Benefits Guide

Transcription

1 Benefits Guide

2 ABOUT THIS BENEFITS GUIDE This Benefits Guide describes your benefit options and their costs for the 2015/2016 plan year. It also outlines the steps you need to take to select and enroll in the appropriate coverage. This guide is interactive. Simply roll your mouse over a link and click for more information. Review the Guide carefully and feel free to contact the Benefits Office in the District s Human Resources Department if you have questions. The benefits described in this booklet are effective from July 1, 2015 through June 30, Table of Contents Enrollment Eligibility Who is Eligible? When Are Changes Allowed Completing Your Online Enrollment An Overview of Your Benefits Medical Plans & Pharmacy Choice Plus Traditional Core PPO Plan Choice Plus HDHP 2600 Plan Plan Comparison Resources & Wellness Voluntary Dental Plan Basic & Voluntary Life Insurance Voluntary Vision Plan Voluntary Short-Term Disability Flexible Spending Accounts Monthly Premiums Important Notices Customer Service About the Valley Schools Employee Benefits Trust Premium Provider Flyer VSP TruHearing & Diabetic Eye Care Flyer United Healthcare Rally Flyer

3 ENROLLMENT ELIGIBILITY Who is Eligible? Benefits-eligible employees are eligible to participate in the District s benefit plans as of the first of the month following their hire date. Benefits-eligible employees can also extend medical, dental, voluntary vision, and voluntary life insurance coverage to their eligible dependents. Eligible dependents are generally defined as: Your legal spouse Your or your spouse s tax-qualified dependent child(ren) married or unmarried under age 26 (Note: dental, vision and optional life coverage term at age 25 for dependents.) A dependent child includes your: Natural child Stepchild Legally adopted child Child placed for adoption Child for whom you have legal guardianship Child for whom health care coverage is required through a Qualified Medical Child Support Order (QMCSO) Unmarried child of any age with a mental retardation or physical handicap who is incapable of self-sustaining employment as a result of that handicap. However, to be eligible for coverage, your child must have been covered by the District s or another medical insurance plan at the time he or she became disabled. Proof of the child s disability is required. If you have questions, contact the Benefits Office in the Human Resources Department to verify your dependents eligibility. You may be asked to provide proof in support of your dependents eligibility. Under the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), there were new mandatory data reporting requirements for group health plans, which went into effect in These new reporting requirements were designed to facilitate coordination of benefits with Medicare. They require insurers and plan administrators to collect data, such as Social Security Numbers, for all plan participants, including dependents. To comply with this requirement, you now need to provide your dependents Social Security Numbers when you enroll them in coverage. If you are covering dependents in 2015/16, include their Social Security Numbers while completing your online enrollment. 2

4 When Are Changes Allowed? Benefit plans are administered on a policy year basis from July 1 through June 30 of each year. Thus, the elections you make during this annual Open Enrollment are effective from July 1, 2015 through June 30, Because the benefits you elect are offered on a pre-tax basis, the Internal Revenue Service (IRS) does not allow changes to these benefit elections outside of the annual Open Enrollment period unless you have a qualified mid-year change in status event, such as: An employee s marriage or divorce The birth or adoption of an employee s child The death of an employee s spouse or child Change in the employee/spouse/dependent s employment status, work schedule or residence that affects their eligibility for benefit coverage Coverage of a child due to a Qualified Medical Child Support Order (QMCSO) Entitlement or loss of entitlement to Medicare or Medicaid Certain changes in the cost of coverage, composition of coverage or curtailment of coverage of the employee or spouse s plan Changes consistent with Special Enrollment rights and FMLA leaves You need to submit your benefit changes online. PLEASE NOTE: You will be required to submit proof of the mid-year changes (birth certificate, marriage license, etc.) to the Benefits Office before the mid-year change can be authorized and changes must be submitted within 30 days of the change in status event. The Plan will then determine if your change is permitted and if so, changes will become effective on the first day of the month following the approved change in status event (except for newborn and adopted children who are covered back to the date of birth or adoption or placement for adoption). Changes Allowed under the Children s Health Insurance Program Reauthorization Act of 2009 Effective April 1, 2009, the Children s Health Insurance Program Reauthorization Act of 2009 created a new special enrollment period that applies to group health plans, similar to those currently in effect for the loss of eligibility for other group coverage or qualifying life status changes. Under this Act, group health plans must permit employees and dependents who are eligible for group health plan coverage to enroll in the plan if they: Lose eligibility for Medicaid or SCHIP coverage OR Become eligible to participate in a premium assistance program under Medicaid or SCHIP In both cases, you must request special enrollment within 60 days (of the loss of Medicaid/SCHIP or of the eligibility determination), or wait until the plan s next annual enrollment period. 33

5 WELCOME TO PVUSD ONLINE ENROLLMENT Your personalized enrollment site can be accessed from any computer with an internet connection. You will be able to make all of your elections, changes, add or drop dependents and determine current coverage and changes for the new plan year by going online to: and following the instructions on the following pages to assist you in initiating your benefit elections. COMPLETING YOUR ONLINE ENROLLMENT We encourage all employees to take an active role in their benefits enrollment and on an ongoing basis as you use your benefits throughout the coming year. This booklet includes information on the benefits available for election for 2015/16 as well as instructions on completing your elections online. All employees must complete the 2015/16 Benefit Election Enrollment process online. Depending on the elections you decide to make, you may need to complete and return forms that can also be found online. IMPORTANT! You must complete your online benefits enrollment by 1:00 p.m. Arizona time, 5:00 p.m. Eastern standard time, May 31, If you do not complete the enrollment process you will stay in the same plan you are in for the plan year with the exception of flexible spending accounts. If you do not complete the enrollment process online, you will NOT have an opportunity to elect or change coverage until next year s Open Enrollment period unless you have a permitted mid-year change in status. 4

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13 AN OVERVIEW OF YOUR BENEFITS Medical Plans Benefits-eligible employees may choose to enroll in one of two medical plans provided through UnitedHealthcare: The Choice Plus Traditional Core Plan The Choice Plus HDHP 2600 (high deductible health plan) with or without a health savings account Following is a summary of each plan s features. Be sure to review this information carefully. Refer to the premium chart on page 22 for a basic comparison of benefits coverage under the plans. You can find more information through the UnitedHealthcare website at www. myuhc.com. The Choice Plus Traditional Core Plan When you enroll in the Core plan, you may visit any provider, including specialists, without a referral. Using a UnitedHealthcare network provider (in-network) versus an out-of-network provider determines the level of benefits you receive and how they are paid. You can expect the highest level of benefits when you seek in-network care. Premium Provider Advantage You save money by choosing a UnitedHealth Premium tier 1 physician. You can reduce your out-of-pocket costs by using physicians who have received the UnitedHealth Premium designation for quality and cost efficiency. Please see the list of applicable specialties in the flyer on page 26 and visit UnitedHealthPremium.com for program details. Note that physician and facility designations are subject to change. Always check your provider s status when making an appointment. Plan Year Deductible Some healthcare services, such as inpatient hospital care, are subject to an annual deductible under the Core plan. You pay for these services out of your own pocket until meeting the plan year deductible. Then, once you meet the plan year deductible, the benefits coverage for these services kicks in. Choice Plus Traditional Core Plan Core Plan Deductible In-network Out-of-network Plan Year Deductible $1,500 individual; $3,600 individual; $3,000 family $7,200 family Copayments Good News! You pay a set amount of money called a copayment for some in-network services, such as doctor s office visits, and specialist s visits. Core Plan Copayment Levels In-network Premium Provider Out-of-network Copayments for Physician s $30 per visit $20 per visit You pay a percentage Office Visits of eligible expenses (see Coinsurance on page 14) Copayments for Specialist s $55 per visit $45 per visit You pay a percentage Office Visits of eligible expenses (see Coinsurance on page 14) There are no changes to the plan or the medical premiums! 12

14 Plan Benefits Coverage (Coinsurance) Once you meet the deductible (for services subject to a deductible under the Core plan), the plan s coinsurance benefits kick in. Coinsurance is the percentage of eligible expenses that you and the plan share when you receive care. You are responsible for your share of coinsurance until reaching the plan year out-of-pocket maximum. Coinsurance levels vary by plan as follows: Core Plan Coinsurance Benefits Choice Plus Core Plan In-network Out-of-network Coinsurance Plan pays 80%, Plan pays 50%, you pay 20% of you pay 50% of eligible expenses eligible expenses Plan Year Out-of-Pocket Maximum The plan year out-of-pocket maximum is the most you will pay for services covered through coinsurance during the plan year. When you reach the maximum, the plan generally pays 100% for eligible coinsurance expenses. As a result of the Affordable Care Act, all copays and deductibles now accumulate towards your out-of-pocket maximum. The out-of-pocket maximum for each plan has been adjusted to accommodate this change and are as follows: Core Plan Out-of-Pocket Maximum Benefits Choice Plus Core Plan In-network Out-of-network Out-of-pocket $6,000 individual; $12,000 individual; maximum $12,000 family $24,000 family The out-of-pocket maximum includes the amounts you pay for copayments and deductible. Your share of coinsurance for outof-network services in excess of UnitedHealthcare s allowable charges for a service does not count toward the out-of-pocket maximum. When you seek out-of-network care, be sure to discuss your possible share of the costs with your non-network provider and UnitedHealthcare before you receive care. There are no pharmacy changes for the 2015/2016 Plan Year Prescription Drug Coverage under the Core Plan Under the Core plan, you may fill your prescriptions through any pharmacy. However, you ll pay less out of your pocket when you use a participating retail pharmacy or the OptumRX home delivery network (available online through You will pay a $100 deductible for individual coverage, and a $300 deductible for family coverage before your copays are charged on any of the pharmacy options below. Prescription drugs are covered under a three-tier schedule. A list of drugs found within each tier is available through the UnitedHealthcare Web site Your copay is based on the category you and your doctor choose. Your deductible applies to each pharmacy category: Choice Plus Core Plans Prescription Drug Coverage Prescription Drug Participating Retail Pharmacy Home Delivery Network Non-Participating Retail Pharmacy Category (up to 31-day supply) (up to 90-day supply) (up to 31-day supply) Tier 1 $0 copay after $100 individual $0 copay after $100 individual $10 copay after deductible is met plus any deductible is met or $300 for family deductible is met or $300 for family amount over the average wholesale price Tier 2 $30 copay after $100 individual $60 copay after $100 individual $30 copay after deductible is met plus any deductible is met or $300 for family deductible is met or $300 for family amount over the average wholesale price Tier 3 $60 copay after $100 individual $120 copay after $100 individual $60 copay after deductible is met plus deductible is met or $300 for family deductible is met or $300 for family any amount over the average wholesale price 13 13

15 The Choice Plus HDHP with Health Savings Account The HDHP with or without a Health Savings Account plans combines a high-deductible PPO plan with a tax-advantaged Health Savings Account (HSA) that helps you pay for eligible medical expenses. When you enroll, the District provides funds for your HSA, which you can use to pay the cost of qualified healthcare expenses. The plans also provide resources and tools to help you make informed healthcare buying decisions. Most benefit-eligible employees who select HDHP 2600 with HSA will receive a District-provided HSA contribution. If you qualify to open and fund an HSA and select the HDHP 2600, the district will provide up to $480 for individual coverage, and $680 for employee plus spouse, employee plus child(ren) and family coverage. Please note that the total contribution amounts are based on a full year of enrollment in the Plan. Funds will be deposited during the 2015/16 plan year. Refer to page 15 for more information about funding your HSA. PLEASE NOTE: If you are on Medicare you can elect HDHP 2600, but you CANNOT fund a Health Savings Account per IRS regulations. If you have questions regarding this, please contact your benefit s office for more details. HDHP 2600 with or without HSA Plan Benefits Coverage Under these plans, you can see any doctor you want. However, you will pay less if you use a UnitedHealthcare network provider. The plans provide benefits as follows: HDHP 2600 with or without HSA Plan Year Deductibles As you seek healthcare, you must meet the plan year deductible before the plan s benefits kick in. Deductibles for the HDHP 2600 are $2,600 for each individual and up to $5,200 for families. You can use your Health Savings Account to pay for any qualified medical expense, including those incurred while meeting your deductible. Then, once you exhaust your HSA funds, you pay any additional expenses required to meet the deductible out of your own pocket. The HSA plan covers most in-network preventative care services at 100%, with no deductible required. We strongly encourage you to advise your physician when you schedule your exam and again at the appointment, that your appointment is for your annual wellness or preventative exam and should be coded appropriately. Plan Benefits Coverage (Coinsurance) After meeting the plan year deductible, the plan s coinsurance benefits kick in. The plan pays 80% and you pay 20% for most in-network charges. When you seek care out-of-network, UnitedHealthcare pays 50% of the expenses it defines as eligible for coverage under the plan. You pay the balance. You are responsible for your share of coinsurance until reaching the plan year out-of-pocket maximum. Plan Year Out-of-Pocket Maximum What s New Contributions: HDHP 2600 enrollees will receive up to $480 for individual coverage and $680 for all other tiers. Due to IRS requirements, the deductible on the HDHP has been increaed to $2,600 for indivudal coverage, and $5,200 for family coverage. There are no rate changes. See rate table on page 23. The out-of-pocket maximum is the most you will pay for eligible expenses during the plan year. After reaching the maximum, the plan pays 100% for eligible expenses. The plan year out-of-pocket maximum for in-network care for the HDHP 2600 is $4,500 for individuals and $9,000 for families; for out-of-network care, it is $9,000 for individuals and $18,000 for families. In-network and out-of-network maximums accumulate separately. In addition, if you enroll in family coverage, the family outof-pocket maximum applies. The amount you pay to satisfy your plan year deductible is included in the out-of-pocket maximum. However, your share of coinsurance for out-of-network services in excess of UnitedHealthcare s allowable charges does not count toward the outof-pocket maximum. When you seek out-of-network care, be sure to discuss your possible share of the costs with your nonnetwork provider and UnitedHealthcare before you receive care. 14

16 Funding and Using Your Health Savings Account When you enroll in the HDHP with HSA, the District sets up and partially funds an HSA on your behalf. Funds can ONLY be deposited after the Benefits Department receives your OptumHealth Bank form. The District s contribution to most eligible employees accounts for the 2015/16 plan year on the 2600 plan is $480 for an individual, and $680 for all other coverage tiers. The IRS also allows you to contribute to your HSA until the total contributions yours and the District s equal the annual IRS maximum contribution. The maximum contribution for the coming tax year if you elect employee-only coverage is $3,300; the maximum contribution if you elect employee plus family coverage is $6,550. Employees age 55 to 64 are also eligible to make an additional catch-up contribution to their own HSA account. The amount allowed by the IRS in the 2015 tax year is $1,000. The District s contribution to an HSA Plan participant s account is deposited in equal increments over 21 pay periods during the plan year. If you choose to make voluntary contributions, those contributions are deducted from your pay, over 21 pay periods, in equal increments throughout the plan year. Contributions are available for use when deposited to your account. If a balance remains in your HSA at the plan year s end, the funds roll over for your use during the next plan year, or in future years. In addition, you accumulate tax-free interest on your HSA funds. Thus, you can use your account to save for care you may need in the future. Finally, your HSA account is portable. If you leave the District or switch medical plans, you can continue to use your HSA funds for qualified healthcare expenses. Note: The applicable service fee of $1.00 to $3.00 is automatically deducted by OptumHealth Bank from your HSA balance each month depending on your account selection. IMPORTANT Federal law does not allow participants in Medicare to contribute to an HSA. Thus, if you are currently enrolled in Medicare or may become eligible for Medicare during the plan year, you should carefully consider whether the HDHP with HSA Plan makes sense for you. Visit the links below to learn more about HDHP s with HSA s: Health Care Lane OptumHealth Bank HSA Users Guide What is an HSA video Participants in the District s Healthcare Flexible Spending Account Take Note If you enroll in the HSA Plan and wish to also enroll in the District s Healthcare Flexible Spending Account, special rules apply. You can use your Healthcare Flexible Spending Account on a limited use basis only. See pages 20 & 21 for more information regarding the District s Flexible Spending Accounts. 15

17 Prescription Drug Coverage under the High Deductible Health Plan Under the HDHP, you may fill your prescriptions through any pharmacy. However, you ll pay less out of your pocket when you use a participating retail pharmacy or the Optum RX home delivery network (available online through Prescription drugs are covered under a three-tier schedule. In addition, you will have coverage for certain Expanded Preventive Medications, which will not be subject to the deductible. A list of all covered drugs found within each tier is available through the UnitedHealthcare Web site or your benefits portal to download the full list. HDHP Prescription Drug Coverage Before meeting the plan year deductible Prescription Drug Participating Retail Pharmacy Home Delivery Network Non-Participating Retail Pharmacy Category (up to 31-day supply) (up to 90-day supply) (up to 31-day supply) Tier 1 You pay UHC negotiated cost You pay UHC negotiated cost You pay full retail cost Tier 2 You pay UHC negotiated cost You pay UHC negotiated cost You pay full retail cost Tier 3 You pay UHC negotiated cost You pay UHC negotiated cost You pay full retail cost After meeting the plan year deductible Prescription Drug Participating Retail Pharmacy Home Delivery Network Non-Participating Retail Pharmacy Category (up to 31-day supply) (up to 90-day supply) (up to 31-day supply) Tier 1 $10 copay $25 copay $10 copay, plus any amount over average wholesale price for drug Tier 2 $30 copay $75 copay $30 copay, plus any amount over average wholesale price for drug Tier 3 $50 copay $125 copay $50 copay, plus any amount over average wholesale price for drug To find a UnitedHealthcare network doctor, pharmacy, or facility (such as a hospital), refer to the online provider directory, available through and follow the directions to locate a provider either by geography or name. You do not need to be a registered member to access the provider directory. Medical Plan Comparison Benefits Coverage for UnitedHealthcare In-network Services Plan Feature Choice Plus Traditional Core Plan Choice Plus HDHP 2600 Deductible $1,500 individual; $3,000 family $2,600 individual $5,200 family Coinsurance Plan pays 80% and you pay 20% Plan pays 80% and you pay 20% Out-of-Pocket Maximum $6,000 individual, $12,000 family (Payments toward deductible and copays for services ARE included) $4,500 individual $9,000 family (Payments toward deductible ARE included) Preventive Care Plan pays 100% Plan pays 100%; services are NOT subject to deductible Doctor s Office Visit $20*/$30 copay Plan pays 80% after deductible Specialist s Visit $45*/$55 copay Plan pays 80% after deductible Inpatient Hospital Plan pays 80% after deductible Plan pays 80% after deductible * You will pay lower copays by using a Premier Provider. Please see page for details

18 Free Advice Care24 When you enroll in one of the District s medical plans, you will have access to UnitedHealthcare s 24-hour referral service, called Care24. Care24 is staffed with registered nurses and master s level counselors who can help with almost any problem ranging from medical and family matters to personal, legal, financial, and emotional issues. Care24 is confidential and provided at no additional cost to medical plan participants (employees and dependents). Call to speak with a counselor anytime, day or night, 7 days a week, 365 days a year. Your Payroll Deductions for Your Medical Plan Election It is the District s current philosophy and practice to pay the single premium amount and a base amount of the family premium toward our benefit eligible employees monthly medical plan premium. The base amount may vary, based on the number of hours you work and whether you have a benefit-eligible spouse who works for the District. The base amount is applied to the plan and coverage level you select, and you are responsible for the resulting share of the monthly premium cost (if any) over 21 pay periods during the plan year. Waiving Medical Coverage You are not required to enroll in medical coverage through the District. For example, if you have medical coverage through another source (e.g., your spouse s employer-sponsored plan), you might find it more practical or cost-effective for you to cover your family under that plan. If you choose to waive coverage, complete the online process to decline coverage. District Wellness Paradise Valley USD is committed to supporting optimum health and wellness for district employees and their families. P.R.E.P. (Prevention Reward Employee Program) encourages members to get healthy and stay healthy. P. R. E. P. is designed to make participation as streamlined as possible while focusing on key practices of good health. Members are asked to complete two wellness activities. The third program option applies only to those who qualify for participation.* Primary Options: 1. Annual Wellness Exam 2. Health Assessment (HA) Additional Option: Enroll in DPCA Program if applicable (Diabetes Prevention & Control Alliance) Members are encouraged to read the complete P.R.E.P. guide on your benefits portal to gain an understanding of the program specifics, requirements, and available options. *Please note that wellness options and activities can be added or modified at any time during the plan year. Please check your distirct newsletters or bullitiens for updated wellness program communications. 17

19 Voluntary Dental Plan Benefits-eligible employees may choose to enroll in a voluntary dental plan. Two plans are offered, and coverage is provided through Delta Dental of Arizona. The Delta Dental plans allow you to visit any dentist or specialist without a referral. The coverage levels provided will typically be higher when you visit a Delta Dental network provider. If you choose to visit a non-participating provider, Delta Dental will still provide benefits (at reduced levels). Note: The plan provides coverage for your eligible dependents under age 25. When making an appointment with your dentist, verify that he or she is a participating provider with Delta Dental. You can also verify your dentist s affiliation with Delta and/or find a Delta Dental provider through the Delta Dental Web site at or by calling Delta Dental at , extension 2. The tables below outline the benefit coverage under the dental plans. Delta Dental Premier In-Network Benefit Highlights Core Plan Offered to Benefits-Eligible Employees Plan Year Deductible Plan Year Maximum Routine Services Preventive Care and Diagnostic Care Basic Services Restorative Care and Oral Surgery (simple extractions) Major Services Prosthodontics, Bridge and Denture Repair, Endodontics, and Periodontics Orthodontics $50 individual, $150 family $1,500 per person The plan pays 100% when you seek care through a Delta Dental provider. Services are not subject to plan year deductible. No waiting period applies for these services. The plan pays 80%, after deductible when you seek care through a Delta Dental provider. The plan pays 50%, after deductible when you seek care through a Delta Dental provider. Benefits provided after completion of a six-month waiting period. The plan pays 50%, after deductible when you seek care through a Delta Dental provider. $1,000 lifetime maximum. Benefits provided after completion of a 12-month waiting period. Delta Dental Premier Plan Highlights Advantage Plan Offered to Benefits-Eligible Employees Plan Year Deductible Plan Year Maximum Routine Services Preventive Care and Diagnostic Care Basic Services Restorative Care, Oral Surgery, Endodontics, and Periodontics Major Services Prosthodontics, Bridge and Denture Repair Orthodontics $25 individual, $75 family $2,000 per person The plan pays 100% when you seek care through a Delta Dental provider. Services are not subject to plan year deductible. The plan pays 80%, after deductible when you seek care through a Delta Dental provider. The plan pays 50%, after deductible when you seek care through a Delta Dental provider. The plan pays 50%, after deductible when you seek care through a Delta Dental provider. $1,000 lifetime maximum. In the event you need extensive dental work, ask your dentist to submit a pre-estimate of the services to Delta Dental. This permits Delta to review the treatment plan and let you know your financial responsibility prior to the service being performed. A detailed benefits summary is posted on the PVUSD benefits portal. What s New? Delta premiums have increased slightly due to claims utilization and increased membership. Please see page 23 for premium details

20 Basic Life Insurance The District provides eligible employees with basic life insurance coverage. This benefit is provided at no cost to you. Highlights of the Basic Life Insurance Coverage Who is Eligible? District employees as outlined in their respective collective bargaining agreements What is the Benefit? Life insurance: One times your basic annual earnings, up to $150,000 After you reach age 70 the policy amount is reduced by 50%. You must designate a beneficiary for the basic life insurance. (A beneficiary is the person who receives the basic life insurance benefit in the event of your death.) You may add or change your beneficiary by completing the online enrollment. Voluntary Life Insurance If you are eligible for basic life insurance, you have the opportunity to purchase additional voluntary life insurance coverage for yourself and your eligible spouse and dependent children. Coverage is underwritten by Voya Financial, formerly ING. Voluntary Life Insurance Coverage Options Coverage for What can you buy Yourself Purchase coverage in $10,000 increments, up to 5 times your salary. The maximum benefit is $500,000. Your spouse Your dependent children Purchase coverage in $10,000 increments, up to $150,000. You can elect dependent coverage only if you purchase voluntary coverage for yourself. Your spouse s coverage cannot exceed your basic and voluntary life insurance coverage combined. Purchase coverage in $2,000 increments, up to $10,000. The maximum benefit for children under six months is $500. You can elect dependent coverage only if you purchase voluntary coverage for yourself. After you reach age 70, the policy amount is reduced by 50%. When your spouse reaches age 70, his/her coverage ceases. IMPORTANT WHEN EVIDENCE OF GOOD HEALTH IS REQUIRED If you are applying for coverage for the first time, you will need to submit evidence of your good health. If you wish to increase your current coverage level during this year s Open Enrollment you must provide ING with evidence of your good health. Coverage will not be issued until Voya Financial approves your evidence of good health. 19

21 Voluntary Vision Plan Benefits-eligible employees have the opportunity to enroll in our voluntary vision coverage through VSP. You can choose employee only or employee plus family coverage. Under the VSP plan, you may visit any vision care provider. However, benefits are provided at significantly higher levels when you visit a network doctor. You can see a complete list of providers at: Vision Plan Highlights Plan Feature Benefits at a VSP Network Provider Out-of-Network Benefits Eye Exam After your $10 copay, the plan pays 100% every year The plan pays up to $45 Lenses After your $25 copay, the plan pays 100% every year The plan pays up to $30 for single vision; $50 for bifocal; $65 for trifocal; $100 for lenticular Frames The plan pays up to $150 every 2 years The plan pays up to $70 every 2 years Contacts (In lieu of lenses and frames) Medically necessary lenses * The plan pays 100% after your copay The plan pays up to $210 for medically necessary contacts Elective contact lenses The plan pays $150 and $105 for elective contacts *Prescribed by a doctor for certain medical or visual/refractive conditions. Patients must meet certain criteria to qualify. Good News! Their are no rate or plan changes with VSP Voluntary Short-Term Disability Benefits-eligible employees can elect to purchase voluntary short-term disability coverage. The plan provides monthly income replacement benefits based on your annual salary, not to exceed 66 2 /3% of your salary. Benefits are paid in the event you cannot work due to pregnancy or a covered non-occupational illness or injury, for up to six months of your continuous disability. You can choose from two benefit options: Voluntary Short-Term Disability Options Short-Term Disability Plan 1 Short-Term Disability Plan 2 Coverage begins following a 14-day waiting period. Short-term disability benefits are payable for up to six months during your continuous disability. Coverage begins following a 30-day waiting period. Short-term disability benefits are payable for up to five months during your continuous disability. Your benefit payment will be offset by other sources of income as defined by Assurant Employee Benefits group policies. However, the minimum monthly benefit amount payable under the voluntary short-term disability policy cannot be lower than 25% of your gross monthly benefit, regardless of the amount of income you receive from other sources. IMPORTANT PRE-EXISTING CONDITION LIMITATIONS The policy does not pay benefits for disabilities that begin within 12 months of your initial enrollment in the plan, if you received medical treatment, consultation, care, or services (including diagnostic measures), or took prescribed drugs or medicines for the disabling condition during the 12 months prior to your initial enrollment date. To be eligible for coverage during pregnancy, you cannot be pregnant before the benefit effective date (e.g., July 1, 2015 if you are enrolling during Open Enrollment)

22 Flexible Spending Accounts (FSAs) The Flexible Spending Accounts the Healthcare Flexible Spending Account and the Dependent Care Flexible Spending Account are separate flexible spending accounts that can help you save money on taxes by allowing you to pay for certain expenses with before-tax dollars. The plans are administered by BASIC. Contact a BASIC representative at for more detailed information regarding FSAs. If you would like to participate in an FSA for 2015/16, you must complete your election which can be found on your online enrollment portal. How Flexible Spending Accounts Work You decide how much you want to contribute on a fiscal year basis into one or both of the FSAs when you enroll. Your FSA contributions are deducted from your paycheck, in equal amounts on a before-tax basis. Your election stays in effect for the entire plan year (July 1 through June 30). You cannot increase, decrease, or cancel your contributions outside of the plan s enrollment period, unless you have a qualified mid-year change in status (see page 3 for information about status changes). You use your FSA contributions to pay your eligible expenses under the Healthcare Flexible Spending Account or Dependent Care Account. The IRS defines the eligible expenses that are permitted for reimbursement, and only those that comply with the Internal Revenue Code are eligible. You cannot use the contributions you make to the Healthcare Flexible Spending Account to reimburse yourself for eligible expenses under the Dependent Care Account, or vice versa. The General Purpose Healthcare Flexible Spending Account The General Purpose Healthcare Flexible Spending Account lets you set aside before-tax dollars to help you pay for eligible medical, dental, and vision care expenses. You can contribute up to $2,500 for 2015/16. You do not need to be enrolled in a District healthcare plan to contribute to the Healthcare Flexible Spending Account. However, you must be a benefitseligible employee to enroll. Eligible Expenses Healthcare expenses that are eligible for reimbursement under an FSA are defined and governed by the IRS. In general, you can use the money in the Healthcare Flexible Spending Account to pay for eligible healthcare expenses that aren t covered by your or your spouse s healthcare plans or used as healthcare deductions on your income tax return. Examples of eligible expenses include: Medical expenses such as deductibles, copays, and your share of coinsurance Over-the-counter drugs for which you have a doctor s prescription Medical supplies such as hearing aids and diabetic supplies Your share of the costs for dental services including exams, fillings, bridges and orthodontia Your share of the costs for vision care services including eyeglasses, contact lenses and cleaning supplies and corrective vision surgery Making Your Annual FSA Election The IRS requires you to elect your FSA contributions every year. If you wish to participate from July 1, 2015 through June 30, 2016, you need to make your 2015/2016 election during Open Enrollment or your initial benefit enrollment period. Your current contribution, if any, will not carry forward. If you choose to enroll for 2015/2016, your contribution will be deducted from your pay in equal increments over 21 pay periods on a pre-tax basis. To enroll for 2015/2016 please visit your online enrollment portal at: You can use the plan s Flex Convenience debit card to pay most eligible expenses through your Healthcare Flexible Spending Account. You must keep your receipts in case you are asked to verify your eligible expenses. Alternatively, you may submit your expenses for reimbursement through paper claim forms. The claim form is available through BASIC s Web site at com, or by calling BASIC at

23 Using the Healthcare Flexible Spending Account with the HSA Plan If you choose to enroll in the Health Savings Account medical plan and you also wish to contribute to the Healthcare Flexible Spending Account, you can use your Healthcare Flexible Spending Account funds on a limited use basis, as follows: You can use your FSA funds to pay your eligible dental and vision care expenses, not covered through the medical plan. You can use your FSA funds to pay your eligible healthcare expenses AFTER you meet your annual HSA plan deductible. The Dependent Care Account The Dependent Care Account lets you set aside before-tax dollars to help you pay the cost of care for your eligible dependents so that you (and your spouse) can work outside your home. You can contribute up to $5,000 annually. However, your contributions can be limited by your tax-filing status, by your spouse s participation in a similar plan, if your spouse is disabled or a full-time student, or if you use the federal dependent care tax credit. Consult your tax or financial advisor to determine how much to contribute to the Dependent Care Account. Your contributions are deducted from your paycheck, in equal amounts on a before-tax basis. Funds are available for reimbursement of eligible expenses after an expense is incurred and up to the balance currently available in your account. Eligible Expenses The Dependent Care Account is regulated by the IRS, and only those expenses that comply with the Internal Revenue Code are covered. Eligible expenses may include your costs for child day care, or care for an elder dependent while you are working or attending school full-time during the day. Examples of eligible expenses include: Before and after school care that meets the criteria for reimbursement under the plan Care provided by an Au Pair/nanny that meets the criteria for reimbursement under the plan Custodial care for qualified tax dependents that meets the criteria for reimbursement under the plan Elder care including adult day care that meets the criteria for reimbursement under the plan A detailed summary of eligible expenses is available on request from BASIC s at or by calling BASIC at Getting Reimbursed If accepted by your dependent care provider, you can use the plan s Flex Convenience debit card to pay most eligible expenses through your Dependent Care Account. You must keep your receipts in case you are asked to verify your eligible expense. Alternatively, you may submit your expenses for reimbursement through paper claim forms. The claim form is available through the District s Web site, the BASIC s Web site at FSAs: Use It or Lose It Rule The IRS governs the administration of Flexible Spending Account plans, and once you elect to set aside money in an FSA, you must use it for eligible expenses incurred during the plan year or incurred prior to your last day of employment if you terminate employment with the District. You should make every effort to file your FSA claims as you incur expenses. However, you have 90 days after the plan yearend (June 30) to file claims for reimbursement. After that point, you forfeit, or lose, any unused funds. Because of this IRS use it or lose it rule, be sure to carefully estimate the amount you want to contribute to the FSAs before making your elections. Helpful Links BASIC Flex Tax Savings Calculator IRS Summary of Eligible Expenses 22

24 2015/2016 Rate Sheet Medical Tier Total Monthly Premium District Contribution for EE Only District Contribution for Dependent(s) Total District Cost Per Montht Employee Cost Per Month Bi-Weekly Deduction* District HSA Contribution per Month CORE PLAN PPO HDHP PLAN (2600) EE Only $ $ N/A $ $0.00 $0.00 EE + Spouse $1, $ $ $ $ $ EE +Child(ren) $ $ $85.00 $ $ $ EE + Family $1, $ $ $ $ $ EE Only $ $ N/A $ $0.00 $0.00 $40.00 EE + Spouse $ $ $ $ $ $ $56.67 EE +Child(ren) $ $ $85.00 $ $ $ $56.67 EE + Family $1, $ $ $ $ $ $56.67 Contact the Benefits Office for the DUAL rate Dental CORE PLAN ADVANTAGE PLAN Vision Tier Total Monthly Premium Employee Bi-Weekly Deduction* EE ONLY $34.53 $19.74 EE + 1 or more $97.77 $55.87 EE ONLY $44.20 $25.26 EE + 1 or more $ $70.73 Tier Total Monthly Premium Employee Bi-Weekly Deduction* EE ONLY $7.56 $4.32 EE + 1 or more $20.85 $11.92 Rates on Short Term Disability and Voluntary Life Insurance will vary. Premiums are typically based on: the plan, level of coverage and age. *The published Bi-Weekly amount is based on 21 pay period deductions with 12 months of coverage. NOTE: Bi-weekly deductions are calculated by multiplying the above premium by the number of months of coverage then divided by the number of pay periods remaining. Please keep in mind that the rates quoted online through the Benefits Portal is an estimate only as deductions may take up to 2 pay periods to process. 3/31/2015 DH 23 23

25 IMPORTANT NOTICES The following notice are available for your information in your Summary Plan Document (SPD): Women s Health and Cancer Rights Act Patient Protection and Affordable Care Act Statement of Rights under the Newborn s and Mother s Health Protection Act HIPAA Privacy Notice Leave for Military Service (USERRA) Medicare Part D Notice (of Creditable/Non-Creditable Coverage) FMLA Children s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) Continuation Coverage Under COBRA 24

26 CUSTOMER SERVICE If you have general questions about your benefits or the enrollment process, feel free to contact your benefits representative. Contact our plan providers directly if you have questions or would like more detailed information about our plans. Or, contact the Benefits Office in the District s Human Resources Department for assistance. Contact For Questions About... Phone Web site UnitedHealthcare Core Plan & HDHP OptumHealth Bank HSA Account Information Delta Dental of Arizona Voluntary Dental Plans VSP Voluntary Vision Plan Voya Financial (formerly ING) Basic & Voluntary Life Insurance Plan Assurant Voluntary Short-Term Disability Plan (Brockhurst & Associates, local agent) BASIC Flexible Spending Accounts ext Care24 Nurse, Financial & Legal Advice This Benefits Guide provides only the highlights of certain provisions of the benefit programs available to eligible District members effective July 1, Complete details are contained in the respective plan documents and insurance contracts. In case of conflict between the information in this Benefits Guide and the wording in the official plan documents, the plan documents will govern. 2015/16 benefits contracts supersede all previous plan documents and contracts. About the Valley Schools Employee Benefits Trust Valley Schools was created in 1986 by a group of Arizona school districts to provide the opportunity for joint purchasing of insurance with the management of a professional staff of trust and pool administrators. The Paradise Valley Unified School District (PVUSD) is one of the founding members. The number of members expanded through the years, as did the number of benefits available through this group effort. The Valley Schools Employee Benefits Trust (VSEBT) is the trust managed by Valley Schools to provide health, dental, life, vision, COBRA and other employee benefits to its members. VSEBT purchases these benefits as a group, but offers member districts the flexibility to provide different benefits to their employees. Through VSEBT, your district is able to get better rates and services offered than it may be able to negotiate on its own. The key advantage is size. The bigger an organization is, the more concessions our insurance vendors will make. Your district retains complete autonomy in deciding your benefit packages and carriers. Your district also benefits from the lower group rates, but only pays for its own services. It does not subsidize other members. VSEBT employs a full-time staff to follow up on management review and medical utilization information. VSEBT has a professional financial and program staff to serve all our members. In addition, VSEBT offer a wide array of wellness programs and other specialized services to member districts. The administrative costs are lower due to the ability of multiple districts to share these costs rather than duplicate them with individual contracting. As an employee of the Paradise Valley Unified School District, you might not be aware of VSEBT, and that is understandable. VSEBT works behind the scenes to improve your services and constantly negotiate better rates as directed by our member Board of Directors. VSEBT is managed by the Valley Schools Management Group (VSMG), a non-profit, governmental entity formed in accordance with Arizona Revised Statutes Title 11, Sections 951, 952, , and 953 and in accordance with Arizona Department of Education Rule R A

27 WELCOME. Medical You are enrolled in the UnitedHealthcare Tiered Benefits Plan Your plan features You save money by choosing a UnitedHealth Premium physician. You can reduce your out-of-pocket costs by using physicians who have received the UnitedHealth Premium designation for quality and cost efficiency. Please see the list of applicable specialties to the right and visit UnitedHealthPremium.com for program details. Note that physician and facility designations are subject to change. Always check your provider s status when making an appointment. You can choose any doctor or hospital in our network, and you don t need referrals. You can save money when you choose doctors (including specialists), hospitals and pharmacies in the network. Remember, if you receive care outside of the network, the plan will not cover the cost. Your preventive care is covered 100% in our network. You don t have to pay any out-of-pocket costs (co-payment, co-insurance or deductible) for preventive care as long as you use a network doctor. Services included 24-hour registered nurses You can call and speak directly with a registered nurse anytime. Healthy Pregnancy Program Soon-to-be mothers can have personal support through every stage of their pregnancy and delivery. Employee Assistance Program You can receive confidential support for a wide range of personal and work-related needs. Care management You ll have access to special programs to help you make more informed health care decisions. Pharmacy You have coverage for a wide range of prescriptions. Plus, you have access to 64,000+ retail network pharmacies across the U.S. Choose with confidence. The UnitedHealth Premium program takes the guesswork out of your doctor search. You ll save money when you visit physicians who have received the UnitedHealth Premium designation for quality and cost efficiency. The program currently evaluates doctors in the specialties below, but we continue to add new specialties to enhance your plan. Visit UnitedHealthPremium.com for the latest information. Allergy Cardiology Cardiology - Electrophysiology Cardiology - Interventional Endocrinology Family Medicine 1 Infectious Disease Internal Medicine 1 Nephrology Neurology Neurosurgery - Spine Obstetrics/Gynecology 1 Orthopaedics - General Orthopaedics - Foot/Ankle Orthopaedics - Hand Orthopaedics - Hip/Knee Orthopaedics - Shoulder/Elbow Orthopaedics - Spine Pediatrics 1 Pulmonology Rheumatology 1 These are considered primary care physicians. Your family s health, in your hands. UnitedHealthcare Health4Me TM helps make managing your benefits and family s health a lot simpler. Use it to easily find the information you need and the care you re looking for. It even includes EasyConnect, a call-back feature that lets you skip phone menus and being put on hold. A customer care professional will call you back. 26