2021 Employee Benefits Summary - Inside you will find information about our: Milton, GA
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2021 Employee Benefits Summary Inside you will find information about our: Benefits Enrollment • Health Benefits • Dental and Vision Benefits • Life and Disability Benefits Supplemental Programs • Flexible Spending Accounts This booklet provides a summary of plan highlights. Please consult the carrier’s contract for complete information on covered charges, limitations, and exclusions. This is not a binding contract. The carrier’s contract will prevail. If you have further questions please contact the carrier or Relation Insurance Services.
welcome 2021 MILTON"' ESTABLISHED 2006 Dear City of Milton Employees: We are pleased to present your 2021 benefits package. We understand that your health and well-being are very important to you, your family, and the City's success. We are committed to providing our employees and their eligible dependents with a comprehensive benefits package including medical, dental, vision, life, and disability insurance. We strive to ensure that your benefit program is not only high quality, but also affordable in this world of increasing healthcare costs. Our renewal with Cigna went very well this year with the City receiving only minor increases. In 2021, we will continue to offer a Base Plan and a High Deductible Health Plan (HDHP) for medical options. The High Deductible option gives you a way, through a Health Savings Account (HSA), to set aside pre-tax dollars to pay for expenses in the HDHP. In addition, the City will contribute an annual amount of $750, $ l,125, or $1,500, based on your level of coverage to your HSA, to help pay for your eligible expenses. If enrolled in the Base Plan, you will receive a $500 contribution from the City in the form of a Health Reimbursement Account (HRA) to help pay for expenses. You may also enroll in the Flexible Spending Account (FSA), offered through our provider Basic. The annual contribution limit for the FSA is $2,750 for health related expenses and $5,000 for dependent care. Your plan selections will remain in effect through December 31, 2021. There will continue to be one dental plan offered through Cigna. The deductible and annual maximums have not changed for the dental plan. The vision plan remains with VSP, and there are no changes to the benefit levels or network. We are proud to continue to offer competitive rates for benefits. All rate changes are detailed in this book. This benefits booklet is designed as a resource to help you review your benefit choices, and serves as a summary of the various programs offered to you as an employee of the City of Milton. Additionally, you may contact our insurance broker's office, Relation, for any questions or concerns that you may have. All contact information is listed on the back cover of this booklet. Sincerely, St�ity Manager 2006 Heritage Walk Milton, GA 30004 P: 678.242.2500 IF: 678.242.2499 info@cityofmiltonga.usIwww.cityofmiltonga.us OGOO Contents Benefits Focus ���������������������������������������������������������������������������������� 1 Special Health Programs���������������������������������������������������������������� 19 Benefits Eligibility & Changes ������������������������������������������������������� 2-3 FSA �������������������������������������������������������������������������������������������������� 20 Medical Benefits ������������������������������������������������������������������������� 4-14 AFLAC Programs������������������������������������������������������������������������������ 21 Dental���������������������������������������������������������������������������������������������� 15 Benefits Rates �������������������������������������������������������������������������������� 22 Vision ���������������������������������������������������������������������������������������������� 16 Notices���������������������������������������������������������������������������������������23-25 Life and AD&D�������������������������������������������������������������������������������� 17 Contact Information ��������������������������������������������������������Back Cover Disability and EAP �������������������������������������������������������������������������� 18 This booklet provides a summary of plan highlights. Please consult the insurance contract for complete information on covered charges, limitations, and exclusions. This is not a binding contract. The carrier’s contract will prevail. If you have further questions, please contact the carrier or Relation Insurance Services.
BENEFITS FOCUS Our Benefit Goals Reminders for This Year: We evaluate our benefit programs each year • Both the POS and the HDHP plan will have an enhanced to make sure that we accomplish several goals. benefit when using a Cigna Care Designated (CCD) provider. We strive to: • The POS members will enjoy a lower primary care or specialist • Promote health and wellness among The City of Milton visit copay. employees and their dependents. • The HDHP members will enjoy a greater coinsurance level • Provide employees with affordable access to health when using a CCD provider. The CCD designation C can be benefits. found on provider lists located on myCigna.com. • Provide competitive benefits programs. • Due to a merger between Cigna and Express Scripts, all • Provide resources to support employees and their members will receive new ID cards for the new plan year dependents as they make important decisions about starting January 1st 2021. their health and health care. • Effective January 1st 2021, Amwell for Cigna will no longer be a Virtual Care option for Cigna members. MD Live will remain as the sole telehealth provider. Your Benefits are Paid for with Pre-Tax Dollars Every penny in your paycheck counts. To help you stretch your income, we established a Cafeteria Plan or Flexible Benefit Plan that allows you to pay for your benefits using pre-tax money. What Does a Cafeteria Plan Mean to Me? ••••• You save at least 15% in Federal Tax ••••• You save 1.45% in FICA Tax ••••• You save 6% in Georgia State Tax ••••• More flexibility— you have a menu of benefit alternatives and levels and can choose the right options for you 2021 | EMPLOYEE BENEFITS SUMMARY 1
BENEFIT ELIGIBILITY AND CHANGES Benefit Eligibility The City of Milton provides a comprehensive employee benefit program to all full-time employees. Employees are eligible for coverage on the first day of the month following date of hire for medical, dental, vision, life, disability and FSA benefits. You can enroll the following dependents in our group benefit plans: • Your legal spouse. • Children under age 26. • Unmarried children of any age if totally disabled and claimed as a dependent on your federal income tax return (documentation of handicapped status must be provided). • Dependents for which you have legal guardianship or custody. Legal documentation will be required. Many employees have other dependents living with them who are not eligible for our benefit plan. Dependents NOT eligible to be added to your benefit plans include: • Grandchildren, nieces, nephews or other children who do not meet specifications listed above. • Common law spouses (same or opposite sex). • Ex-spouses, unless required via court order (documentation required). • Parents, step-parents, grandparents, aunts, uncles, or other relatives who are not qualified legal dependents (even if they live in your house). How to Enroll for Benefits: Open Enrollment for the 2021 plan year will take place during the month of November. All changes will be effective January 1, 2021. To review and select your benefits, log in to the payroll system and navigate to My Benefits>Enrollment. 2 EMPLOYEE BENEFITS SUMMARY | 2021
BENEFIT ELIGIBILITY AND CHANGES Making Changes to Your Benefits Benefit deductions are withheld from your paycheck on a pre-tax basis and your ability to make changes to these benefits is restricted by the IRS. Once enrolled, most pre-tax benefit elections cannot be changed until the next annual Open Enrollment period, unless you have a Qualifying Life Event. The Most Common Life Status Changes • Marriage, divorce, legal separation • Birth or adoption • Change in your or your spouse’s work status that affects your benefits or an eligible dependent’s benefits • Change in health coverage due to your spouse’s annual Open Enrollment period • Change in eligibility for you or a dependent for Medicaid or Medicare • Receipt of a Qualified Medical Child Support Order or other court order To make benefit changes as a result of your Life Status Change as allowed under Section 125 of the IRS Code, you must: • Notify Human Resources within 30 days of the date of the qualifying event • Provide proof of your life status event, and • Complete and submit your enrollment form. Keeping Your Benefits When Eligibility Changes Sometimes life happens and you need to move, stop working or In order to select and continue COBRA benefits you change employers. While the City of Milton hopes that you stay must: with us for a long time, circumstances are not always the way we • Submit an election to continue COBRA within 60 days from hope. COBRA allows you and/or dependents to continue medical, the date the notice is received, or 60 days from the date dental, and vision benefits that are in place at the time eligibility coverage is terminated, whichever is later. changes. The cost for health benefits is 100% of the benefit cost • Submit your COBRA payment within 45 days from the date plus a 2% administrative fee. that COBRA coverage is elected. Upon receipt of payment, Medical, dental, and/or vision benefits terminate on the last day of benefits are retroactive, thus effective on the date your the month of your last day of work. benefits ended. • Submit future payments on time or benefits will be cancelled. If you are enrolled in life and/or disability benefits, these benefits Once cancelled, COBRA benefits cannot be reinstated. will end on your last day of employment with the City of Milton. These benefits are convertible and/or portable, and information COBRA benefits can generally be continued for the on your conversion rights will be provided to you at that time. following timeframes: How does COBRA work? • 18 months if your employment with the City of Milton ends Your COBRA notice is mailed to you from Basic once your • 36 months if eligibility is lost as a result of a divorce termination is processed. You should receive it at your home within • 29 months if you are deemed disabled. You must apply for the 15-20 days after your termination. Basic’s contact information is additional 11 months when you first enroll in COBRA listed on the back cover. 22021 | EMPLOYEE BENEFITS SUMMARY Y 3
MEDICAL BENEFITS Medical Benefits The City of Milton offers two health plan options through Cigna, our Point of Service (POS) and our High-Deductible Health Plan with a Health Savings Account (HSA). Point of Service - Open Access Plan (POS) High Deductible Health Plan (HDHP with HSA) The POS option works like a traditional health plan. Employees The HDHP option is a high-deductible health insurance plan pay a $35 copay for in-network visits to their Primary Care ideal for employees who: Physician and a $50 copay to see an in-network specialist. If you • Prefer to pay lower premiums visit a Cigna CCD doctor, your copay for a primary care visit will • Want to save money for future health care expenses be $25 and a specialist visit will be $40. Certain other services are and post-retirement medical costs covered at 100% after the $2,500/$7,500 deductible is reached. • Like to control how their money is spent Out-of-network services are subject to a higher deductible, cost • Want all covered medical and prescription expenses to apply more, and you may have to file your benefit claims yourself or towards the deductible pay for services and wait for reimbursement from Cigna. HDHP participants who utilize doctors with the Cigna Care Designation (CCD) will enjoy a coinsurance level of 100% after meeting their deductible of $3,000 / $6,000. Wellness Services for POS and HDHP HDHP participants have the added benefit of a HSA contribution Plan Member Cost from the City. The City contributes between $750 and $1,500 to Annual Physical Free the HSA to be applied to qualifying medical expenses. Employees Well Child Care Free have the option of making additional pre-tax contributions Preventative Immunizations Free to their HSA to use now or as savings towards future medical Mammograms/Pap/Prostate Free expenses. All new enrollees’ contributions will be prorated for *Contact Cigna for specific guidelines on preventative care the plan year. myCigna.com myCigna Mobile App Register today. It’s this easy: myCigna Mobile App gives you a simple way to 1. Go to myCigna.com and select “Register.” personalize, organize and access your important 2. Enter your personal details like name, address and date of birth. health information – on the go. It puts you in control 3. Confirm your identity with secure information like your Cigna of your health, so you can get more out of life. ID, social security number or a security question. This will make sure only you can access your information. The myCigna App has big features. 4. Create a user ID and password. 5. Review and submit. • Access the health care professional directory Now you’re ready to log in to your personal, secure myCigna. • View and easily print, email, and scan your ID cards com site. See how the site has been redesigned with you in mind, • View and search recent and past claims making it easy to navigate and find what you need: • Look up and compare drug costs and find the closest pharmacy • Manage and track claims • Access and view account balances • Find doctors and medical services • Store and organize important contact information • Manage and track your health information • Custom health team feature to keep track of your in network • See cost estimates for medical procedures doctors, dentists and facilities • Compare quality of care ratings for doctors and hospitals • Receive proactive messages from Cigna to guide you • Access a variety of health and wellness tools and resources • Click to chat feature when you need assistance • Print ID cards 4 EMPLOYEE BENEFITS SUMMARY | 2021
MEDICAL BENEFITS: HRA Health Reimbursement Arrangements Employees are provided a $500 HRA which is funded by the City of Milton and used to provide employees with reimbursement for qualified medical or prescription expenses incurred by the employee or a covered dependent under the Cigna Base POS plan. The HRA can be used to offset the cost of your prescription deductible, prescription copays and medical deductible. Our HRA is administered by Basic. Their contact information is located on the back page of the booklet. Using My HRA Deadline for Filing 2020 Claims 1. Rx Copays- you may use your debit card at the pharmacy or Please file these claims for reimbursement as soon as possible submit an EOB manually. in order to avoid a delay in processing. The plan is set up with 2. Rx Deductible- you may use your debit card at the pharmacy a 90 day run out for 2020 claims, which means that they would or submit an EOB manually. need to receive the claims by midnight on 3/31/21 to process them for reimbursement. Any 2020 claims received after 3. Medical Deductible- you must obtain an EOB from Cigna and midnight on 3/31/21 will be denied. Services can be incurred submit these expenses manually. until midnight on 12/31/20, any services after that will apply to the 2021 plan year. Any balance left in the HRA after the grace If Submitting an HRA Claim Manually period for claims will be forfeited. 1. Wait until Cigna processes your claim and you receive your Explanation of Benefits (EOB) in the mail or online. 2. Use the EOB to determine what portion of the claim was Sample Eligible Expenses applied to your deductible. • Hospital Inpatient Services: room and board, hospital services 3. Complete the claim form from Basic HRA. and supplies (x-ray, lab, anesthesia, etc.), physician services 4. Send the EOB and Claim Form to Basic for processing. (surgeon, anesthesiologist, radiologist, pathologist, etc.) 5. Reimbursements will be made directly to you. • Inpatient Mental Health Care • Inpatient Substance Abuse Treatment If your provider requests payment at the time of service, pay the • In-Office Surgery bill and save your receipt. Once you receive your EOB from Cigna, • Outpatient lab & radiology send it to Basic for processing and they will reimburse you. • Outpatient Hospital: outpatient facility (lab, x-ray, anesthesia etc.), outpatient physician services (surgeon, radiologist, anesthesiologist, pathologist, etc.) • Advanced radiology/imaging services (MRI, MRA, PET, CT- Scan, and Nuclear Medicine) • Radiation Therapy • Prescription Drug Copay • Skilled Nursing Facility • Prescription Drug Deductible 2021 | EMPLOYEE BENEFITS SUMMARY 5
MEDICAL BENEFITS: HDHP WITH HSA HSA: A Health-Wise Investment for Your Future Money in your HSA is YOURS The City of Milton Contribution to Your HSA Money left in your HSA rolls over each year and may accumulate Employee Only $750 interest once a certain account balance is reached to help you Employee + Spouse or Child(ren) $1,125 save for future medical expenses. Your HSA fund is portable Family $1,500 should you terminate employment with the City of Milton or choose to move to a traditional plan in the future. The City of Milton Contributions to Employee Health Savings Accounts The City of Milton makes contributions to employees’ Health Savings Accounts at the beginning of each calendar year to help pay for qualified medical expenses that apply towards the plan deductible. HSA Qualified Medical Expenses Examples of qualified medical expenses. Listed below are the most common examples of qualified medical expenses. You can find a complete listing at www.irs.gov. Search under Internal Revenue Service (IRS) Publication 502, Medical and Dental Expenses. • Acupuncture • Hospital services • Alcoholism treatment • Laboratory fees • Ambulance • Long-term care (for medical expenses and premiums) • Artificial limb • Nursing home • Artificial teeth • Nursing services • Breast reconstruction surgery (mastectomy-related) • Operations/surgery (excluding unnecessary cosmetic surgery) • Chiropractor • Physical therapy • Contact lenses • Prescription medicines or drugs • Cosmetic surgery (if due to trauma or disease) • Psychiatric care • Dental treatment (X-rays, fillings, braces, extractions, etc.) • Psychologist • Diagnostic devices (such as blood sugar test kits for diabetics) • Speech therapy • Doctor’s office (including physicians, surgeons, specialists or • Stop-smoking programs other medical practitioners) visits and procedures • Vasectomy • Drug addiction treatment • Weight-loss programs (to treat a specific disease diagnosed by • Drugs, prescription a physician) • Eyeglasses and exams • Wheelchair • Eye surgery (such as laser eye surgery or radial keratotomy) • Wig • Fertility enhancements • X-rays • Hearing aids (and batteries for use) 6 EMPLOYEE BENEFITS SUMMARY | 2021
MEDICAL BENEFITS - HDHP WITH HSA HDHP WITH HSA In-Network Out-of-Network Lifetime Maximum Unlimited Unlimited Calendar Year Deductible $3,000 Individual $6,000 Individual $6,000 Family $12,000 Family Out-of-Pocket Maximum $4,000 Individual $12,000 Individual (includes deductible, coinsurance, and copays and RX copays) $8,000 Family $24,000 Family Amount Plan Pays Amount Plan Pays Office Visits 90% after deductible non-CCD provider / 100% after deductible with CCD provider C 70% after deductible Preventive Care 100%; deductible waived 70% after deductible Coinsurance (amount plan pays after you meet the deductible) 90% non-CCD provider / 100% with CCD provider C 70% after deductible Prescription Drug – The full plan deductible must be met before prescription copays apply. Once you meet your out-of-pocket maximum, prescription drugs will be covered at 100%. • Retail - up to a 30-day supply Tier 1 $15 copay after plan deductible (same for in- and out-of-network) Tier 2 $35 copay after plan deductible Tier 3 $60 copay after plan deductible • Mail Order/Rx90 Now - per 90-day supply Tier 1 $45 copay after plan deductible (same for in- and out-of-network) Tier 2 $105 copay after plan deductible Tier 3 $180 copay after plan deductible This summary should not be considered a full explanation of benefits, see certificate for exact coverage and exclusions. Frequently Asked Questions About HSAs: What will I receive once I have made my election? Do doctors require payment at the time of service? Your debit card and your Cigna ID card will each be mailed to Most network physicians will bill Cigna first and then bill you for your home separately. In addition, you will receive a Certificate of your adjusted costs. Coverage detailing your plan benefits. If you are new to the HSA, What happens to my HSA if I never withdraw funds, Health Equity will send a welcome kit to your home 7-10 business change jobs, or retire? days after notification of your enrollment. Funds in your HSA are yours, even if you change employers or How do I make deposits to my account? retire. The less that you spend on current medical expenses, Deposits to your HSA can be made through pre-tax payroll the more money stays in your account accumulating interest. deductions. Unlike an FSA, you can change your payroll deductions Under IRS guidelines, HSAs are treated like IRAs. HSA funds are for the HSA during the year. Combined employee/employer never taxed or penalized if they are used for qualified medical contributions for 2021 cannot exceed $3,600 for individuals expenses. Funds can be withdrawn for any reason, without or $7,200 for families. Anyone over age 55 can contribute an penalty once you reach age 65. additional $1,000 for catch-up contributions. What expenses are counted towards my deductible? Who verifies that my HSA was used for qualified Only medical expenses covered by your medical plan apply expenses? towards your deductible. However, HSA funds used for qualified Save your receipts — in the event of an IRS audit, you are medical expenses not covered under your medical plan (for responsible for providing documentation to the IRS. example, orthodontia), will not count towards your health plan deductible. 2021 Annual Max: $3,600 Individual & $7,200 Family Can I pay for services that cost more than my HSA balance? If you enroll in the HDHP you must visit No, your HSA balance must be sufficient to cover the expense www.healthequity.com to authorize a Health before funds are withdrawn, or you must wait until you have Savings Account after you receive a welcome packet enough money in the account and then submit the expense for in the mail detailing the process. reimbursement. 2021 | EMPLOYEE BENEFITS SUMMARY Y 7
MEDICAL BENEFITS - POS PLAN In-Network Benefits Out-of-Network Benefits Lifetime Maximum Unlimited Unlimited Calendar Year Deductible (separate, do not combine in- and out-of-network) $2,500 individual $5,000 individual $7,500 family $15,000 family Out-of-Pocket Maximum (includes deductible, coinsurance, medical copays $6,600 individual $19,800 individual and pharmacy costs) Non-covered items do not apply. $13,200 family $39,600 family Office Visits: Preventive Care Well Child and Immunizations Plan pays 100% (not subject to deductible) Plan pays 70% after deductible (ded. waived through age 5) Periodic Health Examinations Plan pays 100% (not subject to deductible) Plan pays 70% after deductible Prostate Screening or Annual Gynecology Examination Plan pays 100% (not subject to deductible) Plan pays 70% after deductible Office Visits: Illness or Injury Primary Care Physician $35 copay non- CCD provider / Plan pays 70% after deductible $25 copay with CCD provider C Specialty Care Visit $50 copay non-CCD provider / Plan pays 70% after deductible $40 copay with CCD provider C Urgent Care Visit $60 copay Surgery In Office Setting Plan pays 100% after deductible Plan pays 70% after deductible Cigna Virtual Care Services - Online Physician Visit $35 copay Not Covered Inpatient Services Daily Room, Board, Nurse Care (at semi-private room rate), ICU, Physician Plan pays 100% after deductible Plan pays 70% after deductible Services Outpatient Services Surgery Facility, Hospital Charges, Physician Services, Diagnostic X-ray, Lab Plan pays 100% after deductible Plan pays 70% after deductible Emergency Room (Not Covered for Non-Emergency) $200 copay (waived if admitted) Therapy Services Chiropractic Care (35-visit calendar year max.) $35 copay Plan pays 70% after deductible Occupational and Speech Therapy (35-visit calendar year max.) $35 copay Plan pays 70% after deductible Physical Therapy (35-visit calendar year max.) $35 copay Plan pays 70% after deductible Mental Health/Substance Abuse - No referral required. Services must be authorized. Inpatient / Intensive Outpatient Program / Partial Hospitalization Plan pays 100% after deductible Plan pays 70% after deductible Office Services (physician fee) $35 copay Plan pays 70% after deductible Outpatient Facility Services (physician fee) Plan pays 100% after deductible Plan pays 70% after deductible Other Services Skilled Nursing Facility (30 day benefit period max.) Plan pays 100% after deductible Plan pays 70% after deductible Home Health Care (120-visit calendar year max.) Plan pays 100% after deductible Plan pays 70% after deductible Hospice Care Plan pays 100% after deductible Plan pays 70% after deductible Ambulance (when medically necessary) Plan pays 100% after deductible Durable Medical Equipment Plan pays 100% after deductible Plan pays 70% after deductible Prescription Drug - To receive coverage your prescription must be filled at a network pharmacy. Each retail prescription has a 30-day or 90-day limit, mail order maintenance prescriptions have a 90-day limit. All member cost shares (copays, coinsurance, and deductible) for pharmacy benefits will apply to the plan Out-of-Pocket Maximum. Members must file a claim form for reimbursement when using an out-of-network pharmacy. *If a member receives a brand name drug that falls on Tier 2 or Tier 3 that has a generic equivalent available, the member pays 100% the difference between the Brand Name price and the generic price, plus the appropriate Brand Name copay, unless the physician indicates DAW (dispense as written). Rx Plan Deductible $150 individual / $300 Family (does not apply to Tier 1 retail or mail order prescriptions) Retail Tier 1 / Mail Order Tier 1 $10 copay / $30 copay Retail Tier 2 / Mail Order Tier 2 $40 copay / $120 copay Retail Tier 3 / Mail Order Tier 3 $75 copay / $225 copay This summary should not be considered a full explanation of benefits, see certificate for exact coverage and exclusions. 8 EMPLOYEE BENEFITS SUMMARY | 2021
MEDICAL BENEFITS Cigna Member Benefits Look for the Cigna Care Designation Choosing the right doctor is a big decision – one where you might want a doctor you can trust with your health – and you can afford. The Cigna Care Designation (CCD) is one decision-making tool you can use to choose a doctor. Cigna checks education and board certifications, and they also check to see if the quality of care has earned recognition from within the medical industry. What does the Cigna Care Designation mean? C The Cigna Care Designation identifies those doctors in the Cigna network who have achieved top results on Cigna’s quality and cost-efficiency measures. Cigna evaluates network doctors, using nationally recognized industry standards for quality and cost- efficiency. To earn the Cigna Care Designation, a doctor must qualify for both quality and cost efficiency ratings for an eligible specialty. There are 18 common medical specialties and 3 primary care categories represented within the CCD network. Get help choosing a hospital, too. Just look for the Centers of Excellence Designation. Choose an in- network hospital that’s right for you. Cigna reviews how successful a hospital is in treating 27 common conditions. Cigna’s ratings are based on actual patient outcomes, average lengths of stay, and average costs gathered from outside sources. Hospitals that demonstrate better health outcomes at lower costs for one of the reviewed conditions earn Cigna’s top rating – the Cigna Centers of Excellence designation. See Cigna’s hospital ratings on myCigna.com. Cigna Virtual Care How Cigna Virtual Care Works: Register for virtual care visits using MDlive on myCigna.com - Advanced registration allows services to be available when you need them. Virtual Care By Phone: Virtual Care By Video Conference: Step 1: Call Toll-Free Step 1: Visit the Website Patients call a toll-free hotline available 24/7/365 including Patients visit the MDlive website or can download the mobile holidays. MDlive at 1-888-726-3171. app and then log in with user name and password. Step 2: Speak with a Coordinator Step 2: Find a Doctor A consultation coordinator locates the next available doctor and The system helps the patients search for a doctor by criteria, prepares patients for the consultation. such as specialty, language, gender, location, or simply finds the next available doctor. Step 3: Speak with a Doctor Once an available doctor is located, the system automatically Step 3: See the Doctor Online calls and connects the doctor to the patient. Once an available doctor is located, the system automatically calls and connects the doctor to the patient. 2021 | EMPLOYEE BENEFITS SUMMARY 9
MEDICAL BENEFITS Cigna Care Management What is Care Management Preferred? Care Management Preferred offers a comprehensive care management solution. Our model is: Inpatient and outpatient precertification One team, one goal: Outstanding customer support Precertification helps the members know in advance whether Our care management approach is delivered through a multi- a procedure, treatment or service will be covered under their disciplinary team including a nurse, social worker, medical health care plan. It also helps make sure they get the right director, pharmacist and behavioral professional. We connect care in the right setting. This could save them from costly or the dots, bring together the right people and resources to help unnecessary care. improve the health of the members. Dedicated care managers connect the dots Specialty care management for whole health support Our care managers work with the members, their families and Cigna’s Specialty Care Management programs are designed to their doctors. Our approach integrates medical, behavioral, help members with complex health issues. These programs pharmacy, disability, and disease management. All while feature care managers who are nurses with expertise and helping customers maximize their benefits. training in condition management. Omada- Diabetes Prevention Program Omada is a digital lifestyle program that inspires healthy habits Omada features: though technology and support programs. The goal is to help you • Interactive program to guide your journey accomplish the changes that matter most in the areas of eating, • Wireless smart scale to monitor your progress activity, stress, and sleep. The program is available at no additional • Weekly online lessons to empower you cost if you or your covered adult dependents are enrolled in the • Professional Omada health coach for added support company medical plan offered through Cigna, are at risk for • Small online peer group to keep you engaged diabetes or heart disease, and are accepted into the program. To see if you are eligible for the program log in to- myCigna/Wellness/health topics & resources/ Chronic Conditions: Prevention & Management/Diabetes Healthy Rewards Cigna’s Healthy Rewards® provides discounts of up to 60% on various wellness programs and services, ranging from Weight Management and Nutrition, to Vision and Hearing Care, and Tobacco Cessation. To learn more about these and other Healthy Rewards® programs, visit Cigna.com/rewards (password: savings) or call 1-800-258-3312. For a complete list of Healthy Rewards vendors and programs, visit Cigna.com/rewards.com or call 1-800-258-3312. Active&Fit Direct Program As a Cigna Customer, you have access to discounts on health programs through Cigna Healthy Rewards program. Cigna members and any dependents over the age of 18 are eligible to join the Active & Fit gym membership network. Start by logging in to myCigna.com> Wellness> Healthy Rewards-Discount Programs> Fitness & Mind/Body> Fitness Discounts> Low-cost Fitness Center Memberships> Learn More. Memberships are $25 per month (plus a $25 enrollment fee) which allows you access to multiple local gyms in the Active & Fit network. 10 EMPLOYEE BENEFITS SUMMARY | 2021
MEDICAL BENEFITS Prescriptions Preventive Medications You may not have to pay a copay, a coinsurance (the percentage you pay after you meet your deductible) and/or a deductible (the amount you pay before your plan starts to pay) for some preventive medications. Please check your plan materials to understand how preventive medications are covered for you. Preventive medications are used for the prevention of conditions such as high blood pressure, high cholesterol, diabetes, asthma, osteoporosis, heart attack, stroke and prenatal nutrient deficiency. As with all covered medications, you would need a prescription from your doctor to process the claim under your pharmacy plan (including over the counter medications). Remember, you can use the Prescription Drug Price Quote Tool on myCigna.com for real-time drug pricing specific to your plan. You can also call the number on the back of your ID card 24 hours a day, 365 days a year, for help. Cigna 90Now Program Retail drugs for a 30 day supply may be obtained In-Network at a wide range of pharmacies across the nation. Prescriptions for a 90 day supply will be available at select network pharmacies or Cigna Home Delivery. Cigna 90Now: 30-Day Specialty Medication Supply Limit: You may fill your medications in a 30 or 90 day supply. If you Specialty medications are used to treat rare and chronic choose to fill a 30 day prescription, it can be filled at any network conditions. These medications are costly and are one of the retail pharmacy or Cigna Home Delivery. If you choose to fill a fastest growing components of health care costs. On average, 90 day prescription, it must be filled at a 90 day network retail members fill specialty medications twice a year costing around pharmacy or Cigna Home Delivery to be covered by the plan. $6300 per script. As a member continues through therapy, the need often arises to change the prescription due to side effects or You will enjoy: a new medication may come to market that can more effectively • Easy refills – up to a 90-day supply means fewer refills treat the condition. Many of these medications are then wasted • Reminder service to refill or take your medication available at because the member has to discontinue the old medication for Cigna.com/CoachRx the new. • Cigna's free QuickFill service will call or email you when its Specialty medications are limited to a 30-day supply at retail and time to refill your prescriptions Cigna Home Delivery Pharmacy. • Fast answers from Cigna pharmacists 24/7 at 1-800-285-4812 2021 | EMPLOYEE BENEFITS SUMMARY 11
MEDICAL BENEFITS How to Save Money with Cigna! With healthcare costs continuing to rise, it’s more important than ever to be conscious of how much you are paying for the care you receive. Becoming an educated healthcare consumer is a great way to help you manage your out-of-pocket healthcare expenses. You don’t have to go it alone. Cigna is on your side. Cigna has the tools and support you need to help you find a quality in-network doctor near you, including 24/7 live customer service, plus a host of valuable resources to help you manage and track claims, and compare cost and quality information. Cigna tools are accessible online or on the go, through myCigna.com or with the free myCigna mobile App. Top Seven Tips to Save Money with Cigna 1. Schedule your annual checkup. Preventive care is key to good health and is covered at 100%. Getting your annual checkup can help keep you in shape. Covered services include: • Routine physical examinations • Well baby and child care • Screening mammography • Screening colonoscopy or sigmoidoscopy • Cervical cancer screenings • Prostate cancer screening • Diabetes screenings • Bone and mineral density tests The best way to treat a serious illness is by catching it early or stopping it from happening. During your checkup, your doctor can often detect the early signs of more serious issues. Remember, in order to receive the 100% preventive care benefit, services must be received in accordance with USPTF guidelines under Health Care Reform and your physician must code the claims as preventive. Call Cigna 24/7/365 at 1-866-494-2111 to help find a primary care provider within your area! 2. Find the best providers. The Cigna Care Designation (CCD) is one decision-making tool you can use to choose a doctor. Cigna checks education and board certifications, and they also check to see if the quality of care has earned recognition from within the medical industry. Providers who meet Cigna’s specific quality and cost-efficiency criteria will have the Cigna Care Designation symbol next to their name in the online provider directory tools. Quality recognition ratings are assigned to providers and provider groups indicating the quality criteria met, and stars are used to communicate cost-efficiency performance as compared with their peers of the same specialty type and geographic market. Results in the top category for cost-efficiency assessment will be displayed with three stars. Sample: Online Health Care Professional Directory display (myCigna.com) Quality, cost efficiency and Cigna Care Designation displays Cigna Care Designation Symbol Cost Efficiency Rating 12 EMPLOYEE BENEFITS SUMMARY | 2021
MEDICAL BENEFITS 3. Find the most cost effective Rx. There are three ways to spend less on medicine: • Buy generic. When it comes to generic vs. brand name drugs, the main difference is name and appearance. Generic drugs are manufactured to be just as effective as brand name drugs and they are less expensive. Always check with your doctor or pharmacist to understand your options. • Ask your doctor about getting a three-month supply of your prescription. 90-day prescriptions may be filled using Cigna Home Delivery Pharmacy or your preferred retail pharmacy. You may be able to save money when you switch from a retail pharmacy to Cigna’s Home Delivery Pharmacy. Call Cigna Home Delivery Pharmacy at 1-800-285-4812. • Compare drug costs at different pharmacies. Login to myCigna.com> Select Prescriptions Tab> Select “Price a Medication”> Enter or Select a Drug Name> Enter Form/Dosage, Quantity, Frequency and Duration> Get cost estimates. 4. Stay In-Network. Costs will be lower if you choose to see doctors, hospitals and facilities in Cigna’s network. If you use an out-of-network provider, your costs can add up quickly. You’re going to pay full price and not the discounted price an in-network doctor would charge. Out-of- Network doctors / facilities may balance bill you for the amount that Cigna does not cover. When you are scheduled for surgery, ensure that the surgeon, anesthetist, and facility are all In-Network. How to search for an In-Network Provider: • The provider directory on myCigna.com shows you results based on your health plan network and your location. Log in to myCigna. com> Select Find Care & Costs Tab> Find care and cost estimates in your area by “Primary Care, Doctor by Type, Doctor by Name, Reason for Visit or Locations”> Select “Doctor by Type” and Enter a specialty or type of doctor> For example, type “Primary Care Provider”> Results for In-Network primary care providers near your area will be displayed. • Know before you go. Before you visit any provider or facility, we recommend you call ahead to be sure they are in your plan’s network, as well as confirm their address, office hours, and that they are accepting new patients. Cigna is available 24/7/365! Call anytime day or night for live customer service at 1-866-494-2111. 5. Shop with Cigna for the best outpatient facilities for diagnostic tests. Costs can vary significantly depending on where you receive care. MRIs, CTs and PET scans can cost much less at some facilities. You can save by making a more informed choice about where you get your services. You could save money without giving up quality care. Local facilities offer the same services at a lower cost. • The provider directory on myCigna.com shows you cost of service within your location. Login to myCigna.com> Select Find Care & Costs Tab> Find care and cost estimates in your area by “Primary Care, Doctor by Type, Doctor by Name, Reason for Visit or Locations”> For example, Select “Reason for Visit” and Enter procedure “Shoulder MRI Scan with Dye”> Select Facilities> Results for facility costs near your area will be displayed. • Connect directly with the Cigna Customer Service team. Cigna’s team can find the most cost-effective facility for a service. Cigna will help you compare costs for hundreds of procedures. Call anytime day or night for live customer service at 1-866-494-2111. Freestanding Facility vs Outpatient Hospital Radiology Center Cost Outpatient Hospital Cost MRI: $706 MRI: $1,676 CT Scan: $457 CT Scan: $1,376 Potential Savings: Over $900 National averages of participating facilities; actual costs will vary. The information provid- ed here is intended to be general information on how you can get the most out of your plan and your health care dollars. It is not intended as medical advice. You should consider all relevant factors and consult with your treating doctor when selecting a provider for care. 2021 | EMPLOYEE BENEFITS SUMMARY 13
MEDICAL BENEFITS 6. The value of In-Network labs. One of the biggest contributors to your health care costs may be laboratory expenses. You can save money if you use an In-Network lab instead of an Out-of-Network lab. Cigna’s network includes national labs like LabCorp or Quest as well as regional and local labs. It’s easy to find In-Network labs in your area by using the Cigna directory. These In-Network labs can provide general and specialty laboratory and pathology testing in locations that are convenient and cost-effective. You have a choice when it’s time for lab tests, like blood work. Labs in Cigna’s network give you quality service at a lower cost. When your doctor says you need lab tests, tell your doctor you want to stay In-Network. Even if samples are taken in the doctor’s office, you can ask for them to be sent to an In-Network lab. 7. Access care in the right settings. Deciding whether to see a doctor, go to urgent care, or use another option can be difficult. When you need treatment for common ailments and injuries, you have more choices. Now you can get high-quality, affordable services for a wide variety of routine medical conditions through different types of settings. Cigna Health Information Line: A telephone service staffed by nurses that helps you understand and make informed decisions about health issues you are experiencing, at no extra cost. It can help you choose the right care in the right setting at the right time, whether it’s reviewing home treatment options, following up on a doctor’s appointment, or finding the nearest urgent care center. Just call Cigna at 1-866-494-2111. Lower Cost and Time Greater Your Guide For Where To Go When You Need Medical Care Cigna Virtual Care Convenience Care Clinic Doctor’s Office Urgent Care Center Emergency Room Treat minor medical Treat minor medical The best place to go for For conditions that For immediate conditions. Connect concerns. Staffed by routine or preventive aren't life threatening. treatment of critical with board-certified nurse practitioners and care, to keep track of Staffed by nurses and injuries or illness. Open doctor via video or physician assistants. medications. doctors and usually 24/7. If a situation phone. Located in retail stores have extended hours. seems life-threatening, and pharmacies. call 911 or go to nearest ER. Colds and flu Colds and flu General health issues Fever and flu Sudden numbness, Rashes Rashes or skin conditions Preventative care symptoms weakness Sore throats Sore throats, earaches, Routine checkups Minor cuts, sprains, Uncontrolled bleeding Headaches and sinus pain Immunizations and burns, rashes Seizure or loss of Stomachaches Minor cuts or burns screenings Headaches consciousness Fever Pregnancy testing Lower back pain Shortness of breath Allergies Vaccines Joint pain Chest pain Acne Minor respiratory Head injury/ major UTIs and more symptoms trauma Urinary tract infections Blurry or loss of vision Costs same or less than Costs same or lower May charge copay/ Costs lower than Costs highest. No a visit with primary care than doctor's office. No coinsurance and/or ER. No appointment appointments needed. provider. Appointments appointment needed. deductible. Usually needed. Wait times will Wait times may be typically in an hour or need appointment. vary. long. less. The information provided here is intended to be general information on how you can get the most out of your plan and your health care dollars. It is not intended as medical advice. You should consider all relevant factors and consult with your treating doctor when selecting a provider for care. 14 EMPLOYEE BENEFITS SUMMARY | 2021
DENTAL Cigna Dental Plan Good oral hygiene is part of a healthy lifestyle. D E N TA L S E R V I C E S IN-NETWORK BENEFITS Calendar year Deductible $50 individual $150 family Out-of Network Reimbursement Members billed for charges above the (In-network reimbursement is always paid at the contracted rate) 90% UCR amount Preventive Services • Oral exams, dental cleanings, fluoride and sealants 100% no deductible Basic Services • Fillings, oral surgery - simple extractions, periodontics, root canal therapy, 80% after deductible endodontics, brush biopsy Major Services • Oral surgery, inlays, onlays, crowns, dentures, bridges and implants 50% after deductible Orthodontia • Adults and Dependent Children 50% to $1,500 lifetime maximum Implants 50% after deductible $1,500 lifetime maximum Maximum Annual Benefit (per individual per calendar year) $1,500 It’s About More Than a Pretty Smile Our oral health affects our ability to speak, smell, taste, chew, and swallow. However, oral diseases, which can range from cavities to oral cancer, cause pain and disability for millions of people each year. Visit Your Dentist Regularly Regular preventive visits to your dentist can help protect your health, and we are talking about more than just your mouth. Recent studies have linked gum disease to damage elsewhere in the body. According to the Centers for Disease Control and Prevention, there may be associations between oral infections and diabetes, heart disease, stroke, and preterm, low- weight births. Research is underway to further examine these connections. Plan members can visit a network provider two times a year for a cleaning and the plan pays for 100% of preventive services. You can visit any dentist; however, STAY IN-NETWORK if you want the best value. To find out if your dentist is in-network, visit www.mycigna.com or call 866-494-2111 2021 | EMPLOYEE BENEFITS SUMMARY 15
VISION Vision Plan Taking care of your vision is important to your overall health. VSP members can take care of their vision and have routine eye exams, while saving money on all of their eye care needs. To start using your benefit, visit www.vsp.com or call 1-800-877-7195 to locate a participating provider. Did You Know? Taking care of your vision can also A qualified vision care professional mean early detection for symptoms of: can help treat and manage: • Diabetes • Cataracts • Hypertension • Corneal diseases • High cholesterol • Diabetic retinopathy • Tumors • Eye infections • Thyroid disorders • Glaucoma • Neurological disorders • Macular degeneration Your Coverage with a VSP Provider Benefit Description Copay Frequency WellVision Exam • Focuses on your eyes and overall wellness $10 Every calendar year Prescription Glasses $30 See frame and lenses • $130 allowance for a wide selection of frames Included in • $150 allowance for featured frame brands Frame Prescription Every calendar year • 20% savings on the amount over your allowance Glasses • $70 Walmart®/Costco® frame allowance Included in • Single vision, lined bifocal, and lined trifocal lenses Lenses Prescription Every calendar year • Polycarbonate lenses for dependent children Glasses • Standard progressive lenses $0 • Tints/Photochromic adaptive lenses $0 Lens Enhancements • Premium progressive lenses $80 - $90 Every calendar year • Custom progressive lenses $120 - $160 • Average savings of 35-40% on other lens enhancements Contacts (instead of • $130 allowance for contacts; copay does not apply Up to $60 Every calendar year glasses) • Contact lens exam (fitting and evaluation) • As a VSP member, you can visit your VSP doctor for medical and urgent eyecare. Your VSP doctor can diagnose, treat, and monitor common eye conditions like pink eye, and more Primary Eyecare $20 As needed serious conditions like sudden vision loss, glaucoma, diabetic eye disease, and cataracts. Ask your VSP doctor for details. Glasses and Sunglasses • Extra $20 to spend on featured frame brands. Go to vsp.com/offers for details. • 30% savings on additional glasses and sunglasses, including lens enhancements, from the same VSP provider on the same day as your WellVision Exam. Or get 20% from any VSP provider within 12 months of your last WellVision Exam. Extra Savings Retinal Screening • No more than a $39 copay on routine retinal screening as an enhancement to a WellVision Exam Laser Vision Correction • Average 15% off the regular price or 5% off the promotional price; discounts only available from contracted facilities • After surgery, use your frame allowance (if eligible) for sunglasses from any VSP doctor Your Coverage with Out-of-Network Providers: Get the most out of your benefits and greater savings with a VSP network doctor. Call Member Services for out-of-network plan details. 16 EMPLOYEE BENEFITS SUMMARY | 2021
LIFE AND AD&D Unum Life Insurance and Accidental Death & Dismemberment Employees are automatically enrolled at NO COST in our base group life and AD&D insurance with Unum. Full- time employees are covered for up to three times annual earnings up to a maximum of $550,000. The AD&D benefits are three times your annual salary plus $50,000. Voluntary Life Insurance The Voluntary Life and AD&D Insurance program provides coverage above the amount paid for by the City of Milton. Employees can purchase $10,000 increments up to a maximum of $500,000 (not to exceed 5x annual salary), with a guarantee issue* amount of $100,000. In addition, you can purchase coverage for a spouse in $5,000 increments to a maximum of 100% of the employee amount. Not to exceed $500,000 with a guarantee issue* amount of $25,000. Children are eligible for coverage in $2,000 increments to a maximum of $10,000. *Guarantee Issue is the amount of coverage new hires are guaranteed without answering any medical questions. Why buy Voluntary Life and AD&D coverage? Voluntary Life provides a lump sum cash benefit to surviving dependents to cover immediate costs such as funeral expenses or ongoing living expenses. Life insurance benefits often help survivors adjust to the loss of income related to the death of a wage earner, or provide funds for college or retirement for the survivors. Voluntary Life Employee Coverage Spouse Coverage Child(ren) Coverage Maximum: Voluntary Life Voluntary Life Increments Voluntary Life Increments of $10,000 up to a of $5,000 up to a maximum Increments of $2,000 maximum of $500,000. Not to of 100% of employee amount. up to a maximum of exceed 5x salary. Not to exceed $500,000. $10,000 Increments of: $10,000 $5,000 $2,000 Evidence of Insurability Required Electing an amount over the GI Amount or it you have previously declined coverage Guaranteed Issue Amount $100,000 $25,000 $10,000 Waiver of Premium If it is determined that you are totally disabled, your life insurance benefit will continue without payment of premium, subject to certain conditions. What is Evidence of Insurability? Unum requires EOI in order for new employees to purchase insurance above the guaranteed issue amount, or for any employee who has previously declined coverage. If you or your dependents have medical conditions that make it difficult to purchase life insurance on your own, you should consider applying for life insurance when you are hired. EOI involves completing a medical questionnaire and receiving carrier approval before your insurance takes effect. Dependents are covered up to age 19 or to age 26 if they are full time student. 2021 | EMPLOYEE BENEFITS SUMMARY 17
DISABILITY AND EAP Disability One third of all Americans between the ages of 35 and 65 will become disabled for more than 90 days, according to the American Council of Life Insurers. Short-Term Disability (STD) insurance provides income continuation if you are ever unable to work due to a non-work related accident or illness. Long Term Disability (LTD) insurance provides income continuation for both non-work and work-related accidents or illnesses. The City of Milton pays the full cost of both STD and LTD for full-time employees through Unum. STD STD begins on the 8th day after a qualifying accident or illness. STD lasts for up to 16 weeks and pays a weekly benefit equal to 66.67% of your weekly earnings to a maximum of $1,500 per week. The maximum period of payment is 16 weeks. LTD LTD begins on the 121st day after a qualifying accident or illness and pays a monthly benefit equal to 60% of your monthly income up to $7,500 per month. The maximum benefit period is to age 65 or the Social Security Normal Retirement Age. Employee Assistance Program (EAP) Our EAP is a company-paid benefit that provides confidential counseling services for you and your family members at no cost. The EAP can help you when problems in your life start to interfere with your family, your job, and your peace of mind. Our EAP provider, Families First / fei Behavioral Health, also provides referrals for child and elder care, as well as legal services and financial counseling. Your calls and counseling services are completely confidential. For more information contact Families First/fei Behavioral Health at 1-800-824-4372 or on the web at www.feieap.com. Username: milton 18 EMPLOYEE BENEFITS SUMMARY | 2021
SPECIAL HEALTH PROGRAMS Non-Tobacco User Discount Our non-tobacco user discount remains in effect for this plan year. All employees and your covered dependents MUST complete an affidavit indicating whether or not you use tobacco products. If you and or a covered dependent use tobacco, you will pay the full medical premium contribution. If you DO NOT use tobacco, you will receive a $25 discount per paycheck on your medical plan premiums. Ready to End Your Tobacco Addiction? If you don’t already live tobacco free, we encourage you to do so. If you currently use tobacco, we have included some tobacco cessation resources in this booklet to help you quit. Employees who are tobacco free or becomes tobacco free are rewarded with a discount off the cost of life and medical insurance. In order to support our employees in their goals to end tobacco usage, the City will continue to offer a tobacco cessation reimbursement program. The program reimburses employees tobacco cessation products only. The individual reimbursement limit is $260 per year. Please contact human resources for more information about the program. Health Benefits of Quitting Within 20 minutes: • Your blood pressure and pulse rate drop to normal. Within 24 hours: • Your risk of a sudden heart attack goes down. Within 2 weeks to 3 months: • Your circulation improves. Walking becomes easier. Your lungs work better. Wounds heal more quickly. Resource List Within 1 to 9 months: • You have more energy. Your coughing, nasal congestion, fatigue, and shortness of breath Your Physician improve. Within 1 year: Georgia Tobacco Quitline • Your risk of coronary heart disease is half that of someone still using tobacco. 1-877-270-7867 Within 5 years: www.smokefree.gov • Your chances of developing lung cancer drop by nearly 50% compared to people who smoke one pack a day. Your risk of mouth cancer is half that of a tobacco user. American Lung Association Atlanta Within 10 years: 770-434-5864 • Your risks of cancer goes down. Your risk of stroke and lung cancer are now similar to that of www.lungusa.org someone who never smoked. CDC-Tobacco Information and Prevention Source (TIPS) Finding the Right Tobacco www.cdc.gov/tobacco Cessation Program Kill the Can www.killthecan.org The program that works best for you may be very different from the program that works best for someone else. Talk to your primary care physician. That person is one of your best resources for E-Cigarettes https://e-cigarettes. finding cessation programs designed to meet your total health needs. Your physician can discuss surgeongeneral.gov over-the-counter and prescription medications, and provide a reference as well. 2021 | EMPLOYEE BENEFITS SUMMARY 19
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