Benefits

Dental Plans

Delta Dental

• Delta Dental Benefits and Premiums
• Delta Dental Enrollment Form
• Dentist Locator (Choose Delta Dental Premier)

NOTE: Delta Dental does NOT issue cards.

UnitedHealthCare Dental

• Select Managed Care Direct Compensation
• Getting Started
• Dentist Locator
  (Click here for Instructions on Online Provider Directory Instructions) Note, you must choose a primary care dentist or one will be assigned to you.
• Schedule of Benefits
• UnitedHealthCare Enrollment Form

Vision Service Plan (VSP)

• VSP Benefits and Premiums
• VSP Enrollment Form
• Exclusive Member Extras
• What do your eyes say about you?
• TruHearing Aid Discount Offer

NOTE: VSP does NOT issue cards

Life Insurance

Basic Coverage

The County provides each eligible employee with life insurance as follows:

• At least one, but less than three continuous years of service – $1,000.
• Three, but less than five continuous years of service – $3,000.
• Five, but less than ten continuous years of service – $5,000.
• Ten continuous years of service or more – $10,000.

Supplemental Coverage

Employees in the Exempt, Senior Management, Middle Management, Sheriff’s Management, Deputy Sheriffs, Sergeants, and Confidential representation units also receive additional life insurance in accordance with their respective MOU or Resolution.

Optional Coverage

Employees may purchase additional term life insurance, in increments of $25,000, to a maximum of $200,000, at the County’s rate. An application form and authorization for payroll deduction are required.

Please note Evidence of Insurability Required for Amounts over $100,000 and any amount after 30 days from date of hire.

Beneficiary: If you are in the retirement system, your beneficiary is the person you listed as your beneficiary for retirement, unless you file a Change Form with Human Resources designating a separate life insurance beneficiary.

Forms for Additional Term Life Insurance (VOYA)

• Life Insurance Enrollment Form – Click on Life Insurance and when the Windows box opens up, select SAVE and save to your desktop, print and fill it out.
• Evidence of Insurability Form
• Evidence of Insurability Form Instructions
• Life Insurance Change Form – Complete this form if you have any name or address changes, would like to reduce your coverage amount or cancel your coverage.
• Life Insurance Rates
• Conversion Form – Complete this form to convert your group life insurance to individual life insurance when you leave the County.
• Conversion Instructions – Instructions for converting your group life coverage to individual coverage when you leave the County.
• Term Life Insurance Continuation Request Form

IRS 457 Deferred Compensation Plan

• What Is a Deferred Compensation Plan?
• How Much Can I Contribute?
• How Can I Enroll and How Do I contribute?
• Frequently Asked Questions (FAQ’s)
• Self Directed Brokerage Account Fast Facts
• Pre-Retirement Catch-Up Brochure
• Account Access Online Guide
• Deferred Compensation Enrollment Book
• Deferred Compensation Investment Policy
• Did you know?

Mass Mutual Forms

• Custom Enrollment Form
• Easy Enrollment Form
• Beneficiary Designation Form
• Contribution Change Form
• Pre-Retirement Catch-Up Form
• Benefit Election Withdrawal Form (To request a full or partial withdrawal of funds, after you leave employment)
• Unforeseen Emergency Withdrawal Request Form (While still employed – See details on what is considered an emergency)
• Required Minimum Distribution Form

For more information click here: http://retiresmart.com, or call (800) 743-5274.

Employee Assistance Program

Voluntary Products

Managed by Chimienti and Associates

• Short Term Disability
• Critical Illness
• Cancer Plan
• Accident Plan
• Universal Life Insurance
• Term Life Insurance

Contact Chimienti and Associates at (877) 733-1670

Section 125: Medical and Health Spending Accounts

Plan Administrator

Effective July 1, 2014 American Fidelity Assurance (AFA) will be the County’s claims administrator for the Section 125 Flexible Benefits Plan.

Increase in Maximum Deferral

The maximum deferral limit has increased from $2,550 last year to $2,600 this year.

Modified Use it Or Lose It Rule

The IRS has modified the “Use It or Lose It” rule to allow participants to carry over up to $500 of unspent funds into the following plan year. The new rules also provide that a carryover does not reduce the following year’s deferral limit, which allows you to plan ahead for larger, discretionary medical expenditures (such as a child’s orthodontia) to have additional funds available.

Because of the tax advantages of a medical spending account, the IRS has established strict guidelines – the “Use It Or Lose It Rule” – for funds in excess of the $500 carryover amount that are not used by the end of the year. If you contribute funds to a Medical Spending Account and leave a balance over $500 in your account, you will lose any remaining balance in the account at the end of the Plan year. For this reason, you should plan carefully when you determine how much to place in the account.

Because of the new $500 carryover provision, most employees could receive tax benefits by putting money into a Medical SpendingAccount. Contact the Human Resources Employee Benefits Office for more information to see if participating in the Plan is right for you.

Debit Card and Direct Deposit Reimbursement

AFA will provide the option to use Debit Transaction Cards as the primary payment method for the FSA portion of the Plan. This means you can directly pay for medical care at the point of service with no out of pocket cost and no requirement to file claims and then wait for a reimbursement check (you must still save receipts for tax purposes or if AFA requests documentation of the claim). An additional option is to choose direct deposit for reimbursement of any manually submitted claims which will give you quicker access to your money without having to wait for a check to arrive in the mail. You can also still pay for services out of pocket, file for reimbursement at your convenience, and receive a check in the mail.

Forms and Additional Information

Links:

• AFA Mobile App
• List of Eligible Expenses

Documents:

• Flexible Spending and Voluntary Benefits Guide
• Section 125 Flexible Benefit Plan Enrollment Form
• Rules of Participation
• Debit Card Information
• Request for Additional Debit Card
• Direct Deposit Authorization Form
• Health Care Reimbursement Form
• Dependent Care Reimbursement Form

COBRA

• COBRA Information
• COBRA Rates
• Continuation of Benefits while on a Leave of Absence

Post-Employment Health Plans

• Notice of Claims Administrator Change
• Plan Highlights
• Employee Enrollment Form (needs to be submitted with first reimbursement request)
• Reimbursement Claim Form (to request reimbursement of out-of-pocket expenses)
• Direct Deposit Form
• Change in Employee Information Form
• HIPAA Notice

Retirement

Retirement Benefits are administered by San Joaquin County Employees’ Retirement Association (SJCERA). You may contact them at (209) 468-2163 or visit their website.

Click for more information at www.sjcera.org.

• Retirement Contribution Rates
• Retiree Open Enrollment 18-19
• Medicare Rate Sheet
• Medicare Summary of Benefits
• Non-Medicare Rate Sheet
• Non-Medicare Summary of Benefits
• Blended Family Rate Sheet for Families with Medicare and Non-Medicare
• Dental Plan Rates and Benefits Summary
• Vision Plan Rates and Benefits Summary
• Medicare Prescription Drug Coverage

Employee Benefits Forms

Medical

• Kaiser Enrollment Form
• Select Enrollment Form
• Premier Enrollment Form
• Opt Out Form

Dental

• Delta Dental Enrollment Form
• United HealthCare Enrollment Form

Vision

• VSP Enrollment Form

Life Insurance

• Life Insurance Enrollment Form
• Evidence of Insurability Form

Flexible Spending Accounts

• Flexible Spending Enrollment Form
• Health Care Reimbursement Form
• Dependent Care Reimbursement Form