2013 Employee Benefits Guidebook - Administration Home

EMPLOYEE BENEFITS 

Open Enrollment 

GUIDEBOOK 

A comprehensive guide to your 

EMPLOYEE BENEFITS 

for the 

2013 

Plan Year 

2013 Employee Benefit Guidebook 

Updated August 2013

EL PASO COUNTY’S 

EMPLOYEE BENEFITS GUIDEBOOK 

PLAN YEAR 2013 

PREFACE 

Your Benefits Guidebook is intended to provide information you need to assist with your 

employee benefit selections: 

 

 

 

 

 

The types of questions you can ask yourself to help you decide which plan(s) are best for 

you and your family; 

What benefits are available for the 2013 plan year; 

What administrative steps you must take to enroll; 

How to access your benefits; 

Where you can go to get more information or assistance regarding any of the plans 

offered by El Paso County. 

To take full advantage of the benefits, please take the time to fully consider each of the available 

benefit plan options explained in the guidebook. 

We have included a benefits telephone directory on the following page for your convenience 

when you have benefit questions. Please feel free to contact any of the vendors directly for any 

plan-related questions you may have now and throughout the year. 

If you have a general question regarding any of the benefit plans, please do not hesitate to call 

the EL Paso County EBMS Benefit Division at 719-520-7420, Monday-Friday, 8:00 a.m. to 5:00 

p.m. 

OPEN ENROLLMENT 

Please remember that open enrollment is the only time of the year that you may elect to make 

changes to benefit plans without having a Qualifying Life Event. 

ABOUT THE BENEFITS GUIDEBOOK 

This Guidebook is intended to provide a general overview of all the insurance benefit plans, 

including eligibility, cost, contact information and how to use your benefits. Should there be an 

inconsistency with any communications regarding these plans the actual Master Plan Documents 

will govern. Any information contained herein may be subject to change. 



PHONE DIRECTORY 

Employment, Benefits, and Medical Services Department 

Employee Benefits Division .......................................................................... 719 520-7420 

E-Mail ..................................................................................................ebms@elpasoco.com 

Workers Compensation Division.................................................................... 719 520-7486 

HIPAA Compliance........................................................................................ 719 520-7402 

Finance/Payroll Office 

Rhonda Wagoner ............................................................................................ 719 520-6427 

Debra Morrow................................................................................................. 719 520-7404 

Payroll Fax...................................................................................................... 719 520-6469 

Medical Plans 

Use the Member Service Number and Website below for Questions, Claims, ID Cards, and Pre- 

Authorizations 

Employee Benefits Management Services (EBMS) Member Services.......1-866-887-4115 

EBMS miBenefits Website Address............................................................www.ebms.com 

Care Link Pre-Notification and Priority Maternity Care .............................1-866-894-1505 

Cofinity Medical Network Customer Service Number and Website 

Find a Provider.................................... www.cofinity.net/EPCDirectory/Index.aspx 

Cofinity Medical Provider Network Customer Service...................1-800-831-1166 

El Paso County Employee Health Centers 

Regional Development Center (RDC) Health Center..................................... 719 520-7080 

Customer Service Center (CSC) ..................................................................... 719 520-7600 

Prescription Benefits 

Catamaran Rx Customer Service.................................................................1-800-207-2568 

Website .................................................................................................mycatamaranrx.com 

Mail Service Prescription Refills..............................1-800-RX-REFILL (1-800-797-3345) 

BriovaRx Specialty ........................................................................................1-800-850-9122 

Dental Plans 

Guardian Dental Member Services..............................................................1-800-541-7846 

Guardian Dental Web site...................................................... www.GuardianAnytime.com 



Vision Plan 

EyeMed Vision Care Customer Service ......................................................1-866-723-0596 

EyeMed Vision Care Website................................................. www.eyemedvisioncare.com 

Flexible Spending Accounts 

PayFlex Customer Service: .........................................................................1-800-284-4885 

PayFlex Claim Fax Number: ...................................................................... 1-800-450-0016 

PayFlex Website .................................................................................. www.healthhub.com 

Reach Your Peak Health Management Program 

Reach Your Peak Program Questions email:..................... RYPsimplywell@elpasoco.com 

Program Website................................................................................ www.simplywell.com 

Website Technical Questions.......................................................................1-877-991-9355 

Wellness Reimbursement Account (WRA) Website........................... www.healthhub.com 

Wellness Reimbursement Account (WRA) Customer Service…………...1-800-284-4885 

Employee Assistance Program (EAP) 

ComPsych ...................................................................................................1-800-272-7255 

Website ..................................................www.guidanceresources.com Web ID COM589 

Life and Disability Insurance 

UNUM Life Insurance .……………………………………………………1-800-421-0344 

Plan Highlights & Forms ........http://w3.unum.com/enroll/ElPasoCounty/enrollment.aspx 

Short Term Disability (policy #907374) - to file a claim...................... 888 673-9940 

STD Fax ................................................................................................ 800 447-2498 

General Questions Contact the Employee Benefits Office .................. 719 520-7420 

El Paso County Retirement Plan 

Retirement Benefit Information...................................................................... 719 520-7490 

Internet Address...............................................................................www.epcretirement.org 

Deferred Compensation (457 Plan) 

Great West Retirement Services ..................................................................1-800-947-4409 

Key-Talk ......................................................................................................1-800-701-8255 

Web Site....................................................................................................... www.gwrs.com 



IMPORTANT INFORMATION 

SUMMARY OF BENEFITS AND COVERAGE (SBC) AND SUMMARY PLAN 

DOCUMENTS (SPD): For a copy of the Summary of Benefits and Coverage and also the 

Summary Plan Documents contact the Employee, Benefits and Medical Services Department 

(EBMS) Benefits Division at (719) 520-7402, or go to www.elpasoco.com under the EBMS 

Benefits Division. This information is also available on Depot, the El Paso County Intranet site. 

ENROLLMENT AND EFFECTIVE DATE OF COVERAGE FOR MEDICAL, DENTAL, 

VISION AND LIFE INSURANCE BENEFITS: Eligible employees must complete the 

enrollment process (even if waiving coverage) through Employee Self Service (ESS) or by 

completing a Benefit Enrollment Form. Employees enrolling for coverage agree to pay the 

required contributions. Dependents of an eligible employee may not be enrolled in the Medical, 

Dental and Vision plans unless the employee is also enrolled for coverage under the Plan. 

If both spouses are employees of El Paso County and both are eligible for benefits, you should 

carefully review the contribution rates and select the option that provides the best coverage for 

you and your family at the lowest total cost. If both parents of an eligible dependent child are 

enrolled as a subscriber, only one parent may enroll the child as a dependent. 

ELIGIBLE DEPENDENTS: Eligible dependents include your lawful spouse and children who 

are less than 26 years old. Dependent children are also covered if age 26 or more years old and 

primarily supported by you and incapable of self-sustaining employment by reason of mental or 

physical handicap. You may be required to provide proof of the child’s dependent status to the 

health care provider or to the EBMS Benefits Division. 

You must provide the social security number (SSN) for dependents enrolled on our medical plan. 

Federal law requires group health plans and claim administrators to provide reports to the 

Centers for Medicare & Medicaid Services (CMS). We understand that you may have concerns 

with sharing your SSN. However, federal law requires that we collect this information so that 

accurate reports can be provided to CMS. This information will be shared only for reporting 

directly to CMS. The medical administrator sends the reports to CMS using a secure data 

transmission method to ensure the privacy and security of your information. 

Documentation for any covered dependents is also a requirement. If an employee enrolls a 

spouse, a copy of the marriage certificate must be provided. If enrolling children, copies of birth 

certificates must also be provided. These persons are excluded as Dependents: other 

individuals living in the covered Employee's home, but who are not eligible as defined in the 

Summary Plan Document (SPD); the divorced former Spouse of the Employee; foster children; 

or any person who is covered under the Plan as an Employee. See the SPD for additional 

information on eligible classes of dependents. 



ENROLLMENT: Enrollment must be completed within 31 days of your full-time hire date. If 

you do not enroll within this 31 day period, you will not be eligible to enroll until the next open 

enrollment period, unless you have a Qualifying Life Event. 

Full-time employees are required to have medical coverage. Therefore, if you waive medical 

coverage offered by El Paso County, you must provide proof of other medical coverage. 

If you do not submit your enrollment for medical coverage within the first 31 days, or 

waive coverage and fail to provide proof of other medical insurance coverage, EBMS has 

the right to enroll you in the lowest medical plan option offered and you will be required to 

pay past due premiums. If you do not submit your enrollment for dental coverage, you will not 

be eligible for enrollment in a dental plan until the next dental plan Open Enrollment period. 

WHEN COVERAGE IS EFFECTIVE: If you are hired full-time starting from the 1 st through 

the 15 th of the month, coverage for you and any of your enrolled dependents is effective on the 

first day of the next month. If you are hired full-time starting the 16 th through the last day of the 

month, coverage for you and any of your enrolled dependents is effective on the first day of the 

second following month. (Example 1: First day of full-time employment is January 15 th , 

coverage is effective February 1 st . Example 2: First day of full-time employment is January 

16 th , coverage is effective March 1 st .) 

In no event will health services be rendered or delivered before the effective date of coverage. 

WHEN COVERAGE ENDS: Coverage ends on the last day of the month that you separate 

employment, are no longer a full-time employee, the last day premiums are paid through, or 

when you no longer meet the eligibility requirements. 

ANNUAL OPEN ENROLLMENT: Every year each eligible employee is given an opportunity 

to change his or her benefit elections for the upcoming benefit plan year. Benefit elections made 

during the open enrollment period take effect January 1 st of the following calendar year. Changes 

to open enrollment elections will only be accepted if received by EBMS in writing by the last 

business day in December. After this date, changes can only be made during the plan year if you 

have a Qualifying Life Event (please see the Making Changes on the following page). 

BENEFIT PLAN YEAR: El Paso County’s “Plan Year” begins January 1 st and ends December 

31 st . 

CALENDAR YEAR DEDUCTIBLE: El Paso County’s “Calendar Year Deductible” begins 

January 1 st and ends December 31 st . 

PROVIDER AND FACILITY CONTRACTS: Although most physicians or providers and 

facilities that contract with our insurance plans remain with those network(s) year after year, you 

should always contact the plan vendor to verify that they are still participating in the plan 

network(s) and to verify if they are accepting new patients to ensure coverage. 



EMPLOYEE CONTRIBUTIONS AND POP: The employee medical, dental, vision and life 

insurance benefit contributions (see the monthly contribution schedule in this guidebook) are 

deducted the first and second pay period of each month through payroll deduction. (These 

deductions will not be taken when there is a third pay period in the month.) El Paso County 

health plans are Premium Only Plans (POP) allowing deductions to be taken on a pre-tax basis. 

With pre-tax deductions, you will not pay federal, state or social security taxes on these monies, 

but you may not claim your medical or dental premiums as a deduction on your Federal Income 

Tax Return. Because your taxable income will be smaller under the pre-tax method, your tax 

withholding will be less and your take home pay may be higher. A lower social security 

reportable income may lower your potential income from social security upon retirement. 

Unless you submit a written request for your contributions to be taken on after tax basis, 

contributions for health and/or dental premiums will automatically be deducted on a pre-tax 

basis. 

BENEFITS MAY BE TERMINATED FOR NON-PAYMENT OF BENEFIT PREMIUMS. 

ARRANGEMENT MUST BE MADE IN ADVANCE WITH THE EBMS BENEFITS 

DIVISION IF BENEFIT CONTRIBUTIONS ARE NOT DEDUCTED THROUGH 

PAYROLL (SUCH AS WHEN AN EMPLOYEE IS OFF WORK DUE TO WORKERS 

COMPENSATION, FMLA OR OTHER UNPAID LEAVE OF ABSENCE.) YOU WILL 

BE GIVEN 30 DAYS NOTICE EXCEPT IN CASES OF FRAUD OR INTENTIONAL 

MISREPRESENTATION. 

MAKING CHANGES – QUALIFYING LIFE EVENTS: If you have a qualifying life event as 

defined by the IRS you MUST submit a Benefit Change form directly to the EBMS Benefits 

Division within 31 days of the life event effective date. 

The following is a list of Qualifying Life Events and the required documentation: 

Qualifying Life Event Required Documentation: 

• Marriage: Marriage Certificate 

• Dissolution of Marriage/Common Law: Divorce Decree 

• Divorce: Divorce Decree 

• Legal Separation: Court Decree 

• Annulment: Court Decree 

• Birth/Adoption/Custody of Dependent: Birth Certificate/Final Court Decree 

• Death of a Dependent: Death Certificate 

• Loss/Gain of Spousal Medical/Dental Coverage: Letter from Spouses Former Employer 

or Insurance Company 

• Ineligible Dependent: Proof of Age 

• Medicare Eligibility: Proof of Medicare Eligibility 

• Medicaid Eligibility for your Dependents: Proof of Medicaid Eligibility 



Contact the EBMS Benefits Division with any questions regarding documentation. 

IF YOU DO NOT SUBMIT THE BENEFIT CHANGE FORM WITHIN THE 31-DAY 

PERIOD, YOU WILL NOT BE ALLOWED TO MAKE A CHANGE UNTIL THE NEXT 

OPEN ENROLLMENT PERIOD OR YOUR NEXT QUALIFYING LIFE EVENT. El 

Paso County can require you to provide documentation of your qualifying life event 

whenever you request changes. 

Failure to remove a dependent within 31 days of when the dependent is no longer eligible 

(i.e. divorce) will result in additional premiums due based on the COBRA rates and may be 

deducted through payroll. 

QUALIFYING LIFE EVENT EFFECTIVE DATE: Your new benefit elections made as a result 

of a Qualifying Life Event will take effect on the first day of the month coincident with or 

following the effective date of the Qualifying Life Event. Any benefit election changes must be 

consistent with the Qualifying Life Event. 

Changes to coverage due to a Marriage or Birth/Adoption/Custody of Dependent will take effect 

on the day of the Qualifying Life Event. 

COBRA: In the event of a loss of coverage, you and/or your eligible dependents may be eligible 

to continue medical/dental/vision insurance for a period of up to 18 months, or 29 months for 

disabled individuals. Please contact the Employee Benefits Office for more information. 

REACH YOUR PEAK HEALTH MANAGEMENT PROGRAM: Reach Your Peak (RYP) is a 

wellness program designed to assist you by promoting and maintaining your good health. If you 

(and your spouse, if applicable) are enrolled in the County medical plan, you can participate in 

this program. Please call 719 520-6960 with any questions and for information on the 

enrollment period. 

WORKERS COMPENSATION: For employees who are injured on the job or develop 

occupational illnesses, this insurance pays for all reasonable and necessary medical expenses 

and, if necessary, partial wage replacement during periods of temporary disability. It may also 

provide permanent disability entitlements for those who qualify. 

For any personal health (non-work related) problems, please seek the advise of your family 

physician. Worker’s Compensation does not cover expenses for non-work related accidents, 

injuries or illnesses (for example, a private automobile accident). Your health insurance 

coverage would apply. 

IF INJURED ON THE JOB, WRITTEN NOTICE MUST BE GIVEN TO YOUR EMPLOYER 

WITHIN FOUR (4) WORKING DAYS OF THE ACCIDENT PURSUANT TO SECTION 8- 

43-102-1 C.R.S. 

For questions regarding workers compensation, call the EBMS Workers Compensation Division 

at 719 520-7488. 



MEDICAL, VISION AND DENTAL PLAN PREMIUMS 

EMPLOYEE MONTHLY CONTRIBUTIONS 

January 1 st , 2013 

2013 Employee Benefits 

Employee 

Only 

Employee + 

Spouse 


Children 


Family 

El Paso County 

Medical/EBMS 

Cofinity EPO 

Network Plan 

Guardian PPO 

Dental Low 

Guardian PPO 

Dental High 

$73.84 $265.36 $246.10 $328.50 

$14.98 $25.16 $38.93 $56.91 

$38.90 $65.36 $101.15 $147.83 

EyeMed Vision Plan $5.72 $10.87 $11.44 $16.82 



MEDICAL PLANS 

EBMS MEDICAL BENEFITS 

EL PASO COUNTY MEDICAL EPO PLAN: 

In 2013 you will have one medical plan option – the El Paso County Medical EPO Plan 

administered by Employee Benefit Management Services (EBMS).* With this plan you have 

access to the County Employee Health Centers and a customized El Paso County Cofinity 

Network. 

The custom Cofinity Network uses only Penrose Hospital and Penrose affiliated providers and 

facilities to serve the Colorado Springs service area. Any non-emergent, medical services must 

be provided through a provider or facility contracted with Cofinity for this custom network. If 

you have procedures performed at a Memorial facility (now University of Colorado Health) or 

other non-contracted facilities (other than true emergencies and/or certain medical procedures 

not available through Penrose that have been pre-approved by the CareLink Care Management 

team), it will not be covered. You may find out if a provider is in the custom El Paso County 

Cofinity Network by calling Cofinity Provider Network Customer Service by logging on to their 

website at www.cofinity.net/EPCDirectory/Index.aspx. 

This plan has a $2,000 individual deductible ($6,000 Family Maximum) that applies to some 

services such as inpatient hospital services, surgery, and ambulance. 

See the EBMS Summary of Benefits on the following pages for additional information on 

deductibles, co-pays and co-insurance. 

*Please note that our medical plan administrator has the same acronym but is NOT the same as 

the El Paso County Employment, Benefits & Medical Services (EBMS) Department. 

GENERAL INFORMATION: Once you make your elections you may not change or cancel 

your benefits or change enrolled dependents until the next open enrollment period, unless you 

have a Qualifying Life Event. 

GRANDFATHERED HEALTH PLAN: 

El Paso County believes this Medical Health Plan is a “grandfathered health plan” under the 

Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the 

Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that 

was already in effect when that law was enacted. Being a grandfathered health plan means that 

your Plan may not include certain consumer protections of the Affordable Care Act that apply to 

other plans, for example, the requirement for the provision of preventive health services without 

any cost sharing. However, grandfathered health plans must comply with certain other consumer 

protections in the Affordable Care Act, for example, the elimination of lifetime limits on 

benefits. 



Questions regarding which protections apply and which protections do not apply to a 

grandfathered health plan and what might cause a plan to change from grandfathered health plan 

status can be directed to the plan administrator at EPC EBMS Benefits Department (719) 520- 

7420. You may also contact the U.S. Department of Health and Human Services at 

www.healthreform.gov. 

Medical Plan Summaries: 

Two medical plan summaries are listed on the following pages. 1.) The Standard Medical EPO 

Benefits Schedule reflects benefits for employees who did not meet the Reach Your Peak (RYP) 

Wellness 2012-2013 requirements for Phase 1 by the established deadline. 2.) The Reach Your 

Peak (RYP) Medical EPO Benefits Schedule reflects benefits for employees who are considered 

Reach Your Peak Wellness Program Participants. The RYP benefits are effective the first of the 

calendar year following complete enrollment in the RYP program. Please refer to the 

appropriate schedule of benefits. Your medical ID card will reflect the plan in which you are 

enrolled. 



STANDARD MEDICAL EPO BENEFITS SUMMARY 

PARTICIPATING 

PROVIDERS 

CALENDAR YEAR 

ANNUAL LIMIT $2,000 ,000 

NON-PARTICIPATING 

PROVIDERS 

DEDUCTIBLE, PER CALENDAR YEAR 

Per Covered Person $2,000 Not Covered 

Per Family Unit $6,000 Not Covered 

MAXIMUM OUT-OF-POCKET AMOUNT, PER CALENDAR YEAR 



The Plan will pay the designated percentage of Covered Charges until out-of-pocket amounts are reached, at 

which time the Plan will pay 100% of the remainder of Covered Charges for the rest of the Calendar Year unless 

stated otherwise. 

The following charges do not apply toward the out-of-pocket maximum and are never paid at 100%. 

 

Copayments 

COVERED CHARGES 

Hospital Services 

Inpatient Room and Board 75% after deductible and $500 

copayment per admission 

semiprivate room rate 

Intensive Care Unit 75% after deductible and $500 


Not Covered 

Not Covered 

Outpatient Facility Services 

Hospital's ICU Charge 

75% after $250 copayment per 

visit 

No deductible applies 

Not Covered 

Outpatient Physician services 

75%, no deductible or 

copayment applies 

Note: The copayment will apply as long as services billed include one or more of the facility room charges: 

Operating room, recovery room, procedures room, treatment room, and observation room. 

Skilled Nursing Facility, Rehabilitation 75% after deductible the 

Not Covered 

Hospital and 

Sub-Acute Facilities 

facility's semiprivate room rate 

Emergency Room Services 

100% after $200 copayment per visit; 



(including ER Physician services) 

Medical Non-Emergency Care 

Note: The ER copayment will be waived 

if admitted to the Hospital directly from 

the ER. 

Urgent Care Services 


visit; 



Not Covered 

Not Covered 

Note: The Urgent Care copayment will be waived if admitted to the Hospital directly from Urgent Care. 

Physician Services 

Inpatient Services 75% after deductible Not Covered 

El Paso County Employee Health Center 

(“Clinic”) Office Visit 

Primary Care Physician (PCP) 

Office Visit 


visit 



visit 

Not Covered 

Not Covered 


Note: A Primary Care Physician (PCP) is defined as a general practitioner, family practitioner, general internist 

(internist whose practice is 70% general medicine), Nurse Practitioner, Physician’s Assistant, or pediatrician. 

An OB/GYN will be considered a specialist. 

Specialist office visits 

Surgery performed in the office (including 

any medical supplies and injections 

rendered during the surgery) 


visit 


100% after $10 Clinic, $50 PCP 

or 

$75 Specialist copayment per 

visit 

Not Covered 

Not Covered 


Injections (other than allergy or 

100% 

chemotherapy) 

No deductible or copayment 

will apply 

Allergy serum and injections 100% 


will apply 

Preventive Care 

Routine Well Care 

(ages birth through adult) 

100% after $10 Clinic copay or 

$40 copayment for all other 

providers 


Not Covered 

Not Covered 

Not Covered 

Includes: Routine office visits, routine physical examination, mammogram, gynecological exam, Pap smear, 

PSA, routine lab and x-rays, routine colonoscopy, flexible sigmoidoscopy, and immunizations. 



Ambulance Service 

75% after deductible 

Note: Pre-authorization with the Claims Administrator will be required for non-emergent transport. 

Advanced Radiological Imaging (i.e., 

MRIs, MRAs, CAT Scans, PET Scans and 

Nuclear Medicine) 

75% 


will apply 

Not Covered 

Diagnostic X-ray & Lab Testing 100% 


Not Covered 

Durable Medical Equipment 100% 

Not Covered 


will apply 

Home Health Care 75% after deductible Not Covered 

Home Infusion Therapy 75% after deductible Not Covered 

Hospice Care 


Not Covered 

Note: A pre-authorization is required prior to services being rendered. Please see the Covered Charges section fo 

Bereavement Counseling 


Not Covered 

Mental Disorders and Substance Abuse Treatment 

Inpatient Services Payable as any other Illness Not Covered 

Outpatient Visits 

100% after $10 copayment 

Not Covered 


Morbid Obesity Benefit Payable as any other Illness Not Covered 

more information regarding this benefit. 

Nutritional Evaluation 

Outpatient Short-Term Rehabilitation 

Therapy and Chiropractic Services 

Payable as any other Illness 

3 visits per Calendar Year 

maximum 

100% after $20 copay per visit 


Not Covered 

Not Covered 

Includes: Cardiac Rehab, Physical Therapy, Speech Therapy, Occupational Therapy, Pulmonary Rehab, 

Cognitive Therapy and Chiropractic services. 

Multiple services provided on the same day constitute one visit, but a separate copayment will apply to the 

services provided by each Physician. 

Orthotics 75% after deductible Not Covered 

Note: See Covered Charges section for details. 

Prosthetics 100% 

Not Covered 


will apply 

Pregnancy * 

Initial visit 

(to confirm Pregnancy) 

100% after $75 Specialist office 

visit copayment 

Not Covered 



All subsequent prenatal visits, postnatal 

visits, and Physician’s delivery charges 

(i.e., global maternity fee) 

Physician’s office visits in addition to the 

global maternity fee (when performed by 

an OB/GYN or specialist) 

Delivery – Facility charges 

(Inpatient Hospital, Birthing Center) 

Organ Transplants 

Transportation Benefit Maximum 

(Available only when using a COE 

facility) 


100% after $75 office visit 

copayment 


Payable per Inpatient 

Hospitalization benefit 

Payable as any other illness 

$10,000 Lifetime Maximum 

Not Covered 

Not Covered 

Not Covered 

Not Covered 

Note: See the Covered Charges section for more information regarding this benefit. 

Wigs 



Note: Limited to the initial purchase of a wig when deemed Medically Necesssary due to temporary or permanen 

hair loss. See the Covered Charges section for more information regarding this benefit. 

All Other Eligible Charges 75% after deductible Not Covered 



REACH YOUR PEAK MEDICAL EPO BENEFITS SCHEDULE 

PARTICIPATING 

PROVIDERS 

CALENDAR YEAR 

ANNUAL LIMIT $2, 000,000 

NON-PARTICIPATING 

PROVIDERS 

DEDUCTIBLE, PER CALENDAR YEAR 



MAXIMUM OUT-OF-POCKET AMOUNT, PER CALENDAR YEAR 



The Plan will pay the designated percentage of Covered Charges until out-of-pocket amounts are reached, at whi 

time the Plan will pay 100% of the remainder of Covered Charges for the rest of the Calendar Year unless stated 

otherwise. 

The following charges do not apply toward the out-of-pocket maximum and are never paid at 100%. 

 

Copayments 

Upon a completed referral by the Clinic, recommended testing service and procedures rendered to determine or 

establish a diagnosis will be payable at 100% and will not be subject to either deductible or copayment. Once a 

diagnosis has been established, additional recommended medical treatments / services will be payable per norma 

REACH YOUR PEAK BENEFITS– REFERRAL REQUIREMENT 

Plan provisions. 

COVERED CHARGES 

Hospital Services 

Inpatient Room and Board 75% after deductible and $500 


Not Covered 

the semiprivate room rate 

Intensive Care Unit 75% after deductible and $500 


Not Covered 

Outpatient Facility Services 

Outpatient Physician services 

Hospital's ICU Charge 


visit 


75%, no deductible or copayment 

applies 

Not Covered 



Note: The copayment will apply as long as services billed include one or more of the facility room charges: 

Operating room, recovery room, procedures room, treatment room, and observation room. 

Skilled Nursing Facility, Rehabilitation 

Hospital and 

Sub-Acute Facilities 

75% after deductible the facility's 

semiprivate room rate 

Not Covered 

Emergency Room Services 

(including ER Physician services) 

100% after $200 copayment per visit; 


Medical Non-Emergency Care 

Not Covered 

Note: The ER copayment will be waived if admitted to the Hospital directly from the ER. 

Urgent Care Services 


Not Covered 

visit; 


Note: The Urgent Care copayment will be waived if admitted to the Hospital directly from Urgent Care. 

Physician Services 

Inpatient Services 75% after deductible Not Covered 

El Paso County Employee Health Center 100% after $10 copayment per 

Not Covered 

(Clinic) Office Visit 

visit 

Primary Care Physician (PCP) 

Office Visit 



visit 


Not Covered 

Note: A Primary Care Physician (PCP) is defined as a general practitioner, family practitioner, general internist 

(internist whose practice is 70% general medicine), Nurse Practitioner, Physician’s Assistant, or pediatrician. 

An OB/GYN will be considered a specialist. 

Specialist office visits 

Surgery performed in the office (including 

any medical supplies and injections 

rendered during the surgery) 


visit 


100% after $10 Clinic, $50 PCP 

or 

$75 Specialist copayment per visit 

Not Covered 

Not Covered 


Injections (other than allergy or 

100% 

chemotherapy) 

No deductible or copayment will 

apply 

Allergy serum and injections 100% 


apply 

Preventive Care* 

Routine Well Care 

(ages birth through adult) 

100% 


applies 

Not Covered 

Not Covered 

Not Covered 



Includes: Routine office visits, routine physical examination, mammogram, gynecological exam, Pap smear, PSA 

eight additional services that will be covered without cost-sharing requirements, please refer to SPD for full deta 

routine lab and x-rays, routine colonoscopy, flexible sigmoidoscopy, and immunizations. 

*Note: Due to the Affordable Care Act, Women’s preventive health care services has been expanded to include 

Ambulance Service 


Note: Pre-authorization with the Claims Administrator will be required for non-emergent transport. 

Advanced Radiological Imaging (i.e., 

MRIs, MRAs, CAT Scans, PET Scans and 

Nuclear Medicine) 

75% 


apply 

Not Covered 

Note: A pre-authorization is required prior to services being rendered. Please see the Covered Charges section fo 

Diagnostic X-ray & Lab Testing 100% 

Not Covered 


Durable Medical Equipment 100% 

Not Covered 


apply 

Home Health Care 75% after deductible Not Covered 

Home Infusion Therapy 75% after deductible Not Covered 

Hospice Care 75% after deductible Not Covered 

Mental Disorders and Substance Abuse Treatment 

Inpatient Services Payable as any other Illness Not Covered 

Outpatient Visits 

100% after $10 copayment 

Not Covered 


Morbid Obesity Benefit Payable as any other Illness Not Covered 

more information regarding this benefit. 

Nutritional Evaluation 


3 visits per Calendar Year 

maximum 

Not Covered 

Outpatient Short-Term Rehabilitation 

Therapy and Chiropractic Services 

100% after $20 copay per visit 


Not Covered 

Includes: Cardiac Rehab, Physical Therapy, Speech Therapy, Occupational Therapy, Pulmonary Rehab, Cogniti 

Therapy and Chiropractic services. 

Multiple services provided on the same day constitute one visit, but a separate copayment will apply to the servic 

provided by each Physician. 

Orthotics 75% after deductible Not Covered 

Note: See Covered Charges section for details. 

Prosthetics 100% 


apply 

Not Covered 



Pregnancy * 

Initial visit 

(to confirm Pregnancy) 

100% after $75 Specialist office 

visit copayment 

Not Covered 

All subsequent prenatal visits, postnatal 

visits, and Physician’s delivery charges (i.e., 

global maternity fee) 

Physician’s office visits in addition to the 

global maternity fee (when performed by an 

OB/GYN or specialist) 


100% after $75 office visit 

copayment 


Not Covered 

Not Covered 

Delivery – Facility charges 

(Inpatient Hospital, Birthing Center) 

Payable per Inpatient 

Hospitalization benefit 

Not Covered 

* Note: If a Clinic referral is received either to confirm a Pregnancy or after the initial diagnosis has been 

made and the Covered Person also enrolls in the CareLink Priority Maternity Care program during the 

first trimester of the Pregnancy, the Covered Person will not be subject to the inpatient hospital copay, 

inpatient hospital deductible or inpatient Physician deductible for the delivery charges or other pregnancy 

related treatment (billed with a primary diagnosis of “Pregnancy”). ER copay will also be waived if the vi 

is Pregnancy related (billed with a primary diagnosis of “Pregnancy”) 

Organ Transplants 


Not Covered 

Transportation Benefit Maximum 

(Available only when using a COE facility) 


Note: See the Covered Charges section for more information regarding this benefit. 

Wigs 



Note: Limited to the initial purchase of a wig when deemed Medically Necesssary due to temporary or permanen 

hair loss. See the Covered Charges section for more information regarding this benefit. 

All Other Eligible Charges 75% after deductible Not Covered 

This Guidebook is only a summary of benefits and is not a binding contract. Summary Plan Documents, Certificates of 

Coverage, and the El Paso County Policies and Procedures Manual describes benefits in great detail and are available 

through ESS or by contacting the Employee Benefits office. Should there be differences between this summary and the plan 

documents, contracts or policies, the plan documents, contract, and/or policies will govern. 



Employee/Retiree Health Centers 

Employees, retirees, spouses and children enrolled in the County’s medical plan can receive high 

quality health care services through the El Paso County Employee Health Centers (Clinics), operated 

by Take Care Health Systems.. 

El Paso County Employee Health Centers compliment your medical insurance benefits, providing 

you with comprehensive, affordable, convenient and excellent health care. Two Board Certified 

Family Physicians and a Board Certified Nurse Practitioner provide service at both El Paso County 

Employee Health Centers. This program works in collaboration with both providers and your 

medical insurance benefits to ensure that you receive the very best in health care. The Health 

Centers offer acute care as well as a variety of preventive health and wellness educational services. 

When appropriate, the Health Centers can also make referrals to Specialists. The Health Center 

Physicians and Nurse Practitioners can also write prescriptions. 

Health Center copays are only $10.00 for both nurse practitioner and PCP visits! Other medical 

services, such as immunizations and vaccinations, may carry an additional cost. 

Ensuring your privacy and maintaining confidentiality is assured — strict adherence to HIPAA 

guidelines ensures all personal medical information obtained by the Health Centers and pharmacies 

is protected and kept completely confidential. 

Following are just a few examples of the many services offered: 

Health Center Services include: 

Comprehensive Individual/Family Primary Care 

Urgent and Acute Care (flu, fever, viral 

infections, nausea, cuts, sprains/strains) 

Preventive Health (annual adult and children 

physicals) 

Disease Management 

Stress Management Counseling 

Smoking Cessation Counseling 

Wellness Education / Support 

Referrals to specialists 

Vaccinations, Injections & Laboratory Services 


Updated October 2013

Wellness Exams 

The County Employee Health Centers offer physicals for employees, dependents and retirees and 

their enrolled dependents. The cost of a physical is $10.00. 

Adults – Well Woman Physicals: Well woman physicals are also offered in the Health Centers. 

The physical includes a pap smear, breast exam and consultation on specific concerns or questions. 

Prenatal care is not offered at the Health Centers. 

Adolescents – Physicals: School and sports physicals are offered. The physicals include a 

comprehensive examination, risk appraisal, vision screen and appropriate vaccinations. Health and 

wellness advice will also be provided. Please bring record of immunizations and required school 

forms. 

2013 RYP Program Participants who are enrolled on the County Medical Plan will receive 

100% preventive coverage and will not be responsible for copayments. 

Regional Development Center (RDC) Health Center 

2880 International Circle, Lower Level 

Colorado Springs, CO 80910 

(719) 520-7080 

Monday-Friday 8 am to 5 pm 

Citizens Service Center (CSC) Health Center 

1675 W. Garden of the Gods Road, Suite 1053 

Colorado Springs, CO 809-7 

(719) 520-7600 

Monday-Friday 8 am to 5 pm 


Updated October 2013

El Paso County Health Centers 

Disease Management Program 

Disease management is an approach to healthcare that can help a patient learn how to manage a 

chronic disease. It is the concept of integrating care, minimizing the effects of a disease or chronic 

condition, and ultimately improving the lives of those being treated. 

Disease Management at the El Paso County Employee Health Centers is a confidential, on-site 

health improvement program, exclusively for El Paso County employees, retirees and dependents 

enrolled in the El Paso County medical plan. You will have the opportunity to work one-on-one 

with the Health Centers’ medical teams in lowering your health risks(s) such as type 2 diabetes, 

coronary heart disease, high blood pressure, heart failure, asthma, emphysema and lower back pain. 

The Disease Management Program at El Paso County Employee Health Centers is designed to help 

you and your doctor work together in managing your chronic health condition – whether you have 

been diagnosed by your own primary care physician, or you see a physician at one of the El Paso 

County Employee Health Centers. 

This program is 100% private, voluntary, and confidential. The services are provided by TakeCare 

Health Systems, the manager of our on-site El Paso County Employee Heath Centers. You can be 

assured that El Paso County will never have access to any individual health information from this 

program. 

For more information contact either the Health Centers at 520-7080 or 520-7600. 

©2008 Walgreens Health Initiatives, Inc., a wholly owned subsidiary of Walgreen Co. All rights reserved. 2013 Employee Benefits Guidebook 

Updated January 2013

Walgreens Health Initiatives now Catamaran 

Walgreens Health Initiatives (WHI) now Catamaran, administers the Prescription Drug Program 

for El Paso County. El Paso County Employees may fill their prescription through any 

Walgreens retail store for a 30 and/or 90-day supply. You can also obtain a 90-day supply of 

maintenance medications through the Walgreens Mail Service (Tempe, AZ facility). 

Filling Prescriptions at a Retail Pharmacy 

Filling through Catamaran will provide you with convenient access to a nationwide network of 

more than 6,500 retail Walgreens pharmacies. You can obtain a complete listing of pharmacies 

in your network by accessing the WHI website at www.walgreenshealth.com. Go to the 

pharmacy locator link, enter your six-digit RxGrp number of 112359 (found on your ID card), 

and enter your zip code or city and state. 

Filling Prescriptions at the Mail Service Pharmacy 

Through the Mail Service benefit, you can take advantage of convenient delivery of your 

covered maintenance medications to your home or other specified address. Maintenance 

medications are defined as medications that are used for chronic, long-term conditions such as 

high blood pressure, high cholesterol, etc. Specialty pharmacy medications are not considered to 

be maintenance medications. 

In order to use the Walgreens Mail Service pharmacy you will need to: 

Fill out a new Walgreens mail registration form, which was provided to you in your 

Catamaran Prescription packets. You can fill out one registration for your entire family 

even though you may not be filling a prescription for all members in your family. 

Obtain new prescription(s) from your doctor, and mail the originals along with your 

completed registration form, and copayment. The address to mail your order is provided 

on the Walgreens mail registration form. 

Please allow 14 days to process and mail your prescription(s). 

Catamaran Clinical Programs 

Specialty Pharmacy (injectable and oral medications) 

Catamaran Specialty Pharmacy provides convenient, dependable access to medications for 

people living with complex health conditions. Our programs and services focus on injectables, 

oral medications, and medication therapies involving strict compliance requirements; special 

storage, handling, and delivery; complex administration methods; and 

education/monitoring/ongoing support. Drugs that fall under this program can only be dispensed 

at a Walgreens retail pharmacy or via a home delivery method through the Walgreens Mail 

Service pharmacy. These drugs will be limited to a 30-day supply regardless if dispensed at a 

retail pharmacy or at a mail service pharmacy. Specialty Pharmacy copayments will apply at 

retail/mail. 

Drugs include the following, but are not limited to: Cystic Fibrosis medications, Enzyme 

replacement medications, Viral Hepatitis medications, Multiple Sclerosis medications, Growth 



Hormones, and all other biotech medications. Please call toll free at 1-888-782-8443 to preenroll 

in the Specialty Pharmacy program. 

Clinical Prior Authorization (CPA) 

Certain prescriptions may require “clinical prior authorization” or approval from Catamaran 

before they will be covered by your plan. The categories/medications that require clinical prior 

authorization may include, but are not limited to: 

Acne Topical (i.e. Retin-A, Avita, Differin) exceeding age 24 

Actiq 

ADHD/Narcolepsy (i.e. Dexedrine, Ritalin, Cylert) exceeding age 19 

Anabolic Steroids (oral, topical, injectable) 

Antiemetics (oral, i.e. Kytril, Zofran) are limited to a 7 day supply per 25 days. CPA if 

quantity limit is exceeded. 

Botulin Toxins (i.e. Botox, Myobloc) 

Butorphanol exceeding 2 bottles(5 ml)/25 days 

Byetta 

Crinone 8% 

Duragesic exceeding a quantity of 15/25 days 

Fentora 

Impotency (i.e. Viagra, Caverject, Levitra, Cyalis) CPA with max quantity of 8, if 

approved. 

Insomnia (i.e. Ambien, Restoril, Sonata) exceeding quantity of 90/144 days 

Lamisil/Sporanox/Penlac 

Oxycontin 

To request prior authorization for your prescription, the pharmacy, the physician or you may 

call the Prior Authorization Department toll free at 1-877-665-6609. Please have available the 

name of your medication, physician’s name, phone (and fax number, if available), your ID 

number, and your Rx Group number of 112359. 

Quantity Limits: 

Certain categories/medications may have quantity limits. These categories/medications may include, 

but are not limited to: 

 

 

 

 

 

 

Sleep Aids 

Pain Management 

Anti-Nausea 

Anti-psychotics 

Anti-depressants 

Migraine 

Your Cost: Retail, Mail-Order and Specialty Pharmacy 

When covered prescriptions are filled under this program, you will share a portion of the cost; the plan 

pays for the remainder. Your prescription drug program provides you with three-tier options. These 

formulary medications have received FDA approval as safe and effective. The Catamaran Preferred 



Medication List (PML)/formulary is available on the website at www.walgreenshealth.com. The online 

guide is updated regularly every calendar quarter or more often if needed to reflect important 

changes. Please note that although a drug is on a formulary, it does not necessarily mean that it is a 

covered drug under your plan. Refer to your Summary Plan Description for a list of 

coverages/exclusions. 

Walgreens Concierge Prescription Delivery to El Paso County Health 

Centers 

Walgreens is pleased to provide Concierge prescription delivery service to El Paso County RDC & 

CSC Health Centers effective January 2, 2013! With this new service offering, if you receive a 

prescription from a Take Care Health medical provider at the El Paso County CSC or RDC Health 

Center and would like to pickup your prescription at the CSC or RDC Health Center, you can take 

advantage of the Concierge Delivery Service. Below are a few highlights of this new service: 

Service Options: Concierge delivery service to the CSC Health Center is provided by Walgreens 

located at 4315 Centennial Blvd. (PH: 719-264-1400). Concierge delivery service to RDC Health 

Center will be provided by Walgreens located at 303 South Circle Dr. 

(Phone number: 719-444-8569). 

Sign-up for Express Pay: In order for Walgreens to deliver your prescription to the El Paso County 

Health Center (RDC or CSC), you must sign-up for Express Pay which allows payment for delivered 

prescriptions. There are two easy ways to enroll in Express Pay: 

1) visit any Walgreens store and put a credit or debit card on file 

OR 

2) register for Express Pay online at: http://www.walgreens.com/pharmacy/expresspay-info 

Request Concierge Service: Once you have signed up for Express Pay, you can request Concierge 

Prescription Delivery service by making a verbal request to your El Paso County Health Center 

medical provider for each El Paso County Health Center medical provider prescription (new or refill) 

that you would like to pick-up at the onsite health center. Please note if you have a refill prescription 

setup at another Walgreens (different from Service Options listed above), then you will need to contact 

Walgreens and request that the originating refill prescription be transferred to the designated 

Walgreens Pharmacy servicing El Paso County RDC or CSC Health Center. 

Same Day Delivery: Prescriptions submitted by El Paso County Health Center medical providers 

Mon-Fri by 12:00 pm to Walgreens will be eligible for same day pickup at the RDC or CSC Health 

Center between 2:30 pm-4:00 pm. Please note some exceptions may apply. 

Next Day Delivery: Prescriptions submitted by El Paso County Health Center medical providers Mon- 

Fri after 12:00 pm to Walgreens will be eligible for next day pickup at the RDC or CSC Health Center 

between 2:30 pm - 4:00 pm. Please note some exceptions may apply. 

Returns: Please note that any prescriptions not picked up by 4:00 pm each Friday will be returned to 

the Walgreens Pharmacy that delivered the prescription. 



Your costs for the program are as follows: 

Pharmacy 

Walgreens 

Retail 

Pharmacy 

Drug Type/Copay Tier 

Member Copay 

Up to a 30 Day 84-90 Day 

Supply 

Supply* 

Generic $6.00 $15.00 

Preferred Brand $24.00 $60.00 

Non-Preferred Brand $42.00 $105.00 

Preferred Brand - Specialty Medication** $100.00 

Non-Preferred Brand - Specialty Medication** $200.00 

Up to a 90 Day 

Supply 

Walgreens 

Mail Order 

Pharmacy 

Generic $15.00 

Preferred Brand $60.00 

Non-Preferred Brand $105.00 

Preferred Brand - Specialty Medication** $100.00 

Non-Preferred Brand - Specialty Medication** $200.00 

*Your prescription must be written for at least an 84-day supply in order to obtain at the retail pharmacy. 

**Covered Specialty Pharmacy medications are limited to a 30-day supply. For Specialty Pharmacy medications, a Patient 

Max-Out-of-Pocket (MOOP) of $2,500.00 applies per individual, per calendar year. Once the MOOP is met, the member's 

copayment is zero for the remainder of the calendar year. 

Note: Eligible RYP members who have been compliant with their diabetes, hypertension, and/or 

cardiovascular disease medications will receive waived copays for the fourth quarter of the calendar 

year. This program begins in 2013. 

It is standard pharmacy practice (and in some states, it is even required by law) to substitute generic 

equivalents for brand-name drugs whenever possible. When you use the mail service or a 

participating retail pharmacy, you may receive generic substitutes whenever available and allowable. 

If you select a brand name drug when a generic equivalent is available, you will be responsible for 

the difference in the cost of the brand and generic drug, plus your applicable 

Copayment.


Updated August 2013 

EYEMED 

VISION PLAN 

Basic Services Network Non-Network 

Exams with Dilation as Necessary $10 copay $35 

Exam Options: 

Standard Contact Lens Fit and Follow-Up Up to $55 N/A 

Premium Contact Lens Fit and Follow-Up 10% off Retail Price N/A 

Materials No copay N/A 

Frequency of Services 

Exams 

every 12 months 

Lenses 


Frames 


Contact Lenses 


Lenses Network Non-Network 

Standard Plastic Lenses: 

Single Vision $25 copay $40 

Bifocals $25 copay $60 

Trifocals $25 copay $60 

Lenticular $25 copay $80 

Standard Progressive Lens* $90 $60 

Premium Progressive Lens* $90 

$60 

80% of charge less $120 allowance 

Lens Options: 

UV Treatment $15 N/A 

Tint (Solid and Gradient) $15 N/A 

Standard Plastic Scratch Coating $0 $5 

Standard Polycarbonate – Adults $40 N/A 

Standard Polycarbonate – Kids under 19 $40 N/A 

Standard Anti-Reflective Coating $45 N/A 

Polarized 20% off Retail Price N/A 

Other Add-Ons 20% off Retail Price N/A 

Contact Lenses (in lieu of lenses & frames) 

Medically Necessary 

Conventional 

Disposable 

Standard Frames 

No copay 

$130 allowance 

No copay; $130 allowance 

15% off balance over $130 


Plus balance over $130 


20% off balance over $130 

Additional Benefits 

Fundus Photography Up to $39 N/A 

Lasik or PRK from U.S. Laser Network 15% off Retail Price or 5% off promotional 

Additional Pair of Glasses 

price 

40% discount off complete pair eyeglass 

purchases & 15% discount off conventional 

contact lenses once the funded benefit has been 

$200 

$105 

$105 

$45 

N/A 

N/A

* Standard/Premium Progressive lenses not covered - fund as a Bifocal Lens 

used 

Additional Discounts: 

Members also receive 15% off retail price or 5% off promotional price for Lasik or PRK from the US Laser 

Network, owned and operated by LCA Vision. 

After initial purchase, replacement contact lenses may be obtained via the Internet at substantial savings 

and mailed directly to the member. Details are available at www.eyemedvisioncare.com. 

The contact lens benefit allowance is not applicable to this service. 

Benefit Allowances provide no remaining balance for future use within the same Benefit Frequency. 

Certain brand name Vision Materials in which the manufacturer imposes a no-discount practice. 

Additional Purchases and Out-of-Pocket Discount Benefits are not provided for services or materials arising 

from: Orthoptic or vision training, subnormal vision aids and any associated supplemental testing; Aniseikonic 

lenses; Medical and/or surgical treatment of the eye, eyes or supporting structures; Any eye or Vision 

Examination, or any corrective eyewear required by a Policyholder as a condition of employment; safety 

eyewear; Services provided as a result of any Workers’ Compensation law, or similar legislation, or required by 

any governmental agency or program whether federal, state or subdivisions thereof; Plano (non-prescription) 

lenses and/or contact lenses; Non-prescription sunglasses; Two pair of glasses in lieu of bifocals; Services or 

materials provided by any other group benefit plan providing vision care; Certain brand name Vision Materials in 

which the manufacturer imposes a no-discount policy; or Services rendered after the date an Insured Person 

ceases to be covered under the Policy, except when Vision Materials ordered before coverage ended are 

delivered, and the services rendered to the Insured Person are within 30 days from the date of such order. Lost or 

broken lenses, frames, glasses, or contact lenses will not be replaced except in the next Benefit Frequency when 

Vision Materials would next become available. 

Benefits may not be combined with any discount, promotional offering, or other group benefit plans. 

Standard/Premium Progressive Lens not covered - fund as a Bifocal Lens. Standard Progressive Lens covered - 

fund Premium Progressive as a Standard. Member will receive a 20% discount on remaining balance at 

Participating Providers beyond plan coverage; the discount does not apply to EyeMed's Providers' professional 

services or disposable contact lenses. Members also receive a 40% discount off complete pair eyeglass purchases 

and a 15% discount off conventional contact lenses once the funded benefit has been used. 

Underwritten by Combined Insurance Company of America, 5050 Broadway, Chicago, IL 60640, except in New 

York. CICA Form # VN P63007 0801. This is a snapshot of your benefits. The Certificate of Insurance is on file 

with your employer. 



Guardian 

DENTAL PLANS 

El Paso County offers two options with Guardian Dental: Low Option PPO and a High Option PPO. A 

comparison of the two plans is shown on the following page. 

On the Low and High Guardian Dental options, dental procedures are covered either through a Guardian 

Dental Guard Preferred Network PPO dental provider or through any licensed dentist. A listing of Network 

providers can be found through the Guardian website at www.GuardianAnytime.com, clock on the “Find a 

Provider” in the right hand corner of the page. Next click the box “Find a Dentist”. When prompted for the 

Dental Plan, select “PPO”, and for the Dental Network choose ‘DentalGuard Preferred” Network. 

Guardian Dental 

Comparison of 2013 Plans 

DENTAL SERVICES LOW OPTION HIGH OPTION 

In 

Network 

Out of 

Network 

In 

Network 

Out of 

Network 

Teeth Cleaning – 2 per calendar year 100% 80% 100% 100% 

Oral Evaluations (Diagnostic) 100% 80% 100% 100% 

X Rays (Diagnostic) 100% 80% 100% 100% 

Lab and Other Diagnostic Tests 100% 80% 100% 100% 

Prophylaxis (Preventive) 100% 80% 100% 100% 

Fluoride Treatment (Preventive) for children 

100% 80% 100% 100% 

under age 19 

Fillings (Amalgam & Anterior Composites) 80% 60% 90% 70% 

Crowns: Stainless Steel 80% 60% 90% 70% 

Simple Extractions 80% 60% 90% 70% 

Oral Surgery (simple extractions) 80% 60% 90% 70% 

Endodontic Services – Root Canal Therapy 50% 30% 90% 70% 

Periodontal Services 50% 30% 90% 70% 

Inlays/Onlays/Bridges 50% 30% 60% 30% 

Dentures and other Removable Prosthetics 50% 30% 60% 30% 

Fixed Prosthetics 50% 30% 60% 30% 

Crowns: Resin, Metal 50% 30% 60% 30% 

Implants 50% 30% 60% 30% 

Orthodontia N/A N/A 50% 50% 

Orthodontia Eligibility N/A Adults and Children 

Deductible Per Person $50/$150 $50/$150 $25/$75 $50/$150 

Deductible applies to Preventive & Diagnostic No No No No 

Ortho Lifetime Maximum N/A N/A $1500 

Calendar Maximum includes In and Out of 

$1,000 $1,000 $1,500 $1,500 

Network 

Waiting Period applies No No 

Out of Network Basis MAC UCR 90th 

This Guidebook is only a summary of benefits and is not a binding contract. Summary Plan Documents, Certificates of Coverage, and the El Paso County 

Policies and Procedures Manual describes benefits in great detail and are available through ESS or by contacting the Employee Benefits office. Should 

there be differences between this summary and the plan documents, contracts or policies, the plan documents, contract, and/or policies will govern 

Dental Rate Proposal 



Maximum Rollover Feature: 

With Maximum Rollover, Guardian will roll over a portion of your unused annual maximum into your 

personal Maximum Rollover Account (MRA). The MRA can be used in further years, if you reach the 

plan’s annual maximum. 

Even better, if you use the services of Preferred Providers exclusively during the benefit year, Guardian will 

increase the amount credited to your MRA. 

To qualify, you must submit a claim for covered services for which a benefit payment is issued, in excess of 

any deductible or co-pay, and you must not exceed the paid claims threshold during the benefit year. 

You and your insured dependents maintain separate MRAs based on your own claim activity. Each MRA 

may not exceed the MRA limit. 

You will receive an annual MRA statement detailing your account and those of your dependents. 

High Plan: 

Low Plan: 

PLAN ANNUAL 

MAXIMUM ** 

THRESHOLD 

MAXIMUM 

ROLLOVER AMOUNT 

IN-NETWORK ONLY 

MAXIMUM 


MAXIMUM 

ROLLOVER 

ACCOUNT LIMIT 

$1500 $700 $350 $500 $1250 

PLAN ANNUAL 

MAXIMUM ** 

THRESHOLD 

MAXIMUM 


IN-NETWORK ONLY 

MAXIMUM 


MAXIMUM 

ROLLOVER 

ACCOUNT LIMIT 

$1000 $500 $250 $350 $1000 

This Guidebook is only a summary of benefits and is not a binding contract. Summary Plan Documents, Certificates of Coverage, and the El Paso County 

Policies and Procedures Manual describes benefits in great detail and are available through ESS or by contacting the Employee Benefits office. Should 

there be differences between this summary and the plan documents, contracts or policies, the plan documents, contract, and/or policies will govern 



What is an FSA? 

FLEXIBLE SPENDING ACCOUNTS (FSA) 

An FSA is a Flexible Spending Account that allows you to set aside money for eligible expenses on a pre-tax 

basis. There are two types of Flexible Spending Accounts available - a healthcare account and a dependent day 

care account. 

What you need to know about FSAs 

• You may only determine your contribution in an FSA during open enrollment or when you first become 

eligible. 

• You do not need to be covered by your employer’s health plan to participate in an FSA. 

• Expenses must be for services received, not for services to be provided in the future. 

• Once you establish your plan year contribution, you may only change it if you experience a Qualifying Life 

Event. 

• Any claims that were incurred during the plan year must be submitted for reimbursement by the end of your 

run out period (60 days). The run out date is 60 days after the end of your plan year or February 28, 2014. 

• Any amount left in your healthcare and/or dependent day care FSA at the end of the plan year will be 

forfeited. 

An FSA is a smart way to save! 

Annual 

Salary 

Healthcare contribution 

Dependent day 

care contribution 

Savings 

$20,000 $1,500 $0 $405 

$40,000 $1,750 $4,000 $1,553 

$60,000 $2,000 $4,500 $1,755 

Getting started is as easy as 1-2-3! 

1. Estimate the amount you will spend on out-of-pocket healthcare expenses and/or dependent day care 

expenses during the plan year. 

• Review expenses from prior plan year. 

• Use our planning tools available at HealthHub.com 

2. Decide how much you wish to set aside in your healthcare FSA and/or dependent day care FSA. 

• Divide your annual contribution by 26 pay periods in your plan year to determine the amount that 

will be deducted from you paycheck each pay period. 



3. As you incur eligible healthcare and dependent day care expenses throughout the year, you can 

access your funds by: 

• Using your PayFlex Card OR 

• Submitting a claim for reimbursement 

Quick Tip: View a listing of eligible expenses Login to HealthHub.com > My HealthHub Resources > 

Planning Tools 

My HealthHub Resources: Education & Planning Tools 

• Savings calculator to help you estimate your healthcare & dependent day care expenses 

• Digital library designed to help you understand FSAs 

• Educational materials & forms to better assist you with your spending account(s) 

Quick Tip: Find out how much you can save Login to HealthHub.com > My HealthHub Resources > 

Planning Tools 

Healthcare Flexible Spending Account: 

What you should know: 

Reimburses you for out-of-pocket medical, dental, prescription or vision services, such as deductibles, copays, 

and coinsurance. The maximum annual amount reimbursed may not exceed $2,500. 

Allows you to set aside money for eligible expenses on a pre-tax basis for you, your spouse and/or 

dependents. 

You do not pay Federal income or Social Security taxes on this money. 

Your entire contribution is available at the beginning of the plan year. 

View a detailed listing of eligible expenses at HealthHub.com 

OTC Items 

Since January 1, 2011, certain OTC medicines and drugs are considered ineligible unless you have a written 

prescription from your doctor. You cannot get reimbursed for OTC drugs or medicine unless you have a 

prescription. In addition, healthcare cards (e.g., PayFlex Card ) cannot be used to pay for OTC drugs and 

medicines. 

Dependent Day Care Flexible Spending Account: 

What you should know: 

Reimburses you for expenses such as day care, before and after school programs, nursery school or 

preschool, summer day camp and even adult day care. 

For day care expenses of a child under age 13 OR for the care of a dependent who is physically or mentally 

incapable of taking care of themselves. 

You and your spouse, if married must be actively working, seeking employment, or full-time student, in 

order to get reimbursed. 



You can only be reimbursed up to the amount that is available in your account. 

View a detailed listing of eligible expenses at HealthHub.com 

The annual expense reimbursement may not exceed: 

o the lesser of your earned income; 

o if married, your spouse’s earned income; 

o $5,000 ($2,500 if married, filing separate income tax returns) 

Eligible expenses: 

• Licensed day care provider 

• In-home provider as long as the care provider is not your child under age 19, or someone you claim as a 

tax dependent 

• Summer camps (not overnight) 

• Tuition through preschool 

• Before and after school care (under age 13) 

Ineligible expenses: 

• Tuition expenses for kindergarten and beyond 

• Overnight camps 

• Child care expenses for a child 13 or older (unless disabled) 

• Child care expenses for night-time babysitting 

• Child care expenses while you are on an extended leave of absence 

• Care provided by an older dependent or sibling 

Questions? 

Contact PayFlex Customer Service at 800.284.4885, 7am-7pm, Monday – Friday and Saturday 9am-2pm CT. 

Quick Tip: Enroll in direct deposit Login to HealthHub.com > Financial Center > Enroll in Direct Deposit 

Reimbursement Methods 

Online: www.HealthHub.com 

Fax: 402.231.4310 

Mail: PayFlex Systems USA, Inc. 

PO Box 3039 Omaha, NE 

68103-3039 



LIFE INSURANCE PLANS 

BASIC LIFE/ACCIDENTAL DEATH AND DISMEMBERMENT PLAN BENEFIT 

EMPLOYEE: LIFE BENEFIT: $40,000 AD&D BENEFIT: $40,000 

SPOUSE: LIFE BENEFIT: $2,000 AD&D BENEFIT: $0 

CHILD: LIFE BENEFIT: $1,000 first 6 months/$2,000 thereafter until age 26 

TERM LIFE: This coverage is Term Life Insurance. The Life Insurance benefit is payable to 

the designated beneficiary upon the death of the insured. Coverage is provided for the time 

period that you are eligible and premium is paid. There is no cash value associated with this 

product. 

AD&D: Accidental Death and Dismemberment Insurance provides specified benefits for a 

covered accidental bodily injury that directly causes dismemberment (i.e. the loss of a hand, foot, 

or eye). In the event that death occurs to an employee from a covered accident, both the Life and 

the AD&D benefit would be payable. 

ELIGIBILITY: All full-time active employees working 40 or more hours per week in an eligible 

class are eligible for coverage on the policy effective date. A delayed effective date will apply if 

the employee is not actively at work on the date the insurance would otherwise take effect. 

GUARANTEE ISSUE: For timely entrants enrolled within 30 days of becoming eligible, up to 

$40,000 in coverage is available without any evidence of insurability requirement. 

LIVING BENEFIT: A living benefit (also called an Accelerated Death Benefit) is available to 

employees who have satisfied the Active Work Rule. When such employees are diagnosed as 

terminally ill (having 12 months or less to live), they may withdraw up to 75% of their life 

insurance coverage to a maximum of $30,000. The death benefit will be reduced by the amount 

taken as a Living Benefit, plus interest. 

PORTABILITY: If you terminate your employment or if you become ineligible for this 

coverage, you have the option to convert all or part of the amount of Life Insurance in force on 

the date of termination at the group rates. Conversion election must be made within 30 days of 

your date of termination. 

BENEFIT REDUCTION: Life and AD&D benefits will terminate at retirement. Prior to this, 

reduce to: 65% at age 70 and at age 75 benefits reduce further to 50% of the original amount. 

This is only a summary of coverage and is not a binding contract. A certificate of coverage will 

be made available to you that will describe the benefits in greater detail. Should there be 

differences between this summary and the contract, the contract will govern. 



VOLUNTARY TERM LIFE INSURANCE 

Voluntary Term Life insurance is an optional benefit. Coverage is available in $10,000 

units starting at $10,000 up to the lesser of seven (7) times your salary rounded to the next 

highest $10,000 or $500,000 for employees and up to the lesser of 100% of the employee’s 

elected amount or $250,000 for spouses. You may also elect a flat $10,000 of coverage for 

dependent child(ren). 

You must elect coverage in order to elect coverage for your spouse or dependent child(ren). 

If you choose to elect AD&D coverage, the amount of coverage will be the same as your life 

insurance. 

Up to $200,000 of coverage is guaranteed for you the employee and up to $30,000 for your 

spouse as long as you, your spouse or dependent children meet eligibility requirements and 

enroll within the first 30 days from your eligibility date. This means no medical questions are 

asked in order to sign up for coverage up to these limits. 

Any coverage applied for above the guaranteed coverage amounts requires an Evidence of 

Insurability form to be completed along with the Enrollment Form. These forms can be found at 

http://w3.unum.com/enroll/ElPasoCounty/enrollment.aspx. 

If you do not elect the minimum coverage when first eligible, you will only be eligible again at 

the next Open Enrollment period and Evidence of Insurability will be required to obtain this 

coverage. 

Additional medical information may be required depending on the amount applied for, or in 

response to the information disclosed on the application. 

During the 2013 open enrollment period, if you already have the minimum amount of life 

insurance ($10,000) for yourself and your dependents, you can purchase additional insurance up 

to the Guaranteed Issue (GI) amount, as long as you remain actively at work. 

Please see rates on the following page. 



AD&D Coverage Rates 

Employee, Spouse & Child 

AD&D 

Semi-Monthly Rate 

$.100 per $10,000 

Term Life 

Coverage Rates 

Rates shown are your semi-monthly deduction: 

A tobacco user is defined as anyone who currently uses or has used a 

tobacco product within the last 12 months. 

Employee and Spouse Life Semi-Monthly 

Step Rates per $10,000 

Child Life 

Semi-Monthly Rate 

Age Non-Tobacco Tobacco 

15-24 0.220 0.310 $1.00 per $10,000 

25-29 0.220 0.310 

30-34 0.265 0.395 

35-39 0.310 0.530 

40-44 0.570 1.275 

45-49 0.925 2.155 

50-54 1.585 3.390 

55-59 2.465 5.700 

60-64 3.870 8.850 

65-69 6.700 15.95 

70-74 12.50 28.50 

75+ 12.50 28.50 

Insurance Age: Your rate is based on your insurance age. To calculate your insurance age, 

subtract your year of birth from the year your coverage becomes effective. 



DISABILITY BENEFITS 

SHORT TERM DISABILITY (STD) - Unum Policy #907374 

WEEKLY BENEFIT: If you are Totally Disabled beyond the elimination period due to a 

covered injury or sickness, you may be eligible to receive a weekly benefit of 60% of your basic 

weekly income to a maximum benefit of $1,000. This benefit may be reduced by income or 

benefits from certain other income sources listed in your plan document. 

DEFINITION OF TOTAL DISABILITY: Total Disability is defined as the inability to perform 

the material and substantial duties of the employees’ regular occupation due to injury or illness 

as certified by a health care provider and approved by the Disability Management Company. 

ELIGIBILITY DATE: An employee becomes eligible for coverage provided by the Policy on 

the later of the Policy’s effective date or the date the Insured Employee satisfies the Waiting 

Period specified in the Policy Effective Date. 

POLICY EFFECTIVE DATE: Employees are eligible for coverage on the first of the month 

following the first day of full-time employment or concurrent with their date of hire if hired on 

the first day of the month. If you are hired full-time starting from the 1 st through the 15 th of the 

month, coverage is effective the first day of the next month. If you are hired full-time starting 

the 16 th through the last day of the month, coverage is effective on the first day of the second 

following month. (Example 1: First day of full-time employment is January 15 th , coverage is 

effective February 1 st . Example 2: First day of full-time employment is January 16 th , coverage 

is effective March 1 st .) 

ELIMINATION PERIOD: Benefits begin following 14 continuous days of Disability or 

following exhaustion of available sick and vacation benefits, whichever is later. 

HOW TO REPORT A DISABILITY CLAIM: 

1. Advise your supervisor or manager as soon as possible, preferably on or before your first 

absence. 

2. Call the UNUM hotline at 888-673-9940 as soon as possible, or you can access the form 

on the following website: http://w3.unum.com/enroll/ElPasoCounty/enrollment.aspx 

NOTIFICATION OF CLAIM DECISION: The insurance company will notify both the 

employee and the Benefits Administrator of their claim decision. Claims can take a few weeks 

or even longer to be processed so employees are encouraged to submit their paperwork as soon 

as possible. STD checks are available in the Employee Benefits and Medical Services Benefits 

Division office after 9:00 a.m. on paydays. 

SUMMARY PLAN DESCRIPTION (SPD): The SPD information may be obtained by 

contacting the Employee Benefits Division at 719-520-7420. 

WHO PAYS FOR DISABILITY COVERAGE: Employees are required to contribute $5.00 per 

pay period for their Short Term Disability coverage. 



LONG TERM DISABILITY (LTD) – Unum Policy # 907338 

MONTHLY BENEFIT: If you are Totally Disabled beyond the elimination period due to a 

covered injury or sickness, you will be eligible to receive a weekly benefit of 60% of predisability 

earnings (when combined with other income sources) up to a maximum monthly 

benefit of $6,500. This benefit may be reduced by income or benefits from certain other income 

sources listed in your certificate. 

ELIMINATION PERIOD: You need to satisfy a 180-day elimination period before benefits 

would begin. This elimination period can be satisfied with days of Partial Disability, Total 

Disability or a combination of both. The elimination period may be met by days of disability 

built up over an accumulation period of 360 days, so there is no penalty for briefly attempting to 

return to work during this elimination period. 

ELIGIBILITY: All full-time active employees working 40 or more hours per week are eligible 

for coverage on the policy effective date. A delayed effective date will apply if the employee is 

not actively at work on the date the insurance would otherwise take effect. 

DEFINITION OF TOTAL DISABILITY: Total Disability is defined as the inability to perform 

each of the main duties of your own occupation, due to injury and illness. Your “own” 

occupation is covered for 24 months. Following this, the definition of disability becomes the 

inability to perform any occupation for which you are reasonably fitted, based on your 

experience, education or training. 

BENEFIT DURATION: Benefits may continue to be paid until you reach age 65/SSNRA, as 

long as you meet the definition of disability. Please note that certain conditions may be limited 

benefit durations. Review your employee certificate of coverage for clarification. 

PRE-EXISTING CONDITION: Benefits will not be paid for any disability for which you 

received medical treatment, care or consultation, including diagnostic measures or took 

prescribed drugs or medications during the three months preceding your effective date under this 

policy, until you are covered under this policy (or a prior policy) for 12 consecutive months 

before disability begins. 

SUMMARY PLAN DESCRIPTION (SPD): The Long Term Disability SPD information may 

be obtained by contacting the Employee Benefits office at 719-520-7420. 

WHO PAYS FOR DISABILITY COVERAGE: El Paso County pays the full cost for Long Term 

Disability premium costs. 

For more information, please contact the EBMS Benefits Division. 

This is only a summary of coverage and is not a binding contract. Certificates of Coverage, which describes 

benefits in great detail, are available through ESS or by contacting the EBMS Benefits Division. Should there 

be differences between this summary and the plan contract, the contract will govern. 





EL PASO COUNTY RETIREMENT PLAN 

The El Paso County Retirement Plan is a Defined Benefit Plan as stated under section 401(a) of 

the IRS Code. Participation is mandatory. 

CONTRIBUTION LEVEL: Beginning January 1, 2013, the contribution amount is 8% of your 

pre-tax salary. The County also contributes 8% each pay period. By having the contributions 

withheld on a pre-tax basis, the amount of your taxable income is lowered. No additional 

contributions can be made to this Plan. 

VESTING: If hired after January 1, 2013, the vesting period under this Plan is 8 years. If hired 

prior to January 1, 2013 the vesting period is 5 years. This means after you have been employed 

5 or 8 years, depending on your hire date and once you reach the age requirements, you would be 

eligible for a lifetime retirement benefit. 

RETIREMENT ELIGIBILITY: Normal retirement age is 62. You can retire under the Rule 

of 75 with a full benefit. The Rule of 75 = your age and service total the number 75 (i.e. age 50 

with 25 years). No minimum age. Early retirement is age 55 at a reduced rate of 3% for each 

year you are under 62. All benefits are lifetime benefits. 

BENEFIT CALCULATION: The benefit is calculated using your FAMP Final Average 

Monthly Salary (highest 36 months out of last 10 years) x Service x the benefit multiplier. 

Pre-2010 employment- 

The formula for calculating your monthly benefit is: 

(FAMP x Service x 2.22%) + (FAMP x Service x 2.00%) 

Post-2010 employment- 

The formula for calculating your monthly benefit is: 

FAMP x Service x 2.00% 

SEPARATION BENEFITS – NOT VESTED: If hired after 2013 and you leave employment 

with less than 8 years of service, you are required to remove your contributions from the Plan. If 

hired prior to 2013 and you leave employment with less than 5 years of service, you are required 

to remove your contributions from the Plan. You are paid your contributions plus interest. The 

County’s portion is forfeited. 

Since the money was withheld on a pre-tax basis, unless the money is rolled over into an IRA or 

another retirement plan, 20% Federal Income Tax is withheld from the distribution. In addition, 

at the time you file your taxes for the year in which you received the distribution; there is a 10% 

early distribution penalty if you are under age 59½ . If you roll it over, taxes are deferred and 

there is no tax penalty. 

SEPARATION BENEFITS – VESTED: If hired after 2013 and you leave employment with 8 

years or more of service, you have the option of taking the money out of the Plan with the same



provisions stated above. If hired before 2013 and you leave employment with 5 years or more of 

service, you have the option of taking the money out of the Plan with the same provisions stated 

above. 

You may choose to leave your money in the Plan until you are eligible to begin a monthly 

benefit anytime between age 55 and 61 at a reduced benefit (3% for each year under age 62), or 

at age 62 with no reduction. No further contributions can be made. Your contributions 

accumulate interest. The current interest rate is 3%. 

You may withdraw the money at anytime which then forfeits any future benefits and the taxes 

and penalties apply. Again, you only get back your contributions plus interest. The County’s 

portion is forfeited. 

DEATH BENEFITS: If you die while you are actively employed by the County and are not 

vested, your beneficiary will receive your contributions and interest. 

If you die, were vested and under age 55, your beneficiary could take two times your account 

balance or they could leave the money in the Plan until you would have been 55. They would 

then receive a lifetime benefit equal to 60% of the benefit you had accrued. If you were already 

55 and vested, they could begin that 60% benefit immediately. If you were already 62, it would 

be treated as a 100% J & S benefit and benefits would begin immediately. 

IF YOU LEAVE AND RETURN: If you leave employment and return to work full-time 

within 48 months and had removed your contributions from the Plan, you have the option of repaying 

your contributions, plus interest, for the period of time you were gone. You would get 

credit for your prior service. You have one year from the date you are re-hired to re-pay the 

Plan. If you were vested and left your money in the Plan, you would pick up where you left off 

and would be credited with the prior service at retirement. 

PURCHASE OF SERVICE: Hired post-2013 and after 8 years or hired pre-2013 and after 5 

years you can purchase service from a previous employer. The cost is based upon an actuarial 

equivalent of your final average salary at the time of purchase. You would be purchasing service 

from a previous employer that you participated in a retirement plan with but are not entitled to a 

retirement benefit from. It has to be full-time employment. Verification from your previous 

employer is needed stating your dates of full-time employment and non-vested status. 

MEDICAL BENEFITS: To be eligible for continuation of medical coverage the employee 

must be enrolled on the county’s medical plan at the time of retirement. Retiree Eligibility 

Definitions: Normal Retirement – Age 62 Years and who have a minimum of eight (8) years, if 

hired after 2013, or five (5) years, if hired prior to 2013, of creditable service as an employee of 

El Paso County are eligible for continuation of health insurance medical benefits, if enrolled at 

the time of retirement. 

Early Retirement – Retirees who were fifty-five (55) years of age or older when he/she left the 

continuous service of El Paso County and who have a minimum of eight (8) years, if hired after 

2013, or five (5) years, if hired prior to 2013, of creditable service as an employee of El Paso 

County are eligible for continuation of health insurance medical benefits, if enrolled at the time



of retirement. Elected officials who were fifty-five (55) years of age or older when he/she left 

the service of El Paso County and who have a minimum of eight (8) years, if elected after 2013, 

or five (5) years, if elected prior to 2013, of creditable service with El Paso County are eligible 

for continuation of the County’s self-funded medical benefits, if enrolled at the time of 

separation. This eligibility clause is effective for all employees retiring after January 1, 2003. 

Special Early Retirement – Rule of 75 Years. Age + creditable (continuous) years of service 

must equal 75 years. (No minimum age requirement) 

Eligibility: Retirees and eligible dependents (spouses and/or children) of retirees may continue 

medical coverage on the County’s self-funded medical plans if the retiree is currently enrolled 

and elects such coverage at the time of retirement. (Retirement is not a qualifying life event.) 

Spouses and dependent children can continue coverage under the medical plans if they meet the 

eligibility requirements outlined in Chapter IX of the El Paso County Employee Policies and 

Procedures manual. 

Spouses may continue to receive coverage under their own identity after the retiree has become 

entitled to Medicare, reached age sixty-five (65) or death. The spouse is eligible to remain on 

the EPO medical plan until age sixty-five (65) or Medicare entitlement, whichever may occur 

first, at which time they may choose to enroll in the 65+ PPO Plan. 

Dependent children of a retiree that is no longer eligible for the medical plans will be allowed to 

continue coverage as a dependent on the EPO Medical Plan until the retiree’s spouse reaches the 

age of sixty-five (65) or Medicare entitlement, provided the dependent child meets the eligibility 

requirements. Once the retiree’s spouse reaches the age of sixty-five (65) or Medicare 

entitlement, the dependent child is no longer eligible for the EPO Medical Plan. 

If the retiree has coverage for eligible dependent children and no spouse coverage and the retiree 

becomes entitled to Medicare, reaches age sixty-five (65), or dies, the dependent child is eligible 

to remain on the EPO Medical Plan until they no longer meet the definition of an Eligible 

Dependent. 

When enrolled retirees and spouses of retirees become Medicare eligible, they are no longer 

eligible for the EPO plan but can enroll at that time in the PPO 65 + Plan, provided the member 

is also enrolled in Medicare Part A and Part B. The PPO 65+ Plan will be the covered 

individual’s secondary insurance and pay after Medicare pays in accordance with plan 

provisions. Please contact the Employee Benefits office for more information at 719-520-7420. 

(The PPO 65+ Plan will only be offered if the County meets all eligibility requirements as 

defined by the Plan Provider. If the eligibility requirements are not met, the benefit will not be 

offered until such eligibility is guaranteed and will begin on January 1st of the following year.) 

For the retiree and dependents of the retiree to be eligible for continuation of health benefits, 

the retiring employee and dependents must be currently enrolled and elect to continue the 

coverage at the time of retirement. If the retiring employee does not elect continuation of the



benefit at the time of retirement, the benefit is forfeited for the retiree and dependents of the 

retiree. 

If the retiring employee is married to another El Paso County employee, the retiring employee 

may elect to be covered under the active married employee. 

Contribution Schedule: The cost for continuation of health benefits for retirees and dependents 

of retirees will be subject to the premium rate for the benefit plan(s) elected; however, the county 

may provide a medical plan retirement subsidy depending upon the number of years of creditable 

service the retiree had at the time of retirement. If the premium rate of the medical plan selected 

is less than the provided subsidy, no subsidy reimbursement to the retiree will occur. If the 

premium rate of the medical plan selected is more than the provided subsidy, the balance due 

will be deducted from the retiree’s benefit payment 

If the premium rate of the medical or dental plan exceeds the retiree benefit payment, the retiree 

is responsible to make payment for the health benefits directly to the Retirement Plan office by 

the 1 st day of each month. Non-Payment of Health Premiums: In the event of late or nonpayment 

of health premiums, coverage will be terminated retroactively to the last day coverage 

was paid in full. You will be given 30 days notice except in cases of fraud or intentional 

misrepresentation. Health benefits will not be reinstated if payment has not been received in 

full by the end of the 30-day grace period. 

The Health Plan Trust Board will determine the subsidy amount. The retiree subsidy rate may be 

re-evaluated and may be adjusted each year with increases to the retiree subsidy, which will be 

based on contributions for active employees. 

RETIREE DENTAL AND VISION PLAN 

Retirees who meet the eligibility requirements of the medical plan are also eligible for 

continuation of dental and vision coverage if enrolled at the time of retirement. The rate for 

dental and vision coverage will be based on the actual cost of plans. 

BOARD OF RETIREMENT: The Board of Retirement consists of seven members. Two are 

elected by the participants. Two are appointed by the BOCC. One is the County Treasurer who is 

mandated by State Statute to be on the Board and two associate members, employees appointed 

by the second and third largest employers. 

The Board makes all decisions pertaining to the Plan (COLAS, benefit factor, investment 

managers, etc.) 

WEB SITE ADDRESS- www.epcretirement.org: 

A Web Site has been established to provide more current and detailed information. Information 

provided: 

Benefit Calculator (Calculate your own benefit) 

Investment Performance 

Financial Statements 

Actuarial Report



DISCLAIMER 

Other Retirement Planning Tools 

El Paso County Retirement Plan Document 

Minutes of Meetings 

This summary information is intended to provide general information about the El Paso 

County Retirement Plan. The El Paso County Retirement Plan Document is the governing 

authority.



NOTICE OF PRIVACY PRACTICES 

GROUP MEDICAL PLAN 

(El Paso County Medical Group Plan) 

GROUP DENTAL PLAN 

(Guardian Dental Group Plan) 

FLEXIBLE SPENDING ACCOUNT (FSA) (PayFlex) 

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE 

USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS 

INFORMATION. PLEASE REVIEW IT CAREFULLY. 

El Paso County provides many types of services, such as employee benefits, various health, welfare, and wellness 

activities as well as an assortment of social services. We must collect information about you in order to provide 

these services. 

At El Paso County, we respect your privacy and will protect your health information responsibly and professionally. 

Both Federal and State law require that we maintain the privacy of your health information. 

This Notice of Privacy Practices is being provided to you as a requirement of the Health Insurance Portability and 

Accountability Act (HIPAA) and describes how we may collect, use, and disclose your health information. It also 

describes your rights concerning your health information. El Paso County is required to abide by the terms of the 

Notice that’s currently in effect. 

As you read this Notice, you’ll see an important term: “Protected Health Information” or PHI. PHI is 

individually identifiable health information, including health and demographic information created, transmitted 

and/or received by us that can reasonably be used to identify you regardless of form (oral, written, or electronic). 

Some examples of PHI might be age, gender, and address information. PHI also includes information relating to 

your past, present, and future physical or mental health or condition, the provision of health care and/or health care 

related services, and payment for that care. 

To the extent practical or feasible, any PHI created, transmitted, received and/or otherwise used by us shall, 

regardless of form (oral, written, or electronic), be de-identified in order to protect individual privacy.



DESIGNATED PRIVACY OFFICER 

In compliance with HIPAA regulatory requirements, El Paso County has designated a “Privacy Officer” who is 

responsible for overseeing privacy









4 th Revision: January 1, 2013 (removed reference to Cigna and United Health Care Dental, changed Medical Plan 

Account number) 

5 th Distribution (sent by EBMS October 2012 to fulfill every three year requirement) 

5th Revision: September 1 st , 2012 (removed onsite pharmacy information and updated applicable program and cost 

information for 2013. Not a material change to the document.)

2013 Employee Benefits Guidebook - Administration Home

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