Page 59 - Employee Handbook 1-2015 rev9

In accordance with provision of the Affordable Care Act, employees who test positive for
tobacco use may continue to receive the health care premium discount provided that they
complete an approved tobacco cessation program.

Coverage will be effective on the first day of the month following one month of
continuous employment or certification for benefits. Questions about group health insurance can
be addressed by contacting the Human Resources Department.

Changes to group health insurance can be made only during the fall annual enrollment
period unless there is a qualifying life event. Please see the list of qualifying life events in the
“Premium Conversion Plan” section below.

W. Group Dental Insurance

The City of Winston-Salem offers a no-cost direct dental reimbursement plan to its full-
time employees and those part-time and temporary employees certified for benefits. This plan is
administered by a third party provider.

The City’s direct dental reimbursement plan is designed to assist the employee by sharing the
financial burden of good dental health. The maximum calendar year benefit is $1,100. Benefits are
provided as follows:

City pays 100% of the first $300.00
Employee pays the next $50.00 as a deductible
City pays 80% of the next $250 up to $200
City pays 50% of the rest of the charges up to an additional benefit of $600.00

Total benefit paid by City = $1,100.00 per member per year

In addition, a lifetime orthodontia benefit of $1,500 is available for covered dependent
children up to age 18.

Summary plan documents detailing the dental plan are available in the Human Resources
Department. Claims may be filed by either the dentist or the employee. Employees wishing to
file claims may contact their department’s Human Resources Liaison or the Human Resources
Department to obtain dental claim forms. Claims and reimbursement forms can also be found on
the Employee Center forms page at http://wshome.cityofws.org/wshome/forms/forms.

Coverage will be effective on the first day of the month following one month of
continuous employment or certification for benefits. Dependent coverage is also available
through payroll deduction. Contact the Human Resources Department for the current rate.

X. Premium Conversion

Effective September 1, 1988, the City of Winston-Salem adopted a Premium Conversion
plan for the purchase of certain non-taxable fringe benefits. This plan provides for the deduction

City of Winston-Salem Employee Handbook November 2014 Revision 50