Carson City School District Health Benefits

Transcription

1 HUMAN RESOURCES / BENEFITS P. O. Box West King Street Telephone: (775) Carson City, Nevada Fax: (775) Carson City School District Health Benefits Calendar Year Plan Effective: effective date through December 31, 2018 Health Benefits Carson City School District takes pride in providing employer paid benefits for the individual employee (at no cost to the employee). There is a 30 day eligibility wait period for Health Benefits, making eligibility on the 31 st day of employment. As an eligible employee, you would have the options of electing any or all benefits for your dependents and/or spouse. The employee is responsible for the cost of the premiums of the elected dependents. Payment for those premiums would be deducted from the semi-monthly payroll deduction (pre-tax). Our benefits are provided by the following carriers: PROMINENCE HEALTH PLANS HMO High HMO Low PPO High HDHP/HSA (High Deductible Health Plan associated with a Health Savings Account, HSA, offered by OPTUM Bank) Kansas City Life Dental High Option Low Option (Base) EYEMED Vision Care Kansas City Life - Life Policy (50% reduction in benefit after age 70) High Option $50k Low Option (Base) $20k

2 FLEXIBLE SPENDING ACCOUNTS (FSA) Flexible Spending Accounts allow you to set aside money before taxes to pay for eligible health out-of-pocket expenses. Our FSA s vendor is Connect Your Care. MEDICAL REIMBURSEMENT ACCOUNT (FSA): This savings account reimburses out-of-pocket health cost expenses not covered by your medical, dental, and vision insurance DEPENDENT CARE ACCOUNT: This account allows you to pay for eligible dependent day care expenses with pre-tax dollars LIMITED FLEXIBLE SPENDING ACCOUNT (FSL) is associated with the HDHP/HSA plan which allows assistance with out-of-pocket expenses limited for dental and vision only. Dependents If a member chooses to insure their dependents, they will shadow the plan they have elected for themselves. They are not limited to which plans they add them to. ie; dental, vision or medical. They are responsible for the premiums for the plans they chose for their dependents. This packet contains valuable health benefits information. Our benefits run on a calendar year, ending on December 31st of each year. Benefits elected at the time of hire cannot be changed until the District s annual Open Enrollment, which is held each November for the upcoming calendar year. Upon leaving the District, the health benefits will end on the day of separation. With a minimum of 10 years of service, the District will offer the option to self-pay for continuation on our group plans. With under 10 years of eligible service, COBRA benefits will be offered. The District s enrollment system is an internet-based electronic enrollment and benefit management system with top-level security. Employees can access their benefit information using the District s web site Listed is a brief description of plan coverage. For a full comparison of plans, please refer to the Medical Plan Benefits spreadsheet included in your packet. The following Health Benefit plan options are offered: Medical/Prescription Insurance provided by Prominence Health Plans o Prescription RX co-pay (MedImact Rx) Formulary Generic $10 (Generic on List) Formulary Brand $30 (Name Brand on list) Non-Formulary $50 (Name Brand-not on list) No charge for the Food and Drug Administration (FDA) - approved contraceptive methods; birth control pills (only generic brands on list, sterilization procedures, patient education and counseling)

3 Note: If you elect a PPO plan which allows Out-of-Network claims, be advised that the vendor (doctor s office, clinic, hospital, etc.) has the right to Balance Bill you. Because the Out-of-Network vendor is not contracted with Prominence Health Plans, it does not have to except the reasonable claim rate that Prominence determines your benefit on. Therefore they can bill the member personally the unpaid balance. These Balance Bills can be of extreme amounts. MAJOR Procedures and Rx on ALL plans must have PRE-Aurthorization! o HMO High (HMO515) Must choose a Primary Care Provider (PCP) Effective in PCP referral is no longer necessary to visit a specialist in the network however, some specialist require a referral to be seen. No out-of-network coverage (TRAMA emergency only) No deductible Co-pays for services o HMO Low (HMO B3030) Co-pays for incidental services Deductible for MAJOR services o PPO High (HC027) Can see any Doctor in network without referral Meet deductible then 10% of service/procedure listed Office co-pays determined by doctor if coded as a procedure, deductible would apply Health First National Network available (see below) o High Deductible Health Plan (HDHP) (HD027) w/health Savings Account (HSA) CANNOT have secondary insurance with this plan because of the association with the Health Savings Account (HSA) Covered Medical services are charged at a contracted rate. Must meet deductible before accepted coverage is at 100% Covered Pharmaceuticals charged at a contracted rate until out of pocket maximum is met, then 0% co-pay for covered Rx. ($10,$30,$50 co-pays DO NOT apply to this plan) Exception: No charge for the FDA approved contraceptive methods; birth control pills (only generic brands on list), sterilization procedures, patient education and counseling. Medical services, doctor visits, etc. are charged at a contracted rate until deductible is met, then covered 100% in net-work Once deductible has been satisfied, services are covered at 100% Present Prominence medical id card for all claims Preventative Health Services covered 100% without meeting deductible Annual mammograms covered 100%, baseline only. If the procedure is diagnostic, the deductible would apply. o The new widely offered 3-D screening has not yet become a covered procedure Annual well-women preventative care visit (Pap & pelvic exam). If the procedure is diagnostic, the deductible would apply. Well baby visits, immunizations and vaccinations Prostate screening Colonoscopy after age 50

4 Health First National Network available (see below OPTUM is the District s Third Party Administrator for the Health Savings Account (HSA) -Section 125 o HSA accounts, which are governed by the IRS, are only available with a High Deductible Health Plan (HDHP). If a maximum contribution to this account occurs in the year, you must be on this plan for a full CALENDAR year to avoid penalties on your income taxes. You will have to declare your contributions and distributions for your HSA on your income tax filing. The contributions to this account should not affect your tax liability. o If spouse has an HSA account, be aware of the maximum allowed contribution per year for joint income tax filings o Keep all receipts as a backup for your income tax filing o CCSD will contribute $125 per pay period into your personal HSA account. After 24 pay periods (1 year), the district will have contributed $3,000 on your behalf, equal to your medical in-network deductible. Your HSA monies belong to you and will rollover into the next calendar year if not used. You DO NOT lose these dollars. o Employee can also contribute funds (2018 Limits; Individual $3,450 and Family $6,900 maximum ): Single coverage on HDHP-maximum contribution is $3,450, of which the district contributes $3,000 in a calendar year, leaving only $450 available for the member to self-fund Family Coverage (Yourself and one other) on the HDHP maximum contribution $6,900, of which the district contributes $3,000 in a calendar year, leaving $3,900 available for the member to self-fund o Only the funds in the account are available for distribution o HSA monies can only be used for services deemed medical, see HSA Qualifying Expenses in this packet o HSA monies can be used for medical services for ANYONE that is declared on the member s income tax filing for that year o First district contribution for the plan year will be on January 15th o Over 55 years old - $1,000 extra catch-up allowed, self-funded Health First National Network Available to PPO plan holders only Is an Out-of-Network for Out-of-State RESIDENCE on our Nevada plan, to receive In-Network benefits Continued

5 Dental Insurance is provided by Kansas City Life KCLife has gone cardless. o Two (2) options available Low PPO Has a maximum benefit of $1,000 per year (District paid base plan for employee) PREVENTATIVE services covered 80/20% (Cleanings, exams, x-rays, etc.) High PPO Has a maximum benefit of $1,500 per year (Buy-up option) PREVENTATIVE services covered 100% (Cleanings, exams, x-rays, etc.) o BOTH PLANS Cover 80/20% after a $50 deductible has been met for BASIC procedures (fillings, periodontics, endodontic, root canals) Cover 50/50% after a $50 deductible has been met for MAJOR procedures (Bridges, dentures, crowns) o Orthodontics 50/50% coverage on both plans Maximum Benefit (Lifetime-includes previous carriers) $1,000 Low option $1,500 High option Life / AD&D Insurance is provided by Kansas City Life o Two (2) options are available, pick one (1) Low - $20,000 coverage (District paid) High - $50,000 coverage (Buy-up option) o Age Reduction NEW: at 70 years of age, the pay-off benefit is reduced 50% Vision Insurance is provided by EyeMed VisionCare o One (1) option is available (District paid) o Plan coverage; in-network and out-of-network o Provider List changes often, check new listing and always check with provider Continued...

6 Connect Your Care Flexible Spending Accounts (FSA)-Section 125 o Self-funded Medical FSA available limit; maximum $2,550, minimum $100 Election amount available at beginning of year, deductions are spread over 24 pay periods with the Section 125 pre-tax benefit o Self-funded Dependent Care FSA available limit; max. $5,000, minimum $100 This savings account is for professional daycare reimbursement Election amount available at beginning of year, deductions are spread over 24 pay periods with the Section 125 pre-tax benefit o Self-funded Limited FSA available limit; max.$2,550, minimum $100 Available only to a member enrolled in the medical HDHP This savings account is to be used for Dental or Vision expenses only Election amount available at beginning of year, deductions are spread over 24 pay periods with the Section 125 pre-tax benefit The above FSA plans are USE IT or LOSE IT. Monies are available for All Qualifying Expense claims incurred in the year of contribution. The district has a GRACE period in place, where you can incur claims up to March 15, of the following year, however claims MUST reflect that the claim is for the previous plan year. Claims must be submitted no later than March 31, or unused dollars are forfeited. Open Enrollment elections are during the month of November for the upcoming year s Benefit Plans. If you have any questions, please feel free to call me at (775) Human Resources/Health Benefits (775) main (775) fax