2015 City & County of San Francisco New Employee Orientation: Health Benefits

Welcome.

Congratulations on your new job!

HSS Contact Information

PHONE: (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:

www.myhss.org

Health Service System (HSS) Overview

• Your health benefits are determined by: - Your employer or department

- Your union

• HSS is the administrator of City & County of San Francisco employee health benefits: - Medical - Employee Assistance Program (EAP) - Dental - Flexible Spending - Vision - Long Term Disability (most unions)

- Group Life Insurance (some unions)

• Health benefits plan year is January to December.

Benefits Enrollment Process• Three opportunities to enroll or make changes:

- New Employee - Change in Family Status - Annual Open Enrollment

• Starts with an HSS Enrollment Application.

• Documentation (marriage certificate, birth certificate, etc.) is required to enroll dependents.

• You must meet deadlines for submitting application and required documentation.

• If you do not complete enrollment within 30 days of your start work date you must wait until Open Enrollment.

Enrollment of New Employees

• Must enroll in a medical and/or dental plan within 30 calendar days of your start work date.

• If you do not enroll within the first 30 days you must wait for the next Annual Open Enrollment.

• Coverage starts on the first day of the coverage period following your start work date if you submit required application and documentation by the 30 day deadline.

Eligible Dependents

• Legal Spouse or Domestic Partner

• Children from birth 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 partnership, birth or adoption

• No dual eligibility for two related employees enrolled in HSS medical, dental or vision plans

Ineligible Dependents

HSS routinely audits enrollment. You must notify HSS if enrolled dependents are no longer eligible to be covered on your plan.

• Divorced ex-spouse

• Former domestic partner after legal dissolution of partnership

• Legally separated spouse or domestic partner

• Step-children associated with former spouse or partner

• Children who no longer meet age or other eligibility requirements

How Do I Choose a Health 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, balancing coverage if your partner has a plan, etc.)

Medical Plan Options: Co-pay CostsSERVICE

HMOKaiser

HMOBlue Shield

PPOCity Plan

Primary Care Provider yes yes no

Deductible $0 $0 $250 per enrollee

Office Visit$0 - preventive

$20 - other$0 - preventive

$25 - other

85% In-Network(preventive 100%)

50% Out-of-Network

Service Area Kaiser, ER Blue Shield Network, ER

PPO, Out-of-Network

/Worldwide

Information on this chart is effective January–December 2015.

Medical Plan Premium Contributions• Employee premium contributions vary depending on:

- Union- How many people are covered- Medical plan - City of San Francisco employer contribution

• Contributions also vary based on number of covered individuals:- Employee Only - Employee + 1 Dependent - Employee Only + 2 or more Dependents

• To review your premium contribution rates, see your HSS Benefits Guide or visit the HSS website: myhss.org.

2015 Dental Plan OptionsSERVICE

PPODelta Dental*

Dental HMODeltaCare USA

Dental HMOPacific Union

Dental Offices in SF more than 500 14 32

Primary Care Dentist no yes yes

Authorization to Specialist no yes yes

Cleaning & Exam100% / 6 months

3x/yr pregnant 100% / 6 months 100% / 6 months

Fillings 90%/80% 100% 100%

Orthodontia 50%; $2500 max child

$350 start fee; $1600 max child

$350 start fee; $1600 max child

Waiting Period some exceptions* none none

Service Area outside of areamust live in DHMO

areamust live in DHMO area

*Delta Dental costs shown are for PPO/Premiere/Out-of-Network. Premiere and out-of-network dentist costs are higher. 6-month waiting period for dentures, pontics, bridges, orthodontia and implants.

VSP Vision Plan• Vision benefits are only available if you are enrolled in a

medical plan.

• The City pays all premium contributions for the vision benefit. Employee is responsible for any co-pay costs.

• 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 - urgent eye care $5 co-pay- frames/lenses/contacts every 24 months, co-pay $25 - frames/contacts covered to $150- some unions have VDT benefit for computer users

• Claim reimbursement for service from non-VSP providers.

Flexible Spending Accounts (FSAs)• Optional; 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: wageworks.com

FSAs: Types & Examples• Healthcare

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

• Dependent Care (licensed facilities)- day care services- in-home care- nursery- summer day camp

FSAs: Things to Consider• How much do you want to contribute in 2015?

- minimum $260 - maximum $2,500 for Healthcare FSA- maximum $5,000 for Dependent Care FSA

• For reimbursement, submit receipts and documentation to the FSA administrator FBMC.

• Enroll as new employee or annually during Open Enrollment.

• Healthcare FSA only: the amount you designate as your total annual contribution is available on day one of the plan year.

• Healthcare FSA only: up to $500 in unused contributions will automatically carry over to next plan year.

Long Term Disability (LTD) Plan• This employer-paid benefit is only available to some employees,

depending on bargaining unit.

• Provides 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 your union.

• Administered by Aetna.

Group Life Insurance Plan• This benefit is available to some bargaining units: MEA, MAA,

SEIU 1021, Teamsters 856, TWU 200, IFPTE Local 21• Administered by Aetna• Amount: varies by union • Eligibility

- permanent: date when employment begins- 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.

Family Status Change

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

- marriage, divorce, legal separation- domestic partnership (joining or dissolving)

- birth or adoption of a child

If your family situation changes, you may change some health benefits within 30 calendar days of the event.

- loss of other coverage

- obtaining other coverage

- ineligibility

- death

1 30

Open Enrollment

• Next Open Enrollment takes place October 2015 for January to December 2016 plan year.

• During Open Enrollment you may:- keep or change your benefit elections- add or drop dependents- open or re-open a flexible spending account

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

Unpaid Leave of Absence

• If you wish to continue (or waive) health benefits during your leave, you must notify HSS before you go on leave.

• For all types of leave, payments must be made to HSS each month you are on leave, for the full monthly employee premium amount.

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.

HSS Employee Assistance Program (EAP)• Short-term therapy and counseling

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

• Staffed by state certified, licensed therapists

• Completely confidential

• Voluntary

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

• To schedule a confidential EAP appointment call (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. See Benefits Guide for list.

• Health plans may also offer additional wellness benefits.

• Individual departments may also offer other wellness programs.

Stay Informed About Your Benefits• Rates and benefits change every year!

• Visit myhss.org often and register online for monthly email updates.

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

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

Health Service System Website

New Hire Benefits Information Online

http://myhss.org/member_services/newhires/

Questions?