Employee Benefits Guide
A comprehensive guide to understanding your employee benefits program
Plan Year 2026/2027
What’s Inside Introduction
We know you work hard every day to achieve your personal and professional goals. Since your health and wellness are key to meeting these goals, we are pleased to offer a comprehensive benefits package that supports your health, mind and body. May you always be Working Towards Wellness!
If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, federal law gives you more choices for your prescription drug coverage. Please see Important Notices for more details.
Read this guide learn more about these and other benefits. You may only enroll for or make changes to your benefits during Open Enrollment (OE), or when you have a Qualifying Life Event (QLE) (see page 5).
Your Benefits Plan Year: July 1, 2026 through June 30, 2027
Availability of Summary Health Information
Your benefits program offers two medical coverage options. To help you make an informed choice, review each plan’s Summary of Benefits and Coverage documents, which are available in Employee Navigator and www.mprbenefits.com.
Important Contacts
Eligibility
Who is Eligible for Benefits
Eligibility
Enrollment
Coverage Begins
Regular, full-time employee
• Working an average of 30 hours per week
• Enroll by the deadline given by Human Resources
• Benefits begin on the first of the month following or coinciding with your hire date.
Qualifying Life Events
Regular, full-time employee
• Working an average of 30 hours per week
• Enroll during OE or when you have a QLE
• OE: Start of the plan year
• QLE: Ask Human Resources
Dependent(s)
• Your legal spouse Child(ren) under age 26 regardless of student, dependency, or marital status
• Child(ren) over age 26 who are fully dependent on you for support due to a mental or physical disability and who are indicated as such on your federal tax return
• You must enroll the dependent(s) at OE or for a QLE
• When covering dependents, you must enroll for and be on the same plans
• Based on OE or QLE effective dates
You may only change coverage during the plan year if you have a QLE such as:
Undergoing FMLA, COBRA event, court judgment or decree
Becoming eligible for Medicare, Medicaid, or
Receiving a Qualified Medical Child Support Order
or
Significant change in cost of spouse’s
How to Enroll
Employee Navigator
FIRST-TIME
USERS
Go to www.employeenavigator.com.
1. If this is your first time to log in, click Register. Once you register, use your username and password to log in.
2. Enter your personal information and company identifier City of Ozark and click Next
3. Create a username (work email address recommended) and password, then check the I agree to terms and conditions box before you click Finish.
4. If you used an email address as your username, you will get a validation email to that address to log in and begin the step-by-step enrollment process.
RETURNING USERS
Go to www.employeenavigator.com
1. Click Start Here
2. Confirm or update your personal information and click Save & Continue.
3. Edit or add dependents, if needed, then click Save & Continue.
4. Follow the steps on the screen for each benefit to select or decline coverage. To decline coverage, click Don’t want this benefit? and select the reason for declining.
5. When you finish making your benefit elections, review the summary of your selections. If they are correct, click the Click to Sign button to complete and submit your enrollment choices. Your enrollment will not be complete until you click the Click to Sign button.
MPR
FIRST-TIME
USERS
Go to www.mprbenefits.com.
1. If this is your first time to log in, click Register. Once you register, use your username and password to log in.
2. Enter your personal information and company identifier MPR and click Next
3. Create a username (work email address recommended) and password, then check the I agree to terms and conditions box before you click Finish.
4. If you used an email address as your username, you will get a validation email to that address to log in and begin the step-by-step enrollment process.
RETURNING USERS
Go to www.mprbenefits.com
1. Click Start Here
2. Confirm or update your personal information and click Next.
3. Edit or add dependents, if needed, then click Save & Continue.
4. Follow the steps on the screen for each benefit to select or decline coverage.
5. When your enrollment is complete, you will receive a confirmation number, and the option to Print Your Benefit Summary. Your To Do list will notify you if you have any additional actions needed to complete your enrollment.
Medical Coverage
Medical Provider:
UMR: Midwest Public Risk (MPR) Network:
UnitedHealthcare Choice Plus (includes Cox and Mercy providers)
About This Coverage
You have a choice of two medical plans:
• Base Plan with HSA – This QHDHP plan has a $1,700 individual and a $3,400 family in-network deductible.
• Buy-Up Plan – This PPO plan has a $1,000 individual and a $3,000 family in-network deductible.
Qualified High Deductible Health Plan
A Qualified High Deductible Health Plan (QHDHP) allows you to see any provider when you need care, and you will pay less for care when you go to in-network providers. In exchange for a lower per-paycheck cost for medical benefits, you must satisfy a higher plan deductible that applies to almost all health care expenses, including prescription drugs. If you enroll in the HDHP, you may be eligible to open a Health Savings Account (HSA — see page 16).
Preferred Provider Organization
A Preferred Provider Organization (PPO) plan allows you to see any provider when you need care. When you see in-network providers for care, you will pay less and get the highest level of benefits. You will pay more for care if you use out-of-network providers. When you see innetwork providers, your office visits, urgent care visits, and prescription drugs are covered with a copay, and most other network services are covered at the deductible and coinsurance level.
Medical Benefits Summary
Prescription Drugs
Your MPR coverage includes prescription benefits for retail, mail order (home delivery), and specialty drugs.
Carrier:
CVS Caremark
Prescription Drug List
MPR controls prescription drug costs by negotiating discounts on medications. Covered drugs are listed in the Prescription Drug List. If you take maintenance medications, review the list with your doctor to see which ones are covered and available. If your medication is not listed, call the phone number on your CVS Pharmacy ID card.
RETAIL
Members can fill a 30-day supply at any pharmacy in the CVS/Caremark network; however, 90-day supplies are only available through CVS Retail Pharmacies or CVS Mail Order Pharmacy.
HOME DELIVERY
If you take medication on a daily basis, consider using home delivery. It is a convenient, low-cost option that delivers up to a 90-day supply right to your home. You will need to set up an online pharmacy account and/or download the app to easily manage your prescriptions.
SPECIALTY
If you need a specialty drug to treat a complex or chronic condition, you will be asked to enroll in a specialty drug program. It offers support to ensure the medication works well for you and costs as little as possible. If you do not enroll in the program, the specialty drug may not be covered. Certain exclusions and limitations apply. Visit www.cvsspecialty.com or call 800-237-2767 for more information.
Sign Up for Home Delivery
Visit www.caremark.com . Call 888-964-0090 .
Download the CVS Caremark app.
PrudentRx Copay Assistance
PrudentRx is only available on the Copay 1000 plan and helps reduce or eliminate your out-of-pocket costs for eligible specialty medications. The program works with drug manufacturers to secure available copay assistance on your behalf. When enrolled, you’ll pay $0 out-of-pocket for medications on your plan’s specialty drug list filled through CVS Specialty, as well as select high-cost limited distribution drugs (LDDs), as outlined in the PrudentRx Copay Program drug list.
• Visit www.cvsspecialty.com
• Call 800-237-2767.
MPR Resources
UMR Member Portal
Access your plan details at www.umr.com, your personalized member website. Once you register for an account, you can:
• Find care and compare costs for in-network providers and services
• Check your plan balances, view your claims and access your health plan ID card
• Access wellness programs and view clinical recommendations
• Get 24/7 access to board-certified doctors via virtual visits
Mobile App
Download the UMR | Health app to:
• Find nearby in-network care
• See your claim details and view progress toward your deductible
• View and share your health plan ID card with your doctor’s office
• Video chat with a doctor 24/7 via virtual visits
Visit www.umr.com to learn more.
Health Navigator
Sun Life Health Navigator provides personalized health care guidance and advocacy to help members confidently navigate the health care system. Through dedicated Care Advisors and a team of medical experts, members receive support with understanding diagnoses, finding top specialists, obtaining expert second opinions, coordinating care, and evaluating treatment options. Powered by PinnacleCare, Health Navigator helps employees access the right care at the right time.
• Visit www.sunlife.com/healthnav
• Call 888-352-4969 (Monday-Friday, 7:00 a.m. to 5:00 p.m. CT).
MPR Resources
UMR Rewards
Live Well Reward$ is a part of the MPR Wellness Program. Using this program will assist you in getting healthy and staying healthy. Employees will be eligible for MPR’s rafflebased incentive platform.
With Live Well Reward$, employees on an MPR Plan can earn points towards incentives by getting involved in wellness activities, including:
• Getting a preventive care exam
• Completing a biometric screening
• Completing an online Health Assessment
• Participating in MPR or UMR Wellness Challenges Register for Live Well Reward$ at www.umr.com
Weight Loss Programs
Real Appeal is a free online weight loss program that provides personal coaching to help you and eligible family members lose weight and keep it off. On average, participants lose 10 pounds after attending just four online sessions.
• One-on-one Coaching
Get help staying on track to reach your goals with online, coach-led group sessions.
• $0 Out-of-pocket
Real Appeal is offered at no additional cost as part of your health plan benefits.
• Success Kit
Get scales, recipes, fitness equipment, and more delivered to your door.
Learn more and start today at https://success.realappeal.com .
Nourish is a virtual weight management and nutrition program that connects members with a Registered Dietitian for personalized, evidence-based support. Nourish is designated as an in-network provider through the UMR/ UHC Choice Plus Network and offers convenient telehealth appointments and ongoing messaging between visits. Members receive customized nutrition plans, coaching, and lifestyle guidance designed to promote sustainable weight loss and long-term health improvements.
Get started at www.nourish.com .
Joint and Muscle Pain Management
Hinge Health can help relieve your joint and muscle pain with personalized exercise therapy – at no cost to you! Your remote care may be done in the comfort of your own home. Get unlimited one-on-one health coaching and free motion-tracking technology for form correction. Average results show 68% pain reduction. Learn more and apply by emailing free@tcnavigator.com or calling 423-824-2273 . Also available in Spanish.
Women’s Health Needs
Visana Health provides virtual, whole-person women’s health care designed to support employees through every stage of life. Members receive personalized care from a multidisciplinary team of women’s health specialists who address concerns such as menopause and hormonal health, gynecological conditions, reproductive health, preventive care, and related chronic conditions. Through extended virtual appointments, evidence-based treatment plans, and ongoing clinical support, Visana Health helps members better understand their symptoms, access timely care, and take control of their long-term health and well-being. Visit https://go.visanahealth.com/um .
WORKING TOWARDS REWARDS
Telemedicine
Allows 24/7/365 access to board-certified doctors from your mobile phone or computer.
Your medical coverage offers virtual visit services through Teladoc . Connect anytime day or night with a boardcertified doctor via your mobile device or computer for free or for the same cost than a visit to your regular physician.
While a virtual visit does not replace your primary care physician, it is a convenient and cost-effective option when you need care and:
• Have a non-emergency issue and are considering an after hours health care clinic, urgent care clinic, or emergency room for treatment
• Are on a business trip, vacation, or away from home
• Are unable to see your primary care physician
When to Use Telemedicine
Use virtual visits for minor conditions such as:
• Sore throat
• Headache
• Stomachache
• Cold/Flu
• Mental health issues
• Allergies
• Fever
• Urinary tract infections
• Dermatology
Do not use virtual visits for serious or life-threatening emergencies.
Telemedicine visits are covered when you use a Teladoc provider at www.umr.com, www.teladoc.com, or through the Teladoc Health app.
Registration is Easy
Register with Teladoc so you are ready to use this valuable service when and where you need it.
Visit www.teladoc.com Call 800-835-2362
Download the Teladoc app
Did You Know?
Your regular provider may offer telemedicine services, so it is best to ask now and know what your options are before you need care. Costs may differ from Teladoc services.
Health Care Options
Becoming familiar with your options for medical care can save you time and money. Health Care Provider
Non-Emergency Care
Access to care via phone, online video, or mobile app whether you are home, work, or traveling; medications can be prescribed
Virtual Visits
24 hours a day, 7 days a week
Generally, the best place for routine preventive care; established relationship; able to treat based on medical history
Doctor’s Office
Office hours vary
Usually lower out-of-pocket cost than urgent care; when you can’t see your doctor; located in stores and pharmacies
Retail Clinic
Hours vary based on store hours
When you need immediate attention; walk-in basis is usually accepted
Generally includes evening, weekend, and holiday hours
Urgent
Care
Life-threatening or critical conditions; trauma treatment; multiple bills for doctor and facility
24 hours a day, 7 days a week
Services do not include trauma care; can look similar to an urgent care center, but medical bills may be 10 times higher
24 hours a day, 7 days a week
• Allergies Cough/cold/flu
• Rash
• Stomachache
• Infections Sore and strep throat
• Vaccinations
• Minor injuries/sprains/strains
• Common infections Minor injuries
• Pregnancy tests
• Vaccinations
15 minutes
• Sprains and strains
• Minor broken bones Small cuts that may require stitches
• Minor burns and infections
• Chest pain
• Difficulty breathing
• Severe bleeding
• Blurred or sudden loss of vision
• Major broken bones
• Most major injuries except trauma
• Severe pain
4+ hours
Varies
Note: Examples of symptoms are not inclusive of all health issues. Wait times described are only
This information is not intended as medical advice. If you have questions, please call the phone number on the back of your
Health Savings Account
Offsets your medical costs, reduces your taxes, and offers a long-term taxadvantaged savings account.
An HSA is a tax-deductible savings plan that allows you to put aside pretax dollars to use for current or future health care expenses. It is also a tax-exempt tool to supplement your retirement savings. It is always yours to keep, even if you change health plans or jobs.
HSA Contributions
2026 Maximum Contributions
• Individual – $4,400
• Family (filing jointly) – $8,750
• Catch-Up Contribution (if age 55+) – $1,000
HSA Eligibility
You are eligible to open and contribute to an HSA if you or your spouse are:
• Enrolled in an HSA-eligible plan (Base Plan)
• Not covered by another plan that is not qualified, such as your spouse’s health plan
• Not enrolled in a Health Care Flexible Spending Account (FSA)
• Not eligible to be claimed as a dependent on someone else’s tax return
• Not enrolled in Medicare, Medicaid, or TRICARE
• Not receiving Veterans Administration benefits without a disability rating
Important HSA Information
• Always ask your network doctor to file claims with your medical, dental, or vision carrier so you will get the highest level of benefits. You can pay the doctor with your HSA debit card for any balance due.
• You, not your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit.
• You may open an HSA at the financial institution of your choice, but only accounts opened through Optum Bank are eligible for automatic payroll deduction.
Open an HSA
If you meet the eligibility requirements, you may open an HSA administered by Optum Bank . You will receive a debit card to manage your HSA account reimbursements. Keep in mind, available funds are limited to the balance in your HSA. To open an account, go to www.umr.com.
Contributions
If you enroll in the Base Plan with HSA, City of Ozark will contribute $141.67 monthly to your HSA beginning July 1, 2026, totaling $1,700 for the plan year.
You decide whether to use the money in your account to pay for qualified expenses or let it grow for future use. If you are age 55 or older, you may make a yearly catch-up contribution of up to $1,000 to your HSA. If you turn 55 at anytime during the plan year, you are eligible to make the catch-up contribution for the entire plan year.
Qualified HSA Expenses
Shows some medical expenses that are eligible for payment under your Health Care HSA.
• Abdominal supports
• Acupuncture
• Air conditioner (when necessary for relief from difficulty in breathing)
• Alcoholism treatment
• Ambulance
• Anesthetist
• Arch supports
• Artificial limbs
• Autoette (when used for relief of sickness/disability)
• Blood tests
• Blood transfusions
• Braces
• Cardiographs
• Chiropractor
• Contact lenses
• Convalescent home (for medical treatment only)
• Crutches
• Dental treatment
• Dental X-rays
• Dentures
• Dermatologist
• Diagnostic fees
• Diathermy
• Drug addiction therapy
• Drugs (prescription)
• Elastic hosiery (prescription)
• Eyeglasses
• Fees paid to health institute prescribed by a doctor
• FICA and FUTA tax paid for medical care service
• Fluoridation unit
• Guide dog
• Gum treatment
• Gynecologist
• Healing services
• Hearing aids and batteries
• Hospital bills
• Hydrotherapy
• Insulin treatment
• Lab tests
• Lead paint removal
• Legal fees
• Lodging (away from home for outpatient care)
This list is not all-inclusive; additional expenses may qualify and the items listed may change in accordance with IRS regulations. Refer to IRS Publication 502 Medical and Dental Expenses at www.irs.gov for complete details.
• Metabolism tests
• Neurologist
• Nursing (including board and meals)
• Obstetrician
• Operating room costs
• Ophthalmologist
• Optician
• Optometrist
• Oral surgery
• Organ transplant (including donor’s expenses)
• Orthopedic shoes
• Orthopedist
• Osteopath
• Oxygen and oxygen equipment
• Pediatrician
• Physician
• Physiotherapist
• Podiatrist
• Postnatal treatments
• Practical nurse for medical services
• Prenatal care
• Prescription medicines
• Psychiatrist
• Psychoanalyst
• Psychologist
• Psychotherapy
• Radium therapy
• Registered nurse
• Special school costs for the handicapped
• Spinal fluid test
• Splints
• Surgeon
• Telephone or TV equipment to assist the hard-of-hearing
• Therapy equipment
• Transportation expenses (relative to health care)
• Ultraviolet ray treatment
• Vaccines
• Vitamins (if prescribed)
• Wheelchair
• X-rays
Dental Coverage
Helps maintain fresh breath, healthy gums and teeth, and other dental work.
DPPO Plan
Two levels of benefits are available with the DPPO plan: in-network and out-of-network. You may see any dental provider for care, but you will pay less and get the highest level of benefits with in-network providers. You could pay more if you use an out-of-network provider.
Dental Benefits Summary
Dental Provider: Principal
Predetermination of Benefits
Vision Coverage
Helps detect certain medical issues, prolong your eyesight, and correct vision or eye problems.
Vision Benefits Summary
Our vision plan offers quality care to help preserve your health and eyesight. Regular exams can detect certain medical issues such as diabetes and high cholesterol, in addition to vision and eye problems. You may seek care from any vision provider, but the plan will pay the highest level of benefits when you see innetwork providers. Coverage is provided through Principal using the VSP vision network.
If you use an out-of-network provider, you will pay upfront and request reimbursement based on the amounts shown in the table.
•
•
Life and AD&D Insurance
Provides your loved ones with a financial safety net after your death and/or after an accident that causes loss of life, limb, or function.
Life and Accidental Death and Dismemberment (AD&D) insurance through Principal are important to your financial security, especially if others depend on you for support or vice versa. With Life insurance, you or your beneficiary(ies) can use the coverage to pay off debts such as credit cards, loans, and bills. AD&D coverage provides specific benefits if an accident causes bodily harm or loss (e.g., the loss of a hand, foot, or eye). If death occurs from an accident, 100% of the AD&D benefit would be paid to you or your beneficiary(ies). Life and AD&D coverage amounts reduce by 35% at age 65, and by 50% at age 70.
Basic Life and AD&D
Basic Life and AD&D insurance are provided at no cost to you. You are automatically covered at $25,000 for each benefit.
Dependent Basic Life Coverage
You may elect a flat amount of Basic Life coverage for your spouse and child(ren). The flat amount is $10,000 for your spouse and $1,000 for your child(ren). The cost for dependent Basic Life coverage is deducted from your biweekly paycheck. This coverage does not include AD&D, and it does not require proof of good health.
Designating a Beneficiary
A beneficiary is the person or entity you elect to receive the death benefits of your Life and AD&D insurance policies. You can name more than one beneficiary, and you can change beneficiaries at anytime. If you name more than one beneficiary, you must identify how much each beneficiary will receive (e.g., 50% or 25%).
Voluntary Life and AD&D
If you need more coverage than Basic Life and AD&D, you may buy Voluntary Life and AD&D for yourself and your dependent(s). If you do not elect Voluntary Life and AD&D insurance when first eligible, or if you want to increase your benefit amount at a later date, you may need to show proof of good health. You must elect Voluntary Life and AD&D coverage for yourself before covering your spouse and/or child(ren).
During OE, you can enroll in or increase coverage for yourself, spouse, or children by two increments without showing proof of good health provided the requested increase amount doesn’t exceed the Guaranteed Issue amount.
Voluntary Life and AD&D
Spouse
Child(ren)
• Increments of $5,000, up to $100,000, not to exceed 100% of employee amount
• Under 70 new hire Guaranteed Issue $30,000 Age 70+ new hire Guaranteed Issue $10,000
• Birth to 14 days – $1,000
• 15 days to age 26 – $10,000 not to exceed 100% of employee amount
• New hire Guaranteed Issue $10,000
Disability Insurance
Provides partial income protection if you are unable to work due to a covered accident or illness.
We provide Short Term Disability (STD) at no cost to you through Principal.
Short Term Disability
STD coverage pays a percentage of your weekly salary if you are temporarily disabled and unable to work due to an illness, pregnancy or non-work-related injury. STD benefits are not payable if the disability is due to a job-related injury or illness. If a medical condition is job-related, it is considered workers’ compensation, not STD.
If you have surgery scheduled and expect to miss more than seven days of work, you can begin a disability claim with Principal. Contact Human Resources for the claim packet.
If you were temporarily unable to work, would you be able to cover your bills?
Additional Benefits
Helps you and family members cope with a variety of personal or workrelated issues.
Employee Assistance Program
The Employee Assistance Programs (EAPs) from Principal and MPR provide confidential counseling and support services at little or no cost to you to help with:
• Relationships
• Work/life balance
• Stress and anxiety
• Will preparation and estate resolution
• Grief and loss
• Child and elder care resources
• Substance abuse
Coverage includes three face-to-face sessions per issue, per year with a certified therapist. These sessions can be used for you or any of your eligible dependents. Additional sessions can be purchased at a discounted rate. Visit www.guidanceresources.com for more details.
Will Preparation and ID Theft Kit
Use online resources and tools provided by ARAG to prepare, print, and store essential legal documents such as a will, living will, health care power of attorney, durable power of attorney, and medical treatment authorization for minors.
Additionally, access estate planning tools and resources, a personal information organizer, and an identity theft kit at www.aragwills.com/principal
the EAP
support at any hour of the day or night. Call 844-869-2365 or 833-955-3397. Visit www.guidanceresources.com, program name: PrincipalCore and/or MPR6 Download the GuidanceNow app.
Paid Time Off and Holidays
The City of Ozark is committed to supporting the health, well-being, and work-life balance of its employees. This section outlines the city’s paid time off benefits, including vacation and sick leave accrual, as well as the holidays observed throughout the year for which eligible employees receive paid time off.
Paid Time Off
VACATION
Full-time employees who have successfully completed their 90-day probationary period will receive one week (40 hours) of vacation leave.
Observed Holidays
Eligible City of Ozark employees receive paid time off for the following observed holidays.
SICK TIME
Sick time starts accruing from the day you start. You accumulate 3.69 hours every pay period, with a maximum of 480 hours. You must be employed with the City for 90 days before you have the ability to use your sick time. Any exceptions require director approval.
Gym Membership
City of Ozark employees enjoy a complimentary membership to the Ozark Community Center (The OC), offering access to fitness equipment, group classes, and recreational facilities.
Family members can be added for just $8 per paycheck. For more details on amenities and programs, visit https://ozarkmissouri.com/97/the-ozark-community-center.
WORKING TOWARDS HEALTH
Important Required Documentation
Employees are responsible for uploading required documents on www.mprbenefits. com. Social Security Numbers are required for all covered individuals for compliance purposes.
Legally Married Spouse
Copy of your 1040 tax return filed for the prior year* (page 1 only) which lists the names of the dependents you are covering and shows a “married” filing status. Please conceal any financial information,
If you were married during the current year, you must submit a copy of a state-issued marriage certificate
Domestic Partners are not eligible dependents
Birth Child of Employee or Employee’s Spouse
Copy of your 1040 tax return filed for the prior year (page 1 only) which lists the names of the dependents you are covering. Please conceal any financial information, OR for newborn children, Employee must submit the following:
A copy of the hospital certificate of birth
To be followed by a state-issued birth certificate that includes the parents’ names.
If the child is the birth child of your spouse and your spouse is not covered under the MPR health and/or dental or vision plan(s), OR you do not claim the dependent on your tax form, you must submit the following documentation:
Copy of your 1040 tax return filed for the prior year (page 1 only) which shows a “married” filing status. Please conceal any financial information, AND
Copy of a state-issued birth certificate (not a hospital certificate of birth) naming your spouse as a parent.
Disabled Child Over the Age of 26
Copy of the physician’s documentation of mental or physical disability, AND
Copy of your 1040 tax return filed for the prior year* (page 1 only) which lists the names of the dependents you are covering. Please conceal any financial information.
Adopted Child or Child placed for Adoption with you or your spouse
Copy of your 1040 tax return filed for the prior year (page 1 only) which lists the names of the dependents you are covering. Please conceal any financial information. If you did not claim the dependent on your tax form or the child was placed with you for adoption in the current year, you must submit the following:
Copy of official adoption records naming you or your spouse as a parent.
Legal Guardianship
Copy of your 1040 tax return filed for the prior year* (page 1 only) which lists the names of the dependents you are covering. Please conceal any financial information, AND
Copy of court decree naming you or your spouse as legal guardian. A notarized affidavit WILL NOT be accepted as legal guardianship.
A grandchild is not an eligible dependent unless legal guardianship as been established.
If the guardianship was established in the current year, a copy of the court decree granting you or your spouse legal guardianship will suffice.
Child of a Qualified Medical Child Support Order (QMCSO)
If the Employee is not enrolled in coverage at the time of the court order, they must enroll and add dependent children according to the court order. A copy of the QMCSO as executed by the court is required.
Member Entity should upload required document(s).
Documentation is required within 30 days of Enrollment. Your Dependent’s Enrollment Will Be Pended Until Documentation is Received. If not received, coverage will not be activated.
Important Notices
Women’s Health and Cancer Rights Act of 1998
In October 1998, Congress enacted the Women’s Health and Cancer Rights Act of 1998. This notice explains some important provisions of the Act. Please review this information carefully.
As specified in the Women’s Health and Cancer Rights Act, a plan participant or beneficiary who elects breast reconstruction in connection with a mastectomy is also entitled to the following benefits:
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; and
Prostheses and treatment of physical complications of the mastectomy, including lymphedema.
Health plans must determine the manner of coverage in consultation with the attending physician and the patient. Coverage for breast reconstruction and related services may be subject to deductibles and coinsurance amounts that are consistent with those that apply to other benefits under the plan.
Special Enrollment Rights
This notice is being provided to ensure that you understand your right to apply for group health insurance coverage. You should read this notice even if you plan to waive coverage at this time.
Loss of Other Coverage or Becoming Eligible for Medicaid or a state Children’s Health Insurance Program (CHIP)
If you are declining coverage for yourself or your dependents because of other health insurance or group health plan coverage, you may be able to later 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 enroll within 31 days after your or your dependents’ other coverage ends (or after the employer that sponsors that coverage stops contributing toward the other coverage).
If you or your dependents lose eligibility under a Medicaid plan or CHIP, or if you or your dependents become eligible for a subsidy under Medicaid or CHIP, you may be able to enroll
yourself and your dependents in this plan. You must provide notification within 60 days after you or your dependent is terminated from, or determined to be eligible for, such assistance.
Marriage, Birth or Adoption
If you have a new dependent as a result of a marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must enroll within 31 days after the marriage, birth, or placement for adoption.
For More Information or Assistance
To request special enrollment or obtain more information, contact:
City of Ozark
Human Resources
205 N. 1st St. P.O. Box 295 Ozark, MO 65721
417-581-2407
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 Ozark and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to enroll in a Medicare drug plan. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.
If neither you nor any of your covered dependents are eligible for or have Medicare, this notice does not apply to you or the dependents, as the case may be. However, you should still keep a copy of this notice in the event you or a dependent should qualify for coverage under Medicare in the future. Please note, however, that later notices might supersede this notice.
1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage through a Medicare Prescription Drug Plan or a Medicare Advantage Plan that offers prescription drug coverage. All Medicare prescription 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 Ozark has determined that the prescription drug coverage offered by the City of Ozark medical plan is, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage pays and is considered Creditable Coverage.
Because your existing coverage is, on average, at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to enroll in a Medicare prescription drug plan, as long as you later enroll within specific time periods.
You can enroll in a Medicare prescription drug plan when you first become eligible for Medicare. If you decide to wait to enroll in a Medicare prescription drug plan, you may enroll later, during Medicare Part D’s annual enrollment period, which runs each year from October 15 through December 7 but as a general rule, if you delay your enrollment in Medicare Part D after first becoming eligible to enroll, you may have to pay a higher premium (a penalty).
You should compare your current coverage, including which drugs are covered at what cost, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. See the Plan’s summary plan description for a summary of the Plan’s prescription drug coverage. If you don’t have a copy, you can get one by contacting City of Ozark at the phone number or address listed at the end of this section.
If you choose to enroll in a Medicare prescription drug plan and cancel your current City of Ozark prescription drug coverage, be aware that you and your dependents may not be able to get this coverage back. To regain coverage, you would have to re-enroll in the Plan, pursuant to the Plan’s eligibility and enrollment rules. You should review the Plan’s summary plan description to determine if and when you are allowed to add coverage.
If you cancel or lose your current coverage and do not have prescription drug coverage for 63 days or longer prior to enrolling in the Medicare prescription drug coverage, your monthly premium will be at least 1% per month greater for every month that you did not have coverage for as long as you have Medicare prescription drug coverage. For example, if nineteen months lapse without coverage, your premium will always be at least 19% higher than it would have been without the lapse in coverage.
Important Notices
For more information about this notice or your current prescription drug coverage:
Contact the Human Resources Department at 417-581-2407
NOTE: You will receive this notice annually and at other times in the future, such as before the next period you can enroll in Medicare prescription drug coverage and if this coverage changes. You may also request a copy.
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 will get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription 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 877-486-2048
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. Information about this extra help is available from the Social Security Administration (SSA) online at www. socialsecurity.gov, or you can call them at 800-772-1213 . TTY users should call 800-3250778
Remember: Keep this Creditable Coverage notice. If you enroll in one of the new plans approved by Medicare which offer prescription drug coverage, 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 whether or not you are required to pay a higher premium (a penalty).
July 1, 2026
City of Ozark Human Resources
205 N. 1st St. P.O. Box 295 Ozark, MO 65721
417-581-2407
Notice of HIPAA Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) imposes numerous requirements on employer health plans concerning the use and disclosure of individual health information. This information known as protected health information (PHI), includes virtually all individually identifiable health information held by a health plan –whether received in writing, in an electronic medium or as oral communication. This notice describes the privacy practices of the Employee Benefits Plan (referred to in this notice as the Plan), sponsored by City of Ozark , hereinafter referred to as the plan sponsor.
The Plan is required by law to maintain the privacy of your health information and to provide you with this notice of the Plan’s legal duties and privacy practices with respect to your health information. It is important to note that these rules apply to the Plan, not the plan sponsor as an employer.
You have the right to inspect and copy protected health information which is maintained by and for the Plan for enrollment, payment, claims and case management. If you feel that protected health information about you is incorrect or incomplete, you may ask the Human Resources Department to amend the information. For a full copy of the Notice of Privacy Practices describing how protected health information about you may be used and disclosed and how you can get access to the information, contact the Human Resources Department.
Complaints: If you believe your privacy rights have been violated, you may complain to the Plan and to the Secretary of Health and Human Services. You will not be retaliated against for filing a complaint. To file a complaint, please contact the Privacy Officer.
City of Ozark Human Resources
205 N. 1st St. P.O. Box 295 Ozark, MO 65721
417-581-2407
Conclusion
PHI use and disclosure by the Plan is regulated by a federal law known as HIPAA (the Health Insurance Portability and Accountability Act). You may find these rules at 45 Code of Federal Regulations Parts 160 and 164. The Plan intends to comply with these regulations. This Notice attempts to summarize the regulations. The regulations will supersede any discrepancy between the information in this Notice and the regulations.
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www. healthcare.gov.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance . If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272) .
Important Notices
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://www.myalhipp.com/ Phone: 1-855-692-5447
Alaska – Medicaid
The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/ Phone: 1-866-251-4861
Email: CustomerService@MyAKHIPP.com
Medicaid Eligibility: https://health.alaska. gov/dpa/Pages/default.aspx
Arkansas – Medicaid
Website: http://myarhipp.com/
Phone: 1-855-MyARHIPP (855-692-7447)
California– Medicaid
Health Insurance Premium Payment (HIPP)
Program Website: http://dhcs.ca.gov/hipp
Phone: 916-445-8322
Fax: 916-440-5676
Email: hipp@dhcs.ca.gov
Colorado – Health First Colorado (Colorado’s Medicaid Program) and Child Health Plan Plus (CHP+)
Health First Colorado website: https://www. healthfirstcolorado.com/
Health First Colorado Member Contact Center: 1-800-221-3943/State Relay 711
CHP+: https://hcpf.colorado.gov/childhealth-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
Florida – Medicaid
Website: https://www.flmedicaidtplrecovery. com/flmedicaidtplrecovery.com/hipp/index. html
Phone: 1-877-357-3268
Georgia – Medicaid
GA HIPP Website: https://medicaid.georgia. gov/health-insurance-premium-paymentprogram-hipp
Phone: 678-564-1162, Press 1
GA CHIPRA Website: https://medicaid. georgia.gov/programs/third-party-liability/ childrens-health-insurance-programreauthorization-act-2009-chipra
Phone: 678-564-1162, Press 2
Indiana – Medicaid
Health Insurance Premium Payment Program
All other Medicaid
Website: https://www.in.gov/medicaid/ http://www.in.gov/fssa/dfr/
Family and Social Services Administration Phone: 1-800-403-0864
Member Services Phone: 1-800-457-4584
Iowa
– Medicaid and CHIP (Hawki)
Medicaid Website: https://hhs.iowa.gov/ programs/welcome-iowa-medicaid
Medicaid Phone: 1-800-338-8366
Hawki Website: https://hhs.iowa.gov/ programs/welcome-iowa-medicaid/iowahealth-link/hawki
Hawki Phone: 1-800-257-8563
HIPP Website: https://hhs.iowa.gov/ programs/welcome-iowa-medicaid/feeservice/hipp
HIPP Phone: 1-888-346-9562
Kansas – Medicaid
Website: https://www.kancare.ks.gov/ Phone: 1-800-792-4884
HIPP Phone: 1-800-967-4660
Kentucky
– Medicaid
Kentucky Integrated Health Insurance Premium Payment Program (KI-HIPP)
Website: https://chfs.ky.gov/agencies/dms/ member/Pages/kihipp.aspx
Phone: 1-855-459-6328
Email: KIHIPP.PROGRAM@ky.gov
KCHIP Website: https://kynect.ky.gov Phone: 1-877-524-4718
Kentucky Medicaid Website: https://chfs. ky.gov/agencies/dms
Louisiana – Medicaid
Louisiana Medicaid Website: https://www. ldh.la.gov/healthy-louisiana
Medicaid Customer Service Line: 1-888-3426207
Louisiana Medicaid email: healthy@la.gov
Louisiana Health Insurance Premium Program (LaHIPP) Website: https://www.ldh. la.gov/lahipp
LaHIPP phone: 1-877-697-6703
LaHIPP email: La.HIPP@la.gov
LaHIPP fax: 1-888-716-9787
LaHIPP mailing address: 100 Crescent Centre Parkway, Suite 1000 Tucker, GA
30084
Maine – Medicaid
Enrollment Website: https://www. mymaineconnection.gov/benefits/ s/?language=en_US
Phone: 1-800-442-6003
TTY: Maine relay 711
Private Health Insurance Premium Webpage: https://www.maine.gov/dhhs/ofi/ applications-forms
Phone: 1-800-977-6740
TTY: Maine Relay 711
Massachusetts – Medicaid and CHIP
Website: https://www.mass.gov/masshealth/ pa
Phone: 1-800-862-4840
TTY: 711
Email: masspremassistance@accenture.com
Minnesota – Medicaid
Website: https://mn.gov/dhs/health-carecoverage/ Phone: 1-800-657-3672
Missouri – Medicaid
Website: http://www.dss.mo.gov/mhd/ participants/pages/hipp.htm
Phone: 573-751-2005
Montana – Medicaid
Website: https://dphhs.mt.gov/ MontanaHealthcarePrograms/HIPP Phone: 1-800-694-3084
Email: HHSHIPPProgram@mt.gov
Nebraska – Medicaid
Website: http://www.ACCESSNebraska. ne.gov
Phone: 1-855-632-7633
Lincoln: 402-473-7000
Omaha: 402-595-1178
Nevada – Medicaid
Medicaid Website: http://dhcfp.nv.gov
Medicaid Phone: 1-800-992-0900
New Hampshire – Medicaid
Website: https://www.dhhs.nh.gov/ programs-services/medicaid/healthinsurance-premium-program
Phone: 603-271-5218
Toll free number for the HIPP program: 1-800-852-3345, ext. 15218
Email: DHHS.ThirdPartyLiabi@dhhs.nh.gov
Important Notices
New Jersey – Medicaid and CHIP
Medicaid Website: http://www.state.nj.us/ humanservices/dmahs/clients/medicaid/ Phone: 1-800-356-1561
CHIP Premium Assistance Phone: 609-6312392
CHIP Website: http://www.njfamilycare.org/ index.html
CHIP Phone: 1-800-701-0710 (TTY: 711)
New York – Medicaid
Website: https://www.health.ny.gov/health_ care/medicaid/
Phone: 1-800-541-2831
North Carolina – Medicaid
Website: https://medicaid.ncdhhs.gov
Phone: 919-855-4100
North Dakota – Medicaid
Website: https://www.hhs.nd.gov/healthcare
Phone: 1-844-854-4825
Oklahoma – Medicaid and CHIP
Website: http://www.insureoklahoma.org
Phone: 1-888-365-3742
Oregon – Medicaid
Website: https://healthcare.oregon.gov/ Pages/index.aspx
Phone: 1-800-699-9075
Pennsylvania – Medicaid and CHIP
Website: https://www.pa.gov/en/services/ dhs/apply-for-medicaid-health-insurancepremium-payment-program-hipp.html
Phone: 1-800-692-7462
CHIP Website: https://www.dhs.pa.gov/chip/ pages/chip.aspx
CHIP Phone: 1-800-986-KIDS (5437)
Rhode Island – Medicaid and CHIP
Website: http://www.eohhs.ri.gov/ Phone: 1-855-697-4347 or 401-462-0311
(Direct RIte Share Line)
South Carolina – Medicaid
Website: https://www.scdhhs.gov
Phone: 1-888-549-0820
South Dakota - Medicaid
Website: https://dss.sd.gov
Phone: 1-888-828-0059
Texas – Medicaid
Website: https://www.hhs.texas.gov/ services/financial/health-insurancepremium-payment-hipp-program
Phone: 1-800-440-0493
Utah – Medicaid and CHIP
Utah’s Premium Partnership for Health Insurance (UPP) Website: https://medicaid. utah.gov/upp/
Email: upp@utah.gov
Phone: 1-888-222-2542
Adult Expansion Website: https://medicaid. utah.gov/expansion/
Utah Medicaid Buyout Program Website: https://medicaid.utah.gov/buyout-program/ CHIP Website: https://chip.utah.gov/
Vermont– Medicaid
Website: https://dvha.vermont.gov/ members/medicaid/hipp-program Phone: 1-800-250-8427
Virginia – Medicaid and CHIP
Website: https://coverva.dmas.virginia.gov/ learn/premium-assistance/famis-select https://coverva.dmas.virginia.gov/learn/ premium-assistance/health-insurancepremium-payment-hipp-programs
Medicaid/CHIP Phone: 1-800-432-5924
Washington – Medicaid
Website: https://www.hca.wa.gov/ Phone: 1-800-562-3022
West Virginia – Medicaid and CHIP
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
Website: https://www.dhs.wisconsin.gov/ badgercareplus/p-10095.htm Phone: 1-800-362-3002
Wyoming – Medicaid
Website: https://health.wyo.gov/ healthcarefin/medicaid/programs-andeligibility/ Phone: 1-800-251-1269
To see if any other States have added a premium assistance program since January 31, 2026 , or for more information on special enrollment rights, can 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
Continuation of Coverage Rights Under COBRA
Under the Federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), if you are covered under the City of Ozark group health plan you and your eligible dependents may be entitled to continue your group health benefits coverage under the City of Ozark plan after you have left employment with the company. If you wish to elect COBRA coverage, contact your Human Resources Department for the applicable deadlines to elect coverage and pay the initial premium.
Plan Contact Information
City of Ozark Human Resources
205 N. 1st St. P.O. Box 295 Ozark, MO 65721
417-581-2407
Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/ or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that have not signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-ofpocket limit.
Important Notices
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
You are protected from balance billing for:
Emergency services – If you have an emergency medical condition and get emergency services from an out-ofnetwork provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You cannot be balance billed for these emergency services. This includes services you may get after you are in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
Certain services at an in-network hospital or ambulatory surgical center – When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network costsharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers cannot balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other services at these in-network facilities, out-of-network providers cannot balance bill you, unless you give written consent and give up your protections.
You are never required to give up your protections from balance billing. You also are not required to get care out-of-network. You can choose a provider or facility in your plan’s network.
When balance billing is not allowed, you also have the following protections:
You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay outof-network providers and facilities directly.
Your health plan generally must:
• Cover emergency services without requiring you to get approval for services in advance (prior authorization).
• Cover emergency services by out-ofnetwork providers.
• Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
• Count any amount you pay for emergency services or out-ofnetwork services toward your deductible and out-of-pocket limit.
If you believe you have been wrongly billed, you may contact your insurance provider. Visit www.cms.gov/nosurprises for more information about your rights under federal law.
New 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.
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 on your premium that you’re eligible for depends on your household income. You may also be eligible for a tax credit that lowers your costs.
Does Employment-Based 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 lowestcost 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 employment-based 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.
Important Notices
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 eithersubmit 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 www. HealthCare.gov or call the Marketplace Call
Center at 1-800-318-2596 . TTY users can call 1-855-889-4325
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 employer sponsored 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. 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/medicaidchip/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 Human Resources.
The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit www.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 Ozark
4. Employer Identification Number (EIN): 44-6000241
5. Employer Address: 205 N. 1st Street
6. Employer Phone Number: 417-581-2407
7. City: Ozark
8. State: MO 9. ZIP Code: 65721
10. Who can we contact at this job?: Tracey Hasler, Human Resources Director
11. Phone Number (if different from above): N/A
12. E-Mail Address: thasler@ozarkmissouri.org
As your employer, we offer a health plan to all eligible employees (see the Eligibility section of this guide) This coverage meets the minimum value standard, and the cost of this coverage to you is intended to be affordable, based on employee wages.
1 Indexed annually; see https://www.irs.gov/pub/irsdrop/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.
This brochure highlights the main features of the City of Ozark employee benefits program. It does not include all plan rules, details, limitations and exclusions. The terms of your benefit plans are governed by legal documents, including insurance contracts. Should there be an inconsistency between this brochure and the legal plan documents, the plan documents are the final authority. City of Ozark reserves the right to change or discontinue its employee benefits plans at anytime.