Employee Benefits Guide
We are pleased to offer a full benefits package to you and your eligible dependents. Read this guide to know what benefits are available to you.
Availability of Summary
Our benefits program offers three medical plan options. To help you make an informed choice, review each plan’s Summary of Benefits and Coverage, available from Human Resources.
Eligibility
FOR YOUR EMPLOYEE BENEFITS
New Hire
Who is Eligible
• A regular, full-time employee working an average of 30 hours or more per week
When to Enroll
• By the deadline given by Human Resources
When Coverage Starts
• First of the month following your date of hire
Employee
Who is Eligible
• A regular, full-time employee working an average of 30 hours or more per week
When to Enroll
• During Open Enrollment (OE) or for a Qualifying Life Event (QLE)
When Coverage Starts
• OE: Start of the plan year
• QLE: Ask Human Resources
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 Legal Notices for more details.
Dependent(s)
Who is Eligible
• Your legal spouse
• Children under age 26 regardless of student, dependency, or marital status
• Children age 26 or older 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
When to Enroll
• During OE or for a QLE
• When covering dependents, you must enroll for and be on the same plans
When Coverage Starts
• Ask Human Resources Marriage
Qualifying Life Events
CHANGING COVERAGE OUTSIDE OF OPEN ENROLLMENT
You may only enroll for or make changes to coverage during the plan year if you are a new hire or if you have a QLE, such as:
Adoption/placement for adoption
Change in benefits eligibility
Death of spouse
Death of child
FMLA, COBRA event, judgment, or decree
Becoming eligible for Medicare, Medicaid, or TRICARE
Receiving a Qualified Medical Child Support Order
Gain or loss of benefits coverage
Change in employment status affecting benefits
Significant change in cost of spouse’s coverage
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How to Enroll
To begin the enrollment process, go to www.benefitsinhand.com.
First-time users: Follow steps 1-4.
Returning users: Log in and start at step 5.
First-time users: Click the New User Registration link. Once you register, you will use your username and password to log in.
2 Enter your personal information and Company Identifier of Dickinson TX and click Next.
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Create a username (work email address recommended) and password, then check the I agree to terms and conditions box before you click Finish
If you used an email address as your username, you will receive a validation email to that address. You may now log in to the system.
5 Returning users: Click the Start Enrollment button to begin the enrollment process.
6 Confirm or update your personal information and click Save & Continue. 7
Edit or add dependents who need to be covered on your benefits. Once all dependents are listed, click Save & Continue.
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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.
When you finish making your benefit elections, review your selections. If correct, click the Click to Sign button to complete and submit your enrollment choices.
Medical
Carrier: Blue Cross Blue Shield of Texas (BCBSTX) Network: Blue Essentials HMO network and Blue Choice PPO network
Your medical plan options protect you and your family from major financial hardship in the event of illness or injury. You have a choice of three plans:
● Base HMO Plan – $3,000 Individual and $9,000 Family in-network deductible
● HSA Mid Plan – $3,500 Individual and $7,000 Family in-network deductible. This plan is HSA eligible.
● Buy-Up PPO Plan – $2,500 Individual and $7,500 Family in-network deductible
Health Maintenance Organization
With a Health Maintenance Organization (HMO) plan, you must seek care from in-network providers in the HMO network. The selection of a primary care physician is required, and you need a referral to see a specialist. Always confirm that your doctors and specialists are in-network before seeking care.
High Deductible Health Plan
A High Deductible Health Plan (HDHP) allows you to see any provider when you need care, and you will pay less 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 Base HDHP, you may be eligible to open a Health Savings Account (HSA).
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, you will pay less and get the highest level of benefits. You will pay more for care if you use out-ofnetwork providers. When you see in-network providers, your office visits, urgent care visits, and prescription drugs are covered with a copay, and most other services are covered at the deductible and coinsurance level.
Medical Benefits Summary
FOR PREVENTIVE TO CHRONIC CARE
Traveling Outside Texas with the HMO
Your BCBSTX HMO is Texas-based, but you are covered when you travel:
• Emergency care: Always covered nationwide — no prior authorization needed.
• Urgent care: BlueCard gives you access to doctors and hospitals nationwide. Call your PCP first — prior authorization is required.
• Non-emergency care: Use MDLIVE telemedicine with prescriptions sent to a local pharmacy.
• 90+ days away : The Away from Home Care program connects you to a local Blue Cross Blue Shield HMO.
Your Choice of Doctors
With the HMO plan on the Blue Essentials network, you have access to a wide range of providers, including:
• Kelsey-Seybold Clinic – Over 850 doctors and specialists working together through one connected electronic health record for a streamlined experience.
Prescription Drugs – Retail Up to 30-day supply
• Preferred generic
• Non-preferred generic
• Preferred brand name
• Non-preferred brand name
Prescription Drugs – Specialty Up to 30-day supply
• Preferred
• Non-preferred
Prescription Drugs – Mail Order Up to 90-day supply
• Preferred generic
• Non-preferred generic
• Preferred brand name
• Non-preferred brand name
$0-$10
$10-$20
$50-$70 $100-$120
$150
$250
$0
$30 $150 $300
1 This is only a Summary of Benefits. For specific plan details, limitations, and exclusions, refer to your Certificate of coverage. If a discrepancy exists between the information provided in this document and the Plan Documents, the Plan Documents will govern.
2 The amount you pay after the deductible is met.
• Other Blue Essentials Providers – Flexibility to choose from thousands of additional doctors, clinics, and hospitals across the network, which may be more convenient or better fit your personal healthcare needs.
Choosing a Kelsey-Seybold Primary Care Physician Gives You Access to ALL KelseySeybold Doctors
Your Kelsey-Seybold primary care physician (PCP) gives you direct access to all Kelsey-Seybold doctors and over 65 specialties without referrals. To choose a PCP, visit kelseyseybold.com/find. You can see any physician without a referral.
Important : While Kelsey-Seybold is a featured option in the Blue Essentials HMO network, you are not limited to Kelsey-Seybold doctors. You may choose other in-network providers, specialists, and hospitals within Blue Essentials.
Medical Benefits Summary
FOR PREVENTIVE TO CHRONIC CARE
Prescription Drugs – Retail Up to 30-day supply
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Drugs – Mail Order Up to 90-day supply
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¹ This is only a Summary of Benefits. For specific plan details, limitations, and exclusions, refer to your Certificate of coverage. If a discrepancy exists between the information provided in this document and the Plan Documents, the Plan Documents will govern.
2 The amount you pay after the deductible is met.
Health Savings Account
Administrator: Flores & Associates
A Health Savings Account (HSA) lets you save with three key tax benefits: tax-free contributions, growth, and withdrawals. You are automatically enrolled. Funds can be used for dependents even if not on the HDHP. Your HSA is always yours, even if you change plans or jobs. The City of Dickinson will contribute $91.80 per employee per month in 2026. During OE, you may also elect to make additional pre-tax HSA contributions through payroll deductions.
HSA Eligibility
You are eligible if you are:
• Enrolled in the HSA Mid Plan option.
• Not covered by another non-HDHP plan (e.g., spouse’s plan)
• Not enrolled in a Health Care FSA
• Not a dependent on someone else’s tax return
• Not enrolled in Medicare, Medicaid, or TRICARE
• Not receiving Veterans Administration benefits
Note: Only accounts opened through Flores & Associates qualify for automatic payroll deductions.
the Flores app
Age 55+: You may contribute an additional $1,000 per year.
Next Level Prime
PRIMARY AND URGENT CARE
Next Level Prime offers no-cost health care services for:
• Primary and chronic care management
• Preventive care
• Urgent care
• 24/7 telemedicine virtual visits
• Care navigation
• Health and wellness coaching
Next Level Prime takes a more in-depth and personal approach to healing and wellness, starting with your annual exam. Plus, it offers more convenience with virtual visits, multiple locations, and extended business hours.
Primary Care
• Annual physicals
• Well-woman exams
• Well-child exams
• Vaccinations
• Diabetes
• Hypertension
• Thyroid conditions
• Depression and anxiety
• Chronic diseases
• Preventive screenings
• Blood draws
• Specialist referrals
Urgent Care
• Upper respiratory Infections
• Urinary tract Infections
• X-rays for acute injuries
• Sprains, strains, splints, and casts
• Gastroenteritis
• IV fluids for dehydration
• Stitches for lacerations
• Abscesses
• Pink eye
• Rashes
• Headaches and ear infections
• Back pain
New for the 2026-2027 Plan Year!
The City is excited to introduce Next Level Prime, now available to all employees at no cost. This benefit provides access to valuable wellness and lifestyle resources designed to support your overall health and well-being. Employees may also choose to enroll eligible spouses and dependents for a flat cost of $30 per month, covering all enrolled family members (not per person).
Annual Checkup Procedures
Step 1 – Meet virtually with a Prime provider to discuss your medical history, health challenges, and concerns.
Step 2 – Go to any Next Level location for an in-person exam and labs. Schedule this through Prime’s Care Navigator any day of the week from 9:00 a.m. to 9:00 p.m. CT.
Step 3 – Meet virtually with your Prime provider to review results, discuss any risk factors, and create a wellness plan.
Prepare for Prime
Your Next Level Prime membership gives you unlimited access to medical care at any Next Level location, seven days a week, 9:00 a.m. - 9:00 p.m.
Contact Next Level Prime
Visit navigator@nextlevelurgentcare.com . Call 832-957-6200
Download the Next Level Urgent Care app (Text NLUCAPP to 313131) and press the orange button to connect with a care navigator.
Prescription Drugs
FOR SHORT- OR LONG-TERM CARE MANAGEMENT
Carrier: Blue Cross Blue Shield of Texas
Your medical coverage includes prescription benefits for retail, mail order (home delivery), and specialty drugs.
Prescription Drug List
Your medical carrier 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 member ID card.
Retail
Use any participating retail pharmacy to fill short-term, nonspecialty medications. Retail pharmacies often fill or refill 30- to 90-day supplies.
Note: CVS pharmacies (including CVS inside Target stores) are not part of the BCBSTX network.
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.
Sign Up for Home Delivery
Visit www.bcbstx.com
Call 800-521-2227
Download the BCBSTX app.
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.
Save Money. Buy Generic Drugs!
Generic drugs are a safe and effective option to brandname drugs – and they cost much less! They have the same active ingredients, strength, and dosage form as brand-name drugs, and they also meet the same rigorous quality and safety standards set by the Food and Drug Administration.
FOR CONVENIENT, 24/7 CARE
Carrier: MDLIVE
Your medical coverage offers telemedicine services so you can connect anytime day or night with a boardcertified doctor via your mobile device or computer.
While telemedicine 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 afterhours 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 telemedicine for minor conditions such as:
• Sore throat
• Headache
• Stomachache
• Cold/flu
• Allergies
• Dermatology
• Primary care
• Fever
• Urinary tract infections
Do not use telemedicine for serious or life-threatening emergencies.
Get More Information or Register
Skip the trip to your doctor! Register for an account so you can get on-demand medical care.
Visit www.mdlive.com/bcbstx
Call 888-680-8646
Text BCBSTX to 635-483
Download the MDLIVE app.
Health Care Options
Becoming familiar with your options for medical care can save you time and money.
Non-emergency Care
Telemedicine
Access to care via phone, online video, or mobile app whether you are home, work, or traveling; medications can be prescribed.
24 hours a day, 7 days a week
Doctor’s Office
Generally, the best place for routine preventive care; established relationship; able to treat based on medical history.
Office hours vary Infections Sore and strep throat
Retail Clinic
Usually lower out-of-pocket cost than urgent care; when you can’t see your doctor; located in stores and pharmacies.
Hours vary based on store hours
Urgent Care
When you need immediate attention; walk-in basis is usually accepted.
Generally includes evening, weekend, and holiday hours Sprains and strains
Emergency Care
Hospital ER
Life-threatening or critical conditions; trauma treatment ; multiple bills for doctor and facility.
24 hours a day, 7 days a week
Freestanding ER
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
Chest pain
Difficulty breathing
Severe bleeding
Blurred or sudden loss of vision Major broken bones
Most major injuries except trauma Severe pain
Note: Examples of symptoms are not inclusive of all health issues. Wait times described are only estimates. This information is not intended as
advice. If you have questions, please call the phone number on the back of your medical ID card.
BCBSTX Resources
FOR GETTING THE MOST OUT OF YOUR MEDICAL COVERAGE
BCBSTX Member Portal and App
Blue Access for Members (BAM) is the secure BCBSTX member website where you can:
• Check claim status or history
• Confirm dependent eligibility
• Sign up for electronic Explanation of Benefits statements
• Locate in-network providers
• Print or request an ID card
• Review your benefits
• Get tips to live and eat healthier Register for an account at www.bcbstx.com
Get the BCBSTX app for easy access to your information. Log in from your mobile device to access your BAM account.
Nurseline
Call 800-581-0368 for access to registered nurses who can answer general health questions, make appointments with your doctor, and help determine where to go for emergency health care services. You can also access an audio library of more than 1,000 health-related topics in both English and Spanish.
Cash Rewards Program
Member Rewards offers you cash rewards when you use the Provider Finder tool to choose the lower-cost, quality option for your health care.
• Visit www.bcbstx.com , register for or log in to BAM, and select Find Care
• Shop and compare costs for screenings, scans, surgeries, and more.
• Get the procedure or service at a reward-eligible location.
• Receive a cash reward by check, mailed directly to your home, after the claim is paid and the location is verified as reward-eligible.
Blue365 Discounts
Blue365 can save you money on health and wellness products and services not covered by insurance. There are no claims to file, and you do not need a referral or preauthorization. Visit www.blue365deals.com/bcbstx to sign up and receive weekly featured deals by email. Discount categories include:
• Apparel and footwear
• Fitness
• Hearing and vision
Well onTarget Wellness Program
• Home and family
• Nutrition
• Personal care
If you are enrolled in a BCBSTX medical plan, Well onTarget helps you set and reach your health goals while earning rewards. Redeem points for merchandise, gift cards, and charitable donations.
Program Features
• Health Assessment : Receive a personalized health report and action plan.
• Fitness Program: Access discounted gym memberships nationwide, digital home fitness, and wellness service discounts.
• Digital Self-Management Programs: Six-week programs and educational tools for common health conditions.
• Wellness Coaching: One-on-one support from dietitians, nurses, and trainers.
• Tools and Trackers: Monitor weight, blood pressure, activity, sleep, tobacco use, and more. Visit www.bcbstx.com or www.wellontarget.com and download the AlwaysOn app
BCBSTX Wellness
Preventive Services
Your health plan covers screenings and services with no out-of-pocket costs when you visit a doctor in your plan’s provider network – even if you have not met your deductible. Some examples of preventive care services covered by your plan include general wellness exams each year, assessments and counseling, and screenings for diabetes, cancer, or depression. Preventive services are provided for women, men, and children of all ages.
FREE Digital Mental Health
Get free online help dealing with stress, worry, depression, insomnia, social anxiety, substance abuse, panic, and resilience. Learn to Live’s online program helps you break through bad thinking patterns with:
• Quick and easy lessons
• One-on-one coaching
To sign up, log in to BAM at www.bcbstx.com , click Wellness and then Digital Mental Health, or visit www.learntolive.com/welcome/bcbstx and use code:
BETTERME . Or tap Digital Mental Health in the BCBSTX app. You can also register minors (ages 13-17).
VirtualCheckup
Catapult Health offers an in-home VirtualCheckup program for your preventive care. It is fast, free, and easy to do! Simply order your kit for home delivery, follow the directions, and complete your VirtualCheckup with a Catapult nurse practitioner. Everything you need to collect vital information is included in the kit and is yours to keep (including a blood pressure monitor). Visit www.virtualcheckup.com/BCBSTX for details.
Weight Loss
Wondr is a free digital weight loss program that teaches you how to eat your favorite foods and still lose weight, have energy, stress less, and sleep better. Wondr is not a diet plan. There are no points, plans, or calories to count. It teaches you skills to know how and when you eat and improve your long-term health. Enroll at https://wondrhealth. com/bcbstx or get the Wondr app
Relief for Back, Joint, and Muscle Pain
Hinge Health helps Blue Cross and Blue Shield of Texas members prevent, manage, and recover from ongoing pain that affects the back, joints, and muscles. Through the mobile app, you get personalized exercise therapy, educational tools, and one-on-one support from physical therapists and health coaches – all from home, at no additional cost.
• Guided exercise therapy tailored to your needs.
• Support from licensed physical therapists and health coaches.
• Convenient, flexible, and designed to reduce pain and improve mobility.
To get started, visit www.bcbstx.com or www.hingehealth.com/bcbstx , or call 888-762-2583
Flex by Airrosti provides personalized care for muscle and joint pain (back or neck issues, carpal tunnel, plantar fasciitis, tension headaches, and more). Convenient in-clinic and virtual care options are available to serve you. Airrosti provides:
• Evaluation – A 10-15 minute complimentary evaluation with an Airrosti provider
• Assessment – An expert assessment of your injury or any pain-related issues
• Review – A review of findings and discussion of your treatment options
• Personalized plan – Targeted exercises, recovery tools, and provider-guided treatment
Visit www.airrosti.com/flex or call 800-404-6050 to schedule a free virtual evaluation.
BCBSTX Wellness
Reversing Type 2 Diabetes
Twin Health offers a revolutionary program that helps reverse type 2 diabetes by treating the root cause: metabolic dysfunction. Members wear simple health trackers like a continuous glucose monitor and activity sensor to receive real-time, personalized guidance on sleep, nutrition, activity, and more. This approach – tailored to your individual lifestyle with a support team – improves mood, energy, and long-term health. Many have reversed type 2 diabetes in six months, with major reductions in A1C and medication use.
• Visit www.twinhealth.com
• Call 866-456 1234
• Email support@twinhealth.com
Diabetes and High Blood Pressure Management
Omada helps with type 2 diabetes and high blood pressure. Apply online at https://omadahealth.com/bcbstx and get:
• A smart scale to monitor progress on managing your weight
• Professional coaches
• Engaging weekly lessons
• Supportive peer group
Cancer Services and Support
If you or a covered family member are diagnosed with cancer, Cancer Services and Support provides personalized guidance and expert support at no additional cost. This support includes:
• Cancer Services and Support Hub – with benefits, resources, and care navigation tools.
• Expert Review – by cancer specialists who collaborate with your doctor.
• Dedicated Nurse Support – from your diagnosis through post-treatment.
• Care Coordination –as well as education throughout your treatment.
Log in to www.bcbstx.com and select Cancer Support or call the number on the back of your member ID card and ask for a cancer care nurse.
BCBSTX Maternity Benefits
Our medical plans cover pregnancy and maternity care including lab tests, sonograms, delivery, hospital stay, and more. You will pay your normal coinsurance and copays for office visits, but you only pay for the first visit before and after the birth.
Maternity Support
Special Beginnings supports you from early pregnancy until six weeks after delivery, including:
• Online prenatal classes
• Support from a dedicated service coordinator before and after your baby is born
• 24-hour Nurse Advice Line ( 844-971-8906 )
It is free, easy, and confidential. Call 888-421-7781 to enroll or get more details.
Dental
Our dental plans help you maintain good oral health through affordable options for preventive care, including regular checkups and other dental work.
DPPO Plans
Two levels of benefits are available with both DPPO plans: in-network and out-ofnetwork. 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.
1 You will be reimbursed up to the Maximum Allowable Charge (MAC) for services received from an out-of-network dentist. You are responsible for charges in excess of the MAC.
2 Payment for covered services received from an out-of-network dentist is based on the 90th percentile of Usual, Customary, and Reasonable (UCR) charges.
Carrier: Blue Cross Blue Shield of Texas
Network: EyeMed
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 in-network providers.
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• Fitting and
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Flexible Spending Accounts
FOR HEALTH AND DEPENDENT CARE EXPENSES
Set aside pretax dollars from each paycheck to pay for certain IRS-approved health and dependent care expenses. We offer the following Flexible Spending Accounts (FSAs).
Health Care FSA
The Health Care FSA covers qualified medical, dental, and vision expenses for you and your eligible dependents. Eligible expenses include:
• Deductibles, copays, and coinsurance
• Prescription drugs
• Braces, glasses, and contacts
• Hearing aids and batteries
If you enrolled in an HDHP and contribute to an HSA, you may not contribute to a Health Care FSA.
Note: You can not be reimbursed twice for the same qualified expense. You may not pay for a health bill with your Nonstop, HSA, HRA, FSA and also get reimbursed from insurance or other account.
Dependent Care FSA
The Dependent Care FSA helps pay expenses associated with caring for children under age 13 and elder dependents so you or your spouse can work or attend school full-time.
Dependent Care FSA Guidelines
• To be eligible, you (and your spouse, if married) must be gainfully employed, looking for work, a full-time student, or incapable of self-care.
• You can use funds for daycare or babysitter expenses for your children under age 13, but only for the part of the year when the child is under 13.
• Only day camps – not overnight camps – can be considered for reimbursement.
2026 Maximum FSA Contributions
Care FSA You have access to all your FSA funds right away.
Dependent Care FSA Reimbursement is limited to the total amount deposited in your account at that time.
Administrator: Flores & Associates Get More Information or Submit Receipts
$7,500 (single parent filing head of household; or married filing jointly) $3,750 (married filing separately)
How to Pay or Get Reimbursed
Use your FSA debit card (excludes the Dependent Care FSA). OR
Pay out-of-pocket, and submit your receipts for reimbursement.
• You can use funds for care of a spouse or dependent of any age who spends at least eight hours a day in your home and is mentally or physically incapable of self-care.
• The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes.
Health Care FSAs allow you to carry over up to $610 into the next plan year. You have until August 31, 2027, to file any claims.
Download the Flores Mobile app. Visit fsastore.com for an array of FSA-eligible products.
Visit www.flores247.com Call 800-532-3327
Qualified HSA and FSA Expenses
The products and services listed below are examples of medical expenses eligible for payment under your Health Care FSA or HSA*. This list is not all-inclusive; additional expenses may qualify, and the items listed are subject to change in accordance with IRS regulations. Please refer to IRS Publication 502 Medical and Dental Expenses at www.irs.gov for complete details.
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
* Excludes Dependent Care FSA.
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)
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
Life and AD&D Insurance
FOR FINANCIAL SECURITY AFTER DEATH OR LOSS
Carrier: Blue Cross Blue Shield of Texas
Life and Accidental Death and Dismemberment (AD&D) insurance 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 at 1x your annual salary up to $50,000, paid by The City of Dickinson.
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).
Employee
Spouse
Child(ren)
• Increments of $10,000 up to $500,000, not to exceed five times your annual earnings
• Guaranteed Issue $100,000
• Increments of $5,000 up to $250,000, not to exceed 50% of the employee amount
• Guaranteed Issue $25,000
• Birth to 15 days: $100
• 15 days to age 26: 1,000 increments up to $10,000
Coverage is portable!
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%).
Line of Duty Rider
The Line of Duty Rider provides an additional benefit if a covered officer is seriously injured or loses their life while performing official job duties. This added protection helps provide extra financial support to the employee or their beneficiaries during a line-of-duty incident.
Disability Insurance
Disability insurance provides partial income protection if you are unable to work due to a covered accident or illness. We offer Voluntary Short Term Disability (STD) for you to purchase, and we provide Long Term Disability (LTD) at no cost to you.
Voluntary Short Term Disability
Voluntary 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 jobrelated injury or illness. If a medical condition is job-related, it is considered workers’ compensation, not STD.
Voluntary Short Term Disability Benefits
Employer-paid Long Term Disability
LTD insurance pays a percentage of your monthly salary for a covered disability or injury that prevents you from working for a specific period of time. Benefits begin at the end of an elimination period and continue while you are disabled up to the maximum benefit period.
Long Term Disability Benefits
1 Social Security Normal Retirement Age
1 Benefits may not be paid for any
within 12 months prior to your effective date until you have been
for 12 months.
2 Benefits may not be paid for any condition treated within three months prior to your effective date until you have been covered under this plan for 12 months.
Supplemental Coverage
Accident Insurance
Accident insurance provides affordable protection against a sudden, unforeseen accident. It helps offset the direct and indirect expenses such as copayments, deductibles, ambulance, physical therapy, childcare, rent, and other costs not covered by traditional health plans. You will be paid a specific sum of money directly based on the care and services provided for your covered accident. Use the money any way you see fit.
Accident Insurance
Ambulance
• Ground
Confinement
Critical Care Unit Admission
Critical Care Unit Confinement
Specific Sum Injuries
$150 per day
$750
$350 per day
Dislocations, fractures, concussions, burns, additional injuries, surgeries, lacerations and more $20 - $7,000
Critical Illness Insurance
Critical Illness insurance helps pay the cost of non-medical expenses related to a covered critical illness or cancer. The plan provides a lump sum benefit payment to you upon first and second diagnosis of any covered critical illness or cancer. The benefit can help cover expenses such as lost income, out-of-town treatments, special diets, daily living, and household upkeep costs.
Critical Illness Insurance Coverage Amounts
Employee
Spouse – Up to $10,000 Guaranteed Issue, not to exceed 50% of employee's election amount.
Child – Up to $10,000 Guaranteed Issue
Wellness Benefit – $50 (one per covered person per calendar year) 100% of Benefit
Invasive cancer; heart attack; stroke; major organ transplant; major burns; coma; brain injury; advanced Alzheimer’s disease; advanced multiple sclerosis; ALS; end-stage renal failure; and more 25% of Benefit
For conditions such as carcinoma in situ, major heart surgery and more
Please
* Percentage of benefit paid for dismemberment is dependent on type of loss. Please
Hospital Indemnity Insurance
Hospital Indemnity insurance helps you with the high cost of medical care by paying you a cash benefit when you have an inpatient hospital stay or are admitted to an intensive care unit. You decide how to use the cash, whether it’s to pay for bills, gas, childcare or eldercare, medication, or other out-ofpocket expenses. Hospital
Indemnity Insurance
Employee Assistance Program
FOR WHEN YOU NEED A HELPING HAND
The Employee Assistance Program (EAP) is a voluntary work-based program that offers free and confidential support to employees dealing with personal/work-related problems. This program is available through the ComPsych GuidanceResources. This program is a prepaid service offered by the City of Dickinson to you and your household members and is available to employees enrolled in a medical plan. This program provides the following:
Free access to services
Getting help is easy, confidential, and free. Simply call 844-213-8968 and let them know how they can assist you.
Experienced care
All therapists are experienced master’s/Ph.D.-level clinicians located at offices convenient to your home or work. They provide a structured, face-to-face approach to helping employees and their household members find solutions to everyday challenges.
Confidentiality
All calls and visits to ComPsych GuidanceResources are confidential as defined by law. Information about you or the issues shared will not be disclosed to your organization or other persons without your written permission.
Solutions for life’s changes
Visit www.guidancenow.com (web ID: TXEAP) to see the self-help tools and resources available. Then call to schedule a free, confidential appointment with one of their many skilled professionals.
Any concern that troubles you, gets out-of-hand or reduces your ability to concentrate can be brought to ComPsych GuidanceResources at no cost to you. The program can assist with:
Mental Health
• Family/parenting issues
• Grief or bereavement
• Eldercare issues
• Anger management
• Alcohol or drug problems
Financial
• Tax/IRS questions
• Credit advice
• Personal budgeting
Legal
• Free simple will
• Bankruptcy and credit
• Estate planning*
• Work or personal stress
• Marital or relationship problems
• Coping with change
• Retirement planning
• College tuition planning
• Debt consolidation
• Identity theft protection
• Divorce and family matters*
• Consumer rights*
*Advice and analysis up to 30 minutes per issue.
Additional Benefits
As a BCBSTX member, you and your eligible dependents have the following value-add programs available at no cost to you. Some programs and services are based on the coverage you elect. See your plan for specific details.
Basic Life Value Adds
Beneficiary Resource Service
This program, offered through LifeWorks , combines family wellness and security at the most difficult times. Services may include grief and financial counseling, funeral planning, legal support, and online information. Services include:
• Unlimited phone contact is available for up to one year with a grief counselor, legal advisor or financial planner.
• Five face-to-face sessions or equivalent professional time with a grief counselor, legal advisor, and/or financial advisor for up to one year from the date of loss.
Call 800-769-9187 for details.
DearbornCares
DearbornCares provides an advance payment of the life insurance benefit to help beneficiaries cover their immediate expenses, such as funeral costs and medical bills.
• Pays up to a total of $100,000 of employer-paid basic life insurance benefits
• Applies to claims with 1, 2, or 3 named beneficiaries
• Available for covered employees and retirees
• No death certificate required
• Employer is required to submit the claim form with all required information
Travel Resource Services
This program, through Assist America, provides travel assistance for you and your dependents if you are traveling more than 100 miles from home. Representatives can help with pretrip planning or assistance in an emergency while traveling. Access this service via email at medservices@assistamerica.com or call 800-872-1414
Long Term Disability Value Adds
Disability Resource Services
Whether it’s an emotional, legal or financial issue, Disability Resource Service s provides the resources for support and solutions. Services include:
• Face-to-Face Sessions 3 per issue in a geographically accessible location to address behavioral issues.
• Unlimited Telephonic Support 24 hours a day, 7 days a week to help address behavioral issues.
• Web-Based Services. GuidanceResources® is a secure website with self-assessments, search tools, and extensive content on personal health. It also offers tools for personal, relational, legal, health, and financial concerns.
Municipality Value Adds
Accidental Death Benefits
This program provides additional 50% accidental death benefits specifically designed to bring more financial security to police and firefighters.
In the line of duty benefit: provides an additional accidental death benefit to the beneficiary of a public safety officer if killed in an accident while on the job.
Retirement Plan
Administrator: TCG Services
A 457(b) plan can be a powerful tool to help you be financially secure in retirement. Our 457(b) plan can help you reach your investment goals.
Important Points About the 457(b) Plan
• The plan is overseen by school superintendents and chief financial officers, together with HUB Investment Partners (formerly TCG Advisors).
• There is no 10% early distribution penalty tax (standard taxes still apply).
• There are no surrender charges or hidden fees.
• You may start, stop or change your payroll deduction contribution to the Plan at anytime.
• You may contribute up to $23,500 for 2026 if you are under age 50, $31,000 if you are age 50 or over, and $34,750 if you are ages 60–63.
• With this plan, you have access to FinPath, a financial wellness tool to help you with complex financial topics like retirement, banking, student loan forgiveness, budgeting, insurance, debt management and more.
• You have unlimited phone calls and online meetings with Plan Specialists.
Enrollment
You must enroll through our 457(b) administrator.
FinPath is a comprehensive financial wellness platform that provides access to personalized one-on-one coaching with certified financial coaches (via phone, video, or in-person), a suite of interactive online tools for budgeting, debt management, emergency planning, credit improvement, and retirement preparation, plus educational courses on topics like banking, student loans, and insurance.
Activate Your Free Account
Visit www.finpathwellness.com/register
Call 833-777-6545
Get More Information
Monday through Friday, from 8:00 a.m. to 7:00 p.m. CT.
Visit www.tcgservices.com
Call 800-943-9179
Fax 888-989-9247.
Email 457@tcgservices.com
Pet Insurance
Pet insurance from Spot provides a financial safety net for you and your furry family. Get reimbursed for accidents and illnesses, and get a prompt response via the 24/7 pet health helpline.
Covered Services
• Emergency visits
• Lab fees
• Behavioral problems
• X-rays and tests
• Surgeries
• Cancer
• And more
Accidents
Accident coverage will take care of costs for injuries and emergencies related to accidents such as torn ligaments, bite wounds, cuts, broken bones, lodged foreign objects, and toxic ingestions.
Illnesses
This coverage reimburses you for the costs of major and minor illnesses such as cancer, arthritis, allergies, and digestive problems.
Hereditary and Congenital Conditions
This benefit covers the cost of inherited conditions and birth defects that do not show symptoms until later in your pet’s life like heart disease, eye disorders, and hip dysplasia.
Behavioral Issues
This benefit helps with the cost of visits to the veterinarian for concerning behaviors that may be related to anxiety or compulsive behavior including excessive licking, fur pulling, and destruction of the home.
How Spot Pet Insurance Works
1. Visit any licensed veterinarian.
2. Submit your claim online.
3. Get reimbursed for eligible veterinarian bills.
Enroll Now
Use priority code: EB_DICKINSONTX
Visit https://spotpet.link/dickinsontx or scan the QR code below to learn more.
Call 888-343-2340
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 Dickinson Human Resources 4403 Highway 3 Dickinson, TX 77539 281-337-6200
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 Dickinson 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 Dickinson has determined that the prescription drug coverage offered by the City of Dickinson 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. The HSA plan is not considered Creditable Coverage.
Important Notices
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 Dickinson 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 Dickinson 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.
For more information about this notice or your current prescription drug coverage:
Contact the Human Resources Department at 281-337-6236
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 800-325-0778
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 Dickinson Human Resources 4403 Highway 3 Dickinson, TX 77539 281-337-6200
Notice of HIPAA Privacy Practices
THIS NOTICE OF PRIVACY PRACTICES DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Important Notices
This Notice of Privacy Practices (the “Notice”) describes the legal obligations of Company’s Group Health Plan (the “Plan”) and your legal rights regarding your protected health information held by the Plan under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH Act). Among other things, this Notice describes how your protected health information may be used or disclosed to carry out treatment, payment, or health care operations, or for any other purposes that are permitted or required by law.
We are required to provide this Notice of Privacy Practices to you pursuant to HIPAA.
The HIPAA Privacy Rule protects only certain medical information known as “protected health information.”
Generally, protected health information (PHI) is health information, including demographic information, collected from you or created or received by a health care provider, a health care clearinghouse, a health plan, or your employer on behalf of a group health plan, from which it is possible to individually identify you and that relates to:
1. Your past, present, or future physical or mental health or condition;
2. The provision of health care to you; or
3. The past, present, or future payment for the provision of health care to you.
I. Contact Information
If you have any questions about this Notice or about our privacy practices, and for any correspondence or requests related to the contents of this Notice, please contact:
City of Dickinson Human Resources 4403 Highway 3 Dickinson, TX 77539
281-337-6200
II. Effective Date
This Notice is effective February 15, 2026.
III. Our Responsibilities
We are required by law to:
1. maintain the privacy of your PHI;
2. provide you with certain rights with respect to your PHI;
3. provide you with a copy of this Notice of our legal duties and privacy practices with respect to your PHI; and
4. follow the terms of the Notice that is currently in effect.
We reserve the right to change the terms of this Notice and to make new provisions regarding your PHI that we maintain, as allowed or required by law. If we make any material change to this Notice, we will provide you with a copy of our revised Notice of Privacy Practices.
IV. How We May Use and Disclose Your PHI
Under the law, we may use or disclose your PHI under certain circumstances without your permission. The following categories describe the different ways that we may use and disclose your PHI. For each category of uses or disclosures we will explain what we mean and present some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories. Note that we will use and disclose PHI as described below unless otherwise prohibited or restricted by applicable state or other law, and that information can lose its protected status as PHI once re-disclosed by a recipient.
For Treatment. When and as appropriate, we may use or disclose medical information about you to facilitate medical treatment or services by health care providers. We may disclose medical information about you to providers, including doctors, nurses, technicians, medical students, or other hospital personnel who are involved in taking care of you. For example, we might disclose information about you with physicians who are treating you.
For Payment. We may use or disclose your protected health information to determine your eligibility for Plan benefits, to facilitate payment for the treatment and services you receive from health care providers, to determine benefit responsibility under the Plan, or to coordinate Plan coverage. For example, we may tell your health care provider about your medical history to determine whether a particular treatment is experimental, investigational, or medically necessary, or to determine whether the Plan will cover the treatment. We may also share your protected health information with a utilization review or pre-certification service provider. Likewise, we may share your protected health information with another entity to assist with the adjudication or subrogation of health claims or to another health plan to coordinate benefit payments.
Important Notices
For Health Care Operations. We may use and disclose your protected health information for other Plan operations. These uses and disclosures are necessary to run the Plan. For example, we may use medical information in connection with conducting quality assessment and improvement activities; underwriting, premium rating, and other activities relating to Plan coverage; submitting claims for stop-loss (or excess-loss) coverage; conducting or arranging for medical review, legal services, audit services, and fraud and abuse detection programs; business planning and development such as cost management; and business management and general Plan administrative activities. However, we will not use your genetic information for underwriting purposes.
Substance Use Disorder (SUD) Treatment Information.
Some of your health information may be part of a SUD patient record and subject to additional protections under federal law (42 CFR Part 2) governing confidentiality of SUD patient records.
If we receive or maintain any information about you from a SUD treatment program that is covered by 42 CFR Part 2 (a “Part 2 Program”) through a general consent you provide to the Part 2 Program to use and disclose the SUD patient record for purposes of treatment, payment or health care operations, we may use and disclose your SUD patient record for treatment, payment and health care operations purposes as described in this Notice. If we receive or maintain your SUD patient record through specific consent you provide to us or another third party, we will use and disclose your SUD patient record only as expressly permitted by you in your consent as provided to us. In no event will we use or disclose your SUD patient record, or testimony that describes the information contained in your SUD patient record, in any civil, criminal, administrative, or legislative proceedings by any Federal, State, or local authority, against you, unless authorized by your consent or the order of a court after it provides you notice of the court order.
To Business Associates. We may contract with individuals or entities known as Business Associates to perform various functions on our behalf or to provide certain types of services. In order to perform these functions or to provide these services, Business Associates will receive, create, maintain, transmit, use, and/or disclose your PHI, but only after they agree in writing with us to implement appropriate safeguards regarding your PHI. For example, we may disclose your PHI to a Business Associate to process your claims for Plan benefits or to provide support services, such as utilization management, pharmacy benefit management, or subrogation, but only after the Business Associate enters into a Business Associate contract with us.
Treatment Alternatives or Health-Related Benefits
and Services. We may use and disclose your protected health information to send you information about treatment alternatives or other health-related benefits and services that might be of interest to you.
As Required by Law. We will disclose your PHI when required to do so by federal, state, or local law. For example, we may disclose your PHI when required by national security laws or public health disclosure laws.
To Avert a Serious Threat to Health or Safety. We may use and disclose your PHI when necessary to prevent a serious threat to your health and safety, or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat. For example, we may disclose your PHI in a proceeding regarding the licensure of a physician.
To Plan Sponsors. For the purpose of administering the plan, we may disclose PHI to certain employees of the Employer. However, those employees will only use or disclose that information as necessary to perform plan administration functions or as otherwise required by HIPAA, unless you have authorized further disclosures. Your PHI cannot be used for employment purposes without your specific authorization.
Important Notices
V. Special Situations
In addition to the above, the following categories describe other possible ways that we may use and disclose your PHI without your specific authorization. For each category of uses or disclosures, we will explain what we mean and present some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
Organ and Tissue Donation. If you are an organ donor, we may release your PHI after your death to organizations that handle organ procurement or organ, eye, or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
Military. If you are a member of the armed forces, we may release your PHI as required by military command authorities. We may also release PHI about foreign military personnel to the appropriate foreign military authority. Workers’ Compensation. We may release your PHI for workers’ compensation or similar programs, but only as authorized by, and to the extent necessary to comply with, laws relating to workers’ compensation and similar programs that provide benefits for work-related injuries or illness.
Public Health Risks. We may disclose your PHI for public health activities. These activities generally include the following:
1. to prevent or control disease, injury, or disability;
2. to report births and deaths;
3. to report child abuse or neglect;
4. to report reactions to medications or problems with products;
5. to notify people of recalls of products they may be using;
6. to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
7. to notify the appropriate government authority if we believe that a patient has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree, or when required or authorized by law.
Health Oversight Activities. We may disclose your PHI to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose your PHI in response to a court or administrative order. We may also disclose your PHI in response to a subpoena, discovery request, or other lawful process by someone involved in a legal dispute, but only if efforts have been made to tell you about the request or to obtain a court or administrative order protecting the information requested.
Law Enforcement. We may disclose your PHI if asked to do so by a law-enforcement official.
1. in response to a court order, subpoena, warrant, summons, or similar process;
2. to identify or locate a suspect, fugitive, material witness, or missing person;
3. about the victim of a crime if, under certain limited circumstances, we are unable to obtain the victim’s agreement;
4. about a death that we believe may be the result of criminal conduct; and
5. about criminal conduct.
Coroners, Medical Examiners, and Funeral Directors. We may release PHI to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients to funeral directors, as necessary to carry out their duties.
National Security and Intelligence Activities. We may release your PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Inmates. If you are an inmate of a correctional institution or are in the custody of a law-enforcement official, we may disclose your PHI to the correctional institution or law-enforcement official if necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
Important Notices
Research. We may disclose your PHI to researchers when:
1. The individual identifiers have been removed; or
2. When an institutional review board or privacy board has reviewed the research proposal and established protocols to ensure the privacy of the requested information and approves the research.
VI. Required Disclosures
The following is a description of disclosures of your PHI we are required to make.
Government Audits. We are required to disclose your PHI to the Secretary of the United States Department of Health and Human Services when the Secretary is investigating or determining our compliance with the HIPAA privacy rule.
Disclosures to You. When you request, we are required to disclose to you the portion of your PHI that contains medical records, billing records, and any other records used to make decisions regarding your health care benefits. We are also required, when requested, to provide you with an accounting of most disclosures of your PHI if the disclosure was for reasons other than for payment, treatment, or health care operations, and if the PHI was not disclosed pursuant to your individual authorization.
VII. Other Disclosures
Personal Representatives. We will disclose your PHI to individuals authorized by you, or to an individual designated as your personal representative, attorney-infact, etc., so long as you provide us with a written notice/ authorization and any supporting documents (i.e., power of attorney). Note: Under the HIPAA privacy rule, we do not have to disclose information to a personal representative if we have a reasonable belief that:
1. You have been, or may be, subject to domestic violence, abuse, or neglect by such person; or
2. Treating such person as your personal representative could endanger you; and
3. In the exercise of professional judgment, it is not in your best interest to treat the person as your personal representative.
Spouses and Other Family Members. With only limited exceptions, we will send all mail to the employee. This includes mail relating to the employee’s spouse and other family members who are covered under the Plan and includes mail with information on the use of Plan benefits by the employee’s spouse and other family members and information on the denial of any Plan benefits to the employee’s spouse and other family members. If a person covered under the Plan has requested Restrictions or Confidential Communications (see below under “Your Rights”), and if we have agreed to the request, we will send mail as provided by the request for Restrictions or Confidential Communications.
Authorizations. Other uses or disclosures of your PHI not described above will only be made with your written authorization. For example, in general and subject to specific conditions, we will not use or disclose your psychiatric notes; we will not use or disclose your PHI for marketing; and we will not sell your PHI, unless you give us a written authorization. You may revoke written authorizations at any time, so long as the revocation is in writing. Once we receive your written revocation, it will only be effective for future uses and disclosures. It will not be effective for any information that may have been used or disclosed in reliance upon the written authorization and prior to receiving your written revocation.
VIII. Your Rights
You have the following rights with respect to your PHI:
Right to Inspect and Copy. You have the right to inspect and copy certain PHI that may be used to make decisions about your Plan benefits. If the information you request is maintained electronically, and you request an electronic copy, we will provide a copy in the electronic form and format you request, if the information can be readily produced in that form and format; if the information cannot be readily produced in that form and format, we will work with you to come to an agreement on form and format. If we cannot agree on an electronic form and format, we will provide you with a paper copy.
To inspect and copy your PHI, you must submit your request in writing. If you request a copy of the information, we may charge a reasonable fee for the costs of copying, mailing, or other supplies associated with your request.
Important Notices
We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to your medical information, you may request that the denial be reviewed by submitting a written request.
Right to Amend. If you feel that the PHI we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the Plan.
To request an amendment, your request must be made in writing. In addition, you must provide a reason that supports your request.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
1. is not part of the medical information kept by or for the Plan;
2. was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
3. is not part of the information that you would be permitted to inspect and copy; or
4. is already accurate and complete.
If we deny your request, you have the right to file a statement of disagreement with us and any future disclosures of the disputed information will include your statement.
Right to an Accounting of Disclosures. You have the right to request an “accounting” of certain disclosures of your PHI. The accounting will not include (1) disclosures for purposes of treatment, payment, or health care operations; (2) disclosures made to you; (3) disclosures made pursuant to your authorization; (4) disclosures made to friends or family in your presence or because of an emergency; (5) disclosures for national security purposes; and (6) disclosures incidental to otherwise permissible disclosures.
To request this list or accounting of disclosures, you must submit your request in writing. Your request must state the time period you want the accounting to cover, which may not be longer than six years before the date of the request. Your request should indicate in what form you want the list (for example, paper or electronic). The first list you request within a 12-month period will be provided free of charge. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Right to Request Restrictions.
You have the right to request a restriction or limitation on your PHI that we use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on your PHI that we disclose to someone who is involved in your care or the payment for your care, such as a family member or friend. For example, you could ask that we not use or disclose information about a surgery that you had.
Except as provided in the next paragraph, we are not required to agree to your request. However, if we do agree to the request, we will honor the restriction until you revoke it or we notify you.
We will comply with any restriction request if (1) except as otherwise required by law, the disclosure is to a health plan for purposes of carrying out payment or health care operations (and is not for purposes of carrying out treatment); and (2) the PHI pertains solely to a health care item or service for which the health care provider involved has been paid in full by you or another person.
To request restrictions, you must make your request in writing. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply-for example, disclosures to your spouse.
Right to Request Confidential Communications.
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
To request confidential communications, you must make your request in writing. We will not ask you the reason for your request. Your request must specify how or where you wish to be contacted. We will accommodate all reasonable requests.
Important Notices
Right to Be Notified of a Breach. You have the right to be notified in the event that we (or a Business Associate) discover a breach of unsecured PHI.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.
IX. Complaints
If you believe that your privacy rights have been violated, you may file a complaint with the Plan or with the Office for Civil Rights of the United States Department of Health and Human Services. To file a complaint with the Plan, contact the person listed in the Contact Information section of this Notice. All complaints must be submitted in writing. You will not be penalized, or in any other way retaliated against, for filing a complaint with the Office for Civil Rights or with us..
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 employersponsored 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.
Website: http://www.myalhipp.com/
Phone: 1-855-692-5447
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
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
Health First Colorado website: https://www. healthfirstcolorado.com/
Health First Colorado Member Contact Center: 1-800221-3943/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
Important Notices
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/healthinsurance-premium-payment-program-hipp
Phone: 678-564-1162, Press 1
GA CHIPRA Website: https://medicaid.georgia.gov/ programs/third-party-liability/childrens-health-insuranceprogram-reauthorization-act-2009-chipra
Phone: 678-564-1162, Press 2
Indiana – Medicaid
Health Insurance Premium Payment Program
All other Medicaid
Website: https://www.in.gov/medicaid/ http://www.in.gov/fssa/dfr/
Family and Social Services Administration
Phone: 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/welcomeiowa-medicaid/iowa-health-link/hawki
Hawki Phone: 1-800-257-8563
HIPP Website: https://hhs.iowa.gov/programs/welcomeiowa-medicaid/fee-service/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 Website: https://www.ldh.la.gov/ healthy-louisiana
Medicaid Customer Service Line: 1-888-342-6207
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-care-coverage/ Phone: 1-800-657-3672
Missouri – Medicaid
Website: http://www.dss.mo.gov/mhd/participants/pages/ hipp.htm
Phone: 573-751-2005
Montana – Medicaid
Website: 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
Louisiana – Medicaid
Important Notices
New Hampshire – Medicaid
Website: https://www.dhhs.nh.gov/programs-services/ medicaid/health-insurance-premium-program
Phone: 603-271-5218
Toll free number for the HIPP program: 1-800-852-3345, ext. 15218
Email: DHHS.ThirdPartyLiabi@dhhs.nh.gov
New Jersey – Medicaid and CHIP
Medicaid Website: http://www.state.nj.us/humanservices/ dmahs/clients/medicaid/
Phone: 1-800-356-1561
CHIP Premium Assistance Phone: 609-631-2392
CHIP Website: http://www.njfamilycare.org/index.html
CHIP Phone: 1-800-701-0710 (TTY: 711) New York – Medicaid
Website: https://www.health.ny.gov/health_care/ medicaid/
Phone: 1-800-541-2831
North Carolina – Medicaid
Website: https://medicaid.ncdhhs.gov
Phone: 919-855-4100
North Dakota – Medicaid
Website: https://www.hhs.nd.gov/healthcare
Phone: 1-844-854-4825
Oklahoma – Medicaid and CHIP
Website: http://www.insureoklahoma.org
Phone: 1-888-365-3742
Oregon – Medicaid
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-formedicaid-health-insurance-premium-payment-programhipp.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-insurance-premium-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/premiumassistance/famis-select https://coverva.dmas.virginia.gov/learn/premiumassistance/health-insurance-premium-payment-hippprograms
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 (1-855-6998447)
Wisconsin – Medicaid and CHIP
Website: https://www.dhs.wisconsin.gov/ badgercareplus/p-10095.htm
Phone: 1-800-362-3002
Wyoming – Medicaid
Website: https://health.wyo.gov/healthcarefin/medicaid/ programs-and-eligibility/ Phone: 1-800-251-1269
Important Notices
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 Dickinson group health plan you and your eligible dependents may be entitled to continue your group health benefits coverage under the City of Dickinson 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 Dickinson Human Resources
4403 Highway 3 Dickinson, TX 77539 281-337-6200
Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or get treated by an out-ofnetwork 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-ofnetwork 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-of-pocket limit.
“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-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network costsharing 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 cost-sharing 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, outof-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 outof-network. You can choose a provider or facility in your plan’s network.
Important Notices
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 out-ofnetwork 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-of-network providers.
Base what you owe the provider or facility (costsharing) 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-of-network 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 lowest-cost plan that would cover all family members does not exceed 9.12% of the employee’s household income.1, 2
Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered through your employment, then you may lose access to whatever the employer contributes to the employmentbased coverage. Also, this employer contribution—as well as your employee contribution to employmentbased coverag—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.
When Can I Enroll in Health Insurance Coverage through the Marketplace?
You can enroll in a Marketplace health insurance plan during the annual Marketplace Open Enrollment Period. Open Enrollment varies by state but generally starts November 1 and continues through at least December 15.
Outside the annual Open Enrollment Period, you can sign up for health insurance if you qualify for a Special Enrollment Period. In general, you qualify for a Special Enrollment Period if you’ve had certain qualifying life events, such as getting married, having a baby, adopting a child, or losing eligibility for other health coverage. Depending on your Special Enrollment Period type, you may have 60 days before or 60 days following the qualifying life event to enroll in a Marketplace plan.
There is also a Marketplace Special Enrollment Period for individuals and their families who lose eligibility for Medicaid or Children’s Health Insurance Program (CHIP) coverage on or after March 31, 2023, through July 31, 2024. Since the onset of the nationwide COVID-19 public health emergency, state Medicaid and CHIP agencies generally have not terminated the enrollment of any Medicaid or CHIP beneficiary who was enrolled on or after March 18, 2020, through March 31, 2023. As state Medicaid and CHIP agencies resume regular eligibility and enrollment practices, many individuals may no longer be eligible for Medicaid or CHIP coverage starting as early as March 31, 2023. The U.S. Department of Health and Human Services is offering a temporary Marketplace Special Enrollment period to allow these individuals to enroll in Marketplace coverage.
Marketplace-eligible individuals who live in states served by HealthCare.gov and either- submit a new application or update an existing application on HealthCare.gov between March 31, 2023 and July 31, 2024, and attest to a termination date of Medicaid or CHIP coverage within the same time period, are eligible for a 60-day Special Enrollment Period. That means that if you lose Medicaid or CHIP coverage between March 31, 2023, and July 31, 2024, you may be able to enroll in Marketplace coverage within 60 days of when you lost Medicaid or CHIP coverage. In addition, if you or your family members are enrolled in Medicaid or CHIP coverage, it is important to make sure that your contact information is up to date to make sure you get any information about changes to your eligibility. To learn more, visit www.HealthCare.gov or call the Marketplace Call Center at 1-800-318-2596. TTY users can call 1-855-889-4325
This brochure highlights the main features of the City of Dickinson 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 Dickinson reserves the right to change or discontinue its employee benefits plans at anytime.
