Q: Do I need to complete a new enrollment form if I don't want to make changes?
Yes. Every full-time employee will be required to complete an enrollment worksheet.
Q: What information will I need to complete the enrollment form?
Be sure to have the names of your dependents, dates of birth, and Social Security numbers.
Q: Do I need to schedule an appointment with an enroller?
You must schedule an appointment with an enroller if you are interested in enrolling in voluntary products.
Q: Which core insurance plans can I opt out of through the waiver process?
All employees are required to enroll themselves in each of the five basic insurance plans, unless the employee qualifies for a waiver because the employee meets certain requirements of the MOU that allows them to opt out, or the employee is under an individual employment agreement. As a practical matter, this means you can opt out of medical, dental, or vision, since these are the items that could be covered under a spouse's insurance. All employees are required to be enrolled in the City's disability and life insurance plans. Please note that there are limited guidelines for waiver eligibility. If you think you are eligible and want to obtain a waiver, please contact Rosa Winzer directly at 385-6867 to find out the specific requirements.
Q: Is acupuncture covered under the medical or chiropractic coverages?
No, acupuncture is not covered under the City's medical benefits.
Q: How is the orthodontic benefit coordinated with other insurance plans?
For employees seeking orthodontia coverage, the City plan will be the primary plan and the spouse's plan will pay as a secondary payer. For dependent children, the parent with the birthday that occurs first in the year would be primary.
Q: For VSP, does the "12 months" or the "24 months" in the plans start on January 1?
No. Eligibility for benefits is based on your actual date of service. For example, if you participate in the core plan and get new glasses on March 7, 2011, your next date of eligibility for new glasses would be March 7, 2012.
Q: Is the $120 vision allowance "retail" or "wholesale" pricing?
It's retail pricing.
Q: If I get injured on the job, do I use short term, or long term disability insurance?
No. Your disability insurance covers non-industrial injuries. If you are disabled as a result of an on-the-job event, your injury would be workers' compensation.
Q: Can the voluntary short-term disability be used together with the long-term disability plan? How?
Yes. Even though they are different insurance companies, if you choose to purchase the voluntary short-term disability product will be coordinated with the City's disability plan. This means that the long-term disability plan benefits will apply after the short-term plan benefits are exhausted.
Q: What is the maximum amount of life insurance I can purchase for my child through the Lincoln Financial additional term life insurance?
Lincoln Financial dependent life insurance policy is a flat benefit of $10,000. Note: there are some benefit imitations for the age brackets as follows: birth to 13 days old - $0 benefit, 14 days old - 6 months of age - $250 benefit, 6 months of age-19 years of age, (to age 25) if full time student- $10,000 benefit.
Q: Can I enroll my siblings in the voluntary plans?
No. The voluntary products are for eligible employees their spouse and dependent children only.
Q: To use the Section 125 Dependent Care Flexible Spending Account, does the person being cared for have to be my dependent on my income tax return?
Dependent means either: a. For purposes of the Medical Reimbursement Account, any individual who meets the definition of a dependent under Code section 152(a); b. For purposes of the Dependent Care Reimbursement Account, either: (1) a child who is under the age of 13 and with respect to whom an employee or his or her spouse is entitled to a dependency exemption under Section 151(c) of the Code; or (2) a relative or household member of an employee who receives over half of his or her support from the employee and who is physically or mentally incapable of caring for himself or herself; or (3) the spouse of an employee who is physically or mentally incapable of caring for himself or herself.
Q: Does the provider being paid through the Section 125 Dependent Care Account have to be licensed?
No. But they do need to have a Social Security number or taxpayer identification number, and should report the income from your payment on their own income taxes.
Q: Can the Section 125 Dependent Care Account be used to cover elderly parents who are in a nursing home of other facility?
No. Overnight care facilities are not eligible expenses under the Dependent Care Spending Account Section 125 guidelines.
Q: For the Section 125 Medical Spending Account, is March 31 the last date for getting claims paid before I lose the remaining balance?
For the medical spending account, claims must be incurred in 2011 (by December 31). You will have until March 31, 2012 to submit claims for expenses incurred in 2011.
Q: Do the Section 125 Plans affect my income for PERS purposes?
No. Setting aside money through a Section 125 plan reduces your taxable income reported to the Internal Revenue Service, but it does not affect your compensation reported to PERS for calculation of your retirement benefit.
Q: If I use the Section 125 Dependent Care Account, can I still get a child care credit on my income tax?
In general, under the current tax structure, the Dependent Day Care Reimbursement Account will be more advantageous than the tax credit if your family's income is over $24,000. The actual amount of your taxes will depend upon a variety of factors. Please contact your tax advisor for recommendation.
Q: What is the definition of “deductible”?
The amount for which the insured is liable before the plan will make payment.
Q: Is a colonoscopy considered preventive medicine? What if polyps were removed and examined for biopsy, is this still considered preventive?
A colonoscopy is considered routine preventive until the scenario which you have described, it is then considered medical.
In the following scenarios, how would a deductible be applied?
A member goes to primary care physician for routine physical (women wellness, or male physical). The doctor requests blood work to evaluate cholesterol, sugar levels, etc.
Unless the blood work is because symptoms were presented or checking up on a known condition, this would be considered a routine preventive visit with corresponding lab…no deductible.
A member takes a child to the pediatrician for flu-like and ear infection symptoms. A throat culture is taken from the child. A return appointment is scheduled for follow up visit to review throat culture results. How is the deductible applied in this scenario?
The deductible would apply to the lab work.
A pregnant member attends prenatal appointments. The member is hospitalized as inpatient for 48 hours following delivery. The baby has complications and must be transported to Valley Children’s Hospital. Will a deductible apply to the baby’s medical needs?
Yes, in this scenario the baby is being treated for medical services. They have become a patient in their own right, creating separate charges, and benefits will apply accordingly.
Q: When can I enroll my over-age dependent child (up to age 26)?
To request coverage for a child who has not attained age 26, you must enroll the over age dependent during open enrollment, or within 30 days of a qualifying event.
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