Benefits Guide

Transcription

1 Benefits Guide Improving Our Wellness Together

2 Welcome to your 2017/2018 Benefits Open Enrollment We are honored to present your Benefit Options! The elections you make during open enrollment will be effective October 1, 2017 through September 30, Rocky River City Schools offers you and your eligible family members a comprehensive and valuable benefits program. We encourage you to take the time to educate yourself about your options and choose the best coverage for you and your family. What s New for 2017/2018 A new Rocky River City Schools Mobile App to access enrollment, benefit info, etc. TradeCheck Business Expense Account will be offered Short and Long Term Disability and Voluntary Term Life Insurance will be moving to One America. A new Ultimate Plan option will be available for the LifeLock Identity Theft Protection. What s in this guide? Open Enrollment Process....3 Mobile App.4 Medical & Prescription Drug Coverage 5-6 Glossary of Medical Terms 7-9 Flexible Spending Account...10 TradeCheck Account.11 Dental..12 Vision Voluntary Benefits Life Insurance Disability Identity Theft Protection 20 Important Contacts When can I Enroll? 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 the annual open enrollment period, there would need to be a qualifying event such as the birth 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. 2

3 Rocky River City Schools Benefits Guide Open Enrollment Process The benefits you elect during Open Enrollment will be effective October 1, Open Enrollment is the one time per year that you can make changes to your benefits without a qualifying life event. Open Enrollment will be held from Monday, August 28th through Sunday, September 10th All benefit eligible employees MUST complete an enrollment in order to have coverage in the new plan year effective October 1st. We have again partnered with Explain My Benefits, our benefit technology/communication vendor to assist in our Open Enrollment. This year we will have a self-service online enrollment using the EMB Enroll online system. How to Enroll Decide which of these two convenient enrollment options best fits your needs: Self-Service - available August 28 - September 10 Visit click on the red Log into Your Benefit System button and move through the enrollment system at your own pace. Review the posted benefit guide and plan summaries to help you with your benefit decisions. If choosing this option, be sure to click submit at the end of the process and make note of your confirmation number. Return to the system anytime and click your confirmation number to view your confirmation statement. Meet with a Benefits Counselor - onsite September 5 - September 8 Explain My Benefits will be on-site to assist with any questions you may have an help you enroll in your benefits. See Benefit Portal for location information. Reminders When using any of the above options for enrollment: Be sure to review the 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) 3

4 4 Mobile App

5 Medical & Prescription Drug Rocky River City Schools Benefits Guide Medical Mutual of Ohio is the medical insurance provider and Express Scripts is the prescription drug coverage provider for the Rocky River City Schools through the Suburban Health Consortium. 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 Rocky River City Schools. The PPO plan allows 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 In Network Medical Mutual PPO Out of Network Individual $400 $800 Family* $800 $1,600 Coinsurance 10% 30% Out of Pocket Maximum includes deductible + coinsurance Individual $1,775 $2,750 Family $2,750 $5,500 Doctor s Office Primary Care Visit $25 copay $25 copay Specialist Visit $25 copay $25 copay Preventive care/screening/immunization No Charge 30% after deductible Laboratory Services Diagnostic X-ray 10% after deductible 30% after deductible Diagnostic Blood Work 10% after deductible 30% after deductible Imaging (CT/PET scans, MRIs) 10% after deductible 30% after deductible Outpatient Services Facility Fee (e.g. ambulatory surgery center) 10% after deductible 30% after deductible Physician/Surgeon Fees (Outpatient) 10% after deductible 30% after deductible Emergency Services Emergency Room Services $100 copay $100 copay Emergency Medical Transportation 10% after deductible 30% after deductible Urgent Care $25 copay $25 copay Inpatient Hospital Services Facility Fee (e.g. hospital room) 10% after deductible 30% after deductible Physician/Surgeon Fee (Inpatient) 10% after deductible 30% after deductible 5

6 Medical & Prescription Drug Mental Health/Behavioral Health/Substance Abuse Services Mental/Behavioral Health Outpatient Services Mental/Behavioral Health Inpatient Services Substance Use Disorder Outpatient (Alcoholism) Substance Use Disorder Outpatient (Drug Use) Substance Use Disorder Inpatient (Alcoholism) Substance Use Disorder Inpatient (Drug Use) Maternity Services In Network Medical Mutual PPO (Continued) Out of Network Benefits paid based on corresponding medical benefits Benefits paid based on corresponding medical benefits Benefits paid based on corresponding medical benefits Benefits paid based on corresponding medical benefits Benefits paid based on corresponding medical benefits Benefits paid based on corresponding medical benefits Prenatal and Postnatal Care (Office Visits) No Charge 30% after deductible Delivery and all Inpatient Services 10% after deductible 30% after deductible Home Health/Rehabilitation Services Home Health Care 10% after deductible 30% after deductible Rehabilitation Services (Physical Therapy) 10% after deductible 30% after deductible Habilitation Services (Occupational Therapy) 10% after deductible 30% after deductible Habilitation Services (Speech Therapy) (10 visits, then Medical Review - Professional; Unlimited - Institutional) 10% after deductible 30% after deductible Skilled Nursing Care 10% after deductible 30% after deductible Durable Medical Equipment (Includes Wigs, which are limited to 1 per benefit period, when hair loss is due to chemotherapy or radiation) 10% after deductible 30% after deductible Hospice Services 10% after deductible 30% after deductible Dental or Eye Care for Children Eye Exam (Child) No Charge 30% after deductible Glasses Dental Check-up (Child) Prescription Not Covered Not Covered Generic Drugs Preferred Brand Drugs $15 copay - retail (30 days) $15 copay - mail order (90 days) $30 copay - retail (30 days) $30 copay - mail order (90 days) $15 copay - retail (30 days) Not covered - mail order $30 copay - retail (30 days) Not covered - mail order Non-preferred Brand Drugs $45 copay - retail (30 days) $45 copay - retail (35 days) Specialty Drugs Same as Retail Copays Same as Retail Copays 6 *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 26.

7 Glossary of Medical Terms Rocky River City Schools Benefits Guide Allowed Amount: The maximum payment the plan will pay for a covered health care service. May also be called eligible expense, payment allowance, or negotiated rate. Appeal: A request that your health insurer or plan review a decision that denies a benefit or payment (either in whole or in part. Balance Billing: When a provider bills you for the balance remaining on the bill that your plan doesn t cover. This amount is the difference between the actual billed amount and the allowed amount. Claim: A request for a benefit (including reimbursement of a health care expense) made by your or your health care provider to your health insurer or plan for items or services you think are covered. Coinsurance: Your share of the costs of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service. You generally pay coinsurance plus any deductibles you owe. Complications of Pregnancy: Conditions due to pregnancy, labor, and delivery that require medical care to prevent serious harm to the health of the mother or the fetus. Morning sickness and a nonemergency caesarean section generally are not complications of pregnancy. Copayment: A fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by type of covered health care service. Cost Sharing: Your share of costs for services that a plan covers that you must pay out of your own pocket (sometimes called out-of-pocket costs ). Some examples are copayments, deductibles and coinsurance. Cost-sharing Reductions: Discounts that reduce the amount you pay for certain services covered by an individual plan you buy through the Marketplace. Deductible: An amount you could owe during a coverage period (usually one year) for covered health care services before your plan begins to pay. An overall deductible applies to all or almost all covered items and services. A plan with an overall deductible may also have separate deductibles that apply to specific services or groups of services. A play may also have only separate deductibles. Diagnostic Test: Tests to figure out what your health problem is. For example, an x- ray can be a diagnostic test to see if you have a broken bone. Durable Medical Equipment (DME): Equipment and supplies ordered by a health care provider for everyday or extended use. DME may include: oxygen equipment, wheelchairs and crutches. Emergency Medical Transportation: Ambulance services for an emergency medical condition. Types of emergency medical transportation may include transport by air, land or sea. Your plan may not cover all types of emergency medical transportation or may pay less for certain types. Emergency Room/Emergency Services: Services to check for an emergency medical condition and treat you to keep an emergency medical condition from getting worse. These services may be provided in a licensed hospital s emergency room or other place that provides care for emergency medical conditions. Excluded Services: Health care services that your plan does not pay for or cover. Formulary: A list of drugs your plan covers. A formulary may include how much your share of the cost is for each drug. Your plan may put drugs in different cost sharing levels or tiers. Grievance: A complaint that you communicate to your health insurer or plan. Habilitation Services: Health care services that help a person keep, learn or improve skills and functioning for daily living. The services may include physical and occupational therapy, speech-language pathology, and other services for people with disabilities in a variety of inpatient and/or outpatient settings. Health Insurance: A contract that requires a health insurer to pay some or all of your health care costs in exchange for a premium. A health insurance contract may also be called a policy or plan. Home Health Care: Health care services and supplies you get in your home under your doctor s orders. Services may be provided by nurses, therapists, social workers, or other licensed health care providers. Home health care usually does not include help with non-medical tasks, such as cooking, cleaning or driving. Hospice Services: Services to provide comfort and support for persons in the last stages of a terminal illness and their families. Hospitalization: Care in a hospital that requires admission as an inpatient and usually requires an overnight stay. Some plans may consider an overnight stay for observation as outpatient care instead of inpatient care. Hospital Outpatient Care: Care in a hospital that usually does not require an overnight stay. 7

8 Glossary of Medical Terms Individual Responsibility Requirement: Sometimes called the individual mandate, the duty you may have to be enrolled in health coverage that provides minimum essential coverage. In-network Coinsurance: Your share (for example, 20%) of the allowed amount for covered healthcare services. Your share is usually lower for in-network covered services. Marketplace: A marketplace for health insurance where individuals, families and small businesses can learn about their plan options; compare plans based on costs, benefits and other important features; apply for and received financial help with premiums and cost sharing based on income; and choose a plan and enroll in coverage. Also known as an Exchange. Maximum Out-of-Pocket Limit: Yearly amount the federal government sets as the most each individual or family can be required to pay in cost sharing during the plan year for covered, in-network services. Applies to most types of health plans and insurance. This amount may be higher than the out-of-pocket limits stated for your plan. Medically Necessary: Health care services or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease, or its symptoms, including habilitation, and that meet accepted standards of medicine. Minimum Essential Coverage: Health coverage that will meet the individual responsibility requirement. Minimum essential coverage generally includes plans, health insurance available through the Marketplace or other individual market policies, Medicare, Medicaid, CHIP, TRICARE, and certain other coverage. Minimum Value Standard: A basic standard to measure the percent of permitted costs the plan covers. Network: The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services. Network Provider (Preferred Provider): A provider who has a contract with your health insurer or plan who has agreed to provide services to members of a plan. You will pay less if you see a provider in the network. Also called participating provider. Orthotics and Prosthetics: Leg, arm, back and neck braces, artificial legs, arms and eyes, and external breast prostheses after a mastectomy. These services include: adjustment, repairs and replacements required because of breakage, wear, loss, or a change in the patient s physical condition. Out-of-Network Coinsurance: Your share (for example, 40%) of the allowed amount for covered health care services to providers who don t contract with your health insurance or plan. Out-of-network coinsurance usually costs you more than in-network coinsurance. Out-of-Network Copayment: A fixed amount (for example, $30) you pay for covered health care services from providers who do not contract with your health insurance or plan. Out-of-network copayments usually are more than innetwork copayments. Out-of-Network Provider (Non-Preferred Provider): A provider who doesn t have a contract with your plan to provide services. If your plan covers out-ofnetwork services, you will usually pay more to see an out-of-network provider than a preferred provider. Your policy will explain what those costs may be. May also be called non-participating instead of out-of-network provider. Out-of-Pocket Limit: The most you could pay during a coverage period (usually one year) for your share of the costs of covered services. After you meet this limit the plan will usually pay 100% of the allowed amount. This limit helps you plan for health care costs. This limit never includes your premium, balanced billed charges or health care your plan doesn t cover. Some plans don t count all of our copayments, deductible, coinsurance payments, out-of-network payments, or other expenses toward this limit. Physician Services: Health care services a licensed medical physician, including an M.D. or D.O., provides or coordinates. Plan: Health coverage issued to you directly (individual plan) or through an employer, union or other group sponsor that provides coverage for certain health care costs. Preauthorization: A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment (DME) is medically necessary. Sometimes called prior authorization, prior approval or precertification. Your health insurance or plan may require preauthorization for certain services before your receive the, except in an emergency. Preauthorization isn t a promise that your health insurance or plan will cover the cost. 8

9 Glossary of Medical Terms Rocky River City Schools Benefits Guide Premium: The amount that must be paid for your health insurance or plan. You and/or your employer usually pay it monthly, quarterly or yearly. Premium Tax Credits: Financial help that lowers your taxes to help you and your family pay for private health insurance. You can get this help if you get health insurance through the Marketplace and your income is below a certain level. Prescription Drug Coverage: Coverage under a plan that helps pay for prescription drugs. Prescription Drugs: Drugs and medications that by law require a prescription. Preventive Care (Preventive Service): Routine health care, including screenings, check-ups and patient counseling, to prevent or discover illness, disease, or other health problems. Primary Care Physician: A physician, including an M.D. or D.O., who provides or coordinates a range of health care services for you. Primary Care Provider: A physician, including an M.D. or D.O., nurse practitioner, clinical nurse specialist, or physician assistant, as allowed under state law and terms of the plan, who provides, coordinates, or helps you access a range of health care services. Provider: An individual or facility that provides health care services. The plan may require the provider to be licensed, certified or accredited as required by law. Reconstructive Surgery: Surgery and follow-up treatment needed to correct or improve a part of the body because of birth defects, accidents, injuries or medical conditions. Referral: A written order from your primary care provider for you to see a specialist or get certain health care services. In many HMOs, you need to get a referral before you can get health care services from anyone except your primary care provider. If you don t get a referral first, the plan may not pay for the services. Rehabilitation Services: Health care services that help a person keep, get back, or improve skills and functioning for daily living that have been lost or impaired because a person was sick, hurt, or disabled. These services may include physical and occupational therapy, speech-language pathology, and psychiatric rehabilitation services in a variety of inpatient and/or outpatient settings. Screening: A type of preventive care that includes tests or exams to detect the presence of something, usually performed when you have no symptoms, signs, or prevailing medical history of a disease or condition. Skilled Nursing Care: Services performed or supervised by licensed nurses in your home or in a nursing home. Skilled nursing care is not the same as skilled care services, which are services performed by therapists or technicians (rather than licensed nurses) in your home or in a nursing home. Specialist: A provider focusing on a specific area of medicine or a group of patients to diagnose, manage, prevent, or treat certain types of symptoms and conditions. Specialty Drug: A type of prescription drug that, in general, requires special handling or ongoing monitoring and assessment by a health care professional, or is relatively difficult to dispense. Generally, specialty drugs are the most expensive drugs on a formulary. UCR (Usual, Customary and Reasonable): The amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service. The UCR amount sometimes is used to determine the allowed amount. Urgent Care: Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care. 9

10 Flexible Spending Account The district offers Flexible Spending Accounts (FSA) for both medical and dependent care through American Benefits Group. You may elect to participate in either FSA or both. If you have predictable medical expenses for yourself or your family, such as deductibles and copays, or any work-related day care expenses, FSAs may be right for you. FSAs allow you to set aside money for reimbursement of healthcare and day care expenses you regularly pay. The amount you set aside is not taxed and is automatically deducted from your paycheck and deposited into the FSA. During the year, you have access to this account for reimbursement of some expenses that are not covered by insurance. An FSA not only results in a substantial tax savings, it also increases your spending power. There are two types of FSAs: Medical Flexible Spending Account This money will not be taxable income to you and can be used to offset the cost of a wide variety of eligible medical expenses that generate out-of-pocket costs for your or your qualified dependents. Employees can also receive reimbursement for expenses related to dental and vision care (that are not classified as cosmetic). Note: The entire Health Care FSA election is available to you on the first day coverage is effective. Maximum contributions to a Medical FSA is $2,600 per plan year A sample list of qualified expenses eligible for reimbursement include, but are not limited to: Ambulance Service Chiropractic Care Dental fees/orthodontic fees Diagnostic Tests/Health Screenings Doctors Fees Drug Addiction/Alcoholism Treatment Experimental Medical Treatment Eyeglasses/Contact Lenses Hearing Aids and Exams Injections & Vaccinations Lasik Surgery Mental Healthcare Nursing Services Optometrist Fees Physician Office Visits Prescription Drugs Sunscreen Wheelchairs Dependent Care FSA This account allows you to set aside up to an annual maximum of $5,000 if you are a single or married and file a joint tax return ($2,500 if you are married and file a separate tax return) for work-related day care expenses. Qualified expenses include adult and child day care centers, preschool, and before/after school care for eligible children and adults. Please note that if your family s annual income is over $20,000, this reimbursement option will most likely save you more than the dependent care tax credit you take on your tax return. To qualify, your dependent must be: A child under the age of 13, or A child, spouse or other dependent that is physically or mentally incapable of self-care and spends at least 8 hours a day in your household. Note: Unlike the Healthcare FSA, you will only be reimbursed up to the amount that has been deducted from your paycheck for Dependent Care expenses. 10

11 TradeCheck Account Rocky River City Schools Benefits Guide The IRS allows employers to establish a reimbursement program for employees who incur out-of-pocket business expenses allowing the employee to use this money tax-free to pay for qualified business expenses. We will reduce your gross pay by your projected qualified business expenses for the plan year and put the money aside to give you a tax-free reimbursement for their qualified expenses. During the plan year, we will make available the funds converted to tax-fee funds from gross wages, every pay period towards those expected tax-free reimbursement. Once the projected reimbursement amount has been established it cannot be changed in any manner during the plan year. The tax-free funds cannot be converted to wages once established. All business expenses must be submitted within 60 days of purchase, except when the plan year ends, then all submissions must occur by December 10, On a pay period basis, you are advanced the money tax-free that has been put aside to allow you to have the money up front to assist in paying for your out-of-pocket expenses. If reimbursement submission(s) exceed pay period contributions made by you to date, per pay period advance amounts will not be altered in any manner. Should you cease to be employed by Rocky River City Schools within 2 months of receiving any such reimbursement, you must repay all reimbursements (less consumables, union dues, cell phone usage to date, subscriptions to date, and so forth) made during the last 2 months of employment. By December 10, 2018, any tax-free advances left over in your account that were not submitted and substantiated by you, will be added as taxable on your next paycheck. Example Semi-Monthly Paycheck Comparison Current TradeCheck Gross Pay $3, $3, Section 125 Health Insurance $ $ Section 132d Business Expenses $ 0.00 $ * Pension $ $ Taxable Income $2, $2, Payroll Taxes, Fed, State, Med $ $ Take Home Pay $2, $1, Tax-Free Reimbursement Advance $ 0.00 $ Administration Fee $ 0.00 $ 3.50 Adjusted Take Home Pay $2, $2, Increased Semi-Monthly Take Home $

12 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 Rocky River City Schools dental benefit plan. Coverage Type Low Plan High Plan Deductible (Individual/Family) Applies to Type B & C Services Only Annual Maximum Benefits (per individual) Type A - Preventive (Cleanings, exams, fluorides, x-rays, sealants and space maintainers) Type B - Basic Restorative (Amalgam & composite fillings, simple extractions, root canals, oral surgery, anesthesia, palliative treatment and periodontics) Type C - Major Restorative (Bridges, crowns, implants, crown repairs and dentures) Orthodontia Lifetime Maximum (per individual) Child Only up to Age 19 Insured Responsibility $25 / $50 $25 / $50 $1,750 $1, % 100% 80% 80% 70% 70% 60% (Lifetime max. $1500) Deductible; and any provider balance billing in excess of the 40th percentile UCR for out-of-network providers 60% (Lifetime max. $1500) Deductible; and any provider balance billing in excess of the 90th percentile UCR for out-of-network providers FYI To locate a network PPO provider, go to Your out-of-pocket costs may be more if you choose an out-of-network provider. 12 *Dependents ages up to age 26. Coverage terminates on the date the child turns 26.

13 Vision Rocky River City Schools Benefits Guide Regular eye examinations cannot only determine your need for corrective eyewear, but also may detect general health problems in their earliest stages. Protection for your eyes should be a major concern to everyone. Go to to locate a network provider. Description In-Network Out-of-Network Comprehensive Eye Exam Once every 12 months $10 co-pay Up to $40 reimbursement Eyeglass Lenses Once Every 12 Months Once Every 12 Months Single Vision, Lined Bifocal and Trifocal $10 co-pay Up to $40 - $80 reimbursement Lenticular $10 co-pay Up to $80 reimbursement Standard Progressive $80 co-pay Up to $60 reimbursement Premium Progressive $120 - $260 co-pay N/A Eyeglass Frames Once Every 24 Months Once Every 24 Months $130 allowance Up to $45 reimbursement Contact Lenses (in lieu of glasses) Once Every 12 Months Once Every 12 Months Necessary Contact Lenses Non-Selection Disposable Contact Lenses Selection Disposable Contact Lenses Selection Planned Replacement Monthly Wear Contact Lenses $10 co-pay $105 allowance $10 for Boxes 1-4 $10 for Boxes 1-2 Up to $210 reimbursement Up to $105 reimbursement N/A N/A Dependents ages 26 and under can be covered with no requirements. Coverage terminates for dependents at the end of the month in which they turn

14 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 are being offered through Trustmark. Accident Plan A plan that helps pay for the unexpected expenses that result from an accident On and off the job coverage = 24 hours per day, 7 days a week Family coverage available Sports related injuries covered as well Just a few examples of benefit included in the plan: Emergency Room Visits - $200 Hospitalization - $2,000 admission benefit, $400 per day benefit Fractures - up to $10,000 Dislocations - up to $8,000 Health Screening Benefit - $100 per insured per year See brochure for a complete list of benefits Semi Monthly Payroll Deductions Employee Employee & Spouse Employee & Children* Family* $9.53 $14.54 $17.68 $22.69 *Dependents up to age 26 can be covered regardless of student status. 14

15 Critical Illness/Cancer Rocky River City Schools Benefits Guide Critical Illness/Cancer is a benefit that will pay you a lump sum of money if you are diagnosed with a critical illness, heart attack, internal cancer or stroke. The cash benefit is provided upon the first diagnosis of a covered condition to help you with associated costs and beyond. Special Underwriting for Initial Offering ONLY Guaranteed Issue: $20,000 employee / $10,000 spouse / $2,000 children If you waived this benefit previously, you must answer a few health questions and be approved for coverage. Regardless of other coverage in force, the benefit is paid out in a full lump sum. Examples of covered conditions: Invasive Cancer, Heart Attack, Stroke, Renal (Kidney Failure), Blindness, ALS (Lou Gehrig s Disease), Major Organ Transplant, Paralysis of Two or More Limbs, Coronary Artery Bypass Surgery (25% benefit), Carcinoma In Situ (25% benefit) A Health Screening Benefit is included in your Critical Illness/Cancer Policy and Trustmark pays up to $100 for each insured. Each covered person will get one immunization or one screening test per calendar year. Examples of health screenings: Low dose mammography Stress test Serum Cholesterol Bone Marrow Pap Smear Colonoscopy Prostate specific antigen Chest X-ray Also included is a Subsequent Benefit that provides a cash payment for each of the covered conditions in the event the covered person is diagnosed with multiple different covered conditions or illnesses. Each subsequent diagnosed condition is paid at 100% of the original benefit with a 90 day separation period. Rates This benefit is customized by each employee so rates vary, but can start as little as a few dollars a week. See brochure for more details. Your specific rate will be calculated for you in the electronic enrollment system. 15

16 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. Rocky River City Schools offers a variety of programs to meet your life insurance needs. Rocky River City Schools provides a basic life and accidental death and dismemberment (AD&D) insurance coverage, through CoreSource, to all benefit eligible employees at no cost to the employee based on your contract. Universal Life with Long Term Care Trustmark Universal Life with Long Term Care includes both a death benefit and a living benefit. Trustmark Universal Life with Long Term Care is a permanent life insurance that is designed to match your needs throughout your lifetime. It pays a higher death benefit during your working years when expenses are high and you need maximum protection. The Universal Life with Long Term Care is priced to remain the same cost to you until age 100. The death benefit reduces at age 70 when the need for life insurance typically decreases. The Living Benefit, Long Term Care never reduces and is 4% of the original death benefit per month for up to 25 months. If you use the Long Term Care benefit, your death benefit amount does not reduce due to the Benefit Restoration feature included. Coverage available for spouse and children as well. Rates Special Underwriting for Initial Offering Guaranteed Issue (Employee Only) The lesser of the face amount purchased by $16 per week or $200,000 If you waived this benefit previously, you must answer a few health questions and be approved for coverage. 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. 16

17 Voluntary Term Life Rocky River City Schools Benefits Guide This benefit was previously offered through Lincoln You also have the opportunity to purchase supplemental coverage for yourself, spouse and dependent children through OneAmerica. Please note that dependent children include unmarried adopted, natural or stepchildren age 14 days to age 19 (age 25 if unmarried and a full-time student). Employee Spouse Child Benefit Schedule Increments of $10,000 Increments of $5,000 Flat $10,000 Maximum Benefit $100,000 (not to exceed 5x Annual Earnings) $30,000 N/A Minimum Benefit $10,000 $5,000 N/A Guarantee Issue (initial offering only) $100,000 $30,000 Full Benefit Age Reduction Schedule To 65% at age 65 To 40% at age 70 To 25% at age 75 To 10% at age 80 To 65% at age 65 To 40% at age 70 To 25% at age 75 To 10% at age 80 N/A Monthly Rates for Voluntary Term Life Age Band Employee & Spouse Life Monthly Rate per $1,000* Age Band Employee & Spouse Life Monthly Rate per $1,000* Child Life Monthly Rate 0-29 $ $0.78 $ $ $ $ $ $ ** $ $ ** $ $0.50 *Spouse rate is based on employee age. **Employee only rates, spouse only eligible to enroll through age 69. Example: A 36 year old female, Sally, wants to purchase $50,000 of term life insurance..10 x 50 = $5.00 x 12/24 = $2.50 Monthly rate # of units/$1,000 monthly premium Semi-Monthly Per $1,000 Premium 17

18 Short Term Disability This benefit was previously offered through Lincoln As an employee of Rocky River City Schools, you are able to enroll in Short Term Disability (STD) coverage through One America. 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. Option 1 Option 2 Option 3 Option 4 Injury/Sickness Elimination Period 30/30 Days 7/7 Days 30/30 Days 7/7 Days Maximum Benefit Period 22 Weeks 26 Weeks 22 Weeks 26 Weeks Benefit Percentage 60% Weekly Earnings 60% Weekly Earnings 40% Weekly Earnings 40% Weekly Earnings Maximum Weekly Benefit $2,500 $2,500 $2,500 $2,500 Monthly Rate per $10 of Weekly Benefit $0.800 $1.300 $0.800 $1.300 Pre-Existing Condition: Anything you received medical treatment, advice or consultation, care or services including diagnostic measures, or had drugs or medicine prescribed or take in the 3 months prior to your insurance effective date will not be covered for the first 6 months of the policy. Option 1 Calculation Option 2 Calculation Based on an employee with a $31,200 annual salary Option 3 Calculation Option 4 Calculation Weekly Earnings $600 $600 Weekly Earnings $600 $600 Multiply by 60% $360 $360 Multiply by 40% $240 $240 Divide Coverage by Divide Coverage by Multiply by Rate $0.800 $1.300 Multiply by Rate $0.800 $1.30 Est. Monthly Cost $28.80 $46.80 Est. Monthly Cost $19.20 $31.20 Divide by 2 to get Semi-Monthly Rate $14.40 $23.40 Divide by 2 to get Semi-Monthly Rate $9.60 $

19 Long Term Disability Rocky River City Schools Benefits Guide This benefit was previously offered through Lincoln As an employee of Rocky River City Schools, you are eligible to enroll in Long Term Disability (LTD) coverage through One America. LTD coverage supplements your lost wages should you be unable to work due to an illness or injury. LTD coverage begins after missing the specified elimination period below due to a medically certified reason. Benefits are payable up to the specified benefit duration period below. Option 1 Option 2 Option 3 Elimination Period 180 Days 180 Days 180 Days Maximum Benefit Period SSFRA* SSFRA* SSFRA* Benefit Percentage 40% Monthly Earnings 30% Monthly Earnings 20% Monthly Earnings Maximum Monthly Benefit $5,000 $5,000 $5,000 Pre-Existing Condition: Anything you received medical treatment, advice or consultation, care or services including diagnostic measures, or had drugs or medicine prescribed or take in the 3 months prior to your insurance effective date will not be covered for the first 12 months of the policy. Monthly Premium Rate per $100 of Monthly Benefit for All Options Age Rate Age Rate Age Rate Age Rate <30 $ $ $ $ $ $ $ $ $ $1.610 Option 1 Calculation (40%) Option 2 Calculation (30%) Based on a 35 year old employee with a $36,000 annual salary Option 3 Calculation (20%) Monthly Earnings $3,000 $3,000 $3,000 Multiply by Benefit Percentage $1,200 $900 $600 Divide Coverage by Multiply by Rate from table above $0.700 $0.700 $0.700 Est. Monthly Cost $8.40 $6.30 $4.20 Divide by 2 to get Semi-Monthly Rate $4.20 $3.15 $2.10 *Social Security Full Retirement Age 19

20 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 in both of the plans offered: Benefit Elite Plan LifeLock Identity 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 Ultimate Plan New for ! Provides all of the benefits of the Benefit Elite Plan plus: Stolen Funds Replacement - up to $1,000,000 Credit Card, Checking & Savings with Account Activity Alerts Online Annual Credit Report Online Annual Credit Score Checking & Savings Account Application Alerts Bank Account Takeover Alerts Credit Inquiry Alerts Online Annual Tri-Bureau Credit Reports & Scores Monthly Credit Score Tracking File Sharing Network Searches Sex Offender Registry Reports Priority Live Member Service Support $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* Benefit Elite Plan $4.25 $8.49 $7.43 $11.68 Ultimate Plan (New) $12.75 $25.49 $18.06 $30.81 *Employee & Children and Family Tiers: You may enroll up to 8 children with 4 of those children between the ages of 18 and

21 Important Contacts Rocky River City Schools Benefits Guide Vendor Phone Number Website Medical Medical Mutual of Ohio Prescription Coverage Express Scripts Dental CoreSource Vision United Healthcare Basic Life CoreSource Flexible Spending Account American Benefits Group Voluntary Life, STD, LTD OneAmerica Voluntary Benefits Trustmark Identity Theft Protection LifeLock Trustmark Claims Help Explain My Benefits , Option 3 service@explainmybenefits.biz 21

22 Benefit Guide Description Please Note: This guide provides information regarding the Rocky River City 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.