City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014...

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City of Frisco 2014 Benefits Overview

Transcript of City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014...

Page 1: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

City of Frisco

2014 Benefits Overview

Page 2: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions

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Page 3: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Healthcare Reform Update

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Individual Mandate for coverage is effective January 1, 2014

Individuals must have coverage or pay a tax penalty (Penalty – the greater of $95 or 1% of household income)

City of Frisco benefit-eligible employees are not eligible for a Federal subsidy because you have access to the City of Frisco medical plans

Insurance Marketplace Notices were provided by the City of Frisco to all employees

City’s medical plan meets all Federal Requirements for affordable premium and essential coverage

How Healthcare Reform Impacts You

Page 5: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Overview of Changes for 2014

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Page 6: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

New in 2014Medical PPO plan designs The $0 deductible PPO plan will not be an option for 2014 There are still three plan options: $250, $500 and $1500

deductible plans Urgent Care copay increases to $60 Annual Out-of-Pocket Maximum will include Deductibles and

Copays for office visits and Rx Lower copays when you see a UHC Premium Physician

Short Term Disability (STD) plan for all eligible employees All eligible employees will have a STD plan that pays 40% to

$200 per week This plan will pay after 30 days of disability and is paid for by

the City Employees will have the option to buy up to 60% benefit to

$1,000 per weekLong Term Disability (LTD) plan design Plan will move to a 180-day elimination period The LTD plan will coordinate with the STD planWorksite Benefits UNUM will be the new carrier for Accident and Critical

Illness/Cancer plans

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Tier 1

Page 7: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Understanding Healthcare TermsDeductible – The amount you pay out of your own pocket before your insurance pays (just like your car insurance deductible)

Coinsurance – After you have met your deductible, this is the amount/share of the costs you pay for your medical expenses and bills. (For example, on the Medical Plans, the coinsurance is 80% in network. The medical plan pays 80% and you would pay 20%)

Copayments – The amount you pay at the time of service in the doctor’s office or at the pharmacy

Out of Pocket Maximum – The most you would have to pay in a single year out of your own pocket. This includes deductible, medical and Rx copays and your medical coinsurance. After you meet your Out of Pocket Maximum, the plan pays 100% for the rest of the calendar year.

Network Provider – Doctors, hospitals and other health care professionals with whom we have negotiated prices and are part of our network. Also called “in-network” provider or participating provider.

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Medical and Pharmacy Updates NEW: $0 Deductible NOT available

NEW: Plan options will be $250, $500, and $1500 deductible

NEW: 80% Coinsurance on all plans (you pay 20%)

NEW: Out-of-Pocket Max will include deductibles, copay for office visits and Rx

Lower Copays ($20 for PCP and $30 for Specialist) when using UnitedHealthcare Physicians

Preventive Prescription Drug List available at $0 copay (no change)

Select “Over the Counter” Drugs available for $5 Copay (no change)

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Tier 1

Page 9: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

The UnitedHealth Premium program evaluates doctors for quality and cost efficiency to help you choose a doctor with confidence

UnitedHealth Premium doctors: Practice evidence-based care Are more likely to follow new research and

clinical trials May have lower surgery repeat rates

Want Lower Copays?In 2014, you can reduce your copay if you see a Physician:

$20 Primary Care Physician / $30 Specialist

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Tier 1

Page 10: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

10Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

UnitedHealth Premium® Program

*Data as of early 2014.

• Longest running physician quality and cost efficiency designation program (2005)• National industry, evidence-based and specialty society standards • Evaluate doctors on more than 75 conditions and 300 measures• Physicians who fail to meet quality not eligible for cost efficiency

• 148 markets and 26 specialties evaluated*• Accounts for more than 80% of all medical costs*• Includes primary care physicians and specialists

• Available to members at no additional cost• Integrated into customer service, clinical and online experiences• Benefit designs based on Premium designation

Received the National Committee for Quality Assurance (NCQA) program Physician Quality (PQ) certification and meets the Consumer Purchaser Disclosure Project’s Patient Charter standards

Quality & cost transparency

Access

Broad application

Recognition

Visit www.mychoicenotchance.

com10

Tier 1

Page 11: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Low ($250) Deductible PlanType of coverage Network benefit Non-network

benefit

Annual Deductible

Out of Pocket

$250 per Person/ $500 per Family

$1,750 per Person/ $3,500 per Family

$500 per Person/ Unlimited per Family

Unlimited per Person/ Unlimited

per Family

Physician’s office services

$20 Tier 1 /$40 Non-Tier 1

copayment 40% coinsurance

Specialist office visit

$30 Tier 1 /$60 Non-Tier 1

copayment40% coinsurance

Emergency room services $150 copayment $150 copayment

Urgent care center services $60 copayment 40% coinsurance

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Page 12: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Medium ($500) Deductible Plan Type of coverage Network benefit Non-network

benefit

Deductible $500 per Person/ $1,000 per Family

$1,000 per Person/ Unlimited per Family

Out of Pocket $2,750 per Person/ $5,500 per Family

Unlimited per Person/ Unlimited

per Family

Physician’s office services

$20 Tier 1 /$40 Non-Tier 1

copayment

40% After deductible

Specialist office visit

$30 Tier 1 /$60 Non-Tier 1

copayment

40% After deductible

Emergency room services $150 copayment $150 copayment

Urgent care center services $60 copayment 40% After

deductible12

Page 13: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

High Deductible ($1,500) PlanType of coverage Network benefit Non-network

benefit

Deductible $1,500 per Person/ $3,000 per Family

$3,000 per Person/ Unlimited per Family

Out of Pocket $3,000 per Person/ $6,000 per Family

Unlimited per Person/ Unlimited

per Family

Physician’s office services

$20 Tier 1 /$40 Non-Tier 1

copayment

40% After deductible

Specialist office visit

$30 Tier 1 /$60 Non-Tier 1

copayment

40% After deductible

Emergency room services $150 copayment $150 copayment

Urgent care center services $60 copayment 40% After

deductible 13

Page 14: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Preventive vs. Diagnostic

No symptoms, illness, or history prompting the screening

In accordance with age and gender guidelines

Preventive Care Symptoms

require further diagnosis

Previous abnormal test results prompt earlier or more frequent screenings

Previous abnormal test results prompt rescreening.

Diagnostic

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Retail Mail order

Tier 1$15 Your Cost 1-Month Supply

$30 Your Cost 3-Month Supply

Tier 2$25 Your Cost 1-Month Supply

$50 Your Cost 3-Month Supply

Tier 3$50 Your Cost 1-Month Supply

$100 Your Cost3-Month Supply

This is the current copayment/coinsurance structure of the plan in effect today. These amounts are subject to change.Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Lowest

Cost

Highest

Cost

Pharmacy Costs

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Page 16: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Health Care Flexible Spending Account

Keep your

receipts!

You can set aside $2,500 to pay or

reimburse yourself for eligible health care

expenses such as: Doctor’s office visit costs and

procedures Eyeglasses, contact lenses and

supplies and vision exams Dental treatments, including X-

rays, cleanings, fillings and orthodontic treatment

Covered prescriptions Over-the-counter (OTC) supplies

and equipment 16

Page 17: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Dependent Care Flexible Spending Account

Keep your

receipts!

Save even more. You can set aside $5,000 to pay

or reimburse yourself for eligible dependent care

expenses such as:

Qualified day care expenses for children under age 13 Adult dependents not capable of caring

for themselves Babysitters, day care and day camps

may qualify

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Page 18: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Health4MeInformation at your fingertips Health plan

information ID card Claims status GPS provider searchA personal touch Help with claims Coverage questions Finding a providerAvailable on iPhone® and Android™

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Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Care24® - EMPLOYEE ASSISTANCE PROGRAM3 FREE VISITS PER YEARCall Care24 services about: Legal Issues Relationship Issues Coping with grief and loss Questions to ask your doctor Men’s, women’s and children’s

health Prevention Help Finding a doctor Information on medications General Health Information

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Page 20: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Questions?

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Page 21: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

City Of Frisco Dental Plans

Your Dental Health Can Affect Your Overall

Health2014 Plans - Assurant DPPO & DHMO

Page 22: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

DHMO Plan Key Points: Ease of use – no claims to file, deductibles, etc. 1

No Deductibles

No waiting periods

No Annual Maximums

Must select a dentist – each member can have his or her own

Easy to understand co-pays (your out of pocket costs)

1Customer may be required to file a claim in some instances.22

Page 23: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Sample DHMO Treatment Plan copays Cleaning visit:

Office Visit copay $0

D0150 Comprehensive Exam copay $0

D0272 Bitewing X-rays copay $0

D1110 Prophylaxis-adult copay $0

Total out of pocket $0

Crown: D2750 Crown (porcelain fused to high noble metal) copay

$275

D2950 Core Buildup, including pins copay $75

Temporary Filling copay $15

Lab Fees copay $200-250 varies

Total out of pocket $565 - $615

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Page 24: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

PPO Plan Key Points Freedom to see any dentist What’s covered?

Calendar year max $1500 per person

Calendar year deductible $50 individual/$150 family

Preventive Services 100%Routine oral exams, routine cleanings (frequency limitations may apply)

General Services 80%Fillings, x-rays, oral surgery, extractions, endodontics (root canals, etc.), periodontics (treatment of gums)

Major Services 50%Crowns, bridgework, dentures, implants

Orthodontia $2,000 lifetime benefit24

Page 25: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Network dentists can save you* $$Average charge for

crown**

Minus DHA discount

Actual Fee

Insurance pays 50%

Claimant pays

Network Dentist

Non-Network Dentist $938

30%

$657

$328

$328

$938

NA

$938

$469

$469

You could save $141 by going to a DHA dentist!!

Example:

*This example is for illustrative purposes only. Cost of dental procedures may differ depending on location or dental provider. Savings may also differ in cases when deductibles apply or if the DHA-Premier dentist’s discount differs from 30%

**Based on Assurant Employee Benefits’ 2010 claims data for Union Security Insurance Company and Union Security Life Insurance Company of New York. Figures have been rounded to the nearest dollar.

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City of Frisco

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Page 27: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

$10 Exam Copayment

WARNING SIGNS FROM VISION EXAMSA comprehensive eye exam can reveal early warning signs to many medical problems including: Diabetes High Cholesterol Cancer

Voluntary Platinum $150

Service/Material

Participating Provider

Non-Participating Provider

Examination Paid in Full (no additional cost to you)

Up to: $43.00 Retail Value

Hypertension

Brain Tumors

Lupus

Multiple Sclerosis

Thyroid Disease Rheumatoid

Arthritis

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Voluntary Platinum $150

Service/Material Participating Provider

Non-Participating Provider

Frame Up to: $150.00 Retail Value

Up to: $40.00 Retail Value

Lenses: (Clear, Standard, Glass, or Plastic)

Single Vision (per pair)

Paid in Full Up to: $30.00 Retail Value

Bifocal (per pair) Paid in Full Up to: $45.00 Retail Value

Trifocal (per pair) Paid in Full Up to: $45.00 Retail Value

Polycarbonate (per pair)

Paid in Full Up to: $20.00 Retail Value

$20 Eyewear Copayment

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Page 29: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Service/Material Participating Provider

Non-Participating Provider

Contact Lenses:

Elective Up to $200.00 Up to: $185.00 Retail Value

Medically Required

Paid in Full Up to: $185.00 Retail Value

Voluntary Platinum $150

Laser Vision Correction: $200.00 allowance (in or out of network) – in lieu of eyewear benefit

Non-Covered Eyewear Discount:discount of 20% from a participating provider’s usual and customary fees for eyewear purchases which exceed the benefit coverage

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Page 30: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Monthly Premiums - Voluntary ParticipationEmployee only $6.80

Employee + Spouse

$11.60

Employee + Child(ren)

$12.26

Employee + Family

$18.39

Frequency:

Vision Examination

Once Each 12 Months

Frame Once Each 12 Months

Lenses Once Each 12 Months

Contact Lenses

Once Each 12 Months

Voluntary Platinum $150

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Page 31: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Group Term Life Insurance with Accidental Death & Dismemberment

Review of features

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Page 32: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

How much insurance do you need?People use life insurance to:

Pay for their final arrangements

Provide financial protection for those who rely on their income

If others rely on your income,

use this worksheet to figure out

how much coverage you need.

Page 33: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Basic and Voluntary Life/AD&D Coverage — for youBasic Life/AD&D Coverage

$50,000

Voluntary Life/AD&D Coverage

Maximum coverage amount - $10,000 increments to $200,000

Accidental death & dismemberment – paid in addition to the

life benefit if you or a covered dependent:

Die in a covered accident

Suffer a covered dismemberment or disability33

Page 34: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Coverage —for your spouse & dependents

Who can have it?

Spouse- Increments of $10,000 up to $250,000Available with purchase of employee coverage; your spouse may be required to answer a few health questions.

Child- Option of $5,000 or $10,000Available with purchase of employee coverage for eligible children, step-children, legally adopted children and grandchildren, ages 14 days through 26 years.

Available family coverage

Page 35: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Evidence of Insurability You must complete this form:

if you declined this benefit in the past and now want to buy this coverage for yourself

to increase the coverage you currently have ($250,000 is the maximum allowed total).

if you declined this coverage in the past for your spouse and now want to buy this coverage for your spouse.

You must send this form to UNUM no later than October 21st for review.

Your coverage is not effective until UNUM has notified

Human Resources that your application is approved.

Page 36: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Value-added featuresLife Planning Financial &

LegalResources counseling

services

Comprehensive, personalized financial plan with 12 months of follow up

Personalized service through a toll-free telephonic counseling session with specially trained Ceridian counselors. No sales pitches!

Available to survivors or to insured individuals if terminally ill

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Page 37: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Short -Term Disability Insurance

An overview of the benefits

EN-1545 (03-12) 37

Page 38: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

What would you do if your paycheck stopped tomorrow?How would you pay the bills if you were

disabled?A disability could last for weeks, months or

even longer.

Would you: Be able to rely on your savings? Borrow from friends or family? Depend on your credit cards?

Would medical insurance, workers’ compensation or

social security disability cover your earnings if you

became disabled?

The answer is NO in most cases.

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Page 39: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

It’s important to know your policy’s definition of disability.

You are disabled when Unum determines that: You are limited from performing the material and

substantial duties of your regular occupation due to sickness or injury; and

You have a 20% or more loss in weekly earnings due to the same sickness or injury

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Page 40: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

How much coverage can you have? Base Policy: If you meet the definition of

disability, you would be eligible to receive a weekly benefit equal to 40% of your basic weekly earnings, up to a maximum of $200 per week. This benefit is paid for by the City of Frisco for every benefits-eligible employee.

Buy-Up Policy: If you meet the definition of disability, you would be eligible to receive a weekly benefit equal to 60% of your basic weekly earnings, up to a maximum of $1,000 per week. You can choose to buy 20% additional benefit, for a total weekly benefit of 60%.

What is the elimination period? 30 days

Your benefit amount

What else do I need to know:

If you are disabled, you may receive a benefit for up to 22 weeks.

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Page 41: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Long-Term Disability Insurance

An overview of the benefits

EN-1544 (7-12) 41

Page 42: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

A disability could last for weeks, months or even longer. Could you pay your bills for months without a

paycheck?Most people can’t afford it.

Would you:• Be able to access money you have saved?• Borrow from friends or family?• Run up credit card debt?

Would other insurance help?Most often it does not. Medical insurance doesn’t replace lost income. Workers’ compensation only covers job-related

issues. Social Security disability only helps if your disability

is terminal or is expected to last at least a year.42

Page 43: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Know your plan’s definition of disabilityIt’s important to understand what is covered.

You are limited from performing the duties required of your regular occupation due to sickness or injury; and

You have a 20% or more loss of monthly earnings due to the sickness or injury; and

You are under the regular care of a physician.

Does this plan cover mental disability? Disabilities due to mental illness and disabilities based

primarily on self-reported symptoms have a limited payment period of 24 months per lifetime.

Such benefits would continue beyond 24 months only if you are institutionalized or hospitalized as a result of the disability.

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Page 44: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

What is the Plan Design?

Your monthly LTD benefit amount equals 60 % of your basic monthly earnings to a maximum of $5,500

As long as you continue to meet the definition of disability, your LTD benefits are payable up to age 65. If you are over the age of 60 on the date of your disability, your maximum period of payment will occur according to the schedule specified in your contract.

What is the elimination period? 180 days

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Your benefit amount

*Please refer to your policy certificate for the full list of offsets

BenefitDuration

Importantthings to consider

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Page 45: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Can other benefits reduce my disability benefits?Your disability benefit may be reduced by the amount of

other incomereplacement you receive for the same disability, such as

benefits fromSocial Security, workers’ compensation.*

An example of how the amount of benefit may be reduced or offset by

income from other sources: Individual’s weekly pre-disability earnings:...........$3,000

Long term disability benefit percentage:............... x 60%

Unreduced maximum benefit:............................. $1,800

Less Social Security disability benefit per month:... $900

Less state disability income benefit per month:......-$300

Monthly long term disability benefit:.....................$60045

*Example above illustrates how at least two common reductions would reduce the maximum benefit the individual would receive (benefit percent and amounts are for illustration purposes only and may not be representative of your plan). Please refer to your policy certificate for the full list of offsets

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Page 46: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Worldwide emergency travel assistance is included with this benefitFor travel:

Anywhere in the world24-hour phone access to: Pre-qualified medical providers Access to western-style medicine Ambulance and air ambulance Lost/stolen medication replacement…

and moreCovers: Business and personal travel Family members

Worldwide emergency travel assistance services are provided by Assist America, Inc. These services are available with selected Unum insurance offerings. Exclusions, limitations and prior notice requirements may apply, and service features, terms and eligibility criteria are subject to change. The services are not valid after termination of coverage and may be withdrawn at any time. Please contact your Unum representative for full details. Assist America pays for all assistance services it provides. Medical expenses such as prescriptions or physician, lab or medical facility fees are paid by the employee or the employee’s health insurance.

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Page 47: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Group AccidentInsurance

An overview of the benefits

EN-1604 (06-13)

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Page 48: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Why Do You Need Accident Insurance?

The benefitofferings

An accidental injury can bust your budgetAccident insurance can pay a benefit directly to you if you suffer a covered injury. It can offset the high cost of co-pays, deductibles and other expenses your medical insurance doesn’t cover.

Rob’s storyRob bought a new bike so he could lose a few pounds — but he lost his balance instead. He was diagnosed with a torn knee ligament and a broken toe. Rob had one lucky break — his accident insurance paid him $900!

Here’s how Rob’s plan helped: $400 ambulance benefit1

$150 emergency room benefit2

$100 fractured toe $150 two follow up visits $100 crutches

If Rob was more seriously injured, this plan could:

Pay a catastrophic benefit up to $100,0003

Cover loss of sight, hearing, paralysis, etc. Pay a death benefit of $50,000 if he dies due to an accident

Benefit amounts are for illustration purposes only. Actual benefit amounts can change depending on actual plan design and situs state. 1 In CT, there is a $500 benefit payable for outpatient emergency room medical care for accidental ingestion of a controlled substance. 2 In CA and CT, no ground or air ambulance benefit is payable. 3 In ME, catastrophic benefits amounts vary. 48

Page 49: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

How accident insurance works

How it protects Pays a lump-sum benefit based on type of injury

sustained and treatment needed

Covered injuries include broken bones, cuts, burns, eye injuries, ruptured discs, coma, etc.

Benefit can be used however you choose

The benefitofferings

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Page 50: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Additional coverage optionsWellness BenefitEach covered individual will automatically receive the health screening benefit rider, which can pay $50 annual for a covered health screening test1.

Covered tests include: Colonoscopy

Mammography

Pap smear

Skin cancer biopsy

PSA (blood test for prostate cancer)

Serum cholesterol test to determine LDL and HDL levels

Stress test on a bicycle or treadmill

¹Not available in all states50

Page 51: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Available family coverageEmployee coverage Accident insurance is offered to all eligible employees

who are actively at work¹.

Spouse coverage Spouses between the ages of 17 and 64. Must live in

the United States

Child coverage Coverage is available to children, stepchildren, and

legally adopted children newborn to 26 years* who depend on the employee for support.

The benefitofferings

*In GA, IL and ND, child coverage is available newborn until their 27th birthday.1 Being “actively at work” means that on the day the employee applies for coverage, he/she is working at one of his/her company’s business locations, or is working at a location where he/she is required to represent his/her company. If he/she is applying for coverage on a day that is not a workday, then he/she will be considered actively at work if he/she meets this definition as of the last scheduled workday. Employees are not considered actively at work if their normal duties are limited or altered due to their health, or if they are on a leave of absence. 51

Page 52: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

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No health questions to answer for the base plan. If you apply, you automatically receive the base plan.

Your coverage is portable, so you take it even if you leave the company or retire. Unum will bill you directly for the same premium.

Premiums are conveniently deducted from your paycheck.

Family coverage available.

Why purchase accident insurance coverage?

Page 53: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Group Critical Illness Insurance

An overview of the benefits

Underwritten by:Unum Life Insurance Company of America

EN-1197 (8-11) (03/2013)53

Page 54: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Why buy critical illness insurance?

If you are ill and can’t work, how would you pay for everyday expenses such as: Mortgage Car payment Credit card payments Household expenses Dependent care

The costs for care and treatment of a critical illness.

Health insurance typically covers

Diagnostic tests Transportation to health

facilities Private nursing or home

health care Alternative or experimental

treatments

Health insurance may not cover:

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Page 55: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Could your wallet survive a serious illness?Critical illness insurance can help you keep your finances in check, by providing a benefit when the expenses of a serious illness start to add up.Lisa’s story:Lisa was planning her daughter’s wedding when a stroke disrupted her plans. Thanks to her critical illness coverage, Lisa was able to afford the out-of-pocket costs her medical insurance didn’t cover.Lisa’s critical illness insurance helped cover the costBecause she had selected a benefit amount of $20,000, her plan paid her that amount in a lump sum, regardless of what she spent. Lisa could use it for her out-of-pocket costs and to help pay the bills while she was unable to work.

Lisa was able to focus on her goal for recovery: to dance at her daughter’s wedding!

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Advantages A benefit can be paid for each covered condition Employee-paid coverage is portable Dependent children are automatically covered at 25% of

the employee benefit amount

Additional diagnosis benefit Multiple payouts automatically included in the plan design Each condition payable once per lifetime per covered

individual Additional benefits payable for diagnosis of another critical

illness if separated by 90 days or more and medically unrelated

Group Critical Illness Plan Benefits

Page 57: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Group Critical Illness Plan Benefits Covered conditionsBlindness Benign brain tumor Coronary artery bypass surgery* End-stage renal (kidney) failureHeart attack Major organ failureStroke*

Covered conditions due to injuryComa Permanent paralysisOccupational HIV

Optional cancer coverageCancer Carcinoma in situ**

Specific childhood conditionsCerebral palsy; cleft lip or palate; cystic fibrosis; Down syndrome; spina bifida

The benefitoffering

PA – Permanent paralysis is not a covered condition. CA, IN and MN – Occupational HIV is not a covered condition. FL – Portability is not available. ID, NH – Outline of coverage provided at time of application. GA, CA, ME, TX – Comprehensive Health coverage is required. * In NH Stroke is call Severe Stroke. Also, Coronary artery bypass surgery and Carcinoma y situ for children is covered at 100% of the employee’s payable benefit amount. **100% of the benefit payable for each covered condition, with the exception of coronary artery bypass surgery and carcinoma in situ, which are paid at 25% of the purchased benefit amount. Please see policy definitions for complete details about these covered conditions.

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Page 58: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Each covered individual will automatically receive the wellness benefit, which can pay $50 per calendar year per insured individual1 if a covered health screening test is performed. Screening tests include, but are not limited to:

1 Insured individuals are eligible for benefits 30 days after the effective date of coverage.

Wellness benefit

Colonoscopy

Mammography

Pap smear

Skin cancer biopsy

PSA (blood test for prostate cancer)

Chest X-rays

Stress test on a bicycle or treadmill

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Page 59: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

This benefit can provide:

An additional payout for a second occurrence of:• A benign brain tumor• Heart attack• Coma• Stroke

A benefit payout of 100%

12 months must elapse between occurrences of the same condition

Recurrence benefit

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Family coverage options

Who can have it? Benefit

Employees who are actively at work

$5,000 to $50,000 in $1,000 increments

Children newborn to age 26, regardless of marital or student status. All eligible children are automatically covered at 25% of the employee benefit amount (no additional cost)

Eligible children are covered for the same conditions as the employee and some specific childhood conditions. Diagnosis must occur after the child’s coverage effective date.

Spouse ages 17 through 64 with purchase of employee coverage

$5,000 to $30,000 in $1,000 increments

Page 61: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Employee Enrollment

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Page 62: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Log in User name: your first initial, last name and employee number

If you forgot your password, enter your user name and click on FORGOT PASSWORD to retrieve your hint, then follow the instructions and the link to have a temporary password issued. You can also contact HR for assistance.

Adding Dependents for the first timeDates of birth and social security numbers are required. You will also need to provide proof of dependency (marriage certificate; birth or adoption certification; etc.) to HR.

AvailabilityThis site is unavailable every Thursday at 10:00 p.m. – 5:00 a.m. for maintenance.

Employee Self-Service (ESS)

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Page 63: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

NEW FOR 2014

Worksite Benefits – Accident and Critical Illness Payroll deductions for all AFLAC policies will end

12/31/2013.

If you want to keep your AFLAC policy/policies, you must contact Dennis Esarte, AFLAC rep., to arrange payment directly to AFLAC.

You may keep any AFLAC policies you currently have and elect the UNUM Worksite Benefits.

If you elect the UNUM Accident or Critical Illness benefits, you must call the City of Frisco Benefits Center at 1.888.659.1477 to complete your enrollment within the deadline. Otherwise, your election will be considered invalid and will be cancelled. 63

Page 64: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Additional Benefits paid by City of Frisco Basic Life

$50,000 for all benefits-eligible employees Basic AD&D

$50,000 for all benefits-eligible employees Death must result from accident

TMRS Death Benefit 1X your annual salary If retired, $7,500

Supplemental AD&D Benefit Police Officers and Firefighters only $100,000 policy

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Page 65: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Compass Health Services

A Compass Health Pro can assist you with: Finding a quality doctor/scheduling the

appointment for you Answering questions about your health

insurance Assist with pricing estimates for Medical, Rx,

Dental and Vision services Help you to reconcile your medical bills Assisting your dependents even if on a different

benefit plan

Page 66: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

Compass Health Services

All your information is confidential Compass does not receive any money for

recommending a doctor, lab, hospital, etc. Medical advice is not provided Your Health Pro is available by phone or email

Monday-Friday 8:00 am – 6:00 pm

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Page 67: City of Frisco 2014 Benefits Overview. Agenda Healthcare Reform Update Overview of Changes for 2014 Where You Fit In Plan Details Open Enrollment Questions.

REMINDERS

Benefits effective Jan. 1-Dec. 31 Deductions begin Jan. 3, 2014 pay check Call the City of Frisco Benefits Center to

complete your enrollment if you elect the Unum Accident or Critical Illness benefits

Enrollment Deadline: 12 Noon, Monday, Oct. 21st

http://chv-munisweb.mss/ from work https://ess.friscotexas.gov from home 67