A Summary of Employee Benefit Plans Enrollment Guide for the School Year

Transcription

1 Tumwater School District Continuous Student Learning in a Caring, Engaging Environment A Summary of Employee Benefit Plans Enrollment Guide for the School Year Benefit Fair August 29, :00 p.m. - 6:00 p.m. Location: District Office, Board Room Enrollment Deadline September 17, 2012 for October 1, 2012 Coverage To change your plans contact: Tabitha Bayne (360) tabitha.bayne@tumwater.k12.wa.us This guide is only a brief description of insurance coverage under the Tumwater School District s benefits program. The provisions of the actual plan documents and contracts will govern in the case of any discrepancy.

2 Welcome Customer Service Representatives Welcome to the school year. We hope you will find this benefits summary helpful in making your benefit plan selections for the school year. We will be having a benefits fair August 29, 2012 from 3:00 p.m. - 6:00 p.m. in the District Office Board Room. The Carriers will be available to answer questions and discuss plan changes. Please visit our benefit website at: You may call payroll staff at any time for enrollment forms and assistance. Best Regards, The Tumwater District Office Staff Tumwater School District Employee Benefit Contact Contact Person Direct Phone # Tabitha Bayne (360) tabitha.bayne@tumwater.k12.wa.us Plan Contacts Website Customer Service Premera Blue Cross / WEA (800) Group Health Cooperative (888) Washington Dental Service / WEA (800) Willamette Dental / WEA (800) Vision Service Plan / WEA (800) The Standard Life and AD&D (800) The Standard Long Term Disability (800) Horizon EAP (888) Ameritas Vision (800) AFLAC (800) American Fidelity / WEA (800) Propel Insurance (800)

3 Table of Contents Enrollment Updates... 5 Benefits Funding and Pooling Rate Summary... 9 Enrollment Information Eligibility How to Enroll or Change Plans Changing Elections After Open Enrollment Mandatory Benefits Dental Insurance Vision Insurance The Standard Life Insurance The Standard Long Term Disability Horizon Health EAP Services How to Select a Medical Plan Benefits at a Glance Voluntary Benefits Voluntary Life Insurance - The Standard Voluntary Vision - Ameritas American Family Life Assurance Company (AFLAC) Voluntary Short and Long Term Disability Deferred Compensation Plan (DCP) Tax Sheltered Annuities / 403 (b) Flexible Spending Accounts (FSA) Health Savings Account (HSA) Informational Resources Health Insurance Portability and Accountability Act (HIPAA) Family Medical Leave Act (FMLA) Medicare Part D Program The Consolidated Omnibus Budget Reconciliation Act (COBRA) Basic Health of Washington Healthy Kids Now! / Children s Health Insurance Program (CHIP) Washington State Department of Retirement Systems Notice of Change in Status...26 Online Benefit Information

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5 Enrollment Benefits Fair August 29, :00 p.m. - 6:00 p.m. District Office Board Room 621 Linwood Ave SW Tumwater, WA Open Enrollment August 13 th through September 17 th Employees making changes must complete and submit a new enrollment form to the Payroll Department before the deadlines set forth. To be effective October 1, 2012, the Payroll Department must receive enrollment forms no later than September 17, A second open enrollment period will not take place. The information herein is not a contract. It is a summary of benefits. Each plan described excludes certain conditions and types of treatment from coverage or payment. Detailed information regarding the contractual benefits, limitations and exclusions are available through the Payroll Department. Please direct any questions to the Payroll Department. This summary was printed in August of Please note, revisions may be made by bargaining units or insurers at any time after this date. Please refer to the most current contract for up to date coverage limits. No action is required if you are not making any changes to your current plan selections. Please note that Premera Blue Cross Plan 1 will no longer be available starting October 1, If you are enrolled in Plan 1 and take no action you will be defaulted into Premera Blue Cross Plan 2. Disclaimer This enrollment guide is a brief description of your coverage. It is not intended as a complete description of benefits. Although we ve made every effort to ensure the accuracy of this guide, provisions of the official plan documents and contracts will govern in the case of any discrepancy. This program is subject to review and (according to the provisions of any applicable collective bargaining agreement) may be modified or terminated in whole or in part at any time for any reason. This guide does not create a contract of employment between the district and any employee. The information included in the communication is provided for informational and demonstration purposes only and is not intended as a contract. Neither Propel Insurance, bargaining units nor carriers noted in this publication guarantee the accuracy or completeness of the information. Neither Propel Insurance nor carriers shall in any circumstances be liable for economic loss due to your reliance on this information. Recipients should note that said publication is objective and impartial in content unless clearly noted otherwise. 4

6 Updates Medical This year Group Health Cooperative HMO medical premiums increase at a uniform rate of 2.22%. However, changes to WEA Premera Blue Cross medical premiums vary widely. Plans 2, 3, and 5 increased from 4.5% to 7.5%, depending on plan and tier. Easy Choice plans decreased 2.5% to + 0.7% depending upon tier. Please refer to the Rate Change Summary on page 7 for more information. WEA Premera Blue Cross Plan One is No Longer Offered Plan 1 was projected to soon reach levels that were unsustainable from a premium prospective. As a result, WEA has made the decision to eliminate Plan 1. The good news is that all Plan 1 employees will see a decrease in monthly premiums as they move to other comprehensive plan alternatives, which for most people will result in a net overall savings. This is true even after taking into consideration higher copayments and cost-shares. WEA Premera Blue Cross Plan Two No benefit changes WEA Premera Blue Cross Plan Three No benefit changes WEA Premera Blue Cross Plan Five 10% coinsurance (Premera pays 90%) with a $500 out-of-pocket maximum, which is capped at $1,500 for a family WEA Premera Blue Cross Plan EasyChoice A, B and C No Plan Changes WEA Premera Blue Cross QHDHP Due to SB 5940, a Qualified High Deductible Health Plan (QHDHP) plan is now being offered through Premera Blue Cross. The new plan offers a lower monthly premium with high deductibles and a Health Savings Account (HSA). The HSA is an opportunity for employees to put pre-tax, payroll deducted dollars into a savings account that can be accessed for costs associated with health care. American Fidelity will be administering the HSA. There will be no employer contribution to HSA accounts for employees selecting the QHDHP plan except for PSE members. An employer HSA contribution of up to $125 per month will be made only to PSE members not using their full employer contribution. Any employer HSA contribution will reduce the amount otherwise provided to the PSE benefit pool. WEA Premera Blue Cross All All women s health care services will now be covered under the Preventative Care benefits. These services will be covered at 100% of Premera s allowed amount. This includes such services as oral contraceptives and sterilization services. A list of all services included in this change are available on Premera s website. All medically necessary self-administered oral medications that can be used to eradicate or slow the growth of cancerous cells will be covered at 100% of Premera s allowed amount for all covered health conditions. Providers will now be required to submit a copy of the physician s prescription, therapy treatment goals and progress notes with any claim for physical therapy, occupational therapy or speech therapy services Group Health Cooperative No Plan Changes 5

7 Dental Updates WEA Select WDS Delta Dental No Plan Changes WEA Willamette Dental No Plan Changes WEA Vision Service Plan (VSP) No Plan Changes Ameritas Vision Plan (PSE and TAP only) No Plan Changes The Standard Life and Disability No Plan Changes Flexible Spending Account Flexible Spending Account (FSA) will be administered through American Fidelity starting October 1, If you choose to enroll in the FSA program for October 1, 2012 through September 30, 2013 you will receive a new VISA Card from American Fidelity. You will still have the 90 day grace period to submit claims to Flex-Plan for any expenses incurred from October 1, 2011 through September 30, The FSA open enrollment period will be August 13th through September 30th. American Fidelity American Fidelity will be offering a variety of new optional benefits: Flexible Spending Account, HSA (only for employee s who sign up for the HQHDP), Long Term Care Insurance, Hospital Indemnity Plan, Critical Illness Plan, Accident Only Insurance Plan, Cancer Insurance Basic, Enhanced and Enhanced Plus, Accidental Death and Dismemberment Insurance and Life Insurance. Please contact American Fidelity at for questions and to sign-up for any of the plans. Other Important Changes IRS rules stipulate that a participant cannot make changes to any pre-tax deduction after the Section 125 Plan year has begun unless the participant experiences a qualified election change event as defined by the IRS. This means that we will only have ONE open enrollment from August 13th through September 17th. Any elections made during the open enrollment period will be effective October 1, 2012 through September 30, 2013 and no changes will be permitted after open enrollment unless a qualified election change event occurs such as adding a qualified dependent. 6

8 Benefit Funding and Pooling Rate Change Summary Premium increases from to Premera Blue Cross Medical Plan Two +4.5% to +7.5% depending on tier Plan Three +4.5% to +7.5% depending on tier Plan Five +4.5% to +7.5% depending on tier EasyChoice A, B and C -2.5% to +0.7% depending on tier Group Health Cooperative Medical 2.22% Washington Dental Service Plan A (WEA Plan 186) -4.2% with Orthodontia Plan A -5.1% Managed Care Plan -5.2% with Orthodontia Plan A -5.1% Willamette Dental Managed Care Plan 1-2.5% Managed Care Plan 1 Orthodontia Plan 4-3.5% Vision Services Plan E 10.3% Mandatory Life Insurance Policy # % Policy #626865A The monthly state flow-through allocation for 1.0 FTE will remain at $ In addition, collective bargaining agreements provide a district allocation of local funding to employee benefit pools for each bargaining group. These allocations vary by bargaining unit. How to Calculate Your Benefit Premiums Each employee group/bargaining unit chooses which Basic Benefits to offer their employees/members. The employee-benefit allocation will be utilized to purchase medical, dental, vision, group disability, and group term life insurance. In all groups, the first dollars are applied to negotiated mandatory benefits such as life, dental, vision, and LTD, and the balance is available for medical. Any remaining dollars from an individual are then pooled and divided among those employees with payroll deductions to reduce their payroll deduction. Use the Insurance Rate Summary on pages 9 and 10 to estimate your monthly benefit premiums. 1. Find the column for your bargaining group. 2. Take the state allocation for add the estimated pool contribution for your bargaining group, and multiply that by your FTE (see example on page 8) 3. Select from the mandatory plans provided on pages 9 and 10 for your group. 4. Subtract the amount of mandatory benefits from your total benefit allocation estimate. This amount is what you have left to apply towards medical insurance. 5. If medical insurance is desired, select the medical plan and covered family members you prefer from the lower part of the page. If the medical premium amount is greater than what you had left after deducting your mandatory benefit, the difference will be a payroll deduction. Any additional voluntary benefit that you select will be a payroll deduction. 7 0% Mandatory Long Term Disability 0%

9 How to Estimate Your Employer Contribution Benefit Funding and Pooling Step 1 - Determine Your Benefit FTE For certificated employees: Your Benefit Full-Time Equivalent (FTE) is the same as your contract FTE. A 1.0 employee is one working 7.5 hours per day for 180 days (1350 hours per year). If you work less than 1350 hours, calculate your partial Benefit FTE by dividing your contract hours per year by Example: 3.0 hours for 180 days = 540 hours / 1350 = 0.40 FTE For classified employees: Your Benefit FTE is greater than your contract FTE if you work less than 1440 hours per year. A 1.0 Benefit FTE employee is one working 1440 or more hours per year. Calculate your Benefit FTE by multiplying your contract hours per day times days per year and dividing by Example: 4.0 hours for 260 days = 1040 hours / 1440 = FTE 3.0 hours for 190 days = 570 hours / 1440 = FTE Step 2 - Estimate your Employer Benefit Contributions as Follows: A. The state flow-through allocation of $ per FTE; and $ B. Estimate the pool contribution per FTE for your bargaining group. C. Sum of A & B D. Your Benefit FTE E. Multiply C & D Estimated Total Pool contributions are not known at this time; however, they will decrease due to premium increases. Pool contributions vary by bargaining groups and change each time pooling is calculated. For reference, the pool contributions per FTE are below: Bargaining Unit TEA $ TAP $ TOPA $ PSE $ DO Non Rep $68.49 Principals $54.17 Administrators $61.02 New Market Skills Center $ per FTE Step 3 - Calculate Your Estimated Employer Contribution Your estimated employer contribution equals your Benefit FTE determined in Step 1 times the estimated employer contribution for your bargaining unit calculated in Step 2. Examples using pooling contributions: Benefit FTE x ($ $106.33) = $ Benefit FTE x ($ $194.42) = $

10 Rate Summary Allocation per FTE = $ pool contribution DO ADMIN DO NON REP Plans in this Section are MANDATORY IF OFFERED Dental Insurance - Mandatory (Select One) Washington Dental Service Plan A (1) (WEA Plan 186) $ $ Plan A (1) - Ortho Plan A (WEA Plan 186) N/A N/A Managed Care Plan $65.25 $65.25 Managed Care Plan - Ortho Plan A N/A N/A Willamette Dental of Washington Managed Care Plan 1 $74.70 $74.70 Managed Care Plan 1 - Ortho Plan 4 N/A N/A Long Term Disability - Mandatory N/A $15.50 Life Insurance - Mandatory Employee (20,000), Dependents (2,000) $6.70 $6.70 Vision Service Plan - Mandatory (Plan E) $19.75 $19.75 Medical Plans Offered Blue Cross Plan 2 (# ) Employee $ $ Employee & Spouse $ $ Employee, Spouse, & Child(ren) $ $ Employee & Child(ren) $ $ Blue Cross Plan 3 (# ) Employee $ $ Employee & Spouse $ $ Employee, Spouse, & Child(ren) $ $ Employee & Child(ren) $ $ Blue Cross Plan 5 (Foundation Plan) Employee $ $ Employee & Spouse $ $ Employee, Spouse, & Child(ren) $ $ Employee & Child(ren) $ $ Blue Cross Plan EasyChoice A, B, & C (Semi-Catastrophic Plan) Employee $ $ Employee & Spouse $ $ Employee, Spouse, & Child(ren) $ $ Employee & Child(ren) $ $ Blue Cross Plan QHDHP Employee $ $ Employee & Spouse $ $ Employee, Spouse, & Child(ren) $ $ Employee & Child(ren) $ $ Group Health (# , #003500) Employee $ $ Employee & Spouse $1, $1, Employee, Spouse, & Child(ren) $1, $1, Employee & Child(ren) $1, $1,

11 Rate Summary PRINCIPALS NMSC PSE TEA TAP TOPA N/A $ $ N/A $ $ $ N/A N/A $ N/A N/A N/A $65.25 $65.25 N/A $65.25 $65.25 $80.15 N/A N/A $80.15 N/A N/A N/A $74.70 $74.70 N/A $74.70 $74.70 $85.75 N/A N/A $85.75 N/A N/A N/A $15.50 N/A $15.50 N/A N/A $6.70 $6.70 $6.70 N/A $6.70 $6.70 $19.75 $19.75 N/A $19.75 N/A $19.75 Medical Plans Offered $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1,

12 Enrollment Information Eligibility Employees Medical plan selections of current enrollees remain unchanged unless an enrollment change form is submitted, an eligibility status changes or your plan is eliminated during open enrollment. All payroll deductions for medical benefits are automatically deducted on a pre-tax basis unless a written request has been made to the District Office. New employees scheduled to work at least 50% of any month are eligible for benefits the first of the month following the date in which they were hired. Enrollment forms must be submitted to the Human Resources Department by the 10th of the month in order to receive benefits for the following month. Employees who do not enroll during the initial enrollment period may not be able to enroll until the next open enrollment period unless there has been a qualifying event. Evidence of insurability may be required for some types of coverage. Dependents Enrolled employees may enroll eligible dependents in the same plan(s). Eligible dependents are: Your lawful spouse, state registered domestic partner or your legally separated spouse. Your dependent children to age 26 - natural children, stepchildren, legally adopted children, children specified in a court order or divorce decree. Medical, vision, and dental coverage is available to qualifying domestic partners and their dependents for all bargaining groups. How to Enroll or Change Plans Generally, the choices made during the open enrollment period remain in effect for the plan year. Follow these steps: 1. Read about the benefit choices and review the rates. 2. Decide whether to continue with current benefit coverage or change. 3. If no changes are being made, no action is required. 4. If changes are being made, complete a new enrollment form and return it to the Payroll Department by September 17, 2012 for October 1st coverage. 5. Current plan benefits will remain in effect until the next open enrollment period if new enrollment forms are not received by the stated deadlines unless you are currently enrolled in Premera Plan 1. If you are currently enrolled in Premera Plan 1 and do not submit a new enrollment form with a new plan selection you will be defaulted into Premera Plan 2. Changing Elections After Open Enrollment Changes cannot be made after open enrollment deadlines unless there is a change in family status, such as: Marriage / Divorce Enrolled family member dies Birth / Adoption Employee or spouse go on an unpaid leave of absence Employee or spouse have a significant change in employment status (part-time to full-time or vice versa) Loss of coverage A new enrollment form must be filled out within 30 days of the change in status (60 days for newborns and adoptions). 11

13 Mandatory Benefits The following is a list of the mandatory benefits for all employees who work a minimum of 15 hours per week. These benefits vary by Collective Bargaining Agreement (see pages 9 & 10). Eligible employees need to enroll in the plans elected by their group, which may include life insurance, long term disability, vision, and dental. The monthly premiums for these plans are paid by the employer and are deducted from the benefit allocation. Washington Dental Service (WDS) / WEA is a traditional dental plan. It is incentive based with a maximum of $1,750, increased to $2,000 when a Delta Dental PPO dentist is used. Member dentists will submit claims directly to Washington Dental Service for the subscriber and are paid at a higher level. Non -member dentists are required to submit claims using the claim form available on the WDS website. Dental fees may be higher for non-member dentists. WDS / WEA Plan 1 WDS / WEA Managed Care Willamette Dental Managed Care Providers choice of WDS or Non- WDS member dentists copay may apply to some preventive services services must be provided by Willamette Dental providers to receive coverage. Annual Maximum $1,750 out of network $2,000 in network (if you use a Delta Dental PPO dentist) unlimited unlimited Diagnostic and Preventive Care 70% - 100% incentive* $15 copay, then 100% $15 copay, then 100% Restorative Care 70% - 100% incentive* $15 copay, then 100% 100% after various copays Crowns 70% - 100% incentive* copay depends on service type $50 copay Dentures & Bridges 50% copay depends on service type $50 copay With Orthodontia Plan A (TEA and Principals Only) With Orthodontia Plan A (TEA and Principals Only) With Orthodontia Plan 4 (TEA and Principals Only) Orthodontia 50% $1,000 lifetime maximum 50% $1,000 lifetime maximum $150 copay $1,500 copay maximum *How the incentive plan works: WDS encourages regular dental care. WDS pays 70% of covered services for Preventive and Restorative care during the first plan year of coverage. This advances by 10% annually (effective October 1st) - provided the plan is used at least once per benefit year for applicable services to a maximum of 100%. Failure to use the plan once each benefit year causes the level to drop by 10% below the last level of payment, but never below the original 70%. Each eligible employee and dependent creates his or her own percentage point level. The incentive plan does not apply to the 50% allowance for the cost of Major Care, Implants or Orthodontia. 12

14 Mandatory Benefits Vision Service Plan / WEA Plan E (For All Groups Except PSE & TAP) Benefits VSP Participation Providers Other Licensed Vision Providers Examinations Once each calendar year paid in full after $25 copay $34.00 Out-of-Pocket Copay on Materials Lenses Once each calendar year $25 copay then paid as shown below: member pays all charges exceeding the allowances listed below: Single Vision paid in full $38.00 Bifocal paid in full $70.00 Trifocal paid in full $76.00 Lenticular paid in full $ Continuous Blend paid in full $ Lens Tinting, Coating, or Oversized Lenses paid in full no additional allowance Contact Lenses (pair) Once each two calendar years Frames Once each two calendar years $ $ $ $

15 Mandatory Benefits Standard Life Insurance (For All Groups Except TEA) - #626865A must work a minimum of 15 hours per week to be eligible See Certificate of Coverage for details Basic Life and AD&D Dependents Employee - $20,000 Dependents - $2,000 Decreasing term life policy. Benefits will reduce starting at age 65. Standard Long Term Disability (District Office Support Staff, New Market Skills Center and TEA) - #626865B must work a minimum of 15 hours per week to be eligible See Certificate of Coverage for details Benefits Maximum Benefits Maximum Waiting Period 66 2/3% of the first $7,500 of pre-disability earnings, reduced by deductible income $5,000 before reduction by deductible income 90 days Horizon Health EAP Services (District Office Support Staff, New Market Skills Center and TEA) Employee Assistance Program with Telephone and Face-to-Face Assessment and Counseling provided for all eligible Long Term Disability participants. HorizonCare services can help with the following issues, among others: Child and Elder Care Alcohol and Drug Abuse Life Improvement Difficulties in Relationships Stress and Anxiety with Work or Family Depression Personal Achievement Emotional Well-Being Financial and Legal Concerns Grief and Loss HorizonOnline 1. Enter this address in your web browser: 2. Enter standard as the login ID (in all lowercase letters) when prompted 3. Enter eap4u as the password (in all lowercase letters) when prompted 14

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17 How to Select a Medical Plan Preferred Provider Organization (PPO) Plan Choices: Your WEA Select Plan is called a Heritage or Foundation plan. It uses a network of contacted providers (known as Heritage Network or Foundation Network ) to provide health care services to you. These providers are also called network providers. The plan makes available to you sufficient numbers and types of providers to give you access to all covered services in compliance with applicable state regulations governing access to providers. Your plan provides the highest level of benefits, (and lower out-of-pocket costs) when you use a network provider. The plan also features an out-of-network option. When you use a licensed health care provider who is not part of the network, (also called an out-of-network provider) benefits for covered services are provided at a lower level of benefits (and higher out-of-pocket costs). Health Maintenance Organization (HMO) / Managed Care Plan Choice: Group Health Cooperative - The HMO/Managed Care type plans provide you with managed benefits and usually at a lower cost at the time of service. However, these plans require that you select a primary care provider (PCP) from their list of providers. Your PCP will then either provide or coordinate all of you care (except in the care of a medical emergency). Choosing a primary care doctor - or any doctor, for that matter - is probably the most important health care decision you will make. Primary care doctors have the expertise to provide medical care over a long period of time. They help you stay healthy, manage your care, and will recommend specialists for particular conditions when warranted. The guidelines below will help you search for and choose a physician that will best suit you and your family s needs: Make a List of Potential Candidates Review provider directories, available on the benefits website. Remember, if choosing an HMO plan, services most likely are not covered if seeing a physician outside of the network. If choosing a PPO plan, you can choose a doctor that is not in the network, but you may have to pay extra out-of-pocket if you do so. Does the doctor have experience with my condition? Does the doctor have privileges at the hospital of my choice? Interview Your Final Choices Narrow your list to a few top choices, and set up interviews with each physician. Was the doctor receptive to your interview/screening? Does the doctor communicate clearly? Does the doctor have a proactive approach to wellness and prevention? Are the office personnel friendly and appropriate? Researching and meeting several doctors before making you choice may be time-consuming, but is well worth your effort. Together, you and your doctor can manage your overall health and wellbeing, and address any conditions you have with quality, cost-effective treatments. 16

18 Benefits at a Glance Group Health Cooperative Premera Blue Cross / WEA Plan / Network HMO Plan 2 - Heritage Website Dependent Age Limit to age 26 to age 26 Deductible $0 per person $0 family $100 per person $300 family Office Visit 100% after $25 copay 100% after $25 copay* Lab & X-Ray 100% 80% Preventive Care Hospital Inpatient Outpatient 100% unlimited 100% after $100 copay per day for up to 3 days per admit same as office visit 100%* unlimited 80% after $150 copay per day $450 copay maximum pcy 80% after $100 surgery copay Emergency Room (copay waived if admitted) $150 copay $75 copay Prescription Drugs Separate deductible up to 30 day supply n/a up to 34 day supply n/a Generic $15 copay $10 copay Brand $30 copay $20 copay Non-Formulary n/a $35 copay Mail Order Maintenance Spinal Manipulation Vision Exam up to 90 day supply 3 copays same as office visit 10 visits pcy same as office visit (once every 12 months) $150 hardware allowance (once every 12 months up to 100 day supply $10 / $20 / $35 same as office visit unlimited visits pcy* not covered Out-of-Pocket maximum $2,000 per person $4,000 family $1,500 per person $4,500 family Life Insurance not included $12,500 *These services do not apply to your calendar year deductible pcy= per calendar year 17

19 Benefits at a Glance Premera Blue Cross / WEA Premera Blue Cross / WEA Plan / Network Plan 3 - Heritage Plan 5 - Foundation Website Dependent Age Limit to age 26 to age 26 Deductible $200 per person $600 family $100 per person $300 family Office Visit 100% after $30 copay* 100% after $15 copay Lab & X-Ray 80% 90% Preventive Care Hospital Inpatient Outpatient 100%* unlimited 80% after $300 copay per day $900 copay maximum pcy 80% after $150 surgery copay 100% unlimited 90% after $200 copay per day $600 copay maximum per Admission, $1,000 family maximum pcy 90% Emergency Room (copay waived if admitted) $100 copay $50 copay Prescription Drugs Separate deductible up to 34 day supply n/a up to 30 day supply n/a Generic $15 copay $10 copay Brand $25 copay $15 copay Non-Formulary $40 copay $30 copay Mail Order Maintenance Spinal Manipulation up to 100 day supply $15 / $25 / $40 same as office visit unlimited visits pcy* up to 90 day supply $10 / $30 / $60 same as office visit unlimited visits pcy* Vision Exam not covered not covered Out-of-Pocket maximum (Does not include deductible or copays) $2,750 per person $8,250 family $500 per person $1,500 per family Life Insurance $12,500 $12,500 *These services do not apply to your calendar year deductible pcy= per calendar year 18

20 Benefits at a Glance Premera Blue Cross / WEA Premera Blue Cross / WEA Plan / Network Easy Choice A - Heritage Easy Choice B - Heritage Website Dependent Age Limit to age 26 to age 26 Deductible $1,000 per person $3,000 family $750 per person $2,250 family Office Visit 100% after $15 copay* 100% after $30 copay* Lab & X-Ray Preventive Care Hospital paid in full up to the first $1,000 then deductible and coinsurance apply 100%* unlimited 75% 100%* unlimited Inpatient 80% 75% Outpatient 80% 75% Emergency Room (copay waived if admitted) $100 copay $150 copay Prescription Drugs Separate deductible up to 30 day supply $500 per person deductible waived for generics up to 30 day supply $250 per person Generic no copay no copay Brand 70% $30 copay Non-Formulary 70% $45 copay Mail Order Maintenance Spinal Manipulation up to 90 day supply $0 / 75% / 75% same as office visit 12 visits pcy* up to 100 day supply $0 / $75 / $112 same as office visit 12 visits pcy* Vision Exam not covered not covered Out-of-Pocket maximum (Does not include deductible or copays) $5,000 per person $15,000 family $4,000 per person $12,000 family Life Insurance $12,500 $12,500 *These services do not apply to your calendar year deductible pcy= per calendar year 19

21 Benefits at a Glance Premera Blue Cross / WEA Premera Blue Cross / WEA Plan / Network Easy Choice C - Foundation QHDHP Website Dependent Age Limit to age 26 to age 26 Deductible $0 per person $0 family $1,500 per person $3,000 per family Office Visit 100% after $35 copay* Deductible & Coinsurance Lab & X-Ray 65% 80% Preventive Care Hospital 100%* unlimited 100%* unlimited Inpatient 65% 80% Outpatient 65% 80% Emergency Room (copay waived if admitted) $200 copay 80% Prescription Drugs Separate deductible up to 30 day supply $500 per person up to 30 day supply Subject to deductible and coinsurance Generic no copay 80% after deductible Brand $30 copay 80% after deductible Non-Formulary $45 copay 80% after deductible Mail Order Maintenance Spinal Manipulation up to 90 day supply $0 / $75 / $112 same as office visit 12 visits pcy* up to 90 day supply 80% after deductible 80% 12 visits pcy Vision Exam not covered not covered Out-of-Pocket maximum (Does not include deductible or copays) $7,500 per person $22,500 family $4,000 per person $8,000 family Life Insurance $12,500 $12,500 *These services do not apply to your calendar year deductible pcy= per calendar year 20

22 Voluntary Benefits The Tumwater School District offers a variety of voluntary plans that may be a benefit to employees. Please contact the Payroll Office for information or forms on any of the following benefits. Voluntary Life Insurance - Standard Available to all Active Employees regularly working at least hours each week Temporary, seasonal employees, or full-time members of the armed forces are not eligible Policy #VTL Employee Guarantee Issue Level up $50,000 at the time of employment Spouse Guarantee Issue Level up to $10,000 at the time of employment: $2,000 Composite Rate $0.40 $5,000 Composite Rate $1.00 $10,000 Composite Rate $2.00 Lower Rate for Employee and Spouse for Non-Smoking Contact the Payroll Department for Rate Schedules Voluntary Vision- Ameritas Available to PSE and TAP Employees Covered vision services paid in full to a $200 maximum per calendar year Employee $9.04 Employee & Spouse $18.08 Employee, Spouse, & Children $24.56 Employee & Children $15.52 American Family Life Assurance Company (AFLAC) Mark Bunda (360) AFLAC offers various supplemental policies covering out-of-pocket medical expenses, everyday living expenses, and/or loss of income, and life insurance. Employees must complete an application process with the AFLAC agent for this insurance. Open enrollment is September 1 st - October 11 th. American Fidelity Assurance Company Voluntary Short and Long Term Disability Plan options vary for employees according to bargaining agreements Open Enrollment is August 15 th - November 30 th Eligible if working at least 17.5 hours per week Contact Payroll Office for Brochure American Fidelity Assurance Company (866) Voluntary Tax-Deferred Retirement Savings Accounts Tumwater School District provides two voluntary tax-deferred retirement savings options: Deferred Compensation and 403(b) Plans. Both allow employees to direct a portion of their monthly pre-tax earnings to a supplemental retirement account. Enrollment information for these plans is distributed to each employee through district main in September. Enrollment is open throughout the school year. Deferred Compensation Program (DCP) DCP is administered by the Washington State Department of Retirement Systems and offers investment options similar to the district sponsored SERS 3 and TRS 3 defined contribution retirement plans. For more information visit the DCP website at: Employees enrolling on-line must provide a copy of their enrollment form to the district Payroll Office in order to begin payroll deferrals. 21

23 Voluntary Benefits 403(b) Plans (also called Tax Sheltered Annuities) 403(b) plans are similar to 401(k) plans offered in the private sector. The district has retained CPI Common Remitter Services to administer this program and meet new federal guidelines. Employees may open a 403(b) account with one of the approved vendors displayed on the CPI website at To use the CPI website you will need to register by entering the last four digits of your social security number, your date of birth, and the Tumwater plan number: After applying for a 403(b) account with an approved vendor, you must enter your monthly contribution amount on the CPI website to begin payroll deferrals. For assistance talk to your financial advisor, visit the CPI website, or call the CPI Participant Service Center at (877) For additional assistance, please contact Tabitha Bayne at (360) Flexible Spending Account (FSA) with VISA Debit Card Open enrollment is September for Plan Year October 1 st - September 30 th. A Flexible Spending Account (FSA) program enables you to set aside money on a pre-tax basis to pay for health and day care costs, saving you 25% - 40%. An FSA is the only benefit that actually saves you money on the cost of health and day care expenses. Health Care FSA Allows up to $5,000 per year of tax-free dollars to pay for out-of-pocket medical, dental or vision expenses, as well as prescriptions, incurred by you and your dependents. Next year the maximum allowed amount will be $2,500. VISA Debit Card A debit card that pays for your expenses from the Health Care FSA. Dependent Care FSA Allows up to $5,000 per year of tax-free dollars to pay for work-related dependent care costs. This includes private day care, licensed day care or elderly care. Next year the maximum allowed amount will be $2,500. Who is eligible? All employees eligible for group benefits. Must I enroll every year that I want to participate? Yes, you must sign a new election form each year, or else your participation will automatically stop at the end of the plan year. How does it work? Open enrollment is in September for an effective date of October 1 st. Once Open Enrollment is over, you cannot make any changes to your enrollment unless you experience a qualifying event. Estimate your expenses for the Plan Year and enroll in an FSA for that amount. The money is deducted pre-tax from each paycheck and is deposited into an account. Claims for expenses are submitted to the account and the reimbursement is issued to you accordingly. What if I don t use all of my contribution? All money left unclaimed in your account will be forfeited to the plan. There will be a grace period of 90 days at the end of the Plan Year, in which you can submit old claims. The date of service of all claims must be within the Plan Year. How am I saving money? By participating in the FSA, you will avoid FICA (7.65%) and Federal Income tax (10% - 35%). 22

24 Voluntary Benefits Health Savings Account (H.S.A.) Plan Year October 1 September 30 Administered by American Fidelity A Health Savings Account (H.S.A.) is an account that you can use to pay medical expenses. Must be in conjunction with a qualified high deductible health plan (QHDHP) You own the account Tax-advantages: contribute pre-tax money, funds accrue tax-free and withdraw funds taxfree when used for eligible medical expenses Funds rollover each year, so you can use your H.S.A. to save tax-free money for retirement You own the account, even if you leave the company How does the H.S.A./QHDHP work? You contribute money to the H.S.A. You can use H.S.A. dollars to pay your health insurance deductible, along with other qualified medical expenses such as dental or vision services Once you meet your deductible, your insurance pays additional covered expenses in accordance with our plan Who is eligible for an H.S.A.? Anyone who is: Covered by an QHDHP Not enrolled in Medicare Not covered under other health insurance (does not include specific disease or illness insurance, accident, disability, dental care, vision care and long term care insurance) Not another person s dependent H.S.A. Contribution Limits Each year the I.R.S. sets contribution limits 2012 Limits: $3,100 for individual coverage $6,250 for family coverage For individuals ages 55-plus, the I.R.S. allows additional catch-up contributions Eligible individuals may contribute an extra $1,000 for the year H.S.A. Distribution Rules Distributions from your H.S.A. are tax-free if they are taken for qualified medical expenses Your H.S.A. can only be used for expenses that are incurred on or after the date the H.S.A. was established H.S.A. distributions can be taken for qualified medical expenses for the following people: Account holder (person covered by the QHDHP) Spouse of that individual (even if not covered by the QHDHP) Dependents of that individual (even if not covered by the QHDHP) Qualified Medical Expenses Most medical care that is subject to your deductible Prescription drugs Over-the-counter drugs, only if you obtain a prescription Insulin Dental and vision care 23

25 Informational Resources Health Insurance Portability and Accountability Act (HIPAA) In December 2000, the U.S. Department of Health and Human Services released final regulations that place restrictions on how personal identifiable health information may be used and disclosed by certain organizations. These regulations implement the privacy requirements contained within the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act (HIPAA) of While some states have laws that protect health information, this Federal regulation establishes a uniform, minimum level of privacy protections for all health information. Family Medical Leave Act (FMLA) On February 5, 1993, President Clinton signed into law the Federal Family and Medical Leave Act (FMLA) of This law became effective on August 5, Generally, the Family and Medical Leave Act of 1993 provides that covered employers must comply with certain criteria when an eligible employee requests a leave under the terms of this law. Medicare Part D Program Beginning in 2006, Medicare beneficiaries can receive subsidized prescription drug coverage through the new Medicare Part D Program. The Consolidated Omnibus Budget Reconciliation Act (COBRA) COBRA requires that employers provide employees and dependents that lose group health benefits with an opportunity to continue group health insurance coverage under certain circumstances. For more information about individual COBRA rights and requirements, please contact the Payroll Department or reference the websites listed below. A copy of a Notice of Qualifying Event has been added to this book for convenience purposes. Washington State Department of Retirement Systems Questions regarding TRS / SERS / PERS benefit information please contact the Department of Retirement Systems at (800) or (360) Basic Health of Washington Basic Health is a state-sponsored program that provides affordable health care coverage to low-income Washington State residents through private health plans. Healthy Kids Now! / Children s Health Insurance Program (CHIP) Low-cost or free health insurance is available for kids & teens in Washington State! GET Program GET is Washington state s 529 prepaid college tuition program. Shared Leave Program Contact Payroll Office. 24

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27 Notice of a Divorce or a Child s Loss of Dependent Status Use this notice to notify the employer s Plan administrator of a qualifying event that may entitle a spouse or dependent child to a COBRA coverage period of 36-months. Procedure: This form, and any required or requested documentation, must be completed and returned to the employer s Plan administrator within the notification period by mail or personal delivery unless an alternate means of notification is approved in advance by the employer s Plan administrator. Oral notice is not acceptable. Notification Period: There is a 60-day notification period that begins with the date of the qualifying event or, if later, the date coverage is lost. This form, and any requested documentation, must be provided to the employer s Plan administrator within the 60-day notification period. A timely notification will be determined by a postmark date or date of personal delivery. You are responsible for providing proof of timely submission. If the submission is not timely, you may lose your rights to COBRA. Who May Provide Notice: The covered employee, a qualified beneficiary, or a representative acting on their behalf may give notice. A notice provided by any of these individuals will satisfy any responsibility to provide notice on behalf of all related qualified beneficiaries. More Information: For more information regarding your rights and obligations under COBRA, refer to this General Notice, the SPD or contact the employer s Plan administrator. Mailing or Delivery Address: It is your responsibility to obtain current mailing or delivery information from your SPD or by contacting your employer s Plan administrator. Date of the qualifying event: Qualifying events resulting in COBRA entitlement: Divorce of employee and spouse. Attach a copy of the divorce decree. Dependent child no longer meets the plan requirements to maintain dependent status. Name: Reason*: *Additional proof may be requested such as a marriage certificate or birth certificate. You will have 15 business days to provide the requested information. All required documentation must be provided within the 60 day notification period. I certify that the above information is true. Completed by: employee spouse dependent child other (describe) Address: If the address of the qualified beneficiary is different from the one on record, please write in the new address in Comments, at the bottom of form, or contact the employer s Plan administrator for instructions. Print Name: First 5-digits of SSN: Signature: Date: Phone Number: Employer: Comments: This form may be found on the online benefit site. 26

28 Online Benefit Information Instantly access your employee benefits information from WORK or HOME! Benefit Plan Summaries Benefit Plan Providers Benefit Plan Resources Benefit Plan Forms Benefit Plan Websites HOW TO ACCESS Log onto Tumwater s website: Click on: Staff Click on: Employee Benefits Then Click on the Online Benefit Information Icon ONE STEP WEB ACCESS TO YOUR BENEFIT PLAN INFORMATION 24 HOURS A DAY 7 DAYS A WEEK Prepared by: Propel Insurance 1201 Pacific Avenue, Suite 1000 Tacoma, WA (800)