See back cover for benefit plan contact information
Table of Contents
As a full-time employee with the City of Arlington , there are many important benefit decisions that need to be made within the first 30 days of employment and annually thereafter . This guide provides a summary of the benefits offered by the City . Additional benefit documents , links and forms are included on the Human Resources portal , and employees are strongly encouraged to review these materials to assist in making benefit plan decisions .
Benefit Overview / Employee Eligibility ................................. 2 Dependent Eligibility ............................................... 3 Family Status Change – Life Events .................................... 4 Online Enrollment Access and Resources ............................... 5 2020 Plan Updates ................................................. 8 Important Programs to Help Save Money .............................. 9 Tobacco Surcharge ................................................. 9 Employee Assistance Program ( EAP ). ................................. 10 Health and Wellness Centers ........................................ 10 Wellness for Life Program .......................................... 11 Medical and Pharmacy Summary .................................... 13 Prescription Drug Coverage ........................................ 14 Individual Health Savings Account ( HSA ). .............................. 15 Flexible Spending Accounts ( FSA ) ................................... 16 Dental Plan Summary .............................................. 17 Vision Plan Summary .............................................. 18 Life Insurance Plan Summary ........................................ 19 Long Term Disability and Short Term Disability .......................... 20 Optional Benefit Plans ............................................. 21 Retirement Plans ................................................. 22 Important Required Notices ......................................... 23 Continuation Coverage Rights under COBRA .................... 23 Children ’ s Health Insurance Program ( CHIP ) Notice ............... 23 Medicare Part D and Other Required Notices .................... 24
Appendix A - Educational Information Active Employees Eligible for Medicare ........................ 25 HSA - How do I know if I can contribute ? ....................... 26 HSA / FSA Comparison Chart ................................ 27 HSA / FSA Decision Chart ................................... 29 Appendix B - Plan Rates ............................................ 30 Benefit Plan Contact Information ............................. Back Cover
Declining Coverage
If you have medical coverage under another plan , you may choose to decline ( waive ) the City ’ s medical plans . When an employee makes this choice , a “ Declination of Medical Coverage Affidavit ” form must be completed and returned to HR along with an enrollment form .
Some examples of other coverage could be :
• Your spouse ’ s or parents ’ plan
• A government insurance program
• An individual policy or other group coverage
See back cover for benefit plan contact information
NOTE : Any information that is false and / or inaccurate or enrolling dependents that do not meet eligibility guidelines ( see page 3 ) is a material misrepresentation . This conduct may result in discipline up to and including termination of employment , personal liability for benefits received and / or criminal prosecution . Additional consequences may apply .
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