BENEFITS GUIDE 2022 January 1-December 31, 2022 - Angleton, TX
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2022 BENEFITS GUIDE January 1—December 31, 2022
Welcome
Your benefits are an important part of your overall
compensation. We are pleased to offer a Inside
comprehensive array of valuable benefits to protect
your health, your family and your way of life. This guide Medical
answers some of the basic questions you may have Dental
about your benefits. Please read it carefully, along with
any supplemental materials you receive. Vision
Health Spending
Eligibility Choose Carefully Account (HSA)
You are eligible for benefits if you work 30 or
more hours per week. You may also enroll
Due to IRS regulations, you cannot
change your elections until the next
Flexible Spending
your eligible family members under certain
plans you choose for yourself. Eligible family
annual Open Enrollment period, unless Account (FSA)
you have a qualified life event during
members include: the year. Following are examples of the
▪ Your legally married spouse most common qualified life events:
Life and AD&D
▪ Your registered domestic partner (RDP) ▪ Marriage or divorce
Contact information
and/or their children, where applicable ▪ Birth or adoption of a child
by state law
▪ Child reaching the maximum
▪ Your children who are your biological age limit
children, stepchildren, adopted children
or children for whom you have legal ▪ Death of a spouse, RDP, or child
custody (age restrictions may apply). ▪ You lose coverage under your
Disabled children age 26 or older who spouse’s/RDP’s plan
meet certain criteria may continue on
your health coverage. ▪ You gain access to state coverage
under Medicaid or CHIP
When Coverage Begins Making Changes
▪ New Hires: You must complete the To make changes to your benefit
enrollment process within 30 days of elections, you must contact Human
your date of hire. If you enroll on time, Resources within 31 days of the
coverage is effective on the first of the qualified life event (including
month following 30 days of service from newborns). Be prepared to show
your date of hire. documentation of the event such as a
marriage license, birth certificate or a
If you fail to enroll on time, you will NOT divorce decree. If changes are not
have benefits coverage (except for city submitted on time, you must wait until
paid benefits). the next Open Enrollment period to
▪ Open Enrollment: Changes made make your election changes.
during Open Enrollment are effective
January 1 - December 31, 2022.
Medical
We are proud to offer you a choice of medical plans that
provide comprehensive medical and prescription drug
coverage. The plans also offer many resources and tools to help
you maintain a healthy lifestyle. Following is a brief description of
each plan.
United Healthcare PPO
This plan gives you the freedom to seek care from the provider of
your choice. However, you will maximize your benefits and
reduce your out-of-pocket costs if you choose a provider who
participates in the network.
▪ The plan pays the full cost of qualified in-network preventive
health care services.
▪ You pay the full cost of non-preventive health care services
until you meet the annual deductible. You may also have to
pay a fixed dollar amount (copay) for certain services.
▪ Once you meet the deductible, you pay a percentage of
certain health care expenses (coinsurance) and the plan
pays the rest.
▪ You can withdraw HSA funds tax-free to pay for current
▪ Once your deductible, copays and coinsurance add up to qualified health care expenses, or save them for the future,
the out-of-pocket maximum, the plan pays the full cost of all also tax-free. Unused funds roll over from year to year and
qualified health care services for the rest of the year. are yours to keep, even if you change medical plans or
leave your employer.
United Healthcare HSA
The High-Deductible Health Plan (HDHP) works similarly to a HSA Contribution Limit 2022
traditional PPO:
Employee Only $3,650
▪ You may see any health care provider and still receive
Family (employee + 1 or more) $7,300
coverage, but will maximize your benefits and lower your out
-of-pocket costs if you see an in-network provider. Catch-up (age 55+) $1,000
▪ The plan pays the full cost of qualified in-network preventive
Important Notes:
health care services.
▪ You must meet certain eligibility requirements to have an
▪ You pay the full cost of non-preventive health care services
HSA: You must a) be at least 18 years old, b) be covered
until you meet the annual deductible. Once you meet the
under a qualified HDHP, c) must not be enrolled in Medicare
deductible, you pay a percentage of your health care
and d) cannot be claimed as a dependent on another
expenses (coinsurance) and the plan pays the rest. person’s tax return. For more information, please refer to
▪ Once your deductible and coinsurance add up to the out-of- IRS Publication 969.
pocket maximum, the plan pays the full cost of all qualified ▪ For a complete list of qualified health care expenses, refer to
health care services for the rest of the year.
IRS Publication 502, visit www.irs.gov/pub/irs-pdf/p502.pdf .
The HSA
▪ Adult children must be claimed as dependents on your tax
The HDHP comes with a type of savings account called a health
return for their medical expenses to qualify for payment or
savings account, or HSA. The HSA lets you set aside pre-tax
reimbursement from your HSA.
dollars to help offset your annual deductible and pay for qualified
health care expenses. ▪ Only those employees participating in the Medical HSA Plan
are eligible to enroll in the Health Spending Account.
Here’s how the HSA works:
▪ You decide if you want to contribute pre-tax funds to the
HSA through automatic payroll deductions.
▪ The City will contribute $1,500 annually to your HSA if you
enroll in the HSA Medical Plan.
▪ Your contributions, in addition to the City’s contributions,
may not exceed the annual IRS limits listed below.
Medical (Cont’d)
United Healthcare United Healthcare
PPO HSA
Key Medical Benefits
In-Network Only Out-of-Network1 In-Network Only Out-of-Network1
Deductible (per calendar year)
Individual / Family $500 / $1,000 $1,000 / $2,000 $2,800 / $5,600 $5,000 / $10,000
Out-of-Pocket Maximum (per calendar year)
Individual / Family $3,500 / $7,000 $6,850 / $13,700 $6,350 / $12,700 $10,000 / $20,000
City Contribution to Your Health Savings Account (HSA) (per calendar year; prorated for new hires/newly eligible)
Individual / Family Not Applicable $1,500
Covered Services
$35 PCP, $0 for Child
Office Visits (physician/specialist) 60%* 80%* 50%*
Dental
We are proud to offer you a United Healthcare Dental Plan. The City of Angleton pays 100% of employee cost. Here is a snapshot of
the coverage offered through the 2022 dental plan.
United Healthcare Dental PPO: This plan offers you the freedom and flexibility to use the dentist of your choice. However, you will
maximize your benefits and reduce your out-of-pocket costs if you choose a dentist who participates in the United Healthcare network.
Following is a high-level overview of the coverage available.
Key Dental Benefits United Healthcare PPO Plan
Deductible (per calendar year)
Individual / Family $50 / $150
Benefit Maximum (per calendar year; Preventive, Basic, and Major Services combined)
Per Individual $1,500
Covered Services
Preventive Services 100%
Basic Services* 80%
Major Services* 50%
Orthodontia (Child up to Age 19 Only) 50%; $1,000 Lifetime Maximum Benefit
*Benefits with an asterisk ( * ) require the deductible be met before the Plan begins to pay.
Note: If you use an out-of-network provider, you will be responsible for any charges above the maximum allowed amount.
Dental Costs Per Deduction Period—26
Employee Only $0
Employee + Spouse $16.45
Employee + Child(ren) $9.90
Employee + Family $28.66Vision
We are proud to offer you the United Healthcare Vision Plan.
The United Healthcare (UHC) Vision Plan gives you the freedom to seek care from the provider of your choice. However, you will maximize
your benefits and reduce your out-of-pocket costs if you choose a provider who participates in the United Healthcare (UHC) network.
Key Vision Benefits In-Network Out-of-Network
Reimbursement
Exam (once every 12 months) $10 Up to $40
Materials Copay
$25 N/A
Lenses (once every 12 months)
Lenses (once every 12 months)
Single Vision Up to $40
Bifocal $25 Materials Copay, then Covered in Full Up to $60
Trifocal Up to $80
Covered up to $130 + 30% discount on
Frames (once every 24 months) Up to $45
amounts over $130
Contact Lenses (once every
12 months; in lieu of glasses)
Medically Necessary Covered in Full Up to $210
Elective Up to $105 Up to $105
Vision Costs Per Deduction Period—26
Employee Only $1.38
Employee + Spouse $3.76
Employee + Child(ren) $4.01
Employee + Family $6.73Flexible Spending Accounts
We provide you with an opportunity to participate in a flexible spending
account (FSA) administered through Flores. FSAs allow you to set aside a
portion of your income, before taxes, to pay for qualified health care expenses.
Because that portion of your income is not taxed, you pay less in federal income,
FSA Rules
Social Security and Medicare taxes.
YOU MUST ENROLL EACH YEAR TO
PARTICIPATE
Health Care FSA
Because FSAs can give you a significant
For 2022, you may contribute up to $2,750 to cover qualified health care tax advantage, they must be administered
expenses incurred by you, your spouse and your children up to age 26.
Some qualified expenses include: according to specific IRS rules:
• Coinsurance • Prescriptions • Eye exams/
eyeglasses Health Care FSA Grace Period: You can
• Copayments • Dental treatment
• Lasik eye surgery incur expenses through March 15 of the
• Deductibles • Orthodontia
following year, but those expenses must
For a complete list of eligible expenses, visit www.irs.gov/pub/irs-pdf/p502.pdf.
be filed by March 31.
Life and AD&D
Benefit Option Guaranteed Issue1
Life/AD&D Insurance
$10,000 increments up to
Life Insurance provides your named beneficiary(ies) with a Employee $150,000
$500,000
benefit in the event of your death.
Accidental Death and Dismemberment (AD&D) Insurance $5,000 increments up to
Spouse $50,000
provides specified benefits to you in the event of a covered $250,000
accidental bodily injury that directly causes dismemberment
(i.e., the loss of a hand, foot, or eye). In the event that your Child(ren) $1,000 increments up to $10,000 $10,000
death occurs due to a covered accident, both the Life and
the AD&D benefit would be payable. Monthly Age Rated Premiums
Employee/Spouse
(Rates Based on Employee/
Basic Life/AD&D (Company-paid) (Rate Per $1,000)
Spouse Age)
This benefit is provided at NO COST to you through Dearborn. Up to 24 $0.082
25-29 $0.082
Benefit Amount $15,000
30-34 $0.082
35-39 $0.116
Voluntary Life/AD&D (Employee Paid) 40-44 $0.175
If you determine you need more than the basic coverage, you may 45-49 $0.246
purchase additional coverage for yourself and your eligible family
members. 50-54 $0.388
55-59 $0.651
Benefit Option Guaranteed Issue1 60-64 $1.008
Spouse $10,000 $10,000 65-69 $1.569
70-74 $2.487
Child(ren) $2,000 $2,000
75 and above $4.391
Cost Per Family $1.165
Child Life Rate Per $1,000 $0.222
1. During your initial eligibility period only, you can receive coverage up to the Guaranteed
Issue amounts without having to provide Evidence of Insurability (EOI, or information about
your health). Coverage amounts that require EOI will not be effective unless approved by
the insurance carrier.Cost of Benefits
Your contributions toward the cost of benefits are automatically deducted from your pay check before taxes. The
amount will depend upon the plan you select and if you choose to cover eligible family members.
Contact Information
Coverage Carrier Phone # Website/Email
Medical United Healthcare (866) 414-1959 www.myuhc.com
Dental United Healthcare (800) 445-9090 www.myuhcdental.com
Vision United Healthcare (800) 638-3120 www.myuhcvision.com
Health Spending Account (HSA) Flores (800) 532-3327 www.flores247.com
Flexible Spending Account (FSA) Flores (800) 532-3327 www.flores247.com
Life/AD&D Dearborn National (800) 721-7987 www.mydearborngroup.com
Questions?
If you have additional
questions,
you may also contact:
HR Team
Colleen Martin
(979) 849-4364, x2132
cmartin@angleton.tx.us
Desiree Valadez
(979) 849-4364, x2117
dvaladez@angleton.tx.us
DISCLAIMER: The material in this benefits brochure is for informational purposes only and is neither an offer of coverage or medical or legal advice. It
contains only a partial description of plan or program benefits and does not constitute a contract. Please refer to the Summary Plan Description (SPD) for
complete plan details. In case of a conflict between your plan documents and this information, the plan documents will always govern. Annual Notices:
ERISA and various other state and federal laws require that employers provide disclosure and annual notices to their plan participants. The company will
distribute all required notices annually.You can also read
