FHCSD 2013 Employee Benefits Package - Family Health Centers ...

family health centers
of san diego
2013
Employee Benefits Overview Brochure
Elm Street Family Health Center
City Heights II Family Health Center
KidCare Express III
Family Health Centers of San Diego
823 Gateway Center Way,
San Diego, California, USA 92102
Telephone: 619-515-2300
www.fhcsd.org
Logan Heights Family Health Center
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Family Health Centers of San Diego (FHCSD) was established in
1970 as a result of a demonstration led by community activists
and a well-known grandmother and Barrio Logan resident, Laura
Rodriguez. Laura was involved in many worthy causes and
dedicated her life to improving the community of Barrio Logan.
Most special to her heart, was “La Clinica”.
Family Health Centers of San Diego Founder
Laura Rodriguez
Table of Contents
After growing up without a neighborhood health facility, Laura was
inspired to lead a movement to establish a clinic in Barrio Logan
for children in her community. Once the clinic opened, Laura
worked tirelessly for 24 years to ensure its success. She was
known for her famous tamales and once said, “Making tamales
while talking about the health center’s needs has put me in
contact with hundreds of folks who helped build our center. After
all, Barrio Logan is my neighborhood. I will give it the best I’ve
got.” Laura had a humble beginning but received many awards
and was recognized as a Presidential “Point-of-Light”. Today
FHCSD is the second largest federally qualified health center in
the nation, and we honor Laura by fulfilling our mission to provide
caring, affordable, high quality healthcare and supportive services
to anyone in need.
Welcome........................................................................................................................................3
Benefits-at-a-Glance.......................................................................................................................4
Eligibility and Enrollment ...............................................................................................................5
Medical Plan Choices......................................................................................................................6
Medical Plan Highlights..................................................................................................................7
Preventive Care Services..................................................................................................................8
Prescription Drug Coverage..............................................................................................................9
Dental Plan Choices......................................................................................................................10
Vision Plan...................................................................................................................................11
Flexible Spending Accounts....................................................................................................12 - 13
Life and AD&D Insurance..............................................................................................................14
Long Term Disability and Supplemental Insurance...........................................................................15
Retirement 403(b) and 457(b) Plans..............................................................................................16
Wellness......................................................................................................................................17
Additional Benefits................................................................................................................18 - 19
Glossary of Terms.........................................................................................................................20
Keeping You Informed...................................................................................................................21
Employee Benefits Service Center..................................................................................................22
Notes..........................................................................................................................................23
Important Contact Information...........................................................................................Back Cover

Welcome
Welcome to Your 2013 Employee Benefits
At Family Health Centers of San Diego, we believe one of our most important investments is providing a
competitive employee benefits program. We appreciate the value of our employees and the contributions they bring
to the workplace and to our mission. We know our employees view their benefits package as an important part of
their total compensation.
For 2013, we are pleased to offer our employees and their families a comprehensive benefits package. This
year, we made a decision to continue our policy of paying a significant portion of the employee and dependent
premiums. This is an investment in the health of our valued employees and helps insure the health of their loved
ones.
This guide was prepared to assist FHCSD employees in making informed decisions regarding their benefits. The
benefits package offers a variety of coverage options that help our employees choose a plan that best meets their
needs. Please read the guide carefully and keep it as a decision-making reference.
We acknowledge benefit packages are complex. To help facilitate a better understanding of the available benefits,
Family Health Centers of San Diego partnered with Intercare Insurance Solutions to develop a benefit hotline for
our employees and their family members. This toll-free number insures our employees have immediate access to
accurate and timely answers to their benefit questions.
Contact the Employee Benefits Service Center
Extension 4200 or 877-679-2011
service@intercaresolutions.com
Hours: Monday through Friday
7:00 a.m. to 5:30 p.m. Pacific Time
Closed on major U.S. holidays
Regards,
Fran Butler-Cohen
CEO
3

Benefits-at-a-Glance
Medical
BENEFIT
Basic Life and AD&D
Long Term Disability (LTD)
Employee Assistance Program (EAP)
COVERAGE OPTIONS
COSTS SHARED BY YOU AND Family health Centers of San Diego
• UnitedHealthcare SignatureValue Advantage HMO
• UnitedHealthcare SignatureValue HMO (Full Network)
• Kaiser Permanente HMO
• SIMNSA HMO
100% OF COSTS PAID BY Family health Centers of San Diego
• The Standard
Benefit is equal to 2x annual earnings to a minimum of $40,000
and a maximum of $500,000.
• The Standard
Benefit is equal to 50% of monthly salary to a maximum of
$10,000/month for up to 24 months.
• Horizon Health
Up to 3 face-to-face counseling sessions per incident for you or any
member of your household.
100% OF COSTS PAID BY YOU
Dental
• CIGNA DHMO
• Principal Dental EPO
• Principal Dental PPO
• SIMNSA DHMO
Vision • Vision Service Plan PPO
• The Standard
Additional Life Insurance
The minimum you can elect is $10,000. Coverage is available in
$10,000 increments up to a maximum of $500,000. Spouse and
child(ren) coverage is also available.
• The Standard
Enhanced Long Term Disability (LTD) Benefit is equal to 60% of monthly salary to a maximum of
$12,000/month up to the current retirement age (age 65).
• Contribute up to $2,500 pre-tax dollars per year for eligible
Flexible Spending Accounts (FSA)
healthcare expenses.
• Contribute up to $5,000 pre-tax dollars per year for eligible
dependent care expenses.
• Aflac Supplemental Benefits
Additional Benefits
• LegalShield and Identity Theft Shield
• VPI Pet Insurance
Retirement Benefits
403(b) Retirement Plan
• Principal Financial Group
You may contribute up to 50% of your pre-tax earnings up to the
federal maximum of $17,500 (additional catch-up contribution of
$5,500 available if you turn age 50 or over anytime during the year).
457(b) Retirement Plan
• Principal Financial Group
You may contribute up to 100% of your pre-tax earnings up to the
federal maximum of $17,500.
4

Eligibility and Enrollment
Who is Eligible?
All regular Family Health Centers of San Diego (FHCSD)
employees working 30 or more hours per week are
eligible for benefits on the first of the month following
three (3) months of employment.
You can also enroll your eligible dependents for
medical, dental, vision, and voluntary life insurance
coverage. Your eligible dependents include:
Medical, Dental and Vision:
• Your legal spouse or domestic partner
• Your adult children, stepchildren or children of your
domestic partner to age 26 regardless of marital or
student status
• Any children for whom you are required to provide
coverage under a Qualified Medical Child Support
Order
Disabled Child:
• Your unmarried children, step-children or children of
your domestic partner of any age, if they are incapable
of self-care due to a physical or mental disability
Refer to the carrier documents for enrollment requirements
Paying For Coverage
FHCSD pays a significant portion of health premium
costs for you and your eligible dependents. The portion
that you pay for medical, dental and vision is deducted
from your paycheck on a pre-tax basis.
When You Can Enroll
The plan year for benefits is January 1 st to December
31 st . If you do not enroll for coverage during your
eligibility period, you must wait until the next Open
Enrollment period (unless you have a qualifying
event).
How To Enroll
Enrollment is simple and online. You will use
BeneTrac to enroll in your benefits, to check your
coverage and update beneficiaries during the year.
To enroll in BeneTrac online, follow these easy steps:
• Enter the following address into your browser:
https://www.eenroller.net/login.asp?ST=FHSD7891
• Your BeneTrac User Name is your Employee ID.
• Your temporary BeneTrac Password is the last four
digits of your Social Security number. You will be
asked to change your password once you login for
the first time.
• Please use the link “Click here if you have
forgotten your User Name or Password” if you
need help with your BeneTrac User Name or
Password.
• Once you’ve reviewed your personal information
and enrolled/changed your benefits, you will
finalize your changes by clicking on the “Review
and Finalize” button to approve your changes.
Choose Carefully!
The benefit plan year for FHCSD is January 1 st to December 31 st . The benefits you select will stay in place
through December 31, 2013 unless you have a qualifying event as defined by the IRS.
Examples of a qualifying event include:
• Change in marital status (marriage, divorce, legal
separation)
• Change in dependents (birth, adoption, death)
• Change in employment, benefits eligibility, or
cost of benefit coverage for you, your spouse or
dependent
• Reduced hours at work for you or your spouse
• Change in residence causing loss of coverage
• Medicare or Medicaid entitlement for you, your
spouse or dependent
• Loss of other coverage for your dependent
• Qualified Medical Child Support Order (QMCSO)
You must notify Human Resources, and provide documentation, within 30 days of the qualifying event. The
election change must be consistent with the event. Benefit election decisions will then remain in force for the
remainder of the plan year.
5

Medical Plan Choices
Stay Healthy with Medical Coverage
Chula Vista Family Health Center Providers
As a foundation for your good health, FHCSD provides you with a selection of medical plans that offer quality,
flexibility and value.
UnitedHealthcare HMO
You have the option to select the UnitedHealthcare SignatureValue Advantage HMO or the UnitedHealthcare
SignatureValue HMO (Full Network). If you choose either HMO you must select a primary care physician
(PCP) who will manage your care and refer you to a specialist when needed. Each family member may choose
his/her own PCP. The employee and his/her covered dependents must select the same plan. Additionally,
UnitedHealthcare covers treatment for infertility services for the diagnosis of an underlying condition only.
SignatureValue Advantage HMO
• Same high quality care as the SignatureValue HMO (Full Network)
• A slightly more limited network of providers means you will pay less for your medical care
• No access to providers at Scripps Coastal Medical Group, Scripps Clinic and UCSD
SignatureValue HMO (Full Network)
• UnitedHealthcare’s complete network of HMO physicians
• Higher copayments and higher monthly contributions
• Access to providers at Scripps Coastal Medical Group, Scripps Clinic and UCSD
Kaiser Permanente HMO
As a member of Kaiser Permanente, you are encouraged to select a primary care physician, but it is not a
requirement. Most services are covered at 100% after you pay a copayment. There is no deductible with the HMO
and no claim forms for you to submit. Additionally, Kaiser is the only medical plan option that provides coverage
for the treatment of infertility.
SIMNSA Baja HMO
The SIMNSA Baja HMO is an HMO for U.S. workers and their dependents who reside in and who desire to access
care in Mexico (Tijuana and Mexicali). This plan offers a comprehensive medical coverage that includes preventive
care and fixed copays for most services. There is no annual deductible or lifetime dollar maximum. You will have
the ability to choose your own SIMNSA personal physician who will be responsible for providing or coordinating
all of your medical care, including specialty care referrals. Urgent Care Services can be accessed in the U.S. at
all non-Mexico urgent care centers, including FHCSD clinics, for an Out of Area copay.
6

Medical Plan Highlights
Features
UnitedHealthcare
signaturevalue ®
advantage network
hmo
UnitedHealthcare
signaturevalue ®
full network hmo
kaiser
permanente hmo
Employee Contributions (Per Pay Period, Except for 05/31/2013 and 11/27/2013 paychecks)
simnsa
hmo
Calendar Year Deductible
Individual None None None None
Family None None None None
Out-of-Pocket Maximum
Individual $2,000 $3,000 $1,500 N/A
Family $6,000 $9,000 $3,000 N/A
Preventive
Preventive Care Services No Charge No Charge No Charge No Charge
Adult Routine Physicals No Charge No Charge No Charge No Charge
Well-Woman Care No Charge No Charge No Charge No Charge
Well-Baby Preventive Care No Charge No Charge No Charge No Charge
Routine Check-ups (Ages 2-18) No Charge No Charge No Charge No Charge
Immunizations @ PCP No Charge No Charge No Charge No Charge
PHYSICIAN SERVICES
PCP/Specialist Office Visits
$20 Copay (PCP);
$40 Copay (Specialist)
$20 Copay (PCP);
$40 Copay (Specialist)
$20 Copay (PCP);
$40 Copay (Specialist)
$7 Copay
Therapy* $20 Copay $20 Copay $20 Copay $10 Copay
Laboratory and X-Rays - Standard No Charge No Charge No Charge No Charge
Complex X-Rays - CT, MRI, PET $50 Copay $200 Copay No Charge No Charge
Maternity Care No Charge $20 Copay No Charge $7 Copay
Infertility Services Not Covered Not Covered 50% Per Visit Not Covered
Hospital Services
Inpatient Hospital
$250 Copay
Per Admission
$400 Copay
Per Admission
$250 Copay
Per Admission
No Charge
Outpatient Surgery $125 Copay $400 Copay $100 Per Procedure No Charge
Emergency Room
Urgent Care Services
$100 Copay
$40 Copay;
$100 Copay (Out of Area)
$150 Copay
(Waived if Admitted)
$40 Copay;
$75 Copay (Out of Area)
$100 Copay
(Waived if Admitted)
$20 Copay
$25 Copay
(Waived if Admitted);
$100 Copay
(Out of Area)
$25 Copay;
$50 Copay (Out of Area)
Ambulance $50 Copay $50 Copay $50 Copay No Charge
Mental Health
Mental Health Inpatient
You
Pay
FHCSD
Pays
$250 Copay
Per Admission
You
Pay
FHCSD
Pays
$250 Copay
Per Admission
$250 Copay
Per Admission
No Charge
Mental Health Outpatient $40 Copay $40 Copay $20 Per Visit $7 Copay
Chiropractic 1 $15 Copay $15 Copay $15 Copay Not Covered
*
Outpatient Medical Rehabilitation Therapy (Physical, Occupational and Speech)
1
Limited to 20 visits/year.
You
Pay
FHCSD
Pays
You
Pay
FHCSD
Pays
Employee Only $15.00 $210.61 $30.00 $308.47 $15.00 $185.67 $0.00 $79.43
Employee + 1 Dependent $72.50 $412.53 $127.50 $600.18 $72.50 $358.94 $0.00 $143.10
Employee + Family $112.50 $552.97 $195.00 $803.44 $112.50 $479.45 $0.00 $249.22
7

Preventive Care Services
All medical plans cover preventive care services that meet the requirements of federal and state law, including
certain screenings, immunizations and physician visits. If you visit in-network providers, you don’t have to worry
about any out-of pocket costs for preventive care services. If you use an out-of-network provider, a deductible and
out-of-network expenses may apply.
Child Preventive Care (Birth to 18 years)
Preventive Physical Exam
Age-appropriate screening tests may include:
• Newborn screenings
• Vision screening
• Hearing screening
• Developmental and behavioral assessments
• Oral health assessment
• Screening for lead exposure
• Height, weight and body mass index (BMI)
• Screening for sexually transmitted infections
Immunizations:
• Hepatitis A
• Hepatitis B
• Diphtheria, Tetanus, Pertussis
• Varicella (chicken pox)
• Influenza (flu)
• Pneumococcal (pneumonia)
• Human Papillomavirus (HPV)
• Haemophilus Influenza type B (Hib)
• Measles, Mumps, Rubella (MMR)
• Meningococcal (meningitis)
Adult Preventive Care (Age 19 and older)
Preventive Physical Exams
Age-appropriate screening tests may include:
• Cholesterol screening for high risk adults
• Blood pressure
• Screening for depression
• Type 2 Diabetes screening for adults with high
blood pressure
• Breast cancer screening, including exam and
mammography
• Screening for sexually transmitted infections
• HIV screening
• Osteoporosis screening
• Colorectal cancer screening
• Intervention services (includes counseling and
education):
• Screening and counseling for obesity
• Genetic counseling for women with a family
history of breast or ovarian cancer
• Behavioral counseling to promote a healthy
diet
• Primary care intervention to promote
breastfeeding
• Screening and behavioral counseling related
to tobacco use
• Screening and behavioral counseling related
to alcohol misuse
Immunizations:
• Hepatitis A
• Hepatitis B
• Varicella (chicken pox)
• Influenza (flu)
• Pneumococcal (pneumonia)
• Human Papillomavirus (HPV)
• Measles, Mumps, Rubella (MMR)
• Meningococcal (meningitis)
8
This is not a contract or policy. This list is not a contract with UnitedHealthcare, Kaiser or SIMNSA. If there is any difference between this sheet and the group policy, the provisions
of the group policy will govern. Please talk with your doctor about specific health guidelines. This summary of preventive care and physical exam benefits is a brief overview.
Preventive Health Guidelines reflected in this document are recommendations for individuals of average risk. Individuals who are higher-risk, including but not limited to those in
certain racial/ethnic groups or with personal/family medical history, should check with his/her health care provider for preventive health guidance. Please see your Summary Plan
Description as amended, for coverage exclusions and limitations.

Prescription Drug Coverage
All the medical plans have prescription drug benefits.
Kaiser members will coordinate prescriptions through
Kaiser Permanente. You can receive up to a 100-
day mail order supply for maintenance medications.
UnitedHealthcare members can utilize both retail
pharmacy and mail order (90-day supply through
Prescription Solutions by OptumRx via online, phone,
or mail). SIMNSA members are only able to fill
prescriptions at pharmacies in Mexico; prescriptions
are not covered in San Diego.
The following information applies to both
UnitedHealthcare HMO plans.
Mail Order
If you take maintenance medications for chronic
conditions, such as high blood pressure, asthma or
diabetes, using the mail order service can save time
and money.
When using the mail order service, you will receive a
90-day supply for just twice the 30-day copayment.
That’s a 3-month supply for the cost of 2!
Want to Save Money? Think Generic!
Generic drugs may be an effective substitute
for their brand name counterparts and can cost
significantly less. Ask your physician if a suitable,
alternative generic drug is available.
You have three methods to choose from when ordering
refills:
• Online - www.prescriptionsolutions.com
• By Phone - 800-562-6223
• By Mail - Complete the Order or Reorder Form and
mail with payment in full to the address listed on
the form
Retail Pharmacy
Present your medical plan ID card at a participating
pharmacy. You will pay a copayment based on the type
of prescription you receive. You will receive a 30-day
supply for your prescription.
Features
UnitedHealthcare
signaturevalue ®
advantage network
hmo
UnitedHealthcare
signaturevalue ®
full network hmo
kaiser
permanente hmo
simnsa
hmo
Retail Pharmacy Copayment (up to a 30-day supply)
Generic $10 $10 $10
Brand Name $25 $25 $25
Non-Formulary $35 $35 Not Covered
Mail Order Copayment (90-day supply UnitedHealthcare / 100-day supply kaiser)
$10 Copay
Generic $20 $20 $20
Brand Name $50 $50 $50
Not Covered
Non-Formulary $70 $70 Not Covered
Logan Heights Family Health Center Pharmacy Staff
9

Dental Plan Choices
Dental Clinic Family Health Center Staff
Enhance Your Smile with Dental Coverage
Strong teeth and gums are an important part of good health, which is why FHCSD offers you and your eligible
dependents a choice of dental plans to help pay for many of the dental expenses you and your family incur.
The Principal Dental EPO and PPO plans are accepted at FHCSD Dental Clinic locations. All the plans help you
pay for most necessary dental services and supplies, including diagnostic and preventive care (such as exams,
cleanings, and X-rays), and basic and major restorative services (such as fillings, crowns, and dentures). Review
the comparison chart below for a summary of plan features.
Features
CIGNA dhmo
principal
dental epo
principal dental ppo
simnsa dhmo
In-Network Only In-Network Only In-Network Out-of-Network* In-Network Only
10
Employee Contributions (Per Pay Period, Except for 05/31/2013 and 11/27/2013 paychecks)
Employee Only $8.23 $13.59 $19.76 $6.62
Employee + 1 Dependent $15.65 $25.50 $37.07 $11.91
Employee + Family $20.01 $41.60 $60.29 $20.67
Calendar Year Deductible/Maximum
Calendar Year Deductible
(Individual/Family)
None $50 / $150 $50 / $150 None
Calendar Year Maximum
Benefit per Person
None $1,000 $1,000 None
Preventive & Diagnostic Care (Deductible Waived)
Routine Exams, Teeth
Cleaning, Bitewing X-rays
Basic Care
Oral Surgery, Endodontics,
Fillings
Major Care
Inlays, Onlays, Crowns
Orthodontia
$5 Copay for
Office Visits
Refer to Schedule
of Benefits**
Refer to Schedule
of Benefits**
24-Month
Treatment Fee
$1,600/Child
$1,800/Adult
100% 100% 80% 100%
90% 90% 80%
60% 60% 50%
Not Covered
Not Covered
Refer to Schedule
of Benefits**
Refer to Schedule
of Benefits**
24-Month
Treatment
$50/Visit
*When using a non-PPO (out-of-network) provider, you pay your coinsurance plus any amount over the prevailing charge, which is the price most providers in
the geographic area charge for a specific service.
**You can find the full schedule of benefits on BeneTrac.

Vision Plan
Take a Look at Vision Coverage
FHCSD provides vision coverage through Vision Service
Plan (VSP). VSP has one of the largest networks of
private practicing optometrists, ophthalmologists and
opticians.
You have the option to visit a VSP in-network provider or
an out-of-network provider. Your out-of-pocket costs will
be lower if you visit an in-network provider. You will not
receive a VSP I.D. card as it is not required to receive
service. Simply call a VSP network doctor to schedule
an appointment and be sure to tell them you are a VSP
member. The doctor and VSP will handle the rest!
To locate and select a VSP
provider, visit www.vsp.com
or call Customer Service at
800-877-7195.
Logan Heights Family Health Center Vision Care Staff
Special Discounts!
In addition to the vision benefits provided through
your FHCSD benefits program, VSP offers special
discounts on a number of non-covered services,
such as additional pairs of glasses, special lens
options and LASIK surgery.
Vision Service Plan
Features
Out-of-Network
In-Network
Reimbursement
Employee Contributions (Per Pay Period, Except for 05/31/2013 and 11/27/2013 paychecks)
Employee Only $3.82
Employee + Spouse $6.55
Employee + Child(ren) $6.68
Employee + Family $10.77
Benefits
$20 copay
Materials Copay
Applies To Lenses + Frames or
Lenses Only (When Keeping the Same Frames)
Exam
$20 Copay, Then
$20 Copay
Once Every 12 Months
Plan Pays Up To $45
Lenses
Once Every 12 Months
• Single Vision
After Materials Copay,
Plan Pays:
Up to $30
After Materials Copay,
• Bifocal Up to $50
No Charge
• Trifocal Up to $65
Frames
Plan Pays Up To $130 (Retail) +
Plan Pays Up To $70 (Retail)
Once Every 24 Months
20% Off the Amount Over Your Allowance
Contact Lenses (In Lieu of Glasses)
Once Every 12 months
• Contact lens exam (fitting & evaluation)
Plan Pays Up To $60
Plan Pays Up To $45
• Materials (contacts)
Plan Pays Up To $150
Plan Pays Up To $105
11

Flexible Spending Accounts
How the FSA Works
You can reduce your taxable income by participating in the Flexible Spending Account (FSA) plans. The FSA plan
year is January 1 - December 31, 2013. There are two spending accounts you can enroll in:
• Health Care Account - $2,500 per year maximum
• Dependent Care Account - $5,000 per year maximum per household
If you are married and file a separate federal income tax return, you may set aside up to $2,500 for dependent
care. You may choose to participate in one or both of the spending accounts. The money that you contribute
is deducted from your paycheck in equal amounts during the year, except for 5/31/2013 and 11/27/2013
paychecks. Your contributions are deducted before Federal, State, and Social Security taxes are taken out.
Health Care FSA
The Health Care FSA allows you to pay for eligible
health care out-of-pocket costs from your FSA
account. Some examples of eligible expenses include:
• Deductibles & Copayments
• Medically Necessary Maintenance & Support
Devices
• Treatment of Alcoholism or Drug Dependency
• Dental, Vision and Hearing:
• Dental Checkups & Orthodontics
• Glasses & LASIK
• Hearing Aids (including batteries)
Dependent Care FSA
The Dependent Care FSA provides you with the opportunity
to pay for childcare, elder care or other qualified dependent
care services. To qualify for reimbursement, services need to
be related to the care of:
• Children under the age of 13 who are listed as
dependents on your income tax return
• Dependents of any age who are incapable of caring
for themselves and who regularly spend at least 8
hours a day in your home
• Daycare expenses are defined as those that are
necessary in order for you (and your spouse, if
you’re married) to continue working
Eligible Dependent Care expenses, covered while you
are at work, include:
• Babysitters & Day Care Centers
• Nursery School/Preschool
• After School Care Programs
Save Money with a Flexible Spending Account (FSA)
Visit https://fsacalc.ceridian.com/fsacalc/fsacalculator.aspx to see how you can reduce your taxable income
and save money by enrolling in a Flexible Spending Account!
12

Flexible Spending Accounts
Getting Reimbursed
When you have an eligible expense, you can:
• Submit a claim for reimbursement and;
• choose to receive a check by mail or,
• have a direct deposit to your checking or
savings account
• Have funds automatically deducted from your
account by using your FSA Benefits Card.
The Benefits Card can only be used with your Health
Care FSA dollars. You must submit receipts for
reimbursement for your Dependent Care expenses. Your
Health Care and Dependent Care accounts function
separately. You cannot use funds from one account to
pay for eligible expenses from the other account (for
example, using Dependent Care account funds for
health care expenses).
Important IRS Rules
Since you are allowed to reduce your taxes through
your participation in the FSA, certain IRS restrictions
apply.
Any money that you set aside for your Health Care
or Dependent Care accounts that is not used or
reimbursed for claims incurred through December 31,
2013 will be forfeited. Do not contribute more than
the amount you are sure you will use during the plan
year for eligible expenses.
The FSA Benefits Card makes using your Health Care
FSA dollars quick and easy. The card deducts each
payment directly from your FSA account.
You may be occasionally asked to submit your receipt
as proof of an eligible expense. Remember to keep
original receipts for your records as you may be required
to provide documentation directly to the IRS in the
event of a personal tax audit.
13

Life and AD&D Insurance
Basic Life Insurance (paid by FHCSD)
Life insurance protects your family or other
beneficiary(s) in the event of your death while you
are still actively employed at FHCSD. Your coverage
amount will be paid to the beneficiary(s) of your
choice. FHCSD pays for coverage in the amount of:
• Two times your annual earnings
• The benefit amount is a minimum of $40,000 to a
maximum benefit of $500,000
Accidental Death & Dismemberment (paid
by FHCSD)
If your death is due to an accident, your beneficiary
will receive an additional amount through Accidental
Death and Dismemberment (AD&D) coverage. AD&D
coverage is equal to your life insurance coverage
amount. AD&D benefits are payable if you pass away,
lose a limb, or have a loss of speech, hearing, or
eyesight because of a covered accident (either on or
off the job) and the loss occurs within one year of the
covered accident.
The payable amount of your AD&D benefit depends
on the type of loss. In the event of death due to an
accident, your beneficiary(s) may receive both your life
and AD&D benefits.
Note: You will automatically be covered under the
Basic Life Insurance plan.
Designate a Beneficiary!
Don’t forget to designate a beneficiary(s) for your
life and AD&D Benefits.
Open Enrollment is a good time to make sure
your beneficiary information is current and up to
date. You can designate beneficiary in BeneTrac,
our online enrollment system.
Contact the Family Health Centers of San Diego
Employee Benefits Service Center at extension
4200 or 877-679-2011 if you have any
questions.
Downtown Family Healthy Center Staff
Additional Life Insurance (paid by you)
It is important to have enough life insurance protection
for your family. If you determine you need more than
the Basic Life coverage, you may want to supplement
coverage for yourself and your eligible dependents.
To determine how much your premiums will cost for the
Voluntary Life, logon to BeneTrac or to the FHCSD HR
Intranet.
For You
For Your
Spouse
For Your
Children
Voluntary Life Insurance
Coverage is available in $10,000 increments.
Benefit amount is a minimum of $10,000 up to
$500,000.
Guaranteed Issue: $150,000
Coverage is available in $5,000 increments.
Benefit amount is a minimum of $5,000 up to
$500,000 (not to exceed 100 percent of your
additional life coverage).
Guaranteed Issue: $25,000
6 Months to age 21 or 24 (if full-time student) -
$10,000
Guaranteed Issue: $10,000
Guaranteed Issue amounts only apply for newly eligible
employees. If you are electing Additional Life Insurance
outside of when it was initially offered to you, or
amounts is over the guaranteed issue amounts, you will
be required to furnish a Medical History Statement for
approval by the insurance company before coverage can
become effective.
14

Long Term Disability and Supplemental Insurance
Prepare for the Unexpected with Long Term
Disability
Long Term Disability (LTD) insurance provides a portion
of your income if you become unable to perform your
regular job duties for 90 days due to illness or injury.
FHCSD offers you two levels of coverage:
• Base LTD plan (paid by FHCSD)
• Enhanced LTD plan (paid by you)
LTD works with Social Security and any other group
disability coverage to provide you with a combined
monthly benefit equal to:
Base LTD Plan (paid by FHCSD)
• 50% of your monthly pre-disability earnings, up to
$10,000 per month for up to 24 months
Enhanced LTD Plan (paid by you)
Aflac Supplemental Insurance
The following Aflac supplemental plans are
available to you:
• Term Life insurance
• Disability Income Protector
• Sickness Indemnity
• Hospital Protection
• Accident Indemnity
• Cancer Indemnity
• Hospital Intensive Care
• Specified Health Event
Contact Aflac directly to enroll for coverage. See
the back cover for contact information.
• 60% of your monthly pre-disability earnings, up
to $12,000 per month up to your Social Security
Normal Retirement Age under the Enhanced plan
To determine how much your premiums will cost for the
Enhanced LTD plan, logon to BeneTrac or to the FHCSD
HR Intranet.
Note: You will automatically be covered under the Base
LTD plan if you do not enroll for coverage under the
Enhanced LTD plan.
Grossmont Spring Valley Family Health Center
15

Retirement 403(b) and 457(b) Plans
403(b) Plan 1
The 403(b) plan gives you the opportunity to save
pre-tax dollars for your retirement and receive an
employer matching contribution. Eligible employees
may begin making salary deferral contributions on the
first monthly entry date.
You can save from 1 percent to 50 percent of your
total pay up to a maximum deferral of $17,500 for
2013. If you are 50 years or older during the plan year
and you have met the annual maximum deferral, you
may contribute a catch-up deferral of up to $5,500
in 2013. Your salary deferrals are 100% vested
immediately.
FHCSD will make a matching contribution based on
the schedule below:
Years of service
FHCSD match
Less than 1 year 0%
1 year but less than 4 25%
4 or more years 50%
Note: Elective deferral contributions that are over 6 percent of
compensation will not be matched.
FHCSD may make a discretionary contribution in an
amount equal to the following:
years of service
FHCSD Contribution
Less than 1 year 0%
1 year but less than 4 1%
4 or more years 2%
Contributions will be automatically directed to the
plan’s investment default if you do not choose any
investment option(s). You have a menu of funds to
choose from if you wish to direct your investments
beyond the plans default investments.
1
Retirement plan contributions will occur on all 26 pay periods.
457(b) Plan 1
The 457(b) plan is a non-qualified deferredcompensation
retirement plan that is available for
governmental and certain non-governmental employers.
The plan operates similarly to our 403(b) plan and
allows participants to save beyond the limits of the
403(b) plan alone.
You can enroll in the plan if you hold the title of
Director, or Licensed Independent Practitioner, have
completed 90 days of service and work a minimum of
20 hours per week.
You can save from 1 percent to 100 percent of your
total pay up to a maximum deferral of $17,500
for 2013. Your salary deferrals are 100% vested
immediately.
Contributions will be automatically directed to the
plan’s investment default if you do not choose any
investment option(s).
For detailed information about your investment options,
please contact Principal at www.principal.com or call
800-547-7754.
Access Your Retirement Plan Anywhere!
View your retirement account from
the Principal Financial Group ®
anytime and anywhere – with this
free and secure mobile app for
Apple, Android and Blackberry.
Search “Principal Financial” in
your app store to download.
16

Wellness
Wellness
We care about your health and well-being. Elevating
our health is aligned with our cultural values and more
importantly, is in the best interest of every individual
in our organization. Achieving optimal wellness can
increase your well-being, social success, efficiency at
work and overall energy and happiness.
There are several great programs available to you that
help you be well. We encourage you to take advantage
of these programs and resources.
Employee Assistance Program
Because unresolved personal issues can affect every
aspect of one’s life, FHCSD offers you and your family
the Horizon Health Employee Assistance Program
(EAP) at no cost to you. Call the EAP for confidential
assistance with nearly any personal matter you may
be experiencing, including substance abuse, stress,
anxiety, financial concerns, legal concerns, grief and
loss. Counselors can provide free access to in-person
counseling, dependent care referrals, other community
referrals, and written information. The program includes
up to three face-to-face assessment and counseling
sessions per incident per year.
Help When You Need It!
A single call will connect you to a specialist who
will provide you with immediate assistance.
Health Discounts
FHCSD provides discounts on memberships to:
• 24-Hour Fitness
• Curves
• Weight Watchers
Safety Starts With Me
Create and maintain a culture of safety
that values and demonstrates behavior to
promote a safe environment for all.
Our Be Alert! Don’t Get Hurt! Safety and Recognition
Program encourages employee participation in improving
safety in the workplace, and rewards and acknowledges
employees who take action and provide solutions for
work-related safety issues.
Safety Kudos - You can give a co-worker a Safety
Kudos ticket whenever you observe them taking safety
measures in their daily work activities.
Safety Quest - On a quarterly basis, you will
have access to an on-line safety quest for safety
information. All entries submitted with a score of
100% will be entered into a drawing for prizes.
Safety Suggestions - The employee who submits the
best safety suggestion each quarter will receive an
award.
888-293-6948
You can also login to the EAP website at:
www.horizoneap.com
Login ID: standard Password: eap4u
17

Additional Benefits
18
529 CollegeBoundfund Savings Plan
The Section 529 plan through AllianceBernstein
provides a tax-advantaged way for you to save for
college. You contribute to an account on an after-tax
basis and use the money to pay for qualified expenses
(e.g., tuition, books, room and board) for you or your
child(ren). Your earnings in the account will be free
from any federal income taxes.
MEDEX® Travel Assist
This benefit protects you when you travel for business
or pleasure at least 100 miles from your home.
Pre-trip and medical assistance, transportation and
evacuation services are available 24 hours a day.
Coverage is automatic, and FHCSD pays the full cost
for you and your eligible dependents.
New
in
2013
Pet Insurance
VPI Pet Insurance offers affordable
plans for dogs, cats, birds, reptiles
and other exotic pets. Policies cover
a wide range of care, from minor ailments to serious
conditions such as cancer and heart disease. VPI Pet
Insurance reimburses for office visits, prescriptions,
treatments, lab fees, X-rays, surgeries, hospitalization
and more. Pet owners are free to visit any veterinarian
as VPI has coverage in all 50 states including
Washington D.C.
For more details or if you are interested in enrolling,
please contact VPI at 1-877-738-7874 or on line at
www.petinsurance.com/affiliates/fhcsd.
Additional Benefits
• Employee Referral Bonus: A cash bonus is paid to
employees who refer an applicant who are hired
to work at FHCSD. For more information, see HR
policy and www.fhcsd.jobs.
• CPR Certification class offered every other month.
• Union Bank: Benefits include a $50 welcome
bonus when you open a new checking account, no
monthly service charge, free welcome package of
checks, free debit card, free online banking and
bill pay and discounted safe deposit box.
• Movie (AMC & Regal/United Artists/Edwards) and
theme park discounts (Southern California locations).
LegalShield TM
You can enroll in the legal assistance plan, which
is designed to help you with many everyday issues,
including traffic violations, credit problems, child
custody matters, and landlord issues. As a participant
in the LegalShield plan, you will have access to a wide
variety of attorneys from top law firms in your area.
Identity Theft Shield TM
You have the option to enroll for Identity Theft Shield
identity theft protection. This benefit may save you time
and money - and restore your name and credit for you if
your identity is stolen. Trained experts provide you with
fraud alert notifications, perform proactive database
searches, and continuously monitor your credit.
New
in
2013
benefit plan
LegalShield
Employee, Spouse/DP &
Child(ren)
Identity Theft Shield
Employee and Spouse/DP
LegalShield
+ Identity Theft Shield
Employee and Spouse/DP
LegalShield
+ Identity Theft Shield
Employee, Spouse/DP &
Child(ren) to age 18
DP: Domestic Partner
Holidays*
employee contribution
(Per Pay Period, Except
for 05/31/2013 and
11/27/2013 paychecks)
$7.98
$6.48
$12.95
$13.45
Each year FHCSD observes a number of paid holidays,
giving you the opportunity to spend quality time with
family and friends. The following holidays will be
observed in 2013:
• New Year’s Day
• Memorial Day
• Independence Day
• Labor Day
• Thanksgiving Day
• Day after Thanksgiving
• Christmas Day
• Birthday Holiday**
*Regular employees who work at least 24 hours per week are eligible
for holiday pay from commencement of employment. Holiday hours
will be paid to an eligible part-time employee only when a holiday
falls on a day that he/she works on a regular basis and at the same
number of hours regularly scheduled that day.
**All regular employees who work 40 hours per week are eligible to
take their birthday as a paid holiday. Birthday holidays will not be
granted until successful completion of the orientation period.

Additional Benefits
Paid Time Off and Extended Sick Insurance 1
PTO (Paid Time Off) and ESI (Extended Sick Insurance) are benefits provided by FHCSD to ensure employees have
periodic time off for personal recreation and relaxation or while you or a family member is recovering from an illness or
injury.
All regular employees who work 24 or more hours weekly accrue PTO and ESI credit each pay period based on the
percentage of time or number of hours worked for that particular pay period. Part-time employees working less than
24 hours per week, or on-call, per diem or temporary employees are not eligible for PTO/ESI.
PTO Accrual Rate
Maximum PTO accrual is 320 hours.
ESI
Length of Service Days per year Hours per pay period
0 to 4 years 16 days (128 hours) 4.93 hours
5 to 9 years 19 days (152 hours) 5.85 hours
10+ years 22 days (176 hours) 6.78 hours
In most cases, ESI is used for illnesses or injuries that last three or more days. The first two days of illness is
usually paid from your PTO bank (if available). Three days of ESI may be used for bereavement of the death of a
family member. Family members include child, spouse and parent.
ESI Accrual
Full-time regular employees earn 3 days (24 hours) per year of ESI. ESI accrues at a rate of 0.92 hours per pay period.
ESI hours are available for use as they are earned each pay period. You can earn up to a maximum of 720 hours.
1
Employees who have not completed their orientation period accrue PTO/ESI during orientation time, but are not allowed to use PTO/ESI until
successful completion of that period.
Service Awards
All regular full-time and part-time employees are eligible to receive a service award upon completion of five years
of service and at the end of every additional five years of service. Service does not have to be continuous to count
toward service credit for the award.
Discounted Care at FHCSD Clinics
As an employee of FHCSD you, and your immediate family members, are eligible to receive discounted services at
our clinic locations. See the table below for a list of discounted services.
Department
Employee
Discount**
Exceptions
Self Pay
Deposit
Maximum Self-
Pay Discount***
Exceptions
Adults 50% Yes* $35 80% Yes*
Pediatrics 50% Yes* $35 80% Yes*
Women’s 50% Yes* $35 80% Yes*
Dental 25% Yes* Variable** 25% Yes*
Vision Care 40% Yes* $65 40% Yes*
Speech, Hearing, Early Int. 50% No $40 50% No
ENT 50% No $40 50% No
Other Specialties 50% Yes* $40 50% Yes*
* Purchased materials/supplies – costs plus handling fee.
X-Ray and Pharmacy are not subject to discount.
Some procedures discounted down to cost, plus handling fee (i.e. lab,
glasses frames).
** Depends upon treatment rendered. Typical range is $35.00 to $50.00.
*** Subject to minimum fee of $35.00 as well as income and number of
family members.
19

Glossary of Terms
Employee Contribution: The portion an employee
contributes towards their benefits through payroll
deductions.
Copayment: The amount which a covered individual is
required to pay for certain services after meeting any
applicable deductible.
Deductible: The amount of out-of-pocket expenses
that must be paid for services by the insured before
becoming payable by the carrier.
Eligibility: Conditions that an employee must satisfy to
participate in a plan or obtain a benefit.
Enrollment Period: The period of time you have to sign
up for an insurance plan.
EPO: An Exclusive Provider Organization (EPO) is a
network of providers that provide discounted services
to their members. Members are reimbursed only when
in-network providers are used.
Formulary: A list containing the names of certain
prescription drugs that a medical plan covers when
dispensed to its members who have drug coverage.
Guaranteed Issue: The amount of life insurance
coverage you are guaranteed to receive without the
requirement of medical history or examination.
HMO: Health Maintenance Organizations (HMO) offer
a range of health care services at a fixed price and
require that covered individuals see doctors that are
in their network of providers. HMOs require a referral
to network providers after the member has selected a
Primary Care Physician.
In-Network: Medical, dental and vision providers or
facilities who have agreed to discounted fees with
insurance carriers to participate within their provider
networks.
Inpatient: A person who occupies a hospital bed, crib
or bassinet while under observation, care, diagnosis or
treatment for at least 24 hours.
Mail Order Prescriptions: A method of dispensing
medication directly to the patient through the mail
by means of a mail-order drug distribution company.
Offers greatly reduced costs for prescriptions,
especially for long term drug therapy.
Medical Group (network): An organization of physicians
who are generally located in the same facility or
participate in a group network and provide services to
covered individuals.
Member: A person eligible to receive, or receiving,
benefits from an insurance policy. Includes both those
who have enrolled or subscribed and their eligible
dependents.
Non-Formulary: A drug or medication not listed and
approved on a health insurance plan coverage schedule.
Out-of-Network: A healthcare provider with whom an
insurance carrier does not have a contract to provide
services. A member may pay higher copays, coinsurance
and/or deductibles to see an out-of-network provider or
have no coverage at all.
Out-of-Pocket Maximum: The maximum amount of
money a person will pay in addition to copays and
deductibles, in a calendar year.
Outpatient: A person who visits a clinic, emergency
room or health facility and receives health care without
being admitted as an overnight patient.
PCP: Primary Care Physician (PCP) provides treatments
for routine illness and injuries. For members enrolled in
an HMO Plan, a PCP will need to refer the member to a
specialist.
PPO: Preferred Provider Organizations (PPO) have a
network of providers whose services are available to
members at lower cost that services of out-of-network
providers. PPOs allow members to self-refer to any
network provider at any time.
Premium: The amount of money an insurance company
charges for insurance coverage.
Reasonable & Customary: The prevailing charge
made by physicians of similar expertise for a similar
procedure in a particular geographic area.
Wellness: A healthy balance of the mind, body and
spirit that results in an overall feeling of well-being and
leads to a high quality of life.
20

Keeping You Informed
The following important notices can be found on the FHCSD Intranet.
• CA Maternity Coverage
• Continuation of Benefits under COBRA
• Medicaid and the Children’s Health Insurance Program (CHIP)
• Medicare Part D Creditable Coverage
• Newborn And Mothers Health Protection (Out of CA) Act Of 1996
• Patient Protection (Primary Care Physician (PCP) and OB/Gyn selection)
• Privacy Rights
• Qualified Medical Child Support Orders (QMCSO)
• Special Open Enrollment Rights for Certain Individuals under Health Insurance Portability and Accountability
Act of 1996 (HIPAA)
• Wellness Plan Notice
• Women’s Health & Cancer Rights Act
This guide is intended to provide an overview only of the benefits offered by Family Health Centers of San Diego. It is not an offer of
coverage or intended to offer medical advice. It does not contain all plan provisions, limitations and exclusions. Consult your plan
documents (Schedule of Benefits, Certificate of Coverage, Group Insurance Certificate, Booklet, Booklet-Certificate, Group Policy) to
determine governing contractual provisions relating to your plan. In the event of a conflict between this guide and your plan document,
the plan documents will always govern.
Intercare Insurance Solutions California Insurance License 0D80830
21

Employee Benefits Service Center
Employee Benefits Service Center
The Family Health Centers of San Diego Employee
Benefits Service Center, brought to you by Intercare
Insurance Solutions, is proud to offer you a one-stop
shop for your benefits questions.
Here are some of the services we provide:
Claims Assistance
I received a bill from my doctor. I thought these
services were covered. What do I do now?
Referral/Pre-authorization
I need to see a specialist, but I’m having trouble
getting a referral. What do I do?
Eligibility Issues
I tried to pick up a prescription today, but the
pharmacy is saying that I’m not covered. Why?
Benefit Inquiries
I need to have surgery; does my insurance cover it?
How much will my portion of the cost be?
Plan Education
I am on vacation away from home and I need to see
the doctor. What do I do?
Supply Requests
I lost my ID card. How do I get another?
COBRA Administration
I left my employment and need to continue my coverage.
What do I do?
Our service representatives speak English, Spanish,
and Portuguese. For additional languages, we use
over-the-phone translation services.
Employee Benefits Service Center
Ext. 4200
or Call Toll-Free 877-679-2011
Monday through Friday
7:00 a.m. to 5:30 p.m. PST
Closed on major U.S. holidays
E-mail: service@intercaresolutions.com
Fax: 866-214-2211
All inquiries will be responded to within
24 hours of your call or e-mail.
22

Notes
23

Important Contact Information
Benefit
carrier
group
number
phone number
web address
Online Enrollment
System
BeneTrac N/A N/A
https://www.eenroller.net/login.
asp?ST=FHSD7891
User Name: Employee ID
UnitedHealthcare SignatureValue
Advantage HMO
UnitedHealthcare
SignatureValue HMO (Full Network)
525640
525638
800-624-8822 www.uhcwest.com
Medical
Mail Order Prescriptions N/A 800-562-6223 www.prescriptionsolutions.com
Kaiser Permanente HMO 116102 800-464-4000 www.kp.org
SIMNSA HMO 820 800-424-4652 www.simnsa.com
CIGNA DHMO 3335274 800-244-6224 www.cigna.com
Dental
Principal Dental EPO & PPO H44295-1 800-247-4695 www.principal.com
SIMNSA DHMO 820 800-424-4652 www.simnsa.com
Vision Vision Service Plan PPO 30028835 800-877-7195 www.vsp.com
Life/AD&D The Standard 643599 800-628-8600 www.standard.com
LTD The Standard 643599 800-368-1135 www.standard.com
EAP Horizon Health EAP N/A 888-293-6948
www.horizoneap.com
Login ID: standard
Password: eap4u
Travel Assistance Medex N/A 800-527-0218 operations@medexassist.com
FSA Ceridian L06825 877-799-8820 www.ceridian-benefits.com
Aflac Supplemental
Benefits
Aflac RH826 800-992-3522 www.aflac.com
Legal Services LegalShield 14257 800-654-7757 www.legalshield.com
Identity Theft Identity Theft Shield 14257 888-494-8519 www.legalshield.com
Pet Insurance VPI N/A
877-PETS-VPI
(877-738-7874)
www.petinsurance.com/
affiliates/fhcsd
403(b) Plan Principal Financial Group 446501 800-547-7754 www.principal.com
457(b) Plan Principal Financial Group 610033 800-547-7754 www.principal.com
529 Savings Plan
AllianceBernstein
CollegeBoundfund
703584 800-227-2900
www.collegeboundfund.com
(general info)
www.corporatecollegeboundfund.
com
User ID: FHCSD
Password: COLLEGEFUND