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2011 RETIREE Enrollment Guide.pub

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					    Denver Fire Department




    Retiree Benefit Guide
Plan Year January 1, 2011 - December 31, 2011
              The Denver Fire Department Benefit Program
Denver Fire Department offers a variety of benefits, to Retired Denver Firefighters and their eligible dependents, which
are described in this booklet.

What You Need to Do                                             Eligible Dependents
     Read this benefit guide carefully.                         Many of the benefit plans also offer coverage for eligible
     Attend the Annual Open Enrollment Benefits Fair for        dependents. Eligible dependents include the following:
     more information.                                              Your legal spouse, if not legally separated
     If making election changes or enrolling for the first          Your qualifying spousal equivalent
     time contact the FPPA for appropriate enrollment               Your children to age 26
     forms.                                                         Your children over age 26 who are totally disabled
     Submit your completed enrollment form(s) to the
     Human Resources Benefits Team within 30 days of
     retirement, or as directed.
                                                                Eligibility Rules
                                                                If you are currently on a DFD retiree plan, attend an Annual
                                                                Open Enrollment Benefits Fair and complete an enrollment
Available Resources                                             form only if you are making plan or coverage level changes
The following resources are available to assist you in the      for 2011 or contact the FPPA.
enrollment process:
     Benefit Provider Websites and Toll Free                    If you DROP the DFD coverage you WILL NOT BE
     Numbers – each of the carrier web sites contains           ALLOWED TO RE-ENROLL AT SUBSEQUENT Annual
     valuable information regarding the benefit plan and        Open Enrollment periods unless you have a qualified
     an up-to-date list of participating providers. Refer to    Change of Family Status.
     page 5 for additional information.
     If you have questions regarding your premiums or a
     FPPA sponsored plan please contact the FPPA at
                                                                Examples of qualifying Change in
     1-800-332-3772 or 303-770-3772.                            Family Status events:
     For general enrollment questions please contact the                Marriage
     Human Resources Benefits Team at 720-913-3413.                     Legal separation or divorce
                                                                        Death
Your Benefit Choices                                                    Birth or adoption
Denver Fire Department offers the following benefit                     Change in your spouse’s employment or health
package to retired Firefighters:                                        benefits
    Medical Plans – Kaiser Permanente                                   Unpaid leave of absence for you or your spouse
    Dental Plans – Delta Dental                                         New Common Law / Domestic Partner Relationship
    Vision Plan – Humana
                                                                If you experience a Change in Family
Choosing a Coverage Level                                       Status:
You may elect different coverage levels under the
                                                                         You must notify the Benefits Team within thirty-
medical, dental, and/or vision plan(s). For example, you
                                                                         one (31) days of the status change in order to add
may elect employee-only coverage under the medical
                                                                         or delete a dependent or make other changes.
plan and family coverage under the dental plan. This
                                                                         Supporting documentation will be required.
flexibility allows you to best meet the needs of you and
your family. The coverage levels are as follows:                         If you miss the 31-day window, you will not be
      Employee only;                                                     allowed to make changes until the next Annual
      Employee + one dependent;                                          Enrollment period (per section 125 of the IRS tax
      Employee + family; or                                              code).
      Declined Coverage.




                                                               -2-
                                       Pre-65 Retiree Medical Plans
Denver Fire Department offers Retired Firefighters under age 65 and their eligible dependents the choice of an HMO
medical plan as well as a Triple Option plan through Kaiser. The HMO provides coverage at Kaiser facilities only. The
Triple Option plan offers the highest level of benefits if services are provided by Kaiser. There are also benefits for visiting
a participating PHCS network provider, on the Triple Option plan you may also seek Out-of-Network service.
     Benefit Summary               Kaiser HMO                                    Kaiser Triple Option
                                  Network Only              Kaiser Network        PHCS Network*           Out-of-Network
Annual Deductible
Individual                                      None                   None                   $300                     $400
Family                                          None                   None                   $900                    $1,200
Annual Out-of-Pocket Max
Individual                                     $2,000                 $2,000                 $3,000                   $6,000
Family                                         $4,500                 $4,500                 $9,000                  $18,000
Office Visits
Preventive Care                               $5 copay                $5 copay             $20 copay               $70 copay
Primary Care                                 $20 copay               $20 copay             $20 copay           40% after deductible
Specialist                                   $30 copay               $30 copay             $35 copay           40% after deductible
Hospital Services
Inpatient                                   $250 copay              $250 copay         20% after deductible    40% after deductible
Outpatient                                  $100 copay              $100 copay         20% after deductible    40% after deductible
Emergency Room                              $100 copay              $100 copay            $100 copay              $100 copay
Urgent Care                                 $100 copay              $100 copay         20% after deductible    40% after deductible
After-Hours Care                             $50 copay               $50 copay         20% after deductible    40% after deductible
Lab & X-ray
Diagnostic Lab and X-Ray                    No Charge                 No Charge        20% after deductible    40% after deductible
Therapeutic X-Ray                           $30 copay                 $30 copay        20% after deductible    40% after deductible
MRI, nuclear and high tech            $100 copay/procedure      $100 copay/procedure   20% after deductible    40% after deductible
Prescriptions                           (30-day supply)           (30-day supply)        (30-day supply)         (30-day supply)
Generic                                     $10 copay                 $10 copay             $25 copay                 50%
Brand                                       $15 copay                 $15 copay             $35 copay                 50%
Mail Order (90-day supply)             2x the above copay        2x the above copay    2x the above copay              N/A
Lifetime Max Benefit                        Unlimited                 Unlimited                   $1,000,000 per member
*Visit www.multiplan.com/kaiser for online provider directory
Denver Fire Department offers retired Firefighters who do not live in a Kaiser Service area outside Denver, Boulder Colorado
Springs or Pueblo, an Out of Area plan that provides benefits for visiting a participating PHCS network provider. The Out of
Area plan also allows you to seek services that are Out-of-Network with reduced benefit coverage. Please contact the
Human Resources Benefits Team for a zip code listing of the Kaiser Service Area.
                                                                                           Kaiser Out of Area Plan
                            Benefit Summary
                                                                                   PHCS Network          Out-of-Network
Annual Deductible
Individual                                                                                     $300                    $400
Family                                                                                         $900                   $1,200
Annual Out-of-Pocket Max
Individual                                                                                    $3,000                  $6,000
Family                                                                                        $9,000                 $18,000
Office Visits
Preventive Care                                                                             $20 copay              $70 copay
Primary Care                                                                                $20 copay          40% after deductible
Specialist                                                                                  $20 copay          40% after deductible
Hospital Services
Inpatient                                                                              20% after deductible    40% after deductible
Outpatient                                                                             20% after deductible    40% after deductible
Emergency Room                                                                         20% after deductible    20% after deductible
Urgent Care                                                                            20% after deductible    40% after deductible
Lab & X-ray
Diagnostic, Therapeutic and MRI, nuclear and high tech (require pre-certification)     20% after deductible    40% after deductible
Prescriptions                                                                            (30-day supply)         (30-day supply)
Generic                                                                                     $20 copay                  50%
Brand                                                                                       $30 copay                  50%
Mail Order (90-day supply)                                                             2x the above copay              N/A
Lifetime Max Benefit                                                                        Unlimited         $1,000,000 per member

                                                                    -3-
      65+ Retiree Medical Plan and Pre and Post 65 Vision

To enroll in either of the Kaiser Senior Advantage HMO plans you must be entitled to Medicare Part A and enrolled in
Part B. You must also be age 65 or older or disabled, and reside in the Kaiser Service Area of Denver, Boulder,
Colorado Springs and Pueblo. Please contact the FPPA for a zip code listing of the Kaiser Service Area. Kaiser
Permanente is a federally qualified HMO with Medicare+Choice contract.
            Benefit                  Kaiser Senior Advantage Low Plan                Kaiser Senior Advantage High Plan
           Summary                             Network Only                                    Network Only
Office Visits
 Primary Care                                    $20 copay per visit                                $20 copay per visit
 Specialty Care                                  $30 copay per visit                                $30 copay per visit
Preventive Care
 Routine Physical Exam                              No Charge                                          No Charge
 Preventive Services                                No Charge                                          No Charge
 Hearing Exam                                   $20 copay per exam                                 $20 copay per exam
 Vision Exam with Optometrist                   $20 copay per exam                                 $20 copay per exam
 Vision Exam with Ophthalmologist               $30 copay per exam                                 $20 copay per exam
Hospital Services
 Inpatient Care                            $250 copay per day ($500 max)                               $250 copay
 Outpatient Surgery                                 $200 copay                                         $100 copay
 Emergency Room                                     $50 copay                                          $50 copay
 Urgent Care Facility                               $30 copay                                          $30 copay
 Ambulance Services                               20% up to $500                                     20% up to $500
Lab & X-ray
 Lab tests, diagnostics                               No Charge                                          No Charge
 MRI, PET, CT scans                              $100 per procedure                                 $100 per procedure
Prescriptions                                      (30-day supply)                                    (60-day supply)
Generic                                                $10 copay                                          $10 copay
Brand                                                  $30 copay                                          $15 copay
                                               No Medicare Part D Gap                             No Medicare Part D Gap
Mail Order                                 2x retail copay (90-Day Supply)                    1x retail copay (60-Day Supply)
Lifetime Max Benefit                                   Unlimited                                          Unlimited




Denver Fire Department offers vision coverage through Humana to you and your eligible dependents.

The Vision Plan is a Preferred Provider Organization (PPO), which includes a network of participating eye care providers.
You receive the maximum benefits under the plan and pay less out of your pocket amount when you seek care from a
network provider. You do have the option to seek care out-of-network, but you will pay more out of your pocket for those
services.
                                                   Humana Vision Plan
                   Summary of Benefits                              In-Network                               Out-of-Network
Eye Exam (every 12 months, based on last service date)                         $20 copay                     Up to $35 allowance
Lenses (every 12 months, based on last service date)
        Single                                                               $20 copay                      Up to $25 allowance
        Bifocal                                                              $20 copay                      Up to $40 allowance
        Trifocal                                                             $20 copay                      Up to $60 allowance
Frames (every 24 months, based on last service date)                   $40 wholesale allowance            Up to $40 retail allowance
Contact Lenses (every 12 months, based on last service date)
Medically Necessary                                                           Copay waived                  Up to $210 allowance
Elective                                                                     $105 allowance                 Up to $105 allowance
Laser Correction                                                             15% discount                        No discount




                                                            -4-
                       Dental Plans and Contact Information


Three dental plans are available to retirees of the Denver Fire Department and their eligible dependents through Delta
Dental — the Low, Medium and High Plans.

On all three dental options, when you choose to visit a participating Dentist you maximize your benefit plan with access
to lower out-of-pocket expenses. In-network Dentists have agreed to accept Delta Dental reimbursement as full
payment for services rendered. If a non-network provider is used, expenses are reimbursed based on reasonable and
customary (R&C) charges, any charges over the R&C are your responsibility.

                                  Delta Dental Low Plan—Group #7984
  Summary of Benefits                                 In-Network or Out-of-Network(1)
  Annual Deductible                                                     $100 per person
  Preventive Care                                                     70% after deductible
  Basic Services                                                      50% after deductible
  Major Services                                                      30% after deductible
  Annual Max Benefit                                                  $1,000 per member

                                  Delta Dental Medium Plan—Group #7985
  Summary of Benefits                                    In-Network or Out-of-Network(1)
  Annual Deductible                                               $75 per person
  Preventive Care                                              80% after deductible
  Basic Services                                               60% after deductible
  Major Services                                               40% after deductible
  Annual Max Benefit                                            $1,000 per member

                                    Delta Dental High Plan—Group #7986
  Summary of Benefits                                     In-Network or Out-of-Network(1)
  Annual Deductible                                                $75 per person
  Preventive Care                                               100% after deductible
  Basic Services                                                      60% after deductible
  Major Services                                                      50% after deductible
  Annual Max Benefit                                                  $1,500 per member
 (1)
   Reimbursement is based on the PPO dentist’s allowable fee which means the fee from the PPO Discounted Fee
 Schedule that the PPO Dentist has contractually agreed with Delta Dental to accept for treating Eligible Persons
 under this plan.


Contact Information
                       Plan                                      Phone Number                               Web Site
Medical Plan—Kaiser                                       303-338-3800 or 1-800-632-9700                   www.kp.org
Dental Plan—Delta Dental                                  303-741-9305 or 1-800-610-0201                 www.ddpco.com
Vision Plan—Humana (formerly CompBenefits)                        1-800-865-3676                      www.compbenefits.com
Post Employment Health Plan (PEHP)—Nationwide             1-877-677-3678 or 303-452-6300                 www.nrsforu.com
Fire and Police Pension Association—(FPPA)                303-770-3772 or 1-800-332-3772                 www.fppaco.org
Deferred Compensation (457 Plan)

Hartford Life Insurance                                            303-388-0854
Cooney and Associates

ICMA Retirement Corporation                                303-861-7457 or 866-749-5174                  www.icmarc.org
   Laura Heese - Retirement Plan Specialist
Denver Fire Department Human Resources Bureau                      720-913-3413                     http://denverfireonline.com


                                                               -5-
                                                  Retiree Cost

Contributions
Medical Pre-65 Retirees Monthly Contributions:
                              Kaiser HMO - Low Option       Kaiser Triple Option -
                                                                                      Kaiser Out-of-Area PPO
                                   Group #00074                 High Option
                                                                                          Group #00074
                              Sub Group #02 - Denver,          Group #00074
                                                                                          Sub Group #15
                               #05 - Colorado Springs          Sub Group #14
Single                                 $440.00                     $531.00                     $531.00
2-Party                                $880.00                    $1,061.00                   $1,061.00
Family                                $1,272.00                   $1,534.00                   $1,534.00



Medical Post-65 Retirees Monthly Contributions:
                              Kaiser Senior Advantage - Low Option      Kaiser Senior Advantage - High Option
                                         Group #00074                               Group #00074
                                         Sub Group #19                             Sub Group #25
Retiree Only - One Medicare                     $155.20                                $264.24
Retiree + 1 - Two Medicare                      $310.40                                $528.48
Retiree + 1 - One Medicare                      $595.20                                $704.24
Retiree + 2 - One Medicare                      $986.98                               $1,096.02
Retiree + 2 - Two Medicare                      $750.40                                $968.48
Part B Only                                     $663.02                                $763.16


Dental Plans Monthly Contributions:
                                 Delta Dental Low           Delta Dental Medium          Delta Dental High
                                  Group #7984                   Group #7985                Group #7986
Retiree Only                           $16.38                       $22.50                        $28.03
Retiree + 1                            $31.13                       $42.75                        $53.25
Retiree + 2 or more                    $45.68                       $61.71                        $74.68



Vision Plan Monthly Contributions:
                                  Humana Vision
                                  Group #VS5856
Single                                 $4.12
2-Party                                $8.24
Family                                 $11.02




                                                          -6-
                                                        Notices
Grandfathered Status                                                Medicaid and the Children’s Health
This group health plan believes this plan is a                      Insurance Program (CHIP)
“grandfathered health plan” under the Patient Protection
and Affordable Care Act (the Affordable Care Act). As               Offer Free Or Low-Cost Health
permitted by the Affordable Care Act, a grandfathered               Coverage To Children And Families
health plan can preserve certain basic health coverage that         If you are eligible for health coverage from your employer,
was already in effect when that law was enacted. Being a            but are unable to afford the premiums, some States have
grandfathered health plan means that your plan may not              premium assistance programs that can help pay for
include certain consumer protections of the Affordable Care         coverage. These States use funds from their Medicaid or
Act that apply to other plans, for example, the requirement         CHIP programs to help people who are eligible for employer-
for the provision of preventive health services without any         sponsored health coverage, but need assistance in paying
cost sharing. However, grandfathered health plan must               their health premiums.
comply with certain other consumer protections in the
Affordable Care Act, for example, the elimination of lifetime       If you or your dependents are already enrolled in Medicaid or
limits on benefits.                                                 CHIP and you live in a State listed below, you can contact
                                                                    your State Medicaid or CHIP office to find out if premium
Notice of Opportunity to Enroll                                     assistance is available.
in connection with Extension of                                     If you or your dependents are NOT currently enrolled in
Dependent Coverage to Age 26                                        Medicaid or CHIP, and you think you or any of your
Individuals whose coverage ended, or who were denied                dependents might be eligible for either of these programs,
coverage (or were not eligible for coverage), because the           you can contact your State Medicaid or CHIP office or dial 1-
availability of dependent coverage of children ended before         877-KIDS NOW or www.insurekidsnow.gov to find out how
attainment of age 26 are eligible to enroll in the Denver Fire      to apply. If you qualify, you can ask the State if it has a
Department health plan. Individuals may request                     program that might help you pay the premiums for an
enrollment for such children for 30 days from the date of           employer-sponsored plan.
notice. Enrollment will be effective retroactively to January
1, 2011. For more information contact the Human                     Once it is determined that you or your dependents are
Resource Benefits team.                                             eligible for premium assistance under Medicaid or CHIP,
                                                                    your employer’s health plan is required to permit you and
                                                                    your dependents to enroll in the plan – as long as you and
Right to Designate Primary Care                                     your dependents are eligible, but not already enrolled in the
Physician                                                           employer’s plan. This is called a “special enrollment”
The Denver Fire Department Health Plan (“the plan”)                 opportunity, and you must request coverage within 60
generally requires the designation of a primary care                days of being determined eligible for premium
provider. You have the right to designate any primary               assistance.
care provider who participates in our network and who is            ________________________________________________
available to accept you or your family members. For
information on how to select a primary care provider, and           You may be eligible for assistance paying your employer
for a list of the participating primary care providers, contact     health plan premiums. The listing is current as of April
the plan administrator at 720-913-3413.                             16, 2010. You should contact your State for further
                                                                    information on eligibility –
                                                                    COLORADO - Medicaid and CHIP
                                                                    Medicaid Website: http://www.colorado.gov/
                                                                    Medicaid Phone: 1-800-866-3513
                                                                    CHIP Website: http:// www.CHPplus.org
                                                                    CHIP Phone: 303-866-3243




                                                              -7-
                                                      Notices
Women’s Health and Cancer Rights                                     be able to later enroll yourself and your dependents in this
Act Notice                                                           plan if you or your dependents lose eligibility for that other
                                                                     coverage (or if the employer stops contributing toward your or
The Women’s Health and Cancer Rights Act of 1998
                                                                     your dependents’ other coverage).
(“WHCRA”) provides certain protections for individuals
receiving mastectomy-related benefits. Coverage will be              Loss of eligibility includes but is not limited to:
provided in a manner determined in consultation with the
attending physician and the patient, for the following:                  Loss of eligibility for coverage as a result of ceasing to
    All stages of reconstruction of the breast on which the              meet the plan’s eligibility requirements (i.e., legal
    mastectomy was performed                                             separation, divorce, cessation of dependent status, death
    Surgery and reconstruction of the other breast to                    of an employee, termination of employment, reduction in
    produce a symmetrical appearance                                     the number of hours of employment);
    Prostheses                                                           Loss of HMO coverage because the person no longer
    Treatment of physical complications of the mastectomy,               resides or works in the HMO service area and no other
    including lymphedemas                                                coverage option is available through the HMO plan
                                                                         sponsor;
The Denver Fire Department benefits plan provides                        Elimination of the coverage option a person was enrolled
coverage for mastectomies and the related procedures                     in, and another option is not offered in its place;
listed above, subject to the same deductibles and                        Reaching the plan’s lifetime benefit maximum on all
coinsurance applicable to other medical and surgical                     benefits, if the person is covered under a separate plan
benefits provided under this plan.                                       or a single plan with multiple options and the other option
                                                                         has a higher lifetime maximum, or the benefits paid under
If you would like more information on WHCRA benefits,                    the first option were not integrated with the second
please refer to your Kaiser plan booklet or contact Human                option;
Resources at 720-913-3413.                                               Failing to return from an FMLA leave of absence; and
                                                                         Loss of coverage under Medicaid or the Children’s Health
Newborns’ and Mothers’ Health                                            Insurance Program (CHIP).
Protection Act Notice                                                Unless the event giving rise to your special enrollment right is
This notice is required by the Newborns’ and Mothers’                a loss of coverage under Medicaid or CHIP, you must request
Health Protection Act of 1996 (NMHPA). Group health                  enrollment within 30 days after your or your dependents’
plans generally may not, under Federal law, restrict                 other coverage ends (or after the employer that sponsors that
benefits for any hospital length of stay in connection with          coverage stops contributing toward the coverage).
childbirth for the mother or newborn child to less than 48
hours following a vaginal delivery, or less than 96 hours            If the event giving rise to your special enrollment right is a
following a cesarean section. However, federal law                   loss of coverage under Medicaid or CHIP, you may request
generally does not prohibit the mother’s or newborn’s                enrollment under this plan within 60 days of the date you or
attending physician, after consulting with the mother, from          your dependent(s) lose such coverage under Medicaid or
discharging the mother or her newborn earlier than 48                CHIP. Similarly, if you or your dependent(s) become eligible
hours (or 96 hours, as applicable). In any case, the plan            for a state-granted premium subsidy toward this plan, you
may not, under federal law, require that a physician obtain          may request enrollment under this plan within 60 days after
authorization from the plan for prescribing a length of stay         the date Medicaid or CHIP determine that you or your
not in excess of 48 hours (or 96 hours).                             dependent(s) qualify for the subsidy.

Reminder of Availability of                                          In addition, if you have a new dependent as a result of
                                                                     marriage, birth, adoption, or placement for adoption, you may
HIPAA Privacy Notice                                                 be able to enroll yourself and your dependents. However, you
The plan listed above maintains a privacy policy pursuant
                                                                     must request enrollment within 30 days after the marriage,
to the Health Insurance Portability and Accountability Act of
1996 (HIPAA). If you would like a copy of the privacy                birth, adoption, or placement for adoption.
notice, you may contact Human Resources at 720-913-
3413.                                                                To request special enrollment or obtain more information,
                                                                     contact:
                                                                              Human Resources
Special Enrollment Rights                                                     720-913-3413
If you are declining enrollment for yourself or your
                                                                              745 West Colfax Avenue
dependents (including your spouse) because of other
health insurance or group health plan coverage, you may                       Denver, CO 80204

                                                               -8-
Notes




 -9-
Notes




 - 10 -
- 11 -
This document is intended to merely highlight or summarize certain aspects of the employer’s
benefit program(s). It is not a summary plan description (SPD) or an official plan document. Your
rights and obligations under the program(s) are set forth in the official plan documents. All
statements in this summary are subject to the terms of the official plan documents, as interpreted
by the appropriate plan fiduciary. In the case of an ambiguity or outright conflict between a
provision in this summary and a provision in the plan documents, the terms of the plan documents
control. The employer reserves the right to review, change, or terminate the plan, or any benefits
under it, for any reason, at any time and without advance notice to any person.




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                                     8110 E. Union Avenue, Suite 700
                                           Denver, CO 80237

				
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