welcome to open enrollment - hvilletn.org

Welcome to Open Enrollment 2020 – 2021 Benefits Guide

Welcome to Open Enrollment City of Hendersonville

PICK THE BEST BENEFITS FOR YOU AND YOUR FAMILY. The City of Hendersonville strives to provide you and your family with a comprehensive and valuable benefits package. Each year, we have an annual Open Enrollment period in which you may make benefits elections for the coming year. This year’s Open Enrollment period will run from May 11, 2020 through May 22, 2020. Elections you make during this period will become effective on July 1, 2020. IMPORTANT: If you do not make elections during the Open Enrollment period, you will not be enrolled in benefits after July 1, 2020. As we enter this year’s Open Enrollment, we want to make sure you are getting the most out of our benefits; therefore, we are providing this guide to assist you in learning about our benefits. In addition, you may also access all of our benefits information online at www.hvilletnbenefits.com. On hvilletnbenefits.com, you will find details on all plans, as well as our open enrollment presentation video and detailed information about the plan changes for next year. If you have questions about any of the benefits mentioned in this guide, please don’t hesitate to reach out to HR.

TABLE OF CONTENTS Highlights for 2020 - 2021 .................................................................................................................. 4 Online Enrollment ............................................................................................................................... 5 Health Insurance ................................................................................................................................. 7 Telemedicine ....................................................................................................................................... 9 Dental Insurance ............................................................................................................................... 10 Vision Insurance ................................................................................................................................ 12 Disability Income Benefits ................................................................................................................ 13 Base Life Insurance ........................................................................................................................... 14 Voluntary Life Insurance ................................................................................................................... 14 Deferred Compensation (457 Plan) .................................................................................................. 15 Tennessee Consolidated Retirement System (TCRS) ....................................................................... 16 Employee Assistance Plan (EAP) ....................................................................................................... 17 Employee Benefits Portal ................................................................................................................. 18 Questions and Answers .................................................................................................................... 19

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WELCOME TO OPEN ENROLLMENT WHO IS ELIGIBLE? If you’re a full-time employee at The City of Hendersonville, you are eligible to enroll in the benefits outlined in this Guide once you have completed a full month of employment. Full-time employees are those who work 30 hours or more per week. In addition, you can enroll your spouse and children in many of our benefits.

HOW TO ENROLL Are you ready to enroll? The first step is to review your current benefits. Did you move recently or get married? Verify all of your personal information and make any necessary changes.

Once all your information is up to date, it’s time to make your benefit elections. The decisions you make during open enrollment can have a significant impact on your life and finances, so it is important to weigh your options carefully.

This year, our enrollments will be completed in Employee Self Service. You will find more information on enrolling in Employee Self Service on page 5-6.

WHEN TO ENROLL Open enrollment begins on May 11, 2020 and runs through May 22, 2020. The benefits you choose during open enrollment will become effective on July 1, 2020.

HOW TO MAKE CHANGES Unless you experience a life-changing qualifying event, you cannot make changes to your benefits until the next open enrollment period. Therefore, it is very important for you to choose your benefits carefully. Qualifying events include things like:

• Marriage, divorce or legal separation • Birth or adoption of a child • Change in child’s dependent

status • Death of a spouse, child or other

qualified dependent • Change in residence • Change in employment status or a

change in coverage under another employer-sponsored plan

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HIGHLIGHTS FOR 2020-21As you review this benefits guide, you will notice some changes to our benefits package. However, you will notice quickly that the changes are all very positive. A few of these changes, as well as some general notes about our benefits for 2020 – 2021 are below:

• Our health insurance plans are not changing! This means that, despite rising health care costs, there is no change to the plan designs. BlueCross BlueShield is still our medical insurance carrier.

• While our health insurance plans are not changing, we have added an option that will allow some employees to save money. We have added an “Employee + One” rate. This rate is for employees who have previously been paying a full family rate for health insurance and only cover their spouse or one child. These employees will now have a new rate that reflects the fact that they are not covering as many people. All other employees will have no change to their health insurance rates.

• We are still providing Teladoc coverage for anyone who participates in one of the health insurance plans. This allows you to access a doctor from anywhere for minor medical issues by phone 24/7/365 at NO COST to you.

• Our dental carrier will still be Cigna, but we will now offer a new, cheaper ‘DHMO’ plan in addition to the ‘DPPO’ plan that we currently offer. There will be a small cost increase for the current (DPPO) plan, but you will have an option to save considerably if the DHMO plan works for you.

• We have made a substantial increase to the amount of life insurance that the City provides at NO cost to you.

Beginning July 1, 2020, Non-Exempt employees will receive $50,000 of life insurance coverage (increased from $30,000) and Exempt employees will receive $100,000 of coverage (increased from $50,000). In addition, you will still receive accidental death and dismemberment coverage equal to two times your base life insurance amount.

• There are no changes to our vision or disability plans this year.

• You now have an option to make Roth 457 contributions through Voya. This allows you contribute after-tax

dollars and ensure that your contributions and the earnings on that money are not taxed when you withdraw the money after you retire. You will still have the option to make pre-tax deferrals through the Voya plan if you prefer. Additionally, you may make both types of contributions if you like.

• Wellness dollars earned this Wellness Year (2019 – 2020) may now be applied to ANY insurance coverage that

you have. In the past, you had to use these dollars toward medical coverage.

• We are now offering a non-tobacco credit for Retirees. In the past, this was only for active employees.

• You will notice that we have eliminated the option to pay for benefits (medical, dental, vision, etc.) with “post-tax” dollars. Very few employees were using this option, and utilizing pre-tax dollars will save you money on your payroll deductions!

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ONLINE ENROLLMENT This year, ALL employee enrollments MUST be completed through our online enrollment tool, Employee Self Service (ESS). The site is accessible via the Internet at https://employeeportal.hvilletn.org/MSS/default.aspx and can be accessed 24 hours a day, seven days a week. Using this tool will make the enrollment process much easier for you and your family! Online enrollment on the Employee Self Service (ESS) website can be done from any computer with Internet access. There are computers available in every department and a kiosk in Conference Room 1 at City Hall for your convenience if needed. For your security, the Employee Self Service website is encrypted, and password protected. See below for instructions on how to access and log in to ESS:

Once you have logged in, you will be able to complete your enrollment. However, this process will be much easier if you gather some information before you begin.

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BEFORE YOU ENROLL STEP 1: HAVE ALL INFO TO VERIFY DEPENDENTS & BENEFICIARIES

è All dependents must be verified once added to coverage. If you want to add a dependent for coverage for next

year, now is the time to do it. You may not add dependents during the plan year unless you have a qualified change in status, also known as a qualified life event. You will need to provide spouse/dependent’s: • Social Security # • Date of birth • Gender • Address of eligible dependents if they do not reside with you • Relationship of eligible dependents to you

è You will also be required to enter your life insurance beneficiary. This applies to both the base life insurance and

voluntary life insurance. You will need the following information: • Name • Relationship to you • If your beneficiary is a non-person entity, then you will need the entity’s tax id or a Trust number

STEP 2: REVIEW PLAN OPTIONS & MAKE YOUR CHOICES Take time to review the information in the Plans section. It will help you understand your benefit choices. As you are enrolling, you may need to refer to specific plan documents, such as benefit summaries and other plan information. All of this information can be found in the benefits portal – hvilletnbenefits.com. Discuss it with your family, too! Once you have made your elections, you are finished! Congratulations…you don’t need to complete any paper forms or turn anything in!

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HEALTH INSURANCE We are very happy to announce that, despite rising healthcare costs, there have been no changes to the health insurance plans for the coming year. BlueCross BlueShield will remain our health insurance carrier for this year. In addition, we are continuing to provide an additional benefit for every employee who participates in one of our health insurance plans – Teladoc. Teladoc will give you and your family 24/7/365 access to Board-certified doctors for routine health issues at no cost to you! More details on the Teladoc plan may be found on page 9 of this guide. As was the case last year, two of our plans, Plans One and Two, use BlueCross BlueShield’s Network P and one plan, Plan Three, uses Network S. Network S does not include some doctors nor does it include HCA/Tristar hospitals. You should visit www.bcbst.com to ensure that your doctors participate in your network. The following chart compares our benefits that will take effect on July 1, 2020. More details on the plans may be found on our employee portal at www.hvilletnbenefits.com.

Plan Feature1 Plan One Plan Two Plan Three

Deductible - Individual / Family $600 net2 / $1,200 net $350 net3 / $700 net $750 net4 / $1,500 net

Coinsurance 70% 80% 70%

Out-of-pocket Maximum5 - Individual / Family $2,600 / $5,200 $1,600 / $3,200 $3,500 / $7,000

Office Visit Copay Subject to Deductible and Coinsurance

Subject to Deductible and Coinsurance

$30 Primary Care / $50 Specialist

Preventive Services Covered at 100% Covered at 100% Covered at 100%

Emergency Services Copay $250 (waived if admitted)

$250 (waived if admitted)

$250 (waived if admitted)

Facility Services, Outpatient Treatment, Outpatient Therapy, etc.




Mental Health and Substance Abuse Services

Treated the same as other illnesses



Prescription Drug Coverage $15/$45/$65 Copay Subject to Deductible

and Coinsurance $15/$45/$65 Copay

1 Penalties apply for out-of-network utilization. Please review SBC and Certificates. 2 Individual deductible reimbursed by City - $601-$800; $1,201-$1,600 for Family 3 Individual deductible reimbursed by City - $351-$500; $701-$1,000 for Family 4 Individual deductible reimbursed by City - $751-$1,200; $1,501-$2,400 for Family 5 Out-of-pocket maximums reflect the total out-of-pocket maximum and are not reduced for deductibles that are reimbursed.

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YOUR COST IN 2020-21 Good news! Despite rising health care rises and unprecedented changes resulting from health care reform, we are pleased to announce there will be no premium increases for the new plan year for most employees. We have added a new tier of rates called “Employee + One”. This rate is for employees who cover themselves and one other person (either spouse or one child). These employees will see a decrease in rate from the full family rate that they have had to play before. All other employees will have no payroll deduction increases. Monthly employee costs will remain as shown:

Employee Monthly Premiums

Current Rates

(2019-2020) Individual

Employee + One

(includes Individual Cost)

Family (includes Individual

Cost)

July 1, 2020 Rates

Individual

Employee + One

(includes Individual Cost)

Family (includes Individual

Cost)

Plan One $62.38 N/A $544.20 Plan One $62.38 $421.56 $544.20

Plan Two $154.44 N/A $835.15 Plan Two $154.44 $712.84 $835.15

Plan Three $35.00 N/A $392.76 Plan Three $35.00 $268.94 $392.76

* Please note these rates reflect the employee share of the total premium for coverage. The City continues to pay the majority of the cost for all plans.

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TELEMEDICINE If you are a participant in one of our Health Insurance plans, you will have access to no cost telemedicine services provided through Teladoc.

Teladoc uses technology (telephone and video conferencing) to facilitate communication between a state-licensed doctor and you, even though you are not in the same physical location, for the purpose of medical evaluation, diagnosis and treatment. Therefore, you may use the Teladoc benefit to contact a physician and receive medical treatment for a wide variety of medical conditions, including (among many others):

• Cold and flu symptoms • Respiratory infection • Sinus problems • Bronchitis • Allergies • Urinary tract infection • Ear infection • Pink eye • And many more

Telemedicine Advantages Telemedicine offers numerous benefits. Here are just a few of the advantages of using our telemedicine plan:

• Remote Access – With Teladoc, there’s no need to make an appointment with a doctor or sit in a waiting room. You simply call Teladoc to begin a consultation and a state-licensed doctor will return your call in no more than two hours (usually much quicker – the average callback time is 10 minutes).

• Cost Savings – There is NO cost for you to use this service! • Coverage for Your Family – Even if your family members (spouse and children) are not on the City’s health insurance

plans, they may use your Teladoc benefit. • Convenient Care - Doctors are available when you need them - 24 hours a day, 7 days a week!

How to Access Teladoc

• Call the toll-free number: 1-855-VIP-DOCS. • Download the My Benefits Work mobile app, available on the App store and Google Play. • We recommend that you register for Teladoc early. Doing so will prevent delays in accessing the service when you

need it for the first time!! Simply download the app and complete your health history so that the Teladoc doctors may serve you better.

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DENTAL INSURANCE In addition to protecting your smile, dental insurance helps pay for dental care and usually includes regular checkups, cleanings and X-rays. Several studies suggest that oral diseases, such as periodontitis (gum disease), can affect other areas of your body—including your heart. Receiving regular dental care can protect you and your family from the high cost of dental disease and surgery.

This year, to give you more choice, we are adding an additional option for you. This new plan is called a “DHMO” plan. In this plan, you will pay a lower cost for your coverage, but will have some network restrictions – you will need to select a primary care dentist and that dentist will refer you to any specialists that you need. The DHMO network is smaller than our current PPO network; however, we have learned that a number of employees are already using providers in the DHMO network. Therefore, we have added this as an option for you. We encourage you to determine if your dentists participate in the DHMO network by visiting www.cigna.com and searching for your dentist in the DHMO network.

Below is a quick overview of the differences between PPO and DHMO plans:

DPPO vs. DHMO?

DPPO: • Uses network of providers, but also allows for the use

of providers outside the plan’s network. No referrals are required.

• It is more flexible than a DHMO, but is usually more expensive.

• What you pay for services is determined by a percentage of the cost.

DHMO: • Only covers services performed by in-network

providers. There are no out-of-network benefits. Referrals are required to visit a specialist.

• This is a significantly lower cost option, but is more restrictive than a PPO plan.

• What you pay is determined by a detailed, written fee schedule.

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The chart below describes the benefits in our two dental plans:

Type of Service PPO Plan DHMO Plan (Amount You Pay)6

Preventive Services Exams, cleanings, X-rays – 100% Exams, cleanings, X-rays – $0

Basic Services

Fillings, simple extractions, oral surgery, endodontics, periodontics – 70%-100% When you begin employment, your benefit is 70% for these services. As long as you visit your dentist regularly and have necessary services completed during the year, this amount will increase by 10% per year (beginning each July) until you reach 100%. Should you fail to receive regular dental services in a year, your benefit will decrease back to 70%.

Fillings - $0 - $115 Simple extractions – $0 - $125 (depending on procedure) Oral surgery – $12 - $850 (depending on procedure) Endodontics – $14 - $430 (depending on procedure) Periodontics – $0 - $83 (depending on procedure)

Major Services Crowns, bridges, etc. – 50% up to the Annual Maximum

Crowns –$700 - $790 (depending on procedure) Bridges – $750 - $1,015

Annual Maximum $1,000 per person N/A

Orthodontic Services 50% to age 19; $1,000 Lifetime Maximum $2,040 - $2,376 for 24-month treatment

Monthly Payroll Deductions

Employee - $0.00 Family - $57.12

Employee - $0.00 Family - $26.08

6 Your costs are based on the fee schedule for the plan. The entire fee schedule can be found at www.hvilletnbenefits.com. Please review the fee schedule, as the costs listed above are simply examples, and the fee schedule determines your actual cost.

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VISION INSURANCE Driving to work, reading a news article and watching TV are all activities you likely perform every day. Your ability to do all these activities, though, depends on your vision and eye health. Vision insurance can help you maintain your vision as well as detect various health problems. The City of Hendersonville’s vision insurance entitles you to specific eye care benefits. Our policy covers routine eye exams and other procedures and provides specified dollar amounts or discounts for the purchase of eyeglasses and contact lenses. There will be no changes to the plan or rates for our vision plan this year. If you seek the services of a VSP network provider (provider directory may be found at www.vsp.com, your benefits include:

• Routine vision exams for a $20 copay (every 12 months) • $105 allowance for eyeglass frames (every 24 months) • $20 copay for basic eyeglass lenses, plus additional copays for lens add-ons (every 12 months) • $105 allowance for contact lenses (every 12 months)

Monthly payroll deductions for vision coverage are the same as last year - $0.00 for individual coverage and $10.96 for family coverage.

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DISABILITY INCOME BENEFITS At the City of Hendersonville, we want to do everything we can to protect you and your family. That’s why we provide short- and long-term disability insurance—meaning that you pay nothing for this valuable income protection. Without disability coverage, you and your family may struggle to get by if you miss work due to an injury or illness. In the event that you become disabled from a non-work-related injury or sickness, disability income benefits will provide a partial replacement of lost income. Please note, though, that you are not eligible to receive short-term disability benefits if you are receiving workers’ compensation benefits. The chart below describes the benefits of both of our disability plans:

Short-term Disability Long-term Disability

Benefits Begin After you use all your sick leave benefits 181st day of disability

Benefits Payable Weekly Monthly

How is Disability Determined If you are unable to perform your job

Class 1 (Exempt Employees) – if you are unable to perform your job until your reach Social Security Retirement Age

Class 2 (Non-Exempt Employees) – If you are unable to perform your job for 3 years

and, after 3 years, if you are unable to perform any job

Percentage of Income Replaced 67% of weekly salary 60% of monthly salary

Maximum Benefit Duration 26 weeks

Until Social Security Normal Retirement Age

Maximum Benefit Class 1 (Exempt Employees) - $800 per week Class 2 (Non-Exempt Employees) - $500 per week $5,000 per month

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BASIC LIFE INSURANCE Life insurance can help provide for your loved ones, if something were to happen to you. The City of Hendersonville provides full-time employees with group life and accidental death and dismemberment (AD&D) insurance. This year, we are happy to announce that this benefit has been significantly increased! Class 1 (Exempt) employees will now receive $100,000 of life insurance coverage. Class 2 (Non-exempt) employees will now receive $50,000 of coverage. In addition, all employees receive accidental death & dismemberment coverage equal to two times the life insurance amount. Please note that the life and AD&D benefits reduce beginning at age 70. At age 70, the benefits will reduce by 35% of the original amount and further reduce to 50% of the original amount at age 75. The City of Hendersonville pays for the full cost of this benefit—meaning you are not responsible for paying any monthly premiums.

VOLUNTARY LIFE INSURANCE While the City of Hendersonville provides life insurance, some employees may want to purchase additional coverage. Think about your personal circumstances. Are you the sole provider for your household? What other expenses do you expect in the future (for example, college tuition for your child)? Depending on your needs, you may want to consider buying supplemental coverage. With voluntary life insurance, you are responsible for paying the full cost of coverage through payroll deductions. You can purchase coverage for yourself or for your spouse in $10,000 increments. The chart below outlines the monthly costs of purchasing additional coverage.

Monthly Cost for Every $1,000 of Voluntary Life Insurance Coverage

Age <30 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+

Employee Non-Smoker $0.08 $0.09 $0.11 $0.16 $0.28 $0.46 $0.85 $1.25 $2.60 $3.70 $9.30

Employee Smoker $0.12 $0.17 $0.22 $0.36 $0.67 $1.10 $1.75 $2.25 $4.20 $5.70 $13.60

Spouse $0.10 $0.12 $0.15 $0.24 $0.42 $0.65 $1.15 $1.45 $2.90 $4.00 $4.00

Dependent Children $0.60 for $5,000 of coverage

Dependent Life Benefit $1.05 for $5,000 on spouse and $4,000 on children

Please note that the voluntary life benefits reduce beginning at age 70. At age 70, the benefits will reduce by 35% of the original amount and further reduce to 50% of the original amount at age 75, to 35% at age 80 and to 25% at age 85. If you wish to purchase coverage for the first time at this Open Enrollment or wish to add to your existing coverage, you will be asked to complete an Evidence of Insurability application (health questionnaire).

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DEFERRED COMPENSATION (457 PLAN) To help you prepare for the future, the City of Hendersonville sponsors a 457 Plan as part of its benefits package. This plan is similar to a 401(K), although due to IRS regulations, cities are limited to a different version known as a "457 Plan". The 457 Plan is designed as a supplemental retirement plan for state and local government employees. It allows you to set aside a portion of your wages or salary for your retirement before income taxes are deducted. Those contributions are then invested and also grow until received at retirement or separation of service. Beginning this year, you will be able to choose whether to make those contributions on a pre-tax basis (with the earnings being tax-deferred) as you have always been able to do or to make them as “Roth” contributions. Roth contributions are made on an after-tax basis and earnings grow tax-free. Additionally, if you prefer, you can make both types of contributions. Under our 457 Plan with Voya Financial, you have more than 40 investment options from some of the top mutual fund companies like American Funds, Fidelity, T Rowe Price, Pioneer and Voya among others. These investment options are offered with no sales charges, no surrender charges or annual maintenance fees. You can contribute as little as $25 per pay period or under current federal limits up to $19,500 per year. Employees age 50 and older can contribute up to $26,000 per year. 457 Plans are unique in that they have no minimum retirement age requirement like IRAs and 401k plans, where you can be subject to a 10% penalty for taking distributions before age 59½. Upon separation of service, retirement or financial hardship there is no 10% IRS penalty associated with a 457 Plan, regardless of your age at the time of distribution. You may pick up a Voya enrollment guide from the Human Resources Department for complete details and/or contact Ed Stewart, our Voya representative, to receive additional information or to arrange an individual meeting for assistance in enrolling in the 457 Plan. For information contact: Ed Stewart – (615) 627-5936 [email protected]

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TENNESSEE CONSOLIDATED RETIREMENT SYSTEM (TCRS) The City of Hendersonville participates in the Tennessee Consolidated Retirement System (“TCRS”). As of October 1995, the City pays for all employee costs associated with TCRS. All employees who have completed 6 months of full-time employment are eligible to participate in the TCRS plan. Once you have completed 5 years of service, you will become vested in the plan. TCRS is a defined benefit plan. This means that expected benefits are based on a set formula and not how well any investments perform (like our 457 Plan). In its simplest form, the formula for yearly retirement benefits is: Years of service x average final salary x a factor of .015. Example: Your average final annual salary is $30,000. You have 20 years of service credit. Your annual retirement benefit will be $9,000. There are enhancements which will increase this figure. For example, the city authorized a 5% one-time increase and there is a complicated formula involving social security integration levels which may increase benefits also. There is also a special provision for certain military service counting as service credits and certain applicable retiring employees are allowed to count one-half of their unused sick leave balances towards retirement credits. In addition, there are disability provisions which will provide income according to your projected retirement income. You will be eligible for benefits once you have become vested and either completed 30 years of TCRS service or reached age 60. There are provisions for early retirement at a reduced level of benefits. An individual who has ten years of service at age 55 or 25 years of service can retire at a benefit level of 76% of the full retirement benefit amount. There is a .4% reduction for each month of early retirement. We encourage all employees to go to the TCRS Self-Service page of their website to establish an online account. Your personal information and account maintenance will be available and handled through this website. In addition, all employees should check this page to confirm that a beneficiary election is on file for your account and/or make beneficiary changes as needed. All retirement applications are now processed through the TCRS website only. To do so, visit the following link: https://mytcrs.tn.gov/DPAS.WebUI.Internet/Common/Pages/Login.aspx.

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EMPLOYEE ASSISTANCE PROGRAM (“EAP”) The Employee Assistance Program is offered to all employees and immediate family members of the City of Hendersonville through LifeServices EAP. It is a completely confidential counseling program that covers issues such as:

• Depression

• Grief and Loss • Relationship Problems

• Alcohol and Drug Related Issues

• Legal Issues

• Financial Pressures

• Family Problems

• Stress

• Anxiety

Through our EAP program, you will receive up to 8 visits per episode at no cost to you. Provisions can be made with your health insurance carrier to file claims if additional visits are needed.

You can contact LifeServices EAP 24/7/365 toll free at 1-800-822-4847, or you can visit their website at www.lifeserviceseap.com.

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EMPLOYEE BENEFITS PORTAL The City of Hendersonville has an internet portal to help you gain access to your benefits information! You can view it from anywhere you have internet access—your computer, iPhone, iPad, Android phone or tablet. The portal not only serves your benefit hub, but you can also learn how best to use your benefits to save you time and money. Have you ever…

• Needed to know what your doctor’s office copay is? • Been asked by your spouse what your deductible is? • Wanted tips on how to make the most of your benefits? • Arrived at the dentist and realized you have no idea who your carrier is?

It provides:

• Access to robust benefit information, • Side-by-side plan comparison tools, • Library of HR and benefit forms, • Educational and informational articles, • Pinterest-style photos and links to spotlight key programs or events, • Links to all providers, and • So much more.

We are thrilled to offer you and your family this innovative tool. Visit www.hvilletnbenefits.com to get started today. Have questions or need help? Contact the Human Resources Department.

hvilletnbenefits.com

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QUESTIONS & ANSWERS WHAT CHANGES ARE EFFECTIVE JULY 1, 2020?

• New “Employee + One” rate for health insurance for employees who cover themselves and one other person (spouse or one child).

• New, cheaper DHMO dental option is available to you. • Substantially increased base life insurance for all employees. • Wellness dollars can now be used for any insurance benefit, not just health insurance. • New Roth 457 contribution option is available to you.

WHEN ARE THE FORMS DUE AND WHERE DO I RETURN THEM? There are no forms to complete this year. ALL benefits elections will be completed online. You have until Friday, May 22nd to complete your enrollment. More information about the online enrollment process may be found on pages 5-6.

OTHER INFORMATION If you do not complete your enrollment online by Friday, May 22nd, you will NOT be enrolled in benefits for the coming year.

ARE THERE EDUCATIONAL OPPORTUNITIES AVAILABLE? Yes. However, due to social distancing, we are placing our Open Enrollment presentation on the benefits website at hvilletnbenefits.com. On this site, you will be able to watch the entire benefits presentation, as well as smaller presentations about specific changes, such as the addition of the DHMO Plan for dental coverage. Ed Stewart, our Voya representative, will be accepting appointments by phone and email. Mr. Stewart may be contacted with the following contact information: Phone – (615) 627-5936 Email – [email protected] In addition, Mr. Stewart plans to be on-site after the social distancing restrictions are lifted. Tentatively, he is planning to be on-site on June 16-17 to answer your questions in person; however, those dates are subject to change as needed. We will notify you when final dates are set.

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ANNUAL DISCLOSURES SUMMARY OF BENEFITS AND COVERAGE NOTICE (SBC) The required summary of benefits and coverage notice is available online at www.hvilletnbenefits.com, or upon request. It is a standardized four page document that highlights key provisions, limitations and exceptions for all City of Hendersonville medical plans. COBRA The Consolidated Omnibus Budget Reconciliation Act (COBRA) was signed into law in 1986; COBRA gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances. Qualified individuals may be required to pay the entire premium for coverage up to 10% of the cost of the plan. COBRA generally requires that group health plans sponsored by employers offer Team Members and their families the opportunity for a temporary extension of health coverage in certain instances where coverage under the plan would otherwise end. COBRA outlines how Team members and family members pay and elect to continue their coverage. Please see your Human Resources Representative for more information. NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACT DISCLOSURE Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). THE WOMEN’S HEALTH CANCER RIGHTS ACT OF 1998 (WHCRA) If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for: ▪ All stages of reconstruction of the breast on which the mastectomy was performed; ▪ Surgery and reconstruction of the other breast to produce a symmetrical appearance; ▪ Prostheses; and ▪ Treatment of physical complications of the mastectomy, including lymphedema. These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. MEDICARE CREDITABLE COVERAGE NOTICE Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with The City of Hendersonville, Tennessee and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want 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 offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. There are two important things you need to know about your current coverage and Medicare’s 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 set by Medicare. Some plans may also offer more coverage for a higher monthly premium.

2. The City of Hendersonville, Tennessee has determined that the prescription drug coverage offered by the (Insert Name of Plan) is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage 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.

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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 October 15 to December 7. 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 The City of Hendersonville, Tennessee coverage will not be affected. You can keep this coverage if you elect part D and this plan will coordinate with Part D coverage. If you do decide to join a Medicare drug plan and drop your current The City of Hendersonville, Tennessee coverage, be aware that you and your dependents will be able to get this coverage back at a future annual open enrollment. 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 The City of Hendersonville, Tennessee and don’t 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 prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% 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 the following October to join. For More Information About This Notice Or Your Current Prescription Drug Coverage… Contact the person listed below for further information. NOTE: You’ll 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 The City of Hendersonville, Tennessee 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 prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans.

For more information about Medicare prescription drug coverage:

• Visit www.medicare.gov • 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 • Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

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).

Name of Entity/Sender: The City of Hendersonville, Tennessee Contact--Position/Office: Chris Taylor, Interim Personnel Director Address: 101 Maple Drive North. Hendersonville, TN 37075 Phone Number: (615) 822-1000

Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).

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CHILDREN’S HEALTH INSURANCE PROGRAM NOTICE If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272). If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of January 31, 2020. Contact your State for more information on eligibility –

ALABAMA – Medicaid COLORADO – Health First Colorado (Colorado’s Medicaid

Program) & Child Health Plan Plus (CHP+) Website: http://myalhipp.com/ Phone: 1-855-692-5447

Health First Colorado Website: https://www.healthfirstcolorado.com/ Health First Colorado Member Contact Center: 1-800-221-3943/ State Relay 711 CHP+: https://www.colorado.gov/pacific/hcpf/child-health-plan-plus CHP+ Customer Service: 1-800-359-1991/ State Relay 711

ALASKA – Medicaid FLORIDA – Medicaid The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/ Phone: 1-866-251-4861 Email: [email protected] Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx

Website: http://flmedicaidtplrecovery.com/hipp/ Phone: 1-877-357-3268

ARKANSAS – Medicaid GEORGIA – Medicaid

Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447)

Website: https://medicaid.georgia.gov/health-insurance-premium-payment-program-hipp Phone: 678-564-1162 ext 2131

CALIFORNIA – Medicaid INDIANA – Medicaid Website: https://www.dhcs.ca.gov/services/Pages/TPLRD_CAU_cont.aspx Phone: 1-800-541-5555

Healthy Indiana Plan for low-income adults 19-64 Website: http://www.in.gov/fssa/hip/ Phone: 1-877-438-4479 All other Medicaid Website: http://www.indianamedicaid.com Phone 1-800-403-0864

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IOWA – Medicaid and CHIP (Hawki) MONTANA – Medicaid

Medicaid Website: https://dhs.iowa.gov/ime/members Medicaid Phone: 1-800-338-8366 Hawki Website: http://dhs.iowa.gov/Hawki Hawki Phone: 1-800-257-8563

Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP Phone: 1-800-694-3084

KANSAS – Medicaid NEBRASKA – Medicaid Website: http://www.kdheks.gov/hcf/default.htm Phone: 1-800-792-4884

Website: http://www.ACCESSNebraska.ne.gov Phone: 1-855-632-7633 Lincoln: 402-473-7000 Omaha: 402-595-1178

KENTUCKY – Medicaid NEVADA – Medicaid Kentucky Integrated Health Insurance Premium Payment Program (KI-HIPP) Website: https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspx Phone: 1-855-459-6328 Email: [email protected] KCHIP Website: https://kidshealth.ky.gov/Pages/index.aspx Phone: 1-877-524-4718 Kentucky Medicaid Website: https://chfs.ky.gov

Medicaid Website: http://dhcfp.nv.gov Medicaid Phone: 1-800-992-0900

LOUISIANA – Medicaid NEW HAMPSHIRE – Medicaid Website: www.medicaid.la.gov or www.ldh.la.gov/lahipp Phone: 1-888-342-6207 (Medicaid hotline) or 1-855-618-5488 (LaHIPP)

Website: https://www.dhhs.nh.gov/oii/hipp.htm Phone: 603-271-5218 Toll free number for the HIPP program: 1-800-852-3345, ext 5218

MAINE – Medicaid NEW JERSEY – Medicaid and CHIP Website: http://www.maine.gov/dhhs/ofi/public-assistance/index.html Phone: 1-800-442-6003 TTY: Maine relay 711

Medicaid Website: http://www.state.nj.us/humanservices/ dmahs/clients/medicaid/ Medicaid Phone: 609-631-2392 CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710

MASSACHUSETTS – Medicaid and CHIP NEW YORK – Medicaid Website: http://www.mass.gov/eohhs/gov/departments/masshealth/ Phone: 1-800-862-4840

Website: https://www.health.ny.gov/health_care/medicaid/ Phone: 1-800-541-2831

MINNESOTA – Medicaid NORTH CAROLINA – Medicaid Website: https://mn.gov/dhs/people-we-serve/children-and-families/health-care/health-care-programs/programs-and-services/medical-assistance.jsp [Under ELIGIBILITY tab, see “what if I have other health insurance?”] Phone: 1-800-657-3739

Website: https://medicaid.ncdhhs.gov/ Phone: 919-855-4100

MISSOURI – Medicaid NORTH DAKOTA – Medicaid

Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm Phone: 573-751-2005

Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/ Phone: 1-844-854-4825

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OKLAHOMA – Medicaid and CHIP UTAH – Medicaid and CHIP Website: http://www.insureoklahoma.org Phone: 1-888-365-3742

Medicaid Website: https://medicaid.utah.gov/ CHIP Website: http://health.utah.gov/chip Phone: 1-877-543-7669

OREGON – Medicaid VERMONT– Medicaid

Website: http://healthcare.oregon.gov/Pages/index.aspx http://www.oregonhealthcare.gov/index-es.html Phone: 1-800-699-9075

Website: http://www.greenmountaincare.org/ Phone: 1-800-250-8427

PENNSYLVANIA – Medicaid VIRGINIA – Medicaid and CHIP

Website: https://www.dhs.pa.gov/providers/Providers/Pages/Medical/HIPP-Program.aspx Phone: 1-800-692-7462

Website: https://www.coverva.org/hipp/ Medicaid Phone: 1-800-432-5924 CHIP Phone: 1-855-242-8282

RHODE ISLAND – Medicaid and CHIP WASHINGTON – Medicaid

Website: http://www.eohhs.ri.gov/ Phone: 1-855-697-4347, or 401-462-0311 (Direct RIte Share Line)

Website: https://www.hca.wa.gov/ Phone: 1-800-562-3022

SOUTH CAROLINA – Medicaid WEST VIRGINIA – Medicaid

Website: https://www.scdhhs.gov Phone: 1-888-549-0820

Website: http://mywvhipp.com/ Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)

SOUTH DAKOTA - Medicaid WISCONSIN – Medicaid and CHIP

Website: http://dss.sd.gov Phone: 1-888-828-0059

Website: https://www.dhs.wisconsin.gov/publications/p1/p10095.pdf Phone: 1-800-362-3002

TEXAS – Medicaid WYOMING – Medicaid

Website: http://gethipptexas.com/ Phone: 1-800-440-0493

Website: https://wyequalitycare.acs-inc.com/ Phone: 307-777-7531

To see if any other states have added a premium assistance program since January 31, 2020, or for more information on special enrollment rights, contact either:

U.S. Department of Labor U.S. Department of Health and Human Services Employee Benefits Security Administration Centers for Medicare & Medicaid Services www.dol.gov/agencies/ebsa www.cms.hhs.gov 1-866-444-EBSA (3272) 1-877-267-2323, Menu Option 4, Ext. 61565

Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512. The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy

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and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email [email protected] and reference the OMB Control Number 1210-0137. The information in this Benefits Guide is presented for illustrative purposes and is based on information provided by the employer. The text contained in this guide was taken from various summary plan descriptions and benefit information. While every effort was taken to accurately report your benefits, discrepancies or errors are always possible. In case of discrepancy between the guide and actual plan documents, the actual plan documents will prevail. All information is confidential, pursuant to the Health Insurance Portability and Accountability Act of 1996. If you have any questions about the guide, please contact HR.

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