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HomeMy WebLinkAbout000 - Benefit BookletEMPLOYEE BENEFITS GUIDE 2026 2 Contents Getting Started 4 Who’s eligible for benefits? 5 Changing your benefits 6 Plan contacts 7 Your benefit costs Medical, Dental & Vision 9 Medical plans 17 Dental plans 20 Vision plan 21 Healthcare flexible spending account (FSA) 22 Dependent care FSA (DCFSA) 23 Employee assistance program (EAP) Life & Disability 25 Basic life and AD&D 26 Voluntary life and AD&D 27 Voluntary long-term disability 28 Voluntary health-related plans 29 Washington state paid family and medical leave 30 MissionSquare Retirement 32 New Hire DRS 33 Alliant Medicare solutions Important Plan Information 35 Benefit terms glossary 37 Plan notices & documents This guide is an overview and does not provide a complete description of all benefit provisions. For more detailed information, please refer to your plan benefit booklets or summary plan descriptions (SPDs). The plan benefit booklets determine how all benefits are paid. City of Pasco 2026 Benefit Summary DIGITAL ACCESS Access this booklet, required notices, SBCs and other resources for our plan by clicking the bookshelf image below or scanning the QR code. Getting Started No matter where you are in your career, City of Pasco supports you with benefit programs and resources to help you thrive today and prepare for tomorrow. This guide provides an overview of your healthcare coverage, as well as life, disability, retirement, and more benefits. You’ll find tips to help you understand your medical coverage, save time and money on healthcare, reduce taxes, and balance your work and home life. Take a look at what’s available to make the most of your benefits package. 3 2026 Benefits Effective January 01, 2026 – December 31, 2026 Medicare Part D Notice If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a federal law gives you more choices about your prescription drug coverage. Please see the Important Notices section for more details. City of Pasco 2026 Benefit Summary Who’s eligible for benefits? Employees Please contact the City of Pasco Human Resources Team to confirm the hourly requirements for your role. Employees with variable hours and seasonal schedules may be considered eligible for benefits. Contact Human Resources for details. Eligible dependents •Legally married spouse •Biological, adopted or stepchildren up to age 26 •Children over age 26 who are disabled and depend on you for support •Children named in a qualified medical child support order (QMCSO) For additional coverage information, please refer to the benefit booklets for each benefit. Please Note: If an employee and their spouse both work at The City of Pasco, double coverage is not allowed. Spouses will either have to enroll on their own plans separately or enroll as employee/spouse on one plan. This applies to all lines of coverage. When you can enroll If you’re a new employee, you can enroll the first day of the month following your date of hire, and you must enroll within 30 days of becoming eligible. Existing employees can enroll during the annual open enrollment period. If you miss the enrollment deadline, you'll need to wait until the next open enrollment. How to enroll Eligible employees will receive information from the HR department with detailed instructions on how to enroll. 4City of Pasco 2026 Benefit Summary Qualifying Events Outside of open enrollment, you may be able to enroll or make changes to your benefit elections if you have a big change in your life, including: •Change in legal marital status •Change in number of dependents or dependent eligibility status •Change in employment status that affects eligibility for you, your spouse, or dependent child(ren) •Change in residence that affects access to network providers •Change in your health coverage or your spouse’s coverage due to your spouse’s employment •Change in your or a dependent’s eligibility for Medicare or Medicaid •Court order requiring coverage for your child •“Special enrollment event” under the Health Insurance Portability and Accountability Act (HIPAA), including a new dependent by marriage, birth or adoption, or loss of coverage under another health insurance plan •Event allowed under the Children’s Health Insurance Program (CHIP) Reauthorization Act (you have 60 days to request enrollment due to events allowed under CHIP). You must submit any changes within 60 days after the qualifying event. 5 Life happens A change in your life may allow you to update your benefit choices. Watch the video for a quick take on your options. Play Qualifying Life Events video Click to play video City of Pasco 2026 Benefit Summary Plan contacts and resources 6 General Human Resources hr@pasco-wa.gov (509) 545-3408 Medical Premera Blue Cross Policy No. *See ID Card for info Customer Service Phone: (800) 676-1411 Website: https://www.premera.com Express Scripts Rx Group No. *See ID Card for info Customer Service | Help Desk Phone: (800) 676-1411 Website: https://www.premera.com EAP ComPsych Phone: (866) 681-3416 Website: guidanceresources.com Web ID: PREMERAEAP Employer Code: PASCO Dental Delta Dental of Washington PERS Policy No. 09770 LEOFF Policy No. 09771 Customer Service Phone: (800) 554-1907 Website: www.deltadentalwa.com Vision Vision Service Plan Policy No. 12229295 Member Services Phone: (800) 877-7195 Website: www.vsp.com FSA HealthEquity Member Services Phone: (866) 346-5800 Email: Member Services Website: https://new.healthequity.com/login HRA / VEBA Gallagher Customer Care Center Phone: (844) 342-5505 Website: healthinvesthra.com Life/AD&D Symetra Customer No. 3360 Customer Service Phone: (800) 796-3872 Website: www.symetra.com Disability Guardian Policy No. 360751 Customer Response Unit Phone: (800) 627-4200 Email: cru@glic.com Website: guardiananytime.com Voluntary Benefits Aflac Aflac Benefits Advisor Bureimoa Binauea Phone: (509) 833-1215 Email: Bureimoa_Binauea@us.Aflac.com Website: aflacenrollment.com Retirement Plans 457 Mission Square Relationship Manager Mary Rorvik Phone: (202) 655-4011 Email: mrovik@mission.org Website: www.missionsq.org Department of Retirement Systems Phone: (800) 547-6657 Website: www.drs.wa.gov/contact City of Pasco 2026 Benefit Summary LEOFF plan monthly benefit costs 7City of Pasco 2026 Benefit Summary Group Plan Medical IAFF LEOFF $268.76 PPOA (Uniformed)LEOFF $276.54 PPCOA LEOFF $276.54 LEOFF Management LEOFF $310.61 Below are the monthly employee costs. Medical Your Monthly Cost Employee Only $103.24 Employee + Spouse $265.14 Employee + Child(ren)$148.71 Employee + Family $310.61 PERS plan monthly benefit costs Below are the monthly employee costs for all other eligible City of Pasco Employees. Group Plan Dental Vision Administrative / Professional / Non-Rep.PERS $11.59 $6.52 IUOE PERS $11.59 $6.52 PPOA-NU - Non-Uniformed Police PERS $11.59 $6.52 IAFF - Firefighters / Firefighters Paramedics LEOFF $11.59 $0.00 PPOA - Uniformed Police Officers LEOFF $11.59 $6.52 PCOA - Police Commanding Officers Association LEOFF $11.59 $6.52 LEOFF Management LEOFF $11.59 $6.52 IAFFA – Fire Administration PERS $11.59 $6.52 Employee payroll deductions - Dental Below are the monthly employee costs. Healthcare Medical We offer a comprehensive medical plan so you can receive the care you need for you and your family members. Dental Regular checkups and cleanings are covered. If you do need more care, dental insurance helps cover the cost for fillings, gum disease and more. Vision Our vision plan helps cover the cost of eye exams, eyeglasses, and contact lenses to ensure you’re seeing and feeling your best. 8 Our Commitment We believe that our employees should have access to healthcare coverage that promotes preventive care and helps cover the cost of illness. Eligible employees and their eligible dependents can enroll in medical, dental and vision coverage through the City of Pasco benefits program. City of Pasco 2026 Benefit Summary Premera Blue Cross PERS PPO Plan MEDICAL In-Network Out-of-Network* (Balance Billing May Apply) Annual Deductible $200 per individual $600 per family $200 per individual $600 per family Annual Out-of-Pocket Max $2,200 per individual $6,600 per family $2,200 per individual $6,600 per family Office Visit – PCP 20% after deductible 20% after deductible* Office Visit – Specialist 20% after deductible 20% after deductible* Telehealth 20% after deductible 20% after deductible* Chiropractic 20% after deductible 20% after deductible* Lab and X-ray 20% after deductible 20% after deductible* Urgent Care 20% after deductible 20% after deductible* Emergency Room 20% after deductible 20% after deductible Hospitalization First $1,000: No charge; Thereafter: 20% (deductible waived) First $1,000: No charge; Thereafter: 20% (deductible waived)* Outpatient Surgery 20% after deductible 20% after deductible* PRESCRIPTION DRUGS In-Network: Retail Pharmacy In-Network: Mail Order Pharmacy Generic Drugs $0 copay $0 copay Brand Drugs 20% up to $150 20% up to $150 Number of Days Supply Up to 30 days Up to 90 days You always pay the deductible and any copays. The coinsurance (%) shows what you pay after the deductible. We offer a comprehensive medical plan through Premera Blue Cross who utilizes the Premera Blue Cross network. Preventive care is fully covered under the plan if obtained in-network. Review the out-of-pocket costs such as deductible and coinsurance so you can understand how the plan works. To find in-network providers, visit https://www.premera.com/wa/provider/find-a-doctor/doctor-dentists-and-more/. 9City of Pasco 2026 Benefit Summary Medical Plan – PERS *Non-Network services may be subject to provider balance billing Premera Blue Cross LEOFF PPO Plan MEDICAL In-Network Out-of-Network *(Balance Billing May Apply) Annual Deductible $0 per employee $200 per individual dependent $600 per dependent unit $0 per employee* $200 per individual dependent $600 per dependent unit Annual Out-of-Pocket Max $0 per employee $2,200 per individual dependent $13,200 per dependent unit $0 per employee* $2,200 per individual dependent $13,200 per dependent unit Office Visit – PCP Employee: No charge; Dependents: 20% after deductible Employee: No charge*; Dependents: 20% after deductible* Office Visit – Specialist Employee: No charge; Dependents: 20% after deductible Employee: No charge*; Dependents: 20% after deductible* Telehealth Employee: No charge; Dependents: 20% after deductible Employee: No charge*; Dependents: 20% after deductible* Chiropractic Employee: No charge; Dependents: 20% after deductible Employee: No charge*; Dependents: 20% after deductible* Lab and X-ray Employee: No charge; Dependents: 20% after deductible Employee: No charge*; Dependents: 20% after deductible* Urgent Care Employee: No charge; Dependents: 20% after deductible Employee: No charge*; Dependents: 20% after deductible* Emergency Room Employee: No charge; Dependents: 20% after deductible Employee: No charge; Dependents: 20% after deductible Hospitalization Employee: No charge; Dependents: First $1,000: No charge; Thereafter: 20% (deductible waived) Employee: No charge*; Dependents: First $1,000: No charge*; Thereafter: 20% (deductible waived)* Outpatient Surgery Employee: No charge; Dependents: 20% after deductible Employee: No charge*; Dependents: 20% after deductible* PRESCRIPTION DRUGS In-Network: Retail Pharmacy In-Network: Mail Order Pharmacy Generic Drugs $0 copay $0 copay Brand Drugs Employee: No charge; Dependents: 20% up to $150 Employee: No charge; Dependents: 20% up to $150 Number of Days Supply Up to 30 days Up to 90 days You always pay the deductible and any copays. The coinsurance (%) shows what you pay after the deductible. We offer a comprehensive medical plan through Premera Blue Cross who utilizes the Premera Blue Cross network. Preventive care is fully covered under the plan if obtained in-network. Review the out-of-pocket costs such as deductible and coinsurance so you can understand how the plan works. To find in-network providers, visit https://www.premera.com/wa/provider/find-a-doctor/doctor-dentists-and-more/. 10City of Pasco 2026 Benefit Summary Medical Plan – LEOFF *Out-of-Network/Non-Network services may be subject to provider balance billing for covered services. 070176 (10-30-2025) Simple ways to manage your care Create your account on premera.com With your member account on premera.com, you can: • Track your care costs, like your deductible and out-of-pocket maximum • Refill or manage your prescriptions and get dose reminders* • Find in-network providers, hospitals, and pharmacies • Compare prices on medical services and prescription drugs • Learn more about your benefit details Download the Premera mobile app The Premera mobile app gives you quick, easy access to your health plan details and helps you search for care options anytime, anywhere. • Search for providers and specialists • Monitor your claims • Use your virtual ID card as proof of coverage • Explore virtual care services available to you • Connect with virtual care providers • Schedule virtual care visits with your primary care provider Setting up your account on premera.com is simple. You’ll just need: 1 Your email address 2 The identification number from your Premera ID card Follow these steps for easy health plan management. Get started today: 1 Set up your account on premera.com (use instructions above) 2 Download the Premera mobile app on Android or iOS * If your pharmacy benefits are not through Premera, you will not be able to view or manage your prescriptions on your account. 12 Finding a Premera Provider 1.Go to www.Premera.com 2.Click on Find Care/Find a Doctor 3. If you have a Premera account click sign in to search your providers If you do not have a Premera account, click Browse all doctors and specialists 4. Select Heritage for the network and enter desired zip code Please Note: it is best to search by provider name, not facility they are at. 060755 (09-01-2025) Primary care services just for Premera Blue Cross members As a Premera member, you and your family have access to advanced primary care at Kinwell clinics—where your nutrition, fitness, sleep, and mental health are all part of the healthcare conversation. Kinwell’s advanced primary care experience includes: • Integrated preventive services and behavioral health care • Longer appointment times to establish a better one-to-one patient- provider relationship • Dedicated clinician and health coaching support for lifestyle medical programs • Convenient access to in-person and virtual care just for Premera members • Timelier appointment availability Kinwell primary care Kinwell Medical Group is an independent organization that operates primary care clinics providing services for Premera members on behalf of Premera Blue Cross. 3 1015 1 4 79 11 1213 14 16 5 6 8 2 1 Spokane (North Country Homes) 2 Spokane Valley 3 Spokane (6th & Washington) 4 East Wenatchee 5 Pasco 6 Renton 7 Lynnwood 8 Denny Way 9 Poulsbo 10 Mill Creek 11 Olympia 12 Westlake 13 Ballard 14 Bellingham 15 Redmond 16 Federal Way Open now “It was amazing. [My provider] took the time to listen and answer all my questions. I did not feel rushed. It was one of the best doctors appointments I have ever had. I’m so grateful that I made the switch. Definitely will recommend.” — Kinwell patient CURRENT MEMBER? Schedule a virtual or in-person appointment today at kinwellhealth.com. 14 Download 98point6 from the App Store or Google Play. Your 24/7 Virtual Care Benefit 98point6® makes it easy to prioritize health, with trusted diagnosis and treatment available on-demand through the convenience of an app. Ready when you are: •Diagnosis and treatment for 900+ primary care conditions •Available 24/7, nationwide •No travel or waiting rooms •U.S.-based care team, including board-certified physicians •One-stop for prescriptions, lab orders and doctor’s notes Available to all Medical Enrolled Employees and Dependents ages 1+ 98point6 is an independent company that provides virtual medical care services on behalf of Premera Blue Cross. Premera Blue Cross is an Independent Licensee of the Blue Cross Blue Shield Association.066035 (07-19-2024) 053655 (09-01-2025) Virtual care — anytime, anywhere Primary, urgent, and mental health care Illness can occur at any time. So why wait for office hours to have your medical concerns addressed? Whether it’s primary, urgent, or mental health care, the Premera virtual care network prioritizes our member’s needs. Providers are just a few clicks away, and ready to offer you the care you need.* *If you already have the 98point6, Spring Health, or Talkspace apps downloaded, you can continue using them as is. You are not required to access them through the Premera mobile app. 98point6, Spring Health, and Talkspace are independent companies that provide virtual care services on behalf of Premera Blue Cross. On-demand video and text-based primary care where general medicine and primary care providers are available to answer your questions. They can diagnose and treat you if you’re sick or have a chronic condition. Sign in to the Premera mobile app to access 98point6 from the Find Care section. Receive virtual access to a licensed therapist through text or video for non- urgent mental health care. Sign in to the Premera mobile app to access Talkspace from the Find Care section. Receive mental health therapy by phone or video chat for ages 6 and older. Psychiatric and medication management are also available for ages 18 and older. Sign in to the Premera mobile app to access Spring Health from the Find Care section. Dental Plan - PERS Dental coverage provides periodic preventive care, and if there’s a problem,helps with the cost of dental work.You can find a dentist in your area by visiting deltadentalwa.com and searching for a Delta PPO provider. You should receive a separate dental card if you elect dental. Delta Dental of Washington PERS Dental PPO Plus Premier Plan Benefits In-Network Out-of-Network Annual Deductible $25 per individual | $75 per family $25 per individual | $75 per family Annual Plan Maximum $1,500 per individual Shared with in-network Diagnostic & Preventive Routine exams Covered in full Covered in full Routine cleanings Covered in full Covered in full X-rays Covered in full Covered in full Basic Services Fillings You pay 20% after deductible You pay 20% after deductible Oral Surgery You pay 20% after deductible You pay 20% after deductible Endodontics You pay 20% after deductible You pay 20% after deductible Periodontics You pay 20% after deductible You pay 20% after deductible Major Services Crowns You pay 50% after deductible You pay 50% after deductible Implants You pay 50% after deductible You pay 50% after deductible Bridges You pay 50% after deductible You pay 50% after deductible Dentures You pay 50% after deductible You pay 50% after deductible Other Services Orthodontia Not covered Not covered When using an out-of-network provider, you may be responsible for balanced billing charges. For the most savings, visit an in-network provider. 17City of Pasco 2026 Benefit Summary Dental Plan - LEOFF Dental coverage provides periodic preventive care, and if there’s a problem,helps with the cost of dental work.You can find a dentist in your area by visiting deltadentalwa.com and searching for a Delta PPO provider. You should receive a separate dental card if you elect dental. Delta Dental of Washington LEOFF Dental PPO Plus Premier Plan Benefits In-Network Out-of-Network Annual Deductible $0 per employee $25 per individual dependent $75 per dependent unit $0 per employee $25 per individual dependent $75 per dependent unit Annual Plan Maximum $1,500 per individual Shared with in-network Diagnostic & Preventive Routine exams Covered in full Covered in full Routine cleanings Covered in full Covered in full X-rays Covered in full Covered in full Basic Services Fillings You pay 20% after deductible You pay 20% after deductible Oral Surgery You pay 20% after deductible You pay 20% after deductible Endodontics You pay 20% after deductible You pay 20% after deductible Periodontics You pay 20% after deductible You pay 20% after deductible Major Services Crowns You pay 50% after deductible You pay 50% after deductible Implants You pay 50% after deductible You pay 50% after deductible Bridges You pay 50% after deductible You pay 50% after deductible Dentures You pay 50% after deductible You pay 50% after deductible Other Services Orthodontia Not covered Not covered When using an out-of-network provider, you may be responsible for balanced billing charges. For the most savings, visit an in-network provider. 18City of Pasco 2026 Benefit Summary Go digital with MySmile® MySmile is a fast and easy way to manage your dental health online. Anytime, anywhere access to your benefits, in the palm of your hand. Here’s why people are choosing to use MySmile: Anytime, anywhere access 24/7 access to your ID card and benefit information. Don’t miss a thing Get live texting with customer service, email notifications, and helpful digital reminders. No more waiting Sign up for paperless notifications and avoid waiting for paper ‘snail mail.’ Tools that really help you Find the right dentist and estimate costs — so you always ‘know before you go.’ Don’t miss out on anywhere access to your virtual ID card, benefits info, and easy-to-use digital tools. MySmile® has its perks Safe and secure Your health information stays safe and secure digitally. Give paperless a try, If you want to switch back to paper, you can at any time. MySmile 1023 Text JOIN to 56675 to sign-up for MySmile To learn more about MySmile visit: deltadentalwa.com/mysmile Vision Plan Vision coverage helps with the cost of eyeglasses or contacts. But even if you don’t need vision correction, an annual eye exam checks the health of your eyes and can even detect more serious health issues such as diabetes, high blood pressure,high cholesterol, and thyroid disease. Find an eye doctor who’s right for you. Visit vsp.com or call (800)-877-7195. There is no ID card necessary, just let them know you have VSP insurance. If you’d like a card as a reference, create a member account at vsp.com. Vision Service Plan (VSP) VSP Signature PPO Plan Benefits In-Network Out-of-Network Exam / Hardware Copay $25 combined copay $25 combined copay Contact Lens Fitting Up to $60 copay Not applicable Hardware Allowance Single Vision Lenses Covered in full after copay See Benefit Summary Bifocal Lenses Covered in full after copay See Benefit Summary Trifocal Lenses Covered in full after copay See Benefit Summary Frames Up to $130 allowance; 20% savings on remaining balance Reimbursed up to $70 Contact Lenses Up to $130 allowance Reimbursed up to $105 Benefit Frequency Exam 1 x every 12 months Lenses 1 x every 12 months Frames 1 x every 24 months Contacts 1 x every 12 months When using an out-of-network provider, you may be responsible for balanced billing charges. For the most savings, visit an in-network provider. 20City of Pasco 2026 Benefit Summary Healthcare flexible spending account (FSA) Set aside healthcare dollars for the year A healthcare FSA allows you to set aside tax-free money to pay for healthcare expenses you expect to have over the coming year. How the Health Equity FSA plan works •You estimate what your and your dependents’ out-of- pocket costs will be for the coming year. Think about what out-of-pocket costs you expect to have for eligible expenses such as office visits, surgery, dental and vision expenses, prescriptions, and certain drugstore items. •You can contribute up to $3,400, the annual limit set by the IRS. Contributions are deducted from your pay pre- tax, meaning no federal or state tax on that amount. •During the year, you can use your FSA debit card to pay for services and products. Withdrawals are tax-free as long as they’re for eligible healthcare expenses. Estimate carefully! If you don’t spend all the money in your account, you can roll over up to $680 to use the following year. Any additional remaining balance will be forfeited. Potential tax savings Because FSA contributions are pre-tax, they reduce the total amount of your income the government makes you pay taxes on. Tax savings vary depending on filing status and other variables, but here’s an example using single- filer status and marginal federal income tax rates: 21 Are you eligible? You don’t have to enroll in one of our medical plans to participate in the healthcare FSA. Find out more •healthequity.com •Eligible Expenses •Ineligible Expenses Play Flexible Spending Account video Click to play video $60,000 annual pay, contributing $1,700 to FSA $374 22% income tax savings $130 7.65% FICA tax savings $504 Total FSA tax savings $120,000 annual pay, contributing $3,300 to FSA $792 24% income tax savings $252 7.65% FICA tax savings $1044 Total FSA tax savings City of Pasco 2026 Benefit Summary Paying for daycare? Make it tax-free! Dependent care FSA—up to $7,500 per year tax-free A dependent care Flexible Spending Account (FSA) can help families save potentially hundreds of dollars per year on day care. This program is administered by Health Equity. Here's how the Health Equity DFSA plan works You set aside money from your paycheck, before taxes, to pay for work-related day care expenses. Eligible expenses include not only childcare, but also before- and after- school care programs, preschool, and summer day camp for children younger than 13. The account can also be used for day care for a spouse or other adult dependent who lives with you and is physically or mentally incapable of self-care. You can set aside up to $7,500 per household per year. You can pay your dependent care provider directly from your FSA account, or you can submit claims to get reimbursed for eligible dependent care expenses you pay out of pocket. Estimate carefully! You can’t change your FSA election amount mid-year unless you experience a qualifying event. Money contributed to a dependent care FSA must be used for expenses incurred during the same plan year. Unspent funds will be forfeited. Note: The care provider must be able to provide their Social Security Number or their Tax ID number for you to submit your claim. 22 Every opportunity to save The biggest deduction from your paycheck is likely federal income tax. Why not take a bite out of taxes while paying for necessary expenses with tax- free dollars? Watch Flexible Spending accounts video. Click to play video City of Pasco 2026 Benefit Summary (PSOR\HU&RGH3$6&2 Life & Disability Is your family protected? Life, AD&D, and disability insurance can fill financial gaps due to a loss of income. Consider your day-to-day costs and bills during a pregnancy or illness-related disability leave, or how you would manage large expenses (housing, education, loans, credit cards, etc.) after the death of a spouse or partner. If you need more In addition to company-provided coverage, we offer voluntary coverage that you can purchase for yourself, your spouse, and your children. 24 Name Your Beneficiaries If the worst happens, your beneficiary—the person (or people) on record with the life insurance carrier—receives the benefit. Make sure that you name at least one beneficiary for your life insurance benefit, and change your beneficiary as needed if your situation changes. City of Pasco 2026 Benefit Summary City of Pasco- provided life and AD&D insurance Basic Life and AD&D Basic life insurance pays your beneficiary a lump sum if you die.AD&D (accidental death & dismemberment) coverage provides a benefit to you if you suffer from loss of a limb, speech, sight, or hearing, or to your beneficiary if you have a fatal accident. The cost of coverage is paid in full by City of Pasco. Symetra Group Life and AD&D plan Your basic life coverage amount is based on your current role: The benefit amounts above will be reduced if you are age 65 or older. Refer to the plan document for details. 25 A note about taxes Company-provided life insurance coverage over $50,000 is considered a taxable benefit. The value of the benefit over $50,000 will be reported as taxable income on your annual W-2 form. City of Pasco 2026 Benefit Summary Department Directors:$100,000 Division Managers:$75,000 Pasco Police Commanding Officers Association:$75,000 Non-Uniform Pasco Police Officers Associates:$50,000 Administrative/Professional/Non-Rep:$50,000 International Union of Operating Engineers:$50,000 International Association of Firefighters:$50,000 Uniformed Employees of the Pasco Police Officers Association: $50,000 Voluntary life and AD&D insurance Protecting those you leave behind Voluntary life and AD&D insurance allows you to purchase additional life insurance to protect your family's financial security.Coverage is available for your spouse and/or children if you purchase coverage for yourself. Symetra Voluntary Life and AD&D plan Employee $10,000, $25,000, $50,000 or 1 x Basic Annual Earnings rounded to the next higher increment of $1,000. Guaranteed issue of $100,000. Spouse 50% of employee benefit, up to $50,000. Guaranteed issue of $50,000. Children Up to $5,000 benefit amount. Refer to contract for age limitation. 26City of Pasco 2026 Benefit Summary Monthly Rate (per $1,000 in coverage)Employee Spouse Life Rate $0.276 $0.330 AD&D Rate $0.030 $0.030 Child(ren) $0.880 per family* *Premium includes all eligible children. Eligible children include dependent children under age 26, as long as you apply for and are approved for coverage for yourself. Calculate your life and AD&D insurance cost 1. Desired coverage: You:Spouse: 2. Divide step 1 by 1,000 = You:Spouse: 3. Multiply step 2 by life rate from table = You:Spouse: 4. Multiply step 2 by AD&D rate from table = You:Spouse: 5. Add step 3 + step 4 = You:Spouse: 6. Add you + spouse from step 5 + flat child(ren) benefit (if applicable) = Cost per month: Voluntary life and AD&D insurance costs Voluntary Long- term disability insurance LTD benefits cushion the financial impact of a disability Long-term disability (LTD) insurance replaces part of your income for longer term issues such as: •Debilitating illness (cancer, heart disease, etc.) •Serious injuries (accident, etc.) •Heart attack, stroke •Mental disorders If you qualify, LTD benefits begin after short-term disability benefits end. Payments may be reduced by state, federal, or private disability benefits you receive while disabled. You pay the cost of this coverage. Guardian Voluntary Long Term Disability Benefits Amount 60% of earnings, up to a monthly maximum of $5,000 Begins after 90 days of disability Duration Until age 65 or Social Security Normal Retirement Age 27 Things to know about LTD insurance •It can protect you from having to tap into your retirement savings. •You can use LTD benefits however you need, for housing, food, medical bills, etc. •Benefits can last a long time―from weeks to even years―if you remain eligible. City of Pasco 2026 Benefit Summary Voluntary Long Term Disability Rates Monthly Rate per $100 of Coverage AGE EMPLOYEE 15-24 $0.24 25-29 $0.32 30-34 $0.39 35-39 $0.55 40-44 $0.82 45-49 $1.34 50-54 $1.88 55-59 $2.11 60+$1.49 Aflac is there when you need it most AGC2400762 EXP 10/25 Aflac for City of Pasco If medical bills hit you with an unexpected expense, Aflac can help fill that gap when health insurance doesn’t cover everything. Supplemental insurance plans Accident Individual accident insurance can help with unexpected expenses associated with an accidental injury, so you can focus on getting better. Cancer/Specified-Disease Aflac cancer/specified-disease policy provides robust benefits so you can seek the treatment you need while easing the financial concerns that often accompany it– before, during and after diagnosis. Critical Illness (Specified Health Event) An Aflac specified health event policy is designed to help with the costs of treatment if you experience a covered health event. Hospital Confinement Indemnity Health insurance isn’t meant to cover all expenses associated with hospitalization – like deductibles and copays. Aflac hospital insurance can help minimize those out-of-pocket costs so you can focus on recovery. Short-Term Disability What if you couldn't work due to injury or illness? Aflac Short-Term Disability insurance helps replace some of your income and keeps working when you can’t. Whole or Term Life With Aflac’s whole or term life insurance, you can rest easy knowing that your family can have financial security when they need it most. Your Aflac enrollment is happening 11/04/2025 to 12/31/2025. Your Aflac benefits advisor will contact you via 509.494.4989 to schedule your enrollment conversation. Bureimoa Binauea 509.494.4989Bureimoa_Binauea@us.aflac.com Contact your Aflac benefits advisor to learn more about our products. This is a brief product overview only. Coverage may not be available in all states, including but not limited to ID, NJ, NM, NY or VA. Benefits/ premium rates may vary based on plan selected. Optional riders may be available at an additional cost. Policies/riders have limitations and exclusions that may affect benefits payable. Refer to the specified policy/rider form(s) for complete details, benefits, limitations and exclusions. For availability and costs, please contact your local Aflac agent. Individual coverage is underwritten by American Family Life Assurance Company of Columbus | WWHQ | 1932 Wynnton Road | Columbus, GA 31999 | 800.992.3522 |In New York, coverage is underwritten by American Family Life Assurance Company of New York | 22 Corporate Woods Boulevard, Suite 2 | Albany, NY 12211 | 800.366.3436 Washington Paid Family and Medical Leave The Benefits As a Washington worker, you may be able to use Paid Family and Medical Leave benefits to care for yourself or your family. Benefits will generally allow up to 12 weeks of paid leave for: •Bonding after the birth or placement of a child •Your serious health condition •A serious health condition of a qualifying family member •Certain activities related to a family member’s military duty This statewide insurance program is funded by premiums paid by workers and employers through payroll withholding. To receive benefits under the Paid Family and Medical Leave program, you must have worked a total of at least 820 hours for any Washington employers during the previous 12 months. Benefits will provide a percentage of your gross wages – between $100-$1,647 per week (2026 maximum) – while you are on approved leave. To learn more about the program, including additional eligibility criteria, benefits information, and application instructions, visit www.paidleave.wa.gov/workers. 29City of Pasco 2026 Benefit Summary 457 Deferred Compensation Plan www.missionsq.org/enroll All you need to get started is your Employer, Plan Name, or Plan State to visit your plan resource site. MissionSquare Retirement 777 N. Capitol St., NE, Washington, DC 20002­4240 (800) 669­7400 www.missionsq.org JOINFL300980 10/18/2025 For assistance with your Plan and your overall retirement goals, contact your MissionSquare representative. Shirley Brost Retirement Plans Specialist 202­759­7025 sbrost@missionsq.org Start your journey. Visit www.missionsq.org/enroll to join your plan today. www.drs.wa.gov Access the following links for information: New Employees DRS: New Hire PERS 2 PERS Plan 2 - Department of Retirement Systems PERS 3 PERS Plan 3 - Department of Retirement Systems LEOFF LEOFF Plan 2 - Department of Retirement Systems Nearing 65? Get to know Medicare Important deadlines ahead Most people become eligible for Medicare at age 65. At that time, you’ll need to make some important decisions about your health insurance. But the choice isn’t always easy. Maybe you’ll keep working after 65. Maybe you have dependents covered by your City of Pasco-sponsored insurance. Maybe you’re just not sure which options could work best for your situation. Alliant Medicare Solutions Through City of Pasco, you have access to Alliant Medicare Solutions, a free service you, your family, and your friends can use to figure out the best Medicare options for you. How it works •Gather your current health insurance information. •Call Alliant Medicare Solutions at (877) 888-0165 to talk to a licensed insurance agent about your current coverage, your Medicare options, and what might work best for your situation. •Alliant Medicare Solutions can help you enroll in Medicare or email policy information for you to review. Learn more 33 alliantmedicaresolutions.com Alliant Medicare Solutions is provided by Insuractive LLC, a Nebraska resident insurance agency. Insuractive LLC is wholly owned by Alliant Insurance Services, Inc.Your Guide to Medicare booklet Watch Medicare 101 video Watch Social Security Planning video Medicare 101 Social Security Planning Your Guide to Medicare City of Pasco 2026 Benefit Summary Important Plan Information Plan Documents In this section, you’ll find important plan information, including: •A summary of the health plan notices you are entitled to receive annually, and where to find them •A Benefits Glossary to help you understand important insurance terms. If you need more information If you have additional questions or need copies of your benefit documents, please reach out to Human Resources at (509) 545-3408 or visit The City of Pasco Intranet. Click on Human Resources Benefits. 34City of Pasco 2026 Benefit Summary Accumulation Period The period of time during which you can incur eligible expenses toward your deductible, out-of-pocket maximum, and visit limitations. The accumulation period for your deductible and OOP maximum may differ from the period for visit limitations. Aggregate Deductible A type of family deductible in which a family must meet the entire family deductible before the plan covers eligible expenses for any individual. Aggregate Out-of-Pocket Max A type of family out-of-pocket maximum in which a family must meet the entire family out-of-pocket maximum before the plan pays 100% of eligible expenses for any individual. Allowed Amount The maximum amount your insurance plan will pay for an eligible expense. In-network providers cannot bill you for more than the allowed amount. Ambulatory Surgery Center A healthcare facility that specializes in same-day surgical procedures. Annual Limit The maximum dollar amount or number of visits your plan will cover for a specific service during a plan year. If you reach an annual limit, you must pay all associated costs for that service for the rest of the plan year. Balance Billing Balance billing is when an out-of-network provider bills you for more than your plan’s allowed amount. For example, if the provider charges $100 but the plan’s allowed amount is only $70, an out-of-network provider can bill you for the $30 difference. Balance billing may not be allowed for all services; consult your insurance plan documents for details. Beneficiary The people or entities you select to receive a benefit if you die. You must name beneficiaries for life, AD&D, and retirement plans to ensure the money is distributed according to your wishes. Brand-Name Drug A drug sold under its trademarked name. For example, Lipitor is the brand name of a common cholesterol medicine. Your coinsurance for brand -name drugs may be higher if there is a generic equivalent available. Claim A request for payment that you or your provider submits to your insurance plan after you receive services. COBRA The Consolidated Omnibus Budget Reconciliation Act (COBRA) is a federal law allows you to temporarily keep your health insurance after your employment ends, based on certain qualifying events. If you elect COBRA coverage, you pay 100% of the premiums, including any share your employer used to pay, plus a small administrative fee. Coinsurance The percentage of the allowed amount you must pay for an eligible expense. Coinsurance will always add up to 100%. For example, if the plan pays 70% of the allowed amount, your coinsurance is 30%. If your plan has a deductible, you pay 100% of most costs until you have paid the deductible amount. Copayment (Copay) A flat fee you pay for some services, such as a doctor's office visit. You pay the copayment at the time you receive care. In most cases, copays do not count toward your deductible. Deductible The dollar amount you must pay for eligible expenses before your insurance starts covering a portion. The deductible does not apply to preventive care or certain other services. Dental Basic Services Services such as fillings, routine extractions, and some oral surgery procedures. Dental Diagnostic & Preventive Generally includes routine cleanings, oral exams, X-rays, and fluoride treatments. Most plans limit preventive exams and cleanings to twice a year. Dental Major Services Complex or restorative dental work such as crowns, bridges, dentures, inlays, and onlays. Eligible Expense Also referred to as a covered service, this is a service or product for which your insurance plan will pay a portion of the allowed amount. Your plan will not cover any portion of the cost if the expense is not eligible, and the amount you pay will not count toward your deductible. Embedded Deductible A type of family deductible in which the plan covers eligible expenses for each person as soon as they reach their individual deductible. Embedded Out-of-Pocket Max A type of family out-of-pocket maximum in which the plan pays 100% of eligible expenses for a person as soon as they reach their individual out-of-pocket maximum. Excluded Service A service for which your insurance will not pay any portion of the cost. These services may also be referred to as “ineligible,” “not covered,” or “not allowed.” Glossary 35City of Pasco 2026 Benefit Summary Glossary 36 Formulary A list of prescription drugs covered by your medical plan or prescription drug plan. Also called a preferred drug list. Generic Drug A drug that has the same active ingredients as a brand- name drug but is sold under a different name. For example, atorvastatin is the generic name for medicines with the same formula as the brand-name drug Lipitor. Grandfathered A medical plan that is exempt from certain provisions of the Affordable Care Act (ACA). In Network Also known as participating providers, in -network providers have a contract with your insurance plan. They are usually the lowest-cost option because they have agreed not to charge you more than the allowed amount, and your insurance will cover a bigger portion of eligible expenses than with out-of-network providers. Mail Order A medical or prescription drug plan feature allowing a 90- day supply of medicines you take routinely to be delivered by mail. Out of Network Also known as nonparticipating providers, out-of-network providers do not have a contract with your insurance plan. They are typically a higher-cost option because they can charge you more than your plan’s allowed amount, and your insurance will cover a smaller portion of eligible expenses than with in-network providers. Some plans do not cover out-of-network services at all. Out-of-Pocket Costs Healthcare expenses you are responsible for paying, whether from your bank account, credit card, or from a health savings account such as an HSA, FSA or HRA. These costs include any deductibles, copays, and coinsurance you pay for eligible expenses, along with the cost of any services your insurance does not cover. Out-of-Pocket Maximum The maximum amount of money you will have to spend on eligible expenses during a plan year. Once you spend this amount, your plan covers 100% of eligible expenses for the rest of the plan year. Outpatient Care Care from a hospital or clinic that doesn’t require you to stay overnight. Participating Pharmacy Also known as an in-network pharmacy, a participating pharmacy has a contract with your medical or prescription drug plan. You will typically pay lower prescription costs at a participating pharmacy. Plan Year A 12-month period of benefits coverage. The 12-month period may or may not be the same as the calendar year. Preferred Drug A list of prescription drugs your insurance will cover at the highest benefit level. The list, also known as a “formulary,” is based on an evaluation of effectiveness and cost. Your coinsurance may be higher for drugs that are not on this list, or your insurance may not cover them at all. Preventive Care Routine healthcare services that may include screenings, tests, check-ups, immunizations, and patient counseling to prevent illnesses, disease, or other health problems. Primary Care Provider (PCP) Your main doctor. Some insurance plans require you to name a PCP, who will direct or approve all of your healthcare and referrals. Provider A doctor, dentist, physician’s assistant, nurse, hospital, lab, or other healthcare professional or facility that provides healthcare services. Telehealth/Telemedicine A virtual visit with a provider using video chat on a computer, tablet or smartphone. Usual, Customary, and Reasonable (UCR) The cost of a medical service in a geographic area based on what providers in the area usually charge for the same or a similar medical service. Your plan may use the UCR amount as the allowed amount. Urgent Care Care for an illness, injury, or condition that needs attention right away but is not severe enough to require the emergency room. Treatment at an urgent care center generally costs less than an emergency room visit. Vaccinations Also known as “immunizations,” vaccinations are biological preparations that help prevent or reduce the severity of specific diseases. Voluntary Benefit An optional benefit offered by your employer for which you pay the entire premium, usually through payroll deduction. City of Pasco 2026 Benefit Summary Important plan information 37 Health plan notices These notices must be provided to plan participants on an annual basis and are available in the Annual Notices document, located in the back of your benefit summary: •Medicare Part D Notice: Describes options to access prescription drug coverage for Medicare eligible individuals •Women's Health and Cancer Rights Act: Describes benefits available to those that will or have undergone a mastectomy •Newborns' and Mothers' Health Protection Act: Describes the rights of mother and newborn to stay in the hospital 48-96 hours after delivery •HIPAA Notice of Special Enrollment Rights: Describes when you can enroll yourself and/or dependents in health coverage outside of open enrollment •HIPAA Notice of Privacy Practices: Describes how health information about you may be used and disclosed •Premium Assistance Under Medicaid and the Children's Health Insurance Program (CHIP): Describes availability of premium assistance for Medicaid eligible dependents. •The ‘No Surprises’ Rules: Explains rules that protect you from surprise medical bills. COBRA continuation coverage You and/or your dependents may have the right to continue coverage after you lose eligibility under the terms of our health plan. Upon enrollment, you and your dependents receive a COBRA Initial Notice that outlines the circumstances under which continued coverage is available and your obligations to notify the plan when you or your dependents experience a qualifying event. Please review this notice carefully to make sure you understand your rights and obligations. City of Pasco 2026 Benefit Summary Plan documents 38 Important documents for our health plan and retirement plan are available at the end of this benefit summary. Paper copies of these documents and notices are available if requested. If you would like a paper copy, please contact the Plan Administrator. Summary plan descriptions (SPD) The legal document for describing benefits provided under the plan as well as plan rights and obligations to participants and beneficiaries. •City of Pasco 2026 Health Plan Summary of benefits and coverage (SBC) A document required by the Affordable Care Act (ACA) that presents benefit plan features in a standardized format. SBC documents are available after the Annual Notices section in the benefit summary. •Premera Blue Cross LEOFF PPO Plan •Premera Blue Cross PERS PPO Plan Statement of Material Modifications This enrollment guide constitutes a Summary of Material Modifications (SMM) to the City of Pasco 2026 Health Plan. It is meant to supplement and/or replace certain information in the SPD, so retain it for future reference along with your SPD. Please share these materials with your covered family members. City of Pasco 2026 Benefit Summary 39 Annual Notices Medicare Part D Notice Important Notice from City of Pasco About Your Prescription Drug Coverage and Medicare Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with City of Pasco and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage: 1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. 2. City of Pasco has determined that the prescription drug coverage offered by the First Choice Health PPO Plan is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan. When Can You Join A Medicare Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan. What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan? If you decide to join a Medicare drug plan, your City of Pasco coverage will not be affected. See below for more information about what happens to your current coverage if you join a Medicare drug plan. Since the existing prescription drug coverage under First Choice Health PPO Plan is creditable (e.g., as good as Medicare coverage), you can retain your existing prescription drug coverage and choose not to enroll in a Part D plan; or you can enroll in a Part D plan as a supplement to, or in lieu of, your existing prescription drug co verage. If you do decide to join a Medicare drug plan and drop your City of Pasco prescription drug coverage, be aware that you and your dependents can only get this coverage back at open enrollment or if you experience an event that gives rise to a HIPAA Special Enrollment Right. When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan? You should also know that if you drop or lose your current coverage with City of Pasco and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. 40 If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join. For More Information About This Notice Or Your Current Prescription Drug Coverage… Contact the person listed below for further information. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through City of Pasco changes. You also may request a copy of this notice at any time. For More Information About Your Options Under Medicare Prescription Drug Coverage… More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage: • Visit medicare.gov • Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help • Call 800-MEDICARE (800-633-4227). TTY users should call 877-486-2048. If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at socialsecurity.gov, or call them at 800- 772-1213 (TTY 800-325-0778). Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty). Date: 01/01/2026 Name of Entity: City of Pasco Contact-Position/Office: Sara Matzen Address: 525 N Third Avenue, Pasco, WA 99301 Phone Number: (509) 545-3473 41 Women’s Health and Cancer Rights Act If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s 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: • All stages of reconstruction of the breast on which the mastectomy was performed; • Surgery and reconstruction of the other breast to produce a symmetrical appearance; • Prostheses; and • 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 at (509) 545-3473. Newborns’ and Mothers’ Health Protection Act Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). If you would like more information on maternity benefits, call your plan administrator at (509) 545-3473. HIPAA Notice of Special Enrollment Rights If you decline enrollment in City of Pasco’s health plan for you or your dependents (including your spouse) because of other health insurance or group health plan coverage, you or your dependents may be able to enroll in City of Pasco’s health plan without waiting for the next open enrollment period if you: • Lose other health insurance or group health plan coverage. You must request enrollment within 30 days after the loss of other coverage. • Gain a new dependent as a result of marriage, birth, adoption, or placement for adoption. You must request health plan enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. • Lose Medicaid or Children’s Health Insurance Program (CHIP) coverage because you are no longer eligible. You must request medical plan enrollment within 60 days after the loss of such coverage. If you request a change due to a special enrollment event within the 30-day timeframe, coverage will be effective on the date of birth, adoption or placement for adoption date. For all other events, coverage will be effective the first of the month following your request for enrollment. In addition, you may enroll in City of Pasco’s health plan if you become eligible for a state premium assistance program under Medicaid or CHIP. You must request enrollment within 60 days after you gain eligibility for medical plan coverage. If you request this change, coverage will be effective the first of the month following your request for enrollment. Specific restrictions may apply, depending on federal and state law. Note: If your dependent becomes eligible for a special enrollment right, you may add the dependent to your current coverage or change to another health plan. 42 Availability of Privacy Practices Notice We maintain the HIPAA Notice of Privacy Practices for the City of Pasco, describing how health information about you may be used and disclosed. You may obtain a copy of the Notice of Privacy Practices by contacting Sara Matzen at (509) 545-3408 Premium Assistance under Medicaid and the Children’s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you’re 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 aren’t eligible for Medicaid or CHIP, you won’t 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 www.healthcare.gov. 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 www.insurekidsnow.gov 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 aren’t already enrolled. This is called a “special enrollment” 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 www.askebsa.dol.gov 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, 2025. Contact your State for more information on eligibility— ALABAMA – Medicaid Website: http://myalhipp.com/ | Phone: 1-855-692-5447 ALASKA – Medicaid The AK Health Insurance Premium Payment Program | Website: http://myakhipp.com/ | Phone: 1-866-251-4861 Email: CustomerService@MyAKHIPP.com | Medicaid Eligibility: https://health.alaska.gov/dpa/Pages/default.aspx ARKANSAS – Medicaid Website: http://myarhipp.com/ | Phone: 1-855-MyARHIPP (855-692-7447) CALIFORNIA – Medicaid Health Insurance Premium Payment (HIPP) Program website: http://dhcs.ca.gov/hipp Phone: 916-445-8322 | Fax: 916-440-5676 | Email: hipp@dhcs.ca.gov COLORADO – Health First Colorado (Colorado’s Medicaid Program) & Child Health Plan Plus (CHP+) Health First Colorado Website: https://www.healthfirstcolorado.com/ Health First Colorado Member Contact Center: 1-800-221-3943 | State Relay 711 CHP+: https://hcpf.colorado.gov/child-health-plan-plus CHP+ Customer Service: 1-800-359-1991 | State Relay 711 Health Insurance Buy-In Program (HIBI): https://www.mycohibi.com/ | HIBI Customer Service: 1-855-692-6442 43 FLORIDA – Medicaid Website: https://www.flmedicaidtplrecovery.com/flmedicaidtplrecovery.com/hipp/index.html Phone: 1-877-357-3268 GEORGIA – Medicaid GA HIPP Website: https://medicaid.georgia.gov/health-insurance-premium-payment-program-hipp Phone: 678-564-1162, press 1 GA CHIPRA Website: https://medicaid.georgia.gov/programs/third-party-liability/childrens-health-insurance- program-reauthorization-act-2009-chipra | Phone: 678-564-1162, press 2 INDIANA – Medicaid Health Insurance Premium Payment Program All other Medicaid Website: https://www.in.gov/medicaid/ | http://www.in.gov/fssa/dfr/ | Family and Social Services Administration Phone: (800) 403-0864 | Member Services Phone: (800) 457-4584 IOWA – Medicaid and CHIP (Hawki) Medicaid Website: Iowa Medicaid | Health & Human Services | Medicaid Phone: 1-800-338-8366 Hawki Website: Hawki - Healthy and Well Kids in Iowa | Health & Human Services | Hawki Phone: 1-800-257- 8563 HIPP Website: Health Insurance Premium Payment (HIPP) | Health & Human Services (iowa.gov) HIPP Phone: 1-888-346-9562 KANSAS – Medicaid Website: https://www.kancare.ks.gov/ | Phone: 1-800-792-4884 | HIPP Phone: 1-800-967-4660 KENTUCKY – Medicaid Kentucky Integrated Health Insurance Premium Payment Program (KI-HIPP) Website: https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspx | Phone: 1-855-459-6328 Email: KIHIPP.PROGRAM@ky.gov KCHIP Website: https://kynect.ky.gov | Phone: 1-877-524-4718 Kentucky Medicaid Website: https://chfs.ky.gov/agencies/dms LOUISIANA – Medicaid Website: www.medicaid.la.gov or www.ldh.la.gov/lahipp Phone: 1-888-342-6207 (Medicaid hotline) or 1-855-618-5488 (LaHIPP) MAINE – Medicaid Enrollment Website: https://www.mymaineconnection.gov/benefits/s/?language=en _US Phone: 1-800-442-6003 | TTY: Maine relay 711 Private Health Insurance Premium Webpage: https://www.maine.gov/dhhs/ofi/applications-forms Phone: 800-977-6740 | TTY: Maine relay 711 MASSACHUSETTS – Medicaid and CHIP Website: https://www.mass.gov/masshealth/pa | Phone: 1-800-862-4840 | TTY: 711 Email: masspremassistance@accenture.com MINNESOTA – Medicaid Website: https://mn.gov/dhs/health-care-coverage/ | Phone: 1-800-657-3672 MISSOURI – Medicaid Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm | Phone: 573-751-2005 MONTANA – Medicaid Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP Phone: 1-800-694-3084 | email: HHSHIPPProgram@mt.gov NEBRASKA – Medicaid Website: http://www.ACCESSNebraska.ne.gov Phone: 1-855-632-7633 | Lincoln: 402-473-7000 | Omaha: 402-595-1178 NEVADA – Medicaid Medicaid Website: http://dhcfp.nv.gov | Medicaid Phone: 1-800-992-0900 44 NEW HAMPSHIRE – Medicaid Website: https://www.dhhs.nh.gov/programs-services/medicaid/health-insurance-premium-program Phone: 603-271-5218 | Toll-free number for the HIPP program: 1-800-852-3345, ext. 15218 Email: DHHS.ThirdPartyLiabi@dhhs.nh.gov NEW JERSEY – Medicaid and CHIP Medicaid Website: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/ | Phone: 800-356-1561 CHIP Premium Assistance Phone: 609-631-2392 | CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710 (TTY: 711) NEW YORK – Medicaid Website: https://www.health.ny.gov/health_care/medicaid/ | Phone: 1-800-541-2831 NORTH CAROLINA – Medicaid Website: https://medicaid.ncdhhs.gov/ | Phone: 919-855-4100 NORTH DAKOTA – Medicaid Website: https://www.hhs.nd.gov/healthcare | Phone: 1-844-854-4825 OKLAHOMA – Medicaid and CHIP Website: http://www.insureoklahoma.org | Phone: 1-888-365-3742 OREGON – Medicaid and CHIP Website: http://healthcare.oregon.gov/Pages/index.aspx | Phone: 1-800-699-9075 PENNSYLVANIA – Medicaid and CHIP Website: https://www.pa.gov/en/services/dhs/apply-for-medicaid-health-insurance-premium-payment- program-hipp.html | Phone: 1-800-692-7462 CHIP Website: Children's Health Insurance Program (CHIP) (pa.gov) | CHIP Phone: 1-800-986-KIDS (5437) RHODE ISLAND – Medicaid and CHIP Website: http://www.eohhs.ri.gov/ | Phone: 1-855-697-4347 or 401-462-0311 (Direct RIte Share Line) SOUTH CAROLINA – Medicaid Website: https://www.scdhhs.gov | Phone: 1-888-549-0820 SOUTH DAKOTA – Medicaid Website: http://dss.sd.gov | Phone: 1-888-828-0059 TEXAS – Medicaid Website: Health Insurance Premium Payment (HIPP) Program | Texas Health and Human Services Phone: 1-800-440-0493 UTAH – Medicaid and CHIP Utah’s Premium Partnership for Health Insurance (UPP) Website: https://medicaid.utah.gov/upp/ Email: upp@utah.gov | Phone: 1-888-222-2542 | Adult Expansion Website: https://medicaid.utah.gov/expansion/ Utah Medicaid Buyout Program Website: https://medicaid.utah.gov/buyout-program/ CHIP Website: https://chip.utah.gov/ VERMONT – Medicaid Website: Health Insurance Premium Payment (HIPP) Program | Department of Vermont Health Access Phone: 1-800-250-8427 VIRGINIA – Medicaid and CHIP Website: https://coverva.dmas.virginia.gov/learn/premium-assistance/famis-select or https://coverva.dmas.virginia.gov/learn/premium-assistance/health-insurance-premium-payment-hipp- programs Medicaid/CHIP Phone: 1-800-432-5924 WASHINGTON – Medicaid Website: https://www.hca.wa.gov/ | Phone: 1-800-562-3022 45 WEST VIRGINIA – Medicaid and CHIP Website: https://dhhr.wv.gov/bms/ or http://mywvhipp.com/ Medicaid Phone: 304-558-1700 | CHIP Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447) WISCONSIN – Medicaid and CHIP Website: https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm | Phone: 1-800-362-3002 WYOMING – Medicaid Website: https://health.wyo.gov/healthcarefin/medicaid/programs-and-eligibility/ | Phone: 1-800-251-1269 To see if any other states have added a premium assistance program since July 31, 2025, or for more information on special enrollment rights, contact either: U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/agencies/ebsa 1-866-444-EBSA (3272) U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Menu Option 4, Ext. 61565 ACA Disclaimer This offer of coverage may disqualify you from receiving government subsidies for an Exchange plan even if you choose not to enroll. To be subsidy eligible you would have to establish that this offer is unaffordable for you, meaning that the required contribution for employee only coverage under our base plan exceeds 9.02% in 2025 (9.96% in 2026) of your modified adjusted household income. The ‘No Surprises’ Rules The “No Surprises” rules protect you from surprise medical bills in situations where you can’t easily choose a provider who’s in your health plan network. This is especially common in an emergency situation, when you may get care from out-of-network providers. Out-of-network providers or emergency facilities may ask you to sign a notice and consent form before providing certain services after you’re no longer in need of emergency care. These are called “post-stabilization services.” You shouldn’t get this notice and consent form if you’re getting emergency services other than post-stabilization services. You may also be asked to sign a notice and consent form if you schedule certain non-emergency services with an out-of-network provider at an in-network hospital or ambulatory surgical center. The notice and consent form informs you about your protections from unexpected medical bills, gives you the option to give up those protections and pay more for out-of-network care, and provides an estimate of what your out-of-network care might cost. You aren’t required to sign the form and shouldn’t sign the form if you didn’t have a choice of health care provider or facility before scheduling care. If you don’t sign, you may have to reschedule your care with a provider or facility in your health plan’s network. View a sample notice and consent form (PDF). This applies to you if you’re a participant, beneficiary, enrollee, or covered individual in a group health plan or group or individual health insurance coverage, including a Federal Employees Health Benefits (FEHB) plan. 46 General Notice of COBRA Continuation Coverage Rights ** Continuation Coverage Rights Under COBRA** Introduction You’re getting this notice because you recently gained coverage under a group health plan (the Plan). This notice has important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This notice explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect your right to get it. When you become eligible for COBRA, you may also become eligible for other coverage options that may cost less than COBRA continuation coverage. The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end. For more information about your rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description or contact the Plan Administrator. You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees. What is COBRA continuation coverage? COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event. This is also called a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage. If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events: • Your hours of employment are reduced, or • Your employment ends for any reason other than your gross misconduct. If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events: • Your spouse dies; • Your spouse’s hours of employment are reduced; • Your spouse’s employment ends for any reason other than his or her gross misconduct; • Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or • You become divorced or legally separated from your spouse. Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying events: • The parent-employee dies; • The parent-employee’s hours of employment are reduced; • The parent-employee’s employment ends for any reason other than his or her gross misconduct; • The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both); • The parents become divorced or legally separated; or • The child stops being eligible for coverage under the Plan as a “dependent child.” 47 When is COBRA continuation coverage available? The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. The employer must notify the Plan Administrator of the following qualifying events: • The end of employment or reduction of hours of employment; • Death of the employee; or • The employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both). For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you must notify the Plan Administrator within 60 days after the qualifying event occurs. You must provide this notice to Human Resources. How is COBRA continuation coverage provided? Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuat ion coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children. COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months d ue to employment termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage. There are also ways in which this 18-month period of COBRA continuation coverage can be extended: Disability extension of 18-month period of COBRA continuation coverage If you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage, for a maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage. Second qualifying event extension of 18-month period of continuation coverage If your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if the Plan is properly notified about the second qualifying event. This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies; becomes entitled to Medicare benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the dependent child stops being eligible under the Plan as a dependent child. This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred. Are there other coverage options besides COBRA Continuation Coverage? Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicare, Medicaid, Children’s Health Insurance Program (CHIP), or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov. 48 Can I enroll in Medicare instead of COBRA continuation coverage after my group health plan coverage ends? In general, if you don’t enroll in Medicare Part A or B when you are first eligible because you are still employed, after the Medicare initial enrollment period, you have an 8-month special enrollment period1 to sign up for Medicare Part A or B, beginning on the earlier of • The month after your employment ends; or • The month after group health plan coverage based on current employment ends If you don’t enroll in Medicare and elect COBRA continuation coverage instead, you may have to pay a Part B late enrollment penalty and you may have a gap in coverage if you decide you want Part B later. If you elect COBRA continuation coverage and later enroll in Medicare Part A or B before the COBRA continuation coverage ends, the Plan may terminate your continuation coverage. However, if Medicare Part A or B is effective on or before the date of the COBRA election, COBRA coverage may not be discontinued on account of Medicare entitlement, even if you enroll in the other part of Medicare after the date of the election of COBRA coverage. If you are enrolled in both COBRA continuation coverage and Medicare, Medicare will generally pay first (primary payer) and COBRA continuation coverage will pay second. Certain plans may pay as if secondary to Medicare, even if you are not enrolled in Medicare. For more information visit https://www.medicare.gov/medicare-and-you. If you have questions Questions concerning your Plan, or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For more information about your rights under the Employee Retirement Income Security Act (ERISA), including COBRA, the Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.) For more information about the Marketplace, visit www.HealthCare.gov. Keep your Plan informed of address changes To protect your family’s rights, let the Plan Administrator know about any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator. Plan contact information Name of Entity: City of Pasco Contact-Position/Office: Sara Matzen Address: 525 N Third Avenue, Pasco, WA 99301 Phone Number: (509) 545-3473 Notes City of Pasco 2026 Benefit Summary Notes City of Pasco 2026 Benefit Summary 39