2013Full-Time Employee Benefits Guide

This guide provides only a highlight of the benefit plans offered to you by South Suburban and in no way serves as the actual plan description or plan document for the plans. This guide may not reflect the benefit plans in effect for all employees in all circumstances, nor cover all applicable limitations and/or restrictions. The plan documents will always govern the offered benefits that South Suburban provides for you. We reserve the right to modify any or all of these plans at anytime. This guide is not intended as a contract of employment or a guarantee of current or future employment.

1

South Suburban recognizes the importance of providing a comprehensive benefits program to our full-time

and regular part-time benefit eligible employees. These benefits help provide employees and their family

members opportunities to maintain their health and welfare. In this Benefits Summary, employees will be able

to review:

• A description of the South Suburban’s Employee Benefit Program

• Important phone numbers and websites to help manage benefits

For complete details of each benefit plan refer to the complete Summary Plan Descriptions available through

South Suburban’s Human Resources Department. Please review this to understand your benefit enrollment

options, and please retain this Benefits Summary for reference throughout the year. If you need further

assistance, contact the Human Resources Department:

Deanna Heyn – 303.483.7004 Alina Pugel – 303.483.7027Lisa Hoy – 303.483.7007 www.sspr.org/employees

NOTE: We encourage you to read the entire enrollment guide before you enroll. This is a summary of your benefits only. Certain restrictions and exclusions apply. For exact terms and conditions, please refer to your summary plan description (SPD) or Certificate of Coverage. If information in this summary differs from the legal contract, the legal contract is the ruling document. SPD’s or Certificates of Coverage are on District intranet site, SubHub, or available from your Human Resources Department.

CARSON NATURE CENTER (at South Platte Park)

02

WELCOME TO THE 2013 PLAN-YEAR FOR OUR EMPLOYEE BENEFITS PROGRAM! This guide contains valuable information to assist in making your benefit selections. Please take the time to read through this guide along with the Benefit Election Forms and other materials provided. South Suburban’s internal website for employees, SubHub, has a wealth of information regarding your benefits and links to websites of many of the benefit providers.

ANNUAL OPEN ENROLLMENT The annual enrollment period is in November of each year for a January 1st effective date. Open Enrollment is the only time you can change benefit plans or add/drop dependents during a plan year, unless you have a qualified status change as defined in our Plan Documents. In the event of a qualified status change, you must notify Human Resources in writing within 30 days of the change. Examples of a qualified status change include things like birth, death, marriage, divorce, adoption, ineligibility of a dependent, etc.. So please choose your benefits carefully!

WHO IS ELIGIBLEActive full-time and regular part-time (as defined in our Employee Handbook) employees, a covered employee’s spouse (including common law spouse), a same-sex domestic partner, and children from birth up to the limiting age of 26, given the dependents meet all other eligibility requirements as specified in our plan document. Employees are eligible for coverage on their second day of employment and coverage terminates on the last day of employment. Please see the Sum-mary Plan Descriptions for further information concerning eligibility and continuation of coverage under COBRA when a qualifying event occurs.

OPEN ENROLLMENT REQUIREMENTSEvery eligible employee must enroll in benefits for January 1, 2013, during this open enrollment period. You will be receiving information from Human Resources on how to enroll.

Employees must also make an annual election every year to participate in the Dependent Care and/or Medical Spending Reimbursement Accounts.

03

MEDICAL PLAN HIGHLIGHTS HIGH PLAN (Open Access Plus Plan) LOW PLAN (Open Access Plus Plan)

In-Network Out-of-Network In-Network Out-of-NetworkCalendar Year DeductibleIndividualFamily

$200$400

$400$800

$400$800

$600

$1,200

Out-of-Pocket Maximum)(including deductible)IndividualFamily

$3,000$6,000

$6,000$12,000

$4,000$8,000

$6,000$12,000

Preventive Physician Office Visit 100% no deductible 60% after deductible 100% no deductible 50% after deductible

Physician Office Visit $20 copay/100% 60% after deductible 70% after deductible 50% after deductible

Specialist Office Visit $20 copay/100% 60% after deductible 70% after deductible 50% after deductible

Office Surgery $20 copay/100% 60% after deductible 70% after deductible 50% after deductible

Urgent Care $20 copay/100% 60% after deductible 70% after deductible 50% after deductible

Inpatient Hospital Services 80% after deductible 60% after deductible 70% after deductible 50% after deductible

Outpatient Hospital Surgery 80% after deductible 60% after deductible 70% after deductible 50% after deductible

Emergency Room 80% after deductible 80% after deductible & UCR 70% after deductible 70% after deductible & UCR

Prescription DrugsPlan pays 100% of eligible RX expenses after the calendar year out-of-pocket maximums are met

80% after deductible of$50 Individual

$100 Family

Out-of-pocket maximums:$2,000 Individual

$4,000 Family

50% after deductible of$50 Individual

$100 Family

Out-of-pocket maximums:n/an/a

80% after deductible of$50 Individual

$100 Family

Out-of-pocket maximums:$2,000 Individual

$4,000 Family

50% after deductible of$50 Individual

$100 Family

Out-of-pocket maximums:n/an/a

YOUR MEDICAL PLAN OPTIONSThis is a brief overview only and is not a complete list of your covered services. Please refer to your Summary Plan Description (SPD) for a detailed list. Each employee will also receive a summary of Benefits and coverage with this Benefit Guide.

This chart is an overview of both the High & Low Plans and is not all inclusive. The Plan Document will give detailed information about your plan, exclusions, and coverage limitations, as well precertification penalties that apply to many of the benefits listed.

2013 Rates per pay period Employee Pays Employer Pays Total Premium Employee Pays Employer Pays Total Premium

Employee OnlyEmployee + Spouse/DPEmployee + Child(ren)Employee + Family

$37.00$174.00$165.00$267.00

$227.00$370.00$351.00$602.00

$264.00$544.00$516.00$869.00

$19.00$129.00$123.00$198.00

$195.00$303.00$288.00$487.00

$214.00$432.00$411.00$685.00

These amounts are paid twice per month 24 times per year - on a before-tax basis under Section 125, unless employee specifically elects to contribute on an after-tax basis. Contact Human Resources for details. Separate tax treatment may apply to Same-Sex Domestic Partner benefits.

04

GENERAL PROVISIONS DELTA DENTAL PPO PLAN

In-Network Out-of-NetworkCalendar Year DeductibleIndividualFamily

$50$150

$50

$150

Calendar Year Maximum Benefit $1,500 per person $1,000 per person

Preventive Services (deductible waived) Plan pays 100% Plan pays 100% of U&C

Basic Services Plan pays 90% after deductible Plan pays 80% of U&C after deductible

Major Services Plan pays 60% after deductible Play pays 50% of U&C after deductible

Orthodontic ServicesPlan covers orthodontic services for eligible children and adults. Lifetime maximum is $1,000 per individual

Plan pays 50% after deductible Play pays 50% of U&C after deductible

2013 Rates per pay period Employee Pays Employer Pays Total Premium

Employee OnlyEmployee + Spouse/DPEmployee + Child(ren)Employee + Family

$8.00$22.00$25.00$32.00

$16.00$16.00$16.00$16.00

$24.00$38.00$41.00$48.00

These amounts are paid twice per month 24 times per year - on a before-tax basis under Section 125, unless employee specifically elects to contribute on an after-tax basis. Contact Human Resources for details. Separate tax treatment may apply to Same-Sex Domestic Partner benefits.

YOUR DENTAL PLAN OPTIONSThis is a brief overview only and is not a complete list of your covered services. Please refer to your Summary Plan Description (SPD) for a detailed list.

05

BASIC LIFE COVERAGE COMPANY PAID BENEFITSAnnual gross pay between$15,000 & $25,000

$25,000

Annual gross pay greater than $25,000

$50,000

YOUR DENTAL PLAN OPTIONSThis is a brief overview only and is not a complete list of your covered services. Please refer to your Summary Plan Description (SPD) for a detailed list.

YOUR VISION DISCOUNT PROGRAMThe District offers a free vision discount program. If you enroll in Delta Dental, you are eligible to participate in EyeMed Vision Care. For details, contact the Human Resources Department or visit this website: www.eyemedvision.com/deltadental

EMPLOYEE WELLNESS PROGRAMSouth Suburban is proud to provide its employees with a comprehensive employee wellness program. B-WELL stands for the Benefits of Wellness, Education, Laughing and Living well! We encourage you to get involved, save money and improve your overall health!

There are two ways to get involved: 1. Recreation/Facility Use Benefits: Use of the District’s programs and facilities are extended to full-time employees and their immediate family

members. Facility and program use increases productivity in the workplace, minimizes absenteeism due to illness, can improve employee health, promotes employee retention and longevity and assists with District-wide marketing and cross training. See page 9 of this brochure for specific details or visit SubHub.

2. B-FIT Credits: Employees can earn credits by participating in the District’s wellness program. Employees that earn the required credits by October 1st of each year can save on the next years medical and dental premiums. Employees not participating in the medical and dental plan receive B-FIT Bucks that can be spent throughout the District. Don’t miss out on this great opportunity to save money!

EMPLOYEE ASSISTANCE PROGRAM (EAP)For the many personal issues and concerns that arise in life, your Employee Assistance Program is available any time, 24 hours a day, seven days a week, including holidays. It is a free and confidential service that will provide counseling, telephonic consultation, and support services for you and your family members. In addi-tion to counseling services for issues like stress, relationships, depression, grief and loss, substance abuse, etc., they also provide legal services, financial services and child care and elder care services. These services are provided through Mines and Associates. You may visit them at www.minesandassociates.com, or contact them by phone at (303) 832-1068.

CIGNA also offers an Employee Assistance Program to all employees covered by the CIGNA Long-Term Disabilty Plan and their immediate family members. Services through the CIGNA EAP are similar to these offered through Mines and Associates. You can contact CIGNA at 800.538.3543 (identify yourself as a South Suburban employee) to receive additional information.

BASIC LIFE & ACCIDENTAL INSURANCEAs a full-time employee of South Suburban, you are eligible for a variety of company- sponsored benefit plans. The District pays 100% of the cost for your Basic Life and Accident Insurance (also referred to as AD&D).

The Basic Life benefits are listed below based on your annual gross pay. The AD&D insurance is equal to the amount of life insurance coverage you have in the event of death due to an accident. The dismemberment coverage varies and is determined according to the extent of loss.

LONG-TERM DISABILITY PLANThe District offers full-time employees a long-term disability plan to help you pay your household expenses if you become disabled and cannot work. These dis-ability benefits are currently provided by CIGNA and are as follows:

To be eligible for enrollment in the “Buy-up” program, you must enroll as a newly hired employee. To enroll at a later date you will need to complete a health questionnaire and may be denied coverage.

RETIREMENT SAVINGS PLANS South Suburban Parks and Recreation has established a 401(a) and 457 retirement plan to help you prepare for your financial future.

457 Deferred Compensation Plan: The District offers a tax deferred compensation supplementary retirement plan. Information is available in the Human Resources office and there is no specified enrollment period.

401(a) Money Purchase Plan: For full-time employees only, the District contributes an amount equal to 6% of your current regular salary each month, if you qualify for the Plan. To qualify, you must have been a full-time employee for at least 6 months and be at least 201⁄2 years old. Enrollment will be held in January and in July for new employees who meet eligibility requirements. There is no employee match required under this plan.

FLEXIBLE SPENDING ACCOUNTSThe District offers Health and Dependent Care Flexible Spending Accounts (FSAs) which allows you to use tax-free dollars to reimburse yourself for a wide variety of health and/or dependent care expenses not covered through your other benefit plans. THESE PLANS ARE CONSIDERED USE IT OR LOSE IT! Carefully estimate expenses using the information provided on the enrollment form. The maximum annual contribution for the Health Care FSA is $2,500. The maximum annual contribution for the Dependent Care FSA is $5,000 ($2,500 if you are married and filing a separate income tax return.)

06

COVERAGE TO AGE 65 ELIMINATION PERIOD WEEKLY BENEFIT

Basic Long Term Disability (employer paid) 6 months40% of monthly salary

to a maximum benefit of $3,000

Long Term Disability Buy-up (employee paid) 6 months60% of monthly salary

to a maximum benefit of $6,000

07

PAID-TIME OFF BENEFITS

Holiday LeaveThe District observes 7 holidays each year for eligible full-time employees. Employees that must work on a holiday will be eligible to earn compensatory time. (See the Employee Handbook for details.)

• New Years Day • Memorial Day• Independence Day • Labor Day• Thanksgiving Day • The Friday after Thanksgiving• Christmas Day

Personal LeaveThe District gives each full-time employee 24 hours annual personal leave on January 1st. This leave account does not carry over into the following year, and is lost if not used in the year given. Employees may use this leave as they wish with prior approval of the appropriate supervisor. New full-time employees are allotted personal leave as follows:

• Hired between January and March 24 hours• Hired between April and June 16 hours• Hired between July and September 8 hours• Hired between October and December 0 hours

Vacation LeaveFull-time employees earn vacation leave at various rates, based on length of service with the District. Vacation leave is credited to each employee on the date of his/her anniversary as a full-time employee with the District. A maximum of 160 hours may be carried forward from your anniversary date into your next year of service. Employees hired on January 1, 1989, or later accumulate vacation as follows:

• 1st through 5th Anniversary 80 hours• 6th through 10th Anniversary 120 hours• 11th Anniversary 128 hours• 12th Anniversary 136 hours• 13th Anniversary 144 hours• 14th Anniversary 152 hours• 15th Anniversary 160 hours Maximum

Sick LeaveSick leave is credited to each employee’s account at the rate of 8 hours per month. Sick leave is for use in case of illness of the employee or immediate family members (see the Employee Handbook for definition). There is no monetary value to accumulated unused sick leave if the employee leaves em-ployment for any reason. Employees are allowed to accumulate a maximum of 1000 hours of sick leave in their account.

SICK LEAVE SHARING PLANThe District has established an employee sick leave sharing program as a means to voluntarily transfer sick leave to a qualified full-time or regular part-time employee experiencing a catastrophic medical hardship, either personally or by an immediate family member. Contributions to the bank are voluntary, confidential and non-refundable. A minimum donation of 8 hours of accrued sick leave and a maximum donation of 96 hours may be made during any one solicitation period. Human Resources will announce solicitation periods. Full-time and regular part-time employees who experience a catastrophic medi-cal hardship are given an approved Leave of Absence, and are also eligible to apply for donated sick leave from the sick bank. There is no minimum service time. All other types of accrued paid time off (sick, vacation, compensatory time, personal, etc.) must be exhausted before applying for donated sick leave. A written application must be made on the form available from Human Resources. See the full policy in Human Resources for details.

08

OTHER BENEFITSSouth Suburban Parks and Recreation offers the following additional benefits to eligible employees. Please contact your Human Resources Department for eligibility requirements, or assistance with any of the South Suburban Parks and Recreation offered benefits.

ID Theft Recovery CoverageFor all Full-Time employees, covers up to $25,000 of the cost involved in correcting a misuse of your identity. This coverage does not reimburse the employee for money stolen or fraudulently charged to the employee. For complete information on this plan offered through Colorado Districts Property and Liability Pool, please see Human Resources. Additional identity theft resolution services are also available through CIGNA to employees covered by The Long-Term Disability plan and their covered dependents. To access CIGNA services call 888.226.4567 (group #57).

Will Preparation Services*CIGNA offers an online interactive tool to help employees and their spouses create a will and other legal documents. Go to www.CIGNAWillCenter.com.

Beneficiary Services*This program provides a package of financial, bereavement and legal support for your loved ones in the event of your death.

Emergency Medical Services while Traveling*These services are offered through CIGNA Secure Travel and includes arranging and covering the cost of transportation to the nearest hospital or medical facility where you can receive appropriate care. You can call CIGNA at 888.226.4567 (policy # OK963722, group #57) or call collect when outside the U.S. at 202.331.7635.

Discounted Health and Wellness-Related Services*CIGNA’s Healthy Rewards Program offers members discounts on weight management and smoking cessation programs, chiropractic care, anti-cavity products, power toothbrushes, fitness club memberships and more. To access Healthy Rewards: CIGNA.com/rewards, password: savings or call 1.800.258.3312.

Direct DepositEmployees have the opportunity to have paychecks automatically deposited into your bank account. Please contact Payroll or Human Resources for more information.

Credit UnionThe District is affiliated with the Columbine Federal Credit Union. Deposits may be made to your credit union account through payroll deductions each pay period. For more information contact the Credit Union by email: www.columbinefcu.org or by phone (720) 283-2346.

Tuition ReimbursementThe District supports those employees who desire to improve themselves by contributing their time and effort to furthering their education. All full-time and regular part-time employees are eligible to participate in the tuition reimbursement program after successful completion of 6 months of continuous employ-ment in a full-time or regular part-time position. Courses must be taken at an accredited college or university. All requests for tuition reimbursement require approval prior to the start date of the course to be eligible for reimbursement. Approval must be obtained by the employee’s supervisor and the department manager on the Request for Tuition Reimbursement form available in Human Resources. This approval does not guarantee reimbursement, as this benefit is available only as funds are available in the approved District budget and are distributed on a “first come first serve” basis.

*Offered to employees and their covered dependents either through the CIGNA Life or Long Term Disability Plans. Additional informational material on these services is available through the Human Resources department.

09

2013 SUMMARY OF EMPLOYEE RECREATION/FACILITY USE BENEFITS

DESCRIPTION FULL-TIME (Blue I.D. card)

Employee Meal Discount 50% off Employee & Spouse Entrée at SSPR Restaurants(does not include: beverages, appetizers, snacks, pre-packaged foods and events.)

Recreation Centers & Swimming Pools Employee & Immediate Family – FREE Daily admission to centers and poolsBatting Cages Employee & Immediate Family – 1 Token for $0.25Golf:

LittletonSouth SuburbanLone TreeColorado Journey (Mini-Golf)

Employee & Immediate Family - Follow resident reservation policy$1.50 (9 holes)/$3.00 (18 holes) - Includes cart and range balls$2.50 (9 holes)/$5.00 (18 holes) - Includes cart and range balls$4.00 (9 holes)/$8.00 (18 holes) - Includes cart and range balls$1.00 per 18 holes

Littleton Indoor Tennis

Employee & Immediate Family - $1.00 per hourIf non-employee playing partner-District - pay 1/2 district hr. rateNon-district - 1/2 non-district hr. rateCourts reserved only on same day. Space Available. No Block Time Usage.Not for instructional purposes

Ice Arena Employee & Immediate Family – FREE Skating & Skate Rental - During Public Skate Session

Family Sports Center

Employee & Immediate Family$1.50 (9 holes) at the FSC Golf Course$1.00 (18 holes) at the FSC Miniature Golf CourseFamily Entertainment Center - Free rides and attractionsFSC Youth Hockey: 25% DiscountFree Public Skating

Classes Free to Employee & Immediate Family (Space Available Basis)(Excluding District out-of-pocket cost: materials, maint. of equip., uniforms, etc.)

Contracted Classes Free to Employee & Immediate Family (Space Available Basis)(Excluding private contractor fees & District out-of-pocket costs)

Athletic Teams (Youth Only) Free to Employee & Immediate Family (Space Available Basis)(Excluding District out-of-pocket cost: uniforms, pictures, team fees, etc.)

Child Care:Child Discovery Time (CDT) Babysitting

Dependent of Employee (Space available assessed once/yr.)50% Discount CDT10% discount punch card

Pro Shop Merchandise Employee & Immediate Family – Pay Cost + 10%

Lone Tree - Hotel Employee & Immediate Family - $35.00/night (Space Available Basis)Extended Family - $55.95/night (Space Available Basis)

Fitness Assessment Free to Employee, Family 1/2 price – Once per Year (Blood pressure and body fat)Massage Employee – 1 hour - $40.00; 1/2 hour $30.00Blood Work (Once Per Year) Free to Employee – Immediate family pays out-of-pocket costs

See Employee Wellness Program: Facility and Program Use Policy for complete details on this employee benefit

10

BENEFIT CONTACTMedical Great West/CIGNA High and Low Plans (888) 494-2111

www.mycignaforhealth.com(Account # 00605129)

Dental Delta Dental of Colorado (303) 741-9300www.deltadental.com(# 6839)

Vision Delta Dental EyeMed (866) 246-9041www.eyemedvisioncare.com/deltadental

Flexible Spending Account Wage Works (877) 924-3967www.pbs.us.com

Employee Assistance Program (EAP) Mines & Associates (303) 832-1068www.minesandassociates.com

Cigna LTD & Life InsuranceContact Human Resources (303) 483-7027

401(a) Plan Principal Financial Group (800) 547-7754www.principal.com(Group #4-07386)

457 Plan Principal Financial Group (800) 547-7754www.principal.com(Group #7-09699)

Human Resources Department Deanna Heyn (303) 483-7004Alina Pugel (303) 483-7027Lisa Hoy (303) 483-7007Visit SubHub www.sspr.org/employees

CONTACT INFORMATIONIf you have questions that are not answered in this booklet, please contact the appropriate carrier below.

11

IMPORTANT LEGAL NOTICESFederal regulations require South Suburban Parks & Recreation District to provide benefits-eligible employees with the following notices:

Private Health InformationA portion of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) addresses the protection of confidential health information. It applies to all health benefit plans. In short, the idea is to make sure that confidential health information that identifies (or could be used to identify) you is kept completely confidential. This individually identifiable health information is known as “protected health information” (PHI), and it will not be used or disclosed without your written authorization, except as described in the Plans HIPAA Privacy Notice or as otherwise permitted by federal and state health information privacy laws, A copy of the Plan’s Notice of Privacy Practices that describes the Plan’s policies, practices and your rights with respect to your PHI under HIPM is available from your medical plan provider. For more information regarding this Notice, please contact Human Resources or the medical plan directly.

Women’s Health and Cancer Rights ActOn October 21, 1998, Congress passes a bill called the Women’s Health and Cancer Rights Act. This new law requires group health plans that provide coverage for mastectomy to provide coverage for certain reconstructive services. These services include:

• All stages of reconstruction of the breast on which the mastectomy was performed • Surgery and reconstruction of the other breast to produce a symmetrical appearance • Prostheses and treatment of physical complications resulting from mastectomy (including lymphedema)

In addition, the plan may not: • Interfere with a woman’s rights under the plan to avoid these requirements• Offer inducements to the health provider, or assess penalties against the health provider, in an attempt to interfere with the requirements of the law.

This coverage will be provided in consultation with the attending physician and the patient, and will be subject to the same annual deductibles and coinsurance provisions that apply to the mastectomy. For more information, contact your medical plan provider.

Special Enrollment RightsIf you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance coverage, you may be able to enroll yourself and your dependents in the South Suburban Parks & Recreation District health plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing towards your or your dependents’ other coverage). However, you must request enrollment in writing within 30 days after your or your dependent’s other coverage ends (or after the employer stops contributing toward the other coverage).

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 depen-dents, provided that you request enrollment in writing within 30 days after the marriage, birth, adoptions, or placement for adoption. For more information, contact Human Resources.

Notice of Prescription Drug Creditable CoverageSouth Suburban Parks & Recreation District provides a “Notice of Prescription Drug Creditable Coverage” to all Medicare-eligible participants on an annual basis. This notice states that under the South Suburban Parks & Recreation District medical plan, you have prescription drug coverage that is, on average, as generous as the standard Medicare prescription Drug Coverage. A copy of this notice is also available upon request from Human Resources.

Grandfathered Plan StatusSouth Suburban Parks & Recreation District group health plan believes this plan is a “grandfathered health plan” under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that is already in ef-fect when that law was enacted. Being a grandfathered health plan means that the South Suburban Parks & Recreation District group health plan may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits.

You can contact the Employee Benefits Security Administration, U.S. Department of Labor at 1-866-444-3272 or www.dol.gov/ebsa/healthform. This website has a table summarizing which protections do and do not apply to a grandfathered health plans.

12

Medicaid and the Children’s Health Insurance Program -Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)If you or your children are eligible for Medicaid or CHIP and you are eligible for health coverage from your employer, your State may have a premium assistance program that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for these programs, but also have access to health insurance through their employer. If you or your children are not eligible for Medicaid or CHIP, you will not be eligible for these premium assistance programs.

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, you can contact your State Medicaid or CHIP office to find out if premium assistance is available.

If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan.

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must permit you to enroll in your employer plan if you are not already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, you can contact the Department of Labor electronically at www.askebsa.dol.gov or by calling toll-free 1-866-444- EBSA (3272).

COLORADO – Medicaid

Medicaid Website: http://www.colorado.gov/Medicaid Phone (In state): 1-800-866-3513Medicaid Phone(Out of state): 1-800-221-3943

To see if any other States have a premium assistance program or more information on special enrollment rights, you can contact either: U.S. Department of Labor U.S. Department of Health and Human Services Employee Benefits Security Administration Centers for Medicare & Medicaid Services www.dol.gov/ebsa www.cms.hhs.gov

1-866-444-EBSA (3272) 1-877-267-2323, Ext. 61565

Pre-Existing ConditionsThis Plan imposes a pre-existing condition limitation (does not apply to children under age 19). This means that if you have a medical condition before coming to our plan, you might have to wait a certain period of time before the plan will provide coverage for that condition. This limitation applies only to conditions for which medical advice, diagnosis, care or treatment was recommended or received within a three-month period. Generally, this three-month period ends the day before your coverage becomes effective. However, if you were in a waiting period for coverage, the three-month period ends on the day before the waiting period begins. The pre-existing condition limitation does not apply to pregnancy or to a child who is enrolled in the plan within thirty days after birth, adoption or placement for adoption.

This limitation may last up to twelve months (eighteen months if you are a late enrollee) from your first day of coverage, or, if you were in a waiting period, from the first day of your waiting period. However, you can reduce the length of this exclusion period by the number of days of your prior “creditable coverage.” Most prior health coverage is creditable coverage and can be used to reduce the pre-existing limitation period if you have not experienced a break in coverage of at least sixty-three days. To reduce the twelve-month (or eighteen-month) limitation period by your creditable coverage, you should give us a copy of any certificates of creditable coverage you have. If you do not have a certificate, but you do have prior health coverage, we will help you obtain one from your prior plan or issuer. There are other ways that you can show you have creditable coverage. Please contact us if you need help demonstrating creditable coverage.

All questions about the pre-existing condition limitation and creditable coverage should be directed to:

Deanna Heyn | Human Resources Director(303) 483-70046631 S. University Blvd., Centennial, CO 80121

This guide provides only a highlight of the benefit plans offered to you by South Suburban and in no way serves as the actual plan description or plan document for the plans. This guide may not reflect the benefit plans in effect for all employees in all circumstances, nor cover all applicable limitations and/or restrictions. The plan documents will always govern the offered benefits that South Suburban provides for you. We reserve the right to modify any or all of these plans at anytime. This guide is not intended as a contract of employment or a guarantee of current or future employment.

Where There’s Something For Everyone

LONE TREE GOLF CLUB AND HOTEL