Sub Health Insurance Option Food Service - New Hire Memo

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1 MESQUITE ISD BENEFITS Sub Health Insurance Option Food Service - New Hire Memo Welcome to the Mesquite ISD family! If you are a new substitute, you must enroll in or decline medical coverage within 31 days of your hire date. The rate information is attached; more detailed plan information can be accessed on the district s website.* PLEASE NOTE: If you enroll for coverage within 31 days, your coverage will be effective the first of the month following your actively-at-work date. Or you can choose to have your effective date of health coverage begin on your actively-at-work date (the date you start to work+). +If you choose this option, you will pay the full premium amount for the month of your hire date in addition to the next month s premium. *Instructions on Accessing the Benefits Internet Go to Go to EMPLOYEES Go to Benefits Department Go to Health Insurance Option for Substitutes TRS Eligibility: 1. A Mesquite ISD substitute is eligible to enroll in TRS ActiveCare if the substitute works at least 10 hours per week. Hours worked for other school districts are not considered in determining whether a substitute is eligible for benefits through Mesquite ISD. 2. Retirees who have previously declined TRS ActiveCare are not eligible to enroll in MISD insurance. 1. Enroll Action Required 1. Enroll OR 2. Decline If you elect to enroll, you will be responsible for the full premium. Since subs are not members of TRS (Teacher Retirement System), the district contribution does not apply to the health insurance. You will enroll in health insurance at the Benefits Office, which is located in the Florence Annex Building at 105 S Florence St, near Mesquite High School, (the white, rock house on the corner of Main and Florence). You must submit payment for one calendar month with your enrollment form. Premiums are due by the 30 th of each month for the following month. The Benefits Office is open Monday-Thursday, 8 a.m. 4:30 p.m. We are open on Friday from 8 a.m. 4 p.m. During the summer, the office is open Monday-Thursday 7:30 a.m. 5 p.m. and closed on Fridays. 2. Decline If you do not want to enroll in the MISD health plan at this time, complete the MISD declination form (attached to this packet) and return to the Benefits Office. You will have another opportunity to enroll in the health insurance and supplemental insurance (i.e. dental, life, disability) within 31 days of your permanent hire date. If you decline the health insurance during sub new hire enrollment and 31 day permanent new hire window, you will not be able to enroll again until the next plan year unless you experience a Section 125 qualifying event (i.e. marriage, birth). If you experience an event, please complete paperwork in the Benefits Office within 31 days to enroll in insurance and provide proof of event. ******DO NOT DECLINE HEALTH INSURANCE ONLINE; You must complete attached declination forms and return to the Benefits Office*****************

2 PROVIDER HEALTH PLAN ActiveCare 1-HD Rates TRS Premium EE only Aetna E + Sp E + Ch E + Fam ActiveCare 2 EE only Aetna E + Sp E + Ch E + Fam ActiveCare Select Plan No out of network benefits paid!!!! EE only Aetna E + Sp E + Ch E + Fam ActiveCare Scott & White Health Plan MEHC is not in this network. Scott EE only & E + Sp White E + Ch Payment Information E + Fam Payments are due in the benefits office prior to the next month of coverage. Enrollees in the health plan will not receive a monthly bill, invoice or payment reminder. Upon enrollment, your health insurance rate will be determined by the plan/tier you sign up for. Payment receipts will be furnished upon request. If premiums are not received by the 30 th, coverage will be terminated. If the 30 th falls on a weekend or holiday, payment is due last working day of the month. You may pay by check (checks payable to Mesquite ISD), money order, Mastercard, Visa, and Discover. Note: Your coverage may also be cancelled if you lose eligibility for TRS-Activecare* *A substitute who is enrolled in TRS-Active Care and who is then removed from the substitute roster becomes ineligible for health coverage and will be provided notice regarding continuation coverage under COBRA (if eligible). Cancellation due to non-payment is considered a voluntary drop: Therefore you would not be eligible for COBRA. 8/14/15

3 TRS-ActiveCare Plan Highlights Effective September 1, 2015 through August 31, 2016 Network Level of Benefits* Deductible (per plan year) Type of Service ActiveCare 1-HD ActiveCare Select or ActiveCare Select Aetna Whole Health (Baptist Health System and HealthTexas Medical Group; Baylor Scott & White Quality Alliance; Memorial Hermann Accountable Care Network; Seton Health Alliance) Out-of-Pocket Maximum (per plan year; does include medical deductible/ any medical copays/coinsurance/any prescription drug deductible and applicable copays/coinsurance) Coinsurance Plan pays (up to allowable amount) () Office Visit Copay Diagnostic Lab Preventive Care See reverse side for a list of services Teladoc Physician Services High-Tech Radiology (CT scan, MRI, nuclear medicine) Inpatient Hospital (preauthorization required) (facility charges) Emergency Room (true emergency use) Outpatient Surgery Bariatric Surgery Physician charges (only covered if performed at an IOQ facility) Prescription Drugs Drug deductible (per plan year) $2,500 employee only $5,000 employee and spouse; employee and child(ren); employee and family $6,450 employee only $12,900 employee and spouse; employee and child(ren); employee and family 80% 20% $1,200 individual $3,600 family $6,600 individual $13,200 family 80% 20% $30 copay for primary $60 copay for specialist Plan pays 100% (deductible waived) if performed at a Quest facility; 20% after deductible at other facility $1,000 individual $3,000 family $6,600 individual $13,200 family 80% 20% ActiveCare 2 $30 copay for primary $50 copay for specialist Plan pays 100% Plan pays 100% Plan pays 100% $40 consultation fee (applies to deductible and out-of-pocket maximum) Plan pays 100% Plan pays 100% Plan pays 100% (deductible waived) if performed at a Quest facility; 20% after deductible at other facility $100 copay plus $100 copay plus $150 copay per day plus ($750 maximum copay per admission) $150 copay plus (copay waived if admitted) $150 copay per day plus ($750 maximum copay per admission; $2,250 maximum copay per plan year) $150 copay plus (copay waived if admitted) $150 copay per visit plus $150 copay per visit plus $5,000 copay plus Not covered $5,000 copay (does not apply to out-of-pocket maximum) plus Subject to plan year deductible $0 for generic drugs $200 per person for brand-name drugs $0 for generic drugs $200 per person for brand-name drugs Retail Short-Term (up to a 31-day supply) Generic copay Brand copay (preferred list) Brand copay (non-preferred list) Retail Maintenance (after first fill; up to a 31-day supply) Generic copay Brand copay (preferred list) Brand copay (non-preferred list) Mail Order and Retail-Plus (up to a 90-day supply) Generic copay Brand copay (preferred list) Brand copay (non-preferred list) Specialty Drugs Monthly Premium Cost Employee only Employee and spouse Employee and child(ren) Employee and family $20 $40*** 50% coinsurance $25 $50*** 50% coinsurance $45 $105*** 50% coinsurance $20 $40*** $65*** $25 $50*** $80*** $45 $105*** $180*** 20% coinsurance per fill $200 per fill (up to 31-day supply) $450 per fill (32- to 90-day supply) $341 $914 $615 $1,231 $473 $1,122 $762 $1,331 $614 $1,478 $992 $1,521

4 TRS-ActiveCare Plan Highlights TRS-ActiveCare Plans Preventive Care Preventive Care Services ActiveCare 1-HD Network Benefits When Using Network Providers (Provider must bill services as preventive care ) ActiveCare Select or ActiveCare Select Aetna Whole Health (Baptist Health System and HealthTexas Medical Group; Baylor & White Quality Alliance; Memorial Hermann Accountable Care Network; Seton Health Alliance) ActiveCare 2 Network Evidence based items or services that have in effect a rating of A or B in the current recommendations of the United States Preventive Services Task Force (USPSTF). Immunizations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC) with respect to the individual involved. Evidence informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA) for infants, children and adolescents. Additional preventive care and screenings for women, not described above, as provided for in comprehensive guidelines supported by the HRSA. For purposes of this benefit, the current recommendations of the USPSTF regarding breast cancer screening and mammography and prevention will be considered the most current (other than those issued in or around November 2009). The preventive care services described above may change as USPSTF, CDC and HRSA guidelines are modified. Examples of covered services included are routine annual physicals (one per year); immunizations; well-child care; breastfeeding support, services and supplies; cancer screening mammograms; bone density test; screening for prostate cancer and colorectal cancer (including routine colonoscopies); smoking cessation counseling services and healthy diet counseling; and obesity screening/counseling. Examples of covered services for women with reproductive capacity are female sterilization procedures and specified FDA-approved contraception methods with a written prescription by a health care practitioner, including cervical caps, diaphragms, implantable contraceptives, intra-uterine devices, injectables, transdermal contraceptives and vaginal contraceptive devices. Prescription contraceptives for women are covered under the pharmacy benefits administered by Caremark. To determine if a specific contraceptive drug or device is included in this benefit, contact Customer Service at The list may change as FDA guidelines are modified. Annual Vision Examination (one per plan year; performed by an opthalmologist or optometrist using calibrated instruments) Annual Hearing Examination Plan pays 100% (deductible waived) After deductible, plan pays 80%; participant pays 20% After deductible, plan pays 80%; participant pays 20% Plan pays 100% (deductible waived; no copay required) Plan pays 100% (deductible waived; no copay required) $60 copay for specialist $50 copay for specialist $30 copay for primary $60 copay for specialist $30 copay for primary $50 copay for specialist Note: Covered services under this benefit must be billed by the provider as preventive care. If you receive preventive services from a non-network provider, you will be responsible for any applicable deductible and coinsurance under the ActiveCare 1-HD and ActiveCare 2. There is no coverage for non-network services under the ActiveCare Select plan or ActiveCare Select Aetna Whole Health. A specialist is any physician other than family practitioner, internist, OB/GYN or pediatrician. *Illustrates benefits when network providers are used. For some plans non-network benefits are also available; there is no coverage for non-network benefits under the Aetna Select Plan; see Enrollment Guide for more information. Non-contracting providers may bill for amounts exceeding the allowable amount for covered services. Participants will be responsible for this balance bill amount, which maybe considerable. **Includes prescription drug coinsurance ***If the patient obtains a brand-name drug when a generic equivalent is available, the patient will be responsible for the generic copayment plus the cost difference between the brand-name drug and the generic drug. TRS-ActiveCare is administered by Aetna Life Insurance Company. Aetna provides claims payment services only and does not assume any financial risk or obligation with respect to claims. Prescription drug benefits are administered by Caremark.

5 Who thinks school employees should get lower health insurance deductibles? Scott & White Health Plan agrees. Introducing lower deductibles. Call (24 hours a day, 7 days a week)

6 Scott & White Health Plan Summary of Benefits for TRS-ActiveCare Plan Provisions Annual Deductible Annual out-of-pocket maximum (including medical and prescription co-pays and co-insurance) Lifetime Paid Benefit Maximum $800 Individual/ $2,400 Family $5,000 Individual/ $10,000 Family (excludes deductible) None Home Health Services Home Health Care Visit Worldwide Emergency Care $50 co-pay LiveWell! Nurse On Call LiveWell! Online Services After Hours Primary Care Clinics go to $20 co-pay Fully Covered Health Care Services Ambulance and Helicopter $40 co-pay and 20% of charges Preventive Services Standard Lab and X-ray Emergency Room $150 co-pay and 20% of charges LiveWell! Condition Guidance and Wellness Programs Urgent Care Facility $55 co-pay Well Child Care Annual Physicals Immunizations (age appropriate) Outpatient Services Primary Care Specialty Care $20 co-pay $50 co-pay Specialty Medications Tier 1 10% Tier 2 (Preferred) Tier 3 (Premium preferred) 30% Tier 4 (Non-preferred) 50% 3 Other Outpatient Services 1 Diagnostic/Radiology Procedures Eye Exam (one annually) Allergy Serum & Injections Prescription Drugs Annual Benefit Maximum Deductible Does not apply to generic drugs Unlimited $100 Outpatient Surgery Maternity Care Pre-Natal Care Inpatient Delivery $150 co-pay and 20% of charges $150 per day 2 and 20% of charges Ask a SWHP Pharmacy representative how to save money on your prescriptions. Retail Quantity (Up to a 34-day supply) Maintenance Quantity SWHP Pharmacies Only (Up to a 90-day supply) Preferred Generic 4 $3 co-pay $6 co-pay Preferred Brand 30% 30% Non-preferred 50% 50% Inpatient Services Non-formulary Greater of $50 or 50% Not available Overnight hospital stay: includes all medical services including semi-private room or intensive care Diagnostic & Therapeutic Services Physical and Speech Therapy Equipment and Supplies Diabetic Supplies and Equipment Durable Medical Equipment/ Prosthetics $150 per day 2 and 20% of charges $50 co-pay Same as DME or Rx, as appropriate 50% Mail Order Online Refills 1 Includes other services, treatments, or procedures received at time of office visit. 2 $750 maximum co-payment per admission and. 3 Tier 4 co-payment does not count toward out-of-pocket maximum. 4 If a brand name drug is dispensed when a generic is available, 50% co-pay applies.