2023

Employee Benefit Guide

Table of Contents 2023 Open Enrollment Information………………………………………………………………………………………………………………………………..3 Important Information …………………………………………………………………………………………………………………………………………………..4 Important Phone Numbers…………………………………………………………………………………………………………..5 Employee Navigator…………………………………………………………………………………………………………………..6 Employee Premium Summary………………………………………………………………………………………………………7 Medical Information…………………………………………………………………………………………………………………..8 Health Reimbursement Account (HRA)…………………………………………………………………………………………..9 Telemedicine………………………………………………………………………………………………………………………….10 Dental Information……………………………………………………………………………………………………………………11 Vision Information……………………………………………………………………………………………………………………12 Employer Paid Life Insurance……………………………………………………………………………………………………...20 Voluntary Life Insurance……………………………………………………………………………………………………………22 Evidence Of Insurability…………………………………………………………………………………………………………….23 Voluntary Short-Term Disability (STD)…………………………………………………………………………………………...24 Employer Paid Long-Term Disability (LTD)……………………………………………………………………………………..30 Voluntary Accident Insurance……………………………………………………………………………………………………..32 Cancer Insurance…………………………………………………………………………………………………………………….36 Critical Illness Insurance……………………………………………………………………………………………………………42 Flexible Spending Account (FSA)…………………………………………………………………………………………………46 Employee Assistance Program……………………………………………………………………………………………………50 Travel Assistance Program………………………………………………………………………………………………………...52 Beneficiary Resources………………………………………………………………………………………………………………54 Additional Resources………………………………………………………………………………………………………………..56 Annual Notices………………………………………………………………………………………………………………………..62

This guide contains a summary of the benefits offered by the City of Converse. If there is a conflict between the terms of this outline of benefits and the actual contracts, the terms of the contracts will prevail.

2

2023 Open Enrollment Information The 2023 benefit plan year begins 01/01/2023 and ends 12/31/2023. All benefits elected during the annual open enrollment will be effective 01/01/2023.

Know Your Benefits! Below is a summary of the benefits available! BCBS MEDICAL - The City offers a dual plan option with Blue Cross Blue Shield. The plan design has not changed. The City has increased their contribution slightly to minimize the cost to the employee-only premium this year. The city will continue to contribute toward the cost of coverage and provide an HRA benefit for employees enrolled in the highdeductible health plan (HDHP). NOTICE: Employees and dependents should check with their providers before obtaining treatment to ensure the provider(s) are either in or out of network. OBTAINING TREATMENT FROM OUT-OF-NETWORK PROVIDERS WILL [ALMOST] ALWAYS BE MORE EXPENSIVE THAN OBTAINING TREATMENT FROM IN-NETWORK PROVIDERS. Telemedicine - CITY PAID The City will pay telemedicine coverage through Benezon. You can access a licensed physician via phone or e-mail. BCBSTX DENTAL - There will be two plan options to choose from: a PPO and a MAC plan. Rates and coverage may be slightly different. The City will continue contributions to coverage. MetLife Vision - Plan includes coverage for eye exams, materials (such as frames and lenses), and discounts for laser vision correction. This plan has a list of defined network providers. Out-of-network benefits are available on a reimbursement basis only. For more information, including a list of providers, visit www.metlife.com/mybenefits. BCBSTX Base Life - CITY PAID The City will continue to provide employees and their dependents with a life insurance policy while they are active employees at no cost to the employee. BCBSTX Voluntary Life - Employees have the option to purchase additional coverage for themselves and their dependents. During this Open Enrollment as an Employee you may elect up to $100K of benefit without a Statement of health. Any amount higher, adding a spouse or dependent that was not previously covered will require a Statement of Health. Unless you are enrolling within 30 days from your initial hire date. BCBSTX Short Term Disability - Employees may elect to enroll in voluntary STD insurance. Employees can insure up to 60% of their salary to provide coverage in the event of a disability. BCBSTX Long Term Disability - CITY PAID The City will provide LTD insurance to all of its employees. Employees will be insured for up to 60% of their salary to provide coverage in the event of a disability. BCBS Accident - Accident insurance provides coverage for on & off the job accidents. Pays over and above your health insurance and directly to the policy holder. Colonial Cancer - The City will continue current Cancer coverage through Colonial. Cancer insurance provides a multitude of benefits designed to ease the burden of treatment. Pays over and above your health insurance and directly to the policy holder. BCBS Critical Illness- The employee can elect up to $20,000 that provides a lump sum benefit in the event of diagnosed and covered illness. NBS FSA/HRA - Your medical and dependent care Flexible Spending Account (FSA) and Health Reimbursement Arrangement (HRA) will continue to be administered by NBS. BCBSTX EAP - CITY PAID The City will provide Employee Assistance Programs that offer support, guidance, and

3

2023 Important Information Covering Dependents

If you cover dependents on any of your coverages through the City, you must provide the dependent’s name, date of birth, and social security number. You MUST have all of this information before beginning the enrollment process.

Making Changes During the Year Choose your benefits carefully. Several of the employee benefits plan contributions are made on a pre-tax basis and per IRS regulations, contribution amounts cannot be changed after enrollments UNLESS you experience a Qualifying Life Event (sometimes called a Special Enrollment Event). Examples of Qualifying Life Events include:     

Marriage, divorce, legal separation; Death of a spouse or dependent. Birth or adoptions of a child. Loss of coverage due to changes in employment for spouse or dependent. Significant cost or coverage changes

You must submit you benefit change requests to HR and include satisfactory documentation within 30 days of the event. Also note that per the IRS, only changes consistent with the Qualifying Life Event are allowed.

New Employees New employees must complete the enrollment process (even if declining voluntary benefits) within 30 days of their official hire date. Employees must monitor and comply with dates and deadlines. If employees fail to enroll within 30 days, all benefits will be waived. Eligibility will be effective on the first of the month following 30 days from the date of hire.

Very Important

Please carefully review your paycheck(s) after initial enrollment and any/all subsequent changes to your benefits to ensure all deductions are correct. If you find a discrepancy in your paycheck, please contact the HR Assistant at (210) 566-1446. Discrepancies MUST be identified AND reported within the first 30 days from the effective date of enrollment or subsequent change(s) to be considered.

Benefit Related Documents All documents will be available at your HR Department. Employees are also encouraged to go online and/or download TheBenefitsApp to access telemedicine and customer advocacy at NO COST to the employee. Access from ANY device: Online https://thebenefitsapp.com/converse

Download the app

4

Important Phone Numbers BCBS Medical

1-800-521-2227

www.bcbstx.com

Telemedicine

1-800-215-2017

www.benezon.com

BCBS Dental

1-800-521-2227

www.bcbstx.com/provider-finder/dental-group

MetLife Vision

1-800-880-1800

www.metlife.com

BCBS Life Dearborn National

1-877-442-4207

www.dearbornnational.com or [email protected]

BCBS STD Dearborn National

1-877-442-4207

www.dearbornnational.com or [email protected]

BCBS LTD Dearborn National

1-877-442-4207

www.dearbornnational.com or [email protected]

BCBS Accident

1-800-521-2227

www.bcbstx.com

Colonial Life Cancer

1-800-325-4368

www.coloniallife.com

BCBS Critical Illness

1-800-521-2227

www.bcbstx.com

NBS Flex Spending

1-800-422-4661

www.nbsbenefits.com

Employee Assistance Programs

1-866-899-1363

www.guidanceresources.com Click Register to create a new account Enter your company ID: DISRES

City of Converse Human Resources

210-566-1446

[email protected]

Brown & Brown Lori Rice

210-524-2171

[email protected]

5

Enrolling with Employee Navigator The City of Converse is committed to keeping you informed about your benefits. We encourage you to take the time to educate yourself about your options and chooses the best coverage for you and your family. The City of Converse uses a new online system, Employee Navigator, for all new and updated benefit Enrollment Changes.

Registration and Enrollment 1. Navigate to https://employeenavigator.com/login 2. First time user? Choose “Register as a new user” 3. Complete “Create your Account” section; a. b. c. d. e.

Enter First and Last Name Enter the Company Identifier: converse Enter PIN (last 4 digits of Social Security Number) Date of Birth Format: (MM/DD/YYYY) Password must e at least 6 characters and contain a symbol (#, ?, @ etc.) and a number f. Click “Register” 4. Returning User? Enter your Username and password or select “Reset a forgotten password" 5. Click “Start Enrollment” to begin your enrollment 6. Follow the prompts to make your decision 7. Be sure to click the AGREE button to finalize your elections

6

Monthly Premium Summary JANUARY 1, 2023 - DECEMBER 31, 2023 BCBS HDHP BI-WEEKLY MTBCP008H

2023

MONTHLY

MONTHLY BENEFIT COST

Employee Cost

Employer Cost

Employee Cost

Employer Cost

$19.55

$238.73

$42.36

$517.24

$560.16

Empoyee & Spouse (ES)

$270.79

$287.10

$586.71

$622.05

$1,209.93

Employee & Children (EC)

$263.31

$273.92

$570.50

$593.49

$1,165.12

Employee & Family (EF)

$528.49

$310.92

$1,145.07

$673.65

$1,820.52

Employee Only (EO)

BCBS PPO Buy-Up MMTCBP036

BI-WEEKLY

MONTHLY

MONTHLY BENEFIT COST

Employee Cost

Employer Cost

Employee Cost

Employer Cost

Employee Only (EO)

$113.44

$245.60

$245.78

$532.14

$771.92

Empoyee & Spouse (ES)

$486.02

$289.49

$1,053.05

$627.23

$1,680.28

Employee & Children (EC)

$460.40

$286.40

$997.53

$620.53

$1,618.06

Employee & Family (EF)

$836.16

$330.71

$1,811.68

$716.53

$2,528.21

BCBS Dental DTNLM38 MAC

Employee Cost

Employer Cost

Employee Cost

Employer Cost

Employee Only (EO)

$5.11

$5.11

$11.07

$11.07

$22.14

Empoyee & Spouse (ES)

$15.33

$5.11

$33.21

$11.07

$44.28

Employee & Children (EC)

$22.53

$5.11

$48.81

$11.07

$59.88

Employee & Family (EF)

$36.57

$5.11

$79.23

$11.07

$90.30

BCBS Dental DTNHR34

BI-WEEKLY

MONTHLY

BI-WEEKLY

MONTHLY

MONTHLY BENEFIT COST

MONTHLY BENEFIT COST

Employee Cost

Employer Cost

Employee Cost

Employer Cost

$7.20

$5.11

$15.60

$11.07

$26.67

Empoyee & Spouse (ES)

$19.51

$5.11

$42.28

$11.07

$53.35

Employee & Children (EC)

$28.32

$5.11

$61.36

$11.07

$72.43

Employee & Family (EF)

$45.26

$5.11

$98.06

$11.07

$109.13

Employee Only (EO)

MetLife Vision

BI-WEEKLY

MONTHLY

MONTHLY BENEFIT COST

Employee Cost

Employer Cost

Employee Cost

Employer Cost

Employee Only (EO)

$3.59

$0.00

$7.78

$0.00

$7.78

Empoyee & Spouse (ES)

$7.19

$0.00

$15.58

$0.00

$15.58

Employee & Children (EC)

$6.09

$0.00

$13.19

$0.00

$13.19

Employee & Family (EF)

$10.04

$0.00

$21.75

$0.00

$21.75

7

Medical Summary BCBS HDHP with HRA MTBCP008H

BCBS PPO Buy-Up MTBCP036

Blue Choice PPO

Blue Choice PPO

PCP Required

No

No

Includes HRA

Yes

No

In Network

$6,000 Individual / $12,000 Family

$4,000 Individual / $12,000 Family

In Network

100%

70%

$6,000 Individual / $12,000 Family

$8,150 Individual / $16,300 Family

In Network

100% after deductible

70% after deductible

In Network

100% after deductible

70% after deductible

Preventive Care

$0

$0

Office Visit Copay - Primary

100% after deductible

$35 Copay

Office Visit Copay -Specialist

100% after deductible

$70 Copay

Urgent Care

100% after deductible

$75 Copay

ER Visit

100% after deductible

City of Converse Network

Annual Deductible

Coinsurance

Annual Max Out of Pocket: Individual/Fam Cap (MOOP) In Network

MEDICAL SERVICES Hospital Services In-Patient

Out-Patient

Physician Office Visit

$500/occurrence. Deductible and Coinsurance apply

PRESCRIPTION DRUGS None

None

100% after deductible

$0/$10/$50/$100/$150/$250

Drug Deductible RX

8

Health Reimbursement Account Information City of Converse

Health Reimbursement Arrangement (HRA) January 1, 2023– December 31, 2023 Who is eligible?  Employees and Insured Dependents  In-Network Deductible expenses What is the covered individual’s responsibility?  Employee Only - $1400  Family - $2800 How much does the employer reimburse?  Employee Only - $4600  Family - $9200 When must the expense(s) be incurred?  Within the plan year, January 1 through December 31 When is the deadline to file claims that occurred within the plan year?  This plan includes a 90-day run-out period to submit claims for the previous year. How to File Claim: Claims can be filed via mail, fax, or using through the online portal at www.nbsbenefits.com. An explanation of benefits (EOB) is required to file a claim.

9

Telemedicine/Healthcare Advocate This is available for all employees and the members of their household at NO CHARGE

Telemedicine

Telemedicine/Healthcare Advocate Telemedicine/Healthcare Advocate

Telemedicine/Healthcare Advocate Telemedicine/Healthcare Advocate Telemedicine/H

10

Telemedicine/Healthcare Advocate

11

Dental Base Plan

12

Dental Base Plan Continued

13

Dental Buy-Up Plan

14

Dental Buy-Up Plan Continued

15

MetLife Vision

16

MetLife Vision Continued

17

18

MetLife Vision

19

Employer Paid Life Insurance

20

Employer Paid Life Insurance Continued

21

Employee Paid Life Insurance

22

Employee Paid Life Insurance Continued

23

Employee Paid Life Insurance Rates

24

Employee Paid Life Insurance Rates

25

Evidence of Insurability Administration

26

Evidence of Insurability Administration Continued

27

Employee Paid Short-Term Disability

28

Employee Paid Short-Term Disability Rates

29

Employer Paid Long-Term Disability

30

Employer Paid Long-Term Disability

31

Voluntary Accident Insurance

32

Voluntary Accident Insurance Continued

33

Voluntary Accident Insurance Continued

34

Voluntary Accident Insurance Continued

35

Voluntary Cancer Insurance

36

Voluntary Cancer Insurance Continued

37

38

Voluntary Cancer Insurance Continued

39

Voluntary Cancer Insurance Continued

40

Voluntary Cancer Insurance Continued

41

Voluntary Cancer Insurance Continued

42

Voluntary Critical Illness Insurance

43

Voluntary Critical Illness Insurance Continued

44

Voluntary Critical Illness Insurance Continued

45

Voluntary Critical Illness Insurance Continued

46

Flexible Spending Account (FSA)

47

FSA Continued

48

FSA Mobile App

49

FSA/HRA Account Management

50

Employee Assistance Program

51

Employee Assistance Program Continued

52

Travel Resource Services

53

Travel Resource Services Continued

54

Beneficiary Resources

55

Beneficiary Resources Continued

56

Additional Resources

57

Additional Resources

58

Additional Resources

59

Additional Resources

60

Wellness

61

Wellness Continued

62

63

Important Notice from The City of Converse About Your Prescription Drug Coverage and Medicare, Creditable Coverage, City of Converse Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage: 1) Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. 2) has determined that the prescription drug coverage offered by the City of Converse is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.

When Can You Join A Medicare Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15 to December 7. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.

What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan? If you decide to join a Medicare drug plan, your current coverage will not be affected. You can keep this coverage if you elect part D and this plan will coordinate with Part D coverage. If you do decide to join a Medicare drug plan and drop your current coverage, be aware that you and your dependents will be able to get this coverage back at the next annual enrollment opportunity or qualified life event.

When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan? You should also know that if you drop or lose your current coverage with this plan and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.

For More Information About This Notice Or Your Current Prescription Drug Coverage… More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage: 64

  

Visit www.medicare.gov Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-7721213 (TTY 1-800-325-0778). Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).

Or contact the person listed below. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through changes. You also may request a copy of this notice at any time. Effective Date: January 1, 2023

Employer Name: The City of Converse

Contact Name/Title: Mr. John Rudd, HR Director

Address: 406 S. Seguin Road, Converse, TX 78109 ,

Phone: 210-566-1446

Email: [email protected]

65

66

67

68

69

70

71

72

73

74

75

76

77

78

79

80