2018-2019 Benefits Guide
Welcome to Enrollment for your 2018-2019 Benefits! We are honored to present your 2018-2019 Benefit Options! The elections you make during enrollment will be effective through September 30, 2019. Avon Lake City Schools offers you and your eligible family members a comprehensive and valuable benefits program. We encourage you to take the time to educate yourself about your options and choose the best coverage for you and your family. Guide Contents Enrollment Procedures..3 Medical. 4-5 Dental. 6 Vision.. 7 Employee Assistance..8-9 Flexible Spending. 10 Life Insurance.11 Voluntary Benefits..12-13 Identity Theft Protection 14 Important Contacts 15 When can I Enroll? Please reference each specific Plan Document to verify the Dependent Eligibility rules. Elections made now will remain until the next open enrollment period unless you or your family members experience a qualifying event such as the birth of a child, change in marital status, death, or loss of coverage due to no fault of your own. If you experience a qualifying event, you must contact the Business Office within 30 days of the qualifying event in order for coverage to be effective. 2 2018-2019 Benefits Guide
Open Enrollment Procedures The benefits you elect during Open Enrollment will be effective October 1, 2018. Open Enrollment is the one time per year that you can make changes to your benefits without a qualifying life event. Open Enrollment will be held from Friday, August 31st through Saturday, September 8th We have again partnered with Explain My Benefits, our benefit technology/communication vendor to assist in our Open Enrollment. This year we again have a self-service online enrollment using the EMB Enroll online system. How to Enroll Decide which of these three convenient enrollment options best fits your needs: Self-Service - available August 31 - September 8 Visit www.explainmybenefits.com/avon-lake, click on the yellow 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. If choosing this option, be sure to click Submit at the end of the process and make note of your confirmation number. Return to the system anytime and click your confirmation number to view your confirmation statement. Meet with a Benefits Counselor - on-site September 5 - September 7 Explain My Benefits will be on-site to assist with any questions you may have and help you enroll in your benefits. See Benefit Resource Website for location information. Call Center Call the Explain My Benefits call center at 321-296-8060; Option #1 9:00am - 5:00pm EST; Monday - Friday during the enrollment period to speak with a benefit counselor one-on-one regarding your benefits. Reminders When using any of the above options for enrollment: Be sure to review the 2018-2019 Benefit Guide and plan summaries prior to going through any enrollment process Be prepared by gathering dependent and beneficiary information (i.e. Social Security Numbers and Dates of Birth) 2018-2019 Benefits Guide 3
Deductible Medical Medical Mutual is the medical provider this year for Avon Lake City Schools. Comprehensive healthcare provides peace of mind. In case of an illness or injury, you and your family are covered with an excellent medical plan through Avon Lake City Schools. The PPO SuperMed Plus Plan allows you to select where you receive your medical services; however, if you use in-network providers, your out-of-pocket costs will be less. OPTION 1 Medical Mutual of Ohio PPO SuperMed Plus Plan In Network Out of Network Individual $300 $600 Family $600 $1200 Coinsurance 10% 30% Coinsurance Out of Pocket Maximum Individual $500 $1,000 Family $1,000 $2,000 Doctor s Office Office Visit $15 copay $15 copay Preventive Care Services (routine exams, x-rays/tests, immunizations, well baby care and mammograms) Hospital Services No Charge $15 copay plus 30% after deductible Emergency Room $100 copay $100 copay Urgent Care Center Services $15 copay $15 copay plus 30% after deductible Inpatient 10% after deductible 30% after deductible Outpatient Surgery 10% after deductible 30% after deductible Ambulance Service 10% after deductible 30% after deductible Other Services Prenatal, Postnatal, Delivery 10% after deductible 30% after deductible Diagnostic Lab/X-ray 10% after deductible 30% after deductible Diagnostic (MRI, CT Scans, Nuclear Medicine) 10% after deductible 30% after deductible Gastric Bypass Surgery 10% after deductible, Lifetime max. $10,000 30% after deductible, Lifetime max. $10,000 Prescriptions (Express Scripts) Retail Generic/Preferred/Non-Preferred (30 day supply) Direct Mail (90 day supply) Pre-authorization may be required for some drugs $10 / $20 / $40 $10 / $20 / $40 $20 / $40 / $60 Not Covered *Eligible Dependents to age 26 4 2018-2019 Benefits Guide
Medical OPTION 2 Medical Mutual of Ohio Minimum Value Plan In Network Out of Network Deductible Individual $7,150 $14,300 Family $14,300 $28,600 Coinsurance 0% 30% Coinsurance Out of Pocket Maximum Individual $0 $1,000 Family $0 $2,000 Doctor s Office Office Visit 100% after deductible 30% after deductible Preventive Care Services (routine exams, x-rays/tests, immunizations, well baby care and mammograms) Hospital Services No Charge 30% after deductible Emergency Room 100% after deductible - Emergency and 100% after deductible - Emergency Urgent Care Center Services 100% after deductible 30% after deductible Inpatient 100% after deductible 30% after deductible Outpatient Surgery 100% after deductible 30% after deductible Ambulance Service 100% after deductible 30% after deductible Other Services Maternity (Hospital Services) 100% after deductible 30% after deductible Diagnostic Lab/X-ray 100% after deductible 30% after deductible Diagnostic (MRI, CT Scans, Nuclear Medicine) 100% after deductible 30% after deductible Prescriptions (Express Scripts) Retail Generic/Preferred/Non-Preferred (30 day supply) $20 / $45 / $75 $20 / $45/ $75 Direct Mail (90 day supply) Pre-authorization may be required for some drugs $40 / $90 / $150 Not Covered *Eligible Dependents to age 26 2018-2019 Benefits Guide 5
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 Avon Lake City Schools dental benefit plan. Medical Mutual Dental PPO Dentist Calendar Year Deductible Individual / Family* $50 / $100 Annual Maximum $2,500 Preventative Services Exams, Cleanings, X-Rays, etc. Plan pays 100% Deductible is waived. Deductible Applies Basic Services Fillings, Oral Surgery, Root Canals, etc. 80% Covered Major Services Crowns, Bridges Dentures, etc. 60% Covered Orthodontics Lifetime Annual Maximum $2,500 Eligible Dependents to age 25 Deductible does not apply to 60% Covered FYI To locate a network PPO provider, go to www.medmutual.com. Your out-of-pocket costs may be more if you choose an out-of-network provider. *Eligible Dependents to age 25 6 2018-2019 Benefits Guide
Vision 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. For a complete list of providers, go to www.eyemed.com and choose SELECT network or call 1-866-299-1358. EyeMed Vision In-Network Out-of-Network Comprehensive Eye Exam Once every 12 months $15 co-pay Up to $30 reimbursement Eyeglass Lenses Once every 12 months Once every 12 months Single Vision, Lined Bifocal and Trifocal $0 co-pay Up to $25 - $55 reimbursement Standard Progressive $65 co-pay Up to $40 reimbursement Premium Progressive $65, 80% of charge less $120 allowance Up to $40 reimbursement Lenticular $0 co-pay Up to $55 reimbursement Eyeglass Frames Once every 12 months $0 copay $100 allowance 80% of charge over $100 Once every 12 months Up to $50 reimbursement Contact Lenses (in lieu of glasses) Once every 12 months Once every 12 months Conventional (Elective) Contact lens exam $0 copay, $100 allowance, 15% off over $100 Up to $40 Up to $80 reimbursement N/A Laser Vision Correction (LASIK) Discounts available Discounts available *Eligible Dependents to age 25 2018-2019 Benefits Guide 7
Employee Assistance 8 2018-2019 Benefits Guide
Employee Assistance 2018-2019 Benefits Guide 9
Flexible Spending Account A Flexible Spending Account (FSA) helps to fill coverage gaps between health plans and out-of-pocket expenses. A FSA allows you to pay for certain health and dependent care expenses with pre-tax dollars. You won t pay taxes on the funds you put into your FSA, because they re deducted before taxes are calculated. Health FSA This pays for out-of-pocket medical expenses incurred during the year. Maximum Contribution: $2,650 annually Qualified medical expenses include: Co-pays / Deductibles Prescriptions Dental Work Vision Exams Eyeglasses Lasik Chiropractic Care Contact Lens & Supplies Note: Over-the-Counter (OTC) Medications Over-the-counter medications must be accompanied by a doctor s prescription and a reimbursement request to be covered under your FSA. This affects OTC medications only; all other medical supplies (bandaids, first-aid supplies, etc.) will still be eligible for reimbursement. Dependent Care FSA This covers daycare expenses for children up to the age of 13, and for elder dependents (like aging parents) that live in your home. It also covers a spouse or dependent that is physically or mentally challenged for whom you claim an exemption. Maximum Contribution: $5,000 annually Qualified dependent care expenses include: Babysitters Daycare Centers Elder Care Day Camps Preschool After-school Care 10 2018-2019 Benefits Guide
Term Life Insurance Basic Term Life and Accidental Death & Dismemberment 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. Avon Lake City Schools provides a basic life and accidental death and dismemberment (AD&D) insurance of 1x your annual salary to all employees that work 15 hours or more per week at no cost to the employee. Voluntary Supplemental Life You also have the opportunity to purchase supplemental coverage for yourself, spouse (up to a max of $20,000) and children (up to a max of $10,000). Please note that dependent children include unmarried adopted, natural or stepchildren age birth to 26. Employee Spouse Child Benefit Schedule Increments of $10,000 Flat up to $20,000 Flat up to $10,000 Maximum Benefit $300,000 $20,000 $10,000 Minimum Benefit $10,000 $5,000 $2,500 Guarantee Issue (initial offering only) $150,000 $20,000 $10,000 Monthly Rates for Voluntary Term Life Age Band Employee Life Monthly Rate per $1,000 Age Band Employee Life Monthly Rate per $1,000 0-34 $0.075 55-59 $0.052 35-39 $0.095 60-64 $0.695 40-44 $0.135 65-69 $1.045 45-50 $0.195 70+ $2.415 50-54 $0.325 Monthly Rate for Dependent Voluntary Term Life Option 1 Option 2 Option 3 Option 4 Spouse $5,000 $10,000 $15,000 $20,000 Child(ren) $2,500 $5,000 $7,500 $10,000 Monthly Rate $2.00 $4.00 $6.00 $8.00 2018-2019 Benefits Guide 11
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 are being offered through Trustmark. 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 a benefit which is 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. 12 2018-2019 Benefits Guide
Universal Life with Long Term Care 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. Avon Lake City Schools offers a variety of programs to meet your life insurance needs. 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 previously waived this benefit, you must answer a few health questions and be approved for coverage. Life with Long Term Care example: $100,000 Death Benefit Long Term Care Benefit (LTC): Pays a monthly benefit equal to 4% of your death benefit for up to 25 months. Before Age 70 $100,000 After Age 70 $100,000 Benefit Restoration: Restores the death benefit that is reduced to pay for LTC. Total Maximum Benefit: Long Term Care Benefits may double the value of your insurance $100,000 $33,333 $200,000 $133,333 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 of you in the electronic enrollment system. 2018-2019 Benefits Guide 13
Identity Theft Protection 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 in both of the plans offered: Benefit Elite Plan LifeLock Identity 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 Ultimate Plan Provides all of the benefits of the Benefit Elite Plan plus: Stolen Funds Replacement - up to $1,000,000 Credit Card, Checking & Savings with Account Activity Alerts Online Annual Credit Report Online Annual Credit Score Checking & Savings Account Application Alerts Bank Account Takeover Alerts Credit Inquiry Alerts Online Annual Tri-Bureau Credit Reports & Scores Monthly Credit Score Tracking File Sharing Network Searches Sex Offender Registry Reports Priority Live Member Service Support $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 Employee & Spouse Employee & Children* Family* Benefit Elite Plan $4.24 $8.49 $7.43 $11.68 Ultimate Plan $12.74 $25.49 $18.05 $30.80 *Employee & Children and Family Tiers: You may enroll up to 8 children with 4 of those children between the ages of 18 and 26. 14 2018-2019 Benefits Guide
Important Contacts Vendor Phone Number Website Medical & Dental Medical Mutual of Ohio Vision Eyemed Prescriptions Express Scripts Basic & Term Life Insurance One America Flexible Spending Accounts Medical Mutual of Ohio FlexSave Identity Theft Protection LifeLock Voluntary Benefits Trustmark Trustmark Claims Help Explain My Benefits 800-382-5729 866-939-3633 800-282-2881 800-553-5318 800-525-9252 800-543-3562 800-918-8877 888-734-6937, Option 3 www.medmutual.com www.eyemedvisioncare.com www.express-scripts.com www.oneamerica.com www.medmutual.com www.lifelock.com www.trustmarksolutions.com service@explainmybenefits.biz 2018-2019 Benefits Guide 15
Benefit Guide Description Please Note: This guide provides information regarding the Avon Lake City 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.