COSA Health Benefits 2011

8/3/2019 COSA Health Benefits 2011

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City of San Angelo

Benefits of Choice City of Choice

Working Together for a Healthy Well-Being and Financial Security

2011 Benefits Guide2011 Benefits Guide2011 Benefits Guide2011 Benefits Guide

January 1, 2011January 1, 2011January 1, 2011January 1, 2011 December 31, 2011December 31, 2011December 31, 2011December 31, 2011


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1 January 1, 2011 December 31, 201

2011 Benefits Guide

INTRODUCTION

The City of San Angelo is pleased to provide you with abenefits program designed to safeguard your financialand health care needs.

This booklet will assist you in making your benefitdecisions. It is not intended as a complete descriptionof the provisions of the benefit plans, but as a guide tohelp you in making the benefit choices that are best foryou.

Whats Staying the Same for 2011

The following carriers are staying the same for the2011 plan year:

Medical and Prescription Drug (Rx) BCBSTX Dental Plan United Concordia Vision Plan Ameritas Life & AD&D Plan Madison National Life Flexible Spending Accounts (FSA) HealthSmart Supplemental Insurance AFLAC Identity Theft & Legal Services Wildeco, Inc.Whats Changing for 2011

These are the changes for the 2011 plan year:

Medical Plan Contributions Pre-existing condition limits for children under age 19

are being removed

Lifetime maximums on plan benefits are being removed

Coverage for dependents will be extended to age 26 Over-the-counter medications no longer qualify as

eligible expenses for the Health Care Spending Account

ID Cards

Please continue to use your current ID cards for the2011 benefit year.

EMPLOYEE PAYROLL DEDUCTIONSBlue Cross Blue

Shield Medical Plan(Monthly Deductions)

Low PlanMedium

PlanHigh Plan

Emp Only $16.50 $128.80 $203.62

Emp + Spouse $428.08 $663.76 $820.88

Emp + Child(ren) $278.44 $469.24 $596.42Emp + Family $577.72 $858.30 $1,045.34

United ConcordiaDental Plan

Monthly Deductions

Emp Only $0.00

Emp + Spouse $16.25

Emp + Child(ren) $23.40

Emp + Family $39.65

Ameritas VisionLow Plan

Monthly Deductions

Emp Only $3.96

Emp + One $7.92

Emp + Family $10.96

Ameritas VisionHigh Plan

Monthly Deductions

Emp Only $7.96

Emp + One $15.92

Emp + Family $22.20

Madison National Life Basic Life and AD&D Insurance

The City pays 100% of your coverage.

Madison National Life Optional Life and ADD Insurance

These rates are based on the employees age.

AFLAC Supplemental InsuranceThese rates are based on the employees election of coverage.

Pre-65 RETIREE MEMBER PREMIUMSBlue Cross Blue

Shield Medical Plan(Monthly Deductions)

Low PlanMedium

PlanHigh Plan

Emp Only $16.50 $177.43 $259.73

Emp + Spouse $506.64 $765.89 $938.72

Emp + Child(ren) $342.03 $551.90 $691.82

Emp + Family $671.24 $979.87 $1,185.62

NOTE: If you have Medicareor will become eligible forMedicare in the next 12months, a Federal law givesyou more choices about yourprescription drug coverage.Please see page 11 for more

details.


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TABLE OF CONTENTS

Introduction 1

Human Resources Contacts 2

Employee Payroll Deductions 2

Helpful Definitions 3

Medical Benefits 3

Prescription Drug Benefits 3

Dental Coverage 5

Vision Coverage 5

Life Insurance 5

AD&D Insurance 5

Flexible Spending Account (FSA) 6

Supplemental Insurance 7

Notices 8

Benefit Contact Information Inside Back Cover

Who is Eligible?

You are eligible to enroll in the City Benefits programif:

You are a regular, full-time employee of the City ofSan Angelo.

Coverage is scheduled to begin January 1, 2011 or, ifhired after January 1, 2011, on the first day of themonth following full-time employment as an eligibleemployee.

Who are My Eligible Dependents?

You may cover your lawful spouse and dependentchildren. Children are eligible to age 26 regardless ofmarriage and student status. Stepchildren who residewith you and are primarily dependent upon you forsupport are also eligible subject to these same agelimits. A child who is physically or mentallyhandicapped may be eligible for coverage at any age.

Enrollment Requirements

All employees must complete an enrollment form toelect or decline coverage. Forms are due to the HRdepartment by December 17, 2010.

Can I Change My Coverage During the Year?

The benefits you choose will remain in effectthroughout the end of calendar year 2011. You can onlymake a change to your coverage:

During open enrollment, or During the year if you have a qualifying change in

family or employment status. Qualifying changes

include:o A change in your legal marital status,o A change in your number of dependents,

including:

Birth of a child Adoption of a child The placement of a child with you for

adoption

Your dependent child satisfying or ceasingto satisfy eligibility requirements forcoverage, or

The death of a dependent child or spouse

o Your change in employment status or that ofyour spouse

o Such other events as the Plan Administratordetermines will permit a change or revocationof an election under the rules and regulationsof the Internal Revenue Service.

You must notify Human Resources of the requestedchange within 31 days of the change in status.

Taxes and Your Benefits

Your cost for many coverages will be paid on a before-taxbasis through your payroll deductions. This means that yourbenefit deductions go farther because you save the federalincome tax that would otherwise be required on thesecontributions.

PlanWho Pays the

Cost?

Is Your CostBefore Tax or

After Tax?

Medical (Low, Medium and High)

Employee

DependentCOSA/YouCOSA/You

Before TaxBefore Tax

Dental

EmployeeDependent

COSACOSA/You

No CostBefore Tax

Vision

EmployeeDependent

YouYou

Before TaxBefore Tax

Basic Life andAD&D COSA No Cost

Optional Life & AD&D

EmployeeDependent

YouYou

After TaxAfter Tax

SupplementalInsurance

You After Tax

HUMAN RESOURCES

Veronica SanchezHuman Resource Manager325-657-4221

Noreen RodriguezBenefits Clerk328-657-9265


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HELPFUL DEFINITIONS

Calendar Year January 1 through December 31 of eachyear.

Coinsurance The percent of eligible charges that theplan pays.

Copayment (Copay) The amount paid by a coveredperson to a network provider at the time services are

rendered. Copayments for covered services are notapplied to your deductible.

Deductible The amount you pay each calendar yearbefore the plan begins to pay covered health careexpenses.

Medical Emergency A sudden, serious, unexpected andacute onset of an illness or injury where a delay intreatment would cause irreversible deteriorationresulting in a threat to the patients life or body part.

Network Benefits The benefits applicable for thecovered services of a network provider.

Non-Network Benefits The benefits applicable for thecovered services of a non-network provider.

Open Enrollment The period during which existingemployees and their dependents are given theopportunity to enroll in or change their current elections.

Out-of-Pocket Maximum The most a covered personwill pay in deductibles and coinsurance in a calendaryear for covered health care expenses (excludingreductions for provider contracts and usual andcustomary guidelines and copays).

Pre-Existing Condition An illness or condition thatexists and has been diagnosed and/or medically treated(including prescription drugs) by a professional within thethree (3) month period prior to the effective date of your

coverage.

Pre-Existing Condition Limitation A condition will nolonger be considered pre-existing when you have gonetreatment free (including exams, consultations andprescribed medication) for three (3) consecutive monthsor have been covered under the plan for twelve (12)consecutive months. These limitations do not apply tochildren under the age of 19.

Medical Plan HighlightsThe City offers three plan designs to offer flexibility andchoice to their employees. The Citys medical plan isadministered by Blue Cross Blue Shield of Texas. Your medicabenefits are designed to help maintain wellness and protectyou and your family from major financial hardship in theevent of illness or injury. You select the plan that fits yourlifestyle and provides the protection you need. Each medical

plan provides you with coverage, depending on the medicalprovider that you use. Each time you need medical care, youdecide whether to use in-network providers or out-of-network providers.

Preferred Provider Organization (PPO) Plans

The PPO Plans provides a network of health professionals andfacilities from which to choose each time you need medicalcare.

When you use in-network providers, you receive benefits at alower cost and you have no claims to file. If you choose anon-network provider, you will receive benefits at a highercost and you may be required to pay up front, and then file areimbursement claim with the health plan administrator.

Coordination of Insurance Benefits

The City benefits coordinate with those benefits you or yourdependents may be entitled to receive from other plans. Thisprevents duplication of payment if you or your dependentsare covered by another insurance plan. The plan that coversan individual as an Employee is always the primary plan forthat individual. In other words, the City medical plan willalways be primary for you. If your spouse is coveredelsewhere, that plan becomes primary for him/her. Eitheryou or your working spouse, or both, may cover your eligibledependent children under your respective employers plan. Ifthe children have coverage under more than one plan,benefits will be coordinated according to the rules of each

plan. The Citys plan uses the Birthday Rule, which meansthat the parent whose birthday (month and day) comes firstin the year will be the primary payer.

PRESCRIPTION DRUG BENEFITSPrescription Drugs are covered under the medical plan ifprescribed for the treatment of a covered medical condition.You must utilize either a participating pharmacy or the mailorder service.

Non-covered prescriptions include, but are not limited to: Fertility Drugs Growth Hormones Anorexients

Impotency Drugs Smoking Deterrents Prescription Vitamins(except for pre-natal vitamins)

Note: If a brand medication is purchased when a generic is available and theprescribing physician does not indicate dispense as written, the participantwill be responsible for any cost above the applicable co-pay.


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MEDICAL AND PRESCRIPTION BENEFITSBlue Cross Blue Shield of

TexasBlue Cross Blue Shield of

TexasBlue Cross Blue Shield of

Texas

Low Plan Medium Plan High PlanBenefit Features

In-networkOut-of-network



Annual Deductible

Individual $2,000 $4,000 $1,300 $2,600 $750 $1,500

Family $5,000 $10,000 $2,600 $5,200 $1,500 $3,000

Out of Pocket Maximum

Individual $5,000 $10,000 $2,250 $4,500 $1,000 $2,000

Family $15,000 $30,000 $6,750 $13,500 $3,000 $6,000

Coinsurance 80% 50% 80% 50% 80% 50%

Lifetime Maximum Unlimited Unlimited Unlimited

Preventive Services

Immunizations(birth to 6th birth date)

100% 100% 100% 100% 100% 100%

Routine Physicals, Well BabyCare

$35 copay 50% after ded $25 copay 70% after ded $20 copay 70% after ded

Physician Office Visit

Primary Care/ Specialists $35 copay 70% after ded $25 copay 70% after ded $20 copay 70% after ded

Emergency Room Visit

True Emergency 80% after $300 copay, waived ifadmitted 80% after $50 copay, waived ifadmitted 80% after $50 copay, waived ifadmitted

Non-Emergency 80% after $300copay, waived if

admitted

50% after $300copay & ded,

waived ifadmitted

80% after $50copay, waived

if admitted


waived ifadmitted

80% after $50copay, waived if

admitted


waived ifadmitted

Hospital

Inpatient 80% after $300per admit

50% after $300per admit





Outpatient Services 80% after ded 50% after ded 80% after ded 50% after ded 80% after ded 50% after ded

Diagnostic Services

Lab and X-Ray 80% 50% after ded 100% 70% after ded 100% 70% after ded

Certain Diagnostic Procedures 80% after ded 50% after ded 80% after ded 50% after ded 80% after ded 50% after ded

Skilled Nursing 100% 70% after ded 100% 70% after ded 100% 70% after ded

$10,000 per calendar year $10,000 per calendar year $10,000 per calendar yearHome Health Care 100% 70% after ded 100% 70% after ded 100% 70% after ded

$10,000 per calendar year $10,000 per calendar year $10,000 per calendar year

Hospice Care 100% 70% after ded 100% 70% after ded 100% 70% after ded

$20,000 lifetime max $20,000 lifetime max $20,000 lifetime max

Mental Illness

Inpatient 80% after $300per admit






30 days max per calendar yr 30 days max per calendar yr 30 days max per calendar yr

Outpatient Services $35 copay 70% after ded $25 copay 70% after ded $20 copay 70% after ded

30 visits max per calendar yr 30 visits max per calendar yr 30 visits max per calendar yr

Chemical Dependency 3 series of treatments per lifetime 3 series of treatments per lifetime 3 series of treatments per lifetime

Pharmacy Benefits

Deductible $200 annually $200 annually $200 annually

Retail 34 day supply 34 day supply 34 day supply

Generic $15 copay $15 copay $15 copay

Brand Name $60 copay $60 copay $60 copay

Non-Preferred $100 copay $100 copay $100 copay

Mail Order 100 day supply 100 day supply 100 day supply

Generic $30 copay $30 copay $30 copay

Brand Name $120 copay $120 copay $120 copay

Non-Preferred $200 copay

Out ofNetwork

$200 copay

Out ofNetwork

$200 copay

Out ofNetwork


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BLUE CARE CONNECTIONBlue Care Connection from Blue Cross and Blue Shield ofTexas (BCBSTX) is an umbrella of programs that offers youguidance to achieve higher levels of wellness. Throughoutreach, educational resources and health advocacy, theyhelp guide you through the often-complex health care systemso you can focus on what matters most getting healthy andstaying well.

Blue Care Connection program assists members living with

current serious medical conditions, as well as thoseconsidered at risk. If you, or a covered dependent, areconsidered at risk, the programs are uniquely designed todetect health care needs early. Early detection allows themto provide appropriate outreach and meaningful interventionto help prevent future medical complications.

Blue Care Connection programs include:

Blue Care Advisors Experienced and knowledgeable RNs,Licensed Professional Counselors and Licensed Masters-levelSocial Workers with YOUR best health in mind. Advisors willwork with you and your physician to educate, facilitate andmonitor your treatment plan.

Personal Health Manager Online health and wellnessresources to help you adopt and manage healthy behaviors.

24/7 Nurseline Around the clock access through a toll-freenumber to experienced registered nurses who understand andcan help with your health care concerns.

Special Beginnings A maternity program that offersongoing contact with obstetric nurses who provide prenatalrisk assessment education and can coordinate care with yourphysician.

Condition Management Voluntary, health improvementprograms that can help members with: cancer, congestiveheart failure, coronary artery disease, chronic obstructivepulmonary disease, asthma, diabetes, metabolic syndrome(high cholesterol, high blood pressure and obesity) and lowback pain.

Care Management Focuses on traditional elements ofmedical care management with targeted outreach if you arean at risk member.

Case Management Assists if you are a higher-risk membercoping with a complex or catastrophic condition.

Behavior Modification Obesity/Weight ManagementProgram Comprised of Licensed Masters Social Workers andLicensed Professional Counselors who promote wellnessthrough a holistic approach of behavioral coaching, clinicalcoaching, education and condition management.

Enroll Today

To enroll in any Blue Care Connection program, or askquestions about the program, please call toll-free at 1-866-412-8795 or visit the website atwww.bcbstx.com/hs/bluecareconnection.htm.

DENTAL COVERAGE

Dental Benefits to Keep You Smiling

The dental plan will continue to be administered by UnitedConcordia. If you are electing dental coverage fordependents, you must turn in the enrollment form with yourdependents name(s) and information. The PPO indemnitydental plan allows you to receive the same level of benefitswhether you see a dentist who participates in the network ornot, however, you may reduce your out-of-pocket expensesby using a provider that participates with United Concordia.

Dental PPO Indemnity Plan Why Use ParticipatingDentists?

Utilizing participating PPO dentists can save you money andhassles. Participating dentists have agreed to acceptnegotiated fees that are typically 10% to 30% belowcommunity averages. This means your share of the cost islower because the total bill is lower. In addition, you donthave to worry about getting billed for the balance later if thedentists charges exceed the usual and customary charges.

Benefits In/Out-of-Network*

Calendar Year Deductible

Individual $50Family $150

Preventive Services 80%

Periodic oral exams (two per cal year) Bitewing x-rays (two series per cal year) Cleaning (two per calendar year)Basic Services 80%

Restorative fillings Oral surgeryMajor Services 50%

Inlays, onlays, fillings, dentures Endodontics and PeriodonticsOrthodontia Services 50%

Children & AdultCalendar Year Maximum Benefit $1,000

Orthodontic Lifetime Maximum Benefit $1,000

*The in-network percentage of benefits is based on the discounted feenegotiated with the provider. The out-of-network percentage of benefits ispaid at the 90th percentile of the usual and customary rates prevailing in thegeographic area in which the expenses are incurred.


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VISION COVERAGE

Vision Benefits to Improve Your Sight

The City offers two vision care plans through Ameritas for youand your family. Ameritas provides affordable, quality visioncare. You may also choose from a wide selection ofindependent optometrists, ophthalmologists, and opticians inthe San Angelo area and across the country.

Vision Plan 1 High PlanBenefits In-Network Out-of-Network

Annual Deductible

ExamLens/Frames

$10$25

$10$25

Eye Exam(once every 12 months)

Covered in full Reimbursed up to $52

Eyeglass Frames Up to $105.00 Reimbursed up to $40

Eyeglass Lens(once every 12 months)

Covered in full

Single up to $55

Bifocal up to $75

Trifocal up to $95

Contact LensesMedicallyNecessary

Covered in fullReimbursed up to

$210

Elective Contacts Covered up to $105 Reimbursed up to$105

Vision Plan 2 Low Plan

Benefits Maximum Reimbursement

Annual Deductible $20

Eye Exam(once every 12 months)

Reimbursed up to $45

Eyeglass Frames(Once every 12 months)

Reimbursed up to $60

Eyeglass Lens

Single up to $35

Bifocal up to $50

Trifocal up to $65

Contact Lens Reimbursed up to $75

LIFE INSURANCEBasic Life & AD&D Insurance

The City automatically provides basic life and AD&D insurancefor you. You may purchase basic life dependent coverage for$0.75 per month.

$10,000 basic life and AD&D for the employee $3,000 basic life for your spouse $1,500 basic life for child(ren)Optional Life Insurance

If you want a greater level of protection, Optional LifeInsurance coverage is available to purchase.

Life doesnt always bring us what we expect. It helps to knowthat financial security is available for your familyeven ifyou arent. But not everyone has the same need forprotection. Thats why the City provides you with theopportunity to elect Optional Life Insurance on yourself aswell as for your family.

Guarantee Issue

The guarantee issue for optional life is $100,000 for

employees under age 60; $25,000 for employees age 60-69;and $0 for employees age 70 and above. The guarantee issueis $25,000 for spousal coverage and $10,000 for children. Ifyou are electing coverage over these amounts, see the HRDepartment for the appropriate form.

Optional AD&D Insurance

Accidental Death benefits are payable to your beneficiary, inaddition to your Life Insurance benefit, if you die within 365days after a covered accident and the cause of your deathcan be attributed to the covered accident.

Accidental Dismemberment benefits are payable to you if yousuffer a loss that is covered under the plan. The loss musthave occurred within 365 days of the covered accident.

Maximum Benefits

You must purchase coverage on yourself to purchase it foryour family.

Employee maximum of 5 x your salary to a maximum of$500,000 (increments of $10,000)

Spouse 50% of employees amount to a maximum of$250,000 (increments of $5,000)

Dependent child(ren): maximum of $10,000 (incrementsof $2,500 for age 14 days to age 19 or 23 if full timestudent)

Proof of good health is required if you enroll for coverageover the guarantee issue amount or if you do not enroll within31 days from your date of eligibility. At open enrollment,proof of good health will be required if you are increasingyour current coverage. If you were previously eligible forcoverage but declined, proof of good health will be requiredfor any amount of coverage.

Coverage amounts over the guarantee issue maybe obtained by providing evidence of good health simply complete a health questionnaire, which willbe submitted to the insurance company forapproval.


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Employee & SpouseOptional Life Rates (per $1,000)

Age Bands Employee andSpouse* Life Rates

Employee andSpouse* Life &

AD&D Rates

Less than age 25 $0.07 $0.10

25 29 $0.07 $0.10

30 34 $0.08 $0.11

35 39 $0.10 $0.13

40 44 $0.14 $0.17

45 49 $0.22 $0.25

50 54 $0.35 $0.38

55 59 $0.53 $0.56

60 64 $0.71 $0.74

65 69 $1.29 $1.32

70 74 $2.08 $2.11

75 - 79 $3.56 $3.59

80 + $5.21 $5.24

DependentChild** Life

Rates

$0.19per $2,500

$0.22per $2,500

*Spouse premiums are based on spouses age.

**Child rates are not per child rates but cover all eligible child(ren).

Age Benefit Reduction Schedule

When you are age 65 or more, your amount of insurance forBasic and Optional Life and AD&D is limited; your spousesamount of insurance for Dependent Life and AD&D will alsoreduce when you are age 65 or more. Your benefit reduces to65% of the original face amount at age 65, to 45% of theoriginal face amount at age 70 and to 25% of the original face

amount at age 80. All benefits terminate at retirement.Benefits for a dependent spouse will reduce to 50% of theoriginal face amount at age 70 and terminate at age 75.

Flexible Spending Accounts (FSA)The City is pleased to continue to offer a Flexible SpendingAccount (FSA) program to employees, administered byHealthSmart. The plan year will run January 1, 2011 throughDecember 31, 2011.

The FSA program includes plans for Medical FSA Plan andDependent Care FSA Plan. This special account lowers theamount you are required to pay each year in taxes becauseyour deposits are not subject to income or Social Security

taxes.FSA allows you to put aside money on a tax-free basis eachpay period. When you have an eligible expense, you cansubmit a claim for reimbursement from your account.

What Happens if I Do Not Use All of the Money?

According to IRS regulations, any money left in your accountwhich is not used for eligible expenses incurred by the end ofthe plan year must be forfeited. Claims are eligible forreimbursement through February 15 of the following year.This is called the use it or lose it rule and its the

governments way of making sure you use the tax-freespending accounts as they were intended. As you consider theamount to put into your Spending Account, keep this use itor lose it rule in mind.

Eligibility

Employees who are 18 years of age or older, working 30 ormore hours per week and have completed eligibilityrequirements to participate in either of the FSA accounts. Ifyou choose to waive coverage, you may enter the plan on anysubsequent January 1st, unless you have a qualified change infamily status. If you experience a change in family status,please contact the Human Resources Department. You have30 days from the qualified change in family status to add ormake changes to your election.

Maximum Contribution Amounts

The maximum contribution is:

Medical FSA: $5,000 maximum per year Dependent Care FSA: $5,000 maximum per year;

$2,500 if married filing separately

Health Care Spending Account

By using pre-tax payroll contributions, you can receivereimbursement from your Health Care Spending Account foreligible medical, dental, vision and prescription expensesincurred by you or an eligible dependent, as long as theexpenses are not covered or reimbursed by insurance or

another FSA account.You can use the account to receive reimbursement for healthcare related expenses such as:

Deductibles, coinsurance, and copays Costs of eligible services above the reasonable and

customary limits Routine physical exams

Dental and orthodontic expenses Psychiatric care / substance abuse treatment

Dependent Care Spending Accounts

To be eligible to use the Dependent Care Account, you (andyour spouse, if married) must both work outside the home.You may claim dependent care expenses for a dependent thatlives with you and relies on you for more than half of theirsupport. You must claim the person as a dependent on yourfederal income tax return. Eligible dependents include:

Children under the age of 13, and Disabled dependents of any age (such as your disabled

spouse, older child, or parents)

Effective January 1, 2011, you may no longer usethis account for over-the-counter healthitems.

Use It Or Lose It!

You must incur eligible expenses during the planyear to receive reimbursement from the money

you have contributed to the account(s). Allmoney remaining in the account after that date

will be forfeited.

Your Supplemental Coverage Amt $1,000 XMonthly Rate /2 = Pay Period Deduction


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What Type of Care is Covered?

You may only be reimbursed for day-care that enables you towork, not occasional baby-sitters. If you are married, yourspouse must also work, be a full-time student or be disabled.Eligible care includes care in:

Your home Someone elses home A licensed day-care facilityYou may be reimbursed for care provided by a relative, aslong as the person is not your spouse, a child under the age of19, or someone you claim as a dependent on your federalincome tax return.

Reimbursement from your FSA

In order to receive reimbursement from one of your accounts,you must submit a claim form along with a receipt for aneligible expense to the plan administrator. You may obtain aclaim form from the Human Resources Department.

If you are requesting reimbursement from your DependentCare Account, you must provide the social security number ofthe individual caretaker or taxpayer I.D. number, name,

address, and phone number of the day care facility.

You will only be reimbursed for the current amount availablein your account on your next payroll check.

Note: Amounts reimbursed through either plan may not beused as a tax credit on your annual tax return.

How FSA Affects Income Tax and Social Security

FSA affects your taxable earnings for both Federal income taxand Social Security. Since you do not pay income tax on theportion of your salary used to pay for benefits under FSA, youcannot claim those amounts on your Federal income taxreturn at the end of the year.

Since you do not pay Social Security taxes on the portion of

your salary used to pay for benefits under FSA, yourparticipation may affect the benefits you and your familyreceive from Social Security when you retire. This differenceis usually no more than a few dollars each month.

Your retirement plan contributions are based on your grosssalary (your pay before taxes are deducted) and not affectedby FSA. If you are near retirement, you should talk with a taxadvisor to determine what is best for you.

Supplemental InsuranceThe City offers employees ways to protect their selves andtheir families from financial loss due to an untimely accident,critical illness or disability through AFLAC. The City supportsthese supplemental plans offered by AFLAC but you are under

no obligation the choice is yours! Currently the plansoffered through AFLAC are: Accident Policy, Cancer Policy,Intensive Care coverage, Short Term Disability and SpecifiedEvent coverage.

Accident Coverage

This plan provides for accidents. Coverage is provided foraccidental death benefits, follow-up treatment as well asambulance, lodging and transportation.

Cancer Coverage

AFLACs Cancer Expense Protection Plan provides funds toassist you in meeting the cost of cancer treatment. Payrollrates may be continued if employment terminates. Familycoverage includes employee, spouse and unmarrieddependents to age 25.

Intensive Care Coverage

Intensive Care Plan is designed to provide additional funds tohelp meet the expenses for intensive care. This plan providescoverage for hospital facilities such as Intensive Care Unit(ICU), Coronary ICU and Neonatal ICU.

Short Term Disability

This plan is designed to help provide you with a source ofincome if you become disabled due to sickness or off-the-jobinjury. Premiums are based on your salary.

Specified Event Coverage

Benefits are paid for heart attack, stroke, heart by-pass,renal failure, coma, paralysis, major human organ transplantor major third degree burns. This benefit can help provide

assistance covering medical bills.


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Notice of COBRA Continuation CoverageRights

Introduction

You are receiving this notice because you have recently become covered

under the City of San Angelo group health plan (the Plan). This notice

contains important information about your right to COBRA continuationcoverage, which is a temporary extension of coverage under the Plan.

This notice generally explains COBRA continuation coverage, when

it may become available to you and your family, and what you need

to do to protect the right to receive it.

The right to COBRA continuation coverage was created by a federal law,

the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA).

COBRA continuation coverage may be available to you when you would

otherwise lose your group health coverage. It can also become available

to other members of your family who are covered under the Plan whenthey would otherwise lose their group health coverage.

For additional information about your rights and obligations under the

Plan and under federal law, you should review the Plans Summary Plan

Description or contact the Plan Administrator.

What Is COBRA Continuation Coverage?COBRA continuation coverage is a continuation of Plan coverage when

coverage would otherwise end because of a life event known as aqualifying event. Specific qualifying events are listed later in this

notice. After a qualifying event, COBRA continuation coverage must be

offered to each person who is a qualified beneficiary. You, your

spouse, and your dependent children could become qualified beneficiaries

if coverage under the Plan is lost because of the qualifying event. Under

the Plan, qualified beneficiaries who elect COBRA continuation coverage

must pay for COBRA continuation coverage.

If you are an employee, you will become a qualified beneficiary if you

lose your coverage under the Plan because either one of the following

qualifying events happens:

Your hours of employment are reduced; or Your employment ends for any reason other than your gross

misconduct.

If you are the spouse of an employee, you will become a qualified

beneficiary if you lose your coverage under the Plan because any of the

following qualifying events happens:

Your spouse dies; Your spouses hours of employment are reduced; Your spouses employment ends for any reason other than his or her

gross misconduct;

Your spouse becomes enrolled in Medicare benefits (under Part A,Part B, or both); or

You become divorced or legally separated from your spouse.Your dependent children will become qualified beneficiaries if they

will lose coverage under the Plan because any of the following qualifying

events happens:

The parent-employee dies; The parent-employees hours of employment are reduced; The parent-employees employment ends for any reason other than

his or her gross misconduct;

The parent-employee becomes enrolled in Medicare (Part A, Part B,or both);

The parents become divorced or legally separated; or The child stops being eligible for coverage under the Plan as a

dependent child.

When Is COBRA Coverage Available?

The Plan will offer COBRA continuation coverage to qualified

beneficiaries only after the City of San Angelo has been notified that aqualifying event has occurred. When the qualifying event is the end of

employment or reduction of hours of employment, death of the employeein the event of retired employee health coverage, commencement of a

proceeding in bankruptcy with respect to the employer, or the employeesbecoming entitled to Medicare benefits (under Part A, Part B, or both),

the employer must notify the plan of the qualifying event.

You Must Give Notice of Some Qualifying Events

For the other qualifying events (divorce or legal separation of the employee

and spouse or a dependent childs losing eligibility for coverage as adependent child), you must notify the City of San Angelo within 31 days after

the qualifying event occurs.

How Is COBRA Coverage Provided?

Once the City of San Angelo receives proper notice that a qualifying

event has occurred, COBRA continuation coverage will be offered to

each of the qualified beneficiaries. Each qualified beneficiary will have

an independent right to elect COBRA continuation coverage. Covered

employees may elect COBRA continuation coverage on behalf of their

spouses, and parents may elect COBRA continuation coverage on behalf

of their children.

COBRA continuation coverage is a temporary continuation of coverage.When the qualifying event is the death of the employee, the employees

becoming entitled to Medicare benefits (under Part A, Part B, or both),

your divorce or legal separation, or a dependent childs losing eligibility

as a dependent child, COBRA continuation coverage lasts for up to 36

months.

When the qualifying event is the end of employment or reduction of the

employees hours of employment, and the employee became entitled toMedicare benefits less than 18 months before the qualifying event,

COBRA continuation coverage for qualified beneficiaries other than theemployee lasts until 36 months after the date of Medicare entitlement.

For example, if a covered employee becomes entitled to Medicare 8

months before the date on which his employment terminates, COBRAcontinuation coverage for his spouse and children can last up to 36

months after the date of Medicare entitlement, which is equal to 28months after the date of the qualifying event (36 months minus 8

months). Otherwise, when the qualifying event is the end of employmentor reduction of the employees hours of employment, COBRA

continuation coverage generally lasts for only up to a total of 18 months.

There are two ways in which this 18-month period of COBRA

continuation coverage can be extended.

Disability Extension of 18-Month Period of Continuation

Coverage

If you or anyone in your family covered under the Plan is determined bythe Social Security Administration to be disabled and you notify the City

of San Angelo in a timely fashion, you and your entire family may be

entitled to receive up to an additional 11 months of COBRA continuationcoverage, for a total maximum of 29 months. The disability would have

to have started at some time before the 60th day of COBRA continuationcoverage and must last at least until the end of the 18month period of

continuation coverage. Contact the COBRA Administrator for proceduresfor this notice, including a description of any required information or

documentation.

Second Extension of 18-Month Period of Continuation

Coverage

If your family experiences another qualifying event while receiving 18months of COBRA continuation coverage, the spouse and dependent

children in your family can get up to 18 additional months of COBRAcontinuation coverage, for a maximum of 36 months if notice of the

second qualifying event is properly given to the Plan. This extension may

IMPORTANT NOTICES


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be available to the spouse and dependent children receiving continuation

coverage if the employee or former employee dies, becomes entitled to

Medicare benefits (under Part A, Part B, or both), or gets divorced or

legally separated or if the dependent child stops being eligible under the

Plan as a dependent child, but only if the event would have caused the

spouse or dependent child to lose coverage under the Plan had the first

qualifying event not occurred.

If You Have Questions

Questions concerning your Plan or your COBRA continuation coverage

rights should be addressed to the City of San Angelo. For moreinformation about your rights under ERISA, including COBRA, theHealth Insurance Portability and Accountability Act (HIPAA), and other

laws affecting group health plans, contact the nearest Regional or DistrictOffice of the U. S. Department of Labors Employee Benefits Security

Administration (EBSA) in your area or visit the EBSA website at

www.dol.gov/ebsa . (Addresses and phone numbers of Regional andDistrict EBSA Offices are available through EBSAs website.)

Keep Your Plan Informed of Address Changes

In order to protect your familys rights, you should keep the City of SanAngelo informed of any changes in the addresses of family members.

You should also keep a copy, for your records, of any notices you send to

the Plan Administrator.

Plan Contact Information

Contact City of San Angelos Human Resources at 325-657-4221 for thename, address, and telephone number of the party responsible foradministering your COBRA continuation coverage.

MEDICARE PART D NOTICE

Important Notice from City of San Angelo About Your

Prescription Drug Coverage and Medicare

Please read this notice carefully and keep it where you can find it. This

notice has information about your current prescription drug coverage withCity of San Angelo and about your options under Medicares prescription

drug coverage. This information can help you decide whether or not youwant to join a Medicare drug plan. If you are considering joining, you

should compare your current coverage, including which drugs are

covered at what cost, with the coverage and costs of the plans offeringMedicare prescription drug coverage in your area. Information about

where you can get help to make decisions about your prescription drugcoverage is at the end of this notice.

There are two important things you need to know about your current

coverage and Medicares prescription drug coverage:

1. Medicare prescription drug coverage became available in 2006 to

everyone with Medicare. You can get this coverage if you join a

Medicare Prescription Drug Plan or join a Medicare Advantage Plan

(like an HMO or PPO) that offers prescription drug coverage. All

Medicare drug plans provide at least a standard level of coverage setby Medicare. Some plans may also offer more coverage for a higher

monthly premium.

2. City of San Angelo has determined that the prescription drug

coverage offered by the City of San Angelo Employee Benefit Plan

is, on average for all plan participants, expected to pay out as much

as standard Medicare prescription drug coverage pays and istherefore considered Creditable Coverage. Because your existingcoverage is Creditable Coverage, you can keep this coverage and

not pay a higher premium (a penalty) if you later decide to join a

Medicare drug plan.

When Can You Join A Medicare Drug Plan?

You can join a Medicare drug plan when you first become eligible for

Medicare and each year from November 15th through December 31st.

However, if you lose your current creditable prescription drug coverage,

through no fault of your own, you will also be eligible for a two (2)

month Special Enrollment Period (SEP) to join a Medicare drug plan.

What Happens To Your Current Coverage If You Decide

to Join A Medicare Drug Plan?

If you decide to join a Medicare drug plan, your current City of San

Angelo coverage will be affected. For those individuals who electtheBlue Cross and Blue Shield medical and prescription drug plan, the

coverage is creditable so you would not need to enroll in a Medicare PartD plan, as the two plans would coordinate benefits with the City plan

being primary and the Part D plan never paying any benefit.

If you do decide to join a Medicare drug plan and drop your current Cityof San Angelo coverage, be aware that you and your dependents will be

able to get this coverage back during a future open enrollment period,

assuming you are still actively employed by the City of San Angelo.

When Will You Pay A Higher Premium (Penalty) To Join

A Medicare Drug Plan?

You should also know that if you drop or lose your current coverage with

City of San Angelo and dont join a Medicare drug plan within 63

continuous days after your current coverage ends, you may pay a higher

premium (a penalty) to join a Medicare drug plan later.

If you go 63 continuous days or longer without creditable prescriptiondrug coverage, your monthly premium may go up by at least 1% of the

Medicare base beneficiary premium per month for every month that youdid not have that coverage. For example, if you go nineteen months

without creditable coverage, your premium may consistently be at least19% higher than the Medicare base beneficiary premium. You may have

to pay this higher premium (a penalty) as long as you have Medicare

prescription drug coverage. In addition, you may have to wait until thefollowing November to join.

For More Information About This Notice Or Your

Current Prescription Drug Coverage

Contact the person listed below for further information. NOTE: Youll

get this notice each year. You will also get it before the next period you

can join a Medicare drug plan, and if this coverage through City of San

Angelo changes. You also may request a copy of this notice at any time.

For More Information About Your Options Under

Medicare Prescription Drug Coverage

More detailed information about Medicare plans that offer prescriptiondrug coverage is in the Medicare & You handbook. Youll get a copy

of the handbook in the mail every year from Medicare. You may also becontacted directly by Medicare drug plans.

For more information about Medicare prescription drug coverage:

a. Visit www.medicare.gov.b. Call your State Health Insurance Assistance Program (see the inside

back cover of your copy of the Medicare & You handbook for

their telephone number) for personalized help

c. Call 1-800-MEDICARE (1-800-633-4227). TTY users should call1-877-486-2048.

If you have limited income and resources, extra help paying for Medicare

prescription drug coverage is available. For information about this extra

help, visit Social Security on the web at www.socialsecurity.gov, or call

them at 1-800-772-1213 (TTY 1-800-325-0778).


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PRIVACY NOTICE

This Notice Describes How Medical Information About

You May Be Used And Disclosed And How You Can Get

Access To This Information.

The Health Insurance Portability & Accountability Act of 1996

(HIPAA) is a federal program that requires that all medical records and

other individually identifiable health information used or disclosed by us

in any form, whether electronically, on paper, or orally, are kept properly

confidential. This Act gives you significant new rights to understand andcontrol how your health information is used. HIPAA provides penaltiesfor covered entities that misuse personal health information.

As required by HIPAA, we have prepared this explanation of how we arerequired to maintain the privacy of your health information and how we

may use and disclose your health information.

We may use and disclose your medical records only for each of thefollowing purposes: treatment, payment and health care operations.

Treatment means providing, coordinating, or managing health care and

related services by one or more health care providers. An example of this

would include case management.

Payment means such activities as obtaining reimbursement for services,

confirming coverage, billing or collection activities, and utilization

review. An example of this would be adjudicating a claim andreimbursing a provider for an office visit.

Health care operations mean such business-related activities asconducting quality assessment and improvement activities, auditing

functions, cost-management analysis, and customer service. An examplewould be an internal quality assessment review.

We may also create and distribute de-identified health information by

removing all references to individually identifiable information.

We may contact you to provide information about treatment alternativesor other health-related benefits and services that may be of interest to

you.

Any other uses and disclosures will be made only with your written

authorization. You may revoke such authorization in writing and we are

required to honor and abide by that written request, except to the extent

that we have already taken actions relying on your authorization.

You have the following rights with respect to your protected healthinformation, which you can exercise by presenting a written request to

the Privacy Officer:

The right to request restrictions on certain uses and disclosures ofprotected health information, including those related to disclosuresto family members, other relatives, close personal friends, or any

other person identified by you. We are not, however, required toagree to a requested restriction. If we do agree to a restriction, we

must abide by it unless you agree in writing to remove it.

The right to reasonable requests to receive confidentialcommunications of protected health information from us byalternative means or at alternative locations.

The right to inspect and copy your protected health information. The right to amend your protected health information. The right to receive an accounting of non-routine disclosures of

protected health information.

We have the obligation to provide and you have the right to obtain apaper copy of this notice from us at least every three years.

We are required by law to maintain the privacy of your protected health

information and to provide you with notice of our legal duties andprivacy practices with respect to protected health information.

This notice is effective as of April 14, 2004 and we are required to abide

by the terms of the Notice of Privacy Practices currently in effect. We

reserve the right to change the terms of our Notice of Privacy Practices

and to make the new notice provisions effective for all protected health

information that we maintain. We will post and you may request a written

copy of a revised Notice of Privacy Practices from the Office for Civil

Rights.

You have recourse if you feel that your privacy protections have been

violated. You have the right to file a formal, written complaint with us at

the address below, or with the Department of Health & Human Services,Office for Civil Rights, about violations of the provisions of this notice orthe policies and procedures of our office. We will not retaliate against

you for filing a complaint.

For more information about HIPAA or to file a complaint, contact:

The U.S. Department of Health & Human Services

Office for Civil Rights

200 Independence Avenue, S.W.

Washington, D.C. 20201

(202) 619-0257

Toll Free: 1-877-696-6775

WHCRA NOTICE

Womens Health and Cancer Rights Act of 1998

On October 21, 1998, Congress enacted the Womens Health and CancerRights Act of 1998. This notice explains the most important provision ofthe Act. Please review this information carefully. If you or your spouse is

covered under the Medical Plan, please make certain that he or she alsohas the opportunity to review this information.

The Womens Health and Cancer Rights Act of 1998 requires that all

group health plans that provide medical and surgical benefits for amastectomy also must provide coverage for:

Reconstruction of the breast on which the mastectomy has beenperformed;

Surgery and reconstruction of the other breast to produce asymmetrical appearance; and

Prostheses and coverage for any complication in all stages ofmastectomy, including lymphedemas.

The Act requires that coverage be provided in a manner that is consistentwith other benefits provided under the plan. The coverage may be subject

to annual deductible and coinsurance provisions.

The Act prohibits any group health plan from:

Denying a participant or a beneficiary eligibility to enroll or renewcoverage under the plan in order to avoid the requirement of the

Act;

Penalizing, reducing or limiting reimbursement to the attendingprovider (e.g., physician, clinic or hospital) to induce the provider toprovide care inconsistent with the Act; and

Providing monetary incentive to an attending provider to induce theprovider to provide care inconsistent with the Act.

The Womens Health and Cancer Rights Act of 1998 will apply to the

Health Plan on the effective date of your coverage.

OTHER IMPORTANT NOTICES

HIPAA NOTICE

If you were covered under a prior qualified plan and have lost coverage

no more than 63 days prior to the effective date of this plan, you may be

eligible to have all or part of the pre-existing condition limitation waived.

You must provide Blue Cross Blue Shield of Texas with a Certificate of

Creditable Coverage from your prior qualified insurance plan.


14/16


Lifetime Limit No Longer Applies and Enrollment

Opportunity

The lifetime limit on the dollar value of benefits under Blue Cross BlueShield of Texas no longer applies. Individuals whose coverage ended by

reason of reaching a lifetime limit under the plan are eligible to enroll in

the plan. Individuals have 30 days from the date of this notice to requestenrollment. For more information contact Blue Cross Blue Shield of

Texas at 1-800-521-2227.

Notice of Opportunity to Enroll in connection with

Extension of Dependent Coverage to Age 26Individuals whose coverage ended, or who were denied coverage (or

were not eligible for coverage), because the availability of dependent

coverage of children ended before attainment of age 26 are eligible to

enroll in the plans. Individuals may request enrollment for such children

for at least 30 days, beginning not later than the first day of the plan yearbeginning on or after September 23, 2010. If an individual is timely

enrolled, enrollment will be effective retroactively to the first day of theplan year, beginning on or after September 23, 2010. For more

information, call Customer Service at the phone number on the back of

your Blue Cross and Blue Shield ID card.

Special Rule for grandfathered group health plans The plan mayexclude an adult child who has not obtained age 26 from coverage

only if the adult child is eligible to enroll in an employer-sponsored

health plan other than a group health plan of a parent.

For Those Age 50 or Older

Senate Bill 1467 requires benefit plans that cover screening medical

procedures to pay for colorectal examinations for enrollees who are age

50 or older and at normal risk for developing cancer of the colon. Your

benefits are:

An annual fecal occult blood text and a flexible sigmoidoscopyevery five years, or

A colonoscopy every 10 years.Newborns and Mothers Health Protection Act (NMHPA)

The Newborns and Mothers Health Protection Act (NMHPA) restricts

limiting the length of a hospital stay in connection with childbirth for amother or newborn child to less than 48 hours (or 96 hours for a cesarean

delivery). The law does not prohibit earlier discharge if the mother and

her attending physician are in agreement that an earlier discharge isappropriate. In addition, authorization of the hospital stay cannot berequired for stays of 48 hours or less (or 96 hours) nor are early discharge

incentives allowed. Hospital stays begin at delivery or upon hospital

admission (whichever is later).

Your Right to Receive a Certificate of Health Coverage

If your coverage under the health plans sponsored by City of San Angelo

ends, you and your covered dependents will receive a certificate thatshows your period of health coverage under the plan. You may need to

furnish the certificate if you become eligible under another group health

plan if it excludes coverage for certain medical conditions that you havebefore you enroll. You may also need the certificate to buy, for yourself

or your family, an individual insurance policy that does not excludecoverage for medical conditions that are present before you enroll. You

and your dependents may also request a certificate from your medical

plan provider within 24 months of losing coverage under the City of San

Angelo plans.

Initial Notice About Enrollment Rights and Pre-existing

Condition Exclusion Rules in Your Group Health Plan

A federal law called Health Insurance Portability and Accountability Act(HIPPA) requires that we notify you about two very important provisions

in the plan. The first is your right to enroll in the plan under its specialenrollment provision without being considered a late applicant if you

acquire a new dependent or if you decline coverage under this plan for

yourself or an eligible dependent while other coverage is in effect and

late lose that other coverage for certain qualifying reasons. Second, this

notice advises you of the plans pre-existing condition exclusion rules

that may temporarily exclude coverage for certain pre-existing conditions

that you or a family member may have. Section I of this notice may not

apply to certain self-insured, non-federal governmental plans. Contact

your employer or plan administrator for more information.

A. SPECIAL ENROLLMENT PROVISIONS

Loss of other coverage (Excluding Medicaid or a State ChildrensHealth Insurance Program) If you are declining enrollment for yourselfor your dependents (including your spouse) because of other health

insurance or group health plan coverage, you may be able to enrollyourself and your dependents in this plan if you or your dependents lose

eligibility for that other coverage (or if the employer stops contributing

toward your or your dependents other coverage). However, you must

request enrollment within 30 days after your or your dependents other

coverage ends (or after the employer stops contributing toward the other

coverage).

Loss of Coverage for Medicaid or a State Childrens Health

Insurance ProgramIf you decline enrollment for yourself or an eligible dependent (including

your spouse) while Medicaid coverage or coverage under a state

childrens health insurance program is in effect, you may be able to enroll

yourself and your dependents in this plan if you or your dependent lose

eligibility for that other coverage. However, you must request enrollment

within 60 days after you or your dependents coverage ends under

Medicaid or a stat childrens health insurance program.

New dependent by Marriage, Birth, Adoption, or Placement for

AdoptionIf you have a new dependent as a result of marriage, birth, adoption, or

placement for adoption, you may be able to enroll yourself and your

dependents in this plan. However, you must request enrollment within 31

days after the marriage, birth, adoption, or placement for adoption.

Eligibility for State Premium Assistance for Enrollees of Medicaid or

a State Childrens Health Insurance ProgramIf you or your dependents (including your spouse) become eligible for a

state premium assistance subsidy from Medicaid or through a state

childrens health insurance program with respect to coverage under this

plan, you may be able to enroll yourself and your dependents in this plan.However, you must request enrollment within 60 days after your or your

dependents determination of eligibility for such assistance.You or your spouse or dependents may also have special enrollment

rights in another group health plan at the time a claim is denied as a resultof a lifetime limit on all benefits, if you request enrollment within 30

days after the claim has been denied.

To request special enrollment or obtain more information, call Customer

Service at the phone number on the back of your Blue Cross and Blue

Shield ID card.

Grandfathered Health Plan Notice

The City of San Angelo believes the PPO medical plans are a

grandfathered health plan under the Patient Protection and Affordable

Care Act (the Affordable Care Act). As permitted by the Affordable Car

Act, a grandfathered health plan can preserve certain basic health

coverage that was already in effect when that law was enacted. Being a

grandfathered health plan means that your plan or policy may not include

certain consumer protections of the Affordable Care Act that apply to

other plans, for example, the requirement for the provision of preventivehealth services without any cost sharing. However, grandfathered health

plans must comply with certain other consumer protections in the

Affordable Care Act, for example, the elimination of lifetime limits on

benefits.

Questions regarding which protections apply and which protections donot apply to a grandfathered health plan and what might cause a plan to

change from grandfathered health plan status can be directed to the plan

administrator with Human Resources.


15/16

BENEFIT CONTACT INFORMATION

If you have any questions about any of your benefits, below is a list of the companies, the plans they administer, andtheir phone numbers and websites:

Carrier Contact Information

Benefit Plan For Information On Phone/Website

Medical

BCBSTX

Plan benefits, eligibility, preferredproviders, claim status, covered medicalservices, ID Cards

To request pre-certification of a hospitalstay or surgery.

www.bcbstx.com gives the employeeaccess to personal information including,but not limited to claim status, temporaryID cards, etc.

Member Services1-800-521-2227

www.bcbstx.com

Mail Order Prescription DrugProgram

PRIME Therapeutics Mail Order prescription drug benefits1-877-357-7463

www.myprime.com

Dental United Concordia Benefits, claim status, participatingproviders 1-800-332-0366www.ucci.comVision

Ameritas Benefits, claim status, participatingproviders800-659-2223

www.ameritasgroup.com

Life and AD&D

Madison National Life Plan benefits and questions Filing a claim

1-800-356-9601www.madisonlife.com

Flexible Spending Accounts (FSA)

HealthSmart Benefits, filing a claim, claim status1-800-687-0500

www.healthsmart.com

Supplemental Insurance

AFLAC Questions, information or to enroll1-325-653-3959

Joe Max Edmiston

Identity Theft & Legal Services

Wildeco, Inc. Questions, information or to enroll1-325-486-8111Johnny Wilde

If you still have questions, please contact Human Resources at (325)657-4221.

This benefit booklet summarizes the provisions of your Employee Benefits offered by the City of San Angelo effective January 1,2011. Complete details of each plan are included in the official plan documents and contracts. If there is a difference betweenthis book and the documents or contracts, then the documents and contracts will govern. Benefits described in this book may be

changed at any time and do not represent a contractual obligation on the part of the City of San Angelo.


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COSA Health Benefits 2011

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