EMPLOYEE BENEFIT GUIDE - Your 2016 Plan Year: January 1, 2018 - December 31, 2018 - Teton County
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Important Benefit Information Enclosed
YOUR 2018
Your 2016
EMPLOYEE BENEFIT GUIDE
Plan Year: January 1, 2018 – December 31, 2018
Table of Contents
Table of Contents 1
Eligibility & Enrollment 2
Health Insurance 3
Health Savings Account (HSA) 4
Wellness Program 5
Incentive Reimbursement Program 6
Zest Health - Concierge Service & Telemedicine 7-8
Vision & Dental 9
Dependent Care Flexible Spending Account (DCFSA) & Health Reimbursement Account 10
(HRA)
Basic Life and AD&D 11
Supplemental Life and AD&D 12
Long Term Disability 13
Employee Assistance Program (EAP) 14
Voluntary Benefits 15
Pension and Deferred Compensation Plans 16-17
Vacation, Sick & Holiday Leave 18
Teton County Employee Programs 19
Important Notices 20-21
Questions & Contact Info 22
Teton County is pleased to offer you a selection of comprehensive, high quality employee benefits for
eligible employees and their dependents. Based on your personal needs, you have the choice of several
benefits to cover you and your family. Enclosed you will find a brief description of the options available, a
comparison of basic plan coverage and cost information.
We encourage you to read the entire enrollment guide before you enroll.
This is a summary of your County provided benefits only. Certain restrictions and exclusions apply. For
exact terms and conditions, please refer to your summary plan description. If information in this summary
differs from the legal contract, the legal contract is the ruling document. SPD’s are available from your
Human Resources Department.
1
Eligibility & Enrollment
Teton County strives to provide a balanced, comprehensive benefits program for their employees.
The Teton County Employee Benefits program offers you core benefits, such as Medical, Dental,
Vision and Life insurance as well as voluntary & supplemental benefits that help maximize your
coverage options.
This booklet is designed to help you understand the coverages, premiums and options for this year.
This is a reference for you and your family to make informed insurance decisions based on your
specific needs. If you have questions please contact your Human Resources Department.
Changes for 2018
New Concierge Service – Zest & Telemedicine additional details on pages 7-8 of this brochure
When Coverage Begins
• Employees – 1st day of the month following date of hire. Must work 30 hours per week.
• Elected Officials – 1st day of official service
If you terminate employment or move to part-time status your coverage will terminate on the last
day of the month that the change/termination occurs.
Please note: It is important that you enroll in a timely manner. If you do not enroll within your first
31 days of employment then you will not be eligible to enroll without a qualifying life event change
until the next open enrollment period. Open enrollment is Nov 1 – Dec 15 each year for benefits
beginning on January 1.
Retirees - If your employment with Teton County terminates solely due to retirement you can
continue coverage under the plan as a retiree if you:
• Are covered under the plan on the last day of full-time employment.
• Are at least 55 years of age on retirement date.
• Have completed a minimum of nine (9) years consecutive years of full -time service with
Teton County. Employees that worked 9 years are eligible for 5 years of coverage or until
age 65. Employees that worked more than 9 years are eligible for one additional year for
each 2 years over 9 you were employed.
• Pay a monthly contribution to the plan.
Life Event Changes
The following events allow you to change your benefits outside the open enrollment period:
• You get married, divorced, or legally separated
• You add a dependent child through birth, adoption, or change in custody
• Your spouse or a dependent passes away
• Your dependent loses coverage or gains other coverage
• Your spouse loses or qualifies for coverage through his or her employer
If you have a change in status, you must notify Human Resources to complete the necessary change
forms within 31 days of the change. You will need to present documentation, such as a birth,
marriage, or death certificate, or divorce decree.
2
Health Insurance
Benefits In-Network
Annual Deductible
Single $2,400
Family $4,800
Out-of-Pocket Maximum
Single $3,400
Family $6,800
Preventative Care Covered 100%
Office Visits 20% AD
Emergency Room 20% AD
Urgent Care 20% AD
Inpatient Hospital 20% AD
(pre-certification required)
Outpatient Hospital 20% AD
Prescriptions - Retail Order (30 day supply)
Tier 1 (Generic) 20% AD
Tier 2 (Preferred Name Brand) 20% AD**
Tier 3 (Non-Preferred Name Brand) 20% AD**
Tier 4 (Specialty Drug) 20% AD
Prescriptions – Mail Order (90 day supply)
Tier 1 20% AD
Tier 2 20% AD
Tier 3 20% AD
AD = After Deductible
** = Coverage for name brand drugs is only allowed when there is no generic available
Copayments, Coinsurance, Deductibles & Prescription Drug cost shares go towards the Out-of-
Pocket Maximums
To locate coverage
Allegiance Tools and Resources details, claims or for
Look up Claims Status
additional tools and
See your Explanation of Benefit (EOB)
resources from
Review your Summary Plan Document
Allegiance call 1-800-877-
Locate Claims Forms
1122 or log on to:
Link to PPACA Covered Preventive Care List
www.askallegiance.com
www.uspreventiveservicestaskforce.org
To locate an in-network provider near you visit the network websites at
www.1choice.com or www.mycigna.com
This is a summary of benefits. Refer to your plan document for more details. 3
Health Savings Account (HSA)
What is a Health Savings Account (HSA)?
An HSA is a type of bank account that you may set up and use to pay for eligible health care expenses
with pre-tax payroll deductions. Employees are only eligible to enroll and contribute into an HSA
account if the Qualified High Deductible Health Plan is elected. You may access funds via a debit card
(if provided) or you will need to use a check to pay claims. Some accounts may qualify for interest. For
more details please refer to your bank.
To qualify for an HSA you:
•Must be enrolled in a qualified High Deductible Health Plan (QHDHP)
•Must not be covered by any other medical plan that is not an QHDHP (such as a spouse’s plan
including the spouse’s FSA unless it is a limited purpose FSA)
•Must not be entitled to benefits under Medicare
•Must not have received VA benefits in the last 3 months
The contributions from all sources may not exceed the annual maximum allowed or it will be subject
to income tax. The maximum allowed annual contributions for 2018 are;
• Single: $3,450
• Family: $6,900
If you are 55 and older you are allowed to contribute an additional $1000 each year.
Teton County contributes the following amounts to your HSA account:
• Single - $1,200 ($100 per month)
• Family - $2,400 ($200 per month)
Examples of Qualified Expenses: Examples of Non-Qualified Expenses:
• Acupuncture • Dental Care • Cosmetic Surgery
• Alcohol and Drug Rehab • Diabetic Supplies • Diapers
• Birth Control Medication • Eye exam and hardware • Exercise Equipment
• Blood Pressure Monitoring Devices • Hearing Aids • Hygiene Products
• Chiropractor • Home Healthcare • Teeth Whitening
• Contact Lenses • Medical Supplies • Health Club Dues
• Prescriptions • Orthodontia • Nutritional Supplements
For a comprehensive list of qualified expenses visit:
http://www.hsacenter.com/what-is-an-hsa/qualified-medical-expenses/
Your HSA account is governed by the IRS. Amounts used for non-qualified healthcare expenses are
subject to income tax and a 20% penalty.
This is a brief summary of your benefit . Please refer to plan summary for more details.
4
Wellness Program
St. Johns Medical Center
Wellness Blood Screenings
Appointments must be made by calling 307-739-7531, SJMC Blood Lab
Offered Year-Round
Program offers deeply discounted prices
Employees and their covered dependents will be required to pay the cost at the time of service
and submit a claim form for reimbursement to Allegiance
Vitamin D testing is not a covered service under Teton County’s Wellness Benefit
Adults age 18 and older are eligible for the discounted pricing 1x during a 12 month period
Results will be mailed to the patient and the patient’s physician upon request
Interpretations will be offered during the annual Community Health Fair
Covered Services (must be received from St. John’s Medical Center):
$35.00 - Blood Chemistry Profile: Screening for glucose, heart, liver, kidney
and thyroid function – Fasting required.
$10.00 – Hemogram: Complete blood count of red and white blood cells and
platelets; screens for anemia & leukemia.
$10.00 - HgbA1c: Measures blood sugar and control for the prior three months for
diabetics and those with a family history.
$20.00 – PSA Testing: Prostate screening for men.
N/A - Vitamin D-25 Hydroxy: Screening is not covered under the county’s
insurance plan. You will have to pay those fees independently.
This is a brief summary of your benefit . Please refer to plan summary for more details.
5
Incentive Reimbursement Program
Teton County Taxable Reimbursement Program Out-Patient In-Patient
SJMC: All outpatient surgical procedures (invasive
procedure to repair or replace a body part) greater than $250 -
$2,500 for the facility billed charges
Out-of-Area/Cigna: All outpatient procedures for facility
billed charges of $5,000 and greater for out of Wyoming
Hospitals and for any inpatient overnight stay per year per $500 $2,000
employee and/or dependent for a Hospital outside of
Wyoming
* No employee will receive greater than $500 for either themselves or their dependents in a
calendar year for outpatient services, and no more than $2,000 for themselves or their
dependents in a calendar year for inpatient services. Qualified employees must maintain
employment and be considered an active, full time employee receiving a paycheck at time of
disbursement.
Teton County is a self-funded plan and as such, has hired a third party
administrator (TPA), Allegiance to administer the medical and vision plan.
Please Note:
This program is Voluntary
Benefits are paid After-Tax
To receive reimbursement you must provide HR a completed Medical Incentive Reimbursement
Form and an explanation of benefit (EOB). No diagnosis or other confidential information should
be provided.
HR will authorize and submit to payroll. The reimbursement will be included in the employee’s
paycheck on the next pay cycle.
Qualified
Local Network: First Choice of the Midwest – www.1choicem.com
National Network: Cigna – www.mycigna.com
Please Note: Non-network provider services are covered at the same benefit level; however,
amounts above the reasonable and customary charge for the area will be the members
responsibility and are not applied to your deductible.
This is a brief summary of your benefit . Please refer to plan summary for more details.
6
Zest Concierge Services
7
Telemedicine 8
Vision Coverage
VISION In-Network
Comprehensive exam
$25 copay, then covered 100% up to $200
(every 12 months)
* Materials – Glasses (frames Lenses) Covered 100% up to $300 maximum combined
every 24 months OR benefit lenses & frames
** Contacts (every 12 months) Covered 100% up to $300 maximum
* Excludes prescription sunglasses
** In lieu of eyeglass lens benefit
Submit claims to:
Allegiance Benefit Plan Management
PO Box 3018
Missoula, Montana 59806-1269
Allegiance Customer Service:
1-800-877-1122
Dental Coverage
DENTAL In-Network Out-of-Network
Annual Deductible $25 Person / $50 Family
Annual Benefit Maximum (including Preventative) $1,500
Lifetime Ortho Maximum $1,000
Preventive and Diagnostic
Covered 100% Covered 100%
(Deductible Does Not Apply)
Basic Services
Covered 80% AD Covered 80% AD
(Fillings, Endodontics, Periodontics, Oral Surgery)
Major Restorative Services (Crown,
Covered 50% AD Covered 50% AD
bridges, dentures, implants)
Orthodontics – Dependent Child(ren) under age 19
Covered 50% AD Covered 50% AD
(treatment must be on or after benefit effective date)
AD = After Deductible
Looking for a dentist?
Visit www.deltadentalwy.org and search the “Premier” provider list or call
1-800-735-3379 to find a provider, Monday through Thursday from 8:00am
to 5:00pm., Friday from 8:00am to 4:00pm.
This is a brief summary of your benefit . Please refer to plan summary for more details. 9Dependent Care Flexible Spending Account
(DCFSA)
What is a DCFSA?
The County provides a Dependent Care Flexible Spending Account (DCFSA). When you enroll in DCFSA,
the dollars you designate will be deducted from your paycheck on a pre-tax basis and credited to your
FSA. You can use your DCFSA to be reimbursed for child or elder care expenses which enable you to
work. This includes costs you incur for childcare for children under age 13 or adults living with you
whom you claim as a tax dependent. By paying these expenses with pre-tax dollars, you will reduce
your taxable income and take home a larger portion of your paycheck.
PLEASE NOTE: you will need to submit claims and copies of your receipts to receive reimbursement.
2018 annual maximum contribution amount is:
$5,000 – if married and filing jointly
$2,500 – if filing Single
These dollars do not rollover from year to year or from one employer to another; any unused portion
at the end of the year will be forfeited.
REMEMBER – THIS IS USE IT OR LOSE IT
Health Reimbursement Account (HRA)
Health Reimbursement Account (for employees who are 65 years of age or older who are not eligible
to contribute to an HSA)
Teton County contributes the following:
• $100 for single per month
• $200 for family per month.
PLEASE NOTE: This is an Employer owned account. Employees are not able to contribute to this
account on a pre-tax basis.
REMEMBER – THIS IS USE IT OR LOSE IT
For claims or reimbursements call Allegiance at
1-800-877-1122.
To enroll in the DCFSA or HRA please contact
Human Resources
This is a brief summary of your benefit . Please refer to plan summary for more details.
10Basic Life and AD&D Benefits
Basic Life and AD&D
Teton County provides basic life coverage as well as Accidental Death and Dismemberment coverage
for all active, full-time employees working at least 30 or more hours per week. If you do not elect
coverage when you are first eligible you will be subject to medical underwriting.
Basic Life and AD&D Benefits
Employee $10,000
Spouse $2,000
Child (up to 19 yrs) $1,000
Accidental Death (AD&D) $10,000
Accelerated Death Benefit If you are terminally ill, advance payout of 75% up to $250,000
65% of original benefit amount at age 65, 45% at age 70 & 30% at
Age Reduction
age 75
If your employment ends, you can apply for an individual policy
Conversion
without evidence of insurability within 31 days.
Monthly Premium 100% Employer Paid
Contact Us:
https://dmswebintake.group.cigna.com/dmswebintake/LifeAccident/Initialform
call 1-800-238-2125 Monday through Thursday from 8:00am to 5:00pm EST
This is a brief summary of your benefit . Please refer to plan summary for more details. 11Supplemental Life and AD&D Insurance
Supplemental Life Insurance and AD&D
Supplemental Life Insurance and AD&D is a voluntarily elected benefit. Supplemental Group Life and
AD&D insurance provides term life insurance at low rates. Current coverage includes financial
protection in the event you, your spouse and/or one of your dependents die while covered under this
benefit. If you do not elect coverage when you are first eligible you will be subject to proof of good
health.
Supplemental Life and AD&D Benefits
Increments of $10,000 up to maximum of $100,000
Employee
Guaranteed Issue – up to $100,000
Increments of $5,000 up to $50,000 (the spouse amount cannot
Spouse
exceed 50% of employee’s benefit amount)
Increments of $5,000 up to $10,000 (age 15 days up to age 19 or age
Dependent Children
25 if full-time student)
AD&D Benefits Mirrors Supplemental Life Amount
How to figure out your monthly supplemental
Life and AD&D Monthly rates per $1,000
life/AD&D premiums for Employee and/or Spouse
Age Cost for Employee and Spouses coverage:
Under 20 $0.298
Monthly Benefits
20-24 $0.120 Rate per in
Age $1,000 X $1,000’s = Monthly Cost
25-29 $0.102
35 $.122 X 100 = $12.20
30-34 $0.106
35-39 $0.122 How to figure out your per pay period premium for
Employee or Spouse coverage:
40-44 $0.180
Monthly Number
45-49 $0.244 of Number
Premiu Months of pay Cost per
50-54 $0.385 m x in year ÷ periods = paycheck
55-59 $0.619 $12.20 X 12 ÷ 26 = $5.63
60-64 $0.767
65-69 $1.118
70-74 $2.240
75-79 $4.487
Child(ren) = $1.27 per $5,000 (regardless of # of
children)
AD&D = $0.038 per $1,000
This is a brief summary of your benefit . Please refer to plan summary for more details.
12LTD Benefits
LTD Coverage
Teton County provides LTD coverage for all active, full-time employees working at least 30 hours per
week. If you elect coverage 50% of the cost is paid by Teton County.
Benefit LTD
Benefit Coverage amount 66.67%
Maximum Payment Period To age 65
Benefits Begin After 90 day elimination period
Pre-Existing Condition 12 months prior/12 months insured
Maximum Benefit Up to $5,000 per month
Coverage Basis Own Occupation
Monthly Premium 50% Employer Paid
To calculate the cost of coverage, follow these steps:
Step 1: Enter your gross or pre-tax monthly pay (not counting bonus or overtime).
Please note this amount cannot exceed $8,333 $_________________________
Step 2: Multiply gross pay (line 1) by $0.00341 $_________________________
(this is your monthly premium)
Step 3: Times your monthly premium by 12 months and divide by 26 pay periods. This is your per
pay period cost. Divide this amount by 50% for your per pay period cost.
$__________________________
This is a brief summary of your benefit . Please refer to plan summary for more details. 13Employee Assistance Program (EAP)
Life. Just when you think you’ve got it figured out, along comes a challenge. Whether your
needs are big or small, your Life Assistance & Work/Life Support Program is there for you. It can
help you and your family find solutions and restore your peace of mind.
What Can The EAP Do For Me?
Immediate assistance
with a 24 hour hotline
When you call you’ll talk with a trained professional who will:
• Ask about your situation
• Help you clarify the problem 100% Confidential
• Offer guidance and support No cost to you
• Connect you with experts who can help with work-life issues
• Refer you to a local EAP counselor for face-to-face sessions
These confidential services are just a telephone call away for both you and your household
members.
The EAP Services Can Help With These, And Many More Issues:
Life Work Family Legal Money
Childcare Estate
Anxiety Job Stress Budgeting
resources planning
Stress Communication Parenting Wills Identity theft
Co-worker Caring for older Debt
Grief & Loss Legal forms
relationships adults management
Call 800-538-3543
Or
Visit their website at
www.cignabehavioral.com/cgi
9
14 This is a summary of benefits. Refer to your plan document for more details.Voluntary Insurance
15Wyoming Retirement System - Benefits
Wyoming Retirement System (WRS) is a defined benefit program for public employees in Wyoming.
The active membership is comprised of school district employees, University and community college
employees, state and local government employees, and various other political subdivisions in the
State.
WRS offers both a Pension and Deferred Compensation Plan to help you build a secure financial
future:
• PENSION – This benefit plan is designed to provide a monthly income for life and will continue
to grow as long as you are working within the WRS. Your benefit is based on a formula involving
your age at retirement, highest average salary, and years of service; it is not affected by
investment gains or losses. Regular, full-time employees are eligible and automatically enrolled
on date of hire. You become ‘vested’ after 48 months of service.
Pension Plan Contributions Vesting Eligibility
Public Plan 16.62% of Salary: 48 •Age 60 with 4 years
Tier 1 Employee = 8.25% Months service, or
(Eligibility if hired Employer = 8.37%
prior to 09/01/12) (Teton County Contributes 13.94% •Upon meeting the
of employees total salary, leaving requirements of “rule of
employee to fund 2.68%) 85” (age plus your years
of service equal 85 or
more)
Public Plan 16.62% of Salary: 48 •Age 65 with 4 years
Tier 2 Employee = 8.25% Months service, or
(Eligibility if hired on Employer = 8.37%
or after 09/01/12) (Teton County Contributes 13.94% •Upon meeting the
of employees total salary, leaving requirements of “rule of
employee to fund 2.68%) 85” (age plus your years
of service equal 85 or
more)
Fire Plan B 21.245% of salary: 48 Age 50 with 4 years of
Employee = 9.245% Months service
Employer = 12%
Law Enforcement 17.20% of salary: 48 •Age 60 with 4 years of
Employee = 8.6% Months service, or
Employer = 8.6%
(Teton County Contributes 11.25% •Any age with 20 years of
of employees total salary, leaving service
employee to fund 5.95%)
This is a brief summary of your benefit . Please refer to plan summary for more details.
16WRS – Deferred Compensation Plan
This benefit plan helps you build your own retirement by investing pre-tax contributions through
payroll deductions into the Plan. You decide where to invest your contributions by choosing from
an offering of conservative to high-risk investment options. However, you cannot borrow, take
loans, or close your account until your employment ends.
457 Deferred Compensation Plan
Participation is Voluntary and you must complete an
enrollment form.
Enrollment Minimum contribution per pay period is $20 but you can
contribution any amount up to the IRS annual contribution
limit of $18,000.
Eligibility Date of hire or at anytime during your employment.
Voluntary – does not affect your pension benefit or
Contributions contributions to pension plan.
(pre-tax or after tax option) You can increase, decrease, stop or restart contributions at
anytime.
If you are at least 50 years of age, you can contribute up to
Catch up Contributions $6,000 per calendar year.
Each pension plan and the Deferred Compensation Plan has an associated handbook
to help you understand your benefits
WRS Benefit calculator and Plan Documents are
available at: http://retirement.state.wy.us
For more information:
Call: 1-307-777-7691 17Vacation, Sick & Holiday Leave
Teton County provides vacation and sick leave to regular full -time employees.
Leave benefits begin to accrue on the employee’s date of hire.
Vacation:
Vacation is accrued according to seniority, and the employee can accrue a maximum of 240
hours. Any accrued vacation in excess of 240 hours will be forfeited. Vacation time may not be
taken until it has been accrued. Fire/EMS shift personnel working a 24 day tour of duty accrue a
maximum of 336 hours. Please reference Appendix C in the Employee Policies Manual and
Handbook.
Years of Service Hours Per Hours Per Fire/EMS Fire/EMS
Year Pay Period Hours Per Hours Per
Year Pay Period
Date of hire through four full years of 80 Hours 3.08 112 Hours 4.30
service
After completion of 4 full years of service 120 Hours 4.62 168 Hours 6.50
After completion of 9 full years of service 160 Hours 6.15 224 Hours 8.60
Sick Leave:
Regular full-time Fire/EMS shift personnel earn sick leave at a rate of 8 hours per calendar month
(3.70 hrs./pay period), and can accrue a maximum of 480 hours of sick leave. Sick leave may not
be taken until it has been accrued. Any accrued sick leave in excess of 480 hours will be forfeited.
Fire/EMS shift personnel working a 24 day tour of duty accrue 11.2 hours per calendar month
(5.2hrs/pay period), or 134.4 hours per year and a maximum of 672 hours of sick leave.
Holidays:
• New Years Day • Veteran’s Day
• Martin Luther King’s birthday • Thanksgiving (4th Thursday & Friday in November)
• President’s Day • Christmas Eve (office closes at 12:00pm when it
• Memorial Day falls on Mon, Tues, Wed, or Thursday).
• Independence Day • Christmas Day
• Labor Day
18Teton County Employee Programs
Recreation Center Available at no charge to full time employees that work for
Teton County, Wyoming.
Please Note:
• Does not include classes or programs
• Spouse & dependents must pay to use the facility
• Employees must purchase an ID card for $10 or current price
• This is good for 24 months from date of purchase
• Must have proof of employment for your first visit (employee ID or
other form of identification)
Town/County The Town of Jackson has a workout area in the basement of the Town Hall
Exercise Facility Building.
• Available to employees, spouses & dependents from age 18-26.
• You are required to complete & sign an application and waiver and
obtain an electronic security card for access
Bus Pass Program The County will reimburse you 50% of the cost of either a book of 10 rides
or a monthly pass. Please Note; The County can only reimburse up to $105
per month before it becomes taxable.
To obtain this benefit:
• complete a voucher
• attach your receipt
• sign the voucher on claimant line
• have supervisor sign it on the approval line
• Send completed voucher to: County Clerk’s Office
Discounted For year-round, full-time & part-time employees paid through the County
Ski Passes Clerk’s office.
• 20% off August pricing for JH Mountain Resort, Snowking Mountain
and Grand Targhee Resort
• No deadline to purchase discounted passes
• Tri-area sharable pass available during the ski season by RSVP through
County Administration office
19CHIP Notice
Medicaid and the Children’s Health Insurance Program (CHIP)
Offer Free Or Low-Cost Health Coverage To Children And Families
If you are eligible for health coverage from your employer, but are unable to afford the premiums,
some States have premium assistance programs that can help pay for coverage. These States use
funds from their Medicaid or CHIP programs to help people who are eligible for employer-
sponsored health coverage, but need assistance in paying their health premiums.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed
below, you can contact your State Medicaid or CHIP office to find out if premium assistance is
available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any
of your dependents might be eligible for either of these programs, you can contact your State
Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to
apply. If you qualify, you can ask the State if it has a program that might help you pay the premiums
for an employer-sponsored plan.
Once it is determined that you or your dependents are eligible for premium assistance under
Medicaid or CHIP, your employer’s health plan is required to permit you and your dependents to
enroll in the plan – as long as you and your dependents are eligible, but not already enrolled in the
employer’s plan. This is called a “special enrollment” opportunity, and you must request coverage
within 60 days of being determined eligible for premium assistance.
You may also be eligible for assistance paying your employer health plan premiums. Contact your
State for further information on eligibility.
IDAHO – Medicaid and CHIP
Medicaid Website: www.accesstohealthinsurance.idaho.gov
Medicaid Phone: 1-800-926-2588
CHIP Website: www.medicaid.idaho.gov
CHIP Phone: 1-800-926-2588
WYOMING - Medicaid
Website: http://health.wyo.gov/healthcarefin/equalitycare
Phone: 307-777-7531
For more information on special enrollment rights, you can contact either:
U.S. Department of Labor U.S. Department of Health and Human Services
Employee Benefits Security Administration Centers for Medicare & Medicaid Services
www.dol.gov/ebsa www.cms.hhs.gov
1866-444-EBSA (3272) 1-877-267-2323 Ext. 61565
Please Note: This is not an all-inclusive list of states, please contact Human Resources for a full copy of
the notice.
20Employee Notice & Rights
HIPAA Privacy Notice
The Health Insurance Portability and Accountability Act (HIPAA) requires
employers to adhere to strict privacy guidelines and establishes employee’s rights
with regard to their personal health information. If you have any questions
regarding this federal regulation, please speak with your Human Resources
department.
Women's Health & Cancer Rights Act Annual Notice (WHCRA)
Did you know that your plan, as required by the Women’s Health and Cancer
Rights Act of 1998, provides benefits for mastectomy-related services including all
states of reconstruction and surgery to achieve symmetry between the breasts,
prostheses, and complications resulting from a mastectomy, including
lymphedema?
Call your Plan Administrator for more information
COBRA Rights
Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), federal law
makes it possible for certain employees and their eligible dependents to continue
participation in health care plans if coverage would have otherwise been
terminated.
Newborn’s and Mother’s Health Protection Act
The Newborn’s and Mother’s Heath Protection Act of 1996 (NMHPA) affects the
amount of time you and your newborn child are covered for a hospital stay
following childbirth. In general, health insurers and HMOs may not restrict
benefits for a hospital stay in connection with childbirth to less than 48 hours
following a vaginal delivery or 96 hours following a delivery by cesarean section. If
you deliver in the hospital, the 48 hour (or 96 hour) period starts at the time of
delivery. If you deliver somewhere other than the hospital and you are later
admitted to the hospital in connection with the childbirth, the period begins at the
time of admission. Also, a health insurer or HMO cannot require you or your
attending provider to obtain prior authorization for your delivery or show that the
48 hour (or 96 hour) stay is medically necessary. However, a health insurer or
HMO may require you to get prior authorization for any portion of stay after the
48 hours (or 96 hours).
Please contact your Human Resources Department for detailed information on these federal laws.
21Contact Page
Provider Phone / E-Mail Website / Email
Teton County Human Resources
Julianne Fries, HR Director
Laura Moyer, HR Generalist Phone: 307-732-8483 hr@tetoncountywy.gov
Hannah Lewis , HR Assistant
Medical & Vision Phone: 800-877-1122
Allegiance Fax: 406-532-4507 or www.askallegiance.com
866-201-0522
Dental
Delta Dental Phone: 800-735-3379 www.deltadentalwy.org
Policy #: 70025
Zest Health - Concierge Services Mobile App – Refer to Apple & Android
Health Advocate & Telemedicine Phone: 866-333-4725
stores to download
Deductions & H.S.A Contributions
Payroll Clerk or Phone: 307-732-8421
Library Accounting Specialist Phone: 307-733-2164 x 116
Dependent Care Flexible Spending
Account (DCFSA) Phone: 800-877-1122
www.askallegiance.com
Fax: 406-523-3149
Allegiance
Health Reimbursement Account
(HRA) Phone: 800-877-1122
www.askallegiance.com
Fax: 406-523-3149
Allegiance
Life, AD&D & LTD Insurance www.cigna.com
Cigna Policy #OK 964217 Phone: 800-238-2125
Email Life Applications
Life Medical Underwriting Fax: 800.440.0856
https://dmswebintake.group.cigna.com
Phone: 800-732-1603
/dmswebintake/LifeAccident/Initialform
Wyoming Retirement System
(WRS) Phone: 307-777-7691 http://retirement.state.wy.us
Fax: 307-777-5995 Email: pension@wyo.gov
Defined Benefit Program
WRS Deferred Compensation Plan Phone: 307-777-7691 http://www.wrsdcp.com
Fax: 307-777-3621 Email: 457pln@wyo.gov
Voluntary Insurance
Transamerica
Darrell Rawlins Phone: 801-505-6480 drawlins@hayscompanies.com
Hays Companies
Phillip Aguillon Phone: 801-505-6513 paguillon@hayscompanies.com
22We encourage you to read the entire enrollment guide before you enroll.
This benefit guide gives a brief description of what is in the official summary plan
documents for these plans. The benefits that you receive are based upon the
plan’s official documents, not this guide or any other written or oral statement. If
there is conflict between this guide and the official plan document, the official
plan documents will govern in all cases. Teton County reserves the right at any
Important Benefit Information Enclosed
time to change or terminate these plans.
Your 2016
Plan Year: January 1, 2017 – December 31, 2017
2018 Employee Benefits Guide courtesy of Hays CompaniesYou can also read
