Employee Benefits Guide School Year

Transcription

1 Benefits Employee Benefits Guide School Year

2 T A B L E O F C O N T E N T S Enrollment Information...3 Life Status Change...5 Medical...7 Health Savings Account...10 Dental...12 Vision...13 Employee Dual Credit...14 Short Term Disability...15 District Paid Life Insurance...16 Supplemental Life Insurance...17 Sick Leave Bank (SLB)...18 Flexible Spending Account...21 Retirement and 403(b) Retirement Savings Plans...26 COBRA

3 E N R O L L M E N T I N F O R M A T I O N Who is eligible for Dysart Benefits? Certified employees are eligible if they work 50% of a contract or more. This is typically 20+ hours per week. Classified employees must work 6 hours per day or more, typically 30+ hours per week. For employees who work under 30 hours per week, the District will follow the Patient Protection and Affordable Care Act (PPACA) tracking requirements and will notify you if and when you become eligible for medical insurance. Employees who become eligible for medical insurance as a PPACA variable hour employee will not be eligible for any other benefits. When can I enroll? You may enroll in benefits as a new employee once you start your employment with Dysart. As a new hire, you will receive an electronic mail ( ) from a Payroll & Benefits Specialist advising you to enroll. You will have 30 days to enroll starting on the day you start working. If after the first 30 days of your hire date, you have not elected or waived coverage, you will only receive District paid life insurance and all other coverage will be waived. Current employees can make changes during the annual Open Enrollment period or if you meet the requirements of a Life Status Change. What benefit plans are subject to the enrollment period? Medical (HSA option) Short Term Disability* Sick Leave Bank Dental Vision Group Life/AD&D/Voluntary Life Insurance* Health Care & Dependent Care Flexible Spending Account *For Short Term Disability and Voluntary Life Insurance, there is a guarantee issue for the first 30 days of employment. Current employees applying for coverage during annual Open Enrollment period must submit evidence of insurability and wait for approval or denial by the insurance company. How do I enroll? Enrollment is done via an on-line system from any computer with internet access. See the benefitsconnect section at the end of this booklet for more information. Note: For Positive Open Enrollment, ALL employees must re-enroll or they risk losing coverage. Where do I get Enrollment Forms? You will not be submitting enrollment via paper forms. Everything is handled electronically. Before you are able to begin on-line enrollment, your HR Regional Specialist will need to submit your completed Acknowledgement Form to the Benefits Team. How do I pay for my benefits? Payments for Medical, Dental, Vision, Flexible Spending Accounts and Health Savings Accounts are taken from your pay check on a pre-tax basis. Due to regulations, should you cover a Domestic Partner, their premium cost will be deducted from your check on a post-tax basis. ASRS Retirement and tax-sheltered annuity contributions are deducted before State and Federal taxes, but not Social Security or Medicare taxes. All other payments for insurances are deducted on a post-tax basis. Due to holiday breaks, hourly classified employees paid on the 21 pay schedule will have deductions withheld equally over 18 of the 21 pay periods. When do my benefits become effective? For a new employee, benefits are effective the first of the month following or coincident with your hire date. For example, if your hire date is August 6 th, your benefits become effective September 1 st. If your hire date is September 1 st, your benefits would become effective September 1 st. For current employees going through Open Enrollment, benefit changes become effective July 1 st. If you have a qualifying life status change, changes go into effect the first of the month following the date or coincident with the date of the qualifying event. 3

4 E N R O L L M E N T I N F O R M A T I O N Do I have to enroll in each benefit? The District paid life insurance is mandatory. All other benefits are optional, and you only enroll in the benefit plans that best fit you or your family needs. The employee must enroll in benefits in order to have spouse or dependent coverage. When will my benefits end? If you resign or are terminated at any time during the year, your benefits will end the last day of that month. If you work through your contract, but do not renew for the following year, your benefits end on June 30, Should your work hours drop below benefit eligibility, your benefits will end at the end of the month of your fulltime assignment s end date. If you re-new your contract, benefits will continue into the school year as long as you have completed Open Enrollment. Benefits will also end the last day of the month following non- FMLA leave and after 12 weeks of FMLA leave if the employee has not returned to work. Who can I enroll as a dependent? (1) your spouse under a legally valid existing marriage; (2) your children and the children of your spouse, including birth children, legally adopted children, step-children, children placed for adoption, children under legal guardianship substantiated by a court order and children who are entitled to coverage under a medical support order; and (3) a domestic partner and the children of the domestic partner. What if I have more questions? Be sure to review the entire guide. You may also send your questions to benefits@dysart.org or call

5 L I F E S T A T U S C H A N G E May I make changes to my benefit elections outside of my initial eligibility period? After your initial eligibility or Open Enrollment period, you may only change some benefit elections if certain life status events occur. Note: You are not allowed to change plans. Why can t I change my benefits at any time? Because our benefit deductions are taken on a pre-tax basis, we are required to follow the Internal Revenue Service Section 125 rules. The IRS Code is very specific and states that changes can only be made within your initial enrollment period, during our Open Enrollment Period or if the change meets the Life Status Change criteria. What events are considered a Life Status Change? Marriage, divorce, legal separation, or annulment Birth, adoption or legal custody Death of a dependent, spouse or employee Significant change in the health coverage of the employee s spouse attributable to the spouse s employment Employee or employee s spouse starts an unpaid leave or returns from an unpaid leave Medicare enrollment How do I make a Life Status Change? Changes must be made within 31 days of the event. When an event occurs, print off the Life Status Change Form on the Benefits Portal and attach proof to the form of the event. Within the 31 days you will be required to submit this documentation to the Benefits Team supporting your request. Once the documentation is received, your request will need to be approved and processed. Documentation can be dropped off at the Benefits Department in the District Office to ensure we receive it. You are discouraged from using Inter-District mail. When does my Life Status Change become effective? Life Status Changes take effect the first of the month following the date or coincident with the date of the qualifying event. What if I am unsure if I meet the Life Status Change criteria? If you are unsure that you have experienced a Life Status Change, please contact the Benefits Team at benefits@dysart.org or at within 31 days of the event. Life Status Change Guide Change of Status Changes to Coverage Document Examples Birth, Adoption or Legal Guardianship/Custody of Child Spouse or Dependent child becomes eligible under another Group Insurance Plan New dependents may be added to existing medical, dental or vision coverage. Dependent child life insurance coverage can be added or increased. Health and Child Care reimbursement accounts may be added. No other changes can be made. Spouse or child can be dropped from medical, dental and vision coverage. No other changes can be made. Birth Certification Hospital records or documents Court documents Copy of Enrollment Form Online Enrollment Confirmation 5

6 L I F E S T A T U S C H A N G E Life Status Change Guide Change of Status Changes to Coverage Document Examples Dependent Child becomes ineligible due to marriage or reaching age of 26 Divorce, Annulment or Legal Separation Dependent child must be dropped from medical, dental and vision. Dependent child must be dropped from supplemental life insurance. Dependent child may be able to continue coverage via COBRA. No other changes can be made. Spouse and spouse s children/step-children will be dropped from coverage. Spouse and spouse s children/step-children may be able to continue coverage via COBRA. Existing dependent or spousal life insurance will be dropped. No other changes can be made. Marriage Certificate 26 th Birthday of dependent Court documents Divorce Decree Marriage Spouse Gains Employment Spouse Terminates/Resigns Job or Loses Benefits Eligibility Starting of an Unpaid Leave for either employee or spouse Returning from an Unpaid Leave for either employee or spouse Spouse s Open Enrollment Death (Dependent Child or Spouse) Death (Employee) Spouse and spouse s children/step-children can be added to medical, dental or vision coverage. Dependent supplemental life can be added. Spouse supplemental life can be added and may require evidence of insurability. No other changes can be made. Employee, spouse and children can be dropped from all medical, dental and vision coverage provided they are added to the spouse s group coverage. No other changes can be made. Spouse and/or children can be added to medical, dental and vision coverage. No other changes can be made. May drop medical coverage if proof of other credible coverage is provided. May drop dental and vision coverage. May drop Short term disability and supplemental life insurance. (Note: if STD or Supp Life is dropped, will be required to submit evidence of insurability to re-enroll.) May re-enroll in any benefits in which you were enrolled in prior to going on the leave or add new dependents to the existing coverage. Evidence of insurability required for both Short Term Disability and Supplemental Life Coverage. New benefits may be added if the return date is after the beginning of the new fiscal year and Open Enrollment was missed. May add or drop medical, dental and vision coverage. No other changes can be made. Deceased dependent or spouse will be dropped from all coverage. No other changes can be made. All coverage will be automatically terminated. Dependent may continue health-related coverage through COBRA. Life insurance coverage on dependents will be dropped and may be converted to individual policies. Marriage Certificate Copy of Enrollment Form Online Enrollment Confirmation Letter from HR Department of spouse s employer Resignation Letter COBRA Notification Approval letter or for the leave Doctor s release Letter from HR Department confirming return to employment Enrollment form Online Benefits Statement Death Certificate Death Certificate 6

7 M E D I C A L Blue Cross Blue Shield of Arizona (Maricopa County) (outside Arizona) Blue Cross Blue Shield Monthly" Employee Premiums HSA 2500 (1) HSA 1500 (2) PPO 2000 Employee Only $0.00 $27.24 $ Employee & 1 $ $ $ Employee & Family $ $ $1, (1) On the HSA 2500 plan, the employee may contribute pre-tax money into the HSA. Dysart will match up to $750 per year. In addition, employees can receive an additional $250 Dysart contribution to the HSA should they provide proof of a routine physical*. Dysart contributions are not applicable to PPACA eligible employees. (2) On the HSA 1500 plan, the employee may contribute pre-tax money into the HSA. Dysart will match up to $500 per year. In addition, employees can receive an additional $250 Dysart contribution to the HSA should they provide proof of a routine physical*. Dysart contributions are not applicable to PPACA eligible employees. *Refer to the Forms section of the Benefits Portal for the Wellness Benefit FAQ & Form MEDICAL PLAN OPTIONS HSA 2500 Provides benefits at Blue Cross Blue Shield PPO contracted physicians, facilities and providers. Also, it allows out-of-network benefits. Must meet the calendar year deductible before BCBS covers any expenses other than preventive. In-network preventive care covered at no cost to members. After meeting the calendar year deductible, in-network services are covered by BCBS at 80% and 20% is paid by the member. Out-of-network services are covered by BCBS at 60% and 40% by the member after the calendar year deductible is met. The employee may contribute pre-tax money into the HSA. Dysart will match up to $750 per year. In addition, employees can receive an additional $250 Dysart contribution to the HSA should they provide proof of a routine physical. Dysart contributions are not applicable to PPACA eligible employees. Special Medicare note If you (or your dependents) are 65 or older and enroll in this plan and delay your enrollment in Medicare, it s important to note that Medicare will more than likely charge you a higher premium for Medicare when you decide to enroll, as this plan is not credible in Medicare terms. Should you have any questions contact Medicare at MEDICARE. Medicare/Tricare Enrollees If you are enrolled in Medicare or Tricare, you and the District are not allowed to contribute to an HSA Account. 7

8 M E D I C A L HSA 1500 PPO 2000 Provides benefits at Blue Cross Blue Shield PPO contracted physicians, facilities and providers. Also, it allows out-of-network benefits. Must meet the calendar year deductible before BCBS covers any expenses other than preventive. In-network preventive care covered at no cost to members. After meeting the calendar year deductible in-network services are covered by BCBS at 80%, and 20% is paid by the member. Out-of-network services are covered by BCBS at 60%, and 40% by the member, after the calendar year deductible is met. The employee may contribute pre-tax money into the HSA. Dysart will match up to $500 per year. In addition, employees can receive an additional $250 Dysart contribution to the HSA should they provide proof of routine physical. Dysart contributions are not applicable to PPACA eligible employees. Special Medicare note If you (or your dependents) are 65 or older and enroll in this plan and delay your enrollment in Medicare, it s important to note that Medicare will more than likely charge you a higher premium for Medicare when you decide to enroll as this plan is not credible in Medicare terms. Should you have any questions contact Medicare at MEDICARE. Medicare/Tricare Enrollees if you are enrolled in Medicare or Tricare, you and the District are not allowed to contribute to an HSA Account. Provides benefits at Blue Cross Blue Shield PPO contracted physicians, facilities and providers. Also, it allows out-of-network benefits. In-network preventive care covered at no cost to members. In-network benefits Non-preventive visits/specialist office visits, as well as prescriptions, urgent care, emergency room visits, and hospitalizations are subject to co-payments and/or subject to deductible and coinsurance. After meeting the calendar year deductible, In-network services are covered by BCBS at 80% and 20% is paid by the member. Out-of-network services are covered by BCBS at 60% after the calendar year deductible is met. Out-of-network benefits Allows benefits if you choose to use a medical care provider that does NOT contract with BSBCAZ. Benefits are subject to a deductible and coinsurance. Also, Out-ofnetwork providers may charge more than BCBSAZ reasonable and customary rates. 8

9 Plan HSA 2500 HSA 1500 PPO 2000 Benefits In Network Out of Network In Network Out of Network In Network Out of Network Lifetime Maximum Unlimited Unlimited Unlimited Calendar Year Deductible Individual $2,500 if enrolled as employee only $5,000 if enrolled as employee only $1,500 if enrolled as employee only $3,000 if enrolled as employee only $2,000 per individual $3,000 per individual Family $5,000 if enrolled and covering any dependents $10,000 if enrolled and covering any dependents $3,000 if enrolled and covering any dependents $6,000 if enrolled and covering any dependents $4,000 per family $6,000 per family Coinsurance 20% 40% 20% 40% 20% 40% Calendar Year Out-of-Pocket Maximum (Includes Deductible) Individual $5,000 if enrolled as employee only $10,000 if enrolled as employee only $3,000 if enrolled as employee only $6,000 if enrolled as employee only $5,500 per individual $12,290 per individual Family (1 + dependents) $10,000 if enrolled and covering any dependents $20,000 if enrolled and covering any dependents $6,000 if enrolled and covering any dependents $12,000 if enrolled and covering any dependents $12,500 per family $24,580 per family Hospital Services Inpatient Hospital 20%* 40%* 20%* 40%* 20%* 40%* Outpatient Hospital 20%* 40%* 20%* 40%* 20%* 40%* Emergency Room $150 fee per day; then 20%* $150 fee per day, then 20%* $200 copay, then 20%* Urgent Care 20%* 40%* 20%* 40%* $50 40%* Routine Services Preventive Care 0% If initial visit with innetwork provider any out of network claims associated will be paid at innetwork level. 0% If initial visit with innetwork provider any out of network claims associated will be paid at innetwork level. 0% If initial visit with in-network provider any out of network claims associated will be paid at in-network level. Office Visit 20%* 40%* 20%* 40%* $30 40%* Specialist 20%* 40%* 20%* 40%* $60 40%* Prescription Drugs Deductible Yes Plan Deductible Yes Plan Deductible None Generic/Level 1 20%* 40%* 20%* 40%* $15 Copay + difference Preferred Brand/Level2 20%* 40%* 20%* 40%* $35 between IN contracted rate Level 3 and 4 20%* Not Covered 20%* Not Covered $60 and billed rate Mail Order (90 day supply) 20%* Not Covered 20%* Not Covered 2.5 x copay Not Covered * = after deductible is met 9

10 HealthEquity, Inc H E A L T H S A V I N G S A C C O U N T Dysart s HSA 2500 and HSA1500 health insurance plans are high-deductible health plans which qualifies enrollees to participate in a Health Savings Account (HSA) with HealthEquity, Inc. Rules Regarding Health Savings Accounts If you are enrolled in Medicare (any part of Medicare), Tricare, or claimed as a dependent on someone s tax return (other than your spouse), the IRS will NOT allow the District (or you) to make contributions to the Health Savings Account. It is your responsibility to notify the Payroll & Benefits Department if you are not eligible for contributions. Employees enrolled in an HSA medical plan may contribute to their HSA savings account. All contributions made through payroll deductions are taken on a pre-tax basis. For 2015, the maximum that can be contributed for someone enrolled with employee only coverage is $3,350 and $6,650 for employees who are enrolled covering dependents. Employees 55+ of age are eligible to contribute an additional $1,000. Note that the maximum amounts are total contributions which would include both your and the District s match. Below are some FAQs about Health Savings Accounts from HealthEquity, Inc. What exactly is a Health Savings Account (HSA)? It's a savings and spending account that offers members a tax-advantaged way to pay for qualified medical, dental and vision expenses, as well as a way to save for future medical and retirement health care expenses that won't be subject to Federal tax. After the age of 65 money can be withdrawn from the account for any purpose with no tax penalty, but if not used for health care, you will pay your regular tax rate. Who is eligible to open an HSA? Anyone covered by an HSA-eligible health plan and not covered by any non-eligible plan. Dysart s eligible plans are the HSA 2500 and HSA It is important to note the District and employee are not eligible to contribute to the HSA if the employee is enrolled in Medicare or Tricare, the employee is enrolled in another medical plan that is not a high deductible health plan, or if the employee is listed as a dependent on someone else s tax return (other than their spouse). It is the responsibility of the employee to notify the Benefits Department if they are not eligible for contributions to the HSA. How does an HSA work? The member can use their account to make payments for qualified health care expenses using their HealthEquity Visa Health Account Card, online using electronic funds transfer (EFT), or by phone. Who owns the HSA? The member owns the account, regardless of who contributes. The money earns interest and returns over time. What happens to HSA funds if the owner changes jobs or retires? The account still belongs to the owner. Can an HSA ever be used to pay for non-qualified expenses? Once the member reaches age 65 the funds can be used for non-qualified expenses, but withdrawals will be subject to tax. If the funds are used before age 65 for non-qualified expenses, the amount used will be taxed and incur a 20% penalty. 10

11 H E A L T H S A V I N G S A C C O U N T Can a retiree contribute to an HSA? Yes, if they're covered by a high-deductible health plan and not on Medicare. Am I allowed to have an HSA and an FSA (Flexible Spending Account)? Yes, you are able to have an HSA and FSA. However, the FSA will be a special Limited Purpose FSA. The Limited Purpose FSA will only allow expenses for vision and dental care. So individuals can't contribute to an HSA if they're on Medicare or Tricare? No, the law does not allow those on Medicare or Tricare to contribute to an HSA, but they may continue to own and use an HSA if the account was opened before they went on Medicare or Tricare. Do members lose HSA funds at the end of the year? No, any remaining funds roll over into the following year and grow tax-free. Can HSA funds be withdrawn at any time? Absolutely, as long as they're used to pay qualified medical expenses the money is not taxed at the Federal level. If money is withdrawn before age 65 for other expenses, the regular tax rate would apply as well as a 20% penalty. After age 65 there are taxes, but no penalty regardless of how the money is used. Does an HSA earn interest? Yes. Best of all, the interest accumulates tax-free. Can HSA funds be invested? Yes, in stocks, bonds, mutual funds, CDs, and annuities. Which individuals benefit most from HSAs? Health savings accounts are not just for the healthy or the wealthy. HSAs and qualified high-deductible health plans can work for anyone, regardless of their income or the state of their health. HSAs are the best financial vehicle to save for retirement and pay for medical expenses in the meantime. What happens if you no longer have an HSA-eligible plan? You keep your HSA. It's always your money. But you can no longer make contributions to your HSA if you're not with an HSA-eligible health plan. Additional Questions? HealthEquity s Customer Service Number: (24/7, 365 days/year) 11

12 D E N T A L Total Dental Administrators (for list of providers by zip code) TDA EMPLOYEE "MONTHLY" PREMIUMS Prepaid PPO Employee Only $0.00 $21.29 Employee & Spouse $9.25 $50.29 Employee & Child(ren) $13.78 $63.76 Employee & Family $19.19 $90.23 TDA PREPAID DENTAL PLAN (DMO) Provides benefits at contracted dental offices only. No out of network coverage. Each family member can select a different office. Preventive services are paid at 100%. Other services, members pay a co-payment and the insurance company pays the remaining fees. Members can change dentists during the year by contacting the TDA Member Services Department. TDA PPO DENTAL PLAN Provides benefits at any dental office. Higher benefits for those that contract with TDA. Each family member can select a different office. Preventive services are paid at 100%. Other services are subject to a deductible and then member pays percentage of costs. If out-of-network dentist is used, member is responsible for any cost above the Maximum Plan Reimbursement. Dental Benefits At A Glance DHMO/Pre-Paid Benefits PPO Benefits In-Network Only In-Network Out-of-Network Deductible (July 1 June 30) None $50 Number of Deductibles Per Family None 3 Annual Maximum None $1,000 Class I Preventive /Diagnostic 100% 100% Class II Basic (Includes Endodontics & Periodontics) Class III Major (Includes Crowns, Bridges, Dentures) Class IV Orthodontics (Children only) Co-Payment Examples RCT-Molar $395, RCT-Anterior $175 Co-Payment Examples Crown-Porcelain-high noble metal $455 Co-Payment Examples 90% 80% 60% 50% 50% Children Only Class IV Lifetime Maximum Limited Ortho Child $2,800 Limited Ortho Adult $3,200 Comprehensive Child $3,400 Comprehensive Adult $3,700 $1,000 Children Only Emergency Palliative $15 100% 12

13 V I S I O N Avesis , x257 AVESIS EMPLOYEE MONTHLY PREMIUMS Employee Only $ 5.53 Employee & Spouse $10.44 Employee & Child(ren) $11.38 Employee & Family $14.66 In-Network Benefits: $10 co-pay for an exam. $10 co-pay for materials (frames and lenses) subject to the plan allowance. Exam and lenses every 12 months. Frames every 24 months. Contact lens allowance of $130, including fitting and evaluation, in lieu of frames and lenses. Medically necessary contact lenses covered at 100%. 20% off the provider s usual & customary fees for additional purchases or add-ons to standard lenses. LASIK benefit of $150 allowance toward LASIK at an Avesis contracted LASIK provider. One time (lifetime) benefit for one or both eyes and it takes the place of all other benefits for that plan period. Out-of-Network Benefits: The plan provides allowances towards your exam and materials if you choose an out-of-network provider. However, you will get the most for your money by using in-network contracted providers. 13

14 E M P L O Y E E D U A L C R E D I T What if my spouse works for the District? If you and your spouse are both employed by the District and are both 100% eligible for District paid benefits, you can take advantage of a dual-employee credit; however, the dual-employee credit is most advantageous with family coverage. The spouse carrying medical and/or dental will be credited with the amount the District would have paid for the spousal employee if they had independently selected that policy. At no time will the District contribute more than 100% of the total BCBS Monthly Plan Cost. Any premium over and above the credit will be payroll deducted from the employee who has opted for the dual credit coverage. The other employee will be required to waive medical and/or dental coverage in the benefitsconnect system. Note: Dual credit employees are not allowed to select Voluntary Life insurance on their spouse, and only the employee selecting insurance can choose Voluntary Life insurance on the children. One employee selects Medical, Dental, Vision, can select STD and Voluntary Life on self and child(ren). Other employee waives Medical, Dental, Vision, can select STD and Voluntary Life on self only. Blue Cross Blue Shield Monthly Employee Premiums for Employees Receiving Employee Dual Credit Coverage Level HSA 2500 HSA 1500 PPO 2000 Employee & Spouse $0 $58.48 $ Employee & Family $ $ $ Total Dental Administrators Monthly Employee Premiums for Employees Receiving Employee Dual Credit Coverage Level DHMO Dental PPO Dental Employee & Spouse $0 $40.25 Employee & Family $9.15 $

15 S H O R T T E R M D I S A B I L I T Y Assurant, Inc. Questions on Claims: Disability RMS Short Term Disability is offset by sick leave. This means you must use your sick days and/or sick bank time before you will receive disability payments. Waiting period: 5 th day of injury, 5 th day of sickness. 6 Month Duration. Income replacement if you are unable to work because of an injury (non-work related) or illness for up to six months. May select a disability benefit up to 66 2/3% of your monthly salary (to a maximum of $7,500 per month). Pre-existing conditions treated 12 months prior to the effective date will not be covered in the next 12- months. For example, if you are pregnant on the date your insurance became effective, the pregnancy is considered a pre-existing condition. Injury or illness caused during the course of your employment is not covered under this policy. All eligible employees are automatically enrolled into Long-Term Disability with Arizona State Retirement System (ASRS). NEW Employees Guaranteed eligibility during the initial eligibility period (30 days from date of hire) up to $5,000 per month. In future years, you will only be authorized to increase your benefit one level (by $100) and the remaining balance will be subject to medical questions/approval. Annual salary Benefit Amount Monthly Premium Annual salary Benefit Amount Monthly Premium Annual salary Benefit Amount Monthly Premium $5,400 $300 $5.76 $48,600 $2,700 $51.84 $91,800 $5,100 $97.92 $7,200 $400 $7.68 $50,400 $2,800 $53.76 $93,600 $5,200 $99.84 $9,000 $500 $9.60 $52,200 $2,900 $55.68 $95,400 $5,300 $ $10,800 $600 $11.52 $54,000 $3,000 $57.60 $97,200 $5,400 $ $12,600 $700 $13.44 $55,800 $3,100 $59.52 $99,000 $5,500 $ $14,400 $800 $15.36 $57,600 $3,200 $61.44 $100,800 $5,600 $ $16,200 $900 $17.28 $59,400 $3,300 $63.36 $102,600 $5,700 $ $18,000 $1,000 $19.20 $61,200 $3,400 $65.28 $104,400 $5,800 $ $19,800 $1,100 $21.12 $62,000 $3,500 $67.20 $106,200 $5,900 $ $21,600 $1,200 $23.04 $64,800 $3,600 $69.12 $108,000 $6,000 $ $23,400 $1,300 $24.96 $66,600 $3,700 $71.04 $109,800 $6,100 $ $25,200 $1,400 $26.88 $68,400 $3,800 $72.96 $111,600 $6,200 $ $27,000 $1,500 $28.80 $70,200 $3,900 $74.88 $114,400 $6,300 $ $28,800 $1,600 $30.72 $72,000 $4,000 $76.80 $115,200 $6,400 $ $30,600 $1,700 $32.64 $73,800 $4,100 $78.72 $117,000 $6,500 $ $32,400 $1,800 $34.56 $75,600 $4,200 $80.64 $118,800 $6,600 $ $34,200 $1,900 $36.48 $77,400 $4,300 $82.56 $120,600 $6,700 $ $36,000 $2,000 $38.40 $79,200 $4,400 $84.48 $122,400 $6,800 $ $37,800 $2,100 $40.32 $81,000 $4,500 $86.40 $124,200 $6,900 $ $39,600 $2,200 $42.24 $82,800 $4,600 $88.32 $126,000 $7,000 $ $41,400 $2,300 $44.16 $84,600 $4,700 $90.24 $127,800 $7,100 $ $43,198 $2,400 $46.08 $86,400 $4,800 $92.16 $129,600 $7,200 $ $45,000 $2,500 $48.00 $88,200 $4,900 $94.08 $131,400 $7,300 $ $46,800 $2,600 $49.92 $90,000 $5,000 $96.00 $133,200 $7,400 $

16 Symetra D I S T R I C T P A I D L I F E I N S U R A N C E Dysart Unified School District provides Group Term Life Insurance and Accidental Death and Dismemberment Insurance through Symetra. For Most Employees: Life Insurance equal to ONE time your annual base salary to a maximum of $100,000. Accidental death and dismemberment insurance in an amount equal to ONE time you annual base salary to a maximum of $100,000. For Principals, Assistant Principals, Directors & Cabinet Members: Life Insurance equals to two times your annual base salary up to a maximum of $400,000. Accidental death and dismemberment insurance in an amount equal to two times your annual base salary up to a maximum of $400,000. Dependent Coverage: A dependent life policy of $1,000 is available for your spouse/domestic partner, and dependent children up to age 26. There is an employee cost for dependent coverage of $0.16 per month for each $1,000 of coverage. The Fine Print: Life and Accidental Death and Dismemberment Insurance benefits will reduce by 35% at age 65, and 50% at age 70, and benefits terminate at retirement. Dependent Life Coverage for employee s spouse will be reduced by 50% when the spouse reaches age 65. Employees must be eligible for all other benefits in order to be eligible for the District-paid life insurance policy. 16

17 S U P P L E M E N T A L L I F E I N S U R A N C E Symetra Ext Voluntary Selections Eligible for up to five times your annual base salary, not to exceed $500,000. May cover spouse for up to half the employee amount (excluding dual credit employees). May cover your children for $1,000, $5,000 or $10,000 (premium is per policy, NOT per child). Primary dual credit employee can select. Current employees Already enrolled May increase or decrease coverage, but proof of medical insurability will be required on all life insurance increases. New enrollees Will be required to submit proof of medical insurability. New employees Guaranteed eligibility during your initial eligibility period (30 days from date of hire) up to $150,000 for the employee and $50,000 for spousal/domestic partner coverage. Terminating employees You have 30 days following termination of life insurance benefits to apply for portability or conversion. It is the employee s responsibility to submit the portability or conversion form to Symetra. Forms are available on Benefits Portal / My Benefits / Group and Voluntary Life. Supplemental Life Insurance with AD&D Monthly Premium Examples Supplemental Life Only Insurance Monthly Premium Examples Age Employee $100,000 Employee $150,000 Spouse/Domestic Partner $50,000 Age Employee $100,000 Employee $150, $3.00 $4.50 $ $2.00 $ $4.30 $6.45 $ $3.30 $ $6.20 $9.30 $ $5.20 $ $8.10 $12.15 $ $7.10 $ $12.10 $18.15 $ $11.10 $ $19.10 $28.65 $ $18.10 $ $32.90 $49.35 $ $31.90 $ $45.50 $68.25 $ $44.50 $66.75 Child Life Insurance Coverage Premium $1,000 $0.05 $5,000 $0.25 $10,000 $0.50 Premium is per Family 17

18 S ICK L E A V E B A N K ( S L B ) School Year What is it? The Sick Leave Bank is a means by which employees of the Dysart Unified School District can help each other in times of need. It allows employees to voluntarily join the Sick Leave Bank by depositing up to five (5) earned/accrued leave days into the Sick Leave Bank during the Benefits Open Enrollment period. A minimum of one (1) day must be deposited every year to be eligible to participate in the SLB. The day(s) deposited must be from the current year's earned/accrued sick leave. The Sick Leave Bank is a "blind" bank. A "blind bank" is one in which donated sick leave days are not allocated for a specific employee, but are donated to the bank to be used by any eligible employee. What happens if the Sick Leave Bank runs out of days? If a specific account (Classified, Certified, or Administrative) becomes depleted, the Human Resource Committee may solicit new contributions for the specific account, whichever need replenishment. For purposes of this program, a day equals the number of hours scheduled in the normal working day of the donor. Days of leave (or for Classified employees hours of leave), not the actual wage of the donor employee, will be donated. All unused-banked sick leave time in each bank will continue forward to the next school year. Who is Eligible? Only those employees who are members of the Sick Leave Bank may draw upon it if: (1) The employee has a "non-job-related serious illness or injury as defined by the employee s licensed health care practitioner/physician." or (2) If requested for the care of a terminally ill immediate family member, to be defined as the employee s spouse and children as well as parents of the employee or spouse, and (3) The employee expects to be out of paid leave for at least five (5) consecutive work days or more. The Sick Leave Bank cannot be used for non-complicated maternity leave. Ordinarily, childbirth is not considered a serious illness. The application must be supported by a Health Providers medical certification confirming the conditions, which shall include the nature of the illness, diagnosis and prognosis for the return to duty. The application shall be received by the Payroll & Benefits Manager within ten (10) days following the applicant beginning unpaid leave status. In order to be eligible to use banked time, an employee may not be awarded days from the sick leave bank until he/she has exhausted all earned/accrued leave and is expected to be in an unpaid leave status with the District for one (1) continuous week. Only full-time Classified, Certified, or Administrative employees are eligible to enroll in the Sick Leave Bank. Part-time, substitute, or temporary workers are not eligible to enroll in the Sick Leave Bank. There are three (3) separate accounts: Classified, Certified, and Administrative. You join the Sick Leave Bank of your employment classification. Contributions and benefits are allocated according to these employment categories. 18

19 S ICK L E A V E B A N K ( S L B ) No benefited employee shall be eligible for the Sick Leave Bank after he/she has qualified for long-term-disability coverage or worker s compensation. Based on continuous membership in the bank, each approved applicant is limited to the use of no more than: 1-2 years of membership = 25 days 3-4 years of membership = 50 days 5+ years membership = 100 days How do I use it? An employee is not automatically entitled to use of the Sick Leave Bank by reason of contribution or employment. The application for assistance from the Sick Leave Bank must be supported by medical certification confirming the conditions, which shall include the nature of the illness, diagnosis, and prognosis for return to duty. Each employee wanting to use the Sick Leave Bank must apply through the Payroll & Benefits Manager using the proper procedures (see Leaves of Absence Procedures). You join the Sick Leave Bank by enrolling through benefitsconnect during open enrollment. New employees also enroll through benefitsconnect during the benefit enrollment process. Membership in the bank is strictly voluntary. Who oversees the sick leave bank? The daily operation of the Sick Leave Bank is overseen by the Executive Director of Human Resources, including routine determination of the award of benefits. A summary of requests for benefits and awards given will be provided to members of the Review Board and the Governing Board by the Executive Director of Human Resources or designee. The summary will not include names of employees or any information which might identify the employees using the Sick Leave Bank. The Review Board consists of employees who are members of the Human Resources committee representing the three employee groups: Classified, Certified, and Administrative. Appeals Appeals may be submitted by an employee to the chairperson of the Review Board who shall convene a meeting of the Review Board within fifteen (15) working days after receipt of the appeal. The employee may be present at the review meeting and present appropriate information in furtherance of the request. The Review Board shall render its decision, and notify the employee in writing, within five (5) working days after the review meeting. An employee may request that the decision of the Review Board be reviewed by the Governing Board. Such review will be limited to the information submitted at the review meeting. The Governing Board may schedule an executive session for this purpose. The decision of the Governing Board is final. 19

20 S ICK L E A V E B A N K ( S L B ) Limitations Employees will not earn or accrue additional sick leave during the use of banked sick leave. The Sick Leave Bank and regulations in no way interfere with, limit, or reduce the rights of employees under the federal Family and Medical Leave Act, 29 U.S.C No continuing rights are established by this policy. In compliance with established procedure, the Governing Board reserves the right to modify, change, or delete any policy in accord with its own guidelines. 20

21 HealthEquity F L E X I B L E S P E N D I N G A C C O U N T What are Flexible Spending Accounts or FSAs? Flexible Spending Accounts allow you to put money aside on a before-tax basis; the Health Care Spending Account for eligible health care expenses and the Dependent Care Spending Account for eligible dependent care expenses (e.g. for child day-care). The money is taken from your check on a pre-tax basis and deposited into an account that is managed by a third-party administrator, HealthEquity. What types of FSAs are available? HEALTH CARE SPENDING ACCOUNT (Medical Reimbursement Account) Set from $100 to $2,500 per year into the account, pre-tax dollars! Can cover IRS allowable dependents from this account. They do NOT have to be enrolled on any of our policies. For example, if you could enroll your children into our benefit plans but choose not to, you can still use this account for their out-of-pocket medical expenses as well. Money is available immediately from this account. For example, you can set aside $2,500 into an account and have Lasik surgery done in August. You will continue to pay the money into the account on a pre-tax basis, even though you have already spent it! A debit card is offered at no cost to you. There will be a special Limited Purpose FSA available for employees enrolled in an HSA. The Limited Purpose FSA will only allow expenses for vision and dental care. DEPENDENT CARE REIMBURSEMENT ACCOUNT Set from $100 to $5,000 per year into the account (married, filing jointly, or head of household) or between $100 and $2,500 per year (married, filing separately). Dependent day care expenses for children under age 13 or disabled family members who qualify. Only the amount deposited in the account is available for your use When submitting receipts for reimbursement, caregiver must provide their social security number or tax-identification number. The FSA Administrator is required by law to submit this information to the IRS. Depending on your personal income tax situation, you may get a greater tax savings with the childcare credit than the Dependent Care Spending Account. Ask your tax advisor which alternative is best for you. Why should I consider putting money aside in an FSA? Because the money is put aside BEFORE taxes, you save on every dollar you spend. For example, if you pay your child care or health care provider $100 after you have received your paycheck, you probably had to earn $125, which is taxed, to bring home the $100. Because the money put in these accounts is pre-tax, it is like getting a 20-30% discount on health care or dependent care expenses. How do I access money once it has been deposited in a Flexible Spending Account? You may file a claim by submitting receipts to the administrator or use a debit card to access your medical spending account funds. How long do I have to spend this money? You may file a claim for any expense incurred from July 1, 2015 June 30, You will have until September 15, 2016 to file the claim. 21

22 F L E X I B L E S P E N D I N G A C C O U N T Must I use the Debit Card? No. You may file claims manually. Claim forms can be ed to: reimbursementaccounts@heatlhequity.com or faxed and HealthEquity will reimburse you. Claim forms can be found on HealthEquity s website or the benefits portal under Flexible Spending Accounts. What happens if I have money in my Flexible Spending Account at the end of the plan year? The IRS requires that you forfeit any money left in your Flexible Spending Account after September 15, To avoid forfeiting money, you should carefully estimate your uninsured health care expenses and your employment related dependent care expenses before electing contribution amount(s). What if I leave employment with Dysart? You must incur the expense by the last day of your benefit eligibility. For example, if you resign on October 11 th, you will have until October 31 st to have incurred the expense. You will then have 60 days from the date of your termination to request reimbursement. Can I change my contributions to a Flexible Spending Account during the year? After Open Enrollment, you may change your election if certain life status events occur and you must make these changes within 31 days of the event. Can I get more information regarding what is allowable and what is not? Refer to IRS Publication 503 at for the most up-to-date description of eligible and ineligible dependent care expenses. You can also view eligible health care and dependent care expenses on Health Equity s website at If you would rather just talk with a person about allowable expenses, please call HealthEquity, for more clarification. 22

23 FSA Debit Card Information Do I always send my receipts and the reimbursement form after I use my FSA Debit Card? The IRS has set specific requirements for receipt submission when the FSA Debit Card is used. There are only a handful of times you will not have to submit receipts. When physician and pharmacy co-pays match your employer s health care plan, receipts are generally not required. If you use a retailer that is using the IIAS system, you will not be required to submit receipts. All other uses of the card will require you to submit your receipts. What type of merchant s will allow me to use the FSA Debit Card? As of January 1, 2008, grocery, discount and drug stores must have an IIAS inventory control system in place. This allows the merchant to identify over-the-counter purchases as an eligible FSA expense. If you purchase items with your FSA Debit Card at a merchant using the IIAS system, you will NOT need to submit additional documentation. If you try to use your FSA Debit Card at a merchant that does not have the IIAS system your FSA Debit Card will not work. You will have to pay for the items out-of-pocket and submit a claim form for these items. What should I always remember with the FSA Debit Card? Keep your receipts/documentation, just in case. Submit the reimbursement form and receipts within 15 days of using your FSA Debit Card if it is for an expense that doesn t match our medical/pharmacy co-pays. What are some reasons my FSA Debit Card didn t work? Your provider s card terminal may not be set up with a medical provider code. The merchant may not have an IIAS system in place. You may have reached your FSA limit. You have outstanding charges for which you have not submitted documentation. What happens if I forget to send in receipts? HealthEquity will send you a letter stating that Dysart needs to document your use of the FSA Debit Card. If receipts are not received, your card will be de-activated or turned off. You will no longer be able to use the card until the documentation is received or you have reimbursed the fund for your expenditures This seems like a lot of work, why should I get an FSA Debit Card? The FSA Debit Card allows you immediate access to your money. For example, you need to purchase new contact lens or have another procedure done at your dentist office that does not fall into a normal co-pay amount. You will have access to your flexible spending account money with the understanding further documentation may be required in the future. 23

24 Flexible Spending Account Worksheet Flexible spending accounts are a great way to pay for predictable, eligible health care expenses that comply with our plan. This means things like co-payments, deductibles or co-insurance amounts, certain over-the-counter*, and medical supplies are also eligible. Some of the allowable expenses are listed here. For a more complete list, contact HealthEquity. Orthodontia Dentures Medical/Dental co-payments Medical/Dental deductibles Hearing Aids Medical Equipment Acupuncture Laser Eye Surgery Contact Care Supplies Eye glasses/contacts Psychiatric Care Birth control or vasectomy Dependent Care Spending Account is a great way to pay for qualified dependent care. Remember that you may only request reimbursement with a receipt that contains the care provider s tax identification number or social security number. Dependents must be under the age of 13 and claimed on your income taxes. *Only prescribed medicines or drugs (including over-the-counter medicines and drugs that are prescribed) will be considered qualifying medical expenses. Effective January 1, 2011, you will need a prescription from your physician to receive reimbursement for any over the counter medications ESTIMATE YOUR POTENTIAL SAVINGS WITH A FLEXIBLE SPENDING ACCOUNT MEDICAL REIMBURSEMENT ACCOUNT Qualified Expenses DEPENDENT CARE REIMBURSEMENT ACCOUNT Calculation Method One - $5000 or more in annual daycare expenses 1 Dr. Office Copays + 1 Maximum Annual Deduction $5,000 2 Prescription Copays + 2 Number of Pay Periods Remaining / 3 Hospital or Out-patient Surgery Copays + 3 Contribution per Pay Period $250 4 Out-of-Network Deductibles + Approximate Annual Savings x.28 5 Alternative Health Care Costs Multiply line 1 by.28 6 Cost of Over the Counter Medications + 7 Dental Insurance Copays + Calculation Method Two - Less than $5000 in annual daycare expenses 8 Dental Insurance Deductibles & Coinsurance + 5 Total Day Care Cost Contribution per Pay Period Divide line 5 by # of pays 9 Orthodontic Costs + 6 remaining / 10 Copays for Eye Exams, Glasses or Contacts + 7 Maximum Amount to Withhold per Paycheck 11 Other Medical Expenses + 12 Other Medical Expenses + Approximately Annual Savings 13 Other Medical Expenses + 8 Enter Amount from Line 5 14 Total Qualified Expenses Add lines 1 through 13 = 9 Multiply line 8 by.28 x.28 Maximum Withholding for Medical Reimbursements 10 Approximate Annual Savings 15 Line 14 or $2500, whichever is less 16 Contribution per Pay Period Divide line 15 by # of Pays remaining / 17 Maximum Amount to Withhold per Paycheck = Approximate Annual Savings 18 Enter Amount from Line Multiply line 18 by.28 x Approximate Annual Savings = 1 Chiropractic, Acupuncture, Naturopathic, etc. You cannot use a Flexible Spending Account for elective surgery or cosmetic procedures such as laser hair removal, Botox injections, teeth whitening or veneers. Contact our administrator if you are in doubt. (Sorry about that, but we thought you should know.) 24