2025 Benefit Guide
Plan Year Beginning January 1, 2025 – December 31, 2025
This document is an outline of the coverage provided under your employer’s benefit plans based on information provided by your company. It does not include all the terms, coverage, exclusions, limitations, and conditions contained in the official Plan Document, applicable insurance policies and contracts (collectively, the “plan documents”). The plan documents themselves must be read for those details. The intent of this document is to provide you with general information about your employer’s benefit plans. It does not necessarily address all the specific issues which may be applicable to you. It should not be construed as, nor is it intended to provide, legal advice. To the extent that any of the information contained in this document is inconsistent with the plan documents, the provisions set forth in the plan documents will govern in all cases. If you wish to review the plan documents or you have questions regarding specific issues or plan provisions, you should contact your Human Resources/Benefits Department.
Benefits Overview
City of Weatherford is committed to offering a comprehensive benefit package to all eligible employees. The complete benefits package is summarized in this guide. Please read through it to understand what is offered and consider your personal circumstances when making your elections. Your annual enrollment period will be November 11 – November 22, 2024.
Eligibility
You are your dependents are eligible for benefits on your date of hire. Your eligible dependents include:
' Spouse, Domestic Partner
» Only spouses who are not eligible for any other group health coverage may be enrolled on this plan. Spouses who are currently enrolled in another group health plan or who are eligible to be enrolled in another group health plan are not eligible to enroll in this plan. If a spouse is enrolled in this plan and becomes eligible for other group health coverage in the future, the employee must notify the City of Weatherford within thirty (30) days and the spouse must be terminated from this plan as of the earliest date of the other plan’s coverage. By enrolling a spouse in this plan, the employee certifies that the spouse does not have and is not eligible for other group health coverage elsewhere.
' Dependent Children under age 26: Children are defined as your natural children, stepchildren, legally adopted children, and children under your legal guardianship
' Disabled Dependents of any age
Qualifying Live Event
Once benefits are elected, you cannot make a change during the plan year unless you experience a qualifying life event. When one of the following events occurs, you have 30 days from the date of the event to notify Human Resources and request changes to your coverage:
' Change in your legal marital status (marriage, divorce or legal separation)
' Change in the number of your dependents (for example, through birth or adoption)
' Gain or loss of eligibility for coverage
' Entitlement to Medicare or Medicaid
Your change in coverage must be consistent with your change in status. Please direct questions regarding specific life events and your ability to request changes to Human Resources.
Terms to Know
Deductible
The amount you are required to pay each calendar year before any coinsurance payments will be made. Copays do not apply to the deductible. The deductible resets January 1 of each year.
Coinsurance
Plans pay a set percentage of the allowed amount of the covered expense. The amounts listed above reflect your responsibility up to the OOP Maximum.
In-Network OOP Maximum
The highest amount you are required to pay in copays, coinsurance and deductibles for any covered expenses performed by an in-network provider in any calendar year. OOP Maximum resets January 1 of each year.
Out-of-Network Out-of-Pocket (OOP) Maximum
The highest amount you are required to pay in copays, coinsurance and deductibles for covered expenses performed by an in or out-of-network provider in any calendar year. Using out-of-network providers may result in additional costs not included in this maximum if the provider bills more than the allowed amount. OOP Maximum resets January 1 of each year.
Preventive Care
Services include routine physical exams, certain routine test and immunizations. The plans pay 100% after any applicable copays for these services performed in-network when they are coded by the provider as preventive services and are performed in accordance with age and frequency requirements.
Usual and Customary Rates
When members use a Preferred/Participating Provider, they avoid balance billing other than applicable deductibles, coinsurance and/or copayment and out-of-pocket maximums. Reimbursement for out-of- network services may be based on a “reasonable and customary (R&C)” or “usual, customary, and reasonable (UCR)”, such as 80% of R&C or 80% of UCR, or as stated above, based on some percentage (110%-150%) of Medicare. Because there is no contract between the plan and the non-participating provider, the nonparticipating provider is not obligated to accept the plan’s allowance as “reasonable and customary” and may bill the member for any balance. Please note, these differentials can be substantial.
Medical Benefits
Administered by BlueCross BlueShield of Texas City of Weatherford offers two medical plan options with access to an extensive network of providers utilizing the Blue Choice Network.
The PPO plan has set copays for some services and a deductible and coinsurance for others. Copays do not apply toward your deductible, so you will pay copays until you reach your calendar year out-of-pocket maximum. With the HSA Plan, you pay the full negotiated cost for medical services and prescription drugs until you meet your calendar year deductible. When you meet the deductible, you and the plan share the costs (coinsurance) until you reach the calendar year out-of-pocket maximum.
Both plans cover preventative care – like routine physical exams, immunizations, and screenings – at 100% when you use in-network providers. The key difference between the two plans is the premium deducted each pay period, and your out-of-pocket costs when you need medical care.
Front Out of Pocket Costs
Health Savings Account (HSA) Not eligible to open or contribute to an HSA Eligible to open and contribute to an HSA
Calendar Year
Deductible Structure
This plan is ideal if...
January 1 – December 31
• Each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meet the family deductible.
• No single member may contribute more than their individual deductible amount toward the “Family Deductible” amount.
• You like a traditional copay structure, where you know exactly what you will pay for an office visit and prescription each time.
• You are a moderate user of medical benefits – you do not anticipate meeting your deductible and/or out-of-pocket maximum, but still anticipate several doctor’s visits.
• You have high medical expenses and expect to quickly meet your deductible and reach the out-of-pocket maximum during the year.
• You rarely use your benefits outside of preventative care and want to take advantage of an HSA where you can make tax-free contributions – and receive the Company’s contribution – to build a safety net for your family’s future healthcare expenses.
Medical Benefits
Administered by BlueCross BlueShield of Texas Network: Blue Choice Network
The chart below provides a summary of the medical coverage provided by BlueCross BlueShield of Texas. While both plans cover out-of-network provider, it is always best to use in-network providers, as your cost will be less.
All employees enrolled in the medical plan will receive a new medical ID card form BlueCross BlueShield of Texas. Your new ID card will be mailed to your home.
Visit bcbstx.com or call 800.521.2227 for a list of participating providers and/or prescription drug services.
Health Savings Account
Why should I choose a health savings account (HSA)?
An HSA is a benefit that allows you to choose how much of your paycheck you’d like to set aside, before taxes are taken out, for healthcare expenses or use as a retirement savings tool. This plan offers tax savings that a 401(k) and IRA don’t, making it a powerful option for diversifying your retirement portfolio.
It’s yours
Think of your HSA as a personal savings account. Any unspent money in your HSA remains yours, allowing you to grow your balance over time. When you reach age 65, you can withdraw money (without penalty) and use it for anything, including non-healthcare expenses.
Flexibility
Save for a rainy day. Invest for your future retirement. Or spend your funds on qualified expenses, penalty free.
Easy to use
Swipe your benefits debit card at the point of purchase. There is no requirement to verify any of your purchases. We recommend keeping any receipts in case of an IRS audit.
Smart savings
The HSA’s unique, triple-tax savings means the money you contribute, earnings from investments and withdrawals for eligible expenses are all tax-free, making it a savvy savings and retirement tool.
Investment options
You can invest your HSA funds in an interest-bearing account or our standard mutual fund lineup. Savvy investors may opt for a Health Savings Brokerage Account powered by Charles Schwab, giving you access to more than 8,500 mutual funds, stocks and bonds.
Can I enroll?
You must be enrolled in a high-deductible health plan (HDHP) in order to enroll in the HSA. You’re not eligible for an HSA if:
• You’re claimed as a dependent on someone else’s taxes.
• You’re covered by another plan that conflicts with the HDHP, such as Medicare, a medical flexible spending account (FSA) or select health reimbursement arrangements (HRAs).
• You or your spouse are contributing to a medical FSA.
What does it cover?
There are thousands of eligible items. The list includes but is not limited to:
• Copays, coinsurance, insurance premiums
• Doctor visits and surgeries
• Over-the-counter medications (first aid, allergy, asthma, cold/flu, heartburn, etc.)
• Prescription drugs
• Birthing and lamaze classes
• Dental and orthodontia
• Vision expenses, such as frames, contacts, prescription sunglasses, etc.
View our searchable list of eligible expenses at www.wexinc.com/insights/ benefits-toolkit/eligibleexpenses/
My HSA Planner
Why should I get a HSA (video)
Health Savings Account (HSA)
Administered by Wex
If you enroll in the Health Savings Account Plan (HSA), you can contribute pre-tax dollars to your health savings account up to the IRS annual maximum. Not paying taxes on these contributions can mean a savings of 15%-25% depending on your tax bracket.
An HSA account is meant to help save for medical expenses not only this year but for the future. The money in the account rolls over every year and may gain interest. You may also choose to invest the funds in your account. Should you leave the company, you can take the account with you. The money is yours.
The main requirement for opening an HSA is having a high-deductible health plan that meets IRS guidelines for the annual deductible and out-of-pocket maximum. To be an eligible individual and qualify for an HSA, you must also meet the following requirements.
' You are not covered by a non-HDHP health plan (such as a spouse’s plan) or Medicare.
' Any Medicare coverage excludes you from contributing to an HSA.
' You do not receive health benefits under TRICARE.
' You have not received Veterans Administration (VA) benefits within the past three months.
' You cannot be claimed as a dependent on another person’s tax return.
' You are not covered by a general purpose healthcare flexible spending account (FSA) or health reimbursement account (HRA).
Contributing to the HSA
You can start or stop contributions to your HSA at any time during the year. It’s important to remember to open the account as soon as your benefits are effective. You cannot use HSA funds for any expense incurred prior to opening your account. After making your initial contribution, you can use funds from the account to pay for any eligible expense. If you don’t have the money in the account at the time of service, use another form of payment and you can reimburse yourself later after adding money to your HSA account.
The Company will provide a contribution to your Health Savings Account each Plan Year, which counts toward the annual maximum. This contribution amount is based on your coverage level, as outlined above.
Dental Benefits
Administered by MetLife
Good oral care enhances overall physical health, appearance and mental well-being. Problems with the teeth and gums are common and easily treated health problems. Keep your teeth healthy and your smile bright with the City of Weatherford dental benefit plan.
To find a provider or download a generic ID card, visit www.metlife.com/mybenefits
Network: PDP Plus Network
Preventive Dental Services – Type A (2 Exams per year, cleanings, Sealants, x-rays)
Basic Dental Services – Type B (Fillings, Anesthesia, Extractions – Simple; Endontics, Periodontics)
Major Dental Services – Type C (Crowns, inlays, onlays, dentures, repairs, implants)
to Dependents under the age of nineteen (19)
at 100%;
This is a summary of the dental benefits. Late Entrant Waiting Period, Exclusions and Limitations may apply. See Plan Documents for details on how specific services are covered.
Pre-Determine Benefits
Ask your dentist to request a pre-determination of benefits for treatments with anticipated charges of $300 or more. This will confirm how much the plan will cover and what you will owe before treatment begins.
City of Weatherford
Voluntary Vision Insurance
Administered by MetLife
Regular eye examinations can not only determine your need for corrective eyewear but also may detect general health problems in their earliest stages. Protection for the eyes should be a major concern to everyone.
Service In-Network - You-Pay
VISION EXAM
– 1 PER 12 MONTHS
Comprehensive exam of vision functions and prescription of corrective eyewear
Retinal Imaging – screening used to take pictures of the inside of the eye, particularly the retina to look for possible changes.
$10 copay
Up to $39 copay
$45 allowance
Applied to the exam allowance
MATERIALS / EYEWEAR (EITHER GLASSES OR CONTACTS) – 1 PER 12 MONTHS
Single
Lined Bifocal
Lined Trifocal
Lenticular
Standard Lens Enhancement
Ultraviolet coating / polycarbonate (child)
$25 copay
Covered in Full
$30 allowance
$50 allowance
$65 allowance
$100 allowance
Applied to the allowance for applicable
Additional Lens Enhancements From $17 copay to $175 depending Up to $50 allowance Progressive Standard Up to $55 copay
Frame Allowance* Up to $130 allowance
CONTACT LENSES – 1 PER 12 MONTHS
Elective
$130 allowance
Necessary Covered in full after eyewear copay
Contact Fitting and Evaluation
$105 allowance
$210 allowance
Standard or Premium fit: Covered in full with a max copay of $60 Applied to the contact lens allowance
RATE – ACTIVE FULL-TIME EMPLOYEES
Employee Only
Employee + Family
$6.68
$20.06
*You will receive an additional 20% off any amount that you pay over your allowance. This offer is available from all participating locations except Costco. If you go to Costco for frames, the benefit will pay up to $70 allowance.
Life and Accidental Death & Dismemberment Insurance
Administered by MetLife
Life Insurance
City of Weatherford provides all full-time, benefit eligible employees with a flat $5,000 life benefit that includes accidental death and dismemberment (AD&D) insurance. This benefit is paid 100% by the City of Weatherford. It is important to inform Human Resource of your beneficiary elections.
Accidental Death & Dismemberment (AD&D) Insurance
Accidental Death & Dismemberment (AD&D) insurance provides payment to you or your beneficiaries if you lose a limb or die in an accident. City of Weatherford provides AD&D coverage in the benefit amount up to or equal to your group term life at no cost to you. This coverage is in addition to your company-paid life insurance described above.
Voluntary Life and Accidental Death & Dismemberment Insurance
Administered by MetLife
You may purchase voluntary life and AD&D insurance in addition to the company-provided coverage.
of $10,000, with the maximum amount being the lesser of 5X pay or $500,000.
Flexible Spending Accounts (FSAs)
Administered by Wex
You can save money on your healthcare and/or dependent day care expenses with an FSA. You set aside funds each pay period on a pretax basis and use them tax-free for qualified expenses. You pay no federal income or Social Security taxes on your contributions to an FSA. (That’s where the savings comes in.) Your FSA contributions are deducted from your paycheck before taxes are withheld, so you save on income taxes and have more take home pay.
Current Employees are required to make elections during Open Enrollment, if they continue would like to continue participating in the FSA plan for the following year.
Healthcare Spending Limit $3,300: Out-of-pocket medical, dental and vision care expenses can be made with pre-tax dollars up to a maximum of $3,300 per plan year. You may contribute to this account even if you nor your dependents participate in the medical, dental or vision benefit plans. A list of eligible medical expense items can be found on the IRS site under Publication 502 – Main Content: https://www.irs.gov/pub/irs-pdf/ p502.pdf
Dependent Care Spending Limit $5,000: Dependent care expenses can be made with pre-tax dollars up to a maximum of $5,000 per plan year; $2,500 if married and filing separately. Examples of dependent care expenses include the costs associated with an individual providing care either in or out of your home or nursery schools and preschool (excluding kindergarten) for children under age 13 or caring for elders.
Important: An employee covered by a High Deductible Health Plan and a Flexible Spending Account that pays or reimburses for qualified medical expenses generally cannot make contributions to a Health Savings Account (HSA). Tax consequences could result if contributions are made to an HSA. Please consult your tax advisor for further guidance.
Here’s How an FSA Works
1. You decide the annual amount (up to the annual maximum for each account) you want to contribute to either or both FSAs based on your expected healthcare and/or dependent childcare expenses.
2. Your contributions are deducted from each paycheck on a pre-tax basis, and deposited into your FSA.
3. Upon enrollment your funds will be loaded onto a debit card that provide easy reimbursement with some types of merchants. You also have the option to pay out of pocket for eligible expenses when incurred, and then submit a reimbursement claim form or file the claim online.
4. You are reimbursed from your FSA. So, you actually pay your expenses with tax-free dollars. Any money left in your account (over the carry over amount), will be forfeited after the end of the plan year, per IRS regulations.
5. Card purchases need to be verified to satisfy IRS requirements. Some purchases can be verified by the merchant at the point of sale, and other purchases will need to be verified with itemized receipts showing dates and types of service. Save your receipts!
Key Points
Be sure to choose your annual election amount carefully as you cannot change your election during the plan year, unless you have a qualified change in status.
Plan Year: January 1, 2025 – December 31, 2025
Run Out Period: 60 days from the end of the Plan Year to submit claims for reimbursement
Contact Information
Ask Your Advocate Team
Put our team to work to maximize your healthcare benefits.
Gallagher is ready to help you get the most from your benefits program by providing support from an advocate at no cost to you. Get assistance with:
1 Insurance cards
Are you missing your insurance cards, need replacement cards, or need to get in touch with an insurance carrier?
2 Benefits questions
Do you need help with specific benefits questions relating to how plans work, coverage questions, or in-network benefits?
3 Eligibility rules
Who can be covered under the plan and when?
4 Provider search
Do you need help finding an innetwork or specialty provider?
5 Prescription/pharmacy issues
Is the pharmacy telling you that your medication is not covered or charging you the full price? Do you need help getting a pre-authorization for your medication?
6 Claims
Are you unsure if your insurance will pay for a certain procedure? Did you receive a bill from a doctor and don’t know why?
Hours of Operation
Important Notices
HIPAA Special Enrollment Rights
City of Weatherford Health Plan Notice of Your HIPAA Special Enrollment Notice of Your HIPAA Special Enrollment Rights
Our records show that you are eligible to participate in the City of Weatherford Health Plan Notice of Your HIPAA Special Enrollment (to actually participate, you must complete an enrollment form and may be required to pay part of the premium through payroll deduction).
A federal law called HIPAA requires that we notify you about an important provision in the plan – your right to enroll in the plan under its “special enrollment provision” if you acquire a new dependent, or if you decline coverage under this plan for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain qualifying reasons.
Loss of Other Coverage (Excluding Medicaid or a State Children’s Health Insurance Program). If you decline enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage is in effect, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 30 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).
Loss of Coverage for Medicaid or a State Children’s Health Insurance Program. If you decline enrollment for yourself or for an eligible dependent (including your spouse) while Medicaid coverage or coverage under a state children’s health insurance program is in effect, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage. However, you must request enrollment within 60 days after your or your dependents’ coverage ends under Medicaid or a state children’s health insurance program.
New Dependent by Marriage, Birth, Adoption, or Placement for Adoption. If you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your new dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption.
Eligibility for Premium Assistance Under Medicaid or a State Children’s Health Insurance Program. If you or your dependents (including your spouse) become eligible for a state premium assistance subsidy from Medicaid or through a state children’s health insurance program with respect to coverage under this plan, you may be able to enroll yourself and your dependents in this plan. However, you must request enrollment within 60 days after your or your dependents’ determination of eligibility for such assistance.
To request special enrollment or to obtain more information about the plan’s special enrollment provisions, contact Diana Allen – Director of Human Resources at 817.598.4204 or dallen@weatherfordtx.gov
Important Warning
If you decline enrollment for yourself or for an eligible dependent, you must complete our form to decline coverage. On the form, you are required to state that coverage under another group health plan or other health insurance coverage (including Medicaid or a state children’s health insurance program) is the reason for declining enrollment, and you are asked to identify that coverage. If you do not complete the form, you and your dependents will not be entitled to special enrollment rights upon a loss of other coverage as described above, but you will still have special enrollment rights when you have a new dependent by marriage, birth, adoption, or placement for adoption, or by virtue of gaining eligibility for a state premium assistance subsidy from Medicaid or through a state children’s health insurance program with respect to coverage under this plan, as described above. If you do not gain special enrollment rights upon a loss of other coverage, you cannot enroll yourself or your
dependents in the plan at any time other than the plan’s annual open enrollment period, unless special enrollment rights apply because of a new dependent by marriage, birth, adoption, or placement for adoption, or by virtue of gaining eligibility for a state premium assistance subsidy from Medicaid or through a state children’s health insurance program with respect to coverage under this plan.
Maternity Coverage
For maternity stays, in accordance with federal law, the plan does not 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 normal delivery, or less than 96 hours following a cesarean delivery. However, federal law generally does not prevent the mother’s or newborn’s attending care provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours, as applicable). The plan cannot require a provider to prescribe a length of stay any shorter than 48 hours (or 96 hours following a cesarean delivery).
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 insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).
Women’s Health & 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 the plan. Therefore, the following deductibles and coinsurance apply:
PPO Plan (Individual: 90% coinsurance and $1,000 deductible; Family: 90% coinsurance and $2,000 deductible) HSA Plan (Individual: 90% coinsurance and $3,750 deductible; Family: 90% coinsurance and $7,500 deductible)
If you would like more information on WHCRA benefits, please call your Plan Administrator at 817.598.4204 or dallen@weatherfordtx.gov
Patient Protections Disclosure
The City of Weatherford Health Plan Notice of Your HIPAA Special Enrollment generally allows the designation of a primary care provider. You have the right to designate any primary care provider who participates in our network and who is available to accept you or your family members. For information on how to select a primary care provider, and for a list of the participating primary care providers, contact the BlueCross BlueShield of Texas at 800.521.2227 or www.bcbstx.com
For children, you may designate a pediatrician as the primary care provider. You do not need prior authorization from TML, City of Weatherford 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 our 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 TML at 800.282.5385 or www.tmlhealthbenefits.org
HIPAA Notice of Privacy Practices Reminder
Protecting Your Health Information Privacy Rights
City of Weatherford is committed to the privacy of your health information. The administrators of the City of Weatherford Health Plan Notice of Your HIPAA Special Enrollment (the “Plan”) use strict privacy standards to protect your health information from unauthorized use or disclosure.
The Plan’s policies protecting your privacy rights and your rights under the law are described in the Plan’s Notice of Privacy Practices. You may receive a copy of the Notice of Privacy Practices by contacting Diana Allen – Director of Human Resources at 817.598.4204 or dallen@weatherfordtx.gov.
Notice of Creditable Coverage
Important Notice from City of Weatherford 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 Weatherford 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 Weatherford has determined that the prescription drug coverage offered by the medical 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 15 to December 7.
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 current City of Weatherford coverage may be affected.
If you do decide to join a Medicare drug plan and drop your current City of Weatherford coverage, be aware that you and your dependents may be able to get this coverage back.
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 Weatherford 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.
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 Weatherford 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 www.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 www.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: January 1, 2025
Name of Entity/Sender: City of Weatherford
Contact: Diana Allen
Address: 303 Palo Pinto Street
Weatherford, TX 76086
Phone Number: 817.598.4208
COBRA General Notice
Model General Notice of COBRA Continuation Coverage Rights (For use by single-employer group health plans)
** 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.”
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: Diana Allen.
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 continuation 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 due 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.
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.
City of Weatherford
Diana Allen Director of Human Resources
303 Palo Pinto St.
Weatherford, Texas 76086-4202
United States
817.598.4204
1 https://www.medicare.gov/basics/get-started-with-medicare/sign-up/when-does-medicare-coverage-start
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 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 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, 2024. Contact your state for more information on eligibility.
ALABAMA – Medicaid
http://myalhipp.com
855.692.5447
ALASKA – Medicaid
The AK Health Insurance Premium Payment Program http://myakhipp.com/ | 866.251.4861
CustomerService@MyAKHIPP.com
Medicaid Eligibility: https://health.alaska.gov/dpa/Pages/default.aspx
ARKANSAS – Medicaid
http://myarhipp.com 855.MyARHIPP (855.692.7447)
CALIFORNIA – Medicaid
Health Insurance Premium Payment (HIPP) Program http://dhcs.ca.gov/hipp 916.445.8322 | Fax: 916.440.5676| Email: hipp@dhcs.ca.gov
COLORADO – Medicaid and CHIP
Health First Colorado (Colorado’s Medicaid Program) https://www.healthfirstcolorado.com
Member Contact Center: 800.221.3943 | State Relay 711 Child Health Plan Plus (CHP+) https://www.colorado.gov/pacific/hcpf/child-health-plan-plus Customer Service: 800.359.1991 | State Relay 711
Health Insurance Buy-In Program (HIBI) https://www.mycohibi.com/ HIBI Customer Service: 855.692.6442
FLORIDA – Medicaid
www.flmedicaidtplrecovery.com/flmedicaidtplrecovery.com/hipp/index.html 877.357.3268
GEORGIA – Medicaid
GA HIPP Website: https://medicaid.georgia.gov/ health-insurance-premium-payment-program-hipp 678.564.1162, Press 1
GA CHIPRA Website: https://medicaid. georgia.gov/programs/third-party-liability/ childrens-health-insurance-program-reauthorization-act-2009-chipra 678.564.1162, Press 2
INDIANA – Medicaid
Health Insurance Premium Payment Program
Family and Social Services Administration http://www.in.gov/fssa/dfr/ | 800.403.0864
All other Medicaid https://www.in.gov/medicaid/ | 800.457.4584
IOWA – Medicaid and CHIP (Hawki)
Medicaid: https://hhs.iowa.gov/programs/welcome-iowa-medicaid 800.338.8366
Hawki: https://hhs.iowa.gov/programs/welcome-iowa-medicaid/ iowa-health-link/hawki 800.257.8563
HIPP: https://hhs.iowa.gov/programs/welcome-iowa-medicaid/ fee-service/hipp 888.346.9562
KANSAS – Medicaid
https://www.kancare.ks.gov/ 800.792.4884 | HIPP Phone: 800.967.4660
KENTUCKY – Medicaid
Kentucky Integrated Health Insurance Premium Payment Program (KI-HIPP): https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspx 855.459.6328 | KIHIPP.PROGRAM@ky.gov
KCHIP: https://kynect.ky.gov | 877.524.4718
Medicaid: https://chfs.ky.gov/agencies/dms
LOUISIANA – Medicaid
www.medicaid.la.gov or www.ldh.la.gov/lahipp
888.342.6207 (Medicaid hotline) or 855.618.5488 (LaHIPP)
MAINE – Medicaid
Enrollment: https://www.mymaineconnection.gov/ benefits/s/?language=en_US
800.442.6003 | TTY: Maine relay 711
Private Health Insurance Premium: https://www.maine.gov/dhhs/ofi/ applications-forms
800.977.6740 | TTY: Maine relay 711
MASSACHUSETTS – Medicaid and CHIP
https://www.mass.gov/masshealth/pa
800.862.4840 | TTY: 711| Email: masspremassistance@accenture. com
MINNESOTA – Medicaid
https://mn.gov/dhs/health-care-coverage/ 800.657.3672
MISSOURI – Medicaid
http://www.dss.mo.gov/mhd/participants/pages/hipp.htm 573.751.2005
MONTANA – Medicaid
http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP 800.694.3084 | Email: HHSHIPPProgram@mt.gov
NEBRASKA – Medicaid
http://www.ACCESSNebraska.ne.gov
Phone: 855.632.7633 | Lincoln: 402.473.7000 | Omaha: 402.595.1178
NEVADA – Medicaid
http://dhcfp.nv.gov
800.992.0900
NEW HAMPSHIRE – Medicaid
https://www.dhhs.nh.gov/programs-services/medicaid/ health-insurance-premium-program
603.271.5218 | Toll free number for the HIPP program: 800.852.3345, ext. 15218 | Email: DHHS.ThirdPartyLiabi@dhhs. nh.gov
NEW JERSEY – Medicaid and CHIP
Medicaid: http://www.state.nj.us/humanservices/dmahs/clients/ medicaid
800.356.1561
CHIP: http://www.njfamilycare.org/index.html
800.701.0710 (TTY: 711) | Premium Assistance: 609.631.2392
NEW YORK – Medicaid
https://www.health.ny.gov/health_care/medicaid/ 800.541.2831
NORTH CAROLINA – Medicaid
https://dma.ncdhhs.gov
919.855.4100
NORTH DAKOTA – Medicaid https://www.hhs.nd.gov/healthcare
844.854.4825
OKLAHOMA – Medicaid and CHIP
http://www.insureoklahoma.org
888.365.3742
OREGON – Medicaid and CHIP
http://healthcare.oregon.gov/Pages/index.aspx
800.699.9075
PENNSYLVANIA – Medicaid and CHIP
https://www.pa.gov/en/services/dhs/apply-for-medicaid-healthinsurance-premium-payment-program-hipp.html
800.692.7462
CHIP Website: https://www.dhs.pa.gov/CHIP/Pages/CHIP.aspx CHIP Phone: 800.986.KIDS (5437)
RHODE ISLAND – Medicaid and CHIP http://www.eohhs.ri.gov
855.697.4347 or 401.462.0311 (Direct RIte Share Line)
SOUTH CAROLINA – Medicaid
http://www.scdhhs.gov
888.549.0820
SOUTH DAKOTA – Medicaid
http://dss.sd.gov
888.828.0059
TEXAS – Medicaid
https://www.hhs.texas.gov/services/financial/ health-insurance-premium-payment-hipp-program
800.440.0493
UTAH – Medicaid and CHIP
Utah’s Premium Partnership for Health Insurance (UPP) https://medicaid.utah.gov/upp/ | Email: upp@utah.gov | 888.222.2542
Adult Expansion: https://medicaid.utah.gov/expansion/ Utah Medicaid Buyout Program: https://medicaid.utah.gov/ buyout-program/ CHIP: https://chip.utah.gov/
VERMONT – Medicaid https://dvha.vermont.gov/members/medicaid/hipp-program 800.250.8427
VIRGINIA – Medicaid and CHIP
https://coverva.dmas.virginia.gov/learn/premium-assistance/ famis-select https://coverva.dmas.virginia.gov/learn/premium-assistance/ health-insurance-premium-payment-hipp-programs
Medicaid and Chip: 800.432.5924
WASHINGTON – Medicaid
https://www.hca.wa.gov/ 800.562.3022
WEST VIRGINIA – Medicaid and CHIP
https://dhhr.wv.gov/bms/ or http://mywvhipp.com/ Medicaid: 304.558.1700
CHIP Toll-free: 855.MyWVHIPP (855.699.8447)
WISCONSIN – Medicaid and CHIP
https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm 800.362.3002
WYOMING – Medicaid
https://health.wyo.gov/healthcarefin/medicaid/ programs-and-eligibility/ 800.251.1269
To see if any other states have added a premium assistance program since July 31, 2024, or for more information on special enrollment rights, contact either:
U.S. Department of Labor
Employee Benefits Security Administration
www.dol.gov/agencies/ebsa
866.444.EBSA (3272)
OMB Control Number 1210-0137 (expires 1/31/2026)
Paperwork Reduction Act Statement
U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services
www.cms.hhs.gov
877.267.2323, Menu Option 4, Ext. 61565
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 U.S.C. 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 U.S.C. 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 U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20220 or email ebsa.opr@ dol.gov and reference the OMB Control Number 1210-0137.
Marketplace Notice
Health Insurance Marketplace Coverage Options and Your Health Coverage
PART A: General Information
Even if you are offered health coverage through your employment, you may have other coverage options through the Health Insurance Marketplace (“Marketplace”). To assist you as you evaluate options for you and your family, this notice provides some basic information about the Health Insurance Marketplace and health coverage offered through your employment.
What is the Health Insurance Marketplace?
The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers “one-stop shopping” to find and compare private health insurance options in your geographic area.
Can I Save Money on my Health Insurance Premiums in the Marketplace?
You may qualify to save money and lower your monthly premium and other out-of-pocket costs, but only if your employer does not offer coverage, or offers coverage that is not considered affordable for you and doesn’t meet certain minimum value standards (discussed below). The savings that you’re eligible for depends on your household income. You may also be eligible for a tax credit that lowers your costs.
Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?
Yes. If you have an offer of health coverage from your employer that is considered affordable for you and meets certain minimum value standards, you will not be eligible for a tax credit, or advance payment of the tax credit, for your Marketplace coverage and may wish to enroll in your employment-based health plan. However, you may be eligible for a tax credit, and advance payments of the credit that lowers your monthly premium, or a reduction in certain cost-sharing, if your employer does not offer coverage to you at all or does not offer coverage that is considered affordable for you or meet minimum value standards. If your share of the premium cost of all plans offered to you through your employment is more than 9.12%1 of your annual household income, or if the coverage through your employment does not meet the “minimum value” standard set by the Affordable Care Act, you may be eligible for a tax credit, and advance payment of the credit, if you do not enroll in the employment-based health coverage. For family members of the employee, coverage is considered affordable if the employee’s cost of premiums for the lowest-cost plan that would cover all family members does not exceed 9.12% of the employee’s household income.1 2
Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered through your employment, then you may lose access to whatever the employer contributes to the employmentbased coverage. Also, this employer contribution -as well as your employee contribution to employment-based coverage- is generally excluded from income for federal and state income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis. In addition, note that if the health coverage offered through your employment does not meet the affordability or minimum value standards, but you accept that coverage anyway, you will not be eligible for a tax credit. You should consider all of these factors in determining whether to purchase a health plan through the Marketplace.
1 Indexed annually; see https://www.irs.gov/pub/irs-drop/rp-22-34.pdf for 2023.
2 An employer-sponsored or other employment-based health plan meets the “minimum value standard” if the plan’s share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs. For purposes of eligibility for the premium tax credit, to meet the “minimum value standard,” the health plan must also provide substantial coverage of both inpatient hospital services and physician services.
When Can I Enroll in Health Insurance Coverage through the Marketplace?
You can enroll in a Marketplace health insurance plan during the annual Marketplace Open Enrollment Period. Open Enrollment varies by state but generally starts November 1 and continues through at least December 15. Outside the annual Open Enrollment Period, you can sign up for health insurance if you qualify for a Special Enrollment Period. In general, you qualify for a Special Enrollment Period if you’ve had certain qualifying life events, such as getting married, having a baby, adopting a child, or losing eligibility for other health coverage. Depending on your Special Enrollment Period type, you may have 60 days before or 60 days following the qualifying life event to enroll in a Marketplace plan.
There is also a Marketplace Special Enrollment Period for individuals and their families who lose eligibility for Medicaid or Children’s Health Insurance Program (CHIP) coverage on or after March 31, 2023, through July 31, 2024. Since the onset of the nationwide COVID-19 public health emergency, state Medicaid and CHIP agencies generally have not terminated the enrollment of any Medicaid or CHIP beneficiary who was enrolled on or after March 18, 2020, through March 31, 2023. As state Medicaid and CHIP agencies resume regular eligibility and enrollment practices, many individuals may no longer be eligible for Medicaid or CHIP coverage starting as early as March 31, 2023. The U.S. Department of Health and Human Services is offering a temporary Marketplace Special Enrollment period to allow these individuals to enroll in Marketplace coverage.
Marketplace-eligible individuals who live in states served by HealthCare.gov and either submit a new application or update an existing application on HealthCare.gov between March 31, 2023 and July 31, 2024, and attest to a termination date of Medicaid or CHIP coverage within the same time period, are eligible for a 60-day Special Enrollment Period. That means that if you lose Medicaid or CHIP coverage between March 31, 2023, and July 31, 2024, you may be able to enroll in Marketplace coverage within 60 days of when you lost Medicaid or CHIP coverage. In addition, if you or your family members are enrolled in Medicaid or CHIP coverage, it is important to make sure that your contact information is up to date to make sure you get any information about changes to your eligibility. To learn more, visit HealthCare.gov or call the Marketplace Call Center at 800.318.2596. TTY users can call 855.889.4325
What about Alternatives to Marketplace Health Insurance Coverage?
If you or your family are eligible for coverage in an employment-based health plan (such as an employersponsored health plan), you or your family may also be eligible for a Special Enrollment Period to enroll in that health plan in certain circumstances, including if you or your dependents were enrolled in Medicaid or CHIP coverage and lost that coverage. Generally, you have 60 days after the loss of Medicaid or CHIP coverage to enroll in an employment-based health plan, but if you and your family lost eligibility for Medicaid or CHIP coverage between March 31, 2023 and July 10, 2023, you can request this special enrollment in the employment-based health plan through September 8, 2023. Confirm the deadline with your employer or your employment-based health plan.
Alternatively, you can enroll in Medicaid or CHIP coverage at any time by filling out an application through the Marketplace or applying directly through your state Medicaid agency. Visit https://www.healthcare.gov/medicaid-chip/getting-medicaid-chip/ for more details.
How Can I Get More Information?
For more information about your coverage offered through your employment, please check your health plan’s summary plan description or contact Diana Allen.
The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.
PART B: Information About Health Coverage Offered by Your Employer
This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application.
3. Employer name
City of Weatherford
5. Employer address
303 Palo Pinto St
7. City Weatherford
4. Employer Identification Number (EIN) 75-6000707
6. Employer phone number 817.598.4204
8. State Texas 9. ZIP code 76086-4202
10. Who can we contact about employee health coverage at this job?
Diana Allen
11. Phone number (if different from above)
12. Email address dallen@weatherfordtx.gov
Here is some basic information about health coverage offered by this employer:
' As your employer, we offer a health plan to: ; All employees. Eligible employees are: Full-Time Employees
Some employees. Eligible employees are:
' With respect to dependents: ; We do offer coverage. Eligible dependents are: Spouses and Children
We do not offer coverage.
; If checked, this coverage meets the minimum value standard, and the cost of this coverage to you is intended to be affordable, based on employee wages.
**Even if your employer intends your coverage to be affordable, you may still be eligible for a premium discount through the Marketplace. The Marketplace will use your household income, along with other factors, to determine whether you may be eligible for a premium discount. If, for example, your wages vary from week to week (perhaps you are an hourly employee or you work on a commission basis), if you are newly employed mid-year, or if you have other income losses, you may still qualify for a premium discount.
If you decide to shop for coverage in the Marketplace, HealthCare.gov will guide you through the process. Here's the employer information you'll enter when you visit HealthCare.gov to find out if you can get a tax credit to lower your monthly premiums.
This benefits guide prepared by
