Active Employee Benefits

Active employees can choose from among several medical and dental plans, as well as vision, life insurance, and other coverage. During this enrollment, take a special look at the High-Deductible Medical Plan options.

Open Enrollment is your annual opportunity to reconsider your City of Atlanta benefit options and make changes, if appropriate, for you and your family. The City continues to offer you a wide variety of benefit options, including two high-deductible and two traditional Medical Plan options, choices in Dental Plan coverage, a Vision Plan, supplemental life insurance, and flexible benefits.

 

New for the 2017-2018 Benefits Plan Year

Tobacco Use Surcharge

As we announced in April 2017, a $50 per month surcharge will be added to your medical premium if you use a tobacco product.

The surcharge will not apply if you pledge to enroll in a tobacco cessation program, offered through your selected Medical Plan (BCBS or Kaiser), by September 1, 2017. You will need to be tobacco free for two months and complete a Tobacco Use Attestation Form, available from Employee Benefits.

Tobacco use is defined as any use of tobacco products within the past two months. It does not include the religious or ceremonial use of tobacco.

Extended Benefits Plan Year 

Our fiscal year 2018 Benefit Plan Year will be extended to 16 months (versus the current 12 months) to allow the City to move from a fiscal plan year (September to August) to a calendar plan year (January to December). The benefits of moving to a calendar year include making it easier to manage the Flexible Spending Accounts and running our enrollment season on the same schedule as other municipalities and companies.

The rates for the 2017-2018 plan year will run from September 2017 through December 2018. We will have a short plan year (from September 2018 through December 2018) to allow the participants in the Flexible Spending Accounts to extend coverage beyond August 31, 2018.

During that time, we also will allow active and retired employees an opportunity to make changes to the Medical, Dental and Vision Plans before we move to the calendar year schedule. Additionally, the deductibles and out-of-pocket maximums for those plans will be extended during the September 2018 through December 2018 period. For example, your $500 deductible for medical will be extended for 16 months instead of 12.

BCBS POS

In the BCBS POS…

  • Premiums will decrease slightly,
  • Emergency Room visit copays will increase to $300 (a $50 increase), and
  • The ambulance fee per trip increases to $300 (a $50 increase).

Kaiser Permanente HMO

In the Kaiser Permanente HMO, premiums will increase slightly.

In addition… 

  • The Emergency Room visit copay will increase to $300 (a $50 increase).
  • The ambulance fee per trip will increase to $300 (a $50 increase).
  • The copay for a specialist office visit will increase to $35 (a $5 increase).
  • And the copay for filling a generic prescription drug will increase to $20 KP/$30 NWK (a $5 increase).

No Other Plan Design Changes

There are no changes in the BCBS or Kaiser high-deductible Medical Plans or in the Dental, Life, Short-Term Disability or Voluntary Insurance Plans.

 

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Medical Plan Options

The City of Atlanta offers two high-deductible and two traditional Medical Plan options. Consider carefully when choosing a plan. Your out-of-pocket costs include your paycheck contribution, the plan’s annual deductible, copayments, and coinsurance. This year, take a special look at the two high-deductible plans. Though the deductible is higher than in a traditional plan, the paycheck contribution is significantly lower. This means your out-of-pocket costs for the year might be less than what you would pay under a traditional plan option.

High-Deductible Medical Plan Options

Alongside the traditional Medical Plan options, the City of Atlanta is pleased to offer additional choices again this year. These plan options are called “high-deductible” plans, because their initial deductibles are higher than under the traditional plans. In return, however, you pay a lower premium. They also have some special features not found in traditional plans.This type of healthcare plan, also known as a “consumer-directed” type of health plan, has shown encouraging results in controlling costs for both participants and employers. More importantly, high-deductible plans achieve this goal by focusing on the individual’s health, involving you more directly in the way you consume health care, and helping you make more informed healthcare decisions.There are two high-deductible plan options to choose from:

  • Lumenos with Health Savings Account, offered by Anthem Blue Cross Blue Shield
  • Kaiser HMO High-Deductible Health Plan

Important Features

  • Both high-deductible plans include Health Savings Accounts (HSAs). You can contribute pre-tax dollars to your HSA and use them to help meet your annual deductible responsibility and other out-of-pocket health costs. Unused HSA dollars can be saved or invested and carried over into future years. In addition, the City of Atlanta will contribute to your HSA each year — $500 for individuals, and $750 for families (employee plus one or more dependents).
  • Both plans cover 100% of in-network preventive care, even before you meet the deductible. Preventive care is paid by the plan, not with dollars from your HSA.
  • Once you have satisfied the plan’s out-of-pocket maximum, your in-network allowable expenses will be paid at 100% for the remainder of the year.
  • Under the Lumenos plan, you may receive care from either in-network or out-of-network providers. To receive the highest level of reimbursement (80%), you should obtain services in-network. You will receive a lower level of reimbursement for out-of-network care (60%) and pay more of the costs.
  • Under the Kaiser HMO plan, only in-network care is covered. The Plan pays 90% after the deductible for covered services.
  • Active employees can earn up to $250 additional funding in incentives paid at the end of the plan year (August 2018) from the City in their HSA: $150 for an annual exam, $50 for completion of an online Health Risk Assessment (HRA), and $50 for obtaining a biometric screening from your PCP.

Here is how the two plans work.

Feature Fact
Health Savings Account
First, use your HSA to pay for covered services. You can contribute pre-tax dollars and use them to help meet your annual deductible. Unused HSA funds roll over from year to year.
Contributions to Your HSA
For 2017-2018, you can contribute up to the following:

  • $3,450 for individual coverage
  • $6,900 for family coverage
  • $1,000 catch-up contribution for members age 55 or older

Note: These limits apply to all combined contributions from any source, except rollover funds.

City of Atlanta Contribution
The City makes a contribution to help you get started.
Employer Contribution

  • $500 for individual coverage
  • $750 for family coverage
Free Preventive Care
To help you stay healthy, preventive care is covered at 100%, including certain screenings, immunizations, and physician visits.
Preventive Care
There is no deduction from your HSA or any out-of-pocket costs for you if you receive your preventive care from in-network providers.
Meet Your Deductible
The deductible is the annual amount you pay, either out-of-pocket or using your HSA, before you reach the traditional health coverage portion of the plan.
Lumenos with HSA Kaiser HMO HDHP
In-Network

  • $1,300 individual
  • $3,900 family
Out-of-Network

  • $2,500 individual
  • $7,500 family
In-Network Only

  • $1,300 individual
  • $3,900 family
Traditional Health Coverage
After you meet your deductible, the plans work like traditional PPO or HMO plans. You pay coinsurance (a percentage of charges), and the plan pays the rest.
In-Network

  • Plan pays 80% after deductible for network providers
  • Plan pays 80% after deductible for network pharmacies
Out-of-Network

  • Plan pays 60% after deductible for out-of-network providers
  • Plan pays 80% after deductible for out-of-network pharmacies
In-Network Only
Plan pays 90% after deductible for covered services
Out-of-Pocket Maximum
For your protection, the total amount you spend out-of-pocket is limited. Once you spend that amount, the plan pays 100% of the cost for covered services for the remainder of the year.
In-Network

  • $3,500 individual
  • $7,000 family

Deductible counts toward maximum

Out-of-Network

  • $7,000 individual
  • $14,000 family

Deductible counts toward maximum

In-Network Only
Under the Kaiser plan, you meet your out-of-pocket maximum once you’ve met your annual deductible

Covered services under the two plans are generally the same as those under the BlueChoice POS and Kaiser HMO plans.

Using Your Health Savings Account

An HSA provides you with the opportunity to save money on a pre-tax basis to pay for medical expenses now or in the future. Unused HSA funds roll over from year to year, and can even be saved for use during your retirement years. Your HSA belongs to you — you can even take the account with you if you leave employment with the City.

You will receive a debit card to pay for qualified medical expenses using your HSA. And, if you have money in your HSA, the plan will automatically draw from your HSA funds to pay for deductible-related expenses before billing you for health care services and supplies.

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Traditional Medical Plan Options

Traditional Medical Plan Options

Following are details about the traditional Medical Plan options available to you. For a chart showing a side-by-side comparison of the BlueChoice POS and Kaiser Permanente HMO Plans, see your enrollment guide.

BlueChoice POS Plan

BlueChoice POS Plan

Primary Care Physician

A primary care physician, or PCP, is a doctor who specializes in family or general practice, internal medicine, or pediatrics and participates in the BlueChoice Option network. Each BlueChoice Option member must select a PCP. Your PCP is responsible for providing or coordinating necessary care for you 24 hours per day, seven days a week. For additional medical information, call BlueChoice On-Call, available 24 hours per day, seven days a week.

Blue Cross Blue Shield of Georgia will designate a PCP for you if you do not list one on your Enrollment Application. You may change your PCP by notifying Blue Cross Blue Shield of Georgia. If notification is received prior to the 25th of the month, the PCP will change on the first of the following month. Notification after the 25th will delay the change a month.

In-Network versus Out-of-Network

As a BlueChoice Option member, you have the ability to receive services either from providers in the BlueChoice Option network or outside this network. Generally, you will pay less out of your own pocket if you elect in-network services. In-Network Services are those services that are either provided or coordinated by your PCP. Some services do not require PCP coordination. Please keep in mind that even though a referral is not required for certain services, you must select a provider from the network directory to receive in-network benefits. Services that do not require a PCP referral include:

  • OB/GYN services for the treatment of an obstetrical or gynecological-related condition.
  • Covered vision care services from a network ophthalmologist or optometrist. (Routine vision services may not be covered under your policy – if you do not know if you have routine vision coverage, please call customer service at 1-800-368-0766.)
  • Dermatological care for skin-related conditions.
  • Mental Health or Substance Abuse Benefits – You may contact Blue Cross Blue Shield of Georgia Behavioral Health directly at 1-800-368-0766 without contacting your PCP.

Pre-Existing Condition Limitation and Credit for Prior Coverage

There is no pre-existing condition limitation.

Preventive Care

Preventive care visits are covered at 100% with no copay and no deductible. They include:

  • Well-child care and immunizations
  • Periodic health examinations
  • Annual gynecological examination (no PCP referral required; must use in-network provider for in-network benefits)
  • Prostate screening

Emergencies

If you have a medical emergency, call 911 or proceed immediately to the nearest hospital emergency room. A “medical emergency” is defined as “a condition of recent onset and sufficient severity, including but not limited to severe pain, that would lead a prudent layperson possessing an average knowledge of medicine and health, to believe that his or her condition, sickness, or injury is of such a nature that failure to obtain immediate medical care could result in their health being in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ.”

Prescription Drugs

BlueChoice Option offers prescription drug coverage through a pharmacy network that includes many national pharmacy chains and select local pharmacies. Coverage is provided according to our preferred drug formulary for prescriptions written by a network physician and filled at a network pharmacy. Out-of-network prescriptions also are subject to the preferred drug formulary.

Medications with a generic equivalent will be filled as generic unless the physician indicates DAW (dispense as written). If DAW is not indicated, members who choose the brand over the generic will pay the applicable copayment plus the difference in cost between the brand name and the generic. All specialty medications must be filled through the Mail Order program.

Summary of Limitations and Exclusions

Your Summary Plan Description will provide you with complete benefit coverage information. Some key limitations and exclusions, however, are listed below:

  • Care or treatment that is not medically necessary
  • Cosmetic surgery, except to restore function altered by disease or trauma
  • Dental care and oral surgery; except for accidental injury to natural teeth, treatment of TMJ, and extraction of impacted teeth
  • Routine physical examinations necessitated by employment, foreign travel, or participation in school athletic programs
  • Occupation-related illness or injury
  • Treatment, drugs, or supplies considered experimental or investigational
  • Surgical or medical care for: artificial insemination, in-vitro fertilization, reversal of voluntary sterilization, radial keratotomy, learning disabilities, mental retardation, hyperkinetic syndrome, or autistic disease of childhood
  • Smoking cessation products

Prior Authorization

Your PCP must coordinate most in-network services. For in-network services, your PCP (or the specialist to whom you were referred by your PCP) will be responsible for ensuring that any surgical procedures or inpatient admissions obtain the necessary prior authorization. For out-of-network services, you should be sure that Blue Cross Blue Shield Healthcare Plan of Georgia has authorized the following procedures prior to these services being rendered:

  • Home health care services
  • All outpatient surgery, including laparoscopic and arthroscopic procedures
  • Durable Medical Equipment over $250
  • MRIs
  • EMGs
  • All scopes, including endoscopy and colonoscopy
  • Myelography
  • Cardiac catheterization
  • Infertility services

Note: This list is subject to change. If you receive out-of-network treatment and prior authorization was not obtained, all charges will be denied. You, the member, will be responsible for all charges.

Vision

The coverage will be limited to one eye examination for corrective lenses per member in a 12-month period (corrective lenses include contacts as well as glasses). Office visit copayment should be the same as for any other specialist ($30 in-network and 70% of UCR, after the deductible, out-of-network).

The City will not cover lenses, frames, disposable, or hard contact lenses and POS members are encouraged to utilize the BCBS discounted vision program.

Additional Information

Should you need additional information, the resources are your Provider Directory/Member Guide and your Summary Plan Description. You also may visit www.bcbsga.com for more information. If you have specific questions that require an answer from a BCBS representative, please call one of the following numbers:

  • Customer Service: 1-800-368-0766
  • Blue Cross Blue Shield of Georgia Behavioral Health (Mental Health/Substance Abuse Services): 1-800-368-0766
  • BlueChoice On-Call: 1-888-724-2583

It is important to keep in mind that this material is a brief outline of benefits and covered services and is not a contract. Please refer to your Summary Plan Description for a complete explanation of covered services, limitations, and exclusions.

Wellness Programs Through Blue Cross Blue Shield

We continue to emphasize and encourage you and your family to both practice preventive care and take advantage of the 360° Health programs for maintaining your health. 360° Health® from Blue Cross Blue Shield of Georgia (BCBSGa) is a total health solution that surrounds you with an integrated suite of resources and health programs designed to give you the information and support your need to reach your own level of optimal wellness. From online resources to personalized interactions with registered nurses, 360° Health can help you become more engaged in your health care and make the decisions that are right for you.

Some of the exciting resources BCBSGa are making available to you include:

  • ConditionCare programs* – For eligible employees and their dependents diagnosed with asthma (pediatric and adult), chronic obstructive pulmonary disease (COPD), heart failure (HF), coronary artery disease (CAD), or diabetes (pediatric and adult). To register, simply call 1-800-638-4754.

*For the ConditionCare programs, a nurse may proactively initiate telephone calls throughout the year to determine if you or a covered family member might benefit from the program. The program supports you and your physician’s care plan. Of course, participation in the program is completely voluntary and confidential.

  • 24/7 NurseLine – Talk with a registered nurse any time. Simply call 1-888-724-2583 (also located on your BCBSGa insurance card). (Hint: program this number into your cell phone.)
  • Future Moms – Your start to a healthy pregnancy. Please join this award-winning maternity management program for great information, support, and materials. Register today: 1-866-664-5404.
  • Healthy Lifestyles – Online and in-person coaching for a healthier life. This lifestyle program focuses on tobacco use, exercise, weight management, self-care, stress management, nutrition, depression prevention, and medication adherence.
  • MyHealth Assessment (employees only) – A health risk appraisal that can be completed online at www.bcbsga.com — $50 incentive for completion of health risk assessment (HRA), $50 incentive for obtaining a biometric screening from your PCP or at a City-sponsored screening site, and $150 incentive for completion of your annual physical with your PCP.
  • Healthy Living – A trusted health information resource powered by WebMD and brought to us at no charge as BCBSGa members.
  • Anthem Care Comparison – A tool that will allow you to compare healthcare providers, treatment options, and pharmaceutical products.
  • Special Offers – A discount program for you that will give you access to a wide variety of services and products like fitness club memberships, Weight Watchers®, and Jenny Craig®—the list goes on and on. Access these discounts at  www.bcbsga.com.

We hope these free and confidential resources will help you and your families become healthier and improve your view on health. To access the online tools, simply register one time at www.BCBSGa.com to create your own user name and password. (To register please have your BCBSGa insurance card – the only time you will need it.)

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Kaiser Permanente HMO

Kaiser Permanente HMO

Get the Most Out of Your Health Plan

  • 24-hour Nurse Advice – Kaiser’s nurses are here for you 24/7. For general questions, or urgent advice, please contact us at 404-365-0966 or 1-800-611-1811.
  • Specialties – Kaiser has added even more specialties to our growing list of services. Go to www.kp.org to see which specialties are available at each of our medical facilities.
  • Strive to Thrive – Wellness Coaching by Phone: Whether you want to eat healthy, quit tobacco, manage your weight, exercise more, or reduce stress, Kaiser’s wellness coaches can help you find ways to succeed. Wellness coaching is done over the telephone and offered to members at no cost. Call 1-866-862-4295 to get started.
  • Healthworks Wellness Plan – $50 incentive for completion of the Total Health Assessment. $50 incentive for obtaining a biometric screening from your PCP or at a City-sponsored screening site. $150 incentive for completion of your annual physical.
  • Urgent Care – If you are considering going to the ER and don’t have a life-threatening illness or injury, call a Kaiser urgent care center—they may be able to take care of you more quickly and at a lower out-of-pocket cost to you.

Kaiser Permanente Urgent Care Centers Adult: Monday – Friday, noon to 10 p.m.; Saturday and Sunday, 10 a.m. to 6 p.m. Pediatrics: Monday – Friday, 6 p.m. to 8 p.m.; Saturday and Sunday, 10 a.m. to 6 p.m. (Panola Medical Center: 10 a.m. to 2 p.m.)

  • Townpark Comprehensive Medical Center, 750 Townpark Lane, Kennesaw, GA 30144
  • Southwood Medical Center, 2400 Mt. Zion Parkway, Jonesboro, GA 30236
  • Panola Medical Center, 5400 Hillandale Drive, Lithonia, GA 30058
  • Gwinnett Comprehensive Medical Center, 3650 Steve Reynolds Boulevard, Duluth, GA 30096

Preventive Care

Preventive care visits are covered at 100% with no copay and no deductible. They include:

  • Immunizations
  • Well-child physicals
  • Annual adult physicals
  • Annual gynecological examination
  • Mammograms
  • Prostate screening

Where do I receive medical care?

When you join Kaiser Permanente, you pick your own personal physician from the group of doctors practicing at any Kaiser medical center. Currently, Kaiser Permanente has 26 conveniently located medical centers throughout metro Atlanta: Alpharetta, Brookwood at Peachtree, Cascade, Crescent, Cumberland, Decatur, Douglasville, East Cobb, Conyers, Fayette, Forsyth, Glenlake, Gwinnett, Henry, Holly Springs, Lawrenceville, Newnan, Panola, Peachtree Center, Snellville, Southwood, Sugar-Hill Buford, TownPark, West Cobb, West Marietta, and Stonecrest.

For a listing of the providers covered under the Kaiser Permanente plan, please visit www.kp.org.

How do I choose or change my primary care physician?

Kaiser asks you to choose a personal physician upon enrollment so that you and your doctor can develop a partnership and work together to make sure you get the quality care you deserve. Your personal physician will guide and coordinate any care you receive in the hospital or from specialists. Having one doctor who arranges your care and knows your medical history can help you get the right care from the right people.

You may choose a physician in family medicine, general practice, adult medicine, or pediatrics/adolescent medicine as a personal physician.

How do I make an appointment?

There is one number to call to make or cancel appointments, speak with an advice nurse, or access after-hours urgent care — regardless of which Kaiser Permanente Medical Center you use. Call the Health Line at 404-365-0966 locally or 1-800-611-1811 long distance.

To schedule or cancel appointments, you may call Monday through Friday from 7 a.m. to 7 p.m. The Health Line is open so you can speak with an advice nurse 24 hours, seven days a week. You also may schedule and cancel appointments yourself by logging into www.kp.org.

What if I need to see a specialist?

As a Kaiser Permanente member, you have direct access to Audiology, Behavioral Health, Breast Care, Cardiology, Dermatology, Endocrinology, Gastroenterology, General Surgery, Infectious Disease, Nephrology, Neurology, Obstetrics/Gynecology, Oncology, Otolaryngology (ENT), Perinatology, Podiatry, Psychiatry, Pulmonology, Rheumatology, Urogynecology, Urology, Wound Care, and Pain Management. No referral is required for specialty services available at the Kaiser Permanente Medical Centers. A referral is required for specialty care outside of a Kaiser Permanente Medical Center.

What if I need to be admitted to the hospital?

Kaiser Permanente is affiliated with some of Atlanta’s most prestigious hospitals. The personal physician you choose will determine the hospital to which you will be admitted. The hospitals used for most inpatient care are: Children’s Healthcare of Atlanta at Scottish Rite, Northside Hospital, and Piedmont Hospital.

Get Connected.

Take a minute to register on www.kp.org and enjoy the 24-hour convenience of these secure online features:

  • Order prescription refills*
  • Request or cancel routine doctor’s appointments*
  • Get personalized plans for losing weight, managing stress, and eating healthy
  • Online total health assessment as well as healthy living classes

You’ll also have online access to these new, time-saving features:*

  • Email your doctor’s office
  • View certain lab tests results
  • Monitor your ongoing health conditions
  • Review past office visit information

To register, visit www.kp.org/register.

*Available for members receiving care/refilling prescriptions at Kaiser Permanente medical centers.

What should I do if I need Emergency Care?

If you have an emergency, call 911 or go to the nearest emergency room.

An emergency medical condition is a medical condition manifesting itself by acute symptoms of sufficient severity (including, but not limited to severe pain) such that a prudent layperson, with an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in:

  • Serious impairment to bodily functions; or
  • Serious dysfunction of any bodily organ or part; or
  • Serious jeopardy to the health of the individual or, in the case of a pregnant woman, the health of the woman or her unborn child.

If you are hospitalized, you should call (or have someone else call) the Kaiser Permanente Health Line—404-365-0966 (locally) or 1-800-611-1811 (long distance)—to notify us of your hospital admission as soon as you can within 24 hours of your admission. This will allow us to consult with the physician providing your care and to coordinate further medical care.

You will pay a $300 copayment for emergency room services. (Emergency fees are waived if you are admitted.) Students attending school outside of the Kaiser Permanente service area will be covered for up to $1,000 for follow-up care associated with emergency services. You are responsible for 20% of the cost up to $1,000 for follow-up emergency care.

Do I fill out claim forms?

There are no claim forms required if care is provided, prescribed, or directed by a Kaiser Permanente physician. If there is a copayment, coinsurance, or deductible, you will be expected to pay at the time you receive the services.

If you have any questions about claims, please call a Claims Services Representative at 404-365-0966.

What if I have additional questions?

Call Customer Services at 404-365-0966 (locally) or 1-800-611-1811 (long distance). You also can visit www.kp.org.

City of Atlanta Active Employees
PCP Selection If a PCP is no chosen upon enrollment, one will be assigned based upon the medical center closest to your home.
Customer Service 404-365-0966
800-611-1811 toll-free
Monday – Friday, 8:30 a.m. until 9 p.m.
Saturday – Sunday, 8 a.m. until 2 p.m.
Referral Self-referral to Mental Health/Chemical Dependency, Dermatology and OB/GYN Care. All other specialty care services require prior authorization from your PCP.

Summary of Limitations and Exclusions

Your Group Agreement or Evidence of Coverage will provide you with complete benefit coverage information. Some key limitations and exclusions, however, are listed below.

  • Services that are not medically necessary
  • Certain exams and other services required for obtaining or maintaining employment or participation in employee programs or required for insurance or licensing, or on court order or for parole or probation
  • Cosmetic services
  • Custodial or intermediate care
  • Services that an employer or a government agency is required by law to provide
  • Experimental or investigational services
  • Eye surgery, including laser surgery, to correct refractive defects
  • Services for conditions arising from military service
  • Services related to the treatment of morbid obesity (except certain health education programs that are covered)
  • Routine foot care
  • Sexual reassignment services
  • Reversal of voluntary sterility
  • Conditions covered by Workers’ Compensation or under employer liability law

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Dental Plan Options

Dental Plan Options

The City of Atlanta offers two PPO Dental Plan options (with and without orthodontia coverage) and one dental HMO.

Following are details about the Dental Plan options.

Dental PPO Options Through Blue Cross Blue Shield Dental

The Blue Cross Blue Shield of Georgia Dental Plan lets you visit any licensed dentist or specialist you want, with costs that are normally lower when you choose a network provider. You pay the BCBS negotiated rate for covered services from participating dentists even if you exceed your annual benefit maximum. There is no deductible for diagnostic and preventive services.

Emergency Dental Treatment Overseas

As a BCBS of Georgia dental member, you and your eligible covered dependents automatically have access to the International Emergency Dental Program. With this program, you may receive emergency dental care from our listing of credentialed dentists while traveling or working nearly anywhere in the world.

If You Are Pregnant or Living With Diabetes

If you are pregnant or living with diabetes, you can sign up to receive one additional dental cleaning or periodontal maintenance procedure per year.

BCBS Dental PPO High Option
(with orthodontia)
Low Option
(without orthodontia)
Annual Benefit Maximum (per person) $2,000 $2,000
Annual Deductible (individual/family)* $50/$150 $50/$150
Dental Services BCBS pays: BCBS pays:
Diagnostic and Preventive Services (exams, cleanings, X-rays) 100% 100%
Basic Services (fillings, extractions, root canals, periodontic scaling, and root planning) 80% 80%
Major Services (crowns, dentures, bridges) 50% 50%
Orthodontic Services (adults and dependent children) 50% Not Covered
Orthodontia Lifetime Maximum (per person) $1,500 N/A

*Deductible waived for diagnostic/preventive services.

Limitations and Exclusions

Here is a partial listing of Dental Plan limitations and exclusions.

  • Exams and cleanings – Limited to two per calendar year.
  • Complete series X-rays – Limited to once every five years.
  • Topical fluoride application – Limited to once every 12 months for members through age 18.
  • Sealants – Limited to first and second molars once every 24 months per tooth through age 15.
  • Fillings – Limited to once per surface per tooth in any 24 months.
  • Fixed or removable dentures, partials and bridges – Covered once in any seven-year period.
  • Orthodontia (High Option only) – Limited to one course of treatment per member per lifetime.
  • Dental implants – Not covered.
  • Wisdom teeth – Surgical extraction of wisdom teeth not covered if teeth do not exhibit symptoms or affect oral health of the member.

Dental Plans

Finding a Dentist

To select a dentist by name or location:

  • Go to bcbsga.com/my dental, or
  • Call Customer Service at the toll-free number listed on the back of your ID card.

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Dental HMO Through Delta Dental

With the Delta Dental DHMO program, you have coverage for preventive, basic, and major services, and you can take advantage of:

  • Lowest payroll deduction option
  • No deductibles
  • No annual maximum
  • Generally lower out-of-pocket expenses than a traditional program

Delta Dental Description of Benefits and Copayments

Choice of Dentists

Delta Dental contracts with dentists in the community to provide quality care to our members. To receive benefits, you and each of your dependents must select a dental facility from the Delta Dental list of participating dental offices. Dentists undergo a thorough review process prior to participation in the network. If you wish, you may select a different dentist for each covered dependent so that each covered dependent can receive dental care where it is most convenient.

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Vision Plan

United Healthcare Vision Benefits

Covered Services

The United Healthcare Vision plan covers the following services.

  • Comprehensive vision exam – $15 copay, once every 12 months. A vision examination is provided by a network optometrist or ophthalmologist, after applicable copay.
  • Materials – $25 copay. The materials copay is a single payment that applies to the entire purchase of eyeglasses (lenses and frames), or contacts in lieu of eyeglasses.
  • Pair of lenses (for eyeglasses) – Once every 12 months. Standard single vision, lined bifocal, lined trifocal, and lenticular lenses are covered in full. Standard scratch-resistant coating, tints, and UV also are covered in full. Options such as progressive lenses, polycarbonate lenses, and anti-reflective coating may be available at a discount.
  • Frames – Once every 12 months. The plan provides a $130 frame allowance at both private practice and retail providers.
  • Contact lenses (in lieu of eyeglasses) – Once every 12 months. Both elective and “necessary”* contact lenses are covered in full after applicable copay. The fitting/evaluation fees, contacts (including disposables), and up to two follow-up visits are covered in full (after applicable copay) for many popular brands, such as Acuvue by Johnson & Johnson and Optima by Bausch & Lomb. If covered disposable contact lenses are chosen, up to six boxes (depending on prescription) are included when obtained from a network provider. (It is important to note that UnitedHealthcare Vision’s covered-in-full contact lenses may vary by provider.)

A $150 allowance is applied toward the fitting/evaluation fees and purchase of contact lenses outside of UnitedHealthcare Vision’s covered-in-full contacts (materials copay does not apply). Toric, gas permeable, and bifocal contacts are all examples of contacts that are outside of our covered-in-full selection. *“Necessary” contact lenses are determined at the provider’s discretion for one or more of the following conditions: following cataract surgery; to correct extreme vision problems that cannot be corrected with spectacle lenses; with certain conditions of anisometropia; with certain conditions of keratoconus. If your provider considers your contacts necessary, you should ask your provider to contact UnitedHealthcare Vision concerning the reimbursement that UnitedHealthcare Vision will make before you purchase such contacts.

  • Laser vision benefit – UnitedHealthcare Vision has partnered with the Laser Vision Network of America (LVNA) to provide our members with access to discounted laser vision correction providers. Members receive 15% off usual and customary pricing, 5% off promotional pricing at over 500 network provider locations and even greater discounts through set pricing at Lasik Plus locations. For more information, call 1-888-563-4497 or visit www.uhclasik.com.

Benefits for Services From Out-of-Network Providers

The plan will pay certain benefits obtained from out-of-network providers.

Service Amount
Exam – Optometrist or Ophthalmologist Up to $40
Lenses:

  • Single vision
  • Bifocal
  • Trifocal
  • Lenticular
 

  • Up to $40
  • Up to $60
  • Up to $80
  • Up to $80
Frames Up to $45
Contact lenses (in lieu of eyeglasses):

  • Elective
  • Necessary
 

  • Up to $150
  • Up to $210

If you choose an out-of-network provider, you will need to send your itemized receipts, with the primary-insured’s unique identification number and the patient’s name and date of birth, to:

UnitedHealthcare Vision
P. O. Box 30978
Salt Lake City, UT  84130
Fax: (248) 733-6060

Please note: Receipts for services and materials purchased on different dates must be submitted together at the same time to receive reimbursement.

Provider Locator

With UnitedHealthcare Vision you are able to choose from network private practice providers and retail chain providers. Prior to enrolling in or using the UnitedHealthcare Vision program, if you would like to identify a network provider, visit www.myuhcvision.com or call UnitedHealthcare Vision’s Provider Locator Service at 1-800-839-3242 and follow the voice prompts:

  • Enter the primary insured’s unique identification number.
  • Enter the ZIP code for the area you wish to check.
  • After each entry, the system will repeat what you have entered and ask that you “Press 1” if correct, or “Press 2” if incorrect.
  • The system will then identify up to three network providers in the requested ZIP code area.
  • If you wish to hear the selections again, “Press 1”. To enter another five-digit ZIP code, “Press 2”.

Prior to using your benefits at a network provider, please call the provider and make an appointment. Please inform the provider that you are a UnitedHealthcare Vision participant. PLEASE NOTE: If there are differences in this statement and the Group Policy, the Group Policy is the governing document. Please retain this Benefit Summary and Vision Care Program description that includes detailed benefit information and instructions on how to use the program. Customer Service is available toll-free at 1-800-638-3120 from 8 a.m. to 11 p.m., Monday through Friday, and from 9 a.m. to 6:30 p.m. on Saturdays. ID cards will be issued to all enrollees or may be obtained online.

Important to Remember

  • Always identify yourself as a UnitedHealthcare Vision participant when making your appointment. This will assist your provider in obtaining a claim authorization number prior to your visit.
  • Benefits are available every 12 months, based on last date of service.
  • Your $150 contact lens allowance includes the fitting/evaluation fee as well as the purchase of contact lenses. For example, if the fitting/evaluation fee is $30, you will have $120 towards the purchase of contact lenses. The allowance may be separated at some retail chain locations between the examining physician and the optical store. Toric, gas permeable, and bifocal contacts are all examples of contacts that are outside of our covered-in-full selection.

The following services and materials are excluded from coverage under the Policy:

  • Post-cataract lenses
  • Non-prescription items
  • Medical or surgical treatment for eye disease, that requires the services of a physician
  • Worker’s Compensation services or materials
  • Services or materials that the patient, without cost, obtains from any governmental organization or program
  • Services or materials that are not specifically covered by the Policy
  • Replacement or repair of lenses and/or frames that have been lost or broken
  • Cosmetic extras, except as stated in the Policy’s Table of Benefits

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Employee Life Insurance

You make a great investment in your family. You spend time with them. You care for them. You work for them, and if you’re not there for them, you want them protected. The City of Atlanta provides you with a basic amount of Group Life insurance and Accidental Death and Dismemberment Insurance (AD&D) to help protect your loved ones in the event of your death. There is an additional “In the Line of Duty” Benefit for First Responders. The City of Atlanta also provides you with the opportunity to apply for Additional Life insurance from Minnesota Life Insurance Company.

The following is an outline of the life insurance benefits that are available. This information is provided as an overview and does not constitute a contract. Please refer to the life insurance policy for detailed explanation of policy provisions. You DO NOT have to complete an application UNLESS you are making a change.

If you wish to add a dependent or change your coverage from no coverage to one time basic salary, or increase your additional coverage by more than $20,000, you must complete an Evidence of Insurability form at any Open Enrollment meeting or you may make an appointment by calling the DHR – Employee Benefits at 404-330-6036. These changes are subject to the approval by the Minnesota Life Insurance Company underwriters. However, you may drop your coverage, or any dependent coverage, during Open Enrollment.

Eligibility

To be eligible for this plan:

  • You must be an active full-time or part-time permanent employee of the City of Atlanta.
  • To enroll in the Supplemental Life plan, you must be enrolled in the Basic Life plan.
  • For Dependent Life insurance, your spouse or children must not be full-time members of the armed forces of any country.

Employee Coverage Amount

  • The City provides each active employee with $40,000 in Life and Accidental Death and Dismemberment (AD&D) coverage.
  • Active employees also can purchase Basic Life and AD&D insurance in the amount of 1 x base salary (no City contribution).
  • The Supplemental Life plan allows you to select increments of $10,000 up to $200,000 (no City contribution).

Spouse and Dependent Coverage Amount

  • Dependent Life Insurance also is available and would provide the following coverage:
    • Spouse/Domestic Partner: $5,000
    • Child between birth and six months: $600
    • Child between six months and 26 years: $5,000
    • Note that both Spouse/Domestic Partner and child coverage cannot exceed 100% of the employee’s amount of Basic Life Insurance.
  • A Surviving Spouse/Domestic Partner who is insured at the time an employee or retiree passes away will be eligible to continue his/her $5,000 life insurance coverage.

Important Notice

You, as an employee, are free to designate a minor as the beneficiary of your life insurance proceeds. However, no benefits will be paid to a child who has not yet reached the age of majority (18 years old, in Georgia). Instead, you may want to designate a guardian or trustee for the benefit of the minor. If you are considering appointing a minor as your beneficiary, you may want to consult with an attorney.

Employee Coverage Effective Date

Please contact your employee benefits representative for more information regarding the following requirements that must be satisfied for your insurance to become effective. You must satisfy:

  • Eligibility requirements
  • An eligibility waiting period
  • Evidence of insurability is required at this time for any coverage you have previously declined or for an upgrade in coverage and requests for an increase to Supplemental Life in excess of $20,000.
  • An employee must be actively at work. This means that if you are not actively at work on the day before the scheduled effective date of insurance including Dependent Life Insurance, your insurance will not become effective until the day after you complete 31 days of active work as an eligible employee.

Suicide Exclusion

Under the Supplemental Life plan, there is an exclusion for death resulting from suicide or other intentionally self-inflicted injury. The amount payable will exclude amounts that have not been continuously in effect for at least two years on the date of death.

Portability

If you leave your employment, you may be eligible to continue your group life insurance from Minnesota Life Insurance Company through the portability provision. Please see your employee benefits representative for additional information.

Conversion

If your insurance ends because your employment terminates, you may be eligible to convert the terminated coverage to an individual life insurance policy without providing evidence of insurability. Please see your employee benefits representative for additional information.

If You Become Terminally Ill

Under the Accelerated Benefit provisions, you may be eligible to receive up to 100% of your Basic Life insurance and Supplemental Life insurance (up to a maximum of $1,000,000) if you become terminally ill, have a life expectancy of less than 12 months, and meet other eligibility requirements. This benefit allows you to use the proceeds as you desire—whether to cover medical expenses or to maintain your quality of life. The amount paid under the Accelerated Benefit provision would reduce the amount of Basic Life insurance and Supplemental Life insurance payable upon your death.

If You Have Questions

If you have any questions about eligibility enrollment or life insurance coverage, contact the DHR – Employee Benefits at (404) 330-6036.

If you have questions regarding conversion of your life insurance coverage, call Minnesota Life Insurance Company at 1-866-293-6047.

Minnesota Life Insurance Company

Minnesota Life Insurance Company is one of the country’s largest group life insurers. It is among the highest rated group life insurance companies according to the independent rating agencies that analyze the financial soundness and an insurance company’s ability to pay claims. For more information about the rating agencies and to see how Minnesota Life compares to other companies, please visit www.securian.com/financials.

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Short-Term Disability

Colonial Life’s Short-Term Disability Insurance offers monthly benefit if you are disabled and can’t work due to a covered accident or covered sickness. You may choose the amount of your disability benefits to meet your needs (subject to income limits) — up to 60% of your gross monthly income up to $4,000 per month with Guaranteed Issue (no health questions). Higher monthly benefits are available up to $7,500 per month with additional underwriting.

Maternity, psychiatric, and psychological conditions are included. With Colonial Life’s guaranteed issue Short-Term Disability Insurance:

  • You are paid regardless of any other insurance you may have with other insurance companies.
  • Benefits are paid directly to you (unless you specify otherwise).
  • You may choose the amount of your disability benefits to meet your needs (subject to income limits).
  • You pay for coverage through convenient payroll deduction.
  • Your coverage is portable at ported rates.

NOTE: Colonial Life is the exclusive provider of Short-Term Disability Insurance for City of Atlanta employees. Employees transferring prior group coverage to Colonial Life will receive credit for time insured.

For more information or to enroll, schedule a one-to-one meeting with your Colonial Life Benefits Counselor. Contact the Colonial Life District Office at 770-446-7201. Visit www.visityouville.com/cityofatlanta for more information on Colonial Life benefits or to help you select which products may be best for you and your family.

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Supplemental Flexible Benefits

Supplemental Flexible Benefits

The City of Atlanta is pleased to sponsor the Supplemental Flexible Benefits Plan so you can use your pre-tax dollars to pay for several different insurance and benefits programs according to your specific needs.

Flexible Spending Accounts

Section 125 of the Internal Revenue Code currently allows you, thru payroll deduction, to elect up to $5,000 per plan year for dependent care reimbursement and up to $2,600 for unreimbursed medical expenses. ADP/WageWorks is the plan administrator.

All elected officials, appointed officials, all full-time, and part-time permanent employees are eligible to participate in the program from date of hire. The choices you make are for the full plan year.

All claims must be filed within 90 days of the end of the plan year (August 31, 2018). We will sponsor a short plan year from September 2018 through December 2018 to allow you to extend your Flexible Spending Account coverage for that period.

PLEASE NOTE: FLEX SPENDING ACCOUNT/DEPENDENT CARE ACCOUNT PARTICIPATION

There is no automatic enrollment through Oracle Self-Service and participants currently enrolled in an FSA/DCR plan will not automatically be re-enrolled for the next benefit plan year. Changes to your FSA/DCR contributions can only be made during the Open Enrollment period.

Supplemental Insurance Plans

Our supplemental insurance plans are offered by Aflac and Colonial Life. You can chose the insurer you prefer. If you’re sick or hurt, Aflac or Colonial Life Insurance pays benefits directly to you—not the hospital or doctor—to help with your expenses.

While you focus on recovery, the plan focuses on paying you quickly. Most claims are processed in about four business days.

Use benefits however you want. It’s your decision how to use the cash—use it to help pay for rent, child care, or groceries.

Coverages are available for you and your family (for most products). You will pay for premiums through payroll deduction and you will have the ability to take most coverages with you if you change jobs or retire.

Aflac Benefit Offerings

  • Lump Sum Critical Illness Insurance—(Guaranteed issue) Provides a single cash benefit to you if you are diagnosed or treated for critical illness events. The benefit is triggered by a covered serious health condition such as heart attack, stroke, end-stage renal failure, major organ transplant, paralysis, coma, and other select conditions.
  • Cancer Care Insurance—(Guaranteed issue) Pays benefits to help with the cost of cancer screening and cancer treatment including radiation, chemotherapy, hospitalization, surgery, travel, and other select expenses.
  • Accident Indemnity Insurance—(Guaranteed issue) Pays cash benefits to help with expenses in the event of a covered accidental injury, dismemberment, or death. Benefits help cover the costs that go beyond standard major medical coverage.
  • Hospital Indemnity Insurance—(Guaranteed issue*) Pays for out-of-pocket hospital expenses that may not be fully covered by major medical insurance (such as deductibles, copayments, and coinsurance), including hospitalization for injury or sickness, emergency room benefit, and other select expenses.
  • Critical Care and Recovery Insurance—(Guaranteed issue) Pays up to $25,000 benefits for a covered primary specified health event. The benefits can be used to help pay for medical treatment, living expenses, or other out-of-pocket expenses. Covered events may include coma, heart attack, stroke, coronary bypass surgery, major organ transplant, third-degree burns, paralysis, end-stage renal failure, cardiac arrest, and other select conditions.

For more information or questions, contact Aflac at 678-886-9454 or T1_Thomas@us.aflac.com.

*Pre-existing condition limitations apply: a sickness or physical condition, whether diagnosed or not, for which the insured was treated, had medical testing, received medical advice or had taken medication within 12 months before the coverage effective date. The insurer will not pay for losses that are defined as a pre-existing condition within the first 12 months of the policy.

Colonial Life Benefit Offerings

  • Group Cancer Insurance—(Guaranteed issue*) The plan helps with cancer treatment which may include radiation, chemotherapy, hospitalization, surgery, travel, extended care and other select expenses. A benefit also is payable once per calendar year for all covered persons who receive one of 17 routine cancer screening tests.
  • Group Accident Insurance—(Guaranteed issue*) Pays cash benefits to help with expenses in the event of a covered on or off the job accidental injury, dismemberment, or death. Benefits help cover deductibles, copayments, hospitalization, transportation and lodging. Health screening benefit included.
  • Group Hospital Indemnity Insurance (Medical Bridge)—(Guaranteed issue*) Pays for out-of-pocket hospital expenses that may not be fully covered by major medical insurance (such as deductibles, copayments, and coinsurance), including hospitalization for injury or sickness, outpatient surgery, diagnostic services, emergency room benefit, and other select expenses. Health screening benefit included. HSA and Non-HSA compatible plans available.
  • Group Critical Care Insurance—(Guaranteed issue amounts for up to $25,000*) Lump sum benefits of up to $50,000 benefits for a covered primary specified health event. The benefits can be used to help pay for medical treatment, living expenses, or other out-of-pocket expenses. Covered events may include cancer, heart attack, stroke, coronary bypass surgery, major organ failure, end-stage renal failure, and other select conditions. Health screening benefit included.

For more information or questions, contact Colonial Life at 770-446-7201 or www.visityouville.com/cityofatlanta.

*Pre-existing condition limitations apply: a sickness or physical condition, whether diagnosed or not, for which the insured was treated, had medical testing, received medical advice or had taken medication within 12 months before the coverage effective date. The insurer will not pay for losses that are defined as a pre-existing condition within the first 12 months of the policy.

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Deferred Compensation Plans

Deferred Compensation Plans

You have an opportunity to participate in the City of Atlanta Deferred Compensation Plan (in accordance with Section 457 of the Internal Revenue Code). This is a Deferred Compensation Plan into which you can set aside pre-tax dollars or a Roth plan with after-tax dollars—especially valuable to your overall financial planning for retirement. Please note: this plan is not a savings account.

The primary purpose of a Deferred Compensation Plan is to allow you to set aside a portion of your salary and receive its value when you retire. The amount of current earnings deferred will not be considered as income for tax purposes until its value is paid, as provided in the plan. At that time, it will be taxable as ordinary income.

By deferring payment of income taxes until you receive the value of your account as a retirement benefit, you can set aside more of your current earnings for retirement. Therefore, you may reduce the total amount of income taxes paid in your lifetime and accumulate a larger sum for retirement under the plan than if you had invested after-tax dollars outside the plan.

You may stop your contributions at any time. If you wish to increase the amount of your deferral, you may do so subject to the legal maximum at any time. If necessary, you may increase, decrease, or reinstate your deferral amount at any time. If you want to make deduction changes, contact the Department of Finance – Payroll Division or the company with whom you are participating.

Your account will begin earning investment income on the date your deferral is deposited into your account with the provider.

A distribution of all or portion of your Deferred Compensation Account is permitted in the event you experience an Unforeseeable Financial Hardship, as defined by the IRS, which is beyond your control. Evidence is required to be sent with a written request for withdrawal. For details, call the company with whom you are participating.

Note: Deferred Compensation does not affect your City Retirement or Social Security. For federal tax purposes, your W-2 will reflect only your adjusted gross income.

You should investigate the plan if you currently save on a regular basis, you are paying a substantial amount of tax, your family has two or more incomes, or you are approaching retirement.

If you make the election to participate in the City of Atlanta’s Deferred Compensation Plan (457 Deferred Compensation Plan or Roth Plan), please contact VOYA Financial Services at 1-800-564-6001.

All employees are eligible to participate. The plan is entirely voluntary. Employees may only participate with one company at a time.

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401(a) Defined Contribution Plan

401(a) Defined Contribution Plan

The City of Atlanta implemented a mandatory 401(a) Defined Contribution Plan for full-time permanent general employees (does not include sworn police officers and firefighters) hired on or after July 1, 2001.

Effective November 2005, this plan was amended to exclude full-time permanent general employees hired after that date that are classified “overtime eligible” or are in pay grade 18 or below. These employees will participate in the City of Atlanta General Employees Defined Benefit Pension Plan.

Effective September 1, 2011, all new hires at a pay grade less than 19, as well as sworn Police and Fire Department employees, are required to participate in the Combination Plan (with both a defined benefit and a defined contribution).

Employees eligible to participate in the Defined Contribution Plan must complete an enrollment form and make their investment fund selections.

For current Defined Contribution Plan participants seeking transaction assistance and account inquiries, please contact VOYA Financial Services at 1-800-584-6001. For enrollment assistance, including investment education, please call Wendy Moy at 678-462-8623. Once your account is established, you also may obtain access at www.VOYAretirementplans.com.

Upon termination, Defined Contribution Plan participants must contact VOYA Financial Services at 1-800-584-6001 to begin the process of Pension Fund withdrawal.

To access your account online: www.VOYAretirementplans.com.

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