De Soto School District Employee Benefits Guide

Transcription

De Soto School District
Employee Benefits Guide
2016 Plan Year
Welcome to Annual Enrollment for
your Benefits!
De Soto School District remains committed to offering a comprehensive and competitive
benefits package to our employees. A comprehensive benefits package means you should
have choices. Just as your bring your own unique talents to the District, you have your own
unique coverage needs. By offering you choices, you will be able to find the combination of
coverage that’s right for you, your family and your goals. We recognize the importance of
medical benefits to our employees and their families – and that’s why the district is
committed to helping you manage your health care and associated costs.
All Benefits Eligible Employees will need to re-enroll during Open Enrollment; otherwise you will be automatically
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enrolled in the Blue Saver HDHP plan for 2016. Plan Year.
www.benefits-direct.com/desoto/
Our employees are our most
valuable asset.
That’s why we are committed to a comprehensive employee benefit program that helps our
employees stay healthy, feel secure and maintain a work/life balance.
Stay Healthy
 Medical - Blue Cross & Blue Shield of Kansas City
 Dental – Delta Dental of Kansas
Feeling Secure
 Life/AD&D – Reliance Standard
 Short Term Disability (STD) – Administered by UNUM
 Health Savings Account (HSA) – Wells Fargo Must be enrolled in the BlueSaver HDHP to participate
 Medical Expense Flexible Spending Account – Flex Made Easy
 Dependent Care Expense Flexible Spending Account – Flex Made Easy
 Voluntary Products –
o Vision – Surency
o Cancer and Critical Illness – Loyal American
o Accident – Humana
o Permanent Life and Long Term Care – Combined Life
o Identity Theft – InfoArmor/PrivacyArmor
Benefits Direct has been selected to conduct our annual enrollment services this year! You will not
be asked to enroll on-line, then later meet with American Fidelity separately before year end – just
ONE visit with a counselor from Benefits Direct and all of your 2016 elections will be made at once!
Benefits Direct: (877) 523-0176
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Contact Information
Refer to this list when you need to contact one of your benefit vendors. For general information
contact Gabby Philbrook.
MEDICAL/RX:
Blue Cross & Blue Shield of KC
Policy #30183000
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(816) 395-2270
HEALTH SAVINGS ACCOUNT (HSA):
Wells Fargo Bank
(800) 950-0105
DENTAL:
Delta Dental of Kansas
Policy #5103
www.mybluekc.com
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www.wellsfargo.com/hsa
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(800) 234-3375
www.deltadentalks.com
LIFE AND AD&D:
Reliance Standard
(877) 523-0176
www.reliancestandard.com
DISABILITY INSURANCE:
UNUM
Short-Term Disability
(800) 858-6843
Policy #133964
www.unum.com
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Kansas Public Employees Retirement System (KPERS)
Long-Term Disability
(888) 275-5737
www.kpers.org
FLEXIBLE SPENDING ACCOUNTS:
Flex Made Easy
(855) 615-3679
www.flexmadeeasy.com
VISION INSURANCE:
Surency Vision
(866) 818-8805
www.surency.com
TERM LIFE INSURANCE:
Reliance Standard
(877) 523-0176
www.reliancestandard.com
CANCER/ICU INSURANCE:
Loyal American
(877) 523-0176
ACCIDENT INSURANCE:
Humana
(877) 523-0176
CRITICAL ILLNESS INSURANCE:
Loyal American
(877) 523-0176
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PERMANENT TERM LIFE & LONG-TERM CARE:
Combined Life
(877) 523-0176
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IDENTITY THEFT PROTECTION:
InfoArmor
(877) 523-0176
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https://myportal.infoarmor.com
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Who is Eligible?
You and the following family members are eligible for coverage:
legal spouse and dependent child/ren (through the end of the
calendar year in which they reach age 26). It is your responsibility to
notify Gabby Philbrook of any changes in your eligible dependent’s
status (i.e. no longer married, child reached limiting age, etc.).
Verifying Social Security #’s
Note: You must verify that your enrolled dependent’s Social Security numbers are entered and are correct in
HR InTouch prior to meeting with a benefits enroller. In order to comply with the Affordable Care Act, the
District will report to the Federal Government enrolled employees’ and dependents’ Social Security numbers,
along with other required information about our plans. To avoid personal tax consequences, it is important to
verify that the information we have is correct.
How do I verify that my enrolled dependent’s Social Security numbers are entered and are
correct in HR InTouch?
Once you logon to HR InTouch, complete the following steps:
-Go to Your Benefits tab
-Click on the Make Changes button
-Click on the Dependents button
-Click the Actions drop down menu and click Edit; verify that all of the dependent’s Social Security numbers
are entered and correct.
-Once you verify that the SSNs are entered and accurate, click Save to save all of your changes.
When is Enrollment?
Open enrollment runs from November 2 through November 13. Final elections must be made by
November 13. The benefits you elect during annual enrollment will be effective from January 1, 2016
through December 31, 2016.
How do I Enroll?
Due to the addition of two new medical plans and voluntary benefits as well as ACA reporting
requirements, we ARE REQUIRING benefit eligible employees attend a one-on-one enrollment
appointment.
Two Ways to Schedule an Appointment:
1. Online at www.benefits-direct.com/desoto/
2. Call 877-523-0176
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Date
Locations
Monday, November 2
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
Mill Valley High School
Clear Creek Elementary
Tuesday, November 3
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
Riverview Elementary
Wednesday, November 4
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
Mill Creek Middle School
Starside Elementary
Thursday, November 5
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Belmont Elementary
Prairie Ridge Elementary
Monticello Trails Middle School
Friday, November 6
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
Belmont Elementary
De Soto High School
Monday, November 9
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Monticello Trails Middle School
Tuesday, November 10
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
Mill Creek Middle School
Horizon Elementary
Lexington Trails Middle School
Wednesday, November 11
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
Horizon Elementary
Mize Elementary
Thursday, November 12
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
Starside Elementary
De Soto High School
Access House/Service Center
Friday, November 13


Admin Office
Prairie Ridge Elementary
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How do I Make Changes Mid-Year?
Unless you have a qualified change in status, you cannot make
changes to the benefits you elect until the next annual enrollment
period. Qualified changes in status include birth of a child, adoption,
marriage, death, divorce, a court order requiring provision of
insurance to a dependent, loss of coverage (if you or your
spouse/dependents are covered under another plan and then lose
that coverage), Medicare eligibility, going from part-time to full-time,
move or transfer out of the plan’s service area, or a reduction in
hours that makes you ineligible for coverage.
Should you wish to make changes to your elections due to a qualifying event, you have 30 days from
the event to make your changes in HR InTouch. Otherwise, you will have to wait until the next annual
enrollment to make any changes to your benefit elections.
If you are eligible to enroll in the Federal Marketplace (Exchange) due to a Special Enrollment during
the year, you will be permitted to drop coverage under this plan.
Insurance Lingo….
Deductible – The deductible is the amount of your covered expenses you must pay each policy year before
the insurance company begins to pay.
Coinsurance – After the deductible is met, you and the insurance carrier will share in the payment of your
healthcare related bills. The coinsurance amount will depend on the plan you choose and whether in-network
or out-of-network providers are utilized.
Covered Expenses – Covered expenses are the expenses that are eligible for reimbursement. All the
insurance plans generally provide benefits for medically necessary services and supplies ordered by a doctor
or dentist. Each option also provides benefits for certain routine and preventive services. Under all plans,
when benefits are paid for out-of-network covered expenses, the insurance companies will consider payment
of those expenses only up to the Reasonable & Customary (R&C) limits.
Copayment – Copayment refers to a fixed cost that you must pay per occurrence. Copayments are paid
directly to the providers (i.e. physician or pharmacy).
Out-of-Pocket Maximum – This maximum limits your out-of-pocket expenses (including deductibles and
coinsurance only) in any one policy year.
Reasonable & Customary – The insurance company will not pay for any charge above the Reasonable and
Customary (R&C) limit when you receive services from out-of-network providers, and these charges do not
apply towards your out-of-pocket maximums. R&C charges are the fees usually charged for comparable
services and supplies in your geographic area. If your service with an out-of-network provider exceeds R&C,
the provider may bill you for the excess. Because in-network providers charge agreed-upon rates, you will
never exceed R&C charges when you use in-network providers.
Qualifying Events: As a reminder, you may change your elections outside of the annual enrollment period
only if you have a qualifying event. Qualifying events are the birth of a child, adoption, marriage, death,
divorce, a court order requiring provision of insurance to a dependent, loss of coverage (if you or your
spouse/dependents are covered under another plan and then lose that coverage), Medicare eligibility, going
from part-time to full-time, move or transfer out of the plan’s service area, or a reduction in hours that makes
you ineligible for coverage. All qualifying event changes must be consistent with the change in status. If you
experience a qualifying event, it is YOUR responsibility to make the applicable changes in HR InTouch.
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Medical Insurance
De Soto School District will be adding two additional medical plan offerings making that a total of five
plans, all through Blue Cross & Blue Shield of Kansas City (BCBS), for the 2016 plan year.
The following chart provides a high level comparison of benefits that will be effective January 1,
2016.
NEW!
NEW!
Base HDHP
Plan Type &
Network
Deductible
Individual
Family
Coinsurance
Out-of-Pocket
Max
Individual
Family
Blue Select Plus
Buy Up
HDHP
Preferred
Care Blue
In-Network Out of Network
$7,500
$15,000
30%
$3,000
$6,000
20%
$3,000
$6,000
$15,000
$30,000
$3.000
$6,000
Deductible
Preventive Care
Covered 100%
Blue Select Plus
Buy Up
PPO
Preferred
Care Blue
Buy-Up
HMO
HMOBlue Care
$1,000
$2,000
20%
None
None
20%
$5,500
$11,000
In-Network Out of Network
$3,000
$6,000
0%
Physician Office
Visits
Base PPO
Deductible
Covered 100%
$1,000
$2,000
20%
$2,500
$5,000
50%
$ 5,500
$11,000
$27,500
$55,000
$30 copay
$30 Copay
$4,000
$8,000
$25 / $50
Copay
Covered 100%
Covered
100%
Covered
100%
Hospital
Deductible
Deductible
Deductible then 20%
Deductible,
then 20%
20%
Emergency Room
Deductible
Deductible
$75 then deductible
then 20%
$75 copay,
then
deductible,
then 20%
$100
Copay
Urgent Care
Prescription Drugs
Deductible
Deductible
$30 copay
$30 Copay
$50 Copay
Medical Plan
Deductible, then:
Medical Plan
Deductible, then:
$100 Ind. Ded./$300
Fam. Ded.
$100 Ind.
Ded./$300
Fam. Ded.
$100 Ind.
Ded./$300
Fam. Ded.
0%
0%
$10 Copay
$10 Copay
$10 Copay
0%
0%
$50 Copay
$50 Copay
$50 Copay
Tier 1
Tier 2
Tier 3
$70 Copay
$70 Copay
0%
0%
$70 Copay
The above comparison is for illustrative purposes only and does not include all benefits, out-of-network benefits, plan limitations, and/or
exclusions. Please refer to the actual BCBS benefit summary/Summary Plan Description (SPD) for detailed information. In the event
there is a discrepancy in benefits, the carrier benefit summary/SPD will always govern.
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As an employee, the health benefits available to you represent a significant component of your
compensation package. They also provide important protection for you and your family in the case of
illness or injury.
Choosing a health coverage option is an important decision. To help you make an informed choice,
your plan makes available a Summary of Benefits and Coverage (SBC), which summarizes important
information about any health coverage option in a standard format, to help you compare your options.
The SBC is available on the HR InTouch website at: https://usd232.hrintouch.com/ . They are
located on the Open Enrollment page in HR InTouch under "Open Enrollment Documents". For
BCBS members, they are also available by accessing your member portal at www.mybluekc.com. A
paper copy is also available, free of charge, by contacting Gabby Philbrook, Benefits Coordinator, at
913-667-6200 or [email protected].
Patient-Centered Medical Home
Blue KC has designated certain primary care physician practices as “Patient-Centered Medical
Homes”. These practices have demonstrated their commitment to open communication with their
patients to include other physicians and pharmacists who treat that patient, with the goal of providing
Blue KC members with coordinated, comprehensive health services.
Through technology and shared information, the benefit to members seeing Patient-Centered Medical
Home providers should be more flexible scheduling, better coordination with multiple physicians who
treat the same member and more personalized care.
You can find a Patient-Centered Medical Home provider by going to the provider directory on the Blue
KC.com website. Check the box next to the provider specialty that says “Select Medical Home
Provider”.
COMPASS
Members who are enrolled in all medical plans EXCEPT the HMO option now have access to a
Compass Health Pro – a “concierge” who can help you make decisions about how and where to seek
services that are recommended by your doctor. For example, if a member is advised to have a
medical test or procedure, the Compass Health Pro can work with the member to determine where
the service can be performed, how much the plan will pay, what the member’s financial responsibility
may be, and more. The Compass Health Pro can schedule appointments and help the member
understand the doctor and facility charges after the procedure is complete. Compass can be reached
at [email protected] or by calling 877-912-0789.
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Your Medical Insurance Cost in 2016
The following are the 2016 monthly premiums, which are deducted from your paycheck through the
District’s Cafeteria Plan. (All premiums are deducted on a pre-tax basis and will be divided between your two paychecks each month)
Base HDHP (Blue Select +)
Employee Only
Employee + Spouse
Employee + Child(ren)
Employee + Family
Buy Up HDHP
Employee Only
Employee + Spouse
Employee + Family
Base PPO (Blue Select +)
Employee Only
Employee + Spouse
Employee + Family
Buy-Up PPO
Employee Only
Employee + Spouse
Employee + Family
NEW! BLUE SELECT PLUS NETWORK
Monthly Rates
Total Cost
District Pays
You Pay
$ 437.25
$437.25
$0
$1053.78
$437.25
$616.53
$ 773.91
$437.25
$336.66
$1390.44
$437.25
$953.19
PREFERRED CARE BLUE NETWORK
Monthly Rates
Total Cost
District Pays
You Pay
$ 471.65
$437.25
$ 34.40
$1136.67
$437.25
$ 699.42
$ 834.79
$437.25
$ 397.54
$1499.82
$437.25
$1062.57
NEW! BLUE SELECT PLUS NETWORK
Monthly Rates
Total Cost
District Pays
You Pay
$ 468.86
$437.25
$ 31.61
$1129.96
$437.25
$ 692.71
$ 830.83
$437.25
$ 393.58
$1490.95
$437.25
$1053.70
PREFERRED CARE BLUE NETWORK
Monthly Rates
Total Cost
District Pays
You Pay
$ 505.89
$437.25
$ 68.64
$1219.22
$437.25
$ 781.97
$ 896.50
$437.25
$ 459.25
$1608.74
$437.25
$1171.49
Buy-Up HMO
Employee Only
Employee + Spouse
Employee + Family
Total Cost
$ 586.40
$1413.23
$1037.92
$1864.74
BLUE CARE NETWORK
Monthly Rates
District Pays
$437.25
$437.25
$437.25
$437.25
You Pay
$ 149.15
$ 975.98
$ 600.67
$1427.49
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Health Savings Accounts
(HSA)
Available as an option ONLY to those that enroll in the BlueSaver HDHP.
What is a Health Savings Account (HSA)?
A HSA combines a lower premium, High Deductible Health Plan (HDHP) with an employee-directed,
tax-advantaged savings account.
What are the advantages of HSA?
 A HSA works much like an IRA. The money is yours and rolls over year to year, accumulating as
you age, and from one qualified HDHP to another. Depending on the HSA vendor, you may be
able to direct how those funds are invested, and a 2-4% annual investment return is often
guaranteed.
 Contributions and investment earnings are tax-free, as are disbursements from the account to pay
for qualified expenses. Funds withdrawn for non-qualified expenses will be assessed a 20%
penalty in addition to normal taxation. The penalty is waived in the event of death, disability, or
attainment of Medicare eligible age.
 Besides your health plan deductible, HSA qualified medical expenses include the same type of
things as covered by a traditional Cafeteria 125Flexible Spending Account (e.g. dental, vision, and
prescription drug out-of-pocket costs), and some things which Cafeteria 125plans do not allow:
COBRA premium, post-age 65 retiree health insurance premium other than Medicare supplement
policies, Long Term Care insurance premiums, and health insurance premiums if you are receiving
unemployment.
How much can I contribute to my HSA?
For 2016, maximum contributions to your HSA are $3,350/individual or $6,750/family. Additionally,
for individuals age 55 and over, a “catch-up” contribution is allowed in addition to the maximums
noted above. The “catch-up” contribution for 2016 is an additional $1,000.
Who is eligible to participate in a HSA?
Those covered by a HDHP. Employees, dependent spouses and/or children who are also
covered by any non-qualified plan, including Medicare, are not eligible for the HSA. If you own a
HSA account and later enroll in a non-qualified plan, you can continue to pay for healthcare
expenses on a tax-free, penalty-free basis and your account will continue to accumulate interest
tax-free, but you cannot contribute to the plan while enrolled in the non-qualified plan.
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Who is NOT eligible to participate in a HSA?
You are NOT eligible to make or receive contributions to a HSA if:
 You have other medical insurance coverage, unless that coverage is also a HDHP, OR
 You have medical coverage provided by TriCare, Medicare or Medicaid, OR
 You have been in receipt of non-preventive care benefits from the Department of Veteran’s Affairs
(VA) or one of its facilities, including prescription drugs, in the prior 3-month period, you are
excluded from contributing or receiving contributions the next 3 months, OR
 You or your spouse participate in a Cafeteria 125 Medical Flexible Spending Account (FSA). You
are considered to be a “beneficiary” of your spouse’s Medical FSA even if you do not plan to run
your expenses through it. (NOTE: There is no restriction to participating in a Cafeteria 125
Dependent Care Account, Limited Flexible Spending Account or sheltering premium payments for
medical, dental, vision, and life insurance.), OR
 You or your spouse are covered under a Health Reimbursement Account.
Now that you know what HSAs are, how they benefit you, and who is qualified to participate, let's take
another look at the HDHP program.
On the HDHP:
 The office visit and Rx co-pays are eliminated. With the exception of in-network routine preventive
exams/screenings paid by BCBS at 100%, all other charges related to diagnostic office visits,
hospital services, and prescription drugs will apply to your deductible.
 The plan provides 100% coverage in-network after the deductible is met, so all remaining charges
are paid in full. This means that your out-of-pocket maximum under this plan is truly $2,600.
 If you remain in-network, you will still benefit from BCBS’ contracts with their network providers.
Only the discounted "allowable" amount will apply to your deductible, not the full bill. Contracted
discounts average 40-50% savings.
 Your up-front deductible is offset by reduced premiums as well as contributions you may make to
the HSA. Keep in mind, all contributions to the HSA roll over year to year (no “use it or lose it” rule)
and may eventually provide full reimbursement of all out-of-pocket costs.
How do I open my HSA?
You will need to elect the HSA during open enrollment if you select the BlueSaver HDHP.
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Dental Insurance
De Soto School District will continue to offer dental benefits through Delta Dental of Kansas. To
maximize your benefits, you will want to use a participating dentist. You can find a list of participating
dentists at www.deltadentalks.com or call customer service at 800-234-3375. The following chart
provides a high level overview of benefits that will be effective January 1, 2016.
Delta Dental of Kansas
In Network
(Premier or PPO)
Network
Deductible
$25
$75
Yes
- Individual
- Family
-Waived for Preventive
Coinsurance
(Member Pays)
- Preventive
- Basic
- Major
Orthodontia
Maximum Benefits
- Calendar Year Maximum
0%
20% After Deductible
50% After Deductible
Not Available
$1,500 Per Person (diagnostic and preventive expenses no longer
apply to the annual max effective 1/1/16)
The above comparison is for illustrative purposes only and does not include all benefits, out-of-network rates, plan limitations, and/or
exclusions. Please refer to the actual Delta Dental benefit summary/Summary Plan Description (SPD) for detailed information. In the
event there is a discrepancy in benefits, the carrier benefit summary/SPD will always govern.
Your Dental Insurance Cost in 2016
Monthly Rates
Employee Only
$0
Employee + Spouse
$37.12
$17.17
Employee + Family
$54.29
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District Paid Life and AD&D
De Soto School District will now offer Life Insurance programs through Reliance Standard. To
access information about your claims, please go to www.reliancestandard.com or call customer
service at 877-523-0176. The following chart provides a high level overview of benefits that will be
effective January 1, 2016.
Product
Benefit
Employer Paid Group Term Life
Employee: $50,000
Employer Paid Accidental Death and
Dismemberment
Employee: $50,000
Disability Insurance
Short-Term Disability
All eligible employees are automatically covered with short-term disability insurance, 100% paid
for by the District, regardless of full-time status.
 STD covers any off-the-job physician-documented disability, which results in a loss of income.
 The STD wait period is 30 calendar days or the exhaustion of your sick leave, whichever
occurs later, after your accident/illness.
 After the wait period, the benefit pays 65% of base salary, up to a maximum of $1,250 per
week, for up to 26 weeks.
Long-Term Disability
All employees needing long-term disability will apply for it through KPERS which will work in
conjunction with the Social Security Administration for a maximum benefit of 60% of base salary.
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Cafeteria Plan/ Flexible Spending
Account (FSA)
You must re-enroll in the plan to participate for the plan year January 1, 2016 through December 31,
2016. It is mandatory, due to IRS regulations, that we capture your elections.
Part 1) Pre-tax Premiums
Your premium contributions for medical and dental insurance coverage will automatically be ran
through the Cafeteria 125 plan on a pre-tax basis – allowing additional tax savings and increasing
your take-home pay. All eligible premiums will be automatically deducted on a pre-tax basis.
Please remember, by allowing your deductions to be taken on a pre-tax basis, this limits you from
making any plan changes mid-year unless there is a qualifying event as described at the beginning of
this memo.
Part 2) Healthcare Flexible Spending Account (FSA)
De Soto School District provides you the opportunity to pay for out-of-pocket medical, dental and
vision expenses with pre-tax dollars through the Flexible Spending Account. Contributions to your
FSA come out of your paycheck before any taxes are taken out. This means that you don’t pay
Federal income tax, Social Security taxes, or State and local income taxes on the portion of your
paycheck you contribute to your FSA. You should contribute the amount of money you expect to pay
out of pocket for eligible expenses for the plan year. If you do not use the money you contributed it
will not be refunded to you. This is the use-it-or-lose-it rule.
 The maximum that you can contribute to the FSA is $2,550. All the funds are available day one
of the plan year.
 The plan includes a rollover provision that allows you to rollover into the 2017 plan year
unused funds contributed in 2016 (up to a maximum of $500).
Part 3) Limited Healthcare Flexible Spen ding Account (LFSA)
This account offers you the same pre-tax savings opportunity as the FSA mentioned in Part 2,
however it is limited to dental and vision expenses only. You cannot use the funds from this account
to pay for medical expenses. This account if for individuals participating in the HDHP with a Health
Savings Account. It allows someone to use all the funds in their HSA to cover their medical expenses
and still have additional funds through the LFSA to pay for dental and vision expenses. You should
contribute the amount of money you expect to pay out of pocket for eligible expenses for the plan
year. If you do not use the money you contributed it will not be refunded to you. This is the use-it-orlose-it rule.
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 The maximum that you can contribute to the FSA is $2,550. All the funds are available day one
of the plan year.
 The plan now includes a rollover provision that allows you to rollover into the 2017 plan year
unused funds contributed in 2016 (up to a maximum of $500).
Part 4) Dependent Day Care Expense Account (DDC)
A dependent care FSA is used to reimburse expenses related to care of eligible dependents while
you and your spouse work. The contributions to your dependent daycare account come out of your
paycheck before any taxes are taken out. You should contribute the amount of money you expect to
pay out of pocket for eligible expenses for the plan year. If you do not use the money you contributed
it will not be refunded to you or carried forward to a future plan year. This is the use-it-or-lose-it rule.
The maximum that you can contribute to the Dependent Care Flexible Spending Account is $5,000 if
you are a single employee or married filing jointly, or $2,500 if you are married and filing separately.
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Vision Insurance
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Supplemental Term Life Insurance
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Cancer/ICU Insurance
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Accident Insurance
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Critical Illness Insurance
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Permanent Term Life with Long-Term Care
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Identity Theft Protection
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NOTICE OF PRIVACY PRACTICES
Your Information. Your Rights. Our Responsibilities.
This notice describes how medical information about you may be used and disclosed and how you
can get access to this information. Please review it carefully.
YOUR RIGHTS
You have the right to:
 Get a copy of your health and claims records
 Correct your health and claims records
 Request confidential communication
 Ask us to limit the information we share
 Get a list of those with whom we’ve shared your information
 Get a copy of this privacy notice
 Choose someone to act for you
 File a complaint if you believe your privacy rights have been violated
YOUR CHOICES
You have some choices in the way that we use and share information as we:
 Answer coverage questions from your family and friends
 Provide disaster relief
 Market our services and sell your information
OUR USES AND DISCLOSURES
We may use and share your information as we:
 Help manage the health care treatment you receive
 Run our organization
 Pay for your health services
 Administer your health plan
 Help with public health and safety issues
 Do research
 Comply with the law
 Respond to organ and tissue donation requests and work with a medical examiner or funeral
director
 Address workers’ compensation, law enforcement, and other government requests
 Respond to lawsuits and legal actions
YOUR RIGHTS
When it comes to your health information, you have certain rights. This section explains your rights
and some of our responsibilities to help you.
Get a copy of health and claims records
 You can ask to see or get a copy of your health and claims records and other health
information we have about you. Ask us how to do this.
 We will provide a copy or a summary of your health and claims records, usually within 30 days
of your request. We may charge a reasonable, cost-based fee.
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Ask us to correct health and claims records
 You can ask us to correct your health and claims records if you think they are incorrect or
incomplete. Ask us how to do this.
 We may say “no” to your request, but we’ll tell you why in writing within 60 days.
Request confidential communications
 You can ask us to contact you in a specific way (for example, home or office phone) or to send
mail to a different address.
 We will consider all reasonable requests, and must say “yes” if you tell us you would be in
danger if we do not.
Ask us to limit what we use or share
 You can ask us not to use or share certain health information for treatment, payment, or our
operations.
 We are not required to agree to your request, and we may say “no” if it would affect your care.
Get a list of those with whom we’ve shared information
 You can ask for a list (accounting) of the times we’ve shared your health information for six
years prior to the date you ask, who we shared it with, and why.
 We will include all the disclosures except for those about treatment, payment, and health care
operations, and certain other disclosures (such as any you asked us to make). We’ll provide
one accounting a year for free but will charge a reasonable, cost-based fee if you ask for
another one within 12 months.
Get a copy of this privacy notice
 You can ask for a paper copy of this notice at any time, even if you have agreed to receive the
notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you
 If you have given someone medical power of attorney or if someone is your legal guardian,
that person can exercise your rights and make choices about your health information.
 We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated
 You can complain if you feel we have violated your rights by contacting us using the
information on page 1.
 You can file a complaint with the U.S. Department of Health and Human Services Office for
Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201,
calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
 We will not retaliate against you for filing a complaint.
YOUR CHOICES
For certain health information, you can tell us your choices about what we share. If you have a clear
preference for how we share your information in the situations described below, talk to us. Tell us
what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to:
 Share information with your family, close friends, or others involved in payment for your care
 Share information in a disaster relief situation
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead
and share your information if we believe it is in your best interest. We may also share your
information when needed to lessen a serious and imminent threat to health or safety.
50 | P a g e
In these cases we never share your information unless you give us written permission:
 Marketing purposes
 Sale of your information
OUR USES AND DISCLOSURES
How do we typically use or share your health information? We typically use or share your health
information in the following ways.
Help manage the health care treatment you receive
 We can use your health information and share it with professionals who are treating
you. Example: A doctor sends us information about your diagnosis and treatment plan
so we can arrange additional services.
Run our organization
 We can use and disclose your information to run our organization and contact you when
necessary.
 We are not allowed to use genetic information to decide whether we will give you coverage
and the price of that coverage.
 This does not apply to long term care plans. Example: We use health information about you to
develop better services for you.
Pay for your health services
 We can use and disclose your health information as we pay for your health services. Example:
We share information about you with your dental plan to coordinate payment for your dental
work.
HOW ELSE CAN WE USE OR SHARE YOUR HEALTH INFORMATION?
We are allowed or required to share your information in other ways – usually in ways that contribute
to the public good, such as public health and research. We have to meet many conditions in the law
before we can share your information for these purposes. For more information see:
www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Help with public health and safety issues
We can share health information about you for certain situations such as:
 Preventing disease
 Helping with product recalls
 Reporting adverse reactions to medications
 Reporting suspected abuse, neglect, or domestic violence
 Preventing or reducing a serious threat to anyone’s health or safety
Do research
We can use or share your information for health research.
Comply with the law
We will share information about you if State or Federal laws require it, including with the
Department of Health and Human Services if it wants to see that we’re complying with Federal
privacy law.
Respond to organ and tissue donation requests and work with a medical examiner or funeral director
 We can share health information about you with organ procurement organizations.
 We can share health information with a coroner, medical examiner, or funeral director when an
51 | P a g e
individual dies.
Address workers’ compensation, law enforcement, and other government requests
We can use or share health information about you:
 For workers’ compensation claims
 For law enforcement purposes or with a law enforcement official
 With health oversight agencies for activities authorized by law
 For special government functions such as military, national security, and presidential
protective services
Respond to lawsuits and legal actions
We can share health information about you in response to a court or administrative order, or in
response to a subpoena.
OUR RESPONSIBILITIES
 We are required by law to maintain the privacy and security of your protected health
information.
 We will let you know promptly if a breach occurs that may have compromised the privacy or
security of your information.
 We must follow the duties and privacy practices described in this notice and give you a copy of
it.
 We will not use or share your information other than as described here unless you tell us we
can in writing. If you tell us we can, you may change your mind at any time. Let us know in
writing if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
CHANGES TO THE TERMS OF THIS NOTICE
We can change the terms of this notice, and the changes will apply to all information we have about
you. The new notice will be available upon request, on our web site, and we will mail a copy to you.
 Effective date of Notice: 10/1/2014
 Privacy contact: De Soto School District, Gabby Philbrook, 35200 West 91 st Street, De Soto,
KS 66018
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General Notice of COBRA Continuation Coverage Rights
Introduction
If you have recently gained coverage under a group health plan sponsored by Blue Valley Schools, this notice
pertains to you. This notice has important information about your right to COBRA continuation coverage, which
is a temporary extension of coverage under the Plan. This notice explains COBRA continuation coverage,
when it may become available to you and your family, and what you need to do to protect your right to get it.
When you become eligible for COBRA, you may also become eligible for other coverage options that may cost
less than COBRA continuation coverage.
The right to COBRA continuation coverage was created by a Federal law, the Consolidated Omnibus Budget
Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and other
members of your family when group health coverage would otherwise end. For more information about your
rights and obligations under the Plan and under Federal law, you should review the Plan’s Summary Plan
Description or contact the Plan Administrator.
You may have other options available to you when you lose group health coverage. For example, you may be
eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through
the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs.
Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you
are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees.
What is COBRA continuation coverage?
COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a
life event. This is also called a “qualifying event.” Specific qualifying events are listed later in this notice. After
a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified
beneficiary.” You, your spouse, and your dependent children could become qualified beneficiaries if coverage
under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect
COBRA continuation coverage must pay for COBRA continuation coverage.
If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan
because of the following qualifying events:
•
Your hours of employment are reduced, or
•
Your employment ends for any reason other than your gross misconduct.
If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage
under the Plan because of the following qualifying events:
•
Your spouse dies;
•
Your spouse’s hours of employment are reduced;
•
Your spouse’s employment ends for any reason other than his or her gross misconduct;
•
Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or
•
You become divorced or legally separated from your spouse.
Your dependent children will become qualified beneficiaries if they lose coverage under the Plan
because of the following qualifying events:
•
The parent-employee dies;
•
The parent-employee’s hours of employment are reduced;
•
The parent-employee’s employment ends for any reason other than his or her gross misconduct;
•
The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both);
53 | P a g e
•
•
The parents become divorced or legally separated; or
The child stops being eligible for coverage under the Plan as a “dependent child.”
When is COBRA continuation coverage available?
The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator
has been notified that a qualifying event has occurred.
The employer must notify the Plan Administrator of the following qualifying events:
•
The end of employment or reduction of hours of employment;
•
Death of the employee; or
•
The employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both).
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s
losing eligibility for coverage as a dependent child), you must notify the Plan Administrator within 60 after the
qualifying event occurs. You must provide this notice to: Shila Rolleston in the BV Benefits Department (913)
239-4235 or call the BV Enrollment Call Center at (888) 972-3430. Note, proof of the qualifying event must be
provided.
How is COBRA continuation coverage provided?
Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation
coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an
independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation
coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their
children.
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due
to employment termination or reduction of hours of work. Certain qualifying events, or a second qualifying
event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of
coverage.
There are also ways in which this 18-month period of COBRA continuation coverage can be extended:
Disability extension of 18-month period of COBRA continuation coverage
If you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you
notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to get up to an
additional 11 months of COBRA continuation coverage, for a maximum of 29 months. The disability would
have to have started at some time before the 60th day of
COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA
continuation coverage.
Second qualifying event extension of 18-month period of continuation coverage
If your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the
spouse and dependent children in your family can get up to 18 additional months of COBRA continuation
coverage, for a maximum of 36 months, if the Plan is properly notified about the second qualifying event. This
extension may be available to the spouse and any dependent children getting COBRA continuation coverage if
the employee or former employee dies; becomes entitled to Medicare benefits (under Part A, Part B, or both);
gets divorced or legally separated; or if the dependent child stops being eligible under the Plan as a dependent
child. This extension is only available if the second qualifying event would have caused the spouse or
dependent child to lose coverage under the Plan had the first qualifying event not occurred.
54 | P a g e
Are there other coverage options besides COBRA Continuation Coverage?
Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and
your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options
(such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost
less than COBRA continuation coverage. You can learn more about many of these options at
www.healthcare.gov.
If you have questions
Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the
contact or contacts identified below. For more information about your rights under the COBRA law, the Patient
Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional
or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your
area or visit www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are
available through EBSA’s website.) For more information about the Marketplace, visit www.HealthCare.gov.
Keep your Plan informed of address changes
To protect your family’s rights, let the Plan Administrator know about any changes in the addresses of family
members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator.
 Plan contact information: De Soto School District, Gabby Philbrook, 35200 West 91st Street, De Soto, KS 66018
Your CBIZ Team
700 West 47th Street, Suite 1100, Kansas City, MO 64112
Janet Willis
Senior Account Executive
Direct Line: 816-945-5202
[email protected]
Ann Spletstoser
Senior Account Manager
Direct Line: 816-945-5135
[email protected]
De Soto Benefits Department
35200 West 91st Street, De Soto, KS 66018
Gabby Philbrook
Benefits Coordinator
913-667-6200
[email protected]
55 | P a g e
This guide prepared by:
Please note that the information in this Enrollment Guide is presented for illustrative purposes and is based on information provided by
the employer. The information contained in this Guide was taken from brochures and benefit information. While every effort was taken
to accurately report your benefits, discrepancies, or errors are always possible. In case of discrepancy between the Guide and the
actual plan documents the actual plan documents will prevail. All information is confidential, pursuant to the Health Insurance
Portability and Accountability Act of 1996. If you have any questions about your Guide, please refer to your Employee Manual for
additional information or contact your Benefits Manager.
56 | P a g e

De Soto School District Employee Benefits Guide

Transcription

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