Appendix_E_-_2023_Employee_Benefits_Guide.pdf

CITY OF ST. PETERSBURG

BENEFITS GUIDE

2023 - 2024

2023 BENEFITS GUIDE

TABLE OF CONTENTS

INTRODUCTON AND ELIGIBILITY……………………………………………………………….…………..…….……………..……...…………..3

CONTACT INFORMATION …………………………….………………………………………………………..….……………...…….………….Ê….4

QUALIFYING EVENTSÊ……………………………………………………………………………………………….…….…………..….…..……………5

OPEN ENROLLMENT INFORMATION………………………………………………………………………….……………..…..…..…………….6

HEALTH BENEFITS

Health and Wellness Center………………………………………………………………………………...……………………………...…….…...7

MedicalÊPlanÊFeatures…………………………………………...……………………………………………………………………………...……..8-9

MedicalÊPlanÊOverviewÊ……………………………...……………………………………………………………………………………..…..……...10

HealthÊReimbursementÊAccountsÊ…...………………………………………………………………………………………………..…………...11

Medical Plan Comparison & Payroll Deduc�ons …………………………………………………………………………….………..12-15

Dental Benefits & Payroll Deduc�onsÊ………………………………………………………………………………………….……………….16

Vision Benefits & Payroll Deduc�onsÊ………………………………………………………………………………………………….………..17

EmployeeÊAssistanceÊProgramÊ…………………………………………..………………………….…………………………………….……

FlexibleÊSpendingÊAccountsÊ……………………………………..…...…………………………………………………………….………………..19

FINANCIAL BENEFITS

LifeÊInsuranceÊ………...….……………………………………..…...…………………………………………………………………………..…..20-21

Frequently Asked Ques�ons & Other Programs ………………………………..……………………………………….…………….22-23

Sidebar T

ELIGIBILITY

Employee Eligibility EligibleÊemployeesÊareÊprovidedÊanÊannualÊ(“openÊenrollment”)ÊopportunityÊtoÊmakeÊenrollmentÊchangesÊtoÊcurrentÊ CityÊ ofÊ St.Ê PetersburgÊ benefitsÊ programÊ elections.ÊÊ Full-timeÊ andÊ full-timeÊ temporaryÊ employeesÊ areÊ eligibleÊ forÊ benefitsÊonÊtheÊ1stÊdayÊofÊtheÊmonthÊnearestÊ60ÊdaysÊofÊemployment.ÊÊPart-timeÊemployeesÊwhoÊaverageÊoverÊ30Ê hoursÊofÊworkÊperÊweekÊforÊaÊcontinuousÊ12ÊmonthÊperiodÊmayÊbeÊeligibleÊtoÊenrollÊinÊoneÊofÊtheÊMedicalÊPlans.

Dependent Eligibility—Medical Only AÊdependentÊisÊdefinedÊasÊaÊcoveredÊemployee’sÊlegalÊspouseÊorÊaÊdependentÊchildÊofÊtheÊemployeeÊorÊemployee’sÊ spouse.ÊÊDependentÊchildrenÊmayÊbeÊcoveredÊun�lÊtheÊendÊofÊtheÊcalendarÊyearÊinÊwhichÊtheyÊturnÊageÊ30.ÊÊ AÊdependentÊchildÊisÊdefinedÊas:

· AÊnaturalÊchild

· AÊstep-child

· AÊlegallyÊadoptedÊchild

· AÊchildÊplacedÊforÊadop�on

· AÊchildÊforÊwhomÊlegalÊguardianshipÊhasÊbeenÊawardedÊtoÊtheÊcoveredÊemployeeÊorÊtheÊemployee’sÊspouse

· UnmarriedÊchildrenÊofÊanyÊageÊwhoÊbecomeÊmentallyÊorÊphysicallyÊdisabledÊbeforeÊreachingÊtheÊageÊlimit Note:

*FL Statute 627.6562 Dependent Coverage: Health insurance coverage may be available for dependents ages 26 to

30. Please contact the Benefits Division for more information at 727-893-7279.

Dependent Eligibility - Dental and Vision AÊdependentÊ isÊdefinedÊasÊaÊcoveredÊemployee’sÊ legalÊspouseÊorÊdependentÊchildÊofÊ theÊemployeeÊorÊemployee’sÊ spouse.ÊDependentÊchildrenÊmayÊbeÊcoveredÊun�lÊtheÊendÊofÊtheÊcalendarÊyearÊinÊwhichÊtheÊchildÊturnsÊ26.Ê

INTRODUCTION

TheÊCityÊofÊSt.ÊPetersburgÊunderstandsÊthatÊyourÊbenefitsÊareÊimportantÊtoÊyouÊandÊyourÊfamily.ÊThisÊBenefitsÊGuideÊ providesÊaÊdescriptionÊofÊtheÊbenefitsÊavailableÊtoÊyou.Ê TheÊBenefitsÊGuideÊisÊnotÊanÊemployee/employerÊcontract.ÊItÊisÊnotÊintendedÊtoÊcoverÊallÊprovisionsÊofÊallÊplans,ÊbutÊ isÊÊaÊquickÊreferenceÊguide.ÊPleaseÊseeÊtheÊrespectiveÊplanÊdocumentsÊforÊaÊcompleteÊdescriptionÊofÊtheÊbenefits.Ê WeÊ encourageÊ youÊ toÊ reviewÊ eachÊ sectionÊ ofÊ theÊ guideÊ andÊ toÊ discussÊ theÊ optionsÊ availableÊ toÊ youÊ withÊ yourÊ dependents.Ê PayÊ closeÊ attentionÊ toÊ applicableÊ copaymentsÊ andÊ deductibles,Ê howÊ toÊ fileÊ claims,Ê preauthorizationÊ requirements,ÊparticipatingÊnetworksÊandÊservicesÊthatÊmayÊbeÊ limitedÊorÊnotÊcoveredÊ(exclusions).ÊThisÊguideÊwillÊ giveÊyouÊanÊoverviewÊofÊyourÊbenefitsÊandÊhelpÊyouÊtoÊbeÊbetterÊpreparedÊforÊtheÊenrollmentÊprocess.

RESOURCE/SERVICE

PROVIDER

CONTACT SOURCE DETAILS

United Healthcare (Medical Plans)

On-Site Representa�ve Member Services Website

727-893-7911 Lauren Gibson 1-800-377-5154 www.myuhc.com

Humana (Dental Plans)

Member Services Website

1-800-979-4760 www.humana.com

Humana (Vision Plans)

Member Services Website

1-877-398-2980 www.humana.com

Ameriflex (Flexible Spending Accounts)

Member Services Email Website

1-888-868-3539 service@myameriflex.comÊ www.myameriflex.com

The Standard Life Insurance Company (Basic Life, Supplemental Life & AD&D)

Member Services Website

1-800-325-5757 www.standard.com

ComPsych (Employee Assistance Program)

Member Services Website Company Web ID

1-888-327-5769 www.guidanceresources.com Web ID:STPETE

Benefits Division Human Resources 727-893-7279 or 727-893-7819 www.stpete.org/hr benefits@stpete.org

Pension Division Last Name Begins M-Z Sherri McLean

727-893-7044 Sherri.mclean@stpete.org

Pension Division Last Name Begins A-L Steven Fyalkowski

727-893-7045 Steven.fyalkowski@stpete.org

CONTACT INFORMATION

IfÊyouÊhaveÊspecificÊques�onsÊaboutÊaÊbenefitÊplan,ÊpleaseÊcontactÊtheÊadministratorÊlistedÊ below, or your local human resources department.

Florida Relay offersÊspecializedÊphoneÊservicesÊtoÊcommunicateÊforÊthoseÊmembersÊandÊtheirÊ dependentsÊwhoÊhaveÊhearing,Êspeech,ÊorÊvisualÊdifficul�es.ÊFloridaÊRelayÊcanÊbeÊreachedÊbyÊ dialing 711 toll free 24 hours 7 days a week.

Qualifying Life Event Per Internal Revenue Service rules, coverage elec�ons made at Open Enrollment cannot be changed un�l the next annual Open Enrollment period.

TheÊonlyÊexcep�onÊtoÊthisÊisÊifÊyouÊexperienceÊaÊ“QualifyingÊLifeÊEvent”.ÊÊQualifyingÊLifeÊEventÊallowsÊyouÊtoÊmakeÊaÊ changeÊtoÊyourÊbenefitÊelec�onsÊwithinÊ30 days of the event.ÊÊ

ExamplesÊofÊQualifyingÊEventsÊinclude,ÊbutÊareÊnotÊlimitedÊto:

· Marriage

· DivorceÊ

· Birth,Êadop�on,ÊorÊlegalÊcustodyÊofÊaÊdependentÊchild

· LossÊofÊotherÊgroupÊinsuranceÊcoverage

· Death

· Spouse’sÊopenÊenrollment

If you experience a Qualifying Event for marriage or adding a child and want to make a change, you must do so using Oracle Self-Service and you must also submit any required documents to the Benefits Division within 30 days of the event. Examples of required documents include marriage certificates, birth certificates, etc. For all other qualifying events please contact the Benefits Office directly. Any notification and or certifications received after 30 days of life event you and your dependents will be ineligible for enrollments and changes.

Your Responsibility

BeforeÊ youÊenroll,ÊmakeÊ sureÊ youÊunderstandÊ theÊplan(s)Ê andÊaskÊ anyÊques�onsÊ youÊmayÊhave.ÊA�erÊ youÊenroll,Ê checkÊyourÊfirstÊpaycheckÊ stubÊ toÊmakeÊ sureÊ thatÊ theÊ correctÊ amountÊ isÊ beingÊdeductedÊandÊallÊ theÊbenefitsÊ youÊ electedÊareÊincluded.ÊÊAlsoÊverifyÊthatÊallÊbeneficiaryÊinforma�onÊisÊupÊtoÊdate.

OPEN ENROLLMENT INFORMATION

February 13th — February 28th The 2023 Benefits Guide is also available online!

An Open Enrollment presentation is available on the City’s Intranet, Internet, or as a link in city email from the Benefits Division.

Carefully review open enrollment information at www.stpete.org/benefits. You can access the City website from your work or home computer, tablet, or smartphone. If you have questions or need assistance contact the Benefits Division.

All required documents, including birth certificates, marriage certificates, and Age 26 and Over Forms must be submitted to the Benefits Division no later than March 10, 2023. Also, a valid Social Security Number must be provided for each covered dependent.

City’s Life Insurance

The Supplemental Life Insurance Medical History Statement form required for Evidence of Insurability can be found on the city’s intranet. You must complete this form if you or your dependent (s) do not have current supplemental coverage through TheStandard or are electing an increase in coverage. Submit the completed form(s) to TheStandard by emailing to MUSC@standard.com, faxing to (971) 321-5996, or mailing to the ad-dress on the form by March 10, 2023.

Flexible Spending Accounts (FSA)

You must re-enroll n FSA and make your annual contribution election in Oracle Self-Service each plan year.

Your current elections will NOT be carried over into the 2023 plan year.

Beneficiary Designation

Make sure to review and update your Beneficiaries : Benefits, Pension, Deferred Comp. and Roth

Open Enrollment Signup Sessions Location Time Monday February 13th MSC Building (CR800) 2:00 p.m. - 4:00 p.m.

Friday February 17th PD Employees Only 2:00 p.m. - 4:00 p.m.

Thursday February 16th Sanitation 12:30 p.m. - 5:30 p.m.

Wednesday February 22nd Fire 9:00 a.m. - 11:00 a.m.

Friday February 24th Water Resources

(Classroom A) 9:00 a.m. - 12:00 p.m.

Tuesday February 28th MSC Building (CR800) 8:00 a.m. - 5:00 p.m. Last Day

City of St. Petersburg

Health and Wellness Center

TheÊCityÊofÊSt.ÊPetersburgÊHealthÊ&ÊWellnessÊCenter,ÊoffersÊallÊeligibleÊemployeesÊaÊfull-serviceÊprimaryÊcareÊ facilityÊ ledÊ byÊ Dr.Ê IsraelÊ Wojnowich,Ê aÊ Board-CertifiedÊ FamilyÊ PracticeÊ Physician.Ê Ê ServicesÊ providedÊ atÊ theÊ Center,ÊincludingÊtheÊdispensingÊofÊcertainÊprescriptionÊdrugs,ÊisÊprovidedÊatÊNOÊCOST.

Dependents age 14 and over must be covered by the City’s Group Medical Plan in order to use the Wellness Center.

Note: AnyÊservicesÊprovidedÊoutsideÊtheÊcenterÊdueÊtoÊaÊreferralÊareÊsubjectÊtoÊapplicableÊcopays,Ê deduc�bles,ÊandÊco-insurance.

Bayfront Health MyChart

CommunicateÊ withÊ yourÊ doctor.Ê StayÊ connectedÊ toÊ yourÊ healthcareÊ withÊ BayfrontÊ HealthÊ St.Ê PetersburgÊ MyChart.Ê ManageÊ appointments,Ê accessÊ testÊ results,Ê requestÊ prescrip�onÊ refills—forÊ yourselfÊ andÊ yourÊ approvedÊappointees.ÊÊSignÊupÊforÊMyChartÊbyÊvisi�ngÊh�ps://mychart.bayfrontstpete.com

Ê ToÊscheduleÊyourÊappointmentÊcallÊ(727) 553-7474.ÊÊ

HoursÊofÊOpera�on:ÊMonday—FridayÊ8:00ÊamÊtoÊ5:00Êpm.ÊClosedÊdailyÊfromÊ12:00pm-1:00pmÊforÊlunch.Ê The Health and Wellness Center is located at: 603 7th St. Suite 350 St. Petersburg, FL 33701.

MEDICAL PLAN FEATURES

UnitedHealthcare Virtual Visits (Must be enrolled in one of the medical plans)

AÊvirtualÊvisitÊletsÊyouÊseeÊandÊtalkÊtoÊaÊdoctorÊfromÊtheÊcomfortÊofÊyourÊhomeÊorÊofficeÊwithoutÊanÊappointment.ÊÊVirtualÊ visitsÊareÊdesignedÊtoÊprovideÊtreatmentÊforÊnon-emergencyÊmedicalÊcondi�ons.ÊÊAppointmentsÊcanÊtakeÊplaceÊbyÊmobileÊ deviceÊorÊcomputer.ÊMostÊvisitsÊtakeÊaboutÊ10-15Êminutes.ÊÊDoctorsÊcanÊalsoÊwriteÊprescrip�ons,ÊifÊneeded,ÊforÊpickÊupÊatÊ yourÊ localÊ pharmacy.Ê VirtualÊ visitsÊ areÊ administeredÊ byÊ UnitedHealthcare.Ê PrimaryÊ careÊ copaysÊ apply.Ê ToÊ learnÊmoreÊ aboutÊVirtualÊVisits,ÊgoÊtoÊwww.uhc.com/virtualvisits.

Nurseline (Provided by UHC)

ConnectsÊyouÊtoÊaÊRegisteredÊNurseÊ24Êhours/7daysÊaÊweekÊbyÊcalling:Ê1-877-365-7949. Nurseline can:

▪AssistÊinÊmanagingÊaÊchronicÊcondi�onÊandÊassessingÊtreatmentÊop�ons

▪Iden�fyÊUnitedHealthÊPremium®Êdesigna�onÊprogramÊprovidersÊandÊhelpÊscheduleÊappointments

▪ProvideÊcoachingÊÊonÊmedica�onÊadherence,ÊdrugÊinterac�onsÊorÊmedica�onÊalterna�ves

▪Preven�veÊcareÊinforma�onÊandÊhealthyÊlifestyleÊcoaching

Lab Tests

LaboratoryÊ testsÊ canÊbeÊcompletedÊatÊ aÊ LabCorpÊ ÊorÊQuestÊDiagnos�csÊ facility.Ê Ê ToÊfindÊaÊ facilityÊvisitÊ labcorp.comÊ orÊ questdiagnos�cs.com.ÊÊ

UHC Premium Program ®

Iden�fiesÊin-networkÊdoctorsÊandÊhospitalsÊwhoÊdemonstrateÊadherenceÊtoÊqualityÊandÊcostÊefficiencyÊstandardsÊbasedÊonÊ evidence-basedÊmedicine.ÊÊAÊpremium-designatedÊdoctorÊwillÊhaveÊaÊlowerÊcopayÊthanÊotherÊspecialists.Ê

Health4Me® Mobile Applica�on

WhetherÊ youÊ areÊ travelingÊ orÊ justÊ awayÊ fromÊ home,Ê theÊ Health4MeÊ appÊ keepsÊ yourÊ healthÊ informa�onÊwithinÊ reach,Ê whereverÊyouÊgo.ÊÊTheÊwww.myuhc.comÊmobileÊappÊ-ÊmakesÊitÊeasierÊtoÊmanageÊyourÊUnitedHealthcareÊhealthÊplan.ÊÊUseÊ theÊappÊtoÊfindÊaÊdoctor,ÊaccessÊyourÊIDÊcard,ÊviewÊclaims,ÊfindÊpharmacies,ÊandÊfillÊprescrip�ons.ÊÊDownloadÊforÊfreeÊonÊ theÊAppleÊiTunesÊAppÊStore®Êand/orÊtheÊAndroid®ÊMarket.ÊÊ

MEDICAL PLAN FEATURES

Healthcare Cost Es�mator Tool

AccessÊ theÊ UHCÊ costÊ es�matorÊ toolÊ atÊwww.myuhc.comÊ orÊ onÊ theÊ Health4MeÊ app.Ê ThisÊ toolÊ allowsÊ youÊ toÊ researchÊtheÊcareÊyouÊneedÊandÊgetÊanÊaverageÊcostÊes�mateÊforÊmedicalÊservices.ÊÊYouÊcanÊcompareÊdifferentÊ networkÊprovidersÊinÊtermsÊofÊcostÊandÊqualityÊandÊgetÊaÊpersonalizedÊoutÊofÊpocketÊcostÊes�mate.Ê

Mail Order Pharmacy

YouÊcanÊorderÊupÊtoÊaÊ three-monthÊsupplyÊofÊmedica�onÊthatÊyouÊtakeÊregularlyÊandÊgetÊ itÊdeliveredÊrightÊ toÊ yourÊhome.ÊÊThisÊnotÊonlyÊsavesÊyouÊaÊtripÊtoÊtheÊpharmacyÊbutÊyouÊwillÊusuallyÊseeÊaÊsavingsÊonÊyourÊout-of-pocketÊ costs.Ê Ê UseÊ theÊ Health4MeÊ app,Ê goÊ toÊwww.myuhc.comÊ orÊ callÊ theÊ numberÊ onÊ yourÊ IDÊ cardÊ toÊ getÊ started.ÊÊ

Prescrip�on Drug List (PDL)

AÊ prescrip�onÊ drugÊ listÊ (PDL)Ê isÊ aÊ listÊ ofÊ allÊ medica�on,Ê organizedÊ intoÊ costÊ levels,Ê calledÊ �ers.Ê Ê NotÊ allÊ prescrip�onÊdrugsÊareÊcovered;ÊcheckÊtheÊPDLÊtoÊfindÊtheÊmedica�onsÊcoveredÊbyÊyourÊbenefitÊplan.ÊÊ

LookÊatÊ theÊPDLÊwithÊyourÊdoctorÊ toÊreviewÊcostsÊandÊanyÊapprovalsÊyouÊmightÊneedÊtoÊgetÊ fromÊyourÊhealthÊ planÊtoÊfillÊyourÊprescrip�ons.ÊÊYouÊcanÊtalkÊtoÊyourÊdoctorÊaboutÊlowerÊcostÊop�onsÊifÊaÊcertainÊmedica�onÊdoesÊ notÊfitÊyourÊbudget.Ê ÊChangesÊtoÊtheÊPDLÊcanÊhappen,ÊsoÊbeÊsureÊtoÊcheckÊitÊo�enÊtoÊmakeÊsureÊyouÊhaveÊtheÊ mostÊ upÊ toÊ dateÊ informa�on.Ê Ê YouÊ canÊ findÊ theÊ PDLÊ underÊ theÊ PharmaciesÊ &Ê Prescrip�onsÊ sec�onÊ ofÊ www.myuhc.com.ÊÊÊ

In & Out-of-Network Benefits

IfÊyouÊenrollÊinÊtheÊChoiceÊPlus,ÊChoiceÊHDPÊorÊHDPÊBasicÊplansÊyouÊmayÊuseÊout-of-networkÊprovidersÊforÊcare.ÊÊ However,ÊkeepÊinÊmindÊthatÊyouÊwillÊtypicallyÊpayÊhigherÊcostsÊforÊout-of-networkÊcare.ÊÊYourÊcareÊisÊalsoÊsubjectÊ toÊbalanceÊbilling.ÊÊBalanceÊbillingÊisÊwhenÊyouÊareÊresponsibleÊforÊout-of-networkÊchargesÊgreaterÊthanÊtheÊUHCÊ allowableÊ amount.Ê Ê AnÊ out-of-networkÊ providerÊ canÊ chargeÊ youÊ overÊ andÊ aboveÊ whatÊ UHCÊ considersÊ theirÊ allowableÊamount.ÊÊWhenÊpossibleÊseekÊcareÊinÊtheÊUHCÊnetwork.

MEDICAL PLAN OVERVIEW

TheÊCityÊofÊSt.ÊPetersburgÊisÊprovidingÊfourÊ(4)ÊplanÊop�onsÊthroughÊUnitedHealthcare.ÊÊTheÊplansÊofferedÊareÊtheÊChoiceÊ HighÊDeduc�bleÊPlanÊ(HDP)ÊwithÊHRA,ÊÊtheÊHighÊDeduc�bleÊPlanÊ(BasicÊPlan),ÊtheÊChoiceÊEPOÊandÊtheÊChoiceÊPlusÊPPOÊ Plan.Ê

TheÊChoiceÊEPOÊPlanÊ isÊanÊin-networkÊonlyÊplan.Ê ÊByÊusingÊ In-networkÊproviders,ÊyouÊmayÊhaveÊaÊgreaterÊcoverageÊofÊ benefitsÊandÊlowerÊout-of-pocketÊexpenses.

YouÊcanÊlocateÊaÊphysicianÊbyÊvisi�ngÊUHC’sÊwebsiteÊatÊwww.myuhc.comÊorÊyouÊcanÊcontactÊUnitedHealthcareÊmemberÊÊ services.ÊÊToÊreviewÊtheÊcoveredÊlistÊofÊprescrip�onÊmedica�ons,ÊpleaseÊlogÊonÊtoÊwww.myuhc.com.Ê

Explana�on of Plan Year Deduc�ble and Plan Year Out-of-Pocket Maximum Plan Year Deduc�ble

TheÊPlanÊYearÊDeduc�bleÊisÊaÊspecifiedÊdollarÊamountÊthatÊyouÊmustÊpayÊifÊyouÊuseÊcertainÊcoveredÊservices.ÊTheÊplanÊ deduc�bleÊresetsÊeveryÊyear.ÊÊThereÊareÊindividualÊandÊfamilyÊdeduc�bles. ÊOnceÊanÊindividualÊorÊaÊfamilyÊdeduc�bleÊhasÊ beenÊsa�sfied,ÊcoinsuranceÊand/orÊcopaysÊmayÊapply.Ê ÊCoinsuranceÊisÊyourÊshareÊofÊtheÊcostsÊofÊaÊhealthÊcareÊserviceÊ andÊitÊisÊtheÊamountÊyouÊpayÊa�erÊtheÊdeduc�bleÊhasÊbeenÊmet.ÊÊ

Plan Year Out-of-Pocket Maximum

TheÊPlanÊYearÊOut-of-PocketÊMaximumÊisÊtheÊtotalÊamountÊofÊcoveredÊexpenses,Ê (includingÊdeduc�bles,Êcoinsurance,Ê andÊcopayments)ÊpaidÊbyÊyou,ÊeitherÊindividuallyÊorÊcombinedÊasÊaÊcoveredÊfamily. Ê

A�erÊtheÊ individualÊand/orÊ familyÊout-of-pocketÊmaximumÊhasÊbeenÊsa�sfiedÊ inÊaÊplanÊyear,ÊpaymentÊ forÊ in-networkÊ coveredÊservicesÊÊforÊtheÊcoveredÊindividual/familyÊwillÊbeÊpayableÊbyÊtheÊplanÊatÊtheÊrateÊofÊ100%ÊforÊtheÊremainderÊofÊ theÊplanÊyear,ÊsubjectÊtoÊanyÊotherÊterms,Êlimita�ons,ÊandÊexclusions.

HEALTH REIMBURSEMENT ACCOUNT

IfÊyouÊenrolledÊinÊtheÊChoiceÊHDPÊyouÊwillÊalsoÊhaveÊaÊHealth Reimbursement Account.ÊTheÊHealthÊReimbursementÊ AccountÊ isÊ fundedÊ byÊ theÊ CityÊ toÊ helpÊ offsetÊ yourÊ out-of-pocketÊ medicalÊ costs.ÊÊ ThereÊ isÊ noÊ requirementÊ thatÊ theÊ accountÊbeÊpre-fundedÊandÊtheÊfundsÊremainÊinÊcontrolÊofÊtheÊCityÊun�lÊanÊeligibleÊreimbursementÊclaimÊisÊsubmi�ed.ÊÊ YourÊaccountÊwillÊautoma�callyÊbeÊfundedÊwithÊ$250ÊeachÊplanÊyear.ÊÊWhenÊyouÊareÊenrolledÊinÊtheÊChoiceÊHDP,ÊyouÊ canÊincreaseÊtheÊfundingÊbyÊcomple�ngÊwellnessÊac�vi�esÊasÊfollows:

* Taking a Health Risk Assessment (Rally Health Survey) at www.myuhc.com or via the Wellness Portal at cospwellness.mycernerwellness.com = $125

* Receive a Biometric Screening by your physician or at the Wellness Center and submit the biometric comple�on form to the Benefits Office = $200

* A�est to being tobacco free and submit a form to the Benefits Office = $125

* All forms can be found on the City Intranet.

All forms must be completed and submi�ed to Benefits by 12/31/2023, to receive funds for The 2023 Plan Year.

IfÊyouÊhaveÊaÊdependentÊcoveredÊunderÊtheÊChoiceÊHDPÊaddi�onalÊwellnessÊincen�veÊdollarsÊcanÊbeÊearned.ÊÊ

TheÊmaximumÊcontribu�onÊforÊanÊemployeeÊwithÊsingleÊcoverageÊ isÊ$700,ÊandÊforÊanÊemployeeÊwithÊemployeeÊandÊ spouseÊ orÊ childÊ coverage,Ê theÊ maximumÊ amountÊ isÊ $1,150Ê (onlyÊ spousesÊ areÊ requiredÊ toÊ completeÊ theÊ wellnessÊ ac�vi�es).Ê

FundsÊcanÊbeÊusedÊtoÊoffsetÊanyÊdeduc�blesÊandÊcoinsuranceÊyouÊareÊresponsibleÊfor.Ê Ê IfÊyouÊdoÊnotÊuseÊallÊofÊyourÊ HRAÊ fundsÊ inÊ theÊ planÊ year,Ê fundsÊwillÊ rolloverÊ upÊ toÊ aÊmaximumÊ ofÊ $2,300Ê ($700Ê forÊ youÊ andÊ $450Ê forÊ coveredÊ dependent).ÊÊ

SeeÊ“UnderstandingÊtheÊChoiceÊHDP“ÊbrochureÊforÊdetails.ÊÊThe HRA only applies to the Choice HDP Plan

MEDICAL BENEFITS

High Deduc�ble Plan (Basic) Total Premium

Single $557.17

Two Person $1,197.93

Family $1,576.81

City Contribu�on

$417.88

$898.45

$1,182.61

Monthly Employee Deduc�on

$139.29

$299.48

$394.20

COBRA

Premium

$568.31

$1,221.89

$1,608.35

Twice Monthly Employee Deduc�on

$69.65

$149.74

$197.10

Benefit Details High Deduc�ble Plan (Basic)

Network Access In-Network Out-of-Network

Plan Year Deduc�bles (PYD) Your Responsibility

Individual / Family $5,000 / $10,000 $15,000 / $30,000

Your Benefit Plan Details Your Responsibility

Coinsurance (when applicable) 0% 30%

Individual / Family Out-Of-Pocket Maximum* $5,000 / $10,000 $15,000 / $30,000

Professional Services

PrimaryÊCareÊPhysicianÊ(PCP)ÊOfficeÊVisitsÊ 0%ÊA�erÊPYD 30%ÊA�erÊPYD

SpecialistÊOfficeÊVisitsÊ 0%ÊA�erÊPYD 30%ÊA�erÊPYD

Preven�veÊCareÊVisitsÊ No Charge 30%ÊA�erÊPYD

Hospital Services

Inpa�entÊHospitaliza�onÊ/ÊOutpa�entÊHospitaliza�onÊ 0%ÊA�erÊPYD 30%ÊA�erÊPYD

Urgent Care Center 0%ÊA�erÊPYD 30%ÊA�erÊPYD

EmergencyÊRoomÊ(copayÊwaivedÊifÊadmi�ed) 0%ÊA�erÊIn-NetworkÊPYD

Independent Lab/ X-Ray, MRI, MRA, CT & PET Scans 0%ÊA�erÊPYD 30%ÊA�erÊPYD

Pharmacy

AnnualÊRxÊDeduc�ble N/A N/A

Tier 1 0%ÊA�erÊPYD 30%

Tier 2 0%ÊA�erÊPYD 30%

Tier 3 0%ÊA�erÊPYD 30%

SpecialtyÊDrugs 0%ÊA�erÊPYD 30%

MailÊOrderÊPharmacyÊ(90ÊDayÊSupply) 0%ÊA�erÊPYD 30%

*Out-of-Pocket Maximum includes Plan Year Deduc�ble (PYD), Copays, Coinsurance and Rx.

(24) PAYROLL DEDUCTIONS - EFFECTIVE 4/1/2023

MEDICAL BENEFITS ** Consult page 11 for addi�onal informa�on regarding the Health Reimbursement

BBeenneefifittÊÊDDeettaaiillss CChhooiicceeÊÊHHiigghhÊÊDDeedduucc��bbbblleeÊÊPPllaannÊÊ((HHDDPPÊÊwwiitthhÊÊHHRRAA))**

NetworkÊAccessÊ IInn--NNeettwwoorrkk OOuutt--ooff--NNeettwwoorrkk

PPllaannÊÊYYeeaarrÊÊDDeedduucc��bbbblleessÊÊÊÊ((PPYYDD YYoouurrÊÊRReessppoonnssiibbiilliittyyÊÊ

IndividualÊ/ÊFamilyÊ $1,750Ê/Ê$3,500 $3,500Ê/Ê$7,000

YYoouurrÊÊBBeenneefifittÊÊPPllaannÊÊDDeettaaiillss YYoouurrÊÊRReessppoonnssiibbiilliittyyÊÊ

CoinsuranceÊ(whenÊapplicable)Ê 10% 30%

IndividualÊ/ÊFamilyÊOut-Of-PocketÊMaximum** $3,500Ê/Ê$7,000 $7,000Ê/Ê$14,000

PPrrooffeessssiioonnaallÊÊSSeerrvviicceess

PrimaryÊCareÊPhysicianÊ(PCP)ÊOfficeÊVisitsÊ $25ÊCopay 30%ÊA�erÊPYDÊ

SpecialistÊOfficeÊVisitsÊ $35ÊCopayÊ-ÊÊPremiumÊDesignatedÊ

Provider Ê$45ÊCopayÊ-ÊOther

30%ÊA�erÊPYD

Preven�veÊCareÊVisitsÊ NoÊChargeÊ 30%ÊA�erÊDed

HHoossppiittaallÊÊSSeerrvviicceessÊÊ

Inpa�entÊHospitaliza�onÊ $300ÊCopayÊperÊdayÊupÊtoÊ5ÊdaysÊ thenÊ10%ÊA�erÊPYD

$300ÊCopayÊperÊdayÊupÊtoÊ5ÊdaysÊ thenÊ30%ÊA�erÊPYD

Outpa�entÊHospitaliza�onÊ 10%ÊA�erÊPYD 30%ÊA�erÊPYD

UrgentÊCareÊCenterÊ $50ÊCopayÊA�erÊPYD 30%ÊA�erÊPYD

EmergencyÊRoomÊ(copayÊwaivedÊifÊadmi�ed) $250ÊCopayÊA�erÊPYD

IndependentÊLab/ÊX-Ray,ÊMRI,ÊÊMRA,ÊCTÊ&ÊPETÊScans 10%ÊA�erÊPYD 30%ÊA�erÊPYDÊ

PPhhaarrmmaaccyy

AnnualÊRxÊDeduc�ble $200ÊIndividual/$400ÊFamilyÊÊ

TierÊ1 $15ÊCopay $15ÊCopay

TierÊ2 $35ÊA�erÊRxÊDed $35ÊA�erÊRxÊDed

TierÊ3Ê $50ÊA�erÊRxÊDed $50ÊA�erÊRxÊDed

SpecialtyÊDrugs 25%ÊA�erÊRxÊDed N/A

MailÊOrderÊPharmacyÊ(90ÊDayÊSupply) $45/$105/$150Ê (TierÊ2ÊandÊ3ÊCopayÊA�erÊRxÊDed) NotÊCoveredÊ

Choice High Deduc�ble Plan Total Premium

Single $701.75

Two Person $1,508.78

Family $1,985.99

City Contribu�on

$526.31

$1,131.59

$1,489.49

Monthly Employee Deduc�on

$175.44

$377.19

$496.50

COBRA

Premium

$715.79

$1,538.96

$2,025.71

Twice Monthly Employee Deduc�on

$87.72

$188.60

$248.25

MEDICAL BENEFITS

Benefit Details Choice EPO

NetworkÊAccessÊ In-Network

Plan Year Deduc�bles (PYD) Your Responsibility

IndividualÊ/ÊFamily $750Ê/Ê$1,500

Your Benefit Plan Details Your Responsibility

CoinsuranceÊ(whenÊapplicable)Ê 0%

IndividualÊ/ÊFamilyÊOut-Of-PocketÊMaximum1 $3,000Ê/Ê$6,000

Professional Services

PrimaryÊCareÊPhysicianÊ(PCP)ÊOfficeÊVisitsÊ $30ÊCopay

SpecialistÊOfficeÊVisitsÊ $35ÊCopayÊ-ÊPremiumÊÊÊDesignatedÊProviderÊ Ê$50ÊCopayÊ-ÊOther

Preven�veÊCareÊVisitsÊ NoÊCharge

Hospital Services

Inpa�entÊHospitaliza�onÊ $300ÊCopayÊperÊdayÊupÊtoÊ3ÊdaysÊA�erÊPYD

Outpa�entÊHospitaliza�onÊ 0%ÊA�erÊPYDÊ

UrgentÊCareÊCenterÊ $50ÊCopayÊA�erÊPYD

Emergency Room (copayÊwaivedÊifÊadmi�ed) $250ÊCopayÊA�erÊPYD

IndependentÊLab/ÊX-Ray NoÊChargeÊ

MRI,ÊÊMRA,ÊCTÊ&ÊPETÊScans 0%ÊA�erÊPYD

Pharmacy

AnnualÊRxÊDeduc�ble $200ÊIndividualÊ/Ê$400ÊFamilyÊ

TierÊ1 $15ÊCopay

TierÊ2 $35ÊA�erÊRxÊDed

TierÊ3Ê $50ÊA�erÊRxÊDed

SpecialtyÊDrugs 25%ÊA�erÊRxÊDed

MailÊOrderÊPharmacyÊ(90ÊDayÊSupply) $45/$105/$150Ê(TierÊ2ÊandÊ3ÊCopayÊA�erÊRxÊDed)

Choice EPO Total Premium

Single $814.79

Two Person $1,751.81

Family $2,305.85

City Contribu�on

$611.09

$1,313.86

$1,729.39

Monthly Employee Deduc�on

$203.70

$437.95

$576.46

COBRA

Premium

$831.09

$1,786.85

$2,351.97

Twice Monthly Employee Deduc�on

$101.85

$218.96

$288.23

MEDICAL BENEFITS

Benefit Details Choice Plus (PPO)

NetworkÊAccessÊ In-Network Out-of-Network

Plan Year Deduc�bles (PYD) Your Responsibility

IndividualÊ/ÊFamily $750Ê/Ê$1,500 $1,500Ê/Ê$3,000

Your Benefit Plan Details Your Responsibility

CoinsuranceÊ(whenÊapplicable)Ê 10% 30%

IndividualÊ/ÊFamilyÊOut-Of-PocketÊMaximum1 $3,000Ê/Ê$6,000 $6,000Ê/Ê$12,000

Professional Services

PrimaryÊCareÊPhysicianÊ(PCP)ÊOfficeÊVisitsÊ $30ÊCopay 30%ÊA�erÊPYDÊ

SpecialistÊOfficeÊVisitsÊ $35ÊCopayÊ-ÊPremiumÊDesignatedÊ

ProviderÊ Ê$50ÊCopayÊ-ÊOther

30%ÊA�erÊPYD

Preven�veÊCareÊVisitsÊ NoÊChargeÊ 30%ÊA�erÊPYD

Hospital Services

Inpa�entÊHospitaliza�onÊ $300ÊCopayÊperÊdayÊupÊtoÊ3ÊdaysÊ thenÊ10%ÊA�erÊPYD

$300ÊCopayÊperÊdayÊupÊtoÊ3ÊdaysÊ thenÊ30%ÊA�erÊPYD

Outpa�entÊHospitaliza�onÊ 10%ÊA�erÊPYD 30%ÊA�erÊPYD

UrgentÊCareÊCenterÊ $50ÊCopayÊA�erÊPYD 30%ÊA�erÊPYD

Emergency Room (copayÊwaivedÊifÊadmi�ed) $250ÊCopayÊA�erÊPYD

IndependentÊLab/ÊX-Ray,ÊMRI,ÊÊMRA,ÊCTÊ&ÊPETÊScans 10%ÊA�erÊPYD 30%ÊA�erÊPYDÊ

Pharmacy

AnnualÊRxÊDeduc�ble $200ÊIndividualÊ/Ê$400ÊFamilyÊÊ

TierÊ1 $15ÊCopay $15ÊCopay

TierÊ2 $35ÊA�erÊRxÊDed $35ÊA�erÊRxÊDed

TierÊ3Ê $50ÊA�erÊRxÊDed $50ÊA�erÊRxÊDed

SpecialtyÊDrugs 25%ÊA�erÊRxÊDed N/A

MailÊOrderÊPharmacyÊ(90ÊDayÊSupply) $45/$105/$150Ê (TierÊ2ÊandÊ3ÊCopayÊA�erÊRxÊDed)

NotÊCoveredÊ

Choice Plus Plan Total Premium

Single $901.87

Two Person $1,821.84

Family $2,525.35

City Contribu�on

$676.40

$1,366.38

$1,894.01

Monthly Employee Deduc�on

$225.47

$455.46

$631.34

COBRA

Premium

$919.91

$1,858.28

$2,575.86

Twice Monthly Employee Deduc�on

$112.74

$227.73

$315.67

DENTAL BENEFITS

HumanaÊ isÊourÊexclusiveÊdentalÊcarrier.Ê ÊYouÊwillÊhaveÊaÊchoiceÊofÊelec�ngÊtheÊDHMOÊorÊPPOÊPlan.Ê ÊTheÊDHMOÊplanÊoffersÊ In- NetworkÊcoverageÊonlyÊandÊrequiresÊyouÊtoÊselect a Primary Care den�st.ÊÊ

TheÊ PPOÊplanÊ providesÊ bothÊ In-NetworkÊ andÊOut-of-NetworkÊ coverage.Ê ÊWithÊ theÊ PPOÊPlan,Ê youÊminimizeÊ yourÊ out-of-pocketÊ expensesÊwhenÊyouÊseekÊcareÊfromÊaÊÊdentalÊproviderÊcontractedÊwithÊHumana.ÊPlan includes 3 rou�ne cleanings per calendar year and white composite fillings are covered.

WhenÊyouÊchooseÊaÊden�stÊoutsideÊofÊtheÊHumanaÊPPOÊnetwork,ÊyourÊout-of-pocketÊcostsÊwillÊbeÊhigherÊandÊyouÊmayÊbeÊsubjectÊ toÊbalanceÊbilling*ÊforÊproviderÊfeesÊthatÊexceedÊtheÊcontractedÊamountÊallowedÊbyÊHumana.ÊÊYouÊcanÊlocateÊIn-NetworkÊdentalÊ providersÊ byÊ callingÊ (800) 979-4760 orÊ byÊ visi�ngÊ Êwww.humana.com.Ê Ê IfÊ youÊ didÊ notÊ enrollÊ inÊ theÊ PPOÊplanÊwhenÊ youÊwereÊ ini�allyÊeligible,ÊyouÊareÊconsideredÊtoÊbeÊaÊlateÊentrantÊandÊthereÊwillÊbeÊaÊ12ÊmonthÊwai�ngÊperiodÊforÊBasicÊandÊMajorÊservices.ÊÊ

*The DHMO HS195 requires a facility code be entered into Oracle Self-Service upon ini�al enrollment.

Plan Type DHMO * PPO

Network Access In-Network In-Network Out-of-Network*

N/A UnlimitedÊ

Your Responsibility Your Responsibility Your Responsibility

ÊÊÊIndividualÊ/ÊFamilyÊDeduc�ble NÊ/ÊA $50Ê/Ê$150Ê

Dental Descrip�on

ÊÊÊPreven�ve-ClassÊI SeeÊScheduleÊofÊBenefits NoÊCharge Ê10%

ÊÊÊBasic-ClassÊII SeeÊScheduleÊofÊBenefitsÊ 15%ÊA�erÊPYD 30%ÊA�erÊPYD

ÊÊÊMajor-ClassÊIII SeeÊScheduleÊofÊBenefitsÊ 45%ÊA�erÊPYD 50%ÊA�erÊPYD

Orthodon�a ChildrenÊtoÊ19ÊyearsÊ

ÊÊÊBenefitÊÊÊÊ ChildÊ/ÊAdult:Ê

$2,185Ê+ÊmonthlyÊ adjustmentÊfeesÊ

BenefitÊ50%Ê/ÊLife�meÊMax:Ê$2,000Ê

Plan Year Maximum (PYD) Exclusive of Orthodon�a

*OutÊofÊNetworkÊBenefitsÊsubjectÊtoÊBalanceÊBillingÊforÊchargesÊoverÊtheÊreimbursementÊscheduleÊ

DHMO Plan Total Premium Monthly

Twice Monthly Employee Deduc�on

DHMO - Single $15.46 $7.73

DHMO - Family $42.53 $21.27

DPPO - Single $27.56 $13.87

COBRA Premium

$15.77

$43.38

$28.11

DHMO - Two Person $27.05 $13.52 $27.59

DPPO Plan Total Premium

Monthly Twice Monthly Employee

Deduc�on COBRA Premium

DPPO - Family $90.20 $45.10 $92.00

DPPO - Two Person $58.42 $29.21 $59.59

VISION BENEFITS

YourÊvisionÊisÊimportantÊtoÊyourÊhealth.ÊWhetherÊyourÊvisionÊisÊ20/20ÊorÊlessÊthanÊperfect,ÊeveryoneÊneedsÊtoÊtakeÊgoodÊ careÊofÊtheirÊeyes.

TheÊHumanaÊvisionÊBasicÊandÊHighÊPlansÊareÊbeingÊofferedÊasÊaÊpartÊofÊtheÊCityÊofÊStÊPetersburg’sÊcommitmentÊtoÊyourÊ well-being.Ê TheÊ HumanaÊ visionÊ plansÊ provideÊ affordableÊ qualityÊ visionÊ careÊ na�onwide.Ê ThroughÊ Humana’sÊ providerÊ network,Ê youÊ canÊ obtainÊ aÊ comprehensiveÊ rou�neÊ visionÊ examina�on,Ê asÊ wellÊ asÊ eyeglassesÊ (lensesÊ andÊ frames),Ê orÊ contactÊlenses.Ê

CarefullyÊreviewÊtheÊvisionÊcareÊplanÊsummaryÊprovidedÊandÊtakeÊadvantageÊofÊthisÊveryÊimportantÊbenefit.ÊYouÊcanÊcallÊ Humana’sÊCustomerÊServiceÊCenterÊatÊ1-877-398-2980 orÊvisitÊwww.humana.comÊ toÊanswerÊques�onsÊyouÊmayÊhaveÊ regardingÊcontractedÊprovidersÊandÊcoveredÊservices.

Plan Basic Plan

Network Access In-Network Out-of- Network

Rou�neÊEyeÊ ExamÊ

$0ÊÊCopay $30ÊAllowanceÊ

Frequency 12ÊMonths

VISION PAYROLL CONTRIBUTIONS

Basic Plan Total

Premium Monthly

Twice Monthly

Employee Deduc�on

COBRA

Premium

Basic - Single $0.92 $0.46 $0.94 Basic - Two Person $1.40 $0.70 $1.43

Basic - Family $2.33 $1.17 $2.38

High Plan Total

Premium Monthly

Twice Monthly

Employee Deduc�on

COBRA

Premium

High - Single $5.79 $2.90 $5.90

High - Family $15.42 $7.71 $15.73

Materials LensesÊÊÊÊÊÊÊ

DiscountsÊavailableÊthroughÊpar�cipa�ngÊ providersÊÊ

High - Two Person $11.53 $5.76 $11.76

Plan High Plan Network Access In-Network Out-of-

Network Rou�neÊEyeÊ ExamÊ $10ÊÊCopay $30ÊAllowanceÊ

Frequency 12ÊMonths

Materials Lenses

(StandardÊ Plas�c)

SingleÊVision $15ÊCopayÊ $25ÊAllowance

Bifocals $15ÊCopay $40ÊAllowanceÊ

Trifocals $15ÊCopayÊ $60ÊAllowance

Frequency 12ÊMonths

Frames

Frames $130ÊallowanceÊ $65ÊAllowanceÊ

Frequency 12ÊMonths

Contacts

Lenses $135ÊAllowanceÊ $104Ê AllowanceÊ

MedicallyÊ NecessaryÊ Contacts

NoÊCharge $200Ê AllowanceÊ

Frequency 12ÊMonths

(In Lieu of Glasses)

EMPLOYEE ASSISTANCE PROGRAM (EAP)

Administered by ComPsych

ThisÊprogramÊoffersÊyouÊprofessionalÊassistanceÊinÊdealingÊwithÊaÊvarietyÊofÊwork/lifeÊissues.ÊFromÊstressÊorÊ depressionÊtoÊlegalÊorÊfinancialÊissues,ÊtheÊCityÊofÊSt.ÊPetersburgÊEAPÊcanÊhelp!

TheÊpremiumÊforÊthisÊprogramÊisÊfullyÊpaidÊbyÊtheÊCityÊofÊSt.ÊPetersburgÊandÊavailableÊtoÊyouÊandÊyourÊdependentsÊ byÊcallingÊ1-888-327-5769Ê24ÊhoursÊaÊdayÊ/Ê7ÊdaysÊaÊweek.ÊYouÊcanÊalsoÊlogÊonÊonlineÊatÊ www.guidanceresources.comÊ(CompanyÊWebÊID:ÊSTPETE).

ServicesÊProvidedÊinclude:Ê

·General Counseling forÊ stress,Ê depression,Ê familyÊ issues,Ê substanceÊ abuse,Ê childÊ care,Ê workÊ lifeÊ services,Ê educa�onalÊresources,ÊmarriageÊcounselingÊandÊelderÊcareÊresourcesÊ

·WellnessÊassistanceÊforÊsmokingÊcessa�on,ÊweightÊlossÊandÊexerciseÊamongÊothers

·Financial Planning resourcesÊ suchÊ asÊ investmentÊ plans,Ê estateÊ planning,Ê debtÊ reduc�on,Ê re�rementÊ planning,Ê bankruptcy,ÊtaxÊsupport,ÊcollegeÊfundingÊandÊbudgetÊmanagement

·Legal Services includingÊreferralsÊandÊdiscountsÊforÊservicesÊsuchÊasÊcrea�ngÊorÊmodifyingÊaÊwill,ÊconsumerÊissues,Ê criminalÊma�ers,ÊlivingÊwills,ÊpowerÊofÊa�orney,Êsepara�onÊandÊdivorceÊandÊtrafficÊma�ers.ÊÊ

FLEXIBLE SPENDING ACCOUNTS (FSA) -

If you choose Flexible Spending Accounts, you must enroll in Oracle each plan year. Enrollments do not automa�cally roll over to subsequent plan years.

FlexibleÊSpendingÊAccountsÊhelpÊyouÊsaveÊmoneyÊfromÊyourÊpaycheckÊÊbyÊusingÊpre-taxÊcontribu�onsÊtoÊpayÊforÊcertainÊ eligibleÊhealthÊcareÊorÊdependentÊcareÊexpenses.Ê ÊYourÊcontribu�onsÊareÊdeductedÊbeforeÊFederalÊandÊSocialÊSecurityÊ taxesÊareÊwithheld.ÊYouÊwillÊbeÊreimbursedÊasÊclaimsÊforÊeligibleÊexpensesÊareÊsubmi�ed.ÊDependentÊCareÊclaimsÊmustÊ beÊsubmi�edÊasÊtheyÊareÊ incurredÊonlineÊatÊwww.ameriflex.comÊÊorÊyouÊmayÊcontactÊAmeriflexÊcustomerÊserviceÊwithÊ anyÊques�onsÊbyÊdialingÊ1-888-868-3539ÊorÊemailÊservice@myameriflex.com

Debit Card

IfÊyouÊenrollÊinÊtheÊHealthÊCareÊFSAÊyouÊwillÊreceiveÊaÊnewÊdebitÊcardÊfromÊourÊnewÊcarrierÊAmeriflexÊforÊtheÊ2023-2024Ê planÊyear.ÊÊ

FSAÊdebitÊcardsÊcanÊbeÊusedÊtoÊpayÊforÊeligibleÊexpensesÊwhenÊeligibleÊservicesÊareÊreceivedÊorÊpurchased.ÊForÊaÊlistÊofÊ eligibleÊexpensesÊpleaseÊvisitÊwww.FSAstore.comÊÊorÊscan the first QR code below.

YouÊ canÊ contributeÊ $300Ê -Ê $3,050Ê perÊ planÊ yearÊ toÊ yourÊHealthÊ CareÊ FSAÊ andÊ$600Ê -Ê $5,000Ê perÊ planÊ yearÊ ($2,500Ê ifÊ marriedÊandÊfilingÊseparateÊtaxÊreturns)ÊtoÊyouÊDependentÊCareÊFSAÊ($600Êminimum).ÊÊTheÊtotalÊamountÊyouÊdecideÊtoÊ contributeÊ isÊ deductedÊ overÊ theÊ numberÊofÊ payÊ periodsÊwithinÊ yourÊ enrollmentÊ planÊ year.Ê Ê BeÊ sureÊ toÊ es�mateÊ yourÊ yearlyÊ expensesÊ carefullyÊ toÊ determineÊ yourÊ contribu�onÊ amount.Ê Ê UnreimbursedÊ fundsÊ le�Ê inÊ theÊ DependentÊ CareÊ accountÊatÊtheÊendÊofÊtheÊyearÊareÊforfeited.ÊÊ

Health Care Account | Annual Contribu�on Limit: $3,050

TheÊHealthÊ CareÊ FSAÊ reimbursesÊ eligibleÊ healthcareÊexpensesÊ incurredÊ byÊ youÊorÊ yourÊ eligibleÊ dependentÊ (s).Ê EligibleÊ expensesÊincludeÊhealthÊcareÊexpenses,ÊdentalÊexpensesÊandÊvisionÊexpenses.ÊÊForÊaÊcompleteÊlis�ngÊofÊeligibleÊexpensesÊ seeÊ IRSÊPublica�onÊ502ÊatÊwww.irs.gov.Ê ÊYouÊmustÊu�lizeÊ theÊ fundsÊ inÊ theÊaccountÊduringÊtheÊplanÊyearÊ inÊwhichÊyouÊ contribute.Ê ÊYouÊareÊallowedÊ toÊcarryÊoverÊupÊtoÊ$610Ê inÊunusedÊ fundsÊ thisÊyear.Ê ÊAnythingÊunusedÊoverÊ$610ÊwillÊbeÊ forfeited.ÊÊÊScan the middle QR code for a FSA Presenta�on

Dependent Care Account | Annual Contribu�on Limit: $5,000

TheÊDependentÊCareÊFSAÊreimbursesÊforÊexpensesÊincurredÊforÊtheÊcareÊofÊaÊchildÊunder age 13,ÊaÊdisabledÊchildÊorÊanÊ elderÊdependentÊadult.ÊÊAÊpaidÊreceiptÊwithÊtheÊcaregiver’sÊnameÊandÊdatesÊofÊserviceÊisÊrequired.ÊEligibleÊforÊdayÊcareÊ centers,ÊelderÊcareÊcenters,ÊnurseryÊschools,ÊsummerÊdayÊcamps,ÊandÊbefore-and-a�erÊschool.ÊÊThereÊisÊnoÊcarryÊoverÊforÊ unusedÊ dependentÊ careÊ amounts,Ê ifÊ amountÊ electedÊ isÊ notÊ usedÊ beforeÊ theÊ endÊ ofÊ theÊ planÊ yearÊ thoseÊ fundsÊ areÊ forfeited.ÊÊScan the last QR code for a Dependent Care Presenta�on

LIFE INSURANCE INCLUDING AD&D

Administered by The Standard TheÊCityÊofÊSt.ÊPetersburgÊautoma�callyÊprovidesÊallÊeligibleÊFull-�meÊemployeesÊwithÊBasicÊTermÊLifeÊ InsuranceÊandÊ AccidentalÊDeathÊ&ÊDismembermentÊ(AD&D)ÊasÊfollows:

Active Classified Employees $10,000

Professionals $20,000

Firefighters, Firefighter/Paramedics, Lieutenants, Fire Captain, Fire District Chiefs

1x Annual Salary rounded to the nearest $1,000

Police Sergeant, Police Lieutenant, Police Officers, Forensics Services Technicians & Latent Print Examiners

1x Annual Salary rounded to the nearest $1,000

Classification Amount of Insurance

Administrative Management $100,000

Elected Officials $100,000

WhileÊtheÊCityÊhasÊautoma�callyÊenrolledÊyouÊinÊtheÊLifeÊInsuranceÊplan,ÊpleaseÊmakeÊsureÊyouÊreviewÊandÊupdateÊyourÊÊÊÊÊÊÊÊÊÊÊÊÊÊÊ BeneficiariesÊinÊOracleÊSelf-Service.ÊÊYouÊmayÊupdateÊyourÊbeneficiaryÊinÊOracleÊSelf-ServiceÊatÊanyÊ�me.ÊÊPleaseÊcontactÊ theÊBenefitsÊDivisionÊifÊnecessaryÊforÊques�onsÊpertainingÊtoÊenrollmentÊorÊbeneficiariesÊat:Ê727-893-7279.

Supplemental Life Insurance for You:

YouÊmayÊpurchaseÊsupplementalÊlifeÊinsuranceÊforÊyourself,Êspouse,ÊandÊchildrenÊwithÊtheÊop�onÊtoÊchooseÊfromÊthreeÊ differentÊlevelsÊofÊcoverageÊbasedÊonÊyourÊsalary.Ê Supplemental Life Insurance for Your Spouse:

EmployeesÊmayÊelectÊcoverageÊforÊspouseÊsupplementalÊlifeÊinsuranceÊinÊamountsÊofÊ$10,000, $25,000 or $50,000.ÊYouÊ mayÊelectÊcoverageÊforÊyourÊspouseÊprovidedÊthatÊyouÊapplyÊforÊandÊareÊapprovedÊ forÊsupplementalÊcoverageÊatÊleastÊ 2xÊyourÊspouse’sÊcoverage.

Supplemental Life Insurance for Your Child(ren):

YouÊmayÊcoverÊyourÊunmarriedÊdependentÊchildrenÊfromÊageÊsixÊmonthsÊtoÊageÊ20Ê(ageÊ25ÊifÊtheyÊareÊenrolledÊasÊaÊfull- �meÊstudent)ÊinÊtheÊamountÊofÊ$5,000 or $10,000.Ê YouÊmayÊelectÊcoverageÊforÊyourÊchild(ren)ÊprovidedÊthatÊyouÊapplyÊ forÊandÊareÊapprovedÊ forÊsupplementalÊcoverageÊ.

Evidence of Insurability (EOI):

AnÊ EOIÊ FormÊ isÊ requiredÊ forÊ supplementalÊ insuranceÊ purchasedÊ a�erÊ theÊ ini�alÊ eligibilityÊ periodÊ orÊ forÊ addi�onalÊ voluntaryÊcoverageÊpurchasedÊatÊaÊlaterÊdate.ÊÊTheÊEOIÊmustÊbeÊsubmi�edÊtoÊTheÊStandardÊLifeÊInsuranceÊCompanyÊforÊ approval.ÊÊYouÊcanÊfindÊtheÊformÊonÊtheÊCity’sÊIntranetÊsite.ÊÊEOIÊformsÊshouldÊbeÊmailedÊtoÊTheÊStandardÊat:Ê The Standard Insurance Company, Medical Underwri�ng 900 S.W. Fi�h Avenue Portland, OR 92704

Supplemental Accidental Death and Dismemberment Insurance (AD&D)

Supplemental Accidental Life Insurance for You: EmployeesÊmayÊpurchaseÊpersonalÊAD&DÊinsuranceÊcoverageÊfromÊ $25,000ÊtoÊ$300,000Ê(upÊtoÊaÊmaximumÊofÊ10xÊyourÊsalary).ÊÊYouÊmayÊalsoÊÊcoverÊyourÊSpouseÊandÊChildrenÊbyÊ choosingÊfamilyÊcoverage.ÊÊ

SUPPLEMENTAL LIFE INSURANCE RATES

Salary Range Low Op�on Monthly Cost

Medium Op�on

Monthly Cost

High Op�on Monthly Cost

$25,000 - 29,999 $25,000 $8.43 $50,000 $16.85 $75,000 $25.28

$30,000 - 34,999 $30,000 $10.11 $60,000 $20.22 $90,000 $30.33

$35,000 - 39,999 $35,000 $11.80 $70,000 $23.59 $105,000 $35.39

$40,000 - 44,999 $40,000 $13.48 $80,000 $26.96 $120,000 $40.44

$45,000 - 49,999 $45,000 $15.17 $90,000 $30.33 $135,000 $45.50

$50,000 or more $50,000 $16.85 $100,000 $33.70 $150,000 $50.55

Spouse $10,000 $2.58 $25,000 $6.45 $50,000 $12.90

Child $5,000 $0.70 N/A N/A $10,000 $1.40

Supplemental Accidental Death and Dismemberment Insurance (AD&D) Rates

Coverage Amount Employee Only Monthly Cost

Family Plan Monthly Cost

$25,000 $0.58 $0.88

$50,000 $1.15 $1.75

$75,000 $1.73 $2.63

$100,000 $2.30 $3.50

$125,000 $2.88 $4.38

$150,000 $3.45 $5.25

$175,000 $4.03 $6.13

$200,000 $4.60 $7.00

$225,000 $5.18 $7.88

$250,000 $5.75 $8.75

$275,000 $6.33 $9.63

$300,000 $6.90 $10.50

FREQUENTLY ASKED QUESTIONS & OTHER PROGRAMS

What is Open Enrollment and when are changes effec�ve? -ÊOpenÊEnrollmentÊisÊwhenÊyouÊcanÊmakeÊchangesÊtoÊyourÊ coverageÊforÊtheÊupcomingÊbenefitÊyearÊ(AprilÊ1,Ê2023ÊtoÊMarchÊ31,Ê2024).ÊÊDuringÊOpenÊEnrollmentÊyouÊmay,Ê1)ÊEnroll,Ê ifÊyouÊpreviouslyÊwaivedÊcoverage,Ê2)ÊCancelÊcoverage,Ê3)ÊAddÊorÊremoveÊdependents,Ê4)ÊChangeÊcoverageÊamountsÊforÊ SupplementalÊLifeÊAnd/orÊAD&DÊInsurance.Ê Ê(Evidence of Insurability form must be submi�ed to the Standard for request to increase the Supplemental Life coverage.)

You must make your elec�ons in Oracle Self-Services prior to the close of business on February 28,2023.

What do I need to Enroll? - YourÊOracleÊIDÊandÊPasswordÊareÊrequired.ÊÊIfÊyouÊdoÊnotÊknowÊyourÊpasswordÊandÊhaveÊaÊ CityÊe-mailÊaddress,ÊgoÊtoÊtheÊOracleÊE-BusinessÊSuiteÊLoginÊpageÊandÊclickÊonÊtheÊ“Forgot Username and Password” link andÊfollowÊtheÊprompts.ÊÊAÊnewÊpasswordÊwillÊbeÊe-mailedÊtoÊyou.ÊÊIfÊyouÊdoÊnotÊhaveÊaÊCityÊe-mailÊaddress,ÊcallÊ theÊDoTSÊHelpÊDeskÊatÊ727-893-7200ÊandÊrequestÊyourÊOracleÊpasswordÊbeÊreset.ÊÊTheÊHelpÊDeskÊmustÊspeakÊtoÊyouÊ andÊyouÊmustÊprovideÊÊ theÊ lastÊ fourÊdigitsÊofÊyourÊSocialÊ SecurityÊnumberÊandÊ theÊmonthÊandÊdayÊofÊyourÊbirthÊ forÊ verifica�on.ÊÊ I am going to re�re soon, what do I need to know? -ÊIfÊyouÊareÊplanningÊtoÊre�reÊbetweenÊAprilÊ1,Ê2023ÊandÊMarchÊ 31,Ê 2024,Ê thisÊopenÊenrollmentÊperiodÊ isÊ yourÊ lastÊ chanceÊ toÊ selectÊ theÊbenefitÊplansÊyouÊwillÊ takeÊ intoÊ re�rement.ÊÊ Re�reesÊdon’tÊhaveÊopenÊenrollmentÊperiodsÊbutÊcanÊmakeÊchangesÊifÊtheyÊhaveÊaÊqualifyingÊevent.ÊÊCurrently,Êre�reeÊ premiumsÊdifferÊforÊhealthÊandÊlifeÊinsuranceÊbutÊareÊtheÊsameÊforÊdental,ÊvisionÊandÊAD&D.ÊÊMoreÊinforma�onÊcanÊbeÊ foundÊinÊtheÊpublica�onÊ“Re�reeÊBenefitsÊLine”.ÊÊThisÊisÊavailableÊinÊtheÊBenefitsÊDivisionÊandÊcanÊalsoÊbeÊfoundÊonlineÊ atÊwww.stpete.org/retreebenefits.

Note:

▪A valid Social Security Number must be entered in Oracle Self-Service for each covered dependent.

▪If you wish to start or con�nue a Flexible Spending Account elec�on, you MUST enroll via Oracle Self-Service.Ê

▪All changes and new elec�ons must be entered in Oracle Self-Service no later than February 28, 2023.Ê

▪IfÊyouÊnewlyÊelectÊgroupÊhealthÊcoverageÊforÊaÊchildÊageÊ26ÊorÊover,ÊyouÊmustÊcompleteÊtheÊ“DependentÊChildÊAgeÊ26Ê orÊ overÊ -Ê Applica�onÊ forÊ Coverage”Ê form.Ê Ê AÊ separateÊ formÊ forÊ eachÊ childÊ isÊ required.Ê (VisitÊ theÊ internetÊ orÊÊÊÊÊÊ intranetÊsite)ÊtoÊprintÊtheÊform.ÊÊ

▪Required documents must be submi�ed to the Benefits Division by March 10, 2023.

I am a new enrollee, what do I do? - CollectÊ theÊ requiredÊ informa�onÊ suchÊ as:Ê SocialÊ SecurityÊ Numbers,Ê birthÊ cer�ficatesÊandÊmarriageÊcer�ficatesÊifÊapplicable,ÊandÊnamesÊofÊallÊdependentsÊalongÊwithÊyourÊOracleÊpassword.ÊÊUseÊ OracleÊSelf-ServiceÊtoÊselectÊyourÊbenefitsÊbeforeÊtheÊendÊofÊtheÊenrollmentÊperiodÊ(withinÊ30ÊdaysÊofÊyourÊdateÊofÊhireÊ forÊnewÊemployees)ÊÊandÊsubmitÊrequiredÊdocumenta�onÊtoÊtheÊBenefitsÊDivision,ÊwithinÊtheÊprescribedÊ�meÊframe.Ê What if I don’t want to make changes to my current coverage or covered benefits? - NoÊac�onÊisÊrequiredÊÊtoÊkeepÊ yourÊcurrentÊhealth,ÊdentalÊorÊvisionÊcoverage.ÊÊIf you have a Flexible Spending Account (FSA) and wish to par�cipate in 2023 or if you wish to enroll in the FSA for the first �me, you must enroll via Oracle Self-Service.ÊÊ ConfirmÊ yourÊ address,Ê maritalÊ status,Ê contactÊ informa�onÊ andÊ beneficiariesÊ inÊ OracleÊ Self-Service,Ê andÊ makeÊ anyÊ changesÊthatÊareÊnecessary.Ê ÊYouÊmayÊchangeÊpersonalÊ informa�onÊandÊbeneficiaryÊdesigna�onsÊatÊanyÊ�meÊduringÊ theÊyear.ÊÊ What documenta�on will be required to add dependents? - EligibleÊ dependentsÊ areÊ aÊ legalÊ spouseÊ andÊ natural,Ê adoptedÊorÊstepchildrenÊ(underÊtheÊageÊofÊ30ÊforÊgroupÊhealth;ÊunderÊageÊ26ÊforÊdental/vision).ÊÊ

For ChildrenÊ -Ê Verifica�onÊ ofÊ naturalÊ childrenÊ mustÊ indicateÊ youÊ asÊ theÊ parentÊ ofÊ theÊ child.Ê Ê ForÊ stepchildren,Ê verifica�onÊmustÊ indicateÊ yourÊ spouseÊ asÊ theÊ child’sÊ parent.Ê Ê AÊ birthÊ cer�ficateÊ (notÊ BirthÊ Registra�onÊ Card),Ê childÊ supportÊcourtÊorder,Êcourt-cer�fiedÊguardianshipÊpapersÊetc.ÊmayÊbeÊused.ÊÊ

Verifica�onÊofÊadoptedÊ/fosterÊchildrenÊmustÊbeÊbyÊofficialÊcourtÊdocumentsÊ indica�ngÊtheÊchildÊhasÊbeenÊplacedÊ inÊ yourÊhome.ÊÊ 22

FREQUENTLY ASKED QUESTIONS & OTHER PROGRAMS

For a SpouseÊ-ÊAnÊofficialÊmarriageÊcer�ficateÊmustÊbeÊprovidedÊtoÊtheÊBenefitsÊDivisionÊtoÊenrollÊyourÊspouse.ÊÊ

SocialÊSecurityÊNumbersÊmustÊbeÊinputÊviaÊOracleÊSelf-ServiceÊforÊallÊdependents.ÊÊ

How do I pay for my benefits?Ê-ÊWithÊtheÊCity’sÊPremiumÊPaymentÊPlan,ÊcostÊofÊbenefitsÊ(exceptÊforÊSpouseÊ/ÊChildren’sÊ LifeÊInsuranceÊandÊGroupÊHealthÊcoverageÊforÊnon-qualifyingÊdependents)ÊisÊpaidÊwithÊpre-taxÊdollars.ÊÊDeduc�onsÊwillÊ beÊtakenÊforÊ24ÊpayÊperiodsÊperÊyear.ÊExcep�on:ÊFlexibleÊSpendingÊAccountÊdeduc�onsÊareÊdeductedÊeachÊpayÊperiod.ÊÊ TheÊPremiumÊPaymentÊPlanÊisÊautoma�cÊwhenÊyouÊenroll,Êhowever,ÊifÊyouÊdoÊnotÊwishÊpremiumÊdeduc�onsÊtoÊbeÊmadeÊ pre-tax,ÊcallÊtheÊBenefitsÊDivisionÊatÊ727-893-7279.ÊÊ

Other Benefits

Florida 529 Savings Plan -ÊTheÊFloridaÊ529ÊSavingsÊPlanÊisÊaÊtax-advantagedÊplanÊdesignedÊtoÊencourageÊsavingÊforÊfutureÊ collegeÊcosts.ÊÊAÊcontribu�onÊamountÊofÊyourÊchoosingÊisÊdeducted,Êa�er-tax,ÊfromÊeachÊpaycheckÊandÊisÊinvestedÊinÊtheÊ availableÊ investmentÊ op�onsÊ thatÊ youÊ choose.Ê Contribu�onsÊ mayÊ beÊ started,Ê stoppedÊ orÊ changedÊ atÊ anyÊ �me.ÊÊ WithdrawalsÊmadeÊforÊqualifiedÊhigherÊeduca�onÊexpensesÊareÊtax-free.ÊÊRestric�onsÊandÊfeesÊapply,ÊcallÊ727-893-7304 forÊmoreÊinforma�on.ÊÊ

457 Deferred Compensa�on Plan -ÊTheÊCity’sÊ457ÊDeferredÊCompensa�onÊPlanÊisÊaÊwayÊforÊyouÊtoÊsaveÊforÊre�rement.ÊÊ Contribu�onsÊareÊdeductedÊonÊaÊpre-taxÊbasisÊfromÊyourÊpaycheck.ÊÊYouÊhaveÊaÊchoiceÊofÊseveralÊdifferentÊinvestmentÊ op�onsÊinÊwhichÊtoÊinvestÊyourÊcontribu�ons.ÊÊContribu�onsÊandÊearningsÊareÊtaxableÊwhenÊpaidÊoutÊofÊtheÊplan.ÊÊ

Contact your Pension Representa�ve for more informa�on and instruc�ons on how to enroll.

Last name begins with A-L: Steven Fyalkowski 727-893-7045 or steven.fyalkowski@stpete.org

Last name begins with M-Z: Sherri McLean 727-893-7044 or sherri.mclean@stpete.org

© 2019 Gallagher Benefit Services, Inc. All rights reserved. BG\GBS\TK8

This benefit summary prepared by

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