RETIREE Benefit Newsletter

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Nicholas Paul
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...... 9 Non-Discrimination Disclosure............. 10 How to Enroll............ 11 The School District of Clayton is getting ready for the 2019 benefit year which begins on January 1, 2019.

1 RETIREE Benefit Newsletter 2019 OPEN ENROLLMENT SUBJECT Table of Contents PAGE MEDICAL Base Plan Buy-Up Plan QHDHP DENTAL PPO - Delta Dental DHMO - Cigna VISION. EyeMed ADDITIONAL INFORMATION Medicare & H.S.A Medicaid/CHIP Notice... 8 OPEN ENROLLMENT Access Information Enrollment Dates Non-Discrimination Disclosure How to Enroll The School District of Clayton is getting ready for the 2019 benefit year which begins on January 1, The District s benefit package will continue to offer Medical, Dental, and Vision benefit plans, Anthem Blue Cross Blue Shield will continue to be our medical carrier for the upcoming year. The benefits offered to you contain three medical plan options. These include a Base, Buy-Up, and a Qualified High Deductible Health Plan. The Qualified High Deductible Health Plan allows those who are not enrolled in Medicare to enroll in a Health Savings Account. You will once again have the choice between two dental plans, a PPO and a DHMO. The PPO plan will be provided by Delta Dental and allows you to move freely between In-Network and Non-Network providers. The DHMO plan is again offered through CIGNA. This type of plan offers a greater benefit, however, it is more restrictive as you must choose a network provider for your dental care. You will receive all services from that provider and be referred to a specialist for any specialty dental procedures. The vision plan will be administered through EyeMed. A brief summary of all our benefit plans along with rates based upon the coverage you select are provided in this newsletter. Open enrollment begins on October 22 and ends on October 29. Mary Jo Gruber Chief Financial Officer PLEASE NOTE: IF YOU DO NOT WANT TO MAKE ANY CHANGES THIS YEAR TO YOUR BENEFITS, YOU DO NOT NEED TO DO ANYTHING. YOUR CURRENT ELECTIONS WILL CONTINUE WITH OUR 2019 CARRIERS. IF YOU WANT TO MAKE CHANGES TO YOUR BENEFITS, YOU WILL NEED TO LOG INTO THE PORTAL AND MAKE THE NECESSARY CHANGES. YOU CAN ALSO CALL EXPLAIN MY BENEFITS AT Option 3 AND THEY WILL ASSIST WITH YOUR ELECTIONS AND/OR CHANGES. Page 1

2 BASE PLAN The deductible, co-pays, and prescription drug co-pays count towards the out-of-pocket maximum. Traditional PPO Medical Plans BUY-UP PLAN This option offers the lowest out-of-pocket maximum. The co-pays, and prescription drug co-pays count towards the out-of-pocket maximum. Benefit/Service In Network Non-Network Benefit/Service In Network Non-Network Deductible $750 / Individual $1,500 / Family $1,500 / Individual $3,000 / Family Coinsurance 4 Out-of-Pocket Maximum Office Visit Preventive Care Inpatient Hospital $3,500 / Individual $7,000 / Family $30 Primary Care $60 Specialist 10 Covered $6,000 / Individual $12,000 / Family Deductible $250 / Individual $500 / Family $500/ Individual $1,000 / Family Coinsurance Out-of-Pocket Maximum Office Visit Preventive Care Inpatient Hospital $2,500 / Individual $5,000 / Family $25 Primary Care $50 Specialist 10 Covered $4,000 / Individual $8,000 / Family Outpatient Hospital 4 Outpatient Hospital Urgent Care $50 Co-Pay 4 Urgent Care $50 Co-Pay Emergency Room $300 Co-Pay $300 Co-Pay Emergency Room $200 Co-Pay $200 Co-Pay Prescription Tier 1 Tier 2 Tier 3 Mail Order Tier 1 Tier 2 Tier 3 $10 Co-Pay $40 Co-Pay $70 Co-Pay $20 Co-Pay $80 Co-Pay $140 Co-Pay Not Covered Not Covered Prescription Tier 1 Tier 2 Tier 3 Mail Order Tier 1 Tier 2 Tier 3 $10 Co-Pay $40 Co-Pay $70 Co-Pay $20 Co-Pay $80 Co-Pay $140 Co-Pay Not Covered Not Covered BASE PLAN - MONTHLY COST Retiree BUY UP PLAN - MONTHLY COST Retire Employee Only $ Employee & Spouse $1, Employee & Children $1, Employee & Family $1, Employee Only $ Employee & Spouse $1, Employee & Children $1, Employee & Family $2, Page 2

3 Qualified High Deductible Health Plan (HSA Qualified) If you elect the Qualified High Deductible Health Plan (QHDHP) you can also participate in a Health Savings Account (HSA) if you are not enrolled in, or eligible for, Medicare. You cannot be covered elsewhere under a non-qualified plan. All expenses count towards the deductible, which has to be satisfied first before you receive benefits under this plan. The single deductible applies to the family deductible. Once the single deductible has been satisfied, benefits for that member are payable subject to coinsurance. Once the family deductible has been satisfied, benefits for the family will be payable subject to coinsurance. Benefit/Service In Network Non-Network Deductible $3,000/ Individual $6,000 / Family $6,000 / Individual $12,000 / Family Coinsurance Out-of-Pocket Maximum Office Visit Preventive Care Inpatient Hospital Outpatient Hospital $4,000 / Individual $8,000 / Family Deductible 10 Covered $9,000 / Individual $15,000 / Family The IRS requires specific rules to be followed when setting up and utilizing an HSA. Please be familiar with these rules before setting up your HSA. Employees age 55 and over may contribute an additional $1,000 annually to their HSA. You cannot be enrolled in another health plan that is not a QHDHP. If you are enrolled in Medicare you cannot participate in the Health Savings Account. You or your spouse cannot participate in a Medical Flexible Spending Account. You may use your HSA for reimbursement of any eligible health care expenses for eligible dependents even if they are not participating in the QHDHP. IRS rules dictate calendar year maximum deposits into Health Savings Accounts. You cannot exceed these set maximums. Maximum allowed deposits for the calendar year 2019 are: Individual Accounts: $3,500 Family Accounts: $7,000 Urgent Care Emergency Room Prescription Retail & Mail Order Deductible then Not Covered QUALIFIED HIGH DEDUCTIBLE PLAN Retiree Employee $ Employee & Spouse/ $ Employee & Child(ren) $ Employee & Family $1, ANTHEM BLUE CROSS BLUE SHIELD To find helpful medical benefit information and tools, log on to anthem.com Log on to: My Online Services Find Doctors and Hospitals Check Claim Status Order New ID Cards Print Temporary ID Cards View Benefits Refill Mail Order Prescriptions Access Anthem s Drug List Member Services: Policy No Page 3

4 Dental - PPO You have two dental plan options. One option is a PPO plan with Delta Dental. This option offers you more freedom to choose any dentist. The second option is a Dental Health Maintenance Organization (DHMO) with Cigna (Shown on Page 5). Benefits PPO PREMIER Deductible Individual Family Coinsurance Diagnostic/Preventive Basic Services Major Services Orthodontia (child) Annual Maximum Benefit Ortho Lifetime Max. NON- NETWORK You Pay You Pay You Pay $50 $150 Deductible is Waived 4 5 Deductible Does Not Apply $50 $150 Deductible is Waived Deductible Does Not Apply $1,500/person $1,000/child $50 $150 Deductible is Waived Deductible Does Not Apply 9 Percentile Plan Highlights If you believe your dental procedure will exceed $300, have your dentist contact Met Life for an estimate. Is your dentist a nonnetwork dentist? Benefits will be paid at the 90th percentile, which means what 9 out of 10 dentists charge in area where your dentist is located. This could cause you to have higher out-of-pocket expenses. Retiree - PPO Employee $41.08 Employee & Spouse $82.17 Employee & Child(ren) $94.71 Met Life our PPO dental carrier. Log on to: Find a Dentist Check Claim Status Order New ID Cards Member Services: Customer Service: service@deltadentalmo.com Policy Number: Employee & Family $ Page 4

5 Dental - DHMO The CIGNA DHMO patient charge schedule is not changing for Following is a sample schedule: Plan Highlights You are responsible for a $5 Office Visit Fee per patient, per office visit. You have to be on the dentist s roster in order to receive treatment. CODE PROCEDURE PATIENT PAYS D1110 Adult Cleaning No Charge D0270 Bitewings No Charge D0330 Panoramic X-Ray No Charge D2330 Composite - Surface No Charge D2140 Amalgam - 1 surface No Charge Check the Patient Charge Schedule K1-V9 before receiving services to know what your responsibility is. The Patient Charge Schedule K1-V9 is located in Custom Solutions or you can contact Barb Daves in the Business Office for a copy. If a procedure is not shown in the schedule, it is not covered. D2752 Crown - Porcelain $425 D6794 Crown - Titanium $460 D3310 Root Canal - Anterior $210 D3320 Root Canal - Bicuspid $245 D3330 Root Canal - Molar $335 D4210 Gingivectomy 4 per Quad $180 D5110 Full Upper Denture $625 D5120 Full Lower Denture $625 D6065 Implant supported porcelain/ ceramic crown $790 Ortho 24-Month Treatment Fee $2,040 Retiree - DHMO Employee $26.67 Employee & Spouse/SSDP $46.74 Employee & Child(ren) $49.46 Employee & Family $74.96 Cigna our DHMO Dental Carrier Log on to: Find a Dentist Check Claim Status Order New Id Cards Member Services: Policy Number: Page 5

6 Vision Plan Benefit/Service In Network You Pay Non- Network Reimbursement PLAN HIGHLIGHTS Exam Co-pay $35 Frequency Exam Lenses Frames Lenses Single Bifocal Trifocal $5 Co-pay then Frames $50 Wholesale $125 to $150 Retail Every 12 months Every 12 months Every 24 months $35 $45 $60 $35 If you visit one of EyeMed s providers you do not have to obtain a voucher. Your vision provider can receive your benefits electronically. Non-Network benefits are based on a reimbursement schedule. You are eligible for savings on Lasik vision services. Savings range from 4 to 5 off the national average price of traditional Lasik. Contact lens allowance is for lenses. In network providers are contracted to charge no more than $40 for the standard contact lens fit and follow up exam. Contacts Medically Necessary Cosmetic UCR* $130 Allowance $250 $130 Allowance * UCR refers to Usual Customary and Reasonable charges. To determine the UCR, EyeMed takes the procedural charge of area providers and calculates an average. Charges above this average become your responsibility. Retiree EyeMed is our vision carrier Log on to: To find a provider Member Services: Policy Number: Employee $4.40 Employee & Spouse $8.36 Employee & Children $8.80 Employee & Family $12.94 Page 6

7 Additional Information How Your Medical Plan Works with Medicare THIS IS IMPORTANT IF YOU ARE A RETIREE AGE 65 OR OLDER... If you are a retiree of The School District of Clayton who elects to be covered under the medical plan and you are age 65 or older, you MUST enroll in Medicare Part A and Part B. The reason: The medical plan provided to you through your retirement from The School District of Clayton is offered as secondary or supplemental coverage to Medicare. Failure to enroll in Medicare Part A and Part B will cause you to have more out of pocket expenses because Medicare pays first under Medicare Secondary Payer rules established by the Center for Medicare Services. Anthem will consider the claim after Medicare payment has been determined. If you do not have Medicare Part A and Part B coverage, Anthem will pay the claim as if Medicare paid and consider only the remaining amount if allowable under Clayton s benefit plan leaving you to pay what Medicare would have paid and your deductible. If you are not currently signed up for Medicare Part A and Part B, please contact the Department of Social Security for details. Additional HSA Information The IRS requires specific rules to be followed when setting up and utilizing an HSA. Please be familiar with these rules before setting up your HSA. Employees age 55 and over may contribute an additional $1,000 annually to their HSA. You cannot be enrolled in another health plan that is not a QHDHP. If you are enrolled in Medicare you cannot participate in the Health Savings Account. If you are a retiree and not participating in Medicare, you are allowed to set up a Health Savings Account at your selected financial institution. If you retire and are currently participating in the HSA with Anthem, you will be required to pay the associated fees. If you enroll any family member, you must satisfy the family deductible before benefits are paid. You or your spouse cannot participate in a Medical Flexible Spending Account. You can participate in a Dependent Care Flexible Spending Account. You may use your HSA for reimbursement of any eligible health care expenses for eligible dependents even if they are not participating in the QHDHP. Save your receipts. The IRS is notified of all distributions. Here is how you do it OR Want To Know What Medicare Covers? 1. Go to 2. Go to the top of the page, on the tool bar go to What Medicare Covers. 3. Under What Medicare Covers click on Your Medicare Coverage. 4. In the dialog box, enter what medical care you are needing to determine if covered. 5. Click on Go after you have entered the information. 6. View results. You may call Medicare with your questions: Phone: Page 7

8 Additional Information - Continued Open Enrollment Important Notice Our benefit plan year is from January 1 through December 31. You are asked to make your elections for the 2019 plan year through the online enrollment process which is October 22 through October 29. When your enrollment period is closed, you will not be able to make any changes to your elected coverage until the next open enrollment period or you experience a qualifying life change event. A life change event includes death, marriage, divorce, birth or adoption of a child, or if your spouse loses or gains coverage through his or her employer. Medicaid Children s Health Insurance Program (CHIP) Offer Free Or Low- Health Coverage To Children And Families If you are eligible for health coverage from your employer, but are unable to afford the premiums, some States have premium assistance programs that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums. CBIZ Custom Solutions provides a copy of the form listing the states that offer assistance. Please access and locate forms or contact the Business Office. You can also contact: U.S. Department of Labor Employee Benefits Security Administration EBSA (3272) U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services , Ext Page 8

On Line Enrollment Review Your Benefits Visit our benefits portal to review your benefit guide, Important documents and watch benefit education videos. ExplainMyBenefits.

9 On Line Enrollment Review Your Benefits Visit our benefits portal to review your benefit guide, Important documents and watch benefit education videos. ExplainMyBenefits.com/clayton Enroll in the Online system School District of Clayton provides electronic enrollment through Explain My Benefits. Explain My Benefits provides eligible Retirees the ability to make group insurance benefit elections and changes online during the annual open enrollment and qualifying events. Enrollment has never been easier. Accessible 24 hours a day, information about all of your benefit election options, including premiums and carrier contact information are available to help you make informed decisions. You can also log into the Explain My Benefits portal at anytime or download the Mobile App, to review your benefits, access carrier links, update your personal information for yourself and your dependents, and process qualifying life events. Self-Service Visit explainmybenefits.com/clayton on any computer, click on the blue Log into Your Benefit System button and move through the enrollment system at your own pace. Or, download the new Mobile App on your phone or tablet and move through the enrollment at your own pace. Be sure to click submit at the end of the process and make note of your confirmation number. If you do not receive a confirmation number, you have not completed your enrollment and you will not be enrolled in your benefits. Return to the system anytime and click your confirmation number to view your confirmation statement. For assistance, please call Customer Service at ; Option 3 PLEASE REMEMBER IF YOU ARE NOT MAKING ANY CHANGES TO YOUR CURRENT BENEFIT ELECTIONS, YOU DO NOT NEED TO DO ANYTHING. YOUR CURRENT ELECTIONS WILL CONTINUE WITH THE 2019 CARRIERS. Page 9

10 Non-Discrimination Disclosure It is the policy of the School District of Clayton not to discriminate on the basis of race. color, religion, gender, national origin, age, or disability in its programs or employment practices as required by Title VI and VII of the Civil Rights Act of Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975 and Title II of the Americans with Disabilities Act of Behavior that is not unlawful or does not rise to the level of illegal discrimination or harassment might be unacceptable for the workplace or the educational environment. Demeaning or otherwise harmful actions are prohibited, particularly if directed at personal characteristics. Accordingly, the District prohibits discrimination or harassment on the basis of sexual orientation, perceived sexual orientation or gender identity. Inquires related to the District s employment practices should be directed to Dr. Tim Dilg, School District of Clayton, #2 Mark Twain Circle, Clayton, Missouri or by phone at (314) Inquiries related to the District s student programs should be directed to Kashina Bell, Assistant Superintendent of Student Services, School District of Clayton, #2 Mark Twain Circle, Clayton, Missouri or by phone at (314) Inquiries or concerns regarding civil rights compliance by school districts should be directed to the local school district Title IX/non-discrimination coordinator. Inquiries and complaints may also be directed to the Kansas City Office, Office for Civil Rights, US Department of Education, 8930 Ward Parkway, Suite 2037, Kansas City, MO 64114; (816) ; TDD (877) School District of Clayton #2 Mark Twain Circle Clayton, Missouri (314) About This Bulletin 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. Page 10

EMPLOYEE BENEFIT NEWSLETTER

EMPLOYEE BENEFIT NEWSLETTER BENEFIT INFORMATION Parkway School District s employee benefit plans renew January 1, 2014, which means it is time for the Annual Enrollment period. Our benefit package includes