benefits guide

BENEFITS GUIDE Employee Handbook Open Enrollment 125 Cafeteria Plan Medical & Dental Insurance Supplemental Insurance SUFFOLK Flexible Spending Accounts PUBLIC SCHOOLS
Annuity Plans Virginia Retirement System Calendar Employee Handbook 1
2012 – 2013 School Year This booklet is intended to be only an overview of the
benefit plans offered by Suffolk Public Schools.
Booklet printed courtesy of AccuFlex Services, Inc.
2
Table of contents
Your Team
1
Superintendent Greeting
School Board Members
BenefitsStaff
GeTTinG STarTed
Online Enrollment Process
4
inSurance memorandum
Health, Dental & Supplemental Insurance Memo
5
chanGe in FamilY STaTuS
QualifyingStatusChange
8
medical inSurance
Anthem HealthKeepers
AnthemKeyCare
Autism Spectrum Disorder
Prescription
VisionCoverage(Thiscoverageappliestobothhealthplans)
9
denTal inSurance
Anthem Dental Basic Option
Anthem Dental High Option
21
SupplemenTal inSurance
NTACancer
NTAHeartDisease&Stroke
NTAICU
NTAAccident
NTADisability
NTASupplementalRates
25
Flexible SpendinG accounTS
AccuFlex Medical Expense Flexible Spending Account
PrepaidBenefitsCard
DependentCareFlexibleSpendingAccount
FrequentlyAskedQuestions
41
annuiTY planS - Tax deFerred
SavinGS
OMNI
403(b)/457(b)
ProviderList
51
virGinia reTiremenT SYSTem
RetirementBenefits
LifeInsurance
OptionalLifeInsurance
MyVRS
53
calendar
SchoolCalendar/EmployeeCalendar
Payschedule
54
emploYee handbook
EmployeeHandbook
SickLeaveBank
57
WorkerS’ compenSaTion
Procedures&PanelofPhysicians
70
SuFFolk ciTY emploYeeS Federal crediT union
Whatweoffer
71
leGal reSourceS
VoluntaryGroupLegalServices
72
Federal required poSTer
ChildAbuse/Workers’Comp./DepartmentofLaborPoster
73
Suffolk Public Schools does not discriminate on the basis of race, color, national origin, sex, disability, or age in its programs and
activities. The following person has been designated to handle inquiries regarding the nondiscrimination policies:
2473 (5.12)
Kevin L. Alston
Assistant Superintendent of Administrative Services
100 N. Main Street
P.O. Box 1549
Suffolk, VA 23434
3
Phone: (757) 925-6750
Email: [email protected]
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Deran R. Whitney, Ed.D. Superintendent of Suffolk Public Schools Dear Colleagues: The school division is providing this 2012­13 school year Benefits Guide/Employee Handbook as a helpful resource to each of our valued staff members. The Benefits Guide contains information on our benefits, open enrollment process, health & dental insurance benefits and premium rates, supplemental insurance products and tax sheltered annuity products. The Employee Handbook is also included, along with many other important pieces of information. I trust you will take time to read this booklet and keep it convenient so you may refer to it during the school year. If you have questions or need further information about anything in this booklet, feel free to contact the related department listed here. We are here to assist you with answering your questions. I appreciate the efforts of every member of the Suffolk Public Schools’ team. As our motto says: Every Child a Star…Together, We Help Them Shine! We look forward to an exciting 2012­13 school year. Sincerely, Deran R.Whitney, Ed.D. Information contained in this booklet is intended for general use only. The Policy Manual of the Suffolk City School Board and its regulations will always take priority over this booklet, as the policy manual provides specific wording and updated standards by the School Board.
1
Suffolk School Board as of January 2011 Michael J. Debranski, Ed. D. Chairman Suffolk Borough Thelma Hinton Vice Chairman Nansemond Borough Linda Bouchard Chuckatuck Borough Diane B. Foster Sleepy Hole Borough Phyllis C. Byrum Whaleyville Borough Lorraine B. Skeeter Cypress Borough
Enoch Copeland Holy Neck Borough 2
Suffolk Public Schools Benefits Staff Benefits Department Phone Number Extension Annuities Finance 925­6756 668215 Credit Union Finance 925­6756 668215 Direct Deposit Finance 925­6754 668207 Employee Assistance Program (EAP) Bon Secours 398­2374 Flexible Spending Accounts Finance 925­6756 668215 Garnishments/Child Support/Tax Liens Finance 925­6756 668214 Health Insurance / Dental Insurance Finance 925­6756 668213 Leave Finance 925­6754 668207 Leave of Absence/Family Medical Leave Human Resources 925­6758 668302 668305 Life Insurance/Optional Life Ins. Human Resources 925­6758 668302 668305 Sick Leave Bank Human Resources Finance 925­6758 925­6756 668309 668213 Suffolk Education Foundation Public Information Finance 925­6752 925­6756 668704 668215 Supplemental Insurance Finance 925­6756 668215 Tax Withholding Allowance Finance 925­6756 668214 United Way Public Information Finance 925­6752 925­6756 668704 668215 Virginia Retirement System Human Resources 925­6758 668302 668305 W­2 Replacements Finance 925­6754 668207 Workers’ Compensation Human Resources 925­6758 668302
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To access the website, go to
www.accuflexservices.com
Information Needed to Register:
Group ID: 2218
Name
Date of birth
Employee ID# or last 4 digist of SSN
Email address
(If you do not have an email address,
please use [email protected])
Choose a security question and answer
Employees will need to set up a login ID
and password in order to return to the
online enrollment during the open
enrollment period.
All Passwords must contain 3 out of
the 4 following:
Lower Case Letter; Upper Case Letter;
Number (1-9); Symbol;
and be 6-20 characters in length.
4
MEMORANDUM TO: All Employees Eligible for Insurance Benefits FROM: Deran R. Whitney, Ed.D., Superintendent Wendy K. Forsman, Executive Director of Finance Hilda W. Harmon, Assistant Director of Finance DATE: May 1, 2012 RE: Health, Dental and Supplemental Insurance Open Enrollment for 2012­2013 Please Read this Memo Thoroughly and Completely! Disregarding this memo could result in loss of employee benefits! Returning Employees – On­line open enrollment for all insurance coverages for the 2012­2013 school year will be held May 21, 2012 through May 28, 2012 for coverage from October 1, 2012 through September 30, 2013. This will be your only on­line opportunity to enroll for the 2012­2013 school year. After this on­line enrollment period, employees interested in continuing health, dental or any other supplemental products must meet with an enroller (during the established schedule) to do so. Your principal/supervisor will inform you when an enroller will be available at your school/location. Furthermore, once the enroller schedules are completed, an employee will only be allowed to add/change coverage if there is an eligible status change, such as marriage, divorce, birth or death. Such add/change must be submitted within 30 days of the qualifying event. Written documentation of each status change is required. This year, we will continue to use the AccuFlex online open enrollment, however it will only be available from May 21, 2012 to May 28, 2012. AccuFlex will again serve as our benefit enrollers for employee benefit selections for the upcoming school year. The enrollers will be visiting each building for open enrollment assistance, individual meetings (if desired) and to complete any required AccuFlex application forms. Employees should complete the online open enrollment as soon as possible so any questions may be answered when the enrollers are in the buildings. Every employee must complete the online open enrollment for individual benefit selections, even if no benefits are desired. (continued)
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Page 2 All eligible employees must complete the online open enrollment process (May 21, 2012 through May 28, 2012) to make their benefit elections and deductions. This includes your election to enroll in the Anthem health and dental plans, the supplemental insurance plans, such as cancer and disability, and in the pre­tax non­reimbursed medical, dependent care accounts and premium conversion accounts. This will be your only opportunity to enroll in these plans; therefore it is very important that you make your selection before the open enrollment deadline. This is also your opportunity to elect pre­tax or post­tax treatment of deductions. Employees are reminded: Once you elect pre­tax treatment, you cannot add, change or delete coverages during the plan year, unless an eligible status change occurs. Written documentation of each status change is required. All health & dental insurance changes are effective October 1, 2012 with the first payroll deduction beginning September 14, 2012. Supplemental products and other pre­tax deduction changes are effective September 1, 2012, with the first payroll deduction also beginning September 14, 2012. New Employees – Enrollment for all insurance coverages for the 2012­2013 school year must be completed within 30 days of your official hire date for coverage from October 1, 2012 through September 30, 2013. This will be your only opportunity to enroll for the 2012­2013 school year. After 30 days, an employee will only be allowed to add/change coverage if there is an eligible status change, such as marriage, divorce, birth or death. Such add/change must be submitted within 30 days of the qualifying event. Written documentation of each status change is required. Returning & New Employees – Changes to Health & Dental Insurance Enrollment – Every employee who makes any change in health or dental insurance, or who enrolls for the first time, needs to be certain they have entered all of the required information in the online enrollment system. All HealthKeepers HMO plans require the selection of a primary care physician (PCP) at the time of enrollment. Please be careful that all dependents for which you desire coverage are listed under each plan selected. If not, go back and correct. The summary page generated at the conclusion of the online enrollment should be reviewed carefully to ensure all of the desired changes are shown. This will be the only opportunity to make changes during the open enrollment period. After open enrollment ends, an employee will only be allowed to add/change coverage if there is an eligible status change. Health Insurance – We will continue to offer Anthem Blue Cross & Blue Shield HealthKeepers 10 HMO and KeyCare 15 PPO. No changes will be made to the existing health insurance plan benefits for the 2012­2013 plan year, other than certain benefit enhancements required by the Health Care Reform Act. Due to our past health claims history, future projected health claims and contract renewal negotiations, employee premiums for the new plan year will remain the same as the current plan year. (continued)
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Page 3 Dental Insurance – We will continue to offer Anthem Blue Cross & Blue Shield Basic and High dental plan options. No changes will be made to the existing dental insurance plan benefits for the 2012­2013 plan year, other than Anthem has expanded their provider access network. Due to our past dental claims history, future projected dental claims and contract renewal negotiations, employee premiums for the new plan year will remain the same as the current plan year. Each employee will be provided a Benefits Guide & Employee Handbook which will include information on the health & dental plan benefits, along with information on the supplemental insurance products and other pre­tax voluntary deductions. This booklet is in the same layout as the online open enrollment, so employees may review benefits while making their open enrollment deduction selections. 2012-13 Employee Monthly Rates (on a 10-month basis)
For All Insurance Options Anthem Health Insurance HMO 10 PPO 15 Employee Only Employee Plus One Employee Plus One Dual Family Family Dual $ 24.30 293.40 24.30 412.50 24.30 $102.30 454.40 185.30 630.50 242.30 Anthem Dental Insurance Basic High $ 9.50 23.78 14.26 49.46 39.94 $ 19.38 41.06 31.54 80.06 70.54 (The “dual” options apply when a married couple are both employed by Suffolk Public Schools, are both eligible for insurance benefits and are both on the same plan.) Electronic Information – Health & dental plan benefits information and provider directories, along with information on dependent children insurance eligibility, insurance coverage after retirement, and insurance coverage after separation from employment is available on the Finance Department webpage. We also encourage employees to access the internet websites for health & dental information, including the provider lists, which are continuously updated. Questions concerning this memorandum should be directed to Melissa Gardner in the Finance Department via SPS e­mail, extension 668213 or 925­6756. For additional information regarding these plans or specific benefit questions, you may contact the health and dental companies as follows: Anthem (health) HealthKeepers Product 10 HMO KeyCare 15 PPO (local) 326­5260 1­800­451­1527 7
Anthem (dental) Basic & High 1­866­956­8607
Qualifying Status Change
Eligible Status Changes
During the plan year, employees are eligible to make changes to their pre-tax
deductions if there is a qualifying event. Examples of qualifying events according to
Internal Revenue Service regulations are:
 Change in Legal Marital Status
o Marriage, Death, Divorce and Legal Separation
 Change in Tax Dependents
o Birth, Adoption and Death
 Changes in Employment Status That Affect Eligibility
o Spouse Job Status
o Spouse Eligibility for Benefits
 Change in Dependent Eligibility Requirement
o Dependent Ineligible for Coverage
 Open Enrollment Under Spouse’s Plan
 Certain Court Orders
o Health Insurance Order
 Eligibility for Medicare and Medicaid
Written documentation is required for all status changes and must be presented within 30
days of the qualifying event.
For more information regarding change of status, contact the Payroll office at
668213.
8
Your Anthem Benefits
Anthem HealthKeepers 10
Suffolk Public Schools
Covered Services
You Pay
Preventive Care Services
Preventive care services that meet the requirements of federal and state law, including certain screenings, immunizations
and physician visits.
 well-child visits
 Pap tests
 screening tests
 immunizations
 mammograms
 Prostate Specific Antigen (PSA) test
 checkups
 prostate exams
 gynecological exams
*During the course of a routine screening procedure, abnormalities or problems may be identified that require immediate
intervention or additional diagnosis. If this occurs, and your provider performs additional necessary procedures, the service
will be considered diagnostic and/or surgical, rather than screening, depending on the claim for the services submitted by
your provider, which will result in a member cost share.
Doctor Visits
 office visits
 in-office surgery
 home visits
 voluntary family planning
 urgent care visits
Labs, Diagnostic X-rays and Other Outpatient Diagnostic Test
 diagnostic x-rays
 lab work
 diagnostic tests
A copay does not apply when these services are provided by the same provider on the same day as the office
visit.

advanced diagnostic imaging services
Your payment responsibility is waived if services are billed as a part of an emergency room visit.
No charge*
$10 for each visit to your PCP
$20 for each visit to a specialist
$10 for each visit to your PCP
$20 for each visit to a specialist
$100 for each visit
Other Outpatient Services
 hospice services

 insulin pumps and oxygen

durable medical equipment
partial day mental health and substance abuse services
No charge

ambulance travel
No charge

home health care services
No charge

prosthetic devices
 injectable medication*
(*excluding chemotherapy medications, allergy injections and serum dispensed in a physician’s office)
*You will also pay an additional $10 or $20 office visit copayment depending on the type of provider who treats
you.
20% of the amount the health
care professionals in our
network have agreed to accept
for their services
Therapy Service
 occupational therapy
 physical therapy
 speech therapy
Limited to 30 combined visits per calendar year for physical therapy and occupational therapy services, and 30
visits per calendar year for speech therapy services.
 chemotherapy, radiation, cardiac and
$20 for each visit
$20 for each visit
respiratory therapy.
 dialysis
$20 for each calendar month
spinal manipulation and
manual medical therapy services
Limited to 30 visits per calendar year.
$20 for each visit
Outpatient Infusion Services
facility
ambulatory infusion centers
home services
Outpatient Surgery in a Hospital or Facility
$20 for each visit
No charge
No charge
 surgery
$100 for each visit
For the benefits listed with specific limits, all services received during the calendar year from January 1 to December 31 for that benefit are applied to
that limit.
SPS Oct 2011/2012
9
HealthKeepers, Inc., is an independent licensee of the Blue Cross and Blue Shield
Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies,
Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the
Blue Cross and Blue Shield Association.
Covered Services
You Pay
Inpatient Stays in a Hospital or Facility
 semi-private room
 private room when approved when approved in advance
 intensive or coronary care unit

$250 per admission
No charge
skilled nursing facility (100 days for each admission)
Maternity

$50 per pregnancy
all routine pre- and postnatal care (excluding inpatient stays)
 diagnostic testing (such as ultrasounds, non-stress tests and other
fetal monitor procedures)
Outpatient Mental Health and Substance Abuse
 medication management
 individual therapy up to 30 minutes in length
 group therapy
 other mental health and substance abuse visits
Routine Vision
 an annual routine eye exam
Plus valuable discounts on eyewear
Emergency Care and Out of the Service Area Urgent Care


$20 for each visit
$20 for each visit
$15 for each visit
urgent care visit
$20 for each visit
true emergency care visits in or out of the service area
$100 for each visit to an
emergency room*
*Waived if admitted directly to the hospital.
Out-of-Pocket Maximums
What You Will Pay for Covered Services in One Calendar Year (January 1 - December 31)
When using in-plan professionals
If you are the only one covered by your plan, you will pay $1,500 for covered services outlined in this insert. Once you have reached this amount, your payment
for covered services is $0, except for those services listed below that do not count toward the annual out-of-pocket maximum.
 If two people are covered under your plan, each of you will pay $1,500 ($3,000 total).
 If three or more people are covered under your plan, together you will pay $3,000. However, no family member will pay more than $1,500 toward the limit.
The following do not count toward the calendar year out-of-pocket maximum. You will still need to pay:
 the costs associated with vision benefits
 the cost of prescription drugs
 the cost of dental benefits
 the cost of care received when the benefit limits have been reached
Some benefits may be subject to balance billing, if provided by a non-participating provider. For more information on balance billing, see the enrollment brochure.
This summary of benefits has been updated to comply with federal and state requirements, including applicable provisions of the recently enacted federal health care reform laws. As
we receive additional guidance and clarification on the new health care reform laws from the U.S. Department of Health and Human Services, Department of Labor and Internal
Revenue Service, we may be required to make additional changes to this summary of benefits.
HealthKeepers, Inc. believes this plan is a ‘‘grandfathered health plan’’ under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable
Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that
this plan may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services
without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime
limits on benefits.
Questions regarding which protections of the Affordable Care Act apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change
from grandfathered health plan status can be directed to HealthKeepers, Inc. at the telephone number printed on the back of your member identification card, or contact your group
benefits administrator if you do not have an identification card. For ERISA plans, you may also contact the Employee Benefits Security Administration, U.S. Department of Labor at
1–866–444–3272 or www.dol.gov/ebsa/healthreform. This Web site has a table summarizing which protections do and do not apply to grandfathered health plans. For nonfederal
governmental plans, you may also contact the U.S. Department of Health and Human Services at www.healthcare.gov.
10
Your Anthem Benefits
Anthem KeyCare 15 Plan
Suffolk Public Schools
In-Network Services
You Pay
Preventive Care Services
Preventive care services that meet the requirements of federal and state law, including certain screenings, immunizations
and physician visits.
 well-baby visits
 immunizations
 checkups


 Pap tests
 mammograms

gynecological exams
prostate exams
No charge*
Prostate Specific Antigen (PSA) tests
screening tests
*During the course of a routine screening procedure, abnormalities or problems may be identified that require immediate
intervention or additional diagnosis. If this occurs, and your provider performs additional necessary procedures, the service
will be considered diagnostic and/or surgical, rather than screening, depending on the claim for the services submitted by
your provider, which will result in a member cost share.
Routine Vision
 annual routine eye exam
Plus valuable discounts on eyewear
Doctor Visits
 office visits
 physical and occupational therapy in an office setting
 urgent care visits
(30 combined visits)*
 home visits
 speech therapy visits in an office setting (30 visit limit)*
 pre- and postnatal office visits**
 spinal manipulations and other manual medical intervention visits
 in office surgery
(30 visit limit)*
*Limited to 30 combined visits per calendar year for physical therapy and occupational therapy services, and 30 separate
visits each per calendar year for speech therapy and spinal manipulation services.
**If your physician submits one bill for prenatal, delivery, and postnatal care, services are covered as maternity delivery
services. (See Inpatient stay section.)
Labs, X-rays and Other Outpatient Services
 diagnostic lab services
 respiratory therapy
 diagnostic x-rays
 infusion services
 dialysis
 shots and therapeutic injections, including infusion medications
 chemotherapy (not given orally)
 durable medical equipment
 professional ground ambulance services
 radiation therapy
 medical appliances, supplies and medications

Outpatient Services in a Hospital or Facility
 physical therapy and occupational therapy (30 combined visits)*
 speech therapy (30 visit limit)*
* Limited to 30 combined visits per calendar year for physical therapy and occupational therapy services, and 30 visits per
calendar year for speech therapy services.
 emergency room
 surgery
*For the services billed by the doctor, you will pay an additional $15 or $30 depending on the type of doctor who
treats you.
Mental Health and Substance Abuse Outpatient Services
 office visits


No charge*
$15 for each visit
$15 for each visit to a family or
general practitioner, internist or
pediatrician
$30 for each visit to a specialist
20% of the amount the health
care professionals in our
network have agreed to accept
for their services
$30 plus 20% of the amount the
health care professionals in our
network have agreed to accept
for their services
$100 plus 20% of the amount
the health care professionals in
our network have agreed to
accept for their services*
$15 for each visit
outpatient facility (including partial day treatment and intensive outpatient programs)
outpatient facility professional provider services
20% of the amount the health
care professionals in our network
have agreed to accept for their
services
For the benefits listed with specific limits, all services received during the calendar year from January 1 to December 31 for that benefit
(whether received in-network or out-of-network) are applied to that limit.
SPS Oct 2011/2012
In most of Virginia: Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Virginia, Inc. (serving Virginia excluding
the city of Fairfax, the town of Vienna and the area east of State Route 123).Independent licensee of the Blue Cross and Blue Shield
Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols
are registered marks of the Blue Cross and Blue Shield Association.
11
In-Network Services
You Pay
Care at Home

hospice care
No charge

home health care visits by a nurse or aide (90 visits)
No charge
 private duty nursing ($500
maximum)*
*Since there is no network for this service, you may be billed for the difference between what we pay for this
service and the amount the private duty nursing service charged.
Inpatient Stays in a Network Hospital or Facility
 semi-private room, intensive care or similar unit
If your physician submits one bill for prenatal, delivery, and postnatal care, services are covered as maternity
delivery services.
 physician, nursing and other
medically necessary professional services in the hospital including anesthesia, surgical and
maternity delivery services
 skilled nursing facility care (100 days for each admission)
20% of the amount the health
care professionals in our
network have agreed to accept
for their services
$300 plus 20% of the amount
the health care professionals in
our network have agreed to
accept for their services
20% of the amount the health
care professionals in our
network have agreed to accept
for their services
Out-of-Network Services
Using Doctors, Hospitals and Other Health Care Professionals not Contracted to Provide Benefits
It’s important to remember that health care professionals not in our network can charge whatever they want for their services. If what they charge is more
than the fee our network health care professionals have agreed to accept for the same service, they may bill you for the difference between the two amounts.
You will pay all the costs associated with the covered services outlined in this insert until you have paid $400 in one calendar year. This is called your
out-of-network deductible.
 If two people are covered under your plan, each of you will pay the first $400 of the cost of your care ($800 total).
 If three or more people are covered under your plan, together you will pay the first $800 of the cost of your care.
However, the most one family member will pay is $400.
Once you have reached this amount, when you receive covered services we will pay 70% of the fee our network health care professionals have agreed to
accept for the same service. You will pay the rest, including any difference between the fee our network health care professionals have agreed to accept for
the same service and the amount the health care professional not in our network charges. If you go to an eye care professional not in our network for your
routine eye examination, we will pay $30 (whether or not you have reached the $400 out-of-network deductible) and you will pay the rest of what the
professional charges.
12
Out-of-Pocket Maximums
What You Will Pay for Covered Services in One Calendar Year (January 1 - December 31)
When using network professionals
If you are the only one covered by your plan, you will pay $2,000 for covered services outlined in this insert. Once you have reached this amount, your payment
for covered services is $0, except for those services listed below that do not count toward the annual out-of-pocket maximum*.
 If two people are covered under your plan, each of you will pay $2,000 ($4,000 total).
 If three or more people are covered under your plan, together you will pay $4,000. However, no family member will
pay more than $2,000 toward the limit.
When not using network professionals
If you are the only one covered by your plan, you will pay $4,000 for covered services outlined in this insert. Once you have reached this amount, your payment
for covered services is $0, except for those services listed below that do not count toward the annual out-of-pocket maximum*.
 If two people are covered under your plan, each of you will pay $4,000 ($8,000 total).
 If three or more people are covered under your plan, together you will pay $8,000. However, no family member will
pay more than $4,000 toward the limit.
*The following do not count toward the calendar year out-of-pocket maximum:
 your share of the cost of prescription drugs and routine vision care
 the cost of care received when the benefit limits have been reached
 the cost of services and supplies not covered under your Anthem KeyCare 15 plan
 the additional amount health care professionals not in our network may bill you when their charge is more than what we pay
This summary of benefits has been updated to comply with federal and state requirements, including applicable provisions of the recently enacted federal health care reform laws. As
we receive additional guidance and clarification on the new health care reform laws from the U.S. Department of Health and Human Services, Department of Labor and Internal
Revenue Service, we may be required to make additional changes to this summary of benefits.
Anthem Blue Cross and Blue Shield believes this plan is a ‘‘grandfathered health plan’’ under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted
by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered
health plan means that this plan may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of
preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for
example, the elimination of lifetime limits on benefits.
Questions regarding which protections of the Affordable Care Act apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change
from grandfathered health plan status can be directed to Anthem Blue Cross and Blue Shield at the telephone number printed on the back of your member identification card, or
contact your group benefits administrator if you do not have an identification card. For ERISA plans, you may also contact the Employee Benefits Security Administration, U.S.
Department of Labor at 1–866–444–3272 or www.dol.gov/ebsa/healthreform. This Web site has a table summarizing which protections do and do not apply to grandfathered health
plans. For nonfederal governmental plans, you may also contact the U.S. Department of Health and Human Services at www.healthcare.gov.
13
Autism Spectrum Disorder
Covered Services
You Pay
Autism Spectrum Disorder (ASD) – For children from age 2 through 6
Diagnosis of autism spectrum disorder;
Treatment of autism spectrum disorder;
o
o
o
o
o
Behavioral Health Treatment*
Pharmacy Care
Psychiatric Care
Psychological Care
Therapeutic Care**
Member cost shares will be dependent
on the services rendered. Please refer
to the Summary of Benefits.
* Mental Health Services
**Unlimited physical, occupational and speech therapy.
Applied Behavioral Analysis
o
Limited to a $35,000 per member annual maximum.
20% after applicable deductible if any
Out-of-Network Services
Using Doctors, Hospitals and Other Health Care Professionals not Contracted to Provide Benefits
If your plan includes out-of-network benefits and you receive covered services from a health care provider outside of our network, the out-ofnetwork deductible and coinsurance applies as outlined in the Summary of Benefits.
Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of
Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. Anthem Blue Cross and Blue
Shield and its affiliated HMO HealthKeepers, Inc. are independent licensees of the Blue Cross Blue Shield Association.
®ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols
are registered marks of the Blue Cross and Blue Shield Association.
02219VAMENABS
14
Your prescription drug benefits
Pharmacy
Pharmacy network
network
Anthem’s
Anthem’s prescription
prescription drug
drug program
program manages
manages more
more than
than 400
400 million
million prescriptions
prescriptions each
each year.
year. With
With aa broad
broad
retail
pharmacy
network,
home
delivery
and
a
specialty
unit
that
dispenses
high-cost,
biotech
therapies,
retail pharmacy network, home delivery and a specialty unit that dispenses high-cost, biotech therapies,
our
our comprehensive
comprehensive approach
approach helps
helps you
you manage
manage your
your pharmacy
pharmacy benefits.
benefits.
Some
Some members
members have
have aa tiered
tiered drug
drug list/formulary,
list/formulary, or
or list
list of
of covered
covered medications,
medications, which
which assigns
assigns drugs
drugs to
to
specific
tiers
based
on
cost.
Tier
1
drugs
have
the
most
affordable
copay.
Tier
2
drugs
cost
slightly
more,
specific tiers based on cost. Tier 1 drugs have the most affordable copay. Tier 2 drugs cost slightly more,
and
and Tier
Tier 33 drugs
drugs have
have the
the highest
highest copay
copay amounts.
amounts.
Under
Under your
your plan,
plan, for
for third-tier
third-tier drugs
drugs you’ll
you’ll pay
pay the
the greater
greater of
of the
the third-tier
third-tier copayment
copayment or
or 20
20 percent
percent coinsurance
coinsurance with
with aa
$200
or
$400
per-prescription
maximum.
There
will
also
be
a
$3,500
per
member
per
calendar
year
out-of-pocket
$200 or $400 per-prescription maximum. There will also be a $3,500 per member per calendar year out-of-pocket
maximum
maximum included
included with
with this
this benefit.
benefit.
Tier
Tier 11
Copay
Copay
Tier
Tier 22
Copay
Copay
Up
Up to
to aa 30-day
30-day medication
medication supply
supply at
at
participating
retail
pharmacies
participating retail pharmacies
$10
$10
$30
$30
Up
Up to
to aa 90-day
90-day medication
medication supply
supply
delivered
to
your
delivered to your home
home
$20
$20
$60
$60
Your
Your Prescription
Prescription Drug
Drug 10-30-50
10-30-50
or
or 20%
20% Plan
Plan
Tier
Tier 33
Copay
Copay
The
The greater
greater of
of $50
$50 or
or 20%
20%
coinsurance
with
a
$200
coinsurance with a $200
prescription
prescription maximum
maximum
The
The greater
greater of
of $100
$100 or
or 20%
20%
coinsurance
coinsurance with
with aa $400
$400
prescription
prescription maximum
maximum
Retail
Retail pharmacies
pharmacies
Our
Our retail
retail pharmacy
pharmacy network
network includes
includes more
more than
than 62,000
62,000 pharmacies
pharmacies throughout
throughout the
the United
United States.
States. That
That
means
you
have
convenient
access
to
your
prescriptions
wherever
you
are
–
at
home,
work
means you have convenient access to your prescriptions wherever you are – at home, work or
or even
even on
on
vacation.
vacation. To
To find
find out
out ifif your
your pharmacy
pharmacy participates
participates in
in our
our network,
network, contact
contact Customer
Customer Care
Care at
at the
the phone
phone
number
number listed
listed on
on your
your member
member ID
ID card.
card. Or,
Or, visit
visit anthem.com
anthem.com for
for aa list
list of
of participating
participating pharmacies.
pharmacies.
Most
Most plans
plans allow
allow you
you to
to get
get up
up to
to aa 30-day
30-day supply
supply of
of covered
covered medications
medications at
at aa retail
retail pharmacy.
pharmacy. Simply
Simply
show
show your
your ID
ID card
card at
at the
the pharmacy
pharmacy and
and pay
pay the
the appropriate
appropriate copay.
copay.
You’ll
You’ll get
get the
the most
most from
from your
your benefits
benefits by
by using
using aa participating
participating retail
retail pharmacy.
pharmacy. Choosing
Choosing aa non-network
non-network
pharmacy
pharmacy means
means you’ll
you’ll pay
pay the
the full
full cost
cost of
of the
the prescription.
prescription. Then,
Then, you
you must
must submit
submit aa claim
claim form
form to
to our
our
pharmacy
program
for
reimbursement,
based
on
your
benefit.
pharmacy program for reimbursement, based on your benefit.
Home
Home delivery
delivery pharmacy
pharmacy
Home
Home delivery
delivery is
is for
for people
people who
who take
take medications
medications on
on an
an ongoing
ongoing basis.
basis. Our
Our preferred
preferred home
home delivery
delivery
pharmacy
delivers
the
medications
you
need,
right
to
your
door.
You
can
easily
refill
home
pharmacy delivers the medications you need, right to your door. You can easily refill home delivery
delivery
prescriptions
prescriptions by
by phone,
phone, fax,
fax, mail
mail or
or online.
online. And,
And, view
view benefit
benefit information
information 24/7
24/7 at
at anthem.com.
anthem.com.
As
As aa home
home delivery
delivery customer,
customer, you’ll
you’ll also
also enjoy:
enjoy:
•• Free
standard
shipping
Free standard shipping
•• Personal
Personal prescription
prescription counseling
counseling
•• Direct
access
to
licensed
Direct access to licensed pharmacists
pharmacists
Suffolk
Suffolk Public
Public Schools/Rx
Schools/Rx
15
•
•
Our 99.99 percent accuracy rate, plus multiple safety checks by licensed pharmacists
Experienced Customer Care associates to answer benefit questions
Getting started with home delivery
Switching to home delivery is simple. Choose from one of the following methods:
•
By phone: Call 866-281-4279, Monday through Friday, 8:30 a.m. to 8 p.m., Eastern Standard
Time, to get your free cost-savings estimate. You’ll find out how much your prescription will cost
and how much you’ll save. We’ll even contact your doctor for a new prescription and arrange for
delivery. Be sure to have the following information handy: prescription information, doctor’s name,
phone number, medication names/strengths and credit card information (including cardholder
name, account number and expiration date).
•
By mail: To get an order form, call the Customer Care number on your member ID card. Or,
download a form from anthem.com. Click on the “Members” tab, and you'll find a link to the form
under Members Spotlight. Print the form and mail your completed order form, original prescription
and payment information to:
Home Delivery Pharmacy
PO Box 66785
St. Louis MO 63166-6785
•
By fax: Have your doctor fax your prescription information to 800-600-8105. The prescription must
be faxed directly from your doctor’s office. If there is a question about your prescription(s), we’ll
contact your doctor.
Ordering home delivery refills
With home delivery, you don’t have to worry about running out of medication. That’s because we’ll call to
let you know when you’re running low. You can easily reorder by phone, online or by mail:
•
By phone: Have your prescription label and credit card ready. Call 866-281-4279 and select the
“Automated Refill Order Line” option from the menu, or press zero at any time to speak to a care
coordinator. If you are speech or hearing impaired, call 800-899-2114. Follow the prompts to place
your order.
•
Online: Go to anthem.com, log in and click on the “MyPharmacy” tab.
•
By mail: Complete an order form and affix your label or write the prescription refill number in the
area provided. Mail the order form with the proper payment to:
Home Delivery Pharmacy
PO Box 66785
St. Louis MO 63166-6785
Specialty pharmacy
Specialty medications are the fastest growing segment of U.S. drug spending today. These breakthrough
biotech drugs are revolutionizing care for people with these medication needs. Anthem’s specialty
Suffolk Public Schools/Rx
16
pharmacy offers a robust, personalized support program for people with chronic and complex conditions.
These conditions may include but aren’t limited to:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Alpha 1 antitrypsin deficiency
Asthma
Cancer
Crohn’s Disease
Gaucher’s Disease
Hemophilia
Hepatitis C
HIV/AIDS
Infertility
Multiple sclerosis
Primary immune deficiency
Psoriasis
Pulmonary arterial hypertension
Rheumatoid arthritis
Respiratory syncytial virus (RSV)
Transplant
Our pharmacy care advocates, registered nurses and clinical pharmacists work together to provide
disease-specific care management. We’ll coordinate specialty pharmacy activities to help improve the
quality and cost of care. And we’ll do everything we can to help you achieve the best possible outcomes
from your treatments.
Ordering specialty medications
You can order specialty medications by phone or fax:
•
By phone: Call 800-870-6419 to verify your information. Pharmacy care advocates are available
Monday through Friday, 8 a.m. to 10 p.m., Eastern Standard Time.
•
By fax: You can have your doctor fax your prescription(s) and a copy of your ID card to 800-8242642.
Drug list/formulary
Anthem’s drug list/formulary is a list of brand and generic medications that are approved by the U.S. Food
and Drug Administration (FDA) and covered by your plan. We’re committed to providing you with access to
quality medications at a price you can afford. Through detailed research, we find drugs with the highest
success rates that also help lower the cost of care.
Our Pharmacy and Therapeutics (P&T) Committee then reviews and selects these medications for their
safety, effectiveness and value. The P&T Committee includes a large group of doctors and pharmacists
who are not employees of Anthem Blue Cross and Blue Shield. This group and other professionals are
responsible for the decisions surrounding our drug list/formulary.
Medications on the drug list/formulary are subject to periodic review. Log in to anthem.com to view the
most current list or call the phone number on your member ID card to check a specific drug.
Suffolk Public Schools/Rx
17
Generic medications
Our drug list/formulary includes money-saving generics, as well as brand medications. By choosing a
generic, you get the same effect as the brand drug – but normally at a lower cost.
Generic and brand drugs have the same active ingredient, strength and dose. The FDA requires generics
to meet the same high standards for purity, quality, safety and strength.
Even though the active ingredient of a generic is identical to its brand counterpart, manufacturers may use
different inactive ingredients. This could affect the color, shape and size. But because generics must meet
the same FDA standards as brand drugs, you can feel confident the generic is just as safe and effective.
Ask your doctor if a generic is right for you.
Prior authorization
Most prescriptions are filled right away when you take them to the pharmacy. However, some drugs need
our review and approval before they’re covered. This process, called prior authorization, helps ensure
drugs are used as recommended by the FDA. Prior authorization focuses mainly on drugs that may have:
•
•
•
•
Risk of serious side effects or dangerous drug interactions
High potential for incorrect use or abuse
Better alternatives that may cost you less
Restrictions for use with very specific conditions
If your doctor prescribes a drug that requires prior authorization, we’ll send an electronic notice to your
pharmacy. This lets the pharmacist know that additional health information is needed for review.
By monitoring the use of certain drugs, prior authorization helps keep you safe and make your medications
affordable. To check if your medication requires prior authorization, visit anthem.com or call the number
on your member ID card.
Anthem Blue Cross and Blue Shield receives financial credits from drug manufacturers based on total volume of the claims processed for their
product utilized by Anthem members. These credits are retained by Anthem as a part of its fee for administering the program for self-funded groups
and used to help stabilize rates for fully-insured groups. Reimbursements to pharmacies are not affected by these credits.
This benefits overview insert is only one piece of your entire enrollment package. See the enrollment brochure for a list of your plan’s exclusions and
limitations and applicable policy form numbers.
Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the
City of Fairfax, the Town of Vienna, and the area east of State Route 123. Anthem Blue Cross and Blue Shield and its affiliated HMO,
HealthKeepers, Inc., are independent licensees of the Blue Cross and Blue Shield Association. ®ANTHEM is a registered trademark of Anthem
Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield
Association.
Suffolk Public Schools/Rx
18
WELCOME TO
BLUE VIEW VISION!
Good news—your vision plan
is flexible and easy to use.
This benefit summary outlines
the basic components of your
plan, including quick answers
about what’s covered, your
discounts, and much more!
Blue View VisionSM
Your Blue View Vision network
Blue View Vision offers you one of the largest vision care networks in the industry, with a wide selection of
experienced ophthalmologists, optometrists, and opticians. Blue View Vision’s network also includes convenient
retail locations, many with evening and weekend hours, including LensCrafters®, Target Optical®, JCPenney®
Optical, Sears OpticalSM, and Pearle Vision® locations. Best of all – when you receive care from a Blue View Vision
participating provider, you receive the greatest benefits and money-saving discounts.
Out-of-network services
Did we mention we’re flexible? You can choose to receive care outside of the Blue View Vision network.
You simply get an allowance toward the eye exam and you pay the rest. (Network benefits and
discounts will not apply.) Just pay in full at the time of service and then file a claim for reimbursement.
YOUR BLUE VIEW VISION PLAN AT-A-GLANCE
VISION CARE SERVICES
Annual routine eye exam (once every calendar
year)
IN-NETWORK
OUT-OF-NETWORK
$15 copayment
$30 allowance
DISCOUNTS
Savings on eyewear and accessories
When you visit a participating Blue View Vision eye care professional or vision center, you’ll pay the discount price for as many
pairs of eyeglasses and/or supplies of conventional (non-disposable) contact lenses as you would like. Take advantage of these
savings –it means more money in your pocket!
BLUE VIEW VISION ADDITIONAL SAVINGS
MEMBER SAVINGS
Eye Glass Frame*
35% discount off retail*
Contact Lenses**
Conventional (non-disposable)
15% off retail price
Standard Plastic Lenses*
Single Vision
Bifocal
Trifocal
You Pay: $50
You Pay: $70
You Pay: $105
Eyeglass Lens Options/Upgrades* – For those who like to add
an extra touch to their eyewear!
UV Coating
Tint (Solid and Gradient)
Standard Scratch-Resistance
Standard Polycarbonate
Standard Progressive (Add-on to bifocal)
Standard Anti-Reflective Coating
You Pay: $15
You Pay: $15
You Pay: $15
You Pay: $40
You Pay: $65
You Pay: $45
Other Add-ons and Services
Includes some non-prescription sunglasses, lens cleaning
supplies, contact lens solutions and eyeglass cases, etc.
20% off retail price
Discounts are subject to change without notice.
* If frames, lenses or lens options are purchased separately, members get a 20% discount instead.
**Discount does not apply to fitting fees or services.
19
WELCOME TO
BLUE VIEW VISION!
Good news—your vision plan
is flexible and easy to use.
This benefit summary outlines
the basic components of your
plan, including quick answers
about what’s covered, your
discounts, and much more!
And – there’s more! You also get access to discounts on other vision services through SpecialOffers.
Visit anthem.com/specialoffers to learn more about these valuable savings.
Laser vision correction surgery
Glasses or contacts may not be the answer for every person. That’s why we offer further savings with
discounts on refractive surgery. Pay a discounted amount per eye for LASIK or PRK Laser Vision
correction. For more information go to SpecialOffers at anthem.com/specialoffers and select Vision
Care.
USING YOUR BLUE VIEW VISION PLAN
The Blue View Vision network is for routine eye care only. If you need medical treatment for your eyes,
visit a participating eye care physician from your medical network. Your out-of-pocket expenses related
to the vision benefits do not count toward your annual out-of-pocket limit and are never waived, even if
your annual out-of-pocket limit is reached.
This benefit overview insert is only one piece of your entire enrollment package. Exclusions and limitations are listed in the enrollment brochure.
Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Virginia, Inc. An independent licensee of the Blue Cross and Blue Shield Association.
*Registered marks Blue Cross and Blue Shield Association. Blue View Vision is a service mark of the Blue Cross and Blue Shield Association.
Blue View Vision PPO EO
MVASB1535A (12/09)
20
Suffolk Public Schools
Anthem Dental Complete Network
Basic Option Value Plan – Group #868864
Effective Date 10/01/2012
In Network Anthem Pays:
Out of Network Anthem Pays:
Diagnostic & Preventive Services
Exams & cleanings, x-rays, fluoride treatments,
sealants
100%
100% of maximum allowable
fee
Basic Services
Emergency treatment for relief of pain,
amalgam restorations (silver fillings) and
composite resin restorations (white fillings)
80%
80% of maximum allowable fee
Endodontics
Pulpotomies on primary teeth for dependent
children, root canal therapy on permanent teeth
80%
80% of maximum allowable fee
Periodontics
Surgical/Nonsurgical periodontics
80%
80% of maximum allowable fee
Oral Surgery
Surgical/Nonsurgical extractions, all other oral
surgery
80%
80% of maximum allowable fee
Service & Description
(posterior composites alternate to amalgam)
Deductible
Per person/per family (calendar year)
No deductible for diagnostic and preventive
services
$100/$300
Calendar Year Plan Maximum Per person
$1,000
This is a summary of benefits only and does not guarantee coverage.
For a complete list of covered services and limitations/exclusions, please refer to the Dental Benefit Plan Summary.
21
LIMITATIONS & EXCLUSIONS
Limitations—Below is a partial listing of plan limitations.
Please see your certificate of coverage for a full list
Exclusions — Below is a partial listing of non-covered services.
Please see your Certificate of Coverage for a full list.
Diagnostic and Preventive Services
Oral evaluations (exam). Limited to two per Calendar Year.
Prophylaxis (cleaning). Limited to two per Calendar Year.
Bitewing x-rays. Limited to one series of films per 12 months for all
ages.
Intraoral x-rays, single film. Limited to four films per 12-month
period.
Complete series x-rays (panoramic or full-mouth). Limited to once
every 36 months.
Services provided before or after the term of this coverage.
Services received before your effective date or after your coverage
ends, unless otherwise specified in the plan certificate.
Restorative Services – applicable if these services are covered under
your plan
Fillings. Limited to once per surface per tooth in any 24 months.
Composite restorations on posterior (back) teeth are limited to the
same allowance as for amalgam (silver filling). Member must pay the
difference in cost.
Root canal therapy. Limited to once per 36 months per tooth.
Coverage is for permanent teeth only.
Periodontal surgery. Limited to one complex service per single tooth
or quadrant in any 36 months, and only if the pocket depth of the tooth
is 5 millimeters or greater.
Periodontal scaling and root planing. Limited to once per quadrant
in 24 months when the tooth pocket has a depth of 4 millimeters or
greater.
Cosmetic dentistry. Any services performed for cosmetic purposes
including, but not limited to, external bleaching, bleaching of nonvital discolored teeth.
Drugs and medications. Intravenous conscious sedation, IV sedation
and general anesthesia when performed with non-surgical dental care.
Analgesia, analgesic agents, anxiolysis nitrous oxide, therapeutic drug
injections, medicines, or drugs for non-surgical or surgical dental care
except that intravenous conscious sedation is eligible as a separate
benefit when performed in conjunction with complex surgical
services.
Extraction. Surgical removal of asymptomatic, non-pathologic third
molars.
NETWORK & CONTACT INFORMATION
Finding a Dentist: Go online to www.anthem.com/mydentalvision or Call Anthem Dental Customer Service at 866-956-8607
Participating Providers are dentists who have contracted with us to provide dental care to our members at a negotiated rate. When using a
participating dentist, you will only be responsible for your deductible and coinsurance amounts, if applicable.
Non-Participating Providers are dentists who have not contracted with us and therefore may charge their usual fee for services they provide to you.
When using a non-participating dentist, you will be responsible for your deductible and coinsurance amounts, if applicable, plus any amount over our
Covered Expense, up to the dentist’s billed charges. While the percentage we pay is the same whether you receive dental services in-network or outof-network, you may end up paying more out of pocket when you visit a non-participating provider.
The in-network Dental providers mentioned in this communication are independently contracted providers who exercise independent
professional judgment. They are not agents or employees of Anthem BlueCross BlueShield
CALL
WRITE
Refer to the toll-free number indicated on the back of your plan identification card or
Call (866) 956-8607 to speak in-person with a U.S. based customer service
representative during normal business hours. Calling after-hours? We may still be able
to assist you with our interactive voice-response system at (866) 956-8607.
Refer to the back of your plan
Identification card for the address.
Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans, Inc. Independent licensee of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered
trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.
22
Suffolk Public Schools
Anthem Dental Complete Network
High Option Classic Plan – Group #868864
Effective Date 10/01/2012
In Network Anthem Pays:
Out of Network Anthem Pays:
Diagnostic & Preventive Services
Exams & cleanings, x-rays, fluoride treatments,
sealants
100%
100% of maximum allowable
fee
Basic Services
Emergency treatment for relief of pain,
amalgam restorations (silver fillings) and
composite resin restorations (white fillings)
80%
80% of maximum allowable fee
Endodontics
Pulpotomies on primary teeth for dependent
children, root canal therapy on permanent teeth
80%
80% of maximum allowable fee
Periodontics
Surgical/Nonsurgical periodontics
80%
80% of maximum allowable fee
Oral Surgery
Surgical/Nonsurgical extractions, all other oral
surgery
80%
80% of maximum allowable fee
Major Restorative
Crowns
50%
50% of maximum allowable fee
Prosthetic Repairs and Adjustments
Denture adjustments and repairs, bridge repair
50%
50% of maximum allowable fee
Prosthetics
Dentures (full and partial), bridges
50%
50% of maximum allowable fee
50%
50% of maximum allowable fee
Service & Description
(posterior composites alternate to amalgam)
Orthodontics
Treatment for the prevention/correction of
malocclusion, available for dependent children
only, age 8 up to age 19
Deductible
Per person/per family (calendar year)
No deductible for diagnostic and preventive
services or orthodontics
$100/$300
Calendar Year Plan Maximum Per person
$1,000
Lifetime Ortho Maximum Per Eligible child
$1,000
This is a summary of benefits only and does not guarantee coverage.
For a complete list of covered services and limitations/exclusions, please refer to the Dental Benefit Plan Summary.
23
LIMITATIONS & EXCLUSIONS
Limitations—Below is a partial listing of plan limitations.
Please see your certificate of coverage for a full list
Diagnostic and Preventive Services
Oral evaluations (exam). Limited to two per Calendar Year.
Prophylaxis (cleaning). Limited to two per Calendar Year.
Bitewing x-rays. Limited to one series of films per 12 months for all
ages.
Intraoral x-rays, single film. Limited to four films per 12-month
period.
Complete series x-rays (panoramic or full-mouth). Limited to once
every 36 months.
Restorative Services – applicable if these services are covered under
your plan
Fillings. Limited to once per surface per tooth in any 24 months.
Composite restorations on posterior (back) teeth are limited to the
same allowance as for amalgam (silver filling). Member must pay the
difference in cost.
Crowns. Limited to once per tooth in a five year period.
Fixed and removable prosthodontics – dentures, partials, bridges
covered once in any five year period. Benefits are provided for the
replacement of an existing bridge, denture or partial for members age
16 or older if the appliance is five years old or older and cannot be
made serviceable.
Root canal therapy. Limited to once per 36 months per tooth.
Coverage is for permanent teeth only.
Periodontal surgery. Limited to one complex service per single tooth
or quadrant in any 36 months, and only if the pocket depth of the tooth
is 5 millimeters or greater.
Periodontal scaling and root planing. Limited to once per quadrant
in 24 months when the tooth pocket has a depth of 4 millimeters or
greater.
Additional Limitation for Orthodontic Services if Orthodontia is
included as a benefit of your plan.
Orthodontia. Limited to one course of treatment per lifetime.
Exclusions — Below is a partial listing of non-covered services.
Please see your Certificate of Coverage for a full list.
Services provided before or after the term of this coverage.
Services received before your effective date or after your coverage
ends, unless otherwise specified in the plan certificate.
Cosmetic dentistry. Any services performed for cosmetic purposes
including, but not limited to, external bleaching, bleaching of nonvital discolored teeth.
Drugs and medications. Intravenous conscious sedation, IV sedation
and general anesthesia when performed with non-surgical dental care.
Analgesia, analgesic agents, anxiolysis nitrous oxide, therapeutic drug
injections, medicines, or drugs for non-surgical or surgical dental care
except that intravenous conscious sedation is eligible as a separate
benefit when performed in conjunction with complex surgical
services.
Extraction. Surgical removal of asymptomatic, non-pathologic third
molars.
NETWORK & CONTACT INFORMATION
Finding a Dentist: Go online to www.anthem.com/mydentalvision or Call Anthem Dental Customer Service at 866-956-8607
Participating Providers are dentists who have contracted with us to provide dental care to our members at a negotiated rate. When using a
participating dentist, you will only be responsible for your deductible and coinsurance amounts, if applicable.
Non-Participating Providers are dentists who have not contracted with us and therefore may charge their usual fee for services they provide to you.
When using a non-participating dentist, you will be responsible for your deductible and coinsurance amounts, if applicable, plus any amount over our
Covered Expense, up to the dentist’s billed charges. While the percentage we pay is the same whether you receive dental services in-network or outof-network, you may end up paying more out of pocket when you visit a non-participating provider.
The in-network Dental providers mentioned in this communication are independently contracted providers who exercise independent
professional judgment. They are not agents or employees of Anthem BlueCross BlueShield
CALL
WRITE
Refer to the toll-free number indicated on the back of your plan identification card or
Call (866) 956-8607 to speak in-person with a U.S. based customer service
representative during normal business hours. Calling after-hours? We may still be able
to assist you with our interactive voice-response system at (866) 956-8607.
Refer to the back of your plan
Identification card for the address.
Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans, Inc. Independent licensee of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered
trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.
24
National Teachers Associates Life Insurance Company
Providing Peace of Mind and
Quality Protection to All We Insure
75-375 (11/11)
Underwritten25
by: National Teachers Associates Life Insurance Company (NTA Life)
4949 Keller Springs Rd • Addison, Texas 75001 • P.O. Box 802207 - Dallas, Texas 75380 • (888) 671-6771 • ntalife.com
Uncertain about your need for NTA’s Supplemental
Insurance Programs? Consider these facts!
C
Fact... The overall cost for Cancer in the year 2010 was estimated at $263.8 billion:
$102.8 billion was for direct medical expenses, but tremendously more, $161 billion, was non-medical costs.
39%
61 %
Non-Medical Costs
Medical Costs
•LossofIncome
•TransportationCosts
•Food,Lodging&LongDistancePhoneCosts
•LongConvalescence(Recovery)
•ChildCareExpenses
•Deductible&Co-InsuranceonotherInsurance
•ForcedLiquidationofTangibleAssets
•OtherUnforeseenExpenses
•HospitalRoom&Board
•Drugs&Medicine
•Surgeon&Other
UnforeseenExpenses
It is estimated that approximately 11.4 million Americans
with a history of Cancer were alive in January 2006.
According to the American Cancer Society,
the lifetime risk of developing Cancer is:
• In 2010, about 1,529,560 new cases were expected to be diagnosed.
• In the U.S., Cancer is the second most common cause of death
(exceeded only by cardiovascular disease).
12
• Cancer is the leading cause of death by illness in children.
• About 207,090 new invasive cases of breast cancer were expected
to occur among U.S. women in 2010.
in
(for males)
&
13
in
(for females)
• More than 1 million cases of Skin Cancers were expected
to be diagnosed in 2010.
• Most importantly, thousands of lives could be
saved each year with early detection and treatment.
Source: Cancer
Cancer Facts
Facts and
and Figures
Figures 2010
2010 American
American Cancer
Cancer Society.
Society. The
The above
above facts
facts are
are presented
presented for
for information
information only
only and
and do
do not
not imply
imply coverage
coverage provided
provided under
under this
this policy
policy or
or endorsement
endorsement
Source:
of the
the American
American Cancer
Cancer Society.
Society. The
The American
American Cancer
Cancer Society
Society does
does not
not endorse
endorse any
any product
product or
or service.
service.
of
(2)
75-375 (11/11)
(11/11)
26
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75-375
75-3
75-3
Cardiovascular
Disease
Remains the #1 killer in the U.S.
• ApproximateLeadingcausesofdeathperyear(2006):
#1CardiovascularDisease
831,272*
#2 Cancer
559,888
#3 Accident
144,264
(* includes heart disease and heart attacks)
• In 2006, an estimated 7,235,000
inpatient cardiovascular operations
and procedures were performed in
the U.S.
• The cost for Cardiovascular
Diseasein2010isestimatedat
$503.2 billion in direct medical
and non-medical costs.
• Nearly 2,300 Americans die of
CardiovascularDiseaseeachday,
an average of 1 death every 38
seconds.
• Stroke is a leading cause of
severe, long-term disability in
the U.S.
• In 2007, there were 4,084,000
visits to emergency departments
with a primary diagnosis of
CardiovascularDisease.
Cardiovascular
Risk Factors
DiabetesMellitus
Alzheimer’sDisease
Accidents
Cancer
HeartAttack,Heart
Disease,Stroke,Etc.
Number of Deaths
•Heart&StrokeRelated617,527
•Cancer566,137
•CLRDisease141,075
•Accidents121,207
•Alzheimer’sDisease82,476
•DiabetesMellitus70,601
ChronicLower
RespiratoryDisease
Significant
Causes of Death
U.S.2008MortalityRates
•Heredity
•IncreasingAge
•HighCholesterol
•Smoking
•LackofExercise
•Overweight
•Diabetes
•Stress
•HighBloodPressure
Source: XU J., Miniño, A., Kochanek K., Deaths: Preliminary Data for 2008. National Vital Statistics
Reports,Vol.59No.2.Hyattsville,Maryland:NationalCenterforHealthStatistics,December9,2010.
Cardiovascular Disease Mortality
In 2006, more than 432,000
female lives were claimed by
Cardiovascular Disease (nearly 1
death every minute).
In 2006, 1 of every 2.9 deaths in
America (34.3%) was related to
CardiovascularDisease.
Source:HeartandStrokeFacts:HeartDiseaseandStrokeStatistics2010update,AmericanHeartAssociation.Theabovefactsarepresentedforinformationonlyanddonoimplycoverage
underthispolicyorendorsementoftheAmericanHeartAssociation.TheAmericanHeartAssociationdoesnotendorseanyproductorservice.
75-375 (11/11)
27
(3)
Cancer Insurance Program
Educators
Benefits for your actual costs (except as noted) up
to the maximum whether or not Hospital confined:
Select
Series
®
GREEN LEVEL
TREATMENT BENEFITS
GOLD LEVEL
$1,500
1. Express Payment: Paid one time for a Covered Person
upon the first diagnosis of Cancer (other than Skin Cancer)
regardless of actual costs.
$2,000
Up to $50/Year
2. Cancer Screening Wellness Benefit: Paid for
mammography exam, pap-smear lab, chest x-ray, colonoscopy,
certain blood tests, and other wellness tests specified in your
Policy. No lifetime maximum!
Up to $75/Year
$200/Day
3. Hospital Confinement: Paid for each of the first 60 Days
of One Period of Confinement that you are an Inpatient in a
Hospital, regardless of actual costs. No lifetime maximum!
$300/Day
$600/Day
4. Extended Hospital Confinement: Paid in lieu of all
other benefits for the 61st and later Days of One Period of
Confinement that you are an Inpatient in a Hospital, regardless
of actual costs. No lifetime maximum!
$900/Day
Up to $200/day
Up to $1,000/mo.
Up to $500/mo.
Up to $1,000 per
Confinement
35¢/mile by car
Up to $50/day
Up to $400 for
consultation
Up to $200 for
transportation
Up to $200/trip
5. Radiation and Chemotherapy: Paid on a daily basis in
or out of the Hospital for radiation therapy and chemotherapy
specified in your Policy or for NCI Sponsored Experimental
Treatment. No lifetime maximum!
• Oral Chemotherapy paid on a monthly basis.
• Self-injected or pump meds paid on a monthly
basis.
6. Transportation: Paid for 2 one-way trips per One Period
of Confinement for you and a family member’s coach air,
train, and bus tickets, or car mileage allowance. Your Hospital
confinement must be more than 100 miles from your home,
within the U.S. and possessions or Canada, and prescribed
by your Physician. No lifetime maximum!
7. Outpatient and Family Member Lodging: Paid for hotel
or motel up to 14 days for a Covered Person while receiving
Outpatient treatment, and for a family member of a Hospital
confined Covered Person per One Period of Confinement.
Treatment must be more than 100 miles from the Covered
Person’s home and within U.S. and possessions or Canada.
No lifetime maximum!
8. National Cancer Institute (NCI) Evaluation/Consultation:
Paid once for NCI’s opinion on your Cancer treatment.
• Consultation/Evaluation: Not payable on the same day
as the 2nd or 3rd Surgical Opinion Benefit.
• Transportation: Paid if NCI’s Cancer Center is more
than 100 miles from home, but not payable on the same
day as the Covered Person Transportation Benefit.
9. Ambulance: Paid for 2 one-way trips by ground or air to or
from a Hospital for One Period of Confinement. In Michigan,
we will pay ambulance benefit directly to provider if provider
unpaid at time of your claim. No lifetime maximum!
Up to $300/day
Up to $1,200/mo.
Up to $600/mo.
Up to $1,500 per
Confinement
40¢/mile by car
Up to $60/day
Up to $600 for
consultation
Up to $300 for
transportation
Up to $300/trip
Policy GRC-2004 (1/03) with state specific versions. Premium and benefits vary
with the plan selected. See back page for exceptions and limitations.
28
(4)
75-375 (11/11)
75-3
GOLD LEVEL
GREEN LEVEL
Up to $10,000
Up to $5,000
Up to $1,000
10. Bone Marrow Transplant: Paid for implant of human
bone marrow tissue once per Covered Person, whether or not
experimental, in lieu of Surgeon’s Fee, Anesthesia Benefits, and
NCI Experimental Treatment.
• For Covered Person as Inpatient in Hospital.
• For Covered Person on Outpatient basis.
• For donor expenses (if not the Covered Person).
Up to $15,000
Up to $7,500
Up to $1,500
Up to $2,000
11. Stem Cell Transplant: Paid for a peripheral stem cell transplant
once per Covered Person, in lieu of Surgeon’s Fee and Anesthesia
Benefits.
Up to $3,000
Up to $5,000
for the most costly
surgeries
12. Surgeon’s Fee: Paid for surgery in or out of the Hospital,
including surgery for Skin Cancer, up to the maximum amount
described in the Policy based on the severity of the operation as
rated in the Federal Register. No lifetime maximum!
• Reconstructive surgery: Paid similarly if performed within 3
years of a covered surgery.
• Biopsy surgery: Paid similarly for confirmed Cancer.
Up to $7,500
for the most costly
surgeries
Up to $225
13. 2nd & 3rd Surgical Opinions: Paid to give you peace of mind that
a first opinion recommending surgery is appropriate. No lifetime
maximum!
Up to $300
Up to 25% of
Surgeon’s Benefit
14. Anesthesia: Paid to cover costs of administering anesthesia in or
out of the Hospital for a covered surgery. No lifetime maximum!
Up to 25% of
Surgeon’s Benefit
Up to $30/Day
15. Attending Physician: Paid daily during the first 60 Days of One
Period of Confinement while you are in the Hospital for visits by a
Physician other than the surgeons. No lifetime maximum!
Up to $40/Day
Up to $125/Day
16. Private Duty Nurse: Paid daily during the first 60 Days of One
Period of Confinement for an 8-hour shift (prorated if less) while
you are in the Hospital, if ordered by your Physician. No lifetime
maximum!
Up to $150/Day
$200/Confinement
$400/Year
17. Inpatient Drugs and Diagnostic Testing: Paid for each One
Period of Confinement as an Inpatient up to the yearly maximum,
regardless of actual costs. No lifetime maximum!
$300/Confinement
$600/Year
Up to $50/unit
18. Blood, Plasma, & Platelets: Paid for each unit of blood, plasma,
and platelets during the first 60 Days of One Period of Confinement—
maximum 50 units per year. No lifetime maximum!
Up to $75/unit
Up to $1,200 each
Up to $100/Year
19. Prosthesis:
• Surgically implanted if due to covered surgery.
• Non-surgically implanted, such as wigs and special bras.
Up to $2,000 each
Up to $150/Year
Up to $100/day
20. Skilled Nursing Facility and At Home Nursing: Paid up to
same number of Days as Hospital confined. Confinement in a Skilled
Nursing Facility (in Iowa, “Nursing Facility”) must start within 14 days
after Hospital discharge. Private duty Nurse at home must start within
3 days of Hospital discharge. No lifetime maximum!
Up to $150/day
Up to $100/day
$12,000 max.
21. Hospice: Paid for care in a Hospice facility or at home by a
licensed Hospice facility to a terminally ill Covered Person. Benefits
paid at 50% rate after 60 days. Lifetime maximum.
Up to $125/day
$15,000 max.
29
75-375 (11/11)
(5)
Cancer Insurance Program
Heart Disease, Heart Attack, Stroke Insurance Program
Educators
Benefits available whether or not you are
Hospital confined & without regard to actual costs:
Select
Series
®
GREEN LEVEL
$1,500
Up to $50/Year
TREATMENT BENEFITS
GOLD LEVEL
1. Initial Occurrence: Paid once per Covered Person.
Paid upon the first Heart Attack or Stroke, or for the first
confinement for a Day in a Hospital due to Heart Disease or
Carotid Artery Disease. (Not payable solely due to occurrence
of a TIA.) Paid without regard to actual costs.
$2,000
2. Heart Screening Wellness Benefit: Paid for any combination
of wellness exams and tests specified in your Policy to evaluate
the heart or cardiovascular system for example Lipid profiles
and resting EKG. No lifetime maximum!
Up to $75/Year
Up to $150/Year
3. Diagnostic or Emergency Room (“ER”) Procedures:
Paid for evaluation of symptoms of a Covered Condition, for
care in an ER, or for Diagnostic Procedures listed in your
Policy. No lifetime maximum!
Up to $200/Year
Up to $100/TripGround
Up to $300/Trip-Air
4. Ambulance: Paid for 2 one-way trips by ground and 2 one-way
trips by air to or from a Hospital per Calendar Year to evaluate
symptoms of a Covered Condition. In Michigan, we will pay
ambulance benefit directly to provider if provider unpaid at time
of your claim. No lifetime maximum!
Up to $125/TripGround
Up to $450/Trip-Air
Up to $200/facility
5. Surgical Facility: Paid for a day of use of an operating
room facility for a covered surgery (if separately billed). No
lifetime maximum!
Up to $300/facility
Up to $5,000 for
the most costly
surgeries
6. Primary Surgeon’s Fee: Paid for primary surgeon up to
the maximum amount described in the Policy based on the
severity of the operation as rated in the Federal Register. No
lifetime maximum!
Up to $7,500 for
the most costly
surgeries
Up to 25% of
Surgeon’s Fee
Benefit
7. Assistant Surgeon’s Fee: Paid for one Assistant Surgeon
(if any). No lifetime maximum!
Up to 25% of
Surgeon’s Fee
Benefit
Up to $50
8. 2nd & 3rd Surgical Opinions: Paid to give you peace of mind
that a first opinion recommending surgery is appropriate. No
lifetime maximum!
Up to $75
Up to 25% of
Primary Surgeon’s
Fee Benefit
9. Anesthesia: Paid to cover professional fees of an
anesthesiologist or anesthetist and anesthesia directly charged
by the Hospital or Outpatient Care Facility. Paid only in
connection with a covered surgery. No lifetime maximum!
Up to 25% of
Primary Surgeon’s
Fee Benefit
Up to $500/Year
10. Implanted Cardiac Device: Paid for implanted pacemaker
or similar electronic device to regulate heart rhythm. No
lifetime maximum!
Up to $750/Year
Policy GRH-1004 (9/06) with state specific versions. Premium and benefits
vary with the plan selected. See back page for exceptions and limitations.
Covered Conditions: Heart disease, Carotid artery disease, Heart attaCk, stroke,
and, exCept as to tHe initial oCCurrenCe Benefit, transient isCHemiC attaCk (“tia”)
30
(6)
75-375 (11/11)
75-37
GREEN LEVEL
Benefits for your actual costs (except as noted)
up to the maximum while Hospital confined:
GOLD LEVEL
$200/Day
11. Hospital Confinement: Paid for each of the first 60 Days of One
Period of Confinement that you are an Inpatient in a Hospital for a Covered
Condition. Paid without regard to actual costs. No lifetime maximum!
$300/Day
$300/Day
12. Extended Hospital Confinement: Paid without regard to actual
costs in lieu of all other benefits (except the Heart Transplant Benefit)
requiring Hospital confinement for the 61st and later Days of One
Period of Confinement that you are an Inpatient in a Hospital. No
lifetime maximum!
$400/Day
$20,000
13. Heart Transplant: Paid for implantation of a natural human heart
once per Covered Person, without regard to actual costs.
$30,000
$400/
14. Hospital Medications: Paid for each One Period of Confinement up
to twice a year, without regard to actual costs. No lifetime maximum!
$600/
Confinement
Up to $75/Day
15. Private Duty Nurse: Paid for a minimum 4-hour daily shift
during the first 60 Days you are in the Hospital, if ordered by your
Physician. No lifetime maximum!
Up to $100/Day
Up to $50/Day
16. Attending Physician: Paid during the first 60 Days you are in
the Hospital for visits by a Physician other than the surgeons. No
lifetime maximum!
Up to $75/Day
Up to $30/unit
17. Blood, Plasma, & Platelets: Paid for each unit of blood, plasma,
and platelets during the first 60 Days. Maximum 25 units per year.
No lifetime maximum!
Up to $40/unit
Up to $50/Day
18. Physiotherapy: Paid for up to 15 days of treatment by a
registered physiotherapist during the first 60 Days for each One
Period of Confinement. No lifetime maximum!
Up to $75/Day
Up to $150/
Confinement
19. Electrocardiogram or Echocardiogram: Paid for either
procedure during the first 60 Days of One Period of Confinement.
No lifetime maximum!
Up to $200/
Confinement
Up to $150/
Confinement
20. Oxygen: Paid for use of oxygen and related equipment during the
first 60 Days of One Period of Confinement. No lifetime maximum!
Up to $200/
Confinement
Up to $500/
Confinement
21. Transportation: Paid for 2 one-way trips per One Period of
Confinement for you and for one family member’s coach air, train,
and bus tickets, or one car mileage allowance. Your Hospital
confinement must be more than 100 miles from your home, within the
U.S. and possessions or Canada, and prescribed by your Physician.
No lifetime maximum!
Up to $750/
Confinement
Confinement
33¢/mile by car
50¢/mile by car
Up to $50/day
22. Family Member Lodging: Paid for hotel or motel up to 14 days
for one family member of a Hospital confined Covered Person per
One Period of Confinement. Treatment must be more than 100
miles from the Covered Person’s home and within the U.S. and
possessions or Canada. No lifetime maximum!
Up to $75/day
Up to $50/day
23. Post-hospital Continuing Care: Paid for up to 30 days per One
Period of Confinement for services that begin within the first 14 days
after Hospital discharge. Payable only through the 180th day after the
Hospital discharge for: overnight confinement in a Skilled Nursing Facility
(in Iowa, “Nursing Facility”) or rehabilitation facility, services of a private
duty Nurse for a minimum of 4-hour daily shift at home, or a registered
physiotherapist other than while Hospital confined. No lifetime maximum!
Up to $75/day
31
75-375 (11/11)
(7)
Heart / Stroke Insurance Program
Outstanding Features
Providing
payment of benefits
payment of benefits
directly to you or
whomever you
designate
Guaranteeing that
most of our
programs are
renewable for
Offering continuous
protection during
career
Paying in addition to
other
events
PPO
Changing Insurance
including HMO and
Life
Here are some answers to your questions about exceptions & limitations.
1. What is the purpose for buying these insurance policies?
ThesePoliciesareLIMITEDBENEFITINSURANCEPOLICIES(insomestates,“SPECIFIEDDISEASEPOLICIES”).Theyprovide
insurance protection only for treatment of the named disease and, except in AR Policies andVA Heart Policies, do not cover any other
diseaseorsicknessorincapacity,eventhoughsuchdisease,sickness,orincapacitymaybecaused,complicated,orotherwiseaffected(inWV,
“directlycausedoraggravated”)bythenamedcovereddisease(or“thetreatmentthereof,”inWV).ThesePoliciesaredesignedtosupplement
comprehensive health insurance and are valuable when purchased as an addition to comprehensive health insurance.
2. Can I rely on the description of the benefits in this brochure?
Yes,however,spacelimitsustoprovidingonlygeneraldescriptions.READYOURPOLICYCAREFULLYsinceonlythePolicyprovisions,
not this brochure, control. This brochure is only a summary.
3. Are the capitalized words I see throughout the brochure, like “Day” and “Hospital” capitalized for a reason?
Yes,criticaldefinitionsofcapitalizedwordsarecontainedinyourPolicy,alongwithacompletedescriptionofallexceptionsandlimitations.
4. Can I decide to cancel the Policy at any time, and can you, the insurance company, cancel it as well?
YoucancancelthePolicybysimplynotpayingtherenewalpremiumatanytime.However,electionstopaypremiumsthroughpre-tax
deductionsinanIRSSection125plangenerallymayonlybechangedattheendofaplanyearorafteraqualifyingevent.We,theinsurance
company,cannotcancelthePolicyandguaranteeyoutherighttokeepitinforcebytimelypayingyourpremiumswhendueorduringthe
GracePeriodforyourentirelife.Wedohavetherighttoincreasepremiums,butonlyifwedosoforallsimilarpoliciesinyourstate.
5. How do we resolve any dispute that might arise?
Ifthedisputeisoverclaims,youhavetherighttohaveourClaimsAppealCommitteereviewthematter.Wehaveanexcellentrecordatresolving
disputesandmisunderstandingswithoutanypartyneedingtoresorttolegalaction!AnyunresolveddisputeconcerningyourCancerPolicywill
begovernedbytheDisputeResolutionPrograminyourPolicy(exceptinAR,DC,IL,IA,andTN).Anyunresolveddisputeconcerningyour
HeartPolicywillalsobegovernedbytheDisputeResolutionPrograminyourPolicy(exceptinAR,DC,IL,IA,LA,NC,SC,andVA).
6. Can I send my Policy back and get my money back if after reading it I decide I don’t want it?
Yes.Senditbacktous(orinNC,toouragent)within10daysforafullrefundandthePolicywillbevoidedfromitsdateofissue.Awritten
requestforcancellationisrequiredtoaccompanyyourreturnedPolicyinMichigan.
7. When might a benefit for a covered disease not be payable to me?
Nocoverageisprovidedfortwoyears(oneyearinNCCancerPolicy,threeyearsinDC,NV)afterthePolicyisissuedforacovereddiseasethat
isaPreexistingConditionorthatisFirstManifested(inHeartpoliciesexceptILandNC,“FirstManifestedorFirstOccurs”;“Manifestedor
Occurs”inVAHeartandINPolicies;“Manifested”inVACancerPolicy)withinthefirst30daysaftertheCoverageEffectiveDateofthePolicy
(otherthanastonewbornoradoptedchildrenafterthePolicyisissued).ForcovereddiseasesFirstManifestedwithinthe30daysfollowing
theCoverageEffectivedate,NCHeartandVAPolicieswillonlyprovidecoverageforcareandtreatmentreceivedmorethan31daysafterthe
CoverageEffectiveDate.Generally,aPreexistingConditionisacondition,whetherknownorunknown,forwhichmedicaladviceortreatment
wasrecommendedbyorreceivedfromaPhysicianwithintheoneyearperiod(fiveyearperiodforARHeartPolicyandIAPolicies;twoyear
periodforILHeartandWVPolicies;sixmonthperiodforNVHeartPolicy;tenyearperiodinVAPolicies)beforetheCoverageEffective
Date,orforwhichsymptomsexisted(inNCCancerPolicies,“wasFirstManifested”)withintheoneyearperiod(fiveyearperiodforAR
HeartandIAPolicies;twoyearperiodforWVPolicies;sixmonthperiodforNVHeartPolicyandVAPolicies)beforetheCoverageEffective
Datethatwouldcauseanordinarilyprudentperson(“person”inDC)toseekdiagnosis,care,ortreatment.InNCHeartPolicies,aPreexisting
conditionisaconditionforwhichmedicaladvice,diagnosis,care,ortreatmentwasrecommendedbyorreceivedfromaPhysicianwithinthe
oneyearperiodimmediatelyprecedingtheCoverageEffectiveDate.InSCPolicies,aPreexistingConditionisaconditionmisrepresentedor
not revealed in the application and for which symptoms existed prior to the effective date of coverage that would cause an ordinarily prudent
persontoseekdiagnosis,care,ortreatmentorforwhichmedicaladviceortreatmentwasrecommendedbyorreceivedfromaPhysician.
8. Can I receive treatment anywhere in the world and be paid benefits?
BenefitsareonlypayablefortreatmentintheU.S.,itspossessions,andCanada.
9. Can I receive insurance protection for my spouse and children?
Yes,foranadditionalpremium.InsteadofanIndividualPlan,youmayelectaSingle-ParentPlantocoveryouandyourunmarriedChildren,
oraFamilyPlanforyou,yourSpouseandChildren.Eachpersonappliedformustmeettheunderwritingstandardstohavecoverage.
10. Is there any coverage for events before the Policy is issued or after the Policy lapses or terminates?
TheCoverageisprovidedaftertheCoverageEffectiveDateforaCoveredPersonanduntilthePolicyterminates(otherthancontinuous
Hospitalconfinementforupto90Days).
© 2011
2011 National
National Teachers
Teachers Associates
Associates Life
Life Insurance
Insurance Company
Company
©
32
(8)
(8)
75-375 (11/11)
(11/11)
75-375
Educators
Select
Series
National Teachers Associates Life Insurance Company
®
Intensive Care
Confinement
and Stepdown
Unit Insurance
Policy Series GRI-2015-VA
(1/03). Premium and benefits will
vary with the plan selected.
P.O. Box 802207 • Dallas, Texas 75380 • (888) 671-6771 • www.ntalife.com
Hospital Intensive Care Confinement Benefit
You may select any of these benefit levels. Premium and benefits will
vary with the plan selected. For ICU Confinement, we pay your actual
charges up to:
$300/Day
$9,000/Month
(based on a 30 Day stay)
$600/Day
$18,000/Month
$900/Day
$27,000/Month
(based on a 30 Day stay)
(based on a 30 Day stay)
Hospital Stepdown Care Unit Confinement Benefit
For Stepdown Care Unit Confinement, we pay 50% of your Intensive
Care Confinement benefit.
30 days of Continuous Protection
Benefits paid beginning on 1st Day for an Injury and 2nd Day for any
Sickness for up to 30 Days of continuous confinement, whether in
an ICU or Stepdown Unit or a combination of both. For benefits on or
after the first day of the month after a Covered Person’s 70th birthday,
benefits are paid at 50% of the plan amount.
Optional
Specified
Disease
Benefit Rider
Rider Series GR-1045-VA
(10/96). This benefit is available
only if elected and is offered at
additional premium.
For any of the following Specified Diseases, we will pay the actual
charges up to $150 per Day through the 90th Day, and up to $300 per
Day thereafter, of inpatient Hospital confinement for a Specified Disease
First Manifested 30 days following a Covered Person’s Coverage
Effective Date. No other benefits for Specified Disease will be payable
under the base policy.
Amyotrophic Lateral Sclerosis
Diphtheria
Encephalitis
Legionnaire’s Disease
Lupus Erythematosus
Meningitis
Multiple Sclerosis
Muscular Dystrophy
Osteomyelitis
Poliomyelitis
Rabies
Scarlet Fever
Sickle Cell Anemia
Tetanus
Toxic Shock Syndrome
Tuberculosis
Tularemia
Typhoid Fever
NTA
75-275-VA (9/11)
33
NTA
Life
™
ExCEPtionS, ExCluSionS, anD liMitationS FoR intEnSiVE CaRE unit
This Policy will not pay benefits for care and treatment in any type of Hospital room, ward or unit other than an ICU or
Stepdown Unit located in Canada or the United States or its possessions or that is rendered after your coverage terminates.
If an Intensive Care Confinement due to a Sickness is Manifested within the 30 days from the Coverage Effective Date,
benefits for that specific condition will only be paid for Intensive Care Confinement which begins on or after the 31st day
from the Coverage Effective Date. Subsequent periods of confinement for the same or related cause are considered a
continuation of the first confinement unless separated by 30 or more days. A Day must include an overnight stay.
There are a number of specific exclusions and limitations. In general, no benefits are payable for Intensive Care
Confinement due to: suicide or intentionally self-inflicted Injury while sane or insane; war or any act of war, whether declared
or not, riot or civil commotion, or service in the armed forces or units auxiliary thereto; any claim for covered services
incurred as a result of a Covered Person being legally intoxicated or under the influence of any narcotic or hallucinogenic
drug, unless prescribed by the Covered Person’s Physician; mental or nervous disorder without demonstrable organic
cause; alcoholism, drug addiction or chemical dependency; commission or attempted commission of a felony or while
engaging in an illegal occupation; or childbirth or pregnancy, unless the cause of loss relating to pregnancy meets the
definition of Complications of Pregnancy. (False labor, occasional spotting, Physician prescribed rest, morning sickness
and similar conditions that occur in a difficult pregnancy generally are not Complications of Pregnancy for which benefits
are payable.) For benefits on or after the first day of the month after a Covered Person’s 70th birthday, benefits are paid
at 50% of the plan amount.
This Policy does not cover any ICU Confinement resulting from a preexisting condition for 1 year after the Coverage
Effective Date. “Preexisting Condition” means a condition, whether known or unknown, for which medical advice or
treatment was recommended by or received from a Physician within the one year period before the Coverage Effective
Date, or symptoms existed within the one year period before the Coverage Effective Date that would cause an ordinarily
prudent person to seek diagnosis, care or treatment.
ExCEPtionS, ExCluSionS, anD liMitationS FoR SPECiFiED DiSEaSE
We will not pay benefits that are due to: Hospital confinement not directly due to a Specified Disease; Hospital confinement
received outside Canada or the United States or its possessions; or a mental or nervous disorder without demonstrable
organic cause, alcoholism, drug addiction or chemical dependency. If Specified Disease is Manifested within the first 30
days following the Coverage Effective Date for a Covered Person, benefits for that specific condition will only be paid
for Hospital confinement which begins more than two years after the Coverage Effective Date. If a covered Hospital
confinement is due to more than one Specified Disease, benefits will only be payable for one Specified Disease. If a
Specified Disease is diagnosed while a Covered Person is confined to a Hospital for care and treatment other than the
Specified Disease, we will pay the part of the Hospital confinement attributable to the Specified Disease beginning with
the date of diagnosis.
This Rider does not cover any Specified Disease resulting from a preexisting condition for 1 year after the Coverage
Effective Date. “Preexisting Condition” means a condition, whether known or unknown, for which medical advice or
treatment was recommended by or received from a Physician within the ten year period before the Coverage Effective
Date, or symptoms existed within the six month period before the Coverage Effective Date that would cause an ordinarily
prudent person to seek diagnosis, care or treatment.
This brochure is only a summary. The actual policy provisions will control. Refer to your policy and any attached riders for a complete
detail of all exclusions and limitations and for important definitions of capitalized terms. Read your policy carefully. If you are not satisfied, you have 10 days after you receive your policy to return it to us or our Agent. The premium paid will be refunded and the policy
will be void from its date of issue. Any dispute under this policy may be resolved by arbitration under the Dispute Resolution Program
described in the policy, rather than judicial proceedings. See your policy for details.
Underwritten By:
National Teachers Associates Life Insurance Company
P.O. Box 802207 • Dallas, Texas 75380 • (888) 671-6771 • www.ntalife.com
75-275-VA (9/11)
34
© 2011 National Teachers Associates Life Insurance Company
Accident Insurance Program
Educators
Select
Series
®
National Teachers Associates Life Insurance Company
P.O. Box 802207 • Dallas, Texas 75380 • (888) 671-6771 • www.ntalife.com
Uncertain about your need for NTA’s Accident
Insurance Program? Consider these facts!
The estimated economic impact of accidents is over
$652 billion or $5,700 per U.S. family each year.1
Accidents result in more than 28.3 million
emergency room visits in the U.S. each year.3
In the U.S., approximately 80% of the cost of an
accident is attributable to wage and productivity loss.2
In the U.S., children account for more than 40%
of the emergency room visits for accidents.4
1 National Safety Council. Report on Injuries in America. Injury Facts® (2008).
2 Center for Disease Control. The Economic Cost of Injuries-Facts (2006).
GREEN LEVEL
3 Center for Disease Control. 2005 Emergency Department Summary, Table 13 (2007).
4 Center for Disease Control. Unintentional All Injury Causes (WISQARS) (2006).
TREATMENT BENEFITS
GOLD LEVEL
Program Benefits for a Covered Injury:
$2,500
Up to $11,500
Up to $9,000
$300 per DAY
First Day Hospital Confinement
$3,750
Inpatient hospitalization for the first Injury each year
Up to $17,250
Inpatient hospitalization for every additional Injury each year
Up to $13,500
This benefit is paid a maximum of one time per Calendar Year,
per Covered Person
Continuing Hospital Confinement
Maximum 30 Days per Covered Injury. Not payable for any Day
that the First Day Hospital Confinement benefit is paid.
$450 per DAY
Injury Care Benefit:
$250 per VISIT
for outpatient treatment in a Hospital emergency room,
Emergency Care Clinic, or physician’s office
Maximum of 1 Visit per Covered Injury, 2 Visits per Calendar Year
$375 per VISIT
Coverage for Spouse and Children is provided if the Single Parent
or Family Plan is selected for an additional premium.
$1,500 per TRIP
$500 per TRIP
$100 per DAY
Ambulance Benefit:
Air Ambulance Benefit
Land Ambulance Benefit
Maximum of 1 trip per Covered Injury, 2 trips per Calendar Year
Attending Physician Benefit:
Payable for each Day of paid hospitalization under the Policy
$2,250 per TRIP
$750 per TRIP
$150 per DAY
Insurance Policy Form GRA-3003-VA (4/11). Premium and benefits will vary with the program selected.
This brochure is only a summary. See your Policy for details on35
exclusions and limitations. Capitalized items are defined by your Policy.
75-3003-BRO-VA (2/12)
GREEN LEVEL
GOLD LEVEL
TREATMENT BENEFITS
At-Home Recovery Benefit:
Payable for each Day of paid hospitalization under the Policy
$300 per day
1 Day of hospitalization = 3 days of home recovery benefit
$450 per day
$6,300
$12,600
Examples of Benefit:
7 Days paid hospitalization:
14 Days paid hospitalization:
$9,450
$18,900
$150 per
Diagnostic Image
Diagnostic Imaging Benefit:
for x-ray, ultrasound, sonogram, CT scan, or MRI of a Covered Injury
Maximum 1 image per Covered Injury, 2 images per Calendar Year
$225 per
Diagnostic Image
This policy does not provide benefits for loss if the Covered Person’s Injury is caused or contributed to by:
Suicide, attempted suicide, or
intentionally self-inflicted injury
Bodily infirmity, mental infirmity, or
psychiatric illness; or medical /surgical
treatment therefor
Disease, sickness, infection or other
disorders*
Infestation by any virus, bacteria, or
microorganism*
The Covered Person’s intoxication
Medical treatment or elective procedure
that is not medically necessary, including,
but not limited to, cosmetic surgery
[Cosmetic surgery does not include
reconstructive surgery when such service is
incidental to or follows surgery resulting from
trauma, infection, or other disease of the
involved part]
Any poison, gas, or fumes voluntarily
absorbed, inhaled, or taken; or medical/
surgical treatment of these acts
The voluntary use or taking of a narcotic,
unless taken/used as prescribed by a
physician
The Covered Person’s commission or
attempted commission of a felony
The voluntary taking of any poison
Participation in a riot or civil commotion
War, any act of war
Active duty status in the Armed Forces
[premium refund may be available if
Company is notified in advance of service]
Accident means a sudden, unexpected, and unforeseen event which results in a Covered Person’s Inpatient Hospital confinement or receipt of medical
services at a Hospital, Emergency Care Clinic, or Medical Practitioner’s office within 14 days after the event.
Injury means bodily harm that: (1) is sustained by a Covered Person; (2) is caused by an Accident; (3) is the direct cause of loss, independent of
disease, bodily infirmity, or any other cause; (4) occurs on or after the Coverage Effective Date; and (5) is not excluded from coverage under the
“Exclusions and Limitations” provision of this Policy. All Injuries sustained in any one Accident, all complications arising therefrom, and recurrences
of complications shall be deemed to be a single Injury for purposes of determining maximum benefits per Injury.
*Benefits are available if the condition is a medical complication that is: (1) caused by and arising out of a covered Injury and (2) treated by a Medical
Practitioner within 14 days of the covered Injury.
Underwritten By:
National Teachers Associates Life Insurance Company
P.O. Box 802207 • Dallas, Texas 75380 • (888) 671-6771 • www.ntalife.com
75-3003-BRO-VA (2/12)
36
© 2012 National Teachers Associates Life Insurance Company
Disability Income Protection Plan
Educators
National Teachers Associates Life Insurance Company
Select
Series
P.O. Box 802207 • Dallas, Texas 75380 • (888) 671-6771 • www.ntalife.com
®
PROTECT YOUR MOST IMPORTANT ASSET - YOUR ABILITY TO EARN INCOME!
Everything you have now and everything in your plans for the future is dependent upon your ability to work and earn an
income. If you’re like most people, you probably have insurance to protect your home, car, and savings — but do you have
insurance to protect your ability to earn an income? At the bottom line, your income is the foundation that holds up the rest.
Pays In Addition To Any Other Insurance including sick leave, workers’ compensation and social security.
Coverage For Sickness Or Accident on or off the job, even during the summer, anywhere in the world.
More than 19 million working-age Americans - 10.9% of people ages 21 to 64 have a work disability.1
Three in ten American workers entering the work force today will become disabled before retiring.2
In the U. S., there are approximately 71,780 disabling injuries every day. That is one disabling injury every 1.2 seconds.3
1 U.S. Census Bureau, 2008 Current Population Survey 2 Social Security Administration, Fact Sheet 2009 3 National Safety Council: Injury Facts 2008 Edition
BENEFITS BEFORE AGE 70 IF GAINFULLY EMPLOYED
1. Accidental Disability - Basic Benefits
When you become Totally Disabled within 90 days as a result of a covered Injury,
benefits are payable after the elimination period shown in your policy up to 6 full
months of continuous Total Disability, prorated on a daily basis. You choose the
monthly benefit amount.
2. Sickness Disability - Basic Benefits
When you become Totally Disabled due to a covered Sickness, benefits are payable
after the elimination period shown in your policy up to 6 full months of continuous
Total Disability, prorated on a daily basis. You choose the monthly benefit amount.
You choose up to
$2,500/mo.
($83.33 /day)
You choose up to
$2,500/mo.
($83.33 /day)
3. Pregnancy Benefit
When you deliver a child during or at the end of the third trimester you will be deemed
Totally Disabled due to a covered Sickness for a period of 45 days, and will receive
benefits for such time less the elimination period in your policy. Total Disability due to
childbirth or pregnancy (other than Complications of Pregnancy) must begin after the
first 300 days following the Coverage Effective Date to be eligible for benefits.
up to
$2,500/mo.
($83.33 /day)
4. Hospital Confinement Benefit
While you are Hospital Confined due to Injury or Sickness, benefits are payable from the first
day up to 6 full months of continuous confinement, prorated on a daily basis. Subsequent
Hospital Confinement from the same or related conditions is considered a new confinement
only if it begins more than 30 days after the end of the prior confinement. These benefits
are paid in addition to the basic Injury and Sickness Disability Benefits.
5. When Your Benefits Are Combined
When you are Totally Disabled and Hospital Confined, monthly benefits, subject to the
maximum time limits on individual benefits, are combined.
37
75-404-VA (3/12)
up to
$2,500/mo.
($83.33 /day)
up to
$5,000/mo.
($166.67 /day)
Insurance Policy Series GRD-6004-VA (9/10)
Premium and Benefits will vary with the coverage selected.
6. Physician Benefit
6.
Physician
Benefit
- up
to $75/visit
-Benefit
up topayable
$75/visit
for consultation with a Physician, such as at
Benefit
for consultation
withroom,
a Physician,
such as at
an officepayable
visit or hospital
emergency
for the purpose
of
an
office
visit
or
hospital
emergency
room,
for
the
purpose
of
obtaining a diagnosis, treatment, or medical advice, whether
obtaining
a diagnosis,
treatment,
or medical
advice,
whether
or not Hospital
Confined.
The benefit
is payable
for up
to two
or
not per
Hospital
Confined.
The benefit
payable
two
per is
visit
varies for
andup
is to
based
visits
calendar
year. (Amount
(Amount
perbenefit
visit varies
andselected).
is based
visits
per calendar
year.
on a percentage
of the
Total
Disability
amount
on a percentage of the Total Disability benefit amount selected).
8. Ambulance Service
8.
Ambulance
Service
-up
to $1,250-air
$625-ground
-up
to
$1,250-air
$625-ground
Benefit payable for expenses
incurred for two one-way
Benefit
forYear
expenses
incurred
two one-way
trips perpayable
Calendar
by ground
or air for
ambulance
for a
trips
per
Calendar
Year
by
ground
or
air
ambulance
for a
covered Injury or Sickness which requires transportation
covered
Injury ortoSickness
requires
transportation
by ambulance
or from which
a Hospital.
(Amount
per trip
by
ambulance
to
or
from
a
Hospital.
(Amount
per trip
varies and is based on a percentage of the Total Disability
varies
is based
on a percentage of the Total Disability
benefitand
amount
selected).
benefit amount selected).
7. Waiver of Premium
7.
Waiverdue
of Premium
Premiums
under this Policy during your period of Total Disability due to a covered Injury or Sickness are waived
Premiums
due
Policy
during your
period
of Total Disability
due to paid
a covered
or Sickness
waived
after the first
60under
days this
of Total
Disability
for up
to 6 months,
and Premiums
duringInjury
the Insured’s
first are
60 days
of
after
the
first
60
days
of
Total
Disability
for
up
to
6
months,
and
Premiums
paid
during
the
Insured’s
first
60
days
of
the continuous Total Disability are refunded.
the continuous Total Disability are refunded.
BENEFITS ON OR AFTER AGE 70 OR WHILE NOT GAINFULLY EMPLOYED
BENEFITS ON OR AFTER AGE 70 OR WHILE NOT GAINFULLY EMPLOYED
1. Hospital Confinement Benefit
1.
Hospital
Confinement
Benefit
While
you are
Hospital Confined
due to a covered Injury or Sickness, benefits are payable
While
youfirst
are Hospital
dueoftocontinuous
a covered confinement.
Injury or Sickness,
benefits
are payable
from the
day up toConfined
180 days
Hospital
Confinement
must
from
the
first
day
up
to
180
days
of
continuous
confinement.
Hospital
Confinement
must
begin within 30 days of Covered Injury. Subsequent Hospital Confinement from the same
or
begin
30 days
of Covered aInjury.
Subsequent Hospital
Confinement
from30
thedays
same
or
relatedwithin
conditions
is considered
new confinement
only if it begins
more than
after
related
considered a new confinement only if it begins more than 30 days after
the endconditions
of the priorisconfinement.
the end of the prior confinement.
2. Convalescent Benefit
2.
Convalescent
Benefit Confinement, benefits are payable for the same number of days as
Following
a covered Hospital
Following
a covered
HospitalBenefit
Confinement,
arethe
payable
fordisability
the same
number
days as
your Hospital
Confinement.
amount benefits
is equal to
monthly
benefit
youofselected.
your Hospital Confinement. Benefit amount is equal to the monthly disability benefit you selected.
up to
up
$ to
5,000/mo.
/mo.
$5,000
($166.67 /day)
($166.67 /day)
up to
up
$ to
2,500/mo.
/mo.
$2,500
($83.33 /day)
($83.33 /day)
3. Physician Benefit
3.
Physician
Benefit
payableBenefit
for consultation with a Physician, such as at an office visit or hospital emergency room, for the purpose
Benefit
payable
for consultation
withor
a Physician,
such as
at an office
or hospital
emergency
room,isfor
the purpose
of obtaining
a diagnosis,
treatment,
medical advice,
whether
or notvisit
Hospital
Confined.
The benefit
payable
for up
of
obtaining
a
diagnosis,
treatment,
or
medical
advice,
whether
or
not
Hospital
Confined.
The
benefit
is
payable
up
to two visits per calendar year. up to $75/visit. (Ammount per visit varies and is based on a percentage of thefor
Total
to
two visits
per calendar
year. up to $75/visit. (Ammount per visit varies and is based on a percentage of the Total
Disability
benefit
amount selected).
Disability benefit amount selected).
4. Ambulance Service
4.
Ambulance
Benefit
payable forService
expenses incurred for two one-way trips per Calendar Year by ground or air ambulance for a covered
Benefit
forwhich
expenses
incurred
for two one-way
trips per to
Calendar
by ground
or airper
ambulance
a covered
Injury orpayable
Sickness
requires
transportation
by ambulance
or from Year
a Hospital.
(Amount
trip variesfor
and
is based
(Amount
per
trip
varies
and
is based
Injury
or
Sickness
which
requires
transportation
by
ambulance
to
or
from
a
Hospital.
on a percentage of the Total Disability benefit amount selected). up to $1,250-air $625-ground
on a percentage of the Total Disability benefit amount selected). up to $1,250-air $625-ground
5. Waiver of Premium
5.
Waiverdue
of Premium
Premiums
under this Policy during your period of Hospital Confinement due to an Injury or Sickness are waived
Premiums
due
Policy during
your period
of Hospital
Confinement
due
toPremiums
an Injury orpaid
Sickness
after the first
60under
days this
of continuous
Hospital
Confinement
for up
to 6 months,
and
during are
the waived
first 60
after
the
first
60
days
of
continuous
Hospital
Confinement
for
up
to
6
months,
and
Premiums
paid
during
the
first 60
days of the continuous Hospital Confinement are refunded.
days of the continuous Hospital Confinement are refunded.
Your policy contains a number of specific exclusions and limitations. We will not pay concurrent benefits for multiple
Your
policy
contains awhich
number
ofat
specific
exclusions
and
limitations.
We
will notfor
paySickness
concurrent
for multiple
Injuries
or Sicknesses
occur
the same
time during
a Total
Disability.
Benefits
arebenefits
not payable
unless
Injuries
or Sicknesses
whichoroccur
at the
same31
time
during
Total
Disability.
BenefitsDate.
for Sickness
payable
unless
the Sickness
is Manifested
Occurs
at least
days
afterathe
Coverage
Effective
You are are
not not
eligible
for benefits
the
Sickness
is ManifestedHospital
or Occurs
at leastWaiver
31 days
after the Coverage
Effective Date.
You are
not eligible
benefits
(Total
Disability-Sickness,
Disability,
of Premium
or Convalescence)
attributable
to child
birth orfor
pregnancy
(Total
Disability,
Waiver
Premium
or Convalescence)
attributable
to child
birthInorgeneral,
pregnancy
(other Disability-Sickness,
than ComplicationsHospital
of Pregnancy)
during
the of
first
300 days
following the Coverage
Effective
Date.
no
(other
than
of Pregnancy)
first 300 days
following
the suicide
Coverage
Effective Date.
In general,
no
benefits
areComplications
payable for Injury
or Sickness during
causedthe
or contributed
to by
attempted
or intentionally
self-inflicted
Injury,
benefits
are payable
Injury
or Sickness
caused
or duty
contributed
tothe
by attempted
suicide
or intentionally
self-inflicted
Injury,
war, participation
in afor
riot
or civil
commotion,
active
status in
armed forces,
voluntary
use of any
narcotic (unless
war,
participation
a riot orand
civiltaken
commotion,
active
status in the
armed use
forces,
voluntary
of any
narcotic
(unless
prescribed
to the in
individual
as directed
byduty
a Physician),
voluntary
of poisons
or use
gases,
Injury
resulting
from
prescribed
the individual
taken
as directed
a Physician),
voluntary
use of poisons
or gases,
Injury resulting
from
intoxication,toacting
as a pilotand
or crew
member
in anyby
aircraft,
passenger
on non-commercial
aircraft,
commission
or attempted
intoxication,
as a pilot
or crewtreatment
member inorany
aircraft,
passenger
aircraft, commission
or not
attempted
commission acting
of a felony,
or medical
elective
procedure
thaton
is non-commercial
not medically necessary,
including, but
limited
commission
a felony,
or medical
treatment
or elective
that surgery
is not medically
necessary,
including,
buttonot
limited
to, cosmetic of
surgery.
Cosmetic
surgery
shall not
include procedure
reconstructive
when such
service is
incidental
or follows
to,
cosmetic
surgery.
surgery shall
not include
surgery
resulting
fromCosmetic
trauma, infection
or other
diseasereconstructive
of the involvedsurgery
part. when such service is incidental to or follows
surgery resulting from trauma, infection or other disease of the involved part.
In addition to these specific exclusions and limitations, your policy does not cover Preexisting Conditions for one year after the
In
addition Effective
to these specific
exclusionsCondition
and limitations,
policy does
not cover
Preexisting
Conditions
onerecommended
year after the
Coverage
Date. Preexisting
meansyour
a condition
for which
medical
advice or
treatmentfor
was
Coverage
Effective
Preexisting
Condition
means period
a condition
for the
which
medical Effective
advice or Date;
treatment
was
recommended
by or received
fromDate.
a Physician
within
the one-year
before
Coverage
or for
which
symptoms
by
or received
from
a Physician
within
thethe
one-year
period
beforeDate
the Coverage
or forprudent
which symptoms
existed
within the
one-year
period
before
Coverage
Effective
that wouldEffective
cause anDate;
ordinarily
person to
existed
within the
one-year
period before the Coverage Effective Date that would cause an ordinarily prudent person to
seek diagnosis,
care,
or treatment.
seek diagnosis, care, or treatment.
These exclusions and limitations, and all other matters in this brochure are only a summary. The actual policy provisions will control.
These
exclusions
limitations,
and alldetail
otherofmatters
in this and
brochure
are only
summary.
Thedefinitions
actual policy
provisions will
control.
Read your
policy and
carefully
for a complete
all exclusions
limitations
anda for
important
of capitalized
terms.
If you
Read
your
policy carefully
complete
detail
of all your
exclusions
limitations
capitalized
terms. If and
you
are not
satisfied,
you havefor
10adays
after you
receive
policyand
to return
it to usand
or for
ourimportant
Agent. Thedefinitions
premium of
paid
will be refunded
are
satisfied,
you receive your policy to return it to us or our Agent. The premium paid will be refunded and
the not
policy
will beyou
voidhave
from10itsdays
dateafter
of issue.
the policy will be void from its date of issue.
Underwritten By:
Underwritten By:
National Teachers Associates Life Insurance Company
National
Teachers
Associates
Life Insurance
Company
P.O. Box 802207
• Dallas, Texas
75380 • (888) 671-6771
• www.ntalife.com
P.O. (3/12)
Box 802207 • Dallas, Texas 75380 • (888) 671-6771 • www.ntalife.com
75-404-VA
38
75-404-VA (3/12)
© 2012 National Teachers Associates Life Insurance Company
© 2012 National Teachers Associates Life Insurance Company
Monthly Premiums
National Teachers Associates Life Insurance Company
P.O. Box 802207 • Dallas, Texas 75380 • (888) 671-6771 • www.ntalife.com
Monthly Premiums
Based on a 10 month billing
INDIVIDUAL
W/BBR* W/OUT
CANCER
HEART
Green
Gold
ALL PURPOSE
INTENSIVE CARE
SINGLE PARENT
W/BBR*
W/OUT
FAMILY
W/BBR* W/OUT
37.59
55.65
2.10
21.48
31.80
1.20
50.19
71.19
3.47
28.68
40.68
1.98
62.79
92.19
4.20
35.88
52.68
2.40
58.70
77.60
33.54
44.34
65.00
83.90
37.14
47.94
96.50
125.90
55.14
71.94
8.82
17.64
26.46
5.04
10.08
15.12
10.71
21.42
32.13
6.12
12.24
18.36
17.95
35.91
53.86
10.26
20.52
30.78
* BENEFIT BOOSTER RIDER
$200
$180
$160
$140
$120
$100
$80
$60
$40
$20
$0
1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th
year year year year year year year year year year
39
Monthly Premiums
National Teachers Associates Life Insurance Company
P.O. Box 802207 Dallas, Texas 75380 (888) 671-6771 www.ntalife.com
National Teachers Associates Life Insurance Company
Providing Peace of Mind & Quality Protection to All We Insure
Montly Premiums (Based on a 10 month billing)
ACCIDENT
Occupation Group 1
Green
Gold
Occupation Group 2
Green
Gold
Combination
Occupational Group
Green
Gold
NTA DISABILITY
Issue Age
18 - 44
45 - 54
55 - 64
INDIVIDUAL
SINGLE PARENT
FAMILY
19.14
29.92
29.94
44.34
43.14
63.54
33.54
50.34
50.34
75.54
71.94
107.94
57.54
85.74
$1000
$1500
$2000
49.20
55.56
78.72
71.40
80.94
115.68
93.60
106.32
152.64
40
P . O . B o x 1 3 9 2 • A d d i s o n , T e x a s 7 5 0 0 7 -­‐ 1 3 9 2 ( 8 8 8 ) 4 8 3 -­‐ 1 3 9 2 • F a x ( 8 8 8 ) 2 1 1 -­‐ 1 3 9 2 m a r k e t i n g @ a c c u f l e x s e r v i c e s . c o m • w w w . a c c u f l e x s e r v i c e s . c o m 41
Your Cafeteria Plan Benefit Program The Cafeteria Plan Benefit Program allows you to select from a menu of benefits such as Group Health, Dependent Care Accounts, Flexible Spending Accounts, Supplemental Programs and more, leaving you to choose those benefits that meet your specific needs. The cost of the benefits that you choose is then deducted from your paycheck prior to taxes. Whereas otherwise you would be paying with your after-­‐tax dollars, you may now benefit from pretax payments, leaving you with more money to take home. By implementing this plan, your employer is helping you to reduce your taxes and to increase your spendable income. The cost-­‐saving advantage of the plan is simple. Any benefit costs or insurance premiums that you pay for under the plan are paid on a pretax basis. The example below illustrates the advantage of participating in the Cafeteria Plan as compared to participating in a plan without the same benefits. Without Cafeteria Plan Gross Monthly Earnings $5000 $0 $1000 $0 $0 $0 $0 $300 $150 $150 $400 $5000 $4000 Withholding Tax FICA and Medicare Taxes (5.65%) Federal Income Tax (25%) $1202 $895 After Tax Payments Group Health Premiums Pretax Eligible Supplemental Programs Out-­‐of-­‐Pocket Medical Dependent Care $1000 $0 Taxable Earnings $283 $919 Monthly Take-­‐Home Pay $5000 Pre Tax Benefits Group Health Premiums Pretax Eligible Supplemental Programs Out-­‐of-­‐Pocket Medical Dependent Care With Cafeteria Plan $300 $150 $150 $400 $2798 Monthly Savings = $307 Yearly Savings = $3678* $226 $669 $0 $0 $0 $0 $3105 * This example is intended to provide typical tax savings based on the 2012 Federal Tax Rates. Actual savings will vary based on individual tax circumstances. Additional savings of state and local taxes may also be realized. For more information, contact your tax professional.
42
®
Eligible Expenses
BABY/CHILD TO AGE 13
Breast Pump
Lactation Consultant*
Special Formula*
Tuition: Special School/Teacher for
Disability or Learning Disability*
Well Baby /Well Child Exams & Care
DENTAL
Dental X-Rays
Dentures and Bridges
Exams and Teeth Cleaning
Extractions and Fillings
Oral Surgery
Orthodontia
Periodontal Services
EYES
Eye Exams
Eyeglasses and Contact Lenses
Laser Eye Surgeries
Prescription Sunglasses
Radial Keratotomy
HEARING
Hearing Aids and Batteries
Hearing Exams
LAB EXAMS/TESTS
Blood Tests and Metabolism Tests
Body Scans
Cardiograms
Laboratory Fees
X-Rays
MEDICAL EQUIPMENT/SUPPLIES
Air Purification Equipment*
Arches and Orthotic Inserts
Contraceptive Devices
Crutches, Walkers, Wheel Chairs
Exercise Equipment*
Hospital Beds*
Mattresses*
Nebulizers
Orthopedic Shoes*
Oxygen*
Post-Mastectomy Clothing
Prosthetics
Syringes
Wigs*
MEDICATIONS
Insulin
Prescription Drugs
OBSTETRICS
Doulas*
Lamaze Class
OB/GYN Exams
OB/GYN Prepaid Maternity Fees
(reimbursable after date of birth)
Pre- and Postnatal Treatments
PRACTITIONERS
Allergist
Chiropractor
Christian Science Practitioner
Dermatologist
MEDICAL PROCEDURES/SERVICES
Homeopath
Acupuncture
Naturopath*
Alcohol and Drug/Substance Abuse
(inpatient treatment/outpatient care). Optometrist
Osteopath
Ambulance
Physician
Fertility Enhancement and Treatment
Psychiatrist or Psychologist
Hospital Services
Immunization
THERAPY
In Vitro Fertilization
Alcohol and Drug Addiction
Physical Examination
(not employment-related)
Counseling (not marital or career)
Reconstructive Surgery (due to a
Exercise Programs*
Hypnosis*
congenital defect, accident, or
Massage*
medical treatment)
Service Animals
Occupational
Sterilization/Sterilization Reversal
Physical
Transplants (including organ donor)
Smoking Cessation Programs*
Transportation*
Speech
Weight Loss Programs*
Note: This list is not meant to be all-inclusive, as other expenses not specifically mentioned may also qualify. Also, expenses
marked with an asterisk (*) are “potentially eligible expenses” that require a medical practitioner’s note stating that the
item or service will be used to treat a specific medical condition. For additional information, please contact AccuFlex
Services, Inc. at 888-483-1392.
43
2511 (3/11)
The following is a list of expenses which are generally not eligible for reimbursement under the FSA because they are considered toiletries, cosmetic or primarily for general health and well being or are otherwise disqualified.
Ineligible Expenses:
Chapstick
Face creams
Mouth washes & oral anesthetics
Childcare
Feminine hygiene products
Over the counter medicines
Child rearing classes
Food items
Personal training
COBRA payments
Funeral expenses
Shaving cream and razors
Cosmetics
Gym memberships
Soap and shampoo
Cosmetic surgery
Hair removal treatments
Suntan lotion
Deodorants
Late fees on medical bills
Surrogate expenses
Diapers (for infant or toddler use)
Marriage, family or career counseling
Teeth whitening kits
Drugs and medicines obtained from
foreign countries
Medicated shampoos and soaps
Toothpaste and toothbrushes
Vitamins (unless prescribed)
Note: This list is not meant to be all-inclusive.
Please Note: The IRS will not allow over-the-counter medicines or drugs to be purchased with or reimbursed under the
Health Care FSA unless accompanied by a prescription.
Eligible Over-the-Counter Items
Note: Product categories are listed in bold face; common examples of products are listed in regular face.
The following is a high level list of over-the-counter (OTC) items that are eligible for reimbursement under the Health
Care FSA plan.
Antiseptics, Wound Cleansers
Alcohol, Epsom salt, peroxide
Baby Electrolytes
Pedialyte, Enfalyte
Denture Adhesives, Repair,
and Cleansers
PoliGrip, Benzodent, Efferdent
Diabetes Testing and Aids
Insulin, Ascencia, One Touch,
Diabetic Tussin, insulin syringes,
glucose products
Diagnostic Products
First Aid Dressings and Supplies
Elastics/Athletic Treatments
Hearing Aid/Medical Batteries
Incontinence Products
Thermometers, blood pressure
monitors, cholesterol testing
ACE, Futuro, elastic bandages,
braces, hot/cold therapy,
orthopedic supports, rib belts
Eye Care
Contact lens care
Family Planning
Band Aid, 3M Nexcare,
non-sport tapes
Attends, Depend, GoodNites for
juvenile incontinence
Reading Glasses and Maintenance
Accessories
Pregnancy and ovulation kits
For additional information, please contact
AccuFlex Services, Inc. at 888-483-1392
44
2511 (3/11)
Flexible Spending Account (FSA) A Flexible Spending Account is a benefit provided by your employer that allows you to contribute a chosen amount of your gross income to a designated account or accounts before taxes are calculated. These accounts are for unreimbursed medical expenses not covered by your insurance. With an FSA you can be reimbursed throughout the plan year as you incur the expenses. Most medical expenditures not reimbursed by an insurance plan or any other source, such as copayments, vision care, dental costs, and routine physicals, are qualified medical expenses under an FSA Plan. These expenses may be either for you or for your dependents. Cosmetic surgery procedures and some other health-­‐
related expenses do not qualify. Easy to Use Two options exist for using the FSA dollars on qualified expenses. (1) Any qualified expenses that you pay using any form of payment may be submitted to AccuFlex Services, Inc. for reimbursement. Upon receiving proof of payment and documentation indicating the expense is a qualified expense, you will be reimbursed from your FSA. Reimbursements can be made through a direct deposit into your designated bank account. (2) Alternatively, upon enrolling in the FSA program, you will be issued a Benny Prepaid Benefits Card that can be used to pay for qualified expenses. The Benny Card acts similarly to a debit card, enabling you to avoid using other funds to pay these expenses. Simply swipe your card and the amount of your eligible expense will be automatically deducted from your account. Keep in mind that you may still be required to submit receipts to establish that the expense was a qualified expense. Benny Card Your Benny Card contains the value of your annual health care FSA election amount. Much like a debit card, you can use your Benny Card to easily pay for eligible medical expenses. Using the Card helps you keep cash in your wallet. You’ll have no claim forms to complete and you won’t have to wait to get a check in the mail. Simply swipe your Card, and the amount of your eligible expense will be automatically deducted from your account. If you use the Card at participating pharmacies, discount stores, department stores, and supermarkets, in most cases, you won’t be asked to submit receipts for those purchases (DON’T FORGET! Always save receipts for FSA purchases made with the Card, as you may be asked to submit receipts to verify that your expenses comply with IRS guidelines.) Checking the balance on your FSA is simple too. With the Benny Card, you will have online access 24 hours a day to verify expenses and check your current balance remaining in your account. You may also contact our customer service department during business hours if you prefer. Estimate Your Expenses Any FSA dollars not used for expenses are forfeited. This is what is known as the “use it or lose it” provision of Section 125. It is very important to be conservative in estimating your expenses for the plan year. 45
GUIDELINES FOR THE USE OF FSA, HRA, and HSA FUNDS TO PURCHASE
OVER THE COUNTER PRODUCTS AFTER 1/1/11
Dear Participant:
The recently enacted Patient Protection and Affordable Care Act of 2010 has changed the rules for the
purchase of over the counter (OTC) products using your Flexible Spending Account (FSA), Health
Reimbursement Arrangement (HRA), or Health Savings Account (HSA) pre-tax funds.
Effective January 1, 2011 the IRS does not allow OTC medicines and drugs to be reimbursed
using your FSA, HRA, or HSA dollars.
1. FSA, HRA, or HSA funds can no longer be used to purchase OTC medicines and drugs unless the
medicine or drug is prescribed. A “prescription” means a written or electronic order for a medicine or
drug that meets the legal requirements of a prescription in the state in which the medical expense is
incurred and that is issued by an individual who is legally authorized to issue a prescription in that state.
Ineligible OTC drugs and medicines affected include items in the following categories:
Acid controllers
Contraceptives
Medicated nasal sprays,
drops, & inhalers
Acne medications
Cough, cold & flu
Medicated respiratory
Allergy & sinus
Denture pain relief
treatments & vapor products
Antibiotic products
Digestive aids
Motion sickness
Antifungal (Foot)
Ear care
Oral remedies or treatments
Antiparasitic treatments
Eye care
Pain relief (includes aspirin)
Antiseptics & wound
Feminine antifungal & anti-itch
Skin treatments
cleansers
Fiber laxatives (bulk forming)
Sleep aids & sedatives
Anti-diarrheals
First aid burn remedies
Smoking deterrents
Anti-gas
Foot care treatment
Stomach remedies
Anti-itch & insect bite
Hemorrhoidal preps
Unmedicated nasal sprays,
Baby rash ointments &
Homeopathic remedies
drops & inhalers
creams
Incontinence protection &
Unmedicated vapor products
Baby teething pain
treatment products
Cold sore remedies
Laxatives (non-fiber)
2. If you have a prescription for an OTC medicine or drug, you can use your Benny™ Prepaid
Benefits Card for this purchase as long as the prescription is filled by the pharmacist with an
Rx number assigned. If your OTC prescription is not filled by a pharmacist, you must pay out
of pocket and submit a manual claim requesting reimbursement.
3. You can continue to use your FSA, HRA, or HSA funds to purchase eligible OTC items that are not
considered a medicine or drug (e.g. bandages, splints, contact lens solution, etc.) Please note that
insulin remains an eligible expense with or without a prescription. So, your Benny Prepaid
Benefits Card can continue to be used for these purchases.
4. If you have questions about this OTC change or need more information, please contact your Plan
Administrator using the phone number listed on the back of your Card.
EC-148 012411
46
AccuFlex Services, Inc.
1. Receipts are requested if an expense doesn’t match a co-pay amount according to the
school’s insurance premiums. AccuFlex Services, Inc. is in compliance with the IRS and
Evolution Benefits. The documentation requested is for adjudication purposes only.
2. Most dental/vision transactions will require receipts because they vary in amount and
can’t be auto-adjudicated.
3. If a transaction is set up as recurring, the Benny system only keeps that information in
their system for 1 year. The expense has to be set up as recurring again each new plan
year. We will do our best to catch these but an initial receipt request may be issued
again.
4. New Benny cards are automatically re-issued by Evolution Benefits 2 weeks prior to the
expiration date.
5. The first two (2) receipt requests are sent by email, if we have an email address on file.
If not, a hard copy letter is sent through the mail. The final request letter is sent 90 days
after the transaction date and at that time the card is suspended until the proper
documentation is received and adjudicated in the Benny system.
6. To check your balance and transaction history please register your account at
www.mybenny.com.
7. Please inform AccuFlex Services, Inc. of an address or e-mail change to ensure your
letters are being delivered properly. Also if you are set up on ACH (direct deposit) for
your claims, please notify us of any banking changes. Direct deposit forms are located
on our website www.accuflexservices.com.
8. If your school has an HSA account through AccuFlex or another group, they may have a
limited FSA account with us that is used for dental or vision only.
9. If your group has elected a grace period, those funds are exhausted from the current
plan year first (Benny card or manual claim) before being deducted from the next plan
year’s elections.
10.
There is a $5.00 fee to replace the Benny card. They are issued in increments of 2 in
the employee’s name only, but your spouse or child may use the cards. The re-issue
usually takes 7-10 business days from the request date.
47
Dependent Care Account (DCA) A Dependent Care Account allows you to contribute a chosen amount of your pretax income to a designated account or accounts, from which you are reimbursed for eligible dependent-­‐care expenses. Qualifying expenses include those that enable you to attend work or school while your dependent is cared for by another service or individual, such as pre-­‐school tuition or payment to an eligible daycare provider. Qualifying Dependents To qualify as a dependent under the program, an individual must fall within the definitions specified by the IRS Child and Dependent Care Expenses Publication 503. According to this legislature, a qualifying person is: 1. Your qualifying child who is your dependent and who was under age 13 when the care was provided; 2. Your spouse who was not physically or mentally able to care for himself or herself and lived with you for more than half the year; or 3. A person who was not physically or mentally able to care for himself or herself, lived with you for more than half the year, and either: a. Was your dependent, or b. Would have been your dependent except that: i.
He or she received gross income of $3,650 or more, ii.
He or she filed a joint return, or iii.
You, or your spouse if filing jointly, could be claimed as a dependent on someone else's 2010 return. Contribution Limits DCA contributions are limited to the following amounts as specified: • $5,000 annually for a single person or married couple filing a joint income tax return, and • $2,500 annually for each married participant who files a separate income tax return. The amount of your contribution cannot be more than either your earned income or your spouses earned income, whichever is less. Earned income includes wages, salaries, tips, and other employee compensation, plus net earnings from self-­‐employment. Continuation of Benefits Upon layoff or termination of employment, you no longer qualify for the Dependent Care Account benefit. Only bills for services incurred prior to your layoff or termination date can be submitted for reimbursement. Reimbursements from your DCA are provided to you as soon as contributions to your account are received from your employer. Plan Ahead You will be reimbursed from the balance of contributions in your account at the time of request. Any excess reimbursement claim will be carried forward. As additional contributions are made into the account, you will be reimbursed at that time. Any DCA contributions not used for qualified expenses are forfeited. This is what is known as the “use it or lose it” provision of Section 129. It is very important to be conservative in estimating your expenses for the plan year. 48
Frequently Asked Questions Q: What is The Cafeteria Plan Benefit Program? A: Q: How do I benefit from participating in this Program? A: Q: A: A: You can only make changes to your elections if you have a qualifying event such as a change in status or a significant change in available coverage. Some change of status events include: • Change in legal marital status • Change in number of dependents • Change in work status or schedule of participant or participant’s family • Judgment decree or court order • Significant change (25%) in premiums of a health insurance policy • Entitlement to Medicare or Medicaid What other features are there in the plan in addition to not taxing my health and medical-­‐related insurance premiums? A: You must make your benefit election annually prior to the beginning of the effective date of the benefit program plan year. The plan year is typically a 12-­‐month period, though not necessarily a calendar year. Your employer determines the dates of the plan year. Can I make changes in my election after the plan year starts? Q: You benefit by taking advantage of the tax savings. By participating in a cafeteria plan you increase your spendable income by reducing what you pay in taxes. Reducing the amount you pay in Federal, Social Security, and in some cases state and local taxes, there is a possible savings of between 25% and 40% of every dollar you contribute to the plan. When do I enroll in the Cafeteria Plan Benefit Program? Q: It is an employer-­‐sponsored benefit plan that allows an employee to select from a menu of available benefits, choosing those benefits that meet the employee’s specific needs. The benefits that are chosen are then paid for through a salary reduction agreement with the employer. Salary reduction means that the employee is able to use “pretax” dollars to pay for certain benefits. The plan also allows you to establish accounts to deduct unreimbursed medical expenses through a flexible spending account (“FSA”) and dependent care expenses through a dependent care account (“DCA”) from your gross pay before taxes are calculated and deducted. 49
Q: What is a qualified medical expense for reimbursement under the FSA plan? A: Q: How do I check the balance of my medical FSA? A: Q: You will have access to view your balance online, 24 hours a day to verify expenses and check your current balance remaining in your account. You may also contact our customer service department during business hours if you prefer. Who is considered a qualified dependent for reimbursement of dependent care expenses? A: Q: Most medical expenditures not reimbursed by an insurance plan or any other source, such as co-­‐payments, vision care, dental costs, and routine physicals, are qualified medical expenses. These expenses may be either for you or for your dependents. Cosmetic surgery procedures and some other health-­‐related expenses do not qualify. Your dependent children under the age of 13 or a dependent spouse or other adult physically not able to care for himself or herself is considered to be a qualified dependent, if their dependent care expenses could qualify for the federal income tax credit on your tax return. What if my dependent care expense is in excess of the amount in my account? A: You will be reimbursed for whatever is in your account. The balance for the expenses will be carried forward to future months. As additional payments are made into the account, you will be reimbursed at that time. Q: Can I switch dollars between my DCA and FSA accounts? Q: What happens if I don’t incur enough expenses to get back the money deposited into my reimbursement account? A: A: Q: No. The dollars must be used in each account as specified on the election form. Any expense dollars not used for expenses are forfeited. This is what is known as the “use it or lose it” provision of Section 125. It is very important to be conservative in estimating your expenses for the plan year. Can I take the tax credit for the dependent care or the medical expense deduction on my income tax return if I am in this plan? A: No. Expenses reimbursed under this plan may not be used when calculating your medical expenses deduction or the dependent care tax credit. Because it is sometimes more advantageous to take the dependent care tax credit on your tax return than to participate in the dependent expense reimbursement account, you should discuss which alternative is the best for you with your tax advisor. 50
Tax­Deferred Annuity Plans 403 (b) & 457(b) Annuities Administered by The OMNI Group Suffolk Public Schools has contracted with "The OMNI Group" to administer our 403(b) and 457(b) Retirement Plan in compliance with new IRS guidelines. Under our agreement, it is OMNI's responsibility to ensure that the district, its employee participants, and each of our providers adhere to all of the many compliance regulations of the IRS. As part of the process of assuring compliance with IRS regulations, OMNI has standardized our tax sheltered annuity forms. Interested employees must complete and sign the OMNI Salary Reduction Agreement (SRA) and submit it directly to OMNI. IRS regulations will not permit OMNI to process a payroll deduction without a completed form. Forms must be submitted by any pay date to be effective the following pay date. You may contact The OMNI Group by using their toll free customer service number at 1 (888) 544­6664 or you may visit their web site at www.OMNI403b.com . The school division offers both IRS Section 403(b) and Section 457(b) deferred compensation plans to all of its employees, including part­time and substitute employees. Both of these plans allow the employee to defer compensation (maximum amounts apply) on a per­pay basis, saving current payroll withholding taxes and providing the employee with additional retirement income. The example below shows a net pay comparison of pre­tax and after­tax deductions to an annuity. Example of Pre‐Tax Annuity Savings With $100 Without $100 Annuity Annuity Deduction Deduction Per­pay Salary: $1,500 $1,500 Pre­Tax Annuity Deduction: Taxable Salary: (100) 1,400 (­0­) 1,500 Payroll Withholding Taxes: (226) (246) $1,174 $1,254 Net Pay Amount: After­Tax Net Pay: Pre­Tax Net Pay: Difference in Net Pay: $1,254 1,174 $80 In this example, a $100 pre­tax annuity deduction reduces the employee’s pay by $80.
51
Some of the differences between 403(b) and 457(b) deferred compensation plans are: 





Contribution Amounts
Catch‐up Provisions
Loans
Withdrawals
Distribution age
Early Withdrawal Penalties Employees should discuss their individual long­term goals with the company representatives to determine which plan or plans are best suited for them. Contributions to these plans are voluntary and are funded through employee payroll deduction. Approved companies are listed below and may be selected by any employee for salary deferral via payroll deduction. Approved Annuity Companies Horace Mann Life Insurance Company
 E. Kaye Weaver (757) 562­0936 ING Life Insurance and Annuity Company
 Thomas R. Griffin (757) 941­8713
 Joe Newman (757) 548­6271
 Nichols Orenduff (804) 673­6633 Lincoln Financial Group
 Wardell M. Nottingham (757) 461­7455 MetLife
 Brooke Larson (757) 312­0620
 Vickie Pulley (757) 619­5819 The Hartford
 Shandre Harasty (757) 393­0016
 Rob Estes (757) 484­7192
 Margie Wiley (757) 539­5800 VALIC
 Raleigh Martin (757) 288­7154 or 800 44­VALIC You may find additional information, links to the annuity providers, the OMNI Salary Reduction Agreement (SRA) and the OMNI website on the Finance Department web page.
52
Virginia Retirement System Virginia Retirement System Retirement Benefits– Membership in the Virginia Retirement System (VRS) is mandatory for all full­time employees. Under certain conditions, VRS allows for the purchase of prior service credit through payroll or in a lump sum payment at the employee’s current salary rate. Part­time employees are not eligible for VRS membership. The Human Resources Department staff are available to assist employees with questions on retirement benefits. Life Insurance Benefits­ Employees eligible for membership in VRS are also provided life insurance benefits for their survivors. The School Board pays the mandatory cost of the VRS group life insurance premium. Coverage equals two times the annual income on the insured employee for natural death and four times the annual salary for accidental death. Employees need to complete a change of beneficiary form with VRS should their survivor status change (for example: marriage, divorce, death, etc). The Human Resources Department staff can assist employees with making beneficiary changes. Optional Life Insurance Benefits­ Employees eligible for membership in VRS are also eligible to purchase optional life insurance for themselves and their family members. This benefit is voluntary and the premiums are paid 100% by the employee through payroll deduction. New employees may enroll within 31 days of their hire date. Existing employees may apply for enrollment by completing a VRS Evidence of Insurability form. To obtain more information about VRS Life Insurance and VRS Optional Life Insurance visit http://www.securian.com/mmedia/VRS.html or contact the Human Resources Department staff at 668302 or 668305. myVRS­ Employees eligible for membership in VRS may access various retirement related information through the myVRS website. A new addition to the myVRS website is the Member Benefit Profile (MBP) annual statement. The MBP statements are now available to all VRS eligible employees online and replace the paper statements received each fall. Only support department employees will continue to receive paper statements. To obtain more information about myVRS visit www.varetire.org.
53
Suffolk Public Schools
SCHOOL CALENDAR 2012-2013
August 20-22
August 23-24
August 27-31
September 3
September 4
October 3
November 5
2012
November 6
November 12
November 16
JULY
S
1
8
15
22
29
M
2
9
16
23
30
T
3
10
17
24
31
W
4
11
18
25
T
5
12
19
26
F
6
13
20
27
S
7
14
21
28
AUGUST
S
M
5
12
19
26
6
13
20
27
T
W
1
7 8
14 15
21 22
28 29
T
2
9
16
23
30
F
3
10
17
24
31
S
4
11
18
25
2
9
16
23
30
M
3
10
17
24
T
4
11
18
25
W
F
6 7
13 14
20 21
27 28
S
1
8
15
22
29
OCTOBER
S
7
14
21
28
M
1
8
15
22
29
T
2
9
16
23
30
W
3
10
17
24
31
February 18
February 28
March 28
March 29
April 1-5
April 17
May 10
May 27
May 28-29
May 30, 31, June 3-5
June 8
June 17, 18
T
5
12
19
26
January 28
February 8
June 11, 12, 13, 14
June 14
SEPTEMBER
S
November 21
November 22-23
December 12
December 20
December 21-January 1
January 2
January 21
January 22, 23, 24, 25
January 25
T F S
4 5 6
11 12 13
18 19 20
25 26 27
New Teacher Orientation
System Wide Staff Development
Pre-Service Week
Schools Closed for All-Labor Day Holiday
First Day of School
Interim Reports Issued
End of 1st Grading Period
Total Days 1st grading Period (45 Days)
Schools Closed for Students - Staff Development Day
School Closed for All - Veterans Day
School Closed for Students - Parent /Teacher Conferences
10:00 a.m.-6:00 p.m. Lunch 1:00 p.m.-2:30 p.m.
Early Dismissal (Thanksgiving Break Begins)
School Closed for All-Thanksgiving Holiday
Interim Reports Issued
Winter Break begins at End of Day
School Closed for All-Winter Break
School Re-opens after Winter Break
Schools Closed for All-Martin Luther King, Jr. Holiday
1st Semester Exams - Early Dismissal: January 23-25
Total Days 2nd Grading Period (45 Days)
End of 1st Semester (90 Days)
Schools Closed for Students-Clerical Day
School Closed for Students-Parent/Teacher Conferences
10:00 a.m.-6:00 p.m. Lunch 1:00 p.m.-2:30 p.m.
Schools Closed for All-Presidents Day Holiday
Interim Reports Issued
End of 3rd Grading Period (41 Days)
Clerical Day for Teachers - No school for Students
School Closed for All-Spring Break
Report Cards Distributed
Interim Reports Issued
Schools Closed for All-Memorial Day Holiday
Exempt Notification
Senior Exams
Graduation: King’s Fork - 9:00 a.m.
Nansemond River 11:30 a.m.
Lakeland 2:00 p.m.
2nd Semester Exams - Early Dismissal: June 12-15
End of 4th Grading Period (49 Days)
End of 2nd Semester (90 Days)
Teacher Clerical Days
Aug.
Nov.
Jan.
Feb.
March
June
Martin Luther King, Jr. Day
Presidents’ Day Holiday
Spring Break
Memorial Day
*Teacher Clerical/Inservice Days
Work Hours: 8:30 a.m. - 3:30 p.m.
NOVEMBER
S
M
T
W
4
11
18
25
5
12
19
26
6
13
20
27
7
14
21
28
T F S
1 2 3
8 9 10
15 16 17
22 23 24
29 30
DECEMBER
S
M
T
W
2
9
16
23
30
3
10
17
24
31
4
11
18
25
5
12
19
26
T
F
6 7
13 14
20 21
27 28
S
1
8
15
22
29
Non Teaching Days
Returning
New
7
10
2
2
1
1
1
1
1
1
2
2
14
17
HOLIDAYS
Labor Day
Veterans Day
Thanksgiving Holiday
Winter Break
1
1
2
8
1
1
5
1
20
There are 180 actual teaching days. Clerical days for inservice planning, evaluation,
conferences and related services: 17 days for new teachers and 14 days for previously
employed teachers. 3 – 6 days are subject to assignment by the School Board according to
the contracts for teachers.
MAKE-UP DAYS: If a FULL day is missed then a FULL day shall be used to compensate
for instructional time. The first two days missed will be covered by the extra instructional
hours that are built into the school schedule. The third day missed may be made up on
Parent/Teacher Conference Day (either November or February date). The fourth day
missed will be made up on Presidents’ Day, February 18, 2013. The fifth day missed will
be made up on Memorial Day, May 27, 2013. The sixth day may be made up on a Saturday.
KEY - Holidays in GREEN
- End of each reporting period
- Denotes teacher workdays
- Parent/Teacher Conference Days
54
JANUARY
S
M
6
13
20
27
7
14
21
28
T
1
8
15
22
29
W
2
9
16
23
30
T
3
10
17
24
31
F
4
11
18
25
S
5
12
19
26
FEBRUARY
S
M
T
W
T
3
10
17
24
4
11
18
25
5
12
19
26
6
13
20
27
7
14
21
28
F S
1 2
8 9
15 16
22 23
MARCH
*Early Dismissal: 11:45 a.m. - Middle & High Schools; 12:45 p.m. - Elementary Schools
Teaching Days
1st Semester (90 Days)
1st Grading Period 2nd Grading Period
Sept.
19
Nov.
14
Oct.
23
Dec.
14
Nov.
3
Jan.
17
45
45
2nd Semester (90 Days)
3rd Grading Period 4th Grading Period
Jan.
3
Apr.
17
Feb.
18
May
22
Mar.
20
June
10
41
49
2013
S
M
T
W
3
10
17
24
31
4
11
18
25
5
12
19
26
T
6
7
13 14
20 21
27 28
F S
1 2
8 9
15 16
22 23
29 30
APRIL
S
7
14
21
28
M
1
8
15
22
29
T
2
9
16
23
30
W
3
10
17
24
T
4
11
18
25
F
5
12
19
26
S
6
13
20
27
T
2
9
16
23
30
F S
3 4
10 11
17 18
24 25
31
MAY
S
M
T
5
12
19
26
6
13
20
27
7
14
21
28
W
1
8
15
22
29
JUNE
S
M
T
W
T
F
2
9
16
23
30
3
10
17
24
4
11
18
25
5
12
19
26
6
13
20
27
7
14
21
28
S
1
8
15
22
29
“Every Child is a Star”
Suffolk Public Schools
P. O. Box 1549
Suffolk, Virginia 23439
2012-2013 CALENDAR FOR ADMINISTRATIVE & SUPPORT PERSONNEL
2012
JULY
S
1
8
15
22
29
M
2
9
16
23
30
T
3
10
17
24
31
W
4
11
18
25
T F S
5 6 7
12 13 14
19 20 21
26 27 28
Paid Holidays
AUGUST
S
M
T
5
12
19
26
6
13
20
27
7
14
21
28
JULY
AUGUST
SEPTEMBER
OCTOBER
NOVEMBER
DECEMBER
JANUARY
FEBRUARY
MARCH
APRIL
MAY
JUNE
W
1
8
15
22
29
T
2
9
16
23
30
F
3
10
17
24
31
S
4
11
18
25
*10 MONTH CUSTODIAN
WORKDAYS
0
15
19
23
19
14
21
19
21
17
22
10
200
+ 20
220
2013
10 MONTH EMPLOYEE
HOLIDAYS
Sept. 3
Nov. 12, 22, 23
Dec. 21-31
Jan. 1, 21
Feb. 18
April 1-5
May 27
JANUARY
S
M
6
13
20
27
7
14
21
28
M
T
W
T F
2
9
16
23
30
3
10
17
24
4
11
18
25
5
12
19
26
6 7
13 14
20 21
27 28
S
1
8
15
22
29
OCTOBER
7
14
21
28
T
2
9
16
23
30
W
3
10
17
24
31
T F S
4
5 6
11 12 13
18 19 20
25 26 27
NOVEMBER
S
M
T
W
4
11
18
25
5
12
19
26
6
13
20
27
7
14
21
28
*10-Month Custodians begin Monday, August 13, 2012 and end Friday, June
14, 2013.
*Other 10-month employees (nurses, teacher assistants, bus drivers, bus
assistants, cafeteria workers) will work the number of days specified in their
respective contracts.
S
M
T
W
3
10
17
24
4
11
18
25
5
12
19
26
6
13
20
27
M
T
W
2
9
16
23
30
3
10
17
24
31
4
11
18
25
5
12
19
26
F S
4 5
11 12
18 19
25 26
T
F S
1 2
7 8 9
14 15 16
21 22 23
28
T
1
8
15
22
29
F S
2 3
9 10
16 17
23 24
30
*12 MONTH EMPLOYEES
# WORKDAYS
JULY
AUGUST
SEPTEMBER
OCTOBER
NOVEMBER
DECEMBER
JANUARY
FEBRUARY
MARCH
APRIL
MAY
JUNE
Paid Holidays
21
23
19
23
19
14
21
19
21
17
22
20
239
+ 21
260
12 MONTH EMPLOYEES
HOLIDAYS
July 4
Sept. 3
Nov. 12, 22, 23
Dec. 21-31
Jan. 1, 21
Feb. 18
April 1-5
May 27
S
M
T
W
T
3
10
17
24
31
4
11
18
25
5
12
19
26
6
13
20
27
7
14
21
28
F
1
8
15
22
29
S
2
9
16
23
30
APRIL
S
7
14
21
28
M
1
8
15
22
29
T
2
9
16
23
30
W
3
10
17
24
T
4
11
18
25
F
5
12
19
26
S
6
13
20
27
MAY
S
5
12
19
26
M
6
13
20
27
T
7
14
21
28
DECEMBER
S
T
3
10
17
24
31
MARCH
S
M
1
8
15
22
29
W
2
9
16
23
30
FEBRUARY
SEPTEMBER
S
T
1
8
15
22
29
W
1
8
15
22
29
T
2
9
16
23
30
F S
3 4
10 11
17 18
24 25
31
JUNE
T
F
6 7
13 14
20 21
27 28
S
1
8
15
22
29
S
KEY - Holidays in GREEN
- End of each grading period
- Denotes teacher workdays
- Parent/Teacher Conference Days
55
M
T
W
2 3
9 10
16 17
23 24
30
4
11
18
25
5
12
19
26
T
F
6 7
13 14
20 21
27 28
S
1
8
15
22
29
PROCEDURE FOR TWICE A MONTH PAY FOR 2012­2013 1. All 12­month employees will receive their annual salary in 24 increments (2 per month; July 2012 – June 2013). 2. All 10­month (licensed and non­licensed) employees will be given the option to receive their annual salary in 20 increments (2 per month; September 2012 – June 2013) or 24 increments (2 per month; September 2012 – August 2013). This pay option must be selected on the contract and cannot be changed. ALL contracted employees must enroll in direct deposit. 3. Most fixed monthly deductions will be divided in half and deducted each pay period, except during the months of July and August. No health, dental or supplemental insurances, dues or annuities will be deducted in July or August. Credit union deductions will be on a twelve month basis. When an employee wishes to make changes in his fixed deductions, such changes must be submitted to the Finance Department on the first day of each month in which the employee wishes the changes to be effective. All changes are subject to pre­tax regulations, if applicable. All annuity changes must be submitted through the Suffolk Public Schools TPA (Third Party Administrator). 4. Absences without pay will be deducted as the Finance Department is informed of such absences prior to payroll deadlines. Deductions for absences may not be deferred to future pay periods. 5. When an employee is on leave of absence, he/she must submit payments to the Finance Department to continue insurance coverage. The employee is also responsible for notifying the principal or supervisor immediately when he/she is on extended leave or leave of absence. 6. The Finance Department will be unable to honor releases of garnishments or tax liens unless the release is received at least ten business days prior to the pay date. 7. Pay dates will be as follows: July August September October November December 12 15 14 15 15 14 31 31 28 31 30 20 January February March April May June 15 15 15 15 15 7 31 28 28 30 31 14 8. If an employee loses or mutilates a check, he/she must submit a request in writing to the Finance Department for a replacement check. The replacement check will be issued within 10 business days following receipt of the request or bank stop payment verification, whichever is later. 9. When school is in session, direct deposit statements will be given to the principal or supervisor for distribution. When school is not in session, direct deposit statements will be mailed. Any check lost in the mail will require a ten business day waiting period for a replacement check to be re­issued. 10. All leave will be accumulated semi­monthly. Ten­month employees will earn leave from September through June. No leave may be taken before it has been earned. Personal leave (ten­month employees only) will be granted at the rate of one day per semester and cannot be taken in advance. Leave used will be deducted each pay period as leave requests are received and approved in accordance with cutoff dates.
56
2012 ­ 2013 2010
- 2011
Information contained in this booklet is intended for general use only. The Policy Manual of the Suffolk Information
contained in this booklet is intended for general use only. The Policy Manual of the Suffolk
City School
School Board
Board and
and its
its regulations
regulations will
will always
always take
take priority
priority over
over this
this booklet,
booklet, as
as the
the policy
policy manual
manual City
provides specific wording and updated standards by the School Board.
provides
specific wording and updated standards by the School Board.
59
57
Table of Contents Absences or Tardiness Nepotism Change in Status Outside Employment Child Abuse/Child Molestation Pay Days Commissions and Gifts/Conflict of Interest Payroll Deductions Conduct Personnel Files Contract Status Pony Mail Corporal Punishment Possession of Firearms Criminal History Record Information Checks Reduction in Force (RIF) Direct Deposit Retiree Health Care Benefits Disciplinary Procedure Salary Adjustments Discrimination Selling to Students or Parents Distribution of Outside Material Sexual and Disability Harassment Dress Code Sick Leave Bank Educational Supplements Smoking Employee Assistance Program SOFA Emergency School Closings Star Points Evaluation of Performance Substance Abuse Fair Labor Standards Act Suffolk Education Foundation Grievance Procedure Tax Shelter Annuities Health Requirements Teacher Experience Credit Holidays Telephone Calls Identification Badges Transfers of Assignment Insurance Transporting Students Internet and Electronic Communication Use Travel Approval and Reimbursement Inventory of School Property Tutoring Job Descriptions United Way Leave Options Virginia Retirement System Membership Licensure Workers’ Compensation License Renewal
58
General Policy and Procedure Absences or Tardiness­ Employees are required to inform their principal or immediate supervisor of their intended absence or tardiness from their duties as far in advance as possible. This request to be absent is made to allow the principal or department head to make necessary arrangements for a substitute. Employees should adhere to the guidelines set by their respective school or department. Change in Status­ Any change in name, address, telephone number, or other personal information should be reported. The correction should be submitted immediately to Human Resources on a “Change of Status” form. These forms are available in each school office and department or they may be obtained through the Human Resources Department. Child Abuse/Child Molestation­ Any assault on a child will not be accepted within Suffolk Public Schools. If personnel are found guilty of a charge involving abuse or molestation of a child, then their employment will be terminated immediately. In addition, all school employees must do their part to report child abuse and neglect. If any employee has reason to suspect child abuse or neglect, state law requires that the suspected abuse or neglect be reported to the Suffolk Department of Social Services. Free online training modules are offered to assist employees on how to recognize possible abuse/neglect and provide support to children who may have been victimized. Commissions and Gifts/Conflict of Interest­ Employees may not accept any commission, gift or other favor from any person or persons doing business with Suffolk Public Schools. Exchange of gifts between students and staff is not encouraged. Furthermore, the selling of goods and services for personal use of employees or students is not permitted during school hours on school property without written authorization from the Superintendent. Conduct­ Every school employee is a representative of Suffolk Public Schools. As such, employees are expected to act in a manner that will uphold the reputation of the schools within the community at all times. Contract Status­ Professional employees must serve three years (180 days per year) on a probationary contract before earning a continuing contract. Employees who have previously earned a continuing contract in another school division in Virginia must serve a one­year probationary period with Suffolk Public Schools and perform satisfactorily during that probationary period before Suffolk Public Schools will issue a continuing contract. An employee who was under a continuing contract in Virginia, then left and returned before the beginning of the third year will be required to serve a one­year probationary period. An employee who left for longer than three years must begin a new three­year probationary period. Corporal Punishment­ Employees are not allowed to administer corporal punishment to students. Criminal History Record Information Checks­ School Board policy does not allow the employment or continued employment of classified, professional, or administrative personnel who may be deemed unsuited for service by reason of criminal conviction. Therefore, new employees are required to submit fingerprints and other descriptive information to the Human Resources Department for forwarding to the State Police to obtain criminal history record information. Direct Deposit­ As a benefit to staff, direct deposit is offered to all employees. Ten­month employees who elect to receive their pay over twelve months must enroll in direct deposit. Employees may enroll in direct deposit at any time during the year. For more information, contact the Finance Department.
59
Disciplinary Procedure­ In order for Suffolk Public Schools to operate at its fullest capacity, employees must abide by the disciplinary rules and high standards of conduct set in place. With the Standards of Conduct, each employee is expected to:
 Fulfill reasonable requests from authorized supervisors;
 Be on time to work;
 Be courteous and tactful with co­workers and the public;
 Obey and comply with all health and safety regulations;
 Work as effectively and efficiently as possible;
 Refrain from engaging in criminal, dishonest, immoral, or disgraceful conduct and;
 Use Suffolk Public Schools’ facilities and property only for official activities. Alongside these responsibilities of employees are disciplinary rules that must be followed. If not adhered to, these offenses may require disciplinary actions. Offenses include those in which an employee fails to meet the standards of job performance or displays inappropriate work behavior. Examples of such offenses are:
 Unsatisfactory attendance or excessive tardiness;
 Abuse of work time such as unauthorized time away from the area;
 Inadequate or unsatisfactory job performance;
 Disruptive behavior;
 Violation of safety rules;
 Conviction of a traffic violation while using a public vehicle;
 Stealing school division property;
 Threatening, intimidating, coercing, interfering with other employees;
 Being insubordinate, and;
 Being convicted of a felony. This list is not inclusive. Any conduct which challenges the success of a department or school will result in a form of disciplinary action. Suffolk Public Schools has established an administrative procedure for handling any disciplinary problem that should arise. Employee disciplinary actions can be any one or combination of the following:
 Oral Reprimand­ A verbal discussion between supervisor and employee. The employee is cautioned about unsatisfactory work performance and/or conduct;
 Written Reprimand­ Written documentation to employee from supervisor. The employee is advised and cautioned about unsatisfactory work performance and/or misconduct. A copy may be placed in the official personnel file of the employee;
 Suspension with Pay ­ Temporarily removing an employee from the job. The employee still receives pay for days on suspension;
 Suspension without Pay ­ Temporarily removing an employee from the job. The employee does not receive pay for days on suspension, and;
 Dismissal­ Involuntary separation from employment with Suffolk Public Schools. The severity of any of the above disciplinary actions will be determined by the circumstances of the disciplinary problem. Suffolk Public Schools reserves the right to make administrative changes to this procedure at any time. Discrimination­ The School Board is committed to a policy of non­discrimination in regard to race, color, sex, age, religion, disability, national origin, marital status or physical disability, except in those situations where such disability will constitute employment liability. This commitment will prevail in all of its policies concerning staff, students, educational programs and services, and individual entities with which the School Board does business. Distribution of Outside Material­ A “Request to Visit School Principal and/or Distribute Materials” form must be sent to the central office for approval by the interested party for permission to visit the principal and/or distribute material. The interested party must present the approved form to the school principal or designee. The form will indicate how the material may be distributed to students and/or staff. Typically, student flyers will only be allowed to “post and stack” in a commons area. In addition, the School Board strictly prohibits the distribution of materials or information to students which publicly endorses groups or organizations involved in a marketing, philosophical, or political campaign. This includes material that advocates the election or defeat of any candidate, advocates the passage or defeat of any matter pending before a governing body, or religious literature of any description.
60
Dress Code­ Staff members are expected to uphold a professional appearance in the workplace. All wardrobe decisions should be mindful to create the best image possible for Suffolk Public Schools. Educational Supplements­ Pay supplements are provided for master’s degrees, certificates of advanced study, certificates of clinical competency, and doctorate degrees. All master's degree supplements are given in one­half increments. Employees must provide the following information to the Human Resources Department: notice of admission to graduate school, copy of an approved program or course of study leading to the master's degree, an official statement from the college setting forth the number of semester hours required for the master's degree, and an official transcript. Employee Assistance Program­ The Bon Secours Employee Assistance program is a free, confidential service for employees, their immediate family members and significant others. Assessment and counseling sessions will be held at times convenient for you and/or your family. The services of the EAP counselor are free to all Suffolk Public Schools employees and families. However, when referrals to community resources and/or private practitioners are made, the employee must pay for any costs not covered under his/her insurance program. To make an appointment call 1­800­EAP­ 3257 or 757­398­2374. Emergency School Closings­ If a decision is made to close Suffolk Public Schools because of weather conditions, or to close a single school for other reasons, media outlets will be notified. Television stations informed include WTKR­ Channel 3, WAVY­Channel 10, WVEC­Channel 13, and WSPS­Charter Channel 6. Various radio stations may be given specific closing information, and an after­hours recording is available by calling 925­6750. In addition, an automated calling system may be deployed with a recorded phone message to employees’ home phones. Evaluation of Performance­ Suffolk Public Schools is interested in helping all employees perform their jobs in a satisfactory manner. In order to accomplish this goal, employees shall be evaluated annually. Fair Labor Standards Act­ The Fair Labor Standards Act (FLSA) establishes minimum wage, overtime pay, and record­ keeping standards for full­time and part­time employees. All employees are covered under FLSA. All non­exempt employees are covered for overtime pay/comp time. A timesheet is required for all non­exempt employees. Employees who are non­exempt have job codes ending with “1”. The definition of hours worked is all hours an employee must be on duty and working, or on the employer’s work site and working. If the employee’s immediate supervisor allows the employee to be on the work site working or to take work home, this is included as hours worked. Breaks are not considered as hours worked if the time is 30 minutes or more. Grievance Procedure­ All employees are encouraged to discuss problems openly with their immediate supervisor to ensure that problems are resolved at the appropriate level. When problems cannot be resolved, the grievance procedures adopted by the Virginia State Board of Education are the procedures under which all formal grievances of employees will be processed. A copy is located in the Suffolk City Public School Policy Manual. Health Requirements­ All new employees, or employees being re­employed after more than a year of separation, must submit a health certificate signed by a licensed physician verifying that the employee appears to be free of communicable tuberculosis. The signed certificate must be based on tests performed no more than 12 months prior to entering, or reentering, employment. Holidays­ Schools and all departments are typically closed for the following holidays: Labor Day, Thanksgiving, Winter Holiday, Martin Luther King Jr. Day, Presidents’ Day, Spring Holiday, Memorial Day, and Independence Day for all 12­ month employees. Employees should check their calendar for specific dates and days allotted for these holidays. An inclement weather make up day schedule is stated on the SPS annual calendar. Scheduled make up days may be altered at the discretion of the Superintendent. Identification Badges­ School employees must wear ID badges in plain sight at all times while on school property. Contact the Human Resources Department at 925­6758 if a replacement badge is needed. A $5.00 fee is charged for each replacement badge.
61
Insurance:
 Health and dental insurance plans are available to all full­time employees (except 3­ and 4­hour cafeteria workers, substitutes, and other part­time employees). The health and dental insurance plans are not automatically deducted. You must complete the required enrollment applications to enroll in any desired insurance plans. All new employees must enroll in these benefit plans within 30 days of his/her hire date. If a new employee does not enroll in a health and/or dental plan within 30 days of being hired, he/she must wait until the next annual open enrollment period to enroll. All employees must renew their enrollment, if desired, during the annual open enrollment period.
 Supplemental insurance plans are available through payroll deduction including cancer, accident and disability insurance, as well as non­reimbursed medical expense and dependent care expense plans. Employees desiring any of these supplemental insurances or pre­taxable benefits must enroll within 30 days of his/her hire date by contacting the Finance Department.
 Pre­tax election forms must be completed by all employees during the annual open enrollment period. Annual pre­tax elections are irrevocable unless an eligible family status change occurs; such as marriage or divorce, birth or adoption of a child, death of spouse or dependent, etc. Internet and Electronic Communication Use­ Access to electronic mail and the Internet allows employees to explore thousands of libraries, databases, and bulletin boards while exchanging messages with Internet users throughout the world. The communication network is provided for employees to research and communicate with others. Communications on the network are often public in nature. Suffolk Public Schools provides electronic mail and Internet services as an educational tool and to aid staff in fulfilling their duties. In that access to the communication network is a privilege, and not a right, it entails responsibility. Access to network services is given to employees who agree to act in a considerate and responsible manner. This responsible manner includes adhering to the following:
 Employees are not to post personal contact information about themselves or others. Personal contact information includes name, address, telephone number, school address, or any other identifiable information. Employees also should not use the Internet for commercial purposes;
 Employees are not to use the system to engage in any illegal act, such as arranging for a drug sale, purchasing alcohol and/or weapons, threatening another person, violation of copyright or other contracts, or any other activity in violation of any federal, state or local law, rule and/or regulation;
 Restrictions against inappropriate language and/or messages apply to public messages, private messages, and material posted on web pages. Employees shall not use obscene, profane, lewd, inflammatory, threatening, or disrespectful language;
 Employees are not to engage in personal attacks, including prejudicial or discriminatory attacks. Employees cannot harass another person. Harassment is defined as persistently behaving in such a manner that annoys another person. Employees shall not use the system or allow the system to be used by anyone else for any activity that is considered profane or obscene (pornographic) that advocates illegal acts, or that advocates violence or discrimination toward other people (hate literature) and;
 Employees cannot post, publish or display any obscene, profane, threatening, illegal or other inappropriate material on Suffolk Public Schools’ computer system and cannot vandalize the computer system, including destroying data by creating or spreading viruses or by other means.
 Use resources appropriately. Uses that interfere with the proper functioning of Suffolk Public Schools’ information technology resources are prohibited. Such inappropriate uses would include but are not limited to insertions of viruses into computer systems, e­mail spam, chain letters, destruction of another's files, use of software tools that attack IT resources, violation of security standards, and violation of SPS Acceptable Use and Internet Safety Regulation of School Board Policy/Regulation 5­91.1.
 Staff members should avoid open social networking websites offering an interactive, user­submitted network of friends, personal profiles, blogs, groups, photos, music and videos (My Space, Face Book, etc.) where students can send messages and pictures. Participation in sites of this nature may compromise the ethical integrity of an employee’s position and jeopardize one’s employment.
62
 Refrain from prohibited personal uses. Information technology resources, including Suffolk Public Schools’ electronic address (e­mail, web), shall not be used for personal commercial gain, for charitable solicitations unless these are authorized by the Superintendent, for personal political activities such as campaigning for candidates for public office, or for lobbying of public officials. For purposes of this policy, "lobbying" does not include individual faculty or staff sharing information or opinions with public officials on matters of policy within their areas of expertise. Faculty and staff consulting that is in conformity with Suffolk Public Schools’ guidelines are permissible.
 Suffolk Public Schools may also inspect files or monitor usage for a limited time when there is probable cause to believe a user has violated this regulation. Inspections or monitoring related to violations of this regulation must be authorized in advance by the Superintendent or by the Superintendent’s designee, or the Director of Technology Services. Such inspections or monitoring will be conducted without notice to the user by an authorized investigator.
 Violations may result in School Board disciplinary action or referral to appropriate external authorities.
 The employee is responsible for the information contained in the entire SPS Acceptable Use and Internet Safety Regulation of School Board Policy/Regulation 5­91.1. Inventory of School Property­ Taking inventory is a necessary process for the school system to adequately measure replacement needs and costs, insurance expenses, and various other assessments. As such, Suffolk Public Schools has an inventory system in place to identify all goods and materials belonging to the system. Job Descriptions­ Job descriptions are not meant to detail every obligation of the employee, but rather inform the applicant of the general responsibilities expected within the position. Leave Options:
 Annual Leave­ Annual Leave for vacations or other personal reasons for all 12 month full­time salaried employees shall be earned according to the following schedule: o Years 1­10 of experience = 1 day per month o Years 11­20 of experience = 1.5 days per month o Years 21 and over of experience = 2 days per month Employees wishing to use leave must submit, in advance, a request on the Suffolk Online Form Administrator (SOFA). Annual leave earned by an eligible employee may be accumulated during the year, with a maximum of 48 days at June 30 th .
 Bereavement Leave­ Leave is granted for employees for the death of a loved one. Five days of sick leave can be used for a death in the immediate family. Immediate family includes spouse, child, mother, father, brother, sister, daughter­in­law, son­in­law, mother­in­law, father­in­law, brother­in­law, sister­in­law, grandparent, grandchild or any other person for whom the employee has primary care responsibility. Such leave must be taken in minimum of one­fourth day increments. Employees wishing to use leave must submit, in advance, a request on the Suffolk Online Form Administrator (SOFA).
 Court Appearance­ When employees need to be absent from their jobs to appear in court on behalf of themselves or a minor child, the absence, except in criminal cases, will not be charged against the employees’ leave. If employees are called to appear in court on behalf of the school division, the absence will be charged to professional leave. If employees are subpoenaed to court through no fault of their own, such as to be a witness, no leave will be charged. Employees are required to submit a copy of the subpoena, court documentation, certificate of attendance, and a “Jury Duty and Other Leave Request” form. Except for Jury Duty, employees must return to work after they are finished at court.
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 Family and Medical Leave of Absence­ Employees who have been employed for at least 12 months and who have worked at least 1,250 hours during the previous 12 months, shall be entitled to up to 12 work weeks of leave with or without pay during any fiscal year (July 1 through June 30). Employees using unpaid leave will be required to first use any accumulated sick leave, personal leave, and/or vacation. Such sick leave, personal leave, or vacation will count against the 12 weeks of available unpaid leave. Leave may be granted for the following reasons: o The birth or adoption of a child; o A serious health condition of a spouse, child, or parent, which requires the employee to provide care; o A serious health condition (physical or psychological), which makes the employee unable to perform essential job functions; o The care of a foster child, and: o Military caregiver The Human Resources Department must be notified to arrange for continuation of benefits as soon as the employee is aware that family medical leave/extended leave will be needed. If the employee anticipates an absence to exceed ten working days, then an extended leave or family medical leave form needs to be reviewed with the employee. The employee should contact the Human Resources Department for an appointment to review and complete the Family Medical/Extended Leave Form.
 Jury Duty­ Employees called to serve on jury duty will be granted leave with pay. All jury duty leave must be approved in advance. A “Jury Duty and Other Leave Request” form along with a copy of the subpoena to serve must be submitted to the employee’s supervisor. (Please see supervisor for leave procedures.)
 Leave of Absence ­ A Leave of Absence without pay may be granted to employees upon the recommendation of the Superintendent with approval by the School Board. Leave of Absence may be granted for educational purposes, personal illnesses, maternity, paternity, or other activities approved by the Superintendent, for a period not to exceed one year. Approval of the request for leave of absence assures an employee that, at the expiration of the leave, the employee will be offered the first available position for which the employee is qualified/licensed.
 Military Leave­ Absence from duty is allowed for full­time personnel to fulfill military obligations in National Guard or reserve organizations of the Armed Forces. Military leave without loss of pay or benefits, not to exceed fifteen calendar days in any calendar year, will be granted. Such leave is for the purpose of fulfilling obligations in the National Guard, military reserve organizations, and in response to orders issued by the Governor under Paragraph 44­75 of the 1950 Code of Virginia, as amended. Military service in excess of fifteen calendar days will be authorized to comply with current federal and state regulations. Employees are to specifically request to their superior officer that military duty be fulfilled during the summer months when students are not regularly in school. The Superintendent may grant military leave without pay to any employee who is ordered to active duty in the military of the United States. Except in times of national emergency or war, the maximum period of time allowed for military leave without pay will be two years, approved one year at a time. An employee who returns from military leave will have the advantage of any step increases which would have been due if the employee had remained in the service of the school division. The employee will also have prior sick leave credit restored.
 Personal Leave­ Personal Leave is an emergency leave option. Personal leave is provided so that employees who are not eligible for vacation leave may conduct personal business, which cannot be conducted except during scheduled work hours. Ten­month employees earn one day of personal leave each semester (two days a year). Personal Leave may not be used on the last workday before or the first workday after a holiday or vacation period. Personal Leave may not be used on any days prior to the first day of school, nor on any days after the last student day of school. Unused personal leave days will be credited toward accumulated sick leave. One unused day will be automatically carried over to the next school year unless the employee opts out. Employees wishing to use leave must submit, in advance, a request on the Suffolk Online Form Administrator (SOFA).
 Professional Leave­ Professional Leave may be granted when employees are approved to attend professional conferences or staff development activities. There is no pay deduction for approved professional leave. Employees on professional leave are considered to be at work at locations other than their regular assignments. A “Professional Leave Request” form must be submitted to the employee’s supervisor when such leave is requested. (This includes summer and weekend conferences.)
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 Sick Leave­ Sick leave is accumulated at the rate of one day per month and cannot be used in advance. Ten­ month employees who elect 12­month pay only accumulate 10 days per year. Sick leave may be accumulated without limit. A sick leave day is equal to the employee’s scheduled work day. An employee may begin taking sick leave as soon as they have earned the leave. Sick leave is allowed for personal illness, injury, quarantine, illness in the employee’s immediate family, and necessary appointments with physicians. You may use up to five days in a row for death or illness in the immediate family. Immediate family includes spouse, child, mother, father, brother, sister, daughter­in­law, son­in­law, mother­in­law, father­in­law, brother­in­law, sister­in­law, grandparent, grandchild or any other person for whom the employee has primary care responsibility. An employee can transfer up to 90 days of accumulated sick leave under the same sick leave program from other Virginia school divisions.
 Thirty Day Rule­ After exhausting all available leave, an employee may be eligible for leave without pay for a period not to exceed 30 days provided Family Medical Leave Benefits have not been utilized. Licensure­ The state of Virginia requires that teachers in public schools hold valid licenses in compliance with the regulations set forth by the State Board of Education. The Collegiate Professional License is a five­year renewable license granted to an applicant who has fulfilled the state requirements for licensure. The Provisional License is a three­year nonrenewable license issued when an applicant does not meet the requirements of a Collegiate Professional License. When all deficiencies have been satisfied, a five­year renewable license will be issued. Other five­year licenses include the Postgraduate Professional License, Pupil Personnel Services License, Superintendent License, Technical Professional License, and Vocational Evaluator License. For more information, contact the Human Resources Department. License Renewal­ The teaching license is valid for a five­year period based on an individual professional development plan. There are ten options as described in the Virginia Licensure Renewal Manual that provide opportunities for the license holder to obtain the 180 points needed for license renewal. License holders who do not have a master’s degree must take a course, worth 90 points, in their content area for renewal. The cost for renewal is $25.00 either by personal check, cashier’s check, or money order payable to the “Treasurer of Virginia.” The license holder’s Individualized Renewal of License Record should be completed after January 1 st but before June 1 st of the final year of the current validity period. The new license will not be issued until the year the license expires. It is the responsibility of the principal or department head to forward all documentation for renewing the license to the Human Resource Technicians. Nepotism­ The School Board may not employ any family member of the Superintendent or of a School Board member. A father, mother, brother, sister, spouse, son, daughter, son­in­law, daughter­in­law, sister­in­law or brother­in­law are considered to be family members. This limitation does not apply to a family member who was employed by a written contract with the School Board, or employed as a substitute teacher, by the School Board before the Superintendent or School Board member took office. If someone was employed prior to becoming a member of the family, the family member may not be given any greater employment than what was obtained in the last full school year prior to the taking of office of the Superintendent or School Board member. Any family member of an employee may not be employed by the School Board if a family member is to be in a direct supervisory and/or administrative relationship to another family member. The employment and assignment of family members in the same department or school is discouraged. Outside Employment­ Employees are not to be employed with any private business or outside activity – including self­ employment ­­ that will detract from the effectiveness in his or her assigned duties or will reflect adversely upon Suffolk Public Schools. Employees interested in attaining outside employment must first secure permission from the Superintendent before entering into supplementary employment. Pay Days­ Employees are typically paid on the 15 th and last day of every month. Direct deposit is available to all contracted employees and is highly recommended. When there is inclement weather, the distribution of actual checks may be delayed. Ten­month employees are given the option to spread their pay over twelve months should they desire pay over the summer. However, this contract election is irrevocable and requires direct deposit.
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Payroll Deductions­ Employees are provided the benefit of participating in several voluntary payroll deductions. These deductions are optional and are funded entirely through employee contributions. Some of those offered are: Supplemental Insurance (such as cancer, accident, and disability), Suffolk City Employees Federal Credit Union, 403(b) Tax Deferred Annuities, 457(b) Tax Deferred Annuities, Unreimbursed Medical Expense Plan, Dependent Care Expense Plan, Education Association of Suffolk, Suffolk Education Foundation, and United Way. To enroll in any of these voluntary deductions, please contact the Finance Department for additional information. Personnel Files­ All information in an employee’s personnel file, with the exception of pre­employment references, may be inspected by the employee. Pre­employment references may be reviewed if the employee did not waive the right to review the references. If employees would like to review their individual files, they should contact the Human Resources Department for an appointment. Pony Mail­ For internal mail delivery to other departments, employees, and schools within the division, the pony service is available. Possession of Firearms­ All employees of Suffolk Public Schools are prohibited from carrying, bringing, using or possessing any weapon, in any school building, on school grounds, in any school vehicle or at any school­sponsored activity, without the authorization of the Superintendent. Any employee who violates this rule will be subject to disciplinary actions including dismissal from employment. All incidents involving illegal carrying of a firearm shall be reported in accordance with state law. Reduction in Force­ Reduction in Force (RIF) means the action taken to reduce the number of allocated positions in the school system. The division Superintendent is authorized by the School Board to implement the required reduction in force action when necessitated by budget or program change. Retiree Health Care Benefits­ Suffolk Public Schools employees who qualify for regular or disability Virginia Retirement System retirement prior to age 65 are eligible to continue on the School Board’s group health insurance plan. The employee must have been employed by Suffolk Public Schools for a total of ten years and been enrolled in Suffolk Public Schools’ group health insurance plan for at least 24 months immediately preceding the effective date of retirement. At the time of retirement the retiree can select the level of continual coverage. However, the level of continual coverage selected by the retiree must be equal to or less than that which the retiree had during the last 24 months of employment with Suffolk Public Schools. Salary Adjustments­ A salary adjustment will be given on an annual basis to an employee who receives a certificate, degree, or qualifications that entitles the employee to a higher salary level than stipulated in the original contract. Salaries will be adjusted once each year on or before October 15 th and February 15 th of the current school year. In order for the adjustments to be made and applied for that particular school year, updated information must be received in the Human Resources Department by October 15 th and February 15 th . Selling to Students or Parents­ While within the school/school grounds, employees of Suffolk Public Schools cannot sell nor offer to sell any article or service to employees, students, or parents except for the regularly established school cafeteria program. Sexual and Disability Harassment­ It is the policy of the School Board to maintain a working and learning environment for all its employees and students which provides for fair and equitable treatment, including freedom from sexual harassment, disability harassment, or harassment because of race, national origin, or religion. Sick Leave Bank­ The Sick Leave Bank is available to contracted employees already receiving sick leave benefits who are incapacitated by long­term personal illness or injury. Membership is voluntary. An employee may enroll in any year prior to October 15 th by donating one day of sick leave. Subsequent assessments of additional days may be required. The Sick Leave Bank Board, which reviews each employee application to use up to 45 days from the bank, is made up of teachers and support employees. After receiving all eligible 45 days from the sick leave bank, employees may request, in writing, donated days through the Human Resources Department. Smoking­ Smoking, chewing or any other use of any tobacco product is prohibited on school property
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SOFA­ Suffolk Online Form Administrator (SOFA) is an online Internet service provided for any Suffolk Public Schools employee. This online resource allows employees to enter in leave requests at any time. The leave of the employee is then either approved or disapproved by the employee’s direct supervisor. Star Points­ The purpose of Star Points is to promote continuous professional development that is self­initiated. One Star Point is awarded for each hour spent in the professional development activity. Star Points are earned after attending a conference, a workshop, an institute or by taking a course. A Star Point may be earned by viewing a video clip from the PD 360 program and then completing both reflection and follow­up questions. Star Points are earned from March 1st of one calendar year to March 1st of the next. The completion of the required fifteen (15) Star Points, or lack of, is documented on each teacher’s summative evaluation. Most recertification points may count as Star Points. Further details are available through Human Resources. Substance Abuse ­ The School Board is committed to maintaining a drug­free workplace. As such, it is a direct violation of School Board policy for any person to manufacture, sell, distribute, possess, or give away any controlled substance, imitation controlled substance, or marijuana while upon School Board property. School Board property includes schools, any school bus, school bus stop, or areas within 1,000 feet of designated School Board property. School Board property also includes areas within 1,000 feet of any school bus stop during the time when school children are waiting to be taken from and/or transported to school or a school sponsored activity. Also, any employee who enters school property and/or reports for duty while under the influence of illegal drugs shall be immediately suspended until the School Board takes further action. In addition, it is a condition for continued employment with Suffolk Public Schools that each employee not engage in any such prohibited conduct and notify the Superintendent of any criminal drug conviction no later than 5 days after such conviction. Suffolk Education Foundation­ The Foundation is a tax­exempt organization which directly supports Suffolk Public Schools by providing college scholarships to graduates of the three public high schools, instructional grants, and tuition assistance for students enrolled in dual­credit courses where they earn college credit in high school. As a school division, a spring campaign is conducted for the Suffolk Education Foundation involving staff and students in each school and department. Employees can make donations through payroll deduction. Tax Shelter Annuities­ Employees may contribute to tax­deferred annuities through payroll deduction. Suffolk Public Schools has selected companies to offer products to employees. Annuity deductions may be started anytime during the year. Payroll deductions for annuities are made from September to June, with no deduction in July and August. The Payroll Deduction Authorization Form must be completed by the employee and returned to the Finance Department by the end of the month in order to be processed for the first payroll of the following month. Teacher Experience Credit­ Any teacher employed by Suffolk Public Schools can receive full credit for teaching experience outside of their current contract. In order to do so, the employee must have previously worked as a teacher full­time for 90 days or more under a teaching contract during any school year. Then, credit will be issued if the teaching experience was either in:
 a public school (in­state or out­of­state);
 an accredited institution of higher learning (in­state or out­of­state);
 a school operated on a federally supported military installation where academic credit is accepted to the public schools of Virginia;
 a public resident school such as the Virginia School for the Deaf and Blind, or;
 an accredited private school for which teachers receive credit under the Virginia Retirement System. Phone Calls­ On both personal cell phones and school provided phones, personal calls are to be kept to a minimum. Transfers of Assignment­ There are two types of transfers, voluntary and administrative. Voluntary transfers are those requested by the employees. A window for voluntary transfers is opened online annually. Administrative transfers are those initiated by the Superintendent or his designated representative. Transporting Students­ Suffolk Public Schools employees may not transport students in their personal vehicles.
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Travel Approval and Reimbursement­ The School Board recognizes that travel is sometimes required by its employees to perform their duties completely and efficiently. It is necessary for some employees to travel to local, regional, state and/or national meetings, seminars, and/or conferences to gain additional knowledge of the latest developments in their respective fields which will benefit Suffolk Public Schools and its students. Employees are required to prepare an estimate of the total cost of any proposed professional leave on the “Professional Leave Request” form. The number of employees allowed to attend the same conference/convention will be determined by the Superintendent or designee. Lodging expenses and meals consumed at the hotel may be charged to the employee’s personal charge card. The total invoice, noting payment by charge card, shall be submitted with the travel voucher for reimbursement. At the end of the month, the employee shall complete a travel voucher. The voucher must be completed and submitted no later than the 15 th of the following month to the coordinator/supervisor for approval for reimbursement. Detailed Receipts must accompany the travel voucher for all expenses incurred in order to receive reimbursement. It is the responsibility of the employee to obtain a receipt where one is not given automatically. Mileage may be claimed at the rate approved by the School Board. Tutoring­ Professional staff members may not be paid for tutoring students enrolled in a class under their direct supervision except for a student who has been approved for homebound instruction. United Way­ Suffolk Public Schools supports a variety of community charities, and each school has events for charities of their choosing. However, the United Way of South Hampton Roads serves as an umbrella organization which funds more than 70 agencies serving the needs of youth, those in poverty, the elderly, and those with disabilities. As a school division, a fall campaign is conducted for United Way involving staff and students in each school and department. Employees have the opportunity to make donations through payroll deduction. Virginia Retirement System Membership­ Membership in the Virginia Retirement System (VRS) is mandatory for all full­time employees. Under certain conditions the VRS allows for the purchase of prior service credit through payroll or in a lump sum payment at the employee’s current salary rate. Part­time employees are not eligible for VRS membership. The School Board also pays the mandatory cost of VRS group life insurance. Coverage equals two times the annual income on the insured employee for natural death and four times the annual salary for accidental death. Employees need to complete a change of beneficiary form should their status change (for example: divorce, death, etc). Up to 48 days of accumulated annual leave is compensated at the employees’ daily rate of pay at time of retirement. Accumulated sick leave is reimbursed by the school board at the time of retirement. The current rate is $35.00 per day. For more information, contact the Human Resources Department. Workers’ Compensation­ Suffolk Public Schools furnishes workers’ compensation insurance coverage at no cost to employees. Suffolk Public School employees who sustain injuries, occupational disease or death as a result of a work­ related accident are entitled to financial and medical benefits as prescribed by the Industrial Commission of Virginia. Suffolk Public Schools procures the services of several physicians who will provide medical services in several areas, including the handling of workers’ compensation claims. Employees who decline to use the physicians provided will be responsible for the expense for any medical treatment or physician bills and will be denied leave benefits. The employee must immediately notify his/her supervisor in writing of the injury, explaining the nature of the injury, detailing how the injury was sustained, and making a declaration of whether or not he/she will use the panel of physicians. Should an employee require medical attention, he/she must select a physician from the Suffolk Public Schools’ Panel of Physicians. The following benefits are provided under the workers’ compensation program: medical expenses, permanent disability payments, death benefits, and compensation for lost time.
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Sick Leave Bank The Suffolk Public Schools Sick Leave Bank has been in operation since 1995 and currently has more than 1,000 active members. The Sick Leave Bank has awarded more than 900 days that have benefited employees who had become seriously ill or injured and did not have enough sick leave days to continue being paid. Without this benefit, these employees would not have received a pay check for their awarded time. All employees who are eligible for sick leave benefits are also eligible for membership in the Suffolk Public Schools’ Sick Leave Bank. The open enrollment period for the Sick Leave Bank each year is from September 15 through October 15. Any new employee, as well as returning employees who are not currently members of the Sick Leave Bank, may enroll during this period. Current Sick Leave Bank memberships will automatically renew each year unless a reassessment of days is required. New employees may enroll when hired, but must enroll within 30 days of their hire date. Employees who have received the approved forty­five (45) days from the Sick Leave Bank and need additional days may request donated days. An employee who is requesting donated leave must submit a written request to the Human Resources Department. The request must include the reason donated leave is requested and the approximate duration of the employee's absence. A doctor's certificate verifying this information must accompany the request. If the employee's request is approved by the Sick Leave Bank Board, the Human Resources Department will send sick leave donation authorization forms to principals and department heads to coordinate the donations. Employees do not have to be a member of the Sick Leave Bank to donate days, but employees must be a member of the Sick Leave Bank to receive donated days. Employees may not solicit donated sick leave from other employees. Employees may only donate in whole­day increments. No employee may donate more than five (5) days of earned sick leave to any one employee during a single fiscal year. Donated days will be accepted in the order the days were donated and will only be accepted up to the total number of days needed by the specific recipient. For more information, contact the Human Resources Department at 668309.
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Workers’ Compensation SUFFOLK PUBLIC SCHOOLS WORKERS’ COMPENSATION PROCEDURES Every accident must be reported to the school nurse or principal immediately. At the time of the accident, you must choose a physician from the Panel of Network Physicians. If you do not select a physician from the panel, you will be responsible for all medical bills and you will be denied workers’ compensation pay benefits (except under certain emergency conditions). In case of job related injury, please contact one of the approved physicians during office hours. Please keep in mind that even though you may be injured on Suffolk Public Schools property, it is not necessarily compensable under workers’ compensation. Compensable claims will be determined by the Suffolk Public Schools Workers’ Compensation Third Party Administrator. In the case of a panel physician releasing you to light duty, please be reminded that Suffolk Public Schools has a light duty policy and should you be offered and refuse light duty, you will lose your workers’ compensation pay benefits even if the claim is found to be compensable. However, medical bills will be paid. APPROVED PANEL OF PHYSICIANS Sentara Obici Occupational Health Services Obici Hospital – Ground Floor 2800 Godwin Blvd. Suffolk, VA 23434 Phone: 934­4162 Belleharbour 3920 A Bridge Road Suite 100 Suffolk, VA 23435 Phone: 983­0080 Family Medicine Associates 2050 Hillpoint Blvd. – North Suffolk, VA 23434 Phone: 934­3434 FOR SERVICES BEYOND THE SCOPE OF THE ABOVE PRACTICES, YOU WILL BE REFERRED TO A NETWORK PHYSICIAN ALLERGIST OPTHALMOLOGIST ORTHOPEDIC SURGERY Dr. Gary Moss 528 Albermarle Drive Chesapeake, VA 23322 Phone: 547­7702 Dr. Andrew J. O’Dwyer, Jr. 2016 Meade Parkway Suffolk, VA 23434 Phone: 539­1533 Orthopedic Surgery Center 2012 Meade Parkway Suffolk, VA 23434 Phone: 539­1477 Dr. Gary Sajko 2463 Pruden Blvd. Suffolk, VA 23434 Phone: 925­1136 Sports Medicine & Ortho Ctr. 150 Burnetts Way Suffolk, VA 23434 Phone: 539­9333 FOR SEVERE OR IMMEDIATE EMERGENCY SITUATIONS, USE SENTARA OBICI HOSPITAL EMERGENCY ROOM.
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521 W. Washington St. Phone: 757­809­3640 SHARES & CERTIFICATES Share Accounts Establish membership by opening a Share Account with a minimum balance of $25.00 and a one­time new member fee of $1.00. Children’s Shares Help children start good financial habits early with a Children’s Share Account. Open with a minimum of $5.00 and a one time new member fee of $1.00. Share Draft Checking Whether you prefer to write a check or pay bills electronically, we can help with a Share Draft Checking Account. Get your first box of checks free when you open a checking account.* Get future check orders free with Direct Deposit. No fees. No minimum balance. *Limitations apply. Christmas Clubs Save for Christmas each year with a Christmas Club Account. Funds are available for withdrawal October 15 th . If withdrawn early, there is a penalty of $25.00 per withdrawal. Vacation Clubs Works just like a Christmas Club Account with funds becoming available on April 15 th . Individual Retirement Account’s  Save for your retirement with a Traditional or Roth IRA.  Save for a child’s educational expenses with a Coverdell Educational Savings Account. Share & IRA Certificates Earn more by saving with a Certificate. Invest for 6 or 12 months. P.O. Box 4234 Suffolk, VA 23439 Fax: 757­809­3642 www.svcefcu.org LOANS New & Used Vehicles Whether you want or need to purchase a new or used car, truck, motorcycle, boat, or RV we can help. We offer competitive rates and simple­interest loans. Share Secured Need some extra cash but don’t want to deplete your hard earned savings? Borrow against your own funds for a low rate and flexible payment schedule. Partially Secured Borrow at a lower rate than a Signature loan by using a vehicle as security for part of the loan. Pay Day Loan Alternative Avoid costly fees and finance charges charged by check cashing and payday lenders. We will assist you for less and help you save. Signature Whatever your reason, we have funds to lend. Come see us for competitive rates and terms on personal loans. CREDIT CARDS WITH REWARDS Enjoy a low rate of 4.99% for the first 6 months and 9.99% thereafter with our Platinum VISA Credit Card. Earn points towards merchandise and travel with our ScoreCard Rewards Program. There is no annual fee. Make your payment automatically with payroll deduction. CUMONEY PREPAID DEBIT CARDS Get access to your cash without visiting the Credit Union. Use your CUMoney Prepaid Debit Card wherever VISA is accepted. Load it automatically with payroll deduction. DIRECT DEPOSIT & PAYROLL DEDUCTION  Save automatically with either Direct Deposit or Payroll Deduction. Have part of your pay check deposited each pay period to save in various share accounts, reload your CUMoney Card, or pay your credit union loan or VISA Credit Card.  Don’t wait for the check to arrive in the mail. Have your Paycheck, Social Security or other Retirement benefits, and tax refunds direct deposited to your account. Funds are available immediately upon receipt. VISA GIFT CARDS Need to get someone a gift and don’t know what to give them? Visa Gift Cards are great for anyone and any event! LOAN INSURANCES Protect your loans with Credit Life, Credit Disability, and Guaranteed Asset Protection. Call us for more information. HOME FINANCIAL SERVICES Information about your Credit Union account 24/7. Sign up for access to your account to check balances, transfer funds within authorized accounts, request a check to be mailed to you, and view E­statements. CAR DEALER RELATIONSHIPS  Duke Automotive  Barton Ford  Roger Fowler’s Sales & Service FACEBOOK Become a fan of your Credit Union! E­STATEMENTS Why wait for your statement to reach you in the mail? Save time and trees with E­Statements. FRIENDLY MEMBER SERVICE When you become a member of the credit union, you become an owner of the credit union. We are here to serve you!
NOTARY PUBLIC We have notary services available to members. 71
Suffolk Public Schools
Voluntary Group Legal Services Plan
Legal Resources® has been providing comprehensive legal services and representation for our Members and their
dependents for over 20 years. The most often needed legal services are covered at 100%, meaning the Member,
spouse and dependents pay no attorney fees when they use these services. Legal Resources allows Members to
select their own law firm from an extensive local network and provides access to over 11,000 attorneys nationwide.
Once enrolled, a Member may call their selected law firm directly to get legal help or they can call our Member
Services Team of certified paralegals to ask coverage questions, update account information, or to change law
firms. The plan is payroll deducted at $21.60 per month over 10 months and provides coverage for a 12 month
period beginning October 2012 through September 2013.
Offered at annual open enrollment or new hires can enroll within the first 30 days of employment only.
To enroll go to: www.legalresources.net
Click on Online Enrollment
Company Code: 2988
Password: spslegal
Complete form and submit
Questions? Call 800-728-5768 / 757-498-1220 or email [email protected]
Attorney Fee Savings for You and Your Family†
Most often used Services
Estimated Attorney Fees
without Legal Resources*
Attorney Fees as a
Legal Resources
member**
Legal Counsel and Advice for all Covered Benefits
$300-$400/hr
-0-
Traffic Court Representation
$750-$1250
-0-
Will Preparation
$500-$750
-0-
Reviewing a Financial Contract or Lease
$300/hr
-0-
Tenant Disputes with Landlords
$300/hr
-0-
Uncontested Divorce Representation
$1250-$2000
-0-
Uncontested Domestic Adoption (includes name change)
$1000-$1500
-0-
Purchasing, Selling or Refinancing a Primary Residence
$400-$700
-0-
$1000-$1500
-0-
(Includes living will, medical durable power of attorney,
advance directives, and coverage provisions for minors)
(A minimum $50.00 administrative charge will apply in all
real estate closings conducted by the Plan Attorney)
Defending a Civil Action in District Court
Defending your child in Juvenile Court (misdemeanor)
$875-$1500
-0*“Estimated Attorney Fees” demonstrates the potential savings our legal plan provides. The estimated attorney fees do not represent actual payments but rather the standard fee or
hourly rate an attorney would charge for that service. Please review the Legal Resources™ Master Plan Contract for a complete description of all services and limitations
PRIOR to enrollment. **Subscriber responsible for all non-attorney costs (filing fees, fines, court costs, etc.).
† Family includes spouse and dependent children under 19 years of age or under 23 years of age if a full-time student.
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Form VWC1
Make The Call
Child Abuse Reporting
Reports can be made to
your supervisor or
designee, to the local social
services department at
923-3000 or through the
National Child Abuse and
Neglect Hotline at
EMPLOYEE RIGHTS
WORKERS'
COMPENSATION NOTICE
UNDER THE FAIR LAbOR STANDARDS AcT
THE UNITED STATES DEPARTMENT OF LABOR WAGE AND HOUR DIVISION
FEDERAL MINIMUM WAGE
The employees of this business are covered by the Virginia Workers' Compensation Act. In case of injury by accident or
notice of an occupational disease:
State law requires any
school employee when
acting in their professional
roles, to immediately
report suspicions of child
abuse or neglect that may
have occured both within
and outside of the school
setting.
$7.25
THE EMPLOYEE SHOULD:
1. Immediately give notice to the employer, in writing, of the injury or occupational disease and the date of
accident or notice of the occupational disease.
OVERTIME PAY
At least 1½ times your regular rate of pay for all hours worked over 40 in a workweek.
CHILD LABOR
An employee must be at least 16 years old to work in most non-farm jobs and at least 18 to work in non-farm
jobs declared hazardous by the Secretary of Labor.
2. Promptly give to the employer and to the Virginia Workers' Compensation Commission notice of any
claim for compensation for the period of disability beyond the seventh day after the accident. In case of fatal
injuries, notice must be given by one or more dependents of the deceased or by a person in their behalf.
Youths 14 and 15 years old may work outside school hours in various non-manufacturing, non-mining,
non-hazardous jobs under the following conditions:
No more than
•3 hours on a school day or 18 hours in a school week;
•8 hours on a non-school day or 40 hours in a non-school week.
3. In case of failure to reach an agreement with the employer in regard to compensation under the act, file
application with the Commission for a hearing within two years of the date of accidental injury or first
communication of the diagnosis of an occupational disease.
4. If medical treatment is anticipated for more than two years from the date of the accident and no award has
been entered, the employee should file a claim with the Commission within two years from the date of the
accident.
Also, work may not begin before 7 a.m. or end after 7 p.m., except from June 1 through Labor Day, when
evening hours are extended to 9 p.m. Different rules apply in agricultural employment.
TIP CREDIT
Employers of “tipped employees” must pay a cash wage of at least $2.13 per hour if they claim a tip credit
against their minimum wage obligation. If an employee’s tips combined with the employer’s cash wage of
at least $2.13 per hour do not equal the minimum hourly wage, the employer must make up the difference.
Certain other conditions must also be met.
ENFORCEMENT
The Department of Labor may recover back wages either administratively or through court action, for the
employees that have been underpaid in violation of the law. Violations may result in civil or criminal action.
NOTE: The employer's report of accident is not the filing of a claim for the employee. The voluntary
payment of wages or compensation during disability, or of medical expenses, does not affect the running of
the time limitation for filing claims. An award based on a voluntary agreement must be entered or a claim
filed within two years; one year in death cases.
Employers may be assessed civil money penalties of up to $1,100 for each willful or repeated violation of
the minimum wage or overtime pay provisions of the law and up to $11,000 for each employee who is the
subject of a violation of the Act’s child labor provisions. In addition, a civil money penalty of up to $50,000
may be assessed for each child labor violation that causes the death or serious injury of any minor employee,
and such assessments may be doubled, up to $100,000, when the violations are determined to be willful
or repeated. The law also prohibits discriminating against or discharging workers who file a complaint or
participate in any proceeding under the Act.
THE EMPLOYER SHOULD:
1. At the time of the accident, give the employee the names of at least three physicians from which the
employee may select the treating physician.
1-800-552-7096
School employees reporting abuse or
neglect in good faith are immune from
civil or criminal liability or administrative penalty or sanction unless such
person has acted in bad faith or with
malicious purpose.
2. Report the injury to the Commission through your carrier or directly to the Commission.
•Certainoccupationsandestablishmentsareexemptfromtheminimumwageand/orovertimepay
provisions.
•SpecialprovisionsapplytoworkersinAmericanSamoaandtheCommonwealthoftheNorthernMariana
Islands.
•Somestatelawsprovidegreateremployeeprotections;employersmustcomplywithboth.
•Thelawrequiresemployerstodisplaythisposterwhereemployeescanreadilyseeit.
•Employeesunder20yearsofagemaybepaid$4.25perhourduringtheirfirst90consecutivecalendardays
of employment with an employer.
•Certainfull-timestudents,studentlearners,apprentices,andworkerswithdisabilitiesmaybepaidlessthan
the minimum wage under special certificates issued by the Department of Labor.
ADDITIONAL
INFORMATION
3. Accurately determine the employee's average weekly wage, including overtime, meals, uniforms, etc.
Questions may be answered by contacting the Commission. A booklet explaining the Workers' Compensation Act is
available without cost from:
THE VIRGINIA WORKERS' COMPENSATION COMMISSION
1000 DMV Drive
Richmond, Virginia 23220
For additional information:
1-866-4-USWAGE
WHD
WWW.WAGEHOUR.DOL.GOV
(1-866-487-9243)
1-877-664-2566
vwc.state.va.us
Va. Code 22.1 - 253.13:6
Va. Code 63.2 -1509A
Va. Code 63.2 -1512
PER HOUR
BEGINNING JULY 24, 2009
TTY: 1-877-889-5627
U.S. Department of Labor
U.S. Wage and Hour Division
Wage and Hour Division
WHD Publication 1088 (Revised July 2009)
Every employer within the operation of the Virginia Workers' Compensation Act MUST POST THIS NOTICE IN A
CONSPICUOUS PLACE in his place of business.
~FEDERAL/STATE POSTERS~
EMPLOYEE RIGHTS AND RESPONSIBILITIES
UNDER THE FAMILY AND MEDICAL LEAVE ACT
Basic Leave Entitlement
FMLA requires covered employers to provide up to 12 weeks of unpaid, jobprotected leave to eligible employees for the following reasons:
• For incapacity due to pregnancy, prenatal medical care or child birth;
• To care for the employee’s child after birth, or placement for adoption
or foster care;
• To care for the employee’s spouse, son or daughter, or parent, who has
a serious health condition; or
• For a serious health condition that makes the employee unable to
perform the employee’s job.
Military Family Leave Entitlements
Eligible employees with a spouse, son, daughter, or parent on active duty or
call to active duty status in the National Guard or Reserves in support of a
contingency operation may use their 12-week leave entitlement to address
certain qualifying exigencies. Qualifying exigencies may include attending
certain military events, arranging for alternative childcare, addressing certain
financial and legal arrangements, attending certain counseling sessions, and
attending post-deployment reintegration briefings.
FMLA also includes a special leave entitlement that permits eligible
employees to take up to 26 weeks of leave to care for a covered
servicemember during a single 12-month period. A covered servicemember
is a current member of the Armed Forces, including a member of the
National Guard or Reserves, who has a serious injury or illness incurred in
the line of duty on active duty that may render the servicemember medically
unfit to perform his or her duties for which the servicemember is undergoing
medical treatment, recuperation, or therapy; or is in outpatient status; or is on
the temporary disability retired list.
Use of Leave
An employee does not need to use this leave entitlement in one block. Leave
can be taken intermittently or on a reduced leave schedule when medically
necessary. Employees must make reasonable efforts to schedule leave for
planned medical treatment so as not to unduly disrupt the employer’s
operations. Leave due to qualifying exigencies may also be taken on an
intermittent basis.
Full version available in each building
Substitution of Paid Leave for Unpaid Leave
Employees may choose or employers may require use of accrued paid leave
while taking FMLA leave. In order to use paid leave for FMLA leave,
employees must comply with the employer’s normal paid leave policies.
Employee Responsibilities
Every day many unemployed workers tell us that unemployment insurance is due them “because they
have paid for it.” This is not true in Virginia. There are no deductions from your paycheck for
unemployment insurance. Employers’ taxes are deposited in a trust fund from which unemployment
insurance benefits are paid. Do not confuse unemployment insurance with Old Age and Survivors
Insurance to which both you and your employer contribute.
Employees must provide 30 days advance notice of the need to take FMLA
leave when the need is foreseeable. When 30 days notice is not possible, the
employee must provide notice as soon as practicable and generally must
comply with an employer’s normal call-in procedures.
Employees must provide sufficient information for the employer to
determine if the leave may qualify for FMLA protection and the anticipated
timing and duration of the leave. Sufficient information may include that the
employee is unable to perform job functions, the family member is unable to
perform daily activities, the need for hospitalization or continuing treatment
by a health care provider, or circumstances supporting the need for military
family leave. Employees also must inform the employer if the requested
leave is for a reason for which FMLA leave was previously taken or certified.
Employees also may be required to provide a certification and periodic
recertification supporting the need for leave.
YOU MAY APPLY FOR UNEMPLOYMENT INSURANCE BENEFITS IF:
•
•
Employer Responsibilities
Benefits and Protections
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 prior to the start of an employee’s leave.
Eligibility Requirements
Employees are eligible if they have worked for a covered employer for at
least one year, for 1,250 hours over the previous 12 months, and if at least 50
employees are employed by the employer within 75 miles.
Definition of Serious Health Condition
A serious health condition is an illness, injury, impairment, or physical or
mental condition that involves either an overnight stay in a medical care
facility, or continuing treatment by a health care provider for a condition that
either prevents the employee from performing the functions of the
employee’s job, or prevents the qualified family member from participating
in school or other daily activities.
Covered employers must inform employees requesting leave whether they
are eligible under FMLA. If they are, the notice must specify any additional
information required as well as the employees’ rights and responsibilities. If
they are not eligible, the employer must provide a reason for the ineligibility.
Covered employers must inform employees if leave will be designated as
FMLA-protected and the amount of leave counted against the employee’s
leave entitlement. If the employer determines that the leave is not FMLAprotected, the employer must notify the employee.
Enforcement
An employee may file a complaint with the U.S. Department of Labor or
may bring a private lawsuit against an employer.
FMLA does not affect any Federal or State law prohibiting discrimination, or
supersede any State or local law or collective bargaining agreement which
provides greater family or medical leave rights.
Subject to certain conditions, the continuing treatment requirement may be
met by a period of incapacity of more than 3 consecutive calendar days
combined with at least two visits to a health care provider or one visit and a
regimen of continuing treatment, or incapacity due to pregnancy, or
incapacity due to a chronic condition. Other conditions may meet the
definition of continuing treatment.
FMLA section 109 (29 U.S.C. § 2619) requires FMLA covered
employers to post the text of this notice. Regulations 29
C.F.R. § 825.300(a) may require additional disclosures.
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
For additional information:
1-866-4US-WAGE (1-866-487-9243) TTY: 1-877-889-5627
WWW.WAGEHOUR.DOL.GOV
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












































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





















































 Every accident must be reported to the school nurse or principal immediately.
IF YOU ARE WORKING REDUCED HOURS:
The first week your hours have been reduced; file a claim for partial benefits by calling 1-866-832-2363,
or in person at the nearest Virginia Employment Commission office.
TO BE ELIGIBLE FOR BENEFITS, THE LAW REQUIRES THAT YOU:
•
•
 At the time of the accident, the employee must choose a physician from the Panel of
Physicians approved by Suffolk Public Schools and Sedgwick CMS.
 Failure to select a physician from the Panel of Physicians will result in the employee
being responsible for all medical bills and may be denied worker’s compensation pay
benefits.
 Suffolk Public Schools has a light duty policy with regard to worker’s compensation and
the employee is expected to return to work in a light duty capacity should he/she be
released to do so by the Panel Physician. If the employee refuses light duty, he/she will
lose worker’s compensation pay benefits.
•
•
•

























THE LAW
THE LAW REQUIRES EMPLOYERS TO POST THIS NOTICE IN A PLACE VISIBLE TO ALL WORKERS.
An Equal Opportunity Employer/Program
Auxiliary aids and services are available upon request to individuals with disabilities.
This notice is available in Spanish. Direct requests to:
Employer Accounts Unit
PO Box 1358
Richmond, VA 23218-1358
VEC B-29 (7/06)
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Equal Employment Opportunity is
Private Employers, State and Local Governments, Educational Institutions, Employment Agencies and Labor Organizations
Applicants to and employees of most private employers, state and local governments, educational institutions,
employment agencies and labor organizations are protected under Federal law from discrimination on the following bases:
RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN
Title VII of the Civil Rights Act of 1964, as amended, protects applicants and
employees from discrimination in hiring, promotion, discharge, pay, fringe benefits,
job training, classification, referral, and other aspects of employment, on the basis
of race, color, religion, sex (including pregnancy), or national origin. Religious
discrimination includes failing to reasonably accommodate an employee’s religious
practices where the accommodation does not impose undue hardship.
GENETICS
Title II of the Genetic Information Nondiscrimination Act of 2008 protects applicants
and employees from discrimination based on genetic information in hiring,
promotion, discharge, pay, fringe benefits, job training, classification, referral, and
other aspects of employment. GINA also restricts employers’ acquisition of genetic
information and strictly limits disclosure of genetic information. Genetic information
includes information about genetic tests of applicants, employees, or their family
members; the manifestation of diseases or disorders in family members (family
medical history); and requests for or receipt of genetic services by applicants,
DISABILITY
Title I and Title V of the Americans with Disabilities Act of 1990, as amended, protect employees, or their family members.
qualified individuals from discrimination on the basis of disability in hiring, promotion,
discharge, pay, fringe benefits, job training, classification, referral, and other
RETALIATION
aspects of employment. Disability discrimination includes not making reasonable
All of these Federal laws prohibit covered entities from retaliating against a
accommodation to the known physical or mental limitations of an otherwise qualified person who files a charge of discrimination, participates in a discrimination
individual with a disability who is an applicant or employee, barring undue hardship. proceeding, or otherwise opposes an unlawful employment practice.
AGE
The Age Discrimination in Employment Act of 1967, as amended, protects
applicants and employees 40 years of age or older from discrimination based on
age in hiring, promotion, discharge, pay, fringe benefits, job training, classification,
referral, and other aspects of employment.
WHAT TO DO IF YOU BELIEVE DISCRIMINATION HAS OCCURRED
There are strict time limits for filing charges of employment discrimination. To
preserve the ability of EEOC to act on your behalf and to protect your right to file a
private lawsuit, should you ultimately need to, you should contact EEOC promptly
when discrimination is suspected:
The U.S. Equal Employment Opportunity Commission (EEOC), 1-800-669-4000
(toll-free) or 1-800-669-6820 (toll-free TTY number for individuals with hearing
SEX (WAGES)
In addition to sex discrimination prohibited by Title VII of the Civil Rights Act, as impairments). EEOC field office information is available at www.eeoc.gov or
amended, the Equal Pay Act of 1963, as amended, prohibits sex discrimination in in most telephone directories in the U.S. Government or Federal Government
the payment of wages to women and men performing substantially equal work, section. Additional information about EEOC, including information about charge
in jobs that require equal skill, effort, and responsibility, under similar working filing, is available at www.eeoc.gov.
conditions, in the same establishment.
APRIL 2012
73
File a claim with the Virginia Employment Commission.
Have earned sufficient wages from employers who are subject to the Unemployment
Compensation Act of Virginia or any other state within your Base Period.
Must be unemployed through no fault of your own.
Must be able and available to work and making an active search for work.
Continue to report as instructed by the Virginia Employment Commission.
You cannot be paid unemployment benefits until you have filed your claim. To speed payment of benefits,
you should file your claim as soon as you become unemployed or your hours are reduced. If you have
any questions about your rights and responsibilities under the Virginia Unemployment Compensation Act,
visit the nearest office of the Virginia Employment Commission.
WHD Publication 1420 Revised January 2009
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
Worker’s Compensation Procedures
For additional information, contact the Human Resources Department at 925-6758.
U.S. Department of Labor | Employment Standards Administration | Wage and Hour Division
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SUFFOLK PUBLIC SCHOOLS
Unlawful Acts by Employers
FMLA makes it unlawful for any employer to:
• Interfere with, restrain, or deny the exercise of any right provided under
FMLA;
• Discharge or discriminate against any person for opposing any practice
made unlawful by FMLA or for involvement in any proceeding under
or relating to FMLA.
You are totally unemployed, or
You are working at reduced wages and hours,
IF YOU ARE TOTALLY UNEMPLOYED OR ON A TEMPORARY LAYOFF:
The first week you are unemployed; register for work; and file a claim for benefits by calling 1-866-8322363, online at www.VaEmploy.com or in person at the nearest Virginia Employment Commission office.
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YOUR RIGHTS UNDER USERRA
THE UNIFORMED SERVICES EMPLOYMENT
AND REEMPLOYMENT RIGHTS ACT
USERRA protects the job rights of individuals who voluntarily or involuntarily leave employment positions to undertake
military service or certain types of service in the National Disaster Medical System. USERRA also prohibits employers
from discriminating against past and present members of the uniformed services, and applicants to the uniformed services.
REEMPLOYMENT RIGHTS
HEALTH INSURANCE PROTECTION
You have the right to be reemployed in your civilian job if you leave that
job to perform service in the uniformed service and:
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you ensure that your employer receives advance written or verbal
notice of your service;
you have five years or less of cumulative service in the uniformed
services while with that particular employer;
you return to work or apply for reemployment in a timely manner
after conclusion of service; and
you have not been separated from service with a disqualifying
discharge or under other than honorable conditions.
If you are eligible to be reemployed, you must be restored to the job and
benefits you would have attained if you had not been absent due to
military service or, in some cases, a comparable job.
RIGHT TO BE FREE FROM DISCRIMINATION AND RETALIATION
If you:
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are a past or present member of the uniformed service;
have applied for membership in the uniformed service; or
are obligated to serve in the uniformed service;
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initial employment;
reemployment;
retention in employment;
promotion; or
any benefit of employment
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 (e.g., pre-existing condition exclusions) except
for service-connected illnesses or injuries.
ENFORCEMENT
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then an employer may not deny you:
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If you leave your job to perform military service, you have the right
to elect to continue your existing employer-based health plan
coverage for you and your dependents for up to 24 months while in
the military.
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The U.S. Department of Labor, Veterans Employment and Training
Service (VETS) is authorized to investigate and resolve complaints
of USERRA violations.
For assistance in filing a complaint, or for any other information on
USERRA, contact VETS at 1-866-4-USA-DOL or visit its website at
http://www.dol.gov/vets. An interactive online USERRA Advisor can
be viewed at http://www.dol.gov/elaws/userra.htm.
If you file a complaint with VETS and VETS is unable to resolve it,
you may request that your case be referred to the Department
of Justice or the Office of Special Counsel, as applicable, for
representation.
You may also bypass the VETS process and bring a civil action
against an employer for violations of USERRA.
because of this status.
In addition, an employer may not retaliate against anyone assisting in
the enforcement of USERRA rights, including testifying or making a
statement in connection with a proceeding under USERRA, even if that
person has no service connection.
The rights listed here may vary depending on the circumstances. The text of this notice was prepared by VETS, and may be viewed on the internet at
this address: http://www.dol.gov/vets/programs/userra/poster.htm. Federal law requires employers to notify employees of their rights under USERRA,
and employers may meet this requirement by displaying the text of this notice where they customarily place notices for employees.
U.S. Department of Labor
1-866-487-2365
U.S. Department of Justice
Office of Special Counsel
1-800-336-4590
Publication Date—July 2008
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