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2023 Benefit Book
Your Benefits - October 1, 2023 to September 30, 2024 41 lk Ar 1 s a Benefit Changes & Reminders Effective 10/1/2023 - - - - - - - - - - - - - - - - - - - - - - - - - Medical: ■ We continue to offer a single High Deductible Health Plan (HDHP). ■ Primary Care and Virtual Visits are included. ■ United Health Network on the back of the ID cards is for out-of-state care. Outside of Idaho, Nevada and Utah. Reminders: ■ Deductible and Out of Pocket Maximum are plan year, not calendar year. The plan year is October 1st through September 30tn. ■ The City of Twin Falls will continue to contribute $1,000 to the Health Savings Accounts (HSA) for those enrolled in the City's health plan. ■ SelectHealth Wellness Rewards program is included. You can earn up to $240 per person or $580 per family. ■ Voluntary Long-Term Care is offered. ■ Benefit Spot mobile application is included. Login: TFCity2020 Important Note:The material in this benefits brochure is for informational purposes only and is neither an offer of coverage or medical or legal advice.It contains only a partial description of plan or program benefits and does not constitute a contract.Please refer to the Summary Plan Description(SPD)for complete plan details.In case of a conflict between your plan documents and this information,the plan documents will always govern.Annual Notices:ERISA and various other state and federal laws require that employers provide disclosure and Welcome Inside Your benefits are an important part of your overall Page 4 compensation. We are pleased to offer a comprehensive array of valuable benefits to protect Cost of Benefits your health, your family and your way of life. This guide answers some of the basic questions you may havePage 11 about your benefits. Please read it carefully. Employee . . Open Enrollment Dates: Voluntary Dental -Page August 7,2023 to September 15,2023. Voluntary Vision - Page 25 On an annual basis, even if declining coverage, all employees must complete benefit election Page 29 changes, including additions and deletions of Choose Carefully family members and return forms to payroll by September 15,2023. Due to IRS regulations, you cannot Long Term Disability - Page 31 change your elections until the next annual Open Enrollment period, unless you have a qualified life event during Eligibility the year. Following are examples of the You are eligible for benefits if you are a most common qualified life events: Short Term Disability - Page 33 regularly scheduled employee working 20 or Marriage or divorce more hours per week.You may also enroll your ■ Birth or adoption of a child Page eligible family members under certain plans you ■ Child reaching the maximum choose for yourself. Eligible family members age limit include: Page ■ Death of a spouse, or child Voluntary Pet Insurance - ■ Your legally married spouse ■ A loss of coverage ■ Your children who are your biological N Open enrollment of a spouse children, stepchildren, adopted children or children for whom you have legal You gain access state coverage custody(age restrictions may apply). under Medicaid orr CHIP Disabled children age 26 or older who meet certain criteria may continue on your health coverage. Making Changes To make changes to your benefit elections,you must contact Human Resources within 30 days of the qualified life event(including newborns). Be prepared to show documentation of the event such as a marriage license, birth certificate or a divorce decree. If changes are not submitted on time,you must wait until the next Open Enrollment period to make your election changes. r(nnt�nrt Woo rmatr r) i Medical SelectHealth G1017524 800-538-5038 selecthealth.org Healthy Living Program SelectHealth G1017524 800-442-5238 selecthealth.org Delta Dental 3135 888-333-3582 deltadentalid.com Dental Willamette Dental ID310 855-433-6825 willamettedental.com Voluntary Vision VSP 30042591 800-877-7195 vsp.com Life Insurance and Accidental Death & Standard 4859088 800-628-8600 standard.com Dismemberment Long Term Disability Employee Assistance Program BPA 800-726-0003 bpahealth.com Voluntary Accident, Individual plan Cancer, Critical Illness, Colonial numbers for 800-325-4368 coloniallife.com Short Term Disability employees Voluntary Pet Insurance Pet's Best 1037065566 888-984-8700 petsbest.com/CTFPETS Voluntary Life Insurance NCPERS 800-525-8056 NCPERS@healthsmart.com Flexible Spending Account & Health Savings Account HealthEquity 866-346-5800 healthequity.com Administration Voluntary Long Term Care LTC Solutions, Inc. 02467V 877-286-2852 LTCiBenefitsTeam@ Itc-solutions.com — — — — — — — — — — — — — — — — — — — — — — — — Questions? If you have additional questions, you may contact: Wellness Program Disclosure The City of Twin Falls offers a voluntary wellness Toni Price, Broker program. The program includes health evaluations for 208-737-6438 employees and for spouses that are insured on our toni.price@hubinternational.com health plan and participate in the Healthy Living Program. We offer reasonable accommodations for any Christee Nelson,Account Manager individuals with disabilities. If you use Tobacco/ 208-737-6428 Nicotine/eCigarettes, we also provide Tobacco Cessation christee.nelson@hubinternational.com Program. Please contact Human Resources at 208-735-7340 to learn about the accommodations and Ida Clark, Human Resources Director alternatives that are available. Premium incentives are 208208-735-7340 -735-73 0 included based on participation in a health evaluation iclark@tfidand non-tobacco use. Kristen Kohntopp, Benefits&Safety Coordinator 208-735-7328 kkohntopp@tfid.org Celene Nino, Payroll 208-735-7246 cnino@tfid.org m ^ m " T a > w o ` g r a a a 3CX a3 3 a a O c EL 0 or E 00LnLn0 O ts c o0 coo o " - v 0 c O a ui N n o a o o o Ln of o V w 00 N U �''C Il 01 N r, V y O C m y ci ci ci N y O C m y ci N M M y C p a V iA iA iA iA G/ O• O a V iA iA iA iA iA T E V •l T E V 2 O W O O W O CL £ z a Z £ z a Z W Z W 0 v T Y•a0, O O O O O > T O O O O O y O O Ln o Ln Ln 0 O t O O O O O u £ a) CLW T n L! N n i en O 4 Ln Oq R Ln l0 W 3 ` ei Ln I, cn W O L In N Z m V iA A iA iA Ahh N Z U All. N c c I £ 0 0 3 a c -Z. Z a c = Z E o m ° 2 d a o 0 0 0 0 0 ° 2 Z a a "YI N @ u Q o Coco N N m U Q 0 0 0 0 O O- O c a a 0 c a d O O O O o u > c o 0 0 0 0 v •� > c H Qj a°1i 3 = c v`ni vLn v`ni v`ni v 0 0) 3 :. £ e e +h +h O 0. c u p O d c u p O N C Z O C Z O £ E ELU £ a uj v c a c p H • OO OA f. a�7 C vm , L L � •p O O O O o p a E v r 0 vi c vi ui o aW N •U . 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Z W W W W LL W W W W LL 14 N M Dental and Vision Costs: - - - - - - - - - - - - - - - - - - - - - - - - Delta Dental of Idaho: ') tip on 1 2023-2024 Rates Bi-Weekly Monthly Employee Only $38.00 City Paid City Paid Employee/Spouse $85.00 $23.50 $47.00 Employee/Child $85.00 $23.50 $47.00 Employee/2+Children $129.00 $45.50 $91.00 Employee/Spouse/Child(ren) $129.00 $45.50 $91.00 Willamette Dental Group: Option 2 2023-2024 Rates Bi-Weekly Monthly Employee Only $44.00 $3.00 $6.00 Employee/Spouse $105.00 $33.50 $67.00 Employee/Child $105.00 $33.50 $67.00 Employee/2+Children $160.00 $61.00 $122.00 Employee/Spouse/Child(ren) $160.00 $61.00 $122.00 - - - - - - - - - - - - - - -.- - - - - - - - - - - - - - - - - - - - - - Voluntary Vision:VSP Standard Option Voluntary Vision:`ASP Easy Option Bi-Weekly Monthly Bi-Weekly Monthly Employee Only $5.50 $11.00 Employee Only $7.00 $14.00 Employee/Spouse $7.50 $15.00 Employee/Spouse $10.00 $20.00 Employee/Child $7.50 $15.00 Employee/Child $1 Employee/2+Children $13.50 $27.00 $ Employee/Spouse/Child(ren) $13.50 $27.00 Employee/2+Children $17.50. 0 $35.00 .00 Employee/Spouse/Child(ren) $17.50 $35.00 Rates are effective October 1,2023 through September 30,2024 Forms must be completed electronically through Laserfiche Forms please follow this link: https://forms.tfid.org/Forms/ BenefitandlnsuranceEnrollment '>r�N4 City of Twin Falls , ►� Plan Date: October 1, 2023 - September 30,2024 s':.. .a Medical deductible & out of pocket maximum reset annually effective October 1st. — — — — — — — — — — — — — — — — — — — — — — — — SelectHealth - Medical ($1,000 HSA contribution paid by the City) High Deductible Health Plan Individual Deductible - $2,500 In Network/ $2,750 Out of Network Family Deductible: $5,000 In Network/ $5,500 Out of Network (2 or more) Out of Pocket Maximum Individual $4,000 In Network/$5,500 Out of Network Out of Pocket Maximum Family: $8,000 In Network/$11,000 Out of Network Coinsurance: 80% In Network/60% Out of Network (Non-Embedded deductible&Outof Pocket Maximum.) Must meet family deductible if two or more are enrolled. Delta Dental of Idaho- Dental Option 1 (Employee cost is paid by the City) Deductible : $50 Individual/ $150 Family Willamette Dental Group - Dental Option 2 (A portion of cost is paid by the City) Office Visit: $20 Copay, Preventive: $20 Copay, Fillings: $25 Copay, Routine Extractions: $25 Copay (no deductibles) VSP - Voluntary Vision (2 plan options to choose from) Annual exam: $20 Copay )up Life Insurance and Accidental Death & Dismemberment- Standard (100% employer paid) $25,000 Employee Life $25,000 Employee Accidental Death & Dismemberment $1,000 Spouse and Child Life Life Insurance/Accidental Death & Dismemberment (reduces 35% at age 65, reduces 50% at age 70, and 65% at age 75) - rm Disability - Stand 1 (100% employer paid) 60% of the first $10,000 of monthly pre-disability earnings; $6,000 maximum 180 day elimination period Payable to 65+ Empw_,`e Hssistance Program (EAP) - (Business Psychology AssociateE (100% employer paid) Up to 6 sessions per incident per program year Voluntary Accident, Cancer, Critical Illness, Short Term Disability - Colonial Life Voluntary Long Term Care - LTC Solutions, Inc. Voluntary Pet Insurance - Pet's Best Voluntary Life Insurance - NCPERS (Refer to attached outline of benefits.) (This page is intentionally left blank for double-sided printing) City of Twin Falls - Qualified High Deductible Health Plan (HDHP) with Health Savings Account (HSA) (6/15/23) 2023 IRS HSA maximum contribution amounts: Individual$3,850;Family$7,750 2024 IRS HSA maximum contribution amounts: Individual$4,150;Family$8,300 High Deductible Health Plan specifics: • Employees receive $1,000 contribution to their HSA account paid by the City. Employee may also contribute income tax-free up to IRS maximum amount shown above. • You must meet the deductible before the health plan will pay. Exceptions: preventive care and medications mentioned below. • If you are enrolled with 2 or more on the plan, the family deductible must be met first before the health plan pays (same exceptions as mentioned above) • Copays for doctor visits are eliminated. You must pay cost for visit until deductible is met. • Copays for prescriptions are eliminated. You must pay cost for the prescription until deductible is met. Exception: Medications in one of the following categories:Asthma & COPD, Cardiovascular Antiadrenergic, Cardiovascular, Cholesterol, Diabetes-Insulin, Diabetes Non-Insulin, Mental Health and Osteoporosis. (Refer to SelectHealth Deductible Waived list. Copays included: $7/$21/$42/$100) Flexible Spending Account(FSA)/Limited FSA: • You (or anyone else) are not eligible to contribute to an HSA account if you have funds in a health FSA. The IRS allows one or the other. Exception. you may enroll in a `Limited FSA for vision and dental expenses'up to $2,600 and `Dependent Care FSA'. (Your HSA account may also be used to pay for dental and vision expenses. The limited FSA allows for additional tax-free money to be set aside for dental and vision expenses.) • If you plan to have an HSA account, use FSA money ASAP by 12/31 and do not re-enroll in the FSA medical plan. If money is remaining in your FSA account after 12/31, you are considered re- enrolled. • HealthEquity is the administrator that oversees the HSA accounts for employees. The employee authorizes the account to be opened in their own name. • IRS rules state that HSA's can only be funded when an employee is enrolled in a qualified high deductible health plan. You are not eligible to contribute to an HSA if you are enrolled on a non- HDHP (traditional type plan say with your spouse or parents). • Employer and employee may contribute to the HSA up to the total individual or family amount per year. The IRS determines the annual amounts, and they are usually increased by a small amount annually. • Money in the HSA account may be used by the employee to help meet their medical or dental deductibles; vision copays; office visit copays and to help pay for `qualified' medical/dental/vision expenses. • Money in the employee's HSA account is owned by employee and goes with employee if they leave employment at group. • Money in an HSA account carries forward from year to year. • Contributions that the employee chooses to make are made pre-tax from the employee's pay. • You can use HSA funds for all family member expenses whether they are covered under the HDHP or not. • You can contribute the family amount if there are 2 or more individuals enrolled on the HDHP. • Money in an HSA grows tax-deferred and is withdrawn tax-free if money is used for a `qualified' medical expense. (Qualified expenses list may be found on the IRS website.) • Money may also earn interest as the funds in the HSA account grows. • Employee can make a one-time transfer from IRA to HSA subject to specific limit (as of 2008). • There is a $1,000 per year `catch up' amount allowed at age 55 and older. • Employee may also use the money in the HSA account to pay COBRA insurance premiums. Long term care insurance premium (subject to IRS mandated limits based on age and adjust annually); Long term care services and decisions; Health care coverage while receiving unemployment compensation under federal or state low; Medicare and other health care coverage if you were 65 or older (other than premiums for a Medicare supplemental policy, such as Medigap.) • HDHP medical plans help individuals become better consumers as it makes us more responsible for medical care purchases and medical decisions. We learn to shop for our care and needs like we do when purchasing a car or other major purchases. • You are unable to use HSA funds to pay for dependent child or adult care. • You cannot contribute new funds to an HSA savings account if you are enrolled in Medicare. If you had HSA prior to age 65 and Medicare, you could keep and use the money but no new contributions can be made to the HSA account. • If employee is enrolled on HDHP and spouse is on Medicare, employee can add spouse to HDHP and contribute the family amount. (Spouse can't open HSA account.) • You can't contribute to an HSA if you are claimed as dependent on someone else's taxes. • Keep receipts for expenses in case you are audited by the IRS. • Mistaken distributions can be returned to HSA account. • If death occurs, the spouse becomes owner of the HSA account. If spouse is not beneficiary, the money in the account will become taxable to the dependent. City of 1 11 110/01/20231 Si� MEMBER PAYMENT SUMMARY se ect r i ea I t h IN-NETWORK OUT-O&NETWORK SELECTHEALTH NETWORK/HSA QUALIFIED when using in-Network Providers,you are responsible When using out-of-Network Providers,you are to pay the amounts in this column. responsible to pay the amounts in this column. CONDITIONS A • LIMITATIONS Pre-Existing Conditions(PEC) None Benefit Accumulator Period plan Year Maximum Annual Out-of-Network Payment-(per plan Year) None None MEDICAL DEDUCTIBLE AND MEDICAL OUT-OF-POCKET"' IN-NETWORK OUT-OF-NETWORK Self Only Coverage,1 person enrolled-per plan Year Deductible $2,500 $2,750 Out-of-Pocket Maximum $4,000 $5,500 Family Coverage,2 or more enrolled-per plan Year Deductible $5,000 $5,500 Out-of-Pocket Maximum $8,000 $11,000 (Medical and Pharmacy hicluded in the Out-of-Pocket Maximum) INPATIENT SERVICES IN-NETWORK OUT-OF-NETWORK Medical,Surgical and Hospice 20%after Deductible 40%after Deductible Skilled Nursing Facility4-Up to 60 days per plan Year 20%after Deductible 40%after Deductible Inpatient Rehab Therapy:Physical,Speech,Occupational 20%after Deductible 40%after Deductible Up to 40 days per plan Year for all therapy types combined Physician's Fees-(Medical,Surgical,Maternity,Anesthesia) 20%after Deductible 40%after Deductible PROFESSIONAL • • • Office Visits&Minor Office Surgeries Primary Care Provider(PCP)1 $15 after Deductible 40%after Deductible Primary Care Provider(PCP)Virtual Visitsl Covered 100%after Deductible 40%after Deductible Specialist/Secondary Care Provider(SCP)1 $25 after Deductible 40%after Deductible Allergy Tests See Office Visits Above 50%after Deductible Allergy Treatment and Serum 20%after Deductible 50%after Deductible Major Surgery 20%after Deductible 40%after Deductible Physician's Fees-(Medical,Surgical,Maternity,Anesthesia) 20%after Deductible 40%after Deductible PREVENTIVE SERVICES AS OUTLINED OUT-OF-NETWORK Primary Care Provider(PCP)I Covered 100% 50%after Deductible Specialist/Secondary Care Provider(SCP)1 Covered 100% 50%after Deductible Adult and Pediatric Immunizations Covered 100% 50%after Deductible Elective Immunizations-herpes zoster(shingles),rotavirus Covered 100% 50%after Deductible Diagnostic Tests:Minor Covered 100% 50%after Deductible Other Preventive Services Covered 100% 50%after Deductible VISION • • Preventive Eye Exams Covered 100% 50%after Deductible All Other Eye Exams $25 after Deductible 40%after Deductible • • ' Outpatient Facility and Ambulatory Surgical 20%after Deductible 40%after Deductible Ambulance(Air or Ground)-Emergencies Only 20%after Deductible See In-Network Benefit Emergency Room $75 after Deductible See In-Network Benefit Urgent Care Facilities $35 after Deductible 40%after Deductible Intermountain Connect Carew Covered 100%after Deductible See Professional,Inpatient,Outpatient, or Miscellaneous Services Radiation 20%after Deductible 40%after Deductible Dialysis 20%after Deductible 40%after Deductible Diagnostic Tests:Minor Covered 100%after Deductible 40%after Deductible Diagnostic Tests:Major 20%after Deductible 40%after Deductible Home Health,Hospice,Outpatient Private Nurse 20%after Deductible 40%after Deductible Outpatient Cardiac Rehab Covered 100%after Deductible 40%after Deductible Outpatient Rehab/Habilitative Therapy:Physical,Speech,Occupational $25 after Deductible 40%after Deductible ID-MPS RDHP 01i01i23 See other side for additional benefits City of 1 11 110/01/20231 Si� MEMBER PAYMENT SUMMARY se ect r i ea I t h IN-NETWORK OUT-OF-NETWORK SELECTHEALTH NETWORK/HSA QUALIFIED MISCELLANEOUSOUT-OF-NETWORK Durable Medical Equipment(DME)4 20%after Deductible 40%after Deductible Miscellaneous Medical Supplies(MMS)3 20%after Deductible 40%after Deductible Autism Spectrum Disorder See Professional,Inpatient,Outpatient,or See Professional,Inpatient,Outpatient,or Mental Health and Chemical Dependency Mental Health and Chemical Dependency Services Services Maternity4 See Professional,Inpatient or Outpatient 40%after Deductible Cochlear Implants,Hearing Aids,or Auditory Osscointegrated Devices2,4 See Professional,Inpatient or Outpatient 50%after Deductible One device every 36 months per ear. Up to 45 language/speech therapy visits during the 12 months after the delivery of the covered device. Infertility-Select Services 50%after Deductible 50%after Deductible TMJ(Temporomandibular Joint)Services-Up to$2,000 lifetime See Professional,Inpatient or Outpatient 50%after Deductible OPTIONAL BENEFITS IN-NETWORKOUT-OF-NETWORK Mental Health and Chemical Dependency (combined benefits) Office Visits $15 after Deductible 40%after Deductible Virtual Visits Covered 100%after Deductible 40%after Deductible Inpatient 20%after Deductible 40%after Deductible Outpatient 20%after Deductible 40%after Deductible Residential Treatment 20%after Deductible 40%after Deductible Chiropractic $30 after Deductible 40%after Deductible (up to 20 visits per plan Year) Injectable Drugs,Chemotherapy,and Specialty Medications 20%after Deductible 40%after Deductible Bariatric Surgery(Up to one surgery/lifetime)4 See Professional,Inpatient or Outpatient 40%after Deductible PRESCRIPTIONDRUGS Prescription Drug List(formulary) RxSelect® Prescription Drugs-Up to 30 Day Supply of Covered Medications 4 Tier 1 $7 after In-Network Deductible Tier 2 $21 after In-Network Deductible Tier 3 $42 after In-Network Deductible Tier 4 $100 after In-Network Deductible Maintenance Drugs-90 Day Supply(Mail-Order,Retail90 e)-selected drugs 4 Tier 1 $7 after hi-Network Deductible Tier 2 $42 after In-Network Deductible Tier 3 $126 after In-Network Deductible Deductible Waiver Certain prescription drugs are not subject to the Deductible Generic Substitution Required Generic required or must pay Copay plus cost difference between name brand and generic 1 Refer to selecthealth.org/findadoctor to identify whether a Provider is a primary or secondary care Provider. 2 Refer to your Certificate of Coverage for more information. 3 Frequency and/or quantity limitations apply to some Preventive care and MMS Services. 4 Preauthorization is required for certain Services.Benefits may be reduced or denied if you do not preauthorize certain Services with Out-of-Network Providers.Please refer to Section 11--"Healthcare Management",in your Certificate of Coverage,for details. 5 All Deductible/Copay/Coinsurance amounts are based on the Allowed Amount and not on billed charges.Out-of-Network Providers or Facilities may not accept the Allowed Amount for Covered Services.When this occurs,you may be responsible for Excess Charges. 6 Certain Services as noted on this document and in your Certificate of Coverage are not subject to the Deductible. All Covered Services obtained outside the United States,except for routine,Urgent,or Emergency conditions require preauthorization. To contact Member Services,call800-538-5038 weekdays,from 7:00 a.m.to 8:00 p.m.,Saturdays,from 9:00 a.m.to 2:00 p.m. TTYusers should call 711. BeneJus are administered and underwritten by SelectHealth,Inc.Sm(domiciled in Utah). ID-MPS HDHP 01/01/23 04/19/23 selecthealth.org Deductible Waived - Drugs, Devices, and Tests Some of our High Deductible Health Plans (HDHPs) provide coverage for maintenance Devices > Furosemide > Alogliptin > Peak Flow Meter > Hydrochlorothiazide > Bagsimi medications, devices, and tests before you Asthma and COPD > Lisinop/HCTZ > Bydureon meet your deductible. To find out if your plan > Albuterol/HFA > Lisinopril > Byetta > Losartan > Farxiga includes this benefit, take a look at your > Anoro Ellipta> Ar to > Losartan/HCTZ > Gli de Member Payment Summary (MPS) or contact > Arnuity Ellipta > Metoprolol > Glipiziie our Pharmacy team. > Asmanex > Multaq > Glucagen > Atrovent/HFA > Nebivolol > Glucagon We've listed the most commonly used covered > Budesonide > AOmlodartan/HCTZ > Glyxambi > Coliresp t > Olmesartan/HCTZ > Jardiance medications, devices, and tests with no- > Daliresp deductible coverage*. If you don't see the one > Flovent > Olmesartan > Jentadueto you are looking for, call our Pharmacy team. > Fluticasone/ > Propranolol > Metformin> Ranolazine Salmeterol > Pioglitazone > Ipratropium > Spironolactone > Segluromet To get a free glucose meter/monitor, sign up for > Levalbuterol > Telmisartan/ > Steglatro the MyFreeStyle Program at myfreestyle.Com Amlodipine. > Montelukast > Telmisartan/HCTZ > Synjardy > Proventil > Telmisartan > Tradjenta > Pulmicort > Trandolopril/ > Trulicity > Qvar Verapamil > Xigduo XR r > Serevent > Triamterene/HCTZ > Spiriva > Valsartan/HCTZ Diabetes-Testing > Stiolto > Valsartan Supplies CALL OUR PHARMACY TEAM > Striverdi > Warfarin > Freestyle Test Strips 800-S38-SO38 > Symbicort > Xarelto > Freestyle Lite Test > Terbutaline Strips Treleg> y Cholesterol > releg in/HFA > Atorvastatin Anti-depressants > Cholestyramine > Citalopram > Wixela Inhub > Colestipol > Escitalopram Cardiovascular > Fenofibrate > Fluoxetine Antiadrenergics > Livalo > Fluvoxamine > Clonidine > Pravastatin > Minipress > Paroxetine > Rosuva > Sertraline t > Prazosin > Simvastatin atin / Cardiovascular Osteoporosis Diabetes- Insulin > Amlodipine/ > Alendronate l � > Insulin aspart: Olmesartan Tests > Amlodipine > Lantus > Hemoglobin A1c - > Atenolol > Novolin Testing > Candesartan/HCTZ > Novolin N > International l > Candesartan > Novolin R Normalized Ratio 1 : > Carvedilol > Novolog (INR)Testing > Corlanor > Novolog Mix > Low-density Lipoprotein(LDL) > Diltiazem > Toujeo Testing > Eliquis Diabetes- > Retinopathy > Entresto Non-Insulin Screening SelectHealth refers to many of the drugs in this list by their respective trademarks, but SelectHealth does not own those trademarks;the manufacturer or supplier of each drug owns the drug's trademark.By listing these drugs,SelectHealth does not endorse or sponsor any drug,manufacturer,or supplier.And these manufacturers and suppliers do not endorse or sponsor any SelectHealth service or plan and are not affiliated with SelectHealth. *This list is not a complete list of all covered drugs and may be subject to change. Other limitations may apply. selecthealth. Your Health. Connected. You've got options when it comes to remote care. Get care wherever, whenever. Download the MyHealth+ App to get started or use the web version: intermountainhealthcare.org/myhealth. The doctor is always in with Intermountain Connect Care' Get urgent care 24/7 from home with virtual doctor visits at no or low out-of-pocket cost to you. When you can't get in to see your regular doctor, use Connect Care for: > Stuffy and runny nose > Eye infections > Lower back pain > Allergies > Cough > Joint pain or strains > Sore throat > Painful urination > Minor skin problems The typical wait time is under 10 minutes, and you can save an average of $400 per visit compared with the ER. Note: For true emergencies, call 911 or go to the ER. > In the My Health+app select"Virtual Visit,"and choose"Connect Care Urgent Care." fl -F T1 Not sure where to start? Try our free, 24/7 Nurse Line. Talk to a nurse about any condition to get advice on how and where to get care. Call 844-265-7648. SelectHealth Healthy Living Program Check this list often to make sure you are staying up-to-date with your SelectHealth Healthy Living program engagements. CREATE YOUR SELECTHEALTH ACCOUNT If you don't already have an account, visit selecthealth.org and register for one. You'll have access to your Member Checklist and health tools from the Dashboard page. 0 ANNUAL HEALTH SCREENING Attend a work-site health education and screening event or visit your doctor or PCP for an annual screening. HEALTH ASSESSMENT VIRGIN PULSE HEALTH CHECK The Health Check is an online health # assessment that gives you a health score ` based on your lifestyle. F DIGITAL COACHING VIRGIN PULSE JOURNEYS Digital Coaching programs can help 1 you create new healthy habits or keep the ones you have. 1 ` ACTIVITY CAMPAIGNS VIRGIN PULSE CHALLENGES Stay motivated with Activity Campaigns. Choose two challenges per year that fit your needs. Here are your options: """"""""""""""""""""""""""""""" If you complete the Team Challenge and 7,000 steps > 7,000 Steps Challenge in the same month,you only get credit for one. (20 days in one month) > Promoted Team Challenges Review your SelectHealth Member Checklist to check (offered quarterly) your progress. > Four individual promoted Healthy Refer to the Member Guide for additional details on how to Habit Challenges (offered monthly) participate in the Share Healthy Living Program. •ns? Call 800-442-5260. ©2020 SelectHealth.All rights reserved.1304759 11120 W12 AIL IT 1: 1 w ` r � 1 ACCESS YOUR BENEFITS ANYTIME, ANYWHERE -WITH Benefmp Spot - k/POWERED BY HUB INTERNATIONAL BIG NEWS... WE 'VE GONE MOBILE ,' To help you access your benefits and HR information— WITH BENEFIT SPOT, even when you're away from work and need it most— YOU'LL BE ABLE TO: we've launched Benefit Spot! Call HR directly • Access your Benefits Guide DOWNLOADING THE APP IS EASY! SIMPLY- and basic plan information • Watch educational videos Q Search "Benefit Spot" on the Apple App Store • Look up carrier contact or Google Play or scan this QR code. information • Estimate costs for common Download the app to your smartphone or health care procedures using our cost comparison tools other mobile device. And more! E/ Whenever you launch the app,TFCity202O to CITY OF U access our plan information. ❑ TWIN FALL NOTE:The company code is case sensitive. i That's it—you're ready to go! Q .eta memo Qu0 V �. Employee Assistance rogram Accessing your benefits is easy, confidential, and no cost to you. Life Hannens! Talking with a counselor can improve relationships, reduce stress, increase job satisfaction, and so much more. Choose your setting In-person, video, phone, text or chat. Select a mental health professional that is right for you. Plus, find timely advice at your fingertips Resources and referral services on a wide spectrum of work, family, and personal issues such as... Stress Management Legal Consultation Professional Growth Financial Success Parenting and Eldercare Mental Health These services are provided to you AND your eligible family members, at no cost to you. AND it's confidential - no names are shared with your employer. Login to see details of your plan and to access the online resources www.bpahealth.com/EAP-home username: City of Twin Falls password: 8007260003. PBegin your counseling sessions by choosing ONE of the following: 1. Call 800-726-0003 or Text 208-336-4275 M-Th: 8am-6pm, F: 8am-5pm (MST) 2. Complete Online Request Form https://www.coanitoforms.com/BPAHealth/ea Pon linerequest 3. Quick start with BetterHelp p Immediate access to telehealth counseling options - ►},� like video, phone, chat, and text through our partner p www.betterhello.com/bpahealth A Crisis Counselors are available by phone 24/7 B� 1 HEALTH J TIMELY AD . YOURFING ' Work Life Resources i Su. Resources and Referral Services v Professional consultation and referrals to assist with a spectrum of work, family, and personal issues such as... • Legal Advice • Healthy Living & Wellbeing • Creating a Budget • Elder Care Tips and Referrals • Parenting Concerns • Pet Ownership Resources • Financial Consultation • ID Theft Consultation • Buying or Selling a Home • Tax Services On Demand Webinars Savings Center Content such as... Purchases such as... • Greener Living • Home Appliance and Electronics • Suicide Prevention • Travel - Airfare, Hotels, Car Rental • Caring for Care Givers • Discounted Movie Tickets • Gender Equality in the Workplace • Auto Purchases • Stress Management • Luxury Shopping and more! BPAHealth.com/EAP-Home Log in steps: username: City of Twin Falls and 8007260003 is your password For questions or support call us at 800-726-0003 or text 208-336-4275 M-Th: 8am-6pm, F: 8am-5pm (MST) Employee Assistance Program SAVINGS CENTER OfFEATURES INCLUDE: The program offers a wide array of online VI discounts from leading name-brand retailers, restaurants, and movie theaters. To take advantage of these discounts, log on to your work-life website, and click on the Savings Center on the homepage. / Follow the directions to register and start saving. i Bills, health care, retirement savings, and taxes all take enough out of our paychecks already. What about everything else? To help you stretch your dollar, you and your family have access to a free online benefit: the Savings Center. Register for free on your employee support website. TOLL-FREE:800-000-0000 &% WEBSITE:www.bpahealth.com/eap-home H E A LT H USERNAME:City of Twin Falls• PASSWORD:8007260003 Then visit Work-Life Resources (This page is intentionally left blank for double-sided printing) d DELTA DENTAL deltadentalid.com Benefit Summary GENERAL BENEFIT PLAN SUMMARY City of Twin Falls Group Number: 3135 Contract Effective Date: 10/01/2023 Benefit Overview PPO Premier Non-Participating Per Person Deductible $50 $50 $50 Excluding Diagnostic and Preventive services per benefit year Family Deductible $150 $150 $150 Excluding Diagnostic and Preventive services per benefit year Maximum Benefit $1,000 $1,000 $1,000 Per eligible person per benefit year Maximum Benefit Rollover $3,050* $2,500* $0 Services You pay the % below Preventive & Diagnostic Services 0% 20% 20% Examinations, X-rays, teeth cleaning Basic Services 20% 30% 30% Fillings, root canals, extractions, oral surgery Major Services 50% 60% 60% Crowns, implants, onlays, bridges, dentures Late enrollee waiting period is 24 months PARTICIPATING AND NON-PARTICIPATING DENTISTS If the dentist is a network participating dentist, Delta Dental will base payment on the lesser of the Submitted Amount or the Contract Fee. Delta Dental will send payment to the participating dentist and the subscriber will be responsible for any co-payment and/or any non-covered services. If the dentist is a non-participating dentist, Delta Dental will base payment on the lesser of the Submitted Amount or Delta Dental's non-participating dentist Fee. It is the subscriber's responsibility to make full payment to the non-participating Dentist. For dental services rendered by an out-of-state dentist, Delta Dental will base payment on the lesser of the Submitted Amount or the Contract Fee in that area, if the out-of-state dentist is a participating dentist with a Delta Dental plan in the state in which the service is rendered. See back page for benefits and limitations Delta Dental of Idaho Customer Service 555 E Parkcenter Blvd (208) 489-3580 Boise, ID 83706 (800) 356-7586 DDI Ben Book 0318 d DELTA DENTAL deltadentalid.com Benefits and Limitations Class I Preventive and Diagnostic Services Periodic exam is allowed 2 times every benefit year. Bitewing x-rays are allowed 1 time every 12 months . Full mouth series or panoramic x-rays are allowed 1 time every 5 years from last date of service . Adult and child cleanings are allowed 2 times every 1 year (restricts against periodontal maintenance within the same time period). Fluoride treatment is allowed 1 time every 12 months from last date of service through age 18. Class II Basic Services Fillings restricted to same tooth/surface are allowed 1 time every 24 months . Periodontal surgeries per quadrant are allowed 1 time every 3 years from last date of service . Periodontal scaling and root planing-per quadrant is allowed 1 time every 24 months from last date of service. Periodontal maintenance procedure is allowed 1 time every 6 months from last date of service. Class III Major Restorative Services Porcelain, porcelain substrate, and cast restorations are not payable for children less than 12 years of age. Crowns, stainless steel crowns, onlays, or bridges on same tooth are allowed 1 time every 7 years from last date of service . Partials or dentures per arch are allowed 1 time every 7 years from last date of service for ages 16 and older. Implants Implants are a covered benefit per tooth (including crowns) with a maximum lifetime benefit of $900 or the plan's annual maximum, whichever is less. Ages 19 and over. Dependents Eligible children must be under age 26. GENERAL PLAN INFORMATION 1. Optional treatment: If the subscriber or eligible dependent selects a more expensive service than is customarily provided. For example, if teeth can be restored satisfactorily with amalgam or composite material, the cost of inlays, onlays and crowns are not covered and the cost difference between the covered and the non-covered procedure is to be borne by the patient. 2. Payment provisions: The following guidelines will be used to determine the date on which a service shall be paid: a. Full dentures or partial dentures: On the date the final impression is taken. Delta Dental of Idaho Customer Service 555 E Parkcenter Blvd (208) 489-3580 Boise, ID 83706 (800) 356-7586 DDI Ben Book 0318 CITY OF 1`WIN FALLS v1 qq 4 Willamette oA`e Quo¢ Dental Group SERVING CONVENIENT PLAN FEATURES • No annual maximum', deductible or waiting periods with predictable out-of-pocket costs • Benefit coverage at all Willamette Dental Group locations • Extended hours: Monday — Friday 7am — 5:30pm and rotating Saturdays regionally • Easy appointment scheduling —just call 1.855.433.6825 • Emergency services available in-person in 48 hours or less and on-call 24/7 • All dental specialty services available, including orthodontics for all ages YOUR BENEFITS EFFECTIVE DATE: 10/1/2023 COVERED SERVICE BENEFIT Annual Maximum No Annual Maximum* Deductible No Deductible General &Ortho Office Visit You Pay$20 per Visit Diagnostic& Preventive Services Covered with Office Visit Copay Fillings You Pay a $25 Copay Porcelain-Metal Crown You Pay a $150 Copay** Complete Upper or Lower Denture You Pay a $300 Copay** Bridge(per Tooth) You Pay a $150 Copay** Root Canal Therapy—Anterior/Bicuspid/Molar You Pay$100/$125/$150 Copays Osseous Surgery(per Quadrant) You Pay a $150 Copay Root Planing (per Quadrant) You Pay a $65 Copay Routine Extraction (Single Tooth) You Pay a $25 Copay Surgical Extraction You Pay a $85 Copay Comprehensive Orthodontia Treatment You Pay a $2,000 Copay Dental Implant Surgery Benefit maximum of$1,500 per calendar year Nitrous Oxide You Pay a $40 Copay Specialty Office Visit You Pay a $30 Copay per Visit Out of Area Emergency Care Reimbursement You pay charges in excess of$100 *Benefits for implant surgery have a benefit maximum,if covered. **Dental implant-supported prosthetics(crowns,bridges,and dentures)are not a covered benefit. Underwritten by Willamette Dental of Idaho,Inc. Please refer to your Certificate of Coverage for limitations and exclusions. QUESTIONS? Contact our Member Services team via email at memberservices@willamettedental.com or by phone at 1.855.433.6825. 019-ID(10/21) Idaho Provider List Willamette .- . . For Appointments or Customer Service, please call 1.855.433.6825. Boise Twin Falls 607 N Mitchell St Boise, ID 83704 452 Cheney Drive West, Suite 150 Mervin Young, DDS Twin Falls, ID 83301 Randell Terry, DMD Jared K Rowberry, DMD Jon Ryan T Miler, DDS, OS, Orthodontist Nate Peterson, DDS Kelley Dunay, DMD, Orthodontist Coeur d'Alene 943 West Ironwood Drive, Suite 200 Idaho Falls Coeur d'Alene, ID 83814 2860 Valencia Drive, Suite 100 Hannah Ingram, DDS Idaho Falls, ID 83404 Daniel Shaw, DDS Mark Chambers, DDS Andrew Reichert, DDS Trent Buehler, DMD Lana Nysse, DDS MSD, Orthodontist Dwight D. Baker, DDS, Orthodontist Meridian Nampa 1075 S Wells Street 16145 N High Desert St. Meridian, ID 83642 Nampa, ID 83687 Jeremy Draper, DMD Terry Taylor, DMD David Seegmiller, DDS Benjamin Armstrong, DDS Wesley Brimhall, DMD Troy Smith DDS, Orthodontist Daniel B Jenks, DDS, Endodontist Jeremy Hixson, DMD, Oral Surgeon Visit us on the web at www.WillametteDental.com Rev 3.29.2023 *This provider list is subject to change at any time Vsp vision care Vsp.. vision care VSP Choice with EasyOptions (Easy Options Not Available at Costco, VSP Choice Walmart or Sam's Club). Savings Never Looked So Good Ak Get access to more than • • • in savings from VSP and other popular brands for your iA eye care d overall wellness A" Frames shown are by Lenton&Rusby. Discover Exclusive Member Extras VSP-exclusive member extras Eyewear and eye care Special Offers are available at all VSPs` network doctor locations! This interactive flier allows you to click on any offer shown below and find out more details. GLASSES AND SUNGLASSES VSP pFIEWER Extra HOYA $20 Get 6-month satisfaction Premier Offers guaranteed protection to Spend with Hoya lenses. Maximize your savings with Get more value with an Premier Offers only available at Extra $20 to spend on Premier Program locations. Featured Frame Brands like Save 20% On additional bebe, Calvin Klein, Cole Haan, pairs of Nike glasses Eyewear Get a one year Dragon Flexon', Lacoste, and sunglasses. Protection worry-free warranty Nike and more.12 on Featured Frame Brands. Extra � �i insync Save up to 40% on SunSync`° snuSCN+COMB Save up supply o, d $310 See better.Live better. an annuall Supply Of to Spend Light-Reactive Lenses.23 contact lenses. Get an Extra $40 to spend on Aelect Featured Frame Brands. techshield® Glasses Get up to a $100 Save up to 40% Rebate rebate on the perfect on all TechShield pair of glasses.° Up to Anti-Reflective Coatings.2.3 • Off 11OYA Try Hoya lenses Lens Enhancements TT worry-free for unity six months. 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LasikP Thelus� LASIKo Vision N V I S 1410PN T L C Laser Eye Centers INSTITOTE° EYE CENTERS Save up to $1,000 Save up to $1,000 Get up to $1,000+ Get up to $1,000 off LASIK.' off LASIK' off all custom off LASIK at TLC.' LASIK and PRK.' HEALTH & WELLNESS LEISURE & LIFESTYLE HEALTH & FINANCIAL WELL-BEING Support for Sim le Diabetes �SprMval es �CareCredit' ® everplans Management Find resources to help Receive free access to Get instant, Get your home and prevent or delay Type a variety of everyday in-office application life organized with a 2 Diabetes like lifestyle savings like family for promotional smart digital vault built coaching, diabetes entertainment, health financing available to securely store your educational materials, and wellness, cash on eye care important documents and more. rewards, travel, and eyewear. and information for and more.' just $27 a year. MemberView all Exclusive • • • - Offers subject to change without notice.Some members may not be eligible for all offers.Visit vsp.com/offers for terms and conditions on specific offers. 1.Brands and promotions are subject to change.2.Available to VSP members with applicable plan benefits.3.Savings based on doctor's retail price and vary by plan and purchase selection;average savings determined after benefits are applied.4.Perfect Pair up to$100 rebate expires 11/30/2021,rebate offer terms and conditions apply and are subject to change.Rebate offer valid from 7/1/2021 through 11/30/2021,and must be redeemed by 12/31/2021.The Sponsor/Offeror of this rebate is Plexus Optix,Inc.S.VSP is providing information to its members but does not offer or provide any discount hearing program.VSP makes no endorsement,representations or warranties regarding any products or services offered by TruHearing,a third-party vendor.TruHearing is not insurance and not subject to state insurance regulations.For additional information please visit https://www.vsp.com/offers/special-offers/hearing-aids/truhearing.For questions,contact TruHearing directly.Not available directly from VSP in the states of Washington and California.S.Not all locations are on the VSP Laser VisionCare Network.Please call VSP Member Services at 800.877.7195 to confirm the location you're interested in visiting is in network.7.Some members may not be eligible for this program;visit vsp.com/slmplevalues for terms and conditions. All third-party marks,product names,logos,and brands are the property of their respective owners.Use of these marks,names,logos and/or brands does not imply endorsement.Members who participate in a Medicaid/state-funded plan are not eligible for the above offer. ©2022 Vision Service Plan.All rights reserved. VSP and Eyeconic are registered trademarks of Vision Service Plan.Unity,TechShield,and SunSync are registered trademarks of Plexus Optix,Inc. All other brands or marks are the property of their respective owners.104209 VCCM Classification:Public Employer Paid Life Insurance provided to you at no cost. Standard Insurance Company City of Twin Falls Group Policy#485908 • Effective Date March 1,2002 Group Basic Life and Accidental Death and Dismemberment Insurance Group Basic Life insurance from Standard Insurance Company helps provide financial protection by promising to pay a benefit in the event of an eligible member's, or his or her dependent's covered death. Basic Accidental Death and Dismemberment (AD&D} insurance may provide an additional amount in the event of a covered death or dismemberment as a result of an accident. The cost of this insurance is paid by City of Twin Falls. Eligibility Definition of a Member You are a member if you are an active Council Member or employee of City of Twin Falls and regularly working at least 20 hours each week.You are not a member if you are a temporary or seasonal employee, a full-time member of the armed forces, a leased employee or an independent contractor. Class Definition Class 1- Members hired on or after the first of the month through the 15th of the month Class 2- Members hired on or after the 16th of the month through the last day of the month EligibilityWaiting Period You are eligible on the first of the month that follows or coincides with 60 consecutive days as a member. Benefits Basic Life Coverage Amount Your Basic Life coverage amount is$25,000. Basic AD&D Coverage Amount For a covered accidental loss of life,your Basic AD&D coverage amount is equal to your Basic Life coverage amount. For other covered losses, a percentage of this benefit will be payable. Life Age Reductions Basic Life and AD&D insurance coverage amount reduces to 65 percent at age 65,to 50 percent at age 70 and to 35 percent at age 75. Group Basic Life and Accidental Death and Dismemberment Insurance Basic Dependents Life Coverage The Basic Dependents Life coverage amount for your eligible spouse is Amount $1,000.Your spouse is the person to whom you are legally married. The Basic Dependents Life coverage amount for each of your eligible children is$1,000. Child means your child from live birth through age 20 (through age 24 if a registered student in full-time attendance at an accredited educational institution). Other Basic Life Features and Services - Accelerated Benefit - Right to Convert Provision - Life Services Toolkit - Travel Assistance - Portability of Insurance Provision - Waiver of Premium - Repatriation Benefit Other Basic AD&D Features - Air Bag Benefit - Family Benefits Package - Seat Belt Benefit This information is only a brief description of the group Basic Life/AD&D and Basic Dependents Life insurance policy sponsored by City of Twin Falls.The controlling provisions will be in the group policy issued by The Standard.The group policy contains a detailed description of the limitations,reductions in benefits,exclusions and when The Standard and City of Twin Falls may increase the cost of coverage, amend or cancel the policy.A group certificate of insurance that describes the terms and conditions of the group policy is available for those who become insured according to its terms. For more complete details of coverage,contact your human resources representative. Standard Insurance Company 1100 SW Sixth Avenue Portland OR 97204 www.standard.com SI 13279-0-10-485908 (7/19) 61,0393-386025 Standard Insurance Company Employer Paid Long Term Disability provided to you at no cost. Standard Insurance Company City of Twin Falls fit Group Policy#485908 Effective Date October 1,2002 Group Long Term Disability Insurance Group Long Term Disability insurance from Standard Insurance Company helps provide financial protection for insured members by promising to pay a monthly benefit in the event of a covered disability. The cost of this insurance is paid by City of Twin Falls. Eligibility Definition of a Member You are a member if you are a regular employee of City of Twin Falls,actively working at least 20 hours per week, and a citizen or resident of the United States or Canada.You are not a member if you are a temporary or seasonal employee,a full-time member of the armed forces, a leased employee or an independent contractor. Class Definition Class 1-Safety Members hired on or after the first of the month through the 15th of the month Class 2-Safety Members hired on or after the 16th of the month through the last day of the month C lass 3-Non-safety Members hired on or afterthe first ofthe month through the 15th of the month Class 4- Non-safety Members hired on or after the 16th of the month through the last day of the month EligibilityWaiting Period You are eligible on the first of the month that follows or coincides with 60 consecutive days as a member. Benefits Monthly Benefit 60 percent of the first$10,000 of monthly predisability earnings, reduced by deductible income(e.g.,work earnings,workers' compensation, state disability,etc.) Maximum Monthly Benefit $6,000 Minimum Monthly Benefit $100 Benefit Waiting Period 180days Group Long Term Disability Insurance Definition of Disability Class 1&2: For the benefit waiting period and the first 12 months that Long Term Disability benefits are payable,you will be considered disabled if, as a result of physical disease,injury,pregnancy or mental disorder: • You are unable to perform with reasonable continuity the material duties of your own occupation, and • You suffer a loss of at least 20 percent of your predisability earnings when working in your own occupation. You are not considered disabled merely because your right to perform your own occupation is restricted, including a restriction or loss of license. After the own occupation period of disability,you will be considered disabled if,as a result of a physical disease,injury,pregnancy or mental disorder,you are unable to perform with reasonable continuity the material duties of any occupation. Class 3&4: For the benefit waiting period and the first 24 months that Long Term Disability benefits are payable,you will be considered disabled if, as a result of physical disease,injury,pregnancy or mental disorder: • You are unable to perform with reasonable continuity the material duties of your own occupation, and • You suffer a loss of at least 20 percent of your predisability earnings when working in your own occupation. You are not considered disabled merely because your right to perform your own occupation is restricted, including a restriction or loss of license. After the own occupation period of disability,you will be considered disabled if,as a result of a physical disease, injury,pregnancy or mental disorder,you are unable to perform with reasonable continuity the material duties of any occupation. Maximum Benefit Period If you become disabled before age 62, Long Term Disability benefits may continue during disability until age 65. If you become disabled at age 62 or older,the benefit duration is determined by the age when disability begins: Age Maximum Benefit Period 62 3 years 6 months 63 3 years 64 2 years 6 months 65 2 years 66 1 year 9 months 67 1 year 6 months 68 1 year 3 months 69+ 1 year Other Features and Services • 24 hour coverage, including coverage for work-related • Return to Work Incentive disabilities • Survivors Benefit • Reasonable Accommodation Expense Benefit . Waiver of Premium while Long Term Disability benefits • Rehabilitation Plan Provision are payable Standard Insurance Company Colonial Life. Voluntary benefits The benefits of good hard work.,, Choices to protect what you've worked so hard to build Each individual's lifestyle and needs are different from the next.Voluntary benefits from Colonial Life—on both an individual and group platform—offer a broad range of financial protection options for employees and their families. - Disability Insurance ■ Individual Disability-A short-term disability product that replaces a portion of income for on/off-job or off-job only disabilities.Optional features include psychiatric and psychological conditions benefits and waiver of elimination period forfirst day hospital �° confinement.Guaranteed-issue and simplified-issue options are available. Accident Insurance ■ Individual Accident-Aguaranteed-issue,composite-rated,guaranteed-renewable accident product that offers several coverage levels to fit all budgets.Employer-optional p g g benefits are available to customize the accident product offering.Additional employee- choice riders can create a comprehensive product package. Special Risk Insurance ■ Individual Cancer-A cancer product that pays indemnity-based benefits to help cover TWCITOF IN FALLS medical and non-medical expenses related to cancer diagnosis and treatment. ,J ■ Individual Critical Illness-A critical illness product that provides a lump-sum benefit A`FseR ,�Q�o for the diagnosis of a critical illness. Supplemental Health insurance ■ Individual Medical Bridges"'-A hospital confinement indemnity product that To learn more,contact: supplements your core medical coverage,offering benefits such as hospital confinement,health screening orwellness,rehabilitation unit confinement and doctor's TROY D GIFFORD 208-860-8294 troy@ apxbenefits.com Learn more about the products available to you and schedule an appointment with a benefit counselor by visiting the website below. https://learn.colonial Iife.com/cityoftwinfal Is Colon ialLife.com NS-16028 3-17 1 NS-16028 r Important coverage features: ■ With most products, coverage is available to spouses and eligible dependent children. ■ Benefits are paid directly to the insured,unless specified otherwise. ■ With most products, employees can continue coverage with no increase in premiums if they retire orchangejobs. ■ With most products, employees may receive benefits regardless of any other insurance. ■ Premiums are payroll deducted for easy administration. Learn more about what we have to . Colonat • CdoniaLife.com ACCIDENT,CANCER,CRITICAL ILLNESS,AND HOSPITAL INDEMNITY PRODUCTS PROVIDE LIMITED BENEFITS. The policies,their names or their provisions may vary or be unavailable in some states.The policies have exclusions and limitations which may affect any benefits payable.Seethe actual policy or your Colonial Life representative for specific provisions and details of availability. Insurance products are underwritten by Colonial Life&Accident Insurance Company,Columbia,SC. ©2018 Colonial Life&Accident Insurance Company.All rights reserved.Colonial Life is a registered trademark and marketing brand NS-16028 of Colonial Life&Accident Insurance Company. 0 LTC SOLUTIONS, INC. What is LTC Insurance? The Cost' E), Nursing home costs are averaging$112,300 per year. With an average Olength of stay at 2.4 years,total costs can exceed $269,520. 9 2022 Annual Cost /Average Stay Long-term care insurance is designed to pay jII� for custodial care once you are in need of assistance with two or more Activities of Daily Living or have a cognitive impairment like dementia or Alzheimer's. Home Care Assisted Living Nursing Home 3 Years 2.5-3 Years 2.4 Years Long-term care insurance will pay for care received at home, in a nursing home or $55,000 $50,000 $112,300 assisted living facility. The Risk Ages 65+ 56%of couples without long- 67% term care insurance spend 0.1% 2.3% 12.5% Ages 18+ House Fire Auto Accident Disability their income down to the • 40% poverty level after one partner ®� has spent 6 months in a nursing home.'When compared to using other lines Long-Term Care of personal insurance, long- - I term care is the highest risk. City of Twin Falls' Plan Highlights Benefit Features Available Plan Options Monthly Benefit Amount Nursing Home Facility(100%) $50,000, $100,000, Assisted Living Facility(100%) $200,000 or$300,000 Professional Home Care(100%) Monthly Access Limit 2% Inflation Protection None, 1%Compound, 3%compound or 5%compound Elimination Period 90 days Voluntary Long Term Care City of City of Twin Falls has partnered with LTC Solutions, Inc., an expert in the long-term care insurance marketplace, and LifeSecure, a well-established carrier in the industry.Together, we bring you the opportunity to purchase a valuable long- term care insurance plan with discounted group rates. How Much Does a Plan Cost? Every benefit dollar makes a difference when you need care. LifeSecure offers many plan choices, allowing you to choose a plan that offers enough coverage to be meaningful to you and your family at an affordable rate. To give you an idea of pricing, here are Monthly Premium some examples of monthly premiums for a $100,000 benefit bank, 2% monthly access 30 $29.25 limit, no Inflation plan. 40 $40.17 Actual rates will vary based on age of 50 $58.17 applicant and plan design. 60 $96.83 Eligibility How Are Premiums Paid? Newly-eligible or newly-hired employees and their Spouses9 may apply Employee and spouse premiums will be for coverage with fewer health questions10for 90 days following date of payroll deducted. hire.This is a one-time opportunity that will not be offered at future open enrollments. If you leave City of Twin Falls, you will have All other benefit eligible employees and their Spouses9 who did not the opportunity to continue your coverage enroll during the qualifying period or would like to make changes to at the same rate. existing coverage may enroll at anytime with full underwriting. For More Information 1 Genworth 2019 Cost of Care Survey.Tenth Edition. © Online Benefit Guide' 2 Based on an 8-hour day for a homemaker at$19/hour to a home health aide for$21/hour. 3 Health Insurance Association of America www.mvltcguide.com/twinfalls 4 Karter,Michael J.,Fire Loss in the United States during 2004,National Fire Protection Association. 5 Bureau of the Census Data,2000 and 2000 data collected from the federal Highway Administration, November 2001 ® Toll-Free: 6 US Department of Health and Human Services."National Clearinghouse for Long Term Care (877) 286-2852 Information." 2011. 7 Long-Term Care.AHRQ Focus on Research.AHRQ Pub No.02-M028,March 2002.Agency for Healthcare Research&Quality Email: 8 US Department of Health and Human Services.What is Long-Term Care?2009. 9 Active employees ages 18-69 working at least 20 hours per week. LTCiBenefitsTeam@ Itc-solutions.com 10 Active employees ages 18-64 working at least 20 hours per week.Eligible employees ages 65-69 may apply with full underwriting.Spouses ages 18-49 working 20+hours per week for their employer may apply with reduced underwriting provided the eligible employee also applies for coverage.Spouses ages 50-69 may apply with full underwriting. I y Pets Best PET HEALTH INSURANCE Flexible Pet Insurance r . , T1 Coverager How pet insurance . OReady for anything. I Attend to Your Pet O 24/7 pet helpline support. When yourpet getinjured, they can get treatment s Customizable plans for cats and dogs. fromany veterinarianin the US or ... Be the best pet parent you can be 0 File a Claim You have an unbreakable bond with your pet which is You file a claim through why our coverage eliminates the stress, heartache, and our app or online, and you don't uncertainty associated with unexpected events. When need to send us medical records your pet gets sick or injured, they can get treatment they unless ' r them. need, when they need it. 0 Easy Reimbursement • Use any licensed veterinarian in the US or Canada — Your reimbursement can including specialty and emergency clinics be conveniently and easily Exclusive employee discount on a BestBenefit plan' deposited directly into yourbank • Optional coverage for routine care . you wonder • Around the clock support from the 24/7 pet helpline • Easy claims submission ENJOY • Self-service through our mobile app U P � O O EMPLOYE R TO DISCOUNT Pet insurance coverage offered and administered by Pets Best Insurance Services,LLC is underwritten by American Pet Insurance Company,a New York insurance company headquartered at 6100 4th Ave.S.Suite 200 Seattle,WA 98108,or Independence American Insurance Company,a Delaware insurance company located at 11333 N.Scottsdale Rd,Ste.160,Scottsdale, City of Twin Falls AZ 85254.Pets Best Insurance Services,LLC(CA agency#O1`37530)is a licensed insurance agency located at 10840 Ballantyne Commons Parkway,Charlotte,NC 28277.Each insurer has sole financial To begin, enroll responsibility for its own products.Please refer to your declarations page to determine the underwriter for your policy.Terms and conditions apply.See your policy for details.*5%group discount applies to www _tsb_ BestBenefit plans;discount not available in AK,HI,or TN.Save 5%when you enroll more than one pet. • Discount applies to BestBenefit plans. or call 888-984-8700 ,I1 synchrony I Pets Best is a Synchrony(NYSE:SYF)Health and Wellness solution. Reference discount code: CTFPETS Pets Bes ' PET HEALTH INSURANCE r 1 Plan - e Overview Plan Coverage Essential Plus Elite Annual Coverage Limit for Unexpected $5,000 - $5,000 - $5,000 - Accidents and Illness Unlimited Unlimited Unlimited Annual Deductible $50 - $1,000 $50 - $1,000 $50 - $1,000 Reimbursement Percentage 70% - 90% 70% - 90% 70% - 90% Accidents, Illnesses, Cancer, Hereditary O O O Conditions, Emergency Surgeries & Rx Meds* Accidents & Illness Exam Fees Associated with O O the Diagnosis of Your Pet for an Eligible Injury or Illness. This is not intended to cover routine exams. Rehabilitative, Acupuncture & Chiropractic O Coverage to Treat Eligible Injuries and Illnesses. Wellness Add-On for Routine Care Coverage to help pay for regular and expected O O O veterinary visits. Please see Wellness Plans Summary for pricing information. Accident-Only Coverage If your pet currently has Addison's Disease,Cushing's Disease, Diabetes,Cancer, Feline Leukemia or Feline Immunodeficiency Virus,they can enroll for Accident Only coverage, but will be ineligible for illness coverage.The Accident Only plan does not cover medical issues such as illness or cancer, but provides up to$10,000 in annual coverage for things like broken legs,snake bites,accidental swallowing and more.Coverage starts at$9 per month for dogs,and$6 per month for cats.* • -I Pet insurance coverage offered and administered by Pets Best Insurance Services,LLC is underwritten by American Pet Insurance Company,a New York insurance company headquartered at 6100 4th Ave.S.Suite 200 Seattle,WA 98108,or Independence American Insurance Company,a Delaware insurance company located at 11333 N.Scottsdale Rd,Ste.160, Scottsdale,AZ 85254.Pets Best Insurance Services,LLC(CA agency#OF37530)is a licensed insurance agency located at 10840 Ballantyne Commons Parkway,Charlotte,NC 28277.Each insurer has sole financial responsibility for its own products.Please refer to your declarations page to determine the underwriter for your policy.Terms and conditions apply.See your policy for details.*Most plans cover prescription medications.Download our formulary at petsbest.com/coverage.$7/month for cats and$10/month for dogs in WA.Coverage applies to eligible conditions only and is subject to all terms, conditions,limitations and exclusions in the policy.Please review policy form for complete details. ill synchrony I Pets Best is a Synchrony(NYSE:SYF)Health and Wellness solution. • & )� Pets Best PET HEALTH INSURANCE Routine Care k+ Coverage Routine care coverage for dogs and cats helps pay for regular veterinary visits. There are two tiers of routine care coverage that can be added to one of our pet health insurance plans for an additional premium at the time you enroll, or at your annual renewal. Benefits are available to you on your policy start date, so you can start using your routine care plan as soon as your policy goes into effect. Essential Wellness BestWellnessTM 0 $14-21.75/per month' 0 $26-32.58 /per month' Total Annual Benefits up to $305 Total Annual Benefits up to $535 Benefits Include o 0e) == OOM Wellness Exams Spaying & Neuteringt Teeth Cleaningt Microchipping Diagnostic Panels Preventative Medications Vaccinations Routine care plans not sold as a stand-alone plan and if purchased must be added to a BestBenefit Accident and Illness Plan. *Price varies by state,and by pet age.Get a quote to see pricing and for your pet.t Benefits only available with BestWellness plan r Pet insurance coverage offered and administered by Pets Best Insurance Services,LLC is underwritten by American Pet Insurance Company,a New York insurance company headquartered at 6100 4th Ave.S.Suite 200 Seattle,WA 98108,or Independence American Insurance Company,a Delaware insurance company located at 11333 N. Scottsdale Rd,Ste.160,Scottsdale,AZ 85254.Pets Best Insurance Services,LLC(CA agency#OF37530)is a licensed insurance agency located at 10840 Ballantyne Commons Parkway, Charlotte,NC 28277.Each insurer has sole financial responsibility for its own products.Please refer to your declarations page to determine the underwriter for your policy.Terms and conditions apply.See your policy for details. ,11 synchrony I Pets Best is a Synchrony(NYSE:SYF)Health and Wellness solution. Or >> Pets Best PET HEALTH INSURANCE j FAG How long are Pets Best's waiting periods? procedures. We want your pet to receive the best A waiting period refers to the amount of time after possible care, which is why we also cover visits to enrolling before your pet is eligible for coverage.Waiting specialists and emergency after-hours clinics. periods vary by the type of coverage and start on the effective date of your policy. Once met, waiting periods Do I need to have the Routine Care option? are waived for continuous, uninterrupted policy renewals. Not at all!You can simply pay the annual expenses of Pets Best offers some of the shortest waiting periods in routine care, like dental cleaning,vaccinations and blood the industry following the policy effective date. Get a work, on your own. However, our routine care options quote for specific information on waiting periods in your are designed to save you money on expected and state. preventative care for your pet. When can I insure my pet with Pets Best? Will Pets Best cover my pet's dental needs? You can enroll your pet as young as 7 weeks. Like Good dental care is incredibly important to your pet's children, puppies and kittens have the highest risk of overall health. Our BestBenefit plans include coverage accidents. Their immune systems aren't mature, so for periodontal disease and other dental issues if proper they're more susceptible to infectious diseases. Pets Best preventative care as outlined in the policy document has plans have no upper age limits, so senior dogs and cats been performed. get the same great coverage as kittens and puppies. How do I file a claim? My pet is already sick or injured. Can pet The easiest and fastest way to file a claim is through your insurance help? customer account or one of our mobile apps. Once you Pets Best is here for unexpected accidents and illnesses. log in you can submit and view claims, and sign up for It does not cover preexisting conditions. However, direct deposit.You can also send your claim via email, many future accidents and illnesses should be covered fax, or standard mail. It's up to you! if something happens. We also offer accident-only coverage for pets with severe chronic conditions, and Do you use a benefit schedule? wellness coverage to help manage the cost of routine No,our BestBenefit plan does not use a benefit schedule care for your pet. but our BestWellnes plan does,which is a list that puts a limit on what each type of treatment can cost. Instead, Can I use my own veterinarian? we reimburse your choice of up to 90%* of your vet bill Yes. Pets Best has no networks, so you can use any after the deductible of your choice, up to your plan's licensed veterinarian in the US or Canada. We also maximum benefit. have no schedule of benefits and no pre-authorization • Pet insurance coverage offered and administered by Pets Best Insurance Services,LLC is underwritten by American Pet Insurance Company,a New York insurance company headquartered at 6100 4th Ave.S.Suite 200 Seattle,WA 98108,or Independence American Insurance Company,a Delaware insurance company located at 11333 N.Scottsdale Rd,Ste.160,Scottsdale,AZ 85254.Pets Best Insurance Services,LLC(CA agency#OF37530)is a licensed insurance agency located at 10840 Ballantyne Commons Parkway,Charlotte,NC 28277.Each insurer has sole financial responsibility for its own products.Please refer to your declarations page to determine the underwriter for your policy.Terms and conditions apply.See your policy for details.*Select a plan that reimburses 70%,80%,or 90%of the cost of eligible veterinary treatment.Limited to covered expenses. ,11 synchrony I Pets Best is a Synchrony(NYSE:SYF)Health and Wellness solution.