Benefits Guide. July 2015 June 2016

Transcription

1 Benefits Guide July 2015 June 2016

2 What s Inside. Introduc on Enrollment... 4 Changing Benefits During The Year... 5 Health Care Program Choices... 6 Medical Benefits... 7 Dental Benefits Vision Benefits Life and Disability Benefits Flexible Spending Account (FSA) (b) Plan Special No ces Contact Informa on

3 INTRODUCTION KIPP DC Team + Family, KIPP DC has made some important changes to our benefit package for the school year. This Benefit Guidebook outlines these changes and provides addi onal resources to help you determine the best benefit op ons for you and your family. The biggest change to our benefits package involves our health care plan. Star ng July 1st, KIPP DC employees will have access to three Aetna plans: the Health Network Only (HNOnly) plan, the Preferred Provider Organiza on (PPO) plan, and a new Health Savings Account (HSA) plan. Due to the rising costs of health care plans, all three of these op ons require employee contribu ons. We hope that the informa on in this guide will help you determine which plan will best meet your own health needs. We are also excited to con nue to offer excellent coverage for dental and vision, life and disability benefits, Flexible Spending Accounts, a 403(b) plan, and other so benefits. In order to provide you with as much informa on as possible about your op ons, we will be offering a series of Annual Enrollment mee ngs to answer your ques ons. Resources will also be available through the HR Portal. Addi onally, you can always reach out to the HR Team (hr@kippdc.org), to learn more about your benefits. We look forward to another healthy and produc ve year at KIPP DC! Best Susan & Allison 3

4 ENROLLMENT Open Enrollment runs from May 26th through June 5th, 2015: KIPP DC s plan year is from July 1st, 2015 June 30th, If during Open Enrollment, you want to make a coverage change, add or drop a dependent, or par cipate in a Flexible Spending Account, please follow our Open Enrollment guidelines and helpful ps below. If you do not make a change, you will be automa cally enrolled in the same benefit plan(s) you were enrolled in for the school year. All new elec ons and benefit changes must be made by comple ng the appropriate open enrollment procedures via ADP. If you have any ques ons or concerns about this process, please contact the KIPP DC HR Department at the contact informa on listed below. Shannon Benson Director of Human Resources HR@kippdc.org Chris ne Kim Senior Human Resources Associate HR@kippdc.org Caitlin Baker Human Resources Associate HR@kippdc.org Helpful Tips! Eligibility All full me employees working at least 30 hours per week are eligible for benefits through KIPP DC. Eligible Dependents Your eligible dependents for medical, dental and vision coverage include: Your legal spouse Your child(ren) up to age 26 Your child(ren) age 26 or older who is incapable of self support because of a total physical or mental disability that occurred while covered under the plan. Coverage Levels You may choose from the following coverage levels for your medical, dental and vision op ons: Employee Employee + child(ren) Employee + spouse/partner Employee + family It is important to monitor the eligibility of your dependents for benefits coverage (as detailed in this guide). You may be required at any me to provide proof of your dependent s eligibility. Employee Checklist: Elect a medical plan for yourself and family (Subsidized by KIPP DC for employees and dependents) Elect dental coverage for yourself and family (Covered by KIPP DC for employees. Subsidized by KIPP DC for dependents) Elect vision coverage for yourself and family (Op onal for employees and dependents through payroll deduc on) Elect HSA/FSA par cipa on and contribu on Health Savings Account (High Deduc ble Health Plan par cipants only), Health Care FSA, Dependent Care FSA, & Parking/Transit (Op onal for Employees through payroll deduc on) Designate 403(b) contribu on Supplemental life insurance (Op onal for employees through payroll deduc on) 4 Default Elec ons: If you are a returning employee, you will be defaulted into your current plan op on and coverage level. PPO Dental Plan for employees and dependents currently covered. Voluntary Vision Plan for employees and dependents currently covered. Not par cipa ng Employees must elect/reelect if they would like to partake. 3% of your paycheck unless you elect otherwise. Amount of addi onal life insurance employee and dependents are covered today.

5 CHANGING BENEFITS DURING THE YEAR The benefit elec ons you make during open enrollment remain in effect for the en re year. You cannot change your elec ons during the year unless you have a qualified life event. Some of these events include: Qualified life events must be submi ed within 31 days of the date of your life event. Birth or adop on of an eligible child Marriage or divorce A change in your dependent s eligibility for benefits A change in employment status for you or your spouse You or your dependent becomes enrolled in Medicare or Medicaid Your dependent ceases to sa sfy the dependent eligibility requirements Contact Human Resources to execute a change at HR@kippdc.org. Addi onal contact informa on is below: When you have a qualified life event, no fy Human Resources to execute the change. You must no fy HR within 31 days of the date of your life event. Otherwise, you will have to wait un l the next annual enrollment to change your benefits. You will be able to change your benefit elec on(s) as long as the change is consistent with your qualified life event. You will be required to furnish documenta on of the change to KIPP DC within 31 days of the event. Suppor ng documenta on must contain the reason for the change and date of the event. Shannon Benson Chris ne Kim Caitlin Baker

6 OVERVIEW OF PROGRAM CHOICES FOR Medical Plans HDHP HSA (HNO) HNO PPO The three medical plans are administered by Aetna and include coverage for prescrip on drugs. (See Page 10 for more details) The Plans offer discounted rates when you obtain medical care within the network. You may use providers outside of the network if enrolled in the PPO plan, but your out ofpocket costs will be higher and less predictable. Health Savings Account (HSA) Available to HDNP HSA (HNO) par cipants only Dental Plan PPO Vision Plan Life & Disability Plans Flexible Spending Accounts Health Care Dependent Care Parking/Transit 403B Re rement Savings Plan If you choose to enroll in the High Deduc ble Health Plan (HDHP), you have the opportunity to u lize a Health Savings Account (HSA). An HSA allows you to put away money on a pre tax basis to pay for qualified medical expenses tax free. The account is owned by the employee and rolls over from year to year, even if you no longer par cipate in an HDHP. (See Pages 13 and 23 for more details) The MetLife dental plan covers preven ve care at 100% with no deduc ble. The Plan provides greater coverage for basic and major services within the network. You may use providers outside of the network, but your costs will be higher and less predictable. The vision plan is administered by Group Vision Service and provides coverage for an eye exam, lenses and frames and/or contact lenses, as well as addi onal discounts from network providers. The Reliance Standard administered Life/AD&D and Long Term Disability Plans are provided by KIPP DC at no cost to you. Voluntary Supplemental Life Insurance is available to cover yourself and your dependents beyond the employer paid coverage. Flexible Spending Accounts (FSAs), administered by 125 Company, give you the opportunity to set aside pre tax money to pay out of pocket costs for eligible health, dependent care, and transporta on expenses. All full me KIPP DC employees have the choice to par cipate in the FSAs. Limita ons apply to the health FSA for those who also par cipate in the HSA. KIPP DC s 403(b) is administered by Transamerica. Employee contribu ons are set at 3% unless designated otherwise. KIPP DC contributes 3% and a 100% match of employees contribu ons, up to 3%. An employee is vested a er 3 years. EMPLOYEE COSTS PER PAY PERIOD HDHP HSA (HNO) MEDICAL Employee $13.25 Employee + Child(ren) $ Employee + Spouse $ Family $ HNO MEDICAL Employee $26.50 Employee + Child(ren) $ Employee + Spouse $ Family $ PPO MEDICAL Employee $ Employee + Child(ren) $ Employee + Spouse $ Family $ DENTAL Employee $0.00 Employee + Child(ren) $10.87 Employee + Spouse $16.80 Family $23.23 VISION Employee $2.90 Employee + Child(ren) $5.95 Employee + Spouse $5.79 Family $9.65 6

7 MEDICAL BENEFITS IN DETAIL MEDICAL BENEFITS Aetna Op on 1: HDHP HSA (HNO) Op on 2: HNO Op on 3: PPO 7

8 WHICH TYPE OF PLAN IS RIGHT FOR YOU? Employee premiums HDHP HSA (HNO) HNO PPO KIPP DC pays 93% of the employee only rate. You pay the difference if you choose to cover your dependents. KIPP DC contributes 93% of the HDHP HSA (HNO) employeeonly, and you are responsible for the remaining cost for yourself and any dependents. KIPP DC contributes 93% of the HDHP HSA (HNO) employee only rate, and you are responsible for the remaining cost for yourself and any dependents. Availability of Network/ Cost Share Employee only has the choice of providers and facili es in the HNOnly network. No out of network coverage (besides emergency) is available. Employee only has the choice of providers and facili es in the HNOnly network. No out of network coverage (besides emergency) is available. Employee has the flexibility to use any provider, however elec ng providers in the Aetna PPO network will result in lower or no cost share. If you use out of network providers (OON), a higher cost share will result. Out of pocket expenses Plan members must meet their deduc ble before any benefits are payable for nonpreven ve care services. Once the deduc ble is met, the employee pays coinsurance un l the out ofpocket maximum is met. Copays (with no deduc ble) apply to many covered services. The deduc bles are lower and apply to a limited number of covered services, such as hospitaliza on, outpa ent surgery and sophis cated diagnos c services (e.g., MRI and CT). The employee pays copays un l the out of pocket maximum is met. Eligibility for HSA / FSA HSA / Limited Purpose FSA FSA FSA Preven ve care Eligible in network preven ve care services are covered at 100%; no copay, deduc ble or coinsurance applies. Primary care and specialist office visits You pay the cost of all provider care un l you meet your deduc ble. Then you pay coinsurance for eligible claims up to the annual outof pocket maximum. You pay your copay for office visits. You pay your copay for office visits. Prescrip on benefits Inpa ent services and outpa ent surgery facili es You pay the cost of all prescrip ons un l you meet your deduc ble. Then you pay a copay for eligible prescrip ons up to the annual out of pocket maximum. You pay coinsurance a er you have met your deduc ble, up to the out of pocket maximum. You pay a copay for covered prescrip ons. 8 You pay a copay for covered prescrip ons. You pay coinsurance a er you There is no charge for have met your deduc ble, up Inpa ent services. to the out of pocket maximum.

9 MEDICAL OPTIONS The chart below highlights your costs and covered services under each medical plan HDHP HSA (HNO) HNO PPO MEDICAL BENEFITS In Network In Network In Network Out of Network ANNUAL DEDUCTIBLES (Individual/Family) ANNUAL OUT OF POCKET MAXIMUM (Individual/Family) OFFICE SERVICES Preven ve Services Physician Specialist Maternity Office Visits $1,500/$3,000 $500/$1,000 None $500/$1,000 $3,000/$6,000 $3,000/$6,000 $1,500/$3,000 $3,000/$6,000 No Charge No Charge No Charge 20% A er Deduc ble 10% A er Deduc ble $20 Co Pay $20 Co Pay 20% A er Deduc ble 10% A er Deduc ble $40 Co Pay $20 Co Pay 20% A er Deduc ble No Charge No Charge No Charge 20% A er Deduc ble HOSPITAL SERVICES Inpa ent Hospitaliza on 10% A er Deduc ble 10% A er Deduc ble No Charge 20% A er Deduc ble Outpa ent Surgery 10% A er Deduc ble 10% A er Deduc ble No Charge 20% A er Deduc ble Lab Tests & X rays Emergency Room Visit 10% A er Deduc ble 10% A er Deduc ble No Charge 20% A er Deduc ble 10% A er Deduc ble $150 Co Pay $100 Co Pay Same As In Network Urgent Care Services 10% A er Deduc ble $25 Co Pay $25 Co Pay 20% A er Deduc ble THERAPY & SERVICES Physical/Occupa onal/ Speech Therapy 10% A er Deduc ble $40 Co Pay $20 Co Pay 20% A er Deduc ble Chiroprac c Services 10% A er Deduc ble $40 Co Pay $20 Co Pay 20% A er Deduc ble Outpa ent Mental Illness & Substance Abuse services 10% A er Deduc ble $40 Co Pay $20 Co Pay 20% A er Deduc ble PRESCRIPTION BENEFITS Tier 1 $20 A er Deduc ble $20 Co Pay $15 Co Pay $ % Tier 2 $40 A er Deduc ble $40 Co Pay $35 Co Pay $ % Tier 3 $70 A er Deduc ble $70 Co Pay $60 Co Pay $ % Mail Order 2x Retail 2x Retail 2x Retail N/A Please note: This is only intended as a summary of benefits. Please refer to plan documents for full details. 9

10 PRESCRIPTION DRUG BENEFITS Employees who have elected medical coverage through Aetna receive prescrip on drug coverage through Aetna s pharmacy program. When you fill your prescrip on at a par cipa ng retail pharmacy, you may purchase up to a 30 day supply of covered drugs. At the pharmacy, you will need to present your ID card and make the required copayment. Tier 1: Generic Tier 2: Preferred Brand Name Tier 3: Non Preferred Brand Name If you use a maintenance drug, for chronic condi ons such as arthri s, asthma, diabetes, heart or others, you may use the mail order program to receive a 90 day supply at a reduced cost to you. HNO Retail Pharmacy Mail Order Program Copays 30 day supply 90 day supply Tier 1 $20 $40 Tier 2 $40 $80 Tier 3 $70 $140 Please Note: If you are enrolled in the HDHP HSA (HNO), the full cost of the drug is applied to the deduc ble before any benefits are considered for payment under the pharmacy plan. A er you meet the integrated medical and pharmacy deduc ble, you will pay the applicable copays above. PPO Retail Pharmacy Mail Order Program Copays 30 day supply 90 day supply Tier 1 $15 $30 Tier 2 $35 $70 Tier 3 $60 $120 Out of Network Copay + 20% Coinsurance Not Covered Use Aetna s Mail Order Program for Maintenance Drugs: Aetna Rx Home Delivery Save money: Depending on your plan, you can get up to a 90 day supply of medicine for less cost. Standard shipping is free. Save me: Re order just once every three months with no trips to the pharmacy. You can re order by phone or use the order form located on the HR Portal. Save worries: Your medicine is securely packed and mailed quickly and securely to you. Registered pharmacists check all orders for accuracy. If you have an emergency, you can call the program at any me. Set up mail order delivery Step by Step: 1. Get a prescrip on from your doctor for a 90 day supply of your maintenance drug(s). 2. Complete an order form. 3. Mail the form to the address listed, along with your prescrip on and payment. Your doctor can also fax the Aetna Rx Home Delivery service your prescrip on and order form. Everything to manage mail order is on your Aetna Navigator website 10

11 TELADOC Available through your KIPP DC Aetna medical plan beginning July 1, 2015! A welcome kit is being mailed to your home with instruc ons for se ng up your Teladoc account, comple ng your medical history and reques ng a consult. Once you're set up, a Teladoc doctor is always just a call or click away. 24 / 7 / 365 ACCESS TALK TO A DOCTOR ANYTIME WHAT IS TELADOC? GET THE CARE YOU NEED MEET OUR DOCTORS Teladoc gives you 24/7/365 access to U.S. board cer fied doctors who can treat many of your medical issues by phone or video. It is not insurance but an added medical benefit that gives you an affordable alterna ve to costly urgent care or ER visits. Teladoc doctors can treat many medical condi ons, including: Cold & flu symptoms Allergies Bronchi s Urinary tract infec on Respiratory infec on Sinus problems Teladoc is simply a new way to access qualified doctors. All Teladoc doctors: Are prac cing PCPs, pediatricians, and family medicine physicians Average 15 years experience Are U.S. board cer fied and licensed in your state And more! Are creden aled every three years, mee ng NCQA standards Co Pays for Members: HDHP HSA (HNO) HNO PPO $40 (goes towards deduc ble accumula on) $40 co pay $20 co pay Teladoc.com/Aetna Teladoc ( ) Facebook.com/Teladoc Teladoc.com/mobile 11

12 IMPORTANT MEDICAL TERMS TO KNOW Coinsurance The part of a medical bill that you pay after reaching your deductible. For example, if your medical bill is $100 and your coinsurance is 20%, you pay $20. The insurance company pays $80. The percentage of coinsurance that you pay can vary between plans, and it s important to realize that the amount you pay could be lower if you qualify for cost-sharing reductions. Copayments Copayments (or copays) are fixed, upfront dollar amounts that you pay each time you receive certain health care services. Many plans offer copays that give you the security of knowing your costs in advance. Also, it s important to remember that all plans cover preventive services with no cost sharing. There are no copays or coinsurance for in-network preventive services like annual check-ups, mammograms and colonoscopies. Deductible The dollar amount you must pay each benefit period (usually a year) for your health care expenses before your plan begins to pay. For example, if you have a $500 deductible, that s the amount you will pay before your plan will pay for covered in-network services. When picking your plan, you should choose the one with the highest deductible amount that you can comfortably pay in a calendar year. Some services may not require you to meet a deductible before your plan pays. We offer a variety of deductibles so you re sure to find a plan that fits your needs and budget. In-network providers These are health care providers who have an agreement with the health plan pertaining to payment as a network participant. Out-of-network providers Health care providers who do not have an agreement with the plan where they can be considered a network participant. You usually pay more when you use out-of-network health care providers. Out-of-pocket maximum: The highest amount you will need to pay each benefit period (usually a year) for covered in-network care before your insurance company pays 100%. For example, if your out-of-pocket maximum is $2,000, once you have paid $2,000 the insurance company pays for 100% of the plan allowance for covered in-network care. This does not include any services not covered by your plan. Premium Your monthly premium is the amount you pay each month for your health insurance. Usually, plans that have a higher deductible have a lower monthly premium, while plans with a lower deductible will likely have a higher premium. Formulary A formulary is a list of prescription drugs that are covered by your health insurance plan. A drug s formulary status affects how much you pay for each drug. It s important to make sure the prescriptions you need are covered in your plan s formulary. 12

13 INTRODUCTION TO HEALTH SAVINGS ACCOUNTS (HSAS) An HSA is for qualified medical expenses. You must have a qualified high deductible health plan (HDHP) to contribute to an HSA. An HSA lets you take more control of your health care. You use the HSA to pay for qualified medical expenses. You can use it as you have expenses. Or you can save the funds for future expenses. You decide when you use your funds. You also decide what expenses you pay with your HSA funds. You can also invest the funds. An HSA offers triple tax savings. Pre-tax or tax-deductible contributions.(1) Tax-free interest and investment earnings.(2) Tax-free distributions, when used for qualified medical expenses. Anyone can contribute to your HSA. This includes you, your employer, your spouse or anyone else. You can then make tax-free withdrawals to pay for eligible medical expenses. This includes expenses for you, your spouse and your tax dependents. This is true even if you have a self-only HDHP. HSAs are portable. This means that you keep your HSA. This is true even if you change employers or stop working. Unlike a Flexible Spending Account (FSA), there is no use-it-or-lose-it rule with HSAs. If you don t use funds, they remain in your HSA each year. They also continue to earn tax-free interest. If you invest your HSA funds, they remain in the investment account, like an IRA or 401(k). This all means that HSAs have the potential for long-term, tax-free savings. In addition to having a qualified HDHP, there are some other eligibility requirements. You can t be enrolled in Medicare. You can t have any non-permitted coverage. You can t be claimed as someone else s tax dependent. There are no income limits. (1)You should consult a tax advisor. Tax references are at the federal level. State taxes may vary. (2) Investment products are not FDIC insured, have no bank guarantee and may lose value. 13

14 DENTAL BENEFITS IN DETAIL DENTAL BENEFITS MetLife MAC PPO 14

15 DENTAL BENEFITS KIPP DC provides individual MetLife dental coverage to its full me employees. You have the op on to extend coverage to your dependents with an addi onal contribu on, deducted from your paycheck. You may also choose to waive dental coverage. If you do, you will not be able to enroll in a dental plan un l the next annual enrollment period, unless you have a qualified life event. NOTE: Your dental plan gives you the flexibility to use both in network and out of network providers. However, if you choose a non par cipa ng den st, your out of pocket costs may be higher. The den st/ prac ce has not agreed to accept nego ated fees, so you may be responsible for the difference in cost between the den st's fee and your plan's benefit payment. Annual Deduc ble The chart below highlights your costs and covered services under your dental plan. Coverage Type In Network Out of Network Preven ve Care Exams and cleanings (twice in a calendar year), X rays and sealants Basic Services Fillings Endodon cs, periodon cs and surgery Major Services Crowns, inlays, onlays, cast restora ons and bridges Orthodon c Services For children up to age 19 $50 per person/ $150 per family No charge, no deduc ble $50 per person/ $150 per family 20% 20% 50% 50% No coverage No coverage Annual Benefit Maximum $1,500 per person $1,500 per person Life me Orthodon c Maximum N/A N/A DENTAL EMPLOYEE COSTS PER PAY PERIOD Employee $0.00 Employee + Child(ren) $10.87 Employee + Spouse $16.80 Family $23.23 Easy access to Dental Informa on: MetLife provides you easy access to your dental informa on when you visit Find a network den st. Verify plan eligibility & view benefit plan coverage. Es mate the average cost of dental procedures using Fee Finder. View claims informa on and status. 15

16 VISION BENEFITS IN DETAIL VISION BENEFITS Group Vision Service PPO (Voluntary Benefit) 16

17 VOLUNTARY VISION BENEFITS Group Vision Service Member Access Online Resources Locate a provider or view your benefits. Customer Service Call customer service to ask about your benefits or to locate a provider. Call Center Hours 7 days a week 8:00 a.m. to 11:00 p.m. Monday Saturday 11a.m. to 8:00 p.m. Sunday Addi onal Savings Program Members have access to discounts in addi on to their covered benefits. Members will receive discounts on lens op ons and addi onal purchases. Discounts are available from network providers only and are not insured benefits. 40% discount off complete addi onal pairs of glasses (Lenses and Frames must be purchased at the same me). 20% discount off eyewear accessories such as lens treatment, specialized lenses, non prescrip on sunglasses and more. Visit the GVS website to learn about more discounts using the Addi onal Savings Program. Employees and their dependents have the op on of par cipa ng in KIPP DC s voluntary vision plan through payroll deduc on. The voluntary vision plan is administered by Group Vision Service and pays benefits for both in network and out of network services. When you visit an in network provider, benefits are greater and there are no claim forms to file. When you use an out of network provider, you will be responsible for filing claims and reimbursed at the scheduled amounts listed in the chart below. You may also choose to waive vision coverage. If you do, however, you will not be able to enroll in the Vision Plan un l the next annual enrollment period, unless you have a qualified life event. The chart below provides an overview of covered services and benefits under the vision plan. Vision Exam (every 12 months) Frames (every 24 months) Lenses (every 12 months) Contact Lenses In lieu of lenses (every 12 months) In Network Covered 100%, a er $10 copay Out of Network Covered at 100%, up to $32 $130 allowance Covered at 100%, up to $45 Covered at 100%, a er $20 copay for single vision, bifocal, or trifocal in standard/basic plas c w/ Standard Scratch Resistance Reimbursed up to: Necessary: $250 Elec ve: $130 VISION EMPLOYEE COSTS PER PAY PERIOD Employee $2.90 Employee + Child(ren) $5.95 Employee + Spouse $5.79 Family $9.65 Reimbursed up to: Single vision: $30 Bifocal: $45 Trifocal: $75 Standard Scratch: $12 Reimbursed up to: Necessary: $200 Elec ve: $105 17

18 LIFE & DISABILITY BENEFITS IN DETAIL LIFE & DISABILITY BENEFITS Reliance Standard Group Life/AD&D Long Term Disability Voluntary Life 18

19 EMPLOYER PAID LIFE AND DISABILITY BENEFITS The Life and Disability Plans are provided by KIPP DC at no cost to employees and administered by Reliance Standard. TERM LIFE SUMMARY OF GROUP LIFE AND AD&D BENEFITS This coverage is Term Life Insurance. The life insurance benefit is payable to the designated beneficiary upon the death of the insured. AD&D Accidental Death and Dismemberment Insurance provides specified benefits for a covered accidental bodily injury that directly causes dismemberment (i.e.: the loss of a hand, foot, or eye). In the event that death occurs from a covered accident, both the Life and the AD&D benefit would be payable. LIFE BENEFIT $50,000 AD&D BENEFIT $50,000 GUARANTEE ISSUE $50,000 SUMMARY OF GROUP LONG TERM DISABILITY BENEFITS MONTHLY BENEFIT 60% of covered earnings, up to a maximum benefit of $6,000 per month. FEATURES Extended Disability Benefit Mental/Nervous Illness Limita on 24 month outpa ent Minimum Benefit Payable $100 Own Occupa on Coverage 24 months Offsets (such as, but not limited to, Social Security, Workers Compensa on, State Disability Plans) Pre Exis ng Condi on Limita on 3/12 Residual and Par al Disability Specific Indemnity Benefit Substance Abuse Limita on 24 months Survivor Benefit 3 months Transfer of Coverage provision Work Incen ve & Child Care provisions Reliance Standard Customer Care Center customer.service@rsli.com Phone: (800) Weekdays between 8am and 7pm ELIMINATION PERIOD BENEFIT DURATION 90 consecu ve days of total disability. Benefits will not extend beyond the longer of: age 65 or Social Security Normal Re rement Age. Value Added Benefits Employee Assistance/Work Life Program Travel Assistance Service Bereavement Counseling Service 19

20 VOLUNTARY LIFE AND AD&D Voluntary Life & AD&D are employee paid through payroll deduc ons and administered by Reliance Standard. KIPP DC offers you the opportunity to purchase term life insurance at group rates from Reliance Standard, a trusted benefits carrier for over a century. You may elect coverage for yourself as well as your dependent spouse and/or dependent children. Life insurance can be an important step in safeguarding your family s overall financial plan. How much do I need? Experts recommend that you have at least five to ten mes your annual income in life insurance protec on. If you don t think you already have as much coverage as you may need, this is your opportunity to secure addi onal protec on for your family. You can purchase the amount that s right for you. You may be eligible to purchase as much as $500,000 of coverage. What are my op ons through KIPP DC? Please refer to the graph below. Employee Life & AD&D Spouse Life & AD&D Child Life & AD&D Choose from a minimum of Age 14 days to 6 months: $1,000 BENEFIT AMOUNT Choose from a minimum of $10,000 to a maximum of $500,000 (in $10,000 increments) for yourself. $10,000 to a maximum of $500,000 (in $10,000 increments) for your spouse. Age 6 months to 20 years of age (26, if full me student): choice of $2,500, $5,000; $7,500 or $10,000 The benefit amounts chosen Choose one benefit amount for all eligible children in family. Under age 60: $100,000 GAURENTEE ISSUE Age 60 but under age 70: $10,000 Under age 60: $30,000 Age 60 or older: none $10,000 (All) Age 70 or older: none Premium rates are based on age and desired amount of coverage. Please contact Human Resources if you are interested in purchasing addi onal life insurance coverage for yourself, your spouse, or your children. 20

21 EMPLOYEE ASSISTANCE PROGRAM (EAP) life resource.com Username: hmsa Password: myresource The Employee Assistance Program (EAP) is included with KIPP DC s Life and Disability Plans at no cost to the employees and their dependents. The EAP is a confiden al, voluntary service that provides professional counseling and referral services designed to help you and your family members with personal, job or family related ques ons or concerns. Your EAP can help you and your dependents iden fy, resolve and gain control over personal problems that may be interfering with work and daily life. Please feel free to contact the EAP at the informa on listed below. Dedicated Toll Free Crisis Line hours a day 7 days a week 365 days a year Telephonic Diagnos c Assessment and Problem Resolu on Sessions Employees and dependents will receive a telephonic assessment and up to 3 telephonic short term problem resolu on sessions per issue. Referral services coordinated with exis ng health insurance benefits if longer treatment is recommended. Some common concerns the EAP can help with: Stress, Anxiety, Depression Life transi ons Grief & Loss Divorce / Separa on Conflict Resolu on Substance abuse Work Life Counseling Legal & Financial Consulta ons BEREAVEMENT COUNSELING SERVICE For confiden al, personal assistance, please call the toll free number for counseling hours a day 7 days a week 365 days a year TRAVEL ASSISTANCE FOR YOU AND YOUR FAMILY 24-Hour Travel Assistance Through your group coverage with Reliance Standard, you automa cally receive travel assistance services provided by On Call Interna onal. On Call is a 24 hour, toll free service that provides a comprehensive range of informa on, referral, coordina on and arrangement services designed to respond to most medical care situa ons and many other emergencies you may encounter when you travel. On Call also offers pre trip assistance including passport/visa requirements, foreign currency and weather informa on. For emergency medical, legal and travel assistance informa on and referral service 24 hours a day, 365 days a year, call: In the U.S., toll free Worldwide, collect

22 FLEXIBLE SPENDING ACCOUNTS IN DETAIL FLEXIBLE SPENDING ACCOUNTS 125Company Health Dependent Care Parking/Transit 22

23 WAYS TO SAVE HSA & FSAs The below chart shows the features and limits of the HSA and FSA op ons KIPP DC offers. HEALTH SAVINGS ACCOUNT (HSA) LIMITED PURPOSE HEALTH CARE FSA* HEALTH CARE FSA** Available if you select these plans The KIPP DC High Deduc ble Health Plan (HDHP) The KIPP DC High Deduc ble Health Plan (HDHP) or another HDHP The KIPP DC tradi onal HNO or PPO plans or another non HDHP plan How much you may contribute $3,350 (employee only coverage) or $6,650 (all other coverage levels). Catch up contribu ons of up to $1,000 per year may also be permi ed if you are age 55 or older. Up to $2,550 for the plan year. Expenses you may pay from your account (full list can be found online) Out of pocket medical, prescrip on drug, dental, and vision expenses Out of pocket expenses incurred during the current plan year: Dental Vision Out of pocket expenses incurred during the current plan year: Medical Prescrip on drugs Dental Vision Account balance available to reimburse expenses Time limits for using your account balance Current account balance No limit En re contribu on amount elected for the plan year. Must use plan year account balance for expenses incurred through June 30, If you don t use all your account balance each year How it saves you money Any account balance carries over from year to year Your contribu ons are taxfree, which reduces your taxable income and increases your take home pay Any investment or interest earnings on your account balance is tax free Distribu ons are tax free if used for qualified health care expenses You forfeit any plan year account balance not used toward expenses incurred between July 1, 2015 and June 30, Your contribu ons are tax free, which reduces your taxable income and increases your take home pay You pay for health care expenses with pre tax dollars *The limited purpose FSA is available to employees who enroll in the KIPP DC or other HDHP. HDHP members may not enroll in the health care FSA, unless you are ineligible to par cipate in the HSA. **You do not have to par cipate in a KIPP DC medical plan to enroll in a health care FSA. For 2015, the federally qualified annual HDHP deduc ble is $1,300 for single coverage and $2,600 for family coverage 23

24 WAYS TO SAVE HSA & FSAs The below chart shows the features and limits of the addi onal FSA op ons KIPP DC offers. Available if you select these plans DEPENDENT CARE FSA PARKING/TRANSIT FSA Any of the KIPP DC health plans. However, you do not have to par cipate in a KIPP DC medical plan to enroll in the Dependent Care FSA or Parking/Transit FSA. How much you may contribute Expenses you may pay from your account (full list can be found online) Up to $5,000 for plan year (total per family) Eligible day care expenses incurred during the current plan year: Day camp Elder care Before and a er school care (for children up to age 13) In home day care Up to $250 per month for Parking and up to $130 per month for Transit on your SmarTrip card Parking and Mass Transit expenses incurred by the employee for travel between their residence and work place are considered eligible. Account balance available to reimburse expenses Current account balance Time limits for using your account balance Must use plan year account balance for expenses incurred through June 30, If you don t use all your account balance each year You forfeit any 2014 plan year account balance not used toward expenses incurred between July 1, 2015 and June 30, If the full amount is not used by the employee before the end of the program year, the le over amount is carried forward to the next year. How it saves you money Your contribu ons are tax free, which reduces your taxable income and increases your take home pay You pay for health care expenses with pre tax dollars 24

25 RETIREMENT PLAN IN DETAIL RETIREMENT PLAN Transamerica 403(b) 25

26 RETIREMENT Welcome to the KIPP DC Re rement Plan! Providing a re rement plan that lets you save for the future is important to KIPP DC. We want you to clearly understand if you are doing everything you can to reach your re rement savings goals and how to get there if you s ll need a li le help. Transamerica Re rement Solu ons specialty is offering services, educa on, and an overall re rement planning experience dedicated to making sure you know how to plan for the re rement you ve always wanted. Here are a few of the ways Transamerica can help you achieve your goals: Automated tools and services for crea ng and improving your strategy. Access Transamerica s website at my.trsre re.com which hosts prac cal, interac ve saving and inves ng resources that help you set smart goals, check your progress in real me, and make changes (if you need them) to get re rement ready. Informa on and educa on to help you make decisions with confidence. Award winning customer service and educa on that makes re rement planning easy to understand and easy to do. They will keep you engaged during the planning process and help you understand what you can do to reach your savings goals. Transamerica representa ves can be reached at Investment choices. Whether you want to build your own investment mix or prefer a one step solu on, Transamerica has your bases covered. Remember, though, that diversifica on can't guarantee a profit or protect you against a loss, so be sure to review your investments regularly. What you need to know: Your contribu ons to the plan You will be automa cally enrolled in the plan. This means that 3% of your pay will be withheld from your pay and contributed to the plan on a pre tax basis unless you elect otherwise. Your investment elec ons Once your contribu ons begin, they will be invested in the plan s Qualified Default Investment Alterna ve Por olioxpress unless you elect otherwise. Making changes You can access your online account at my.trsre re.com to change your contribu on amount, update your investment elec ons and establish your beneficiary designa on. You will also be receiving an enrollment packet to your home address on file. How to learn more: Detailed informa on about the provisions and benefit features of the plan is available on KIPP DC s New Hire Website at h p:// hire documents/ (password: workhard) and on KIPP DC s HR Portal. Informa on about the investment op ons offered in the plan and any expenses associated with the investment op ons or administra ve services of the plan can be found once you access your account at Transamerica at my.trsre re.com. Transamerica representa ves are available to help answer your ques ons. They can be reached

27 RETIREMENT Eligibility: Employees are eligible to enroll in the Plan a er mee ng the eligibility requirements listed below: There is no minimum age or service requirement. The Plan does not allow par cipa on by employees who are nonresident aliens Entry: Upon mee ng the eligibility requirements, you may enroll in the Plan upon date of hire. Contribu ons: Employee Through payroll deduc ons you may make pre tax contribu ons and/or Roth deferrals of up to $18,000 for The if you are over the age of 50, or are turning 50 in the plan year, you may contribute an addi on $6,000 as a catch up contribu on. Employer Each year in addi on to deposi ng your salary deferrals, KIPP DC may make matching discre onary non elec ve contribu ons subject to the ves ng schedule. For the plan year, KIPP DC contributes 3% of an employee s salary and matches up to 3% of the employee s contribu ons. Employees must be 21 years of age to receive employer contribu ons, and temporary employees and interns are not eligible to receive employer contribu ons. Ves ng Tes ng refers to your ownership of a benefit from the Plan. The money that you contribute and the money it earns is always 100% vested. Any rollover or transfer contribu ons you make are also 100% vested. Employer contribu ons are subject to the following ves ng schedule: Years of Service Ves ng % 1 0% 2 0% 3 100% Distribu ons: Money may be distributed from your Plan account for the following events: Death Disability Termina on of Service Rollover: You are allowed to roll over money into your account prior to becoming eligible to par cipate. Please see your Plan Administrator for rollover details. For more informa on, please contact Transamerica at the contact informa on listed below. Transamerica Please visit: Kippdc.trsre re.com

28 SPECIAL NOTICES Summary of Material Modifica ons This Guide to Benefits Enrollment cons tutes a Summary of Material Modifica ons ( SMM ) which describes changes to your health care program effec ve 7/1/2015 This SMM is a summary of the changes made to the program and the par al terms of NFP s medical, dental, vision, flexible spending accounts, health savings account, life and accident insurance and disability plans. The SMM is not an official plan document. The actual terms of the plans are contained in the plan documents. In the event of any discrepancy, or any conflict between this SMM and the official plan documents, the official plan documents will govern. This SMM should be retained with your other benefits informa on. KIPP DC reserves the right to change, amend, or cease these benefits at any me. No ce of HIPAA Special Enrollment Rights If you are declining enrollment for yourself or your dependents (including your spouse) because of other insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan in the future, if you or your dependents lose eligibility for that other coverage (or if the employer stops contribu ng toward your or your dependents other coverage). However, you must request enrollment within 31 days of when your or your dependents other coverage ends (or a er the employer stops contribu ng toward the other coverage). In addi on, 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. Again, you must request enrollment within 31 days of the marriage, birth, adop on, or placement for adop on. To request special enrollment, contact Human Resources. Newborns and Mothers Health Protec on Act Under federal law, health care plans may not restrict any hospital length of stay in connec on with childbirth for the mother or newborn child to less than 48 hours following a normal delivery, or less than 96 hours following a Cesarean sec on. Federal law, however, generally does not prohibit the mother s or newborn s a ending provider, a er consul ng with the mother and with the mother s consent, from discharging the mother or her newborn earlier than 48 hours (96 hours as applicable). Women s Health and Cancer Rights Act Health care plans that cover mastectomies must also cover post mastectomy reconstruc ve breast surgery. Specifically, health plans must cover: Reconstruc on of the breast on which the mastectomy has been performed Surgery and reconstruc on of the other breast to produce a symmetrical appearance Prostheses Treatment of physical complica ons at all stages of the mastectomy, including lymphedemas Benefits required by law will be provided in consulta on between the pa ent and the a ending physician. These benefits are subject to the health plan s regular deduc bles, copayments and coinsurance. 28

29 SPECIAL NOTICES Children s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you are eligible for health coverage from your employer, your State may have a premium assistance program that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for these programs, but also have access to health insurance through their employer. If you or your children are not eligible for Medicaid or CHIP, you will not be eligible for these premium assistance programs. If you or your dependents are already enrolled in Medicaid or CHIP, you can contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, you can contact your State Medicaid or CHIP office or dial KIDS NOW or to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay the premiums for an employer sponsored plan. Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must permit you to enroll in your employer plan if you are not already enrolled. This is called a special enrollment opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have ques ons about enrolling in your employer plan, you can contact the Department of Labor electronically at or by calling toll free EBSA (3272). For State Specific contact informa on, please go to: ce.doc COBRA Rights No ce If you enroll in medical, dental or vision coverage, or a Health Care Flexible Spending Account, you should be aware of your rights under COBRA (the Consolidated Omnibus Budget Reconcilia on Act, as amended). Among other things, COBRA mandates that an employer give employees the ability to con nue those same coverages, on a self paid basis, a er leaving employment. For more informa on, contact Human Resources. Termina on of Health Coverage for Cause, Including Fraud or Inten onal Misrepresenta on KIPP DC reserves the right to terminate health care coverage for you and/or your dependent prospec vely without no ce for cause (as determined by the Plan Administrator), or if you and/or your dependent are otherwise determined to be ineligible for coverage under the plan. In addi on, if you or your covered dependent commits fraud or inten onal misrepresenta on in an applica on for health coverage under the plan, in connec on with a benefit claim or appeal, or in response to any request for informa on, the Plan Administrator may terminate your coverage retroac vely upon 30 days no ce. Failure to inform any of such persons that you or your dependent are covered under another group health plan or knowingly providing false informa on in order to obtain or con nue coverage for an ineligible dependent are examples of ac ons that cons tute fraud under the plan. 29

30 SPECIAL NOTICES Important No ce from KIPP DC About Your 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 KIPP DC 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. KIPP DC has determined that the prescrip on drug coverage offered by Aetna 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 Aetna coverage through KIPP DC may be affected. The current prescrip on plan $15/$35/$60 is creditable. You can keep this coverage if you elect part D and this plan will coordinate with Part D coverage. If you do decide to join a Medicare drug plan and drop your current KIPP DC coverage, be aware that you and your dependents may not be able to get this coverage back. 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 KIPP DC 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. 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 October to join. 30

31 SPECIAL NOTICES For More Informa on About This No ce Or Your Current Prescrip on Drug Coverage Contact the person listed below for further informa on or call Aetna Pharmacy at AETNA RX ( ). 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 KIPP DC 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: 07/01/2015 Name of En ty/sender KIPP DC Contact Posi on/office Human Resources Address 2600 Virginia Ave NW Suite 900 Washington, DC Phone Number