2018 Benefits Guide. Your Health Your Decision

Transcription

1 2018 Benefits Guide Your Health Your Decision

2 Welcome to your 2018 Benefits Enrollment What s in the Guide? Enrollment Process 3 Medical 4-6 Flexible Spending Account 7 Dental 8 Vision 9 Voluntary Benefits 10 Life Insurance Disability Identity Theft Protection 15 Important Contacts 16 We are honored to present your 2018 Benefit Options! The elections you make during your enrollment will be effective through December 31, The cost of Medical, Dental and Vision benefits vary by your employment classification. Basic Life and AD&D is paid by New Albany Plain Local Schools for all employees. In addition, there are voluntary benefits (Voluntary Life and Accidental Death & Dismemberment, Short- Term Disability, Long-Term Disability, Accident, Flexible Spending Accounts and LifeLock) with reasonable group rates that you can purchase through New Albany Plain Local Schools payroll deductions. When can I Enroll? Elections made now will remain until the next open enrollment period unless you or your family members experience a qualifying event. If you experience a qualifying event, you must contact the Treasurer s Office (Fiscal Specialist) within 31 days. 2

3 Enrollment Process 2018 Benefits Guide New Albany Plain Local Schools New Albany Plain Local Schools provides electronic enrollment through Explain My Benefits. Explain My Benefits provides eligible employees the ability to make group insurance benefit elections and changes online during the annual open enrollment, new hire orientation and qualifying events. Enrollment has never been easier. Accessible 24 hours a day, information about all of your employee benefits election options, including premiums and carrier contact information, are also available to help you make informed decisions. You can also log into the Explain My Benefits portal at anytime to review your benefits, access carrier links, update your personal information for yourself and dependents, update your beneficiaries and process qualifying life events. How to Enroll Self-Service Visit click on the red Log into Your Benefit System button and move through the enrollment system at your own pace Review the posted benefit guide and plan summaries to help you with your benefit decisions. 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. Reminders Be sure to review the 2018 Benefits Guide and plan summaries prior to going through the enrollment process Be prepared by gathering dependent and beneficiary information (i.e. Social Security Numbers and Dates of Birth) 3

4 Medical Deductible In Network HSA Plan A Out of Network Single $6,550 $10,000 Family* $13,100 $20,000 Coinsurance 100% 50% Out of Pocket Maximum Single $6,550 $15,000 Family* $13,100 $30,000 Doctor s Office Office Visit 100% after deductible 50% after deductible Preventive Care Services (routine exams, x-rays/tests, immunizations, well baby care and mammograms) Hospital Services No Cost Share 50% after deductible Emergency Room 100% after deductible 100% after deductible Urgent Care Center Services 100% after deductible 50% after deductible Inpatient 100% after deductible 50% after deductible Outpatient Surgery 100% after deductible 50% after deductible Ambulance Service 100% after deductible 100% after deductible Other Services Medical Mutual of Ohio - HSA Plan A If you enroll in the High Deductible Health Plan you may also enroll in a Health Savings Account. Any money you contribute into this account will be withdrawn from your check before taxes are deducted to help pay for eligible medical, dental and vision expenses and any unused money in your HSA will carry forward. Also, your HSA is yours to keep which means that you can take it with you if you change jobs or retire. If you have any money remaining in your HSA after your retirement, you may withdraw the money as cash. Please check with your tax advisor for more information about possible tax implications HSA Contribution Limits: Single: $3,450 Family: $6, HSA Board Paid Contribution**: Single: $750 Family: $2,000 A Catch Up contribution of an additional $1,000 can be made at any time during the year in which a participant turns 55. Diagnostic Lab/X-ray 100% after deductible 50% after deductible Diagnostic (MRI, CT Scans, Nuclear Medicine) 100% after deductible 50% after deductible Rx OC (Express Scripts) Retail Generic/Preferred/Non-Preferred (31 day supply) Direct Mail (90 day supply) Pre-authorization may be required for some drugs 100% after deductible 50% after deductible 100% after deductible Not covered *Eligible Dependents to age 28 **The Board contribution to the HSA account is made to the employee s CME Credit Union HSA account. 4

5 Medical Medical Mutual of Ohio - HSA Plan B Deductible In Network HSA Plan B 2018 Benefits Guide New Albany Plain Local Schools If you enroll in the High Deductible Health Plan you may also enroll in a Health Savings Account. Any money you contribute into this account will be withdrawn from your check before taxes are deducted to help pay for eligible medical, dental and vision expenses and any unused money in your HSA will carry forward. Also, your HSA is yours to keep which means that you can take it with you if you change jobs or retire. If you have any money remaining in your HSA after your retirement, you may withdraw the money as cash. Please check with your tax advisor for more information about possible tax implications HSA Contribution Limits: Single: $3,450 Family: $6, HSA Board Paid Contribution**: Single: $375 Family: $1,000 A Catch Up contribution of an additional $1,000 can be made at any time during the year in which a participant turns 55. Out of Network Single $3,250 $6,500 Family* $6,550 $13,000 Coinsurance 100% 50% Out of Pocket Maximum Single $3,250 $13,000 Family* $6,550 $26,000 Doctor s Office Office Visit 100% after deductible 50% after deductible Preventive Care Services (routine exams, x-rays/tests, immunizations, well baby care and mammograms) Hospital Services No Cost Share 50% after deductible Emergency Room 100% after deductible 100% after deductible Urgent Care Center Services 100% after deductible 50% after deductible Inpatient 100% after deductible 50% after deductible Outpatient Surgery 100% after deductible 50% after deductible Ambulance Service 100% after deductible 100% after deductible Other Services Diagnostic Lab/X-ray 100% after deductible 50% after deductible Diagnostic (MRI, CT Scans, Nuclear Medicine) 100% after deductible 50% after deductible Rx OC (Express Scripts) Retail Generic/Preferred/Non-Preferred (31 day supply) Direct Mail (90 day supply) Pre-authorization may be required for some drugs 100% after deductible 50% after deductible 100% after deductible Not covered *Eligible Dependents to age 28 **The Board contribution to the HSA account is made to the employee s CME Credit Union HSA account. 5

6 Health Savings Account (HSA) What is an HSA? A health savings account (HSA) is a tax-favored savings account. Money in the savings account helps pay your deductibles, coinsurance and out of pocket expenses. Once the deductible is met, the plan starts paying. Money left in the savings account may earn interest and is yours to keep. New Albany Plain Local Schools uses CME Federal Credit Union for HSA accounts. HSAs have many benefits: The money you put in your HSA account is pre-tax and tax deductible. You don t pay taxes on withdrawals when paying for qualified medical expenses. YOUR HSA balance can be carried over year after year. You own the savings account and you decide when to use the funds in it to pay for qualified medical expenses! New Albany Plain Local Schools will make a contribution to your Health Savings Account. The contribution that applies to you will be shown when you process your enrollment transaction, if you are able to open and fund a Health Savings Account (see questions below to see if you qualify to open and fund an Health Savings Account). 6 Maximum Annual HSA Contributions (total of employer and employee contributions): Individual - $3,450 Family - $6,850 If you are 55 years or older, you may contribute an additional $1,000 annually If you answer YES to any of the following questions, you are NOT eligible to open or fund a Health Savings Account: 1. In 2018, will you be covered by another non-qualified medical plan such as a PPO, Medicare or Tricare? 2. In 2018, will you or a spouse participate in a General Purpose Flexible Spending Account? 3. In 2018, will you be enrolled in either Medicare Part A, Part B, Part C or Part D? 4. In 2018, if you are under age 26, will you be claimed as a dependent on your parents tax return, or covered under your parents health insurance plan?

7 Flexible Spending Account (FSA) 2018 Benefits Guide New Albany Plain Local Schools FSAs help to fill coverage gaps between health plans and out-of-pocket expenses. An FSA allows you to pay for certain medical, dental vision and dependent care expenses with pre-tax dollars. You won t pay taxes on the funds you put into your FSA because they are deducted on a pre-tax basis. There are 2 Medical FSAs and a Dependent Care FSA available and are administered by FlexSystems. General Purpose FSA Limited Purpose FSA Dependent Care FSA Who is Eligible? Maximum Annual Contribution New Albany employees who enroll in one of the medical plans and cannot have a Health Savings Account or who waive coverage under both medical plans. New Albany employees who are enrolled in one of the New Albany medical HDHP Plans and who have an HSA. New Albany employees with a qualifying dependent. $2,600 per employer $2,600 per employer $5,000 per family Sample of Qualified Expenses Co-pays/Deductibles Prescriptions Dental Work Vision Exams Eyeglasses Lasik Chiropractic Care Contact Lenses & Supplies Dental & Vision Expenses Only Dental Work Vision Exams Eyeglasses Lasik Contact Lenses & Supplies Babysitters Daycare Centers Elder Care Day Camps Preschool After-School Care Eligible dependents are children up to age 13 and/or elder dependents (i.e. aging parents) that live in your home. Also covers a spouse or dependent who is physically or mentally challenged and for whom you claim an exemption. 7

8 Dental Good oral care enhances overall physical health, appearance and mental well-being. Problems with the teeth and gums are common and easily treated health problems. Keep your teeth healthy and your smile bright with the New Albany Plain Local Schools dental benefit plan. Annual Deductible Maximum Payment Delta Dental PPO PPO Dentist Premier Dentist Nonparticipating Dentist $25 per person, maximum of $75 per family $1,500 per person per calendar year Diagnostic & Preventive Diagnostic & Preventive - exams, cleanings, fluoride and space maintainers 100% 100% 100% Sealants - to prevent decay of permanent teeth 100% 100% 100% Brush Biopsy - to detect oral cancer 100% 100% 100% Radiographs - X-rays 100% 100% 100% Basic Services (Deductible Applies) Emergency Palliative Treatment - to temporarily relieve pain 80% 80% 80% Minor Restorative Services - fillings and crown repair Go to to locate a network PPO or Premier provider. Please note that your out-ofpocket costs may be more if you choose to go to a nonparticipating provider. Eligible Dependents to age % 80% 80% Endodontic Services - root canals 80% 80% 80% Periodontic Services - to treat gum disease 80% 80% 80% Oral Surgery Services - extractions and dental surgery 80% 80% 80% Other Basic Services 80% 80% 80% Relines and Repairs - to bridges, dentures and implants Major Services (Deductible Applies) 60% 60% 60% Major Restorative Services - crowns 60% 60% 60% Prosthodontic Services - bridges, dentures and implants Orthodontic Services ($1,000 lifetime max) Braces Orthodontic Age Limit 60% 60% 60% Orthodontic Services 60% 60% 60% No Age Limit

9 Vision 2018 Benefits Guide New Albany Plain Local Schools Regular eye examinations cannot only determine your need for corrective eyewear, but also may detect general health problems in their earliest stages. Protection for your eyes should be a major concern to everyone. Vision is through EyeMed. Vision Care Services EyeMed Basic Vision Plan EyeMed Buy-Up Vision Plan In-Network Out-of-Network In-Network Out-of-Network Exam with Dilation N/A N/A $15 Copay Up to $30 Standard Contact Lens Exam N/A N/A Up to $40 N/A Premium Contact Lens Exam N/A N/A 10% off retail N/A Retinal Imaging N/A N/A Up to $39 N/A Frames $0 Copay, $130 Allowance, 80% of charge over $130 Up to $65 $0 Copay, $130 Allowance, 80% of charge over $130 Up to $65 Single Vision Lenses $15 Copay Up to $25 $15 Copay Up to $25 Bifocal Lenses $15 Copay Up to $40 $15 Copay Up to $40 Trifocal Lenses $15 Copay Up to $60 $15 Copay Up to $60 Standard Progressive Lenses $80 Up to $40 $80 Up to $40 Premium Progressive Lenses $80, 80% of charge less $120 Allowance Up to $40 $80, 80% of charge less $120 Allowance Up to $40 Lenticular Lenses $15 Copay Up to $60 $15 Copay Up to $60 UV Treatment $15 N/A $15 N/A Tint $15 N/A $15 N/A Standard Scratch Coating $15 N/A $15 N/A Standard Polycarbonate $40 N/A $40 N/A Standard Anti-Reflective $45 N/A $45 N/A Polarized 20% off retail N/A 20% off retail N/A Other Add-Ons & Services 20% off retail N/A 20% off retail N/A Conventional Contacts $0 Copay, $130 Allowance, 85% of charge over $130 Up to $104 $0 Copay, $130 Allowance, 85% of charge over $130 Up to $104 Disposable Contacts $0 Copay, $130 Allowance, plus balance over $130 Up to $104 $0 Copay, $130 Allowance, plus balance over $130 Up to $104 Medically Necessary Contacts $0 Copay, Paid in Full Up to $200 $0 Copay, Paid in Full Up to $200 Lasik or PRK 15% off retail, 5% off promo N/A 15% off retail, 5% off promo N/A Frequency Examination N/A Once every 12 months Lenses & Contacts Frames Once every 12 months Once every 12 months For a complete list of providers, go to or call Dependents are eligible to age 19, and to age 25 if full-time student. 9

10 Voluntary Benefits What are Voluntary Benefits? Voluntary Benefits are offered to strengthen your overall benefits package. You customize the benefit based on need and affordability. Ownership Policies are fully portable and belong to you if you leave your employer, same price and same plan Benefits are payroll deducted Cash benefits are paid directly to you, not to a hospital or to a doctor Benefits are paid regardless of any other coverage you may have Level premiums Rates do not increase with age Guaranteed Renewable Designed to provide additional cash flow to assist with out of pocket medical costs and other bills The Voluntary Benefits offered through Trustmark are Accident and Universal Life. Accident Plan A plan that helps pay for the unexpected expenses that result from an accident On and off the job coverage = 24 hours per day, 7 days a week Family coverage available Sports related injuries covered as well Just a few examples of benefit included in the plan: Emergency Room Visits - $200 Hospitalization - $2,000 admission benefit, $400 per day benefit Fractures - up to $10,000 Dislocations - up to $8,000 Health Screening Benefit - $100 per insured per year See brochure for a complete list of benefits Semi-Monthly Payroll Deductions Employee Employee & Spouse Employee & Children* Family* $9.53 $14.54 $17.68 $22.69 *Dependents up to age 26 can be covered regardless of student status. 10

11 Basic Life and AD&D 2018 Benefits Guide New Albany Plain Local Schools The amount of life insurance that is right for you depends on a variety of factors, including your age, family status, personal savings, financial commitments, etc. New Albany Plain Local Schools offers a variety of programs to meet your life insurance needs. New Albany Plain Local Schools provides a basic life and accidental death and dismemberment (AD&D) insurance coverage, through Prudential, to all benefit eligible employees at no cost to the employee based on your contract. Trustmark Universal Life with Long Term Care Universal Life with Long Term Care includes both a death benefit and a living benefit. Trustmark Universal Life with Long Term Care is a permanent life insurance that is designed to match your needs throughout your lifetime. It pays a higher death benefit during your working years when expenses are high and you need maximum protection. The Universal Life with Long Term Care is priced to remain the same cost to you until age 100. The death benefit reduces at age 70 when the need for life insurance typically decreases. The Living Benefit, Long Term Care never reduces and is 4% of the original death benefit per month for up to 25 months. If you use the Long Term Care benefit, your death benefit amount does not reduce due to the Benefit Restoration feature included. Coverage available for spouse and children as well. Special Underwriting for Initial Offering Guaranteed Issue (Employee Only) The lesser of the face amount purchased by $16 per week or $200,000 If you waived this benefit previously, you must answer a few health questions and be approved for coverage. Rates This benefit is customized by each employee so rates vary, but can start as little as a few dollars a week. Your specific rate will be calculated for you on the electronic enrollment system. 11

12 Voluntary Term Life You also have the opportunity to purchase supplemental coverage for yourself, spouse and dependent children, through Prudential. Please note that dependent children include unmarried, adopted, natural or stepchildren age 14 days to age 19 (age 25 if unmarried and a full-time student). You may elect Voluntary Life Insurance in increments of $5,000 to a maximum of $500,000, not to exceed 5x covered annual salary. You may elect Voluntary Life Insurance on your spouse in increments of $2,500 to a maximum of $100,000, not to exceed 100% of your Optional Life Benefit. You may also elect Voluntary Life Insurance on your child(ren) up to $10,000. Guaranteed Issue Amount $100,000 employee (not to exceed 5x annual salary) / $25,000 spouse / $10,000 children Age Band Employee & Spouse* Life Monthly Rate per $1,000 Age Band Employee & Spouse* Life Monthly Rate per $1,000 Child Life Monthly Rates per $1,000 <25 $ $ $ $ $ $ $ $ $ $ $ $ *Spouse life cost based on employee s age. Monthly Rates for Voluntary Term Life and AD&D Example: A 36 year old female, Sally, wants to purchase $50,000 of term life insurance..083 x 50 = $4.15 x 12/24 = $2.08 Monthly rate # of units/$1,000 monthly premium Semi-Monthly Per $1,000 Premium Rates Your specific rate will be calculated for you on the electronic enrollment system. 12

13 Short Term Disability 2018 Benefits Guide New Albany Plain Local Schools As an employee of New Albany Plain Local Schools, you are able to enroll in Short Term Disability (STD) coverage through One America. STD coverage supplements your lost wages should you be unable to work due to an illness, injury or pregnancy. STD coverage begins after missing the specific elimination period below due to a medically certified reason. Benefits are payable up to the specific benefit duration period below. Option 1 Option 2 Option 3 Option 4 Injury/Sickness Elimination Period 30/30 Days 7/7 Days 30/30 Days 7/7 Days Maximum Benefit Period 22 Weeks 26 Weeks 22 Weeks 26 Weeks Benefit Percentage 60% Weekly Earnings 60% Weekly Earnings 40% Weekly Earnings 40% Weekly Earnings Maximum Weekly Benefit $2,500 $2,500 $2,500 $2,500 Monthly Rate per $10 of Weekly Benefit $0.800 $1.300 $0.800 $1.300 Pre-Existing Condition: Anything you received medical treatment, advice or consultation, care or services including diagnostic measures, or had drugs or medicine prescribed or take in the 3 months prior to your insurance effective date will not be covered for the first 6 months of the policy. Option 1 Calculation Option 2 Calculation Option 3 Calculation Option 4 Calculation Based on an employee with a $31,200 annual salary Weekly Earnings $600 $600 Weekly Earnings $600 $600 Multiply by 60% $360 $360 Multiply by 40% $240 $240 Divide Coverage by Divide Coverage by Multiply by Rate $0.800 $1.300 Multiply by Rate $0.800 $1.300 Est. Monthly Cost $28.80 $46.80 Est. Monthly Cost $19.20 $31.20 Divide by 2 to get Semi-Monthly Rate $14.40 $23.40 Divide by 2 to get Semi-Monthly Rate $9.60 $

14 Long Term Disability As an employee of New Albany Plain Local Schools, you are eligible to enroll in Long Term Disability (LTD) coverage through One America. LTD coverage supplements your lost wages should you be unable to work due to an illness or injury. LTD coverage begins after missing the specified elimination period below due to a medically certified reason. Benefits are payable up to the specified benefit duration period below. Option 1 Option 2 Option 3 Elimination Period 180 Days 180 Days 180 Days Maximum Benefit Period SSFRA* SSFRA* SSFRA* Benefit Percentage 40% Monthly Earnings 30% Monthly Earnings 20% Monthly Earnings Maximum Monthly Benefit $5,000 $5,000 $5,000 Pre-Existing Condition: Anything you received medical treatment, advice or consultation, care or services including diagnostic measures, or had drugs or medicine prescribed or take in the 3 months prior to your insurance effective date will not be covered for the first 12 months of the policy. Monthly Premium Rate per $100 of Monthly Benefit for All Options Age Rate Age Rate Age Rate Age Rate <30 $ $ $ $ $ $ $ $ $ $1.610 Option 1 Calculation (40%) Option 2 Calculation (30%) Based on a 35 year old employee with a $36,000 annual salary Option 3 Calculation (20%) Monthly Earnings $3,000 $3,000 $3,000 Multiply by Benefit Percentage $1,200 $900 $600 Divide Coverage by Multiply by Rate from table above $0.700 $0.700 $0.700 Est. Monthly Cost $8.40 $6.30 $4.20 Divide by 2 to get Semi-Monthly Rate $4.20 $3.15 $2.10 *Social Security Full Retirement Age 14

15 Identity Theft Protection 2018 Benefits Guide New Albany Plain Local Schools Identity theft in the United States is a major problem that continues to be on the rise. Professional protection and assistance have become important tools in fighting the identity theft epidemic. Thieves today can get a hold of your personal information from trash cans, dumpsters, stolen mail, and even shoulder surfing. Once thieves have your information, it s a simple matter to open new fraudulent accounts and make purchases in your name. When you enroll in LifeLock, you can be confident knowing that they are available 24 hours a day, 7 days a week, and committed 100% to helping protect your information as if it were their own. LifeLock offers Proactive Protection: LifeLock Identity Theft Alert System Lost Wallet Protection Address Change Verification Black Market Website Surveillance Live Member Service Support LifeLock Privacy Monitor Reduce Pre-Approved Credit Card Offers Identity Restoration Support Stolen Funds Replacement - up to $100,000 Fictitious Identity Monitoring Court Records Scanning Data Breach Notifications Investment Account Activity Alerts $1 Million Total Service Guarantee LifeLock s proactive approach works to help stop identity theft before it happens. As a LifeLock member, if you become a victim of identity theft because of a failure in their service, they will help fix it at their expense, up to $1,000,000. Semi-Monthly Payroll Deductions Employee Only Employee & Spouse *Employee & Children *Family $4.25 $8.50 $7.44 $11.69 *Employee & Children and Family Tiers: You may enroll up to 8 children with 4 of those children between the ages of 18 and

16 Important Contacts Vendor Phone Number Website Medical Medical Mutual of Ohio Health Savings Accounts CME Federal Credit Union Prescriptions Express Scripts com Dental Delta Dental Vision EyeMed Life Insurance Prudential Disability One America Flexible Spending Accounts FlexSave Identity Theft Protection LifeLock Voluntary Benefits Trustmark Trustmark Claims Help Explain My Benefits , Option service@explainmybenefits.biz District Broker Grady Benefits

17 Benefit Guide Description Please Note: This guide provides information regarding the New Albany Plain Local Schools benefit program. More detailed information is available from the plan documents and administrative contacts. The plans and policies stated in this information are not a contract or a promise of benefits of any kind, and therefore, should not be interpreted as such.