Welcome to your 2019 Benefits Enrollment

Transcription

1 2019 Benefits Guide

2 Welcome to your 2019 Benefits Enrollment What s in the Guide? Enrollment Process....3 Mobile App..4 Login Instructions...5 Medical Flexible Spending Accounts....8 Dental Vision Voluntary Benefits Life Insurance Disability Identity Theft Protection We are honored to present your 2019 Benefit Options! The elections you make during your enrollment will become effective through December 31, Big Walnut Schools offers you and your eligible family members a comprehensive and valuable benefit program. We encourage you to take the time to educate yourself about your options and choose the best coverage for you and your family. LegalShield Important Contacts. 18 When can I Enroll? New hire initial enrollment and annual open enrollment allows for employees of the District to enroll or make changes in any of the plans without a qualifying event. In order to make changes outside of your enrollment period, there would need to be a qualifying event such as the birth or adoption of a child, change in marital status, death, or loss of coverage due to no fault of your own. An enrollment application must be submitted to the insurance carrier via the Treasurer s office within thirty-one (31) days of the qualifying event in order for coverage to be effective Big Walnut Schools

3 Enrollment Process Big Walnut Local Schools provides electronic enrollment through Explain My Benefits. Explain My Benefits provides eligible employees the ability to make group insurance benefit elections and changes online during the annual open enrollment, new hire orientation and qualifying events. Enrollment has never been easier. Accessible 24 hours a day, information about all of your employee benefits election options, including premiums and carrier contact information, are also available to help you make informed decisions. You can also log into the Explain My Benefits portal at anytime or download the Mobile App, to review your benefits, access carrier links, update your personal information for yourself and dependents, update your beneficiaries and process qualifying life events. How to Enroll Self-Service Visit click on the yellow Log into Your Benefit System button and move through the enrollment system at your own pace. Please see login instructions on page 5. Be sure to click submit at the end of the process and make note of your confirmation number. If you do not receive a confirmation number you have not completed your enrollment and you will not be enrolled in your benefits. Return to the system anytime and click your confirmation number to view your confirmation statement. Mobile App Log into the Explain My Benefits mobile app using the company code bwls, select enroll from the menu on the right. Go through the enrollment and finalize by clicking SUBMIT. Please see login instructions on page 5. Reminders When using any of the above options for enrollment: Be sure to review the 2019 Benefit Guide and plan summaries prior to going through any enrollment process Be prepared by gathering dependent and beneficiary information (i.e. Social Security Numbers and Dates of Birth) 2019 Big Walnut Schools 3

4 Mobile App 1. Visit the Apple or Android App Store 2. Search for: Explain My Benefits 3. Download the free app! 4. Enter company code: bwls Big Walnut Schools

5 Login Instructions 2019 Big Walnut Schools 5

6 Medical Comprehensive healthcare provides peace of mind. In case of an illness or injury, you and your family are covered with an excellent medical plan through Big Walnut Schools. Big Walnut Local Schools will have two PPO plans (depending on your union agreement) that allow you to select where you receive your medical services; however, if you use in-network providers, your out-of-pocket costs will be less. Deductible United Healthcare Low Plan This plan applies to OAPSE #524 and OAPSE #696 ONLY. In Network Out of Network Individual $200 $500 Family $400 $1,000 Coinsurance 10% 30% Out of Pocket Maximum Individual $800 $3,000 Family $1,600 $6,000 Doctor s Office Primary Care Office Visit / Virtual Visit $15 copay 30% after deductible Specialist Office Visit $25 copay 30% after deductible Preventive Care Services (routine exams, x-rays/tests, immunizations, well baby care and mammograms) $0 copay 30% after deductible Hospital Services Emergency Room $125 copay $125 copay Urgent Care Center Services $50 copay 30% after deductible Inpatient 10% after deductible 30% after deductible Outpatient Surgery 10% after deductible 30% after deductible Other Services Lab Testing $0 copay 30% after deductible X-ray and Major Diagnostic Testing $0 copay 30% after deductible Ambulance - Ground / Air 10% after deductible 10% after deductible Prescriptions Retail Generic Drug (30 day supply) $10 / $15 / $20 $10 / $15 / $20 Direct Mail (90 day supply) $20 / $30 / $40 N/A *Dependent children up to age 26 regardless of financial dependence, student status, residence or marital status. Dependents are automatically dropped from health insurance coverage at the end of the month in which the dependent turns Big Walnut Schools

7 Medical United Healthcare High Plan In Network Out of Network Deductible Individual $500 $500 Family $1,000 $1,000 Coinsurance 10% 30% Out of Pocket Maximum Individual $1,500 $3,000 Family $3,000 $6,000 Doctor s Office Primary Care Office Visit / Virtual Visit $25 copay 30% after deductible Specialist Office Visit $35 copay 30% after deductible Preventive Care Services (routine exams, x-rays/tests, immunizations, well baby care and mammograms) $0 copay 30% after deductible Hospital Services Emergency Room $200 copay $200 copay Urgent Care Center Services $75 copay 30% after deductible Inpatient 10% after deductible 30% after deductible Outpatient Surgery 10% after deductible 30% after deductible Other Services Lab Testing $0 copay 30% after deductible X-ray and Major Diagnostic Testing $0 copay 30% after deductible Ambulance - Ground / Air 10% after deductible 10% after deductible Prescriptions Retail Generic Drug (31 day supply) $10 / $20 / $50 $10 / $20 / $50 Direct Mail (90 day supply) $25 / $50 / $125 N/A *Dependent children up to age 26 regardless of financial dependence, student status, residence or marital status. Dependents are automatically dropped from health insurance coverage at the end of the month in which the dependent turns Big Walnut Schools 7

8 Flexible Spending Account FSAs help to fill coverage gaps between health plans and out-of-pocket expenses. An FSA allows you to pay for certain health and dependent care expenses with pre-tax dollars. You won t pay taxes on the funds you put into your FSA because they re deducted before taxes are calculated. The FSA is administered by Discovery Benefits. Health FSA This pays for out-of-pocket healthcare expenses incurred during the year Maximum Contribution: $2,650 annually Qualified healthcare expenses include: Co-pays / Deductibles Prescriptions Dental Care Vision Exams Eyeglasses Lasik Chiropractic Care Contact Lens & Supplies Note: Over-the-Counter (OTC) Medications Over-the-counter medications must be accompanied by a doctor s prescription and a reimbursement request to be covered under your FSA. This affects OTC medications only; all other medical supplies (band-aids, firstaid supplies, etc.) will still be eligible for reimbursement. Further guidance is expected from the IRS, and an updated list will be provided as soon as it becomes available. Dependent Care FSA This covers daycare expenses for children up to the age of 13, and for elder dependents (like aging parents) that live in your home. It also covers a spouse or dependent that is physically or mentally challenged for whom you claim an exemption. Maximum Contribution: $5,000 annually* Qualified dependent care expenses include: Babysitters Daycare Centers Elder Care Day Camps Preschool After-school Care *$5,000 per year if filing jointly or single head of household *$2,500 per year if filing separately Big Walnut Schools

9 Dental Good oral care enhances overall physical health, appearance and mental well-being. Problems with the teeth and gums are common and easily treated health problems. Keep your teeth healthy and your smile bright with the Big Walnut Local Schools dental benefit plan through Delta Dental. Plan PPO Dentist Delta Dental PPO Premier Dentist Non-Participating Dentist Calendar Year Deductible Individual / Family* $25 / $50 Annual Maximum $1,000 Preventative Services Exams, Cleanings, X-Rays, etc. Plan pays 100% Deductible is waived. Deductible Applies Basic Services Fillings, Oral Surgery, Root Canals, etc. 80% Covered 80% Covered 80% Covered Major Services Crowns, Bridges, Dentures, etc. 50% Covered 50% Covered 50% Covered Orthodontics Lifetime Annual Maximum $1,000 No Age Limit Deductible does not apply to Orthodontic services. 50% Covered Go to to locate a network provider. Please note that your out-of-pocket costs may be more if you choose to go to an out-of-network provider. Dependent children up to age 26 regardless of financial dependence, student status, residence or marital status. Dependents are automatically dropped from dental insurance coverage at the end of the month in which the dependent turns Big Walnut Schools 9

10 Vision Regular eye examinations cannot only determine your need for corrective eyewear, but also may detect general health problems in their earliest stages. An annual vision exam should be a part of our annual wellness routine. To find providers in the EyeMed network, please search under the Select Network. Description Comprehensive Eye Exam Once every 12 months Frames Once every 12 months Eyeglass Lenses In-Network $10 Copay $150 Allowance, 80% of charge over $150 EyeMed Vision Once every 12 months Out-of Network Up to $30 reimbursement Up to $75 Single Vision, Bifocal & Trifocal $10 Copay Up to $25 / $40 / $60 Standard Progressive $75 Up to $40 Premium Progressive Lens Options $75, 80% of charge less $120 Allowance Up to $40 Anti-Reflective Coating $45 N/A Scratch Resistant Coating $15 N/A Standard Polycarbonate (Kids under 19) $0 Up to $20 Contact Lenses (in lieu of glasses) Conventional (Elective) Disposable $150 allowance; 15% off retail over $150 $150 allowance; plus balance over $150 Once every 12 months Up to $120 Up to $120 Medically Necessary Paid in Full Up to $200 Contact Lens Exam (Standard) Up to $40 N/A Dependent children up to age 26 regardless of financial dependence, student status, residence or marital status. Dependents are automatically dropped from vision insurance coverage at the end of the month in which the dependent turns Big Walnut Schools

11 Voluntary Benefits What are Voluntary Benefits? Voluntary Benefits are offered to strengthen your overall benefits package. You customize the benefit based on need and affordability. Ownership Policies are fully portable and belong to you if you leave your employer, same price and same plan Benefits are payroll deducted Cash benefits are paid directly to you, not to a hospital or to a doctor Benefits are paid regardless of any other coverage you may have Level premiums Rates do not increase with age Guaranteed Renewable Designed to provide additional cash flow to assist with out of pocket medical costs and other bills The Voluntary Benefits offered through Transamerica are Accident, Cancer and Universal Life. Transamerica Accident The Accident Insurance helps pay for the unexpected expenses that can result from an accident. On and off-the-job coverage (24/7) Sports related injuries covered also Money is paid directly to you for (please see brochure for a complete list of benefits): Initial Doctor s Office Visit: $163 Fractures: up to $6,500 Hospitalization: $2,100 admission, $275 per day Dislocations: up to $5,200 A Wellness Benefit is included in your Accident Policy and Transamerica pays $100 for each insured. Each covered person will get one immunization or one screening test per calendar year. Examples of Health Screenings include: Low-dose Mammogram Serum Cholesterol Fasting blood glucose test Pap Smear Prostate Specific Antigen (PSA) Stress Test on a bicycle or treadmill Semi-Monthly Employee & Employee & Employee Family* Payroll Spouse Children* Deductions $14.92 $23.26 $18.66 $27.64 *Dependents up to age 26 can be covered regardless of student status Big Walnut Schools 11

12 Voluntary Benefits Transamerica Cancer Plan The Cancer Plan will pay benefits to you if you are diagnosed with cancer. This plan pays you directly. Some benefits pay by the day or treatment, while others reimburse you for expenses you incur. Either way, it can be a source of financial support just when you and your family need it most! Just a few examples of benefits included in the plan: Initial Diagnosis - $3,000 Hospital Confinement - $200 per day Surgery - up to $3,000 (Inpatient), up to $4,500 (Outpatient) Radiation & Chemotherapy - $10,000 per 12 month period Bone Marrow and/or Stem Cell - $10,000 per 12 month period An Annual Cancer Screening Benefit is included in your policy and Transamerica pays $100 for each insured. Each covered person will get one cancer screening test per calendar year. Examples of Cancer Screenings: Mammogram Pap Smear Chest X-ray Prostate-Specific Antigen Test (PSA) Bone Marrow Testing Semi- Employee & Employee & Monthly Employee Spouse Children* Family* Payroll Deductions $12.27 $22.20 $14.02 $ Big Walnut Schools

13 Voluntary Benefits Transamerica Universal Life with Long Term Care Universal Life with Long Term Care includes both a death benefit and a living benefit. Universal Life with Long Term Care is a permanent life insurance that is designed to match your needs throughout your lifetime. The Universal Life with Long Term Care is priced to remain the same cost to you until age 100. The Living Benefit, Long Term Care is 4% of the death benefit per month for up to 25 months if confined in a nursing or assisted living facility or 2% of the death benefit per month for up to 50 months if receiving home health care or day care. Monthly premiums are waived while using the Long Term Care benefits. If you use the Long Term Care benefit, your death benefit amount does reduce. Coverage available for spouse and children as well. Special Underwriting for Initial Offereing Guaranteed Issue Up to $100,000 employee / up to $15,000 spouse / $25,000 children Rates This benefit is customized by each employee so rates vary, but can start as little as a few dollars a week. Your specific rate will be calculated for you in the electronic enrollment system. Basic Life and AD&D The amount of life insurance that is right for you depends on a variety of factors, including your age, family status, personal savings, financial commitments, etc. Big Walnut Local Schools offers a variety of programs to meet your life insurance needs. Big Walnut Schools provides a basic life and accidental death and dismemberment (AD&D) insurance coverage to all benefit eligible employees at no cost to the employee based on your contract through Dearborn National. You can also purchase Supplemental Life insurance for you and your dependents through Dearborn National. Please see page 14 for details Big Walnut Schools 13

14 Supplemental Life and AD&D Employee & Spouse Voluntary Term Life & AD&D You also have the opportunity to purchase supplemental coverage for yourself, spouse and dependents. Please note that dependent children include unmarried adopted, natural or stepchildren age 15 days to age 26, if unmarried, supported by you, and/or a full-time student. How much can I get? Employee: You may purchase in $10,000 increments up to 5x your base salary to a maximum of $500,000. Spouse: You may purchase for your spouse no more than 50% of your elected amount in $5,000 increments up to $100,000. Child(ren): You may purchase for your children up to $10,000 in $1,000 increments for children up to 26 years. Please note there is no death benefit for children ages birth to 14 days and a benefit of $100, 15 days to 6 months. Guarantee Issue for New Hires Only Employee - $100,000 Spouse - $25,000 Child(ren) - $10,000 Age Band Rate per $1,000 AgeBank Rate Per $1,000 <30 $ $ $ $ $ $ $ $ $ $2.167 Child Life & AD&D Monthly Rates $1,000 $0.291 $6,000 $1.746 $2,000 $0.582 $7,000 $2.037 $3,000 $0.873 $8,000 $2.328 $4,000 $1.164 $9,000 $2.619 $5,000 $1.455 $10,000 $2.910 Example: A 36 year old female wants to purchase $50,000 of term life insurance..107 X 50 = $5.35 Rate per $1,000 # of units/$1,000 Monthly Premium Your specific rate will be calculated for you in the electronic enrollment system. If coverage was not applied for at initial eligibility (or if an increase in coverage is requested at a later date) Evidence of Insurability must be provided, including health questions for any insured Big Walnut Schools

15 Short Term Disability As an employee of Big Walnut Local Schools, you are able to enroll in Short Term Disability (STD) coverage through Transamerica. STD coverage supplements your lost wages should you be unable to work due to an illness, injury or pregnancy. STD coverage begins after missing the specific elimination period below due to a medically certified reason. Benefits are payable up to the specific benefit duration period below. There are two elimination period and benefit period options available to you: Option 1 Elimination Period for sickness, accident or pregnancy: Maximum Benefit Period: Option 2 Elimination Period for sickness, accident or pregnancy: Maximum Benefit Period: 7 Days 26 Weeks 7 Days 24 Months Weekly Benefit: The lesser of 60% of your monthly earnings to a maximum benefit of $3,000 Pre-Existing Condition: Anything you received medical treatment, advice or consultation, care or services including diagnostic measures, or had drugs or medicine prescribed or taken in the 12 months prior to your insurance effective date will not be covered for the first 12 months of the policy. Rates: Your specific rate will be calculated for you in the electronic enrollment system Big Walnut Schools 15

16 Identity Theft Protection Identity theft in the United States is a major problem that continues to be on the rise. Professional protection and assistance have become important tools in fighting the identity theft epidemic. Thieves today can get a hold of your personal information from trash cans, dumpsters, stolen mail, and even shoulder surfing. Once thieves have your information, it s a simple matter to open new fraudulent accounts and make purchases in your name. When you enroll in LifeLock, you can be confident knowing that they are available 24 hours a day, 7 days a week, and committed 100% to helping protect your information as if it were their own. LifeLock offers Proactive Protection: LifeLock Identity Theft Alert System Lost Wallet Protection Address Change Verification Black Market Website Surveillance Live Member Service Support LifeLock Privacy Monitor Reduce Pre-Approved Credit Card Offers Identity Restoration Support Stolen Funds Replacement - up to $100,000 Fictitious Identity Monitoring Court Records Scanning Data Breach Notifications Investment Account Activity Alerts $1 Million Total Service Guarantee LifeLock s proactive approach works to help stop identity theft before it happens. As a LifeLock member, if you become a victim of identity theft because of a failure in their service, they will help fix it at their expense, up to $1,000,000. Semi-Monthly Payroll Deductions Employee Employee & Spouse Employee & Children* Family* $4.25 $8.50 $7.44 $11.69 *Employee & Children and Family Tiers: You may enroll up to 8 children with 4 of those children between the ages of 18 and Big Walnut Schools

17 LegalShield Everyone deserves legal protection. At LegalShield, we ve been offering legal plans to our members for over 40 years, creating a world where everyone can access legal protection - and everyone can afford it. Unexpected legal questions arise every day and with LegalShield on your side, you ll have access to a quality law firm 24/7, for covered personal situations. From real estate to speeding tickets to Will preparation, and beyond, we re here to help you with any personal legal matter - no matter how traumatic or how trivial it may seem. Because our dedicated law firms are prepaid, their sole focus is on serving you, rather than billing you. Our Promise to You As one of the first companies in North America to provide legal expense plans to consumers, we now provide legal services to over 1.4 million families across the U.S. and Canada - representing approximately 4 million people. An with over 650 employees dedicated to serving you, our promise remains the same: to provide outstanding legal services by quality law firms at an affordable price. Expected and unexpected legal issues arise every day. But with a LegalShield Plan, you get access to advise and counsel on an unlimited number of personal legal issues from lawyers with an average of 19 years experience. Advice & Consultation - Advice, Letters and Phone Calls on Your Behalf, Contract & Document Review, 24/7 Emergency Assistance Family Matters (family plan only) - Uncontested Name Change Assistance, Uncontested Adoption Representation, Uncontested Separation/Divorce Representation Representation - Trial Defense Services Document Preparation - Standard Will Preparation, Residential Loan Document Assistance (family plan only) Auto Motor Vehicle Services IRS IRS Audit Legal Services Semi-Monthly Individual Family Payroll Deductions $8.48 $ Big Walnut Schools 17

18 Important Contacts Vendor Phone Number Website Medical United Healthcare Dental Delta Dental Vision Eyemed Voluntary Benefits Transamerica Basic Life & Supplemental Life Dearborn National Identity Theft Protection LifeLock Legal LegalShield Flexible Spending Accounts Discovery Benefits District Insurance Brokers Arthur J. Gallagher & Company Transamerica Benefits Claims Help Explain My Benefits , Option 3 service@explainmybenefits.biz Big Walnut Schools

19 Benefit Guide Description Please Note: This guide provides information regarding the Big Walnut Local Schools benefit program. More detailed information is available from the plan documents and administrative contacts. The plans and policies stated in this information are not a contract or a promise of benefits of any kind, and therefore, should not be interpreted as such.