OPEN ENROLLMENT GUIDE

Transcription

1 Allen Park Public Schools 2017 OPEN ENROLLMENT GUIDE ADMINISTRATION, SUPERINTENDENT, SECRETARIES Open Enrollment Period until November 28th All employees must complete a 2017 enrollment form! Failure to return signed 2017 enrollment forms by November 28, 2016 will result in NO coverage!

2 O E P Open Enrollment for making insurance benefit changes will be un l Monday, November 28th. All employees must complete 2017 enrollment forms. Failure to return enrollment forms by Monday, November 28th will result in no coverage! Please note that based on the renewal rate changes and Public Act 152 your employee contribu on or pre tax premium deduc on maybe changing effec ve January 1st. Remember that the choices you make now will be effec ve January 1, 2017 and will remain in effect un l December 31, 2017 unless you experience a qualified special enrollment event. Enrollment Forms are due no later than Monday, November 28, Action Steps: 1. Review this 2017 Open Enrollment Guide 2. Complete all necessary enrollment forms and return it to Joannie Payne at Riley by Monday, November 28th The Following forms need to be completed: HAP PPO Enrollment form or HAP HMO Enrollment form 1 FSA form ADN Dental form MESSA Vision / Life form Cafeteria Election form (if applicable) All employees must complete all 2017 enrollment forms! Failure to return signed 2017 enrollment forms by November 28, 2016 will result in NO benefits.

3 M P D S Below is a brief summary of the three plans being offered effec ve January 1, More detail of these plans can be found on the Benefit Summaries on the next pages of this booklet. Summary of Benefit Coverage s can be found on the district website at Note: This summary is not a guarantee of benefits HAP HMO Plan 1 HAP PPO Plan 2 HAP HMO Plan 3 Deduc ble In Network In Network Out Network In Network Based on a Calendar Year $200/$400 $1,000/ $2,000 $2,000/$4,000 $1,000/$2,000 Physician Office Services Office Visit $10 Copay $30 copay 20% coinsurance a er deduc ble $10 Copay Emergency Medical Care Emergency Room $50 Copay $150 copay $150 copay $50 Copay Urgent Care Visits $10 Copay $50 copay $50 copay $10 Copay Prescrip on Drugs Generic / Preferred Brand / Non Preferred Brand $10 generic copay $40 brand copay $10 generic copay $40 brand copay Not Covered $10 generic copay $40 brand copay 2

4 HAP HMO P 1 3

5 HAP PPO P 2 4

6 HAP PPO P 2 C 5

7 HAP HMO P 3 6

8 HAP Medical Options New this year Allen Park Public Schools will be offering three different medical plans for employees to choose from. Two of the plan will be HMO s offered through HAP. The third plan will be a PPO plan offered through Alliance Health & Life (HAP PPO). The HMO plans require that everyone in your family choose a Primary Care Physician (PCP). This PCP will direct all your health care needs. You must u lize this PCP for all services. Should you need to see a specialist you must get a referral from your PCP. Your PCP MUST perform, arrange, or authorize ALL medical treatment, including tests and referrals to specialists. The other plan op on is a PPO Plan. PPO plan meaning you have freedom of choice to see any doctor you choose. You will have coverage both In and Out of Network. All employees have the ability to seek In Network care (by using the HAP website to locate in network doctors and hospitals ( The best way to find a PCP is by accessing the HAP website: then go to find a doctor. Please refer to the separate HAP handout with detailed instruc ons on naviga ng the website. 7

9 Flexible Spending Accounts As you know, health care and day care expenses can really add up. Flexible Spending Accounts give you a way to pay for these expenses with tax free dollars. Because you bypass taxes, you save money. There are two types of accounts: Health Care Flexible Spending Account Up to a $2,550 annual elec on Dependent Care Flexible Spending Account Up to a $5,000 annual elec on You may choose to par cipate in one or both of these op ons, depending on your individual needs. Flexible Spending Accounts allow you to save money because your contribu ons to the accounts are deducted from your pay before Federal and Social Security taxes are calculated. The amount of savings you will enjoy by par cipa ng in a Flexible Spending Account will depend on your individual tax bracket and the amount of money that is withheld form your paycheck on a tax free basis. The Health Care Flexible Spending Account is designed to help you pay for health expenses that are not covered by your basic health plans, including deduc ble amounts you have to pay and copays or co insurance amounts required by your insurance plans. Eligible expenses also include many expenses that may not covered by your vision or dental plan. The Dependent Care Flexible Spending Account is similar to the Health Care Flexible Spending Account; it allows you to pay for eligible dependent day care expenses with pre tax dollars. To decide whether a Dependent Care Flexible Spending Account is right for you, determine if you will incur eligible expenses. Generally, child and elder care companion services are eligible expenses, as are Social Security and other taxes you pay a caregiver. Any ques on about these accounts can be directed to Health Equity at: or 8

10 Waiving Medical Coverage Cash in lieu If you choose to decline the medical plan offered by Allen Park Public Schools, you may be eligible to receive cash in lieu of coverage. In order to receive the cash in lieu, you must provide proof of other coverage. By elec ng into the cash in lieu op on, you are acknowledging that you understand you will only be allowed to change your elec on during the next open enrollment period or during a qualified event. The cash in lieu amount is determined per Collec ve Bargaining Agreement NOTE: You MUST provide proof of other coverage in order to receive the cash in lieu credit. Acceptable forms of proof would include: A copy from insurance carrier website showing you listed as having insurance; a le er from the subscriber s employer sta ng you have or will have coverage lis ng an effec ve date. You will need to provide this documenta on to Joannie Payne at Riley. You will NOT receive the opt out credit un l documenta on is received by Allen Park Public Schools. 9

11 D 10

12 MESSA V S 11

13 L D C HIPAA N Life and Disability Coverage Based on your Collec ve Bargaining Agreement or Employment Agreement you may be eligible for Life Insurance and Disability Insurance (i.e. income replacement). Cigna is the insurance company and Sun Life is the carrier for the Disability. Detailed informa on on these plans can be found on the district website. Please note, your Life Insurance benefit will be paid to the most recent Beneficiary Form Allen Park Public Schools has on file. It is your responsibility to update the Beneficiary Form when circumstances change. A new Beneficiary Form can be found on the districts website. HIPAA No ce As part of the HIPAA regula ons, the Allen Park Public Schools health plan is required to advise employees of the Allen Park Public Schools privacy prac ces with regard to your protected health informa on. Protected health informa on (PHI) is defined as informa on about you, which is maintained by Allen Park Public Schools to carry out certain health care opera ons such as eligibility, enrollment, payment of premiums and payment of claims on your behalf. Any health informa on received by the Allen Park Public Schools Benefits staff is, and shall con nue to be, handled in a confiden al manner. Allen Park Public Schools has implemented a number of security measures to help prevent unauthorized access to such informa on. You are encouraged to carefully review the No ce of Privacy Prac ces document that is provided in this benefit guide. 12

14 A N Women s Health & Cancer Rights Act If you receive plan benefits in connec on with a mastectomy, you are en tled to coverage for the following under the plan: Reconstruc on of the breast on which the mastectomy was performed Surgery and reconstruc on of the other breast to produce a symmetrical appearance Prostheses and treatment for physical complica ons for all stages of a mastectomy, including lymphedemas (swelling associated with the removal of lymph nodes) The plan will determine the manner of coverage in consulta on with you and your a ending doctor. Coverage for breast reconstruc on and related services will be subject to deduc bles and coinsurance amounts that are consistent with those that apply to other benefits under the plan. If you would like further informa on about the Women's Health & Cancer Rights Act, please contact your medical carrier or your employer. Newborn's and Mother's Health Protec on Act Group health plans and health insurance issuers generally may not, under federal law, restrict benefits for any hospital length of stay in connec on with childbirth for the mother or newborn child to less than 48 hours following a normal vaginal delivery, or less than 96 hours following a cesarean sec on. However, federal law generally does not prohibit the mother's or newborn's a ending physician, a er consul ng with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, health plan providers may not require that a provider obtain authoriza on for prescribing a hospital length of stay of less than 48 hours (or 96 hours). Special Enrollment Events/Changes in Family Status If you decline coverage for yourself and/or your dependents (including your spouse) now because you are covered by another health insurance plan, you may be able to enroll yourself or your dependents in this plan in the future. If you acquire a new dependent as a result of marriage, birth, adop on or placement for adop on, you may be able to enroll your dependents provided that you request enrollment within 30 days a er the event. These events are referred to as changes in family status. In addi on, if you were to lose coverage, you must request enrollment within 30 days a er the coverage ends and if the event qualifies as a family status change. When you become enrolled as the result of a Special Enrollment Event, coverage will be made effec ve on the date of the event. 13

15 N P P THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. The Health Insurance Portability & Accountability Act of 1996 ( HIPAA ) is a federal program that requires that all medical records and other individually iden fiable health informa on used or disclosed by us in any form, whether electronically, on paper, or orally, are kept properly confiden al. This Act gives you significant new rights to understand and control how your health informa on is used. HIPAA provides penal es for covered enes that misuse personal health informa on. As required by HIPAA, we have prepared this explana on of how we are required to maintain the privacy of your health informa on and how we may use and disclose your health informa on. We may use and disclose your medical records only for each of the following purposes: treatment, payment and health care opera ons. Treatment means providing, coordina ng, or managing health care and related services by one or more health care providers. An example of this would include case management. Payment means such ac vi es as obtaining reimbursement for services, confirming coverage, billing or collec on ac vi es, and u liza on review. An example of this would be adjudica ng a claim and reimbursing a provider for an office visit. Health care opera ons include the business aspects of running our health plan, such as conduc ng quality assessment and improvement ac vi es, audi ng func ons, cost management analysis, and customer service. An example would be an internal quality assessment review. We may also create and distribute de iden fied health informa on by removing all references to individually iden fiable informa on. We may contact you to provide informa on about treatment alterna ves or other health related benefits and services that may be of interest to you. Any other uses and disclosures will be made only with your wri en authoriza on. You may revoke such authoriza on in wri ng and we are required to honor and abide by that wri en request, except to the extent that we have already taken ac ons relying on your authoriza on. You have the following rights with respect to your protected health informa on, which you can exercise by presen ng a wri en request to the Privacy Officer: The right to request restric ons on certain uses and disclosures of protected health informa on, including those related to disclosures to family members, other rela ves, close personal friends, or any other person iden fied by you. We are not, however, required to agree to a requested restric on. If we do agree to a restric on, we must abide by it unless you agree in wri ng to remove it. The right to reasonable requests to receive confiden al communica ons of protected health informa on from us by alterna ve means or at alterna ve loca ons. The right to inspect and copy your protected health informa on. The right to amend your protected health informa on. The right to receive an accoun ng of non rou ne disclosures of protected health informa on. We have the obliga on to provide and you have the right to obtain a paper copy of this no ce from us at least every three years. We are required by law to maintain the privacy of your protected health informa on and to provide you with no ce of our legal du es and privacy prac ces with respect to protected health informa on. This no ce is effec ve as of January 1, 2017 and we are required to abide by the terms of the No ce of Privacy Prac ces currently in effect. We reserve the right to change the terms of our No ce of Privacy Prac ces and to make the new no ce provisions effec ve for all protected health informa on that we maintain. We will post and you may request a wri en copy of a revised No ce of Privacy Prac ces from this office. You have recourse if you feel that your privacy protec ons have been violated. You have the right to file a formal, wri en complaint with us at the address below, or with the Department of Health & Human Services, Office for Civil Rights, about viola ons of the provisions of this no ce or the policies and procedures of our office. We will not retaliate against you for filing a complaint. 14

16 M P D N Important No ce from Allen Park Public Schools About Your CREDITABLE Prescrip on Drug Coverage and Medicare Please read this no ce carefully and keep it where you can find it. This no ce has informa on about your current prescrip on drug coverage with Allen Park Public Schools and about your op ons under Medicare s prescrip on drug coverage. This informa on can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescrip on drug coverage in your area. Informa on about where you can get help to make decisions about your prescrip on drug coverage is at the end of this no ce. There are two important things you need to know about your current coverage and Medicare s prescrip on drug coverage: 1. Medicare prescrip on drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescrip on Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescrip on drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. 2. Allen Park Public Schools has determined that the prescrip on drug coverage offered by MESSA is, on average for all plan par cipants, expected to pay out as much as standard Medicare prescrip on drug coverage pays and is therefore considered Creditable Coverage. Because your exis ng coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan. When Can You Join A Medicare Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th. However, if you lose your current creditable prescrip on drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan. You should also know that if you drop or lose your current coverage with Priority Health and don t join a Medicare drug plan within 63 con nuous days a er your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 con nuous days or longer without creditable prescrip on drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescrip on drug coverage. In addi on, you may have to wait un l the following November to join. For More Informa on About This No ce Or Your Current Prescrip on Drug Coverage Contact the person listed below for further informa on NOTE: You ll get this no ce each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Allen Park Public Schools changes. You also may request a copy of this no ce at any me. For More Informa on About Your Op ons Under Medicare Prescrip on Drug Coverage More detailed informa on about Medicare plans that offer prescrip on drug coverage is in the Medicare & You handbook. You ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more informa on about Medicare prescrip on drug coverage: Visit Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the Medicare & You handbook for their telephone number) for personalized help Call MEDICARE ( ). TTY users should call What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan? If you decide to join a Medicare drug plan, your current coverage will not be affected. Summary of Op ons for Medicare Eligible Employees (and/or Dependents): Con nue medical and prescrip on drug coverage and do not elect Medicare D coverage. Impact your claims con nue to be paid by Allen Park Public Schools health plan. Con nue medical and prescrip on drug coverage and elect Medicare D coverage. Impact As an ac ve employee (or dependent of an ac ve employee) the Allen Park Public Schools health plan con nues to pay primary on your claims (pays before Medicare D). Drop the coverage and elect Medicare Part D coverage. Impact Medicare is your primary coverage. You will not be able to rejoin the Allen Park Public Schools health plan unless you experience a family circumstance change or un l the next open enrollment period. If you do decide to join a Medicare drug plan and drop your current coverage, be aware that you and your dependents will not be able to get this coverage back unless you experience a family status change or un l the next open enrollment period. When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan? 15 If you have limited income and resources, extra help paying for Medicare prescrip on drug coverage is available. For informa on about this extra help, visit Social Security on the web at or call them at (TTY ). Remember: Keep this Creditable Coverage no ce. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this no ce 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). Date: January 1, 2017 Name of En ty/sender: Pam Smart Contact Posi on/office: Allen Park Public Schools Address: smart@appschools.com Phone Number: CMS Form CC Updated April 1, 2015 According to the Paperwork Reduc on Act of 1995, no persons are required to respond to a collec on of informa on unless it displays a valid OMB control number. The valid OMB control number for this informa on collec on is The me required to complete this informa on collec on is es mated to average 8 hours per response ini ally, including the me to review instruc ons, search exis ng data resources, gather the data needed, and complete and review the informa on collec on. If you have comments concerning the accuracy of the me es mate(s) or sugges ons for improving this form, please write to: CMS, 7500 Security Boulevard, A n: PRA Reports Clearance Officer, Mail Stop C , Bal more, Maryland

17 COBRA NOTICE Model General No ce Of COBRA Con nua on Coverage Rights ** Con nua on Coverage Rights Under COBRA** Introduc on You re ge ng this no ce because you recently gained coverage under a group health plan (the Plan). This no ce has important informa on about your right to COBRA con nua on coverage, which is a temporary extension of coverage under the Plan. This no ce explains COBRA con nua on coverage, when it may become available to you and your family, and what you need to do to protect your right to get it. When you become eligible for COBRA, you may also become eligible for other coverage op ons that may cost less than COBRA con nua on coverage. The right to COBRA con nua on coverage was created by a federal law, the Consolidated Omnibus Budget Reconcilia on Act of 1985 (COBRA). COBRA con nua on coverage can become available to you and other members of your family when group health coverage would otherwise end. For more informa on about your rights and obliga ons under the Plan and under federal law, you should review the Plan s Summary Plan Descrip on or contact the Plan Administrator. You may have other op ons available to you when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out of pocket costs. Addi onally, you may qualify for a 30 day special enrollment period for another group health plan for which you are eligible (such as a spouse s plan), even if that plan generally doesn t accept late enrollees. What is COBRA con nua on coverage? COBRA con nua on coverage is a con nua on of Plan coverage when it would otherwise end because of a life event. This is also called a qualifying event. Specific qualifying events are listed later in this no ce. A er a qualifying event, COBRA con nua on coverage must be offered to each person who is a qualified beneficiary. You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA con nua on coverage: must pay for COBRA con nua on coverage. If you re an employee, you ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events: Your hours of employment are reduced, or Your employment ends for any reason other than your gross misconduct. 16

18 COBRA NOTICE If you re the spouse of an employee, you ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events: Your spouse dies; Your spouse s hours of employment are reduced; Your spouse s employment ends for any reason other than his or her gross misconduct; Your spouse becomes en tled to Medicare benefits (under Part A, Part B, or both); or You become divorced or legally separated from your spouse. Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying events: The parent employee dies; The parent employee s hours of employment are reduced; The parent employee s employment ends for any reason other than his or her gross misconduct; The parent employee becomes en tled to Medicare benefits (Part A, Part B, or both); The parents become divorced or legally separated; or The child stops being eligible for coverage under the Plan as a dependent child. When is COBRA con nua on coverage available? The Plan will offer COBRA con nua on coverage to qualified beneficiaries only a er the Plan Administrator has been no fied that a qualifying event has occurred. The employer must no fy the Plan Administrator of the following qualifying events: The end of employment or reduc on of hours of employment; Death of the employee; 17 The employee s becoming en tled to Medicare benefits (under Part A, Part B, or both). For all other qualifying events (divorce or legal separa on of the employee and spouse or a dependent child s losing eligibility for coverage as a dependent child), you must no fy the Plan Administrator within 60 days a er the qualifying event occurs. You must provide this no ce to: Joannie Payne at Riley. How is COBRA con nua on coverage provided? Once the Plan Administrator receives no ce that a qualifying event has occurred, COBRA con nua on coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA con nua on coverage. Covered employees may elect COBRA con nua on coverage on behalf of their spouses, and parents may elect COBRA con nua on coverage on behalf of their children. COBRA con nua on coverage is a temporary con nua on of coverage that generally lasts for 18 months due to employment termina on or reduc on of hours of work. Certain qualifying events, or a second qualifying event during the ini al period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage. There are also ways in which this 18 month period of COBRA con nua on coverage can be extended:

19 COBRA NOTICE Disability extension of 18 month period of COBRA con nua on coverage If you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you no fy the Plan Administrator in a mely fashion, you and your en re family may be en tled to get up to an addi onal 11 months of COBRA con nua on coverage, for a maximum of 29 months. The disability would have to have started at some me before the 60th day of COBRA con nua on coverage and must last at least un l the end of the 18 month period of COBRA con nua on coverage. Second qualifying event extension of 18 month period of con nua on coverage If your family experiences another qualifying event during the 18 months of COBRA con nua on coverage, the spouse and dependent children in your family can get up to 18 addi onal months of COBRA con nua on coverage, for a maximum of 36 months, if the Plan is properly no fied about the second qualifying event. This extension may be available to the spouse and any dependent children ge ng COBRA con nua on coverage if the employee or former employee dies; becomes en tled to Medicare benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the dependent child stops being eligible under the Plan as a dependent child. This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred. Are there other coverage op ons besides COBRA Con nua on Coverage? Yes. Instead of enrolling in COBRA con nua on coverage, there may be other coverage op ons for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage op ons (such as a spouse s plan) through what is called a special enrollment period. Some of these op ons may cost less than CO BRA con nua on coverage. You can learn more about many of these op ons at If you have ques ons Ques ons concerning your Plan or your COBRA con nua on coverage rights should be addressed to the contact or contacts iden fied below. For more informa on about your rights under the Employee Re rement Income Security Act (ERISA), including COBRA, the Pa ent Protec on and Affordable Care Act, and other laws affec ng group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor s Employee Benefits Security Administra on (EBSA) in your area or visit (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA s website.) For more informa on about the Marketplace, visit Keep your Plan informed of address changes To protect your family s rights, let the Plan Administrator know about any changes in the addresses of family members. You should also keep a copy, for your records, of any no ces you send to the Plan Administrator. Plan contact informa on: Joannie Payne at Riley, Payroll & Benefits, Allen Park Schools 9601 Vine Ave. Allen Park, MI (p) (f ) payne@appublicschools.com 18

20 V C Carrier Website Phone Number HAP Health Equity - FSA ADN Dental MESSA Vision / Life Action Steps: 1. Review this 2017 Open Enrollment Guide 2. Complete all necessary enrollment forms and return it to Joannie Payne at Riley by Monday, November 28th The Following forms need to be completed: HAP PPO Enrollment form or HAP HMO Enrollment form FSA form ADN Dental form MESSA Vision / Life form Cafeteria Election form (if applicable) All employees must complete all 2017 enrollment forms! Failure to return signed 2017 enrollment forms by November 28, 2016 will result in NO benefits. 19

21 Allen Park Public Schools The contents of this booklet is intended for use as an easy to read summary only. It does not constitute a contract. Additional limitations and exclusions may apply. For an official description of benefits, please refer to each carrier s official certificate/benefit guide.