Davie Benefits 2016 Print

Town of Davie
2016
Benefit
Highlights
The Town of Davie strives to be the
preeminent community in South Florida to
live, work, learn, and play while treasuring
our preserved natural settings.
Davie Benefits 2016.indd 2-3 9/21/2015 8:45:26 PM

Table of Contents

Welcome to Your Benefits – What’s New? 2
Benefits Selection Form 3
Eligibility & Benefit Dollars 4
United Healthcare Plan Designs 5
United Healthcare Care 24 Services,
United Healthcare Health Discount Program & 6
Optum Pharmacy Management Program
Humana Dental Plans 7
Humana VisionCare 8
The Standard Life Insurance 9
UNUM Disability Insurance
Qualifying Events & Compliance Notices 10
Flexible Spending Accounts 11
457 Deferred Compensation, We Florida Financial Credit Union, 12
Genworth Long Term Care, & Treasury Direct Savings Bonds

Legal Plans & VPI Pet Insurance 13
Aflac Supplemental Benefits 14
Colonial Life & Accident Supplemental Benefits 15
Contact Phone Numbers and Websites 16
Contact Information
Booklet Designed by Cadence Graphic Design
www.cadencegraphicdesign.com16
Phone and Fax numbers Email and/or website
Town of Davie –
Human Resources Department
Stacey H. S. Hipsman, HR Director
Shaun Gelvez, Administrative Aide
Grace Garagozzo, Benefits Analyst
Makia Curry, HR Assistant
Sandra Scott, HR Manager
Daniele Graydon, HR Manager
Kettly Calixte, Ass’t Risk Mgt Coordinator
Phone 954-797-1100 Main No.
Phone 954-797-1169
Phone 954-797-1069
Phone 954-797-1194
Phone 954-797-1093
Phone 954-797-1172
Phone 954-797-1022
Phone 954-797-1097
Email: davie-fl.gov
Email: shipsman@davie-fl.gov
Email: sgelvez@davie-fl.gov
Email: ggaragozzo@davie-fl.gov
Email: mcurry@davie-fl.gov
Email: sandra_scott@davie-fl.gov
Email: dgraydon@davie-fl.gov
Email: kcalixte@davie-fl.gov
Aflac
Gloria Schulze, Rep
Gene Villa, Rep
Aflac Claims Department
Aflac Customer Service
Phone 954-560-4150
Phone 561-714-4224
Phone 800-992-3522 Claims
Fax 877-442-3522 Claims
Phone 800-992-3522 Cust. Svc.
Fax 800-448-8922 Cust. Svc.
Email: schulze7@bellsouth.net
Email: gene@definovilla.com
www.aflac.com
We Florida Financial Credit Union
2000 N. Flamingo Rd.
Pembroke Pines, FL 33028
Phone 954-745-2400 www.wefloridafinancial.com
Colonial Life
Donna Tilton, Rep
Colonial Client Services
Phone 954-829-4930
Phone 800-325-4368
Email: colonialins@aol.com
www.coloniallife.com
Genworth Long Term Care
Gloria Schulze, Rep
Gene Villa
Genworth Customer Service
Phone 954-560-4150
Phone 561-714-4224
Phone 888-436-9678
Email: schulze7@bellsouth.net
Email: gene@definovilla.com
Humana Dental
Customer Service for Dental Phone 800-233-4013 www.humanadental.com
Humana Vision Care
Customer Service for Vision Phone 866-537-0229 www.humanavisioncare.com
Voya - 457 Plan & Roth IRA
Erik Sherman, Rep
Voya Customer Service
Phone 305-579-4026
Phone 800-584-6001
www.voyaretirementplans.com
LegalShield
Yvette Mayo, Rep
Phone 407-719-4897 cell
Phone 407-657-1940 office
Fax 407-671-2496
Email: mayogroupbenefits@msn.com
www.legalshield.com/info/TownofDavie
Customer Service: 800-654-7757
The Standard Life Insurance Co.
Group Service Phone 800-378-4668 www.standard.com
TreasuryDirect for Savings Bonds www.treasurydirect.gov
United Healthcare
Customer Service
CARE24-Employee Asst. Prog.
Optum Mail Order Pharmacy
Health Discount Program
Phone 866-633-2446
Phone 888-887-4114
Phone 888-739-5820
Phone 800-377-0263
www.myuhc.com
www.myuhc.com
www.optumrx.com
www.myuhc.com under Extra
Programs and Discounts
U.S. Legal
Dixie Kuehn, Rep
Customer Service
Phone 321-799-2986 office
321-403-0156 cell
Phone 800-356-LAWS
Email: DixieKuehn@clf.rr.com
www.uslprotects.com
UNUM
Short and Long Term Disability Phone 800-858-6843 www.unum.com
VPI Pet Insurance
Cynthia Martinez Phone 714-706-5476 Email: cmartinez@petinsurance.com
WageWorks
Flexible Spending Accounts
Phone 800-950-0105
Fax 877-782-8889
www.takecarewageworks.com
email claims to:
claims@takecareclaims.com

All benefits in the booklet are subject to change. This is an Employee Benefits Highlights Summary and not a contract. All benefits are subject to the provisions and
exclusions of the master contract.
TOWN OF DAVIE - 2016 EMPLOYEE BENEFIT HIGHLIGHTS
Colonial Life

Whole Life - Guaranteed Issue up to $25,000 face amount (no health questions asked) for employees of Town of
Davie. Up to $50,000 face amount available with our simplified issue (only asks 3 health questions). The guaranteed
purchase option rider allows you to increase the face amount to a maximum of $100,000 without any health questions
(available to purchase up to age 55). Face amounts up to $300,000 for employees, $100,000 for spouse. Colonial Whole
Life policy builds cash value. Your premiums will never increase because of health or age. The Accelerated Death Benefit
allows you to request up to 75% of the face amount if you are diagnosed with a terminal illness. Colonial Life Whole Life
Policy is paid up at either age 65 or age 95. Available for Employee and/or Spouse.
Universal Life Insurance with Long Term Care Universal Life is a flexible premium and adjustable death
benefit that accumulates cash value. The Colonial Long Term care rider can advance up to 4% of the face amount of
your universal life policy’s death benefit to provide payments for qualified long term care service. Example $100,000 of
Universal Life will provide $4,000 month benefit for up to two years at a long term care facility such as a nursing home,
assisted living facility, home health care or adult day care.
Juvenile Universal Life Insurance This is a policy which builds cash value. Example - When each of my
grandchildren were born I purchased a basic $25000 policy for under $10 month. At age 12 my grandson was diagnosed
with diabetes. The policy issued at his birth is the only life insurance coverage he will ever have. Protect your children/
grandchildren with this permanent, economical policy.
Critical Illness coverage compliments your major medical insurance by providing a lump sum of $10,000 - $75,000 Benefit
Amount – You choose the amount! Use to pay the direct or indirect costs related to one of the following covered critical illnesses:
< Heart Attack < Stroke
< Major Organ Failure < Cancer
< End Stage Renal(Kidney) Failure < Coma
< Permanent Paralysis < Blindness
< Occupational HIV < Occupational Infectious Hepatitis B, C or D
Term Life Insurance
10 Year Term/ 20 Year Term/ 30 Year Term offers level death benefits for specific term. Includes Accelerated Death Benefit.
You can convert your policy to a Colonial Life Cash Value Insurance. Coverage available to employee and/or spouse.
Donna Tilton Phone: 954-968-6799 colonialins@aol.com
Colonial Life Phone: 1-800-325-4368

* Benefits are paid directly to you
* Coverage can continue if you retire
or change jobs at same premium
Benefits that Count!Benefits that Count!
152
Welcome to Your Benefits
The Town of Davie offers a comprehensive benefit package for all eligible employees. A variety of these employee benefit
programs have been highlighted in this booklet as a general reference. Please refer to the Town of Davie’s Employee
Handbook and Operating Procedures and group insurance Certificates of Coverage for detailed descriptions of all available
employee benefit programs and stipulations therein. Questions and further clarifications regarding this booklet’s contents
may be directed to the Human Resources Department.
What’s New
The Health Insurance Marketplace - In complying with Federal law, the Town of Davie’s Human Resources Department has
distributed required notification to all Town employees regarding the Health Insurance Marketplace. This notification explained
that Americans are required to obtain health insurance coverage. Town employees and their dependents who are enrolled in
the Town’s United Healthcare coverage will not be affected by these new laws, but any dependents or spouses not covered
must have their own coverage. If you need additional information, please contact the Human Resources Department.
NEW Online Benefit Enrollment with BenTek®!
The Town of Davie is putting you in charge of your benefit enrollment. All benefit eligible employees are provided access
to electronic enrollment through the BenTek Employee Benefit Center (EBC). The EBC provides you the ability to make
your group benefit elections online for the annual open enrollment, new hire enrollment and to make any changes to your
coverage election due to a qualifying life event.
BenTek® is accessible 24 hours a day during the annual open enrollment period. Information about all of your employee
benefit options, premiums and carrier contact information is available to help you make informed decisions. You may also
log on any time throughout the year to review your benefit elections, access carrier contact information, review and update
your life insurance beneficiaries and report any qualifying life events that impact your benefit coverage needs.
To access the Employee Benefit Center:
< Log on to https://www.mybentek.com/davie
< First Time User? Click on First Time User to create your confidential user profile, including your user name and password.
< Enter the BenTek EBC to review your current benefit elections, learn about your benefit options and make any new
elections or changes in your elections.
< You may also review your life insurance beneficiary designation(s) and make any necessary changes.
Should you experience technical difficulties, please contact BenTek Support at support@mybentek.com or call 888-5-BenTek
(888-523-6835) Monday through Friday, during regular business hours.
To access your group insurance benefits online, log on to the EBC at www.mybentek.com/davie
Changes to the Medical FSA “Use It or Lose It” Rules - For 2016, the IRS has established the maximum amount that
can be contributed to a qualified FSA at $2,550. But, you can now roll over up to $500 of unused FSA funds to the following
year! Your rollover will not impact your contribution limit, which means your total balance in the next plan year could be up
to $3,050. So, if you have any 2015 money you have not spent by the end of the 2015 plan year (12/31/2015) up to $500
maximum, it will carry over into your 2016 Medical FSA account. This carryover is NOT for the Dependent Day care FSA –
ONLY the Medical FSA.
Remember – since 2011, Medical FSA funds cannot be used for over-the-counter medicines unless specifically prescribed
by a doctor. You must sign up each year for a Medical or Dependent Day care FSA. WageWorks is the company that
handles our FSA accounts and reimbursements, and there are WageWorks forms for signing up for an FSA and for
sending in claims. Claims may also be initiated online with WageWorks at www.takecarewageworks.com or emailed to
claims@takecareclaims.com. An FSA participant can establish a secure online account at www.takecarewageworks.com
where they will be able to track their claims submissions, print claim forms, make address changes, etc. Employees can
get the forms and sign up with Human Resources or with your Aflac representative.
UNUM Disability Insurance
There are some plan design changes on the UNUM Short and Long Term Disability plans. See page 6 for details.
Introducing the Colonial policyholder website – Coloniallife.com. You can set up your account at coloniallife.com by
answering a few simple questions. You can apply online for your annual $50 wellness screening benefit (within 12 months).
DON’T FORGET!!!
$50.00 Annual Wellness Screening Benefit

Aflac Voluntary Supplemental Benefits
During each annual open enrollment period, you can meet individually with an Aflac representative to discuss adding new
voluntary benefits or to review the plans in which you are currently enrolled. New hires will have the opportunity to meet with
a representative to sign up for policies. If the policies are pre-taxed, you can only add/change/delete a policy at the Open
Enrollment period or if you have a change in family status. Below are the various Aflac plan options.
q Aflac pays cash directly to you, (unless you assign the benefits)
q Affordable premiums and convenient payroll deduction
q Compliments your health insurance benefits – provides quick, additional income for your initial out-of-pocket
expenses such as deductibles, co-insurance, and living expenses
q Portable – if you terminate your employment or retire, you may continue your Aflac coverage at the same price
and same benefits, even into retirement. Dependent children covered to age 26
q Coverage is available for your spouse and qualifying, dependent children on all of the following products
Off-the-Job Accident Indemnity Plan: Provides cash if you have an off-the-job accident and receive medical care. If you
break a tooth and go to a dentist, if you hurt your back in a fall and go to a chiropractor, or if your child is injured at school and
is taken to an ER or Urgent Care, etc. – you have a claim. Helps cover co-pays, deductibles, and out of pocket expenses.
Family coverage available. Dependent children are covered to age 26 on family plan. You can purchase separate, non-
payroll Accident coverage for other family members and older children. There is a $60 wellness benefit (one per policy)
each “plan year” after the first year.
Cancer Indemnity Plan: Pays cash benefits and helps create a cash flow if you are diagnosed with cancer and for cancer
treatments. Four levels available. Family coverage available, and dependent children are covered until age 26. Covers skin
cancer, as well as internal cancer. Totally portable at the same price if you leave or retire – keep it all your life. $40 or $75
wellness benefit for each covered person each calendar year.
Hospital Indemnity Plan: Pays a benefit when a covered person requires hospital confinement for 23 hours or more for a
covered sickness or injury and a charge is incurred. Family coverage available. Can be used for maternity.
All Aflac policies are totally portable at the same price if you leave or retire. Be sure to collect your wellness benefits!
It’s very important to carefully read the brochures and outlines of coverage for each policy, as well as speak individually to
an Aflac Representative to get the details, applications, and necessary information on each plan. Your Aflac Reps:
Gene Villa phone 561-714-4224 gene@definovilla.com
Gloria Schulze phone 954-560-4150 schulze7@bellsouth.net
14 3
2016 Benefits Selection Form
I. Benefit Choice Dollars $395 $635 $610 $835 per pay period
B1 B2 B3 B4
II. Required Insurance Selections All premiums are per pay period
Medical
Employee
Only
($395)
Employee
+ Spouse
($635)
Employee +
Children
($610)
Employee +
Family
($835)
Selected
Amount
Pay Code
United HealthCare EPO
$348 $796 $743 $1081 22, 18, 17, 04
United HealthCare POS $341 $758 $691 $1021 24, 25, 26, 27
$1,300 Ded/HSA w/$1000.00 in account
($41.67 deposited each pay period)
$309.67 $680.67 $619.67 $923.67 28, 29, 30, 31 / 32
Disability/Life Insurance
Long Term Disability
- Post tax Deduction
Adjustments to salary will alter premium
Max benefit 50% to $ 7500/month
LT
Short Term Disability
- Post Tax deduction
Adjustments to salary will alter premium
Maximum benefit 50% to $1500 per week
03
Life Insurance (AD&D, $50,000) Base Life Insurance $2.95 BL
III. Optional Insurance Selections
Dental Employee
Only
Employee &
Spouse
Employee &
Children
Employee &
Family
Selected
Amount
Pay Code
Humana HMO HS205 $6.08 $12.15 $13.67 $22.00 AD, A5, A6, 07
Humana (Adv Plus 3S) $10.51 $21.51 $21.85 $35.93 15, A3, A4, 16
Humana PPO Plan (LOW) $13.29 $26.55 $35.33 $50.70 10, A1, A2, 09
Humana PPO Plan (HIGH) $17.68 $35.35 $47.02 $67.48 A7, A8, A9, A10
Post tax Life - Additional/Supplemental SEE SEPARATE SHEET FOR LIFE INSURANCE RATES.
Rates are based on age. Select total amount of coverage in increments of $10,000 $__________ S1
Dependent Life Insurance Coverage
(Post tax)
$10,000 dependent life coverage Spouse $1.27 DS
DC
$10,000 dependent life coverage (child/children) $1.00
AFLAC - Attach new AFLAC enrollment card, or write in Current amount if you have no changes. 02
Colonial Life – Insurance Products COL
Legal Shield Services Legal $7.98 Identity Theft
$6.48/$6.97
Combination $12.95 PP
Vision Care Plan Single-$3.40 Family-$9.72 VS, VF
US Legal Services Legal - $9.38 Identity - $4.98 Combination $11.35 UL
Flex Spending - Medical - Pay period minimum $10.00/maximum $104.16 M1
Flex Spending - Dependent Care - Pay period minimum $10.00/maximum $200.00 C1
Additional Health Savings Account Contribution 33
TOTAL $__________
Miscellaneous

Group Insurance Eligibility
The Town’s group insurance plan year for 2016 is from January 1st through December 31st.
Employees are eligible to participate in the Town’s insurance plans if they are full time employees working at least 30 hours
per week. Coverage will be effective the 1st of the month following 30 days of employment. If you separate employment
from the Town, insurance will continue through the end of the month in which the separation occurred. COBRA continuation
of coverage is available as applicable by law.
Dependent Eligibility
A dependent is defined as the legal spouse (a person to whom the participant is legally married) and/or dependent children
of the participant or the spouse. Dependent children may be covered through the end of the calendar year in which the child
reaches age 26 for medical, dental and vision. The term “child” includes any of the following:
lA natural child lA legally adopted child
lA stepchild lA foster child
lA newborn (up to age 18 months) of a covered dependent (Florida)
l A child for whom legal guardianship has been awarded to the participant or the participant’s spouse
Dependent Eligibility Age Requirements
Applies to Dependent through the age of 26:
Eligibility requirements for eligible over-age dependents have been eliminated for group medical, dental and vision insurance.
Over-age dependents may be covered by these plans through the end of the calendar year in which the child turns age 26.
Disabled Dependents
Coverage for an unmarried dependent child may be continued beyond age 26 if:
lThe dependent is physically or mentally disabled and incapable of self-sustaining employment, AND
lThe dependent is otherwise eligible for coverage under the group medical plan, AND
lThe dependent has been continuously insured; AND
lCoverage began prior to the age of 19.
lProof of disability will be required upon request. Please contact Human Resources if further clarification is required.
Tobacco Policy
Effective October 1, 2015, the Town has adopted a non-tobacco hire policy for any employees hired on or after this date. In
addition, there will be a $50 monthly surcharge for any new dependent added to the health insurance if they are a tobacco
user.
Group Insurance Premium Funding “Benefit Dollars”
The Town of Davie offers funding through “Benefit Dollars” to all benefit eligible employees. These Benefit Dollars are to be
used to contribute to the cost of insurance premiums each employee incurs. The employee may choose how the funds are
applied and to which plans they would like them to be applied. For more information regarding Benefit Dollars or how they
work, please contact Human Resources.
Summary of Benefits and Coverage
A Summary of Benefits & Coverage (SBC) for each Medical Plan Option is provided as a supplement to this booklet
which is being distributed to the New Hires and Existing Employees during open enrollment. These summaries are an
important item in understanding your benefit options. A copy of these SBC documents is also available as follows:
From: Human Resources Department Phone: 954-797-1100
Address: 6591 Orange Dr. Email: ggaragozzo@davie.fl.gov
Davie, FL 33314 Through the enrollment software - BenTek: www.mybentek.com/davie
The SBC is only a summary of the plan’s coverage.Acopy of the plan document, policy, or certificate of coverage should be consulted
to determine the governing contractual provisions of the coverage.Acopy of the actual group certificate of coverage can be reviewed
and obtained by contacting the Human Resources Department or at the following web address: www.mybentek.com/davie.
Ifyouhaveanyquestionsabouttheplanofferingsorcoverageoptions,pleasecontacttheHumanResourcesDepartmentat(954)797-1100.
Legal Plans
The Town offers employees the opportunity to participate in a voluntary legal insurance program provided by either Legal
Shield or U.S. Legal Services through payroll deduction. These plans are portable if you leave the Town of Davie or retire,
and both plans help cover the costs of legal services, motor vehicle legal services, trial defense services, IRS audit legal
services, etc. Each has an optional plan covering services for identity theft, credit reports, credit monitoring and identity
restoration. One price covers the family (See brochures for more details).
LegalShield & Identity Theft Shield
LegalShield gives you the ability to talk to an attorney on any matter without worrying
about high hourly costs. For one flat monthly fee you can access legal advice, no
matter how traumatic or trivial the issue.
< Advice – unlimited issues < Assistance with traffic-related Issues
< Access for covered emergency situations 24/7 < Trial Defense – Pre-Trial & Representation at trial
< Letters/calls made on your behalf < Assistance on IRS audit issues
< Lawyers prepare your will, living will, and < Extensive list of online legal forms
healthcare power of attorney < Review contracts & documents up to 10 pages in length

Optional Identity Theft Shield puts the experts in the field of identity restoration on your side.
U.S. Legal Services & Legal & Identity Protection Plans
By enrolling in this plan, participants will have direct access to attorneys who
will provide services for a variety of issues that include, but are not limited to:
f Divorce f Child Custody & Support f Domestic Adoption f Consumer Law
f Bankruptcy f Foreclosure Assistance f Criminal Law f Real Estate
f Traffic Tickets, DUI f Debt Collection Defense f Estate Planning f Wills & Trusts
The optional Identity Defender program assists at the inception of a fraud-related emergency, helps restore identity and
good credit, helps with ID theft, and educates on preventive steps to protect identity.
VPI Pet Insurance
Part of the Nationwide Insurance family, VPI Pet Insurance is the largest provider of pet insurance,
and has insured over 1 million pets since 1982. Coverage is provided for dogs, cats, birds and
exotics, with your choice of several plans and optional wellness coverage. You can use any
veterinarian, and 4 out of 5 vets recommend VPI. Visit the following link for a 5% discount on
plans, view an informational video on pet insurance, and get a quote on coverage for your pet:
www.petinsurance.com/affiliates/davieflgov.
Creating an Environment that is Conducive to
Innovation, Creativity, and Collaboration
Creating an Environment that is Conducive to
Innovation, Creativity, and Collaboration
4 13

457 Plan Deferred Compensation Administered by VOYA
As a Town Employee, you can participate in a 457 Deferred Compensation Plan, under which you can make pre-tax
contributions through payroll deduction into a variety of investment options to save for retirement. By setting aside a portion
of your income to accumulate on a tax-deferred basis, you pay fewer tax dollars now, and your savings and investment
earnings accumulate tax-deferred until you start drawing from the plan at retirement.
Your 457 Plan is a non-qualified tax-deferred compensation plan that works very much like other retirement plans such
as a 401(k) and 403(b). Your payroll-deducted contributions are deferred into the 457 Plan on a pretax basis, lowering
your taxable income. The 457 assets grow tax-deferred until they are withdrawn from the account, at which time you pay
the taxes. You may use this plan to save for retirement through systematic deposits each pay period, while also reducing
taxable income, your contributions and earnings grow tax-free, and you only pay taxes when you withdraw the funds.
Contributions may also be made to a Roth 457 Plan after-tax. When you take your money out at retirement, your contributions
and earnings do not get taxed.
You can get more information on these plans through Human Resources, or calling the
plan representative Erik Sherman, at 305-579-4026.
We Florida Financial Credit Union
We Florida Financial Credit Union is a financial cooperative that offers many banking-type
services such as savings and checking accounts, auto loans, mortgages and home equity loans,
credit cards and atm’s, as well as having on-line member assistance programs, calculators, and
seminars. The Credit Union is located at 2000 N. Flamingo Road in Pembroke Pines, and can
be reached at 954-745-2400. Visit their website at www.wefloridafinancial.com.
Genworth Long Term Care Insurance
Long term care insurance can help you plan for future financial security if you need help with care in
a nursing home, assisted care facility (including Alzheimer’s facilities), adult day care, or in your own
home. Learn about protecting your assets with a state qualified long-term care partnership policy.
Help protect your family and your financial plan with a policy from a leader in the long-term care
industry. Because of the complexity and details of these policies, separate long-term care meetings
will be held throughout the year.
TreasuryDirect Payroll Savings Plan for Purchasing Savings Bonds
TreasuryDirect offers a Payroll Savings Plan feature that allows employees
to make recurring purchases of electronic savings bonds by having money
from each paycheck sent automatically to a TreasuryDirect account, just like
sending your pay to a bank by direct deposit. Once your Payroll Savings Plan
is set up in TreasuryDirect, the system will automatically purchase the type and dollar value of bond you want every time
you have accumulated enough money in your Account to make the purchase. For example: If you want to buy $50 Series I
Savings Bonds, and you ask your employer to withhold $25 from each pay, TreasuryDirect will purchase a $50 bond for you
every other payday. You don’t have to think about it again or do anything else. The purchase is automatic until you change
it or end the payroll funding. More information is available on the website www.treasurydirect.gov or at Human Resources.
12 5
United Healthcare 2016
Schedule of
Benefit
Summary
EPO Select
Choice
Plus
POS
In Network Out of Network
HDHP w/HSA
In Network Out of Network
Annual Deductible/Family
Maximum None $200/$400 $500/$1,000 $1,300/$2,600 $3,250/$6,500
Out Of Pocket
Maximum
$2,500/$5,000
no
$2,500/$5,000
no
$3,000/$6,000
no
$2,600/$5,200
aggregate
yes
$5,000/$10,000
aggregate
yes
Physician Office Visit $15 per visit $15 per visit Ded & 40% Ded & 20% Ded & 40%
Specialist Office Visit
Premium Designated
Non Premium Designated
$30 per visit
$40 per visit
$30 per visit
$40 per visit
Ded & 40%
Ded & 40%
Ded & 20%
Ded & 20%
Ded & 40%
Ded & 40%
Preventive Care Service No Co-payment No Co-payment Ded & 40% No Co-payment Ded & 40%
Hospital –
Inpatient Stay
$100/Day
$300/Max
Ded & 20% Ded & 40% Ded & 20% Ded & 40%
Hospital – Out Patient $200 Ded & 20% Ded & 40% Ded & 20% Ded & 40%
High End Diagnostic Testing
MRI, CAT Scans,
PET Scans, CT Scans
$100 Ded & 20% Ded & 40% Ded & 20% Ded & 40%
Low End Diag. Testing
X-Rays, Labwork,
Mammograms
No Co-payment Ded & 20% Ded & 40% Ded & 20% Ded & 40%
Urgent Care Center Services $30 Co-pay $30 Co-pay Ded & 40% Ded & 20% Ded & 40%
Emergency Room $200 $200 Ded & 40% 100% after Ded 100% after Ded
Prescription Coverage
$10 Tier I
$30 Tier II
$50 Tier III
$10 Tier I
$30 Tier II
$50 Tier III
$10 Tier I
$30 Tier II
$50 Tier III
Ded then $10 Tier I
Ded then $30 Tier II
Ded then $50 Tier III
Ded then $10 Tier I
Ded then $30 Tier II
Ded then $50 Tier III

Flexible Spending Accounts allow you to use pre-tax dollars to pay for eligible out-of-pocket medical expenses for yourself
and your dependents, and/or dependent care expenses. Our FSA’s are administered by WageWorks, and all applications,
forms, brochures and information are available through the Aflac Reps or Human Resources.
Recently the U.S. Department of the Treasury modified the “Use It or Lose It” rule which required any leftover balance in
a Healthcare FSA to be forfeited at the end of the plan year. Under the new rule, you will be able to carryover up to $500
of your unused WageWorks Healthcare FSA balance remaining at the end of a plan year, so you no longer end up losing
unused funds up to $500. This rule change limits your risk of losing any unused funds (up to $500.00) and gives you more
control and flexibility in managing your out-of-pocket healthcare expenses.
For 2016: Please review your current balance and your planned expenses for the remainder of this year. Note that up to
$500 of any remaining balance from 2015 will be carried over into your 2016 account. It will not affect your election limit for
2016 – you can carry a total balance of the full election amount for 2016 ($2,550), plus any carryover from 2015 (up to $500)
for a total balance of up to $3,050.
Uncovered, unreimbursed healthcare expenses (out-of-pocket) for purposes of a Medical FSA are defined by the IRS, and
can include medical, dental, vision deductibles, co-pays and coinsurance, eyeglasses and contact lenses, prescription drug
co-pays, and more. By using your Medical Healthcare FSA, you can pay for eligible medical expenses with pre-tax dollars
and reduce your taxable income. The maximum you can contribute to your Medical FSA is $2,550 per the IRS. Expenses
must be incurred within the Plan Year (1/1/2016 – 12/31/2016) except for the new $500 carryover amount.
With a Dependent Care FSA, you can set aside dollars on a pre-tax basis to pay for dependent day care expenses. You
can contribute a maximum of $5,000 per plan year (1/1/2016 – 12/31/2016), pay the expenses, and submit a reimbursement
form after paying for the day care. You cannot participate in this account and take a dependent care tax credit on your taxes
at year-end (it is one or the other). These expenses must be for the care of a child age 12 and under, or for a dependent
who is not capable of self-care. You will be reimbursed from your Dependent Care Spending Account only up to the amount
you have contributed at any given time. Reimbursement requests must be submitted and received by WageWorks within
30 days after the end of the plan year. There is no carryover on the Dependent Care Account.
Medical Healthcare and Dependent Care Spending Accounts are separate, and you cannot transfer money from one
account to the other. You may not use money in your Healthcare Spending Account for reimbursement of a domestic
partner’s medical, dental or vision expenses (per the IRS).
Some questions on FSA Accounts should be directed to a tax advisor.
United Healthcare Care 24 Services – Employee Assistance Program
The Employee Assistance Program is available to ALL employees and their dependents living in the same household. It is
a great free source for health information and emotional support available 24 hours a day, 7 days a week at 1-888-887-4114
or on the web at www.myuhc.com. Nurses and specialists are available 24 hours a day to answer your questions on illness,
injuries, stress and anxiety, coping with grief and loss, finding a doctor, personal legal or financial concerns, prevention and
self-care, medications and general health information, and many more topics. Emotional support is also available from
master’s-level specialists when you need help dealing with life’s challenges. Get help with stress, anxiety, depression, grief,
marriage difficulties and more. You also have access to an audio library, a website, and a nurse online via Chat. Pick up a
brochure from HR and visit the website.
United Healthcare Health Discount Program
This is a discount plan that provides discounts at certain health care providers for medical services, and is NOT insurance.
The discount plan member is obligated to pay for all health care services, but will receive a discount from these health care
providers who have contracted with the discount plan organization.
Save on these wellness resources to help you live a healthier life:
vWeight management from Jenny Craig, Nutrisystem and other popular programs
vNutrition counseling
vFitness clubs including select locations of Golds Gym, Curves, Anytime Fitness, My Gym, Jazzercize,
Lifetime Fitness, Snap Fitness
vFitness equipment and apparel
vNatural products and foods
vStress reduction and relaxation resources
vSmoking cessation programs
vAcupuncture, Chiropractic Care
vMassage Therapy, Natural Medicine
vInfertility Treatment
vHearing Devices, Laser eye surgery
Find information on participating programs at www.myuhc.com, under Extra Programs and Discounts. A full brochure giving
more information can be obtained from Human Resources.
OptumRx Pharmacy Management Program
The pharmacy management program provides clinical pharmacy services that promote choice, accessibility and value. The
program offers a broad network of pharmacies (more than 56,000 nationwide) to provide convenient access to medications.
While most pharmacies participate in the network, you should check first – call your pharmacist or visit the online pharmacy
service at www.myuhc.com. The online service offers you home delivery of prescriptions, the ability to view personal
benefit coverage, access health and well being information, and check the location of network retail neighborhood
pharmacies by zip code.
Respecting and Promoting Diverse and Sustainable Community
and Neighborhood Values with consideration of our historic roots
Respecting and Promoting Diverse and Sustainable Community
and Neighborhood Values with consideration of our historic roots
Flexible Spending Accounts (FSA’s)
The Healthcare Flexible Spending Account “Use It or Lose It” Rule has Changed –
Now Features a $500 Carryover
Health Care Spending Account (Medical FSA)
Dedication to Excellence in Service DeliveryDedication to Excellence in Service Delivery
116
Retail Network
Pharmacy
For up to a 31 day supply
Home Delivery Network
Pharmacy
Retail Non-Network
Pharmacy
Tier 1 $10 $20 $10
Tier 2 $30 $60 $30
Tier 3 $50 $100 $50
Dependent Care Spending Account

Qualifying Events and IRS Code Section 125
Premiums for medical, dental, vision and certain supplemental insurance policies and contributions to FSA accounts (Health
Care and Dependent Care FSA’s) and HSA accounts are deducted through a Cafeteria Plan established under Section 125
of the Internal Revenue Code and are pre-tax to the extent permitted. Under Section 125, changes to your pre-tax benefits
can be made ONLY during the Open Enrollment period unless you or your qualified dependents experience a qualifying
event, and the request to make a change is made within 30 days of the qualifying event.
Under certain circumstances, you may be allowed to make changes to your benefits elections during the plan year, if the
event affects your own, your spouse’s, or your dependent’s coverage eligibility. An “eligible” qualifying event is determined
by the Internal Revenue Service (IRS) Code, Section 125.
Examples of qualifying events include the following:
vGain or loss of eligibility for Medicaid or CHIP coverage (60 day notification period)
vAn increase or decrease in your work hours causes eligibility or ineligibility
vA covered dependent no longer meets eligibility criteria for coverage
vYou, your spouse, or dependent(s) terminate or start employment
vYou have a child, gain legal custody or adopt a child
vA child gains or loses coverage with an ex-spouse
vYour spouse and/or other dependent(s) die(s)
vGain or loss of Medicare coverage
vYou get married or divorced
IMPORTANT – If you experience a qualifying event, you must contact Human Resources within 30 days of the qualifying
event to make the appropriate changes to your coverage. Beyond 30 days, requests will be denied, and the employee may
be responsible both legally and financially for any claim and/or expense incurred as a result of the employee or a dependent
who continues to be enrolled but no longer meets eligibility requirements. If approved, changes will take place on the first
of the month following the qualifying event, except for newborns, which are effective on the date of birth. Any cancellations
will be processed at the end of the month, except coverage terminates on the date following a death. You may be required
to furnish valid documentation supporting a change in status or “Qualifying Event.”
Compliance Notices
10 7
Health Information Privacy Notice - the employer/plan
sponsor of a Group Health Plan must comply with applicable
federal and state laws to maintain the privacy of your
Protected Health Information (PHI). PHI may not be used
or disclosed for purposes other than enrollment, treatment,
payment, operations and disclosures required by HIPAA law
without a valid authorization.
Health Insurance Portability & Accountability Act
(HIPAA) - HIPAA nondiscrimination provisions state that
individuals may not ne denied eligibility or continued eligibility
to enroll in a group medical plan based on health factors, nor
charged more for coverage than similar employees.
Special Enrollment Rights - If you are declining enrollment
for yourself or your eligible dependents because of other
health coverage, HIPAA Special Enrollment Rights may in
the future allow you to enroll yourself or your dependents
in the plan, provided that you request enrollment within 30
days after your other coverage ends. In addition, if you have
a new dependent as a result of marriage, birth, adoption or
placement for adoption; you may be able to enroll yourself
and your dependents, provided you request enrollment
within 30 days of the event.
Notice of Privacy Practice of The Town of Davie - The
Town’s Privacy Notice is available and you can obtain a
copy by contacting the Human Resources Department.
COBRA Continuation of Medical Coverage Benefits -
Under the Consolidated Omnibus Budget Reconciliation Act
(COBRA), employees and/or dependents may be able to
continue their enrollment in certain medical plans such as
health and dental, if such coverage is terminated or changed
due to a qualifying event.
Medicare Part D Creditable Coverage - The Town’s
prescription drug coverage is considered Creditable
Coverage under Medicare Part D. If you or your dependents
are or will be eligible for Medicare, you may obtain more
information by requesting a Medicare Part D Disclosure of
Creditable Coverage Notice.
Woman’s Health and Cancer RightsAct of 1998 (WHCRA)
- The Town’s medical plans provide medical and surgical
benefits for post-mastectomy related services including
all stages of reconstruction, surgery to achieve symmetry,
prostheses and treatment of complications, including lymph
edema.
Humana HS205 Humana Advantage Plus 3S
Benefit Description
Must use participating providers.
Plan pays 100% after fixed
co-payment for service.
Must use participating providers.
Plan pays 100% after fixed
co-payment for service.
Calendar Year
Maximum Benefit None None
Annual Deductible
(Individual/Family) None None
Preventative Care No Co-pay No Co-pay
Basic Services Fixed Co-pay Schedule Fixed Co-pay Schedule
Fillings, Periodontics &
Endontics Fixed Co-pay Schedule Fixed Co-pay-Schedule
Major Services Fixed Co-pay-Schedule Fixed Co-pay-Schedule
Orthodontics
Children $1,800
Adults $2,000 Children $2,100 Adults $2,300
Humana PPO
Low PPO High PPO
In Network/Out of Network In Network/ Out of Network
Benefit Description
Plan payment is based on provider's
reduced contracted fees.
Plan payment is based on reasonable and
customary allowances.
Calendar Year
Maximum Benefit $1,000 per participant $2,000 per participant
Annual Deductible
(Individual/Family) $50/$150 $50/$150
Preventative Care Covered at 100% Covered at 100%
Basic Services 80% after deductible 80% after deductible
Fillings, Periodontics,
Endodontics 80% after deductible 80% after deductible
Major Services 50% after deductible 50% after deductible
Orthodontics
Children only - 50% Lifetime
maximum of $1, 000 Children only - 50% Lifetime maximum of $1, 000
Dental Plans
The Town of Davie offers four different Humana dental plans. Two plans are network based only plans, and two plans
are PPO. Outlines of coverage and plan brochures along with costs for each plan are available in Human Resources.
The Humana HS205 plan is a DHMO prepaid plan that focuses on maintaining oral health, prevention and cost-
containment. In order to receive services, a primary dentist from the network must be selected. There are no deductibles
to meet and no waiting periods. The plan provides covered services at a fixed co-pay applicable at either a participating
general dentist or participating specialist.
The Humana Advantage Plus plan is a network based plan. As long as you seek treatment from a Humana Advantage
plan network provider there is no need to choose a primary care dentist. This plan also has a list of fixed co-payments for
dental services. More services are covered under this plan. If a service is not listed on the schedule of benefits, dentists
will give you a 20 percent discount off their usual fee.
Both HS205 and Advantage Plus dental plans have no annual deductible and no annual maximum.
The Humana PPO Low and PPO High dental plans provide the freedom to see any dentist of your choice. The PPO plans
have both in-network and out-of network-coverage. These plans have an annual deductible and a calendar maximum.
The PPO Low plan provides $1,000 annual maximum coverage, based on provider’s reduced contracted network fees.
The PPO High plan provides a maximum allowable fee coinsurance with $2,000 annual maximum coverage
SolsticeHumana PPO
PPO Low PPO High
HumanaHS205 HumanaAdvantagePlus

98
The Standard
Life/AD&D Employee Benefits
The Standard Insurance Company provides Group Life andAccidental Death & Dismemberment Insurance for the employees
of the Town of Davie. A summary of these benefits are listed below. A complete description of conditions and exclusions
can be found in The Standard brochures and outlines of coverage available at Human Resources.
Group Term Life Insurance
z The Town provides $50,000 of Life Insurance for each employee.
z Accidental Death and Dismemberment (AD&D) is also covered for each employee.
z This coverage is paid for by your employer, Town of Davie.
z Employee benefits reduced on a schedule starting at age 65.
Voluntary Additional Life Insurance
Additional life and additional AD&D insurance may be purchased via payroll deduction. An employee may purchase in
increments of $10,000 to a maximum of $400,000, not to exceed a 5 times annual earnings.
Dependent Life – Spouse/Children
Life and AD&D insurance may be purchased on a spouse or children with the following limits:
z Up to $10,000 for a spouse
z $10,000 for a child
z Dependent coverage includes unmarried children from live birth through age 20, or through age 24 if the child is
a full-time registered student.
z Spouse coverage will reduce on a schedule starting at age 65.
z A Member must be enrolled in the Additional Life to enroll in the Spouse Life plan

Additional Plan Features
z Travel Assistance: This service provides access to appropriate medical care and other emergency services
whenever traveling at least 100 miles from home or in a foreign country for trips lasting up to 180 days.
Travel Assistance offers a range of professional, 24-hour medical and legal assistance and coordination services.
z Family Benefits Package: It provides extra AD&D benefits to help families transition due to the loss of an insured
member. The package includes a Child Care Benefit (child care expense reimbursement for children under age 13);
a Career Adjustment Benefit (education expense reimbursement for spouses); and a Higher Education Benefit
(college expense reimbursement for children).
z Accelerated Benefit: Terminally ill members may withdraw up to 75% of their Life benefit to a maximum of $500,000
(when Basic Life and any Additional Life are combined).
z If you terminate employment or become ineligible for this coverage, you have the option to take your coverage with
you by either porting or converting all or a portion of your eligible insurance coverage’s in force.
UNUM Short-Term & Long-Term Disability Insurance
UNUM provides Group Short-Term Disability and Group Long-Term Disability Insurance for the Town of Davie. Following
are some of the details, but complete descriptions, conditions, and exclusions can be found in the UNUM brochures and
outlines of coverage available at Human Resources.
Short-Term Disability UNUM
aThe Town provides short-term disability insurance, which is intended to protect part of your income for a short duration in
case you become ill or injured and, under doctor’s orders, cannot work.
aThe policy provides 50% of weekly salary up to $1,500 per week for up to 9 weeks maximum.
aBenefits begin on the 31st day for an off-the-job accident or illness.
aCoverage terminates when you terminate employment with the Town of Davie or at retirement.
Long-Term Disability UNUM
aThe Town provides long-term disability insurance which is intended to protect part of your income for a longer duration
after you have depleted short-term disability or any sick leave you might have.
aThe policy pays 50% of salary up to $7,500 per month, beginning after 90 days.
aThis coverage terminates when you terminate employment with the Town of Davie or at retirement.
See brochures for more details, conditions and limitations. Controlling provisions are provided in the policy, and this summary does not modify those
provisions or the insurance in any way. This is not a binding contract. A certificate of coverage will be made available to you that describes the benefits in
greater detail. Should there be a difference between this summary and the contract, the contract will govern.
See brochures for more details, conditions and limitations.
Humana VisionCare for the Town of Davie
Open your eyes to high-quality vision care! The VisionCare plan is simple to use. Select a doctor from the provider directory
and call for an appointment. At the time of the appointment, present your ID Card to the participating provider. Members pay
only their co-payments and any extra cosmetic options selected. There are no additional forms to complete or claims to file.
Members can also choose an out-of-network provider, pay the doctor at the time of the visit, and submit receipts to Humana
for reimbursement. Benefits are paid according to a reimbursement schedule available online or in the Humana Vision
Summary of Benefits available from Human Resources.
Through the Humana website at www.HumanaVisionCare.com, you have access to a variety of online services: view your
benefits, view your claims, check the status of a claim, get an up-to-date listing of participating vision providers, and more.
The chart below is a basic outline of benefits. Please consult the Humana Enrollment Vision Summary of Benefits brochure
for more details, limitations, procedures, exclusions, and a vision provider directory.
Nurturing the health, safety, and welfare of the communityNurturing the health, safety, and welfare of the community
This schedule shows only a few of the covered procedures. The full benefits of each plan will be determined by the contract.
For a complete listing of benefits, exclusions, and limitations, please see the full VisionCare brochure available from Human
Resources and reference the certificate of coverage.
Plan Provisions Participating Doctor (After
co-payments/Up to plan limits)
Examples of
Non-Network
Service
Frequency
Exam $10 co-pay $35
Lenses Single Vision Materials $20 co-pay $25 Once every 12 months
Lenses Bifocal Materials $20 co-pay $40 Once every 12 months
Lenses Trifocal Materials $20 co-pay $60 Once every 12 months
Frame $40 wholesale allowance $40 Once every 24 months
Contact Lenses-
Exam & Lenses
Allowance of $120 in place of the
lens/frame benefit $120 Once every 12 months
LASIK – when services are
received from a TLC
Truvision network provider
888-358-3937
Silver Package $ 895/eye Conventional
Gold Package $1,295/eye Custom
Platinum Package $1,895/eye Custom-
LASIK-Plus (Bladeless)

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