2026-2027_employee_benefits_guide.pdf

Exactly as extracted, unformatted — for checking against the original. The readable version is easier to read.

Town of Centreville
Employee Benefits Guide
Plan Year: July 1, 2026 - June 30, 2027
Human Resources Department Email: hr@townofcentreville.org

Table of Contents
Welcome Message 2
Eligibility 3
Key Dates & Reminders 4
Provider Directory 5
New This Year 6
Employee Per Pay Cost 7
Benecon Cost Containment (ConnectCare 3) 9
Medical & Prescription Plan Highlights 10
Medical Coverage Overview 12
Cigna Membership Information 13
Employee Assistance Program (EAP) 15
Dental Plan Benefits 17
Vision Plan Benefits 18
Flexible Spending Accounts (FSA) 19
Life & AD&D Insurance 23
Short Term & Long Term Disability Benefits 24
Holidays and Leave 26
Maryland State Retirement and Pension System 27
Deferred Compensation 29
Retiree Health Reimbursement Arrangement Stipend 30
YMCA Gym Membership 32
Important Notice About Your Prescription Drug Coverage & Medicare 33
Required Federal Notices 37
Disclaimer 46
How to Enroll 47
Employee Portal (CHR) 52
Benefits Summary 2026 - 2027 1

Welcome Message
The Town of Centreville (“Town”) takes pride in offering a comprehensive and
competitive benefits package to our employees. The Town, through all our
benefits partners, offers you a benefits program that allows choice and flexibility.
Through this guide, you can select benefits that work best for you and your
family.
2026-2027 Plan Year
Benefits will be effective for the July 1, 2026 – June 30, 2027, plan year.
The Town continues to evaluate ways to improve the quality of your
healthcare and keep our health plans competitively priced, while controlling
costs for you and the Town. We encourage staff to become and remain
engaged in these efforts by being educated on the plans and using them
wisely. Be sure to participate in Employee Wellness programs and activities,
and partner with your physician to get appropriate preventive screenings.
Also, consider programs like mail order pharmacy and generic prescriptions
to lower your copays and overall plan costs.
When reviewing your benefits, please be aware of the difference between the
following terms:
Calendar Year – runs from January 1 to December 31 and resets each
January 1.
Plan Year – Town benefit plan year, which runs from July 1 to June 30.
Every 12 months – a rolling 12 months that begins on the date of your
most recent service.
Take time to review available plan options before selecting. Consider
the benefits and costs carefully to choose a package that meets your
and your family's needs throughout the year.
For specific plan details, check the guide sections or the Provider Directory
section. You can also email Human Resources at hr@townofcentreville.org to
request the specific plan document.
Benefits Summary 2026 - 2027 2

ELIGIBILITY
Employees Making Changes
All Town employees, as defined by the The benefits plan year runs July 1 through
Town of Centreville, are benefits eligible June 30. You will not be able to make
(full-time and permanent part-time changes to your elections during the plan
employees who normally work 20 or more
year unless you or one of your dependents
hours a week). Please check each benefit
experience a qualified change-in-status
for details.
event. If you do not experience a qualified
change-in-status event, the elections you
Dependents
make and their related payroll deductions
will remain in effect through June 30,
In addition to enrolling yourself, you may
2026.
also enroll any eligible dependents. Eligible
dependents are defined below:
You must notify the Human Resources
Department within 30 days of the qualified
Spouse: a person to whom you are
legally married by ceremony. change-in-status event in order to make a
change to your benefit elections.
Dependent Children: your biological, Documentation supporting the change will
adopted, or legal dependents up to age 26 be required.
regardless of student, financial, and
marital status.
What is a qualified change-in-status event?
Marriage or Divorce
Change in employment status for you, your spouse, or your dependent child
Birth, Adoption, or Death
Eligibility for or loss of other coverage due to your spouse's Open Enrollment
period, or loss or gain of benefit eligibility
➡
It is important to take time to review the plan options available to you prior to
making your selections. Consider each benefit and the associated costs
carefully and choose the benefits package that will meet your and your family's
needs throughout the year.
Benefits Summary 2026 - 2027 3

Key Dates Important Reminders
Open Enrollment - May 13 - May 27 Qualifying Life Events
Open enrollment is held annually in May. Supporting documentation may
Benefit elections become effective July 1. be required and changes must
typically be submitted within 30
days of the event.
New Hire Deadline Dependent Verification
Newly eligible employees must enroll within 30 Employees may be required to
days of becoming eligible. provide documentation
verifying dependent eligibility.
Payroll Deduction Start Preventive Care
Benefit deductions begin on the first payroll In-network preventive care
following coverage effective dates. services are generally covered
MD FAMLI payroll contributions beginning at 100% under the medical
January 1, 2027. (More info to come) plan.
Benefits Summary 2026 - 2027 4

Provider Directory
Benefit Provider Phone Number Website/Email
Medical and
Cigna 1-800-244-6224 www.mycigna.com
Prescription
Dental United Concordia 1-800-332-0366 www.unitedconcordia.com
NVA (National Vision
Vision 1-800-672-7723 www.e-nva.com
Administrators, LLC)
Flexible Spending
CareFlex 1-888-577-2762 mycareflex.wealthcareportal.com
Account (FSA/DCA)
Life and Disability OneAmerica Financial 1-800-553-5318 www.oneamerica.com
Cigna 877-622-4327 www.mycigna.com
Employee Assistance
Program (EAP)
OneAmerica 855-387-9727 guidanceresources.com
Accident, Cancer,
AFLAC 410-463-4162 matthew_pastva@aflac.com
Hospital, Critical Care
Maryland State Retirement
Retirement 410-625-5555 sra.maryland.gov (mySRPS)
and Pension System
CBIZ 610-891-1677 rory.glackin@CBIZ.com
Deferred
Corebridge Financial 410-859-2164 adam.grace@corebridgefinancial.com
Compensation
MissionSquare 202-962-3495 csorokos@missionsq.org
Questions?
You can obtain information by contacting the Human Resources Department or
our benefit providers directly.
Benefits Summary 2026 - 2027 5

New This Year
You can now use your NVA vision benefits online with UVP and purchase
premium eyewear from the comfort of your home! (See Vision Benefits for
more info)
OneAmerica is our new Life Insurance Carrier. Life benefits have not changed
and new this year, OneAmerica offers EAP and Travel Assistance. (See Life
Benefits for more info)
Health Holidays are coming! - The Town received over $60k in health surplus
because of lower claim costs! (Great job in maintaining preventive care and
continuing to strive for a healthy lifestyle!). The Council approved to give
those funds back to employees by paying for their health insurance
premiums as described below:
Hourly and Salary employees will not pay their health insurance
premiums on the following check dates:
12/04/2026
12/18/2026
Upcoming benefit: Maryland Paid Family and Medical Leave Insurance
(FAMLI) Program (Effective January 1, 2028) More information will be
emailed.
Benefits Summary 2026 - 2027 6

Employee Per Pay Cost (24 Pays)
Medical Rates
FY27 Plan Monthly Contract Town Pays for Eligible Employee Bi-Weekly
Cost Eligible Employees Pays Deduction
OAP Gold Plan 85% 15%
Employee $1,277.51 $1,085.88 $191.63 $95.81
Employee + $2,938.83 $2,498.01 $440.82 $220.41
Spouse
Employee + $2,363.17 $2,008.69 $354.48 $177.24
Child(ren)
Family $3,577.56 $3,040.93 $536.63 $268.32
Deductible - Up to $1,300 $0 $0
Employee
Deductible - Up to $2,600 $0 $0
Family
OAP Silver Plan 85% 15%
Employee $1,132.14 $962.32 $169.82 $84.91
Employee + $2,604.48 $2,213.81 $390.67 $195.34
Spouse
Employee + $2,094.25 $1,780.11 $314.14 $157.07
Child(ren)
Family $3,170.49 $2,694.92 $475.57 $237.79
Deductible - Up to $2,000 $0 $0
Employee
Deductible - Up to $4,000
Family
The Town established a Health Reimbursement Account (HRA) and contributes up to 100% to
pay for your eligible out-of-pocket expenses during the plan year.
Benefits Summary 2026 - 2027 7

Dental Rates
FY27 Plan Monthly Cost Town Pays for Eligible Employee Bi-Weekly
Eligible Employees Pays Deduction
United Concordia - Medium 85% 15%
Employee $29.90 $23.75 $6.15 $3.08
Family $94.34 $74.94 $19.40 $9.70
Vision Rates
FY27 Plan Monthly Cost Town Pays for Eligible Employee Bi-Weekly
Eligible Employees Pays Deduction
NVA - Vision 85% 15%
Employee $4.70 $4.00 $0.70 $0.35
Family $11.73 $9.97 $1.76 $0.88
Benefits Summary 2026 - 2027 8

The ConnectCare3 Benefit
What is ConnectCare3?
ConnectCare3 is a confidential benefit provided to employees and their dependents covered under the
health plan at no additional cost. ConnectCare3 has no affiliation with any insurance carrier or hospital
system. We aim to provide callers with positive health outcomes on their health and wellness journey.
Available Services
Patient Advocacy
The patient advocates are the first line of contact when reaching out to ConnectCare3. They also
assist our clinical team with conducting research.
Nurse Navigation
The nurse navigators are available to work with patients who have received a medical diagnosis
that requires a specialist. Our nurses can provide education on a diagnosis and treatments,
physician options, and can help patients prepare for physician appointments.
Chronic Disease Management & Prevention
The Chronic Disease Management & Prevention team consists of registered nurses, certified
health coaches, and registered dietitians. Our team approach to preventing and managing
chronic conditions provides you with access to resources and expertise all in one place.
Nutrition Education
Our registered dietitians will help patients to understand the connection between diet and health
by completing a thorough nutritional assessment and providing healthy meal plans and alternatives.
Tobacco Cessation
Work one-on-one with our Tobacco Cessation coaches to achieve and maintain a tobacco-free life.
How to Enroll
Contact us at 877-223-2350 or info@connectcare3.com to enroll in our services today.
Sign Up to Receive Health & Wellness Updates
Scan the QR code to sign up to receive our health and wellness resources!
For more information, visit connectcare3.com
©2023 ConnectCare3,LLC - AllRightsReserved
Benefits Summary 2026 - 2027 9

Medical & Prescription Plan Highlights
The chart below highlights your costs for some of the services available to you under the
medical plan. For full plan details, please refer to your Cigna plan summaries.
Silver Plan Gold Plan
Plan Features In-Network ONLY YOU PAY In-Network ONLY YOU PAY
Plan Network Open Access Plus Open Access Plus
Referrals for Specialist No No
Primary Care Physician Required No No
Annual Deductible
$2,000 Individual $1,300 Individual
Amount covered by the Town per
$4,000 Family $2,500 Family
plan year before the plan begins to
(Employee pays $0) (Employee pays $0)
pay benefits for certain services.
Annual Out-of-Pocket Maximum $6,000 Individual
$2,600 Individual
$6,850 Individual-In a Family
$5,200 Family
$12,000 Family
Preventive Care Services $0 $0
Office Visits, Labs, and Testing
Primary Care Physician Office Visits 10% coinsurance $0
Specialist Office Visits 10% coinsurance $0
Diagnostic X-Rays 10% coinsurance $0
Mental Health/Substance Abuse
10% coinsurance $0
Office Visits
Emergency Care, Urgent Care, and
Hospitalization
Emergency Room 10% coinsurance $0
Urgent Care 10% coinsurance $0
Inpatient Hospitalization 10% coinsurance $0
Outpatient Surgical Facilities 10% coinsurance $0
Prescription Drugs - In-Network Only
Annual Deductible None
Benefits Summary 2026 - 2027 10

Retail 30-Day Supply
$10 copay $10 copay
Tier 1: Generic
$40 copay $40 copay
Tier 2: Preferred Brand
$75 copay $75 copay
Tier 3: Non-Preferred Brand
Retail 90-Day Supply
$25 copay $25 copay
Tier 1: Generic
$100 copay $100 copay
Tier 2: Preferred Brand
$188 copay $188 copay
Tier 3: Non-Preferred Brand
Home Delivery (per 90-day supply)
$25 copay $25 copay
Tier 1: Generic
$100 copay $100 copay
Tier 2: Preferred Brand
$188 copay $188 copay
Tier 3: Non-Preferred Brand
This chart is intended for comparison purposes only. If there are any discrepancies, the plan
document will govern.
Summary of Benefits and Coverage (SBC)
Choosing a health coverage option is an important decision. To help you make an
informed choice, a Summary of Benefits and Coverage (SBC), which summarizes
important information in a standard format, is available for review. If you are currently
enrolled, you will be provided with a copy of the SBC for the plan in which you are
currently enrolled in connection with Open Enrollment. If you are a new hire and
enrolling for the first time, you will be provided with a copy of the SBC for each medical
plan option with your benefits enrollment materials.
Benefits Summary 2026 - 2027 11

Medical Coverage Overview
Keeping you and your family in good health
The Town of Centreville cares about your health and wellbeing. The
health benefits available to you represent a significant component of
your compensation package, and they provide important protection to
keep you and your family in good health. Employees have the option to
enroll in either the HRA OAPIN Silver or the HRA OAPIN Gold Plan Need to locate a participating
through Cigna. provider?
None of the plans require you to choose a Primary Care Physician (PCP) Go to www.cigna.com and select
or obtain a referral to see a specialist. The Silver and Gold plans require “Find a Doctor.” Choose your
that you see an in-network provider in order to receive benefits. search location and select your
medical plan option to search for a
participating provider near you.
Choosing the right type of care
Your doctor knows best
Your personal physician best understands your health.
Having a personal physician can result in overall better care.
Save money with generic drugs
But what if you get sick or injured when your doctor’s office is closed?
Ask your doctor if it’s
Cigna Members: 24/7 medical advice
appropriate to use a generic
Health Information Line: get advice on a diagnosis or where to receive drug rather than a brand drug.
care (1-800-244-6224). Generic drugs contain the same
Cigna Telehealth Connection: access virtual doctor visits for common, active ingredients and are
uncomplicated, non-emergency health issues. Refer to the next page identical in dose, form and
for more details. administrative method as a
brand name, but cost less.
Urgent Care Centers
Urgent care centers are usually open after normal business hours,
including evenings and weekends.
Many urgent care centers offer on-site diagnostic tests.
In most situations, you’ll find that you save time and money by going
to urgent care instead of the Emergency Room. Make sure that the
urgent care center you select is in the network!
Emergency Room (ER)
ERs are the best place for treating severe/life-threatening conditions.
ERs provide the most expensive type of care.
Benefits Summary 2026 - 2027 12

Cigna Membership Information
myCigna.com Cigna Mobile App
When you’re better informed, you make better choices. The myCigna mobile app gives you
Cigna’s personalized website, www.mycigna.com, provides an easy way to organize and
access to your plan information, as well as many online access your important health
tools with information to help you make more informed information - anytime, anywhere.
health decisions. Want to find out how to improve your Download the free app and gain
fitness or eat better? Cigna’s online tools can help you stay instant access to multiple
active and take care of your health. services.
24/7 Medical Advice
Cigna Telehealth
Good news! Your Cigna medical plans provide you with access to two telehealth
services: American Well (AmWell) and MDLive. This service is called Cigna
Telehealth Connection: telehealth services designed to offer you greater control
when you need to see a doctor.
With Cigna Telehealth Connection, you can get the care you need - including
most prescriptions - for a wide range of minor conditions. You can connect with a
board-certified doctor when, where, and how it works best for you - via video or
phone - without having to leave home or work.
AmWell and MDLive televisits can be a cost-effective alternative to a
convenience care clinic or urgent care center, and cost less than going to the
emergency room. Costs are the same as a visit with a primary care provider.
Choose when: Day or night, weekdays, weekends, and holidays
Choose where: Home, work, or on the go
Choose how: Phone or video chat
Choose who: AmWell or MDLive doctors
You are encouraged to register for one or both services, so you’re ready when
and if you need care. Signing up is easy. Set up and create an account with one or
both AmWell (AmWellforCigna.com) and MDlive (MDLiveforCigna.com)
complete a medical history using their “virtual clipboard,” and download AmWell
Benefits Summary 2026 - 2027 13

for Cigna App and MDLive for Cigna App to your smartphone/mobile device.
24-Hour Health Information Line
The 24-Hour Health Information Line (HIL) assists individuals in understanding
the right level of treatment at the right time. Trained nurses are available 24
hours a day, seven days a week, 365 days a year to provide health and medical
information and direction to the most appropriate resource. To speak with a
nurse, call 1-800-244-6224.
Preventive care covered at 100%
Prevention is the best medicine, and your Cigna medical plans
cover a wide range of preventive services to help you and your
family lead healthy, productive lives. These services include
annual routine examinations, well-childcare visits,
immunizations, routine OB/GYN visits, mammograms, PAP tests,
prostate screenings, and other services as required by the
Affordable Care Act. These preventive services are covered in
full in-network.
Benefits Summary 2026 - 2027 14

Benefits Summary 2026 - 2027 15

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Dental Plan Benefits
United Concordia - Medium Plan
Plan Features In-Network* YOU Out-of-Network* YOU
PAY PAY
Annual Program Deductible (per person/per family) $0/$0 $0/$0
Annual Program Maximum (per person) $1,500
Excludes Orthodontics
Preventive Care
Exams, cleanings, flouride, x-rays, sealants, space $0 $0
maintainers, palliative treatment
Basic Care
Basic restorative fillings, simple extractions, repairs of
$0 $0
crowns, inlays, onlays, bridges & dentures,
endodontics, complex oral surgery, general anesthesia
Major Care
Nonsurgical periodontics, surgical periodontics, inlays,
50% 50%
onlays, crowns, prosthetics (bridges, dentures),
implants
Orthodontics for dependent children to age 19
50% 50%
Diagnostic, active, retention treatment
This chart is intended for comparison purposes only. If there are any discrepancies, the plan
document will govern. Out-of-Network dentists may balance bill up to their usual fees. To locate
an in-network provider for the United Concordia plan, visit www.UnitedConcordia.com.
Benefits Summary 2026 - 2027 17

Vision Plan Benefits
National Vision Administrators, L.L.C.
Basic Benefit In-Network YOU PAY Out-of-Network Plan
Reimbursement
Exam
$0 Up to $32
Once every 12 months
Lenses
Once every 12 months
Standard glass or plastic Up to $26
Single Vision
$0 Up to $36
Bifocal
Up to $46
Trifocal
Up to $72
Lenticular
Frames Retail Allowance
Once every 24 months Up to $60 Up to $30
(20% discount off balance)*
Contacts
(Instead of glasses)
Up to $85
Once every 12 months Up to $85 retail
15% discount (conventional) or 10%
discount (disposable)
Up to $225
Medically necessary
(pre-approval required) $0
This chart is intended for comparison purposes only. If there are any discrepancies, the plan
document will govern. To locate a participating provider, visit www.e-nva.com.
Benefits Summary 2026 - 2027 18

Flexible Spending Accounts (FSA)
Flexible Spending Accounts (FSAs) allow you to set aside pre-tax dollars to pay yourself
back for eligible health care and dependent care expenses. There are two types of FSAs:
Health Care FSA and Dependent Care FSAs. The FSAs are administered by CareFlex.
In order to participate in the FSA, you must enroll each year. Your annual contribution
stays in effect during the entire year (July 1 through June 30). The only time you can
change your election is during Open Enrollment or if you experience a qualified change-
in-status event.
All employees who participate in a Flexible Spending Account Plan will receive an FSA
debit card as a way to pay up front for qualified expenses. The FSA debit card will be
mailed to your home. If you already have a card, keep it! You will not receive a new one
until it expires.
Health Care FSA
The Health Care FSA helps you stretch your budget for health care expenses for you and
your dependents by allowing you to pay for these expenses using tax-free dollars. You
may set aside up to $3,200 annually in pre-tax dollars, which is deducted out of your pay
throughout the year.
Funds can be used to pay for qualified health care expenses such as deductibles,
medical and prescription copays, dental expenses, and vision expenses. You can use the
FSA for expenses for yourself, your spouse, and your dependent children. Your annual
contribution amount is deposited into your account and is available to you at the
beginning of the plan year. As you incur expenses, use your debit card to pay for your
expenses or submit a claim to be reimbursed.
The Health Care FSA allows you to rollover up to $640 in your account at the end of
the plan year. You will have 90 days after the end of the plan year to submit claims
incurred during the plan year.
Benefits Summary 2026 - 2027 19

Carryover Provision
When you choose how much to contribute to an FSA, be sure to estimate your expenses
carefully. The Health Care FSA allows you to rollover up to $640 in your account at the
end of the plan year. Any funds exceeding $640 in your Health Care FSA and ANY fund
remaining in your Dependent Care FSA at the end of the plan year will be forfeited.
You will have 90 days after the end of the plan year to submit claims incurred during
that plan year.
Dependent Care FSA
The Dependent Care FSA allows you to pay for eligible dependent care expenses with
tax-free dollars. You may set aside up to $5,000 annually in pre-tax dollars, or $2,500 if
you are married and file taxes separately from your spouse.
Contributing to a Dependent Care FSA allows you to pay dependent care expenses so
that you and your spouse can work, look for work, or attend school full-time. It includes
daycare (center or individual daycare), before and after school care, summer day camp,
and elder care.
Eligible expenses include the below:
Care for your dependent child thru age 12 whom you can claim as a dependent for
tax purposes
Care for your dependent child who resides with you and who is physically or
mentally incapable of caring for him/herself
Care for your spouse or parent who is physically or mentally incapable of caring for
him/herself
Benefits Summary 2026 - 2027 20

Town of Centreville
Plan Year: July 1, 2026 to June 30, 2027
The Health Care Spending Account (FSA) and Dependent Care Account (DCA) allow employees the ability to set aside pre-
tax dollars to pay for out-of-pocket medical and dependent care (day care) expenses incurred by both the employee and their
qualified dependents.
Employee Eligibility: All full-time employees working 30 or more hours per week or 130 hours per month are eligible for
the FSA benefit. Employees are not required to be enrolled in the company sponsored health plan to participate in the FSA
benefit. New hire waiting period is the first day of the next month following date of hire.
Health Care Spending Account (FSA) Maximum Election ................ $3,200.00 [Employee Funded]
Health Care FSA Carryover Provision – Up to $640.00 of unused Health Care Spending Account (FSA) funds will roll-over to
the next plan year after the conclusion of the run-out period. [Note: The Carryover Provision does not apply to terminated
employees and does not apply to the Dependent Care Account (DCA).]
Health Care Spending Account (FSA) – Coverage includes all qualified dependents, including spouse. Dependent children
are covered up to the end of the calendar year in which dependent turns 26. Eligible expenses include qualified medical
expenses not reimbursed by other insurance, including vision expenses, non-cosmetic dental expenses, over-the-counter
(OTC) medicines, menstrual care products (tampons and pads), PPE personal protective equipment (face masks, hand
sanitizer, and sanitizing wipes), and medical supplies. To help determine what expenses qualify for payment /
reimbursement, please view the CareFlex Eligible Expense Guide on the CareFlex Participant Portal. Expenses paid out of
pocket may also be submitted for manual claim reimbursement.
Dependent Care Account (DCA) Maximum Election........................$5,000.00 [Employee Funded]
If you are married and file a separate return, the maximum DCA election amount is $2,500.00
Dependent Care Account (DCA) – Coverage includes dependents thru age 12; disabled/elder dependents (regardless of
age). Eligible day care expenses include adult/child day care centers, providers of day care outside of the home, provider of
day care who comes to your home, before/after school care, and summer day camps. Expenses for a child in nursery school,
pre-school, or similar programs for children below the level of kindergarten are eligible. Expenses to attend kindergarten or
a higher grade, summer school, overnight camps, and tutoring are not eligible expenses. To help determine what expenses
qualify for payment / reimbursement from the DCA plan please view the CareFlex Eligible Expense Guide on the CareFlex
Participant Portal. Enrolling in the Dependent Care Account will require you to complete IRS Form 2441 as part of your
annual income tax return filing process.
Benefit Changes – Election remains in effect until the end of the plan year. An election change is only permitted if you
experience a qualifying event (i.e., birth, adoption or death of a dependent; marriage or divorce; or if you or your spouse
experience a change in employment or medical insurance coverage). Additional changes for a DCA include a significant
increase or decrease in the cost of day care services. A qualifying event may allow for an increase or decrease of your
benefit amount consistent with the event. Changes to benefits must be made within 30 days of the date of the qualifying
event.
Run-Out Period:......................................................................................... 60-Days from Last Day of Plan Year
Allows time after the last day of the plan year to submit manual claims for dates of services incurred during the plan year –
expenses are eligible based on the date of service, not the payment date.
Reimbursement Method ..................... Benefit Card and Manual Claim (refunded via Direct Deposit or Check)
Termed Employees – Coverage Ceases ................................................................................................................. Date of Term
Benefit Card Deactivated .................................................................................................................................. Date of Term
Term Run-Out Period .................................................................................................................. 60 Days from Date of Term
For more information, call 888-577-2762
205 W. Dares Beach Road (cid:0) Prince Frederick, MD 20678 (cid:0) https://mycareflex.wealthcareportal.com
Benefits Summary 2026 - 2027 21

Flexible Spending Accounts (FSA & DCA)
Important Plan Information
FSA Health Care Carryover Provision – To help eliminate the effect of the “use it or lose it” rule, your employer has adopted
the FSA Health Care Carryover Provision. The Carryover Provision allows a certain amount of unused FSA Health Care and
funds to be rolled over to the next plan year after the conclusion of the run-out period. The allowed amount to be carried
over is determined by your employer; see FSA Health Care Carryover Provision amount noted on reverse side. [Note: The FSA
Carryover Provision does not apply to the DCA Dependent Care plan and does not apply to terminated employees.]
What to Expect When You Use Your Benefit Card – Documentation will be required to be submitted for review for all card
transactions except pharmacy expenses approved at the point of sale. CareFlex has made improvements by utilizing
technology to manage the communication process with members. It is a thorough process as CareFlex can review
transactions with certainty that the funds were appropriately used. We provide various methods of communicating
information with us. For example, the CareFlex Participant Portal identifies and lists on the homepage transactions under
review allowing members to attach the requested documentation directly to the transaction. We also offer a convenient
CareFlex Mobile App with the same key features that also allows participants to snap a picture of their documentation and
upload the picture to the transaction.
Online Account Access – CareFlex provides electronic access to your plan information, plan design, account balance,
transactions history, online claim filing, and more through the CareFlex Participant Portal and CareFlex Mobile App.
Once you register, the same Username and Password is used to access your account through both the portal and the
mobile app.
CareFlex Participant Portal – to access the portal, go to the Portal web page: https://mycareflex.wealthcareportal.com.
CareFlex Mobile App – CareFlex offers a free mobile app for ultimate “on the go” convenience. Simply search for CareFlex
Mobile App in the Apple App Store or Google Play.
Do not use your CareFlex Benefits Card to pay for previous plan year expenses. Your benefit card only recognizes current
plan year funds. Once a new plan year begins, do not use your benefit card to pay for dates of services in the previous plan
year. Expenses are eligible based on the date of service, not the date of payment. If you receive an invoice during the new
plan year for dates of service in the previous plan year, pay with another form of payment and submit a manual claim to
CareFlex for reimbursement from previous plan year funds. All reimbursement requests received after the plan year run
out period will be denied.
Reimbursements – Participants have two options to submit eligible expenses for reimbursement:
Online Claim Filing (https://mycareflex.wealthcareportal.com): Log on to the CareFlex Participant Portal to file a manual
claim. Attach appropriate documentation to your online claim; or email, fax, or mail the documentation to CareFlex.
Paper Claim Submission: Email, fax, or mail a manual reimbursement request to CareFlex. Reimbursement forms can be
downloaded from the CareFlex Participant Portal FSA Resources section. Reimbursement request forms must be
completed and signed and include appropriate documentation to process the claim.
Appropriate proof of service/purchase documentation includes: an itemized prescription label (containing the pharmacy
name, patient name, prescription number, and prescription amount), an itemized provider statement [must include the
provider name, patient name, date of service, description of service, charges, medical insurance adjustment/payment (if
applicable), and patient responsibility], or an Explanation of Benefits (EOB) obtained from the insurance carrier.
Important Notes: (1) cancelled checks, credit card receipts, and/or non-itemized receipts or statements are not acceptable
proof of services, and (2) remember to send copies of documentation and keep the originals for your records.
Benefits Summary 2026 - 2027 22

Life & AD&D Insurance
Basic Life and AD&D Insurance
Life insurance helps protect your family from financial risk and sudden loss of income in
the event of your death. Accidental Death and Dismemberment (AD&D) insurance
provides an additional benefit if you lose your life, sight, hearing, speech, or limbs in an
accident.
The Town of Centreville provides you with a basic life insurance benefit at no cost to you
through OneAmerica Financial in the amounts below:
Class One - All Full-time permanent employees authorized to work and reside in the
United States. Eligible employees must work 40 or more hours per week and cannot
be considered a part-time, temporary or seasonal employee. - $50,000
Benefits will reduce by 35% at age 65 and at age 70, benefits will reduce an additional
25% of the original amount.
Don’t forget to designate a life insurance beneficiary and keep it up-to-date as your life
status changes.
Benefits Summary 2026 - 2027 23

Disability Benefits
🩺 Short-Term Disability (STD) 🏥 Long-Term Disability (LTD)
Temporary income protection while you Income protection for extended
recover disabilities
Eligibility Eligibility
👥 Full-time permanent employees 👤 Full-time permanent employees
📅 12 continuous months of service 🕒 40+ hours/week
⏱ 1,250 hours worked in prior 12 months 🇺🇸 Authorized to work in the U.S.
✔
Must be actively at work
Benefit Amount
Benefit Amount
💵
60% of weekly earnings
⬆ Max: $1,500/week 💰 60% of monthly earnings
⬇ Min: $25/week ⬆ Max: $5,000/month
Waiting Period Waiting Period
⏳ 7-day elimination period ⏳ 90-days of Total Disability
(Injury or sickness)
Benefit Duration
Benefit Duration
SSNRA - Social Security Normal Retirement
📆
Up to 12 weeks Age (if continuously disabled)
Cost Cost
🏛 100% paid by the Town 🏛 100% paid by the Town
Benefits Summary 2026 - 2027 24

Important Coverage Information
Maternity Coverage - Covered the same as any qualifying disability
Other Income Benefits - Benefits may be reduced by other eligible
income sources
Continuation of Coverage - Coverage may continue during:
Approved Leave of Absence
Temporary Layoff
Military Leave
This chart is intended for comparison purposes only. If there are any discrepancies, the plan
document will govern.
Benefits Summary 2026 - 2027 25

Holidays and Leave
Paid Holidays Sick Leave*
Fourteen paid holidays per year Accrue 4 hours every pay
Unlimited accrual
New Year’s Day
Birthday of Dr. Martin Luther King, Jr. Personal Days
President’s Day
Good Friday Twenty-four hours beginning
Memorial Day the first pay period in the
Juneteenth calendar year
Independence Day
Labor Day
Columbus Day
*For temporary and permanent part-
Veterans Day time employees, please refer to the
Thanksgiving Day Sick and Safe Leave policy in the
Day after Thanksgiving Town’s Personnel Manual for
Christmas Eve eligibility requirements.
Christmas Day
Annual Leave
0 - 4 years of service = 4 hours per pay
5 - 9 years of service = 6 hours per pay
10 + years of service = 8 hours per pay
Benefits Summary 2026 - 2027 26

Maryland State Retirement and Pension System
The Town of Centreville became a member of the Maryland State Retirement and
Pension System (MSRP) Employees Pension on July 1, 2013 and a member of the
Maryland State Law Enforcement Officers Pension System (LEOPS) on July 1,
2021.
Enrollment into the Employees’ Pension or LEOPS is mandatory for any
employee employed after these dates. Employees are required to contribute 7%
of their annual compensation into this plan. The contributions are made with
pre-tax dollars, thereby; reducing the employee’s taxable income for the year.
Employees Pension
In order for any employee to receive benefits from this plan, they have to
participate for at least 10 years. Normal retirement is at least 90 years of
combined age and years of eligibility service. For example:
Age 57 with 33 years of service,
Age 60 with 30 years of service, or
Age 63 with 27 years of service
LEOPS
In order for sworn personnel to receive benefits from this plan, depends on their
service credit or their age:
Age 50 or
25 years of eligibility service at any age
Benefits Summary 2026 - 2027 27

Deferred Retirement Option Program (DROP)
DROP is available to eligible members of LEOPS. This is a voluntary program, you
can “retire” and begin accumulating your retirement benefits in a DROP account
while you continue to work and draw a paycheck.
The Maryland State Retirement Agency has a new
secure website, mySRPS.com where Employees can
access info related to their retirement account.
By simply logging into your mySRPS account, you will be able to view Personal
Statements of Benefits, update beneficiaries, create estimates and more. If you
do not have a mySRPS account, go to sra.maryland.gov, click mySRPS Login, click
Register, and then follow the instructions.
Benefits Summary 2026 - 2027 28

Deferred Compensation
To enhance retirement savings, employees have the option of participating in a
deferred compensation program, also called a 457b plan. A 457b plan allows
employees to set aside funds on a pre-tax basis for retirement.
The Town of Centreville offers opportunities for tax-deferred retirement savings
and the ability to select from the agencies listed below you would like to work
with:
Provider Contact Person Contact Info
CBIZ Rory Glackin 610-891-1677
Corebridge Financial Adam Grace 410-859-2164
MissionSquare Caroline Sorokos 202-962-3495
What is a 457(b) plan?
A 457(b) deferred compensation plan lets you save and invest for the future with
tax advantages you can’t get from regular savings and investment accounts. It
works most like a 401(k) plan, but it is tailored to government employees and
certain nonprofit workers.
These options are available for any employee who wants to make investments to
save for retirement. Please refer to your financial advisor for what plan works
best for your situation.
Benefits Summary 2026 - 2027 29

Town of Centreville
Plan Year: July 1, 2026 to June 30, 2027
Your former employer has established a Retiree Health Reimbursement Arrangement (HRA) plan to assist you in
paying for out-of-pocket medical expenses and qualified individual health insurance premiums.
HRA Election – Retiree Only ....................................................... $2,400.00 [Employer Funded]
HRA Benefit Pro-rated: Mid-year enrollees will have their HRA benefit pro-rated to reflect the number of months
remaining in the plan.
Run Out Period: ........................................................................................ 60-Days from Last Day of Plan Year
Allows time after the last day of the plan year to submit manual claims for dates of services incurred during the
plan year – expenses are eligible based on the date of service, not the payment date.
Reimbursement Method ................................................................................ Benefit Card and Manual Claim
Employee Eligibility: Retired employees who have at least 10 years of service with the Town of Centreville.
Termed Retirees – Coverage Ceases .......................................................................................... Last Day of Month
Benefit Card Deactivated ....................................................................................................... Last Day of Month
Term Run-Out Period ............................................................................................... 60 Days from Date of Term
Benefit Changes – Benefit changes do not apply to this plan.
Qualified Dependents – Dependents are not covered under this plan.
Eligible Expenses – Eligible expenses include all qualified medical expenses not reimbursed by other insurance,
including vision expenses, non-cosmetic dental expenses, over-the-counter (OTC) medicines, menstrual care
products (tampons and pads), PPE personal protective equipment (face masks, hand sanitizer, and sanitizing
wipes), and medical supplies. Expenses paid out of pocket may also be submitted for manual claim
reimbursement.
What to Expect When You Use Your Benefit Card – Documentation will be required to be submitted for review
for all card transactions except pharmacy expenses approved at the point of sale. CareFlex provides various
methods of communicating information with us. For example, the CareFlex Participant Portal identifies and lists on
the homepage transactions under review allowing members to attach the requested documentation directly to
the transaction. CareFlex also offers a convenient CareFlex Mobile App with the same key features allowing
participants to snap a picture of their documentation and upload the picture to the transaction.
For more information, call 888-577-2762
205 W. Dares Beach Road (cid:0) Prince Frederick, MD 20678 (cid:0) https://mycareflex.wealthcareportal.com
Benefits Summary 2026 - 2027 30

Health Reimbursement Arrangement (HRA)
Important Plan Information
Online Account Access – CareFlex provides electronic access to your plan enrollment guide, plan design, account
balance, transactions history, online claim filing, and more through the CareFlex Participant Portal and CareFlex
Mobile App. Once you register, the same Username and Password is used to access your account through both the
portal and the mobile app.
CareFlex Participant Portal – to access the portal, go to: https://mycareflex.wealthcareportal.com.
CareFlex Mobile App – CareFlex offers a free mobile app for ultimate “on the go” convenience. Simply search for
CareFlex Mobile App in the Apple App Store or Google Play.
Do not use your CareFlex Benefits Card to pay for previous plan year expenses. Your benefit card only recognizes
current plan year funds. Once a new plan year begins, do not use your benefit card to pay for dates of services in
the previous plan year. Expenses are eligible based on the date of service, not the date of payment. If you receive
an invoice during the new plan year for dates of service in the previous plan year, pay with another form of
payment and submit a manual claim to CareFlex for reimbursement from previous plan year funds. All
reimbursement requests received after the plan year run out period will be denied.
Reimbursements – Participants have two options to submit eligible expenses for reimbursement:
Online Claim Filing (https://mycareflex.wealthcareportal.com): Log on to the CareFlex Participant Portal to file a
manual claim. Attach appropriate documentation to your online claim; or email, fax, or mail the documentation
to CareFlex.
Paper Claim Submission: Email, fax, or mail a manual reimbursement request to CareFlex. Reimbursement forms
can be downloaded from the CareFlex Participant Portal HRA Resources section. Reimbursement request forms
must be completed and signed and include appropriate documentation to process the claim.
Appropriate proof of service/purchase documentation includes: an itemized prescription label (containing the
pharmacy name, patient name, prescription number, and prescription amount), an itemized provider statement
[must include the provider name, patient name, date of service, description of service, charges, medical insurance
adjustment/payment (if applicable), and patient responsibility], or an Explanation of Benefits (EOB) obtained from
the insurance carrier.
Important Notes: (1) cancelled checks, credit card receipts, and/or non-itemized receipts or statements are not
acceptable proof of services, and (2) remember to send copies of documentation and keep the originals for your
records.
For more information, call 888-577-2762
205 W. Dares Beach Road (cid:0) Prince Frederick, MD 20678 (cid:0) https://mycareflex.wealthcareportal.com
Benefits Summary 2026 - 2027 31

YMCA Membership Benefit
🏋
Healthy Employees, Healthy Community
The Town of Centreville provides a complimentary YMCA membership to all full-
time and permanent part-time employees. This benefit is offered at no cost to
the employee and includes membership coverage for eligible household family
members.
Benefit Includes
✔
Access to YMCA fitness facilities
✔
Group exercise classes
✔
Wellness and recreational programs
✔
Household family membership coverage
Eligibility
👥
Full-time employees
👥
Permanent part-time employees
How to Enroll
📞
Contact Human Resources to enroll or for additional information.
Benefits Summary 2026 - 2027 32

Important Notice About Your Prescription Drug
Coverage & Medicare
If you and your covered dependents are not currently covered by Medicare and
will not become covered by Medicare within the next 12 months, this Notice is
for informational purposes only.
Please read this notice carefully and keep it where you can find it. This notice has
information about your current prescription drug coverage with the Town of
Centreville and about your options under Medicare’s prescription drug coverage.
This information can help you decide whether or not you want to join a Medicare
drug plan. If you are considering joining, you should compare your current
coverage, including which drugs are covered at what cost, with the coverage and
costs of the plans offering Medicare prescription drug coverage in your area.
Information about where you can get help to make decisions about your
prescription drug coverage is at the end of this notice.
There are two important things you need to know about your current coverage
and Medicare’s prescription drug coverage:
1. Medicare prescription drug coverage became available in 2006 to everyone
with Medicare. You can get this coverage if you join a Medicare Prescription
Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers
prescription drug coverage. All Medicare drug plans provide at least a
standard level of coverage set by Medicare. Some plans may also offer more
coverage for a higher monthly premium.
2. Town of Centreville has determined that the prescription drug coverage
offered by Cigna Gold or Silver Plan is, on average for all plan participants,
expected to pay out as much as standard Medicare prescription drug
coverage pays and is therefore considered Creditable Coverage. Because
your existing coverage is Creditable Coverage, you can keep this coverage
Benefits Summary 2026 - 2027 33

and not pay a higher premium (a penalty) if you later decide to join a
Medicare drug plan.
When Can You Join A Medicare Drug Plan?
You can join a Medicare drug plan when you first become eligible for Medicare
and each year from October 15th to December 7th.
However, if you lose your current creditable prescription drug coverage, through
no fault of your own, you will also be eligible for a two (2) month Special
Enrollment Period (SEP) to join a Medicare drug plan.
What Happens To Your Current Coverage If You Decide To Join A Medicare Drug
Plan?
If you decide to join a Medicare drug plan, your current Town of Centreville
coverage will not be affected.
Gold Plan
The prescription drug coverage that is offered through Town of Centreville has
an annual deductible, employer contribution of $1,300 for individual and $2,600
for family. Participants are responsible for co-payments that vary by the drug
type and whether the prescription is filled at a retail pharmacy or through mail
order. For prescriptions obtained at a participating retail pharmacy (up to a 30-
day supply) the co-payments are: $10 for Generic Drugs, $40 for Brand-Name
Formulary Drugs, and $75 for Brand-Name Non-Formulary Drugs. For
prescriptions obtained at a participating retail pharmacy (up to a 90 day supply)
the co-payments are: $25 for Generic Drugs, $100 for Brand-Name Formulary
Drugs, and $188 for Non-preferred brand Drugs. For prescriptions obtained
through mail order (up to a 90 day supply) the co-payments are: $25 for Generic
Drugs, $100 for Brand-Name Formulary Drugs, and $188 for Brand-Name Non-
Formulary Drugs.
Silver Plan
The prescription drug coverage that is offered through Town of Centreville has
an annual deductible, employer contribution of $2,000 for individual and $4,000
for family. Participants are responsible for co-payments that vary by the drug
type and whether the prescription is filled at a retail pharmacy or through mail
order. For prescriptions obtained at a participating retail pharmacy (up to a 30
Benefits Summary 2026 - 2027 34

day supply) the co-payments are: $10 for Generic Drugs, $40 for Brand-Name
Formulary Drugs, and $75 for Brand-Name Non-Formulary Drugs. For
prescriptions obtained at a participating retail pharmacy (up to a 90 day supply)
the co-payments are: $25 for Generic Drugs, $100 for Brand-Name Formulary
Drugs, and $188 for Non-preferred brand Drugs. For prescriptions obtained
through mail order (up to a 90 day supply) the co-payments are: $25 for Generic
Drugs, $100 for Brand-Name Formulary Drugs, and $188 for Brand-Name Non-
Formulary Drugs.
If you do decide to join a Medicare drug plan and drop your current Town of
Centreville Gold or Silver Cigna Plan coverage, be aware that you and your
dependents will be able to get this coverage back.
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?
You should also know that if you drop or lose your current coverage with Town of
Centreville and don’t join a Medicare drug plan within 63 continuous days after
your current coverage ends, you may pay a higher premium (a penalty) to join a
Medicare drug plan later.
If you go 63 days or longer without creditable prescription drug coverage, your
monthly premium may go up by at least 1% of the Medicare base beneficiary
premium per month for every month that you did not have that coverage. For
example, if you go nineteen months without creditable coverage, your premium
may consistently be at least 19% higher than the Medicare base beneficiary
premium. You may have to pay this higher premium (a penalty) as long as you
have Medicare prescription drug coverage. In addition, you may have to wait
until the following October to join.
For More Information about This Notice or Your Current Prescription Drug
Coverage…
Contact the person listed below for further information. NOTE: You’ll get this
notice each year. You will also get it before the next period you can join a
Medicare drug plan, and if this coverage through Town of Centreville changes.
You also may request a copy of this notice at any time.
For More Information about Your Options under Medicare Prescription Drug
Coverage…
Benefits Summary 2026 - 2027 35

More detailed information about Medicare plans that offer prescription drug
coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook
in the mail every year from Medicare. You may also be contacted directly by
Medicare drug plans.
For more information about Medicare prescription drug coverage:
Visit www.medicare.gov
Call your State Health Insurance Assistance Program (see the inside back cover
of your copy of the “Medicare & You” handbook for their telephone number) for
personalized help.
Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
If you have limited income and resources, extra help paying for Medicare
prescription drug coverage is available. For information about this extra help,
visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-
772-1213 (TTY 1-800-325-0778).
Remember: Keep this Creditable Coverage notice. If you decide to join one of
the Medicare drug plans, you may be required to provide a copy of this notice
when you join to show whether or not you have maintained creditable coverage
and, therefore, whether or not you are not required to pay a higher premium (a
penalty).
Date: July 1, 2026
Name of Entity/Sender: Town of Centreville
Contact--Position/Office: Krystel Ebaugh- Human Resources Manager/Wharf
Building
Address: 101 Water Way, Centreville, MD 21617
Phone Number: 410-758-1180 Ext. 12
Benefits Summary 2026 - 2027 36

2026 Annual
Notices
Inside this issue: Introduction
Summary of 1
Benefits and This brochure includes the annual notices that should be distributed to all covered employees
Coverage (SBC) and dependents. This newsletter contains important information so we encourage you to read
all sections.
Special Enrollment 1
If you have questions regarding any items contained in this newsletter, please contact your Hu-
Rights Notice
man Resources office or plan administrator for more information.
WHCRA 2
Enrollment Notice We hope you find this information helpful and informative.
Patient Protections 2
Notice
Summary of Benefits and Coverage
Notice of 2 The Health Care Reform law states that all groups must implement the
Availability of requirement that health plans and health insurers provide consumers
Notice of Privacy with a Summary of Benefits and Coverage (SBC). The stated purpose
Practices of the SBC is to “accurately describe the benefits and coverage under
the applicable plan or coverage,” which will allow participants to better
Premium 3 compare plan terms and benefits.
Assistance under
Medicaid and CHIP In addition, all group health plans will have to distribute a brief
standard summary of benefits and must use and distribute a uniform
Your Rights 4 glossary containing definitions for common terms (e.g. “copay”,
Against Surprise 5 “deductible”, etc.).
Medical Bills
This should be distributed annually, no later than December 1st and
Dependent 6 within seven days per any employee request. The medical SBC will be
Enrollment created by the insurance carrier and provided to each group for
Limitations distribution.
In addition, if your group has a stand-alone HRA or FSA that covers
Newborns’ Act 6
expenses beyond excepted benefits, then the plan sponsor, not the
Disclosure
insurance carrier, will create and distribute that SBC.
Special Enrollment Rights Notice
If you are declining enrollment for yourself or your dependents (including your spouse) be-
cause of other health insurance coverage, you may in the future be able to enroll yourself or
your dependents in this plan, provided that you request enrollment within 30 days after your
coverage ends. In addition, if you have a new dependent as a result of marriage, birth, adop-
tion, or placement for adoption, you may be able to enroll yourself and your dependents, pro-
vided that you request enrollment within 30 days after the marriage, birth, adoption, or place-
ment for adoption.
Benefits Summary 2026 - 2027 37

2026 Annual Notices Page 2
WHCRA Enrollment Notice
If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the
Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-
related benefits, coverage will be provided in a manner determined in consultation with the attending
physician and the patient, for:
• 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 of the mastectomy, including lymphedema.
These benefits will be provided subject to the same deductibles and coinsurance applicable to other
medical and surgical benefits provided under this plan.
If you would like more information on WHCRA benefits, call your Plan Administrator at the phone
number on the back of your carrier ID card.
Patient Protections Disclosure Notice
You do not need prior authorization from the carrieror from any other person (including a primary care provider) in order to obtain
access to obstetrical or gynecological care from a health care professional in network who specializes in obstetrics or gynecology.
The health care professional, however, may be required to comply with certain procedures, including obtaining prior authorization for
certain services, following a pre-approved treatment plan, or procedures for making referrals. For a list of participating health care
professionals who specialize in obstetrics or gynecology, contact your insurance carrier by calling the number on the back of your ID
card.
FOR GROUPS WITH HMO PLANS:
The employer’s group health plan generally requires or allows the designation of a primary care provider. You have the right to des-
ignate any primary care provider who participates in the network and who is available to accept you or your family members. For
children, you may designate a pediatrician as the primary care provider. For information on how to select a primary care provider,
and for a list of the participating primary care providers, contact your insurance carrier by calling the number on the back of your ID
card.
Notice of Availability of Notice of Privacy Practices
Your group health plan (the Plan) is required by the Health Insurance Portabilityand Accountability Act of
1996 (HIPAA) and its regulations to maintain the privacy of your protected health information (PHI) and
to provide plan participants with notice of its legal duties and privacy practices with respect to PHI. PHI is
any individually identifiable information that is received or maintained by the Plan in electronic, written, or
oral form that pertains to your past, present or future mental or physical condition, the provision of
health care services for that condition, and the payment for those services.
The Plan is required by law to tell you:
The Plan’s uses and disclosures of your PHI;
The Plan’s duties with respect to your PHI;
Your right to file a complaint with the Plan and with the Secretary of the U.S. Department of Health and
Human Services; and
The person to contact for further information about the Plan’s privacy practices.
A copy of the Notice of Privacy Practices is available to all individuals whose PHI will be used or main-
tained by the Plan. If you would like a copy of the Plan’s Notice of Privacy Practices, please contact your
Human Resources office or plan administrator.
Benefits Summary 2026 - 2027 38

2026 Annual Notices Page 3
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’re eligible for health coverage from your employer, your state may
have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or
your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able
to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit https://pennie.com
(in Pennsylvania) or www.healthcare.gov.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a state listed below, 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, contact your State Medicaid or CHIP office or dial 1-877-KIDSNOW or
www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the
premiums for an employer-sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan,
your employer must allow you to enroll in your employer plan if you aren’t 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, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-
444-EBSA (3272).
If you live in one of the following states, you may be eligible for assistance paying your employer health plan
premiums. The following list of states is current as of July 31, 2024. Contact your state for more information on
eligibility -
Maryland – Medicaid and MCHP
Medicaid Website:
health.maryland.gov/mmcp/pages/home/
aspx
Medicaid Phone: 855-642-8571
To see if any other states have added a premium assis-
CHP Website:
tance program since July 31, 2023 or for more infor-
ttps://www.marylandhealthconnection.g
mation on special enrollment rights, contact either:
ov
CHIP Phone: 855-642-8572:
U.S. Department of Labor
Employee Benefits Security Administration
www.dol.gov/agencies/ebsa
1-866-444-EBSA (3272)
Delaware – Medicaid and CHIP
Website:
U.S. Department of Health and Human Services
https://medicaid.dhss.delaware.gov
Centers for Medicare & Medicaid Services
Phone: 1-800-372-2022
www.cms.hhs.gov
1-877-267-2323, Menu Option 4, Ext. 61565
PENNSYLVANIA – Medicaid
OMB Control Number 1210-0137 (expires 01/31/2026)
Website:
http://www.dhs.pa.gov/Services/Assistance/Pages/HIPP-
Program.aspx
Phone: 1-800-692-7462
Benefits Summary 2026 - 2027 39

2026 Annual Notices Page 4
Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or get treated by an out-of-network provider at an in-
network hospital or ambulatory surgical center, you are protected from surprise billing
or balance billing.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs,
such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to
pay the entire bill if you see a provider or visit a health care facility that isn’t in your health
plan’s network.
“Out-of-network” describes providers and facilities that haven’t signed a contract with your
health plan. Out-of-network providers may be permitted to bill you for the difference between
what your plan agreed to pay and the full amount charged for a service. This is called “balance
billing.” This amount is likely more than in-network costs for the same service and might not
count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is
involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but
are unexpectedly treated by an out-of-network provider.
You are protected from balance billing for:
Emergency services
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility,
the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and
coinsurance). You can’t be balance
billed for these emergency services. This includes services you may get after you’re in stable
condition, unless you give written consent and give up your protections not to be balanced
billed for these post-stabilization services.
Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain
providers there may be out-of-network. In these cases, the most those providers may bill you is
your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia,
pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist
services. These providers can’t balance bill you and may not ask you to give up your protections
not to be balance billed.
If you get other services at these in-network facilities, out-of-network providers can’t balance
bill you, unless you give written consent and give up your protections
You’re never required to give up your protections from balance billing. You also
aren’t required to get care out-of-network. You can choose a provider or facility
in your plan’s network. Contact the Maryland Insurance Administration Department at
www.insurance.maryland.gov or by phone at 1-800-492-6116 or if you have difficulty finding a provider or facility in
your plan’s network.
Benefits Summary 2026 - 2027 40

2026 Annual Notices Page 5
When balance billing isn’t allowed, you also have the following
protections:
• You are only responsible for paying your share of the cost (like the copayments,
coinsurance, and deductibles that you would pay if the provider or facility was in-network).
Your health plan will pay out-of-network providers and facilities directly.
• Your health plan generally must:
* Cover emergency services without requiring you to get approval for services in
advance (prior authorization).
* Cover emergency services by out-of-network providers.
* Base what you owe the provider or facility (cost-sharing) on what it would pay an
in-network provider or facility and show that amount in your explanation of
benefits.
* Count any amount you pay for emergency services or out-of-network services
toward your deductible and out-of-pocket limit.
If you believe you’ve been wrongly billed, you may contact the Maryland Insurance
Department at www.insurance.maryland.gov or by phone at 1-800-492-6116.
Visit www.insurance.maryland.gov for more information about your rights under federal and
state law. You may also visit https://www.cms.gov/nosurprises for information from the federal
government.
Benefits Summary 2026 - 2027 41

2026 Annual Notices Page 6
Notice of Dependent Enrollment Limitations
Newborns: Must be enrolled within 30 days of birth. If they are not en-
rolled within this time frame, they are not eligible until the next open enroll-
ment period. If no open enrollment period exists, they are not eligible until a
30 Life Status Event occurs (which may not occur in many instances).
Adoption/Judgments/Decrees/Etc.: Must be enrolled as of effective date
listed on legal documentation. Refer to Plan Document on day limitation (i.e.
30 or 60 days to enroll).
Newborns’ Act Disclosure
Group health plans and health insurance issuers offering group health insur-
ance coverage generally may not restrict benefits for any hospital length of
stay in connection with childbirth for the mother or newborn child to less
than 48 hours following a vaginal delivery, or less than 96 hours following a
delivery by cesarean section.
However, the plan or issuer may pay for a shorter stay if the attending provid-
er (e.g., physician, nurse midwife, or physician assistant), after consultation
with the mother, discharges the mother or newborn earlier.
Benefits Summary 2026 - 2027 42

New Health Insurance Marketplace Coverage
Form Approved
Options and Your Health Coverage OMB No. 1210-0149
(expires 12-31-2026)
PART A: General Information
When key parts of the healthcare law take effect in 2014, there will be a new way to buy health insurance: the Health Insurance Marketplace. To
assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace and employment -
based health coverage offered by your employer.
What is the Health Insurance Marketplace?
The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers "one-stop shopping"
to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right
away. Open enrollment for health insurance coverage through the Marketplace begins in October 2013 for coverage starting as early as January 1,
2014.
Can I Save Money on my Health Insurance Premiums in the Marketplace?
You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn't
meet certain standards. The savings on your premium that you're eligible for depends on your household income.
Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?
Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for
a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be
eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does
not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and
not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet
the "minimum value" standard set by the
Affordable Care Act, you may be eligible for a tax credit.1
Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the
employer contribution (if any) to the employer-offered coverage. Also, this employer contribution -as well as your employee contribution to
employer-offered coverage- is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the
Marketplace are made on an after-tax basis.
How Can I Get More Information?
For more information about your coverage offered by your employer, please check your summary plan description or
contact Human Resources Department at hr@townofcentreville.org or 410-758-1180 Ext. 12
.
The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the
Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health
insurance coverage and contact information for a Health Insurance Marketplace in your area.
1 An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by
the plan is no less than 60 percent of such costs.
Benefits Summary 2026 - 2027 43

PART B: Information About Health Coverage Offered by Your Employer
Thissection containsinformation aboutany health coverage offeredby your employer.If you decidetocompletean
application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to
correspond to the Marketplace application.
3.Employer name 4.Employer Identification Number (EIN)
Town of Centreville
52-6000782
5.Employer address 6.Employer phone number
101 Lawyers Row
410-758-1180
7.City 8.State 9.ZIP code
Centreville Maryland 21617
10.Who can we contact about employee health coverage at this job?
Human Resources Department 410-758-1180 Ext. 12
11.Phone number (if different from above) 12.Email address
410-758-1180 Ext. 31 hr@townofcentreville.org
Here is some basic information about health coverage offered by this employer:
• As your employer, we offer a health plan to:
All employees. Eligible employees are:
X
Some employees. Eligible employees are:
Regular Full-time employees and permanent part-time employees working at least 20 or more hours a week.
• With respect to dependents:
X We do offer coverage. Eligible dependents are:
Spouse: a person to whom you are legally married by ceremony.
Dependent Children: your biological, adopted, or legal dependents up to age 26 regardless of student,
financial, and marital status
We do not offer coverage.
X
If checked, this coverage meets the minimum value standard, and the cost of this coverage to you is intended to be
affordable, based on employee wages.
** Even if your employer intends your coverage to be affordable, you may still be eligible for a premium discount
through the Marketplace. The Marketplace will use your household income, along with other factors, to
determine whether you may be eligible for a premium discount. If, for example, your wages vary from week to
week (perhaps you are an hourly employee or you work on a commission basis), if you are newly employed
mid-year, or if you have other income losses, you may still qualify for a premium discount.
If you decide to shop for coverage in the Marketplace, HealthCare.gov will guide you through the process. Here's the
employer information you'll enter when you visit HealthCare.gov to find out if you can get a tax credit to lower your
monthly premiums.
Benefits Summary 2026 - 2027 44

The information below corresponds to the Marketplace Employer Coverage Tool. Completing this section is optional for
employers, but will help ensure employees understand their coverage choices.
13. Is the employee currently eligible for coverage offered by this employer, or will the employee be eligible in
the next 3 months?
Yes (Continue)
13a. If the employee is not eligible today, including as a result of a waiting or probationary period, when is the
employee eligible for coverage? (mm/dd/yyyy) (Continue)
No (STOP and return this form to employee)
14. Does the employer offer a health plan that meets the minimum value standard*?
XYes (Go to question 15) No (STOP and return form to employee)
15. For the lowest-cost plan that meets the minimum value standard* offered only to the employee (don't include
family plans): If the employer has wellness programs, provide the premium that the employee would pay if he/ she
received the maximum discount for any tobacco cessation programs, and didn't receive any other discounts based on
wellness programs.
a. How much would the employee have to pay in premiums for this plan? $ 8 4 . 9 1
XTwice a month
b. How often? Weekly Every 2 weeks Monthly Quarterly Yearly
If the plan year will end soon and you know that the health plans offered will change, go to question 16. If you don't
know, STOP and return form to employee.
16. What change will the employer make for the new plan year?
Employer won't offer health coverage
Employer will start offering health coverage to employees or change the premium for the lowest-cost plan
available only to the employee that meets the minimum value standard.* (Premium should reflect the
discount for wellness programs. See question 15.)
a. How much would the employee have to pay in premiums for this plan? $
b. How often? Weekly Every 2 weeks Twice a month Monthly Quarterly Yearly
• An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by the
plan is no less than 60 percent of such costs (Section 36B(c)(2)(C)(ii) of the Internal Revenue Code of 1986)
Benefits Summary 2026 - 2027 45

Disclaimer
THIS GUIDE IS NOT A CONTRACT
This guide is a summary of the general benefits available to Town of Centreville
employees and eligible retirees and describes the highlights of our benefits in
non-technical language. Our specific rights to benefits under the plan are
governed solely, and in every respect, by the official documents and not the
information in this summary. If there is any discrepancy between the
descriptions of the programs as contained in this guide and the official plan
documents, the language of the official document shall prevail as accurate.
Please refer to the plan-specific documents for detailed plan information. Any
plan benefits may be modified in the future to meet Internal Revenue Service
rules as decided by the Town.
Benefits Summary 2026 - 2027 46

Centrally HR
CBIZ Human Capital Management
Benefit Enrollment Steps
Updated: 10/1/2024
Benefit Enrollment Steps
Start Enrollment
Open Enrollment
1. Navigate to the My Benefits card on the homepage and click “Start open enrollment” to begin the event.
If you do not see a My benefits card, navigate to My Info > My Benefits > Enrollment to begin the enrollment
event.
2. You will be directed to the Enrollment Event. Please read the Instructions and begin the event. Click the blue
“Continue” button at the top right to advance to the next page in the event.
© Copyright 2024. CBIZ, Inc. NYSE Listed: CBZ. All rights reserved.
Benefits Summary 2026 - 2027 47

Centrally HR
CBIZ Human Capital Management
Benefit Enrollment Steps
Updated: 10/1/2024
You and Your Family
If you have added family members previously, they will be visible on the “You and your family” section.
ADDING FAMILY MEMBERS (DEPENDENTS, SPOUSE OR BENEFICIARIES)
1. To add existing contacts to the “You and your family” list, click the “Add family member” button.
2. A new window will open.
Select the appropriate family member to add to your benefits and click ‘Apply’.
© Copyright 2024. CBIZ, Inc. NYSE Listed: CBZ. All rights reserved.
Benefits Summary 2026 - 2027 48

Centrally HR
CBIZ Human Capital Management
Benefit Enrollment Steps
Updated: 10/1/2024
The family member will now be visible on the You and your family page.
Select a Plan
Plan Highlights and the cost per pay period for the coverage level selected will show on the benefit enrollment page
1. Change the coverage level on the benefit plan to see the cost per pay period.
2. To see additional details about a specific benefit plan, click “Show More.”
3. To enroll in a benefit plan, click “Select” on that benefit plan card.
After you select the desired coverage, a new window will open.
1. Review and confirm the level of coverage desired and add/update as needed.
2. Click Save and Select.
3. Confirm that the benefit is selected
4. Click “Continue” to proceed.
© Copyright 2024. CBIZ, Inc. NYSE Listed: CBZ. All rights reserved.
Benefits Summary 2026 - 2027 49

Centrally HR
CBIZ Human Capital Management
Benefit Enrollment Steps
Updated: 10/1/2024
Beneficiaries
If your employer offers plans requiring a Beneficiary, you may be reminded to fill in the required information.
ADD A NEW BENEFICIARY
1. Click “Add New” to enter a new beneficiary not listed in your existing contacts.
2. Enter the new beneficiary on the Account Contacts page and click Continue.
3. Click “OK” to confirm the contact was successfully added.
4. Assign the desired percentage to the new beneficiary and click “Save”.
5. Review your beneficiaries and click “Save and Select” to continue.
© Copyright 2024. CBIZ, Inc. NYSE Listed: CBZ. All rights reserved.
Benefits Summary 2026 - 2027 50

Centrally HR
CBIZ Human Capital Management
Benefit Enrollment Steps
Updated: 10/1/2024
FINISH UP
Once all benefits have been selected, advance to the “Finish Up” section.
The page will list your selections.
1. To edit a selection, click the Edit Pencil next to the plan.
2. Click , save the document on your computer, and print a confirmation page of your elections.
3. Click Submit to request approval of your enrollment.
You may be required to electronically sign your benefit enrollment.
1. Follow the steps if prompted for a password or wet signature. Below is an example of a wet signature.
© Copyright 2024. CBIZ, Inc. NYSE Listed: CBZ. All rights reserved.
Benefits Summary 2026 - 2027 51

Employee Portal – Centrally HR (CHR)
INSTRUCTIONS:
• Your username is your first initial and last name (i.e. – John Smith = JSmith). Usernames are NOT case
sensitive.
• First time users must type in their username and click forgot password to reset their password. A
temporary password will be emailed to your primary work email address (@qac.org for CPD employees,
@townofcentreville.org for all other employees).
CHR is accessible via mobile app, Town website (found under Human Resources, Employee Portal), or
•
via CHR URL logon page
https://secure5.entertimeonline.com/ta/CBIZ20602.login?rnd=CPW&%40rtm=1
Benefits Summary 2026 - 2027 52