BENEFITS ENROLLMENT GUIDE Plan Year: September 1, 2017 through August 31, 2018

Transcription

1 BENEFITS ENROLLMENT GUIDE Plan Year: September 1, 2017 through August 31, 2018 Nacogdoches ISD: Maxine Symmank NISD Employee Benefits Coordinator Phone: , ext 8833 Lacey Parmer Employee Benefits Manager Phone:

2 Your Enrollment Overview Nacogdoches Independent School District and BancorpSouth Insurance would like to take this opportunity to present to you the benefit information for the upcoming plan year. This information has been created to bring forth a brief overview of your benefit choices as well as offer you a reference guide when questions may arise regarding your insurance plans. Please take the time to look over the information contained in this booklet to familiarize yourself with the benefits that are provided to you as an employee of Nacogdoches ISD. The plan year for Nacogdoches ISD is September 1, 2017 through August 31, Payroll deductions for your benefits will begin in September. This guide contains a summary of the benefits offered by Nacogdoches ISD. If there is a conflict between the terms of this outline of benefits and the actual contracts, the terms of the contracts will prevail. Information That You Need Due to the Affordable Care Act (ACA) all eligible employees, including active contributing TRS Members and Employees regularly working 10 hours per week MUST either enroll for coverage or Decline Coverage. ACA Reporting Requirements for TRS ActiveCare requires the following information. Please make sure you have the below information prior to completing your enrollment. All Social Security Numbers for every Family Member (even if you do not cover them) Residence Address (Street, City, State and zip code) NO PO Boxes; needed to verify county where the participant lives for ACA Telephone Number (home or cell) KNOW BEFORE YOU GO! When making doctor appointments, it s always a good idea to make sure the provider participates in the network. This helps keep your costs lower. You can always check for a provider online via the carrier website or simply ask your doctor. For medical and pharmacy benefits, you will receive and ID card as well as a separate card for Dental elections. Vision elections will not receive a card. You will need to let your provider know you work with Nacogdoches ISD and tell them you have VSP for the benefit. They will file the claim using your name, SSN, DOB, etc. BancorpSouth Insurance Services, Inc. 2

3 Online Enrollment Instructions 1. In order to begin your benefits enrollment, please proceed to Employees have the option to go online and complete their own enrollment through the self service online enrollment! The online enrollment system can be accessed from any computer, smart phone or tablet. (see instructions below) Should you not wish to complete your enrollment online you will need to see a representative on your campus to complete your enrollment. 2. At the Login screen, you will need to enter your User Name and Password. User Name = first initial followed by last name and last four digits of your Social Security Number Password = nacisd (all passwords have been reset to nacisd) Example employee Jane Doe User Name: jdoexxxx (represents the last 4 digits of SSN) Password: nacisd (you will be prompted to change at first login. Your new password must be at least five characters and contain at least one number. 3. Once you have logged into the system, you will be prompted to the Welcome Screen. Click the button that reads Click Here to Begin Your Enrollment. 4. At this point you will be on the Current Benefits screen. For new hires, this screen will be blank. Review and click continue. 5. On the next screen (Verify Information), you will add any dependents you currently claim based on IRS guidelines. You will need to enter them regardless if you choose to elect coverage for them or not. This is due to healthcare reform. It is very important to complete the Name, SSN, DOB, Gender and Relationship for each dependent. Once done, click submit and add any other dependent to be covered. After dependents have been added click the Continue Enrollment button. 6. You will be prompted to add a beneficiary for the employer paid life insurance. You may add a primary and contingent beneficiary but keep in mind the % share must total 100% for each the primary and the contingent. 7. From this point, you will proceed through each benefit option selecting to either elect or decline each coverage type. There will be instructions located at the top of each page as well as links to specific plan information for each type of coverage, such as schedule of benefits, etc. As you progress through the enrollment, the plans that you elect will be marked with a blue check and the plans you decline will be marked with a red x. There is also a running total of the cost of your elected coverage in the top left corner of the screen. For benefits where dependent coverage is elected, you will need to select which dependent to add. 8. Once you have completed your enrollment, you will be directed to a Confirmation Statement. This page will list all of the benefits you have selected. Please review the statement to make sure the information is correct and any dependents you have chosen to enroll are showing. BE SURE TO CLICK ON THE COMPLETE ENROLLMENT BUTTON. You can then print the confirmation statement or take a snapshot of it from your smart phone or tablet for your records. Note: You may log into the system as many times as you would like and make changes until the enrollment end date. Your final election will be used for the plan year. The enrollment guide provides the benefit highlights. For a more detailed summary of each of the benefits, click on the blue link within each coverage screen. A plan summary will be available in PDF for each plan. BancorpSouth Insurance Services, Inc. 3

4 TRS-ActiveCare Plan Highlights Effective September 1, 2017 through August 31, 2018 In-Network Level of Benefits* Medical Coverage ActiveCare 1-HD ActiveCare Select or ActiveCare Select Whole Health (Baptist Health System and HealthTexas Medical Group; Baylor Scott & White Quality Alliance; Kelsey Select; Memorial Hermann Accountable Care Network; Seton Health Alliance) ActiveCare 2 Deductible (per plan year) In-Network Out-of-Network Out-of-Pocket Maximum (per plan year; medical and prescription drug deductibles, copays, and coinsurance count toward the out-of-pocket maximum) In-Network Out-of-Network Coinsurance In-Network Participant pays (after deductible) Out-of-Network Participant pays (after deductible) Office Visit Copay Participant pays Diagnostic Lab Participant pays Preventive Care See below for examples Teladoc Physician Services High-Tech Radiology (CT scan, MRI, nuclear medicine) Participant pays Inpatient Hospital (preauthorization required) (facility charges) Participant pays Emergency Room (true emergency use) Participant pays Outpatient Surgery Participant pays Bariatric Surgery Physician charges (only covered if performed at an IOQ facility) Participant pays Annual Vision Examination (one per plan year; performed by an ophthalmologist or optometrist using calibrated instruments) Participant pays Annual Hearing Examination Participant pays $2,500 employee only/$5,000 family $5,000 employee only/$10,000 family The individual out-of-pocket maximum only includes covered expenses incurred by that individual. $6,550 individual/$13,100 family $13,100 individual/$26,200 family 20% 40% of allowed amount $1,200 individual/$3,600 family Not applicable. This plan does not cover outof-network services except for emergencies. $7,150 individual/$14,300 family Not applicable. This plan does not cover outof-network services except for emergencies. 20% Not applicable. This plan does not cover outof-network services except for emergencies. 20% after deductible $30 copay for primary $60 copay for specialist 20% after deductible Plan pays 100% (deductible waived) if performed at a Quest facility; participant pays 20% after deductible at other facility $1,000 individual/$3,000 family $2,000 individual/$6,000 family $7,150 individual/$14,300 family $14,300 individual/$28,600 family 20% 40% of allowed amount $30 copay for primary $50 copay for specialist Plan pays 100% Plan pays 100% Plan pays 100% $40 consultation fee (counts toward deductible and out-of-pocket maximum) Plan pays 100% Plan pays 100% Plan pays 100% (deductible waived) if performed at a Quest facility; participant pays 20% after deductible at other facility 20% after deductible $100 copay plus 20% after deductible $100 copay plus 20% after deductible 20% after deductible $150 copay per day plus 20% after deductible ($750 maximum copay per admission) 20% after deductible $200 copay plus 20% after deductible (copay waived if admitted) 20% after deductible $150 copay per visit plus 20% after deductible $5,000 copay (does apply to out-ofpocket maximum) plus 20% after deductible Not covered $150 copay per day plus 20% after deductible ($750 maximum copay per admission; $2,250 maximum copay per plan year) $200 copay plus 20% after deductible (copay waived if admitted) $150 copay per visit plus 20% after deductible $5,000 copay (does not apply to outof-pocket maximum) plus 20% after deductible 20% after deductible $60 copay for specialist $50 copay for specialist 20% after deductible $30 copay for primary $60 copay for specialist $30 copay for primary $50 copay for specialist Preventive Care Some examples of preventive care frequency and services: Routine physicals annually age 12 and over Well-child care unlimited up to age 12 Well woman exam & pap smear annually age 18 and over Mammograms 1 every year age 35 and over Colonoscopy 1 every 10 years age 50 and over Prostate cancer screening 1 per year age 50 and over Smoking cessation counseling 8 visits per 12 months Healthy diet/obesity counseling unlimited to age 22; age 22 and over 26 visits per 12 months Breastfeeding support 6 lactation counseling visits per 12 months Note: Covered services under this benefit must be billed by the provider as preventive care. Non-network preventive care is not paid at 100%. If you receive preventive services from a non-network provider, you will be responsible for any applicable deductible and coinsurance under the ActiveCare 1-HD and ActiveCare 2. There is no coverage for non-network services under the ActiveCare Select plan or ActiveCare Select Whole Health. For a complete listing of preventive care services, please view the Benefits Booklet at for the latest list of covered services. TRS-ActiveCare is administered by Aetna Life Insurance Company. Aetna provides claims payment services only and does not assume any financial risk or obligation with respect to claims. Prescription drug benefits are administered by Caremark.

5 TRS-ActiveCare Plan Highlights Prescription Coverage ActiveCare 1-HD ActiveCare Select or ActiveCare Select Whole Health (Baptist Health System and HealthTexas Medical Group; Baylor Scott & White Quality Alliance; Kelsey Select; Memorial Hermann Accountable Care Network; Seton Health Alliance) ActiveCare 2 Drug Deductible (per person, per plan year) Short-Term Supply at a Retail Location (up to a 31-day supply) Tier 1 Generic Tier 2 Preferred Brand Tier 3 Non-Preferred Brand Extended-Day Supply at Mail Order or Retail-Plus Pharmacy Location (60- to 90-day supply)**** Tier 1 Generic Tier 2 Preferred Brand Tier 3 Non-Preferred Brand Must meet plan-year deductible before plan pays.** 20% coinsurance after deductible, except for certain generic preventive drugs that are covered at 100%.** 20% coinsurance after deductible $0 generic; $200 brand $0 generic; $200 brand $20 for a 1- to 31-day supply $40 for a 1- to 31-day supply*** 50% coinsurance for a 1- to 31-day supply*** $45 for a 60- to 90-day supply $105 for a 60- to 90-day supply*** 50% coinsurance for a 60- to 90-day supply*** $20 for a 1- to 31-day supply $40 for a 1- to 31-day supply*** $65 for a 1- to 31-day supply*** $45 for a 60- to 90-day supply $105 for a 60- to 90-day supply*** $180 for a 60- to 90-day supply*** Specialty Medications 20% coinsurance after deductible 20% coinsurance per fill $200 per fill (up to 31-day supply) $450 per fill (32- to 90-day supply) Short-Term Supply of a Maintenance Medication at Retail Location (up to a 31-day supply) The second time a participant fills a short-term supply of a maintenance medication at a retail pharmacy, they will pay a convenience fee. They will be charged the coinsurance and copays in the row below the second time they fill a short-term supply of a maintenance medication. Participants can avoid paying the convenience fee by filling a larger day supply of a maintenance medication through mail order or at a Retail-Plus location. Tier 1 Generic Tier 2 Preferred Brand Tier 3 Non-Preferred Brand 20% coinsurance after deductible $35 for a 1- to 31-day supply $60 for a 1- to 31-day supply*** 50% coinsurance for a 1- to 31-day supply*** $35 for a 1- to 31-day supply $60 for a 1- to 31-day supply*** $90 for a 1- to 31-day supply*** What is a maintenance medication? Maintenance drugs are prescriptions commonly used to treat conditions that are considered chronic or long-term. These conditions usually require regular, daily use of medicines. Examples of maintenance drugs are those used to treat high blood pressure, heart disease, asthma and diabetes. When does the convenience fee apply? For example, if you are covered under TRS-ActiveCare Select, the first time you fill a 31-day supply of a generic maintenance drug at a retail pharmacy you will pay $20, then you will pay $35 each month that you fill a 31-day supply of that generic maintenance drug at a retail pharmacy. A 90-day supply of that same generic maintenance medication would cost $45, and you would save $225 over the year by filling a 90-day supply. Premium Information for ALEX You will need to enter the applicable amount YOUR ANNUAL COST from the table below into ALEX when prompted. To determine this cost, ask your Benefits Administrator for your monthly cost (this is the amount you will owe each month after your employer contributes to your coverage). Then multiply your monthly cost by 12 to get YOUR ANNUAL COST. TRS-ActiveCare Monthly Premium ActiveCare 1-HD ActiveCare Select/ ActiveCare Select Whole Health ActiveCare 2 Your Monthly Cost (amount you pay after employer contribution) Your Annual Cost (use this amount for ALEX) Individual $351 $514 $714 +Spouse $991 $1,264 $1,694 +Children $671 $834 $1,062 +Family $1,316 $1,589 $2,004 A specialist is any physician other than family practitioner, internist, OB/GYN or pediatrician. *Illustrates benefits when in-network providers are used. For some plans non-network benefits are also available; there is no coverage for non-network benefits under the ActiveCare Select or ActiveCare Select Whole Health Plan; see Enrollment Guide for more information. Non-contracting providers may bill for amounts exceeding the allowable amount for covered services. Participants will be responsible for this balance bill amount, which maybe considerable. **For ActiveCare 1-HD, certain generic preventive drugs are covered at 100%. Participants do not have to meet the deductible ($2,500 - individual, $5,000 - family) and they pay nothing out of pocket for these drugs. The list of drugs is on the TRS-ActiveCare website. ***If a participant obtains a brand-name drug when a generic equivalent is available, they are responsible for the generic copay plus the cost difference between the brand-name drug and the generic drug. ****Participants can fill 32-day to 90-day supply through mail order.

6 Monthly Medical Rates (includes $ monthly contribution from district) TRS ActiveCare 1-HD TRS ActiveCare Select TRS ActiveCare 2 Employee Only $35.00 $ $ Employee & Spouse $ $ $1, Employee & Child(ren) $ $ $ Employee & Family $1, $1, $1, Medical Pharmacy BancorpSouth Insurance Services, Inc. 6

7 BancorpSouth Insurance Services, Inc. 7

8 BancorpSouth Insurance Services, Inc. 8

9 BancorpSouth Insurance Services, Inc. 9

10 BancorpSouth Insurance Services, Inc. 10

11 Metlife Basic Life & AD&D Metlife Voluntary Life & AD&D Dependent children will have coverage until the end of the month which they reach 26 years of age. BancorpSouth Insurance Services, Inc. 11

12 Metlife Voluntary Life & AD&D Effective 9/1/2017, Metlife will grandfather current Voluntary Life & AD&D elections. Current employees (those currently enrolled and those who have previously waived coverage) have the option to elect or increase coverage equal to 2 benefit levels ($10,000 or $20,000 on Employee and $5,000 or $10,000 on Spouse) up to the guarantee issue without answering any medical questions. Employee may elect $10,000 on child(ren) guarantee issue. New hires are eligible, subject to maximum amounts, up to $250,000 guarantee issue on the Employee, $50,000 guarantee issue on the Spouse and $10,000 guarantee issue on the Child(ren) over 1 year of age. BancorpSouth Insurance Services, Inc. 12

13 Metlife Dental New hires electing within 31 days of eligibility: Employees who do not elect during their initial 31 day eligibility: MONTHLY RATE Employee Only $30.96 Employee + Spouse $71.64 Employee + Child(ren) $70.90 Employee + Family $ Dependent children will have coverage until the end of the month of which they reach 26 years of age. BancorpSouth Insurance Services, Inc. 13

14 Metlife Dental BancorpSouth Insurance Services, Inc. 14

15 Metlife Dental To find a provider: Click Find a Dental Provider Type in zip code Select PDP Plus BancorpSouth Insurance Services, Inc. 15

16 Metlife Vision To find a provider: index.html Click Find a Vision Provider Type in zip code Select Metlife Vision PPO (Metlife uses the VSP network) MONTHLY RATE Low Plan High Plan Employee Only $7.41 $9.13 Employee + 1 Dependent $10.70 $13.24 Employee + Family $19.17 $23.74 Dependent children will have coverage until the end of the month of which they reach 26 years of age. BancorpSouth Insurance Services, Inc. 16

17 Standard Disability Income BancorpSouth Insurance Services, Inc. 17

18 Standard Disability Income BancorpSouth Insurance Services, Inc. 18

19 (for annual earnings greater than $104,400 please see online summary) Standard Disability Income BancorpSouth Insurance Services, Inc. 19

20 Allstate Accident Insurance ** Includes Outpatient Physicians Treatment benefit ** which pays for up to 2 visits for Employee or 4 visits for Family per calendar year to any board certified physician. Easy claim process just keep a copy of your itemized receipt and file the claim to Allstate! Dependent children covered to age 26. BancorpSouth Insurance Services, Inc. 20

21 Allstate Cancer Insurance Includes annual Wellness benefit! Dependent children covered to age 26. Allstate does not pay benefits for a pre-existing condition during the 12 month period beginning on the date that the person s coverage starts. See plan summary for more information. A pre-ex condition is a disease/ condition in which symptoms existed within 12 month period prior to effective date. Providers Cancer benefit as well as a benefit for 29 other specified diseases. See detailed plan summary online! BancorpSouth Insurance Services, Inc. 21

22 Texas Life Permanent Life Insurance BancorpSouth Insurance Services, Inc. 22

23 Texas Life Permanent Life Insurance To CONTINUE Texas Life elections when using the online enrollment system, you will click Continue Elections within the Texas Life benefit screen. You can then continue with the enrollment by clicking on the next benefit link on the left side of the screen under Getting Started. To CANCEL Texas Life coverage, you must (1) Call Texas Life at AND (2) Maxine Symmank at Please note this is a two step process and in order to cancel properly you MUST do both. BancorpSouth Insurance Services, Inc. 23

24 Texas Life Permanent Life Insurance BancorpSouth Insurance Services, Inc. 24

25 Texas Life Permanent Life Insurance BancorpSouth Insurance Services, Inc. 25

26 TASC FlexSystem Flexible Spending Account (Healthcare Expenses) Nacogdoches ISD will contribute $53.00 per month to an FSA account for those employees that DECLINE the TRS/Aetna medical insurance. To receive, you MUST login and WAIVE/DECLINE on the Medical screen and WAIVE/DECLINE on the Medical Waiver screen. BancorpSouth Insurance Services, Inc. 26

27 TASC FlexSystem Flexible Spending Account (Healthcare Expenses) BancorpSouth Insurance Services, Inc. 27

28 TASC FlexSystem Flexible Spending Account (Healthcare Expenses) BancorpSouth Insurance Services, Inc. 28

29 TASC FlexSystem Flexible Spending Account (Healthcare Expenses) BancorpSouth Insurance Services, Inc. 29

30 TASC FlexSystem Flexible Spending Account (Healthcare Expenses) BancorpSouth Insurance Services, Inc. 30

31 TASC FlexSystem Flexible Spending Account (Dependent Care Expenses) BancorpSouth Insurance Services, Inc. 31

32 OMNI 403(b) & 457(b) Administration BancorpSouth Insurance Services, Inc. 32

33 BancorpSouth Insurance Services, Inc. 33

34 Carrier Contact Information Medical Insurance Provider Name: TRS Active Care Aetna Phone Number: Website: Pharmacy Provider Name: TRS Active Care / Caremark Phone Number: Website: Group Life & AD&D, Voluntary Life & AD&D Provider Name: Metlife Phone Number: Website: Dental Provider Name: Metlife Phone Number: Website: Vision Provider Name: Metlife Phone Number: Website: Disability Income Provider Name: Standard Phone Number: Website: Accident & Cancer Provider Name: Allstate Phone Number: Website: Permanent Life Insurance Provider Name: Texas Life Phone Number: Website: Health Care & Dependent Care Flexible Spending Accounts Provider Name: TASC Phone Number: Website: 403(b) & 457(b) Administration Provider Name: OMNI (USEBSG) Phone Number: Website: BancorpSouth Insurance Services, Inc. 34

35 Newly eligible employees must complete their online enrollment within 30 days. At other times during the year, you may request changes (additions, voluntary cancellations, etc) ONLY when there is a qualifying event or family status change, and the proposed change is consistent with the family status change event or during open enrollment of each year for a September 1st effective date. When a qualifying event or family status change occurs, you must contact Human Resources and complete any necessary enrollment forms within 30 days from the date of the event. Family status changes include: Change in legal marital status (e.g., marriage or divorce); Change in the number of dependents (e.g., birth, adoption or placement for adoption, death); Change in employment status or residency of the employee, spouse or dependent that affects Reminders Employees are responsible for notifying Human Resources if a dependent is no longer eligible for benefits. Failure to notify HR will affect COBRA availability and premium refunds. From time to time other coverage information and accident details may be requested by the carrier please respond promptly to expedite processing of claims. Deadline for enrollment is August 25, 2017! Questions & Answers What forms MUST be completed? Enrollment should be completed online by employee self-service or with a representative eliminating the need for paper enrollment forms. Should you miss the online enrollment period and still be within the 30 day enrollment period, you will need to contact Human Resources. Who do I contact with questions? Contact Maxine Symmank at , ext 8833 or Lacey Parmer with BancorpSouth Insurance at with any questions you may have. BancorpSouth Insurance Services, Inc. 35