Woodland Public Schools

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1 Woodland Public Schools A SUMMARY OF HEALTH & WELFARE BENEFIT PLANS FOR THE SCHOOL YEAR Benefits Fair Open Enrollment September 10, 2013 September 1st, :30 6:00 pm through Woodland High/Middle School Commons September 14th, 2013 Applications are to be returned to Carol Wood in the Human Resources Department. To be effective by November 1 st, your application must be received by Carol Wood no later than September 14 th at the District Office. Open Enrollment September 1 - September 14, 2013 for an effective date of November 1, 2013 for all lines of coverage. WEA Select Plans can be previewed beginning Aug 22 at If you are currently enrolled in a Medical, Dental and/or Vision plan and do not wish to make any changes, you will automatically stay in your current plan. If you are a new hire or wish to make changes, you will need to enroll using the online system or by calling the WEA Select Benefits Center at , Monday through Friday, 7:00 am to 6:00 pm Pacific Time Please Note: *All plan and rate changes have been outlined in bold

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3 TABLE OF CONTENTS Insurance Company Representatives and Support Numbers... 4 How to Select a Medical Plan... 5 Insurance Premiums for Benefit changes for Medical Plan Descriptions WEA Premera Blue Cross Plan 2 - Heritage... 8 WEA Premera Blue Cross Plan 3 - Heritage... 9 WEA Premera Blue Cross EasyChoice WEA Premera Blue Cross Plan 5-Foundation WEA Premera Blue Cross QHDHP-Foundation Kaiser Permanente (HMO) HDHP-HSA Plan Questions and Answers Mandatory Benefits Kaiser - Dental Insurance Standard/VSP - Vision Insurance Voluntary Benefits American Fidelity - Flexible Benefit Spending Account / Section Helpful Information Healthy Kids Now! Basic Health Plan of Washington C.O.B.R.A Qualifications for Shared Sick Leave School Employee s Retirement Systems Washington State Deferred Compensation Program (DCP) Family Medical Leave Act Glossary

4 James Doty SEIU Dana Preston SEIU Jody Brentin Secretary Donna Carnes KWRL Dan Uhlenkott Admin WOODLAND PUBLIC SCHOOLS INSURANCE COMMITTEE MEMBERS Michael Green WDO Carol Wood WDO Stacy Brown Non-Rep Brent LiaBraaten WEA Mary Gronseth - WEA INSURANCE SUPPORT Payroll & Benefits Carol Wood Insurance Consultants The Partners Group Medical Premera Blue Cross Plans 2, 3, 5, EasyChoice & QHDHP Washington Education Association Customer Service : Kaiser Permanente Traditional HMO Plan, Vision Customer Service: Dental Kaiser Permanente Customer Service: INSURANCE COMPANY REPRESENTATIVES Vision Standard VSP Customer Service: Voluntary Products American Fidelity Flexible Spending Account Washington Education Association Aon Consulting: Customer Service: Should you have any questions, please contact any of the above insurance carriers or our agent, The Partners Group at (877)

5 How to Select a Medical Plan Woodland Public Schools offers six different medical plans to choose from. An explanation of each plan offered, including plan names are listed below. PREFERRED PROVIDER ORGANIZATION type plans contract with a large number of providers. If you choose to receive your care through a preferred provider the insurance company will pay a very high percentage of the charges. If you choose to receive care through a non-preferred provider, the insurance company will pay a lower percentage of the charges. Preferred Provider Plan Choices: WEA / Premera Blue Cross Plans 2, 3, EasyChoice & 5-Foundation HIGH DEDUCTIBLE HEALTH PLAN (HDHP) type plans have a high deductible, and require that the deductible is met prior to the insurance company making payment for any service except for preventive services. These plans are eligible to be paired with a Health Savings Account (HSA) that enables the member to pay for healthcare with pre-tax dollars. These plans are also PPO plans, which contract with a large number of providers. If you choose to receive your care through a preferred provider the insurance company will pay a very high percentage of the charges. If you choose to receive care through a non-preferred provider, then the insurance company will pay a lower percentage of the charges. HDHP-HSA Plan Choice: WEA / Premera Blue Cross QHDHP - Foundation HEALTH MAINTENANCE ORGANIZATION (HMO) type plans provide you with managed benefits and usually at a lower cost at the time of service. This plan requires that you select a primary care provider (PCP) from their list of providers. Your PCP will then either provide or coordinate all of your care (except in the case of medical emergency). HMO Plan Choice: Kaiser Permanente E.R. PHYSICIANS & HOSPITALS NOTICE: E.R. Physicians and the Hospitals they practice in are not always participating with the same insurance companies. The physicians and hospitals are usually under separate contracts. RECOMMENDATION: To receive the highest benefits your insurance provides it is a good idea to check your nearest emergency room and physician participation prior to needing these services. You may do this by calling your insurance company or checking their website. For changes or new enrollment, all forms MUST be completed by to be effective on Special Enrollment Rights Description If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance coverage, you may in the future be able to enroll yourself or your dependents in the school district plans, provided that you request enrollment within days (depending upon carrier) after your other coverage ends. Request for enrollment of a new child by birth, adoption or placement for adoption must be made within 60 days of the date of birth, adoption or placement for adoption. Request for enrollment of all other newly eligible dependents must be made within days (depending upon carrier) of the dependent s attaining eligibility. Unless the above applies, understand that you may not be able to obtain coverage under the group insurance plan until the next open enrollment period. Obtaining coverage in the future will be subject to administrative rules and laws in force at that time. See your HR Department for specific timelines. 5

6 Woodland Public Schools Monthly Insurance Premium Medical WEA Plan 2 Premera Blue Cross WEA Plan 3 Premera Blue Cross WEA Plan 5 Foundation Premera Blue Cross Subscriber $ $ $ Subscriber & Spouse $ $ $ Subscriber & Children $ $ $ Subscriber & Family $ $ $ Medical WEA EasyChoice Premera Blue Cross WEA QHDHP Premera Blue Cross Kaiser Permanente Subscriber $ $ $ Subscriber & Spouse $ $ $ Subscriber & Children $ $ $ Subscriber & Family $ $ $ Kaiser Dental DHMO Plan Kaiser Dental PPO Plan Vision- Standard VSP Network Subscriber $75.62 $63.44 $8.52 Subscriber & Spouse $ $ $18.36 Subscriber & Children $ $ $14.80 Subscriber & Family $ $ $ State Allocation = $ for full time employees (varies depending on pooling outcome). From the above state allocation come the following premiums: Retiree Medical ($64.40), Dental, Vision, Long Term Disability (if applicable). The amount remaining, depending on the pooling outcome goes toward medical premiums. It is recommended that all employees read this sheet. Because of rate increases this year, you may now have payroll deduction costs or your current costs may increase with your present medical plan. Please Note: For Exclusions, Limitations, & Clarifications see the individual plan booklets. This comparison is not a contract. 6

7 Woodland Public Schools Benefit changes for Washington State Allocation State allocation for employee benefits will remain at $ The Retiree Medical Carve out amount will decrease from $65.17 to $ WEA - Premera Blue Cross Plan 2, Plan 3, Easychoice, Plan 5 and QHDHP Benefit changes include: Plan 2 deductible increased from $100 (individual) / $300 (family) to $200 (individual) / $600 (family). Plan 3 deductible increased from $200 (individual) / $600 (family) to $300 (individual) / $900 (family). Plan 5 deductible increased from $100 (individual) / $300 (family) to $200 (individual) / $600 (family) for In-Network services. Out of network deductible has increased from $250 per person to $350 per person. Rate Changes: All plans have increased in premium by 16.4% to 17% depending on tier Kaiser Permanente DME subject to Out of Pocket Specialty office visit copay increasing to $25 Advanced Imaging copay increasing to $ % Rate Increase Kaiser Permanente Dental No benefit changes No rate change Standard Vision No benefit changes 7.0% Rate Increase 7

8 Eligible Health Care Providers Annual Deductible WEA Select Premera Blue Cross Plan 2 Any licensed provider worldwide (except as stated). Only Network Providers agree not to bill for amounts over the allowable charges. Enrollees receive greater benefits using Heritage Network Providers. $200 (Individual) / $600 (Family) Combined In & Out of Network 4 th quarter carry over applies (November and December only) IN-NETWORK BENEFITS OUT-OF-NETWORK BENEFITS Coinsurance (Benefit) Level 80% 60% Out of Pocket Maximum Physician Office Calls Preventive Care Services (PCY = Per Calendar Year) Chiropractic Services Prescription Drug Co-payment Retail (34 day supply) Mail Order (100 day supply) Ambulance Services Emergency Room Co-payment Hospital Inpatient Services (PCY = Per Calendar Year) Once you have paid $1,500 Individual/$4,500 Family; benefits will be covered at 100% of allowable charges thereafter. (Includes deductible, does not include copayments) $25 Co-pay then covered at 100% of allowable charges; Deductible waived. Covered at 100% of allowable charges; No Annual Limit; Deductible waived. Unlimited Visits $25 Co-pay then covered at 100% of allowable charges; Deductible waived. At Participating Retail Pharmacies; Deductible waived. $10 generic $20 preferred brand $35 non-preferred brand Same copay as Retail. Subject to deductible, then covered at 80% of allowable charges. $30 Co-pay then covered at 100% of allowable charges; Deductible waived. Covered at a 80% of allowable charges; No Annual Limit; Deductible applies. Unlimited Visits $30 Co-pay then covered at 100% of allowable charges; Deductible waived. At Non-Participating Retail Pharmacies; Deductible waived. Paid at 60% of allowable charges AFTER $10 generic $20 preferred brand $35 non-preferred brand Not covered Subject to deductible, then covered at 60% of allowable charges. $75 co-payment per ER visit; Co-pay waived if admitted. Subject to deductible & $150 co-pay per day to a maximum of $450 per person PCY; Covered at 80% of allowable charges thereafter. Subject to deductible & $150 co-pay per day to a maximum of $450 per person PCY; Covered at 60% of allowable charges thereafter. Inpatient Surgery See Hospital Inpatient Services above. See Hospital Inpatient Services above. Outpatient Surgery Outpatient Lab & X-Ray Services Mental Health Inpatient Services Mental Health Outpatient Services (PCY = Per Calendar Year) Routine Vision Care Maximum Lifetime Benefit Life / AD&D Insurance Subject to deductible & $100 co-pay; Covered at 80% of allowable charges thereafter. Subject to deductible, then covered at 80% of allowable charges thereafter. Unlimited Days Subject to inpatient co-pay & deductible, then covered at 80% of allowable charges thereafter. Unlimited Visits $25 Co-pay then covered at 100% of allowable charges; Deductible waived. Not Covered. Unlimited Subject to deductible & $100 co-pay; Covered at 60% of allowable charges thereafter. Subject to deductible, then covered at 60% of allowable charges thereafter. Unlimited Days Subject to inpatient co-pay & deductible, then covered at 60% of allowable charges thereafter. Unlimited Visits $30 Co-pay then covered at 100% of allowable charges; Deductible waived. Flat $12,500 Life & Accidental Death & Dismemberment for employee only; Benefits reduce to $8,125 for ages 65-69; and to $6,250 for ages 70 and older. 8

9 Eligible Health Care Providers Annual Deductible WEA Select Premera Plan 3 Any licensed provider worldwide (except as stated). Only Network Providers agree not to bill for amounts over the allowable charges. Enrollees receive greater benefits using Heritage Network Providers. $300 (Individual) / $900 (Family) Combined In & Out of Network 4 th quarter carry over applies (November and December only) IN-NETWORK BENEFITS OUT-OF-NETWORK BENEFITS Coinsurance (Benefit) Level 80% 60% Out of Pocket Maximum Physician Office Calls Preventive Care Services (PCY = Per Calendar Year) Chiropractic Services Prescription Drug Co-payment Retail (34 day supply) Mail Order (100 day supply) Ambulance Services Emergency Room Co-payment Hospital Inpatient Services (PCY = Per Calendar Year) Once you have paid $2,750 Individual/$8,250 Family; benefits will be covered at 100% of allowable charges thereafter. (Includes deductible, does not include copayments) $30 Co-pay then covered at 100% of allowable charges; Deductible waived. Covered at 100% of allowable charges ; No Annual Limit; Deductible waived. Unlimited Visits $30 Co-pay then covered at 100% of allowable charges; Deductible waived. At Participating Retail Pharmacies; Deductible waived. $15 generic $25 preferred brand $40 non-preferred brand Same copay as Retail. Subject to deductible, then covered at 80% of allowable charges. $40 Co-pay then covered at 100% of allowable charges; Deductible waived. Covered at a 80% of allowable charges; No Annual Limit; Deductible applies. Unlimited Visits $40 copay then covered at 100% of allowable charges; Deductible waived. At Non-Participating Retail Pharmacies; Deductible waived. Paid at 60% of allowable charges AFTER $15 generic $25 preferred brand $40 non-preferred brand Not covered Subject to deductible, then covered at 60% of allowable charges. $100 co-payment per ER visit; Co-pay waived if admitted. Subject to deductible & $300 co-pay per day to a maximum of $900 per person PCY; Covered at 80% of allowable charges thereafter. Subject to deductible & $300 co-pay per day to a maximum of $900 per person PCY; Covered at 60% of allowable charges thereafter. Inpatient Surgery See Hospital Inpatient Services above. See Hospital Inpatient Services above. Outpatient Surgery Outpatient Lab & X-Ray Services Mental Health Inpatient Services Mental Health Outpatient Services (PCY = Per Calendar Year) Routine Vision Care Maximum Lifetime Benefit Life / AD&D Insurance Subject to deductible & $150 co-pay; Covered at 80% of allowable charges thereafter. Subject to deductible, then covered at 80% of allowable charges thereafter. Unlimited Days Subject to inpatient copay and deductible, then covered at 80% of allowable charges thereafter. Unlimited Visits $30 co-pay then covered at 100% of allowable charges; Deductible waived. Not Covered. Unlimited Subject to deductible & $150 co-pay; Covered at 60% of allowable charges thereafter. Subject to deductible, then covered at 60% of allowable charges thereafter. Unlimited Days Subject to inpatient copay and deductible, then covered at 60% of allowable charges thereafter. Unlimited Visits $40 co-pay then covered at 100% of allowable charges; Deductible waived. Flat $12,500 Life & Accidental Death & Dismemberment for employee only; Benefits reduce to $8,125 for ages 65-69; and to $6,250 for ages 70 and older. 9

10 Eligible Health Care Providers EasyChoice Plan Option WEA Select Premera Blue Cross EasyChoice (A, B, C) Any licensed provider worldwide (except as stated). Only Network Providers agree not to bill for amounts over the allowable charges. Enrollees receive greater benefits using In-Network Providers. IN-NETWORK BENEFITS OUT-OF-NETWORK BENEFITS A B C A B C Provider Network Heritage Heritage Foundation Any covered provider Annual Deductible PCY (per calendar year) Coinsurance (Benefit) Level Out of Pocket Maximum PCY $1,000/person $3,000/ family $750/person $2,250/family $0/person $0/family $2,000/person $6,000/family 4 th quarter carry over applies (November and December only) $1,500/person $4,500/family 80% 75% 65% 50% $5,000/person $15,000/ family $4,000/person $12,000/family $7,500/person $22,500/family Physician Office Calls $15 $30 $35 Preventive Care Screenings/ Mammography Chiropractic Services 12 visits PCY Prescription Drugs Rx Deductible (waived for generics) Out-of-pocket Maximum Retail(30 day supply) Mail Order (90 day supply) Deductible waived Unlimited; covered in full; deductible waived $250/person $750/family No out-of-pocket maximum for out-of-network provider services 50% Not covered Covered in full; deductible waived 50% $15 $30 $35 Deductible waived $500/person $250/person $500/person $5,000/person PCY (includes Rx deductible) Generic / Preferred brand / Non-preferred brand $0 / 30% / 30% $0 / $30 / $45 $0 / 25% / 25% $0 / $75 / $112 50% Not covered Ambulance Services Deductible + Coinsurance Deductible + Coinsurance Emergency Room Co-pay (waived if admitted) $100 $150 $200 $100 $150 $200 Hospital Inpatient Deductible + Coinsurance Deductible + Coinsurance Inpatient Surgery Deductible + Coinsurance Deductible + Coinsurance Outpatient Surgery Deductible + Coinsurance Deductible + Coinsurance Outpatient Lab & X-Ray Services Mental Health Inpatient Services Unlimited Days Mental Health Outpatient Services Unlimited Visits Routine Vision Care Maximum Lifetime Life / AD&D Insurance Covered in full up to $1,000 then deductible + coinsurance Deductible + Coinsurance Deductible + Coinsurance Deductible + Coinsurance $15 $30 $35 Deductible waived Not Covered. Unlimited Deductible + Coinsurance Deductible + Coinsurance Deductible + Coinsurance Flat $12,500 Life & Accidental Death & Dismemberment for employee only; Benefits reduce to $8,125 for ages 65-69; and to $6,250 for ages 70 and older. 10

11 Eligible Health Care Providers Annual Deductible WEA Select Premera Blue Cross Plan 5 FOUNDATION NETWORK Any licensed provider worldwide (except as stated). Only Network Providers agree not to bill for amounts over the allowable charges. Enrollees receive greater benefits using Foundation Network Providers. (The Foundation provider network is a smaller network than Heritage network and does NOT include UW Physicians. To view providers, please go to com, click Provider Directory. ) $200 (Individual) / $600 (Family) 4 th quarter carry over applies (November and December only) IN-NETWORK BENEFITS $350 per enrollee per calendar year 4 th quarter carry over applies (November and December only) OUT-OF-NETWORK BENEFITS Coinsurance (Benefit) Level 90% 70% Out of Pocket Maximum Physician Office Calls Preventive Care Services (PCY = Per Calendar Year) Chiropractic Services Prescription Drug Co-payment Retail (30 day supply) Mail Order (90 day supply) Ambulance Services Emergency Room Co-payment Hospital Inpatient Services (PCY = Per Calendar Year) Once you have paid $500 Individual/$1,500 Family; benefits will be covered at 100% of allowable charges thereafter. (Includes deductible, does not include co-payments) $15 Co-pay then covered at 100% of allowable charges; Deductible waived. Covered at 100% of allowable charges; No Annual Limit; Deductible waived. Unlimited Visits $15 Co-pay then covered at 100% of allowable charges; Deductible waived. At Participating Retail Pharmacies; Deductible waived $10 generic / $15 preferred brand $30 non-preferred brand $10 generic / $30 preferred brand $60 non-preferred brand Subject to deductible & $50 Co-pay, then covered at 90% of allowable charges. No Maximum Subject to deductible, then covered at 70% of allowable charges; No co-pay. Not Covered Unlimited Visits Subject to deductible, then covered at 70% of allowable charges; No co-pay. At Non-Participating Retail Pharmacies; Deductible waived Paid at 60% of allowable charges AFTER $10 generic / $15 preferred brand $30 non-preferred brand Not Covered Subject to deductible & $50 Co-pay, then covered at 90% of allowable charges. $50 co-payment per ER visit; Co-pay waived if admitted. Subject to deductible & $200 co-pay per inpatient admission, then covered at 90% of allowable charges thereafter; (Maximum copay of $600/person - $1,000/family PCY) Subject to deductible, then covered at 70% of allowable charges thereafter. Inpatient Surgery See Hospital Inpatient Services above. See Hospital Inpatient Services above. Outpatient Surgery Outpatient Lab & X-Ray Services Mental Health Inpatient Services Mental Health Outpatient Services Routine Vision Care Maximum Lifetime Benefit Life / AD&D Insurance Subject to deductible, then covered at 90% of allowable charges thereafter. Subject to deductible, then covered at 90% of allowable charges thereafter. Unlimited Days Subject to inpatient copay and deductible, then covered at 90% of allowable charges thereafter. Unlimited Visits $15 co-pay then covered at 100% of allowable charges; Deductible waived. Not Covered. Unlimited Subject to deductible, then covered at 70% of allowable charges thereafter. Subject to deductible, then covered at 70% of allowable charges thereafter. Unlimited Days Subject to deductible, then covered at 70% of allowable charges thereafter. Unlimited Visits Subject to deductible then covered at 70% of allowable charges thereafter; No co-pay. Flat $12,500 Life & Accidental Death & Dismemberment for employee only; Benefits reduce to $8,125 for ages 65-69; and to $6,250 for ages 70 and older. 11

12 Eligible Health Care Providers WEA Select Premera Blue Cross QHDHP FOUNDATION NETWORK Any licensed provider worldwide (except as stated). Only Network Providers agree not to bill for amounts over the allowable charges. Enrollees receive greater benefits using Foundation Network Providers. (The Foundation provider network is a smaller network than Heritage network and does NOT include UW Physicians. To view providers, please go to click Provider Directory. ) Annual Deductible $1,500 (Individual) / $3,000 (Individual+Family*) IN-NETWORK BENEFITS 4 th quarter carry over does not apply $3,000 (Individual) / $6,000 (Individual+Family*) OUT-OF-NETWORK BENEFITS Coinsurance (Benefit) Level 80% 50% Out of Pocket Maximum Once you have paid $4,000 Individual/$8,000 Individual+Family*; benefits will be covered at 100% of allowable charges thereafter. (Includes deductible) No Maximum Physician Office Calls 80% 50% Preventive Care Services (PCY = Per Calendar Year) Chiropractic Services Covered at 100% of allowable charges; No Annual Limit; Deductible waived. 12 visits PCY 80% Exams Not Covered; Screenings are subject to deductible, then covered at 50% of allowable charges. 12 visits PCY 50% Prescription Drug Co-payment Retail (30 day supply) Mail Order (90 day supply) 80% 80% Ambulance Services 80% 80% Emergency Room Co-payment $0 Co-pay; subject to deductible then covered at 80% Hospital Inpatient Services 80% 50% Inpatient Surgery 80% 50% Outpatient Surgery 80% 50% Outpatient Lab & X-Ray Services 80% 50% Mental Health Inpatient Services 80% 50% Mental Health Outpatient Services Routine Vision Care Maximum Lifetime Benefit 80% 50% Not Covered. Unlimited; $2,000,000 Annual Maximum Benefit Life / AD&D Insurance Flat $12,500 Life & Accidental Death & Dismemberment for employee only; Benefits reduce to $8,125 for ages 65-69; and to $6,250 for ages 70 and older. *Prior to benefits being paid out for any family member, the full Individual+Family deductible must be met. In order for benefits to be covered at 100% after meeting the Out-of-Pocket Maximum for any family member, the full Individual+Family Out-of-Pocket Maximum must be met. The family deductible and family Out-of-Pocket Maximum apply when the subscriber and one or more dependents are enrolled. 12

13 Eligible Health Care Providers Annual Deductible Coinsurance (Benefit) Level Kaiser Permanente (HMO Plan) (Group # ) Must use Kaiser designated providers. None 100% through Kaiser designated providers except for copays. Out of Pocket Maximum Once you have paid $600 (Individual) / $1,200 (Family), benefits will be covered at 100% of allowable charges thereafter. (Does not include Prescription drug copayments) Physician Office Calls Preventive Care Services Chiropractic Services Prescription Drug Copay Retail (30 day supply) $15 copay per office visit. $25 copay for specialist office visits Covered at 100% of allowable charges; (Includes well baby care & well adult visits-following child/adult schedules.) 12 self referral visits per member per calendar year. $15 copay then covered at 100% of allowable charges; Prior authorization required after first 12 visits. At Participating pharmacies, most drugs*: $15 formulary generic $30 formulary brand Non-formulary drugs are not covered. Mail Order (90 day supply) Ambulance Services Kaiser & Non-Kaiser Emergency Room Copay Hospital Inpatient Services Inpatient Surgery Outpatient Surgery Diagnostic Lab & X-Ray Mental Health Inpatient Mental Health Residential/Day Benefit Mental Health Outpatient $30 formulary generic $60 formulary brand Non-formulary drugs are not covered. $75 copay (medically necessary transportation only.) $75 copay per ER visit plus any other copayments that normally apply. $50 copay per day up to $250 per admission, then covered in full. Covered in full after Inpatient copayment $20 copay then covered in full. $15 copay, then covered at 100% for all covered services. $50 copay for advanced imaging (MRI, PET, CT) $50 copay per day up to $250 per admission then covered in full. $50 copay per day up to $250 per admission then covered in full. $15 copay then covered at 100% of allowable charges; Vision Care $15 copay per eye exam then covered at 100%. Maximum Lifetime Benefit Life / AD&D Insurance None N/A 13

14 HDHP-HSA PLAN QUESTIONS AND ANSWERS This is a brief overview and is not inclusive of all tax laws regarding HSAs. More information can be found at in IRS Publication 969, or consult your tax professional. How does the High Deductible Health Plan (HDHP) and Health Savings Account (HSA) work? On the HDHP, the deductible must be met prior to your medical plan making payment for any service, except for preventive care. All services including prescriptions must be paid for in full until the deductible is met. You can use the funds in your HSA to pay for services and prescriptions. Once the deductible is met, you are responsible for coinsurance including prescription drugs. If there is family coverage, the entire family deductible must be met prior to your medical plan making payment. Who is eligible to participate in an HSA? In order to be eligible for an HSA, you must be covered by a HDHP and you or your enrolled spouse cannot be also covered under another medical plan unless the other plan is also an IRS qualified HDHP. If a spouse is covered by the school district, and is also covered by their employer or on an individual basis with a non-hdhp plan, they must choose only one of the medical plans. If you are no longer covered by a High Deductible Health Plan, or you enroll in Medicare, you cannot continue to contribute to the HSA, but you can continue to use the funds to pay for qualified medical expenses. You may not participate in an HSA if you can be claimed as a dependent on another person s tax return. Any person covered under the HDHP cannot participate in a Flex-Spending Account (FSA) or Health Reimbursement Account (HRA), including VEBA, unless it is a non-medical FSA, such as a daycare reimbursement FSA, or an HRA, VEBA or FSA that is limited to non-medical expenses. If your spouse has an FSA that could cover your medical expenses, you cannot participate in an HSA. As the HSA is a bank account, you must be eligible to open a bank account, this process may include a credit check. Procedure: 1. When going to the doctor or a pharmacy for a prescription, always present your medical insurance card at the time of service. 2. Your doctor will then bill your medical plan, or the pharmacy will apply your insurance information to the prescription. Your medical plan will process the claim, applying the charges to the deductible. If you go to a participating doctor or pharmacy, any discounts your medical plan has negotiated will apply and will reduce your out of pocket costs. You will also receive an Explanation of Benefits (EOB) from your medical plan, which will explain what your responsibility is and how much of the charges have been applied to your deductible. 3. You can now pay the provider with your HSA debit card. Many providers will bill you and provide space on the bill for you to write in your HSA debit card number to pay for the charges. If a provider or pharmacy does not allow credit card payments, you will need to submit your receipt for reimbursement. Contributions: You (and/or your employer) can contribute to your HSA up to the federal annual limit. The total allowed contributions for 2013, including employer contributions, is $3,250 for an individual only; and $6,450 for a family-when the HDHP coverage is employee plus dependent(s). The limit increases to $3,300 for individual and $6,550 for family for If you are over age 55, you may contribute an additional $1,000 per calendar year. A married couple with two separate Health Savings Accounts is limited to a total of $6,550 between the two accounts if one of the spouses has a HDHP with employee + dependent(s) coverage. To contribute the full limit, you must be enrolled in a HDHP on December 1 of the calendar year. If you are not enrolled in a HDHP on December 1 of a calendar year, you may only contribute 1/12 the annual limit times the number of months you were covered on a HDHP. Your contributions to your HSA will be deducted from your paycheck on a pre-tax basis and deposited by the school district. 14

15 HDHP-HSA PLAN QUESTIONS AND ANSWERS, Continued Distributions: Any time you go to the doctor or fill a prescription before your deductible is met, you can use the funds from your HSA. In addition, you are allowed to use your HSA for any qualified medical expense for medical, dental, vision, or other items that are allowed according to IRS Publication 502. For example, if you have a child who will need braces, you are allowed to contribute to your HSA with pre-tax dollars to pay for the braces. Over-the-counter drugs (with the exception of insulin) are not eligible expenses unless you have a written prescription from a physician. Any distribution that is not a qualified medical expense is subject to a 20% tax penalty and income taxes. Important facts about your HSA The HSA is a bank account in your name that belongs to you. If you leave the school district, the account goes with you, and you can continue to use the account for qualified medical expenses. Any monthly bank fees for the HSA bank account are your responsibility and will be deducted directly from your HSA. Unlike an FSA, you can only use funds that have been already been deposited into your HSA account. If you have a bill for $400, but only $200 deposited to date in your HSA, you only have the $200 available to you. If you use HSA funds for anything that is not a qualified medical expense, there is a 20% tax penalty, and you must report the amount to the IRS as regular income. You should keep all receipts for purchases made with your HSA card, to prove the purchases were a qualified medical expense in case you are audited by the IRS. If you choose to go to a pharmacy that participates with the IIAS system, charges will be auto-adjudicated at the time of purchase. (a list of participating merchants is available at You cannot use your HSA funds for any item or service prior to your effective date on the plan. For example, if your plan was effective 10/1/13 and dentist performed a crown for you on September 5, 2013, and your portion is $400 of the cost of the crown, you cannot use your HSA funds for this service. You can use HSA funds for qualified medical expenses for any tax dependent, even if they are not covered by your HDHP. However, you cannot use HSA funds for qualified medical expenses for someone who is not a dependent according to the IRS, for example, a child who is over age 26, or a domestic partner who is not a tax dependent. All deductibles for HSA eligible High Deductible Health Plans reset on January 1 of each calendar year. There is no carryforward of deductibles met in the prior year. Therefore, if you join a HDHP November 1, your medical expenses will be subject to the entire annual deductible for November and December and the entire deductible will reset on January 1. 15

16 MANDATORY BENEFITS Dental Insurance- DHMO Plan Kaiser Group # Eligible Classes All Employees (Family Coverage: Spouse and Dependents to age 26) Brief Plan Description Annual Maximum Benefit (Nov 1 - Oct 31) Preventive (Exams, X-Rays, Cleaning etc.) Restorative (Fillings, Extractions, etc.) Major Care (Crowns, Bridges,etc.) Major Care (Full & Partial Dentures, relines, rebases etc.) Emergency Care Nightguards Orthodontics (Children under age 18 only) No Annual Maximum Covered in full after a $5 copay (per visit) Covered in full after a $5 copay (per visit) Covered at 80% plus a $5 copay (per visit) Covered at 50% plus a $5 copay (per visit) From Participating Providers: - $25 for Emergency and Urgent Dental Care visits on the same or next business day plus any other Charges that normally apply. From Non-Participating Providers outside the Service Area: Any Charges that normally apply plus amounts that exceed Usual and Customary Charges for qualifying claims. Covered at 90% after a $5 copay (per visit) Member pays first $100 plus 30% of charges over $100, to a maximum add l payment of $200 (a total maximum of $300 out of pocket.) All Services on this plun MUST be provided by network providers in order to receive coverage. There is no coverage provided by a non-network provider (this does not apply to Emergence or Urgent Dental Care visits outside the service area.) Dental Insurance- PPO Plan Kaiser Group # Eligible Classes All Employees (Family Coverage: Spouse and Dependents to age 26) Brief Plan Description Annual Maximum Benefit (Nov 1 - Oct 31) $2,000 Deductible No annual deductible Preventive (Exams, X-Rays, Cleaning etc.) Covered in full Restorative (Fillings, Extractions, etc.) Covered at 80% Major Care (Crowns, Bridges,etc.) Covered at 50% Major Care (Full & Partial Dentures, relines, rebases etc.) Emergency Care Orthodontics (Children under age 18 only) Covered at 50% Dependent on service billed Covered at 50% of Charges up to a Lifetime Benefit Maximum of $1,000, and 100% of charges thereafter. You may see any licensed dentist on this plan but PPO dentists have agreed to charge fees that are less than the usual and customary dental fees. Vision Insurance Vision Benefits: Group No.: # Standard VSP Signature Network Eligible Class: All Employees Brief Description of Vision Plan: Frequency of Service: Exams Once each 12 months Lenses Once each 12 months Frames Once each 24 months Contact Lens* Once each 24 months Coverage Exams $10 copay Hardware $25 copay Lenses** Single Vision, Lined Bifocal, Trifocal, Lenticular - $25 copay Contact Lens $120 allowance *In lieu of lenses & frames. ** Additional Lens options available at an additional cost This is a summary of In-Network benefits. For Out-of-Network benefits, refer to your benefit booklet. 16

17 VOLUNTARY BENEFITS (The following voluntary products are not endorsed by Woodland Public Schools, but are offered as benefit enhancements) Flexible Benefit Spending Arrangement / Section 125 (The open enrollment period is from February 1 st through February 28 th each year for an effective date of March 1 st.) FLEXIBLE BENEFIT SPENDING ACCOUNTS / PLAN 125 AMERICAN FIDELITY: There are three ways to save by participating in the Section 125 Plan by pre-taxing eligible insurance premiums, by participating in the Dependent Day Care Flexible Spending Account (Dependent Day Care FSA), and by participating in the Health Flexible Spending Account (Health FSA). Consider the following reasons to participate: Tax Advantages Participating in the Section 125 plan helps you lower the amount you pay in taxes and thereby, increase your take-home pay. Control You decide how much to put into the Flexible Spending Accounts. Out-of-Pocket Medical / Dental Expenses You can pre-tax eligible medical and dental expenses, such as orthodontia, copayments, and deductibles. You must have a medical practitioner s prescription on file in order to be reimbursed for over-the-counter drugs and medicines. Dependent Care Expenses The Dependent Day Care FSA reimburses for certain eligible dependent care costs (e.g., daycare) with pre-tax dollars and thus reduces your taxable income. The eligible insurance plans available under Section 125 include dental, health, and vision insurance. These benefits will automatically be pre-taxed under the plan. If an employee does not want to participate in this plan, they must sign and return a Premium Payment Plan Refusal form to Carol Wood by February 28, Elections made under the Section 125 plan must remain in place for the length of the plan year unless the employee experiences an allowable election change event mid-plan year (consult your employer for more details). An employee cannot change or revoke their Health FSA election during the contract year. Cancellation or changes for this account are allowed only during the next annual open enrollment period. To take advantage of either or both of the Flexible Spending Accounts, you must complete an election form and return it to the payroll office prior to February 28, Employees currently participating in either of the Flexible Spending Accounts also need to submit a new election form for 2014 to the payroll office. Health Care Reform Over-the-counter medicines: Over-the-counter ( OTC ) medicines and drugs are no longer eligible under your Health Care FSA unless you have a prescription from your licensed health care professional. OTC medicines and drugs include items such as Advil, Tylenol, allergy medicine, antacid, etc. Items that are not medicines or drugs (ex:bandaid, gauze, reading glasses, braces etc.) are still eligible without a prescription. Please consider this when making your election. SB

18 HELPFUL INFORMATION Healthy Kids Now! Free or Low-Cost Health Insurance for Kids & Teens in Washington State Infants through teenagers can receive free or low-cost health insurance. Many families in Washington State qualify and don t know it. These programs are flexible and cover kids in many types of households. This health insurance program covers a full range of services that all children need to stay healthy. For more information, please call or visit BASIC HEALTH OF WASHINGTON Basic Health is a low cost health insurance program offered through the State of Washington, for residents who qualify. If you qualify for a subsidized rate (depending upon total family monthly income and family size) you could receive health insurance coverage for your children at a low cost through this program. Parents do not have to enroll in Basic Health in order to enroll their children. For more information on Basic Health, please call or visit C.O.B.R.A. and Continuation of Coverage COBRA Notification, Rights and Responsibilities for Employees and Dependents COBRA Notices and Further Information. It is very important that you notify your employer regarding any change in status such as divorce or legal separation of the employee and spouse or a dependent child s losing eligibility for coverage as a dependent child. Please contact your payroll officer for the form(s) that may need to be filled out. If you or a qualifying family member have any questions about notices provided to you by your employer, or questions about COBRA, please contact your payroll officer below. Carol Wood, Payroll Technician Woodland Public Schools 800 Third Street Woodland, WA (360)

19 QUALIFICATIONS FOR SHARED SICK LEAVE Who may share their sick leave? Employees who have 22+ days of sick leave accrued after donation. Can employees from one bargaining group share their sick leave with an employee from another bargaining group? Yes, as long as the employee who is sharing the sick leave has 22+ days accrued after donation. What qualifications are required to receive shared sick leave? Employees who are requesting shared sick leave must have (and/or a member of their immediate family) a condition(s) that is extreme and/or extraordinary. An extreme and/or extraordinary condition(s) would include a medical condition(s), which, if not treated, may result in severe consequences (i.e. death, permanent disability, etc). Examples of extreme and/or extraordinary conditions include some of the following: Cancer (treatment of cancer) Major life threatening surgery Some mental disorders Medically necessary leaves due to injury and/or illness Examples of conditions, which, do not qualify for shared sick leave include some of the following: broken bones some mental disorders flu surgery that is not 100% medically necessary maternity leave Each request for shared sick leave is determined on an individual basis. As stated above, your condition (and/or a member of your immediate family) must have an extreme and/or extraordinary condition, which, if not treated, may result in severe consequences (i.e. death, permanent disability, etc.). 19

20 School Employee s Retirement Systems Questions regarding PERS / SERS / TRS benefit information please contact the Department of Retirement Department of Retirement Systems Internet Site Address: Washington State Deferred Compensation Program (DCP) What is the Deferred Compensation Program? The Deferred Compensation Program (DCP) helps you save for retirement on a pre-tax basis, offering the options you need to develop a personal investment strategy. With DCP, you authorize your employer to postpone or defer a part of your income, before taxes are calculated and have that money invested in your DCP account. Both the income you save and the earnings on your investments grow tax-deferred to add to your future retirement and Social Security benefits. With DCP, you decide how much money you want deducted from each paycheck. That can be as little as $360 per year or as much as the annual legal maximum of $17,500 if you are under age 50 and $23,000 if you are over age 50 for How does Deferred Compensation Work? With DCP, you may elect to defer a portion of your salary until retirement or separation from service. Automatic payroll deduction makes savings easy as the amount you choose to defer is taken from your gross income before taxed. For example, if you are in the 15% tax bracket, for every $100 you earn, you keep only $85 because $15 is withheld for federal income taxes. If you elect to defer $100 into a DCP account, however, your take home pay is only reduced by $85 because the $100 is deferred before taxes are calculated. When deciding how much to save, consider adding that extra income to your deferral amount. It can have a significant impact at the time you retire. Should you have questions or would like more information on the Washington State Deferred Compensation Program call the DCP information line at Representatives are available Monday through Friday, 8:00 am 5:00 pm. Contact DCP by dcpinfo@drs.wa.gov You can also write them at the following address: Department of Retirement Systems Deferred Compensation Program PO Box Olympia, WA

21 Family Medical Leave Act of 1993 (FMLA) The Federal Family and Medical Leave Act (FMLA) was signed into law in February The law took effect on August 5, 1993 and guarantees up to 12 weeks of unpaid leave each year to workers who need time off for birth or adoption of a child, to care for a spouse or immediate family member with a serious illness, or who are unable to work because of a serious health condition. To be eligible for FMLA leave, an employee must have worked for Woodland Public Schools for the last 12 months and have worked at least 1,250 hours during 12 months prior to the beginning of the leave. The FMLA is an employer law; it covers employers with 50 or more employees and affects many job-related rights of employees. Among other things, this law also affects the health benefit plans maintained by employers who are required to comply. Employers are required by FMLA to continue to provide group health benefits at the same level and under the same conditions as if the employee had continued to be actively at work. A person who fails to return from an FMLA leave may be entitled to continuation of coverage under COBRA. 21

22 ************************* Glossary of Terms ************************* Allowed charges Services rendered or supplies furnished by a health provider that qualify as covered expenses and for which insurance coverage will pay in whole or in part, subject to any deductible, coinsurance or table of allowances included within the plan design. Coinsurance A provision under Which the enrollee and the carrier each share a percentage of the cost of a covered service. A typical coinsurance arrangement is 80% / 20%. This means the carrier will pay 80% of eligible charges and the enrollee will pay 20%. Copayment Generally used to refer to a fixed dollar amount the subscriber pays to the provider at the time of service. Deductible The amount of out-of-pocket expenses that must be paid for health services by the covered person before the carrier will begin to pay benefits. Dependents The term generally applies to the spouse and children of a covered individual. Explanation of benefits (EOB) A description, sent to patients by health insurance carriers, that describes what benefits were paid for a particular claim. Also called a Claims Processing Report. Family deductible A deductible that is satisfied by the combined expenses of all family members. For example, a program with a $200 deductible may limit its application of the deductible to a maximum of three deductibles ($600) for the family, regardless of the number of family members enrolled. On HSA plans with more than one enrollee, the entire family deductible must be satisfied before benefits are payable for ANY enrollee. Inpatient A person who has been admitted to a hospital or other facility and requires an overnight stay. Maximum benefit The largest dollar amount the plan will pay toward the cost of a specific benefit or for health care overall. The maximum benefit available under most traditional plans for instance is usually between $1,000,000 and $2,000,000 (lifetime per enrollee). Open enrollment A period during which subscribers in a health benefit program have an opportunity to make changes in their health coverage (select an alternative program, for insurance); or a period when uninsured individuals can obtain coverage without presenting evidence of insurability (health statements). Out-of-pocket expenses Those health care expenses for which the enrollee is responsible. These include deductible, coinsurance, copayments and any costs above the amount the insurer considers usual and customary or reasonable (unless the provider has agreed not to charge the enrollee for those amounts). Out-of-pocket maximum The amount that the enrollee must pay for deductibles, coinsurance and copayments in a defined period (usually a calendar year) before the insurer covers all remaining eligible expenses at 100%. Outpatient services Services provided to an individual who has not been admitted to a hospital or other facility. These services may be provided in the outpatient department of a hospital, in a doctor s office or in some other setting. Provider One who provides health care services (examples: hospital, physician, physical therapist, home health agency) or supplies. Referral A formal process that authorizes a Health Maintenance Organization (HMO) or Point of Service (POS) member to receive care from a specialist or hospital. 22

23 ***NOTES***

24 The information herein is not a contract. It is a summary of the benefits available. It is not intended to be an all-inclusive description of Plan benefits, limitations or exclusions, and should not be used in lieu of a Plan book. Be sure to consult your Plan booklet, or consult with the insurance company representative before making your selection. If there are any discrepancies between this summary and the official Plan documents and booklets, the official Plan documents and booklets prevail. Please direct any questions to Carol Wood (360) or The Partners Group at (877) This summary was printed on September 9, 2013 Any further information, revision by bargaining units or by insurers after this date could change or modify the information contained herein. Benefit summary prepared by: The Partners Group for the Woodland Public Schools 800 Third Street Woodland, WA 98674