HomeMy WebLinkAboutClassification and Compensation Committee Agenda Packet - January 18, 2017City of Colleyville Page 1
City of Colleyville
Classification and
Compensation Committee
Agenda
City Hall
100 Main Street
Colleyville, Texas 76034
817. 503.1000
www.colleyville.com
Wednesday, January 18, 2017
6:00 p.m.
Executive Conference Room
Third Floor – City Hall
1.CALL TO ORDER
2. INTRODUCTION OF COMMITTEE MEMBERS AND COMMITTEE
CHARGE
3. PRESENTATION AND DISCUSSION
3a Discussion of Classification and Compensation Study
4. DISCUSSION OF FUTURE MEETING DATES
5.ADJOURNMENT
I hereby certify this agenda was posted on City Hall bulletin boards Friday,
January 13, 2017 by 5:00 p.m.
Amy Shelley, TRMC
City Secretary
A quorum of the Colleyville City Council and/or any other Colleyville Board,
Commission, or Committee may be in attendance at this meeting.
Any matter on this agenda may, at the discretion of the governing body, be
opened for public comment and discussion.
If you plan to attend this public meeting and have a disability that requires special
accommodations, please advise the Economic Development Marketing Coordinator
at least 48 hours in advance at 817.503.1050, and reasonable accommodations
will be made to assist you.
City of Colleyville Page 1
City of Colleyville
Classification and
Compensation Committee
Agenda Briefing
City Hall
100 Main Street
Colleyville, Texas 76034
www.colleyville.com
Agenda Number 3a Agenda Date 01/18/2017 Number
Type Presentation and Discussion
Department Human Resources
Title
Discussion of Classification and Compensation Study
Strategy Map Connection
L1- Attract, develop, and retain skilled employees who embrace our values
B4- Cultivate a culture of transparency and consistent communication
Explanation
Human Resources Director Rachel Huitt will lead the discussion and review of this item.
Attachments
1.City of Colleyville Compensation Philosophy and Strategy
2.City of Colleyville Pay Plan with Functional Titles
3.Q1 Employment Report FY16
4.Q2 Employment Report FY16
5.Q3 Employment Report FY16
6.Q4 Employment Report FY16
7.Summary of Employee Leave Policies
8.Insurance Benefits Guide
9.Presentation to Classification and Compensation Study Committee
CITY OF COLLEYVILLE
COMPENSATION PHILOSOPHY & STRATEGY
Effective Fiscal Year 2014
PURPOSE
The City of Colleyville (City) values its employees as the key to providing efficient,
effective, responsive and creative public services.
The purpose of a compensation system is to support the recruitment, motivation and
retention of well-qualified employees. In order to obtain and maintain taxpayer
support, the compensation system should be fiscally sound and cost effective while
supporting the employees of the City by encouraging them to be responsive to
customers/taxpayers.
The compensation system shall be administered in an efficient, cost effective,
responsive, fair and equitable manner to meet the needs of all stakeholders including
elected officials, managers, employees and citizens of the City.
GOAL 1 – ORGANIZE THE WORK
To provide for a simplified flexible classification system that defines the general scope
and complexity of the work required. The classification system will also facilitate internal
equity across all jobs within all departments of the City.
Objective 1 – Broad Class Structure
To establish a classification structure that reflects meaningful and measurable
differences in the level of work within each occupational group but maintains the
flexibility necessary for employee growth and efficient management.
Strategies – Broadly Defined Classes
The classification system will consist of broadly defined classes that reflect the
essential duties and responsibilities performed by incumbents in each class.
This approach will facilitate flexibility in the assignment of duties to individual
employees within the job classification.
Where practical and feasible within each occupational group, there will be an
opportunity for career advancement opportunities. The differences in job
levels will be clearly defined and defensible.
Objective 2 – Classification Structure
The classification plan will meet the current needs of the departments while providing
maximum flexibility to manage and organize the work in a changing environment.
1
CITY OF COLLEYVILLE
COMPENSATION PHILOSOPHY & STRATEGY
Effective Fiscal Year 2014
Strategies – Classification System Maintenance
The existing classification system will be reviewed to identify current
requirements that may inhibit management flexibility. Recommendations will
be made to make the system consistent with the City’s goals and objectives
and will position the City to be responsive to change.
The class specifications, including the statements of essential duties, minimum
qualifications, and physical requirements, will be written to reflect the current
needs of the City. The goal is to ensure that new hires are qualified and
capable of performing the work required. Incumbents who currently do not
meet the minimum qualifications will be grandfathered into their current
classes. However, any incumbent not meeting the new minimum
requirements will be required to acquire the applicable knowledge and/or
skills within a reasonable time period so that they will be qualified for their
job. Otherwise, the employee may apply for vacant positions elsewhere in the
City, or other positions external to the City, for which they qualify.
Objective 3 – Reclassification of Jobs
The reclassification process will be administered by the Human Resources
Department in an efficient, cost effective, responsive, fair, and equitable manner to
meet the needs of both the City and its employees. Because the City has adopted the
concept of broad job classifications, the number of reclassifications should be minimal
since the differences between classifications will be clearly defined.
Strategies – Reclassification Process
Timetables will be established which will set the time the reclassifications will
be reviewed and acted upon.
Responsibilities for each step of the reclassification process will be
established to include the employee, department head, and the Human
Resources Department.
Employees will be notified in writing of the results of the reclassification
process and the reasons for approval or denial.
Employees who are reclassified will not receive any adjustment in their base
compensation unless the salary range for the class into which they are
reclassified has a minimum salary that exceeds the employee’s current salary.
Reclassification should not be used to circumvent promotions into a higher job
classification.
Objective 4 – Creation of New Jobs
The classification system will be responsive to organizational and environmental
change through the creation of new classes and redefinition of job responsibilities as
defined by the City and its departments.
2
CITY OF COLLEYVILLE
COMPENSATION PHILOSOPHY & STRATEGY
Effective Fiscal Year 2014
Strategies – New Job Development Process
The class specifications will be reviewed by the departments on an annual
basis to ensure they meet current needs. The Human Resources Department
will facilitate the review process.
The Human Resources Department will respond to department requests for
individual reclassification, and will assist with the revision of class
specifications and development of new class specifications within the broad
class concept, as necessary to meet the on-going operational requirements of
the City.
GOAL 2 – DISTRIBUTE PAY
The compensation system should reflect economic conditions of the various occupational
labor markets in which the City competes. The system should also reward employees
who perform at above-standard levels within their respective job class.
Objective 1 – Compensation Levels
Compensation levels should reflect the multiple labor markets (both public sector and
private sector) in which the City competes. The value of compensation offered to City
employees shall be consistent with the value of compensation offered by employers
with whom the City must compete within both the public and the private sectors.
Strategies – Executive Level Classes
For FLSA exempt classes and jobs that are most commonly found in the public
sector, the labor market should include the various government entities within
Texas. The jurisdictions and organizations should be similar in size and
character and perform a similar range of services as the City. Salary
comparisons shall reflect the cost of labor differences for each geographic
location.
Strategies – All Other Classes
For FLSA non-exempt classes, the labor market should include public and
private sector employers in the Dallas/Fort Worth metropolitan area that are
of a similar size and complexity to the City and/or with whom the City
competes for such employees.
Objective 2 – Market Parity
Pay grade midpoints should approximate the actual average salaries paid to positions
in the relevant labor market(s) as reported in salary survey and market pricing results.
Pay range minimums and maximums should be established from survey/market
pricing results to provide for market parity within the pay structures.
3
CITY OF COLLEYVILLE
COMPENSATION PHILOSOPHY & STRATEGY
Effective Fiscal Year 2014
Strategies – Range Spans
The salary structure should provide sufficient breadth with range spans based
on the level of the job classification and market information. Typically, salary
ranges for lower level jobs are narrower than for upper level jobs. For
example, defined jobs within an organization might have a maximum salary
that is only 20% to 25% greater than the salary range minimum for the job
class. For executive level jobs, the salary range maximum may be as much as
75% to 90% greater than the minimum of the salary range for the class. This
range spread at higher levels in the organization reflects a variety of factors
including a longer learning curve, greater consequence of error, the cost of
recruitment and training, and increasing value to the organization over time.
As class structures become broader to accommodate simplification and
flexibility, broader salary ranges will have higher maximum rates of pay than
with a narrow structure.
Strategies – Depth of Range Progression
The salary structure should provide sufficient depth to achieve midpoint
progression between salary ranges of five to ten percent. (This is the
percentage difference in salary range midpoints from one level or salary
grade to the next.) The salary structure is based on a multiple regression
model using salary survey results. (Most regression models exclude outliers
that exceed two standard deviations from the norm.)
Strategies – Process for Salary Progression
The length of time for progression within the salary range should increase as
jobs move up the salary grade structure. Progression within the salary range
should be based on proficient or competent performance up to the 50th
percentile or job rate of the established salary range. Progression above the
job rate of the salary range shall be based on performance that is above
proficient and should be tied to the performance management process.
Compensation above the job rate will be performance based and may be
added to base compensation or may be granted as a one-time bonus.
Strategies – Job Rate Percentile
Each classification should have a job rate (the midpoint for non-sworn
positions and the maximum for sworn positions) set at a percentage of the
actual average salary paid incumbents occupying like positions in the relevant
labor market. The job rate shall approximate the 50th percentile or the
median of pay for like positions in the labor market.
Strategies – Hiring Range
The hiring range is from the range minimum for minimally acceptable
qualified candidates to the job rate for exceptionally well qualified candidates.
4
CITY OF COLLEYVILLE
COMPENSATION PHILOSOPHY & STRATEGY
Effective Fiscal Year 2014
Appointment above the mid-point will require the approval of the City
Manager.
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Communications & Marketing
Dustin Dangli, Marketing Coordinator
Community Development
Caleb Tandy, Urban Forester
Library
Katy Okelberry, Library Assistant
Police
Bobby Cure, Police Officer
NEW HIRES
F OUR (4) N EW EMPLOYEES WERE H IRED DURIN G THE F IRST QUAR TER:
S E PA R AT I ONS
TWO (2) POSIT I ONS WERE VACATE D DURIN G THE F IRST QUAR T ER WITH AN A VERA GE EMPLOYEE
T E NURE OF 2.47 YEA RS:
Fire
Firefighter—1.91 years
Municipal Court
Senior Count Clerk/Juvenile Case Manager — 3.03 years
H UMAN R ESOUR C ES DEPA RTME NT
EMPLOY M E NT R E POR T
F O R FIRST QUAR T ER FISCAL YE A R 2016
*The turnover rate is figured by taking the number of regular part-time and full-time
separations during the specified period divided by the average number of employees on the
payroll, and multiplying the result by 100.
Finance
Brian Hogan, Chief Financial Officer
Fire
Javier Gil, Firefighter/EMT
Library
Kayla Sorenson, Library Assistant
Municipal Court
Regina Warner, Administrative Court Clerk
Parks
Heather Dowell, Parks Manager
Police
Jack Eustace, Police Officer
Tracy Gordon, Records Manager
Jeffrey Prater, Police Officer
Public Works
Oscar Chavez, Project Engineer
Marcello Garcia, Field Technician
Alejandro Nuncio, Field Technician
Mike Norton, Streets/Drainage Operations and Maintenance Mgr
Gilberto Rolon, Field Technician
N EW HIRES
T H I RTEEN (13) NEW EMPLOY EES WERE
H I RED D U R I NG THE SECOND QUARTER:
S EPARATI ONS
EIGHT (8) POSI T I ONS WERE VACATED D U R I NG THE F I RST QUARTER W I TH AN A V ERAGE EMPLOY EE
TENU RE OF 4.97 YEARS:
Community Development
Building Inspector — 2.38 years
Library
Librarian PT — 1.08 years
Municipal Court
Administrative Court Clerk — .59 years
Police
Lead Records Coordinator — 1.87 years
Police/Warrant Officer — 30.48 years
Public Works
Field Technician — 1.35 years
Environmental Compliance Specialist — .95 years
Recreation
Administrative Support Technician — 1.05 years
HUMAN RESOU RCES DEPARTMENT
E MPLOY MENT REPORT
F OR SECOND Q U ARTER FI SCAL YEAR 2016
*The turnover rate is figured by taking the number of regular part-time and full-time
separations during the specified period divided by the average number of employees on the
payroll, and multiplying the result by 100.
POSITIONS DIFFI C U L T TO FILL
Police Officer — unable to attract applicants who
meet minimum qualifications
M & O Technician — unable to attract applicants with
related experience
Librarian Part-time — unable to attract applicants
who meet minimum qualifications
Community Development
David Alexander, Building Inspector
Araceli Botello, Planning Technician
Tanya Wilson, Plans Examiner
Fire
Brent Wilson, Firefighter/EMT
Library & Recreation
Grant Hodges, Part-time Recreation Specialist
Julie Kyer Prewitt, Part-time Administrative Support Specialist
Lourdes McWithey, Part-time Librarian
Municipal Court
Lorena Manriquez, Administrative Court Clerk
Public Works
Mark Martinez, Field Technician
Douglas Price, Meter Reader
N EW HIRES
T EN (10) NEW EMPLOYEES WERE HIRED
D U RING THE THIRD QUARTER:
S EPARATIO NS
N INE (9) P O SITIO NS WERE VACATED D U RING THE THIRD QUARTER WITH AN A V ERAGE EMPLOYEE
TENU RE OF 3.09 YEARS:
Community Development
Planning and Zoning Assistant—5.47 years
Plans Examiner — 1.23 years
Community Development Director—1.07 years
Economic Development
Economic Development Director— 6.82 years
Fire
Firefighter/Paramedic— 2.33 years
Firefighter/Paramedic— 5.01 years
Library
Youth Services Librarian— 2.18 years
Part-time Library Assistant — .68 years
Public Works
Meter Reader— 2.99 years
HUMAN RESOURCES DEPARTMENT
E MPLOY MENT REPO RT
FO R THIRD Q U ARTER FISCAL YEAR 2016
*The turnover rate is figured by taking the number of regular part-time and full-time
separations during the specified period divided by the average number of employees on the
payroll, and multiplying the result by 100.
POSITIONS DIFFI C U L T TO FILL
Economic Development Director — unable to attract
applicants who meet desired qualifications
Police Officer — unable to attract applicants who meet
minimum qualifications
Engineer — unable to attract applicants with related ex-
perience
Community Development
Benjamin Bryner, Community Development Director
Fire
Jason Fisch, Firefighter/EMT
Police
Tiffany Camelin, Police Records Clerk
Joshua Newman, Police Recruit
Chase Owens, Police Officer
Zachary Watson, Police Recruit
April Zablosky, Police Officer
Public Works
Brian Arteaga, Meter Reader
N EW HIRES
E IGHT (8) NEW EMPL O Y EES WERE H I RED
THIS QUARTER:
SEPARATI ONS
ELE V EN (11) POSIT I ONS WERE VACATED D U R I N G THE THIS QUARTER W I TH AN A V ERAG E EMPL O Y EE
TENU RE OF 3.18 YEARS:
Communications & Marketing
Communications & Marketing Director—10.98 years
Economic Development
Economic Development Coordinator — 1.54 years
Parks
Parks Maintenance Worker — 1.60 years
Police
Police Officer — 3.96 years
Part-time Records Clerk — 9.90 years
Public Works
Temporary Construction Manager — 1.92 years
Meter Reader — 0.20 years
M&O Technician — 0.56 years
M&O Technician — 1.93 years
GIS Technician — 2.04 years
Police
Part-time Recreation Specialist — 0.30 years
HUMAN RE S O U RCES DEPARTMENT
E MPL O Y MENT REPORT
F OR FO U RTH Q U ARTER FIS CAL YEAR 2016
*The turnover rate is figured by taking the number of regular part-time and full-time separations
during the specified period divided by the average number of employees on the payroll, and multiply-
ing the result by 100.
POSITIONS DIFFI C ULT TO FILL
Engineer — unable to attract applicants with related experience
1
Employee Leave Policies Summary
Vacation - All regular full-time and part-time employees shall be entitled to accrue vacation leave
for each complete month of active service with the city. The accrual rate will be based on length of
service with the city and number of hours worked per regular workweek. Employees are eligible to
use vacation leave after successful completion of their first six months of employment. The following
represents the accrual rates:
First 60 Months Days Hours Maximum Vacation
of Service Per Year Per Month Accrual Hours/Days
40-hour employees 10 6.67 200/25
40-hour sworn police 10 6.67 200/25
24-hour certified fire 5.0 shifts 10.00 300/12.5 shifts
61 through 180 Months
40-hour employees 15 10.00 300/37.5
40-hour sworn police 15 10.00 300/37.5
24-hour certified fire 7.0 shifts 14.00 420/17.5 shifts
Over 181 Months
40-hour employees 20 13.33 400/50
40-hour sworn police 20 13.33 400/50
24-hour certified fire 10.0 shifts 20.00 600/25 shifts
Sick Leave – All regular full-time and part-time employees are eligible to accrue sick leave. Full-
time employees accrue sick leave at the rates below. Regular part-time employees accrue sick leave
at a rate proportional to the number of hours worked. Regular full-time and part-time employees
accrue sick leave during their probationary period and are eligible to use the leave upon accrual.
Employees are not allowed to use sick leave until it is accrued. The following chart represents the
accrual rates:
D a y s H o u r s M a x i m u m S i c k
Per Year Per Month Accrual Hours/Days
40-hour employees 12 8 720/90
40-hour sworn police 12 8 720/90
24-hour certified fire 6.0 shifts 12.00 1080/45 shifts
Compensatory Time for Non-Exempt Employees
Compensatory time for non-exempt employees will be accrued at one and one-half hours
for each overtime hour worked.
The maximum accrual is 40 hours for non-exempt employees and sworn police employees.
Certified fire employees may accumulate up to 56 hours of comp time.
When employees wish to take comp time off, they will request the time from their
2
immediate supervisor in writing. The Department Director may elect to pay the employee
on the next payroll cycle, in lieu of approving the requested time off.
The city may, at any time, elect to pay an employee for any or all of an employee’s accrued
compensatory time.
Upon separation from employment, non-exempt employees will be paid the balance of their
accrued compensatory time.
Compensatory Time for Exempt Employees
Compensatory time for exempt employees is calculated on a straight time basis; accruing at
the rate of one hour for each hour of overtime worked. All compensatory time must be
associated with a project or assignment, which requires overtime of one hour or more
during the scheduled workday or on a day not regularly scheduled to work. Compensatory
time must be documented on departmental time sheets.
A maximum balance of 240 hours of compensatory leave may be accrued by exempt
employees.
Exempt employees wishing to use compensatory time leave, will make a request for the time
off from their Department Director.
The city has no legal obligation to pay its exempt employees overtime or to provide them
with compensatory time.
Upon separation from employment, no payment will be received for accrued compensatory
leave.
2
20177 Be
Integ
enef
grity – Se
fits E
ervice – I
Enro
Innovatio
ollm
ion
mentt Guide
This guide highlights the main features of many of the benefit plans sponsored by the City of Colleyville. Full
details of these plans are contained in the legal documents governing the plans. If there is any discrepancy
between the plan documents and the information described here, the plan documents will govern. In all cases,
the plan documents are the exclusive source for determining rights and benefits under the plans. Participation
in the plans does not constitute an employment contract. The City of Colleyville reserves the right to modify,
amend or terminate any benefit plan or practice described in this guide. Nothing in this guide guarantees that
any new plan provisions will continue in effect for any period of time.
3
TABLE OF CONTENTS
BENEFITS OVERVIEW ...................................................................................... 4
WHO IS ELIGIBLE ............................................................................................. 5
MAKING CHANGES TO COVERAGE ........................................................................ 6
MEDICAL PLAN ................................................................................................... 7
PRESCRIPTION DRUG COVERAGE .......................................................................... 8
COMPASS ........................................................................................................ 10
DENTAL PLAN .................................................................................................. 11
VISION PLAN ................................................................................................... 12
LIFE INSURANCE ............................................................................................... 13
LONG TERM DISABLITY ..................................................................................... 14
FLEXIBLE SPENDING ACCOUNTS ........................................................................ 15
EMPLOYEE ASSISTANCE PROGRAM (EAP) .......................................................... 18
WELLNESS PROGRAM ....................................................................................... 19
HOLMES MURPHY BENEFIT HELPLINE ................................................................ 21
IMPORTANT CONTACTS .................................................................................... 22
HEALTH COVERAGE NOTICES ............................................................................ 23
BE
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nd your pock
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urance
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ance Program
m
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VERV
ROGRAM
our simple ro
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ad cold turns
g. Or even w
s benefits are
benefits pro
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sing the plan
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YOU CO
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u and you ha
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But sometim
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e Spending A
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eeds an exte
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chool, beatin
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Or your son’s
ensive root c
for all types
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gram is to ta
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are eligible
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first day of th
EPENDEN
may also co
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Your eligible
coverage
“Children” ar
adopted chil
Physically or
may be requ
WHEN
ITIAL EN
en you first jo
nroll yoursel
oll on time, c
owing 30 day
ays of becom
olled in comp
Accidental D
the Employe
e to wait unt
other benefit
NNUAL O
ual Open En
S ELIG
to enroll in t
ork at least 3
he month fo
NT ELIG
over your elig
pouse.
children up
re defined as
dren, and ch
mentally dis
ested.
COVE
NROLLM
oin the City
f and your d
overage beg
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ming eligible
pany-sponso
Death & Dism
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il the next an
ts and make
OPEN E
rollment, tak
GIBLE
the City of C
0 hours per
ollowing 30 d
IBILITY
gible depend
p to age 26 fo
s your natura
hildren for w
sabled childr
ERAG
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of Colleyville
dependents f
gins the first
yment. If you
e, you will au
ored benefits
membermen
e Program (E
nnual Open
changes to
NROLLM
kes place in
Colleyville’s b
week. As a r
days of cont
dents, includ
or medical, d
al children, s
whom you ar
ren of any ag
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for benefits.
of the mont
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utomatically
s, such as Ba
nt (AD&D) In
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Enrollment t
coverage.
MENT
August. Cov
5
benefit plans
regular, full-t
inuous servi
ding:
dental and v
stepchildren,
e the court-
ge who are i
GINS
30 days
If you
th
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be
asic Life
nsurance
u will
to enroll
verage takes
s if you are a
time employ
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vision
, legally-
appointed le
incapable of
effect on O
If your ch
for coverag
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must
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a regular, ful
yee, you are
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October 1.
ild becomes
ge (i.e., turn
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notify the H
urces Depart
l-time emplo
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an.
rt. Proof of d
s ineligible
ning age 26
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Human
tment.
oyee
benefits on
disability
6
MAKING CHANGES TO COVERAGE
Once you make your benefit elections, these choices remain in effect until the next annual Open Enrollment
unless you have a qualified status change or you or your eligible dependents become eligible for coverage
through special enrollment rules.
If you have a qualified status change or you have another allowable event, you can make certain changes
during the plan year. However, you must make your enrollment change within 30 days of the event by
completing a Benefit Changes/Enrollment form and returning it to Human Resources. If you do not return your
form within 30 days, you will have to wait until the next Open Enrollment to make new elections.
Qualified status changes include, but are not limited to:
Change in number of eligible dependents due to birth, adoption, placement for adoption, or death
Gain or loss of dependent status (i.e., your child reaches the age limit for eligibility)
Change in legal marital status, including marriage, divorce, or death of a spouse
Change in residence or workplace that changes your or your dependent’s eligibility for coverage
Change in employment status, such as starting or ending employment, for you, your spouse, or your
children
End of the maximum period for COBRA coverage
For a more complete list of qualified status changes, refer to the Summary Plan Description.
SPECIAL ENROLLMENT RULES
If you choose not to enroll yourself or your dependents (including your spouse) because you have other
coverage, you may be able to enroll yourself and your dependents at a later date if:
You or your dependents lose Medicaid or Children’s Health Insurance Program (“CHIP”) coverage as a result
of a loss of eligibility for such coverage, or
If you or your dependents become eligible for a premium assistance subsidy under Medicaid or CHIP.
You must enroll within 60 days of the qualified events shown in the “Special Enrollment Rules” above.
If your dependent also had other health coverage and lost that coverage in the above situations, they may be
added to your coverage. However, you will not be able to add yourself or your dependents to this coverage if
the other coverage was terminated “for cause” (including failure to pay the required premiums on time).
In addition to the changes described above, you may enroll yourself and your spouse (with or without the new
dependent) in the City of Colleyville health plan following marriage or adoption, placement for adoption, or
birth of a child, as long as you request enrollment within 30 days of the event. You must be enrolled to cover
your dependents. If you have a special enrollment event and want to enroll for health coverage, call Human
Resources.
Human resources will require proof of special enrollment event, such as copy of marriage license,
divorce decree, birth certificate, etc.
7
Is Your Doctor In the BCBS Network?
Providers in the BCBS network may change.
To find out if your doctor participates in the
network, go to www.bcbstx.com and choose
the Blue Choice Network.
MEDICAL PLAN
The City of Colleyville’s medical options both provide coverage for the same types of expenses, such as
doctor’s office visits, preventive care, prescription drugs, and hospitalization. You choose the option that makes
the most sense for you and your family based on your needs and what you want to pay for coverage.
Your new Compass benefit can help you find the lowest cost, highest quality providers in the network. Please
see page 10 for additional details.
CHOOSING A MEDICAL OPTION
When it comes to medical coverage, the City of Colleyville offers
you these choices:
PPO Base plan
PPO Buy-up plan
MEDICAL PLAN COMPARISON
PPO Base Plan PPO Buy-Up Plan
In-Network Out-of-Network In-Network Out-of-Network
Annual Deductible
Individual $4,000 $8,000 $2,000 $4,000
Family $8,000 $16,000 $4,000 $16,000
Annual Out-of-Pocket Maximum
Individual $5,000 $10,000 $3,000 $8,000
Family $10,000 $20,000 $6,000 $16,000
Coinsurance/Copays
Preventive Care 100% 50% after deductible 100% 70% after deductible
Primary Care Physician $30 copay 50% after deductible $25 copay 70% after deductible
Specialist $50 copay 50% after deductible $30 copay 70% after deductible
Urgent Care $75 copay 50% after deductible $75 copay 70% after deductible
Emergency Room – copay
waived if admitted
80% after $250
copay 50% after deductible
9
90% after $200
copay 70% after deductible
Inpatient Hospital Care 80% after
deductible 50% after deductible 90% after
deductible 70% after deductible
Outpatient Surgery 80% after the
deductible 50% after deductible 90% after the
deductible 70% after deductible
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9
2017 MEDICAL RATES
Base Plan Buy-Up Plan
Employer
Monthly
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Premium
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Employer
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EE Cost
Monthly
EE Cost
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eeonly2 $468.68 $517.96 $49.28 $22.75 $468.68 $569.82 $101.14 $46.68
eeonly3 $370.11 $517.96 $147.85 $68.24 $370.11 $569.82 $199.71 $92.17
ee1/sp1 $976.24 $1,159.30 $183.06 $84.49 $976.24 $1,275.35 $299.11 $138.05
ee1/sp2 $915.22 $1,159.30 $244.08 $112.65 $915.22 $1,275.35 $360.13 $166.22
ee1/sp3 $793.17 $1,159.30 $366.13 $168.98 $793.17 $1,275.35 $482.18 $222.54
ee2/sp1 $926.95 $1,159.30 $232.35 $107.24 $926.95 $1,275.35 $348.40 $160.80
ee2/sp2 $865.93 $1,159.30 $293.37 $135.40 $865.93 $1,275.35 $409.42 $188.96
ee2/sp3 $743.89 $1,159.30 $415.41 $191.73 $743.89 $1,275.35 $531.46 $245.29
ee3/sp1 $828.39 $1,159.30 $330.91 $152.73 $828.39 $1,275.35 $446.96 $206.29
ee3/sp2 $767.37 $1,159.30 $391.93 $180.89 $767.37 $1,275.35 $507.98 $234.45
ee3/sp3 $645.33 $1,159.30 $513.98 $237.22 $645.33 $1,275.35 $630.03 $290.78
ee1/ch1 $813.73 $931.88 $118.15 $54.53 $813.73 $1,025.17 $211.44 $97.59
ee2/ch2 $725.07 $931.88 $206.82 $95.45 $725.07 $1,025.17 $300.11 $138.51
ee3/ch3 $547.73 $931.88 $384.15 $177.30 $547.73 $1,025.17 $477.44 $220.36
ee1/fam1 $1,268.73 $1,568.64 $299.91 $138.42 $1,268.73 $1,725.68 $456.95 $210.90
ee1/fam2 $1,168.76 $1,568.64 $399.88 $184.56 $1,168.76 $1,725.68 $556.92 $257.04
ee1/fam3 $968.83 $1,568.64 $599.81 $276.84 $968.83 $1,725.68 $756.85 $349.32
ee2/fam1 $1,219.45 $1,568.64 $349.19 $161.16 $1,219.45 $1,725.68 $506.23 $233.64
ee2/fam2 $1,119.48 $1,568.64 $449.16 $207.30 $1,119.48 $1,725.68 $606.20 $279.78
ee2/fam3 $919.54 $1,568.64 $649.10 $299.58 $919.54 $1,725.68 $806.14 $372.06
ee3/fam1 $1,120.88 $1,568.64 $447.76 $206.66 $1,120.88 $1,725.68 $604.80 $279.14
ee3/fam2 $1,020.92 $1,568.64 $547.73 $252.80 $1,020.92 $1,725.68 $704.77 $325.28
ee3/fam3 $820.98 $1,568.64 $747.66 $345.08 $820.98 $1,725.68 $904.70 $417.56
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11
DENTAL PLAN
The City of Colleyville’s Dental Plan is administered through BCBS and provides you and your family with
coverage for typical dental expenses, such as cleanings, X-rays, fillings, and orthodontia for children.
DENTAL PPO PLAN
The Dental PPO allows you the freedom to visit any dentist, without referrals, for all of your dental care. If you
receive care from one of BCBSs preferred dentists, you’ll pay less for your care. If you choose a non-preferred
dentist, your share of costs will generally be higher and you may need to file your own claims.
For a list of Blue Cross Blue Shield’s preferred dentists, go to:
http://www.bcbstx.com/onlinedirectory/dental.htm and select BlueCare Dental from the drop down menu
DENTAL PLAN HIGHLIGHTS
Plan Feature PPO
Annual Deductible
Individual
Family
3 month deductible carryover applies
$50
$150
Annual Benefit Maximum $1,500
Preventive Services
(Exams, routine cleanings, fluoride treatments,
x-rays, space maintainers, sealants
100% (no deductible)
Basic Services
(Oral surgery, restorative services, denture
repair, endodontic, periodontic)
80% after deductible
Major Services
(Crowns, jackets, casts, bridges, dentures, inlays,
onlays)
50% after deductible
Orthodontia 50%, up to a lifetime maximum of $1,000 (limited
to dependent children under the age of 26)
Coverage Monthly City Employee Employee
Level Premium Monthly Monthly Biweekly
Employee Only $29.61 $29.61 $0.00 $0.00
Employee + Spouse $60.65 $29.61 $31.04 $14.33
Employee + Children $58.56 $29.61 $28.95 $13.36
Employee + Family $97.46 $29.61 $67.85 $31.32
12
VISION PLAN
The City of Colleyville’s Vision Plan promotes preventive care through regular eye exams and provides
coverage for corrective materials, such as glasses and contact lenses. The Vision Plan is administered through
Superior Vision.
VISION COVERAGE
If you enroll in vision coverage, you can go to any eye care provider you choose for care. However, if you
choose providers who are part of the Superior Vision network, you will receive a discount on services. To find a
network provider, go to www.superiorvision.com and choose the Superior Select Southwest network when
prompted.
The Vision Plan is designed to cover eye care needs that are visually necessary. You have to pay extra if you
choose certain cosmetic or elective eyewear, so be sure to ask your eye doctor what items are covered by the
plan before you purchase materials.
VISION PLAN HIGHLIGHTS
In-Network Out-of-Network
Plan Feature You Pay Reimbursement
Exam $10 Copay Reimbursement up to $35 after copay
Single Vision Lenses $25 Copay Reimbursement up to $25 after copay
Bifocal Lenses $25 Copay Reimbursement up to $40 after copay
Trifocal Lenses $25 Copay Reimbursement up to $45 after copay
Lenticular Lenses $25 Copay Reimbursement up to $80 after copay
Frames Up to $130 of retail value Reimbursement up to $70 after copay
Elective Contacts $160 max after copay Reimbursement up to $80 after copay
Benefit Frequency
Exam Once every 12 months
Frames Once every 24 months
Lenses Once every 12 months
Contacts Once every 12 months
Coverage Monthly City Employee Employee
Level Premium Monthly Monthly Biweekly
Employee Only $4.93 $0.00 $4.93 $2.28
Employee + Spouse $8.94 $0.00 $8.94 $4.13
Employee + Children $9.42 $0.00 $9.42 $4.35
Employee + Family $14.35 $0.00 $14.35 $6.62
13
LIFE INSURANCE
The City of Colleyville offers life insurance coverage to provide financial protection in the event you or your
dependents die while you are still working. This coverage is administered through Dearborn National.
BASIC LIFE INSURANCE
The City of Colleyville automatically provides $15,000 of Basic Life Insurance for all eligible employees at no
cost. The benefit is paid to your beneficiaries in the event of your death.
BASIC AD&D INSURANCE
City of Colleyville also provides $15,000 of accidental death and dismemberment (AD&D) insurance for you to
help with expenses in the event you die or become injured as a result of an accident. The AD&D coverage is
automatically included with the basic life insurance.
OPTIONAL LIFE/AD&D INSURANCE
In addition to Basic Life and AD&D Insurance, you may also purchase Optional Life and AD&D Insurance for
yourself, your spouse and your dependent children. However, you may only elect coverage for your
dependents if you enroll for Optional Life coverage for yourself. You pay for the cost of Optional Life Insurance
on an after-tax basis through payroll deductions.
OPTIONAL LIFE/AD&D INSURANCE COVERAGE
Coverage For Coverage Available
Employee $10,000 increments, up to a maximum of $500,000
Any amount you elect over $200,000 is subject to Evidence of Insurability.
If you wish to enroll or increase your coverage after your initial eligibility, any new amount you elect
will be subject to Evidence of Insurability.
You can increase your coverage by $10,000/year without being subject to Evidence of Insurability as
long as the total amount of coverage doesn’t exceed the guaranteed issue amount.
Spouse $5,000 increments up to 50% of employee benefit amount. Any amount elected over $50,000 is
subject to Evidence of Insurability.
Evidence of insurability is required for any coverage you elect for your spouse if you enroll him/her
after the initial eligibility period as a new hire.
Child(ren) Age 15 days to 6 months: $100
Age 6 months to 25 years: Up to $10,000 in $2000 increments
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15
Benefits Participant Services
6:00 a.m. to 9:00 p.m. CST M-F
Toll-Free: 866-451-3399
Toll-Free Fax: 866-451-3245
customerservice@discoverybenefits.com
FLEXIBLE SPENDING ACCOUNTS
The City of Colleyville allows you to contribute to one or both
Flexible Spending Accounts (FSAs), which allow you to save taxes on
certain out-of-pocket health care and dependent care expenses. The
FSAs are administered by Discovery Benefits
HOW THE FSAS WORK
The City offers two types of FSAs:
Health Care FSA
Dependent Care FSA
If you elect to contribute to one or both of the FSAs, you choose an annual amount to be taken from each of
your paychecks and deposited into your account throughout the year. Your contributions are taken out of your
paycheck before you pay taxes, so you save money. Then, when you have eligible health care or dependent
care expenses, you can use the account to reimburse yourself, up to the amount you have elected to contribute
to your account for the year.
With both accounts, the IRS requires you to use all of the money in your account by the end of the year
or you lose it. This is called the “use it or lose it” rule.
FSA Grace Period
You have an additional 2 ½ months after the end of the plan year in September to use your FSA dollars.
Discovery will use Grace period dollars before using your new election dollars. You must elect an FSA account
for the new plan year in order to have access to grace period dollars. Use your FSA dollars to pay for expenses
incurred through December 15, 2016 as long as you submit claims to TASC by February 15, 2017
HEALTH CARE FSA
You can use the Health Care FSA to pay for eligible out-of-pocket expenses that are not covered by another
health plan. Examples include, but are not limited to:
Medical or dental deductibles
Office visit copays
Coinsurance amounts
Amounts you pay for prescription drugs
Amounts you pay for certain over-the-counter items
Eyeglasses, contacts, and other vision-related expenses not covered by the vision plan
Orthodontia expenses not covered by the dental plan
For a complete list of eligible expenses, visit www.discoverybenefits.com
Annual Contribution Amount
You can contribute up to $2,550 per year to the Health Care FSA.
16
It’s important to keep copies of all
your receipts—even if you are not
required to submit them as proof of
your expense. That way, if the IRS asks
for substantiation of your expenses,
you will have the receipts.
Over-the-Counter Medications
You must have a doctor’s prescription to use the Health Care FSA to reimburse yourself for certain over-the-
counter medications. Examples of medications that require you to
submit a doctor’s prescription include:
Acid controllers, digestive aids, and stomach remedies
Allergy and sinus medicines
Anti-itch and insect bite remedies
Cold sore remedies
Cold, cough, and flu drugs
Pain relief medications
Respiratory treatments
Sleep aids and sedatives
How the Debit Card Works
If you enroll in the Health Care FSA, you will receive one debit card in the mail. To request additional debit
cards for your family members, please contact Discovery Benefits.
You can use your debit card at certain places to pay for eligible expenses up-front, such as prescription drugs
and office visit copays, without having to pay with cash and wait for a reimbursement. If you use your debit
card at a health care provider’s office or at a vendor that has the software in place to track eligible FSA
expenses, you will not be required to submit a receipt. For a list of vendors that have this software, go to
www.discoverybenefits.com. However, for most debit card transactions, you will need to submit your
receipts as substantiation of your expense, so it’s important to keep them.
If you choose not to use your debit card, you can always pay for your eligible expense and file a claim for
reimbursement.
DEPENDENT CARE FSA
The Dependent Care FSA helps you afford day care for your children under age 13 or for a disabled dependent.
There are some special rules for participating in this account:
The day care expenses must be necessary so you can work.
You can only be reimbursed for expenses incurred during the plan year.
If you are married, your spouse must be employed, a full-time student at least five months during the plan
year, or mentally or physically disabled and unable to provide care for himself or herself.
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19
WELLNESS PROGRAM
The LiveWell Colleyville wellness program offers City of Colleyville employees and spouses an opportunity each
year to improve or maintain their health. The City cares about your health; therefore, the wellness program
provides you with fun, robust programming options geared toward the specific areas of your health that need
improvement. The LiveWell program is your way to better, healthier living. Together we can live well -
together we can be well.
HOW TO PARTICIPATE
Participate in the baseline health screenings and complete the tobacco affidavit, then submit results by the
deadline. The Human Resources department will communicate to all employees of important dates and
deadlines for these screenings.
EARN THE MAXIMUM PREMIUM INCENTIVE
Each plan year, Medical premiums paid by the City are based on meet and/or improve in 4 out of 5 risk
measures. All individuals meeting or improving in four out of the five identified screening measures and
meeting the requirements listed below will automatically earn the maximum premium subsidy.
REQUIREMENTS
1. Complete your health screening and tobacco affidavit.*
2. Meet/improve in four of the five identified screening measures (see “The Numbers” chart).
* Tobacco users must complete the online tobacco cessation program to qualify for Tier 1 status.
Screening Measure
Optimal Range
Women Men
Waist Circumference ≤35 ≤40
Blood Pressure <130/85 <130/85
HDL Cholesterol ≥50 ≥40
LDL Cholesterol <130 <130
Glucose <100 <100
ADA COMPLIANCE
Participants who are unable to achieve the recommended value for certain measures due to a health condition
(pregnancy or other disability governed by the ADA) will require a doctor’s statement so that appropriate
alternatives may be provided.
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24
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU
CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
The Health Insurance Portability & Accountability Act of 1996 (“HIPAA”) is a federal law 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 and control how
your health information is used. HIPAA provides penalties for covered entities that misuse personal health information.
As required by HIPAA, we have prepared this explanation of how we are required to maintain the privacy of your health
information and how we may use and disclose your health information.
We may use and disclose your health information only for each of the following purposes: treatment, payment, health care
operations and certain special situations.
• 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 and reimbursing a provider for an office
visit.
• Health care operations include the business aspects of running our health plan, such as conducting quality assessment
and improvement activities, auditing functions, cost-management analysis, health plan budgeting, carrier bidding, and
customer service. An example would be an internal quality assessment review or to a business associate of the health plan.
• Special Situations include disclosures for your safety or for the safety of the general public; to individuals involved in
your care or payment for your care (unless you specifically object to such disclosures); for instances of national security; for
worker’s compensation; for organ donation programs (if you are an organ donor); to military command (if you are a
member of the armed services); to coroners, medical examiners or funeral directors; or as otherwise required by law.
We may also create and distribute de-identified health information by removing all references to individually identifiable
information.
We may communicate with you to provide information about treatment alternatives or other health-related benefits and
services that may be of interest to you; however, if we are receiving compensation for these communications, we must first
obtain written authorization from you.
We may not use or disclose your genetic information for underwriting purposes. We may also not sell your health
information without your express written authorization, unless the sale is part of a merger, transfer, sale or consolidation
of the health plan to another health plan.
We will not use your protected health information for employment purposes or another benefits plan without your written
authorization.
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 health information, which you can exercise by presenting a
written request to the Privacy Officer:
25
• The right to inspect and copy your protected health information, either electronically or on paper, and obtain this copy
within 30 days or within 60 days if we are unable to provide the information within 30 days and notify you of the delay
within the first 30 days.
• The right to reasonable requests to receive confidential communications of protected health information from us by
alternative means or at alternative locations.
•The right to request restrictions on certain uses and disclosures of protected health information, including those related
to disclosures to family members, other relatives, close personal friends, or any other person identified by you. We are not,
however, required to agree to a requested restriction, unless the request is made to restrict disclosure to an insurer or
health plan for purposes of carrying out payment or health care operations (and is not for purposes of carrying out
treatment), and the protected health information pertains solely to a health care item or service for which you have paid
out of pocket in full. If we do agree to a restriction, we must abide by it unless you agree in writing to remove it.
• The right to request an amendment of your protected health information. We are not required to agree to the requested
amendment of your information, but will consider your request.
• The right to receive an accounting of certain non-routine disclosures of protected health information that were not
disclosed for treatment, payment or health care operations.
• We have the obligation to provide and you have the right to obtain notice from us in the event that the privacy or
security of your protected health information has been breached.
• You have the right to opt out of any communications that may be construed as fundraising or marketing for the health
plan.
• We have the obligation to let you know about the availability of this notice every three years. You have the right to
receive a paper copy of this notice from us upon request.
We are required by law to maintain the privacy of your protected health information and to provide you with notice of our
legal duties and privacy practices with respect to protected health information.
This notice is effective as of August 17, 2016 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 provide you with a copy of the revised
notice within 60 days of the change.
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 or the policies and procedures of our office. We will not retaliate against you for
filing a complaint.
Please contact us for more information:
Privacy Officer
Rachel Huitt, Human Resources Director
100 Main Street
Colleyville, TX 76034
(817) 503 - 1072
For more information about HIPAA or to file a complaint:
The U.S. Department of Health & Human Services Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
(202) 619-0257 or Toll Free: 1-877-696-6775
26
MEDICARE PRESCRIPTION DRUG NOTICE
IMPORTANT NOTICE FROM THE CITY OF
COLLEYVILLE 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 with the City of Colleyville 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. City of Colleyville has determined that the prescription drug coverage offered by City of Colleyville
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.
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
15th to December 7th.
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 Colleyville coverage may be affected. If you do
decide to join a Medicare drug plan and drop your current City of Colleyville coverage, be aware that you and
your dependents may not be able to get this coverage back.
27
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 Colleyville 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 and if this
coverage through City of Colleyville 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
“Medicare & You” handbook for their telephone number) for personalized help
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).
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).
Date: August, 2016
Name of Entity/Sender: City of Colleyville
Contact/Office: HR Director
Address: 100 Main Street, Colleyville TX 76034
Phone Number: 817.503.1072
28
COBRA RIGHTS NOTICE
You are receiving this notice because you have recently become eligible for coverage under the City of Colleyville health plan (the Plan).
This notice contains important information about your right to COBRA continuation coverage, which is a temporary extension of
coverage under the City of Colleyville 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 can become 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 when they 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 your Summary Plan Description or contact Human Resources.
WHAT IS COBRA CONTINUATION COVERAGE?
COBRA continuation coverage is a continuation of group health plan coverage when coverage would otherwise end because of a life
event known as a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event occurs, 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 a qualifying event. Qualified beneficiaries who elect
COBRA continuation coverage must pay for that coverage.
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.
Your spouse will become a qualified beneficiary if he or she loses coverage under the Plan because any of the following qualifying
events happens:
Your hours of employment are reduced;
Your employment ends for any reason other than your gross misconduct;
Your death;
Your entitlement to Medicare benefits (under Part A, Part B or both); or
You become divorced or legally separated.
Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because any of the following
qualifying events happens:
Your hours of employment are reduced;
Your employment ends for any reason other than your gross misconduct;
Your death;
Your entitlement to Medicare benefits (under Part A, Part B or both);
Your divorce or legal separation; or
The dependent stops being eligible for coverage under the Plan as a “dependent child.”
WHEN IS COBRA COVERAGE AVAILABLE?
City of Colleyville will offer COBRA continuation coverage to qualified beneficiaries only after it has been notified that a qualifying event
occurred. For the following qualifying events, City of Colleyville will notify the administrator for COBRA continuation coverage, of the
qualifying event:
Your hours of employment are reduced;
Your employment ends;
Your death; or
Your entitlement to Medicare benefits (under Part A, Part B or both).
29
YOU MUST GIVE NOTICE OF SOME QUALIFYING EVENTS
For the following qualifying events, you or a family member must notify City of Colleyville Human Resources within 60 days after the
qualifying event occurs:
Your divorce or legal separation; or
Your dependent’s loss of eligibility for coverage as a “dependent child.”
You must notify City of Colleyville of the qualifying event by contacting Human Resources
HOW IS COBRA COVERAGE PROVIDED?
Once City of Colleyville receives 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. You may elect
continuation coverage on behalf of your spouse and dependent children. Your spouse may also elect continuation coverage on behalf
of your dependent children.
COBRA continuation coverage is a temporary continuation of coverage. When the qualifying event is one of the following, COBRA
continuation coverage lasts for up to a total of 36 months for your spouse/dependent children:
Your death;
Your divorce or legal separation; or
Your dependent stops being eligible for coverage under the plan as a “dependent child.”
When the qualifying event is one of the following events, COBRA continuation coverage lasts for up to a total of
18 months for qualified beneficiaries:
Your hours of employment are reduced; or
Your employment ends for any reason other than your gross misconduct.
When the qualifying event is your reduction in hours or your termination of employment and you were entitled to Medicare benefits
prior to the qualifying event, additional coverage for your spouse and dependents may be available. Your spouse and dependents
would be eligible to receive up to 36 months of COBRA continuation coverage from the date of your entitlement to Medicare. For
example, if you became entitled to Medicare eight months before the date your employment terminates, COBRA continuation coverage
for your spouse and dependent children can last up to 36 months after the date of Medicare entitlement, which is equal to 28 months
after the date of the qualifying event (36 months minus 8 months prior to the qualifying event).
There are two ways in which an 18-month period of COBRA continuation coverage can be extended.
Disability Extension of 18-Month Period of Continuation Coverage
COBRA coverage may be available for you and your family up to a total of 29 months at a higher premium if:
You, your covered spouse or your covered dependents (including newborn and newly adopted children) are determined to
be disabled, as defined by the Social Security Act, prior to the qualifying event or during the first 60 days of COBRA coverage;
The Social Security Administration’s disability determination is received within the disabled individual’s
18 months of COBRA coverage;
The disability lasts at least until the end of the 18-month period of continuation coverage; and
City of Colleyville is notified of the Social Security Administration’s disability determination within 60 days of the disabled
individual’s receipt of a Social Security Disability award. If the disability determination occurred before COBRA coverage
started, you’re required to notify Human Resources within the first 60 days of COBRA coverage.
You, your covered spouse or your covered dependents must notify City of Colleyville within 60 days of receipt of the disability
determination and prior to the end of the initial 18-month continuation period in order to receive the coverage extension. To notify City
of Colleyville of the disability determination, contact Human Resources.
You, your covered spouse or your covered dependents must notify City of Colleyville within 30 days of the date the disability ends by
contacting Human Resources.
30
Second Qualifying Event Extension of 18-Month Period of Continuation Coverage
If your family experiences another qualifying event while receiving 18 months of COBRA continuation coverage, your spouse and
dependent children can receive up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months. Additional
continuation coverage is available only if the event would have caused your spouse or dependent child to lose coverage under the Plan
had the first qualifying event not occurred. These events include:
Your death;
Your entitlement to Medicare (under Part A, Part B or both);
Your divorce or legal separation; or
Your dependent stops being eligible for coverage under the plan as a “dependent child.”
You, your covered spouse or your covered dependents must notify City of Colleyville within 60 days after the event occurs in order to
receive this additional coverage.
EVENTS THAT MAY CHANGE CONTINUED COVERAGE
Once your COBRA coverage begins, you may be able to change your COBRA coverage elections based on plan rules if you experience a
qualified change in status. You, your covered spouse or your covered dependents must notify City of Colleyville by contacting Human
Resources within 60 days of the qualified change in status to change your COBRA coverage. See your Summary Plan Description for
detailed information on allowable changes in status. Adding family members to COBRA coverage may result in a higher premium for
this additional coverage.
You may also change COBRA coverage if a child is born to the covered employee or placed for adoption with the covered employee
during the 18-, 29- or 36-month continuation period. In such case, you must notify City of
Colleyville Human Resources within 60 days of the birth or placement to cover the new dependent as a qualified beneficiary under
COBRA. There may be a higher premium for this additional coverage.
EVENTS THAT END CONTINUED COVERAGE
COBRA coverage will end automatically upon the expiration of the 18-, 29- or 36-month continuation periods described on the
previous pages. In addition, COBRA coverage will end automatically if any of the following situations occur:
City of Colleyville stops providing group health benefits;
Premiums are not paid within 30 days of the due date (with the exception of the initial premium which is due within 45 days
of your election date); or
A person eligible for continued benefits becomes covered under any other group health plan (unless the health plan has an
enforceable pre-existing condition clause) or becomes entitled to Medicare.
If your coverage ends because of expiration of the 18-, 29- or 36-month limit, you may be able to convert coverage to an individual
policy if this right currently exists in the Plan.
ARE THERE OTHER COVERAGE OPTIONS BESIDES COBRA CONTINUATION COVERAGE?
Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the
Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan) through what is called a
“special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many
of these options at www.healthcare.gov.
ADDRESS INFORMATION
Be sure to keep your current address information up to date with City of Colleyville. Doing so is the only way to ensure that important
benefit information will reach you.
YOUR RIGHTS UNDER THE EMPLOYEE RETIREMENT INCOME SECURITY ACT (ERISA)
Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified
below. For more information about your rights under the Employee Retirement Income Security Act (ERISA), including COBRA, the
Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or District Office
of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit www.dol.gov/ebsa. (Addresses
and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.) For more information about the
Marketplace, visit www.HealthCare.gov
FOR MORE INFORMATION
If you have any questions about COBRA continuation coverage, contact City of Colleyville Human Resources at 817-503-1071.
31
OTHER NOTICES
NOTICE OF REASONABLE ALTERNATIVES TO WELLNESS PROGRAM PARTICIPATION
Your health plan is committed to helping you achieve your best health. Rewards for participating in a wellness program
are available to all eligible employees. If you think you might be unable to meet a standard for a reward under the City of
Colleyville’s wellness program, you might qualify for an opportunity to earn the same reward by different means. Please
contact Baylor Scott & White to work with you (and if you wish, with your doctor) to find a wellness program with the
same reward that is right for you in light of your health status.
NEWBORN & MOTHERS HEALTH PROTECTION NOTICE
For maternity hospital stays, in accordance with federal law, the Plan does not 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 delivery.
However, federal law generally does not prevent the mother’s or newborn’s attending care provider, after consulting with
the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours, as applicable). The plan
cannot require a provider to prescribe a length of stay any shorter than 48 hours (or 96 hours following a Cesarean
delivery).
WOMEN’S HEALTH AND CANCER RIGHTS ACT OF 1998
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 consultations with the attending physician and the patient, for:
All states of reconstruction of the breast on which the mastectomy was performed
Surgery and reconstruction of the other breast to produce a symmetrical appearance
Prostheses
Treatment of physical complications of the mastectomy, including lymphedema
These benefits will be provided subject to the same deductibles, copays and coinsurance applicable to other medical and
surgical benefits provided under your medical plan. For more information on WHCRA benefits, contact the Human
Resources or your medical plan administrator.
EXPANDED COVERAGE FOR WOMEN’S PREVENTIVE CARE
Under the Affordable Care Act, City of Colleyville provides female plan participants with expanded access to
recommended in-network preventive services, including contraceptives, without cost sharing.
Additional women’s preventive services that will be covered without cost sharing requirements include:
Well-woman visits
Gestational diabetes screening
HPV DNA testing
STI counseling, and HIV screening and counseling
Contraception and contraceptive counseling
Breastfeeding support, supplies, and counseling
Domestic violence screening
For a description of what these items include, visit https://www.healthcare.gov/what-are-my-preventive-care-
benefits/#part=2.
32
OPEN ENROLLMENT CHECKLIST
DATES: August 17 – September 2, 2016
FORM SUBMISSION DEADLINE: Friday, September 2, 2016, 5:00 p.m. (Last day for changes)
FORMS TO BE COMPLETED
Blue Cross Blue Shield Medical Insurance - Only employees making changes
Blue Cross Blue Shield Dental Insurance - Only employees making changes
Dearborn Life and Long Term Disability insurance (combined form) – Only employees making changes
Superior Vision Insurance – Only employees making changes
Flexible Spending Account - Medical or Dependent account – Only if employees want to enroll or continue
participation
Nationwide – voluntary supplemental retirement plan - Only if employees want to enroll or make changes.
See Nationwide representative during the open enrollment meeting for more information.
Allstate – voluntary critical illness, cancer, accident, short term disability - Only if employees want to enroll
or make changes. See the Allstate representative during the open enrollment meeting for more
information.
Please return all completed forms to Human Resources by September 2, 2016 for an
effective date of October 1, 2016.
If you have questions regarding the medical insurance or other benefits, please contact Human Resources at
817-503-1070.
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