay. Deductible applies. Paid at 80%
Paid at 60%
Mental Health Care (inpatient)
Paid at 100% after $200
Paid at 100% after deductible. Paid at 80% after $200 copay Paid at 60% after $200
copay
copay
Mental Health Care (outpatient)
Paid at 100% after $15 copay $15 copay per individual,
Paid at 80% after deductible
per individual, family or
family or couple session.
couple session.
Deductible applies.
Physician Office Visit
Paid at 100% after $15
copay.
Paid at 100% after $15 copay. Paid at 80%
Deductible applies.
Prescription Drugs (retail)
For a 30 day supply:
Generic: $15 copay
Brand: $30 copay
Contraceptive drugs and
devices are covered subject
to the pharmacy copay.
For a 30-day supply:
Generic: $15 copay
Brand: $30 copay
Contraceptive drugs and
devices are covered subject
to the pharmacy copay.
Paid at 60%
City of Seattle Preventive Plan*
Aetna In-Network
Out-of-Network
Paid 100% after one $15
copay
Paid at 60%
Paid at 90% after $200 copay Paid at 60% after $200
copay
Paid at 100% after $15 copay Paid at 60% after deductible
Paid at 100% after $15 copay Paid at 60%
per visit (waived for preventive
care)
For a 31-day supply:
For a 31-day supply:
Not covered
Generic: 30% coinsurance.
Generic: 30% coinsurance
Not covered
Brand: 40% coinsurance
Brand: 40% coinsurance
The minimum coinsurance is
The minimum coinsurance is
$10, or actual cost of the drug
$10, or actual cost of the drug
if less. Maximum is $100 per
if less. Maximum is $100 per
drug.
drug.
Copays do not apply to OOP Copays do not apply to OOP Coinsurance applies to the prescription $1,200 out-of-pocket annual maximum per person, $3,600 per family.
Max. Smoking cessation
Max. Smoking cessation
Prescription Allowance on all non-sedating antihistamines (for allergy symptoms) and Proton Pump Inhibitors (for
prescription drugs not subject prescription drugs not subject heartburn relief and ulcer treatment). City pays $20 per month, and plan participant pays remaining; some over the
to pharmacy copay.
to pharmacy copay.
counter medications are also included. $5 copay for generic diabetic drugs and supplies, $15 copay for brand. Many
contraceptive products are covered. IUDs and Depo Provera covered under the medical plan benefit. Coinsurance for
asthma, anti-high cholesterol, and tobacco cessation drugs 10% for generic and 20% for brand pharmacy.
Prescription Drugs (mail order)
For a 90 day supply:
For a 90 day supply:
Generic: $45 copay
Generic: $30 copay
Brand: $90 copay
Brand: $60 copay
Contraceptive drugs and devices are covered subject to the
pharmacy copay. Copays do not apply to the OOP Max.
Preventive Care
Paid at 100% after $15 copay
Covers adult physical and
well child exams, most
immunizations, hearing
exams, eye exams, digital
rectal exams/prostatespecific antigen test,
colorectal cancer screening,
pap smear exam and
mammogram.
For a 90-day supply:
Not Covered
Generic: 30% coinsurance
Brand: 40% coinsurance
Minimum is $20 or double the
cost of the drug if less. The
maximum is $200 per drug.
Paid at 100% after $15 copay Mammograms paid at 80%.
Mammograms paid at 60%
Covers adult physical and well
child exams, most
immunizations, hearing
No other preventive services are covered
exams, eye exams, digital
rectal exams/prostate-specific
antigen test, colorectal cancer
screening, pap smear exam
and mammogram.
Hearing exams subject to
deductible.
For a 90-day supply:
Not Covered
Generic: 30% coinsurance
Brand: 40% coinsurance
Minimum is $20 or double the
cost of the drug if less. The
maximum is $200 per drug.
Paid at 100% (copay waived)
Covers adult physical and well
child exams, immunizations,
digital rectal exams/prostatespecific antigen test, colorectal
cancer screening.
Paid at 60% for well woman
care and mammograms
No other preventive
services covered
Page 19
Group Health Cooperative (GHC)*
Standard Plan
Deductible Plan
Rehabilitation Services (inpatient)
Paid at 100% after $200
Paid at 100% after deductible.
copay per admission
Maximum of 60 days per calendar year
(combined with other therapy benefits)
Rehabilitation Services (outpatient)
Paid at 100% after $15 copay $15 copay Deductible applies.
Maximum of 60 visits per calendar year
(combined with other therapy benefits)
City of Seattle Traditional Plan*
Aetna In-Network
Out-of-Network
Paid at 80% after $200 copay Paid at 60% after $200
copay
Paid at 90% after $200 copay Paid at 60% after $200
copay
Maximum of 120 days per calendar year for skilled nursing
and rehab services in- and out-of-network combined
Paid at 80%
Paid at 60%
Includes medically necessary physical/massage, speech,
and occupational therapy for non-chronic conditions.
Coinsurance does not apply to OOP Max. Coverage of
services subject to Aetna’s review for medical necessity at
any time
Paid at 100% after $15 copay Paid at 60%
Includes medically necessary physical/massage, speech,
occupational and cardiac/pulmonary therapy for non-chronic
conditions. Coverage of services subject to Aetna’s review
for medical necessity at any time
Skilled Nursing Facility
Paid at 100%. 60 day
60 day maximum per calendar Paid at 80% after $200 copay Paid at 60% after $200
maximum per calendar year. year. Paid at 100% after
copay
deductible.
Maximum of 90 days per calendar year for
in- and out-of-network combined
Smoking Cessation
Paid at 100% for individual
Paid at 100% for individual
Lifetime maximum of one
Not covered
or group sessions
or group sessions
90-day supply of aids or
Nicotine replacement therapy included in Prescription Drug drugs.
Coinsurance 10% generic,
benefit
20% brand. See Prescription
Drugs.
Spinal Manipulations
Paid at 100% after $15 copay $15 copay.
Paid at 80%
Paid at 60%
Deductible applies.
Self-referral to GHC designated providers. Must meet GHC
Maximum of 10 visits per calendar year
protocol. Maximum of 10 visits per calendar year.
for in-network and out-of-network combined.
Sterilization Procedures
Outpatient: Paid at 100%
Outpatient: $15 copay.
Inpatient: Paid at 80% after
Inpatient: Paid at 60% after
after $15 copay
Deductible applies.
$200 copay
$200 copay
Outpatient: Paid at 80%
Temporomandibular Joint Services
Covered as any other
Covered as any other service;
service; copays/coinsurance copays/coinsurance depend
depend on type and location on type and location of service
of service provided. 5,000
provided.
lifetime maximum
$5,000 lifetime maximum
Tooth Injury (due to accident)
Not covered
Not covered
City of Seattle Preventive Plan*
Aetna In-Network
Out-of-Network
Covered as any other service;
copays/coinsurance depend
on type and location of service
provided.
Outpatient: Paid at 60%
Covered as any other
service;
copays/coinsurance
depend on type and
location of service
provided.
$5,000 lifetime maximum for non-surgical services
in- and out-of-network combined.
Inpatient: Paid at 80% after
$200 copay
Outpatient: Paid at 80%
Paid at 90% after $200 copay Paid at 60% after $200
copay
Maximum of 120 days per calendar year for rehab services
and skilled nursing in- and out-of-network combined
Smoking cessation
prescription drugs covered
subject to 10% generic, 20%
brand drug coinsurance.
Not covered
Paid at 100% after $15 copay Paid at 60%
Maximum of 20 visits per calendar year
for in-network and out-of-network combined.
Inpatient: Paid at 90% after
$200 copay
Inpatient: Paid at 60% after
$200 copay
Outpatient: Paid at 90%
Outpatient: Paid at 60%
Covered as any other service;
copays/coinsurance depend
on type and location of service
provided.
Covered as any other
service; copays/coinsurance
depend on type and location
of service provided.
$5,000 lifetime maximum for non-surgical services
in- and out-of-network combined.
Inpatient: Paid at 60% after Inpatient: Paid at 90% after
Inpatient: Paid at 60% after
$200 copay
$200 copay
$200 copay
Outpatient: Paid at 60%
Outpatient: Paid at 100%
Outpatient: Paid at 60%
after $15 copay for office visit.
Other charges paid at 90%
Page 20
Group Health Cooperative (GHC)*
Standard Plan
Deductible Plan
Vision Exam/Hardware
Exam: Paid at 100% after
$15 copay. One exam every
12 months.
Hardware: Not covered.
X-ray and Lab Tests
Paid at 100%
Exam: Paid at 100% after
$15 copay. One exam every
12 months.
Hardware: Not covered.
Paid at 100%. Deductible
applies.
City of Seattle Traditional Plan*
Aetna In-Network
Out-of-Network
City of Seattle Preventive Plan*
Aetna In-Network
Out-of-Network
Covered under Vision Service Plan.
Covered under Vision Service Plan.
Paid at 80%
Provider responsible for
obtaining precertification of
high tech radiology
Paid at 60%
Paid at 90%
Provider responsible for
obtaining precertification of
high tech radiology
Paid at 60%
*
Coverage for any service is subject to the carrier’s determination of medical necessity and adherence to their clinical policy guidelines.
** Applies to Aetna -- Recognized charges are the lower of the provider's usual charge for performing a service, and the charge Aetna determines to
be the recognized charge percentage in the geographic area where the service is provided.
*** Applies to Aetna – Aexcel network, a specialty network of doctors in 13 specialty areas. The coinsurance level will drop 10% for non-Aexcel
doctors in the 13 specialty areas (coinsurance applies to in-network, out-of-pocket maximum). Call 1-877-292-2480for more information about the
Aexcel network.
Plan details are in your medical plan booklet at http://ourhouse/Dept-HR/HR-Pages/HR-Benefits/HR-Ben-RA-RM-Insurance.htm
This document is not a contract.
Paying Out-of-Network Claims
The following is an explanation of how out-of-network claims are paid by Aetna. This will explain how “Recognized Charges” are used, and how the
amount that you are “balance billed” is calculated.
Explanation of Terms
Recognized Charge - The charge determined by Aetna on a semiannual basis to be in the 70th percentile of the charges made for a service or supply
by providers in the geographic area where it is furnished. The 70th percentile is determined by the maximum amount that 70% of providers charge for a
particular service in the geographic area where the service is provided. For example, if 70% of the doctors in a specific area charge $100 or less for an
office visit, the Recognized Charge at the 70th percentile would be $100.
Out-of-network reimbursement level – The percentage of the “Recognized Charge” that Aetna will reimburse an out-of-network provider. Aetna uses
60% of the “Recognized Charge” for most eligible claims. The member pays the remaining 40% of the “Recognized Charge.”
Out-of-network provider – A provider who does not have a contractual reimbursement relationship with Aetna. When Aetna receives a claim from an
out-of-network provider, Aetna determines the “Recognized Charge” and pays 60% of that amount if the out-of-pocket maximum has not been
satisfied, even though the provider may actually charge more that the “Recognized Charge.”
Page 21
Health Care Premiums
2013 Premium Sharing
Effective January 1, 2013, you will pay the monthly premium amount listed below. The table
also shows the total premium amount each month for each employee’s coverage, and
SHA’s contribution.
Total
Monthly
Premium
Employee, with or
without children
SHA Pays
Medical Plan
City of Seattle
Preventive
City of Seattle
Traditional
Group Health
Standard
Group Health
Deductible
Employee
Pays
Employee with Spouse/Domestic
Partner, with or without children
SHA Pays
Employee Pays
$1,074.61
$1,026.49
$48.12
$976.11
$98.50
$972.32
$972.32
$ 0.00
$939.98
$32.34
$1,063.65
$1,015.25
$48.40
$963.75
$99.90
$979.61
$954.61
$25.00
$922.69
$56.92
Your premium will be divided into two equal payments and taken from the first two pay checks of the
month for the current month’s coverage. (For example, deductions taken in January will pay for
January coverage.) No premiums are deducted from the third paycheck. Premiums are deducted on
a pre-tax basis, reducing your taxable income.
*Provided they are IRS tax dependents.
Page 22
Health Care Premiums
Enrolling
Spouse/DP
To cover a spouse or domestic partner (and tax dependents of your domestic
partner), you must complete an SHA Benefit Election form, and an Affidavit of
Marriage/ Domestic Partnership.
Spouse/DP/
Dependents Who
are IRS Tax
Dependents
If they are IRS tax dependents, the rate information on the previous page
applies. If you enroll your domestic partner and your domestic partner’s
children, you will be taxed on the value of their medical coverage if they are
not your tax dependents. (The value of the benefits will be imputed to your
gross income.)
DP/Dependents
Who are Not IRS
Tax Dependents
After Tax Premium Contributions
If you choose to cover a domestic partner who is not your IRS tax
dependent, the portion of the premium deducted from your paycheck (your
contribution) that pays for his/her coverage must be taken “after tax” to
comply with IRS regulations.
Medical Plans
Monthly Premium Contribution Taken
After Taxes for Domestic Partner
City of Seattle Preventive
$50.38
City of Seattle Traditional
$32.34
GHC Standard
$51.50
GHC Deductible
$31.92
Imputed Income for Value of Health Coverage
In addition, if your domestic partner, or your partner’s non-IRS tax
dependent’s children do not qualify as your IRS tax dependents, you will also
be taxed on the SHA-paid value of their medical, dental and vision coverage
as required by IRS regulations. The following amounts will be listed on your
paycheck as taxable income each month and are subject to federal income
and Social Security tax withholding. These values have been adjusted to
reflect the premium amounts taken after-tax (as explained above) so you are
not taxed twice.
Page 23
Health Care Premiums
DP/Dependents
Who are Not IRS
Tax Dependents
(cont’d.)
Domestic Partner [Same-Sex Spouse] Coverage Information
If your domestic partner/same-sex spouse or your partner’s non-IRS tax
dependent’s children do not qualify as your IRS tax dependents, the following
amounts will be listed on your paycheck as taxable income each month and
are subject to federal income and Social Security tax withholding. (These
values have been adjusted to reflect the premium amounts taken after-tax so
you are not taxed twice.)
Medical/Dental/Vision Coverage Values with Washington Dental Service
Coverage
Taxable Benefit
Amount – (with
WDS)
2013 Monthly Taxable Values of SHA Coverage Provided to:
Your Non-IRS Tax Dependent Domestic Partner/
Same-Sex Spouse, or
Your Domestic Partner’s Non-IRS Tax Dependent’s Child
Type of Coverage
Domestic Partner/
Taxable Amount Per
Same-Sex Spouse
Child
Taxable Amount
$562.58
$245.18
Preventive Plan
Traditional Plan
$522.27
$221.84
GHC Standard
$555.21
$242.68
GHC Deductible
$526.85
$223.51
WDS Coverage
$65.67
$45.97
Vision Coverage
$4.69
$3.28
$10.66
$7.46
Buy-Up Vision Plan
Total Taxable Value with WDS & VSP Basic Plan
Preventive Plan
$632.94
Traditional Plan
$592.63
GH Standard Plan
$625.57
$294.43
$271.09
$291.93
GH Deductible Plan
$272.76
$597.21
Total Taxable Value with WDS and VSP Buy-Up Plan
$638.91
Preventive Plan
$298.61
Traditional Plan
$598.60
$275.27
GH Standard Plan
$631.54
$296.11
GH Deductible Plan
$603.18
$276.94
Page 24
Health Care Premiums
DP/Dependents
Who are Not IRS
Tax Dependents
(cont’d.)
Taxable Benefit
Amount – (with
DHS)
Medical/Dental/Vision Coverage Values with Dental Health Services
Coverage
2013 Monthly Taxable Values of City Coverage Provided to:
Your Non-IRS Tax Dependent Domestic Partner/
Same-Sex Spouse, or
Your Domestic Partner’s Non-IRS Tax Dependent’s Child
Type of Coverage
Domestic Partner/
Taxable Amount Per
Same-Sex Spouse
Child
Taxable Amount
Preventive Plan
$562.58
$245.18
Traditional Plan
$522.27
$221.84
GHC Standard
$555.21
$242.68
GHC Deductible
$526.85
$78.15
$223.51
$54.70
$4.69
$3.28
$10.66
$7.46
DHS Coverage
Basic Vision Plan
Buy-Up Vision Plan
Total Taxable Value with DHS & VSP Basic Plan
Preventive Plan
$645.42
Traditional Plan
$605.11
GH Standard Plan
$638.05
$609.69
GH Deductible Plan
$303.16
$279.82
$300.66
$281.49
Total Taxable Value With DHS & VSP Buy-Up Plan
$651.39
Preventive Plan
$307.34
Traditional Plan
$611.08
$284.00
GH Standard Plan
$644.02
$304.84
GH Deductible Plan
$615.66
$285.67
Page 25
Prescription Drug Coverage
Prescription Drug Retail Program
Aetna classifies medications into three tiers:



Generic
Preferred brand-name
Non-preferred brand-name
Group Health Cooperative uses two classifications:


Preventive and
Traditional
Plans (Aetna)
Generic
Preferred brand-name (no coverage for non-preferred brands)
With the Aetna plans, you pay 30% of the actual cost for generic drugs, and 40%
for preferred and non-preferred brand-name drugs, up to a maximum of $100 per
drug per month. There is a $1,200 annual out-of-pocket maximum per member
for retail and mail order drugs.
Present your medical plan ID card at any Aetna network retail pharmacy.
Prescriptions filled at a non-network pharmacy will not be covered. You may
contact the toll-free Member Services number on the back of your ID card to find a
participating pharmacy, or check the website at http://www.aetnanavigator.com/.
GHC Plans
You are responsible for a $15 copay for generic drugs and a $30 copay for brand
name drugs. All prescriptions must be filled at a GHC pharmacy. Prescriptions
filled at any non-GHC pharmacy will not be covered.
See next page for more detailed information about prescription drug coverage.
Page 26
Prescription Drug Coverage Comparison
Plan Features
GHC Standard
GHC
Deductible
Aetna
Preventive
Aetna
Traditional
Annual out-ofpocket Maximum
Rx copays do not
apply to out-ofpocket maximum.
Rx copays do not
apply to out-ofpocket maximum.
$1,200
$1,200
You pay $15 copay
for generic drugs;
$30 copay for brand
name drugs.
You pay $15 copay
for generic drugs;
$30 copay for brand
name drugs.
Not applicable
Not applicable
Not applicable.
Not applicable.
You pay 30% of
actual cost of
generic drug; 40%
of cost for brand
drugs*
$10 or actual cost
of drug if less.
$100 per
prescription
You pay 30% of
actual cost of
generic; 40% of
cost for brand
drugs*
$10 or actual cost
of drug if less
$100 per
prescription
30-day
Not covered
30-day
Not covered
31-day
Not covered
31-day
Not covered
 Coinsurance
Generic:$45 copay
Brand: $90 copay
Generic:$30 copay
Brand: $60 copay
You pay 30% of
actual cost of
generic; 40% of
cost for brand drugs
 Minimum
Not applicable
Not applicable
Not applicable
Not applicable
You pay 30% of
actual cost of
generic drug; 40%
of cost for brand
drugs
$30 or actual cost
of drug if less.
$200 per
prescription
90-day supply
90-day supply
90-day supply
90-day supply
Retail
 Coinsurance
 Minimum
Coinsurance
 Monthly out-ofpocket
Maximum
 Days Supply
 Out-of-Network
Mail Order


Coinsurance
Monthly out-ofpocket
Maximum
Days Supply
$30 or actual cost
of drug if less.
$200 per
prescription
*Coinsurance exceptions:
 City pays $20 towards cost of proton pump inhibitors and non-sedating antihistamines and you pay the
remaining amount, whether medication is purchased over-the-counter or is a brand name drug.

You pay 10% of cost for generic and 20% for brand drugs for anti-high cholesterol, asthma, and tobacco
cessation drugs

Diabetic drugs and supplies have special copays: $5 copay for generic, $15 copay for brand.
Page 27
Dental Plan Options
There are two dental plans: Washington Dental Service (WDS) and Dental Health
Services (DHS).
Washington Dental Service
If you select WDS, you can receive services from any dentist, but your out-ofpocket expenses may be lower if you choose a dentist who belongs to the WDS
network.
Selecting a WDS dentist means:



The portion of the dentist bill you pay is smaller than if you use a non-network
dentist.
You do not need to submit a claim - the dentist’s office will submit the claim
form.
After you pay your portion of the bill, the dentist will not bill you more for a
covered service. (A non-WDS dentist may bill you for the portion of the bill that
WDS does not cover.)
Payment of
Routine Care
Benefits
The WDS Incentive program is designed to promote regular dental care by
increasing from one incentive period to the next, the amount paid for preventive care
and regular visits. During the first incentive period, the payment level for covered
and allowable Preventive and Diagnostic (routine care) benefits will be 70 percent
even if you had WDS coverage through a previous employer. This payment level
increases by 10 percent — up to a maximum of 100 percent — each successive
incentive period in which routine care benefits are used at least once by the eligible
person(s). If the once-a-year visit is missed, the payment level will be decreased by
10 percent for each period during which routine care benefits are not used. In no
event will the payment level be less than 70 percent.
Orthodontia
WDS offers orthodontia benefits for children. Pre-treatment estimates are
recommended. The orthodontia benefit is paid at a 50% level to a lifetime
maximum of $1,500 for each eligible child. There is no adult orthodontia
coverage.
Plan Ahead
Use your medical Flexible Spending Account to pay your portion of orthodontia with
pretax dollars.
Page 28
Dental Plan Options
Dental Health Services
The Dental Health Services Plan provides greater benefits for services received in
network than if you enroll in WDS, but the DHS network of participating dentists is
smaller.
Selecting a Dental Health Services dentist means:


There are no deductibles or annual maximums.
Coverage does not decrease if you do not visit your dentist regularly.
Payment of
Basic Services
This plan has an office visit copay of $10 for all employees. There are also
copays for selected services. The plan comparison on the next page lists services
and copay requirements.
Orthodontia
DHS offers both child and adult (age 25 and over) orthodontia. Orthodontia
charges include: a copayment of $1,800 per adult or $1,000 per child for
orthodontic treatment; a $150 charge for the initial exam, study models and Xrays; and a $10 copay for each visit during the course of treatment.
Plan Ahead
Use your medical Flexible Spending Account to pay your portion of orthodontia
with pretax dollars.
Dental Plan
Comparison
The table on the next page compares the coverages offered by the two dental
plans.
Page 29
Dental Plan Comparison
Plan Features
Washington Dental Service
(WDS)
Dental Health Services (DHS)
Calendar Year
Deductible
$50 per person, $150 per family
(No deductible for preventive
services)
$2,000 per person per year
$0
Annual Maximum
Benefit
Diagnostic and
Incentive payments levels
Preventive (routine and
1st Year – 70%
emergency exams, x-rays,
2nd Year – 80%
cleaning, fluoride
3rd Year – 90%
treatment, sealants)
4th Year – 100%
Inlays (Fillings)
Constant 70%
Crowns, Onlays
Constant 70%
Prosthodonic Services
(Dentures, Bridges)
Constant 50%
Orthodontia
Lifetime Maximum
Choice of Providers
Child(ren) Only
Plan pays 50%
$1,500
In-Network: Any contracted
provider.
Out-of-Network: Expenses paid
will be based on actual charges or
Washington Dental Service’s
maximum allowable fees for
nonparticipating dentists,
whichever is less. You will be
responsible for any balance
remaining.
No Annual Maximum.
$10 office visit copay
Two additional cleanings for
pregnant women, up to four
cleanings.
$10 office visit copay
Covers composite fillings in all teeth
(posterior composite fillings
additional $15)
$75 (plus $70 noble, $100 high
noble, $125 upgraded, specialize
porcelain if applicable per unit.)
$125 plus $10 office visit copay
(dentures)
$75 plus $10 office visit copay
(bridges)
($70 on noble, $100 on high noble
metal & titanium, and $125 charge
on upgraded, specialized porcelain)
Available for Child & Adult
Adult (age 25 and over) $1,800 plus
$150 for initial exam, study models
and x-rays covers full course of
treatment plus $10 copay for each
visit (new cases)
Orthodontia cases (less than age
25) $1,000 copay $150 for initial
exam, study models and x-rays
covers full course of treatment plus
$10 copay for each visit (new cases)
N/A
In-Network: Any contracted provider
in the DHS network.
Out-of-Network: No out-of-network
coverage.
Page 30
Dental Plan Comparison (continued)
Plan Features
Washington Dental
Service (WDS)
Dental Health Services
(DHS)
Periodontics (surgical
and nonsurgical
procedures for treatment
of the tissues supporting
the teeth)
Endodontics (treatment
of tissues surrounding
root of tooth)
Paid according to incentive
payment levels shown above
Paid at 100% after $25 copay for
periodontal scaling and
maintenance at general dentist. If
referred to periodontist, member
pays 20%.
Paid at 100% after applicable copay
($50 for anterior, $75 for bicuspid, or
$100 for molar root canal) If referred
to an endodontist, member pays
20%.
Paid at 100% after $10 office visit
copay for general dentist. If referred
to an oral surgeon, member pays
20%
Oral Surgery (routine and
surgical extractions)
Temporomandibular
Joint (TMJ) Disorders
Dental Implants
Other
Paid according to incentive
payment levels shown above,
Root canal treatment of same
tooth covered only once in a 2year period.
Paid according to incentive
payment levels shown above,
Root canal treatment of same
tooth covered only once in a 2year period.
Not covered
Constant 50%
N/A
$1,000 annual maximum
$5,000 lifetime maximum
Call DHS Office for details – fees
apply
Occlusal (night guard) with $350
copay
2013 Monthly Dental Premiums
Dental
Plan
Total
Monthly
Premium
Amount
Employee’s Monthly Premium Contribution
Coverage for Employee with or
without children
Coverage for Employee with
Spouse/Domestic Partner with or
without children
Washington
Dental
Service
$121.51
$0
$0
Dental
Health
Services
$144.60
$0
$0
New Employees: Remember - You have 31 days from your hire date to enroll in the medical, dental,
vision and most optional insurance plans.
Page 31
Vision Coverage
Vision Service
Plan
SHA offers two vision plans through Vision Service Plan. The Basic plan is fully
paid by SHA. The vision Buy-Up plan is paid by the employee. The Buy-Up plan
provides more frequent coverage of lenses, frames and contact lenses and
includes coverage of progressive lenses.
If you use a VSP provider, you will receive the benefits listed in the following table.
If you use a non-VSP provider, the Plan will reimburse you for expenses in the
amounts shown.
Plan Ahead
Lens options such as scratch coating, anti-reflective coating, and high density
plastic are not covered by either plan. If you want any features not covered by a
vision plan, plan ahead and use your FSA to pay for it with pre-tax dollars.
Vision Benefits
Plan Feature
Eye exam:
Coverage by Provider
VSP Provider
Non-VSP Provider
$10 copay. Exam covered in full.
Covered up to $50.
$25 copay.
Basic and Buy-Up Plans:
Covered each calendar
year
Lenses and Frames:
Basic Plan: Covered every
other calendar year
Frames covered in full up to
contract allowance of $150.
$25 copay.
Lenses covered up to $50 - $100
depending on type of lens.
Frames covered up to $70.
Buy-Up Plan: Covered
every calendar year
Basic Plan: Single vision, lined
bifocal, lined trifocal lenses are
covered in full; progressive lenses
not covered**
Basic Plan: Single vision, lined
bifocal, lined trifocal lenses are
covered as shown above;
progressive lenses not covered**
Buy-up Plan: Single vision, lined
bifocal, lined trifocal, and
progressive lenses are covered in
full.
Buy-up Plan: Single vision, lined
bifocal, lined trifocal covered as
shown above; progressive lenses
covered up to $100.
Page 32
Vision Coverage
Vision Benefits (continued)
Plan Feature
Coverage by Provider
VSP Provider
Non-VSP Provider
Contact Lenses:
Basic Plan: Covered every
other calendar year
Buy-Up Plan: Covered every
calendar year
Basic Plan: Contact lens fitting
and evaluation exam & contact
lenses covered up to elective
contact lens allowance of $120.*
Basic Plan: Elective contact
lenses covered up to $105;
includes contact lens evaluation
exam, fitting and materials.*
Buy-up Plan: Contact lens fitting
and evaluation exam and contact
lenses covered up to contract
allowance of $150.*
Buy-Up Plan: Elective contact
lenses covered up to $105;
includes contact lens evaluation
exam, fitting and materials.*
Basic and Buy-Up Plans: Lens options such as scratch coating, antireflective coating, or high density plastic not covered.
*Medically necessary contacts are covered in full (up to $210 at a Non-VSP Provider) when patient
meets specific requirements as determined by VSP doctor at the time of service.
Other:
2013 Monthly Vision Premiums
Vision Plan
Total
Monthly
Premium
Amount
Employee’s Monthly Premium Contribution
Coverage for Employee with or
without children
Coverage for Employee with
Spouse/Domestic Partner with
or without children
Vision Service
Basic Plan
$8.68
$0
$0
Buy-Up Plan
$19.72
$8.68
$11.04
New Employees: Remember - You have 31 days from your hire date to enroll in the medical, dental,
vision and most optional insurance plans.
Page 33
Optional Insurance
Optional
Insurance
Choices
The following is a list of all your optional insurance choices. SHA offers paid
Basic Long-Term Disability Insurance and shares the cost of Group Term Life
Insurance with you. Accidental Death and Dismemberment and Long-Term Care
insurance premiums are paid in full by the employee. You can purchase
additional insurance coverage within 31 days of your hire date, during an Open
Enrollment period, or within 31 days of a qualifying change in family status.





Accidental Death and Dismemberment (AD&D) insurance for yourself and
family members
Supplemental Long-Term Disability insurance for yourself
Life insurance for yourself and family members
Supplemental Life insurance for yourself and family members
Long-Term Care insurance for yourself and family members
Page 34
Optional Insurance – AD&D
Accidental Death
and
Dismemberment
(AD&D)
To supplement your Basic and Supplemental Life Insurance, you may purchase
Accidental Death and Dismemberment (AD&D) Insurance for yourself,
spouse/domestic partner and/or children. AD&D Insurance pays a death
benefit (principal sum or full insurance amount) if the insured person dies due to
an accident; it also pays a percentage of the death benefit if the covered person
loses a limb(s) or becomes paralyzed. For example, a person who is covered
by AD&D Insurance would receive 50% of the principal sum (full insurance
amount) if he/she lost a limb from an injury relating to an accident.
How to Decide if
You Need AD&D
You can cover yourself in $25,000 increments up to $500,000. The amount of
coverage for your family members is a percentage of your coverage amount.
For example, John Smith has “Employee and Family” coverage for himself and
his two children (no spouse). If one of his children dies, he receives a payout of
20% of the principal sum. If John had a spouse, he would receive 15% of the
principal sum if his child were to die. Charts showing costs and payout
percentages can be found on the next page.
If you don’t have life insurance or other insurance plans to cover your family if
something should happen to you, you may consider purchasing AD&D
coverage.
New Employees: Remember - You have 31 days from your hire date to enroll
in the medical, dental, vision and most optional insurance plans.
Page 35
Optional Insurance – AD&D
Accidental Death & Dismemberment Costs
Monthly Cost to Employee:
Cost of AD&D for
“Employee Only” and
“Employee and Family”
Coverage
Payout Amounts if
“Employee and Family”
Coverage is Selected
Principal Sum:
Employee Only:
Employee and
Family
$25,000
$.75
$1.00
$50,000
$1.50
$2.00
$75,000
$2.25
$3.00
$100,000
$3.00
$4.00
$125,000
$3.75
$5.00
$150,000
$4.50
$6.00
$175,000
$5.25
$7.00
$200,000
$6.00
$8.00
$225,000
$6.75
$9.00
$250,000
$7.50
$10.00
$275,000
$8.25
$11.00
$300,000
$9.00
$12.00
$325,000
$9.75
$13.00
$350,000
$10.50
$14.00
$375,000
$11.25
$15.00
$400,000
$12.00
$16.00
$425,000
$12.75
$17.00
$450,000
$13.50
$18.00
$475,000
$14.25
$19.00
$500,000
$15.00
$20.00
Family includes
employee and:
Percentage of
principal sum you
receive if your
spouse/partner dies
Percentage of
principal sum you
receive if a child
dies
Spouse/DP Only
(no children)
60%
0%
50%
15%
0%
20%
Spouse/DP &
Children
Children Only
(no spouse/DP)
Page 36
Optional Insurance – Long Term Disability
Basic LongTerm Disability
(LTD)
The basic benefits package provided by SHA includes a Long-Term Disability
(LTD) policy that will pay you a portion of your monthly pay if you are sick or
injured and cannot work. If you are disabled according to the plan definition,
the benefit will combine with other income sources, if any, to pay you up to
$400 per month after a 90-day waiting period while you are unable to work.
SHA offers the opportunity to purchase additional LTD coverage. The
additional LTD protection will combine with other income sources, if any, to
provide you with 60% of your monthly base pay over $667 up to a maximum
$8,333 of monthly base pay.
Supplemental
LTD
If you do not sign up for Supplemental LTD coverage as a new employee, you
can elect to add Supplemental LTD earnings protection during a subsequent
Open Enrollment period; however, you may have a longer waiting period for
pre-existing conditions.
How Much Will
Additional
Disability
Coverage Cost?
The cost for this additional level of earnings protection is figured according to
the following formula:
Subtract $667 from your base monthly pay.
Multiply the remaining amount by .0065.
For example, if your base monthly pay is $2,000, your monthly premium would
be $9.99 per month.
($2,000 - $667 = $1,333 x .0065 =$8.66/month)
Your monthly cost will increase each time your pay increases.
How to Decide if
You Need
Supplemental
LTD
When deciding whether or not to purchase Supplemental LTD, ask yourself the
following questions:
1. If I were unable to work for a period of time, would I be able to support
myself/family on the basic benefit of $400 per month?
2. Do I have personal savings or other sources of income to maintain my
current lifestyle if I am unable to work?
If you answer “no” to either of these questions, you may want to consider
purchasing Supplemental LTD coverage.
If you are currently eligible to receive a retirement benefit from the WA State or
you were to leave employment if you became disabled, you may not want to
elect this coverage because the maximum LTD benefit you would receive
under those circumstances would be $100 per month.
Page 37
Optional Insurance – Group Term Life
Group Term Life
(GTL) Insurance
SHA benefits program includes two levels of optional Term Life Insurance: Basic
and Supplemental. The City and you pay for Basic Life Insurance; you pay the
full cost for Supplemental Life Insurance. You can sign up for Group Term Life
Insurance within 31 days of your hire date, during an Open Enrollment period, or
within 31 days of a qualifying change in family status.
Basic Life
Insurance
This optional coverage provides you with a Term Life Insurance benefit amount
equal to one-and-a-half times your annual salary. SHA contributes 40% of the
cost and you pay the remaining 60% of the cost. A table with information
regarding the monthly cost of Basic Term Life Insurance follows.
How Much Will
Coverage Cost?
Your coverage amount is equal to your annual salary, rounded up to the next
$1,000 increment, multiplied by 1.5. Your monthly premium equals $0.066 times
each $1,000 of coverage.
For example, if your salary is $78,600 per year, round it up to $79,000. Your
coverage amount is $118,500 (Calculation: $79,000 x 1.5 = $118,500). Your
premium is $7.78 per month (Calculation: $0.066 x 118).
If you sign up for Basic Term Life Insurance as a new employee, you are
guaranteed coverage. However, if you sign up for it later, you will be required to
complete a Medical History Statement, which must be approved by the insurance
company before your life insurance takes effect. If you have certain health
conditions, you could be denied coverage.
This policy includes a conversion privilege which allows you to continue some
level of coverage if you leave SHA employment. Conversion is guaranteed,
which means you can continue the policy regardless of any existing medical
condition. It is more costly because of this provision, but could allow you to
maintain coverage when you otherwise might not qualify for new life insurance
coverage.
Limited Basic
Life Insurance
IRS rules state that the value of Basic Life Insurance over $50,000, which is paid
for by SHA, is taxable. Because SHA pays 40% of the cost for your Basic Term
Life Insurance, you may have some taxable value. If you do, the amount on
which you pay taxes will be shown on your second paycheck each month. You
may limit your Basic Term Life Insurance coverage amount to $50,000 to avoid
the additional taxes by signing a notarized Waiver form available at Human
Resources department.
Page 38
Optional Insurance – Group Term Life
Basic Group Life Insurance Costs
Costs for
Basic Life
Insurance
(based on
employee’s
annual
earnings)
Employee's Annual
Earnings
Amount of
Insurance
$29,000.01 – $30,000
$30,000.01 – $31,000
$31,000.01 – $32,000
$32,000.01 – $33,000
GTL Limited
$33,000.01 – $34,000
$34,000.01 – $35,000
$35,000.01 – $36,000
$36,000.01 – $37,000
$37,000.01 – $38,000
$38,000.01 – $39,000
$39,000.01 – $40,000
$40,000.01 – $41,000
$41,000.01 – $42,000
$42,000.01 – $43,000
$43,000.01 - $44,000
$44,000.01 - $45,000
$45,000.01 - $46,000
$46,000.01 - $47,000
$47,000.01 - $48,000
$48,000.01 - $49,000
$45,000
$46,500
$48,000
$49,500
$50,000
$51,000
$52,500
$54,000
$55,500
$57,000
$58,500
$60,000
$61,500
$63,000
$64,500
$66,000
$67,500
$69,000
$70,500
$72,000
$73,500
$49,000.01
$50,000.01
$51,000.01
$52,000.01
$50,000
$51,000
$52,000
$53,000
$75,000
$76,500
$78,000
$79,500
$53,000.01 – $54,000
$54,000.01 – $55,000
$81,000
$82,500
$55,000.01 – $56,000
$56,000.01 – $57,000
$84,000
$85,500
$57,000.01 – $58,000
$87,000
$5.74
$58,000.01 – $59,000
$88,500
$5.84
$59,000.01 – $60,000
$90,000
$60,000.01 – $61,000
$61,000.01 – $62,000
$91,500
$93,000
$5.94
$6.04
$62,000.01
$63,000.01
$64,000.01
$65,000.01
$66,000.01
$67,000.01
–
–
–
–
–
–
–
–
–
–
$63,000
$64,000
$65,000
$66,000
$67,000
$68,000
$94,500
$96,000
$97,500
$99,000
$100,500
$102,000
Employee
Monthly
Premium
$2.97
$3.07
$3.17
$3.27
$3.30
$3.37
$3.47
$3.56
$3.66
$3.76
$3.86
$3.96
$4.06
$4.16
$4.26
$4.36
$4.46
$4.55
$4.65
$4.75
$4.85
$4.95
$5.05
$5.15
$5.25
$5.35
$5.45
$5.54
$5.64
$6.14
$6.24
$6.34
$6.44
$6.53
$6.63
$6.73
SHA
Monthly
Premium
Total
Monthly
Premium
$1.98
$2.05
$2.11
$2.18
$2.20
$2.24
$2.31
$2.38
$2.44
$2.51
$2.57
$2.64
$2.71
$2.77
$2.84
$2.90
$2.97
$3.04
$3.10
$3.17
$3.23
$3.30
$3.37
$3.43
$3.50
$3.56
$4.95
$5.12
$5.28
$5.45
$5.50
$5.61
$5.78
$5.94
$6.11
$6.27
$6.44
$6.60
$6.77
$6.93
$7.10
$7.26
$7.43
$7.59
$7.76
$7.92
$8.09
$8.25
$8.42
$8.58
$8.75
$8.91
$3.63
$3.70
$3.76
$3.83
$3.89
$3.96
$4.03
$4.09
$4.16
$4.22
$4.29
$4.36
$4.42
$4.49
$9.08
$9.24
$9.41
$9.57
$9.74
$9.90
$10.07
$10.23
$10.40
$10.56
$10.73
$10.89
$11.06
$11.22
Page 39
Optional Insurance – Group Term Life
Basic Group Life Insurance Costs - Continued
Employee's Annual
Earnings
Amount of
Insurance
Employee
Monthly
Premium
SHA
Monthly
Premium
Total
Monthly
Premium
$68,000.01 – $69,000
$103,500
$69,000.01 – $70,000
$70,000.01 – $71,000
$105,000
$106,500
$6.83
$6.93
$71,000.01 – $72,000
$72,000.01 - $73,000
$108,000
$109,500
$73,000.01 - $74,000
$111,000
$7.33
$74,000.01 - $75,000
$112,500
$7.43
$75,000.01 - $76,000
$114,000
$7.52
$76,000.01 - $77,000
$115,500
$7.62
$77,000.01 - $78,000
$117,000
$7.72
$78,000.01 - $79,000
$118,500
$7.82
$79,000.01 - $80,000
$120,000
$7.92
$80,000.01 - $81,000
$121,500
$8.02
$81,000.01 - $82,000
$123,000
$8.12
$82,000.01 - $83,000
$124,500
$8.22
$83,000.01 - $84,000
$126,000
$8.32
$84,000.01 - $85,000
$127,500
$8.42
$85,000.01 - $86,000
$129,000
$8.51
$86,000.01 - $87,000
$130,500
$8.61
$87,000.01 - $88,000
$132,000
$8.71
$88,000.01 - $89,000
$133,500
$8.81
$89,000.01 - $90,000
$135,000
$8.91
$90,000.01 - $91,000
$136,500
$9.01
$91,000.01 - $92,000
$138,000
$9.11
$92,000.01 - $93,000
$139,500
$9.21
$93,000.01 - $94,000
$141,000
$9.31
$94,000.01 - $95,000
$142,500
$9.41
$95,000.01 - $96,000
$144,000
$9.50
$96,000.01 - $97,000
$145,500
$9.60
$97,000.01 - $98,000
$147,000
$9.70
$4.55
$4.62
$4.69
$4.75
$4.82
$4.88
$4.95
$5.02
$5.08
$5.15
$5.21
$5.28
$5.35
$5.41
$5.48
$5.54
$5.61
$5.68
$5.74
$5.81
$5.87
$5.94
$6.01
$6.07
$6.14
$6.20
$6.27
$6.34
$6.40
$6.47
$11.39
$11.55
$11.72
$11.88
$12.05
$12.21
$12.38
$12.54
$12.71
$12.87
$13.04
$13.20
$13.37
$13.53
$13.70
$13.86
$14.03
$14.19
$14.36
$14.52
$14.69
$14.85
$15.02
$15.18
$15.35
$15.51
$15.68
$15.84
$16.01
$16.17
$7.03
$7.13
$7.23
Your coverage amount is equal to your annual salary, rounded up to the next $1,000 increment,
multiplied by 1.5. Your monthly premium equals $0.066 times each $1,000 of coverage.
For example, if your salary is $78,600 per year, round it up to $79,000. Your coverage amount is
$118,500 (Calculation: $79,000 x 1.5 = $118,500). Your premium is $7.78 per month
(Calculation: $0.066 x 118).
Page 40
Optional Insurance – Group Term Life
Supplemental
Life Insurance
SHA offers an additional life insurance option—Supplemental Term Life. As
long as you are enrolled for Basic Term Life Insurance, you may purchase
Supplemental Life Insurance for yourself and your eligible family members.
You pay the entire cost for Supplemental Term Life Insurance coverage. In
order for your family members to be covered, you must first enroll yourself.
This coverage is subject to various election rules:



You may purchase up to four times your base salary in Supplemental
Term Life Insurance for yourself. The amount is rounded down to the
nearest $5,000. For example, if your salary is $34,000 and you
purchase one times your base salary, your actual coverage amount is
$30,000.
To cover your spouse/domestic partner, you may purchase in multiples
of $5,000 up to a maximum of 50% of the amount of coverage you
purchase on yourself. For example, if you purchase $120,000 of
Supplemental Term Life Insurance on yourself, you may purchase up to
$60,000 of coverage for your spouse/domestic partner.
You may purchase $2,000, $5,000 or $10,000 of coverage for your
child(ren). Children may be covered until their 21st birthday, or 25th
birthday if they are full-time students. Coverage cannot exceed 50% of
the amount of supplemental coverage you purchase for yourself.
Election rules also state:



If the Supplemental Term Life Insurance maximum of four times your
basic salary exceeds $1,000,000 when added to the amount of your
Basic Life Insurance, you will need to complete and submit a Medical
History Statement regardless of when you enroll.
If you do not sign up when first eligible, you must submit a Medical
History Statement and your coverage will be subject to approval.
When you are first eligible, you can purchase up to $50,000 in
Supplemental insurance for your spouse/domestic partner without a
Medical History Statement. If you want to purchase more than $50,000
on your spouse/domestic partner, he or she must submit a Medical
History Statement. If you wait for Open Enrollment, a Medical History
Statement will be required and must be approved for any amount.
Page 41
Optional Insurance– Group Term Life
Costs for Supplemental Term Life Insurance for you and your spouse/domestic
partner are based on your age. Costs for covering eligible children are fixed,
and the monthly premium is the same regardless of how many children you
cover.
How to Decide
if You Need Life
Insurance
When deciding if you should buy life insurance, ask yourself the following
questions:



Am I solely or largely responsible for the financial well-being of my
family?
Would my family need additional income to live on if something
happened to me?
Should I elect coverage now because no Medical History Statement is
required but would be required later, and I might not qualify?
If you answered yes to these questions, you may want to consider purchasing
supplemental life insurance.
The following tables show the cost of supplemental GTL insurance for you, your
spouse/partner, and your children.
Costs for
Covering
Yourself and
Your Spouse/
Domestic
Partner for
Supplemental
Life Insurance
Costs for
Covering Your
Children
Supplemental GTL for Employee and Spouse/Domestic
Partner
Your Age
Monthly cost/$1,000
of coverage
18-29
$.032
30-34
$.048
35-39
$.064
40-44
$.090
45-49
$.152
50-54
$.232
55-59
$.360
60-64
$.552
65+
$.960
Supplemental GTL for Children
Amount of coverage
Monthly cost*
$2,000
$0.40
$5,000
$1.00
$10,000
$2.00
*Cost covers all children.
Page 42
Optional Insurance – HAIG Free Life Insurance
HAIG Free Life
insurance
Housing Authority Insurance Group (HAIG) offers a free $5,000.00 life
insurance policy to active eligible SHA employees only. The coverage amount
will be reduced for an active employee at age 65 to $3,250 and age 70 to
$2,500.00. This policy is written with the Guardian Life Insurance Company of
America, with the policy holder being Housing Authority Insurance, Inc. This
free HAIG life insurance plan covers you for as long as you are an active
employee, and does not cover you when you retire, or separate from SHA
employment.
Please be sure to submit your HAIG beneficiary form within 31 days from your
date of hire. Please note that you will not be given another opportunity to sign
up for the free life insurance until the annual open enrollment.
The Seattle Housing Authority and/or HAIG intends to provide this life insurance
indefinitely but reserves the right to amend or terminate this insurance at
anytime with or without notice.
Page 43
Optional Insurance – Long-Term Care
Long-Term
Care
Long Term Care is defined as the type of care received when someone needs
assistance with what is known as the Activities of Daily Living – basic activities like
dressing, bathing, eating and moving around that can be impaired by an accident,
illness or advancing age. Long Term Care is not limited to the elderly. Accidents
or unexpected illness can happen at any time and at any age. We are offering
long term care insurance through Unum Insurance Company, which holds a
superior industry rating. The insurance is voluntary, guaranteed renewable and
portable.
Coverage may be purchased for the employee, employee’s spouse or domestic
partner, employee’s parent or grandparent, employee’s sibling or child age 18 and
over, or the spouse’s/domestic partner’s parent or grandparent. The cost of the
insurance will be based on the applicant’s age at the time the coverage goes into
effect.
Coverage for benefits up to and including $6,000 per month on a Guarantee Issue
basis is automatically approved for new employees if you submit your enrollment
within 31 days from date of hire. Coverage for benefits higher than $6,000 or
benefits not on a Guarantee Issue basis will require the completion of a medical
questionnaire for evidence of insurability. Coverage levels for anyone other than
the employee will require the completion of a medical questionnaire. You and your
eligible dependent(s) can enroll anytime with Long Term Care. However, if you
apply after the 31 days when first eligible, your application is subject to
underwriting approval. Note: any level of coverage applied for which requires the
completion of a medical questionnaire is not guaranteed, but subject to review and
approval. Long Term Care packets are available upon request in Human
Resources.
How to
Determine if
You Need
Long-Term
Care
Insurance
You should consider purchasing Long-Term Care Insurance if you have a history
of disabling hereditary illness in your family (such as Alzheimer’s), if you have an
existing medical condition that will worsen over time, or if your family would have
to use savings or sell assets to pay for long-term care.
For more information or to request an enrollment kit, please contact Human
Resources at (206) 615-3328.
Page 44
Optional Insurance - Flexible Spending Accounts
Flexible
Spending
Accounts
SHA’s Flexible Spending Account (FSA) Plans allow you to set aside pre-tax
dollars from your paycheck ($120 annual minimum, $2,500.00 annual maximum for
Health Care FSA plan or $5,000.00 for Dependent Care FSA plan) to pay for
eligible expenses not covered through other benefit programs. When you put
money into an FSA, you do not pay federal or Social Security taxes on it. As a
result, your taxable income is reduced and your taxes are lower.
You can sign up for flexible spending accounts within 31 days of your hire date,
during an Open Enrollment period, or within 31 days of a qualifying change in
family status. There are two types of FSA Plans:
Health Care
FSA Account
Health Care FSA – allows you to set aside money to pay for expenses not
covered by your health plans (e.g., deductibles, copays, or expenses for
orthodontia that exceed the plan maximum). Health care premiums are not eligible
expenses because they are already deducted from your paycheck on a pre-tax
basis. You must submit receipts for reimbursement by March 31 of the following
year.
Dependent
Care FSA
Account
Dependent Care FSA – allows you to set aside money to pay for eligible
dependent care expenses for your child, disabled spouse, or tax dependent parent
(or anyone who qualifies as a dependent on your IRS tax form) while you and your
spouse/domestic partner work ($5,000 annual maximum).
As you incur eligible expenses, you submit bills and receipts, and receive
reimbursement up to the amount you elect to have withheld from your paychecks
throughout the year. There are restrictions on the amount you can contribute and
the types of expenses that can be reimbursed. SHA offers a “grace period” of 21/2 months after the end of the plan year which allows participants to continue to
incur claims. The deadline to submit for reimbursement is March 31 following the
plan year.
Money left in the account by the end of the “grace period” (March 15) cannot be
refunded.
Page 45
Guaranteed Education Tuition (GET)
Guaranteed
Education
Tuition (GET)
We all know how important a college education is to Washington’s future
generations. The cost of that college education is increasing an average of 7
percent per year. In order to help families prepare for these future costs, the 1997
Washington State Legislature created the Guaranteed Education Tuition (GET)
Program. GET allows families to purchase college tuition now for use in the future,
giving families peace of mind about their children’s future education.
GET is Washington’s 529 prepaid college tuition program. Families prepay for
their children’s college tuition today and have peace of mind knowing that the
value of their accounts is guaranteed by the State of Washington to keep pace with
rising college tuition. GET is the fastest-growing prepaid college tuition program in
the nation in both assets and number of accounts.
The State of Washington guarantees that a family that buys one year of college
tuition today (100 GET units) will have one year of college tuition when it’s time for
college, no matter how much tuition increases in the future. GET works on a unit
system, with 100 GET units equal to one year of resident undergraduate tuition
and required state fees at the most expensive Washington public university, either
the University of Washington or Washington State University.
Families can use their accounts at nearly any public or private college in the United
States and some schools in other countries. The value of the account is the same,
whether the child attends a local community college or a private, or out-of-state
college.
For your convenience, GET is available through payroll deduction. You can
contribute as little as $20 per month per account. There is no maximum monthly
contribution. Payroll deduction allows you to prepare for your children’s future
higher education needs in a way that is convenient and safe. You decide when
you want the contribution to start or stop. To find out more information, please
contact 1-(800)-955-2318 or visit their website at www.get.wa.gov. Brochures are
available in Human Resources.
Page 46
Commute Trip Reduction Program
Commute Trip
Reduction
Program.
Visit the Ourhouse Rideshare Program pages at http://ourhouse/Dept-HR/HRPages/HR-Benefits/HR-Ben-RideShare.htm to learn more about Commute Trip
Reduction Programs such as the Guaranteed Ride Home.
Transit Pass
Subsidy and
Tax Savings
Program
The Internal Revenue Code allows employee co-pays for the ORCA transit pass
to be deducted from paychecks on a pre-tax basis. Once the deduction has been
withheld from your paycheck, the IRS will not allow you to revoke the deduction or
receive a refund. Actual savings will vary depending on your federal tax filing
status and the amount of the ORCA transit pass. Employees who purchase a
payroll-deducted ORCA transit pass are automatically enrolled in the pre-tax plan.
Zipcar
SHA employees can get a discounted membership in Zipcar. SHA will pay the
application fee, and your first year membership fee. Your monthly costs as a
member will vary depending on how much you use the Zipcar vehicles – see the
Rideshare Program brochure for details.
Use a rideshare mode to get to work. Then use Zipcar to go to doctor
appointments, do special errands during the day, or drive home after working an
extended day. Zipcar vehicles are located throughout Seattle and in Bellevue.
You'll have access to the entire Zipcar fleet on evenings and weekends. For more
information and to apply online, go inweb/sdot/ctr/carshare.htm
Page 47
Employee Assistance Program
Employee
Assistance
Program
(EAP)
SHA offers you and your family the services of an Employee Assistance Program
(EAP) through Wellspring Family Services. An Employee Assistance Program
provides short-term, confidential counseling for you and your family at no out-ofpocket expense to you. You may use the EAP as soon as you are hired as a
regular SHA employee. Simply call 1-800-553-7798 (Local: (206) 654-4144; TTY:
(866) 704-6355.
Your EAP provides:
 Problem assessment
 Information and referral services
 Short-term counseling
 Education and information
 A 24-hour call center
 Nationwide coverage
 Accessibility for family members
 Access and accommodations for persons with disabilities
 Multilingual capabilities
 Management consultation
 Workplace seminars
You and your family members are each entitled to six face-to-face counseling
visits, per issue, per year at no cost to you. The EAP can assist you with issues
such as aging and care giving, parenting support and education, stress, anxiety
and depression, financial and legal concerns, addictions, family and relationships
and many other issues. All discussions between you and the EAP therapist are
confidential. Personal information is never shared with anyone, including your
employer, at any time without your direct knowledge and approval. (Exceptions
are made only in cases governed by law to protect individuals threatened by
violence.)
You can also access a wealth of information or schedule an appointment via their
website at www.wfseap.org. Just type Seattle Housing Authority in the user
name box. The Wellspring Family Services websites contains more information
about the program as well as over 80 topics on health and life-styles, daily features
and news articles, and resource links (e.g. news, books, reviews, self-help
assessments, symptom information, medications, etc). You may also make an
EAP appointment via the website.
Page 48
Retirement
Public
Employees’
Retirement
System
(PERS)
Public Employees’ Retirement System (PERS) membership is defined by
Washington State statutes, and is mandatory if you are hired into an “eligible”
position. Most SHA employees are members of the Washington Department of
Retirement Systems (DRS), Public Employees Retirement System (PERS).
However, if you are retired from or have been a member of the Seattle, Spokane or
Tacoma Employee’s Retirement System, your PERS enrollment must be verified
and approved by DRS. It is the employee’s responsibility to indicate that on their
Retirement Status form.
Seattle Housing Authority offers two programs to help you prepare financially for
retirement.
WA State
Deferred
Compensation

PERS Plan 1 is for employees who established membership before
October 1, 1977.

PERS Plan 2 is for employees who established membership on or after
October 1, 1977.

PERS Plan 3 went into effect September 1, 2002
Your retirement benefits can be view at www.drs.wa.gov or you may request a
PERS handbook at Human Resources.
You can sign up for deferred compensation at any time. Remember, however, that
access to this money once it is deferred is governed by very strict IRS regulations,
and is not readily available to you. For more information, or to sign up for Deferred
Compensation, please contact 1-800-423-1524, or check their website at
http://www.drs.wa.gov/.
Page 49
Leave Benefits
Annual Leave/Vacation
Please refer to the SHA Manual of Operations E-Section on the SHA Intranet Ourhouse for more
details on the following leave benefits.
SHA provides you with paid annual leave so you can take time away from work for rest and relaxation.
Annual leave begins to accrue with the first day of employment. All eligible employees will accrue
annual leave based on paid hours each bi-weekly pay period. Part time employee accruals are prorated based on paid hours each pay period. Paid hours include regular work hours or any type of paid
time off, including annual leave, sick leave, merit leave, additional leave, holidays, personal holidays,
compensatory time taken, etc. Any overtime/compensatory hours worked are not factored towards
leave accruals.
Annual Leave Accrual Rate
During
Service
Year
Full-Time
Hours
Accrued
Each Pay
Period (80
hours)
Total
Hours
Earned
During FT
Pay Period
Year
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25 +
3.84
4.00
4.15
4.31
4.46
4.62
4.77
4.92
5.08
5.23
5.23
5.23
5.23
5.54
5.54
5.54
5.85
5.85
5.85
6.15
6.15
6.15
6.46
6.77
7.69
100
104
108
112
116
120
124
128
132
136
136
136
136
144
144
144
152
152
152
160
160
160
168
176
200
PartTime
Accrued
Each Pay
Period
(40
hours)
1.92
2.00
2.08
2.16
2.23
2.31
2.39
2.46
2.54
2.62
2.62
2.62
2.62
2.77
2.77
2.77
2.93
2.93
2.93
3.08
3.08
3.08
3.23
3.39
3.85
PartTime
Accrued
Each Pay
Period
(48
hours)
2.30
2.40
2.49
2.59
2.68
2.77
2.86
2.95
3.05
3.14
3.14
3.14
3.14
3.32
3.32
3.32
3.51
3.51
3.51
3.69
3.69
3.69
3.88
4.06
4.61
PartTime
Accrued
Each Pay
Period
(50
hours)
2.40
2.50
2.59
2.69
2.79
2.89
2.98
3.08
3.18
3.27
3.27
3.27
3.27
3.46
3.46
3.46
3.66
3.66
3.66
3.84
3.84
3.84
4.04
4.23
4.81
PartTime
Accrued
Each Pay
Period
(60
hours)
2.88
3.00
3.11
3.23
3.35
3.47
3.58
3.69
3.81
3.92
3.92
3.92
3.92
4.16
4.16
4.16
4.39
4.39
4.39
4.61
4.61
4.61
4.85
5.08
5.77
Part-Time
Accrued
Each Pay
Period
(70
hours)
3.36
3.50
3.63
3.77
3.90
4.04
4.17
4.31
4.45
4.58
4.58
4.58
4.58
4.85
4.85
4.85
5.12
5.12
5.12
5.38
5.38
5.38
5.65
5.92
6.73
Page 50
Leave Benefits (Continued)
Sick Leave
SHA provides you with paid sick leave, which may be used for medical, dental or vision appointments,
for preventative care or treatment, or for when you or a close relative living with and/or dependent upon
you are sick or injured.
If you are a full-time employee you will accrue 3.69 hours of sick leave per pay period. If you are a
part-time employee your accrual is pro-rated. You begin accruing sick leave every pay period. There is
no maximum limit to the sick leave that you can accrue or carry over into subsequent years.
Other Leave Benefits
Holidays
SHA provides nine (9) established holidays to all eligible employees each year. The established
holidays are: New Year's Day; Martin Luther King's Birthday; Presidents' Day; Memorial Day;
Independence Day; Labor Day; Thanksgiving Day; the day after Thanksgiving, and Christmas Day.
When any of these holidays falls on a Saturday, Friday is given off; where they fall on a Sunday,
Monday is given off.
You must work or have paid leave on the day before a holiday in order to receive holiday pay. For
example, if a holiday falls on a Monday and your last scheduled work day is Friday, you must either
work on Friday or use your accrued paid leave in order to be paid for the Monday holiday. Please refer
to the SHA Manual of Operations on the SHA Intranet Ourhouse for more details.
Personal Holidays
Each new year you will also be given three personal holidays which can be taken at your discretion,
with the prior permission of your supervisor. Personal holidays must be taken in full eight-hour
increments. They must be used by December 31 of each year, and unused days may not be carried
over to the next year. To be eligible to receive paid time off for all three personal holidays, you must
begin employment by June 1 of the calendar year. If you are hired after June 1, and before November
11, two personal holidays will be allowed to be used by the end of the calendar year. If you are hired
on November 11 or later, no personal holidays will be given for that year.
Bereavement Leave
One day of company-paid Bereavement Leave, and up to five (5) consecutive days of sick leave may
be used in the event of a death in the employee’s family. Exceptions to taking the five days of sick
leave consecutively may be made with supervisor approval, for example in the case where the funeral
or memorial service occurs over a week after the date of death.
The employee shall give notice to his or her immediate supervisor as soon as possible and shall, if
requested by the employee’s supervisor, provide substantiation to support the request. The
employee’s family shall include the employee’s spouse or domestic partner and the following relations
to the employee, spouse or domestic partner: parents (natural parent, stepparent, or adoptive parent),
parents-in-law, children (natural child, stepchild, adoptive child or foster child), siblings (natural sibling,
stepsibling or adoptive sibling), grandparent or grandchild. Additional leave may be taken with
supervisor approval. If you are a member of a bargaining unit, please refer to your union contract for
details.
Page 51
Other Leave Benefits (Continued)
Voluntary Leave Transfer
You are permitted to voluntarily donate your annual leave and/or sick leave to a fellow employee who
has exhausted, or is about to exhaust all his/her paid leave, and who must take additional time off
because of his/her own illness or injury, or because of an illness or injury of a close relative who is living
with and/or is dependent upon the employee, or while taking Family Medical Leave (FMLA), or when an
employee experiences a death in the family which qualifies under the SHA bereavement policy. If you
want to donate leave, you must retain a balance of 240 hours of sick leave, or a balance of 80 hours of
annual leave.
If you want to receive donated leave, you must have used up (or are about to use up) all of your
accrued annual leave, sick leave and personal holidays. You also cannot be receiving workers’
compensation payments, long-term disability payments, or payments under the Teamster’s Local 117
union contract. Please refer to policy E12.1-5 for additional details about the Voluntary Leave Transfer
program.
Family Medical Leave (FMLA)
The Family and Medical Leave Act (FMLA) allows you to take up to 12 weeks of unpaid Family Medical
Leave for personal or medical reasons, birth or adoption of a child, care of a spouse or domestic
partner, or parent or child who has a serious health condition. You must be with SHA for one year to be
eligible for Family Leave and have worked at least 1,250 hours during the 12-month period immediately
preceding the beginning of the leave.
Also, SHA will permit an employee who is a “spouse, son, daughter, parent, or next of kin” to take up to
26 work weeks of leave to care for a “member of the Armed Forces, including a member of the National
Guard of Reserves, who is undergoing medical treatment, recuperation, or therapy, is otherwise in
outpatient status, or is otherwise on the temporary disability retired list, for a serious injury or illness.”
Please refer to E12.1-6 in the Employment section of the Manual of Operations for additional rules and
procedures regarding FMLA leaves.
Medical Leave Without Pay
In exceptional circumstances, you may be able to take a medical leave without pay (LWOP) due to an
illness or injury. You must have exhausted all your Sick Leave, Annual Leave and FMLA Leave before
you can request a Medical Leave.
Washington Maternity Disability
If you become pregnant, state law allows you to take an unpaid leave of absence covering the actual
period of temporary disability related to your pregnancy or childbirth, either before or after the birth.
This leave is in addition to the provisions of the Family and Medical Leave Act, and is typically used
before FMLA.
Personal Leave Without Pay
You may request a personal leave without pay in exceptional circumstances to care for a
member of your domiciled family due to an extended illness or injury; for an extension of travel,
vacation or social service activities; or for other personal reasons. You must have exhausted
all other means of paid leave (including FMLA, where appropriate), before a personal leave
without pay is granted.
Page 52
Other Leave Benefits (Continued)
Jury Duty, Trial Witness Leave
SHA recognizes that you have a civic and legal responsibility to serve as a juror, or to appear as a trial
witness from time to time, and will provide you with paid leave to perform these civic duties. You must
bring a copy of your summons to your supervisor when you first receive a jury duty order, so that your
supervisor can plan for your absence. If you are asked to serve as a trial witness, you must bring a
copy of your subpoena.
You will receive your normal base pay while serving as a juror or trial witness. In order to receive your
normal salary you must turn over your civic duty compensation minus costs for transportation, parking,
and other fees paid.
Military Leave
You are entitled to Military Leave with pay not to exceed twenty-one (21) working days during each
year beginning October 1 and ending September 30 in order to take part in active training duty in such
manner and at such time as you may be ordered to active duty or active training duty.
Please see employee policy E12 1-4 on Personal and Other Leaves, for additional information
regarding extended military leave.
Administrative Leave
The Executive Director or a designee, at his/her discretion, may authorize paid Administrative leave for
activities related to SHA. Administrative leave must be authorized in advance, and is not charged
against your annual or sick leave.
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Glossary
Balance billing
The amount over and above your co-insurance amount that you may be required to
pay if you use a non-network provider. See the explanation for Paying an Out-ofnetwork provider at the end of this Glossary.
Coinsurance
The arrangement by which both the Plan and the employee share a specified ratio of
the covered expenses under the policy. For example, the Aetna Open Choice
Traditional Plan pays 80% of most covered expenses while the employee pays the
remaining 20% of covered expenses once the deductible has been met.
Copay
A fee paid at the time a medical or dental service is provided. A copay may be a
percentage of charges, but is usually a flat fee. In general, copayments may not be
applied toward the coinsurance or out-of-pocket deductibles.
Deductible
The amount of covered expenses that must be incurred before benefits are paid by
the Plan. The deductible is set on an annual basis and there are individual and family
deductibles.
Eligible Expenses
Expenses as defined in the health plan as being eligible for coverage. This could
involve specified health services fees or "reasonable and customary charges."
Formulary
A list of preferred brand-name and generic drugs. Drugs are selected for inclusion
based on evaluation criteria developed by each Plan. Formularies are different
depending on the Plan, and may change to include new drugs, or to drop brand-name
drugs as generic equivalents become available.
Generic Drug
A drug which contains the same active ingredients in the same amounts as the brandname product, although it may differ in color, shape or size from the brand-name
product. It is produced after the brand name drug's patent has expired. It is also
called a "generic equivalent."
Network Provider
A medical provider, such as a physician, who has a signed a contract to participate in
a health plan. Also known as a preferred provider.
Non-network Provider
A provider who has not signed a contract with a health plan. Also known as a nonpreferred provider.
Out-of-Pocket Cost
The amount not covered by the plan that the plan member pays. This includes such
things as coinsurance, deductibles, etc.
Out-of-Pocket Limit
(Out-of-Pocket
Maximum)
The amount of copays and/or coinsurance an individual will be required to pay within
a calendar year before most covered expenses are covered in full.
Pre-existing condition
A physical condition that existed prior to the effective date of a policy. In many health
policies these are not covered until after a stated period of time has elapsed. SHA’s
medical plans cover all pre-existing conditions.
Preferred Provider
A medical provider, such as a physician, who has a signed a contract to participate in
a health plan. Also known as a network provider
Preventive Care
Care that consists of routine physical examinations and immunizations. The emphasis
is on preventing illnesses before they occur.
Recognized Charge
The charge determined by Aetna on a semi-annual basis to be in the 70th percentile of
the charges made for a service or supply by providers in the geographic area where it
is furnished.
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Who to Contact if You Have Questions
If you have questions or want more information, contact the following organizations by phone or obtain
information through their web sites.
If you have questions, contact the following organizations by phone or obtain information through their
web sites.
(877) 292-2480
www.aetnanavigator.com
to find a doctor:
www.aetna.com/docfind/custom/cityof
seattle/
(888) 901-4636
www.ghc.org
(800) 877-7195
www.vsp.com
(206) 788-3444
(877) 495-4455
www.dentalhealthservices.com
Washington Dental Service (WDS)
WDS Group #: 160
(206) 522-2300
(800)-554-1907
www.ddpwa.com
WA State Retirement Systems (PERS)
800-547-6657
www.drs.wa.gov
WA State Deferred Compensation
Program
(800) 423-1524
(360) 664-7000
www.drs.wa.gov/dcp
Employee Assistance Program
Wellspring Family Services
Long Term Care
UNUM Provident
(800) 553-7798
(206) 654-4144
www.wfseap.org
user name: Seattle Housing Authority
(800) 421-0344
www.unum.com
Life, AD&D, LTD
(206) 615-3328
Human Resources on Ourhouse
Flexible Spending Accounts
Flex Plan Services
(425) 452-3500
(800) 669-3539
www.flex-plan.com
Guaranteed Education Tuition (GET)
(877) 438-8848
www.get.wa.gov
Aetna Medical Insurance
Traditional Group #: 10029010012
Preventive Group #: 10029020012
Group Health Medical Insurance
Standard Group #: 0284958
Deductible Group #: 0961055
Vision Service Plan
VSP Group #: 12080805-0027
Dental Health Services (DHS)
DHS Group #: W203
Visit the Human Resources Benefits pages on Ourhouse for more information on Benefits.
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Schedule of Deductions
Please refer to the chart below to see when your benefit deductions are taken out of your paycheck.
Please make sure to review your paycheck when you make changes to your benefits to ensure
that the correct amounts are deducted.
Deduction
AD&D Insurance
1st Check
of the
Month
X
Bus/Flex Pass
2nd Check
of the
Month
3rd Check of
the Month
X
Charities
X
X
Deferred Comp
X
X
Disability (LTD)
X
Federal Income Tax
X
X
X
FICA
X
X
X
Flex Spending Accounts
X
X
Guaranteed Education Tuition (GET)
X
X
Life Insurance (GTL)
X
Long Term Care (LTC)
X
X
Medical
X
X
Medicare
X
X
Parking
X
X
PERS (Retirement)
X
Union/Local Dues
X
Vision Service Buy Up Plan
X
X
X
X
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