An Overview of Your 2012 Employee Benefits

An Overview of Your

2012 Employee Benefits

Medical Prescription Wellness

Program Dental Life and

Accident Short-Term

Disability Flexible

Spending Accounts (FSAs) Voluntary Benefits (Long-Term Care & Universal Life)

Your 2012 Overview of Employee Benefits

Welcome!

This pamphlet is a summary of the benefit choices that are available for you to enroll or make election changes for 2012 Plan Year. The City's annual enrollment period for active employees will be Monday, October 10 ? Friday, October 28. During this time you can make benefit election changes without a qualified life event, such as add or remove a dependent on your health or dental coverage; except when court-ordered.

You will be able to review and make your benefit elections for 2012 using the web enrollment website at .

Making Changes During the Year

Generally, you can only change your benefit elections during the Annual Enrollment period, unless you experience a qualified life event (QLE) such as marriage, divorce, birth or adoption, or spouse's employment status change. Human Resources must be notified within thirty (30) days of QLE.

Highlights & Changes for the 2012 Plan Year

Prescription coverage will no longer be included with BCBSNC medical coverage - Express Scripts Pharmacy will replace Medco as the prescription drug administrator

Premium rates, deductibles, and out-of-pocket maximums for medical plans will increase

Primary physician visit copay decreased to $20

Dental Plan benefit increased to first $300 paid at 100% and the annual maximum benefit increased to $1,100

Wellness premium discount increased from $25 to $30 per month on medical premiums

Participation in a wellness education program or class is required for wellness premium discount eligibility

Tobacco-free discount eligibility will be determined by biometric results

PLEASE NOTE: Biometric results* will determine the eligibility for the $20 Tobacco-Free Discount. If you enroll in the Basic Plus Plan and biometric results report a positive use of tobacco products, your plan coverage will change from the Basic Plus to Basic at the tobacco-use rate. If you waive your participation in the Biometric Screening, but are enrolled in one of the City's medical plans, the plan coverage will default to the Basic Plan at the tobacco-use rate.

*Biometric results are protected under HIPPA and the City of Winston-Salem and Human Resources are only provided minimal information to determine eligibility.

Your 2012 Overview of Employee Benefits

BlueCross BlueShield of NC PPO Plans

Medical Insurance gives you peace of mind and lets you focus on what's truly important ? a speedy recovery. You can choose from the following affordable plans:

Medical Benefits Summary

Coverage

Basic PPO

Basic Plus PPO

In-Network

Out-ofNetwork

In-Network

Out-ofNetwork

Annual Deductible

Individual

$500

$1,000

$375

$750

Family

$1,000

$2,000

$750

$1,500

Out-of-Pocket Maximum (including deductible)

Individual

$2,000

$4,000

$1,500

$3,000

Family

$4,000

$8,000

$3,000

$6,000

Physician's Office Visits

Primary

$20 copay

60%*

$20 copay

70%*

Specialist

$45 copay

60%*

$35 copay

70%*

Outpatient

Diagnostics

(including X-rays,

80%*

60%*

90%*

70%*

lab work, etc)

Well-Child Care

$0

60%*

$0

70%*

Adult Preventive

Care Vision &

$0

60%*

$0

70%*

Hearing Exam

Hospital Care

Inpatient

80%*

60%*

$300 copay + 90%*

70%*

Outpatient

80%*

60%*

$150 copay + 90%*

70%*

Emergency Treatment

Emergency Room $100 copay $100 copay $100 copay

$100 copay

Urgent Care

$45 copay $45 copay $35 copay $35 copay

Ambulance Service

80%*

80%*

90%*

90%*

Physical/Speech and Occupational Therapies

Up to 60 visits combined/ Speech - 30 visits

$45 copay

60%*

$35 copay

70%*

Chiropractic ? 30 visits per year

$45 copay

60%*

$35 copay

70%*

*After deductible.

For a complete list of covered services, please refer to your Summary Plan Description.

2012 Medical Premium Rates

Monthly premiums are deducted equally in the first and second pay periods of each month. Premiums are collected a month in advance. For Wellness Discount eligibility, refer to the Wellness section of this benefits overview.

Basic Plan Premium Comparison

Basic Plan

Level of City Coverage Cost

Employee Only

Employee Child

Employee/ Spouse

Employee/ Children

Employee/ Family

$385 $690 $810 $1,100 $1,240

Employee Monthly Premium*

$90 $166 $212 $298 $350

Monthly Premium

Tobacco User

Wellness Discount

$30

TobaccoFree

Discount $20

$60

$70

$136

$146

$182

$192

$268

$278

$320

$330

TobaccoFree

Discount $20 +

Wellness Discount

$30

$40

$116

$162

$248

$300

* This premium applies to employees who are not participating in Wellness and use tobacco products including, but not limited to smoking (cigarettes, cigars, pipes, etc) and smokeless (snuff, chewing, etc)

Basic Plus Plan Premium Comparison

Basic Plus Plan

Level of

City

Coverage

Cost

Employee Only

Employee Child

Employee/ Spouse

Employee/ Children

Employee/ Family

$502 $904 $1,054

$1,420

$1,615

Monthly Premium

Employee Monthly Premium*

Wellness Discount

$30

$124

$94

$296

$266

$355

$325

$490

$460

$570

$540

NOTE: Only tobacco-free employees may enroll in Basic Plus Plan. Tobaccofree discount does not apply.

Your 2012 Overview of Employee Benefits

Prescription Drug Program ? Express Scripts Pharmacy

Effective January 1, 2012, Express Scripts will be the new prescription drug administrator (replacing Medco). You can get your prescription filled at a participating retail pharmacy or home-delivered through mail order.

An Express Scripts drug card will be sent to you to specifically use for prescriptions. You can access Express Scripts online at express- for prescription history, order refills, drug pricing, or as a resource tool for drug and health information.

Prescription Plan Benefits Summary

Prescription Plan

Retail Drugs (30-Day Supply) Generic Formulary Non-Formulary/

Specialty

Mail-Order Drugs (90-Day Supply) Generic Formulary Non-Formulary/

Specialty

Basic Plan

In-

Out-

Network

of-

Network

Basic Plus Plan

InNetwork

OutofNetwork

$10 Copay

$10 Copay

$30 Copay

N/A

$25 Copay

N/A

$50 Copay

$45 Copay

$20 Copay

$20 Copay

$60 Copay

N/A

$50 Copay

N/A

$100 Copay

$90 Copay

NOTE: Prescription copays are not applied to annual deductible or out-ofpocket maximums

Prescriptions can be filled at a participating retail pharmacy (such as CVS, RiteAid, etc.). Present your Express Scripts drug card at the time your prescription is filled.

View your prescription claims and order refills using the Express Scripts website address express-.

With mail order, you can take advantage of a ninety (90) day supply of maintenance medication (i.e. blood pressure, birth control, allergy, etc.) for the cost of two (2) copays.

If you have questions about your prescription coverage, contact Express Scripts customer service at 1-877-512-1319.

Drug formulary may differ from Medco's, which may cause an increase or decrease in your copay amount depending on the drug tier.

Wellness Program: LifeSmart

LifeSmart is the City's wellness program. Its mission is to be a good steward of public funds by providing City employees and their families with tools to help prevent, reduce, and reverse negative health issues and establish positive practices that promote good health.

Wellness Premium Discount

All eligible employees will receive a $30 wellness discount on their monthly medical premium. Eligible employees include: new hires, current wellness participants, newly-enrolled participants (during annual enrollment), or those becoming eligible for coverage during the plan year. Employees participating in the $30 premium discount must complete all of the following:

Biometric Screening -- Participant must have completed biometric screening offered in September 2011 (except participants who enrolled in one of the City's medical plans with a coverage effective date 7/01/2011 or later).

Annual Physical -- Physical must be completed by your physician during plan year ( Jan. 1 ? Dec. 31). You may be required to provide documentation of your completed physical. Note: Members can receive one routine physical exam and related diagnostic services per benefit period or plan year (Jan. 1 ? Dec. 31) as a 100% covered benefit. An annual physical can be scheduled at anytime during the plan year (ex. Rex had a physical in Aug. 2011, he can schedule another physical in June 2012).

Health Risk Assessment (HRA) -- You must complete or update your HRA between Jan. 1, 2012 ? March 31, 2012 at , to include participants initially enrolling in medical coverage during annual enrollment.

Wellness Education Class -- You must complete at least one wellness education class during the plan year (Jan. 1 ? Dec. 31). You may attend a class that is offered by the City's Employee Health Services or another provider such as BCBSNC Member Health Services, Wake Forest Best Health, or others. For eligible programs, visit the employee center web page or contact the City's Health Services Coordinator at 748-3866.

Tobacco-Free Discount

Employees who do not use tobacco products are eligible to receive a $20 tobacco-free discount on their monthly medical premium. Tobacco-free status will be verified through biometric screening. Participants in this premium discount must have participated in biometric screening in September 2011 (except participants who enrolled in one of the City's medical plans with a coverage effective date as of 7/01/2011 or later).

If you have an interest in being tobacco-free, enroll and complete a tobacco cessation program through Employee Medical Services or BCBSNC by June 30, 2012. You can request eligibility for the tobacco-free discount after June 30, if you remain tobacco-free and documentation of completed program is provided to Human Resources by July 15, 2012.

Your 2012 Overview of Employee Benefits

Dental Plan

The City's dental plan covers a full range of services and all dental claims are handled by Flores and Associates (Flores247. com). You can use the dentist of your choice. Orthodontia is only available for covered dependents under age of 19 with a lifetime maximum benefit of $1,500. There is a one-year waiting period for orthodontia and dental services other than preventive care for dependents added during annual enrollment. Monthly premiums and benefits are listed in charts below.

Dental Benefits Summary

Amount of Service First $300

Next $50

Next $250 Next $1,200

City Share

100% 0% 80% 50%

Employee Share 0%

$50 Deductible

20% 50%

City Paid Benefit

$300

$0

$200 $600

Dental Premium Comparison

Level of Coverage Employee Only Employee/Family

Monthly Premium

$0 $21

$1,100 annual maximum benefit per covered member.

Life Insurance: Basic, Supplemental & Dependent Coverage

Basic Life

All full-time employees are eligible for City-paid Basic Life Insurance for the benefit amount of an employee's annual salary up to a maximum of $150,000.

Supplemental Life

All full-time employees are eligible to apply for additional voluntary life insurance coverage for up to 3 times their annual salary at a maximum of $300,000? maximum increase to $400,000 with an approved Evidence of Insurability (EOI). If you wish to apply for coverage or increase your coverage from 1x to 3x, an EOI application is necessary. Cost of Benefit: .21 per $1,000 requested coverage.

Accidental Death and Personal Loss (AD&PL)

AD&PL coverage is an added benefit to Basic and Supplemental Life, which will also pay a benefit amount up to employee's annual salary or equivalent to elected coverage amount.

Dependent Life

You can apply for dependent life insurance for your spouse and/ or dependent child(ren). The benefit amount for a covered spouse is $10,000 and $5,000 for each covered unmarried child up to age 26. If you wish to enroll your spouse, an EOI must be completed. Child(ren) can be enrolled without EOI requirement. Cost of Benefit: $2.54 per month to cover dependents. Please refer to Summary Plan Description for more information.

Voluntary Short-Term Disability

All full-time and part-time/temporary employees who are eligible for benefits may apply for Voluntary Short-Term Disability. It replaces some income if you are sick, injured (excludes workrelated illness or injury), or pregnant. In order to receive benefits, you cannot be actively working for pay. You do not have to exhaust your accrued paid leave prior to filing a claim to receive shortterm disability. An EOI application must be completed if you wish to apply for coverage or increase your current weekly benefit election. Enrollment or election increase approval is required.

Benefit Minimum Weekly Benefit Maximum Weekly Benefit (Weekly benefit amount may not need exceed 70% of your gross weekly earnings) Waiting Period

Accident

Illness/Injury/Pregnancy

Benefit Duration

Amount

$100

$650

0 Days 7 Days 26 weeks

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