2026_Retiree_Benefits_Guide_-_Revised_Final.pdf

Retiree Benefits

There is NO Open Enrollment for Retiree’s

YOUR CURRENT COVERAGE AUTOMATICALLY RENEWS

April 1, 2026 – March 31, 2027

This information will be made available in alternate formats for persons with disabilities upon request.

*RETIREE NEWS*

Please Join Benefits

Annual Retiree Meeting Friday, March 6th 9 a.m. to 11 a.m.

Gladden Park Recreation Center

3901 30th Ave. N. St. Petersburg, FL 33712 All are Welcome to Attend!

DO NOT enroll in any outside Medicare or Medicare Advantage Plan!

You will LOSE your City Coverage!

• If someone visits your home about insurance, it’s NOT a City plan.

• If you get a call about an insurance plan, it’s NOT a City plan.

• If you’re told a plan won’t affect your City coverage, FALSE, It’s NOT a City plan.

• Be aware Ad’s and TV Commercials about open enrollment, sign-ups, and deadlines are NOT for a City plan.

Signing any paperwork or agreeing over the phone will TERMINTATE your City coverage. Once your City coverage is canceled, you cannot re-enroll. If you’re unsure, call the Benefits Office at 727-893-7819.

Health Insurance Premium Contributions:

• Group 1: If you retired before October 1, 2008, the City pays 75% of your health insurance premiums based on the Retiree Choice Plus Base Option PPO rate.

(See rates on pg. 8)

• Group 2: If you were hired before January 1, 2009, and retire after October 1, 2008, the City contributes:

o $297.72 for Single Coverage o $601.37 for Two-Person Coverage o $833.58 for Family Coverage

Note: These are the maximum amounts the City will contribute. (See rates on

pg. 9)

• Group 3: If you were hired after January 1, 2009, you’ll pay the full cost of your health plan. The City will not contribute to any premiums. (See rates on pg. 10)

Coverage for Surviving Dependents:

• Retired before March 1, 1978: Coverage continues as long as the surviving dependent receives pension benefits, with the City paying part of the health coverage premiums.

• Retired between March 1, 1978 – March 31, 1988: Coverage lasts up to 12 months, or until pension benefits end (whichever comes first), with the City still contributing. After that, COBRA is available for up to 36 months, but the full cost of premiums (plus a 2% admin fee) will be the dependent's responsibility.

• Retired after April 1, 1988: COBRA coverage is available for up to 36 months, with the full cost of premiums (plus a 2% admin fee) paid by the dependent. There is no City contribution.

If you enroll in any outside Medicare or Medicare Advantage plan, your CITY COVERAGE will be TERMINATED permanently. Once terminated, you and any covered dependents will lose coverage and cannot re-enroll. This action is final. If you have any questions, please contact Benefits at 727-893-7819.

Medicare Eligibility:

• When you turn 65 and become eligible for Medicare, Medicare will be your primary insurance, and the City’s plan will be secondary.

• Enroll in Medicare Part A & B to Keep Your Benefits Active!

You must enroll in Medicare Part A and B for your benefits to work properly. If you skip Part B, you’ll be responsible for all claims Medicare Part B would cover. United will not pay those claims.

• MEDICARE PART D if you have City Coverage and enrolled in UnitedHealthcare or Humana through the City, you don’t need to sign up for Part D. Your City plan includes credible prescription coverage that pays and therefore is considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.

• Approved for Social Security Disability benefits, enroll in Medicare Part A & B. Notify Benefits and send a copy of your Medicare card to change your Healthcare plan option.

WARNING: YOUR CITY MEDICAL COVERAGE WILL BE TERMINDATED!

If you choose to enroll in any outside Medicare or Medicare Advantage plan, your City medical coverage will be permanently terminated, and you will not be able to re-enroll.

Before making any changes, contact the City’s Benefits Office immediately at 727-893-7819 for guidance.

Health and Wellness Center:

The City of St. Petersburg Health and Wellness Center is exclusively available to retirees and their eligible dependents who are currently covered under one of the City’s group medical plans. This includes retirees and their dependents (age 14 and over) who are also covered by the City’s medical coverage. Coverage is required for both the retiree and their dependents to access services at the Health and Wellness Center.

Make sure you’re covered before visiting!

IMPORTANT: You are NOT eligible for Health and Wellness Center services if you are NOT enrolled in a City Medical plan. Eligibility requires active enrollment in a City Medical plan.

603 7th Street South, Suite 350. St. Petersburg, FL, 33701 Hours of operation: Monday – Friday 8:00am to 5:00pm

Closed 12:00 – 1:00 for Lunch Phone number: (727) 553-7474

Dr. Israel Wojnowich and his team provide primary care, chronic disease management, and treatment for illnesses. Benefits of the Wellness Center include:

• High-quality care from a Board-Certified Family Practice Physician

• Secure, private, HIPAA-compliant services

• Health risk evaluation and coaching to improve quality of life

• No co-pay for eligible individuals covered by City medical insurance

• No co-pay for prescriptions dispensed at the Center, if eligible and covered by City medical insurance

Orlando Health MyChart:

Communicate with your doctor. Stay connected to your healthcare with Orlando Health MyChart. Manage appointments, access test results, for yourself and your covered and approved dependents. Sign up for MyChart by visiting https://mychart.bayfrontstpete.com https://mychart.bayfrontstpete.com/

2026 – 2027 GROUP HEALTH PLANS

Group Health Plan Comparison UnitedHealthcare and Humana will continue to administer the City’s group health plans for retirees. See the “Summary of Benefits and Coverage” for more details. There are no changes for the 2026 – 2027 plan year.

Plan UHC Choice (EPO) In-Network Only

UHC Choice Plus (PPO) In-Network *

UHC HDP plan In-Network *

Annual Deductibles $1,000 Individual $2,000 Family

$1,000 Individual $2,000 Family

$2,000 Individual $4,000 Family

Coinsurance 0% 10% 10%

Hospital $300/5 days and deductible

$300/5 days 10% co-ins after deductible

$300/5 days 10% co-ins after deductible

Emergency Room $300 co-pay and deductible

$300 co-pay and deductible

$300 co-pay and deductible

Physician:

$30 - $60 co-pay $30 - $60 co-pay $30 - $60 co-pay

Urgent Care Center $50 and deductible $50 and deductible $50 and deductible

Preventative Care 100% Coverage 100% Coverage 100% Coverage

Skilled nursing facility 100% coverage and deductible (Limit: 60 days per plan year)

10% co-ins and deductible (Limit: 60 days per plan year)

10 % co-ins and deductible (Limit: 60 days per plan year)

Rehabilitation Services

$30 co-pay per visit (limit 60 visits each type of service, multiple visits per day)

$35 co-pay per visit (limit 60 visits each type of service, multiple visits per day)

$35 co-pay per visit (limit 60 visits each type of service, multiple visits per day)

Outpatient Surgery -hospital

100% coverage after deductible 10% co-ins and deductible 10% co-ins and deductible

Annual Out of Pocket Limit

$3,500 Individual, $7,000 Family

$3,500 Individual, $7,000 Family

$4,000 Individual, $8,000 Family

Lifetime Maximum Benefit No lifetime maximum benefit

No lifetime maximum benefit

No lifetime maximum benefit

Prescription Drug Coverage (Tier 1-4)

$15; $35; $70; 25% Tier 2-4 $200/$400 deductible. Accumulates to Annual Out of Pocket

$15; $35; $70; 25% Tier 2-4 $200/$400 deductible. Accumulates to Annual Out of Pocket

$15; $35; $70; 25% Tier 2-4 $200/$400 deductible. Accumulates to Annual Out of Pocket

NOTE: The information shown above is general information only. Benefit plan provisions are governed by the applicable plan documents. All questions and concerns regarding specific coverage and benefits should be directed to the respective insurance carriers. Anything in this summary that is inconsistent with the plan documents shall be suspended by and governed by the plan documents.

2026 – 2027 GROUP HEALTH PLANS

Group Health Plan Comparison UnitedHealthcare and Humana will continue to administer the City’s group health plans for retirees. See the “Summary of Benefits and Coverage” for more details. There are no changes for the 2026 – 2027 plan year.

UHC HDP BASIC

(Must pay first $5k)

UHC Choice Plus Base

PPO

In-Network *

Humana Gold (HMO) In-Network

Humana Choice PPO In-Network *

$5,000 Individual $10,000 Family

$1,000 Individual $2,000 Family

NA NA

100% after deductible 0% NA NA

100% after deductible $300/5 days and deductible

$150/5 days per admission $150/5 days per admission

100% after deductible $300 co-pay and deductible $65 co-pay $65 co-pay

100% after deductible $30 - $60 co-pay

$20 co-pay $20 co-pay

100% after deductible $50 and deductible $5-$20 co-pay $10-$20 co-pay

100% Coverage 100% Coverage 100% Coverage 100% Coverage

100% after deductible 100% coverage and deductible (Limit: 60 days per plan year)

$25 co-pay per day (Days 21-100)

$75 co-pay per day (Days 21-100)

100% after deductible

$45 co-pay per visit (limit 60 visits each type of service, multiple visits per day)

$20 co-pay based on services received

$15-$20 co-pay per visit

100% after deductible 100% coverage after deductible $100 co-pay per visit $100 co-pay per visit

$5,000 Individual $10,000 Family

$3,500 Individual, $7,000 Family $2,500 per plan year $4,000 per plan year

No lifetime maximum benefit

$100,000 Maximum Per covered person

Benefits apply to Medicare covered services

Benefits apply to Medicare covered services

100% after deductible

$15; $35; $70; 25% Tier 2-4 $200/$400 deductible. Accumulates to Annual Out of Pocket

$4; $25; $40; 33% $4; $25; $40; 33%

NOTE: The information shown above is general information only. Benefit plan provisions are governed by the applicable plan documents. All questions and concerns regarding specific coverage and benefits should be directed to the respective insurance carriers. Anything in this summary that is inconsistent with the plan documents shall be suspended by and governed by the plan documents.

GROUP 1 HEALTH PLAN RATES PLAN YEAR 2026 - 2027

Group 1 If you retired prior to October 1, 2008, the City will continue to subsidize your health insurance premiums at 75% of the Retiree Choice Plus Base Option PPO rate.

Total Cost City Contribution Retiree Cost

Benefit Plan Monthly Monthly Monthly UnitedHealthcare CHOICE (EPO)

Single $1,007.46 $445.42 $562.04 Two Person $2,166.07 $899.70 $1,266.37

Family $2,851.12 $1,247.09 $1,604.03 UnitedHealthcare CHOICE PLUS (PPO)

Single $1,115.14 $445.42 $669.72 Two Person $2,252.66 $899.70 $1,352.96

Family $3,122.52 $1,247.09 $1,875.43 UnitedHealthcare (PPO) HDP

Single $867.70 $445.42 $422.28 Two Person $1,865.56 $899.70 $965.86

Family $2,455.62 $1,247.09 $1,208.53 UnitedHealthcare HDP Basic

Single $688.93 $445.42 $243.51 Two Person $1,481.21 $899.70 $581.51

Family $1,949.68 $1,247.09 $702.59 The Plans Below are Medicare Plans available to retirees and covered dependents with Medicare Parts A & B

UnitedHealthcare CHOICE PLUS-BASE OPTION (PPO) Single $593.90 $445.42 $148.48

Two Person $1,199.60 $899.70 $299.90 Family $1,662.78 $1,247.09 $415.70

HUMANA GOLD (HMO)

Single $31.77 $31.77 $0

Two Person $63.54 $63.54 $0

HUMANA CHOICE (PPO)

Single $308.01 $308.01 $0 Two Person $616.02 $616.02 $0

GROUP 2 HEALTH PLAN RATES PLAN YEAR 2026 - 2027

Group #2 If you were hired prior to January 1, 2009, and retire after October 1, 2008, the City will contribute the following amount:

$297.72 for Single Coverage, $601.37 for Two Person Coverage & $833.58 for Family Coverage NOTE! The amounts shown are the maximum amounts the City will contribute.

Total Cost City Contribution Retiree Cost

Benefit Plan Monthly Monthly Monthly UnitedHealthcare CHOICE (EPO)

Single $1,007.46 $297.72 $709.74 Two Person $2,166.07 $601.37 $1,564.70

Family $2,851.12 $833.58 $2,017.54 UnitedHealthcare CHOICE PLUS (PPO)

Single $1,115.14 $297.72 $817.42 Two Person $2,252.66 $601.37 $1,651.29

Family $3,122.52 $833.58 $2,288.94 UnitedHealthcare (PPO) HDP

Single $867.70 $297.72 $569.98 Two Person $1,865.56 $601.37 $1,264.19

Family $2,455.62 $833.58 $1,622.04 UnitedHealthcare HDP Basic

Single $688.93 $297.72 $391.21 Two Person $1,481.21 $601.37 $879.84

Family $1,949.68 $833.58 $1,116.10 The Plans Below are Medicare Plans available to retirees and covered dependents with Medicare Parts A & B UnitedHealthcare CHOICE PLUS-BASE OPTION (PPO)

Single $593.90 $297.72 $296.18 Two Person $1,199.60 $601.37 $598.23

Family $1,662.78 $833.58 $829.20

HUMANA GOLD (HMO)

Single $31.77 $31.77 $0.00 Two Person $63.54 $63.54 $0.00

HUMANA CHOICE (PPO)

Single $308.01 $297.72 $10.29

Two Person $616.02 $601.37 $14.65

GROUP 3 HEALTH PLAN RATES PLAN YEAR 2026 - 2027

Group #3 All employees hired after January 1, 2009, who retire will pay the TOTAL cost of the Plan Coverage. The City will NOT contribute to the cost of any monthly premiums.

Total Cost No City Contribution Retiree Cost

Benefit Plan Monthly Monthly Monthly UnitedHealthcare CHOICE (EPO)

Single $1,007.46 $0 $1,007.46 Two Person $2,166.07 $0 $2,166.07

Family $2,851.12 $0 $2,851.12 UnitedHealthcare CHOICE PLUS (PPO)

Single $1,115.14 $0 $1,115.14 Two Person $2,252.66 $0 $2,252.66

Family $3,122.52 $0 $3,122.52 UnitedHealthcare (PPO) HDP

Single $867.70 $0 $867.70 Two Person $1,865.56 $0 $1,865.56

Family $2,455.62 $0 $2,455.62 UnitedHealthcare HDP Basic

Single $688.93 $0 $688.93 Two Person $1,481.21 $0 $1,481.21

Family $1,949.68 $0 $1,949.68 The Plans Below are Medicare Plans available to retirees and covered dependents with Medicare Parts A & B UnitedHealthcare CHOICE PLUS-BASE OPTION (PPO)

Single $593.90 $0 $593.90 Two Person $1,199.60 $0 $1,199.60

Family $1,662.78 $0 $1,662.78

HUMANA GOLD (HMO)

Single $31.77 $0 $31.77 Two Person $63.54 $0 $63.54

HUMANA CHOICE (PPO)

Single $308.01 $0 $308.01

Two Person $616.02 $0 $616.02

Humana Dental:

Retirees enrolled in the DHMO must select a participating provider. You will need to contact Humana directly to designate/update your participating provider. Call customer service at 1-800-979-4760 for participating providers and request a copy of your card.

Group ID#782141.

Monthly Cost Single Two Person Family

Humana DHMO HS195 $17.28 $30.22 $47.52 Humana PPO $33.15 $70.28 $108.52

Humana Vision:

Call customer service at 1-800-979-4760 for participating providers and request a copy of your card. Group ID#782141.

Monthly Cost Single Two Person Family

Vision Basic $0.92 $1.40 $2.33 Vision High Option $5.79 $11.53 $15.42

Basic Life & AD&D:

Group Policy #631957-I

Life Insurance is offered by The Standard Life Insurance Company. The amount of your coverage was determined at the time you retired and cannot be changed. Rates are unchanged for 2026.

Monthly Rates, Per $1,000 of Coverage

Basic Life $5.366 AD&D - Single $.023 AD&D - Family $.035

Frequently asked Questions:

1. When can I make changes to my enrollment?

Only if you experience a qualifying life event (e.g., marriage, birth, divorce, loss of coverage, turning 65, etc.).

Note: Dropping coverage means you cannot re-enroll later.

2. What are qualifying life events?

• Turning 65

• Approval of Social Security Disability

• Marriage or divorce

• Birth or adoption of a child

• Loss of other coverage

• Death of a dependent

3. How long do I have to report a qualifying life event?

You have 30 days from the event to report it and submit required forms. After 30 days, changes cannot be made.

4. Can I change my life insurance/AD&D beneficiary?

Yes, submit a notarized form to the Benefits Division. Call 727-893-7819 or email benefits@stpete.org

5. Can I do a one-time drop in medical coverage?

Yes, you can drop to a lower tier of coverage. However, once processed, you will not be eligible to re-enroll in your original plan.

6. How long do I have to switch to a Medicare plan with the City?

Retirees 65+ can switch anytime, but you must be enrolled in Medicare Parts A & B. Enrollment is not retroactive.

WARNING: PERMANENT LOSS OF CITY MEDICAL COVERAGE!

Signing up for any outside Medicare/Advantage plan will automatically terminate your City medical insurance – you will not be able to get it back.

Call the City’s Benefits Office before you enroll 727-893-7819.

mailto:benefits@stpete.org

7. What happens if I sign up for an outside Medicare plan while on a City medical plan? Your City medical plan will be terminated, and you cannot re-enroll in the City's plan.

IMPORTANT: YOUR CITY MEDICAL COVERAGE WILL BE

TERMINATED! If you enroll in any outside Medicare/Advantage plan, your City medical plan will terminate permanently, and you cannot re-enroll. Contact the City’s Benefits Office 727-893-7819.

8. What’s the difference between the Choice Plus and Choice Plus Base options?

The ONLY difference between the Choice Plus and Choice Plus Base PPO is the Choice Plus Base has a $100,000 lifetime maximum benefit, while the Choice Plus has no lifetime maximum benefit.

9. What happens if I or my covered dependent reaches the $100,000 lifetime benefit max under United’s Base Option PPO plan?

• Coverage Ends: United STOPS paying claims once the $100,000 max is reached.

• Out-of-Pocket Costs: You’re responsible for any remaining expenses.

• Switch Plans: To maintain City coverage, you MUST enroll in another City medical plan.

• Premium Change: New plan premiums will vary & subject to change each plan year.

Benefits Contact Information:

Need additional Retiree Benefits information? Visit:

www.stpete.org/retireebenefits

• Retiree Benefits, contact Morgan Morrow 727-893-7819 or Monica Parrish 727-893-7279. Email: benefits@stpete.org

• UnitedHealthcare, Lauren Gibson 727-893-7911 or lauren_gibson@uhc.com

• Humana (Medical Plans), Lucy Gidaro 727-247-5588 or Michael “Mike” Pinchotti 727-366-5437 or

• Humana Dental – Customer Service 1-800-979-4760

• Humana Vision – Customer Service 1-877-398-2980

• Ameriflex (Direct Bill Retiree) o Call: 888-868-3539 o Email: service@myameriflex.com o Live Chat: myameriflex.com

DON’T RISK LOSING YOUR CITY MEDICAL COVERAGE!

Enrolling in any outside Medicare/Advantage plan means your City Medical plan ends forever.

Talk to the City’s Benefits Office 727-893-7819 before you enroll.

Pension Contact Information:

http://www.stpete.org/retireebenefits https://www.deviantart.com/mondspeer/art/Traffic-Cone-test-491268852 https://creativecommons.org/licenses/by-nc-sa/3.0/ https://creativecommons.org/licenses/by-nc-sa/3.0/

Pension Contact Information:

Need help logging into the Pensioner Self-Service portal http://athena.stpete.org.

Contact the Pension Division at 727-893-7367 or email pension@stpete.org

• Pension Questions/Assistance:

o Last name begins with A-L: Steven Fyalkowski 727-

893-7045 or steven.fyalkowski@stpete.org o Last name begins with M-Z: Sherri McLean 727-893-

7044 or sherri.mclean@stpete.org o Pension@stpete.org

• Mission Square (457 Deferred Compensation, Roth IRA

&401(a) Plans:

o Sharyn Hyla 202-759-7219 shyla@missionsq.org

Have you moved?

Need to update your address?

Contact Pension and request an Address Change Form.

A correct address ensures you receive all important benefit mailings and notifications—don’t miss out on valuable information!

mailto:pension@stpete.org

RETIREE POLICY

CITY OF ST. PETERSBURG

RETIREE GROUP INSURANCE PROGRAM

JANUARY 2026

1. Eligibility:

To qualify for the City of St Petersburg Retiree Group Insurance Program, an employee must meet the retirement eligibility criteria of the City retirement plan in which they are enrolled at the time they leave employment. The plans are:

• Employees’ Retirement System – Eligible for Service Retirement Income or Disability Retirement Income

• 1984 Supplemental Police Officer’s Retirement System – Eligible for Service Retirement, Early Retirement or Disability Benefits

• Supplemental Firefighter’s Retirement System – Eligible for Normal Retirement, Early Retirement or Disability Benefits

• 401a Management Plan – Eligible for Normal Retirement, Eligible for Disability Benefits under the City’s Group Long Term Disability Insurance Program

(NOTE: Employees eligible for a future Vested Retirement Benefit or receiving a Vested Retirement Benefit from any of the plans shown above are not eligible for participation in the Retiree Group Insurance Program. See the respective plan document for eligibility requirements.)

2. At the Time of Retirement or Disability Retirement:

a. Employees enrolled in any group health, dental, vision or AD&D plan who retire will be eligible to continue coverage as determined by the guidelines established by the applicable insurance carrier and/or by the City. Group health, dental, vision and AD&D coverage for retirees and any covered dependents can be continued after retirement if the employee is enrolled in the respective plan on the day before their retirement or disability retirement date. Covered dependents include a spouse and dependent children who meet the respective plan’s eligibility requirements and are enrolled on the day before the employee’s retirement or disability retirement date.

b. Employees or their covered dependents who are eligible for Medicare at the time of retirement may stay in the plan in which they are currently enrolled, or they may choose to enroll in the City’s Choice Plus Retiree Base Option Plan, Medicare HMO or Medicare PPO, either at the time of retirement or at any time thereafter.

c. Non-management employees enrolled in the City’s Group Basic Life insurance plan who retire will be eligible for $5,000 of continued coverage subject to the rules and guidelines of the insurance carrier. Premiums are fully paid by the retiree.

d. Management employees may choose to continue basic life insurance coverage of $50,000, $25,000 or $10,000. Premiums are fully paid by the retiree. The coverage that is chosen will decrease by 50% at age 70, subject to the rules and guidelines of the insurance carrier.

e. Supplemental Life Insurance coverage cannot be continued under the group program after retirement but may be converted to an individual policy with the insurance carrier, subject to the rates and guidelines of the carrier. Note: Per carrier rules, Individuals retiring at age 65 or over are not eligible to continue Supplemental Life Insurance coverage.

3. During Retirement:

a) Retirees do not have an annual open enrollment period and generally remain enrolled in the plan(s) selected at the time of retirement.

Exceptions to this include:

1) At the time of eligibility for Medicare, the Retiree and/or covered dependent may make certain changes in their health plan coverage (see #3 below).

2) If the City makes a significant change in a plan the City may, but is not required to, offer retirees a special election period. As special election periods are offered at the City’s discretion, any special election period is subject to City restrictions and the rules and guidelines of the respective insurance carrier(s), if any.

3) A retiree may change to a lower-tier-group health plan at any time. (Exception -only Medicare eligible retirees may enroll in the City’s Choice Plus Retiree Base Option Plan, Medicare HMO or Medicare PPO). Retirees and/or their covered dependents who elect to move to a lower tier plan will be permitted to return to their former plan if the request is made more than 90 days after the new plan coverage effective date and prior to one year from the new plan coverage effective date, provided that the former plan (or similar plan) is available. The former coverage will be reinstated as soon as reasonably possible and will not be retroactive. This option is only available one time for pre-Medicare eligible retirees.

The hierarchy of group health plans is as follows:

Choice Plus Plan Choice Plan Choice HDP HDP Basic Choice Plus Retiree Base Option Plan – (if Medicare eligible) Humana Medicare PPO (if Medicare eligible) Humana Medicare HMO (if Medicare eligible)

b) The City may, but is not required to, contribute to the premium cost for retiree group health coverage. The amount and method of determining any such contribution will be determined by the City and may be changed or discontinued at any time at the discretion of the City. Premiums for life, dental, vision and AD&D are fully paid by the retiree.

c) Any premium or portion of a premium paid by the City and/or the retiree will be adjusted whenever the premium rate changes.

d) Retirees may terminate their participation in the City’s group health, dental, vision life and/or AD&D insurance plans at any time after retirement. Re-enrollment is not permitted.

e) Retirees may make changes in their coverage based on qualifying events but only when the change is requested within 31 days of the qualifying event. (Contact the Benefits Division for a list of qualifying events).

f) Retirees and covered dependents not eligible for Medicare must all be covered under the same group health plan.

4. Group Health Plan – Medicare Eligibility:

When a retiree or a covered dependent becomes eligible for Medicare it is important for the retiree or covered dependent to enroll in Medicare Parts A & B at the time of initial Medicare eligibility. The City’s group health insurance automatically becomes a secondary payor at the time of Medicare eligibility. This means that the plan will not pay claims that would otherwise be covered by Medicare, even if the Retiree or covered dependent does not enroll in Medicare Parts A & B.

Retirees and covered dependents who become eligible for Medicare may:

a) remain in their current plan.

b) elect a Medicare HMO or Medicare PPO plan at any time; or

c) enroll in the Choice Plus Retiree Base Option Plan at any time.

After choosing to enroll in another plan, retirees may not return to their previous plan, except as provided for as follows:

Retirees and/or their covered dependents who are eligible for Medicare and elect to move to the Medicare HMO or Medicare PPO plan will be permitted to return to their former plan as long as the request is made more than 90 days after the new plan coverage effective date and prior to one year from the new plan coverage effective date, provided that the former plan (or a similar plan) is available. The former coverage will be reinstated as soon as reasonably possible and will not be retroactive. After one year from the effective date of enrollment in a Medicare Plan the retiree and/or covered dependent may not enroll in a non-Medicare coordinated plan.

If a retiree is eligible for Medicare and a covered dependent is not (or vice versa) each of the members may enroll in a different plan. For instance, a Medicare eligible retiree may be enrolled in the Choice Plus Retiree Base Option Plan, and a non-Medicare eligible dependent may be enrolled in the Choice Plan. Each will be charged the applicable premium for single coverage in the respective plan.

Retirees and/or their covered dependents who are eligible for Medicare and are enrolled in the Choice Plus Retiree Base Option plan and reach the plans lifetime maximum limit of $100,000 per covered person that enrollee will become ineligible to continue coverage under the Choice Plus Retiree Base Option plan. Retirees and/or their covered dependents that reach their lifetime maximum limit will be given the option to enroll in another City’s health plan coverage. Plan coverage will be based on plans available at the time of reaching the lifetime maximum. Retirees will be charged the applicable premium for coverage in the respective plan in which enrolled.

5. Cost of Coverage:

a) Health - The cost of coverage amount depends on the plan selected, the number of dependents enrolled, the retiree’s date of retirement and the City’s contribution, if any.

1) Retirees who retired prior to October 1, 2008 - The City will continue to share in the cost of the group health coverage by a contribution equaling 75% of the Choice Plus Retiree Base Option Plan monthly premium applied to the plan in which the retiree is enrolled.

2) Retirees who were who were hired before January 1, 2009, and retire after October

1, 2008 - The City will contribute the capped contribution. City capped contributions are as follows:

Single coverage: $297.72 Two-person coverage: $601.37 Family coverage: $833.58

The retiree is responsible for any monthly premium amounts in excess of the City’s contribution. All premiums are paid on an after-tax basis.

3) Employees hired on or after January 1, 2009, who subsequently retire will pay the full cost of the Plan coverage. The City will not share the cost of the monthly premiums.

All premiums are paid on an after-tax basis.

b) Dental, Vision, Life and AD&D – Retirees are responsible for the full cost of coverage.

All premiums are paid on an after-tax basis.

c) Premiums are paid monthly, generally as a deduction from the retiree’s pension payment.

Premiums are due and payable prospectively, for instance, the premium for coverage for the month of May is due on the last business day of April.

6. Death of the Retiree:

Surviving dependents who were insured for health, dental and/or vision insurance on the date of the retiree’s death will be eligible to continue coverage dependent upon the date of the former employee’s date of retirement, as follows:

a) If the employee retired prior to March 1, 1978:

1) Surviving covered dependents can continue to be covered until the end of the period for which the surviving dependent receives pension benefits. For example, if the retiree chose lifetime benefits for the surviving spouse at the time of retirement, the spouse could continue group insurance coverage for his/her lifetime.

2) If the pension benefits for the surviving dependent end prior to the dependent’s death, the dependent(s) may continue enrollment in group insurance through COBRA for the balance of the 36-month COBRA entitlement period, if any.

b) If the employee retired during the period March 1, 1978, through March 31, 1988

1) Surviving covered dependents can continue coverage for up to 12 months after the retiree’s death, or the end of the period for which pension benefits are received, whichever is shorter.

2) After pension benefits for the surviving dependent end, the dependent(s) may continue enrollment in group insurance through COBRA for the balance of the 36-month COBRA entitlement period, if any.

c) If the employee retired on or after April 1, 1988:

Surviving covered dependents may continue coverage under COBRA for up to 36 months.

Note: Continuation of coverage elected under a) above runs concurrently with any COBRA continuation entitlement. Surviving dependents are responsible for the full cost of coverage plus a 2% administrative charge. There is no City premium contribution for the group health plan when a surviving dependent is receiving coverage due to COBRA.

7. Other Provisions:

a) Only dependents meeting the qualifications contained in the respective plan documents will be eligible for coverage under any group insurance plan.

b) Retirees and dependents are responsible for notifying the Benefits Division of qualifying events that affect the eligibility for coverage, such as marriage, divorce, death, birth, etc.

The Benefits Division must be advised in writing and receive any required documentation within 31 days of any event(s) to make changes.

c) Benefit plan provisions are governed by the applicable insurance certificates of coverage and/or the respective plan documents. The respective insurance carriers or administrative service providers and the City are responsible for plan administration. All questions and concerns regarding claims and services should be directed to the insurance carrier or administrative service provider.

d) The City reserves the right to change plans, insurance carriers or administrative service providers and to add, change or terminate any plan or any coverage at any time.

e) For Sworn Police and Fire employees who become disabled or die in the line of duty, the City will provide health insurance benefits to the employee and/or dependents who meet the eligibility requirements of any applicable federal or state statute which may apply and is in effect at the time.

8. Incorrect Pay (Under or Overpayments):

a) Overcharge for Benefits

If a retiree has been overcharged for coverage in a retiree benefit plan, the City shall correct the situation by paying any funds due to the retiree on the next pension payroll after the proper determination and corrective calculations have been made and processed.

b) Underpayment for Benefits

If a retiree has underpaid the deduction for coverage in a retiree benefit plan, financial restitution is due to the City. Generally, such restitution shall be made immediately by personal check to the City or by pension deductions from the next pension payroll after the proper determination has been made. At the retiree’s option, restitution may be accomplished through pension deductions over the same period of time as the retiree received the overpayment.

NOTES:

The information in this guide is a summary of the benefits available to you and should not be intended to take the place of the official carriers’ Members Certificates of Coverage of the respective Summary Plan Descriptions (SPD). This guide contains a general description of benefits to which you and your eligible dependents may be entitled. This guide does not change or otherwise interpret the terms of the official plan documents.

To the extent that any of the information contained in this guide is inconsistent with the official plan documents, the provisions of the official documents will govern in all cases, and the plan documents and carrier certificates will prevail.

City of St. Petersburg reserves the right, in its sole and absolute discretion, to amend, modify or terminate, in whole or in part, any of all the provisions of the benefits plans.

Human Resources

One Fourth Street North - St. Petersburg, FL 33701