What You Need To Know

Complete plan details are available in the Summary Plan Documents available from the Human Resources Department. In the event of any discrepancy between any document and the official Plan Document, the Plan Document shall govern.

Eligibility

Eligible Retiree
The City of San Antonio's Retiree Benefit Program is open to eligible City of San Antonio retirees and their eligible dependents. Employees who retire from the City and immediately file for retirement through the Texas Municipal Retirement System (TMRS) are eligible for the City's retiree medical benefits as follows:

• Employees with an original hire date prior to October 1, 2007 are eligible to enroll in a City retiree medical plan with     a total combined premium subsidy of 67%.
• Employees with an original hire date on or after October 1, 2007 are eligible as follows:
  • 0-4 years of City service are not eligible to participate
  • 5-9 years of City service are eligible to participate with no City subsidy
  • 10+ years of City service are eligible to participate with 50% City-subsidized premium
    

Retirees who meet eligibility requirements for retiree medical benefits must enroll in a City retiree medical plan within 31 days from the date of retirement. If no election is made or coverage is terminated anytime after the initial enrollment, your City retiree eligibility will permanently end unless you can provide proof of continuous enrollment in another group health plan and you request enrollment in City retiree medical within 31 days of involuntary loss of that coverage.

Eligible Dependent
Dependents may be enrolled in City retiree health benefits if they were covered at the time of your retirement and you enroll them at the time of your initial retiree medical election. Dependents who continue to meet eligibility requirements will remain on the plan until you remove them, cease to make the required contribution or the dependent no longer meets the eligibility criteria. You may also enroll an eligible dependent within 31 days of their loss of other continuous group health coverage.

Health care benefits are available to domestic partners. For this year only, retirees who retired before January 1, 2012, have the option of adding their domestic partner and their partner's child to the City's health plan.

If you precede your spouse/domestic partner in death, the covered spouse/domestic partner will be eligible to continue participation at the single retiree rate for the remainder of his or her lifetime. Eligibility would end in the event the spouse remarries.

Domestic Partners
City-sponsored benefits are available to domestic partners (same and opposite gender) and their dependent children. Domestic partnership is defined as a committed relationship between two (2) adults, which meets all of the following conditions:

• Partnership Partnership is in effect for at least six (6) months;
• Both partners at least 18 years of age;
• Both partners are each other’s sole domestic partner and intend to remain so indefinitely;
• Neither partner is married (legally or by common law) to, or legally separated from anyone else;
• Partners are not related by blood or marriage to a degree of closeness that would prohibit marriage in the state in which they   reside;
• Both partners agree they are in a committed relationship and consider each other jointly responsible for each other’s    common welfare and financial obligations; and
• Both partners agree that they are not in the relationship solely to obtain benefits coverage.

Domestic Partner Enrollment Packet
The Domestic Partner Enrollment Packet includes an enrollment form, the Affidavit of Domestic Partnership, and information regarding domestic partner tax implications. The completed Domestic Partner Enrollment Packet along with all of the required information must be submitted to Human Resources Customer Service during Open Enrollment or within 31 days of establishing a domestic partnership to add to your domestic partner to the City's health plans.

Domestic Partner Tax Implications
When you enroll your domestic partner or your partner’s child in one of the City’s health plans, the IRS considers the City’s contribution toward the additional coverage as income for federal tax purposes. This income is the amount the City contributes towards the cost of additional coverage for your domestic partner and/or your partner’s child.

The amount of this income depends upon the plan in which you are enrolled and the level of your coverage. This income increases your taxable gross income for federal income taxes and FICA (Social Security and Medicare). More details are available in the Domestic Partner Enrollment Packet.

This monthly income must be added to your gross taxable income per IRS Code. Below is a simplified example of how this income is calculated. The City understands that this is a complex issue. Please consult your personal tax advisor for assistance.

Qualifying Life Events
Elections made during Open Enrollment will be effective for the upcoming plan year, January 1 through December 31, 2012. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) allows for special enrollment when certain Qualifying Life Events occur.

Qualifying Life Events may include:
• Marriage
• Establishment of a Domestic Partnership
• Divorce, Legal Separation, Annulment, Dissolution of a Domestic Partnership
• Birth or Adoption of an Eligible Child
• Change in you or your spouse’s/domestic partner's work status (full-time or part-time) that affects benefits eligibility
• Change in your child’s eligibility for benefits
• Qualified Medical Child Support Order
• Death of a dependent

You must notify the Employee Benefits Office within 31 calendar days of your Qualifying Life Event and provide all required documentation in order for the changes in your coverage to take effect during the calendar year. If you fail to notify the Employee Benefits Office within 31 days and do not provide documentation, you must wait until the next Open Enrollment period to change your benefit elections.

Medical
The following comprehensive health care plan options offer access to the UnitedHealthcare Preferred Provider Organization (PPO) ChoicePlus network. In each of the plan options you have the freedom to see any physician or other healthcare professional from the UnitedHealthcare Network, including specialists, without a referral. UnitedHealthcare is committed to helping retired City of San Antonio employees and their dependents live the healthiest lives possible.

In order for you to get the most from the program, it is important that you understand your choices. Retired employees under age 65 can choose from three (3) different medical plans which offer a choice of deductible, co-insurance and co-payment levels.

VALUE PPO
Highest out-of-pocket expense, lowest premium contribution

In-Network Benefits - Participants who choose in-network providers pay:

• Annual deductible of $900 for individual ($1,800 for family coverage) for plan year 2012
• Office visit co-payment is $25, which is not subject to deductible or co-insurance
• Once your deductible is satisfied, the cost drops to 20% of discounted eligible expenses to a maximum of $3,000 per individual or $6,000 for family coverage per year, excluding the deductible.  Amounts above this annual maximum are paid by the City at 100% of eligible expense.

Out-of-Network Benefits - Participants who choose out-of-network providers pay:

• Annual deductible of $1,800 for individual ($3,600 for family coverage) for plan year 2012
• Once your annual out-of-network deductible is satisfied, the cost drops to 40% of eligible billed charges to a maximum of $6,000 per individual or $12,000 for family coverage per year, excluding the deductible.   

STANDARD PPO
Mid-level out-of-pocket expense, mid-level premium contribution

In-Network Benefits - Participants who choose in-network providers pay:

• Annual deductible of $600 for individual ($1,200 for family coverage) for plan year 2012
• Office visit co-payment is $20, which is not subject to deductible or co-insurance
• Once your deductible is satisfied, the cost drops to 20% of discounted eligible expenses to a maximum of $2,400 per individual or $4,800 for family coverage per year, excluding the deductible. Amounts above this annual maximum are paid by the City at 100% of eligible expense.

Out-of-Network Benefits - Participants who choose out-of-network providers pay:

• Annual deductible of $1,200 for individual ($2,400 for family coverage) for plan year 2012
• Once your annual out-of-network deductible is satisfied, the cost drops to 40% of eligible billed charges to a maximum of $4,800 per individual or $9,600 for family coverage per year, excluding the deductible.

PREMIER PPO
Lower out-of-pocket expenses, higher premium contribution

In-Network Benefits - Participants who choose in-network providers pay:

• Annual deductible of $300 for individual ($600 for family coverage) for plan year 2012 
• Office visit co-payment is $15, which is not subject to deductible or co-insurance
• Once your deductible is satisfied, the cost drops to 10% of discounted  eligible expenses to a maximum of $1,200 per individual or $2,400 for family coverage per year, excluding the deductible. Amounts above this annual maximum are paid by the City at 100% of eligible expense.

Out-of-Network Benefits - Participants who choose out-of-network providers pay:

• Annual deductible of $600 for individual ($1,200 for family coverage) for plan year 2012 
• Once your annual out-of-network deductible is satisfied, the member cost drops to 40% of eligible billed charges to a maximum of $2,400 per individual or $4,800 for family coverage per year, excluding the deductible. 

Prescription Drug Benefit

The City's prescription drug benefit, administered by UnitedHealthcare, includes access to both chain and independent stores including more than 60,000 in-network retail pharmacies. Pharmacy benefits can be accessed through your UnitedHealthcare ID Card. Visit www.myuhc.com to find an in-network pharmacy near you.

Generic Prescription Drugs
Prescription drugs are placed into tiers, and each tier is assigned a cost. Tier 1 contains most generic prescription drugs, and it is usually the lowest-cost tier option. Generic prescription drugs contain the same active ingredients as brand name drugs, typically found in Tiers 2 and 3. Over 75% of brand name drugs have an available generic equivalent.

In 2012, co-pays for Tier 1 generic prescription drugs have been reduced by 50% and will cost only $5. You still have the option of purchasing brand name prescription drugs when generic equivalents are available; however, you will pay co-insurance (percentage based on the cost of the drug) up to a maximum dollar amount. If the brand name prescription drug does not have an equivalent, then you will only need to pay a co-pay amount.

Value-Based Co-pays
It is important for retirees and their dependents with diabetes to follow their prescription drug regimen to effectively manage their condition. To assist retirees and their dependents who have diabetes with achieving a better quality of life, the City’s Value-Based Co-pay plan offers prescription drugs related to diabetes at reduced amounts. For Tier 1 generic diabetes prescription drugs, co-pays have been eliminated, and the co-pays for Tiers 2 and 3 have been reduced.

90-day and Mail Order Prescription
A 90-day supply for maintenance medications is available at any of the participating pharmacies or through the UnitedHealthcare Mail Order Pharmacy Program administered by Medco Mail Order. Medco Mail Order, a partner of UnitedHealthcare, allows you to manage your 90-day supply with reminders and easy online ordering. Contact Human Resources Customer Service to obtain mail order enrollment packets or visit UnitedHealthcare online at www.myuhc.com.

Vision
A voluntary vision plan benefit is available to retirees who are currently on the City's medical plan through Davis Vision. This plan provides you with access to a national network of doctors and retail providers to help you care for your eyes. Eye exams, eyeglasses, and contacts are available to you at only the cost of applicable co-pays. To locate a vision provider near you or for additional information, log onto davisvision.com, click on the Members tab, and enter the 2472 (City's Client Code) in the Open Enrollment section. You can also call Davis Vision at (800) 448-9372.

Davis Vision is the administrator of the voluntary vision plan; however, enrollment and billing information comes directly from a company called Your Benefit Plan, a vendor of Davis Vision.

Contact Lens and Frame Benefits
Contact lenses selected (in lieu of eyeglasses) from Davis Vision's Contact Lens Collection are covered in full. Davis Vision's partnership with LENS123 gives you the option of ordering replacement contact lenses through mail-order and having them delivered to your home.

Through Davis Vision's Frame Collection, you have access to several designer and brand name frames (in lieu of contacts) at only the cost of applicable co-pays. Plan eyewear includes a one-year eyeglass breakage warranty at no cost to you.

Benefit Summary

Additional Discounted Lens Options and Coatings with Davis Vision
Scratch-Resistant:  $0
Polycarbonate Lenses: $0² - $40
Standard Anti-Reflective (AR) Coating: $40
Standard Progressives (no-line bifocal): $65
Plastic Photosensitive (Transitions³): $90

¹The Davis Vision Collection is available at most participating independent provider locations.
²For dependent children, monocular patients, and patients with prescriptions of 6.00 diopters or greater.
³Additional discounts not applicable at Walmart or Sam’s Club locations.

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