Benefit Enrollment Guide 20 25
2 CITY OF LAMAR If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a Federal law gives you more choices about your prescription drug coverage. Please see pages 23-24 for more details. TABLE OF CONTENTS Benefits Overview & Eligibility ............................................... 3 Medical Benefits ............................................... 4 Anthem Sydney App ............................................... 6 Health Savings Account ............................................... 7 Flexible Spending Account ............................................... 8 Dental Benefits ............................................... 9 Vision Insurance ............................................. 10 Life and Accidental Death & Dismemberment Insurance ........ 11 Voluntary Life and AD&D Insurance ....................................... 11 Short-Term Disability ............................................. 12 Long-Term Disability ............................................. 12 Additional Benefits ............................................. 13 Employee Contributions for Benefits .................................... 14 Legal Notices ............................................. 16 Contact Information ............................................. 35
3 CITY OF LAMAR The City of Lamar is proud to offer a comprehensive benefits package to eligible, employees who work a minimum of 30 hours per week. The complete benefits package is briefly summarized in this booklet. You share the costs of some benefits, and the City of Lamar provides other benefits at no cost to you. In addition, there are voluntary benefits with reasonable group rates that you can purchase through payroll deductions. ENROLL FOR 2025 BENEFITS ELIGIBILITY You and your dependents are eligible for the City of Lamar’s benefits on the first of the month after 1 month of employment. Your eligible family members include: • Your legal spouse, including civil union, and domestic partner • Your child, defined as younger than 26 years old and is natural or legally adopted child, a stepchild, the child of your domestic partner, or a child who has been placed under your legal guardianship. • Your child, who satisfies the above definition of child, age 26 or older, and who is mentally or physically incapable of earning a living, and primarily supported by you QUALIFYING LIFE EVENT Elections made now will remain in effect until the next open enrollment period, unless you or your family members experience a qualifying event. If you experience a qualifying event, you must contact HR within 30 days. Examples of qualifying events include: • Marriage, legal separation, or divorce; • Birth or adoption of a child; • Change in employment status for you or your spouse; • Change in dependent’s benefits eligibility status (e.g., a dependent child exceeding the maximum age for coverage); • Change in place of residence causing a loss of eligibility (i.e., permanently moving outside of the service area); • Loss of a dependent (death)
CITY OF LAMAR 4 Administered by County Health Pool (CHP)-Anthem Network Comprehensive and preventive healthcare coverage is important in protecting you and your family from the financial risks of unexpected illness and injury. The City of Lamar offers you a choice of two (2) plans: a PPO Plan and a High Deductible Health Plan (HDHP). With the Preferred Provider Organization (PPO) plan, you and your family members may visit any licensed provider but will receive the greatest out-of-pocket savings if you see an in-network provider. If you choose to see an out-of-network provider, you will incur additional out-of-pocket expenses, and you may be billed for the difference in the cost of the services (called balance billing). When you see an in-network provider, you are protected from balance billing. The High Deductible Health Plan (HDHP) option is a qualified plan for a Health Savings Account (HSA). With an HSA, you are able to set aside pre-tax funds into an account to be used for qualified medical expenses. For more information on how your HSA works, please see the HSA section of this booklet. To find an in-network provider, please visit www.anthem.com, select the “Individual & Family”, click on “Find a Doctor” and select the Preferred PPO Provider Network. PPO B2000 PLAN HDHP W/ HSA 2500 Plan In-Network Out-of-Network In-Network Out-of-Network Calendar-Year Deductible (single/family) $2,000 / $4,000 $4,000 / $8,000 $2,500 / $5,000 $5,000 / $10,000 Calendar-Year Out-of-Pocket Maximum (single/family) $5,250 / $12,000 $10,000 / $26,000 $5,000 / $6,850 $10,000 / $20,000 Coinsurance 20% 40% 20% 40% DOCTOR’S OFFICE Primary Care Office Visit $35 copay then 20% after deductible 40% after deductible 20% after deductible 40% after deductible Specialist Office Visit $35 copay 20% after deductible 40% after deductible 20% after deductible 40% after deductible Preventive Care 100% Covered 40%, no deductible 100% Covered 40%, no deductible PRESCRIPTION DRUGS—RETAIL 30-DAY SUPPLY/ MAIL ORDER 90-DAY SUPPLY Prescription Drug Deductible $75 per person Not covered N/A Not covered Retail - Generic Drug $10 copay or 20% of cost, whichever is greater 20% after deductible Retail - Formulary Drug $25 copay or 30% of cost, whichever is greater 20% after deductible Retail - Non-formulary Drug $35 copay or 50% of cost, whichever is greater 20% after deductible Mail Order - All Tiers $25/$60/$115 copay 20% after deductible MEDICAL & PHARMACY
5 CITY OF LAMAR PPO HRA B2000 PLAN HDHP/ HSA 2500 PLAN In-Network Out-of-Network In-Network Out-of-Network HOSPITAL SERVICES Emergency Room 20% after deductible 20% after deductible Inpatient 20% after deductible 40% after deductible 20% after deductible 40% after deductible Outpatient Surgery 20% after deductible 40% after deductible 20% after deductible 40% after deductible Urgent Care Services $35 copay, then 20% after deductible 40% after deductible 20% after deductible 40% after deductible MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES Inpatient Services 20% after deductible 40% after deductible 20% after deductible 40% after deductible Outpatient Services Office visit: $35 copay; Other outpatient: 20% after deductible 40% after deductible 20% after deductible 40% after deductible OTHER SERVICES Diagnostic text (x-ray, blood work) 20% after deductible 40% after deductible 20% after deductible 40% after deductible Advanced Imaging (CT/PET scan, MRIs) $200 copay, then 20% after deductible $200 copay, then 40% after deductible 20% after deductible 40% after deductible Maternity Services $35 copay, then 20% after deductible 40% after deductible 20% after deductible 40% after deductible All other maternity hospital/ physician services 20% after deductible 40% after deductible 20% after deductible 40% after deductible Physical, Occupational and Speech Therapy Services $35 copay, then 20% after deductible 40% after deductible 20% after deductible 40% after deductible MEDICAL & PHARMACY TELEMEDICINE BENEFIT Administered by County Health Pool (Anthem Network) Have a health question? Under the weather? With LiveHealth Online, you don’t have to schedule an appointment, drive to the doctor’s office, and then wait for your appointment. In fact, you don’t even have to leave your home or office. Doctors can answer questions, make a diagnosis, and even prescribe basic medications when needed. With LiveHealth Online, you get: • Immediate doctor visits through live video • Your choice of U.S. board-certified doctors • Private, secure and convenient online visits When can you use LiveHealth Online? As always, you should call 911 with any emergency. Otherwise, you can use LiveHealth Online whenever you have a health concern and don’t want to wait. Doctors are available 24 hours a day, seven days a week, 365 days a year.
6 CITY OF LAMAR ANTHEM SYDNEY APP The Sydney Health mobile app makes healthcare easier! Use Sydney Health to keep track of your health and benefits— all in one place. With a few taps, you can quickly access your plan details, Member Services, virtual care, and wellness resources. Sydney Health stays one step ahead—moving your health forward by building a world of wellness around you. Find Care Search for doctors, hospitals and other healthcare professionals in-network and compare costs. You can filter providers by what is most important to you, such as gender, languages spoken, or location. You’ll be matched with the best results based on your personal needs. My Health Dashboard Use My Health Dashboard to find news on health topics that interest you, health and wellness tips, and personalized action plans that can help you reach your goals. It also offers a customized experience just for you, such as syncing your fitness tracker and tracking your meals. Chat If you have questions about your benefits or need information, Sydney Health can help you quickly find what you’re looking for and connect you to an Anthem representative. Virtual Care Connect directly to care from the convenience of home. Assess your symptoms quickly using the Symptom Checker or talk to a doctor via chat or video session. Community Resources This resource center helps you connect with organizations offering no-cost or reduced-cost programs that can help with food, transportation, child care and more. My Health Records See a full picture of your family’s health in one secure place. Use a single profile to view, download, and share information such as health histories and electronic medical records directly from your smartphone or computer.
7 CITY OF LAMAR Under Age 55 Age 55 and Older Coverage Tier Employee Only Employee + 1 Family Employee Only Employee + 1 Family IRS Maximum $4,300 $8,550 $8,550 $5,300 $9,550 $9,550 Advantages of the High Deductible Health Plan (HDHP) with an HSA The HDHP option is designed to encourage you to be more conscientious of your healthcare expenditures. It also offers a number of special features, for example: • It has a lower monthly payroll contribution • You have access to a Health Savings Account (HSA) that allows you to put aside money, tax-free, to pay for eligible medical expenses. You choose when to use the money in your HSA account. It rolls over from year to year, allowing the balance to increase. Setting Up an HSA Account You can open and contribute to an HSA if you: 1. Are covered by an HSA-qualified health plan (HDHP); 2. Are not covered by other health insurance (with some exceptions); 3. Are not enrolled in Medicare; 4. Are not eligible to be claimed as a dependent on another person’s tax return; 5. Have not received health benefits from the Veterans Administration with the exception of services for a “service related disability” or an Indian Health Services facility within the last three months; and 6. Are not covered by your own or your spouse’s Healthcare Flexible Spending Account. Contributing to Your HSA Health Savings Accounts have a triple tax advantage: • Contribute tax-free • Invest tax-free • Make withdrawals for eligible medical expenses, or for any use after age 65 tax-free Using Your HSA Funds Money you use from your HSA to pay for qualified medical expenses is federally tax-free. If you use money for reasons other than qualified medical expenses before age 65, that money is taxable and subject to a 20 penalty. This isn’t a complete list of rules and requirements for HSAs. More info can be found in the publication 969 of the IRS, at www.irs.gov. HEALTH SAVINGS ACCOUNT If you enroll in the HDHP 2500 medical plan, you are eligible to contribute to a Health Savings Account. A Health Savings Account is an individually-owned, tax-advantaged account that you can use to pay for current or future IRS-qualified medical expenses. With a HSA, you’ll have the potential to build more savings for healthcare expenses or additional retirement savings through self-directed investment options. Your contribution amount cannot exceed the IRS maximum for HSA contributions during a calendar year. Below is a chart reflecting the IRS calendar year maximums for 2025: Special Considerations: 1. You CANNOT use HSA dollars on Domestic Partners unless they are your legal tax dependent. 2. Your adult children 19-26 MUST be a tax dependent to be eligible to use your HSA dollars for their expenses. If they are not tax dependents, they may open their own HSA and contribute up to the full family maximum.
8 CITY OF LAMAR FLEXIBLE SPENDING ACCOUNTS Administered by Rocky Mountain Reserve Flexible Spending Accounts (FSAs) allow benefit eligible employees to use pretax dollars for healthcare or child/dependent care expenses not covered by insurance plans. Employees contribute a portion of each paycheck to an FSA and save significantly on taxes. Money in an FSA can be used to pay for out-of-pocket medical, dental and vision expenses or dependent care expenses. Employees do not need to be enrolled in the City’s health plan or any health plan to have an FSA. The City of Lamar offers you a choice of a Healthcare Flexible Spending Account, Limited Purpose Flexible Spending Account, and a Dependent Care Flexible Spending Account. Healthcare FSA—PPO 2000 A Healthcare FSA is a pre-tax benefit account used to pay for eligible medical, dental, and vision care expenses that aren’t covered by your insurance plan or elsewhere. It’s a smart, simple way to save money while keeping you and your family healthy and protected. The IRS sets a limit on how much you can contribute to this account each year. For 2024, the spending limit is $3,200.* Limited Purpose FSA—HDHP 2500 A Limited Purpose FSA (LPFSA) is a flexible spending account that only reimburses you for eligible dental and vision expenses. A LPFSA is available to employees who are enrolled in a high deductible health plan (HDHP); you may enroll in both the LPFSA and the HSA. By establishing a LPFSA, you can save money on taxes by using your LPFSA dollars for your dental and vision expenses ONLY while preserving your HSA funds for other purposes, including simply saving those funds for the future. The IRS sets a limit on how much you can contribute to this account each year. For 2024, the spending limit is $3,200.* Dependent Care FSA A Dependent Care FSA is a pre-tax benefit account used to pay for dependent care services, such as preschool, summer day camp, before or after school programs, and child or elder daycare. A Dependent Care FSA is a smart, simple way to save money while taking care of your loved ones so that you can continue to work. The IRS sets a limit on how much you can contribute to this account each year. For 2024, the spending limit is $5,000 if married and filing jointly or head of household or $2,500 if married and filing separately.* Here’s How an FSA Works 1. You decide the annual amount (up to the set limit for each account) you want to contribute to either or both FSAs based on your expected healthcare and/or dependent childcare/elder care expenses. 2. Elections are deducted from each paycheck before income and Social Security taxes, and deposited into your FSA. Your entire annual election is available immediately after the beginning of the plan year for the Health Care FSA and LPFSA. For the Dependent Care FSA you can only receive the amount that is in your account when your claim is paid. 3. For eligible healthcare expenses you can pay with the Healthcare FSA or LPFSA debit card or submit a claim form for reimbursement. For dependent care, you pay for eligible expenses when incurred, and then submit a reimbursement claim form or file the claim online. 4. You are reimbursed from your FSA, so you actually pay your expenses with tax-free dollars. 5. At the end of the calendar year, any unused amount in your Healthcare FSA will be forfeited with the exception of a maximum $640 rollover to be used for the next calendar year.* The $640 rollover does not apply to the Dependent Care FSA. *Subject to change pending the release of the 2025 annual contribution limits from the IRS.
9 CITY OF LAMAR SERVICES DENTAL PLAN A IN-NETWORK & OUT-OF-NETWORK DENTAL PLAN B IN-NETWORK & OUT-OF-NETWORK Calendar-Year Deductible $50 per person; $150 family limit $50 per person; $150 family limit Calendar-Year Benefit Maximum $1,500 $1,500 Preventive Dental Services (cleanings, exams, xrays, spacers and other preventive services) 100% covered; no deductible 100% covered; no deductible Basic Dental Services (simple extractions, fillings, root canal therapy, oral surgery with general anesthesia or IV sedation) 20% after deductible 20% after deductible Major Dental Services (crowns, inlays, onlays, bridges, dentures, other select prosthodontic services) 50% after deductible Not Covered Orthodontia Services (covered to age 19) 50% to $1,000 lifetime maximum Not Covered Administered by County Health Pool (CHP)—Anthem Network Good oral care enhances overall physical health, appearance and mental well-being. Problems with the teeth and gums are common and easily treated health problems. The City of Lamar offers competitive benefits designed to provide high quality dental care. You and your family members may visit any licensed dentist but will receive the greatest out-ofpocket savings if you see an in-network dentist. If you choose to see an out-of-network dentist, you will incur additional out-ofpocket expenses, and you may be billed for the difference in the cost of the services (called balance billing). When you see an in-network dentist, you are protected from balance billing. To find out if your dentist is in-network or to verify your dental coverage, contact Anthem Customer Service at (855) 769-1467 or visit www.anthem.com. DENTAL BENEFITS For additional plan information and benefits, please review the dental plan documents.
CITY OF LAMAR 10 Service IN-NETWORK (Any VSP Provider) Out-of-Network (Any qualified non-network provider of your choice) Eye Exam — once every 12 months $15 copay; covered in full Up to $45 reimbursement LENSES — ONCE EVERY 12 MONTHS Single Vision Lenses $15 copay; covered in full Up to $30 reimbursement Lined Bifocal Lenses $15 copay; covered in full Up to $50 reimbursement Lined Trifocal Lenses $15 copay; covered in full Up to $65 reimbursement FRAMES — ONCE EVERY 24 MONTHS Frames $150 allowance ($80 allowance at Costco); then 20% over your allowance Up to $70 reimbursement CONTACT LENSES — ONCE EVERY 12 MONTHS Medical Necessary $150 allowance Up to $110 reimbursement Contact Lens Exam (Separate Fitting and Evaluation) Up to $60 copay N/A Convention or Disposable Lens $150 allowance Up to $110 reimbursement Administered by County Health Pool (CHP)—VSP Network Your eyes can provide a window to your overall health. Through routine exams your provider may be able to detect general health problems in their early stages along with determining if you need corrective lenses. The City of Lamar knows your vision care is personal and so is your relationship with your eye doctor. That’s why the City of Lamar has partnered with VSP/CHP to provide you with access to affordable care, and quality eyewear. Find an in-network provider or to view and print an ID card at www.vsp.com. VSP does not send out ID cards. VISION BENEFITS
CITY OF LAMAR 11 LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE Life insurance provides financial security for the people who depend on you. Your beneficiaries will receive a lump sum payment if you die while employed by the City of Lamar. Additionally, Accidental Death and Dismemberment (AD&D) insurance provides payment to you or your beneficiaries if you lose a limb or die in an accident. The City of Lamar provides basic life insurance and AD&D coverage at no cost to you. VOLUNTARY LIFE INSURANCE Insured by Lincoln Financial You may purchase life insurance in addition to your company-provided coverage. You may also purchase life insurance for your dependents if you purchase additional coverage for yourself. You are guaranteed coverage without answering medical questions if you enroll when you are first eligible. Coverage is not effective until evidence of insurability is approved by Lincoln Financial. LIFE & AD&D INSURANCE Voluntary Life and AD&D Benefit Employees 5x your annual salary to a maximum of $500,000, in increments of $10,000 Guarantee Issue: $110,000 Spouses Up to $250,000 in increments of $5,000. Not to exceed 50% of employee coverage Guarantee Issue: $30,000 Child(ren) Age 14 days to 26 years $10,000 Guarantee issue: $10,000 Benefit County Health Pool (Anthem) $10,000 Lincoln Financial $50,000 Voluntary Life and AD&D Election Rules: *During Open Enrollment, employees can increase their current voluntary life elections by up to two increments without completing Evidence of Insurability (EOI) or answering medical questions. Increases may go above the Guaranteed Issue amount as long as they are within two increments of current coverage amount. **Employees and spouses who previously waived coverage may join the plan for up to two increments of coverage without completing Evidence of Insurability (EOI). ***Employees who were previously withdrawn or denied coverage due to EOI MUST submit EOI for any additional amount elected. ****Child coverage is available without submitting an EOI at all times.
12 CITY OF LAMAR DISABILITY INSURANCE SHORT-TERM DISABILITY (STD) Insured by Lincoln Financial Short-Term Disability insurance can provide employees with the peace of mind that a protected paycheck brings, if you are unable to work because of an illness or injury that occurs off the job. Lincoln’s Short-Term Disability plan provides income, after satisfying the elimination period, if you become disabled due to an injury or illness. The City of Lamar provides LTD coverage at no cost to you. Once enrolled in the plan, you can take advantage of the following benefits: Elimination Period: 14 days Benefit Amount: 60% of your weekly salary Benefit Maximum: Varies by employee class Benefit Duration: Varies by employee class LONG-TERM DISABILITY (LTD) Insured by Lincoln Financial Meeting your basic living expenses can be a real challenge if you become disabled. Your options may be limited to personal savings, spousal income and possibly Social Security. Long Term Disability insurance provides protection for your most valuable asset — your ability to earn an income. The City of Lamar provides LTD coverage at no cost to you. For Police and Fire Employees, with Lincoln Financial Group, you will receive a cash benefit of 60% of your monthly salary (up to $4,000) starting 90 days after you are out of work and continuing up to age 65 or Social Security Normal Retirement Age (SSNRA), whichever is later. Please note that if you are approved for the FPPA benefit and have received a benefit from Lincoln via short or long-term disability, for the same time period, you will be required to reimburse Lincoln for any benefit they paid since the Lincoln policy is offset by FPPA Benefit. For Police and Fire Employees, with the FPPA Benefit, you will receive up to 70% of your monthly salary (to no max) and must be expected to be disabled for a year or more. There is no elimination period. Please see the policy plan document for full list of benefits and exclusions.
CITY OF LAMAR 13 Personal issues, planning for life events or simply managing daily life can affect employees’ work, health, and family. The suite of services offered by an Employee Assistance Program that provides support, resources, and information for personal and work-life issues. City of Lamar offers an Employee Assistance Program to provide you and your family members with the assistance you need in your everyday life. You receive up to five (5) face-to-face counseling sessions per incident, per year through Lincoln Financials' EmployeeConnect program. EmployeeConnect offers professional, confidential services to help you and your loved ones improve your quality of life. EMPLOYEE ASSISTANCE PROGRAM In-Person Guidance Unlimited 24/7 Assistance Online Resources Some matters are best resolved by meeting with a professional in person. With EmployeeConnect, you and your family get: • In-person help for short-term issues (up to five sessions with a counselor per person, per issue, per year) • In-person consultations with network lawyers including one free 30-minute in-person consultation per legal issues, and 25% off subsequent meetings You and your family can access the following services anytime — online, on the mobile app or with a toll-free call • Information and referrals on family matters, such as child and elder care, pet care, vacation planning, moving, car buying, college planning and more • Legal information and referrals for family law, estate planning, consumer and civil law • Financial guidance on household budgeting and short and long-term planning EmployeeConnect offers a wide range of information and resources you can research and access on your own. Expert advice and support tools are just a click away when you visit GuidanceResources.com or download the GuidanceNow mobile app. You’ll find: • Articles and tutorials • Videos • Interactive tools, including financial calculators, budgeting worksheets and more Take Advantage of Employee Connect For more infromation about the employee assistance program , visit www.GuardianResources.com, download the GuidanceNow mobile app or call 888.628.4824 Log In Credentials: Username: LFGSupport Password: LFGSupport1
14 CITY OF LAMAR ADDITIONAL BENEFITS • Aflac is different from health insurance. It pays cash benefits directly to you. • Aflac is financial protection: Income protection, medical expense coverage, expenses for daily living. • Even if you don’t have health insurance you can still participate in Aflac. This is also true for your dependents. • You have the convenience of payroll deduction at discounted group-rates. • Aflac benefits are pre-determined and pay cash regardless of any other insurance you have. • You can take Aflac with you at the same low group rate, you will not have annual rate increases. Accident Policy—coverage 24/7, on and off the job for accidents • Initial doctor visit for an injury $75-$100. ER or Urgent Care visit due to an injury $150-$200. • Follow up visits due to an injury $35. Physical therapy visits due to an injury $350 per visit. • First day in the hospital due to an injury$1,125. $225 each additional night. • Additional benefits for specific injuries: Ligament damage, torn cartilage, fractures, sutures, burns, surgeries, appliances, teeth injuries, coma, eye injuries, and so forth. • Ambulance and flight-for life benefits due to an injury. • Diagnostics such as MRI, CT Scan, etc. Plus many additional benefits. • Wellness benefit per family member per year $25-$75 (increases each year you have the policy). Hospital Policy—Benefits for sickness, accidents, and maternity • No waiting period for treatment (new). • Hospitalization admission $1,150, hospital confinement, and intensive care benefits. • Surgical and anesthesia benefits (inpatient and outpatient). • ER visits $50-$100, doctor’s office visits $25, telemedicine visit benefit. • Diagnostics, chiropractic and prescription benefits. Critical Illness Policy—Coverage for cancer, heart attack, stroke, by-pass surgery, renal failure, carcinoma in situ plus 10 more heart conditions. • Guarantee issue regardless of preexisting conditions up to $20,000 in coverage ($10,000 for a spouse). • Up to $50,000 available for an employee and up to $25,000 available for a spouse. • Additional occurrence: Pays if there is an occurrence of another qualifying event after just six months. • Re-occurrence benefit: Pays if there is a re-occurrence of the same qualifying event after six months. • Non-invasive cancer benefit (such as some types of breast cancer). Skin cancer benefit. • $50.00 wellness benefit for employee & spouse annually. The above overview is for illustration purposes only. For specific details refer to the product brochures. Enrollment: Complete your Aflac application and return it to HR or email your application to admin@priceassociates.net Questions on enrolling or policies? Call us! 303-400-1424 Administered by AFLAC
15 CITY OF LAMAR 2025 MONTHLY CONTRIBUTIONS FOR BENEFITS MEDICAL PPO B2000 TOTAL PREMIUM CITY EMPLOYEE MONTHLY EMPLOYEE PER PAYCHECK Employee Only $1,035.00 $776.25 $258.75 $129.38 Employee + $1,941.00 $1,455.75 $485.25 $242.63 Employee + Two or More Dependents $2,385.00 $1,788.75 $596.25 $298.13 MEDICAL HDHP 2500 TOTAL PREMIUM CITY EMPLOYEE MONTHLY EMPLOYEE PER PAYCHECK Employee Only $906.00 $679.50 $226.50 $113.25 Employee + $1,698.00 $1,273.50 $424.50 $212.25 Employee + Two or More Dependents $2,088.00 $1,566.00 $522.00 $261.00 DENTAL PLAN A TOTAL PREMIUM CITY EMPLOYEE MONTHLY EMPLOYEE PER PAYCHECK Employee Only $38.00 $28.50 $9.50 $4.75 Employee + $75.90 $56.92 $18.98 $9.49 Employee + Two or More Dependents $98.55 $73.91 $24.64 $12.32 DENTAL PLAN B TOTAL PREMIUM CITY EMPLOYEE MONTHLY EMPLOYEE PER PAYCHECK Employee Only $19.65 $14.73 $4.92 $2.46 Employee + $39.45 $29.59 $9.86 $4.93 Employee + Two or More Dependents $51.25 $38.43 $12.82 $6.41 VISION TOTAL PREMIUM CITY EMPLOYEE MONTHLY EMPLOYEE PER PAYCHECK Employee Only $6.00 $0.00 $6.00 $3.00 Employee + $11.92 $0.00 $11.92 $5.96 Employee + Two or More Dependents $15.50 $0.00 $15.50 $7.75 EMPLOYEE CONTRIBUTIONS
CITY OF LAMAR 16 AFLAC SEMI-MONTHLY CONTRIBUTIONS GROUP CRITICAL ILLNESS (EMPLOYEE, NON-TOBACCO) AGE $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000 18 - 29 $2.06 $3.43 $4.79 $6.16 $7.52 $8.89 $10.26 $11.62 $12.99 $14.36 30 - 39 $2.86 $5.04 $7.21 $9.38 $11.55 $13.73 $15.90 $18.07 $20.24 $22.42 40 - 49 $5.38 $10.06 $14.75 $19.43 $24.11 $28.80 $33.48 $38.17 $42.85 $47.54 50 - 59 $9.35 $18.00 $26.65 $35.31 $43.96 $52.62 $61.27 $69.92 $78.58 $87.23 60+ $16.74 $32.79 $48.85 $64.90 $80.95 $97.00 $113.05 $129.10 $145.15 $161.20 GROUP CRITICAL ILLNESS (SPOUSE, NON-TOBACCO) AGE $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25,000 18 - 29 $2.06 $2.74 $3.43 $4.11 $4.79 $5.47 $6.16 $6.84 $7.52 30 - 39 $2.86 $3.95 $5.04 $6.12 $7.21 $8.30 $9.38 $10.47 $11.55 40 - 49 $5.38 $7.72 $10.06 $12.40 $14.75 $17.09 $19.43 $21.77 $24.11 50 - 59 $9.35 $13.67 $18.00 $22.33 $26.65 $30.98 $35.31 $39.64 $43.96 60+ $16.74 $24.77 $32.79 $40.82 $48.85 $56.87 $64.90 $72.92 $80.95 GROUP CRITICAL ILLNESS (EMPLOYEE, TOBACCO) AGE $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000 18 - 29 $2.75 $4.80 $6.85 $8.91 $10.96 $13.02 $15.07 $17.12 $19.18 $21.23 30 - 39 $4.43 $8.17 $11.90 $15.64 $19.37 $23.11 $26.85 $30.58 $34.32 $38.055 40 - 49 $8.75 $16.80 $24.85 $32.91 $40.96 $49.02 $57.07 $65.12 $73.18 $81.23 50 - 59 $15.74 $30.79 $45.84 $60.89 $75.94 $90.99 $106.04 $121.09 $136.14 $151.185 60+ $28.35 $56.01 $83.67 $111.32 $138.98 $166.64 $194.30 $221.95 $249.61 $277.265 GROUP CRITICAL ILLNESS (SPOUSE, TOBACCO) AGE $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25,000 18 - 29 $2.75 $3.77 $4.80 $5.83 $6.85 $7.88 $8.91 $9.93 $10.96 30 - 39 $4.43 $6.30 $8.17 $10.03 $11.90 $13.77 $15.64 $17.51 $19.37 40 - 49 $8.75 $12.77 $16.80 $20.83 $24.85 $28.88 $32.91 $36.94 $40.96 50 - 59 $15.74 $23.27 $30.79 $38.32 $45.84 $53.36 $60.89 $68.41 $75.94 60+ $28.35 $42.18 $56.01 $69.84 $83.67 $97.49 $111.32 $125.15 $138.98 EMPLOYEE CONTRIBUTIONS GROUP ACCIDENT EMPLOYEE GROUP HOSPITAL EMPLOYEE Employee $7.23 Employee $15.98 Employee + Spouse $11.31 Employee + Spouse $31.61 Employee + Child(ren) $14.98 Employee + Child(ren) $27.16 Family $19.06 Family $42.79
17 CITY OF LAMAR LEGAL NOTICES PATIENT PROTECTIONS DISCLOSURE The City of Lamar Health Plan generally may require the designation of a primary care provider. You have the right to designate any primary care provider who participates in our network and who is available to accept you or your family members. Until you make this designation, Anthem designates one for you. For information on how to select a primary care provider, and for a list of the participating primary care providers, contact the Anthem at 866.698.0087 or www.anthem.com. For children, you may designate a pediatrician as the primary care provider. You do not need prior authorization from Anthem or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in our network who specializes in obstetrics or gynecology. The health care professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a preapproved treatment plan, or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, contact the Anthem at 866.698.0087 or www.anthem.com. WOMEN’S HEALTH & CANCER RIGHTS ACT If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (“WHCRA”). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for: • All stages of reconstruction of the breast on which the mastectomy was performed; • Surgery and reconstruction of the other breast to produce a symmetrical appearance; • Prostheses; and • Treatment of physical complications of the mastectomy, including lymphedema. These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under the plan. Therefore, the following deductibles and coinsurance apply: Plan 1: PPO B2000 PLAN (Individual: 20% coinsurance and $2,000 deductible; Family: 20% coinsurance and $4,000 deductible) Plan 2: HDHP W/ HSA 2500 Plan (Individual: 20% coinsurance and $2,500 deductible; Family: 20% coinsurance and $5,000 deductible) If you would like more information on WHCRA benefits, please call your Plan Administrator at 719.336.1366 or Margaret.saldana@ci.lamar.co.us. NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACT Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).
CITY OF LAMAR 18 LEGAL NOTICES Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272). If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of July 31, 2024. Contact your State for more information on eligibility – ALABAMA – Medicaid ALASKA – Medicaid Website: http://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 ARKANSAS – Medicaid CALIFORNIA – Medicaid Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447) 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
19 CITY OF LAMAR LEGAL NOTICES COLORADO – Health First Colorado (Colorado’s Medicaid Program) & Child Health Plan Plus (CHP+) FLORIDA – Medicaid Health First Colorado Website: https://www.healthfirstcolorado.com/ Health First Colorado Member Contact Center: 1-800-221-3943/State Relay 711 CHP+: https://hcpf.colorado.gov/child-health-plan-plus CHP+ Customer Service: 1-800-359-1991/State Relay 711 Health Insurance Buy-In Program (HIBI): https://www.mycohibi.com/ HIBI Customer Service: 1-855-692-6442 Website: https://www.flmedicaidtplrecovery.com/ flmedicaidtplrecovery.com/hipp/index.html Phone: 1-877-357-3268 GEORGIA – Medicaid INDIANA – Medicaid GA HIPP Website: https://medicaid.georgia.gov/healthinsurance-premium-payment-program-hipp Phone: 678-564-1162, Press 1 GA CHIPRA Website: https://medicaid.georgia.gov/programs/ third-party-liability/childrens-health-insurance-programreauthorization-act-2009-chipra Phone: 678-564-1162, Press 2 Healthy Indiana Plan for low-income adults 19-64 Website: http://www.in.gov/fssa/hip/ Phone: 1-877-438-4479 All other Medicaid Website: https://www.in.gov/medicaid/ Phone: 1-800-457-4584 IOWA – Medicaid and CHIP (Hawki) KANSAS – Medicaid Medicaid Website: https://dhs.iowa.gov/ime/members Medicaid Phone: 1-800-338-8366 Hawki Website: http://dhs.iowa.gov/Hawki Hawki Phone: 1-800-257-8563 HIPP Website: https://dhs.iowa.gov/ime/members/medicaid-ato-z/hipp HIPP Phone: 1-888-346-9562 Website: https://www.kancare.ks.gov/ Phone: 1-800-792-4884 HIPP Phone: 1-800-967-4660 KENTUCKY – Medicaid LOUISIANA – Medicaid Kentucky Integrated Health Insurance Premium Payment Program (KI-HIPP) Website: https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspx Phone: 1-855-459-6328 Email: KIHIPP.PROGRAM@ky.gov KCHIP Website: https://kidshealth.ky.gov/Pages/index.aspx Phone: 1-877-524-4718 Kentucky Medicaid Website: https://chfs.ky.gov/agencies/dms Website: www.medicaid.la.gov or www.ldh.la.gov/lahipp Phone: 1-888-342-6207 (Medicaid hotline) or 1-855-618-5488 (LaHIPP) MAINE – Medicaid MASSACHUSETTS – Medicaid and CHIP Enrollment Website: https://www.mymaineconnection.gov/benefits/s/? language=en_US Phone: 1-800-442-6003 TTY: Maine relay 711 Private Health Insurance Premium Webpage: https://www.maine.gov/dhhs/ofi/applications-forms Phone: 1-800-977-6740 TTY: Maine relay 711 Website: https://www.mass.gov/masshealth/pa Phone: 1-800-862-4840 TTY: 711 Email: masspremassistance@accenture.com
CITY OF LAMAR 20 LEGAL NOTICES MINNESOTA – Medicaid MISSOURI – Medicaid Website: https://mn.gov/dhs/people-we-serve/children-and-families/ health-care/health-care-programs/programs-and-services/otherinsurance.jsp Phone: 1-800-657-3739 Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm Phone: 573-751-2005 MONTANA – Medicaid NEBRASKA – Medicaid Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP Phone: 1-800-694-3084 Email: HHSHIPPProgram@mt.gov Website: http://www.ACCESSNebraska.ne.gov Phone: 1-855-632-7633 Lincoln: 402-473-7000 Omaha: 402-595-1178 NEVADA – Medicaid NEW HAMPSHIRE – Medicaid Medicaid Website: http://dhcfp.nv.gov Medicaid Phone: 1-800-992-0900 Website: https://www.dhhs.nh.gov/programs-services/medicaid/ health-insurance-premium-program Phone: 603-271-5218 Toll free number for the HIPP program: 1-800-852-3345, ext. 5218 NEW JERSEY – Medicaid and CHIP NEW YORK – Medicaid Medicaid Website: http://www.state.nj.us/humanservices/ dmahs/clients/medicaid/ Medicaid Phone: 609-631-2392 CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710 Website: https://www.health.ny.gov/health_care/medicaid/ Phone: 1-800-541-2831 NORTH CAROLINA – Medicaid NORTH DAKOTA – Medicaid Website: https://medicaid.ncdhhs.gov/ Phone: 919-855-4100 Website: https://www.hhs.nd.gov/healthcare Phone: 1-844-854-4825 OKLAHOMA – Medicaid and CHIP OREGON – Medicaid Website: http://www.insureoklahoma.org Phone: 1-888-365-3742 Website: http://healthcare.oregon.gov/Pages/index.aspx Phone: 1-800-699-9075 PENNSYLVANIA – Medicaid and CHIP RHODE ISLAND – Medicaid and CHIP Website: https://www.dhs.pa.gov/Services/Assistance/Pages/HIPPProgram.aspx Phone: 1-800-692-7462 CHIP Website: Children's Health Insurance Program (CHIP) (pa.gov) CHIP Phone: 1-800-986-KIDS (5437) Website: http://www.eohhs.ri.gov/ Phone: 1-855-697-4347, or 401-462-0311 (Direct RIte Share Line) SOUTH CAROLINA – Medicaid SOUTH DAKOTA - Medicaid Website: https://www.scdhhs.gov Phone: 1-888-549-0820 Website: http://dss.sd.gov Phone: 1-888-828-0059 TEXAS – Medicaid UTAH – Medicaid and CHIP Website: Health Insurance Premium Payment (HIPP) Program | Texas Health and Human Services Phone: 1-800-440-0493 Medicaid Website: https://medicaid.utah.gov/ CHIP Website: http://health.utah.gov/chip Phone: 1-877-543-7669
21 CITY OF LAMAR LEGAL NOTICES VERMONT– Medicaid VIRGINIA – Medicaid and CHIP Website: Health Insurance Premium Payment (HIPP) Program | Department of Vermont Health Access Phone: 1-800-250-8427 Website: https://coverva.dmas.virginia.gov/learn/premiumassistance/famis-select https://coverva.dmas.virginia.gov/learn/premiumassistance/health-insurance-premium-payment-hipp-programs Medicaid/CHIP Phone: 1-800-432-5924 WASHINGTON – Medicaid WEST VIRGINIA – Medicaid and CHIP Website: https://www.hca.wa.gov/ Phone: 1-800-562-3022 Website: https://dhhr.wv.gov/bms/ http://mywvhipp.com/ Medicaid Phone: 304-558-1700 CHIP Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447) WISCONSIN – Medicaid and CHIP WYOMING – Medicaid Website: https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm Phone: 1-800-362-3002 Website: https://health.wyo.gov/healthcarefin/medicaid/programs-andeligibility/ Phone: 1-800-251-1269 To see if any other states have added a premium assistance program since January 31, 2024, or for more information on special enrollment rights, contact either: U.S. Department of Labor U.S. Department of Health and Human Services Employee Benefits Security Administration Centers for Medicare & Medicaid Services www.dol.gov/agencies/ebsa www.cms.hhs.gov 1-866-444-EBSA (3272) 1-877-267-2323, Menu Option 4, Ext. 61565 Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512. The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email ebsa.opr@dol.gov and reference the OMB Control Number 1210-0137. OMB Control Number 1210-0137 (expires 1/31/2026)
CITY OF LAMAR 22 LEGAL NOTICES HIPAA NOTICE OF PRIVACY PRACTICES REMINDER Protecting Your Health Information Privacy Rights City of Lamar is committed to the privacy of your health information. The administrators of the City of Lamar Health Plan (the “Plan”) use strict privacy standards to protect your health information from unauthorized use or disclosure. The Plan’s policies protecting your privacy rights and your rights under the law are described in the Plan’s Notice of Privacy Practices. You may receive a copy of the Notice of Privacy Practices by contacting Margaret Saldana - Human Resources Manager at 719.336.1366 or Margaret.saldana@ci.lamar.co.us. HIPAA SPECIAL ENROLLMENT RIGHTS City of Lamar Health Plan Notice of Your HIPAA Special Enrollment Rights Our records show that you are eligible to participate in the City of Lamar Health Plan (to actually participate, you must complete an enrollment form and pay part of the premium through payroll deduction). A federal law called HIPAA requires that we notify you about an important provision in the plan - your right to enroll in the plan under its “special enrollment provision” if you acquire a new dependent, or if you decline coverage under this plan for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain qualifying reasons. Loss of Other Coverage (Excluding Medicaid or a State Children’s Health Insurance Program). If you decline enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage is in effect, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 31 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage). Loss of Coverage for Medicaid or a State Children’s Health Insurance Program. If you decline enrollment for yourself or for an eligible dependent (including your spouse) while Medicaid coverage or coverage under a state children’s health insurance program is in effect, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage. However, you must request enrollment within 60 days after your or your dependents’ coverage ends under Medicaid or a state children’s health insurance program. New Dependent by Marriage, Birth, Adoption, or Placement for Adoption. If you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your new dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. Eligibility for Premium Assistance Under Medicaid or a State Children’s Health Insurance Program – If you or your dependents (including your spouse) become eligible for a state premium assistance subsidy from Medicaid or through a state children’s health insurance program with respect to coverage under this plan, you may be able to enroll yourself and your dependents in this plan. However, you must request enrollment within 60 days after your or your dependents’ determination of eligibility for such assistance.
CITY OF LAMAR 23 To request special enrollment or to obtain more information about the plan’s special enrollment provisions, contact: Margaret Saldana - Human Resources Manager at 719.336.1366 or Margaret.saldana@ci.lamar.co.us. Important Warning If you decline enrollment for yourself or for an eligible dependent, you must complete our form to decline coverage. On the form, you are required to state that coverage under another group health plan or other health insurance coverage (including Medicaid or a state children’s health insurance program) is the reason for declining enrollment, and you are asked to identify that coverage. If you do not complete the form, you and your dependents will not be entitled to special enrollment rights upon a loss of other coverage as described above, but you will still have special enrollment rights when you have a new dependent by marriage, birth, adoption, or placement for adoption, or by virtue of gaining eligibility for a state premium assistance subsidy from Medicaid or through a state children’s health insurance program with respect to coverage under this plan, as described above. If you do not gain special enrollment rights upon a loss of other coverage, you cannot enroll yourself or your dependents in the plan at any time other than the plan’s annual open enrollment period, unless special enrollment rights apply because of a new dependent by marriage, birth, adoption, or placement for adoption, or by virtue of gaining eligibility for a state premium assistance subsidy from Medicaid or through a state children’s health insurance program with respect to coverage under this plan.
24 CITY OF LAMAR LEGAL NOTICES NOTICE OF CREDITABLE COVERAGE Important Notice from City of Lamar About Your Prescription Drug Coverage and Medicare Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with City of Lamar and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage: 1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. 2. City of Lamar has determined that the prescription drug coverage offered by the medical plan is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan. When Can You Join a Medicare Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan. What Happens to Your Current Coverage if You Decide to Join a Medicare Drug Plan? If you decide to join a Medicare drug plan, your current City of Lamar coverage will not be affected. If you do decide to join a Medicare drug plan and drop your current City of Lamar coverage, be aware that you and your dependents may not be able to get this coverage back. When Will You Pay a Higher Premium (Penalty) to Join a Medicare Drug Plan? You should also know that if you drop or lose your current coverage with City of Lamar and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later.
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