2021 Benefits Guide

Plan Year January 1, 2021 through December 31, 2021

Revised 09.28.2020

The City of Littleton is pleased to provide you with benefit offerings to help you take care of your well-being now and into the future. We want each and every participant to receive the highest quality health coverage at the most affordable price possible.

This booklet provides a high-level overview of the plans. More information about our plan is available in your full plan description or by contacting HR.

Table of Contents Benefit Program Overview ............................................................................................................................. 3 Benefit Eligibility ............................................................................................................................................ 4 Enrollment Instructions ................................................................................................................................. 6 Medical Plan .................................................................................................................................................. 9 Medical Plan Costs ........................................................................................................................................ 11 Cost Savings Resources ................................................................................................................................ 12 Prescriptions ................................................................................................................................................ 13 City of Littleton Employee Wellness Clinic .................................................................................................... 15 Dental Plan ................................................................................................................................................... 17 Dental Plan Costs ......................................................................................................................................... 18 Vision Plan ................................................................................................................................................... 19 Vision Plan Costs .................................................................................................................................................. 20 Life Insurance ............................................................................................................................................... 21 Voluntary Life/AD&D ................................................................................................................................... 22 Disability Insurance ...................................................................................................................................... 23

Employee Assistance Program ..................................................................................................................... 24

Tax Savings Programs ................................................................................................................................... 25

Legal Shield ................................................................................................................................................... 26

Time-Off Benefits .......................................................................................................................................... 27 Retirement Plans ......................................................................................................................................... 30

Tuition Reimbursement ............................................................................................................................... 32 Wellness Program ........................................................................................................................................ 32 Plan Contacts ............................................................................................................................................... 33 Important Plan Notices and Documents ....................................................................................................... 34

Benefit Program Overview

Contact Human Resources for Help City of Littleton – Human Resources (303) 795-3857 HR@littletongov.org

BENEFIT OFFERINGS MEDICAL Cigna LocalPlus Plan

Medical plan includes: - $500 deductible for in-network providers - $25 copays for visits to PCP and $50 copay for visits to specialists - 80% coinsurance for other services - (Copays/coinsurance shown are for in-network providers)

DENTAL Delta Dental PPO plan: - Preventative care covered at 100% - $50 deductible for other services

VISION The VSP network for vision care, including a $10 copay for in-network exams and allowances for glasses or contacts

BASIC LIFE & ACCIDENTAL DEATH & DISMEMBERMENT

1.5 x your annual salary, up to $250,000 of coverage for both life and accidental death & dismemberment (AD&D).

SHORT-TERM AND LONG- TERM DISABILITY

Benefit varies based on years of service. (see pg. 23 for details)

VOLUNTARY BENEFIT OPTIONS

Employees may choose to purchase voluntary benefits through convenient payroll deduction:

- Employee & Dependent Supplemental Life Insurance - Flexible Spending Accounts

EMPLOYEE ASSISTANCE PROGRAM

Regular full and part-time employees and their dependents (living in their household) are eligible for 5 free sessions per incident, per person, per

calendar year. RETIREMENT PLANS General Employee Retirement Plan

Police Employee Pension Plan Deferred Compensation Plan

PAID HOLIDAYS The city observes 9.5 paid holidays per year

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Benefit Eligibility The City of Littleton allows employees to participate in the plans if they meet the minimum service hour requirements, as outlined in the table below, and are a regular employee. *

BENEFIT Part-Time Rate Service Requirement

Full-Time Rate Service Requirement

Medical 20+ hours per week 30+ hours per week

Dental, Vision, Life, AD&D, Long-Term Disability 20+ hours per week 30+ hours per week

Voluntary Benefits through Voya 20+ hours per week 30+ hours per week

Employee Assistance Program All full-time and part-time employees

*If you are a temporary employee working 30 hours or more, you may be eligible for medical benefits due to provisions of the Affordable Care Act (healthcare reform). Please see Human Resources if you have any questions.

Eligible dependents* • Legal spouse (same or opposite sex) • Civil union partner • Common-law spouse • Child(ren) to the age of 26 — married and unmarried- biological, legally adopted, or legal custody • Stepchild(ren) to the age of 26 — the employee must be married to the child’s parent

Eligibility Documents Required Proof of eligibility is required for all dependents covered on the City’s insurance. Acceptable documentation includes:

• Marriage certificates for spouses • Civil union certificate for civil union partner • Birth certificates or proof of legal guardianship for children • Affidavit for common-law spouses

*Domestic partners verified prior to December 31, 2019 are still considered eligible dependents.

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To request a benefits change, notify Human Resources within 30 days of the qualifying life event. Change requests submitted after 30 days cannot be accepted. You will need to provide proof of the event, such as a marriage license or birth certificate.

When you can enroll You can enroll in benefits as a new hire, during our annual enrollment period or if you experience a qualifying life event. New hires or employees who have a change in employment status that makes them eligible for benefits must enroll within 30 days of their hire date or eligibility date. Coverage is effective on the first of the month following their date of hire or eligibility.

Changing your benefits Outside of open enrollment, you may be able to add or remove dependents or change benefit options if you experience a qualifying life event. A qualifying life event is a change in your family status or employment that affects your benefits eligibility. Examples include:

• Marriage or divorce • Birth, adoption, death of a dependent • A dependent child is no longer eligible because they have reached age 26 • Change in the employment of an employee or an employee’s spouse that affects benefit eligibility

It is the employee’s responsibility to submit the appropriate paperwork to Human Resources within 30 days of the event. If this deadline is missed, the employee must wait until the next open enrollment period to make changes.

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2020 Open Enrollment Enroll online from Tuesday, October 27, 2020 through Monday, November 9,

2020

Online Enrollment Instructions- Sage Employee Self-Service

The City of Littleton uses Sage Employee Self Service to make the benefits enrollment process easy and convenient.

Beginning Tuesday, October 27, 2020, Employee Self Service will enable you to enter, customize, validate, and confirm your benefits selection and dependent information online.

Selecting Your Benefits Online is Simple!

Just follow these step-by-step instructions.

Log onto SAGE Employee Self Service at

https://benefits.littletongov.org/sagebenefits/default.aspx

Review Message Center and Enter Open Enrollment

There will be Open Enrollment Notifications on the left of the screen click “Open Enrollment”

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Online Enrollment Instructions- Sage Employee Self-Service

Once you have started the Open Enrollment Session

You will notice your enrollment status will show “Incomplete” (you must re-elect your benefits)

To navigate to each page use the arrows at the top of the page on the right.

Adding or Editing Dependents

§ If you do not see your dependents listed under “Dependents” you can add or edit by clicking the plus sign

o If you would also like them to be a beneficiary, select “Both” as the type of dependent. o You must select the coverage tier AND check the box next to the Dependents name

to elect coverage. o Important: If you are choosing to cover a dependent (Spouse/Child(ren)), you must

select the correct tier (Employee + spouse, EE+Child(ren), or Family) AND choose the dependents that are to be covered

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Reviewing and Confirming

§ Print a copy for your records

Understanding Flexible Spending Elections You must select or waive the Flex Spending Account

§ Note: When entering an annual amount, do not use dollar signs, commas, or decimals.

IMPORTANT: Submitting your Benefit Elections

§ You must change select “I’M FINISHED” § Enter your ESS Username § Enter your ESS Password § Enter your Social Security number (WITH DASHES) ie. 211-11-1111 § Click Done

o You should receive a “Congratulations” email instantly showing you successfully completed Open Enrollment.

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Your Medical Plan The City of Littleton offers one medical plan through the Cigna LocalPlus network. Your plan includes free preventive care from in-network providers to ensure that you are staying healthy. The medical plan provides in- and out-of-network benefits, providing you the freedom to choose a provider. However, you will maximize the plan benefits and pay less out of your pocket when you choose an in-network provider. Your plan provides a large network of doctors, hospitals, and labs.

Your Plan offers

• Online tools and health resources to make managing your care and coverage easier • 24/7 access to a Cigna AmWell or MDLIVE doctors for confidential, expert answers to your

health questions • Access to Cigna mobile app to find network doctors, compare cost information, order

prescriptions, and more. • Cigna Cancer Support for patients and families • 90-Day Prescription Refills on maintenance medications with Cigna 90 Now.

Make sure you choose a doctor that is in the LocalPlus Network to get the most out of your benefits!

• Go to myCigna.com and sign in with your user ID and passcode. (If you’re not already registered for myCigna.com, click on “Register Now” to sign up)

• Click on the “Find a Doctor” tab • Enter the requested details for your search • Click on “Search” to see all the doctors and hospitals in the LocalPlus Network. (If there is no

LocalPlus Network in your search area, you’ll see a link to our Away From Home Care Network)

With these benefits, you can be confident you are getting the best value for your health care and coverage dollars. Please visit www.mycigna.com and don’t forget to register for access to many member resources and tools that are also available on the mobile app.

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Cigna LocalPlus The table below summarizes the key features of the medical plan. The coinsurance amounts listed reflect the amount you pay. Please refer to the official plan documents for additional information on coverage and exclusions.

In-Network Out-of-Network Annual Deductible

Individual $500 $1000

Two Person/Family $1000 $2000

Annual Out-of-Pocket Max

Individual $4,000 $10,000

Two Person/Family $8,000 $20,000

Preventive Services Plan pays 100% Plan pays 50%

Office Visit

$25 copay

$50 copay

Primary Provider 50% Coinsurance

Specialist 50% Coinsurance

Urgent Care $50 copay $50 copay

Emergency Room Plan pays 80% after deductible Plan pays 80% after deductible

Lab and X-ray Plan pays 80% after deductible Plan pays 50% after deductible

Inpatient Hospitalization Plan pays 80% after deductible Plan pays 50% after deductible

Outpatient Surgery Plan pays 80% after deductible

Plan pays 50% after deductible

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Medical Plan Costs Listed below are the biweekly costs for medical insurance. The amount you pay for coverage is deducted from your paycheck on a pre-tax basis.

Full-Time Biweekly Medical Costs

Coverage Level

Full-Time Rate

Employee Medical Cost

Full-Time Rate

City Medical Cost

Employee Only $34.23 $308.04 Employee + Spouse $140.16 $560.62 Employee + Child(ren) $130.06 $520.24 Employee + Family $200.22 $800.89

Part-Time Biweekly Medical Costs

Coverage Level

Part-Time Rate

Employee Medical Cost

Part-Time Rate

City Medical Cost

Employee Only $136.90 $205.36 Employee + Spouse $350.39 $350.39 Employee + Child(ren) $325.14 $325.16 Employee + Family $500.56 $500.56

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Cost Saving Resources Chat with a Doctor at Home, Work or on the Go

Cigna Telehealth Connection lets you get the care you need – including most prescriptions – for a wide range of minor conditions. Now you can connect with a board-certified doctor via secure video chat or phone, without leaving your home or office. When, where, and how it works best for you!

24/7 Medical Advice

• Televisits with AmWell and MDLIVE can be a cost-effective alternative to a convenience care clinic or urgent care center and cost less than going to the emergency room.

• Connect with a board-certified doctor via secure video or chat or phone, without leaving your home. • Choose when: Day or night, weekdays, weekends, and holidays. • Choose where: Home, work, or on the go. • Choose how: Phone or video chat. • Choose who: AmWell or MDLIVE doctors.

• You can speak with a doctor for help with:

Sore Throat Fever Rash Headache Cold & Flu Acne

Stomachache Allergies UTI’s and more…

• The cost of a phone or online visit is the same or less than with your primary care provider. • The telehealth services are only available for minor, non-life-threatening conditions. In an

emergency, dial 911 or go to the nearest hospital.

Register for one or both today so you’ll be ready to use a telehealth service when and where you need it.

AmWellforCigna.com* MDLIVEforCigna.com* 855-667-9722 888-726-3171

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Prescriptions 90 Day Prescription Refills, More Choice

Your plan includes a new maintenance medication program called Cigna 90 Now. Maintenance medications are taken regularly, over time, to treat ongoing health conditions. Cigna 90 Now offers you more choice in how and where you can fill your prescriptions.

Choose What Works Best For You

• If you choose to fill your prescription in a 90-day supply, you have to use a 90-day retail pharmacy in your plan’s network, or Cigna Home Delivery Pharmacy

• If you choose to fill your prescription in a 30-day supply, you can use any retail pharmacy in your plan’s network.

Where You Can Fill a 90-day Prescription

• With Cigna 90 Now, your plan offers a retail pharmacy network that gives you more choices in

where you can fill your 90-day prescriptions. • There are thousands of retail pharmacies in your network. They include local pharmacies, grocery

stores, retail chains, and wholesale warehouse stores – all places where you already shop. • If you prefer the convenience of having your medications delivered to your home, you can also use

Cigna Home Delivery Pharmacy to fill your prescriptions.

Cigna Home Delivery Pharmacy

• The Cigna Home Delivery Pharmacy will deliver your medication to you at the location of your choice with free shipping included every time.

For More Information About Your Pharmacy Network, You Can Go To

Cigna 90 Now Pharmacy Network: Cigna.com/Rx90network Cigna Home Delivery Pharmacy: Cigna.com/home-delivery-pharmacy or 800-285-4812

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Prescriptions – Specialty Medications Under your Cigna prescription drug plan, you and your dependents can fill one prescription at a retail pharmacy. After that, your specialty medications will only be covered when you use Cigna Specialty Pharmacy Services. These prescriptions can be delivered to your home.

Ordering Your Specialty Medications Contact Cigna at 800-351-3606. Give the representative your medication, doctor’s information, and payment information. Cigna will then contact your doctor and coordinate any necessary benefit approvals. You can also log in to myCigna.com and visit the Cigna Home Pharmacy page for more information. You can see the real- time pricing of medications.

More Than Just Your Medication

• 24/7 access to customer service and pharmacists to help answer any questions • Free standard shipping anywhere in the U.S. • Condition-specific support and therapy management • Convenient delivery right to your door or preferred location • Helpful coaching and reminder services • Supplies like tape, bandages, sharps collectors, swabs, etc. • Access to educational materials and more • Discreet packaging at no additional cost to protect quality and privacy • Financial assistance may be available for costly medications

For More Information About Your Specialty Medications, You Can Go To

Cigna Specialty Pharmacy Services: 800-351-3606 Cigna Home Delivery Pharmacy: Cigna.com/home-delivery-pharmacy

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City of Littleton Employee Wellness Clinic by CareHere CareHere offers a City of Littleton Employee Wellness clinic. It is free to employees, their spouses, and dependents, two years of age and older who are covered by the City of Littleton’s health plan.

Primary Care

You can get care for your sore throat, a cold, or the flu, and help with high blood pressure or diabetes. Your City of Littleton Employee Wellness clinic will treat both acute and chronic conditions, all at no cost to you.

The City of Littleton Employee Wellness clinic will dispense dozens of select generic medications and also provide annual physicals, health coaching, lab work, and much more.

Benefits

• No deductibles or co-pays for visits • No cost for on-site labs • No cost for available generic medications • Short or no time in a waiting room • Schedule appointments online, on your smartphone or tablet, or by calling the 24/7 helpline • Private and secure records will not be shared with your employer or anyone else without your

permission

Location

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Dental Did you know that regular dental checkups keep your smile bright and also help keep your whole body healthy? Many people believe that they need to see a dentist only if they are in pain or when something is wrong, but regular dental visits can contribute to a lifetime of good oral health. Our dental coverage provides cleanings, exams, and x-rays. If there’s a problem, your plan helps with the cost of dental work.

The City of Littleton offers a dental plan through Delta Dental. The PPO Plan provides a lower benefit level for a lower monthly premium. You may visit any dentist; however, you receive the greatest benefits when you visit in-network dentists. To find a provider call 1-800-610-0201 or go to www.deltadental.com.

PPO Plan In-Network

Delta PPO and Premiere Dentist

Out-Of-Network

Calendar Year Deductible

Individual/Family $50

$150

Annual Plan Maximum $2,000 per person

Diagnostic & Preventive Plan pays 100% (deductible waived)

Basic Services Plan pays 100% after deductible

Fillings Plan pays 100% after deductible

Root Canals Plan pays 100% after deductible

Periodontics Plan pays 100% after deductible

Major Services Plan pays 50% after deductible

Orthodontic Services Plan Pays 50% ($1800 lifetime max per person – children to age 24 only)

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Dental Plan Costs Listed below are the biweekly costs for dental insurance. The amount you pay for coverage is deducted from your paycheck on a pre-tax basis.

Full-Time Biweekly Dental Costs

Coverage Level

Full-Time Rate

Employee Dental Cost

Full-Time Rate

City Dental Cost Employee Only $0 $19.04 Employee + Spouse $18.82 $21.17 Employee + Child(ren) $26.44 $21.17 Employee + Family $45.49 $21.17

Part-Time Biweekly Dental Costs

Coverage Level

Part-Time Rate

Employee Dental Cost

Part-Time Rate City Dental Cost

Employee Only $5.71 $13.33 Employee + Spouse $25.99 $13.99 Employee + Child(ren) $30.94 $16.66 Employee + Family $49.99 $16.66

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Vision Vision coverage helps with the cost of eyeglasses or contacts. But even if you don’t need vision correction, an annual eye exam checks the health of your eyes and can even detect more serious health issues such as diabetes, high blood pressure, high cholesterol, and thyroid disease.

Our vision plan uses the VSP network of providers. It covers an exam and lenses every 12 months and covers eyeglass frames every 24 months. You can search for a doctor online at www.vsp.com or by calling 1 (800) 216-6248.

VSP Vision Care Plan In-Network Out-Of-Network

Examination (Every 12 Months)

$10 Copay

Up to $50

Spectacle Lenses (Every 12 Months)

Single $25 Copay Up to $50

Bifocal $25 Copay Up to $75

Trifocal $25 Copay Up to $100

Frames

(Every 24 Months) $130 Allowance; then 20% off

balance over $130

Up to $70

Contacts Instead of Glasses (Every 12 Months)

$130 Allowance

Up to $60

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Vision Plan Costs Listed below are the biweekly costs for vision insurance. The amount you pay for coverage is deducted from your paycheck on a pre-tax basis.

Full-Time Biweekly Vision Costs

Coverage Level

Full-Time Rate

Employee Vision Cost

Full-Time Rate City Vision Cost

Employee Only $0 $4.38 Employee + Spouse $2.62 $4.38 Employee + Child(ren) $2.78 $4.37 Employee + Family $7.14 $4.38

Part-Time Biweekly Vision Costs

Coverage Level

Part-Time Rate

Employee Vision Cost

Part-Time Rate City Vision Cost

Employee Only $1.31 $3.06 Employee + Spouse $3.55 $3.45 Employee + Child(ren) $3.70 $3.45 Employee + Family $8.07 $3.45

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Make sure that you have named a beneficiary for your life insurance benefit and update it if your family or marital status changes.

Life Insurance

Life insurance can fill a number of financial gaps for a family recovering from the death of a loved one. Without enough life insurance, many families have to reduce their standard of living after the loss of an income. Consider your current and future financial needs when evaluating how much coverage you need. The most common short and long-term financial needs include:

• Medical bills and funeral expenses • Living expenses for the surviving family (housing, food, clothing, utilities, etc.) • Large expenses, e.g., college education, or home mortgage • Taxes and debts that need to be settled.

Basic Life and AD&D Basic Life Insurance pays your beneficiary a lump sum if you die. AD&D (Accidental Death & Dismemberment) provides another layer of benefits to either you or your beneficiary if you suffer certain injuries or death from an accident. The City of Littleton pays 100% of the premium for basic life and AD&D.

2021 Voya Financial LIFE and AD&D

Basic Life and AD&D Amount Employee: 1.5 x employee annual earnings, up to $250,000

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Make sure that you have named a beneficiary for your life insurance benefit and update it if your family or marital status changes.

Voluntary Life and AD&D You may supplement your basic life and AD&D coverage with voluntary coverage through Voya Financial. If you are a new employee enrolling when you first become eligible, you will be guaranteed $100,000 of coverage up to 3 times your annual earnings for yourself without having to submit a medical questionnaire.

You may purchase life insurance in the following coverage amounts:

2021 Voya FINANCIAL VOLUNTARY LIFE and AD&D

Voluntary Life and AD&D Amounts

Employee: A maximum of $500,000 or 5 x earnings, in increments of $10,000

Spouse: A maximum of $50,000, in increments of $5,000, may not exceed 50% of the employee’s voluntary life amount

Child(ren): $10,000

Contact HR for rates on voluntary life insurance

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Disability Insurance

Disability insurance replaces part of your pay while you are unable to work so you have a continuing income for living expenses.

2021 Voya Financial Short-Term Disability

Should you become disabled, short-term disability (STD) may provide you 60% of your pre-disability salary up to $3,500 per week. STD is available after a 2-week waiting period of the time of disability. The City of Littleton pays 100% of the premium for short-term disability insurance.

Benefit Amount 60% of weekly pre-disability earnings

Maximum Benefit $3,500 per week

Elimination Benefit 14 days Accident or Illness

Benefit Duration 11 weeks

2021 Voya Financial Long-Term Disability If you are unable to work for longer than ninety days, long-term disability (LTD) coverage replaces part of your monthly income. Payments may be reduced by state, federal, or private disability benefits you receive while disabled. The City of Littleton pays 100% of the premium for long-term disability insurance.

General Government Benefit Commissioned Police Eligible for Normal Retirement

Monthly benefit 60% of salary, up to a maximum of $6,000

40% of salary, up to a maximum of $2,000

Benefits begin 90 days after injury or illness 180 days after injury or illness

Effective date Date of hire Date of hire

Maximum payment period

Later of 65 or Social Security Normal Retirement Age

Later of 65 or Social Security Normal Retirement Age

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You also have 24/7 access to a ComPsych Guidance Resources program that offers someone to talk to and resources to consult whenever and wherever you need them.

Call: 877-533-2363 (max. 3 calls per issue) Online: guidanceresources.com (Web ID: My5848i)

Employee Assistance Program

Regular full and part-time employees and their dependents (living in their household) are eligible for five (5) free sessions per incident, per person, per calendar year.

Everyone has been affected by personal problems at some time in is his/her life. These problems may affect personal happiness and create disruption in job performance. Because the City of Littleton values its employees and the work they perform, we have provided an Employee Assistance Program (EAP) through Mines and Associates. The EAP provides assessment referral, focused therapy and coaching for employees and their household members in dealing with such issues as:

Abuse Anxiety Career Depression

Child & Eldercare Death, Grief & Dying Financial Problems Mood Disorders

Drug/Alcohol Concerns Eating Disorders Stress Supervisory Resources

Legal Referrals Marital & Relationship Psychological Sexual

Work-Related Wellness Coaching

The use of the Employee Assistance Program is strictly confidential. Your contact with the EAP and your counselor will not be discussed within the organization in any way without your written permission. There will be no information in your personnel file pertaining to the use of the EAP. The EAP offices are located away from the workplace to provide as much privacy as possible.

Additionally, supervisors have access to unlimited workplace consultation regarding work performance issues.

For more information, please contact Mines and Associates at (303) 832-1068 or by visiting their website at www.minesandassociates.com

The biggest deduction from your paycheck is likely federal income tax. Why not take a bite out of taxes while participating in these programs which you pay for with pre-tax dollars?

Tax Savings Programs Flexible Spending Accounts

The City of Littleton offers two flexible spending account (FSA) options – the Heath Care FSA – which allows you to pay eligible health care and dependent care expenses with pre-tax dollars. The FSAs are administered by 24HourFlex. Log into your account at www.24HOURFLEX.com to: view your account balance(s), calculate tax savings, view eligible expenses, download forms, view transaction history, and more. You will receive a 24HourFlex stored value VISA card, which can be used to pay for eligible health care at the point of service. If you do not use your card or if you have dependent care expenses to be reimbursed, submit a claim form and a bill or itemized receipt from the provider to 24HourFlex.

Health Care FSA The health care FSA through 24HourFlex allows you to set aside money from your paycheck on a pre-tax basis (before income taxes are withheld) to pay for eligible out-of-pocket expenses, such as deductibles, copays, and other health-related expenses, that are not paid by the medical, dental, or vision plans. Over-the-counter (OTC) medication is not eligible for reimbursement without a prescription.

The health care FSA maximum contribution is $2,750 for the 2021 plan year.

Dependent Care FSA The Dependent Care FSA allows you to set aside money from your paycheck on a pre-tax basis for daycare expenses to allow you and your spouse to work or attend school full-time. Eligible dependents are children under 13 years of age, or a child over 13, spouse, or elderly parent residing in your house which is physically or mentally unable to care for himself or herself. Examples of eligible expenses are daycare facility fees, before-and-after- school care, and in-home babysitting fees (income must be reported by your care provider).

The dependent care FSA maximum contribution is $5,000 for the 2021 plan year.

Estimate carefully! Any balance remaining in your Health Care Reimbursement Account at the end of the plan year up to $500 will be carried forward and used to fund your account in the next plan year. This carryover amount does not apply to the Dependent Care FSA. Any remaining balances, at the end of the plan year, will be forfeited.

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Legal Services LegalShield/IDShield

The City of Littleton offers access to LegalShield (www.legalshield.com/info/littletonco) to help you with frustrating legal endeavors.

LegalShield covers various legal needs that you may have.

Services Provided with LegalShield Preventative Legal Services

• Legal consultation and advice • Will preparation

Motor Vehicle Services • Legal expenses from traffic violations • Driver’s license assistance

Trial Defense Legal Services • Up to 60 hours of attorney time if you are

a named defendant in a civil or job related criminal action.

IRS Audit Legal Services • Up to 50 hours of attorney time if you

receive a written notice of an IRS audit.

IDShield covers various identity security needs that you may have, including:

Services Provided with IDShield Privacy Monitoring

• Comprehensive identity protection • Monitors your name, SSN and other

numbers

Security Monitoring • Monitors SSN, credit cards, and bank

accounts • Quarterly credit score tracking

Consultation • 24/7/365 live support

Full-Service Restoration • Complete identity recovery services

Plans Bi-Weekly Rates LegalShield Legal Plan $7.27

LegalShield Legal plus IDShield Individual $11.40

LegalShield Legal plus IDShield Family $14.17

IDShield Full Individual $4.13

IDShield Full Family $8.75

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*The holidays listed above are fully paid for general government full-time employees.

Time-Off Benefits The City observes the following holidays*:

2021 Holiday Schedule New Year’s Day January 1, 2021 Martin Luther King Jr. Day January 18, 2021 President’s Day February 15, 2021 Memorial Day May 31, 2021 Independence Day July 5, 2021 (observance) Labor Day September 6, 2021 Thanksgiving Day November 25, 2021 Day after Thanksgiving November 26, 2021 Christmas Eve Afternoon December 23, 2021 (close at 12:00 PM) Christmas Day December 24, 2021 (observance)

For general government part-time employees (20+ hours per week), the above holidays are prorated at the following levels:

*Commissioned police officers, detectives, corporals, sergeants, and emergency services dispatchers are granted additional vacation hours in lieu of paid holidays. Floating Holidays General government regular Full-Time employees and emergency service dispatchers receive 40 hours annually of floating holiday. General government regular part-time employees of 20 hours or more are eligible for 12 annually of floating holiday. At the end of each calendar year, and at the time of termination from employment, unused floating holiday hours will be forfeited.

Paid Hours Per Holiday Weekly Hours Worked Paid Hours Per Holiday

20 4 24 5 28 6 32 7

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Time-Off Benefits (cont.) Vacation Leave Policy* Employees receive paid vacation leave on an annual basis at the following schedule.

Part-Time Employees 2021 Vacation Benefit Level 20 hour 24 hour 28 hour 32 hour Date of Hire to 5 yrs. 64 77 90 103 5 yrs. Up to 10 yrs. 76 92 107 122 10 yrs. Up to 15 yrs. 84 101 118 135 15 yrs. Up to 20 yrs. 96 116 135 154 Over 20 yrs. 104 125 146 167

Vacation Carry Over: Up to 100 hours

Full-Time Employees 2021 Vacation

Benefit Level General

Government Dispatch Commissioned Police Officers,

Corporals, & Sergeants Date of Hire to 5 yrs. 128 204 230 5 yrs. Up to 10 yrs. 152 228 246 10 yrs. Up to 15 yrs. 168 244 270 15 yrs. Up to 20 yrs. 192 268 286 Over 20 yrs. 208 284 306

Vacation Carryover Max 200 hours

Max 150 hours

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Time-Off Benefits (cont.) Sick Leave Policy*

Full-time regular employees earn eight hours of sick leave accrual per month. There is no carry over limit from year to year.

Part-time regular employees of 20 or more hours per week earn sick leave on a monthly basis at the following schedule:

Temporary, seasonal, and variable hour employees will accrue sick leave at one hour of paid sick leave for every 30 hours worked, up to a maximum of 48 hours/year.

Flexible Schedules Certain employees may be eligible for flexible scheduling arrangements, including compressed workweeks, early or late start times, and telecommuting. Flexible scheduling arrangements are at the discretion of the Department Director/Chief or City Manager.

*The City evaluates holiday, vacation, and sick time off benefits on an ongoing basis should any changes happen to the accruals, employees will be notified.

Part-Time Employees Sick Hours Earned Per Month Weekly Hours Worked Paid Hours Earned

20 4 24 5 28 6 32 7

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Retirement Plans 457 Deferred Compensation Plan

The City of Littleton offers employees with a regular part-time or full-time status of 20 hours per week or more to elect to participate in the 457 Deferred Compensation Plan. The employee can elect contribution amounts and make investment selections. The contributions can be made up to the IRS maximum contribution amount ($19,500 in 2021). Employees 50 or older can contribute an additional $6,500 per year as a designated “catch- up” provision.

Employees are eligible for this plan on their date of hire.

The City of Littleton will provide employees with a match on voluntary elected contributions. The match is up to 2% for general government and police employees hired before 10/14/18 that elected to stay with IMCA. The employer voluntary match for the police plan is contributed in the employee’s 401(a) vesting schedule. The employer voluntary match for the general government plans is contributed to the employee’s 457 plan.*

All employees are immediately fully vested in the employer’s contribution to the 457 plan. *In 2020, the city match to the 457-retirement plan was suspended for full-time employees through 2021.

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Retirement Plans (cont.) General Employee Retirement Plan 401a

The City of Littleton offers regular full-time status employees of 40 hours or more per week a retirement/401(a) plan. Employees are fully vested in the employer’s contributions to the 401(a) after five years of employment or age 55.

Employees are eligible for this plan on their date of hire.

The chart below details the specific contribution schedule.

General Employee Retirement Plan/401(a) and FPPA Contributions

Employee Classification 2021 Mandatory Employee Contribution

City of Littleton Contribution

401(a) – General Government Employees 5% 7% 401(a) – Commissioned Police Personnel – Hired before 10/14/18 and did not elect FPPA 10% 10%*

FPPA Defined Benefit Plan – Commissioned Police Personnel – Hired on or after 10/14/18

11.5% 8%

FPPA Defined Benefit Plan – Commissioned Police Personnel – Hired before 10/14/18

11.5% 12%

*This number can go up to 12% if police personnel have elected to contribute to the 457 plan. The city matches up to 2% on this election and it is deposited into the police personnel's 401(a) plan. *In 2020, the city match to the 457-retirement plan was suspended through 2021.

Roth Individual Retirement Account

The City of Littleton offers employees with a regular part-time or full-time status of 20 hours per week or more to elect to participate in a Roth Individual Retirement Account. The employee can elect contribution amounts and make investment selections. The contributions can be made up to the IRS maximum contribution amount of $6,000 per year after-tax for employees under the age of 50 and $7,000 per year after-tax for employees over the age of 50. There are no city contributions.

Employees are eligible for this plan on their date of hire.

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Tuition Reimbursement The City of Littleton offers tuition reimbursement to regular full-time employees (40 hours or more per week) when funding is available. Eligible courses for advanced degrees and education related to an employee’s position with the City. Reimbursements will be approved within the program’s criteria on a first-come-first- served basis when funding is available up to $3,000 annually.

*In 2020, this program has been suspended through 2021.

Wellness Program

The City’s wellness program is designed to promote and improve health and well-being in the lives of City employees through health education and wellness programs. Our goal is to establish a work environment that promotes a healthy lifestyle both at work and at home. Our wellness program is focused on preventative health care, health education, and fostering healthy lifestyles.

Employees and spouses are invited to participate in a variety of health programs that can earn individuals up to $300 per year or $600 per household, per year! Our easy to use program offers cash incentives for completing wellness goals such as an annual physical, telephonic coaching, and other preventative exams. In addition, we offer an array of health programs for all employees. Contact Human Resources for more information!

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Plan Contacts

Plan type Provider Phone Web Policy # City of Littleton Human Resources

City of Littleton 303-795-3857 HR@littletongov.org N/A

Medical Cigna 1 (800) 244-6224 www.mycigna.com 3332146

City of Littleton Employee Wellness Clinic

CareHere (877) 423-1330 www.carehere.com N/A

Dental PPO Delta Dental Insurance Company

1 (800) 610-0201 www.deltadentalco.com 1235

Vision Vision Service Plan 1 (800) 216-6248 www.vsp.com 12198600

Life and AD&D Voya Financial 1 (800) 955-7736 www.voya.com 696692

Voluntary Life and AD&D

Short Term Disability (STD)

Long Term Disability (LTD)

Voya Financial

1 (800) 423-2765 www.voya.com

696692

FSA Administration 24HourFlex (800) 651-4855 www.24HourFlex.com

Email: Info@24HourFlex.com

N/A

EAP Mines & Associates (800) 873-7138 www.minesandassociates.com 8963

CompPsych Guidance Voya (877) 533-2363 www.guidanceresources.com Web ID:My5848i

FPPA Fire and Police Pension Association

(800) 332-3772 www.fppaco.org N/A

401(a) Retirement Plan ICMA-RC (800) 669-7400 www.icmarc.org GG # 107464

Police # 107465

457 Deferred Comp ICMA-RC (800) 669-7400 www.icmarc.org 300177

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Important plan notices & documents Summary Plan Descriptions

The legal document for describing benefits provided under the plan as well as plan rights and obligations to participants and beneficiaries. Please contact HR for your Summary Plan Description.

Summary of Benefits and Coverage

A summary document that presents each of our benefit plan features in a standardized format. Please contact HR for your Summary of Benefits and Coverage.

Medical Continuation Information Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), employees may continue medical and/or dental coverage at their own expense. In addition, spouses, domestic partners and dependents (called Qualified Beneficiaries) may also continue medical and/or dental coverage at their own expense.

What is COBRA Continuation Coverage?

COBRA continuation coverage is a continuation of Plan coverage when coverage would otherwise end because of a life event known as a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage.

If you are an employee, you will become a qualified beneficiary if you lose your coverage under the Plan because either one of the following qualifying events happens:

• Your hours of employment are reduced, and you are no longer eligible for coverage, or • Your employment ends for any reason other than your gross misconduct; • Your spouse dies; • Your spouse’s hours of employment are reduced and he or she is no longer eligible for coverage; • Your spouse’s employment ends for any reason other than his or her gross misconduct; • Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or you become

divorced or legally separated from your spouse.

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Medical Continuation Information (cont.) Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because any of the following qualifying events happens:

• The parent-employee dies; • The parent-employee’s hours of employment are reduced and he or she is no longer eligible for

coverage; • The parent-employee’s employment ends for any reason other than his or her gross misconduct; • The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both); • The parents become divorced or legally separated; or • The child stops being eligible for coverage under the plan as a “dependent child.”

When is COBRA Coverage Available?

The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. When the qualifying event is the end of employment or reduction of hours of employment, death of the employee, or commencement of a proceeding in bankruptcy with respect to the City of Littleton, the employer will notify the insurance provider of the qualifying event.

You Must Give Notice of Some Qualifying Events

For the other qualifying events (employee becoming entitled to Medicare benefits, divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you must notify human resources within 60 days after the qualifying event occurs.

How is COBRA Coverage Provided?

Once the Plan Administrator 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. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children. All COBRA notices and enrollment information is sent directly from 24hr Flex.

Additional information regarding COBRA benefits, including the length of COBRA coverage, is available on NiC (or in the Human Resources office).

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Medicare Part D Notice of Creditable Coverage

Important Notice from the City of Littleton, 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 Littleton, and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug Plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the Plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.

There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:

1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this

coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.

2. The City of Littleton has determined that the prescription drug coverage offered by Cigna 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 Credible 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.

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Medicare Part D Notice of Creditable Coverage (Cont.)

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 City of Littleton coverage will not be affected. See below for more information about what happens to your current coverage if you join a Medicare drug plan.

Since the existing prescription drug coverage under Cigna is creditable (e.g., as good as Medicare coverage), you can retain your existing prescription drug coverage and choose not to enroll in a Part D plan; or you can enroll in a Part D plan as a supplement to, or in lieu of, your existing prescription drug coverage.

If you do decide to join a Medicare drug plan and drop your coverage through the City of Littleton, be aware that you and your dependents can only get this coverage back.

When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?

You should also know that if you drop or lose your current coverage with The City of Littleton 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 at (303) 795-3857. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through The City of Littleton 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.

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Medicare Part D Notice of Creditable Coverage (Cont.)

For more information about Medicare prescription drug coverage:

• Visit www.medicare.gov

• Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help.

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

If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).

Availability of Privacy Practices Notice We maintain the HIPAA Notice of Privacy Practices for describing how health information about you may be used and disclosed. You may obtain a copy of the Notice of Privacy Practices by contacting the plan administrator.

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

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Women’s Health and Cancer Rights Act

If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for:

● All stages of reconstruction of the breast on which the mastectomy was performed; ● Surgery and reconstruction of the other breast to produce a symmetrical appearance; ● Prostheses; and ● Treatment of physical complications of the mastectomy, including lymphedema.

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. If you would like more information on WHCRA benefits, call your plan administrator.

Newborns’ and Mothers’ Health Protection Act Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). If you would like more information on maternity benefits, call your plan administrator at (303) 795-3857.

HIPAA Notice of Special Enrollment Rights If you decline enrollment in City of Littleton health plan for you or your dependents (including your spouse) because of other health insurance or group health plan coverage, you or your dependents may be able to enroll in City of Littleton health plan without waiting for the next open enrollment period if you:

● Lose other health insurance or group health plan coverage. You must request enrollment within 30 days

after the loss of other coverage.

● Gain a new dependent as a result of marriage, birth, adoption, or placement for adoption. You must request health plan enrollment within 30 days after the marriage, birth, adoption, or placement for adoption.

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HIPAA Notice of Special Enrollment Rights (Cont.)

● Lose Medicaid or Children’s Health Insurance Program (CHIP) coverage because you are no longer eligible.

You must request medical plan enrollment within 60 days after the loss of such coverage.

If you request a change due to a special enrollment event within the 30-day timeframe, coverage will be effective the date of birth, adoption, or placement for adoption. For all other events, coverage will be effective the first of the month following your request for enrollment. In addition, you may enroll in The City of Littleton’s health plan if you become eligible for a state premium assistance program under Medicaid or CHIP. You must request enrollment within 60 days after you gain eligibility for medical plan coverage. If you request this change, coverage will be effective the first of the month following your request for enrollment. Specific restrictions may apply, depending on federal and state law.

Note: If your dependent becomes eligible for a special enrollment right, you may add the dependent to your current coverage or change to another health plan.

Premium Assistance Under Medicaid and the Children's Health Insurance Program

If you or your children are eligible for Medicaid or CHIP and you are eligible for health coverage from your employer, your State may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs. Still, you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.

If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1- 877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your State if it has a program that might help you pay the premiums for an employer-sponsored plan.

If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of

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Premium Assistance Under Medicaid and the Children's Health Insurance Program (Cont.)

being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).

If you live in another state, you may be eligible for assistance paying your employer health plan premiums. Contact your State for more information on eligibility.

To see if your state has added a premium assistance program since January 31, 2019, or for more information on special enrollment rights, contact either:

U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/agencies/ebsa 1-866-444-EBSA (3272)

U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Menu Option 4, Ext. 61565

NOTICE FOR CITY OF LITTLETON SPONSORED WELLNESS PROGRAM Motivate Me is a voluntary wellness program available to all regular part and full-time employees working 20+ hours per week. The program is administered by Cigna according to federal rules permitting employer- sponsored wellness programs that seek to improve employee health or prevent disease, including the Americans with Disabilities Act of 1990, the Genetic Information Nondiscrimination Act of 2008, and the Health Insurance Portability and Accountability Act, as applicable, among others. If you choose to participate in the wellness program, you will be asked to complete a voluntary health risk assessment or "HRA" that asks a series of questions about your health-related activities and behaviors and whether you have or had certain medical conditions (e.g., cancer, diabetes, or heart disease). You will be given the option to complete a biometric screening, which will include a blood test for total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, glucose and/or other applicable tests. You are not required to complete the HRA or to participate in the blood test or other medical examinations.

However, employees who choose to participate in the wellness program may receive incentives through the Motivate Me program. Although you are not required to complete the HRA, only employees who do so will receive incentives. Please review the Motivate Me program for specific incentives and requirements.

Additional incentives for completing incentive activities may be available for employees who participate in certain health-related activities for example online coaching, telephonic coaching, Apps & Activities or achieve

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NOTICE FOR CITY OF LITTLETON SPONSORED WELLNESS PROGRAM (Cont.)

certain health outcomes, for example, BMI, blood pressure, total cholesterol, LDL cholesterol, blood glucose, waist circumference.

For all participants: If you think you might be unable to meet a standard for a reward under this wellness program, you might qualify for an opportunity to earn the same rewards by different means. Contact Cigna at 1-800-244-6224 and they will work with you and, if you wish, with your doctor.

For participants who may have an impairment: If you are unable to participate in any of the program events, activities or goals, because of a disability, you may be entitled to a reasonable accommodation for participation or an alternative standard for rewards. For work-site accommodations, please contact Human Resources at (303) 795-3857; for accommodations with online, phone or other Cigna programs, please contact Cigna at 1-800-244-6224.

The information from your HRA and the results from your biometric screening will be used to provide you with information to help you understand your current health and potential risks, and may also be used to offer you services through the wellness program, such as online coaching, telephonic coaching or other applicable services. You also are encouraged to share your results or concerns with your doctor.

Protections from Disclosure of Medical Information We are required by law to maintain the privacy and security of your personally identifiable health information. Although the wellness program and City of Littleton may use aggregate information it collects to design a program based on identified health risks in the workplace. Cigna and Motivate Me will never disclose any of your personal information either publicly or to the employer except as necessary to respond to a request from you for a reasonable accommodation needed to participate in the wellness program, or as expressly permitted by law. Medical information that personally identifies you that is provided in connection with the wellness program will not be provided to your supervisors or managers and may never be used to make decisions regarding your employment.

Your health information will not be sold, exchanged, transferred, or otherwise disclosed except to the extent permitted by law to carry out specific activities related to the wellness program, and you will not be asked or required to waive the confidentiality of your health information as a condition of participating in the wellness program or receiving an incentive. Anyone who receives your information for purposes of providing you services as part of the wellness program will abide by the same confidentiality requirements. The personally identifiable health information that Cigna and Motivate Me will only be used in order to provide you with services under the wellness program.

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Protections from Disclosure of Medical Information (Cont.) In addition, all medical information obtained through the wellness program will be maintained separate from your personnel records, and no information you provide as part of the wellness program will be used in making any employment decision. Although no one can prevent all cyber-attacks, Cigna has an information security program consisting of people, process, and technology- including encryption and monitoring tools designed to protect electronic information. We maintain safeguards intended to protect the security of your information. In the event of a data breach, as defined by law, involving information you provide in connection with the wellness program, we will notify you as required by law.

You may not be discriminated against in employment because of the medical information you provide as part of participating in the wellness program, nor may you be subjected to retaliation if you choose not to participate.

If you have questions or concerns regarding this notice, or about protections against discrimination and retaliation, please contact Human Resources at (303) 795-3857.

PAPERWORK REDUCTION ACT STATEMENT According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to a penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512.

The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email ebsa.opr@dol.gov and reference the OMB Control Number 1210-0137.

OMB Control Number 1210-0137 (expires 12/31/2019)

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Look-Back Measurement Method You and your dependents are eligible for the medical plan if you are a full-time employee. A full-time employee is generally an employee who works on average 130 hours per month, as defined by the ACA. Hours that count toward full-time status include each hour for which an employee is paid or entitled to payment for the performance of duties for the employer, and each hour for which an employee is paid or entitled to payment for a period of time during which no duties are performed due to vacation, holiday, illness, incapacity (including disability), layoff, jury duty, military duty, or leave of absence. ACA full-time status can affect or determine medical benefits eligibility but is not a guarantee of benefits eligibility. The City of Littleton uses the Look-Back Measurement Method to determine whether an employee meets this eligibility threshold.

New Full-Time Employees

If you are hired as a new full-time employee (work on average 130 or more hours a month), you and your dependents are generally eligible for The City of Littleton’s health plan coverage as of the first of the month following date of hire

New Employees Hired To Work a Variable Hour or Seasonal Schedule

If you are hired into a part-time position, a position where your hours vary and The City of Littleton is unable to determine — as of your date of hire — whether you will be a full-time employee (work on average 130 or more hours a month), or you are hired as a seasonal employee who will work for six (6) consecutive months or less (regardless of monthly hours worked), you will be placed in an initial measurement period (IMP) of 12 months to determine whether you are a full-time employee.

Your 12-month IMP will begin on the first of the month following your date of hire and will last for 12 months. If, during your IMP, you average 30 or more hours a week over that 12-month period, you will be full-time and, if otherwise eligible for benefits, you will be offered coverage by the first of the second month after your IMP ends.

Your full-time status will remain in effect during associated stability period, which will last 12 months from the date that status is determined. If your employment is terminated during that stability period, and you were enrolled in benefits, you will be offered coverage under COBRA.

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Ongoing Employees

The City of Littleton uses the look-back measurement method to determine health plan eligibility for ongoing employees. An ongoing employee is an individual who has been employed for an entire standard measurement period. A standard measurement period is the 12-month period of time over which The City of Littleton counts employee hours to determine which employees work full-time.

An employee is deemed full-time if he or she averages 130 or more hours a month over the 12-month standard measurement period. Those employees who average 130 or more hours a month over the 12-month standard measurement period will be full-time and, if otherwise eligible for benefits, offered coverage as of the first day of the stability period associated with the standard measurement period. Full-time status will be in effect for a 12-month stability period.

If your employment is terminated during a stability period, and you were enrolled in benefits, you will be offered continued coverage under COBRA.

The City of Littleton uses the standard measurement period and the associated stability period annual cycle set forth below.

Standard Measurement Period: Time to determine if you work 130+ hours per month on average – used to establish if you are "full-time" or "part-time" for medical eligibility October 1-September 30.

Stability Period: Time during which you will be considered "full-time" or "part-time" for medical plan eligibility - based on hours worked during the preceding Measurement Period January 1 – December 31.

Calendar Year Standard Measurement Period Stability Period 2019 October 1, 2017-September 30, 2018 January 1, 2019-December 31, 2019 2020 October 1, 2018-September 30, 2019 January 1, 2020-December 31, 2020 2021 October 1, 2019-September 30, 2020 January 1, 2021-December 31, 2021 2022 October 1, 2020-September 30, 2021 January 1, 2022-December 31, 2022 2023 October 1, 2021-September 30, 2022 January 1, 2023-December 31, 2023

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Revised 09/28/2020