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Employee Total Rewards Guide 2020 - Reston Total Rewards Gui… · Recognizing and rewarding...

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Employee Total Rewards Guide 2020 Compensation, Recognition & Rewards See page 3 Wellness Program & Benefits See page 5 Training & Career Development See page 22 Work/Life Balance See page 21 Total Rewards Contact your Human Resources team at 703-435-7990 or [email protected] with any questions or concerns about your Total Rewards Package
Transcript
Page 1: Employee Total Rewards Guide 2020 - Reston Total Rewards Gui… · Recognizing and rewarding employees for achieving a sustainable impact. Award criteria includes: •Progressive

Employee Total Rewards Guide

2020

Compensation Recognition amp Rewards

See page 3

Wellness Program amp Benefits

See page 5

Training amp Career Development

See page 22

WorkLife Balance See page 21

Total Rewards

Contact your Human Resources team at 703-435-7990 or hrrestonorg with any questions or concerns about your Total Rewards Package

Reston Association is committed to providing a comprehensive Total Rewards Package

The goal of Restonrsquos Total Rewards Package is to create value for employees

by striving to meet their professional goals and personal needs

Reston Association Core Values Service bull Collaboration bull Stewardship bull Innovation bull Leadership

2

Compensation

Base Pay Reston Association strives to be competitive with wages within our industry and within our community We believe in an equitable balanced total pay program that offers competitive pay RA hires employees within the minimum of market pay range or RArsquos salary grade range whichever is greater for the job with variations based on job-related skills education ability experience and the current job market RArsquos salary ranges and job descriptions are available to view in CommonHumRes

Annual Performance Reviews amp Merit Increases Performance reviews are scheduled annually A merit increase may be applied to your base pay in conjunction with your performance review You and your supervisor should also review your job description at this time and inform HR if any updates are necessary

Recognition amp Rewards

Kudos Notes Take a minute to recognize a co-worker for something positive by writing them a Kudos Note There is never a reason too small There is a Kudos board at CSF and WNEC (Nature House) and there are three Kudos boards at Headquarters There will be periodic Kudos Note drawings throughout the year

Reston Employee Awards Program (REAP) The purpose of REAP is to recognize and reward employees for going above and beyond in performing their responsibilities and service to the organization Nominations for REAP awards are reviewed by the REAP Committee on a monthly basis Employees can receive an individual or group REAP award

3

Recognition amp Rewards

Reston Association recognizes and rewards employees for going above and beyond in performing their responsibilities and service to the organization and to all that Reston encompasses Employees can be recognized and rewarded by their peers by receiving an Achievement award or a Recognition award

Achievement Recognizing and rewarding employees for achieving a sustainable impact Award criteria includes bull Progressive for RA and RArsquos goals bull Innovative bull Sustained Excellence bull Saves RA timemoneyother resources

Recognition Recognizing and rewarding employees for a moment of excellence Award criteria includes bull A moment of excellence performed under challenging or uncommon circumstances bull A single event of outstanding service that goes beyond onersquos core job responsibilities and that demonstrates

an employeersquos willingness to take initiative in assisting internal andor external customers

Service Awards Reston Association provides awards for reaching years of service milestones Awards are given in December of the year in which you reach one of the following service milestones 5 years bull 10 years bull 15 years bull 20 years bull 25 years bull 30 years bull 35 years

Employee of the Year Every year Reston Association selects an Employee of the Year The purpose of the Employee of the Year award is to honor those who have invested their time and taken initiative to make significant contributions to the organization and community over the course of the year with consideration given to past achievements and contributions The Employee of the Year receives one paid day off certificate a $500 bonus and dedication of a tree in Reston

4

Benefits ndash RArsquos Wellness Program

Reston Association is committed to providing a culture that promotes healthy living through education and resources RArsquos Wellness Program works to achieve this commitment through its goals

To help employees reduce lifestyle risk factors and become better health care consumers

To raise employee awareness about the importance of preventative health care and overall wellness including financial and mental

To provide employees a work environment that supports positive health and fitness practices

Every year at RArsquos annual wellness and benefits fair in November you will be given a Passport to Wellness where you earn stamps for individual and group activities Benefits of participating in the Wellness Program include

Wellness screenings and flu shots at the Benefits Fair in November Quarterly Brown Bag presentations related to wellness and workplace topics Activities events and team challenges such as the YMCA Corporate Challenge car

free days blood drives water-only challenges smoothie days and more Earn stamps for participation in individual and group activities Redeem your stamps

for prizes including the grand prize

5

Benefits ndash PlanContact Information

Enrollment in the majority of these benefits must be done within 30 days of hire during open enrollment or within 30 days of a qualifying life change event Open enrollment occurs annually from mid-November to mid-December

Benefits elected during open enrollment will take effect January 1

The employee their spouse or domestic partner (regardless of sex) and their children under age 26 are eligible to enroll in benefits

Insurance Benefits

Health Insurance Provider Name Kaiser Permanente group 3007-4 (HMO Select) 3007-6 (POS) 3007-10 (HRA-DHMO) Provider Contact Member Services 301-468-6000 Provider Web Address wwwkporg

Dental Insurance Provider Name MetLife group 5469528 Provider Contact Member Services 800-ASK-4MET Provider Web Address httpsmybenefitsmetlifecom

Supplemental Vision Insurance ndash two options 1Provider Name VSP group 30017163

Provider Contact Member Services 800-877-7195 Provider Web Address wwwvspcom

2Provider Name SpecteraUHC group GA9N9747BW Provider Contact Member Services 800-839-3242 Provider Web Address wwwmyuhccom

Flexible Spending Accounts (FSA) amp Dependent Care Accounts (DCA) Contact Optum Health Provider Contact Member Services 800-243-5543 Provider Web Address httpssecureoptumhealthfinancialcom

LifeADampD Short-term Disability (STD) amp Long-term Disability (LTD) Insurance Provider Name Sun Life group 211628 Provider Contact Member Services 800-247-6875 Provider Web Address wwwsunlifecomus

Savings Benefits 401(k) Retirement Savings Plan (pre-tax and Roth)

Provider Name Ascensus Broker Contact Mark Ivcevich 301-326-1521 markqp-consultingcom Web Address httpsmyaccountascensuscomrplink

529 College Savings Plan Contact Human Resources

6

Medical Premium Costs per Paycheck for Employees Hired Prior to 1-1-2019

The amount of your paycheck cost difference will be dependent on the type of coverage you choose

for 2020 (see last column on the table below)

Rates are effective January 1 2020

HRA-HMO

Signature

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $50725 $3512

Employee + 1 $101444 $8193

Employee + Family $147096 $12408

HMO Select

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $58173 $4027

Employee + 1 $116340 $9397

Employee + Family $168696 $14229

POS Select

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $85966 $5951

Employee + 1 $171932 $13887

Employee + Family $249293 $21028

NOTE The Health Insurance Premium Bank is still available to those who qualify Request for

assistance must be made annually by December 15th or within 30 days of a qualifying event

7

Medical Premium Costs per Paycheck for Employees Hired After 1-1-2019

The amount of your paycheck cost difference will be dependent on the type of coverage you choose

for 2020 (see last column on the table below)

Rates are effective January 1 2020

HRA-HMO

Signature

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $50725 $4682

Employee + 1 $101444 $10535

Employee + Family $147096 $15802

HMO Select

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $58173 5370

Employee + 1 $116340 $12081

Employee + Family $168696 $18122

POS Select

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $85966 $7935

Employee + 1 $171932 $17854

Employee + Family $249293 $26781

NOTE The Health Insurance Premium Bank is still available to those who qualify Request for

assistance must be made annually by December 12th or within 30 days of a qualifying event

8

Dental amp Vision Premium Costs per Paycheck

The following rates represent your monthly Dental and Vision premiums effective January 1 2020

MetLife Dental Per Paycheck

FULL-TIME Cost

Per Paycheck

PART-TIME Cost

Employee $000

Contact HR for cost Employee + 1 $000

Employee + Family $000

VSP Vision Per Paycheck Cost

Employee $513

Employee + Adult $864

Employee + Child $882

Employee + Family $1423

SpecteraUHC Vision Per Paycheck Cost

Employee $415

Employee + Adult $843

Employee + Child $883

Employee + Family $1116

9

Health Insurance ndash Option 1

DHMO HRA Signature In Network You Pay Out-of-Network You Pay

Deductible Coinsurance Out-of-Pocket

$750 Individual$1500 Family (RA funds) 9010

$3000 Individual $6000 Family

(less than regular HMO)

NA

Primary Care and Specialist Office Visit $15 PCP$25 Specialist NO COVERAGE

Emergency Room Visits $75 per visit (waived

if admitted) NO COVERAGE

Hospital ndash Inpatient Stay 10 after deductible NO COVERAGE

Home Health Care 10 after deductible NO COVERAGE

Outpatient Facility Services 10 after deductible NO COVERAGE

X-Ray and Laboratory Services 10 after deductible NO COVERAGE

Specialty Imaging (CTMRIPET scan) 10 after deductible NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Inpatient Facility

10 after deductible NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Outpatient Facility

$7 copay-group therapy $15 copay-individual therapy per visit

NO COVERAGE

Vision (Children Only) $15 PCP$25 Specialist NO COVERAGE

Prescription Drug Program (30 day supply) Generic Drug (Tier 1) Preferred Brand Name Drug (Tier 2) Non-Preferred Brand Drug (Tier 3) Up to 90 day supply ndash 3 co-pays for Plan and Participating Pharmacies Mail Order Up to 90 day supply- 2 co-pays

$0 deductible

Plan $20 Participating $30 Plan $30 Participating $50 Plan $45 Participating $65

$20$30$45

Kaiser Permanente D-HMO HRA Signature (Facilities Only) With the Signature Network members receive quality care at the Kaiser medical centers in Maryland Virginia and the District of Columbia Medical centers offer convenient services including primary care specialty care laboratory radiology and pharmacy at most locations and in some locations optical Signature members also have access to more than 40 hospitals in the region

10

Health Insurance ndash Option 2

Kaiser Permanente HMO Select (Facilities amp Contracted Providers Only) With the Select Network members may receive quality care at the Kaiser medical centers in Maryland Virginia and the District of Columbia Building on the Signature physician network the Select network adds access to more than 15000 contracted community physicians in private practice Select members also have access to more than 40 hospitals in the region

HMO Select In-Network You Pay Out-of-Network

You Pay

Deductible Coinsurance Out-of-Pocket

None 100

$3500 Individual $9400 Family

NA

Primary Care and Specialist Office Visit $30 PCP$40 Specialist NO COVERAGE

Emergency Room Visits $100 per visit

(waived if admitted) NO COVERAGE

Hospital ndash Inpatient Stay $250 per admission NO COVERAGE

Home Health Care No charge NO COVERAGE

Outpatient Facility Services $100 NO COVERAGE

X-Ray and Laboratory Services No charge NO COVERAGE

Specialty Imaging (CTMRIPET scan) $50 per test NO COVERAGE

Chiropractic amp Acupuncture Services $40 copay

20 visits per contract year NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Inpatient Facility

$250 per admission NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Outpatient Facility

$15 copay-group therapy $30 copay-individual therapy per visit

NO COVERAGE

Vision (Children Only) $30 PCP$40 Specialist NO COVERAGE

Prescription Drug Program (30 day supply) Generic Drug (Tier 1) Preferred Brand Name Drug (Tier 2) Non-Preferred Brand Drug (Tier 3) Up to 90 day supply ndash 3 co-pays for Plan and Participating Pharmacies Mail Order Up to 90 day supply- 2 co-pays

$0 deductible

Plan $20 Participating $30 Plan $35 Participating $50 Plan $50 Participating $75

$20$35$50

11

Kaiser Permanente POS Select (Facilities amp Contracted Providers with an Out of Network Option) Members can use in-plan benefits by using a Kaiser facility or a contracted primary care physician Your chosen PCP will provide care and coordinate referrals and hospital admissions Members also have the freedom to choose any other licensed provider outside the provider network however you will be responsible for deductibles and coinsurance above the health planrsquos payment

POS Select In-Network You Pay Out-of-Network

you pay

Deductible Coinsurance Out-of-Pocket

None 100

$3500 Individual $9400 Family

$300 Individual $600 Family

8020 $3000 Individual

$6000 Family

Primary Care and Specialist Office Visit $15 PCP$30 Specialist 20 of UCR

Emergency Room Visits $75 per visit (waived if

admitted) $75 per visit

(waived if admitted)

Hospital ndash Inpatient Stay $250 per admission 20 of UCR

Home Health Care No charge 20 of UCR

Outpatient Facility Services $50 20 of UCR

X-Ray and Laboratory Services No charge 20 of UCR

Specialty Imaging (CTMRIPET scan) No charge 20 of UCR

Mental Health (MG) amp Substance Abuse (SA) ndash Inpatient Facility

$250 per admission 20 of UCR

Mental Health (MG) amp Substance Abuse (SA) ndash Outpatient Facility

$7 copay-group therapy $15 copay-individual therapy per visit

20 of UCR

Vision (Children Only) $15 PCP$30 Specialist per visit 20 of UCR

Prescription Drug Program (30 day supply) Generic Drug (Tier 1) Preferred Brand Name Drug (Tier 2) Non-Preferred Brand Drug (Tier 3) Up to 90 day supply ndash 3 co-pays for Plan and Participating Pharmacies Mail Order Up to 90 day supply- 2 co-pays

$0 deductible

Plan $20 Participating $30 Plan $35 Participating $50 Plan $50 Participating $75

$20$35$50

Health Insurance ndash Option 3

12

Dental Insurance

MetLife Dental PPO The Dental PPO plan is 100 Employer Paid for all tiers and provides comprehensive coverage with a nationwide PPO network This gives members access to more in-network dentists making it easier for them to reduce out-of-pocket costs for covered procedures and treatments Dental procedure frequencies Preventative care covers an exam and cleaning (once every 6 months) Fluoride treatment (two per benefit period under age 19 only) Full mouth X-ray (once every 60 months) Bitewing X-ray (once every 12 months age 14 and over once every 12 months under age 14)

PPO Dental Plan Features In-Network Out-of-Network

Type A Preventive Care Services (oral exams cleanings x-rays sealants)

100 of Fee Schedule 100 of Usual amp Customary

Charge

Type B Basic Restorative Dental Services (fillings simple extractions space maintainers)

80 of Fee Schedule 80 of Usual amp Customary

Charge

Type B Major Surgical Dental Services (Endodontics amp Periodontics)

80 of Fee Schedule 80 of Usual amp Customary

Charge

Type C Major Restorative Dental Services (bridges crowns dentures implants)

50 of Fee Schedule 50 of Usual amp Customary

Charge

Orthodontia (under age 19 only)

Lifetime maximum - $1000 50 of allowed benefit

Calendar Year Deductible Applies to Type B amp C services only

$25 Single $75 Family

Calendar Year Maximum Per Person $1500 combined maxper calendar year

Prior to receiving dental services it is recommended that you first obtain a pre-determination of benefits from your dentist so you know exactly how much your dental insurance will cover Spouses domestic partners and dependent children to age 26 (regardless of student status) are eligible

13

Vision Insurance ndash Option 1

Vision Plan through VSP (Voluntary) VSP is the largest private provider vision carrier in the country VSP contracts with Costcoreg Optical Eye Care Centers of America Inctrade which includes popular stores like EyeMasters VisionWorld and Hour Eyes and other quality retail chains When you visit a VSP participating provider your benefits include routine vision exams lenses and preferred pricing on all patient options Frequency Eye Exam 12 monthsLenses 12 monthsFrames 24 monthsContact Lenses 12 months

Vision Plan Features In-Network Out-of-Network

Annual Routine Eye Exam $10 copay Plan pays up to $45

Eyeglass Lenses (standard) Single Bifocal Trifocal

Covered in Full Covered in Full Covered in Full

Plan pays up to $30 Plan pays up to $50 Plan pays up to $65

Frames $130 allowance then 20 off remaining balance

Plan pays up to $70

Necessary Contact Lenses Covered in Full Plan pays up to $210

Elective Contact Lenses $130 allowance Plan pays up to $105

Elective Contact Lenses fitting and evaluation Covered in Full after $60

copay Not Available

Spouses domestic partners and dependent children to age 19 (or to age 25 if FT student) are eligible

14

Vision Insurance ndash Option 2

Vision Plan through Spectera UHC (Voluntary)

UHC offers you one of the largest vision care networks in the industry Their network includes convenient retail locations including My Eye Dr and Hour Eyes Best of all ndash when you receive care from a participating provider you receive the greatest benefits and money-saving discounts

Frequency Eye Exam 12 monthsLenses 12 monthsFrames 12 monthsContact Lenses 12 months

Vision Plan Features In-Network Out-of-Network

Annual Routine Eye Exam $10 copay Plan pays up to $40

Eyeglass Lenses (standard) Single Bifocal Trifocal

$25 copay $25 copay $25 copay

Plan pays up to $40 Plan pays up to $60 Plan pays up to $80

Frames $2500 copay $130 retail frame

allowance 30 discount above allowance

Plan pays up to $45

Necessary Contact Lenses $25 copay Plan pays up to $210

Elective Contact Lenses

$25 copay from the ldquoCovered contact lens

selectionrdquo All others- $105

allowance

Plan pays up to $105

Elective Contact Lenses fitting and evaluation Covered in Full after $25

copay Not Available

Spouses and dependent children to age 26 are eligible

15

Pre-tax FSA amp DCA

Flexible Spending Account (FSA) through Optum Health The Flexible Spending Account provides employees a means to reduce their taxes by the amount of their out of pocket health-related expenses (subject to eligibility) This tax free savings program allows employees to submit receipts for reimbursement for medical dental vision care prescription drug co-payments and other expenses not covered by our insurance In 2020 employees may contribute up to $2750 per year toward their FSA Employees have until March 14 2020 to use the money in their FSA or else they lose it (This contribution amount could change based on IRS guideline updates)

Dependent Care Spending Account (DCA) through Optum Health The Dependent Care Spending Account provides employees a means to reduce their taxes by the amount of their child care costs to a licensed provider up to $5000 annually

Health Insurance Premium Bank

Reston Association has established a program to help regular full-time and regular part-time employees pay their portion of the health insurance premium This program is only available to employees who are enrolled in or plan to enroll in the Kaiser Permanente HMO health insurance plans offered by the Reston Association Employees are eligible to apply to the Health Insurance Premium Bank if their adjusted gross household incomes are less than or equal to $60000 Requests for assistance must be made annually or at any time there is a qualifying event and submitted to Human Resources with necessary documentation by December 12th of each year To apply complete a request form (available in CommonHumResBenefits) and submit to HR with a copy of your most recent tax return showing adjusted gross household income This threshold is subject to change

16

Life and ADampD Insurance

Basic LifeADampD Insurance Reston Association provides 100 employer paid Life and ADampD Insurance through Sun Life to employees working 25 or more hours per week Coverage becomes effective the first of the month following six months of service

Benefit 2x Annual Earnings to a maximum of $200000 Age reduction Benefit reduced to 65 at age 65 and to 50 at age 70

Optional LifeADampD Insurance for Employee Spouse and Dependent Children

Optional Life Insurance for the employee spouse and dependent children is available at the employeersquos cost Optional Life is not available for domestic partners

Employee Benefit Increments of $10000 to a maximum of the lesser of $300000 or 3x your Basic Annual Earnings

Spouse Benefit Increments of $5000 to a maximum of $150000 Dependent Child Benefit Increments of $1000 to a maximum of $10000

Your amount of Dependent Spouse and Dependent Child Optional Life Insurance cannot exceed 50 of your amount of Optional Life Insurance Initial eligibility period will require evidence of insurability

STD amp LTD Insurance

Short Term and Long Term Disability Reston Association provides eligible employees with short and long-term disability income benefits through Sun Life In the event you become disabled from a non work-related injury or sickness disability income benefits are provided as a source of income These benefits are 100 employer paid

Benefit Short-Term Disability Long-Term Disability

Income Replacement -Eligible Employees -Executives

60 60

Elimination Period - Accidental Injury - Sickness

29 days 90 days

Benefit Period 9 weeks maximum To Social Security

normal retirement age

Benefit Maximum -Eligible Employees -Executives

$1000 per week $6000 per month $8000 per month 17

At a cost of $19month you can enroll in the Legal Resources benefit As a Legal Resources Member you have immediate and ongoing access to comprehensive legal coverage services and expertise that will easily save you money mdash and could save you a whole lot more Covered legal services include

Legal Advice and Consultation Tenant Dispute with Landlord District Court Representation for Civil Action Review of a Financial Contract or Lease Purchase sale or refinance of primary home Traffic Court Representation (includes 1st DUI) Will Preparation Uncontested Divorce Representation Defense of Child in Court (misdemeanor)

Legal Resources

Employee Assistance Program (EAP)

Reston Association offers a free confidential Employee Assistance Program (EAP) to all employees and their eligible dependents Through RArsquos EAP provider Lytle EAP Partners you and your immediate family members have immediate access on your date of hire to confidential professional counseling and referral services for help with anything that affects you or your dependentsrsquo well-being You can reach an EAP counselor by dialing 1-800-327-7272 24 hours a day or you may visit their website at wwwLytleEAPcom (password is reston) for more information Visit wwwLytleEAPcom for web-based legal financial worklife resources There are also work-related resources available online for managers Note Since EAP services are provided as a benefit only RA makes no representation concerning quality of care

18

401(k) Retirement Savings Plan

Reston Association offers two 401(k) retirement savings plans through Ascensusmdasha traditional 401(k) plan in which employee contributions are made pre-tax and a 401(k) Roth in which employee contributions are made after tax RA matches employee contributions dollar for dollar up to a total of 7 of your annual salary You can begin making contributions to the 401(k) plan and become eligible for RArsquos match following six months of service You always own 100 of your salary contributions

It is possible to borrow against a portion of your vested 401(k) account balance by taking a 401(k) loan You may request a participant loan using an application form which can be obtained by contacting Human Resources Your ability to obtain a 401(k) loan will depend on specific qualifying factors (defined in the 401(k) Summary Plan Description document) The 401(k) Plan Administrator will determine whether you satisfy these factors To access your 401(k) plan online httpsmyaccountascensuscomrplink Check account balance and rate of return Change fund elections Request a 401k loan View fund pricing and performance View and print quarterly statements

19

529 College Savings Plan (employer-sponsored)

A 529 college savings plan provides those saving for college with an unmatched combination of benefits You can open a 529 plan for anyone mdash your child grandchild spouse a friend or even yourself Assets in a 529 plan can be used to pay for a variety of higher education expenses including required books tuition room and board supplies and certain other required fees and expenses Earnings in 529 accounts can grow free from federal tax Withdrawals for qualified higher education expenses are free from federal tax Option to set up recurring automatic fund transfers directly from your bank account making it easy for you to invest The account owner rather than the beneficiary maintains control of account assets and determines the timing and amount of distributions Account owners can change beneficiaries without penalty provided the new beneficiary is a member of the previous beneficiaryrsquos family For more information please contact Human Resources

Additional Benefits

Free passes for employees and their dependents to all of RArsquos pools and tennis courts as well as discounted rates for all RA Programs and Camps Some restrictions may apply

Discounted gym membership rates at the Reston YMCA and Crunch Fitness Bike Share Program - Reston Association makes bicycles and helmets available to employees to rent on a daily

basis Please contact Member Services Discounted Tennis Rackets amp Shoes ndash Employees can purchase certain tennis shoes and rackets at wholesale

prices through RArsquos Tennis Department Contact the Tennis Department for more information Discounted autohome insurance - Liberty Mutual Insurance Company partners with RA to offer all employees

discounts on automobile and homeowner insurance Contact John Valenti at JohnValentilibertymutualcom

20

Reston Association provides generous paid time off benefits to accommodate the diverse needs of staff and to provide a positive worklife balance The amount of paid time off you earn per year is based on your years of service In addition Reston Association observes 9 paid holidays and assigns one paid floating holiday per year For more information on paid time off benefits and how to request time off please refer to the Reston Association Employee Handbook

WorkLife Balance ndash Paid Time Off (PTO)

Teleworking

The medical leave bank is available to help employees in extenuating circumstances protect their incomes by receiving paid leave once their personal PTO is used up A maximum of six (6) workweeks may be granted for each Medical Leave Bank request If additional time is necessary a new request must be made For program eligibility and criteria go to CommonHumResBenefits

Medical Leave Bank

Volunteer Release Time

On a per position basis employees may be allowed to telework for part of their workweek or in certain circumstances Such arrangements must be in compliance with the written administrative procedure including being approved in advance by the department director

Employees are encouraged to become involved in their communities lending their voluntary support to programs that enrich the quality of life and opportunities for all citizens This benefit allows employees to take paid-time off during a work day to participate in a volunteer activity that benefits the community at large Such activities are typically sponsored by a charitable or service organization or work with one or more individuals in need of assistance or special service

21

Training amp Career Development

Reston Association offers two types of learning opportunities for employees mdashinformal and formalmdashto foster individual development and training and career planning

I Informal Learning Opportunities (individual development amp training)

Focus on individual acquiring or enhancing specific task andor process skills to perform his or her current job better Typically this type of learning is not ldquodegree- orientedrdquo

Participants may or may not receive attendance or achievement certificate

Conferences workshops seminars webinars online courses etc typically lasting a few hours to one week

Requests for this type of training should be made to your supervisor or department head

II Formal Learning Opportunities (career planning)

Professional DevelopmentCareer Planning

Formalstructured learning geared toward improving and maintaining professional competence enhancing career progression staying abreast of new technologies and best practices developing process skills andor compliance with professional regulations

Future but not degree-oriented CEUs may be earned

May lead to qualification or credential required to obtain or retain specific certification

Opportunity may range from semester-long academic course to 24 month program with wide range of content and learning experience

Tuition Reimbursement Program

Supports formal education goals (AA bachelors masters) of individual to enhance knowledge and skills in specific areaindustry

Learning must be job-related and accomplished at or through accredited learning institution or e-learning platform connected with the institution

Requests for this type of training should be made to Human Resources as soon as foreseeable to ensure best availability of funds to support reimbursement

22

23

Lifetime limit not applicable and enrollment opportunity The lifetime limit on the dollar value of benefits under our medical plan no longer applies Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan Individuals have 30 days from the date of this notice to request enrollment For more information contact Human Resources or call the medical insurance carrier at the telephone number on your identification card

Notice on Patient Protections The medical HMO plan generally allows the designation of a primary care provider You have the right to designate any primary care provider who participates in the network and who is available to accept you or your family members Until you make this designation the medical carrier designates one for you For information on how to select a primary care provider and for a list of the participating primary care providers contact the medical insurance carrier at the number listed on your identification card

For children you may designate a pediatrician as the primary care provider You do not need prior authorization from the medical insurance carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in the network who specializes in obstetrics or gynecology The health care professional however may be required to comply with certain procedures including obtaining prior authorization for certain services following a pre-approved treatment plan or procedures for making referrals For a list of participating health care professionals who specialize in obstetrics or gynecology contact the medical insurance carrier at the number listed on your identification card

OTC Drug Reimbursements for FSAsHRAsHSAs Under the new Health Care Reform law (PPACA) the cost of an over-the-counter medicine or drug cannot be reimbursed from the account unless a prescription is obtained The change does not affect insulin even if purchased without a prescription or other health care expenses such as medical devices eyeglasses contact lenses co-pays and deductibles The new standard applies only to purchases made on or after January 1 2011

A similar rule is in effect for Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs)

The IRS has also posted a questions and answers section on its website httpwwwirsgovnewsroomarticle0id=22730800html concerning these provisions

Patient Protection and Affordable Care Act (PPACA) Mandatory Notices

The text below is an annual open enrollment required notice

24

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION PLEASE REVIEW IT CAREFULLY

Our Pledge to You

This notice is intended to inform you of the privacy practices followed by the Reston Associationrsquos Employee Benefit Plan (the Plan) and the Planrsquos legal obligations regarding your protected health information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) The notice also explains the privacy rights you and your family members have as participants of the Plan It is effective on April 14 2011

The Plan often needs access to your protected health information in order to provide payment for health services and perform plan administrative functions We want to assure the plan participants covered under the Plan that we comply with federal privacy laws and respect your right to privacy Reston Association requires all members of our workforce and third parties that are provided access to protected health information to comply with the privacy practices outlined in this notice

Protected Health Information Your protected health information is protected by the HIPAA Privacy Rule Generally protected health information is information that identifies an individual created or received by a health care provider health plan or an employer on behalf of a group health plan that relates to physical or mental health conditions provision of health care or payment for health care whether past present or future

How We May Use Your Protected Health Information Under the HIPAA Privacy Rule we may use or disclose your protected health information for certain purposes without your permission This section describes the ways we can use and disclose your protected health information

bull Payment We use or disclose your protected health information without your written authorization in order to determine eligibility for benefits seek reimbursement from a third party or coordinate benefits with another health plan under which you are covered For example a health care provider that provided treatment to you will provide us with your health information We use that information in order to determine whether those services are eligible for payment under our group health plan

bull Health Care Operations We use and disclose your protected health information in order to perform plan administration functions such as quality assurance activities resolution of internal grievances and evaluating plan performance For example we review claims experience in order to understand participant utilization and to make plan design changes that are intended to control health care costs

bull Treatment Although the law allows use and disclosure of your protected health information for purposes of treatment as a health plan we generally do not need to disclose your information for treatment purposes Your physician or health care provider is required to provide you with an explanation of how they use and share your health information for purposes of treatment payment and health care operations

bull As permitted or required by law We may also use or disclose your protected health information without your written authorization for other reasons as permitted by law We are permitted by law to share information subject to certain requirements in order to communicate information on health-related benefits or services that may be of interest to you respond to a court order or provide information to further public health activities (eg preventing the spread of disease) without your written authorization We are also permitted to share protected health information during a corporate restructuring such as a merger sale or acquisition We will also disclose health information about you when required by law for example in order to prevent serious harm to you or others

The text below is an annual open enrollment required notice

25

Notice of Privacy Practices

bull Pursuant to your Authorization When required by law we will ask for your written authorization before using or disclosing your protected health information If you choose to sign an authorization to disclose information you can later revoke that authorization to prevent any future uses or disclosures

bull To Business Associates We may enter into contracts with entities known as Business Associates that provide services to or perform functions on behalf of the Plan We may disclose protected health information to Business Associates once they have agreed in writing to safeguard the protected health information For example we may disclose your protected health information to a Business Associate to administer claims Business Associates are also required by law to protect protected health information

bull To the Plan Sponsor We may disclose protected health information to certain employees of Reston Association for the purpose of administering the Plan These employees will use or disclose the protected health information only as necessary to perform plan administration functions or as otherwise required by HIPAA unless you have authorized additional disclosures Your protected health information cannot be used for employment purposes without your specific authorization

Your Rights bull Right to Inspect and Copy In most cases you have the right to inspect and copy the protected health

information we maintain about you If you request copies we will charge you a reasonable fee to cover the costs of copying mailing or other expenses associated with your request Your request to inspect or review your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to inspect and copy your health information To the extent your information is held in an electronic health record you may be able to receive the information in an electronic format

bull Right to Amend If you believe that information within your records is incorrect or if important information is missing you have the right to request that we correct the existing information or add the missing information Your request to amend your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to amend your health information If we deny your request you may file a statement of disagreement with us for inclusion in any future disclosures of the disputed information

bull Right to an Accounting of Disclosures You have the right to receive an accounting of certain disclosures of your protected health information The accounting will not include disclosures that were made (1) for purposes of treatment payment or health care operations (2) to you (3) pursuant to your authorization (4) to your friends or family in your presence or because of an emergency (5) for national security purposes or (6) incidental to otherwise permissible disclosures

Your request to for an accounting must be submitted in writing to the person listed below You may request an accounting of disclosures made within the last six years You may request one accounting free of charge within a 12-month period

The text below is an annual open enrollment required notice

25

26

The information provided herein is intended to be a summary of benefits only and in no way supersedes the actual plan documents provided by the insurance carriersadministrators For more detailed information pertaining to your employee benefit plans including limitations and exclusions

please refer to the plan documents andor evidence of coverage provided by the carriersadministrators

Womenrsquos Health and Cancer Rights Act of 1998

If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos Health and Cancer Rights Act of 1998 (WHCRA) For individuals receiving mastectomy-related benefits coverage will be provided in a manner determined in consultation with the attending physician and the patient for

bull All stages of reconstruction of the breast on which the mastectomy was performed bull Surgery and reconstruction of the other breast to produce a symmetrical appearance bull Prostheses and bull Treatment of physical complications of the mastectomy including lymphedema

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan If you would like more information on WHCRA benefits call your plan administrator

CHIP-Childrens Health Insurance Program (CHIP) Reauthorization Act of 2009

Medicaid and the Childrenrsquos Health Insurance Program (CHIP) offer free or low-cost health coverage to children and families If you are eligible for health coverage from your employer but are unable to afford the premiums some States have premium assistance programs that can help pay for coverage These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage but need assistance in paying their health premiums

If you or your dependents are already enrolled in Medicaid or CHIP you can contact your state Medicaid or CHIP office to find out if premium assistance is available For a list of the contacts in each State go to wwwdolgovebsachipmodelnoticedoc

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify you can then contact the State to find out if it has a program that might help you pay the premiums for an employer-sponsored plan

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP your employerrsquos health plan is required to permit you and your dependents to enroll in the plan ndash as long as you and your dependents are eligible but not already enrolled in the employerrsquos plan This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance

The text below is an annual open enrollment required notice

26

27

Premium Assistance Under Medicaid and the

Childrenrsquos Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your

employer your state may have a premium assistance program that can help pay for coverage using funds

from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot

be eligible for these premium assistance programs but you may be able to buy individual insurance coverage

through the Health Insurance Marketplace For more information visit wwwhealthcaregov

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below

contact your State Medicaid or CHIP office to find out if premium assistance is available

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your

dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-

877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a

program that might help you pay the premiums for an employer-sponsored plan

If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible

under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already

enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days

of being determined eligible for premium assistance If you have questions about enrolling in your

employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)

If you live in one of the following states you may be eligible for assistance paying your employer

health plan premiums The following list of states is current as of July 31 2019 Contact your State for

more information on eligibility ndash

ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcom

Phone 1-855-692-5447

Website httpflmedicaidtplrecoverycomhipp

Phone 1-877-357-3268

ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program

Website httpmyakhippcom

Phone 1-866-251-4861

Email CustomerServiceMyAKHIPPcom

Medicaid Eligibility

httpdhssalaskagovdpaPagesmedicaiddefaultaspx

Website httpsmedicaidgeorgiagovhealth-

insurance-premium-payment-program-hipp

Phone 678-564-1162 ext 2131

ARKANSAS ndash Medicaid INDIANA ndash Medicaid

Website httpmyarhippcom

Phone 1-855-MyARHIPP (855-692-7447)

Healthy Indiana Plan for low-income adults 19-64

Website httpwwwingovfssahip

Phone 1-877-438-4479

All other Medicaid

Website httpwwwindianamedicaidcom

Phone 1-800-403-0864

COLORADO ndash Health First Colorado

(Coloradorsquos Medicaid Program) amp Child Health

Plan Plus (CHP+)

IOWA ndash Medicaid

Health First Colorado Website

httpswwwhealthfirstcoloradocom

Health First Colorado Member Contact Center

1-800-221-3943 State Relay 711

CHP+ httpswwwcoloradogovpacifichcpfchild-health-

plan-plus

CHP+ Customer Service 1-800-359-1991 State Relay

711

Website

httpdhsiowagovHawki

Phone 1-800-257-8563

28

KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid

Website httpwwwkdheksgovhcf

Phone 1-785-296-3512

Website httpswwwdhhsnhgovoiihipphtm

Phone 603-271-5218

Toll free number for the HIPP program 1-800-852-3345 ext 5218

KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP

Website httpschfskygov

Phone 1-800-635-2570

Medicaid Website

httpwwwstatenjushumanservices

dmahsclientsmedicaid

Medicaid Phone 609-631-2392

CHIP Website httpwwwnjfamilycareorgindexhtml

CHIP Phone 1-800-701-0710

LOUISIANA ndash Medicaid NEW YORK ndash Medicaid

Website httpdhhlouisianagovindexcfmsubhome1n331

Phone 1-888-695-2447

Website httpswwwhealthnygovhealth_caremedicaid

Phone 1-800-541-2831

MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid

Website httpwwwmainegovdhhsofipublic-assistanceindexhtml

Phone 1-800-442-6003

TTY Maine relay 711

Website httpsmedicaidncdhhsgov

Phone 919-855-4100

MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid

Website httpwwwmassgoveohhsgovdepartmentsmasshealth

Phone 1-800-862-4840

Website httpwwwndgovdhsservicesmedicalservmedicaid

Phone 1-844-854-4825

MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP

Website

httpsmngovdhspeople-we-serveseniorshealth-carehealth-care-

programsprograms-and-servicesother-insurancejsp

Phone 1-800-657-3739

Website httpwwwinsureoklahomaorg

Phone 1-888-365-3742

MISSOURI ndash Medicaid OREGON ndash Medicaid

Website httpwwwdssmogovmhdparticipantspageshipphtm

Phone 573-751-2005

Website httphealthcareoregongovPagesindexaspx

httpwwworegonhealthcaregovindex-eshtml

Phone 1-800-699-9075

MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid

Website httpdphhsmtgovMontanaHealthcareProgramsHIPP

Phone 1-800-694-3084

Website

httpwwwdhspagovprovidermedicalassistancehealthinsuranc

epremiumpaymenthippprogramindexhtm

Phone 1-800-692-7462

NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP

Website httpwwwACCESSNebraskanegov

Phone (855) 632-7633

Lincoln (402) 473-7000

Omaha (402) 595-1178

Website httpwwweohhsrigov

Phone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)

29

NEVADA ndash Medicaid SOUTH CAROLINA ndash Medicaid

Medicaid Website httpsdhcfpnvgov

Medicaid Phone 1-800-992-0900

Website httpswwwscdhhsgov

Phone 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid

Website httpdsssdgov

Phone 1-888-828-0059

Website httpswwwhcawagov

Phone 1-800-562-3022 ext 15473

TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascom

Phone 1-800-440-0493

Website httpmywvhippcom

Toll-free phone 1-855-MyWVHIPP (1-855-699-8447)

UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgov

CHIP Website httphealthutahgovchip

Phone 1-877-543-7669

Website

httpswwwdhswisconsingovpublicationsp1p10095p

df

Phone 1-800-362-3002

VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorg

Phone 1-800-250-8427

Website httpswyequalitycareacs-inccom

Phone 307-777-7531

VIRGINIA ndash Medicaid and CHIP Medicaid Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

Medicaid Phone 1-800-432-5924

CHIP Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

CHIP Phone 1-855-242-8282

To see if any other states have added a premium assistance program since July 31 2019 or for more

information on special enrollment rights contact either

US Department of Labor US Department of Health and Human Services

Employee Benefits Security Administration Centers for Medicare amp Medicaid Services

wwwdolgovagenciesebsa wwwcmshhsgov

1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565

Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond

to a collection of information unless such collection displays a valid Office of Management and Budget (OMB)

control number The Department notes that a Federal agency cannot conduct or sponsor a collection of

information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and

the public is not required to respond to a collection of information unless it displays a currently valid OMB control

number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to

penalty for failing to comply with a collection of information if the collection of information does not display a

currently valid OMB control number See 44 USC 3512

The public reporting burden for this collection of information is estimated to average approximately seven minutes

per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other

aspect of this collection of information including suggestions for reducing this burden to the US Department of

Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance

Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and

reference the OMB Control Number 1210-0137 OMB Control Number 1210-0137 (expires 12312019)

Notes

30

Notes

31

Prepared by

Please contact Reston Associationrsquos Human Resources Department at 703-435-7990 or hrrestonorg with any

questions related to your Total Rewards Guide

copy 2019 McGriff Insurance Services Inc

Page 2: Employee Total Rewards Guide 2020 - Reston Total Rewards Gui… · Recognizing and rewarding employees for achieving a sustainable impact. Award criteria includes: •Progressive

Reston Association is committed to providing a comprehensive Total Rewards Package

The goal of Restonrsquos Total Rewards Package is to create value for employees

by striving to meet their professional goals and personal needs

Reston Association Core Values Service bull Collaboration bull Stewardship bull Innovation bull Leadership

2

Compensation

Base Pay Reston Association strives to be competitive with wages within our industry and within our community We believe in an equitable balanced total pay program that offers competitive pay RA hires employees within the minimum of market pay range or RArsquos salary grade range whichever is greater for the job with variations based on job-related skills education ability experience and the current job market RArsquos salary ranges and job descriptions are available to view in CommonHumRes

Annual Performance Reviews amp Merit Increases Performance reviews are scheduled annually A merit increase may be applied to your base pay in conjunction with your performance review You and your supervisor should also review your job description at this time and inform HR if any updates are necessary

Recognition amp Rewards

Kudos Notes Take a minute to recognize a co-worker for something positive by writing them a Kudos Note There is never a reason too small There is a Kudos board at CSF and WNEC (Nature House) and there are three Kudos boards at Headquarters There will be periodic Kudos Note drawings throughout the year

Reston Employee Awards Program (REAP) The purpose of REAP is to recognize and reward employees for going above and beyond in performing their responsibilities and service to the organization Nominations for REAP awards are reviewed by the REAP Committee on a monthly basis Employees can receive an individual or group REAP award

3

Recognition amp Rewards

Reston Association recognizes and rewards employees for going above and beyond in performing their responsibilities and service to the organization and to all that Reston encompasses Employees can be recognized and rewarded by their peers by receiving an Achievement award or a Recognition award

Achievement Recognizing and rewarding employees for achieving a sustainable impact Award criteria includes bull Progressive for RA and RArsquos goals bull Innovative bull Sustained Excellence bull Saves RA timemoneyother resources

Recognition Recognizing and rewarding employees for a moment of excellence Award criteria includes bull A moment of excellence performed under challenging or uncommon circumstances bull A single event of outstanding service that goes beyond onersquos core job responsibilities and that demonstrates

an employeersquos willingness to take initiative in assisting internal andor external customers

Service Awards Reston Association provides awards for reaching years of service milestones Awards are given in December of the year in which you reach one of the following service milestones 5 years bull 10 years bull 15 years bull 20 years bull 25 years bull 30 years bull 35 years

Employee of the Year Every year Reston Association selects an Employee of the Year The purpose of the Employee of the Year award is to honor those who have invested their time and taken initiative to make significant contributions to the organization and community over the course of the year with consideration given to past achievements and contributions The Employee of the Year receives one paid day off certificate a $500 bonus and dedication of a tree in Reston

4

Benefits ndash RArsquos Wellness Program

Reston Association is committed to providing a culture that promotes healthy living through education and resources RArsquos Wellness Program works to achieve this commitment through its goals

To help employees reduce lifestyle risk factors and become better health care consumers

To raise employee awareness about the importance of preventative health care and overall wellness including financial and mental

To provide employees a work environment that supports positive health and fitness practices

Every year at RArsquos annual wellness and benefits fair in November you will be given a Passport to Wellness where you earn stamps for individual and group activities Benefits of participating in the Wellness Program include

Wellness screenings and flu shots at the Benefits Fair in November Quarterly Brown Bag presentations related to wellness and workplace topics Activities events and team challenges such as the YMCA Corporate Challenge car

free days blood drives water-only challenges smoothie days and more Earn stamps for participation in individual and group activities Redeem your stamps

for prizes including the grand prize

5

Benefits ndash PlanContact Information

Enrollment in the majority of these benefits must be done within 30 days of hire during open enrollment or within 30 days of a qualifying life change event Open enrollment occurs annually from mid-November to mid-December

Benefits elected during open enrollment will take effect January 1

The employee their spouse or domestic partner (regardless of sex) and their children under age 26 are eligible to enroll in benefits

Insurance Benefits

Health Insurance Provider Name Kaiser Permanente group 3007-4 (HMO Select) 3007-6 (POS) 3007-10 (HRA-DHMO) Provider Contact Member Services 301-468-6000 Provider Web Address wwwkporg

Dental Insurance Provider Name MetLife group 5469528 Provider Contact Member Services 800-ASK-4MET Provider Web Address httpsmybenefitsmetlifecom

Supplemental Vision Insurance ndash two options 1Provider Name VSP group 30017163

Provider Contact Member Services 800-877-7195 Provider Web Address wwwvspcom

2Provider Name SpecteraUHC group GA9N9747BW Provider Contact Member Services 800-839-3242 Provider Web Address wwwmyuhccom

Flexible Spending Accounts (FSA) amp Dependent Care Accounts (DCA) Contact Optum Health Provider Contact Member Services 800-243-5543 Provider Web Address httpssecureoptumhealthfinancialcom

LifeADampD Short-term Disability (STD) amp Long-term Disability (LTD) Insurance Provider Name Sun Life group 211628 Provider Contact Member Services 800-247-6875 Provider Web Address wwwsunlifecomus

Savings Benefits 401(k) Retirement Savings Plan (pre-tax and Roth)

Provider Name Ascensus Broker Contact Mark Ivcevich 301-326-1521 markqp-consultingcom Web Address httpsmyaccountascensuscomrplink

529 College Savings Plan Contact Human Resources

6

Medical Premium Costs per Paycheck for Employees Hired Prior to 1-1-2019

The amount of your paycheck cost difference will be dependent on the type of coverage you choose

for 2020 (see last column on the table below)

Rates are effective January 1 2020

HRA-HMO

Signature

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $50725 $3512

Employee + 1 $101444 $8193

Employee + Family $147096 $12408

HMO Select

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $58173 $4027

Employee + 1 $116340 $9397

Employee + Family $168696 $14229

POS Select

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $85966 $5951

Employee + 1 $171932 $13887

Employee + Family $249293 $21028

NOTE The Health Insurance Premium Bank is still available to those who qualify Request for

assistance must be made annually by December 15th or within 30 days of a qualifying event

7

Medical Premium Costs per Paycheck for Employees Hired After 1-1-2019

The amount of your paycheck cost difference will be dependent on the type of coverage you choose

for 2020 (see last column on the table below)

Rates are effective January 1 2020

HRA-HMO

Signature

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $50725 $4682

Employee + 1 $101444 $10535

Employee + Family $147096 $15802

HMO Select

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $58173 5370

Employee + 1 $116340 $12081

Employee + Family $168696 $18122

POS Select

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $85966 $7935

Employee + 1 $171932 $17854

Employee + Family $249293 $26781

NOTE The Health Insurance Premium Bank is still available to those who qualify Request for

assistance must be made annually by December 12th or within 30 days of a qualifying event

8

Dental amp Vision Premium Costs per Paycheck

The following rates represent your monthly Dental and Vision premiums effective January 1 2020

MetLife Dental Per Paycheck

FULL-TIME Cost

Per Paycheck

PART-TIME Cost

Employee $000

Contact HR for cost Employee + 1 $000

Employee + Family $000

VSP Vision Per Paycheck Cost

Employee $513

Employee + Adult $864

Employee + Child $882

Employee + Family $1423

SpecteraUHC Vision Per Paycheck Cost

Employee $415

Employee + Adult $843

Employee + Child $883

Employee + Family $1116

9

Health Insurance ndash Option 1

DHMO HRA Signature In Network You Pay Out-of-Network You Pay

Deductible Coinsurance Out-of-Pocket

$750 Individual$1500 Family (RA funds) 9010

$3000 Individual $6000 Family

(less than regular HMO)

NA

Primary Care and Specialist Office Visit $15 PCP$25 Specialist NO COVERAGE

Emergency Room Visits $75 per visit (waived

if admitted) NO COVERAGE

Hospital ndash Inpatient Stay 10 after deductible NO COVERAGE

Home Health Care 10 after deductible NO COVERAGE

Outpatient Facility Services 10 after deductible NO COVERAGE

X-Ray and Laboratory Services 10 after deductible NO COVERAGE

Specialty Imaging (CTMRIPET scan) 10 after deductible NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Inpatient Facility

10 after deductible NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Outpatient Facility

$7 copay-group therapy $15 copay-individual therapy per visit

NO COVERAGE

Vision (Children Only) $15 PCP$25 Specialist NO COVERAGE

Prescription Drug Program (30 day supply) Generic Drug (Tier 1) Preferred Brand Name Drug (Tier 2) Non-Preferred Brand Drug (Tier 3) Up to 90 day supply ndash 3 co-pays for Plan and Participating Pharmacies Mail Order Up to 90 day supply- 2 co-pays

$0 deductible

Plan $20 Participating $30 Plan $30 Participating $50 Plan $45 Participating $65

$20$30$45

Kaiser Permanente D-HMO HRA Signature (Facilities Only) With the Signature Network members receive quality care at the Kaiser medical centers in Maryland Virginia and the District of Columbia Medical centers offer convenient services including primary care specialty care laboratory radiology and pharmacy at most locations and in some locations optical Signature members also have access to more than 40 hospitals in the region

10

Health Insurance ndash Option 2

Kaiser Permanente HMO Select (Facilities amp Contracted Providers Only) With the Select Network members may receive quality care at the Kaiser medical centers in Maryland Virginia and the District of Columbia Building on the Signature physician network the Select network adds access to more than 15000 contracted community physicians in private practice Select members also have access to more than 40 hospitals in the region

HMO Select In-Network You Pay Out-of-Network

You Pay

Deductible Coinsurance Out-of-Pocket

None 100

$3500 Individual $9400 Family

NA

Primary Care and Specialist Office Visit $30 PCP$40 Specialist NO COVERAGE

Emergency Room Visits $100 per visit

(waived if admitted) NO COVERAGE

Hospital ndash Inpatient Stay $250 per admission NO COVERAGE

Home Health Care No charge NO COVERAGE

Outpatient Facility Services $100 NO COVERAGE

X-Ray and Laboratory Services No charge NO COVERAGE

Specialty Imaging (CTMRIPET scan) $50 per test NO COVERAGE

Chiropractic amp Acupuncture Services $40 copay

20 visits per contract year NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Inpatient Facility

$250 per admission NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Outpatient Facility

$15 copay-group therapy $30 copay-individual therapy per visit

NO COVERAGE

Vision (Children Only) $30 PCP$40 Specialist NO COVERAGE

Prescription Drug Program (30 day supply) Generic Drug (Tier 1) Preferred Brand Name Drug (Tier 2) Non-Preferred Brand Drug (Tier 3) Up to 90 day supply ndash 3 co-pays for Plan and Participating Pharmacies Mail Order Up to 90 day supply- 2 co-pays

$0 deductible

Plan $20 Participating $30 Plan $35 Participating $50 Plan $50 Participating $75

$20$35$50

11

Kaiser Permanente POS Select (Facilities amp Contracted Providers with an Out of Network Option) Members can use in-plan benefits by using a Kaiser facility or a contracted primary care physician Your chosen PCP will provide care and coordinate referrals and hospital admissions Members also have the freedom to choose any other licensed provider outside the provider network however you will be responsible for deductibles and coinsurance above the health planrsquos payment

POS Select In-Network You Pay Out-of-Network

you pay

Deductible Coinsurance Out-of-Pocket

None 100

$3500 Individual $9400 Family

$300 Individual $600 Family

8020 $3000 Individual

$6000 Family

Primary Care and Specialist Office Visit $15 PCP$30 Specialist 20 of UCR

Emergency Room Visits $75 per visit (waived if

admitted) $75 per visit

(waived if admitted)

Hospital ndash Inpatient Stay $250 per admission 20 of UCR

Home Health Care No charge 20 of UCR

Outpatient Facility Services $50 20 of UCR

X-Ray and Laboratory Services No charge 20 of UCR

Specialty Imaging (CTMRIPET scan) No charge 20 of UCR

Mental Health (MG) amp Substance Abuse (SA) ndash Inpatient Facility

$250 per admission 20 of UCR

Mental Health (MG) amp Substance Abuse (SA) ndash Outpatient Facility

$7 copay-group therapy $15 copay-individual therapy per visit

20 of UCR

Vision (Children Only) $15 PCP$30 Specialist per visit 20 of UCR

Prescription Drug Program (30 day supply) Generic Drug (Tier 1) Preferred Brand Name Drug (Tier 2) Non-Preferred Brand Drug (Tier 3) Up to 90 day supply ndash 3 co-pays for Plan and Participating Pharmacies Mail Order Up to 90 day supply- 2 co-pays

$0 deductible

Plan $20 Participating $30 Plan $35 Participating $50 Plan $50 Participating $75

$20$35$50

Health Insurance ndash Option 3

12

Dental Insurance

MetLife Dental PPO The Dental PPO plan is 100 Employer Paid for all tiers and provides comprehensive coverage with a nationwide PPO network This gives members access to more in-network dentists making it easier for them to reduce out-of-pocket costs for covered procedures and treatments Dental procedure frequencies Preventative care covers an exam and cleaning (once every 6 months) Fluoride treatment (two per benefit period under age 19 only) Full mouth X-ray (once every 60 months) Bitewing X-ray (once every 12 months age 14 and over once every 12 months under age 14)

PPO Dental Plan Features In-Network Out-of-Network

Type A Preventive Care Services (oral exams cleanings x-rays sealants)

100 of Fee Schedule 100 of Usual amp Customary

Charge

Type B Basic Restorative Dental Services (fillings simple extractions space maintainers)

80 of Fee Schedule 80 of Usual amp Customary

Charge

Type B Major Surgical Dental Services (Endodontics amp Periodontics)

80 of Fee Schedule 80 of Usual amp Customary

Charge

Type C Major Restorative Dental Services (bridges crowns dentures implants)

50 of Fee Schedule 50 of Usual amp Customary

Charge

Orthodontia (under age 19 only)

Lifetime maximum - $1000 50 of allowed benefit

Calendar Year Deductible Applies to Type B amp C services only

$25 Single $75 Family

Calendar Year Maximum Per Person $1500 combined maxper calendar year

Prior to receiving dental services it is recommended that you first obtain a pre-determination of benefits from your dentist so you know exactly how much your dental insurance will cover Spouses domestic partners and dependent children to age 26 (regardless of student status) are eligible

13

Vision Insurance ndash Option 1

Vision Plan through VSP (Voluntary) VSP is the largest private provider vision carrier in the country VSP contracts with Costcoreg Optical Eye Care Centers of America Inctrade which includes popular stores like EyeMasters VisionWorld and Hour Eyes and other quality retail chains When you visit a VSP participating provider your benefits include routine vision exams lenses and preferred pricing on all patient options Frequency Eye Exam 12 monthsLenses 12 monthsFrames 24 monthsContact Lenses 12 months

Vision Plan Features In-Network Out-of-Network

Annual Routine Eye Exam $10 copay Plan pays up to $45

Eyeglass Lenses (standard) Single Bifocal Trifocal

Covered in Full Covered in Full Covered in Full

Plan pays up to $30 Plan pays up to $50 Plan pays up to $65

Frames $130 allowance then 20 off remaining balance

Plan pays up to $70

Necessary Contact Lenses Covered in Full Plan pays up to $210

Elective Contact Lenses $130 allowance Plan pays up to $105

Elective Contact Lenses fitting and evaluation Covered in Full after $60

copay Not Available

Spouses domestic partners and dependent children to age 19 (or to age 25 if FT student) are eligible

14

Vision Insurance ndash Option 2

Vision Plan through Spectera UHC (Voluntary)

UHC offers you one of the largest vision care networks in the industry Their network includes convenient retail locations including My Eye Dr and Hour Eyes Best of all ndash when you receive care from a participating provider you receive the greatest benefits and money-saving discounts

Frequency Eye Exam 12 monthsLenses 12 monthsFrames 12 monthsContact Lenses 12 months

Vision Plan Features In-Network Out-of-Network

Annual Routine Eye Exam $10 copay Plan pays up to $40

Eyeglass Lenses (standard) Single Bifocal Trifocal

$25 copay $25 copay $25 copay

Plan pays up to $40 Plan pays up to $60 Plan pays up to $80

Frames $2500 copay $130 retail frame

allowance 30 discount above allowance

Plan pays up to $45

Necessary Contact Lenses $25 copay Plan pays up to $210

Elective Contact Lenses

$25 copay from the ldquoCovered contact lens

selectionrdquo All others- $105

allowance

Plan pays up to $105

Elective Contact Lenses fitting and evaluation Covered in Full after $25

copay Not Available

Spouses and dependent children to age 26 are eligible

15

Pre-tax FSA amp DCA

Flexible Spending Account (FSA) through Optum Health The Flexible Spending Account provides employees a means to reduce their taxes by the amount of their out of pocket health-related expenses (subject to eligibility) This tax free savings program allows employees to submit receipts for reimbursement for medical dental vision care prescription drug co-payments and other expenses not covered by our insurance In 2020 employees may contribute up to $2750 per year toward their FSA Employees have until March 14 2020 to use the money in their FSA or else they lose it (This contribution amount could change based on IRS guideline updates)

Dependent Care Spending Account (DCA) through Optum Health The Dependent Care Spending Account provides employees a means to reduce their taxes by the amount of their child care costs to a licensed provider up to $5000 annually

Health Insurance Premium Bank

Reston Association has established a program to help regular full-time and regular part-time employees pay their portion of the health insurance premium This program is only available to employees who are enrolled in or plan to enroll in the Kaiser Permanente HMO health insurance plans offered by the Reston Association Employees are eligible to apply to the Health Insurance Premium Bank if their adjusted gross household incomes are less than or equal to $60000 Requests for assistance must be made annually or at any time there is a qualifying event and submitted to Human Resources with necessary documentation by December 12th of each year To apply complete a request form (available in CommonHumResBenefits) and submit to HR with a copy of your most recent tax return showing adjusted gross household income This threshold is subject to change

16

Life and ADampD Insurance

Basic LifeADampD Insurance Reston Association provides 100 employer paid Life and ADampD Insurance through Sun Life to employees working 25 or more hours per week Coverage becomes effective the first of the month following six months of service

Benefit 2x Annual Earnings to a maximum of $200000 Age reduction Benefit reduced to 65 at age 65 and to 50 at age 70

Optional LifeADampD Insurance for Employee Spouse and Dependent Children

Optional Life Insurance for the employee spouse and dependent children is available at the employeersquos cost Optional Life is not available for domestic partners

Employee Benefit Increments of $10000 to a maximum of the lesser of $300000 or 3x your Basic Annual Earnings

Spouse Benefit Increments of $5000 to a maximum of $150000 Dependent Child Benefit Increments of $1000 to a maximum of $10000

Your amount of Dependent Spouse and Dependent Child Optional Life Insurance cannot exceed 50 of your amount of Optional Life Insurance Initial eligibility period will require evidence of insurability

STD amp LTD Insurance

Short Term and Long Term Disability Reston Association provides eligible employees with short and long-term disability income benefits through Sun Life In the event you become disabled from a non work-related injury or sickness disability income benefits are provided as a source of income These benefits are 100 employer paid

Benefit Short-Term Disability Long-Term Disability

Income Replacement -Eligible Employees -Executives

60 60

Elimination Period - Accidental Injury - Sickness

29 days 90 days

Benefit Period 9 weeks maximum To Social Security

normal retirement age

Benefit Maximum -Eligible Employees -Executives

$1000 per week $6000 per month $8000 per month 17

At a cost of $19month you can enroll in the Legal Resources benefit As a Legal Resources Member you have immediate and ongoing access to comprehensive legal coverage services and expertise that will easily save you money mdash and could save you a whole lot more Covered legal services include

Legal Advice and Consultation Tenant Dispute with Landlord District Court Representation for Civil Action Review of a Financial Contract or Lease Purchase sale or refinance of primary home Traffic Court Representation (includes 1st DUI) Will Preparation Uncontested Divorce Representation Defense of Child in Court (misdemeanor)

Legal Resources

Employee Assistance Program (EAP)

Reston Association offers a free confidential Employee Assistance Program (EAP) to all employees and their eligible dependents Through RArsquos EAP provider Lytle EAP Partners you and your immediate family members have immediate access on your date of hire to confidential professional counseling and referral services for help with anything that affects you or your dependentsrsquo well-being You can reach an EAP counselor by dialing 1-800-327-7272 24 hours a day or you may visit their website at wwwLytleEAPcom (password is reston) for more information Visit wwwLytleEAPcom for web-based legal financial worklife resources There are also work-related resources available online for managers Note Since EAP services are provided as a benefit only RA makes no representation concerning quality of care

18

401(k) Retirement Savings Plan

Reston Association offers two 401(k) retirement savings plans through Ascensusmdasha traditional 401(k) plan in which employee contributions are made pre-tax and a 401(k) Roth in which employee contributions are made after tax RA matches employee contributions dollar for dollar up to a total of 7 of your annual salary You can begin making contributions to the 401(k) plan and become eligible for RArsquos match following six months of service You always own 100 of your salary contributions

It is possible to borrow against a portion of your vested 401(k) account balance by taking a 401(k) loan You may request a participant loan using an application form which can be obtained by contacting Human Resources Your ability to obtain a 401(k) loan will depend on specific qualifying factors (defined in the 401(k) Summary Plan Description document) The 401(k) Plan Administrator will determine whether you satisfy these factors To access your 401(k) plan online httpsmyaccountascensuscomrplink Check account balance and rate of return Change fund elections Request a 401k loan View fund pricing and performance View and print quarterly statements

19

529 College Savings Plan (employer-sponsored)

A 529 college savings plan provides those saving for college with an unmatched combination of benefits You can open a 529 plan for anyone mdash your child grandchild spouse a friend or even yourself Assets in a 529 plan can be used to pay for a variety of higher education expenses including required books tuition room and board supplies and certain other required fees and expenses Earnings in 529 accounts can grow free from federal tax Withdrawals for qualified higher education expenses are free from federal tax Option to set up recurring automatic fund transfers directly from your bank account making it easy for you to invest The account owner rather than the beneficiary maintains control of account assets and determines the timing and amount of distributions Account owners can change beneficiaries without penalty provided the new beneficiary is a member of the previous beneficiaryrsquos family For more information please contact Human Resources

Additional Benefits

Free passes for employees and their dependents to all of RArsquos pools and tennis courts as well as discounted rates for all RA Programs and Camps Some restrictions may apply

Discounted gym membership rates at the Reston YMCA and Crunch Fitness Bike Share Program - Reston Association makes bicycles and helmets available to employees to rent on a daily

basis Please contact Member Services Discounted Tennis Rackets amp Shoes ndash Employees can purchase certain tennis shoes and rackets at wholesale

prices through RArsquos Tennis Department Contact the Tennis Department for more information Discounted autohome insurance - Liberty Mutual Insurance Company partners with RA to offer all employees

discounts on automobile and homeowner insurance Contact John Valenti at JohnValentilibertymutualcom

20

Reston Association provides generous paid time off benefits to accommodate the diverse needs of staff and to provide a positive worklife balance The amount of paid time off you earn per year is based on your years of service In addition Reston Association observes 9 paid holidays and assigns one paid floating holiday per year For more information on paid time off benefits and how to request time off please refer to the Reston Association Employee Handbook

WorkLife Balance ndash Paid Time Off (PTO)

Teleworking

The medical leave bank is available to help employees in extenuating circumstances protect their incomes by receiving paid leave once their personal PTO is used up A maximum of six (6) workweeks may be granted for each Medical Leave Bank request If additional time is necessary a new request must be made For program eligibility and criteria go to CommonHumResBenefits

Medical Leave Bank

Volunteer Release Time

On a per position basis employees may be allowed to telework for part of their workweek or in certain circumstances Such arrangements must be in compliance with the written administrative procedure including being approved in advance by the department director

Employees are encouraged to become involved in their communities lending their voluntary support to programs that enrich the quality of life and opportunities for all citizens This benefit allows employees to take paid-time off during a work day to participate in a volunteer activity that benefits the community at large Such activities are typically sponsored by a charitable or service organization or work with one or more individuals in need of assistance or special service

21

Training amp Career Development

Reston Association offers two types of learning opportunities for employees mdashinformal and formalmdashto foster individual development and training and career planning

I Informal Learning Opportunities (individual development amp training)

Focus on individual acquiring or enhancing specific task andor process skills to perform his or her current job better Typically this type of learning is not ldquodegree- orientedrdquo

Participants may or may not receive attendance or achievement certificate

Conferences workshops seminars webinars online courses etc typically lasting a few hours to one week

Requests for this type of training should be made to your supervisor or department head

II Formal Learning Opportunities (career planning)

Professional DevelopmentCareer Planning

Formalstructured learning geared toward improving and maintaining professional competence enhancing career progression staying abreast of new technologies and best practices developing process skills andor compliance with professional regulations

Future but not degree-oriented CEUs may be earned

May lead to qualification or credential required to obtain or retain specific certification

Opportunity may range from semester-long academic course to 24 month program with wide range of content and learning experience

Tuition Reimbursement Program

Supports formal education goals (AA bachelors masters) of individual to enhance knowledge and skills in specific areaindustry

Learning must be job-related and accomplished at or through accredited learning institution or e-learning platform connected with the institution

Requests for this type of training should be made to Human Resources as soon as foreseeable to ensure best availability of funds to support reimbursement

22

23

Lifetime limit not applicable and enrollment opportunity The lifetime limit on the dollar value of benefits under our medical plan no longer applies Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan Individuals have 30 days from the date of this notice to request enrollment For more information contact Human Resources or call the medical insurance carrier at the telephone number on your identification card

Notice on Patient Protections The medical HMO plan generally allows the designation of a primary care provider You have the right to designate any primary care provider who participates in the network and who is available to accept you or your family members Until you make this designation the medical carrier designates one for you For information on how to select a primary care provider and for a list of the participating primary care providers contact the medical insurance carrier at the number listed on your identification card

For children you may designate a pediatrician as the primary care provider You do not need prior authorization from the medical insurance carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in the network who specializes in obstetrics or gynecology The health care professional however may be required to comply with certain procedures including obtaining prior authorization for certain services following a pre-approved treatment plan or procedures for making referrals For a list of participating health care professionals who specialize in obstetrics or gynecology contact the medical insurance carrier at the number listed on your identification card

OTC Drug Reimbursements for FSAsHRAsHSAs Under the new Health Care Reform law (PPACA) the cost of an over-the-counter medicine or drug cannot be reimbursed from the account unless a prescription is obtained The change does not affect insulin even if purchased without a prescription or other health care expenses such as medical devices eyeglasses contact lenses co-pays and deductibles The new standard applies only to purchases made on or after January 1 2011

A similar rule is in effect for Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs)

The IRS has also posted a questions and answers section on its website httpwwwirsgovnewsroomarticle0id=22730800html concerning these provisions

Patient Protection and Affordable Care Act (PPACA) Mandatory Notices

The text below is an annual open enrollment required notice

24

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION PLEASE REVIEW IT CAREFULLY

Our Pledge to You

This notice is intended to inform you of the privacy practices followed by the Reston Associationrsquos Employee Benefit Plan (the Plan) and the Planrsquos legal obligations regarding your protected health information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) The notice also explains the privacy rights you and your family members have as participants of the Plan It is effective on April 14 2011

The Plan often needs access to your protected health information in order to provide payment for health services and perform plan administrative functions We want to assure the plan participants covered under the Plan that we comply with federal privacy laws and respect your right to privacy Reston Association requires all members of our workforce and third parties that are provided access to protected health information to comply with the privacy practices outlined in this notice

Protected Health Information Your protected health information is protected by the HIPAA Privacy Rule Generally protected health information is information that identifies an individual created or received by a health care provider health plan or an employer on behalf of a group health plan that relates to physical or mental health conditions provision of health care or payment for health care whether past present or future

How We May Use Your Protected Health Information Under the HIPAA Privacy Rule we may use or disclose your protected health information for certain purposes without your permission This section describes the ways we can use and disclose your protected health information

bull Payment We use or disclose your protected health information without your written authorization in order to determine eligibility for benefits seek reimbursement from a third party or coordinate benefits with another health plan under which you are covered For example a health care provider that provided treatment to you will provide us with your health information We use that information in order to determine whether those services are eligible for payment under our group health plan

bull Health Care Operations We use and disclose your protected health information in order to perform plan administration functions such as quality assurance activities resolution of internal grievances and evaluating plan performance For example we review claims experience in order to understand participant utilization and to make plan design changes that are intended to control health care costs

bull Treatment Although the law allows use and disclosure of your protected health information for purposes of treatment as a health plan we generally do not need to disclose your information for treatment purposes Your physician or health care provider is required to provide you with an explanation of how they use and share your health information for purposes of treatment payment and health care operations

bull As permitted or required by law We may also use or disclose your protected health information without your written authorization for other reasons as permitted by law We are permitted by law to share information subject to certain requirements in order to communicate information on health-related benefits or services that may be of interest to you respond to a court order or provide information to further public health activities (eg preventing the spread of disease) without your written authorization We are also permitted to share protected health information during a corporate restructuring such as a merger sale or acquisition We will also disclose health information about you when required by law for example in order to prevent serious harm to you or others

The text below is an annual open enrollment required notice

25

Notice of Privacy Practices

bull Pursuant to your Authorization When required by law we will ask for your written authorization before using or disclosing your protected health information If you choose to sign an authorization to disclose information you can later revoke that authorization to prevent any future uses or disclosures

bull To Business Associates We may enter into contracts with entities known as Business Associates that provide services to or perform functions on behalf of the Plan We may disclose protected health information to Business Associates once they have agreed in writing to safeguard the protected health information For example we may disclose your protected health information to a Business Associate to administer claims Business Associates are also required by law to protect protected health information

bull To the Plan Sponsor We may disclose protected health information to certain employees of Reston Association for the purpose of administering the Plan These employees will use or disclose the protected health information only as necessary to perform plan administration functions or as otherwise required by HIPAA unless you have authorized additional disclosures Your protected health information cannot be used for employment purposes without your specific authorization

Your Rights bull Right to Inspect and Copy In most cases you have the right to inspect and copy the protected health

information we maintain about you If you request copies we will charge you a reasonable fee to cover the costs of copying mailing or other expenses associated with your request Your request to inspect or review your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to inspect and copy your health information To the extent your information is held in an electronic health record you may be able to receive the information in an electronic format

bull Right to Amend If you believe that information within your records is incorrect or if important information is missing you have the right to request that we correct the existing information or add the missing information Your request to amend your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to amend your health information If we deny your request you may file a statement of disagreement with us for inclusion in any future disclosures of the disputed information

bull Right to an Accounting of Disclosures You have the right to receive an accounting of certain disclosures of your protected health information The accounting will not include disclosures that were made (1) for purposes of treatment payment or health care operations (2) to you (3) pursuant to your authorization (4) to your friends or family in your presence or because of an emergency (5) for national security purposes or (6) incidental to otherwise permissible disclosures

Your request to for an accounting must be submitted in writing to the person listed below You may request an accounting of disclosures made within the last six years You may request one accounting free of charge within a 12-month period

The text below is an annual open enrollment required notice

25

26

The information provided herein is intended to be a summary of benefits only and in no way supersedes the actual plan documents provided by the insurance carriersadministrators For more detailed information pertaining to your employee benefit plans including limitations and exclusions

please refer to the plan documents andor evidence of coverage provided by the carriersadministrators

Womenrsquos Health and Cancer Rights Act of 1998

If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos Health and Cancer Rights Act of 1998 (WHCRA) For individuals receiving mastectomy-related benefits coverage will be provided in a manner determined in consultation with the attending physician and the patient for

bull All stages of reconstruction of the breast on which the mastectomy was performed bull Surgery and reconstruction of the other breast to produce a symmetrical appearance bull Prostheses and bull Treatment of physical complications of the mastectomy including lymphedema

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan If you would like more information on WHCRA benefits call your plan administrator

CHIP-Childrens Health Insurance Program (CHIP) Reauthorization Act of 2009

Medicaid and the Childrenrsquos Health Insurance Program (CHIP) offer free or low-cost health coverage to children and families If you are eligible for health coverage from your employer but are unable to afford the premiums some States have premium assistance programs that can help pay for coverage These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage but need assistance in paying their health premiums

If you or your dependents are already enrolled in Medicaid or CHIP you can contact your state Medicaid or CHIP office to find out if premium assistance is available For a list of the contacts in each State go to wwwdolgovebsachipmodelnoticedoc

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify you can then contact the State to find out if it has a program that might help you pay the premiums for an employer-sponsored plan

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP your employerrsquos health plan is required to permit you and your dependents to enroll in the plan ndash as long as you and your dependents are eligible but not already enrolled in the employerrsquos plan This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance

The text below is an annual open enrollment required notice

26

27

Premium Assistance Under Medicaid and the

Childrenrsquos Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your

employer your state may have a premium assistance program that can help pay for coverage using funds

from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot

be eligible for these premium assistance programs but you may be able to buy individual insurance coverage

through the Health Insurance Marketplace For more information visit wwwhealthcaregov

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below

contact your State Medicaid or CHIP office to find out if premium assistance is available

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your

dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-

877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a

program that might help you pay the premiums for an employer-sponsored plan

If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible

under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already

enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days

of being determined eligible for premium assistance If you have questions about enrolling in your

employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)

If you live in one of the following states you may be eligible for assistance paying your employer

health plan premiums The following list of states is current as of July 31 2019 Contact your State for

more information on eligibility ndash

ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcom

Phone 1-855-692-5447

Website httpflmedicaidtplrecoverycomhipp

Phone 1-877-357-3268

ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program

Website httpmyakhippcom

Phone 1-866-251-4861

Email CustomerServiceMyAKHIPPcom

Medicaid Eligibility

httpdhssalaskagovdpaPagesmedicaiddefaultaspx

Website httpsmedicaidgeorgiagovhealth-

insurance-premium-payment-program-hipp

Phone 678-564-1162 ext 2131

ARKANSAS ndash Medicaid INDIANA ndash Medicaid

Website httpmyarhippcom

Phone 1-855-MyARHIPP (855-692-7447)

Healthy Indiana Plan for low-income adults 19-64

Website httpwwwingovfssahip

Phone 1-877-438-4479

All other Medicaid

Website httpwwwindianamedicaidcom

Phone 1-800-403-0864

COLORADO ndash Health First Colorado

(Coloradorsquos Medicaid Program) amp Child Health

Plan Plus (CHP+)

IOWA ndash Medicaid

Health First Colorado Website

httpswwwhealthfirstcoloradocom

Health First Colorado Member Contact Center

1-800-221-3943 State Relay 711

CHP+ httpswwwcoloradogovpacifichcpfchild-health-

plan-plus

CHP+ Customer Service 1-800-359-1991 State Relay

711

Website

httpdhsiowagovHawki

Phone 1-800-257-8563

28

KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid

Website httpwwwkdheksgovhcf

Phone 1-785-296-3512

Website httpswwwdhhsnhgovoiihipphtm

Phone 603-271-5218

Toll free number for the HIPP program 1-800-852-3345 ext 5218

KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP

Website httpschfskygov

Phone 1-800-635-2570

Medicaid Website

httpwwwstatenjushumanservices

dmahsclientsmedicaid

Medicaid Phone 609-631-2392

CHIP Website httpwwwnjfamilycareorgindexhtml

CHIP Phone 1-800-701-0710

LOUISIANA ndash Medicaid NEW YORK ndash Medicaid

Website httpdhhlouisianagovindexcfmsubhome1n331

Phone 1-888-695-2447

Website httpswwwhealthnygovhealth_caremedicaid

Phone 1-800-541-2831

MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid

Website httpwwwmainegovdhhsofipublic-assistanceindexhtml

Phone 1-800-442-6003

TTY Maine relay 711

Website httpsmedicaidncdhhsgov

Phone 919-855-4100

MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid

Website httpwwwmassgoveohhsgovdepartmentsmasshealth

Phone 1-800-862-4840

Website httpwwwndgovdhsservicesmedicalservmedicaid

Phone 1-844-854-4825

MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP

Website

httpsmngovdhspeople-we-serveseniorshealth-carehealth-care-

programsprograms-and-servicesother-insurancejsp

Phone 1-800-657-3739

Website httpwwwinsureoklahomaorg

Phone 1-888-365-3742

MISSOURI ndash Medicaid OREGON ndash Medicaid

Website httpwwwdssmogovmhdparticipantspageshipphtm

Phone 573-751-2005

Website httphealthcareoregongovPagesindexaspx

httpwwworegonhealthcaregovindex-eshtml

Phone 1-800-699-9075

MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid

Website httpdphhsmtgovMontanaHealthcareProgramsHIPP

Phone 1-800-694-3084

Website

httpwwwdhspagovprovidermedicalassistancehealthinsuranc

epremiumpaymenthippprogramindexhtm

Phone 1-800-692-7462

NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP

Website httpwwwACCESSNebraskanegov

Phone (855) 632-7633

Lincoln (402) 473-7000

Omaha (402) 595-1178

Website httpwwweohhsrigov

Phone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)

29

NEVADA ndash Medicaid SOUTH CAROLINA ndash Medicaid

Medicaid Website httpsdhcfpnvgov

Medicaid Phone 1-800-992-0900

Website httpswwwscdhhsgov

Phone 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid

Website httpdsssdgov

Phone 1-888-828-0059

Website httpswwwhcawagov

Phone 1-800-562-3022 ext 15473

TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascom

Phone 1-800-440-0493

Website httpmywvhippcom

Toll-free phone 1-855-MyWVHIPP (1-855-699-8447)

UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgov

CHIP Website httphealthutahgovchip

Phone 1-877-543-7669

Website

httpswwwdhswisconsingovpublicationsp1p10095p

df

Phone 1-800-362-3002

VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorg

Phone 1-800-250-8427

Website httpswyequalitycareacs-inccom

Phone 307-777-7531

VIRGINIA ndash Medicaid and CHIP Medicaid Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

Medicaid Phone 1-800-432-5924

CHIP Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

CHIP Phone 1-855-242-8282

To see if any other states have added a premium assistance program since July 31 2019 or for more

information on special enrollment rights contact either

US Department of Labor US Department of Health and Human Services

Employee Benefits Security Administration Centers for Medicare amp Medicaid Services

wwwdolgovagenciesebsa wwwcmshhsgov

1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565

Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond

to a collection of information unless such collection displays a valid Office of Management and Budget (OMB)

control number The Department notes that a Federal agency cannot conduct or sponsor a collection of

information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and

the public is not required to respond to a collection of information unless it displays a currently valid OMB control

number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to

penalty for failing to comply with a collection of information if the collection of information does not display a

currently valid OMB control number See 44 USC 3512

The public reporting burden for this collection of information is estimated to average approximately seven minutes

per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other

aspect of this collection of information including suggestions for reducing this burden to the US Department of

Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance

Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and

reference the OMB Control Number 1210-0137 OMB Control Number 1210-0137 (expires 12312019)

Notes

30

Notes

31

Prepared by

Please contact Reston Associationrsquos Human Resources Department at 703-435-7990 or hrrestonorg with any

questions related to your Total Rewards Guide

copy 2019 McGriff Insurance Services Inc

Page 3: Employee Total Rewards Guide 2020 - Reston Total Rewards Gui… · Recognizing and rewarding employees for achieving a sustainable impact. Award criteria includes: •Progressive

Compensation

Base Pay Reston Association strives to be competitive with wages within our industry and within our community We believe in an equitable balanced total pay program that offers competitive pay RA hires employees within the minimum of market pay range or RArsquos salary grade range whichever is greater for the job with variations based on job-related skills education ability experience and the current job market RArsquos salary ranges and job descriptions are available to view in CommonHumRes

Annual Performance Reviews amp Merit Increases Performance reviews are scheduled annually A merit increase may be applied to your base pay in conjunction with your performance review You and your supervisor should also review your job description at this time and inform HR if any updates are necessary

Recognition amp Rewards

Kudos Notes Take a minute to recognize a co-worker for something positive by writing them a Kudos Note There is never a reason too small There is a Kudos board at CSF and WNEC (Nature House) and there are three Kudos boards at Headquarters There will be periodic Kudos Note drawings throughout the year

Reston Employee Awards Program (REAP) The purpose of REAP is to recognize and reward employees for going above and beyond in performing their responsibilities and service to the organization Nominations for REAP awards are reviewed by the REAP Committee on a monthly basis Employees can receive an individual or group REAP award

3

Recognition amp Rewards

Reston Association recognizes and rewards employees for going above and beyond in performing their responsibilities and service to the organization and to all that Reston encompasses Employees can be recognized and rewarded by their peers by receiving an Achievement award or a Recognition award

Achievement Recognizing and rewarding employees for achieving a sustainable impact Award criteria includes bull Progressive for RA and RArsquos goals bull Innovative bull Sustained Excellence bull Saves RA timemoneyother resources

Recognition Recognizing and rewarding employees for a moment of excellence Award criteria includes bull A moment of excellence performed under challenging or uncommon circumstances bull A single event of outstanding service that goes beyond onersquos core job responsibilities and that demonstrates

an employeersquos willingness to take initiative in assisting internal andor external customers

Service Awards Reston Association provides awards for reaching years of service milestones Awards are given in December of the year in which you reach one of the following service milestones 5 years bull 10 years bull 15 years bull 20 years bull 25 years bull 30 years bull 35 years

Employee of the Year Every year Reston Association selects an Employee of the Year The purpose of the Employee of the Year award is to honor those who have invested their time and taken initiative to make significant contributions to the organization and community over the course of the year with consideration given to past achievements and contributions The Employee of the Year receives one paid day off certificate a $500 bonus and dedication of a tree in Reston

4

Benefits ndash RArsquos Wellness Program

Reston Association is committed to providing a culture that promotes healthy living through education and resources RArsquos Wellness Program works to achieve this commitment through its goals

To help employees reduce lifestyle risk factors and become better health care consumers

To raise employee awareness about the importance of preventative health care and overall wellness including financial and mental

To provide employees a work environment that supports positive health and fitness practices

Every year at RArsquos annual wellness and benefits fair in November you will be given a Passport to Wellness where you earn stamps for individual and group activities Benefits of participating in the Wellness Program include

Wellness screenings and flu shots at the Benefits Fair in November Quarterly Brown Bag presentations related to wellness and workplace topics Activities events and team challenges such as the YMCA Corporate Challenge car

free days blood drives water-only challenges smoothie days and more Earn stamps for participation in individual and group activities Redeem your stamps

for prizes including the grand prize

5

Benefits ndash PlanContact Information

Enrollment in the majority of these benefits must be done within 30 days of hire during open enrollment or within 30 days of a qualifying life change event Open enrollment occurs annually from mid-November to mid-December

Benefits elected during open enrollment will take effect January 1

The employee their spouse or domestic partner (regardless of sex) and their children under age 26 are eligible to enroll in benefits

Insurance Benefits

Health Insurance Provider Name Kaiser Permanente group 3007-4 (HMO Select) 3007-6 (POS) 3007-10 (HRA-DHMO) Provider Contact Member Services 301-468-6000 Provider Web Address wwwkporg

Dental Insurance Provider Name MetLife group 5469528 Provider Contact Member Services 800-ASK-4MET Provider Web Address httpsmybenefitsmetlifecom

Supplemental Vision Insurance ndash two options 1Provider Name VSP group 30017163

Provider Contact Member Services 800-877-7195 Provider Web Address wwwvspcom

2Provider Name SpecteraUHC group GA9N9747BW Provider Contact Member Services 800-839-3242 Provider Web Address wwwmyuhccom

Flexible Spending Accounts (FSA) amp Dependent Care Accounts (DCA) Contact Optum Health Provider Contact Member Services 800-243-5543 Provider Web Address httpssecureoptumhealthfinancialcom

LifeADampD Short-term Disability (STD) amp Long-term Disability (LTD) Insurance Provider Name Sun Life group 211628 Provider Contact Member Services 800-247-6875 Provider Web Address wwwsunlifecomus

Savings Benefits 401(k) Retirement Savings Plan (pre-tax and Roth)

Provider Name Ascensus Broker Contact Mark Ivcevich 301-326-1521 markqp-consultingcom Web Address httpsmyaccountascensuscomrplink

529 College Savings Plan Contact Human Resources

6

Medical Premium Costs per Paycheck for Employees Hired Prior to 1-1-2019

The amount of your paycheck cost difference will be dependent on the type of coverage you choose

for 2020 (see last column on the table below)

Rates are effective January 1 2020

HRA-HMO

Signature

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $50725 $3512

Employee + 1 $101444 $8193

Employee + Family $147096 $12408

HMO Select

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $58173 $4027

Employee + 1 $116340 $9397

Employee + Family $168696 $14229

POS Select

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $85966 $5951

Employee + 1 $171932 $13887

Employee + Family $249293 $21028

NOTE The Health Insurance Premium Bank is still available to those who qualify Request for

assistance must be made annually by December 15th or within 30 days of a qualifying event

7

Medical Premium Costs per Paycheck for Employees Hired After 1-1-2019

The amount of your paycheck cost difference will be dependent on the type of coverage you choose

for 2020 (see last column on the table below)

Rates are effective January 1 2020

HRA-HMO

Signature

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $50725 $4682

Employee + 1 $101444 $10535

Employee + Family $147096 $15802

HMO Select

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $58173 5370

Employee + 1 $116340 $12081

Employee + Family $168696 $18122

POS Select

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $85966 $7935

Employee + 1 $171932 $17854

Employee + Family $249293 $26781

NOTE The Health Insurance Premium Bank is still available to those who qualify Request for

assistance must be made annually by December 12th or within 30 days of a qualifying event

8

Dental amp Vision Premium Costs per Paycheck

The following rates represent your monthly Dental and Vision premiums effective January 1 2020

MetLife Dental Per Paycheck

FULL-TIME Cost

Per Paycheck

PART-TIME Cost

Employee $000

Contact HR for cost Employee + 1 $000

Employee + Family $000

VSP Vision Per Paycheck Cost

Employee $513

Employee + Adult $864

Employee + Child $882

Employee + Family $1423

SpecteraUHC Vision Per Paycheck Cost

Employee $415

Employee + Adult $843

Employee + Child $883

Employee + Family $1116

9

Health Insurance ndash Option 1

DHMO HRA Signature In Network You Pay Out-of-Network You Pay

Deductible Coinsurance Out-of-Pocket

$750 Individual$1500 Family (RA funds) 9010

$3000 Individual $6000 Family

(less than regular HMO)

NA

Primary Care and Specialist Office Visit $15 PCP$25 Specialist NO COVERAGE

Emergency Room Visits $75 per visit (waived

if admitted) NO COVERAGE

Hospital ndash Inpatient Stay 10 after deductible NO COVERAGE

Home Health Care 10 after deductible NO COVERAGE

Outpatient Facility Services 10 after deductible NO COVERAGE

X-Ray and Laboratory Services 10 after deductible NO COVERAGE

Specialty Imaging (CTMRIPET scan) 10 after deductible NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Inpatient Facility

10 after deductible NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Outpatient Facility

$7 copay-group therapy $15 copay-individual therapy per visit

NO COVERAGE

Vision (Children Only) $15 PCP$25 Specialist NO COVERAGE

Prescription Drug Program (30 day supply) Generic Drug (Tier 1) Preferred Brand Name Drug (Tier 2) Non-Preferred Brand Drug (Tier 3) Up to 90 day supply ndash 3 co-pays for Plan and Participating Pharmacies Mail Order Up to 90 day supply- 2 co-pays

$0 deductible

Plan $20 Participating $30 Plan $30 Participating $50 Plan $45 Participating $65

$20$30$45

Kaiser Permanente D-HMO HRA Signature (Facilities Only) With the Signature Network members receive quality care at the Kaiser medical centers in Maryland Virginia and the District of Columbia Medical centers offer convenient services including primary care specialty care laboratory radiology and pharmacy at most locations and in some locations optical Signature members also have access to more than 40 hospitals in the region

10

Health Insurance ndash Option 2

Kaiser Permanente HMO Select (Facilities amp Contracted Providers Only) With the Select Network members may receive quality care at the Kaiser medical centers in Maryland Virginia and the District of Columbia Building on the Signature physician network the Select network adds access to more than 15000 contracted community physicians in private practice Select members also have access to more than 40 hospitals in the region

HMO Select In-Network You Pay Out-of-Network

You Pay

Deductible Coinsurance Out-of-Pocket

None 100

$3500 Individual $9400 Family

NA

Primary Care and Specialist Office Visit $30 PCP$40 Specialist NO COVERAGE

Emergency Room Visits $100 per visit

(waived if admitted) NO COVERAGE

Hospital ndash Inpatient Stay $250 per admission NO COVERAGE

Home Health Care No charge NO COVERAGE

Outpatient Facility Services $100 NO COVERAGE

X-Ray and Laboratory Services No charge NO COVERAGE

Specialty Imaging (CTMRIPET scan) $50 per test NO COVERAGE

Chiropractic amp Acupuncture Services $40 copay

20 visits per contract year NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Inpatient Facility

$250 per admission NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Outpatient Facility

$15 copay-group therapy $30 copay-individual therapy per visit

NO COVERAGE

Vision (Children Only) $30 PCP$40 Specialist NO COVERAGE

Prescription Drug Program (30 day supply) Generic Drug (Tier 1) Preferred Brand Name Drug (Tier 2) Non-Preferred Brand Drug (Tier 3) Up to 90 day supply ndash 3 co-pays for Plan and Participating Pharmacies Mail Order Up to 90 day supply- 2 co-pays

$0 deductible

Plan $20 Participating $30 Plan $35 Participating $50 Plan $50 Participating $75

$20$35$50

11

Kaiser Permanente POS Select (Facilities amp Contracted Providers with an Out of Network Option) Members can use in-plan benefits by using a Kaiser facility or a contracted primary care physician Your chosen PCP will provide care and coordinate referrals and hospital admissions Members also have the freedom to choose any other licensed provider outside the provider network however you will be responsible for deductibles and coinsurance above the health planrsquos payment

POS Select In-Network You Pay Out-of-Network

you pay

Deductible Coinsurance Out-of-Pocket

None 100

$3500 Individual $9400 Family

$300 Individual $600 Family

8020 $3000 Individual

$6000 Family

Primary Care and Specialist Office Visit $15 PCP$30 Specialist 20 of UCR

Emergency Room Visits $75 per visit (waived if

admitted) $75 per visit

(waived if admitted)

Hospital ndash Inpatient Stay $250 per admission 20 of UCR

Home Health Care No charge 20 of UCR

Outpatient Facility Services $50 20 of UCR

X-Ray and Laboratory Services No charge 20 of UCR

Specialty Imaging (CTMRIPET scan) No charge 20 of UCR

Mental Health (MG) amp Substance Abuse (SA) ndash Inpatient Facility

$250 per admission 20 of UCR

Mental Health (MG) amp Substance Abuse (SA) ndash Outpatient Facility

$7 copay-group therapy $15 copay-individual therapy per visit

20 of UCR

Vision (Children Only) $15 PCP$30 Specialist per visit 20 of UCR

Prescription Drug Program (30 day supply) Generic Drug (Tier 1) Preferred Brand Name Drug (Tier 2) Non-Preferred Brand Drug (Tier 3) Up to 90 day supply ndash 3 co-pays for Plan and Participating Pharmacies Mail Order Up to 90 day supply- 2 co-pays

$0 deductible

Plan $20 Participating $30 Plan $35 Participating $50 Plan $50 Participating $75

$20$35$50

Health Insurance ndash Option 3

12

Dental Insurance

MetLife Dental PPO The Dental PPO plan is 100 Employer Paid for all tiers and provides comprehensive coverage with a nationwide PPO network This gives members access to more in-network dentists making it easier for them to reduce out-of-pocket costs for covered procedures and treatments Dental procedure frequencies Preventative care covers an exam and cleaning (once every 6 months) Fluoride treatment (two per benefit period under age 19 only) Full mouth X-ray (once every 60 months) Bitewing X-ray (once every 12 months age 14 and over once every 12 months under age 14)

PPO Dental Plan Features In-Network Out-of-Network

Type A Preventive Care Services (oral exams cleanings x-rays sealants)

100 of Fee Schedule 100 of Usual amp Customary

Charge

Type B Basic Restorative Dental Services (fillings simple extractions space maintainers)

80 of Fee Schedule 80 of Usual amp Customary

Charge

Type B Major Surgical Dental Services (Endodontics amp Periodontics)

80 of Fee Schedule 80 of Usual amp Customary

Charge

Type C Major Restorative Dental Services (bridges crowns dentures implants)

50 of Fee Schedule 50 of Usual amp Customary

Charge

Orthodontia (under age 19 only)

Lifetime maximum - $1000 50 of allowed benefit

Calendar Year Deductible Applies to Type B amp C services only

$25 Single $75 Family

Calendar Year Maximum Per Person $1500 combined maxper calendar year

Prior to receiving dental services it is recommended that you first obtain a pre-determination of benefits from your dentist so you know exactly how much your dental insurance will cover Spouses domestic partners and dependent children to age 26 (regardless of student status) are eligible

13

Vision Insurance ndash Option 1

Vision Plan through VSP (Voluntary) VSP is the largest private provider vision carrier in the country VSP contracts with Costcoreg Optical Eye Care Centers of America Inctrade which includes popular stores like EyeMasters VisionWorld and Hour Eyes and other quality retail chains When you visit a VSP participating provider your benefits include routine vision exams lenses and preferred pricing on all patient options Frequency Eye Exam 12 monthsLenses 12 monthsFrames 24 monthsContact Lenses 12 months

Vision Plan Features In-Network Out-of-Network

Annual Routine Eye Exam $10 copay Plan pays up to $45

Eyeglass Lenses (standard) Single Bifocal Trifocal

Covered in Full Covered in Full Covered in Full

Plan pays up to $30 Plan pays up to $50 Plan pays up to $65

Frames $130 allowance then 20 off remaining balance

Plan pays up to $70

Necessary Contact Lenses Covered in Full Plan pays up to $210

Elective Contact Lenses $130 allowance Plan pays up to $105

Elective Contact Lenses fitting and evaluation Covered in Full after $60

copay Not Available

Spouses domestic partners and dependent children to age 19 (or to age 25 if FT student) are eligible

14

Vision Insurance ndash Option 2

Vision Plan through Spectera UHC (Voluntary)

UHC offers you one of the largest vision care networks in the industry Their network includes convenient retail locations including My Eye Dr and Hour Eyes Best of all ndash when you receive care from a participating provider you receive the greatest benefits and money-saving discounts

Frequency Eye Exam 12 monthsLenses 12 monthsFrames 12 monthsContact Lenses 12 months

Vision Plan Features In-Network Out-of-Network

Annual Routine Eye Exam $10 copay Plan pays up to $40

Eyeglass Lenses (standard) Single Bifocal Trifocal

$25 copay $25 copay $25 copay

Plan pays up to $40 Plan pays up to $60 Plan pays up to $80

Frames $2500 copay $130 retail frame

allowance 30 discount above allowance

Plan pays up to $45

Necessary Contact Lenses $25 copay Plan pays up to $210

Elective Contact Lenses

$25 copay from the ldquoCovered contact lens

selectionrdquo All others- $105

allowance

Plan pays up to $105

Elective Contact Lenses fitting and evaluation Covered in Full after $25

copay Not Available

Spouses and dependent children to age 26 are eligible

15

Pre-tax FSA amp DCA

Flexible Spending Account (FSA) through Optum Health The Flexible Spending Account provides employees a means to reduce their taxes by the amount of their out of pocket health-related expenses (subject to eligibility) This tax free savings program allows employees to submit receipts for reimbursement for medical dental vision care prescription drug co-payments and other expenses not covered by our insurance In 2020 employees may contribute up to $2750 per year toward their FSA Employees have until March 14 2020 to use the money in their FSA or else they lose it (This contribution amount could change based on IRS guideline updates)

Dependent Care Spending Account (DCA) through Optum Health The Dependent Care Spending Account provides employees a means to reduce their taxes by the amount of their child care costs to a licensed provider up to $5000 annually

Health Insurance Premium Bank

Reston Association has established a program to help regular full-time and regular part-time employees pay their portion of the health insurance premium This program is only available to employees who are enrolled in or plan to enroll in the Kaiser Permanente HMO health insurance plans offered by the Reston Association Employees are eligible to apply to the Health Insurance Premium Bank if their adjusted gross household incomes are less than or equal to $60000 Requests for assistance must be made annually or at any time there is a qualifying event and submitted to Human Resources with necessary documentation by December 12th of each year To apply complete a request form (available in CommonHumResBenefits) and submit to HR with a copy of your most recent tax return showing adjusted gross household income This threshold is subject to change

16

Life and ADampD Insurance

Basic LifeADampD Insurance Reston Association provides 100 employer paid Life and ADampD Insurance through Sun Life to employees working 25 or more hours per week Coverage becomes effective the first of the month following six months of service

Benefit 2x Annual Earnings to a maximum of $200000 Age reduction Benefit reduced to 65 at age 65 and to 50 at age 70

Optional LifeADampD Insurance for Employee Spouse and Dependent Children

Optional Life Insurance for the employee spouse and dependent children is available at the employeersquos cost Optional Life is not available for domestic partners

Employee Benefit Increments of $10000 to a maximum of the lesser of $300000 or 3x your Basic Annual Earnings

Spouse Benefit Increments of $5000 to a maximum of $150000 Dependent Child Benefit Increments of $1000 to a maximum of $10000

Your amount of Dependent Spouse and Dependent Child Optional Life Insurance cannot exceed 50 of your amount of Optional Life Insurance Initial eligibility period will require evidence of insurability

STD amp LTD Insurance

Short Term and Long Term Disability Reston Association provides eligible employees with short and long-term disability income benefits through Sun Life In the event you become disabled from a non work-related injury or sickness disability income benefits are provided as a source of income These benefits are 100 employer paid

Benefit Short-Term Disability Long-Term Disability

Income Replacement -Eligible Employees -Executives

60 60

Elimination Period - Accidental Injury - Sickness

29 days 90 days

Benefit Period 9 weeks maximum To Social Security

normal retirement age

Benefit Maximum -Eligible Employees -Executives

$1000 per week $6000 per month $8000 per month 17

At a cost of $19month you can enroll in the Legal Resources benefit As a Legal Resources Member you have immediate and ongoing access to comprehensive legal coverage services and expertise that will easily save you money mdash and could save you a whole lot more Covered legal services include

Legal Advice and Consultation Tenant Dispute with Landlord District Court Representation for Civil Action Review of a Financial Contract or Lease Purchase sale or refinance of primary home Traffic Court Representation (includes 1st DUI) Will Preparation Uncontested Divorce Representation Defense of Child in Court (misdemeanor)

Legal Resources

Employee Assistance Program (EAP)

Reston Association offers a free confidential Employee Assistance Program (EAP) to all employees and their eligible dependents Through RArsquos EAP provider Lytle EAP Partners you and your immediate family members have immediate access on your date of hire to confidential professional counseling and referral services for help with anything that affects you or your dependentsrsquo well-being You can reach an EAP counselor by dialing 1-800-327-7272 24 hours a day or you may visit their website at wwwLytleEAPcom (password is reston) for more information Visit wwwLytleEAPcom for web-based legal financial worklife resources There are also work-related resources available online for managers Note Since EAP services are provided as a benefit only RA makes no representation concerning quality of care

18

401(k) Retirement Savings Plan

Reston Association offers two 401(k) retirement savings plans through Ascensusmdasha traditional 401(k) plan in which employee contributions are made pre-tax and a 401(k) Roth in which employee contributions are made after tax RA matches employee contributions dollar for dollar up to a total of 7 of your annual salary You can begin making contributions to the 401(k) plan and become eligible for RArsquos match following six months of service You always own 100 of your salary contributions

It is possible to borrow against a portion of your vested 401(k) account balance by taking a 401(k) loan You may request a participant loan using an application form which can be obtained by contacting Human Resources Your ability to obtain a 401(k) loan will depend on specific qualifying factors (defined in the 401(k) Summary Plan Description document) The 401(k) Plan Administrator will determine whether you satisfy these factors To access your 401(k) plan online httpsmyaccountascensuscomrplink Check account balance and rate of return Change fund elections Request a 401k loan View fund pricing and performance View and print quarterly statements

19

529 College Savings Plan (employer-sponsored)

A 529 college savings plan provides those saving for college with an unmatched combination of benefits You can open a 529 plan for anyone mdash your child grandchild spouse a friend or even yourself Assets in a 529 plan can be used to pay for a variety of higher education expenses including required books tuition room and board supplies and certain other required fees and expenses Earnings in 529 accounts can grow free from federal tax Withdrawals for qualified higher education expenses are free from federal tax Option to set up recurring automatic fund transfers directly from your bank account making it easy for you to invest The account owner rather than the beneficiary maintains control of account assets and determines the timing and amount of distributions Account owners can change beneficiaries without penalty provided the new beneficiary is a member of the previous beneficiaryrsquos family For more information please contact Human Resources

Additional Benefits

Free passes for employees and their dependents to all of RArsquos pools and tennis courts as well as discounted rates for all RA Programs and Camps Some restrictions may apply

Discounted gym membership rates at the Reston YMCA and Crunch Fitness Bike Share Program - Reston Association makes bicycles and helmets available to employees to rent on a daily

basis Please contact Member Services Discounted Tennis Rackets amp Shoes ndash Employees can purchase certain tennis shoes and rackets at wholesale

prices through RArsquos Tennis Department Contact the Tennis Department for more information Discounted autohome insurance - Liberty Mutual Insurance Company partners with RA to offer all employees

discounts on automobile and homeowner insurance Contact John Valenti at JohnValentilibertymutualcom

20

Reston Association provides generous paid time off benefits to accommodate the diverse needs of staff and to provide a positive worklife balance The amount of paid time off you earn per year is based on your years of service In addition Reston Association observes 9 paid holidays and assigns one paid floating holiday per year For more information on paid time off benefits and how to request time off please refer to the Reston Association Employee Handbook

WorkLife Balance ndash Paid Time Off (PTO)

Teleworking

The medical leave bank is available to help employees in extenuating circumstances protect their incomes by receiving paid leave once their personal PTO is used up A maximum of six (6) workweeks may be granted for each Medical Leave Bank request If additional time is necessary a new request must be made For program eligibility and criteria go to CommonHumResBenefits

Medical Leave Bank

Volunteer Release Time

On a per position basis employees may be allowed to telework for part of their workweek or in certain circumstances Such arrangements must be in compliance with the written administrative procedure including being approved in advance by the department director

Employees are encouraged to become involved in their communities lending their voluntary support to programs that enrich the quality of life and opportunities for all citizens This benefit allows employees to take paid-time off during a work day to participate in a volunteer activity that benefits the community at large Such activities are typically sponsored by a charitable or service organization or work with one or more individuals in need of assistance or special service

21

Training amp Career Development

Reston Association offers two types of learning opportunities for employees mdashinformal and formalmdashto foster individual development and training and career planning

I Informal Learning Opportunities (individual development amp training)

Focus on individual acquiring or enhancing specific task andor process skills to perform his or her current job better Typically this type of learning is not ldquodegree- orientedrdquo

Participants may or may not receive attendance or achievement certificate

Conferences workshops seminars webinars online courses etc typically lasting a few hours to one week

Requests for this type of training should be made to your supervisor or department head

II Formal Learning Opportunities (career planning)

Professional DevelopmentCareer Planning

Formalstructured learning geared toward improving and maintaining professional competence enhancing career progression staying abreast of new technologies and best practices developing process skills andor compliance with professional regulations

Future but not degree-oriented CEUs may be earned

May lead to qualification or credential required to obtain or retain specific certification

Opportunity may range from semester-long academic course to 24 month program with wide range of content and learning experience

Tuition Reimbursement Program

Supports formal education goals (AA bachelors masters) of individual to enhance knowledge and skills in specific areaindustry

Learning must be job-related and accomplished at or through accredited learning institution or e-learning platform connected with the institution

Requests for this type of training should be made to Human Resources as soon as foreseeable to ensure best availability of funds to support reimbursement

22

23

Lifetime limit not applicable and enrollment opportunity The lifetime limit on the dollar value of benefits under our medical plan no longer applies Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan Individuals have 30 days from the date of this notice to request enrollment For more information contact Human Resources or call the medical insurance carrier at the telephone number on your identification card

Notice on Patient Protections The medical HMO plan generally allows the designation of a primary care provider You have the right to designate any primary care provider who participates in the network and who is available to accept you or your family members Until you make this designation the medical carrier designates one for you For information on how to select a primary care provider and for a list of the participating primary care providers contact the medical insurance carrier at the number listed on your identification card

For children you may designate a pediatrician as the primary care provider You do not need prior authorization from the medical insurance carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in the network who specializes in obstetrics or gynecology The health care professional however may be required to comply with certain procedures including obtaining prior authorization for certain services following a pre-approved treatment plan or procedures for making referrals For a list of participating health care professionals who specialize in obstetrics or gynecology contact the medical insurance carrier at the number listed on your identification card

OTC Drug Reimbursements for FSAsHRAsHSAs Under the new Health Care Reform law (PPACA) the cost of an over-the-counter medicine or drug cannot be reimbursed from the account unless a prescription is obtained The change does not affect insulin even if purchased without a prescription or other health care expenses such as medical devices eyeglasses contact lenses co-pays and deductibles The new standard applies only to purchases made on or after January 1 2011

A similar rule is in effect for Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs)

The IRS has also posted a questions and answers section on its website httpwwwirsgovnewsroomarticle0id=22730800html concerning these provisions

Patient Protection and Affordable Care Act (PPACA) Mandatory Notices

The text below is an annual open enrollment required notice

24

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION PLEASE REVIEW IT CAREFULLY

Our Pledge to You

This notice is intended to inform you of the privacy practices followed by the Reston Associationrsquos Employee Benefit Plan (the Plan) and the Planrsquos legal obligations regarding your protected health information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) The notice also explains the privacy rights you and your family members have as participants of the Plan It is effective on April 14 2011

The Plan often needs access to your protected health information in order to provide payment for health services and perform plan administrative functions We want to assure the plan participants covered under the Plan that we comply with federal privacy laws and respect your right to privacy Reston Association requires all members of our workforce and third parties that are provided access to protected health information to comply with the privacy practices outlined in this notice

Protected Health Information Your protected health information is protected by the HIPAA Privacy Rule Generally protected health information is information that identifies an individual created or received by a health care provider health plan or an employer on behalf of a group health plan that relates to physical or mental health conditions provision of health care or payment for health care whether past present or future

How We May Use Your Protected Health Information Under the HIPAA Privacy Rule we may use or disclose your protected health information for certain purposes without your permission This section describes the ways we can use and disclose your protected health information

bull Payment We use or disclose your protected health information without your written authorization in order to determine eligibility for benefits seek reimbursement from a third party or coordinate benefits with another health plan under which you are covered For example a health care provider that provided treatment to you will provide us with your health information We use that information in order to determine whether those services are eligible for payment under our group health plan

bull Health Care Operations We use and disclose your protected health information in order to perform plan administration functions such as quality assurance activities resolution of internal grievances and evaluating plan performance For example we review claims experience in order to understand participant utilization and to make plan design changes that are intended to control health care costs

bull Treatment Although the law allows use and disclosure of your protected health information for purposes of treatment as a health plan we generally do not need to disclose your information for treatment purposes Your physician or health care provider is required to provide you with an explanation of how they use and share your health information for purposes of treatment payment and health care operations

bull As permitted or required by law We may also use or disclose your protected health information without your written authorization for other reasons as permitted by law We are permitted by law to share information subject to certain requirements in order to communicate information on health-related benefits or services that may be of interest to you respond to a court order or provide information to further public health activities (eg preventing the spread of disease) without your written authorization We are also permitted to share protected health information during a corporate restructuring such as a merger sale or acquisition We will also disclose health information about you when required by law for example in order to prevent serious harm to you or others

The text below is an annual open enrollment required notice

25

Notice of Privacy Practices

bull Pursuant to your Authorization When required by law we will ask for your written authorization before using or disclosing your protected health information If you choose to sign an authorization to disclose information you can later revoke that authorization to prevent any future uses or disclosures

bull To Business Associates We may enter into contracts with entities known as Business Associates that provide services to or perform functions on behalf of the Plan We may disclose protected health information to Business Associates once they have agreed in writing to safeguard the protected health information For example we may disclose your protected health information to a Business Associate to administer claims Business Associates are also required by law to protect protected health information

bull To the Plan Sponsor We may disclose protected health information to certain employees of Reston Association for the purpose of administering the Plan These employees will use or disclose the protected health information only as necessary to perform plan administration functions or as otherwise required by HIPAA unless you have authorized additional disclosures Your protected health information cannot be used for employment purposes without your specific authorization

Your Rights bull Right to Inspect and Copy In most cases you have the right to inspect and copy the protected health

information we maintain about you If you request copies we will charge you a reasonable fee to cover the costs of copying mailing or other expenses associated with your request Your request to inspect or review your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to inspect and copy your health information To the extent your information is held in an electronic health record you may be able to receive the information in an electronic format

bull Right to Amend If you believe that information within your records is incorrect or if important information is missing you have the right to request that we correct the existing information or add the missing information Your request to amend your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to amend your health information If we deny your request you may file a statement of disagreement with us for inclusion in any future disclosures of the disputed information

bull Right to an Accounting of Disclosures You have the right to receive an accounting of certain disclosures of your protected health information The accounting will not include disclosures that were made (1) for purposes of treatment payment or health care operations (2) to you (3) pursuant to your authorization (4) to your friends or family in your presence or because of an emergency (5) for national security purposes or (6) incidental to otherwise permissible disclosures

Your request to for an accounting must be submitted in writing to the person listed below You may request an accounting of disclosures made within the last six years You may request one accounting free of charge within a 12-month period

The text below is an annual open enrollment required notice

25

26

The information provided herein is intended to be a summary of benefits only and in no way supersedes the actual plan documents provided by the insurance carriersadministrators For more detailed information pertaining to your employee benefit plans including limitations and exclusions

please refer to the plan documents andor evidence of coverage provided by the carriersadministrators

Womenrsquos Health and Cancer Rights Act of 1998

If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos Health and Cancer Rights Act of 1998 (WHCRA) For individuals receiving mastectomy-related benefits coverage will be provided in a manner determined in consultation with the attending physician and the patient for

bull All stages of reconstruction of the breast on which the mastectomy was performed bull Surgery and reconstruction of the other breast to produce a symmetrical appearance bull Prostheses and bull Treatment of physical complications of the mastectomy including lymphedema

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan If you would like more information on WHCRA benefits call your plan administrator

CHIP-Childrens Health Insurance Program (CHIP) Reauthorization Act of 2009

Medicaid and the Childrenrsquos Health Insurance Program (CHIP) offer free or low-cost health coverage to children and families If you are eligible for health coverage from your employer but are unable to afford the premiums some States have premium assistance programs that can help pay for coverage These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage but need assistance in paying their health premiums

If you or your dependents are already enrolled in Medicaid or CHIP you can contact your state Medicaid or CHIP office to find out if premium assistance is available For a list of the contacts in each State go to wwwdolgovebsachipmodelnoticedoc

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify you can then contact the State to find out if it has a program that might help you pay the premiums for an employer-sponsored plan

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP your employerrsquos health plan is required to permit you and your dependents to enroll in the plan ndash as long as you and your dependents are eligible but not already enrolled in the employerrsquos plan This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance

The text below is an annual open enrollment required notice

26

27

Premium Assistance Under Medicaid and the

Childrenrsquos Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your

employer your state may have a premium assistance program that can help pay for coverage using funds

from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot

be eligible for these premium assistance programs but you may be able to buy individual insurance coverage

through the Health Insurance Marketplace For more information visit wwwhealthcaregov

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below

contact your State Medicaid or CHIP office to find out if premium assistance is available

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your

dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-

877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a

program that might help you pay the premiums for an employer-sponsored plan

If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible

under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already

enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days

of being determined eligible for premium assistance If you have questions about enrolling in your

employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)

If you live in one of the following states you may be eligible for assistance paying your employer

health plan premiums The following list of states is current as of July 31 2019 Contact your State for

more information on eligibility ndash

ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcom

Phone 1-855-692-5447

Website httpflmedicaidtplrecoverycomhipp

Phone 1-877-357-3268

ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program

Website httpmyakhippcom

Phone 1-866-251-4861

Email CustomerServiceMyAKHIPPcom

Medicaid Eligibility

httpdhssalaskagovdpaPagesmedicaiddefaultaspx

Website httpsmedicaidgeorgiagovhealth-

insurance-premium-payment-program-hipp

Phone 678-564-1162 ext 2131

ARKANSAS ndash Medicaid INDIANA ndash Medicaid

Website httpmyarhippcom

Phone 1-855-MyARHIPP (855-692-7447)

Healthy Indiana Plan for low-income adults 19-64

Website httpwwwingovfssahip

Phone 1-877-438-4479

All other Medicaid

Website httpwwwindianamedicaidcom

Phone 1-800-403-0864

COLORADO ndash Health First Colorado

(Coloradorsquos Medicaid Program) amp Child Health

Plan Plus (CHP+)

IOWA ndash Medicaid

Health First Colorado Website

httpswwwhealthfirstcoloradocom

Health First Colorado Member Contact Center

1-800-221-3943 State Relay 711

CHP+ httpswwwcoloradogovpacifichcpfchild-health-

plan-plus

CHP+ Customer Service 1-800-359-1991 State Relay

711

Website

httpdhsiowagovHawki

Phone 1-800-257-8563

28

KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid

Website httpwwwkdheksgovhcf

Phone 1-785-296-3512

Website httpswwwdhhsnhgovoiihipphtm

Phone 603-271-5218

Toll free number for the HIPP program 1-800-852-3345 ext 5218

KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP

Website httpschfskygov

Phone 1-800-635-2570

Medicaid Website

httpwwwstatenjushumanservices

dmahsclientsmedicaid

Medicaid Phone 609-631-2392

CHIP Website httpwwwnjfamilycareorgindexhtml

CHIP Phone 1-800-701-0710

LOUISIANA ndash Medicaid NEW YORK ndash Medicaid

Website httpdhhlouisianagovindexcfmsubhome1n331

Phone 1-888-695-2447

Website httpswwwhealthnygovhealth_caremedicaid

Phone 1-800-541-2831

MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid

Website httpwwwmainegovdhhsofipublic-assistanceindexhtml

Phone 1-800-442-6003

TTY Maine relay 711

Website httpsmedicaidncdhhsgov

Phone 919-855-4100

MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid

Website httpwwwmassgoveohhsgovdepartmentsmasshealth

Phone 1-800-862-4840

Website httpwwwndgovdhsservicesmedicalservmedicaid

Phone 1-844-854-4825

MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP

Website

httpsmngovdhspeople-we-serveseniorshealth-carehealth-care-

programsprograms-and-servicesother-insurancejsp

Phone 1-800-657-3739

Website httpwwwinsureoklahomaorg

Phone 1-888-365-3742

MISSOURI ndash Medicaid OREGON ndash Medicaid

Website httpwwwdssmogovmhdparticipantspageshipphtm

Phone 573-751-2005

Website httphealthcareoregongovPagesindexaspx

httpwwworegonhealthcaregovindex-eshtml

Phone 1-800-699-9075

MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid

Website httpdphhsmtgovMontanaHealthcareProgramsHIPP

Phone 1-800-694-3084

Website

httpwwwdhspagovprovidermedicalassistancehealthinsuranc

epremiumpaymenthippprogramindexhtm

Phone 1-800-692-7462

NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP

Website httpwwwACCESSNebraskanegov

Phone (855) 632-7633

Lincoln (402) 473-7000

Omaha (402) 595-1178

Website httpwwweohhsrigov

Phone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)

29

NEVADA ndash Medicaid SOUTH CAROLINA ndash Medicaid

Medicaid Website httpsdhcfpnvgov

Medicaid Phone 1-800-992-0900

Website httpswwwscdhhsgov

Phone 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid

Website httpdsssdgov

Phone 1-888-828-0059

Website httpswwwhcawagov

Phone 1-800-562-3022 ext 15473

TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascom

Phone 1-800-440-0493

Website httpmywvhippcom

Toll-free phone 1-855-MyWVHIPP (1-855-699-8447)

UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgov

CHIP Website httphealthutahgovchip

Phone 1-877-543-7669

Website

httpswwwdhswisconsingovpublicationsp1p10095p

df

Phone 1-800-362-3002

VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorg

Phone 1-800-250-8427

Website httpswyequalitycareacs-inccom

Phone 307-777-7531

VIRGINIA ndash Medicaid and CHIP Medicaid Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

Medicaid Phone 1-800-432-5924

CHIP Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

CHIP Phone 1-855-242-8282

To see if any other states have added a premium assistance program since July 31 2019 or for more

information on special enrollment rights contact either

US Department of Labor US Department of Health and Human Services

Employee Benefits Security Administration Centers for Medicare amp Medicaid Services

wwwdolgovagenciesebsa wwwcmshhsgov

1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565

Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond

to a collection of information unless such collection displays a valid Office of Management and Budget (OMB)

control number The Department notes that a Federal agency cannot conduct or sponsor a collection of

information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and

the public is not required to respond to a collection of information unless it displays a currently valid OMB control

number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to

penalty for failing to comply with a collection of information if the collection of information does not display a

currently valid OMB control number See 44 USC 3512

The public reporting burden for this collection of information is estimated to average approximately seven minutes

per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other

aspect of this collection of information including suggestions for reducing this burden to the US Department of

Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance

Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and

reference the OMB Control Number 1210-0137 OMB Control Number 1210-0137 (expires 12312019)

Notes

30

Notes

31

Prepared by

Please contact Reston Associationrsquos Human Resources Department at 703-435-7990 or hrrestonorg with any

questions related to your Total Rewards Guide

copy 2019 McGriff Insurance Services Inc

Page 4: Employee Total Rewards Guide 2020 - Reston Total Rewards Gui… · Recognizing and rewarding employees for achieving a sustainable impact. Award criteria includes: •Progressive

Recognition amp Rewards

Reston Association recognizes and rewards employees for going above and beyond in performing their responsibilities and service to the organization and to all that Reston encompasses Employees can be recognized and rewarded by their peers by receiving an Achievement award or a Recognition award

Achievement Recognizing and rewarding employees for achieving a sustainable impact Award criteria includes bull Progressive for RA and RArsquos goals bull Innovative bull Sustained Excellence bull Saves RA timemoneyother resources

Recognition Recognizing and rewarding employees for a moment of excellence Award criteria includes bull A moment of excellence performed under challenging or uncommon circumstances bull A single event of outstanding service that goes beyond onersquos core job responsibilities and that demonstrates

an employeersquos willingness to take initiative in assisting internal andor external customers

Service Awards Reston Association provides awards for reaching years of service milestones Awards are given in December of the year in which you reach one of the following service milestones 5 years bull 10 years bull 15 years bull 20 years bull 25 years bull 30 years bull 35 years

Employee of the Year Every year Reston Association selects an Employee of the Year The purpose of the Employee of the Year award is to honor those who have invested their time and taken initiative to make significant contributions to the organization and community over the course of the year with consideration given to past achievements and contributions The Employee of the Year receives one paid day off certificate a $500 bonus and dedication of a tree in Reston

4

Benefits ndash RArsquos Wellness Program

Reston Association is committed to providing a culture that promotes healthy living through education and resources RArsquos Wellness Program works to achieve this commitment through its goals

To help employees reduce lifestyle risk factors and become better health care consumers

To raise employee awareness about the importance of preventative health care and overall wellness including financial and mental

To provide employees a work environment that supports positive health and fitness practices

Every year at RArsquos annual wellness and benefits fair in November you will be given a Passport to Wellness where you earn stamps for individual and group activities Benefits of participating in the Wellness Program include

Wellness screenings and flu shots at the Benefits Fair in November Quarterly Brown Bag presentations related to wellness and workplace topics Activities events and team challenges such as the YMCA Corporate Challenge car

free days blood drives water-only challenges smoothie days and more Earn stamps for participation in individual and group activities Redeem your stamps

for prizes including the grand prize

5

Benefits ndash PlanContact Information

Enrollment in the majority of these benefits must be done within 30 days of hire during open enrollment or within 30 days of a qualifying life change event Open enrollment occurs annually from mid-November to mid-December

Benefits elected during open enrollment will take effect January 1

The employee their spouse or domestic partner (regardless of sex) and their children under age 26 are eligible to enroll in benefits

Insurance Benefits

Health Insurance Provider Name Kaiser Permanente group 3007-4 (HMO Select) 3007-6 (POS) 3007-10 (HRA-DHMO) Provider Contact Member Services 301-468-6000 Provider Web Address wwwkporg

Dental Insurance Provider Name MetLife group 5469528 Provider Contact Member Services 800-ASK-4MET Provider Web Address httpsmybenefitsmetlifecom

Supplemental Vision Insurance ndash two options 1Provider Name VSP group 30017163

Provider Contact Member Services 800-877-7195 Provider Web Address wwwvspcom

2Provider Name SpecteraUHC group GA9N9747BW Provider Contact Member Services 800-839-3242 Provider Web Address wwwmyuhccom

Flexible Spending Accounts (FSA) amp Dependent Care Accounts (DCA) Contact Optum Health Provider Contact Member Services 800-243-5543 Provider Web Address httpssecureoptumhealthfinancialcom

LifeADampD Short-term Disability (STD) amp Long-term Disability (LTD) Insurance Provider Name Sun Life group 211628 Provider Contact Member Services 800-247-6875 Provider Web Address wwwsunlifecomus

Savings Benefits 401(k) Retirement Savings Plan (pre-tax and Roth)

Provider Name Ascensus Broker Contact Mark Ivcevich 301-326-1521 markqp-consultingcom Web Address httpsmyaccountascensuscomrplink

529 College Savings Plan Contact Human Resources

6

Medical Premium Costs per Paycheck for Employees Hired Prior to 1-1-2019

The amount of your paycheck cost difference will be dependent on the type of coverage you choose

for 2020 (see last column on the table below)

Rates are effective January 1 2020

HRA-HMO

Signature

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $50725 $3512

Employee + 1 $101444 $8193

Employee + Family $147096 $12408

HMO Select

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $58173 $4027

Employee + 1 $116340 $9397

Employee + Family $168696 $14229

POS Select

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $85966 $5951

Employee + 1 $171932 $13887

Employee + Family $249293 $21028

NOTE The Health Insurance Premium Bank is still available to those who qualify Request for

assistance must be made annually by December 15th or within 30 days of a qualifying event

7

Medical Premium Costs per Paycheck for Employees Hired After 1-1-2019

The amount of your paycheck cost difference will be dependent on the type of coverage you choose

for 2020 (see last column on the table below)

Rates are effective January 1 2020

HRA-HMO

Signature

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $50725 $4682

Employee + 1 $101444 $10535

Employee + Family $147096 $15802

HMO Select

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $58173 5370

Employee + 1 $116340 $12081

Employee + Family $168696 $18122

POS Select

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $85966 $7935

Employee + 1 $171932 $17854

Employee + Family $249293 $26781

NOTE The Health Insurance Premium Bank is still available to those who qualify Request for

assistance must be made annually by December 12th or within 30 days of a qualifying event

8

Dental amp Vision Premium Costs per Paycheck

The following rates represent your monthly Dental and Vision premiums effective January 1 2020

MetLife Dental Per Paycheck

FULL-TIME Cost

Per Paycheck

PART-TIME Cost

Employee $000

Contact HR for cost Employee + 1 $000

Employee + Family $000

VSP Vision Per Paycheck Cost

Employee $513

Employee + Adult $864

Employee + Child $882

Employee + Family $1423

SpecteraUHC Vision Per Paycheck Cost

Employee $415

Employee + Adult $843

Employee + Child $883

Employee + Family $1116

9

Health Insurance ndash Option 1

DHMO HRA Signature In Network You Pay Out-of-Network You Pay

Deductible Coinsurance Out-of-Pocket

$750 Individual$1500 Family (RA funds) 9010

$3000 Individual $6000 Family

(less than regular HMO)

NA

Primary Care and Specialist Office Visit $15 PCP$25 Specialist NO COVERAGE

Emergency Room Visits $75 per visit (waived

if admitted) NO COVERAGE

Hospital ndash Inpatient Stay 10 after deductible NO COVERAGE

Home Health Care 10 after deductible NO COVERAGE

Outpatient Facility Services 10 after deductible NO COVERAGE

X-Ray and Laboratory Services 10 after deductible NO COVERAGE

Specialty Imaging (CTMRIPET scan) 10 after deductible NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Inpatient Facility

10 after deductible NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Outpatient Facility

$7 copay-group therapy $15 copay-individual therapy per visit

NO COVERAGE

Vision (Children Only) $15 PCP$25 Specialist NO COVERAGE

Prescription Drug Program (30 day supply) Generic Drug (Tier 1) Preferred Brand Name Drug (Tier 2) Non-Preferred Brand Drug (Tier 3) Up to 90 day supply ndash 3 co-pays for Plan and Participating Pharmacies Mail Order Up to 90 day supply- 2 co-pays

$0 deductible

Plan $20 Participating $30 Plan $30 Participating $50 Plan $45 Participating $65

$20$30$45

Kaiser Permanente D-HMO HRA Signature (Facilities Only) With the Signature Network members receive quality care at the Kaiser medical centers in Maryland Virginia and the District of Columbia Medical centers offer convenient services including primary care specialty care laboratory radiology and pharmacy at most locations and in some locations optical Signature members also have access to more than 40 hospitals in the region

10

Health Insurance ndash Option 2

Kaiser Permanente HMO Select (Facilities amp Contracted Providers Only) With the Select Network members may receive quality care at the Kaiser medical centers in Maryland Virginia and the District of Columbia Building on the Signature physician network the Select network adds access to more than 15000 contracted community physicians in private practice Select members also have access to more than 40 hospitals in the region

HMO Select In-Network You Pay Out-of-Network

You Pay

Deductible Coinsurance Out-of-Pocket

None 100

$3500 Individual $9400 Family

NA

Primary Care and Specialist Office Visit $30 PCP$40 Specialist NO COVERAGE

Emergency Room Visits $100 per visit

(waived if admitted) NO COVERAGE

Hospital ndash Inpatient Stay $250 per admission NO COVERAGE

Home Health Care No charge NO COVERAGE

Outpatient Facility Services $100 NO COVERAGE

X-Ray and Laboratory Services No charge NO COVERAGE

Specialty Imaging (CTMRIPET scan) $50 per test NO COVERAGE

Chiropractic amp Acupuncture Services $40 copay

20 visits per contract year NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Inpatient Facility

$250 per admission NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Outpatient Facility

$15 copay-group therapy $30 copay-individual therapy per visit

NO COVERAGE

Vision (Children Only) $30 PCP$40 Specialist NO COVERAGE

Prescription Drug Program (30 day supply) Generic Drug (Tier 1) Preferred Brand Name Drug (Tier 2) Non-Preferred Brand Drug (Tier 3) Up to 90 day supply ndash 3 co-pays for Plan and Participating Pharmacies Mail Order Up to 90 day supply- 2 co-pays

$0 deductible

Plan $20 Participating $30 Plan $35 Participating $50 Plan $50 Participating $75

$20$35$50

11

Kaiser Permanente POS Select (Facilities amp Contracted Providers with an Out of Network Option) Members can use in-plan benefits by using a Kaiser facility or a contracted primary care physician Your chosen PCP will provide care and coordinate referrals and hospital admissions Members also have the freedom to choose any other licensed provider outside the provider network however you will be responsible for deductibles and coinsurance above the health planrsquos payment

POS Select In-Network You Pay Out-of-Network

you pay

Deductible Coinsurance Out-of-Pocket

None 100

$3500 Individual $9400 Family

$300 Individual $600 Family

8020 $3000 Individual

$6000 Family

Primary Care and Specialist Office Visit $15 PCP$30 Specialist 20 of UCR

Emergency Room Visits $75 per visit (waived if

admitted) $75 per visit

(waived if admitted)

Hospital ndash Inpatient Stay $250 per admission 20 of UCR

Home Health Care No charge 20 of UCR

Outpatient Facility Services $50 20 of UCR

X-Ray and Laboratory Services No charge 20 of UCR

Specialty Imaging (CTMRIPET scan) No charge 20 of UCR

Mental Health (MG) amp Substance Abuse (SA) ndash Inpatient Facility

$250 per admission 20 of UCR

Mental Health (MG) amp Substance Abuse (SA) ndash Outpatient Facility

$7 copay-group therapy $15 copay-individual therapy per visit

20 of UCR

Vision (Children Only) $15 PCP$30 Specialist per visit 20 of UCR

Prescription Drug Program (30 day supply) Generic Drug (Tier 1) Preferred Brand Name Drug (Tier 2) Non-Preferred Brand Drug (Tier 3) Up to 90 day supply ndash 3 co-pays for Plan and Participating Pharmacies Mail Order Up to 90 day supply- 2 co-pays

$0 deductible

Plan $20 Participating $30 Plan $35 Participating $50 Plan $50 Participating $75

$20$35$50

Health Insurance ndash Option 3

12

Dental Insurance

MetLife Dental PPO The Dental PPO plan is 100 Employer Paid for all tiers and provides comprehensive coverage with a nationwide PPO network This gives members access to more in-network dentists making it easier for them to reduce out-of-pocket costs for covered procedures and treatments Dental procedure frequencies Preventative care covers an exam and cleaning (once every 6 months) Fluoride treatment (two per benefit period under age 19 only) Full mouth X-ray (once every 60 months) Bitewing X-ray (once every 12 months age 14 and over once every 12 months under age 14)

PPO Dental Plan Features In-Network Out-of-Network

Type A Preventive Care Services (oral exams cleanings x-rays sealants)

100 of Fee Schedule 100 of Usual amp Customary

Charge

Type B Basic Restorative Dental Services (fillings simple extractions space maintainers)

80 of Fee Schedule 80 of Usual amp Customary

Charge

Type B Major Surgical Dental Services (Endodontics amp Periodontics)

80 of Fee Schedule 80 of Usual amp Customary

Charge

Type C Major Restorative Dental Services (bridges crowns dentures implants)

50 of Fee Schedule 50 of Usual amp Customary

Charge

Orthodontia (under age 19 only)

Lifetime maximum - $1000 50 of allowed benefit

Calendar Year Deductible Applies to Type B amp C services only

$25 Single $75 Family

Calendar Year Maximum Per Person $1500 combined maxper calendar year

Prior to receiving dental services it is recommended that you first obtain a pre-determination of benefits from your dentist so you know exactly how much your dental insurance will cover Spouses domestic partners and dependent children to age 26 (regardless of student status) are eligible

13

Vision Insurance ndash Option 1

Vision Plan through VSP (Voluntary) VSP is the largest private provider vision carrier in the country VSP contracts with Costcoreg Optical Eye Care Centers of America Inctrade which includes popular stores like EyeMasters VisionWorld and Hour Eyes and other quality retail chains When you visit a VSP participating provider your benefits include routine vision exams lenses and preferred pricing on all patient options Frequency Eye Exam 12 monthsLenses 12 monthsFrames 24 monthsContact Lenses 12 months

Vision Plan Features In-Network Out-of-Network

Annual Routine Eye Exam $10 copay Plan pays up to $45

Eyeglass Lenses (standard) Single Bifocal Trifocal

Covered in Full Covered in Full Covered in Full

Plan pays up to $30 Plan pays up to $50 Plan pays up to $65

Frames $130 allowance then 20 off remaining balance

Plan pays up to $70

Necessary Contact Lenses Covered in Full Plan pays up to $210

Elective Contact Lenses $130 allowance Plan pays up to $105

Elective Contact Lenses fitting and evaluation Covered in Full after $60

copay Not Available

Spouses domestic partners and dependent children to age 19 (or to age 25 if FT student) are eligible

14

Vision Insurance ndash Option 2

Vision Plan through Spectera UHC (Voluntary)

UHC offers you one of the largest vision care networks in the industry Their network includes convenient retail locations including My Eye Dr and Hour Eyes Best of all ndash when you receive care from a participating provider you receive the greatest benefits and money-saving discounts

Frequency Eye Exam 12 monthsLenses 12 monthsFrames 12 monthsContact Lenses 12 months

Vision Plan Features In-Network Out-of-Network

Annual Routine Eye Exam $10 copay Plan pays up to $40

Eyeglass Lenses (standard) Single Bifocal Trifocal

$25 copay $25 copay $25 copay

Plan pays up to $40 Plan pays up to $60 Plan pays up to $80

Frames $2500 copay $130 retail frame

allowance 30 discount above allowance

Plan pays up to $45

Necessary Contact Lenses $25 copay Plan pays up to $210

Elective Contact Lenses

$25 copay from the ldquoCovered contact lens

selectionrdquo All others- $105

allowance

Plan pays up to $105

Elective Contact Lenses fitting and evaluation Covered in Full after $25

copay Not Available

Spouses and dependent children to age 26 are eligible

15

Pre-tax FSA amp DCA

Flexible Spending Account (FSA) through Optum Health The Flexible Spending Account provides employees a means to reduce their taxes by the amount of their out of pocket health-related expenses (subject to eligibility) This tax free savings program allows employees to submit receipts for reimbursement for medical dental vision care prescription drug co-payments and other expenses not covered by our insurance In 2020 employees may contribute up to $2750 per year toward their FSA Employees have until March 14 2020 to use the money in their FSA or else they lose it (This contribution amount could change based on IRS guideline updates)

Dependent Care Spending Account (DCA) through Optum Health The Dependent Care Spending Account provides employees a means to reduce their taxes by the amount of their child care costs to a licensed provider up to $5000 annually

Health Insurance Premium Bank

Reston Association has established a program to help regular full-time and regular part-time employees pay their portion of the health insurance premium This program is only available to employees who are enrolled in or plan to enroll in the Kaiser Permanente HMO health insurance plans offered by the Reston Association Employees are eligible to apply to the Health Insurance Premium Bank if their adjusted gross household incomes are less than or equal to $60000 Requests for assistance must be made annually or at any time there is a qualifying event and submitted to Human Resources with necessary documentation by December 12th of each year To apply complete a request form (available in CommonHumResBenefits) and submit to HR with a copy of your most recent tax return showing adjusted gross household income This threshold is subject to change

16

Life and ADampD Insurance

Basic LifeADampD Insurance Reston Association provides 100 employer paid Life and ADampD Insurance through Sun Life to employees working 25 or more hours per week Coverage becomes effective the first of the month following six months of service

Benefit 2x Annual Earnings to a maximum of $200000 Age reduction Benefit reduced to 65 at age 65 and to 50 at age 70

Optional LifeADampD Insurance for Employee Spouse and Dependent Children

Optional Life Insurance for the employee spouse and dependent children is available at the employeersquos cost Optional Life is not available for domestic partners

Employee Benefit Increments of $10000 to a maximum of the lesser of $300000 or 3x your Basic Annual Earnings

Spouse Benefit Increments of $5000 to a maximum of $150000 Dependent Child Benefit Increments of $1000 to a maximum of $10000

Your amount of Dependent Spouse and Dependent Child Optional Life Insurance cannot exceed 50 of your amount of Optional Life Insurance Initial eligibility period will require evidence of insurability

STD amp LTD Insurance

Short Term and Long Term Disability Reston Association provides eligible employees with short and long-term disability income benefits through Sun Life In the event you become disabled from a non work-related injury or sickness disability income benefits are provided as a source of income These benefits are 100 employer paid

Benefit Short-Term Disability Long-Term Disability

Income Replacement -Eligible Employees -Executives

60 60

Elimination Period - Accidental Injury - Sickness

29 days 90 days

Benefit Period 9 weeks maximum To Social Security

normal retirement age

Benefit Maximum -Eligible Employees -Executives

$1000 per week $6000 per month $8000 per month 17

At a cost of $19month you can enroll in the Legal Resources benefit As a Legal Resources Member you have immediate and ongoing access to comprehensive legal coverage services and expertise that will easily save you money mdash and could save you a whole lot more Covered legal services include

Legal Advice and Consultation Tenant Dispute with Landlord District Court Representation for Civil Action Review of a Financial Contract or Lease Purchase sale or refinance of primary home Traffic Court Representation (includes 1st DUI) Will Preparation Uncontested Divorce Representation Defense of Child in Court (misdemeanor)

Legal Resources

Employee Assistance Program (EAP)

Reston Association offers a free confidential Employee Assistance Program (EAP) to all employees and their eligible dependents Through RArsquos EAP provider Lytle EAP Partners you and your immediate family members have immediate access on your date of hire to confidential professional counseling and referral services for help with anything that affects you or your dependentsrsquo well-being You can reach an EAP counselor by dialing 1-800-327-7272 24 hours a day or you may visit their website at wwwLytleEAPcom (password is reston) for more information Visit wwwLytleEAPcom for web-based legal financial worklife resources There are also work-related resources available online for managers Note Since EAP services are provided as a benefit only RA makes no representation concerning quality of care

18

401(k) Retirement Savings Plan

Reston Association offers two 401(k) retirement savings plans through Ascensusmdasha traditional 401(k) plan in which employee contributions are made pre-tax and a 401(k) Roth in which employee contributions are made after tax RA matches employee contributions dollar for dollar up to a total of 7 of your annual salary You can begin making contributions to the 401(k) plan and become eligible for RArsquos match following six months of service You always own 100 of your salary contributions

It is possible to borrow against a portion of your vested 401(k) account balance by taking a 401(k) loan You may request a participant loan using an application form which can be obtained by contacting Human Resources Your ability to obtain a 401(k) loan will depend on specific qualifying factors (defined in the 401(k) Summary Plan Description document) The 401(k) Plan Administrator will determine whether you satisfy these factors To access your 401(k) plan online httpsmyaccountascensuscomrplink Check account balance and rate of return Change fund elections Request a 401k loan View fund pricing and performance View and print quarterly statements

19

529 College Savings Plan (employer-sponsored)

A 529 college savings plan provides those saving for college with an unmatched combination of benefits You can open a 529 plan for anyone mdash your child grandchild spouse a friend or even yourself Assets in a 529 plan can be used to pay for a variety of higher education expenses including required books tuition room and board supplies and certain other required fees and expenses Earnings in 529 accounts can grow free from federal tax Withdrawals for qualified higher education expenses are free from federal tax Option to set up recurring automatic fund transfers directly from your bank account making it easy for you to invest The account owner rather than the beneficiary maintains control of account assets and determines the timing and amount of distributions Account owners can change beneficiaries without penalty provided the new beneficiary is a member of the previous beneficiaryrsquos family For more information please contact Human Resources

Additional Benefits

Free passes for employees and their dependents to all of RArsquos pools and tennis courts as well as discounted rates for all RA Programs and Camps Some restrictions may apply

Discounted gym membership rates at the Reston YMCA and Crunch Fitness Bike Share Program - Reston Association makes bicycles and helmets available to employees to rent on a daily

basis Please contact Member Services Discounted Tennis Rackets amp Shoes ndash Employees can purchase certain tennis shoes and rackets at wholesale

prices through RArsquos Tennis Department Contact the Tennis Department for more information Discounted autohome insurance - Liberty Mutual Insurance Company partners with RA to offer all employees

discounts on automobile and homeowner insurance Contact John Valenti at JohnValentilibertymutualcom

20

Reston Association provides generous paid time off benefits to accommodate the diverse needs of staff and to provide a positive worklife balance The amount of paid time off you earn per year is based on your years of service In addition Reston Association observes 9 paid holidays and assigns one paid floating holiday per year For more information on paid time off benefits and how to request time off please refer to the Reston Association Employee Handbook

WorkLife Balance ndash Paid Time Off (PTO)

Teleworking

The medical leave bank is available to help employees in extenuating circumstances protect their incomes by receiving paid leave once their personal PTO is used up A maximum of six (6) workweeks may be granted for each Medical Leave Bank request If additional time is necessary a new request must be made For program eligibility and criteria go to CommonHumResBenefits

Medical Leave Bank

Volunteer Release Time

On a per position basis employees may be allowed to telework for part of their workweek or in certain circumstances Such arrangements must be in compliance with the written administrative procedure including being approved in advance by the department director

Employees are encouraged to become involved in their communities lending their voluntary support to programs that enrich the quality of life and opportunities for all citizens This benefit allows employees to take paid-time off during a work day to participate in a volunteer activity that benefits the community at large Such activities are typically sponsored by a charitable or service organization or work with one or more individuals in need of assistance or special service

21

Training amp Career Development

Reston Association offers two types of learning opportunities for employees mdashinformal and formalmdashto foster individual development and training and career planning

I Informal Learning Opportunities (individual development amp training)

Focus on individual acquiring or enhancing specific task andor process skills to perform his or her current job better Typically this type of learning is not ldquodegree- orientedrdquo

Participants may or may not receive attendance or achievement certificate

Conferences workshops seminars webinars online courses etc typically lasting a few hours to one week

Requests for this type of training should be made to your supervisor or department head

II Formal Learning Opportunities (career planning)

Professional DevelopmentCareer Planning

Formalstructured learning geared toward improving and maintaining professional competence enhancing career progression staying abreast of new technologies and best practices developing process skills andor compliance with professional regulations

Future but not degree-oriented CEUs may be earned

May lead to qualification or credential required to obtain or retain specific certification

Opportunity may range from semester-long academic course to 24 month program with wide range of content and learning experience

Tuition Reimbursement Program

Supports formal education goals (AA bachelors masters) of individual to enhance knowledge and skills in specific areaindustry

Learning must be job-related and accomplished at or through accredited learning institution or e-learning platform connected with the institution

Requests for this type of training should be made to Human Resources as soon as foreseeable to ensure best availability of funds to support reimbursement

22

23

Lifetime limit not applicable and enrollment opportunity The lifetime limit on the dollar value of benefits under our medical plan no longer applies Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan Individuals have 30 days from the date of this notice to request enrollment For more information contact Human Resources or call the medical insurance carrier at the telephone number on your identification card

Notice on Patient Protections The medical HMO plan generally allows the designation of a primary care provider You have the right to designate any primary care provider who participates in the network and who is available to accept you or your family members Until you make this designation the medical carrier designates one for you For information on how to select a primary care provider and for a list of the participating primary care providers contact the medical insurance carrier at the number listed on your identification card

For children you may designate a pediatrician as the primary care provider You do not need prior authorization from the medical insurance carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in the network who specializes in obstetrics or gynecology The health care professional however may be required to comply with certain procedures including obtaining prior authorization for certain services following a pre-approved treatment plan or procedures for making referrals For a list of participating health care professionals who specialize in obstetrics or gynecology contact the medical insurance carrier at the number listed on your identification card

OTC Drug Reimbursements for FSAsHRAsHSAs Under the new Health Care Reform law (PPACA) the cost of an over-the-counter medicine or drug cannot be reimbursed from the account unless a prescription is obtained The change does not affect insulin even if purchased without a prescription or other health care expenses such as medical devices eyeglasses contact lenses co-pays and deductibles The new standard applies only to purchases made on or after January 1 2011

A similar rule is in effect for Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs)

The IRS has also posted a questions and answers section on its website httpwwwirsgovnewsroomarticle0id=22730800html concerning these provisions

Patient Protection and Affordable Care Act (PPACA) Mandatory Notices

The text below is an annual open enrollment required notice

24

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION PLEASE REVIEW IT CAREFULLY

Our Pledge to You

This notice is intended to inform you of the privacy practices followed by the Reston Associationrsquos Employee Benefit Plan (the Plan) and the Planrsquos legal obligations regarding your protected health information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) The notice also explains the privacy rights you and your family members have as participants of the Plan It is effective on April 14 2011

The Plan often needs access to your protected health information in order to provide payment for health services and perform plan administrative functions We want to assure the plan participants covered under the Plan that we comply with federal privacy laws and respect your right to privacy Reston Association requires all members of our workforce and third parties that are provided access to protected health information to comply with the privacy practices outlined in this notice

Protected Health Information Your protected health information is protected by the HIPAA Privacy Rule Generally protected health information is information that identifies an individual created or received by a health care provider health plan or an employer on behalf of a group health plan that relates to physical or mental health conditions provision of health care or payment for health care whether past present or future

How We May Use Your Protected Health Information Under the HIPAA Privacy Rule we may use or disclose your protected health information for certain purposes without your permission This section describes the ways we can use and disclose your protected health information

bull Payment We use or disclose your protected health information without your written authorization in order to determine eligibility for benefits seek reimbursement from a third party or coordinate benefits with another health plan under which you are covered For example a health care provider that provided treatment to you will provide us with your health information We use that information in order to determine whether those services are eligible for payment under our group health plan

bull Health Care Operations We use and disclose your protected health information in order to perform plan administration functions such as quality assurance activities resolution of internal grievances and evaluating plan performance For example we review claims experience in order to understand participant utilization and to make plan design changes that are intended to control health care costs

bull Treatment Although the law allows use and disclosure of your protected health information for purposes of treatment as a health plan we generally do not need to disclose your information for treatment purposes Your physician or health care provider is required to provide you with an explanation of how they use and share your health information for purposes of treatment payment and health care operations

bull As permitted or required by law We may also use or disclose your protected health information without your written authorization for other reasons as permitted by law We are permitted by law to share information subject to certain requirements in order to communicate information on health-related benefits or services that may be of interest to you respond to a court order or provide information to further public health activities (eg preventing the spread of disease) without your written authorization We are also permitted to share protected health information during a corporate restructuring such as a merger sale or acquisition We will also disclose health information about you when required by law for example in order to prevent serious harm to you or others

The text below is an annual open enrollment required notice

25

Notice of Privacy Practices

bull Pursuant to your Authorization When required by law we will ask for your written authorization before using or disclosing your protected health information If you choose to sign an authorization to disclose information you can later revoke that authorization to prevent any future uses or disclosures

bull To Business Associates We may enter into contracts with entities known as Business Associates that provide services to or perform functions on behalf of the Plan We may disclose protected health information to Business Associates once they have agreed in writing to safeguard the protected health information For example we may disclose your protected health information to a Business Associate to administer claims Business Associates are also required by law to protect protected health information

bull To the Plan Sponsor We may disclose protected health information to certain employees of Reston Association for the purpose of administering the Plan These employees will use or disclose the protected health information only as necessary to perform plan administration functions or as otherwise required by HIPAA unless you have authorized additional disclosures Your protected health information cannot be used for employment purposes without your specific authorization

Your Rights bull Right to Inspect and Copy In most cases you have the right to inspect and copy the protected health

information we maintain about you If you request copies we will charge you a reasonable fee to cover the costs of copying mailing or other expenses associated with your request Your request to inspect or review your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to inspect and copy your health information To the extent your information is held in an electronic health record you may be able to receive the information in an electronic format

bull Right to Amend If you believe that information within your records is incorrect or if important information is missing you have the right to request that we correct the existing information or add the missing information Your request to amend your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to amend your health information If we deny your request you may file a statement of disagreement with us for inclusion in any future disclosures of the disputed information

bull Right to an Accounting of Disclosures You have the right to receive an accounting of certain disclosures of your protected health information The accounting will not include disclosures that were made (1) for purposes of treatment payment or health care operations (2) to you (3) pursuant to your authorization (4) to your friends or family in your presence or because of an emergency (5) for national security purposes or (6) incidental to otherwise permissible disclosures

Your request to for an accounting must be submitted in writing to the person listed below You may request an accounting of disclosures made within the last six years You may request one accounting free of charge within a 12-month period

The text below is an annual open enrollment required notice

25

26

The information provided herein is intended to be a summary of benefits only and in no way supersedes the actual plan documents provided by the insurance carriersadministrators For more detailed information pertaining to your employee benefit plans including limitations and exclusions

please refer to the plan documents andor evidence of coverage provided by the carriersadministrators

Womenrsquos Health and Cancer Rights Act of 1998

If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos Health and Cancer Rights Act of 1998 (WHCRA) For individuals receiving mastectomy-related benefits coverage will be provided in a manner determined in consultation with the attending physician and the patient for

bull All stages of reconstruction of the breast on which the mastectomy was performed bull Surgery and reconstruction of the other breast to produce a symmetrical appearance bull Prostheses and bull Treatment of physical complications of the mastectomy including lymphedema

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan If you would like more information on WHCRA benefits call your plan administrator

CHIP-Childrens Health Insurance Program (CHIP) Reauthorization Act of 2009

Medicaid and the Childrenrsquos Health Insurance Program (CHIP) offer free or low-cost health coverage to children and families If you are eligible for health coverage from your employer but are unable to afford the premiums some States have premium assistance programs that can help pay for coverage These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage but need assistance in paying their health premiums

If you or your dependents are already enrolled in Medicaid or CHIP you can contact your state Medicaid or CHIP office to find out if premium assistance is available For a list of the contacts in each State go to wwwdolgovebsachipmodelnoticedoc

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify you can then contact the State to find out if it has a program that might help you pay the premiums for an employer-sponsored plan

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP your employerrsquos health plan is required to permit you and your dependents to enroll in the plan ndash as long as you and your dependents are eligible but not already enrolled in the employerrsquos plan This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance

The text below is an annual open enrollment required notice

26

27

Premium Assistance Under Medicaid and the

Childrenrsquos Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your

employer your state may have a premium assistance program that can help pay for coverage using funds

from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot

be eligible for these premium assistance programs but you may be able to buy individual insurance coverage

through the Health Insurance Marketplace For more information visit wwwhealthcaregov

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below

contact your State Medicaid or CHIP office to find out if premium assistance is available

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your

dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-

877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a

program that might help you pay the premiums for an employer-sponsored plan

If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible

under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already

enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days

of being determined eligible for premium assistance If you have questions about enrolling in your

employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)

If you live in one of the following states you may be eligible for assistance paying your employer

health plan premiums The following list of states is current as of July 31 2019 Contact your State for

more information on eligibility ndash

ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcom

Phone 1-855-692-5447

Website httpflmedicaidtplrecoverycomhipp

Phone 1-877-357-3268

ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program

Website httpmyakhippcom

Phone 1-866-251-4861

Email CustomerServiceMyAKHIPPcom

Medicaid Eligibility

httpdhssalaskagovdpaPagesmedicaiddefaultaspx

Website httpsmedicaidgeorgiagovhealth-

insurance-premium-payment-program-hipp

Phone 678-564-1162 ext 2131

ARKANSAS ndash Medicaid INDIANA ndash Medicaid

Website httpmyarhippcom

Phone 1-855-MyARHIPP (855-692-7447)

Healthy Indiana Plan for low-income adults 19-64

Website httpwwwingovfssahip

Phone 1-877-438-4479

All other Medicaid

Website httpwwwindianamedicaidcom

Phone 1-800-403-0864

COLORADO ndash Health First Colorado

(Coloradorsquos Medicaid Program) amp Child Health

Plan Plus (CHP+)

IOWA ndash Medicaid

Health First Colorado Website

httpswwwhealthfirstcoloradocom

Health First Colorado Member Contact Center

1-800-221-3943 State Relay 711

CHP+ httpswwwcoloradogovpacifichcpfchild-health-

plan-plus

CHP+ Customer Service 1-800-359-1991 State Relay

711

Website

httpdhsiowagovHawki

Phone 1-800-257-8563

28

KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid

Website httpwwwkdheksgovhcf

Phone 1-785-296-3512

Website httpswwwdhhsnhgovoiihipphtm

Phone 603-271-5218

Toll free number for the HIPP program 1-800-852-3345 ext 5218

KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP

Website httpschfskygov

Phone 1-800-635-2570

Medicaid Website

httpwwwstatenjushumanservices

dmahsclientsmedicaid

Medicaid Phone 609-631-2392

CHIP Website httpwwwnjfamilycareorgindexhtml

CHIP Phone 1-800-701-0710

LOUISIANA ndash Medicaid NEW YORK ndash Medicaid

Website httpdhhlouisianagovindexcfmsubhome1n331

Phone 1-888-695-2447

Website httpswwwhealthnygovhealth_caremedicaid

Phone 1-800-541-2831

MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid

Website httpwwwmainegovdhhsofipublic-assistanceindexhtml

Phone 1-800-442-6003

TTY Maine relay 711

Website httpsmedicaidncdhhsgov

Phone 919-855-4100

MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid

Website httpwwwmassgoveohhsgovdepartmentsmasshealth

Phone 1-800-862-4840

Website httpwwwndgovdhsservicesmedicalservmedicaid

Phone 1-844-854-4825

MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP

Website

httpsmngovdhspeople-we-serveseniorshealth-carehealth-care-

programsprograms-and-servicesother-insurancejsp

Phone 1-800-657-3739

Website httpwwwinsureoklahomaorg

Phone 1-888-365-3742

MISSOURI ndash Medicaid OREGON ndash Medicaid

Website httpwwwdssmogovmhdparticipantspageshipphtm

Phone 573-751-2005

Website httphealthcareoregongovPagesindexaspx

httpwwworegonhealthcaregovindex-eshtml

Phone 1-800-699-9075

MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid

Website httpdphhsmtgovMontanaHealthcareProgramsHIPP

Phone 1-800-694-3084

Website

httpwwwdhspagovprovidermedicalassistancehealthinsuranc

epremiumpaymenthippprogramindexhtm

Phone 1-800-692-7462

NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP

Website httpwwwACCESSNebraskanegov

Phone (855) 632-7633

Lincoln (402) 473-7000

Omaha (402) 595-1178

Website httpwwweohhsrigov

Phone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)

29

NEVADA ndash Medicaid SOUTH CAROLINA ndash Medicaid

Medicaid Website httpsdhcfpnvgov

Medicaid Phone 1-800-992-0900

Website httpswwwscdhhsgov

Phone 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid

Website httpdsssdgov

Phone 1-888-828-0059

Website httpswwwhcawagov

Phone 1-800-562-3022 ext 15473

TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascom

Phone 1-800-440-0493

Website httpmywvhippcom

Toll-free phone 1-855-MyWVHIPP (1-855-699-8447)

UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgov

CHIP Website httphealthutahgovchip

Phone 1-877-543-7669

Website

httpswwwdhswisconsingovpublicationsp1p10095p

df

Phone 1-800-362-3002

VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorg

Phone 1-800-250-8427

Website httpswyequalitycareacs-inccom

Phone 307-777-7531

VIRGINIA ndash Medicaid and CHIP Medicaid Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

Medicaid Phone 1-800-432-5924

CHIP Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

CHIP Phone 1-855-242-8282

To see if any other states have added a premium assistance program since July 31 2019 or for more

information on special enrollment rights contact either

US Department of Labor US Department of Health and Human Services

Employee Benefits Security Administration Centers for Medicare amp Medicaid Services

wwwdolgovagenciesebsa wwwcmshhsgov

1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565

Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond

to a collection of information unless such collection displays a valid Office of Management and Budget (OMB)

control number The Department notes that a Federal agency cannot conduct or sponsor a collection of

information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and

the public is not required to respond to a collection of information unless it displays a currently valid OMB control

number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to

penalty for failing to comply with a collection of information if the collection of information does not display a

currently valid OMB control number See 44 USC 3512

The public reporting burden for this collection of information is estimated to average approximately seven minutes

per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other

aspect of this collection of information including suggestions for reducing this burden to the US Department of

Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance

Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and

reference the OMB Control Number 1210-0137 OMB Control Number 1210-0137 (expires 12312019)

Notes

30

Notes

31

Prepared by

Please contact Reston Associationrsquos Human Resources Department at 703-435-7990 or hrrestonorg with any

questions related to your Total Rewards Guide

copy 2019 McGriff Insurance Services Inc

Page 5: Employee Total Rewards Guide 2020 - Reston Total Rewards Gui… · Recognizing and rewarding employees for achieving a sustainable impact. Award criteria includes: •Progressive

Benefits ndash RArsquos Wellness Program

Reston Association is committed to providing a culture that promotes healthy living through education and resources RArsquos Wellness Program works to achieve this commitment through its goals

To help employees reduce lifestyle risk factors and become better health care consumers

To raise employee awareness about the importance of preventative health care and overall wellness including financial and mental

To provide employees a work environment that supports positive health and fitness practices

Every year at RArsquos annual wellness and benefits fair in November you will be given a Passport to Wellness where you earn stamps for individual and group activities Benefits of participating in the Wellness Program include

Wellness screenings and flu shots at the Benefits Fair in November Quarterly Brown Bag presentations related to wellness and workplace topics Activities events and team challenges such as the YMCA Corporate Challenge car

free days blood drives water-only challenges smoothie days and more Earn stamps for participation in individual and group activities Redeem your stamps

for prizes including the grand prize

5

Benefits ndash PlanContact Information

Enrollment in the majority of these benefits must be done within 30 days of hire during open enrollment or within 30 days of a qualifying life change event Open enrollment occurs annually from mid-November to mid-December

Benefits elected during open enrollment will take effect January 1

The employee their spouse or domestic partner (regardless of sex) and their children under age 26 are eligible to enroll in benefits

Insurance Benefits

Health Insurance Provider Name Kaiser Permanente group 3007-4 (HMO Select) 3007-6 (POS) 3007-10 (HRA-DHMO) Provider Contact Member Services 301-468-6000 Provider Web Address wwwkporg

Dental Insurance Provider Name MetLife group 5469528 Provider Contact Member Services 800-ASK-4MET Provider Web Address httpsmybenefitsmetlifecom

Supplemental Vision Insurance ndash two options 1Provider Name VSP group 30017163

Provider Contact Member Services 800-877-7195 Provider Web Address wwwvspcom

2Provider Name SpecteraUHC group GA9N9747BW Provider Contact Member Services 800-839-3242 Provider Web Address wwwmyuhccom

Flexible Spending Accounts (FSA) amp Dependent Care Accounts (DCA) Contact Optum Health Provider Contact Member Services 800-243-5543 Provider Web Address httpssecureoptumhealthfinancialcom

LifeADampD Short-term Disability (STD) amp Long-term Disability (LTD) Insurance Provider Name Sun Life group 211628 Provider Contact Member Services 800-247-6875 Provider Web Address wwwsunlifecomus

Savings Benefits 401(k) Retirement Savings Plan (pre-tax and Roth)

Provider Name Ascensus Broker Contact Mark Ivcevich 301-326-1521 markqp-consultingcom Web Address httpsmyaccountascensuscomrplink

529 College Savings Plan Contact Human Resources

6

Medical Premium Costs per Paycheck for Employees Hired Prior to 1-1-2019

The amount of your paycheck cost difference will be dependent on the type of coverage you choose

for 2020 (see last column on the table below)

Rates are effective January 1 2020

HRA-HMO

Signature

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $50725 $3512

Employee + 1 $101444 $8193

Employee + Family $147096 $12408

HMO Select

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $58173 $4027

Employee + 1 $116340 $9397

Employee + Family $168696 $14229

POS Select

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $85966 $5951

Employee + 1 $171932 $13887

Employee + Family $249293 $21028

NOTE The Health Insurance Premium Bank is still available to those who qualify Request for

assistance must be made annually by December 15th or within 30 days of a qualifying event

7

Medical Premium Costs per Paycheck for Employees Hired After 1-1-2019

The amount of your paycheck cost difference will be dependent on the type of coverage you choose

for 2020 (see last column on the table below)

Rates are effective January 1 2020

HRA-HMO

Signature

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $50725 $4682

Employee + 1 $101444 $10535

Employee + Family $147096 $15802

HMO Select

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $58173 5370

Employee + 1 $116340 $12081

Employee + Family $168696 $18122

POS Select

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $85966 $7935

Employee + 1 $171932 $17854

Employee + Family $249293 $26781

NOTE The Health Insurance Premium Bank is still available to those who qualify Request for

assistance must be made annually by December 12th or within 30 days of a qualifying event

8

Dental amp Vision Premium Costs per Paycheck

The following rates represent your monthly Dental and Vision premiums effective January 1 2020

MetLife Dental Per Paycheck

FULL-TIME Cost

Per Paycheck

PART-TIME Cost

Employee $000

Contact HR for cost Employee + 1 $000

Employee + Family $000

VSP Vision Per Paycheck Cost

Employee $513

Employee + Adult $864

Employee + Child $882

Employee + Family $1423

SpecteraUHC Vision Per Paycheck Cost

Employee $415

Employee + Adult $843

Employee + Child $883

Employee + Family $1116

9

Health Insurance ndash Option 1

DHMO HRA Signature In Network You Pay Out-of-Network You Pay

Deductible Coinsurance Out-of-Pocket

$750 Individual$1500 Family (RA funds) 9010

$3000 Individual $6000 Family

(less than regular HMO)

NA

Primary Care and Specialist Office Visit $15 PCP$25 Specialist NO COVERAGE

Emergency Room Visits $75 per visit (waived

if admitted) NO COVERAGE

Hospital ndash Inpatient Stay 10 after deductible NO COVERAGE

Home Health Care 10 after deductible NO COVERAGE

Outpatient Facility Services 10 after deductible NO COVERAGE

X-Ray and Laboratory Services 10 after deductible NO COVERAGE

Specialty Imaging (CTMRIPET scan) 10 after deductible NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Inpatient Facility

10 after deductible NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Outpatient Facility

$7 copay-group therapy $15 copay-individual therapy per visit

NO COVERAGE

Vision (Children Only) $15 PCP$25 Specialist NO COVERAGE

Prescription Drug Program (30 day supply) Generic Drug (Tier 1) Preferred Brand Name Drug (Tier 2) Non-Preferred Brand Drug (Tier 3) Up to 90 day supply ndash 3 co-pays for Plan and Participating Pharmacies Mail Order Up to 90 day supply- 2 co-pays

$0 deductible

Plan $20 Participating $30 Plan $30 Participating $50 Plan $45 Participating $65

$20$30$45

Kaiser Permanente D-HMO HRA Signature (Facilities Only) With the Signature Network members receive quality care at the Kaiser medical centers in Maryland Virginia and the District of Columbia Medical centers offer convenient services including primary care specialty care laboratory radiology and pharmacy at most locations and in some locations optical Signature members also have access to more than 40 hospitals in the region

10

Health Insurance ndash Option 2

Kaiser Permanente HMO Select (Facilities amp Contracted Providers Only) With the Select Network members may receive quality care at the Kaiser medical centers in Maryland Virginia and the District of Columbia Building on the Signature physician network the Select network adds access to more than 15000 contracted community physicians in private practice Select members also have access to more than 40 hospitals in the region

HMO Select In-Network You Pay Out-of-Network

You Pay

Deductible Coinsurance Out-of-Pocket

None 100

$3500 Individual $9400 Family

NA

Primary Care and Specialist Office Visit $30 PCP$40 Specialist NO COVERAGE

Emergency Room Visits $100 per visit

(waived if admitted) NO COVERAGE

Hospital ndash Inpatient Stay $250 per admission NO COVERAGE

Home Health Care No charge NO COVERAGE

Outpatient Facility Services $100 NO COVERAGE

X-Ray and Laboratory Services No charge NO COVERAGE

Specialty Imaging (CTMRIPET scan) $50 per test NO COVERAGE

Chiropractic amp Acupuncture Services $40 copay

20 visits per contract year NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Inpatient Facility

$250 per admission NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Outpatient Facility

$15 copay-group therapy $30 copay-individual therapy per visit

NO COVERAGE

Vision (Children Only) $30 PCP$40 Specialist NO COVERAGE

Prescription Drug Program (30 day supply) Generic Drug (Tier 1) Preferred Brand Name Drug (Tier 2) Non-Preferred Brand Drug (Tier 3) Up to 90 day supply ndash 3 co-pays for Plan and Participating Pharmacies Mail Order Up to 90 day supply- 2 co-pays

$0 deductible

Plan $20 Participating $30 Plan $35 Participating $50 Plan $50 Participating $75

$20$35$50

11

Kaiser Permanente POS Select (Facilities amp Contracted Providers with an Out of Network Option) Members can use in-plan benefits by using a Kaiser facility or a contracted primary care physician Your chosen PCP will provide care and coordinate referrals and hospital admissions Members also have the freedom to choose any other licensed provider outside the provider network however you will be responsible for deductibles and coinsurance above the health planrsquos payment

POS Select In-Network You Pay Out-of-Network

you pay

Deductible Coinsurance Out-of-Pocket

None 100

$3500 Individual $9400 Family

$300 Individual $600 Family

8020 $3000 Individual

$6000 Family

Primary Care and Specialist Office Visit $15 PCP$30 Specialist 20 of UCR

Emergency Room Visits $75 per visit (waived if

admitted) $75 per visit

(waived if admitted)

Hospital ndash Inpatient Stay $250 per admission 20 of UCR

Home Health Care No charge 20 of UCR

Outpatient Facility Services $50 20 of UCR

X-Ray and Laboratory Services No charge 20 of UCR

Specialty Imaging (CTMRIPET scan) No charge 20 of UCR

Mental Health (MG) amp Substance Abuse (SA) ndash Inpatient Facility

$250 per admission 20 of UCR

Mental Health (MG) amp Substance Abuse (SA) ndash Outpatient Facility

$7 copay-group therapy $15 copay-individual therapy per visit

20 of UCR

Vision (Children Only) $15 PCP$30 Specialist per visit 20 of UCR

Prescription Drug Program (30 day supply) Generic Drug (Tier 1) Preferred Brand Name Drug (Tier 2) Non-Preferred Brand Drug (Tier 3) Up to 90 day supply ndash 3 co-pays for Plan and Participating Pharmacies Mail Order Up to 90 day supply- 2 co-pays

$0 deductible

Plan $20 Participating $30 Plan $35 Participating $50 Plan $50 Participating $75

$20$35$50

Health Insurance ndash Option 3

12

Dental Insurance

MetLife Dental PPO The Dental PPO plan is 100 Employer Paid for all tiers and provides comprehensive coverage with a nationwide PPO network This gives members access to more in-network dentists making it easier for them to reduce out-of-pocket costs for covered procedures and treatments Dental procedure frequencies Preventative care covers an exam and cleaning (once every 6 months) Fluoride treatment (two per benefit period under age 19 only) Full mouth X-ray (once every 60 months) Bitewing X-ray (once every 12 months age 14 and over once every 12 months under age 14)

PPO Dental Plan Features In-Network Out-of-Network

Type A Preventive Care Services (oral exams cleanings x-rays sealants)

100 of Fee Schedule 100 of Usual amp Customary

Charge

Type B Basic Restorative Dental Services (fillings simple extractions space maintainers)

80 of Fee Schedule 80 of Usual amp Customary

Charge

Type B Major Surgical Dental Services (Endodontics amp Periodontics)

80 of Fee Schedule 80 of Usual amp Customary

Charge

Type C Major Restorative Dental Services (bridges crowns dentures implants)

50 of Fee Schedule 50 of Usual amp Customary

Charge

Orthodontia (under age 19 only)

Lifetime maximum - $1000 50 of allowed benefit

Calendar Year Deductible Applies to Type B amp C services only

$25 Single $75 Family

Calendar Year Maximum Per Person $1500 combined maxper calendar year

Prior to receiving dental services it is recommended that you first obtain a pre-determination of benefits from your dentist so you know exactly how much your dental insurance will cover Spouses domestic partners and dependent children to age 26 (regardless of student status) are eligible

13

Vision Insurance ndash Option 1

Vision Plan through VSP (Voluntary) VSP is the largest private provider vision carrier in the country VSP contracts with Costcoreg Optical Eye Care Centers of America Inctrade which includes popular stores like EyeMasters VisionWorld and Hour Eyes and other quality retail chains When you visit a VSP participating provider your benefits include routine vision exams lenses and preferred pricing on all patient options Frequency Eye Exam 12 monthsLenses 12 monthsFrames 24 monthsContact Lenses 12 months

Vision Plan Features In-Network Out-of-Network

Annual Routine Eye Exam $10 copay Plan pays up to $45

Eyeglass Lenses (standard) Single Bifocal Trifocal

Covered in Full Covered in Full Covered in Full

Plan pays up to $30 Plan pays up to $50 Plan pays up to $65

Frames $130 allowance then 20 off remaining balance

Plan pays up to $70

Necessary Contact Lenses Covered in Full Plan pays up to $210

Elective Contact Lenses $130 allowance Plan pays up to $105

Elective Contact Lenses fitting and evaluation Covered in Full after $60

copay Not Available

Spouses domestic partners and dependent children to age 19 (or to age 25 if FT student) are eligible

14

Vision Insurance ndash Option 2

Vision Plan through Spectera UHC (Voluntary)

UHC offers you one of the largest vision care networks in the industry Their network includes convenient retail locations including My Eye Dr and Hour Eyes Best of all ndash when you receive care from a participating provider you receive the greatest benefits and money-saving discounts

Frequency Eye Exam 12 monthsLenses 12 monthsFrames 12 monthsContact Lenses 12 months

Vision Plan Features In-Network Out-of-Network

Annual Routine Eye Exam $10 copay Plan pays up to $40

Eyeglass Lenses (standard) Single Bifocal Trifocal

$25 copay $25 copay $25 copay

Plan pays up to $40 Plan pays up to $60 Plan pays up to $80

Frames $2500 copay $130 retail frame

allowance 30 discount above allowance

Plan pays up to $45

Necessary Contact Lenses $25 copay Plan pays up to $210

Elective Contact Lenses

$25 copay from the ldquoCovered contact lens

selectionrdquo All others- $105

allowance

Plan pays up to $105

Elective Contact Lenses fitting and evaluation Covered in Full after $25

copay Not Available

Spouses and dependent children to age 26 are eligible

15

Pre-tax FSA amp DCA

Flexible Spending Account (FSA) through Optum Health The Flexible Spending Account provides employees a means to reduce their taxes by the amount of their out of pocket health-related expenses (subject to eligibility) This tax free savings program allows employees to submit receipts for reimbursement for medical dental vision care prescription drug co-payments and other expenses not covered by our insurance In 2020 employees may contribute up to $2750 per year toward their FSA Employees have until March 14 2020 to use the money in their FSA or else they lose it (This contribution amount could change based on IRS guideline updates)

Dependent Care Spending Account (DCA) through Optum Health The Dependent Care Spending Account provides employees a means to reduce their taxes by the amount of their child care costs to a licensed provider up to $5000 annually

Health Insurance Premium Bank

Reston Association has established a program to help regular full-time and regular part-time employees pay their portion of the health insurance premium This program is only available to employees who are enrolled in or plan to enroll in the Kaiser Permanente HMO health insurance plans offered by the Reston Association Employees are eligible to apply to the Health Insurance Premium Bank if their adjusted gross household incomes are less than or equal to $60000 Requests for assistance must be made annually or at any time there is a qualifying event and submitted to Human Resources with necessary documentation by December 12th of each year To apply complete a request form (available in CommonHumResBenefits) and submit to HR with a copy of your most recent tax return showing adjusted gross household income This threshold is subject to change

16

Life and ADampD Insurance

Basic LifeADampD Insurance Reston Association provides 100 employer paid Life and ADampD Insurance through Sun Life to employees working 25 or more hours per week Coverage becomes effective the first of the month following six months of service

Benefit 2x Annual Earnings to a maximum of $200000 Age reduction Benefit reduced to 65 at age 65 and to 50 at age 70

Optional LifeADampD Insurance for Employee Spouse and Dependent Children

Optional Life Insurance for the employee spouse and dependent children is available at the employeersquos cost Optional Life is not available for domestic partners

Employee Benefit Increments of $10000 to a maximum of the lesser of $300000 or 3x your Basic Annual Earnings

Spouse Benefit Increments of $5000 to a maximum of $150000 Dependent Child Benefit Increments of $1000 to a maximum of $10000

Your amount of Dependent Spouse and Dependent Child Optional Life Insurance cannot exceed 50 of your amount of Optional Life Insurance Initial eligibility period will require evidence of insurability

STD amp LTD Insurance

Short Term and Long Term Disability Reston Association provides eligible employees with short and long-term disability income benefits through Sun Life In the event you become disabled from a non work-related injury or sickness disability income benefits are provided as a source of income These benefits are 100 employer paid

Benefit Short-Term Disability Long-Term Disability

Income Replacement -Eligible Employees -Executives

60 60

Elimination Period - Accidental Injury - Sickness

29 days 90 days

Benefit Period 9 weeks maximum To Social Security

normal retirement age

Benefit Maximum -Eligible Employees -Executives

$1000 per week $6000 per month $8000 per month 17

At a cost of $19month you can enroll in the Legal Resources benefit As a Legal Resources Member you have immediate and ongoing access to comprehensive legal coverage services and expertise that will easily save you money mdash and could save you a whole lot more Covered legal services include

Legal Advice and Consultation Tenant Dispute with Landlord District Court Representation for Civil Action Review of a Financial Contract or Lease Purchase sale or refinance of primary home Traffic Court Representation (includes 1st DUI) Will Preparation Uncontested Divorce Representation Defense of Child in Court (misdemeanor)

Legal Resources

Employee Assistance Program (EAP)

Reston Association offers a free confidential Employee Assistance Program (EAP) to all employees and their eligible dependents Through RArsquos EAP provider Lytle EAP Partners you and your immediate family members have immediate access on your date of hire to confidential professional counseling and referral services for help with anything that affects you or your dependentsrsquo well-being You can reach an EAP counselor by dialing 1-800-327-7272 24 hours a day or you may visit their website at wwwLytleEAPcom (password is reston) for more information Visit wwwLytleEAPcom for web-based legal financial worklife resources There are also work-related resources available online for managers Note Since EAP services are provided as a benefit only RA makes no representation concerning quality of care

18

401(k) Retirement Savings Plan

Reston Association offers two 401(k) retirement savings plans through Ascensusmdasha traditional 401(k) plan in which employee contributions are made pre-tax and a 401(k) Roth in which employee contributions are made after tax RA matches employee contributions dollar for dollar up to a total of 7 of your annual salary You can begin making contributions to the 401(k) plan and become eligible for RArsquos match following six months of service You always own 100 of your salary contributions

It is possible to borrow against a portion of your vested 401(k) account balance by taking a 401(k) loan You may request a participant loan using an application form which can be obtained by contacting Human Resources Your ability to obtain a 401(k) loan will depend on specific qualifying factors (defined in the 401(k) Summary Plan Description document) The 401(k) Plan Administrator will determine whether you satisfy these factors To access your 401(k) plan online httpsmyaccountascensuscomrplink Check account balance and rate of return Change fund elections Request a 401k loan View fund pricing and performance View and print quarterly statements

19

529 College Savings Plan (employer-sponsored)

A 529 college savings plan provides those saving for college with an unmatched combination of benefits You can open a 529 plan for anyone mdash your child grandchild spouse a friend or even yourself Assets in a 529 plan can be used to pay for a variety of higher education expenses including required books tuition room and board supplies and certain other required fees and expenses Earnings in 529 accounts can grow free from federal tax Withdrawals for qualified higher education expenses are free from federal tax Option to set up recurring automatic fund transfers directly from your bank account making it easy for you to invest The account owner rather than the beneficiary maintains control of account assets and determines the timing and amount of distributions Account owners can change beneficiaries without penalty provided the new beneficiary is a member of the previous beneficiaryrsquos family For more information please contact Human Resources

Additional Benefits

Free passes for employees and their dependents to all of RArsquos pools and tennis courts as well as discounted rates for all RA Programs and Camps Some restrictions may apply

Discounted gym membership rates at the Reston YMCA and Crunch Fitness Bike Share Program - Reston Association makes bicycles and helmets available to employees to rent on a daily

basis Please contact Member Services Discounted Tennis Rackets amp Shoes ndash Employees can purchase certain tennis shoes and rackets at wholesale

prices through RArsquos Tennis Department Contact the Tennis Department for more information Discounted autohome insurance - Liberty Mutual Insurance Company partners with RA to offer all employees

discounts on automobile and homeowner insurance Contact John Valenti at JohnValentilibertymutualcom

20

Reston Association provides generous paid time off benefits to accommodate the diverse needs of staff and to provide a positive worklife balance The amount of paid time off you earn per year is based on your years of service In addition Reston Association observes 9 paid holidays and assigns one paid floating holiday per year For more information on paid time off benefits and how to request time off please refer to the Reston Association Employee Handbook

WorkLife Balance ndash Paid Time Off (PTO)

Teleworking

The medical leave bank is available to help employees in extenuating circumstances protect their incomes by receiving paid leave once their personal PTO is used up A maximum of six (6) workweeks may be granted for each Medical Leave Bank request If additional time is necessary a new request must be made For program eligibility and criteria go to CommonHumResBenefits

Medical Leave Bank

Volunteer Release Time

On a per position basis employees may be allowed to telework for part of their workweek or in certain circumstances Such arrangements must be in compliance with the written administrative procedure including being approved in advance by the department director

Employees are encouraged to become involved in their communities lending their voluntary support to programs that enrich the quality of life and opportunities for all citizens This benefit allows employees to take paid-time off during a work day to participate in a volunteer activity that benefits the community at large Such activities are typically sponsored by a charitable or service organization or work with one or more individuals in need of assistance or special service

21

Training amp Career Development

Reston Association offers two types of learning opportunities for employees mdashinformal and formalmdashto foster individual development and training and career planning

I Informal Learning Opportunities (individual development amp training)

Focus on individual acquiring or enhancing specific task andor process skills to perform his or her current job better Typically this type of learning is not ldquodegree- orientedrdquo

Participants may or may not receive attendance or achievement certificate

Conferences workshops seminars webinars online courses etc typically lasting a few hours to one week

Requests for this type of training should be made to your supervisor or department head

II Formal Learning Opportunities (career planning)

Professional DevelopmentCareer Planning

Formalstructured learning geared toward improving and maintaining professional competence enhancing career progression staying abreast of new technologies and best practices developing process skills andor compliance with professional regulations

Future but not degree-oriented CEUs may be earned

May lead to qualification or credential required to obtain or retain specific certification

Opportunity may range from semester-long academic course to 24 month program with wide range of content and learning experience

Tuition Reimbursement Program

Supports formal education goals (AA bachelors masters) of individual to enhance knowledge and skills in specific areaindustry

Learning must be job-related and accomplished at or through accredited learning institution or e-learning platform connected with the institution

Requests for this type of training should be made to Human Resources as soon as foreseeable to ensure best availability of funds to support reimbursement

22

23

Lifetime limit not applicable and enrollment opportunity The lifetime limit on the dollar value of benefits under our medical plan no longer applies Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan Individuals have 30 days from the date of this notice to request enrollment For more information contact Human Resources or call the medical insurance carrier at the telephone number on your identification card

Notice on Patient Protections The medical HMO plan generally allows the designation of a primary care provider You have the right to designate any primary care provider who participates in the network and who is available to accept you or your family members Until you make this designation the medical carrier designates one for you For information on how to select a primary care provider and for a list of the participating primary care providers contact the medical insurance carrier at the number listed on your identification card

For children you may designate a pediatrician as the primary care provider You do not need prior authorization from the medical insurance carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in the network who specializes in obstetrics or gynecology The health care professional however may be required to comply with certain procedures including obtaining prior authorization for certain services following a pre-approved treatment plan or procedures for making referrals For a list of participating health care professionals who specialize in obstetrics or gynecology contact the medical insurance carrier at the number listed on your identification card

OTC Drug Reimbursements for FSAsHRAsHSAs Under the new Health Care Reform law (PPACA) the cost of an over-the-counter medicine or drug cannot be reimbursed from the account unless a prescription is obtained The change does not affect insulin even if purchased without a prescription or other health care expenses such as medical devices eyeglasses contact lenses co-pays and deductibles The new standard applies only to purchases made on or after January 1 2011

A similar rule is in effect for Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs)

The IRS has also posted a questions and answers section on its website httpwwwirsgovnewsroomarticle0id=22730800html concerning these provisions

Patient Protection and Affordable Care Act (PPACA) Mandatory Notices

The text below is an annual open enrollment required notice

24

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION PLEASE REVIEW IT CAREFULLY

Our Pledge to You

This notice is intended to inform you of the privacy practices followed by the Reston Associationrsquos Employee Benefit Plan (the Plan) and the Planrsquos legal obligations regarding your protected health information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) The notice also explains the privacy rights you and your family members have as participants of the Plan It is effective on April 14 2011

The Plan often needs access to your protected health information in order to provide payment for health services and perform plan administrative functions We want to assure the plan participants covered under the Plan that we comply with federal privacy laws and respect your right to privacy Reston Association requires all members of our workforce and third parties that are provided access to protected health information to comply with the privacy practices outlined in this notice

Protected Health Information Your protected health information is protected by the HIPAA Privacy Rule Generally protected health information is information that identifies an individual created or received by a health care provider health plan or an employer on behalf of a group health plan that relates to physical or mental health conditions provision of health care or payment for health care whether past present or future

How We May Use Your Protected Health Information Under the HIPAA Privacy Rule we may use or disclose your protected health information for certain purposes without your permission This section describes the ways we can use and disclose your protected health information

bull Payment We use or disclose your protected health information without your written authorization in order to determine eligibility for benefits seek reimbursement from a third party or coordinate benefits with another health plan under which you are covered For example a health care provider that provided treatment to you will provide us with your health information We use that information in order to determine whether those services are eligible for payment under our group health plan

bull Health Care Operations We use and disclose your protected health information in order to perform plan administration functions such as quality assurance activities resolution of internal grievances and evaluating plan performance For example we review claims experience in order to understand participant utilization and to make plan design changes that are intended to control health care costs

bull Treatment Although the law allows use and disclosure of your protected health information for purposes of treatment as a health plan we generally do not need to disclose your information for treatment purposes Your physician or health care provider is required to provide you with an explanation of how they use and share your health information for purposes of treatment payment and health care operations

bull As permitted or required by law We may also use or disclose your protected health information without your written authorization for other reasons as permitted by law We are permitted by law to share information subject to certain requirements in order to communicate information on health-related benefits or services that may be of interest to you respond to a court order or provide information to further public health activities (eg preventing the spread of disease) without your written authorization We are also permitted to share protected health information during a corporate restructuring such as a merger sale or acquisition We will also disclose health information about you when required by law for example in order to prevent serious harm to you or others

The text below is an annual open enrollment required notice

25

Notice of Privacy Practices

bull Pursuant to your Authorization When required by law we will ask for your written authorization before using or disclosing your protected health information If you choose to sign an authorization to disclose information you can later revoke that authorization to prevent any future uses or disclosures

bull To Business Associates We may enter into contracts with entities known as Business Associates that provide services to or perform functions on behalf of the Plan We may disclose protected health information to Business Associates once they have agreed in writing to safeguard the protected health information For example we may disclose your protected health information to a Business Associate to administer claims Business Associates are also required by law to protect protected health information

bull To the Plan Sponsor We may disclose protected health information to certain employees of Reston Association for the purpose of administering the Plan These employees will use or disclose the protected health information only as necessary to perform plan administration functions or as otherwise required by HIPAA unless you have authorized additional disclosures Your protected health information cannot be used for employment purposes without your specific authorization

Your Rights bull Right to Inspect and Copy In most cases you have the right to inspect and copy the protected health

information we maintain about you If you request copies we will charge you a reasonable fee to cover the costs of copying mailing or other expenses associated with your request Your request to inspect or review your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to inspect and copy your health information To the extent your information is held in an electronic health record you may be able to receive the information in an electronic format

bull Right to Amend If you believe that information within your records is incorrect or if important information is missing you have the right to request that we correct the existing information or add the missing information Your request to amend your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to amend your health information If we deny your request you may file a statement of disagreement with us for inclusion in any future disclosures of the disputed information

bull Right to an Accounting of Disclosures You have the right to receive an accounting of certain disclosures of your protected health information The accounting will not include disclosures that were made (1) for purposes of treatment payment or health care operations (2) to you (3) pursuant to your authorization (4) to your friends or family in your presence or because of an emergency (5) for national security purposes or (6) incidental to otherwise permissible disclosures

Your request to for an accounting must be submitted in writing to the person listed below You may request an accounting of disclosures made within the last six years You may request one accounting free of charge within a 12-month period

The text below is an annual open enrollment required notice

25

26

The information provided herein is intended to be a summary of benefits only and in no way supersedes the actual plan documents provided by the insurance carriersadministrators For more detailed information pertaining to your employee benefit plans including limitations and exclusions

please refer to the plan documents andor evidence of coverage provided by the carriersadministrators

Womenrsquos Health and Cancer Rights Act of 1998

If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos Health and Cancer Rights Act of 1998 (WHCRA) For individuals receiving mastectomy-related benefits coverage will be provided in a manner determined in consultation with the attending physician and the patient for

bull All stages of reconstruction of the breast on which the mastectomy was performed bull Surgery and reconstruction of the other breast to produce a symmetrical appearance bull Prostheses and bull Treatment of physical complications of the mastectomy including lymphedema

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan If you would like more information on WHCRA benefits call your plan administrator

CHIP-Childrens Health Insurance Program (CHIP) Reauthorization Act of 2009

Medicaid and the Childrenrsquos Health Insurance Program (CHIP) offer free or low-cost health coverage to children and families If you are eligible for health coverage from your employer but are unable to afford the premiums some States have premium assistance programs that can help pay for coverage These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage but need assistance in paying their health premiums

If you or your dependents are already enrolled in Medicaid or CHIP you can contact your state Medicaid or CHIP office to find out if premium assistance is available For a list of the contacts in each State go to wwwdolgovebsachipmodelnoticedoc

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify you can then contact the State to find out if it has a program that might help you pay the premiums for an employer-sponsored plan

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP your employerrsquos health plan is required to permit you and your dependents to enroll in the plan ndash as long as you and your dependents are eligible but not already enrolled in the employerrsquos plan This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance

The text below is an annual open enrollment required notice

26

27

Premium Assistance Under Medicaid and the

Childrenrsquos Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your

employer your state may have a premium assistance program that can help pay for coverage using funds

from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot

be eligible for these premium assistance programs but you may be able to buy individual insurance coverage

through the Health Insurance Marketplace For more information visit wwwhealthcaregov

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below

contact your State Medicaid or CHIP office to find out if premium assistance is available

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your

dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-

877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a

program that might help you pay the premiums for an employer-sponsored plan

If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible

under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already

enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days

of being determined eligible for premium assistance If you have questions about enrolling in your

employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)

If you live in one of the following states you may be eligible for assistance paying your employer

health plan premiums The following list of states is current as of July 31 2019 Contact your State for

more information on eligibility ndash

ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcom

Phone 1-855-692-5447

Website httpflmedicaidtplrecoverycomhipp

Phone 1-877-357-3268

ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program

Website httpmyakhippcom

Phone 1-866-251-4861

Email CustomerServiceMyAKHIPPcom

Medicaid Eligibility

httpdhssalaskagovdpaPagesmedicaiddefaultaspx

Website httpsmedicaidgeorgiagovhealth-

insurance-premium-payment-program-hipp

Phone 678-564-1162 ext 2131

ARKANSAS ndash Medicaid INDIANA ndash Medicaid

Website httpmyarhippcom

Phone 1-855-MyARHIPP (855-692-7447)

Healthy Indiana Plan for low-income adults 19-64

Website httpwwwingovfssahip

Phone 1-877-438-4479

All other Medicaid

Website httpwwwindianamedicaidcom

Phone 1-800-403-0864

COLORADO ndash Health First Colorado

(Coloradorsquos Medicaid Program) amp Child Health

Plan Plus (CHP+)

IOWA ndash Medicaid

Health First Colorado Website

httpswwwhealthfirstcoloradocom

Health First Colorado Member Contact Center

1-800-221-3943 State Relay 711

CHP+ httpswwwcoloradogovpacifichcpfchild-health-

plan-plus

CHP+ Customer Service 1-800-359-1991 State Relay

711

Website

httpdhsiowagovHawki

Phone 1-800-257-8563

28

KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid

Website httpwwwkdheksgovhcf

Phone 1-785-296-3512

Website httpswwwdhhsnhgovoiihipphtm

Phone 603-271-5218

Toll free number for the HIPP program 1-800-852-3345 ext 5218

KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP

Website httpschfskygov

Phone 1-800-635-2570

Medicaid Website

httpwwwstatenjushumanservices

dmahsclientsmedicaid

Medicaid Phone 609-631-2392

CHIP Website httpwwwnjfamilycareorgindexhtml

CHIP Phone 1-800-701-0710

LOUISIANA ndash Medicaid NEW YORK ndash Medicaid

Website httpdhhlouisianagovindexcfmsubhome1n331

Phone 1-888-695-2447

Website httpswwwhealthnygovhealth_caremedicaid

Phone 1-800-541-2831

MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid

Website httpwwwmainegovdhhsofipublic-assistanceindexhtml

Phone 1-800-442-6003

TTY Maine relay 711

Website httpsmedicaidncdhhsgov

Phone 919-855-4100

MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid

Website httpwwwmassgoveohhsgovdepartmentsmasshealth

Phone 1-800-862-4840

Website httpwwwndgovdhsservicesmedicalservmedicaid

Phone 1-844-854-4825

MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP

Website

httpsmngovdhspeople-we-serveseniorshealth-carehealth-care-

programsprograms-and-servicesother-insurancejsp

Phone 1-800-657-3739

Website httpwwwinsureoklahomaorg

Phone 1-888-365-3742

MISSOURI ndash Medicaid OREGON ndash Medicaid

Website httpwwwdssmogovmhdparticipantspageshipphtm

Phone 573-751-2005

Website httphealthcareoregongovPagesindexaspx

httpwwworegonhealthcaregovindex-eshtml

Phone 1-800-699-9075

MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid

Website httpdphhsmtgovMontanaHealthcareProgramsHIPP

Phone 1-800-694-3084

Website

httpwwwdhspagovprovidermedicalassistancehealthinsuranc

epremiumpaymenthippprogramindexhtm

Phone 1-800-692-7462

NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP

Website httpwwwACCESSNebraskanegov

Phone (855) 632-7633

Lincoln (402) 473-7000

Omaha (402) 595-1178

Website httpwwweohhsrigov

Phone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)

29

NEVADA ndash Medicaid SOUTH CAROLINA ndash Medicaid

Medicaid Website httpsdhcfpnvgov

Medicaid Phone 1-800-992-0900

Website httpswwwscdhhsgov

Phone 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid

Website httpdsssdgov

Phone 1-888-828-0059

Website httpswwwhcawagov

Phone 1-800-562-3022 ext 15473

TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascom

Phone 1-800-440-0493

Website httpmywvhippcom

Toll-free phone 1-855-MyWVHIPP (1-855-699-8447)

UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgov

CHIP Website httphealthutahgovchip

Phone 1-877-543-7669

Website

httpswwwdhswisconsingovpublicationsp1p10095p

df

Phone 1-800-362-3002

VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorg

Phone 1-800-250-8427

Website httpswyequalitycareacs-inccom

Phone 307-777-7531

VIRGINIA ndash Medicaid and CHIP Medicaid Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

Medicaid Phone 1-800-432-5924

CHIP Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

CHIP Phone 1-855-242-8282

To see if any other states have added a premium assistance program since July 31 2019 or for more

information on special enrollment rights contact either

US Department of Labor US Department of Health and Human Services

Employee Benefits Security Administration Centers for Medicare amp Medicaid Services

wwwdolgovagenciesebsa wwwcmshhsgov

1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565

Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond

to a collection of information unless such collection displays a valid Office of Management and Budget (OMB)

control number The Department notes that a Federal agency cannot conduct or sponsor a collection of

information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and

the public is not required to respond to a collection of information unless it displays a currently valid OMB control

number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to

penalty for failing to comply with a collection of information if the collection of information does not display a

currently valid OMB control number See 44 USC 3512

The public reporting burden for this collection of information is estimated to average approximately seven minutes

per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other

aspect of this collection of information including suggestions for reducing this burden to the US Department of

Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance

Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and

reference the OMB Control Number 1210-0137 OMB Control Number 1210-0137 (expires 12312019)

Notes

30

Notes

31

Prepared by

Please contact Reston Associationrsquos Human Resources Department at 703-435-7990 or hrrestonorg with any

questions related to your Total Rewards Guide

copy 2019 McGriff Insurance Services Inc

Page 6: Employee Total Rewards Guide 2020 - Reston Total Rewards Gui… · Recognizing and rewarding employees for achieving a sustainable impact. Award criteria includes: •Progressive

Benefits ndash PlanContact Information

Enrollment in the majority of these benefits must be done within 30 days of hire during open enrollment or within 30 days of a qualifying life change event Open enrollment occurs annually from mid-November to mid-December

Benefits elected during open enrollment will take effect January 1

The employee their spouse or domestic partner (regardless of sex) and their children under age 26 are eligible to enroll in benefits

Insurance Benefits

Health Insurance Provider Name Kaiser Permanente group 3007-4 (HMO Select) 3007-6 (POS) 3007-10 (HRA-DHMO) Provider Contact Member Services 301-468-6000 Provider Web Address wwwkporg

Dental Insurance Provider Name MetLife group 5469528 Provider Contact Member Services 800-ASK-4MET Provider Web Address httpsmybenefitsmetlifecom

Supplemental Vision Insurance ndash two options 1Provider Name VSP group 30017163

Provider Contact Member Services 800-877-7195 Provider Web Address wwwvspcom

2Provider Name SpecteraUHC group GA9N9747BW Provider Contact Member Services 800-839-3242 Provider Web Address wwwmyuhccom

Flexible Spending Accounts (FSA) amp Dependent Care Accounts (DCA) Contact Optum Health Provider Contact Member Services 800-243-5543 Provider Web Address httpssecureoptumhealthfinancialcom

LifeADampD Short-term Disability (STD) amp Long-term Disability (LTD) Insurance Provider Name Sun Life group 211628 Provider Contact Member Services 800-247-6875 Provider Web Address wwwsunlifecomus

Savings Benefits 401(k) Retirement Savings Plan (pre-tax and Roth)

Provider Name Ascensus Broker Contact Mark Ivcevich 301-326-1521 markqp-consultingcom Web Address httpsmyaccountascensuscomrplink

529 College Savings Plan Contact Human Resources

6

Medical Premium Costs per Paycheck for Employees Hired Prior to 1-1-2019

The amount of your paycheck cost difference will be dependent on the type of coverage you choose

for 2020 (see last column on the table below)

Rates are effective January 1 2020

HRA-HMO

Signature

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $50725 $3512

Employee + 1 $101444 $8193

Employee + Family $147096 $12408

HMO Select

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $58173 $4027

Employee + 1 $116340 $9397

Employee + Family $168696 $14229

POS Select

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $85966 $5951

Employee + 1 $171932 $13887

Employee + Family $249293 $21028

NOTE The Health Insurance Premium Bank is still available to those who qualify Request for

assistance must be made annually by December 15th or within 30 days of a qualifying event

7

Medical Premium Costs per Paycheck for Employees Hired After 1-1-2019

The amount of your paycheck cost difference will be dependent on the type of coverage you choose

for 2020 (see last column on the table below)

Rates are effective January 1 2020

HRA-HMO

Signature

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $50725 $4682

Employee + 1 $101444 $10535

Employee + Family $147096 $15802

HMO Select

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $58173 5370

Employee + 1 $116340 $12081

Employee + Family $168696 $18122

POS Select

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $85966 $7935

Employee + 1 $171932 $17854

Employee + Family $249293 $26781

NOTE The Health Insurance Premium Bank is still available to those who qualify Request for

assistance must be made annually by December 12th or within 30 days of a qualifying event

8

Dental amp Vision Premium Costs per Paycheck

The following rates represent your monthly Dental and Vision premiums effective January 1 2020

MetLife Dental Per Paycheck

FULL-TIME Cost

Per Paycheck

PART-TIME Cost

Employee $000

Contact HR for cost Employee + 1 $000

Employee + Family $000

VSP Vision Per Paycheck Cost

Employee $513

Employee + Adult $864

Employee + Child $882

Employee + Family $1423

SpecteraUHC Vision Per Paycheck Cost

Employee $415

Employee + Adult $843

Employee + Child $883

Employee + Family $1116

9

Health Insurance ndash Option 1

DHMO HRA Signature In Network You Pay Out-of-Network You Pay

Deductible Coinsurance Out-of-Pocket

$750 Individual$1500 Family (RA funds) 9010

$3000 Individual $6000 Family

(less than regular HMO)

NA

Primary Care and Specialist Office Visit $15 PCP$25 Specialist NO COVERAGE

Emergency Room Visits $75 per visit (waived

if admitted) NO COVERAGE

Hospital ndash Inpatient Stay 10 after deductible NO COVERAGE

Home Health Care 10 after deductible NO COVERAGE

Outpatient Facility Services 10 after deductible NO COVERAGE

X-Ray and Laboratory Services 10 after deductible NO COVERAGE

Specialty Imaging (CTMRIPET scan) 10 after deductible NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Inpatient Facility

10 after deductible NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Outpatient Facility

$7 copay-group therapy $15 copay-individual therapy per visit

NO COVERAGE

Vision (Children Only) $15 PCP$25 Specialist NO COVERAGE

Prescription Drug Program (30 day supply) Generic Drug (Tier 1) Preferred Brand Name Drug (Tier 2) Non-Preferred Brand Drug (Tier 3) Up to 90 day supply ndash 3 co-pays for Plan and Participating Pharmacies Mail Order Up to 90 day supply- 2 co-pays

$0 deductible

Plan $20 Participating $30 Plan $30 Participating $50 Plan $45 Participating $65

$20$30$45

Kaiser Permanente D-HMO HRA Signature (Facilities Only) With the Signature Network members receive quality care at the Kaiser medical centers in Maryland Virginia and the District of Columbia Medical centers offer convenient services including primary care specialty care laboratory radiology and pharmacy at most locations and in some locations optical Signature members also have access to more than 40 hospitals in the region

10

Health Insurance ndash Option 2

Kaiser Permanente HMO Select (Facilities amp Contracted Providers Only) With the Select Network members may receive quality care at the Kaiser medical centers in Maryland Virginia and the District of Columbia Building on the Signature physician network the Select network adds access to more than 15000 contracted community physicians in private practice Select members also have access to more than 40 hospitals in the region

HMO Select In-Network You Pay Out-of-Network

You Pay

Deductible Coinsurance Out-of-Pocket

None 100

$3500 Individual $9400 Family

NA

Primary Care and Specialist Office Visit $30 PCP$40 Specialist NO COVERAGE

Emergency Room Visits $100 per visit

(waived if admitted) NO COVERAGE

Hospital ndash Inpatient Stay $250 per admission NO COVERAGE

Home Health Care No charge NO COVERAGE

Outpatient Facility Services $100 NO COVERAGE

X-Ray and Laboratory Services No charge NO COVERAGE

Specialty Imaging (CTMRIPET scan) $50 per test NO COVERAGE

Chiropractic amp Acupuncture Services $40 copay

20 visits per contract year NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Inpatient Facility

$250 per admission NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Outpatient Facility

$15 copay-group therapy $30 copay-individual therapy per visit

NO COVERAGE

Vision (Children Only) $30 PCP$40 Specialist NO COVERAGE

Prescription Drug Program (30 day supply) Generic Drug (Tier 1) Preferred Brand Name Drug (Tier 2) Non-Preferred Brand Drug (Tier 3) Up to 90 day supply ndash 3 co-pays for Plan and Participating Pharmacies Mail Order Up to 90 day supply- 2 co-pays

$0 deductible

Plan $20 Participating $30 Plan $35 Participating $50 Plan $50 Participating $75

$20$35$50

11

Kaiser Permanente POS Select (Facilities amp Contracted Providers with an Out of Network Option) Members can use in-plan benefits by using a Kaiser facility or a contracted primary care physician Your chosen PCP will provide care and coordinate referrals and hospital admissions Members also have the freedom to choose any other licensed provider outside the provider network however you will be responsible for deductibles and coinsurance above the health planrsquos payment

POS Select In-Network You Pay Out-of-Network

you pay

Deductible Coinsurance Out-of-Pocket

None 100

$3500 Individual $9400 Family

$300 Individual $600 Family

8020 $3000 Individual

$6000 Family

Primary Care and Specialist Office Visit $15 PCP$30 Specialist 20 of UCR

Emergency Room Visits $75 per visit (waived if

admitted) $75 per visit

(waived if admitted)

Hospital ndash Inpatient Stay $250 per admission 20 of UCR

Home Health Care No charge 20 of UCR

Outpatient Facility Services $50 20 of UCR

X-Ray and Laboratory Services No charge 20 of UCR

Specialty Imaging (CTMRIPET scan) No charge 20 of UCR

Mental Health (MG) amp Substance Abuse (SA) ndash Inpatient Facility

$250 per admission 20 of UCR

Mental Health (MG) amp Substance Abuse (SA) ndash Outpatient Facility

$7 copay-group therapy $15 copay-individual therapy per visit

20 of UCR

Vision (Children Only) $15 PCP$30 Specialist per visit 20 of UCR

Prescription Drug Program (30 day supply) Generic Drug (Tier 1) Preferred Brand Name Drug (Tier 2) Non-Preferred Brand Drug (Tier 3) Up to 90 day supply ndash 3 co-pays for Plan and Participating Pharmacies Mail Order Up to 90 day supply- 2 co-pays

$0 deductible

Plan $20 Participating $30 Plan $35 Participating $50 Plan $50 Participating $75

$20$35$50

Health Insurance ndash Option 3

12

Dental Insurance

MetLife Dental PPO The Dental PPO plan is 100 Employer Paid for all tiers and provides comprehensive coverage with a nationwide PPO network This gives members access to more in-network dentists making it easier for them to reduce out-of-pocket costs for covered procedures and treatments Dental procedure frequencies Preventative care covers an exam and cleaning (once every 6 months) Fluoride treatment (two per benefit period under age 19 only) Full mouth X-ray (once every 60 months) Bitewing X-ray (once every 12 months age 14 and over once every 12 months under age 14)

PPO Dental Plan Features In-Network Out-of-Network

Type A Preventive Care Services (oral exams cleanings x-rays sealants)

100 of Fee Schedule 100 of Usual amp Customary

Charge

Type B Basic Restorative Dental Services (fillings simple extractions space maintainers)

80 of Fee Schedule 80 of Usual amp Customary

Charge

Type B Major Surgical Dental Services (Endodontics amp Periodontics)

80 of Fee Schedule 80 of Usual amp Customary

Charge

Type C Major Restorative Dental Services (bridges crowns dentures implants)

50 of Fee Schedule 50 of Usual amp Customary

Charge

Orthodontia (under age 19 only)

Lifetime maximum - $1000 50 of allowed benefit

Calendar Year Deductible Applies to Type B amp C services only

$25 Single $75 Family

Calendar Year Maximum Per Person $1500 combined maxper calendar year

Prior to receiving dental services it is recommended that you first obtain a pre-determination of benefits from your dentist so you know exactly how much your dental insurance will cover Spouses domestic partners and dependent children to age 26 (regardless of student status) are eligible

13

Vision Insurance ndash Option 1

Vision Plan through VSP (Voluntary) VSP is the largest private provider vision carrier in the country VSP contracts with Costcoreg Optical Eye Care Centers of America Inctrade which includes popular stores like EyeMasters VisionWorld and Hour Eyes and other quality retail chains When you visit a VSP participating provider your benefits include routine vision exams lenses and preferred pricing on all patient options Frequency Eye Exam 12 monthsLenses 12 monthsFrames 24 monthsContact Lenses 12 months

Vision Plan Features In-Network Out-of-Network

Annual Routine Eye Exam $10 copay Plan pays up to $45

Eyeglass Lenses (standard) Single Bifocal Trifocal

Covered in Full Covered in Full Covered in Full

Plan pays up to $30 Plan pays up to $50 Plan pays up to $65

Frames $130 allowance then 20 off remaining balance

Plan pays up to $70

Necessary Contact Lenses Covered in Full Plan pays up to $210

Elective Contact Lenses $130 allowance Plan pays up to $105

Elective Contact Lenses fitting and evaluation Covered in Full after $60

copay Not Available

Spouses domestic partners and dependent children to age 19 (or to age 25 if FT student) are eligible

14

Vision Insurance ndash Option 2

Vision Plan through Spectera UHC (Voluntary)

UHC offers you one of the largest vision care networks in the industry Their network includes convenient retail locations including My Eye Dr and Hour Eyes Best of all ndash when you receive care from a participating provider you receive the greatest benefits and money-saving discounts

Frequency Eye Exam 12 monthsLenses 12 monthsFrames 12 monthsContact Lenses 12 months

Vision Plan Features In-Network Out-of-Network

Annual Routine Eye Exam $10 copay Plan pays up to $40

Eyeglass Lenses (standard) Single Bifocal Trifocal

$25 copay $25 copay $25 copay

Plan pays up to $40 Plan pays up to $60 Plan pays up to $80

Frames $2500 copay $130 retail frame

allowance 30 discount above allowance

Plan pays up to $45

Necessary Contact Lenses $25 copay Plan pays up to $210

Elective Contact Lenses

$25 copay from the ldquoCovered contact lens

selectionrdquo All others- $105

allowance

Plan pays up to $105

Elective Contact Lenses fitting and evaluation Covered in Full after $25

copay Not Available

Spouses and dependent children to age 26 are eligible

15

Pre-tax FSA amp DCA

Flexible Spending Account (FSA) through Optum Health The Flexible Spending Account provides employees a means to reduce their taxes by the amount of their out of pocket health-related expenses (subject to eligibility) This tax free savings program allows employees to submit receipts for reimbursement for medical dental vision care prescription drug co-payments and other expenses not covered by our insurance In 2020 employees may contribute up to $2750 per year toward their FSA Employees have until March 14 2020 to use the money in their FSA or else they lose it (This contribution amount could change based on IRS guideline updates)

Dependent Care Spending Account (DCA) through Optum Health The Dependent Care Spending Account provides employees a means to reduce their taxes by the amount of their child care costs to a licensed provider up to $5000 annually

Health Insurance Premium Bank

Reston Association has established a program to help regular full-time and regular part-time employees pay their portion of the health insurance premium This program is only available to employees who are enrolled in or plan to enroll in the Kaiser Permanente HMO health insurance plans offered by the Reston Association Employees are eligible to apply to the Health Insurance Premium Bank if their adjusted gross household incomes are less than or equal to $60000 Requests for assistance must be made annually or at any time there is a qualifying event and submitted to Human Resources with necessary documentation by December 12th of each year To apply complete a request form (available in CommonHumResBenefits) and submit to HR with a copy of your most recent tax return showing adjusted gross household income This threshold is subject to change

16

Life and ADampD Insurance

Basic LifeADampD Insurance Reston Association provides 100 employer paid Life and ADampD Insurance through Sun Life to employees working 25 or more hours per week Coverage becomes effective the first of the month following six months of service

Benefit 2x Annual Earnings to a maximum of $200000 Age reduction Benefit reduced to 65 at age 65 and to 50 at age 70

Optional LifeADampD Insurance for Employee Spouse and Dependent Children

Optional Life Insurance for the employee spouse and dependent children is available at the employeersquos cost Optional Life is not available for domestic partners

Employee Benefit Increments of $10000 to a maximum of the lesser of $300000 or 3x your Basic Annual Earnings

Spouse Benefit Increments of $5000 to a maximum of $150000 Dependent Child Benefit Increments of $1000 to a maximum of $10000

Your amount of Dependent Spouse and Dependent Child Optional Life Insurance cannot exceed 50 of your amount of Optional Life Insurance Initial eligibility period will require evidence of insurability

STD amp LTD Insurance

Short Term and Long Term Disability Reston Association provides eligible employees with short and long-term disability income benefits through Sun Life In the event you become disabled from a non work-related injury or sickness disability income benefits are provided as a source of income These benefits are 100 employer paid

Benefit Short-Term Disability Long-Term Disability

Income Replacement -Eligible Employees -Executives

60 60

Elimination Period - Accidental Injury - Sickness

29 days 90 days

Benefit Period 9 weeks maximum To Social Security

normal retirement age

Benefit Maximum -Eligible Employees -Executives

$1000 per week $6000 per month $8000 per month 17

At a cost of $19month you can enroll in the Legal Resources benefit As a Legal Resources Member you have immediate and ongoing access to comprehensive legal coverage services and expertise that will easily save you money mdash and could save you a whole lot more Covered legal services include

Legal Advice and Consultation Tenant Dispute with Landlord District Court Representation for Civil Action Review of a Financial Contract or Lease Purchase sale or refinance of primary home Traffic Court Representation (includes 1st DUI) Will Preparation Uncontested Divorce Representation Defense of Child in Court (misdemeanor)

Legal Resources

Employee Assistance Program (EAP)

Reston Association offers a free confidential Employee Assistance Program (EAP) to all employees and their eligible dependents Through RArsquos EAP provider Lytle EAP Partners you and your immediate family members have immediate access on your date of hire to confidential professional counseling and referral services for help with anything that affects you or your dependentsrsquo well-being You can reach an EAP counselor by dialing 1-800-327-7272 24 hours a day or you may visit their website at wwwLytleEAPcom (password is reston) for more information Visit wwwLytleEAPcom for web-based legal financial worklife resources There are also work-related resources available online for managers Note Since EAP services are provided as a benefit only RA makes no representation concerning quality of care

18

401(k) Retirement Savings Plan

Reston Association offers two 401(k) retirement savings plans through Ascensusmdasha traditional 401(k) plan in which employee contributions are made pre-tax and a 401(k) Roth in which employee contributions are made after tax RA matches employee contributions dollar for dollar up to a total of 7 of your annual salary You can begin making contributions to the 401(k) plan and become eligible for RArsquos match following six months of service You always own 100 of your salary contributions

It is possible to borrow against a portion of your vested 401(k) account balance by taking a 401(k) loan You may request a participant loan using an application form which can be obtained by contacting Human Resources Your ability to obtain a 401(k) loan will depend on specific qualifying factors (defined in the 401(k) Summary Plan Description document) The 401(k) Plan Administrator will determine whether you satisfy these factors To access your 401(k) plan online httpsmyaccountascensuscomrplink Check account balance and rate of return Change fund elections Request a 401k loan View fund pricing and performance View and print quarterly statements

19

529 College Savings Plan (employer-sponsored)

A 529 college savings plan provides those saving for college with an unmatched combination of benefits You can open a 529 plan for anyone mdash your child grandchild spouse a friend or even yourself Assets in a 529 plan can be used to pay for a variety of higher education expenses including required books tuition room and board supplies and certain other required fees and expenses Earnings in 529 accounts can grow free from federal tax Withdrawals for qualified higher education expenses are free from federal tax Option to set up recurring automatic fund transfers directly from your bank account making it easy for you to invest The account owner rather than the beneficiary maintains control of account assets and determines the timing and amount of distributions Account owners can change beneficiaries without penalty provided the new beneficiary is a member of the previous beneficiaryrsquos family For more information please contact Human Resources

Additional Benefits

Free passes for employees and their dependents to all of RArsquos pools and tennis courts as well as discounted rates for all RA Programs and Camps Some restrictions may apply

Discounted gym membership rates at the Reston YMCA and Crunch Fitness Bike Share Program - Reston Association makes bicycles and helmets available to employees to rent on a daily

basis Please contact Member Services Discounted Tennis Rackets amp Shoes ndash Employees can purchase certain tennis shoes and rackets at wholesale

prices through RArsquos Tennis Department Contact the Tennis Department for more information Discounted autohome insurance - Liberty Mutual Insurance Company partners with RA to offer all employees

discounts on automobile and homeowner insurance Contact John Valenti at JohnValentilibertymutualcom

20

Reston Association provides generous paid time off benefits to accommodate the diverse needs of staff and to provide a positive worklife balance The amount of paid time off you earn per year is based on your years of service In addition Reston Association observes 9 paid holidays and assigns one paid floating holiday per year For more information on paid time off benefits and how to request time off please refer to the Reston Association Employee Handbook

WorkLife Balance ndash Paid Time Off (PTO)

Teleworking

The medical leave bank is available to help employees in extenuating circumstances protect their incomes by receiving paid leave once their personal PTO is used up A maximum of six (6) workweeks may be granted for each Medical Leave Bank request If additional time is necessary a new request must be made For program eligibility and criteria go to CommonHumResBenefits

Medical Leave Bank

Volunteer Release Time

On a per position basis employees may be allowed to telework for part of their workweek or in certain circumstances Such arrangements must be in compliance with the written administrative procedure including being approved in advance by the department director

Employees are encouraged to become involved in their communities lending their voluntary support to programs that enrich the quality of life and opportunities for all citizens This benefit allows employees to take paid-time off during a work day to participate in a volunteer activity that benefits the community at large Such activities are typically sponsored by a charitable or service organization or work with one or more individuals in need of assistance or special service

21

Training amp Career Development

Reston Association offers two types of learning opportunities for employees mdashinformal and formalmdashto foster individual development and training and career planning

I Informal Learning Opportunities (individual development amp training)

Focus on individual acquiring or enhancing specific task andor process skills to perform his or her current job better Typically this type of learning is not ldquodegree- orientedrdquo

Participants may or may not receive attendance or achievement certificate

Conferences workshops seminars webinars online courses etc typically lasting a few hours to one week

Requests for this type of training should be made to your supervisor or department head

II Formal Learning Opportunities (career planning)

Professional DevelopmentCareer Planning

Formalstructured learning geared toward improving and maintaining professional competence enhancing career progression staying abreast of new technologies and best practices developing process skills andor compliance with professional regulations

Future but not degree-oriented CEUs may be earned

May lead to qualification or credential required to obtain or retain specific certification

Opportunity may range from semester-long academic course to 24 month program with wide range of content and learning experience

Tuition Reimbursement Program

Supports formal education goals (AA bachelors masters) of individual to enhance knowledge and skills in specific areaindustry

Learning must be job-related and accomplished at or through accredited learning institution or e-learning platform connected with the institution

Requests for this type of training should be made to Human Resources as soon as foreseeable to ensure best availability of funds to support reimbursement

22

23

Lifetime limit not applicable and enrollment opportunity The lifetime limit on the dollar value of benefits under our medical plan no longer applies Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan Individuals have 30 days from the date of this notice to request enrollment For more information contact Human Resources or call the medical insurance carrier at the telephone number on your identification card

Notice on Patient Protections The medical HMO plan generally allows the designation of a primary care provider You have the right to designate any primary care provider who participates in the network and who is available to accept you or your family members Until you make this designation the medical carrier designates one for you For information on how to select a primary care provider and for a list of the participating primary care providers contact the medical insurance carrier at the number listed on your identification card

For children you may designate a pediatrician as the primary care provider You do not need prior authorization from the medical insurance carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in the network who specializes in obstetrics or gynecology The health care professional however may be required to comply with certain procedures including obtaining prior authorization for certain services following a pre-approved treatment plan or procedures for making referrals For a list of participating health care professionals who specialize in obstetrics or gynecology contact the medical insurance carrier at the number listed on your identification card

OTC Drug Reimbursements for FSAsHRAsHSAs Under the new Health Care Reform law (PPACA) the cost of an over-the-counter medicine or drug cannot be reimbursed from the account unless a prescription is obtained The change does not affect insulin even if purchased without a prescription or other health care expenses such as medical devices eyeglasses contact lenses co-pays and deductibles The new standard applies only to purchases made on or after January 1 2011

A similar rule is in effect for Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs)

The IRS has also posted a questions and answers section on its website httpwwwirsgovnewsroomarticle0id=22730800html concerning these provisions

Patient Protection and Affordable Care Act (PPACA) Mandatory Notices

The text below is an annual open enrollment required notice

24

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION PLEASE REVIEW IT CAREFULLY

Our Pledge to You

This notice is intended to inform you of the privacy practices followed by the Reston Associationrsquos Employee Benefit Plan (the Plan) and the Planrsquos legal obligations regarding your protected health information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) The notice also explains the privacy rights you and your family members have as participants of the Plan It is effective on April 14 2011

The Plan often needs access to your protected health information in order to provide payment for health services and perform plan administrative functions We want to assure the plan participants covered under the Plan that we comply with federal privacy laws and respect your right to privacy Reston Association requires all members of our workforce and third parties that are provided access to protected health information to comply with the privacy practices outlined in this notice

Protected Health Information Your protected health information is protected by the HIPAA Privacy Rule Generally protected health information is information that identifies an individual created or received by a health care provider health plan or an employer on behalf of a group health plan that relates to physical or mental health conditions provision of health care or payment for health care whether past present or future

How We May Use Your Protected Health Information Under the HIPAA Privacy Rule we may use or disclose your protected health information for certain purposes without your permission This section describes the ways we can use and disclose your protected health information

bull Payment We use or disclose your protected health information without your written authorization in order to determine eligibility for benefits seek reimbursement from a third party or coordinate benefits with another health plan under which you are covered For example a health care provider that provided treatment to you will provide us with your health information We use that information in order to determine whether those services are eligible for payment under our group health plan

bull Health Care Operations We use and disclose your protected health information in order to perform plan administration functions such as quality assurance activities resolution of internal grievances and evaluating plan performance For example we review claims experience in order to understand participant utilization and to make plan design changes that are intended to control health care costs

bull Treatment Although the law allows use and disclosure of your protected health information for purposes of treatment as a health plan we generally do not need to disclose your information for treatment purposes Your physician or health care provider is required to provide you with an explanation of how they use and share your health information for purposes of treatment payment and health care operations

bull As permitted or required by law We may also use or disclose your protected health information without your written authorization for other reasons as permitted by law We are permitted by law to share information subject to certain requirements in order to communicate information on health-related benefits or services that may be of interest to you respond to a court order or provide information to further public health activities (eg preventing the spread of disease) without your written authorization We are also permitted to share protected health information during a corporate restructuring such as a merger sale or acquisition We will also disclose health information about you when required by law for example in order to prevent serious harm to you or others

The text below is an annual open enrollment required notice

25

Notice of Privacy Practices

bull Pursuant to your Authorization When required by law we will ask for your written authorization before using or disclosing your protected health information If you choose to sign an authorization to disclose information you can later revoke that authorization to prevent any future uses or disclosures

bull To Business Associates We may enter into contracts with entities known as Business Associates that provide services to or perform functions on behalf of the Plan We may disclose protected health information to Business Associates once they have agreed in writing to safeguard the protected health information For example we may disclose your protected health information to a Business Associate to administer claims Business Associates are also required by law to protect protected health information

bull To the Plan Sponsor We may disclose protected health information to certain employees of Reston Association for the purpose of administering the Plan These employees will use or disclose the protected health information only as necessary to perform plan administration functions or as otherwise required by HIPAA unless you have authorized additional disclosures Your protected health information cannot be used for employment purposes without your specific authorization

Your Rights bull Right to Inspect and Copy In most cases you have the right to inspect and copy the protected health

information we maintain about you If you request copies we will charge you a reasonable fee to cover the costs of copying mailing or other expenses associated with your request Your request to inspect or review your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to inspect and copy your health information To the extent your information is held in an electronic health record you may be able to receive the information in an electronic format

bull Right to Amend If you believe that information within your records is incorrect or if important information is missing you have the right to request that we correct the existing information or add the missing information Your request to amend your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to amend your health information If we deny your request you may file a statement of disagreement with us for inclusion in any future disclosures of the disputed information

bull Right to an Accounting of Disclosures You have the right to receive an accounting of certain disclosures of your protected health information The accounting will not include disclosures that were made (1) for purposes of treatment payment or health care operations (2) to you (3) pursuant to your authorization (4) to your friends or family in your presence or because of an emergency (5) for national security purposes or (6) incidental to otherwise permissible disclosures

Your request to for an accounting must be submitted in writing to the person listed below You may request an accounting of disclosures made within the last six years You may request one accounting free of charge within a 12-month period

The text below is an annual open enrollment required notice

25

26

The information provided herein is intended to be a summary of benefits only and in no way supersedes the actual plan documents provided by the insurance carriersadministrators For more detailed information pertaining to your employee benefit plans including limitations and exclusions

please refer to the plan documents andor evidence of coverage provided by the carriersadministrators

Womenrsquos Health and Cancer Rights Act of 1998

If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos Health and Cancer Rights Act of 1998 (WHCRA) For individuals receiving mastectomy-related benefits coverage will be provided in a manner determined in consultation with the attending physician and the patient for

bull All stages of reconstruction of the breast on which the mastectomy was performed bull Surgery and reconstruction of the other breast to produce a symmetrical appearance bull Prostheses and bull Treatment of physical complications of the mastectomy including lymphedema

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan If you would like more information on WHCRA benefits call your plan administrator

CHIP-Childrens Health Insurance Program (CHIP) Reauthorization Act of 2009

Medicaid and the Childrenrsquos Health Insurance Program (CHIP) offer free or low-cost health coverage to children and families If you are eligible for health coverage from your employer but are unable to afford the premiums some States have premium assistance programs that can help pay for coverage These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage but need assistance in paying their health premiums

If you or your dependents are already enrolled in Medicaid or CHIP you can contact your state Medicaid or CHIP office to find out if premium assistance is available For a list of the contacts in each State go to wwwdolgovebsachipmodelnoticedoc

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify you can then contact the State to find out if it has a program that might help you pay the premiums for an employer-sponsored plan

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP your employerrsquos health plan is required to permit you and your dependents to enroll in the plan ndash as long as you and your dependents are eligible but not already enrolled in the employerrsquos plan This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance

The text below is an annual open enrollment required notice

26

27

Premium Assistance Under Medicaid and the

Childrenrsquos Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your

employer your state may have a premium assistance program that can help pay for coverage using funds

from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot

be eligible for these premium assistance programs but you may be able to buy individual insurance coverage

through the Health Insurance Marketplace For more information visit wwwhealthcaregov

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below

contact your State Medicaid or CHIP office to find out if premium assistance is available

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your

dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-

877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a

program that might help you pay the premiums for an employer-sponsored plan

If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible

under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already

enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days

of being determined eligible for premium assistance If you have questions about enrolling in your

employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)

If you live in one of the following states you may be eligible for assistance paying your employer

health plan premiums The following list of states is current as of July 31 2019 Contact your State for

more information on eligibility ndash

ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcom

Phone 1-855-692-5447

Website httpflmedicaidtplrecoverycomhipp

Phone 1-877-357-3268

ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program

Website httpmyakhippcom

Phone 1-866-251-4861

Email CustomerServiceMyAKHIPPcom

Medicaid Eligibility

httpdhssalaskagovdpaPagesmedicaiddefaultaspx

Website httpsmedicaidgeorgiagovhealth-

insurance-premium-payment-program-hipp

Phone 678-564-1162 ext 2131

ARKANSAS ndash Medicaid INDIANA ndash Medicaid

Website httpmyarhippcom

Phone 1-855-MyARHIPP (855-692-7447)

Healthy Indiana Plan for low-income adults 19-64

Website httpwwwingovfssahip

Phone 1-877-438-4479

All other Medicaid

Website httpwwwindianamedicaidcom

Phone 1-800-403-0864

COLORADO ndash Health First Colorado

(Coloradorsquos Medicaid Program) amp Child Health

Plan Plus (CHP+)

IOWA ndash Medicaid

Health First Colorado Website

httpswwwhealthfirstcoloradocom

Health First Colorado Member Contact Center

1-800-221-3943 State Relay 711

CHP+ httpswwwcoloradogovpacifichcpfchild-health-

plan-plus

CHP+ Customer Service 1-800-359-1991 State Relay

711

Website

httpdhsiowagovHawki

Phone 1-800-257-8563

28

KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid

Website httpwwwkdheksgovhcf

Phone 1-785-296-3512

Website httpswwwdhhsnhgovoiihipphtm

Phone 603-271-5218

Toll free number for the HIPP program 1-800-852-3345 ext 5218

KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP

Website httpschfskygov

Phone 1-800-635-2570

Medicaid Website

httpwwwstatenjushumanservices

dmahsclientsmedicaid

Medicaid Phone 609-631-2392

CHIP Website httpwwwnjfamilycareorgindexhtml

CHIP Phone 1-800-701-0710

LOUISIANA ndash Medicaid NEW YORK ndash Medicaid

Website httpdhhlouisianagovindexcfmsubhome1n331

Phone 1-888-695-2447

Website httpswwwhealthnygovhealth_caremedicaid

Phone 1-800-541-2831

MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid

Website httpwwwmainegovdhhsofipublic-assistanceindexhtml

Phone 1-800-442-6003

TTY Maine relay 711

Website httpsmedicaidncdhhsgov

Phone 919-855-4100

MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid

Website httpwwwmassgoveohhsgovdepartmentsmasshealth

Phone 1-800-862-4840

Website httpwwwndgovdhsservicesmedicalservmedicaid

Phone 1-844-854-4825

MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP

Website

httpsmngovdhspeople-we-serveseniorshealth-carehealth-care-

programsprograms-and-servicesother-insurancejsp

Phone 1-800-657-3739

Website httpwwwinsureoklahomaorg

Phone 1-888-365-3742

MISSOURI ndash Medicaid OREGON ndash Medicaid

Website httpwwwdssmogovmhdparticipantspageshipphtm

Phone 573-751-2005

Website httphealthcareoregongovPagesindexaspx

httpwwworegonhealthcaregovindex-eshtml

Phone 1-800-699-9075

MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid

Website httpdphhsmtgovMontanaHealthcareProgramsHIPP

Phone 1-800-694-3084

Website

httpwwwdhspagovprovidermedicalassistancehealthinsuranc

epremiumpaymenthippprogramindexhtm

Phone 1-800-692-7462

NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP

Website httpwwwACCESSNebraskanegov

Phone (855) 632-7633

Lincoln (402) 473-7000

Omaha (402) 595-1178

Website httpwwweohhsrigov

Phone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)

29

NEVADA ndash Medicaid SOUTH CAROLINA ndash Medicaid

Medicaid Website httpsdhcfpnvgov

Medicaid Phone 1-800-992-0900

Website httpswwwscdhhsgov

Phone 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid

Website httpdsssdgov

Phone 1-888-828-0059

Website httpswwwhcawagov

Phone 1-800-562-3022 ext 15473

TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascom

Phone 1-800-440-0493

Website httpmywvhippcom

Toll-free phone 1-855-MyWVHIPP (1-855-699-8447)

UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgov

CHIP Website httphealthutahgovchip

Phone 1-877-543-7669

Website

httpswwwdhswisconsingovpublicationsp1p10095p

df

Phone 1-800-362-3002

VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorg

Phone 1-800-250-8427

Website httpswyequalitycareacs-inccom

Phone 307-777-7531

VIRGINIA ndash Medicaid and CHIP Medicaid Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

Medicaid Phone 1-800-432-5924

CHIP Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

CHIP Phone 1-855-242-8282

To see if any other states have added a premium assistance program since July 31 2019 or for more

information on special enrollment rights contact either

US Department of Labor US Department of Health and Human Services

Employee Benefits Security Administration Centers for Medicare amp Medicaid Services

wwwdolgovagenciesebsa wwwcmshhsgov

1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565

Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond

to a collection of information unless such collection displays a valid Office of Management and Budget (OMB)

control number The Department notes that a Federal agency cannot conduct or sponsor a collection of

information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and

the public is not required to respond to a collection of information unless it displays a currently valid OMB control

number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to

penalty for failing to comply with a collection of information if the collection of information does not display a

currently valid OMB control number See 44 USC 3512

The public reporting burden for this collection of information is estimated to average approximately seven minutes

per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other

aspect of this collection of information including suggestions for reducing this burden to the US Department of

Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance

Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and

reference the OMB Control Number 1210-0137 OMB Control Number 1210-0137 (expires 12312019)

Notes

30

Notes

31

Prepared by

Please contact Reston Associationrsquos Human Resources Department at 703-435-7990 or hrrestonorg with any

questions related to your Total Rewards Guide

copy 2019 McGriff Insurance Services Inc

Page 7: Employee Total Rewards Guide 2020 - Reston Total Rewards Gui… · Recognizing and rewarding employees for achieving a sustainable impact. Award criteria includes: •Progressive

Medical Premium Costs per Paycheck for Employees Hired Prior to 1-1-2019

The amount of your paycheck cost difference will be dependent on the type of coverage you choose

for 2020 (see last column on the table below)

Rates are effective January 1 2020

HRA-HMO

Signature

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $50725 $3512

Employee + 1 $101444 $8193

Employee + Family $147096 $12408

HMO Select

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $58173 $4027

Employee + 1 $116340 $9397

Employee + Family $168696 $14229

POS Select

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $85966 $5951

Employee + 1 $171932 $13887

Employee + Family $249293 $21028

NOTE The Health Insurance Premium Bank is still available to those who qualify Request for

assistance must be made annually by December 15th or within 30 days of a qualifying event

7

Medical Premium Costs per Paycheck for Employees Hired After 1-1-2019

The amount of your paycheck cost difference will be dependent on the type of coverage you choose

for 2020 (see last column on the table below)

Rates are effective January 1 2020

HRA-HMO

Signature

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $50725 $4682

Employee + 1 $101444 $10535

Employee + Family $147096 $15802

HMO Select

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $58173 5370

Employee + 1 $116340 $12081

Employee + Family $168696 $18122

POS Select

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $85966 $7935

Employee + 1 $171932 $17854

Employee + Family $249293 $26781

NOTE The Health Insurance Premium Bank is still available to those who qualify Request for

assistance must be made annually by December 12th or within 30 days of a qualifying event

8

Dental amp Vision Premium Costs per Paycheck

The following rates represent your monthly Dental and Vision premiums effective January 1 2020

MetLife Dental Per Paycheck

FULL-TIME Cost

Per Paycheck

PART-TIME Cost

Employee $000

Contact HR for cost Employee + 1 $000

Employee + Family $000

VSP Vision Per Paycheck Cost

Employee $513

Employee + Adult $864

Employee + Child $882

Employee + Family $1423

SpecteraUHC Vision Per Paycheck Cost

Employee $415

Employee + Adult $843

Employee + Child $883

Employee + Family $1116

9

Health Insurance ndash Option 1

DHMO HRA Signature In Network You Pay Out-of-Network You Pay

Deductible Coinsurance Out-of-Pocket

$750 Individual$1500 Family (RA funds) 9010

$3000 Individual $6000 Family

(less than regular HMO)

NA

Primary Care and Specialist Office Visit $15 PCP$25 Specialist NO COVERAGE

Emergency Room Visits $75 per visit (waived

if admitted) NO COVERAGE

Hospital ndash Inpatient Stay 10 after deductible NO COVERAGE

Home Health Care 10 after deductible NO COVERAGE

Outpatient Facility Services 10 after deductible NO COVERAGE

X-Ray and Laboratory Services 10 after deductible NO COVERAGE

Specialty Imaging (CTMRIPET scan) 10 after deductible NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Inpatient Facility

10 after deductible NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Outpatient Facility

$7 copay-group therapy $15 copay-individual therapy per visit

NO COVERAGE

Vision (Children Only) $15 PCP$25 Specialist NO COVERAGE

Prescription Drug Program (30 day supply) Generic Drug (Tier 1) Preferred Brand Name Drug (Tier 2) Non-Preferred Brand Drug (Tier 3) Up to 90 day supply ndash 3 co-pays for Plan and Participating Pharmacies Mail Order Up to 90 day supply- 2 co-pays

$0 deductible

Plan $20 Participating $30 Plan $30 Participating $50 Plan $45 Participating $65

$20$30$45

Kaiser Permanente D-HMO HRA Signature (Facilities Only) With the Signature Network members receive quality care at the Kaiser medical centers in Maryland Virginia and the District of Columbia Medical centers offer convenient services including primary care specialty care laboratory radiology and pharmacy at most locations and in some locations optical Signature members also have access to more than 40 hospitals in the region

10

Health Insurance ndash Option 2

Kaiser Permanente HMO Select (Facilities amp Contracted Providers Only) With the Select Network members may receive quality care at the Kaiser medical centers in Maryland Virginia and the District of Columbia Building on the Signature physician network the Select network adds access to more than 15000 contracted community physicians in private practice Select members also have access to more than 40 hospitals in the region

HMO Select In-Network You Pay Out-of-Network

You Pay

Deductible Coinsurance Out-of-Pocket

None 100

$3500 Individual $9400 Family

NA

Primary Care and Specialist Office Visit $30 PCP$40 Specialist NO COVERAGE

Emergency Room Visits $100 per visit

(waived if admitted) NO COVERAGE

Hospital ndash Inpatient Stay $250 per admission NO COVERAGE

Home Health Care No charge NO COVERAGE

Outpatient Facility Services $100 NO COVERAGE

X-Ray and Laboratory Services No charge NO COVERAGE

Specialty Imaging (CTMRIPET scan) $50 per test NO COVERAGE

Chiropractic amp Acupuncture Services $40 copay

20 visits per contract year NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Inpatient Facility

$250 per admission NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Outpatient Facility

$15 copay-group therapy $30 copay-individual therapy per visit

NO COVERAGE

Vision (Children Only) $30 PCP$40 Specialist NO COVERAGE

Prescription Drug Program (30 day supply) Generic Drug (Tier 1) Preferred Brand Name Drug (Tier 2) Non-Preferred Brand Drug (Tier 3) Up to 90 day supply ndash 3 co-pays for Plan and Participating Pharmacies Mail Order Up to 90 day supply- 2 co-pays

$0 deductible

Plan $20 Participating $30 Plan $35 Participating $50 Plan $50 Participating $75

$20$35$50

11

Kaiser Permanente POS Select (Facilities amp Contracted Providers with an Out of Network Option) Members can use in-plan benefits by using a Kaiser facility or a contracted primary care physician Your chosen PCP will provide care and coordinate referrals and hospital admissions Members also have the freedom to choose any other licensed provider outside the provider network however you will be responsible for deductibles and coinsurance above the health planrsquos payment

POS Select In-Network You Pay Out-of-Network

you pay

Deductible Coinsurance Out-of-Pocket

None 100

$3500 Individual $9400 Family

$300 Individual $600 Family

8020 $3000 Individual

$6000 Family

Primary Care and Specialist Office Visit $15 PCP$30 Specialist 20 of UCR

Emergency Room Visits $75 per visit (waived if

admitted) $75 per visit

(waived if admitted)

Hospital ndash Inpatient Stay $250 per admission 20 of UCR

Home Health Care No charge 20 of UCR

Outpatient Facility Services $50 20 of UCR

X-Ray and Laboratory Services No charge 20 of UCR

Specialty Imaging (CTMRIPET scan) No charge 20 of UCR

Mental Health (MG) amp Substance Abuse (SA) ndash Inpatient Facility

$250 per admission 20 of UCR

Mental Health (MG) amp Substance Abuse (SA) ndash Outpatient Facility

$7 copay-group therapy $15 copay-individual therapy per visit

20 of UCR

Vision (Children Only) $15 PCP$30 Specialist per visit 20 of UCR

Prescription Drug Program (30 day supply) Generic Drug (Tier 1) Preferred Brand Name Drug (Tier 2) Non-Preferred Brand Drug (Tier 3) Up to 90 day supply ndash 3 co-pays for Plan and Participating Pharmacies Mail Order Up to 90 day supply- 2 co-pays

$0 deductible

Plan $20 Participating $30 Plan $35 Participating $50 Plan $50 Participating $75

$20$35$50

Health Insurance ndash Option 3

12

Dental Insurance

MetLife Dental PPO The Dental PPO plan is 100 Employer Paid for all tiers and provides comprehensive coverage with a nationwide PPO network This gives members access to more in-network dentists making it easier for them to reduce out-of-pocket costs for covered procedures and treatments Dental procedure frequencies Preventative care covers an exam and cleaning (once every 6 months) Fluoride treatment (two per benefit period under age 19 only) Full mouth X-ray (once every 60 months) Bitewing X-ray (once every 12 months age 14 and over once every 12 months under age 14)

PPO Dental Plan Features In-Network Out-of-Network

Type A Preventive Care Services (oral exams cleanings x-rays sealants)

100 of Fee Schedule 100 of Usual amp Customary

Charge

Type B Basic Restorative Dental Services (fillings simple extractions space maintainers)

80 of Fee Schedule 80 of Usual amp Customary

Charge

Type B Major Surgical Dental Services (Endodontics amp Periodontics)

80 of Fee Schedule 80 of Usual amp Customary

Charge

Type C Major Restorative Dental Services (bridges crowns dentures implants)

50 of Fee Schedule 50 of Usual amp Customary

Charge

Orthodontia (under age 19 only)

Lifetime maximum - $1000 50 of allowed benefit

Calendar Year Deductible Applies to Type B amp C services only

$25 Single $75 Family

Calendar Year Maximum Per Person $1500 combined maxper calendar year

Prior to receiving dental services it is recommended that you first obtain a pre-determination of benefits from your dentist so you know exactly how much your dental insurance will cover Spouses domestic partners and dependent children to age 26 (regardless of student status) are eligible

13

Vision Insurance ndash Option 1

Vision Plan through VSP (Voluntary) VSP is the largest private provider vision carrier in the country VSP contracts with Costcoreg Optical Eye Care Centers of America Inctrade which includes popular stores like EyeMasters VisionWorld and Hour Eyes and other quality retail chains When you visit a VSP participating provider your benefits include routine vision exams lenses and preferred pricing on all patient options Frequency Eye Exam 12 monthsLenses 12 monthsFrames 24 monthsContact Lenses 12 months

Vision Plan Features In-Network Out-of-Network

Annual Routine Eye Exam $10 copay Plan pays up to $45

Eyeglass Lenses (standard) Single Bifocal Trifocal

Covered in Full Covered in Full Covered in Full

Plan pays up to $30 Plan pays up to $50 Plan pays up to $65

Frames $130 allowance then 20 off remaining balance

Plan pays up to $70

Necessary Contact Lenses Covered in Full Plan pays up to $210

Elective Contact Lenses $130 allowance Plan pays up to $105

Elective Contact Lenses fitting and evaluation Covered in Full after $60

copay Not Available

Spouses domestic partners and dependent children to age 19 (or to age 25 if FT student) are eligible

14

Vision Insurance ndash Option 2

Vision Plan through Spectera UHC (Voluntary)

UHC offers you one of the largest vision care networks in the industry Their network includes convenient retail locations including My Eye Dr and Hour Eyes Best of all ndash when you receive care from a participating provider you receive the greatest benefits and money-saving discounts

Frequency Eye Exam 12 monthsLenses 12 monthsFrames 12 monthsContact Lenses 12 months

Vision Plan Features In-Network Out-of-Network

Annual Routine Eye Exam $10 copay Plan pays up to $40

Eyeglass Lenses (standard) Single Bifocal Trifocal

$25 copay $25 copay $25 copay

Plan pays up to $40 Plan pays up to $60 Plan pays up to $80

Frames $2500 copay $130 retail frame

allowance 30 discount above allowance

Plan pays up to $45

Necessary Contact Lenses $25 copay Plan pays up to $210

Elective Contact Lenses

$25 copay from the ldquoCovered contact lens

selectionrdquo All others- $105

allowance

Plan pays up to $105

Elective Contact Lenses fitting and evaluation Covered in Full after $25

copay Not Available

Spouses and dependent children to age 26 are eligible

15

Pre-tax FSA amp DCA

Flexible Spending Account (FSA) through Optum Health The Flexible Spending Account provides employees a means to reduce their taxes by the amount of their out of pocket health-related expenses (subject to eligibility) This tax free savings program allows employees to submit receipts for reimbursement for medical dental vision care prescription drug co-payments and other expenses not covered by our insurance In 2020 employees may contribute up to $2750 per year toward their FSA Employees have until March 14 2020 to use the money in their FSA or else they lose it (This contribution amount could change based on IRS guideline updates)

Dependent Care Spending Account (DCA) through Optum Health The Dependent Care Spending Account provides employees a means to reduce their taxes by the amount of their child care costs to a licensed provider up to $5000 annually

Health Insurance Premium Bank

Reston Association has established a program to help regular full-time and regular part-time employees pay their portion of the health insurance premium This program is only available to employees who are enrolled in or plan to enroll in the Kaiser Permanente HMO health insurance plans offered by the Reston Association Employees are eligible to apply to the Health Insurance Premium Bank if their adjusted gross household incomes are less than or equal to $60000 Requests for assistance must be made annually or at any time there is a qualifying event and submitted to Human Resources with necessary documentation by December 12th of each year To apply complete a request form (available in CommonHumResBenefits) and submit to HR with a copy of your most recent tax return showing adjusted gross household income This threshold is subject to change

16

Life and ADampD Insurance

Basic LifeADampD Insurance Reston Association provides 100 employer paid Life and ADampD Insurance through Sun Life to employees working 25 or more hours per week Coverage becomes effective the first of the month following six months of service

Benefit 2x Annual Earnings to a maximum of $200000 Age reduction Benefit reduced to 65 at age 65 and to 50 at age 70

Optional LifeADampD Insurance for Employee Spouse and Dependent Children

Optional Life Insurance for the employee spouse and dependent children is available at the employeersquos cost Optional Life is not available for domestic partners

Employee Benefit Increments of $10000 to a maximum of the lesser of $300000 or 3x your Basic Annual Earnings

Spouse Benefit Increments of $5000 to a maximum of $150000 Dependent Child Benefit Increments of $1000 to a maximum of $10000

Your amount of Dependent Spouse and Dependent Child Optional Life Insurance cannot exceed 50 of your amount of Optional Life Insurance Initial eligibility period will require evidence of insurability

STD amp LTD Insurance

Short Term and Long Term Disability Reston Association provides eligible employees with short and long-term disability income benefits through Sun Life In the event you become disabled from a non work-related injury or sickness disability income benefits are provided as a source of income These benefits are 100 employer paid

Benefit Short-Term Disability Long-Term Disability

Income Replacement -Eligible Employees -Executives

60 60

Elimination Period - Accidental Injury - Sickness

29 days 90 days

Benefit Period 9 weeks maximum To Social Security

normal retirement age

Benefit Maximum -Eligible Employees -Executives

$1000 per week $6000 per month $8000 per month 17

At a cost of $19month you can enroll in the Legal Resources benefit As a Legal Resources Member you have immediate and ongoing access to comprehensive legal coverage services and expertise that will easily save you money mdash and could save you a whole lot more Covered legal services include

Legal Advice and Consultation Tenant Dispute with Landlord District Court Representation for Civil Action Review of a Financial Contract or Lease Purchase sale or refinance of primary home Traffic Court Representation (includes 1st DUI) Will Preparation Uncontested Divorce Representation Defense of Child in Court (misdemeanor)

Legal Resources

Employee Assistance Program (EAP)

Reston Association offers a free confidential Employee Assistance Program (EAP) to all employees and their eligible dependents Through RArsquos EAP provider Lytle EAP Partners you and your immediate family members have immediate access on your date of hire to confidential professional counseling and referral services for help with anything that affects you or your dependentsrsquo well-being You can reach an EAP counselor by dialing 1-800-327-7272 24 hours a day or you may visit their website at wwwLytleEAPcom (password is reston) for more information Visit wwwLytleEAPcom for web-based legal financial worklife resources There are also work-related resources available online for managers Note Since EAP services are provided as a benefit only RA makes no representation concerning quality of care

18

401(k) Retirement Savings Plan

Reston Association offers two 401(k) retirement savings plans through Ascensusmdasha traditional 401(k) plan in which employee contributions are made pre-tax and a 401(k) Roth in which employee contributions are made after tax RA matches employee contributions dollar for dollar up to a total of 7 of your annual salary You can begin making contributions to the 401(k) plan and become eligible for RArsquos match following six months of service You always own 100 of your salary contributions

It is possible to borrow against a portion of your vested 401(k) account balance by taking a 401(k) loan You may request a participant loan using an application form which can be obtained by contacting Human Resources Your ability to obtain a 401(k) loan will depend on specific qualifying factors (defined in the 401(k) Summary Plan Description document) The 401(k) Plan Administrator will determine whether you satisfy these factors To access your 401(k) plan online httpsmyaccountascensuscomrplink Check account balance and rate of return Change fund elections Request a 401k loan View fund pricing and performance View and print quarterly statements

19

529 College Savings Plan (employer-sponsored)

A 529 college savings plan provides those saving for college with an unmatched combination of benefits You can open a 529 plan for anyone mdash your child grandchild spouse a friend or even yourself Assets in a 529 plan can be used to pay for a variety of higher education expenses including required books tuition room and board supplies and certain other required fees and expenses Earnings in 529 accounts can grow free from federal tax Withdrawals for qualified higher education expenses are free from federal tax Option to set up recurring automatic fund transfers directly from your bank account making it easy for you to invest The account owner rather than the beneficiary maintains control of account assets and determines the timing and amount of distributions Account owners can change beneficiaries without penalty provided the new beneficiary is a member of the previous beneficiaryrsquos family For more information please contact Human Resources

Additional Benefits

Free passes for employees and their dependents to all of RArsquos pools and tennis courts as well as discounted rates for all RA Programs and Camps Some restrictions may apply

Discounted gym membership rates at the Reston YMCA and Crunch Fitness Bike Share Program - Reston Association makes bicycles and helmets available to employees to rent on a daily

basis Please contact Member Services Discounted Tennis Rackets amp Shoes ndash Employees can purchase certain tennis shoes and rackets at wholesale

prices through RArsquos Tennis Department Contact the Tennis Department for more information Discounted autohome insurance - Liberty Mutual Insurance Company partners with RA to offer all employees

discounts on automobile and homeowner insurance Contact John Valenti at JohnValentilibertymutualcom

20

Reston Association provides generous paid time off benefits to accommodate the diverse needs of staff and to provide a positive worklife balance The amount of paid time off you earn per year is based on your years of service In addition Reston Association observes 9 paid holidays and assigns one paid floating holiday per year For more information on paid time off benefits and how to request time off please refer to the Reston Association Employee Handbook

WorkLife Balance ndash Paid Time Off (PTO)

Teleworking

The medical leave bank is available to help employees in extenuating circumstances protect their incomes by receiving paid leave once their personal PTO is used up A maximum of six (6) workweeks may be granted for each Medical Leave Bank request If additional time is necessary a new request must be made For program eligibility and criteria go to CommonHumResBenefits

Medical Leave Bank

Volunteer Release Time

On a per position basis employees may be allowed to telework for part of their workweek or in certain circumstances Such arrangements must be in compliance with the written administrative procedure including being approved in advance by the department director

Employees are encouraged to become involved in their communities lending their voluntary support to programs that enrich the quality of life and opportunities for all citizens This benefit allows employees to take paid-time off during a work day to participate in a volunteer activity that benefits the community at large Such activities are typically sponsored by a charitable or service organization or work with one or more individuals in need of assistance or special service

21

Training amp Career Development

Reston Association offers two types of learning opportunities for employees mdashinformal and formalmdashto foster individual development and training and career planning

I Informal Learning Opportunities (individual development amp training)

Focus on individual acquiring or enhancing specific task andor process skills to perform his or her current job better Typically this type of learning is not ldquodegree- orientedrdquo

Participants may or may not receive attendance or achievement certificate

Conferences workshops seminars webinars online courses etc typically lasting a few hours to one week

Requests for this type of training should be made to your supervisor or department head

II Formal Learning Opportunities (career planning)

Professional DevelopmentCareer Planning

Formalstructured learning geared toward improving and maintaining professional competence enhancing career progression staying abreast of new technologies and best practices developing process skills andor compliance with professional regulations

Future but not degree-oriented CEUs may be earned

May lead to qualification or credential required to obtain or retain specific certification

Opportunity may range from semester-long academic course to 24 month program with wide range of content and learning experience

Tuition Reimbursement Program

Supports formal education goals (AA bachelors masters) of individual to enhance knowledge and skills in specific areaindustry

Learning must be job-related and accomplished at or through accredited learning institution or e-learning platform connected with the institution

Requests for this type of training should be made to Human Resources as soon as foreseeable to ensure best availability of funds to support reimbursement

22

23

Lifetime limit not applicable and enrollment opportunity The lifetime limit on the dollar value of benefits under our medical plan no longer applies Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan Individuals have 30 days from the date of this notice to request enrollment For more information contact Human Resources or call the medical insurance carrier at the telephone number on your identification card

Notice on Patient Protections The medical HMO plan generally allows the designation of a primary care provider You have the right to designate any primary care provider who participates in the network and who is available to accept you or your family members Until you make this designation the medical carrier designates one for you For information on how to select a primary care provider and for a list of the participating primary care providers contact the medical insurance carrier at the number listed on your identification card

For children you may designate a pediatrician as the primary care provider You do not need prior authorization from the medical insurance carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in the network who specializes in obstetrics or gynecology The health care professional however may be required to comply with certain procedures including obtaining prior authorization for certain services following a pre-approved treatment plan or procedures for making referrals For a list of participating health care professionals who specialize in obstetrics or gynecology contact the medical insurance carrier at the number listed on your identification card

OTC Drug Reimbursements for FSAsHRAsHSAs Under the new Health Care Reform law (PPACA) the cost of an over-the-counter medicine or drug cannot be reimbursed from the account unless a prescription is obtained The change does not affect insulin even if purchased without a prescription or other health care expenses such as medical devices eyeglasses contact lenses co-pays and deductibles The new standard applies only to purchases made on or after January 1 2011

A similar rule is in effect for Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs)

The IRS has also posted a questions and answers section on its website httpwwwirsgovnewsroomarticle0id=22730800html concerning these provisions

Patient Protection and Affordable Care Act (PPACA) Mandatory Notices

The text below is an annual open enrollment required notice

24

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION PLEASE REVIEW IT CAREFULLY

Our Pledge to You

This notice is intended to inform you of the privacy practices followed by the Reston Associationrsquos Employee Benefit Plan (the Plan) and the Planrsquos legal obligations regarding your protected health information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) The notice also explains the privacy rights you and your family members have as participants of the Plan It is effective on April 14 2011

The Plan often needs access to your protected health information in order to provide payment for health services and perform plan administrative functions We want to assure the plan participants covered under the Plan that we comply with federal privacy laws and respect your right to privacy Reston Association requires all members of our workforce and third parties that are provided access to protected health information to comply with the privacy practices outlined in this notice

Protected Health Information Your protected health information is protected by the HIPAA Privacy Rule Generally protected health information is information that identifies an individual created or received by a health care provider health plan or an employer on behalf of a group health plan that relates to physical or mental health conditions provision of health care or payment for health care whether past present or future

How We May Use Your Protected Health Information Under the HIPAA Privacy Rule we may use or disclose your protected health information for certain purposes without your permission This section describes the ways we can use and disclose your protected health information

bull Payment We use or disclose your protected health information without your written authorization in order to determine eligibility for benefits seek reimbursement from a third party or coordinate benefits with another health plan under which you are covered For example a health care provider that provided treatment to you will provide us with your health information We use that information in order to determine whether those services are eligible for payment under our group health plan

bull Health Care Operations We use and disclose your protected health information in order to perform plan administration functions such as quality assurance activities resolution of internal grievances and evaluating plan performance For example we review claims experience in order to understand participant utilization and to make plan design changes that are intended to control health care costs

bull Treatment Although the law allows use and disclosure of your protected health information for purposes of treatment as a health plan we generally do not need to disclose your information for treatment purposes Your physician or health care provider is required to provide you with an explanation of how they use and share your health information for purposes of treatment payment and health care operations

bull As permitted or required by law We may also use or disclose your protected health information without your written authorization for other reasons as permitted by law We are permitted by law to share information subject to certain requirements in order to communicate information on health-related benefits or services that may be of interest to you respond to a court order or provide information to further public health activities (eg preventing the spread of disease) without your written authorization We are also permitted to share protected health information during a corporate restructuring such as a merger sale or acquisition We will also disclose health information about you when required by law for example in order to prevent serious harm to you or others

The text below is an annual open enrollment required notice

25

Notice of Privacy Practices

bull Pursuant to your Authorization When required by law we will ask for your written authorization before using or disclosing your protected health information If you choose to sign an authorization to disclose information you can later revoke that authorization to prevent any future uses or disclosures

bull To Business Associates We may enter into contracts with entities known as Business Associates that provide services to or perform functions on behalf of the Plan We may disclose protected health information to Business Associates once they have agreed in writing to safeguard the protected health information For example we may disclose your protected health information to a Business Associate to administer claims Business Associates are also required by law to protect protected health information

bull To the Plan Sponsor We may disclose protected health information to certain employees of Reston Association for the purpose of administering the Plan These employees will use or disclose the protected health information only as necessary to perform plan administration functions or as otherwise required by HIPAA unless you have authorized additional disclosures Your protected health information cannot be used for employment purposes without your specific authorization

Your Rights bull Right to Inspect and Copy In most cases you have the right to inspect and copy the protected health

information we maintain about you If you request copies we will charge you a reasonable fee to cover the costs of copying mailing or other expenses associated with your request Your request to inspect or review your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to inspect and copy your health information To the extent your information is held in an electronic health record you may be able to receive the information in an electronic format

bull Right to Amend If you believe that information within your records is incorrect or if important information is missing you have the right to request that we correct the existing information or add the missing information Your request to amend your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to amend your health information If we deny your request you may file a statement of disagreement with us for inclusion in any future disclosures of the disputed information

bull Right to an Accounting of Disclosures You have the right to receive an accounting of certain disclosures of your protected health information The accounting will not include disclosures that were made (1) for purposes of treatment payment or health care operations (2) to you (3) pursuant to your authorization (4) to your friends or family in your presence or because of an emergency (5) for national security purposes or (6) incidental to otherwise permissible disclosures

Your request to for an accounting must be submitted in writing to the person listed below You may request an accounting of disclosures made within the last six years You may request one accounting free of charge within a 12-month period

The text below is an annual open enrollment required notice

25

26

The information provided herein is intended to be a summary of benefits only and in no way supersedes the actual plan documents provided by the insurance carriersadministrators For more detailed information pertaining to your employee benefit plans including limitations and exclusions

please refer to the plan documents andor evidence of coverage provided by the carriersadministrators

Womenrsquos Health and Cancer Rights Act of 1998

If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos Health and Cancer Rights Act of 1998 (WHCRA) For individuals receiving mastectomy-related benefits coverage will be provided in a manner determined in consultation with the attending physician and the patient for

bull All stages of reconstruction of the breast on which the mastectomy was performed bull Surgery and reconstruction of the other breast to produce a symmetrical appearance bull Prostheses and bull Treatment of physical complications of the mastectomy including lymphedema

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan If you would like more information on WHCRA benefits call your plan administrator

CHIP-Childrens Health Insurance Program (CHIP) Reauthorization Act of 2009

Medicaid and the Childrenrsquos Health Insurance Program (CHIP) offer free or low-cost health coverage to children and families If you are eligible for health coverage from your employer but are unable to afford the premiums some States have premium assistance programs that can help pay for coverage These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage but need assistance in paying their health premiums

If you or your dependents are already enrolled in Medicaid or CHIP you can contact your state Medicaid or CHIP office to find out if premium assistance is available For a list of the contacts in each State go to wwwdolgovebsachipmodelnoticedoc

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify you can then contact the State to find out if it has a program that might help you pay the premiums for an employer-sponsored plan

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP your employerrsquos health plan is required to permit you and your dependents to enroll in the plan ndash as long as you and your dependents are eligible but not already enrolled in the employerrsquos plan This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance

The text below is an annual open enrollment required notice

26

27

Premium Assistance Under Medicaid and the

Childrenrsquos Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your

employer your state may have a premium assistance program that can help pay for coverage using funds

from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot

be eligible for these premium assistance programs but you may be able to buy individual insurance coverage

through the Health Insurance Marketplace For more information visit wwwhealthcaregov

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below

contact your State Medicaid or CHIP office to find out if premium assistance is available

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your

dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-

877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a

program that might help you pay the premiums for an employer-sponsored plan

If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible

under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already

enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days

of being determined eligible for premium assistance If you have questions about enrolling in your

employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)

If you live in one of the following states you may be eligible for assistance paying your employer

health plan premiums The following list of states is current as of July 31 2019 Contact your State for

more information on eligibility ndash

ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcom

Phone 1-855-692-5447

Website httpflmedicaidtplrecoverycomhipp

Phone 1-877-357-3268

ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program

Website httpmyakhippcom

Phone 1-866-251-4861

Email CustomerServiceMyAKHIPPcom

Medicaid Eligibility

httpdhssalaskagovdpaPagesmedicaiddefaultaspx

Website httpsmedicaidgeorgiagovhealth-

insurance-premium-payment-program-hipp

Phone 678-564-1162 ext 2131

ARKANSAS ndash Medicaid INDIANA ndash Medicaid

Website httpmyarhippcom

Phone 1-855-MyARHIPP (855-692-7447)

Healthy Indiana Plan for low-income adults 19-64

Website httpwwwingovfssahip

Phone 1-877-438-4479

All other Medicaid

Website httpwwwindianamedicaidcom

Phone 1-800-403-0864

COLORADO ndash Health First Colorado

(Coloradorsquos Medicaid Program) amp Child Health

Plan Plus (CHP+)

IOWA ndash Medicaid

Health First Colorado Website

httpswwwhealthfirstcoloradocom

Health First Colorado Member Contact Center

1-800-221-3943 State Relay 711

CHP+ httpswwwcoloradogovpacifichcpfchild-health-

plan-plus

CHP+ Customer Service 1-800-359-1991 State Relay

711

Website

httpdhsiowagovHawki

Phone 1-800-257-8563

28

KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid

Website httpwwwkdheksgovhcf

Phone 1-785-296-3512

Website httpswwwdhhsnhgovoiihipphtm

Phone 603-271-5218

Toll free number for the HIPP program 1-800-852-3345 ext 5218

KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP

Website httpschfskygov

Phone 1-800-635-2570

Medicaid Website

httpwwwstatenjushumanservices

dmahsclientsmedicaid

Medicaid Phone 609-631-2392

CHIP Website httpwwwnjfamilycareorgindexhtml

CHIP Phone 1-800-701-0710

LOUISIANA ndash Medicaid NEW YORK ndash Medicaid

Website httpdhhlouisianagovindexcfmsubhome1n331

Phone 1-888-695-2447

Website httpswwwhealthnygovhealth_caremedicaid

Phone 1-800-541-2831

MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid

Website httpwwwmainegovdhhsofipublic-assistanceindexhtml

Phone 1-800-442-6003

TTY Maine relay 711

Website httpsmedicaidncdhhsgov

Phone 919-855-4100

MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid

Website httpwwwmassgoveohhsgovdepartmentsmasshealth

Phone 1-800-862-4840

Website httpwwwndgovdhsservicesmedicalservmedicaid

Phone 1-844-854-4825

MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP

Website

httpsmngovdhspeople-we-serveseniorshealth-carehealth-care-

programsprograms-and-servicesother-insurancejsp

Phone 1-800-657-3739

Website httpwwwinsureoklahomaorg

Phone 1-888-365-3742

MISSOURI ndash Medicaid OREGON ndash Medicaid

Website httpwwwdssmogovmhdparticipantspageshipphtm

Phone 573-751-2005

Website httphealthcareoregongovPagesindexaspx

httpwwworegonhealthcaregovindex-eshtml

Phone 1-800-699-9075

MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid

Website httpdphhsmtgovMontanaHealthcareProgramsHIPP

Phone 1-800-694-3084

Website

httpwwwdhspagovprovidermedicalassistancehealthinsuranc

epremiumpaymenthippprogramindexhtm

Phone 1-800-692-7462

NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP

Website httpwwwACCESSNebraskanegov

Phone (855) 632-7633

Lincoln (402) 473-7000

Omaha (402) 595-1178

Website httpwwweohhsrigov

Phone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)

29

NEVADA ndash Medicaid SOUTH CAROLINA ndash Medicaid

Medicaid Website httpsdhcfpnvgov

Medicaid Phone 1-800-992-0900

Website httpswwwscdhhsgov

Phone 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid

Website httpdsssdgov

Phone 1-888-828-0059

Website httpswwwhcawagov

Phone 1-800-562-3022 ext 15473

TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascom

Phone 1-800-440-0493

Website httpmywvhippcom

Toll-free phone 1-855-MyWVHIPP (1-855-699-8447)

UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgov

CHIP Website httphealthutahgovchip

Phone 1-877-543-7669

Website

httpswwwdhswisconsingovpublicationsp1p10095p

df

Phone 1-800-362-3002

VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorg

Phone 1-800-250-8427

Website httpswyequalitycareacs-inccom

Phone 307-777-7531

VIRGINIA ndash Medicaid and CHIP Medicaid Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

Medicaid Phone 1-800-432-5924

CHIP Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

CHIP Phone 1-855-242-8282

To see if any other states have added a premium assistance program since July 31 2019 or for more

information on special enrollment rights contact either

US Department of Labor US Department of Health and Human Services

Employee Benefits Security Administration Centers for Medicare amp Medicaid Services

wwwdolgovagenciesebsa wwwcmshhsgov

1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565

Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond

to a collection of information unless such collection displays a valid Office of Management and Budget (OMB)

control number The Department notes that a Federal agency cannot conduct or sponsor a collection of

information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and

the public is not required to respond to a collection of information unless it displays a currently valid OMB control

number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to

penalty for failing to comply with a collection of information if the collection of information does not display a

currently valid OMB control number See 44 USC 3512

The public reporting burden for this collection of information is estimated to average approximately seven minutes

per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other

aspect of this collection of information including suggestions for reducing this burden to the US Department of

Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance

Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and

reference the OMB Control Number 1210-0137 OMB Control Number 1210-0137 (expires 12312019)

Notes

30

Notes

31

Prepared by

Please contact Reston Associationrsquos Human Resources Department at 703-435-7990 or hrrestonorg with any

questions related to your Total Rewards Guide

copy 2019 McGriff Insurance Services Inc

Page 8: Employee Total Rewards Guide 2020 - Reston Total Rewards Gui… · Recognizing and rewarding employees for achieving a sustainable impact. Award criteria includes: •Progressive

Medical Premium Costs per Paycheck for Employees Hired After 1-1-2019

The amount of your paycheck cost difference will be dependent on the type of coverage you choose

for 2020 (see last column on the table below)

Rates are effective January 1 2020

HRA-HMO

Signature

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $50725 $4682

Employee + 1 $101444 $10535

Employee + Family $147096 $15802

HMO Select

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $58173 5370

Employee + 1 $116340 $12081

Employee + Family $168696 $18122

POS Select

(Kaiser)

Monthly

Billed

Premium to

RA

2020 EE Per

Paycheck

Cost

Employee $85966 $7935

Employee + 1 $171932 $17854

Employee + Family $249293 $26781

NOTE The Health Insurance Premium Bank is still available to those who qualify Request for

assistance must be made annually by December 12th or within 30 days of a qualifying event

8

Dental amp Vision Premium Costs per Paycheck

The following rates represent your monthly Dental and Vision premiums effective January 1 2020

MetLife Dental Per Paycheck

FULL-TIME Cost

Per Paycheck

PART-TIME Cost

Employee $000

Contact HR for cost Employee + 1 $000

Employee + Family $000

VSP Vision Per Paycheck Cost

Employee $513

Employee + Adult $864

Employee + Child $882

Employee + Family $1423

SpecteraUHC Vision Per Paycheck Cost

Employee $415

Employee + Adult $843

Employee + Child $883

Employee + Family $1116

9

Health Insurance ndash Option 1

DHMO HRA Signature In Network You Pay Out-of-Network You Pay

Deductible Coinsurance Out-of-Pocket

$750 Individual$1500 Family (RA funds) 9010

$3000 Individual $6000 Family

(less than regular HMO)

NA

Primary Care and Specialist Office Visit $15 PCP$25 Specialist NO COVERAGE

Emergency Room Visits $75 per visit (waived

if admitted) NO COVERAGE

Hospital ndash Inpatient Stay 10 after deductible NO COVERAGE

Home Health Care 10 after deductible NO COVERAGE

Outpatient Facility Services 10 after deductible NO COVERAGE

X-Ray and Laboratory Services 10 after deductible NO COVERAGE

Specialty Imaging (CTMRIPET scan) 10 after deductible NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Inpatient Facility

10 after deductible NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Outpatient Facility

$7 copay-group therapy $15 copay-individual therapy per visit

NO COVERAGE

Vision (Children Only) $15 PCP$25 Specialist NO COVERAGE

Prescription Drug Program (30 day supply) Generic Drug (Tier 1) Preferred Brand Name Drug (Tier 2) Non-Preferred Brand Drug (Tier 3) Up to 90 day supply ndash 3 co-pays for Plan and Participating Pharmacies Mail Order Up to 90 day supply- 2 co-pays

$0 deductible

Plan $20 Participating $30 Plan $30 Participating $50 Plan $45 Participating $65

$20$30$45

Kaiser Permanente D-HMO HRA Signature (Facilities Only) With the Signature Network members receive quality care at the Kaiser medical centers in Maryland Virginia and the District of Columbia Medical centers offer convenient services including primary care specialty care laboratory radiology and pharmacy at most locations and in some locations optical Signature members also have access to more than 40 hospitals in the region

10

Health Insurance ndash Option 2

Kaiser Permanente HMO Select (Facilities amp Contracted Providers Only) With the Select Network members may receive quality care at the Kaiser medical centers in Maryland Virginia and the District of Columbia Building on the Signature physician network the Select network adds access to more than 15000 contracted community physicians in private practice Select members also have access to more than 40 hospitals in the region

HMO Select In-Network You Pay Out-of-Network

You Pay

Deductible Coinsurance Out-of-Pocket

None 100

$3500 Individual $9400 Family

NA

Primary Care and Specialist Office Visit $30 PCP$40 Specialist NO COVERAGE

Emergency Room Visits $100 per visit

(waived if admitted) NO COVERAGE

Hospital ndash Inpatient Stay $250 per admission NO COVERAGE

Home Health Care No charge NO COVERAGE

Outpatient Facility Services $100 NO COVERAGE

X-Ray and Laboratory Services No charge NO COVERAGE

Specialty Imaging (CTMRIPET scan) $50 per test NO COVERAGE

Chiropractic amp Acupuncture Services $40 copay

20 visits per contract year NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Inpatient Facility

$250 per admission NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Outpatient Facility

$15 copay-group therapy $30 copay-individual therapy per visit

NO COVERAGE

Vision (Children Only) $30 PCP$40 Specialist NO COVERAGE

Prescription Drug Program (30 day supply) Generic Drug (Tier 1) Preferred Brand Name Drug (Tier 2) Non-Preferred Brand Drug (Tier 3) Up to 90 day supply ndash 3 co-pays for Plan and Participating Pharmacies Mail Order Up to 90 day supply- 2 co-pays

$0 deductible

Plan $20 Participating $30 Plan $35 Participating $50 Plan $50 Participating $75

$20$35$50

11

Kaiser Permanente POS Select (Facilities amp Contracted Providers with an Out of Network Option) Members can use in-plan benefits by using a Kaiser facility or a contracted primary care physician Your chosen PCP will provide care and coordinate referrals and hospital admissions Members also have the freedom to choose any other licensed provider outside the provider network however you will be responsible for deductibles and coinsurance above the health planrsquos payment

POS Select In-Network You Pay Out-of-Network

you pay

Deductible Coinsurance Out-of-Pocket

None 100

$3500 Individual $9400 Family

$300 Individual $600 Family

8020 $3000 Individual

$6000 Family

Primary Care and Specialist Office Visit $15 PCP$30 Specialist 20 of UCR

Emergency Room Visits $75 per visit (waived if

admitted) $75 per visit

(waived if admitted)

Hospital ndash Inpatient Stay $250 per admission 20 of UCR

Home Health Care No charge 20 of UCR

Outpatient Facility Services $50 20 of UCR

X-Ray and Laboratory Services No charge 20 of UCR

Specialty Imaging (CTMRIPET scan) No charge 20 of UCR

Mental Health (MG) amp Substance Abuse (SA) ndash Inpatient Facility

$250 per admission 20 of UCR

Mental Health (MG) amp Substance Abuse (SA) ndash Outpatient Facility

$7 copay-group therapy $15 copay-individual therapy per visit

20 of UCR

Vision (Children Only) $15 PCP$30 Specialist per visit 20 of UCR

Prescription Drug Program (30 day supply) Generic Drug (Tier 1) Preferred Brand Name Drug (Tier 2) Non-Preferred Brand Drug (Tier 3) Up to 90 day supply ndash 3 co-pays for Plan and Participating Pharmacies Mail Order Up to 90 day supply- 2 co-pays

$0 deductible

Plan $20 Participating $30 Plan $35 Participating $50 Plan $50 Participating $75

$20$35$50

Health Insurance ndash Option 3

12

Dental Insurance

MetLife Dental PPO The Dental PPO plan is 100 Employer Paid for all tiers and provides comprehensive coverage with a nationwide PPO network This gives members access to more in-network dentists making it easier for them to reduce out-of-pocket costs for covered procedures and treatments Dental procedure frequencies Preventative care covers an exam and cleaning (once every 6 months) Fluoride treatment (two per benefit period under age 19 only) Full mouth X-ray (once every 60 months) Bitewing X-ray (once every 12 months age 14 and over once every 12 months under age 14)

PPO Dental Plan Features In-Network Out-of-Network

Type A Preventive Care Services (oral exams cleanings x-rays sealants)

100 of Fee Schedule 100 of Usual amp Customary

Charge

Type B Basic Restorative Dental Services (fillings simple extractions space maintainers)

80 of Fee Schedule 80 of Usual amp Customary

Charge

Type B Major Surgical Dental Services (Endodontics amp Periodontics)

80 of Fee Schedule 80 of Usual amp Customary

Charge

Type C Major Restorative Dental Services (bridges crowns dentures implants)

50 of Fee Schedule 50 of Usual amp Customary

Charge

Orthodontia (under age 19 only)

Lifetime maximum - $1000 50 of allowed benefit

Calendar Year Deductible Applies to Type B amp C services only

$25 Single $75 Family

Calendar Year Maximum Per Person $1500 combined maxper calendar year

Prior to receiving dental services it is recommended that you first obtain a pre-determination of benefits from your dentist so you know exactly how much your dental insurance will cover Spouses domestic partners and dependent children to age 26 (regardless of student status) are eligible

13

Vision Insurance ndash Option 1

Vision Plan through VSP (Voluntary) VSP is the largest private provider vision carrier in the country VSP contracts with Costcoreg Optical Eye Care Centers of America Inctrade which includes popular stores like EyeMasters VisionWorld and Hour Eyes and other quality retail chains When you visit a VSP participating provider your benefits include routine vision exams lenses and preferred pricing on all patient options Frequency Eye Exam 12 monthsLenses 12 monthsFrames 24 monthsContact Lenses 12 months

Vision Plan Features In-Network Out-of-Network

Annual Routine Eye Exam $10 copay Plan pays up to $45

Eyeglass Lenses (standard) Single Bifocal Trifocal

Covered in Full Covered in Full Covered in Full

Plan pays up to $30 Plan pays up to $50 Plan pays up to $65

Frames $130 allowance then 20 off remaining balance

Plan pays up to $70

Necessary Contact Lenses Covered in Full Plan pays up to $210

Elective Contact Lenses $130 allowance Plan pays up to $105

Elective Contact Lenses fitting and evaluation Covered in Full after $60

copay Not Available

Spouses domestic partners and dependent children to age 19 (or to age 25 if FT student) are eligible

14

Vision Insurance ndash Option 2

Vision Plan through Spectera UHC (Voluntary)

UHC offers you one of the largest vision care networks in the industry Their network includes convenient retail locations including My Eye Dr and Hour Eyes Best of all ndash when you receive care from a participating provider you receive the greatest benefits and money-saving discounts

Frequency Eye Exam 12 monthsLenses 12 monthsFrames 12 monthsContact Lenses 12 months

Vision Plan Features In-Network Out-of-Network

Annual Routine Eye Exam $10 copay Plan pays up to $40

Eyeglass Lenses (standard) Single Bifocal Trifocal

$25 copay $25 copay $25 copay

Plan pays up to $40 Plan pays up to $60 Plan pays up to $80

Frames $2500 copay $130 retail frame

allowance 30 discount above allowance

Plan pays up to $45

Necessary Contact Lenses $25 copay Plan pays up to $210

Elective Contact Lenses

$25 copay from the ldquoCovered contact lens

selectionrdquo All others- $105

allowance

Plan pays up to $105

Elective Contact Lenses fitting and evaluation Covered in Full after $25

copay Not Available

Spouses and dependent children to age 26 are eligible

15

Pre-tax FSA amp DCA

Flexible Spending Account (FSA) through Optum Health The Flexible Spending Account provides employees a means to reduce their taxes by the amount of their out of pocket health-related expenses (subject to eligibility) This tax free savings program allows employees to submit receipts for reimbursement for medical dental vision care prescription drug co-payments and other expenses not covered by our insurance In 2020 employees may contribute up to $2750 per year toward their FSA Employees have until March 14 2020 to use the money in their FSA or else they lose it (This contribution amount could change based on IRS guideline updates)

Dependent Care Spending Account (DCA) through Optum Health The Dependent Care Spending Account provides employees a means to reduce their taxes by the amount of their child care costs to a licensed provider up to $5000 annually

Health Insurance Premium Bank

Reston Association has established a program to help regular full-time and regular part-time employees pay their portion of the health insurance premium This program is only available to employees who are enrolled in or plan to enroll in the Kaiser Permanente HMO health insurance plans offered by the Reston Association Employees are eligible to apply to the Health Insurance Premium Bank if their adjusted gross household incomes are less than or equal to $60000 Requests for assistance must be made annually or at any time there is a qualifying event and submitted to Human Resources with necessary documentation by December 12th of each year To apply complete a request form (available in CommonHumResBenefits) and submit to HR with a copy of your most recent tax return showing adjusted gross household income This threshold is subject to change

16

Life and ADampD Insurance

Basic LifeADampD Insurance Reston Association provides 100 employer paid Life and ADampD Insurance through Sun Life to employees working 25 or more hours per week Coverage becomes effective the first of the month following six months of service

Benefit 2x Annual Earnings to a maximum of $200000 Age reduction Benefit reduced to 65 at age 65 and to 50 at age 70

Optional LifeADampD Insurance for Employee Spouse and Dependent Children

Optional Life Insurance for the employee spouse and dependent children is available at the employeersquos cost Optional Life is not available for domestic partners

Employee Benefit Increments of $10000 to a maximum of the lesser of $300000 or 3x your Basic Annual Earnings

Spouse Benefit Increments of $5000 to a maximum of $150000 Dependent Child Benefit Increments of $1000 to a maximum of $10000

Your amount of Dependent Spouse and Dependent Child Optional Life Insurance cannot exceed 50 of your amount of Optional Life Insurance Initial eligibility period will require evidence of insurability

STD amp LTD Insurance

Short Term and Long Term Disability Reston Association provides eligible employees with short and long-term disability income benefits through Sun Life In the event you become disabled from a non work-related injury or sickness disability income benefits are provided as a source of income These benefits are 100 employer paid

Benefit Short-Term Disability Long-Term Disability

Income Replacement -Eligible Employees -Executives

60 60

Elimination Period - Accidental Injury - Sickness

29 days 90 days

Benefit Period 9 weeks maximum To Social Security

normal retirement age

Benefit Maximum -Eligible Employees -Executives

$1000 per week $6000 per month $8000 per month 17

At a cost of $19month you can enroll in the Legal Resources benefit As a Legal Resources Member you have immediate and ongoing access to comprehensive legal coverage services and expertise that will easily save you money mdash and could save you a whole lot more Covered legal services include

Legal Advice and Consultation Tenant Dispute with Landlord District Court Representation for Civil Action Review of a Financial Contract or Lease Purchase sale or refinance of primary home Traffic Court Representation (includes 1st DUI) Will Preparation Uncontested Divorce Representation Defense of Child in Court (misdemeanor)

Legal Resources

Employee Assistance Program (EAP)

Reston Association offers a free confidential Employee Assistance Program (EAP) to all employees and their eligible dependents Through RArsquos EAP provider Lytle EAP Partners you and your immediate family members have immediate access on your date of hire to confidential professional counseling and referral services for help with anything that affects you or your dependentsrsquo well-being You can reach an EAP counselor by dialing 1-800-327-7272 24 hours a day or you may visit their website at wwwLytleEAPcom (password is reston) for more information Visit wwwLytleEAPcom for web-based legal financial worklife resources There are also work-related resources available online for managers Note Since EAP services are provided as a benefit only RA makes no representation concerning quality of care

18

401(k) Retirement Savings Plan

Reston Association offers two 401(k) retirement savings plans through Ascensusmdasha traditional 401(k) plan in which employee contributions are made pre-tax and a 401(k) Roth in which employee contributions are made after tax RA matches employee contributions dollar for dollar up to a total of 7 of your annual salary You can begin making contributions to the 401(k) plan and become eligible for RArsquos match following six months of service You always own 100 of your salary contributions

It is possible to borrow against a portion of your vested 401(k) account balance by taking a 401(k) loan You may request a participant loan using an application form which can be obtained by contacting Human Resources Your ability to obtain a 401(k) loan will depend on specific qualifying factors (defined in the 401(k) Summary Plan Description document) The 401(k) Plan Administrator will determine whether you satisfy these factors To access your 401(k) plan online httpsmyaccountascensuscomrplink Check account balance and rate of return Change fund elections Request a 401k loan View fund pricing and performance View and print quarterly statements

19

529 College Savings Plan (employer-sponsored)

A 529 college savings plan provides those saving for college with an unmatched combination of benefits You can open a 529 plan for anyone mdash your child grandchild spouse a friend or even yourself Assets in a 529 plan can be used to pay for a variety of higher education expenses including required books tuition room and board supplies and certain other required fees and expenses Earnings in 529 accounts can grow free from federal tax Withdrawals for qualified higher education expenses are free from federal tax Option to set up recurring automatic fund transfers directly from your bank account making it easy for you to invest The account owner rather than the beneficiary maintains control of account assets and determines the timing and amount of distributions Account owners can change beneficiaries without penalty provided the new beneficiary is a member of the previous beneficiaryrsquos family For more information please contact Human Resources

Additional Benefits

Free passes for employees and their dependents to all of RArsquos pools and tennis courts as well as discounted rates for all RA Programs and Camps Some restrictions may apply

Discounted gym membership rates at the Reston YMCA and Crunch Fitness Bike Share Program - Reston Association makes bicycles and helmets available to employees to rent on a daily

basis Please contact Member Services Discounted Tennis Rackets amp Shoes ndash Employees can purchase certain tennis shoes and rackets at wholesale

prices through RArsquos Tennis Department Contact the Tennis Department for more information Discounted autohome insurance - Liberty Mutual Insurance Company partners with RA to offer all employees

discounts on automobile and homeowner insurance Contact John Valenti at JohnValentilibertymutualcom

20

Reston Association provides generous paid time off benefits to accommodate the diverse needs of staff and to provide a positive worklife balance The amount of paid time off you earn per year is based on your years of service In addition Reston Association observes 9 paid holidays and assigns one paid floating holiday per year For more information on paid time off benefits and how to request time off please refer to the Reston Association Employee Handbook

WorkLife Balance ndash Paid Time Off (PTO)

Teleworking

The medical leave bank is available to help employees in extenuating circumstances protect their incomes by receiving paid leave once their personal PTO is used up A maximum of six (6) workweeks may be granted for each Medical Leave Bank request If additional time is necessary a new request must be made For program eligibility and criteria go to CommonHumResBenefits

Medical Leave Bank

Volunteer Release Time

On a per position basis employees may be allowed to telework for part of their workweek or in certain circumstances Such arrangements must be in compliance with the written administrative procedure including being approved in advance by the department director

Employees are encouraged to become involved in their communities lending their voluntary support to programs that enrich the quality of life and opportunities for all citizens This benefit allows employees to take paid-time off during a work day to participate in a volunteer activity that benefits the community at large Such activities are typically sponsored by a charitable or service organization or work with one or more individuals in need of assistance or special service

21

Training amp Career Development

Reston Association offers two types of learning opportunities for employees mdashinformal and formalmdashto foster individual development and training and career planning

I Informal Learning Opportunities (individual development amp training)

Focus on individual acquiring or enhancing specific task andor process skills to perform his or her current job better Typically this type of learning is not ldquodegree- orientedrdquo

Participants may or may not receive attendance or achievement certificate

Conferences workshops seminars webinars online courses etc typically lasting a few hours to one week

Requests for this type of training should be made to your supervisor or department head

II Formal Learning Opportunities (career planning)

Professional DevelopmentCareer Planning

Formalstructured learning geared toward improving and maintaining professional competence enhancing career progression staying abreast of new technologies and best practices developing process skills andor compliance with professional regulations

Future but not degree-oriented CEUs may be earned

May lead to qualification or credential required to obtain or retain specific certification

Opportunity may range from semester-long academic course to 24 month program with wide range of content and learning experience

Tuition Reimbursement Program

Supports formal education goals (AA bachelors masters) of individual to enhance knowledge and skills in specific areaindustry

Learning must be job-related and accomplished at or through accredited learning institution or e-learning platform connected with the institution

Requests for this type of training should be made to Human Resources as soon as foreseeable to ensure best availability of funds to support reimbursement

22

23

Lifetime limit not applicable and enrollment opportunity The lifetime limit on the dollar value of benefits under our medical plan no longer applies Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan Individuals have 30 days from the date of this notice to request enrollment For more information contact Human Resources or call the medical insurance carrier at the telephone number on your identification card

Notice on Patient Protections The medical HMO plan generally allows the designation of a primary care provider You have the right to designate any primary care provider who participates in the network and who is available to accept you or your family members Until you make this designation the medical carrier designates one for you For information on how to select a primary care provider and for a list of the participating primary care providers contact the medical insurance carrier at the number listed on your identification card

For children you may designate a pediatrician as the primary care provider You do not need prior authorization from the medical insurance carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in the network who specializes in obstetrics or gynecology The health care professional however may be required to comply with certain procedures including obtaining prior authorization for certain services following a pre-approved treatment plan or procedures for making referrals For a list of participating health care professionals who specialize in obstetrics or gynecology contact the medical insurance carrier at the number listed on your identification card

OTC Drug Reimbursements for FSAsHRAsHSAs Under the new Health Care Reform law (PPACA) the cost of an over-the-counter medicine or drug cannot be reimbursed from the account unless a prescription is obtained The change does not affect insulin even if purchased without a prescription or other health care expenses such as medical devices eyeglasses contact lenses co-pays and deductibles The new standard applies only to purchases made on or after January 1 2011

A similar rule is in effect for Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs)

The IRS has also posted a questions and answers section on its website httpwwwirsgovnewsroomarticle0id=22730800html concerning these provisions

Patient Protection and Affordable Care Act (PPACA) Mandatory Notices

The text below is an annual open enrollment required notice

24

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION PLEASE REVIEW IT CAREFULLY

Our Pledge to You

This notice is intended to inform you of the privacy practices followed by the Reston Associationrsquos Employee Benefit Plan (the Plan) and the Planrsquos legal obligations regarding your protected health information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) The notice also explains the privacy rights you and your family members have as participants of the Plan It is effective on April 14 2011

The Plan often needs access to your protected health information in order to provide payment for health services and perform plan administrative functions We want to assure the plan participants covered under the Plan that we comply with federal privacy laws and respect your right to privacy Reston Association requires all members of our workforce and third parties that are provided access to protected health information to comply with the privacy practices outlined in this notice

Protected Health Information Your protected health information is protected by the HIPAA Privacy Rule Generally protected health information is information that identifies an individual created or received by a health care provider health plan or an employer on behalf of a group health plan that relates to physical or mental health conditions provision of health care or payment for health care whether past present or future

How We May Use Your Protected Health Information Under the HIPAA Privacy Rule we may use or disclose your protected health information for certain purposes without your permission This section describes the ways we can use and disclose your protected health information

bull Payment We use or disclose your protected health information without your written authorization in order to determine eligibility for benefits seek reimbursement from a third party or coordinate benefits with another health plan under which you are covered For example a health care provider that provided treatment to you will provide us with your health information We use that information in order to determine whether those services are eligible for payment under our group health plan

bull Health Care Operations We use and disclose your protected health information in order to perform plan administration functions such as quality assurance activities resolution of internal grievances and evaluating plan performance For example we review claims experience in order to understand participant utilization and to make plan design changes that are intended to control health care costs

bull Treatment Although the law allows use and disclosure of your protected health information for purposes of treatment as a health plan we generally do not need to disclose your information for treatment purposes Your physician or health care provider is required to provide you with an explanation of how they use and share your health information for purposes of treatment payment and health care operations

bull As permitted or required by law We may also use or disclose your protected health information without your written authorization for other reasons as permitted by law We are permitted by law to share information subject to certain requirements in order to communicate information on health-related benefits or services that may be of interest to you respond to a court order or provide information to further public health activities (eg preventing the spread of disease) without your written authorization We are also permitted to share protected health information during a corporate restructuring such as a merger sale or acquisition We will also disclose health information about you when required by law for example in order to prevent serious harm to you or others

The text below is an annual open enrollment required notice

25

Notice of Privacy Practices

bull Pursuant to your Authorization When required by law we will ask for your written authorization before using or disclosing your protected health information If you choose to sign an authorization to disclose information you can later revoke that authorization to prevent any future uses or disclosures

bull To Business Associates We may enter into contracts with entities known as Business Associates that provide services to or perform functions on behalf of the Plan We may disclose protected health information to Business Associates once they have agreed in writing to safeguard the protected health information For example we may disclose your protected health information to a Business Associate to administer claims Business Associates are also required by law to protect protected health information

bull To the Plan Sponsor We may disclose protected health information to certain employees of Reston Association for the purpose of administering the Plan These employees will use or disclose the protected health information only as necessary to perform plan administration functions or as otherwise required by HIPAA unless you have authorized additional disclosures Your protected health information cannot be used for employment purposes without your specific authorization

Your Rights bull Right to Inspect and Copy In most cases you have the right to inspect and copy the protected health

information we maintain about you If you request copies we will charge you a reasonable fee to cover the costs of copying mailing or other expenses associated with your request Your request to inspect or review your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to inspect and copy your health information To the extent your information is held in an electronic health record you may be able to receive the information in an electronic format

bull Right to Amend If you believe that information within your records is incorrect or if important information is missing you have the right to request that we correct the existing information or add the missing information Your request to amend your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to amend your health information If we deny your request you may file a statement of disagreement with us for inclusion in any future disclosures of the disputed information

bull Right to an Accounting of Disclosures You have the right to receive an accounting of certain disclosures of your protected health information The accounting will not include disclosures that were made (1) for purposes of treatment payment or health care operations (2) to you (3) pursuant to your authorization (4) to your friends or family in your presence or because of an emergency (5) for national security purposes or (6) incidental to otherwise permissible disclosures

Your request to for an accounting must be submitted in writing to the person listed below You may request an accounting of disclosures made within the last six years You may request one accounting free of charge within a 12-month period

The text below is an annual open enrollment required notice

25

26

The information provided herein is intended to be a summary of benefits only and in no way supersedes the actual plan documents provided by the insurance carriersadministrators For more detailed information pertaining to your employee benefit plans including limitations and exclusions

please refer to the plan documents andor evidence of coverage provided by the carriersadministrators

Womenrsquos Health and Cancer Rights Act of 1998

If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos Health and Cancer Rights Act of 1998 (WHCRA) For individuals receiving mastectomy-related benefits coverage will be provided in a manner determined in consultation with the attending physician and the patient for

bull All stages of reconstruction of the breast on which the mastectomy was performed bull Surgery and reconstruction of the other breast to produce a symmetrical appearance bull Prostheses and bull Treatment of physical complications of the mastectomy including lymphedema

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan If you would like more information on WHCRA benefits call your plan administrator

CHIP-Childrens Health Insurance Program (CHIP) Reauthorization Act of 2009

Medicaid and the Childrenrsquos Health Insurance Program (CHIP) offer free or low-cost health coverage to children and families If you are eligible for health coverage from your employer but are unable to afford the premiums some States have premium assistance programs that can help pay for coverage These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage but need assistance in paying their health premiums

If you or your dependents are already enrolled in Medicaid or CHIP you can contact your state Medicaid or CHIP office to find out if premium assistance is available For a list of the contacts in each State go to wwwdolgovebsachipmodelnoticedoc

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify you can then contact the State to find out if it has a program that might help you pay the premiums for an employer-sponsored plan

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP your employerrsquos health plan is required to permit you and your dependents to enroll in the plan ndash as long as you and your dependents are eligible but not already enrolled in the employerrsquos plan This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance

The text below is an annual open enrollment required notice

26

27

Premium Assistance Under Medicaid and the

Childrenrsquos Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your

employer your state may have a premium assistance program that can help pay for coverage using funds

from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot

be eligible for these premium assistance programs but you may be able to buy individual insurance coverage

through the Health Insurance Marketplace For more information visit wwwhealthcaregov

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below

contact your State Medicaid or CHIP office to find out if premium assistance is available

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your

dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-

877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a

program that might help you pay the premiums for an employer-sponsored plan

If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible

under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already

enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days

of being determined eligible for premium assistance If you have questions about enrolling in your

employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)

If you live in one of the following states you may be eligible for assistance paying your employer

health plan premiums The following list of states is current as of July 31 2019 Contact your State for

more information on eligibility ndash

ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcom

Phone 1-855-692-5447

Website httpflmedicaidtplrecoverycomhipp

Phone 1-877-357-3268

ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program

Website httpmyakhippcom

Phone 1-866-251-4861

Email CustomerServiceMyAKHIPPcom

Medicaid Eligibility

httpdhssalaskagovdpaPagesmedicaiddefaultaspx

Website httpsmedicaidgeorgiagovhealth-

insurance-premium-payment-program-hipp

Phone 678-564-1162 ext 2131

ARKANSAS ndash Medicaid INDIANA ndash Medicaid

Website httpmyarhippcom

Phone 1-855-MyARHIPP (855-692-7447)

Healthy Indiana Plan for low-income adults 19-64

Website httpwwwingovfssahip

Phone 1-877-438-4479

All other Medicaid

Website httpwwwindianamedicaidcom

Phone 1-800-403-0864

COLORADO ndash Health First Colorado

(Coloradorsquos Medicaid Program) amp Child Health

Plan Plus (CHP+)

IOWA ndash Medicaid

Health First Colorado Website

httpswwwhealthfirstcoloradocom

Health First Colorado Member Contact Center

1-800-221-3943 State Relay 711

CHP+ httpswwwcoloradogovpacifichcpfchild-health-

plan-plus

CHP+ Customer Service 1-800-359-1991 State Relay

711

Website

httpdhsiowagovHawki

Phone 1-800-257-8563

28

KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid

Website httpwwwkdheksgovhcf

Phone 1-785-296-3512

Website httpswwwdhhsnhgovoiihipphtm

Phone 603-271-5218

Toll free number for the HIPP program 1-800-852-3345 ext 5218

KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP

Website httpschfskygov

Phone 1-800-635-2570

Medicaid Website

httpwwwstatenjushumanservices

dmahsclientsmedicaid

Medicaid Phone 609-631-2392

CHIP Website httpwwwnjfamilycareorgindexhtml

CHIP Phone 1-800-701-0710

LOUISIANA ndash Medicaid NEW YORK ndash Medicaid

Website httpdhhlouisianagovindexcfmsubhome1n331

Phone 1-888-695-2447

Website httpswwwhealthnygovhealth_caremedicaid

Phone 1-800-541-2831

MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid

Website httpwwwmainegovdhhsofipublic-assistanceindexhtml

Phone 1-800-442-6003

TTY Maine relay 711

Website httpsmedicaidncdhhsgov

Phone 919-855-4100

MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid

Website httpwwwmassgoveohhsgovdepartmentsmasshealth

Phone 1-800-862-4840

Website httpwwwndgovdhsservicesmedicalservmedicaid

Phone 1-844-854-4825

MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP

Website

httpsmngovdhspeople-we-serveseniorshealth-carehealth-care-

programsprograms-and-servicesother-insurancejsp

Phone 1-800-657-3739

Website httpwwwinsureoklahomaorg

Phone 1-888-365-3742

MISSOURI ndash Medicaid OREGON ndash Medicaid

Website httpwwwdssmogovmhdparticipantspageshipphtm

Phone 573-751-2005

Website httphealthcareoregongovPagesindexaspx

httpwwworegonhealthcaregovindex-eshtml

Phone 1-800-699-9075

MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid

Website httpdphhsmtgovMontanaHealthcareProgramsHIPP

Phone 1-800-694-3084

Website

httpwwwdhspagovprovidermedicalassistancehealthinsuranc

epremiumpaymenthippprogramindexhtm

Phone 1-800-692-7462

NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP

Website httpwwwACCESSNebraskanegov

Phone (855) 632-7633

Lincoln (402) 473-7000

Omaha (402) 595-1178

Website httpwwweohhsrigov

Phone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)

29

NEVADA ndash Medicaid SOUTH CAROLINA ndash Medicaid

Medicaid Website httpsdhcfpnvgov

Medicaid Phone 1-800-992-0900

Website httpswwwscdhhsgov

Phone 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid

Website httpdsssdgov

Phone 1-888-828-0059

Website httpswwwhcawagov

Phone 1-800-562-3022 ext 15473

TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascom

Phone 1-800-440-0493

Website httpmywvhippcom

Toll-free phone 1-855-MyWVHIPP (1-855-699-8447)

UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgov

CHIP Website httphealthutahgovchip

Phone 1-877-543-7669

Website

httpswwwdhswisconsingovpublicationsp1p10095p

df

Phone 1-800-362-3002

VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorg

Phone 1-800-250-8427

Website httpswyequalitycareacs-inccom

Phone 307-777-7531

VIRGINIA ndash Medicaid and CHIP Medicaid Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

Medicaid Phone 1-800-432-5924

CHIP Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

CHIP Phone 1-855-242-8282

To see if any other states have added a premium assistance program since July 31 2019 or for more

information on special enrollment rights contact either

US Department of Labor US Department of Health and Human Services

Employee Benefits Security Administration Centers for Medicare amp Medicaid Services

wwwdolgovagenciesebsa wwwcmshhsgov

1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565

Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond

to a collection of information unless such collection displays a valid Office of Management and Budget (OMB)

control number The Department notes that a Federal agency cannot conduct or sponsor a collection of

information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and

the public is not required to respond to a collection of information unless it displays a currently valid OMB control

number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to

penalty for failing to comply with a collection of information if the collection of information does not display a

currently valid OMB control number See 44 USC 3512

The public reporting burden for this collection of information is estimated to average approximately seven minutes

per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other

aspect of this collection of information including suggestions for reducing this burden to the US Department of

Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance

Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and

reference the OMB Control Number 1210-0137 OMB Control Number 1210-0137 (expires 12312019)

Notes

30

Notes

31

Prepared by

Please contact Reston Associationrsquos Human Resources Department at 703-435-7990 or hrrestonorg with any

questions related to your Total Rewards Guide

copy 2019 McGriff Insurance Services Inc

Page 9: Employee Total Rewards Guide 2020 - Reston Total Rewards Gui… · Recognizing and rewarding employees for achieving a sustainable impact. Award criteria includes: •Progressive

Dental amp Vision Premium Costs per Paycheck

The following rates represent your monthly Dental and Vision premiums effective January 1 2020

MetLife Dental Per Paycheck

FULL-TIME Cost

Per Paycheck

PART-TIME Cost

Employee $000

Contact HR for cost Employee + 1 $000

Employee + Family $000

VSP Vision Per Paycheck Cost

Employee $513

Employee + Adult $864

Employee + Child $882

Employee + Family $1423

SpecteraUHC Vision Per Paycheck Cost

Employee $415

Employee + Adult $843

Employee + Child $883

Employee + Family $1116

9

Health Insurance ndash Option 1

DHMO HRA Signature In Network You Pay Out-of-Network You Pay

Deductible Coinsurance Out-of-Pocket

$750 Individual$1500 Family (RA funds) 9010

$3000 Individual $6000 Family

(less than regular HMO)

NA

Primary Care and Specialist Office Visit $15 PCP$25 Specialist NO COVERAGE

Emergency Room Visits $75 per visit (waived

if admitted) NO COVERAGE

Hospital ndash Inpatient Stay 10 after deductible NO COVERAGE

Home Health Care 10 after deductible NO COVERAGE

Outpatient Facility Services 10 after deductible NO COVERAGE

X-Ray and Laboratory Services 10 after deductible NO COVERAGE

Specialty Imaging (CTMRIPET scan) 10 after deductible NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Inpatient Facility

10 after deductible NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Outpatient Facility

$7 copay-group therapy $15 copay-individual therapy per visit

NO COVERAGE

Vision (Children Only) $15 PCP$25 Specialist NO COVERAGE

Prescription Drug Program (30 day supply) Generic Drug (Tier 1) Preferred Brand Name Drug (Tier 2) Non-Preferred Brand Drug (Tier 3) Up to 90 day supply ndash 3 co-pays for Plan and Participating Pharmacies Mail Order Up to 90 day supply- 2 co-pays

$0 deductible

Plan $20 Participating $30 Plan $30 Participating $50 Plan $45 Participating $65

$20$30$45

Kaiser Permanente D-HMO HRA Signature (Facilities Only) With the Signature Network members receive quality care at the Kaiser medical centers in Maryland Virginia and the District of Columbia Medical centers offer convenient services including primary care specialty care laboratory radiology and pharmacy at most locations and in some locations optical Signature members also have access to more than 40 hospitals in the region

10

Health Insurance ndash Option 2

Kaiser Permanente HMO Select (Facilities amp Contracted Providers Only) With the Select Network members may receive quality care at the Kaiser medical centers in Maryland Virginia and the District of Columbia Building on the Signature physician network the Select network adds access to more than 15000 contracted community physicians in private practice Select members also have access to more than 40 hospitals in the region

HMO Select In-Network You Pay Out-of-Network

You Pay

Deductible Coinsurance Out-of-Pocket

None 100

$3500 Individual $9400 Family

NA

Primary Care and Specialist Office Visit $30 PCP$40 Specialist NO COVERAGE

Emergency Room Visits $100 per visit

(waived if admitted) NO COVERAGE

Hospital ndash Inpatient Stay $250 per admission NO COVERAGE

Home Health Care No charge NO COVERAGE

Outpatient Facility Services $100 NO COVERAGE

X-Ray and Laboratory Services No charge NO COVERAGE

Specialty Imaging (CTMRIPET scan) $50 per test NO COVERAGE

Chiropractic amp Acupuncture Services $40 copay

20 visits per contract year NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Inpatient Facility

$250 per admission NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Outpatient Facility

$15 copay-group therapy $30 copay-individual therapy per visit

NO COVERAGE

Vision (Children Only) $30 PCP$40 Specialist NO COVERAGE

Prescription Drug Program (30 day supply) Generic Drug (Tier 1) Preferred Brand Name Drug (Tier 2) Non-Preferred Brand Drug (Tier 3) Up to 90 day supply ndash 3 co-pays for Plan and Participating Pharmacies Mail Order Up to 90 day supply- 2 co-pays

$0 deductible

Plan $20 Participating $30 Plan $35 Participating $50 Plan $50 Participating $75

$20$35$50

11

Kaiser Permanente POS Select (Facilities amp Contracted Providers with an Out of Network Option) Members can use in-plan benefits by using a Kaiser facility or a contracted primary care physician Your chosen PCP will provide care and coordinate referrals and hospital admissions Members also have the freedom to choose any other licensed provider outside the provider network however you will be responsible for deductibles and coinsurance above the health planrsquos payment

POS Select In-Network You Pay Out-of-Network

you pay

Deductible Coinsurance Out-of-Pocket

None 100

$3500 Individual $9400 Family

$300 Individual $600 Family

8020 $3000 Individual

$6000 Family

Primary Care and Specialist Office Visit $15 PCP$30 Specialist 20 of UCR

Emergency Room Visits $75 per visit (waived if

admitted) $75 per visit

(waived if admitted)

Hospital ndash Inpatient Stay $250 per admission 20 of UCR

Home Health Care No charge 20 of UCR

Outpatient Facility Services $50 20 of UCR

X-Ray and Laboratory Services No charge 20 of UCR

Specialty Imaging (CTMRIPET scan) No charge 20 of UCR

Mental Health (MG) amp Substance Abuse (SA) ndash Inpatient Facility

$250 per admission 20 of UCR

Mental Health (MG) amp Substance Abuse (SA) ndash Outpatient Facility

$7 copay-group therapy $15 copay-individual therapy per visit

20 of UCR

Vision (Children Only) $15 PCP$30 Specialist per visit 20 of UCR

Prescription Drug Program (30 day supply) Generic Drug (Tier 1) Preferred Brand Name Drug (Tier 2) Non-Preferred Brand Drug (Tier 3) Up to 90 day supply ndash 3 co-pays for Plan and Participating Pharmacies Mail Order Up to 90 day supply- 2 co-pays

$0 deductible

Plan $20 Participating $30 Plan $35 Participating $50 Plan $50 Participating $75

$20$35$50

Health Insurance ndash Option 3

12

Dental Insurance

MetLife Dental PPO The Dental PPO plan is 100 Employer Paid for all tiers and provides comprehensive coverage with a nationwide PPO network This gives members access to more in-network dentists making it easier for them to reduce out-of-pocket costs for covered procedures and treatments Dental procedure frequencies Preventative care covers an exam and cleaning (once every 6 months) Fluoride treatment (two per benefit period under age 19 only) Full mouth X-ray (once every 60 months) Bitewing X-ray (once every 12 months age 14 and over once every 12 months under age 14)

PPO Dental Plan Features In-Network Out-of-Network

Type A Preventive Care Services (oral exams cleanings x-rays sealants)

100 of Fee Schedule 100 of Usual amp Customary

Charge

Type B Basic Restorative Dental Services (fillings simple extractions space maintainers)

80 of Fee Schedule 80 of Usual amp Customary

Charge

Type B Major Surgical Dental Services (Endodontics amp Periodontics)

80 of Fee Schedule 80 of Usual amp Customary

Charge

Type C Major Restorative Dental Services (bridges crowns dentures implants)

50 of Fee Schedule 50 of Usual amp Customary

Charge

Orthodontia (under age 19 only)

Lifetime maximum - $1000 50 of allowed benefit

Calendar Year Deductible Applies to Type B amp C services only

$25 Single $75 Family

Calendar Year Maximum Per Person $1500 combined maxper calendar year

Prior to receiving dental services it is recommended that you first obtain a pre-determination of benefits from your dentist so you know exactly how much your dental insurance will cover Spouses domestic partners and dependent children to age 26 (regardless of student status) are eligible

13

Vision Insurance ndash Option 1

Vision Plan through VSP (Voluntary) VSP is the largest private provider vision carrier in the country VSP contracts with Costcoreg Optical Eye Care Centers of America Inctrade which includes popular stores like EyeMasters VisionWorld and Hour Eyes and other quality retail chains When you visit a VSP participating provider your benefits include routine vision exams lenses and preferred pricing on all patient options Frequency Eye Exam 12 monthsLenses 12 monthsFrames 24 monthsContact Lenses 12 months

Vision Plan Features In-Network Out-of-Network

Annual Routine Eye Exam $10 copay Plan pays up to $45

Eyeglass Lenses (standard) Single Bifocal Trifocal

Covered in Full Covered in Full Covered in Full

Plan pays up to $30 Plan pays up to $50 Plan pays up to $65

Frames $130 allowance then 20 off remaining balance

Plan pays up to $70

Necessary Contact Lenses Covered in Full Plan pays up to $210

Elective Contact Lenses $130 allowance Plan pays up to $105

Elective Contact Lenses fitting and evaluation Covered in Full after $60

copay Not Available

Spouses domestic partners and dependent children to age 19 (or to age 25 if FT student) are eligible

14

Vision Insurance ndash Option 2

Vision Plan through Spectera UHC (Voluntary)

UHC offers you one of the largest vision care networks in the industry Their network includes convenient retail locations including My Eye Dr and Hour Eyes Best of all ndash when you receive care from a participating provider you receive the greatest benefits and money-saving discounts

Frequency Eye Exam 12 monthsLenses 12 monthsFrames 12 monthsContact Lenses 12 months

Vision Plan Features In-Network Out-of-Network

Annual Routine Eye Exam $10 copay Plan pays up to $40

Eyeglass Lenses (standard) Single Bifocal Trifocal

$25 copay $25 copay $25 copay

Plan pays up to $40 Plan pays up to $60 Plan pays up to $80

Frames $2500 copay $130 retail frame

allowance 30 discount above allowance

Plan pays up to $45

Necessary Contact Lenses $25 copay Plan pays up to $210

Elective Contact Lenses

$25 copay from the ldquoCovered contact lens

selectionrdquo All others- $105

allowance

Plan pays up to $105

Elective Contact Lenses fitting and evaluation Covered in Full after $25

copay Not Available

Spouses and dependent children to age 26 are eligible

15

Pre-tax FSA amp DCA

Flexible Spending Account (FSA) through Optum Health The Flexible Spending Account provides employees a means to reduce their taxes by the amount of their out of pocket health-related expenses (subject to eligibility) This tax free savings program allows employees to submit receipts for reimbursement for medical dental vision care prescription drug co-payments and other expenses not covered by our insurance In 2020 employees may contribute up to $2750 per year toward their FSA Employees have until March 14 2020 to use the money in their FSA or else they lose it (This contribution amount could change based on IRS guideline updates)

Dependent Care Spending Account (DCA) through Optum Health The Dependent Care Spending Account provides employees a means to reduce their taxes by the amount of their child care costs to a licensed provider up to $5000 annually

Health Insurance Premium Bank

Reston Association has established a program to help regular full-time and regular part-time employees pay their portion of the health insurance premium This program is only available to employees who are enrolled in or plan to enroll in the Kaiser Permanente HMO health insurance plans offered by the Reston Association Employees are eligible to apply to the Health Insurance Premium Bank if their adjusted gross household incomes are less than or equal to $60000 Requests for assistance must be made annually or at any time there is a qualifying event and submitted to Human Resources with necessary documentation by December 12th of each year To apply complete a request form (available in CommonHumResBenefits) and submit to HR with a copy of your most recent tax return showing adjusted gross household income This threshold is subject to change

16

Life and ADampD Insurance

Basic LifeADampD Insurance Reston Association provides 100 employer paid Life and ADampD Insurance through Sun Life to employees working 25 or more hours per week Coverage becomes effective the first of the month following six months of service

Benefit 2x Annual Earnings to a maximum of $200000 Age reduction Benefit reduced to 65 at age 65 and to 50 at age 70

Optional LifeADampD Insurance for Employee Spouse and Dependent Children

Optional Life Insurance for the employee spouse and dependent children is available at the employeersquos cost Optional Life is not available for domestic partners

Employee Benefit Increments of $10000 to a maximum of the lesser of $300000 or 3x your Basic Annual Earnings

Spouse Benefit Increments of $5000 to a maximum of $150000 Dependent Child Benefit Increments of $1000 to a maximum of $10000

Your amount of Dependent Spouse and Dependent Child Optional Life Insurance cannot exceed 50 of your amount of Optional Life Insurance Initial eligibility period will require evidence of insurability

STD amp LTD Insurance

Short Term and Long Term Disability Reston Association provides eligible employees with short and long-term disability income benefits through Sun Life In the event you become disabled from a non work-related injury or sickness disability income benefits are provided as a source of income These benefits are 100 employer paid

Benefit Short-Term Disability Long-Term Disability

Income Replacement -Eligible Employees -Executives

60 60

Elimination Period - Accidental Injury - Sickness

29 days 90 days

Benefit Period 9 weeks maximum To Social Security

normal retirement age

Benefit Maximum -Eligible Employees -Executives

$1000 per week $6000 per month $8000 per month 17

At a cost of $19month you can enroll in the Legal Resources benefit As a Legal Resources Member you have immediate and ongoing access to comprehensive legal coverage services and expertise that will easily save you money mdash and could save you a whole lot more Covered legal services include

Legal Advice and Consultation Tenant Dispute with Landlord District Court Representation for Civil Action Review of a Financial Contract or Lease Purchase sale or refinance of primary home Traffic Court Representation (includes 1st DUI) Will Preparation Uncontested Divorce Representation Defense of Child in Court (misdemeanor)

Legal Resources

Employee Assistance Program (EAP)

Reston Association offers a free confidential Employee Assistance Program (EAP) to all employees and their eligible dependents Through RArsquos EAP provider Lytle EAP Partners you and your immediate family members have immediate access on your date of hire to confidential professional counseling and referral services for help with anything that affects you or your dependentsrsquo well-being You can reach an EAP counselor by dialing 1-800-327-7272 24 hours a day or you may visit their website at wwwLytleEAPcom (password is reston) for more information Visit wwwLytleEAPcom for web-based legal financial worklife resources There are also work-related resources available online for managers Note Since EAP services are provided as a benefit only RA makes no representation concerning quality of care

18

401(k) Retirement Savings Plan

Reston Association offers two 401(k) retirement savings plans through Ascensusmdasha traditional 401(k) plan in which employee contributions are made pre-tax and a 401(k) Roth in which employee contributions are made after tax RA matches employee contributions dollar for dollar up to a total of 7 of your annual salary You can begin making contributions to the 401(k) plan and become eligible for RArsquos match following six months of service You always own 100 of your salary contributions

It is possible to borrow against a portion of your vested 401(k) account balance by taking a 401(k) loan You may request a participant loan using an application form which can be obtained by contacting Human Resources Your ability to obtain a 401(k) loan will depend on specific qualifying factors (defined in the 401(k) Summary Plan Description document) The 401(k) Plan Administrator will determine whether you satisfy these factors To access your 401(k) plan online httpsmyaccountascensuscomrplink Check account balance and rate of return Change fund elections Request a 401k loan View fund pricing and performance View and print quarterly statements

19

529 College Savings Plan (employer-sponsored)

A 529 college savings plan provides those saving for college with an unmatched combination of benefits You can open a 529 plan for anyone mdash your child grandchild spouse a friend or even yourself Assets in a 529 plan can be used to pay for a variety of higher education expenses including required books tuition room and board supplies and certain other required fees and expenses Earnings in 529 accounts can grow free from federal tax Withdrawals for qualified higher education expenses are free from federal tax Option to set up recurring automatic fund transfers directly from your bank account making it easy for you to invest The account owner rather than the beneficiary maintains control of account assets and determines the timing and amount of distributions Account owners can change beneficiaries without penalty provided the new beneficiary is a member of the previous beneficiaryrsquos family For more information please contact Human Resources

Additional Benefits

Free passes for employees and their dependents to all of RArsquos pools and tennis courts as well as discounted rates for all RA Programs and Camps Some restrictions may apply

Discounted gym membership rates at the Reston YMCA and Crunch Fitness Bike Share Program - Reston Association makes bicycles and helmets available to employees to rent on a daily

basis Please contact Member Services Discounted Tennis Rackets amp Shoes ndash Employees can purchase certain tennis shoes and rackets at wholesale

prices through RArsquos Tennis Department Contact the Tennis Department for more information Discounted autohome insurance - Liberty Mutual Insurance Company partners with RA to offer all employees

discounts on automobile and homeowner insurance Contact John Valenti at JohnValentilibertymutualcom

20

Reston Association provides generous paid time off benefits to accommodate the diverse needs of staff and to provide a positive worklife balance The amount of paid time off you earn per year is based on your years of service In addition Reston Association observes 9 paid holidays and assigns one paid floating holiday per year For more information on paid time off benefits and how to request time off please refer to the Reston Association Employee Handbook

WorkLife Balance ndash Paid Time Off (PTO)

Teleworking

The medical leave bank is available to help employees in extenuating circumstances protect their incomes by receiving paid leave once their personal PTO is used up A maximum of six (6) workweeks may be granted for each Medical Leave Bank request If additional time is necessary a new request must be made For program eligibility and criteria go to CommonHumResBenefits

Medical Leave Bank

Volunteer Release Time

On a per position basis employees may be allowed to telework for part of their workweek or in certain circumstances Such arrangements must be in compliance with the written administrative procedure including being approved in advance by the department director

Employees are encouraged to become involved in their communities lending their voluntary support to programs that enrich the quality of life and opportunities for all citizens This benefit allows employees to take paid-time off during a work day to participate in a volunteer activity that benefits the community at large Such activities are typically sponsored by a charitable or service organization or work with one or more individuals in need of assistance or special service

21

Training amp Career Development

Reston Association offers two types of learning opportunities for employees mdashinformal and formalmdashto foster individual development and training and career planning

I Informal Learning Opportunities (individual development amp training)

Focus on individual acquiring or enhancing specific task andor process skills to perform his or her current job better Typically this type of learning is not ldquodegree- orientedrdquo

Participants may or may not receive attendance or achievement certificate

Conferences workshops seminars webinars online courses etc typically lasting a few hours to one week

Requests for this type of training should be made to your supervisor or department head

II Formal Learning Opportunities (career planning)

Professional DevelopmentCareer Planning

Formalstructured learning geared toward improving and maintaining professional competence enhancing career progression staying abreast of new technologies and best practices developing process skills andor compliance with professional regulations

Future but not degree-oriented CEUs may be earned

May lead to qualification or credential required to obtain or retain specific certification

Opportunity may range from semester-long academic course to 24 month program with wide range of content and learning experience

Tuition Reimbursement Program

Supports formal education goals (AA bachelors masters) of individual to enhance knowledge and skills in specific areaindustry

Learning must be job-related and accomplished at or through accredited learning institution or e-learning platform connected with the institution

Requests for this type of training should be made to Human Resources as soon as foreseeable to ensure best availability of funds to support reimbursement

22

23

Lifetime limit not applicable and enrollment opportunity The lifetime limit on the dollar value of benefits under our medical plan no longer applies Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan Individuals have 30 days from the date of this notice to request enrollment For more information contact Human Resources or call the medical insurance carrier at the telephone number on your identification card

Notice on Patient Protections The medical HMO plan generally allows the designation of a primary care provider You have the right to designate any primary care provider who participates in the network and who is available to accept you or your family members Until you make this designation the medical carrier designates one for you For information on how to select a primary care provider and for a list of the participating primary care providers contact the medical insurance carrier at the number listed on your identification card

For children you may designate a pediatrician as the primary care provider You do not need prior authorization from the medical insurance carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in the network who specializes in obstetrics or gynecology The health care professional however may be required to comply with certain procedures including obtaining prior authorization for certain services following a pre-approved treatment plan or procedures for making referrals For a list of participating health care professionals who specialize in obstetrics or gynecology contact the medical insurance carrier at the number listed on your identification card

OTC Drug Reimbursements for FSAsHRAsHSAs Under the new Health Care Reform law (PPACA) the cost of an over-the-counter medicine or drug cannot be reimbursed from the account unless a prescription is obtained The change does not affect insulin even if purchased without a prescription or other health care expenses such as medical devices eyeglasses contact lenses co-pays and deductibles The new standard applies only to purchases made on or after January 1 2011

A similar rule is in effect for Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs)

The IRS has also posted a questions and answers section on its website httpwwwirsgovnewsroomarticle0id=22730800html concerning these provisions

Patient Protection and Affordable Care Act (PPACA) Mandatory Notices

The text below is an annual open enrollment required notice

24

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION PLEASE REVIEW IT CAREFULLY

Our Pledge to You

This notice is intended to inform you of the privacy practices followed by the Reston Associationrsquos Employee Benefit Plan (the Plan) and the Planrsquos legal obligations regarding your protected health information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) The notice also explains the privacy rights you and your family members have as participants of the Plan It is effective on April 14 2011

The Plan often needs access to your protected health information in order to provide payment for health services and perform plan administrative functions We want to assure the plan participants covered under the Plan that we comply with federal privacy laws and respect your right to privacy Reston Association requires all members of our workforce and third parties that are provided access to protected health information to comply with the privacy practices outlined in this notice

Protected Health Information Your protected health information is protected by the HIPAA Privacy Rule Generally protected health information is information that identifies an individual created or received by a health care provider health plan or an employer on behalf of a group health plan that relates to physical or mental health conditions provision of health care or payment for health care whether past present or future

How We May Use Your Protected Health Information Under the HIPAA Privacy Rule we may use or disclose your protected health information for certain purposes without your permission This section describes the ways we can use and disclose your protected health information

bull Payment We use or disclose your protected health information without your written authorization in order to determine eligibility for benefits seek reimbursement from a third party or coordinate benefits with another health plan under which you are covered For example a health care provider that provided treatment to you will provide us with your health information We use that information in order to determine whether those services are eligible for payment under our group health plan

bull Health Care Operations We use and disclose your protected health information in order to perform plan administration functions such as quality assurance activities resolution of internal grievances and evaluating plan performance For example we review claims experience in order to understand participant utilization and to make plan design changes that are intended to control health care costs

bull Treatment Although the law allows use and disclosure of your protected health information for purposes of treatment as a health plan we generally do not need to disclose your information for treatment purposes Your physician or health care provider is required to provide you with an explanation of how they use and share your health information for purposes of treatment payment and health care operations

bull As permitted or required by law We may also use or disclose your protected health information without your written authorization for other reasons as permitted by law We are permitted by law to share information subject to certain requirements in order to communicate information on health-related benefits or services that may be of interest to you respond to a court order or provide information to further public health activities (eg preventing the spread of disease) without your written authorization We are also permitted to share protected health information during a corporate restructuring such as a merger sale or acquisition We will also disclose health information about you when required by law for example in order to prevent serious harm to you or others

The text below is an annual open enrollment required notice

25

Notice of Privacy Practices

bull Pursuant to your Authorization When required by law we will ask for your written authorization before using or disclosing your protected health information If you choose to sign an authorization to disclose information you can later revoke that authorization to prevent any future uses or disclosures

bull To Business Associates We may enter into contracts with entities known as Business Associates that provide services to or perform functions on behalf of the Plan We may disclose protected health information to Business Associates once they have agreed in writing to safeguard the protected health information For example we may disclose your protected health information to a Business Associate to administer claims Business Associates are also required by law to protect protected health information

bull To the Plan Sponsor We may disclose protected health information to certain employees of Reston Association for the purpose of administering the Plan These employees will use or disclose the protected health information only as necessary to perform plan administration functions or as otherwise required by HIPAA unless you have authorized additional disclosures Your protected health information cannot be used for employment purposes without your specific authorization

Your Rights bull Right to Inspect and Copy In most cases you have the right to inspect and copy the protected health

information we maintain about you If you request copies we will charge you a reasonable fee to cover the costs of copying mailing or other expenses associated with your request Your request to inspect or review your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to inspect and copy your health information To the extent your information is held in an electronic health record you may be able to receive the information in an electronic format

bull Right to Amend If you believe that information within your records is incorrect or if important information is missing you have the right to request that we correct the existing information or add the missing information Your request to amend your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to amend your health information If we deny your request you may file a statement of disagreement with us for inclusion in any future disclosures of the disputed information

bull Right to an Accounting of Disclosures You have the right to receive an accounting of certain disclosures of your protected health information The accounting will not include disclosures that were made (1) for purposes of treatment payment or health care operations (2) to you (3) pursuant to your authorization (4) to your friends or family in your presence or because of an emergency (5) for national security purposes or (6) incidental to otherwise permissible disclosures

Your request to for an accounting must be submitted in writing to the person listed below You may request an accounting of disclosures made within the last six years You may request one accounting free of charge within a 12-month period

The text below is an annual open enrollment required notice

25

26

The information provided herein is intended to be a summary of benefits only and in no way supersedes the actual plan documents provided by the insurance carriersadministrators For more detailed information pertaining to your employee benefit plans including limitations and exclusions

please refer to the plan documents andor evidence of coverage provided by the carriersadministrators

Womenrsquos Health and Cancer Rights Act of 1998

If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos Health and Cancer Rights Act of 1998 (WHCRA) For individuals receiving mastectomy-related benefits coverage will be provided in a manner determined in consultation with the attending physician and the patient for

bull All stages of reconstruction of the breast on which the mastectomy was performed bull Surgery and reconstruction of the other breast to produce a symmetrical appearance bull Prostheses and bull Treatment of physical complications of the mastectomy including lymphedema

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan If you would like more information on WHCRA benefits call your plan administrator

CHIP-Childrens Health Insurance Program (CHIP) Reauthorization Act of 2009

Medicaid and the Childrenrsquos Health Insurance Program (CHIP) offer free or low-cost health coverage to children and families If you are eligible for health coverage from your employer but are unable to afford the premiums some States have premium assistance programs that can help pay for coverage These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage but need assistance in paying their health premiums

If you or your dependents are already enrolled in Medicaid or CHIP you can contact your state Medicaid or CHIP office to find out if premium assistance is available For a list of the contacts in each State go to wwwdolgovebsachipmodelnoticedoc

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify you can then contact the State to find out if it has a program that might help you pay the premiums for an employer-sponsored plan

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP your employerrsquos health plan is required to permit you and your dependents to enroll in the plan ndash as long as you and your dependents are eligible but not already enrolled in the employerrsquos plan This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance

The text below is an annual open enrollment required notice

26

27

Premium Assistance Under Medicaid and the

Childrenrsquos Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your

employer your state may have a premium assistance program that can help pay for coverage using funds

from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot

be eligible for these premium assistance programs but you may be able to buy individual insurance coverage

through the Health Insurance Marketplace For more information visit wwwhealthcaregov

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below

contact your State Medicaid or CHIP office to find out if premium assistance is available

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your

dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-

877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a

program that might help you pay the premiums for an employer-sponsored plan

If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible

under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already

enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days

of being determined eligible for premium assistance If you have questions about enrolling in your

employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)

If you live in one of the following states you may be eligible for assistance paying your employer

health plan premiums The following list of states is current as of July 31 2019 Contact your State for

more information on eligibility ndash

ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcom

Phone 1-855-692-5447

Website httpflmedicaidtplrecoverycomhipp

Phone 1-877-357-3268

ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program

Website httpmyakhippcom

Phone 1-866-251-4861

Email CustomerServiceMyAKHIPPcom

Medicaid Eligibility

httpdhssalaskagovdpaPagesmedicaiddefaultaspx

Website httpsmedicaidgeorgiagovhealth-

insurance-premium-payment-program-hipp

Phone 678-564-1162 ext 2131

ARKANSAS ndash Medicaid INDIANA ndash Medicaid

Website httpmyarhippcom

Phone 1-855-MyARHIPP (855-692-7447)

Healthy Indiana Plan for low-income adults 19-64

Website httpwwwingovfssahip

Phone 1-877-438-4479

All other Medicaid

Website httpwwwindianamedicaidcom

Phone 1-800-403-0864

COLORADO ndash Health First Colorado

(Coloradorsquos Medicaid Program) amp Child Health

Plan Plus (CHP+)

IOWA ndash Medicaid

Health First Colorado Website

httpswwwhealthfirstcoloradocom

Health First Colorado Member Contact Center

1-800-221-3943 State Relay 711

CHP+ httpswwwcoloradogovpacifichcpfchild-health-

plan-plus

CHP+ Customer Service 1-800-359-1991 State Relay

711

Website

httpdhsiowagovHawki

Phone 1-800-257-8563

28

KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid

Website httpwwwkdheksgovhcf

Phone 1-785-296-3512

Website httpswwwdhhsnhgovoiihipphtm

Phone 603-271-5218

Toll free number for the HIPP program 1-800-852-3345 ext 5218

KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP

Website httpschfskygov

Phone 1-800-635-2570

Medicaid Website

httpwwwstatenjushumanservices

dmahsclientsmedicaid

Medicaid Phone 609-631-2392

CHIP Website httpwwwnjfamilycareorgindexhtml

CHIP Phone 1-800-701-0710

LOUISIANA ndash Medicaid NEW YORK ndash Medicaid

Website httpdhhlouisianagovindexcfmsubhome1n331

Phone 1-888-695-2447

Website httpswwwhealthnygovhealth_caremedicaid

Phone 1-800-541-2831

MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid

Website httpwwwmainegovdhhsofipublic-assistanceindexhtml

Phone 1-800-442-6003

TTY Maine relay 711

Website httpsmedicaidncdhhsgov

Phone 919-855-4100

MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid

Website httpwwwmassgoveohhsgovdepartmentsmasshealth

Phone 1-800-862-4840

Website httpwwwndgovdhsservicesmedicalservmedicaid

Phone 1-844-854-4825

MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP

Website

httpsmngovdhspeople-we-serveseniorshealth-carehealth-care-

programsprograms-and-servicesother-insurancejsp

Phone 1-800-657-3739

Website httpwwwinsureoklahomaorg

Phone 1-888-365-3742

MISSOURI ndash Medicaid OREGON ndash Medicaid

Website httpwwwdssmogovmhdparticipantspageshipphtm

Phone 573-751-2005

Website httphealthcareoregongovPagesindexaspx

httpwwworegonhealthcaregovindex-eshtml

Phone 1-800-699-9075

MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid

Website httpdphhsmtgovMontanaHealthcareProgramsHIPP

Phone 1-800-694-3084

Website

httpwwwdhspagovprovidermedicalassistancehealthinsuranc

epremiumpaymenthippprogramindexhtm

Phone 1-800-692-7462

NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP

Website httpwwwACCESSNebraskanegov

Phone (855) 632-7633

Lincoln (402) 473-7000

Omaha (402) 595-1178

Website httpwwweohhsrigov

Phone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)

29

NEVADA ndash Medicaid SOUTH CAROLINA ndash Medicaid

Medicaid Website httpsdhcfpnvgov

Medicaid Phone 1-800-992-0900

Website httpswwwscdhhsgov

Phone 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid

Website httpdsssdgov

Phone 1-888-828-0059

Website httpswwwhcawagov

Phone 1-800-562-3022 ext 15473

TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascom

Phone 1-800-440-0493

Website httpmywvhippcom

Toll-free phone 1-855-MyWVHIPP (1-855-699-8447)

UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgov

CHIP Website httphealthutahgovchip

Phone 1-877-543-7669

Website

httpswwwdhswisconsingovpublicationsp1p10095p

df

Phone 1-800-362-3002

VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorg

Phone 1-800-250-8427

Website httpswyequalitycareacs-inccom

Phone 307-777-7531

VIRGINIA ndash Medicaid and CHIP Medicaid Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

Medicaid Phone 1-800-432-5924

CHIP Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

CHIP Phone 1-855-242-8282

To see if any other states have added a premium assistance program since July 31 2019 or for more

information on special enrollment rights contact either

US Department of Labor US Department of Health and Human Services

Employee Benefits Security Administration Centers for Medicare amp Medicaid Services

wwwdolgovagenciesebsa wwwcmshhsgov

1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565

Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond

to a collection of information unless such collection displays a valid Office of Management and Budget (OMB)

control number The Department notes that a Federal agency cannot conduct or sponsor a collection of

information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and

the public is not required to respond to a collection of information unless it displays a currently valid OMB control

number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to

penalty for failing to comply with a collection of information if the collection of information does not display a

currently valid OMB control number See 44 USC 3512

The public reporting burden for this collection of information is estimated to average approximately seven minutes

per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other

aspect of this collection of information including suggestions for reducing this burden to the US Department of

Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance

Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and

reference the OMB Control Number 1210-0137 OMB Control Number 1210-0137 (expires 12312019)

Notes

30

Notes

31

Prepared by

Please contact Reston Associationrsquos Human Resources Department at 703-435-7990 or hrrestonorg with any

questions related to your Total Rewards Guide

copy 2019 McGriff Insurance Services Inc

Page 10: Employee Total Rewards Guide 2020 - Reston Total Rewards Gui… · Recognizing and rewarding employees for achieving a sustainable impact. Award criteria includes: •Progressive

Health Insurance ndash Option 1

DHMO HRA Signature In Network You Pay Out-of-Network You Pay

Deductible Coinsurance Out-of-Pocket

$750 Individual$1500 Family (RA funds) 9010

$3000 Individual $6000 Family

(less than regular HMO)

NA

Primary Care and Specialist Office Visit $15 PCP$25 Specialist NO COVERAGE

Emergency Room Visits $75 per visit (waived

if admitted) NO COVERAGE

Hospital ndash Inpatient Stay 10 after deductible NO COVERAGE

Home Health Care 10 after deductible NO COVERAGE

Outpatient Facility Services 10 after deductible NO COVERAGE

X-Ray and Laboratory Services 10 after deductible NO COVERAGE

Specialty Imaging (CTMRIPET scan) 10 after deductible NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Inpatient Facility

10 after deductible NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Outpatient Facility

$7 copay-group therapy $15 copay-individual therapy per visit

NO COVERAGE

Vision (Children Only) $15 PCP$25 Specialist NO COVERAGE

Prescription Drug Program (30 day supply) Generic Drug (Tier 1) Preferred Brand Name Drug (Tier 2) Non-Preferred Brand Drug (Tier 3) Up to 90 day supply ndash 3 co-pays for Plan and Participating Pharmacies Mail Order Up to 90 day supply- 2 co-pays

$0 deductible

Plan $20 Participating $30 Plan $30 Participating $50 Plan $45 Participating $65

$20$30$45

Kaiser Permanente D-HMO HRA Signature (Facilities Only) With the Signature Network members receive quality care at the Kaiser medical centers in Maryland Virginia and the District of Columbia Medical centers offer convenient services including primary care specialty care laboratory radiology and pharmacy at most locations and in some locations optical Signature members also have access to more than 40 hospitals in the region

10

Health Insurance ndash Option 2

Kaiser Permanente HMO Select (Facilities amp Contracted Providers Only) With the Select Network members may receive quality care at the Kaiser medical centers in Maryland Virginia and the District of Columbia Building on the Signature physician network the Select network adds access to more than 15000 contracted community physicians in private practice Select members also have access to more than 40 hospitals in the region

HMO Select In-Network You Pay Out-of-Network

You Pay

Deductible Coinsurance Out-of-Pocket

None 100

$3500 Individual $9400 Family

NA

Primary Care and Specialist Office Visit $30 PCP$40 Specialist NO COVERAGE

Emergency Room Visits $100 per visit

(waived if admitted) NO COVERAGE

Hospital ndash Inpatient Stay $250 per admission NO COVERAGE

Home Health Care No charge NO COVERAGE

Outpatient Facility Services $100 NO COVERAGE

X-Ray and Laboratory Services No charge NO COVERAGE

Specialty Imaging (CTMRIPET scan) $50 per test NO COVERAGE

Chiropractic amp Acupuncture Services $40 copay

20 visits per contract year NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Inpatient Facility

$250 per admission NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Outpatient Facility

$15 copay-group therapy $30 copay-individual therapy per visit

NO COVERAGE

Vision (Children Only) $30 PCP$40 Specialist NO COVERAGE

Prescription Drug Program (30 day supply) Generic Drug (Tier 1) Preferred Brand Name Drug (Tier 2) Non-Preferred Brand Drug (Tier 3) Up to 90 day supply ndash 3 co-pays for Plan and Participating Pharmacies Mail Order Up to 90 day supply- 2 co-pays

$0 deductible

Plan $20 Participating $30 Plan $35 Participating $50 Plan $50 Participating $75

$20$35$50

11

Kaiser Permanente POS Select (Facilities amp Contracted Providers with an Out of Network Option) Members can use in-plan benefits by using a Kaiser facility or a contracted primary care physician Your chosen PCP will provide care and coordinate referrals and hospital admissions Members also have the freedom to choose any other licensed provider outside the provider network however you will be responsible for deductibles and coinsurance above the health planrsquos payment

POS Select In-Network You Pay Out-of-Network

you pay

Deductible Coinsurance Out-of-Pocket

None 100

$3500 Individual $9400 Family

$300 Individual $600 Family

8020 $3000 Individual

$6000 Family

Primary Care and Specialist Office Visit $15 PCP$30 Specialist 20 of UCR

Emergency Room Visits $75 per visit (waived if

admitted) $75 per visit

(waived if admitted)

Hospital ndash Inpatient Stay $250 per admission 20 of UCR

Home Health Care No charge 20 of UCR

Outpatient Facility Services $50 20 of UCR

X-Ray and Laboratory Services No charge 20 of UCR

Specialty Imaging (CTMRIPET scan) No charge 20 of UCR

Mental Health (MG) amp Substance Abuse (SA) ndash Inpatient Facility

$250 per admission 20 of UCR

Mental Health (MG) amp Substance Abuse (SA) ndash Outpatient Facility

$7 copay-group therapy $15 copay-individual therapy per visit

20 of UCR

Vision (Children Only) $15 PCP$30 Specialist per visit 20 of UCR

Prescription Drug Program (30 day supply) Generic Drug (Tier 1) Preferred Brand Name Drug (Tier 2) Non-Preferred Brand Drug (Tier 3) Up to 90 day supply ndash 3 co-pays for Plan and Participating Pharmacies Mail Order Up to 90 day supply- 2 co-pays

$0 deductible

Plan $20 Participating $30 Plan $35 Participating $50 Plan $50 Participating $75

$20$35$50

Health Insurance ndash Option 3

12

Dental Insurance

MetLife Dental PPO The Dental PPO plan is 100 Employer Paid for all tiers and provides comprehensive coverage with a nationwide PPO network This gives members access to more in-network dentists making it easier for them to reduce out-of-pocket costs for covered procedures and treatments Dental procedure frequencies Preventative care covers an exam and cleaning (once every 6 months) Fluoride treatment (two per benefit period under age 19 only) Full mouth X-ray (once every 60 months) Bitewing X-ray (once every 12 months age 14 and over once every 12 months under age 14)

PPO Dental Plan Features In-Network Out-of-Network

Type A Preventive Care Services (oral exams cleanings x-rays sealants)

100 of Fee Schedule 100 of Usual amp Customary

Charge

Type B Basic Restorative Dental Services (fillings simple extractions space maintainers)

80 of Fee Schedule 80 of Usual amp Customary

Charge

Type B Major Surgical Dental Services (Endodontics amp Periodontics)

80 of Fee Schedule 80 of Usual amp Customary

Charge

Type C Major Restorative Dental Services (bridges crowns dentures implants)

50 of Fee Schedule 50 of Usual amp Customary

Charge

Orthodontia (under age 19 only)

Lifetime maximum - $1000 50 of allowed benefit

Calendar Year Deductible Applies to Type B amp C services only

$25 Single $75 Family

Calendar Year Maximum Per Person $1500 combined maxper calendar year

Prior to receiving dental services it is recommended that you first obtain a pre-determination of benefits from your dentist so you know exactly how much your dental insurance will cover Spouses domestic partners and dependent children to age 26 (regardless of student status) are eligible

13

Vision Insurance ndash Option 1

Vision Plan through VSP (Voluntary) VSP is the largest private provider vision carrier in the country VSP contracts with Costcoreg Optical Eye Care Centers of America Inctrade which includes popular stores like EyeMasters VisionWorld and Hour Eyes and other quality retail chains When you visit a VSP participating provider your benefits include routine vision exams lenses and preferred pricing on all patient options Frequency Eye Exam 12 monthsLenses 12 monthsFrames 24 monthsContact Lenses 12 months

Vision Plan Features In-Network Out-of-Network

Annual Routine Eye Exam $10 copay Plan pays up to $45

Eyeglass Lenses (standard) Single Bifocal Trifocal

Covered in Full Covered in Full Covered in Full

Plan pays up to $30 Plan pays up to $50 Plan pays up to $65

Frames $130 allowance then 20 off remaining balance

Plan pays up to $70

Necessary Contact Lenses Covered in Full Plan pays up to $210

Elective Contact Lenses $130 allowance Plan pays up to $105

Elective Contact Lenses fitting and evaluation Covered in Full after $60

copay Not Available

Spouses domestic partners and dependent children to age 19 (or to age 25 if FT student) are eligible

14

Vision Insurance ndash Option 2

Vision Plan through Spectera UHC (Voluntary)

UHC offers you one of the largest vision care networks in the industry Their network includes convenient retail locations including My Eye Dr and Hour Eyes Best of all ndash when you receive care from a participating provider you receive the greatest benefits and money-saving discounts

Frequency Eye Exam 12 monthsLenses 12 monthsFrames 12 monthsContact Lenses 12 months

Vision Plan Features In-Network Out-of-Network

Annual Routine Eye Exam $10 copay Plan pays up to $40

Eyeglass Lenses (standard) Single Bifocal Trifocal

$25 copay $25 copay $25 copay

Plan pays up to $40 Plan pays up to $60 Plan pays up to $80

Frames $2500 copay $130 retail frame

allowance 30 discount above allowance

Plan pays up to $45

Necessary Contact Lenses $25 copay Plan pays up to $210

Elective Contact Lenses

$25 copay from the ldquoCovered contact lens

selectionrdquo All others- $105

allowance

Plan pays up to $105

Elective Contact Lenses fitting and evaluation Covered in Full after $25

copay Not Available

Spouses and dependent children to age 26 are eligible

15

Pre-tax FSA amp DCA

Flexible Spending Account (FSA) through Optum Health The Flexible Spending Account provides employees a means to reduce their taxes by the amount of their out of pocket health-related expenses (subject to eligibility) This tax free savings program allows employees to submit receipts for reimbursement for medical dental vision care prescription drug co-payments and other expenses not covered by our insurance In 2020 employees may contribute up to $2750 per year toward their FSA Employees have until March 14 2020 to use the money in their FSA or else they lose it (This contribution amount could change based on IRS guideline updates)

Dependent Care Spending Account (DCA) through Optum Health The Dependent Care Spending Account provides employees a means to reduce their taxes by the amount of their child care costs to a licensed provider up to $5000 annually

Health Insurance Premium Bank

Reston Association has established a program to help regular full-time and regular part-time employees pay their portion of the health insurance premium This program is only available to employees who are enrolled in or plan to enroll in the Kaiser Permanente HMO health insurance plans offered by the Reston Association Employees are eligible to apply to the Health Insurance Premium Bank if their adjusted gross household incomes are less than or equal to $60000 Requests for assistance must be made annually or at any time there is a qualifying event and submitted to Human Resources with necessary documentation by December 12th of each year To apply complete a request form (available in CommonHumResBenefits) and submit to HR with a copy of your most recent tax return showing adjusted gross household income This threshold is subject to change

16

Life and ADampD Insurance

Basic LifeADampD Insurance Reston Association provides 100 employer paid Life and ADampD Insurance through Sun Life to employees working 25 or more hours per week Coverage becomes effective the first of the month following six months of service

Benefit 2x Annual Earnings to a maximum of $200000 Age reduction Benefit reduced to 65 at age 65 and to 50 at age 70

Optional LifeADampD Insurance for Employee Spouse and Dependent Children

Optional Life Insurance for the employee spouse and dependent children is available at the employeersquos cost Optional Life is not available for domestic partners

Employee Benefit Increments of $10000 to a maximum of the lesser of $300000 or 3x your Basic Annual Earnings

Spouse Benefit Increments of $5000 to a maximum of $150000 Dependent Child Benefit Increments of $1000 to a maximum of $10000

Your amount of Dependent Spouse and Dependent Child Optional Life Insurance cannot exceed 50 of your amount of Optional Life Insurance Initial eligibility period will require evidence of insurability

STD amp LTD Insurance

Short Term and Long Term Disability Reston Association provides eligible employees with short and long-term disability income benefits through Sun Life In the event you become disabled from a non work-related injury or sickness disability income benefits are provided as a source of income These benefits are 100 employer paid

Benefit Short-Term Disability Long-Term Disability

Income Replacement -Eligible Employees -Executives

60 60

Elimination Period - Accidental Injury - Sickness

29 days 90 days

Benefit Period 9 weeks maximum To Social Security

normal retirement age

Benefit Maximum -Eligible Employees -Executives

$1000 per week $6000 per month $8000 per month 17

At a cost of $19month you can enroll in the Legal Resources benefit As a Legal Resources Member you have immediate and ongoing access to comprehensive legal coverage services and expertise that will easily save you money mdash and could save you a whole lot more Covered legal services include

Legal Advice and Consultation Tenant Dispute with Landlord District Court Representation for Civil Action Review of a Financial Contract or Lease Purchase sale or refinance of primary home Traffic Court Representation (includes 1st DUI) Will Preparation Uncontested Divorce Representation Defense of Child in Court (misdemeanor)

Legal Resources

Employee Assistance Program (EAP)

Reston Association offers a free confidential Employee Assistance Program (EAP) to all employees and their eligible dependents Through RArsquos EAP provider Lytle EAP Partners you and your immediate family members have immediate access on your date of hire to confidential professional counseling and referral services for help with anything that affects you or your dependentsrsquo well-being You can reach an EAP counselor by dialing 1-800-327-7272 24 hours a day or you may visit their website at wwwLytleEAPcom (password is reston) for more information Visit wwwLytleEAPcom for web-based legal financial worklife resources There are also work-related resources available online for managers Note Since EAP services are provided as a benefit only RA makes no representation concerning quality of care

18

401(k) Retirement Savings Plan

Reston Association offers two 401(k) retirement savings plans through Ascensusmdasha traditional 401(k) plan in which employee contributions are made pre-tax and a 401(k) Roth in which employee contributions are made after tax RA matches employee contributions dollar for dollar up to a total of 7 of your annual salary You can begin making contributions to the 401(k) plan and become eligible for RArsquos match following six months of service You always own 100 of your salary contributions

It is possible to borrow against a portion of your vested 401(k) account balance by taking a 401(k) loan You may request a participant loan using an application form which can be obtained by contacting Human Resources Your ability to obtain a 401(k) loan will depend on specific qualifying factors (defined in the 401(k) Summary Plan Description document) The 401(k) Plan Administrator will determine whether you satisfy these factors To access your 401(k) plan online httpsmyaccountascensuscomrplink Check account balance and rate of return Change fund elections Request a 401k loan View fund pricing and performance View and print quarterly statements

19

529 College Savings Plan (employer-sponsored)

A 529 college savings plan provides those saving for college with an unmatched combination of benefits You can open a 529 plan for anyone mdash your child grandchild spouse a friend or even yourself Assets in a 529 plan can be used to pay for a variety of higher education expenses including required books tuition room and board supplies and certain other required fees and expenses Earnings in 529 accounts can grow free from federal tax Withdrawals for qualified higher education expenses are free from federal tax Option to set up recurring automatic fund transfers directly from your bank account making it easy for you to invest The account owner rather than the beneficiary maintains control of account assets and determines the timing and amount of distributions Account owners can change beneficiaries without penalty provided the new beneficiary is a member of the previous beneficiaryrsquos family For more information please contact Human Resources

Additional Benefits

Free passes for employees and their dependents to all of RArsquos pools and tennis courts as well as discounted rates for all RA Programs and Camps Some restrictions may apply

Discounted gym membership rates at the Reston YMCA and Crunch Fitness Bike Share Program - Reston Association makes bicycles and helmets available to employees to rent on a daily

basis Please contact Member Services Discounted Tennis Rackets amp Shoes ndash Employees can purchase certain tennis shoes and rackets at wholesale

prices through RArsquos Tennis Department Contact the Tennis Department for more information Discounted autohome insurance - Liberty Mutual Insurance Company partners with RA to offer all employees

discounts on automobile and homeowner insurance Contact John Valenti at JohnValentilibertymutualcom

20

Reston Association provides generous paid time off benefits to accommodate the diverse needs of staff and to provide a positive worklife balance The amount of paid time off you earn per year is based on your years of service In addition Reston Association observes 9 paid holidays and assigns one paid floating holiday per year For more information on paid time off benefits and how to request time off please refer to the Reston Association Employee Handbook

WorkLife Balance ndash Paid Time Off (PTO)

Teleworking

The medical leave bank is available to help employees in extenuating circumstances protect their incomes by receiving paid leave once their personal PTO is used up A maximum of six (6) workweeks may be granted for each Medical Leave Bank request If additional time is necessary a new request must be made For program eligibility and criteria go to CommonHumResBenefits

Medical Leave Bank

Volunteer Release Time

On a per position basis employees may be allowed to telework for part of their workweek or in certain circumstances Such arrangements must be in compliance with the written administrative procedure including being approved in advance by the department director

Employees are encouraged to become involved in their communities lending their voluntary support to programs that enrich the quality of life and opportunities for all citizens This benefit allows employees to take paid-time off during a work day to participate in a volunteer activity that benefits the community at large Such activities are typically sponsored by a charitable or service organization or work with one or more individuals in need of assistance or special service

21

Training amp Career Development

Reston Association offers two types of learning opportunities for employees mdashinformal and formalmdashto foster individual development and training and career planning

I Informal Learning Opportunities (individual development amp training)

Focus on individual acquiring or enhancing specific task andor process skills to perform his or her current job better Typically this type of learning is not ldquodegree- orientedrdquo

Participants may or may not receive attendance or achievement certificate

Conferences workshops seminars webinars online courses etc typically lasting a few hours to one week

Requests for this type of training should be made to your supervisor or department head

II Formal Learning Opportunities (career planning)

Professional DevelopmentCareer Planning

Formalstructured learning geared toward improving and maintaining professional competence enhancing career progression staying abreast of new technologies and best practices developing process skills andor compliance with professional regulations

Future but not degree-oriented CEUs may be earned

May lead to qualification or credential required to obtain or retain specific certification

Opportunity may range from semester-long academic course to 24 month program with wide range of content and learning experience

Tuition Reimbursement Program

Supports formal education goals (AA bachelors masters) of individual to enhance knowledge and skills in specific areaindustry

Learning must be job-related and accomplished at or through accredited learning institution or e-learning platform connected with the institution

Requests for this type of training should be made to Human Resources as soon as foreseeable to ensure best availability of funds to support reimbursement

22

23

Lifetime limit not applicable and enrollment opportunity The lifetime limit on the dollar value of benefits under our medical plan no longer applies Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan Individuals have 30 days from the date of this notice to request enrollment For more information contact Human Resources or call the medical insurance carrier at the telephone number on your identification card

Notice on Patient Protections The medical HMO plan generally allows the designation of a primary care provider You have the right to designate any primary care provider who participates in the network and who is available to accept you or your family members Until you make this designation the medical carrier designates one for you For information on how to select a primary care provider and for a list of the participating primary care providers contact the medical insurance carrier at the number listed on your identification card

For children you may designate a pediatrician as the primary care provider You do not need prior authorization from the medical insurance carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in the network who specializes in obstetrics or gynecology The health care professional however may be required to comply with certain procedures including obtaining prior authorization for certain services following a pre-approved treatment plan or procedures for making referrals For a list of participating health care professionals who specialize in obstetrics or gynecology contact the medical insurance carrier at the number listed on your identification card

OTC Drug Reimbursements for FSAsHRAsHSAs Under the new Health Care Reform law (PPACA) the cost of an over-the-counter medicine or drug cannot be reimbursed from the account unless a prescription is obtained The change does not affect insulin even if purchased without a prescription or other health care expenses such as medical devices eyeglasses contact lenses co-pays and deductibles The new standard applies only to purchases made on or after January 1 2011

A similar rule is in effect for Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs)

The IRS has also posted a questions and answers section on its website httpwwwirsgovnewsroomarticle0id=22730800html concerning these provisions

Patient Protection and Affordable Care Act (PPACA) Mandatory Notices

The text below is an annual open enrollment required notice

24

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION PLEASE REVIEW IT CAREFULLY

Our Pledge to You

This notice is intended to inform you of the privacy practices followed by the Reston Associationrsquos Employee Benefit Plan (the Plan) and the Planrsquos legal obligations regarding your protected health information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) The notice also explains the privacy rights you and your family members have as participants of the Plan It is effective on April 14 2011

The Plan often needs access to your protected health information in order to provide payment for health services and perform plan administrative functions We want to assure the plan participants covered under the Plan that we comply with federal privacy laws and respect your right to privacy Reston Association requires all members of our workforce and third parties that are provided access to protected health information to comply with the privacy practices outlined in this notice

Protected Health Information Your protected health information is protected by the HIPAA Privacy Rule Generally protected health information is information that identifies an individual created or received by a health care provider health plan or an employer on behalf of a group health plan that relates to physical or mental health conditions provision of health care or payment for health care whether past present or future

How We May Use Your Protected Health Information Under the HIPAA Privacy Rule we may use or disclose your protected health information for certain purposes without your permission This section describes the ways we can use and disclose your protected health information

bull Payment We use or disclose your protected health information without your written authorization in order to determine eligibility for benefits seek reimbursement from a third party or coordinate benefits with another health plan under which you are covered For example a health care provider that provided treatment to you will provide us with your health information We use that information in order to determine whether those services are eligible for payment under our group health plan

bull Health Care Operations We use and disclose your protected health information in order to perform plan administration functions such as quality assurance activities resolution of internal grievances and evaluating plan performance For example we review claims experience in order to understand participant utilization and to make plan design changes that are intended to control health care costs

bull Treatment Although the law allows use and disclosure of your protected health information for purposes of treatment as a health plan we generally do not need to disclose your information for treatment purposes Your physician or health care provider is required to provide you with an explanation of how they use and share your health information for purposes of treatment payment and health care operations

bull As permitted or required by law We may also use or disclose your protected health information without your written authorization for other reasons as permitted by law We are permitted by law to share information subject to certain requirements in order to communicate information on health-related benefits or services that may be of interest to you respond to a court order or provide information to further public health activities (eg preventing the spread of disease) without your written authorization We are also permitted to share protected health information during a corporate restructuring such as a merger sale or acquisition We will also disclose health information about you when required by law for example in order to prevent serious harm to you or others

The text below is an annual open enrollment required notice

25

Notice of Privacy Practices

bull Pursuant to your Authorization When required by law we will ask for your written authorization before using or disclosing your protected health information If you choose to sign an authorization to disclose information you can later revoke that authorization to prevent any future uses or disclosures

bull To Business Associates We may enter into contracts with entities known as Business Associates that provide services to or perform functions on behalf of the Plan We may disclose protected health information to Business Associates once they have agreed in writing to safeguard the protected health information For example we may disclose your protected health information to a Business Associate to administer claims Business Associates are also required by law to protect protected health information

bull To the Plan Sponsor We may disclose protected health information to certain employees of Reston Association for the purpose of administering the Plan These employees will use or disclose the protected health information only as necessary to perform plan administration functions or as otherwise required by HIPAA unless you have authorized additional disclosures Your protected health information cannot be used for employment purposes without your specific authorization

Your Rights bull Right to Inspect and Copy In most cases you have the right to inspect and copy the protected health

information we maintain about you If you request copies we will charge you a reasonable fee to cover the costs of copying mailing or other expenses associated with your request Your request to inspect or review your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to inspect and copy your health information To the extent your information is held in an electronic health record you may be able to receive the information in an electronic format

bull Right to Amend If you believe that information within your records is incorrect or if important information is missing you have the right to request that we correct the existing information or add the missing information Your request to amend your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to amend your health information If we deny your request you may file a statement of disagreement with us for inclusion in any future disclosures of the disputed information

bull Right to an Accounting of Disclosures You have the right to receive an accounting of certain disclosures of your protected health information The accounting will not include disclosures that were made (1) for purposes of treatment payment or health care operations (2) to you (3) pursuant to your authorization (4) to your friends or family in your presence or because of an emergency (5) for national security purposes or (6) incidental to otherwise permissible disclosures

Your request to for an accounting must be submitted in writing to the person listed below You may request an accounting of disclosures made within the last six years You may request one accounting free of charge within a 12-month period

The text below is an annual open enrollment required notice

25

26

The information provided herein is intended to be a summary of benefits only and in no way supersedes the actual plan documents provided by the insurance carriersadministrators For more detailed information pertaining to your employee benefit plans including limitations and exclusions

please refer to the plan documents andor evidence of coverage provided by the carriersadministrators

Womenrsquos Health and Cancer Rights Act of 1998

If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos Health and Cancer Rights Act of 1998 (WHCRA) For individuals receiving mastectomy-related benefits coverage will be provided in a manner determined in consultation with the attending physician and the patient for

bull All stages of reconstruction of the breast on which the mastectomy was performed bull Surgery and reconstruction of the other breast to produce a symmetrical appearance bull Prostheses and bull Treatment of physical complications of the mastectomy including lymphedema

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan If you would like more information on WHCRA benefits call your plan administrator

CHIP-Childrens Health Insurance Program (CHIP) Reauthorization Act of 2009

Medicaid and the Childrenrsquos Health Insurance Program (CHIP) offer free or low-cost health coverage to children and families If you are eligible for health coverage from your employer but are unable to afford the premiums some States have premium assistance programs that can help pay for coverage These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage but need assistance in paying their health premiums

If you or your dependents are already enrolled in Medicaid or CHIP you can contact your state Medicaid or CHIP office to find out if premium assistance is available For a list of the contacts in each State go to wwwdolgovebsachipmodelnoticedoc

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify you can then contact the State to find out if it has a program that might help you pay the premiums for an employer-sponsored plan

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP your employerrsquos health plan is required to permit you and your dependents to enroll in the plan ndash as long as you and your dependents are eligible but not already enrolled in the employerrsquos plan This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance

The text below is an annual open enrollment required notice

26

27

Premium Assistance Under Medicaid and the

Childrenrsquos Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your

employer your state may have a premium assistance program that can help pay for coverage using funds

from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot

be eligible for these premium assistance programs but you may be able to buy individual insurance coverage

through the Health Insurance Marketplace For more information visit wwwhealthcaregov

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below

contact your State Medicaid or CHIP office to find out if premium assistance is available

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your

dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-

877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a

program that might help you pay the premiums for an employer-sponsored plan

If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible

under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already

enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days

of being determined eligible for premium assistance If you have questions about enrolling in your

employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)

If you live in one of the following states you may be eligible for assistance paying your employer

health plan premiums The following list of states is current as of July 31 2019 Contact your State for

more information on eligibility ndash

ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcom

Phone 1-855-692-5447

Website httpflmedicaidtplrecoverycomhipp

Phone 1-877-357-3268

ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program

Website httpmyakhippcom

Phone 1-866-251-4861

Email CustomerServiceMyAKHIPPcom

Medicaid Eligibility

httpdhssalaskagovdpaPagesmedicaiddefaultaspx

Website httpsmedicaidgeorgiagovhealth-

insurance-premium-payment-program-hipp

Phone 678-564-1162 ext 2131

ARKANSAS ndash Medicaid INDIANA ndash Medicaid

Website httpmyarhippcom

Phone 1-855-MyARHIPP (855-692-7447)

Healthy Indiana Plan for low-income adults 19-64

Website httpwwwingovfssahip

Phone 1-877-438-4479

All other Medicaid

Website httpwwwindianamedicaidcom

Phone 1-800-403-0864

COLORADO ndash Health First Colorado

(Coloradorsquos Medicaid Program) amp Child Health

Plan Plus (CHP+)

IOWA ndash Medicaid

Health First Colorado Website

httpswwwhealthfirstcoloradocom

Health First Colorado Member Contact Center

1-800-221-3943 State Relay 711

CHP+ httpswwwcoloradogovpacifichcpfchild-health-

plan-plus

CHP+ Customer Service 1-800-359-1991 State Relay

711

Website

httpdhsiowagovHawki

Phone 1-800-257-8563

28

KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid

Website httpwwwkdheksgovhcf

Phone 1-785-296-3512

Website httpswwwdhhsnhgovoiihipphtm

Phone 603-271-5218

Toll free number for the HIPP program 1-800-852-3345 ext 5218

KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP

Website httpschfskygov

Phone 1-800-635-2570

Medicaid Website

httpwwwstatenjushumanservices

dmahsclientsmedicaid

Medicaid Phone 609-631-2392

CHIP Website httpwwwnjfamilycareorgindexhtml

CHIP Phone 1-800-701-0710

LOUISIANA ndash Medicaid NEW YORK ndash Medicaid

Website httpdhhlouisianagovindexcfmsubhome1n331

Phone 1-888-695-2447

Website httpswwwhealthnygovhealth_caremedicaid

Phone 1-800-541-2831

MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid

Website httpwwwmainegovdhhsofipublic-assistanceindexhtml

Phone 1-800-442-6003

TTY Maine relay 711

Website httpsmedicaidncdhhsgov

Phone 919-855-4100

MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid

Website httpwwwmassgoveohhsgovdepartmentsmasshealth

Phone 1-800-862-4840

Website httpwwwndgovdhsservicesmedicalservmedicaid

Phone 1-844-854-4825

MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP

Website

httpsmngovdhspeople-we-serveseniorshealth-carehealth-care-

programsprograms-and-servicesother-insurancejsp

Phone 1-800-657-3739

Website httpwwwinsureoklahomaorg

Phone 1-888-365-3742

MISSOURI ndash Medicaid OREGON ndash Medicaid

Website httpwwwdssmogovmhdparticipantspageshipphtm

Phone 573-751-2005

Website httphealthcareoregongovPagesindexaspx

httpwwworegonhealthcaregovindex-eshtml

Phone 1-800-699-9075

MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid

Website httpdphhsmtgovMontanaHealthcareProgramsHIPP

Phone 1-800-694-3084

Website

httpwwwdhspagovprovidermedicalassistancehealthinsuranc

epremiumpaymenthippprogramindexhtm

Phone 1-800-692-7462

NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP

Website httpwwwACCESSNebraskanegov

Phone (855) 632-7633

Lincoln (402) 473-7000

Omaha (402) 595-1178

Website httpwwweohhsrigov

Phone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)

29

NEVADA ndash Medicaid SOUTH CAROLINA ndash Medicaid

Medicaid Website httpsdhcfpnvgov

Medicaid Phone 1-800-992-0900

Website httpswwwscdhhsgov

Phone 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid

Website httpdsssdgov

Phone 1-888-828-0059

Website httpswwwhcawagov

Phone 1-800-562-3022 ext 15473

TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascom

Phone 1-800-440-0493

Website httpmywvhippcom

Toll-free phone 1-855-MyWVHIPP (1-855-699-8447)

UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgov

CHIP Website httphealthutahgovchip

Phone 1-877-543-7669

Website

httpswwwdhswisconsingovpublicationsp1p10095p

df

Phone 1-800-362-3002

VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorg

Phone 1-800-250-8427

Website httpswyequalitycareacs-inccom

Phone 307-777-7531

VIRGINIA ndash Medicaid and CHIP Medicaid Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

Medicaid Phone 1-800-432-5924

CHIP Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

CHIP Phone 1-855-242-8282

To see if any other states have added a premium assistance program since July 31 2019 or for more

information on special enrollment rights contact either

US Department of Labor US Department of Health and Human Services

Employee Benefits Security Administration Centers for Medicare amp Medicaid Services

wwwdolgovagenciesebsa wwwcmshhsgov

1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565

Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond

to a collection of information unless such collection displays a valid Office of Management and Budget (OMB)

control number The Department notes that a Federal agency cannot conduct or sponsor a collection of

information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and

the public is not required to respond to a collection of information unless it displays a currently valid OMB control

number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to

penalty for failing to comply with a collection of information if the collection of information does not display a

currently valid OMB control number See 44 USC 3512

The public reporting burden for this collection of information is estimated to average approximately seven minutes

per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other

aspect of this collection of information including suggestions for reducing this burden to the US Department of

Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance

Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and

reference the OMB Control Number 1210-0137 OMB Control Number 1210-0137 (expires 12312019)

Notes

30

Notes

31

Prepared by

Please contact Reston Associationrsquos Human Resources Department at 703-435-7990 or hrrestonorg with any

questions related to your Total Rewards Guide

copy 2019 McGriff Insurance Services Inc

Page 11: Employee Total Rewards Guide 2020 - Reston Total Rewards Gui… · Recognizing and rewarding employees for achieving a sustainable impact. Award criteria includes: •Progressive

Health Insurance ndash Option 2

Kaiser Permanente HMO Select (Facilities amp Contracted Providers Only) With the Select Network members may receive quality care at the Kaiser medical centers in Maryland Virginia and the District of Columbia Building on the Signature physician network the Select network adds access to more than 15000 contracted community physicians in private practice Select members also have access to more than 40 hospitals in the region

HMO Select In-Network You Pay Out-of-Network

You Pay

Deductible Coinsurance Out-of-Pocket

None 100

$3500 Individual $9400 Family

NA

Primary Care and Specialist Office Visit $30 PCP$40 Specialist NO COVERAGE

Emergency Room Visits $100 per visit

(waived if admitted) NO COVERAGE

Hospital ndash Inpatient Stay $250 per admission NO COVERAGE

Home Health Care No charge NO COVERAGE

Outpatient Facility Services $100 NO COVERAGE

X-Ray and Laboratory Services No charge NO COVERAGE

Specialty Imaging (CTMRIPET scan) $50 per test NO COVERAGE

Chiropractic amp Acupuncture Services $40 copay

20 visits per contract year NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Inpatient Facility

$250 per admission NO COVERAGE

Mental Health (MG) amp Substance Abuse (SA) ndash Outpatient Facility

$15 copay-group therapy $30 copay-individual therapy per visit

NO COVERAGE

Vision (Children Only) $30 PCP$40 Specialist NO COVERAGE

Prescription Drug Program (30 day supply) Generic Drug (Tier 1) Preferred Brand Name Drug (Tier 2) Non-Preferred Brand Drug (Tier 3) Up to 90 day supply ndash 3 co-pays for Plan and Participating Pharmacies Mail Order Up to 90 day supply- 2 co-pays

$0 deductible

Plan $20 Participating $30 Plan $35 Participating $50 Plan $50 Participating $75

$20$35$50

11

Kaiser Permanente POS Select (Facilities amp Contracted Providers with an Out of Network Option) Members can use in-plan benefits by using a Kaiser facility or a contracted primary care physician Your chosen PCP will provide care and coordinate referrals and hospital admissions Members also have the freedom to choose any other licensed provider outside the provider network however you will be responsible for deductibles and coinsurance above the health planrsquos payment

POS Select In-Network You Pay Out-of-Network

you pay

Deductible Coinsurance Out-of-Pocket

None 100

$3500 Individual $9400 Family

$300 Individual $600 Family

8020 $3000 Individual

$6000 Family

Primary Care and Specialist Office Visit $15 PCP$30 Specialist 20 of UCR

Emergency Room Visits $75 per visit (waived if

admitted) $75 per visit

(waived if admitted)

Hospital ndash Inpatient Stay $250 per admission 20 of UCR

Home Health Care No charge 20 of UCR

Outpatient Facility Services $50 20 of UCR

X-Ray and Laboratory Services No charge 20 of UCR

Specialty Imaging (CTMRIPET scan) No charge 20 of UCR

Mental Health (MG) amp Substance Abuse (SA) ndash Inpatient Facility

$250 per admission 20 of UCR

Mental Health (MG) amp Substance Abuse (SA) ndash Outpatient Facility

$7 copay-group therapy $15 copay-individual therapy per visit

20 of UCR

Vision (Children Only) $15 PCP$30 Specialist per visit 20 of UCR

Prescription Drug Program (30 day supply) Generic Drug (Tier 1) Preferred Brand Name Drug (Tier 2) Non-Preferred Brand Drug (Tier 3) Up to 90 day supply ndash 3 co-pays for Plan and Participating Pharmacies Mail Order Up to 90 day supply- 2 co-pays

$0 deductible

Plan $20 Participating $30 Plan $35 Participating $50 Plan $50 Participating $75

$20$35$50

Health Insurance ndash Option 3

12

Dental Insurance

MetLife Dental PPO The Dental PPO plan is 100 Employer Paid for all tiers and provides comprehensive coverage with a nationwide PPO network This gives members access to more in-network dentists making it easier for them to reduce out-of-pocket costs for covered procedures and treatments Dental procedure frequencies Preventative care covers an exam and cleaning (once every 6 months) Fluoride treatment (two per benefit period under age 19 only) Full mouth X-ray (once every 60 months) Bitewing X-ray (once every 12 months age 14 and over once every 12 months under age 14)

PPO Dental Plan Features In-Network Out-of-Network

Type A Preventive Care Services (oral exams cleanings x-rays sealants)

100 of Fee Schedule 100 of Usual amp Customary

Charge

Type B Basic Restorative Dental Services (fillings simple extractions space maintainers)

80 of Fee Schedule 80 of Usual amp Customary

Charge

Type B Major Surgical Dental Services (Endodontics amp Periodontics)

80 of Fee Schedule 80 of Usual amp Customary

Charge

Type C Major Restorative Dental Services (bridges crowns dentures implants)

50 of Fee Schedule 50 of Usual amp Customary

Charge

Orthodontia (under age 19 only)

Lifetime maximum - $1000 50 of allowed benefit

Calendar Year Deductible Applies to Type B amp C services only

$25 Single $75 Family

Calendar Year Maximum Per Person $1500 combined maxper calendar year

Prior to receiving dental services it is recommended that you first obtain a pre-determination of benefits from your dentist so you know exactly how much your dental insurance will cover Spouses domestic partners and dependent children to age 26 (regardless of student status) are eligible

13

Vision Insurance ndash Option 1

Vision Plan through VSP (Voluntary) VSP is the largest private provider vision carrier in the country VSP contracts with Costcoreg Optical Eye Care Centers of America Inctrade which includes popular stores like EyeMasters VisionWorld and Hour Eyes and other quality retail chains When you visit a VSP participating provider your benefits include routine vision exams lenses and preferred pricing on all patient options Frequency Eye Exam 12 monthsLenses 12 monthsFrames 24 monthsContact Lenses 12 months

Vision Plan Features In-Network Out-of-Network

Annual Routine Eye Exam $10 copay Plan pays up to $45

Eyeglass Lenses (standard) Single Bifocal Trifocal

Covered in Full Covered in Full Covered in Full

Plan pays up to $30 Plan pays up to $50 Plan pays up to $65

Frames $130 allowance then 20 off remaining balance

Plan pays up to $70

Necessary Contact Lenses Covered in Full Plan pays up to $210

Elective Contact Lenses $130 allowance Plan pays up to $105

Elective Contact Lenses fitting and evaluation Covered in Full after $60

copay Not Available

Spouses domestic partners and dependent children to age 19 (or to age 25 if FT student) are eligible

14

Vision Insurance ndash Option 2

Vision Plan through Spectera UHC (Voluntary)

UHC offers you one of the largest vision care networks in the industry Their network includes convenient retail locations including My Eye Dr and Hour Eyes Best of all ndash when you receive care from a participating provider you receive the greatest benefits and money-saving discounts

Frequency Eye Exam 12 monthsLenses 12 monthsFrames 12 monthsContact Lenses 12 months

Vision Plan Features In-Network Out-of-Network

Annual Routine Eye Exam $10 copay Plan pays up to $40

Eyeglass Lenses (standard) Single Bifocal Trifocal

$25 copay $25 copay $25 copay

Plan pays up to $40 Plan pays up to $60 Plan pays up to $80

Frames $2500 copay $130 retail frame

allowance 30 discount above allowance

Plan pays up to $45

Necessary Contact Lenses $25 copay Plan pays up to $210

Elective Contact Lenses

$25 copay from the ldquoCovered contact lens

selectionrdquo All others- $105

allowance

Plan pays up to $105

Elective Contact Lenses fitting and evaluation Covered in Full after $25

copay Not Available

Spouses and dependent children to age 26 are eligible

15

Pre-tax FSA amp DCA

Flexible Spending Account (FSA) through Optum Health The Flexible Spending Account provides employees a means to reduce their taxes by the amount of their out of pocket health-related expenses (subject to eligibility) This tax free savings program allows employees to submit receipts for reimbursement for medical dental vision care prescription drug co-payments and other expenses not covered by our insurance In 2020 employees may contribute up to $2750 per year toward their FSA Employees have until March 14 2020 to use the money in their FSA or else they lose it (This contribution amount could change based on IRS guideline updates)

Dependent Care Spending Account (DCA) through Optum Health The Dependent Care Spending Account provides employees a means to reduce their taxes by the amount of their child care costs to a licensed provider up to $5000 annually

Health Insurance Premium Bank

Reston Association has established a program to help regular full-time and regular part-time employees pay their portion of the health insurance premium This program is only available to employees who are enrolled in or plan to enroll in the Kaiser Permanente HMO health insurance plans offered by the Reston Association Employees are eligible to apply to the Health Insurance Premium Bank if their adjusted gross household incomes are less than or equal to $60000 Requests for assistance must be made annually or at any time there is a qualifying event and submitted to Human Resources with necessary documentation by December 12th of each year To apply complete a request form (available in CommonHumResBenefits) and submit to HR with a copy of your most recent tax return showing adjusted gross household income This threshold is subject to change

16

Life and ADampD Insurance

Basic LifeADampD Insurance Reston Association provides 100 employer paid Life and ADampD Insurance through Sun Life to employees working 25 or more hours per week Coverage becomes effective the first of the month following six months of service

Benefit 2x Annual Earnings to a maximum of $200000 Age reduction Benefit reduced to 65 at age 65 and to 50 at age 70

Optional LifeADampD Insurance for Employee Spouse and Dependent Children

Optional Life Insurance for the employee spouse and dependent children is available at the employeersquos cost Optional Life is not available for domestic partners

Employee Benefit Increments of $10000 to a maximum of the lesser of $300000 or 3x your Basic Annual Earnings

Spouse Benefit Increments of $5000 to a maximum of $150000 Dependent Child Benefit Increments of $1000 to a maximum of $10000

Your amount of Dependent Spouse and Dependent Child Optional Life Insurance cannot exceed 50 of your amount of Optional Life Insurance Initial eligibility period will require evidence of insurability

STD amp LTD Insurance

Short Term and Long Term Disability Reston Association provides eligible employees with short and long-term disability income benefits through Sun Life In the event you become disabled from a non work-related injury or sickness disability income benefits are provided as a source of income These benefits are 100 employer paid

Benefit Short-Term Disability Long-Term Disability

Income Replacement -Eligible Employees -Executives

60 60

Elimination Period - Accidental Injury - Sickness

29 days 90 days

Benefit Period 9 weeks maximum To Social Security

normal retirement age

Benefit Maximum -Eligible Employees -Executives

$1000 per week $6000 per month $8000 per month 17

At a cost of $19month you can enroll in the Legal Resources benefit As a Legal Resources Member you have immediate and ongoing access to comprehensive legal coverage services and expertise that will easily save you money mdash and could save you a whole lot more Covered legal services include

Legal Advice and Consultation Tenant Dispute with Landlord District Court Representation for Civil Action Review of a Financial Contract or Lease Purchase sale or refinance of primary home Traffic Court Representation (includes 1st DUI) Will Preparation Uncontested Divorce Representation Defense of Child in Court (misdemeanor)

Legal Resources

Employee Assistance Program (EAP)

Reston Association offers a free confidential Employee Assistance Program (EAP) to all employees and their eligible dependents Through RArsquos EAP provider Lytle EAP Partners you and your immediate family members have immediate access on your date of hire to confidential professional counseling and referral services for help with anything that affects you or your dependentsrsquo well-being You can reach an EAP counselor by dialing 1-800-327-7272 24 hours a day or you may visit their website at wwwLytleEAPcom (password is reston) for more information Visit wwwLytleEAPcom for web-based legal financial worklife resources There are also work-related resources available online for managers Note Since EAP services are provided as a benefit only RA makes no representation concerning quality of care

18

401(k) Retirement Savings Plan

Reston Association offers two 401(k) retirement savings plans through Ascensusmdasha traditional 401(k) plan in which employee contributions are made pre-tax and a 401(k) Roth in which employee contributions are made after tax RA matches employee contributions dollar for dollar up to a total of 7 of your annual salary You can begin making contributions to the 401(k) plan and become eligible for RArsquos match following six months of service You always own 100 of your salary contributions

It is possible to borrow against a portion of your vested 401(k) account balance by taking a 401(k) loan You may request a participant loan using an application form which can be obtained by contacting Human Resources Your ability to obtain a 401(k) loan will depend on specific qualifying factors (defined in the 401(k) Summary Plan Description document) The 401(k) Plan Administrator will determine whether you satisfy these factors To access your 401(k) plan online httpsmyaccountascensuscomrplink Check account balance and rate of return Change fund elections Request a 401k loan View fund pricing and performance View and print quarterly statements

19

529 College Savings Plan (employer-sponsored)

A 529 college savings plan provides those saving for college with an unmatched combination of benefits You can open a 529 plan for anyone mdash your child grandchild spouse a friend or even yourself Assets in a 529 plan can be used to pay for a variety of higher education expenses including required books tuition room and board supplies and certain other required fees and expenses Earnings in 529 accounts can grow free from federal tax Withdrawals for qualified higher education expenses are free from federal tax Option to set up recurring automatic fund transfers directly from your bank account making it easy for you to invest The account owner rather than the beneficiary maintains control of account assets and determines the timing and amount of distributions Account owners can change beneficiaries without penalty provided the new beneficiary is a member of the previous beneficiaryrsquos family For more information please contact Human Resources

Additional Benefits

Free passes for employees and their dependents to all of RArsquos pools and tennis courts as well as discounted rates for all RA Programs and Camps Some restrictions may apply

Discounted gym membership rates at the Reston YMCA and Crunch Fitness Bike Share Program - Reston Association makes bicycles and helmets available to employees to rent on a daily

basis Please contact Member Services Discounted Tennis Rackets amp Shoes ndash Employees can purchase certain tennis shoes and rackets at wholesale

prices through RArsquos Tennis Department Contact the Tennis Department for more information Discounted autohome insurance - Liberty Mutual Insurance Company partners with RA to offer all employees

discounts on automobile and homeowner insurance Contact John Valenti at JohnValentilibertymutualcom

20

Reston Association provides generous paid time off benefits to accommodate the diverse needs of staff and to provide a positive worklife balance The amount of paid time off you earn per year is based on your years of service In addition Reston Association observes 9 paid holidays and assigns one paid floating holiday per year For more information on paid time off benefits and how to request time off please refer to the Reston Association Employee Handbook

WorkLife Balance ndash Paid Time Off (PTO)

Teleworking

The medical leave bank is available to help employees in extenuating circumstances protect their incomes by receiving paid leave once their personal PTO is used up A maximum of six (6) workweeks may be granted for each Medical Leave Bank request If additional time is necessary a new request must be made For program eligibility and criteria go to CommonHumResBenefits

Medical Leave Bank

Volunteer Release Time

On a per position basis employees may be allowed to telework for part of their workweek or in certain circumstances Such arrangements must be in compliance with the written administrative procedure including being approved in advance by the department director

Employees are encouraged to become involved in their communities lending their voluntary support to programs that enrich the quality of life and opportunities for all citizens This benefit allows employees to take paid-time off during a work day to participate in a volunteer activity that benefits the community at large Such activities are typically sponsored by a charitable or service organization or work with one or more individuals in need of assistance or special service

21

Training amp Career Development

Reston Association offers two types of learning opportunities for employees mdashinformal and formalmdashto foster individual development and training and career planning

I Informal Learning Opportunities (individual development amp training)

Focus on individual acquiring or enhancing specific task andor process skills to perform his or her current job better Typically this type of learning is not ldquodegree- orientedrdquo

Participants may or may not receive attendance or achievement certificate

Conferences workshops seminars webinars online courses etc typically lasting a few hours to one week

Requests for this type of training should be made to your supervisor or department head

II Formal Learning Opportunities (career planning)

Professional DevelopmentCareer Planning

Formalstructured learning geared toward improving and maintaining professional competence enhancing career progression staying abreast of new technologies and best practices developing process skills andor compliance with professional regulations

Future but not degree-oriented CEUs may be earned

May lead to qualification or credential required to obtain or retain specific certification

Opportunity may range from semester-long academic course to 24 month program with wide range of content and learning experience

Tuition Reimbursement Program

Supports formal education goals (AA bachelors masters) of individual to enhance knowledge and skills in specific areaindustry

Learning must be job-related and accomplished at or through accredited learning institution or e-learning platform connected with the institution

Requests for this type of training should be made to Human Resources as soon as foreseeable to ensure best availability of funds to support reimbursement

22

23

Lifetime limit not applicable and enrollment opportunity The lifetime limit on the dollar value of benefits under our medical plan no longer applies Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan Individuals have 30 days from the date of this notice to request enrollment For more information contact Human Resources or call the medical insurance carrier at the telephone number on your identification card

Notice on Patient Protections The medical HMO plan generally allows the designation of a primary care provider You have the right to designate any primary care provider who participates in the network and who is available to accept you or your family members Until you make this designation the medical carrier designates one for you For information on how to select a primary care provider and for a list of the participating primary care providers contact the medical insurance carrier at the number listed on your identification card

For children you may designate a pediatrician as the primary care provider You do not need prior authorization from the medical insurance carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in the network who specializes in obstetrics or gynecology The health care professional however may be required to comply with certain procedures including obtaining prior authorization for certain services following a pre-approved treatment plan or procedures for making referrals For a list of participating health care professionals who specialize in obstetrics or gynecology contact the medical insurance carrier at the number listed on your identification card

OTC Drug Reimbursements for FSAsHRAsHSAs Under the new Health Care Reform law (PPACA) the cost of an over-the-counter medicine or drug cannot be reimbursed from the account unless a prescription is obtained The change does not affect insulin even if purchased without a prescription or other health care expenses such as medical devices eyeglasses contact lenses co-pays and deductibles The new standard applies only to purchases made on or after January 1 2011

A similar rule is in effect for Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs)

The IRS has also posted a questions and answers section on its website httpwwwirsgovnewsroomarticle0id=22730800html concerning these provisions

Patient Protection and Affordable Care Act (PPACA) Mandatory Notices

The text below is an annual open enrollment required notice

24

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION PLEASE REVIEW IT CAREFULLY

Our Pledge to You

This notice is intended to inform you of the privacy practices followed by the Reston Associationrsquos Employee Benefit Plan (the Plan) and the Planrsquos legal obligations regarding your protected health information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) The notice also explains the privacy rights you and your family members have as participants of the Plan It is effective on April 14 2011

The Plan often needs access to your protected health information in order to provide payment for health services and perform plan administrative functions We want to assure the plan participants covered under the Plan that we comply with federal privacy laws and respect your right to privacy Reston Association requires all members of our workforce and third parties that are provided access to protected health information to comply with the privacy practices outlined in this notice

Protected Health Information Your protected health information is protected by the HIPAA Privacy Rule Generally protected health information is information that identifies an individual created or received by a health care provider health plan or an employer on behalf of a group health plan that relates to physical or mental health conditions provision of health care or payment for health care whether past present or future

How We May Use Your Protected Health Information Under the HIPAA Privacy Rule we may use or disclose your protected health information for certain purposes without your permission This section describes the ways we can use and disclose your protected health information

bull Payment We use or disclose your protected health information without your written authorization in order to determine eligibility for benefits seek reimbursement from a third party or coordinate benefits with another health plan under which you are covered For example a health care provider that provided treatment to you will provide us with your health information We use that information in order to determine whether those services are eligible for payment under our group health plan

bull Health Care Operations We use and disclose your protected health information in order to perform plan administration functions such as quality assurance activities resolution of internal grievances and evaluating plan performance For example we review claims experience in order to understand participant utilization and to make plan design changes that are intended to control health care costs

bull Treatment Although the law allows use and disclosure of your protected health information for purposes of treatment as a health plan we generally do not need to disclose your information for treatment purposes Your physician or health care provider is required to provide you with an explanation of how they use and share your health information for purposes of treatment payment and health care operations

bull As permitted or required by law We may also use or disclose your protected health information without your written authorization for other reasons as permitted by law We are permitted by law to share information subject to certain requirements in order to communicate information on health-related benefits or services that may be of interest to you respond to a court order or provide information to further public health activities (eg preventing the spread of disease) without your written authorization We are also permitted to share protected health information during a corporate restructuring such as a merger sale or acquisition We will also disclose health information about you when required by law for example in order to prevent serious harm to you or others

The text below is an annual open enrollment required notice

25

Notice of Privacy Practices

bull Pursuant to your Authorization When required by law we will ask for your written authorization before using or disclosing your protected health information If you choose to sign an authorization to disclose information you can later revoke that authorization to prevent any future uses or disclosures

bull To Business Associates We may enter into contracts with entities known as Business Associates that provide services to or perform functions on behalf of the Plan We may disclose protected health information to Business Associates once they have agreed in writing to safeguard the protected health information For example we may disclose your protected health information to a Business Associate to administer claims Business Associates are also required by law to protect protected health information

bull To the Plan Sponsor We may disclose protected health information to certain employees of Reston Association for the purpose of administering the Plan These employees will use or disclose the protected health information only as necessary to perform plan administration functions or as otherwise required by HIPAA unless you have authorized additional disclosures Your protected health information cannot be used for employment purposes without your specific authorization

Your Rights bull Right to Inspect and Copy In most cases you have the right to inspect and copy the protected health

information we maintain about you If you request copies we will charge you a reasonable fee to cover the costs of copying mailing or other expenses associated with your request Your request to inspect or review your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to inspect and copy your health information To the extent your information is held in an electronic health record you may be able to receive the information in an electronic format

bull Right to Amend If you believe that information within your records is incorrect or if important information is missing you have the right to request that we correct the existing information or add the missing information Your request to amend your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to amend your health information If we deny your request you may file a statement of disagreement with us for inclusion in any future disclosures of the disputed information

bull Right to an Accounting of Disclosures You have the right to receive an accounting of certain disclosures of your protected health information The accounting will not include disclosures that were made (1) for purposes of treatment payment or health care operations (2) to you (3) pursuant to your authorization (4) to your friends or family in your presence or because of an emergency (5) for national security purposes or (6) incidental to otherwise permissible disclosures

Your request to for an accounting must be submitted in writing to the person listed below You may request an accounting of disclosures made within the last six years You may request one accounting free of charge within a 12-month period

The text below is an annual open enrollment required notice

25

26

The information provided herein is intended to be a summary of benefits only and in no way supersedes the actual plan documents provided by the insurance carriersadministrators For more detailed information pertaining to your employee benefit plans including limitations and exclusions

please refer to the plan documents andor evidence of coverage provided by the carriersadministrators

Womenrsquos Health and Cancer Rights Act of 1998

If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos Health and Cancer Rights Act of 1998 (WHCRA) For individuals receiving mastectomy-related benefits coverage will be provided in a manner determined in consultation with the attending physician and the patient for

bull All stages of reconstruction of the breast on which the mastectomy was performed bull Surgery and reconstruction of the other breast to produce a symmetrical appearance bull Prostheses and bull Treatment of physical complications of the mastectomy including lymphedema

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan If you would like more information on WHCRA benefits call your plan administrator

CHIP-Childrens Health Insurance Program (CHIP) Reauthorization Act of 2009

Medicaid and the Childrenrsquos Health Insurance Program (CHIP) offer free or low-cost health coverage to children and families If you are eligible for health coverage from your employer but are unable to afford the premiums some States have premium assistance programs that can help pay for coverage These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage but need assistance in paying their health premiums

If you or your dependents are already enrolled in Medicaid or CHIP you can contact your state Medicaid or CHIP office to find out if premium assistance is available For a list of the contacts in each State go to wwwdolgovebsachipmodelnoticedoc

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify you can then contact the State to find out if it has a program that might help you pay the premiums for an employer-sponsored plan

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP your employerrsquos health plan is required to permit you and your dependents to enroll in the plan ndash as long as you and your dependents are eligible but not already enrolled in the employerrsquos plan This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance

The text below is an annual open enrollment required notice

26

27

Premium Assistance Under Medicaid and the

Childrenrsquos Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your

employer your state may have a premium assistance program that can help pay for coverage using funds

from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot

be eligible for these premium assistance programs but you may be able to buy individual insurance coverage

through the Health Insurance Marketplace For more information visit wwwhealthcaregov

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below

contact your State Medicaid or CHIP office to find out if premium assistance is available

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your

dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-

877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a

program that might help you pay the premiums for an employer-sponsored plan

If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible

under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already

enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days

of being determined eligible for premium assistance If you have questions about enrolling in your

employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)

If you live in one of the following states you may be eligible for assistance paying your employer

health plan premiums The following list of states is current as of July 31 2019 Contact your State for

more information on eligibility ndash

ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcom

Phone 1-855-692-5447

Website httpflmedicaidtplrecoverycomhipp

Phone 1-877-357-3268

ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program

Website httpmyakhippcom

Phone 1-866-251-4861

Email CustomerServiceMyAKHIPPcom

Medicaid Eligibility

httpdhssalaskagovdpaPagesmedicaiddefaultaspx

Website httpsmedicaidgeorgiagovhealth-

insurance-premium-payment-program-hipp

Phone 678-564-1162 ext 2131

ARKANSAS ndash Medicaid INDIANA ndash Medicaid

Website httpmyarhippcom

Phone 1-855-MyARHIPP (855-692-7447)

Healthy Indiana Plan for low-income adults 19-64

Website httpwwwingovfssahip

Phone 1-877-438-4479

All other Medicaid

Website httpwwwindianamedicaidcom

Phone 1-800-403-0864

COLORADO ndash Health First Colorado

(Coloradorsquos Medicaid Program) amp Child Health

Plan Plus (CHP+)

IOWA ndash Medicaid

Health First Colorado Website

httpswwwhealthfirstcoloradocom

Health First Colorado Member Contact Center

1-800-221-3943 State Relay 711

CHP+ httpswwwcoloradogovpacifichcpfchild-health-

plan-plus

CHP+ Customer Service 1-800-359-1991 State Relay

711

Website

httpdhsiowagovHawki

Phone 1-800-257-8563

28

KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid

Website httpwwwkdheksgovhcf

Phone 1-785-296-3512

Website httpswwwdhhsnhgovoiihipphtm

Phone 603-271-5218

Toll free number for the HIPP program 1-800-852-3345 ext 5218

KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP

Website httpschfskygov

Phone 1-800-635-2570

Medicaid Website

httpwwwstatenjushumanservices

dmahsclientsmedicaid

Medicaid Phone 609-631-2392

CHIP Website httpwwwnjfamilycareorgindexhtml

CHIP Phone 1-800-701-0710

LOUISIANA ndash Medicaid NEW YORK ndash Medicaid

Website httpdhhlouisianagovindexcfmsubhome1n331

Phone 1-888-695-2447

Website httpswwwhealthnygovhealth_caremedicaid

Phone 1-800-541-2831

MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid

Website httpwwwmainegovdhhsofipublic-assistanceindexhtml

Phone 1-800-442-6003

TTY Maine relay 711

Website httpsmedicaidncdhhsgov

Phone 919-855-4100

MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid

Website httpwwwmassgoveohhsgovdepartmentsmasshealth

Phone 1-800-862-4840

Website httpwwwndgovdhsservicesmedicalservmedicaid

Phone 1-844-854-4825

MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP

Website

httpsmngovdhspeople-we-serveseniorshealth-carehealth-care-

programsprograms-and-servicesother-insurancejsp

Phone 1-800-657-3739

Website httpwwwinsureoklahomaorg

Phone 1-888-365-3742

MISSOURI ndash Medicaid OREGON ndash Medicaid

Website httpwwwdssmogovmhdparticipantspageshipphtm

Phone 573-751-2005

Website httphealthcareoregongovPagesindexaspx

httpwwworegonhealthcaregovindex-eshtml

Phone 1-800-699-9075

MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid

Website httpdphhsmtgovMontanaHealthcareProgramsHIPP

Phone 1-800-694-3084

Website

httpwwwdhspagovprovidermedicalassistancehealthinsuranc

epremiumpaymenthippprogramindexhtm

Phone 1-800-692-7462

NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP

Website httpwwwACCESSNebraskanegov

Phone (855) 632-7633

Lincoln (402) 473-7000

Omaha (402) 595-1178

Website httpwwweohhsrigov

Phone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)

29

NEVADA ndash Medicaid SOUTH CAROLINA ndash Medicaid

Medicaid Website httpsdhcfpnvgov

Medicaid Phone 1-800-992-0900

Website httpswwwscdhhsgov

Phone 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid

Website httpdsssdgov

Phone 1-888-828-0059

Website httpswwwhcawagov

Phone 1-800-562-3022 ext 15473

TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascom

Phone 1-800-440-0493

Website httpmywvhippcom

Toll-free phone 1-855-MyWVHIPP (1-855-699-8447)

UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgov

CHIP Website httphealthutahgovchip

Phone 1-877-543-7669

Website

httpswwwdhswisconsingovpublicationsp1p10095p

df

Phone 1-800-362-3002

VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorg

Phone 1-800-250-8427

Website httpswyequalitycareacs-inccom

Phone 307-777-7531

VIRGINIA ndash Medicaid and CHIP Medicaid Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

Medicaid Phone 1-800-432-5924

CHIP Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

CHIP Phone 1-855-242-8282

To see if any other states have added a premium assistance program since July 31 2019 or for more

information on special enrollment rights contact either

US Department of Labor US Department of Health and Human Services

Employee Benefits Security Administration Centers for Medicare amp Medicaid Services

wwwdolgovagenciesebsa wwwcmshhsgov

1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565

Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond

to a collection of information unless such collection displays a valid Office of Management and Budget (OMB)

control number The Department notes that a Federal agency cannot conduct or sponsor a collection of

information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and

the public is not required to respond to a collection of information unless it displays a currently valid OMB control

number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to

penalty for failing to comply with a collection of information if the collection of information does not display a

currently valid OMB control number See 44 USC 3512

The public reporting burden for this collection of information is estimated to average approximately seven minutes

per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other

aspect of this collection of information including suggestions for reducing this burden to the US Department of

Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance

Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and

reference the OMB Control Number 1210-0137 OMB Control Number 1210-0137 (expires 12312019)

Notes

30

Notes

31

Prepared by

Please contact Reston Associationrsquos Human Resources Department at 703-435-7990 or hrrestonorg with any

questions related to your Total Rewards Guide

copy 2019 McGriff Insurance Services Inc

Page 12: Employee Total Rewards Guide 2020 - Reston Total Rewards Gui… · Recognizing and rewarding employees for achieving a sustainable impact. Award criteria includes: •Progressive

Kaiser Permanente POS Select (Facilities amp Contracted Providers with an Out of Network Option) Members can use in-plan benefits by using a Kaiser facility or a contracted primary care physician Your chosen PCP will provide care and coordinate referrals and hospital admissions Members also have the freedom to choose any other licensed provider outside the provider network however you will be responsible for deductibles and coinsurance above the health planrsquos payment

POS Select In-Network You Pay Out-of-Network

you pay

Deductible Coinsurance Out-of-Pocket

None 100

$3500 Individual $9400 Family

$300 Individual $600 Family

8020 $3000 Individual

$6000 Family

Primary Care and Specialist Office Visit $15 PCP$30 Specialist 20 of UCR

Emergency Room Visits $75 per visit (waived if

admitted) $75 per visit

(waived if admitted)

Hospital ndash Inpatient Stay $250 per admission 20 of UCR

Home Health Care No charge 20 of UCR

Outpatient Facility Services $50 20 of UCR

X-Ray and Laboratory Services No charge 20 of UCR

Specialty Imaging (CTMRIPET scan) No charge 20 of UCR

Mental Health (MG) amp Substance Abuse (SA) ndash Inpatient Facility

$250 per admission 20 of UCR

Mental Health (MG) amp Substance Abuse (SA) ndash Outpatient Facility

$7 copay-group therapy $15 copay-individual therapy per visit

20 of UCR

Vision (Children Only) $15 PCP$30 Specialist per visit 20 of UCR

Prescription Drug Program (30 day supply) Generic Drug (Tier 1) Preferred Brand Name Drug (Tier 2) Non-Preferred Brand Drug (Tier 3) Up to 90 day supply ndash 3 co-pays for Plan and Participating Pharmacies Mail Order Up to 90 day supply- 2 co-pays

$0 deductible

Plan $20 Participating $30 Plan $35 Participating $50 Plan $50 Participating $75

$20$35$50

Health Insurance ndash Option 3

12

Dental Insurance

MetLife Dental PPO The Dental PPO plan is 100 Employer Paid for all tiers and provides comprehensive coverage with a nationwide PPO network This gives members access to more in-network dentists making it easier for them to reduce out-of-pocket costs for covered procedures and treatments Dental procedure frequencies Preventative care covers an exam and cleaning (once every 6 months) Fluoride treatment (two per benefit period under age 19 only) Full mouth X-ray (once every 60 months) Bitewing X-ray (once every 12 months age 14 and over once every 12 months under age 14)

PPO Dental Plan Features In-Network Out-of-Network

Type A Preventive Care Services (oral exams cleanings x-rays sealants)

100 of Fee Schedule 100 of Usual amp Customary

Charge

Type B Basic Restorative Dental Services (fillings simple extractions space maintainers)

80 of Fee Schedule 80 of Usual amp Customary

Charge

Type B Major Surgical Dental Services (Endodontics amp Periodontics)

80 of Fee Schedule 80 of Usual amp Customary

Charge

Type C Major Restorative Dental Services (bridges crowns dentures implants)

50 of Fee Schedule 50 of Usual amp Customary

Charge

Orthodontia (under age 19 only)

Lifetime maximum - $1000 50 of allowed benefit

Calendar Year Deductible Applies to Type B amp C services only

$25 Single $75 Family

Calendar Year Maximum Per Person $1500 combined maxper calendar year

Prior to receiving dental services it is recommended that you first obtain a pre-determination of benefits from your dentist so you know exactly how much your dental insurance will cover Spouses domestic partners and dependent children to age 26 (regardless of student status) are eligible

13

Vision Insurance ndash Option 1

Vision Plan through VSP (Voluntary) VSP is the largest private provider vision carrier in the country VSP contracts with Costcoreg Optical Eye Care Centers of America Inctrade which includes popular stores like EyeMasters VisionWorld and Hour Eyes and other quality retail chains When you visit a VSP participating provider your benefits include routine vision exams lenses and preferred pricing on all patient options Frequency Eye Exam 12 monthsLenses 12 monthsFrames 24 monthsContact Lenses 12 months

Vision Plan Features In-Network Out-of-Network

Annual Routine Eye Exam $10 copay Plan pays up to $45

Eyeglass Lenses (standard) Single Bifocal Trifocal

Covered in Full Covered in Full Covered in Full

Plan pays up to $30 Plan pays up to $50 Plan pays up to $65

Frames $130 allowance then 20 off remaining balance

Plan pays up to $70

Necessary Contact Lenses Covered in Full Plan pays up to $210

Elective Contact Lenses $130 allowance Plan pays up to $105

Elective Contact Lenses fitting and evaluation Covered in Full after $60

copay Not Available

Spouses domestic partners and dependent children to age 19 (or to age 25 if FT student) are eligible

14

Vision Insurance ndash Option 2

Vision Plan through Spectera UHC (Voluntary)

UHC offers you one of the largest vision care networks in the industry Their network includes convenient retail locations including My Eye Dr and Hour Eyes Best of all ndash when you receive care from a participating provider you receive the greatest benefits and money-saving discounts

Frequency Eye Exam 12 monthsLenses 12 monthsFrames 12 monthsContact Lenses 12 months

Vision Plan Features In-Network Out-of-Network

Annual Routine Eye Exam $10 copay Plan pays up to $40

Eyeglass Lenses (standard) Single Bifocal Trifocal

$25 copay $25 copay $25 copay

Plan pays up to $40 Plan pays up to $60 Plan pays up to $80

Frames $2500 copay $130 retail frame

allowance 30 discount above allowance

Plan pays up to $45

Necessary Contact Lenses $25 copay Plan pays up to $210

Elective Contact Lenses

$25 copay from the ldquoCovered contact lens

selectionrdquo All others- $105

allowance

Plan pays up to $105

Elective Contact Lenses fitting and evaluation Covered in Full after $25

copay Not Available

Spouses and dependent children to age 26 are eligible

15

Pre-tax FSA amp DCA

Flexible Spending Account (FSA) through Optum Health The Flexible Spending Account provides employees a means to reduce their taxes by the amount of their out of pocket health-related expenses (subject to eligibility) This tax free savings program allows employees to submit receipts for reimbursement for medical dental vision care prescription drug co-payments and other expenses not covered by our insurance In 2020 employees may contribute up to $2750 per year toward their FSA Employees have until March 14 2020 to use the money in their FSA or else they lose it (This contribution amount could change based on IRS guideline updates)

Dependent Care Spending Account (DCA) through Optum Health The Dependent Care Spending Account provides employees a means to reduce their taxes by the amount of their child care costs to a licensed provider up to $5000 annually

Health Insurance Premium Bank

Reston Association has established a program to help regular full-time and regular part-time employees pay their portion of the health insurance premium This program is only available to employees who are enrolled in or plan to enroll in the Kaiser Permanente HMO health insurance plans offered by the Reston Association Employees are eligible to apply to the Health Insurance Premium Bank if their adjusted gross household incomes are less than or equal to $60000 Requests for assistance must be made annually or at any time there is a qualifying event and submitted to Human Resources with necessary documentation by December 12th of each year To apply complete a request form (available in CommonHumResBenefits) and submit to HR with a copy of your most recent tax return showing adjusted gross household income This threshold is subject to change

16

Life and ADampD Insurance

Basic LifeADampD Insurance Reston Association provides 100 employer paid Life and ADampD Insurance through Sun Life to employees working 25 or more hours per week Coverage becomes effective the first of the month following six months of service

Benefit 2x Annual Earnings to a maximum of $200000 Age reduction Benefit reduced to 65 at age 65 and to 50 at age 70

Optional LifeADampD Insurance for Employee Spouse and Dependent Children

Optional Life Insurance for the employee spouse and dependent children is available at the employeersquos cost Optional Life is not available for domestic partners

Employee Benefit Increments of $10000 to a maximum of the lesser of $300000 or 3x your Basic Annual Earnings

Spouse Benefit Increments of $5000 to a maximum of $150000 Dependent Child Benefit Increments of $1000 to a maximum of $10000

Your amount of Dependent Spouse and Dependent Child Optional Life Insurance cannot exceed 50 of your amount of Optional Life Insurance Initial eligibility period will require evidence of insurability

STD amp LTD Insurance

Short Term and Long Term Disability Reston Association provides eligible employees with short and long-term disability income benefits through Sun Life In the event you become disabled from a non work-related injury or sickness disability income benefits are provided as a source of income These benefits are 100 employer paid

Benefit Short-Term Disability Long-Term Disability

Income Replacement -Eligible Employees -Executives

60 60

Elimination Period - Accidental Injury - Sickness

29 days 90 days

Benefit Period 9 weeks maximum To Social Security

normal retirement age

Benefit Maximum -Eligible Employees -Executives

$1000 per week $6000 per month $8000 per month 17

At a cost of $19month you can enroll in the Legal Resources benefit As a Legal Resources Member you have immediate and ongoing access to comprehensive legal coverage services and expertise that will easily save you money mdash and could save you a whole lot more Covered legal services include

Legal Advice and Consultation Tenant Dispute with Landlord District Court Representation for Civil Action Review of a Financial Contract or Lease Purchase sale or refinance of primary home Traffic Court Representation (includes 1st DUI) Will Preparation Uncontested Divorce Representation Defense of Child in Court (misdemeanor)

Legal Resources

Employee Assistance Program (EAP)

Reston Association offers a free confidential Employee Assistance Program (EAP) to all employees and their eligible dependents Through RArsquos EAP provider Lytle EAP Partners you and your immediate family members have immediate access on your date of hire to confidential professional counseling and referral services for help with anything that affects you or your dependentsrsquo well-being You can reach an EAP counselor by dialing 1-800-327-7272 24 hours a day or you may visit their website at wwwLytleEAPcom (password is reston) for more information Visit wwwLytleEAPcom for web-based legal financial worklife resources There are also work-related resources available online for managers Note Since EAP services are provided as a benefit only RA makes no representation concerning quality of care

18

401(k) Retirement Savings Plan

Reston Association offers two 401(k) retirement savings plans through Ascensusmdasha traditional 401(k) plan in which employee contributions are made pre-tax and a 401(k) Roth in which employee contributions are made after tax RA matches employee contributions dollar for dollar up to a total of 7 of your annual salary You can begin making contributions to the 401(k) plan and become eligible for RArsquos match following six months of service You always own 100 of your salary contributions

It is possible to borrow against a portion of your vested 401(k) account balance by taking a 401(k) loan You may request a participant loan using an application form which can be obtained by contacting Human Resources Your ability to obtain a 401(k) loan will depend on specific qualifying factors (defined in the 401(k) Summary Plan Description document) The 401(k) Plan Administrator will determine whether you satisfy these factors To access your 401(k) plan online httpsmyaccountascensuscomrplink Check account balance and rate of return Change fund elections Request a 401k loan View fund pricing and performance View and print quarterly statements

19

529 College Savings Plan (employer-sponsored)

A 529 college savings plan provides those saving for college with an unmatched combination of benefits You can open a 529 plan for anyone mdash your child grandchild spouse a friend or even yourself Assets in a 529 plan can be used to pay for a variety of higher education expenses including required books tuition room and board supplies and certain other required fees and expenses Earnings in 529 accounts can grow free from federal tax Withdrawals for qualified higher education expenses are free from federal tax Option to set up recurring automatic fund transfers directly from your bank account making it easy for you to invest The account owner rather than the beneficiary maintains control of account assets and determines the timing and amount of distributions Account owners can change beneficiaries without penalty provided the new beneficiary is a member of the previous beneficiaryrsquos family For more information please contact Human Resources

Additional Benefits

Free passes for employees and their dependents to all of RArsquos pools and tennis courts as well as discounted rates for all RA Programs and Camps Some restrictions may apply

Discounted gym membership rates at the Reston YMCA and Crunch Fitness Bike Share Program - Reston Association makes bicycles and helmets available to employees to rent on a daily

basis Please contact Member Services Discounted Tennis Rackets amp Shoes ndash Employees can purchase certain tennis shoes and rackets at wholesale

prices through RArsquos Tennis Department Contact the Tennis Department for more information Discounted autohome insurance - Liberty Mutual Insurance Company partners with RA to offer all employees

discounts on automobile and homeowner insurance Contact John Valenti at JohnValentilibertymutualcom

20

Reston Association provides generous paid time off benefits to accommodate the diverse needs of staff and to provide a positive worklife balance The amount of paid time off you earn per year is based on your years of service In addition Reston Association observes 9 paid holidays and assigns one paid floating holiday per year For more information on paid time off benefits and how to request time off please refer to the Reston Association Employee Handbook

WorkLife Balance ndash Paid Time Off (PTO)

Teleworking

The medical leave bank is available to help employees in extenuating circumstances protect their incomes by receiving paid leave once their personal PTO is used up A maximum of six (6) workweeks may be granted for each Medical Leave Bank request If additional time is necessary a new request must be made For program eligibility and criteria go to CommonHumResBenefits

Medical Leave Bank

Volunteer Release Time

On a per position basis employees may be allowed to telework for part of their workweek or in certain circumstances Such arrangements must be in compliance with the written administrative procedure including being approved in advance by the department director

Employees are encouraged to become involved in their communities lending their voluntary support to programs that enrich the quality of life and opportunities for all citizens This benefit allows employees to take paid-time off during a work day to participate in a volunteer activity that benefits the community at large Such activities are typically sponsored by a charitable or service organization or work with one or more individuals in need of assistance or special service

21

Training amp Career Development

Reston Association offers two types of learning opportunities for employees mdashinformal and formalmdashto foster individual development and training and career planning

I Informal Learning Opportunities (individual development amp training)

Focus on individual acquiring or enhancing specific task andor process skills to perform his or her current job better Typically this type of learning is not ldquodegree- orientedrdquo

Participants may or may not receive attendance or achievement certificate

Conferences workshops seminars webinars online courses etc typically lasting a few hours to one week

Requests for this type of training should be made to your supervisor or department head

II Formal Learning Opportunities (career planning)

Professional DevelopmentCareer Planning

Formalstructured learning geared toward improving and maintaining professional competence enhancing career progression staying abreast of new technologies and best practices developing process skills andor compliance with professional regulations

Future but not degree-oriented CEUs may be earned

May lead to qualification or credential required to obtain or retain specific certification

Opportunity may range from semester-long academic course to 24 month program with wide range of content and learning experience

Tuition Reimbursement Program

Supports formal education goals (AA bachelors masters) of individual to enhance knowledge and skills in specific areaindustry

Learning must be job-related and accomplished at or through accredited learning institution or e-learning platform connected with the institution

Requests for this type of training should be made to Human Resources as soon as foreseeable to ensure best availability of funds to support reimbursement

22

23

Lifetime limit not applicable and enrollment opportunity The lifetime limit on the dollar value of benefits under our medical plan no longer applies Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan Individuals have 30 days from the date of this notice to request enrollment For more information contact Human Resources or call the medical insurance carrier at the telephone number on your identification card

Notice on Patient Protections The medical HMO plan generally allows the designation of a primary care provider You have the right to designate any primary care provider who participates in the network and who is available to accept you or your family members Until you make this designation the medical carrier designates one for you For information on how to select a primary care provider and for a list of the participating primary care providers contact the medical insurance carrier at the number listed on your identification card

For children you may designate a pediatrician as the primary care provider You do not need prior authorization from the medical insurance carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in the network who specializes in obstetrics or gynecology The health care professional however may be required to comply with certain procedures including obtaining prior authorization for certain services following a pre-approved treatment plan or procedures for making referrals For a list of participating health care professionals who specialize in obstetrics or gynecology contact the medical insurance carrier at the number listed on your identification card

OTC Drug Reimbursements for FSAsHRAsHSAs Under the new Health Care Reform law (PPACA) the cost of an over-the-counter medicine or drug cannot be reimbursed from the account unless a prescription is obtained The change does not affect insulin even if purchased without a prescription or other health care expenses such as medical devices eyeglasses contact lenses co-pays and deductibles The new standard applies only to purchases made on or after January 1 2011

A similar rule is in effect for Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs)

The IRS has also posted a questions and answers section on its website httpwwwirsgovnewsroomarticle0id=22730800html concerning these provisions

Patient Protection and Affordable Care Act (PPACA) Mandatory Notices

The text below is an annual open enrollment required notice

24

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION PLEASE REVIEW IT CAREFULLY

Our Pledge to You

This notice is intended to inform you of the privacy practices followed by the Reston Associationrsquos Employee Benefit Plan (the Plan) and the Planrsquos legal obligations regarding your protected health information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) The notice also explains the privacy rights you and your family members have as participants of the Plan It is effective on April 14 2011

The Plan often needs access to your protected health information in order to provide payment for health services and perform plan administrative functions We want to assure the plan participants covered under the Plan that we comply with federal privacy laws and respect your right to privacy Reston Association requires all members of our workforce and third parties that are provided access to protected health information to comply with the privacy practices outlined in this notice

Protected Health Information Your protected health information is protected by the HIPAA Privacy Rule Generally protected health information is information that identifies an individual created or received by a health care provider health plan or an employer on behalf of a group health plan that relates to physical or mental health conditions provision of health care or payment for health care whether past present or future

How We May Use Your Protected Health Information Under the HIPAA Privacy Rule we may use or disclose your protected health information for certain purposes without your permission This section describes the ways we can use and disclose your protected health information

bull Payment We use or disclose your protected health information without your written authorization in order to determine eligibility for benefits seek reimbursement from a third party or coordinate benefits with another health plan under which you are covered For example a health care provider that provided treatment to you will provide us with your health information We use that information in order to determine whether those services are eligible for payment under our group health plan

bull Health Care Operations We use and disclose your protected health information in order to perform plan administration functions such as quality assurance activities resolution of internal grievances and evaluating plan performance For example we review claims experience in order to understand participant utilization and to make plan design changes that are intended to control health care costs

bull Treatment Although the law allows use and disclosure of your protected health information for purposes of treatment as a health plan we generally do not need to disclose your information for treatment purposes Your physician or health care provider is required to provide you with an explanation of how they use and share your health information for purposes of treatment payment and health care operations

bull As permitted or required by law We may also use or disclose your protected health information without your written authorization for other reasons as permitted by law We are permitted by law to share information subject to certain requirements in order to communicate information on health-related benefits or services that may be of interest to you respond to a court order or provide information to further public health activities (eg preventing the spread of disease) without your written authorization We are also permitted to share protected health information during a corporate restructuring such as a merger sale or acquisition We will also disclose health information about you when required by law for example in order to prevent serious harm to you or others

The text below is an annual open enrollment required notice

25

Notice of Privacy Practices

bull Pursuant to your Authorization When required by law we will ask for your written authorization before using or disclosing your protected health information If you choose to sign an authorization to disclose information you can later revoke that authorization to prevent any future uses or disclosures

bull To Business Associates We may enter into contracts with entities known as Business Associates that provide services to or perform functions on behalf of the Plan We may disclose protected health information to Business Associates once they have agreed in writing to safeguard the protected health information For example we may disclose your protected health information to a Business Associate to administer claims Business Associates are also required by law to protect protected health information

bull To the Plan Sponsor We may disclose protected health information to certain employees of Reston Association for the purpose of administering the Plan These employees will use or disclose the protected health information only as necessary to perform plan administration functions or as otherwise required by HIPAA unless you have authorized additional disclosures Your protected health information cannot be used for employment purposes without your specific authorization

Your Rights bull Right to Inspect and Copy In most cases you have the right to inspect and copy the protected health

information we maintain about you If you request copies we will charge you a reasonable fee to cover the costs of copying mailing or other expenses associated with your request Your request to inspect or review your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to inspect and copy your health information To the extent your information is held in an electronic health record you may be able to receive the information in an electronic format

bull Right to Amend If you believe that information within your records is incorrect or if important information is missing you have the right to request that we correct the existing information or add the missing information Your request to amend your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to amend your health information If we deny your request you may file a statement of disagreement with us for inclusion in any future disclosures of the disputed information

bull Right to an Accounting of Disclosures You have the right to receive an accounting of certain disclosures of your protected health information The accounting will not include disclosures that were made (1) for purposes of treatment payment or health care operations (2) to you (3) pursuant to your authorization (4) to your friends or family in your presence or because of an emergency (5) for national security purposes or (6) incidental to otherwise permissible disclosures

Your request to for an accounting must be submitted in writing to the person listed below You may request an accounting of disclosures made within the last six years You may request one accounting free of charge within a 12-month period

The text below is an annual open enrollment required notice

25

26

The information provided herein is intended to be a summary of benefits only and in no way supersedes the actual plan documents provided by the insurance carriersadministrators For more detailed information pertaining to your employee benefit plans including limitations and exclusions

please refer to the plan documents andor evidence of coverage provided by the carriersadministrators

Womenrsquos Health and Cancer Rights Act of 1998

If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos Health and Cancer Rights Act of 1998 (WHCRA) For individuals receiving mastectomy-related benefits coverage will be provided in a manner determined in consultation with the attending physician and the patient for

bull All stages of reconstruction of the breast on which the mastectomy was performed bull Surgery and reconstruction of the other breast to produce a symmetrical appearance bull Prostheses and bull Treatment of physical complications of the mastectomy including lymphedema

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan If you would like more information on WHCRA benefits call your plan administrator

CHIP-Childrens Health Insurance Program (CHIP) Reauthorization Act of 2009

Medicaid and the Childrenrsquos Health Insurance Program (CHIP) offer free or low-cost health coverage to children and families If you are eligible for health coverage from your employer but are unable to afford the premiums some States have premium assistance programs that can help pay for coverage These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage but need assistance in paying their health premiums

If you or your dependents are already enrolled in Medicaid or CHIP you can contact your state Medicaid or CHIP office to find out if premium assistance is available For a list of the contacts in each State go to wwwdolgovebsachipmodelnoticedoc

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify you can then contact the State to find out if it has a program that might help you pay the premiums for an employer-sponsored plan

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP your employerrsquos health plan is required to permit you and your dependents to enroll in the plan ndash as long as you and your dependents are eligible but not already enrolled in the employerrsquos plan This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance

The text below is an annual open enrollment required notice

26

27

Premium Assistance Under Medicaid and the

Childrenrsquos Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your

employer your state may have a premium assistance program that can help pay for coverage using funds

from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot

be eligible for these premium assistance programs but you may be able to buy individual insurance coverage

through the Health Insurance Marketplace For more information visit wwwhealthcaregov

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below

contact your State Medicaid or CHIP office to find out if premium assistance is available

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your

dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-

877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a

program that might help you pay the premiums for an employer-sponsored plan

If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible

under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already

enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days

of being determined eligible for premium assistance If you have questions about enrolling in your

employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)

If you live in one of the following states you may be eligible for assistance paying your employer

health plan premiums The following list of states is current as of July 31 2019 Contact your State for

more information on eligibility ndash

ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcom

Phone 1-855-692-5447

Website httpflmedicaidtplrecoverycomhipp

Phone 1-877-357-3268

ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program

Website httpmyakhippcom

Phone 1-866-251-4861

Email CustomerServiceMyAKHIPPcom

Medicaid Eligibility

httpdhssalaskagovdpaPagesmedicaiddefaultaspx

Website httpsmedicaidgeorgiagovhealth-

insurance-premium-payment-program-hipp

Phone 678-564-1162 ext 2131

ARKANSAS ndash Medicaid INDIANA ndash Medicaid

Website httpmyarhippcom

Phone 1-855-MyARHIPP (855-692-7447)

Healthy Indiana Plan for low-income adults 19-64

Website httpwwwingovfssahip

Phone 1-877-438-4479

All other Medicaid

Website httpwwwindianamedicaidcom

Phone 1-800-403-0864

COLORADO ndash Health First Colorado

(Coloradorsquos Medicaid Program) amp Child Health

Plan Plus (CHP+)

IOWA ndash Medicaid

Health First Colorado Website

httpswwwhealthfirstcoloradocom

Health First Colorado Member Contact Center

1-800-221-3943 State Relay 711

CHP+ httpswwwcoloradogovpacifichcpfchild-health-

plan-plus

CHP+ Customer Service 1-800-359-1991 State Relay

711

Website

httpdhsiowagovHawki

Phone 1-800-257-8563

28

KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid

Website httpwwwkdheksgovhcf

Phone 1-785-296-3512

Website httpswwwdhhsnhgovoiihipphtm

Phone 603-271-5218

Toll free number for the HIPP program 1-800-852-3345 ext 5218

KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP

Website httpschfskygov

Phone 1-800-635-2570

Medicaid Website

httpwwwstatenjushumanservices

dmahsclientsmedicaid

Medicaid Phone 609-631-2392

CHIP Website httpwwwnjfamilycareorgindexhtml

CHIP Phone 1-800-701-0710

LOUISIANA ndash Medicaid NEW YORK ndash Medicaid

Website httpdhhlouisianagovindexcfmsubhome1n331

Phone 1-888-695-2447

Website httpswwwhealthnygovhealth_caremedicaid

Phone 1-800-541-2831

MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid

Website httpwwwmainegovdhhsofipublic-assistanceindexhtml

Phone 1-800-442-6003

TTY Maine relay 711

Website httpsmedicaidncdhhsgov

Phone 919-855-4100

MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid

Website httpwwwmassgoveohhsgovdepartmentsmasshealth

Phone 1-800-862-4840

Website httpwwwndgovdhsservicesmedicalservmedicaid

Phone 1-844-854-4825

MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP

Website

httpsmngovdhspeople-we-serveseniorshealth-carehealth-care-

programsprograms-and-servicesother-insurancejsp

Phone 1-800-657-3739

Website httpwwwinsureoklahomaorg

Phone 1-888-365-3742

MISSOURI ndash Medicaid OREGON ndash Medicaid

Website httpwwwdssmogovmhdparticipantspageshipphtm

Phone 573-751-2005

Website httphealthcareoregongovPagesindexaspx

httpwwworegonhealthcaregovindex-eshtml

Phone 1-800-699-9075

MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid

Website httpdphhsmtgovMontanaHealthcareProgramsHIPP

Phone 1-800-694-3084

Website

httpwwwdhspagovprovidermedicalassistancehealthinsuranc

epremiumpaymenthippprogramindexhtm

Phone 1-800-692-7462

NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP

Website httpwwwACCESSNebraskanegov

Phone (855) 632-7633

Lincoln (402) 473-7000

Omaha (402) 595-1178

Website httpwwweohhsrigov

Phone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)

29

NEVADA ndash Medicaid SOUTH CAROLINA ndash Medicaid

Medicaid Website httpsdhcfpnvgov

Medicaid Phone 1-800-992-0900

Website httpswwwscdhhsgov

Phone 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid

Website httpdsssdgov

Phone 1-888-828-0059

Website httpswwwhcawagov

Phone 1-800-562-3022 ext 15473

TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascom

Phone 1-800-440-0493

Website httpmywvhippcom

Toll-free phone 1-855-MyWVHIPP (1-855-699-8447)

UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgov

CHIP Website httphealthutahgovchip

Phone 1-877-543-7669

Website

httpswwwdhswisconsingovpublicationsp1p10095p

df

Phone 1-800-362-3002

VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorg

Phone 1-800-250-8427

Website httpswyequalitycareacs-inccom

Phone 307-777-7531

VIRGINIA ndash Medicaid and CHIP Medicaid Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

Medicaid Phone 1-800-432-5924

CHIP Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

CHIP Phone 1-855-242-8282

To see if any other states have added a premium assistance program since July 31 2019 or for more

information on special enrollment rights contact either

US Department of Labor US Department of Health and Human Services

Employee Benefits Security Administration Centers for Medicare amp Medicaid Services

wwwdolgovagenciesebsa wwwcmshhsgov

1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565

Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond

to a collection of information unless such collection displays a valid Office of Management and Budget (OMB)

control number The Department notes that a Federal agency cannot conduct or sponsor a collection of

information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and

the public is not required to respond to a collection of information unless it displays a currently valid OMB control

number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to

penalty for failing to comply with a collection of information if the collection of information does not display a

currently valid OMB control number See 44 USC 3512

The public reporting burden for this collection of information is estimated to average approximately seven minutes

per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other

aspect of this collection of information including suggestions for reducing this burden to the US Department of

Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance

Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and

reference the OMB Control Number 1210-0137 OMB Control Number 1210-0137 (expires 12312019)

Notes

30

Notes

31

Prepared by

Please contact Reston Associationrsquos Human Resources Department at 703-435-7990 or hrrestonorg with any

questions related to your Total Rewards Guide

copy 2019 McGriff Insurance Services Inc

Page 13: Employee Total Rewards Guide 2020 - Reston Total Rewards Gui… · Recognizing and rewarding employees for achieving a sustainable impact. Award criteria includes: •Progressive

Dental Insurance

MetLife Dental PPO The Dental PPO plan is 100 Employer Paid for all tiers and provides comprehensive coverage with a nationwide PPO network This gives members access to more in-network dentists making it easier for them to reduce out-of-pocket costs for covered procedures and treatments Dental procedure frequencies Preventative care covers an exam and cleaning (once every 6 months) Fluoride treatment (two per benefit period under age 19 only) Full mouth X-ray (once every 60 months) Bitewing X-ray (once every 12 months age 14 and over once every 12 months under age 14)

PPO Dental Plan Features In-Network Out-of-Network

Type A Preventive Care Services (oral exams cleanings x-rays sealants)

100 of Fee Schedule 100 of Usual amp Customary

Charge

Type B Basic Restorative Dental Services (fillings simple extractions space maintainers)

80 of Fee Schedule 80 of Usual amp Customary

Charge

Type B Major Surgical Dental Services (Endodontics amp Periodontics)

80 of Fee Schedule 80 of Usual amp Customary

Charge

Type C Major Restorative Dental Services (bridges crowns dentures implants)

50 of Fee Schedule 50 of Usual amp Customary

Charge

Orthodontia (under age 19 only)

Lifetime maximum - $1000 50 of allowed benefit

Calendar Year Deductible Applies to Type B amp C services only

$25 Single $75 Family

Calendar Year Maximum Per Person $1500 combined maxper calendar year

Prior to receiving dental services it is recommended that you first obtain a pre-determination of benefits from your dentist so you know exactly how much your dental insurance will cover Spouses domestic partners and dependent children to age 26 (regardless of student status) are eligible

13

Vision Insurance ndash Option 1

Vision Plan through VSP (Voluntary) VSP is the largest private provider vision carrier in the country VSP contracts with Costcoreg Optical Eye Care Centers of America Inctrade which includes popular stores like EyeMasters VisionWorld and Hour Eyes and other quality retail chains When you visit a VSP participating provider your benefits include routine vision exams lenses and preferred pricing on all patient options Frequency Eye Exam 12 monthsLenses 12 monthsFrames 24 monthsContact Lenses 12 months

Vision Plan Features In-Network Out-of-Network

Annual Routine Eye Exam $10 copay Plan pays up to $45

Eyeglass Lenses (standard) Single Bifocal Trifocal

Covered in Full Covered in Full Covered in Full

Plan pays up to $30 Plan pays up to $50 Plan pays up to $65

Frames $130 allowance then 20 off remaining balance

Plan pays up to $70

Necessary Contact Lenses Covered in Full Plan pays up to $210

Elective Contact Lenses $130 allowance Plan pays up to $105

Elective Contact Lenses fitting and evaluation Covered in Full after $60

copay Not Available

Spouses domestic partners and dependent children to age 19 (or to age 25 if FT student) are eligible

14

Vision Insurance ndash Option 2

Vision Plan through Spectera UHC (Voluntary)

UHC offers you one of the largest vision care networks in the industry Their network includes convenient retail locations including My Eye Dr and Hour Eyes Best of all ndash when you receive care from a participating provider you receive the greatest benefits and money-saving discounts

Frequency Eye Exam 12 monthsLenses 12 monthsFrames 12 monthsContact Lenses 12 months

Vision Plan Features In-Network Out-of-Network

Annual Routine Eye Exam $10 copay Plan pays up to $40

Eyeglass Lenses (standard) Single Bifocal Trifocal

$25 copay $25 copay $25 copay

Plan pays up to $40 Plan pays up to $60 Plan pays up to $80

Frames $2500 copay $130 retail frame

allowance 30 discount above allowance

Plan pays up to $45

Necessary Contact Lenses $25 copay Plan pays up to $210

Elective Contact Lenses

$25 copay from the ldquoCovered contact lens

selectionrdquo All others- $105

allowance

Plan pays up to $105

Elective Contact Lenses fitting and evaluation Covered in Full after $25

copay Not Available

Spouses and dependent children to age 26 are eligible

15

Pre-tax FSA amp DCA

Flexible Spending Account (FSA) through Optum Health The Flexible Spending Account provides employees a means to reduce their taxes by the amount of their out of pocket health-related expenses (subject to eligibility) This tax free savings program allows employees to submit receipts for reimbursement for medical dental vision care prescription drug co-payments and other expenses not covered by our insurance In 2020 employees may contribute up to $2750 per year toward their FSA Employees have until March 14 2020 to use the money in their FSA or else they lose it (This contribution amount could change based on IRS guideline updates)

Dependent Care Spending Account (DCA) through Optum Health The Dependent Care Spending Account provides employees a means to reduce their taxes by the amount of their child care costs to a licensed provider up to $5000 annually

Health Insurance Premium Bank

Reston Association has established a program to help regular full-time and regular part-time employees pay their portion of the health insurance premium This program is only available to employees who are enrolled in or plan to enroll in the Kaiser Permanente HMO health insurance plans offered by the Reston Association Employees are eligible to apply to the Health Insurance Premium Bank if their adjusted gross household incomes are less than or equal to $60000 Requests for assistance must be made annually or at any time there is a qualifying event and submitted to Human Resources with necessary documentation by December 12th of each year To apply complete a request form (available in CommonHumResBenefits) and submit to HR with a copy of your most recent tax return showing adjusted gross household income This threshold is subject to change

16

Life and ADampD Insurance

Basic LifeADampD Insurance Reston Association provides 100 employer paid Life and ADampD Insurance through Sun Life to employees working 25 or more hours per week Coverage becomes effective the first of the month following six months of service

Benefit 2x Annual Earnings to a maximum of $200000 Age reduction Benefit reduced to 65 at age 65 and to 50 at age 70

Optional LifeADampD Insurance for Employee Spouse and Dependent Children

Optional Life Insurance for the employee spouse and dependent children is available at the employeersquos cost Optional Life is not available for domestic partners

Employee Benefit Increments of $10000 to a maximum of the lesser of $300000 or 3x your Basic Annual Earnings

Spouse Benefit Increments of $5000 to a maximum of $150000 Dependent Child Benefit Increments of $1000 to a maximum of $10000

Your amount of Dependent Spouse and Dependent Child Optional Life Insurance cannot exceed 50 of your amount of Optional Life Insurance Initial eligibility period will require evidence of insurability

STD amp LTD Insurance

Short Term and Long Term Disability Reston Association provides eligible employees with short and long-term disability income benefits through Sun Life In the event you become disabled from a non work-related injury or sickness disability income benefits are provided as a source of income These benefits are 100 employer paid

Benefit Short-Term Disability Long-Term Disability

Income Replacement -Eligible Employees -Executives

60 60

Elimination Period - Accidental Injury - Sickness

29 days 90 days

Benefit Period 9 weeks maximum To Social Security

normal retirement age

Benefit Maximum -Eligible Employees -Executives

$1000 per week $6000 per month $8000 per month 17

At a cost of $19month you can enroll in the Legal Resources benefit As a Legal Resources Member you have immediate and ongoing access to comprehensive legal coverage services and expertise that will easily save you money mdash and could save you a whole lot more Covered legal services include

Legal Advice and Consultation Tenant Dispute with Landlord District Court Representation for Civil Action Review of a Financial Contract or Lease Purchase sale or refinance of primary home Traffic Court Representation (includes 1st DUI) Will Preparation Uncontested Divorce Representation Defense of Child in Court (misdemeanor)

Legal Resources

Employee Assistance Program (EAP)

Reston Association offers a free confidential Employee Assistance Program (EAP) to all employees and their eligible dependents Through RArsquos EAP provider Lytle EAP Partners you and your immediate family members have immediate access on your date of hire to confidential professional counseling and referral services for help with anything that affects you or your dependentsrsquo well-being You can reach an EAP counselor by dialing 1-800-327-7272 24 hours a day or you may visit their website at wwwLytleEAPcom (password is reston) for more information Visit wwwLytleEAPcom for web-based legal financial worklife resources There are also work-related resources available online for managers Note Since EAP services are provided as a benefit only RA makes no representation concerning quality of care

18

401(k) Retirement Savings Plan

Reston Association offers two 401(k) retirement savings plans through Ascensusmdasha traditional 401(k) plan in which employee contributions are made pre-tax and a 401(k) Roth in which employee contributions are made after tax RA matches employee contributions dollar for dollar up to a total of 7 of your annual salary You can begin making contributions to the 401(k) plan and become eligible for RArsquos match following six months of service You always own 100 of your salary contributions

It is possible to borrow against a portion of your vested 401(k) account balance by taking a 401(k) loan You may request a participant loan using an application form which can be obtained by contacting Human Resources Your ability to obtain a 401(k) loan will depend on specific qualifying factors (defined in the 401(k) Summary Plan Description document) The 401(k) Plan Administrator will determine whether you satisfy these factors To access your 401(k) plan online httpsmyaccountascensuscomrplink Check account balance and rate of return Change fund elections Request a 401k loan View fund pricing and performance View and print quarterly statements

19

529 College Savings Plan (employer-sponsored)

A 529 college savings plan provides those saving for college with an unmatched combination of benefits You can open a 529 plan for anyone mdash your child grandchild spouse a friend or even yourself Assets in a 529 plan can be used to pay for a variety of higher education expenses including required books tuition room and board supplies and certain other required fees and expenses Earnings in 529 accounts can grow free from federal tax Withdrawals for qualified higher education expenses are free from federal tax Option to set up recurring automatic fund transfers directly from your bank account making it easy for you to invest The account owner rather than the beneficiary maintains control of account assets and determines the timing and amount of distributions Account owners can change beneficiaries without penalty provided the new beneficiary is a member of the previous beneficiaryrsquos family For more information please contact Human Resources

Additional Benefits

Free passes for employees and their dependents to all of RArsquos pools and tennis courts as well as discounted rates for all RA Programs and Camps Some restrictions may apply

Discounted gym membership rates at the Reston YMCA and Crunch Fitness Bike Share Program - Reston Association makes bicycles and helmets available to employees to rent on a daily

basis Please contact Member Services Discounted Tennis Rackets amp Shoes ndash Employees can purchase certain tennis shoes and rackets at wholesale

prices through RArsquos Tennis Department Contact the Tennis Department for more information Discounted autohome insurance - Liberty Mutual Insurance Company partners with RA to offer all employees

discounts on automobile and homeowner insurance Contact John Valenti at JohnValentilibertymutualcom

20

Reston Association provides generous paid time off benefits to accommodate the diverse needs of staff and to provide a positive worklife balance The amount of paid time off you earn per year is based on your years of service In addition Reston Association observes 9 paid holidays and assigns one paid floating holiday per year For more information on paid time off benefits and how to request time off please refer to the Reston Association Employee Handbook

WorkLife Balance ndash Paid Time Off (PTO)

Teleworking

The medical leave bank is available to help employees in extenuating circumstances protect their incomes by receiving paid leave once their personal PTO is used up A maximum of six (6) workweeks may be granted for each Medical Leave Bank request If additional time is necessary a new request must be made For program eligibility and criteria go to CommonHumResBenefits

Medical Leave Bank

Volunteer Release Time

On a per position basis employees may be allowed to telework for part of their workweek or in certain circumstances Such arrangements must be in compliance with the written administrative procedure including being approved in advance by the department director

Employees are encouraged to become involved in their communities lending their voluntary support to programs that enrich the quality of life and opportunities for all citizens This benefit allows employees to take paid-time off during a work day to participate in a volunteer activity that benefits the community at large Such activities are typically sponsored by a charitable or service organization or work with one or more individuals in need of assistance or special service

21

Training amp Career Development

Reston Association offers two types of learning opportunities for employees mdashinformal and formalmdashto foster individual development and training and career planning

I Informal Learning Opportunities (individual development amp training)

Focus on individual acquiring or enhancing specific task andor process skills to perform his or her current job better Typically this type of learning is not ldquodegree- orientedrdquo

Participants may or may not receive attendance or achievement certificate

Conferences workshops seminars webinars online courses etc typically lasting a few hours to one week

Requests for this type of training should be made to your supervisor or department head

II Formal Learning Opportunities (career planning)

Professional DevelopmentCareer Planning

Formalstructured learning geared toward improving and maintaining professional competence enhancing career progression staying abreast of new technologies and best practices developing process skills andor compliance with professional regulations

Future but not degree-oriented CEUs may be earned

May lead to qualification or credential required to obtain or retain specific certification

Opportunity may range from semester-long academic course to 24 month program with wide range of content and learning experience

Tuition Reimbursement Program

Supports formal education goals (AA bachelors masters) of individual to enhance knowledge and skills in specific areaindustry

Learning must be job-related and accomplished at or through accredited learning institution or e-learning platform connected with the institution

Requests for this type of training should be made to Human Resources as soon as foreseeable to ensure best availability of funds to support reimbursement

22

23

Lifetime limit not applicable and enrollment opportunity The lifetime limit on the dollar value of benefits under our medical plan no longer applies Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan Individuals have 30 days from the date of this notice to request enrollment For more information contact Human Resources or call the medical insurance carrier at the telephone number on your identification card

Notice on Patient Protections The medical HMO plan generally allows the designation of a primary care provider You have the right to designate any primary care provider who participates in the network and who is available to accept you or your family members Until you make this designation the medical carrier designates one for you For information on how to select a primary care provider and for a list of the participating primary care providers contact the medical insurance carrier at the number listed on your identification card

For children you may designate a pediatrician as the primary care provider You do not need prior authorization from the medical insurance carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in the network who specializes in obstetrics or gynecology The health care professional however may be required to comply with certain procedures including obtaining prior authorization for certain services following a pre-approved treatment plan or procedures for making referrals For a list of participating health care professionals who specialize in obstetrics or gynecology contact the medical insurance carrier at the number listed on your identification card

OTC Drug Reimbursements for FSAsHRAsHSAs Under the new Health Care Reform law (PPACA) the cost of an over-the-counter medicine or drug cannot be reimbursed from the account unless a prescription is obtained The change does not affect insulin even if purchased without a prescription or other health care expenses such as medical devices eyeglasses contact lenses co-pays and deductibles The new standard applies only to purchases made on or after January 1 2011

A similar rule is in effect for Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs)

The IRS has also posted a questions and answers section on its website httpwwwirsgovnewsroomarticle0id=22730800html concerning these provisions

Patient Protection and Affordable Care Act (PPACA) Mandatory Notices

The text below is an annual open enrollment required notice

24

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION PLEASE REVIEW IT CAREFULLY

Our Pledge to You

This notice is intended to inform you of the privacy practices followed by the Reston Associationrsquos Employee Benefit Plan (the Plan) and the Planrsquos legal obligations regarding your protected health information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) The notice also explains the privacy rights you and your family members have as participants of the Plan It is effective on April 14 2011

The Plan often needs access to your protected health information in order to provide payment for health services and perform plan administrative functions We want to assure the plan participants covered under the Plan that we comply with federal privacy laws and respect your right to privacy Reston Association requires all members of our workforce and third parties that are provided access to protected health information to comply with the privacy practices outlined in this notice

Protected Health Information Your protected health information is protected by the HIPAA Privacy Rule Generally protected health information is information that identifies an individual created or received by a health care provider health plan or an employer on behalf of a group health plan that relates to physical or mental health conditions provision of health care or payment for health care whether past present or future

How We May Use Your Protected Health Information Under the HIPAA Privacy Rule we may use or disclose your protected health information for certain purposes without your permission This section describes the ways we can use and disclose your protected health information

bull Payment We use or disclose your protected health information without your written authorization in order to determine eligibility for benefits seek reimbursement from a third party or coordinate benefits with another health plan under which you are covered For example a health care provider that provided treatment to you will provide us with your health information We use that information in order to determine whether those services are eligible for payment under our group health plan

bull Health Care Operations We use and disclose your protected health information in order to perform plan administration functions such as quality assurance activities resolution of internal grievances and evaluating plan performance For example we review claims experience in order to understand participant utilization and to make plan design changes that are intended to control health care costs

bull Treatment Although the law allows use and disclosure of your protected health information for purposes of treatment as a health plan we generally do not need to disclose your information for treatment purposes Your physician or health care provider is required to provide you with an explanation of how they use and share your health information for purposes of treatment payment and health care operations

bull As permitted or required by law We may also use or disclose your protected health information without your written authorization for other reasons as permitted by law We are permitted by law to share information subject to certain requirements in order to communicate information on health-related benefits or services that may be of interest to you respond to a court order or provide information to further public health activities (eg preventing the spread of disease) without your written authorization We are also permitted to share protected health information during a corporate restructuring such as a merger sale or acquisition We will also disclose health information about you when required by law for example in order to prevent serious harm to you or others

The text below is an annual open enrollment required notice

25

Notice of Privacy Practices

bull Pursuant to your Authorization When required by law we will ask for your written authorization before using or disclosing your protected health information If you choose to sign an authorization to disclose information you can later revoke that authorization to prevent any future uses or disclosures

bull To Business Associates We may enter into contracts with entities known as Business Associates that provide services to or perform functions on behalf of the Plan We may disclose protected health information to Business Associates once they have agreed in writing to safeguard the protected health information For example we may disclose your protected health information to a Business Associate to administer claims Business Associates are also required by law to protect protected health information

bull To the Plan Sponsor We may disclose protected health information to certain employees of Reston Association for the purpose of administering the Plan These employees will use or disclose the protected health information only as necessary to perform plan administration functions or as otherwise required by HIPAA unless you have authorized additional disclosures Your protected health information cannot be used for employment purposes without your specific authorization

Your Rights bull Right to Inspect and Copy In most cases you have the right to inspect and copy the protected health

information we maintain about you If you request copies we will charge you a reasonable fee to cover the costs of copying mailing or other expenses associated with your request Your request to inspect or review your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to inspect and copy your health information To the extent your information is held in an electronic health record you may be able to receive the information in an electronic format

bull Right to Amend If you believe that information within your records is incorrect or if important information is missing you have the right to request that we correct the existing information or add the missing information Your request to amend your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to amend your health information If we deny your request you may file a statement of disagreement with us for inclusion in any future disclosures of the disputed information

bull Right to an Accounting of Disclosures You have the right to receive an accounting of certain disclosures of your protected health information The accounting will not include disclosures that were made (1) for purposes of treatment payment or health care operations (2) to you (3) pursuant to your authorization (4) to your friends or family in your presence or because of an emergency (5) for national security purposes or (6) incidental to otherwise permissible disclosures

Your request to for an accounting must be submitted in writing to the person listed below You may request an accounting of disclosures made within the last six years You may request one accounting free of charge within a 12-month period

The text below is an annual open enrollment required notice

25

26

The information provided herein is intended to be a summary of benefits only and in no way supersedes the actual plan documents provided by the insurance carriersadministrators For more detailed information pertaining to your employee benefit plans including limitations and exclusions

please refer to the plan documents andor evidence of coverage provided by the carriersadministrators

Womenrsquos Health and Cancer Rights Act of 1998

If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos Health and Cancer Rights Act of 1998 (WHCRA) For individuals receiving mastectomy-related benefits coverage will be provided in a manner determined in consultation with the attending physician and the patient for

bull All stages of reconstruction of the breast on which the mastectomy was performed bull Surgery and reconstruction of the other breast to produce a symmetrical appearance bull Prostheses and bull Treatment of physical complications of the mastectomy including lymphedema

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan If you would like more information on WHCRA benefits call your plan administrator

CHIP-Childrens Health Insurance Program (CHIP) Reauthorization Act of 2009

Medicaid and the Childrenrsquos Health Insurance Program (CHIP) offer free or low-cost health coverage to children and families If you are eligible for health coverage from your employer but are unable to afford the premiums some States have premium assistance programs that can help pay for coverage These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage but need assistance in paying their health premiums

If you or your dependents are already enrolled in Medicaid or CHIP you can contact your state Medicaid or CHIP office to find out if premium assistance is available For a list of the contacts in each State go to wwwdolgovebsachipmodelnoticedoc

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify you can then contact the State to find out if it has a program that might help you pay the premiums for an employer-sponsored plan

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP your employerrsquos health plan is required to permit you and your dependents to enroll in the plan ndash as long as you and your dependents are eligible but not already enrolled in the employerrsquos plan This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance

The text below is an annual open enrollment required notice

26

27

Premium Assistance Under Medicaid and the

Childrenrsquos Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your

employer your state may have a premium assistance program that can help pay for coverage using funds

from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot

be eligible for these premium assistance programs but you may be able to buy individual insurance coverage

through the Health Insurance Marketplace For more information visit wwwhealthcaregov

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below

contact your State Medicaid or CHIP office to find out if premium assistance is available

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your

dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-

877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a

program that might help you pay the premiums for an employer-sponsored plan

If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible

under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already

enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days

of being determined eligible for premium assistance If you have questions about enrolling in your

employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)

If you live in one of the following states you may be eligible for assistance paying your employer

health plan premiums The following list of states is current as of July 31 2019 Contact your State for

more information on eligibility ndash

ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcom

Phone 1-855-692-5447

Website httpflmedicaidtplrecoverycomhipp

Phone 1-877-357-3268

ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program

Website httpmyakhippcom

Phone 1-866-251-4861

Email CustomerServiceMyAKHIPPcom

Medicaid Eligibility

httpdhssalaskagovdpaPagesmedicaiddefaultaspx

Website httpsmedicaidgeorgiagovhealth-

insurance-premium-payment-program-hipp

Phone 678-564-1162 ext 2131

ARKANSAS ndash Medicaid INDIANA ndash Medicaid

Website httpmyarhippcom

Phone 1-855-MyARHIPP (855-692-7447)

Healthy Indiana Plan for low-income adults 19-64

Website httpwwwingovfssahip

Phone 1-877-438-4479

All other Medicaid

Website httpwwwindianamedicaidcom

Phone 1-800-403-0864

COLORADO ndash Health First Colorado

(Coloradorsquos Medicaid Program) amp Child Health

Plan Plus (CHP+)

IOWA ndash Medicaid

Health First Colorado Website

httpswwwhealthfirstcoloradocom

Health First Colorado Member Contact Center

1-800-221-3943 State Relay 711

CHP+ httpswwwcoloradogovpacifichcpfchild-health-

plan-plus

CHP+ Customer Service 1-800-359-1991 State Relay

711

Website

httpdhsiowagovHawki

Phone 1-800-257-8563

28

KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid

Website httpwwwkdheksgovhcf

Phone 1-785-296-3512

Website httpswwwdhhsnhgovoiihipphtm

Phone 603-271-5218

Toll free number for the HIPP program 1-800-852-3345 ext 5218

KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP

Website httpschfskygov

Phone 1-800-635-2570

Medicaid Website

httpwwwstatenjushumanservices

dmahsclientsmedicaid

Medicaid Phone 609-631-2392

CHIP Website httpwwwnjfamilycareorgindexhtml

CHIP Phone 1-800-701-0710

LOUISIANA ndash Medicaid NEW YORK ndash Medicaid

Website httpdhhlouisianagovindexcfmsubhome1n331

Phone 1-888-695-2447

Website httpswwwhealthnygovhealth_caremedicaid

Phone 1-800-541-2831

MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid

Website httpwwwmainegovdhhsofipublic-assistanceindexhtml

Phone 1-800-442-6003

TTY Maine relay 711

Website httpsmedicaidncdhhsgov

Phone 919-855-4100

MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid

Website httpwwwmassgoveohhsgovdepartmentsmasshealth

Phone 1-800-862-4840

Website httpwwwndgovdhsservicesmedicalservmedicaid

Phone 1-844-854-4825

MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP

Website

httpsmngovdhspeople-we-serveseniorshealth-carehealth-care-

programsprograms-and-servicesother-insurancejsp

Phone 1-800-657-3739

Website httpwwwinsureoklahomaorg

Phone 1-888-365-3742

MISSOURI ndash Medicaid OREGON ndash Medicaid

Website httpwwwdssmogovmhdparticipantspageshipphtm

Phone 573-751-2005

Website httphealthcareoregongovPagesindexaspx

httpwwworegonhealthcaregovindex-eshtml

Phone 1-800-699-9075

MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid

Website httpdphhsmtgovMontanaHealthcareProgramsHIPP

Phone 1-800-694-3084

Website

httpwwwdhspagovprovidermedicalassistancehealthinsuranc

epremiumpaymenthippprogramindexhtm

Phone 1-800-692-7462

NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP

Website httpwwwACCESSNebraskanegov

Phone (855) 632-7633

Lincoln (402) 473-7000

Omaha (402) 595-1178

Website httpwwweohhsrigov

Phone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)

29

NEVADA ndash Medicaid SOUTH CAROLINA ndash Medicaid

Medicaid Website httpsdhcfpnvgov

Medicaid Phone 1-800-992-0900

Website httpswwwscdhhsgov

Phone 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid

Website httpdsssdgov

Phone 1-888-828-0059

Website httpswwwhcawagov

Phone 1-800-562-3022 ext 15473

TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascom

Phone 1-800-440-0493

Website httpmywvhippcom

Toll-free phone 1-855-MyWVHIPP (1-855-699-8447)

UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgov

CHIP Website httphealthutahgovchip

Phone 1-877-543-7669

Website

httpswwwdhswisconsingovpublicationsp1p10095p

df

Phone 1-800-362-3002

VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorg

Phone 1-800-250-8427

Website httpswyequalitycareacs-inccom

Phone 307-777-7531

VIRGINIA ndash Medicaid and CHIP Medicaid Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

Medicaid Phone 1-800-432-5924

CHIP Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

CHIP Phone 1-855-242-8282

To see if any other states have added a premium assistance program since July 31 2019 or for more

information on special enrollment rights contact either

US Department of Labor US Department of Health and Human Services

Employee Benefits Security Administration Centers for Medicare amp Medicaid Services

wwwdolgovagenciesebsa wwwcmshhsgov

1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565

Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond

to a collection of information unless such collection displays a valid Office of Management and Budget (OMB)

control number The Department notes that a Federal agency cannot conduct or sponsor a collection of

information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and

the public is not required to respond to a collection of information unless it displays a currently valid OMB control

number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to

penalty for failing to comply with a collection of information if the collection of information does not display a

currently valid OMB control number See 44 USC 3512

The public reporting burden for this collection of information is estimated to average approximately seven minutes

per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other

aspect of this collection of information including suggestions for reducing this burden to the US Department of

Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance

Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and

reference the OMB Control Number 1210-0137 OMB Control Number 1210-0137 (expires 12312019)

Notes

30

Notes

31

Prepared by

Please contact Reston Associationrsquos Human Resources Department at 703-435-7990 or hrrestonorg with any

questions related to your Total Rewards Guide

copy 2019 McGriff Insurance Services Inc

Page 14: Employee Total Rewards Guide 2020 - Reston Total Rewards Gui… · Recognizing and rewarding employees for achieving a sustainable impact. Award criteria includes: •Progressive

Vision Insurance ndash Option 1

Vision Plan through VSP (Voluntary) VSP is the largest private provider vision carrier in the country VSP contracts with Costcoreg Optical Eye Care Centers of America Inctrade which includes popular stores like EyeMasters VisionWorld and Hour Eyes and other quality retail chains When you visit a VSP participating provider your benefits include routine vision exams lenses and preferred pricing on all patient options Frequency Eye Exam 12 monthsLenses 12 monthsFrames 24 monthsContact Lenses 12 months

Vision Plan Features In-Network Out-of-Network

Annual Routine Eye Exam $10 copay Plan pays up to $45

Eyeglass Lenses (standard) Single Bifocal Trifocal

Covered in Full Covered in Full Covered in Full

Plan pays up to $30 Plan pays up to $50 Plan pays up to $65

Frames $130 allowance then 20 off remaining balance

Plan pays up to $70

Necessary Contact Lenses Covered in Full Plan pays up to $210

Elective Contact Lenses $130 allowance Plan pays up to $105

Elective Contact Lenses fitting and evaluation Covered in Full after $60

copay Not Available

Spouses domestic partners and dependent children to age 19 (or to age 25 if FT student) are eligible

14

Vision Insurance ndash Option 2

Vision Plan through Spectera UHC (Voluntary)

UHC offers you one of the largest vision care networks in the industry Their network includes convenient retail locations including My Eye Dr and Hour Eyes Best of all ndash when you receive care from a participating provider you receive the greatest benefits and money-saving discounts

Frequency Eye Exam 12 monthsLenses 12 monthsFrames 12 monthsContact Lenses 12 months

Vision Plan Features In-Network Out-of-Network

Annual Routine Eye Exam $10 copay Plan pays up to $40

Eyeglass Lenses (standard) Single Bifocal Trifocal

$25 copay $25 copay $25 copay

Plan pays up to $40 Plan pays up to $60 Plan pays up to $80

Frames $2500 copay $130 retail frame

allowance 30 discount above allowance

Plan pays up to $45

Necessary Contact Lenses $25 copay Plan pays up to $210

Elective Contact Lenses

$25 copay from the ldquoCovered contact lens

selectionrdquo All others- $105

allowance

Plan pays up to $105

Elective Contact Lenses fitting and evaluation Covered in Full after $25

copay Not Available

Spouses and dependent children to age 26 are eligible

15

Pre-tax FSA amp DCA

Flexible Spending Account (FSA) through Optum Health The Flexible Spending Account provides employees a means to reduce their taxes by the amount of their out of pocket health-related expenses (subject to eligibility) This tax free savings program allows employees to submit receipts for reimbursement for medical dental vision care prescription drug co-payments and other expenses not covered by our insurance In 2020 employees may contribute up to $2750 per year toward their FSA Employees have until March 14 2020 to use the money in their FSA or else they lose it (This contribution amount could change based on IRS guideline updates)

Dependent Care Spending Account (DCA) through Optum Health The Dependent Care Spending Account provides employees a means to reduce their taxes by the amount of their child care costs to a licensed provider up to $5000 annually

Health Insurance Premium Bank

Reston Association has established a program to help regular full-time and regular part-time employees pay their portion of the health insurance premium This program is only available to employees who are enrolled in or plan to enroll in the Kaiser Permanente HMO health insurance plans offered by the Reston Association Employees are eligible to apply to the Health Insurance Premium Bank if their adjusted gross household incomes are less than or equal to $60000 Requests for assistance must be made annually or at any time there is a qualifying event and submitted to Human Resources with necessary documentation by December 12th of each year To apply complete a request form (available in CommonHumResBenefits) and submit to HR with a copy of your most recent tax return showing adjusted gross household income This threshold is subject to change

16

Life and ADampD Insurance

Basic LifeADampD Insurance Reston Association provides 100 employer paid Life and ADampD Insurance through Sun Life to employees working 25 or more hours per week Coverage becomes effective the first of the month following six months of service

Benefit 2x Annual Earnings to a maximum of $200000 Age reduction Benefit reduced to 65 at age 65 and to 50 at age 70

Optional LifeADampD Insurance for Employee Spouse and Dependent Children

Optional Life Insurance for the employee spouse and dependent children is available at the employeersquos cost Optional Life is not available for domestic partners

Employee Benefit Increments of $10000 to a maximum of the lesser of $300000 or 3x your Basic Annual Earnings

Spouse Benefit Increments of $5000 to a maximum of $150000 Dependent Child Benefit Increments of $1000 to a maximum of $10000

Your amount of Dependent Spouse and Dependent Child Optional Life Insurance cannot exceed 50 of your amount of Optional Life Insurance Initial eligibility period will require evidence of insurability

STD amp LTD Insurance

Short Term and Long Term Disability Reston Association provides eligible employees with short and long-term disability income benefits through Sun Life In the event you become disabled from a non work-related injury or sickness disability income benefits are provided as a source of income These benefits are 100 employer paid

Benefit Short-Term Disability Long-Term Disability

Income Replacement -Eligible Employees -Executives

60 60

Elimination Period - Accidental Injury - Sickness

29 days 90 days

Benefit Period 9 weeks maximum To Social Security

normal retirement age

Benefit Maximum -Eligible Employees -Executives

$1000 per week $6000 per month $8000 per month 17

At a cost of $19month you can enroll in the Legal Resources benefit As a Legal Resources Member you have immediate and ongoing access to comprehensive legal coverage services and expertise that will easily save you money mdash and could save you a whole lot more Covered legal services include

Legal Advice and Consultation Tenant Dispute with Landlord District Court Representation for Civil Action Review of a Financial Contract or Lease Purchase sale or refinance of primary home Traffic Court Representation (includes 1st DUI) Will Preparation Uncontested Divorce Representation Defense of Child in Court (misdemeanor)

Legal Resources

Employee Assistance Program (EAP)

Reston Association offers a free confidential Employee Assistance Program (EAP) to all employees and their eligible dependents Through RArsquos EAP provider Lytle EAP Partners you and your immediate family members have immediate access on your date of hire to confidential professional counseling and referral services for help with anything that affects you or your dependentsrsquo well-being You can reach an EAP counselor by dialing 1-800-327-7272 24 hours a day or you may visit their website at wwwLytleEAPcom (password is reston) for more information Visit wwwLytleEAPcom for web-based legal financial worklife resources There are also work-related resources available online for managers Note Since EAP services are provided as a benefit only RA makes no representation concerning quality of care

18

401(k) Retirement Savings Plan

Reston Association offers two 401(k) retirement savings plans through Ascensusmdasha traditional 401(k) plan in which employee contributions are made pre-tax and a 401(k) Roth in which employee contributions are made after tax RA matches employee contributions dollar for dollar up to a total of 7 of your annual salary You can begin making contributions to the 401(k) plan and become eligible for RArsquos match following six months of service You always own 100 of your salary contributions

It is possible to borrow against a portion of your vested 401(k) account balance by taking a 401(k) loan You may request a participant loan using an application form which can be obtained by contacting Human Resources Your ability to obtain a 401(k) loan will depend on specific qualifying factors (defined in the 401(k) Summary Plan Description document) The 401(k) Plan Administrator will determine whether you satisfy these factors To access your 401(k) plan online httpsmyaccountascensuscomrplink Check account balance and rate of return Change fund elections Request a 401k loan View fund pricing and performance View and print quarterly statements

19

529 College Savings Plan (employer-sponsored)

A 529 college savings plan provides those saving for college with an unmatched combination of benefits You can open a 529 plan for anyone mdash your child grandchild spouse a friend or even yourself Assets in a 529 plan can be used to pay for a variety of higher education expenses including required books tuition room and board supplies and certain other required fees and expenses Earnings in 529 accounts can grow free from federal tax Withdrawals for qualified higher education expenses are free from federal tax Option to set up recurring automatic fund transfers directly from your bank account making it easy for you to invest The account owner rather than the beneficiary maintains control of account assets and determines the timing and amount of distributions Account owners can change beneficiaries without penalty provided the new beneficiary is a member of the previous beneficiaryrsquos family For more information please contact Human Resources

Additional Benefits

Free passes for employees and their dependents to all of RArsquos pools and tennis courts as well as discounted rates for all RA Programs and Camps Some restrictions may apply

Discounted gym membership rates at the Reston YMCA and Crunch Fitness Bike Share Program - Reston Association makes bicycles and helmets available to employees to rent on a daily

basis Please contact Member Services Discounted Tennis Rackets amp Shoes ndash Employees can purchase certain tennis shoes and rackets at wholesale

prices through RArsquos Tennis Department Contact the Tennis Department for more information Discounted autohome insurance - Liberty Mutual Insurance Company partners with RA to offer all employees

discounts on automobile and homeowner insurance Contact John Valenti at JohnValentilibertymutualcom

20

Reston Association provides generous paid time off benefits to accommodate the diverse needs of staff and to provide a positive worklife balance The amount of paid time off you earn per year is based on your years of service In addition Reston Association observes 9 paid holidays and assigns one paid floating holiday per year For more information on paid time off benefits and how to request time off please refer to the Reston Association Employee Handbook

WorkLife Balance ndash Paid Time Off (PTO)

Teleworking

The medical leave bank is available to help employees in extenuating circumstances protect their incomes by receiving paid leave once their personal PTO is used up A maximum of six (6) workweeks may be granted for each Medical Leave Bank request If additional time is necessary a new request must be made For program eligibility and criteria go to CommonHumResBenefits

Medical Leave Bank

Volunteer Release Time

On a per position basis employees may be allowed to telework for part of their workweek or in certain circumstances Such arrangements must be in compliance with the written administrative procedure including being approved in advance by the department director

Employees are encouraged to become involved in their communities lending their voluntary support to programs that enrich the quality of life and opportunities for all citizens This benefit allows employees to take paid-time off during a work day to participate in a volunteer activity that benefits the community at large Such activities are typically sponsored by a charitable or service organization or work with one or more individuals in need of assistance or special service

21

Training amp Career Development

Reston Association offers two types of learning opportunities for employees mdashinformal and formalmdashto foster individual development and training and career planning

I Informal Learning Opportunities (individual development amp training)

Focus on individual acquiring or enhancing specific task andor process skills to perform his or her current job better Typically this type of learning is not ldquodegree- orientedrdquo

Participants may or may not receive attendance or achievement certificate

Conferences workshops seminars webinars online courses etc typically lasting a few hours to one week

Requests for this type of training should be made to your supervisor or department head

II Formal Learning Opportunities (career planning)

Professional DevelopmentCareer Planning

Formalstructured learning geared toward improving and maintaining professional competence enhancing career progression staying abreast of new technologies and best practices developing process skills andor compliance with professional regulations

Future but not degree-oriented CEUs may be earned

May lead to qualification or credential required to obtain or retain specific certification

Opportunity may range from semester-long academic course to 24 month program with wide range of content and learning experience

Tuition Reimbursement Program

Supports formal education goals (AA bachelors masters) of individual to enhance knowledge and skills in specific areaindustry

Learning must be job-related and accomplished at or through accredited learning institution or e-learning platform connected with the institution

Requests for this type of training should be made to Human Resources as soon as foreseeable to ensure best availability of funds to support reimbursement

22

23

Lifetime limit not applicable and enrollment opportunity The lifetime limit on the dollar value of benefits under our medical plan no longer applies Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan Individuals have 30 days from the date of this notice to request enrollment For more information contact Human Resources or call the medical insurance carrier at the telephone number on your identification card

Notice on Patient Protections The medical HMO plan generally allows the designation of a primary care provider You have the right to designate any primary care provider who participates in the network and who is available to accept you or your family members Until you make this designation the medical carrier designates one for you For information on how to select a primary care provider and for a list of the participating primary care providers contact the medical insurance carrier at the number listed on your identification card

For children you may designate a pediatrician as the primary care provider You do not need prior authorization from the medical insurance carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in the network who specializes in obstetrics or gynecology The health care professional however may be required to comply with certain procedures including obtaining prior authorization for certain services following a pre-approved treatment plan or procedures for making referrals For a list of participating health care professionals who specialize in obstetrics or gynecology contact the medical insurance carrier at the number listed on your identification card

OTC Drug Reimbursements for FSAsHRAsHSAs Under the new Health Care Reform law (PPACA) the cost of an over-the-counter medicine or drug cannot be reimbursed from the account unless a prescription is obtained The change does not affect insulin even if purchased without a prescription or other health care expenses such as medical devices eyeglasses contact lenses co-pays and deductibles The new standard applies only to purchases made on or after January 1 2011

A similar rule is in effect for Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs)

The IRS has also posted a questions and answers section on its website httpwwwirsgovnewsroomarticle0id=22730800html concerning these provisions

Patient Protection and Affordable Care Act (PPACA) Mandatory Notices

The text below is an annual open enrollment required notice

24

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION PLEASE REVIEW IT CAREFULLY

Our Pledge to You

This notice is intended to inform you of the privacy practices followed by the Reston Associationrsquos Employee Benefit Plan (the Plan) and the Planrsquos legal obligations regarding your protected health information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) The notice also explains the privacy rights you and your family members have as participants of the Plan It is effective on April 14 2011

The Plan often needs access to your protected health information in order to provide payment for health services and perform plan administrative functions We want to assure the plan participants covered under the Plan that we comply with federal privacy laws and respect your right to privacy Reston Association requires all members of our workforce and third parties that are provided access to protected health information to comply with the privacy practices outlined in this notice

Protected Health Information Your protected health information is protected by the HIPAA Privacy Rule Generally protected health information is information that identifies an individual created or received by a health care provider health plan or an employer on behalf of a group health plan that relates to physical or mental health conditions provision of health care or payment for health care whether past present or future

How We May Use Your Protected Health Information Under the HIPAA Privacy Rule we may use or disclose your protected health information for certain purposes without your permission This section describes the ways we can use and disclose your protected health information

bull Payment We use or disclose your protected health information without your written authorization in order to determine eligibility for benefits seek reimbursement from a third party or coordinate benefits with another health plan under which you are covered For example a health care provider that provided treatment to you will provide us with your health information We use that information in order to determine whether those services are eligible for payment under our group health plan

bull Health Care Operations We use and disclose your protected health information in order to perform plan administration functions such as quality assurance activities resolution of internal grievances and evaluating plan performance For example we review claims experience in order to understand participant utilization and to make plan design changes that are intended to control health care costs

bull Treatment Although the law allows use and disclosure of your protected health information for purposes of treatment as a health plan we generally do not need to disclose your information for treatment purposes Your physician or health care provider is required to provide you with an explanation of how they use and share your health information for purposes of treatment payment and health care operations

bull As permitted or required by law We may also use or disclose your protected health information without your written authorization for other reasons as permitted by law We are permitted by law to share information subject to certain requirements in order to communicate information on health-related benefits or services that may be of interest to you respond to a court order or provide information to further public health activities (eg preventing the spread of disease) without your written authorization We are also permitted to share protected health information during a corporate restructuring such as a merger sale or acquisition We will also disclose health information about you when required by law for example in order to prevent serious harm to you or others

The text below is an annual open enrollment required notice

25

Notice of Privacy Practices

bull Pursuant to your Authorization When required by law we will ask for your written authorization before using or disclosing your protected health information If you choose to sign an authorization to disclose information you can later revoke that authorization to prevent any future uses or disclosures

bull To Business Associates We may enter into contracts with entities known as Business Associates that provide services to or perform functions on behalf of the Plan We may disclose protected health information to Business Associates once they have agreed in writing to safeguard the protected health information For example we may disclose your protected health information to a Business Associate to administer claims Business Associates are also required by law to protect protected health information

bull To the Plan Sponsor We may disclose protected health information to certain employees of Reston Association for the purpose of administering the Plan These employees will use or disclose the protected health information only as necessary to perform plan administration functions or as otherwise required by HIPAA unless you have authorized additional disclosures Your protected health information cannot be used for employment purposes without your specific authorization

Your Rights bull Right to Inspect and Copy In most cases you have the right to inspect and copy the protected health

information we maintain about you If you request copies we will charge you a reasonable fee to cover the costs of copying mailing or other expenses associated with your request Your request to inspect or review your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to inspect and copy your health information To the extent your information is held in an electronic health record you may be able to receive the information in an electronic format

bull Right to Amend If you believe that information within your records is incorrect or if important information is missing you have the right to request that we correct the existing information or add the missing information Your request to amend your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to amend your health information If we deny your request you may file a statement of disagreement with us for inclusion in any future disclosures of the disputed information

bull Right to an Accounting of Disclosures You have the right to receive an accounting of certain disclosures of your protected health information The accounting will not include disclosures that were made (1) for purposes of treatment payment or health care operations (2) to you (3) pursuant to your authorization (4) to your friends or family in your presence or because of an emergency (5) for national security purposes or (6) incidental to otherwise permissible disclosures

Your request to for an accounting must be submitted in writing to the person listed below You may request an accounting of disclosures made within the last six years You may request one accounting free of charge within a 12-month period

The text below is an annual open enrollment required notice

25

26

The information provided herein is intended to be a summary of benefits only and in no way supersedes the actual plan documents provided by the insurance carriersadministrators For more detailed information pertaining to your employee benefit plans including limitations and exclusions

please refer to the plan documents andor evidence of coverage provided by the carriersadministrators

Womenrsquos Health and Cancer Rights Act of 1998

If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos Health and Cancer Rights Act of 1998 (WHCRA) For individuals receiving mastectomy-related benefits coverage will be provided in a manner determined in consultation with the attending physician and the patient for

bull All stages of reconstruction of the breast on which the mastectomy was performed bull Surgery and reconstruction of the other breast to produce a symmetrical appearance bull Prostheses and bull Treatment of physical complications of the mastectomy including lymphedema

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan If you would like more information on WHCRA benefits call your plan administrator

CHIP-Childrens Health Insurance Program (CHIP) Reauthorization Act of 2009

Medicaid and the Childrenrsquos Health Insurance Program (CHIP) offer free or low-cost health coverage to children and families If you are eligible for health coverage from your employer but are unable to afford the premiums some States have premium assistance programs that can help pay for coverage These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage but need assistance in paying their health premiums

If you or your dependents are already enrolled in Medicaid or CHIP you can contact your state Medicaid or CHIP office to find out if premium assistance is available For a list of the contacts in each State go to wwwdolgovebsachipmodelnoticedoc

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify you can then contact the State to find out if it has a program that might help you pay the premiums for an employer-sponsored plan

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP your employerrsquos health plan is required to permit you and your dependents to enroll in the plan ndash as long as you and your dependents are eligible but not already enrolled in the employerrsquos plan This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance

The text below is an annual open enrollment required notice

26

27

Premium Assistance Under Medicaid and the

Childrenrsquos Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your

employer your state may have a premium assistance program that can help pay for coverage using funds

from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot

be eligible for these premium assistance programs but you may be able to buy individual insurance coverage

through the Health Insurance Marketplace For more information visit wwwhealthcaregov

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below

contact your State Medicaid or CHIP office to find out if premium assistance is available

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your

dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-

877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a

program that might help you pay the premiums for an employer-sponsored plan

If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible

under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already

enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days

of being determined eligible for premium assistance If you have questions about enrolling in your

employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)

If you live in one of the following states you may be eligible for assistance paying your employer

health plan premiums The following list of states is current as of July 31 2019 Contact your State for

more information on eligibility ndash

ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcom

Phone 1-855-692-5447

Website httpflmedicaidtplrecoverycomhipp

Phone 1-877-357-3268

ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program

Website httpmyakhippcom

Phone 1-866-251-4861

Email CustomerServiceMyAKHIPPcom

Medicaid Eligibility

httpdhssalaskagovdpaPagesmedicaiddefaultaspx

Website httpsmedicaidgeorgiagovhealth-

insurance-premium-payment-program-hipp

Phone 678-564-1162 ext 2131

ARKANSAS ndash Medicaid INDIANA ndash Medicaid

Website httpmyarhippcom

Phone 1-855-MyARHIPP (855-692-7447)

Healthy Indiana Plan for low-income adults 19-64

Website httpwwwingovfssahip

Phone 1-877-438-4479

All other Medicaid

Website httpwwwindianamedicaidcom

Phone 1-800-403-0864

COLORADO ndash Health First Colorado

(Coloradorsquos Medicaid Program) amp Child Health

Plan Plus (CHP+)

IOWA ndash Medicaid

Health First Colorado Website

httpswwwhealthfirstcoloradocom

Health First Colorado Member Contact Center

1-800-221-3943 State Relay 711

CHP+ httpswwwcoloradogovpacifichcpfchild-health-

plan-plus

CHP+ Customer Service 1-800-359-1991 State Relay

711

Website

httpdhsiowagovHawki

Phone 1-800-257-8563

28

KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid

Website httpwwwkdheksgovhcf

Phone 1-785-296-3512

Website httpswwwdhhsnhgovoiihipphtm

Phone 603-271-5218

Toll free number for the HIPP program 1-800-852-3345 ext 5218

KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP

Website httpschfskygov

Phone 1-800-635-2570

Medicaid Website

httpwwwstatenjushumanservices

dmahsclientsmedicaid

Medicaid Phone 609-631-2392

CHIP Website httpwwwnjfamilycareorgindexhtml

CHIP Phone 1-800-701-0710

LOUISIANA ndash Medicaid NEW YORK ndash Medicaid

Website httpdhhlouisianagovindexcfmsubhome1n331

Phone 1-888-695-2447

Website httpswwwhealthnygovhealth_caremedicaid

Phone 1-800-541-2831

MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid

Website httpwwwmainegovdhhsofipublic-assistanceindexhtml

Phone 1-800-442-6003

TTY Maine relay 711

Website httpsmedicaidncdhhsgov

Phone 919-855-4100

MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid

Website httpwwwmassgoveohhsgovdepartmentsmasshealth

Phone 1-800-862-4840

Website httpwwwndgovdhsservicesmedicalservmedicaid

Phone 1-844-854-4825

MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP

Website

httpsmngovdhspeople-we-serveseniorshealth-carehealth-care-

programsprograms-and-servicesother-insurancejsp

Phone 1-800-657-3739

Website httpwwwinsureoklahomaorg

Phone 1-888-365-3742

MISSOURI ndash Medicaid OREGON ndash Medicaid

Website httpwwwdssmogovmhdparticipantspageshipphtm

Phone 573-751-2005

Website httphealthcareoregongovPagesindexaspx

httpwwworegonhealthcaregovindex-eshtml

Phone 1-800-699-9075

MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid

Website httpdphhsmtgovMontanaHealthcareProgramsHIPP

Phone 1-800-694-3084

Website

httpwwwdhspagovprovidermedicalassistancehealthinsuranc

epremiumpaymenthippprogramindexhtm

Phone 1-800-692-7462

NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP

Website httpwwwACCESSNebraskanegov

Phone (855) 632-7633

Lincoln (402) 473-7000

Omaha (402) 595-1178

Website httpwwweohhsrigov

Phone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)

29

NEVADA ndash Medicaid SOUTH CAROLINA ndash Medicaid

Medicaid Website httpsdhcfpnvgov

Medicaid Phone 1-800-992-0900

Website httpswwwscdhhsgov

Phone 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid

Website httpdsssdgov

Phone 1-888-828-0059

Website httpswwwhcawagov

Phone 1-800-562-3022 ext 15473

TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascom

Phone 1-800-440-0493

Website httpmywvhippcom

Toll-free phone 1-855-MyWVHIPP (1-855-699-8447)

UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgov

CHIP Website httphealthutahgovchip

Phone 1-877-543-7669

Website

httpswwwdhswisconsingovpublicationsp1p10095p

df

Phone 1-800-362-3002

VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorg

Phone 1-800-250-8427

Website httpswyequalitycareacs-inccom

Phone 307-777-7531

VIRGINIA ndash Medicaid and CHIP Medicaid Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

Medicaid Phone 1-800-432-5924

CHIP Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

CHIP Phone 1-855-242-8282

To see if any other states have added a premium assistance program since July 31 2019 or for more

information on special enrollment rights contact either

US Department of Labor US Department of Health and Human Services

Employee Benefits Security Administration Centers for Medicare amp Medicaid Services

wwwdolgovagenciesebsa wwwcmshhsgov

1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565

Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond

to a collection of information unless such collection displays a valid Office of Management and Budget (OMB)

control number The Department notes that a Federal agency cannot conduct or sponsor a collection of

information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and

the public is not required to respond to a collection of information unless it displays a currently valid OMB control

number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to

penalty for failing to comply with a collection of information if the collection of information does not display a

currently valid OMB control number See 44 USC 3512

The public reporting burden for this collection of information is estimated to average approximately seven minutes

per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other

aspect of this collection of information including suggestions for reducing this burden to the US Department of

Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance

Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and

reference the OMB Control Number 1210-0137 OMB Control Number 1210-0137 (expires 12312019)

Notes

30

Notes

31

Prepared by

Please contact Reston Associationrsquos Human Resources Department at 703-435-7990 or hrrestonorg with any

questions related to your Total Rewards Guide

copy 2019 McGriff Insurance Services Inc

Page 15: Employee Total Rewards Guide 2020 - Reston Total Rewards Gui… · Recognizing and rewarding employees for achieving a sustainable impact. Award criteria includes: •Progressive

Vision Insurance ndash Option 2

Vision Plan through Spectera UHC (Voluntary)

UHC offers you one of the largest vision care networks in the industry Their network includes convenient retail locations including My Eye Dr and Hour Eyes Best of all ndash when you receive care from a participating provider you receive the greatest benefits and money-saving discounts

Frequency Eye Exam 12 monthsLenses 12 monthsFrames 12 monthsContact Lenses 12 months

Vision Plan Features In-Network Out-of-Network

Annual Routine Eye Exam $10 copay Plan pays up to $40

Eyeglass Lenses (standard) Single Bifocal Trifocal

$25 copay $25 copay $25 copay

Plan pays up to $40 Plan pays up to $60 Plan pays up to $80

Frames $2500 copay $130 retail frame

allowance 30 discount above allowance

Plan pays up to $45

Necessary Contact Lenses $25 copay Plan pays up to $210

Elective Contact Lenses

$25 copay from the ldquoCovered contact lens

selectionrdquo All others- $105

allowance

Plan pays up to $105

Elective Contact Lenses fitting and evaluation Covered in Full after $25

copay Not Available

Spouses and dependent children to age 26 are eligible

15

Pre-tax FSA amp DCA

Flexible Spending Account (FSA) through Optum Health The Flexible Spending Account provides employees a means to reduce their taxes by the amount of their out of pocket health-related expenses (subject to eligibility) This tax free savings program allows employees to submit receipts for reimbursement for medical dental vision care prescription drug co-payments and other expenses not covered by our insurance In 2020 employees may contribute up to $2750 per year toward their FSA Employees have until March 14 2020 to use the money in their FSA or else they lose it (This contribution amount could change based on IRS guideline updates)

Dependent Care Spending Account (DCA) through Optum Health The Dependent Care Spending Account provides employees a means to reduce their taxes by the amount of their child care costs to a licensed provider up to $5000 annually

Health Insurance Premium Bank

Reston Association has established a program to help regular full-time and regular part-time employees pay their portion of the health insurance premium This program is only available to employees who are enrolled in or plan to enroll in the Kaiser Permanente HMO health insurance plans offered by the Reston Association Employees are eligible to apply to the Health Insurance Premium Bank if their adjusted gross household incomes are less than or equal to $60000 Requests for assistance must be made annually or at any time there is a qualifying event and submitted to Human Resources with necessary documentation by December 12th of each year To apply complete a request form (available in CommonHumResBenefits) and submit to HR with a copy of your most recent tax return showing adjusted gross household income This threshold is subject to change

16

Life and ADampD Insurance

Basic LifeADampD Insurance Reston Association provides 100 employer paid Life and ADampD Insurance through Sun Life to employees working 25 or more hours per week Coverage becomes effective the first of the month following six months of service

Benefit 2x Annual Earnings to a maximum of $200000 Age reduction Benefit reduced to 65 at age 65 and to 50 at age 70

Optional LifeADampD Insurance for Employee Spouse and Dependent Children

Optional Life Insurance for the employee spouse and dependent children is available at the employeersquos cost Optional Life is not available for domestic partners

Employee Benefit Increments of $10000 to a maximum of the lesser of $300000 or 3x your Basic Annual Earnings

Spouse Benefit Increments of $5000 to a maximum of $150000 Dependent Child Benefit Increments of $1000 to a maximum of $10000

Your amount of Dependent Spouse and Dependent Child Optional Life Insurance cannot exceed 50 of your amount of Optional Life Insurance Initial eligibility period will require evidence of insurability

STD amp LTD Insurance

Short Term and Long Term Disability Reston Association provides eligible employees with short and long-term disability income benefits through Sun Life In the event you become disabled from a non work-related injury or sickness disability income benefits are provided as a source of income These benefits are 100 employer paid

Benefit Short-Term Disability Long-Term Disability

Income Replacement -Eligible Employees -Executives

60 60

Elimination Period - Accidental Injury - Sickness

29 days 90 days

Benefit Period 9 weeks maximum To Social Security

normal retirement age

Benefit Maximum -Eligible Employees -Executives

$1000 per week $6000 per month $8000 per month 17

At a cost of $19month you can enroll in the Legal Resources benefit As a Legal Resources Member you have immediate and ongoing access to comprehensive legal coverage services and expertise that will easily save you money mdash and could save you a whole lot more Covered legal services include

Legal Advice and Consultation Tenant Dispute with Landlord District Court Representation for Civil Action Review of a Financial Contract or Lease Purchase sale or refinance of primary home Traffic Court Representation (includes 1st DUI) Will Preparation Uncontested Divorce Representation Defense of Child in Court (misdemeanor)

Legal Resources

Employee Assistance Program (EAP)

Reston Association offers a free confidential Employee Assistance Program (EAP) to all employees and their eligible dependents Through RArsquos EAP provider Lytle EAP Partners you and your immediate family members have immediate access on your date of hire to confidential professional counseling and referral services for help with anything that affects you or your dependentsrsquo well-being You can reach an EAP counselor by dialing 1-800-327-7272 24 hours a day or you may visit their website at wwwLytleEAPcom (password is reston) for more information Visit wwwLytleEAPcom for web-based legal financial worklife resources There are also work-related resources available online for managers Note Since EAP services are provided as a benefit only RA makes no representation concerning quality of care

18

401(k) Retirement Savings Plan

Reston Association offers two 401(k) retirement savings plans through Ascensusmdasha traditional 401(k) plan in which employee contributions are made pre-tax and a 401(k) Roth in which employee contributions are made after tax RA matches employee contributions dollar for dollar up to a total of 7 of your annual salary You can begin making contributions to the 401(k) plan and become eligible for RArsquos match following six months of service You always own 100 of your salary contributions

It is possible to borrow against a portion of your vested 401(k) account balance by taking a 401(k) loan You may request a participant loan using an application form which can be obtained by contacting Human Resources Your ability to obtain a 401(k) loan will depend on specific qualifying factors (defined in the 401(k) Summary Plan Description document) The 401(k) Plan Administrator will determine whether you satisfy these factors To access your 401(k) plan online httpsmyaccountascensuscomrplink Check account balance and rate of return Change fund elections Request a 401k loan View fund pricing and performance View and print quarterly statements

19

529 College Savings Plan (employer-sponsored)

A 529 college savings plan provides those saving for college with an unmatched combination of benefits You can open a 529 plan for anyone mdash your child grandchild spouse a friend or even yourself Assets in a 529 plan can be used to pay for a variety of higher education expenses including required books tuition room and board supplies and certain other required fees and expenses Earnings in 529 accounts can grow free from federal tax Withdrawals for qualified higher education expenses are free from federal tax Option to set up recurring automatic fund transfers directly from your bank account making it easy for you to invest The account owner rather than the beneficiary maintains control of account assets and determines the timing and amount of distributions Account owners can change beneficiaries without penalty provided the new beneficiary is a member of the previous beneficiaryrsquos family For more information please contact Human Resources

Additional Benefits

Free passes for employees and their dependents to all of RArsquos pools and tennis courts as well as discounted rates for all RA Programs and Camps Some restrictions may apply

Discounted gym membership rates at the Reston YMCA and Crunch Fitness Bike Share Program - Reston Association makes bicycles and helmets available to employees to rent on a daily

basis Please contact Member Services Discounted Tennis Rackets amp Shoes ndash Employees can purchase certain tennis shoes and rackets at wholesale

prices through RArsquos Tennis Department Contact the Tennis Department for more information Discounted autohome insurance - Liberty Mutual Insurance Company partners with RA to offer all employees

discounts on automobile and homeowner insurance Contact John Valenti at JohnValentilibertymutualcom

20

Reston Association provides generous paid time off benefits to accommodate the diverse needs of staff and to provide a positive worklife balance The amount of paid time off you earn per year is based on your years of service In addition Reston Association observes 9 paid holidays and assigns one paid floating holiday per year For more information on paid time off benefits and how to request time off please refer to the Reston Association Employee Handbook

WorkLife Balance ndash Paid Time Off (PTO)

Teleworking

The medical leave bank is available to help employees in extenuating circumstances protect their incomes by receiving paid leave once their personal PTO is used up A maximum of six (6) workweeks may be granted for each Medical Leave Bank request If additional time is necessary a new request must be made For program eligibility and criteria go to CommonHumResBenefits

Medical Leave Bank

Volunteer Release Time

On a per position basis employees may be allowed to telework for part of their workweek or in certain circumstances Such arrangements must be in compliance with the written administrative procedure including being approved in advance by the department director

Employees are encouraged to become involved in their communities lending their voluntary support to programs that enrich the quality of life and opportunities for all citizens This benefit allows employees to take paid-time off during a work day to participate in a volunteer activity that benefits the community at large Such activities are typically sponsored by a charitable or service organization or work with one or more individuals in need of assistance or special service

21

Training amp Career Development

Reston Association offers two types of learning opportunities for employees mdashinformal and formalmdashto foster individual development and training and career planning

I Informal Learning Opportunities (individual development amp training)

Focus on individual acquiring or enhancing specific task andor process skills to perform his or her current job better Typically this type of learning is not ldquodegree- orientedrdquo

Participants may or may not receive attendance or achievement certificate

Conferences workshops seminars webinars online courses etc typically lasting a few hours to one week

Requests for this type of training should be made to your supervisor or department head

II Formal Learning Opportunities (career planning)

Professional DevelopmentCareer Planning

Formalstructured learning geared toward improving and maintaining professional competence enhancing career progression staying abreast of new technologies and best practices developing process skills andor compliance with professional regulations

Future but not degree-oriented CEUs may be earned

May lead to qualification or credential required to obtain or retain specific certification

Opportunity may range from semester-long academic course to 24 month program with wide range of content and learning experience

Tuition Reimbursement Program

Supports formal education goals (AA bachelors masters) of individual to enhance knowledge and skills in specific areaindustry

Learning must be job-related and accomplished at or through accredited learning institution or e-learning platform connected with the institution

Requests for this type of training should be made to Human Resources as soon as foreseeable to ensure best availability of funds to support reimbursement

22

23

Lifetime limit not applicable and enrollment opportunity The lifetime limit on the dollar value of benefits under our medical plan no longer applies Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan Individuals have 30 days from the date of this notice to request enrollment For more information contact Human Resources or call the medical insurance carrier at the telephone number on your identification card

Notice on Patient Protections The medical HMO plan generally allows the designation of a primary care provider You have the right to designate any primary care provider who participates in the network and who is available to accept you or your family members Until you make this designation the medical carrier designates one for you For information on how to select a primary care provider and for a list of the participating primary care providers contact the medical insurance carrier at the number listed on your identification card

For children you may designate a pediatrician as the primary care provider You do not need prior authorization from the medical insurance carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in the network who specializes in obstetrics or gynecology The health care professional however may be required to comply with certain procedures including obtaining prior authorization for certain services following a pre-approved treatment plan or procedures for making referrals For a list of participating health care professionals who specialize in obstetrics or gynecology contact the medical insurance carrier at the number listed on your identification card

OTC Drug Reimbursements for FSAsHRAsHSAs Under the new Health Care Reform law (PPACA) the cost of an over-the-counter medicine or drug cannot be reimbursed from the account unless a prescription is obtained The change does not affect insulin even if purchased without a prescription or other health care expenses such as medical devices eyeglasses contact lenses co-pays and deductibles The new standard applies only to purchases made on or after January 1 2011

A similar rule is in effect for Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs)

The IRS has also posted a questions and answers section on its website httpwwwirsgovnewsroomarticle0id=22730800html concerning these provisions

Patient Protection and Affordable Care Act (PPACA) Mandatory Notices

The text below is an annual open enrollment required notice

24

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION PLEASE REVIEW IT CAREFULLY

Our Pledge to You

This notice is intended to inform you of the privacy practices followed by the Reston Associationrsquos Employee Benefit Plan (the Plan) and the Planrsquos legal obligations regarding your protected health information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) The notice also explains the privacy rights you and your family members have as participants of the Plan It is effective on April 14 2011

The Plan often needs access to your protected health information in order to provide payment for health services and perform plan administrative functions We want to assure the plan participants covered under the Plan that we comply with federal privacy laws and respect your right to privacy Reston Association requires all members of our workforce and third parties that are provided access to protected health information to comply with the privacy practices outlined in this notice

Protected Health Information Your protected health information is protected by the HIPAA Privacy Rule Generally protected health information is information that identifies an individual created or received by a health care provider health plan or an employer on behalf of a group health plan that relates to physical or mental health conditions provision of health care or payment for health care whether past present or future

How We May Use Your Protected Health Information Under the HIPAA Privacy Rule we may use or disclose your protected health information for certain purposes without your permission This section describes the ways we can use and disclose your protected health information

bull Payment We use or disclose your protected health information without your written authorization in order to determine eligibility for benefits seek reimbursement from a third party or coordinate benefits with another health plan under which you are covered For example a health care provider that provided treatment to you will provide us with your health information We use that information in order to determine whether those services are eligible for payment under our group health plan

bull Health Care Operations We use and disclose your protected health information in order to perform plan administration functions such as quality assurance activities resolution of internal grievances and evaluating plan performance For example we review claims experience in order to understand participant utilization and to make plan design changes that are intended to control health care costs

bull Treatment Although the law allows use and disclosure of your protected health information for purposes of treatment as a health plan we generally do not need to disclose your information for treatment purposes Your physician or health care provider is required to provide you with an explanation of how they use and share your health information for purposes of treatment payment and health care operations

bull As permitted or required by law We may also use or disclose your protected health information without your written authorization for other reasons as permitted by law We are permitted by law to share information subject to certain requirements in order to communicate information on health-related benefits or services that may be of interest to you respond to a court order or provide information to further public health activities (eg preventing the spread of disease) without your written authorization We are also permitted to share protected health information during a corporate restructuring such as a merger sale or acquisition We will also disclose health information about you when required by law for example in order to prevent serious harm to you or others

The text below is an annual open enrollment required notice

25

Notice of Privacy Practices

bull Pursuant to your Authorization When required by law we will ask for your written authorization before using or disclosing your protected health information If you choose to sign an authorization to disclose information you can later revoke that authorization to prevent any future uses or disclosures

bull To Business Associates We may enter into contracts with entities known as Business Associates that provide services to or perform functions on behalf of the Plan We may disclose protected health information to Business Associates once they have agreed in writing to safeguard the protected health information For example we may disclose your protected health information to a Business Associate to administer claims Business Associates are also required by law to protect protected health information

bull To the Plan Sponsor We may disclose protected health information to certain employees of Reston Association for the purpose of administering the Plan These employees will use or disclose the protected health information only as necessary to perform plan administration functions or as otherwise required by HIPAA unless you have authorized additional disclosures Your protected health information cannot be used for employment purposes without your specific authorization

Your Rights bull Right to Inspect and Copy In most cases you have the right to inspect and copy the protected health

information we maintain about you If you request copies we will charge you a reasonable fee to cover the costs of copying mailing or other expenses associated with your request Your request to inspect or review your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to inspect and copy your health information To the extent your information is held in an electronic health record you may be able to receive the information in an electronic format

bull Right to Amend If you believe that information within your records is incorrect or if important information is missing you have the right to request that we correct the existing information or add the missing information Your request to amend your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to amend your health information If we deny your request you may file a statement of disagreement with us for inclusion in any future disclosures of the disputed information

bull Right to an Accounting of Disclosures You have the right to receive an accounting of certain disclosures of your protected health information The accounting will not include disclosures that were made (1) for purposes of treatment payment or health care operations (2) to you (3) pursuant to your authorization (4) to your friends or family in your presence or because of an emergency (5) for national security purposes or (6) incidental to otherwise permissible disclosures

Your request to for an accounting must be submitted in writing to the person listed below You may request an accounting of disclosures made within the last six years You may request one accounting free of charge within a 12-month period

The text below is an annual open enrollment required notice

25

26

The information provided herein is intended to be a summary of benefits only and in no way supersedes the actual plan documents provided by the insurance carriersadministrators For more detailed information pertaining to your employee benefit plans including limitations and exclusions

please refer to the plan documents andor evidence of coverage provided by the carriersadministrators

Womenrsquos Health and Cancer Rights Act of 1998

If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos Health and Cancer Rights Act of 1998 (WHCRA) For individuals receiving mastectomy-related benefits coverage will be provided in a manner determined in consultation with the attending physician and the patient for

bull All stages of reconstruction of the breast on which the mastectomy was performed bull Surgery and reconstruction of the other breast to produce a symmetrical appearance bull Prostheses and bull Treatment of physical complications of the mastectomy including lymphedema

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan If you would like more information on WHCRA benefits call your plan administrator

CHIP-Childrens Health Insurance Program (CHIP) Reauthorization Act of 2009

Medicaid and the Childrenrsquos Health Insurance Program (CHIP) offer free or low-cost health coverage to children and families If you are eligible for health coverage from your employer but are unable to afford the premiums some States have premium assistance programs that can help pay for coverage These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage but need assistance in paying their health premiums

If you or your dependents are already enrolled in Medicaid or CHIP you can contact your state Medicaid or CHIP office to find out if premium assistance is available For a list of the contacts in each State go to wwwdolgovebsachipmodelnoticedoc

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify you can then contact the State to find out if it has a program that might help you pay the premiums for an employer-sponsored plan

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP your employerrsquos health plan is required to permit you and your dependents to enroll in the plan ndash as long as you and your dependents are eligible but not already enrolled in the employerrsquos plan This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance

The text below is an annual open enrollment required notice

26

27

Premium Assistance Under Medicaid and the

Childrenrsquos Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your

employer your state may have a premium assistance program that can help pay for coverage using funds

from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot

be eligible for these premium assistance programs but you may be able to buy individual insurance coverage

through the Health Insurance Marketplace For more information visit wwwhealthcaregov

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below

contact your State Medicaid or CHIP office to find out if premium assistance is available

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your

dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-

877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a

program that might help you pay the premiums for an employer-sponsored plan

If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible

under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already

enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days

of being determined eligible for premium assistance If you have questions about enrolling in your

employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)

If you live in one of the following states you may be eligible for assistance paying your employer

health plan premiums The following list of states is current as of July 31 2019 Contact your State for

more information on eligibility ndash

ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcom

Phone 1-855-692-5447

Website httpflmedicaidtplrecoverycomhipp

Phone 1-877-357-3268

ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program

Website httpmyakhippcom

Phone 1-866-251-4861

Email CustomerServiceMyAKHIPPcom

Medicaid Eligibility

httpdhssalaskagovdpaPagesmedicaiddefaultaspx

Website httpsmedicaidgeorgiagovhealth-

insurance-premium-payment-program-hipp

Phone 678-564-1162 ext 2131

ARKANSAS ndash Medicaid INDIANA ndash Medicaid

Website httpmyarhippcom

Phone 1-855-MyARHIPP (855-692-7447)

Healthy Indiana Plan for low-income adults 19-64

Website httpwwwingovfssahip

Phone 1-877-438-4479

All other Medicaid

Website httpwwwindianamedicaidcom

Phone 1-800-403-0864

COLORADO ndash Health First Colorado

(Coloradorsquos Medicaid Program) amp Child Health

Plan Plus (CHP+)

IOWA ndash Medicaid

Health First Colorado Website

httpswwwhealthfirstcoloradocom

Health First Colorado Member Contact Center

1-800-221-3943 State Relay 711

CHP+ httpswwwcoloradogovpacifichcpfchild-health-

plan-plus

CHP+ Customer Service 1-800-359-1991 State Relay

711

Website

httpdhsiowagovHawki

Phone 1-800-257-8563

28

KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid

Website httpwwwkdheksgovhcf

Phone 1-785-296-3512

Website httpswwwdhhsnhgovoiihipphtm

Phone 603-271-5218

Toll free number for the HIPP program 1-800-852-3345 ext 5218

KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP

Website httpschfskygov

Phone 1-800-635-2570

Medicaid Website

httpwwwstatenjushumanservices

dmahsclientsmedicaid

Medicaid Phone 609-631-2392

CHIP Website httpwwwnjfamilycareorgindexhtml

CHIP Phone 1-800-701-0710

LOUISIANA ndash Medicaid NEW YORK ndash Medicaid

Website httpdhhlouisianagovindexcfmsubhome1n331

Phone 1-888-695-2447

Website httpswwwhealthnygovhealth_caremedicaid

Phone 1-800-541-2831

MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid

Website httpwwwmainegovdhhsofipublic-assistanceindexhtml

Phone 1-800-442-6003

TTY Maine relay 711

Website httpsmedicaidncdhhsgov

Phone 919-855-4100

MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid

Website httpwwwmassgoveohhsgovdepartmentsmasshealth

Phone 1-800-862-4840

Website httpwwwndgovdhsservicesmedicalservmedicaid

Phone 1-844-854-4825

MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP

Website

httpsmngovdhspeople-we-serveseniorshealth-carehealth-care-

programsprograms-and-servicesother-insurancejsp

Phone 1-800-657-3739

Website httpwwwinsureoklahomaorg

Phone 1-888-365-3742

MISSOURI ndash Medicaid OREGON ndash Medicaid

Website httpwwwdssmogovmhdparticipantspageshipphtm

Phone 573-751-2005

Website httphealthcareoregongovPagesindexaspx

httpwwworegonhealthcaregovindex-eshtml

Phone 1-800-699-9075

MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid

Website httpdphhsmtgovMontanaHealthcareProgramsHIPP

Phone 1-800-694-3084

Website

httpwwwdhspagovprovidermedicalassistancehealthinsuranc

epremiumpaymenthippprogramindexhtm

Phone 1-800-692-7462

NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP

Website httpwwwACCESSNebraskanegov

Phone (855) 632-7633

Lincoln (402) 473-7000

Omaha (402) 595-1178

Website httpwwweohhsrigov

Phone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)

29

NEVADA ndash Medicaid SOUTH CAROLINA ndash Medicaid

Medicaid Website httpsdhcfpnvgov

Medicaid Phone 1-800-992-0900

Website httpswwwscdhhsgov

Phone 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid

Website httpdsssdgov

Phone 1-888-828-0059

Website httpswwwhcawagov

Phone 1-800-562-3022 ext 15473

TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascom

Phone 1-800-440-0493

Website httpmywvhippcom

Toll-free phone 1-855-MyWVHIPP (1-855-699-8447)

UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgov

CHIP Website httphealthutahgovchip

Phone 1-877-543-7669

Website

httpswwwdhswisconsingovpublicationsp1p10095p

df

Phone 1-800-362-3002

VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorg

Phone 1-800-250-8427

Website httpswyequalitycareacs-inccom

Phone 307-777-7531

VIRGINIA ndash Medicaid and CHIP Medicaid Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

Medicaid Phone 1-800-432-5924

CHIP Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

CHIP Phone 1-855-242-8282

To see if any other states have added a premium assistance program since July 31 2019 or for more

information on special enrollment rights contact either

US Department of Labor US Department of Health and Human Services

Employee Benefits Security Administration Centers for Medicare amp Medicaid Services

wwwdolgovagenciesebsa wwwcmshhsgov

1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565

Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond

to a collection of information unless such collection displays a valid Office of Management and Budget (OMB)

control number The Department notes that a Federal agency cannot conduct or sponsor a collection of

information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and

the public is not required to respond to a collection of information unless it displays a currently valid OMB control

number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to

penalty for failing to comply with a collection of information if the collection of information does not display a

currently valid OMB control number See 44 USC 3512

The public reporting burden for this collection of information is estimated to average approximately seven minutes

per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other

aspect of this collection of information including suggestions for reducing this burden to the US Department of

Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance

Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and

reference the OMB Control Number 1210-0137 OMB Control Number 1210-0137 (expires 12312019)

Notes

30

Notes

31

Prepared by

Please contact Reston Associationrsquos Human Resources Department at 703-435-7990 or hrrestonorg with any

questions related to your Total Rewards Guide

copy 2019 McGriff Insurance Services Inc

Page 16: Employee Total Rewards Guide 2020 - Reston Total Rewards Gui… · Recognizing and rewarding employees for achieving a sustainable impact. Award criteria includes: •Progressive

Pre-tax FSA amp DCA

Flexible Spending Account (FSA) through Optum Health The Flexible Spending Account provides employees a means to reduce their taxes by the amount of their out of pocket health-related expenses (subject to eligibility) This tax free savings program allows employees to submit receipts for reimbursement for medical dental vision care prescription drug co-payments and other expenses not covered by our insurance In 2020 employees may contribute up to $2750 per year toward their FSA Employees have until March 14 2020 to use the money in their FSA or else they lose it (This contribution amount could change based on IRS guideline updates)

Dependent Care Spending Account (DCA) through Optum Health The Dependent Care Spending Account provides employees a means to reduce their taxes by the amount of their child care costs to a licensed provider up to $5000 annually

Health Insurance Premium Bank

Reston Association has established a program to help regular full-time and regular part-time employees pay their portion of the health insurance premium This program is only available to employees who are enrolled in or plan to enroll in the Kaiser Permanente HMO health insurance plans offered by the Reston Association Employees are eligible to apply to the Health Insurance Premium Bank if their adjusted gross household incomes are less than or equal to $60000 Requests for assistance must be made annually or at any time there is a qualifying event and submitted to Human Resources with necessary documentation by December 12th of each year To apply complete a request form (available in CommonHumResBenefits) and submit to HR with a copy of your most recent tax return showing adjusted gross household income This threshold is subject to change

16

Life and ADampD Insurance

Basic LifeADampD Insurance Reston Association provides 100 employer paid Life and ADampD Insurance through Sun Life to employees working 25 or more hours per week Coverage becomes effective the first of the month following six months of service

Benefit 2x Annual Earnings to a maximum of $200000 Age reduction Benefit reduced to 65 at age 65 and to 50 at age 70

Optional LifeADampD Insurance for Employee Spouse and Dependent Children

Optional Life Insurance for the employee spouse and dependent children is available at the employeersquos cost Optional Life is not available for domestic partners

Employee Benefit Increments of $10000 to a maximum of the lesser of $300000 or 3x your Basic Annual Earnings

Spouse Benefit Increments of $5000 to a maximum of $150000 Dependent Child Benefit Increments of $1000 to a maximum of $10000

Your amount of Dependent Spouse and Dependent Child Optional Life Insurance cannot exceed 50 of your amount of Optional Life Insurance Initial eligibility period will require evidence of insurability

STD amp LTD Insurance

Short Term and Long Term Disability Reston Association provides eligible employees with short and long-term disability income benefits through Sun Life In the event you become disabled from a non work-related injury or sickness disability income benefits are provided as a source of income These benefits are 100 employer paid

Benefit Short-Term Disability Long-Term Disability

Income Replacement -Eligible Employees -Executives

60 60

Elimination Period - Accidental Injury - Sickness

29 days 90 days

Benefit Period 9 weeks maximum To Social Security

normal retirement age

Benefit Maximum -Eligible Employees -Executives

$1000 per week $6000 per month $8000 per month 17

At a cost of $19month you can enroll in the Legal Resources benefit As a Legal Resources Member you have immediate and ongoing access to comprehensive legal coverage services and expertise that will easily save you money mdash and could save you a whole lot more Covered legal services include

Legal Advice and Consultation Tenant Dispute with Landlord District Court Representation for Civil Action Review of a Financial Contract or Lease Purchase sale or refinance of primary home Traffic Court Representation (includes 1st DUI) Will Preparation Uncontested Divorce Representation Defense of Child in Court (misdemeanor)

Legal Resources

Employee Assistance Program (EAP)

Reston Association offers a free confidential Employee Assistance Program (EAP) to all employees and their eligible dependents Through RArsquos EAP provider Lytle EAP Partners you and your immediate family members have immediate access on your date of hire to confidential professional counseling and referral services for help with anything that affects you or your dependentsrsquo well-being You can reach an EAP counselor by dialing 1-800-327-7272 24 hours a day or you may visit their website at wwwLytleEAPcom (password is reston) for more information Visit wwwLytleEAPcom for web-based legal financial worklife resources There are also work-related resources available online for managers Note Since EAP services are provided as a benefit only RA makes no representation concerning quality of care

18

401(k) Retirement Savings Plan

Reston Association offers two 401(k) retirement savings plans through Ascensusmdasha traditional 401(k) plan in which employee contributions are made pre-tax and a 401(k) Roth in which employee contributions are made after tax RA matches employee contributions dollar for dollar up to a total of 7 of your annual salary You can begin making contributions to the 401(k) plan and become eligible for RArsquos match following six months of service You always own 100 of your salary contributions

It is possible to borrow against a portion of your vested 401(k) account balance by taking a 401(k) loan You may request a participant loan using an application form which can be obtained by contacting Human Resources Your ability to obtain a 401(k) loan will depend on specific qualifying factors (defined in the 401(k) Summary Plan Description document) The 401(k) Plan Administrator will determine whether you satisfy these factors To access your 401(k) plan online httpsmyaccountascensuscomrplink Check account balance and rate of return Change fund elections Request a 401k loan View fund pricing and performance View and print quarterly statements

19

529 College Savings Plan (employer-sponsored)

A 529 college savings plan provides those saving for college with an unmatched combination of benefits You can open a 529 plan for anyone mdash your child grandchild spouse a friend or even yourself Assets in a 529 plan can be used to pay for a variety of higher education expenses including required books tuition room and board supplies and certain other required fees and expenses Earnings in 529 accounts can grow free from federal tax Withdrawals for qualified higher education expenses are free from federal tax Option to set up recurring automatic fund transfers directly from your bank account making it easy for you to invest The account owner rather than the beneficiary maintains control of account assets and determines the timing and amount of distributions Account owners can change beneficiaries without penalty provided the new beneficiary is a member of the previous beneficiaryrsquos family For more information please contact Human Resources

Additional Benefits

Free passes for employees and their dependents to all of RArsquos pools and tennis courts as well as discounted rates for all RA Programs and Camps Some restrictions may apply

Discounted gym membership rates at the Reston YMCA and Crunch Fitness Bike Share Program - Reston Association makes bicycles and helmets available to employees to rent on a daily

basis Please contact Member Services Discounted Tennis Rackets amp Shoes ndash Employees can purchase certain tennis shoes and rackets at wholesale

prices through RArsquos Tennis Department Contact the Tennis Department for more information Discounted autohome insurance - Liberty Mutual Insurance Company partners with RA to offer all employees

discounts on automobile and homeowner insurance Contact John Valenti at JohnValentilibertymutualcom

20

Reston Association provides generous paid time off benefits to accommodate the diverse needs of staff and to provide a positive worklife balance The amount of paid time off you earn per year is based on your years of service In addition Reston Association observes 9 paid holidays and assigns one paid floating holiday per year For more information on paid time off benefits and how to request time off please refer to the Reston Association Employee Handbook

WorkLife Balance ndash Paid Time Off (PTO)

Teleworking

The medical leave bank is available to help employees in extenuating circumstances protect their incomes by receiving paid leave once their personal PTO is used up A maximum of six (6) workweeks may be granted for each Medical Leave Bank request If additional time is necessary a new request must be made For program eligibility and criteria go to CommonHumResBenefits

Medical Leave Bank

Volunteer Release Time

On a per position basis employees may be allowed to telework for part of their workweek or in certain circumstances Such arrangements must be in compliance with the written administrative procedure including being approved in advance by the department director

Employees are encouraged to become involved in their communities lending their voluntary support to programs that enrich the quality of life and opportunities for all citizens This benefit allows employees to take paid-time off during a work day to participate in a volunteer activity that benefits the community at large Such activities are typically sponsored by a charitable or service organization or work with one or more individuals in need of assistance or special service

21

Training amp Career Development

Reston Association offers two types of learning opportunities for employees mdashinformal and formalmdashto foster individual development and training and career planning

I Informal Learning Opportunities (individual development amp training)

Focus on individual acquiring or enhancing specific task andor process skills to perform his or her current job better Typically this type of learning is not ldquodegree- orientedrdquo

Participants may or may not receive attendance or achievement certificate

Conferences workshops seminars webinars online courses etc typically lasting a few hours to one week

Requests for this type of training should be made to your supervisor or department head

II Formal Learning Opportunities (career planning)

Professional DevelopmentCareer Planning

Formalstructured learning geared toward improving and maintaining professional competence enhancing career progression staying abreast of new technologies and best practices developing process skills andor compliance with professional regulations

Future but not degree-oriented CEUs may be earned

May lead to qualification or credential required to obtain or retain specific certification

Opportunity may range from semester-long academic course to 24 month program with wide range of content and learning experience

Tuition Reimbursement Program

Supports formal education goals (AA bachelors masters) of individual to enhance knowledge and skills in specific areaindustry

Learning must be job-related and accomplished at or through accredited learning institution or e-learning platform connected with the institution

Requests for this type of training should be made to Human Resources as soon as foreseeable to ensure best availability of funds to support reimbursement

22

23

Lifetime limit not applicable and enrollment opportunity The lifetime limit on the dollar value of benefits under our medical plan no longer applies Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan Individuals have 30 days from the date of this notice to request enrollment For more information contact Human Resources or call the medical insurance carrier at the telephone number on your identification card

Notice on Patient Protections The medical HMO plan generally allows the designation of a primary care provider You have the right to designate any primary care provider who participates in the network and who is available to accept you or your family members Until you make this designation the medical carrier designates one for you For information on how to select a primary care provider and for a list of the participating primary care providers contact the medical insurance carrier at the number listed on your identification card

For children you may designate a pediatrician as the primary care provider You do not need prior authorization from the medical insurance carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in the network who specializes in obstetrics or gynecology The health care professional however may be required to comply with certain procedures including obtaining prior authorization for certain services following a pre-approved treatment plan or procedures for making referrals For a list of participating health care professionals who specialize in obstetrics or gynecology contact the medical insurance carrier at the number listed on your identification card

OTC Drug Reimbursements for FSAsHRAsHSAs Under the new Health Care Reform law (PPACA) the cost of an over-the-counter medicine or drug cannot be reimbursed from the account unless a prescription is obtained The change does not affect insulin even if purchased without a prescription or other health care expenses such as medical devices eyeglasses contact lenses co-pays and deductibles The new standard applies only to purchases made on or after January 1 2011

A similar rule is in effect for Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs)

The IRS has also posted a questions and answers section on its website httpwwwirsgovnewsroomarticle0id=22730800html concerning these provisions

Patient Protection and Affordable Care Act (PPACA) Mandatory Notices

The text below is an annual open enrollment required notice

24

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION PLEASE REVIEW IT CAREFULLY

Our Pledge to You

This notice is intended to inform you of the privacy practices followed by the Reston Associationrsquos Employee Benefit Plan (the Plan) and the Planrsquos legal obligations regarding your protected health information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) The notice also explains the privacy rights you and your family members have as participants of the Plan It is effective on April 14 2011

The Plan often needs access to your protected health information in order to provide payment for health services and perform plan administrative functions We want to assure the plan participants covered under the Plan that we comply with federal privacy laws and respect your right to privacy Reston Association requires all members of our workforce and third parties that are provided access to protected health information to comply with the privacy practices outlined in this notice

Protected Health Information Your protected health information is protected by the HIPAA Privacy Rule Generally protected health information is information that identifies an individual created or received by a health care provider health plan or an employer on behalf of a group health plan that relates to physical or mental health conditions provision of health care or payment for health care whether past present or future

How We May Use Your Protected Health Information Under the HIPAA Privacy Rule we may use or disclose your protected health information for certain purposes without your permission This section describes the ways we can use and disclose your protected health information

bull Payment We use or disclose your protected health information without your written authorization in order to determine eligibility for benefits seek reimbursement from a third party or coordinate benefits with another health plan under which you are covered For example a health care provider that provided treatment to you will provide us with your health information We use that information in order to determine whether those services are eligible for payment under our group health plan

bull Health Care Operations We use and disclose your protected health information in order to perform plan administration functions such as quality assurance activities resolution of internal grievances and evaluating plan performance For example we review claims experience in order to understand participant utilization and to make plan design changes that are intended to control health care costs

bull Treatment Although the law allows use and disclosure of your protected health information for purposes of treatment as a health plan we generally do not need to disclose your information for treatment purposes Your physician or health care provider is required to provide you with an explanation of how they use and share your health information for purposes of treatment payment and health care operations

bull As permitted or required by law We may also use or disclose your protected health information without your written authorization for other reasons as permitted by law We are permitted by law to share information subject to certain requirements in order to communicate information on health-related benefits or services that may be of interest to you respond to a court order or provide information to further public health activities (eg preventing the spread of disease) without your written authorization We are also permitted to share protected health information during a corporate restructuring such as a merger sale or acquisition We will also disclose health information about you when required by law for example in order to prevent serious harm to you or others

The text below is an annual open enrollment required notice

25

Notice of Privacy Practices

bull Pursuant to your Authorization When required by law we will ask for your written authorization before using or disclosing your protected health information If you choose to sign an authorization to disclose information you can later revoke that authorization to prevent any future uses or disclosures

bull To Business Associates We may enter into contracts with entities known as Business Associates that provide services to or perform functions on behalf of the Plan We may disclose protected health information to Business Associates once they have agreed in writing to safeguard the protected health information For example we may disclose your protected health information to a Business Associate to administer claims Business Associates are also required by law to protect protected health information

bull To the Plan Sponsor We may disclose protected health information to certain employees of Reston Association for the purpose of administering the Plan These employees will use or disclose the protected health information only as necessary to perform plan administration functions or as otherwise required by HIPAA unless you have authorized additional disclosures Your protected health information cannot be used for employment purposes without your specific authorization

Your Rights bull Right to Inspect and Copy In most cases you have the right to inspect and copy the protected health

information we maintain about you If you request copies we will charge you a reasonable fee to cover the costs of copying mailing or other expenses associated with your request Your request to inspect or review your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to inspect and copy your health information To the extent your information is held in an electronic health record you may be able to receive the information in an electronic format

bull Right to Amend If you believe that information within your records is incorrect or if important information is missing you have the right to request that we correct the existing information or add the missing information Your request to amend your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to amend your health information If we deny your request you may file a statement of disagreement with us for inclusion in any future disclosures of the disputed information

bull Right to an Accounting of Disclosures You have the right to receive an accounting of certain disclosures of your protected health information The accounting will not include disclosures that were made (1) for purposes of treatment payment or health care operations (2) to you (3) pursuant to your authorization (4) to your friends or family in your presence or because of an emergency (5) for national security purposes or (6) incidental to otherwise permissible disclosures

Your request to for an accounting must be submitted in writing to the person listed below You may request an accounting of disclosures made within the last six years You may request one accounting free of charge within a 12-month period

The text below is an annual open enrollment required notice

25

26

The information provided herein is intended to be a summary of benefits only and in no way supersedes the actual plan documents provided by the insurance carriersadministrators For more detailed information pertaining to your employee benefit plans including limitations and exclusions

please refer to the plan documents andor evidence of coverage provided by the carriersadministrators

Womenrsquos Health and Cancer Rights Act of 1998

If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos Health and Cancer Rights Act of 1998 (WHCRA) For individuals receiving mastectomy-related benefits coverage will be provided in a manner determined in consultation with the attending physician and the patient for

bull All stages of reconstruction of the breast on which the mastectomy was performed bull Surgery and reconstruction of the other breast to produce a symmetrical appearance bull Prostheses and bull Treatment of physical complications of the mastectomy including lymphedema

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan If you would like more information on WHCRA benefits call your plan administrator

CHIP-Childrens Health Insurance Program (CHIP) Reauthorization Act of 2009

Medicaid and the Childrenrsquos Health Insurance Program (CHIP) offer free or low-cost health coverage to children and families If you are eligible for health coverage from your employer but are unable to afford the premiums some States have premium assistance programs that can help pay for coverage These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage but need assistance in paying their health premiums

If you or your dependents are already enrolled in Medicaid or CHIP you can contact your state Medicaid or CHIP office to find out if premium assistance is available For a list of the contacts in each State go to wwwdolgovebsachipmodelnoticedoc

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify you can then contact the State to find out if it has a program that might help you pay the premiums for an employer-sponsored plan

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP your employerrsquos health plan is required to permit you and your dependents to enroll in the plan ndash as long as you and your dependents are eligible but not already enrolled in the employerrsquos plan This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance

The text below is an annual open enrollment required notice

26

27

Premium Assistance Under Medicaid and the

Childrenrsquos Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your

employer your state may have a premium assistance program that can help pay for coverage using funds

from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot

be eligible for these premium assistance programs but you may be able to buy individual insurance coverage

through the Health Insurance Marketplace For more information visit wwwhealthcaregov

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below

contact your State Medicaid or CHIP office to find out if premium assistance is available

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your

dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-

877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a

program that might help you pay the premiums for an employer-sponsored plan

If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible

under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already

enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days

of being determined eligible for premium assistance If you have questions about enrolling in your

employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)

If you live in one of the following states you may be eligible for assistance paying your employer

health plan premiums The following list of states is current as of July 31 2019 Contact your State for

more information on eligibility ndash

ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcom

Phone 1-855-692-5447

Website httpflmedicaidtplrecoverycomhipp

Phone 1-877-357-3268

ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program

Website httpmyakhippcom

Phone 1-866-251-4861

Email CustomerServiceMyAKHIPPcom

Medicaid Eligibility

httpdhssalaskagovdpaPagesmedicaiddefaultaspx

Website httpsmedicaidgeorgiagovhealth-

insurance-premium-payment-program-hipp

Phone 678-564-1162 ext 2131

ARKANSAS ndash Medicaid INDIANA ndash Medicaid

Website httpmyarhippcom

Phone 1-855-MyARHIPP (855-692-7447)

Healthy Indiana Plan for low-income adults 19-64

Website httpwwwingovfssahip

Phone 1-877-438-4479

All other Medicaid

Website httpwwwindianamedicaidcom

Phone 1-800-403-0864

COLORADO ndash Health First Colorado

(Coloradorsquos Medicaid Program) amp Child Health

Plan Plus (CHP+)

IOWA ndash Medicaid

Health First Colorado Website

httpswwwhealthfirstcoloradocom

Health First Colorado Member Contact Center

1-800-221-3943 State Relay 711

CHP+ httpswwwcoloradogovpacifichcpfchild-health-

plan-plus

CHP+ Customer Service 1-800-359-1991 State Relay

711

Website

httpdhsiowagovHawki

Phone 1-800-257-8563

28

KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid

Website httpwwwkdheksgovhcf

Phone 1-785-296-3512

Website httpswwwdhhsnhgovoiihipphtm

Phone 603-271-5218

Toll free number for the HIPP program 1-800-852-3345 ext 5218

KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP

Website httpschfskygov

Phone 1-800-635-2570

Medicaid Website

httpwwwstatenjushumanservices

dmahsclientsmedicaid

Medicaid Phone 609-631-2392

CHIP Website httpwwwnjfamilycareorgindexhtml

CHIP Phone 1-800-701-0710

LOUISIANA ndash Medicaid NEW YORK ndash Medicaid

Website httpdhhlouisianagovindexcfmsubhome1n331

Phone 1-888-695-2447

Website httpswwwhealthnygovhealth_caremedicaid

Phone 1-800-541-2831

MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid

Website httpwwwmainegovdhhsofipublic-assistanceindexhtml

Phone 1-800-442-6003

TTY Maine relay 711

Website httpsmedicaidncdhhsgov

Phone 919-855-4100

MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid

Website httpwwwmassgoveohhsgovdepartmentsmasshealth

Phone 1-800-862-4840

Website httpwwwndgovdhsservicesmedicalservmedicaid

Phone 1-844-854-4825

MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP

Website

httpsmngovdhspeople-we-serveseniorshealth-carehealth-care-

programsprograms-and-servicesother-insurancejsp

Phone 1-800-657-3739

Website httpwwwinsureoklahomaorg

Phone 1-888-365-3742

MISSOURI ndash Medicaid OREGON ndash Medicaid

Website httpwwwdssmogovmhdparticipantspageshipphtm

Phone 573-751-2005

Website httphealthcareoregongovPagesindexaspx

httpwwworegonhealthcaregovindex-eshtml

Phone 1-800-699-9075

MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid

Website httpdphhsmtgovMontanaHealthcareProgramsHIPP

Phone 1-800-694-3084

Website

httpwwwdhspagovprovidermedicalassistancehealthinsuranc

epremiumpaymenthippprogramindexhtm

Phone 1-800-692-7462

NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP

Website httpwwwACCESSNebraskanegov

Phone (855) 632-7633

Lincoln (402) 473-7000

Omaha (402) 595-1178

Website httpwwweohhsrigov

Phone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)

29

NEVADA ndash Medicaid SOUTH CAROLINA ndash Medicaid

Medicaid Website httpsdhcfpnvgov

Medicaid Phone 1-800-992-0900

Website httpswwwscdhhsgov

Phone 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid

Website httpdsssdgov

Phone 1-888-828-0059

Website httpswwwhcawagov

Phone 1-800-562-3022 ext 15473

TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascom

Phone 1-800-440-0493

Website httpmywvhippcom

Toll-free phone 1-855-MyWVHIPP (1-855-699-8447)

UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgov

CHIP Website httphealthutahgovchip

Phone 1-877-543-7669

Website

httpswwwdhswisconsingovpublicationsp1p10095p

df

Phone 1-800-362-3002

VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorg

Phone 1-800-250-8427

Website httpswyequalitycareacs-inccom

Phone 307-777-7531

VIRGINIA ndash Medicaid and CHIP Medicaid Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

Medicaid Phone 1-800-432-5924

CHIP Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

CHIP Phone 1-855-242-8282

To see if any other states have added a premium assistance program since July 31 2019 or for more

information on special enrollment rights contact either

US Department of Labor US Department of Health and Human Services

Employee Benefits Security Administration Centers for Medicare amp Medicaid Services

wwwdolgovagenciesebsa wwwcmshhsgov

1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565

Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond

to a collection of information unless such collection displays a valid Office of Management and Budget (OMB)

control number The Department notes that a Federal agency cannot conduct or sponsor a collection of

information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and

the public is not required to respond to a collection of information unless it displays a currently valid OMB control

number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to

penalty for failing to comply with a collection of information if the collection of information does not display a

currently valid OMB control number See 44 USC 3512

The public reporting burden for this collection of information is estimated to average approximately seven minutes

per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other

aspect of this collection of information including suggestions for reducing this burden to the US Department of

Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance

Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and

reference the OMB Control Number 1210-0137 OMB Control Number 1210-0137 (expires 12312019)

Notes

30

Notes

31

Prepared by

Please contact Reston Associationrsquos Human Resources Department at 703-435-7990 or hrrestonorg with any

questions related to your Total Rewards Guide

copy 2019 McGriff Insurance Services Inc

Page 17: Employee Total Rewards Guide 2020 - Reston Total Rewards Gui… · Recognizing and rewarding employees for achieving a sustainable impact. Award criteria includes: •Progressive

Life and ADampD Insurance

Basic LifeADampD Insurance Reston Association provides 100 employer paid Life and ADampD Insurance through Sun Life to employees working 25 or more hours per week Coverage becomes effective the first of the month following six months of service

Benefit 2x Annual Earnings to a maximum of $200000 Age reduction Benefit reduced to 65 at age 65 and to 50 at age 70

Optional LifeADampD Insurance for Employee Spouse and Dependent Children

Optional Life Insurance for the employee spouse and dependent children is available at the employeersquos cost Optional Life is not available for domestic partners

Employee Benefit Increments of $10000 to a maximum of the lesser of $300000 or 3x your Basic Annual Earnings

Spouse Benefit Increments of $5000 to a maximum of $150000 Dependent Child Benefit Increments of $1000 to a maximum of $10000

Your amount of Dependent Spouse and Dependent Child Optional Life Insurance cannot exceed 50 of your amount of Optional Life Insurance Initial eligibility period will require evidence of insurability

STD amp LTD Insurance

Short Term and Long Term Disability Reston Association provides eligible employees with short and long-term disability income benefits through Sun Life In the event you become disabled from a non work-related injury or sickness disability income benefits are provided as a source of income These benefits are 100 employer paid

Benefit Short-Term Disability Long-Term Disability

Income Replacement -Eligible Employees -Executives

60 60

Elimination Period - Accidental Injury - Sickness

29 days 90 days

Benefit Period 9 weeks maximum To Social Security

normal retirement age

Benefit Maximum -Eligible Employees -Executives

$1000 per week $6000 per month $8000 per month 17

At a cost of $19month you can enroll in the Legal Resources benefit As a Legal Resources Member you have immediate and ongoing access to comprehensive legal coverage services and expertise that will easily save you money mdash and could save you a whole lot more Covered legal services include

Legal Advice and Consultation Tenant Dispute with Landlord District Court Representation for Civil Action Review of a Financial Contract or Lease Purchase sale or refinance of primary home Traffic Court Representation (includes 1st DUI) Will Preparation Uncontested Divorce Representation Defense of Child in Court (misdemeanor)

Legal Resources

Employee Assistance Program (EAP)

Reston Association offers a free confidential Employee Assistance Program (EAP) to all employees and their eligible dependents Through RArsquos EAP provider Lytle EAP Partners you and your immediate family members have immediate access on your date of hire to confidential professional counseling and referral services for help with anything that affects you or your dependentsrsquo well-being You can reach an EAP counselor by dialing 1-800-327-7272 24 hours a day or you may visit their website at wwwLytleEAPcom (password is reston) for more information Visit wwwLytleEAPcom for web-based legal financial worklife resources There are also work-related resources available online for managers Note Since EAP services are provided as a benefit only RA makes no representation concerning quality of care

18

401(k) Retirement Savings Plan

Reston Association offers two 401(k) retirement savings plans through Ascensusmdasha traditional 401(k) plan in which employee contributions are made pre-tax and a 401(k) Roth in which employee contributions are made after tax RA matches employee contributions dollar for dollar up to a total of 7 of your annual salary You can begin making contributions to the 401(k) plan and become eligible for RArsquos match following six months of service You always own 100 of your salary contributions

It is possible to borrow against a portion of your vested 401(k) account balance by taking a 401(k) loan You may request a participant loan using an application form which can be obtained by contacting Human Resources Your ability to obtain a 401(k) loan will depend on specific qualifying factors (defined in the 401(k) Summary Plan Description document) The 401(k) Plan Administrator will determine whether you satisfy these factors To access your 401(k) plan online httpsmyaccountascensuscomrplink Check account balance and rate of return Change fund elections Request a 401k loan View fund pricing and performance View and print quarterly statements

19

529 College Savings Plan (employer-sponsored)

A 529 college savings plan provides those saving for college with an unmatched combination of benefits You can open a 529 plan for anyone mdash your child grandchild spouse a friend or even yourself Assets in a 529 plan can be used to pay for a variety of higher education expenses including required books tuition room and board supplies and certain other required fees and expenses Earnings in 529 accounts can grow free from federal tax Withdrawals for qualified higher education expenses are free from federal tax Option to set up recurring automatic fund transfers directly from your bank account making it easy for you to invest The account owner rather than the beneficiary maintains control of account assets and determines the timing and amount of distributions Account owners can change beneficiaries without penalty provided the new beneficiary is a member of the previous beneficiaryrsquos family For more information please contact Human Resources

Additional Benefits

Free passes for employees and their dependents to all of RArsquos pools and tennis courts as well as discounted rates for all RA Programs and Camps Some restrictions may apply

Discounted gym membership rates at the Reston YMCA and Crunch Fitness Bike Share Program - Reston Association makes bicycles and helmets available to employees to rent on a daily

basis Please contact Member Services Discounted Tennis Rackets amp Shoes ndash Employees can purchase certain tennis shoes and rackets at wholesale

prices through RArsquos Tennis Department Contact the Tennis Department for more information Discounted autohome insurance - Liberty Mutual Insurance Company partners with RA to offer all employees

discounts on automobile and homeowner insurance Contact John Valenti at JohnValentilibertymutualcom

20

Reston Association provides generous paid time off benefits to accommodate the diverse needs of staff and to provide a positive worklife balance The amount of paid time off you earn per year is based on your years of service In addition Reston Association observes 9 paid holidays and assigns one paid floating holiday per year For more information on paid time off benefits and how to request time off please refer to the Reston Association Employee Handbook

WorkLife Balance ndash Paid Time Off (PTO)

Teleworking

The medical leave bank is available to help employees in extenuating circumstances protect their incomes by receiving paid leave once their personal PTO is used up A maximum of six (6) workweeks may be granted for each Medical Leave Bank request If additional time is necessary a new request must be made For program eligibility and criteria go to CommonHumResBenefits

Medical Leave Bank

Volunteer Release Time

On a per position basis employees may be allowed to telework for part of their workweek or in certain circumstances Such arrangements must be in compliance with the written administrative procedure including being approved in advance by the department director

Employees are encouraged to become involved in their communities lending their voluntary support to programs that enrich the quality of life and opportunities for all citizens This benefit allows employees to take paid-time off during a work day to participate in a volunteer activity that benefits the community at large Such activities are typically sponsored by a charitable or service organization or work with one or more individuals in need of assistance or special service

21

Training amp Career Development

Reston Association offers two types of learning opportunities for employees mdashinformal and formalmdashto foster individual development and training and career planning

I Informal Learning Opportunities (individual development amp training)

Focus on individual acquiring or enhancing specific task andor process skills to perform his or her current job better Typically this type of learning is not ldquodegree- orientedrdquo

Participants may or may not receive attendance or achievement certificate

Conferences workshops seminars webinars online courses etc typically lasting a few hours to one week

Requests for this type of training should be made to your supervisor or department head

II Formal Learning Opportunities (career planning)

Professional DevelopmentCareer Planning

Formalstructured learning geared toward improving and maintaining professional competence enhancing career progression staying abreast of new technologies and best practices developing process skills andor compliance with professional regulations

Future but not degree-oriented CEUs may be earned

May lead to qualification or credential required to obtain or retain specific certification

Opportunity may range from semester-long academic course to 24 month program with wide range of content and learning experience

Tuition Reimbursement Program

Supports formal education goals (AA bachelors masters) of individual to enhance knowledge and skills in specific areaindustry

Learning must be job-related and accomplished at or through accredited learning institution or e-learning platform connected with the institution

Requests for this type of training should be made to Human Resources as soon as foreseeable to ensure best availability of funds to support reimbursement

22

23

Lifetime limit not applicable and enrollment opportunity The lifetime limit on the dollar value of benefits under our medical plan no longer applies Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan Individuals have 30 days from the date of this notice to request enrollment For more information contact Human Resources or call the medical insurance carrier at the telephone number on your identification card

Notice on Patient Protections The medical HMO plan generally allows the designation of a primary care provider You have the right to designate any primary care provider who participates in the network and who is available to accept you or your family members Until you make this designation the medical carrier designates one for you For information on how to select a primary care provider and for a list of the participating primary care providers contact the medical insurance carrier at the number listed on your identification card

For children you may designate a pediatrician as the primary care provider You do not need prior authorization from the medical insurance carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in the network who specializes in obstetrics or gynecology The health care professional however may be required to comply with certain procedures including obtaining prior authorization for certain services following a pre-approved treatment plan or procedures for making referrals For a list of participating health care professionals who specialize in obstetrics or gynecology contact the medical insurance carrier at the number listed on your identification card

OTC Drug Reimbursements for FSAsHRAsHSAs Under the new Health Care Reform law (PPACA) the cost of an over-the-counter medicine or drug cannot be reimbursed from the account unless a prescription is obtained The change does not affect insulin even if purchased without a prescription or other health care expenses such as medical devices eyeglasses contact lenses co-pays and deductibles The new standard applies only to purchases made on or after January 1 2011

A similar rule is in effect for Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs)

The IRS has also posted a questions and answers section on its website httpwwwirsgovnewsroomarticle0id=22730800html concerning these provisions

Patient Protection and Affordable Care Act (PPACA) Mandatory Notices

The text below is an annual open enrollment required notice

24

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION PLEASE REVIEW IT CAREFULLY

Our Pledge to You

This notice is intended to inform you of the privacy practices followed by the Reston Associationrsquos Employee Benefit Plan (the Plan) and the Planrsquos legal obligations regarding your protected health information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) The notice also explains the privacy rights you and your family members have as participants of the Plan It is effective on April 14 2011

The Plan often needs access to your protected health information in order to provide payment for health services and perform plan administrative functions We want to assure the plan participants covered under the Plan that we comply with federal privacy laws and respect your right to privacy Reston Association requires all members of our workforce and third parties that are provided access to protected health information to comply with the privacy practices outlined in this notice

Protected Health Information Your protected health information is protected by the HIPAA Privacy Rule Generally protected health information is information that identifies an individual created or received by a health care provider health plan or an employer on behalf of a group health plan that relates to physical or mental health conditions provision of health care or payment for health care whether past present or future

How We May Use Your Protected Health Information Under the HIPAA Privacy Rule we may use or disclose your protected health information for certain purposes without your permission This section describes the ways we can use and disclose your protected health information

bull Payment We use or disclose your protected health information without your written authorization in order to determine eligibility for benefits seek reimbursement from a third party or coordinate benefits with another health plan under which you are covered For example a health care provider that provided treatment to you will provide us with your health information We use that information in order to determine whether those services are eligible for payment under our group health plan

bull Health Care Operations We use and disclose your protected health information in order to perform plan administration functions such as quality assurance activities resolution of internal grievances and evaluating plan performance For example we review claims experience in order to understand participant utilization and to make plan design changes that are intended to control health care costs

bull Treatment Although the law allows use and disclosure of your protected health information for purposes of treatment as a health plan we generally do not need to disclose your information for treatment purposes Your physician or health care provider is required to provide you with an explanation of how they use and share your health information for purposes of treatment payment and health care operations

bull As permitted or required by law We may also use or disclose your protected health information without your written authorization for other reasons as permitted by law We are permitted by law to share information subject to certain requirements in order to communicate information on health-related benefits or services that may be of interest to you respond to a court order or provide information to further public health activities (eg preventing the spread of disease) without your written authorization We are also permitted to share protected health information during a corporate restructuring such as a merger sale or acquisition We will also disclose health information about you when required by law for example in order to prevent serious harm to you or others

The text below is an annual open enrollment required notice

25

Notice of Privacy Practices

bull Pursuant to your Authorization When required by law we will ask for your written authorization before using or disclosing your protected health information If you choose to sign an authorization to disclose information you can later revoke that authorization to prevent any future uses or disclosures

bull To Business Associates We may enter into contracts with entities known as Business Associates that provide services to or perform functions on behalf of the Plan We may disclose protected health information to Business Associates once they have agreed in writing to safeguard the protected health information For example we may disclose your protected health information to a Business Associate to administer claims Business Associates are also required by law to protect protected health information

bull To the Plan Sponsor We may disclose protected health information to certain employees of Reston Association for the purpose of administering the Plan These employees will use or disclose the protected health information only as necessary to perform plan administration functions or as otherwise required by HIPAA unless you have authorized additional disclosures Your protected health information cannot be used for employment purposes without your specific authorization

Your Rights bull Right to Inspect and Copy In most cases you have the right to inspect and copy the protected health

information we maintain about you If you request copies we will charge you a reasonable fee to cover the costs of copying mailing or other expenses associated with your request Your request to inspect or review your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to inspect and copy your health information To the extent your information is held in an electronic health record you may be able to receive the information in an electronic format

bull Right to Amend If you believe that information within your records is incorrect or if important information is missing you have the right to request that we correct the existing information or add the missing information Your request to amend your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to amend your health information If we deny your request you may file a statement of disagreement with us for inclusion in any future disclosures of the disputed information

bull Right to an Accounting of Disclosures You have the right to receive an accounting of certain disclosures of your protected health information The accounting will not include disclosures that were made (1) for purposes of treatment payment or health care operations (2) to you (3) pursuant to your authorization (4) to your friends or family in your presence or because of an emergency (5) for national security purposes or (6) incidental to otherwise permissible disclosures

Your request to for an accounting must be submitted in writing to the person listed below You may request an accounting of disclosures made within the last six years You may request one accounting free of charge within a 12-month period

The text below is an annual open enrollment required notice

25

26

The information provided herein is intended to be a summary of benefits only and in no way supersedes the actual plan documents provided by the insurance carriersadministrators For more detailed information pertaining to your employee benefit plans including limitations and exclusions

please refer to the plan documents andor evidence of coverage provided by the carriersadministrators

Womenrsquos Health and Cancer Rights Act of 1998

If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos Health and Cancer Rights Act of 1998 (WHCRA) For individuals receiving mastectomy-related benefits coverage will be provided in a manner determined in consultation with the attending physician and the patient for

bull All stages of reconstruction of the breast on which the mastectomy was performed bull Surgery and reconstruction of the other breast to produce a symmetrical appearance bull Prostheses and bull Treatment of physical complications of the mastectomy including lymphedema

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan If you would like more information on WHCRA benefits call your plan administrator

CHIP-Childrens Health Insurance Program (CHIP) Reauthorization Act of 2009

Medicaid and the Childrenrsquos Health Insurance Program (CHIP) offer free or low-cost health coverage to children and families If you are eligible for health coverage from your employer but are unable to afford the premiums some States have premium assistance programs that can help pay for coverage These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage but need assistance in paying their health premiums

If you or your dependents are already enrolled in Medicaid or CHIP you can contact your state Medicaid or CHIP office to find out if premium assistance is available For a list of the contacts in each State go to wwwdolgovebsachipmodelnoticedoc

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify you can then contact the State to find out if it has a program that might help you pay the premiums for an employer-sponsored plan

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP your employerrsquos health plan is required to permit you and your dependents to enroll in the plan ndash as long as you and your dependents are eligible but not already enrolled in the employerrsquos plan This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance

The text below is an annual open enrollment required notice

26

27

Premium Assistance Under Medicaid and the

Childrenrsquos Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your

employer your state may have a premium assistance program that can help pay for coverage using funds

from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot

be eligible for these premium assistance programs but you may be able to buy individual insurance coverage

through the Health Insurance Marketplace For more information visit wwwhealthcaregov

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below

contact your State Medicaid or CHIP office to find out if premium assistance is available

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your

dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-

877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a

program that might help you pay the premiums for an employer-sponsored plan

If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible

under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already

enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days

of being determined eligible for premium assistance If you have questions about enrolling in your

employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)

If you live in one of the following states you may be eligible for assistance paying your employer

health plan premiums The following list of states is current as of July 31 2019 Contact your State for

more information on eligibility ndash

ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcom

Phone 1-855-692-5447

Website httpflmedicaidtplrecoverycomhipp

Phone 1-877-357-3268

ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program

Website httpmyakhippcom

Phone 1-866-251-4861

Email CustomerServiceMyAKHIPPcom

Medicaid Eligibility

httpdhssalaskagovdpaPagesmedicaiddefaultaspx

Website httpsmedicaidgeorgiagovhealth-

insurance-premium-payment-program-hipp

Phone 678-564-1162 ext 2131

ARKANSAS ndash Medicaid INDIANA ndash Medicaid

Website httpmyarhippcom

Phone 1-855-MyARHIPP (855-692-7447)

Healthy Indiana Plan for low-income adults 19-64

Website httpwwwingovfssahip

Phone 1-877-438-4479

All other Medicaid

Website httpwwwindianamedicaidcom

Phone 1-800-403-0864

COLORADO ndash Health First Colorado

(Coloradorsquos Medicaid Program) amp Child Health

Plan Plus (CHP+)

IOWA ndash Medicaid

Health First Colorado Website

httpswwwhealthfirstcoloradocom

Health First Colorado Member Contact Center

1-800-221-3943 State Relay 711

CHP+ httpswwwcoloradogovpacifichcpfchild-health-

plan-plus

CHP+ Customer Service 1-800-359-1991 State Relay

711

Website

httpdhsiowagovHawki

Phone 1-800-257-8563

28

KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid

Website httpwwwkdheksgovhcf

Phone 1-785-296-3512

Website httpswwwdhhsnhgovoiihipphtm

Phone 603-271-5218

Toll free number for the HIPP program 1-800-852-3345 ext 5218

KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP

Website httpschfskygov

Phone 1-800-635-2570

Medicaid Website

httpwwwstatenjushumanservices

dmahsclientsmedicaid

Medicaid Phone 609-631-2392

CHIP Website httpwwwnjfamilycareorgindexhtml

CHIP Phone 1-800-701-0710

LOUISIANA ndash Medicaid NEW YORK ndash Medicaid

Website httpdhhlouisianagovindexcfmsubhome1n331

Phone 1-888-695-2447

Website httpswwwhealthnygovhealth_caremedicaid

Phone 1-800-541-2831

MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid

Website httpwwwmainegovdhhsofipublic-assistanceindexhtml

Phone 1-800-442-6003

TTY Maine relay 711

Website httpsmedicaidncdhhsgov

Phone 919-855-4100

MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid

Website httpwwwmassgoveohhsgovdepartmentsmasshealth

Phone 1-800-862-4840

Website httpwwwndgovdhsservicesmedicalservmedicaid

Phone 1-844-854-4825

MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP

Website

httpsmngovdhspeople-we-serveseniorshealth-carehealth-care-

programsprograms-and-servicesother-insurancejsp

Phone 1-800-657-3739

Website httpwwwinsureoklahomaorg

Phone 1-888-365-3742

MISSOURI ndash Medicaid OREGON ndash Medicaid

Website httpwwwdssmogovmhdparticipantspageshipphtm

Phone 573-751-2005

Website httphealthcareoregongovPagesindexaspx

httpwwworegonhealthcaregovindex-eshtml

Phone 1-800-699-9075

MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid

Website httpdphhsmtgovMontanaHealthcareProgramsHIPP

Phone 1-800-694-3084

Website

httpwwwdhspagovprovidermedicalassistancehealthinsuranc

epremiumpaymenthippprogramindexhtm

Phone 1-800-692-7462

NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP

Website httpwwwACCESSNebraskanegov

Phone (855) 632-7633

Lincoln (402) 473-7000

Omaha (402) 595-1178

Website httpwwweohhsrigov

Phone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)

29

NEVADA ndash Medicaid SOUTH CAROLINA ndash Medicaid

Medicaid Website httpsdhcfpnvgov

Medicaid Phone 1-800-992-0900

Website httpswwwscdhhsgov

Phone 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid

Website httpdsssdgov

Phone 1-888-828-0059

Website httpswwwhcawagov

Phone 1-800-562-3022 ext 15473

TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascom

Phone 1-800-440-0493

Website httpmywvhippcom

Toll-free phone 1-855-MyWVHIPP (1-855-699-8447)

UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgov

CHIP Website httphealthutahgovchip

Phone 1-877-543-7669

Website

httpswwwdhswisconsingovpublicationsp1p10095p

df

Phone 1-800-362-3002

VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorg

Phone 1-800-250-8427

Website httpswyequalitycareacs-inccom

Phone 307-777-7531

VIRGINIA ndash Medicaid and CHIP Medicaid Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

Medicaid Phone 1-800-432-5924

CHIP Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

CHIP Phone 1-855-242-8282

To see if any other states have added a premium assistance program since July 31 2019 or for more

information on special enrollment rights contact either

US Department of Labor US Department of Health and Human Services

Employee Benefits Security Administration Centers for Medicare amp Medicaid Services

wwwdolgovagenciesebsa wwwcmshhsgov

1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565

Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond

to a collection of information unless such collection displays a valid Office of Management and Budget (OMB)

control number The Department notes that a Federal agency cannot conduct or sponsor a collection of

information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and

the public is not required to respond to a collection of information unless it displays a currently valid OMB control

number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to

penalty for failing to comply with a collection of information if the collection of information does not display a

currently valid OMB control number See 44 USC 3512

The public reporting burden for this collection of information is estimated to average approximately seven minutes

per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other

aspect of this collection of information including suggestions for reducing this burden to the US Department of

Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance

Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and

reference the OMB Control Number 1210-0137 OMB Control Number 1210-0137 (expires 12312019)

Notes

30

Notes

31

Prepared by

Please contact Reston Associationrsquos Human Resources Department at 703-435-7990 or hrrestonorg with any

questions related to your Total Rewards Guide

copy 2019 McGriff Insurance Services Inc

Page 18: Employee Total Rewards Guide 2020 - Reston Total Rewards Gui… · Recognizing and rewarding employees for achieving a sustainable impact. Award criteria includes: •Progressive

At a cost of $19month you can enroll in the Legal Resources benefit As a Legal Resources Member you have immediate and ongoing access to comprehensive legal coverage services and expertise that will easily save you money mdash and could save you a whole lot more Covered legal services include

Legal Advice and Consultation Tenant Dispute with Landlord District Court Representation for Civil Action Review of a Financial Contract or Lease Purchase sale or refinance of primary home Traffic Court Representation (includes 1st DUI) Will Preparation Uncontested Divorce Representation Defense of Child in Court (misdemeanor)

Legal Resources

Employee Assistance Program (EAP)

Reston Association offers a free confidential Employee Assistance Program (EAP) to all employees and their eligible dependents Through RArsquos EAP provider Lytle EAP Partners you and your immediate family members have immediate access on your date of hire to confidential professional counseling and referral services for help with anything that affects you or your dependentsrsquo well-being You can reach an EAP counselor by dialing 1-800-327-7272 24 hours a day or you may visit their website at wwwLytleEAPcom (password is reston) for more information Visit wwwLytleEAPcom for web-based legal financial worklife resources There are also work-related resources available online for managers Note Since EAP services are provided as a benefit only RA makes no representation concerning quality of care

18

401(k) Retirement Savings Plan

Reston Association offers two 401(k) retirement savings plans through Ascensusmdasha traditional 401(k) plan in which employee contributions are made pre-tax and a 401(k) Roth in which employee contributions are made after tax RA matches employee contributions dollar for dollar up to a total of 7 of your annual salary You can begin making contributions to the 401(k) plan and become eligible for RArsquos match following six months of service You always own 100 of your salary contributions

It is possible to borrow against a portion of your vested 401(k) account balance by taking a 401(k) loan You may request a participant loan using an application form which can be obtained by contacting Human Resources Your ability to obtain a 401(k) loan will depend on specific qualifying factors (defined in the 401(k) Summary Plan Description document) The 401(k) Plan Administrator will determine whether you satisfy these factors To access your 401(k) plan online httpsmyaccountascensuscomrplink Check account balance and rate of return Change fund elections Request a 401k loan View fund pricing and performance View and print quarterly statements

19

529 College Savings Plan (employer-sponsored)

A 529 college savings plan provides those saving for college with an unmatched combination of benefits You can open a 529 plan for anyone mdash your child grandchild spouse a friend or even yourself Assets in a 529 plan can be used to pay for a variety of higher education expenses including required books tuition room and board supplies and certain other required fees and expenses Earnings in 529 accounts can grow free from federal tax Withdrawals for qualified higher education expenses are free from federal tax Option to set up recurring automatic fund transfers directly from your bank account making it easy for you to invest The account owner rather than the beneficiary maintains control of account assets and determines the timing and amount of distributions Account owners can change beneficiaries without penalty provided the new beneficiary is a member of the previous beneficiaryrsquos family For more information please contact Human Resources

Additional Benefits

Free passes for employees and their dependents to all of RArsquos pools and tennis courts as well as discounted rates for all RA Programs and Camps Some restrictions may apply

Discounted gym membership rates at the Reston YMCA and Crunch Fitness Bike Share Program - Reston Association makes bicycles and helmets available to employees to rent on a daily

basis Please contact Member Services Discounted Tennis Rackets amp Shoes ndash Employees can purchase certain tennis shoes and rackets at wholesale

prices through RArsquos Tennis Department Contact the Tennis Department for more information Discounted autohome insurance - Liberty Mutual Insurance Company partners with RA to offer all employees

discounts on automobile and homeowner insurance Contact John Valenti at JohnValentilibertymutualcom

20

Reston Association provides generous paid time off benefits to accommodate the diverse needs of staff and to provide a positive worklife balance The amount of paid time off you earn per year is based on your years of service In addition Reston Association observes 9 paid holidays and assigns one paid floating holiday per year For more information on paid time off benefits and how to request time off please refer to the Reston Association Employee Handbook

WorkLife Balance ndash Paid Time Off (PTO)

Teleworking

The medical leave bank is available to help employees in extenuating circumstances protect their incomes by receiving paid leave once their personal PTO is used up A maximum of six (6) workweeks may be granted for each Medical Leave Bank request If additional time is necessary a new request must be made For program eligibility and criteria go to CommonHumResBenefits

Medical Leave Bank

Volunteer Release Time

On a per position basis employees may be allowed to telework for part of their workweek or in certain circumstances Such arrangements must be in compliance with the written administrative procedure including being approved in advance by the department director

Employees are encouraged to become involved in their communities lending their voluntary support to programs that enrich the quality of life and opportunities for all citizens This benefit allows employees to take paid-time off during a work day to participate in a volunteer activity that benefits the community at large Such activities are typically sponsored by a charitable or service organization or work with one or more individuals in need of assistance or special service

21

Training amp Career Development

Reston Association offers two types of learning opportunities for employees mdashinformal and formalmdashto foster individual development and training and career planning

I Informal Learning Opportunities (individual development amp training)

Focus on individual acquiring or enhancing specific task andor process skills to perform his or her current job better Typically this type of learning is not ldquodegree- orientedrdquo

Participants may or may not receive attendance or achievement certificate

Conferences workshops seminars webinars online courses etc typically lasting a few hours to one week

Requests for this type of training should be made to your supervisor or department head

II Formal Learning Opportunities (career planning)

Professional DevelopmentCareer Planning

Formalstructured learning geared toward improving and maintaining professional competence enhancing career progression staying abreast of new technologies and best practices developing process skills andor compliance with professional regulations

Future but not degree-oriented CEUs may be earned

May lead to qualification or credential required to obtain or retain specific certification

Opportunity may range from semester-long academic course to 24 month program with wide range of content and learning experience

Tuition Reimbursement Program

Supports formal education goals (AA bachelors masters) of individual to enhance knowledge and skills in specific areaindustry

Learning must be job-related and accomplished at or through accredited learning institution or e-learning platform connected with the institution

Requests for this type of training should be made to Human Resources as soon as foreseeable to ensure best availability of funds to support reimbursement

22

23

Lifetime limit not applicable and enrollment opportunity The lifetime limit on the dollar value of benefits under our medical plan no longer applies Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan Individuals have 30 days from the date of this notice to request enrollment For more information contact Human Resources or call the medical insurance carrier at the telephone number on your identification card

Notice on Patient Protections The medical HMO plan generally allows the designation of a primary care provider You have the right to designate any primary care provider who participates in the network and who is available to accept you or your family members Until you make this designation the medical carrier designates one for you For information on how to select a primary care provider and for a list of the participating primary care providers contact the medical insurance carrier at the number listed on your identification card

For children you may designate a pediatrician as the primary care provider You do not need prior authorization from the medical insurance carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in the network who specializes in obstetrics or gynecology The health care professional however may be required to comply with certain procedures including obtaining prior authorization for certain services following a pre-approved treatment plan or procedures for making referrals For a list of participating health care professionals who specialize in obstetrics or gynecology contact the medical insurance carrier at the number listed on your identification card

OTC Drug Reimbursements for FSAsHRAsHSAs Under the new Health Care Reform law (PPACA) the cost of an over-the-counter medicine or drug cannot be reimbursed from the account unless a prescription is obtained The change does not affect insulin even if purchased without a prescription or other health care expenses such as medical devices eyeglasses contact lenses co-pays and deductibles The new standard applies only to purchases made on or after January 1 2011

A similar rule is in effect for Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs)

The IRS has also posted a questions and answers section on its website httpwwwirsgovnewsroomarticle0id=22730800html concerning these provisions

Patient Protection and Affordable Care Act (PPACA) Mandatory Notices

The text below is an annual open enrollment required notice

24

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION PLEASE REVIEW IT CAREFULLY

Our Pledge to You

This notice is intended to inform you of the privacy practices followed by the Reston Associationrsquos Employee Benefit Plan (the Plan) and the Planrsquos legal obligations regarding your protected health information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) The notice also explains the privacy rights you and your family members have as participants of the Plan It is effective on April 14 2011

The Plan often needs access to your protected health information in order to provide payment for health services and perform plan administrative functions We want to assure the plan participants covered under the Plan that we comply with federal privacy laws and respect your right to privacy Reston Association requires all members of our workforce and third parties that are provided access to protected health information to comply with the privacy practices outlined in this notice

Protected Health Information Your protected health information is protected by the HIPAA Privacy Rule Generally protected health information is information that identifies an individual created or received by a health care provider health plan or an employer on behalf of a group health plan that relates to physical or mental health conditions provision of health care or payment for health care whether past present or future

How We May Use Your Protected Health Information Under the HIPAA Privacy Rule we may use or disclose your protected health information for certain purposes without your permission This section describes the ways we can use and disclose your protected health information

bull Payment We use or disclose your protected health information without your written authorization in order to determine eligibility for benefits seek reimbursement from a third party or coordinate benefits with another health plan under which you are covered For example a health care provider that provided treatment to you will provide us with your health information We use that information in order to determine whether those services are eligible for payment under our group health plan

bull Health Care Operations We use and disclose your protected health information in order to perform plan administration functions such as quality assurance activities resolution of internal grievances and evaluating plan performance For example we review claims experience in order to understand participant utilization and to make plan design changes that are intended to control health care costs

bull Treatment Although the law allows use and disclosure of your protected health information for purposes of treatment as a health plan we generally do not need to disclose your information for treatment purposes Your physician or health care provider is required to provide you with an explanation of how they use and share your health information for purposes of treatment payment and health care operations

bull As permitted or required by law We may also use or disclose your protected health information without your written authorization for other reasons as permitted by law We are permitted by law to share information subject to certain requirements in order to communicate information on health-related benefits or services that may be of interest to you respond to a court order or provide information to further public health activities (eg preventing the spread of disease) without your written authorization We are also permitted to share protected health information during a corporate restructuring such as a merger sale or acquisition We will also disclose health information about you when required by law for example in order to prevent serious harm to you or others

The text below is an annual open enrollment required notice

25

Notice of Privacy Practices

bull Pursuant to your Authorization When required by law we will ask for your written authorization before using or disclosing your protected health information If you choose to sign an authorization to disclose information you can later revoke that authorization to prevent any future uses or disclosures

bull To Business Associates We may enter into contracts with entities known as Business Associates that provide services to or perform functions on behalf of the Plan We may disclose protected health information to Business Associates once they have agreed in writing to safeguard the protected health information For example we may disclose your protected health information to a Business Associate to administer claims Business Associates are also required by law to protect protected health information

bull To the Plan Sponsor We may disclose protected health information to certain employees of Reston Association for the purpose of administering the Plan These employees will use or disclose the protected health information only as necessary to perform plan administration functions or as otherwise required by HIPAA unless you have authorized additional disclosures Your protected health information cannot be used for employment purposes without your specific authorization

Your Rights bull Right to Inspect and Copy In most cases you have the right to inspect and copy the protected health

information we maintain about you If you request copies we will charge you a reasonable fee to cover the costs of copying mailing or other expenses associated with your request Your request to inspect or review your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to inspect and copy your health information To the extent your information is held in an electronic health record you may be able to receive the information in an electronic format

bull Right to Amend If you believe that information within your records is incorrect or if important information is missing you have the right to request that we correct the existing information or add the missing information Your request to amend your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to amend your health information If we deny your request you may file a statement of disagreement with us for inclusion in any future disclosures of the disputed information

bull Right to an Accounting of Disclosures You have the right to receive an accounting of certain disclosures of your protected health information The accounting will not include disclosures that were made (1) for purposes of treatment payment or health care operations (2) to you (3) pursuant to your authorization (4) to your friends or family in your presence or because of an emergency (5) for national security purposes or (6) incidental to otherwise permissible disclosures

Your request to for an accounting must be submitted in writing to the person listed below You may request an accounting of disclosures made within the last six years You may request one accounting free of charge within a 12-month period

The text below is an annual open enrollment required notice

25

26

The information provided herein is intended to be a summary of benefits only and in no way supersedes the actual plan documents provided by the insurance carriersadministrators For more detailed information pertaining to your employee benefit plans including limitations and exclusions

please refer to the plan documents andor evidence of coverage provided by the carriersadministrators

Womenrsquos Health and Cancer Rights Act of 1998

If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos Health and Cancer Rights Act of 1998 (WHCRA) For individuals receiving mastectomy-related benefits coverage will be provided in a manner determined in consultation with the attending physician and the patient for

bull All stages of reconstruction of the breast on which the mastectomy was performed bull Surgery and reconstruction of the other breast to produce a symmetrical appearance bull Prostheses and bull Treatment of physical complications of the mastectomy including lymphedema

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan If you would like more information on WHCRA benefits call your plan administrator

CHIP-Childrens Health Insurance Program (CHIP) Reauthorization Act of 2009

Medicaid and the Childrenrsquos Health Insurance Program (CHIP) offer free or low-cost health coverage to children and families If you are eligible for health coverage from your employer but are unable to afford the premiums some States have premium assistance programs that can help pay for coverage These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage but need assistance in paying their health premiums

If you or your dependents are already enrolled in Medicaid or CHIP you can contact your state Medicaid or CHIP office to find out if premium assistance is available For a list of the contacts in each State go to wwwdolgovebsachipmodelnoticedoc

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify you can then contact the State to find out if it has a program that might help you pay the premiums for an employer-sponsored plan

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP your employerrsquos health plan is required to permit you and your dependents to enroll in the plan ndash as long as you and your dependents are eligible but not already enrolled in the employerrsquos plan This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance

The text below is an annual open enrollment required notice

26

27

Premium Assistance Under Medicaid and the

Childrenrsquos Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your

employer your state may have a premium assistance program that can help pay for coverage using funds

from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot

be eligible for these premium assistance programs but you may be able to buy individual insurance coverage

through the Health Insurance Marketplace For more information visit wwwhealthcaregov

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below

contact your State Medicaid or CHIP office to find out if premium assistance is available

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your

dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-

877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a

program that might help you pay the premiums for an employer-sponsored plan

If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible

under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already

enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days

of being determined eligible for premium assistance If you have questions about enrolling in your

employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)

If you live in one of the following states you may be eligible for assistance paying your employer

health plan premiums The following list of states is current as of July 31 2019 Contact your State for

more information on eligibility ndash

ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcom

Phone 1-855-692-5447

Website httpflmedicaidtplrecoverycomhipp

Phone 1-877-357-3268

ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program

Website httpmyakhippcom

Phone 1-866-251-4861

Email CustomerServiceMyAKHIPPcom

Medicaid Eligibility

httpdhssalaskagovdpaPagesmedicaiddefaultaspx

Website httpsmedicaidgeorgiagovhealth-

insurance-premium-payment-program-hipp

Phone 678-564-1162 ext 2131

ARKANSAS ndash Medicaid INDIANA ndash Medicaid

Website httpmyarhippcom

Phone 1-855-MyARHIPP (855-692-7447)

Healthy Indiana Plan for low-income adults 19-64

Website httpwwwingovfssahip

Phone 1-877-438-4479

All other Medicaid

Website httpwwwindianamedicaidcom

Phone 1-800-403-0864

COLORADO ndash Health First Colorado

(Coloradorsquos Medicaid Program) amp Child Health

Plan Plus (CHP+)

IOWA ndash Medicaid

Health First Colorado Website

httpswwwhealthfirstcoloradocom

Health First Colorado Member Contact Center

1-800-221-3943 State Relay 711

CHP+ httpswwwcoloradogovpacifichcpfchild-health-

plan-plus

CHP+ Customer Service 1-800-359-1991 State Relay

711

Website

httpdhsiowagovHawki

Phone 1-800-257-8563

28

KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid

Website httpwwwkdheksgovhcf

Phone 1-785-296-3512

Website httpswwwdhhsnhgovoiihipphtm

Phone 603-271-5218

Toll free number for the HIPP program 1-800-852-3345 ext 5218

KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP

Website httpschfskygov

Phone 1-800-635-2570

Medicaid Website

httpwwwstatenjushumanservices

dmahsclientsmedicaid

Medicaid Phone 609-631-2392

CHIP Website httpwwwnjfamilycareorgindexhtml

CHIP Phone 1-800-701-0710

LOUISIANA ndash Medicaid NEW YORK ndash Medicaid

Website httpdhhlouisianagovindexcfmsubhome1n331

Phone 1-888-695-2447

Website httpswwwhealthnygovhealth_caremedicaid

Phone 1-800-541-2831

MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid

Website httpwwwmainegovdhhsofipublic-assistanceindexhtml

Phone 1-800-442-6003

TTY Maine relay 711

Website httpsmedicaidncdhhsgov

Phone 919-855-4100

MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid

Website httpwwwmassgoveohhsgovdepartmentsmasshealth

Phone 1-800-862-4840

Website httpwwwndgovdhsservicesmedicalservmedicaid

Phone 1-844-854-4825

MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP

Website

httpsmngovdhspeople-we-serveseniorshealth-carehealth-care-

programsprograms-and-servicesother-insurancejsp

Phone 1-800-657-3739

Website httpwwwinsureoklahomaorg

Phone 1-888-365-3742

MISSOURI ndash Medicaid OREGON ndash Medicaid

Website httpwwwdssmogovmhdparticipantspageshipphtm

Phone 573-751-2005

Website httphealthcareoregongovPagesindexaspx

httpwwworegonhealthcaregovindex-eshtml

Phone 1-800-699-9075

MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid

Website httpdphhsmtgovMontanaHealthcareProgramsHIPP

Phone 1-800-694-3084

Website

httpwwwdhspagovprovidermedicalassistancehealthinsuranc

epremiumpaymenthippprogramindexhtm

Phone 1-800-692-7462

NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP

Website httpwwwACCESSNebraskanegov

Phone (855) 632-7633

Lincoln (402) 473-7000

Omaha (402) 595-1178

Website httpwwweohhsrigov

Phone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)

29

NEVADA ndash Medicaid SOUTH CAROLINA ndash Medicaid

Medicaid Website httpsdhcfpnvgov

Medicaid Phone 1-800-992-0900

Website httpswwwscdhhsgov

Phone 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid

Website httpdsssdgov

Phone 1-888-828-0059

Website httpswwwhcawagov

Phone 1-800-562-3022 ext 15473

TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascom

Phone 1-800-440-0493

Website httpmywvhippcom

Toll-free phone 1-855-MyWVHIPP (1-855-699-8447)

UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgov

CHIP Website httphealthutahgovchip

Phone 1-877-543-7669

Website

httpswwwdhswisconsingovpublicationsp1p10095p

df

Phone 1-800-362-3002

VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorg

Phone 1-800-250-8427

Website httpswyequalitycareacs-inccom

Phone 307-777-7531

VIRGINIA ndash Medicaid and CHIP Medicaid Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

Medicaid Phone 1-800-432-5924

CHIP Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

CHIP Phone 1-855-242-8282

To see if any other states have added a premium assistance program since July 31 2019 or for more

information on special enrollment rights contact either

US Department of Labor US Department of Health and Human Services

Employee Benefits Security Administration Centers for Medicare amp Medicaid Services

wwwdolgovagenciesebsa wwwcmshhsgov

1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565

Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond

to a collection of information unless such collection displays a valid Office of Management and Budget (OMB)

control number The Department notes that a Federal agency cannot conduct or sponsor a collection of

information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and

the public is not required to respond to a collection of information unless it displays a currently valid OMB control

number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to

penalty for failing to comply with a collection of information if the collection of information does not display a

currently valid OMB control number See 44 USC 3512

The public reporting burden for this collection of information is estimated to average approximately seven minutes

per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other

aspect of this collection of information including suggestions for reducing this burden to the US Department of

Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance

Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and

reference the OMB Control Number 1210-0137 OMB Control Number 1210-0137 (expires 12312019)

Notes

30

Notes

31

Prepared by

Please contact Reston Associationrsquos Human Resources Department at 703-435-7990 or hrrestonorg with any

questions related to your Total Rewards Guide

copy 2019 McGriff Insurance Services Inc

Page 19: Employee Total Rewards Guide 2020 - Reston Total Rewards Gui… · Recognizing and rewarding employees for achieving a sustainable impact. Award criteria includes: •Progressive

401(k) Retirement Savings Plan

Reston Association offers two 401(k) retirement savings plans through Ascensusmdasha traditional 401(k) plan in which employee contributions are made pre-tax and a 401(k) Roth in which employee contributions are made after tax RA matches employee contributions dollar for dollar up to a total of 7 of your annual salary You can begin making contributions to the 401(k) plan and become eligible for RArsquos match following six months of service You always own 100 of your salary contributions

It is possible to borrow against a portion of your vested 401(k) account balance by taking a 401(k) loan You may request a participant loan using an application form which can be obtained by contacting Human Resources Your ability to obtain a 401(k) loan will depend on specific qualifying factors (defined in the 401(k) Summary Plan Description document) The 401(k) Plan Administrator will determine whether you satisfy these factors To access your 401(k) plan online httpsmyaccountascensuscomrplink Check account balance and rate of return Change fund elections Request a 401k loan View fund pricing and performance View and print quarterly statements

19

529 College Savings Plan (employer-sponsored)

A 529 college savings plan provides those saving for college with an unmatched combination of benefits You can open a 529 plan for anyone mdash your child grandchild spouse a friend or even yourself Assets in a 529 plan can be used to pay for a variety of higher education expenses including required books tuition room and board supplies and certain other required fees and expenses Earnings in 529 accounts can grow free from federal tax Withdrawals for qualified higher education expenses are free from federal tax Option to set up recurring automatic fund transfers directly from your bank account making it easy for you to invest The account owner rather than the beneficiary maintains control of account assets and determines the timing and amount of distributions Account owners can change beneficiaries without penalty provided the new beneficiary is a member of the previous beneficiaryrsquos family For more information please contact Human Resources

Additional Benefits

Free passes for employees and their dependents to all of RArsquos pools and tennis courts as well as discounted rates for all RA Programs and Camps Some restrictions may apply

Discounted gym membership rates at the Reston YMCA and Crunch Fitness Bike Share Program - Reston Association makes bicycles and helmets available to employees to rent on a daily

basis Please contact Member Services Discounted Tennis Rackets amp Shoes ndash Employees can purchase certain tennis shoes and rackets at wholesale

prices through RArsquos Tennis Department Contact the Tennis Department for more information Discounted autohome insurance - Liberty Mutual Insurance Company partners with RA to offer all employees

discounts on automobile and homeowner insurance Contact John Valenti at JohnValentilibertymutualcom

20

Reston Association provides generous paid time off benefits to accommodate the diverse needs of staff and to provide a positive worklife balance The amount of paid time off you earn per year is based on your years of service In addition Reston Association observes 9 paid holidays and assigns one paid floating holiday per year For more information on paid time off benefits and how to request time off please refer to the Reston Association Employee Handbook

WorkLife Balance ndash Paid Time Off (PTO)

Teleworking

The medical leave bank is available to help employees in extenuating circumstances protect their incomes by receiving paid leave once their personal PTO is used up A maximum of six (6) workweeks may be granted for each Medical Leave Bank request If additional time is necessary a new request must be made For program eligibility and criteria go to CommonHumResBenefits

Medical Leave Bank

Volunteer Release Time

On a per position basis employees may be allowed to telework for part of their workweek or in certain circumstances Such arrangements must be in compliance with the written administrative procedure including being approved in advance by the department director

Employees are encouraged to become involved in their communities lending their voluntary support to programs that enrich the quality of life and opportunities for all citizens This benefit allows employees to take paid-time off during a work day to participate in a volunteer activity that benefits the community at large Such activities are typically sponsored by a charitable or service organization or work with one or more individuals in need of assistance or special service

21

Training amp Career Development

Reston Association offers two types of learning opportunities for employees mdashinformal and formalmdashto foster individual development and training and career planning

I Informal Learning Opportunities (individual development amp training)

Focus on individual acquiring or enhancing specific task andor process skills to perform his or her current job better Typically this type of learning is not ldquodegree- orientedrdquo

Participants may or may not receive attendance or achievement certificate

Conferences workshops seminars webinars online courses etc typically lasting a few hours to one week

Requests for this type of training should be made to your supervisor or department head

II Formal Learning Opportunities (career planning)

Professional DevelopmentCareer Planning

Formalstructured learning geared toward improving and maintaining professional competence enhancing career progression staying abreast of new technologies and best practices developing process skills andor compliance with professional regulations

Future but not degree-oriented CEUs may be earned

May lead to qualification or credential required to obtain or retain specific certification

Opportunity may range from semester-long academic course to 24 month program with wide range of content and learning experience

Tuition Reimbursement Program

Supports formal education goals (AA bachelors masters) of individual to enhance knowledge and skills in specific areaindustry

Learning must be job-related and accomplished at or through accredited learning institution or e-learning platform connected with the institution

Requests for this type of training should be made to Human Resources as soon as foreseeable to ensure best availability of funds to support reimbursement

22

23

Lifetime limit not applicable and enrollment opportunity The lifetime limit on the dollar value of benefits under our medical plan no longer applies Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan Individuals have 30 days from the date of this notice to request enrollment For more information contact Human Resources or call the medical insurance carrier at the telephone number on your identification card

Notice on Patient Protections The medical HMO plan generally allows the designation of a primary care provider You have the right to designate any primary care provider who participates in the network and who is available to accept you or your family members Until you make this designation the medical carrier designates one for you For information on how to select a primary care provider and for a list of the participating primary care providers contact the medical insurance carrier at the number listed on your identification card

For children you may designate a pediatrician as the primary care provider You do not need prior authorization from the medical insurance carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in the network who specializes in obstetrics or gynecology The health care professional however may be required to comply with certain procedures including obtaining prior authorization for certain services following a pre-approved treatment plan or procedures for making referrals For a list of participating health care professionals who specialize in obstetrics or gynecology contact the medical insurance carrier at the number listed on your identification card

OTC Drug Reimbursements for FSAsHRAsHSAs Under the new Health Care Reform law (PPACA) the cost of an over-the-counter medicine or drug cannot be reimbursed from the account unless a prescription is obtained The change does not affect insulin even if purchased without a prescription or other health care expenses such as medical devices eyeglasses contact lenses co-pays and deductibles The new standard applies only to purchases made on or after January 1 2011

A similar rule is in effect for Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs)

The IRS has also posted a questions and answers section on its website httpwwwirsgovnewsroomarticle0id=22730800html concerning these provisions

Patient Protection and Affordable Care Act (PPACA) Mandatory Notices

The text below is an annual open enrollment required notice

24

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION PLEASE REVIEW IT CAREFULLY

Our Pledge to You

This notice is intended to inform you of the privacy practices followed by the Reston Associationrsquos Employee Benefit Plan (the Plan) and the Planrsquos legal obligations regarding your protected health information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) The notice also explains the privacy rights you and your family members have as participants of the Plan It is effective on April 14 2011

The Plan often needs access to your protected health information in order to provide payment for health services and perform plan administrative functions We want to assure the plan participants covered under the Plan that we comply with federal privacy laws and respect your right to privacy Reston Association requires all members of our workforce and third parties that are provided access to protected health information to comply with the privacy practices outlined in this notice

Protected Health Information Your protected health information is protected by the HIPAA Privacy Rule Generally protected health information is information that identifies an individual created or received by a health care provider health plan or an employer on behalf of a group health plan that relates to physical or mental health conditions provision of health care or payment for health care whether past present or future

How We May Use Your Protected Health Information Under the HIPAA Privacy Rule we may use or disclose your protected health information for certain purposes without your permission This section describes the ways we can use and disclose your protected health information

bull Payment We use or disclose your protected health information without your written authorization in order to determine eligibility for benefits seek reimbursement from a third party or coordinate benefits with another health plan under which you are covered For example a health care provider that provided treatment to you will provide us with your health information We use that information in order to determine whether those services are eligible for payment under our group health plan

bull Health Care Operations We use and disclose your protected health information in order to perform plan administration functions such as quality assurance activities resolution of internal grievances and evaluating plan performance For example we review claims experience in order to understand participant utilization and to make plan design changes that are intended to control health care costs

bull Treatment Although the law allows use and disclosure of your protected health information for purposes of treatment as a health plan we generally do not need to disclose your information for treatment purposes Your physician or health care provider is required to provide you with an explanation of how they use and share your health information for purposes of treatment payment and health care operations

bull As permitted or required by law We may also use or disclose your protected health information without your written authorization for other reasons as permitted by law We are permitted by law to share information subject to certain requirements in order to communicate information on health-related benefits or services that may be of interest to you respond to a court order or provide information to further public health activities (eg preventing the spread of disease) without your written authorization We are also permitted to share protected health information during a corporate restructuring such as a merger sale or acquisition We will also disclose health information about you when required by law for example in order to prevent serious harm to you or others

The text below is an annual open enrollment required notice

25

Notice of Privacy Practices

bull Pursuant to your Authorization When required by law we will ask for your written authorization before using or disclosing your protected health information If you choose to sign an authorization to disclose information you can later revoke that authorization to prevent any future uses or disclosures

bull To Business Associates We may enter into contracts with entities known as Business Associates that provide services to or perform functions on behalf of the Plan We may disclose protected health information to Business Associates once they have agreed in writing to safeguard the protected health information For example we may disclose your protected health information to a Business Associate to administer claims Business Associates are also required by law to protect protected health information

bull To the Plan Sponsor We may disclose protected health information to certain employees of Reston Association for the purpose of administering the Plan These employees will use or disclose the protected health information only as necessary to perform plan administration functions or as otherwise required by HIPAA unless you have authorized additional disclosures Your protected health information cannot be used for employment purposes without your specific authorization

Your Rights bull Right to Inspect and Copy In most cases you have the right to inspect and copy the protected health

information we maintain about you If you request copies we will charge you a reasonable fee to cover the costs of copying mailing or other expenses associated with your request Your request to inspect or review your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to inspect and copy your health information To the extent your information is held in an electronic health record you may be able to receive the information in an electronic format

bull Right to Amend If you believe that information within your records is incorrect or if important information is missing you have the right to request that we correct the existing information or add the missing information Your request to amend your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to amend your health information If we deny your request you may file a statement of disagreement with us for inclusion in any future disclosures of the disputed information

bull Right to an Accounting of Disclosures You have the right to receive an accounting of certain disclosures of your protected health information The accounting will not include disclosures that were made (1) for purposes of treatment payment or health care operations (2) to you (3) pursuant to your authorization (4) to your friends or family in your presence or because of an emergency (5) for national security purposes or (6) incidental to otherwise permissible disclosures

Your request to for an accounting must be submitted in writing to the person listed below You may request an accounting of disclosures made within the last six years You may request one accounting free of charge within a 12-month period

The text below is an annual open enrollment required notice

25

26

The information provided herein is intended to be a summary of benefits only and in no way supersedes the actual plan documents provided by the insurance carriersadministrators For more detailed information pertaining to your employee benefit plans including limitations and exclusions

please refer to the plan documents andor evidence of coverage provided by the carriersadministrators

Womenrsquos Health and Cancer Rights Act of 1998

If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos Health and Cancer Rights Act of 1998 (WHCRA) For individuals receiving mastectomy-related benefits coverage will be provided in a manner determined in consultation with the attending physician and the patient for

bull All stages of reconstruction of the breast on which the mastectomy was performed bull Surgery and reconstruction of the other breast to produce a symmetrical appearance bull Prostheses and bull Treatment of physical complications of the mastectomy including lymphedema

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan If you would like more information on WHCRA benefits call your plan administrator

CHIP-Childrens Health Insurance Program (CHIP) Reauthorization Act of 2009

Medicaid and the Childrenrsquos Health Insurance Program (CHIP) offer free or low-cost health coverage to children and families If you are eligible for health coverage from your employer but are unable to afford the premiums some States have premium assistance programs that can help pay for coverage These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage but need assistance in paying their health premiums

If you or your dependents are already enrolled in Medicaid or CHIP you can contact your state Medicaid or CHIP office to find out if premium assistance is available For a list of the contacts in each State go to wwwdolgovebsachipmodelnoticedoc

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify you can then contact the State to find out if it has a program that might help you pay the premiums for an employer-sponsored plan

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP your employerrsquos health plan is required to permit you and your dependents to enroll in the plan ndash as long as you and your dependents are eligible but not already enrolled in the employerrsquos plan This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance

The text below is an annual open enrollment required notice

26

27

Premium Assistance Under Medicaid and the

Childrenrsquos Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your

employer your state may have a premium assistance program that can help pay for coverage using funds

from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot

be eligible for these premium assistance programs but you may be able to buy individual insurance coverage

through the Health Insurance Marketplace For more information visit wwwhealthcaregov

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below

contact your State Medicaid or CHIP office to find out if premium assistance is available

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your

dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-

877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a

program that might help you pay the premiums for an employer-sponsored plan

If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible

under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already

enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days

of being determined eligible for premium assistance If you have questions about enrolling in your

employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)

If you live in one of the following states you may be eligible for assistance paying your employer

health plan premiums The following list of states is current as of July 31 2019 Contact your State for

more information on eligibility ndash

ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcom

Phone 1-855-692-5447

Website httpflmedicaidtplrecoverycomhipp

Phone 1-877-357-3268

ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program

Website httpmyakhippcom

Phone 1-866-251-4861

Email CustomerServiceMyAKHIPPcom

Medicaid Eligibility

httpdhssalaskagovdpaPagesmedicaiddefaultaspx

Website httpsmedicaidgeorgiagovhealth-

insurance-premium-payment-program-hipp

Phone 678-564-1162 ext 2131

ARKANSAS ndash Medicaid INDIANA ndash Medicaid

Website httpmyarhippcom

Phone 1-855-MyARHIPP (855-692-7447)

Healthy Indiana Plan for low-income adults 19-64

Website httpwwwingovfssahip

Phone 1-877-438-4479

All other Medicaid

Website httpwwwindianamedicaidcom

Phone 1-800-403-0864

COLORADO ndash Health First Colorado

(Coloradorsquos Medicaid Program) amp Child Health

Plan Plus (CHP+)

IOWA ndash Medicaid

Health First Colorado Website

httpswwwhealthfirstcoloradocom

Health First Colorado Member Contact Center

1-800-221-3943 State Relay 711

CHP+ httpswwwcoloradogovpacifichcpfchild-health-

plan-plus

CHP+ Customer Service 1-800-359-1991 State Relay

711

Website

httpdhsiowagovHawki

Phone 1-800-257-8563

28

KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid

Website httpwwwkdheksgovhcf

Phone 1-785-296-3512

Website httpswwwdhhsnhgovoiihipphtm

Phone 603-271-5218

Toll free number for the HIPP program 1-800-852-3345 ext 5218

KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP

Website httpschfskygov

Phone 1-800-635-2570

Medicaid Website

httpwwwstatenjushumanservices

dmahsclientsmedicaid

Medicaid Phone 609-631-2392

CHIP Website httpwwwnjfamilycareorgindexhtml

CHIP Phone 1-800-701-0710

LOUISIANA ndash Medicaid NEW YORK ndash Medicaid

Website httpdhhlouisianagovindexcfmsubhome1n331

Phone 1-888-695-2447

Website httpswwwhealthnygovhealth_caremedicaid

Phone 1-800-541-2831

MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid

Website httpwwwmainegovdhhsofipublic-assistanceindexhtml

Phone 1-800-442-6003

TTY Maine relay 711

Website httpsmedicaidncdhhsgov

Phone 919-855-4100

MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid

Website httpwwwmassgoveohhsgovdepartmentsmasshealth

Phone 1-800-862-4840

Website httpwwwndgovdhsservicesmedicalservmedicaid

Phone 1-844-854-4825

MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP

Website

httpsmngovdhspeople-we-serveseniorshealth-carehealth-care-

programsprograms-and-servicesother-insurancejsp

Phone 1-800-657-3739

Website httpwwwinsureoklahomaorg

Phone 1-888-365-3742

MISSOURI ndash Medicaid OREGON ndash Medicaid

Website httpwwwdssmogovmhdparticipantspageshipphtm

Phone 573-751-2005

Website httphealthcareoregongovPagesindexaspx

httpwwworegonhealthcaregovindex-eshtml

Phone 1-800-699-9075

MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid

Website httpdphhsmtgovMontanaHealthcareProgramsHIPP

Phone 1-800-694-3084

Website

httpwwwdhspagovprovidermedicalassistancehealthinsuranc

epremiumpaymenthippprogramindexhtm

Phone 1-800-692-7462

NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP

Website httpwwwACCESSNebraskanegov

Phone (855) 632-7633

Lincoln (402) 473-7000

Omaha (402) 595-1178

Website httpwwweohhsrigov

Phone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)

29

NEVADA ndash Medicaid SOUTH CAROLINA ndash Medicaid

Medicaid Website httpsdhcfpnvgov

Medicaid Phone 1-800-992-0900

Website httpswwwscdhhsgov

Phone 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid

Website httpdsssdgov

Phone 1-888-828-0059

Website httpswwwhcawagov

Phone 1-800-562-3022 ext 15473

TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascom

Phone 1-800-440-0493

Website httpmywvhippcom

Toll-free phone 1-855-MyWVHIPP (1-855-699-8447)

UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgov

CHIP Website httphealthutahgovchip

Phone 1-877-543-7669

Website

httpswwwdhswisconsingovpublicationsp1p10095p

df

Phone 1-800-362-3002

VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorg

Phone 1-800-250-8427

Website httpswyequalitycareacs-inccom

Phone 307-777-7531

VIRGINIA ndash Medicaid and CHIP Medicaid Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

Medicaid Phone 1-800-432-5924

CHIP Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

CHIP Phone 1-855-242-8282

To see if any other states have added a premium assistance program since July 31 2019 or for more

information on special enrollment rights contact either

US Department of Labor US Department of Health and Human Services

Employee Benefits Security Administration Centers for Medicare amp Medicaid Services

wwwdolgovagenciesebsa wwwcmshhsgov

1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565

Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond

to a collection of information unless such collection displays a valid Office of Management and Budget (OMB)

control number The Department notes that a Federal agency cannot conduct or sponsor a collection of

information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and

the public is not required to respond to a collection of information unless it displays a currently valid OMB control

number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to

penalty for failing to comply with a collection of information if the collection of information does not display a

currently valid OMB control number See 44 USC 3512

The public reporting burden for this collection of information is estimated to average approximately seven minutes

per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other

aspect of this collection of information including suggestions for reducing this burden to the US Department of

Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance

Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and

reference the OMB Control Number 1210-0137 OMB Control Number 1210-0137 (expires 12312019)

Notes

30

Notes

31

Prepared by

Please contact Reston Associationrsquos Human Resources Department at 703-435-7990 or hrrestonorg with any

questions related to your Total Rewards Guide

copy 2019 McGriff Insurance Services Inc

Page 20: Employee Total Rewards Guide 2020 - Reston Total Rewards Gui… · Recognizing and rewarding employees for achieving a sustainable impact. Award criteria includes: •Progressive

529 College Savings Plan (employer-sponsored)

A 529 college savings plan provides those saving for college with an unmatched combination of benefits You can open a 529 plan for anyone mdash your child grandchild spouse a friend or even yourself Assets in a 529 plan can be used to pay for a variety of higher education expenses including required books tuition room and board supplies and certain other required fees and expenses Earnings in 529 accounts can grow free from federal tax Withdrawals for qualified higher education expenses are free from federal tax Option to set up recurring automatic fund transfers directly from your bank account making it easy for you to invest The account owner rather than the beneficiary maintains control of account assets and determines the timing and amount of distributions Account owners can change beneficiaries without penalty provided the new beneficiary is a member of the previous beneficiaryrsquos family For more information please contact Human Resources

Additional Benefits

Free passes for employees and their dependents to all of RArsquos pools and tennis courts as well as discounted rates for all RA Programs and Camps Some restrictions may apply

Discounted gym membership rates at the Reston YMCA and Crunch Fitness Bike Share Program - Reston Association makes bicycles and helmets available to employees to rent on a daily

basis Please contact Member Services Discounted Tennis Rackets amp Shoes ndash Employees can purchase certain tennis shoes and rackets at wholesale

prices through RArsquos Tennis Department Contact the Tennis Department for more information Discounted autohome insurance - Liberty Mutual Insurance Company partners with RA to offer all employees

discounts on automobile and homeowner insurance Contact John Valenti at JohnValentilibertymutualcom

20

Reston Association provides generous paid time off benefits to accommodate the diverse needs of staff and to provide a positive worklife balance The amount of paid time off you earn per year is based on your years of service In addition Reston Association observes 9 paid holidays and assigns one paid floating holiday per year For more information on paid time off benefits and how to request time off please refer to the Reston Association Employee Handbook

WorkLife Balance ndash Paid Time Off (PTO)

Teleworking

The medical leave bank is available to help employees in extenuating circumstances protect their incomes by receiving paid leave once their personal PTO is used up A maximum of six (6) workweeks may be granted for each Medical Leave Bank request If additional time is necessary a new request must be made For program eligibility and criteria go to CommonHumResBenefits

Medical Leave Bank

Volunteer Release Time

On a per position basis employees may be allowed to telework for part of their workweek or in certain circumstances Such arrangements must be in compliance with the written administrative procedure including being approved in advance by the department director

Employees are encouraged to become involved in their communities lending their voluntary support to programs that enrich the quality of life and opportunities for all citizens This benefit allows employees to take paid-time off during a work day to participate in a volunteer activity that benefits the community at large Such activities are typically sponsored by a charitable or service organization or work with one or more individuals in need of assistance or special service

21

Training amp Career Development

Reston Association offers two types of learning opportunities for employees mdashinformal and formalmdashto foster individual development and training and career planning

I Informal Learning Opportunities (individual development amp training)

Focus on individual acquiring or enhancing specific task andor process skills to perform his or her current job better Typically this type of learning is not ldquodegree- orientedrdquo

Participants may or may not receive attendance or achievement certificate

Conferences workshops seminars webinars online courses etc typically lasting a few hours to one week

Requests for this type of training should be made to your supervisor or department head

II Formal Learning Opportunities (career planning)

Professional DevelopmentCareer Planning

Formalstructured learning geared toward improving and maintaining professional competence enhancing career progression staying abreast of new technologies and best practices developing process skills andor compliance with professional regulations

Future but not degree-oriented CEUs may be earned

May lead to qualification or credential required to obtain or retain specific certification

Opportunity may range from semester-long academic course to 24 month program with wide range of content and learning experience

Tuition Reimbursement Program

Supports formal education goals (AA bachelors masters) of individual to enhance knowledge and skills in specific areaindustry

Learning must be job-related and accomplished at or through accredited learning institution or e-learning platform connected with the institution

Requests for this type of training should be made to Human Resources as soon as foreseeable to ensure best availability of funds to support reimbursement

22

23

Lifetime limit not applicable and enrollment opportunity The lifetime limit on the dollar value of benefits under our medical plan no longer applies Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan Individuals have 30 days from the date of this notice to request enrollment For more information contact Human Resources or call the medical insurance carrier at the telephone number on your identification card

Notice on Patient Protections The medical HMO plan generally allows the designation of a primary care provider You have the right to designate any primary care provider who participates in the network and who is available to accept you or your family members Until you make this designation the medical carrier designates one for you For information on how to select a primary care provider and for a list of the participating primary care providers contact the medical insurance carrier at the number listed on your identification card

For children you may designate a pediatrician as the primary care provider You do not need prior authorization from the medical insurance carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in the network who specializes in obstetrics or gynecology The health care professional however may be required to comply with certain procedures including obtaining prior authorization for certain services following a pre-approved treatment plan or procedures for making referrals For a list of participating health care professionals who specialize in obstetrics or gynecology contact the medical insurance carrier at the number listed on your identification card

OTC Drug Reimbursements for FSAsHRAsHSAs Under the new Health Care Reform law (PPACA) the cost of an over-the-counter medicine or drug cannot be reimbursed from the account unless a prescription is obtained The change does not affect insulin even if purchased without a prescription or other health care expenses such as medical devices eyeglasses contact lenses co-pays and deductibles The new standard applies only to purchases made on or after January 1 2011

A similar rule is in effect for Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs)

The IRS has also posted a questions and answers section on its website httpwwwirsgovnewsroomarticle0id=22730800html concerning these provisions

Patient Protection and Affordable Care Act (PPACA) Mandatory Notices

The text below is an annual open enrollment required notice

24

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION PLEASE REVIEW IT CAREFULLY

Our Pledge to You

This notice is intended to inform you of the privacy practices followed by the Reston Associationrsquos Employee Benefit Plan (the Plan) and the Planrsquos legal obligations regarding your protected health information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) The notice also explains the privacy rights you and your family members have as participants of the Plan It is effective on April 14 2011

The Plan often needs access to your protected health information in order to provide payment for health services and perform plan administrative functions We want to assure the plan participants covered under the Plan that we comply with federal privacy laws and respect your right to privacy Reston Association requires all members of our workforce and third parties that are provided access to protected health information to comply with the privacy practices outlined in this notice

Protected Health Information Your protected health information is protected by the HIPAA Privacy Rule Generally protected health information is information that identifies an individual created or received by a health care provider health plan or an employer on behalf of a group health plan that relates to physical or mental health conditions provision of health care or payment for health care whether past present or future

How We May Use Your Protected Health Information Under the HIPAA Privacy Rule we may use or disclose your protected health information for certain purposes without your permission This section describes the ways we can use and disclose your protected health information

bull Payment We use or disclose your protected health information without your written authorization in order to determine eligibility for benefits seek reimbursement from a third party or coordinate benefits with another health plan under which you are covered For example a health care provider that provided treatment to you will provide us with your health information We use that information in order to determine whether those services are eligible for payment under our group health plan

bull Health Care Operations We use and disclose your protected health information in order to perform plan administration functions such as quality assurance activities resolution of internal grievances and evaluating plan performance For example we review claims experience in order to understand participant utilization and to make plan design changes that are intended to control health care costs

bull Treatment Although the law allows use and disclosure of your protected health information for purposes of treatment as a health plan we generally do not need to disclose your information for treatment purposes Your physician or health care provider is required to provide you with an explanation of how they use and share your health information for purposes of treatment payment and health care operations

bull As permitted or required by law We may also use or disclose your protected health information without your written authorization for other reasons as permitted by law We are permitted by law to share information subject to certain requirements in order to communicate information on health-related benefits or services that may be of interest to you respond to a court order or provide information to further public health activities (eg preventing the spread of disease) without your written authorization We are also permitted to share protected health information during a corporate restructuring such as a merger sale or acquisition We will also disclose health information about you when required by law for example in order to prevent serious harm to you or others

The text below is an annual open enrollment required notice

25

Notice of Privacy Practices

bull Pursuant to your Authorization When required by law we will ask for your written authorization before using or disclosing your protected health information If you choose to sign an authorization to disclose information you can later revoke that authorization to prevent any future uses or disclosures

bull To Business Associates We may enter into contracts with entities known as Business Associates that provide services to or perform functions on behalf of the Plan We may disclose protected health information to Business Associates once they have agreed in writing to safeguard the protected health information For example we may disclose your protected health information to a Business Associate to administer claims Business Associates are also required by law to protect protected health information

bull To the Plan Sponsor We may disclose protected health information to certain employees of Reston Association for the purpose of administering the Plan These employees will use or disclose the protected health information only as necessary to perform plan administration functions or as otherwise required by HIPAA unless you have authorized additional disclosures Your protected health information cannot be used for employment purposes without your specific authorization

Your Rights bull Right to Inspect and Copy In most cases you have the right to inspect and copy the protected health

information we maintain about you If you request copies we will charge you a reasonable fee to cover the costs of copying mailing or other expenses associated with your request Your request to inspect or review your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to inspect and copy your health information To the extent your information is held in an electronic health record you may be able to receive the information in an electronic format

bull Right to Amend If you believe that information within your records is incorrect or if important information is missing you have the right to request that we correct the existing information or add the missing information Your request to amend your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to amend your health information If we deny your request you may file a statement of disagreement with us for inclusion in any future disclosures of the disputed information

bull Right to an Accounting of Disclosures You have the right to receive an accounting of certain disclosures of your protected health information The accounting will not include disclosures that were made (1) for purposes of treatment payment or health care operations (2) to you (3) pursuant to your authorization (4) to your friends or family in your presence or because of an emergency (5) for national security purposes or (6) incidental to otherwise permissible disclosures

Your request to for an accounting must be submitted in writing to the person listed below You may request an accounting of disclosures made within the last six years You may request one accounting free of charge within a 12-month period

The text below is an annual open enrollment required notice

25

26

The information provided herein is intended to be a summary of benefits only and in no way supersedes the actual plan documents provided by the insurance carriersadministrators For more detailed information pertaining to your employee benefit plans including limitations and exclusions

please refer to the plan documents andor evidence of coverage provided by the carriersadministrators

Womenrsquos Health and Cancer Rights Act of 1998

If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos Health and Cancer Rights Act of 1998 (WHCRA) For individuals receiving mastectomy-related benefits coverage will be provided in a manner determined in consultation with the attending physician and the patient for

bull All stages of reconstruction of the breast on which the mastectomy was performed bull Surgery and reconstruction of the other breast to produce a symmetrical appearance bull Prostheses and bull Treatment of physical complications of the mastectomy including lymphedema

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan If you would like more information on WHCRA benefits call your plan administrator

CHIP-Childrens Health Insurance Program (CHIP) Reauthorization Act of 2009

Medicaid and the Childrenrsquos Health Insurance Program (CHIP) offer free or low-cost health coverage to children and families If you are eligible for health coverage from your employer but are unable to afford the premiums some States have premium assistance programs that can help pay for coverage These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage but need assistance in paying their health premiums

If you or your dependents are already enrolled in Medicaid or CHIP you can contact your state Medicaid or CHIP office to find out if premium assistance is available For a list of the contacts in each State go to wwwdolgovebsachipmodelnoticedoc

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify you can then contact the State to find out if it has a program that might help you pay the premiums for an employer-sponsored plan

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP your employerrsquos health plan is required to permit you and your dependents to enroll in the plan ndash as long as you and your dependents are eligible but not already enrolled in the employerrsquos plan This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance

The text below is an annual open enrollment required notice

26

27

Premium Assistance Under Medicaid and the

Childrenrsquos Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your

employer your state may have a premium assistance program that can help pay for coverage using funds

from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot

be eligible for these premium assistance programs but you may be able to buy individual insurance coverage

through the Health Insurance Marketplace For more information visit wwwhealthcaregov

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below

contact your State Medicaid or CHIP office to find out if premium assistance is available

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your

dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-

877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a

program that might help you pay the premiums for an employer-sponsored plan

If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible

under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already

enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days

of being determined eligible for premium assistance If you have questions about enrolling in your

employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)

If you live in one of the following states you may be eligible for assistance paying your employer

health plan premiums The following list of states is current as of July 31 2019 Contact your State for

more information on eligibility ndash

ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcom

Phone 1-855-692-5447

Website httpflmedicaidtplrecoverycomhipp

Phone 1-877-357-3268

ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program

Website httpmyakhippcom

Phone 1-866-251-4861

Email CustomerServiceMyAKHIPPcom

Medicaid Eligibility

httpdhssalaskagovdpaPagesmedicaiddefaultaspx

Website httpsmedicaidgeorgiagovhealth-

insurance-premium-payment-program-hipp

Phone 678-564-1162 ext 2131

ARKANSAS ndash Medicaid INDIANA ndash Medicaid

Website httpmyarhippcom

Phone 1-855-MyARHIPP (855-692-7447)

Healthy Indiana Plan for low-income adults 19-64

Website httpwwwingovfssahip

Phone 1-877-438-4479

All other Medicaid

Website httpwwwindianamedicaidcom

Phone 1-800-403-0864

COLORADO ndash Health First Colorado

(Coloradorsquos Medicaid Program) amp Child Health

Plan Plus (CHP+)

IOWA ndash Medicaid

Health First Colorado Website

httpswwwhealthfirstcoloradocom

Health First Colorado Member Contact Center

1-800-221-3943 State Relay 711

CHP+ httpswwwcoloradogovpacifichcpfchild-health-

plan-plus

CHP+ Customer Service 1-800-359-1991 State Relay

711

Website

httpdhsiowagovHawki

Phone 1-800-257-8563

28

KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid

Website httpwwwkdheksgovhcf

Phone 1-785-296-3512

Website httpswwwdhhsnhgovoiihipphtm

Phone 603-271-5218

Toll free number for the HIPP program 1-800-852-3345 ext 5218

KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP

Website httpschfskygov

Phone 1-800-635-2570

Medicaid Website

httpwwwstatenjushumanservices

dmahsclientsmedicaid

Medicaid Phone 609-631-2392

CHIP Website httpwwwnjfamilycareorgindexhtml

CHIP Phone 1-800-701-0710

LOUISIANA ndash Medicaid NEW YORK ndash Medicaid

Website httpdhhlouisianagovindexcfmsubhome1n331

Phone 1-888-695-2447

Website httpswwwhealthnygovhealth_caremedicaid

Phone 1-800-541-2831

MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid

Website httpwwwmainegovdhhsofipublic-assistanceindexhtml

Phone 1-800-442-6003

TTY Maine relay 711

Website httpsmedicaidncdhhsgov

Phone 919-855-4100

MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid

Website httpwwwmassgoveohhsgovdepartmentsmasshealth

Phone 1-800-862-4840

Website httpwwwndgovdhsservicesmedicalservmedicaid

Phone 1-844-854-4825

MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP

Website

httpsmngovdhspeople-we-serveseniorshealth-carehealth-care-

programsprograms-and-servicesother-insurancejsp

Phone 1-800-657-3739

Website httpwwwinsureoklahomaorg

Phone 1-888-365-3742

MISSOURI ndash Medicaid OREGON ndash Medicaid

Website httpwwwdssmogovmhdparticipantspageshipphtm

Phone 573-751-2005

Website httphealthcareoregongovPagesindexaspx

httpwwworegonhealthcaregovindex-eshtml

Phone 1-800-699-9075

MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid

Website httpdphhsmtgovMontanaHealthcareProgramsHIPP

Phone 1-800-694-3084

Website

httpwwwdhspagovprovidermedicalassistancehealthinsuranc

epremiumpaymenthippprogramindexhtm

Phone 1-800-692-7462

NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP

Website httpwwwACCESSNebraskanegov

Phone (855) 632-7633

Lincoln (402) 473-7000

Omaha (402) 595-1178

Website httpwwweohhsrigov

Phone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)

29

NEVADA ndash Medicaid SOUTH CAROLINA ndash Medicaid

Medicaid Website httpsdhcfpnvgov

Medicaid Phone 1-800-992-0900

Website httpswwwscdhhsgov

Phone 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid

Website httpdsssdgov

Phone 1-888-828-0059

Website httpswwwhcawagov

Phone 1-800-562-3022 ext 15473

TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascom

Phone 1-800-440-0493

Website httpmywvhippcom

Toll-free phone 1-855-MyWVHIPP (1-855-699-8447)

UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgov

CHIP Website httphealthutahgovchip

Phone 1-877-543-7669

Website

httpswwwdhswisconsingovpublicationsp1p10095p

df

Phone 1-800-362-3002

VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorg

Phone 1-800-250-8427

Website httpswyequalitycareacs-inccom

Phone 307-777-7531

VIRGINIA ndash Medicaid and CHIP Medicaid Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

Medicaid Phone 1-800-432-5924

CHIP Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

CHIP Phone 1-855-242-8282

To see if any other states have added a premium assistance program since July 31 2019 or for more

information on special enrollment rights contact either

US Department of Labor US Department of Health and Human Services

Employee Benefits Security Administration Centers for Medicare amp Medicaid Services

wwwdolgovagenciesebsa wwwcmshhsgov

1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565

Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond

to a collection of information unless such collection displays a valid Office of Management and Budget (OMB)

control number The Department notes that a Federal agency cannot conduct or sponsor a collection of

information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and

the public is not required to respond to a collection of information unless it displays a currently valid OMB control

number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to

penalty for failing to comply with a collection of information if the collection of information does not display a

currently valid OMB control number See 44 USC 3512

The public reporting burden for this collection of information is estimated to average approximately seven minutes

per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other

aspect of this collection of information including suggestions for reducing this burden to the US Department of

Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance

Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and

reference the OMB Control Number 1210-0137 OMB Control Number 1210-0137 (expires 12312019)

Notes

30

Notes

31

Prepared by

Please contact Reston Associationrsquos Human Resources Department at 703-435-7990 or hrrestonorg with any

questions related to your Total Rewards Guide

copy 2019 McGriff Insurance Services Inc

Page 21: Employee Total Rewards Guide 2020 - Reston Total Rewards Gui… · Recognizing and rewarding employees for achieving a sustainable impact. Award criteria includes: •Progressive

Reston Association provides generous paid time off benefits to accommodate the diverse needs of staff and to provide a positive worklife balance The amount of paid time off you earn per year is based on your years of service In addition Reston Association observes 9 paid holidays and assigns one paid floating holiday per year For more information on paid time off benefits and how to request time off please refer to the Reston Association Employee Handbook

WorkLife Balance ndash Paid Time Off (PTO)

Teleworking

The medical leave bank is available to help employees in extenuating circumstances protect their incomes by receiving paid leave once their personal PTO is used up A maximum of six (6) workweeks may be granted for each Medical Leave Bank request If additional time is necessary a new request must be made For program eligibility and criteria go to CommonHumResBenefits

Medical Leave Bank

Volunteer Release Time

On a per position basis employees may be allowed to telework for part of their workweek or in certain circumstances Such arrangements must be in compliance with the written administrative procedure including being approved in advance by the department director

Employees are encouraged to become involved in their communities lending their voluntary support to programs that enrich the quality of life and opportunities for all citizens This benefit allows employees to take paid-time off during a work day to participate in a volunteer activity that benefits the community at large Such activities are typically sponsored by a charitable or service organization or work with one or more individuals in need of assistance or special service

21

Training amp Career Development

Reston Association offers two types of learning opportunities for employees mdashinformal and formalmdashto foster individual development and training and career planning

I Informal Learning Opportunities (individual development amp training)

Focus on individual acquiring or enhancing specific task andor process skills to perform his or her current job better Typically this type of learning is not ldquodegree- orientedrdquo

Participants may or may not receive attendance or achievement certificate

Conferences workshops seminars webinars online courses etc typically lasting a few hours to one week

Requests for this type of training should be made to your supervisor or department head

II Formal Learning Opportunities (career planning)

Professional DevelopmentCareer Planning

Formalstructured learning geared toward improving and maintaining professional competence enhancing career progression staying abreast of new technologies and best practices developing process skills andor compliance with professional regulations

Future but not degree-oriented CEUs may be earned

May lead to qualification or credential required to obtain or retain specific certification

Opportunity may range from semester-long academic course to 24 month program with wide range of content and learning experience

Tuition Reimbursement Program

Supports formal education goals (AA bachelors masters) of individual to enhance knowledge and skills in specific areaindustry

Learning must be job-related and accomplished at or through accredited learning institution or e-learning platform connected with the institution

Requests for this type of training should be made to Human Resources as soon as foreseeable to ensure best availability of funds to support reimbursement

22

23

Lifetime limit not applicable and enrollment opportunity The lifetime limit on the dollar value of benefits under our medical plan no longer applies Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan Individuals have 30 days from the date of this notice to request enrollment For more information contact Human Resources or call the medical insurance carrier at the telephone number on your identification card

Notice on Patient Protections The medical HMO plan generally allows the designation of a primary care provider You have the right to designate any primary care provider who participates in the network and who is available to accept you or your family members Until you make this designation the medical carrier designates one for you For information on how to select a primary care provider and for a list of the participating primary care providers contact the medical insurance carrier at the number listed on your identification card

For children you may designate a pediatrician as the primary care provider You do not need prior authorization from the medical insurance carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in the network who specializes in obstetrics or gynecology The health care professional however may be required to comply with certain procedures including obtaining prior authorization for certain services following a pre-approved treatment plan or procedures for making referrals For a list of participating health care professionals who specialize in obstetrics or gynecology contact the medical insurance carrier at the number listed on your identification card

OTC Drug Reimbursements for FSAsHRAsHSAs Under the new Health Care Reform law (PPACA) the cost of an over-the-counter medicine or drug cannot be reimbursed from the account unless a prescription is obtained The change does not affect insulin even if purchased without a prescription or other health care expenses such as medical devices eyeglasses contact lenses co-pays and deductibles The new standard applies only to purchases made on or after January 1 2011

A similar rule is in effect for Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs)

The IRS has also posted a questions and answers section on its website httpwwwirsgovnewsroomarticle0id=22730800html concerning these provisions

Patient Protection and Affordable Care Act (PPACA) Mandatory Notices

The text below is an annual open enrollment required notice

24

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION PLEASE REVIEW IT CAREFULLY

Our Pledge to You

This notice is intended to inform you of the privacy practices followed by the Reston Associationrsquos Employee Benefit Plan (the Plan) and the Planrsquos legal obligations regarding your protected health information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) The notice also explains the privacy rights you and your family members have as participants of the Plan It is effective on April 14 2011

The Plan often needs access to your protected health information in order to provide payment for health services and perform plan administrative functions We want to assure the plan participants covered under the Plan that we comply with federal privacy laws and respect your right to privacy Reston Association requires all members of our workforce and third parties that are provided access to protected health information to comply with the privacy practices outlined in this notice

Protected Health Information Your protected health information is protected by the HIPAA Privacy Rule Generally protected health information is information that identifies an individual created or received by a health care provider health plan or an employer on behalf of a group health plan that relates to physical or mental health conditions provision of health care or payment for health care whether past present or future

How We May Use Your Protected Health Information Under the HIPAA Privacy Rule we may use or disclose your protected health information for certain purposes without your permission This section describes the ways we can use and disclose your protected health information

bull Payment We use or disclose your protected health information without your written authorization in order to determine eligibility for benefits seek reimbursement from a third party or coordinate benefits with another health plan under which you are covered For example a health care provider that provided treatment to you will provide us with your health information We use that information in order to determine whether those services are eligible for payment under our group health plan

bull Health Care Operations We use and disclose your protected health information in order to perform plan administration functions such as quality assurance activities resolution of internal grievances and evaluating plan performance For example we review claims experience in order to understand participant utilization and to make plan design changes that are intended to control health care costs

bull Treatment Although the law allows use and disclosure of your protected health information for purposes of treatment as a health plan we generally do not need to disclose your information for treatment purposes Your physician or health care provider is required to provide you with an explanation of how they use and share your health information for purposes of treatment payment and health care operations

bull As permitted or required by law We may also use or disclose your protected health information without your written authorization for other reasons as permitted by law We are permitted by law to share information subject to certain requirements in order to communicate information on health-related benefits or services that may be of interest to you respond to a court order or provide information to further public health activities (eg preventing the spread of disease) without your written authorization We are also permitted to share protected health information during a corporate restructuring such as a merger sale or acquisition We will also disclose health information about you when required by law for example in order to prevent serious harm to you or others

The text below is an annual open enrollment required notice

25

Notice of Privacy Practices

bull Pursuant to your Authorization When required by law we will ask for your written authorization before using or disclosing your protected health information If you choose to sign an authorization to disclose information you can later revoke that authorization to prevent any future uses or disclosures

bull To Business Associates We may enter into contracts with entities known as Business Associates that provide services to or perform functions on behalf of the Plan We may disclose protected health information to Business Associates once they have agreed in writing to safeguard the protected health information For example we may disclose your protected health information to a Business Associate to administer claims Business Associates are also required by law to protect protected health information

bull To the Plan Sponsor We may disclose protected health information to certain employees of Reston Association for the purpose of administering the Plan These employees will use or disclose the protected health information only as necessary to perform plan administration functions or as otherwise required by HIPAA unless you have authorized additional disclosures Your protected health information cannot be used for employment purposes without your specific authorization

Your Rights bull Right to Inspect and Copy In most cases you have the right to inspect and copy the protected health

information we maintain about you If you request copies we will charge you a reasonable fee to cover the costs of copying mailing or other expenses associated with your request Your request to inspect or review your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to inspect and copy your health information To the extent your information is held in an electronic health record you may be able to receive the information in an electronic format

bull Right to Amend If you believe that information within your records is incorrect or if important information is missing you have the right to request that we correct the existing information or add the missing information Your request to amend your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to amend your health information If we deny your request you may file a statement of disagreement with us for inclusion in any future disclosures of the disputed information

bull Right to an Accounting of Disclosures You have the right to receive an accounting of certain disclosures of your protected health information The accounting will not include disclosures that were made (1) for purposes of treatment payment or health care operations (2) to you (3) pursuant to your authorization (4) to your friends or family in your presence or because of an emergency (5) for national security purposes or (6) incidental to otherwise permissible disclosures

Your request to for an accounting must be submitted in writing to the person listed below You may request an accounting of disclosures made within the last six years You may request one accounting free of charge within a 12-month period

The text below is an annual open enrollment required notice

25

26

The information provided herein is intended to be a summary of benefits only and in no way supersedes the actual plan documents provided by the insurance carriersadministrators For more detailed information pertaining to your employee benefit plans including limitations and exclusions

please refer to the plan documents andor evidence of coverage provided by the carriersadministrators

Womenrsquos Health and Cancer Rights Act of 1998

If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos Health and Cancer Rights Act of 1998 (WHCRA) For individuals receiving mastectomy-related benefits coverage will be provided in a manner determined in consultation with the attending physician and the patient for

bull All stages of reconstruction of the breast on which the mastectomy was performed bull Surgery and reconstruction of the other breast to produce a symmetrical appearance bull Prostheses and bull Treatment of physical complications of the mastectomy including lymphedema

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan If you would like more information on WHCRA benefits call your plan administrator

CHIP-Childrens Health Insurance Program (CHIP) Reauthorization Act of 2009

Medicaid and the Childrenrsquos Health Insurance Program (CHIP) offer free or low-cost health coverage to children and families If you are eligible for health coverage from your employer but are unable to afford the premiums some States have premium assistance programs that can help pay for coverage These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage but need assistance in paying their health premiums

If you or your dependents are already enrolled in Medicaid or CHIP you can contact your state Medicaid or CHIP office to find out if premium assistance is available For a list of the contacts in each State go to wwwdolgovebsachipmodelnoticedoc

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify you can then contact the State to find out if it has a program that might help you pay the premiums for an employer-sponsored plan

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP your employerrsquos health plan is required to permit you and your dependents to enroll in the plan ndash as long as you and your dependents are eligible but not already enrolled in the employerrsquos plan This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance

The text below is an annual open enrollment required notice

26

27

Premium Assistance Under Medicaid and the

Childrenrsquos Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your

employer your state may have a premium assistance program that can help pay for coverage using funds

from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot

be eligible for these premium assistance programs but you may be able to buy individual insurance coverage

through the Health Insurance Marketplace For more information visit wwwhealthcaregov

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below

contact your State Medicaid or CHIP office to find out if premium assistance is available

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your

dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-

877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a

program that might help you pay the premiums for an employer-sponsored plan

If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible

under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already

enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days

of being determined eligible for premium assistance If you have questions about enrolling in your

employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)

If you live in one of the following states you may be eligible for assistance paying your employer

health plan premiums The following list of states is current as of July 31 2019 Contact your State for

more information on eligibility ndash

ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcom

Phone 1-855-692-5447

Website httpflmedicaidtplrecoverycomhipp

Phone 1-877-357-3268

ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program

Website httpmyakhippcom

Phone 1-866-251-4861

Email CustomerServiceMyAKHIPPcom

Medicaid Eligibility

httpdhssalaskagovdpaPagesmedicaiddefaultaspx

Website httpsmedicaidgeorgiagovhealth-

insurance-premium-payment-program-hipp

Phone 678-564-1162 ext 2131

ARKANSAS ndash Medicaid INDIANA ndash Medicaid

Website httpmyarhippcom

Phone 1-855-MyARHIPP (855-692-7447)

Healthy Indiana Plan for low-income adults 19-64

Website httpwwwingovfssahip

Phone 1-877-438-4479

All other Medicaid

Website httpwwwindianamedicaidcom

Phone 1-800-403-0864

COLORADO ndash Health First Colorado

(Coloradorsquos Medicaid Program) amp Child Health

Plan Plus (CHP+)

IOWA ndash Medicaid

Health First Colorado Website

httpswwwhealthfirstcoloradocom

Health First Colorado Member Contact Center

1-800-221-3943 State Relay 711

CHP+ httpswwwcoloradogovpacifichcpfchild-health-

plan-plus

CHP+ Customer Service 1-800-359-1991 State Relay

711

Website

httpdhsiowagovHawki

Phone 1-800-257-8563

28

KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid

Website httpwwwkdheksgovhcf

Phone 1-785-296-3512

Website httpswwwdhhsnhgovoiihipphtm

Phone 603-271-5218

Toll free number for the HIPP program 1-800-852-3345 ext 5218

KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP

Website httpschfskygov

Phone 1-800-635-2570

Medicaid Website

httpwwwstatenjushumanservices

dmahsclientsmedicaid

Medicaid Phone 609-631-2392

CHIP Website httpwwwnjfamilycareorgindexhtml

CHIP Phone 1-800-701-0710

LOUISIANA ndash Medicaid NEW YORK ndash Medicaid

Website httpdhhlouisianagovindexcfmsubhome1n331

Phone 1-888-695-2447

Website httpswwwhealthnygovhealth_caremedicaid

Phone 1-800-541-2831

MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid

Website httpwwwmainegovdhhsofipublic-assistanceindexhtml

Phone 1-800-442-6003

TTY Maine relay 711

Website httpsmedicaidncdhhsgov

Phone 919-855-4100

MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid

Website httpwwwmassgoveohhsgovdepartmentsmasshealth

Phone 1-800-862-4840

Website httpwwwndgovdhsservicesmedicalservmedicaid

Phone 1-844-854-4825

MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP

Website

httpsmngovdhspeople-we-serveseniorshealth-carehealth-care-

programsprograms-and-servicesother-insurancejsp

Phone 1-800-657-3739

Website httpwwwinsureoklahomaorg

Phone 1-888-365-3742

MISSOURI ndash Medicaid OREGON ndash Medicaid

Website httpwwwdssmogovmhdparticipantspageshipphtm

Phone 573-751-2005

Website httphealthcareoregongovPagesindexaspx

httpwwworegonhealthcaregovindex-eshtml

Phone 1-800-699-9075

MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid

Website httpdphhsmtgovMontanaHealthcareProgramsHIPP

Phone 1-800-694-3084

Website

httpwwwdhspagovprovidermedicalassistancehealthinsuranc

epremiumpaymenthippprogramindexhtm

Phone 1-800-692-7462

NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP

Website httpwwwACCESSNebraskanegov

Phone (855) 632-7633

Lincoln (402) 473-7000

Omaha (402) 595-1178

Website httpwwweohhsrigov

Phone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)

29

NEVADA ndash Medicaid SOUTH CAROLINA ndash Medicaid

Medicaid Website httpsdhcfpnvgov

Medicaid Phone 1-800-992-0900

Website httpswwwscdhhsgov

Phone 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid

Website httpdsssdgov

Phone 1-888-828-0059

Website httpswwwhcawagov

Phone 1-800-562-3022 ext 15473

TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascom

Phone 1-800-440-0493

Website httpmywvhippcom

Toll-free phone 1-855-MyWVHIPP (1-855-699-8447)

UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgov

CHIP Website httphealthutahgovchip

Phone 1-877-543-7669

Website

httpswwwdhswisconsingovpublicationsp1p10095p

df

Phone 1-800-362-3002

VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorg

Phone 1-800-250-8427

Website httpswyequalitycareacs-inccom

Phone 307-777-7531

VIRGINIA ndash Medicaid and CHIP Medicaid Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

Medicaid Phone 1-800-432-5924

CHIP Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

CHIP Phone 1-855-242-8282

To see if any other states have added a premium assistance program since July 31 2019 or for more

information on special enrollment rights contact either

US Department of Labor US Department of Health and Human Services

Employee Benefits Security Administration Centers for Medicare amp Medicaid Services

wwwdolgovagenciesebsa wwwcmshhsgov

1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565

Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond

to a collection of information unless such collection displays a valid Office of Management and Budget (OMB)

control number The Department notes that a Federal agency cannot conduct or sponsor a collection of

information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and

the public is not required to respond to a collection of information unless it displays a currently valid OMB control

number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to

penalty for failing to comply with a collection of information if the collection of information does not display a

currently valid OMB control number See 44 USC 3512

The public reporting burden for this collection of information is estimated to average approximately seven minutes

per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other

aspect of this collection of information including suggestions for reducing this burden to the US Department of

Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance

Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and

reference the OMB Control Number 1210-0137 OMB Control Number 1210-0137 (expires 12312019)

Notes

30

Notes

31

Prepared by

Please contact Reston Associationrsquos Human Resources Department at 703-435-7990 or hrrestonorg with any

questions related to your Total Rewards Guide

copy 2019 McGriff Insurance Services Inc

Page 22: Employee Total Rewards Guide 2020 - Reston Total Rewards Gui… · Recognizing and rewarding employees for achieving a sustainable impact. Award criteria includes: •Progressive

Training amp Career Development

Reston Association offers two types of learning opportunities for employees mdashinformal and formalmdashto foster individual development and training and career planning

I Informal Learning Opportunities (individual development amp training)

Focus on individual acquiring or enhancing specific task andor process skills to perform his or her current job better Typically this type of learning is not ldquodegree- orientedrdquo

Participants may or may not receive attendance or achievement certificate

Conferences workshops seminars webinars online courses etc typically lasting a few hours to one week

Requests for this type of training should be made to your supervisor or department head

II Formal Learning Opportunities (career planning)

Professional DevelopmentCareer Planning

Formalstructured learning geared toward improving and maintaining professional competence enhancing career progression staying abreast of new technologies and best practices developing process skills andor compliance with professional regulations

Future but not degree-oriented CEUs may be earned

May lead to qualification or credential required to obtain or retain specific certification

Opportunity may range from semester-long academic course to 24 month program with wide range of content and learning experience

Tuition Reimbursement Program

Supports formal education goals (AA bachelors masters) of individual to enhance knowledge and skills in specific areaindustry

Learning must be job-related and accomplished at or through accredited learning institution or e-learning platform connected with the institution

Requests for this type of training should be made to Human Resources as soon as foreseeable to ensure best availability of funds to support reimbursement

22

23

Lifetime limit not applicable and enrollment opportunity The lifetime limit on the dollar value of benefits under our medical plan no longer applies Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan Individuals have 30 days from the date of this notice to request enrollment For more information contact Human Resources or call the medical insurance carrier at the telephone number on your identification card

Notice on Patient Protections The medical HMO plan generally allows the designation of a primary care provider You have the right to designate any primary care provider who participates in the network and who is available to accept you or your family members Until you make this designation the medical carrier designates one for you For information on how to select a primary care provider and for a list of the participating primary care providers contact the medical insurance carrier at the number listed on your identification card

For children you may designate a pediatrician as the primary care provider You do not need prior authorization from the medical insurance carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in the network who specializes in obstetrics or gynecology The health care professional however may be required to comply with certain procedures including obtaining prior authorization for certain services following a pre-approved treatment plan or procedures for making referrals For a list of participating health care professionals who specialize in obstetrics or gynecology contact the medical insurance carrier at the number listed on your identification card

OTC Drug Reimbursements for FSAsHRAsHSAs Under the new Health Care Reform law (PPACA) the cost of an over-the-counter medicine or drug cannot be reimbursed from the account unless a prescription is obtained The change does not affect insulin even if purchased without a prescription or other health care expenses such as medical devices eyeglasses contact lenses co-pays and deductibles The new standard applies only to purchases made on or after January 1 2011

A similar rule is in effect for Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs)

The IRS has also posted a questions and answers section on its website httpwwwirsgovnewsroomarticle0id=22730800html concerning these provisions

Patient Protection and Affordable Care Act (PPACA) Mandatory Notices

The text below is an annual open enrollment required notice

24

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION PLEASE REVIEW IT CAREFULLY

Our Pledge to You

This notice is intended to inform you of the privacy practices followed by the Reston Associationrsquos Employee Benefit Plan (the Plan) and the Planrsquos legal obligations regarding your protected health information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) The notice also explains the privacy rights you and your family members have as participants of the Plan It is effective on April 14 2011

The Plan often needs access to your protected health information in order to provide payment for health services and perform plan administrative functions We want to assure the plan participants covered under the Plan that we comply with federal privacy laws and respect your right to privacy Reston Association requires all members of our workforce and third parties that are provided access to protected health information to comply with the privacy practices outlined in this notice

Protected Health Information Your protected health information is protected by the HIPAA Privacy Rule Generally protected health information is information that identifies an individual created or received by a health care provider health plan or an employer on behalf of a group health plan that relates to physical or mental health conditions provision of health care or payment for health care whether past present or future

How We May Use Your Protected Health Information Under the HIPAA Privacy Rule we may use or disclose your protected health information for certain purposes without your permission This section describes the ways we can use and disclose your protected health information

bull Payment We use or disclose your protected health information without your written authorization in order to determine eligibility for benefits seek reimbursement from a third party or coordinate benefits with another health plan under which you are covered For example a health care provider that provided treatment to you will provide us with your health information We use that information in order to determine whether those services are eligible for payment under our group health plan

bull Health Care Operations We use and disclose your protected health information in order to perform plan administration functions such as quality assurance activities resolution of internal grievances and evaluating plan performance For example we review claims experience in order to understand participant utilization and to make plan design changes that are intended to control health care costs

bull Treatment Although the law allows use and disclosure of your protected health information for purposes of treatment as a health plan we generally do not need to disclose your information for treatment purposes Your physician or health care provider is required to provide you with an explanation of how they use and share your health information for purposes of treatment payment and health care operations

bull As permitted or required by law We may also use or disclose your protected health information without your written authorization for other reasons as permitted by law We are permitted by law to share information subject to certain requirements in order to communicate information on health-related benefits or services that may be of interest to you respond to a court order or provide information to further public health activities (eg preventing the spread of disease) without your written authorization We are also permitted to share protected health information during a corporate restructuring such as a merger sale or acquisition We will also disclose health information about you when required by law for example in order to prevent serious harm to you or others

The text below is an annual open enrollment required notice

25

Notice of Privacy Practices

bull Pursuant to your Authorization When required by law we will ask for your written authorization before using or disclosing your protected health information If you choose to sign an authorization to disclose information you can later revoke that authorization to prevent any future uses or disclosures

bull To Business Associates We may enter into contracts with entities known as Business Associates that provide services to or perform functions on behalf of the Plan We may disclose protected health information to Business Associates once they have agreed in writing to safeguard the protected health information For example we may disclose your protected health information to a Business Associate to administer claims Business Associates are also required by law to protect protected health information

bull To the Plan Sponsor We may disclose protected health information to certain employees of Reston Association for the purpose of administering the Plan These employees will use or disclose the protected health information only as necessary to perform plan administration functions or as otherwise required by HIPAA unless you have authorized additional disclosures Your protected health information cannot be used for employment purposes without your specific authorization

Your Rights bull Right to Inspect and Copy In most cases you have the right to inspect and copy the protected health

information we maintain about you If you request copies we will charge you a reasonable fee to cover the costs of copying mailing or other expenses associated with your request Your request to inspect or review your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to inspect and copy your health information To the extent your information is held in an electronic health record you may be able to receive the information in an electronic format

bull Right to Amend If you believe that information within your records is incorrect or if important information is missing you have the right to request that we correct the existing information or add the missing information Your request to amend your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to amend your health information If we deny your request you may file a statement of disagreement with us for inclusion in any future disclosures of the disputed information

bull Right to an Accounting of Disclosures You have the right to receive an accounting of certain disclosures of your protected health information The accounting will not include disclosures that were made (1) for purposes of treatment payment or health care operations (2) to you (3) pursuant to your authorization (4) to your friends or family in your presence or because of an emergency (5) for national security purposes or (6) incidental to otherwise permissible disclosures

Your request to for an accounting must be submitted in writing to the person listed below You may request an accounting of disclosures made within the last six years You may request one accounting free of charge within a 12-month period

The text below is an annual open enrollment required notice

25

26

The information provided herein is intended to be a summary of benefits only and in no way supersedes the actual plan documents provided by the insurance carriersadministrators For more detailed information pertaining to your employee benefit plans including limitations and exclusions

please refer to the plan documents andor evidence of coverage provided by the carriersadministrators

Womenrsquos Health and Cancer Rights Act of 1998

If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos Health and Cancer Rights Act of 1998 (WHCRA) For individuals receiving mastectomy-related benefits coverage will be provided in a manner determined in consultation with the attending physician and the patient for

bull All stages of reconstruction of the breast on which the mastectomy was performed bull Surgery and reconstruction of the other breast to produce a symmetrical appearance bull Prostheses and bull Treatment of physical complications of the mastectomy including lymphedema

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan If you would like more information on WHCRA benefits call your plan administrator

CHIP-Childrens Health Insurance Program (CHIP) Reauthorization Act of 2009

Medicaid and the Childrenrsquos Health Insurance Program (CHIP) offer free or low-cost health coverage to children and families If you are eligible for health coverage from your employer but are unable to afford the premiums some States have premium assistance programs that can help pay for coverage These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage but need assistance in paying their health premiums

If you or your dependents are already enrolled in Medicaid or CHIP you can contact your state Medicaid or CHIP office to find out if premium assistance is available For a list of the contacts in each State go to wwwdolgovebsachipmodelnoticedoc

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify you can then contact the State to find out if it has a program that might help you pay the premiums for an employer-sponsored plan

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP your employerrsquos health plan is required to permit you and your dependents to enroll in the plan ndash as long as you and your dependents are eligible but not already enrolled in the employerrsquos plan This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance

The text below is an annual open enrollment required notice

26

27

Premium Assistance Under Medicaid and the

Childrenrsquos Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your

employer your state may have a premium assistance program that can help pay for coverage using funds

from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot

be eligible for these premium assistance programs but you may be able to buy individual insurance coverage

through the Health Insurance Marketplace For more information visit wwwhealthcaregov

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below

contact your State Medicaid or CHIP office to find out if premium assistance is available

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your

dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-

877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a

program that might help you pay the premiums for an employer-sponsored plan

If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible

under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already

enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days

of being determined eligible for premium assistance If you have questions about enrolling in your

employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)

If you live in one of the following states you may be eligible for assistance paying your employer

health plan premiums The following list of states is current as of July 31 2019 Contact your State for

more information on eligibility ndash

ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcom

Phone 1-855-692-5447

Website httpflmedicaidtplrecoverycomhipp

Phone 1-877-357-3268

ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program

Website httpmyakhippcom

Phone 1-866-251-4861

Email CustomerServiceMyAKHIPPcom

Medicaid Eligibility

httpdhssalaskagovdpaPagesmedicaiddefaultaspx

Website httpsmedicaidgeorgiagovhealth-

insurance-premium-payment-program-hipp

Phone 678-564-1162 ext 2131

ARKANSAS ndash Medicaid INDIANA ndash Medicaid

Website httpmyarhippcom

Phone 1-855-MyARHIPP (855-692-7447)

Healthy Indiana Plan for low-income adults 19-64

Website httpwwwingovfssahip

Phone 1-877-438-4479

All other Medicaid

Website httpwwwindianamedicaidcom

Phone 1-800-403-0864

COLORADO ndash Health First Colorado

(Coloradorsquos Medicaid Program) amp Child Health

Plan Plus (CHP+)

IOWA ndash Medicaid

Health First Colorado Website

httpswwwhealthfirstcoloradocom

Health First Colorado Member Contact Center

1-800-221-3943 State Relay 711

CHP+ httpswwwcoloradogovpacifichcpfchild-health-

plan-plus

CHP+ Customer Service 1-800-359-1991 State Relay

711

Website

httpdhsiowagovHawki

Phone 1-800-257-8563

28

KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid

Website httpwwwkdheksgovhcf

Phone 1-785-296-3512

Website httpswwwdhhsnhgovoiihipphtm

Phone 603-271-5218

Toll free number for the HIPP program 1-800-852-3345 ext 5218

KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP

Website httpschfskygov

Phone 1-800-635-2570

Medicaid Website

httpwwwstatenjushumanservices

dmahsclientsmedicaid

Medicaid Phone 609-631-2392

CHIP Website httpwwwnjfamilycareorgindexhtml

CHIP Phone 1-800-701-0710

LOUISIANA ndash Medicaid NEW YORK ndash Medicaid

Website httpdhhlouisianagovindexcfmsubhome1n331

Phone 1-888-695-2447

Website httpswwwhealthnygovhealth_caremedicaid

Phone 1-800-541-2831

MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid

Website httpwwwmainegovdhhsofipublic-assistanceindexhtml

Phone 1-800-442-6003

TTY Maine relay 711

Website httpsmedicaidncdhhsgov

Phone 919-855-4100

MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid

Website httpwwwmassgoveohhsgovdepartmentsmasshealth

Phone 1-800-862-4840

Website httpwwwndgovdhsservicesmedicalservmedicaid

Phone 1-844-854-4825

MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP

Website

httpsmngovdhspeople-we-serveseniorshealth-carehealth-care-

programsprograms-and-servicesother-insurancejsp

Phone 1-800-657-3739

Website httpwwwinsureoklahomaorg

Phone 1-888-365-3742

MISSOURI ndash Medicaid OREGON ndash Medicaid

Website httpwwwdssmogovmhdparticipantspageshipphtm

Phone 573-751-2005

Website httphealthcareoregongovPagesindexaspx

httpwwworegonhealthcaregovindex-eshtml

Phone 1-800-699-9075

MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid

Website httpdphhsmtgovMontanaHealthcareProgramsHIPP

Phone 1-800-694-3084

Website

httpwwwdhspagovprovidermedicalassistancehealthinsuranc

epremiumpaymenthippprogramindexhtm

Phone 1-800-692-7462

NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP

Website httpwwwACCESSNebraskanegov

Phone (855) 632-7633

Lincoln (402) 473-7000

Omaha (402) 595-1178

Website httpwwweohhsrigov

Phone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)

29

NEVADA ndash Medicaid SOUTH CAROLINA ndash Medicaid

Medicaid Website httpsdhcfpnvgov

Medicaid Phone 1-800-992-0900

Website httpswwwscdhhsgov

Phone 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid

Website httpdsssdgov

Phone 1-888-828-0059

Website httpswwwhcawagov

Phone 1-800-562-3022 ext 15473

TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascom

Phone 1-800-440-0493

Website httpmywvhippcom

Toll-free phone 1-855-MyWVHIPP (1-855-699-8447)

UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgov

CHIP Website httphealthutahgovchip

Phone 1-877-543-7669

Website

httpswwwdhswisconsingovpublicationsp1p10095p

df

Phone 1-800-362-3002

VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorg

Phone 1-800-250-8427

Website httpswyequalitycareacs-inccom

Phone 307-777-7531

VIRGINIA ndash Medicaid and CHIP Medicaid Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

Medicaid Phone 1-800-432-5924

CHIP Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

CHIP Phone 1-855-242-8282

To see if any other states have added a premium assistance program since July 31 2019 or for more

information on special enrollment rights contact either

US Department of Labor US Department of Health and Human Services

Employee Benefits Security Administration Centers for Medicare amp Medicaid Services

wwwdolgovagenciesebsa wwwcmshhsgov

1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565

Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond

to a collection of information unless such collection displays a valid Office of Management and Budget (OMB)

control number The Department notes that a Federal agency cannot conduct or sponsor a collection of

information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and

the public is not required to respond to a collection of information unless it displays a currently valid OMB control

number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to

penalty for failing to comply with a collection of information if the collection of information does not display a

currently valid OMB control number See 44 USC 3512

The public reporting burden for this collection of information is estimated to average approximately seven minutes

per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other

aspect of this collection of information including suggestions for reducing this burden to the US Department of

Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance

Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and

reference the OMB Control Number 1210-0137 OMB Control Number 1210-0137 (expires 12312019)

Notes

30

Notes

31

Prepared by

Please contact Reston Associationrsquos Human Resources Department at 703-435-7990 or hrrestonorg with any

questions related to your Total Rewards Guide

copy 2019 McGriff Insurance Services Inc

Page 23: Employee Total Rewards Guide 2020 - Reston Total Rewards Gui… · Recognizing and rewarding employees for achieving a sustainable impact. Award criteria includes: •Progressive

23

Lifetime limit not applicable and enrollment opportunity The lifetime limit on the dollar value of benefits under our medical plan no longer applies Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan Individuals have 30 days from the date of this notice to request enrollment For more information contact Human Resources or call the medical insurance carrier at the telephone number on your identification card

Notice on Patient Protections The medical HMO plan generally allows the designation of a primary care provider You have the right to designate any primary care provider who participates in the network and who is available to accept you or your family members Until you make this designation the medical carrier designates one for you For information on how to select a primary care provider and for a list of the participating primary care providers contact the medical insurance carrier at the number listed on your identification card

For children you may designate a pediatrician as the primary care provider You do not need prior authorization from the medical insurance carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in the network who specializes in obstetrics or gynecology The health care professional however may be required to comply with certain procedures including obtaining prior authorization for certain services following a pre-approved treatment plan or procedures for making referrals For a list of participating health care professionals who specialize in obstetrics or gynecology contact the medical insurance carrier at the number listed on your identification card

OTC Drug Reimbursements for FSAsHRAsHSAs Under the new Health Care Reform law (PPACA) the cost of an over-the-counter medicine or drug cannot be reimbursed from the account unless a prescription is obtained The change does not affect insulin even if purchased without a prescription or other health care expenses such as medical devices eyeglasses contact lenses co-pays and deductibles The new standard applies only to purchases made on or after January 1 2011

A similar rule is in effect for Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs)

The IRS has also posted a questions and answers section on its website httpwwwirsgovnewsroomarticle0id=22730800html concerning these provisions

Patient Protection and Affordable Care Act (PPACA) Mandatory Notices

The text below is an annual open enrollment required notice

24

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION PLEASE REVIEW IT CAREFULLY

Our Pledge to You

This notice is intended to inform you of the privacy practices followed by the Reston Associationrsquos Employee Benefit Plan (the Plan) and the Planrsquos legal obligations regarding your protected health information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) The notice also explains the privacy rights you and your family members have as participants of the Plan It is effective on April 14 2011

The Plan often needs access to your protected health information in order to provide payment for health services and perform plan administrative functions We want to assure the plan participants covered under the Plan that we comply with federal privacy laws and respect your right to privacy Reston Association requires all members of our workforce and third parties that are provided access to protected health information to comply with the privacy practices outlined in this notice

Protected Health Information Your protected health information is protected by the HIPAA Privacy Rule Generally protected health information is information that identifies an individual created or received by a health care provider health plan or an employer on behalf of a group health plan that relates to physical or mental health conditions provision of health care or payment for health care whether past present or future

How We May Use Your Protected Health Information Under the HIPAA Privacy Rule we may use or disclose your protected health information for certain purposes without your permission This section describes the ways we can use and disclose your protected health information

bull Payment We use or disclose your protected health information without your written authorization in order to determine eligibility for benefits seek reimbursement from a third party or coordinate benefits with another health plan under which you are covered For example a health care provider that provided treatment to you will provide us with your health information We use that information in order to determine whether those services are eligible for payment under our group health plan

bull Health Care Operations We use and disclose your protected health information in order to perform plan administration functions such as quality assurance activities resolution of internal grievances and evaluating plan performance For example we review claims experience in order to understand participant utilization and to make plan design changes that are intended to control health care costs

bull Treatment Although the law allows use and disclosure of your protected health information for purposes of treatment as a health plan we generally do not need to disclose your information for treatment purposes Your physician or health care provider is required to provide you with an explanation of how they use and share your health information for purposes of treatment payment and health care operations

bull As permitted or required by law We may also use or disclose your protected health information without your written authorization for other reasons as permitted by law We are permitted by law to share information subject to certain requirements in order to communicate information on health-related benefits or services that may be of interest to you respond to a court order or provide information to further public health activities (eg preventing the spread of disease) without your written authorization We are also permitted to share protected health information during a corporate restructuring such as a merger sale or acquisition We will also disclose health information about you when required by law for example in order to prevent serious harm to you or others

The text below is an annual open enrollment required notice

25

Notice of Privacy Practices

bull Pursuant to your Authorization When required by law we will ask for your written authorization before using or disclosing your protected health information If you choose to sign an authorization to disclose information you can later revoke that authorization to prevent any future uses or disclosures

bull To Business Associates We may enter into contracts with entities known as Business Associates that provide services to or perform functions on behalf of the Plan We may disclose protected health information to Business Associates once they have agreed in writing to safeguard the protected health information For example we may disclose your protected health information to a Business Associate to administer claims Business Associates are also required by law to protect protected health information

bull To the Plan Sponsor We may disclose protected health information to certain employees of Reston Association for the purpose of administering the Plan These employees will use or disclose the protected health information only as necessary to perform plan administration functions or as otherwise required by HIPAA unless you have authorized additional disclosures Your protected health information cannot be used for employment purposes without your specific authorization

Your Rights bull Right to Inspect and Copy In most cases you have the right to inspect and copy the protected health

information we maintain about you If you request copies we will charge you a reasonable fee to cover the costs of copying mailing or other expenses associated with your request Your request to inspect or review your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to inspect and copy your health information To the extent your information is held in an electronic health record you may be able to receive the information in an electronic format

bull Right to Amend If you believe that information within your records is incorrect or if important information is missing you have the right to request that we correct the existing information or add the missing information Your request to amend your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to amend your health information If we deny your request you may file a statement of disagreement with us for inclusion in any future disclosures of the disputed information

bull Right to an Accounting of Disclosures You have the right to receive an accounting of certain disclosures of your protected health information The accounting will not include disclosures that were made (1) for purposes of treatment payment or health care operations (2) to you (3) pursuant to your authorization (4) to your friends or family in your presence or because of an emergency (5) for national security purposes or (6) incidental to otherwise permissible disclosures

Your request to for an accounting must be submitted in writing to the person listed below You may request an accounting of disclosures made within the last six years You may request one accounting free of charge within a 12-month period

The text below is an annual open enrollment required notice

25

26

The information provided herein is intended to be a summary of benefits only and in no way supersedes the actual plan documents provided by the insurance carriersadministrators For more detailed information pertaining to your employee benefit plans including limitations and exclusions

please refer to the plan documents andor evidence of coverage provided by the carriersadministrators

Womenrsquos Health and Cancer Rights Act of 1998

If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos Health and Cancer Rights Act of 1998 (WHCRA) For individuals receiving mastectomy-related benefits coverage will be provided in a manner determined in consultation with the attending physician and the patient for

bull All stages of reconstruction of the breast on which the mastectomy was performed bull Surgery and reconstruction of the other breast to produce a symmetrical appearance bull Prostheses and bull Treatment of physical complications of the mastectomy including lymphedema

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan If you would like more information on WHCRA benefits call your plan administrator

CHIP-Childrens Health Insurance Program (CHIP) Reauthorization Act of 2009

Medicaid and the Childrenrsquos Health Insurance Program (CHIP) offer free or low-cost health coverage to children and families If you are eligible for health coverage from your employer but are unable to afford the premiums some States have premium assistance programs that can help pay for coverage These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage but need assistance in paying their health premiums

If you or your dependents are already enrolled in Medicaid or CHIP you can contact your state Medicaid or CHIP office to find out if premium assistance is available For a list of the contacts in each State go to wwwdolgovebsachipmodelnoticedoc

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify you can then contact the State to find out if it has a program that might help you pay the premiums for an employer-sponsored plan

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP your employerrsquos health plan is required to permit you and your dependents to enroll in the plan ndash as long as you and your dependents are eligible but not already enrolled in the employerrsquos plan This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance

The text below is an annual open enrollment required notice

26

27

Premium Assistance Under Medicaid and the

Childrenrsquos Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your

employer your state may have a premium assistance program that can help pay for coverage using funds

from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot

be eligible for these premium assistance programs but you may be able to buy individual insurance coverage

through the Health Insurance Marketplace For more information visit wwwhealthcaregov

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below

contact your State Medicaid or CHIP office to find out if premium assistance is available

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your

dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-

877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a

program that might help you pay the premiums for an employer-sponsored plan

If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible

under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already

enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days

of being determined eligible for premium assistance If you have questions about enrolling in your

employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)

If you live in one of the following states you may be eligible for assistance paying your employer

health plan premiums The following list of states is current as of July 31 2019 Contact your State for

more information on eligibility ndash

ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcom

Phone 1-855-692-5447

Website httpflmedicaidtplrecoverycomhipp

Phone 1-877-357-3268

ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program

Website httpmyakhippcom

Phone 1-866-251-4861

Email CustomerServiceMyAKHIPPcom

Medicaid Eligibility

httpdhssalaskagovdpaPagesmedicaiddefaultaspx

Website httpsmedicaidgeorgiagovhealth-

insurance-premium-payment-program-hipp

Phone 678-564-1162 ext 2131

ARKANSAS ndash Medicaid INDIANA ndash Medicaid

Website httpmyarhippcom

Phone 1-855-MyARHIPP (855-692-7447)

Healthy Indiana Plan for low-income adults 19-64

Website httpwwwingovfssahip

Phone 1-877-438-4479

All other Medicaid

Website httpwwwindianamedicaidcom

Phone 1-800-403-0864

COLORADO ndash Health First Colorado

(Coloradorsquos Medicaid Program) amp Child Health

Plan Plus (CHP+)

IOWA ndash Medicaid

Health First Colorado Website

httpswwwhealthfirstcoloradocom

Health First Colorado Member Contact Center

1-800-221-3943 State Relay 711

CHP+ httpswwwcoloradogovpacifichcpfchild-health-

plan-plus

CHP+ Customer Service 1-800-359-1991 State Relay

711

Website

httpdhsiowagovHawki

Phone 1-800-257-8563

28

KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid

Website httpwwwkdheksgovhcf

Phone 1-785-296-3512

Website httpswwwdhhsnhgovoiihipphtm

Phone 603-271-5218

Toll free number for the HIPP program 1-800-852-3345 ext 5218

KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP

Website httpschfskygov

Phone 1-800-635-2570

Medicaid Website

httpwwwstatenjushumanservices

dmahsclientsmedicaid

Medicaid Phone 609-631-2392

CHIP Website httpwwwnjfamilycareorgindexhtml

CHIP Phone 1-800-701-0710

LOUISIANA ndash Medicaid NEW YORK ndash Medicaid

Website httpdhhlouisianagovindexcfmsubhome1n331

Phone 1-888-695-2447

Website httpswwwhealthnygovhealth_caremedicaid

Phone 1-800-541-2831

MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid

Website httpwwwmainegovdhhsofipublic-assistanceindexhtml

Phone 1-800-442-6003

TTY Maine relay 711

Website httpsmedicaidncdhhsgov

Phone 919-855-4100

MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid

Website httpwwwmassgoveohhsgovdepartmentsmasshealth

Phone 1-800-862-4840

Website httpwwwndgovdhsservicesmedicalservmedicaid

Phone 1-844-854-4825

MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP

Website

httpsmngovdhspeople-we-serveseniorshealth-carehealth-care-

programsprograms-and-servicesother-insurancejsp

Phone 1-800-657-3739

Website httpwwwinsureoklahomaorg

Phone 1-888-365-3742

MISSOURI ndash Medicaid OREGON ndash Medicaid

Website httpwwwdssmogovmhdparticipantspageshipphtm

Phone 573-751-2005

Website httphealthcareoregongovPagesindexaspx

httpwwworegonhealthcaregovindex-eshtml

Phone 1-800-699-9075

MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid

Website httpdphhsmtgovMontanaHealthcareProgramsHIPP

Phone 1-800-694-3084

Website

httpwwwdhspagovprovidermedicalassistancehealthinsuranc

epremiumpaymenthippprogramindexhtm

Phone 1-800-692-7462

NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP

Website httpwwwACCESSNebraskanegov

Phone (855) 632-7633

Lincoln (402) 473-7000

Omaha (402) 595-1178

Website httpwwweohhsrigov

Phone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)

29

NEVADA ndash Medicaid SOUTH CAROLINA ndash Medicaid

Medicaid Website httpsdhcfpnvgov

Medicaid Phone 1-800-992-0900

Website httpswwwscdhhsgov

Phone 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid

Website httpdsssdgov

Phone 1-888-828-0059

Website httpswwwhcawagov

Phone 1-800-562-3022 ext 15473

TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascom

Phone 1-800-440-0493

Website httpmywvhippcom

Toll-free phone 1-855-MyWVHIPP (1-855-699-8447)

UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgov

CHIP Website httphealthutahgovchip

Phone 1-877-543-7669

Website

httpswwwdhswisconsingovpublicationsp1p10095p

df

Phone 1-800-362-3002

VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorg

Phone 1-800-250-8427

Website httpswyequalitycareacs-inccom

Phone 307-777-7531

VIRGINIA ndash Medicaid and CHIP Medicaid Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

Medicaid Phone 1-800-432-5924

CHIP Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

CHIP Phone 1-855-242-8282

To see if any other states have added a premium assistance program since July 31 2019 or for more

information on special enrollment rights contact either

US Department of Labor US Department of Health and Human Services

Employee Benefits Security Administration Centers for Medicare amp Medicaid Services

wwwdolgovagenciesebsa wwwcmshhsgov

1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565

Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond

to a collection of information unless such collection displays a valid Office of Management and Budget (OMB)

control number The Department notes that a Federal agency cannot conduct or sponsor a collection of

information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and

the public is not required to respond to a collection of information unless it displays a currently valid OMB control

number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to

penalty for failing to comply with a collection of information if the collection of information does not display a

currently valid OMB control number See 44 USC 3512

The public reporting burden for this collection of information is estimated to average approximately seven minutes

per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other

aspect of this collection of information including suggestions for reducing this burden to the US Department of

Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance

Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and

reference the OMB Control Number 1210-0137 OMB Control Number 1210-0137 (expires 12312019)

Notes

30

Notes

31

Prepared by

Please contact Reston Associationrsquos Human Resources Department at 703-435-7990 or hrrestonorg with any

questions related to your Total Rewards Guide

copy 2019 McGriff Insurance Services Inc

Page 24: Employee Total Rewards Guide 2020 - Reston Total Rewards Gui… · Recognizing and rewarding employees for achieving a sustainable impact. Award criteria includes: •Progressive

24

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION PLEASE REVIEW IT CAREFULLY

Our Pledge to You

This notice is intended to inform you of the privacy practices followed by the Reston Associationrsquos Employee Benefit Plan (the Plan) and the Planrsquos legal obligations regarding your protected health information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) The notice also explains the privacy rights you and your family members have as participants of the Plan It is effective on April 14 2011

The Plan often needs access to your protected health information in order to provide payment for health services and perform plan administrative functions We want to assure the plan participants covered under the Plan that we comply with federal privacy laws and respect your right to privacy Reston Association requires all members of our workforce and third parties that are provided access to protected health information to comply with the privacy practices outlined in this notice

Protected Health Information Your protected health information is protected by the HIPAA Privacy Rule Generally protected health information is information that identifies an individual created or received by a health care provider health plan or an employer on behalf of a group health plan that relates to physical or mental health conditions provision of health care or payment for health care whether past present or future

How We May Use Your Protected Health Information Under the HIPAA Privacy Rule we may use or disclose your protected health information for certain purposes without your permission This section describes the ways we can use and disclose your protected health information

bull Payment We use or disclose your protected health information without your written authorization in order to determine eligibility for benefits seek reimbursement from a third party or coordinate benefits with another health plan under which you are covered For example a health care provider that provided treatment to you will provide us with your health information We use that information in order to determine whether those services are eligible for payment under our group health plan

bull Health Care Operations We use and disclose your protected health information in order to perform plan administration functions such as quality assurance activities resolution of internal grievances and evaluating plan performance For example we review claims experience in order to understand participant utilization and to make plan design changes that are intended to control health care costs

bull Treatment Although the law allows use and disclosure of your protected health information for purposes of treatment as a health plan we generally do not need to disclose your information for treatment purposes Your physician or health care provider is required to provide you with an explanation of how they use and share your health information for purposes of treatment payment and health care operations

bull As permitted or required by law We may also use or disclose your protected health information without your written authorization for other reasons as permitted by law We are permitted by law to share information subject to certain requirements in order to communicate information on health-related benefits or services that may be of interest to you respond to a court order or provide information to further public health activities (eg preventing the spread of disease) without your written authorization We are also permitted to share protected health information during a corporate restructuring such as a merger sale or acquisition We will also disclose health information about you when required by law for example in order to prevent serious harm to you or others

The text below is an annual open enrollment required notice

25

Notice of Privacy Practices

bull Pursuant to your Authorization When required by law we will ask for your written authorization before using or disclosing your protected health information If you choose to sign an authorization to disclose information you can later revoke that authorization to prevent any future uses or disclosures

bull To Business Associates We may enter into contracts with entities known as Business Associates that provide services to or perform functions on behalf of the Plan We may disclose protected health information to Business Associates once they have agreed in writing to safeguard the protected health information For example we may disclose your protected health information to a Business Associate to administer claims Business Associates are also required by law to protect protected health information

bull To the Plan Sponsor We may disclose protected health information to certain employees of Reston Association for the purpose of administering the Plan These employees will use or disclose the protected health information only as necessary to perform plan administration functions or as otherwise required by HIPAA unless you have authorized additional disclosures Your protected health information cannot be used for employment purposes without your specific authorization

Your Rights bull Right to Inspect and Copy In most cases you have the right to inspect and copy the protected health

information we maintain about you If you request copies we will charge you a reasonable fee to cover the costs of copying mailing or other expenses associated with your request Your request to inspect or review your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to inspect and copy your health information To the extent your information is held in an electronic health record you may be able to receive the information in an electronic format

bull Right to Amend If you believe that information within your records is incorrect or if important information is missing you have the right to request that we correct the existing information or add the missing information Your request to amend your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to amend your health information If we deny your request you may file a statement of disagreement with us for inclusion in any future disclosures of the disputed information

bull Right to an Accounting of Disclosures You have the right to receive an accounting of certain disclosures of your protected health information The accounting will not include disclosures that were made (1) for purposes of treatment payment or health care operations (2) to you (3) pursuant to your authorization (4) to your friends or family in your presence or because of an emergency (5) for national security purposes or (6) incidental to otherwise permissible disclosures

Your request to for an accounting must be submitted in writing to the person listed below You may request an accounting of disclosures made within the last six years You may request one accounting free of charge within a 12-month period

The text below is an annual open enrollment required notice

25

26

The information provided herein is intended to be a summary of benefits only and in no way supersedes the actual plan documents provided by the insurance carriersadministrators For more detailed information pertaining to your employee benefit plans including limitations and exclusions

please refer to the plan documents andor evidence of coverage provided by the carriersadministrators

Womenrsquos Health and Cancer Rights Act of 1998

If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos Health and Cancer Rights Act of 1998 (WHCRA) For individuals receiving mastectomy-related benefits coverage will be provided in a manner determined in consultation with the attending physician and the patient for

bull All stages of reconstruction of the breast on which the mastectomy was performed bull Surgery and reconstruction of the other breast to produce a symmetrical appearance bull Prostheses and bull Treatment of physical complications of the mastectomy including lymphedema

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan If you would like more information on WHCRA benefits call your plan administrator

CHIP-Childrens Health Insurance Program (CHIP) Reauthorization Act of 2009

Medicaid and the Childrenrsquos Health Insurance Program (CHIP) offer free or low-cost health coverage to children and families If you are eligible for health coverage from your employer but are unable to afford the premiums some States have premium assistance programs that can help pay for coverage These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage but need assistance in paying their health premiums

If you or your dependents are already enrolled in Medicaid or CHIP you can contact your state Medicaid or CHIP office to find out if premium assistance is available For a list of the contacts in each State go to wwwdolgovebsachipmodelnoticedoc

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify you can then contact the State to find out if it has a program that might help you pay the premiums for an employer-sponsored plan

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP your employerrsquos health plan is required to permit you and your dependents to enroll in the plan ndash as long as you and your dependents are eligible but not already enrolled in the employerrsquos plan This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance

The text below is an annual open enrollment required notice

26

27

Premium Assistance Under Medicaid and the

Childrenrsquos Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your

employer your state may have a premium assistance program that can help pay for coverage using funds

from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot

be eligible for these premium assistance programs but you may be able to buy individual insurance coverage

through the Health Insurance Marketplace For more information visit wwwhealthcaregov

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below

contact your State Medicaid or CHIP office to find out if premium assistance is available

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your

dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-

877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a

program that might help you pay the premiums for an employer-sponsored plan

If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible

under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already

enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days

of being determined eligible for premium assistance If you have questions about enrolling in your

employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)

If you live in one of the following states you may be eligible for assistance paying your employer

health plan premiums The following list of states is current as of July 31 2019 Contact your State for

more information on eligibility ndash

ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcom

Phone 1-855-692-5447

Website httpflmedicaidtplrecoverycomhipp

Phone 1-877-357-3268

ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program

Website httpmyakhippcom

Phone 1-866-251-4861

Email CustomerServiceMyAKHIPPcom

Medicaid Eligibility

httpdhssalaskagovdpaPagesmedicaiddefaultaspx

Website httpsmedicaidgeorgiagovhealth-

insurance-premium-payment-program-hipp

Phone 678-564-1162 ext 2131

ARKANSAS ndash Medicaid INDIANA ndash Medicaid

Website httpmyarhippcom

Phone 1-855-MyARHIPP (855-692-7447)

Healthy Indiana Plan for low-income adults 19-64

Website httpwwwingovfssahip

Phone 1-877-438-4479

All other Medicaid

Website httpwwwindianamedicaidcom

Phone 1-800-403-0864

COLORADO ndash Health First Colorado

(Coloradorsquos Medicaid Program) amp Child Health

Plan Plus (CHP+)

IOWA ndash Medicaid

Health First Colorado Website

httpswwwhealthfirstcoloradocom

Health First Colorado Member Contact Center

1-800-221-3943 State Relay 711

CHP+ httpswwwcoloradogovpacifichcpfchild-health-

plan-plus

CHP+ Customer Service 1-800-359-1991 State Relay

711

Website

httpdhsiowagovHawki

Phone 1-800-257-8563

28

KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid

Website httpwwwkdheksgovhcf

Phone 1-785-296-3512

Website httpswwwdhhsnhgovoiihipphtm

Phone 603-271-5218

Toll free number for the HIPP program 1-800-852-3345 ext 5218

KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP

Website httpschfskygov

Phone 1-800-635-2570

Medicaid Website

httpwwwstatenjushumanservices

dmahsclientsmedicaid

Medicaid Phone 609-631-2392

CHIP Website httpwwwnjfamilycareorgindexhtml

CHIP Phone 1-800-701-0710

LOUISIANA ndash Medicaid NEW YORK ndash Medicaid

Website httpdhhlouisianagovindexcfmsubhome1n331

Phone 1-888-695-2447

Website httpswwwhealthnygovhealth_caremedicaid

Phone 1-800-541-2831

MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid

Website httpwwwmainegovdhhsofipublic-assistanceindexhtml

Phone 1-800-442-6003

TTY Maine relay 711

Website httpsmedicaidncdhhsgov

Phone 919-855-4100

MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid

Website httpwwwmassgoveohhsgovdepartmentsmasshealth

Phone 1-800-862-4840

Website httpwwwndgovdhsservicesmedicalservmedicaid

Phone 1-844-854-4825

MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP

Website

httpsmngovdhspeople-we-serveseniorshealth-carehealth-care-

programsprograms-and-servicesother-insurancejsp

Phone 1-800-657-3739

Website httpwwwinsureoklahomaorg

Phone 1-888-365-3742

MISSOURI ndash Medicaid OREGON ndash Medicaid

Website httpwwwdssmogovmhdparticipantspageshipphtm

Phone 573-751-2005

Website httphealthcareoregongovPagesindexaspx

httpwwworegonhealthcaregovindex-eshtml

Phone 1-800-699-9075

MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid

Website httpdphhsmtgovMontanaHealthcareProgramsHIPP

Phone 1-800-694-3084

Website

httpwwwdhspagovprovidermedicalassistancehealthinsuranc

epremiumpaymenthippprogramindexhtm

Phone 1-800-692-7462

NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP

Website httpwwwACCESSNebraskanegov

Phone (855) 632-7633

Lincoln (402) 473-7000

Omaha (402) 595-1178

Website httpwwweohhsrigov

Phone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)

29

NEVADA ndash Medicaid SOUTH CAROLINA ndash Medicaid

Medicaid Website httpsdhcfpnvgov

Medicaid Phone 1-800-992-0900

Website httpswwwscdhhsgov

Phone 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid

Website httpdsssdgov

Phone 1-888-828-0059

Website httpswwwhcawagov

Phone 1-800-562-3022 ext 15473

TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascom

Phone 1-800-440-0493

Website httpmywvhippcom

Toll-free phone 1-855-MyWVHIPP (1-855-699-8447)

UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgov

CHIP Website httphealthutahgovchip

Phone 1-877-543-7669

Website

httpswwwdhswisconsingovpublicationsp1p10095p

df

Phone 1-800-362-3002

VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorg

Phone 1-800-250-8427

Website httpswyequalitycareacs-inccom

Phone 307-777-7531

VIRGINIA ndash Medicaid and CHIP Medicaid Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

Medicaid Phone 1-800-432-5924

CHIP Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

CHIP Phone 1-855-242-8282

To see if any other states have added a premium assistance program since July 31 2019 or for more

information on special enrollment rights contact either

US Department of Labor US Department of Health and Human Services

Employee Benefits Security Administration Centers for Medicare amp Medicaid Services

wwwdolgovagenciesebsa wwwcmshhsgov

1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565

Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond

to a collection of information unless such collection displays a valid Office of Management and Budget (OMB)

control number The Department notes that a Federal agency cannot conduct or sponsor a collection of

information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and

the public is not required to respond to a collection of information unless it displays a currently valid OMB control

number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to

penalty for failing to comply with a collection of information if the collection of information does not display a

currently valid OMB control number See 44 USC 3512

The public reporting burden for this collection of information is estimated to average approximately seven minutes

per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other

aspect of this collection of information including suggestions for reducing this burden to the US Department of

Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance

Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and

reference the OMB Control Number 1210-0137 OMB Control Number 1210-0137 (expires 12312019)

Notes

30

Notes

31

Prepared by

Please contact Reston Associationrsquos Human Resources Department at 703-435-7990 or hrrestonorg with any

questions related to your Total Rewards Guide

copy 2019 McGriff Insurance Services Inc

Page 25: Employee Total Rewards Guide 2020 - Reston Total Rewards Gui… · Recognizing and rewarding employees for achieving a sustainable impact. Award criteria includes: •Progressive

25

Notice of Privacy Practices

bull Pursuant to your Authorization When required by law we will ask for your written authorization before using or disclosing your protected health information If you choose to sign an authorization to disclose information you can later revoke that authorization to prevent any future uses or disclosures

bull To Business Associates We may enter into contracts with entities known as Business Associates that provide services to or perform functions on behalf of the Plan We may disclose protected health information to Business Associates once they have agreed in writing to safeguard the protected health information For example we may disclose your protected health information to a Business Associate to administer claims Business Associates are also required by law to protect protected health information

bull To the Plan Sponsor We may disclose protected health information to certain employees of Reston Association for the purpose of administering the Plan These employees will use or disclose the protected health information only as necessary to perform plan administration functions or as otherwise required by HIPAA unless you have authorized additional disclosures Your protected health information cannot be used for employment purposes without your specific authorization

Your Rights bull Right to Inspect and Copy In most cases you have the right to inspect and copy the protected health

information we maintain about you If you request copies we will charge you a reasonable fee to cover the costs of copying mailing or other expenses associated with your request Your request to inspect or review your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to inspect and copy your health information To the extent your information is held in an electronic health record you may be able to receive the information in an electronic format

bull Right to Amend If you believe that information within your records is incorrect or if important information is missing you have the right to request that we correct the existing information or add the missing information Your request to amend your health information must be submitted in writing to the person listed below In some circumstances we may deny your request to amend your health information If we deny your request you may file a statement of disagreement with us for inclusion in any future disclosures of the disputed information

bull Right to an Accounting of Disclosures You have the right to receive an accounting of certain disclosures of your protected health information The accounting will not include disclosures that were made (1) for purposes of treatment payment or health care operations (2) to you (3) pursuant to your authorization (4) to your friends or family in your presence or because of an emergency (5) for national security purposes or (6) incidental to otherwise permissible disclosures

Your request to for an accounting must be submitted in writing to the person listed below You may request an accounting of disclosures made within the last six years You may request one accounting free of charge within a 12-month period

The text below is an annual open enrollment required notice

25

26

The information provided herein is intended to be a summary of benefits only and in no way supersedes the actual plan documents provided by the insurance carriersadministrators For more detailed information pertaining to your employee benefit plans including limitations and exclusions

please refer to the plan documents andor evidence of coverage provided by the carriersadministrators

Womenrsquos Health and Cancer Rights Act of 1998

If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos Health and Cancer Rights Act of 1998 (WHCRA) For individuals receiving mastectomy-related benefits coverage will be provided in a manner determined in consultation with the attending physician and the patient for

bull All stages of reconstruction of the breast on which the mastectomy was performed bull Surgery and reconstruction of the other breast to produce a symmetrical appearance bull Prostheses and bull Treatment of physical complications of the mastectomy including lymphedema

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan If you would like more information on WHCRA benefits call your plan administrator

CHIP-Childrens Health Insurance Program (CHIP) Reauthorization Act of 2009

Medicaid and the Childrenrsquos Health Insurance Program (CHIP) offer free or low-cost health coverage to children and families If you are eligible for health coverage from your employer but are unable to afford the premiums some States have premium assistance programs that can help pay for coverage These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage but need assistance in paying their health premiums

If you or your dependents are already enrolled in Medicaid or CHIP you can contact your state Medicaid or CHIP office to find out if premium assistance is available For a list of the contacts in each State go to wwwdolgovebsachipmodelnoticedoc

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify you can then contact the State to find out if it has a program that might help you pay the premiums for an employer-sponsored plan

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP your employerrsquos health plan is required to permit you and your dependents to enroll in the plan ndash as long as you and your dependents are eligible but not already enrolled in the employerrsquos plan This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance

The text below is an annual open enrollment required notice

26

27

Premium Assistance Under Medicaid and the

Childrenrsquos Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your

employer your state may have a premium assistance program that can help pay for coverage using funds

from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot

be eligible for these premium assistance programs but you may be able to buy individual insurance coverage

through the Health Insurance Marketplace For more information visit wwwhealthcaregov

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below

contact your State Medicaid or CHIP office to find out if premium assistance is available

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your

dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-

877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a

program that might help you pay the premiums for an employer-sponsored plan

If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible

under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already

enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days

of being determined eligible for premium assistance If you have questions about enrolling in your

employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)

If you live in one of the following states you may be eligible for assistance paying your employer

health plan premiums The following list of states is current as of July 31 2019 Contact your State for

more information on eligibility ndash

ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcom

Phone 1-855-692-5447

Website httpflmedicaidtplrecoverycomhipp

Phone 1-877-357-3268

ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program

Website httpmyakhippcom

Phone 1-866-251-4861

Email CustomerServiceMyAKHIPPcom

Medicaid Eligibility

httpdhssalaskagovdpaPagesmedicaiddefaultaspx

Website httpsmedicaidgeorgiagovhealth-

insurance-premium-payment-program-hipp

Phone 678-564-1162 ext 2131

ARKANSAS ndash Medicaid INDIANA ndash Medicaid

Website httpmyarhippcom

Phone 1-855-MyARHIPP (855-692-7447)

Healthy Indiana Plan for low-income adults 19-64

Website httpwwwingovfssahip

Phone 1-877-438-4479

All other Medicaid

Website httpwwwindianamedicaidcom

Phone 1-800-403-0864

COLORADO ndash Health First Colorado

(Coloradorsquos Medicaid Program) amp Child Health

Plan Plus (CHP+)

IOWA ndash Medicaid

Health First Colorado Website

httpswwwhealthfirstcoloradocom

Health First Colorado Member Contact Center

1-800-221-3943 State Relay 711

CHP+ httpswwwcoloradogovpacifichcpfchild-health-

plan-plus

CHP+ Customer Service 1-800-359-1991 State Relay

711

Website

httpdhsiowagovHawki

Phone 1-800-257-8563

28

KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid

Website httpwwwkdheksgovhcf

Phone 1-785-296-3512

Website httpswwwdhhsnhgovoiihipphtm

Phone 603-271-5218

Toll free number for the HIPP program 1-800-852-3345 ext 5218

KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP

Website httpschfskygov

Phone 1-800-635-2570

Medicaid Website

httpwwwstatenjushumanservices

dmahsclientsmedicaid

Medicaid Phone 609-631-2392

CHIP Website httpwwwnjfamilycareorgindexhtml

CHIP Phone 1-800-701-0710

LOUISIANA ndash Medicaid NEW YORK ndash Medicaid

Website httpdhhlouisianagovindexcfmsubhome1n331

Phone 1-888-695-2447

Website httpswwwhealthnygovhealth_caremedicaid

Phone 1-800-541-2831

MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid

Website httpwwwmainegovdhhsofipublic-assistanceindexhtml

Phone 1-800-442-6003

TTY Maine relay 711

Website httpsmedicaidncdhhsgov

Phone 919-855-4100

MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid

Website httpwwwmassgoveohhsgovdepartmentsmasshealth

Phone 1-800-862-4840

Website httpwwwndgovdhsservicesmedicalservmedicaid

Phone 1-844-854-4825

MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP

Website

httpsmngovdhspeople-we-serveseniorshealth-carehealth-care-

programsprograms-and-servicesother-insurancejsp

Phone 1-800-657-3739

Website httpwwwinsureoklahomaorg

Phone 1-888-365-3742

MISSOURI ndash Medicaid OREGON ndash Medicaid

Website httpwwwdssmogovmhdparticipantspageshipphtm

Phone 573-751-2005

Website httphealthcareoregongovPagesindexaspx

httpwwworegonhealthcaregovindex-eshtml

Phone 1-800-699-9075

MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid

Website httpdphhsmtgovMontanaHealthcareProgramsHIPP

Phone 1-800-694-3084

Website

httpwwwdhspagovprovidermedicalassistancehealthinsuranc

epremiumpaymenthippprogramindexhtm

Phone 1-800-692-7462

NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP

Website httpwwwACCESSNebraskanegov

Phone (855) 632-7633

Lincoln (402) 473-7000

Omaha (402) 595-1178

Website httpwwweohhsrigov

Phone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)

29

NEVADA ndash Medicaid SOUTH CAROLINA ndash Medicaid

Medicaid Website httpsdhcfpnvgov

Medicaid Phone 1-800-992-0900

Website httpswwwscdhhsgov

Phone 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid

Website httpdsssdgov

Phone 1-888-828-0059

Website httpswwwhcawagov

Phone 1-800-562-3022 ext 15473

TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascom

Phone 1-800-440-0493

Website httpmywvhippcom

Toll-free phone 1-855-MyWVHIPP (1-855-699-8447)

UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgov

CHIP Website httphealthutahgovchip

Phone 1-877-543-7669

Website

httpswwwdhswisconsingovpublicationsp1p10095p

df

Phone 1-800-362-3002

VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorg

Phone 1-800-250-8427

Website httpswyequalitycareacs-inccom

Phone 307-777-7531

VIRGINIA ndash Medicaid and CHIP Medicaid Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

Medicaid Phone 1-800-432-5924

CHIP Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

CHIP Phone 1-855-242-8282

To see if any other states have added a premium assistance program since July 31 2019 or for more

information on special enrollment rights contact either

US Department of Labor US Department of Health and Human Services

Employee Benefits Security Administration Centers for Medicare amp Medicaid Services

wwwdolgovagenciesebsa wwwcmshhsgov

1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565

Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond

to a collection of information unless such collection displays a valid Office of Management and Budget (OMB)

control number The Department notes that a Federal agency cannot conduct or sponsor a collection of

information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and

the public is not required to respond to a collection of information unless it displays a currently valid OMB control

number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to

penalty for failing to comply with a collection of information if the collection of information does not display a

currently valid OMB control number See 44 USC 3512

The public reporting burden for this collection of information is estimated to average approximately seven minutes

per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other

aspect of this collection of information including suggestions for reducing this burden to the US Department of

Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance

Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and

reference the OMB Control Number 1210-0137 OMB Control Number 1210-0137 (expires 12312019)

Notes

30

Notes

31

Prepared by

Please contact Reston Associationrsquos Human Resources Department at 703-435-7990 or hrrestonorg with any

questions related to your Total Rewards Guide

copy 2019 McGriff Insurance Services Inc

Page 26: Employee Total Rewards Guide 2020 - Reston Total Rewards Gui… · Recognizing and rewarding employees for achieving a sustainable impact. Award criteria includes: •Progressive

26

The information provided herein is intended to be a summary of benefits only and in no way supersedes the actual plan documents provided by the insurance carriersadministrators For more detailed information pertaining to your employee benefit plans including limitations and exclusions

please refer to the plan documents andor evidence of coverage provided by the carriersadministrators

Womenrsquos Health and Cancer Rights Act of 1998

If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos Health and Cancer Rights Act of 1998 (WHCRA) For individuals receiving mastectomy-related benefits coverage will be provided in a manner determined in consultation with the attending physician and the patient for

bull All stages of reconstruction of the breast on which the mastectomy was performed bull Surgery and reconstruction of the other breast to produce a symmetrical appearance bull Prostheses and bull Treatment of physical complications of the mastectomy including lymphedema

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan If you would like more information on WHCRA benefits call your plan administrator

CHIP-Childrens Health Insurance Program (CHIP) Reauthorization Act of 2009

Medicaid and the Childrenrsquos Health Insurance Program (CHIP) offer free or low-cost health coverage to children and families If you are eligible for health coverage from your employer but are unable to afford the premiums some States have premium assistance programs that can help pay for coverage These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage but need assistance in paying their health premiums

If you or your dependents are already enrolled in Medicaid or CHIP you can contact your state Medicaid or CHIP office to find out if premium assistance is available For a list of the contacts in each State go to wwwdolgovebsachipmodelnoticedoc

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify you can then contact the State to find out if it has a program that might help you pay the premiums for an employer-sponsored plan

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP your employerrsquos health plan is required to permit you and your dependents to enroll in the plan ndash as long as you and your dependents are eligible but not already enrolled in the employerrsquos plan This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance

The text below is an annual open enrollment required notice

26

27

Premium Assistance Under Medicaid and the

Childrenrsquos Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your

employer your state may have a premium assistance program that can help pay for coverage using funds

from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot

be eligible for these premium assistance programs but you may be able to buy individual insurance coverage

through the Health Insurance Marketplace For more information visit wwwhealthcaregov

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below

contact your State Medicaid or CHIP office to find out if premium assistance is available

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your

dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-

877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a

program that might help you pay the premiums for an employer-sponsored plan

If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible

under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already

enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days

of being determined eligible for premium assistance If you have questions about enrolling in your

employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)

If you live in one of the following states you may be eligible for assistance paying your employer

health plan premiums The following list of states is current as of July 31 2019 Contact your State for

more information on eligibility ndash

ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcom

Phone 1-855-692-5447

Website httpflmedicaidtplrecoverycomhipp

Phone 1-877-357-3268

ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program

Website httpmyakhippcom

Phone 1-866-251-4861

Email CustomerServiceMyAKHIPPcom

Medicaid Eligibility

httpdhssalaskagovdpaPagesmedicaiddefaultaspx

Website httpsmedicaidgeorgiagovhealth-

insurance-premium-payment-program-hipp

Phone 678-564-1162 ext 2131

ARKANSAS ndash Medicaid INDIANA ndash Medicaid

Website httpmyarhippcom

Phone 1-855-MyARHIPP (855-692-7447)

Healthy Indiana Plan for low-income adults 19-64

Website httpwwwingovfssahip

Phone 1-877-438-4479

All other Medicaid

Website httpwwwindianamedicaidcom

Phone 1-800-403-0864

COLORADO ndash Health First Colorado

(Coloradorsquos Medicaid Program) amp Child Health

Plan Plus (CHP+)

IOWA ndash Medicaid

Health First Colorado Website

httpswwwhealthfirstcoloradocom

Health First Colorado Member Contact Center

1-800-221-3943 State Relay 711

CHP+ httpswwwcoloradogovpacifichcpfchild-health-

plan-plus

CHP+ Customer Service 1-800-359-1991 State Relay

711

Website

httpdhsiowagovHawki

Phone 1-800-257-8563

28

KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid

Website httpwwwkdheksgovhcf

Phone 1-785-296-3512

Website httpswwwdhhsnhgovoiihipphtm

Phone 603-271-5218

Toll free number for the HIPP program 1-800-852-3345 ext 5218

KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP

Website httpschfskygov

Phone 1-800-635-2570

Medicaid Website

httpwwwstatenjushumanservices

dmahsclientsmedicaid

Medicaid Phone 609-631-2392

CHIP Website httpwwwnjfamilycareorgindexhtml

CHIP Phone 1-800-701-0710

LOUISIANA ndash Medicaid NEW YORK ndash Medicaid

Website httpdhhlouisianagovindexcfmsubhome1n331

Phone 1-888-695-2447

Website httpswwwhealthnygovhealth_caremedicaid

Phone 1-800-541-2831

MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid

Website httpwwwmainegovdhhsofipublic-assistanceindexhtml

Phone 1-800-442-6003

TTY Maine relay 711

Website httpsmedicaidncdhhsgov

Phone 919-855-4100

MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid

Website httpwwwmassgoveohhsgovdepartmentsmasshealth

Phone 1-800-862-4840

Website httpwwwndgovdhsservicesmedicalservmedicaid

Phone 1-844-854-4825

MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP

Website

httpsmngovdhspeople-we-serveseniorshealth-carehealth-care-

programsprograms-and-servicesother-insurancejsp

Phone 1-800-657-3739

Website httpwwwinsureoklahomaorg

Phone 1-888-365-3742

MISSOURI ndash Medicaid OREGON ndash Medicaid

Website httpwwwdssmogovmhdparticipantspageshipphtm

Phone 573-751-2005

Website httphealthcareoregongovPagesindexaspx

httpwwworegonhealthcaregovindex-eshtml

Phone 1-800-699-9075

MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid

Website httpdphhsmtgovMontanaHealthcareProgramsHIPP

Phone 1-800-694-3084

Website

httpwwwdhspagovprovidermedicalassistancehealthinsuranc

epremiumpaymenthippprogramindexhtm

Phone 1-800-692-7462

NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP

Website httpwwwACCESSNebraskanegov

Phone (855) 632-7633

Lincoln (402) 473-7000

Omaha (402) 595-1178

Website httpwwweohhsrigov

Phone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)

29

NEVADA ndash Medicaid SOUTH CAROLINA ndash Medicaid

Medicaid Website httpsdhcfpnvgov

Medicaid Phone 1-800-992-0900

Website httpswwwscdhhsgov

Phone 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid

Website httpdsssdgov

Phone 1-888-828-0059

Website httpswwwhcawagov

Phone 1-800-562-3022 ext 15473

TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascom

Phone 1-800-440-0493

Website httpmywvhippcom

Toll-free phone 1-855-MyWVHIPP (1-855-699-8447)

UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgov

CHIP Website httphealthutahgovchip

Phone 1-877-543-7669

Website

httpswwwdhswisconsingovpublicationsp1p10095p

df

Phone 1-800-362-3002

VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorg

Phone 1-800-250-8427

Website httpswyequalitycareacs-inccom

Phone 307-777-7531

VIRGINIA ndash Medicaid and CHIP Medicaid Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

Medicaid Phone 1-800-432-5924

CHIP Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

CHIP Phone 1-855-242-8282

To see if any other states have added a premium assistance program since July 31 2019 or for more

information on special enrollment rights contact either

US Department of Labor US Department of Health and Human Services

Employee Benefits Security Administration Centers for Medicare amp Medicaid Services

wwwdolgovagenciesebsa wwwcmshhsgov

1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565

Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond

to a collection of information unless such collection displays a valid Office of Management and Budget (OMB)

control number The Department notes that a Federal agency cannot conduct or sponsor a collection of

information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and

the public is not required to respond to a collection of information unless it displays a currently valid OMB control

number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to

penalty for failing to comply with a collection of information if the collection of information does not display a

currently valid OMB control number See 44 USC 3512

The public reporting burden for this collection of information is estimated to average approximately seven minutes

per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other

aspect of this collection of information including suggestions for reducing this burden to the US Department of

Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance

Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and

reference the OMB Control Number 1210-0137 OMB Control Number 1210-0137 (expires 12312019)

Notes

30

Notes

31

Prepared by

Please contact Reston Associationrsquos Human Resources Department at 703-435-7990 or hrrestonorg with any

questions related to your Total Rewards Guide

copy 2019 McGriff Insurance Services Inc

Page 27: Employee Total Rewards Guide 2020 - Reston Total Rewards Gui… · Recognizing and rewarding employees for achieving a sustainable impact. Award criteria includes: •Progressive

27

Premium Assistance Under Medicaid and the

Childrenrsquos Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your

employer your state may have a premium assistance program that can help pay for coverage using funds

from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot

be eligible for these premium assistance programs but you may be able to buy individual insurance coverage

through the Health Insurance Marketplace For more information visit wwwhealthcaregov

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below

contact your State Medicaid or CHIP office to find out if premium assistance is available

If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your

dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-

877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a

program that might help you pay the premiums for an employer-sponsored plan

If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible

under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already

enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days

of being determined eligible for premium assistance If you have questions about enrolling in your

employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)

If you live in one of the following states you may be eligible for assistance paying your employer

health plan premiums The following list of states is current as of July 31 2019 Contact your State for

more information on eligibility ndash

ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcom

Phone 1-855-692-5447

Website httpflmedicaidtplrecoverycomhipp

Phone 1-877-357-3268

ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program

Website httpmyakhippcom

Phone 1-866-251-4861

Email CustomerServiceMyAKHIPPcom

Medicaid Eligibility

httpdhssalaskagovdpaPagesmedicaiddefaultaspx

Website httpsmedicaidgeorgiagovhealth-

insurance-premium-payment-program-hipp

Phone 678-564-1162 ext 2131

ARKANSAS ndash Medicaid INDIANA ndash Medicaid

Website httpmyarhippcom

Phone 1-855-MyARHIPP (855-692-7447)

Healthy Indiana Plan for low-income adults 19-64

Website httpwwwingovfssahip

Phone 1-877-438-4479

All other Medicaid

Website httpwwwindianamedicaidcom

Phone 1-800-403-0864

COLORADO ndash Health First Colorado

(Coloradorsquos Medicaid Program) amp Child Health

Plan Plus (CHP+)

IOWA ndash Medicaid

Health First Colorado Website

httpswwwhealthfirstcoloradocom

Health First Colorado Member Contact Center

1-800-221-3943 State Relay 711

CHP+ httpswwwcoloradogovpacifichcpfchild-health-

plan-plus

CHP+ Customer Service 1-800-359-1991 State Relay

711

Website

httpdhsiowagovHawki

Phone 1-800-257-8563

28

KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid

Website httpwwwkdheksgovhcf

Phone 1-785-296-3512

Website httpswwwdhhsnhgovoiihipphtm

Phone 603-271-5218

Toll free number for the HIPP program 1-800-852-3345 ext 5218

KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP

Website httpschfskygov

Phone 1-800-635-2570

Medicaid Website

httpwwwstatenjushumanservices

dmahsclientsmedicaid

Medicaid Phone 609-631-2392

CHIP Website httpwwwnjfamilycareorgindexhtml

CHIP Phone 1-800-701-0710

LOUISIANA ndash Medicaid NEW YORK ndash Medicaid

Website httpdhhlouisianagovindexcfmsubhome1n331

Phone 1-888-695-2447

Website httpswwwhealthnygovhealth_caremedicaid

Phone 1-800-541-2831

MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid

Website httpwwwmainegovdhhsofipublic-assistanceindexhtml

Phone 1-800-442-6003

TTY Maine relay 711

Website httpsmedicaidncdhhsgov

Phone 919-855-4100

MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid

Website httpwwwmassgoveohhsgovdepartmentsmasshealth

Phone 1-800-862-4840

Website httpwwwndgovdhsservicesmedicalservmedicaid

Phone 1-844-854-4825

MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP

Website

httpsmngovdhspeople-we-serveseniorshealth-carehealth-care-

programsprograms-and-servicesother-insurancejsp

Phone 1-800-657-3739

Website httpwwwinsureoklahomaorg

Phone 1-888-365-3742

MISSOURI ndash Medicaid OREGON ndash Medicaid

Website httpwwwdssmogovmhdparticipantspageshipphtm

Phone 573-751-2005

Website httphealthcareoregongovPagesindexaspx

httpwwworegonhealthcaregovindex-eshtml

Phone 1-800-699-9075

MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid

Website httpdphhsmtgovMontanaHealthcareProgramsHIPP

Phone 1-800-694-3084

Website

httpwwwdhspagovprovidermedicalassistancehealthinsuranc

epremiumpaymenthippprogramindexhtm

Phone 1-800-692-7462

NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP

Website httpwwwACCESSNebraskanegov

Phone (855) 632-7633

Lincoln (402) 473-7000

Omaha (402) 595-1178

Website httpwwweohhsrigov

Phone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)

29

NEVADA ndash Medicaid SOUTH CAROLINA ndash Medicaid

Medicaid Website httpsdhcfpnvgov

Medicaid Phone 1-800-992-0900

Website httpswwwscdhhsgov

Phone 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid

Website httpdsssdgov

Phone 1-888-828-0059

Website httpswwwhcawagov

Phone 1-800-562-3022 ext 15473

TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascom

Phone 1-800-440-0493

Website httpmywvhippcom

Toll-free phone 1-855-MyWVHIPP (1-855-699-8447)

UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgov

CHIP Website httphealthutahgovchip

Phone 1-877-543-7669

Website

httpswwwdhswisconsingovpublicationsp1p10095p

df

Phone 1-800-362-3002

VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorg

Phone 1-800-250-8427

Website httpswyequalitycareacs-inccom

Phone 307-777-7531

VIRGINIA ndash Medicaid and CHIP Medicaid Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

Medicaid Phone 1-800-432-5924

CHIP Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

CHIP Phone 1-855-242-8282

To see if any other states have added a premium assistance program since July 31 2019 or for more

information on special enrollment rights contact either

US Department of Labor US Department of Health and Human Services

Employee Benefits Security Administration Centers for Medicare amp Medicaid Services

wwwdolgovagenciesebsa wwwcmshhsgov

1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565

Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond

to a collection of information unless such collection displays a valid Office of Management and Budget (OMB)

control number The Department notes that a Federal agency cannot conduct or sponsor a collection of

information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and

the public is not required to respond to a collection of information unless it displays a currently valid OMB control

number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to

penalty for failing to comply with a collection of information if the collection of information does not display a

currently valid OMB control number See 44 USC 3512

The public reporting burden for this collection of information is estimated to average approximately seven minutes

per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other

aspect of this collection of information including suggestions for reducing this burden to the US Department of

Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance

Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and

reference the OMB Control Number 1210-0137 OMB Control Number 1210-0137 (expires 12312019)

Notes

30

Notes

31

Prepared by

Please contact Reston Associationrsquos Human Resources Department at 703-435-7990 or hrrestonorg with any

questions related to your Total Rewards Guide

copy 2019 McGriff Insurance Services Inc

Page 28: Employee Total Rewards Guide 2020 - Reston Total Rewards Gui… · Recognizing and rewarding employees for achieving a sustainable impact. Award criteria includes: •Progressive

28

KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid

Website httpwwwkdheksgovhcf

Phone 1-785-296-3512

Website httpswwwdhhsnhgovoiihipphtm

Phone 603-271-5218

Toll free number for the HIPP program 1-800-852-3345 ext 5218

KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP

Website httpschfskygov

Phone 1-800-635-2570

Medicaid Website

httpwwwstatenjushumanservices

dmahsclientsmedicaid

Medicaid Phone 609-631-2392

CHIP Website httpwwwnjfamilycareorgindexhtml

CHIP Phone 1-800-701-0710

LOUISIANA ndash Medicaid NEW YORK ndash Medicaid

Website httpdhhlouisianagovindexcfmsubhome1n331

Phone 1-888-695-2447

Website httpswwwhealthnygovhealth_caremedicaid

Phone 1-800-541-2831

MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid

Website httpwwwmainegovdhhsofipublic-assistanceindexhtml

Phone 1-800-442-6003

TTY Maine relay 711

Website httpsmedicaidncdhhsgov

Phone 919-855-4100

MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid

Website httpwwwmassgoveohhsgovdepartmentsmasshealth

Phone 1-800-862-4840

Website httpwwwndgovdhsservicesmedicalservmedicaid

Phone 1-844-854-4825

MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP

Website

httpsmngovdhspeople-we-serveseniorshealth-carehealth-care-

programsprograms-and-servicesother-insurancejsp

Phone 1-800-657-3739

Website httpwwwinsureoklahomaorg

Phone 1-888-365-3742

MISSOURI ndash Medicaid OREGON ndash Medicaid

Website httpwwwdssmogovmhdparticipantspageshipphtm

Phone 573-751-2005

Website httphealthcareoregongovPagesindexaspx

httpwwworegonhealthcaregovindex-eshtml

Phone 1-800-699-9075

MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid

Website httpdphhsmtgovMontanaHealthcareProgramsHIPP

Phone 1-800-694-3084

Website

httpwwwdhspagovprovidermedicalassistancehealthinsuranc

epremiumpaymenthippprogramindexhtm

Phone 1-800-692-7462

NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP

Website httpwwwACCESSNebraskanegov

Phone (855) 632-7633

Lincoln (402) 473-7000

Omaha (402) 595-1178

Website httpwwweohhsrigov

Phone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)

29

NEVADA ndash Medicaid SOUTH CAROLINA ndash Medicaid

Medicaid Website httpsdhcfpnvgov

Medicaid Phone 1-800-992-0900

Website httpswwwscdhhsgov

Phone 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid

Website httpdsssdgov

Phone 1-888-828-0059

Website httpswwwhcawagov

Phone 1-800-562-3022 ext 15473

TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascom

Phone 1-800-440-0493

Website httpmywvhippcom

Toll-free phone 1-855-MyWVHIPP (1-855-699-8447)

UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgov

CHIP Website httphealthutahgovchip

Phone 1-877-543-7669

Website

httpswwwdhswisconsingovpublicationsp1p10095p

df

Phone 1-800-362-3002

VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorg

Phone 1-800-250-8427

Website httpswyequalitycareacs-inccom

Phone 307-777-7531

VIRGINIA ndash Medicaid and CHIP Medicaid Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

Medicaid Phone 1-800-432-5924

CHIP Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

CHIP Phone 1-855-242-8282

To see if any other states have added a premium assistance program since July 31 2019 or for more

information on special enrollment rights contact either

US Department of Labor US Department of Health and Human Services

Employee Benefits Security Administration Centers for Medicare amp Medicaid Services

wwwdolgovagenciesebsa wwwcmshhsgov

1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565

Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond

to a collection of information unless such collection displays a valid Office of Management and Budget (OMB)

control number The Department notes that a Federal agency cannot conduct or sponsor a collection of

information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and

the public is not required to respond to a collection of information unless it displays a currently valid OMB control

number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to

penalty for failing to comply with a collection of information if the collection of information does not display a

currently valid OMB control number See 44 USC 3512

The public reporting burden for this collection of information is estimated to average approximately seven minutes

per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other

aspect of this collection of information including suggestions for reducing this burden to the US Department of

Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance

Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and

reference the OMB Control Number 1210-0137 OMB Control Number 1210-0137 (expires 12312019)

Notes

30

Notes

31

Prepared by

Please contact Reston Associationrsquos Human Resources Department at 703-435-7990 or hrrestonorg with any

questions related to your Total Rewards Guide

copy 2019 McGriff Insurance Services Inc

Page 29: Employee Total Rewards Guide 2020 - Reston Total Rewards Gui… · Recognizing and rewarding employees for achieving a sustainable impact. Award criteria includes: •Progressive

29

NEVADA ndash Medicaid SOUTH CAROLINA ndash Medicaid

Medicaid Website httpsdhcfpnvgov

Medicaid Phone 1-800-992-0900

Website httpswwwscdhhsgov

Phone 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid

Website httpdsssdgov

Phone 1-888-828-0059

Website httpswwwhcawagov

Phone 1-800-562-3022 ext 15473

TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascom

Phone 1-800-440-0493

Website httpmywvhippcom

Toll-free phone 1-855-MyWVHIPP (1-855-699-8447)

UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgov

CHIP Website httphealthutahgovchip

Phone 1-877-543-7669

Website

httpswwwdhswisconsingovpublicationsp1p10095p

df

Phone 1-800-362-3002

VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorg

Phone 1-800-250-8427

Website httpswyequalitycareacs-inccom

Phone 307-777-7531

VIRGINIA ndash Medicaid and CHIP Medicaid Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

Medicaid Phone 1-800-432-5924

CHIP Website

httpwwwcovervaorgprograms_premium_assistan

cecfm

CHIP Phone 1-855-242-8282

To see if any other states have added a premium assistance program since July 31 2019 or for more

information on special enrollment rights contact either

US Department of Labor US Department of Health and Human Services

Employee Benefits Security Administration Centers for Medicare amp Medicaid Services

wwwdolgovagenciesebsa wwwcmshhsgov

1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565

Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond

to a collection of information unless such collection displays a valid Office of Management and Budget (OMB)

control number The Department notes that a Federal agency cannot conduct or sponsor a collection of

information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and

the public is not required to respond to a collection of information unless it displays a currently valid OMB control

number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to

penalty for failing to comply with a collection of information if the collection of information does not display a

currently valid OMB control number See 44 USC 3512

The public reporting burden for this collection of information is estimated to average approximately seven minutes

per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other

aspect of this collection of information including suggestions for reducing this burden to the US Department of

Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance

Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and

reference the OMB Control Number 1210-0137 OMB Control Number 1210-0137 (expires 12312019)

Notes

30

Notes

31

Prepared by

Please contact Reston Associationrsquos Human Resources Department at 703-435-7990 or hrrestonorg with any

questions related to your Total Rewards Guide

copy 2019 McGriff Insurance Services Inc

Page 30: Employee Total Rewards Guide 2020 - Reston Total Rewards Gui… · Recognizing and rewarding employees for achieving a sustainable impact. Award criteria includes: •Progressive

Notes

30

Notes

31

Prepared by

Please contact Reston Associationrsquos Human Resources Department at 703-435-7990 or hrrestonorg with any

questions related to your Total Rewards Guide

copy 2019 McGriff Insurance Services Inc

Page 31: Employee Total Rewards Guide 2020 - Reston Total Rewards Gui… · Recognizing and rewarding employees for achieving a sustainable impact. Award criteria includes: •Progressive

Notes

31

Prepared by

Please contact Reston Associationrsquos Human Resources Department at 703-435-7990 or hrrestonorg with any

questions related to your Total Rewards Guide

copy 2019 McGriff Insurance Services Inc

Page 32: Employee Total Rewards Guide 2020 - Reston Total Rewards Gui… · Recognizing and rewarding employees for achieving a sustainable impact. Award criteria includes: •Progressive

Prepared by

Please contact Reston Associationrsquos Human Resources Department at 703-435-7990 or hrrestonorg with any

questions related to your Total Rewards Guide

copy 2019 McGriff Insurance Services Inc


Recommended