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    Employee Benefits & Forms

    ACA Regulations & Important Guidelines

    Preventive Services Covered under the Affordable Care Act
    Glossary of Health Coverage and Medical Terms
    American Heart Association Flyers
    Premium Assistance Under Medicaid and the Children's Health Insurance Program (CHIP)

    Aflac

    Aflac is a supplemental insurance that provides an additional layer of financial protection in the event of a serious accident or illness.

    Employees can sign up for this service within 30 days of hire, or annually in October, during Open Enrollment for the upcoming year.

    Price Sheet
    Election Form

    City of Chico Dedicated Aflac Website: http://www.aflac.com/chico

    Questions? Contact your Aflac representative:
    Adam Brubaker
    (530) 949-3767
    ​adam@leftoutins.com

    CalPERS Retirement

    Customer Service: 888-CalPERS (or 888-225-7377)
    www.calpers.ca.gov
    CalPERS Beneficiary Designation
    Planning Your Service Retirement (Pub 1)
    Service Retirement Application (Pub 43)
    Retirement Allowance Estimate Request (BSD-470)
    Local Miscellaneous Benefits (Pub 8)
    Local Safety Benefits (Pub 9)
    Service Credit Purchase Options (Pub 12)
    Power of Attorney (Pub 30)
    Community Property Guide (Pub 38A)
    CalPERS Pension Worksheet

    Have you created a “My CalPERS” Account yet?  The CalPERS website is a fantastic resource! Members can review their employee and employer contributions and utilize calculators to estimate retirement amounts, as well as access recent forms and publications.  Signing up is easy, visit: https://www.calpers.ca.gov/.

    Deferred Compensation – Mission Square (Formerly: ICMA-RC)

    Another great way to save for retirement – contribute to a Mission Square retirement plan automatically each paycheck!

    Video Intro: Get to know your 457 Account

    Employees can enroll in Deferred Compensation at any time. Elections and changes are effective the first of the month following the request.

    Did you know? CPSA and CPOA members have a 10% match!

    Enrolling online is quick and easy!

    1. Go to www.icmarc.org/selfenroll
    2. Enter and confirm your Social Security number, then enter the City’s plan number: 307126
    3. Select your enrollment method:
      • Express: enter your personal information and contribution information. Later, through Account Access, you can submit your investment and beneficiary information.
      • Comprehensive: enter your personal information, beneficiary information, contribution information, investment allocations, and create a user ID.
      • Note: At this time, City employees can only elect dollar amounts and not percentages with ICMA. Please only list dollar amounts.
    4. Use the print enrollment form feature at the end of your online enrollment process to print the form.
    5. Provide HR a copy of your enrollment form and complete a copy of the Contribution Change Form in order to initiate your contribution through payroll deductions.

    Need additional help? Watch a short video guide to see how easy it can be to enroll online. You can also contact the City’s ICMA-RC representative listed below.

    Once you’re enrolled, use the following resources:

    Extra Forms:
    Contribution Change Form
    EZ Enroll Online Flyer
    Enrollment Form
    Beneficiary Designation Form
    Direct Rollover Packet
    Pre-Retirement Catch Up Form
    Withdrawal Packet
    Fund Performance Report 02/28/2021

    Employee Assistance Plan (MHN)

    Customer Service: (800) 322-9707
    www.mhn.com
    MHN Informational Flyer
    MHN Legal Services Flyer
    MHN Financial Services Flyer
    MHN Evidence of Coverage

    Employee Wellness & Extras

    The City of Chico provides additional wellness opportunities designed to support staff both at work and at home.

    Ergonomics
    In an effort to reduce ergonomic issues related to employee workstations and/or working conditions and habits, ergonomic assessments are available to any employee, upon their request, or the request of their supervisor.

    Comprehensive ergonomic assessments will be completed by HR, or through a certified consultant. To request an assessment, employees or supervisors must contact HR to arrange an appointment.

    Farm Fresh to You
    City of Chico employees are eligible to join a Community Supported Agriculture (CSA) delivery box at a discounted rate!

    For more information, and a link to join, read the Farm Fresh to You flyer.

    FlightCare Membership
    Employees who join the FlightCare Membership Program are not billed for out-of-pocket expenses when FlightCare or a reciprocating emergency air transport service is used.  To view information about this program and enroll online, Click Here.

    Flu Shot Clinics
    The City normally offers a no-cost Flu Shot Clinic each year during Open Enrollment (employees must provide prescription card). Employees who are unable to attend the scheduled Flu Shot Clinic are still able to receive zero-cost Flu Shots at any pharmacy with their prescription card.

    Fitness Discounts
    Human Resources provides a flyer of local fitness centers.  Employees may need to show proof of employment with the City of Chico upon enrollment. Fitness Discounts 2022

    Benefits Fair
    The City normally holds a Benefits Fair in early October to coincide with the City’s Open Enrollment period.  It’s a great way for employees to meet service providers and have their questions answered.

    Some of our participating vendors

    • AFLAC
    • Anthem Blue Cross
    • Carrum Health
    • Delta Dental
    • EPIC
    • Lincoln Financial Life/LTD/STD
    • MHN Employee Assistance Program
    • Mission Square Deferred Compensation
    • Rite Aid Flu Shot Clinic
    • Sterling HSA
    • VSP Vision

    Hero Homebuyer Program
    The Hero Homebuyer Credit is designed to help public employees purchase or refinance a home by offering up to $20,000 to cover closing costs and expenses.  For more information, visit the Hero Homebuyer Program by Clicking Here.

    Lactation Room
    A designated lactation room is available, by appointment, on the third-floor of the City’s Municipal Building.

    Please contact Human Resources, at x7900, to reserve needed times.

    Prescription Savings
    Express Scripts Home-Delivery
    Employees can utilize Express Scripts home delivery to have a 90-day supply of prescriptions delivered at a lower rate than the 30-day refill cost.

    Customer Service: (800) 711-0917
    https://www.express-scripts.com/

    GoodRX.com
    Prescription costs for City of Chico employees are often already low-cost; however, additional savings can be found if employees elect to utilize services such as GoodRX.com.

    Water Cooler Locations
    Each department has at least one water cooler available, to ensure easy access to fresh water and cut down on bottled water usage within the building.

    Group and Voluntary Life
    & Short/Long-Term Disability Insurance (Lincoln Financial Group)

    ​All active, full-time, permanent employees working at least 20 hours per week and their eligible spouse and children are eligible for coverages.

    Enrollment is available within 30 days of hire, or annually in October, during Open Enrollment for the upcoming year.

    Group Life: The City of Chico provides City-paid Group Life Insurance of the annual salary, rounded to the next thousand, for qualified employees.

    Voluntary Life: This is in addition to the City-paid Group Life Insurance that is provided to qualified employees at no cost!

    Coverages Available:

    • Employee: $10,000 increments, up to 5x the employee’s annual earnings, not to exceed $500,000.
    • Employee Accidental Death & Dismemberment (AD&D): $10,000 increments, up to 5x the employee’s annual earnings, not to exceed $500,000. Coverage may be purchased regardless of whether or not voluntary life is purchased.
    • Spouse: $5,000 increments, up to 100% of employee coverage for voluntary life or AD&D.
    • Children, birth – 6 months: $1,000
    • Children, 6 months – 19 (or 26 if full-time student): $2,000 increments, not to exceed $10,000.

    www.LFG.com
    Summary of Life Insurance Benefits
    Lincoln Disability One
    Lincoln LifeKeys Flyer
    Lincoln Travel Connect Flyer
    Life Insurance Beneficiary Designation
    Short Term Disability Claim Form
    Lincoln City Paid Life and AD&D Policy Certificate
    Lincoln Voluntary Life Policy Certificate
    Lincoln Voluntary AD&D Policy Certificate

    Medical, Dental, & Vision Insurance

    2022 Active Employee Benefits Guide
    2023 Active Employee Benefits Guide

    Applications/Change Forms

    Benefits Application & Change Form - Active Employees
    When adding dependents to your benefits, proof of dependent status is required. Please review the Dependent Verification Instructions, for types of proof accepted.

    Opt Outs
    Opt-out is available for those employees who have other medical coverage in place. 
    Medical Opt-Out Form & Certification of Other Coverage

    Individuals who previously opted out will need to re-verify during Open Enrollment. HR will contact you individually to arrange renewed documentation.

    Anthem Blue Cross Medical Insurance
    Anthem Customer Service

    Customer Service: (800) 967-3015
    www.anthem.com/ca/EIAHealth

    Plan Summary of Benefits &
    Coverage (SBC)
    EPO EPO SBC
    HDHP HDHP SBC
    PPO 80/20 PPO 80/20 SBC
    PPO 90/10 PPO 90/10 SBC

    Anthem Blue Cross General Information
    How to Find a Provider Instructions
    Anthem Claim Form
    Take Care of Yourself - Preventative Services
    Anthem Special Services Flyers
    Anthem Live Health Online Flyer
    Anthem Temporary ID Card Instructions
    Anthem Blue Cross Online Resources
    Anthem Blue Cross Drug Formulary
    Anthem Specialty Pharmacy (HDHP)

    Express Scripts
    Customer Service: (800) 711-0917
    https://www.express-scripts.com/
    Medco Frequently Asked Questions
    Medco Mail Order Form
    Medco Claim Form

    Sterling Health Savings Account (HSA)
    Customer Service: (800) 617-4729
    CustomerService@SterlingHSA.com
    www.SterlingHSA.com
    2021 Sterling Enrollment Form 
    Sterling HSA Salary Redirection Form (Payroll Change Form)
    Sterling Change Of Account Form

    Delta Dental Insurance
    Customer Service: (800) 765-6003
    www.deltadentalins.com
    Delta Dental SBC
    Find a Network Dentist
    Delta Dental Dentist Directory
    Delta Dental Informational Flyers
    Delta Claim Form
    Where's My Dental ID Card?

    VSP Vision Insurance
    Customer Service: (800) 877-7195
    https://www.vsp.com/
    VSP Vision SBC
    Where's my VSP ID Card? Plus other FAQs.
    VSP Member Accounts Online
    VSP Schedule of Benefits
    VSP Primary Eyecare
    Exclusive VSP Rebates & Special Offers
    VSP Tru Hearing member Discount
    VSP Out Of Network Claim Form

    Carrum Health
    Customer Service: (888) 855-7806
    my.carrumhealth.com/EIAHealth
    Carrum Flyer
    Carrum What to Expect
    Carrum Frequently Asked Questions

    Modifying Elections & Open Enrollment

    After medical, dental, vision, and flexible spending account elections are made, Internal Revenue Service (IRS) regulations generally permit changing those elections only during the next open enrollment (October of each year). However, if you experience a “qualifying event” during the year you may change certain benefit plan elections mid-year. The Human Resources & Risk Management Office must be notified of a qualifying event within 30 days of the event in order to make changes to your elections. No exceptions to the 30 day notification deadline are permitted. 

    Open Enrollment
    Held annually during the month of October.

    During Open Enrollment, employees can:

    • add or delete dependents from Medical, Dental and Vision or choose a new Medical plan;
    • enroll in, increase or drop Voluntary Life Insurance;
    • enroll/re-enroll in a Section 125 Medical or Dependent Care Flexible Spending Account (FSA);
    • enroll in, or change, AFLAC coverages.

    NOTE:  If you do not wish to change your benefits or re-enroll in an FSA, no action is required during Open Enrollment.

    ScholarShare 529 College Savings Program

    Why save for college with ScolarShare529?
    A 529 is one of the best ways to save for higher education. ScholarShare 529 benefits include:

    • 100% tax-free growth can mean more money for higher education.
    • Low fees that ensure your savings primarily go toward education costs.
    • Parent-owned 529 accounts have less impact on financial aid eligibility than other saving methods.
    • Tax-free withdrawals for qualified higher education expenses, like tuition, room and board, books, computers, and more.
    • Eligible for use at most schools nationwide and many abroad – undergraduate and graduate programs, community colleges and trade schools.
    • Overseen by the ScholarShare Investment Board, an agency of the State of California.

    Questions?
    Click Here to schedule a time to meet with our designated rep, Adal Padilla.

    Adal Padilla
    (628) 231-6519
    Adalberto.Padilla@tiaa.org

    Forms:
    529 Brochure
    529 Guide
    529 Enrollment Guide

    Section 125 Flexible Benefits Program (will be changing to Sterling Administrators in 2023)

    Flexible Spending Accounts are part of Section 125, established by the IRS. Section 125 allows employees to set aside money for future medical and child care costs on a pre-tax basis.

    Employees can enroll in a Medical FSA or a Limited Purpose FSA (Dental & Vision Only), and/or a Dependent Care FSA.

    Enrollment is available within 30 days of hire, or annually in October, during Open Enrollment for the upcoming year.

    Make reimbursements and payments even easier – use the Mobile App!

    Customer Service: (800) 574-5448
    customerservice@basicpacific.com
    www.basicpacific.com
    Flexible Spending Account Calculator

    2021 FSA Enrollment Form & Worksheet
    FSA Medical Information
    FSA Dependent Care Information

    Section 125 Summary Plan Description

    Flexible Spending Accounts MUST be re-elected annually, during Open Enrollment.

    Returning Forms to HR

    If you complete paper copies, please don’t email items containing social security numbers – it’s too risky.  Instead:

    • Put them in an interoffice envelope and send them to HR.
    • Or, scan the item to the secure HR Scan Drive by using the closest copier:
      • Scan your proxy card
      • Press Scan > Scan to HR.  (Note a slight variation for PD copiers: Scan & Send > One-Touch > HR Scans – you may have to follow the down-pointing arrow/bottom right if there’s an extensive list.)
      • Your document will magically appear in a scan folder on our end and will be acknowledged by an HR staff person within a short period of time (watch your email for a confirmation).  Hold on to your originals until you receive confirmation; otherwise, no need to send the originals to HR.

    Still need assistance?

    Contact Your HR TEAM!

    Retiree/COBRA Benefits

    Plan Information

    2022 Retiree & COBRA Benefits Guide
    2023 Retiree & COBRA Benefits Guide

    The City is contracted with Workterra for Retiree and COBRA insurance administration. Retirees or COBRA participants wishing to make a change must contact Workterra directly at: 888-327-2770.

    Turning 65?
    Medicare is effective the first of the month your birthday falls in.

    Retirees turning 65 within the next year do not need to make an Open Enrollment Election change in anticipation of the eventual Medicare status. Turning 65 is a “qualifying event” and the change can be made within 30 days of your birthday.  Retirees can either:

    • Drop the City’s Retiree coverage, or
    • Retain the City’s coverage to use as a secondary insurance (premiums will change depending on selection).

    NOTE: If you drop the City’s Retiree coverage, your dependents cannot stay on the insurance. They will transition to COBRA coverage, which is a limited-term benefit.

    For more information about Medicare and coordinating benefits, follow this helpful link.

    Once you have reviewed options and made your choice, contact Workterra at 888-327-2770 to request the change.

    Quick Summary

    Core Benefits Available

    CalPERS Retirement Medical (4 plan options)
    457 Deferred Compensation Dental + Orthodontic Benefit
    Short Term Disability Vision
    Long Term Disability Flexible Spending Account
    Employee Assistance
    Program
    Group & Voluntary Life Insurance

    Time Off Benefits

    Vacation Sick Leave
    Paid Holidays Military Leave
    Bereavement Leave Jury Duty Leave
    Personal Time Off/
    Management Leave*
    Maternity/Paternity Leave

    *Eligibility Depends on bargaining unit and position.

    Historical Summary of Employee Benefits - by Union

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