Employee Benefits Guide

Transcription

1 CHERRY CREEK SCHOOLS Employee Benefits Guide Benefits Office 4700 S. Yosemite St. Greenwood Village, CO

2 CHERRY CREEK SCHOOL DISTRICT EMPLOYEE BENEFITS BENEFITS DESIGNED TO MEET YOUR NEEDS All benefit plans are effective July 1, 2018 June 30, 2019 We are proud to provide a robust benefit program to our employees. Through its medical, dental, life, vision, and disability insurance coverage, the program offers valuable protection to you and your family. This program is considered to be one of the finest benefit programs in Colorado. The program allows you to choose among a variety of benefit options and to determine how your benefit dollars are spent. This workbook describes the benefit program available to all benefit eligible employees of Cherry Creek School District. This workbook: Explains your choices for each plan. Provides information about eligibility and changes to eligibility. Helps you make the benefit decisions that are right for you. Please use the Employee Self-Service Online Enrollment Tool to complete your enrollment. NOTE: This document is an outline of the coverage proposed by the carrier(s). It not intended as a complete benefit description of all coverage. The carrier(s) group policies govern all coverage, and contain all terms, covenants and conditions of coverage. The information contained in this workbook is only a guide. The benefit decisions are yours. 2

3 CHERRY CREEK SCHOOL DISTRICT EMPLOYEE BENEFITS AN INTRODUCTION Cherry Creek Schools offers you a wide variety of choices in benefits. A cafeteria benefit plan enables you to choose plans with varying costs that fit your needs and the needs of your family. WHAT CHOICE OF BENEFITS DO I HAVE? You may make choices in these plans: Medical Dental Vision Health Savings Account (HSA) must be enrolled in the Kaiser HDHP 5000 Medical Plan Medical Flexible Spending Account (FSA) Dependent Care Flexible Spending Account (FSA) Voluntary Life Insurance Voluntary Accidental Death & Dismemberment (AD&D) Plans which are part of this program, and are provided to eligible employees at no cost are: Basic Life Insurance/AD&D Long Term Disability (Refer to separate policy information for Basic Life Insurance & LTD) 3

4 MEDICAL OPTIONS Kaiser Permanente KHDP 5000 DHMO 1500 DHMO 500 Added Choice (Triple Option) Waive Coverage - *Cafeteria Dollar eligible employee groups MUST provide proof of other group coverage. Individual plans will not be accepted including plans through Connect for Health Colorado COVERAGE FOR ALL EMPLOYEES PAID BY THE DISTRICT Employee Assistance Program (EAP) DENTAL OPTIONS Delta Dental Premier Plus PPO (PPO Plus) Preferred Provider Option (PPO) Exclusive Provider Option (EPO) Waive Coverage Opt for Coverage VISION OPTIONS VSP Waive Coverage Medical Flexible Spending Account/FSA FLEX ACCOUNTS OPTIONS 24 Hour Flex Dependent Care Flexible Spending Account/FSA HEALTH SAVINGS ACCOUNT (HSA) OPTIONS HSA Bank Medical Flexible Spending Account/FSA Dependent Care Flexible Spending Account/FSA VOLUNTARY LIFE INSURACE OPTIONS UNUM Voluntary Life Insurance Voluntary Life AD&D COVERAGE FOR ELIGIBLE EMPLOYEES PAID BY THE DISTRICT Basic Life & AD&D Long Term Disability * Please note that all benefits eligible employees receiving a district contribution must submit proof of other coverage to be able to waive the medical coverage offered by the district. Other coverage is defined as coverage from another group health plan, Medicare, Medicaid or Tri-County insurance. If you do not submit proof of other coverage, you will be automatically enrolled into the Kaiser DHMO 1500 employee only plan. 4

5 TABLE OF CONTENTS Enrollment Periods... 7 Eligibility... 8 Change of Status Tax Elections Kaiser Permanente Kaiser Plan Summary Kaiser Plan Comparison Grid Mental Health Urgent and Emergency Care Option Additional Plan Information Employee Assistance Program (EAP) Delta Dental Plan VSP Vision Plan Hour Flex (Flexible Spending Accounts) Health Savings Accounts (HSA s) Unum Life Insurance Retirement Plan Options Plan Contact Information

6 Enrollment Periods & Eligibility Provisions 6

7 CHERRY CREEK SCHOOL DISTRICT EMPLOYEE BENEFITS ENROLLMENT PERIODS NEW EMPLOYEE ENROLLMENT All benefit eligible employees will receive an enrollment packet through via your Cherry Creek Schools account. Please ensure you have access to your Active Directory and Password. If you do not receive an , please contact your manager or the benefits department at The benefit choices you make take effect the first day of the month following 30 days of continuous employment. Benefits are current month. This means that payroll deductions to pay for the coverage are current month. (i.e. June paycheck deduction to pay for coverage in June). ANNUAL OPEN ENROLLMENT Open Enrollment is held annually for all benefit eligible employees in Cherry Creek School District during the month of May with a benefit effective date of July 1. You cannot change your elections during the plan year unless you have a status change. The plan year is from July 1 through June 30. The premiums for all plans will be effective in July 1, for all employee groups. 7

8 CHERRY CREEK SCHOOL DISTRICT EMPLOYEE BENEFITS ELIGIBILITY PROVISIONS WHO IS ELIGIBLE? Eligible employees: You are eligible for the benefits package if you are an employee working 50 percent of a full-time contract or 20 hours or more in an eligible employee group. For more information on eligibility see our benefits page in the Backyard. Eligible dependents: Your legal spouse (must submit marriage license), common law spouse (must sign common law affidavit) or civil union spouse (must submit civil union certificate). Child indicates your dependent children. This definition includes: natural children, stepchildren, legally adopted children, a child placed for adoption, or children under permanent courtappointed legal guardianship. An eligible child is defined as a child of the employee through the end of the month in which the child turns age 26. With the exception of legal guardianship, dependent children do not have to reside in the household of the subscriber. Cherry Creek requires proof of such relationships (legal adoption papers, legal custody papers, etc.) that the dependent qualifies for coverage. NOTE: Foster children are not considered eligible dependents and may not be enrolled (applies to all benefits). An unmarried child who is 26 years of age or older incapable of self-support because of mental incompetence or severe physical handicap as certified by a physician and by the insurance carriers. You may enroll your eligible dependents in some of the plans that you are enrolled in and are not required to enroll them in all of your plans. Dependents must be enrolled in the same plan type as you are - for example: You can not be enrolled in Kaiser Triple Option and have your dependents in Kaiser DHMO 500 plan. You do not have to go to the same providers. If you do not enroll all of your eligible dependents now, you may do so at future open enrollments only (unless a change in status occurs). See Change in Status Section for details on special enrollments. 8

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11 CHANGE IN STATUS AND SPECIAL ENROLLMENT RULES As a participant in the Benefit Cafeteria Plan, you are entitled to revoke your prior benefits election and enter into a new election in the event of certain changes in status. The change in your benefits election must be due to and be consistent with the change in status. The change must be acceptable under the regulations issued by the Department of Treasury, and with the District Summary Plan document. A change to your elections must be made within thirty-one days of the qualifying event. Supporting documentation is required. Change in Marital Status Change in legal marital status including marriage, death of the spouse, divorce, legal separation or annulment. Change in Number of Tax Dependents Change in the number of tax dependents including birth, adoption, and placement for adoption or death of a dependent, permanent legal guardianship. Changes in Spouse, or Dependent s Eligibility under an Employer s Plan Change in dependent status in satisfying or ceasing to satisfy the eligibility requirements of the plan, such as change in marital status. Gain or loss of Medicaid or Medicare entitlement. Entitlement to COBRA. Special Requirements relating to the Family and Medical Leave Act (FMLA). Change in Employment Status that Changes Eligibility Status Change of employment status, such as termination or commencement of employment by the employee, spouse or dependent. Change in work schedule, such as a reduction or increase in hours of employment by the employee, spouse or dependent, including a switch between part-time and full-time, a strike or lockout, a change in worksite, or commencement or return from an unpaid leave of absence. Change in eligibility due to change in residency of the employee, spouse or dependent. Change in Cost or Coverage Significant cost increase in your or your dependent s coverage. Significant curtailment of your or your dependent s coverage. Addition or elimination of benefit package option under your or your dependent s employer s plan. Change in coverage or open enrollment of spouse or dependent under other employer s plan provided that the employee, spouse or dependent elects coverage under the dependent s plan. Cost or coverage change of status is not applicable for Medical Spending or Dependent Care Flexible Spending Accounts (FSAs). Applicable for Dependent Care Flexible Spending Accounts only: Change in dependent care provider. Change in dependent care costs. Dependent attains the age of

12 CHERRY CREEK SCHOOL DISTRICT EMPLOYEE BENEFITS TAX ELECTIONS FOR PREMIUMS PRE-TAX CONTRIBUTIONS If the benefit plans you select cost more than the District s monthly contribution, you may contribute benefit dollars out of your paycheck with pre-tax dollars for these plans: Medical Coverage Dental Coverage Vision Coverage Health Savings Account (HSA) must be enrolled in the Kaiser 5000 plan; cannot enroll in FSA Medical Flexible Spending Account (FSA) Dependent Care Flexible Spending Account (FSA) Cherry Creek will automatically default your tax selection to a pre-tax basis. You pay no federal or state income, Medicare, or PERA taxes on your pre-tax contributions. AFTER-TAX CONTRIBUTIONS When you approach the final four years before retirement, PERA recommends that if your benefit selections exceed your district contribution, you may wish to change your status to after-tax. The amount that exceeds the district contribution is taken directly out of your salary and when deducted on a pre-tax basis, this reduces the earnings reported to PERA and lowers your highest average salary. If your premium totals are less than the district contribution, this will not affect your PERA earnings and may only be contributed on a pre-tax basis. Please contact PERA if you have questions related to your highest average salary. An employee may elect to have Medical, Dental, Vision, Voluntary life and Voluntary AD&D premiums on an after tax basis. You cannot participate in the Medical FSA or Dependent Care FSA on an after-tax basis. Once elected, this selection will continue for the full plan year. A change can only be made during open enrollment. 12

13 Medical Plans 13

14 ALL MEDICAL PLANS Cherry Creek Choice offers four medical plan options through Kaiser Permanente. You may also choose to waive coverage under a medical plan but only if you submit evidence that you are covered under another group medical insurance plan, Medicare, Medicaid, or Tri-County. Each medical option is priced separately to reflect the benefits of the plan. Each medical plan option is described in detail on the pages that follow. CHOICES THE MEDICAL PLAN OPTIONS ARE: Kaiser Permanente DHMO 1500 The DHMO 1500 saves you money in premium by including higher deductibles and coinsurance while still offering co-pays for office visits and prescriptions. The DHMO 1500 plan requires you to access care through Kaiser Permanente facilities/providers. You may make appointments directly with your PCP or Specialist. While you may self-refer to a Specialist, Kaiser Permanente encourages the relationship between yourself, your PCP and your Specialist in coordinating your overall care. Kaiser Permanente DHMO 500 The DHMO 500 plan has a lower deductible and co-insurance than the DHMO 1500 plan. The plan requires you to access care from Kaiser Permanente facilities/providers. You may make appointments directly with your PCP or with a Specialist. While you may self-refer to a Specialist, Kaiser Permanente encourages the relationship between yourself, your PCP and your Specialist in coordinating your overall care. Kaiser Permanente HDHP 5000 The HDHP 5000 saves you money in premium with higher deductibles and coinsurance, when compared to the DHMO Office visits, prescriptions, and other benefits are subject to the deductible first before you begin paying coinsurance or copays for covered services. You may make appointments directly with your PCP or with a Specialist. While you may self-refer to a Specialist, Kaiser Permanente encourages the relationship between yourself, your PCP and your Specialist in coordinating your overall care. Kaiser Permanente Added Choice Triple Option The Added Choice Triple Option allows you to choose to access care from Kaiser Permanente facilities/ providers or Private Healthcare Systems (PHCS) facilities/providers inside and outside of Colorado or any other facility/provider. Benefit levels vary based on the facilities/providers accessed. Co-pays for preventive care apply to tier three. Prescriptions are available outside of the Kaiser Permanente formulary. No Coverage You may choose to waive all medical coverage only if you submit evidence that you are covered under another group medical insurance plan, Medicare, Medicaid or Tri-County by providing a copy of a current ID card that includes the group name and effective date of benefits. Please note that benefits eligible employees that receive no district contributions towards medical benefits, are not required to show proof of other coverage. If you waive all medical coverage at this time, you will not have another opportunity to enroll for medical coverage until the next enrollment period, unless you qualify for special enrollment. 14

15 PARTICIPATING HOSPITALS AND DOCTORS The medical plan choices offered vary by the type and level of benefits available, but there are also important differences having to do with your choice of medical care providers. Kaiser Permanente has specific lists of participating hospitals, doctors/facilities, and other medical care providers. For the most current information, you may review these lists on-line at: Kaiser Permanente DHMO 1500, Kaiser Permanente DHMO 500, and Kaiser Permanente HDHP Kaiser Permanente Added Choice Triple Option Permanente (locally and nationally) A summary of these primary benefit differences is provided on the following pages. Please Note: Centura Facilities are not in the PHCS network. Colorado State law requires an Access Plan describing Kaiser Permanente s network of providers and services to be available. To obtain a copy, call Customer Service at ARBITRATION By enrolling in Kaiser Permanente, you agree to have all disputes and/or claims for money damages exceeding the Small Claims Court limit in Colorado, including issues of medical malpractice, decided by neutral arbitration rather than by a jury or court trial. MISCELLANEOUS The Affordable Care Act requires carriers to make available a Summary of Benefits & Coverage (SBC), which is intended to facilitate comparison of health plans. The SBC must be provided the first day of open enrollment and with enrollment or application materials for newly eligible employees. Point-of-Service benefits are underwritten by the Kaiser Permanente Insurance Company, a subsidiary of Kaiser Permanente Foundation Health Plan. This is only a summary. It does not fully describe your health care coverage. For complete details on your coverage, including exclusions and plan terms, please refer to your employer s Service Agreement and the Kaiser Permanente Insurance Company (KPIC) Group Policy and Certificate of Insurance. The Service Agreement and KPIC Group Policy are the legally binding documents between Kaiser Permanente Foundation Health Plan of Colorado, KPIC and its members. In the event of ambiguity and/or conflict between this summary and/or the Service Agreement and KPIC Group Policy, the Service Agreement and the KPIC Group Policy shall control. 15

16 CHERRY CREEK SCHOOL DISTRICT EMPLOYEE BENEFITS FREQUENTLY ASKED QUESTIONS HOW DO YOU CHOOSE THE OPTION THAT S RIGHT FOR YOU? The medical plan that is right for you will not necessarily be the medical plan that is right for your coworker. The medical plan options offer ranges of benefits and costs. WHAT CAN I AFFORD TO SPEND EACH MONTH FOR A MEDICAL PLAN? Only you can determine this based on the District s contributions, the other benefits you want to purchase, and your own budget. It may be more economical to choose a lower cost plan, and only pay co-payments or deductibles if you actually use the plan. IF MY CHILD ATTENDS COLLEGE OUT OF THE AREA, WILL THEIR CARE BE COVERED UNDER ALL OF THE PLANS? The Kaiser Permanente DHMO and HDHP Plans have an Out-of-Area Dependent benefit which allows for dependents outside of any Kaiser Permanente service area with coverage of five (5) office visits, five (5) pharmacy fills and five (5) X-rays covered at their normal copay/coinsurance at a local provider. The Kaiser Permanente Added Choice Triple Option provides coverage for college student dependents attending school outside of the Kaiser Permanente service area through Tier 2 (PHCS Providers) and Tier 3 (any licensed provider), at the applicable co-pays and coinsurance and deductible. Any college student dependent enrolled in either the Kaiser Permanente DHMO, HDHP, or Added Choice Triple Option who attends school in another Kaiser Permanente service area outside of Colorado will have visiting member benefits and can obtain routine and follow-up care at any Kaiser Permanente facility. WHICH PLANS WILL PROVIDE THE BEST PREVENTIVE CARE BENEFITS? Because of Health Care Reform, you will not pay anything for a preventive care visit in either of the DHMO plans or the first two tiers of the Added Choice Triple Option plan. However, Tier 3 of the Added Choice Triple Option Plan does require a co-pay and preventive services are limited. IF I CHOOSE TO WAIVE MEDICAL COVERAGE, CAN I GET BACK INTO THE PLAN AT ANOTHER DATE? You must wait to enroll until the next annual enrollment period, unless you are eligible for special enrollment in which case you may enroll within 31 days of that change. The effective date must be the date when the previous coverage ended. 16

17 CHERRY CREEK SCHOOL DISTRICT EMPLOYEE BENEFITS FREQUENTLY ASKED QUESTIONS (Continued) WHAT ARE THE MAJOR DIFFERENCES BETWEEN THE HEALTH PLANS? Kaiser Permanente DHMO 1500, DHMO 500, & HDHP 5000 vs. Kaiser Permanente Added Choice Triple Option Kaiser Permanente physicians are employed by Colorado Permanente Medical Group. Members must seek care at Kaiser Permanente facilities for DHMO or HDHP benefits and for Option 1 of the Added Choice Triple Option in-network benefits. Other facilities/hospitals may be used in life threatening, urgent, and emergency situations. Please refer to your Evidence of Coverage for more information. In Kaiser Permanente s Added Choice Triple Option you may choose from three provider tier options. Option 1: The Kaiser Permanente DHMO facilities/providers offer the least amount of out-of-pocket expense. Option 2: PHCS facilities/providers are available with a higher out-of-pocket expense. Option 3: You may see any provider anywhere with an even higher out-of-pocket expenses. At each point of service you are free to choose any of the provider options listed. The member is responsible for satisfying the deductible for benefits with a coinsurance for all other services. (See Summary of Benefits & Coverage for more details). St. Joseph s and Good Samaritan are the primary hospitals contracted with Kaiser Permanente DHMO in the Denver/Boulder areas. After hours emergency care can be obtained at any licensed facility. There are other Kaiser Permanente facilities that provide after-hours care, you can find these facilities on their website at With the exception of the out-of-area student benefit, Kaiser Permanente s DHMO has no coverage outside the DHMO service area unless it is urgent or emergency care. HOW DO I ACCESS MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES? As a member of any Kaiser Permanente medical plan, you have access to four Mental Behavioral Health Facilities and two Substance Abuse Facilities in Kaiser Permanente s network for most of your mental health / substance abuse needs. To obtain services, you do not need a referral. Simply call one of the facilities listed below: Highline Behavioral Health Center East Dakota Avenue Denver, CO Baseline Behavioral Health Center 580 Mohawk Drive Boulder, CO Hidden Lake Behavioral Health Center 7701 Sheridan Boulevard Arvada, CO Northern Colorado Behavioral Health Services Ridgeline Behavioral Health Center 9139 S. Ridgeline Boulevard Highlands Ranch, CO Southern Colorado Behavioral Health Services

18 CHERRY CREEK SCHOOL DISTRICT EMPLOYEE BENEFITS FREQUENTLY ASKED QUESTIONS (Continued) DO I HAVE TO USE KAISER PERMANENTE FACILITIES FOR MENTAL HEALTH / SUBSTANCE ABUSE EVEN IF I AM ON THE ADDED CHOICE TRIPLE OPTION? As a member of the Kaiser Permanente Added Choice Triple Option plan you can access the facilities listed above for the lowest cost. You can use any licensed facility for inpatient and outpatient care, but benefits will be paid according to lower out-of-network or PHCS benefits. HOW DO I ACCESS ALTERNATIVE CARE SERVICES? For other services such as acupuncture or chiropractic care please contact Kaiser Permanente for participating providers. These services are not covered under the schedule of benefits, but may be available at a reduced fee. HOW DO I ACCESS THE EYE EXAMINATION BENEFIT? You can have an annual eye exam with applicable co-pay for glasses as a part of your Kaiser Permanente benefit package. The eye examination benefit does not include the cost of eyeglasses, contact lenses or contact lens fittings. Contact lens exams are available at an additional charge. A referral from a primary care physician is not required. Simply call the Kaiser Permanente optical department of your choice and make an appointment. Please note that this benefit is only going to be available at a Kaiser Permanente facility. There is no benefit on the Added Choice Triple Option Tier 2 or 3. DOES KAISER PERMANENTE OFFER ANY OTHER SERVICES? Kaiser Permanente offers a variety of courses, webinars for everything from weight loss, smoking cessation, yoga classes, parenting classes and more for all Kaiser Permanente members and non-members. Health Education Courses (On-site courses offered at Kaiser Permanente facilities and hospitals) Kaiser Permanente offers many health education courses at several of their facilities for a cost for all members and non-members. For a listing of their courses please visit their website at you will be directed to select your region and city to find the course closest to you. Call to register. 18

19 CHERRY CREEK SCHOOL DISTRICT EMPLOYEE BENEFITS IMPORTANT KAISER PERMANENTE PHONE NUMBERS Kaiser Permanente Appointments and Medical Advice Kaiser Permanente New Member Connect department This department will help you choose your physician, transition prescriptions, access care, learn about your benefits, register for and more. Point-of-Service Internal Referral This number is for use by your Out-of-Plan provider to refer you to a Kaiser Permanente specialist or for a diagnostic test requiring an appointment. Permanente Advantage Pre-certification/prior authorization for Out-of-Plan Services or utilization management services for care outside of Tier 1. See Additional Information Section for details. PHCS To locate a network provider contact PHCS or visit their Web site at Permanente 24 hours a day (select PPO network when searching). 19

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52 CHERRY CREEK SCHOOL DISTRICT EMPLOYEE BENEFITS FLEXIBLE SPENDING ACCOUNTS 24HourFlex is the administrator of two individual Flexible Spending Accounts (FSA): one for healthcare (medical) expenses and one for dependent childcare/elder care expenses. You can enroll in one or both FSAs. You can save money on your healthcare and/or dependent day care expenses with an FSA. You set aside funds each pay period on a pretax basis and use them tax-free for qualified expenses. You pay no federal income taxes on your contributions to an FSA. (That s where the savings comes in.) Your FSA contributions are deducted from your paycheck before taxes are withheld, so you save on income taxes and have more disposable income. You and your tax qualified dependents do not need to be enrolled in the CCSD Medical, Dental, or Vision plans to enroll in the FSA. Medical FSA Limit: $2,650 If eligible, you are able to contribute up to $500 of unused cafeteria monies towards your Medical Spending Account. If you were hired prior to July 1, 2006 and have the option of keeping the district contribution as cash, your total Medical Spending Account limit remains $2,650. If you were hired after July 1, 2006 your total Medical Spending Account limit is $3,150 ($2650, plus the additional $500 in cafeteria monies). Dependent Care FSA Limit: $5,000 individual or joint tax return/$2,500 married filing separate tax return per calendar year. You will receive an FSA Debit Card once you ve enrolled for the new plan year. If you already have a debit card and it is not expired, it will be loaded with your new election. The debit card can be used to pay for any eligible expense. Use it at your doctor s office, to pay for prescriptions, and for dental or vision expenses. Be sure to save any itemized receipts. 24HourFlex may ask you to substantiate the charges. An eligible receipt is one that lists the date of service, who the provider was, what service or product was purchased, and the amount. A credit card slip is not an eligible receipt. 52

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72 CHERRY CREEK SCHOOL DISTRICT EMPLOYEE BENEFITS RETIREMENT ACCOUNTS How to Enroll in a Cherry Creek Supplemental Retirement Saving Plan 401(k) Traditional or Roth To obtain forms for New Enrollment or Changes Employee Self Service Payroll in the Backyard After your first payroll deduction you will login to: peraplus-401k457-and-pera-dc-plan-information and choose your investment options. 403(b) Traditional To obtain information for Enrollment and current 403(b) Vendor List Employee Self Service Payroll in the Backyard Pages/default.aspx Employees should first choose and contact an Agent from the Approved Vendor List along with completing the Salary Reduction Agreement Form (SRA). 457 Traditional or Roth Login to: or call to enroll and make your investment options. For more information please visit the Payroll department page in The Backyard: 72

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74 CARRIER CONTACT INFO Kaiser Permanente Added Choice Triple Option Customer Service Delta Dental of Colorado Customer Service Premier Plan (#1108) PPO Plan (#1726) EPO Plan (#7094) Vision Service Providers (VSP) Customer Service 24 Hour Flex Help Center or Providers: Premier Network Providers: PPO Network (DPO) Providers: PPO Network or Unum Life Insurance Employee Assistance Program (EAP) Compsych HealthSmart (COBRA) Customer service Lincoln Financial Group (LTD) Customer service PERA Customer service Retirement Accounts (401k, 403b, 457 plans, etc.) 74