Flexible Benefits Office
(REV: 5-27-2022)
This document, with embedded links, is available online at sandiego.gov/riskmanagement/services/benets
Health Plans:
August 1, 2022 - December 31, 2022
Flexible Spending Accounts (FSA):
July 1, 2022 - December 31, 2022
Short Plan
Year
2022
FLEXIBLE BENEFITS
Information and Costs Booklet
2
2022 Short Plan Year
Flexible Benets Information and Costs
3
4
10
18
19
21
23
24
26
Calendar Year Transition
Benefits Enrollment Information
Flexible Benefit Plan (FBP) Credit Amounts
Health Plan Eligibility
Medical Plans and Costs
Dental Plans and Costs
Vision Plans and Costs
Life Insurance Plans and Costs
Benefits Plan Contact Information
Fiscal/Annual Calendar
27
Table of Contents
FOR QUESTIONS:
Risk Management – Flexible Benets
Email: Bene[email protected]
Employee Benets Website:
www.sandiego.gov/riskmanagement/services/benets
Calendar Year Transition
3
2022 Short Plan Year
Flexible Benets Information and Costs
Health Plan Year: Transition to Calendar Year Basis
The City will be making a signicant change to the administration of its health benet plans. These changes
directly impact all employees that are eligible for the benets under the City’s Flexible Benets Plan. The City will
be transitioning its health benets plan year period from a scal year basis to a calendar year. This transition
will occur during 2022 and it will impact the plan year period for the City’s medical, dental, vision, life, and exible
spending accounts (FSA). This change will require a short plan year from August 1, 2022 to December 31, 2022
(July 1, 2022 to December 31, 2022 for FSA) to allow the transition to a new 12-month plan year that aligns with
the calendar year. This means that there will be two open enrollment periods in 2022:
Fiscal Year 2022
• Medical, dental, vision, and life insurance coverage period: 8/1/2021 through 7/31/2022
• Flexible spending accounts (FSA): 7/1/2021 through 6/30/2022
Short Plan Year
• Medical, dental, vision, and life insurance: 8/1/2022 through 12/31/2022
• Flexible spending accounts (FSA): 7/1/2022 through 12/31/2022
Calendar Year 2023
• Medical, Dental, Vision, Life Insurance, and FSA: 1/1/2023 through 12/31/2023
Year 2023 and all future years will follow this same calendar year coverage period from Jan 1 – Dec 31.
The following diagram illustrates the transition process. Please note: the benets information contained
within this booklet only pertains to the Short Plan Year. An updated booklet will be provided for the 2023
Calendar Year.
Open Enrollment
Period
Medical, Dental,
Vision, and Life
Coverage Period
Flexible
Spending Accounts
(FSA) Period
Short Plan Year 5/16/2022 – 6/3/2022 8/1/2022 – 12/31/2022 7/1/2022 – 12/31/2022
2023 Calendar Year
October/November 2022 1/1/2023 – 12/31/2023 1/1/2023 – 12/31/2023
2 Open
Enrollments
in Calendar
Year 2022
Action
Required Now:
Elect your benets
for the Short
Plan Year.
Don’t Forget:
Enrollment for the
2023 Calendar Year
will be during Oct./
Nov. of 2022.
2022 Short Plan Year Enrollment Information
4
2022 Short Plan Year
Flexible Benets Information and Costs
Plan the benet options you want to enroll in:
1. Determine the amount of your FBP credits. See page 10.
2. Select your Basic Life Insurance coverage. See pages 24-25. (REQUIRED)
3. Choose your medical plan or waive enrollment. See pages 19-20. (REQUIRED)
4. Select your dental and vision plans. See page 21-23. (OPTIONAL)
5. Determine the Flexible Spending Accounts you wish to participate in. (OPTIONAL)
a. Dental/Medical/Vision (DMV). See page 7.
b. Dependent/Child Care (DCC). See page 7.
6. If eligible, contribute $10 or more of your remaining
FBP Credits to the 401(k) Flex plan. See page 8. (OPTIONAL)
Benets Enrollment application in SAP:
To review or make changes to your benets, log in to SAP using
your City user ID and password and click on the Access Benets
Info tile, then the Benets Enrollment tile. The application
will walk you through the steps for reviewing, changing and
conrming your benet enrollment.
Choosing Your Flexible Benefits Plan Options
The City of San Diego oers a Flexible Benets Plan (FBP) to all eligible employees.
This IRS-qualied, cafeteria-style benets program includes medical, vision and dental
insurance and Flexible Spending Account plans.
The City also provides you FBP credits to apply
toward the cost of these plans. The FBP credit
amount is based on your bargaining unit and
medical coverage election (e.g., employee-only vs
family). In accordance with the MOUs, certain credit
tiers have cash-back limitations. Please refer to the
2022 FBP Credit Table for credit tier information by
bargaining unit. Note, the comments detail how the
credits may be applied.
A video overview of the benets
enrollment process is available on the
Open Enrollment website.
5
2022 Short Plan Year
Flexible Benets Information and Costs
HEALTH PLANS
Detailed information regarding your medical, dental and vision
plans can be found on the Employee Benets website. Learn more
about your options by selecting your bargaining unit and reviewing
the available resources and plan documents.
Enrolling Dependents
If you are enrolling dependents into your health plans for the rst
time, you will need to provide dependent verication documents
within 30 days of enrollment. Acceptable documents include:
• Spouse – Marriage certicate
• Domestic Partner – Notarized Adavit of Domestic Partner
Relationship or Registration of Domestic Partnership led
with the state of California
• Children – Birth certicate, adoption records, hospital
verication letter, and/or court legal document
Documents may be submitted by
1. Scan and email to Bene[email protected]
Subject Line: Dependent Verication Documents
2. Fax to 619-533-3256
HMO Enrollment
If you or your dependents will be enrolling in an HMO plan (except
Kaiser) a Primary Care Physician (PCP), will be automatically
assigned to you. Those plans include Cigna, Sharp, Anthem Blue
Cross (Local 145) and California Care (POA ALADS) for medical
HMOs and dental HMOs such as Delta Dental, MetLife and Dental
Health Services. You can make changes to the assigned Primary
Care Physician (PCP) later on through the carrier’s portal or by
calling them directly.
Proper documentation must
be submitted by the required
deadline (within 30 days of
enrollment) to maintain coverage
for your dependents. If proper
documentation is not received
timely, your dependents will be
dis-enrolled from the plan and
you will be responsible for any
claims retroactive to the date you
enrolled. You will not be able to
re-enroll them until the next
Open Enrollment period unless
you have a Qualifying Event.
6
2022 Short Plan Year
Flexible Benets Information and Costs
LIFE INSURANCE
Basic Term Life
City employees are required to enroll in Basic Term Life Insurance.
If you are represented by MEA, Local 127 or Teamsters you must
select the level of your Basic Term Life Insurance between $10,000,
$25,000 or $50,000 for a minimal annual cost. If you are not a
member of one of these groups, you will be enrolled in a $50,000
Basic Term Life Insurance policy paid by the City.
Supplemental Life
You may sign up for Supplemental Life Insurance for yourself, your
spouse/domestic partner and your child. A child is only eligible to
enroll if the employee and/or spouse is also enrolled in
Supplemental Life Insurance. If you and your spouse/domestic partner both work for the City:
• Only one Supplemental Life Insurance plan can be purchased per employee
• A child may only be covered by one employee
When you sign up for Supplemental Life Insurance during your initial enrollment period (within 30 days of your
date of hire/re-hire or promotion), within 30 days of your qualifying event or, you:
• Have a Guaranteed Issue Amount (GIA) of $250,000 and your spouse/domestic has a GIA of $50,000
• Will not be required to provide Evidence of Insurability (e.g., proof of good health)
• Can sign up your child for $5,000 or $10,000 of coverage.
Supplemental coverage for your spouse/domestic partner cannot exceed the
combined employee coverage for Basic and Supplemental Life. For example,
if an employee has $50,000 in Basic Life Insurance and $100,000 in
Supplemental Life Insurance, the total coverage for a spouse/domestic partner
cannot exceed $150,000.
The Hartford will contact you to provide Evidence of Insurability (EOI)* when:
a. Applying for a level of coverage more than the Guaranteed Issue
Amount of $250,000;
b. Applying for an increase of more than the one level allowed during
Open Enrollment;
c. Applying for coverage for the first time and increasing your level
of coverage outside your initial enrollment or qualifying event
periods; or
d. There is a lapse in paying the premium while on a leave of absence
without pay. Coverage and payroll deductions will begin upon
approval by The Hartford.
Supplemental Life Insurance: Available Throughout the Year
To sign up for, or make changes to your Supplemental Life Insurance benets,
go to the Benets Enrollment application in SAP and select Life Insurance.
*EOIs are not required for children.
The Hartford also oers
enhanced services such as:
Estate Guidance
®
Will Services;
Travel Assistance with ID Theft
Protection and Assistance;
Beneciary Assist Counseling
Services; Funeral Planning
and Concierge Services with a
f u n e r a l - r e l a t e d c o s t c o m p a r i s o n
tool. Additional information
is available on the Employee
Benets website.
Please plan carefully as funds designated for childcare
and healthcare related services must be incurred by
the grace period deadline, with receipts submitted
by the run-out period deadline, in order to be
reimbursed (see diagram below).
Any unclaimed monies cannot be carried
over into the next plan year and are forfeited.
Once your account has been established you will
be contacted by HealthEquity/WageWorks with
instructions on how to create an account
online at wageworks.com
and process claims.
7
2022 Short Plan Year
Flexible Benets Information and Costs
FLEXIBLE SPENDING ACCOUNTS
Flexible Spending Accounts (FSAs) allow you to use pre- tax
dollars to pay for approved dependent care costs and health
care expenses for you and your dependents. The City contracts
with HealthEquity/WageWorks® to manage its FSAs for
employees. HealthEquity/WageWorks oers you the ability to:
• Submit receipts for reimbursement from your
mobile phone.
• Set up payments for your recurring expenses.
• Use a HealthEquity/WageWorks debit card for
your allowable dental, medical and vision
(DMV) expenses.
• Manage your account online 24-hours a day.
To participate in an FSA, designate the total amount you wish to
contribute over the plan year. Pre-tax deductions are taken out
of your paycheck on a semi-monthly basis through the end of
the plan year, which is December 31, 2022. The 2022 Short Plan
Year minimum and maximum designations for FSA accounts are:
• Dental/Medical/Vision (DMV): $120/$1,425
• Dependent/Child Care (DCC): $120/$2,500
JULY
1
MAR
15
MAR
31
DEC
31
2-1/2 Month Grace PeriodPlan Year
15-day
Run-out Period
Expenses for the short plan year must be incurred by March 15th and submitted
to HealthEquity/WageWorks by March 31, 2023.
FSA elections are not carried
over into the next plan year.
You are required to sign up
each plan year if you wish to
participate.
RETIREMENT SAVINGS PLANS
401(k) and 457(b) Deferred Compensation Plan
All employees are eligible to participate in the City’s 401(k) plan and
the City’s 457(b) deferred compensation plan, regardless of hire
date.
The maximum amount you can contribute to your 401(k) and
457(b) Deferred Compensation plans is $20,500 per savings plan
per calendar year. If you are 50 years of age or older by Dec. 31,
you may also be eligible to contribute an additional $6,500 to each
plan. Minimum contributions to each plan are $10 per pay period.
The City does not make any matching contributions to the 401(k) or
457(b) plans.
The 457(b) plan also has a catch-up provision which allows
City employees to defer up to twice the annual limit (e.g., $41,000
for 2022) three years prior to retirement. To see if you qualify, or
to apply for the three-year catch-up provision, contact the
Employee Savings Division at 619-236-6600.
Designate an amount per pay period you would like to contribute
toward your 401(k) and/or 457(b) accounts, based on bi-weekly*
contributions. Contributions will automatically stop once you meet
your annual calendar limit. You can adjust contributions to your
401(k) or 457(b) Deferred Compensation plans at any time by going
to the Retirement Savings event in your Benefits Enrollment
application on the SAP portal.
Depending on your date of hire and credit tier, you may have the
option to allocate excess flex credits toward the 401(k) plan. If
eligible, you have the option of allocating $10 or more of the
remaining credits toward the 401(k) if your Flexible Benefits Plan
(FBP) credits are greater than the costs of your selected benefits.
Flex deductions are taken on a semi-monthly basis**.
*bi-weekly = every two weeks or
26 times per year
**semi-monthly = 2 deductions per month or
24 times per year
8
2022 Short Plan Year
Flexible Benets Information and Costs
Please note: If you make changes to your
401(k), please allow two weeks to take effect.
Your first check following the two week
waiting period will reflect your contribution
changes. If you make a change to your
457(b) Deferred Compensation plan
contribution,it will go into effect the
following month (i.e., if the change request
is made in June, the contribution change
will occur in July).
Contributions to the 457(b) plan will lower
contributions to your SPSP-H and 401(a)
plan.
The City’s Retirement Savings
plans are administered by
Principal (for the 401(k) plan)
and CalPERS (for the 457(b) plan).
Following your enrollment, you
will be able to access your account
information online or by calling
the administrator’s participant
service center (found on page 26).
9
2022 Short Plan Year
Flexible Benets Information and Costs
BENEFIT CHANGES DUE TO QUALIFYING EVENTS
You may make changes to your benefits outside of the Open
Enrollment period if you experience a qualifying event. Types of
qualifying events include family status changes (such as marriage and
birth or adoption of a child), gain or loss of medical coverage,
or a divorce judgment/court order.
If you have experienced a qualifying event and would like
to make enrollment changes, please complete and submit
the Qualifying Event Form in SAP within 30 days from the
date of the event. Proof of the qualifying event and
dependent verification documents will be required. If you
miss the 30-day deadline, you will need to wait until the
next Open Enrollment period to make changes. Please refer
to the Qualifying Event Chart on the Employee Benefits
website for more details.
BENEFICIARIES
A beneficiary is someone who receives funds from your employee
savings or life insurance plans in the event of your death. It is
always a good practice to annually review your beneficiaries to ensure
they are current.
Beneficiary Designations:
Beneficiary designations for life insurance must be completed in the
Benefits Enrollment application on the SAP portal. Beneficiary
designations for Retirement Savings Plans must be completed on the
financial institution's website.
You may designate any individual or qualified trust as beneficiary,
however, if you are married or have a domestic partner and you live in a
community property state, such as California, special rules apply: Your
spouse or registered domestic partner must be designated at least 50%
primary beneficiary unless he/she signs a notarized consent waiver. This
rule applies to life insurance plans as well as all the retirement savings
plans (401(a), 401(k), SPSP or SPSP-H). If you have questions or you need
to submit a waiver, email [email protected].
A Note About Trusts:
If you will be listing a trust as a beneficiary, IRS regulations allow you to
name a trust as your beneficiary under certain circumstances (please
refer to Q-5 and A-5). If the trust does not meet these requirements,
beneficiaries will be designated as outlined in the plan document.
City FBP Credits
10
2022 Short Plan Year
Flexible Benets Information and Costs
MEA (Municipal Employees Association)
ANNUAL SEMI-MONTHLY (24 PAY PERIODS)*
Notes
FULL-TIME
1/2 TIME
(40)
3/4 TIME
(60)
FULL TIME
(80 or 112)
Most recent hire date prior to 7/1/2020
Waive $11,705.00 $487.71 $487.71 $487.71
Credits may be used for dental,
vision, basic life insurance, flexible
spending accounts, or 401k flex. Any
remaining flex credits may be
cashed-out as taxable income.
Employee only $11,705.00 $487.71 $487.71 $487.71
Credits may be used for medical,
dental, and vision insurance, basic
life insurance, flexible spending
accounts, or 401k flex. Any
remaining flex credits may be
cashed-out as taxable income.
Employee &
Spouse/Domestic Partner
$16,000.00
$666.67 $666.67 $666.67
Credits may be used for medical,
dental, vision, basic life insurance, or
flexible spending accounts only. Any
remaining flex credits may not be
cashed-out or allocated to 401k flex.
Employee & Children $14,000.00 $583.33 $583.33 $583.33
Employee &
Spouse/Domestic Partner &
Children
$22,000.00 $916.67 $916.67 $916.67
Most recent hire date on or after 7/1/2020
Waive $1,000.00 $41.67 $41.67 $41.67
Credits may be used for dental,
vision, basic life insurance, flexible
spending accounts, or 401k flex. Any
remaining flex credits may be
cashed-out as taxable income.
During enrollment, employees must
certify they have qualifying medical
coverage in order to receive the
cash-out option.
Employee only $7,600.00 $316.67 $316.67 $316.67
Credits may be used for medical,
dental, vision, basic life insurance, or
flexible spending accounts only. Any
remaining flex credits may not be
cashed-out or allocated to 401k flex.
Employee &
Spouse/Domestic Partner
$16,000.00
$666.67 $666.67 $666.67
Employee & Children $14,000.00 $583.33 $583.33 $583.33
Employee &
Spouse/Domestic Partner &
Children
$22,000.00
$916.67 $916.67 $916.67
*variances due to rounding
Medical Plan Dependent
Coverage Level
(credit tier)
City FBP Credits
(cont.)
11
2022 Short Plan Year
Flexible Benets Information and Costs
Teamsters Local 911
ANNUAL SEMI-MONTHLY (24 PAY PERIODS)*
Notes
FULL-TIME
1/2 TIME
(40)
3/4 TIME
(60)
FULL TIME
(80 or 112)
Most recent hire date prior to 7/1/2021
Waive $13,461.00 $560.88 $560.88 $560.88
Credits may be used for dental,
vision, basic life insurance, flexible
spending accounts, or 401k flex. Any
remaining flex credits may be
cashed-out as taxable income.
Employee only $13,461.00 $560.88 $560.88 $560.88
Credits may be used for medical,
dental, and vision insurance, basic
life insurance, flexible spending
accounts, or 401k flex. Any
remaining flex credits may be
cashed-out as taxable income.
Employee & Spouse/Domestic
Partner
$13,528.00 $563.67 $563.67 $563.67
Credits may be used for medical,
dental, vision, basic life insurance, or
flexible spending accounts only. Any
remaining flex credits may not be
cashed-out or allocated to 401k flex.
Employee & Children $13,547.00 $564.46 $564.46 $564.46
Employee & Spouse/Domestic
Partner & Children
$13,874.00 $578.08 $578.08 $578.08
Most recent hire date on or after 7/1/2021
Waive $1,000.00 $41.67 $41.67 $41.67
Credits may be used for dental,
vision, basic life insurance, flexible
spending accounts, or 401k flex. Any
remaining flex credits may be
cashed-out as taxable income.
During enrollment, employees must
certify they have qualifying medical
coverage in order to receive the
cash-out option.
Employee only $7,600.00 $316.67 $316.67 $316.67
Credits may be used for medical,
dental, vision, basic life insurance, or
flexible spending accounts only. Any
remaining flex credits may not be
cashed-out or allocated to 401k flex.
Employee & Spouse/Domestic
Partner
$13,528.00 $563.67 $563.67 $563.67
Employee & Children $13,547.00 $564.46 $564.46 $564.46
Employee & Spouse/Domestic
Partner & Children
$13,874.00 $578.08 $578.08 $578.08
*variances due to rounding
Medical Plan Dependent
Coverage Level
(credit tier)
City FBP Credits
(cont.)
12
2022 Short Plan Year
Flexible Benets Information and Costs
AFSCME Local 127 (American Federation of State, County, and Municipal Employees)
ANNUAL SEMI-MONTHLY (24 PAY PERIODS)*
Notes
FULL-TIME
1/2 TIME
(40)
3/4 TIME
(60)
FULL TIME
(80 or 112)
Most recent hire date prior to 7/1/2020
Waive $9,956.00 $414.83 $414.83 $414.83
Credits may be used for dental,
vision, basic life insurance, flexible
spending accounts, or 401k flex. Any
remaining flex credits may be
cashed-out as taxable income.
Employee only $10,956.00 $456.50 $456.50 $456.50
Credits may be used for medical,
dental, and vision insurance, basic
life insurance, flexible spending
accounts, or 401k flex. Any
remaining flex credits may be
cashed-out as taxable income.
Employee & Spouse/Domestic
Partner
$16,750.00 $697.92 $697.92 $697.92
Credits may be used for medical,
dental, vision, basic life insurance, or
flexible spending accounts only. Any
remaining flex credits may not be
cashed-out or allocated to 401k flex.
Employee & Children $14,750.00 $614.58 $614.58 $614.58
Employee & Spouse/Domestic
Partner & Children
$21,750.00 $906.25 $906.25 $906.25
Most recent hire date on or after 7/1/2020
Waive $1,000.00 $41.67 $41.67 $41.67
Credits may be used for dental,
vision, basic life insurance, flexible
spending accounts, or 401k flex. Any
remaining flex credits may be
cashed-out as taxable income.
During enrollment, employees must
certify they have qualifying medical
coverage in order to receive the
cash-out option.
Employee only $7,600.00 $316.67 $316.67 $316.67
Credits may be used for medical,
dental, vision, basic life insurance, or
flexible spending accounts only. Any
remaining flex credits may not be
cashed-out or allocated to 401k flex.
Employee & Spouse/Domestic
Partner
$16,750.00 $697.92 $697.92 $697.92
Employee & Children $14,750.00 $614.58 $614.58 $614.58
Employee & Spouse/Domestic
Partner & Children
$21,750.00 $906.25 $906.25 $906.25
*variances due to rounding
Medical Plan Dependent
Coverage Level
(credit tier)
City FBP Credits
(cont.)
13
2022 Short Plan Year
Flexible Benets Information and Costs
IAFF Local 145 (International Association of Fire Fighters)
ANNUAL SEMI-MONTHLY (24 PAY PERIODS)*
Notes
FULL-TIME
1/2 TIME
(40)
3/4 TIME
(60)
FULL TIME
(80 or 112)
Most recent hire date prior to 7/1/2020
Waive $1,750.00 $36.46 $54.69 $72.92
Credits may be used for dental,
vision, basic life insurance, flexible
spending accounts, or 401k flex. Any
remaining flex credits may be
cashed-out as taxable income.
Employee only $9,830.00 $204.79 $307.19 $409.58
Credits may be used for medical,
dental, and vision insurance, basic
life insurance, flexible spending
accounts, or 401k flex. Any
remaining flex credits may be
cashed-out as taxable income.
Employee & Spouse/Domestic
Partner
$18,250.00 $380.21 $570.31 $760.42
Credits may be used for medical,
dental, vision, basic life insurance, or
flexible spending accounts only. Any
remaining flex credits may not be
cashed-out or allocated to 401k flex.
Employee & Children $15,000.00 $312.50 $468.75 $625.00
Employee & Spouse/Domestic
Partner & Children
$20,750.00 $432.29 $648.44 $864.58
Most recent hire date on or after 7/1/2020
Waive $1,000.00 $20.83 $31.25 $41.67
Credits may be used for dental,
vision, basic life insurance, flexible
spending accounts, or 401k flex. Any
remaining flex credits may be
cashed-out as taxable income.
During enrollment, employees must
certify they have qualifying medical
coverage in order to receive the
cash-out option.
Employee only $7,600.00 $158.33 $237.50 $316.67
Credits may be used for medical,
dental, vision, basic life insurance, or
flexible spending accounts only. Any
remaining flex credits may not be
cashed-out or allocated to 401k flex.
Employee & Spouse/Domestic
Partner
$18,250.00 $380.21 $570.31 $760.42
Employee & Children $15,000.00 $312.50 $468.75 $625.00
Employee & Spouse/Domestic
Partner & Children
$20,750.00 $432.29 $648.44 $864.58
*variances due to rounding
Medical Plan Dependent
Coverage level
(credit tier)
City FBP Credits
(cont.)
POA (Police Officers Association) - Police Unit & Police Management
ANNUAL SEMI-MONTHLY (24 PAY PERIODS)*
Notes
FULL-TIME
1/2 TIME
(40)
3/4 TIME
(60)
FULL TIME
(80 or 112)
Most recent hire date prior to 7/1/2021
Waive $7,605.00 $158.44 $237.66 $316.88
Credits may be used for dental,
vision, basic life insurance, flexible
spending accounts, or 401k flex. Any
remaining flex credits may be
cashed-out as taxable income.
Employee only $9,942.00 $207.13 $310.69 $414.25
Credits may be used for medical,
dental, and vision insurance, basic
life insurance, flexible spending
accounts, or 401k flex. Any
remaining flex credits may be
cashed-out as taxable income.
Employee & Spouse/Domestic
Partner
$15,000.00 $312.50 $468.75 $625.00
Credits may be used for medical,
dental, vision, basic life insurance, or
flexible spending accounts only. Any
remaining flex credits may not be
cashed-out or allocated to 401k flex.
Employee & Children $13,500.00 $281.25 $421.88 $562.50
Employee & Spouse/Domestic
Partner & Children
$19,000.00 $395.83 $593.75 $791.67
Most recent hire date on or after 7/1/2021
Waive $1,000.00 $20.83 $31.25 $41.67
vision, basic life insurance, flexible
spending accounts, or 401k flex. Any
remaining flex credits may be
cashed-out as taxable income.
During enrollment, employees must
certify they have qualifying medical
coverage in order to receive the
Employee only $7,600.00 $158.33 $237.50 $316.67
Credits may be used for medical,
dental, vision, basic life insurance, or
flexible spending accounts only. Any
remaining flex credits may not be
cashed-out or allocated to 401k flex.
Employee & Spouse/Domestic
Partner
$15,000.00 $312.50 $468.75 $625.00
Employee & Children $13,500.00 $281.25 $421.88 $562.50
Employee & Spouse/Domestic
Partner & Children
$19,000.00 $395.83 $593.75 $791.67
*variances due to rounding
14
2022 Short Plan Year
Flexible Benets Information and Costs
Medical Plan Dependent
Coverage Level
(credit tier)
DCAA (Deputy City Attorneys Association)
ANNUAL SEMI-MONTHLY (24 PAY PERIODS)*
Notes
FULL-TIME
1/2 TIME
(40)
3/4 TIME
(60)
FULL TIME
(80 or 112)
Most recent hire date prior to 7/1/2020
Waive $9,942.00 $207.13 $310.69 $414.25
Credits may be used for dental,
vision, basic life insurance, flexible
spending accounts, or 401k flex. Any
remaining flex credits may be
cashed-out as taxable income.
Employee only $13,643.00 $284.23 $426.34 $568.46
Credits may be used for medical,
dental, and vision insurance, basic
life insurance, flexible spending
accounts, or 401k flex. Any
remaining flex credits may be
cashed-out as taxable income.
Employee & Spouse/Domestic
Partner
$18,250.00 $380.21 $570.31 $760.42
Credits may be used for medical,
dental, vision, basic life insurance, or
flexible spending accounts only. Any
remaining flex credits may not be
cashed-out or allocated to 401k flex.
Employee & Children $16,150.00 $336.46 $504.69 $672.92
Employee & Spouse/Domestic
Partner & Children
$24,100.00 $502.08 $753.13 $1,004.17
Most recent hire date on or after 7/1/2020
Waive $1,000.00 $20.83 $31.25 $41.67
Credits may be used for dental,
vision, basic life insurance, flexible
spending accounts, or 401k flex. Any
remaining flex credits may be
cashed-out as taxable income.
During enrollment, employees must
certify they have qualifying medical
coverage in order to receive the
cash-out option.
Employee only $7,600.00 $158.33 $237.50 $316.67
Credits may be used for medical,
dental, vision, basic life insurance, or
flexible spending accounts only. Any
remaining flex credits may not be
cashed-out or allocated to 401k flex.
Employee & Spouse/Domestic
Partner
$18,250.00 $380.21 $570.31 $760.42
Employee & Children $16,150.00 $336.46 $504.69 $672.92
Employee & Spouse/Domestic
Partner & Children
$24,100.00 $502.08 $753.13 $1,004.17
*variances due to rounding
City FBP Credits
(cont.)
15
2022 Short Plan Year
Flexible Benets Information and Costs
Medical Plan Dependent
Coverage Level
(credit tier)
City FBP Credits
(cont.)
Unrepresented/Unclassified (Salaried)
ANNUAL SEMI-MONTHLY (24 PAY PERIODS)*
Notes
FULL-TIME
1/2 TIME
(40)
3/4 TIME
(60)
FULL TIME
(80 or 112)
Most recent hire date prior to 7/1/2020
Waive
$9,977.00
$207.85
$311.78
$415.71
Credits may be used for dental,
vision, basic life insurance, flexible
spending accounts, or 401k flex. Any
remaining flex credits may be
cashed-out as taxable income.
Employee only
$13,178.00
$274.54
$411.81
$549.08
Credits may be used for medical,
dental, and vision insurance, basic
life insurance, flexible spending
accounts, or 401k flex. Any
remaining flex credits may be
cashed-out as taxable income.
Employee & Spouse/Domestic
Partner
$17,500.00
$364.58
$546.88
$729.17
Credits may be used for medical,
dental, vision, basic life insurance, or
flexible spending accounts only. Any
remaining flex credits may not be
cashed-out or allocated to 401k flex.
Employee & Children
$16,250.00
$338.54
$507.81
$677.08
Employee & Spouse/Domestic
Partner & Children
$21,500.00
$447.92
$671.88
$895.83
Most recent hire date on or after 7/1/2020
Waive $1,000.00 $20.83 $31.25 $41.67
Credits may be used for dental,
vision, basic life insurance, flexible
spending accounts, or 401k flex. Any
remaining flex credits may be
cashed-out as taxable income.
During enrollment, employees must
certify they have qualifying medical
coverage in order to receive the
cash-out option.
Employee only $7,600.00 $158.33 $237.50 $316.67
Credits may be used for medical,
dental, vision, basic life insurance, or
flexible spending accounts only. Any
remaining flex credits may not be
cashed-out or allocated to 401k flex.
Employee & Spouse/Domestic
Partner
$17,500.00 $364.58 $546.88 $729.17
Employee & Children $16,250.00 $338.54 $507.81 $677.08
Employee & Spouse/Domestic
Partner & Children
$21,500.00 $447.92 $671.88 $895.83
*variances due to rounding
16
2022 Short Plan Year
Flexible Benets Information and Costs
Medical Plan Dependent
Coverage Level
(credit tier)
Unrepresented/Unsalaried (Hourly)
ANNUAL SEMI-MONTHLY (24 PAY PERIODS)*
Notes
FULL-TIME
1/2 TIME
(40)
3/4 TIME
(60)
FULL TIME
(80 or 112)
Most recent hire date prior to 7/1/2020
Waive $6,294.00 $131.13 $196.69 $262.25
Credits may be used for dental,
vision, basic life insurance, flexible
spending accounts, or 401k flex. Any
remaining flex credits may be
cashed-out as taxable income.
Employee only $9,495.00 $197.81 $296.72 $395.63
Credits may be used for medical,
dental, and vision insurance, basic
life insurance, flexible spending
accounts, or 401k flex. Any
remaining flex credits may be
cashed-out as taxable income.
Employee & Spouse/Domestic
Partner
$12,493.00 $260.27 $390.41 $520.54
Credits may be used for medical,
dental, vision, basic life insurance, or
flexible spending accounts only. Any
remaining flex credits may not be
cashed-out or allocated to 401k flex.
Employee & Children $11,920.00 $248.33 $372.50 $496.67
Employee & Spouse/Domestic
Partner & Children
$14,088.00 $293.50 $440.25 $587.00
Most recent hire date on or after 7/1/2020
Waive
$1,000.00
$20.83
$31.25
$41.67
Credits may be used for dental,
vision, basic life insurance, flexible
spending accounts, or 401k flex. Any
remaining flex credits may be
cashed-out as taxable income.
During enrollment, employees must
certify they have qualifying medical
coverage in order to receive the
cash-out option.
Employee only
$7,600.00
$158.33
$237.50
$316.67
Credits may be used for medical,
dental, vision, basic life insurance, or
flexible spending accounts only. Any
remaining flex credits may not be
cashed-out or allocated to 401k flex.
Employee & Spouse/Domestic
Partner
$12,493.00
$260.27
$390.41
$520.54
Employee & Children
$11,920.00
$248.33
$372.50
$496.67
Employee & Spouse/Domestic
Partner & Children
$14,088.00
$293.50
$440.25
$587.00
*variances due to rounding
City FBP Credits
(cont.)
17
2022 Short Plan Year
Flexible Benets Information and Costs
Medical Plan Dependent
Coverage Level
(credit tier)
Health Plan Eligibility
Medical Plans
City/Kaiser Traditional (HMO)
City/Kaiser (HMO)
City/Cigna Scripps Select (HMO)
City/Cigna (HMO)
City/Cigna (PPO)
SDPEBA/Sharp Classic (HMO)
SDPEBA/Sharp Select (HMO)
SDPEBA/Sharp Deductible (HMO)
Local 145/Anthem
Blue Cross (HMO)
POA ALADS/Calif. Care
Basic (HMO - No Dental)
POA ALADS/Calif. Care
Premier (HMO w/Dental)
Dental Plans
City/Delta DHMO
City/Delta DPO
SDPEBA/MetLife DHMO
SDPEBA/MetLife DPO
Local 127/Dental Health
Service DHMO
Local 127/Dental Health
Service DPO
Vision Plans
City/VSP
MEA/VSP
18
2022 Short Plan Year
Flexible Benets Information and Costs
DEPUTY
C
ITY ATTORNEYS
ASSOCIATION
S AN DIEGO
SINCE 2005
UNREPRESENTED
& UNCLASSIFIED
Medical Plans and Costs
19
2022 Short Plan Year
Flexible Benets Information and Costs
MEDICAL PLANS (REQUIRED)
MONTHLY
SEMI-MONTHLY*
POST-
TAX
PRE-
TAX
WAIVE
MEDICAL
Employee
only
$0.00
$0.00
$0.00
City/Kaiser Traditional HMO
Available to All Employees
Employee
only
$580.35
$0.00
$290.18
Employee & Spouse/Domestic Partner
$1,270.96
$0.00
$635.48
Employee & Domestic Partner (post-tax)**
$1,270.96
$345.30
$290.18
Employee & Children
$1,102.67
$0.00
$551.34
Family
$1,764.26
$0.00
$882.13
Family (Domestic Partner post-tax)**
$1,764.26
$330.79
$551.34
City/Kaiser Deductible HMO
Available to All Employees
Employee
only
$446.69
$0.00
$223.35
Employee & Spouse/Domestic Partner
$978.25
$0.00
$489.13
Employee & Domestic Partner (post-tax)**
$978.25
$265.78
$223.35
Employee & Children
$848.71
$0.00
$424.36
Family
$1,357.93
$0.00
$678.97
Family (Domestic Partner post-tax)**
$1,357.93
$254.61
$424.36
City/CIGNA HMO
Available to DCAA, Local 127, Local 911, MEA, POA, Unrepresented, & Unclassified
Employee
only
$1,168.81
$0.00
$584.41
Employee & Spouse/Domestic Partner
$2,559.72
$0.00
$1,279.86
Employee & Domestic Partner (post-tax)**
$2,559.72
$695.45
$584.41
Employee & Children
$2,220.72
$0.00
$1,110.36
Family
$3,553.17
$0.00
$1,776.59
Family (Domestic Partner post-tax)**
$3,553.17
$666.23
$1,110.36
City/CIGNA Scripps Select HMO
Available to All Employees
Employee
only
$579.58
$0.00
$289.79
Employee & Spouse/Domestic Partner
$1,269.09
$0.00
$634.55
Employee & Domestic Partner (post-tax)**
$1,269.09
$344.76
$289.79
Employee & Children
$1,101.27
$0.00
$550.64
Family
$1,762.03
$0.00
$881.02
Family (Domestic Partner post-tax)**
$1,762.03
$330.38
$550.64
CITY/CIGNA Open Access Plan (OAP) PPO
Available to All Employees
Employee
only
$1,286.77
$0.00
$643.39
Employee & Spouse/Domestic Partner
$2,818.09
$0.00
$1,409.05
Employee & Domestic Partner (post-tax)**
$2,818.09
$765.66
$643.39
Employee & Children
$2,444.87
$0.00
$1,222.44
Family
$3,911.81
$0.00
$1,955.91
Family (Domestic Partner post-tax)**
$3,911.81
$733.47
$1,222.44
SDPEBA/Sharp Classic
Available to DCAA, Local 127, Local 911, MEA, POA, Unrepresented, & Unclassified
Employee
only
$670.32
$0.00
$335.16
Employee & Spouse/Domestic Partner
$1,466.20
$0.00
$733.10
Employee & Domestic Partner (post-tax)**
$1,466.20
$397.94
$335.16
Employee & Children
$1,272.26
$0.00
$636.13
Family
$2,034.70
$0.00
$1,017.35
Family (Domestic Partner post-tax)**
$2,034.70
$381.22
$636.13
Fiscal Year 2022
Flexible Benefits Information and Costs
MEDICAL PLANS AND COSTS
1
Medical Plans and Costs (cont.)
20
2022 Short Plan Year
Flexible Benets Information and Costs
MEDICAL PLANS (REQUIRED)
MONTHLY
SEMI-MONTHLY*
POST-TAX
PRE-TAX
SDPEBA/Sharp Select
Available to DCAA, Local 127, Local 911, MEA, POA, Unrepresented, & Unclassified
Employee only
$457.54
$0.00
$228.77
Employee & Spouse/Domestic Partner
$1,000.22
$0.00
$500.11
Employee & Domestic Partner (post-tax)**
$1,000.22
$271.34
$228.77
Employee & Children
$867.96
$0.00
$433.98
Family
$1,387.84
$0.00
$693.92
Family (Domestic Partner post-tax)**
$1,387.84
$259.94
$433.98
SDPEBA/Sharp Saver Deductible HMO
Available to DCAA, Local 127, Local 911, MEA, POA, Unrepresented, & Unclassified
Employee only
$405.38
$0.00
$202.69
Employee & Spouse/Domestic Partner
$885.98
$0.00
$442.99
Employee & Domestic Partner (post-tax)**
$885.98
$240.30
$202.69
Employee & Children
$768.86
$0.00
$384.43
Family
$1,229.26
$0.00
$614.63
Family (Domestic Partner post-tax)**
$1,229.26
$230.20
$384.43
LOCAL 145/Anthem Blue Cross
Available to Local 145 Classified & Unclassified
Employee only
$738.33
$0.00
$369.17
Employee & Spouse/Domestic Partner
$1,723.25
$0.00
$861.63
Employee & Domestic Partner (post-tax)**
$1,723.25 $492.46 $369.17
Employee & Children
$1,414.64
$0.00
$707.32
Family
$2,416.56
$0.00
$1,208.28
Family (Domestic Partner post-tax)**
$2,415.56 $500.96 $707.32
POA/ALADS California Care Basic (No Dental)
Available to POA Classified & Unclassified
Employee only
$776.45
$0.00
$388.23
Employee & Spouse/Domestic Partner
$1,620.78
$0.00
$810.39
Employee & Domestic Partner (post-tax)**
$1,620.78
$422.16
$388.23
Employee & 1 Child
$1,620.78
$0.00
$810.39
Employee & Children
$1,949.26
$0.00
$974.63
Family
$1,949.26
$0.00
$974.63
Family (Domestic Partner post-tax)**
$1,949.26
$164.24
$810.39
POA/ALADS California Care Premier (With Dental)
Available to POA Classified & Unclassified
Employee only
$794.81
$0.00
$397.41
Employee & Spouse/Domestic Partner
$1,651.31
$0.00
$825.66
Employee & Domestic Partner (post-tax)**
$1,651.31
$428.25
$397.41
Employee & 1 Child
$1,651.31
$0.00
$825.66
Employee & Children
$1,994.73
$0.00
$997.37
Family
$1,994.73
$0.00
$997.37
Family (Domestic Partner post-tax)**
$1,994.73
$171.71
$825.66
*Variances due to
rounding
**Domestic partners can only be enrolled on a pre-tax basis if they qualify as a tax dependent under IRS guidelines.
To enroll your Domestic Partner on a pre-tax basis, submit a Tax Dependent Certification form which can be found on the
Flexible Benefits website.
Fiscal Year 2022
Flexible Benefits Information and Costs
MEDICAL PLANS AND COSTS (cont.)
1
Dental Plans and Costs
21
2022 Short Plan Year
Flexible Benets Information and Costs
DENTAL PLANS
(OPTIONAL)
MONTHLY
SEMI-
MONTHLY*
POST-
TAX
PRE-
TAX
CITY/Delta
Dental
DHMO
Available
to
DCAA,
Local
145,
Local
911,
POA,
Unrepresented,
and
Unclassified
Employee
only
$11.71
$0.00
$5.86
Employee
&
Spouse/Domestic
Partner
$23.39
$0.00
$11.70
Employee
&
Domestic
Partner
(post-tax)**
$23.39
$5.84
$5.86
Employee
&
Children
$20.47
$0.00
$10.24
Family
$36.27
$0.00
$18.14
Family
(Domestic
Partner
post-tax)**
$36.27
$7.90
$10.24
CITY/Delta
Dental
DPO
Available
to
DCAA,
Local
145,
Local
911,
POA,
Unrepresented,
and
Unclassified
Employee
only $40.86 $0.00 $20.43
Employee
&
Spouse/Domestic
Partner
$81.64
$0.00
$40.82
Employee
&
Domestic
Partner
(post-tax)**
$81.64
$20.39
$20.43
Employee
&
Children
$79.62 $0.00 $39.81
Family
$126.16
$0.00
$63.08
Family
(Domestic
Partner
post-tax)**
$126.16
$23.27
$39.81
SDPEBA/MetLife
DHMO
Available
to
MEA
Only
Employee
only
$21.00
$0.00
$10.50
Employee
&
Spouse/Domestic
Partner
$40.90
$0.00
$20.45
Employee
&
Domestic
Partner
(post-tax)**
$40.90
$9.95
$10.50
Employee
&
Children
$40.90
$0.00
$20.45
Family
$58.46
$0.00
$29.23
Family
(Domestic
Partner
post-tax)**
$58.46
$8.78
$20.45
SDPEBA/MetLife
DPPO
Available
to
MEA
Only
Employee
only
$66.50
$0.00
$33.25
Employee
&
Spouse/Domestic
Partner
$124.50
$0.00
$62.25
Employee
&
Domestic
Partner
(post-tax)**
$124.50
$29.00
$33.25
Employee
&
Children
$143.00
$0.00
$71.50
Family
$208.50
$0.00
$104.25
Family
(Domestic
Partner
post-tax)**
$208.50
$32.75
$71.50
Fiscal Year 2022
Flexible Benefits Information and Costs
DENTAL PLANS AND COSTS
2
Dental Plans and Costs (cont.)
22
2022 Short Plan Year
Flexible Benets Information and Costs
DENTAL
PLANS
(OPTIONAL)
MONTHLY
SEMI-
MONTHLY*
POST-
TAX
PRE-
TAX
LOCAL
127/Dental
Health
Services
DHMO
Available
to
Local
127
Only
Employee
only
$20.74
$0.00
$10.37
Employee
&
Spouse/Domestic
Partner
$36.62
$0.00
$18.31
Employee
&
Domestic
Partner
(post-tax)**
$36.62 $7.94 $10.37
Employee &
1
Child
$36.62
$0.00
$18.31
Employee
&
Children
$51.18
$0.00
$25.59
Family $51.18 $0.00 $25.59
Family
(Domestic
Partner
post-tax)**
$51.18
$7.28
$18.31
LOCAL
127/Dental
Health
Services
DPO
Available
to
Local
127
Only
Employee
only
$40.60
$0.00
$20.30
Employee
&
Spouse/Domestic
Partner
$78.74
$0.00
$39.37
Employee
&
Domestic
Partner
(post-tax)**
$78.74
$19.07
$20.30
Employee &
1
Child
$78.74 $0.00 $39.37
Employee
&
Children
$147.30
$0.00
$73.65
Family
$147.30
$0.00
$73.65
Family
(Domestic
Partner
post-tax)**
$147.30 $34.28 $39.37
*Variances due to
rounding
**Domestic partners can only be enrolled on a pre-tax basis if they qualify as a tax dependent under IRS guidelines.
To enroll your Domestic Partner on a pre-tax basis, submit a Tax Dependent Certification form which can be found on the
Flexible Benefits website.
Fiscal Year 2022
Flexible Benefits Information and Costs
DENTAL PLANS AND COSTS (cont.)
2
Vision Plans and Costs
23
2022 Short Plan Year
Flexible Benets Information and Costs
VISION
PLANS
(OPTIONAL)
MONTHLY
SEMI-
MONTHLY*
POST-
TAX
PRE-
TAX
CITY/VSP
Available
to
DCAA,
Local
127,
Local
145,
Local
911,
POA,
Unrepresented,
and
Unclassified
Employee
only
$4.70
$0.00
$2.35
Employee
&
Spouse/Domestic
Partner
$9.40
$0.00
$4.70
Employee
&
Domestic
Partner
(post-tax)**
$9.40
$2.35
$2.35
Employee
&
Children
$10.05
$0.00
$5.03
Family
$16.08
$0.00
$8.04
Family
(Domestic
Partner
post-tax)**
$16.08
$3.01
$5.03
SDPEBA/VSP
Available
to
MEA
Only
Employee
only
$18.50
$0.00
$9.25
Employee
&
Spouse/Domestic
Partner
$32.50
$0.00
$16.25
Employee
&
Domestic
Partner
(post-tax)**
$32.50
$7.00
$9.25
Employee
&
Children
$32.50
$0.00
$16.25
Family
$53.50
$0.00
$26.75
Family
(Domestic
Partner
post-tax)**
$53.50
$10.50
$16.25
*Variances due to
rounding
**Domestic p
artners can only be enrolled on a pre-tax basis if they qualify as a tax dependent under IRS guidelines.
To e
nroll your Domestic Partner on a pre-tax basis, submit a Tax Dependent Certification form which can be found on the
Flexible Benefits website.
Fiscal Year 2022
Flexible Benefits Information and Costs
VISION PLANS AND COSTS
2
Life Insurance Plans and Costs
24
2022 Short Plan Year
Flexible Benets Information and Costs
BASIC LIFE
INSURANCE
LIFE
INSURANCE
PLAN
(REQUIRED)
MONTHLY
SEMI-
MONTHLY
Basic
Life
Available
to
MEA,
Local
127
and
Local
911
$10,000
$0.30 $0.15
$25,000
$0.75
$0.38
$50,000
$1.50
$0.75
Basic
Life
Available
to
DCAA,
Local
145,
POA,
Unrepresented
and
Unclassified
$50,000
$0 $0
SUPPLEMENTAL LIFE
INSURANCE
The cost of Supplemental Life Insurance is based on age. If your age changes to the next age bracket during the plan year,
the payroll system will automatically increase the cost of your Supplemental Life Insurance.
SUPPLEMENTAL
LIFE
INSURANCE
–
EMPLOYEE
AGE
AMOUNT
OF
INSURANCE
–
BIWEEKLY
(26
PAY
PERIOD)
DEDUCTION
$25,000
$50,000
$75,000
$100,000
$150,000
$200,000
$250,000
$300,000
$350,000
$400,000
$450,000
$500,000
<30
$0.45
$0.90
$1.35
$1.80
$2.70
$3.60
$4.50
$5.40
$6.30
$7.20
$8.10
$9.00
30 –
34
$0.65
$1.29
$1.94
$2.58
$3.88
$5.17
$6.46
$7.75
$9.05
$10.34
$11.63
$12.92
35 –
39
$0.75
$1.50
$2.25
$3.00
$4.50
$6.00
$7.50
$9.00
$10.50
$12.00
$13.50
$15.00
40 –
44
$0.95
$1.89
$2.84
$3.78
$5.68
$7.57
$9.46
$11.35
$13.25
$15.14
$17.03
$18.92
45 –
49
$1.34
$2.68
$4.02
$5.35
$8.03
$10.71
$13.38
$16.06
$18.74
$21.42
$24.09
$26.77
50 –
54
$2.22
$4.43
$6.65
$8.86
$13.29
$17.72
$22.15
$26.58
$31.02
$35.45
$39.88
$44.31
55 –
59
$3.98
$7.96
$11.94
$15.92
$23.88
$31.85
$39.81
$47.77
$55.73
$63.69
$71.65
$79.62
60 –
64
$6.14
$12.28
$18.42
$24.55
$36.83
$49.11
$61.38
$73.66
$85.94
$98.22
$110.49
$122.77
65 –
69
$11.93
$23.86
$35.79
$47.72
$71.58
$95.45
$119.31
$143.17
$167.03
$190.89
$214.75
$238.62
70 –
74
$20.17
$40.34
$60.51
$80.68
$121.02
$161.35
$201.69
$242.03
$282.37
$322.71
$363.05
$403.38
75 &
Up
$20.17
$40.34
$60.51
$80.68
$121.02
$161.35
$201.69
$242.03
$282.37
$322.71
$363.05
$403.38
Fiscal Year 2022
Flexible Benefits Information and Costs
LIFE INSURANCE PLANS AND COSTS
2
Life Insurance Plans and Costs (cont.)
25
2022 Short Plan Year
Flexible Benets Information and Costs
As a reminder, Supplemental coverage for your spouse/domestic partner cannot exceed the combined employee
coverage for Basic and Supplemental Life.
For example, if an employee has $50,000 in Basic Life Insurance and
$100,000 in Supplemental Life Insurance, the total coverage for a spouse/domestic partner cannot exceed $150,000.
SUPPLEMENTAL
LIFE
INSURANCE
–
SPOUSE
OR
DOMESTIC
PARTNER
AGE
AMOUNT
OF
INSURANCE
–
BIWEEKLY
(26
PAY
PERIOD)
DEDUCTION
$25,000
$50,000
$75,000
$100,000
$150,000
$200,000
$250,000
$300,000
$350,000
$400,000
$450,000
$500,000
<30
$0.50
$0.99
$1.49
$1.98
$2.98
$3.97
$4.96
$5.95
$6.95
$7.94
$8.93
$9.92
30 –
34
$0.69
$1.38
$2.08
$2.77
$4.15
$5.54
$6.92
$8.31
$9.69
$11.08
$12.46
$13.85
35 –
39
$0.78
$1.57
$2.35
$3.14
$4.71
$6.28
$7.85
$9.42
$10.98
$12.55
$14.12
$15.69
40 –
44
$0.98
$1.96
$2.94
$3.92
$5.88
$7.85
$9.81
$11.77
$13.73
$15.69
$17.65
$19.62
45 –
49
$1.37
$2.75
$4.12
$5.49
$8.24
$10.98
$13.73
$16.48
$19.22
$21.97
$24.72
$27.46
50 –
54
$2.26
$4.52
$6.78
$9.05
$13.57
$18.09
$22.62
$27.14
$31.66
$36.18
$40.71
$45.23
55 –
59
$4.03
$8.05
$12.08
$16.11
$24.16
$32.22
$40.27
$48.32
$56.38
$64.43
$72.48
$80.54
60 –
64
$6.18
$12.37
$18.55
$24.74
$37.11
$49.48
$61.85
$74.22
$86.58
$98.95
$111.32
$123.69
65 –
69
$11.97
$23.93
$35.90
$47.86
$71.79
$95.72
$119.65
$143.58
$167.52
$191.45
$215.38
$239.31
70 –
74
$20.20
$40.41
$60.61
$80.82
$121.22
$161.63
$202.04
$242.45
$282.85
$323.26
$363.67
$404.08
75 &
Up
$20.20
$40.41
$60.61
$80.82
$121.22
$161.63
$202.04
$242.45
$282.85
$323.26
$363.67
$404.08
SUPPLEMENTAL LIFE
INSURANCE – CHILDREN
ANNUAL MONTHLY
BIWEEKLY
(26
Pay
Periods)
Coverage
Amount
Each
$5,000
$10
$0.85
$0.39
$10,000
$12
$1.03
$0.48
Fiscal Year 2022
Flexible Benefits Information and Costs
LIFE INSURANCE PLANS AND COSTS (cont.)
2
Contact Information
2022 Short Plan Year
Flexible Benets Information and Costs
26
WEBSITE OR EMAIL ADDRESS PHONE # GROUP #
EMPLOYEE GROUPS
Local 127
afscme127.org 619-640-4939
Local 145
sandiegocityfirefighters.org 619-563-6161
MEA
sdmea.org
619-264-6632
POA
sdpoa.org 858-573-1199
LIFE INSURANCE
The Hartford
thehartford.com 888-563-1124 GL402711
MEDICAL INSURANCE
Cigna
cigna.com 800-244-6224
HMO and OAP (PPO)
3341853
Kaiser
kaiserpermanente.org 800-464-4000
HMO 104303-04
DHMO 104303-12
Sharp
sharphealthplan.com 800-359-2002 79136
145 Anthem BC
anthem.com/ca 800-227-3670 278012
POA ALADS
mybenetchoices.com/SDPOA 800-842-6635 57AJSA
DENTAL INSURANCE
DeltaCare USA DHMO
deltadentalins.com 888-335-8227 79343
Delta Dental PPO
deltadentalins.com 888-335-8227 21003
Local 127 Dental Health
dentalhealthservices.com/local127 888-789-3127
HMO-5024H
PPO-5024P
MEA MetLife Dental
sdpeba.org/ 888-217-9175 5343641
VISION INSURANCE
City VSP Vision
vsp.com 800-877-7195 30057843/0001
MEA VSP Vision
sdpeba.org/ 888-315-8027
FLEXIBLE SPENDING ACCOUNTS
HealthEquity/WageWorks wageworks.com 877-924-3967
FLEXIBLE SPENDING ACCOUNTS
Principal
401(k), 401(a), SPSP, SPSP-H
principal.com/welcome 800-547-7754
CalPERS 457(b) Calpers.voya.com 800-260-0659
ADDITIONAL CONTACTS
Flexible Benets Bene[email protected] 619-236-5924
Employee Savings Plan Bene[email protected] 619-236-6600
Long-Term Disability [email protected] 619-236-6100
SDCERS Employee Retirement sdcers.org 619-525-3600
# Pay Days/End of Pay Period Holidays Payroll Periods PD
1 2 3
4 5 6 7 8 9 10
11 12 13 14 15 16 17
18 19 20 21 22 23 24
25 26 27 28 29 30 31
1 2 3 4 5 6 7
8 9 10 11 12 13 14
15 16 17 18 19 20 21
22 23 24 25 26 27 28
29 30 31 1 2 3 4
5 6 7 8 9 10 11
12 13 14 15 16 17 18
19 20 21 22 23 24 25
26 27 28 29 30 1 2
3 4 5 6 7 8 9
10 11 12 13 14 15 16
17 18 19 20 21 22 23
24 25 26 27 28 29 30
31 1 2 3 4 5 6
7 8 9 10 11 12 13
14 15 16 17 18 19 20
21 22 23 24 25 26 27
28 29 30 1 2 3 4
5 6 7 8 9 10 11
12 13 14 15 16 17 18
19 20 21 22 23 24 25
26 27 28 29 30 31
1 2
3 4 5 6 7 8 9
10 11 12 13 14 15 16
17 18 19 20 21 22 23
24 25 26 27 28 29 30
31 1 2 3 4 5 6
7 8 9 10 11 12 13
14 15 16 17 18 19 20
21 22 23 24 25 26 27
28 29 30 31 1 2 3
4 5 6 7 8 9 10
11 12 13 14 15 16 17
18 19 20 21 22 23 24
25 26 27 28 29 30 1
2 3 4 5 6 7 8
9 10 11 12 13 14 15
16 17 18 19 20 21 22
23 24 25 26 27 28 29
30 31 1 2 3 4 5
6 7 8 9 10 11 12
13 14 15 16 17 18 19
20 21 22 23 24 25 26
27 28 29 30 1 2 3
4 5 6 7 8 9 10
11 12 13 14 15 16 17
18 19 20 21 22 23 24
25 26 27 28 29 30 31
1
2 3 4 5 6 7 8
9 10 11 12 13 14 15
16 17 18 19 20 21 22
23 24 25 26 27 28 29
30 31 1 2 3 4 5
6 7 8 9 10 11 12
13 14 15 16 17 18 19
20 21 22 23 24 25 26
27 28 1 2 3 4 5
6 7 8 9 10 11 12
13 14 15 16 17 18 19
20 21 22 23 24 25 26
27 28 29 30 31 1 2
3 4 5 6 7 8 9
10 11 12 13 14 15 16
17 18 19 20 21 22 23
24 25 26 27 28 29 30
1 2 3 4 5 6 7
8 9 10 11 12 13 14
15 16 17 18 19 20 21
22 23 24 25 26 27 28
29 30 31 1 2 3 4
5 6 7 8 9 10 11
12 13 14 15 16 17 18
19 20 21 22 23 24 25
26 27 28 29 30
July
Aug
Sept
Oct
Nov
Dec
S M T W TH F S PD S M T W TH F S PD S M T W TH F S PD
2021
2022
2022
Jan
July
Feb
Aug
Mar
Sept
Apr
Oct
May
Nov
June
Dec
2021-2022
Fiscal Annual Calendar
15
16
17
18
19
20
21
22
23
24
25
26
1
15
16
17
18
19
20
21
22
23
24
25
26
1
2
3
4
5
6
7
8
9
10
11
12
13
14
2021-2022 Calendar
2022 Short Plan Year
Flexible Benets Information and Costs
This information is available in alternative formats upon request.
27