As an employee of Kalamazoo County Government, enjoying your work and making valuable contributions to our organization are equally vital. The health, satisfaction, and security of you and your family are essential not only to your well-being but, ultimately, to achieving our organization's goals.            

For the 2025 plan year, Kalamazoo County Government has worked hard to offer a  competitive total rewards package with valuable and competitive benefits plans. These programs reflect our commitment to keeping our staff healthy and secure. We understand that your situation is unique, and Kalamazoo County Government offers an overall benefits package that you can shape and mold to fit your needs.        

This booklet contains a summary of your benefits under KalFlex. It is not intended to be a full description of coverage. The complete plans are described in the plan documents provided by the insurance carrier and issued by the plan administrator. They are available on the Kalamazoo County benefits portal or upon request to all interested persons. If there are any discrepancies between this booklet and the plan documents, the plan documents will prevail.

The County Board of Commissioners reserves the right to change employee benefits at any time, up to and including plan design, plan options, plan administrators, and premium sharing. 

Effective Date of Coverage: 

Eligible employees will be effective on the 1st of the month following 30 days of employment.  

Definition of Dependent:

Legal spouse and any child(ren) until the end of the month they turn 26. Children who are physically or mentally disabled and depend on the employee for full-time support may be covered as a sponsored dependent, regardless of age. The employee may have an additional charge to cover a sponsored dependent. The dependent must be disabled before age 19 to qualify. Contact the Human Resources Department for further information.

Qualifying Events: 

The choices you make for the Plan Year will remain in effect for the entire plan year (typically January 1 through December 31), as required by the law. Unless you are eligible for a qualifying event, such as:  

• marriage
• birth
• adoption
• divorce
• death
• change in employment status

You will have 30 days from the date of the qualifying event to make election changes. 

Benefit Election and Enrollment Process: 

Your online enrollment through Employee Self-Service (ESS) has all available benefit options listed for purchase for the current plan year. 

Eligible employees must pay a share of the cost of the health, dental, and vision plan premiums. The premium percentage is based on the employee's regularly scheduled work hours as described below:

    20 to 29.9 hours  - employee pays 40% of medical premium

    30 to 40 hours - employee pays 20% of medical premium

For the 2025 plan year, benefits enrollment will be done online through ESS. All employees will be required to make their 2025 enrollment elections online, including entering all dependents to be covered for the plan year and designating a beneficiary for their life insurance. The information will be available in ESS to allow the employee the opportunity to make any changes to their elections. Electronic submission of the online benefits enrollment form will serve as annual confirmation to ensure Kalamazoo County only deducts for those elections the employee intends each year. Deductions made for elections of coverage will be deducted on a pre-tax basis. For those opting out of health coverage, the opt-out incentive will be paid per pay period and taxed appropriately. All employees waiving all health coverage and indicating "Y" to the attestation of other coverage have proclaimed they have health insurance elsewhere.                 

Impact on your Paycheck

Your KalFlex benefit election costs will be deducted from your paycheck each pay period as a pre-tax deduction. Employees pay 100% of the premium for spouse and/or child(ren) life insurance, which is an after-tax deduction. 

If you have no earnings during a pay period but owe for your benefits, you will be responsible for the premium. You will receive written communication on the amount due and the expected date of payment. If the amount due is not paid within the allotted time, your benefits may be canceled, subject to group continuation provisions. Please refer to Section XIV, Insurance Continuation - COBRA, for details.

Full-time employees (30+ regularly scheduled hours/week) pay 20% of the insurance premiums for health, dental, and vision coverage, as well as a share of the life insurance premium if the employee elects coverage above the standard life option of $20,000. Part-time employees (20 - 29.9 regularly scheduled hours/week) pay 40% of the insurance premiums for health insurance. Part-time employees are not eligible for other benefits. 

We hope this benefits booklet, along with our additional communication and decision-making tools, will help you make the best healthcare choices for you and your family.

Genetic Information Nondiscrimination Act (GINA)

The Genetic Information Nondiscrimination Act of 2008, GINA prohibits the improper use of genetic information in health insurance and employment. The Act prohibits group health plans and health insurers from denying coverage to a healthy individual or charging that person higher premiums based solely on a genetic predisposition to developing a disease in the future.

Newborn and Mothers Health Protection Act

Group health plans and health insurance issuers generally may not, under federal law, 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 cesarean section. However, federal law generally does not prohibit the mother's or the newborn's attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing the length of stay not in excess of 48 hours (or 96 hours).

Women's Health and Cancer Rights Act

Group health plan expenses for a mastectomy shall also include charges for the reconstruction of the breast on which the mastectomy has been performed, surgery and reconstruction of the other breast to produce a symmetrical appearance, and prostheses and treatment of physical complications related to all stages of the mastectomy, including lymphedemas. Coverage shall be provided in a manner determined in consultation with the attending physician and the patient.

Michelle's Law

Michelle's Law allows seriously ill college students, who are covered dependents under health plans, to continue coverage for up to one year while on medically necessary leaves of absence. The leave must be medically necessary as certified by a physician, and the change in enrollment must commence while the dependent is suffering from a serious illness or injury and must cause the dependent to lose student status. Under the law, a dependent child is entitled to the same level of benefits during a medically necessary leave of absence as the child had before taking the leave. Further, if any changes are made to the health plan during the leave, the child remains eligible for the changed coverage in the same manner as would have applied if the changed coverage had been the previous coverage, so long as the changed coverage remains available to other dependent children under the plan.

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The Children's Health Insurance Program Reauthorization Act of 2009
You may be eligible to enroll in your employer-sponsored health plan if you or your dependent lose coverage under Medicaid or a state child health insurance plan and you request coverage under the group health plan within 60 days of the loss of coverage. You may also be eligible to enroll if you become eligible for a premium assistance subsidy for the group health plan through Medicaid or a state child health insurance plan and request coverage under the group health plan within 60 days of becoming eligible for assistance.

USERRA Continuation of Coverage Rights
Under the Uniformed Services Employment and Reemployment Rights Act, if you leave your job to perform military service, you have the right to elect to continue your existing employer-based health plan and coverage for you and your dependents for up to 24 months while in the military. Even if you don't elect to continue coverage during your military service, you have the right to be reinstated in your employer's health plan when you are reemployed, generally without any waiting periods or exclusions except for service-connected illness or injuries.

Family and Medical Leave Act Coverage Rights
During FMLA leave, the employer must maintain the employee's health coverage under any group health plan on the same terms as if the employee had continued to work. Upon return from FMLA leave, most employees must be restored to their original or equivalent positions with equivalent pay, benefits, and other employment terms. Use of FMLA leave cannot result in the loss of any employment benefit that accrued before the start of the employee's leave.

Your Enrollment Rights
If you enroll in your employer plan or waive coverage, you have special enrollment rights for situations that might come up in the future. For example, loss of other health insurance coverage (either through a spouse, parent, or Medicaid), Marriage, Divorce, birth, or adoption of a child.  If you experience any of these situations, you need to notify your HR department so that you and your dependents may enroll in the employer plan as of the date of the change. The insurance company needs to receive an updated enrollment form within 30 days of the special enrollment event.