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County of Santa Barbara Employee Benefits Overview

2019

1

TABLE OF CONTENTS We’ve Got You Covered ................................................................................................... 2

What’s New In 2019?...................................................................................................... 3

Additional Benefits Programs ........................................................................................... 4

Open Enrollment Tips ...................................................................................................... 7

Open Enrollment Events ................................................................................................... 8

Who Can You Cover? ...................................................................................................... 9

Medical ..................................................................................................................... 10

Dental ........................................................................................................................ 15

Vision ........................................................................................................................ 16

Cost of Coverage .......................................................................................................... 17

Additional Insurance Programs ....................................................................................... 19

Special Savings Accounts .............................................................................................. 21

Important Plan Notices and Documents ............................................................................. 23

For Assistance ............................................................................................................. 24

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://cosb.countyofsb.org/hr or contact Human Resources at 568.2818 or 568.2803 for more details.

2

WE’VE GOT YOU COVERED

At the County of Santa Barbara, we believe that you, our employees, are our most important asset. Helping you and your families achieve and maintain good health—physical, emotional and financial—is the reason the County of Santa Barbara offers you this benefits program. We are providing you with this overview to help you understand the benefits that are available to you and how to best use them. Please review it carefully and make sure to ask about any important issues that are not addressed here. A list of plan contacts is provided in this Employee Benefits Overview booklet.

While we've made every effort to make sure that this guide is comprehensive, it cannot 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://cosb.countyofsb.org/hr. The plan benefit booklets determine how all benefits are paid.

The benefits in this summary are effective:

January 1, 2019 - December 31, 2019

OPEN ENROLLMENT PERIOD:

October 15 – November 4, 2018

3

What’s New In 2019?

SOLERA – Lifestyle Change Program

Blue Shield 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. The program meets weekly for 16 weeks and then monthly for the balance of the year. You may choose from an array of national programs like Jenny Craig, Retrofit or HealthSlate. To find out if you qualify for this new preventive program, go to www.solera4me.com/eia and take a one minute quiz.

Health Coaching Weekly Lessons Integrated devices Group Support

Call Solera at 877.486.0141 if you have questions.

CARRUM HEALTH – Outpatient Surgeries Available and Two More Locations

Carrum Health, your voluntary surgery benefit, has added outpatient surgeries to your benefit plan and two additional medical centers. The 80 new outpatient procedures will be available at Hoag Orthopedic Institute in Orange County.

Why Carrum?

• Highest quality surgeons • No medical bills! Coinsurance and

deductible waived* • Travel expenses covered 100% for two • Your own personal Concierge that will:

o Help with forms o Gather medical records o Schedule surgery o Make travel arrangements o Coordinate post-discharge care

FIND OUT MORE: Visit: carrum.me/COSB

Text: “COSB” to 555888 Call us: 1-888-855-7806

*Due to IRS regulations on HDHP plans, the deductible applies but the coinsurance is waived.

4

Additional Benefits Programs The Santa Barbara County offers a variety of free added 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.

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. In addition, you may also receive up to a 90-day supply of Prodigy® diabetic test strips and lancets delivered to your home at no cost. The initial test strip order includes a new Prodigy® diabetic monitor.

Over 1,200 generic medications for free through Rx ‘n Go! What do I have to do?

1. Go to www.rxngo.com and confirm your medication(s) is 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.

Want to learn more about Rx ‘n Go? Watch a short video at vimeo.com/109917892.

Questions? Contact us at 888.697.9646.

We are here to help.

View the available generic and preventive maintenance

medications at www.rxngo.com

*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.

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Why wait for the care you need now? Teladoc gives you 24/7/365 access to a doctor through the convenience of phone or video consults. Avoid the ER cost with only a copayment.

CareCounsel – Your Benefits Counselor CareCounsel is your first point of contact when you need a personal healthcare advocate. We can assistance with benefits, claims, bills, appeals, second opinions, grievances and more. All inquiries are completely confidential. Your benefits CareCounselor will assist you until your issue or problem is resolved. You talk to the same person every time who advocates for you.

GET THE CARE YOU NEED

NEED BENEFITS HELP? HAVE BENEFITS QUESTIONS?

CALL US FIRST! 1-888-227-3334

How long are you waiting for quality medical care?

WITHOUT THE WAIT

Talk to a doctor anytime.

Convenient and lower cost.

Conditions include:

• Cold & Flu symptoms • Allergies • Bronchitis • Respiratory infection • Sinus problems • And more

We have a national network of doctors so you don’t have to wait for care.

Teladoc.com/bsc 1- 800- Teladoc (835-2362)

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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.

Employee Assistance Program 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.

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.

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 ADMHS offices

805.934.6107 or Ext 6107

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

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

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

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

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Open Enrollment Tips REMEMBER Open Enrollment will take place from October 15– November 4, 2018. 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 2019? You do not have to do anything. Your selections will automatically roll over with the exception of your Flexible Spending Account (FSA) 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; • 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 2019 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. You must notify HR Benefits if you are interested in this option. 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 do not have the Employee Guide to BenXcel, go to the Employee Benefits link on the County’s website at http://www.countyofsb.org/hr. Click on the “Open Enrollment 2019 Benefit Year” link to obtain a copy of the Employee Guide. This guide will help you establish a username and/or obtain your password. Please call BCC at 1.800.685.6100 if you need assistance with your account.

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Open Enrollment Events

ONSITE MEETINGS

Employee Benefits would like to invite all Santa Barbara County employees to one of the following Open Enrollment meetings. This year, we will be highlighting the various County benefits that are available to you at no cost and that you may not be aware of. We hope all employees take the opportunity to come to one of our Open Enrollment meetings and talk with our Employee Benefits staff and carrier representatives.

Santa Barbara October 15 10:30am – 12:00pm 1:00pm - 2:30pm

Public Health Auditorium 300 N. San Antonio Road

Santa Barbara October 16 10:30am – 12:00pm 1:00pm - 2:30pm

Admin Building – 1st floor Planning Hearing Room

105 E. Anapamu St.

Lompoc October 17 11:00am – 1:00pm Veterans Memorial Bldg. 100 E. Locust Avenue

Santa Maria October 18 10:30am – 12:00pm

1:00pm - 2:30pm Workforce Center

1410 S. Broadway

Santa Maria October 19 10:30am – 12:00pm 1:00pm - 2:30pm

Board of Supervisor Conference Room 511 E. Lakeside Parkway

Why attend?

• See what’s new for 2019 • Learn about the no cost benefits programs that are available to you • Find out how you can save on maintenance medications • Obtain information on how to reduce surgery costs • Have your benefits questions answered • Register to WIN one of our donated Raffle prizes

Flu and pneumonia shots will be available at the Open Enrollment meetings. You must bring your Express Scripts ID card (Low EPO, High EPO or PPO plan) or Blue Shield ID card (HDHP) with you in order to get a free flu or pneumonia vaccination. Note that there are certain FDA guidelines 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 week 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 are 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 16, 2018 to fax at 805-568-3272 or mail (no originals) to County of Santa Barbara - Employee Wellness and Benefits Division, 1226 Anacapa Street, Santa Barbara, CA 93101, the documentation* that verifies your dependents eligibility. If documentation is not received by November 16, 2018, your dependent(s) will not be added to your health plans for 2019.

*A list of acceptable documentation that meet the County’s eligibility requirements can be found at http://www.countyofsb.org/hr or on the eBenefits website, https://benxcel.net, under the Library tab.

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 may not have benefits or may have their benefits terminated.

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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) $49 Co-pay (LiveHealth Online) 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) $49 Co-pay (LiveHealth Online) 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 $49 Co-pay (LiveHealth Online) No Charge 20%* 20%* No Charge 20%*, 26 visits/ yr** 20%*, 26 visits/ yr** 20%*, 12 visits/ yr

40%* 40%* $49 Co-pay (LiveHealth Online) 40%* 40%* 40%* 40%* 40%*, 26 visits/yr** Not Covered 20%*, 12 visits/ yr

20%* 20%* $49 (LiveHealth Online) No Charge No Charge* No Charge* No Charge 20%*, 26 visits/ yr** 20%*, 26 visits/ yr** 20%*, 12 visits/ yr

40%* 40%* $49 (LiveHealth Online) 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 - member is responsible for coinsurance in addition to any charges over the allowable amount. When members use non-preferred providers, they must pay the applicable copayment/coinsurance plus any amount that exceeds Blue Shield’s allowable amount. Charges in excess of the allowable amount do not count toward the calendar year deductible or out-of-pocket maximum.

12

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

No Charge for up to 90 day supply No Charge 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

No Charge for up to 90 days N/A No Charge for Preventive generic medications

N/A

Note for Out-of-Network benefits - member is responsible for coinsurance in addition to any charges over the allowable amount. When members use non-preferred providers, they must pay the applicable copayment/coinsurance plus any amount that exceeds Blue Shield’s allowable amount. Charges in excess of the allowable amount do not count toward the calendar year deductible or out-of-pocket maximum.

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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

15

Dental Regular visits to your dentists can protect more than your smile; they can help protect your health.

In order to enroll in a dental plan, you and your dependent(s) MUST be enrolled in one of the Santa Barbara 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%

When first enrolling in a DHMO plan, you must choose a primary dentist. If you do not select a dentist, one will automatically be selected for you. If you would like a different dentist than the one that was auto-assigned, you will need to call Delta Dental at 800.422.4234 after Open Enrollment with your selection.

REMEMBER that the County has a special DHMO network with Delta Dental and you must go to www.deltadentalins.com/countyofsantabarbara for a full selection of DHMO providers. Please refer to this website when selecting a new dentist.

16

Vision Routine vision exams are important, not only for correcting vision but because they can detect other serious health conditions.

We offer 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

17

Cost of Coverage

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

All 2019 premiums are noted as twice-monthly premium amounts.

Medical

Premium County

Contribution Pre-Tax

Deductions*

Blue Shield Low Option EPO Medical Plan

Employee Only 395.87 (395.87) 0.00

With 1 Dependent 730.37 (395.87) 334.50

Two + Dependents 1146.87 (395.87) 751.00

Blue Shield High Option EPO Medical Plan

Employee Only 458.37 (395.87) 62.50

With 1 Dependent 846.87 (395.87) 451.00

Two + Dependents 1328.87 (395.87) 933.00

Blue Shield PPO Medical Plan

Employee Only 603.37 (395.87) 207.50

With 1 Dependent 1113.87 (395.87) 718.00

Two + Dependents 1750.37 (395.87) 1354.50 Blue Shield HDHP Medical Plan

Employee Only 345.37 (345.37) 0.00

With 1 Dependent 616.87 (345.37) 271.50

Two + Dependents 968.87 (345.37) 623.50 Kaiser Low Option Medical Plan**

Employee Only 290.87 (290.87) 0.00

With 1 Dependent 544.87 (290.87) 254.00

Two + Dependents 826.87 (290.87) 536.00

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Medical

Premium County

Contribution Pre-Tax

Deductions*

Kaiser High Option Medical Plan**

Employee Only 301.87 (301.87) 0.00

With 1 Dependent 564.37 (301.87) 262.50

Two + Dependents 857.37 (301.87) 555.50

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 2019 premiums will be taken in pay period 1 of 2019. There are two pay periods in 2019 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.

Please Note: Twice-monthly rates include $1.75 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.”

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

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Additional Insurance Programs The Santa Barbara County offers a variety of insurance policies that are available to you. Below are highlights of programs that are offered. If you would like detailed information on any one of the noted benefits, please go online at http://cosb.countyofsb.org/hr where you will find a copy of the full version of the Employee Benefits Overview along with the carrier benefit summaries.

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.

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 after 60 days. The cost of coverage is paid in full by the County of Santa Barbara. Coverage is provided by Voya Financial.

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.

VOLUNTARY WHOLE LIFE INSURANCE

Whole Life insurance, through ManhattanLife (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. To enroll, please call Farmington directly at 877.290.3931.

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. This coverage protects your family financially in the event that you die due to an accident.

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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 provided by Voya Financial 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.

Detailed benefit information on all of the offered policies can be found on the County’s website, http://cosb.countyofsb.org/hr. You may either go to the full version of the Employee Benefits Overview or to the carrier benefit summaries.

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Special Savings Accounts

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. You

must re-enroll every year during Open Enrollment. Your 2018 elected amount will not roll over for 2019.

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 2019, you can set aside up to $2,650.

Dependent Care FSA Account

This plan allows you to set aside up to $5,000 per household 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.

Go to https://benxcel.net to enroll in an FSA for 2019?

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.

Remember that the County also offers a Transit and Parking FSA amount that you may benefit from by participating since your contribution amount is pre-tax.

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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.

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 2019, the County will contribute half of its yearly contribution amount in one lump sum in pay period 1 of 2019 to assist you with funding your new Health Savings Account (HSA). On pay period 14 of 2019, the County will begin depositing the remainder of the yearly contribution amount per the pay period schedule below.

FOR EMPLOYEES CONTINUING ENROLLMENT IN AN HDHP FOR 2019

2019 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 2019

County Contribution Amount on Pay

Period 1 of 2019

County Contribution Amount Starting on

Pay Period 14 of 2019

2019 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

County Yearly Contribution Amount

Employee Only Employee + Dependent(s)

Two Married County Employees w combined coverage

$1,200 $1,800 $3,000

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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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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

Health Savings Account

Sterling HSA Administration 800.617.4729 www.sterlinghsa.com

Flex Spending Accounts and Cobra Coverage

Benefits Coordinators Corporation (BCC)

800.685.6100 https://benxcel.net

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

Contact Employee Benefits and Rewards

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

For Plan/Benefits Assistance

CareCounsel – your first point of contact

888.227.3334 www.carecounsel.com

Employee Self-Service

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

Employee Benefits and Rewards

1226 Anacapa Street

Santa Barbara, CA 93101

Contact CareCounsel for

Benefit Questions

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

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Employee Benefits Brochure designed and developed by

In conjunction with the County of Santa Barbara, January 2019