2015/2016 BENEFIT PLAN YEAR
BENEFITS FOR A HAPPIER HEALTHIER LIFE WHAT S INSIDE 1. ABOUT THIS ENROLLMENT 2. HEALTH & HSA/FSA/DCAP OPTIONS 3. DENTAL 4. VISION 5. LIFE 6. DISABILITY 7. ACCIDENT CARE 8. CRITICAL CARE WITH CANCER CARE 9. EMPLOYEE ASSISTANCE PROGRAM 10. 401(K) PLAN 11. CONTACT INFORMATION WHO S ELIGIBLE FOR COVERAGE Who s Eligible for Coverage: Employees regularly working at least 20 hours per week are eligible to apply for all benefits. Employees regularly working at least 10 hours per week are eligible for health insurance.
ABOUT OPEN ENROLLMENT ABOUT YOUR 2015-2016 BENEFITS PACKAGE YES Prep Public Schools is proud to offer you a benefits package that gives you the options to make the best decisions for your health and the health of your family. Your benefits package is an important piece to help you and your loved ones not only stay physically well, but financially well, too. The benefits offered to you are offered at a discounted group rate, so you can create a comprehensive package that fits within your budget. IMPORTANT NOTES ABOUT THIS BENEFIT YEAR & ENROLLING ONLINE YOUR BENEFIT ENROLLMENT BEGINS ON AUGUST 3 AND ENDS ON AUGUST 24. START BY GOING TO YOUR YES PREP EMPLOYEE BENEFITS WEBSITE AT WWW.YESPREPBENEFITS.ORG TO FIND ALL BENEFITS RELATED ITEMS. YOUR ENROLLMENT OPTIONS: You will be able to enroll three ways: 1. You can enroll online. You do this by going to www.yesprepbenefits.org and clicking on the Enroll Now button. 2. You can meet with someone in person the week of August 17th. You schedule an appointment with the benefit specialist by going to www. yesprepbenefits.org and clicking on the Appointment button. 3. You can speak with a representative in our call center from 8:30 a.m. to 4:30 p.m. Monday through Friday. Just call 1-888-783-9653 and speak with a representative today.
ONLINE ENROLLMENT INSTRUCTIONS BENEFITSCONNECT - OUR NEW PLATFORM TO START YOUR ONLINE ENROLLMENT GO TO WWW.YESPREPBENEFITS.ORG AND NAVIGATE TO THE ENROLL NOW BUTTON. ONCE YOU ARE AT THE ENROLL NOW BUTTON YOU WILL BE ABLE TO BEGIN YOUR ENROLLMENT. WHEN YOU GET TO THE BENEFITSCONNECT WELCOME SITE YOU WILL DO THE FOLLOWING TO LOGIN: 1. ENTER YOUR [YOUR USERNAME] FIRST 6 LETTERS OF YOUR LAST NAME + FIRST LETTER OF HERE S TO LIVING A HAPPIER, HEALTHIER LIFE. YOUR FIRST NAME + LAST FOUR NUMBERS OF YOUR SOCIAL. Example: Employee robert Smith with SSN 123-45-6789 will have the User Name smithr6789 2. ENTER IN YOUR [YOUR TEMP PASSWORD] Your full social security number Once you login, you ll be required to reset your password. FOLLOW THE INSTRUCTIONS AND ELECT YOUR BENEFITS. The site will include some important information about your benefit selections as well as the enrollment process, so be sure to slow down and read the instructions carefully. If you have questions please contact the Call Center at 1-888-783-9653 or make an appointment with a representative for the week of August 17th by going to www.yesprepbenefits.org.
HEALTH COVERAGE CHOOSE THE PLAN THAT WORKS BEST FOR YOU ACTIVECARE 1 HD [OR] ACTIVECARE SELECT [OR] ACTIVECARE 2 WHAT S COVERED? No matter which health option you choose, you re covered. Below, we cover a few things included in your coverage options at no cost to you. YEARLY PHYSICALS IMMUNIZATIONS ANNUAL SCREENINGS [Like your yearly routine physical with your PCP] [Recommended by Advisory Committee of Immunization Practices of the CDC] [Cancer screening mammograms or colonoscopies; bone density tests, etc.] COSTS FOR COVERAGE Costs listed below are shown as per pay premiums. EMPLOYEE ACTIVECARE 1 HD ACTIVECARE SELECT ACTIVECARE 2 HERE S TO LIVING A HAPPIER, HEALTHIER LIFE. YOUR COST $10.75 $51.75 $122.25 PAID BY YES PREP $159.75 $184.75 $184.75 +CHILDREN WHAT YOU PAY $95.25 $143.75 $258.75 PAID BY YES PREP $212.25 $237.25 $237.25 +SPOUSE WHAT YOU PAY $218.50 $297.50 $475.50 PAID BY YES PREP $238.50 $263.50 $263.50 +FAMILY/TWO EMPLOYEE FAMILY WHAT YOU PAY $324.50/$243.50 $349.50/$243.50 $444.50/$338.50 PAID BY YES PREP $291.00/$372.00 $316.00/$422.00 $316.00/$422.00 QUALIFYING ACCOUNT HSA [OR] FSA FSA FSA YOU MAY EITHER ELECT A HEALTH SAVINGS ACCOUNT (HSA) OR A FLEXIBLE SPENDING ACCOUNT (FSA) BUT NOT BOTH.
HEALTH COVERAGE YOUR OUT-OF-POCKET COSTS ACTIVECARE 1 HD ACTIVECARE SELECT ACTIVECARE 2 PLAN YEAR DEDUCTIBLE EMPLOYEE ONLY/EMPLOYEE+ $2,500/$5,000 $1,200/$3,600 $1,000/$3,000 OUT-OF-POCKET MAX EMPLOYEE ONLY/EMPLOYEE+ $6,400/$12,900 $6,600/$13,200 $6,600/$13,200 PHYSICIAN OFFICE VISITS PRIMARY CARE 20% AFTER DEDUCTIBLE $30 COPAY $30 COPAY SPECIALIST CARE 20% AFTER DEDUCTIBLE $60 COPAY $50 COPAY EMERGENCY SERVICES EMERGENCY ROOM 20% AFTER DEDUCTIBLE $150.00 1 + 20% AFTER DEDUCTIBLE $150.00 1 + 20% AFTER DEDUCTIBLE HOSPITALIZATION & SURGICAL INPATIENT PROCEDURE 20% AFTER DEDUCTIBLE $150.00 2 + 20% AFTER DEDUCTIBLE $150.00 2,3 + 20% AFTER DEDUCTIBLE OUTPATIENT PROCEDURE 20% AFTER DEDUCTIBLE $150.00 + 20% AFTER DEDUCTIBLE $150.00 + 20% AFTER DEDUCTIBLE OTHER SERVICES HI-TECH RADIOLOGY 20% AFTER DEDUCTIBLE $100.00 + 20% AFTER DEDUCTIBLE $100.00 + 20% AFTER DEDUCTIBLE TELEDOC PHYSICIAN SERVICES $40 COPAY $0 COPAY $0 COPAY PRESCRIPTIONS GENERIC/BRAND-NAME SUBJECT TO DEDUCTIBLE $0/$200 $0/$200 ABOUT YOUR SAVINGS ACCOUNTS 1. WAIVED IF ADMITTED; 2. $750 COPAY MAX COPAY PER ADMISSION; 3. $2,250 COPAY MAX PER PLAN YEAR HSA: A HSA is like a 401(k) retirement account, but it s for medical expenses. You can only have an HSA if you enroll in an HSA-compatible insurance plan. You can only spend the amount of funds you have already contributed to the account. Contributions to this account are pre-tax and you can invest the funds in your HSA. YES Prep Public Schools will contribute $50 per month to your employee HSA Plan, but does not cover admin costs. Your max yearly contribution $3,250 for individuals and $6,450 for family. FSA: A FSA is set up by your employer. They own the account, but you get to decide which qualified medical expenses to pay for with your FSA. What makes it flexible? It works with most of our employer-sponsored health plans. With an FSA you can use amount of funds you have elected to contribute through the year before you ve contributed the full amount. Contributions to this account are pre-tax. DCAP: A DCAP is an employer-sponsored program that helps employees with the cost of dependent care expenses. It establishes an account from which an employee may seek reimbursement for eligible dependent care expenses. In most cases, a DCAP account is funded by employees with pretax dollars through payroll deductions. Your max yearly contribution for a DCAP (Dependant Care Assistance Program) for a married employee that files a joint tax return is $5,000. A married employee that files a separate tax return may only place up to $2,500 per calendar year in a DCAP.
HSA, FSA & DCAP HSA (HEALTH SAVINGS ACCOUNT) AVAILABLE WITH ACTIVECARE 1HD WHY CHOOSE A HSA Contributions never expire Acts like a 401(k) so you can withdraw funds at qualifying age Contributions are pre-tax ABOUT YES PREP S HSA OPTION YES Prep contributes $50 per month to your employee HSA plan You cover administrative costs Yearly max contribution for individuals is $3,250 Yearly max contribution for families is $6,450 FSA (FLEXIBLE SPENDING ACCOUNT) AVAILABLE WITH ACTIVECARE 1HD; ACTIVECARE SELECT; ACTIVECARE 2 HEALTHY SMILES. HEALTHY HEARTS. HAPPY LIVES. WHY CHOOSE A FSA Yearly funds amounts you choose to contribute are available immediately Contributions are pre-tax up to $2,500 annually You can use for multiple medical expenses ABOUT YES PREP S FSA OPTION You can use funds beginning September 1st, 2015 Funds must be used by September 1st, 2016 (You can rollover $500 of unused funds) DCAP (DEPENDENT CARE ASSISTANCE PROGRAM) AVAILABLE WITH ACTIVECARE HD 1; ACTIVECARE SELECT; ACTIVECARE 2 WHY CHOOSE A DCAP Contributions may be pre-tax You can use for qualifying care options for your dependents ABOUT YES PREP S DCAP OPTION Employees married and filing jointly may contribute $5,000 annually Employees married and filing separately may contribute up to $2,500
DENTAL COVERAGE COSTS FOR COVERAGE Costs listed below are shown as per pay premiums. COVERAGE OPTIONS YOUR COST PER PAY ANNUAL DEDUCTIBLE EMPLOYEE $12.17 $50.00 +CHILDREN $30.08 up to $150.00 +SPOUSE $23.89 up to $100.00 +FAMILY $41.94 up to $150.00 HEALTHY SMILES. HEALTHY HEARTS. HAPPY LIVES. YOUR OUT-OF-POCKET COSTS DIAGNOSTIC/PREVENTIVE YOUR PORTION Exams, Cleanings, Fluoride, Sealants, X-Rays, Space Maintainers 0% BASIC RESTORATIVE Fillings, Simple Extractions, Repairs, Periodontal Maintenance 20% BASIC RESTORATIVE Root Canals, Complex Extractions, Non-Surgical & Surgical Periodontics, Bridges, Dentures, Crowns, Inlays, Onlays, Implants ORTHODONTIA Child Only ($1,500 Lifetime Max) 50% ANNUAL BENEFIT MAX: $1,500 50%
VISION COVERAGE COSTS FOR COVERAGE Costs listed below are shown as per pay premiums. COVERAGE OPTIONS YOUR COST PER PAY EMPLOYEE $3.25 +CHILDREN $5.86 +SPOUSE $5.52 +FAMILY $8.77 YOUR OUT-OF-POCKET COSTS SERVICES IN-NETWORK ALLOWANCE OUT-OF-NETWORK ALLOWANCE IT S TIME TO SEE LIFE A LITTLE MORE CLEARLY. Eye Exam 100% of Cost $35 Frames $130 + 20% Discount 1 $70 Single Vision Lenses 100% of Cost $25 Bifocal Lenses 100% of Cost $40 Trifocal Lenses 100% of Cost $45 Aspheric-Lenticular Lenses 100% of Cost $80 Contact Lenses - Medically Necessary/ Elective 100% of Cost/up to $150 if elective Lasik $200 + Discount 1 $200 $80
LIFE COVERAGE CHOOSE THE COVERAGE AMOUNT THAT WORKS FOR YOU, YOUR BUDGET, AND YOUR FAMILY. COVERAGE IS PORTABLE & CAN BE CONVERTED. [COVERAGE FOR YOU] Elect life and accidental death & dismemberment (AD&D) coverage for yourself (the employee) in increments of $10,000; from a minimum of $20,000 to a maximum of $250,000 without submitting a Medical Evidence of Insurability. You may apply for coverage up to $500,000 by submitting a Medical Evidence of Insurability. Coverage can t exceed five (5) times your annual salary. [COVERAGE FOR YOUR SPOUSE] Elect life and AD&D coverage for your spouse in increments of $5,000; from a minimum of $10,000 to a maximum of $50,000 without submitting a Medical Evidence of Insurability. IT S TIME TO SEE LIFE A LITTLE MORE CLEARLY. You may apply for coverage up to $250,000 by submitting a Medical Evidence of Insurability. Coverage can t exceed 50% of your (the employee s) coverage amount. [COVERAGE FOR YOUR CHILDREN] Elect life and AD&D coverage for your children age six (6) months to 26 years in the amount of $2,500; $5,000; or $10,000. Coverage for children age birth to six (6) months is $1,000. COSTS FOR COVERAGE Costs below are shown as monthly premiums for $1,000 increments. UNDER 30 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+ $0.079 $0.099 $0.113 $0.142 $0.202 $0.311 $0.525 $0.720 $1.289 $2.238 Employee monthly costs are based upon employee s age. Spouse cost per month are based upon spouse s age. MONTHLY COST FOR CHILD(REN) COVERAGE PER $1,000: $0.23
DISABILITY COVERAGE MAKING THE DECISION TO INSURE YOUR INCOME COULD MAKE ALL THE DIFFERENCE IF YOU BECOME DISABLED. [SHORT TERM DISABILITY COVERAGE] Protect up to 66.67% of your weekly earnings to a maximum of $1,250 per week. To calculate your premium you do the following Gross Salary x.67/52/10 x rate = per pay premium. Benefits start on the 8th day of disability caused by a covered illness or accident and may be payable up to 12 weeks if you re disabled from your own occupation due to an accident or illness. A 3/12 pre-existing condition limitation applies. For those currently on The Standard Disabillity Plan will be grandfathered and pre-existing condition clauses will be waived. STD COST FOR COVERAGE Costs below are shown as per pay premiums for $10 increments. UNDER 35 35-39 40-44 45-49 50-54 55-59 60+ YOUR INCOME IS ONE OF YOUR MOST IMPORTANT ASSETS. $0.31 $0.225 $0.20 $0.22 $0.25 $0.29 $0.35 [LONG TERM DISABILITY COVERAGE] Protect up to 66.67% of your monthly earnings up to a maximum of $10,000 per month. To calculate your premium you do the following Gross Salary/12/100 x rate = per pay premium. Benefits start on the 90th day of disability caused by a covered illness or accident and may be payable up to 24 months if you re disabled from your own occupation, or up to your Social Security Full Retirement Age. A 3/12 pre-existing condition limitation applies. For those currently on The Standard Disabillity Plan will be grandfathered and pre-existing condition clauses will be waived. LTD COST FOR COVERAGE Costs below are shown as per pay premiums for $100 increments. UNDER 19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ $0.04 $0.08 $0.11 $0.19 $0.26 $0.37 $.54 $.71 $.91 $.80 $0.38 please note that the sytem will calculate the rates for you
ACCIDENT COVERAGE COVERAGE IS PORTABLE & INCLUDES A $50 WELNESS BENEFIT AND AD&D BENEFITS. INJURY PAYABLE FRACTURES (OPEN/CLOSED) up to $7,500/$3,750 DISLOCATION (OPEN/CLOSED) up to $4,000/$200 TENDONS/LIGAMENTS (REPAIR OF ONE/MORE THAN ONE) up to $800/ $1,200 BLOOD/PLASMA/PLATELETS $300 BURNS up to $10,000 RUPTURED DISC $600 KNEE CARTILAGE (TORN) up to $500 EYE INJURY (WITH SURGICAL REPAIR) up to $200 LACERATIONS (REQUIRING SUTURE) up to $800 ACCIDENTS HAPPEN. MAKE SURE YOU RE COVERED. ACCIDENT EMERGENCY TREATMENT BENEFIT $200 INITIAL HOSPITALIZATION FOR INJURY BENEFIT $600 HOSPITAL CONFINEMENT DAILY BENEFIT $600 ADDITIONAL INTENSIVE CARE UNIT BENEFIT $600 AMBULANCE BENEFIT (GROUND/AIR) $200/ $1,000 PHYSICAL THERAPY BENEFIT $50 up to 6 visits FOLLOW-UP PHYSICIAN BENEFIT $100 COSTS FOR COVERAGE Costs listed below are shown as per pay premiums. COVERAGE OPTIONS YOUR COST PER PAY EMPLOYEE $6.76 +CHILDREN $9.93 +SPOUSE $13.02 +FAMILY $16.17
CRITICAL CARE COVERAGE WITH CANCER CARE COVERAGE IS PORTABLE & INCLUDES A $50 WELNESS BENEFIT. COVERAGE FOR THOSE PREVIOUSLY ENROLLED IN CRITICAL CARE COVERAGE WILL BE GRANDFATHERED. COVERAGE BENEFIT DETAILS GUARANTEED ISSUE (EMPLOYEE/SPOUSE/CHILD(REN) Up to $20,000/$10,000/$5,000 ADDITIONAL OCCURRENCE & RE-OCCURRENCE BENEFITS Included RE-OCCURRENCE BENEFIT Included SPOUSE COVERAGE 50% of Employee Amount CHILD COVERAGE 10% of Employee Amount CONDITION COVERAGE LUMP SUM BENEFIT $5,000-$100,000 HEART ATTACK 100% IT S TIME TO SEE LIFE A LITTLE MORE CLEARLY. STROKE 100% MAJOR ORGAN TRANSPLANT 100% PERMANENT PARALYSIS 100% END STAGE RENAL FAILURE 100% CORONARY ARTERY BYPASS SURGERY 25% INVASIVE CANCER 100% CARCINOMA IN SITU 25% COSTS FOR COVERAGE Costs listed below are shown as per pay premiums per $20,000.* INSURED S AGE YOUR COST PER MONTH AGE 35 $9.90 AGE 45 $17.73 AGE 55 $30.68 *RATES SHOWN ARE NON-TOBACCO FOR EMPLOYEE ONLY COVERAGE
EMPLOYEE ASSISTANCE PROGRAM FOR TIMES WHEN THE GOING GETS TOUGH. AWP is proud to serve as your EAP, offering you and your household valuable, confidential services, at no cost to you. Your benefits are designed to help you manage your daily life, work stress, major life events, or anything else that might affecting your quality of life. Coverage is paid by YES PREP, is confidential, and you can reach AWP 24 hours a day, seven days a week. SOMETIMES, YOU JUST NEED A LITTLE ASSISTANCE. WHAT S INCLUDED? 1 TO 6 COUNSELING VISITS REIMBURSEMENT FOR EMERGENCY CAB FARE IF YOU BECOME IMPAIRED LEGAL ADVICE WELL-COACHI TO HELP YOU LIVE A HEALTHY LIFE SKILL-BUILDING & MORE! BY PHONE: TOLL FREE: 1-800-343-3822 AUSTIN AREA: 512-328-1144 ONLINE: ALLIANCEWP.COM Login using the button in the top-right. From there, you can create a custom login. Temporary Username: YESPREPmember
401(K) PLAN YES PREP 401(K) PLAN SUMMARY At YES Prep we are committed to your personal and professional success. Take action towards your financial future by participating and learning more about the 401 (k) plan, administered by AUL OneAmerica. Start your enrollment now at www.yesprep401k.org. PROTECT YOUR FUTURE. WHAT YOU NEED TO KNOW: YOU MUST BE 21 YEARS OF AGE OR OLDER TO PARTICIPATE YES PREP DOES NOT MAKE EMPLOYER CONTRIBUTIONS AT THIS TIME ON SEPTEMBER 1ST, 2015 ALL EMPLOYEES WILL BE ENROLLED IN THE PLAN AT A 3% DEFAULT CONTRIBUTION INTO A TRADITIONAL IRA ONCE A QUARTER YOU CAN CHANGE YOUR CONTRIBUTIONS YOU CAN CANCEL CONTRIBUTIONS AT ANYTIME CONTACT INFORMATION: PLAN NUMBER: G37501 CUSTOMER SERVICE: 1-800-249-6269 employer at discounted group rate. Certain restrictions and limitations apply. This benefit summary is not a certificate of insurance. For more information about the benefits presented to you, contact your benefits administrator or the carrier listed on this summary. ONLINE PORTAL: WWW.YESPREP401K.ORG
CONTACT INFORMATION WHO TO CONTACT ABOUT YOUR BENEFITS COVERAGE PROVIDER WEB ADDRESS TELEPHONE FAX MEDICAL TRS Active Care www.trsactivecareaetna.com 800-222-9205 xxx-xxx-xxxx HSA HSA Bank www.hsabank.com 800-357-6246 877-851-7041 FSA/DCA TASC www.tasconline.com 800-422-4661 608-441-3099 DENTAL Assurant Employee Benefits www.assurantemployeebenefits.com 800-442-7742 888-208-2323 VISION Superior Vision www.superiorvision.com 800-507-3800 xxx-xxx-xxxx LIFE One America www.oneamerica.com 800-553-5318 888-285-1565 DISABILITY One America www.oneamerica.com 800-553-5318 888-285-1565 ACCIDENT Trustmark www.trustmarksolutions.com 877-201-9323 508-853-2867 IT S TIME TO SEE LIFE A LITTLE MORE CLEARLY. CRITICAL CARE Trustmark www.trustmarksolutions.com 877-201-9323 508-853-2867 EAP AllianceWP www.alliancewp.com 800-343-3822 xxx-xxx-xxxx 401(K) AUL OneAmerica www.yesprep401k.org 800-249-6269 xxx-xxx-xxxx
NOTES 2015 BENEFIT PLAN YEAR