BENEFIT GUIDE - FHCSD

January 1 - December 31, 2017

BENEFIT GUIDE

Your Health. Your Family. Your Life.

WellnessFHCSD

Welcome!An important priority of FHCSD is to provide a competitive employee benefits program for our valued employees. We know our employees view their benefits as an important part of their total compensation package.

For 2017, we are pleased the benefits offered to our employees and their families are even more comprehensive than in previous years. Employees who participate in our wellness program can also earn a discount on their portion of their medical premiums.

This guide will assist FHCSD employees in making informed decisions regarding their benefits. The benefits package offers a variety of coverage options to help our employees choose a plan that best meets their needs. Please read the guide carefully as it will help in making benefit choices.

Benefit packages are complex. To help better understand the available benefits, Family Health Centers of San Diego partnered with HUB International to offer a hotline for our employees and their family members. This toll-free number gives employees immediate and accurate answers to benefit questions.

My Benefits ChampionExtension 4200 or [email protected]:00 a.m. to 5:30 p.m. Pacific Time | Monday through FridayClosed on major U.S. holidays

Regards,

Fran Butler-CohenCEO, Family Health Centers of San Diego

Laura Rodriguez , FounderFamily Health Centers ofSan Diego

Family Health Centers of San Diego (FHCSD) was established in 1970 as a result of a demonstration led by community activists and a well-known grandmother and Barrio Logan resident, Laura Rodriguez. Laura was involved in many worthy causes and dedicated her life to improving the community of Barrio Logan. Most special to her heart, was “La Clinica”.

After growing up without a neighborhood health facility, Laura was inspired to lead a movement to establish a clinic in Barrio Logan for children in her community. Once the clinic opened, Laura worked tirelessly for 24 years to ensure its success. She was known for her famous tamales and once said, “Making tamales while talking about the health center’s needs has put me in contact with hundreds of folks who helped build our center. After all, Barrio Logan is my neighborhood. I will give it the best I’ve got.”

Laura had a humble beginning but received many awards and was recognized as a Presidential “Point-of-Light”. Today FHCSD is the second largest federally qualified health center in the nation, and we honor Laura by fulfilling our mission to provide caring, affordable, high quality healthcare and supportive services to anyone in need.

Table of Contents

GETTING STARTED

02 Benefits-at-a-Glance

WRAPPINGUP

27 Employee PerksDiscounted FHCSD clinic services, tuition reimbursement, computer giveaway, service awards, wireless discounts, employee referral bonus, Tickets2Fun and Home and Auto Insurance discount program.

29 Giving BackScholarship fund, Spirit of the Barrio and !Vive Tu Vida!

03 Eligibility and Enrollment

30 Helpful Definitions31 My Benefits Champion32 Important Notices

133 Contact Information

20 Flexible Spending AccountsHealth Care and Dependent Care accounts.

22 Life and AD&D InsuranceBasic Life and AD&D Insurance for you; Additional Life Insurance for you, your spouse and dependents.

23 Disability InsuranceLong Term Disability insurance for you.

24 Retirement Savings403(b) and 457(b) plans to help you save.

25 Additional BenefitsTravel Assist, Pet Insurance, Legal & IDShield and Aflac Benefits.

08 Medical Care ServicesFree Preventive Care.

09 MedicalFive plan choices that offer a range of health benefits.

15 Prescription Drug CoverageAll of the medical plans provide comprehensive prescription drug coverage.

16 DentalThree plan choices for your dental care.

18 VisionVision coverage and additional discounts for other vision services.

19 Employee CostsEmployee contributions per pay period.

05 FHCSD Wellness ProgramPrograms and resources to help you on your wellness journey.

06 Employee Assistance ProgramConfidential help when you need it, 24/7.

07 Time OffPaid time off, extended sick insurance and holidays to help you balance work and home.

EMOTIONAL PHYSICAL FINANCIAL SOCIAL

PURPOSE

2

Benefits-at-a-GlanceBENEFIT COVERAGE OPTIONS

COSTS SHARED BY YOU AND FAMILY HEALTH CENTERS OF SAN DIEGO

Medical

• UnitedHealthcare SignatureValue Advantage HMO (Limited Network)

• UnitedHealthcare SignatureValue HMO (Full Network)

• Kaiser Permanente HMO

• SIMNSA HMO

• UnitedHealthcare PPO with HSA

100% OF COSTS PAID BY FAMILY HEALTH CENTERS OF SAN DIEGO

Basic Life and AD&D • The Standard - Benefit is equal to 2x annual earnings to a minimum of $40,000 and a maximum of $500,000.

Long Term Disability (LTD) • The Standard - Benefit is equal to 50% of monthly salary to a maximum of $10,000/month for up to 24 months.

Employee Assistance Program • CONCERN EAP - Up to 6 face-to-face counseling sessions per incident for you or any member of your household.

100% OF COSTS PAID BY YOU

Dental• United Concordia DHMO

• United Concordia PPO

• SIMNSA DHMO

Vision • Vision Service Plan PPO

Additional Life Insurance• The Standard - The minimum you can elect is $10,000. Coverage is available

in $10,000 increments up to a maximum of $500,000. Spouse and child(ren) coverage is also available.

Enhanced Long Term Disability (LTD)

• The Standard - Benefit is equal to 60% of monthly salary to a maximum of $12,000/month up to the current retirement age (age 65).

Flexible Spending Accounts (FSA)

• Contribute up to $2,550 pre-tax dollars per year for eligible healthcare expenses.

• Contribute up to $5,000 pre-tax dollars per year for eligible dependent care expenses.

Additional Benefits• Aflac Supplemental Benefits

• LegalShield and IDShield

• VPI Pet Insurance

RETIREMENT BENEFITS

403(b) Retirement Plan

• Principal Financial Group - You may contribute up to 50% of your pre-tax earnings up to the 2017 federal maximum (additional catch-up contribution is available if you turn age 50 or over anytime during the year).

• FHCSD matches 50% of your contributions up to 10% of your pay.

457(b) Retirement Plan • Principal Financial Group - You may contribute up to 100% of your pre-tax earnings up to the 2017 federal maximum.

3

Eligibility & Enrollment

Who Pays?FHCSD and YouFHCSD pays most of the cost of medical coverage for you and your eligible spouse, registered domestic partner and/or children. The amount you pay for medical, dental and vision is taken from your paycheck before federal and state taxes are taken out. This can help reduce the amount of taxes you pay.

Our benefits plan year is fromJanuary 1 to December 31.

Who Can Enroll?Regular Employees• Working full-time (30 hours or more each week on a regular basis).

• Temporary and variable hour employees regularly working 30 ormore hours per week are eligible for medical insurance only.

Spouse/Registered Domestic Partner

• Your legally married spouse (same or opposite sex).

• Your California registered domestic partner (as defined byCalifornia Family Code Section 297).

Children• Your children, stepchildren or children of your registered domestic

partner to age 26, regardless of marital or student status.

• Any children for whom you are required to provide coverage undera Qualified Medical Child Support Order.

• Disabled Child: your unmarried children, step-children or childrenof your registered domestic partner of any age, if they are incapableof self-care due to a physical or mental disability.

Refer to the carrier documents for enrollment requirements.

Your spouse, registered domestic partner and children can be enrolled in our medical, dental, vision, supplemental life insurance plans, Aflac, LegalShield and Identify Theft Shield.

Open Enrollment

• During open enrollment you can add, cancel or change coverage foryou and your eligible family members.

• Open enrollment is November 1 - November 15 every year.

New Hire• You are eligible to enroll on the first of the month following 30

days of employment, not to exceed 60 days.

Example: if you start working at FHCSD on March 15, your benefits start on May 1.

When Can I Enroll?

Important Information• At enrollment you will need to enter the Social Security Number for all covered dependent(s).

• Health Care Reform requires FHCSD to report this health plan information to the IRS each year to show that you andyour dependents have coverage and are not subject to a penalty.

Your personal information will be securely submitted to the IRS and will remain confidential.

4

Eligibility & Enrollment

When Can I Change My Benefits?Open Enrollment• During open enrollment you can make changes to your benefits – like choosing a different medical plan or enrolling

or re-enrolling in the Flexible Spending Account plans.

Qualifying Event• You can make changes during the plan year if something in your life changes (and is an event recognized by the IRS),

such as:

How Can I Enroll?

Marriage, divorce, legal separation

Birth, adoption, deathChange in residence causing loss of coverage

Reduced hours at work for you or your spouse

Qualified Medical Child Support Order (QMCSO)

Change in employment, eligibility, or cost of benefit coverage for you, your spouse or dependent

Medicare or Medicaid entitlement for you, your spouse or dependent

Loss of other coverage for your dependent

Enroll Online at https://www.myworkday.com/fhcsd/login.flex

• If you have forgotten your password email: [email protected].

• You’ll document qualifying event changes in the online Benefit Enrollment System. You must notify Human Resources, and provide documentation, within 30 days of the qualifying event. Any benefit plan election change must be consistent with the qualifying event. Benefit election decisions will then remain in force for the remainder of the plan year.

4

When Can I Change My Benefits? Family Health Centers of San Diego’s Wellness Program has the mission to create a company culture which is productive in all aspects of employee well-being and to be a company that engages employees, reduces employee health risk factors, and constantly provides quality programming through focusing on all Wellness Program Aspects.

FHCSD Wellness Program Aspects

Emotional Well-being - Encouraging our own positive mental health allowing us to rebound and learn from the stresses of life.

Physical Well-being - Seeking safe and healthy choices with our sleep, exercise, and nutrition to reach our full potential.

Social Well-being - Embracing and fulfilling the need to engage with people and coexist peacefully in our communities.

Financial Well-being - Empowering ourselves to be financially secure today and for the future.

Purpose - Making meaningful contributions to our communities

Want to get involved? There is no signing up, there is no enrolling! All information on participating in the program will be communicated regularly through email from [email protected].

FHCSD Wellness Program

5

Wellness Program Disclosure Notice of the Availability of a Reasonable Alternative StandardFamily Health Centers of San Diego is committed to helping you achieve your best health status. Rewards for participating in a wellness program are available to all employees. If you think you might be unable to meet a standard for a reward under this wellness program, you might qualify for an opportunity to earn the same reward by different means. Contact us at [email protected] and we will work with you to find a wellness program with the same reward that is right for you in light of your health status.

CONCERN Employee Assistance ProgramLife is varied and complex. Both at work and in our personal lives. Starting a family or buying a home? Do you need a financial consultant or competent lawyer? Through access to CONCERN’s work/life services, FHCSD wants to help you balance the demands of career and personal life, and to pursue both to their fullest.

Counseling Sometimes, we need the help of an experienced consultant. You, your family and all household members have access to a confidential program providing:

• Unlimited telephonic access

• 24-hour crisis response by licensed counselors, seven days a week

• 6 in-person visits per issue per year

Resilience Hub™ Your virtual mentor, guiding you through exercises, techniques, and tools to activate your inner resources and resolve. The Hub enables you to develop resilience strategies for any and all challenges that come your way.

• Build Your Coping Skills. Access to informative articles and tips help you create coping skills to manage the challenges in your life.

• Use Stress to Your Advantage. Learn techniques and tricks for rethinking stressors. Being able to reframe your perception of the underlying causes allows you to build emotional resilience and the ability to think clearly and function at peak levels when under duress.

• Cultivate Mindful Self-Awareness. Being aware of your thoughts and feelings by purposely focusing your attention on the present moment will help you better respond constructively to any situation.

• Develop and Keep Small Habits. Building and maintaining successful habits starts with small steps. We’ll show you how modest changes in your daily routine can have lifelong positive effects.

LifeAdvisor CONCERN’s LifeAdviser is your wellness one-stop shop for expert information, education, and skill building tools designed to help you better manage:

• Emotional Health

• Financial Concerns

Employee Assistance Program

HELP WHEN YOU NEED IT!A single call will connect you to a specialist who will provide you with immediate assistance.

800.344.4222

You can also login to the website at:

www.concern-eap.com Company Code: FHCSD66

7

At FHCSD, we encourage you to have a healthy work/life balance. Our time off programs are a way for you to relax and recharge so you can be your best you.

Paid Time Off and Extended Sick InsurancePTO (Paid Time Off) and ESI (Extended Sick Insurance) are benefits provided by FHCSD to ensure you have periodic time off for personal recreation and relaxation or while you or a family member is recovering from an illness or injury.

Who is eligible?All regular employees who work 24 or more hours weekly accrue PTO and ESI credit each pay period based on the percentage of time or number of hours worked for that particular pay period.

How do I earn PTO?

PTO ACCRUAL RATE

YEARS OF SERVICE DAYS PER YEAR HOURS PER PAY

PERIOD0 to 4 years 16 days (128 hours) 4.93 hours

5 to 9 years 19 days (152 hours) 5.85 hours

10+ years 22 days (176 hours) 6.78 hours

The maximum PTO accrual is 320 hours. Contact Human Resources for Manager, Director and Provider level PTO accrual rates.

ESI1

In most cases, ESI is used for illnesses or injuries that last three or more days. The first two days of illness is usually paid from your PTO bank (if available). Three days of ESI may be used for bereavement of the death of a family member. Family members include child, spouse and parent.

How do I earn ESI?

• Full-time regular employees earn 3 days (24 hours) per year of ESI.

• ESI accrues at a rate of 0.92 hours per pay period.

• ESI hours are available for use as they are earned each pay period.

• You can earn up to a maximum of 720 hours.

1 Employees who have not completed their orientation period accrue PTO/ESI during orientation time, but are not allowed to use PTO/ESI until successful completion of that period.

Time OffPaid Sick Leave (PSL) - Who is eligible?Temporary, per diem, and regular part-time employees working under 24 hours per week who do not earn PTO or ESI, who work for 30 or more days within a year. PSL does not apply to regular or part-time employees who work more than 24 hours per week who accrue PTO.

How do I earn PSL?

• You will earn at least one hour of PSL for every 30 hours worked.

• The total accrual will be capped at 48 hours per calendar year.

• Employees can only use 3 days (24 hours) per year.

• Accruals cannot be used until the 90th day of employment.

• Unused PSL hours will not be paid out at the end of employment.

• If an employee terminates employment and is rehired within one year, prior accrued PSL hours balance will be reinstated.

Holidays*Each year FHCSD observes a number of paid holidays, giving you the opportunity to spend quality time with family and friends. The following holidays will be observed in 2017:

*Regular employees who work at least 24 hours per week are eligible for holiday pay from commencement of employment. Holiday hours will be paid to an eligible part-time employee only when a holiday falls on a day that he/she works on a regular basis and at the same number of hours regularly scheduled that day.

**All regular employees who work 40 hours per week are eligible to take their birthday as a paid holiday. Birthday holidays will not be granted until successful completion of the orientation period.

• New Year’s Day

• Memorial Day

• Independence Day

• Labor Day

• Thanksgiving Day

• Day after Thanksgiving

• Christmas Day

• Birthday Holiday**

8

Preventive CareDid you know that all medical plans cover preventive care services, for enrolled members, that meet the requirements of federal and state law, including certain screenings, immunizations and physician visits? If you visit in-network providers, you don’t have to pay for preventive care services. If you use an out-of-network provider, a charge may apply.

Child Preventive Care (Birth to 18 years) Preventive Physical ExamAge-appropriate screening tests may include:• Newborn screenings• Vision screening• Hearing screening• Developmental and behavioral assessments• Oral health assessment• Screening for lead exposure• Height, weight and body mass index (BMI)• Screening for sexually transmitted infections

Immunizations:• Hepatitis A• Hepatitis B• Diphtheria, Tetanus, Pertussis• Varicella (chicken pox)• Influenza (flu)• Pneumococcal (pneumonia)• Human Papillomavirus (HPV)• Haemophilus Influenza type B (Hib)• Measles, Mumps, Rubella (MMR)• Meningococcal (meningitis)

Adult Preventive Care (Age 19 and older)Preventive Physical ExamsAge-appropriate screening tests may include:• Cholesterol screening for high risk adults• Blood pressure• Screening for depression• Type 2 Diabetes screening for adults with high blood

pressure• Breast cancer screening, including exam and

mammography• Screening for sexually transmitted infections• HIV screening• Osteoporosis screening• Colorectal cancer screening• Intervention services (includes counseling and

education):• Screening and counseling for obesity• Genetic counseling for women with a family

history of breast or ovarian cancer• Behavioral counseling to promote a healthy diet• Primary care intervention to promote

breastfeeding• Screening and behavioral counseling related to

tobacco use• Screening and behavioral counseling related to

alcohol misuse

Immunizations:• Hepatitis A• Hepatitis B• Varicella (chicken pox)• Influenza (flu)• Pneumococcal (pneumonia)• Human Papillomavirus (HPV)• Measles, Mumps, Rubella (MMR)• Meningococcal (meningitis)

This is not a contract or policy. This list is not a contract with UnitedHealthcare, Kaiser and SIMNSA. If there is any difference between this sheet and the group policy, the provisions of the group policy will govern. Please talk with your doctor about specific health guidelines. This summary of preventive care and physical exam benefits is a brief overview. Preventive Health Guidelines reflected in this document are recommendations for individuals of average risk. Individuals who are higher-risk, including but not limited to those in certain racial/ethnic groups or with personal/family medical history, should check with his/her health care provider for preventive health guidance. Please see your Summary Plan Description as amended, for coverage exclusions and limitations.

9

Medical Plan ChoicesHMO Plans A Health Maintenance Organization (HMO) offers you a range of health benefits, including free preventive care. You have the choice to enroll in one of four HMO plans. With any of the HMO plans, you must see doctors and visit hospitals in the network. Except for emergency and urgent care, if you obtain care outside the HMO’s network without a referral, you will have to pay the full cost of services.

UnitedHealthcare HMOYou have the option to select the UnitedHealthcare SignatureValue Advantage HMO or the UnitedHealthcare SignatureValue HMO (Full Network).

• You and your covered dependents must select the same HMO plan.

• Whichever HMO you choose, you must select a primary care physician (PCP) from a list of doctors provided by the HMO.

• Your PCP coordinates all your care, including referrals to specialists and approving further medical treatment.

• Each family member may choose his/her own PCP.

• UnitedHealthcare covers treatment for infertility services for the diagnosis of an underlying condition only.

SignatureValue Advantage HMO (Limited Network)

• Same high quality care as the SignatureValue HMO (Full Network).

• A slightly more limited network of providers means you will pay less for your medical care.

• No access to providers at Scripps Coastal Medical Group, Scripps Clinic and UCSD.

SignatureValue HMO (Full Network)

• UnitedHealthcare’s complete network of HMO physicians.

• Higher copayments and higher monthly contributions.

• Access to many providers including Scripps Coastal Medical Group, Scripps Clinic and UCSD.

COVERAGE INFORMATION & DOCTOR SEARCHES AT YOUR FINGERTIPS!

Just log on to www.myuhc.com from your smartphone browser and begin using it to search for doctors, access health and wellness resources, and order a health plan ID card.

10

Kaiser Permanente HMOAs a member of Kaiser Permanente, you are encouraged to select a primary care physician, but it is not a requirement.

• Choose your personal doctor. You’re free to change at anytime, for any reason.

• With Kaiser doctor profiles you have access to all the information you need to make the right doctor match.

• Each family member may choose his/her own doctor.

• Access to the full Kaiser health system.

• Most locations include pharmacy, lab, X-ray services, and more.

Most services are covered at 100% after you pay a copayment. There is no deductible with the HMO and no claim forms for you to submit. Additionally, Kaiser is the only medical plan option that provides coverage for the treatment of infertility.

Retiree CoverageFHCSD retirees who are age 65 or older have the option to purchase Retiree Medical Coverage through Kaiser. This Retiree Medical Plan offers enhanced benefits. Retirees may also include coverage for their eligible dependents who are age 65 or older. Please call My Benefits Champion at extension 4200 or 877.679.2011 for additional information.

Medical Plan Choices GOOD HEALTH IS IN YOUR HANDS

My Health Manager is your one-stop online resource for time-saving features. Use it to email your doctor, refill prescriptions, view appointments, and more!

Just download the Kaiser Permanente app for the iPhone, iPad, or iPod touch from the App Store or for Android from Google Play.

Bookmark www.kp.org on your Web-enabled phone or mobile device.

11

UnitedHealthcare & Kaiser Medical Plan Highlights

FEATURES

UNITEDHEALTHCARE SIGNATUREVALUE®

ADVANTAGE NETWORK HMO (LIMITED NETWORK)

UNITEDHEALTHCARESIGNATUREVALUE®

HMO (FULL NETWORK)

KAISERPERMANENTE

HMO

CALENDAR YEAR DEDUCTIBLE

Individual / Family None / None None / None None / None

OUT-OF-POCKET MAXIMUM

Individual / Family $2,000 / $6,000 $3,000 / $9,000 $1,500 / $3,000

PREVENTIVE

Preventive Care ServicesAdult Routine PhysicalsWell-Woman CareWell-Baby Preventive Care Routine Check-ups (Ages 2-18)Immunizations @ PCP

No Charge No Charge No Charge

PHYSICIAN SERVICES

PCP/Specialist Office Visits $20 Copay (PCP); $40 Copay (Specialist)

$20 Copay (PCP); $40 Copay (Specialist)

$20 Copay (PCP); $40 Copay (Specialist)

Therapy* $20 Copay $20 Copay $20 Copay

Laboratory and X-Rays - Standard No Charge No Charge No Charge

Complex X-Rays - CT, MRI, PET $50 Copay $200 Copay No Charge

Maternity Care No Charge $20 Copay No Charge

Infertility Services Not Covered Not Covered 50% Per Visit

Chiropractic1 $15 Copay $15 Copay $15 Copay

HOSPITAL SERVICES

Inpatient Hospital $250 Copay Per Admission $400 Copay Per Admission $250 Copay Per Admission

Outpatient Surgery $125 Copay $400 Copay $100 Per Procedure

Emergency Room $100 Copay $150 Copay (Waived if Admitted)

$100 Copay (Waived if Admitted)

Urgent Care Services $20 Copay; $100 Copay (Out of Area)

$20 Copay; $75 Copay (Out of Area) $20 Copay

Ambulance $50 Copay $50 Copay $50 Copay

MENTAL HEALTH

Mental Health Inpatient $250 Copay Per Admission $250 Copay Per Admission $250 Copay Per Admission

Mental Health Outpatient $40 Copay $40 Copay $20 Per Visit

* Outpatient Medical Rehabilitation Therapy (Physical, Occupational and Speech)

1 Limited to 20 visits/year.

12

Medical PlansSIMNSA Baja HMOThe SIMNSA Baja HMO is an HMO available only to Mexican Nationals. A Mexican National is defined as:

a. a person born in Mexico; b. a person born in another country with a Mexican

father or a Mexican mother, or both; c. a foreign woman or man who marries a Mexican

man or woman and lives in Mexico; or d. a foreigner who becomes naturalized in Mexico.

Features of this plan include:

• Comprehensive medical coverage that includes preventive care and fixed copays for most services.

• No annual deductible or lifetime dollar maximum.

• The ability to choose your own SIMNSA personal physician who will be responsible for providing or coordinating all of your medical care, including specialty care referrals.

• Ability to access all non-Mexico urgent care centers, including FHCSD clinics, for an Out of Area copay.

FEATURES SIMNSA HMOCALENDAR YEAR DEDUCTIBLE

Individual/Family None

OUT-OF-POCKET MAXIMUM

Individual/Family $6,350/$12,700

PREVENTIVE

Preventive Care ServicesAdult Routine Physicals,Well-Woman CareWell-Baby Preventive CareRoutine Check-ups (Ages 2-18)Immunizations @ PCP

No Charge

PHYSICIAN SERVICES

PCP/Specialist Office Visits $7 Copay

Therapy1 $10 Copay

Laboratory and X-Rays - Standard No Charge

Complex X-Rays - CT, MRI, PET No Charge

Maternity Care $7 Copay

Infertility Services Not Covered

Chiropractic Not Covered

Acupuncture $7 Copay

HOSPITAL SERVICES

Inpatient Hospital No Charge

Outpatient Surgery No Charge

Emergency Room $100 Copay (Waived if Admitted)

Urgent Care Services $25 Copay; $50 Copay (Out of Area)

Ambulance No Charge

MENTAL HEALTH

Mental Health Inpatient No Charge

Mental Health Outpatient $7 Copay

PRESCRIPTION

Retail $10 Copay

Non-Preferred Brand $10 Copay

Mail Order Not Covered1 Outpatient Medical Rehabilitation Therapy (Physical, Occupational and Speech)

13

Medical Plans Medical Plan Choices - PPO

This plan is made up of two parts:

1. PPO Health Plan - With the PPO, you pay the full cost of your medical and prescription drug expenses up to the calendar year deductible, before the plan starts to pay (deductible is waived for in-network preventive care).

• After you meet the deductible, the plan shares the cost of eligible expenses. Generally, you’ll pay coinsurance.

• Family Coverage - The PPO has a collective family deductible. This means that all family members contribute towards the family deductible. The plan cannot pay an individual’s claims until the total family deductible has been met, even if he or she has met the individual deductible. Once the family deductible has been satisfied, future claims by all members will be covered at the coinsurance level.

2. Health Savings Account (HSA) - When you enroll in the PPO with HSA plan, you have the opportunity to open an HSA. An HSA is a personal savings account that you and FHCSD contribute to. It can be used to pay for qualified health-related expenses on a pre-tax basis. Here are some of the advantages of an HSA:

• Contributions, interest earnings and withdrawals for qualified health-related expenses are excluded from Federal income tax and FICA (Social Security and Medicare).

• There is no “use it or lose it” rule. Unused funds roll over each year.

• Unused funds can grow through interest and investment earnings and can be “banked” for future health-related expenses.

• The HSA moves with you when you change medical plans, change employers or retire.

• You decide when to use your HSA funds to pay for qualified health- related expenses.

• Your HSA funds can be used in retirement for eligible health related expenses, including Medicare expenses.

How to Open Your HSA Bank Account• You must open an account with HSA Bank within the

first 30 days of your benefit effective date in order to receive the FHCSD seed money. If you do not open your account within the first 30 days, you will forfeit employer funds.

• Human Resources will provide you with the online link or paper application.

• Your account is typically opened within 1-2 business days and your welcome kit and account debit cards will arrive within 7-10 days of opening the account.

• If you have banking/account related questions please contact HSA Bank at 800.357.6246 or visit www.hsabank.com.

UnitedHealthcare PPO with HSA • A PPO medical plan option that gives you more choice and control over how you receive and pay for medical care.

• Employees enrolled in the PPO with HSA cannot enroll in the Health Care Flexible Spending Account (FSA).

FHCSD will to contribute a specific dollar amount to your HSA (seed money):

*Existing Enrollees (benefits effective on January 1) - Employees will receive FHCSD’s contributions equally divided over the 24 pay periods in the year.

*New Enrollees (benefits effective after January 1) - FHCSD’s seed money will be prorated based on your benefits effective date. An initial 20% will be deposited, followed by the remaining 80% equally distributed over the number of remaining pay periods in the plan year.

You also have the ability to contribute to the account. Between FHCSD and you, the maximum annual contribution for 2017 is:

• Employee Only: $3,400

• Employee + Dependent(s): $6,750

• When you reach age 55 or over during the plan year, you can make an additional “catch-up” contribution of $1,000.

• Employee Only: up to $1,500*

• Employee + Dependent(s): up to $2,600*

14

FEATURESUNITEDHEALTHCARE PPO WITH HSA

IN-NETWORK OUT-OF-NETWORK

CALENDAR YEAR DEDUCTIBLE (COMBINED MEDICAL & PHARMACY)2

Individual / Family $1,500 / $2,600 $3,000 / $6,550

OUT-OF-POCKET MAXIMUM (INCLUDES DEDUCTIBLE, COPAYS AND COINSURANCE)

Individual / Family $6,000 / $6,000 $6,550 / $6,550

FHCSD WILL SEED EMPLOYEE HSA FOR 2017

Individual / Family $1,500 / $2,600

PREVENTIVE

Preventive Care Services

No Charge Not CoveredAdult Routine PhysicalsWell-Woman CareWell-Baby

Preventive Care Routine Check-ups (Ages 2-18)Immunizations @ PCP

PHYSICIAN SERVICES

PCP/Specialist Office Visits 10% After Deductible 30% After Deductible

Therapy* 10% After Deductible 30% After Deductible

Laboratory and X-Rays - Standard 10% After Deductible 30% After Deductible

Complex X-Rays - CT, MRI, PET 10% After Deductible 30% After Deductible

Maternity Care 10% After Deductible 30% After Deductible

Infertility Services Not Covered Not Covered

Chiropractic1 10% After Deductible 30% After Deductible

HOSPITAL SERVICES

Inpatient Hospital 10% After Deductible 30% After Deductible

Outpatient Surgery 10% After Deductible 30% After Deductible

Emergency Room 10% After Deductible

Urgent Care Services 10% After Deductible 30% After Deductible

Ambulance 10% After Deductible (Prior Authorization Required for Non-Emergency)

MENTAL HEALTH

Mental Health Inpatient 10% After Deductible 30% After Deductible

Mental Health Outpatient 10% After Deductible 30% After Deductible1 Limited to 24 visits/year.2 If you enroll one or more family members, the family deductible must be satisfied before the plan starts to pay.

UnitedHealthcare Medical Plan Highlights

How the HSA works• You open a Health Savings Account (HSA), established through FHCSD with HSA Bank that you and FHCSD

can put money into (details on how to open your HSA are provided separately).

• You visit a doctor or other health care provider and after your visit, UnitedHealthcare gets a bill.

• UnitedHealthcare sends you an explanation of benefits (EOB). It shows how much you owe for your services.

• You will get a bill for the balance owed to the doctor after your health plan has paid for services.

• Use the money in your HSA to cover out-of-pocket costs. Then use your own money to reach the full amount of the deductible before the plan coinsurance begins to pay for covered services. 14

15

Prescription Drug CoverageUnitedHealthcareUnitedHealthcare members can utilize both retail pharmacy and mail order pharmacy services.

Mail OrderIf you take maintenance medications for chronic conditions, such as high blood pressure, asthma or diabetes, using the mail order service can save time and money. When using the mail order service, you will receive a 3-month supply at a lower cost!

You can order refills:

Online - www.optumrx.com By Phone - 800.562.6223

By Mail - Complete the Order or Reorder Form and mail with payment in full to the address listed on the form.

Retail Pharmacy

• Show your medical plan ID card at a participating pharmacy.

• Your cost will depend on the type of prescription you receive.

• You will receive a 30-day supply for your prescription.

FEATURES

UNITEDHEALTHCARE SIGNATUREVALUE®

ADVANTAGE NETWORK HMO

(LIMITED NETWORK)

UNITEDHEALTHCARESIGNATUREVALUE®

HMO (FULL NETWORK)

UNITEDHEALTHCAREPPO WITH HSA

IN-NETWORK OUT-OF-NETWORK

RETAIL PHARMACY COPAYMENT (UP TO A 30-DAY SUPPLY)

Generic $10 $10 $10 After Deductible $10 After Deductible1

Brand Name $25 $25 $30 After Deductible $30 After Deductible1

Non-Formulary $35 $35 $50 After Deductible $50 After Deductible1

MAIL ORDER COPAYMENT (UP TO A 90-DAY SUPPLY)

Generic $20 $20 $25 After Deductible

Not CoveredBrand Name $50 $50 $75 After Deductible

Non-Formulary $70 $70 $125 After Deductible1 You pay the copay ment amount plus the difference between the cost of the drug when purchased in-network vs. out-of-network.

FEATURES KAISER PERMANENTE HMORETAIL PHARMACY COPAYMENT (UP TO A 30-DAY SUPPLY)

Generic $10

Brand Name $25

Non-Formulary Not Covered

MAIL ORDER COPAYMENT (UP TO A 100-DAY SUPPLY)

Generic $20

Brand Name $50

Non-Formulary Not Covered

Kaiser PermanenteKaiser members can utilize both retail pharmacy and mail order pharmacy services. Kaiser members will coordinate prescriptions through Kaiser Permanente. Prescriptions can be filled at a retail pharmacy or online at www.kp.org.

Mail Order Using the mail order service can save you time and money. You can receive up to a 100-day mail order supply for maintenance medications.

Save Money On Your MedicationsAsk For Generic DrugsYou can save money by asking for generic drugs. The FDA requires that generic drugs have the same high quality, strength, purity, and stability as brand-name drugs.

The next time you need a prescription, ask your doctor to prescribe a generic drug when it is available and appropriate.

Dental Plan ChoicesStrong teeth and gums are an important part of good health, which is why FHCSD offers you a choice of dental plans to help pay for many of the dental expenses you and your family may have.

All the plans help you pay for most necessary dental services and supplies, including:

• Diagnostic and preventive care (such as exams, cleanings, and x-rays)

• Basic and major services (such as fillings, crowns, and dentures)

The DPPO features UCWellness, a dental wellness program that provides enhanced coverage and targeted education for members with pregnancy, diabetes, heart disease and stroke. For more information, visit www.ucci.com or call 800.332.0366

Review the comparison chart below for a summary of plan features.

FEATURES

UNITED CONCORDIA DHMO UNITED CONCORDIA DPPO

IN-NETWORK ONLY IN-NETWORK OUT-OF-NETWORK*

CALENDAR YEAR DEDUCTIBLE

Individual / Family None $50 / $150

CALENDAR YEAR MAXIMUM

Per Person None $1,500***

PREVENTIVE & DIAGNOSTIC CARE (DEDUCTIBLE WAIVED)

Routine Exams, Teeth Cleaning, Bitewing X-rays No Charge You pay 0% You pay 0%

BASIC CARE

Oral Surgery, Endodontics, Fillings Refer to Schedule of Benefits** You pay 10% You pay 20%

MAJOR CARE

Inlays, Onlays, Crowns Refer to Schedule of Benefits** You pay 40% You pay 50%

Orthodontia24-Month Treatment Fee

$1,500/Child $2,000/Adult

Not Covered

*When using a non-PPO (out-of-network) provider, you pay your coinsurance plus any amount over the prevailing charge, which is the price most providers in the geographic area charge for a specific service.**You can find the full schedule of benefits on the Online Benefit Enrollment System.***Preventive Incentive: Preventive care services do not count toward the calendar year maximum

The United Concordia Dental PPO plan is accepted with certain dentists at FHCSD Dental Clinic locations.

16

Dental Plan Choices

FEATURESSIMNSA DHMO

IN-NETWORK ONLY

CALENDAR YEAR DEDUCTIBLE/MAXIMUM

Calendar Year Deductible (Individual/Family) None

Calendar Year Maximum Benefit per Person None

PREVENTIVE & DIAGNOSTIC CARE (DEDUCTIBLE WAIVED)

Routine Exams, Teeth Cleaning, Bitewing X-rays 100%

BASIC CARE

Oral Surgery, Endodontics, Fillings Refer to Schedule of Benefits**

MAJOR CARE

Inlays, Onlays, Crowns Refer to Schedule of Benefits**

Orthodontia 24-Month Treatment $50/Visit

**You can find the full schedule of benefits on the Online Benefit Enrollment System.

SIMNSA DHMOThe SIMNSA DHMO is a Dental HMO available only to Mexican Nationals. A Mexican National is defined as:

a. a person born in Mexico; b. a person born in another country with a Mexican father or a Mexican

mother, or both; c. a foreign woman or man who marries a Mexican man or woman and

lives in Mexico; or d. a foreigner who becomes naturalized in Mexico.

There is no deductible or calendar year maximum. Most diagnostic and preventive procedures are covered at no cost to you, however other services may have a copay associated with them.

17

18

FHCSD provides vision coverage through Vision Service Plan (VSP). VSP has one of the largest networks of private practicing optometrists, ophthalmologists and opticians.

• You can see a VSP in-network provider or an out-of-network provider.

• Your costs will be lower if you visit an in-network provider.

• You will not receive a VSP I.D. card as it is not required to receive service.

• Just call a VSP network doctor to schedule an appointment and be sure to tell them you are a VSP member. The doctor and VSP will handle the rest!

To locate and select a VSP provider, visit www.vsp.com or call Customer Service at 800.877.7195.

Vision Plan

FEATURESVISION SERVICE PLAN

IN-NETWORK OUT-OF-NETWORK REIMBURSEMENT

Materials Copay $20 Copay

ExamOnce Every 12 Months $20 Copay $20 Copay, Then

Plan Pays Up To $45

LensesOnce Every 12 Months After Materials Copay, You Pay: After Materials Copay, Plan Pays:

Single Vision

No Charge

Up to $30

Bifocal Up to $50

Trifocal Up to $65

FramesOnce Every 24 Months

Plan Pays Up To $130 (Retail) + 20% Off the Amount Over Your Allowance Plan Pays Up To $70 (Retail)

Contact Lenses (Instead of Glasses)Once Every 24 Months

Contact lens exam (fitting & evaluation) Plan Pays Up To $60 Plan Pays Up To $45

Materials (contacts) Plan Pays Up To $150 Plan Pays Up To $105

Special Discounts!In addition to the vision benefits provided through your FHCSD benefits program, VSP offers special discounts on a number of non-covered services, such as:• Additional pairs of glasses• Special lens options • LASIK surgery

19

Employee CostsEmployees who participate in the Wellness Program each quarter will earn a $25 credit each paycheck towards the cost of their medical plan during the next quarter! While the Wellness Program is entirely voluntary, only employees who participate in and meet the program’s requirements (or Reasonable Alternative Standard) will earn the $25 credit per pay period. FHCSD may automatically apply the wellness credit to reflect your participation (or the end of your participation) in the Wellness Program.

*Medical contributions are taken out of all paychecks except for 3/31/2017 and 9/29/2017 paychecks.

When any insurance policy or other benefit program provides that benefits continue through the end of the month in which you terminate or are no longer benefit-eligible, your share of the cost for the remainder of the month will be deducted from your paycheck and coverage will continue through the end of the month in which you terminate or lose coverage.

Dental and vision contributions are not impacted by your participation in the health screening or in any wellness programs.

TIER

UNITED CONCORDIA

DHMO

UNITED CONCORDIA

DPPO

SIMNSA DHMO

YOUR COST PER PAY PERIODEmployee Only $7.30 $18.09 $8.04

Employee + Spouse $14.95 $36.00 $14.47

Employee + Child(ren) $16.05 $38.17 $10.05

Employee + Family $22.25 $54.69 $25.12

TIERVSP VISION PLAN

YOUR COST PER PAY PERIOD

Employee Only $4.01

Employee + Spouse $6.87

Employee + Child(ren) $7.02

Employee + Family $11.31

TIER TOTAL COST PER YEAR

TOTAL COST PER PAY PERIOD

FHCSD COSTPER PAY PERIOD

YOUR COSTPER PAY PERIOD*

SIMNSA HMOEmployee Only $2,166.36 $90.27 $60.27 $30.00

Employee + Spouse $3,903.00 $162.63 $130.13 $32.50

Employee + Child(ren) $5,415.84 $225.66 $190.66 $35.00

Employee + Family $6,797.16 $283.22 $245.72 $37.50

KAISER PERMANENTE HMOEmployee Only $5,376.00 $224.00 $178.00 $46.00

Employee + Spouse $12,149.76 $506.24 $397.24 $109.00

Employee + Child(ren) $10,536.96 $439.04 $344.54 $94.50

Employee + Family $16,826.76 $701.12 $549.12 $152.00

UNITEDHEALTHCARE SIGNATUREVALUE® ADVANTAGE NETWORK HMO (LIMITED NETWORK)

Employee Only $6,769.92 $282.08 $236.08 $46.00

Employee + Spouse $14,826.00 $617.75 $506.25 $111.50

Employee + Child(ren) $12,862.80 $535.95 $439.95 $96.00

Employee + Family $20,580.48 $857.52 $700.02 $157.50

UNITEDHEALTHCARE SIGNATUREVALUE® HMO (FULL NETWORK)

Employee Only $10,016.16 $417.34 $350.34 $67.00

Employee + Spouse $21,935.28 $913.97 $718.97 $195.00

Employee + Child(ren) $19,030.68 $792.95 $627.95 $165.00

Employee + Family $30,448.92 $1,268.71 $984.71 $284.00

UNITEDHEALTHCARE PPO WITH HSAEmployee Only $9,263.88 $386.00 $331.00 $55.00

Employee + Spouse $20,287.92 $845.33 $691.83 $153.50

Employee + Child(ren) $17,601.36 $733.39 $602.39 $131.00

Employee + Family $28,162.20 $1,173.43 $954.43 $219.00

20

Flexible Spending AccountsWhat is a Flexible Spending Account (FSA)?• The FSA, administered by WageWorks, is an account that allows you to

save money to use for certain health care and dependent care costs.

• You can enroll in the health care account, the dependent care account, or both.

• The money in the account is only available one year at a time (January 1 - December 31).

How does an FSA work?• You put money into the account through your paycheck, before any

Federal, State, and Social Security taxes are taken out.

• These deductions are taken throughout the year in equal amounts.

• For example, if you decide to put $500 into an FSA, you’ll have $20.83 taken out of 24 paychecks and put into your account.

• The best part? FHCSD does it for you, so you don’t have to worry about transferring money!

• Employees enrolled in the PPO with HSA cannot enroll in the Health Care Flexible Spending Account (FSA).

How do I use the money?When you have an eligible expense, you can:

• Submit a claim for reimbursement and;

• choose to receive a check by mail or,

• have a direct deposit to your checking or savings account.

• Have funds automatically deducted from your account by using your FSA Benefits Card.

• The Benefits Card can only be used with your Health Care FSA dollars.

• You must submit receipts for reimbursement for your Dependent Care expenses.

• The FSA Benefits Card deducts each payment directly from your FSA account.

Your Health Care and Dependent Care accounts function separately. You cannot use funds from one account to pay for eligible expenses from the other account (for example, using Dependent Care account funds for health care expenses).

Account DetailsShould I keep my receipts?Yes. You may be occasionally asked to submit your receipt as proof of an eligible expense. Remember to keep original receipts for your records as you may be required to provide documentation directly to the IRS in the event of a personal tax audit.

How long can I access the money in the account?Any money that you set aside for your Dependent Care account and do not use for claims incurred through December 31, 2017 will be forfeited. For the Health Care account, money in excess of $500 that is not used will be forfeited. An IRS rule allows you to keep up to $500 of unused Healthcare FSA funds and roll it into the next year’s FSA. The rollover has no impact on your maximum annual election. The rollover amount is in addition to your regular election for the following plan year.

21

Can I save money on child care?• Yes. Consider enrolling in the Dependent Care FSA.

How much can I contribute?• You can put up to $5,000 per year into the Dependent

Care FSA.

• If you are married and filing your tax return separately, you can put up to $2,500 per year into the Dependent Care FSA.

Who can I use the money for?• Children under the age of 13 who are listed as

dependents on your income tax return.

• Dependents of any age who are incapable of caring for themselves and who regularly spend at least 8 hours a day in your home.

• Daycare expenses are defined as those that are necessary in order for you (and your spouse, if you’re married) to continue working.

What can I use the money for?Eligible Dependent Care expenses, covered while you are at work, include:

• Babysitters

• Day Care Centers

• Nursery School/Preschool

• After School Care Programs

Dependent Care FSA

Health Care FSA

MOBILE ACCESSVisit m.wageworks.com on your mobile device to:

• Access FSA account balances• Receive account alerts• View important dates

Or download WageWorks’ FREE EZ Receipts® app

You can submit receipts and claims from your mobile device using an easy step-by-step process and will receive a confirmation once your claim has been submitted.

How much can I contribute?• You can put up to $2,550 per year into the Health

Care FSA.

• If you are married and filing your tax return separately, each spouse can put up to $2,550 per year into their own Health Care FSA.

Who can I use the money for?• You

• Your legal spouse

• Your dependent children

What can I use the money for?• Deductibles and copayments

• Medically necessary maintenance and support devices

• Treatment of alcoholism or drug dependency

• Dental, vision and hearing: dental checkups, orthodontics, glasses, LASIK and hearing aids (including batteries)

21

22

Life and AD&D InsuranceBasic Life Insurance (paid by FHCSD)Life insurance protects your family or other beneficiary(s) in the event of your death while you are still actively employed at FHCSD. Your coverage amount will be paid to the beneficiary(s) of your choice.

What is the Basic Life Benefit?FHCSD pays for coverage in the amount of:

• Two times your annual earnings

• The benefit amount is a minimum of $40,000 to a maximum of $500,000

Accidental Death & Dismemberment (paid by FHCSD)If your death is due to an accident, your beneficiary will receive an additional amount through Accidental Death and Dismemberment (AD&D) coverage.

What is the AD&D Benefit?• AD&D coverage is equal to your life insurance

coverage amount.

• AD&D benefits are payable if you pass away, lose a limb, or have a loss of speech, hearing, or eyesight because of a covered accident (either on or off the job) and the loss occurs within one year of the covered accident.

The payable amount of your AD&D benefit depends on the type of loss. In the event of death due to an accident, your beneficiary(s) may receive both your life and AD&D benefits.

Note: You will automatically be covered under the Basic Life Insurance plan.

Designate a Beneficiary!Don’t forget to designate a beneficiary(s) for your life and AD&D Benefits.

You can designate beneficiary in the Online Benefit Enrollment System.

BENEFICIARY: a person or group

that receives benefits, funds

or other property under a will, trust,

insurance policy, etc.

Additional Life Insurance (paid by you)It is important to have enough life insurance protection for your family. If you determine you need more than the Basic Life coverage, you may want to add coverage for yourself and your eligible dependents.

To determine how much it will cost for the Additional Life, log-on to the Online Benefit Enrollment System or the FHCSD HR Intranet.

ADDITIONAL LIFE INSURANCE

For You

Coverage is available in $10,000 increments. Benefit amount is a minimum of $10,000 up to $500,000. Guaranteed Issue: $150,000

For Your Spouse

Coverage is available in $5,000 increments. Benefit amount is a minimum of $5,000 up to $500,000 (not to exceed 100 percent of your additional life coverage).

Guaranteed Issue: $25,000

For Your Children

From live birth through age 25 - $10,000

Guaranteed Issue: $10,000

Guaranteed Issue amounts only apply for newly eligible employees. If you are electing Additional Life Insurance outside of when it was first offered to you, or in amounts over the guaranteed issue, you will be required to submit a Medical History Statement for approval by the insurance company before coverage can become effective.

23

ADDITIONAL LIFE INSURANCE

For You

Coverage is available in $10,000 increments. Benefit amount is a minimum of $10,000 up to $500,000. Guaranteed Issue: $150,000

For Your Spouse

Coverage is available in $5,000 increments. Benefit amount is a minimum of $5,000 up to $500,000 (not to exceed 100 percent of your additional life coverage).

Guaranteed Issue: $25,000

For Your Children

From live birth through age 25 - $10,000

Guaranteed Issue: $10,000

Long Term Disability

Long Term DisabilityLong Term Disability (LTD) insurance pays you a portion of your income if you become unable to perform your regular job duties for 90 days due to illness or injury. FHCSD offers you two levels of coverage:

• Basic LTD plan (paid by FHCSD)

• You will automatically be covered under the Basic LTD plan if you do not enroll for coverage under the Additional LTD plan.

• Additional LTD plan (paid by you)

What is the Long Term Disability Benefit?LTD works with Social Security and any other group disability coverage to provide you with a combined monthly benefit.

Basic LTD Plan (paid by FHCSD)

• You’ll get 50% of your monthly pre-disability earnings, up to $10,000 per month for up to 24 months.

Additional LTD Plan (paid by you)

• You’ll get 60% of your monthly pre-disability earnings, up to $12,000 per month up to your Social Security Normal Retirement Age.

How much does Additional Long Term Disability cost?To determine how much it will cost for the Additional LTD plan, log-on to the Online Benefit Enrollment System or the FHCSD HR Intranet.

KNOW WHERE TO STARTEven with a healthy lifestyle and preventive care, sometimes an illness or accident can still happen. If you become disabled, contact The Standard at 800-368-1135 so they can certify your claim and assist you with the disability claim process.

24

Retirement Saving Plans403(b) PlanThe 403(b) plan gives you the opportunity to save money for your retirement before taxes are taken out. Eligible employees* may begin making contributions on the first pay period administratively feasible (1-2 pay periods generally).

How do I enroll?Employees hired after 1/1/2017 will automatically be enrolled in the 403(b) plan. By default, 6% of your pay will be contributed to the plan. You can change your contribution amount at any time.

How much can I save?• You can save from 1% to 50% of your total pay up to the 2017 IRS

annual maximum.

• If you are 50 years or older you may contribute an additional amount up to the 2017 IRS catch-up contribution maximum.

• The money you contribute is always 100% vested.

When does the money come out of my paycheck?• Retirement plan contributions are taken out of all 26 paychecks.

Is there a match?Yes. FHCSD will match 50% of your contribution up to 10% of your pay. Employee contributions that are over 10% of your pay will not be matched. The matching contributions FHCSD makes on your behalf will vest based on the schedule below:

YEARS OF SERVICE VESTING OF MATCH

Less than 1 year 0%

1 - 2 years 25%

2 - 3 years 50%

3 - 4 years 75%

4 or more years 100%

How is my money invested?

• You have a menu of funds to choose from if you wish to direct your investments.

• If you do not choose your investment option(s), contributions will be automatically deposited in the plan’s investment default.

• For detailed information about your investment options, please contact Principal at www.principal.com or call 800.547.7754.

*You are an eligible employee if you are expected to work at least 1,000 hours per year.

457(b) PlanThe 457(b) plan is a retirement plan that is available for governmental and certain non-governmental employers. The plan operates similarly to our 403(b) plan and allows you to save beyond the limits of the 403(b) plan alone.

Who can enroll?• You can enroll in the plan if you hold

the title of:

• Director or are a Licensed Independent Practitioner

• Have completed 90 days of service

• And work a minimum of 20 hours per week

How much can I save?• You can save from 1% to 100% of your

total pay up to the 2017 IRS annual maximum.

• The money you contribute is always 100% vested.

How is my money invested?

• You have a menu of funds to choose from if you wish to direct your investments.

ACCESS YOUR RETIREMENT PLAN ANYWHERE!

View your retirement account from the Principal Financial Group® anytime and anywhere – with this free and secure

mobile app for Apple, Android and Blackberry. Search “Principal Financial” in your app store to download.

24

Additional BenefitsUnitedHealthcare Global Travel AssistanceThis benefit helps you cope with emergencies when you travel more than 100 miles from home or internationally for trips of up to 180 days. You and your family are automatically covered at no cost to you and it offers the following services 24 hours a day, every day: pre-trip assistance, trip assistance, medical assistance, legal assistance, 24-hour health information, emergency transportation services and personal security services.

For more information, please contact UnitedHealthcare Global at 800.527.0218 or by email at [email protected].

Pet Insurance - NationwideNationwide Pet Insurance offers affordable plans for dogs, cats, birds, reptiles and other exotic pets. Policies cover a wide range of care from minor ailments to serious conditions such as cancer and heart disease. Pet owners are free to visit any veterinarian. Nationwide has coverage in all 50 states including Washington D.C.

Nationwide Pet Insurance reimburses for:

For more details or if you are interested in enrolling, please contact Nationwide at 877.738.7874 or online at www.petinsurance.com/affiliates/fhcsd.

• Office visits

• Prescriptions

• Treatments

• Lab fees

• X-rays

• Surgeries

• Hospitalization

• And more!

25

26

Additional Benefits

Aflac Supplemental InsuranceThe following Aflac supplemental plans are available to you.

For enrollment information, contact:

Phone: 858.429.5442Email: [email protected]

• Critical Illness & Cancer

• Hospital Advantage

• Accident Indemnity

• Term & Whole Life

• Disability IncomeProtection

LegalShieldTM

You can enroll in the legal assistance plan, which is designed to help you with many everyday issues, including traffic violations, credit problems, child custody matters, and landlord issues.

As a participant in the LegalShield plan, you will have access to a wide variety of attorneys from top law firms in your area.

TIER EMPLOYEE COST PER PAY PERIOD1

LEGALSHIELD IDSHIELD LEGALSHIELD + IDSHIELD

Employee Only $7.98 $4.48 $12.45

Employee + Family $7.98 $9.48 $15.45

1Except for 3/31/2017 and 9/29/2017 paychecks

ID ShieldTM

You have the option to enroll for Identity Theft Shield identity theft protection. This benefit may save you time and money - and restore your name and credit for you if your identity is stolen.

Trained experts provide you with fraud alert notifications, perform proactive database searches, and continuously monitor your credit.

27

Additional Benefits Employee PerksDiscounted Care at FHCSD ClinicsAs an employee of FHCSD you, and your immediate family members, are eligible to receive discounted services at our clinic locations (only if you are not otherwise insured). See the table below for a list of discounted services.

DEPARTMENT EMPLOYEE DISCOUNT** EXCEPTIONS SELF PAY

DEPOSIT

MAXIMUM SELF-PAY

DISCOUNT***EXCEPTIONS

Adults 50% Yes* $35 80% Yes*Pediatrics 50% Yes* $35 80% Yes*Women’s 50% Yes* $35 80% Yes*Dental 25% Yes* Variable** 25% Yes*Vision Care 40% Yes* $65 40% Yes*Speech, Hearing, Early Int. 50% No $45 50% NoENT 50% No $45 50% NoOther Specialties 50% Yes* $45 50% Yes*

* Purchased materials/supplies – costs plus handling fee.X-Ray and Pharmacy are not subject to discount.Some procedures discounted down to cost, plus handling fee (i.e. lab, glasses, frames).

** Depends upon treatment rendered. Typical range is $35.00 to $50.00.*** Subject to minimum fee of $35.00 as well as income and number of family members, except for Beach minimum $60.00.

Computer GiveawayFHCSD periodically upgrades agency computers so our employees have the best tools to serve our patients and make our programs as efficient as possible. In recognition and appreciation of our employees, FHCSD gifts the repurposed computers to our employees when available. Giveaway application information is distributed to all employees when available.

Service AwardsAll regular full-time and part-time employees are eligible to receive a service award upon completion of five years of service and at the end of every additional five years of service. Service does not have to be continuous to count toward service credit for the award.

Tuition ReimbursementFHCSD strongly believes in our Standard of Conduct to Learn, Grow, and Continuously Improve. To support FHCSD employees seeking professional growth and development of skills necessary to fulfill our mission of providing affordable quality health care, FHCSD has a Tuition Reimbursement program. For complete program details and how to apply, please see the Tuition Reimbursement policy on the HR-Benefits website.

Who is eligible?Tuition Reimbursement is available for regular employees working 30 hours or more per week.

How much is the reimbursement?FHCSD will reimburse up to fifty percent (50%) of expenses such as tuition, registration fees, text books, and lab fees, up to a maximum of one thousand dollars ($1,000.00) per fiscal year.

What coursework is eligible?Coursework must be a part of a program leading to an certificate or accreditation, Associate of Arts, Bachelors, Masters, or other post-graduate degree related to a substantive area of the business of FHCSD (such as medical, dental, nursing, marketing, accounting, technology, and so forth).

28

Employee PerksWireless DiscountsAT&T• Qualified employees can receive 25% off wireless voice

communication products and data service plans.

• To sign up, visit www.att.com/wireless/premiergpo and enter your 8-digit Foundation Account Number: 04553393.

• You can also visit any AT&T corporate-owned/stand-alone store (but not an authorized retail store).

• The employee must be the primary account holder for his/her family to be eligible for the discount.

• You will be required to provide proof of employment.

Verizon• Get a 22% discount on Verizon Wireless calling plans of

$34.99 monthly access or higher and 25% discount on accessories.

• To register, visit www.verizonwireless.com/discount and enter your work e-mail address. If you do not have a work e-mail address, select the appropriate action under “Don’t Have a Work E-mail Address?”

• You can also visit any Verizon corporate-owned/stand-alone store (but not an authorized retail store) or call 800.899.4249.

• You will be required to provide proof of employment.

SprintEmployees can get a 23% discount on their personal cell phone plans. To get the discount:

• Visit www.sprint.com/verify and enter your cell phone number and validation will be sent to your work email within three days.

• Complete the Employee Verification Form located at www.sprint.com/verify.• Fax the completed form along with proof of

employment.• Visit your nearest Sprint corporate-owned/stand-alone

store.

• Provide proof of employment at the Sprint Store, your name, company name and work email address.

• Call 877.687.8211 and provide Sprint with your name, company name and work email address.

Employee Referral BonusA cash bonus is paid to employees who refer an applicant who is hired to work at FHCSD. For more information, see HR policy and www.fhcsd.org/careers

Tickets2Fun DiscountsFHCSD employees can save up to 40% off nationwide family attractions including:

Here’s how to login & order:

1. Go to www.tix2fun.com and click Login2. First time New Customers click Register Now…3. Enter the Partner Code, FHC5134. Complete your registration. You’re ready to shop.5. Your personal password will be emailed to you later.

6. You’re done! Start Shopping and Saving with Tickets2Fun

For more information contact: Tickets2Fun 949.683.6851

Benefits Plus Home and Auto Insurance Discount ProgramWith Benefits Plus you may be able to save on quality home, renters and auto insurance. As an employee of FHCSD you may qualify for special discounts that can save you money. You’ll also have the option to have policy premiums deducted from your bank account. To obtain a quote or receive more information on this program, all you need to do is call My Benefits Champion at extension 4200 or 877.679.2011.

When you call, you will:

• Receive a professional help with choosing the right insurance

• Get a free, no-obligation quote for coverage

To make sure you get an accurate comparison with your current coverage, be sure to have a copy of your policy handy.

• Disneyland

• California Adventure

• SeaWorld

• Catalina Island Cruises

• Movie Theaters

• Knott’s Berry Farm

• Legoland

• and more!

FHCSD encourages our employees to become engaged not only at work, but also outside of work. We are proud that we give back to the community where FHCSD started and continues to thrive.

The Jenedino Quinzon Memorial Scholarship Fund offers two $1,000 scholarships each year to one FHCSD employee and to a FHCSD employee spouse/partner or dependent who display a desire to grow though learning in healthcare or healthcare-related field of study and who demonstrates a financial need. For more information contact [email protected].

Coined as the “Best Use of a Lunch Hour”, since 1986 Family Health Centers of San Diego has hosted this community luncheon to increase awareness about Family Health Centers of San Diego and its vital role in the surrounding communities. In addition, the event raises critical funding for programs and services by bringing together local business leaders, individuals, military and community leaders for networking, education, entertainment and community building. The luncheon is held from 11:30am to 1:00pm in the Logan Heights neighborhood where the first clinic was founded almost four decades ago. The historical list of supporters, including prominent corporate, political, tribal, military, athletic and community leaders, attend each event to enjoy our famous tamale lunch, network and listen to experts discussing trending topics.

FHCSD partner hosts !Vive tu vida!, an annual health expo promoting Hispanic family physical activity and healthy lifestyles. The San Diego event features FREE health information and screenings including cholesterol, glucose, blood pressure, dental and vision. Additionally, participants will receive information on programs that help save money on household expenses, as well as enrollment information for Covered California and MediCal. Participants enjoy physical activities, live music, healthy snacks and giveaways for the whole family!

Giving Back

29

Helpful Definitions

What Does It Mean?

Employee Contribution: The amount an employee pays for their benefits through payroll deductions.

Copayment: The amount which a covered individual is required to pay for certain services after meeting any applicable deductible.

Deductible: The amount of out-of-pocket expenses that must be paid for services by the insured before becoming payable by the carrier.

Eligibility: Conditions that an employee must meet to participate in a plan or obtain a benefit.

Enrollment Period: The period of time you have to sign up for insurance.

Formulary: A list containing the names of certain prescription drugs that a medical plan covers when dispensed to its members who have drug coverage.

Guaranteed Issue: The amount of life insurance coverage you are guaranteed to receive without the requirement of medical history or examination.

Health Savings Account: A personal savings account that allows you to pay for qualified medical expenses with tax-advantaged dollars. You and/or your employer contribute money to an HSA through pre-tax contributions. The money contributed to the account is not subject to federal income tax at the time of deposit.

HMO: Health Maintenance Organizations (HMO) offer a range of health care services at a fixed price and require that covered individuals see doctors that are in their network of providers. HMOs require a referral to network providers after the member has selected a Primary Care Physician.

In-Network: Medical, dental and vision providers or facilities who have agreed to discounted fees with insurance carriers to participate within their provider networks.

Inpatient: A person who occupies a hospital bed, crib or bassinet while under observation, care, diagnosis or treatment for at least 24 hours.

Mail Order Prescriptions: A method of dispensing medication directly to the patient through the mail by means of a mail-order drug distribution company. Offers greatly reduced costs for prescriptions, especially for long term drug therapy.

Medical Group (network): An organization of physicians who are generally located in the same facility or participate in a group network and provide services to covered individuals.

Member: A person eligible to receive, or receiving, benefits from an insurance policy. Includes both those who have enrolled or subscribed and their eligible dependents.

Non-Formulary: A drug or medication not listed and approved on a health insurance plan coverage schedule.

Out-of-Network: A healthcare provider with whom an insurance carrier does not have a contract to provide services. A member may pay higher copays, and/or deductibles to see an out-of-network provider or have no coverage at all.

Out-of-Pocket Maximum: The maximum amount of money a person will pay in addition to copays and deductibles, in a calendar year.

Outpatient: A person who visits a clinic, emergency room or health facility and receives health care without being admitted as an overnight patient.

PCP: Primary Care Physician (PCP) provides treatments for routine illness and injuries. For members enrolled in an HMO Plan, a PCP will need to refer the member to a specialist.

PPO: Preferred Provider Organizations (PPO) have a network of providers whose services are available to members at lower cost that services of out-of-network providers. PPOs allow members to self-refer to any network provider at any time.

Premium: The amount of money an insurance company charges for insurance coverage. 

Reasonable & Customary: The prevailing charge made by physicians of similar expertise for a similar procedure in a particular geographic area.

Wellness: A healthy balance of the mind, body and spirit that results in an overall feeling of well-being and leads to a high quality of life.

30

MY BENEFITS CHAMPION IS HERE TO HELPMY BENEFITS CHAMPION is the only call you need to make with employee benefit and wellness questions.

31

My Benefits Champion is here to answer your questions and help make your employee benefits easier to use. My Benefits Champion is the only call you need to make for employee benefit and wellness questions...and best of all, it’s free!

Within 24 hours of your initial call, My Benefits Champion will either have the issue resolved or will update you on any further actions including the time frame for resolution. Below are some of the questions My Benefits Champion can answer.

Benefit QuestionsI need to have surgery; does my insurance cover it? How much will my portion of the cost be?

Claims AssistanceI received a bill from my doctor. I thought these services were covered. What do I do now?

ReferralsI need to see a specialist, but I’m having trouble getting a referral. What do I do?

Eligibility IssuesI tried to pick up a prescription today, but the pharmacy is saying that I’m not covered. Why?

My Benefits Champion

My plan didn’t pay my bill. What do I do?

When is Open Enrollment?

Is my provider in-network?

I lost my ID card!

MY BENEFITS CHAMPION IS HERE TO HELPMY BENEFITS CHAMPION is the only call you need to make with employee benefit and wellness questions.

I can’t enroll...help!

Who is eligible for benefits on my plan?

How does my plan work?

Can I have double

coverage?

EXTENSION 4200or 877.679.2011

[email protected]

Fax: 866.214.2211

Monday - Friday

7:00 a.m. to 5:30 p.m. PT

All inquiries will be responded to within 24 hours of your call or e-mail.

Important NoticesThe following important notices can be found on the FHCSD Intranet.

• CA Maternity Coverage

• Continuation of Benefits under COBRA

• Family Health Centers Summary Plan Wrap Document

• Genetic Information Nondiscrimination Act (GINA)

• Health Exchange Notice

• Medicaid and the Children’s Health Insurance Program (CHIP)

• Medicare Part D Creditable Coverage

• Newborn And Mothers Health Protection (Out of CA) Act Of 1996

• Notice Regarding Wellness Program

• Patient Protection (Primary Care Physician (PCP) and OB/Gyn selection)

• Privacy Rights

• Qualified Medical Child Support Orders (QMCSO)

• Special Open Enrollment Rights for Certain Individuals under Health Insurance Portability and Accountability Act of 1996 (HIPAA)

• Summary of Benefits Coverage (SBC)

• Women’s Health & Cancer Rights Act

Additional important carrier information will be provided to you after you enroll.

32

This guide is intended to provide an overview only of the benefits offered by Family Health Centers of San Diego. It is not an offer of coverage or intended to offer medical advice. It does not contain all plan provisions, limitations and exclusions. Consult your plan documents (Schedule of Benefits, Certificate of Coverage, Group Insurance Certificate, Booklet, Booklet-Certificate, Group Policy) to determine governing contractual provisions relating to your plan. In the event of a conflict between this guide and your plan document, the plan documents will always govern.

33

IMPORTANT CONTACT INFORMATION

BENEFIT CARRIER GROUP NUMBER

PHONE NUMBER WEB ADDRESS / E-MAIL

My Benefits Champion N/A N/AExtension 4200

or877.679.2011

[email protected]

Online Benefit Enrollment System N/A N/A N/A https://www.myworkday.com/

fhcsd/login.flex

CONCERNEmployee Assistance Program CONCERN 12006 800.344.4222 concern-eap.com

Company Code: FHCSD

Medical

UnitedHealthcare SignatureValue Advantage HMO (Limited Network)

525640

800.624.8822 myuhc.comUnitedHealthcare SignatureValue HMO (Full Network)

525638

Mail Order Prescriptions N/A 800.562.6223 prescriptionsolutions.com

Kaiser Permanente HMO 116102 800.464.4000 kp.org

SIMNSA HMO 820 800.424.4652 simnsa.com

UnitedHealthcare PPO with HSA 743272 866.633.2446 myuhc.com

Health Savings Account HSA Bank N/A 800.357.6246 hsabank.com

Dental

United Concordia DHMO 903055001 866.357.3304 ucci.com

United Concordia DPPO 903055000 800.332.0366 ucci.com

SIMNSA DHMO 820 800.424.4652 simnsa.com

Vision Vision Service Plan PPO 30028835 800.877.7195 vsp.com

Flexible Spending Accounts (FSA) WageWorks 31214 855.774.7441 wageworks.com

Life/AD&D The Standard 643599 800.628.8600 standard.com

Long Term Disability (LTD) The Standard 643599 800.368.1135 standard.com

403(b) Plan Principal Financial Group 446501 800.547.7754 principal.com

457(b) Plan Principal Financial Group 610033 800.547.7754 principal.com

Pet Insurance Nationwide N/A 877.738.7874 www.petinsurance.com/affiliates/fhcsd

Travel Assistance UnitedHealthcare Global Travel Assistance N/A 800.527.0218 [email protected]

Legal Services LegalShield 14257 800.654.7757 legalshield.com

Identity Theft IDShield 14257 888.494.8519 legalshield.com

Aflac Supplemental Benefits Aflac RH826 858.429.5442 [email protected]

Home, Renters & Auto Insurance Benefits Plus N/A 877.679.2011 champion

@hubinternational.com

Physical

Social

Financial

Purpose

• Embracing and fulfilling the need to engage with people and coexist peacefully in our communities

• Empowering ourselves to be financially secure today and for the future

• Making meaningful contributions to our community

Physical• Seeking safe and healthy choices with our sleep,

exercise, and nutrition to reach our full potential

Emotional• Encouraging our own positive mental health allowing

us to rebound and learn from the stresses of life