EMPLOYEE BENEFITS POLICY AND PROCEDURES MANUAL

1 EMPLOYEE BENEFITS POLICY & PROCEDURES MANUAL CEO-RISK MANAGEMENT DIVISION 1010 10TH STREET, STE 5900, MODESTO CA 95354 (209) 525-5717 EMPLOYEE BENEFITS POLICY & PROCEDURES MANUAL Table of Contents 1. EMPLOYEE BENEFITS Contact Information 2. Effective Dates of Coverage 3. EMPLOYEE BENEFITS Eligibility Guidelines -Dependent Eligibility Requirements -Local Area Zip Code List 4. health Insurance Enrollment PROCEDURES 5. Life Events/Enrollment Changes 6. Medical Plan Descriptions What is a health savings account (HSA)? 7. Dental Plan Descriptions Core Plan Buy Up Plan 8. Vision Plan Description 9. Basic and Supplemental Life Insurance Evidence of Insurability Form Life Insurance POLICY 10. health Insurance Premium Payment PROCEDURES for Unpaid Leave of Absence 11. Termination of health Insurance BENEFITS and COBRA Rights 12. Benefit Summaries 13. Mass Mutual Deferred Compensation Plan and Loan Program 14. Flexible Spending Accounts - Dependent Care or health Reimbursement account 15.

2 EMPLOYEE Assistance Program (EAP) 16. Management Disability Plans- Short Term and Long Term (STD, LTD) 17. Death of an EMPLOYEE /Retiree 18. PARS Public Agency Retirement System 19. Self Service Instructions EMPLOYEE BENEFITS CONTACT INFO VENDOR GROUP # PHONE NUMBER STANISLAUS COUNTY PARTNERS IN health Providers and Referrals for SCPH CA000496 (877) 830-7470 CAPITOL ADMINISTRATORS Claims and Eligibility for SCPH CA000496 (877) 789-8499 ANTHEM BLUE CROSS 275366 (800) 888-8288 DELTA DENTAL 3351 (800) 765-6003 VISION SERVICE PLAN 4450000102 (800) 877-7195 MASS MUTUAL DEFERRED COMP 150163 (800) 528-9009 WELLS FARGO health BENEFIT SERVICES Stanislaus County (866) 884-7374 WAGEWORKS 1428 (800) 950-0105 VOYA/RELIASTAR POLICY #31640-7 #50 Contact EMPLOYEE BENEFITS HUMANA VOLUNTARY BENEFITS Stanislaus County (877) 378-1505 EAP- ComPsych- Guidance Resources Web ID: MY5848i County of Stanislaus (877) 533-2363 PARS- Public Agency Retirement Services- ARS Stanislaus County (800) 540-6369 Ext 130 CEO-RISK MANAGEMENT DIVISION- EMPLOYEE BENEFITS 1010 10TH STREET SUITE 5900 MODESTO 95354 WEBSITE- EMAIL- PHONE- 209-525-5717 E- FAX- 209-567-4367 FAX- 209-525-5779 2/15 EMPLOYEE BENEFITS EFFECTIVE DATES OF COVERAGE NEW HIRES- health Insurance BENEFITS are effective the first of the month, following date of hire.

3 Deductions will be taken, and credits will be given on the first paycheck the EMPLOYEE receives in their first month of coverage, and semi-monthly thereafter. If there is a third paycheck in the month, no deductions or credits will appear. If the EMPLOYEE does not receive two paychecks in their first month of coverage, then deductions and credits for BENEFITS will be doubled on their first paycheck. TERMINATIONS- health Insurance BENEFITS will terminate on the last day of the month of the event of termination, retirement, unpaid absence or covered leave (FMLA, PDL, CFRA) exhausting. When terminating, the EMPLOYEE must work at least one full scheduled day in the month to get coverage for that month. COBRA, if elected, will be effective the first of the month following date of termination. LIFE EVENTS/ENROLLMENT CHANGES- All enrollment changes outside of open enrollment must be made within 30 days from the date of the event. Eligibility and premium changes due to a marriage, divorce or over age dependent will be effective the first of the month following the qualifying event date.

4 Eligibility changes due to the birth of a baby are effective the date of birth, however change in premium will take effect the first of the following month. Eligibility changes due to an adoption are effective the date the child was placed in the home for adoption, however change in premium will take effect the first of the following month. 1/1/13 RETURNING FROM LEAVE OF ABSENCE/SUSPENSION- If health insurance premiums are being paid by the EMPLOYEE while on unpaid absence, County paid BENEFITS will resume the first of the month following your return to full-time employment. If your health insurance was canceled due to non-payment of premiums while on an unpaid absence, County paid BENEFITS will resume the first of the month following your return to full-time employment. There is also a possibility of an adjustment of premiums on your paycheck when you return. If you are enrolled in a Flexible Spending account , you are responsible for the admin fee while on unpaid leave.

5 If you fail to pay the admin fee while you are out, your paycheck will be adjusted accordingly when you return to paid status. There will also be an adjustment to your semi-monthly contribution to the FSA account in order to meet your Annual Pledge. 1/1/13 EMPLOYEE BENEFITS ELIGIBILITY GUIDELINES -MEDICAL, DENTAL, VISION AND LIFE PLANS STANISLAUS COUNTY PARTNERS IN health ANTHEM BLUE CROSS DELTA DENTAL CORE AND BUYUP PLANS VISION SERVICE PLAN VOYA RELIASTAR LIFE INSURANCE Regular full-time employees as defined by their job description in a position that includes insurance BENEFITS , are eligible to enroll in Medical, Dental, Vision and Life coverage along with their qualifying dependents. This coverage will take effect the first day of the month following their date of hire or event. The County provides a semi-monthly contribution towards medical, dental and vision insurance based on the EMPLOYEE 's Standard Hours. A minimum of 30 hours worked per week is required to qualify for County insurance BENEFITS .

6 All employees enrolled will have a share of cost deducted from their paycheck semi-monthly. o Regular full-time employees working 40 hours per week will receive an employer contribution equal to: EPO medical coverage is paid at 80% of the lowest cost EPO coverage level HDHP medical coverage is paid at 95% of the lowest cost HDHP coverage level Dental and Vision coverage is paid at 80% Basic Life is paid at 100% No employer contribution towards Supplemental Life o Employees working a percentage/reduced schedule will have a lower contribution toward health insurance BENEFITS 35 - 39 hours per week = 90% of the employer contribution 30 - 34 hours per week = 75% of the employer contribution Below 30 hours per week = 0% of the employer contribution ( EMPLOYEE will be offered COBRA to continue health coverage at their expense) Employer health insurance contributions will be reduced accordingly for regular full-time employees who are paid less than 80 hours per 14 day period (employees using DOC, ATO etc.)

7 For 3 consecutive pay periods. EMPLOYEE benefit eligibility will be evaluated on a quarterly basis. If the EMPLOYEE 's hours fall below 80 hours in 3 consecutive pay periods in a quarter, the EMPLOYEE 's contributions will be adjusted based on the quarterly average effective the first pay period of the following quarter. BENEFITS will be restored at 100% effective the first pay period of the following quarter in which the EMPLOYEE is paid an average of 80 hours in the quarter. Revised 1/15 Employees enrolled in a High Deductible health Plan (HDHP) will also be enrolled in a health savings account (HSA). The County will fund the individual HSA account in the following amounts: o EMPLOYEE Only - $1,200 annually o EMPLOYEE + 1 - $2,000 annually o Family - $2,000 annually The County will fund 6 months of the HSA account contribution in January for any EMPLOYEE enrolling in an HSA plan. The remaining annual contribution will be deposited semi-monthly over the last 6 months of the year.

8 Employees are required to pay any monthly account related fees on their individual health savings account . Medical Plan Carrier is determined by physical address of the main subscriber. SCPH is only available to local area residents and Anthem BlueCross is only available to out of area residents. Please refer to the local area zip code list. Revised 1/15 DEPENDENT ELIGIBILITY REQUIREMENTS MEDICAL, DENTAL, VISION AND LIFE PLANS STANISLAUS COUNTY PARTNERS IN health HDHP AND EPO PLANS ANTHEM BLUE CROSS HDHP AND EPO PLANS DELTA DENTAL CORE AND BUYUP PLANS VISION SERVICE PLAN VOYA RELIASTAR LIFE INSURANCE 1. EMPLOYEE s legal spouse. *Unless the spouse is a Stanislaus County EMPLOYEE . The County does not allow dual coverage for EMPLOYEE spouses and/or dependents. 2. Child(ren) of the EMPLOYEE up to the age of 26 years including those child(ren) who are adopted or there is legal guardianship. *Unless the dependent child is being covered by another County EMPLOYEE (spouse or ex-spouse of EMPLOYEE , etc).

9 3. EMPLOYEE s CA Registered Domestic Partner as defined by California Secretary of State under state law. If the EMPLOYEE and the EMPLOYEE s partner are of the same sex, or they are opposite sexes and one partner is at least 62 years old, then they are eligible as long as they are registered as a domestic partnership with the Secretary of State. The eligibility criteria for registration of a domestic partnership was set by the California State Legislature and signed by the Governor in 1999. During the legislative process, eligibility of opposite sex couples was limited to senior citizens. Tax implications apply to cost of premiums for Domestic Partner health insurance coverage. Please read details in Tab 4 Enrollment PROCEDURES . 4. Child(ren) of the EMPLOYEE and/or their CA Registered Domestic Partner (see above) up to the age of 26 years including those child(ren) who are adopted or there is legal guardianship. 5. Dependents who exceed the age limit, may be eligible if they meet all the following requirements: they are incapable of self-sustained employment because of mental retardation or physical handicap that occurred prior to reaching the age limit for Dependents and they receive all of their financial support and maintenance from the EMPLOYEE or the EMPLOYEE s Spouse/CA Registered Domestic Partner.

10 Proof of their incapacity and dependency will be required. EMPLOYEE must request enrollment in medical coverage by calling their medical insurance carrier prior to the County's enrollment. Revised 1/15 Stanislaus County Partners in health Service AreaCountyCityZip CodesStanislausAllAllCalaverasAllAllTuol umneAllAllSan JoaquinEscalon, Lathrop, Manteca, Ripon95320, 95330, 95336, 95337, 95366 Page 1 of 2 MercedDelhi, Hilmar, Livingston95315, 95324, 95334As of 10/17/2014952219524795310953289535395370 9522295248953139532995354953729522395249 9531495330953559537395224952509531595334 9535695375952259525195316953359535795379 9522695252953199533695358953809522895254 9532095337953609538195229952559532195346 9536195382952329525795323953479536395383 9523395305953249535095364953869524595307 9532695351953669538795246953099532795352 95367953909536895397 Page 2 of 2As of 10/17/2014 Stanislaus County Partners in health Service AreaComplete Zip Code ListHEALTH INSURANCE ENROLLMENT PROCEDURES -MEDICAL.