2016 Employee Benefit Guide
Welcome to your 2016 Benefit Guide......... -... -... -... -... -... -... -. -... -... -... -.................. -........................... Your benefits are important and we are committed to providing you a choice of affordable comprehensive plans. This Benefit Guide was created to help you understand our plans. Please take time to learn about each plan and choose the plans best for you. This Benefit Guide is only an overview of the employee benefit plans and is not intended to replace your Summary Plan Description (SPD). To receive a copy of the SPD, you may download it from our benefit website or request a copy from the Payroll Department. If you have any questions regarding our employee benefit plans, please contact the Payroll Department. Craig Willford Superintendent of Schools
Important Information Open Enrollment.. Qualifying Life Events Healthcare Reform.... -...... Who is Eligible?.... Employee Benefit Information Website.
Medical Plans Insurance Terms... --.. -. -. --. - - -..... Generic Prescriptions -.. -. -. - -... -. - - - -.. - -. -.....
Provider and Medication Search Find A Doctor... -...... -. - --. -.. -..... Urgent Care Facilities........ Medication Search....... -.........
Tips to Save Money on Health Care -... -. -... -.. - - - --. -- - -. -.. - -. -.. -.. - -.. -..
Open Enrollment Sign-On Instructions..............
Medical Plans - - - - - - -
Medical Plans - - - - -
Medical Deductions 12 Payrolls......... Non-Tobacco........... Tobacco........................................ 21 Payrolls Non-Tobacco.................... Tobacco........................................ 22 Payrolls Non-Tobacco............... Tobacco............................................. 24 Payrolls Non-Tobacco.................... Tobacco........................................
Medical Deductions Non-Tobacco Tobacco 26 Payrolls............................................................ Tobacco USD 260 Derby recognizes the value of employee s health and the countless health benefits of nontobacco use. District employees who are considered tobacco users will pay $25 more per month in medical premiums. Employees are considered non-tobacco users if they have not used any form of tobacco products including but not limited to cigarettes, pipes, cigars, and chewing tobacco for a minimum of 90 days (on or off of the job) and continue to remain tobacco free. Retirees are not eligible for the non-tobacco discount. HSA Plan Deposit tax free money into your HSA and use the HSA money to pay for eligible medical expenses. You are never taxed on this money. Your HSA is completely portable. Whether you change jobs, change medical coverage, change marital status, become unemployed or move to another state you keep your HSA. The money in your HSA rolls over each year to the next year. You do not lose your money. As long as you spend the HSA money on eligible expenses, you are never taxed on the money.
Health Savings Account Q & A........... -...... -....... -.......... -...
Aetna Tools Ask Ann. -.. -. --. -.. -. -.. -... Aetna Mobile - itriage - -.. Member Payment Estimator -. -. --. Teladoc - -
Wellness Program Effective: January 1, 2016- September 30, 2016...............
Wellness Program........
Dental Insurance.. -... Maximum Preventive $1,500.00 per person per calendar year No Deductible 100% Payment Oral examinations one each six months Diagnostic x-rays bitewings once each 12 months full mouth once each 5 years Prophylaxis once each 6 months Fluoride applications up to age 19 Space Maintainers dependent children under age 14 Sealants one per lifetime for dependents under age 16 Deductible Basic Services Major Services Orthodontics $25.00 per person per calendar year $75.00 maximum per family per calendar year Basic & Majors Services are combined to meet the deductible After Deductible 80% Payment Emergency exam by the dentist for treatment of pain Oral surgery including extractions and oral surgery Fillings Endodontic root canals Periodontics treatment of diseases of the gums After Deductible 50% Payment Special Restorative crowns Prosthodontics includes bridges and dentures Not Covered Dependents Unmarried dependents covered up to age 26 Deductions Employee Only EE & Spouse EE & Children Family Deductions Employee Only EE & Spouse EE & Children Family Monthly 21 Payrolls 22 Payrolls $38.94 $22.25 $21.24 $77.75 $44.43 $42.41 $76.25 $43.57 $41.59 $106.39 $60.79 $58.03 24 Payrolls 26 Payrolls $19.47 $17.97 $38.88 $35.88 $38.13 $35.19 $53.20 $49.10 Ways to Save Use Delta Premier contracting dentists to receive the most benefit from your dental plan. Protect your teeth brush and floss at least once per day. Avoid surprises by obtaining a pre-treatment estimate before receiving dental work. Get an oral exam and have your teeth cleaned every six months. It is paid 100% at Delta Premier contracting dentists up to your $1,500 calendar year benefit. -
Basic Life Insurance.....
Voluntary Life Insurance....... - - - - - - - - - - Voluntary Life Rates........... Worksheet -...
Voluntary Vision Plan - Option 1 - - -... - -... - - - - - -
Voluntary Vision Plan - Option 2 -........................................ --
Short Term Disability Plans How long can you go without a paycheck? -... -... -... - - - - - - - This is an estimate of premium cost. Actual deductions may vary slightly due to rounding and payroll frequency................. $ X = $ Your weekly salary* Premium factor Your cost
Flex Spending Accounts. -. -. -. -. -. -.. -.... -........ -....
Flex Spending Accounts Qualifying Health Care Expenses Health Care Expenses NOT Allowed Acupuncture Alcoholism Ambulance Annual Physical Exam Artificial Limb Artificial Teeth Bandages Birth Control Pills Blood Pressure Monitor Body Scan Braille Books & Magazines Breast Pumps & Supplies Breast Reconstruction Capital Expenses Car (special hand controls) Chiropractor Christian Science (Practitioner) Contact Lenses Crutches Dental Treatment Diabetic monitors, test kits, strips and supplies Diagnostic Devices Disabled Dependent Care Drug Addiction Eyeglasses Eye Surgery Fertility Enhancement First Aid Kits Flu Shots Guide Dog Hearing Aids Home Care Home Improvements Hospital Services Laboratory Fees Lactation Expenses Lead-Based Paint Removal Learning Disability Lifetime Care Payments Long-Term Care Medical Conferences Medical Information Plan Mileage (for travel to/ from eligible healthcare) Nursing Home Nursing Services Optometrist Organ Donors Osteopath Oxygen Physical Examination Pregnancy Test Kit Prescription Medicines Prosthesis Psychiatric Care Psychoanalysis Psychologist Saline Solution Sterilization Stop-Smoking Programs Sunscreen (SPF 15+ and Broad Spectrum ) Surgery Telephone (Hearing Impaired) Therapy Transportation (Medical) Baby Sitting Cosmetic Surgery Dancing Lessons Diaper Service Electrolysis or Hair Removal Funeral Expenses Future Medical Care Hair Transplant Health Club Dues Household Help Maternity Clothes Medicine (from Outside U.S.) Nonprescription Medicines Nutritional Supplements Swimming Lessons Teeth Whitening Veterinary Fees Weight-Loss Program Food Items that require Physician Rx Over-the-counter drugs and medications Allergy Medication Diaper Rash Ointments & Creams Over-the-counter Smoking Cessation gum or patches Weight Loss Drugs (for purpose of medical condition) -
Hospital Indemnity Plan - -..... -.... -.... -...................... -.
$10,000 Benefit. -.... Critical Illness Plan -. - -. -. -. - - -.... -.... -.... -.... -.... ANNUAL WELLNESS BENEFIT - $50.00 For Employee & Spouse (if covered) (Wellness benefit may be filed once per calendar year)
Accident Plan... -.. - - - - - - - - - - - - - - - - - - - - ANNUAL WELLNESS BENEFIT - $60.00 For Employee, Spouse & Children (if covered) (Wellness benefit may be filed once per calendar year).................... -
Legal Services. -. -.. - -. -.. -. -.. - -....
403(b) Retirement Plan -.. -.. -. -. -. -. -.... - - - -. - -. - -.. - - -. -. - -... Other Deductions and Benefits NEA... United Way -..
Notices FMLA -. -. -. FMLA (con t) -. - -. - - -.. -.... -. -.....
Notices FMLA (con t) -. - -.. - -. - -. -. -. -. -. -. -. -. FMLA (con t).... Newborn s Act Notice...
Notices Special Enrollment Period -. -. -. -. -. - -. -.. Women s Health & Cancer Rights. -.. HIPAA - Privacy......
Notices SUMMARY OF COBRA BENEFITS.....................
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Contacts.... - - -..... - - -... - - -... - -... -... - -... -.... - - -.... - - -.