City of Nacogdoches 2021 Enrollment Guide

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VISION INSURANCE - LOW PLAN CARRIER: LINCOLN FINANCIAL NETWORK: SPECTERA ● You will pay less out of pocket when you choose an in-network provider. ● Locate an in-network provider at www.myspectera.com. ● You must submit a claim form for out-of-network expenses. ● LASIK surgery discounts available ELECTION MONTHLY EMPLOYEE COST Employee Only $8.67 Employee & Spouse $16.43 Employee & Child(ren) $19.27 Employee & Family $27.12 COVERED BENEFITS IN-NETWORK OUT-OF-NETWORK Eye Exam (every 12 months) $10 copay Up to $40 reimbursement Lenses (every 12 months) Single: 100% after $10 copay Bifocal: 100% after $10 copay Trifocal: 100% after $10 copay Lenticular: 100% after $10 copay Single: $40 copay reimbursement Bifocal: $60 copay reimbursement Trifocal: $80 copay reimbursement Lenticular: $80 copay reimbursement Frames (every 24 months) Up to $130 allowance Up to $45 reimbursement Contact Lenses (every 12 months) Elective Covered Medically Necessary Up to $125 allowance 100% after $10 copay 100% after $10 copay Up to $125 reimbursement Up to $125 reimbursement Up to $125 reimbursement 20
BASIC LIFE AND AD&D INSURANCE CARRIER: LINCOLN FINANCIAL This coverage is provided by City of Nacogdoches at no cost to you. Safeguard the most important people in your life. Think about what your loved ones may face after you're gone. Term life insurance can help them in so many ways, like covering everyday expenses, paying off debt, and protecting savings. AD&D provides even more coverage if you die or suffer a covered loss in an accident. AT A GLANCE: ● A cash benefit of $20,000 to your loved ones in the vent of your death, plus a matching cash benefit if you die in an accident ● A cash benefit to you if you suffer a covered loss in an accident, such as losing a limb or your eyesight ● LifeKeys services, which provide access to counseling, financial and legal support ● TravelConnect services, which give you and your family access to emergency medical assistance when you’re on a trip 100+ miles from home You also have the option to increase your cash benefit by securing additional coverage at affordable group rates. See the enclosed life insurance information for details. ADDITIONAL DETAILS Conversion: You can convert your group term life coverage to an individual life insurance policy without providing evidence of insurability if you lose coverage due to leaving your job or for another reason outlines in the plan contract. AD&D benefits cannot be converted. Continuation of Coverage: You may be able to continue coverage if you leave your job for any reason other than sickness, injury, or retirement. Benefit Reduction: Coverage amounts begin to reduce at age 65 and benefits terminate at retirement. See the plan certificate for details. For complete benefit descriptions, limitations and exclusions, refer to the certificate of coverage. REMINDER Review your beneficiary designations 21
Page 1 and 2: EMPLOYEE BENEFITS ENROLLMENT GUIDE
Page 3 and 4: CONTENTS 04 Benefits Overview 06 Me
Page 5 and 6: BENEFITS OVERVIEW ELIGIBILITY Full-
Page 7 and 8: MEDICAL INSURANCE CARRIER: BLUE CRO
Page 9 and 10: VIRTUAL VISITS / MDLIVE When it com
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Page 13 and 14: FLEXIBLE SPENDING ACCOUNTS Why not
Page 15 and 16: FLEXIBLE SPENDING ACCOUNTS 15
Page 17 and 18: DENTAL INSURANCE CARRIER: BLUE SHIE
Page 19: VISION INSURANCE - HIGH PLAN CARRIE
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Page 25 and 26: VOLUNTARY LIFE INSURANCE CARRIER: L
Page 27 and 28: LONG TERM DISABILITY INSURANCE CARR
Page 29 and 30: ENROLLMENT INSTRUCTION The City of
Page 31 and 32: IMPORTANT CONTACTS BENEFIT CARRIER

City of Nacogdoches 2021 Enrollment Guide

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