8-PD 1.1 Attachment D 2026-Employee-Benefits-Guide.pdf

CITY OF

ROUND ROCK

EMPLOYEE

BENEFITS

WHAT’S

INSIDE

WELCOME

ELIGIBILITY

• Enrollment

• Qualified Life Events and Enrollment Process

MEDICAL PLANS

PHARMACY

• Optum R(x) FAQs

FOCUS ON YOUR WELLBEING

• Wellness Center

• UHC Gym Pass

• Employee Assistance Program

• Additional Benefits

FLEXIBLE SPENDING ACCOUNTS

• Accessing Your FSA

Dental plan

• United Concordia Dental Plan

Vision plan

• Community Eye Care

Life Insurance

• Basic Life Insurance

• Accidental Death and Dismemberment

• Voluntary Life

DISABILITY Insurance

• Short-term

• Long-term

VOLUNTARY BENEFITS

• Accident Insurance

• Critical Illness

• Hospital Indemnity

Retirement

contacts

REQUIRED NOTICES

welcome to your 2026 EMPLOYEE Benefits Guide

At the City of Round Rock, it’s our employees who make the difference in our success. That’s why, each year, you have the opportunity to choose from a variety of benefits that can make a real difference in your life. We offer a broad range of benefits, including health care, life insurance, disability insurance and much more. You can elect a benefit that’s exactly right for your personal situation.

This guide provides a summary of the benefits available to you.

Please review it carefully and make your elections before the deadline. All elections you make during Open Enrollment will be effective on January 1, 2026. No changes will be allowed at any other time unless you have a Qualified Life Event (such as a birth, death, divorce, marriage, etc.).

Full benefits information, including forms, is available online at EmployeeNet: employees.roundrocktexas.gov.

All elections you make during your new hire period will become effective the first day of the month following your hire date.

If you have any questions about your benefits choices or about how to enroll, please contact Human Resources so you can be sure to have the benefits you need.

BENEFITS STAFF:

Tyler Jarl, PHR, SHRM-CP

Human Resources Manager

Phone: 512-341-3143

Email: tjarl@roundrocktexas.gov

Sanghamitra (Sang) Dhar, SPHR, PHR

Human Resources Specialist/Benefits & Wellness

Phone: 512-671-2731

Email: sdhar@roundrocktexas.gov

WELCOME

http://tjarl@roundrocktexas.gov http://sdhar@roundrocktexas.gov

Qualified Life Event Documentation Needed

Change in Marital Status

• Marriage

• Divorce/Legal Separation

• Death

• Copy of marriage certificate

• Copy of divorce decree

• Copy of death certificate

Change in Number of Dependents

• Birth or adoption

• Step-child

• Death

• Copy of birth certificate or copy of legal adoption papers

• Copy of birth certificate plus a copy of the marriage certificate between employee and spouse

• Copy of death certificate

Change in Employment

• Change in your eligibility status (i.e., full-time to part-time)

• Change in spouse’s benefits or employment status

• Notification of increase or reduction of hours that changes coverage status

• Notification of spouse’s employment status that results in a loss or gain of coverage

If you are a full-time or part-time employee and work at least 30 hours per week, you are eligible for benefits. Your benefits are effective on the first day of the month following your date of hire. You may also enroll your eligible dependents for coverage. This includes the following:

• Your legal spouse or declared informal married spouse.

• Children under the age of 26, regardless of student, dependency or marital status..

• Children who are past the age of 26 and are fully dependent on you for support due to a mental or physical disability and who are indicated as such on your federal tax return.

ELIGIBILITY

LIFE EVENT ENROLLMENT PROCESS

If you do not submit a life event request, provide your required documentation to Human Resources and complete your enrollment in ESS within 30 days of the Qualifying Life Event, you will have to wait until the next annual Open Enrollment period to make changes (unless you experience another Qualifying Life Event). You should submit a life event request within the 30 days even if you are awaiting the required documentation. The 30-day window begins when the event occurs, not when the documentation (i.e. marriage license, birth certificate) is received.

Our medical plans with UnitedHealthcare provide you and your family the protection you need for everyday health issues or when the unexpected happens.

Each medical plan offers:

• Comprehensive health care benefits

• In-network preventive care covered at 100%

• Coverage for eligible children up to age 26

• Prescription drug coverage

CHOOSE THE PLAN THAT’S RIGHT FOR YOU

The key difference between the plans is the amount of money you’ll pay each year when you need care. The plans have different:

• Annual deductible amount - the amount you pay each year for eligible in-network and out-of-network charges before the plan begins to pay.

• Out-of-pocket maximums - the most you will pay each year for eligible network services including prescriptions.

• Copay and coinsurance - money you pay toward the cost of covered services.

SAVE WHEN YOU USE IN-NETWORK PROVIDERS

In-network providers offer the highest level of benefits and lower out-of-pocket costs. Network providers charge you reduced fees but providers outside the plan’s network set their own rates, which means you may have to pay the difference if a provider’s fees are above the Reasonable and Customary (R&C) limits.

All urgent care visits will be processed as in-network.

MEDICAL

PLANS

BENEFIT COSTS

Benefit Who Pays Tax Treatment

Medical and Prescription (Rx) City of Round Rock/You Pre-tax

RockCare City of Round Rock N/A

Dental City of Round Rock/You Pre-tax

Vision City of Round Rock/You Pre-tax

Basic Life and Accidental Death & Dismemberment (AD&D) Insurance City of Round Rock N/A

Voluntary Life and Accidental Death & Dismemberment (AD&D) Insurance You After-tax

Short-Term Disability You After-tax

Long-Term Disability City of Round Rock N/A

Flexible Spending Accounts You Pre-tax

457B Deferred Compensation Plan You Pre-tax or After-tax

Employee Assistance Plan City of Round Rock N/A

Accident + Critical Illness + Hospital Gap You After-tax

Prepaid Legal + ID Theft Prevention You After-tax

Terms to Know Benefits can be confusing! Here’s a quick reference to help you navigate commonly used terms:

• Premium – the amount you pay to the health plan every month; like buying a subscription to the network

• Deductible – the amount of money you pay out of pocket for certain covered health care services before your health plan starts to pay.

• Out-of-Pocket Max (OOP) – the most you’ll pay for allowed health care costs in a plan year. If you reach this amount, your plan pays 100% of your care.

• Coinsurance – your share of the costs of a healthcare service;

usually figured as a percentage of the amount charged for services.

• Copay – a fixed amount you pay out of pocket for a healthcare service, usually when you receive the service.

*You pay after deductible

MEDICAL PLANs COMPARISON

UnitedHealthcare Choice Plus Plan UnitedHealthcare EPO Plan

In-Network Out of-Network In-Network Only

Calendar Year Deductible

Individual $1,000 $2,000 $500

Family $3,000 $6,750 $1,500

Calendar Year Out-of-Pocket Maximum (Includes Deductible)

Individual $5,000 $12,000 $2,500

Family $14,500 $36,000 $5,000

You Pay

Coinsurance

Preventive Care $0 copay 50%* $0 copay

Primary Care Physician $25 copay 50%* $25 copay

Children Under Age 19 $0 copay 50%* $0 copay

Specialist UHPD $25 copay Regular $45 copay 50%* $35 copay

Urgent Care $35 copay 50%* $35 copay

Allergy Injections 20%* 50%* 10% Diabetes Education and Counseling $45 copay 50%* 10%*

Inpatient 20%* 50%* 10%*

Outpatient 20%* 50%* 10%* Hospital & Physician Services

- Emergency $300 copay + 20%* $300 copay + 20%* $300 copay + 10%*

Non-Emergency ER Visits Not covered Not covered Not covered Ambulance Services (Ground & Air) 20%* 50%* 10%*

Outpatient Diagnostic Service (CT scans, PET scans, MRI, nuclear medicine)

20%* 50%* 10%*

Outpatient Therapeutic Treatments (dialysis, intravenous chemotherapy or infusion therapy)

20%* 50%* 10%*

Spinal Treatment/ Chiropractic Care

100% at Airrosti $45 copay all others 50%* 100% at Airrosti

$35 copay all others Durable Medical Equipment, Prosthetic Devices, Orthopedic Appliances

20%* 50%* 10%*

Orthotic Devices 20%* 50%* 10%*

*You pay after deductible.

1$10,000 maximum benefit lifetime for travel and lodging payable at 100% at rate of $50 per day for patient or up to $100 per day for patient and one companion.

2If medical criteria is met.

MEDICAL PLANs COMPARISON continued...

UnitedHealthcare Choice Plus Plan UnitedHealthcare EPO Plan

In-Network Out of-Network In-Network Only

You Pay

Cost Sharing Provisions

Home Health Care 20%* (120 visits per year) 50%* 10%*

(120 visits per year)

Hospice Care 20%* 50%* 10%* Occupational, Speech, and Physical Therapy

$45 copay (combined 60 visits per year) 50%* $35 copay

(combined 60 visits per year) Skilled Nursing Facility - Inpatient Rehab Facility (100 days per year maximum)

20%* 50%* 10%*(100 days per year)

Organ or Tissue Transplant Services (must be pre-certified)

20%* (must be performed at a Center of Excellence) Not covered 10%*

Prior authorization is required

Travel and Lodging Benefit Reimbursement Only1 Not covered Reimbursement Only1

Outpatient Mental Illness $45 copay 50%* $35 copay

Outpatient Substance Abuse $45 copay 50%* $35 copay

Outpatient Chemical Dependency $45 copay 50%* $35 copay

Inpatient Mental Illness 20%* 50%* 10%*

Inpatient Substance Abuse 20%* 50%* 10%* Inpatient Chemical Dependency 20%* 50%* 10%*

Hearing Aids 20%* up to $4,000 per calendar year 50%* 10%* up to $4,000 per calendar year

Newborn Inpatient Care 20%* 50%* 10%*

Wig (when prescribed by MD or DO as a result of hair loss)

20%* not to exceed $1,000 per calendar year

20%* not to exceed $1,000 per calendar year

10%* not to exceed $1,000 per calendar year2

UnitedHealthcare Choice Plus Plan Rates

Monthly Rate City Pays Per Month Employee Pays Per Month Employee Pays Semi-Monthly

Employee Only $1,397 $1,257 $140 $70

Employee + Child(ren) $1,607 $1,257 $350 $175

Employee + Family $1,747 $1,257 $490 $245

UnitedHealthcare EPO Plan Rates

Coverage Level Monthly Rate City Pays Per Month Employee Pays Per Month Employee Pays Semi-Monthly

Employee Only $1,362 $1,257 $105 $52.50

Employee + Child(ren) $1,537 $1,257 $280 $140

Employee + Family $1,667 $1,257 $410 $205

Prescription (Rx) Drug Coverage

(Rx) You Pay

Pharmacy

Retail Rx (up to 30-day supply)

Tier 1 $0

Tier 2 $30

Tier 3 $50

Retail Rx (up to 90-day supply)

Tier 1 $0

Tier 2 $90

Tier 3 $150

UHC/Optum Mail Order Retail Rx (up to 90-day supply)

Tier 1 $0

Tier 2 $90

Tier 3 $150

MEDICAL

RATES

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The UnitedHealthcare app and myuhc.com Whether on the go or online, you’ll have access to resources designed to help you:

• View benefit info, claim details and account balances

• Search network providers and facilities for the type of care you may need

• Quickly compare cost estimates before you get care

• Learn about covered preventive care

• Access your health plan ID card and add your plan details to your smartphone’s digital wallet

Register once to access both tools Start by downloading the UnitedHealthcare app or going to myuhc.com and then:

• Tap Register Now on the app, or select Register on the website

• Fill in the required fields and create your username and password

• Enter your contact information and select SMS text or phone call for two-factor authentication - then, agree to the terms and conditions

• Opt in to paperless delivery from your communication preferences

Now you’re registered for - and connected to - the app and the website.

UHC TOOLS

Get Connected

Scan this code to download the app and register, or visit myuhc.com.

MORE THAN JUST COVERAGE

Get more out of your health plan benefits with these two handy digital tools http://myuhc.com http://myuhc.com http://myuhc.com.

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AIRROSTI

Airrosti is a health care group that treats the root cause of soft tissue injuries (including strains, sprains, muscle pulls and chronic knee, hip, back or neck pain).The time Airrosti providers spend with each patient - a full hour of one-on-one care - leads to a more accurate diagnosis and better outcome. Plus, the highly individualized evaluation and treatment often eliminates unnecessary imaging, injections, pharmaceuticals and other costly procedures.

Here’s how it works:

Each patient receives one full hour of assessment, diagnosis, treatment, and education designed to eliminate the pain associated with many common conditions, allowing you to quickly and safely return to activity - usually within three visits (based on patient-reported outcomes).

Employees and their dependents enrolled with the City’s medical plans may receive treatment at Airrosti for a $0 copay (not to exceed 20 visits per member per year).

Contact: www.airrosti.com or 800-404-6050 rockcare - provided by careatc All employees and their dependents age 2 and above, enrolled with the City’s medical plans, may receive primary care at RockCare at no cost.

Services include:

How to Access the CareATC Mobile App:

Securely activate your account by downloading the CareATC app or visiting www.careatc.com/activate. Follow these four, easy steps:

1. Tell Us About Yourself - provide personal details. It’s important you double check that this matches your employer records.

2. Verify Your Identity - complete a short verification quiz.

3. Create Your Account - set up your username and password.

4. Set Up Your Recovery Options - provide a phone number and/or email address to recover login information.

For more information, visit the RockCare webpage on EmployeeNet.

RockCare Hours:

Monday - Thursday: 7 a.m. - 4 p.m.; Friday: 7 a.m. - 3 p.m.; Closed Saturday and Sunday

Note: RockCare is closed from 12 noon - 1 p.m.; Monday - Friday

Walk-ins: Acute/Sickness Only:

Monday - Friday: 7- 7:45 a.m.; Monday - Friday: 1 - 1:45 p.m.

Scheduling:

Call the scheduling line at 512-843-0697, or schedule an appointment through the CareATC mobile app or through your CareATC online patient portal.

MEDICAL

EXTRAS

http://www.airrosti.com http://www.careatc.com/activate

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VIRTUAL

VISITS

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Virtual Visits are a great option when RockCare is closed and as an alternative to urgent care and emergency room visits. It provides you and your enrolled dependents (no age limitations) access 24/7/365 to U.S. board-certified doctors to receive the treatment you need in an easy and timely manner. In addition, you have the ability to send your visit results to RockCare or your primary care physician. With the City of Round Rock UnitedHealthcare plans, your cost is just $25.

benefits of using virtual visits:

• Convenient: speak with a provider with or without an appointment. Save time by connecting to care via computer, tablet or mobile device. Available in all 50 states. Call 800-835-2362.

• Affordable: on average, the cost of an urgent care visit may be two times more expensive, and an ER visit may be eight times more, depending on insurance. Virtual visits are in-network with medical plans and have a $25 copay.

• High Quality Care: non-emergency medical health conditions evaluated by video by an experienced provider. Prescriptions can be sent directly to your pharmacy.

general medical consult

What can I use it for?

Virtual providers are available without an appointment. Members can receive treatment within minutes for non-emergency, acute general medical needs including but not limited to the following.

Virtual doctors have treated:

1 3 visit with a doctor, 24/7 - whenever, wherever

With 24/7 Virtual Visits, you can connect to a doctor by phone or video’ through myuhc.com® or the UnitedHealthcare® app.

a convenient, and faster way to get care

Doctors can treat a wide range of health conditions-including many of the same conditions as an emergency room (ER) or urgent care-and may even prescribe medications, if needed. With a UnitedHealthcare plan, your cost for a 24/7 Virtual Visit is $25.

Consider 24/7 Virtual Visits for these common conditions:

Get Started

Sign in at myuhc.com/vitualvisits | Call 855-615-8335 | Download the UnitedHealthcare app. When accessing virtual visits either through myuhc.com or the UHC app, you will be brought directly to the 24/7 Optum Virtual Care page. If you would like to access Teladoc, Doctor on Demand or AmWell, please scroll down on that page to the FAQ section at the bottom. From there, open the question ‘Are other virtual visit provider groups supported?’ You will then see the links to the three other virtual visit provider options.

$25 copay An estimated 25% of ER visits could be treated with a 24/7 Virtual Visit

1 2 http://myuhc.com/vitualvisits

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OPTUM(RX)

FAQS

is optum(RX) HOME DELIVERY PHARMACY IN MY PLAN’S NETWORK?

Yes, it’s a part of your plan’s pharmacy network.

once i’ve enrolled in home delivery, how long will it take to get my medication(s)?

Medications should arrive 2-5 days after the pharmacy receives completed new and refill orders.

am i able to track my home delivery orders?

Yes. You can track your home delivery orders from your online account or with the app.

what is a long-term medication?

Long-term medications are those you take on a regular basis. They may also be called “maintenance medications.” These may be taken for high blood pressure, cholesterol and depression.

can i use home delivery for any medication?

No. Not all prescriptions may be filled through home delivery. For example, OptumRx home delivery cannot fill prescriptions for certain pain medications like opioids. You can find out which of your prescriptions can be filled through home delivery by going online or using the app. Or, you can call customer service using the number on your member ID card.

what is eprescribe?

It’s a way for your provider to send electronic prescriptions to OptumRx. It is much faster than paper and faxing prescriptions. Be sure to ask your doctor to ePrescribe when possible. Prescriptions for controlled substances, such as opioids, can only be ordered by ePrescribe. Some exceptions apply.

can i set up medication reminders?

Yes. Use your online account to set up email, phone or text alerts for when it’s time to refill or take your medication.

how does the automatic refill program work?

Go online or use the app to enroll eligible medications. Then, OptumRx home delivery will send your refills when it’s time. They will notify you before they ship and they’ll use your approved payment method on file. It’s that easy.

OptumRx Mail Order Benefit Contact Information:

800-356-3477 www.OptumRx.com http://www.OptumRx.com

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WELLNESS CENTER

The Wellness Center is located next to RockCare at 901 Round Rock Ave.

Open daily from 5 a.m. to 10 p.m.

The Wellness Center is available to employees and one guest (immediate family member age 16+ and requires a City-issued ID badge to access.

Guest is required to complete a waiver (available on EmployeeNet).

Whether it’s learning about wellness or engaging in physical activity, the Wellness Center is your go-to spot featuring a variety of gym equipment, including treadmills, elliptical, stair climber, stationary bikes, rowing machines, universal strength machine, free weights, medicine balls, tension bands, foam rollers and more. The facility features a full locker room with three individual shower stalls, 12 lockers and restrooms available. Contact Human Resources for questions.

AUSTIN REGIONAL CLINIC ROUND ROCK

940 Hesters Crossing

Round Rock, TX 78681

Phone: 512-244-9024 Fax: 512-406-7342

Clinic Hours Monday - Friday: 7 a.m. - 5 p.m.

After-Hours Clinic: Monday - Friday: 5 - 9 p.m.

Saturday and Sunday: 8 a.m. - 5 p.m.

CONVENIENCE CARE CLINICS - $0

COPAY

A Convenience Care Clinic is a walk-in facility, or part of a facility or retail store, that provides care for minor conditions that need attention right away but are not emergency medical conditions, such as a cold, strep throat, or a minor allergic reaction. These facilities may also provide basic preventive care services such as health screenings or vaccinations. Visit myuhc.com and the UnitedHealthcare App to locate your local convenience care clinics.

FOCUS ON YOUR

WELLBEING

Where to Go and What to Go For

Convenience Care Clinic

Sprains, strains, bites, rashes, burns, cuts, healthy lifestyle screening, strep throat, pink eye, flu shot

Primary Care Doctor’s Office

Wellness exam, sprains, strains, bites, rashes, burns, cuts, healthy lifestyle screening, strep throat, pink eye, flu shot

Urgent Care Center

Broken bones, sprains, strains, bites, rashes, burns, cuts

Emergency Room Concussions, seizures, chest pain, broken bones

Tip: Make sure any urgent care center you visit is in-network to save you the most money.

unitedhealthcare gym pass With One Pass Select, we’re on a mission to make fitness engaging for everyone. Find a routine that’s right for you whether you work out at home or at the gym. Choose a membership tier that fits your lifestyle and provides everything you need for whole body health in one easy, affordable plan. Members may register through myuhc.com or OnePassSelect.com or call 877-515-9364.

• $29/month, Classic Plan

• $64/month, Standard Plan

• $99/month, Premium Plan

• $144/month, Elite Plan

1 4 http://OnePassSelect.com

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Employee assistance program Everyone may need a little help from time to time. That’s why we offer you and your eligible family members access to licensed counselors through our Employee Assistance Program (EAP). The EAP is available to you whether or not you elect other benefits coverage through the City.

You can contact the EAP for help with the following:

ALLONE HEALTH APP

Taking care of your mental health should be simple, supportive, and always within reach. That’s why we created the AllOne Health App—to make it easier than ever for you to access the care you need, when you need it. Whether you’re navigating life’s challenges, looking for resources, or just need someone to talk to, we’re here to help.

WHAT YOU’LL FIND INSIDE THE APP

Virtual Counseling Made Easy Self-schedule virtual counseling sessions directly through the app.

Izzy, Your AI Mental Health Navigator Receive guidance and personalized support in real time.

On-Demand Self-Help Resources Explore self-guided therapy (iCBT), articles, videos, assessments, and tools.

Real Human Support 24/7 live assistance is always just a tap away when you want to speak to someone.

• Stress

• Anxiety and depression

• Substance abuse (alcohol and/ or drugs)

• Financial issues

• Aging parents

• Marital or family problems

• Pet care

• Maintenance and repair providers

• Community volunteer opportunities

• Child care issues (identifying schools, day care, tutors and more)

Through the EAP, you and your family can receive immediate support and guidance, as well as assessments and referrals for further services.

It’s important to note that all EAP conversations are voluntary and strictly confidential. In addition, there’s never a cost to you when you contact an EAP counselor; the City pays the full cost. You have a benefit of 6 covered sessions per issue per year. However, if you and your counselor determine that additional assistance is needed, you’ll be referred to the most appropriate and affordable resource available.

Although you’re responsible for the cost of referrals, these costs are often covered under your medical plan.

HOW IT WORKS

Download the AllOne Health App from the Apple App Store or Google Play Store.

Sign Up using your existing member portal access code. You’ll still have access to the member portal. However, the new AllOne Health App makes accessing care and requesting support easier and more convenient.

Start Exploring – Book sessions, chat with Izzy, and discover resources that support your whole health.

Download the App and Take the First Step

No matter where you are in your journey, support is here—because your mental health deserves care that’s easy to access, always available, and built around you.

Contact AllOne Health

888-993-7650 www.allonehealth.com/deeroaks

Code: roundrocktexas http://apps.apple.com http://play.google.com http://www.allonehealth.com/deeroaks

1 7 texas legal Texas Legal, a nonprofit founded by the State Bar of Texas, provides inexpensive, convenient access to high quality attorneys, then keeps you and your family safe with insurance for the vast majority of life’s personal legal needs. Included in your Texas Legal membership is access to Experian, an identity theft prevention benefit. Full benefits summaries are on EmployeeNet.

legal shield and idshield Summary: Enrollment with LegalShield gains you access to an entire law firm for assistance with a wide variety of legal matters. Enrollment with IDShield gains you access to comprehensive monitoring or your most personal data, consultation and full restoration if your identity is stolen or compromised. Full benefits summaries are on EmployeeNet.

tuition assistance Tuition assistance is available to employees who are seeking education for career and/or job related development and who are taking for-credit courses through an academic institution. Regular full-time employees with six or more months of service may be eligible for tuition assistance.

The City provides tuition assistance up to $5,000 for full time employees and up to $2,500 for part time employees per fiscal year for tuition and required fees only (books, equipment and supplies are ineligible). These funds are allocated on a first-come, first-served basis. Classes must be offered by an accredited school or university and employees must submit their application to Human Resources prior to the start of their class(es).

Plan Employee Monthly Family Monthly

Select $13.00 $13.00

Preferred $18.00 $18.00

ADDITIONAL

BENEFITS

clay madsen recreation center All employees receive either a free individual membership to the Clay Madsen Recreation Center OR a discounted family membership (immediate family members only).

city pool passes All employees are eligible for free passes for admittance to all City-owned pools (excluding RockNRiver). This benefit is available to employees and their immediate family members.

round rock public library card All employees, regardless of residence, may apply for a free Round Rock Public Library card.

To get a library card, apply in person at the library. The following documentation is required when applying for a Round Rock Public Library card:

• A valid Texas issued ID with current address, OR

• A valid government issued ID and printed official document with current Texas address. Examples of official documents to prove Texas residency are: lease, recent bill, insurance card, check from bank, etc.Plan Employee Monthly Family Monthly

LegalShield $18.95 $18.95

IDShield $8.95 $18.95

Combined $27.90 $33.90

FLEXIBLE

SPENDING ACCOUNTS

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FLEXIBLE SPENDING Account (FSAs) Flexible Spending Accounts (FSAs) with Navia Benefit Solutions allow you to pay for eligible health care and dependent care expenses using tax-free dollars. There are two types of FSAs — the Health Care FSA and the Dependent Care FSA.

Comparing the two types of FSAs

Health Care FSA Dependent Care FSA

Contribute up to $3,400 per year, pre-tax, to pay for services not covered by your medical, dental or vision plan such as copays, coinsurance, deductibles, Contribute up to $7,500 per year, pre-tax, or $3,750 if married and filing separate tax returns to pay for day care expenses associated with caring for elder or

Receive a debit card to pay for eligible medical expenses

(funds must be available in your account).

Receive a debit card to pay for eligible expenses (funds must be available in your account).

Eligible expenses include medical copays, coinsurance, deductibles, eyeglasses and over-the-counter medications (must be prescribed by your doctor).

Can only be used to pay for eligible dependent care expenses including day care, after-school programs and elder care programs.

Submit claims up to February 28 of the following year for expenses from January 1 to December 31.

Per IRS regulations, $680 and less may be rolled over to the next calendar year.

Submit claims up to February 28 of the following year for expenses from January 1 to December 31.

If you do not spend all the money in this FSA by

December 31, per IRS regulations, unused dollars will be forfeited.

If you are contributing to a Health Savings Account (HSA), you are not eligible for the Health Care FSA.

contact navia www.naviabenefits.com customerservice@naviabenefits.com 800-669-3539 | 425-452-3500

1 9 accessing your fsa benefits Rather than filing a claim and waiting for reimbursement, you can use the debit card to pay your provide directly for qualified health care expenses. Funds come directly out of your Health Care FSA and are paid to the provider. Some swipes require Navia to verify the expense, so hang on to your receipts! If Navia needs to verify, they will send you an email or notification via the smartphone app.

You can also submit Health Care FSA and Dependent Care FSA claims online, through the smartphone app for Android and iPhone, email, fax or mail. Claims are processed within a few days and reimbursements are issued according to the City’s reimbursement schedule. Be sure to include documentation that clearly shows the date, type and cost of the service.

Additional Tools

• Online Account Access: You can order additional debit cards, update bank and address information and see up-to-date details of your benefits.

• Online Claims Submission: Upload your documentation, complete the online wizard, and a reimbursement will be on its way within a few days.

• Mobile App: MyNavia allows you to simply snap a photo and submit for reimbursement direct from your mobile device.

• Flexconnect: Sync your various medical, dental and vision benefits with your FSA plan for a quick and easy reimbursement. No need to submit documentation, we’ll get it from the insurance carrier. For additional information, please visit www.naviabenefits.com/participants/resources/flex-connect/.

Election and Claiming Filing Period

Open Enrollment is a great time to look at your benefits and estimate your out-of-pocket expenses. Be sure to only select an amount that you know you will use during your plan year. At the end of the plan year, you will have a claim filing period to turn in any leftover claims for your benefits.

Carryover

Unused Health Care FSA balances up to $680 can be carried over to the subsequent plan year. Health Care FSA funds in excess of $670 are subject to the “use it or lose it” rule. The carryover feature does not apply to unused day care FSA funds.

Carryover amounts will be credited after your claim filing period.

http://www.naviabenefits.com http://customerservice@naviabenefits.com http://www.naviabenefits.com/participants/resources/flex-connect/.

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DENTAL

PLAN

DPPO Plan

In-Network Calendar Year Deductible Individual $50

Family $150

Calendar Year Out-of-Pocket Maximum

Per Individual $2,000

You Pay

Preventive Care

Exams, Cleanings, X-rays, Fluoride Treatments $0

Basic Services

Fillings, Space Maintainers, Sealants, Extractions, Oral Surgery, Endodontics, Periodontics, Emergency Exams 20%

Major Procedures

Crowns, Inlays/Onlays, Dentures and Bridgework, Repairs 50%

Orthodontia 24-Month Treatment Fee — Additional fees will apply for pre-ortho visits and treatment, records and retention, banding

Adults & Children 50% after $50 deductible, up to a lifetime maximum benefit of $1,500 per individual

United Concordia Dental Plan

Monthly Rates

City Pays Per Month

Employee Pays Per Month

Employee Pays Semi- Monthly

Employee Only $52.00 $20.00 $32.00 $16.00

Employee + Spouse $72.00 $20.00 $52.00 $26.00

Employee + Child(ren) $69.00 $20.00 $49.00 $24.50

Employee + Family $105.00 $20.00 $85.00 $42.50 united concordia dental Taking care of your oral health is not a luxury, it is a necessity for long-term optimal health. When you visit a dentist in the network, you will maximize your savings. These dentists have agreed to reduced fees, which means you won’t get charged more than your expected share of the bill.

VISION

PLAN

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Benefits Summary

In-Network Visionworks Out-Of-Network Cost Exam $10 copay $0 Up to $50

Eyewear Allowance (up to $225 allowance for eyewear) $10 copay $0

Up to $191.25 (85% of eyewear allowance)

Contact Lens Fitting, Re-fit or Evaluation $10 copay $0 Up to $48

Benefit Frequency

Comprehensive Exam

Once every calendar year (limited to annual eyewear allowance)

Lenses (including contact lenses)

Frames

Second Pair Discount

Community Eye Care Vision Rates

Monthly Rates City Pays Per Month Employee Pays Per Month

Employee Pays Semi- Monthly

Employee Only $5.86 $5.00 $0.86 $0.43

Employee + Spouse $9.96 $5.00 $4.96 $2.48

Employee + Child(ren) $10.54 $5.00 $5.54 $2.77

Employee + Family $15.62 $5.00 $10.62 $5.31 community eye care You may elect vision care coverage, which provides affordable, quality vision care nationwide. Vision care services and supplies are covered in-network and out-of-network, your benefits are greater when you use in-network providers.

It’s important to give some serious thought to what expenses and income needs your dependents would have if something happened to you. To make sure you have financial protection, the City offers several different types of Life and AD&D insurance with Minnesota Life Insurance Company.

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Coverage Level Coverage Amount

Basic Life and

AD&D

1x of your annual earnings to a maximum of $100,000.

Imputed Income Under current tax laws, imputed income is the value of your Basic Life insurance that exceeds $50,000 and is subject to federal income, Social Security and state income taxes, if applicable. This imputed income amount will be included in your paycheck and shown on your W-2 statement.

BASIC LIFE and AD&D COVERAGE

Basic Life Insurance This coverage is provided at no cost to all benefits-eligible employees. If you purchase additional life insurance for yourself, you may also purchase coverage for your spouse and dependent children.

Accidental Death & Dismemberment (AD&D) This coverage is provided as part of your basic life coverage and provides you specified benefits for a covered accidental bodily injury that directly causes dismemberment (i.e., the loss of a hand, foot or eye). In the event that death occurs from an accident, 100% of the AD&D benefit would be payable to your beneficiary(ies).

Supplemental death benefit The City provides a Supplemental Death Benefit through the City’s retirement program. If you die while employed by the City, the Texas Municipal Retirement System (TMRS) will pay your beneficiary or estate a benefit approximately equal to your current annual salary. If you die during retirement, the benefit is $7,500.

You are automatically enrolled, with no cost to you, in the Supplemental Death Benefit with your TMRS membership.

LIFE AND ACCIDENTAL DEATH &

DISMEMBERMENT INSURANCE

Voluntary Life and AD&D Insurance - For You and Your Dependents

Coverage Level Coverage Amount

Employee Increments of $10,000 up to 5x your salary, not to exceed $500,000.

Spouse Increments of $5,000 up to $500,000, not to exceed 100% of Employee coverage.

Child(ren) $15,000 limited to 100% of the amount for which employee is enrolled.

VOLUNTARY LIFE AND

AD&D COVERAGE OPTIONS

Voluntary life insurance for you, your spouse and children with Minnesota Life Insurance Company, can help protect your family during difficult times. Eligible employees may purchase Voluntary Life and AD&D for themselves and their family. Voluntary Life and AD&D insurance will be deducted from your paycheck on a post-tax basis. Your spouse is not eligible for spouse Voluntary Life insurance if they are eligible for employee Voluntary Life Insurance with the City.

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Age Employee/Spouse Monthly Life Rate per $1,000

Under 25 $0.060

25-29 $0.070

30–34 $0.090

35–39 $0.100

40–44 $0.120

45–49 $0.220

50–54 $0.420

55–59 $0.660

60–64 $0.720

65–69 $1.330

70–74 $2.070

75–79 $2.380

Child Monthly Life Rate $1.80 for $15,000

Employee Monthly Voluntary AD&D Rate $0.025/$1,000

Family Monthly Voluntary AD&D Rate $0.035/$1,000

Voluntary life and AD&D Rates

When you are first eligible for Voluntary Life insurance, you may purchase up to 5x your annual salary, not to exceed $500,000. The first $250,000 will be Guarantee Issue. For any amount that you elect greater than $250,000, you will be required to complete an Evidence of Insurability (EOI).

When your spouse is first eligible for voluntary life insurance, your spouse may elect 100% of what you elect. The first $50,000 will be Guarantee Issue for your spouse. For any amount that your spouse elects greater than $50,000, an EOI will be required. Any new enrollments and increases made during Open Enrollment to currently enrolled amounts will require

EOI.

DISABILITY INSURANCE

If you have a serious injury or illness that keeps you from working, how would you pay your bills? Disability insurance replaces a portion of your income when you are unable to work due to a qualified illness or non-work-related injury.

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Short-Term Disability (STD) Pregnancy, a scheduled surgery or an unplanned illness or injury could keep you off the job and without income for an extended period of time. STD can protect part of your paycheck should you become disabled. Certain exclusions and pre-existing condition limitations may apply. STD is a voluntary benefit. If you do not enroll within 30 days of first becoming eligible, an Evidence of Insurability (EOI) is required.

A qualifying disability is a sickness or injury that causes you to be unable to perform any work for which you are or could be qualified by education, training or experience.

Coverage Benefit

Short-Term Disability

60% of your weekly earnings not to exceed $1,200 weekly for 11 weeks.

Benefit begins after 14 days of disability, not to exceed 11 weeks.

Rate Monthly cost is $0.255 per $10 of covered benefit long-Term Disability (lTD) LTD makes sure you have a portion of your income replaced if you can’t work for an extended period of time due to a non-work-related illness or injury. This coverage is coordinated with other benefits you may receive while disabled, such as Social Security and Worker’s Compensation. LTD payments will last for as long as you are disabled or until you reach your Social Security Normal Retirement Age, whichever comes first. Certain exclusions and pre-existing condition limitations may apply. LTD is provided at no cost to all eligible employees. Enrollment is automatic.

Coverage Benefit

Long-Term Disability

60% of your monthly earnings up to a $5,000 monthly maximum.

Benefit begins after 90 days of disability and payments will last for as long as you are disabled or until you reach your Social Security Normal Retirement Age, whichever is sooner.

2 5 when are you disabled?

To be considered disabled and eligible for LTD benefits, you must be approved by Madison National Life and seeing a doctor regularly for treatment. In addition:

• Your doctor must certify that you are not able to do your job at the City, and;

• You must have lost 20% or more of your pre-disability income due to your illness or injury.

How STD and LTD Can Work Together Let’s say you get hurt while skiing and must be away from work due to injuries.

Here’s how your disability benefits would work:

• For the first 14 calendar days you miss work, you may use your accrued paid leave and receive your regular pay.

• For the next 11 weeks, you would receive STD benefits equal to 60% of your pay, not to exceed $1,200 per week.

• If you’re out longer than 13 weeks and can’t perform your job, LTD replaces 60% of your monthly pay, up to a maximum of $5,000 per month. These benefits would continue until you no longer meet the definition of disabled as defined by Madison National Life.

First 14 Days Your sick/vacation leave may be used to receive salary continuation

Next 11 weeks Approved STD replaces 60% of your weekly pay

After 90 Days LTD begins if approved

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VOLUNTARY

BENEFITS

Accident insurance Helps cover costs related to accidental injuries such as car accidents, falls, or sports injuries. This benefit pays cash directly to you — regardless of other coverage — to use however you need (e.g., deductibles, childcare, groceries, etc.).

Commonly Covered Expenses:

• Emergency room visits

• Hospital stays

• Medical exams (including major diagnostics)

• Physical therapy

• Fractures and dislocations

• Transportation and lodging if the accident occurs away from home

Service Benefit Amount

Ground Ambulance $300

Emergency Room $150

Hospital Admission $1,200

Hospital ICU Admission $2,400

Appliances $225

Dislocated Hip $3,000

Rehabilitation Therapy $30

Concussion $200

Total Benefit Paid $7,505

SAMPLE reimbursements

How the plan works:

John was in a car accident and was transported by ground ambulance to the emergency room and admitted to the hospital. He had a dislocated hip and spent five days in the hospital. He had several physical therapy sessions before returning to work. John submitted his accident claim and received $5,800 from his accident insurance coverage, and used it toward his deductible, copay and supplemental income for his missed work days.

UnitedHealthcare Accident Insurance Rates

Employee Pays Monthly Employee Pays Semi- Monthly

Employee $7.94 $3.97

Employee + Spouse $12.54 $6.27

Employee + Child(ren) $15.42 $7.71

Employee + Family $23.72 $11.86

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CRITICAL ILLNESS insurance Critical Illness insurance with UnitedHealthcare can have a huge impact on your life. A critical illness can keep you from working and can make it difficult to do simple, everyday things. Critical Illness insurance can help reduce your stress – financially and mentally – while you recover from your illness. These illnesses can include, but are not limited to, the following:

• Heart attack

• Multiple Sclerosis

• Stroke

• Major organ failure

• Alzheimer’s disease

• Parkinson’s disease

SAMPLE BENEFIT Amount

How the plan works:

Critical Illness insurance pays a fixed one-time benefit amount if you are diagnosed with a covered disease or illness after your coverage effective date.

You can use this money for any purpose you like. It can help pay for expenses not covered by your health care plan (such as your deductible or copays), lost income, child care, travel to and from treatment, home health care costs or any of your regular household expenses. Pre-existing conditions are excluded.

Tom suffered a small stroke, was hospitalized for five days, then entered rehab.

He received a $20,000 lump-sum benefit to support his recovery and related expenses.

Critical Illness Benefit Options

Coverage Level Benefit Amount Guaranteed Issue Amount

Employee $20,000 All Guaranteed Issue

Spouse $10,000 All Guaranteed Issue

Children $5,000 All Guaranteed Issue

Please refer to the benefits summary posted on EmployeeNet for more information, including rates.

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Hospital Indemnity insurance with UnitedHealthcare is a plan designed to pay for the costs of a hospital admission that may not be covered by other insurance.

The plan covers employees who are admitted to a hospital or ICU for a covered sickness or injury.

Even if your Medical insurance covers most of your hospitalization, you can still receive payments from your Hospital Indemnity insurance plan to cover extra expenses while you recover.

Examples of Covered Expenses

• Hospital Admission

• Hospital Confinement

• Hospital Intensive Care

How does Hospital Indemnity work?

You pay monthly premiums for your Hospital Indemnity insurance plan. If you are admitted to the hospital for an injury or illness, your Hospital Indemnity plan makes cash payments to you.

And with the payments going directly to you, you can use these emergency funds to pay for costs not covered by your medical insurance, Medical insurance deductibles, copays and coinsurance, child care expenses while you are in the hospital or cost-of-living expenses as you recover.

UnitedHealthcare Hospital Gap Rates

Employee Pays Monthly

Employee Pays Semi- Monthly

Employee $5.12 $2.56

Employee + Spouse $11.94 $5.97

Employee + Child(ren) $10.68 $5.34

Employee + Family $18.68 $9.34

HOSPITAL INDEMNITY

GAP INSURANCE

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What does retirement look like for you? Maybe you plan to travel the world. Or maybe you’d like to take up some hobbies closer to home. Whatever your goal, it’s important to take responsibility for your own finances so you have the income you’ll need in the future.

One of the best ways to ensure a secure retirement is to start saving as early as possible. Our retirement plans allow you to save for retirement on a pre-tax basis. You can begin contributing to the plan at any time once you become eligible and can start making contributions to your account through convenient payroll deductions.

texas municipal retirement system (tmrs)

PLANNING FOR

RETIREMENT

• Benefits eligible employees automatically contribute 7% of their salary to TMRS.

• Your account earns a guaranteed 5% interest rate per year at the end of the calendar year, after 12 months of continuous contributions.

• The City of Round Rock contributes 2:1 of an employee’s fund when the employee retires.

Retirement may occur after 20 years of services or at age 60 or above (with at least 5 years of service).

457(b) deferred compensation plans Employees may save more toward retirement than the mandatory 7% with TMRS. Under Section 457 of the Internal Revenue Code, employees may defer pre-tax, post-tax or both, up to the maximum allowed depending upon their age. Participation is handled through payroll deduction each pay period. An employee may join the 457 plan with Nationwide Retirement Solutions anytime during the year. Contribution changes must be submitted to Nationwide Retirement Solutions and are effective the first paycheck of the following month.

• Standard Deferral: $23,500

• Age 50+ Catch-up: Additional $7,500

• Special 457 Catch-up to $47,000

Pre-Tax Post-Tax (Roth) Max contribution per year $23,500 $23,500

Max contribution per year (age 50 and over) $31,000 $31,000

• Minimum contribution per pay period is $10.00.

• Maximum contribution per year includes both plans. Example:

If you are under age 50 and you contribute $4,000 per year to the Roth plan, the maximum that you can contribute per year to the pre-tax plan is $19,500.

contacts

Coverage Contact Website/Email Phone

Medical UnitedHealthcare www.myuhc.com Choice: 888-787-4112

EPO: 888-331-3408

Dental United Concordia www.unitedconcordia.com 877-816-3596

Vision Community Eye Care www.cevision.com 888-254-4290

Flexible Spending Accounts (FSAs) Navia Benefit Solutions www.naviabenefits.com customerservice@naviabenefits.

com

800-669-3539 425-452-3500

Employee Medical Clinic RockCare RockCare webpage on

EmployeeNet 512-843-0697

Life and AD&D Insurance Minnesota Life ochs@ochsinc.com 888-658-0193

Disability Madison National Life ochs@ochsinc.com 800-356-9601 ext. 2410

Retirement Texas Municipal Retirement System (TMRS) www.TMRS.com 800-924-8677

Pharmacy UnitedHealthcare www.myuhc.com 888-290-5416

Employee Assistance Program (EAP)

All One Health www.allonehealth.com/deeroaks 888-993-7650

Legal Assistance

LegalShield Mark Seguin, Account Manager

Texas Legal www.legalshield.com www.texaslegal.com 903-539-6821

Accident, Critical Illness and Hospital Indemnity

UnitedHealthcare www.myuhc.com Claims:866-556-8298 Questions:888-299-2070

Teladoc Teladoc teladoc.com 855-835-2362

Deferred Compensation (Voluntary Retirement)

Nationwide Insurance Wilson Heacock, Retirement Specialist www.nrsforu.com Wilson.Heacock@nationwide.com 361-887-1978

Human Resources Tyler Jarl, Human Resources Manager tjarl@roundrocktexas.gov 512-341-3143

Human Resources Sang Dhar, HR Benefits and Wellness Specialist sdhar@roundrocktexas.gov 512-671-2731

3 0 http://www.myuhc.com http://www.unitedconcordia.com http://www.cevision.com http://www.naviabenefits.com http://customerservice@naviabenefits.com http://customerservice@naviabenefits.com http://ochs@ochsinc.com http://ochs@ochsinc.com http://www.TMRS.com http://www.myuhc.com http://www.allonehealth.com/deeroaks http://www.legalshield.com http://www.texaslegal.com http://www.myuhc.com http://teladoc.com http://www.nrsforu.com http://Wilson.Heacock@nationwide.com http://tjarl@roundrocktexas.gov http://sdhar@roundrocktexas.gov

Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from Williamson County, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.

If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.

If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you…