2021 Benefits Guide Plan Year January 1, 2021 through December 31, 2021 - Littleton CO
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2021 Benefits Guide
Plan Year January 1, 2021 through December 31, 2021
Revised 09.28.2020
The City of Littleton is pleased to provide you with benefit offerings to help you take care of your well-being now and into the future. We want each and every participant to receive the highest quality health coverage at the most affordable price possible. This booklet provides a high-level overview of the plans. More information about our plan is available in your full plan description or by contacting HR. Table of Contents Benefit Program Overview ............................................................................................................................. 3 Benefit Eligibility ............................................................................................................................................ 4 Enrollment Instructions ................................................................................................................................. 6 Medical Plan .................................................................................................................................................. 9 Medical Plan Costs ........................................................................................................................................11 Cost Savings Resources ................................................................................................................................ 12 Prescriptions ................................................................................................................................................ 13 City of Littleton Employee Wellness Clinic .................................................................................................... 15 Dental Plan ...................................................................................................................................................17 Dental Plan Costs ......................................................................................................................................... 18 Vision Plan ................................................................................................................................................... 19 Vision Plan Costs .................................................................................................................................................. 20 Life Insurance ...............................................................................................................................................21 Voluntary Life/AD&D ................................................................................................................................... 22 Disability Insurance...................................................................................................................................... 23 Employee Assistance Program ..................................................................................................................... 24 Tax Savings Programs ...................................................................................................................................25 Legal Shield................................................................................................................................................... 26 Time-Off Benefits .......................................................................................................................................... 27 Retirement Plans ......................................................................................................................................... 30 Tuition Reimbursement ............................................................................................................................... 32 Wellness Program ........................................................................................................................................ 32 Plan Contacts ............................................................................................................................................... 33 Important Plan Notices and Documents ....................................................................................................... 34
Benefit Program Overview
Contact Human Resources for Help
City of Littleton – Human Resources
(303) 795-3857
HR@littletongov.org
BENEFIT OFFERINGS
MEDICAL Cigna LocalPlus Plan
Medical plan includes:
- $500 deductible for in-network providers
- $25 copays for visits to PCP and $50 copay for visits to specialists
- 80% coinsurance for other services
- (Copays/coinsurance shown are for in-network providers)
DENTAL Delta Dental PPO plan:
- Preventative care covered at 100%
- $50 deductible for other services
VISION The VSP network for vision care, including a $10 copay for in-network
exams and allowances for glasses or contacts
BASIC LIFE & ACCIDENTAL 1.5 x your annual salary, up to $250,000 of coverage for both life and
DEATH & DISMEMBERMENT accidental death & dismemberment (AD&D).
SHORT-TERM AND LONG- Benefit varies based on years of service. (see pg. 23 for details)
TERM DISABILITY
VOLUNTARY BENEFIT Employees may choose to purchase voluntary benefits through convenient
OPTIONS payroll deduction:
- Employee & Dependent Supplemental Life Insurance
- Flexible Spending Accounts
EMPLOYEE ASSISTANCE Regular full and part-time employees and their dependents (living in their
PROGRAM household) are eligible for 5 free sessions per incident, per person, per
calendar year.
RETIREMENT PLANS General Employee Retirement Plan
Police Employee Pension Plan
Deferred Compensation Plan
PAID HOLIDAYS The city observes 9.5 paid holidays per year
3
Benefit Eligibility
The City of Littleton allows employees to participate in the plans if they meet the minimum service hour
requirements, as outlined in the table below, and are a regular employee. *
BENEFIT Part-Time Rate Full-Time Rate
Service Requirement Service Requirement
Medical 20+ hours per week 30+ hours per week
Dental, Vision, Life, AD&D, Long-Term Disability 20+ hours per week 30+ hours per week
Voluntary Benefits through Voya 20+ hours per week 30+ hours per week
Employee Assistance Program All full-time and part-time employees
*If you are a temporary employee working 30 hours or more, you may be eligible for medical benefits due to provisions of the Affordable Care
Act (healthcare reform). Please see Human Resources if you have any questions.
Eligible dependents*
• Legal spouse (same or opposite sex)
• Civil union partner
• Common-law spouse
• Child(ren) to the age of 26 — married and unmarried- biological, legally adopted, or legal custody
• Stepchild(ren) to the age of 26 — the employee must be married to the child’s parent
Eligibility Documents Required
Proof of eligibility is required for all dependents covered on the City’s insurance. Acceptable documentation
includes:
• Marriage certificates for spouses
• Civil union certificate for civil union partner
• Birth certificates or proof of legal guardianship for children
• Affidavit for common-law spouses
*Domestic partners verified prior to December 31, 2019 are still considered eligible dependents.
4
When you can enroll
You can enroll in benefits as a new hire, during our annual enrollment period or if you experience a qualifying
life event. New hires or employees who have a change in employment status that makes them eligible for
benefits must enroll within 30 days of their hire date or eligibility date. Coverage is effective on the first of the
month following their date of hire or eligibility.
Changing your benefits
Outside of open enrollment, you may be able to add or remove dependents or change benefit options if
you experience a qualifying life event. A qualifying life event is a change in your family status or employment
that affects your benefits eligibility. Examples include:
• Marriage or divorce
• Birth, adoption, death of a dependent
• A dependent child is no longer eligible because they have reached age 26
• Change in the employment of an employee or an employee’s spouse that affects benefit eligibility
It is the employee’s responsibility to submit the appropriate paperwork to Human Resources within 30 days of
the event. If this deadline is missed, the employee must wait until the next open enrollment period to make
changes.
To request a benefits change, notify Human Resources within 30 days of the qualifying life event.
Change requests submitted after 30 days cannot be accepted. You will need to provide proof of
the event, such as a marriage license or birth certificate.
5
Online Enrollment Instructions- Sage Employee Self-Service
The City of Littleton uses Sage Employee Self Service to make the benefits enrollment process easy
and convenient.
Beginning Tuesday, October 27, 2020, Employee Self Service will enable you to enter, customize,
validate, and confirm your benefits selection and dependent information online.
2020 Open Enrollment
Enroll online from Tuesday, October 27, 2020 through Monday, November 9,
2020
Selecting Your Benefits Online is Simple!
Just follow these step-by-step instructions.
Log onto SAGE Employee Self Service at
https://benefits.littletongov.org/sagebenefits/default.aspx
Review Message Center and Enter Open Enrollment
There will be Open Enrollment Notifications on the left of the screen click “Open Enrollment”
6
Online Enrollment Instructions- Sage Employee Self-Service
Once you have started the Open Enrollment Session
You will notice your enrollment status will show “Incomplete” (you must re-elect your benefits)
To navigate to each page use the arrows at the top of the page on the right.
Adding or Editing Dependents
§ If you do not see your dependents listed under “Dependents” you can add or edit by clicking
the plus sign
o If you would also like them to be a beneficiary, select “Both” as the type of dependent.
o You must select the coverage tier AND check the box next to the Dependents name
to elect coverage.
o Important: If you are choosing to cover a dependent (Spouse/Child(ren)), you must
select the correct tier (Employee + spouse, EE+Child(ren), or Family) AND choose the
dependents that are to be covered
7
Understanding Flexible Spending Elections
You must select or waive the Flex Spending Account
§ Note: When entering an annual amount, do not use dollar signs, commas, or decimals.
Reviewing and Confirming
§ Print a copy for your records
IMPORTANT: Submitting your Benefit Elections
§ You must change select “I’M FINISHED”
§ Enter your ESS Username
§ Enter your ESS Password
§ Enter your Social Security number (WITH DASHES) ie. 211-11-1111
§ Click Done
o You should receive a “Congratulations” email instantly showing you successfully
completed Open Enrollment.
8
Your Medical Plan
The City of Littleton offers one medical plan through the Cigna LocalPlus network. Your plan includes free
preventive care from in-network providers to ensure that you are staying healthy. The medical plan provides
in- and out-of-network benefits, providing you the freedom to choose a provider. However, you will maximize
the plan benefits and pay less out of your pocket when you choose an in-network provider. Your plan provides
a large network of doctors, hospitals, and labs.
Your Plan offers
• Online tools and health resources to make managing your care and coverage easier
• 24/7 access to a Cigna AmWell or MDLIVE doctors for confidential, expert answers to your
health questions
• Access to Cigna mobile app to find network doctors, compare cost information, order
prescriptions, and more.
• Cigna Cancer Support for patients and families
• 90-Day Prescription Refills on maintenance medications with Cigna 90 Now.
Make sure you choose a doctor that is in the LocalPlus Network to get the most out of your benefits!
• Go to myCigna.com and sign in with your user ID and passcode. (If you’re not already
registered for myCigna.com, click on “Register Now” to sign up)
• Click on the “Find a Doctor” tab
• Enter the requested details for your search
• Click on “Search” to see all the doctors and hospitals in the LocalPlus Network. (If there is no
LocalPlus Network in your search area, you’ll see a link to our Away From Home Care
Network)
With these benefits, you can be confident you are getting the best value for your health care and coverage
dollars. Please visit www.mycigna.com and don’t forget to register for access to many member resources and
tools that are also available on the mobile app.
9
Cigna LocalPlus
The table below summarizes the key features of the medical plan. The coinsurance
amounts listed reflect the amount you pay. Please refer to the official plan
documents for additional information on coverage and exclusions.
In-Network Out-of-Network
Annual Deductible
Individual $500 $1000
Two Person/Family $1000 $2000
Annual Out-of-Pocket Max
Individual $4,000 $10,000
Two Person/Family $8,000 $20,000
Preventive Services Plan pays 100% Plan pays 50%
Office Visit
Primary Provider $25 copay 50% Coinsurance
Specialist $50 copay 50% Coinsurance
Urgent Care $50 copay $50 copay
Emergency Room Plan pays 80% after deductible Plan pays 80% after deductible
Lab and X-ray Plan pays 80% after deductible Plan pays 50% after deductible
Inpatient Hospitalization Plan pays 80% after deductible Plan pays 50% after deductible
Outpatient Surgery Plan pays 80% after deductible Plan pays 50% after deductible
10Medical Plan Costs
Listed below are the biweekly costs for medical insurance. The amount you pay for coverage is deducted from
your paycheck on a pre-tax basis.
Full-Time Biweekly Medical Costs
Coverage Level Full-Time Rate Full-Time Rate
Employee Medical Cost City Medical Cost
Employee Only $34.23 $308.04
Employee + Spouse $140.16 $560.62
Employee + Child(ren) $130.06 $520.24
Employee + Family $200.22 $800.89
Part-Time Biweekly Medical Costs
Coverage Level Part-Time Rate Part-Time Rate
Employee Medical Cost City Medical Cost
Employee Only $136.90 $205.36
Employee + Spouse $350.39 $350.39
Employee + Child(ren) $325.14 $325.16
Employee + Family $500.56 $500.56
11Cost Saving Resources
Chat with a Doctor at Home, Work or on the Go
Cigna Telehealth Connection lets you get the care you need – including most prescriptions – for a wide range
of minor conditions. Now you can connect with a board-certified doctor via secure video chat or phone,
without leaving your home or office. When, where, and how it works best for you!
24/7 Medical Advice
• Televisits with AmWell and MDLIVE can be a cost-effective alternative to a convenience care clinic or
urgent care center and cost less than going to the emergency room.
• Connect with a board-certified doctor via secure video or chat or phone, without leaving your home.
• Choose when: Day or night, weekdays, weekends, and holidays.
• Choose where: Home, work, or on the go.
• Choose how: Phone or video chat.
• Choose who: AmWell or MDLIVE doctors.
• You can speak with a doctor for help with:
Sore Throat Fever Rash
Headache Cold & Flu Acne
Stomachache Allergies UTI’s and more…
• The cost of a phone or online visit is the same or less than with your primary care provider.
• The telehealth services are only available for minor, non-life-threatening conditions. In an
emergency, dial 911 or go to the nearest hospital.
Register for one or both today so you’ll be ready to use a telehealth service
when and where you need it.
AmWellforCigna.com* MDLIVEforCigna.com*
855-667-9722 888-726-3171
12Prescriptions
90 Day Prescription Refills, More Choice
Your plan includes a new maintenance medication program called Cigna 90 Now. Maintenance medications
are taken regularly, over time, to treat ongoing health conditions. Cigna 90 Now offers you more choice in
how and where you can fill your prescriptions.
Choose What Works Best For You
• If you choose to fill your prescription in a 90-day supply, you have to use a 90-day retail pharmacy
in your plan’s network, or Cigna Home Delivery Pharmacy
• If you choose to fill your prescription in a 30-day supply, you can use any retail pharmacy in your
plan’s network.
Where You Can Fill a 90-day Prescription
• With Cigna 90 Now, your plan offers a retail pharmacy network that gives you more choices in
where you can fill your 90-day prescriptions.
• There are thousands of retail pharmacies in your network. They include local pharmacies, grocery
stores, retail chains, and wholesale warehouse stores – all places where you already shop.
• If you prefer the convenience of having your medications delivered to your home, you can also use
Cigna Home Delivery Pharmacy to fill your prescriptions.
Cigna Home Delivery Pharmacy
• The Cigna Home Delivery Pharmacy will deliver your medication to you at the location of your
choice with free shipping included every time.
For More Information About Your Pharmacy Network, You Can Go To
Cigna 90 Now Pharmacy Network: Cigna.com/Rx90network
Cigna Home Delivery Pharmacy: Cigna.com/home-delivery-pharmacy or 800-285-4812
13Prescriptions – Specialty Medications
Under your Cigna prescription drug plan, you and your dependents can fill one prescription at a retail pharmacy.
After that, your specialty medications will only be covered when you use Cigna Specialty Pharmacy Services.
These prescriptions can be delivered to your home.
Ordering Your Specialty Medications
Contact Cigna at 800-351-3606. Give the representative your medication, doctor’s information, and payment
information. Cigna will then contact your doctor and coordinate any necessary benefit approvals. You can also
log in to myCigna.com and visit the Cigna Home Pharmacy page for more information. You can see the real-
time pricing of medications.
More Than Just Your Medication
• 24/7 access to customer service and pharmacists to help answer any questions
• Free standard shipping anywhere in the U.S.
• Condition-specific support and therapy management
• Convenient delivery right to your door or preferred location
• Helpful coaching and reminder services
• Supplies like tape, bandages, sharps collectors, swabs, etc.
• Access to educational materials and more
• Discreet packaging at no additional cost to protect quality and privacy
• Financial assistance may be available for costly medications
For More Information About Your Specialty Medications, You Can Go To
Cigna Specialty Pharmacy Services: 800-351-3606
Cigna Home Delivery Pharmacy: Cigna.com/home-delivery-pharmacy
14City of Littleton Employee Wellness Clinic by CareHere
CareHere offers a City of Littleton Employee Wellness clinic. It is free to employees, their spouses, and
dependents, two years of age and older who are covered by the City of Littleton’s health plan.
Primary Care
You can get care for your sore throat, a cold, or the flu, and help with high blood pressure or diabetes. Your
City of Littleton Employee Wellness clinic will treat both acute and chronic conditions, all at no cost to you.
The City of Littleton Employee Wellness clinic will dispense dozens of select generic medications and also
provide annual physicals, health coaching, lab work, and much more.
Benefits
• No deductibles or co-pays for visits
• No cost for on-site labs
• No cost for available generic medications
• Short or no time in a waiting room
• Schedule appointments online, on your smartphone or tablet, or by calling the 24/7 helpline
• Private and secure records will not be shared with your employer or anyone else without your
permission
Location
1516
Dental
Did you know that regular dental checkups keep your smile bright and also help keep your whole body healthy?
Many people believe that they need to see a dentist only if they are in pain or when something is wrong, but
regular dental visits can contribute to a lifetime of good oral health. Our dental coverage provides cleanings,
exams, and x-rays. If there’s a problem, your plan helps with the cost of dental work.
The City of Littleton offers a dental plan through Delta Dental. The PPO Plan provides a lower benefit level for
a lower monthly premium. You may visit any dentist; however, you receive the greatest benefits when you visit
in-network dentists. To find a provider call 1-800-610-0201 or go to www.deltadental.com.
PPO Plan
In-Network Out-Of-Network
Delta PPO and Premiere Dentist
Calendar Year Deductible $50
Individual/Family $150
Annual Plan Maximum $2,000 per person
Diagnostic & Preventive Plan pays 100% (deductible waived)
Basic Services Plan pays 100% after deductible
Fillings Plan pays 100% after deductible
Root Canals Plan pays 100% after deductible
Periodontics Plan pays 100% after deductible
Major Services Plan pays 50% after deductible
Orthodontic Services Plan Pays 50% ($1800 lifetime max per person – children to age 24 only)
17Dental Plan Costs
Listed below are the biweekly costs for dental insurance. The amount you pay for coverage is deducted from
your paycheck on a pre-tax basis.
Full-Time Biweekly Dental Costs
Coverage Level Full-Time Rate Full-Time Rate
Employee Dental Cost City Dental Cost
Employee Only $0 $19.04
Employee + Spouse $18.82 $21.17
Employee + Child(ren) $26.44 $21.17
Employee + Family $45.49 $21.17
Part-Time Biweekly Dental Costs
Coverage Level Part-Time Rate Part-Time Rate
Employee Dental Cost City Dental Cost
Employee Only $5.71 $13.33
Employee + Spouse $25.99 $13.99
Employee + Child(ren) $30.94 $16.66
Employee + Family $49.99 $16.66
18Vision
Vision coverage helps with the cost of eyeglasses or contacts. But even if you don’t need vision correction, an
annual eye exam checks the health of your eyes and can even detect more serious health issues such as
diabetes, high blood pressure, high cholesterol, and thyroid disease.
Our vision plan uses the VSP network of providers. It covers an exam and lenses every 12 months and covers
eyeglass frames every 24 months. You can search for a doctor online at www.vsp.com or by calling
1 (800) 216-6248.
VSP Vision Care Plan
In-Network Out-Of-Network
Examination (Every
12 Months) $10 Copay Up to $50
Spectacle Lenses (Every
12 Months)
Single $25 Copay Up to $50
Bifocal $25 Copay Up to $75
Trifocal $25 Copay Up to $100
Frames $130 Allowance; then 20% off
(Every 24 Months) balance over $130 Up to $70
Contacts
Instead of Glasses (Every
12 Months) $130 Allowance Up to $60
19Vision Plan Costs
Listed below are the biweekly costs for vision insurance. The amount you pay for coverage is deducted from
your paycheck on a pre-tax basis.
Full-Time Biweekly Vision Costs
Coverage Level Full-Time Rate Full-Time Rate
Employee Vision Cost City Vision Cost
Employee Only $0 $4.38
Employee + Spouse $2.62 $4.38
Employee + Child(ren) $2.78 $4.37
Employee + Family $7.14 $4.38
Part-Time Biweekly Vision Costs
Coverage Level Part-Time Rate Part-Time Rate
Employee Vision Cost City Vision Cost
Employee Only $1.31 $3.06
Employee + Spouse $3.55 $3.45
Employee + Child(ren) $3.70 $3.45
Employee + Family $8.07 $3.45
20Life Insurance
Life insurance can fill a number of financial gaps for a family recovering from the death of a loved one. Without
enough life insurance, many families have to reduce their standard of living after the loss of an income. Consider
your current and future financial needs when evaluating how much coverage you need. The most common short
and long-term financial needs include:
• Medical bills and funeral expenses
• Living expenses for the surviving family (housing, food, clothing, utilities, etc.)
• Large expenses, e.g., college education, or home mortgage
• Taxes and debts that need to be settled.
Basic Life and AD&D
Basic Life Insurance pays your beneficiary a lump sum if you die. AD&D (Accidental Death & Dismemberment)
provides another layer of benefits to either you or your beneficiary if you suffer certain injuries or death from an
accident. The City of Littleton pays 100% of the premium for basic life and AD&D.
2021 Voya Financial LIFE and AD&D
Basic Life and AD&D Amount Employee: 1.5 x employee annual earnings, up to $250,000
Make sure that you have named a beneficiary for your life insurance benefit
and update it if your family or marital status changes.
21Voluntary Life and AD&D
You may supplement your basic life and AD&D coverage with voluntary coverage through Voya Financial. If you are
a new employee enrolling when you first become eligible, you will be guaranteed $100,000 of coverage up to 3
times your annual earnings for yourself without having to submit a medical questionnaire.
You may purchase life insurance in the following coverage amounts:
2021 Voya FINANCIAL VOLUNTARY LIFE and AD&D
Voluntary Life and AD&D Employee: A maximum of $500,000 or 5 x earnings,
Amounts in increments of $10,000
Spouse: A maximum of $50,000, in increments of $5,000, may not exceed
50% of the employee’s voluntary life amount
Child(ren): $10,000
Contact HR for rates on voluntary life insurance
Make sure that you have named a beneficiary for your life insurance benefit
and update it if your family or marital status changes.
22Disability Insurance
Disability insurance replaces part of your pay while you are unable to work so you have a continuing income for
living expenses.
2021 Voya Financial Short-Term Disability
Should you become disabled, short-term disability (STD) may provide you 60% of your pre-disability salary up to
$3,500 per week. STD is available after a 2-week waiting period of the time of disability. The City of Littleton pays
100% of the premium for short-term disability insurance.
Benefit Amount 60% of weekly pre-disability earnings
Maximum Benefit $3,500 per week
Elimination Benefit 14 days Accident or Illness
Benefit Duration 11 weeks
2021 Voya Financial Long-Term Disability
If you are unable to work for longer than ninety days, long-term disability (LTD) coverage replaces part of your
monthly income. Payments may be reduced by state, federal, or private disability benefits you receive while
disabled. The City of Littleton pays 100% of the premium for long-term disability insurance.
General Government Benefit Commissioned Police Eligible
for Normal Retirement
Monthly benefit 60% of salary, up to a maximum of 40% of salary, up to a maximum of
$6,000 $2,000
Benefits begin 90 days after injury or illness 180 days after injury or illness
Effective date Date of hire Date of hire
Maximum Later of 65 or Social Security Normal Later of 65 or Social Security Normal
payment period Retirement Age Retirement Age
23Employee Assistance Program
Regular full and part-time employees and their dependents (living in their household) are eligible for five (5)
free sessions per incident, per person, per calendar year.
Everyone has been affected by personal problems at some time in is his/her life. These problems may affect
personal happiness and create disruption in job performance. Because the City of Littleton values its employees
and the work they perform, we have provided an Employee Assistance Program (EAP) through Mines and
Associates. The EAP provides assessment referral, focused therapy and coaching for employees and their
household members in dealing with such issues as:
Abuse Anxiety Career Depression
Child & Eldercare Death, Grief & Dying Financial Problems Mood Disorders
Drug/Alcohol Concerns Eating Disorders Stress Supervisory Resources
Legal Referrals Marital & Relationship Psychological Sexual
Work-Related Wellness Coaching
The use of the Employee Assistance Program is strictly confidential. Your contact with the EAP and your counselor
will not be discussed within the organization in any way without your written permission. There will be no
information in your personnel file pertaining to the use of the EAP. The EAP offices are located away from the
workplace to provide as much privacy as possible.
Additionally, supervisors have access to unlimited workplace consultation regarding work performance issues.
For more information, please contact Mines and Associates at (303) 832-1068 or by visiting their website at
www.minesandassociates.com
You also have 24/7 access to a ComPsych Guidance Resources program that offers someone
to talk to and resources to consult whenever and wherever you need them.
Call: 877-533-2363 (max. 3 calls per issue) Online: guidanceresources.com (Web ID: My5848i)
24Tax Savings Programs
Flexible Spending Accounts
The City of Littleton offers two flexible spending account (FSA) options – the Heath Care FSA – which allows you to
pay eligible health care and dependent care expenses with pre-tax dollars. The FSAs are administered by
24HourFlex. Log into your account at www.24HOURFLEX.com to: view your account balance(s), calculate tax
savings, view eligible expenses, download forms, view transaction history, and more. You will receive a 24HourFlex
stored value VISA card, which can be used to pay for eligible health care at the point of service. If you do not use
your card or if you have dependent care expenses to be reimbursed, submit a claim form and a bill or itemized
receipt from the provider to 24HourFlex.
Health Care FSA
The health care FSA through 24HourFlex allows you to set aside money from your paycheck on a pre-tax basis
(before income taxes are withheld) to pay for eligible out-of-pocket expenses, such as deductibles, copays, and
other health-related expenses, that are not paid by the medical, dental, or vision plans. Over-the-counter (OTC)
medication is not eligible for reimbursement without a prescription.
The health care FSA maximum contribution is $2,750 for the 2021 plan year.
Dependent Care FSA
The Dependent Care FSA allows you to set aside money from your paycheck on a pre-tax basis for daycare expenses
to allow you and your spouse to work or attend school full-time. Eligible dependents are children under 13 years
of age, or a child over 13, spouse, or elderly parent residing in your house which is physically or mentally unable
to care for himself or herself. Examples of eligible expenses are daycare facility fees, before-and-after- school
care, and in-home babysitting fees (income must be reported by your care provider).
The dependent care FSA maximum contribution is $5,000 for the 2021 plan year.
Estimate carefully! Any balance remaining in your Health Care Reimbursement Account at the end of the plan year
up to $500 will be carried forward and used to fund your account in the next plan year. This carryover amount does
not apply to the Dependent Care FSA. Any remaining balances, at the end of the plan year, will be forfeited.
The biggest deduction from your paycheck is likely federal income tax. Why not take a
bite out of taxes while participating in these programs which you pay for with pre-tax
dollars?
25Legal Services
LegalShield/IDShield
The City of Littleton offers access to LegalShield (www.legalshield.com/info/littletonco) to help you with
frustrating legal endeavors.
LegalShield covers various legal needs that you may have.
Services Provided with LegalShield
Preventative Legal Services Motor Vehicle Services
• Legal consultation and advice • Legal expenses from traffic violations
• Will preparation • Driver’s license assistance
Trial Defense Legal Services IRS Audit Legal Services
• Up to 60 hours of attorney time if you are • Up to 50 hours of attorney time if you
a named defendant in a civil or job related receive a written notice of an IRS
criminal action. audit.
IDShield covers various identity security needs that you may have, including:
Services Provided with IDShield
Privacy Monitoring Security Monitoring
• Comprehensive identity protection • Monitors SSN, credit cards, and bank
• Monitors your name, SSN and other accounts
numbers • Quarterly credit score tracking
Consultation Full-Service Restoration
• 24/7/365 live support • Complete identity recovery services
Plans Bi-Weekly Rates
LegalShield Legal Plan $7.27
LegalShield Legal plus IDShield Individual $11.40
LegalShield Legal plus IDShield Family $14.17
IDShield Full Individual $4.13
IDShield Full Family $8.75
26Time-Off Benefits
The City observes the following holidays*:
2021 Holiday Schedule
New Year’s Day January 1, 2021
Martin Luther King Jr. Day January 18, 2021
President’s Day February 15, 2021
Memorial Day May 31, 2021
Independence Day July 5, 2021 (observance)
Labor Day September 6, 2021
Thanksgiving Day November 25, 2021
Day after Thanksgiving November 26, 2021
Christmas Eve Afternoon December 23, 2021 (close at 12:00 PM)
Christmas Day Decemberfull-time
*The holidays listed above are fully paid for general government 24, 2021employees.
(observance)
For general government part-time employees (20+ hours per week), the above holidays are prorated at the
following levels:
Paid Hours Per Holiday
Weekly Hours Worked Paid Hours Per Holiday
20 4
24 5
28 6
32 7
*Commissioned police officers, detectives, corporals, sergeants, and emergency services dispatchers are
granted additional vacation hours in lieu of paid holidays.
Floating Holidays
General government regular Full-Time employees and emergency service dispatchers receive 40 hours
annually of floating holiday. General government regular part-time employees of 20 hours or more are
eligible for 12 annually of floating holiday. At the end of each calendar year, and at the time of termination
from employment, unused floating holiday hours will be forfeited.
27Time-Off Benefits (cont.)
Vacation Leave Policy*
Employees receive paid vacation leave on an annual basis at the following schedule.
Part-Time Employees 2021 Vacation
Benefit Level 20 hour 24 hour 28 hour 32 hour
Date of Hire to 5 yrs. 64 77 90 103
5 yrs. Up to 10 yrs. 76 92 107 122
10 yrs. Up to 15 yrs. 84 101 118 135
15 yrs. Up to 20 yrs. 96 116 135 154
Over 20 yrs. 104 125 146 167
Vacation Carry Over: Up to 100 hours
Full-Time Employees 2021 Vacation
General Commissioned Police Officers,
Benefit Level Government Dispatch Corporals, & Sergeants
Date of Hire to 5 yrs. 128 204 230
5 yrs. Up to 10 yrs. 152 228 246
10 yrs. Up to 15 yrs. 168 244 270
15 yrs. Up to 20 yrs. 192 268 286
Over 20 yrs. 208 284 306
Max 200 hours
Vacation Carryover Max 150 hours
28Time-Off Benefits (cont.)
Sick Leave Policy*
Full-time regular employees earn eight hours of sick leave accrual per month. There is no carry over limit from
year to year.
Part-time regular employees of 20 or more hours per week earn sick leave on a monthly basis at the following schedule:
Part-Time Employees Sick Hours Earned Per Month
Weekly Hours Worked Paid Hours Earned
20 4
24 5
28 6
32 7
Temporary, seasonal, and variable hour employees will accrue sick leave at one hour of paid sick leave for
every 30 hours worked, up to a maximum of 48 hours/year.
Flexible Schedules
Certain employees may be eligible for flexible scheduling arrangements, including compressed workweeks,
early or late start times, and telecommuting. Flexible scheduling arrangements are at the discretion of the
Department Director/Chief or City Manager.
*The City evaluates holiday, vacation, and sick time off benefits on an ongoing basis should any changes
happen to the accruals, employees will be notified.
29Retirement Plans
457 Deferred Compensation Plan
The City of Littleton offers employees with a regular part-time or full-time status of 20 hours per week or more
to elect to participate in the 457 Deferred Compensation Plan. The employee can elect contribution amounts
and make investment selections. The contributions can be made up to the IRS maximum contribution amount
($19,500 in 2021). Employees 50 or older can contribute an additional $6,500 per year as a designated “catch-
up” provision.
Employees are eligible for this plan on their date of hire.
The City of Littleton will provide employees with a match on voluntary elected contributions. The match is up to
2% for general government and police employees hired before 10/14/18 that elected to stay with IMCA. The
employer voluntary match for the police plan is contributed in the employee’s 401(a) vesting schedule. The
employer voluntary match for the general government plans is contributed to the employee’s 457 plan.*
All employees are immediately fully vested in the employer’s contribution to the 457 plan.
*In 2020, the city match to the 457-retirement plan was suspended for full-time
employees through 2021.
30Retirement Plans (cont.)
General Employee Retirement Plan 401a
The City of Littleton offers regular full-time status employees of 40 hours or more per week a retirement/401(a)
plan. Employees are fully vested in the employer’s contributions to the 401(a) after five years of employment
or age 55.
Employees are eligible for this plan on their date of hire.
The chart below details the specific contribution schedule.
General Employee Retirement Plan/401(a) and FPPA Contributions
2021 Mandatory City of Littleton
Employee Classification
Employee Contribution Contribution
401(a) – General Government Employees 5% 7%
401(a) – Commissioned Police Personnel –
10% 10%*
Hired before 10/14/18 and did not elect FPPA
FPPA Defined Benefit Plan –
11.5% 8%
Commissioned Police Personnel – Hired
on or after 10/14/18
FPPA Defined Benefit Plan –
11.5% 12%
Commissioned Police Personnel – Hired
before 10/14/18
*This number can go up to 12% if police personnel have elected to contribute to the 457 plan. The city matches up to 2%
on this election and it is deposited into the police personnel's 401(a) plan. *In 2020, the city match to the 457-retirement
plan was suspended through 2021.
Roth Individual Retirement Account
The City of Littleton offers employees with a regular part-time or full-time status of 20 hours per week or more
to elect to participate in a Roth Individual Retirement Account. The employee can elect contribution amounts
and make investment selections. The contributions can be made up to the IRS maximum contribution amount
of $6,000 per year after-tax for employees under the age of 50 and $7,000 per year after-tax for employees
over the age of 50. There are no city contributions.
Employees are eligible for this plan on their date of hire.
31Tuition Reimbursement
The City of Littleton offers tuition reimbursement to regular full-time employees (40 hours or more per week)
when funding is available. Eligible courses for advanced degrees and education related to an employee’s
position with the City. Reimbursements will be approved within the program’s criteria on a first-come-first-
served basis when funding is available up to $3,000 annually.
*In 2020, this program has been suspended through 2021.
Wellness Program
The City’s wellness program is designed to promote and improve health and well-being in the lives of City
employees through health education and wellness programs. Our goal is to establish a work environment that
promotes a healthy lifestyle both at work and at home. Our wellness program is focused on preventative health
care, health education, and fostering healthy lifestyles.
Employees and spouses are invited to participate in a variety of health programs that can earn individuals up to
$300 per year or $600 per household, per year! Our easy to use program offers cash incentives for completing
wellness goals such as an annual physical, telephonic coaching, and other preventative exams.
In addition, we offer an array of health programs for all employees. Contact Human Resources for more information!
32Plan Contacts
Plan type Provider Phone Web Policy #
City of Littleton Human City of Littleton 303-795-3857 HR@littletongov.org N/A
Resources
Medical Cigna 1 (800) 244-6224 www.mycigna.com 3332146
City of Littleton Employee CareHere (877) 423-1330 www.carehere.com N/A
Wellness Clinic
Dental PPO Delta Dental 1 (800) 610-0201 www.deltadentalco.com 1235
Insurance Company
Vision Vision Service Plan 1 (800) 216-6248 www.vsp.com 12198600
Life and AD&D Voya Financial 1 (800) 955-7736 www.voya.com 696692
Voluntary Life and AD&D
Short Term Disability (STD) Voya Financial 1 (800) 423-2765 www.voya.com 696692
Long Term Disability (LTD)
FSA Administration 24HourFlex (800) 651-4855 www.24HourFlex.com N/A
Email: Info@24HourFlex.com
EAP Mines & Associates (800) 873-7138 www.minesandassociates.com 8963
CompPsych Guidance Voya (877) 533-2363 www.guidanceresources.com Web ID:My5848i
FPPA Fire and Police (800) 332-3772 www.fppaco.org N/A
Pension Association
401(a) Retirement Plan ICMA-RC (800) 669-7400 www.icmarc.org GG # 107464
Police # 107465
457 Deferred Comp ICMA-RC (800) 669-7400 www.icmarc.org 300177
33Important plan notices & documents
Summary Plan Descriptions
The legal document for describing benefits provided under the plan as well as plan rights and obligations to
participants and beneficiaries. Please contact HR for your Summary Plan Description.
Summary of Benefits and Coverage
A summary document that presents each of our benefit plan features in a standardized format. Please contact
HR for your Summary of Benefits and Coverage.
Medical Continuation Information
Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), employees may continue medical and/or
dental coverage at their own expense. In addition, spouses, domestic partners and dependents (called Qualified
Beneficiaries) may also continue medical and/or dental coverage at their own expense.
What is COBRA Continuation Coverage?
COBRA continuation coverage is a continuation of Plan coverage when coverage would otherwise end because
of a life event known as a “qualifying event.” Specific qualifying events are listed later in this notice. After a
qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.”
You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan
is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation
coverage must pay for COBRA continuation coverage.
If you are an employee, you will become a qualified beneficiary if you lose your coverage under the Plan
because either one of the following qualifying events happens:
• Your hours of employment are reduced, and you are no longer eligible for coverage, or
• Your employment ends for any reason other than your gross misconduct;
• Your spouse dies;
• Your spouse’s hours of employment are reduced and he or she is no longer eligible for coverage;
• Your spouse’s employment ends for any reason other than his or her gross misconduct;
• Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or you become
divorced or legally separated from your spouse.
34Medical Continuation Information (cont.)
Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because any
of the following qualifying events happens:
• The parent-employee dies;
• The parent-employee’s hours of employment are reduced and he or she is no longer eligible for
coverage;
• The parent-employee’s employment ends for any reason other than his or her gross misconduct;
• The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both);
• The parents become divorced or legally separated; or
• The child stops being eligible for coverage under the plan as a “dependent child.”
When is COBRA Coverage Available?
The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has
been notified that a qualifying event has occurred. When the qualifying event is the end of employment or
reduction of hours of employment, death of the employee, or commencement of a proceeding in bankruptcy
with respect to the City of Littleton, the employer will notify the insurance provider of the qualifying event.
You Must Give Notice of Some Qualifying Events
For the other qualifying events (employee becoming entitled to Medicare benefits, divorce or legal separation
of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you
must notify human resources within 60 days after the qualifying event occurs.
How is COBRA Coverage Provided?
Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage
will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right
to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf
of their spouses, and parents may elect COBRA continuation coverage on behalf of their children. All COBRA
notices and enrollment information is sent directly from 24hr Flex.
Additional information regarding COBRA benefits, including the length of COBRA coverage, is available on NiC
(or in the Human Resources office).
35Medicare Part D Notice of Creditable Coverage
Important Notice from the City of Littleton, about your Prescription Drug Coverage and
Medicare
Please read this notice carefully and keep it where you can find it. This notice has information about your current
prescription drug coverage with the City of Littleton, and about your options under Medicare’s prescription drug
coverage. This information can help you decide whether or not you want to join a Medicare drug Plan. If you are
considering joining, you should compare your current coverage, including which drugs are covered at what cost,
with the coverage and costs of the Plans offering Medicare prescription drug coverage in your area. Information
about where you can get help to make decisions about your prescription drug coverage is at the end of this
notice.
There are two important things you need to know about your current coverage and Medicare’s prescription
drug coverage:
1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this
coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or
PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of
coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
2. The City of Littleton has determined that the prescription drug coverage offered by Cigna is, on average
for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage
pays and is therefore considered Creditable Coverage. Because your existing coverage is Credible
Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join
a Medicare drug plan.
When Can You Join a Medicare Drug Plan?
You can join a Medicare drug plan when you first become eligible for Medicare and each year from October
15th to December 7th.
However, if you lose your current creditable prescription drug coverage, through no fault of your own, you
will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.
36Medicare Part D Notice of Creditable Coverage (Cont.)
What Happens To Your Current Coverage If You Decide to Join a Medicare Drug Plan?
If you decide to join a Medicare drug plan, your City of Littleton coverage will not be affected. See below for
more information about what happens to your current coverage if you join a Medicare drug plan.
Since the existing prescription drug coverage under Cigna is creditable (e.g., as good as Medicare
coverage), you can retain your existing prescription drug coverage and choose not to enroll in a Part D plan;
or you can enroll in a Part D plan as a supplement to, or in lieu of, your existing prescription drug coverage.
If you do decide to join a Medicare drug plan and drop your coverage through the City of Littleton, be aware
that you and your dependents can only get this coverage back.
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?
You should also know that if you drop or lose your current coverage with The City of Littleton and don’t join a
Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher
premium (a penalty) to join a Medicare drug plan later.
If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium
may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did
not have that coverage. For example, if you go nineteen months without creditable coverage, your premium
may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this
higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have
to wait until the following October to join.
For More Information About This Notice Or Your Current Prescription Drug Coverage…
Contact the person listed below for further information at (303) 795-3857. NOTE: You’ll get this notice each
year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through
The City of Littleton changes. You also may request a copy of this notice at any time.
For More Information About Your Options Under Medicare Prescription Drug Coverage…
More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare &
You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be
contacted directly by Medicare drug plans.
37Medicare Part D Notice of Creditable Coverage (Cont.)
For more information about Medicare prescription drug coverage:
• Visit www.medicare.gov
• Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare
& You” handbook for their telephone number) for personalized help.
• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is
available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or
call them at 1-800-772-1213 (TTY 1-800-325-0778).
Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans,
you may be required to provide a copy of this notice when you join to show whether or not you have
maintained creditable coverage and, therefore, whether or not you are required to pay a higher
premium (a penalty).
Availability of Privacy Practices Notice
We maintain the HIPAA Notice of Privacy Practices for describing how health information about you may be
used and disclosed. You may obtain a copy of the Notice of Privacy Practices by contacting the plan
administrator.
38Women’s Health and Cancer Rights Act
If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s
Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits,
coverage will be provided in a manner determined in consultation with the attending physician and the
patient, for:
● All stages of reconstruction of the breast on which the mastectomy was performed;
● Surgery and reconstruction of the other breast to produce a symmetricalappearance;
● Prostheses; and
● Treatment of physical complications of the mastectomy, including lymphedema.
These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical
and surgical benefits provided under this plan. If you would like more information on WHCRA benefits, call
your plan administrator.
Newborns’ and Mothers’ Health Protection Act
Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any
hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours
following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally
does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from
discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and
issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance
issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). If you would like more information
on maternity benefits, call your plan administrator at (303) 795-3857.
HIPAA Notice of Special Enrollment Rights
If you decline enrollment in City of Littleton health plan for you or your dependents (including your spouse)
because of other health insurance or group health plan coverage, you or your dependents may be able to
enroll in City of Littleton health plan without waiting for the next open enrollment period if you:
● Lose other health insurance or group health plan coverage. You must request enrollment within 30 days
after the loss of other coverage.
● Gain a new dependent as a result of marriage, birth, adoption, or placement for adoption. You must
request health plan enrollment within 30 days after the marriage, birth, adoption, or placement for
adoption.
39HIPAA Notice of Special Enrollment Rights (Cont.)
● Lose Medicaid or Children’s Health Insurance Program (CHIP) coverage because you are no longer eligible.
You must request medical plan enrollment within 60 days after the loss of such coverage.
If you request a change due to a special enrollment event within the 30-day timeframe, coverage will be
effective the date of birth, adoption, or placement for adoption. For all other events, coverage will be
effective the first of the month following your request for enrollment. In addition, you may enroll in The City of
Littleton’s health plan if you become eligible for a state premium assistance program under Medicaid or CHIP.
You must request enrollment within 60 days after you gain eligibility for medical plan coverage. If you request
this change, coverage will be effective the first of the month following your request for enrollment. Specific
restrictions may apply, depending on federal and state law.
Note: If your dependent becomes eligible for a special enrollment right, you may add the dependent to your
current coverage or change to another health plan.
Premium Assistance Under Medicaid and the Children's
Health Insurance Program
If you or your children are eligible for Medicaid or CHIP and you are eligible for health coverage from your
employer, your State may have a premium assistance program that can help pay for coverage, using funds
from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t
be eligible for these premium assistance programs. Still, you may be able to buy individual insurance
coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact
your State Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your
dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-
877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your State if it has a
program that might help you pay the premiums for an employer-sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under
your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled.
This is called a “special enrollment” opportunity, and you must request coverage within 60 days of
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