2 0 17 O P E N E N R O L L M E N T

Open enrollment will be held from November 2nd through December 2, 2016.

All forms are due to Human Resources by Friday, December 2, 2016.

Benefit elections will become effective January 1, 2017.

You have 2 forms attached; each form must be completed and signed.

The sections in RED ink are REQUIRED.

You must turn in both forms, even if you have no changes to make.

Change November 1, 2016

The City elected to discontinue the Patientcare Program effective November 1, 2016. With the introduction of TeleHealth in 2015 and the online tools developed and rolled out by Rocky Mountain Health Plans (RMHP), employee utilization of this benefit did not support continuation of the program.

PROPOSED CHANGES FOR 2017

HEALTH INSURANCE

·  Health care rates will remain the same in 2017 for the Classic 50/75 and the High Deductible Health Plan (HDHP).

·  The employer subsidy for the Direct Primary Care (DPC) plan will be discontinued in 2017.

·  The City will add a new health plan option, the Monument Health Plan.

·  The Back Pain Management Program (BPMP) created to promote outpatient physical therapy while strengthening the overall health of your back will continue in 2017.

·  A chiropractic benefit will be added to the Classic 50/75 and Monument Health Plan effective 1/1/2017. The copay will be $15 for the Classic 50/75 and for the Monument Health Plan. Services are for up to 20 visits as medically indicated, and services must be provided by participating RMHP chiropractors. This benefit won’t be part ofthe HDHP - HMO HSA 3250 or the Retiree plan since they are grandfathered plans.

·  Home Loan announced changes to the fee schedule for a Health Savings Account. (See detailed fee sheet.)

RETIREE HEALTH INSURANCE

·  Active Employee monthly payroll contribution to the Retiree Plan will be $18.48 per pay period.

·  The annual premium inflation rate is 5%. The monthly Retiree cost will increase from 10%

to the proposed 22% of premium.

2016 Premium: $607.95 / Retiree Pays: $62.78
2017 Premium: $640.24
(w/5% inflation Rate) / Retiree Pays: $141.25
(w/22% contribution plus $1.80 tax)
(example only, final rates pending)

LIFE, AD&D AND LONG-TERM DISABILITY

·  The City Council approved a change in providers from UNUM to VOYA. (Changes in approved coverage amounts may require additional paperwork.)

·  Effective January 1, 2017 the employee and employer portion of the FPPA AD&D rate for Sworn Police and Fire will increase from 1.3% to 1.35%

LEAVE POLICY

The Long-term Disability Leave Policy will be restated effective January 1, 2017. Currently, the maximum absence allowed from the date of injury, illness or disability and initial absence is 15 months. Effective January 1, 2017 the maximum absence allowed from the date of injury, illness or disability and initial absence will be 12 months. All qualifying absences initiated prior to January 1, 2017 will be grandfathered under the 2016 policy of 15 months.

Details of plans and coverage are outlined in the Benefits Overview on CityWeb, http://cityweb.ci.grandjct.co.us.

See reverse side for 2017 Insurance Rates

Calculations are estimates – rounding differences may occur once premiums are uploaded to the payroll system.

Proposed 2017 Health Insurance Rates – WITHOUT Wellness Credit

Classic 50/75 / Total Monthly Premiums / City Pays / Monthly Employee Rate / Per 24 Pay Period Employee Rate
Single / $593.56 / $467.12 / $126.44 / $63.22
Double / $1,185.31 / $932.43 / $252.88 / $126.44
Family / $1,569.95 / $1,234.88 / $335.07 / $167.54
HDHP 3250/100 / Total Monthly Premiums / City Pays / Monthly Employee Rate / Per 24 Pay Period Employee Rate
Single / $477.69 / $408.35 / $69.34 / $34.67
Double / $953.58 / $814.92 / $138.66 / $69.33
Family / $1,262.93 / $1,079.19 / $183.74 / $91.87
DPC Plan** / Total Monthly Premiums / City Pays / Monthly Employee Rate / Per 24 Pay Period Employee Rate
Single / $548.56 / $453.09 / $95.47 / $47.74
Double / $1,095.30 / $904.58 / $190.72 / $95.36
Family / $1,450.69 / $1,198.06 / $252.63 / $126.32
Monument PPO / Total Monthly Premiums / City Pays / Monthly Employee Rate / Per 24 Pay Period Employee Rate
Single / $548.54 / $431.70 / $116.84 / $58.42
Double / $1,095.29 / $861.61 / $233.68 / $116.84
Family / $1,450.68 / $1,141.07 / $309.61 / $154.81

**Additional costs are associated with this plan. For more information and details, contact the provider (Ex. Appleton Clinic).

Proposed 2017 Health Insurance Rates – WITH Wellness Credit

Classic 50/75 / Total Monthly Premiums / City Pays, Including
$25 Wellness Credit / Monthly Employee Rate / Per 24 Pay Period Employee Rate
Single / $593.56 / $492.12 / $101.44 / $50.72
Double / $1,185.31 / $957.43 / $227.88 / $113.94
Family / $1,569.95 / $1,259.88 / $310.08 / $155.04
HDHP 3250/100 / Total Monthly Premiums / City Pays, Including
$25 Wellness Credit / Monthly Employee Rate / Per 24 Pay Period Employee Rate
Single / $477.69 / $433.35 / $44.35 / $22.17
Double / $953.58 / $839.92 / $113.66 / $56.83
Family / $1,262.93 / $1,104.19 / $158.74 / $79.37
DPC Plan** / Total Monthly Premiums / City Pays, Including
$25 Wellness Credit / Monthly Employee Rate / Per 24 Pay Period Employee Rate
Single / $548.56 / $478.09 / $70.47 / $35.24
Double / $1,095.30 / $929.58 / $165.72 / $82.86
Family / $1,450.69 / $1,223.06 / $227.63 / $113.82
Monument PPO / Total Monthly Premiums / City Pays, Including
$25 Wellness Credit / Monthly Employee Rate / Per 24 Pay Period Employee Rate
Single / $548.54 / $456.70 / $91.84 / $45.92
Double / $1,095.29 / $886.61 / $208.68 / $104.34
Family / $1,450.68 / $1,166.07 / $284.61 / $142.31

**Additional costs are associated with this plan. For more information and details, contact the provider (Ex. Appleton Clinic).

Proposed 2017 Dental Insurance Rates

Total Monthly Premiums / City Pays / Monthly Employee Rate / Per 24 Pay Period Employee Rate
Employee Only / $42.95 / $25.77 / $17.18 / $8.59
Employee + Spouse / $75.46 / $45.28 / $30.18 / $15.09
Employee + Child(ren) / $101.46 / $60.88 / $40.58 / $20.29
Employee + Family / $134.01 / $80.41 / $53.60 / $26.80

Proposed 2017 Vision Insurance

Total Monthly Premiums / City Pays / Monthly Employee Rate / Per 24 Pay Period Employee Rate
Employee Only / $6.55 / $0.00 / $6.55 / $3.28
Employee + Spouse / $13.75 / $0.00 / $13.75 / $6.88
Employee + Child(ren) / $12.45 / $0.00 / $12.45 / $6.23
Employee + Family / $19.65 / $0.00 / $19.65 / $9.83

G:\Share\BENEFITS\Open Enrollment\2016\Updated 2017 One Page Employee Benefit Summary 10.26.16 Final.docx