CITY OF AUSTIN2022 EMPLOYEE BENEFITS GUIDE Our Benefits Revolve Around You HUMAN RESOURCES DEPARTMENTMedical l Vision l Dental l Life Insurance l Disability l FSA l Wellness
Table of ContentsContact Information.............................................. 1 Employee Wellness................................................. 35Benefits Guide Information................................... 3 HealthyConnections..............................................36Benefits Eligibility................................................. 4 Additional Benefits................................................ 40 Employee Eligibility...............................................5 Employee Assistance Program.................................41 Dependent Eligibility.............................................6 Child Care Program...............................................41 Dependent Documentation....................................7 Maternity & Lactation Support..............................42 Persons Not Eligible...............................................7 Commuter Program...............................................42 Coverage Information............................................8 Smart Commute Rewards......................................43Plan Choices.......................................................... 10 Tuition Reimbursem*nt Program...........................43 Medical Plans and Rates.........................................11 Service Incentive Pay..............................................44 CDHP w/HSA.......................................................12 Direct Deposit .......................................................44 CDHP w/HSA Schedule of Benefits......................14 Employee Discount Page........................................44 CDHP Vision Benefits...........................................14 Affordable Small Dollar Loans................................44 CDHP Pharmacy Benefits......................................14 Homebuyer Assistance Program.............................44 PPO & HMO Schedule of Benefits.......................15 Leave Programs.......................................................45 PPO & HMO Vision Benefits...............................17 Veterans Services Office..........................................48 PPO & HMO Pharmacy Benefits..........................17 Workers’ Compensation.........................................49 Using Mail Order..............................................18 Employee Retirement Systems................................50 Diabetic Bundling.............................................18 Deferred Compensation Plan (457 Plan)................50 HEB Prescription Delivery Service....................18 Social Security........................................................50 Medical Programs..............................................19 Important Benefits Information............................ 51 Vision Plan.............................................................20 Summary of Benefits and Coverage (SBC)..............52 Dental Plan............................................................21 ADA Compliance...................................................52 BlueCare Dental PPO Schedule of Benefits............21 Governing Plan......................................................52 Group Term Life Insurance....................................23 HIPAA...................................................................52 Basic Life Insurance................................................23 The Women’s Health and Cancer Rights.................53 Supplemental Life Insurance.............................23 Patient Protection and Affordable Care Act.............53 Dependent Life Insurance.................................25 COBRA.................................................................53 Supplemental Life Insurance Worksheet.................26 Continuation of Coverage for Domestic Partners...54 Disability...............................................................27 USERRA Continuation of Coverage......................54 Short Term Disability (STD).............................27 Surviving Dependent Coverage...............................54 Long Term Disability (LTD).............................28 Surviving Family/Work-Related Coverage...............54 Long Term Disability Worksheet............................29 Your Prescription Drug Coverage and Medicare .....55 Flexible Spending Accounts (FSA)..........................30 Health Insurance Marketplace................................56 Health Care FSA .............................................30 Premium Assistance Under Medicaid and CHIP....58 Dependent Care FSA ......................................30 Corporate Human Resources Department..............59 Health Care FSA Worksheet..............................32 Dependent Care FSA Worksheet.......................33 Legal Insurance Plan..............................................34The City of Austin is committed to compliance with the Americans with Disabilities Act. Call the Human Resources Department at512-974-3400 (Voice) or 800-735-2989 (Relay Texas TTY number) for more information.Photo credit - Omar Francia, Human Resources Department
Contact InformationCity of Austin BlueCross BlueShieldHuman Resources Department Medical Plans & BlueCare Dental PPOEmployee Benefits Division Toll-Free Number: 888-907-7880Benefits staff are available by phone or in person to 24/7 NurseLine Phone Number: 800-581-0368discuss benefits questions. For your convenience, please HSA Bank Phone Number: 855-731-5220make an appointment before visiting our office. To view the prescription formulary, Explanation of Benefits,Phone Number: 512-974-3284 and print a temporary ID card, visit bcbstx.com/coa.Outlook Email: HRD, Benefits To register, follow these steps:Email: Benefits.HRD@austintexas.govFax Number: 512-974-3420 1. Click Log in. 2. Click Register Now.Office Hours: 8 a.m. to 5 p.m. 3. Follow the prompts to register.Office Location: 505 Barton Springs Road, Suite 600 4. Enter information from your ID card. If you do not have your ID card, you can call 888-907-7880.Online ResourcesResources are available at cityspace, the City’s intranet To find a medical provider, visit bcbstx.com/coa.website, or on the Internet at austintexas.gov/benefits. 1. Click on Doctors and Hospitals tab. 2. Under Find a Provider click on HMO Plan, PPO Plan,Scan the QR code below for easy access to the Employee or HSA Plan.Benefits website. 3. Click Browse by Category and select the type of medical care you are searching for: Medical Care, Urgent Care Center, or Behavioral Health or Search for Names and Specialties. To find a dental provider, visit bcbstx.com/coa. 1. Click on Dental tab. 2. Click on Find a Dentist. 3. Select the criteria by which you want to search for an in- network dentist: • Search by Dentist Name • Search by Location • Search by County • Search by Center Name Retirement Systems City of Austin Employees' Austin Fire Fighters Relief City of Austin Police Retirement System (COAERS) and Retirement Fund (AFRS) Retirement System (PRS) 6836 Austin Center Blvd., Suite 190 4101 Parkstone Heights Dr., 2520 South IH-35, Suite 100 Austin, TX 78731 Suite 270, Austin, TX 78746 Austin, TX 78704 Phone Number: 512-458-2551 Phone Number: 512-454-9567 Phone Number: 512-416-7672 Fax Number: 512-458-5650 Fax Number: 512-453-7197 Fax Number: 512-416-7138 Website: coaers.org Website: afrs.org Website: ausprs.org 1
Avesis ARAGVision Plan Legal Insurance PlanToll-Free Number: 866-563-3589 Toll-Free Number: 800-247-4184 Relay Texas Number: 800-383-4184To view benefits, locate a provider, and check claim status,visit avesis.com. To register, follow these steps: To view covered services and to locate a participating attorney, visit ARAGlegal.com/myinfo. To register, follow these steps:1. Click Member.2. Click Sign Up to Register. 1. Click Member Login.3. Enter contact and account information. 2. Click Create account.4. Agree to Terms and Conditions. 3. Enter your member ID number from your ID card and5. Click Submit and Get Started. your home address ZIP code and click Continue. 4. Enter your email address twice and click Continue. 5. Enter the verification code sent to your email and clickCompuSys/Erisa Group Inc. (Erisa) Submit Code.— COBRA Administration 6. Create a password and click Login.— Child Care Reimbursem*nts For non-members, enter 17886COA for Access Code.Phone Number: 512-250-9397Toll-Free Number: 800-933-7472Fax Number: 512-250-2937 Total Administrative Services CorporationChild Care Assistance Email: COADCAA@cserisa.com (TASC) Flexible Spending Accounts (FSA) & Debit CardAustin Deferred Compensation Plan457 Plan (Empower Retirement) Phone Number: 800-422-4661 Fax Number: 608-661-9601Toll-Free Number: 866-613-6189 To view activity, visit tasconline.com. To register:Email: dcaustin@empower-retirement.com 1. Click Log In.To view and manage your account, visit dcaustin.com. 1. Select Universal Benefit Account Individual/Employee.To enroll, click Register. 2. Enter your email and create a password. 3. Enter the verification code sent to your email and click Verify.ComPsych GuidanceResources® 4. Confirm your name and email address and clickEmployee Assistance Program Continue. 5. Agree to the Terms of Use.Toll-Free Number: 866-586-1456 6. Enter your mobile number. Enter the authentication code sent to your phone and click Verify.To view a list of free webinars, counseling services and morevisit guidanceresources.com To access, follow these steps:1. Click the Register tab.2. Enter austintexas.gov as your Organization Web ID and click the Register button.3. Enter a user name and password.4. Confirm security questions.5. Click the Submit button. 2
Benefits Guide InformationCity of Austin employees have access to benefits approved by the City Council each year as part of the budget process. Thebenefits and services offered by the City may be changed or end at any time. These benefits are not a guarantee of employmentwith the City.This Guide is designed to help you understand your benefits and assist you in making your enrollment decisions. Your rightsare overseen by each Plan. The terms of the Plan and detailed coverage information are included in the document madeavailable by the Plan, which may be a plan document, evidence of coverage, certificate of coverage, contract, etc.In the case of a conflict between information presented in this Guide and the Plan, the Plan's terms take over.City Benefits Employee CommunicationsThe City is concerned for the The Human Resources Department publishes newsletters tohealth, welfare, and safety of educate and inform employees about human resources-relatedits employees and is committed issues. It is important for employees to take time to reviewto providing cost-effective, these publications to avoid missing important information.sustainable benefits that assistemployees in being physically and • The HR Update is published quarterly for employees.mentally healthy. The benefits • CityNews is an online weekly newsletter published by theoffered in this document requires Communications and Public Information Office. It focusesemployees to assume responsibility on the people and projects that define the City of Austinfor the choices they make and to workforce and provides valuable information about Citybe informed on how to use their benefits.benefits effectively. Joya Hayes, Director of Human Resources & Civil Service A variety of methods are used to communicate the benefitsThe City will search for other program to employees and their dependents, includingareas of benefits to the degree where they fill a need of a presentations, newsletters, the City’s website, video onmajor portion of the workforce and to the degree they can be demand, and CityNews.provided cost-effectively and efficiently on a group basis. In addition, benefits staff are available by phone or in person to discuss benefits questions with employees and theirAdministration and Cost-Wise Consumerism families. Communication goals of the benefits programThe overall administration of the benefits program is re- include:evaluated and revised periodically to ensure it is simple,efficient, cost-effective, and satisfies overall goals. Since rising • Educating employees on how to use their benefits.health care costs affect both the City and its employees, the Employees should understand their responsibilityCity will continue to study new coverage options that help for the choices they make.control health care costs. The program is designed to be cost- Employees should follow the requirements of theeffective, for both the short term and the long term. plans. • Educating employees on how to be better users ofEmployee contributions are required to help finance the costof parts of the program. all benefits. Employee choices should be appropriate for their needs. Employees should contribute to the cost-effectiveness of the plans by making informed choices when using their benefits. • Increasing employee understanding of the value of their benefits. 3
BENEFITS ELIGIBILITY• Employee Eligibility• Dependent Eligibility• Persons Not Eligible• Dependent Documentation• Coverage Information 4
Employee EligibilityAs a City employee, including any person in the six-month probationary period, your work status is full-time, part-time, ortemporary.Full-Time Employees – 30 or more hours per weekIf you are in a regular budgeted position, you are considered full-time and are eligible to participate in:• Medical • Long Term Disability • Employee Assistance Program• Vision • Health Care FSA • Child Care Programs• Dental • Dependent Care FSA • Commuter Program• Life Insurance • Group Legal Plan • Retirement (Mandatory)• Short Term Disability • Wellness Program • Deferred CompensationAs a full-time employee, you are eligible for four types of coverage at no cost:• CDHP w/HSA - Employee Only • Basic Life Insurance• Dental - Employee Only • Short Term DisabilityPart-Time Employees – 20 to 29 hours per weekIf you are in a regular budgeted position, you are considered part-time and are eligible to participate in:• Medical • Long Term Disability • Employee Assistance Program• Vision • Health Care FSA • Commuter Program• Dental • Dependent Care FSA • Deferred Compensation• Life Insurance • Group Legal Plan• Short Term Disability • Wellness ProgramAs a part-time employee, you are eligible for Short Term Disability coverage at no cost.Part-Time Employees – Less than 20 hours per weekIf you are in a regular budgeted position, you are considered part-time and are eligible to participate in:• Medical • Health Care FSA • Employee Assistance Program• Vision • Dependent Care FSA • Commuter Program• Dental • Group Legal Plan • Deferred Compensation• Life Insurance • Wellness ProgramTemporary EmployeesIf you are in a temporary position you are eligible to participate in:• Commuter Program • Wellness Program• Employee Assistance Program • Deferred Compensation• Medical – If employed continuously with the City of Austin for 12 months or more. 5
Dependent EligibilityEnrolling Dependents for BenefitsIf you are a full-time or part-time employee, your dependents are eligible for:• Medical • Life Insurance • Group Legal Plan• Vision • Health Care FSA • Wellness Program• Dental • Dependent Care FSA • Employee Assistance ProgramEligible Dependents• Spouse: Your legally married spouse.• Domestic Partner: The individual who lives in the same household and shares the common resources of life in a close, personal, intimate relationship with a City employee if, under Texas law, the individual would not be prevented from marrying the employee on account of age, consanguinity, or prior undissolved marriage to another person. A domestic partner may be of the same or opposite gender as the employee.• Children: Your biological children, stepchildren, legally adopted children, children for whom you have obtained court-ordered guardianship or custody, qualified children placed pending adoption, and children of your domestic partner, if you also cover your domestic partner for the same benefit. Your children must be under 26 years of age.• Dependent Grandchildren: Your unmarried grandchild must meet the requirements listed above and must also qualify as a dependent (as defined by the Internal Revenue Service) on your or your spouse’s federal income tax return.• Disabled Children: To continue City coverage for an eligible dependent past the age 26, the child must be covered as a dependent at the time, unmarried, and must also meet the following definitions: A disabled child must rely on you for more than 50 percent of support. A child is considered disabled if they are incapable of earning a living at the time the child would otherwise cease to be a dependent and depend on you for principal support and maintenance, due to a mental or physical disability. A disabled child continues to be considered an eligible dependent as long as the child remains incapacitated and dependent on you for principal support and maintenance, and you continuously maintain the child’s coverage as a dependent under the plan from the time they otherwise would lose dependent status. A dependent child who loses eligibility and later becomes disabled is not eligible for coverage. A disabled child who was not covered as a dependent immediately prior to the time the child would otherwise cease to be a dependent is not eligible for coverage. A disabled child dependent must be covered continuously on the medical and dental plans. If coverage is dropped, the disabled child will not be allowed to re-enroll. Covering dependents who are not eligible for the City’s insurance programs unfairly raises costs for all participants in the programs, as well as for the City. 6
Dependent DocumentationIf you are adding a dependent under any of the City’s benefits programs, you must provide documentation that supports yourrelationship to the dependent. Social Security Numbers must be provided for all eligible dependents.Acceptable documents are listed below for the following dependents:• Spouse: A marriage certificate which has been recorded as provided by law.• Domestic Partner: A Domestic Partnership Affidavit and Agreement form signed by the employee and domestic partner. Also a Domestic Partnership Tax Dependent Status form signed by the employee.• Child: A certified birth certificate, complimentary hospital birth certificate, Verification of Birth Facts issued by the hospital, or court order establishing legal adoption, guardianship, or conservatorship, or qualified medical child support order, or be the subject of an Administrative Writ.• Child of a Domestic Partner: The documentation listed above must also be provided and the domestic partner must be covered for the same benefit in order to cover a child of a domestic partner.• Stepchild: The documentation listed above must also be provided and a marriage certificate or declaration of informal marriage indicating the marriage of the child’s parent and stepparent.• Dependent Grandchild: The documentation listed above must also be provided and a marriage certificate or declaration of informal marriage that supports the relationship between you and your grandchild.• Disabled Child: A completed Dependent Eligibility Questionnaire verifying an ongoing total disability, including written documentation from a physician verifying an ongoing total disability.• Qualified Child Pending Adoption: For children already placed in your home, an agreement executed between you and a licensed child-placing agency, or the Texas Department of Family and Protective Services, meeting the requirements listed in Dependent Eligibility.Persons Not EligibleDependents do not include:• Individuals on active duty in any branch of military service (except to the extent and for the period required by law).• Permanent residents of a country other than the United States.• Parents, grandparents, or other extended family members not listed under the Eligible Dependents section.• Grandchildren who do not meet the definition of dependent and who are not claimed on your or your spouse’s federal income tax return. 7
Coverage Information • If you enroll within 31 days of the birth of a child, coverage will be the effective on the date of the birth; even if you have Employee and Children or Family coverage, you must complete a Benefits Enrollment Form.Changing Your Benefits Coverage • If you enroll within 31 days of the court-orderedTo change your benefits coverage, you must call the Employee adoption, placement for adoption, guardianship orBenefits Division to schedule an appointment. conservatorship of a child, coverage will be effectiveYou can request changes to your coverage: on the date of the adoption, placement for adoption, guardianship or conservatorship; even if you have family• Within 31 days of a Qualifying Life Event. coverage, you must complete a Benefits Enrollment Form.• Within 31 days of the date you initially become eligible for • If you enroll during Open Enrollment, coverage for you coverage. and any dependents you enroll will be effective on January 1 of the following year.If you miss the deadlines listed above, you must wait untilnext Open Enrollment. To drop coverage for dependents whono longer meet the eligibility requirements, you must call the Duplicate Benefits CoverageEmployee Benefits Division to schedule an appointment to An individual is not eligible to be covered:complete a Benefits Enrollment Form. • As both a City employee and a City retiree, for the same benefit.Qualifying Life Events • As both a City employee or City retiree and as a dependentYou can add, drop, or change coverage for yourself and your of a City employee or City retiree, for the same benefit.dependents when you experience a Qualifying Life Event • As a dependent of more than one City employee, or Citysuch as: marriage, divorce, birth, adoption of a child, death retiree, for the same benefit.of a dependent, establishing a committed living arrangement Any individual found to have duplicate benefits coverage foras domestic partners, dissolution of domestic partnership, the same benefit (including life insurance) will automaticallyloss or gain of other coverage, or change in employment. You be dropped from the duplicate benefit.must call the Employee Benefits Division within 31 days ofthe Qualifying Life Event to schedule an appointment tocomplete a Benefits Enrollment Form. Coverage Ending Dates Coverage for you and your dependents will end on the earliestIn the case of a newborn dependent, your newborn is of the following:temporarily covered for medical for 31 days. After 31 days,if you do not complete a Benefits Enrollment Form and pay • The date the plan in question ends.any required premiums to add your newborn, your newborn • The date the coverage in question ended or is reduced.will no longer have coverage even if you have Employee and • The date the plan is amended to end coverage for you orChildren or Family coverage. your class of dependents. • The last day of the pay period in which you voluntarily drop coverage.Coverage Effective Dates • The last day of the pay period in which your employmentWhen you complete a Benefits Enrollment Form, provide ends.required documentation, and pay any premiums owed, • The last day of the pay period in which you or yourcoverage is effective for you and your dependents as follows: dependents no longer meet eligibility requirements.• If you enroll within 31 days of the date you are first eligible, coverage for you and any dependents you enroll Waiving Coverage will be effective on the date you are first eligible. If you are a full-time or part-time employee declining or• If you enroll within 31 days of a Qualifying Life Event, dropping medical and dental coverage for yourself, you must: (except for the birth of a child or the court-ordered adoption, placement for adoption, guardianship or • Complete a Benefits Enrollment Form. conservatorship of a child), coverage for you and any • Sign a waiver indicating you are aware that medical and dependents you enroll will be effective either the first day dental coverage is available to you by the City of Austin. of the following pay period or the first day of the month following the date you submit the Benefits Enrollment If you later decide you want City provided coverage, you Form. will not be able to enroll until the next Open Enrollment or within 31 days of a Qualifying Life Event. 8
Premium Information Taxable FringeFor full or part-time (20-29 hours) employees, the City pays If you choose benefits coverage for a dependent who doesa portion of your dependent’s medical and dental premiums. not qualify to be claimed on your federal income tax return,The amount paid by the City is not taxable to you if your you may have to pay taxes on the amount of money the Citydependent is a qualified dependent as defined by the Internal contributes for the dependent's medical and dental benefits.Revenue Service (IRS). You are responsible for determining This money is considered taxable income, and must bewhether your dependent meets the IRS dependent definition. reported to the IRS. The City refers to this money as taxable fringe. A spouse is never subject to taxable fringe. If at least one of the children for whom you have elected medical orPremium Deduction Errors dental coverage is a child you claim as a dependent on yourIt is your responsibility to ensure that information on your federal income tax return, the City’s contribution will not beenrollment form, your annual Open Enrollment Coverage considered taxable income.Statement, and Confirmation Statement is correct. If apremium deduction error occurs, you must notify theEmployee Benefits Division. Retiring from the City of Austin After you complete your retirement paperwork with theIf an overpayment occurs due to a City data entry error or an retirement system, you must call the Employee Benefitserror you made when completing your enrollment form or Division within 31 days from your retirement date toparticipating in Open Enrollment, the City will reimburse schedule an appointment to enroll in retiree benefits. If youyou up to a maximum of two pay period premiums. miss this deadline, your next opportunity to enroll will beConversely, if an underpayment occurs due to the City data during Open Enrollment or within 31 days of a Qualifyingentry error or the error you made, the City has the right to Life Event. To avoid a lapse in your benefits coveragecollect any additional premiums owed. The data entry error (from active employee benefits to retiree benefits), you mustwill not invalidate the coverage reflected on your enrollment schedule your appointment no later than the last day of theform. month you are retiring in. 9
PLAN CHOICES• Medical Plans ▶ Consumer Driven Health Plan with a Health Savings Account (CDHP w/HSA) ▶ PPO ▶ HMO• Vision Plan• Dental Plan• Life Insurance• Disability• Flexible Spending Accounts (FSA)• Legal Insurance Plan 10
CDHP w/HSA, PPO, andHMO Medical PlansAs an employee, you choose the medical plan that best meets your needs. Provider and prescription information is availableonline at bcbstx.com/coa.Things to consider when choosing a medical plan:• Premium costs for dependent coverage. • Freedom to not designate a Primary Care Physician.• Amount of copays. • Freedom to seek services from a Specialist without a referral.• Amount of out-of-pocket expenses. • Future expenses and the predictability of inpatient hospital expenses.BlueCross BlueShield Medical Rates - Per Pay Period Full-Time Employees CDHP PPO HMO w/HSA 30 + hours per week Employee Only $ 0.00 $ 5.00 $ 10.00 Employee & Spouse or Domestic Partner $ 91.78 $ 191.12 $ 196.12 Employee & Children $ 45.52 $ 140.80 $ 145.80 Employee & Family or Domestic Partner & Children $ 211.08 $ 320.87 $ 325.87 Part-Time Employees CDHP PPO HMO w/HSA 20 - 29 hours per week Employee Only $ 131.55 $ 120.99 $ 125.99 Employee & Spouse or Domestic Partner $ 340.99 $ 407.70 $ 412.70 Employee & Children $ 274.50 $ 334.33 $ 339.33 Employee & Family or Domestic Partner & Children $ 511.69 $ 602.30 $ 607.30 Part-Time Employees CDHP PPO HMO w/HSA Less than 20 hours per week Employee Only $ 263.10 $ 340.03 $ 408.27 Employee & Spouse or Domestic Partner $ 590.20 $ 763.00 $ 932.35 Employee & Children $ 503.48 $ 651.63 $ 796.08 Employee & Family or Domestic Partner & Children $ 812.30 $1,050.13 $1,283.03CDHP w/HSA Calendar Year SavingsCDHP Employee Only coverage saves you: CDHP Employee Family coverage saves you:$120 – switching from PPO Employee Only $2,635 – switching from PPO Employee & Family$240 – switching from HMO Employee Only $2,755 – switching from HMO Employee & FamilyCity also contributes $500 into your HSA. City also contributes $1,000 into your HSA. 11
CDHP w/HSA – Is it right for you?Benefits of the CDHP w/HSA:• No cost for Employee Only coverage and lower medical premiums if you cover dependents.• Health Savings Account through HSA Bank established in your name with a HSA Bank debit card.• City contribution into a Health Savings Account for Full-Time employees. If enrolling after July 1, 2022, City contribution is reduced to half. Part-Time employees (20-29 hours) receive a reduced contribution. $500 for Employee Only Coverage. $1,000 for Employee & Dependent Coverage.• Ability to contribute money on a pretax basis into a Health Savings Account. $131 maximum per pay period for Employee Only coverage. $262 maximum per pay period for Employee & Dependent coverage.• Ability to increase or decrease your HSA per pay period contributions any time during the year.• The money remaining in your HSA Account (including the City’s contribution) is yours to keep even if you leave employment or retire from the City.• 100 percent coverage for preventive services – such as annual physicals, well baby checks, well woman checks, mammograms, and colonoscopies.• Once you meet your calendar year deductible, the plan will pay 80 percent of Tier 1 providers covered services and 70 percent of Network providers covered services. To reach your deductible, you can pay for expenses using your HSA Bank debit card.• Affordable Care Act (ACA) Preventive Drug List – covered at 100 percent.• CDHP w/HSA Preventive Drug List – No deductible. Plan pays 80 percent for medications for conditions such as heart disease, high blood pressure, high cholesterol, and asthma.• Basic Drug List (Tier 1, 2 & 3 Drugs) – Plan pays 80 percent after you have met your calendar year deductible. To reach your deductible, you can pay your expenses with your HSA Bank debit card.• Tier 1 and Network providers bill you for services after BlueCross BlueShield discounted rates.• Use your Health Savings debit card to meet your deductible and pay for eligible medical, pharmacy, dental, and vision expenses.The chart below highlights how much a family may save if enrolled in the CDHP compared to the HMO, based on a 30+hour work week. CDHP Medical Plan HMO Medical Plan Employee & Family premiums $5,066/year Employee & Family premiums $7,821/year Four primary care doctor visits $ 600/year Four primary care doctor visits $ 100/year Four prescriptions $ 124/year Four prescriptions $ 40/year Total employee paid for the year $5,790 Total paid medical expenses for the year $7,961 City's HSA contribution $1,000 City's HSA contribution No City contribution Net paid medical expenses for the year $4,790 Net paid medical expenses for the year $7,961 A savings of $3,170CDHP Health Savings Account Eligibility:To be eligible to participate in the HSA, you must meet all the requirements below as determined by the IRS. If allrequirements are not met, you and/or your dependents are not eligible to contribute to a HSA. However, you and/or yourdependents are eligible to enroll in the CDHP Medical Plan.• You or your enrolled dependents cannot be claimed on another person’s tax return.• You cannot be enrolled in any plan other than a high-deductible plan including: Medicare, Medicaid, and Tricare.• You or your enrolled dependents cannot be enrolled in Health Care FSA.• You must provide a physical address to HSA Bank (no post office boxes).• You must be a legal resident of the United States.If eligibility is met, your HSA will be opened automatically. 12
How the CDHP w/HSA Works:• Preventive Services – Covered at 100 percent.• Injury or Illness at Tier 1 or Network Provider – The amount you pay will be determined after BlueCross BlueShield discounted rates.• Calendar year deductible – After you meet the deductible, the plan will pay 80 percent of covered services for Tier 1 and 70 percent for Network Providers.• Out-of-Pocket-Maximum – After you meet the out-of-pocket-maximum, the plan pays 100 percent for all eligible covered medical and pharmacy expenses.Example: Bill is enrolled in the CDHP w/HSA, Employee & Children coverage. By enrolling in the CDHP w/HSA insteadof the HMO, Bill saved $2,755 in premiums. Bill's 11-year-old daughter is sick and he takes her to the doctor. The cost of thevisit, after the contracted discount, is $100, and he uses his HSA Bank debit card to pay for the office visit. His out-of-pocketcost is $0 because he uses $100 of the $1,000 the City contributed to his HSA. This was their only medical expense and hisHSA balance of $900 will roll over to 2023.Differences between the CDHP HSA and the Health Care FSA: CDHP Health Savings Health Care Account Flexible Spending Account Is it required that I enroll in a City Yes, in the CDHP. No. medical plan? Does the City contribute money Yes, and the City's contributions are No. into this account? available immediately. Am I able to contribute money into Yes, your contributions are available as Yes, your annual contributions are this account? they are placed in your account each available immediately. pay period. Am I able to change my per pay Yes, you may increase or decrease your Yes, but only within 31 days of a period contributions throughout contributions anytime during the year Qualifying Life Event. the year? with no Qualifying Life Event needed. Will I be issued a debit card? Yes. Yes. Is the account a "Use it or Lose it" No, the City's and your unused Yes, you must use your contributions account? contributions roll over each year. There by the IRS deadline. is no deadline. Do I have to submit receipts? No, but we recommend that you save Yes, when requested. your receipts for your records. Is this an interest-bearing account? Yes. No. Do my dependents who use this Yes. Yes, grandchildren, domestic partner, account have to be IRS dependents? and domestic partner's children. Only employees enrolled in the CDHP are eligible to open a Health Savings Account. 13
CDHP w/HSA Schedule of Benefits CDHP (Blue Choice PPO) Medical Benefits Out-of-Network Tier 1 Providers Network ProvidersDeductible $1,500 - Employee Only $3,000 - Employee Only $3,000 - Employee & Dependents $6,000 - Employee & DependentsPreventive Services Plan pays 100%. Plan pays 60% after deductible.Eligible Covered Services Plan pays 80% after Plan pays 70% after& Facilities deductible. deductible. Plan pays 60% after deductible.Out-of-Pocket Calendar $5,000 - Employee Only $10,000 - Employee OnlyYear Maximum $6,850 - Employee & Dependents $20,000 - Employee & DependentsPrimary Care Physician PCP selection is not required.(PCP)Referrals Required No. A referral is not required to seek services from a Specialist. Approximately $49 for general health,Virtual Visit Copay $100 per session for therapy counseling, and Not applicable. $175 per session for psychiatry.Hearing Aids Not covered. For discounts, visit Blue365 at blue365deals.com/bcbstx. Tier 1 Providers – Providers designated as providing higher quality of care and cost efficiency. CDHP Vision Benefits Routine Vision Eye Exam CDHP (Blue Choice PPO) Out-of-Network Optometrists Plan pays 80% after deductible. Plan pays 60% after deductible. Ophthalmologists Plan pays 80% after deductible. Plan pays 60% after deductible. Frames, Standard Lenses, and Not covered. For discounts, visit Not covered. For discounts, visit Contact Lenses Blue365 at blue365deals.com/bcbstx. Blue365 at blue365deals.com/bcbstx. CDHP Pharmacy Benefits Plan Features (In-Network) CDHP (Blue Choice PPO) Affordable Care Act (ACA) Preventive Drug List Plan pays 100% no deductible. CDHP w/HSA Preventive Drug List Plan pays 80% no deductible. Basic Drug List - Tier 1, 2 & 3 Plan pays 80% after deductible. 90-Day Supply - Mail Order Plan pays 80% after deductible. Pharmacy drugs covered can be found at: bcbstx.com/coa. 14
PPO & HMO Schedule of Benefits Medical PPO (Blue Choice PPO) HMO (Blue Essentials) Benefits Tier 1 Providers Network Providers Tier 1 Providers Network ProvidersIndividual $600 per covered person. None.DeductibleFamilyDeductible Three individual deductibles. None.MaximumOut-of-Pocket $4,250 per covered person or $13,250 per $4,750 per covered person or $9,500 perMaximum family, per calendar year. family, per calendar year.Provider Selection Members may select Tier 1, Network, or Members must select Tier 1 or Network Out-of-Network Providers. Providers. Referrals are required from your PCP to seek services outside of your PCP including Specialists. No benefits coverage without a referral.Primary Care PCP selection is required. If a PCP is notPhysician (PCP) selected, one will be assigned. You will be required to seek services from the assigned PCP selection is not required. PCP. To change your PCP, call BlueCross BlueShield. You may change your PCP on a monthly basis. The change is effective the first day of the following month.Referrals No. A referral is not required to seek services Yes. A referral is required to seek services fromRequired from a Specialist. a Specialist. No benefits coverage without a referral.Residency Must receive services in Bastrop, Blanco,Requirements Burnet, Caldwell, Hays, Travis, or Williamson None. counties. No benefits coverage outside of this area.Out-of-Network $2,000 deductible per covered person. Plan None, except in case of a medical emergency.Benefits pays 60%, up to maximum allowable charge. Out-of-network benefits are subject to network benefit plan limits, pre-approval, and pre-notification requirements. Inpatient Admission are subject to a $500 copay per admission. 15
PPO & HMO Schedule of Benefits PPO (Blue Choice PPO) HMO (Blue Essentials) Tier 1 Providers Network Providers Tier 1 Providers Network ProvidersPreventive Exams Plan pays 100%. Plan pays 100%.Virtual Visit Copay $10 $10Office/TelemedicineVisit Copay Primary Care $15 $30 $15 $30 Specialist $30 $50 $40 $60Convenience Care $25 $25Clinics CopayUrgent Care Copay $40 $50Emergency Room $300 $350CopayAmbulance Services Plan pays 80% after deductible. $300 copay.Outpatient Surgery Plan pays 80% after Plan pays 70% after $750 copay. $1,000 copay. deductible. deductible.Inpatient Admission Plan pays 70% Plan pays 80% after after deductible and $1,750 copay. $3,000 copay. deductible. $250 copay.Allergy Services Plan pays 100%. Plan pays 50%.Immunizations Plan pays 100%. Plan pays 100%. Office visit copays may apply. Office visit copays may apply.Physical, Speech &Occupational TherapyRegistered Dietitian $40 $50Chiropractic CareCopay (20 visit limit)Acupuncture Copay $40 Not covered.(12 visit limit)CT, MRI, PET Scans $100 $150CopayMental Health Care $15 $15Outpatient CopayDurable Medical Plan pays 80% after deductible. Plan pays 100%.EquipmentDisposable MedicalSupplies & Prosthetic Plan pays 80% after deductible. Plan pays 80%.-Orthotic DevicesInsulin Pumps Copay $100 $150Hearing Aids Not covered. For discounts, visit Blue365 at One pair every 48 months. blue365deals.com/bcbstx.Other Covered Refer to your Medical Plan Document or contact BlueCross BlueShield.Medical Expenses 16
PPO & HMO Vision Benefits Routine Vision Exam PPO (Blue Choice PPO) HMO (Blue Essentials)Optometrists $25 $25Ophthalmologists $35 $45Frames, Standard Lenses, and Contact Not covered. For discounts, visit Not covered. For discounts, visitLenses Blue365 at Blue365 at blue365deals.com/bcbstx. blue365deals.com/bcbstx. PPO & HMO Pharmacy Benefits Plan Features PPO (Blue Choice PPO) HMO (Blue Essentials) (In-Network)Affordable Care Act (ACA) Plan pays 100%. Plan pays 100%.Preventive Drugs $50 annual deductible applies to $50 annual deductible applies toDeductible Tier 2 & Tier 3 drugs. Tier 2 & Tier 3 drugs.Basic Drug List - Tier 1 (Generic) $10 copay. $10 copay. Tier 2: $30 or 20% of cost Tier 2: $35 or 20% of costBasic Drug List - Tier 2 (Preferred) (up to $60). (up to $70). Tier 3: $50 or 20% of cost Tier 3: $55 or 20% of costBasic Drug List - Tier 3 (Non-preferred) (up to $100). (up to $110).90-Day Supply - Mail Order 2 x's Tier 1, 2, or 3 copay. 3 x's Tier 1, 2, or 3 copay. CDHP w/HSA, PPO, and HMO Diabetic SuppliesRetail Supplies are covered at participating pharmacies.Mail Order Copays for insulin needles/syringes and/or diabetic supplies are waived when dispensed on the same day as your insulin and oral agents, but only when the insulin or oral agent is dispensed first. Diabetes Program/DrugsA participant can receive approved diabetes medication and testing supplies for free if the participant is coveredunder a City medical plan, at least 15 years of age, and completes requirements of the HealthyConnectionsDiabetes Program. Tobacco Cessation Program/DrugsA participant can receive FDA-approved tobacco-cessation drugs for free if the participant is covered under a Citymedical plan, at least 18 years of age, and completes requirements of the HealthyConnections TobaccoCessation Program. Must obtain a prescription for tobacco cessation drugs from your physician.This applies to select prescription tobacco cessation drugs and over-the-counter nicotine replacement therapy(patches, gums, etc.) at a retail pharmacy or through the mail order service. 17
Using Mail OrderTo begin mail order:• Have your doctor write a prescription for a 90-day supply of your medication (ask for three refills).• Complete the mail order form and attach your prescription.• Provide a check or credit card information.• Within 10 days, your prescription will be delivered to you, postage paid.If your doctor allows you to take a generic drug, this should be indicated on the prescription. Three weeks before your mailorder supply runs out, you will need to request a refill.Your cost:• CDHP w/HSA participants will pay 20 percent of the cost once the in-network deductible is met. If the prescription is for a preventive care medication listed on the CDHP w/HSA Preventive Drug List, no deductible is required and you will only pay 20 percent of the cost. You can use your HSA Bank debit card to pay for your out-of-pocket expenses.• PPO participants receive 90 days of medication for two copays/coinsurance.• HMO participants receive 90 days of medication for three copays/coinsurance.For additional information, visit bcbstx.com/coa or call BlueCross BlueShield at 888-907-7880.Diabetic Bundling – What Your Medical Plan Does for YouA participant's insulin/non-insulin medication and related diabetic supplies can be purchased through mail order for the costof the insulin/non-insulin if prescriptions for the insulin/non-insulin and supplies are submitted at the same time.• CDHP w/HSA participants will pay 20 percent of the cost once the in-network deductible is met. You can use your HSA Bank debit card to pay for your out-of-pocket expenses.• PPO participants will pay two copays/coinsurance for a 90-day prescription.• HMO participants will pay three copays/coinsurance for a 90-day prescription.Enroll in the Diabetes Program to receive select Tier 1 diabetes medication and supplies at no cost. This benefit is available toall participants 18 years of age and older enrolled in a City medical plan. Refer to the Employee Wellness section of this Guidefor details.HEB Prescription Delivery ServiceFree prescription delivery is available to your home in the followingTexas areas: Austin, San Antonio, Waco, Houston, Corpus Christi,and the Border areas within 10 miles of an HEB store.How does it work?• Call your HEB Pharmacy and ask for prescription delivery.• Pay the applicable prescription copay/coinsurance by a credit card, debit card, or your FSA/HSA debit card.• Have someone 18 years or older at home to sign for the delivery.• Provides delivery of prescriptions filled Monday—Friday by 4 p.m. except for major holidays.• Delivers medications as late as 8 p.m.For more information, call your local HEB Pharmacy. 18
Medical ProgramsCancer Services – Specialized cancer nurses offer neededsupport to participants throughout cancer treatment, recovery, andat end of life to assist with treatment decisions and improve a participant’s health care experience. Experienced, caring cancernurses from the cancer support program are available to support participants in several ways. They can:• Find the right doctor for you, explore your treatment options and help you manage symptoms and side effects.• Explain your medications.• Work with your doctors to make sure all your questions are answered and inform them about how you're feeling.• Talk to your spouse, family, children, and employer.Comprehensive Kidney Disease – Specialized nurses offer education, motivation, and reinforcement to ensureintegration with other programs. BlueCross BlueShield offers access to the top-performing centers through their network ofpreferred dialysis centers. You’ll also receive ongoing clinical expertise and help from specialized nurses who can help you:• Understand your treatment options. • Work with your doctor and ask the right questions.• Manage your symptoms and side effects. • Assist with other health concerns, such as high blood pressure, anemia, or nutrition.24/7 NurseLine Services – Coping with health concerns on your own can be tough. With so many choices, it can behard to know whom to trust for information and support. 24/7 NurseLine services were designed specifically to help you getmore involved in your own health care, and to make your health decisions simple and convenient. They will provide you with:• Immediate answers to your health questions any time, anywhere – 24 hours a day, 7 days a week.• Access to experienced registered nurses.• Trusted, physician-approved information to guide your health care decisions.When you call, a registered nurse can:• Discuss your options for the right medical care and assist in guiding you to the correct treatment facility (i.e., Urgent Care, Emergency Room, etc.).• Help you understand treatment options.• Answer medication questions.Call 24/7 NurseLine services any time for health information and support – at no additional cost. Registered nurses areavailable any time, day or night. Call NurseLine services at 800-581-0368.Virtual VisitsTalk to a board-certified physician for both general health and behavioral health servicesfrom the comfort of your home or work. There’s no driving, no crowded waiting rooms,and it’s available 24 hours a day, 7 days a week. Common services include, cold/flu,allergies, asthma, sinus/ear infections, and pink eye. Behavioral health conditions treatedinclude, online counseling, child behavior/learning issues, and stress management.For the PPO and HMO Plan, virtual visits are a $10 copay for general or behavioralhealth. For the CDHP Plan, virtual visits are approximately $49 for general health, $100 per session for therapy counseling,and $175 per session for psychiatry.Log in to bcbstx.com/coa or download the BCBSTX app on your smartphone to access Virtual Visits powered by MDLIVE.You will need your BlueCross BlueShield medical ID number and your banking/credit card information readily available tocharge your copay. If you have questions please call BlueCross BlueShield at 888-907-7880. 19
Vision PlanHealthy eyes and clear vision are an important part of your overall health andquality of life. Avesis will help you care for your sight while saving you money.To view benefits and locate a provider, visit avesis.com or call 866-563-3589. Plan Coverage Covered Service – In-network benefits (limited out-of-network benefits are available). Comprehensive Eye Exam – $10 copay, one exam per calendar year. Frames – Once per calendar year in lieu of contact lenses. Contacts – Once per calendar year in lieu of frames. Up to $125 retail allowance toward provider supplied frame Up to $120 allowance toward provider supplied contacts plus plus 20% off cost exceeding the allowance.* an additional discount off the cost exceeding the allowance*– OR 10% for disposable contacts and 15% for standard contacts. Up to $175 retail allowance if purchased at Vision Works OR plus 20% off cost exceeding the allowance. Medically necessary contact lenses are covered in full with OR prior approval. Up to $200 retail allowance toward frames if purchased using UVP Online. Standard & Specialty Contacts - Evaluation, fitting fees, and follow-up care; $25 copay applies. One year eyeglass breakage warranty included at no additional cost. Standard Eyeglass Lenses – Single, bifocals, trifocals, lenticular, and standard scratch coating. $25 copay, once per calendar year. Polycarbonate lenses for children are covered in full up to age 19. Lens Options Copay Lens Options Copay Standard progressive addition lenses $50 Premium AR Coating $48 Premium progressives (i.e. Varilux, etc.) $90 Ultra AR Coating $60 Intermediate-vision lenses $30 High-index lenses $55 Blended-segment lenses $20 Polarized lenses $75 Ultraviolet coating $12 Glass photochromic lenses $20 Standard anti-reflective (AR) coating $35 Plastic photosensitive lenses $65 * Additional Discounts – Not available at Wal-Mart, Sam's Club, and Costco.Avesis Vision Rates – Per Pay Period Employee Only $ 1.98 Employee & Spouse or Domestic Partner $ 4.28 Employee & Children $ 4.06 Employee & Family or Domestic Partner & Children $ 6.47 20
Dental PlanBlueCare Dental PPO provides you the option of seeking services from in-network and out-of-network dentists. Selecting adentist from the BlueCare Dental PPO network will offer you the greatest savings. When contacting a dentist, ask whether thedentist is contracted in the BlueCare Dental PPO network. To find a dentist, view claims activity, or for more information visitbcbstx.com/coa or call BlueCare Dental at 888-907-7880. For covered services, exclusions, and the out-of-network Table ofAllowances, refer to the BlueCare Dental PPO Plan Document online at austintexas.gov/benefits or call BlueCare Dental PPO.BlueCare Dental PPO Schedule of Benefits BlueCare Dental PPO In-Network BlueCare Dental PPO Out-of-Network Selection of Dentist Member can go to an in-network dentist. Member can go to any dentist; however, the Member will realize greater savings when member is responsible for the difference over the using in-network dentists. Table of Allowance. Annual Deductible $50 per person, per calendar year. Deductible does not apply to Preventive Care. Covered Services Preventive Care, Basic Care, and Major Care – Preventive Care, Basic Care, and Major Care – (other than covered in full. covered up to the Table of Allowance. Orthodontia) Also responsible for amounts over the Table of Allowance. Orthodontia Orthodontia Care – covered in full as work Orthodontia Care – covered up to the Table of progresses up to the Calendar/Lifetime Allowance as work progresses. Orthodontia work Maximum. Orthodontia work already in already in progress is not covered prior to enrolling progress is not covered prior to enrolling in a in a City medical plan. City medical plan. Annual Maximum $2,000 per person, per calendar year. $2,000 per person, per calendar year. Benefit Also responsible for amounts over the Table of Allowance. Orthodontia $2,000 per person, per lifetime. Maximum Benefit Claim Forms Dentists file claims for covered services. Members file claims to be reimbursed for covered services. (Some dental offices may file claims and bill the balance after the plan has paid).Table of Allowance – The most BlueCare Dental PPO will pay an out-of-network dentist for a covered service orprocedure. 21
Orthodontia TreatmentOrthodontia work already in progress would not be covered (including banding prior to enrolling).Expenses are paid only as the work progresses. For out-of-network services, invoice should be submitted for reimbursem*ntafter each visit. Orthodontia benefits paid by the plan are applied toward the calendar year maximum and LifetimeOrthodontia Maximum.The reimbursable amounts for orthodontia expenses are determined as claims are incurred throughout the course of treatment.The reimbursable amounts through FSA or the HSA is the difference between the amount billed and the amount paid by thedental plan. This amount may not match the payment plan you have set up with your dentist.BlueCare Dental PPO Rates – Per Pay Period Full-Time Part-Time Part-Time 30+ hours 20 – 29 hours Less than 20 hours per week per week per week Employee Only $ 0.00 $ 7.12 $ 25.17 Employee & Spouse or Domestic Partner $ 28.51 $ 34.15 $ 70.51 Employee & Children $ 28.51 $ 34.15 $ 70.51 Employee & Family or Domestic Partner & Children $ 28.51 $ 34.15 $ 70.51 22
Group Term Life InsuranceBasic Life InsuranceProvided at no cost for full-time employees. You receive one If you designate a testamentary trust as beneficiary (i.e.times your base annual salary. Base annual salary does not created by will), you should recognize the possibility that yourinclude shift differential, overtime, Service Incentive Pay, will which was intended to create a trust may not be admittedlump sum payments, or stipends. Part-time employees may to probate (because it is lost, contested, or suspended by apurchase Basic Life Insurance. later will).Supplemental Life Insurance Your Beneficiary Designation FormPaid entirely by you. You must have the City’s Basic Life You can update your beneficiary designation two ways.Insurance to purchase Supplemental Life Insurance. You may 1. Log in to the HRD Portal at hrportal.coacd.orgpurchase Supplemental Life Insurance in amounts equal to from your work computer.one, two, three, or four times your base annual salary. 2. By completing a paper Beneficiary Designation Form.Your Supplemental Life coverage amount is rounded down Forms are available from the Employee Benefits Divisionto the nearest $1,000. Your cost is based on your age, salary, or your department's HR.and the amount of insurance selected. You may increaseyour Supplemental Life coverage annually during Open The version with the most recent signature date will be usedEnrollment by one coverage level each year, up to a maximum for payout. It is important to keep your beneficiaries current.of four times your base annual salary.Your Supplemental Life Insurance premiums may be Other Beneficiary Designation Formsdeducted from your pay on a before or after-tax basis. You To change your beneficiary designations for other benefits, domust indicate your choice on your Benefits Enrollment Form. one or more of the following:To calculate your per pay period cost, visit • City of Austin Employees’ Retirement System (COAERS)austintexas.gov/benefits or complete the Supplemental Life participants should call COAERS at 512-458-2551.Insurance Worksheet at the end of the Life Insurance section. • City of Austin Police Retirement System (PRS) participants should call PRS at 512-416-7672.Choosing a Beneficiary • If you participate in the Deferred Compensation Plan,In the event of your death, your Basic Life, Supplemental you can designate a beneficiary online at dcaustin.com.Life, and your final paycheck are paid to your named • If you participate in the CDHP w/HSA, you can designatebeneficiary or beneficiaries. Unless prohibited by law, your a beneficiary online at HSABank.com.life insurance benefits will be distributed to the beneficiariesyou named. Current Texas law states a legally married spouseis entitled to 50 percent of the policy, and if not listed as a Accidental Death and Dismembermentnamed beneficiary, the spouse may contest. (AD&D) Coverage If you are enrolled in Basic and/or Supplemental LifeIf you are legally married and designate less than 50 percent Insurance, you also have AD&D coverage equal to the totalof your life insurance to your spouse, upon your death the life amount of your life insurance.insurance carrier may contact your spouse for confirmationof this reduced percentage. If your spouse is not in agreement If you have an injury that results in a covered loss, as listedand an agreement is not reached between the beneficiaries below, you may be eligible for a percentage of your AD&Dlisted, the Texas court will make the decision. coverage in effect on the date of the accident. The loss must occur within 365 days of the accident. Injury means bodilyIf your named beneficiary is under 18 years of age at the time injury caused by an accident, occurring while coverage is inof your death, court documents appointing a guardian may be force, and resulting directly and independently of all otherrequired before payment can be made. You should talk with causes in a loss covered by the AD&D policy.an attorney to make sure that benefits to a minor will be paidaccording to your wishes. 23
