Medicare Part D Prescription Drug Information If you have Medicare or will become eligible for Medicare in the next 12 months, Federal law gives you

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1 2016 Medicare Part D Prescription Drug Information If you have Medicare or will become eligible for Medicare in the next 12 months, Federal law gives you more choices about your prescription drug coverage. Please see page 26 for more details.

2 Introduc on Welcome to the annual Open Enrollment period for our employee benefit plans for coverage effec ve January 1, This is your opportunity to evaluate the benefit needs for you and your family for the upcoming year. Mason County Central Schools con nue to be commi ed to providing all eligible employees and dependents with a comprehensive and compe ve benefit package. During this open enrollment period you have the op on to enroll in a plan if you previously waived coverage or make changes to your exis ng coverage due to any of the following: Inside This Enrollment Guide Enroll in a plan that be er suits the u liza on needs of you and your family; Enroll eligible dependents not already covered; Introduc on... 2 Medical... 3 Health Savings Account... 4 Priority Summary of Benefits... 6 Dental Vision Federal No ces Medicare Part D Contact Info Remove dependents that are no longer eligible for coverage, or that you no longer wish to cover under the plan(s). Remember that the choices you make now will be effec ve January 1, 2016 and remain in effect un l December 31, 2016, unless you have a qualified family status change. Only those employees that would like to make a change to their current benefit selec ons will need to complete an enrollment form. All current elec ons will be rolled over to the January 1, 2016 effec ve date. If you are enrolling in coverage for the first me or making changes to your current elec ons you must complete a benefit enrollment form. This is also your opportunity to enroll in Voluntary Benefits through Set Seg. The Voluntary benefit packet can be found at: 1. h p://mccschools.org, 2. Click on the Budget and Salary / Compensa on Transparency Repor ng 3. Next you will need to click on the Employer Sponsored Health Care Benefits Plans Dental, Vision, Life, LTD 4. Lastly, click on Employee Paid Op onal Voluntary Benefits Premium Conversion To help minimize your employee contribu on for your medical plan, MCCS will con nue to offer an IRC (Internal Revenue Code) Sec on 125 Premium Conversion Plan. This allows you to pay for your coverage on a pre tax (before tax) basis. As a result, your net take home pay will be higher than if contribu ons were deducted on a post tax (a er tax) basis. Contribu ons taken on a pre tax basis are not subject to federal or state income taxes or FICA taxes. The amount of savings depends on your individual contribu on and tax bracket. Your 2016 Enrollment Elec on will be locked in (January 1st to December 31st). The next open enrollment period will be in the fall for a January 1, 2017 effec ve date. Elec on changes are only allowed if you experience a mid year qualifying event. 2

3 Medical Coverage Medical coverage is certainly one of the most important and necessary parts of a benefit program. Mason County Central Schools offers you the op on to choose between the following two medical plans: Priority Health Priority Health HSA In Network Priority Health HSA Out of Network Deduc ble Based on a Plan Year 9/1 $1,300 / $2,600 $3,000 / $6,000 Health Savings Account Eligible Eligible Total Out of Pocket Maximum $2,000 / $4,000 $3,000 / $6,000 Physician Office Services Office Visit 20% Coinsurance / visit a er deduc ble 40% Coinsurance / visit a er deduc ble Emergency Medical Care Emergency Room 20% Coinsurance / visit a er deduc ble 40% Coinsurance / visit a er deduc ble Urgent Care Visits 20% Coinsurance / visit a er deduc ble 40% Coinsurance / visit a er deduc ble Prescrip on Drugs Generic/ Brand / Non Preferred $10/$40/$80 A er deduc ble No Coverage The above chart is a summary of benefits. Please review the Summary of Benefits & Coverage Document provided by Priority Health. Contact the benefits coordinator for printed copies. Please note, contribu ons are es mates, a por on of the Healthcare Reform taxes and fees are being passed onto MCCS employees. We expect the change to be minimal but final employee contribu ons may vary. In addi on, the amount of the deduc on may vary depending on your employment status (i.e. part me). Contribu ons are guaranteed through August 31, 2016 and are subject to change September 1,

4 Health Savings Account Overview Only those who elect medical coverage through MCCS have the op on to par cipate in the Health Savings Account or HSA, if eligible. You can access your HSA to pay for eligible expenses. In addi on, your account has the ability to grow, year to year, tax deferred. The HSA account is your property and has investment op ons available. Eligibility You must meet certain other requirements in order to par cipate in the HSA Contribu on Feature. To be eligible, you must: (a) be covered by the MCCS High Deduc ble Health Plan; (b) Not be claimed as another person s tax dependent; (c) Not be actually covered by Medicare; and (d) Not have any health coverage other than coverage under a High Deduc ble Health Plan. Other coverage that will disqualify you from being eligible for the HSA contribu on feature includes, but not limited to: coverage under your spouse s health plan if his/hers is not considered a HDHP plan under IRS guidelines, coverage under your spouse s medical reimbursement plan or flexible spending account, and coverage under a health reimbursement arrangement, including your spouse s health reimbursement arrangement. Important Considera on The HSA is separate from the medical high deduc ble plan and is a bank account used to help pay for those expenses not covered by the plan with pre tax dollars. An HSA is an employee s property and HSA account holders are responsible for ensuring they meet the eligibility requirements for the pre tax benefit as well as ensuring the funds are used to pay for qualified medical expense. We encourage you to contact your tax adviser with specific HSA ques ons as the impact of these accounts change based on your circumstances. The next page provides an overview of the important requirements. 4

5 Health Savings Account Con nued HSA Employee Funding In addi on to the Health Savings Account (HSA) funding you may elect to receive from MCCS, you will have the op on to fund your account with pre tax dollars. In order to make this elec on you MUST indicate your elec on Form. No new elec on forms are required unless you are enrolling for the first me. Your current HSA pre tax contribu on will con nue into 2016 unless you complete a form changing the elec on or amount. In addi on, you have the ability to adjust your HSA pre tax elec on monthly. The Statutory Maximum HSA Contribu on for 2015 calendar year is $3,350 for a single and $6,650 for a family. If you are age 55 or older, you can make an addi onal catch up contribu on amount of $1,000 in The HSA cannot receive contribu ons a er you have enrolled in Medicare. Using Your HSA Money in your HSA can be used to pay for a variety of healthcare related expenses for you and your IRS eligible dependents (any out of pocket medical, dental and vision coverage a er the insurance plan pays or processes the claim) ranging from office visits to prescrip on drugs. A full lis ng of eligible expenses can be found at: h p:// pdf/p969.pdf. To pay for expenses, you simply present your HSA debit card to your provider, and money will be deducted directly from your HSA. Your HSA money is tax free as long as it is used to pay for qualified medical expenses. If you use the money for any other reason, you will be required to pay income tax and a 20% tax penalty on that amount (you will not pay a penalty if you are disabled or age 65 or older). Please note that you are not required to submit receipts for the purchases that you make. It is up to you to keep the suppor ng records to show the Internal Revenue Service whether you used the funds to pay qualified medical expenses. For tax filing purposes, HSA contribu ons will appear on your W 2 as a line item. 5

6 6 Summary of Benefits and Coverage

7 Summary of Benefits and Coverage 7

8 8 Summary of Benefits and Coverage

9 Summary of Benefits and Coverage 9

10 10 Summary of Benefits and Coverage

11 Summary of Benefits and Coverage 11

12 12 Summary of Benefits and Coverage

13 Summary of Benefits and Coverage 13

14 Dental Coverage Administrators, Administra ve Support and Support Staff The dental plan will con nue to be administered by SET SEG. The dental plan and benefits are not changing. Below is a summary of plan provisions provided by SET SEG for Administrators, Administra ve Support and Support Staff: 14

15 Dental Coverage Administrators, Administra ve Support and Support Staff 15

16 Dental Coverage Teachers The dental plan will con nue to be administered by SET SEG. The dental plan and benefits are not changing. Below is a summary of plan provisions provided by SET SEG for Teachers: 16

17 Dental Coverage Teachers 17

18 Vision Coverage Administrators The vision plan is not changing coverage will s ll be provided through NVA. Below is an overview of the schedule of benefits provided by NVA for the Administrators: 18

19 Vision Coverage Administrators 19

20 Vision Coverage Support Staff The vision plan is not changing coverage will s ll be provided through NVA. Below is an overview of the schedule of benefits provided by NVA for the Support Staff: 20

21 Vision Coverage Support Staff 21

22 22 Vision Coverage Teachers

23 Vision Coverage Teachers 23

24 24 Vision Coverage EyeEssen al

25 Your Rights Under Federal Law Change in Status or Special Enrollment You may qualify for a special enrollment if certain events occur in your life: If you decline coverage for yourself and/or your dependents (including your spouse) because you are covered under another health plan, you may be able to enroll yourself and/or your dependents in the plan if you experience an involuntary loss of that coverage (e.g., spouse loses his/her job, divorce). If you have a new dependent as a result of marriage, birth, adop on, or placement for adop on, you may be able to enroll yourself and your dependents in the plan. In either situa on, you must request enrollment through the Mason County Central Schools Benefit Center within 30 days a er the special enrollment event as described above. If you enroll as the result of a special enrollment event, coverage will be made effec ve on the date of the event. Newborn and Mother s Health Protec on Act Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connec on with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean sec on. However, Federal law generally does not prohibit the mother s or newborn s a ending provider, a er consul ng with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authoriza on from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). Women's Health Cancer Rights Act No ce Federal law requires a group health plan to provide coverage for the following services to an individual receiving plan benefits in connec on with a mastectomy: These services include: Reconstruc on of the breast upon which the mastectomy has been performed; Surgery/reconstruc on of the other breast to produce a symmetrical appearance; Prosthesis; Physical complica on during all stages of mastectomy, including lymph edemas. The plan may not: Interfere with a woman s right under the plan to avoid these requirements; Offer inducements to the health provider, or assess penal es against the health provider, in an a empt to interfere with the requirements of the law. However, the plan may apply deduc bles and co insurance requirements consistent with other coverage provided under the plan. 25

26 Medicare Part D Important No ce from Mason County Central Schools Health Care Plan About Your CREDITABLE Prescrip on Drug Coverage and Medicare Please read this no ce carefully and keep it where you can find it. This no ce has informa on about your current prescrip on drug coverage with MCCS and about your op ons under Medicare s prescrip on drug coverage. This informa on can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescrip on drug coverage in your area. Informa on about where you can get help to make decisions about your prescrip on drug coverage is at the end of this no ce. There are two important things you need to know about your current coverage and Medicare s prescrip on drug coverage: 1. Medicare prescrip on drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescrip on Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescrip on drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. 2. MCCS has determined that the prescrip on drug coverage offered by the Priority Health is, on average for all plan par cipants, expected to pay out as much as standard Medicare prescrip on drug coverage pays and is therefore considered Creditable Coverage. Because your exis ng coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan. When Can You Join A Medicare Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th. However, if you lose your current creditable prescrip on drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan. What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan? If you decide to join a Medicare drug plan, your current coverage will not be affected. Summary of Op ons for Medicare Eligible Employees (and/or Dependents): Con nue medical and prescrip on drug coverage and do not elect Medicare D coverage. Impact your claims con nue to be paid by MCCS health plan. Con nue medical and prescrip on drug coverage and elect Medicare D coverage. Impact As an ac ve employee (or dependent of an ac ve employee) the MCCS health plan con nues to pay primary on your claims (pays before Medicare D). Drop the coverage and elect Medicare Part D coverage. Impact Medicare is your primary coverage. You will not be able to rejoin the MCCS health plan unless you experience a family circumstance change or un l the next open enrollment period. If you do decide to join a Medicare drug plan and drop your current coverage, be aware that you and your dependents will not be able to get this coverage back unless you experience a family status change or un l the next open enrollment period. If you go 63 con nuous days or longer without creditable prescrip on drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescrip on drug coverage. In addi on, you may have to wait un l the following November to join. For More Informa on About This No ce Or Your Current Prescrip on Drug Coverage Contact the person listed below for further informa on NOTE: You ll get this no ce each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through MCCS changes. You also may request a copy of this no ce at any me. For More Informa on About Your Op ons Under Medicare Prescrip on Drug Coverage More detailed informa on about Medicare plans that offer prescrip on drug coverage is in the Medicare & You handbook. You ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more informa on about Medicare prescrip on drug coverage: Visit Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the Medicare & You handbook for their telephone number) for personalized help Call MEDICARE ( ). TTY users should call If you have limited income and resources, extra help paying for Medicare prescrip on drug coverage is available. For informa on about this extra help, visit Social Security on the web at or call them at (TTY ). Remember: Keep this Creditable Coverage no ce. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this no ce when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty). Date: October 1, 2015 Name of En ty/sender: Kris e Courtland Willick Contact Posi on/office: MCCS Address: 300 W Broadway, Sco ville, MI Phone Number: CMS Form CC Updated April 1, 2011 According to the Paperwork Reduc on Act of 1995, no persons are required to respond to a collec on of informa on unless it displays a valid OMB control number. The valid OMB control number for this informa on collec on is The me required to complete this informa on collec on is es mated to average 8 hours per response ini ally, including the me to review instruc ons, search exis ng data resources, gather the data needed, and complete and review the informa on collec on. If you have comments concerning the accuracy of the me es mate(s) or sugges ons for improving this form, please write to: CMS, 7500 Security Boulevard, A n: PRA Reports Clearance Officer, Mail Stop C , Bal more, Maryland When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan? You should also know that if you drop or lose your current coverage with Priority Health and don t join a Medicare drug plan within 63 con nuous days a er your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later.

27 Ques ons or Need Assistance Medical & Prescrip on Drug Priority Health Dental SET SEG Vision Na onal Vision Administrators (NVA) nva.com Voluntary Benefits SET SEG MCCS Contact Kris e Courtland Willick Nancy VanNortwick x x 111 Every effort has been made to ensure the accuracy and completeness of the benefit descrip ons contained within this no ce. However, this no ce is not meant to be a detailed descrip on of your benefits. Your official plan documents cover your benefits in more detail. Whenever there is a ques on of interpreta on or discrepancy between this no ce and the official plan documents, the official plan documents will govern. This no ce in not intended to create nor to be construed as a contract between the company and its employees for any ma er, including for the provisions of benefits described. 27

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