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EnrollmentOpen Enrollment FairsDateMonday, November 9Time10:00 a.m. to 3:00 p.m.LocationOne Judiciary Square 441 4th Street, NW, Washington, DC 20001Saturday, November 149:00 a.m. to 12:00 p.m.DC Public Schools Central Office 1200 First Street, NE, Washington, DC 20002Tuesday, November 1710:00 a.m. to 3:00 p.m.DC Housing Authority 1133 North Capitol Street, NE , Washington, DC 20002Wednesday, November 1810:00 a.m. to 3:00 p.m.Office of the Chief Financial Officer 1101 4th Street, SW, Washington, DC 20024Thursday, November 1910:00 a.m. to 3:00 p.m.Saint Elizabeths Hospital 1100 Alabama Avenue, SE, Washington, DC 20032Tuesday, December 110:00 a.m. to 3:00 p.m.Frank D. Reeves Center 2000 14th Street, NW, Washington, DC 20009Wednesday, December 210:00 a.m. to 3:00 p.m.John A. Wilson Building 1350 Pennsylvania Avenue, NW, Washington, DC 20004Thursday, December 310:00 a.m. to 3:00 p.m.Child & Family Services Agency 200 I Street, SE, Washington, DC 20003Wednesday, December 94:00 p.m. to 7:00 p.m.DC Public Schools Central Office 1200 First Street, NE, Washington, DC 20002*Please Note: All benefits fairs are open to all DC Government employees regardless of location.12

Benefits ata Glance Eligibility Medical, Dental & Vision Benefits Plan Rates13

Benefits at a GlanceEligibilityDC Government employees eligible to receive benefits include:Changes to plans can be made within 30 days of a qualifying life event.Health, vision, dental and life insurance coverage begins the first fullpay period after the election; for Flexible Spending Accounts, coveragebegins following the first pay period in which a payroll deductionwas made to pay for the benefit; other benefits programs may haveadditional requirements. All full-time permanent employees Part-time permanent employees who generally work at least 30hours per week Employees with temporary full-time appointments of at least 13months who are employed by agencies under authority of the Mayor Dependent Eligibility Temporary and intermittent employees who work for at least 90You are required to provide documentation to verify coverage eligibilitydays within a 12-month evaluation period and are paid at leastfor the dependents that you add during Open Enrollment. You must also30 hours per week (or 120 hours per month) are eligible to onlysubmit dependent eligibility verification. Failure to comply will result inparticipate in an HMO health care plana cancelation of health care coverage for that dependent.Several of the District’s independent agencies also participate in benefitsprograms provided to agencies under full authority of the Mayor.For more on enrolling dependents, including your spouse, stateregistered domestic partner or legal union partner, child(ren) and/Eligible employees may enroll in plans during the designated annualor foster child(ren), please visit http://dchr.dc.gov/page/dependentOpen Enrollment period or within 31 days of their initial employment.eligibility-verification.14

Benefits at a GlanceMedical BenefitsDependent CoverageDistrict of Columbia Employee Health Benefits Program (DCEHBP)Family members eligible for coverage under Self Plus One or Self andFamily enrollment are your spouse (including a valid common lawmarriage) and children under age 26, including legally adoptedchildren, recognized natural (born out of wedlock) children andstepchildren (including children of same-sex domestic partners). A childis eligible for coverage under your Self Plus One enrollment (if they arethe designated covered family member) or Self and Family enrollment,if a state-issued birth certificate lists you as a parent of that child. Undercertain circumstances, you may also continue coverage for a disabledchild 26 years of age or older who is incapable of self-support. For all employees hired after October 1, 1987. The cost is shared by the employee and the District. All employees must pay employee contribution premiums.Additional information can be found at http://dchr.dc.gov/page/employee-benefits.Health Care Providers Aetna HMO, PPO, CDHP Kaiser Permanente HMO UnitedHealthcare HMO Nationwide ChoiceFor more information, please visit ication.15

Benefits at a Glance2016 Plan Rates: MedicalThe following charts list the biweekly rates you will pay for your benefits coverage from January 10 through December 31, 2016.Biweekly Employee Rates: Medical PlansSelf OnlySelf 1FamilyAetna HMOAetna CDHPAetna PPOKaiser Permanente HMOUnitedHealthcare HMO Choice 73.92 145.30 213.61 35.38 69.54 102.23 81.62 160.45 235.88 64.94 124.03 190.26 70.31 134.29 206.01Disclaimer: This Guide is not a contract. Its purpose is to provide summary information about employee benefits. Refer to Summary Plan Descriptions and provider materials for details of each benefit. Every effort has been made to ensure this Guide is accurate. Provisions of the actual contract will govern in the event of a discrepancy.16

Benefits at a Glance2016 Plan Rates: DentalDependent Coverage Provider: Cigna Dental DHMO: District pays 100% of premium costs. DPPO: District pays a portion of premium costs for eligibleCompensation Units 1 and 2 Collective Bargaining Agreementemployees.Eligible family members include your spouse and unmarried, dependentchildren under age 22. This includes legally adopted childrenand recognized natural children who meet certain dependencyrequirements. This also includes stepchildren and foster children wholive with you in a regular parent-child relationship. Under certaincircumstances, you may also continue coverage for a disabled child 22years of age or older who is incapable of self-support.Biweekly Employee Rates: Dental PlansSelf OnlySelf 1FamilyCigna DPPOCigna DHMO 28.09 39.87 51.71 0.00 0.00 0.00For more information, please visit ication.Disclaimer: This Guide is not a contract. Its purpose is to provide summary information about employee benefits. Refer to Summary Plan Descriptions and provider materials for details of each benefit. Every effort has been made to ensure this Guide is accurate. Provisions of the actual contract will govern in the event of a discrepancy.17

Benefits at a Glance2016 Plan Rates: VisionDependent Coverage Provider: Quality Plan Administrators Vision coverage is available at no cost to eligible employees. The District pays 100% of the vision premium.Eligible family members include your spouse and unmarried, dependentchildren under age 22. This includes legally adopted childrenand recognized natural children who meet certain dependencyrequirements. This also includes stepchildren and foster children wholive with you in a regular parent-child relationship. Under certaincircumstances, you may also continue coverage for a disabled child 22years of age or older who is incapable of self-support.Coverage Tiers: Vision2016Self OnlySelf 1Family 0.00 0.00 0.00For more information, please visit ication.Disclaimer: This Guide is not a contract. Its purpose is to provide summary information about employee benefits. Refer to Summary Plan Descriptions and provider materials for details of each benefit. Every effort has been made to ensure this Guide is accurate. Provisions of the actual contract will govern in the event of a discrepancy.18

Benefits YouCan Enroll In 30 Days of Hire/Qualifying Life Event/Open Enrollment Voluntary Coverage You Can Enroll inat Anytime19

Benefits You Can Enroll InBenefits You Can Enroll In: 30 Days of Hire, Qualifying Life Event, Open EnrollmentBenefitOptionsWho PaysHow to EnrollMedical You pay a portion of the cost of coverage. Premiums arededucted from your paycheck on a pre-tax basis.PeopleSoftYou can choose to contribute funds from your paycheck toyour HSA on a pre-tax basis.PeopleSoft Cigna DHMO is 100% employer paid. You pay a portion of the cost of coverage for the CignaDPPO. Premiums are deducted from your paycheck on apre-tax basis.100% employer paid.You pay 2/3 the total cost of the monthly premium and theDistrict pays 1/3. Optional upgrades are availableYou pay the full cost of coverage. Premiums are deductedfrom your paycheck on an after-tax basis.PeopleSoftHealth SavingsAccounts (HSAs)Aetna HMO, PPO, CDHP HSAKaiser Permanente HMOUnitedHealthcare HMO Nationwide ChoiceAetna Consumer Driven Health Plan SavingsAccount (CDHP HSA)**You must be enrolled in the Aetna CDHP to be eligible.Dental Cigna DHMO Cigna DPPOVisionLife Quality Plan Administrators The Standard Insurance CompanyDisability The Standard Insurance Company–– Short Term–– Long TermPeopleSoftNOT AVAILABLE FOROPEN ENROLLMENTPeopleSoftDisclaimer: This Guide is not a contract. Its purpose is to provide summary information about employee benefits. Refer to Summary Plan Descriptions and provider materials for details of each benefit. Every effort has been made to ensure this Guide is accurate. Provisions of the actual contract will govern in the event of a discrepancy.20

Benefits You Can Enroll InBenefitOptionsWho PaysHow to EnrollSupplementalIndemnity AflacYou pay the full cost of coverage. Premiums are deductedfrom your paycheck on a pre-tax basis.Outside of PeopleSoftFlexible SpendingAccounts (FSAs) Benefit Resource, Inc.Contributions are deducted from your paycheck on a pre-taxbasis.PeopleSoft–– Individual Cancer/Specified-Disease–– Individual Hospital Confinement/Sickness–– Individual Specified Health Event–– Health Care FSA–– Dependent Care FSABenefits You Can Enroll In AnytimeBenefitOptionsWho PaysRetirement PlansCommuter 457(b) Deferred Compensation Benefit Resource, Inc.Contributions are deducted from your paycheck on a pre-tax basis. PeopleSoftYou can choose to contribute funds from your paycheck on a pre- PeopleSofttax basis.–– Transit–– ParkingSavings PlanEmployee AssistancePlan (EAP) DC College Savings Plan (Section 529) InovaHow to EnrollContributions are deducted from your paycheck on a pre-tax basis. Outside of PeopleSoft100% employer paid for the first five sessions.Automatically enrolled,but must call for services.Disclaimer: This Guide is not a contract. Its purpose is to provide summary information about employee benefits. Refer to Summary Plan Descriptions and provider materials for details of each benefit. Every effort has been made to ensure this Guide is accurate. Provisions of the actual contract will govern in the event of a discrepancy.21

WellnessResources Provider Resources DPR Fitness Center Benefit22

Wellness ResourcesProvider ResourcesWant More Wellness?If you enroll in a medical plan with the District of Columbia, you will also For more detailed information about these and other available wellnesshave access to wellness resources through your plan provider, including programs and opportunities, please visit http://dchr.dc.gov/page/employee-wellness.programs that can help you: Quit SmokingGet more exerciseImprove your diet with nutritional counselingLose weightIn addition, disease management programs offer support, tools andinformation to help manage chronic conditions, including: AsthmaCongestive heart failureDiabetesHypertension (high blood pressure)23

Wellness ResourcesDepartment of Parks and RecreationFitness Center DeductionMembership TypeCost Per Pay PeriodAnnual CostEmployee (DC Resident)Employee Family* (DC Resident) 0.00 5.00 0.00 130 5.00 130DCHR and the Department of Parks and Recreation (DPR) have partnered Employee (Non-resident)Employee Family* (Non-resident) 7.50 195to offer District Government employees free and reduced rates on DPRfitness center memberships through payroll deduction. Employees*Family is defined as an adult at least 18 years of age living in the same household.have the option to register via PeopleSoft for an annual non-refundable Proof of address and/or proof of relationship is needed to complete the Familyregistration process.membership that will provide the employee and/or their familymembers with access to DPR fitness centers. This discount applies to DPRfitness centers only, it does not include aquatic centers.DPR has more than 20 fitness centers across the city that feature avariety of cardio, strength training and mobile fitness equipment andclasses. Offerings vary by location. For more information, please visithttp://dpr.dc.gov/page/dpr-fitness-centers.24

High-LevelBenefitsOverviewYour benefits are an important partof your overall compensation. TheDistrict of Columbia Government offersa comprehensive array of benefits toprotect your health, your family and yourway of life, including: Medical Benefits & Plan ComparisonsDental BenefitsVision BenefitsEmployee InsuranceWork & Life BenefitsEmployee RetirementEmployee Leave25

Health BenefitsMedical BenefitsDistrict of Columbia Employee Health Benefits Program (DCEHBP)Eligible employees hired on or after October 1, 1987 have the followinghealth plan choices:your options by comparing benefits, evaluating the network of providersand considering the plan’s costs and quality.Dependent CoverageDependents eligible for coverage under Self Plus One or Self andFamily enrollment are your spouse (including a valid common law Aetna HMO, PPO or CDHPmarriage) and children under age 26, including legally adopted Kaiser Permanente HMOchildren, recognized natural (out of wedlock) children and stepchildren UnitedHealthcare HMO(including children of same-sex domestic partners). A child is eligiblefor coverage under Self Plus One enrollment (if they are the designatedYour health insurance premium cost is shared with the District, whichcontributes up to 75 percent toward the total cost. All health insurance covered family member) or Self and Family enrollment if a statepremium deductions are made on a pre-tax basis, unless a specific Pre- issued birth certificate lists you as a parent of that child. Under certainTax Benefits Waiver Form is requested. The waiver is available online at circumstances, you may also continue coverage for a disabled child 26http://dchr.dc.gov or at the DCHR Employee Service Center located at 441 years of age or older who is incapable of self-support.4th Street, NW, Suite 340 North, Washington, DC 20001.For more information, please visit ication.To select the health plan that’s right for you and your family, evaluate26

Health BenefitsPlan Comparisons at a GlanceBenefitAetna CDHPAetna PPOAetna HMOCalendar-Year DeductibleEmployee Only 1,300 750NONEFamily 2,600 1,500NONEOut-of-Pocket Maximum (per calendar year) *Please Note: Some benefits do not apply toward the out-of-pocket maximumEmployee Only 3,425 1,500 3,500Family 6,850 3,000 9,400Inpatient ServicesInpatient HospitalCovered 85% after deductible Covered 100% after 100 per admissiondeductibleHospice CareCovered 85% after deductible Covered 100% afterCovered 100%deductibleSkilled Nursing FacilityN/AN/A 100 per admissionKaiser Permanente HMOUnitedHealthcare ChoiceNONENONENONENONE 3,500 9,400 3,500 9,400Waived if admitted asinpatientNo charge 100 copay per Inpatient Stay 100/admission 100 copay perInpatient StayNo chargeDisclaimer: This Guide is not a contract. Its purpose is to provide summary information about employee benefits. Refer to Summary Plan Descriptions and provider materials for details of each benefit. Every effort has been made to ensure this Guide is accurate. Provisions of the actual contract will govern in the event of a discrepancy.27

Health BenefitsBenefitOutpatient ServicesOffice VisitsAetna CDHPX-rays, Laboratory TestsCovered 85% after deductible Covered 100% if part of anoffice visitCovered 100%; deductibleCovered 100%; deductiblewaivedwaivedCovered 100%; deductiblewaivedCovered 100%; deductiblewaivedCovered 85% after deductibleRoutine ExamsRoutine ImmunizationPreventive CareOutpatient Surgery (at aPlan facility)Short-Term Rehabilitation(physical, occupational orspeech therapy)Chiropractic CareAcupunctureHome Health CareAetna PPOAetna HMOKaiser Permanente HMOUnitedHealthcare ChoiceCovered 100% 10/visit (Primary); 20(Specialist)No charge 10/visit (Primary); 20(Specialist)No chargeCovered 100%No chargeNo chargeCovered 100%; deductiblewaivedCovered 100%; deductiblewaivedCovered 100% afterdeductibleCovered 85% after deductible 15% after deductibleCovered 100%No chargeNo chargeCovered 100%No chargeNo charge 100 per admission 50/visit 50 copay per date of service 20 copay 20/visit 20 copay per outpatient visitNOT COVEREDNOT COVEREDNOT COVEREDNOT COVEREDCovered 85% after deductible Covered 100% afterdeductibleNOT COVEREDNOT COVEREDCovered 100% 20/visit 20/visitNo chargeLimitations may applyLimitations may applyNo chargeCovered 85% after deductible 15 copay; deductible waived Office hours: 10 copay;Disclaimer: This Guide is not a contract. Its purpose is to provide summary information about employee benefits. Refer to Summary Plan Descriptions and provider materials for details of each benefit. Every effort has been made to ensure this Guide is accurate. Provisions of the actual contract will govern in the event of a discrepancy.28

Health BenefitsBenefitEmergency ServicesEmergency RoomServices and SuppliesAmbulanceAetna HMOKaiser Permanente HMOUnitedHealthcare ChoiceCovered 85% after deductible 100 copay/waived ifadmittedCovered 85% after deductible 100% covered; deductiblewaived 50 copay 50/visit 50/visitCovered 100%No chargeNo chargeMaternity CareOffice Visits (for mother)Covered 85% after deductible 30 copayNo charge 10 copayHospital (for mother)15%; after deductible 20 copay for Physicianmaternity services 100 per stay copay forFacility servicesCovered 100%; deductiblewaived 100/admission 100 copay per Inpatient StayNo charge 10 copay50% coinsurance50% coinsuranceOffice Visits (for baby)Medical EquipmentDurable MedicalEquipmentAetna CDHPAetna PPOCovered 100% afterdeductibleCovered 85% after deductible Covered 100% afterdeductibleCovered 85% after deductible Covered 80% after deductible 50%Disclaimer: This Guide is not a contract. Its purpose is to provide summary information about employee benefits. Refer to Summary Plan Descriptions and provider materials for details of each benefit. Every effort has been made to ensure this Guide is accurate. Provisions of the actual contract will govern in the event of a discrepancy.29

Health BenefitsBenefitMental HealthInpatient CareAetna CDHPAetna PPOAetna HMOKaiser Permanente HMOUnitedHealthcare Choice 100/admissionOutpatient CareCovered 85% after deductible Covered 100% after 100 per

Federal Employees Health Benefits Self Plus One Enrollment Type The Office of Personnel Management (OPM) will implement a new enrollment type, Self Plus One, under the Federal Employees Health Benefits (FEHB) Program. The effective date for this new enrollment type will be January 1, 2016. Therefore, Open Enrollment 2016 will