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Plan Information

Summary Plan Description (Medical Plan A and B)
Summary of Benefit Coverage (SBC)
Benefits Guide
Certificate of Life Insurance
Rate Sheet

Retirement

Because of your position with the city, your retirement program is through MFPRSI.

Deferred Compensation

The City will match up to 2.75% of your annual salary.

Coverage Information

Medical Plan A

Provider - Wellmark

Deductible	In	Out
Single	$1,000	$1,500
2 Person	$1,400	$2,250
Family	$1,800	$3,000
Out of Pocket Max	In	Out
Single	$1,600	$3,000
2 Person	$2,400	$4,500
Family	$3,200	$6,000
Co-insurance	In	Out
	90/10	70/30
Office Copay	$25	70/30

Dental

Provider - Delta Dental

Deductible
Single	$25
Family	$50
Preventive Services - Covered 100%
Basic Services - Covered 20% after deductible
Major Services - Covered 50% after deductible
Annual Maximum
First plan year - $1,200 per person
Orthodontia - 50% to $2,000 / lifetime max per person

Vision

Provider - VSP

	In	Out
Services	(Member Benefits)	(Reimbursement)
Eye Exam	Covered 100% after $10 copay	Up to $45
Frame Allowance	$50 wholesale allowance (up to $150 retail value)	Up to $70
Standard Spectacle Lenses Single Vision Lenses Lined Bifocal Lenses Lined Trifocal Lenses Lenticular Lenses	$0 copay, covered 100% $0 copay, covered 100% $0 copay, covered 100% $0 copay, covered 100%	Up to $30 Up to $50 Up to $65 Up to $100
Contact Lenses Fitting & Evaluation Medically Necessary Lenses	Covered 100% after $60 copay Covered 100% after eyeware copay	$210 $210
Frequency
Eye Exam	Once every 12 months	Once every 12 months
Lenses OR Contact Lenses	Once every 12 months	Once every 12 months
Frame	Once every 24 months	Once every 24 months

Flex Spending

Life

Supplemental Life

Hospital Indemnity

Provider - Voya

Four tier plan and dependents to age 26 are eligible for coverage.

Employee only - $5.37/month
Employee + Spouse - $12.53/month
Employee + Child(ren) - $9.49/month
Family - $16.65/month

Accident Insurance

Provider - Voya

Four tier plan and dependents to age 26 are eligible for coverage.

Employee only - $4.93/month
Employee + Spouse - $9.78/month
Employee + Child(ren) - $10.02/month
Family - $14.87/month

Critical Illness

Provider - Voya

Paid in flat amount. Rates are based on age and level of coverage selected.

Employee - $10,000, $20,000, or $30,000
Spouse - $5,000, $10,000, or $15,000
Child - $5,000, $10,000, or $15,000

Identity Theft Protection

Provider - Aura

Coverage available for single or family and choose from two tiers of coverage.

Employee only Total- $5.55/month
Employee only Ultimate- $6.90/month
Family Toital- $9.75/month
Family Ultimate- $12.50/month

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