2 0 2 1 - Workday
2
0 2 1
CITY OF
BALTIMORE
DEPARTMENT OF
HUMAN RESOURCES
Table of Contents
CONTACT INFORMATION ......................................................................................................... 1
Provider Phone Numbers & Websites ........................................................................................ 2
NEW AND IMPORTANT INFORMATION ................................................................................ 3
Information About Your 2021 Benefits ...................................................................................... 4
Medical Plan Information at a Glance ........................................................................................ 5
Enrolling Eligible Dependents .................................................................................................... 6
Documentation for Newly Added Dependents & Family Status Changes ................................. 7
Termination of Covered Dependents Due to a Family Status Change ....................................... 8
Enrollment Due to Coverage Change ......................................................................................... 8
IMPORTANT MEDICARE INFORMATION .......................................................................... 9
Notice of Creditable Coverage.................................................................................................. 10
Flexible Spending Accounts (FSA) .......................................................................................... 13
Qualifying Life Events and Status Changes ............................................................................. 16
Waiver Credits .......................................................................................................................... 18
PREMIUM DEDUCTIONS ......................................................................................................... 20
2021 Premium Rates ................................................................................................................. 21
BENEFIT INFORMATION (Rx, VISION, DENTAL & LIFE INSURANCE) .......................... 27
2021 Prescription Drug Copays Rates ...................................................................................... 28
2021 Medical and Prescription Out-of-Pocket Maximums ...................................................... 28
2021 National Vision Administrators (NVA) ........................................................................... 29
2021 National Vision Administrators (NVA) Rates ................................................................. 30
2021 United Concordia Dental HMO Rates ............................................................................. 31
2021 United Concordia Dental PPO Rates ............................................................................... 33
MetLife: Life / Accidental Death & Dismemberment Insurance ............................................. 35
MEDICAL PLAN COMPARISON .............................................................................................. 37
Comparing Medical Plan Benefits ............................................................................................ 38
2021 BlueChoice Advantage (PPO) ......................................................................................... 39
2021 Health Maintenance Organizations (HMOs) ................................................................... 44
Table of Contents | I
CONTACT INFORMATION
Page | 1
Provider Phone Numbers & Websites
Insurance Companies
Provider
Aetna Select Open Access
(HMO)
Phone Number
Website
(800) 900-7562
BlueChoice Advantage (PPO)
(800) 535-2292
CareFirst Caremark/CVS
(800) 241-3371
Kaiser Permanente (HMO)
(866) 248-0715
MetLife
(866) 492-6983
mybenefits
National Vision
Administrators (NVA)
(800) 672-7723
e-
TASC FSA
(800) 422-4661
United Concordia Dental
(866) 851-7568
WageWorks COBRA
(800) 526-2750
dentalinsurance/member/city-of-baltimore/
pantWeb/login.jsp
Office of Employee Benefits
Provider
7 E. Redwood Street
20th Floor
Baltimore, Maryland 21202
Wellness Program
Phone Number
(410) 396-5830
TTY 711
Fax
(410) 396-5216
Website
(410) 396-3872
DhrWellness/
Retirement Agencies
Provider
Baltimore City Retirement
System (ERS)
Fire & Police Retirement
(F&P)
Maryland State 48-0715
Retirement
(Pension Information)
Retirement Savings Plan
(RSP)
Phone Number
Website
(877) 273-7136
(888) 410-1600
(800) 492-5909
(443) 984-2389
Page | 2
NEW AND IMPORTANT INFORMATION
Page | 3
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- fdic contracting awards
- 1 2 3 4 5 6 7 8 9 11 12 13 14 15 16 17 18 19 20 21 22 23
- 2022 missouri income tax withholding table
- 239 2 219 81 623 3 553 19 102 93 201 13 200 28 652
- 4q 2021 fy 2021 earnings results
- third quarter 2021
- application help
- review of pay and grading structures and conditions of
- 2 0 2 1 workday
- oklahoma state bureau of investigation
Related searches
- 2cos 2x 2 cosx 2 1 0
- 1 or 2 374 374 1 0 0 0 1 168 1 1 default username and password
- 1 or 2 711 711 1 0 0 0 1 168 1 1 default username and password
- 1 or 2 693 693 1 0 0 0 1 168 1 1 default username and password
- 1 or 2 593 593 1 0 0 0 1 or 2dvchrbu 168 1 1 default username and password
- 1 or 2 910 910 1 0 0 0 1 168 1 1 default username and password
- 192 1 or 2 33 33 1 0 0 0 1 1 1 default username and password
- 1 or 2 364 364 1 0 0 0 1 168 1 1 admin username and password
- 1 or 2 633 633 1 0 0 0 1 168 1 1 admin username and password
- 192 1 or 2 735 735 1 0 0 0 1 1 1 default username and password
- 1 or 2 297 297 1 0 0 0 1 168 1 1 username and password verizon
- 1 or 2 948 948 1 0 0 0 1 168 1 1 admin username and password