City of Athens 2023 Enrollment Guide.pptx

EMPLOYEE BENEFITS
ENROLLMENT GUIDE
Plan year 2023
Effective January 1, 2023 to December 31, 2023

CONTENTS
03 Benefits Overview
05 Open Enrollment Instructions
06 Medical Insurance
22 Dental Insurance
24 Vision Insurance
26 Employer Paid Group Life and Accidental Death & Dismemberment
28 Employer Paid Long Term Disability Insurance
29 Voluntary Life Insurance
34 Additional Information
35 Important Contacts
2

BENEFITS OVERVIEW
ENROLLMENT
You can enroll in benefits or change your elections at the following times:
• 30 days prior to your initial eligibility date (as a newly hired employee)
• During the annual benefits open enrollment period
• Within 30 days of experiencing a qualifying life event
BENEFIT OPTIONS
We offer a comprehensive benefits package consisting of:
• Medical Insurance
• Dental Insurance
• Vision Insurance
• Employer Paid Group Life and Accidental Death & Dismemberment
• Employer Paid Long Term Disability
• Voluntary Life Insurance
Open enrollment is November 14 -25, 2022.
Please see page 5 on how to enroll through Employee Navigator.
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BENEFITS OVERVIEW
ELIGIBILITY
Full-time employees working at least 30 hours per week are eligible for
benefits. Newly hired employees need to contact Human Resources for their
eligibility date. Many of the plans offer coverage for eligible dependents,
including:
• Your legal spouse
• Your children to age 26, regardless of student, marital, or tax-dependent
status (including stepchild, legally adopted child, a child placed with you
for adoption, or a child for whom you are the legal guardian)
• Your dependent children over age 26 who are physically or mentally
unable to care for themselves
CHANGING BENEFITS AFTER OPEN ENROLLMENT
You may pay your portion of your select coverages on a pre-tax basis
through the City of Athens cafeteria plan. Thus, due to IRS regulations,
once you have made your elections for the plan year, you cannot change
your benefits until the next annual open enrollment period. The only
exception is if you experience a qualifying event, and election changes
must be consistent with your life event.
To request a benefits change, notify Human Resources within 31 days of
the qualifying life event. Change requests submitted after 31 days cannot
be accepted. You may need to provide proof of the life event.
Qualifying life events include, but are not limited to:
• Marriage, divorce, or legal separation
• Birth or adoption of an eligible child
• Death of your spouse or covered child
• Change in your spouse’s work status that affects his or her benefits
• Change in your child’s eligibility for benefits
• Qualified Medical Child Support Order
4

EMPLOYEE NAVIGATOR ENROLLMENT INSTRUCTIONS
Open Enrollment is available online!
Please visit: https://employeenavigator.com/benefits/Account/Login to review your current
benefits and make any desired plan changes for the new plan year. If you do not request any
changes for the new plan year, your current enrollment WILL automatically renew. Please
review the new plan year information closely. After you have completed your enrollment, be
sure to click the agree button on your Enrollment Summary page.
If you have already registered an account with Employee Navigator, use the username you
created. If you have forgotten your password you may request a password reset at
https://employeenavigator.com/benefits/Account/Reset/ResetEmployee.
If you do not have a username, please go to
https://www.employeenavigator.com/benefits/Account/Register to register. You will be
asked for personal identifying data as well as the company identifier which is athenstx.
Note: If you experience a
Qualifying Event such as marriage,
divorce, birth/adoption of a child
or loss of coverage and need to
make changes to your coverage,
you MUST contact Human
Resources within 30 days of the
event.
If you have any questions, contact the Human Resource Department at 903-677-6612.
This summary of benefits is not intended to be a complete description of the terms of City of Athens insurance benefit plans. Please refer to the plan
document(s) for a complete description. Each plan is governed in all respects by the terms of its legal plan document, rather than by this or any other
summary of the insurance benefits provided by the plan. In the event of any conflict between a summary of the plan and the official document, the
official document will prevail. Although City of Athens maintains its benefit plans on an ongoing basis, City of Athens reserves the right to terminate or
amend each plan, in its entirety or in any part at any time.
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MEDICAL INSURANCE
CARRIER: UNITEDHEALTHCARE
NETWORK: CHOICE
Please refer to the official plan documents for additional information on
coverage and exclusions.
MEDICAL BENEFITS
AXKT MOD WITH KTX RX PLAN
In-Network
Out-of-Network
Calendar Year Deductible - Individual/Family
$3,000 / $6,000
Coinsurance 80 / 20%
Out of Pocket Maximum - Individual/Family
(includes deductible, copays, and coinsurance)
Preventive Care
Primary Care Visit
Specialist Office Visit
Virtual Visits
Urgent care
Emergency Room (non-admitted)
Outpatient Lab / X-Ray
Outpatient Imaging (CT/PET scans, MRI’s)
Inpatient Facility
$7,150 / $14,300
No Charge
Less than age 19: $0 copay
All other covered persons: $10 copay
Designated Network: $40 copay
Network: $80 copay
No Charge
$25 copay
$500 copay
$40 copay
$500 copay
20% after calendar year deductible
Out-of-Network Benefits are not
available with this plan.
Outpatient Facility
PRESCRIPTION COVERAGE
20% after calendar year deductible
Retail
(up to 31 day supply)
Mail Order
(up to 90 day supply)
Tier 1 $20 copay $50 copay
Tier 2 $40 copay $100 copay
Tier 3 $75 copay $187.50 copay
COVERAGE LEVEL MONTHLY DEDUCTION 1ST & 2ND PAY PERIOD DEDUCTION
Employee Only $0.00 $0.00
Employee & Spouse $485.00 $242.50
Employee & Child(ren) $201.56 $100.78
Employee & Family $850.32 $425.16
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MEDICAL INSURANCE
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MEDICAL INSURANCE
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MEDICAL INSURANCE
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MEDICAL INSURANCE
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MEDICAL INSURANCE
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MEDICAL INSURANCE
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MEDICAL INSURANCE
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MEDICAL INSURANCE
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MEDICAL INSURANCE
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MEDICAL INSURANCE
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MEDICAL INSURANCE
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MEDICAL INSURANCE
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MEDICAL INSURANCE
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MEDICAL INSURANCE
20

EMPLOYEE ASSISTANCE PROGRAM
21

DENTAL INSURANCE
CARRIER: UNITEDHEALTHCARE
● You will pay less out of pocket when you choose an in-network provider.
● Locate an in-network provider at www.uhc.com – Find a Dentist. Network is
National Options PPO 30
● Be sure to ask for a pre-treatment estimate.
● Out-of-network providers can balance bill, or bill you for the difference between
the provider’s charge and the allowed amount.
ELECTION
MONTHLY
DEDUCTION
1ST & 2ND PAY
PERIOD DEDUCTION
Employee Only $0.00 $0.00
Employee + 1 $33.78 $16.89
Employee + 2 or more $70.26 $35.13
COVERED BENEFITS
PLAN PAYS
Deductible (per calendar year)
Annual Plan Benefit Maximum
Diagnostic & Preventive Services
Oral evaluation, radiographs, lab and other diagnostic tests,
cleanings, fluoride treatment, sealants, space maintainers
Basic Services
Periodontal & endodontic services, extractions, restorations,
oral surgery, emergency treatment/general services
Major Services
Bridges, crowns, inlays/onlays, dentures (full/partial)
$50 per person, $150 per family
applies to basic and major services
$1,500 per covered member
100%
Orthodontia Services 50%
Lifetime Orthodontia Plan Max $1,000
Annual Maximum Carryover
80%
50%
Included
This Plan includes a roll-over maximum benefit. Some of the unused portion of your annual maximum
may be available in future periods. See page 23 for details.
22

DENTAL INSURANCE
23

VISION INSURANCE
CARRIER: UNITEDHEALTHCARE
● You will pay less out of pocket when you choose an in-network provider.
● Locate an in-network provider at www.myuhcvision.com.
● You must submit a claim form for out-of-network expenses.
● LASIK surgery discounts available
ELECTION
MONTHLY
DEDUCTION
1ST & 2ND PAY PERIOD
DEDUCTION
Employee Only $7.27 $3.64
Employee + 1 $13.08 $6.54
Employee + Family $20.34 $10.17
COVERED BENEFITS IN-NETWORK OUT-OF-NETWORK
Eye Exam Copay (every 12 months)
Materials Copay
Lenses (every 12 months)
$10 copay
$25 copay
Single: Covered in Full
Bifocal: Covered in Full
Trifocal: Covered in Full
Lenticular: Covered in Full
Up to $40
N/A
Single: Up to $40
Bifocal: Up to $60
Trifocal: Up to $ 80
Lenticular: Up to $80
Frames (every 12 months) $150 retail allowance + 30% off balance Up to $45.00
Contact Lenses (every 12 months)
Formulary
Non-Formulary
Medically Necessary
If you choose disposable contacts up to
6 boxes from in-network provider
$150 allowance
Covered in full after copay
Up to $105
Up to $105
Up to $210
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VISION INSURANCE
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EMPLOYER PAID BASIC LIFE AND AD&D
CARRIER: STANDARD
LIFE and ACCIDENTAL DEATH & DISMEMBERMENT (AD&D)
Basic Life and AD&D insurance is automatically provided to all benefits-eligible
employees at no cost. If you die as a result of an accident, your beneficiary
would receive both the life and the AD&D benefit.
Eligibility Waiting period
The eligibility waiting period varies; contact your human resources representative
for details.
Basic Life Coverage Amount 1 times your annual earnings to a maximum of $130,000.
Basic AD&D Coverage Amount
Life Age Reductions
For a covered accidental loss of life, your Basic AD&D coverage amount is equal to
your Basic Life coverage amount. For other covered losses, a percentage of this
benefit will be payable.
Basic Life and AD&D insurance coverage amount reduces to 65% at age 70, to 45% at
age 75 and to 30% at age 80.
Other Group Life Features and Services:
➢
➢
➢
➢
Accelerated Benefit
Life Service Toolkit
Repatriation Benefit
Portability of Insurance Provision
➢
➢
➢
Right to Convert Provision
Standard Secure Access account payment option
Waiver of Premium
Other Group AD&D Features:
➢
➢
➢
➢
Air Bag Benefit
Expanded AD&D Package
Family Benefits Package
Seat Belt Benefit
REMINDER
Review your beneficiary designations
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EMPLOYER PAID LIFE and AD&D
INSURANCE
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EMPLOYER PAID LONG TERM DISABILITY
INSURANCE
CARRIER: STANDARD
Long-term disability (LTD) insurance is automatically provided to all benefits-eligible
employees at no cost. LTD insurance is designed to help you meet your financial needs
during longer disability periods. Benefit may be offset due to other benefits such as
paid sick leave, workers’ compensation.
Monthly Benefit
50 percent of the first $12,000 of monthly predisability earnings, reduced by deductible
income (e.g., work earnings, workers’ compensation, state disability, etc.)
Maximum Monthly Benefit $6,000
Minimum Monthly Benefit
Benefit Waiting Period
Definition of Disability
Maximum Benefit Period
$100 or 10 percent of the Long Term Disability benefit before reduction by deductible
income (whichever is greater).
90 days
For the benefit waiting period and the first 24 months that Long Term Disability benefits
are payable, you will be considered disabled if, as a result of physical disease, injury,
pregnancy or mental disorder:
● You are unable to perform with reasonable continuity the material duties of your
●
own occupation, and
You suffer a loss of at least 20 percent of your predisability earnings when
working in your own occupation.
You are not considered disabled merely because your right to perform your own
occupation is restricted, including a restriction or loss of license.
After the own occupation period of disability, you will be considered disabled if, as a
result of a physical disease, injury, pregnancy or mental disorder, you are unable to
perform with reasonable continuity the material duties of any occupation.
If you become disbaled before age 62, Long Term Disability benefits may continue during
disability until age 65 or to the social Security Normal Retirement Age (SSNRA) or 3 years
6 months, whichever is longest.
If you become disable at age 62 or older. benefit duration is determined by age when
disability begins:
Age
62
63
64
65
66
67
68
69+
Maximum Benefit Period
To SSNRA, or 3 years 6 months, whichever is longer
To SSNRA, or 3 years, whichever is longer
To SSNRA, or 2 years 6 months, whichever is longer
2 years
1 year 9 months
1 year 6 months
1 year 3 months
1 year
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VOLUNTARY LIFE INSURANCE
CARRIER: STANDARD
Help protect your loved ones from financial hardship.
This coverage is designed to help provide financial support and stability to your family should you pass away.
You can also cover your eligible spouse and child(ren). Life insurance is an easy, responsible way to protect your
family from financial hardship during a difficult time and into the future.
Employee Coverage
● Newly hired employees may elect a coverage amount between $10,000 and $250,000 in increments of $10,000 up
to a guarantee issue of $100,000; not to exceed 6 times your annual earnings.
● At annual enrollment, if you are currently enrolled in Additional Life insurance for an amount less than $100,000,
you may elect to increase your coverage by one or two increments of $10,000 annually, up to, but not to exceed,
the guarantee issue amount of $100,000 without having to answer health questions. If you are not currently
enrolled in Additional Life insurance, you may elect to increase your coverage by one or two increments of
$10,000 annually, up to, but not to exceed, the guarantee issue amount of $100,000 without having to answer
health questions.
Spouse Coverage - you can secure term life insurance for your spouse if you select coverage for yourself.
●
●
Newly hired employees may elect a coverage amount on his/her spouse between $5,000 and $50,000 in
increments of $5,000 up to a guarantee issue of $50,000; not to exceed 100% of the employees amount.
At annual enrollment, if your spouse is currently enrolled in Dependents Life insurance for an amount less than
$50,000, you may elect to increase coverage by one or two increments of $5,000 annually, up to, but not to
exceed, the guarantee issue amount of $50,000 without having to answer health questions. If your Spouse is not
currently enrolled in Dependents Life insurance, you may elect to increase coverage by one or two increments of
$5,000 annually, up to, but not to exceed, the guarantee issue amount of $50,000 without having to answer health
questions.
Dependent Children Coverage - you can secure term life insurance for your dependent children under age 26
when you select coverage for yourself.
● Newly hired employees may elect a coverage amount on his/her dependent children between $2,000 and $10,000
in increments of $2,000; not to exceed 100% of the employee’s amount.
● At annual enrollment, you may elect a coverage amount on your children between $2,000 and $6,000 in
increments of $2,000 not to exceed the employee’s amount.
If you and/or your spouse were previously declined coverage by The Standard, you and/or your spouse will
need to submit a medical history statement in order to apply for any amount of coverage during the Annual
Enrollment Period. Visit www.standard.com/mhs to complete and submit a medical history statement online.
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VOLUNTARY LIFE INSURANCE
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VOLUNTARY LIFE INSURANCE
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VOLUNTARY LIFE INSURANCE
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VOLUNTARY LIFE INSURANCE
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Additional Information
Keep In Mind
Employees are responsible for notifying Human Resources if a dependent is no longer eligible for
coverage. Failure to notify HR will affect COBRA availability and premium refunds.
From time to time additional information may be requested by the carriers as it relates to your
benefits- please respond promptly to expedite processing.
Reminders
➢
Employees must go online through Employee Navigator to review your current benefit
elections and make changes / new elections for the 2023 plan year.
➢ Online enrollment must be completed by the end of day, November 25, 2022.
➢
Any forms required (i.e Evidence of Insurability) must be returned to Human Resources by
the end of the day, November 25, 2022.
➢
Contact Sissy Geddie at (903) 677-6612 with any questions you may have.
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IMPORTANT CONTACTS
BENEFIT Carrier BENEFIT WEBSITE
Medical Insurance United Healthcare 888-842-4571 www.uhc.com
Dental Insurance United Healthcare 888-842-4571 www.uhc.com
Vision Insurance United Healthcare 800-638-3120 www.myuhcvision.com
Group Life and AD&D Standard 1-888-937-4783 www.standard.com
Long Term Disability Standard 1-888-937-4783 www.standard.com
Voluntary Life Insurance Standard 1-888-937-4783 www.standard.com
Human Resources Sissy Geddie 903-677-6612 sgeddie@athenstx.gov
YOUR BXS / CADENCE INSURANCE ACCOUNT REPRESENTATIVE:
Lacey Parmer
936-564-1713
Lacey.parmer@cadenceinsurance.com
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City of Athens
903-677-6612