Richmond Retirement System730 East Broad Street * Suite 900 * Richmond, VA 23219

Phone: 804 -646-5958 * 1-888-288-2781 * Fax: 804-646-5299http://www.richmondgov.com/retirement

Richmond Retirement System

November 16, 2015

Contact: Kristina Friar Retirement Specialist

Email: kristina.friar@richmondgov.com Phone: 804 – 646 – 5428

Health and Dental Insurance Open Enrollment is Saturday, November 14, 2015 to Sunday, December 6, 2015

The City of Richmond Department of Human Resources and CIGNA have partnered to mail information about open enrollment to covered retirees, and open enrollment for both CIGNA medical insurance and CIGNA dental insurance will begin on Saturday, November 14, 2015 and end on Sunday, December 6, 2015. During this time, retirees may choose to add, drop, or modify their health and dental insurance coverage. Highlights:

No action is required by retirees; however, retirees are encouraged to read the attached memo to

determine if they want to submit forms to add, drop, or modify coverage.

Retirees who do not submit forms to add, drop, or modify medical coverage will be assigned their current CIGNA medical plan (CIGNA Premier Plan A, CIGNA Classic Plan B, or no coverage). Retirees who do not submit forms to add, drop or modify dental coverage will be assigned the CIGNA dental plan that most closely matches their DELTA DENTAL dental plan (CIGNA Dental PPO, CIGNA Dental DHMO, or no coverage).

Retirees making changes should submit information to the Richmond Retirement System (RRS) at

730 E. Broad Street, Suite 900, Richmond, Virginia 23219. The RRS will close at 5:00 p.m. on Friday, December 4, 2015 and will not reopen until 8:00 a.m. on Monday, December 7, 2015 (after open enrollment has ended).

In general, retiree premium rates will decrease. A summary is provided on the following page. The memo from the City of Richmond Department of Human Resources and CIGNA is attached.

Retirees with questions are encouraged to call the City of Richmond Department of Human Resources at (804) 646-5660 or CIGNA at 1-800-564-7642.

###

N E W S R E L E A S E

C i t y o f R i c h m o n d , V i r g i n i a

Summary of CIGNA Retiree Premium Rates, monthly*

PLAN A, PREMIER PLAN – OPEN ACCESS PLUS 20/40 25 or more Years of Service 15 or more Years of Service 10 or more Years of Service Less than 10 Years of Service

OLD rate NEW rate OLD rate NEW rate OLD rate NEW rate OLD rate NEW rate Retiree Only $226.32 $224.82 $293.73 $291.80 $361.14 $358.76 $970.12 $963.73 Retiree + One $846.24 $840.66 $913.64 $907.62 $981.05 $974.60 $1,940.23 $1,927.46 Family $1,342.17 $1,333.34 $1,409.58 $1,400.30 $1,476.99 $1,467.26 $2,625.60 $2,608.31 Dependent Spouse $594.04 $594.04 $594.04 $594.04 $594.04 $594.04 $594.04 $594.04

PLAN B, CLASSIC PLAN – OPEN ACCESS 25/50 25 or more Years of Service 15 or more Years of Service 10 or more Years of Service Less than 10 Years of Service

OLD rate NEW rate OLD rate NEW rate OLD rate NEW rate OLD rate NEW rate Retiree Only $211.93 $210.54 $279.34 $277.50 $346.74 $344.46 $915.54 $909.51 Retiree + One $813.91 $808.56 $881.32 $875.98 $948.73 $942.48 $1,831.09 $1,819.03 Family $1,295.50 $1,286.98 $1,362.90 $1,353.92 $1,430.31 $1,420.90 $2,477.89 $2,461.58 Dependent Spouse $560.68 $560.68 $560.68 $560.68 $560.68 $560.68 $560.68 $560.68

CHOICE FUND HSA (HIGH DEDUCTIBLE) 25 or more Years of Service 15 or more Years of Service 10 or more Years of Service Less than 10 Years of Service

OLD rate NEW rate OLD rate NEW rate OLD rate NEW rate OLD rate NEW rate Retiree Only N/A $173.38 N/A $228.52 N/A $283.66 N/A $748.99 Retiree + One N/A $665.85 N/A $721.00 N/A $776.54 N/A $1,497.99 Family N/A $1,044.44 N/A $1,098.78 N/A $1,153.13 N/A $1,997.69 Dependent Spouse N/A N/A N/A N/A N/A N/A N/A N/A

*New rates effective January 1, 2016. Use RAPIDS Retiree Self Service to confirm rate changes on January 29, 2016.

Summary of CIGNA Retiree Premium Rates, monthly*

CIGNA Dental DHMO

All Retirees OLD rate NEW rate

Retiree Only $19.14 $17.25 Retiree + Child $31.32 $28.23 Retiree + Spouse $39.00 $35.16 Family $53.40 $48.14

CIGNA Dental PPO

All Retirees OLD rate NEW rate

Retiree Only $28.48 $24.40 Retiree + Child $47.00 $40.27 Retiree + Spouse $58.68 $50.27 Family $92.74 $79.45

*New rates effective January 1, 2016. Use RAPIDS Retiree Self Service to confirm rate changes on January 29, 2016. Because DELTA DENTAL administered a pre-paid plan, no premiums will be paid to on December 31, 2015.

Source: Department of Human Resources Memo provided to the RRS on November 13, 2015 (attached)

2016 H.S.A. Election Form 

 

Health Savings Account Employee Annual Election Form 

 Employees who choose to enroll in the CIGNA Choice Fund Open Access plus HSA Plan (High Deductible) may also make contributions to a Health Savings Account.  The City will make a contribution to your HSA even if you choose not to make a contribution.  

The City’s contribution is prorated based on the effective date of your coverage. 

The City will contribute up to $500 for Employee only and $1,000 for Employee + dependent(s). 

The City's contribution will be deposited the 1st pay period of the month in which coverage is effective. 

Employees may contribute up to the annual maximum minus the amount the City contributes. 

During 2016 employees may contribute up to $2,850 for Employee only and $5,750 for Employee + dependent(s). 

Employees age 55 and older may contribute an additional $1,000 catch‐up contribution. 

Employees age 65 and older may not contribute to the HSA but may participate in the High Deductible health plan. 

Employee contributions will be deducted from the 1st and 2nd paychecks in each month. 

 EMPLOYEE INFORMATION  Employee Name _______________________________________________________________________       First Name      Last Name      M.I.  Employee Date of Birth ________   Employee ID Number or Social Security Number _________________  EMPLOYEE CONTRIBUTION INFORMATIONS  Annual Enrollment _____  New Hire_____        Status Change _____  Coverage Type: Employee Only _____  Employee + Dependent(s) ______ 

 I elect to contribute an annual amount of $ ______________ towards my Health Savings Account.  

I elect to contribute to my HSA with a pre‐tax salary reduction through my employer’s Section 125 Cafeteria Plan, and authorize my employer to deduct the amounts as indicated from my salary and forward the funds to HSA Bank to deposit into my HSA. 

SIGNATURES  Employee Signature ____________________________________________   Date __________________  Employer Signature ____________________________________________    Date __________________  _____________________________________________________________________________________ Employer’s Use Only City Contribution $ ____________ Employee per Pay Contribution $ ____________