Table of Content
- Header
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City of Checotah Benefits
- Your 2025 City of Checotah Benefits
- Required Notices
- How to Enroll
- Eligibility & Qualifying Life Events
- 2025 Medical/Rx Benefits
- Virtual Visits - MDLive
- Summary of Benefits and Coverage (SBC)
- Prescriptions
- BlueCross BlueShield of Oklahoma Resources
- 2025 Dental Benefits
- Dental Summary
- 2025 Vision Benefits
- Vision Summary
- 2025 Basic Life & Voluntary Life & ADD Benefits
- 2025 Disability Benefits
- FSA
- HSA
- 2025 Voluntary Accident, Critical Illness, and Hospital Indemnity Coverage
- Norton LifeLock
- Well Being Resources
- Contact Us
- Footer
Your 2025 City of Checotah Benefits
As a full-time employee of the City of Cheoctah, you are eligible for the comprehensive benefits available to you and your family.
Resources Available
This Benefits Open Enrollment Microsite contains all the necessary benefit summaries, compliance notices and forms required to enroll or make changes to your current elections. Please review these notices to learn about your rights pertaining to your benefits.
Please be sure to:
· Review your benefits open enrollment guide, which highlights the comprehensive coverage available to you and your family.
· Refer to your Summaries of Benefits and Coverage, for more benefit details.
· Read the Benefits Compliance notices to learn about your rights pertaining to your benefits.
Required Notices
Please refer to the Open Enrollment Guide to review the benefit offerings. The deadline for required 2025 enrollment and change forms is April 15, 2025. Please reach out to Human Resources or review the appropriate section(s) below to obtain the required enrollment form(s).
Required Forms for 2025
- City of Checotah Benefit Enrollment Form
- City of Checotah Mutual of Omaha VTL Enrollment/Change Form (Only submit if you have changes.)
- City of Checotah Mutual of Omaha Evidence of Insurability Form (Only submit if you have changes.)
- City of Checotah Mutual of Omaha Beneficiary Designation Form (Only submit if you have changes.)
Eligibility
Regular employees working at least 30 hours per week are eligible to participate in benefits offered by the City of Checotah. When you enroll in the benefits program, you may also cover your eligible benefits. Dependents include your legal spouse, child(ren) up to age 26 (regardless of student status, marital status, residence, or financial dependence on you), and an unmarried child incapable of self-support. The Benefit choices you make during your initial enrollment or annual open enrollment remain in effect for the entire year.
Qualifying Life Events
A Qualifying Life Event or QLE, is a significant change in a person's life that allows them to make changes to their health insurance outside of the regular open enrollment period. Examples of qualifying life events include marriage, divorce, the birth of a child, loss of health coverage, and a change in employment status.
Ready to Enroll?
Complete your enrollment form(s) and return them to Human Resources.
What is a Qualifying Event?
- Marriage
- Divorce
- Birth/Adoption of a child
- Death of a spouse or other enrolled dependent
- Change in spouse’s benefits or employment status
- A dependent becomes eligible for Medicare or Medical
Who are my legal dependents?
Your legal spouse or domestic partner
Your children (up to age 26) including natural children, stepchildren, legally adopted children,
children placed for adoption, children for whom you serve as legal guardian
Disabled dependent child(ren) of any age
When Does My Coverage Start?
If you are a New Hire, you are eligible to participate if you are full-time and work a minimum of 30 hours per week. Your coverage will be effective 1st of the month following 30 days of employment.
Open enrollment, your coverage is effective May 1, 2025
2025 Medical/Rx Benefits
Having access to high quality, affordable health care is a great concern for most people. That’s why we are pleased to offer employees, and their families, comprehensive medical coverage administered by Blue Cross & Blue Shield of Oklahoma (BCBS).
Virtual Visits - MDLive
A virtual visit lets you see and talk to a doctor from your mobile device or computer. When you use one of the provider groups in our virtual visit network, you have benefit coverage for certain non-emergency medical conditions. Virtual visit costs vary based on the medical plan you choose.
WHEN CAN I USE A VIRTUAL VISIT?
When you have a non-emergency condition and:
- your doctor is not available;
- you become ill while traveling;
- When you are considering visiting a hospital emergency room for a non-emergency health condition.
*Your covered children may also use Virtual Visits when a parent or legal guardian is present for the visit.
Examples of Non-Emergency Conditions:
- Bladder infection
- Seasonal flu
- Sinus
- Sore throat
- Stomach
- Rash
- Bronchitis
- Diarrhea
- Fever
- Pink eye
Virtual visits with licensed behavioral health therapists are available by appointment. Get virtual care for:
- Depression
- Eating Disorders
- ADHD
- Substance use disorders
- Trauma and PTSD
- Autism spectrum disorder
HOW DOES IT WORK?
The first time you use a Virtual Visits provider, you will need to set up an account with that Virtual Visits provider group. You will need to complete the patient registration process to gather medical history, pharmacy preference, primary care physician contact information, and insurance information.
Each time you have a virtual visit, you will be asked some brief medical questions, including questions about your current medical concern. If appropriate, you will then be connected using secure live audio and video technology to a doctor licensed to deliver care in the state you are in at the time of your visit. You and the doctor will discuss your medical issue, and, if appropriate, the doctor may write a prescription* for you.
Virtual Visits doctors use e-prescribing to submit prescriptions to the pharmacy of your choice. Costs for the virtual visit and prescription drugs are based on, and payable under, your medical and pharmacy benefits.
- Please note Medical and Pharmacy benefits are not covered as part of your Virtual Visit benefit, and you may still have a copay due at the time of service or when picking up a prescription from the pharmacy. *Prescription services may not be available in all states.
HOW DO I GET ACCESS?
Learn more about Virtual Visits and access direct links by downloading the MDLIVE App on your phone or utilizing the options below.
- Go to Blue Access for Members at www.bcbsok.com or MDLIVE.com/bcbsok
- Call MDLIVE at 888-970-4081
- Text BCBSOK to 6356-483 (MDLIVE’s online assistant Sophie will help you activate your account.)
2025 Dental Benefits
Dental Benefits through Delta Dental provide comprehensive coverage to help you and your family maintain good dental health. Your coverage will be greater when you visit a participating in-network dentist, you will have lower out-of-pocket costs, no balance billing, and claims will be submitted by your dentist on your behalf. Please note, you have the freedom to select a dentist of your choice; When you visit an out-of-network dentist, your cost could be higher, possibly balance billed and the provider may not submit claims on your behalf.
NETWORK: Delta Dental PPO and Premier Network
How do I find an In-Network Provider? Use the helpful link below!
- In-Network providers can also be found by calling 1- or by visiting your provider’s website below or the Delta Dental Provider search button, to search by location, provider/facility name, or search by specialty. Provider website https://www.deltadentalok.org/clients/ok/find-dentist.
Did You Know?
- You have the freedom to select the dentist of your choice; however, when you visit a participating in-network dentist, you will have lower out-of-pocket costs, no balance billing, and claims will be submitted by your dentist on your behalf.
Pre-treatment Estimate
- If your dental care is extensive and you want to plan ahead for the cost, you can ask your dentist to submit a pre-treatment estimate. While it is not a guarantee of payment, a pre-treatment estimate can help you predict your out-of-pocket costs.
PREVENTION FIRST!
Your dental health is an important part of your overall health. Make sure you take advantage of your preventive dental visits. Preventive care services are covered at 100% if you visit an In-Network provider. They are also not subject to the annual deductible.
Looking for more details about how items are covered? Click on the link below to view the formal plan summary.
Dental Summary
Delta Dental Summary
2025 Vision Benefits
VSP offers vision coverage through VSP Choice Providers. VSP Vision helps pay for eye exams, prescription glasses and contact lenses. You receive a higher level of benefits when you see a provider in network, however, out-of-network coverage is provided but may only be handled as reimbursements in some situations. Please note: Members may choose between prescription glasses (lenses and frame) and contact lenses, not both.
Did You Know?
Eyes can give doctors a clear picture of overall wellness. That’s why vision care—and vision benefits—can help employees stay healthy. A comprehensive eye exam can detect early signs of serious health problems, such as:
- Diabetes
- Heart disease
- High blood pressure
- High cholesterol
- Glaucoma and cataracts
To find out if your provider is in-network, please visit the website below.
Vision Summary
Vision Benefit Summary
2025 Basic Life & Voluntary Life & ADD Benefits
Life insurance is an important part of your financial security. Life insurance helps protect your family from financial risk and sudden loss of income in the event of your death. Accidental Death & Dismemberment (AD&D) insurance is equal to your Life benefit in the event of your death being a result of an accident and may also pay benefits for certain injuries sustained.
Basic - Employer Paid $60,000 Benefit
A sudden accident or death can leave you or your loved ones in a vulnerable position. Employees have the opportunity to enroll in Term Life and Accidental Death & Dismemberment insurance which will supplement lost income in the event of an accident or death. If you choose to enroll in employee coverage, this will be in addition to your employer-provided Basic Life coverage.
Voluntary - Employee Paid Life
Coverage is also available for your spouse and/or child dependents, but only after you've elected coverage for yourself. A sudden accident or death can leave you or your loved ones in a vulnerable position. Employees have the opportunity to enroll in Term Life and Accidental Death & Dismemberment insurance which will supplement lost income in the event of an accident or death. If you choose to enroll in employee coverage, this will be in addition to your employer provided Basic Life coverage. Review the full benefit summary below for additional details.
Employee: $10,000 increments up to a maximum of $300,000, cannot exceed 5x your annual salary. ($100,000 GI)
Spouse: $5,000 increments up to $50,000, not to exceed 100% of the employee's benefit. ($50,000 GI)
Children: $10,000 Benefit, one premium covers all eligible dependent children, not to exceed 100% of employee's benefit. ($10,000 GI - per covered child)
Who's Your Beneficiary?
Naming a beneficiary is a crucial part of electing life insurance. Also, don't forget to update your primary or secondary beneficiary if you experience a life event, such as a divorce or birth of a child.
*Guaranteed Issue (GI) and Evidence of Insurability (EOI)
When you are first eligible (at hire) for Voluntary Life and AD&D, you may purchase up to the Guaranteed Issue (GI) for yourself and your spouse without providing proof of good health (EOI). If you enroll in minimum amount of coverage during your initial enrollment, you have the ability to increase your coverage at your next enrollment by up to $10,000, provided the total amount of insurance does not exceed your maximum benefit amount.
2025 Disability Benefits
Short-Term Disability
Everyday illnesses or injuries can interfere with your ability to work. Even a few weeks away from work can make it difficult to manage household costs. Short- Term Disability coverage provides financial protection for you by paying a portion of your income, so you can focus on getting better and worry less about keeping up with your bills. Your coverage pays 60% of your income up to a specific maximum in your benefit summary.
STD Benefit Features
- Benefit begins 15th day Accident/15th day Illness (including pregnancy)
- Benefit equal to 60% of your before-tax weekly earnings, $1,000 max per week – benefit is taxable income; please consult with your tax advisor.
- Up to 24 weeks, maximum benefit period
- No Pre-existing condition limitations apply.
Long-Term Disability
Insurance through Unum can pay you a weekly benefit if you have a covered disability that keeps you from working. Long-Term Disability insurance can replace part of your income while you recover.
LTD Benefit Features
- Benefit begins after 180-day elimination period if you remain disabled.
- Benefit equal to 60% of your before-tax monthly earnings, maximum monthly benefit is $5,000.
- Benefit is taxable income; please consult with your tax advisor.
- Pre-existing condition limitations apply for first 12 months.
2025 Voluntary Accident, Critical Illness, and Hospital Indemnity Coverage
City of Checotah provides a competitive benefits package for all employees as part of our total compensation package. We realize you make benefit choices based on what’s important to you and the needs of your changing lifestyle. Therefore, along with our core benefits, we offer these additional benefits which help to provide financial support to employees. Additional benefits include:
- Accident Care
- Critical Illness
- Hospital Indemnity
Norton LifeLock
Well Being Resources
Wise & Well Training Center
The Wise & Well Training Center serves as a resource for employees to enhance their well-being and support their mental and physical health. If you're in need of a little uplift, visit the Wise & Well Training Center for additional information.
Contact Us
Client Contacts
Laurie Burkhalter
payroll@checotah.net
(918) 473-5411
Account Team Contacts
Robyn Setzer
Account Executive
robyn.setzer@nfp.com
918-794-5134