City of Anaheim
Employee Health Plan
Open Enrollment 2010
Welcome to Open Enrollment for your 2010 benefits.
This year, Open Enrollment is October 7 through What’s Inside
October 21. This is your once-a-year opportunity to
Inside your enrollment packet, you’ll find information
change your City-sponsored benefits. For example,
you need to make your 2010 benefit choices:
■ This flyer, which details what’s changing for 2010,
■ Change medical plans or dental plans
and the steps to take at Open Enrollment
■ Add or remove dependents from your coverage
■ A personalized health plan selection form
■ Enroll in or terminate coverage that shows your current benefit choices and
In November, there will be a separate enrollment for
Flexible Spending Accounts (FSAs) and Supplemental ■ The 2010 Employee Benefits Summary Comparison
Life Insurance, so now is also a good time to begin Chart, which allows you to see side by side the
thinking about whether you want to: benefits offered by each of the health care plans
■ Participate in an FSA for 2010 ■ 2010 Employee Health Plan Contributions, which
details your payroll deductions for the health care
■ Increase or add Supplemental Life Insurance coverage
plans you select
Any changes you make at Open Enrollment or during
■ An important notice about Medicare Part D
the November enrollment period will take effect
prescription drug coverage
January 1, 2010 and will remain in effect through
December 31, 2010. You won’t be able to make any We encourage you to review the information in this
changes to your benefit selections until next year’s enrollment flyer carefully, and then decide which
Open Enrollment unless you have a qualified change benefits are right for you and your family. In addition,
in status. if you need more information about your benefit
options, you can review the City’s 2010 Benefits
Guide, which is available on www.anaheim.net and
Not Making Changes?
If you’re not making any changes to your benefits
for 2010, you don’t need to complete or return a
selection form — your 2009 elections will carry
over automatically. However, you should review
the information about the new Aetna Value HMO
on page 2 to see if it applies to you.
What’s New for 2010
There are changes to some of your City-sponsored
plans for 2010. These changes may impact your benefit Bargaining Unit Employees
decisions for next year.
The City is currently in discussions with bargaining
Medical Plan Changes units about offering the new Aetna Value HMO
Plan in place of the current Aetna HMO Plan. If
As you’ve probably heard, the cost of health care
your bargaining unit decides:
continues to rise at a rate twice that of inflation.
Because you and the City share the cost of your health ■ To offer the Aetna Value HMO Plan and you’ve
care coverage, increases in cost mean both you and the elected to participate in the Aetna HMO
City will pay more for medical coverage. Plan, then you’ll have a chance to revisit your
2010 enrollment, even if the decision is made
While these changes may mean increases to some
sometime after Open Enrollment
out-of-pocket health care costs, overall cost increases
for your coverage have been kept lower by the changes ■ Not to offer the new Aetna Value HMO Plan in
we’re making. 2010, you’ll continue to be able to enroll in the
current Aetna HMO plan
New Aetna Value HMO Plan
Currently, AMEA and IBEW have decided not to
For 2010, the City will introduce the new Aetna Value offer the Aetna Value HMO Plan for 2010 — AMEA
HMO Plan for non-represented employees. This plan will and IBEW members will continue to participate in
replace the existing Aetna HMO Plan for these employees. the current Aetna HMO Plan. All other bargaining
units have not yet made decisions about which
The new Aetna Value HMO Plan will cover the same
HMO plan to offer. If your bargaining unit decides
services as our current HMO Plan and will use the
to offer the new plan, the City will contact you once
same network of providers. However, under the Aetna
negotiations are complete.
Value HMO Plan, your bi-weekly premium costs will
be lower than for the current Aetna HMO Plan while
you’ll generally pay more when you receive care for
Two additional differences with the Aetna Value HMO
Additionally, the Value HMO Plan uses a copay
■ Higher copays for preferred brand name (formulary)
structure that has two different levels. With this plan,
and non-preferred brand name drugs
■ A higher calendar year out-of-pocket maximum:
■ Different copay amounts for regular office visits and
specialist office visits (that’s because specialist visits are » Individual: $2,000
typically much more expensive than regular office visits) » Family: $4,000
■ A higher copay for emergency room visits than for The “calendar-year out-of-pocket maximum” is the
urgent care visits (this means that in non-emergency amount you must pay out of your pocket each plan year
situations, a visit to an urgent care center will generally before the plan begins to pay 100% of eligible expenses.
be less expensive than a trip to the emergency room)
Aetna OAMC Plan: New Deductibles and
Hospitalization Benefits Copays
In response to employee feedback, the Aetna For 2010, the annual deductibles for the Aetna
Value HMO Plan will cover hospitalization at 100%, OAMC Plan will increase. As of January 1, the annual
just like the Aetna HMO Plan. The City knows this deductibles will be:
coverage is a benefit you value.
■ For individuals: $500 in-network and
Aetna OAMC and High Option OAMC Plans:
■ For families: $1,000 in-network and
Increased Prescription Drug Copays
Prescription drug copays will increase for 2010 under
Also in 2010, the copays for specialist visits under the
the following plans:
Aetna OAMC Plan will increase. As a result, the copay
■ Aetna OAMC Plan structure will change to two levels. You’ll pay lower
■ Aetna High Option OAMC Plan copays — $20 per visit — for regular office visits, and
higher copays — $40 per visit — when you see a
The prescription drug benefits under the Aetna Value
specialist. That’s because specialist visits are typically
HMO Plan will be the same as the new benefits
much more expensive than regular office visits.
available under the Aetna OAMC plans.
Note: These changes apply only to the Aetna OAMC
These copay increases will affect preferred brand name
Plan, and not to the Aetna High Option OAMC Plan.
and non-preferred brand name prescriptions. The
With the High Option OAMC Plan, you pay coinsurance
copays for generic drugs won’t change for 2010. The
(a percentage of the cost) for office visits, rather than a
following copays for these medical plans take effect
flat copay. This means that because specialist visits are
January 1, 2010:
usually more expensive than regular office visits, your
Drug Type Copay out-of-pocket coinsurance will usually be higher.
Generic $10 copay
Preferred brand name $30 copay Save with the Mail-Order Pharmacy
Non-preferred brand name $50 copay If you take a maintenance medication regularly,
why not fill your prescriptions through your plan’s
With these new copays, you’ll receive the best mail-order program and receive up to a 90-day
value when you fill your prescription with a generic supply of medication for the cost of just two retail
medication. If no generic is available, your next-lowest- pharmacy copays? When you do the math, you can
cost option is a brand name formulary drug. see that this means you not only get a larger supply
of medication, but you also pay less than you would
at a retail pharmacy.
Using Your Vision Benefits
Interested in taking advantage of the mail-order
See the 2010 Benefits Guide, available on pharmacy? Contact your plan’s Member Services for
www.anaheim.net and http://insider, for more details more details.
about how to use the Aetna vision benefits.
Employee Open Enrollment 2010
Cost Increases for 2010 Electing Coverage During the Enrollment Period
Each year, our vendors evaluate the current year’s Because of the carrier change, you’ll have the
medical claims to determine premiums for the City’s opportunity to purchase certain amounts of additional
plans in the following year. This means that the amount Supplemental Life Insurance without providing
the plans pay out each year has a direct impact on the evidence of insurability (EOI). Typically, when you elect
rates that both you and the City pay for coverage the Supplemental Life Insurance, you’re required to submit
next year. EOI before your coverage takes effect. EOI is a process
that requires you to provide proof of good health and
As a result of the utilization of our plans in 2009, the cost
is commonly required by insurance companies before
for medical plans will be higher in 2010. The changes that
certain levels of coverage are approved. However,
we’re making to the plans — such as new prescription
during a special life insurance Open Enrollment
drug copays, and increased copays and deductibles for
period in November, The Hartford will waive the EOI
the OAMC plan — are designed to help minimize these
requirement for up to a $100,000 increase in your
supplemental life benefit. You’ll still need to provide EOI
There are no increases to the DeltaCare USA DHMO for any supplemental life increase above $100,000 or any
for 2010, and only slight increases to premiums for the supplemental life coverage that increases your combined
Delta Dental PPO plan. See 2010 Employee Health Plan (basic and supplemental life) benefit above $250,000.
Contributions for payroll deductions for the health care
Once this special Open Enrollment period ends,
plans you select.
you’ll be required to provide EOI before you can
New Disability, Life, and AD&D enroll in Supplemental Life Insurance for the first time,
Insurance Company or purchase additional supplemental coverage above
$50,000. If you’ve been considering increasing your
For 2010, the City will replace our current disability,
life and AD&D coverage, don’t let this opportunity
life and accidental death & dismemberment (AD&D)
pass you by!
insurance companies with The Hartford. There will be
no changes to any City-provided benefits under these
plans. (Note that City-provided benefits under these Life and AD&D Insurance Portability
plans depend on your bargaining unit.)
The new life and AD&D insurance through The
Supplemental Life and AD&D Insurance Hartford will be portable, which means you can
choose to keep your coverage if you leave the City.
As an eligible employee, you can elect Supplemental
Life and AD&D Insurance coverage if you’re enrolled
for City-provided basic life or management life
coverage. You can choose coverage equal in $50,000
increments, from $50,000 to $700,000 (up to a
combined maximum of 7 times your earnings or
$750,000, whichever is lower).
You may also choose coverage for your spouse or domestic
partner, up to 50% of your supplemental coverage.
Enrolling for Your 2010 Benefits
Open Enrollment is October 7 – October 21. If you
don’t want to make any changes, you don’t need to Enrolling Dependents?
submit a selection form — your 2009 elections will
If you’re enrolling any family members, you must
automatically carry over to 2010, except for FSAs.
include each dependent’s Social Security number on
your selection form. You must enroll dependents in
During Open Enrollment 2010, you should:
the same plans you choose for yourself.
■ Read the information in your enrollment
More details about which dependents are eligible
for coverage are included in the 2010 Benefits Guide,
■ Decide which benefits will work best for you available on www.anaheim.net and http://insider.
■ Decide which dependents, if any, you want to cover
■ Select a primary care physician, medical group,
or primary dentist if you’re enrolling in a new
Don’t Need Medical Coverage?
Get Cash Back.
plan that requires one
■ Decide if you want to participate in an FSA for 2010 If you’re covered under another medical plan, you
may decline City-sponsored medical coverage. If
Then, determine if you need to take action during
you decline medical coverage, you:
Open Enrollment. Do you want to:
■ Will receive $125 in taxable income added
■ Make changes to your benefits?
to your paycheck each month
■ Increase your Supplemental Life Insurance benefit
■ Must decline medical coverage for any
without submitting evidence of insurability (EOI)?*
■ Increase your Supplemental AD&D Insurance benefit?*
■ Won’t be covered for vision or behavioral
■ Participate in a Health Care or Dependent Care FSA?* health benefits (however, you’re still eligible for
the REACH employee assistance plan)
■ Enroll new dependents?
■ May enroll for dental coverage for yourself and
■ Drop dependents from your coverage?
any eligible family members
If you answered YES to any of these questions, then
■ Can’t change your decision to decline coverage
you need to complete and sign all enrollment forms
for yourself or your family until the next Open
and your selection form, and return them to Human
Enrollment period unless you have a qualified
Resources by October 21*.
change in status (refer to the 2010 Benefits
Keep in mind...if you don’t want to make any changes Guide, available on www.anaheim.net and http://
to your benefits, you don’t have to do anything during insider, for details)
Open Enrollment. Your 2009 benefit elections will
automatically carry over for 2010 (except for FSAs).
* The timeline for 2010 FSA and supplemental life and AD&D enrollment is different from that of Open Enrollment. If you’re enrolling in the FSAs or increasing your
supplemental life or AD&D coverage, you must complete and return the FSA and life/AD&D enrollment forms to Human Resources during the special Open Enrollment
period, which ends November 30.