2016 City & County of San Francisco New Employee Benefits Enrollment

New Employee Orientation January–December 2016

http://www.myhss.org/


Welcome.

Congratulations on your new job!



Health Service System (HSS) Overview

• HSS administers City & County of San Francisco employee health benefits.

- Medical - Flexible Spending Accounts (FSAs)- Vision - Long Term Disability (LTD) Insurance- Dental - Group Life Insurance

- Employee Assistance Program (EAP) - Wellness

• Health benefits plan year is January 1 through December 31.

• You must enroll within 30 days of your start work date to receive health benefits. Your enrollment is not automatic.



How Do I Choose a Medical Plan?

Here are considerations to keep in mind when choosing a health plan:

Cost – how much will I pay?

Choice of doctor, medical group and hospital

Convenience / access to care

Personal situations (medical needs, balancingcoverage if your partner has a plan, etc.)



Medical Plan Premium Contributions

• Employee premium contributions vary based on:

- Employer contribution- Medical / dental plan elected- Union

- Number of covered dependents - Employee only - Employee + 1 dependent - Employee + 2 or more dependents

• To review your premium contribution rates, read your Benefits Guide or visit myhss.org.



HMO Kaiser

HMOBlue Shield

PPOCity Plan

Primary Care Provider yes yes no

Deductible $0 $0$250 member only$500 + 1, $750 + 2

Office Visit $0 - preventive$20 - other

$0 - preventive$25 - other

100% preventive 85% in-network

50% out-of-network

Service Area Kaiser facilities, ER

Blue Shield network, ER

PPO and out-of-network, worldwide

Information on this chart is effective January–December 2016.

Medical Plan Options



VSP Vision Plan• Vision benefits are only available when medical plan is

elected.

• No additional premium contributions required for the vision plan.

• No ID card issued. Make appointment with VSP doctor who gets authorization from VSP.

• VSP network benefits- vision exam every 12 months, co-pay $10 - frames/lenses/contacts every 24 months, co-pay $25 - frames/contacts covered to $150- urgent eye care $5 co-pay

• Claims reimbursed from non-VSP providers.



2016 Dental Plan OptionsPPO

Delta Dental*HMO

DeltaCare USAHMO

UnitedHealthcare

Dental Offices in SF more than 500 14 32

Primary Care Dentist no yes yes

Authorization to Specialist

no yes yes

Service Area outside of area must live in DHMO area

must live in DHMO area

Waiting Period some exceptions* none none

*6-month waiting period for dentures, pontics, bridges, orthodontia and implants.



2016 Dental Plan OptionsPPO

Delta Dental*HMO

DeltaCare USAHMO

UnitedHealthcare

Cleaning and Exam100% / 2x/yr

3x/yr pregnant100% / 6 months 100% every 6 months

Fillings 80% 100% 100%

Orthodontia50%;

$2000 max child$350 start fee; $1500

max child$350 start fee;

$1660 max child

Crowns 80% 100% 100%

*Delta Dental cost shares shown are for PPO/Premiere/out-of-network dentists.



Flexible Spending Accounts (FSAs)

• Optional; you must re-enroll every plan year.

• Saves money by reducing income taxes.

• Allows you to pay for eligible medical, dental and dependent care expenses on a pre-tax basis.

• Contributions you make are deducted from your pay BEFORE Federal, State or Social Security taxes are calculated.

• For list of eligible expenses, visit padmin.com.



FSAs: Types & Examples• Healthcare FSA

- co-pays (office visits, pharmacy)- eyeglasses- orthodontic treatment- weight loss programs (doctor’s order)- over-the-counter medications

(only with prescription)

• Dependent Care FSA - licensed facilities only

- day care services- summer day camp



FSAs: Things to Consider• How much do you want to contribute in 2016?

- minimum $250 - maximum $2,500 for Healthcare FSA - maximum $5,000 for Dependent Care FSA

• For reimbursement, submit receipts and documentation to FSA administrator P&A Group.

• Enroll as a new employee or annually during Open Enrollment.

• Healthcare FSA only: total annual contribution is available on day one of the plan year.

• Healthcare FSA only: up to $500 in unused contri-butions will automatically carryover to next plan year.



Long Term Disability (LTD) Plan• Many union contracts provide for employer-paid LTD

insurance. If this benefit is available to you, the flyer is in your packet.

- eligibility and definition of disability- beginning and end of coverage

• Financial protection by paying a significant percentage of your income while you are disabled.

• Maximum benefit $5,000 per month.

• Waiting period 3 to 6 months depending on union.

• Administered by Aetna.

• No coverage if LOA due to non-medical reasons.



Group Life Insurance Plan • MEA, MAA, SEIU 1021, Teamsters 856, TWU 200,

IFPTE Local 21• Amount varies by union • Eligibility

- permanent: 1st of the month following start date

• - provisional: 1,040 hours in a 6-month period

• Beneficiary - recipient of proceeds to be paid at your death

- you may name more than one beneficiary

- if you don’t name a beneficiary proceeds go to spouse or domestic partner, natural or adopted children, parents or your estate – in this order.



Employee Assistance Program (EAP)

• Short-term therapy and counseling.

• No cost (free) to all City employees and their family members.

• Staffed by state certified, licensed therapists.

• Confidential and voluntary.

• Appointments available 9:00am to 4:00pm, Monday–Friday.

• To schedule an HSS EAP appointment call 1-800-795-2351.



Employee Wellness• Lunchtime fitness classes and workshops throughout the

City. Class calendar online at myhss.org.

• Employee wellness center at 1145 Market Street, 1st Floor.

• Fitness club/gym discounts.

• Health plans also offer wellness benefits.

• Individual departments may also offer other wellness programs.



Benefits Enrollment Process

• Only three opportunities to enroll or make changes:1. Within 30 days of start work date as a new employee

2. Within 30 days of a Qualifying Event (change in status)

3. During annual Open Enrollment

• Dependent documentation (copy of marriage certificate, birth certificate, etc.) must be submitted with signed enrollment form.

• If you miss the 30 day deadline, no enrollment change allowed until Open Enrollment.



New Hire Coverage Effective Date

• Coverage will begin the first day of the coverage period after a complete enrollment application is filed with HSS.

• A complete application includes all dependent documentation and your signed enrollment form.

• To verify the exact date your coverage will begin, contact the Health Service System.



Eligible Dependents• Legal Spouse or Domestic Partner.

• Children from birth up to age 26 (natural child, adopted child, stepchild, domestic partner’s child).

• Children up to age 19 (legal guardianship, court order).

• PROOF: Copy of certificate of marriage or domestic partnership, birth certificate, adoption paperwork, court or guardianship order.

• No dual eligibility for employees or dependents enrolled in HSS medical, dental or vision plans.



Ineligible Dependents• HSS routinely audits enrollment.

• You must notify HSS once your dependents are no longer eligible to be covered on your plan.

• Ineligible dependents:

- Divorced spouse and associated step-children- Former domestic partner after legal dissolution

of partnership

- Legally separated spouse

- Court ordered or guardianship children at age 19

- Natural, step, and adopted children at age 26



Qualifying EventsA qualifying event is a family status change, or other change in status, that allows you to change enrollment choices outside of Open Enrollment.

Qualifying events include:-marriage or legal domestic partnership -birth, adoption, or legal guardianship of a child-divorce, legal separation or dissolution of partnership-loss or obtaining other coverage-moving outside of a plan’s service area-death of dependent or member



Qualifying Events

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29

DEADLINEDAY OF EVENT

If there is a qualifying event, you may change some health benefits within 30 calendar days of the event.

If you miss the 30-day deadline you must wait until the next Open Enrollment.

Don’t wait. Call HSS at 1-415-554-1750 if you have questions about a qualifying event and changing your enrollment choices.

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Open Enrollment

• Next Open Enrollment takes place in October 2016 for the 2017 January through December plan year

• During Open Enrollment you may:- keep or change your benefit elections

- add or drop eligible dependents

- enroll or re-enroll in a Flexible Spending Account

• HSS mails Open Enrollment information. Make sure HSS has your current address!



Unpaid Leave of Absence

• You must notify HSS before, or soon after, you go on leave.

• For all types of unpaid leave, payment must be made to HSS each month you are on leave, for the premium amount due.

• If you do not notify HSS before going on approved leave, or you do not make required payments to HSS while on leave, your benefits may be terminated.

• You must notify HSS when you return to your job after your leave ends so payroll deductions for health benefits can resume.



Unpaid Leave of Absence and FSAs

• If you do not receive a paycheck for any pay period due to unpaid leave, and deductions are not taken to fund an FSA, it will be cancelled.

• Dependent Care FSA must be suspended while you are on leave, and claims incurred during leave are not reimbursable.



Stay In Touch and Informed About Your Benefits

• Always keep your address current with your employer and HSS.

• Rates and benefits change every year.

• Visit myhss.org often for benefits updates.

• Register online for monthly email news.

• Make sure HSS has your correct residential and mailing address. Contact HSS if you have a change of either address.

• Call or visit HSS Member Services if you have questions about your benefits: 1-415-554-1750.



myhss.org



PHONE: 1-415-554-1750IN PERSON:

1145 Market Street 3rd FloorSan Francisco, CA

PHONE AND OFFICE HOURS:

Monday through Friday8:00am to 5:00pm (Open at 9:30 am every other Thursday)

WEBSITE:

myhss.org

Questions? Contact HSS.


Government & Nonprofit

2016 City & County of San Francisco New Employee Benefits Enrollment