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County of Santa Barbara Employee Benefits Overview

2020

County of Santa Barbara Human Resources Department One County. One Future.

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TABLE OF CONTENTS Benefits For The Way You Live ......................................................................................................................... 2

What’s New In 2020? ..................................................................................................................................... 3

Additional Benefits Programs .......................................................................................................................... 8

Open Enrollment Info .................................................................................................................................... 12

Join Us At A “Fun In The Sun” Benefits Fair ...................................................................................................... 13

Who Can You Cover? .................................................................................................................................... 14

Making the Most of Your Benefits ................................................................................................................... 15

Medical ..................................................................................................................................................... 16

Dental ........................................................................................................................................................ 21

Vision ........................................................................................................................................................ 22

Cost of Coverage ......................................................................................................................................... 23

Life and Disability Insurance ......................................................................................................................... 25

Voluntary Accident and Critical Illness Insurance ............................................................................................. 28

Wellness Benefit At A Glance ........................................................................................................................ 29

Special Savings Accounts ............................................................................................................................. 30

Other Programs ........................................................................................................................................... 34

For Assistance ............................................................................................................................................ 36

Key Terms .................................................................................................................................................. 38

Important Plan Notices and Documents ........................................................................................................... 40

Appendix .................................................................................................................................................... 41

Notes ......................................................................................................................................................... 42

Medicare Part D Notice: If you and/or your dependents have Medicare or will become eligible for Medicare in the next 12 months, a federal law gives you more choices about your prescription drug coverage. Please refer to the Legal Notices posted on the County’s website, http://countyofsb.org/hr or contact Human Resources at 568.2818 or 568.2803 for more details.

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BENEFITS FOR THE WAY YOU LIVE

The Santa Barbara County has a benefits program that provides you with the best coverage that is simple and comprehensive. We offer programs that protect your health, your money, your family and help you find balance between your concerns at work and at home. We also know the value of understanding your coverage so that you know how to get care, when you need it, at the lowest cost. With the tools and information in this booklet and related resources, we hope to help you be well today and work towards a healthy and secure future.

The County understands that comparing benefit plans, features and costs can be complicated The Employee Benefits Overview booklet provides information that will help simplify your decision making process. It is a summary of your benefits and does not provide a complete description of all benefit provisions. For more detailed information, please refer to your plan benefit booklets or Evidence of Coverage (EOC) documents at the County’s website, http://countyofsb.org/hr. The plan benefit booklets determine how all benefits are paid.

The benefits in this summary are effective:

January 1, 2020 - December 31, 2020

OPEN ENROLLMENT PERIOD:

October 14 – November 1, 2019

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What’s New In 2020?

BENEFITS COORDINATORS CORP (BCC) – New HSA Administrator

Effective January 1, the County of Santa Barbara will be moving the administration of the HSA account to Benefit Coordinators Corporation (BCC , in order to better integrate your voluntary special savings accounts. By moving from Sterling HSA to BCC’s My SmartCare HSA platform, employees will find it easier to manage your HSA account and with less fees.

Employees who have a current account with Sterling HSA have several options for transition:

1. You may keep your current Sterling HSA account. You will be responsible for a monthly administration fee from Sterling HSA for as long as your account is open. For 2020 County contributions and your personal contributions, you will need to open a new HSA account with BCC (Avidia Bank will be the custodian .

2. You may transfer your Sterling HSA account balance to Avidia Bank. All employees who want to transfer their current HSA funds will need to fill out a HSA Transfer form. Instructions on how, when and where to send this form will be sent to you later this year by BCC and in email by the Benefits & Wellness Division. Remember that your Sterling HSA account must remain open until the last County HSA contribution for 2019 has been deposited.

This year, you must login to the BenXcel portal and select the HSA amount that you want to contribute for 2020. If you are not going to contribute anything in 2020, but only want the County’s HSA contribution amount deposited into your new HSA account, you must still re-enroll in the HSA and input “$0” as your contribution amount. Your current HSA contribution amount will not roll over this year. You must re-enroll in the HSA account. If you do not enroll in the HSA account, a new Avidia HSA account will NOT be opened and you will not be able to receive the County and individual 2020 contribution.

IMPORTANT

During Open Enrollment – all current Blue Shield HDHP employees with an HSA account who want to continue with the HDHP in 2020 must:

• Login to the BenXcel Open Enrollment website, https://benxcel.net • Re-enroll in the HSA account, it will not roll over for 2020

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Insulin medications are now available at no cost! Rx ‘n Go has added insulin products to their drug list. You may now receive up to a 90-day supply of insulin medications such as Humalog, Levemir and Novolog. Prodigy® diabetic test strips and lancets can additionally be delivered to your home at no cost. The initial test strip order includes a new free Prodigy® diabetic monitor. What is Rx ‘n Go? Rx ‘n Go is a voluntary mail order pharmacy benefit. All employees and covered dependents, on a Blue Shield medical plan*, have the option to receive up to a 90-day supply of generic prescription maintenance medications by mail at no cost to you.

What do I have to do? 1. Go to www.rxngo.com and view all

the available medication on the Rx ‘n Go drug list.

2. Complete the Pharmacy Profile form online or by calling Rx ‘n Go.

3. Mail the Pharmacy Profile form and original prescription(s) to Rx ‘n Go. Your physician my also fax, phone or E-Scribe your prescription.

4. Receive your medication(s) by mail at your home.

5. It’s that easy!

Questions? We are here to help at 888.697.9646.

Over 1,200 free generic medications delivered to your home!*

*Note: Due to IRS guideline on the HDHP, only preventive maintenance medications are available to you for free. Rx’ n Go has over 750 preventive medications on their drug list.

NEW DIABETIC PROGRAM

Click on the picture and watch a video to learn more about Rx ‘n Go.

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LIMITED PURPOSE FSA (LPFSA) – Available To All HSA Members

The County will be offering a Limited Purpose FSA account to all employees that are enrolled in the Blue Shield HDHP plan with a Health Savings Account (HSA. The Limited Purpose FSA allows you to set aside pre-tax dollars for dental and vision expenses.

Why open a Limited-Purpose FSA?

1. Contribute up to $2,700 in pre-tax dollars but remember that this is a “use it or lose it” account

2. Use funds for dental and vision expenses only 3. Continue to contribute to your HSA account. Keep your HSA funds when paying dental

and vision expenses and use the Limited-Purpose FSA instead. 4. Use for your dependent’s dental and vision expenses even though they are not enrolled

in your HDHP plan. Must be claimed as dependents on your IRS taxes. 5. Manage both your Limited-Purpose FSA and HSA account in ONE place – use BBC’s

My Smartcare portal or app.

If you have an HSA, you can open a LPFSA!

COUNTY ONSITE CLINICS – Blue Shield HDHP Copay for non-preventive visits

Due to IRS regulations, County employees on the Blue Shield HDHP plan will have a $20 copayment for all non-preventive visits when using the County’s onsite clinics if they have not met their yearly deductible. Once you have met your deductible, all services will be at no cost. All preventive visits/services will remain at no cost. This copayment only affects employees on the HDHP plan. IRS regulations state that you must pay a copayment for non-preventive services until your deductible has been met.

Note that the $20 copayment for onsite clinic services will be a lower copayment than if you would have a doctor’s visit using your Blue Shield benefits.

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Express Scripts – Smart90 Program

What is the Smart 90 program?

This program is available to Express Scripts members on the Blue Shield Low EPO, High EPO and PPO plans that are taking maintenance medication on a daily basis. Express Scripts now gives you a choice on where to dispense a three month supply of your maintenance drugs. You can:

1. Fill your prescription through home delivery from the Express Scripts Pharmacy OR 2. Fill your prescription at any CVS or Walgreens pharmacy

Relax with 90-say supplies.

The bottom line: Be like Kyle – order a 90-day supply of your maintenance medication. Now you have two convenient options through Smart90.

Learn how to be more like Kyle at express-scripts.com/KyleAndNick.

… keeps on track with his medicine

…takes long hikes not worrying about running out of medication

…grabs dinner with friends with the money he is saving

…kicks back by the pool instead of making a monthly pharmacy trip

… misses a dose since he forgot this month’s refill

…waits in line at the pharmacy every month

…possibly pays more than he needs to for his medicine

…makes time in his schedule to drive to the pharmacy month after month

Gets a 90-day supply, so he…

Gets a 30-day supply, so he…

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MY SMARTCARE – BCC’s One Stop Shop For FSA / HSA / Commuter Accounts

BCC has made it easier than ever to manage your FSA and HSA account(s). The My SmartCare online portal and mobile app allows you to freely and securely access your BCC

Reimbursement accounts 24/7/365.

Why register with My SmartCare?

• Real time account balances • Direct deposit management • Claim status and tracking • Transaction history and statements • Electronic claims submission & uploads • Manage your debit card • Receive year end reminders • Get notifications via email or text messages - your choice

ASK EMMA!

The industry’s first voice activated consumer funding account is now available on the My SmartCare mobile app!

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Additional Benefits Programs The Santa Barbara County offers a variety of free programs that are available to all members and covered dependents in the Blue Shield plans. Take advantage of these different programs that can help you stay healthy and save you money.

THE SMARTER VOLUNTARY SURGERY BENEFIT Considering surgery? Carrum Health is your voluntary surgery benefit that allows employees and their dependents to access top surgeons and hospitals across the country at no cost to your, including travel*.

PROCEDURES FULLY COVERED FOR YOU:

EXPLORE YOUR OPTIONS

A wide range of covered procedures at hospitals across California that specialize in the care you need.

CHOOSE THE BEST

Pick from among our highly-qualified surgeons who have performed hundreds of medical procedures on average.

WE’LL TAKE IT FROM HERE

Your travel will be fully-covered with a dedicated patient care specialist to help guide you through every stop of the

LEARN MORE: CALL: 1.888.855.7806 TEXT: “COSB” TO 555888

VISIT: CARRUM.ME/COSB

*Per IRS rules, a portion of the covered travel expenses will be reported as taxable income to the employee. Due to IRS regulations, on HSA plans the deductible applies but coinsurance is waived.

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SOLERA – Lifestyle Change Program

Blue Shield/EIA is offering a free comprehensive 16-week program which will help qualified members lose weight, adopt healthy habits and significantly reduce their risk of developing type 2 diabetes. You have a choice to do the program online or in-person, your choice.

What’s included in the program?

There are many versions of this program and depending if you want to do it online or in-person, most programs include the following:

• 16 weekly lessons, followed by monthly sessions for the rest of the year • Lifestyle health coach to help set goals and keep you on track • Small group for support and encouragement • Helpful tools, like wireless scales and fitness trackers

What are some of the national programs available?

You may choose from an array of national programs like Weight Watchers, Retrofit or HealthSlate.

What is the cost?

It’s free!

What do I do to find out if I qualify?

All you need to do is go to www.solera4me.com/eia and take a one minute quiz. If you are identified as having a risk of developing type 2 diabetes, you will be able to enroll in one of the various programs.

Call Solera at 877.486.0141 if you have questions.

Health Coaching Weekly Lessons Integrated devices Group Support

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Want to see the doctor? Choose “video” as the method for your visit. Feeling camera shy? Choose “phone”. Got a busy schedule? Select a time that’s best for you by choosing “schedule” instead of “as soon as possible”.

You will receive convenient, quality care from a variety of licensed healthcare providers.

Physician Dermatologist Therapist FOR ISSUES LIKE: FOR ISSUES LIKE: FOR ISSUES LIKE: Cold & Flu symptoms Skin infection Stress/anxiety Bronchitis Acne Depression Allergies Skin rash Domestic abuse Pink eye Abrasions Grief counseling Bladder infection Moles/warts Addiction

Visit Teladoc.com/bsc and set up an account or call 1.800.835.2362

Connecting with a doctor within minutes is easy.

1. Request a visit with a doctor 24 hours a day, 365 days a year, by web, phone, or mobile app.

3. If medically necessary, a prescription will be sent to the pharmacy of your choice. It’s that easy!

2. Talk to the doctor. Take as much time as you need…there’s no limits!

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COUNTY ONSITE HEALTH CLINICS The County of Santa Barbara has two employee health clinics for benefit eligible employees, their spouses, registered domestic partners and dependent children age 16 and over. Dependents must be enrolled in the County’s health plan in order to participate. After your first visit, you will be required to schedule a follow-up visit to take a Health Risk Assessment to ensure you are eligible to receive continued services through the clinic.

The clinic provides services for ongoing and episodic illnesses such as:

LOCATIONS

SANTA BARBARA

427 Camino del Remedio

805.681.4700 or Ext 4700

M - F: 7:30am - 4:00pm

SANTA MARIA

500 West Forster Road

Behind BeWell offices

805.934.6107 or Ext 6107

M - F: 7:30am - 4:00pm

• Minor illnesses • Diabetic control • Referral to specialist • Blood pressure • Cholesterol management • Allergies • Lab tests

NEW FOR 2020

Employees and their dependents on the Blue Shield HDHP plan, will have a copayment of $20 for all non-preventive services/visits at the onsite clinics due to IRS regulations. You must first meet your annual deductible before non-preventive services will be at no cost. All preventive visits and services will remain at no cost to you and

your dependents.

All services at the clinics are at no cost to employees and their dependents on the Low EPO, High EPO and PPO plans.

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Open Enrollment Info Open Enrollment will take place from October 14– November 1, 2019. During this time, you are able to enroll in new programs or make changes to your current benefits. What should I do:

1. If I like my current plan selections and do not want to change for 2020? You do not have to do anything. Your selections will automatically roll over with the exception of your Flexible Spending Account (FSA) and Health Savings Account enrollment.

2. If I want to:

• Enroll in any of the County-sponsored plans and voluntary benefits for the first time; • Change or cancel your plan choices; waiver must be supported by other group coverage • Add or drop dependent coverage (Please Note: If you cancel a dependent’s coverage

during Open Enrollment, that dependent is not eligible for COBRA); • Add, change, or cancel your Optional Life, Critical Illness, Accident Plan, and/or

Personal Accident Insurance; • Participate for the first time or continue to participate in FSA Healthcare or Dependent

Care or participate for the first time in an HSA for the 2020 plan year (Note: you cannot open an HSA account if you have an FSA. Your FSA account must have a $0 balance before you can open an HSA);

• Waive participation in County-sponsored medical and dental benefits; and/or • Combined coverage with a spouse or registered domestic partner who is also a benefit-

eligible County employee. Use the eBenefits website for ALL changes You must go online to the County’s eBenefits website, https://benxcel.net, to make all plan changes, dependent additions or deletions, HSA or FSA enrollment, address changes and personal information updates.

If you need the Employee Guide to BenXcel, go to the County’s website at http://countyofsb.org/hr, Employee Benefits link, and “Click” on the “Open Enrollment 2020 Benefit Year” link. This guide will help you establish a username and/or obtain your password. Call BCC at 1.800.685.6100 if you need assistance with your account.

IMPORTANT DURING OPEN ENROLLMENT

All current Blue Shield HDHP employees with an HSA account who want to continue with the Blue Shield HDHP in 2020 must:

• Login to the BenXcel Open Enrollment website, https://benxcel.net • Re-enroll in the HSA account, it will not roll over for 2020

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Join Us At A “Fun In The Sun” Benefits Fair!

The County of Santa Barbara will be hosting a “Party” and would like to invite all County employees to one of our Benefits Fairs. Join us in the festivities!

Santa Maria October 15 10:30am – 2:00pm Betteravia Parking Lot 511 E. Lakeside Parkway

Santa Barbara October 16 10:30am – 2:00pm Human Resources Bldg. -

Parking Lot 1226 Anacapa Street

Lompoc October 17 12:30pm – 2:30pm Veterans Memorial Bldg. 100 E. Locust Avenue

Come have some fun and…

• Get free health screenings • Enjoy interactive activities with a chance to win prizes • Talk to our carriers, local vendors and County departments • Obtain benefit information and giveaways • Enjoy from a variety of delicious food samplings • Have a cold refreshing Italian ice • Register to WIN one of our many donated raffle prizes

JOIN US!

Flu and pneumonia shots will be available at the Benefits Fairs. Bring your Express Scripts ID card (Low EPO, High EPO or PPO plan) or Blue Shield ID card (HDHP) in order to get a free flu or pneumonia vaccination. Note: FDA guidelines apply in order to receive a pneumonia vaccine.

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Who Can You Cover?

WHO IS ELIGIBLE?

A regular civil service employee working 20 or more hours per weeks is eligible for the benefits outlined in this overview. Your coverage for health and dental benefits will be effective on the first of the month following your first pay period worked prior to the first of the following month.

Extra-Help/Contractors on Payroll who have currently enrolled in the County’s health insurance can make health insurance changes during Open Enrollment.

ELIGIBLE DEPENDENTS

• Current legal spouse or registered domestic partner (same or opposite gender).

• Children (including your domestic partner's children):

o Must be under the age of 26 and not be eligible for medical coverage through his or her employer. They do not have to live with you or be enrolled in school. They can be married and/or living and working on their own.

o Eligible children include natural children, stepchildren, legally-adopted children, or children who have been placed in your custody during the adoption process, and physically or mentally handicapped children who depend on you for support, regardless of age.

o A child of a covered domestic partner who satisfies the same conditions as listed above for natural children, stepchildren, or adopted children, and in addition is not a “qualifying

child” (as defined in the Internal Revenue Code) of another individual.

INELIGIBLE DEPENDENTS

• Former spouse/registered domestic partner even if you are court ordered to provide the ex-spouse/former domestic partner with health coverage

• Children age 26 or older • Children of former spouse or former registered

domestic partners • Disabled children over age 26 who were not

enrolled prior to age 26 • Relatives such as grandchildren, grandparents,

parents, aunts, uncles, nieces, nephews, etc. • Foster children • Live-in boyfriend/girlfriend and his/her children

DEPENDENT ELIGIBILITY DOCUMENTATION REQUIREMENTS

If you are adding dependents (spouse and/or dependent children) during Open Enrollment, the County requires that you verify your dependent’s eligibility. You have until November 14, 2019 to fax the eligibility documentation* to SISCO at 563.587.672. If documentation is not received by November 14, 2019, your dependent(s) will not be added to your health plans for 2020.

*A list of acceptable documentation that meet the County’s eligibility requirements can be found on page 35 or at www.countyofsb.org/hr.

QUALIFYING LIFE EVENTS

Make sure to notify Human Resources if you have a qualifying life event and need to make a change (add or drop) to your coverage election. You have 31 days to make your change. These changes include (but are not limited to):

• Birth or adoption of a baby or child • Loss of other healthcare coverage, does not

include private plans • Eligibility for new healthcare coverage • Marriage or Divorce A list of qualifying events can be found in the Legal Document posted on the County’s HR website.

The County has partnered with SISCO to assist in eligibility verification. Please open all correspondence from SISCO. If you do not respond to SISCO, your dependent will not have benefits or may have their benefits terminated.

Click on the icon to watch a video on Qualifying Events.

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Making the Most of Your Benefits

WHEN TO USE THE ER

The emergency room shouldn't be your first choice unless there's a true emergency—a serious or life threatening condition that requires immediate attention or treatment that is only available at a hospital. WHEN TO USE URGENT CARE Urgent care is for serious symptoms, pain, or conditions that require immediate medical attention but are not severe or life-threatening and do not require use of a hospital or ER. Urgent care conditions include, but are not limited to: earache, sore throat, rashes, sprains, flu, and fever up to 104°. ONSITE EMPLOYEE CLINIC The Santa Barbara and Santa Maria clinics are open Monday to Friday from 7:30am – 4:00pm. See page 7 for additional information.

PREVENTIVE OR DIAGNOSTIC?

Preventive care is intended to prevent or detect illness before you notice any symptoms. Diagnostic care treats or diagnoses a problem after you have had symptoms.

Be sure to ask your doctor why a test or service is ordered. Many preventive services are covered at no out-of-pocket cost to you. The same test or service can be preventive, diagnostic, or routine care for a chronic health condition. Depending on why it's done, your share of the cost may change.

Whatever the reason, it's important to keep up with recommended health screenings to avoid more serious and costly health problems down the road.

PREVENTIVE CARE SERVICES

Children:

+ Well-baby care + Annual physicals + Immunizations + Flu shots + Medical/family history and physical exams + Blood pressure checks + Vision screening

Women:

+ Pap tests + Mammograms + Annual physicals + Immunizations + Flu shots + Colonoscopy + Blood pressure checks + Cholesterol (total and HDL)

Men:

+ Colonoscopy + Prostate cancer screening + Annual physicals + Immunizations + Flu shots + Blood pressure checks + Cholesterol (total and HDL)

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Santa Barbara County Medical This comparison chart shows a brief summary of the medical benefits available.

* After annual deductible.

**Chiropractic visits per year are combined with Outpatient Rehabilitation Therapy.

Blue Shield EPO Low Option

Blue Shield EPO High Option

How it Works You must use a Blue Shield in-network PPO contracted provider or your care will not be covered. There are no Out-of-Network benefits with these plans, except in the case of an emergency.

Medical Plan Annual Deductible Lifetime Maximum Annual Co-pay (Out-of-Pocket maximum)

$300 Individual/$600 Family Unlimited $2,000 Individual/$4,000 Family

None Unlimited $1,500 Individual/$3,000 Family

Hospital Care Inpatient

- Physician - Facility Services

Carrum Health Outpatient Surgery Emergency Room Visit

- Not resulting in admission - Resulting in hospital admission

No Charge* $500/ Admission + 20%* No Charge $500/ Admission + 20%* $250 Co-pay (waived if admitted) $500/ Admission + 20%*

No Charge* $300/ Admission + 20%* No Charge No Charge* $150 Co-pay (waived if admitted) $300/ Admission + 20%*

Physician Care Office Visit Specialist Visit Telemedicine Preventive Care/Annual Physical X-Ray. Lab & Pathology Services CT/PET scans, MRIs, MRAs Immunizations Outpatient Rehabilitation Therapy

- Physical, Speech, Occupational, Respiratory

Chiropractic Services Acupuncture Services

$25 Co-pay (not subject to deductible) $40 Co-pay (not subject to deductible) $25 Co-pay (Teladoc) No Charge (not subject to deductible) No Charge* No Charge* No Charge $25 Co-pay, 26 visits/yr (not subject to deductible) Not Covered Not Covered

$20 Co-pay (not subject to deductible) $30 Co-pay (not subject to deductible) $20 Co-pay (Teladoc) No Charge (not subject to deductible) No Charge* No Charge* No Charge $20 Co-pay, 26 visits/yr** (not subject to deductible) $20 Co-pay, 26 visits/yr** $20 Co-pay, 12 visits/yr

Mental Health/Substance Abuse Inpatient - Mental Health Outpatient - Mental Health Chem. Dependency Rehab - Outpatient Detoxification - Inpatient (Detox Only)

$500/ Admission + 20%* $25/ visit (not subject to deductible) $25/ visit (not subject to deductible) $500/Admission + 20%*

$300/ Admission + 20%* $20/ visit (not subject to deductible) $20/ visit (not subject to deductible) $300/ Admission + 20%*

Other Ambulance - ER or authorized transport Prosthetics Hearing Aid - max of $700 every 24 mths Durable Medical Equipment Home Healthcare Services Hospice

$50 per transport* 20%* No Charge* 20%* 20%* No Charge*

$50 per transport* No Charge* No Charge* No Charge* 20%* No Charge*

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Benefits Summary Chart - Blue Shield Plans

Refer to the carrier Evidence of Coverage (EOC) for detailed information on the plan.

Blue Shield PPO

Blue Shield HDHP Plan (PPO)

You may see any provider when you need care. You decide whether to see an in-network or an out-of-network provider each time you need care. When you see in-network providers you typically pay less.

In-Network Out-of-Network In-Network Out-of-Network $750 Ind / $2,250 Family Unlimited $4,750 Ind/ $10,250 Family

$750 Ind / $2,250 Family Unlimited $6,750 / $14,250

$1,500/ $3,000 (combined)

Unlimited $4,500 / $9,000 (combined)

20%* $250/ Admission + 20%* No Charge 20%* $75/ visit + 20%* $250/ Admission + 20%*

40%* 40%* N/A 40%* $75/ visit + 20%* 40%*

20%* 20%* No Charge After Deductible 20%* 20%*(waived if admitted) 20%*

40%* 40%* N/A 40%* 20%*(waived if admitted) 40%*

$30 Co-pay $30 Co-pay $30 Co-pay (Teladoc) No Charge 20%* 20%* No Charge 20%*, 26 visits/ yr** 20%*, 26 visits/ yr** 20%*, 12 visits/ yr

40%* 40%* Not Covered 40%* 40%* 40%* 40%* 40%*, 26 visits/yr** Not Covered 20%*, 12 visits/ yr

20%* 20%* $40 (Teladoc) No Charge No Charge* No Charge* No Charge 20%*, 26 visits/ yr** 20%*, 26 visits/ yr** 20%*, 12 visits/ yr

40%* 40%* Not Covered 40%* 40%* 40%* 40%* Not Covered Not Covered 20%*, 12 visits/ yr

$250/ Admission + 20%* $30/ visit $30/ visit $250/ Admission + 20%*

40%* 40%* 40%* 40%*

20%* 20%* 20%* 20%*

40%* 40%* 40%* 40%*

20%* 20%* 20%* 20%* 20%* No Charge*

20%* 40%* 20%* 40%* Not Covered Not Covered

20%* 20%* 20%* 20%* 20%* No Charge*

20%* 40%* 20%* 40%* Not Covered Not Covered

Note for Out-of-Network benefits - you is responsible for the applicable copayment/coinsurance plus any amount that exceeds Blue Shield’s allowable amount. For inpatient hospitalization, maximum allowed amount per day is $600/day. For outpatient surgery/services, labs and x-rays, maximum allowed per day is $350 per day. For MRI/CT/PET scans, the max allowed per admit is $800. Charges over the allowable amount do not count toward the calendar year deductible or out-of-pocket maximum.

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Santa Barbara County Medical This comparison chart shows a brief summary of the medical benefits available.

Blue Shield EPO Low Option

Blue Shield EPO High Option

Other - Continued Pregnancy/Maternity Care Family Planning - Counseling - Tubal ligation - Vasectomy - Infertility Services (Diagnosis and treatment of causes only)

No Charge* No Charge No Charge $75 per Surgery* 50% of allowed charges*

No Charge* No Charge No Charge $75 per Surgery* 50% of allowed charges*

Diabetes Care Devices and non-testing supplies Diabetes self-management training Rx’ n Go- device/test strips/lancets

20%* $25 Co-pay No Charge

No Charge* $20 Co-pay No Charge

Care Outside of Service Area (benefits provided by the BlueCard Program, for out-of-state emergency and non-emergency care, are provided at the preferred level of the local Blue Plan allowable amount when you use a Blue Cross/Blue Shield provider) · Within US: BlueCard Program · Outside US: BlueCard Worldwide

See Applicable Benefit See Applicable Benefit

See Applicable Benefit See Applicable Benefit

Express Scripts Express Scripts Prescription Drugs Annual Deductible for Brand Only:

$100 Ind / $300 Family*** Annual Deductible for Brand Only: $25 Ind / $75 Family***

Out-of-Pocket Maximum: $4,600 Ind / $9,200 Family

Out-of-Pocket Maximum: $5,100 Ind / $10,200 Family

Retail: Generic/Brand/Non-formulary

$15 / $35/ $50 after annual deductible (30-day supply)

$10 / $35/ $50 after annual deductible (30-day supply)

Mail Order: Generic/Brand/Non-formulary

$30 / $70 / $100 after annual deductible (90-day supply)

$20 / $70/ $100 after annual deductible (90-day supply)

Specialty Medications

20% up to $100 max per script 20% up to $100 max per script

Rx’n Go- Generic Maintenance Medications via Mail Order

$0 Co-pay for up to 90 day supply $0 Co-pay for up to 90 day supply

Pharmacy tip: Please read all mail from Express Scripts or Blue Shield since it will be a notice of a potential change to prescription drug(s) that you are currently taking.

Find all benefit summaries at http://cosb.countyofsb.org/hr/. Please click on the “Employee Benefits” link.

* After annual deductible. *** The Pharmacy Deductible does not apply to the Medical Deductible. Generic medications are not subject to the Pharmacy Deductible.

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Benefits Summary Chart - Blue Shield Plans

Refer to the carrier Evidence of Coverage (EOC) for detailed information on the plan. Blue Shield PPO Blue Shield HDHP Plan (PPO)

In-Network Out-of-Network In-Network Out-of-Network 20%* No Charge No Charge 20%* 50% of allowed charges*

40%* 40%* 40%* 40%* Not Covered

20%* No Charge No Charge 20%* 50% of allowed charges*

40%* 40%* 40%* 40%* Not Covered

20%* $30 Co-pay No Charge

40%* 40%* N/A

20%* 20%* No Charge

40%* 40%* N/A

See Applicable Benefit See Applicable Benefit

See Applicable Benefit See Applicable Benefit

See Applicable Benefit See Applicable Benefit

See Applicable Benefit See Applicable Benefit

Express Scripts Blue Shield Annual Deductible for Brand Only:

$25 Ind / $75 Family*** You must meet the annual deductible first before the noted

co-insurance amounts apply.

Out-of-Pocket Maximum: $1,850 Ind / $2,950 Family

No Limit Medical and Pharmacy have a combined Out-of-Pocket Maximum

$10 / $35/ $50 after annual deductible ( 30-day supply)

$10 / $35/ $50 after annual deductible ( 30-day supply)

20%* ( 30-day supply)

20%* ( 30-day supply)

$20 / $70/ $100 after annual deductible ( 90-day supply)

Not Covered

20%* (90-day supply)

Not Covered

20% up to $100 max per script

Not Covered 20%* up to $100 max / script

Not Covered

$0 Co-pay for up to 90 days N/A $0 Co-pay for Preventive generic medications

N/A

Note for Out-of-Network benefits - you is responsible for the applicable copayment/coinsurance plus any amount that exceeds Blue Shield’s allowable amount. For inpatient hospitalization, maximum allowed amount per day is $600/day. For outpatient surgery/services, labs and x-rays, maximum allowed per day is $350 per day. For MRI/CT/PET scans, the max allowed per admit is $800. Charges over the allowable amount do not count toward the calendar year deductible or out-of-pocket maximum.

Click on the icon to watch a video on Prescriptions Dos and Don’ts.

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Kaiser Medical Plans

Kaiser HMO Low Option

Kaiser HMO High Option

Medical Plan Annual Deductible Lifetime Maximum Annual Co-pay (Out-of-Pocket maximum)

None Unlimited $1,500 Individual/$3,000 Family

None Unlimited $1,500 Individual/$3,000 Family

Hospital Care Inpatient Surgery Outpatient Surgery Emergency Room Visit

- Not resulting in admission - Resulting in hospital admission

$500 per admission $20 Co-pay per procedure $100 Co-pay $500 hospital admission charge

$100 per admission $15 Co-pay per procedure $100 Co-pay $100 hospital admission charge

Physician Care Office Visit Specialist Visit Preventive Care/Annual Physical X-Ray. Lab & Pathology Services CT/PET scans, MRIs, MRAs Immunizations Chiropractic or Acupuncture Services

$20 Co-pay $20 Co-pay No Charge No Charge No Charge No Charge Not Covered

$15 Co-pay $15 Co-pay No Charge No Charge No Charge No Charge Not Covered

Mental Health/Substance Abuse Inpatient - Mental Health Outpatient - Mental Health Chem. Dependency Rehab - Outpatient Detoxification - Inpatient (Detox Only)

$500 per admission $20 Co-pay $20 Copay $500 per admission

$100 per admission $15 Co-pay $15 Co-pay $100 per admission

Other Ambulance Prosthetics Durable Medical Equipment Home Healthcare Services Hospice

$50 per transport No Charge No Charge No Charge (up to 100 visits) No Charge

$50 per transport No Charge No Charge No Charge (up to 100 visits) No Charge

Prescription Drugs Retail: Mail-Order:

$10 Co-pay Generic $35 Co-pay Brand No Non-Formulary Coverage (30-day supply) $20 Co-pay Generic $70 Co-pay Brand No Non-Formulary Coverage (100-day supply) Specialty: 20% up to $150 max per script

$10 Co-pay Generic $30 Co-pay Brand No Non-Formulary Coverage (30-day supply) $20 Co-pay Generic $65 Co-pay Brand No Non-Formulary Coverage (100-day supply) Specialty: 20% up to $150 max per script

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Dental To enroll in a dental plan, you and your dependent(s) MUST be enrolled in one of the County’s medical plans. Dependents may enroll in a medical plan without enrolling in a dental plan.

Delta Dental DHMO DeltaCare USA (15A) Delta Dental PPO Plan – Self-Funded

In-Network In-Network Out-Of-Network

Calendar Year Deductible

$0

$0

$50 Individual (combined in and out-of-network)

$100 Family (combined in and out-of-network)

Annual Plan Maximum

Unlimited $1,500 (combined in and out-of-network)

Waiting Period None None None

Diagnostic and Preventive

Plan pays 100% Plan pays 100% Plan pays 100%

Basic Services

Fillings $8-$395 copay (varies by service, see contract for fee schedule)

Plan pays 80% after deductible

Plan pays 80% after deductible

Root Canals $5-$395 copay (varies by service, see contract for fee schedule)

Plan pays 80% after deductible

Plan pays 80% after deductible

Periodontics $8-$385 copay (varies by service, see contract for fee schedule)

Plan pays 80% after deductible

Plan pays 80% after deductible

Major Services $15-$395 copay (varies by service, see contract for fee schedule)

Plan pays 60% after deductible

Plan pays 60% after deductible

Orthodontic Services

Orthodontia

Lifetime Maximum N/A $1,200 (combined in and out-of-network)

Child $1,900 Plan pays 60% Plan pays 60%

Adult $2,100 Plan pays 60% Plan pays 60%

For DHMO members: When first enrolling in a DHMO plan, you must choose a primary dentist. If you do not, one will automatically be selected for you. To change your auto-assigned dentist, you will need to call Delta Dental at 800.422.4234 after Open Enrollment with your selection.

The County has a special DHMO provider network with Delta Dental. Go to www.deltadentalins.com/countyofsantabarbara for a full selection of DHMO providers. Use this website when selecting a new primary dentist.

Click on the icon to watch a video on Dental Insurance Tips.

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Vision The County of Santa Barbara offers you a vision plan through Vision Service Plan. You do not have to enroll in the medical or dental plan in order to enroll in the Vision plan.

VSP – Choice Vision Plan (Voluntary)

In-Network Out-Of-Network

Examination

Benefit $10 copay then plan pays 100% Plan pays up to the $51 allowance

Frequency 1 x every 12 months In-network limitations apply

Materials $10 copay (combined with examination) then 100%

$10 copay (combined with examination) then 100% (see schedule below)

Eyeglass Lenses

Single Vision Lens Plan pays 100% of basic lens Up to $41 allowance

Bifocal Lens Plan pays 100% of basic lens Up to $63 allowance

Trifocal Lens Plan pays 100% of basic lens

20% off all other lens options

Up to $82 allowance

Frequency 1 x every 24 months or 1 every 12 months if change in prescription

In-network limitations apply

Frames

Benefit Up to $150 retail allowance, then 20% off amount above the allowance

Up to $70

Frequency 1 x every 24 months In-network limitations apply

Contacts (Elective)

Elective Up to $150 allowance (instead of eyeglasses)

Up to $105 allowance (instead of eyeglasses)

Medically Necessary $10 copay Up to $302 allowance

Frequency 1 x every 24 months 1 x every 24 months

Low Vision Benefit

$500 maximum benefit every two years

(for severe vision problems)

Not covered

Laser Vision Correction

15% fee discount Not covered

USING YOUR VSP BENEFIT IS EASY

• Find a VSP doctor or print and ID card at www.vsp.com .

• At your appointment, tell them you have VSP, no ID card is necessary.

• Create an account online to review your benefits.

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Cost of Coverage

The County of Santa Barbara pays for 100% of cost for basic Life, AD&D and LTD coverage.

All 2020 premiums are noted as twice-monthly premium amounts.

Medical

Premium County

Contribution Pre-Tax

Deductions*

Blue Shield Low Option EPO Medical Plan

Employee Only 405.89 (405.89) 0.00

With 1 Dependent 748.89 (405.89) 343.00

Two + Dependents 1175.89 (405.89) 770.00

Blue Shield High Option EPO Medical Plan

Employee Only 469.89 (405.89) 64.00

With 1 Dependent 868.39 (405.89) 462.50

Two + Dependents 1362.39 (405.89) 956.50

Blue Shield PPO Medical Plan

Employee Only 618.89 (405.89) 213.00

With 1 Dependent 1142.39 (405.89) 736.50

Two + Dependents 1794.89 (405.89) 1389.00 Blue Shield HDHP Medical Plan

Employee Only 353.89 (353.89) 0.00

With 1 Dependent 632.39 (353.89) 278.50

Two + Dependents 993.39 (353.89) 639.50 Kaiser Low Option Medical Plan**

Employee Only 298.39 (298.39) 0.00

With 1 Dependent 558.89 (298.39) 260.50

Two + Dependents 847.89 (298.39) 549.50

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Medical

Premium County

Contribution Pre-Tax

Deductions*

Kaiser High Option Medical Plan**

Employee Only 309.89 (309.89) 0.00

With 1 Dependent 579.89 (309.89) 270.00

Two + Dependents 879.39 (309.89) 569.50

Dental

Premium County

Contribution Pre-Tax

Deductions*

Delta Dental DHMO Dental Plan

Employee Only 16.44 (13.03) 3.41

With 1 Dependent 27.02 (13.03) 13.99

Two + Dependents 41.03 (13.03) 28.00 Delta Dental DPPO – County Self-Funded Dental Plan

Employee Only 22.15 (13.03) 9.12

With 1 Dependent 42.56 (13.03) 29.53

Two + Dependents 65.51 (13.03) 52.48

Vision

Premium County

Contribution Pre-Tax

Deductions*

VSP Vision Plan

Employee Only 3.18 N/A 3.18

With 1 Dependent 4.57 N/A 4.57

Two + Dependents 8.20 N/A 8.20

*Premium and County contribution rates in the document reflect a twice monthly deduction schedule taken over 24 pay periods. The first deduction for the 2020 premiums will be taken in pay period 1 of 2020. There are two pay periods in 2020 in which no deduction is taken.

** Kaiser plans are limited to employees who reside in a Kaiser Southern California service area. Please go to www.kp.org to look up your zip code and confirm that you live in the service area.

The County’s benefits allowance amounts can be found at the County’s website, http://cosb.countyofsb.org/hr/.

Please Note: Twice-monthly rates include $1.77 for Employee Assistance Plan (EAP) and CareCounsel Healthcare Assistance Plan. If you and your spouse or domestic partner are both employees and want to combine the County’s contributions toward the cost of your coverage, see the separate sheet online at the County’s website, http://cosb.countyofsb.org/hr/ under “Combined Coverage.”

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Life and Disability Insurance If you have loved ones who depend on your income for support, having life and accidental death insurance can help protect your family's financial security.

BASIC LIFE and AD&D

Basic Life Insurance pays your beneficiary a lump sum if you die. AD&D provides another layer of benefits to either you or your beneficiary if you suffer from loss of a limb, speech, sight, or hearing, or if you die in an accident. The cost of coverage is paid in full by the County of Santa Barbara. Coverage is provided by Voya Financial.

Eligible Group Basic Life and AD&D Amount

Department Heads, Board of Supervisors and Elected Officials

$50,000

Assistant Department Heads $30,000

Managers & Unrepresented Attorneys, Confidential Employees, and employees in job classes represented by:

• Deputy District Attorneys Association • Civil Attorneys Association • Deputy Sheriffs Association • Engineers & Technicians Association • SEIU Local 620 & 721 • Fire Fighters Locals 2046 • Probation Peace Officers Association • Union of American Physicians & Dentists

$20,000

Taxes: Due to IRS regulations, a life insurance benefit of $50,000 is considered a taxable benefit. You will see the value of the benefit included in your taxable income on your paycheck and W-2.

BENEFICIARY REMINDER Beneficiary means a person you name to receive death benefits. You may name one or more beneficiaries. Make sure that you have named a beneficiary for your basic life insurance. You may change your beneficiary at any time. Note that some states require a spouse be named as a beneficiary unless they sign a waiver. Remember that a divorce or separation will not automatically affect a beneficiary designation, so please review you beneficiary election(s) to ensure it accurately reflects your wishes.

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LONG-TERM DISABILITY INSURANCE

Long-Term Disability coverage pays you a certain percentage of your income if you can't work because an injury or illness prevents you from performing any of your job functions over a long time. It's important to know that benefits are reduced by income from other benefits you might receive while disabled, like Workers' Compensation and Social Security.

If you qualify, long-term disability benefits begin 60 after 60 days. The cost of coverage is paid in full by the County of Santa Barbara. Coverage is provided by Voya Financial.

Eligible Group:

Department Heads, Assistant Department Heads, Managers, Unrepresented Attorneys, Confidential Unrepresented Employees, and employees represented by the Union of American Physicians, & Dentists, Deputy District Attorneys Association and Civil Attorneys Association.

Plan pays 60% of your basic monthly income

$9,000 is maximum amount

Benefits begin after 60 days of disability

Social Security normal retirement age is maximum payment period*

Eligible Group:

Employees in job classes represented by:

• Engineers & Technicians Association

• SEIU Local 620 & 721 • Fire Fighters Locals 2046 • Probation Peace Officers

Association

Plan pays 60% of your basic monthly income

$3,600 is maximum amount

Benefits begin after 60 days of disability

Social Security normal retirement age is maximum payment period*

*The age at which the disability begins may affect the duration of the benefits.

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VOLUNTARY TERM LIFE INSURANCE

Voluntary Term Life Insurance allows you to purchase additional life insurance to protect your family's financial security. Coverage is provided by Voya Financial.

Employee Voluntary Term Life Amount

Can elect from $10,000 to $500,000 in increments of $10,000. Guaranteed issue amount is $300,000* or $150,000* for age 60 and over for new hires only.

Spouse or Domestic Partner Voluntary Term Life Amount

Can elect from $10,000 to $500,000 in increments of $10,000 not to exceed 100% of Employee’s Supplemental Life Insurance amount. Guaranteed issue amount is $50,000.*

Child(ren) Voluntary Term Life Amount

Can elect $5,000 or $10,000 (from 6 months to age 26). Guaranteed issue amount is $10,000.

Note: Married employees are not eligible for spouse coverage if the other spouse enrolls in Voluntary Term Life Insurance.

*$20,000 of AD&D is included in this policy at no additional cost.

VOLUNTARY WHOLE LIFE INSURANCE

Whole Life insurance, through Manhattan Life, formerly Humana, provides you with additional financial security and is designed to last through your retirement. A Facility Care Rider offers protection for Long Term Care expenses.

Employee Base Coverage Guaranteed issue limit: up to $14/week.

Coverage minimum is $2,500 to maximum of $125,000.

Spouse Stand-alone Coverage

Guaranteed issue limit: $4/week to max of $15,000.

Coverage minimum is $2,500 to maximum of $50,000.

Child(ren) Stand-alone Coverage

Guaranteed issue limit: up to $10,000.

Coverage minimum is $2,500 to maximum of $25,000.

The plan provides:

• An accelerated death benefit for terminal illness. It will pay when insured is diagnosed with a terminal illness with 6 months or less to live. Payment is 50% of face amount of base plan or $100,000.

• An accelerated benefit for terminal illness. Plan will pay lump sum of 50% of death benefit after diagnosis when life expectancy is 12 months or less.

• A facility care accelerated benefit rider. Provides monthly benefit for licensed adult day care facility or inpatient residential care for nursing home or assisted living facility.

To enroll or for additional information, please call Farmington at 877.290.3931.

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Voluntary Accident and Critical Illness Insurance

VOLUNTARY PERSONAL ACCIDENT

Voluntary Personal Accident Insurance (PAI) is offered by Voya Financial. Premiums are based on a flat rate per $1,000 for Employee only or Family (Spouse/Domestic Partner and Child). Evidence of Insurability (EOI) is not required.

Employee Voluntary Personal Accident

Can elect from $25,000 to $500,000 in $25,000 increments not to exceed 10 times annual salary

Family Voluntary Personal Accident

• Spouse/Domestic Partner – see benefit summary for details

• Child (each) – see benefit summary for details

Plan includes Travel Assistance, Day Care benefits, Emergency Evacuation, Repatriation of Remains and a Seat Belt benefit.

VOLUNTARY ACCIDENT Voluntary Compass Accident Insurance is offered by Voya Financial. This policy helps you pay for the out-of-pocket costs you may experience after an accident. The policy pays a lump sum amount depending on the type of injuries you have sustained such as broken bones, torn ligaments, burns, as well as for expenses from hospitalizations, the ER, office visits or physical therapy. You may use this amount to pay for everyday living expenses or to pay healthcare costs.

The policy also has an annual Wellness Benefit that pays you $150 for completing a screening as well as additional Wellness amounts for your spouse and child(ren).

VOLUNTARY CRITICAL ILLNESS Critical Illness Insurance is an affordable way to protect against the financial stress of a serious illness. It pays a lump-sum benefit if you are diagnosed with a covered illness or condition. This policy is in addition to your health coverage. You may use this benefit to pay:

• Medical expenses • Child care • Home health costs • Mortgage payment/rent and home

maintenance

This policy offers an annual Wellness benefit that provides a $200 reimbursement for covered health screenings.

Coverage is provided by Voya Financial.

Employee Voluntary Critical Illness

Can elect from $5,000 to $30,000 in $5,000 increments. Guaranteed issue amount is $30,000.

Spouse Voluntary Critical Illness

Can elect from $5,000 to $15,000 in $5,000 increments. Guaranteed issue amount is $15,000.

Child Voluntary Critical Illness

Can elect $5,000 or $10,000. Guaranteed issue amount is $10,000.

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Wellness Benefit At A Glance What is a Wellness Benefit?

A Wellness benefit is a rider that is included on your voluntary Accident and Critical Illness plan. It provides an annual payment if you complete a preventive health screening test. You only need to complete one preventive health screening test. This one test can be used for any or all three benefit plans. The Accident and Critical Illness each has a Wellness benefit. Your spouse and/or dependents covered under your plan also have a Wellness benefit.

What type of preventive health screening tests are eligible?

Preventive health screening tests include but are not limited to:

Blood test for triglycerides

Serum Protein Electrophoresis

Fasting blood glucose test Annual physical exam

Pap smear Breast ultrasound, sonogram, MRI Thermography CA 125 (ovarian

cancer) Sigmoidoscopy Chest x-ray PSA ( prostate cancer) Tests for STIs

CEA (blood test for colon cancer)

Mammography Hearing test Ultrasounds for abdominal aortic aneurysms

Bone marrow testing Colonoscopy Routine eye exam Hemoglobin A1C

Cholesterol test CA 15-3 (breast cancer) Routine dental exam Bone density

Hem occult stool analysis

Stress test on bicycle or treadmill

Well child/preventive exam to age 18

Electrocardiogram (EKG)

How do I file a claim?

You can easily file a claim online. 1. Go to voya.com/claims 2. Scroll down to the “Have a Wellness Benefit Claim?” section and click the “Submit your claim”

button. 3. Check all products that apply – Accident, Critical Illness, Hospital Indemnity 4. Click “Continue” and follow the screen prompts. Once all questions are answered, click

“Submit” Your Group Name is: County of Santa Barbara

Your Group Number is: 00684911

Don’t forget to claim your Wellness dollars every year!

Make it a habit to do so right after your annual physical exam.

Click on the icon to view a video on “How To File A Claim”.

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Special Savings Accounts

HEALTH SAVINGS ACCOUNT (HSA)

A Health Savings Account (HSA) is available to employees who participate in the Blue Shield High Deductible Health Plan (HDHP). This is a tax-advantaged savings account that allows you to save pre-tax dollars to pay for qualified health expenses. To open an HSA account or change your contributions, you must go online to the County’s eBenefits website at https://benxcel.net.

Why should I have an HSA Account?

An HSA account is owned by you, goes with you if you leave employment, is tax free and can be used for qualified medical, dental and vision expenses.

The County makes a yearly contribution into your HSA account to help fund your account. This amount is yours to keep even though you may not use the entire contribution amount during the year. Remember that the HSA account is yours and you can take it with you if you decide to leave the County.

Note: you are not eligible to elect an HSA if you are covered by another health plan, such as a health plan sponsored by your spouse’s employer, Medicare, Tricare, or if an employee is claimed as a dependent on another’s tax return.

HSA Contribution Limits for 2020

Annual Single Contribution Maximum $3,550*

Annual Family Contribution Maximum $7,100*

Annual Catch-Up Contribution Maximum (for HSA participants that are 55 years or older)

$1,000

Want to learn more?

Click on the icon to watch a video on how a High Deductible Health Plan works alongside a Health Savings Account.

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How does the County contribute to my HSA?

The County of Santa Barbara will make a yearly contribution into an employee’s Health Savings Accounts (HSA) based on the schedule below.

For first time enrollees in the HDHP in 2020, the County will contribute half of its yearly contribution amount in one lump sum in pay period 1 of 2020 to assist you with funding your new Health Savings Account (HSA). On pay period 14 of 2020, the County will begin depositing the remainder of the yearly contribution amount per the pay period schedule below.

FOR EMPLOYEES CONTINUING ENROLLMENT IN A HDHP FOR 2020

2020 Yearly County Contribution Amount

Employee Only $1,200 ($46.15 per pay

period)

Employee + Dependent(s) $1,800 ($69.23 per pay period)

Two Married County Employees w combined coverage

$3,000 ($115.38 per pay period)

FOR FIRST TIME NEW ENROLLEES IN A HDHP IN 2020

County Contribution Amount on Pay

Period 1 of 2020

County Contribution Amount Starting on

Pay Period 14 of 2020

2020 Yearly County Contribution

Amount

Employee Only $600 $46.15 per pay period ($600)

$1,200

Employee + Dependent(s) $900 $69.23 per pay period

($900) $1,800

Two Married County Employees w combined coverage

$1500 $115.38 per pay period ($1,500) $3,000

Note: the County contribution amount plus the amount that you will contribute should not exceed the IRS contribution limits for 2020 noted on the previous page.

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FLEXIBLE SPENDING ACCOUNT (FSA)

The County of Santa Barbara offers you a Healthcare and/or Dependent Care Flexible Spending

Account (FSA) through Benefits Coordinator Corporation (BCC). You may participate in one or

both plans.

Healthcare FSA Account

This plan allows you to pay for eligible out-of-pocket healthcare expenses with pre-tax dollars. Eligible expenses include medical, dental, or vision costs such as plan deductibles, copays, coinsurance amounts, and other non-covered healthcare costs for you and your tax dependents. For 2020, you can set aside up to $2,700.

Dependent Care FSA Account

This plan allows you to pay for eligible out-of-pocket dependent care expenses with pre-tax dollars. Eligible expenses may include daycare centers, in-home child care, and before or after school care for your dependent children under age 13. Other individuals may qualify if they are considered your tax dependent and are incapable of self-care. It is important to note that you can access money only after it is placed into your dependent care FSA account.

All caregivers must have a tax ID or Social Security number. This information must be included on your federal tax return. If you use the dependent care reimbursement account, the IRS will not allow you to claim a dependent care credit for reimbursed expenses. Consult your tax advisor to determine whether you should enroll in this plan. For 2019, you can set aside up to $5,000 per household for eligible dependent care expenses.

IMPORTANT CONSIDERATIONS

• You must use all of your Healthcare FSA funds by March 15, 2021 or else you will lose them. The FSA plans have a Grace Period that allows you to continue to incur new claims up to 03/15/21, with any remaining funds from your 2020 elected amount.

• Elections cannot be changed during the plan year, unless you have a qualified change in family status.

• FSA funds can be used for you, your spouse, and your tax dependents only.

• Claim forms may be found on the BCC website, https://benxcel.net.

• Stops on the last day of active employment.

• You must re-enroll every year during Open Enrollment. Your 2019 elected amount will not roll over for 2020.

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TRANSIT AND PARKING FSA

The County of Santa Barbara allows you to participate in a Transit/Parking Flexible Spending Account. Use the money for all of your eligible work-related transit and parking expenses. Ineligible expenses include tolls, car maintenance, carpools and gasoline.

Transit – these consist of vouchers, passes and fare cards for

transportation via bus, commercial vanpool or train. The maximum IRS

allowance for 2020 is $265 per month.

Parking – includes parking at or near work, parking at or near a transportation site and Park &

Ride expenses. The maximum IRS allowed amount for 2020 is $265 per month.

How do I enroll in an FSA for 2020

• Go to https://benxcel.net • Create a new User Name and Password to login • Choose the amount you would like deducted from your paycheck in 2020 over 26 pay

periods.

How do I manage my FSA account?

BCC’s My SmartCare is the tool you will use as an online portal or mobile app for iOS/Android users.

1. Online portal: go to https:www.mywealthcareonline.com/bccsmartcare 2. Mobile App: download the “BCC SmartCare” mobile app from your app store 3. My SmartCare registration:

Use your SSN as your Employee ID (No spaces or dashes) User your FSA debit card number as your Registration ID

If you have questions or need assistance, call BCC Customer Service at 800.685.6100.

Want to learn more?

Click on the icon to watch a video on how an FSA plan work and how to best use your funds.

Remember that all FSA amounts will be pre-tax deductions on your paycheck. These include Healthcare, Dependent Care, Transit and Parking.

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Other Programs

HEALTHCARE ADVOCACY PROGRAM

CareCounsel is an independent organization and is not part of your health plan. They are a benefits advocacy program that can help you navigate the complexities of your benefits plan. Your Care Counselor can answer benefits questions, guide you to the appropriate resources, and intervene on your behalf until your issue/problem is resolved. This program is free and completely confidential.

They can assist with:

· Making the best benefits choices during Open Enrollment

· Maximizing your healthcare dollars

· Finding a physician and access care

· Seeking second opinions

· Obtaining necessary authorizations

· Troubleshooting medical claims/bills

· Grievances and appeals

· Connecting you with no-cost healthcare resources

EMPLOYEE ASSISTANCE PROGRAM - EAP

Empathia offers you a comprehensive, voluntary and confidential Employee Assistance Program (EAP) called LifeMatters that is available to all County employees and members in their household. We are dedicated to your overall wellbeing. The program is free of cost.

Contact CareCounsel at 1.888.227.3334 or go online to www.carecounsel.com

What can I get help on? • Legal or financial problems • Caring for an elderly parent • Mental health /substance abuse concerns • Stress management • Marital issues • Parenting and childcare concerns

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Empathia has a vast array of resources, monthly webinars and quarterly newsletters that are available to you and your family by going online at www.mylifematters.com. Company code is: COSB.

Help is available 24/7, 365 days a year by telephone at 800.367.7474.

BEN-IQ

Ben-IQ is a free app that includes much of the information that's included in this booklet, but in a place that's always at your fingertips — your smartphone.

GETTING STARTED WITH BEN-IQ

1. Download and launch the app.

2. Enter your assigned username:

County of Santa Barbara

3. Read and agree to the Terms and Conditions.

Take a tour of Ben-IQ and review plan summaries, and important contacts like our nurse line and EAP. Store and organize ID cards using your phone's camera, and much more! Be sure to share Ben-IQ with your covered family members too.

Click and watch our Ben-IQ video! https://www.brainshark.com/alliant/beniq-hd

Click on the icon to watch a video on what is an EAP benefit.

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For Assistance

Plan Type Provider Phone Number Website

Medical Blue Shield 855.256.9404 www.blueshieldca.com/csac

Kaiser Permanente 800.464.4000 www.kp.org

Carrum Health 888.855.7806 www.carrum.me/cosb

Pharmacy Express Scripts

For EPO/PPO plans 800.711.0917 www.blueshieldca.com/csac

Rx’N Go ( free generic maintenance mail order)

888.697.9646 www.rxngo.com

Dental Delta Dental

DHMO/ Group #76825

DPPO / Group #16458

800.422.4234

800.765.6003

www.deltadentalins.com/ countyofsantabarbara

Vision VSP 800.877.7195 www.vsp.com

Flex Spending Accounts and Cobra Coverage

Benefits Coordinators Corporation (BCC) – My SmartCare

800.685.6100 www.mywealthcareonline.com/bccsmartcare

Voluntary Plans Voya - Term Life, Personal Accident, Critical Illness and Accident Insurance

Contact Employee Benefits

Farmington – for ManhattanLife Whole Life Insurance

877.290.3931 https://plans.farmingtonco.com Username:csb01 Password:csb2012

Employee Assistance Program

Empathia - EAP 800.367.7474 www.mylifematters.com County code: COSB

Health Savings Account

Benefits Corporations Corporation (BCC) – My SmartCare

Avidia Bank

800.685.6100

855.472.9399

www.mywealthcareonline.com/bccsmartcare

For Plan/Benefits Assistance

CareCounsel – your first point of contact

888.227.3334 www.carecounsel.com

Employee Self-Service

County of Santa Barbara Employee portal

https.//essplus.co.santa-barbara.ca.us

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EMPLOYEE BENEFITS DEPARTMENT

Employee Benefits 1226 Anacapa Street Santa Barbara, CA 93101

Contact CareCounsel for Benefit Questions

https://cosb.countyofsb.org/hr/ or email: benefits@co.santa-barbara.ca.us

Employee Benefits Staff:

Maya Barraza Benefits & Wellness Division Chief mabarraza@sbcountyhr.org

Tina Meier Benefits Analyst

tmeier@sbcountyhr.org

Michelle Boccali Benefits Specialist mboccali@sbcountyhr.org

Marlene Zavala Benefits Assistant

mzavala@sbcountyhr.org

Katie Torres County Wellness Partner kltorres@co.santabarbara.ca.us

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Key Terms

MEDICAL/GENERAL TERMS Allowable Charge - The most that an in-network provider can charge you for an office visit or service.

Balance Billing - Non-network providers are allowed to charge you more than the plan's allowable charge. This is called Balance Billing.

Coinsurance - The cost share between you and the insurance company. Coinsurance is always a percentage totaling 100%. For example, if the plan pays 70%, you are responsible for paying the remaining 30% of the cost.

Copay - The fee you pay to a provider at the time of service.

Deductible - The amount you have to pay out-of-pocket for expenses before the insurance company will cover any benefit costs for the year (except for preventive care and other services where the deductible is waived).

Explanation of Benefits (EOB) - The statement you receive from the insurance carrier that explains how much the provider billed, how much the plan paid (if any) and how much you owe (if any). In general, you should not pay a bill from your provider until you have received and reviewed your EOB (except for copays).

Family Deductible - The maximum dollar amount any one family will pay out in individual deductibles in a year. IMPORTANT: If you enroll for family coverage on the 2020 plan, one or more family members will need to meet the deductible.

Individual Deductible - The dollar amount a member must pay each year before the plan will pay benefits for covered services. Important: If you enroll for family coverage on the 2020 plan, the individual deductible does not apply.

In-Network - Services received from providers (doctors, hospitals, etc.) who are a part of your health plan's network. In-network services generally cost you less than out-of-network services.

Out-of-Network - Services received from providers (doctors, hospitals, etc.) who are not a part of your health plan's network. Out-of-network services generally cost you more than in-network services. With some plans, such as HMOs and EPOs, out-of-network services are not covered.

Out-of-Pocket - Healthcare costs you pay using your own money, whether from your bank account, credit card, Health Reimbursement Account (HRA), Health Savings Account (HSA) or Flexible Spending Account (FSA).

Out-of-Pocket Maximum – The most you would pay out-of-pocket for covered services in a year. Once you reach your out-of-pocket maximum, the plan covers 100% of eligible expenses.

Preventive Care – A routine exam, usually yearly, that may include a physical exam, immunizations and tests for certain health conditions.

PRESCRIPTION DRUG TERMS Brand Name Drug - A drug sold under its trademarked name. A generic version of the drug may be available.

Generic Drug – A drug that has the same active ingredients as a brand name drug, but is sold under a different name. Generics only become available after the patent expires on a brand name drug. For example, Tylenol is a brand name pain reliever commonly sold under its generic name, Acetaminophen.

Dispense as Written (DAW) - A prescription that does not allow for substitution of an equivalent generic or similar brand drug.

Maintenance Medications - Medications taken on a regular basis for an ongoing condition such as high cholesterol, high blood pressure, asthma, etc. Oral contraceptives are also considered a maintenance medication.

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Non-Preferred Brand Drug - A brand name drug for which alternatives are available from either the plan's preferred brand drug or generic drug list. There is generally a higher copayment for a non-preferred brand drug.

Preferred Brand Drug - A brand name drug that the plan has selected for its preferred drug list. Preferred drugs are generally chosen based on a combination of clinical effectiveness and cost.

Specialty Pharmacy - Provides special drugs for complex conditions such as multiple sclerosis, cancer and HIV/AIDS.

Step Therapy - The practice of starting to treat a medical condition with the most cost effective and safest drug therapy and progressing to other more costly or risky therapy, only if necessary.

DENTAL TERMS Basic Services - Generally include coverage for fillings and oral surgery.

Diagnostic and Preventive Services - Generally include routine cleanings, oral exams, x-rays, sealants and fluoride treatments. Most plans limit preventive exams and cleanings to two times a year.

Endodontics - Commonly known as root canal therapy.

Implants - An artificial tooth root that is surgically placed into your jaw to hold a replacement tooth or bridge. Many dental plans do not cover implants.

Major Services - Generally include restorative dental work such as crowns, bridges, dentures, inlays and onlays.

Orthodontia - Some dental plans offer Orthodontia services for children (and sometimes adults too) to treat alignment of the teeth. Orthodontia services are typically limited to a lifetime maximum.

Periodontics - Diagnosis and treatment of gum disease.

Pre-Treatment Estimate - An estimate of how much the plan will pay for treatment. A pre-treatment estimate is not a guarantee of payment.

Click on the icon to watch a video on Health Terms.

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Important Plan Notices and Documents

CURRENT HEALTH PLAN NOTICES

Notices must be provided to plan participants on an annual basis are available on the County’s website, http://cosb.countyofsb.org/hr/ and include:

• Medicare Part D Notice Describes options to access prescription drug coverage for Medicare eligible individuals.

• Women's Health and Cancer Rights Act Describes benefits available to those that will or have undergone a mastectomy.

• Newborns' and Mothers' Health Protection Act Describes the rights of mother and newborn to stay in the hospital 48-96 hours after delivery.

• HIPAA Notice of Special Enrollment Rights Describes when you can enroll in health coverage outside of open enrollment.

• Children's Health Insurance Program Reauthorization Act (CHIPRA) Describes availability of premium assistance for Medicaid eligible dependents.

CURRENT PLAN DOCUMENTS

Important documents for our health plans are available on the County’s benefits website, http://cosb.countyofsb.org/hr/ or thru Employee Benefits Division, 805.568.2800, and include:

Summary of Benefits and Coverage (SBCs)

A Summary of Benefits and Coverage (SBC) is a document required by the Affordable Care Act (ACA) that presents benefit plan features in a standardized format. The following SBCs are available:

• Blue Shield Low and High Option EPO Plan

• Blue Shield PPO Plan

• Blue Shield HDHP Plan

• Kaiser Low and High Option HMO Plan

Evidence of Coverage (EOCs)

An Evidence of Coverage (EOC) is a document that describes your benefits under the plan as well as plan rights and obligations to participants and beneficiaries. The following EOC plan descriptions are available:

• Blue Shield Low and High Option EPO Plan

• Blue Shield PPO Plan

• Blue Shield HDHP Plan

• Kaiser Low and High Option HMO Plan

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Appendix DEPENDENT ELIBIGILITY DOCUMENTATION

Dependent Type

Required Documentation Resources to Obtain

Documentation

Dependent Spouse (same or opposite gender)

Marriage Certificate, and the portion of your most recent joint Federal or State Tax Return that lists filing status and includes the name/s of the dependent spouse and/or children. Note: you can black-out confidential financial information.

• County office that issued original

marriage • Certificate • Personal tax records/ IRS • CA Franchise Tax Board • www.vitalchek.com

Registered Domestic

Partner

State of California, County or City issued Declaration/Certificate of Domestic partnership and most recent State of California joint tax return

• County/City office that issued

original certificate • http://www.sos.ca.gov/dpregistry • CA Franchise Tax Board

Dependent child by birth

Birth Certificate (must include parents name), and/or copies of any court orders, divorce decrees or other legal documents relating to custody, health coverage or income tax exemptions

• County office that issued original birth certificate

• Hospital in which child was born • U.S. Department of State (for

children born outside of the U.S) • Social Security Administration • www.vitalchek.com

Dependent child by

Adoption

Final Adoption Papers, and/or copies of any court orders, divorce decrees or other legal documents relating to custody, health coverage or income tax exemptions

• State agency that issued final

adoption papers • Adoption agency that issued

placement papers • Social Security Administration

Dependent stepchild(ren)

Birth Certificate (must include parents name), and/or copies of any court orders, divorce decrees or other legal documents relating to custody, health coverage or income tax exemptions

• County office that issued original

birth certificate • Hospital in which child was born • U.S. Department of State (for

children born outside of the U.S) • Social Security Administration • www.vitalchek.com

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Notes

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Employee Benefits Brochure designed and developed by

In conjunction with the County of Santa Barbara, January 2020