employee benefits guide - California`s Valued Trust
Transcription
employee benefits guide - California`s Valued Trust
EMPLOYEE BENEFITS GUIDE HEALTH & WELFARE BENEFITS for Certificated Employees 2014-2015 Welcome to Desert Sands Unified School District! CONTENTS Desert Sands Unified School District and our consultant, Burnham Benefits, are pleased to provide an array of benefit options to meet the diverse needs of our employees and their families. We have joined California’s Valued Trust (CVT) to offer low-cost comprehensive insurance along with built-in wellness and disease management programs. This brochure provides a summary of your benefit options and is designed to help you make choices and enroll for coverage. If you would like more information about any of the benefits described here, please contact the Risk Management Department: Enrollment Information 2 Annual Notices 4 Medical Insurance 5 Dental Insurance 9 Vision Insurance 10 Julie Schmid, Benefits Office………………………. (760) 771-8513 [email protected] Basic Life and AD&D Insurance 10 Sophai Simok, Benefits Office…………………….. (760) 771-8801 [email protected] Employee Assistance Program 11 Voluntary Benefits 12 Wellness 13 Flexible Spending Accounts 14 Online Member Portal 15 Tentative Employee Contributions 16 Resources and Contacts 17 Section 125 Flexible Benefit Plan Interest Form 19 Desert Sands Unified School District Risk Management Office Barbara Sasser, Risk Manager……………………. (760) 771-8511 [email protected] ENROLLMENT INFORMATION Effective Dates / Plan Years Medical: 07/01/2014 to 09/30/2015 Dental, Vision, Flexible Spending Accounts, Prudential Voluntary Benefits: 07/01/2014 to 06/30/2015 Voluntary Products (Except Prudential): 09/01/2014 to 08/31/2015 Who May Enroll All eligible employees working 4 hours or more per day, or teachers working 50% or more, may participate in Desert Sands Unified School District’s benefits program. Existing part-time employees who have previously declined medical benefits may participate with an increase in hours and board approval. Your eligible dependents include: Legally married spouse Registered domestic partner Disabled dependent children over age 26 (with certification form) Children under age 26 regardless of student or marital status District Website You can access your medical benefits information whenever you want, from home or any place where you have internet access, by visiting the district website. You’ll find documents posted such as the Summary of Benefits and Coverage (SBC), annual notices, DistrictWise Newsletters, helpful carrier resources, and more. The district website is located at: www.dsusd.us - Business Services / Risk Management / Health Benefits Info 2 ENROLLMENT INFORMATION Opting Out California’s Valued Trust (CVT) requires 100% participation for benefit eligible, full-time employees with one exception. If you are a certificated or management employee who is currently opting-out of Medical and taking the Tax Sheltered Annuity (TSA) in lieu of insurance, you may continue to opt-out. Please note, if you re-enroll in Medical (whether at this open enrollment or any future open enrollment), you cannot opt-out again going forward. If you continue to opt-out, you may continue with the TSA. To continue to opt-out and take the TSA, you will need to do the following: Complete the Declination form in the Risk Management Office Complete the TSA form for the new plan year Complete the paper open enrollment process for Dental, Vision and any Voluntary Benefits plan changes When You May Enroll Eligible employees may enroll at the following times: As an eligible new hire Each year, during annual open enrollment Within 30 days of a qualifying event Documents Needed If you have (and are continuing) Medical coverage or if you are planning to enroll in Medical insurance, you must provide certificates for your dependents to CVT (county marriage license, birth certificate, court adoption papers, court ordered legal guardianship papers, state registration for domestic partnerships). When completing the enrollment process, if you have scanning capabilities at your home or worksite, you may upload your scanned documents directly to CVT. You may also fax or email your documents to (559) 437-2965 or [email protected]. If not, you will need to provide copies to Risk Management before your benefits will be approved. If you are unable to locate these certificates, please order now to avoid the rush: www.usbirthcertificate.net www.vitalcheck.com www.sos.ca.gov/dpregistry Paying For Your Coverage You and the District share in the cost of the Medical, Dental and Vision benefits you elect. The Voluntary Benefits you elect will be paid by you at discounted group rates. Your Medical contributions are deducted before taxes are withheld, which saves you tax dollars. Paying for benefits before-tax means that your share of the costs is deducted before taxes are determined, resulting in more take-home pay for you. As a result, the IRS requires that your elections remain in effect for the entire year. You cannot drop or change coverage unless you experience a qualifying event. Changes to Enrollment Each year, there will be an annual open enrollment period prior to each plan’s effective date where you can make new benefit elections for the following plan year. Once you make your benefit elections, you cannot change plans; however you may add or remove a dependent if you experience a qualifying event. Examples of qualifying events include, but are not limited to the following: Marriage, divorce or annulment Birth or adoption of a child A qualified medical child support order Death of a spouse or child A change in your dependent’s eligibility status Loss of coverage from another health plan Please note that coverage for a new spouse or newborn child is not automatic. If you experience a qualifying event, you have 30 days to update your coverage and provide the required certificate. Please contact the Risk Management Department immediately to complete the appropriate election forms as needed. If you do not update your coverage within 30 days from the qualifying event, you must wait until the next annual open enrollment period to update your coverage. 3 The Affordable Care Act and You The Affordable Care Act (ACA) has created new options for purchasing health insurance coverage through a Federal Health Insurance Marketplace. Because Desert Sands Unified School District’s medical plans are considered affordable and meet minimum value under Health Care Reform, eligible employees will not generally see lower premiums or out-of-pocket costs through the marketplace. In addition, employer contributions to your medical benefits will be lost if you choose to purchase coverage through the marketplace, and your portion of medical premiums will no longer be paid via payroll deductions on a pre-tax basis. For more information, please visit www.healthcare.gov. ANNUAL NOTICES ERISA and various other state and federal laws require that employers provide disclosure and annual notices to their plan participants. Desert Sands Unified School District will distribute (via email) all federally required annual notices upon hire and during each annual open enrollment period. Annual notices will also be posted on our district website for you to download and read at your convenience. Note If you have questions regarding annual notices, please contact the Risk Management Department. 4 Annual notices include: Medicare Part D Notice of Creditable Coverage: Plans are required to provide each covered participant and dependent a Certificate of Creditable Coverage to qualify for enrollment in Medicare Part D prescription drug coverage when qualified without a penalty. This notice also provides a written procedure for individuals to request and receive Certificates of Creditable Coverage. HIPAA Notice of Privacy Practices: This notice is intended to inform employees of the privacy practices followed by Desert Sands Unified School District’s group health plan. It also explains the federal privacy rights afforded to you and the members of your family as plan participants covered under a group plan. Women's Health and Cancer Rights Act (WHCRA): The Women's Health and Cancer Rights Act (WHCRA) contains important protections for breast cancer patients who choose breast reconstruction with a mastectomy. The U.S. Departments of Labor and Health and Human Services are in charge of this act of law which applies to group health plans if the plans or coverage provide medical and surgical benefits for a mastectomy. Newborns’ and Mothers’ Health Protection Act: The Newborns' and Mothers' Health Protection Act of 1996 (NMHPA) affects the amount of time a mother and her newborn child are covered for a hospital stay following childbirth. Special Enrollment Rights: Plan participants are entitled to certain special enrollment rights outside of Desert Sands Unified School District’s open enrollment period. This notice provides information on special enrollment periods for loss of prior coverage or the addition of a new dependent. Medicaid & Children’s Health Insurance Program: Some states offer premium assistance programs for those who are eligible for health coverage from their employers, but are unable to afford the premiums. This notice provides information on how to determine if your state offers a premium assistance program. Summary of Benefits and Coverage (SBC): Health insurance issuers and group health plans are required to provide you with an easy-to-understand summary about your health plan’s benefits and coverage. The new regulation is designed to help you better understand and evaluate your health insurance choices. MEDICAL INSURANCE HMO Medical Plans – Kaiser Permanente With the Kaiser Permanente Health Maintenance Organization (HMO) plans, services must be obtained at a Kaiser facility, except in the case of emergency. Kaiser integrates all elements of healthcare such as physicians, medical centers, pharmacy and administration in one convenient facility. In addition, Kaiser offers online tools so you can email your doctor’s office, make appointments, refill prescriptions, and more. Kaiser HMO plan options available: Kaiser Traditional HMO Medical Plan Kaiser HMO Wellness Medical Plan: This plan combines traditional health coverage along with resources to help you make healthy changes. Plus, you’ll have the opportunity to earn up to $400 in rewards. HMO Medical Plans – Blue Shield With the Blue Shield of California Health Maintenance Organization Access+ (HMO) plans, you will be required to select a Primary Care Physician (PCP) within the Blue Shield Access+ HMO network. Your PCP will coordinate all of your medical care. You will receive benefits only if you use the doctors, clinics and hospitals that belong to the medical group in which you are enrolled, except in the case of an emergency. You can receive referrals from your PCP or self-refer to specialists within your PCP’s medical group for a higher copay using the Access+ feature of the plan. All HMO plan options offer prescription drug benefits through CVS/Caremark. Blue Shield HMO plan options available: Blue Shield HMO Medical Plan 1 Blue Shield HMO Medical Plan 2 Blue Shield HMO Medical Plan 3 PPO Medical Plans – Blue Shield The Blue Shield of California Preferred Provider Organization (PPO) plans allow you to direct your own care. You are not limited to the physicians in the PPO network and you may self-refer to specialists. If you receive care from a physician who is a member of the PPO network, a greater percentage of the entire cost will be paid by the insurance plan. You may also obtain services using a nonnetwork provider; however, you will be responsible for the difference between the covered amount and the actual charges and you may be responsible for filing claims. All PPO plan options offer prescription drug benefits through CVS/Caremark. Blue Shield PPO plan options available: Blue Shield PPO Medical Plan 3B Blue Shield PPO Medical Plan 5B Blue Shield PPO Medical Plan 7B Blue Shield High Deductible Health Plan (HDHP) PPO Medical Plan: This plan requires that you meet an annual deductible before medical and prescription drug benefits are covered. You’ll pay only 20% of the cost after you have met the deductible. This plan also meets the requirements for a Health Savings Account (HSA). Call Risk Management for additional details. Blue Shield PPO Wellness Medical Plan: You’ll gain access to wellness resources and have the opportunity to earn up to $400 in wellness credits which can reimburse you for deductible and coinsurance expenses. Alere’s Health Management Program: PPO members and dependents with qualifying chronic conditions are eligible to participate in Alere’s Health Management Program. This program will provide you with the facts you need to know about your condition to help you slow disease progression, lessen the effects, and help you live a healthier life. It’s personal, private and it’s available to you at no additional cost. Start today by calling (877) 864-1327. MDLIVE: PPO members and dependents can call MDLIVE for 24/7/365 access to board-certified doctors by online video, phone or secure email for a $5 copay. Contact MDLIVE if you are considering the ER or urgent care for a non-emergency medical issues, if your primary care physician is not available or if you are traveling. MDLIVE providers practice primary care, pediatrics, family and emergency medicine, and have incorporated MDLIVE into their practice to provide convenient access to quality care. Start today by calling (888) 632-2738 or registering at www.mdlive.com/cvt. 5 MEDICAL INSURANCE Kaiser Traditional HMO Kaiser Blue Shield Blue Shield Blue Shield Wellness HMO HMO 1 HMO 2 HMO 3 Lifetime Maximum Unlimited Unlimited Unlimited Unlimited Unlimited Deductible (Annual) - Individual - Family None None None None None None None None None None Co-Insurance (Plan Pays) 100% 100% 100% 100% 100% Office Visit Copay - Primary Care Physician - Specialist $15 Copay $15 Copay $20 Copay $40 Copay $10 Copay $30 Access+ $15 Copay $30 Access+ $25 Copay $40 Access+ Out-of-Pocket Maximum - Individual - Family $1,500 $3,000 $1,500 $3,000 $1,000 $2,000 $1,500 $3,000 $3,500 $6,000 Inpatient Hospitalization 100% $500/Admin 100% $250/Admin $750/Admin Max 3 Copays/Adm Outpatient Lab and X-Ray 100% $10 Copay 100% 100% 100% Emergency Services $50 Copay $35 Copay $100 Copay $100 Copay $150 Copay Urgent Care $15 Copay $20 Copay $10 Copay ($50 Copay Out of Service Area) $15 Copay ($50 Copay Out of Service Area) $25 Copay ($50 Copay Out of Service Area) 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Not Covered Not Covered $10 Copay $10 Copay $10 Copay 30 Visits Per Year 30 Visits Per Year 30 Visits Per Year Medical Plan Features Preventive Care - Immunizations - Children - Adults Chiropractic Prescription Drugs Plan Features Kaiser Kaiser Blue Shield Blue Shield Blue Shield Retail Pharmacy - Generic Formulary - Brand Name Formulary - Non-Formulary - Supply Limit $5 Copay $10 Copay N/A 30 Days $10 Copay $25 Copay N/A 30 Days $5 Copay $10 Copay $25 Copay 30 Days $10 Copay $20 Copay $35 Copay 30 Days $15 Copay $30 Copay $45 Copay 30 Days Mail Order Pharmacy - Generic Formulary - Brand Name Formulary - Non-Formulary - Supply Limit $10 Copay $20 Copay N/A 31-100 Days $20 Copay $50 Copay N/A 31-100 Days $10 Copay $20 Copay $50 Copay 90 Days $20 Copay $40 Copay $70 Copay 90 Days $30 Copay $60 Copay $90 Copay 90 Days 6 MEDICAL INSURANCE Blue Shield Blue Shield Blue Shield Blue Shield PPO 3B PPO 5B PPO 7B HDHP PPO Blue Shield Wellness PPO Lifetime Maximum $5,000,000 $5,000,000 $5,000,000 $5,000,000 $5,000,000 Deductible (Annual) - Individual - Family $100 $300 $100 $300 $250 $750 $1,250 $3,000 $500 $1,000 Co-Insurance (Plan Pays) 100% 90% 80% 80% 90% Office Visit Copay - Primary Care Physician - Specialist $20 Copay $20 Copay $30 Copay $30 Copay $30 Copay $30 Copay Ded, 80% Ded, 80% $20 Copay $40 Copay Out-of-Pocket Maximum - Individual - Family Ded Only Ded Only Ded + $300 Per Person Ded + $1,000 Per Person Ded + $3,000 Ded + $7,100 Ded + $500 Per Person Inpatient Hospitalization Ded, 100% Ded, 90% Ded, 80% Ded, 80% Ded, 90% Outpatient Lab and X-Ray Ded, 100% Ded, 90% Ded, 80% Ded, 80% Ded, 90% Ded, $75 Copay Ded, $75 Copay Ded, $75 Copay Ded, 80% Ded, $75 Copay $20 Copay $30 Copay $30 Copay Ded, 80% $20 Copay 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Ded, 100% Ded, 90% Ded, 80% Ded, 80% Ded, 90% 13 Visits Per Year 13 Visits Per Year 13 Visits Per Year 13 Visits Per Year 13 Visits/Year CVS / Caremark CVS / Caremark CVS / Caremark CVS / Caremark CVS / Caremark Retail Pharmacy - Generic Formulary - Brand Name Formulary - Non-Formulary - Supply Limit $7 Copay $15 Copay $30 Copay 30 Days $7 Copay $15 Copay $30 Copay 30 Days $7 Copay $15 Copay $30 Copay 30 Days Ded, 80% Ded, 80% Ded, 80% 30 Days $7 Copay $25 Copay $40 Copay 30 Days Mail Order Pharmacy - Generic Formulary - Brand Name Formulary - Non-Formulary - Supply Limit $15 Copay $35 Copay $70 Copay 90 Days $15 Copay $35 Copay $70 Copay 90 Days $15 Copay $35 Copay $70 Copay 90 Days Ded, 80% Ded, 80% Ded, 80% 90 Days $15 Copay $60 Copay $90 Copay 90 Days Medical Plan Features Emergency Services Urgent Care Preventive Care - Immunizations - Children - Adults Chiropractic Prescription Drugs Plan Features CVS / Caremark Generic Versus Brand Drugs: For any brand drug with a generic equivalent available, the generic will be dispensed regardless of what a physician writes. The physician can specify “Dispense as Written” (DAW) or a plan participant can choose a brand drug, but they will always pay the generic c opay plus the cost difference between the brand and generic when a brand name drug is selected and a generic is available. 7 MEDICAL INSURANCE Finding a Kaiser Permanente Medical Provider: Go to www.kaiserpermanente.org or call (800) 464-4000. Finding a Blue Shield HMO Medical Provider: Go to www.blueshieldca.com or call (888) 235-1765. Refer to the Access+ HMO network when prompted. Finding a Blue Shield PPO Medical Provider: Go to www.blueshieldca.com or call (888) 235-1765. Refer to the PPO network when prompted. Tips For Using Your Medical Plan Utilize your free preventive care benefits to stay healthy: Use urgent care centers versus hospital emergency rooms whenever possible: Preventive care benefits are covered at no charge to you. Regular preventive care can reduce the risk of disease, detect health problems early, protect you from higher costs down the road, and most importantly… save your life! Take advantage of these no cost benefits now to hopefully avoid major illnesses and costs in the future. Frequently, patients seek the services of the hospital emergency department for ailments or injuries that could be treated more economically, and just as effectively, at an urgent care center. It is not always easy to determine when you should choose urgent care over the hospital emergency department. The following lists offer some guidance, but are not necessarily all-inclusive. Examples of URGENT CARE situations: Examples of EMERGENCY situations: Any illness or injury that would prompt you to see your primary care physician Any accident or illness that may lead to loss of life or limb, serious medical complication or permanent disability INCLUDING BUT NOT LIMITED TO: Accidents and falls Sprains and broken bones Back problems Breathing difficulties Abdominal pain Minor bleeding/cuts High fever Vomiting, diarrhea or dehydration Severe sore throat or cough Mild to moderate asthma INCLUDING BUT NOT LIMITED TO: Chest pain* Seizures Shock No pulse Unconscious or catatonic state Sudden dizziness, loss of coordination or balance Severe abdominal pain Severe or uncontrollable bleeding Broken bones or compound fractures Severe difficulty breathing or shortness of breath Spinal cord or back injury Severe burns Major head injuries Ingestion of poisons or obstructive objects Animal, snake or human bites *If you believe you may be experiencing a heart attack, call 911 immediately! Do not drive yourself to the emergency room! Use generic and over the counter drugs when available: Use the mail-order prescription drug benefit for maintenance medications: 8 The best way to save on prescriptions is to use generic or over the counter medications as opposed to brand name drugs. The mail order pharmacy is a fast, easy and convenient way to save time and money on your maintenance medications. You can order additional supplies of medication at a discount. See carrier provisions for details. DENTAL INSURANCE PPO Dental Plans With the Delta Dental and MetLife Preferred Provider Organization (PPO) Dental plans, you may visit a PPO dentist and benefit from the negotiated rate or visit a non-network dentist. When you utilize a PPO dentist, your out-of-pocket expenses will be less. You may also obtain services using a non-network dentist; however, you will be responsible for the difference between the covered amount and the actual charges and you may be responsible for filing claims. Plan options available: Delta Dental PPO Dental Plan Delta Dental PPO Incentive Dental Plan: Under this plan, Delta Dental pays 70% of the allowed fees for covered diagnostic, preventive, basic, and major services during the first year you are eligible. This percentage will increase 10% each year (to a maximum of 100%) for each family member, provided that person visits the dentist at least once during the year. If a family member does not use the plan during a calendar year, the percentage remains at the level reached the previous year. If a family member becomes ineligible for benefits and later regains eligibility, the percentage will drop back to 70%. Plan Features Delta Dental PPO Network Calendar Year Maximum Benefit Deductible (Annual) - Individual - Family Non-Network $2,000 Delta Dental PPO Incentive Network Non-Network $2,700 $2,500 MetLife PPO Network Non-Network $2,500 None None None None None None None None None None None None 100% 4 Per Year 50% 4 Per Year 70% - 100% 2 Per Year 70% - 100% 2 Per Year 100% 3 Per Year 100% 3 Per Year Basic (Plan Pays) 100% 50% 70% - 100% 70% - 100% 90% 80% Major (Plan Pays) 100% 50% 70% - 100% 70% - 100% 60% 50% Prosthodontics 50% 50% 50% 50% 60% 50% Preventive (Plan Pays) Cleanings Orthodontia (Child(ren) / Adults) 80% with $2,000 Lifetime Maximum Not Covered 50% with $1,500 Lifetime Maximum Finding a Delta Dental Provider: Go to www.deltadentalins.com or call (866) 499-3001. Refer to the Premier or PPO network when prompted. Finding a MetLife Dental Provider: Go to www.mybenefits.metlife.com/dental or call (800) 942-0854. Tips For Using Your Dental Plan Use contracted network providers when possible. Ask for a predetermination of benefits. Have dental checkups regularly. Under the PPO plan, contracted network providers have rate agreements with insurance companies for services rendered. If you use a non-network provider, your out-of-pocket expenses will be higher and you may be subject to balance billing. We strongly recommend you ask your dentist for a predetermination if total charges are expected to exceed $300. Predetermination enables you and your dentist to know in advance what the payment will be for any service that may be in question. Routine dental visits not only preserve your smile, but they can provide an opportunity for the early detection of serious diseases such as diabetes. 9 VISION INSURANCE The MES Vision and VSP Vision plans provide professional vision care and high quality lenses and frames through a broad network of optical specialists. You will receive richer benefits if you utilize a network provider. If you utilize a non-network provider, you will be responsible to pay all charges at the time of your appointment and will be required to file an itemized claim with MES Vision or VSP Vision. Plan options available: MES Vision plan VSP Vision plan Note Regardless of your age or physical health, it’s important to have regular eye exams. Adults should have their eyes tested to keep their prescriptions current and to check for early signs of eye disease. For children, eye exams can play an important role in normal development. MES Vision PPO Plan Features Examination - Ophthalmologist - Optometrist VSP Vision PPO $20 Copay $20 Copay $60 Allowance $50 Allowance $20 Copay $20 Copay $45 Allowance $45 Allowance 100% 100% 100% $89.50 Allowance $43 Allowance $60 Allowance $75 Allowance $75 Allowance 100% 100% 100% $50-$160 Allowance $45 Allowance $65 Allowance $85 Allowance $85 Allowance Frames 100% $40 Allowance $120 Allowance $47 Allowance Contact Lenses (in lieu of frames/lenses) Lenses - Single Vision - Bifocal - Trifocal - Progressive - Cosmetic/Elective Frequency - Examination - Lenses - Frames - Contact Lenses $100 Allowance $100 Allowance 12 Months 12 Months 24 Months 12 Months (in lieu of frames/lenses) $105 Allowance $105 Allowance 12 Months 12 Months 24 Months 12 Months Finding an MES Vision Provider: Go to www.mesvision.com or call (800) 877-6372 to find a provider near you. The MES Vision network includes access to independent ophthalmologists and optometrists, as well as Costco, LensCrafters, Pearle Vision, Sam's Club, Sears Optical, Target Optical and Wal-mart retail stores. Finding a VSP Vision Provider: Go to www.vsp.com or call (800) 877-7195 to find a provider near you. VSP has the largest network of private-practice eye care doctors in the industry. VSP’s network includes 50,000 access points nationwide. VSP also contracts with Costco Optical, Eye Care Centers of America / Visionworks, and other affiliate retail providers. Please note, benefits may vary at affiliate locations. 10 VALUE OPTIONS EMPLOYEE ASSISTANCE PROGRAM The Employee Assistance Program (EAP) through ValueOptions provides employees and their family members with free, confidential assistance to help with personal or professional problems that may interfere with family or work responsibilities and obligations. Services include: Counseling Sessions: Employees and their family members can receive up to 6 counseling sessions per person, per year (maximum of 2 episodes/courses of treatment) Telephone Referrals: Services are available 24 hours a day, 7 days a week via a toll-free nationwide number Work/Life Services: Specialists refer employees to options and provide support, guidance, and informational materials to empower them to make informed choices about child care, elder care and assistance with other daily life issues Legal-Financial Solutions: Referral services, a free 30 minute legal consultation (either face-to-face or telephonic) and a 25% discount if further services are needed Achieve Solutions Website Access: A dynamic online resource with information, tools and other resources on more than 200 topics, including depression, stress, anxiety, alcohol, marriage, grief and loss, child/elder care and work/life balance Accessing the EAP: To access EAP benefits, go to www.achievesolutions.net/cvt or you may call (877) 397-1032 to be immediately connected to an EAP counselor. 11 VOLUNTARY BENEFITS Voluntary Term Life - Prudential You may elect to purchase Voluntary Term Life insurance at discounted group rates provided by Prudential. You pay for this coverage with after-tax dollars through convenient payroll deductions. Employee You may purchase coverage for yourself in increments of $10,000 up to a maximum benefit of $500,000, not to exceed 5 times your annual salary. Spouse If you buy coverage for yourself, you may also purchase coverage for your eligible spouse. Benefits for your spouse are available in increments of $10,000 to a maximum benefit of $500,000 and may not exceed 100% of your employee election. Children If you buy coverage for yourself, you may also purchase coverage for your eligible dependent child(ren) in the following amounts: $2,500, $5,000, $10,000. Guarantee issue is a pre-approved amount of coverage that does not require you to provide proof of good health, and is available to you during your initial eligibility period (upon hire). Guarantee issue is available in the following amounts: Employee = 2 times your annual salary to $100,000 Spouse = $20,000 Child(ren) = Entire benefit amount If you are no longer in your initial eligibility period, you may enroll in Voluntary Life insurance anytime during open enrollment as long as you provide proof of good health. To provide proof of good health, you will be asked to complete a health questionnaire and are subject to insurance carrier approval. Prudential may approve or decline coverage based on a review of your health history. Voluntary Term AD&D – Prudential You may elect to purchase Voluntary AD&D insurance at discounted group rates provided by Prudential. You pay for this coverage with after-tax dollars through convenient payroll deductions. Employee You may purchase coverage for yourself in the following benefit amounts: $10,000, $25,000, $50,000, $100,000, $250,000 or $500,000. Amounts exceeding $100,000 may not exceed 10 times your annual salary. Spouse If you buy coverage for yourself, you may also purchase coverage for your eligible spouse. Benefits for your spouse are available for 60% of the employee principal amount (less $2,000). Children If you buy coverage for yourself, you may also purchase coverage for your eligible dependent child(ren). Benefits for your children are available for 25% of the employee principal amount (less $2,000 and not to exceed $50,000). 12 VOLUNTARY BENEFITS Permanent Life Desert Sands Unified School District offers you the opportunity to purchase Permanent Life Insurance at discounted group rates. This plan protects your family or other beneficiaries in the event of your death. Permanent Life is portable, which means that you can keep it should you change jobs or retire, with no increase in premiums as long as the District participates in the group plan. Permanent Life options available: American Fidelity American Fidelity (underwritten by Texas Life) Accident Only Insurance – American Fidelity American Fidelity’s Limited Benefit Accident Only insurance plan may help you with the rising costs associated with an accident injury or death. Benefits include accident emergency treatment, medical imaging, inpatient confinement, ambulance and more. Several benefit plan options are available. Cancer Insurance – American Fidelity If you are diagnosed with cancer, American Fidelity’s Limited Benefit Cancer insurance plan may help you maintain your standard of living. Benefit payments can be used however you’d like, including house payments, utilities, and meals/lodging expenses. This policy is portable, which means that you can keep it should you change jobs or retire, with no increase in premiums. Several benefit plan options are available. Please note, this policy must be in place prior to a cancer diagnosis. Legal Plan – Hyatt Legal Desert Sands Unified School District offers you the opportunity to purchase Legal Services through Hyatt Legal Plans at discounted group rates. You pay for this coverage with after-tax dollars through convenient payroll deductions. This plan provides coverage for a number of legal matters such as will preparation, buying or selling a primary home, document review, civil litigation defense and telephone and office consultations for numerous matters (except employment related), business or pre-existing matters. Long Term Care - Unum Long Term Care Insurance provides benefits to help you pay for care during a chronic illness or if you are unable to perform, without substantial assistance from another individual, two or more activities of daily living such as eating, bathing, continence, dressing toileting, transferring, or if you require substantial supervision by another individual to protect your health and safety due to severe cognitive impairment (such as Alzheimer’s disease or mental illness). WELLNESS Desert Sands Unified School District is committed to promoting the mental and physical wellbeing of our employees. With the Fit for Life program, employees have access to: Flu Shots – free of charge at local CVS pharmacy Health screenings hosted at annual health fair: total cholesterol & high density lipids (TC/HDL), blood pressure, body mass index (BMI) and glucose. The district’s Wellness Committee provides employee fitness programs, educational lectures and voluntary group hikes through WOW! Working on Wellness! Event dates and activities are listed on the District calendar. All programs are opened to the DSUSD community. Be a WOW! participant! 13 FLEXIBLE SPENDING ACCOUNTS Important Note About the FSA FSAs offer sizable tax advantages. The tradeoff is that these accounts are subject to strict IRS regulations, including the use-it-orlose-it rule. According to this rule, you must forfeit any money left in your account(s) after your expenses for the year have been reimbursed. The IRS does not allow the return of unused account balances at the end of the plan year, and remaining balances cannot be carried forward to a future plan year. We encourage you to plan ahead to make the most of your FSA dollars. If you are unable to estimate your health care and dependent care expenses accurately, it is better to be conservative and underestimate rather than overestimate your expenses. You can set aside money in Flexible Spending Accounts (FSA) before taxes are deducted to pay for certain health and dependent care expenses, lowering your taxable income and increasing your take home pay. Only expenses for services incurred during the plan year are eligible for reimbursement from your accounts. You choose how you want to receive reimbursement for your eligible expenses. You may use a debit card provided by American Fidelity, sign up for direct deposit to your bank account or you may have a check sent to your home. Please remember that if you are using your debit card, you must save your receipts, just in case American Fidelity needs a copy for verification. Also, all receipts should be itemized to reflect what product or service was purchased. Credit card receipts are not sufficient per IRS guidelines. Medical Expense Reimbursement Account This plan is used to pay for expenses not covered under your health plans, such as deductibles, coinsurance, copays and expenses that exceed plan limits. Employees may defer up to $2,500 pre-tax per year. If you are enrolled in the Blue Shield HDHP plan you are not able to enroll in the Medical Expense Reimbursement Account. Dependent Daycare Reimbursement Account This plan is used to pay for eligible expenses you incur for child care, or for the care of a disabled dependent, while you work. Employees may defer up to $5,000 pre-tax per year. Example: Dan estimates that he will have approximately $1,200 in out-of-pocket health care expenses next year and is looking to increase his take-home pay. Without the Health Care FSA With the Health Care FSA $35,000 $35,000 Pre-tax Health Care FSA $0 $1,200 Taxable Gross Income $35,000 $33,800 Payroll Taxes (at 30%) $10,500 $10,140 Health Care Cost $1,200 $0 Net Pay $23,300 $23,660 $0 $360 Gross Pay (Annual) Annual Net Pay Increase Note Your current FSA elections will expire on June 30th. If you plan to participate in the FSA for the upcoming plan year, you are required to re-enroll. 14 ONLINE MEMBER PORTAL With MyCVT, you and your family can access your medical benefits information whenever you want, from home or any place where you have internet access. Use MyCVT to make your benefit elections, update your personal information, and to locate important benefits documents on the Resource Library. User Login: Website Address: https://mycvt.cvtrust.org To create an account, click on the “Create Account” link under the login fields. Enter information required to create an account: o Email address that is unique to you o Your District name or group identifier o Your social security number An email will arrive in the mailbox provided. Open the email and click on the link to complete the registration and access the portal. You should now be logged into the MyCVT portal. Please remember your account login for all future visits. To start your enrollment click on “Apply for Coverage”. It is very important that each employee login to MyCVT and verify their personal information, elect or decline benefits, and identify a life insurance beneficiary. 15 TENTATIVE EMPLOYEE CONTRIBUTIONS This chart compares the tentative tenthly contributions for our employee benefit plans based on the 2013-2014 agreement. Your cost for coverage will vary depending on the option and level of coverage you choose. Employee contributions for Medical are deducted from your paycheck with pre-tax dollars. This means that contributions are taken from your earnings before taxes – resulting in lower taxes and increased take home pay. 25% Premium Discount: If you have double coverage through a CVT medical plan, due to you and your spouse both being active CVT PPO subscribers, both employees will receive a 25% decrease on their monthly medical premium. This applies when both employees are enrolled in a CVT PPO plan and the discount is based on the basic PPO composite premium. Hours Per Day 50% 60% 80% 100% District Pays Employee Pays 50% 50% 60% 40% 80% 20% 100% 0% $874.58 $780.98 $941.97 $873.57 $789.57 $1,093.42 $1,029.82 $842.95 $771.12 $932.62 $782.37 $688.77 $825.32 $756.92 $672.92 $977.54 $913.94 $714.18 $681.98 $816.74 $597.96 $504.36 $592.02 $523.62 $439.62 $745.79 $682.19 $456.64 $503.70 $584.99 $413.55 $319.95 $358.73 $290.33 $206.33 $514.04 $450.44 $199.10 $325.43 $353.24 $77.00 $75.38 $64.63 $62.24 $60.21 $52.44 $32.73 $29.86 $28.05 $3.21 $0.00 $3.66 $6.12 $16.40 $4.76 $13.91 $2.03 $8.94 $0.00 $3.97 Medical Benefits Kaiser Traditional HMO Kaiser HMO Wellness Blue Shield HMO Plan 1 Blue Shield HMO Plan 2 Blue Shield HMO Plan 3 Blue Shield PPO Plan 3B Blue Shield PPO Plan 5B Blue Shield PPO Plan 7B Blue Shield HDHP PPO Blue Shield PPO Wellness Dental Benefits Delta Dental PPO Delta Dental PPO Incentive MetLife PPO Vision Benefits MES Vision VSP Vision HSA Contribution (Distribution July & January) Single Family 16 $1,200 $2,400 RESOURCES AND CONTACTS Below is a list of insurance carrier contacts should you require assistance with your benefit questions following open enrollment. California’s Valued Trust (CVT) Member Services ………………………....……………………… (800) 288-9870 CVT Website …………………………………..…………………… www.cvtrust.org Medical - Kaiser Permanente Member Services ……………………………………….………… (800) 464-4000 Chirometrics - Chiropractic Member Services …….… (877) 519-8839 Kaiser Permanente Website ………………………………... www.kaiserpermanente.org Medical - Blue Shield HMO/PPO Member Services ……………………………….. HMO/PPO Pre-Admission / Prior Authorization …… HMO/PPO NurseHelp 24/7 …………………………………… PPO Claims Processing (Healthcomp) …………………… PPO Blue Card Program (outside California) …….…… PPO Health Management Program (Alere) …………… Blue Shield Website ………..…………………………………... Prescription Drugs (CVS Caremark) ………….…………… CVS Caremark Website …………………………….…………… (888) 235-1765 (800) 541-6652 (877) 304-0504 (800) 442-7247 (800) 810-2583 (877) 864-1327 www.blueshieldca.com (888) 354-6390 www.caremark.com Note If you are unable to resolve your issues or questions with the insurance carriers, please contact the Risk Management Department. Dental - Delta Dental Member Services ………………………………………………... (866) 499-3001 Delta Dental Website …………………………………………… www.deltadentalins.com Dental - MetLife Member Services …………………….…………………………… (800) 942-0854 MetLife Website ……………………..……………………….…… www.mybenefits.metlife.com/dental Vision - MES Vision Member Services ……………………………….………………… (800) 877-6372 MES Vision Website ………………………………….………….. www.mesvision.com Vision - VSP Vision Member Services ……………………………….………………… (800) 877-7195 VSP Vision Website …………………………………………….… www.vsp.com Employee Assistance Program - Value Options Counselor Services ………….……………………………..……. (877) 397-1032 EAP Website ………………………………………………………… www.achievesolutions.net/cvt Flexible Spending Accounts - American Fidelity Member Services ……………………………….………………… (800) 325-0654 American Fidelity Website …………………………………... www.afadvantage.com Voluntary Products - American Fidelity Member Services ……………………………….………………… (800) 365-9180 American Fidelity Website …………………………………... www.afadvantage.com Legal Plan - Hyatt Legal Member Services ……………………………….………………… (800) 821-6400 Hyatt Legal Website ………………………………………..…... www.legalplans.com 17 NOTES 18 SECTION 125 FLEXIBLE BENEFIT PLAN Interest Form For New Employees Please mark the appropriate line and or boxes and return to your American Fidelity Representative. I would like more information about pre-taxing my benefits under the Section 125 plan. I would like more information about the following voluntary products: Accident Only Insurance*, + Cancer Insurance*, + Disability Income Insurance* Permanent, Portable Life Insurance (underwritten by TX Life Insurance Company)*, ** I would like more information on the following reimbursement accounts available through the Section 125 plan: Medical Expense Reimbursement Maximum $2,500 per Plan Year Dependent Care Reimbursement Maximum $5,000 per Plan Year ($2,500 if you are married and file a separate tax return) I am not interested in participating in the Section 125 plan at this time. *These products may contain limitations, exclusions and waiting periods. **Not eligible under Section 125. +This product is inappropriate for people who are eligible for Medicaid coverage. I would like to be contacted by American Fidelity Assurance Company to learn more about American Fidelity’s products and services. With my signature below, I understand that a representative will call me to schedule my appointments and/or discuss my benefit options. Print Name Signature* Work Phone Home Phone Job Location Classified/Certificated/Mgmt Date Date of Hire *With my signature, I consent to being contacted, including by phone, regardless of my status on any Do-Not-Call list. AMERICAN FIDELITY ASSURANCE COMPANY Lola Rosado | CA License #0700334, Ext 365 San Marcos Branch Office | 1 Civic Center Drive, Suite 360 | San Marcos, CA 92069 (866) 523-1857 | (760) 798-7515 19 2211 Michelson Drive, Suite 1200, Irvine, CA 92612 / Telephone: (949) 833-2983 / Fax: (949) 833-9549 www.burnhambenefits.com This brochure provides an overview of some of your benefit plan choices. It is for informational purposes only. It is not intended to be an agreement for continued employment. Neither is it a legal plan document. If there is a disagreement between this guide and the plan documents, the plan documents will govern. In addition, the plans described in this brochure are subject to change without notice. Continuation of any benefit plan or coverage is at the company’s discretion and in accordance with federal and state laws. If you need additional information or have any questions about the benefit program, please contact the Risk Management Department. Copyright © Burnham Benefits Insurance Services - all rights reserved