Employee Benefits Guide. January 1 December 31, 2019

Transcription

1 Emplyee Benefits Guide 2019 January 1 December 31, 2019

2 Medical and Prescriptin Drugs Benefits are insured by: 4 Medical Plan Optins Effective January 1, 2019 Premium Netwrk HDHP 1 Nn-Premium Netwrk Nn-Netwrk Benefits Premium Netwrk HDHP 2 Nn-Premium Netwrk Nn-Netwrk Benefits Yur csts are summarized belw Yur csts are summarized belw Physician Office Visit 20% after Deductible 20% after Deductible 20% after Deductible Specialist Office Visit 20% after Deductible 30% after Deductible 30% after Deductible Deductible Individual $2,000 Nn-Embedded $2,000 $4,000 $3,000 Nn-Embedded $3,000 $6,000 Family $4,000 $4,000 $8,000 $6,000 $6,000 $12,000 Cinsurance 20% 30% 50% 20% 30% 50% Out-f-Pcket Maximum Individual $3,000 Nn-Embedded $3,000 $5,000 $4,000 Nn-Embedded $4,000 $6,000 Family $6,000 $6,000 $10,000 $7,150 $7,150 $12,000 Preventive Care Services include but are nt limited t: Rutine Exams, Rutine and Nn-Rutine Mammgrams, Pelvic Exams, Pap testing, Immunizatins, Annual diabetic eye exam, Rutine Visin and Hearing exams 100% Cvered 100% Cvered Hspital Services 20% after Deductible Out-Patient Services 20% after Deductible Maternity Services 20% after Deductible Emergency Rm Services Urgent Care Centers Mental & Nervus InPatient 20% after Deductible OutPatient 20% after Deductible Substance Abuse InPatient 20% after Deductible OutPatient 20% after Deductible Retail Prescriptin Drugs Generic 20% after Deductible Preferred 20% after Deductible Nn-Preferred 20% after Deductible Mail Order Prescriptin Drugs Generic 20% after Deductible Nt Cvered 20% after Deductible Nt Cvered Preferred 20% after Deductible Nt Cvered 20% after Deductible Nt Cvered Lifetime Maximum Medical Surgical Treatment f Mrbid Obesity 20% after Deductible 20% after Deductible 20% after Deductible 20% after Deductible HSA Thrugh: Emplyee Family Catch-Up Cntributins Ages 55 and Older Health Savings Accunt (HSA) 2019 Annual IRS Limits $3,500 $7,000 $1,000 The abve is a brief utline t cmmunicate the benefit prgrams. Please see the Plan Certificates fr cmplete plan infrmatin. In a case f a discrepancy, the plan certificates will prevail.

3 Medical and Prescriptin Drugs Benefits are insured by: 4 Medical Plan Optins Effective January 1, 2019 Premium Netwrk HDHP 3 Nn-Premium Netwrk Nn-Netwrk Benefits Premium Netwrk HDHP 4 Nn-Premium Netwrk Nn-Netwrk Benefits Yur csts are summarized belw Yur csts are summarized belw Physician Office Visit 20% after Deductible 20% after Deductible 20% after Deductible Specialist Office Visit 20% after Deductible 30% after Deductible 30% after Deductible Deductible Individual $4,000 Embedded $4,000 $8,000 $5,000 Embedded $5,000 $10,000 Family $8,000 $8,000 $16,000 $10,000 $10,000 $20,000 Cinsurance 20% 30% 50% 20% 30% 50% Out-f-Pcket Maximum Embedded Embedded Individual $5,000 $5,000 $16,000 $6,500 $20,000 Family $10,000 $10,000 $32,000 $13,000 $40,000 Preventive Care Services include but are nt limited t: Rutine Exams, Rutine and Nn-Rutine Mammgrams, Pelvic Exams, Pap testing, Immunizatins, Annual diabetic eye exam, Rutine Visin and Hearing exams 100% Cvered 100% Cvered Hspital Services 20% after Deductible Out-Patient Services 20% after Deductible Maternity Services 20% after Deductible Emergency Rm Services Urgent Care Centers Mental & Nervus InPatient 20% after Deductible OutPatient 20% after Deductible Substance Abuse InPatient 20% after Deductible OutPatient 20% after Deductible Retail Prescriptin Drugs Generic 20% after Deductible Preferred 20% after Deductible Nn-Preferred 20% after Deductible Mail Order Prescriptin Drugs Generic 20% after Deductible Nt Cvered 20% after Deductible Nt Cvered Preferred 20% after Deductible Nt Cvered 20% after Deductible Nt Cvered Lifetime Maximum Medical Surgical Treatment f Mrbid Obesity 20% after Deductible 20% after Deductible 20% after Deductible 20% after Deductible HSA Thrugh: Emplyee Family Catch-Up Cntributins Ages 55 and Older Health Savings Accunt (HSA) 2019 Annual IRS Limits $3,500 $7,000 $1,000 The abve is a brief utline t cmmunicate the benefit prgrams. Please see the Plan Certificates fr cmplete plan infrmatin. In a case f a discrepancy, the plan certificates will prevail.

4 Dental Benefits insured by: Basic Life/AD&D, Shrt Term Disability, Lng Term Disability and Vluntary Life are Insured By: Annual Deductible Individual Family Annual Plan Maximum $25 $50 $1,250 Shrt Term Disability 14 Day Waiting Perid Lifetime Orthdntia Max $1,200 Benefit Percentage: 60% Plan Cinsurance Levels: Maximum Weekly Benefit: $1,000 Preventive Care: Dental Benefit Summary In Netwrk Out f Netwrk X-Rays 80% 80% Cleaning 80% 80% Oral Exams 80% 80% Minimum Weekly Benefit: Maximum Benefit Perid: 10% f Weekly Disability Benefit 11 Weeks Sealants (per tth) 80% 80% Benefit Percentage: 60% Basic Care: Maximum Weekly Benefit: $1,000 Fillings (ne surface) 80% 80% Minimum Weekly Benefit: 10% f Weekly Disability Benefit General Anesthesia 80% 80% Maximum Benefit Perid: 9 Weeks Scaling and Rt Planing 80% 80% Simple Extractins 80% 80% Majr Care: Dentures 80% 80% Single Crwns 80% 80% Orthdntia: 60% 60% Day Benefits Begin: Day Benefits Begin: 30 Day Waiting Perid 15th cnsecutive day f Disability due t accidental injury; & 15th cnsecutive day f Disability due t sickness 31st cnsecutive day f Disability due t accidental injury; & 31st cnsecutive day f Disability due t sickness All Sick Days Must Be Used Befre Shrt Term Disabilty Applies Shrt Term Disability is 100% paid by emplyee Flexible Spending Accunts Administered by: Vluntary Life Emplyee Benefit Benefit Increments $10,000 Benefit Maximum Lesser f 5x's Salary r $500,000 Guarantee Issue $100,000 Spuse Benefit Flexible Spending Accunt Plan Benefit Increments $5,000 Plan Optins Plan Maximums Lesser f $250,000 r 50% f Benefit Maximum Health Care FSA Plan $2,600 Emplyee's Cverage Dependent Care FSA Plan $5,000 Guarantee Issue $50,000 Child Benefit All eligible emplyees are eligible t enrll in the Dependent Birth t 6 mnths $500 Care FSA Plan. Eligible emplyees wh d NOT enrll in 6 mnths t 26 years Units f $1,000 t $10,000 the High Deductible Health Plan are eligible t participate in the Health Care FSA Plan. Guarantee Issue All Guaranteed Issue Vluntary Life is 100% paid by Emplyee Eligibility Yu can enrll fr Single r Family Medical/Dental Cverage at the time yu becme eligible fr benefits. If yu initially decline cverage, yu can nly enrll fr cverage during a Special Enrllment perid due t a Qualifying Event r at Open Enrllment. Eligible Dependents include yur spuse, natural children, newbrn and legally adpted children, stepchildren and children fr whm yu r yur spuse is a legal guardian r children wh ECS has determined are cvered under a "Qualified Medical Child Supprt Order". Dependent Children may be cvered until the end f the year f their 26th birthday. The abve is a brief utline t cmmunicate the benefit prgrams. Please see the Plan Certificates fr cmplete plan infrmatin. In a case f a discrepancy, the plan certificates will prevail.

5 HSAs: Hw d they wrk? This summary prvides a brief verview f Health Savings Accunts. It is nt inclusive f each HSA prvisin. Shuld there be a discrepancy between the infrmatin cntained in this dcument and the HSA Rules and Regulatins stipulated by the IRS, the IRS Rules and Regulatins will gvern. Health Savings Accunts (HSAs) A Health Savings Accunt (HSA) is a cnsumer-riented, tax-advantaged savings accunt that is always cmbined with a High Deductible Health plan (HDHP). It is an interest-accruing accunt, similar t an Individual Retirement Accunt (IRA), which prvides financial cntrl ver hw yu spend yur health care dllars and can be used t pay fr yur ut-f-pcket medical expenses. HSA earnings grw taxdeferred and qualified withdrawals are tax-free withut use it r lse it prvisins fund with a Flexible Spending Accunt (FSA). Mney nt used in yur Health Savings Accunt can be rlled ver t the fllwing year. HSA funds can be used fr all qualified medical expenses, including medical services, as well as eye glasses, dental prcedures, prescriptin drug cverage and ver-the-cunter medicatins prvided yu submit a prescriptin frm yur prvider. HSAs enable yu t pay fr current health expenses and save fr future qualified medical and retiree health expenses n a tax-free basis. Yu must be cvered by a High Deductible Health Plan (HDHP) t be qualified t pen an HSA. An HDHP generally csts less than what traditinal health care cverage csts, s the mney that yu save n insurance premiums can be put int the Health Savings Accunt. Yu wn and cntrl the mney in yur HSA. Decisins n hw t spend the mney are made by yu withut relying n a third party r a health insurer. Yu will als decide what types f investments t make with the mney in the accunt in rder t make it grw. Health Savings Accunt Eligibility Eligible individuals include thse wh are: Cvered by an HSA-qualified High Deductible Health Plan (HDHP) Nt cvered by ther health insurance that is nt an HDHP (including a spuse s plan in which he/she has selected family cverage and/r a General Purpse Healthcare FSA set up by yu r yur spuse)* Nt enrlled in Medicaid Nt enrlled in Medicare Nt eligible t be claimed n anther s tax return There are exceptins: Insurance cverage fr accidents, dental care, disability, lng-term care, and visin care d nt disqualify yu frm pening an HSA; nr d Limited-Purpse FSA s. If yu have Wrker s Cmpensatin benefits, specified disease, r fixed indemnity cverage, yu can als pen an HSA. High Deductible Health Plans (HDHP) Yu must have an HDHP if yu want t pen an HSA. An HDHP is a health insurance plan that generally des nt pay fr the first several thusand dllars f health care expenses. Yur HSA helps pay fr the qualified expenses that yur plan des nt cver. In rder t qualify t pen an HSA, yur HDHP minimum deductible must be at least $1350 (self-nly cverage) r $2,700 (family cverage) fr The annual ut-f-pcket (including deductibles and cpays) cannt exceed $6,750 (self-nly cverage) r $13,500 (family cverage) fr All HDHP s prvide cverage fr preventive care withut requiring deductibles and apply higher ut-f-pcket limits, cpays, & cinsurance fr nn-netwrk services. HSAs and HDHP Cverage Once funds are depsited int the HSA, the accunt can be used t pay fr qualified medical expenses tax-free, even if yu n lnger have HDHP cverage. The funds in yur accunt rll ver autmatically each year and remain indefinitely until used. There is n time limit n using the funds. Plan dcuments and HSA administratr materials will prvide cmplete plan details.

6 HSA Accunt Management There are many institutins which prvide HSAs. In the event an accunt is funded entirely by an emplyer, the banking institutin and cntributins may be pre-selected. If the HSA is fully funded by an emplyee, there may be an advantage t using a specific bank if an emplyer prvides direct depsit f pre-tax HSA cntributins t that bank. If an emplyee chses t set-up and maintains his r her wn HSA, it is imprtant t cnsider the fees, interest rates, investment ptins and ther features assciated with HSAs when selecting a financial institutin. The cntributin generally wuld nt be payrll deducted and will need t be made with after-tax dllars. After-tax cntributins can be deducted frm an emplyee s incme n annual tax returns. Utilizing HSA Accunts Yu can use the mney in yur HSA accunt t pay fr any "qualified medical expense" permitted under federal tax law. This includes mst medical care and medicatins as well as dental and visin care. HSAs can be used t pay fr medical expenses fr yurself as well as yur spuse, and/r yur dependent children. Any amunts used fr purpses ther than t pay fr "qualified medical expenses" are taxable as incme and are als subject t a 20% tax penalty. Emplyees have the ptin f using their HSA debit card r HSA checks (if applicable). Persnal funds may als be used t pay fr qualified expenses and emplyees can then reimburse themselves frm their HSA. Cntributin Limits The 2019 HSA maximum cntributin is $3,500 fr self-nly cverage and $7,000 fr family cverage. These amunts are set by law and will be increased fr inflatin in future years. Yu can cntribute in a lump sum r in any amunts r frequency yu wish. Hwever, yur accunt trustee/custdian (bank, credit unin, insurer, etc.) can impse minimum depsit and balance requirements. Emplyer Cntributins Cntributins t HSAs can be made by yu, yur emplyer, r bth. If yur emplyer cntributes sme f the mney, yu can make up the difference. The maximum cntributin includes mney cntributed by yu and/r yur emplyer. The cmbined cntributins frm yu and yur emplyer cannt exceed the annual maximum as set by the IRS. Catch-Up Cntributins Individuals 55 and lder wh are cvered by an HDHP can make additinal catch-up cntributins each year until they enrll in Medicare. The additinal catch-up cntributins t HSA allwed are as fllws: $1, $1,000 Nte: If an emplyee and spuse are bth age 55 r lder, each individual must have a HSA established fr bth parties t take advantage f the catch-up cntributin. HDHP Cverage Lss Funds depsited int yur HSA remain in yur accunt and autmatically rll ver frm ne year t the next. Yu may cntinue t use the HSA funds fr qualified medical expenses, even if yu are n lnger cvered by an HDHP. Yu may n lnger cntribute t a HSA fr mnths that yu are nt cvered by an HDHP. If yu made a cntributin t yur HSA fr the year based n a full year s cverage by the HDHP, yu will need t withdraw sme f the cntributin t avid the tax n excess HSA cntributins. If yu regain HDHP cverage at a later date, yu can begin making cntributins t yur HSA again. Plan dcuments and HSA administratr materials will prvide cmplete plan details.

7 HSA Advantages There are many advantages f pening a Health Savings Accunt. In additin t the savings f lwer health insurance premiums, 100% f HSA cntributins are pre-taxed. The interest earned by the mney in a HSA is als tax-free. Yu pay n taxes r penalties when yu use yur HSA fr qualified medical expenses. Sme ther advantages include: Tax Savings: Yu can elect t have yur HSA pre-tax cntributins payrll deducted r cntributins can be deducted frm yur grss incme n yur federal tax return. Earnings: Yu will earn interest frm the funds in yur HSA as it grws with tax-deferred interest. Prtability: Yu wn yur accunt, s in the event yu change jbs, yur HSA funds are nt affected. Affrdable Health Cverage: HSA s can cver the cst f medical expenses such as cinsurance, deductibles, and medicatins. Lng-Term Savings: HSA tax-deferred funds can be rlled ver each year, allwing yur accunt t grw. HSA s have been referred t as the "Medical IRA." Retirement Bnus: After age 65, yu may make withdrawals frm yur HSA fr any reasn withut a 20% penalty. Withdrawals fr reasns ther than qualified medical expenses will be subject t rdinary incme tax. Safety Net: There is n "use it r lse it" prvisin, s yu can build up the savings in yur HSA t use fr majr health events. Additinal Cverage: Yu can use HSA funds fr expenses nt cvered by health plans, including dental, ptical, and much mre. Investment Ptential: Many financial institutins allw yu t invest yur HSA funds int stcks, mutual funds and ther investment vehicles, allwing yur mney t grw mre quickly. HSA Mid-Year Eligibility Yur eligibility t cntribute t an HSA is determined by the effective date f yur HDHP cverage. Yu can jin an HSA-cmpatible plan mid-year and make the full IRS-allwed cntributin fr that year, but yu will be required t stay in the plan thrugh December f the fllwing year in rder t avid any tax penalties. If yu are cvered n December 1, 2018 yu are treated as an eligible individual fr the entire year. Hwever, if yu cease t be an eligible individual during 2019, the cntributins yu made fr the mnths in which yu were nt enrlled in a qualified HDHP plan are included in incme and subject t a 20% additinal tax. Health Savings Accunts at Age 65 Yu can cntinue t use yur accunt tax-free fr ut-f-pcket health expenses. When yu enrll in Medicare, yu will n lnger be eligible t cntribute mney t yur accunt but yu can use yur accunt t pay Medicare premiums, deductibles, cpays, and cinsurance under any part f Medicare. If yu have retiree health benefits thrugh yur frmer emplyer, yu can als use yur accunt t pay fr yur share f retiree medical insurance premiums. One expense yu cannt use yur accunt fr is t purchase a Medicare supplemental insurance r Medigap plicy. Once yu turn age 65, yu can use yur accunt t pay fr things ther than medical expenses withut penalty but will be subject t incme tax. Individuals under age 65 wh use their accunts fr nn-medical expenses must pay incme tax and a 20% penalty n the amunt withdrawn. HSA Funds In the Event f a Death If yu are married, yur spuse becmes the wner f the HSA when yu die. If yu are unmarried, the HSA becmes part f yur taxable estate. Further Infrmatin The Treasury Department has additinal infrmatin abut Health Savings Accunts, including answers t frequently asked questins, related IRS frms and publicatins, technical guidance, and links t ther helpful web sites. The Treasury s HSA website can be fund thrugh (click n Health Savings Accunts ) r directly at the fllwing address: Plan dcuments and HSA administratr materials will prvide cmplete plan details.

8 Elkhart Cmmunity Schls Yur health and financial security are imprtant t us. Our benefit prgram ffers a variety f plans that can enhance the lives f yu and yur family bth nw and in the future. As an eligible emplyee, yu will be asked t make decisins abut the emplyee benefits described in this bklet. Please take the time t study the infrmatin abut the benefit plan fferings and g t benefitslver.cm t enrll in yur benefits. Highlights f Our Benefits Fur Cmprehensive Medical Plans Dental Plan Shrt Term Disability Lng Term Disability Vluntary Life Vluntary Dependent Life Flexible Spending Accunts Eligibility All eligible emplyees wh wrk at least 30 hurs per week and certified staff wh wrk at least 20 hurs per week are eligible t participate in the emplyee benefit plans. Fr Medical and Dental plans, cvered dependents include yur spuse and children t the end f the year f their 26 th birthday. Medical Elkhart Cmmunity Schls makes available fur medical plans frm which yu can chse. By ffering fur plans, yu have the chice in selecting the benefit prgram that best fits the needs f yu and yur family. The grup medical prgram is administered by UMR with access thrugh the Chice Plus PPO Netwrk. T btain the mst current participating prvider listing lg nt Dental Dental benefits are prvided thrugh Delta Dental. Yu and yur cvered dependents are autmatically enrlled when yu select medical cverage. The plan is designed t prvide yu and yur dependent family members with Preventive, Basic and Majr dental care. Yu may g t any dentist, hwever thse wh are in the PDP Plus netwrk will be the mst cst effective. Yu can lg nt fr current prvider infrmatin. Disability Shrt-Term Disability insurance is available t all emplyees wrking a minimum f 30 hurs per week and certified staff wrking a minimum f 20 hurs per week. The weekly benefit is 60% f earnings, nt t exceed a $1,000 weekly maximum. Emplyees pay 100% f the Shrt-Term Disability premiums. Lng-Term Disability insurance is available t all emplyees wrking a minimum f 30 hurs per week and certified staff wrking a minimum f 20 hurs per week. The mnthly benefit is up t 66.67% f yur mnthly cvered earnings nt t exceed $7,500 per mnth. If yu apply fr disability insurance mre than 31 days after yu becme eligible, yu will be asked t submit Evidence f Insurability. Vluntary Life Emplyees have the ptin t purchase additinal life insurance fr themselves and their dependents as fllws: Emplyees: Yu may elect increments f $10,000 up t the lesser f 5x s salary r $500,000. Cst is dependent n age and the amunt f insurance elected. Spuse: Yu may elect cverage fr yur spuse in increments f $5,000. Yur spuse s cverage cannt exceed 50% f the emplyee s elected benefit amunt. Cst is dependent n age and amunt elected. Children: Yu may elect cverage fr yur unmarried, dependent children in increments f $1,000 up t $10,000. Flexible Spending Accunts The Flexible Spending Accunts are administered thrugh AdminPr. Emplyees wh are NOT enrlled in the ECS Health Plans are eligible t participate in the Health Care Reimbursement Accunt. All emplyees are eligible t participate in the Dependent Care Reimbursement Accunt.