Employee Benefit Summary Guide

(1)

2013-2014

(2)

Introductory Letter

... 2

About Your Benefits

... 3

2013-2014 Medical Rates

... 5

2013-2014 Dental Rates

... 5

Online Benefit Enrollment - WorkTerra

... 6

Log-in Instructions

... 6

General Guidance ... 7

Notice of Privacy Information Practices

... 8

City of Durham Department Liaisons

... 9

BCBSNC Premium Plan Highlights

... 10

BCBSNC Core Plan Highlights

... 14

BCBSNC Basic Plan Highlights

... 18

BCBSNC Dental Plan Highlights

... 22

Vision Plan

... 23

Employee Assistance Plan

... 24

Group Term Life and AD&D - Unum

... 26

Long Term Disability – Unum

... 30

Short Term Disability – Unum

... 37

Healthcare Reimbursement Arrangement (HRA)

... 42

Flexible Spending Accounts (FSA)

... 44

Colonial Life Voluntary Products

... 47

Hyatt Legal Plan (MetLaw)

... 51

Liberty Mutual (Auto and Home)

... 52

Long Term Care Insurance

... 53

Time Off Benefits

...55

Retirement Benefits

...59

COBRA Benefits – Continuing Your Coverage

...61

Employee Discounts

... 63

Important Contact Information

... 65

About This Guide and Key Terms

... 66

(3)

2 June 2013

Dear City Employee:

We’d like to welcome you to the start of another open enrollment season. It is our pleasure to provide

you with this important resource regarding your benefits at the City of Durham. This guide has all of the

information you will need for open enrollment and throughout the year so that you can make educated

decisions that are right for you and your family. Open Enrollment is a great time to review your existing

benefit plans, evaluate any anticipated needs, learn more about your benefits and make adjustments for

the upcoming year.

Your benefits make up an important part of your total compensation. The City of Durham offers a

comprehensive benefits package for our employees and their eligible dependents. Our benefits

program provides a flexible approach to certain City benefits, allowing you to select coverage that best

meet your needs.

We have placed our major focus on enhancements to the City’s Wellness program in order to create a

culture of wellness. The 2013-2014 plan design continues our effort to be more involved in your health

care decisions, to take advantage of preventive health care options, and to adopt healthy lifestyles.

We encourage you to continue getting the most from your healthcare benefits by expanding your

awareness, attending education sessions, and reading articles and special announcements about health

that may be useful to you and your family.

The City’s 2013 annual OPEN ENROLLMENT period will occur June 18-July 19, 2013. Remember, annual

enrollment is the only chance you have each year to adjust your benefits, except for qualifying events or

when court ordered. Your benefit plan changes must be completed and submitted no later than

Friday, July 19, 2013. Please enroll online at

www.workterra.net

for health, dental, vision, life, long

term disability, short term disability, Hyatt Legal Plans and flexible spending accounts.

For voluntary benefits with Colonial, Liberty Mutual and New York Life you will be able to meet with

enrollment counselors. Stay tuned for the schedule of site location and times.

We look forward to working with you!!!!!!!!!!!

Human Resources Department

(4)

About Your Benefits

Choosing Your Benefits

Some benefits like basic life insurance are automatic. You don’t have to choose them because

the City pays the entire cost. But you must actively choose any benefit that you pay for. Your

part of the cost is automatically deducted from your paycheck. There are two ways that the

money can be deducted:



PRE‐TAX premiums are collected for Medical, Dental and Flexible Spending Accounts;

and



POST‐TAX premiums are collected for the following optional benefit plans: Short‐Term

Disability, Long‐Term Care, Supplemental and Dependent Life Insurance and Universal

Life insurance premiums.

Making Changes

Employee benefit elections must be made before the start of each plan year during open

enrollment or as part of the new hire benefits enrollment process.

Your benefit selection will

remain in effect through August 31, 2014. Generally, you can only change your benefit choices

during the annual benefits enrollment period. However, you can change your applicable benefit

plans during the year if you have a family status change. Family status changes include:



You get married



You get divorced or legally separated



Birth, adoption, or placement of adoption of an eligible child



Death of your spouse or covered child



Change in your or your spouse’s or domestic partner’s work status that affects benefits

eligibility (for example: starting a new job, leaving a job, or leave of absence)



A significant change in your spouse’s or domestic partner’s health coverage attributable

to your spouse’s or domestic partner’s employment



A change in your child’s eligibility for benefits



Becoming eligible for Medicare or Medicaid



Commencement of or returning from an unpaid leave for employee/spouse

If you have a family status change, you must notify your Human Resources team within 30 days of the

change and complete appropriate paperwork within 30 days. Depending on the type of change, you

may need to provide proof of the change (for example: a copy of a marriage license or birth certificate).

If you do not notify your Human Resources team within 30 days, you will have to wait until the next

annual enrollment period to make benefit changes unless you have another family status change

.

Any changes you make to your benefit choices must be directly related to the family status change.

Financial hardship is not a change in life status that qualifies for changing or stopping your insurance

coverages or Flexible Spending Account contributions.

(5)

4 The

IRS

has

strict

regulations

regarding

changes

to

insurance

coverages

and

flexible

spending

account

plans

that

allow

payroll

deductions

on

a

pre

‐

tax

basis.

Once

you

have

elected

your

coverage

and

contribution

amounts,

you

cannot

start,

change,

or

cancel

them

during

the

benefit

period

unless

you

have

a

qualifying

change

in

your

life

status.

The

new

medical

and

dental

insurance

premiums

will

appear

on

your

first

August

2013

paycheck.

All

other

deductions

for

the

2013

‐

2014

plan

years,

if

you

choose

to

participate,

will

begin

on

your

September

2013

paycheck.

When

Coverage

Ends

All

benefits

end

the

last

day

of

the

month

following

a

qualifying

event

change,

separation

of

employment

or

date

of

death.

If

you

have

a

dependent

that

turns

26 years

old

their

coverage

ends

on

their

26th

birthday.

Eligibility

for

Healthcare

Benefits

All

full

‐

time

and

specified

part

‐

time

or

temporary

‐

with

‐

benefits

employees

(not

all

benefits

may

apply

to

temporary

‐

with

‐

benefits

employees)

are

eligible

for

medical

coverage

beginning

on

the

first

day

of

month

following

date

of

employment.

You

may

also

enroll

eligible

dependents,

which

include

your:



Spouse



Domestic

partner

(same

sex

and

opposite

sex)



You

must

complete

an

affidavit

and

provide

two

documents

showing

proof

of

existence

of

the

relationship

for

at

least

6 months

(e.g.,

lease

or

mortgage,

joint

bank

or

credit

account)



Unmarried

children

who

meet

the

IRS

definition

of

a

dependent,

including

legally

adopted,

foster,

and

step

children,

children

placed

for

adoption,

and

children

for

whom

legal

guardianship

has

been

awarded

to

you.

You

can

cover

dependents

up

to

the

age

of

26. 

Unmarried

children

who

are

mentally

or

physical

handicapped

and

incapable

of

self

‐

support,

regardless

of

age.

Contact

the

benefits

team

for

Questions



Michele

Cash,

Benefits

Manager

(919)

560 ‐

4214

ext

23274



Dee

Byers,

Health

&

Wellness

Strategies

Coordinator

(919)

560 ‐

4214

ext

23252



Sofia

Klenke,

HR

Consultant

(919)

560 ‐

4214

ext

23272



Gwen

Burnette,

HR

Consultant

(919)

560 ‐

4214

ext

23281

(6)

City of Durham

2013/2014 Health and Dental Insurance Rate Sheet:

Monthly Employee/City Contributions

HEALTH

‐

BLUE

CROSS/BLUE

SHIELD

Total

City

Employee

Cost

%

Cost

Premium Plan

Single

$640.50

$572.25

89%

$68.25

2 Pty

$1,140.30

$772.64

68%

$367.66

Family

$1,701.00

$1,079.87

63%

$621.13

Core Plan

Single

$572.25

$539.75

94%

$32.50

2 Pty

$936.60

$772.64

82%

$163.96

Family

$1,495.20

$1,079.87

72%

$415.33

Basic Plan

Single

$522.90

100%

$0.00

2 Pty

$898.80

$772.64

86%

$126.16

Family

$1,368.15

$1,079.87

79%

$288.28

DENTAL

‐

BLUE

CROSS/BLUE

SHIELD

Total

City

Employee

Cost

%

Cost

Single

$41.10 $27.54

67%

$13.56

2 Pty

$70.90

$41.12

58%

$29.78

(7)

6 City

of

Durham

O

On

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in

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En

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me

en

nt

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S

Sy

ys

s

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t

em

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Q

ui

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Gu

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id

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e

Login

Instructions

WorkTerra

Website

:

Type

the

following

address

into

your

web

browser:

https://www.workterra.net

If

your

browser

blocks

pop

‐

ups,

you

must

configure

your

browser

to

always

allow

pop

‐

ups

from

this

site.

You

should

see

the

WorkTerra

login

page

pictured

below.

Enter

User

ID

:

Your

User

ID

will

be

your

full

Last

Name

followed

by

your

full

First

Name

without

a

space

between.

For

example,

if

your

name

is

Russ

Bond

your

User

ID

is:

bondruss

Initial

Password

:

Your

password

will

be

your

full

Date

of

Birth

in

MMDDYYYY

format.

For

example,

if

your

Date

of

Birth

is:

July

9,

1983

Then

your

password

is:

07091983

Company

Name:

City

of

Durham

Login:

Click

the

Login

button.

Help:

If

you

need

assistance

logging

in,

please

contact

the

City

of

Durham

Human

Resources

Department.

Legal

Agreement

&

Welcome

Page

Read

the

Employee

Usage

Agreement

and

click

Continue

at

the

bottom

of

the

page.

Read

the

Legal

Agreement

and

click

Continue

at

the

bottom

of

the

page.

(8)

City of Durham

O

On

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li

in

ne

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E

En

nr

r

ol

o

ll

lm

m

en

e

nt

t

Sy

S

ys

st

te

em

m

Qu

Q

ui

ic

ck

k

G

Gu

ui

id

de

e

Change Password

The

first

time

you

log

in

to

WorkTerra,

you

will

be

required

to

create

a

new

password.

You

will

see

the

screen

below.

WorkTerra

password

change

page

pictured

below.

Secret Questions

:

For

additional

security

and

password

recovery,

you

will

select

secret

questions

and

enter

your

answers.

Select

2 Secret

Questions

from

the

dropdown

lists

and

enter

your

Secret

Answers.

New Password

:

Read

the

password

rules

at

the

top

of

the

screen.

Enter

your

new

password.

Enter

your

password

again

to

confirm.

Passwords

are

case

sensitive.

Click

on

the

Save

and

Continue

button.

Demographic Information and Benefit Elections

Step

by

step

instructions

are

available

in

the

forms

library

in

WorkTerra,

on

the

City’s

Human

Resources

intranet

site,

and

from

your

Department

Liaison.

The

following

general

instructions

will

help

you

navigate

WorkTerra

and

successfully

complete

your

enrollment.

Do

not

use

your

internet

browser

“back”

and

“forward”

buttons.

If

you

do,

WorkTerra’s

security

features

will

log

you

out

and

you

will

have

to

log

in

again.

Demographic

information

marked

with

a

red

asterisk

is

mandatory.

Even

if

you

do

not

want

to

enroll

your

spouse

or

children

in

benefits,

add

them

to

the

demographic

section

of

WorkTerra

so

that

you

can

choose

them

as

beneficiaries

of

your

life

insurance

benefits.

To

enroll

in

a

benefit,

choose

the

plan

that

you

want

by

clicking

the

radio

button

to

the

plan

name.

If

you

are

covering

dependents,

select

them

by

clicking

the

box

to

their

name.

If

you

do

not

wish

to

enroll

in

a

benefit,

click

on

the

“Waive

Enrollment”

box.

Click

the

Save

&

Continue

button

to

proceed

forward

through

your

enrollment

options.

(9)

8 Notice of Privacy Information Practices

Our Legal Duty:

We are required by law to protect the privacy of your information, provide this Notice about our information

practices, and follow the information practices that are described in this Notice. In accordance with 45 CFR Section

164.520 (c) (1) (iii), this Notice is provided to the named insured under the Group Health Plan (s). It is the

responsibility of the named insured to share this Notice with his/her dependents. You may also review the City’s

Privacy Policy at

www.durhamnc.gov

. Should you have any questions regarding the Notice(s), you may contact the

Administrative Entity for the appropriate plan or Gwendolyn Burnette, Human Resources Consultant at

.

What is HIPAA?

A federal regulation, the Health Insurance Portability and Accountability Act of 1996, also known as the HIPAA

Privacy Rule, requires the City to provide a detailed notice in writing of its privacy practices. The notice is long

because the HIPAA Privacy Rule requires the City to address a number of specific issues in its notice of privacy

information practices.

Uses and Disclosure of Health Insurance:

The City may contract with individuals and entities (Business Associates) to perform various functions and activities

on the City’s behalf and to provide certain types of services for the City. In their performance of these functions,

activities and services, the City’s Business Associates may receive, create, maintain, use or dispose Protected

Health Information (PHI), but only after the Business Associate has agreed in writing to contract terms designed to

appropriately safeguard the information. The Administrative Entity may use PHI to ascertain, on behalf of the

Group Health Plan(s), ways to improve the quality of health care and to possibly reduce health care costs. The

Administrative Entity may use and disclose PHI for billing, claims management, and collection activities. The vast

majority of the PHI that is received, used, and maintained by the Administrative Entity, on behalf of City’s Group

Health Plan(s), is never seen by the City in its capacity as Plan Sponsor nor in its capacity as the employer.

Complaints Under HIPAA:

If you believe that your privacy rights have been violated, you may complain to the City in care of: Gwendolyn

Burnette, Privacy Officer, HR at 919-560-4214, extension 23281 or

.

You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services, Hubert H.

Humphrey Building, 200 Independence Avenue S.W., Washington, D.C. 20201. All complaints must be submitted in

writing. The City will not retaliate against you for filing a complaint.

Whom to Contact for More Information:

If you have any questions regarding the Notice or the subjects addressed in it, you may contact Gwendolyn

Burnette, Privacy Officer, Human Resources Consultant, at (919) 560-4214, extension 23281 or

(10)

Name

Department

E

‐

mail

Address

Telephone

Barnette,

Keshia

Economic

and

Workforce

Development

919

560 4965

ext

15215

Bass,

Vivienne

Budget

and

Management

Services

919

560 4111

ext

20225

Bass

‐

Hedgepeth,

Joanne

Finance

JoAnn.Bass

‐

919

560 4125

ext

18268

Compton,

Debbie

Inspections

919

560 4144

ext

26147

Egerton,

Terri

Street

Maintenance/Public

Works

919

560 4326

ext

30223

Gardner,

Doris

Police

Employees

Services

919

560 4402

ext

29153

Hester,

Gloria

General

Services

Gloria.

919

560 4197

ext

21238

Horton

‐

Bailey,

Latasha

Fire

Latasha.Horton

‐

919

560 4242

ext

19230

Finch,

Allison

Water

&

Sewer

‐

Maintenance

Division

919

560 4344

ext

35338

Love,

Dan

EO/EA

919

560 4180

ext

17245

Mangum,

Christel

Fire

919

560 4242

ext

19225

McClarty,

Paula

Community

Development

919

560 4570

ext

22221

McDonald,

Cheryl

Neighbor

Improvement

Services

919

560 1647

ext

34248

Merritt,

Sandy

Storm

Water/

GIS

919

560 4326

ext

30224

Mitchell,

Kim

Fleet

Management

919

560 4101

ext

31221

Neal,

Katrena

Human

Resources

919

560 4214

ext

23276

Quick,

Saundra

Information

Technology

919

560 4122

ext

33226

Rhodes,

Brian

Transportation

919

560 4366

ext

36427

Richardson,

Barbara

Parks

and

Recreation

919

560 4355

ext

27211

Smith,

Cheryl

911/Communications

919

560 4500

ext

16276

Staten,

Belinda

Solid

Waste

Management

919

560 4186

ext

32238

Varner,

Lisa

City

Attorney's

Office

919

560 4158

ext

13243

Washington,

Norma

City

Manager's

Office

919

560 4222

ext

11232

Willard,

Susan

Planning

Department

919

560 4137

ext

28265

Williams,

Pamela

Water

Management

919

560 4381

ext

35264

Wright

‐

Corbett,

Evelyn

Mayor's

Office/

City

Clerk's

Office

Evelyn.Wright

‐

919

560 4333

ext

12259

(11)

10

U4964, 7/11

City of Durham

Premium Plan

Effective Date: 09/01/2013

(12)

Blue Options

SM

_{Benefit Highlights (PPO)}

Physician Office Services (See “Outpatient Hospital Services” for “outpatient clinic” or “hospital-based” services.)

In-network Out-of-network1

Office Visit

Includes Office Surgery, Consultation, X-rays, Lab and benefit period

maximum of 4 office visits for the assessment of obesity in and out of network.

Primary Care Provider $15 copayment 70% after deductible

Specialist $30 copayment 70% after deductible

Preventive Care

Routine Examinations, Child Care, Baby Care, Immunizations, Well-Woman Care, colorectal screening, bone mass measurement, newborn hearing screening, routine eye exam and prostate specific antigen tests (PSAs).

Primary Care Provider 100% Not Available*

Specialist

Outpatient Clinic 100%100% Not Available* Not Available*

*Colorectal screening, bone mass measurement, newborn hearing screening, prostate specific antigen tests (PSAs) and certain well woman care like gynecological exams, cervical cancer screening, ovarian cancer screening and screening mammograms are covered Out-of-network.

Therapies

Short-Term Rehabilitative Therapies (Maximums apply to Home, Office and Outpatient Settings):

Physical/Occupational: 30 visits per Benefit Period Speech Therapy: 30 visits per Benefit Period

Primary Care $15 copayment 70% after deductible

Urgent Care Centers and Emergency Room

Urgent Care Centers $15 copayment $15 copayment

Emergency Room Visit (Inpatient Hospital benefits apply if admitted. If held for Observation, Outpatient benefits apply. See “Inpatient and Outpatient Hospital Services”)

$300 copayment $300 copayment Ambulatory Surgical Center 90% after deductible 70% after deductible Inpatient and Outpatient Hospital Services

Hospital and Hospital Based Services 90% after deductible 70% after deductible Outpatient Clinic Services 90% after deductible 70% after deductible

Professional Services 90% after deductible 70% after deductible

Hospital and Professional

Outpatient Labs and Mammograms with surgery or other services 90% after deductible 70% after deductible Outpatient Labs and Mammograms without surgery or other services 100% 70% after deductible Outpatient X-rays, ultrasounds, and other diagnostic tests, such as

EEG’s and EKG’s 90% after deductible 70% after deductible

CT scans, MRI’s, MRA’s and PET scans in any location, including

physician’s office 90% after deductible 70% after deductible

Other Services

Skilled Nursing Facility (60 days per Benefit Period) 90% after deductible 70% after deductible Home Health Care, Ambulance,

Durable Medical Equipment and Hospice 90% after deductible 70% after deductible Maternity

Maternity Delivery includes Prenatal and Post-delivery care

Hospital Services (Delivery) 90% after deductible 70% after deductible Professional Services (Delivery) 90% after deductible 70% after deductible

(13)

12

Page 3

Blue Options

SM

_{Benefit Highlights (PPO)}

Infertility Services

Up to $5,000

Hospital Services 90% after deductible 70% after deductible

Inpatient and Outpatient Professional Services 90% after deductible 70% after deductible Vision (Routine Eye Exams)

Lifetime Maximum, Deductibles & Coinsurance Maximums

100% In-network

Not Available Out-of-network1

The following Deductibles and Coinsurance Maximums apply to the services on the previous page [and Mental Health and Substance Abuse services below]:

Lifetime Benefit Maximum Unlimited Unlimited

Deductibles

Individual(per Benefit Period) $500 $1000

Family (per Benefit Period) $1000 $2000

Coinsurance Maximum

Mental Health and Substance Abuse Services Certified* Non-Certified1

*Inpatient/Outpatient Certification is required. Call Magellan Behavioral Health at 1-800-359-2422.

Mental Health Services

Office visits $30 copayment 70% after deductible

Inpatient Hospital Outpatient Hospital

90% after deductible

90% after deductible 70% after deductible 70% after deductible Substance Abuse Services

Office Visit $30 copayment 70% after deductible

90% after deductible 70% after deductible 70% after deductible Prescription Drugs- Retail Pharmacy

Up to 31 day supply. 32-90 day supply is two copayments. Infertility Drugs up to $5000. MAC B Pricing, Brand Penalty.

Tier 1 (Generic) $0 copayment Copayment + charge over

In-network allowed amount

Tier 2 (Preferred Brand) $20 copayment Copayment + charge over

In-network allowed amount Tier 3 (Brand)

Diabetic Supplies:

Spacers and Peak Flow Meters: Medco Mail Order - 90 day supply:

Tier 1 (Generic) Tier 2 (Preferred Brand) Tier 3 (Brand)

Diabetic Supplies

Spacers and Peak Flow Meters

$35 copayment 100% 100% $0 copayment $40 Copayment $70 copayment 100% 100%

Copayment + charge over In-network allowed amount

100% 100% Not Available Not Available Not Available Not Available Not Available

(14)

ADDITIONAL INFORMATION ABOUT BLUE OPTIONS FROM BCBSNC Benefit Period

The period of time, usually 12 months as stated in the group contract, during which charges for covered services provided to a member must be incurred in order to be eligible for payment by BCBSNC. A charge shall be considered incurred on the date the service or supply was provided to a member. Allowed Amount

The charge that BCBSNC determines using a methodology that is applied to comparable providers for similar services under a similar health benefit plan.

The dollar amount of coinsurance a member must pay prior to BCBSNC paying 100% for certain services. NOTE: In some plans, there is no coinsurance maximum; members are responsible for coinsurance once the deductible has been met. Day and Visit Maximums

All day and visit maximums are on a combined In- and Out-of Network basis.

Utilization Management

To make sure you have access to high quality, cost-effective health care, we manage utilization through a variety of programs including certification, transplant management, concurrent and retrospective review and care management. If you have a concern regarding the final determination of your care, you have the right to appeal the decision. If you would like a copy of a benefit booklet providing more information about our Utilization Management programs, call the toll free number listed in your information packet.

Certification

Certification is a program designed to make sure that your care is given in a cost effective setting and efficient manner. If you need to be hospitalized, you must obtain certification. Non-emergency and non-maternity hospital admissions must be certified prior to the hospitalization. If the admission is not certified, a penalty will be applied.

For maternity admissions, your provider is not required to obtain certification from BCBSNC for prescribing a length of stay up to 48 hours for a normal vaginal delivery, or up to 96 hours for delivery by cesarean section. You or your provider must request certification for coverage for additional days, which will be given by BCBSNC, if medically necessary. All inpatient and certain outpatient Mental Health and Substance Abuse services must be certified in advance by Magellan Behavioral Health. Office visits do not require certification.

In-network providers are responsible for obtaining certifications. The member will bear no financial penalties if the in-network provider fails to obtain the appropriate authorization. The member is responsible for obtaining certification for services rendered by an out-of-network provider. Obtaining certification for Mental Health and Substance Abuse services is the member’s responsibility.

Health and Wellness Program

Because we want to help you stay healthy, we offer a variety of wellness benefits and services. You can take advantage of HealthLine Blue, our 24-hour health information service, a health topics library, asthma and diabetes management and a prenatal program. You will also receive Active Blue, our health magazine and have access to online health and wellness information at www.bcbsnc.com. With our program you can get health advice anytime you need it, so you can learn how to take charge of your health.

What Is Not Covered?

The following are summaries of some of the coverage restrictions. A full explanation and listing of restrictions will be found in your benefit booklet.

Your health benefit plan does not cover services, supplies, drugs or charges that are:

• Not medically necessary

• For injury or illness resulting from an act of war

• For personal hygiene and convenience items

• For inpatient admissions that are primarily for diagnostic studies

• For palliative or cosmetic foot care

• For investigative or experimental purposes

• For hearing aids or tinnitus maskers

• For cosmetic services or cosmetic surgery

• For custodial care, domiciliary care or rest cures

• For treatment of obesity, except for surgical treatment of morbid obesity, or as specifically covered by your health benefit plan

• For reversal of sterilization

• For treatment of sexual dysfunction not related to organic disease

• For conception by artificial means

• For self-injectable drugs in the provider's office

A waiting period for coverage of pre-existing conditions may apply to your coverage. BCBSNC defines pre-existing conditions as those conditions for which medical advice, diagnosis, care or treatment was received or recommended within 6 months of the date that your [BCBSNC] coverage begins. You may receive credit toward the 12-month waiting period if your enrollment date is within 63 days of the termination of your previous health coverage.

The benefit highlights is a summary of Blue Options benefits. This is meant only to be a summary. Final interpretation and a complete listing of benefits and what is not covered are found in and governed by the group contract and benefit booklet. You may preview the benefit booklet by requesting a copy of the Blue Options benefit booklet from BCBSNC Customer Services.

®, SM_{Registration and Service marks of the Blue Cross and Blue Shield Association.}

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14

U4964, 7/11

City of Durham

Core PPO Plan

Effective Date: 09/01/2013

(16)

Blue Options

SM

_{Benefit Highlights (PPO)}

Office Visit

Preventive Care

Specialist

Outpatient Clinic 100%100% Not Available* Not Available*

Therapies

Other Services

Skilled Nursing Facility (60 days per Benefit Period) 80% after deductible 70% after deductible Home Health Care, Ambulance,

Durable Medical Equipment and Hospice 80% after deductible 70% after deductible Maternity

Hospital Services (Delivery) 80% after deductible 70% after deductible Professional Services (Delivery) 80% after deductible 70% after deductible

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Page 3

Blue Options

SM

_{Benefit Highlights (PPO)}

Up to $5,000

Inpatient and Outpatient Professional Services 80% after deductible 70% after deductible Vision (Routine Eye Exams)

100% In-network

The following Deductibles and Coinsurance Maximums apply to the services on the previous page [and Mental Health and Substance Abuse services below]:

Deductibles

Mental Health and Substance Abuse Services

Office Visits $40 copayment 70% after deductible

80% after deductible 70% after deductible 70% after deductible Substance Abuse Services

80% after deductible 70% after deductible 70% after deductible Prescription Drugs

Diabetic Supplies

Spacers and Peak Flow Meters Medco Mail Order - 90 day supply:

Diabetic Supplies

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ADDITIONAL INFORMATION ABOUT BLUE OPTIONS FROM BCBSNC Benefit Period

The period of time, usually 12 months as stated in the group contract, during which charges for covered services provided to a member must be incurred in order to be eligible for payment by BCBSNC. A charge shall be considered incurred on the date the service or supply was provided to a member. Allowed Amount

The charge that BCBSNC determines using a methodology that is applied to comparable providers for similar services under a similar health benefit plan.

The dollar amount of coinsurance a member must pay prior to BCBSNC paying 100% for certain services. NOTE: In some plans, there is no coinsurance maximum; members are responsible for coinsurance once the deductible has been met. Day and Visit Maximums

All day and visit maximums are on a combined In- and Out-of Network basis.

Utilization Management

To make sure you have access to high quality, cost-effective health care, we manage utilization through a variety of programs including certification, transplant management, concurrent and retrospective review and care management. If you have a concern regarding the final determination of your care, you have the right to appeal the decision. If you would like a copy of a benefit booklet providing more information about our Utilization Management programs, call the toll free number listed in your information packet.

Certification

Certification is a program designed to make sure that your care is given in a cost effective setting and efficient manner. If you need to be hospitalized, you must obtain certification. Non-emergency and non-maternity hospital admissions must be certified prior to the hospitalization. If the admission is not certified, a penalty will be applied.

For maternity admissions, your provider is not required to obtain certification from BCBSNC for prescribing a length of stay up to 48 hours for a normal vaginal delivery, or up to 96 hours for delivery by cesarean section. You or your provider must request certification for coverage for additional days, which will be given by BCBSNC, if medically necessary. All inpatient and certain outpatient Mental Health and Substance Abuse services must be certified in advance by Magellan Behavioral Health. Office visits do not require certification.

In-network providers are responsible for obtaining certifications. The member will bear no financial penalties if the in-network provider fails to obtain the appropriate authorization. The member is responsible for obtaining certification for services rendered by an out-of-network provider. Obtaining certification for Mental Health and Substance Abuse services is the member’s responsibility.

Health and Wellness Program

Because we want to help you stay healthy, we offer a variety of wellness benefits and services. You can take advantage of HealthLine Blue, our 24-hour health information service, a health topics library, asthma and diabetes management and a prenatal program. You will also receive Active Blue, our health magazine and have access to online health and wellness information at www.bcbsnc.com. With our program you can get health advice anytime you need it, so you can learn how to take charge of your health.

What Is Not Covered?

The following are summaries of some of the coverage restrictions. A full explanation and listing of restrictions will be found in your benefit booklet.

Your health benefit plan does not cover services, supplies, drugs or charges that are:

• Not medically necessary

• For injury or illness resulting from an act of war

• For personal hygiene and convenience items

• For inpatient admissions that are primarily for diagnostic studies

• For palliative or cosmetic foot care

• For investigative or experimental purposes

• For hearing aids or tinnitus maskers

• For cosmetic services or cosmetic surgery

• For custodial care, domiciliary care or rest cures

• For treatment of obesity, except for surgical treatment of morbid obesity, or as specifically covered by your health benefit plan

• For reversal of sterilization

• For treatment of sexual dysfunction not related to organic disease

• For conception by artificial means

• For self-injectable drugs in the provider's office

A waiting period for coverage of pre-existing conditions may apply to your coverage. BCBSNC defines pre-existing conditions as those conditions for which medical advice, diagnosis, care or treatment was received or recommended within 6 months of the date that your [BCBSNC] coverage begins. You may receive credit toward the 12-month waiting period if your enrollment date is within 63 days of the termination of your previous health coverage.

The benefit highlights is a summary of Blue Options benefits. This is meant only to be a summary. Final interpretation and a complete listing of benefits and what is not covered are found in and governed by the group contract and benefit booklet. You may preview the benefit booklet by requesting a copy of the Blue Options benefit booklet from BCBSNC Customer Services.

®, SM_{Registration and Service marks of the Blue Cross and Blue Shield Association.}

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18

U4964, 7/11

City of Durham

Basic PPO Plan

Effective Date: 09/01/2013

(20)

Blue Options

SM

_{Benefit Highlights (PPO)}

Office Visit

Preventive Care

Specialist Outpatient Clinic

100%

100% Not Available* Not Available*

Therapies

Other Services

Skilled Nursing Facility (60 days per Benefit Period) 80% after deductible 70% after deductible Home Health Care, Ambulance, Durable Medical Equipment and Hospice 80% after deductible 70% after deductible Maternity

Hospital Services (Delivery) 80% after deductible 70% after deductible Professional Services (Delivery) 80% after deductible 70% after deductible Transplants

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Page 3

Blue Options

SM

_{Benefit Highlights (PPO)}

Up to $5,000

Inpatient and Outpatient Professional Services 80% after deductible 70% after deductible Vision (Routine Eye Exam)

100% In-network

The following Deductibles and Coinsurance Maximums apply to the services on the previous page and Mental Health and Substance Abuse services below:

Deductibles

Individual(per Benefit Period) $1,500 $3,000

Family (per Benefit Period) $3,000 $6,000

Individual(per Benefit Period) $3,000 $6,000

Family (per Benefit Period) $6,000 $9,000

Mental Health and Substance Abuse Services

Office Visits $50 copayment 70% after deductible

80% after deductible 70% after deductible70% after deductible Substance Abuse Services

80% after deductible 70% after deductible 70% after deductible Prescription Drugs

Diabetic Supplies

Spacers and Peak Flow Meters Medco Mail Order - 90 day supply:

Diabetic Supplies

Employee Benefit Summary Guide

2013-2014

Table of Contents

Introductory Letter

... 2

About Your Benefits

... 3

2013-2014 Medical Rates

... 5

2013-2014 Dental Rates

... 5

Online Benefit Enrollment - WorkTerra

... 6

Log-in Instructions

... 6

General Guidance ... 7

Notice of Privacy Information Practices

... 8

City of Durham Department Liaisons

... 9

BCBSNC Premium Plan Highlights

... 10

BCBSNC Core Plan Highlights

... 14

BCBSNC Basic Plan Highlights

... 18

BCBSNC Dental Plan Highlights

... 22

Vision Plan

... 23

Employee Assistance Plan

... 24

Group Term Life and AD&D - Unum

... 26

Long Term Disability – Unum

... 30

Short Term Disability – Unum

... 37

Healthcare Reimbursement Arrangement (HRA)

... 42

Flexible Spending Accounts (FSA)

... 44

Colonial Life Voluntary Products

... 47

Hyatt Legal Plan (MetLaw)

... 51

Liberty Mutual (Auto and Home)

... 52

Long Term Care Insurance

... 53

Time Off Benefits

...55

Retirement Benefits

...59

COBRA Benefits – Continuing Your Coverage

...61

Employee Discounts

... 63

Important Contact Information

... 65

About This Guide and Key Terms

... 66

2

June 2013

Dear City Employee:

We’d like to welcome you to the start of another open enrollment season. It is our pleasure to provide

you with this important resource regarding your benefits at the City of Durham. This guide has all of the

information you will need for open enrollment and throughout the year so that you can make educated

decisions that are right for you and your family. Open Enrollment is a great time to review your existing

benefit plans, evaluate any anticipated needs, learn more about your benefits and make adjustments for

the upcoming year.

Your benefits make up an important part of your total compensation. The City of Durham offers a

comprehensive benefits package for our employees and their eligible dependents. Our benefits

program provides a flexible approach to certain City benefits, allowing you to select coverage that best

meet your needs.

We have placed our major focus on enhancements to the City’s Wellness program in order to create a

culture of wellness. The 2013-2014 plan design continues our effort to be more involved in your health

care decisions, to take advantage of preventive health care options, and to adopt healthy lifestyles.

We encourage you to continue getting the most from your healthcare benefits by expanding your

awareness, attending education sessions, and reading articles and special announcements about health