2015 City & County of San Francisco New Employee Orientation: Health Benefits

2. Welcome.
Congratulations on your new job!

3. HSS Contact Information
PHONE:
(415) 554-1750
IN PERSON:
1145 Market Street 3rd
Floor
San Francisco, CA
PHONE AND OFFICE HOURS:
Monday through Friday
8:00am to 5:00pm
(Open at 9:30 am every other Thursday)
WEBSITE:
www.myhss.org

4. Health Service System (HSS) Overview
• Your health benefits are determined by:
- Your employer or department
- Your union
• HSS is the administrator of City & County of San Francisco
employee health benefits:
- Medical - Employee Assistance Program (EAP)
- Dental - Flexible Spending
- Vision - Long Term Disability (most unions)
- Group Life Insurance (some unions)
• Health benefits plan year is January to December.

5. Benefits Enrollment Process
• Three opportunities to enroll or make changes:
- New Employee
- Change in Family Status
- Annual Open Enrollment
• Starts with an HSS Enrollment Application.
• Documentation (marriage certificate, birth certificate, etc.)
is required to enroll dependents.
• You must meet deadlines for submitting application and
required documentation.
• If you do not complete enrollment within 30 days of your
start work date you must wait until Open Enrollment.

6. Enrollment of New Employees
• Must enroll in a medical and/or dental plan within
30 calendar days of your start work date.
• If you do not enroll within the first 30 days you must wait for
the next Annual Open Enrollment.
• Coverage starts on the first day of the coverage period following
your start work date if you submit required application and
documentation by the 30 day deadline.

7. Eligible Dependents
• Legal Spouse or Domestic Partner
• Children from birth to age 26 (natural child, adopted child,
stepchild, domestic partner’s child)
• Children up to age 19 (legal guardianship, court order)
• PROOF: Copy of certificate of marriage or partnership,
birth or adoption
• No dual eligibility for two related employees enrolled in
HSS medical, dental or vision plans

8. Ineligible Dependents
HSS routinely audits enrollment. You must notify HSS if enrolled
dependents are no longer eligible to be covered on your plan.
• Divorced ex-spouse
• Former domestic partner after legal dissolution of partnership
• Legally separated spouse or domestic partner
• Step-children associated with former spouse or partner
• Children who no longer meet age or other eligibility
requirements

9. How Do I Choose a Health Plan?
Here are considerations to keep in mind when choosing
a health plan:
• Cost. How much will I pay?
• Choice of doctor, medical group and hospital
• Convenience / access to care
• Personal situations (medical needs, balancing
coverage if your partner has a plan, etc.)

10. Medical Plan Options: Co-pay Costs
SERVICE
HMO
Kaiser
HMO
Blue Shield
PPO
City Plan
Primary Care
Provider yes yes no
Deductible $0 $0 $250 per enrollee
Office Visit
$0 - preventive
$20 - other
$0 - preventive
$25 - other
85% In-Network
(preventive 100%)
50% Out-of-Network
Service Area Kaiser, ER Blue Shield Network,
ER
PPO,
Out-of-Network
/Worldwide
Information on this chart is effective January–December 2015.

11. Medical Plan Premium Contributions
• Employee premium contributions vary depending on:
- Union
- How many people are covered
- Medical plan
- City of San Francisco employer contribution
• Contributions also vary based on number of covered individuals:
- Employee Only
- Employee + 1 Dependent
- Employee Only + 2 or more Dependents
• To review your premium contribution rates, see your
HSS Benefits Guide or visit the HSS website: myhss.org.

12. 2015 Dental Plan Options
SERVICE
PPO
Delta Dental*
Dental HMO
DeltaCare USA
Dental HMO
Pacific Union
Dental Offices in SF more than 500 14 32
Primary Care Dentist no yes yes
Authorization to Specialist no yes yes
Cleaning & Exam
100% / 6 months
3x/yr pregnant
100% / 6 months 100% / 6 months
Fillings 90%/80% 100% 100%
Orthodontia
50%;
$2500 max child
$350 start fee;
$1600 max child
$350 start fee;
$1600 max child
Waiting Period some exceptions* none none
Service Area outside of area must live in DHMO
area
must live in
DHMO area
*Delta Dental costs shown are for PPO/Premiere/Out-of-Network. Premiere and out-of-network dentist costs are higher.
6-month waiting period for dentures, pontics, bridges, orthodontia and implants.

13. VSP Vision Plan
• Vision benefits are only available if you are enrolled in a
medical plan.
• The City pays all premium contributions for the vision
benefit. Employee is responsible for any co-pay costs.
• No ID card issued. Make appointment with VSP doctor who
gets authorization from VSP.
• VSP Network Benefits
- vision exam every 12 months, co-pay $10 - urgent eye care $5 co-pay
- frames/lenses/contacts every 24 months, co-pay $25 - frames/contacts covered to $150
- some unions have VDT benefit for computer users
• Claim reimbursement for service from non-VSP providers.

14. Flexible Spending Accounts (FSAs)
• Optional; re-enroll every plan year.
• Saves money by reducing income taxes.
• Allows you to pay for eligible medical, dental and
dependent care expenses on a pre-tax basis.
• Contributions you make are deducted from your pay
BEFORE Federal, State or Social Security taxes
are calculated.
• For list of eligible expenses visit: wageworks.com

15. FSAs: Types & Examples
• Healthcare
- co-pays (office visits, pharmacy)
- eyeglasses
- orthodontic treatment
- weight loss programs (with written doctor’s order)
- over-the-counter medications (only with prescription)
• Dependent Care (licensed facilities)
- day care services
- in-home care
- nursery
- summer day camp

16. FSAs: Things to Consider
• How much do you want to contribute in 2015?
- minimum $260
- maximum $2,500 for Healthcare FSA
- maximum $5,000 for Dependent Care FSA
• For reimbursement, submit receipts and documentation
to the FSA administrator FBMC.
• Enroll as new employee or annually during Open Enrollment.
• Healthcare FSA only: the amount you designate as your total
annual contribution is available on day one of the plan year.
• Healthcare FSA only: up to $500 in unused contributions will
automatically carry over to next plan year.

17. Long Term Disability (LTD) Plan
• This employer-paid benefit is only available to some employees,
depending on bargaining unit.
• Provides financial protection by paying a significant percentage
of your income while you are disabled.
• Maximum benefit $5,000 per month.
• Waiting period 3 to 6 months depending on your union.
• Administered by Aetna.

18. Group Life Insurance Plan
• This benefit is available to some bargaining units: MEA, MAA,
SEIU 1021, Teamsters 856, TWU 200, IFPTE Local 21
• Administered by Aetna
• Amount: varies by union
• Eligibility
- permanent: date when employment begins
- provisional: 1,040 hours in a 6 month period
• Beneficiary
- recipient of proceeds to be paid at your death
- you may name more than one beneficiary
- if you don’t name a beneficiary proceeds go to
spouse or domestic partner, natural or adopted
children, parents or your estate – in this order.

19. Family Status Change
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
DEADLINEDAY OF EVENT
- marriage, divorce, legal separation
- domestic partnership (joining
or dissolving)
- birth or adoption of a child
If your family situation changes, you may change some
health benefits within 30 calendar days of the event.
- loss of other coverage
- obtaining other coverage
- ineligibility
- death
1 30

20. Open Enrollment
• Next Open Enrollment takes place October 2015 for
January to December 2016 plan year.
• During Open Enrollment you may:
- keep or change your benefit elections
- add or drop dependents
- open or re-open a flexible spending account
• HSS mails Open Enrollment info. Make sure HSS has your
current address!

21. Unpaid Leave of Absence
• If you wish to continue (or waive) health benefits during
your leave, you must notify HSS before you go on leave.
• For all types of leave, payments must be made to HSS
each month you are on leave, for the full monthly employee
premium amount.
If you do not notify HSS before going on approved leave, or you do not make
required payments to HSS while on leave, your benefits may be terminated.

22. HSS Employee Assistance Program (EAP)
• Short-term therapy and counseling
• No cost (free) to all employees and their family members
• Staffed by state certified, licensed therapists
• Completely confidential
• Voluntary
• Appointments available 9:00am to 4:00pm,
Monday through Friday
• To schedule a confidential EAP appointment call
(800) 795-2351.

23. Employee Wellness
• Lunchtime fitness classes and workshops throughout the City.
Class calendar online at myhss.org.
• Employee wellness center at 1145 Market Street 1st
Floor.
• Fitness club/gym discounts. See Benefits Guide for list.
• Health plans may also offer additional wellness benefits.
• Individual departments may also offer other
wellness programs.

24. Stay Informed About Your Benefits
• Rates and benefits change every year!
• Visit myhss.org often and register online for monthly
email updates.
• Make sure HSS has your correct mailing address.
Contact HSS if you have a change of address.
• Call or visit HSS Member Services if you have questions
about your benefits: (415) 554-1750.

25. Health Service System Website

26. New Hire Benefits Information Online
http://myhss.org/member_services/newhires/

27. Questions?