Benefits Information

Retirement:

  • Mandatory participation in employee retirement account with PERA (Public Employees Retirement Association) of New Mexico PERA Website
    • All employees except certified deputies and certified firefighters contribute to Municipal Plan 2 (MPL2).
      • MPL2 is for non-enhanced members and employees contribute at 10.65% of base salary.  Employer contributes 9.55% of base salary for each employee.
    • Certified Deputies contribute to Municipal Police Plan 5 (MPO5).
      • MPO5 is for enhanced members and employees contributes at 13.8% of base salary.  Employer contributes 22.9% of base salary for each employee.
    • Certified Firefighters contribute to Municipal Fire Plan 5 (MFR5).
      • MFR5 is for enhanced members and employees contributes at 13.7% of base salary.  Employer contributes 25.65% of base salary for each employee.
  • Mandatory participation in NMRHCA (New Mexico Retiree Health Care Authority) available when collecting pension under PERA. NMRHCA Website
    • Non-enhanced members contribute 1% of base salary.  Employer contributes 2% of base salary.
    • Enhanced members contribute 1.25% of base salary.  Employer contributes 2.5% of base salary.
 
Medical Benefits
 
County offers one PPO plan option with Tall Tree Administrators as our Third-Party Administrator (Member Login) with our network being Cigna. 
For Network Medical Provider:  Visit Cigna
Our plan runs on the fiscal year, but deductible and maximum out of pocket run on the calendar year (January – December).
Eligibility:  A new employee becomes eligible for coverage on the first day of the sixth full pay period.
We have a four-tier premium breakout:
  • Employee Only - $58.43 per pay period
  • Employee plus Child(ren) - $116.80 per pay period
  • Employee plus Spouse - $122.63 per pay period
  • Family - $153.50 per pay period

Employee pays 21% of Medical Premium and County pays 79% of Medical Premium.

** Medical Premium includes Medical, Prescription, Group Life, and Short-Term Disability Coverage.

Benefits are subject to deductible and maximum out of pocket each calendar year for each person covered by the Plan.  When three persons who are
covered under one employee’s umbrella have met the annual deductible, the deductible will not apply for that families claims for the remainder of that year.
The medical plan deductible is $500.00; in-network out of pocket maximum is $2,000.00, and, out-of-network out of pocket maximum is $3,000.00.  The
deductible applies to both in and out of network services.  The maximum out of pocket includes: deductible, co-insurance, medical and prescription co-pays.
Please review the summary benefits pages located under Resources in MSS.

 Prescription Benefits - included in medical coverage and premium

Employee and dependents must be covered under the medical plan to be eligible for the prescription program, which is administered by Serve You Rx Pharmacy Benefit Manager Serve You Rx Website.  Our prescriptions are filled as written with a three-tier breakout of generic, preferred formulary, and non-preferred formulary.  Co-pays are $10, $20, $40 respectively for thirty-day supply or ninety-day mail through DirectRx Pharmacy OR $15, $25, $45 for ninety-day retail.

 

Life Insurance  
We offer, with the medical plan, a group life benefit which includes $25,000 Basic and Accidental Death and Dismemberment for the employee and $5,000 for each qualifying dependent. An employee who waives medical coverage may opt to pay $0.78 per pay period to purchase basic Life and AD&D separately for themselves only.
 
 
Short Term Disability
Coverage is available to employees who waive medical coverage and opts to pay $0.51 per pay period. The short-term disability plan provides a $200/week benefit for employees who are disabled because of a non-job-related illness or injury and who are unable because of the illness or injury to fulfill their duties.  An employee will be eligible to receive benefits beginning the 15th day of the illness or injury, and may continue to receive benefits for a maximum of 26 weeks. 
 
Dental Plan
San Juan County offers a competitive dental plan option.  Each member enrolled is eligible for $1,500 per calendar year.  The plan has a $50 deductible ($150 family max). Each member has two cleanings covered by participating providers at no cost. Basic and Restorative is covered at 80% after the $50 deductible.  Major services are covered at 50%.  Orthodontic services are available to youth up to age 19 years of age with a $1,000 lifetime maximum.  The plan has three tiers and has no County funding.
 
Premium breakout:
  • Employee Only - $10.26 per pay period
  • Employee plus One dependent - $34.87 per pay period
  • Family - $47.49 per pay period
 
Vision Plan
San Juan County offers members access to a small local PPO network or an out-of-network fee for service schedule for a minimum premium.  The plan has three tiers and has no County funding.
 
Premium breakout:
  • Employee Only - $2.00 per pay period
  • Employee plus One dependent - $4.00 per pay period
  • Family - $8.00 per pay period
 NOTE:  An employee may only make changes to plan benefits during an open enrollment period unless experiencing a life event.  A life event occurs when an employee experiences a change of family status, including: marital status; birth, adoption, or guardianship of a dependent; death of spouse or dependent; addition of other coverage or loss of other coverage. An employee must report the life event utilizing MSS.  Please contact Felecia Stradling at 505-334-4507 or This email address is being protected from spambots. You need JavaScript enabled to view it.
 
 
Other Benefits:
  • Paid holidays
  • Paid personal day
  • Vacation leave accruals
  • Sick leave accruals
  • For more information about accruals visit the full copy of the San Juan County Employee Handbook - Effective 3/23/2018 - Ordinance No. 34
Miscellaneous Benefits:
  • Employee Assistance Program (6 free counseling sessions per incident for immediate household members- spouse/children).
  • Education Assistance available after one year of employment.  Eligible for up to $1,500 per fiscal year for tuition, registration, and lab fees (dependent on availability of funds and contribution each year).
  • Wellness event offered once a year (vaccines, biometric screening, vendor presentations, etc.)
  • Fitness Facility discounts offered within tri-city area. Fitness activity reimbursements available as appropriate and as established by our CEO usually $100 per fiscal year for gym membership reimbursements must have attended an average of two times per week over a six-month period to receive benefit. 
Supplemental Benefits:
  • Deferred Compensation Plans (457(b)) available through:
    • Public Employee Retirement Association (PERA) SmartSave - Nationwide Retirement Solutions
    • National Association of Counties (NACo) - Nationwide Retirement Solutions
  • Legal Assistance and Identity Theft available through Legal Shield
  • Employee Discounts (hotels, amusement parks, entertainment, games, gift cards, etc.) via Tickets at Work, Perks Card, and Ticket Monster Perks

Questions:

Melissa Wood, CEBS, Benefits & Compensation Manager at 505-334-4504 or This email address is being protected from spambots. You need JavaScript enabled to view it.

Pre-Certification Requirements


For Pre-certification Call Tall Tree Customer Service 1-877-453-4201; ask for pre-certification.  Pre-certification process will begin with Tall Tree and be completed by Cigna.

Tall Tree Administrators

 

Tall Tree Administrators Frequently Asked Questions

General Plan Questions

What is the name of our
insurance company? 
 
Your plan is administered by Tall Tree Administrators. You will find our name, address and telephone number on your ID card. When you present your card to a medical provider, they will generally make a copy and keep it in their office.

Who do I call if I have not received my ID card or if it is incorrect?

Your ID cards are provided by Tall Tree Administrators. We are
happy to correct your cards or mail extra copies.

Eligibility Questions

When can I sign up for benefits? If I dont sign up now, can I come on the plan later?

There are three periods you have available to you for enrolling in your benefit plan. 1) The first 30 days after your hire date (coverage will not begin until the first day of the sixth full pay period). 2) If you do not sign up at that time you will need to wait until the Open Enrollment period with your company. Typically, this happens once a year. Check with your Benefits Coordinator to verify when your Open Enrollment is. 3) If at any time during the year you have a qualifying life event, you may enroll up to 30 days after the event occurs. Qualifying life events can include loss of eligibility on another plan, divorce or legal separation, death, marriage, birth or adoption.

Can I drop coverage any time I want?

Under federal guidelines governing certain tax-favored employee benefit plans, employees cannot drop coverage under this Plan for themselves or any covered dependents except during an open enrollment period, or unless the employee or dependent meets one of the qualifying life events previously listed above.

How long are my dependent children covered?

 
Children are covered to the age of 26. If your dependents have coverage available through their own employer or through a spouse’s employer, they are not eligible to be covered under your plan.

Claims Questions

Do I need to call for pre-authorization?

Yes, if you have a scheduled surgery, your medical provider will gener­ally call for approval. However, it is a good idea to also call and verify this has been done. The number is on your ID card. If you have an emergency, you, or someone close to you, will need to call within 48 hours. Procedures requiring pre-authorization are listed on the Schedule of Medical Benefits.

Am I covered when I travel out of the country?

You are covered while traveling in a foreign country, but since you are out of your assigned network area, the benefits payable are at the OUT of network level.

Is there a number to call if I have prescription questions?

Yes, you may call Tall Tree with any questions. If you would like to contact the prescription company directly, you may call Restat at (800) 248-1062.

If I have to pay for a prescrip­tion, can I be reimbursed?

Yes. If you go to a participating pharmacy you may receive reimburse­ment once the claim is submitted to Restat. Contact Tall Tree Customer Service for a prescription reimbursement form.

PPO Network Questions

 
How do I know if my doctor/hospital is in network?

here are several ways of finding this information. 1) You may refer to the Cigna website at http://www.mycigna.com/ and click on FIND A HEALTH CARE PROFESSIONAL (Brown box on right side). Click on Find a GWH-CIGNA Provider. Now you may search by Name, Specialty or Location. 2) You may call Tall Tree Customer Service for verification. 3) You may contact your provider and ask them directly. Networks may vary depending on location.

If my doctor is on the provider list but wants to use a non-network facility, will I be penalized?

Yes. However, if your doctor is on the network, he will be able to go to a hospital that is also on the network. Be sure to inquire if this is a possibility.

On-Line Claims and Eligibility Look Up

1. Go to www.talltreehealth.com
2. SSN – Enter the employee's Social Security number without spaces or dashes
3. PIN – Enter the employee's Birth date without spaces or dashes. Enter the entire year the employee was born
4. You will then be in the Tall Tree Administrators' system with full access to your records and can:

a. view eligibility records and plan accumulators for all plan participants
b. view all claims for your plan participants
c. e-mail Tall Tree Administrators with any questions or changes you have change your PIN
d. print a Credible Coverage Letter (HIPAA Letter)

CUSTOMER SERVICE • 801.274.8100 or 877.453.4201
MONICA WALTON, SPANISH REPRESENTATIVE • 801.938.1131
FAX NUMBER • 801.274.8900
ADDRESS • PO Box 71570, SLC, UT, 84171
WEB ADDRESS • www.talltreehealth.com

WEB ADDRESS • www.talltreehealth.com