2019 RETIREE BENEFITS GUIDE

Transcription

1 2019 RETIREE BENEFITS GUIDE Students Prepared for THEIR Future

2 TABLE OF CONTENTS CONTACT INFORMATION If you have any questions regarding your benefits, please contact Olathe Public Schools Benefits Department at Medical Blue Cross/Blue Shield of Kansas City Dental Delta Dental of Kansas Vision VSP Contact Information & Table of Contents... 2 Medical Insurance... 3 Spira Care... 4 Medical Plan Options and Costs... 6 Care Options and When to Use Them... 9 Additional Medical Plan Benefits Dental Insurance Vision Insurance Important Notices Glossary of Terms Benefits Team Olathe Public Schools Benefits@olatheschools.org Questions? us at benefits@olatheschools.org

3 MEDICAL INSURANCE 1 HOW TO GET STARTED SELECT YOUR MEDICAL PLAN NEW! Spira Care $2,700 HDHP NEW! Spira Care $2,000 PPO $2,700 HDHP BlueSelect Plus $2,700 HDHP Preferred-Care Blue $1,500 PPO BlueSelect Plus $1,500 PPO Preferred-Care Blue $1,000 PPO BlueSelect Plus $1,000 PPO Preferred-Care Blue Blue-Care HMO TIP: Get the most out of your insurance by using in-network providers. FREQUENTLY ASKED QUESTIONS Will I receive a new Medical ID card? You will receive an ID card in the mail if you are electing medical coverage for the first time or electing to change medical plans in Does the run on a calendar year or fiscal year basis? A calendar year basis. How long can I cover my dependent children? Dependent children are eligible until the end of the calendar year in which they turn age 26. YOUR HEALTH PLAN OPTIONS If you are a Retiree of Olathe Public Schools, you have the choice between nine medical plan options. With each plan, your will run from January 1 December 31, New for 2019 are the two Spira Care options Spira Care $2,700 HDHP and Spira Care $2,000 PPO. Please refer to pages 4-6 for a full description of these two new plans as they work differently from the other medical plans offered by the District. Neither of these plans provide coverage for services received from out-of-network providers, so make sure to carefully review the network of providers available to ensure there will be adequate coverage to meet the healthcare needs of you and any dependents you choose to cover. The other seven plans will provide coverage if you use out-ofnetwork providers, however you will reduce your out-ofpocket costs by using in-network providers due to the significant discounts Blue Cross/Blue Shield has negotiated. If you choose to go out-of-network, you ll be responsible for the difference between the actual charge and Blue Cross/Blue Shield s UCR (Usual, Customary and Reasonable) charge, plus your out-of-network and coinsurance. Both the Spira Care $2,700 HDHP and the $2,700 HDHP BlueSelect Plus plans offer you significantly lower premiums than the other plan options. $1,000 PPO and HMO plan participants: 2019 is the last year these plans will be offered. Beginning on January 1, 2020, the District will not offer these plans as options for you to select. Therefore, we encourage you to take extra time during this open enrollment period to carefully consider all of the medical plan options available before enrolling in one of these plans. The new online PlanSelect tool can help you determine which plan may be the best fit for you. You can find the online PlanSelect tool on our Benefits website located at hr/benefits. 3

4 SPIRA CARE NEW FOR 2019! WHAT IS SPIRA CARE? BlueKC is collaborating with one of the highest performing Blue KC Medical Homes to create Spira Care an innovative new offering centered on a reimagined primary care experience. Spira members will benefit from the network s lower overall costs and convenient access to local providers across the metro area. Only those members and dependents who are enrolled in a Spira Care plan are able to utilize the Spira Care clinics. What is Spira Care? Why Spira Care? WHAT SERVICES ARE INCLUDED IN SPIRA CARE? All primary care and behavioral health services provided at the Care Centers are covered for either no or low out-of-pocket cost to members (depending on which Spira Care plan you elect). WHERE ARE THE CLINICS LOCATED? There are currently two locations - Olathe and Shawnee. OLATHE West 135th St Olathe, KS Three more Care Centers are scheduled to open by January 2019 at the locations below. The Wyandotte County location is scheduled to open mid LEE S SUMMIT 760 NW Blue Pkwy Lee s Summit, MO SHAWNEE Shawnee Mission Pkwy Shawnee, KS LIBERTY 8350 N Church Rd Kansas City, MO Chronic condition management Lab draws Extended full service hours Specialist referrals & scheduling Digital x-rays Common prescriptions filled on-site Routine preventive care Behavioral health sciences CROSSROADS 1916 Grand Blvd Kansas City, MO WYANDOTTE COUNTY Location TBD WHAT IF I NEED CARE OUTSIDE THE CENTER? For all needs outside the Care Centers, you ll have access to the BlueSelect Plus network (hospitals shown below) within the Kansas City metro area. Your dedicated care guide can help you navigate where to go - see the following page to learn more about care guides. Children s Mercy Hospital Children s Mercy Hospital - South Liberty Hospital North Kansas City Hospital Olathe Medical Center Shawnee Mission Medical Center Truman Medical Center - Hospital Hill Truman Medical Center - Lakewood University of Kansas Hospital 4 Questions? us at benefits@olatheschools.org

5 SPIRA CARE CONTINUED SPIRA CARE OPTIONS Beginning January 1, 2019, the District will offer two Spira Care plans the $2,700 HDHP and the $2,000 PPO. Both plans will allow you to take advantage of all of the features of the Care Centers. The difference between the two plans is what you will pay for those services you receive at the Care Center. Below are a few key points for each plan. Please see the following page for a more detailed benefit description. Spira Care $2,700 HDHP A member will incur an affordable charge of $60 for a diagnostic office visit at a Care Center. Diagnostic care includes but is not limited to office visit charges, labs, x-rays, prescriptions dispensed on-site and follow-up care. This charge will apply to the member s and out-of-pocket maximum which are noted on the following page. Once the out-of-pocket maximum is reached, a member will have no additional fees for the rest of the calendar year for services received either at a Care Center or from a provider in the BlueSelect Plus network. Preventive services are still covered at 100% with no or copayment. Spira Care $2,000 PPO All services, both preventive and diagnostic, that are received at a Care Center are covered at 100% with no or copayments. The only exception is a minimal copayment for generic prescription medications that are available and dispensed on-site at the Care Center. Tier 1 and 2 prescription medications that are purchased through a retail pharmacy or through the mail order program are covered at 10 the appropriate copayment. Care received outside of the Care Center but from a BlueSelect Plus provider is subject to the shown on the following page. Once the has been met, the plan will pay 100% for the rest of the calendar year. WHAT IS A CARE GUIDE? As a member of either of the District's Spira Care plans, you will have access to first-class doctors and nurses, as well as a committed Care Guide Team dedicated to simplifying and enhancing your health journey. Care Guides are real people and personal guides, many with nursing and benefit backgrounds, to help you on your health journey. They can coordinate care, answer questions and explain benefits. Members now have a single point of contact for both care and coverage questions. UNDERSTANDING COSTS Your doctor prescribed a blood test and a CT scan, but how much will it cost? And where should you go to have them done? Your Care Guide is ready to provide you with answers to these questions and more, ensuring you have the information you need to make smart healthcare choices for you and your wallet. COORDINATING CARE Imagine you ve recently been discharged from the hospital. Your Care Guide calls to see how you re feeling and follow up on treatment needs. It s a little something we call proactive outreach, and it can be a big help. EXPLAINING BENEFITS You need to visit a specialist outside of your Spira Care Center. Naturally, you have questions. Is the specialist you chose in-network? Have you reached your? Your Care Guide is available to answer your benefit questions. 5

6 Medical Insurance Plan Options and Costs Blue Cross/Blue Shield of Spira Care $2,700 HDHP Spira Care $2,000 PPO Kansas City Retiree Cost Per Month Member Only Member & Spouse Member & Child(ren) 2 - Member $ $1, $1, $1, $1, $ $1, $1, $1, $1, Spira Care Center BlueSelect Plus Out-of- Spira Care Center BlueSelect Plus Out-of- Individual $2,700 $5,400 None None $2,000 $4,000 Member Coinsurance 0% 0% 0% 0% Out-of-Pocket Maximum Individual (includes, coinsurance & copays) $2,700 $5,400 $2,000 $4,000 Office Visit Primary Physician / Specialist Preventive Care Lab and X-ray Major Diagnostics (MRI, CT, PET ) Urgent Care Emergency Room Outpatient Surgery Inpatient Hospital Services Prescription Drug Rx Individual/ Retail (at participating pharmacies) Mail Order (90-day supply) No Separate (Tier 1 only; All other tiers not available) No Separate $15 Copay (Tier 1 only; All other tiers not available) N/A No Separate $15/$50/ $15/$125/ All benefit plans are detailed in the Blue Cross/Blue Shield 2019 Certificate of Coverage (COC). This document is intended to be a brief summary only. If there is any discrepancy between this summary and the COC, the COC will govern in all cases. 6 Questions? us at benefits@olatheschools.org

7 Medical Insurance Plan Options and Costs Blue Cross/Blue Shield of $2,700 Blue Select Plus HDHP Plan $2,700 Preferred Care Blue HDHP Plan Blue-Care HMO Plan Kansas City Retiree Cost Per Month Member Only Member & Spouse Member & Child(ren) 2 - Member $ $1, $1, $1, $1, $ $1, $1, $1, $1, $ $1, $ 1, $2, $2, Individual In- Out-of- In- Out-of- In- Only $2,700 $5,400 $5,400 $10,800 $2,700 $5,400 Member Coinsurance 0% 30% 0% 20% 0% None None Out-of-Pocket Maximum Individual (includes, coinsurance & copays) $2,700 $5,400 $13,500 $27,000 $2,700 $5,400 $5,400 $10,800 $3,500 $8,750 Office Visit Primary Physician / Specialist 3 2 $30 / $60 Copay Preventive Care 3 2 Diagnostics Lab and X-ray Major Diagnostics (MRI, CT, PET ) 3 2 Covered at 100% $200 per occurrence Urgent Care 3 2 $60 Copay Emergency Room $200 Copay Outpatient Surgery 3 2 $300 Copay/occurrence (up to $1500 per member per year) Combined with Inpatient Inpatient Hospital Services Prescription Drug Rx Individual/ Retail (at participating pharmacies) 3 No Separate 2 No Separate $300 Copay/day (up to $1500 per member per year) Combined with Outpatient $200 individual / $400 family Rx then Copay: $12 / $60 / $80 Mail Order (90-day supply) $24 / $120/ $160 Out-of-: Refer to Plan Summary for details Out-of-: Refer to Plan Summary for details Out-of-: Refer to Plan Summary for details All benefit plans are detailed in the Blue Cross/Blue Shield 2019 Certificate of Coverage (COC). This document is intended to be a brief summary only. If there is any discrepancy between this summary and the COC, the COC will govern in all cases. 7

8 Medical Insurance Plan Options and Costs Blue Cross Blue Shield of KC $1,000 PPO BlueSelect Plus $1,000 PPO Preferred-Care Blue Retiree Cost Per Month $1,500 PPO BlueSelect Plus $1,500 PPO Preferred-Care Blue Member Only Member & Spouse Member & Child(ren) 2 - Member Individual Member Coinsurance Out-of-Pocket Maximum Individual (includes, coinsurance & copays) Office Visit Primary Physician / Specialist Preventive Care Diagnostics Lab and X-ray Major Diagnostics (MRI, CT, PET ) Urgent Care Emergency Room Outpatient Surgery Inpatient Hospital Services Prescription Drug In- $1,000 $2,000 $ $1, $1, $2, $2, Out-of- $2,000 $4,000 In- $ $1, $1, $2, $2, $1,000 $2,000 Out-of- In- $1,500 $3,000 $ $1, $1, $1, $1, Out-of- $3,000 $6,000 In- $ $1, $1, $2, $2, $1,500 $3,000 Out-of- 10% 40% 10% 40% 0% 30% 0% 20% $5,000 $10,000 $40 / $80 copay 1 $80 copay $150 copay then then 10% 1 1 $19,875 $39, $150 copay then then 10% 4 4 $5,000 $10,000 $40 / $80 copay 1 $80 copay $150 copay then then 10% 1 1 $15,000 $30, $150 copay then then 10% 4 4 $1,500 $3,000 $7,500 $15, $1,500 $3,000 $3,000 $6, Rx $200 Individual/ $400 $200 Individual/ $400 No Separate No Separate Retail (at participating pharmacies) RX Then Copay $12 / $60 / $80 RX Then Copay $12 / $60 / $80 Mail Order (90-day supply) $24 / $120/ $160 Out-of-: Refer to Plan Summary for details $24 / $120/ $160 Out-of-: Refer to Plan Summary for details Out-of-: Refer to Plan Summary for details Out-of-: Refer to Plan Summary for details All benefit plans are detailed in the Blue Cross/Blue Shield 2019 Certificate of Coverage (COC). This document is intended to be a brief summary only. If there is any discrepancy between this summary and the COC, the COC will govern in all cases. 8 Questions? us at benefits@olatheschools.org

9 CARE OPTIONS AND WHEN TO USE THEM While we recommend that you seek routine medical care from your primary care physician whenever possible, there are alternatives available to you. Services may vary, so it s a good idea to visit the care provider s website. Be sure to check that the facility is in-network by calling Blue Cross/Blue Shield at , or by visiting PRIMARY CARE CONVENIENCE CARE URGENT CARE Routine, primary/ preventive care Non-urgent treatment Vaccinations Common infections (bronchitis, bladder and ear infections, pink eye, strep throat) Minor skin conditions (athlete s foot, cold sores, minor sunburn, poison ivy) Flu shots Pregnancy tests Sore throats Sprains Small cuts Strains Mild asthma attacks Minor infections Screenings Back pain or strains Rashes PRIMARY CARE For routine, primary/ preventive care or non-urgent treatment, we recommend going to your doctor s office. Your doctor knows you and your health history and has access to your medical records. You may also pay the least amount out-of-pocket. CONVENIENCE CARE These providers are a good alternative when you are not able to get to your doctor s office and your condition is not urgent or an emergency. They are often located in malls or retail stores (such as CVS, Walgreens, WalMart and Target), and generally serve patients 18 months of age or older without an appointment. Services may be provided at a lower out-of-pocket cost than an Urgent Care Center. URGENT CARE Sometimes you need medical care fast, but a trip to the emergency room may not be necessary. During office hours, you may be able to go to your doctor s office. Outside regular office hours or if you can t be seen by your doctor immediately you may consider going to an Urgent Care Center, where you can generally be treated for many minor medical problems faster than at an emergency room. EMERGENCY ROOM EMERGENCY ROOM Heavy bleeding Large open wounds Chest pain Sudden change in vision Spinal injuries Difficulty breathing Major burns Sudden weakness or trouble walking Severe head injuries An emergency medical condition is any condition (including severe pain) which you believe that without immediate medical care may result in any of the following: Serious jeopardy to your health or the health of an unborn child Serious impairment to bodily functions Serious dysfunction of any bodily organ or part If you obtain care at an emergency room, you will likely pay more out-of-pocket than if you were treated at your doctor s office, a Convenience Care Center, or Urgent Care facility. If you believe you are experiencing a medical emergency, go to the nearest emergency room or call 911, even if your symptoms are not described here. CALL Emergency services are always considered in-network. If you receive treatment for an emergency in a non-network facility, you may be transferred to an in-network facility once your condition has been stabilized. 9

10 ADDITIONAL MEDICAL PLAN BENEFITS AMWELL TELEHEALTH Telehealth or a virtual visit lets you see and talk to a doctor from your mobile device or computer without an appointment. Blue Cross/Blue Shield partners with American Well (Amwell) to bring you care from the comfort and convenience of your home or wherever you are. Telehealth doctors are available 24 hours a day, 365 days a year. Bladder infection Bronchitis Cold/flu Conditions Commonly Treated: Diarrhea Fever Migraine Rash Sinus problems Sore throat Most visits take about minutes, and your doctor can write a prescription, if needed, that you can pick up at your local pharmacy. To get started, download the Amwell Mobile App and complete the registration. WHAT IS THE COST? Amwell office visits are considered urgent care and will process according to your urgent care benefits, cost sharing or copay, unless otherwise noted in your member certificate. HOW DOES MY SPOUSE ACCESS THE AMWELL BENEFIT? Your spouse should create a separate account to enroll. HOW DO I ADD A CHILD TO MY ACCOUNT? Parents and guardians can add their children who are under age 18 to their account and coordinate/facilitate doctor visits on their behalf. Enroll yourself first and then add your child or dependent to your account. Please note, your child must be with you for the visit to take place. WHAT DO I DO IF I HAVE A CHILD OVER 18 WHO IS STILL ON MY HEALTH INSURANCE? They should enroll as an adult and create their own separate account. HOW DO I MAKE AN APPOINTMENT? 1. Download the Amwell Mobile App with the icon shown to the left or visit Amwell.com. 2. Create an account using your Blue KC member ID card for reference. Ensure you choose Blue KC from the drop-down list. 3. View a list of available doctors, their experience and ratings, and select one. 4. Stream a live visit directly from the Web or your mobile device. If needed and if medically appropriate, you can request a sick slip or back-to-work documents from your Amwell doctor. Amwell Telehealth RX SAVING SOLUTIONS SAVE MONEY AT THE PHARMACY Using real prescription pricing and claims data, Rx Savings Solutions will notify you when you and your family can save money on your prescriptions. STEP 1: Set-Up Savings Alerts Via Text and/or A. Visit mybluekc.com. If you are a first time visitor, click REGISTER NOW. Have your member ID card available to reference. B. Once logged in, click on the Pharmacy Tab at the top. Then click the button Save on Prescriptions. C. Once on the Rx Savings page, fill in your address and mobile phone number to start receiving and/ or text alerts! STEP 2: Review Your Savings Options and Share with Your Doctor A. Switch from Pharmacy A to Pharmacy B B. Switch to a different equally-effective medication STEP 3: Start Saving on Your Prescriptions Rx Savings Solutions 10 Questions? us at benefits@olatheschools.org

11 2 DENTAL INSURANCE DELTA DENTAL IS THE DENTAL CARRIER FOR 2019 Delta Dental offers two plans: Basic and Basic + Orthodontia. The only difference between them is that orthodontia coverage for dependents under age 19 is included in the + Orthodontia plan. Both dental plans are PPOs that offer coverage both in and out-of-network. It is to your advantage to utilize an in-network dentist in order to achieve the greatest cost savings. Delta Dental offers two provider networks. Dentists who participate in the Delta PPO network have agreed to fees that are lower than dentists in the Delta Premier network which, in turn, means lower out-of-pocket costs for you. In addition, dentists participating in either network will file your claims directly, eliminating the need for you to deal with any paperwork. If you choose to go out-of-network, you will be responsible for any cost exceeding Delta Dental s negotiated fees, plus any and coinsurance associated with your procedure. Dependent children are eligible until the end of the calendar year in which they turn age 26. FIND A DENTIST To find a Delta Dental of Kansas provider in your area, visit the website at DIRECTIONS: Click on Find a Dentist Select the Delta Dental PPO or the Delta Dental Premier network You can then search for a dentist by name or by proximity to an address or zip code Click Search for a Dentist for a comprehensive directory of dentists Dental Insurance Plan Options and Costs Delta Dental Member Member & Spouse Member & Child(ren) Member & Plan Type and Delta PPO/ Delta Premier Dental $42 $77 $77 $103 Basic Plan Retiree Cost Per Month Out-of- Basic Dental + Orthodontia N/A N/A $155 $198 Basic + Orthodontia Plan Delta PPO/ Delta Premier Out-of- Individual / $0 / $0 $0 / $0 $0 / $0 $0 / $0 New for 2019! Your preventive exams no longer need to be scheduled at least six months apart. You will now be able to have 2 preventive exams per calendar year, regardless of when those exams occur. Annual Maximum $1,000 $1,000 $1,000 $1,000 Applied to Type A, B & C Services Type A: Preventive & Diagnostic Services Type B: Basic Services 100% 100% 100% 100% 90% 90% 90% 90% Oral evaluations Bitewing X-rays Sealants Full mouth or panoramic X-rays Fillings Periodontics Prophylaxis: cleanings Fluoride treatments Space maintainers Refer to the plan summary for limitations Oral surgery Emergency palliative treatment Type C: Major Services 50% 50% 50% 50% Crowns Dentures Bridges Orthodontia Not Covered Not Covered 50% (lifetime maximum $1,000) 50% (lifetime maximum $1,000) Diagnostics and treatment for dependents under the age 19 11

12 VISION INSURANCE 3 VSP IS THE VISION CARRIER FOR 2019 The vision plan offers coverage both in-network and out-ofnetwork. It is to your advantage to utilize an in-network provider in order to achieve the greatest cost savings. If you go out-of-network, your benefit is based on a reimbursement schedule. Beginning January 1, 2019, there will be a few enhancements made to the plan. Those enhancements are as follows: Standard progressive lenses purchased from a participating VSP provider will now be covered in full. The contact lens allowance will be increased to $150. There will now be two separate allowances for frames, and both are increases over the 2018 allowance. The allowance for featured brand frames will be $200, and the allowance for all other frames will be $150. You can visit for additional information on the frames that fall into each category. Vision Insurance Plan Options and Costs VSP Retiree Cost Per Month Member Member & Spouse Member & Child(ren) Member & $13 $21 $21 $35 Other Savings Opportunities: Examination Copay Prescription Glasses Contact Lens Fitting and Evaluation Frequency of Service Exam Lenses Frames Contacts Lenses Single Bifocal Trifocal Polycarbonate (for children only) Progressive Lenses (Standard) Frames Featured Brands All Other Retail Frames Contact Lenses (In lieu of the eyeglass benefit) In- $10 Copay $25 Copay $60 Max Copay Every 12 months Every 12 months Every 24 months Every 12 months Covered in full Covered in full Covered in full Covered in full Covered in full $200 allowance $150 allowance $150 allowance Out-of- Reimbursement Up to $50 N/A Every 12 months Every 12 months Every 24 months Every 12 months Reimbursement Up to $50 Up to $75 Up to $100 N/A Up to $75 Reimbursement Up to $70 Reimbursement Up to $105 Glasses and Sunglasses Receive a 30% savings on additional glasses and sunglasses, including lens enhancements, from the same VSP provider on the same day as your WellVision Exam. Retinal Screening No more than a $39 copay on routine retinal screening as an enhancement to a WellVision Exam Laser Vision Correction Average 15% off the regular price when you use a contracted facility. Laser Vision 15% off normal retail N/A 12 Questions? us at benefits@olatheschools.org

13 IMPORTANT NOTICES WOMEN S HEALTH AND CANCER RIGHTS ACT OF 1998 As a requirement of the Women s Health and Cancer Rights Act of 1998, your plan provides benefits for mastectomy-related services including all stages of reconstruction and surgery to achieve symmetry between the breasts, prostheses and complications resulting from a mastectomy, including lymphedema. The benefits must be provided and are subject to the health plan s regular copays, s and coinsurance. Contact Blue Cross/Blue Shield at the phone number on the back of your ID card for additional benefit information. IMPORTANT INFORMATION REGARDING 1095 FORMS As an employer with 50 or more eligible employees, we are required to provide 1095-C forms to all members who were eligible for coverage under our group health plan in If you were eligible for coverage under our group plan, you ll receive a personalized 1095-C form before March 31, We are also required to send a copy of your 1095-C form to the IRS. The information reported on Form 1095-C is used in determining whether an employer owes a payment under the employer shared responsibility provisions under section 4980H. Form 1095-C is also used by you and the IRS to determine eligibility for the premium tax credit. You ll need 1095-C form to complete your Federal tax return. MEDICAID CHIP NOTICE Premium Assistance under Medicaid and the Children's Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP, and you re also eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage using funds from their Medicaid or CHIP programs. If you or your children aren t eligible for Medicaid or CHIP, you won t be eligible for these premium assistance programs, but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP, and you live in a state listed on the DOL website provided below, contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office, call 877.KIDS.NOW ( ) or visit insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employersponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, and are eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren t already enrolled. This is called a special enrollment opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at askebsa.dol.gov or call EBSA (3272). For the latest form and states where you may be eligible for assistance paying your employer health premiums, go to dol.gov/ebsa/pdf/ chipmodelnotice.pdf For more information on special enrollment rights, you can contact either: U.S. Department of Labor Member Benefits Security Administration dol.gov/ebsa , option 4, ext U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services cms.hhs.gov

14 MEDICARE PART D CREDITABLE COVERAGE This notice has information about your current prescription drug coverage and about your options under Medicare s prescription drug coverage. If you are eligible for Medicare, the following information can help you decide whether or not you want to join a Medicare drug plan. You should consider comparing your current coverage through our medical plan with the costs of plans offering Medicare prescription drug coverage in your area. Two important things you need to know about your current coverage and Medicare prescription drug coverage: Medicare prescription drug coverage is available if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan. All Medicare drug plans provide at least a standard level of coverage set by Medicare. More coverage may be offered at a higher premium. Olathe Public Schools has determined that the prescription drug coverage offered by Blue Cross/Blue Shield is on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because this coverage is Creditable Coverage, you can keep it and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan. If you lose your current creditable prescription drug coverage through no fault of your own, you will be eligible for a two-month Special Enrollment Period to join a Medicare drug plan. If you decide to join a Medicare drug plan, your current coverage will not be affected. This plan will coordinate with Part D coverage. If you drop your current coverage, be aware that you and your dependents will be able to get this coverage back. If you drop or lose your current coverage and don t join a Medicare drug plan within 63 continuous days after your coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. This information is provided for the Medicare open enrollment period which begins on October 15. If you want more information about Medicare plans that offer prescription drug coverage, you will find it in the Medicare & You handbook or you can visit medicare.gov or call 800.MEDICARE ( ). TTY users: If you have limited income and resources, visit Social Security at socialsecurity.gov, or call (TTY users call ). Keep all Creditable Coverage notices. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of the notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty). 14 Questions? us at benefits@olatheschools.org

15 GLOSSARY OF MEDICAL TERMS Coinsurance The plan s share of the cost of covered services which is calculated as a percentage of the allowed amount. This percentage is applied after the has been met. You pay any remaining percentage of the cost until the out-of-pocket maximum is met. Coinsurance percentages will be different between in-network and non-network services. Copays A fixed amount you pay for a covered health care service. Copays can apply to office visits, urgent care or emergency room services. Copays will not satisfy any part of the. Copays should not apply to any preventive services. The amount of money you pay before services are covered. Services subject to the will not be covered until it has been fully met. It does not apply to any preventive services, as required under the Affordable Care Act. Emergency Room Services you receive from a hospital for any serious condition requiring immediate care. Lifetime Benefit Maximum All plans are required to have an unlimited lifetime maximum. Medically Necessary Health care services or supplies needed to prevent, diagnose or treat an illness, injury, condition, disease or its symptoms, which meet accepted standards of medicine. Provider A provider who has a contract with BCBSKC to provide services at set fees. These contracted fees are usually lower than the provider s normal fees for services. Out-of-pocket Maximum The most you will pay during a set period of time before your health insurance begins to pay 100% of the allowed amount. The, coinsurance and copays are included in the out-of-pocket maximum. Preauthorization A process by BCBSKC to determine if any service, treatment plan, prescription drug or durable medical equipment is medically necessary. This is sometimes called prior authorization, prior approval or precertification. Preventive Services All services coded as Preventive must be covered 100% without a, coinsurance or copayments. UCR (Usual, Customary and Reasonable) The amount paid for medical services in a geographic area based on what providers in the area usually charge for the same or similar service. Urgent Care Care for an illness, injury or condition serious enough that a reasonable person would seek immediate care, but not so severe to require emergency room care. 15

16 Copyright CBIZ, Inc. NYSE Listed: CBZ. All rights reserved. The purpose of this booklet is to describe the highlights of your benefit program. Your specific rights to benefits under the Plans are governed solely, and in every respect, by the official plan documents and insurance contracts, and not by this booklet. If there is any discrepancy between the description of the plans as described in this material and official plan documents, the language of the documents shall govern.