Denver Fire Department

Benefit Guide Active Employees

Plan Year January 1, 2014–December 31, 2014

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The Denver Fire Department Benefits Program Denver Fire Department offers a variety of benefits to you and your eligible dependents, as described in this Benefits Guide. To enroll in any plan please follow the instructions in this guide.

Your Benefit Choices Denver Fire Department offers the following benefit plans to active eligible employees:

Medical plans – Kaiser Permanente

Dental plans – Delta Dental

Vision plan – Humana

Basic life and accidental death & dismemberment (AD&D) insurance

Health Care FSA and Dependent Care FSA – 24 Hour Flex

Plus additional life and disability choices

Eligibility You must enroll within thirty (30) days of your hire date or eligibility date (if you have a family status change you have 31 days), or you may enroll during the annual enrollment period.

Eligible Dependents Many of the benefit plans offer coverage for eligible dependents. Eligible dependents include the following:

Your legal spouse, if not legally separated

Your qualifying spousal equivalent

Your civil union partner

Your children to the end of the month in which they turn age 26

Your children over age 26 who are totally disabled

Choosing a Coverage Level You may elect different coverage levels under the medical and dental plans. For example, you may elect employee only coverage under the medical plan and family coverage under the dental plan. Your medical selection with Kaiser can be no less than your vision coverage for the Humana vision plan. The coverage levels are as follows:

Employee only

Employee + spouse

Employee + child(ren)

Family; or

Decline Coverage

Making Election Changes The Denver Fire Department Benefits Program allows you to make changes once a year during the annual enrollment period. You cannot enroll, change, or terminate your coverage during the year unless you have a change in family status as defined under Section 125 of the Internal Revenue Service (IRS).

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The Denver Fire Department Benefits Program

If you Experience a Change in Family Status Event: You must notify the Human Resources Benefits Team within 31 days of the status change in order to add or delete a dependent or make other changes.

Supporting documentation will be required.

If you miss the 31-day window, you will not be allowed to make changes until the next annual open enrollment period.

Qualifying Change in Family Status Events:

Marriage

Legal separation or divorce

Death

Birth or adoption of a child

Change in your spouse’s employment or health benefits

Unpaid leave of absence for you or your spouse

New common law/domestic partner relationship

New civil union partner

Annual Enrollment Period Open enrollment provides you the opportunity to change your elections for medical, dental, and vision coverage. In order to continue or change your flexible spending accounts you must enroll online. You can also change your Deferred Compensation (457) provider during open enrollment.

To Enroll or Change Elections During the Annual Enrollment Period: 1. Login to DOT using your user name and password 2. Click ―Benefits Enrollment‖ under My Benefits and follow the prompts. 3. You will receive confirmation of your enrollment or election changes. 4. Please note: if enrolling in the HDHMO, you will need to go to the Denver Fire Department Federal Credit Union to

open your Health Savings Account. See page 5 for more information.

Getting Close to Retirement? Employees who are thinking about and/or are ready for retirement, please review the Memorandum of Understanding (MOU) revision number 05-292—a rule that requires a 60-day notice. Contact Human Resources at least 60 days prior to your planned retirement date.

What You Need To Do If You Are a New Hire Read this Benefits Guide carefully.

Complete and sign the Denver Fire Department Benefit Enrollment/Change Form.

Submit your completed enrollment form(s) along with required documentation to the Human Resources Benefits Team within 30 days of your hire date.

Available Resources

The following resources are available to assist you in the enrollment process:

Benefit Provider Websites and Toll-Free Numbers – each of the carrier websites contains valuable information regarding the benefit plan and an up-to-date list of participating providers. The list on the back cover of this guide includes websites and numbers for each carrier.

If you have questions regarding your benefits, please contact the Human Resources Benefits Team at 720-913-3413 or 720-913-6741.

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Summary of Medical Benefit Changes

Changes to all medical plans— Home health care - The special services program for hospice-eligible members will cover unlimited home health visits. Specialty drug tier - The formulary for the prescription drug benefit’s specialty drug tier is changing to include other specialty drugs in addition to self-injectibles for grandfathered plans only. Out-of-area student benefit - The out-of-area student benefit will cover up to 5 office visits, 5 diagnostic x-rays, and 5 prescription drug refills. Applied behavioral analysis - Applied behavioral analysis for the treatment of autism spectrum disorders will be provided as follows: • Up to 550 visits per year for children ages 0-8 • Up to 185 visits per year for children ages 9-18 Early intervention services - Early intervention services for eligible children will be provided up to the maximum number of visits as determined by the State. Over the counter items (OTC) - Certain OTC items as required by the health reform law will be covered at $0 cost share when determined to be clinically appropriate for non-grandfathered plans and for grandfathered plans with health care reform prevention benefits. BRCA testing & counseling - When determined to be clinically appropriate, BRCA testing and counseling will be covered at $0 cost share for non-grandfathered plans and for grandfathered plans with health care reform prevention benefits. Women’s preventive services - Routine prenatal and postnatal visits are not included in the required coverage for women’s preventive services under health care reform.

Changes specific to the HMO Plan and the Triple Option Plan— Out-of-pocket maximum (OPM) changes - Cost shares for essential health benefits (EHBs) will apply to the member’s OPM, including copays and deductibles for non-grandfathered plans.

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Denver Fire Department offers you and your eligible dependents three medical plan options through Kaiser Permanente: the High-Deductible HMO (HDHMO) Plan, the Traditional HMO Plan, and the Triple Option Plan. Both the HDHMO and HMO plans provide in-network coverage only. If you enroll in the HDHMO Plan, you must meet your deductible ($3,000 individual and $6,000 family) before the plan will begin to pay for covered services (including prescriptions and office visits). If you elect dependent coverage, the family deductible must be met either by one individual or by a combination of family members before the plan begins to pay. If you enroll in the Triple Option Plan, you will receive the highest level of benefits and pay less out of pocket by using a Kaiser network provider. You also have the option to use PHCS network providers and out-of-network providers. However, you will pay more out of your pocket for services provided by non-Kaiser providers. Below is a brief summary of the benefits provided by the plans.

*Visit www.multiplan.com/kaiser for online provider directory **Tobacco cessation and contraceptive drugs are 100% covered by the plan. ***If you elect dependent coverage, the family deductible must be met either by one individual or a combination of family members before the plan begins to pay. ****Each eligible out-of-area student must be registered each year. To register, you must complete and submit an Out-of-Area Student Benefit Certification Form to Kaiser. Please contact the Human Resources Benefits Team for more information.

Medical Plans

Benefit Summary Kaiser HDHMO

Kaiser HMO Kaiser Triple Option

Network Only Network Only Kaiser Network PHCS Network*

Out-of-Network

Annual Deductible Individual Family

$1,500

$3,000***

None None

None None

$300 $900

$400

$1,200

Annual Out-of-Pocket Max

Includes deductible Includes deductible

Individual Family

$3,000 $6,000***

$2,000 $4,500

$2,000 $4,500

$3,000 $9,000

$6,000 $18,000

Office Visits Preventive Care Primary Care Specialist

100% covered 20% after ded. 20% after ded.

100% covered

$20 copay $30 copay

100% covered

$20 copay $30 copay

100% covered

$20 copay $35 copay

$70 copay

40% after ded. 40% after ded.

Hospital Services Inpatient Outpatient Emergency Room Urgent/After-Hours Care

20% after ded. 20% after ded. 20% after ded. 20% after ded.

$500 copay $100 copay $100 copay $50 copay

$500 copay $100 copay $100 copay $50 copay

20% after ded. 20% after ded.

$100 copay 20% after ded.

40% after ded. 40% after ded.

$100 copay 40% after ded.

Lab & X-ray Diagnostic Lab and X-Ray Therapeutic X-Ray MRI, nuclear and high tech

20% after ded. 20% after ded. 20% after ded.

No charge $30 copay

$100 copay/procedure

No charge $30 copay

$100 copay/procedure

20% after ded. 20% after ded. 20% after ded.

40% after ded. 40% after ded. 40% after ded.

Prescriptions** 60-day supply 30-day supply 30-day supply 30-day supply 30-day supply

Generic Brand

$15 copay after ded. $40 copay after ded.

$10 copay $20 copay

$10 copay $20 copay

$25 copay $35 copay

50% 50%

Mail Order (90-day supply) 2x retail copay 2x retail copay 2x retail copay 2x retail copay N/A

Lifetime Max Benefit Unlimited Unlimited Unlimited Unlimited Out-of-Area Student Benefit****

5 office visits, 5 x-rays, 5 Rx refills

5 office visits, 5 x-rays, 5 Rx refills

5 office visits, 5 x-rays, 5 Rx refills

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If you enroll in the Kaiser Permanente High-Deductible HMO (HDHMO) Plan, you may be eligible to open and fund a health savings account (HSA). An HSA is a personal health care savings account that you can use to pay out-of-pocket health care expenses with pre-tax dollars. Your contributions are tax free, and the money remains in the account for you to spend on eligible expenses no matter where you work or how long it stays in the account.

HSA Eligibility You are eligible to open and fund an HSA if:

You are covered by an HSA-eligible high-deductible health plan, like the Kaiser Permanente HDHMO.

You are not covered by any other health plan, including a health care flexible spending account provided through your employer or your spouse’s employer

You are not eligible to be claimed as a dependent on someone else’s tax return.

You are not enrolled in Medicare or TRICARE for Life.

You have not received Veterans Administration Benefits in the previous 3 months.

Use Your HSA to Pay for Qualified Health Care Expenses

You can use your HSA money to pay for eligible health care expenses now or in the future.

Funds in your HSA can be used for your expenses and those of your spouse and eligible dependents, even if they are not covered by the Kaiser Permanente HDHMO.

Eligible expenses include doctor’s office visits, eye exams, prescription expenses, dental services, and LASIK surgery.

IRS Publication 502 provides a complete list of eligible expenses and can be found at www.irs.gov.

You can also use your HSA money to pay the following types of insurance premiums: Cobra continuation coverage, Medicare when you reach age 65 or older, Long-term care insurance.

2014 HSA Contribution Maximums The 2014 IRS maximum contributions are as follows:

Employee Only: $3,300 All Other Tiers: $6,550

Individuals age 55 and older may make an

additional $1,000 annual catch-up contribution to their HSA.

Your HSA is an Individually Owned Account

You own and administer your HSA.

You determine how much you will contribute to your account and when to use the money to pay for eligible health care expenses.

Like a bank account, you must have a balance in order to pay for eligible health care expenses.

It is important that you keep receipts for tax documentation.

An HSA allows you to save and roll over money if you do not spend it in the calendar year.

The money in the account is always yours, even if you change health plans or jobs.

There are no vesting requirements or forfeiture provisions.

Maximize Your Tax Savings

Contributions to an HSA are tax free—you may need to take an above-the-line deduction on your federal income tax filing for any amounts you contribute to your HSA.

The money in your HSA (including interest and investment earnings) grows tax free.

As long as you use the funds to pay for eligible expenses, the money is spent tax free.

Opening Your Health Savings Account You can open your HSA at any financial institution that offers health savings accounts. There may be a monthly service fee associated with your account. Denver Fire Department Federal Credit Union has agreed to administer HSAs for credit union members at no charge. To open your account with the credit union, you need to visit their location at 2201 Federal Boulevard, Denver, CO 80211. If you have questions, please contact the credit union at: Phone: 303-228-5300 Toll Free: 866-880-7770 Fax: 303-228-5333 E-mail: webmail@dfdfcu.com

Health Savings Account (HSA)

The City of Denver will deposit money into your

HSA to help you start saving*—

$1,000 for individuals $2,000 for all other coverage tiers

*This money is only available if you enroll in the Kaiser HDHMO and open your HSA with Denver Fire Department Credit Union by 12/31/2013. If you enroll in an HSA at any time other than open enrollment, the City of Denver’s contribution to your account will be pro-rated.

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Kaiser Permanente has been working with the Wellness Team to create an annual physical to match the 1582 national Union standards The physical includes:

Yearly health maintenance examination with primary care physician (PCP).

Yearly fasting cholesterol profile, fasting blood sugar, complete blood count, urinalysis, liver test, and kidney function test.

Heavy metal screening if member has concerns about exposure or symptoms suggesting heavy metal exposure.

HIV and Hepatitis C screening (if member requests or as indicated by CDC guidelines).

Appropriate immunizations as recommended by PCP.

Framingham risk assessment.

1 baseline ECG–if member has hypertension or diabetes this may occur more frequently.

Stress test with or without imaging shall be performed when clinically indicated by history or symptoms or once every 5 years in members with moderate to high Framingham risk score.

Standard Kaiser Permanente cancer screening protocols for colon, prostate, cervical, and breast cancer.

Recommend that all members complete PHQ-9, CAGE-AID, and Epworth-sleep screen prior to PCP visit to review results with PCP.

All services will be provided to the members in the HMO and the Kaiser Triple Option at $0 copay if they use a Kaiser provider. Due to federal regulations around qualified HDHP plans, some services provided will not be covered at 100% (for example, a stress test will cost approximately $400).

Other services that are available and will be covered at the appropriate schedule of benefits:

Audiology testing.

Formal eye exam.

Referrals for behavioral health, chemical dependency, or sleep apnea screening if clinically indicated.

Smart Set Physical for Firefighters

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Denver Fire Department offers you and your eligible dependents vision coverage through Humana. If you enroll in a Kaiser medical plan, you will automatically be enrolled in the same coverage level for vision. You may also elect to enroll in just vision coverage, but your medical selection with Kaiser can be no less than your vision coverage for the Humana vision plan. Visit www.humanavisioncare.com or call 866-537-0229 for details. The vision plan is a PPO plan that includes a network of participating eye care providers. You receive the maximum benefits under the plan, and pay less out of your pocket, when you seek care from a network provider. You do have the option to seek care out of the network, but you will pay more out of your pocket for those services.

Humana Vision Plan

Summary of Benefits In-Network Out-of-Network

Eye Exam (every 12 months; based on last service date) $20 copay Reimbursement up to $35

Lenses (every 12 months; based on last service date)

Single Bifocal

$20 copay $20 copay

Reimbursement up to $25 Reimbursement up to $40

Frames (every 24 months; based on last service date) $40 wholesale allowance Reimbursement up to $40

Contact Lenses (every 12 months; based on last service

date) Medically Necessary

Elective

Copay waived

$105 allowance

Reimbursement up to $210

Reimbursement up to $105

Laser Correction 15% discount No discount

Vision Plan

Dental Plans

Three dental plans are available to you and your eligible dependents through Delta Dental. The EPO plan provides benefits only when you visit a participating EPO dentist. For the Low Plan and High Plan, when you choose a participating dentist you maximize the benefit plan with access to lower out-of-pocket expenses. In-network dentists have agreed to accept Delta Dental’s reimbursement as full payment for services rendered. If a non-network provider is used, expenses are reimbursed based on reasonable and customary (R&C) charges. Any charges over the R&C are your responsibility.

Delta Dental EPO Plan Group #6791

Delta Dental Low Plan Group #6026

Delta Dental High Plan Group #6793

Summary of Benefits In-Network(1)

Only In-Network Out-of-Network(1)

In-Network Out-of-Network(1)

Annual Deductible None $25 individual

$75 family $25 individual

$75 family $25 individual

$75 family $25 individual

$75 family

Preventive Care Copay

Schedule

100% 80%* 100% 100%*

Basic Services 80%* 50%* 90%* 80%*

Major Services 50%* 50%* 60%* 50%*

Annual Max Benefit Unlimited $1,250 $1,250 $2,000 $2,000

Orthodontia Copay Applies 50% 50% 50%

Lifetime Orthodontia Maximum

N/A $1,000 maximum $1,000 maximum $1,000 maximum $1,000 maximum

* Deductible Applies; percentage noted is plan reimbursement. (1) Reimbursement is based on Reasonable and Customary charges.

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Post-Employment Health Plan

Denver Fire Department offers a Post-Employment Health Plan (PEHP) through Nationwide. PEHP is a tax-free defined contribution health reimbursement arrangement (HRA) that allows employers to set aside money for the payment of medical expenses that retirees will incur after separation of service. The account chosen at this time is the Insurance Premium Reimbursement Account. It reimburses qualified health insurance premiums you pay. This includes any qualified health insurance premium, dental insurance premium, Medicare part B and Medicare supplements, and long-term care premiums.

Type of Plan

Employee benefit plan

Internal Revenue Code Section 501(c)(9)

Assets Held

Tax exempt multiple-employer VEBA trusts

Tax Advantages

Employee pays no FICA or federal income taxes on:

Contributions

Investment earnings

Benefits paid from the plan

Plan Contributions

Employer contributions only - salary reduction not permitted

Plan Benefits Tax-free accumulation and reimbursement for qualified post employment medical expenses as defined by the Internal Revenue Code Section 213 (d).

Examples include:

Health insurance premiums

Medicare Part-B premiums

Medicare supplemental insurance premiums

Qualified long-term care premiums

Benefit Flexibility

Upon the employees separating from service or retiring, requests may be made for the reimbursement of medical insurance premiums

Funding Options Insurance Premium Reimbursement Account (IPRA)

Universal Reimbursement Account (URA)

Plan Fee

Employee - $30 annual administrative fee; 0.50% asset fee

Note: No charge for claims reimbursements

Benefit Plan Contributions

Medical Plans—Employee Biweekly Contributions:

Kaiser HDHMO Group #00074

Kaiser HMO

Group #00074 Sub Group #001-Denver,

#007-Colorado Springs

Kaiser Triple Option

Group #00074 Sub Group #13

Employee only $40.67 $54.81 $66.56

Employee + spouse $83.41 $112.53 $136.55

Employee + child(ren) $81.43 $109.72 $133.23

Family $117.52 $158.60 $192.51

Dental Plans—Employee Biweekly Contributions:

Delta Dental Low

Group #6026

Delta Dental EPO Option

Group #6791

Delta Dental High

Group #6793

Single $2.34 $3.13 $7.28

Employee + spouse $5.18 $6.94 $16.17

Employee + child(ren) $4.67 $6.26 $14.57

Family $8.31 $11.13 $25.93

Vision Plans—Employee Monthly Contribution:

Humana Vision

Group #VS5679 Employee only $0.82

Employee + spouse $1.72

Employee + child(ren) $1.42

Family $2.32

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Life, AD&D, Disability Insurance, Tax Deferred Savings Plan, and Flexible Spending Accounts

Basic Life and AD&D Insurance Offered Through The Standard Insurance Company For your peace of mind and the financial protection of your family, the Denver Fire Department provides a basic life and accidental death and dismemberment (AD&D) insurance program. This plan is 100% city paid. Benefits include life and AD&D for one and a half (1.5) times annual base salary to a maximum of $300,000. This coverage is at no cost to all full-time employees. The IRS requires that you pay taxes on the value of any company-provided life insurance benefit that is more than $50,000. The taxes you pay are based on tables established by the IRS and are minimal. This ensures that benefits will not be taxable if paid out to a beneficiary.

Voluntary Life Insurance Offered Through The Standard Insurance Company You can also elect to purchase voluntary life insurance for yourself and your dependents. You can elect up to $50,000 additional coverage for yourself, up to $50,000 for your spouse (over $15,000 will be subject to underwriting approval) and up to $10,000 for each of your children. Elected voluntary life insurance is a payroll deducted benefit and may be subject to underwriting approval.

Additional Voluntary Life Insurance Offered Through Colonial Life & Accident Insurance Company Additional life insurance is available to all eligible Denver Fire Department employees and dependents through payroll deduction. For rate information please contact Karen Koch at 303-791-7771. *All Colonial Life polices can be continued after retirement via pension deduction at the same premium.

Voluntary Short Term Disability (VSTD) Offered Through Colonial Life & Accident Insurance Company Voluntary short-term disability insurance provides financial security while you are unable to perform your main job duties.

Accident disability starts the first day, pays $1,000/month for 12 months.

The accident plan includes AD&D, hospital confinement, medical fees and specific loss.

Sickness Disability starts 15th day, pays $500 or $1,000/month for 12 months.

Premium Cost for VSTD: $43/month; accident sickness cost depends on plan chosen.

Family coverage available for an additional $5.25 for spouse and $4.50 per child.

For additional coverage information contact Karen Koch at 303-791-7771.

Tax Deferred Savings Plan The deferred compensation plan (457 Plan) is a supplemental retirement savings program that allows you to make contributions on a pre-tax basis. Federal, and in most cases, state income taxes are deferred until your assets are withdrawn, usually during retirement when you may be in a lower tax bracket.

What are the benefits of participating in a 457 plan?

You reduce your current income taxes while investing for retirement.

Your earnings accumulate tax-deferred.

You can ―dollar cost average‖ through convenient payroll deductions*.

You may be allowed to make additional "catch-up" contributions if you are 50 (or older) or within three years of your normal retirement age.

If you change jobs, you have the flexibility to move your account into your new employer's retirement plan.

If you retire or leave service early, there is no penalty for withdrawals.

Supplemental investments are helpful in states and communities where no contribution is made to social security.

*Dollar cost averaging does not assure profit or protect against loss in a declining market. Since dollar cost averaging involves continuous investing, regardless of fluctuating prices, investors must consider their level of comfort in continuing to invest

during a declining market.

Other Benefits Defined Benefit Pension provided through the FPPA

Membership with the DFD Credit Union

Option to seek financial/retirement planning assistance

Flex Cash - Flexible Spending Accounts (FSA) Offered through 24HourFlex Denver Fire Department provides flexible spending accounts, through 24HourFlex, which allow you to set aside pre-tax dollars from your paycheck to pay for eligible health care expenses not covered by insurance as well as eligible dependent day care expenses. The flexible spending accounts help you save federal income taxes, Social Security taxes (FICA), and most state income taxes on the amounts you set aside in these accounts. You may contribute up to $2,500 a year to the health care FSA and up to $5,000 a year (or $2,500 per year if you are married and file taxes separately) to the dependent care FSA. Before deciding how much of your pay to put into account, consider carefully your expenses for the coming year. Unused FSA dollars do not carry over from one year to the next.

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Notice Information

Reminder of Availability of Notices Please refer to the Denver Fire Department 2014 Health Plan Notices for the following notices:

Medicare Part D Creditable Coverage Notice HIPAA Comprehensive Notice of Privacy Policy and Procedures Notice of Special Enrollment Rights General COBRA Notice Right to Designate Primary Care Provider and of No Obligation for Pre-Authorization for Ob/Gyn Care Women’s Health and Cancer Rights Notice

If you need an another copy of the notices, you may contact the Department of Safety Human Resources at (720) 913-3413 or (720) 913-6741.

Medicaid and CHIP Notice Please refer to the Medicaid and the Children’s Health Insurance Program (CHIP) Notice for additional information on Medicaid and CHIP. If you need an another copy of the Medicaid and CHIP Notice, you may contact the Department of Safety Human Resources at (720) 913-3413 or (720) 913-6741.

This document is intended to merely highlight or summarize certain aspects of the employer’s benefit program(s). It is not a summary plan description (SPD) or an official plan document. Your rights and obligations under the program(s) are set forth in the official plan documents. All statements in this summary are subject to the terms of the official plan documents, as interpreted by the appropriate plan fiduciary. In the case of an ambiguity or outright conflict between a provision in this summary and a provision in the plan documents, the terms of the plan documents control. The employer reserves the right to review, change, or terminate the plan, or any benefits under it, for any reason, at any time and without advance notice to any person.

Plan Phone Number Website

Medical Plan—Kaiser Permanente 303-338-3800 or 1-800-632-9700 www.kp.org

Dental Plan—Delta Dental of Colorado 303-741-9305 or 1-800-610-0201 www.ddpco.com

Vision Plan—Humana (formerly CompBenefits) 1-866-537-0229 www.humanavisioncare.com

Flex Cash - 24 Hour Flex 303-369-7886 www.24hourflex.com

Life & AD&D 1-800-759-8702 or 1-800-628-8600 www.standard.com

IAFF 858 303-298-7850 www.iaff858.org

Post Employment Health Plan (PEHP) - Nationwide 1-877-677-3678 or 303-452-6300 www.nrsforu.com

Fire and Police Pension Association—(FPPA) 303-770-3772 or 1-800-332-3772 www.fppaco.org

Denver Fire Department Federal Credit Union

303-228-5300 www.dfdfcu.com

Email: webmail@dfdfcu.com

Voluntary Short Term Disability and Life - Colonial Insurance

303-791-7771 or 1-800-325-4368 N/A

Department of Safety Human Resources 720-913-3413 or 720-913-6741 N/A

Contact Information

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