RFP_5800_SLW3030_ATT_3_v1.pdf

City of Austin 2026 Employee Benefits Guide Our Benefits Revolve Around You

IA. Austin Human Resources

Contact Information Benefits Guide Information Austin Human Resources Employee Eligibility Dependent Eligibility Dependent Documentation Coverage Information Qualifying Life Event

Medical Plans CDHP w/HSA Medical Plans Comparison Medical Plans - Pharmacy Mail Order Diabetic Bundling 24/7 NurseLine Virtual Visits - MD Live Dental Plan Orthodontia Treatment Vision Plan Flexible Spending Accounts (FSA) Disability Long Term Disability Worksheet

Table of Contents Group Term Life Insurance Supplement Life Insurance Worksheet Legal Insurance Plan Employee Wellness HealthyConnections

Additional Benefits Employee Assistance Program (EAP) Child Care Assistance Program Get There ATX Service Incentive Program Tuition Reimbursement Program Direct Deposit Affordable Small Dollar Loans Homebuyer Assistance Program Leave Programs Talent Strategy Workers’ Compensation Retirement Deferred Compensation (457 Plan) 2026 Per Pay Period Rates Contact Information Compliance Notices

Austin Human Resources Employee Benefits Division

Employee Benefits staff are available by phone or in person to discuss benefits questions. For your convenience, please make an appointment before visiting our office.

Phone Number: 512-974-3284 Email: Benefits.HRD@austintexas.gov Fax Number: 512-974-3420

Office Hours: Monday–Friday, 8:00 a.m.–5:00 p.m.

Office Location: 505 Barton Springs Road, Suite 600

Online Resources

Resources are available on CitySpace (City Intranet), or at austintexas.gov/benefits. Scan the QR code for easy access to the Employee Benefits website.

Contact Information mailto:benefits.hrd%40austintexas.gov?subject= https://cityofaustin.sharepoint.com/sites/CitySpace/ https://www.austintexas.gov/benefits

City Benefits

The City is committed to providing cost-effective, sustainable benefits that contribute toward your mental and physical health. The benefits offered in this document require you to assume responsibility for the choices you make and to be informed on how to use your benefits effectively.

While the City covers the majority of the cost of employee benefits, employee contributions are required to help finance parts of the benefits program.

The overall administration of the benefits program is evaluated and revised periodically to ensure it is simple, efficient, cost-effective, and aligns with the City’s goals. Since rising health care costs affect both the City and its employees, the City will continue to study new coverage options that help to manage health care costs.

Employee Communications

A variety of methods are used to communicate benefits programs to employees and their dependents, including presentations, newsletters, the City’s website, and City News.

It is important for employees to take time to review these publications to avoid missing important information.

The Monday Morning Briefing (MMB) is emailed weekly to Human Resources staff across all departments by Austin Human Resources and includes timely information about upcoming meetings, events, benefits, and other important Human Resources related topics. To view the MMB, visit cityofaustin.sharepoint.com/sites/CitySpace/SitePages/ Monday-Morning-Briefing.aspx.

In addition, Employee Benefits staff are available by phone or in person to discuss benefits questions with you and your family.

Communication goals of the benefits program include:

◆ Educating you on how to be better consumers of all benefits.

making informed choices when using benefits.

◆ Increasing your understanding of the value of your benefits.

Benefits Guide Information City of Austin employees have access to benefits approved by the City Council each year as part of the budget process. The benefits and services offered by the City may be changed or terminated at any time. These benefits are not a guarantee of employment with the City.

This Guide is designed to help you understand your benefits and assist you in making your enrollment decisions.

The terms of the Plan and detailed coverage information are included in the documents made available by each individual Plan. These could be in the form of a plan document, evidence of coverage, certificate of coverage, contract, etc.

The Guide is not a comprehensive breakdown of all current Benefits program requirements, policies, and exclusions. Please refer to online plan documents for current information pertaining to Benefits programs and incentives. In the case of a conflict between information presented in this Guide and the Plan, please defer to the terms of the Plan, which will always take precedence.

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http://cityofaustin.sharepoint.com/sites/CitySpace/SitePages/Monday-Morning-Briefing.aspx http://cityofaustin.sharepoint.com/sites/CitySpace/SitePages/Monday-Morning-Briefing.aspx

ADA Division

Ensures that all City services and programs are accessible to all people, including those with disabilities. This office assists with requests for reasonable accommodation, delivers compliance training for employees, and consults on disability-related issues citywide.

Compensation Division

Provides tools, resources, and information to departments and employees in order to enhance their knowledge and understanding of policies, procedures and trends related to classification and the City’s base pay plan.

Employee Benefits Division

Assists with questions about medical, dental, vision, life, disability insurance, and Flexible Spending Accounts, and other benefits such as wellness, childcare, and commuter programs.

Staff can also assist with benefits changes due to a qualifying life event, filing disability claims, and life insurance claims.

Employee Relations Division

Provides support and guidance related to Chapter A of the City’s personnel policies and procedures. The division conducts workplace investigations related to discrimination, harassment, and retaliation. Provides guidance on personnel issues and disciplinary actions and oversees the Drug and Alcohol testing for CDL drivers.

LEAD Office

The Learning, Engagement, and Development (LEAD) Office designs and delivers leadership development programs, manages citywide training initiatives, and supports organizational effectiveness through executive coaching, performance management, employee engagement, and strategic consulting. LEAD also oversees New Employee Orientation, citywide compliance training, recognition and engagement programs, and special projects that align with the City of Austin’s mission and values.

Municipal Civil Service/ Civil Service Division

The Civil Service Office serves the Austin Police, Austin Fire, and Emergency Medical Services and also administers processes regarding the initial selection, advancement, and conditions of employment in accordance with Chapter 143 of the Texas Local Government Code, Civil Service Commission Rules, and agreements with employee (labor) associations.

The Municipal Civil Service Office administers the Municipal Civil Service (MCS) rules and serves as the liaison between the MCS Commission and the City.

Quality Assurance Division

Implements a broad framework of continuous quality initiatives aimed at evaluating human resources policies and procedures, the delivery of related services, and providing opportunities to either improve, enhance, or re-engineer existing practices.

Oversees and advises on citywide leave management activities providing direction for leave programs.

Records Division

Updates and maintains City-wide personnel files and provides employment verifications, personnel file review, and employee information updates. All subpoenas and public information requests requiring employee record documents are processed in this division.

Risk and Safety Division

Oversees programs designed to prevent and control employee injuries and to provide injury benefits when employees have an occupational injury. The programs include the citywide safety program and the occupational injury program.

Talent Acquisition Division

Assists applicants, employees, managers, and executives in gaining access to and filling vacant positions with top talent by assessing workforce needs, engaging the community, managing programs, and creating and maintaining City-wide procedures, tools and resources.

Talent Strategy Division

The Talent Strategy Division focuses on recruitment and Veteran initiatives. The division develops and implements a comprehensive, integrated, and strategic focus of recruitments and community engagement activities.

For more information or assistance, please call Austin Human Resources at 512-974-3400.

Austin Human Resources Can Help You!

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Employee Eligibility

Full-Time Employees – 30 or more hours per week

If you are in a regular budgeted position, you are considered full-time and are eligible to participate in:

You are eligible for three types of coverage at no cost:

Part-Time Employees – 20 to 29 hours per week

If you are in a regular budgeted position, you are considered part-time and are eligible to participate in:

Part-Time Employees – Less than 20 hours per week

If you are in a regular budgeted position, you are considered part-time and are eligible to participate in:

Temporary Employees If you are a full-time temporary (non-intern or non-seasonal) employee scheduled to work 30+ hours, you are eligible to participate in:

▶ Medical & Dental – If employed continuously for more than 90 days.

Affiliated Employees If you are an Affiliated Employee you are eligible to participate in:

Surviving Dependents Surviving dependents of an active benefit eligible employee who passes in the line of duty, are eligible to participate in:

As a City employee, including any person in the initial probationary period, your work status is full-time, part-time, or temporary.

Dependent Eligibility Enrolling Dependents for Benefits

If you are full-time or part-time, your dependents are eligible for:

▶ Employee Assistance Program

Eligible Dependents

household and shares the common resources of life in a close, personal, intimate relationship with a City employee if, under Texas law, the individual would not be prevented from marrying the employee on account of age, consanguinity, or prior undissolved marriage to another person. A domestic partner may be of the same or opposite gender as the employee.

◆ Children: Employee’s biological children, stepchildren, legally adopted children, children for whom they have obtained court-ordered guardianship or conservatorship, qualified children placed pending adoption, and children of their domestic partner, if employee also covers their domestic partner for the same benefit. Employee’s children must be under 26 years of age.

◆ Dependent Grandchildren: Employee’s unmarried grandchild for whom they have legally adopted, obtain court-ordered guardianship or court-ordered conservatorship.

◆ Disabled Children: To continue City coverage for an eligible dependent past the age 26, the child must be covered as a dependent at the time, unmarried, and must also meet the following definitions:

and dependent upon employee for more than one-half of their support as defined by the Internal Revenue Code of the United States.

▶ Disabled means any medically determinable condition that prevents the child from engaging in self-sustaining employment.

▶ The child must be currently covered under a City medical plan and the disability must begin before the child turns 26.

▶ Employee must submit satisfactory proof of the disability and dependency, and periodic recertification will be required.

▶ A dependent child who loses eligibility and later becomes disabled is not eligible for coverage.

▶ A disabled child who was not covered as a dependent immediately prior to the time the child would otherwise cease to be a dependent is not eligible for coverage.

▶ A disabled child dependent must be covered continuously on the medical and dental plans. If coverage is dropped, the disabled child will not be allowed to re-enroll.

Persons Not Eligible

Dependents do not include:

◆ Individuals on active duty in any branch of military service (except to the extent and for the period required by law).

◆ Permanent residents of a country other than the United States.

◆ Parents, grandparents, or other extended family members not listed under the Eligible Dependents section.

Dependent Documentation If you are adding a dependent under any of the City’s benefits programs, you must provide documentation that supports your relationship to the dependent. Social Security Numbers must be provided for all eligible dependents.

Dependent Type Acceptable Documents

Spouse A marriage certificate or Declaration of Informal Marriage recorded as provided by law.

Domestic Partner A City of Austin Domestic Partnership and Tax Dependent Status Form and supporting documentation.

Child A certified birth certificate, Verification of Birth Facts (for newborn), qualified medical child support order, Administrative Writ, or court order establishing legal adoption, guardianship, or conservatorship.

Child of a Domestic Partner The child documentation listed above must be provided along with a City of Austin Domestic Partnership and Tax Dependent Status Form.

Stepchild The child documentation listed above must be provided along with a marriage certificate or Declaration of Informal Marriage indicating the marriage of the child’s parent and stepparent.

Dependent Grandchild Documentation supporting a legal adoption, court-ordered guardianship or court-ordered conservatorship and child’s parent’s birth certificate.

Disabled Child A completed BlueCross BlueShield Disabled Dependent Authorization form and Disabled Dependent Physician Certification form verifying an ongoing total disability.

Qualified Child Pending Adoption

For children already placed in employee’s home, an agreement executed between employee and a licensed child-placing agency, or the Texas Department of Family and Protective Services (TDFPS), which meets the requirements listed in Dependent Eligibility.

Enrolling Benefits Insurance Benefits for you and/or your dependents are effective the first day of the month after your date of hire or work status change, provided all required documentation is submitted to the Employee Benefits Division by the enrollment deadline. You have 31 days from your date of hire or work status change to enroll in benefits.

To decline benefits coverage, you must complete enrollment and waive coverages.

Changing Your Benefits Coverage Enrolling Benefits

You can request changes to your benefits coverage:

Duplicate Benefits Coverage

An individual is not eligible to be covered:

same benefit.

◆ As a dependent of more than one City employee, or City retiree, for the same benefit.

It is your responsibility to ensure that you and/or your dependents are not double covered for the same benefit. Duplicate claims will not be paid, and premiums will not be refunded.

Coverage Ending Dates

Coverage for you and your dependents will end on the earliest of the following:

◆ The last day of the month in which you or your dependents no longer meet eligibility requirements.

Taxable Fringe If you choose benefits coverage for a Domestic Partner and/or a Domestic Partner dependent child who does not qualify to be claimed on your federal income tax return, you may have to pay taxes on the amount of money the City contributes for the dependent’s medical and dental benefits. This money is considered taxable income, and must be reported to the IRS. The City refers to this money as taxable fringe. A spouse, biological children, step-children, and adopted children are never subject to taxable fringe. If at least one of the children for whom you have elected medical or dental coverage is a child you claim as a dependent on your federal income tax return, the City’s contribution will not be considered taxable income.

Retiring from the City of Austin After you complete your retirement paperwork with the retirement system, you must call the Employee Benefits Division within 31 days from your retirement date to enroll in retiree benefits. If you miss this deadline, your next opportunity to enroll will be during Open Enrollment or within 31 days of a Qualifying Life Event. To avoid a lapse in your benefits coverage (from active employee benefits to retiree benefits), you must call no later than the last day of the month you are retiring in.

Coverage Information

Qualifying Life Events Elections made during open enrollment will be effective for the upcoming year, January 1–December 31, 2026 The IRS requires that employee benefit elections remain in effect for the entire calendar year unless they experience a Qualifying Life Event.

owed will be deducted from employee paycheck.

Important: If employees miss their Qualifying Life Event deadline, they or their dependents will not have insurance for the current calendar year. The next opportunity to enroll will be during open enrollment held in the fall.

Qualifying Event Supporting Documentation Dependent Documentation

Marriage Marriage Certificate Birth Certificates are required if adding spouse’s children as dependents.

Divorce Certified copy of Divorce Decree Birth Certificates are required if adding children not currently enrolled in benefits.

Birth Birth Certificate, or Verification of birth facts issued by hospital

No additional documentation required.

Adoption Placement for adoption paperwork, or Legal documentation of the adoption

No additional documentation required.

Death Death Certificate No additional documentation required.

Change of spouse’s employment OR Loss or gain of coverage other than employment change

NOTE: Voluntary cancellation of Cobra or private coverage is not considered an event.

Proof of enrollment or termination of benefit coverage (employer, Medicaid, etc.)

Proof must contain effective or termination dates of coverage, type of coverage (medical, dental, vision) and the names of the dependents affected.

Adding Spouse - Marriage certificate/ Declaration of Informal Marriage or 1st page of current year’s tax return

Adding Children - Birth Certificate or 1st page of current year’s tax return

Flexible Spending Account Medical FSA Dependent Care FSA

Medical FSA - proof of gain or loss of dependent

Dependent Care - proof of enrollment or termination of childcare services

No additional documentation required.

Medical Plans You can choose the medical plan that best meets your needs. Provider and prescription information is available online at bcbstx.com/coa.

Things to consider when choosing a medical plan:

expenses.

◆ Use of maintenance prescription drugs.

You have the option of choosing between three medical plans: CDHP w/HSA, PPO, and HMO.

These plans feature co-insurance, deductibles, and in-network preventive screenings covered at 100%. The CDHP w/HSA and PPO feature a nationwide provider network while the HMO (BlueEssentials) connects employees to a smaller group of qualified health care providers (Texas only), with their care being directed by a primary care physician.

CDHP w/HSA Benefits of the CDHP w/HSA:

the current plan year. Regular Part-Time employees (20-29 hours) receive a contribution of half the Full- Time amounts listed below.

◆ Ability to contribute money on a pretax basis into a Health Savings Account.

leave employment or retire from the City.

◆ Use your HSA debit card to meet your deductible and pay for eligible medical, pharmacy, dental, and vision expenses.

BlueCross BlueShield ofTexas http://bcbstx.com/coa

CDHP Health Savings Account Eligibility:

To be eligible to participate in the HSA, you must meet all the requirements below as determined by the IRS.

If all requirements are not met, you and/or your dependents are not eligible to contribute to a HSA. However, you and/or your dependents are eligible to enroll in the CDHP Medical Plan.

Tricare.

If eligibility is met, your HSA will be opened automatically.

How the CDHP w/HSA Works:

BlueShield discounted rates.

◆ Calendar year deductible – After an employee meets the deductible, the plan will pay 80% of covered services for Network Providers.

◆ Out-of-Pocket-Maximum – After an employee meets the out-of-pocket-maximum, the plan pays 100% for all eligible covered medical and pharmacy expenses.

Differences Between the CDHP HSA and the Health Care FSA:

Only employees enrolled in the CDHP are eligible to open a Health Savings Account.

Question CDHP Health Savings Account

Health Care Flexible Spending Account

Is it required that I enroll in a City Medical Plan? Yes, in the CDHP. No.

Does the City contribute money into this account?

Yes, and the City’s contributions are available immediately.

No.

Am I able to contribute money into this account?

Yes, employee contributions are available as they are placed in your account each pay period.

Yes, annual contributions are available immediately.

Am I able to change my per pay period contributions throughout the year?

Yes, you may increase or decrease your contributions anytime during the year without a Qualifying Life Event.

Yes, but only within 31 days of a Qualifying Life Event.

Will I be issued a debit card? Yes. Yes.

Is the account a “Use it or Lose it” account?

No, the City’s and your unused contributions roll over each year. There is no deadline.

Yes, you must use your contributions by the IRS deadline.

Do I have to submit receipts?

No, but we recommend that you save your receipts for your records.

Yes, when requested.

Is this an interest-bearing account? Yes. No.

Do my dependents who use this account have to be IRS dependents? Yes.

Yes, your grandchildren, domestic partner, and domestic partner’s children.

Benefits CDHP (BlueChoice PPO)PPO (BlueChoice PPO)HMO

(BlueEssentials)

Network Out of

Network NetworkNetwork

Deductible

$1,700 EO/

$3,400 Family

$3,200 EO/

$6,400 Family $600 EO/ $1,800 FamilyNo Deductible

Out-of-Pocket Maximum

$5,000 EO/

$6,850 Family

$10,000 EO/

$20,000 Family

$4,250 EO/ $13,250 Family$4,750 EO/ $9,500 Family

Preventative Services

Covered at 100%, No Deductible

40% after Deductible

Covered at 100%, No Deductible

Covered at 100%

Primary Care Physician (PCP)Selection not requiredSelection is not requiredRequired

PCP Visits (including telehealth)

20% after Deductible

40% after Deductible

$15 copay$15 copay

Specialist Visits (including telehealth)

20% after Deductible

40% after Deductible

$30 copay$40 copay

Urgent Care 20% after Deductible

40% after Deductible

$40 copay$50 copay

Emergency Room 20% after Deductible

40% after Deductible

$300 copay$350 copay

Emergency Room Surgery

20% after Deductible

40% after Deductible

20% after Deductible plus $300 ER copay

Covered at 100% after $350 ER copay

Ambulance20% after Deductible20% after Deductible$300 copay

Virtual Visit - MD Live

Approximately $49 for general health, $100 per session for therapy counseling, and $175 per session for psychiatry

N/A$10 copay$10 copay

Inpatient Hospital Stay

20% after Deductible

40% after Deductible

20% after Deductible$1,750 copay

Outpatient Surgery

20% after Deductible

40% after Deductible

20% after Deductible$750 copay

Allergy Services & Immunizations

20% after Deductible

40% after Deductible

Covered at 100%.

(Office visit copays may apply)

Covered at 50%.

(Office visit copays may apply)

Medical Plans Schedule of Benefits

Benefits CDHP (BlueChoice PPO)PPO (BlueChoice PPO)HMO (BlueEssentials)

NetworkOut of NetworkNetworkNetwork

Fertility Lifetime Maximum $20,000 per person, per lifetime.

Lifetime Maximum $20,000 per person, per lifetime.

Lifetime Maximum $20,000 per person, per lifetime.

Acupuncture (24 Visit Limit)20% after Deductible40% after Deductible$40 copayNot Covered

Chiropractor (24 Visit Limit)20% after Deductible40% after Deductible$40 copay$50 copay

CT, MRI, PET

Scans*

20% after Deductible40% after Deductible$100 copay$150 copay

Mental Health Care Outpatient

20% after Deductible40% after Deductible$15 copay$15 copay

Durable Medical Equipment

20% after Deductible40% after Deductible20% after DeductibleMember pays $0

Insulin Pump20% after Deductible40% after Deductible$100 copay$150 copay

Out-of-Network Benefits

Please refer to Out of Network Column.

$2,000 deductible per covered person/$6,000 deductible for Family. Member pays 40%, up to maximum allowable charge.

Out-of-network benefits are subject to network benefit plan limits, pre-approval, and pre-notification requirements.

Inpatient Admission are subject to a $500 copay per admission.

None, except in case of a medical emergency.

* Preauthorization is required

Medical Plans Schedule of Benefits

CDHP (BlueChoice PPO)PPO (BlueChoice PPO)HMO (BlueEssentials)

NetworkOut of NetworkNetworkNetwork

Referrals RequiredNoNo

Yes. A referral is required to seek services from a Specialist. No benefit coverage without a referral.

Residency Requirements

NoneNone Must receive services in the state of Texas. No benefit coverage outside of Texas.

Medical Plans - Pharmacy Pharmacy Benefits CDHP (BlueChoice PPO) PPO (BlueChoice PPO) HMO (BlueEssentials)

ACA Preventative Drugs Covered at 100%, No Deductible

Covered at 100%, No Deductible

Covered at 100%, No Deductible

CDHP w/HSA Preventative Drugs 20%, No Deductible N/A N/A

Deductible Per Person Per Calendar Year 20%, after Deductible $50 Deductible for

Tier 2 & Tier 3 Only $50 Deductible for Tier 2 & Tier 3 Only

Basic Drug List Tier 1 (Generic) 20%, after Deductible $10 $10

Basic Drug List Tier 2 (Preferred) 20%, after Deductible $40 copay or 20% of cost

($70 Max) $45 copay or 20% of cost

($80 Max)

Basic Drug List Tier 3 (Non-Preferred) 20%, after Deductible $60 copay or 20% of cost

($110 Max) $65 copay or 20% of cost

($120 Max)

90 Day - Mail Order 20%, after Deductible 2 copays Tier 1, 2, or 3 3 Copays Tier 1, 2, or 3

Diabetic Supplies CDHP (BlueChoice PPO) PPO (BlueChoice PPO) HMO (BlueEssentials)

Retail Supplies are covered at participating pharmacies.

Mail Order Copays for insulin needles/syringes and/or diabetic supplies are waived when dispensed on the same day as your insulin and oral agents, but only when the insulin or oral agent is dispensed first.

Hearing & Vision Benefits CDHP (BlueChoice PPO) PPO (BlueChoice PPO) HMO (BlueEssentials)

Hearing Aids 20% after Deductible, One pair covered every 48 months

20% after Deductible, One pair covered every 48 months One pair every 48 months

Optometrists 20%, after Deductible $15 copay $15 copay

Ophthalmologists 20%, after Deductible $30 copay $40 copay

FT & Temporary Employees (30+ Hours Per Week)* CDHP w/HSA (BlueChoice PPO) PPO (BlueChoice PPO) HMO (BlueEssentials)

Employee Only $0.00 $15.00 $20.00

Employee & Spouse** $96.37 $200.67 $210.67

Employee & Child(ren) $47.79 $147.84 $157.84

Employee & Family $221.63 $336.91 $346.91

PT (20-29 Hours Per Week) CDHP w/HSA (BlueChoice PPO) PPO (BlueChoice PPO) HMO (BlueEssentials)

Employee Only $138.08 $127.03 $132.03

Employee & Spouse** $358.04 $428.08 $438.08

Employee & Child(ren) $288.22 $351.04 $361.04

Employee & Family $537.27 $632.41 $642.41

Medical Plans - Rates

*Temporary employee rates are based on scheduled hours worked after completing 90 days of consecutive employment **Spouse or Domestic Partner **Spouse or Domestic Partner **Spouse or Domestic Partner

Medical - Per Pay Period

PT (Less than 20 Hours Per Week) CDHP w/HSA (BlueChoice PPO) PPO (BlueChoice PPO) HMO (BlueEssentials)

Employee Only $276.16 $357.03 $428.68

Employee & Spouse** $619.71 $801.14 $978.96

Employee & Child(ren) $528.65 $684.21 $835.88

Employee & Family $852.91 $1,102.63 $1,347.18

Using Mail Order

To begin mail order:

◆ Have doctor write a prescription for a 90-day supply of medication (ask for three refills).

◆ Complete the mail order form and attach prescription.

If your doctor allows you to take a generic drug, this should be indicated on the prescription. Three weeks before your mail order supply runs out, they will need to request a refill.

Your cost:

◆ CDHP w/HSA participants will pay 20% of the cost once the in-network deductible is met. If the prescription is for a preventive care medication listed on the CDHP w/HSA Preventive Drug List, no deductible is required, and you will only pay 20% of the cost. Employee can use their HSA Bank debit card to pay for their out-of-pocket expenses.

◆ PPO participants receive 90 days of medication for two copays/coinsurance.

◆ HMO participants receive 90 days of medication for three copays/coinsurance.

For additional information, visit bcbstx.com/coa or call BlueCross BlueShield at 888-907-7880.

Diabetic Bundling

A participant’s insulin/non-insulin medication and related diabetic supplies can be purchased through mail order for the cost of the insulin/non-insulin if prescriptions for the insulin/non-insulin and supplies are submitted at the same time.

◆ CDHP w/HSA participants will pay 20% of the cost once the in-network deductible is met. Employees can use their HSA Bank debit card to pay for their out-of-pocket expenses.

◆ PPO participants will pay two copays/coinsurance for a 90-day prescription.

◆ HMO participants will pay three copays/coinsurance for a 90-day prescription.

Maven - Fertility & Family Building

Meet Maven, 24/7 virtual health support for you and your family’s future.

Beginning January 1, 2026, Maven will launch as a one-year pilot program available to all participants enrolled in a City medical plan.

Get the support every family deserves with access to hard-to-find specialists, articles, videos, and more. Maven is here for every symptom, feeling, and health goal with expert answers you can trust.

To help you get closer to tomorrow’s goals:

Get started at mavenclinic.com/join/healthplan, or download the Maven Clinic app.

24/7 NurseLine Services

Coping with health concerns on your own can be tough. With so many choices, it can be hard to know whom to trust for information and support. 24/7 NurseLine services were designed specifically to help you get more involved in your own health care, and to make your health decisions simple and convenient. They will provide you with:

◆ Immediate answers to their health questions any time, anywhere – 24 hours a day, 7 days a week.

health care decisions.

When you call, a registered nurse can:

◆ Discuss your options for the right medical care and assist in guiding you to the correct treatment facility (i.e., Urgent Care, Emergency Room, etc.).

Call 24/7 NurseLine services any time for health information and support – at no additional cost. Registered nurses are available any time, day or night. Call NurseLine services at 800-581-0368.

Virtual Visits - MDLIVE

Talk to a board-certified physician for both general health and behavioral health services from the comfort of your home or work.

There’s no driving, no crowded waiting rooms, and it’s available 24 hours a day, 7 days a week. Common services include, cold/flu, allergies, asthma, sinus/ear infections, and pink eye. Behavioral health conditions treated include, online counseling, child behavior/learning issues, and stress management.

For the PPO and HMO Plan, virtual visits are a $10 copay for general or behavioral health. For the CDHP Plan, virtual visits are approximately $49 for general health, $100 per session for therapy counseling, and $175 per session for psychiatry.

Log in to bcbstx.com/coa or download the BCBSTX app on a smartphone to access Virtual Visits powered by MDLIVE. You will need your BlueCross BlueShield medical ID number and banking/credit card information readily available to charge your copay. If you have questions, please call BlueCross BlueShield at 888-907-7880.

http://bcbstx.com/coa https://mavenclinic.com/join/healthplan

Dental Plan

In-Network Out-of-Network

Selection of Dentist

Member can go to an in-network dentist.

Member will realize greater savings when using in-network dentists.

Member can go to any dentist; however, the member is responsible for the difference over the Table of Allowance.

Annual Deductible $50 per person, per calendar year.

Deductible does not apply to Preventive Care.

Covered Services (other than orthodontia)

Preventive Care, Basic Care, and Major Care – covered in full.

Preventive Care, Basic Care, and Major Care – covered up to the Table of Allowance.

Orthodontia

Orthodontia Care – covered in full as work progresses up to the

Calendar/Lifetime Maximum.

Orthodontia work already in progress prior to enrolling, is not covered (including banding).

Orthodontia Care – covered up to the Table of Allowance as work progresses.

Orthodontia work already in progress prior to enrolling, is not covered

(including banding).

Annual Maximum Benefit

$2,000 per person, per calendar year.

Orthodontia Maximum Benefit

$2,000 per person, per lifetime.

Claim Forms Dentists file claims for covered services.

Members file claims to be reimbursed for covered services.

(Some dental offices may file claims and bill the balance after the plan has paid).

BlueCare Dental PPO provides you the option of seeking services from in-network and out-of-network dentists.

Selecting a dentist from the BlueCare Dental PPO network will offer employees the greatest savings. When contacting a dentist, ask whether the dentist is contracted in the BlueCare Dental PPO network.

To find a dentist, view claims activity, or for more information visit bcbstx.com/coa or call BlueCare Dental at 888-907-7880. For covered services, exclusions, and the out-of-network Table of Allowances, refer to the BlueCare Dental PPO Plan Document online at austintexas.gov/benefits or call BlueCare Dental PPO.

Table of Allowance - The most BlueCare Dental PPO will pay an out-of-network dentist for covered service or procedure.

BlueCare Dental PPO Schedule of Benefits

BlueCare Dentar~ http://austintexas.gov/benefits

Orthodontia Treatment

Full Time & Temporary*

30+ hours per week

Regular Part Time 20-29 hours per week

Regular Part-Time less than 20 hours per week

Employees Only $2.50 $9.62 $27.67

Employee & Spouse or Domestic Partner

$28.51 $34.15 $70.51

Employee & Children $28.51 $34.15 $70.51

Employee & Family or Domestic Partner &

Children $32.01 $37.65 $74.01

Orthodontia work already in progress prior to enrolling, is not covered (including banding).

Expenses are paid only as the work progresses. For out-of-network services, invoice should be submitted for reimbursement after each visit. Orthodontia benefits paid by the plan are applied toward the calendar year maximum and Lifetime Orthodontia Maximum.

The reimbursable amounts for orthodontia expenses are determined as claims are incurred throughout the course of treatment. The reimbursable amounts through FSA or the HSA is the difference between the amount billed and the amount paid by the dental plan. This amount may not match the payment plan employees have set up with their dentist.

*Temporary employee rates are based on scheduled hours worked after completing 90 days of consecutive employment.

BlueCare Dental PPO - Per Pay Period

Vision Plan Healthy eyes and clear vision are an important part of overall employee health and quality of life. Avesis will help employees care for their sight while saving them money.

To view benefits and locate a provider, visit myavesis.com or call 866-563-3589.

Coverage Rates Per Pay Period

Employee Only $1.98

Employee & Spouse or Domestic Partner $4.28

Employee & Child(ren) $4.06

Employee & Family or Domestic Partner & Child(ren)

$6.47

Covered Service In-network benefits (limited out-of-network benefits are available).

Comprehensive Eye Exam $10 copay, one exam per calendar year.

Frames

Once per calendar year in lieu of contact lenses.

Up to $125 retail allowance toward provider supplied frame plus 20% off cost exceeding the allowance. OR*

Up to $175 retail allowance if purchased at Vision Works plus 20% off cost exceeding the allowance. OR

Up to $200 retail allowance toward frames if purchased using UVP Online.

Additional pair of eyeglasses, 30% off if purchased at the same time as first pair.

Contacts

Once per calendar year in lieu of frames.

Up to $125 allowance toward provider supplied contacts plus an additional discount off the cost exceeding the allowance*– 10% for disposable contacts and 15% for standard contacts.

OR

Medically necessary contact lenses are covered in full with prior approval.

Standard & Specialty Contacts - Evaluation, fitting fees, and follow-up care;

$25 copay applies.

Standard Eyeglass Lenses Single, bifocals, trifocals, lenticular, and standard scratch coating.

$25 copay, once per calendar year.

Polycarbonate lenses for children are covered in full up to age 19

Lens Options Cost

Standard scratch-resistant coating $0

Standard progressive lenses $50

Premium progressives (i.e. Varilux, etc.) $90

Intermediate-vision lenses $30

Blended-segment lenses $20

Ultraviolet coating $12

Standard anti-reflective (AR) coating $35

Premium AR Coating $48

Ultra AR Coating $60

High Index lenses 1.67 $55

Polarized lenses $75

Glass photochromic lenses $20

Plastic photosensitive lenses $65

Other Lens options Provider discount up to 20%

Plan Coverage

Plan Coverage

*Additional Discounts - Not available at Wal-Mart, Sam’s Club, and Costco.

*Additional Discounts - Not available at Wal-Mart, Sam’s Club, and Costco.

Avesis Vision Rates

- . ~ aves s ~ aGUARDIAN'company https://myavesis.com

An FSA lets you set aside money from your paycheck on a pretax basis to use for eligible out-of-pocket expenses. There are two types of FSA’s that you can participate in:

◆ Health Care FSA – Allows you to pay for eligible medical, dental, vision, hearing, and prescription drug expenses for you, your spouse, and eligible tax dependents.

◆ Dependent Care FSA – Allows you to pay for eligible child care, before and after school care, nursery school, preschool, and summer day camp.

Both accounts are regulated by Internal Revenue Service (IRS) code Section 125 and are administered by Total Administrative Services Corporation (TASC).

IMPORTANT: CDHP participants are not eligible to enroll in the Health Care FSA. You can participate in the CDHP Health Savings Account (HSA) and Dependent Care FSA.

Health Care FSA ◆ You can contribute pretax dollars from your paycheck, up to the IRS limit of $3,300 per year (minimum $5).

◆ Your full contribution is available immediately to pay for eligible health care expenses. It covers you, your spouse, and/or tax dependents for:

contacts ▶ Prescription drugs and prescribed over-the-counter items

For a complete list of eligible health care expenses, call TASC at 800-422-4661 or visit irs.gov.

Dependent Care FSA ◆ You can contribute pretax dollars from your paycheck, up to the IRS limit of $5,000 per year (minimum $5).

◆ Your contributions are available as the funds are deducted from your paycheck.

◆ Funds are for your dependents under age 13, or age 13 or older if physically or mentally incapable of self-care, and spends at least eight hours a day in home.

To calculate your pay period contribution, estimate out-of-pocket expenses for the calendar year (24 pay periods).

If you enroll mid-year, estimate expenses for the number of eligible pay periods remaining for the calendar year.

Refer to the worksheets in this section to assist in calculating per pay period contribution amounts.

Flexible Spending Accounts

(FSA)

Note: You will realize the same type of savings enrolling in Dependent Care FSA.

Per Pay Period Paycheck with Health Care FSA

Paycheck without Health Care FSA

Gross Pay $1,600.00 $1,600.00

Health Care expenses deducted before taxes -$118.00 $0.00

Taxable Pay $1,482.00 $1,600.00

Social Security/Medicare at 7.65% of taxable pay -$113.37 -$122.40

Income Tax at 12% tax bracket -$177.84 -$192.00

After-Tax Pay $1,190.79 $1,285.60

Paying for Health Care after taxes $0.00 -$118.00

Take-Home Pay $1,190.70 $1,167.60 http://irs.gov

Pay with Ease ◆ You can swipe your TASC debit card to pay for your eligible Health Care and Dependent Care expenses. When you use the TASC debit card your expense is automatically paid from your FSA. Note: Dependent Care funds are available as deducted from employee paycheck.

◆ File a claim: You can pay your eligible expenses by cash, check or credit card. Then submit a claim form along with your receipt to pay yourself back. For speed, upload documentation to the TASC app. Your money will be deposited directly into your MyCash account, checking, or savings account within 48–72 hours following the submission of complete and accurate reimbursement request. Note: Claims are not processed on Saturdays.

What is MyCash?

When you submit for a reimbursement, your money will be deposited into your MyCash account. The money can be accessed by the swipe of your TASC card, withdrawn at an ATM, or transferred to your personal checking or savings account. Your money in MyCash is not tied to any Plan year and does not expire. Note: If you choose to withdraw money at an ATM, ATM/bank fees may apply.

Here are a Few FSA Reminders:

◆ You need to save your itemized statements and detailed receipts. You may need to provide documentation to support a claim to TASC or the IRS.

◆ TASC will request documentation for unsupported claims which you must provide.

◆ Use-it-or-Lose-it rule. This means you will lose any unused funds not claimed by the IRS set deadlines below.

reimbursement from 2026 account.

◆ You can enroll in or change your contribution if your are a new employee, have a Qualifying Life Event, or during Open Enrollment.

◆ Orthodontia expenses: The amounts reimbursable for orthodontia expenses are determined as claims are incurred throughout the course of treatment. The amount reimbursable through Health Care FSA is the difference between the amount billed and the amount paid by the dental plan. This amount may not match the payment plan employees have set up with their dentist.

◆ If you do not participate in Open Enrollment, your annual elections will continue the following year.

Dependent Care FSA and the City’s Child Care Programs

If you participate in both the Dependent Care FSA and one of the City’s Childcare Programs during the same year, funds you receive from the combined programs cannot exceed the $5,000 IRS limit.

If you have questions, call the Employee Benefits Division at 512-974-3284.

Leaving City Employment ◆ Health Care FSA – If you terminate employment with the City, you have until May 31, 2027 to submit claims to TASC for expenses that were incurred while you were employed with the City and contributed to your Health Care FSA.

▶ If you have money remaining in your Health Care FSA, you may continue participation through COBRA to incur expenses or to continue to use your FSA funds.

◆ Dependent Care FSA – If you terminate employment with the City, you will have until March 15, 2027 to incur expenses and submit claims to TASC by May 31, 2027 to receive reimbursement for funds accrued in your Dependent Care FSA.

FSA

If an employee is...

...this limit applies for their family each year.

These limits may be reduced if they also participate in a City Childcare Program

Single $5,000

Married, filing a joint tax return Lesser of $5,000, their income, or their spouse’s income

Married, filing a separate tax return Lesser of $2,500, their income, or their spouse’s income

Married with a spouse who is disabled or is a full-time student at least five calendar months of the year

$2,500 if an employee has one dependent;

$5,000 if an employee has two or more dependents

Dependent Care FSA

Disability Short Term Disability (STD)

Coverage is an employer-paid benefit for employees in a regular budgeted position scheduled to work 20 or more hours per week. STD provides income replacement for up to 60 calendar days when unable to work due to off-the-job illness, injury, or pregnancy. Enrollment is automatic. STD may not be used with other City-paid leave, personal leave, or paid benefits.

Definition of Disability To qualify for STD, you must have a physical or mental condition—resulting from pregnancy or a non-work-related illness or injury—that prevents you from performing the essential duties of your job. Your condition must be certified by your healthcare provider and expected to last more than 30 calendar days. Date of Disability is the first scheduled workday you are absent due to your condition. This date starts the 30-day waiting period for STD benefits.

You are responsible for submitting complete and sufficient medical certification with your claim. The Austin Human Resources Leave Administrator will review the documentation, which may include medical records or treatment information, and may contact your healthcare provider to clarify or confirm your certification.

Reduction in Benefits Once approved for STD benefits, you must stop using any paid leave. Your STD benefits will be reduced by any paid leave or work earnings you receive from the City.

Filing a Claim You should submit a Short-Term Disability (STD) claim as soon as you know you may be out of work for more than 30 calendar days due to your medical condition. You can file a claim up to four weeks in advance for planned absences, such as childbirth or scheduled surgery.

Your claim must be submitted to your Department Leave Coordinator within 30 days of your Date of Disability and must include:

When Benefits End STD benefits automatically end on the earliest of the following…