STAY ON TRACK YOUR 2022 M-NCPPC - STAY ON TRACK - Maryland-National ...
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CLICK ON THE NAVIGATION MENU Enrolling in Your Benefits STAY ON Benefits for Active Employees TRACK and Retirees Benefits for Active Employees Only M-NCPPC PROVIDES YOU WITH A COMPREHENSIVE BENEFIT Your Cost for Coverage PACKAGE FOR YOU AND YOUR ELIGIBLE DEPENDENTS. YOUR This guide gives you an overview of your Contacts for More Information 2022 benefit plans. Use this guide to determine M-NCPPC how your benefits can help you stay on BENEFITS track with your health and other aspects of your life throughout the year. Required Benefit Notices Note: The information in this guide is a summary of the benefit plans offered to employees and retirees and their dependents. In the event of any discrepancies between the information in the guide and official plan documents the plan documents supersede.The Commission reserves the right to make changes to its benefits program for all employees, retirees and beneficiaries. Benefits are subject Benefit Enrollment/Change Form to the actual plan terms in effect as of a given time. In the event of a conflict between the terms of any benefit plan and this summary, the terms of the benefit plan will control.
Enrolling in Your Benefits Benefits for Active Employees and Retirees Benefits ENROLLING for Active Employees Only Your IN YOUR Cost for Coverage BENEFITS Contacts for More Information Required Benefit Notices CONTINUED Benefit Enrollment/ Change Form STAY ON TRACK M-NCPPC BENEFIT GUIDE 3
Enrolling in Your Benefits YOUR ELIGIBLE DEPENDENTS ENROLLING INCLUDE YOUR: Benefits IN YOUR BENEFITS for Active Employees • Legal spouse (as recognized under Maryland law) and Retirees • Natural, step, or adopted child under age 26 Benefits ELIGIBILITY for Active • Unmarried child, not in a domestic partnership Employees Only or legal guardianship, age 26 or older who before turning age 26 became totally and permanently Employees are eligible to participate in the plans described in incapacitated due to mental or physical limitations; Your Cost for this guide if classified as one of the following employee types: if they meet certain criteria Coverage • Career FT/PT • Domestic partner (as certified by the Commission) Contacts • Appointed and eligible child(ren) for More Information • P/T Commissioners • Merit Board * Employees • A child for whom you or your covered dependent spouse/partner has permanent (12 months or and retirees • Term Contract longer) legal guardianship before his/her 18th Required may also Benefit birthday (copy of court order required) Notices choose to Retirees are eligible to enroll in the healthcare plans if cover eligible Benefit they were enrolled in health coverage (either through the dependents, Enrollment/ Change * (Dependents of retirees must have been deemed Commission or another source) for the 36 months immediately as applicable. eligible at the time of the retiree’s date of Form retirement. After you retire, new dependents preceding their retirement date and began receiving their are not eligible for coverage. You may not add retirement annuity immediately following active employment. a new spouse, newborn child(ren), or any other dependents who were not enrolled in coverage or CONTINUED deemed eligible at the time of retirement.) STAY ON TRACK M-NCPPC BENEFIT GUIDE 4
Enrolling in Your WHEN AND HOW TO ENROLL Benefits Benefits for Active Employees and Retirees EMPLOYEES RETIREES Benefits When you first become eligible for benefits, you must enroll within 45 days If deemed eligible for healthcare for Active Employees of your date of hire or the date you become eligible for benefits. If you do benefits at the time of retirement Only not enroll within your 45-day enrollment window, you must wait until the next and you elected to receive an open enrollment period to enroll, unless you experience a qualifying life event: immediate pension, retirees Your Cost for marriage, new born, adoption, loss of healthcare coverage, divorce, etc. can enroll as of their date of Coverage retirement or defer enrollment If you have a qualifying life event, you must submit your enrollment and to a future date, including open Contacts for More supporting documents to the Health & Benefits Office no later than 45 days enrollment by providing proof Information following the event. If later, you must wait until the next open enrollment of continuous coverage under a period to make any changes in your benefits. comparable plan(s). Required Benefit Notices Employees have two ways to enroll. Using the online Employee Self Service Retirees enroll in benefits (ESS) platform, during Open Enrollment or completing a benefit enrollment/ by completing the benefit Benefit Enrollment/ change form. For help enrolling using ESS, refer to the ESS User Guide at enrollment/change form- Change Form www.mncppc.org/DocumentCenter/View/15775. included in this guide. LET’S REVIEW YOUR BENEFIT OPTIONS CONTINUED STAY ON TRACK M-NCPPC BENEFIT GUIDE 5
Enrolling in Your LET’S REVIEW YOUR BENEFIT OPTIONS Benefits Benefits for Employees ACTIVE EMPLOYEES AND RETIREES ACTIVE EMPLOYEES ONLY and Retirees BENEFIT PLAN YOUR OPTIONS BENEFIT PLAN YOUR OPTIONS • UnitedHealthcare Choice Plus POS Flexible Spending • Healthcare Flexible Spending Account Benefits for • UnitedHealthcare Select EPO Accounts • Dependent Care Flexible Spending Account Employees Only • UnitedHealthcare Select EPO (Medicare Eligible) • Automatic Basic Life and AD&D 2x base Medical Plan • UnitedHealthcare Medicare Complement (Medicare Eligible) annual salary up to $200,000 (You can opt out at any time) Your • Kaiser Permanente HMO with Prescription Drug Coverage Cost for • Supplemental Life: 1-5x base annual salary, Coverage • Kaiser Permanente Medicare Advantage with Prescription up to $750,000 Drug Coverage (Medicare Eligible) Life and Accidental Death & • Dependent Life: Dismemberment Contacts • CVS Caremark (if you are enrolled in a UHC medical plan) Insurance F Option 1: $10,000 spouse/$5,000 Prescription child(ren) for More Drug • Kaiser Permanente (automatically included when you enroll) Information F Option 2: $20,000 spouse/$10,000 child(ren) • Delta Dental PPO Required Dental Plan F Option 3: $30,000 spouse/$15,000 Benefit • DeltaCare HMO (Delta Dental HMO) child(ren) Notices • EyeMed – Low Option Sick Leave Bank • Employees make annual/sick leave (Enhanced) contribution Benefit Vision Plan • EyeMed – Moderate Option Enrollment/ Change • EyeMed – High Option • Mandatory Basic Long-Term Disability Form Long-Term Disability • Supplemental Long-Term Disability (Base Legal Plan • Legal Resources Salary more than $108,000) CONTINUED STAY ON TRACK M-NCPPC BENEFIT GUIDE 6
Enrolling in Your Benefits Benefits for Active Employees and Retirees MEDICAL PLAN BENEFITS PRESCRIPTION DRUG PLAN DENTAL PLAN VISION PLAN LEGAL PLAN FOR ACTIVE Benefits for Active Employees Only EMPLOYEES Your Cost for Coverage AND RETIREES Contacts for More Information Required Benefit Notices CONTINUED Benefit Enrollment/ Change Form STAY ON TRACK M-NCPPC BENEFIT GUIDE 7
Enrolling in Your Benefits Benefits for Active Employees MEDICAL PLAN and Retirees MEDICAL PLAN STAY ON TRACK PRESCRIPTION DRUG PLAN DENTAL PLAN Did you already have your yearly check-up? VISION PLAN LEGAL PLAN When you have regular check-ups, your doctor can detect health conditions and diseases early. This increases your chance for treatment and cure. Benefits for Active Employees Only Are you up to date on your vaccines and preventive screenings? Use the U.S. Department of Health and Human Services tool, MyHealthfinder at Your https://health.gov/myhealthfinder to obtain a personalized list of vaccines and Cost for Coverage screenings just for you. Contacts If you have not yet had your yearly check-up, schedule it as soon as possible. for More Information Don’t forget to take your personalized list of vaccines and screenings with you and discuss them with your doctor to make sure you stay on track with your health. Required Benefit Notices Remember, your health is your biggest asset, now and all year long. Benefit CONTINUED Enrollment/ Change Form STAY ON TRACK M-NCPPC BENEFIT GUIDE 8
Enrolling in Your DOCUMENTS YOUR MEDICAL Benefits REQUIRED IF Benefits for Active PLAN CHOICES ADDING ELIGIBLE Employees and Retirees DEPENDENTS You can enroll in the following medical plans. MEDICAL PLAN If you are adding dependents to your coverage, PRESCRIPTION DRUG PLAN Eligible dependents can be added as well. you must provide proof of relationship (copies DENTAL PLAN of marriage certificate, birth certificates, VISION PLAN If you are not Medicare Eligible your choices are: adoption papers, etc. and a copy of the Social LEGAL PLAN Security card for each dependent). • UnitedHealthcare (UHC) Select EPO Benefits You can submit these documents: for Active • UnitedHealthcare (UHC) Choice Plus Employees Only • Kaiser Permanente HMO with Prescription Drug Coverage IN-PERSON Health & Benefits Office - 6611 Kenilworth Your Cost for Avenue, Suite 404, Riverdale, MD 20737 Coverage *If you are not an active employee and eligible for Medicare • Call to make an appointment due to age or disability-at any age, your choices are: 301-454-1694 Contacts • Secure Drop Box, in the lobby on the 1st for More • UnitedHealthcare Medicare Complement Floor Information • Kaiser Permanente Medicare Advantage BY U.S. MAIL Required * Active employees who reach age 65 are not required to enroll in Benefit Notices Medicare. As an active employee, the non-Medicare medical plan BY EMAIL remains primary for you and your eligible dependents. To benefits@mncppc.org Encrypt your email when sending personal Benefit documents. If using Outlook, go to www.mncppc. Enrollment/ Change CONTINUED org/DocumentCenter/View/18268 for guidance. Form STAY ON TRACK M-NCPPC BENEFIT GUIDE 9
Enrolling in Your UNITEDHEALTHCARE Benefits Benefits for Active HEARING AID ALLOWANCE Employees and Retirees MEDICAL PLAN PRESCRIPTION DRUG PLAN DENTAL PLAN The Hearing Loss • 48 million Americans VISION PLAN Association of have a significant LEGAL PLAN hearing loss America (HLAA) Benefits Take a FREE hearing for Active provides the • People with hearing Employees test and find out how Only following statistics loss wait an average you can optimize of 7 years before on hearing loss: your savings on Your seeking help. Cost for Coverage hearing aids at www.UHCHearing.com. Adults and children enrolled in the UnitedHealthcare Contacts for More Plans will receive a hearing aid benefit through You can also call Information UnitedHealthcare Hearing. The plan pays 80% and you 1-866-926-6632 pay 20% with a maximum allowance of $3,000 every 36 to set up an Required months. UnitedHealthcare Hearing can save you 50%- Benefit appointment to Notices 80% off standard industry prices. explore your choices. Benefit CONTINUED Enrollment/ Change Form STAY ON TRACK M-NCPPC BENEFIT GUIDE 10
Enrolling in Your VIRTUAL CARE OPTIONS Benefits Benefits 24/7/365 CARE WHENEVER and WHEREVER for Active Employees and Retirees MEDICAL PLAN If your doctor • Your toddler wakes up at 4:00 a.m. with a fever and there is a blizzard PRESCRIPTION DRUG PLAN outside DENTAL PLAN is not in the VISION PLAN office, it is after • While hiking on the trail and you twisted your ankle. Now back at base camp, LEGAL PLAN your ankle is swollen and stiff, but you are nowhere near a healthcare facility Benefits hours, or you for Active Employees are on vacation • You are at the beach and your seasonal allergies start wreaking havoc on Only your fun. Your eyes are itching and so red and puffy that you cannot see the when: sun and waves. Your Cost for Coverage In these situations, how can you get immediate medical care without going to a doctor’s office? In situations such as these and more, you can get help from a doctor using a virtual care option Contacts 24/7/365, including weekends and holidays. Care is available by phone, mobile app, tablet or your for More computer. Virtual Care medical professionals can not only diagnose and treat your condition, but Information also can prescribe medication and call it into a pharmacy.* Your copayment is $00.00 when you use in-network providers. Required Benefit Notices * Go to the nearest Emergency Room if your condition is life-threatening or call 911. Benefit Enrollment/ CONTINUED Change Form STAY ON TRACK M-NCPPC BENEFIT GUIDE 11
Enrolling in Your MAKING A VIRTUAL APPOINTMENT Benefits Benefits for Active Employees and Retirees UnitedHealthcare Members, connect with: MEDICAL PLAN • Your own doctor if they provide this service, or PRESCRIPTION DRUG PLAN • One of UnitedHealthcare’s partner doctors at Optum Virtual DENTAL PLAN Care, Teladoc, Amwell or Doctors on Demand by phone, VISION PLAN LEGAL PLAN mobile or video. Go to www.uhc.com/virtualvisits. Benefits • For behavioral concerns such as stress and anxiety, set up a for Active Employees virtual appointment with a therapist. Follow the instructions Only at www.mncppc.org/DocumentCenter/View/18728. Your Cost for Coverage Kaiser Permanente HMO Members: : Contacts • Make a virtual appointment with a Medical Provider or for More Information Behavioral Health Professional by signing into my.kp.org/ mncppc using a mobile app, computer or tablet or calling 1-800-777-7904 (1-800-700-4901, TTY). For more information Required Benefit go to www.mncppc.org/DocumentCenter/View/18279. Notices Benefit Enrollment/ Change Here are the summaries of the benefits under each medical plan. CONTINUED Form STAY ON TRACK M-NCPPC BENEFIT GUIDE 12
Enrolling in Your HERE ARE THE SUMMARIES Benefits OF THE BENEFITS UNDER EACH MEDICAL PLAN- Benefits for Active If You are Not UNITEDHEALTHCARE UNITEDHEALTHCARE KAISER PERMANENTE HMO WITH Employees and Retirees Eligible for Medicare CHOICE PLUS POS SELECT EPO PRESCRIPTION DRUG COVERAGE IN-NETWORK OUT-OF-NETWORK IN-NETWORK ONLY IN-NETWORK ONLY MEDICAL PLAN $250 individual PRESCRIPTION DRUG PLAN Annual Deductible None $500 2-member None None $600 family DENTAL PLAN $600 individual $1,100 individual $1,100 individual VISION PLAN $1,200 2-member $3,600 family Annual Out-of-Pocket Limit $3,600 family $1,800 family Does not include LEGAL PLAN Includes copays Does include copays; Does not include deductible copays Benefits Preventive Care $0 copay Covered 80% after deductible $0 copay $0 copay for Active Office Visits $10 copay Covered 80% $10 copay $10 copay Employees Only Emergency Room $50 copay, waived if admitted $50 copay, waived if admitted $50 copay, waived if admitted $50 copay, waived if admitted Urgent Care Center $10 copay Covered 80% after deductible $15 copay $15 copay Virtual Visit $0 copay Covered 80% after deductible $0 copay $0 copay Your Cost for Covered 80% after Coverage Inpatient Surgery $0 copay deductible, plus $0 copay $0 copay $100 inpatient deductible $10 copay in office Covered 80% after $0 copay in office Outpatient Surgery $25 copay $0 copay at facility deductible $25 copay at facility Contacts for More Mental Health & Substance Abuse Information Covered 100% Covered 80% after deductibles Covered 100% Covered 100% • Inpatient Mental Health & Substance Abuse $5 copay, group therapy $10 copay Covered 80% after deductibles $10 copay • Out-Patient Services $10 copay, individual therapy Required Out-of the-Country Bona fide emergencies are covered Bona fide emergencies are covered Bona fide emergencies are covered Bona fide emergencies are covered Benefit Notices 80% covered, after deductible, 80% covered every 36 months, up 80% covered every 36 months, up 1 hearing aid every 6 months covered Hearing Aids every 36 months, up to $3,000 to $3,000 maximum to $3,000 maximum up to $1,000 maximum Benefit Enrollment/ Change CONTINUED Form STAY ON TRACK M-NCPPC BENEFIT GUIDE 13
Enrolling in Your Active employees are not required to enroll in Medicare when they reach age 65; your If you are a retiree, when Benefits medical plan remains primary for you and your eligible dependents. you or your eligible COMPARISON OF dependents become Benefits MEDICAL PLANS for Active Medicare eligible due Employees If You are Eligible and Retirees to reaching age 65 or for Medicare due MEDICAL PLAN to Age or Disability UNITEDHEALTHCARE UNITEDHEALTHCARE KAISER PERMANENTE disability at any age you MEDICARE ADVANTAGE MEDICARE SELECT EPO PRESCRIPTION DRUG PLAN at any Age. COMPLEMENT MEDICARE ELIGIBLE WITH PRESCRIPTION must enroll in Medicare DRUG COVERAGE DENTAL PLAN Part A and Part B. None; the plan pays Part A and Part B None; but you must pay Part A VISION PLAN Annual Deductible None deductibles and Part B deductible LEGAL PLAN • Medicare becomes your $1,100 individual $3,400 primary medical plan and Annual Out-of-Pocket Limit N/A $3,600 family Includes copay and Benefits Does not include copays coinsurance your Commission sponsored for Active medical plan becomes Employees Preventive Care Remaining 20% of Medicare approved amount $0 copay $0 copay secondary. Only Office Visits Remaining 20% of Medicare approved amount $10 copay $10 copay Emergency Room $50 copay, waived if Remaining 20% of Medicare approved amount $50 copay, waived if admitted • Provide a copy of your (medical emergency only) admitted Your Medicare card confirming Cost for Urgent Care Center Remaining 20% of Medicare approved amount $15 copay $15 copay Coverage your enrollment to the Virtual Visit Remaining 20% of Medicare approved amount $0 copay $0 copay Health & Benefits Office Inpatient Surgery Covered in full by Medicare $0 copay $0 copay (benefits@mncppc.org or $0 copay in office Fax: 301-454-1687). If you Contacts Outpatient Surgery Remaining 20% of Medicare approved amount $25 copay $25 copay at facility submit your Medicare card by for More Information Mental Health & Substance Abuse email, you are encouraged Remaining 20% of Medicare approved amount Covered 100% Covered 100% • Inpatient to use encryption. If you are $5 copay, group therapy using Outlook, you can refer Mental Health & Substance Abuse to the guide at www.mncppc. Required Remaining 20% of Medicare approved amount $10 copay $10 copay, individual • Out-Patient Services Benefit therapy org/DocumentCenter/ Notices Bona fide emergencies are Bona fide emergencies are View/18268 for assistance to Out-of the-Country Bona fide emergencies are covered covered covered encrypt your email. 80% covered every 36 months, up to $3,000 80% covered every 36 months, 1 hearing aid up to $1,000 Benefit Hearing Aids maximum up to $3,000 maximum per ear every 36 months Enrollment/ CONTINUED Change Form STAY ON TRACK M-NCPPC BENEFIT GUIDE 14
Enrolling in Your Benefits Benefits for Active Employees PRESCRIPTION DRUG PLAN and Retirees MEDICAL PLAN STAY ON 1. Take your medication at the same time every day. PRESCRIPTION DRUG PLAN DENTAL PLAN TRACK 2. Try taking your medications with a daily routine like brushing your teeth or getting ready for bed. Before choosing a mealtime for your VISION PLAN routine, check if your medication should be taken on a full or empty LEGAL PLAN The Federal Drug Administration stomach. (FDA) advises that taking your Benefits 3. Keep a “medicine calendar” with your pill bottles and note each time for Active medication as prescribed-in the you take a dose. Employees Only right dose, at the right time, and 4. Use a pill container. Some types have sections for multiple doses at in the right way is important for different times, such as morning, lunch, evening, and night. Your controlling chronic health conditions Cost for 5. When using a pill container, refill it at the same time each week. For Coverage and your overall long-term health example, every Sunday morning after breakfast. and well-being. If you do not take 6. Purchase timer caps for your pill bottles and set them to go off when Contacts your medication as prescribed, your your next dose is due. Some pill boxes also have timer functions. for More Information health condition could get worse 7. When travelling, be certain to bring enough of your medication, plus a and result in hospitalization. Here few days extra, in case your return is delayed. Required are 8 tips from the FDA to help 8. If you’re flying, keep your medication in your carry-on bag to avoid Benefit Notices you stay on track and take your lost luggage. Temperatures inside the cargo hold could damage your medication as prescribed. medication. Benefit Enrollment/ For more information and resources, read the entire article at https://www.fda.gov/drugs/special- CONTINUED features/why-you-need-take-your-medications-prescribed-or-instructed. Change Form STAY ON TRACK M-NCPPC BENEFIT GUIDE 15
Enrolling STAY ON TRACK WITH YOUR MEDICATIONS in Your Benefits Benefits as prescribed to maintain and improve your health. for Active Employees and Retirees The prescription plan available to you depends on the medical plan you enroll in: MEDICAL PLAN PRESCRIPTION DRUG PLAN If you enroll in a UnitedHealthcare medical plan, you can DENTAL PLAN enroll separately in the CVS Caremark prescription drug plan at VISION PLAN LEGAL PLAN an additional cost. Benefits for Active • If you are not an active employee and are Medicare eligible (enrolled Employees Only in Medicare Part A and Part B) you will be enrolled in the SilverScript Prescription Drug Plan, a Medicare Part D plan approved by the Centers Your for Medicare and Medicare (CMS) that is administered by CVS Caremark. Cost for Coverage If you enroll in a Kaiser Permanente plan, you are covered Contacts automatically in the Kaiser Permanente prescription drug plan for More Information at no extra cost. Required Benefit Each prescription drug plan covers generic, preferred (on the Notices formulary) and non-preferred (not on the formulary) drugs. CVS CONTINUED Benefit Caremark also covers lifestyle drugs that treat such conditions Enrollment/ as baldness, wrinkles, erectile dysfunction and acne. Change Form STAY ON TRACK M-NCPPC BENEFIT GUIDE 16
Enrolling THE PRUDENTRx in Your Benefits USE AUTOMATIC REFILLS Benefits COPAY PROGRAM TO STAY ON TRACK WITH for Active PRESCRIPTIONS Employees and Retirees The PrudentRx Copay Program will be added to the Caremark prescription MEDICAL PLAN drug plan. You will be enrolled if you use a specialty drug. When you fill With Automatic Refills, your prescriptions are refilled PRESCRIPTION DRUG PLAN at a CVS Specialty Pharmacy and are enrolled in the PrudentRx Copay automatically at the right time. You do not have to DENTAL PLAN Program, your copayment will be $0 for specialty medications such as worry about contacting the pharmacy each month VISION PLAN those for Hepatitis C, Autoimmune Conditions, Oncology and Multiple to refill your prescription or call your doctor’s office LEGAL PLAN Sclerosis. If you opt out or do not complete additional steps to enroll you to renew your prescription. When your prescription Benefits for Active will pay 30% of the drug cost. DO NOT OPT OUT! is down to the last refill or is about to expire, the Employees Only pharmacy will contact your doctor to renew. You do • Enrollment in PrudentRx is FREE not have to worry. • Call PrudentRx today at 1-800-578-4403 to make sure they have your member information Your Cost for on file and register for any copay assistance available from drug manufacturers. Coverage • If you are eligible, more information will be mailed to your home from Prudent Rx Use the links below to request Automatic Refills to • Call CVS Specialty Pharmacy at 1-866-387-2573 if you have any questions about your help you stay on track with your prescriptions. Contacts for More specialty drugs. Information • CVS Caremark – Go to www.caremark.com/ Get the PrudentRx facts at manage-prescriptions/refill Required Benefit www.mncppc.org/DocumentCenter/View/18210 Notices • Kaiser Permanente HMO – Register at my.kp.org/ mncppc and go to the Pharmacy Tab to manage You can find the PrudentRx Specialty drug list at Benefit Enrollment/ CONTINUED your prescription services or use the kp.org app. Change www.mncppc.org/DocumentCenter/View/18209 Form STAY ON TRACK M-NCPPC BENEFIT GUIDE 17
Enrolling in Your PRESCRIPTION PLANS SUMMARY Benefits Benefits for Active Here is a summary of your Employees and Retirees Prescription Plans. MEDICAL PLAN CVS CAREMARK PRESCRIPTION PLAN KAISER PERMANENTE PRESCRIPTION PLAN PRESCRIPTION DRUG PLAN DRUG TYPE Participating Retail Pharmacy/Network Mail Order Pharmacy/ CVS Mail Order or CVS Pharmacy Pharmacy Pharmacy Network Pharmacy DENTAL PLAN (up to 90-day supply) (up to 34-day supply)* (up to 30-day supply) (up to 90-day supply) VISION PLAN Generic Drugs $8 copay $16 copay $7/$10 copay $14/$20 copay LEGAL PLAN Preferred Brand Name Drugs $16 copay $32 copay $15/$20 copay $30/$40 copay Benefits Non-Preferred Brand Name Drugs $25 copay $40 copay $30/$35 copay $60/$70 copay for Active Employees $0 copay if enrolled in PrudentRx; otherwise, Only Specialty Drugs N/A N/A N/A you pay 30% of the cost of the drug Lifestyle Drugs 50% copay 50% copay N/A N/A Your *Participating retail pharmacies other than CVS accept the CVS Caremark card to fill short-term medications, up to 34-day supply. Other Participating retail pharmacies include Costco, Giant, Harris Teeter, Cost for Kmart, Sam’s Club, Target, Wal-Mart, Walgreens, and Wegmans. Coverage Use these resources to determine if your drug is on the formulary and how much you will pay out-of-pocket: Contacts for More Information Is your drug on the formulary? CVS Caremark • www.mncppc.org/DocumentCenter/View/216 Required Benefit Kaiser Permanente Notices • Kaiser Permanente HMO - www.mncppc.org/DocumentCenter/View/18267 • Kaiser Permanente Medicare Advantage - www.mncppc.org/DocumentCenter/View/18283 Benefit Enrollment/ Change CONTINUED Form STAY ON TRACK M-NCPPC BENEFIT GUIDE 18
Enrolling in Your Benefits Benefits for Active Employees DENTAL PLAN and Retirees MEDICAL PLAN STAY ON TRACK PRESCRIPTION DRUG PLAN DENTAL PLAN The American Dental Association recommends that you VISION PLAN get a dental exam every 6 months. Dental exams, are LEGAL PLAN important to your overall health. During a dental exam, Benefits your dentist or dental hygienist not only checks your teeth for Active Employees and gums, but also looks for signs and symptoms of other Only health conditions including diabetes, cancer, heart disease, Your osteoporosis and premature birth. Early detection and Cost for follow-up treatment with a doctor or specialist for these Coverage conditions can result in a favorable outcome. Contacts for More For more information on the connection between your oral Information health and your overall health go to www.mncppc.org/ DocumentCenter/View/18197 Required Benefit Notices Smile throughout the year. Get your dental exams. Benefit Enrollment/ CONTINUED Change Form STAY ON TRACK M-NCPPC BENEFIT GUIDE 19
Enrolling in Your DENTAL PLANS Benefits Benefits for Active Employees and Retirees You have two dental plans to choose from: MEDICAL PLAN • DeltaCare USA HMO PRESCRIPTION DRUG PLAN • Delta Dental PPO DENTAL PLAN VISION PLAN LEGAL PLAN The DeltaCare USA HMO features: Delta Dental PPO features: Benefits for Active Employees • Plan does not cover services from providers • Flexibility – You can obtain services from a Only outside of the nationwide DeltaCare provider in the Delta Dental PPO network, Delta network, unless an emergency (up to Dental Premier network, or go out-of-network Your Cost for $100 for emergency dental expenses per to a non-Delta Dental provider. All networks are Coverage emergency) nationwide • You must select a Primary Care dentist or • No need to choose a Primary Care dentist Contacts for More one will be selected for you • No referrals required Information • Primary Care dentist refers you to specialists • Your out-of-pocket costs will be lowest if you see a Required • You pay a preset fee provider in the Delta Dental PPO network, slightly Benefit Notices • No deductibles higher if you see a provider in the Delta Dental Premier network, and highest if you see a non- • No annual dollar maximums Benefit Delta Dental provider. Enrollment/ CONTINUED Change Form STAY ON TRACK M-NCPPC BENEFIT GUIDE 20
Enrolling FEATURES SUMMARY in Your Benefits DELTA DENTAL PPO PLAN MEMBERS Benefits DELTACARE USA for Active Employees HMO DELTA DENTAL PPO Virtual Screenings and and Retirees In-Network In-Network Non-Delta Urgent Care Dental Provider MEDICAL PLAN Annual $50/person $50/person PRESCRIPTION DRUG PLAN None Deductible $150/family $150/family DENTAL PLAN Annual Benefit $2,000/person each $2,000/person each Toothpic offers virtual dental screenings for non- None VISION PLAN Maximum calendar year calendar year urgent/non-emergencies. Use your smartphone to LEGAL PLAN Diagnostic & Preventive upload photos of your teeth, gums or other areas Benefits Services- Exams, Refer to fee of concern and receive a detailed assessment from Covered at 100% Covered at 100%** for Active cleanings, schedule* Employees x-rays and a Delta Dental provider with recommendations Only sealants and next steps within 24 hours. No appointments Basic Services Your – Fillings, root Refer to fee Covered at 80% after Covered at 80%** necessary. To schedule your screening go to https:// canals, gum schedule* deductible after deductible Cost for treatments, oral member.toothpic.com/create-account. Coverage surgery Major Services – Crowns, inlays, Refer to fee Covered at 60% after Covered at 60%** Contacts onlays and cast schedule* deductible after deductible Virtual Consult available for urgent care (pain, for More restorations Information chipped teeth, swollen gums). Schedule a real-time Orthodontics – Adults and Refer to fee Covered at 60% Covered at 60%** video visit with a participating Delta Dental provider. $2,000 lifetime $2,000 lifetime dependent schedule* Required children maximum maximum Go to www.deltadentalvirtualconsult.com. Benefit Notices * View the fee schedule and plan summary at www.mncppc.org/DocumentCenter/View/6355 ** Non-Delta Dental providers can bill you for charges that exceed their reimbursement from Delta Dental. Note: You will be responsible for charges when Toothpic/virtual consults/in-office oral evaluations-combined, exceed 2 visits per Benefit Enrollment/ CONTINUED year. Toothpic fee is fixed at $35/visit. Virtual Consult fees vary. Change Form STAY ON TRACK M-NCPPC BENEFIT GUIDE 21
Enrolling in Your Benefits Benefits for Active Employees VISION PLAN and Retirees MEDICAL PLAN STAY ON TRACK PRESCRIPTION DRUG PLAN DENTAL PLAN Even if you do not wear eyeglasses or contact lenses, the American Optometric VISION PLAN Association advises that those age 18-64 should get a vision exam every two (2) years LEGAL PLAN and those age 65 and older annually. Benefits for Active Employees Your eye doctor not only looks for common conditions that affect your eyesight but Only also those that affect your overall health. Eye doctors may be the first to detect signs Your of conditions such as diabetes, high blood pressure, high cholesterol, skin cancer and Cost for rheumatoid arthritis so you can seek treatment and early intervention. Coverage Some of the common conditions that your eye doctor looks for include dry eyes, Contacts for More glaucoma, cataracts and astigmatism. Use EyeMed’s Eye Condition Simulator, at www. Information eyesiteonwellness.com/eye-diseases/, to see how 12 common eye conditions may be affecting your eyesight and your need to get an eye exam as soon as possible. Required Benefit Notices If you are overdue for an annual vision exam, schedule it as soon as possible. Stay on track with your vision exams. Your vision is Benefit Enrollment/ important- 80% of what we learn is through our eyesight. CONTINUED Change Form STAY ON TRACK M-NCPPC BENEFIT GUIDE 22
Enrolling in Your YOUR VISION PLAN Benefits HERE’S HOW THE EYEMED PLAN OPTIONS COMPARE: Benefits for Active EyeMed Vision Plan’s national network PLAN LOW MODERATE HIGH Employees FEATURE PLAN* PLAN* PLAN* and Retirees provides you with over 100,000 vision care FREQUENCY OF VISION CARE SERVICES MEDICAL PLAN providers to choose from that include both Every Every Every PRESCRIPTION DRUG PLAN independent providers and major retail Exam plan year plan year plan year DENTAL PLAN chains: LensCrafters, Pearle Vision and Target Every other plan Every other plan Every Frame VISION PLAN year year plan year Optical, America’s Best, For Eyes Optical and LEGAL PLAN Every other plan Every Every Lenses more. You can also purchase brand-name year plan year plan year Benefits Every other plan Every Every for Active frames, eyeglasses and contact lenses online Contact Lenses year plan year plan year Employees Only through participating providers: Ray-Ban, IN-NETWORK PROVIDER MEMBER COST* Glasses.com and ContactsDirect. $0 copay; $150 $0 copay; $150 $0 copay; $250 Frames allowance; 20% off allowance; 20% off allowance; 20% off Your balance over $150 balance over $150 balance over $250 Cost for Coverage EyeMed helps pay for routine periodic eye $0 copay; $130 $0 copay; $130 $0 copay: $200 Conventional Contact Lenses allowance; 15% off allowance; 15% off allowance; 15% off exams, eyeglasses and contacts, and related balance over $130 balance over $130 balance over $200 Standard Plastic Lenses –(Single/ Contacts supplies. When you use an in-network Bifocal/Trifocal/Lenticular) $0 copay $0 copay $0 copay for More Information provider you receive discounted services Up to Up to Standard Anti-Reflective Coating $0 copay $45 copay $45 copay and the plan pays a percentage of your cost. Standard Progressive $55 copay $55 copay $0 copay Required There are three vision plan options: low, Up to Up to Standard Tint (Solid/Gradient) $0 copay Benefit $15 copay $15 copay moderate and high. Notices Standard Photochromic/ $75 copay $75 copay $0 copay Transition Benefit CONTINUED Enrollment/ Change * *If you use an out-of-network provider, you will need to pay at time of service and submit a claim for any applicable reimbursements. If the provider charges more than EyeMed’s allowance, you may have to pay the difference. Form STAY ON TRACK M-NCPPC BENEFIT GUIDE 23
Enrolling in Your Benefits Benefits LEGAL PLAN for Active Employees and Retirees LEGAL MEDICAL PLAN RESOURCES PRESCRIPTION DRUG PLAN DENTAL PLAN STAY ON TRACK Legal Resources advises that VISION PLAN You never know when you will need the help of a lawyer- 70% of employees have a LEGAL PLAN traffic accident, divorce, marriage, prenuptial agreement, legal need each year and if Benefits adoption, eviction, landlord disputes, bankruptcy, identity they hire an attorney on their for Active Employees own, the cost could be $300 Only theft, elder care, etc.* or more per hour. Your Experiencing these events, can derail your life, causing you to • If you enroll in Legal Cost for Coverage worry, take time off from work, and affect your physical health Resources you pay $17.00/ as well. With Legal Resources, you have a local law firm on month or $204/year for retainer to help you stay on track with your legal matters so unlimited advice and Contacts for More you can get on with your life. consultation for covered Information services. View a short video to discover what Legal • You must remain in the Required Benefit Resources has to offer to help you stay plan for 12 months before Notices on track with your legal matters at you can cancel coverage https://www.legalresources.com/members/videos. Benefit Enrollment/ CONTINUED Change *Does not cover Commission related lawsuits. Form STAY ON TRACK M-NCPPC BENEFIT GUIDE 24
Enrolling in Your Benefits LEGAL RESOURCES SUMMARY Benefits Here is a summary of the services provided by Legal Resources: for Active Employees CONTINUED and Retirees PLAN FEATURE LEGAL RESOURCES MEDICAL PLAN Who is Covered You, your spouse, and your dependent children up to age 19 or up to age 23, if a full-time student PRESCRIPTION DRUG PLAN Other Family Member Your parents can get 25% discount off legal needs DENTAL PLAN VISION PLAN Legal Consultation Unlimited in-person or telephone advice and consultation for fully covered services LEGAL PLAN Cost of Covered Services Unlimited in-person or telephone advice and consultation for fully covered services Services Benefits Identity Theft Not Covered for Active Civil Actions Under Employees • Prevention and identity recovery assistance • Representation as defendant the Plan: Only • Representation as plaintiff 25% discount Family Law • Insurance matters • Uncontested domestic adoption • Initial administrative hearing Your • Uncontested divorce • Small Claims Court advice Cost for • Uncontested name change Coverage Real Estate Wills and Estate Planning • Purchase, sale, or refinance of primary residence • Will preparation and periodic updates • Tenant-Landlord matters: • Advance medical directive o Eviction Contacts • Financial powers of attorney o Interruption of utilities for More o Habitability Information Traffic Violations • Speeding Consumer Relations and Credit Protection • Reckless driving • Warranty disputes • Driving under the influence (1st Offense/Criminal) Required • Billing disputes For more information on Benefit • Collection agency harassment Preparation and Review of Routine Legal Documents these services go to Notices • Purchase and Sale of Your Home www.LegalResources.com Attorney Assignment You must select one participating firm for all your legal needs Benefit or call l 1-800-728-5768. Enrollment/ Monthly Premium $17.00/month Change Form STAY ON TRACK M-NCPPC BENEFIT GUIDE 25
Enrolling in Your Benefits Benefits for Employees and Retirees Benefits for Employees Only Your Cost for Coverage Contacts for More Information BENEFITS Required Benefit FOR ACTIVE EMPLOYEES ONLY Notices Benefit Enrollment/ Change Form CONTINUED STAY ON TRACK M-NCPPC BENEFIT GUIDE 26
Enrolling in Your Benefits FSA DEADLINES Benefits for FSA FLEXIBLE STAY ON TRACK SPENDING Employees and Retirees Stay on track with your FSA deadlines to ACCOUNTS ensure that you use your funds and file your Benefits for Employees claims before the deadlines. Don’t lose your Only FSA funds, use them. FLEXIBLE SPENDING ACCOUNTS STAY ON TRACK LIFE AND AD&D INSURANCE SICK LEAVE BANK Flexible Spending Accounts (FSAs) allow you to set Incur Eligible File Forfeiture PLAN YEAR Expenses Claims (Loss) aside money from your paycheck, before taxes, to pay Includes LONG-TERM DISABILITY on or no later of Unused Grace Period eligible out-of-pocket expenses incurred by you and your before ……... than ……... Funds Your Cost for dependents. You can also use a debit card for immediate January 1, 2021 – Coverage access to your funds. With a debit card you do not need December 31, 2022 12-month to pay for the eligible expense up front and file a claim 12/31/2022 1/31/2023 2/1/2023 grace period Contacts per relaxation for More for reimbursement. You have the option of enrolling in of IRS rules Information the Healthcare FSA or the Dependent Care FSA. January 1, 2022 – March 15, 2023 Required When you enroll in an FSA you have to keep track of the 3/15/2023 3/31/2023 4/1/2023 Benefit 2.5-month Notices deadlines. If you miss these deadlines, you could lose grace period some or all of your funds at the end of the year; you will Benefit Enrollment/ not be reimbursed. CONTINUED Change Form STAY ON TRACK M-NCPPC BENEFIT GUIDE 27
Enrolling in Your FLEXIBLE SPENDING Benefits There are two Flexible Spending Accounts that you can participate in: Benefits for Employees and Retirees ACCOUNTS HEALTHCARE FSA | DEPENDENT CARE FSA Benefits for HEALTHCARE FSA DEPENDENT CARE FSA Employees Only The Health Care FSA can be used to reimburse If you have dependents, you may have to pay a caregiver to look after eligible expenses that are not covered under your them while you work or attend school. Eligible dependents can be FLEXIBLE SPENDING ACCOUNTS medical, dental, or vision plan. NEW: For 2022, children under age 13 or adults that are elderly or disabled and rely on LIFE AND AD&D INSURANCE you can set aside up to $2,750 and expenses are you for support. For 2022, you can set aside up to $5,000 if married SICK LEAVE BANK reimbursed as you receive the services. and filing jointly or single as head of household or $2,500 if married LONG-TERM DISABILITY and filing separately. Expenses are reimbursed to you when you have Eligible expenses are set by the IRS and include: adequate funds in your account. Your Cost for • Deductibles (for medical, dental and vision) Coverage Examples of eligible dependent care expenses include: • Copayments • Child or adult daycare center fees Contacts • Coinsurance for More • Before-school/afterschool care Information • Hearing Aids (not including tuition expenses) • Orthodontia For a list of eligible For a list of eligible • Day Camp Required expenses, visit expenses, visit Benefit • Chiropractor costs, • Nursery School Notices www.benstrat.com. www.benstrat.com. and more • and more Benefit Enrollment/ CONTINUED Change Form STAY ON TRACK M-NCPPC BENEFIT GUIDE 28
Enrolling in Your Benefits Benefits for THE FSA TAX ADVANTAGE Employees When you participate in the FSAs, you can reduce your and Retirees taxable income and increase your spendable income. Benefits for In the illustration below, you could increase your Employees Only spendable income by $1,417.38/year FLEXIBLE SPENDING ACCOUNTS FSA ELECTIONS WITHOUT WITH LIFE AND AD&D INSURANCE DO NOT ROLL FSA FSA SICK LEAVE BANK OVER TO THE NEXT Gross Annual Salary $45,000 $45,000 LONG-TERM DISABILITY CALENDAR YEAR Healthcare FSA Contribution $0 $2,750 Your Cost for Dependent Care FSA Contribution $0 $3,000 Coverage Unlike other benefits, you Total FSA Contributions $0 $5,750 Contacts must enroll in the for More Information Healthcare FSA and Tax Savings on Total FSA Contribution $0 $1,417.38 Dependent Care State (5% x $5,750) $287.50 Required FSA annually during Benefit Federal (12% x $5,750) $690.00 Notices Open Enrollment. Social Security (7.65% x $5,750) $439.88 Benefit Enrollment/ Change CONTINUED Form STAY ON TRACK M-NCPPC BENEFIT GUIDE 29
Enrolling in Your Benefits Benefits for LIFE AND AD&D FOP members receive INSURANCE Employees and Retirees FREE $50,000 AUTOMATIC BASIC AD&D coverage Benefits for LIFE INSURANCE Employees Only STAY ON TRACK (You may opt-out at any time.) FLEXIBLE SPENDING ACCOUNTS Life happens. You get married, divorced, have children, Click here for the Opt-Out form www.mncppc.org/ LIFE AND AD&D INSURAANCE get an increase in your pay, etc. These are times when you DocumentCenter/View/18507. SICK LEAVE BANK should reevaluate your life insurance coverage. Do you have LONG-TERM DISABILITY enough life insurance coverage at this stage in your life? The Basic plan coverage is 2 times your base annual salary up to a maximum of $200,000. You pay 20% Your Cost for of the premium. In addition to the Basic Coverage, Coverage To determine how much life insurance you need at this stage in your life and the cost, use Securian’s Life you automatically receive Accidental Death & Insurance Needs Calculator at: Dismemberment coverage at 2 times your base annual Contacts for More salary up to a maximum of $200,000. The maximum Information https://www.securian.com/insights-tools/life-insurance- deduction from your pay check ($200,000 coverage) will needs-calculator.html be $2.14 bi-weekly. AD&D insurance provides payment Required Benefit to you if you lose a limb and to your beneficiaries if you Notices Revisit your life insurance on a regular basis to make die in an accident. sure your coverage stays on track with your needs while Benefit Enrollment/ providing financial security for you and your family. CONTINUED Change Form STAY ON TRACK M-NCPPC BENEFIT GUIDE 30
Enrolling in Your Benefits You also have the option of purchasing supplemental life insurance for yourself Benefits for and coverage for your spouse/dependents. You pay 100% of the premium. Employees and Retirees Benefits for Employees SUPPLEMENTAL SPOUSE/DEPENDENT LIFE INSURANCE Only LIFE INSURANCE You may purchase life insurance for your spouse/dependent(s). There are three options. FLEXIBLE SPENDING ACCOUNTS You may purchase one to five If you want to apply LIFE AND AD&D INSURAANCE times your annual base pay, up to OPTION 1 for Supplemental or SICK LEAVE BANK Spouse/Dependent a $750,000. You are guaranteed $10,000 spouse/$5,000 child(ren) coverage, contact the LONG-TERM DISABILITY coverage up to 3 x base annual OPTION 2 Health & Benefits Office Your salary not to exceed $300,000, $20,000 spouse/$10,000 child(ren) • benefits@mncppc.org Cost for without Evidence of Insurability, OPTION 3 • 301-454-1694 Coverage if you enroll within 45 days of $30,000 spouse/$15,000 child(ren) eligibility. Coverage in excess of that (Your spouse must provide Evidence of Insurability) Contacts for More guaranteed coverage ($300,000) or Information Use Securian’s online benefits decision tool, Benefit Scout™ to learn more about 4 x or 5 x base annual salary requires your life insurance options and to determine your cost for basic, supplemental Evidence of Insurability. and spouse/dependent life insurance. Visit www.LifeBenefits.com/MNCPPC. Required Benefit Notices IMPORTANT THINGS • All Life Insurance is term-Life Insurance. There is no cash or surrender value. TO KNOW ABOUT YOUR • If you leave the Commission, you may port or convert all or part of your coverage to an individual CONTINUED Benefit Enrollment/ GROUP LIFE INSURANCE life insurance policy. Premiums may be higher than those paid as an active employee. Change Form STAY ON TRACK M-NCPPC BENEFIT GUIDE 31
Enrolling in Your Benefits THE SICK LEAVE BANK Benefits for SICK LEAVE ENHANCEMENTS BANK Employees *The Sick Leave Bank has been and Retirees enhanced as follows: Benefits for Employees Only STAY ON TRACK YOU HAVE TWO • No waiting periods before or after enrollment • When first becoming benefit eligible, you now have 60 days CHANCES The Sick Leave Bank is a voluntary short-term, income- instead of 45 days to enroll FLEXIBLE SPENDING ACCOUNTS TO ENROLL replacement disability program that enables members • You do not have to exhaust all accrued leave; you may retain IN THE SICK LIFE AND AD&D INSURAANCE LEAVE BANK. up to 80 hours of annual leave who exhaust their accrued leave to access a source of SICK LEAVE BANK • Parental leave for birth, adoptions and foster care up to 12 paid leave when they unable to work for an extended 1. Within 60 weeks. Applies to men and women LONG-TERM DISABILITY period of time and need it most; in the event of their days of hire • Leave to care for a family member who is ill has been own serious illness (including pregnancy), the illness or eligibility extended from 2 weeks to 4 weeks Your Cost for • If you are caring for a child, the age of the child has been Coverage of a family member or parental responsibilities. 2. Open increased from age 19 to age 25 Participants may be required to donate up to 8 hours Enrollment • And more ……………………… of their sick/annual leave each year. Contacts for More Information For the complete details of the enhanced Sick Leave Bank Program, When you participate in the Sick Leave Bank you can view the policy at www.mncppc.org/DocumentCenter/View/222. count on a source of income-replacement to help you Required Benefit stay on track with your financial obligations while you Notices CONTINUED are unable to work. Benefit Enrollment/ Change If you continue to be disabled and are unable to work for 120 days, you may apply for benefits under the Long-Term Disability Plan. Form STAY ON TRACK M-NCPPC BENEFIT GUIDE 32
Enrolling in Your Benefits Benefits for LONG-TERM LONG-TERM DISABILITY (LTD) DISABILITY You are automatically enrolled in the Basic Long-Term Employees and Retirees Disability plan. You pay a portion of the premium. If you become disabled more than 120 days, your LTD plan STAY ON TRACK Benefits for pays 66 2/3% of your basic monthly earnings up to a Employees maximum of $6,000 per month. (Note: Park Police may Only have different benefit levels; refer to your collective If you are unable to work for a period FLEXIBLE SPENDING ACCOUNTS bargaining agreement.) exceeding 120 days, how will you pay LIFE AND AD&D INSURAANCE your bills and support your family? Not SICK LEAVE BANK to worry. The Commission helps you SUPPLEMENTAL LONG-TERM LONG-TERM DISABILITY stay on track with your living expenses DISABILITY by providing you with a basic Long-Term If you earn more than $108,000 annually, you may enroll Your Cost for in the Supplemental Long-Term Disability Plan. Coverage Coverage Disability plan. provides you with 66 2/3% of your base salary between $108,000 to $216,000. This benefit is in addition to any This plan provides you with partial Contacts benefit received under the basic LTD plan. The maximum for More income replacement if you are unable to Information benefit for supplemental coverage is $6,000 per month. work due to a non-occupational injury or You pay 100% of the premium. illness. You can also pay for supplemental Required Benefit long-term disability coverage if your base You can enroll in the Supplemental LTD plan when you first Notices salary exceeds $108,000/year. become eligible or during Open Enrollment each Fall. If Benefit you enroll more than 45 days after your initial eligibility Enrollment/ CONTINUED period, you must provide Evidence of Insurability. Change Form STAY ON TRACK M-NCPPC BENEFIT GUIDE 33
Enrolling in Your Benefits Benefits for Employees and Retirees Benefits for Employees Only Your Cost for Coverage YOUR Contacts for More Information COST FOR Required Benefit Notices COVERAGE Benefit Enrollment/ CONTINUED Change Form STAY ON TRACK M-NCPPC BENEFIT GUIDE 34
Enrolling in Your Benefits Benefits for YOUR RATES COST FOR Employees and Retirees Benefits for Employees Only COVERAGE RATES FRATERNAL ORDER OF POLICE (FOP) This guide provides you with details about Your your benefit plans to assist you in making Cost for Coverage your elections for 2022. While the details of each plan are important, you also need RATES CONTRACT EMPLOYEES Contacts to consider the cost to ensure that your for More Information elections not only fit the needs of you and your family, but also your budget. Click on Required the link to view the 2022 premium rates for Benefit the medical, prescription, dental, vision and RATES MCGEO, NON-UNION REPRESENTED EMPLOYEES Notices group prepaid legal plans. Benefit Enrollment/ Change Employees will also find the premium rates Form for the long-term disability, basic life and accidental death and dismemberment plans. RATES RETIREE AND SURVIVORS MONTHLY CONTINUED STAY ON TRACK M-NCPPC BENEFIT GUIDE 35
Enrolling in Your Benefits Benefits for Employees and Retirees Benefits for Employees Only Your Cost for Coverage CONTACTS Contacts for More Information FOR MORE Required Benefit Notices INFORMATION Benefit Enrollment/ CONTINUED Change Form STAY ON TRACK M-NCPPC BENEFIT GUIDE 36
Enrolling in Your Benefits If you have questions about the benefits described in this guide, you can Benefits for Employees CONTACTS contact the Health & Benefits Office at benefits@mncppc.org or 301-454-1694. You may also contact the benefit providers as listed below. and Retirees BENEFITS PROVIDER PHONE NUMBER WEBSITE MEDICAL Benefits for Employees UnitedHealthcare (All Plans) 1-800-603-4190 (M-F, 8 a.m. to 8 p.m.) www.myuhc.com Only Kaiser Permanente HMO with Prescription Drug Coverage 1-800-777-7902 (24 hours a day/7 days a week) my.kp.org/mncppc/ PRESCRIPTION DRUG Your Cost for -CVS Caremark 1-800-421-5501, 1-800-231-4403 (TTD) www.caremark.com Coverage -SilverScript (Medicare Eligible) 1-800-270-3759, 771 (TTD) DENTAL 1-800-422-4234 DeltaCare HMO) Contacts DeltaCare USA HMO and Delta Dental PPO 1-800-932-0783 (Delta Dental PPO) www.deltadentalins.com for More (Monday-Friday, 8:00 a.m. to 9:00 p.m.) Information VISION 1-866-800-5457 Required EyeMed Vision (Monday-Friday, 7:30 a.m. to 11:00 p.m.) www.eyemed.com Benefit (Saturday-Sunday, 11:00 a.m. to 8:00 p.m.) Notices FLEXIBLE SPENDING ACCOUNTS 1-888-401-FLEX Benefit Benefit Strategies (Monday-Thursday, 8:00 a.m. to 6:00 p.m.) www.benstrat.com Enrollment/ (Friday 8:00 a.m. to 5:00 p.m.) Change Form LIFE AND AD&D INSURANCE 1-866-293-6047 Securian Financial www.LifeBenefits.com (Monday-Friday, 6:00 a.m. to 5:00 p.m.) LEGAL PLAN 1-800-728-5768 Legal Resources www.legalresources.com (Monday-Friday, 8:30 a.m. to 5:30 p.m.) STAY ON TRACK M-NCPPC BENEFIT GUIDE 37
Enrolling in Your Benefits Benefits for Employees and Retirees Benefits for Employees Only Your Cost for Coverage Contacts for More Information REQUIRED Required Benefit Notices BENEFIT NOTICES Benefit Enrollment/ Change Form CONTINUED STAY ON TRACK M-NCPPC BENEFIT GUIDE 38
Enrolling in Your Benefits enrollment within 30 days after you or your dependents’ In addition, continuation of coverage may be available to your REQUIRED other coverage ends (or after the employer stops contributing eligible dependents if: toward the other coverage); • You die Benefits for • If you or your dependents lose Medicaid or Children’s Health BENEFIT Employees Insurance Program (“CHIP”) coverage as a result of a loss • You and your spouse divorce or separate and Retirees of eligibility for such coverage. However, you must request enrollment within 60 days after the loss of such coverage; or • A covered child ceases to be an eligible dependent NOTICES • If you or your dependents become eligible for a premium • You become entitled to Medicare Benefits for assistance subsidy under Medicaid or CHIP. However, you To apply for COBRA coverage, you or a dependent must contact Employees must request enrollment within 60 days after you or your the Health & Benefits Office at 301-454-1694 within 60 days Only dependents become eligible for such assistance. HEALTH INSURANCE PORTABILITY AND of a qualifying life event. You and/or your dependents must pay the full cost of COBRA coverage, i.e., 100% of the monthly ACCOUNTABILITY ACT (HIPAA) In addition, if you have a new dependent as a result of marriage, premium plus 2% for administrative costs. Your birth, adoption or placement for adoption, you may be able to An Important Notice About Your Privacy Cost for Under the law, COBRA must be offered to eligible individuals at enroll yourself and your dependents. However, you must request Coverage group rates. These rates are subject to change annually, based The Health Insurance Portability and Accountability Act of 1996 enrollment within 30 days after the marriage, birth, adoption or placement for adoption. on plan experience. (HIPAA) requires that health plans protect the confidentiality of your private health information. The Plan uses health information about you and your covered dependents only for the purposes To request special enrollment or obtain more information, WOMEN’S HEALTH AND CANCER RIGHTS Contacts for More of providing treatment, paying claims, and related functions. To contact the Health & Benefits Office at 301-454-1694 ACT OF 1998 Information protect the privacy of health information, access to your health information is limited to such purposes. In addition, effective COBRA - CONTINUING COVERAGE FOR This law requires group health plans that provide coverage for April 14, 2003, the Plan complies with the applicable health HEALTH BENEFITS medically necessary mastectomies to also provide coverage for: information privacy requirements of federal regulations issued Required by the Department of Health and Human Services. The Plan’s Under certain circumstances, you and your enrolled dependents • Reconstruction of the breast on which the mastectomy has Benefit privacy policies are described in more detail in the Plan’s privacy been performed; have the right to continue coverage under the medical and Notices notice. You may contact the Commission’s Health & Benefits dental plans, as well as the health care flex account, beyond the • Surgery and reconstruction of the other breast to provide a Office if you would like to receive a copy of the HIPAA notice. time that coverage would have ordinarily ended. You may elect symmetrical appearance; and continuation of coverage for yourself and your dependents if Benefit HIPAA Special Enrollment you lose coverage under the plan due to one of the following • Prostheses and the treatment of physical complications during Enrollment/ qualifying events: all stages of the mastectomy. Change If you are declining enrollment for yourself or your dependents Form (including your spouse) because of other health insurance or • Termination (for reasons other than gross conduct) The Commission’s plans cover mastectomies and the benefits group health plan coverage, you may be able to enroll yourself required by this act. If you would like more information on WHCRA and your dependents in this plan in the following circumstances: • Reduction in employment hours benefits, call the Health & Benefits Office at 301-454-1694. • Retirement • If you or your dependents lose eligibility for that other coverage (or if the employer stops contributing towards you or your • You become entitled to Medicare CONTINUED dependents’ other coverage). However, you must request STAY ON TRACK M-NCPPC BENEFIT GUIDE 39
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