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IntroductionAs City of Oakland employees, you and your family areYou have 60 days from the date of your initial appointmententitled to a number of benefits. This benefits guide containsto enroll, or decline coverage for yourself and eligibleinformation on all of the benefits you are entitled to as anfamily members. Benefits will begin on the 1st of theemployee of the City of Oakland.month after you submit your paperwork and appropriatedocumentation to the Human Resources ManagementIn order to activate your benefits, complete and submit theand Risk Benefits Division. If you do not enroll during thefollowing:initial 60 days and have not experienced a qualifying lifeFF CalPERS Beneficiary Designation FormFF City of Oakland Employee Benefits Record (EBR)Optional Benefit FormsFF Flexible Spending Plan Enrollment formevent, your enrollment will be subject to a 90-day waitingperiod or the following Open Enrollment period, whichevercomes first.For participation in the deferred compensation plan, yourpaperwork needs to be in our office by the 15th of themonth; deductions will begin with the first pay period of thefollowing month. For example, if you submit your paperworkFF Pre-designation of Personal Physicianby January 15th, deductions will begin with the February’sfirst pay period.Any questions you may have regarding the enclosedinformation can be referred to the correspondingrepresentative listed in your “Benefits Telephone Directory”found at the beginning of this guide.Benefit ChoicesThe City recognizes that your benefits are an important part of the reason you choose to work here. The City provides highquality benefits at a reasonable cost to you. You can choose between different medical plans to meet your individual andfamily needs. Since you have some choices to make, it is important to understand the various programs. That is why thisHandbook is being provided for you. There are also individual brochures for each of the benefit plans available in the HumanResources department. Benefits provided by the City for eligible employees include a choice of CalPERS medical plans, adental plan, a vision plan, group life insurance coverage, group disability and optional voluntary benefits.City of Oakland Police9

EligibilityEmployeesEmployees may opt out of coverage with proof of other group coverage.DependentsWhen enrolling dependents, appropriate documentation and/or proof of dependent status is required by the City and will berequested by Human Resources.Accepted forms of proof include Marriage and Birth Certificates, Tax Returns, Local City Government or State Issued Declarationof Domestic Partnership, Adoption Certificate or Proof of Legal Guardianship.For purposes of medical plan coverage, the following dependents are eligible: A spouse who is not currently enrolled as an Certified disabled child age 26 or older Child (up to age 26) for whom you have a parent-employee in a Public Employees Retirement System(PERS)-administered medical planchild relationship (restrictions apply) 10A registered domestic partnerCity of Oakland Police

EnrollmentOpen EnrollmentOnce a year, usually during the fall, the City of OaklandThe following forms must be provided in order toholds an Open Enrollment period. During this time, youcommence your benefits (please attach required copiesmay change to a different medical plan, enroll in theof documents for dependents):dental plan, the vision plan or choose the cash in lieuoption (waiver). You may also add or delete dependents Employee Benefits Record formto your medical, dental or vision plan. CalPERS Beneficiary Designation formSupporting documentation will be required by HumanResources to add or delete new dependents.Programs, and the Guaranteed Ride Home.Enrollment InstructionsPlease submit your forms and required documents toWhen you are hired, you will, receive this Employee BenefitsGuide describing your different benefits.Online enrollment is required for Parking and TransitAdditionalbrochures are available at the City of Oakland. Yourcoverage will start on the first of the month following thedate your enrollment paperwork is received.Here are some basic guidelines you need to keep in mindwhen going over these choices:1. Review the section of this Guide on medical plansto determine which medical plan suits your healthand financial needs.2. Determine your life insurance needs and decide ifyou wish to buy additional coverage above what isprovided by the City.3. Review additional voluntary benefits offered by theCity to determine whether they meet your needs.4. If you have medical coverage through anotherthe Benefits Unit, 150 Frank Ogawa Plaza, 2nd Floor frontcounter or you can fax your forms to 510.238.6560.All benefit information and forms can be found on theCity’s internal website at oaklandnetnews.oaklandnet.com/HR-Selfserve/.Change in BeneficiariesCertain events in your life such as marriage, divorce, ora death in the family can affect who you name as yourdesignated beneficiary for certain benefits.You maychange your beneficiary(ies) at any time. If you wish to doso, you can obtain most beneficiary forms from HumanResources. You can designate a beneficiary for: Deferred Compensation Life Insurance Retirement – CalPERSsource, such as a spouse, you may want toconsider the benefit waiver option. Proof of othergroup coverage will be required in order to qualifyfor this option.City of Oakland Police11

Enrollment (continued)OPOA MOU – Article V – A. Insurance Programs1. Health InsuranceAn eligible unit member will be enrolled in the CalPERS – Public Employees’ Medical and Hospital Care Act Plan(PEMHCA) Bay Area Kaiser Plan with employee-only coverage, unless the unit member submits an Employee BenefitsEnrollment form for a different PEMHCA health plan for enrollment of self and dependents, if any. The exception is ifthe unit member is enrolled in PEMHCA under another CalPERS member’s health plan, as CalPERS does not permit dualenrollment.Any new member, graduating from a City-sponsored police academy, who does not submit enrollment forms within(30) days of eligibility, will be enrolled in the CalPERS Kaiser employee – only plan (1 – Party) by default. During the periodpending the eligible member’s submittal of PEMHCA enrollments forms, the City will maintain the member’s coveragethrough available non-CalPERS PEMHCA medical coverage for up to 30 days, after which, the member will be enrolledin the default plan. If dependent information is on file, the new member will be enrolled in the default CalPERS Kaiserfor member and spouse or family coverage for member, spouse and children.Any member requesting to change from the default CalPERS Bay Area Kaiser plan, absent a qualifying life event, willbe subject to the CalPERS PEMHCA enrollment waiting period of ninety (90) days, unless the plan change has beenapproved by CalPERS as a result of their appeals process.12City of Oakland Police

Changes in CoverageQualifying EventsYou may experience certain events during the plan year that would allow you to change you or your dependent’s medicalcoverage. If any of the following events occur, you must change your benefit coverage within 60 days of the event: Change in your legal marital or domestic partner status, including marriage, death of your spouse/domestic partner, divorce, legal separation orannulment. or death of your dependent. eligibility requirements for dependents. Change in your employment status, includingtermination or commencement of employmentmust affect your coverage options). coverage under Medicare or Medicaid. A significant change in benefit or cost of coveragefor you or your spouse/domestic partner.domestic partner, including an increase ordecrease in the number of hours of employment,You, your spouse/domestic partner or yourdependents enroll for Medicare or Medicaid or losedependent.Change in work schedule for you or your spouse/You, your spouse / domestic partner or yourdependents lose COBRA coverage.of you, your spouse, your domestic partner or your A change in the place of residence or worksite ofyou or your spouse / domestic partner (This moveChange in the number of your dependents,including birth, adoption, placement for adoptionYour dependent satisfies or no longer meets the Your spouse/domestic partner employer providesa switch between full-time and part-time status, athe opportunity to enroll or change benefits duringstrike, lockout or commencement or return from anan open enrollment period.unpaid leave of absence.Special Enrollment Rights as Provided by HIPAA You initially declined coverage under the plan because you had coverage under another plan, and subsequentlyincurred a loss of coverage under the other plan. 13Occurrence of certain events such as birth, adoption, placement for adoption or marriage.City of Oakland Police

Medical – CalPERSThe City of Oakland offers several different medical plan options; Health Maintenance Organizations (HMO) or Preferred ProviderOrganizations (PPO) for all full-time and permanent part-time employees and their eligible dependents.Health Maintenance Organizations (HMOs)HMOs allow you to receive comprehensive coverage at set prices, called copays. Doctors / Other Medical Care Providers. Youcan only use doctors, hospitals, and pharmaciesthat participate in the HMO network. Doctors whoparticipate in the HMO network are called in- networkproviders. There is no coverage if you go to out-ofnetwork providers, except for emergency services. Copays. When you receive medical care, you paya set dollar amount called a copay. Annual Out-of-Pocket Maximum. The HMO plansinclude an annual out-of-pocket maximum. This isthe maximum amount you must pay out of your ownpocket for copays during the plan year. Once youreach the out-of-pocket maximum, the plan pays100% of covered charges for the remainder of theplan year.Annual Deductible. You don’t need to pay anannual deductible before the plan begins to pay fora portion of covered medical services.Preferred Provider Organization (PPO)The PPO plan allows you to use any provider you choose. Doctors / Health Care Providers. You can chooseany doctor you want, and you can go to any hospitalor pharmacy. However, you’ll pay less when you usea provider or facility that participates in-network. Preventive Care. Preventive care is 100% coveredwhen you use in-network providers. Visit healthcare.gov/preventive-care-benefits/ for a complete list ofpreventive care benefits required to be covered at100% per the Affordable Care Act. Annual Deductible. You generally pay an annualdeductible before the plan begins to pay for aportion of covered medical services. Paying for Care. When you receive medical care,there are two ways you pay for services:–– Coinsurance. When you receive any othermedical services, you pay a percentage ofthe cost of the service, and the plan paysthe remaining percentage. This is calledcoinsurance. (You will need to pay the annualdeductible first before coinsurance applies.) Annual Out-of-Pocket Maximum. The PPO includesan out-of-pocket maximum. This is the maximumamount you must pay out of your own pocket (underthe applicable coinsurance percentage) aftermeeting the deductible. Once you reach the out-ofpocket maximum, the plan pays 100% of in- networkcharges for the remainder of the plan year. Pleasenote that your out-of-pocket maximum will be lowerwhen you use in-network providers.–– Copays. When you go to an in-network doctor foran office visit, go to the emergency room, or pickup a prescription, you pay a set dollar amountcalled a copay. (You may need to pay theannual deductible first before the copay applies.)City of Oakland Police14

15Lifetime Plan MaximumImmunizationsWell Woman ExamsMammogramsAdult Periodic Exams withPreventive TestsDiagnostic X-Ray and Lab Tests Inpatient Hospital ServicesPre-Authorization of ServicesRequiredSemi-Private Room & Board;Including Services and Supplies 100%100%100%100%100%Unlimited 3,000 (does not includeRx; see EOC for items notincluded in copay max) 3,000 (does not includeRx; see EOC for items notincluded in copay max)Unlimited 1,500 (does not includeRx; see EOC for items notincluded in copay max) 15 copay 15 copay100% 0 0AnthemTraditional HMO 1,500 (does not includeRx; see EOC for items notincluded in copay max) 15 copay 15 copay100% 0 0AnthemSelect HMO100%Yes100%100%100%100%100%100%100%Unlimited 3,000 (does not includeRx; see EOC for items notincluded in copay max) 1,500 (does not includeRx; see EOC for items notincluded in copay max) 15 copay 15 copay100% 0 0Blue ShieldAccess HMO100%Yes100%100%100%100%100%100%100%Unlimited 3,000 (does not includeRx; see EOC for items notincluded in copay max) 1,500 (does not includeRx; see EOC for items notincluded in copay max) 15 copay 15 copay100% 0 0Health NetSmartCare HMO100%Yes100%Yes100%100%100% (some proceduresmay require a copay)100%100%100%100% (some proceduresmay require a copay)100%100%100%100%Unlimited 3,000 (does not includeRx; see EOC for items notincluded in copay max) 1,500 (does not includeRx; see EOC for items notincluded in copay max) 15 copay 15 copay100% 0 0United HealthCareHMO100%100%100%Unlimited 3,000 (does not includeRx; see EOC for moredetailed coverage) 1,500 (does not includeRx; see EOC for moredetailed coverage) 15 copay 15 copay100% 0 0KaiserHMOCity of Oakland PoliceThe information described on this page is only intended to be a summary of benefits. It does not describe or include all benefit provisions, limitations, exclusions, or qualifications for coverage. Please review plandocuments for full details. If there are any conflicts with information provided on this page, the plan documents will prevail.Pregnancy and Maternity Care(Pre-Natal Care) Maternity CareWell-Child Care Preventive Services Family––Annual Out-of-Pocket Limit/ IndividualOutpatient Specialist Visit ––Office Visit/Exam Family––CoinsuranceIndividual––Annual Deductible General Plan InformationBenefit CategoriesFor more information on CalPERS please visit Human Resources, or the CalPERS website calpers.ca.gov.Medical – CalPERS (continued)

Outpatient FacilityChargeEmergency RoomGround Urgent Care FacilityOutpatient Care entServicesOutpatient CareInpatientHospitalization––Inpatient Care 15 copay (See EOC formore detailed coverage)100% (See EOC for moredetailed coverage) 15 copay (See EOC formore detailed coverage)100% (See EOC for moredetailed coverage) 15 copay (See EOC formore detailed coverage) 15 copay (See EOC formore detailed coverage)100%100% (See EOC for moredetailed coverage) 15 copay100%100% 50 copay waived ifadmitted100%AnthemTraditional HMO100% (See EOC for moredetailed coverage) 15 copay100%100% 50 copay waived ifadmitted100%AnthemSelect HMO 15 copay (See EOC formore detailed coverage)100% (See EOC for moredetailed coverage) 15 copay (See EOC formore detailed coverage)100% (See EOC for moredetailed coverage) 15 copay100%100% 50 copay waived ifadmitted100%Blue ShieldAccess HMO 15 copay (See EOC formore detailed coverage)100% (See EOC for moredetailed coverage) 15 copay (See EOC formore detailed coverage)100% (See EOC for moredetailed coverage) 15 copay100%100% 50 copay waived ifadmitted100%Health NetSmartCare HMO 15 copay/indiv; 5 copay/group (See EOC for moredetailed coverage) 15 copay (See EOC formore detailed coverage)100% (See EOC for moredetailed coverage) 15 copay (See EOC formore detailed coverage) 15 copay/indiv; 7 copay/group (See EOC for moredetailed coverage)100% (See EOC for moredetailed coverage)100% (See EOC for moredetailed coverage) 15 copay100%100% 50 copay waived ifadmitted100%United HealthCareHMO100% (See EOC for moredetailed coverage) 15 copay100%100% 50 copay waived ifadmitted 15 copayKaiserHMOCity of Oakland PoliceThe information described on this page is only intended to be a summary of benefits. It does not describe or include all benefit provisions, limitations, exclusions, or qualifications for coverage. Please review plandocuments for full details. If there are any conflicts with information provided on this page, the plan documents will prevail. Substance AbuseInpatient Care Mental Health Benefits Urgent CareAir Ambulance Emergency Services Surgical ServicesBenefit CategoriesMedical – CalPERS (continued)16

Prescription DrugAnnual Out-of-PocketLimit/FamilyGenericBrand (Formulary/Preferred)Brand (Non-Formulary/Non-preferred)Number of Days Supply GenericBrand (Formulary/Preferred)Brand (Non-Formulary/Non-preferred)Number of Days Supplyfor Mail Order 40 copay (managed byOptumRx) ( 1,000 OOPmax/family; included in RxOOP limit; excludes nonpreferred brands) 40 copay (managed byOptumRx) ( 1,000 OOPmax/family; included in RxOOP limit; excludes nonpreferred brands)90 days90 days 100 copay (managed byOptumRx) 10 copay (managed byOptumRx) ( 1,000 OOPmax/family; included in RxOOP limit; excludes nonpreferred brands) 10 copay (managed byOptumRx) ( 1,000 OOPmax/family; included in RxOOP limit; excludes nonpreferred brands) 100 copay (managed byOptumRx)Yes30 days 50 copay (managed byOptumRx)Yes30 days 50 copay (managed byOptumRx) 20 copay (managed byOptumRx) 5 copay (managed byOptumRx) 5 copay (managed byOptumRx) 20 copay (managed byOptumRx) 11,300 (Mail-order OOP: 1,000/family in addition toMedical OOP limit) 5,650 (in addition toMedical OOP limit)AnthemTraditional HMO 11,300 (Mail-order OOP: 1,000/family in addition toMedical OOP limit) 5,650 (in addition tomedical OOP limit)AnthemSelect HMO90 days 100 copay (managed byOptumRx) 40 copay (managed byOptumRx) ( 1,000 OOPmax/family; included in RxOOP limit; excludes nonpreferred brands) 10 copay (managed byOptumRx) ( 1,000 OOPmax/family; included in RxOOP limit; excludes nonpreferred brands)Yes30 days 50 copay (managed byOptumRx) 20 copay (managed byOptumRx) 5 copay (managed byOptumRx) 11,300 (Mail-order OOP: 1,000/family in addition toMedical OOP limit) 5,650 (in addition toMedical OOP limit)Blue ShieldAccess HMO90 days 100 copay (managed byOptumRx) 40 copay (managed byOptumRx) ( 1,000 OOPmax/family; included in RxOOP limit; excludes nonpreferred brands) 10 copay (managed byOptumRx) ( 1,000 OOPmax/family; included in RxOOP limit; excludes nonpreferred brands)Yes30 days 50 copay (managed byOptumRx) 20 copay (managed byOptumRx) 5 copay (managed byOptumRx) 11,300 (Mail-order OOP: 1,000/family in addition toMedical OOP limit) 5,650 (in addition toMedical OOP limit)Health NetSmartCare HMO100 days (30-day supply forcertain drugs) 40 copay ( 1,000 OOPmax/family; included in RxOOP limit; excludes nonpreferred brands) 10 copay ( 1,000 OOPmax/family; included in RxOOP limit; excludes nonpreferred brands)Yes30 days 20 copay 20 copay 5 copay 11,300 (Mail-order OOP: 1,000/family in addition tomedical OOP limit) 5,650 (in addition toMedical OOP limit)KaiserHMO90 days 100 copay (managed byOptumRx) 40 copay (managed byOptumRx) ( 1,000 OOPmax/family; included in RxOOP limit; excludes nonpreferred brands) 10 copay (managed byOptumRx) ( 1,000 OOPmax/family; included in RxOOP limit; excludes nonpreferred brands)Yes30 days 50 copay (managed byOptumRx) 20 copay (

City of Oakland Police 2 Employee Benefits Program Phone Number Web Site Medical CalPERS 888.225.7377 https://my.calpers.ca.gov Dental Delta Dental - Group No. 00558 800.765.6003 www.deltadentalins.com DeltaCare - Group No. 76003 800.422.4234 www.deltadentalins.com Vision Service Plan - Group No. 00826401 800.877.7195 www .