It Pays to Think Ahead Benefit Summary

Transcription

1 It Pays to Think Ahead Benefit Summary

2 Benefits Overview Aurora Public Schools is proud to offer a comprehensive benefits package to eligible employees. The complete benefit package is briefly summarized in this booklet. You will receive plan booklets, which give you more detailed information about each of these programs. You share the costs of some benefits (medical and dental), and Aurora Public Schools provides other benefits at no cost to you (life, accidental death & dismemberment, EAP, and if you are not yet eligible for PERA, Long-Term Disability). IMPORTANT This document is an outline of the coverage proposed by the carrier(s), based on information provided by your company. It does not include all of the terms, coverage, exclusions, limitations, and conditions of the actual contract language. The policies and contracts themselves must be read for those details. Policy forms for your reference will be made available upon request. The intent of this document is to provide you with general information regarding the status of, and/or potential concerns related to, your current employee benefits environment. It does not necessarily fully address all of your specific issues. It should not be construed as, nor is it intended to provide, legal advice. Questions regarding specific issues should be addressed by your general counsel or an attorney who specializes in this practice area. Benefit Plans Offered Medical Dental Life Insurance Accidental Death & Dismemberment (AD&D) Insurance Flexible Spending Account (FSA) Employee Assistance Program (EAP) Long-Term Disability (for those not eligible for PERA) Eligibility You and your dependents are eligible for Aurora Public Schools medical and dental benefits on the first of the month following date of employment if you are hired between the 1st and the 15th of the month or the first of the month following 30 days of employment if you are hired between the 16th and the end of the month. You are covered on your date of hire for Life, AD&D and if applicable, LTD. Eligible dependents are your spouse or domestic partner, children under age 26, and disabled dependents of any age. Elections made now will remain until the next open enrollment unless you or your family members experience a qualifying event. If you experience a qualifying event, you must contact the Benefits office within 30 days. 2

3 Medical Benefits Administered by United Healthcare and Kaiser Permanente Comprehensive and preventive healthcare coverage is important in protecting you and your family from the financial risks of unexpected illness and injury. A little prevention usually goes a long way especially in healthcare. Regular preventive care provides a no cost review of your health. Small problems can potentially develop into large expenses. By identifying the problems early, often they can be treated at little cost. Comprehensive healthcare also provides peace of mind. In case of an illness or injury, you and your family are covered with an excellent medical plan through Aurora Public Schools. Aurora Public Schools offers you a choice of United Healthcare s Navigate plan or Kaiser s deductible HMO (DHMO) medical plan. With both plans you must receive your medical services from in-network providers. With the Navigate plan, you must select a primary care physician (PCP). Women may see a network OB/GYN for their annual exam without a referral from their PCP. All care must be provided or coordinated by your PCP, with the exception noted above, if you are in the Navigate plan. The Kaiser plan strongly recommends that you select a PCP, but it is not required. MEDICAL BENEFITS UHC Navigate Plan Kaiser DHMO Plan Lifetime Benefit Maximum Annual Deductible (single/family) Annual Out-of-Pocket Maximum (including deductible) Unlimited $1,000/$3,000 $1,000/$3,000 $3,000/$6,000 $4,000/$9,000 Coinsurance 10% 10% DOCTOR S OFFICE Office Visit (PCP/Specialist) $20/$40 copay $25/$50 copay Wellness Care (routine exams, x-rays/tests, immunizations, well baby care and mammograms) PRESCRIPTION DRUGS No charge No charge Retail Generic Drug (30-day supply) Retail Formulary Drug (30-day supply) Retail Non-Formulary Drug (30-day supply) Mail Order Generic Drug (90-day supply) Mail Order Formulary Drug (90-day supply) Mail Order Non-Formulary Drug (90-day supply) $15 copay $15 copay $30 copay $30 copay $50 copay $50 copay $37.50 copay $30 copay $75 copay $60 copay $125 copay $100 copay 3

4 MEDICAL BENEFITS UHC Navigate Plan Kaiser DHMO Plan HOSPITAL SERVICES Emergency Room $300 copay $250 copay Hospital Deductible No separate deductible No separate deductible Inpatient Deductible / 10% Deductible / 10% Outpatient Surgery Deductible / 10% Deductible / 10% Ambulance Service Deductible / 10% 10% up to $500 per trip MENTAL HEALTH SERVICES Inpatient Services Deductible / 10% Deductible / 10% Outpatient Services $20 copay $25 copay SUBSTANCE ABUSE SERVICES Inpatient Services Deductible / 10% Deductible / 10% Outpatient Services $20 copay $25 copay OTHER SERVICES Maternity Services (Prenatal care) All other maternity hospital/ physician services Office copay applies to initial visit only Deductible / 10% Deductible / 10% Deductible / 10% Chiropractic Services Physical, Occupational and Speech Therapy Services $40 copay 20 visits per policy year $20 copay 20 visits per therapy type per policy year Not covered $25 copay 20 visits per therapy type per policy year TMJ and Related Services Not covered Not covered Private Duty Nursing Not covered Deductible / 10% if medically necessary Other Services (Artificial limbs and other prosthetic devices; blood and blood components; leg, arm and neck braces; surgical dressings; casts and splints) Deductible / 10% Deductible / 10% Vision Services (Exam only) $20 copay 1 exam every year $25 copay 4

5 Dental Benefits Administered by Delta Dental Good oral care enhances overall physical health, appearance and mental wellbeing. Problems with the teeth and gums are common and easily treated health problems. Keep your teeth healthy and your smile bright with the Aurora Public Schools dental benefit plan. Annual Deductible (single/family) In-Network $50/$150 Combined in and out of network Annual Benefit Maximum $1,250 Combined in and out of network Preventive Dental Services (cleanings, exams, x-rays) Basic Dental Services (fillings) Major Dental Services (extractions, crowns, inlays, onlays, bridges, dentures, repairs) Out-of-Network PPO $50/$150 Combined in and out of network $1,250 Combined in and out of network 100% 80% 80% 80% 50% 50% Orthodontic Services Not covered Not covered Vision EyeMed Through Delta Dental If you are enrolled in the dental plan you are eligible for vision care savings through EyeMed Vision Care. By accessing an EyeMed network provider you will receive discounts on eye exams, glasses and contact lenses. Life and Accidental Death & Dismemberment Insurance Insured by Cigna Life Insurance Life insurance provides financial security for the people who depend on you. Your beneficiaries will receive a lump-sum payment if you die while employed by Aurora Public Schools. The School District provides basic life insurance of 2 times your annual compensation to a maximum of $250,000 at no cost to you. Accidental Death and Dismemberment (AD&D) Insurance Accidental Death and Dismemberment (AD&D) insurance provides payment to you or your beneficiaries if you lose a limb or die in an accident. Aurora Public Schools provides AD&D coverage of 2 times your annual compensation to a maximum of $250,000 at no cost to you. This coverage is in addition to your company-paid life insurance described above. 5

6 Flexible Spending Accounts (FSAs) Administered by Discovery Benefits You can save money on your health care and/or dependent day care expenses with an FSA. You set aside funds each pay period on a pretax basis and use them taxfree for qualified expenses. You pay no federal or state income taxes on your contributions to an FSA. (That s where the savings comes in.) Your FSA contributions are deducted from your paycheck before taxes are withheld, so you save on income taxes and have more disposable income. Healthcare Spending Limit $2,500 Dependent Care Spending Limit $5,000 Discovery Benefits is the administrator of two individual Flexible Spending Accounts one for health care expenses and one for dependent childcare and elder care expenses. You can enroll in one or both FSAs. You use each account separately, but they work similarly. Here s How an FSA Works 1. You decide the annual amount (see above for the limit for each account) you want to contribute to either or both FSAs based on your expected health care and/or dependent childcare/elder care expenses. 2. Your contributions are deducted from each paycheck before income taxes, and deposited into your FSA. 3. You can pay with the Health Care FSA debit card for eligible health care expenses. For dependent care, you pay for eligible expenses when incurred, and then submit a reimbursement claim form or file the claim online. 4. You are reimbursed from your FSA, so you actually pay your expenses with taxfree dollars. Employee Assistance Program (EAP) Administered by Horizon Health The EAP can provide you with support for a variety of concerns ranging from coping with stress to relationship issues, finding child care, and help with legal and financial matters. All services are confidential and available 24/7 online or by phone. Long-Term Disability Insurance Insured by Cigna Meeting your basic living expenses can be a real challenge if you become disabled. Your options may be limited to personal savings, spousal income and possibly Social Security. Disability insurance provides protection for your most valuable asset your ability to earn an income. Aurora Public Schools provides Long-Term Disability insurance (LTD) coverage at no cost for those employees who do not have five years vested with PERA. LTD coverage provides income when you have been disabled for 180 days or more. Your benefit is 60% of your monthly earnings, up to $1,500 per month. This amount may be reduced by other deductible sources of income or disability earnings. Benefit payments can continue to age 65 if you are under age 60 at the time of disability. 6

7 Contact Information If you have specific questions about any of the benefit plans, please contact the administrator listed below, or your local human resources department. BENEFIT ADMINISTRATOR PHONE WEBSITE/ Medical United Healthcare n/a Medical Kaiser n/a Dental Delta Dental n/a Vision Delta Dental/EyeMed DeltaDental Life and AD&D Insurance Cigna n/a n/a Long-Term Disability Cigna n/a n/a FSA Discovery Benefits Employee Assistance Program Horizon Health n/a Employee Contributions for Benefits Full Time Employees BENEFIT PLAN MONTHLY UNITED HEALTHCARE Employee $31.35 Employee + Spouse $ Employee + Children $ Family $1, KAISER Employee $24.51 Employee + Spouse $ Employee + Children $ Family $ DENTAL Employee $6.39 Employee + Spouse $33.64 Employee + Children $46.45 Family $68.71 Employee Contributions for Benefits Part Time Employees HOURS PER DAY KAISER Employee $ $ $ $ $ $ $ $ $ $ $ $95.81 Employee + Spouse $ $ $ $ $ $ $ $ $ $ $ $ Employee + Children $ $ $ $ $ $ $ $ $ $ $ $ Family $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ UNITED HEALTHCARE Employee $ $ $ $ $ $ $ $ $ $ $ $ Employee + Spouse $1, $1, $1, $1, $ $ $ $ $ $ $ $ Employee + Children $ $ $ $ $ $ $ $ $ $ $ $ Family $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1,

8 Q:\2014\GBS\03\25314A This benefit summary prepared by