Open Enrollment Starts April 10, 2017

Transcription

1 Benefits Enrollment Guide For Benefits Effective July 1, 2017 Welcome to Open Enrollment for Gilbert Public Schools (GPS). During the plan year, July 1, 2017 through June 30, 2018, GPS will offer a comprehensive benefits program to benefits-eligible employees. This Benefits Enrollment Guide provides highlights of the benefits program and will provide information to help you make the best choice for you and your family. Open Enrollment Starts April 10, 2017 Enrolling Online Before you make any decisions, you should review this Benefits Enrollment Guide thoroughly. Be sure to choose your benefit options carefully. You will not be able to make changes to your coverage until the next open enrollment period unless you have a qualifying life event. You must notify GPS in writing within 31 days of the status change. If you do not wish to pay for your contributions pre-tax, you must notify the GPS Insurance Department in writing. If you wish to participate in the Flexible Spending Accounts (FSA), you are required to enroll each year. During open enrollment you can: Add/drop/change medical, dental and vision plans Add/drop/change dependents Enroll in the Flexible Spending Accounts (FSAs) Change your beneficiary information Add/drop/change any voluntary insurance plans Get more information about your benefit plans Important Notice: All employees must complete their Online Enrollment through the ivision Employee Self-Service Portal. Failure to submit your enrollment before the enrollment deadline will result in auto-enrollment into the default Trust Bronze Plan. This plan is employee-only with no dependent coverage available and has a $6,350 deductible. All expenses will be the member s liability until the deductible is met.

2 Your Benefit Choices GPS is dedicated to offering you a comprehensive and competitive benefits package designed to address the health care needs of both you and your family, including: Health care programs medical, prescription drug, dental, and vision benefits Wellness benefits adult and well-child care such as routine immunizations, exams and screenings Flexible Spending Accounts (FSA) offer tax advantages when you set aside pre-tax dollars to pay for eligible health care and/or dependent care expenses Financial protection programs voluntary life insurance, short-term disability insurance, critical illness, accident, and cancer insurance An Employee Assistance Program (EAP) offering confidential counseling to help you deal with a range of life s issues Paying For Your Benefits GPS will pay the full cost (no employee contribution) for employee-only medical coverage in the plan year for the Trust Savings $1,500 Plan and the Trust Savings $2,500 Plan. Additionally, GPS will contribute $375 to the Trust Savings $1,500 Plan HSA and $725 to the Trust Savings $2,500 Plan HSA. GPS s contributions are deposited in equal increments on a pre-tax basis over 20 pay periods. The employee contribution to the employee-only premium on the Trust Plus PPO Plan with EDS Dental will be $432 annually. (The cost with the Trust Choice Dental will be $816 annually.) You will be responsible for the cost of your dependents coverage and any voluntary coverage you elect for you and your family. With the exception of the voluntary benefits, your portion of the costs are deducted from your paycheck on a pre-tax basis saving you federal, state and Social Security taxes by reducing your taxable income. Please continue to use your benefits wisely: Review your medical bills thoroughly to ensure proper billing. Get your medical care from doctors, hospitals, and health care providers who participate in the BlueCross BlueShield of Arizona (BCBSAZ) network. Have your short-term prescriptions filled at retail pharmacies and your maintenance medications filled through mail order. Take responsibility for your health by working toward a healthy weight, getting your flu shot annually, keeping your blood pressure in a safe range and having your cancer screening tests when appropriate. Medical Plan Options You have three medical plan options: The Trust Savings $1,500 Plan (HDHP) The Trust Savings $2,500 Plan (HDHP) The Trust Plus Plan (PPO Plan) With each medical plan option, you have access to providers in a medical network administered by BCBSAZ. Their PPO network consists of doctors, hospitals, and health care facilities that have contracted with them to provide care and services at discounted fees. Since BCBSAZ has a large network, chances are good that your current provider is in the network. Refer to page 8 for contact information should you need to verify your provider s participation or locate a doctor or hospital in your area. Online Access For more information or to find an in-network provider, log on to 2

3 Your Medical Plan Options The Trust Plus Plan The Trust Plus Plan is a PPO plan. You can see any provider you want under this plan option. However, when you use a BCBSAZ PPO provider, your out-of-pocket expenses will be lower. The Trust Savings $1,500 and $2,500 Plans The Trust Savings $1,500 and $2,500 Plans are High Deductible Health Plans (HDHP) that include a Health Savings Account (HSA) component. You can see any provider you want under these options. However, when you use a BCBSAZ PPO provider, your out-of-pocket expenses will be lower. Note: If you choose coverage under the HDHP with the HSA, you cannot contribute to the HSA and be covered under another group health plan (i.e., one offered by your spouse s employer) or other health insurance (such as Medicare), or a general purpose Health FSA. An authorization form must be completed each fiscal year to continue HSA contributions. A Comparison of Medical and Prescription Drug Benefits is provided on page 5, and in the Summary of Benefits & Coverage (SBC) provided separately. Important Information if you are Considering an HDHP (Trust Savings $1,500 or $2,500 Plans) with an HSA Are you in a financial position to pay the annual deductible amount under the HDHP if you or your family have large medical expenses before you accumulate a balance in your HSA? Can you make additional voluntary contributions to an HSA so that funds can accumulate for future health care expenses? If your answers are yes, an HDHP could be right for you. The Trust Savings $1,500 and $2,500 Plans With the Health Savings Account (HSA) Although this option has a higher in-network deductible per person than the other medical option, the HDHP includes an HSA, which will help you save money by allowing you and GPS to deposit before-tax dollars into the HSA to pay for qualified medical expenses. NOTE: If an employee elects dependent coverage (spouse, children or family) the family deductible must be met before the Plan will pay. How the HSA Works GPS will contribute up to $375 to your HSA for the plan year if you choose the Trust Savings $1,500 Plan. GPS will contribute up to $725 to your HSA for the plan year if you choose the Trust Savings $2,500 Plan. GPS s contributions are deposited in equal increments on a pre-tax basis over 20 pay periods. In 2017, your contributions plus GPS s may not exceed the IRS annual maximum contribution amount of $3,400 if you enroll in Employee Only coverage and $6,750 if you enroll in Family coverage. Your contributions to the HSA will be deducted from your paycheck in equal increments over your pay periods, on a pre-tax basis (before federal income, FICA, or state taxes are calculated). You save money because you pay less in taxes. NOTE: You will need to fill out a new HSA Payroll Deduction Form to initiate deductions for If you are over age 55, you can also set aside an additional $1,000 per year as a catch-up contribution. However, GPS will not provide a matching contribution for employee catch-up contributions. GPS will submit all contributions to a bank and an HSA will be established for you. Contributions will be available for use once they are deposited to your account. Your HSA funds may be used by you, your spouse and dependent children to pay for eligible medical expenses, such as deductibles, copays, coinsurance, certain uncovered health care expenses, and many over-the-counter (OTC) medicines and supplies. NOTE: Prescriptions are applied toward the medical deductible and claims are handled through Meritain Health. If a balance remains in your HSA at the plan year s end, the funds will roll over for your use during the next plan year. In addition, you will accumulate tax-free interest on your HSA funds. Your HSA is portable. If you leave your employer or switch medical plans, you can continue to use your funds for qualified health care expenses. You and your employer cannot contribute to your HSA if you are covered by another health plan (unless that other health plan is also a qualified HDHP). For example, if you are covered under your spouse's medical plan, you can only contribute to your HSA if your spouse's medical plan is ALSO a qualified HDHP. You and your spouse cannot be enrolled in the HDHP with HSA and also be enrolled in a Health Care FSA that reimburses for medical services. Other types of coverage such as veterans' benefits, Tricare, Medicaid, or supplemental medical insurance may also prevent you and your employer from being able to contribute to your HSA. If you have any type of Medicare coverage, you and your employer cannot contribute to your HSA. If your spouse has Medicare, but you do not, you may contribute to your HSA as "individual" coverage, not family coverage. 3

4 Get the Care You Need Anytime, Anywhere! Need to consult a doctor about a non-urgent illness, but can t get an appointment with your primary doctor? Teladoc allows you to see a U.S. board certified doctor anytime, through phone and video consults. What is Teladoc? Teladoc is an on-demand health care solution that gives you access to the medical care you need, when you need it. You can talk to a doctor anytime, anywhere about non-emergent medical conditions. What kind of doctors will I be talking with? Teladoc offers highly qualified, experienced doctors who have an average of over years in practice, use the latest technology to provide excellent care, are U.S. board certified and state licensed and specially trained in treating patients through telemedicine. How do I reach Teladoc? By phone Just call (800) Online Request a video consultation online at On the go You can download the Teladoc mobile app by visiting the App Store or Google Play When Do I Use Teladoc? Use Teladoc for medical advice and care when: Your primary care doctor isn t open You re at home, traveling or don t want take time off work to see a doctor You need a prescription or refills Note: There is no guarantee you will be prescribed medication. What can I use Teladoc for? Among the more common conditions Teladoc can help with: Allergies Bronchitis Cold/flu Headaches/migraines Eye/ear infections Rash/skin infections Sinus infections Stomachache/diarrhea Urinary tract infections Plus many other conditions If you are enrolled in the Trust Plus Plan, there is no cost for using Teladoc. For those enrolled in either the Trust Savings $1,500 Plan (HDHP) or the Trust Savings $2,500 Plan (HDHP), using Teladoc is $40 per consult and the cost is applied to your out-of-pocket limit. Preferred Drug Step Therapy Program We want to make sure that everyone who currently is prescribed medication gets the medication they need for their condition. Often a generic, over-the-counter (OTC), or preferred brand name drug is just as effective as a non-preferred brand name drug. The difference is only in the cost. The Preferred Drug Step Therapy Program (PDST) directs plan participants currently using non-preferred brands to switch to these less costly, but equally effective medications. If you have questions, contact Express Scripts at (800)

5 Comparison of Medical and Prescription Drug Benefits Medical Benefits Trust Plus PPO Plan Trust Savings $1,500 Plan (HDHP with HSA) Trust Savings $2,500 Plan (HDHP with HSA) In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network Calendar Year* Deductible Calendar Year Out-of-Pocket Limit*** Physician Office Services Routine Physicals & Wellness employee & spouse only (exams, Pap smears, mammograms, immunizations) Colonoscopy Screening for adults 50 and over (once every 10 years) Well Child Care through age 18 (exams, immunizations) $750/individual $2,250/family $6,350/individual; $12,700 family, then the Plan No maximum pays $1,500/individual $3,000/family $5,000/individual $10,000/family, then the Plan No maximum pays $2,500/individual $5,000/family $6,350/individual $12,700/family, then the Plan No maximum pays 80%* 60%* 80%* 60%* 80%* 60%* Inpatient Hospital $100 copay per admission, then Plan pays 80%* Rehabilitation Services In-patient maximum 80% per illness 60%* $100 copay per admission, then Plan pays 60%* 60% per illness 80%* 60%* 80%* 60%* 80% per illness 60% per illness 80% per illness 60% per illness Urgent Care 80%* 60%* 80%* 60%* 80%* 60%* Prescription Drug Benefits Calendar Year* $50/individual; $150/family Deductible Retail Pharmacy (up to a 30-day supply) Mail Order (up to a 90- day supply) Generic: 20% coinsurance, $10 minimum; Brand: 30% coinsurance** Non-Formulary: 40% coinsurance Specialty: 5% coinsurance, $150 maximum Generic: $20 copay Brand: $40 copay** Non-Formulary: $60 copay Subject to medical deductible and out-of-pocket limit Plan pays 80% after deductible is met and after out-of-pocket limit is met. Plan pays 80% after deductible is met and after out-of-pocket limit is met. Subject to medical deductible and out-of-pocket limit Plan pays 80% after deductible is met and after out-of-pocket limit is met. Plan pays 80% after deductible is met and after out-of-pocket limit is met. * After your medical plan deductible has been met. NOTE: Deductibles are based on the calendar year and run from January 1st through December 31st. ** If you purchase a brand-name drug when a generic is available, your cost will be the copay amount plus the cost difference between the generic drug and the brand-name drug. ***In-network deductibles, copays and coinsurance accumulate to the annual out-of-pocket limit. 5

6 2017 Premium Costs GPS will contribute $5,064 per year toward employee medical, prescription drug, EDS dental and vision coverage. If you want dependent coverage, your premium for your spouse and/or dependents depends on the coverage you choose. Please note that costs are approximate and will be prorated based on your insurance start date. Medical Premiums Trust Plus Plan Employer Monthly Contributions Cost to Employees Annual Premium Monthly Pay Deductions 20 Pay Periods 26 Pay Periods Employee Only $ $ $36.00 $21.60 $16.62 Employee + Spouse $ $5, $ $ $ Employee + Child(ren) $ $3, $ $ $ Employee + Family $ $8, $ $ $ Trust Savings $1,500 Plan* Employee Only $ $0 $0 $0 $0 Employee + Spouse $ $4, $ $ $ Employee + Child(ren) $ $2, $ $ $ Employee + Family $ $7, $ $ $ Trust Savings $2,500 Plan ** Employee Only $ $0 $0 $0 $0 Employee + Spouse $ $3, $ $ $ Employee + Child(ren) $ $2, $ $ $ Employee + Family $ $6, $ $ $ * Includes District HSA contribution of $375 annually ** Includes District HSA contribution of $725 annually Trust Choice Buy-Up Dental Plan Premiums Trust Choice Dental Plan Pay Deductions Monthly 20 Pay Periods 26 Pay Periods Employee Only $32.00 $19.20 $14.77 Employee + Spouse $92.00 $55.20 $42.46 Employee + Child(ren) $73.00 $43.80 $33.69 Employee + Family $ $64.20 $49.38 Employee Assistance Program You have access to an Employee Assistance Program (EAP) through EAP Preferred. Under the EAP, you and your household members can speak with a professional counselor (up to 10 sessions) who can help you with a variety of issues, such as: Marital or family problems Financial or legal difficulties Emotional or stress-related problems Drug or alcohol abuse Problems related to work To speak with a confidential EAP counselor, or to make an appointment call EAP Preferred at (602) Online Access For more information or to find an in-network provider, log on to User name: GPS123 password: eappreferred. 6

7 Your Vision and Dental Plan Options Vision Benefits Vision Plan for the Trust Plus or Trust Savings Plans VSP In-Network Providers Non-VSP Providers Calendar Year Deductible $0 $0 Vision Exam (once every 12 months) $35 allowance (once every 12 months) Single Vision Lenses (once every 12 months) $25 allowance (once every 12 months) Bifocal Lenses (once every 12 months) $40 allowance (pair once every 12 months) Trifocal Lenses (once every 12 months) $55 allowance (pair once every 12 months) Lenticular Lenses (once every 12 months) $100 allowance (pair once every 12 months) Frames (once every 24 months/retail frame allowance $115) $45 allowance (pair once every 12 months) Contact Lenses (elective) $105/pair (once every 12 months) $105/pair (once every 12 months) Contact Lenses (when determined by VSP to be medically necessary not elective) If you enroll in either medical plan, GPS offers you the option to enroll in comprehensive vision coverage to help you maintain healthy vision, including coverage for routine exams, lenses, frames, and contact lenses. Available through Vision Service Plan (VSP), many vision services are covered in full, without claims to file when you use a VSP in-network provider. Charges by non-vsp providers are payable up to the allowable amount. The VSP network consists of optometrists and eyewear providers nationwide. To find an in-network VSP provider, visit the VSP website at or call VSP Member Services at (800) You have two dental plan options: The Employers Dental Services Plan (District Paid Plan) The Trust Choice Dental Plan (Buy Up) The District offers the Employers Dental Services Plan at no cost to the employee. The Plan offers services on a copay basis. Copays will vary dependent on the service. In addition: s, claim forms, yearly maximums or waiting periods Access to one of the largest pre-paid dental networks in Arizona Orthodontic benefits for children and adults The latest dental health news and information through Employers Dental Health Edge SM Customer service based in Arizona Worldwide emergency dental benefits 24 hours a day (once every 12 months) $210 allowance (pair once every 12 months) Dental Benefits Trust Choice Dental Plan In-Network Out-of-Network Calendar Year Deductible $50/person, $150/family Calendar Year Maximum $1,250/person Lifetime Orthodontia/TMJ Benefit $1,750/person Diagnostic & Preventive 80% Restorative (basic) 80%* 60%* Endodontics & Periodontics 60%* 40%* Orthodontia, TMJ, Prosthodontics 60%* 40%* Oral Surgery 60%* 40%* * After your dental plan deductible has been met To find an in-network provider, log on to for the Employers Dental Services Plan (Plan 100N) or for the Trust Choice Plan. If you enroll in the Trust Plus Plan or either of the Trust Savings Plans, you may select the Trust Choice Dental Plan for an additional cost. You and your dependents may receive dental care from any provider you choose. However, if you use a dentist who participates in the BCBSAZ dental network, you will generally pay less for care because network dentists discount their fees. 7

8 Important Contact Information For Questions About... Plan Administration Trust Choice Dental Plan Voluntary Life Insurance Short-term Disability insurance Medical Plan Claims Administration Employers Dental Services (EDS) Plan In-Network Providers (BlueCross BlueShield of Arizona) Prescription Drug Coverage Retail Pharmacy Locations Mail Order Step Therapy Program Vision Plan Flexible Spending Accounts (FSA) Employee Assistance Plan (EAP) Health Saving Account (HSA) Contact... GPS Benefits Department (480) Adriane Dutchover (480) Leigh Ham (480) Julie Gustin (480) Meritain Health (602) or (866) Employers Dental Services (EDS) (800) BlueCross BlueShield of Arizona Express Scripts (800) Vision Services Plan (VSP) (800) or (800) Meritain Health (602) or (877) , select option 3, then enter EAP Preferred (602) Health Equity (866) Caution: If You Decline Medical Plan Coverage Offered Through Gilbert Public Schools If you are in a benefits-eligible position and choose not to be covered by one of GPS medical plan options, remember that you must maintain medical plan coverage elsewhere or you can purchase health insurance through a Marketplace typically at the Marketplace annual enrollment in the fall each year. Americans without medical plan coverage could have to pay a penalty when they file their personal income taxes. Visit the Health Insurance Marketplace for detailed information on individual shared responsibility payment penalty. If you choose to not be covered by a medical plan sponsored by GPS at this enrollment time, your next opportunity to enroll for GPS medical plan coverage is at the next annual open enrollment time, unless you have a qualifying mid-year change event that allows you to add coverage in the middle of the plan year. The information provided in this Benefits Enrollment Guide is of a general nature only and does not replace or alter the official rules and policies in the official plan documents that legally govern the terms and operation of the plans. Receipt of this Guide does not guarantee benefits eligibility. Online Access All benefit information can be accessed under the Benefits tab in the Benefits Information Center when you log into the ivision Employee Self-Service Portal. 8