2027 City of Downey Employee Benefits Information Guide by downeyca

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TABLE OF CONTENTS Benefit Highlights ............................................................................................................................................ 4 Health Insurance Benefits Monthly Premiums ......................................................................................... 6 UNDERSTANDING YOUR BENEFITS ................................................................................................................................... 8 MEDICAL ........................................................................................................................................................................................ 10 DENTAL ........................................................................................................................................................................................... 12 VISION .............................................................................................................................................................................................. 13 BASIC LIFE AND AD&D INSURANCE .................................................................................................................................14 VOLUNTARY LIFE AND AD&D INSURANCE (OPTIONAL) .......................................................................................14 LONG-TERM DISABILITY ......................................................................................................................................................... 15 TRAVEL ASSISTANCE PROGRAM ....................................................................................................................................... 15 EMPLOYEE ASSISTANCE PROGRAM ................................................................................................................................ 15 VOLUNTARY BENEFITS ...........................................................................................................................................................16 Pet Insurance ..................................................................................................................................................................16 Optional Insurance provided through AFLAC. ................................................................................................16 Wellness Program ........................................................................................................................................................16 Deferred Compensation ............................................................................................................................................ 17 ScholarShare 529 – College Savings Plan .......................................................................................................... 17 Professional Development ........................................................................................................................................ 17 Tuition Reimbursement Program .......................................................................................................................... 17 Team Downey Store .................................................................................................................................................... 17 Electric Charging Stations ........................................................................................................................................ 18 Rideshare Program ...................................................................................................................................................... 18 FLEXIBLE SPENDING ACCOUNTS ...................................................................................................................................... 18 CONTACTS .....................................................................................................................................................................................19 Human Resources Department ..............................................................................................................................19 Medical Benefits .......................................................................................................................................................... 20 All Other Benefits ......................................................................................................................................................... 21 COMPLIANCE ............................................................................................................................................................................... 22 Paperwork Reduction Act Statement ................................................................................................... 36

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WELCOME At City of Downey our goal is to provide a comprehensive and competitive benefits program to attract and retain the best employees available. We are dedicated to building a strong organization and providing for the immediate tangible needs of our employees and their dependents. Benefit plans and elections are effective January 1, 2027 through December 31, 2027.

Benefit Highlights Medical Plans • CalPERS Health Plans • Kaiser Permanente (A/O’s Only) Dental Plans • HMO plan through MetLife o In-network benefits only o Primary Dentist required • PPO plan through Delta Dental o In & Out-of-network benefit options o Freedom to select dentists without referrals Vision Plan • Coverage through VSP o In & Out-of-network benefit options Life and AD&D Insurance • Coverage through The Standard • Protection from financial hardship for you & your beneficiaries Voluntary Life and AD&D Insurance • Coverage through The Standard • Additional protection from financial hardship for you & your beneficiaries Long Term Disability • Coverage through The Standard • Financial protection Employee Assistance Program • Coverage through The Standard • Legal, Financial, Emotional, and Health Resources available • 100% confidential - 24/7/365 • Online and telephonic resources Tuition Reimbursement Tuition and Books reimbursed up to 100% (at California State University Long Beach Rates). Maximum 12 units per semester. Pet Insurance

Flexible and affordable Pet Insurance Coverage through Nationwide’s My Pet Protection Travel Assistance • Coverage through The Standard • Domestic & International Travel 100+ miles from home o Work & Leisure Assistance 24/7/365 Flexible Spending Accounts • Coverage through The Advantage Group • Pre-tax money for eligible expenses o Healthcare Flexible Spending Account o Dependent Care Flexible Spending Deferred Compensation Income may be tax deferred through City's 457 Plan through VOYA. Age 50 Catch-Up & Pre-Retirement Catch-Up Contributions Available. Wellness Program • Employee Engagement Events • Wellness Wednesdays • Lunch and Learn Workshops • Healthy Food Options • Financial Wellness Events • Retirement Planning Workshops • Volunteer Opportunities Electric Charging Stations Free Electric Car Charging Stations available at some city sites Professional Development Comprehensive online and in-person training Rideshare Program Incentives available for use of public transportation, carpooling, walking, cycling or ride-share. College Savings Plan A 529 plan is a tax-advantaged savings and investment account designed to help people save for education expenses.

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BENEFIT ELIGIBILITY AND ENROLLMENT PROCESS Eligible Employees • All full-time employees Waiting Period • First of the month following your date of hire. Eligible Dependent Coverage • Your spouse/domestic partner and your dependent child(ren) to age 26. A mentally or physically disabled child may continue coverage with documentation from a physician that is required annually. *In order to approve dependent coverage, you may be asked to provide a valid Certificate of Marriage or Declaration of Domestic Partnership recognized by the State of California. Proof of full-time student status may be required for dental and vision. Waiving Coverage • If you are waiving medical coverage for yourself, you may be asked to provide proof of other medical coverage. • Waiving medical coverage could result in tax penalties that will be collected through federal tax returns. • Employees may waive their medical coverage and receive a monetary allowance; amounts vary depending on tier of coverage being waived. This is your opportunity to opt-out of medical coverage and receive an opt-out allowance based on qualifying alternate group medical coverage. Forms (Enrollment/Change) • You may obtain forms from Human Resources o

Changing Your Coverage • Once you make your benefit selections for the plan year, you can only make changes to your selection if there is a Qualifying Event. You must have the appropriate form completed within thirty (30) days of your date of hire. o Birth or adoption of a child o Marriage, divorce, or legal separation o Death of a spouse or child o Change in your spouse’s employment or benefit status o Open Enrollment for your spouse/domestic partner or dependent child(ren) o Moving out of the HMO’s service area • Annually you will be given the opportunity to change/update your coverage choices during Open Enrollment. All employees must re-certify their benefits each year at Open Enrollment. Update Your Information • All employees are required to submit the Employee Information & Emergency Contact Change Form when you have moved, changed phone numbers or email addresses, or have a new emergency contact. • Notify Human Resources Department if you have a change in family composition due to: o Marriage o Divorce o Birth o Adoption o Death • Review your beneficiaries for: o CalPERS o Life Insurance o Designation of Last Paycheck

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HEALTH INSURANCE BENEFITS MONTHLY PREMIUMS

Effective January 1, 2027

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HEALTH INSURANCE BENEFITS MONTHLY PREMIUMS

Effective January 1, 2027

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UNDERSTANDING YOUR BENEFITS Choosing the right health plan is probably one of the most important decisions you can make for you and your family. What’s important to you – cost, provider choice, convenience?

Considerations When Making Your Medical Plan Decision Carefully review all medical options made available for you and your family members. Variables that impact your selection normally include your dependent’s health, expected medical costs, cost of the choices and anticipated family changes. In deciding on a medical option, consider the following: •

Are your current doctors in the plan network? You’ll receive a higher level of benefits by visiting a network physician or facility

•

How often do you plan to use your medical benefits during the year? Some plans make sense if you require extensive medical care throughout the year or have a longstanding relationship with a nonnetwork provider. Others may be more cost effective with lower out-of-pocket costs if you only need routine care during the year.

•

What are the out-of-pocket costs associated with each plan? Keep in mind that depending on the plan, you may have a copay for doctor’s office visits or an annual deductible before the plan starts paying any benefits.

You can refer to the medical plan comparison charts for a snapshot on commonly used benefits and refer to the plan benefit summary or plan document for details on specific benefits. In a Health Maintenance Organization (HMO), you must designate a Primary Care Physician (PCP) for routine care and/ or referral to a specialist. If you use a provider that is not in the HMO, or if you receive care from a specialist without a referral from your PCP, you may have to pay the full cost of those services. Out-ofpocket costs are generally lower as long as your PCP coordinates all your care. In a Preferred Provider Organization (PPO), there are two kinds of providers. One is known as a preferred provider who provides their services at a negotiated discounted rate and is therefore considered “in-network.” In a PPO plan, you may also see a provider that is considered “out-of-network.” In most cases, when you see an out-of-network provider, your care will still be covered, although not at the in-network negotiated discount rate.

Terms You Should Know 1. Deductible — This is the amount you must pay each calendar year before the plan begins to pay for certain benefits. 2. Co-payment (copay) — This is the fee that you must pay under your plan each time you go to a doctor or hospital for certain services. A copay is also required for prescription drugs.

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3. Co-Insurance — This is the percentage of cost that you share with the plan provider after you have met the deductible. 4. Out-of-Pocket Maximum — The plan limits the amount of money that you will have to pay each year for covered expenses. Once you reach this dollar limit, the plan generally pays 100% of eligible expenses for the rest of the calendar year, up to the lifetime maximum. 5. Usual, Customary and Reasonable (UCR) — PPO plans pay up to a reasonable and customary amount for out-of- network services. Participants will have to pay for any expenses over the reasonable and customary amount, as determined by the insurance provider. Amounts over usual and customary do not apply to your deductible or outof- pocket calendar year maximum.

Generic, Preferred/Formulary Brand Name, and Non-Preferred/NonFormulary Brand Name Drugs The medical plans provide coverage of prescription drugs at various levels: Generic drugs have the same active chemical ingredients and therapeutic effect as their brand-name Equivalents. Though they may vary in color and shape, the Food & Drug Administration requires that they meet the same quality standards. These drugs require the lowest copay. Preferred/Non-Preferred Brand drugs are defined by each plan. This program minimizes the prescribing of specific higher- cost, lower-value prescription drugs (non-preferred medications) and redirects those prescriptions to more cost-effective medications (preferred medications). Typically, these drugs require higher copay than their generic equivalent. Non-Preferred/Non-Formulary Brand drugs are not on the preferred/formulary drug list. Some plans may cover non- preferred/non-formulary brand drugs. If your plan covers these drugs, and you and your physician agree that you should have a non-preferred/non-formulary brand drug, your copay will be higher than that of the other drugs. If you are taking an injectable drug, make sure to consider the benefit differences under each plan to make the best choice for your needs

Loss of Benefits The following circumstances may result in disqualification, or denial, loss, forfeiture, suspension, offset, reduction or recovery of any benefit that a plan participant or dependent might otherwise reasonably expect the Plan to provide: • • • • • •

An employee’s cessation of active service for the employer; A participant’s failure to pay his/her share of the cost of coverage, if any, in a timely manner; A dependent ceases to meet the Plan’s eligibility requirements (e.g., a child reaches a maximum age limit or a spouse divorces the employee); A participant or dependent is injured by a third party, and expenses for treatment may be paid by or recovered from the third party or its insurer; or A claim for benefits is not filed within the Plan’s applicable time limits. Change of status from full-time to part-time.

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MEDICAL City of Downey provides multiple medical options through CalPERS to eligible employees. You can begin to participate in the plan on the first of the month following your date of hire. Highlights include reasonable outof-pocket costs, prescription drugs, and preventive and wellness benefits. All Open Enrollment changes take effect January 1, 2027 through December 31, 2027. Note you cannot change your family coverage level without a Qualifying Life Event during the year.

CalPERS Health Plans Group Coverages DCEA Misc DCEA Maint Exec/ Mid/ Conf DPSAA DFA * Hired on or after 02/09/2017 DFMA* Hired on or after 06/28/2016 DPOA & DPMA * Hired on or after 01/02/2016

Carrier/ Third Party

Group/ Policy Number(s)

CalPERS Health Programs P.O. Box 942714, Sacramento, CA 94229-2714 www.calpers.ca.gov CalPERS Anthem Blue Cross HMO Plans (Select & Traditional) https://www.anthem.com/ca/mcr/calpers CalPERS Blue Shield of California PO Box 272540, Chico, CA 95927 https://myoptions.blueshieldca.com/calpers

PH0001

CalPERS Health Net of California https://calpers.healthnetcalifornia.com/ CalPERS Kaiser Permanente https://mybenefits.kaiserpermanente.org/calpers/ PERS Platinum, PERS Gold https://myoptions.blueshieldca.com/calpers

PH0001

https://welcome.optumrx.com/calpers/landing Sworn Only DFA DFMA DPOA DPMA and DPSAA

CalPERS Peace Officers Research Association of California (PORAC) Administered by Anthem Blue Cross & Express Scripts https://ibtofporac.org/ For eligibility issues contact: 4010 Truxel Road, Sacramento, CA 95834 For benefit or claim information contact:

13079G

Anthem Blue Cross 21555 Oxnard Street, Woodland Hill, CA 91367 https://www.anthem.com/ *United Healthcare is no longer part of CalPERS Health Plan offerings.

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Other Medical (Ambulance Operators Only) Unit City Medical Plan *Ambulance Operators ONLY

Plan/ Website Info

Phone No.

Kaiser Permanente HMO (non-CalPERS) Member Services 800.464.4000

www.kp.org/california Group Policy Number: 100615

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DENTAL Dental coverage for City of Downey is provided by MetLife for HMO, and Dental Dental for PPO to eligible employees. The HMO plan is copay based and all services are performed or referred by your primary care dentist. The PPO plan gives you the freedom to choose any dental provider, but your out-of-pocket costs are lowest when you receive care from a Delta Dental network provider. All Open Enrollment changes take effect January 1, 2027 through December 31, 2027. Note you cannot change your family coverage level without a Qualifying Life Event during the year.

Dental Benefits General Plan Information

MetLife HMO

Network

In-Network Only

In-Network

Out-of-Network

None

$25/person

$2,000/person

$1,000

80% (Deductible waived)

70% (Deductible waived)

80%

70%

50%

Calendar Year Deductible

Unlimited

Calendar Year Maximum

N/A

Lifetime Orthodontic Maximum Diagnostic / Preventive Basic Services

Delta Dental PPO

See benefit summary See benefit summary See benefit summary

Major Orthodontia (adults and children)

See benefit summary

Note: this is a summary highlight overview only and the plan documents contain full details.

Dental Plans/ Group No

Contact

Website

HMO Plan – MetLife (KM05734816)

800-275-4638

www.metlife.com Find a dentist

PPO Plan – Delta Dental (11150)

800-765-6003

www.deltadentalins.com Find a dentist

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VISION Vision coverage for City of Downey is provided by VSP to eligible employees. You may seek treatment with any of the in-network providers. Should you opt to utilize an out-of-network provider, reimbursement for covered services will be provided. Below is a sample of covered benefits. All Open Enrollment changes take effect January 1, 2027 through December 31, 2027. Note you cannot change your family coverage level without a Qualifying Life Event during the year.

Vision Benefits General Plan Information Network

VSP In-Network

Out-of-Network

Examination (every 12 months)

$0 copay

Up to $50

Materials

$0 copay

N/A

Single Vision Lens

Covered in full

Up to $50

Bifocal Lens

Covered in full

Up to $75

Trifocal Lens

Covered in full

Up to $100

Contacts (elective) (every 12 months)

Up to $190*

Up to $105

Frames (every 24 months)

Up to $220*

Up to $70

Copay

Lenses (every 12 months)

Materials

*Increase from last year Note: this is a summary highlight overview only and the plan documents contain full details. Website: https://www.vsp.com/

Group: 30078742

Customer Service: 800.877.7195

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BASIC LIFE AND AD&D INSURANCE Life and Accidental Death and Dismemberment (AD&D) insurance is provided through The Standard at no cost to you, the employee! In the event of your passing, this coverage will pay a life benefit to the beneficiary(ies) you designate.

•

Basic Life Insurance: Financial protection for your loved ones in the event of your death. Coverage amounts vary by employee class, with up to $100,000 for eligible employees. Benefit Amounts: o Management - $100,000 o Sworn Police and Fire - $100,000 o All other active members $50,000 Basic AD&D Insurance: Provides additional financial support in case of accidental death or certain injuries.

•

Accelerated Death Benefit: If diagnosed with a terminal illness, you may access a portion of your life insurance benefit while living. Life Services Toolkit: Access online tools for estate planning, financial management, health and wellness, identity theft prevention, and funeral arrangements. Beneficiaries also receive grief support, legal and financial counseling, and assistance with funeral planning.

See your Certificate of Coverage for benefit amount o Additional benefit if passing is the result of an accident Website: www.standard.com

Group: 643009

Customer Service: 800.628.8600

VOLUNTARY LIFE AND AD&D INSURANCE (OPTIONAL) Voluntary life and AD&D insurance is provided through The Standard. You may elect coverage for yourself, spouse, and/or child(ren). For spouse and child(ren) coverage you must also have employee coverage. At your initial hire, you may elect up the guaranteed issue (GI) amount for your and your spouse with no evidence of insurability (EOI) questions. Any amount over the GI or if you elect coverage after your initial hire date, an EOI must be submitted for approval of coverage. *NEW – You will automatically be enrolled in AD & D Insurance when purchasing Voluntary Life Insurance. Initial Guarantee Issue • Employee $300,000 • Spouse $50,000 • Child(ren) $10,000 Minimum Elections/Increments • Employee $10,000 • Spouse $5,000 • Child(ren) $2,500 Maximum Elections/Increments • Employee $750,000 • Spouse 100% of employee election up to $500k • Child(ren) $10,000

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LONG-TERM DISABILITY City of Downey offers long-term income protection through The Standard to non-safety members in the event you become unable to work due to a non-work-related illness or injury. This benefit covers 60% of your monthly base salary up to $5,000/month. Benefit payments begin after 60 days of disability. Please see the summary plan description for complete plan details.

• • • •

Income Protection: If you become disabled and unable to work, this insurance provides a monthly benefit to help replace lost income. Eligibility: Active employees working at least 30 hours per week are eligible. Waiting period and benefit amounts are detailed in the booklet. Additional Features: Includes living benefit, rehabilitation plan, work incentive, survivor benefits, and premium waiver during disability. City provides Long Term Disability to Management/ Confidential/ Exempt, DPSAA, DFMA, DPMA, IBEW Misc. & Maintenance Groups. All other groups, please consult your unit boards.

TRAVEL ASSISTANCE PROGRAM The Travel Assistance Program is provided through The Standard at no cost to you, the employee! Assistance for you or your family when you are 100+ miles away from home for either personal or business reasons 24/7/365. Services • Transportation home • Emergency evacuation • Prescription replacement • Stolen items assistance • Transport of unattended children or pets Mobile App: Download the Assist America app for onetouch access to emergency services, travel alerts, and embassy locator. Group ID: D2STD Activation Code: 181002 Customer Service: 866.872.1414

EMPLOYEE ASSISTANCE PROGRAM The Employee Assistance Program is provided through The Standard at no cost to you, the employee! Round the clock service that helps employees and their families balance the demands of work, life and personal issues. Services are 100% confidential. Services • 6 face-to-face counseling visits (per issue) • Unlimited phone consultations • Legal services • Financial services • 24/7 ID recovery • Child/elder/pet care resources • Health, fitness, wellness resources • Beneficiary support Email: answers@HealthAdvocate.com

Customer Service: 877.851.1631

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VOLUNTARY BENEFITS Pet Insurance My Pet Protection Choice® is a flexible and affordable pet insurance plan that provides coverage for a wide range of veterinary services, including: • Accidents and injuries • Common and serious illnesses • Hereditary and chronic conditions • Diagnostics and testing • Surgeries and hospitalizations • And more! Visit PetsNationwide.com enter City of Downey or call 877.738.7874

Optional Insurance provided through AFLAC. Accident Plan Accident coverage provides cash benefits for qualifying accident losses. It can help pay for out-of-pocket medical costs, costs that may not be covered under your medical plan, or daily expenses. You may elect coverage for yourself as well as your spouse and/or child(ren). Critical Illness Plan Critical Illness provides a lump-sum cash benefit to help pay for unexpected costs. You decide how to use the benefits: Help pay for out-of-pocket medical costs, prescriptions, hospital bills, daily expenses, rent, food or transportation. Cash benefit is paid directly to you in a lump-sum, tax-free payment. Hospital Indemnity Plan Hospital Indemnity provides a lump-sum cash benefit to help pay for costs that can come with a hospital stay that your health plan doesn’t cover. This plan covers hospitalization for normal pregnancy from day one with no waiting period. Use this coverage to help pay for out-of-pocket medical costs or daily expenses. Cash benefit is paid directly to you in a lump-sum, tax-free payment. AFLAC Representative: Jill Krenkler 760.473.8023 jill_krenkler@us.aflac.com AFLAC Customer Service: 800.992.3522 FAX: 877.442.3522 Group No. LAX34

Wellness Program • • • •

Employee Engagement Events Wellness Wednesdays Lunch and Learn Workshops Healthy Food Options

• • •

Financial Wellness Events Retirement Planning Workshops Volunteer Opportunities

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VOLUNTARY BENEFITS (continued) Deferred Compensation Income may be tax deferred through City's 457 Plan through VOYA. Age 50 Catch-Up & Pre-Retirement CatchUp Contributions Available. Website: enroll.voya.com VOYA Financial Services Representative: Ryan Mayer 323.666.3961 rmayer@voyafa.com Unlock financial confidence with the Voya Learn Library’s quick, easy resources— from budgeting to benefits and retirement planning—to help you make informed, empowered decisions about your financial future. Start exploring today! https://www.voya.com/individuals/learn

ScholarShare 529 – College Savings Plan Employees are able to set up a College Savings 529 Plan and contribute via payroll deduction. Visit www.downeyca.org/employees (Financial Wellness) for details and information. Scholarshare 529 Representative: Heath Polzer https://www.scholarshare529.com/appointments https://www.scholarshare529.com/

Professional Development We offer a range of professional development opportunities including a comprehensive online training library from Vector Solutions, a variety of live and on-demand webinars, customized on-site training, specialized Gateway Consortium Supervisor Training, and access to extensive online courses through LinkedIn Learning and Coursera. Vector Solutions app.targetsolutions.com/downeyca Contact Human Resources for professional development schedule at 562.904.7292 or mrivas@downeyca.org.

Tuition Reimbursement Program Full Time Employees in pursuit of educational advancement to enhance their career in local government are eligible for Tuition Reimbursement. Visit www.downeyca.org/employees (Professional Development) for details or contact Human Resources at 562.904.7292.

Team Downey Store Your 24/7 Team Downey Employee Store and show your Downey Pride by scoring the latest city swag and accessories! Human Resources has some sizing samples. Check in before ordering. https://cityofdowney.axomo.com/

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VOLUNTARY BENEFITS (continued) Electric Charging Stations Employees are eligible for Free Charging. Visit www.downeyca.org/employees (Volunteer Benefits) for charging locations and access credentials. Contact jguerrero@downeyca.org or ext. 6726

Rideshare Program Employees are eligible to receive incentives if they carpool to work at least 51% of their commute. Visit www.downeyca.org/employees (Volunteer Benefits) for guidelines. Contact 562.904.7265 to enroll.

FLEXIBLE SPENDING ACCOUNTS A Flexible Spending Account (FSA) is a special account you put PRE-TAX money into that you use to pay for out of pocket eligible health care expenses OR for qualified dependent care expenses. You don't pay taxes on this money when it comes out of your paycheck, and you don’t pay taxes when you use this money. This means you'll save an amount equal to the taxes you would have paid on the money you set aside into your FSA account. Most folks will find this is generally a savings of around 20-30% in taxes that can be used on qualified expenses instead of having that money go towards taxes. Be aware that you can’t “double dip”, meaning that FSA expenses cannot also be claimed on your taxes. And if you participate in the Dependent Care FSA, you may not also claim the Dependent Care tax credit on your income taxes. There are 2 types of FSA Accounts -- one type, called a “Healthcare FSA” is used for eligible health care expenses; the other type, called a “Dependent Care FSA” is used for qualified dependent care expenses. If you choose to participate, you may have either or both of these FSA account types. Expenses must be incurred within the plan year. 1.

Healthcare FSA o Examples of eligible healthcare expenses include prescription copays, office visit copays, health insurance deductibles, orthodontia expenses, fertility treatments, some over the counter items and much, much more.

Dependent Care FSA o Examples of eligible dependent care expenses include before and after school care, babysitting, child or elder daycare, summer day camp and preschool.

How much can I put into an FSA Account? The IRS sets limits each year on FSA Accounts, as listed below. • Healthcare FSA 2026 Limit $3,400 • Dependent Care FSA 2026 Limit $7,500 *2027 IRS Limits will be updated by November 2026. All employees opting for maximum benefit will be adjusted accordingly unless otherwise requested. Be sure to estimate your annual expenses and make your contributions carefully. Anything over $660 left unspent at the end of the year in the Healthcare FSA is forfeited, and any amount left in the DCFSA at the end of the year is forfeited. If you terminate employment, and still have money left in your FSA account, you have 90 days from the date of termination to submit receipts for reimbursement. The Advantage Group Customer Service 877.506.1660 Group: TAGCTYDOWNY https://www.enrollwithtag.com/ NOTE: FSA elections cannot be changed, added or cancelled until the 1st of the next plan year, unless you have a Qualifying Event such as marriage, birth, day care provider change, etc. and you notify HR within 30 days of the event.

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CONTACTS Human Resources Department The mission of the Human Resources Department is to recruit, develop and retain a diverse, well-qualified and professional workforce that reflects the high standards of the community we serve. The Human Resources Department also provides a wide range of services to City staff through the following areas: Employee Benefits • Disability Claims Administration • Employee Benefits Administration • Workers' Compensation Program Administration Employee and Labor Relations • Employee Training & Development • Employee Engagement • Classification and Compensation • Discipline and Grievances • Leave Program • Memoranda of Understanding Administration • Performance Evaluations • Policies & Resolutions Recruitment & Selection • Job Descriptions and Salary Schedules • Open Recruitments (Full-Time and Temporary/Part-Time) • Promotional Recruitments Human Resources is here to help you whether you are an existing employee, retiree or interested in pursuing a career with the City of Downey. If you have any questions, please contact us at the information below. Additionally, please visit www.downeyca.org/employees

Benefits Administration

Phone No.

Website/Email

Maria Rivas Human Resources Manager

562-904-7292

mrivas@downeyca.org

Angela Ainsworth Human Resources Specialist

562-904-7292

aainsworth@downeyca.org

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CONTACTS (continued) Medical Benefits Group Coverages For Units

Carrier/ Third Party

Group/ Policy Number(s)

Additional Assistance

CalPERS Health Programs P.O. Box 942714, Sacramento, CA 94229-2714

Member Services

www.calpers.ca.gov

P (888) 225-7377

DPSAA

CalPERS Anthem Blue Cross HMO Plans (Select & Traditional)

Member Services

DFA * Hired on or after 02/09/2017 DFMA* Hired on or after 06/28/2016

https://www.anthem.com/ca/mcr/calpers

P (855) 839-4524

CalPERS Blue Shield of California PO Box 272540, Chico, CA 95927

Member Services

https://myoptions.blueshieldca.com/calpers

P (800) 334-5847

DCEA Misc DCEA Maint Exec/ Mid/ Conf

DPOA & DPMA * Hired on or after 01/02/2016

PH0001

CalPERS Health Net of California

Member Services

https://calpers.healthnetcalifornia.com/

P (888) 926-4921

CalPERS Kaiser Permanente

Member Services

https://mybenefits.kaiserpermanente.org/calper s/

P (800) 4644000

PERS Platinum, PERS Gold https://myoptions.blueshieldca.com/calpers

Sworn Only DFA DFMA DPOA DPMA and DPSAA

Member Services PH0001

P (800) 405-2127

https://welcome.optumrx.com/calpers/landing

Included Health

CalPERS Peace Officers Research Association of California (PORAC) Administered by Anthem Blue Cross & Express Scripts

PORAC Member Services

https://ibtofporac.org/

P (800) 655-6397

For eligibility issues contact: 4010 Truxel Road, Sacramento, CA 95834 For benefit or claim information contact:

13079G

CalPERS (888) 225-7377

Anthem Blue Cross 21555 Oxnard Street, Woodland Hill, CA 91367 https://www.anthem.com/ *United Healthcare is no longer part of CalPERS Health Plan offerings.

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CONTACTS (continued) All Other Benefits Plan Name (Group or Policy Number)

Phone No.

Website/Email

HMO Plan – MetLife (KM05734816)

800-275-4638

www.metlife.com

PPO Plan – Delta Dental (11150)

800-765-6003

www.deltadentalins.com

800-877-7195

www.vsp.com

800-628-8600

www.standard.com

800-368-1135

www.standard.com

800-872-1414

medservices@assistamerica.com

877-851-1631

www.healthadvocate.com/standard6

800-992-3522

www.aflac.com

951-506-1660

www.enrollwithtag.com

Dental

Vision VSP (30078742) Basic and Voluntary Life/AD&D The Standard (643009) Long Term Disability The Standard (643009) Travel Assistance Assist America (D2STD) Employee Assistance Program (EAP) Health Advocate (City of Downey) Optional Insurance AFLAC (LAX34) Flexible Spending Accounts The Advantage Group (TAGCTYDOWNY) Deferred Compensation Voya Financial Services (664325)

323-666-3961

https://voyaretirementplans.com rmayer@voyafa.com

949-623-2916

https://www.scholarshare529.com/appointments

877-738-7874

www.petsnationwide.com

ScholarShare 529 College Savings Plan ScholarShare 529 Pet Insurance My Pet Protection

OTHER CONTACTS Ride Share/Commuter Incentives Electric Car Charging Stations

562-904-7265 x.6726

mvillasenor@downeyca.org jguerrero@downeyca.org

Tuition Reimbursement Program

562-904-7292

aainsworth@downeyca.org

Professional Development/ Training

562-904-7292

mrivas@downeyca.org

CITY OF DOWNEY EMPLOYEE BENEFITS INFORMATION GUIDE | 21

COMPLIANCE

Important Legal Notices Affecting Your Health Plan Coverage THE WOMEN’S HEALTH CANCER RIGHTS ACT OF 1998 (WHCRA) 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 mastectomyrelated 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.

NEWBORNS ACT DISCLOSURE - FEDERAL 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).

NOTICE OF SPECIAL ENROLLMENT RIGHTS If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, 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). In addition, 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 dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. Further, if you decline enrollment for yourself or eligible dependents (including your spouse) while Medicaid coverage or coverage under a State CHIP program is in effect, you may be able to enroll yourself and your dependents in this plan if: • coverage is lost under Medicaid or a State CHIP program; or • you or your dependents become eligible for a premium assistance subsidy from the State. In either case, you must request enrollment within 60 days from the loss of coverage or the date you become eligible for premium assistance. To request special enrollment or obtain more information, contact the person listed at the end of this summary. CITY OF DOWNEY EMPLOYEE BENEFITS INFORMATION GUIDE | 22

COMPLIANCE (continued) This group health plan believes this Anthem Blue Cross Premier HMO, Premier PPO, and Kaiser HMO plan is a “grandfathered health plan” under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that your plans may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits. Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the plan administrator at the contact information below. You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at 1-866-444-3272 or www.dol.gov/ebsa/healthreform. This website has a table summarizing which protections do and do not apply to grandfathered health plans.].

PATIENT PROTECTION MODEL DISCLOSURE HMO plans generally require 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. Until you make this designation, the HMO carrier designates one for you. For information on how to select a primary care provider, and for a list of the participating primary care providers, your HMO carrier. For children, you may designate a pediatrician as the primary care provider. You do not need prior authorization from the insurance carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in 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 your HMO carrier.

STATEMENT OF ERISA RIGHTS As a participant in the Plan you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (“ERISA”). ERISA provides that all participants shall be entitled to: Receive Information about Your Plan and Benefits • Examine, without charge, at the Plan Administrator’s office and at other specified locations, the Plan and Plan documents, including the insurance contract and copies of all documents filed by the Plan with the U.S. Department of Labor, if any, such as annual reports and Plan descriptions. • Obtain copies of the Plan documents and other Plan information upon written request to the Plan Administrator. The Plan Administrator may make a reasonable charge for the copies. • Receive a summary of the Plan’s annual financial report, if required to be furnished under ERISA. The Plan Administrator is required by law to furnish each participant with a copy of this summary annual report, if any. CITY OF DOWNEY EMPLOYEE BENEFITS INFORMATION GUIDE | 23

COMPLIANCE (continued) Continue Group Health Plan Coverage If applicable, you may continue health care coverage for yourself, spouse or dependents if there is a loss of coverage under the plan as a result of a qualifying event. You and your dependents may have to pay for such coverage. Review the summary plan description and the documents governing the Plan for the rules on COBRA continuation of coverage rights. Prudent Actions by Plan Fiduciaries In addition to creating rights for participants, ERISA imposes duties upon the people who are responsible for operation of the Plan. These people, called “fiduciaries” of the Plan, have a duty to operate the Plan prudently and in the interest of you and other Plan participants. No one, including the Company or any other person, may fire you or discriminate against you in any way to prevent you from obtaining welfare benefits or exercising your rights under ERISA. Enforce your Rights If your claim for a welfare benefit is denied in whole or in part, you must receive a written explanation of the reason for the denial. You have a right to have the Plan review and reconsider your claim. Under ERISA, there are steps you can take to enforce these rights. For instance, if you request materials from the Plan Administrator and do not receive them within 30 days, you may file suit in federal court. In such a case, the court may require the Plan Administrator to provide the materials and pay you up to $110 per day, until you receive the materials, unless the materials were not sent due to reasons beyond the control of the Plan Administrator. If you have a claim for benefits which is denied or ignored, in whole or in part, and you have exhausted the available claims procedures under the Plan, you may file suit in a state or federal court. If it should happen that Plan fiduciaries misuse the Plan’s money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a federal court. The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If you lose (for example, if the court finds your claim is frivolous) the court may order you to pay these costs and fees. Assistance with your Questions If you have any questions about your Plan, this statement, or your rights under ERISA, you should contact the nearest office of the Employee Benefits and Security Administration, U.S. Department of Labor, listed in your telephone directory or the Division of Technical Assistance and Inquiries, Employee Benefits and Security Administration, U.S. Department of Labor, 200 Constitution Avenue N.W., Washington, D.C. 20210.

CONTACT INFORMATION CONTACT INFORMATION Questions regarding any of this information can be directed to: Maria Rivas, Human Resources Manager 11111 Brookshire Avenue, Downey, CA 90241 (562) 904-7292 mrivas@downeyca.org

CITY OF DOWNEY EMPLOYEE BENEFITS INFORMATION GUIDE | 24

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

Your Information. Your Rights. Our Responsibilities.

Recipients of the notice are encouraged to read the entire notice. Contact information for questions or complaints is available at the end of the notice.

Your Rights

You have the right to: • Get a copy of your health and claims records • Correct your health and claims records • Request confidential communication • Ask us to limit the information we share • Get a list of those with whom we’ve shared your information • Get a copy of this privacy notice • Choose someone to act for you • File a complaint if you believe your privacy rights have been violated

Your Choices

You have some choices in the way that we use and share information as we: • Answer coverage questions from your family and friends • Provide disaster relief • Market our services and sell your information

Our Uses and Disclosures

We may use and share your information as we: • Help manage the health care treatment you receive • Run our organization • Pay for your health services • Administer your health plan • Help with public health and safety issues • Do research • Comply with the law • Respond to organ and tissue donation requests and work with a medical examiner or funeral director • Address workers’ compensation, law enforcement, and other government requests • Respond to lawsuits and legal actions

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

CITY OF DOWNEY EMPLOYEE BENEFITS INFORMATION GUIDE | 25

COMPLIANCE (continued) Get a copy of health and claims records • You can ask to see or get a copy of your health and claims records and other health information we have about you. Ask us how to do this. • We will provide a copy or a summary of your health and claims records, usually within 30 days of your request. We may charge a reasonable, cost-based fee. Ask us to correct health and claims records • You can ask us to correct your health and claims records if you think they are incorrect or incomplete. Ask us how to do this. • We may say “no” to your request, but we’ll tell you why in writing, usually within 60 days. Request confidential communications • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. • We will consider all reasonable requests, and must say “yes” if you tell us you would be in danger if we do not. Ask us to limit what we use or share • You can ask us not to use or share certain health information for treatment, payment, or our operations. • We are not required to agree to your request. Get a list of those with whom we’ve shared information • You can ask for a list (accounting) of the times we’ve shared your health information for up to six years prior to the date you ask, who we shared it with, and why. • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, costbased fee if you ask for another one within 12 months. Get a copy of this privacy notice You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly. Choose someone to act for you • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. • We will make sure the person has this authority and can act for you before we take any action.

CITY OF DOWNEY EMPLOYEE BENEFITS INFORMATION GUIDE | 26

COMPLIANCE (continued) File a complaint if you feel your rights are violated • You can complain if you feel we have violated your rights by contacting us using the information at the end of this notice. • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. • We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. In these cases, you have both the right and choice to tell us to: • Share information with your family, close friends, or others involved in payment for your care • Share information in a disaster relief situation If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety. • In these cases we never share your information unless you give us written permission: Marketing purposes Sale of your information

Our Uses and Disclosures

How do we typically use or share your health information? We typically use or share your health information in the following ways. Help manage the health care treatment you receive We can use your health information and share it with professionals who are treating you. Example: A doctor sends us information about your diagnosis and treatment plan so we can arrange additional services. Pay for your health services We can use and disclose your health information as we pay for your health services. Example: We share information about you with your dental plan to coordinate payment for your dental work. Administer your plan We may disclose your health information to your health plan sponsor for plan administration. Example: Your company contracts with us to provide a health plan, and we provide your company with certain statistics to explain the premiums we charge. Run our organization • We can use and disclose your information to run our organization and contact you when necessary. • We are not allowed to use genetic information to decide whether we will give you coverage and the price of that coverage. This does not apply to long term care plans. CITY OF DOWNEY EMPLOYEE BENEFITS INFORMATION GUIDE | 27

COMPLIANCE (continued) Example: We use health information about you to develop better services for you. How else can we use or share your health information? We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html. Help with public health and safety issues We can share health information about you for certain situations such as: • Preventing disease • Helping with product recalls • Reporting adverse reactions to medications • Reporting suspected abuse, neglect, or domestic violence • Preventing or reducing a serious threat to anyone’s health or safety Do research We can use or share your information for health research. Comply with the law We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law. Respond to organ and tissue donation requests and work with a medical examiner or funeral director • We can share health information about you with organ procurement organizations. • We can share health information with a coroner, medical examiner, or funeral director when an individual dies. Address workers’ compensation, law enforcement, and other government requests We can use or share health information about you: • For workers’ compensation claims • For law enforcement purposes or with a law enforcement official • With health oversight agencies for activities authorized by law • For special government functions such as military, national security, and presidential protective services Respond to lawsuits and legal actions We can share health information about you in response to a court or administrative order, or in response to a subpoena. Our Responsibilities • We are required by law to maintain the privacy and security of your protected health information. • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. • We must follow the duties and privacy practices described in this notice and give you a copy of it. CITY OF DOWNEY EMPLOYEE BENEFITS INFORMATION GUIDE | 28

COMPLIANCE (continued) We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html. •

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, on our web site (if applicable), and we will mail a copy to you.

Other Instructions for Notice •

Effective September 1, 2026

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COMPLIANCE (continued) If you are receiving this electronically, you are responsible for providing a copy of this notice to any Medicare Part D-eligible dependents who are covered under the group health plan.

Important Notice from City of Downey 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 Downey 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 Downey has determined that the prescription drug coverage offered by the CalPERS plans 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.

CITY OF DOWNEY EMPLOYEE BENEFITS INFORMATION GUIDE | 30

COMPLIANCE (continued) 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 coverage will not be affected.

If you do decide to join a Medicare drug plan and drop your current City of Downey coverage, be aware that you and your dependents will 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 Downey 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 Downey changes. You also may request a copy of this notice at any time.

CMS Form 10182-CC Updated April 1, 2011 According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-0990. The time required to complete this information collection is estimated to average 8 hours per response initially, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

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COMPLIANCE (continued) 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 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. 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 1-800-772-1213 (TTY 1-800-325-0778).

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: Name of Entity/Sender: Contact--Position/Office: Address: Phone Number:

September 1, 2026 City of Downey Maria Rivas, Human Resources Manager 11111 Brookshire Avenue, Downey, CA 90241 562-904-7292

CITY OF DOWNEY EMPLOYEE BENEFITS INFORMATION GUIDE | 32

COMPLIANCE (continued) 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 1877-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 January 31, 2026. Contact your State for more information on eligibility –

ALABAMA – Medicaid

Website: http://myalhipp.com/ Phone: 1-855-692-5447

ARKANSAS – Medicaid

Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447)

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

CALIFORNIA – Medicaid

Website: Health Insurance Premium Payment (HIPP) Program http://dhcs.ca.gov/hipp Phone: 916-445-8322 Fax: 916-440-5676 Email: hipp@dhcs.ca.gov

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COLORADO – Health First Colorado (Colorado’s Medicaid Program) & Child Health Plan Plus (CHP+)

FLORIDA – Medicaid

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

Website: https://www.flmedicaidtplrecovery.com/flmedicaidtplrecover y.com/hipp/index.html Phone: 1-877-357-3268

GEORGIA – Medicaid

INDIANA – Medicaid

GA HIPP Website: https://medicaid.georgia.gov/healthinsurance-premium-payment-program-hipp Phone: 678-564-1162, Press 1 GA CHIPRA Website: https://medicaid.georgia.gov/programs/third-partyliability/childrens-health-insurance-program-reauthorizationact-2009-chipra Phone: (678) 564-1162, Press 2

IOWA – Medicaid and CHIP (Hawki)

Medicaid Website: https://dhs.iowa.gov/ime/members Medicaid Phone: 1-800-338-8366 Hawki Website: http://dhs.iowa.gov/Hawki Hawki Phone: 1-800-257-8563 HIPP Website: https://dhs.iowa.gov/ime/members/medicaida-to-z/hipp HIPP Phone: 1-888-346-9562

KENTUCKY – Medicaid

Healthy Indiana Plan for low-income adults 19-64 Website: http://www.in.gov/fssa/hip/ Phone: 1-877-438-4479 All other Medicaid Website: https://www.in.gov/medicaid/ Phone 1-800-457-4584

KANSAS – Medicaid

Website: https://www.kancare.ks.gov/ Phone: 1-800-792-4884 HIPP Phone: 1-800-766-9012

LOUISIANA – 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://kidshealth.ky.gov/Pages/index.aspx Phone: 1-877-524-4718 Kentucky Medicaid Website: https://chfs.ky.gov

MAINE – 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)

MASSACHUSETTS – Medicaid and CHIP

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: 1-800-977-6740 TTY: Maine relay 711

Website: https://www.mass.gov/masshealth/pa Phone: 1-800-862-4840 TTY: (617) 886-8102

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COMPLIANCE (continued) MINNESOTA – Medicaid

MISSOURI – Medicaid

Website: https://mn.gov/dhs/people-we-serve/children-andfamilies/health-care/health-care-programs/programs-andservices/other-insurance.jsp Phone: 1-800-657-3739

Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm Phone: 573-751-2005

MONTANA – Medicaid

NEBRASKA – Medicaid

Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP Phone: 1-800-694-3084 Email: HHSHIPPProgram@mt.gov

Website: http://www.ACCESSNebraska.ne.gov Phone: 1-855-632-7633 Lincoln: 402-473-7000 Omaha: 402-595-1178

NEVADA – Medicaid

NEW HAMPSHIRE – Medicaid

Medicaid Website: http://dhcfp.nv.gov Medicaid Phone: 1-800-992-0900

Website: https://www.dhhs.nh.gov/programsservices/medicaid/health-insurance-premium-program Phone: 603-271-5218 Toll free number for the HIPP program: 1-800-852-3345, ext. 5218

NEW JERSEY – Medicaid and CHIP

NEW YORK – Medicaid

Medicaid Website: http://www.state.nj.us/humanservices/ dmahs/clients/medicaid/ Medicaid Phone: 609-631-2392 CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710

Website: https://www.health.ny.gov/health_care/medicaid/ Phone: 1-800-541-2831

Website: https://medicaid.ncdhhs.gov/ Phone: 919-855-4100

Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/ Phone: 1-844-854-4825

NORTH CAROLINA – Medicaid

NORTH DAKOTA – Medicaid

OKLAHOMA – Medicaid and CHIP

OREGON – Medicaid

Website: http://www.insureoklahoma.org Phone: 1-888-365-3742

PENNSYLVANIA – Medicaid and CHIP

Website: http://healthcare.oregon.gov/Pages/index.aspx http://www.oregonhealthcare.gov/index-es.html Phone: 1-800-699-9075

RHODE ISLAND – Medicaid and CHIP

Website: https://www.dhs.pa.gov/Services/Assistance/Pages/HIPPProgram.aspx Phone: 1-800-692-7462 CHIP Website: Children's Health Insurance Program (CHIP) (pa.gov) CHIP Phone: 1-800-986-KIDS (5437)

Website: http://www.eohhs.ri.gov/ Phone: 1-855-697-4347, or 401-462-0311 (Direct RIte Share Line)

Website: https://www.scdhhs.gov Phone: 1-888-549-0820

Website: http://dss.sd.gov Phone: 1-888-828-0059

Website: http://gethipptexas.com/ Phone: 1-800-440-0493

Medicaid Website: https://medicaid.utah.gov/ CHIP Website: http://health.utah.gov/chip Phone: 1-877-543-7669

SOUTH CAROLINA – Medicaid TEXAS – Medicaid

SOUTH DAKOTA - Medicaid UTAH – Medicaid and CHIP

CITY OF DOWNEY EMPLOYEE BENEFITS INFORMATION GUIDE | 35

COMPLIANCE (continued) VERMONT– Medicaid

Website: Health Insurance Premium Payment (HIPP) Program | Department of Vermont Health Access Phone: 1-800-250-8427

WASHINGTON – Medicaid

VIRGINIA – Medicaid and CHIP

Website: https://www.coverva.org/en/famis-select https://www.coverva.org/en/hipp Medicaid/CHIP Phone: 1-800-432-5924

WEST VIRGINIA – Medicaid and CHIP

Website: https://www.hca.wa.gov/ Phone: 1-800-562-3022

Website: https://dhhr.wv.gov/bms/ http://mywvhipp.com/ Medicaid Phone: 304-558-1700 CHIP Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)

WISCONSIN – Medicaid and CHIP

WYOMING – Medicaid

Website: https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm Phone: 1-800-362-3002

Website: https://health.wyo.gov/healthcarefin/medicaid/programs-andeligibility/ Phone: 1-800-251-1269

To see if any other states have added a premium assistance program since January 31, 2023, 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

Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 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 20210 or email ebsa.opr@dol.gov and reference the OMB Control Number 1210-0137. OMB Control Number 1210-0137 (expires 1/31/2027)

CITY OF DOWNEY EMPLOYEE BENEFITS INFORMATION GUIDE | 36

New Health Insurance Marketplace Coverage Form Approved OMBNo.1210-0149 Options and Your Health Coverage (expires 6-30-2023) PART A: General Information When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace and employment based health coverage offered by your employer.

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. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace begins in October 2013 for coverage starting as early as January 1, 2014.

Can I Save Money on my Health Insurance Premiums in the Marketplace? You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on your household income.

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 meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain costsharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a tax credit.1

Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution -as well as your employee contribution to employer-offered coverage- is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis.

How Can I Get More Information? For more information about your coverage offered by your employer, please check your summary plan description or contact.

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.

1 An employer - sponsored 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.

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

4. Employer Identification Number (EIN)

City of Downey

95-6003508

5. Employer address

6. Employer phone number

11111 Brookshire Avenue

562-904-7292

7. City

8. State

9. ZIP code

Downey

90241

10. Who can we contact about employee health coverage at this job? Maria Rivas 11. Phone number (if different from above)

12. Email address mrivas@downeyca.org

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: As specified in the Summary Plan Description.

•

With respect to dependents: We do offer coverage. Eligible dependents are: As specified in the Summary Plan Description.

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. • An employer - sponsored 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 (Section 36 B(c)(2)(C)(ii) of the Internal Revenue Code of 1986)