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Employees Bi-weekly contributions - Non-tobacco user
Employee only
$15.65
$92.77
Employee + 1
$86.00
$271.92
Employee + 2 or more
$105.59
$350.07
Employees Bi-weekly contributions -Tobacco user
Employee only
$28.15
$105.27
Employee + 1
$98.50
$284.42
Employee + 2 or more
$118.09
$362.57
Retirees under 65 - Monthly contributions
Retiree only
$136.22
$458.02
Retiree + 1
$401.98
$1,178.10
Retiree + 2 or more
$626.86
$1,647.88
Retirees over 65 without Medicare - Monthly contributions
Retiree only
$421.38
$621.80
Retiree + Spouse
$884.90
$1,305.74
Retiree + Family
$1,516.98
$1,617.64
Retirees over 65 with Medicare - Monthly contributions
Retiree w/Medicare
$131.44
$399.60
Retiree + Spouse (1 w/Medicare)
$262.96
$1,049.76
Retiree + Spouse (2 w/Medicare)
$256.36
$440.72
Retiree + Family (1 w/Medicare)
$447.00
$1,140.24
Retiree + Family (2 w/Medicare)
$407.56
$1,047.30
*Rates effective date May 1, 2007
If you are a Medicare–covered Retiree, the Medicare Advantage plans offer distinct financial advantages for you. You have great health care, and four excellent choices, at that! Click here for Medicare Advantage plan rates.
If you or a covered family member use a tobacco product, add $12.50 to the employee rates and $25 to the retiree rates.
The HMO and PPO plans provide access to prescriptions through copayments –always lower than paying the old-fashioned 20% coinsurance. That’s because we want you to take the medications you need to get well, or manage your condition.
Prescription coverage
HMO and PPO
Participating Pharmacy
HMO and PPO
Mail order
30-day supply
90-day supply
$10 generic
$20 generic
$30 preferred
$60 preferred
$45 nonpreferred
$90 nonpreferred
Out-of-Area
Nonparticipating Pharmacy
Out-of-Area
Mail order
50% after $20 copayment per Rx
not available
To find a participating pharmacy, go to www.bcbstx.com and use the pharmacy or provider finder option.
A dental health maintenance organization is a network of dentists, like an HMO, that offers a comprehensive range of dental services for fixed copayments. You choose a primary care dentist who coordinates your care and refers you to specialists. You must live in the service area to enroll.
Features of the DHMO include:
No maximum annual limit on dental services,
No deductibles,
No claim forms to complete for most procedures,
A fixed copayment for dental services, and
A network that includes dentists and orthodontists.
A dental indemnity plan is a traditional plan that lets you receive a comprehensive range of dental services from the provider of your choice anywhere in the United States. You pay a percentage of charges for certain services and file a claim for reimbursement.
To use the plan:
Make an appointment with the dentist of your choice.
If the treatment will cost more than $200, get a cost estimate.
Pay the dentist. Some dentists require patients to pay only their portion.
File a claim for reimbursement within 90 days. Some dentists will file your claim for you.
The chart below shows some services provided under the dental indemnity and DHMO plans. For a complete list of services provided under this plan, refer to the City of Houston Dental Indemnity Plan brochure.
In-network Preferred Dentist Option
If you are enrolled in the dental indemnity plan, you can reduce your out-of-pocket costs by using a preferred dentist. If you receive care from a preferred dentist or a network of dental providers, you will receive a discount on your dental services and have more money in your pocket.
As you can see in the chart below, if you use a preferred dentist, you will realize a considerable savings. The more costly the dental work, such as bridges or dentures, the more savings you will realize. Also, because all fees are reduced, you will receive more services before you reach the $1,000 annual maximum benefit.
Plan
Usual cost
50 percent coinsurance
Out-of-network
$875
$437.50
In-network
$701
$350.50
Your savings
$87.00
The city’s In-network Preferred Dentist Option brochure provides information about this feature as well as a list of preferred dentists in the network. Ask your department human resources liaison for a brochure.
After you pay the annual deductible, the plan will pay 80 percent of services, up to usual and customary limits.
Major Services
Initial fixed bridgework, crowns and dentures, replacement of bridgework
Crown - Titanium - $210
Complete Denture, Maxillary - $260
Immediate Denture, Maxillary - $270
After you pay the annual deductible, the plan will pay 50 percent of services, up to usual and customary limits.
Orthodontic Services
Covered services up to two years
Adult, 24-month Case - $2,000
Adolescent, 24-month Case - $1,800
Interceptive Ortho Service - $1,100
(Primary and Transition Dentition)
After you pay the annual deductible, the plan will pay 50 percent of services, up to usual and customary limits. The lifetime maximum benefit is $1,000 per individual.
This plan pays a daily cash benefit while you or a covered dependent is hospitalized. The money is paid to the employee and may be used for all expenses, even if they are not medical expenses. These payments are in addition to your city medical plan.
Under this plan, pre-existing conditions are not covered for an injury or sickness that required medical advice or attention during the 12-month period before the effective date of coverage.
Accident/Disability Plan
This plan provides a benefit if you or a covered dependent is injured or becomes disabled according to plan guidelines.
The plan will pay a benefit to the employee for:
accidental death,
off-the-job accidents that result in disability, employee only,
hospital income,
emergency room use, and
injury or loss of limb.
These payments are in addition to the city medical plan. If you pay for accident/disability insurance plan coverage with pretax dollars, future disability benefit payments will be taxable income.
Personal Cancer Protector Plan
This plan provides supplemental insurance for you or a covered dependent diagnosed with cancer. Benefits are paid directly to you.
You may use this benefit to pay for medical, travel and other expenses including, but not limited to:
The
Family Medical Leave Act (FMLA) entitles
you to up to 12 weeks of job-protected
leave each Benefit Year (September 1-August
31) for specified family and medical
reasons. The reasons specified in the
act are:
Medical
leave when you are unable to work
due to a serious health condition,
Birth or placement of a child for
adoption or foster care, or
Care of an immediate family member
with a serious health condition.
To
be eligible for FMLA benefits you must
have worked for the city for at least
12 months and have been physically at
work for at least 1,250 hours during
the 12-month period preceding the date
leave begins. You are required to use
your accrued paid leave (vacation or
sick time in the case of your own illness)
in order to be compensated while on
FMLA leave.
For detailed
information regarding FMLA, please contact
your departmental human resources representative.
If you
are a fulltime employee who is NOT a
Classified Police Officer, and you meet
the Plan’s eligibility requirements
of two years participation in the Compensable
Sick Leave program, you will be covered
under the City of Houston Long-Term
Disability (LTD) Plan.* This plan is
paid for by the city in order to protect
the income of employees who become disabled.
If you
become permanently and totally disabled,
the plan will provide a source of income
up to age 65, until death before age
65 or until the disability ends before
age 65. There is an elimination period
of 180 days after the date of disability
during which time benefits are not payable.
To qualify for LTD benefits, the plan
administrator’s medical director
must certify your medical condition
as a permanent and total disability.
*In some
instances, where a preexisting condition
exists, an employee may not become covered
by the plan until after three years
of employment.
For a
more comprehensive description of plan
benefits, contact the Benefits Division
at (713) 837-9400.
The Compensable Sick Leave Plan allows
you to accrue sick hours that may be
used when you are ill. Sick leave accrual
begins immediately for new employees.
The plan allows you to accumulate two
hours 30 minutes per pay period to a
maximum of 65 hours per benefit year.
benefit years begin Sept. 1 and end
Aug. 31. At the end of a benefit year,
the city will match any sick leave hours
that you have accrued during that benefit
year and not used. These hours will
be added to your accruals for the next
benefit year to an accrual of 1,040
hours. After you reach an accrual of
1,040 hours, you will continue to accrue
65 hours each benefit year; however,
the city will not match unused accruals
after 1,040 hours.
A supervisor may require
a doctor’s statement for each
absence for which sick hours are used.
A supervisor must require a doctor’s
statement for all sick hours used in
excess of 64 hours in a benefit year.If
you use 16 or fewer sick hours during
any full benefit year, the plan allows
you to receive personal leave days*.
You must be employed a full benefit
year before you qualify for personal
leave days.
Sick hours used
Personal leave days earned
None
3
One minute to eight hours
2
Nine to 16 hours
1
More than 16 hours
0
The plan provides eight hours for preventive
wellness,* such as doctor or dentist
appointments, during a benefit year.
The eight hours will not reduce the
number of sick hours that you accrue.
You must be employed for a full benefit
year before you qualify to use preventive
wellness hours.
For example:
Employee hired – Feb. 2001
Benefit year starts – Sept.
2001
Employee works a benefit year - Sept.
2001 – Aug. 2002
Employee is entitled to wellness hours – Sept. 2002 – Aug. 2003
and each benefit year thereafter.
*Important Note: Personal leave hours
and preventive wellness hours must be
used during the benefit year in which
they are awarded. Hours do not accumulate
and may not be carried over from one
benefit year to another benefit year.
Holidays
The city grants employees the following
11 paid holidays each year:
2008 Holiday Schedule
New Year’s Day
Tuesday, Jan. 1
Martin Luther King, Jr. Birthday
Monday, Jan. 21
Memorial Day
Monday, May 26
Independence Day
Friday, July 4
Labor Day
Monday, Sept. 1
Veterans' Day
Tuesday, Nov. 11
Thanksgiving Day
Thursday, Nov. 27
Day after Thanksgiving
Friday, Nov. 28
Christmas Eve
Wednesday, Dec. 24
Christmas Day
Thursday, Dec. 25
1 Floating Holiday - per calendar year
The floating holiday for any year is
not available to employees hired on
or after July 1st. Those employees will
be eligible for floating holidays in
subsequent years. The floating holiday
must be used by Dec. 31 of each year.
Wellness Leave
Additionally, employees in the CSL plan who have completed a full benefit year of service are entitled to use up to eight hours of wellness leave during the next benefit year. Wellness leave is to be used for physical examinations and other preventive medical appointments and requires advance notice and documentation from the health provider.
457 Plan
In addition, employees can participate in the 457 Defined Contribution Retirement plan provided by Great-West Services where they can invest for retirement using pre tax dollars.
Employees can elect to participate in this defined contribution savings plan. Contributions to this plan can reduce your taxable income. The plan is similar to a 401(K), but designed for city employees. You may enroll in this plan as soon as you begin employment.
