2016-2017 WCPS Benefits Guide - Washington County Public Schools
Transcription
2016-2017 WCPS Benefits Guide - Washington County Public Schools
Employee Benefits Enrollment Guide benefits that matter PLAN YEAR JULY 1, 2016 – JUNE 30, 2017 Contents Overview 1-6 Medical and prescription 7-14 Dental 15-17 Vision 18-20 Life insurance 21-23 Flexible Spending Accounts (FSA) 24-30 Long Term Disability (LTD) 31-35 Retirement 36-40 Employee Assistance Program (EAP) 41-45 Rate Sheets 46-50 Getting Started How to use this guide This guide is a summary of the Washington County Public Schools insurance plans, benefits descriptions and rules that govern the plan. This guide does not change or replace the express written terms of any policy, plan or coverage, which are subject to change at any What time. benefits are offered? What benefits are offered? Washington County Public Schools offers employees quality benefit options to meet the needs of you and your family. BASIC BENEFITS Paid Holidays Paid Sick Leave Paid Personal Leave Membership in the Maryland State Retirement System* Tuition Reimbursement Employee Assistance Program Washington County Teachers Federal Credit Union membership available Term Life Insurance equal to your annual salary** Term Accidental Death and Dismemberment Insurance** *Membership in the Maryland State Retirement System in mandatory and requires a contribution based on your annual compensation. **Term Life Insurance and Term Accidental Death & Dismemberment Insurance are optional benefits for employees working less than 30 hours per week. OPTIONAL BENEFITS Medical and Prescription insurance Dental insurance Vision insurance 403(b) and 457(b) supplemental retirement plans Long Term Disability Medical and Dependent Care Flexible Spending Accounts Additional Term Life Insurance Additional Accidental Death and Dismemberment Insurance Dependent Life Insurance Want to learn more about your benefits? Visit our website at www.wcpsmd.com/benefits for easy to read summaries and detailed descriptions of all available benefits. 1 Who is eligible? You are eligible to participate in some or all of the benefits described in this guide if you are a: Permanent employee working 15 or more hours per week. Permanent employee on an approved Leave of Absence. What about dependents? Eligible Not Eligible Your children, up to age 26. (Children include your natural children, legally adopted children, current stepchildren, any children you are responsible for carrying health insurance on due to a court order.) Even if your child is married, not living at home, or not attending college, they are still eligible for coverage until age 26. Your spouse after you have divorced Your legally married spouse Your live-in or domestic partner Children of your live-in or domestic partner Your children over age 26 (unless they are disabled) Your grandchildren (unless legal custody arrangement is in place) Your parents Your disabled children of any age (proof of disability required) Your stepchildren after you and your spouse (children’s parent) divorce Provide the proof If you cover dependents, you must provide proof of your relationship when requested. Examples of valid proof are: Spouse – copy of marriage certificate Dependent child (under age 26) – copy of birth certificate, adoption papers, court decree for legal guardianship/custody, QMSO Dependent child (disabled over age 26) – copy of documentation from Social Security Administration, Medicare or physician verifying disability. You may be required to provide updated information periodically. 2 Covering dependents that are not eligible is a violation of the Internal Revenue Code, as well as WCPS regulations – so it is very important that you understand the dependent eligibility requirements. If you find that you are currently covering a dependent under a WCPS benefit plan who does not meet the eligibility requirements, please notify the Benefits Office immediately at 301.766.2810 or benefits@wcps.k12.md.us. When do my benefits start? WCPS maintains a Section 125 plan, which allows most employees to pay for certain benefits with pre-tax dollars. Compliance with Section 125 of the Internal Revenue Code requires WCPS to follow specific rules regarding timeframes for enrollment. At initial hire –All employees working three or more hours per day (15 hours per week) are eligible for some level of benefit coverage. Costs for those benefits range depending on the number of hours you are scheduled to work. When you are first hired and are benefit eligible, you are given 31 days from the date of hire to make any benefit elections. Coverage for most benefits begins on the first of the month following your hire date. If benefits are not elected within 31 days, enrollment must wait until the next open enrollment period or upon experiencing a qualifying event. At initial eligibility – Not all employees hired by WCPS are eligible for benefits on their hire date. Some employees are hired as a substitute, temporary, or are working less than three hours per day. If you experience a work status change that makes you eligible for benefits, you are given 31 days from the effective date of the change to make any benefit elections. Coverage for most benefits begins on the first of the month following your status change. If benefits are not elected within 31 days, enrollment must wait until the next open enrollment period, or upon experiencing a qualifying event. When can I make changes? Compliance with Section 125 of the Internal Revenue Code requires WCPS to follow specific rules regarding timeframes for changes in enrollment. Annual Open Enrollment – Annual Open Enrollment gives you the opportunity to review available benefit plan options and make any changes you want for the following plan year. Any changes you make stay in place for the entire plan year if you pay premiums and remain eligible. 3 Upon experiencing a qualifying event – Experiencing a qualifying event allows you to add, stop or change your benefit plans outside of annual open enrollment. Typical life events may include but are not limited to: Marriage or divorce (not legal separation), Birth or adoption of a child, Death of a spouse or other eligible dependent, Change in a spouse's or child's employment resulting in gain or loss of coverage. You are given 31 days from the effective date of the qualifying event to make any benefit elections. Coverage will begin on the date of the qualifying event. If benefits are not elected within 31 days, enrollment must wait until the next open enrollment period, or upon experiencing another qualifying event. 31 That's the number of days you have to enroll or make a change to your benefits! Don't delay! Special Enrollment - The group health plan also provides two additional special enrollment opportunities. These two new qualifying Life Events are when: You or your dependent's Medicaid or CHIP (Children's Health Insurance Program) coverage is terminated as a result of loss of eligibility, or You or your dependent becomes eligible for a premium assistance subsidy under Medicaid or CHIP. You must request this special enrollment within 60 days of the loss of Medicaid or CHIP coverage, or within 60 days of when eligibility for premium assistance under Medicaid or CHIP is determined. The 31 day notice is still required for all other enrollments. What can I change? Spring Open Enrollment: Changes can be made to medical/prescription, dental, vision, and dependent life insurance. Spring open enrollment is normally conducted in May for changes to take effect July 1. Winter Open Enrollment: Medical and Dependent Care Flexible Spending Account (FSA) enrollments are handled in November for a calendar year enrollment. FSA accounts are the ONLY benefit that you have to re-enroll for each year to stay in the plan! Anytime: Changes can be made to your 403(b) and 457(b) plans anytime through the year. You can also change your supplemental life insurance, 4 supplemental AD&D and long-term disability. If electing life insurance, AD&D or disability after you were first eligible for it, you may be required to complete an Evidence of Insurability form for potential coverage approval from the insurance carrier. How much will the offered benefits cost? You can review additional helpful benefit information at www.wcpsmd.com/benefits The cost of benefits is shown on the FullTime and Part-Time Employee Rate Sheets. Costs are determined on an annual, fiscalyear basis. Employee contributions for certain benefits can vary by bargaining unit, so please refer to your negotiated agreement for details. What happens to my benefits if I need to be off work for an extended period of time? Sometimes events in our life prevent us from being on the job for periods of time. This can impact your pay and your benefits. If you need to be off from work for more than five days and it's not for vacation leave, then you should contact the Benefits Office immediately for guidance. Each employee's situation can be different based on the reason for leave, Family and Medical Leave (FMLA) eligibility, and the benefits you are enrolled for. While it is recognized that advance notice is not always possible, contacting the Benefits Office as soon as you become aware of the possibility of a leave will be beneficial to you so you can prepare accordingly. How do I enroll? New employees and employees making changes during spring open enrollment will use the Employee Self Service (ESS) site to make all changes. Employees experiencing a qualifying event will need to contact the benefits office within 31 days after the event to make appropriate changes. 5 Summary of Benefits Offered Coverage Type Plan Type/Options Who is Eligible Medical and Prescription OAP Premium OAP Standard OAP Limited All employees working 15 hours or more per week Dental PPO All employees working 15 hours or more per week Vision Life Insurance PPO Basic Life, Basic AD&D, Supplemental Life, Voluntary AD&D, Dep. Life Long Term Disability Flexible Spending Accounts Mandatory retirement plan Medical Account, Dependent Care Account Supplemental retirement plan All employees working 15 hours or more per week United Concordia Carrier Contact Info www.cigna.com 1-800-564-7642 (before enrolled) 1-800-244-6224 (after enrolled) www.ucci.com 1-866-851-7568 www.e-nva.com National Vision Administrators (NVA) Minnesota Life 1-800-672-7723 https://web1.lifebenefits.com All employees working 30 or more hours per week Cigna 1-877-282-1752 www.cigna.com All employees working 15 hours or more per week TASC 1-800-362-4462 www.tasconline.com All employees working 15 hours or more per week 1-800-422-4661 http://www.sra.state.md.us/ Employee Pension System Mandatory participation for all employees working 2.75 hours or more per day Maryland State Retirement Agency 403(b) 457(b) 403(b) – All substitute and regular employees of WCPS 403(b) only: AXA Advisors, PlanMember Services,Voya, MetLife 403(b) and 457: MetLife Coordinate through TSA Consulting Group Inova EAP www.inova.org/eap Teacher Pension System 457(b) – Teachers, Administrators and Supervisors Employee Assistance Program (EAP) Insurance Carrier Cigna Up to 6 visits per condition per year free to employee and eligible dependents. All full-time and part-time employees 1-800-492-5909 www.tsacg.com 1-888-796-3786 All calls strictly confidential 1-800-346-0110 6 MEDICAL AND PRESCRIPTION PLAN Medical and prescription coverage is offered through Cigna Health Care. WCPS employees can choose from three different medical plans using Cigna’s OAP network. While the three plans are very similar in nature, there are a few distinct differences in out-of-network availability, deductibles, and out-of-pocket maximums. Please review the summary of medical and prescription benefits for a comparison of the three plans. Cigna is a leader in website and app design. They also firmly believe in overall mental and physical wellness, as well as disease management. If you should enroll, we encourage you to enroll on www.myCigna.com to review your benefits, claims, and to browse through the wealth of wellness information. You can even download the app on your phone to easily access your insurance cards and emergency/urgent care information. 7 Understand your medical plan options open access plus How it works Cigna’s Open Access Plus plan gives you important choices. Each time you need care, you can choose the doctors and other health professionals and facilities that work best for you. Enroll in the Open Access Plus and you’ll get: Options for accessing quality health care • Primary Care Physician (PCP) – You decide if you want to choose a PCP as your personal doctor to help coordinate care and act as a personal health advocate. It’s recommended but not required. • In-network – Choose to see doctors or other health professionals who participate in the Cigna network to keep your costs lower and eliminate paperwork. • No-referral specialist care – If you need to see a specialist, you do not need a referral to see a doctor who participates in the Cigna network – just make the appointment and go! Pre-certification may be necessary for hospitalizations and some types of outpatient care, but there is no paperwork for you. • Out-of-network – You also have the freedom to visit doctors or use facilities that are not part of the Cigna network, but your costs will be higher and you may need to file a claim. 24/7 service – Whenever you need us, customer service representatives are available to take your calls. You can also speak with a health care professional over the phone, any time, day or night. Health and wellness discounts – Enjoy discounts on a variety of health-related products and services. Access to myCigna.com – Use a personalized website to: • Learn more about your plan and the coverage and programs available to you. • View claim history and account transactions; print claim forms when you need them. • Find information and estimate costs for medical procedures and treatments. • Learn how hospitals rank by number of procedures performed, patients’ average length of stay and cost. • Emergency and urgent care – When you need care, you’re covered, 24 hours a day, worldwide. 831758 d 08/12 8 Offered by: Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, and their affiliates. Q&A Do I have to choose a Primary Care Physician (PCP)? No. However, a PCP gives you and your covered family members a valuable resource and can be a personal health advocate. What if my doctor isn’t on your list? That means your PCP does not participate in the Cigna network. To receive your maximum coverage, you should select a doctor from the Cigna list of participating doctors and other health care professionals. You can continue seeing your current doctor, even if he or she is not in Cigna’s network. However, in that case, you will pay higher out-of-pocket costs, and your care will be covered at the out-of-network coverage level. Do I need a referral to see a specialist? Though you may want your personal doctor’s advice and assistance in arranging care with a specialist in the network, you do not need a referral to see a participating specialist. If you choose an out-ofnetwork specialist, your care will be covered at the out-of-network coverage level. What is the difference between in-network coverage and out-of-network coverage? Each time you seek medical care, you can choose your doctor – either a doctor who participates in the Cigna network or someone who does not participate. When you visit a participating doctor, you receive “innetwork coverage” and will have lower out-of-pocket costs. That’s because our participating health care professionals have agreed to charge lower fees, and your plan covers a larger share of the charges. If you choose to visit a doctor outside of the network, your out-of-pocket costs will be higher. What if I need to be admitted to the hospital? covered. Pre-certification is not required for maternity stays of 48 hours for vaginal deliveries or 96 hours for caesarean sections. Depending on your plan, you may be eligible for additional coverage. Any hospital stay beyond the initial 48 or 96 hours must be approved. Who is responsible for obtaining pre-certification? Your doctor will help you decide which procedures require hospital care and which can be handled on an outpatient basis. If your doctor participates in the Cigna network, he or she will arrange for precertification. If you use an out-of-network doctor, you are responsible for making the arrangements. Your plan materials will identify which procedures require pre-certification. How do I find out if my doctor is in the Cigna network before I enroll? It’s quick and easy to search for participating doctors, specialists, pharmacies, hospitals and facilities closest to home and work. Go to Cigna.com and click on “Find a Doctor.” You will be able to: Review the doctor’s education, languages spoken and hospital affiliations, and get a detailed map with directions. What if I go to an out-of-network doctor who sends me to a network hospital? Will I pay in-network or out-of-network charges for my hospitalization? Cigna HealthCare will cover authorized medical services provided by an Open Access Plus participating hospital at your in-network coverage level – whether you were sent there by an in-or outof-network doctor. In an emergency, your care is covered. Requests for non-emergency hospital stays other than maternity stays must be approved in advance or “pre-certified.” This enables Cigna to determine if the services are “Cigna,”“myCigna.com” and “Cigna.com” are registered service marks, and the “Tree of Life” logo and “GO YOU” are service marks, of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided exclusively by such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company (CGLIC), Cigna Health and Life Insurance Company (CHLIC), and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. In Arizona, HMO plans are offered by Cigna HealthCare of Arizona, Inc. In California, HMO and Network plans are offered by Cigna HealthCare of California, Inc. In Connecticut, HMO plans are offered by Cigna HealthCare of Connecticut, Inc. In North Carolina, HMO plans are offered by Cigna HealthCare of North Carolina, Inc. All other medical plans in these states are insured or administered by CGLIC or CHLIC. All models used for illustrative purposes only. Cigna insured OAP product is not available in Arkansas or Puerto Rico. 9 831758 d 08/12 © 2012 Cigna. Some content provided under license. Summary of Cigna Open Access Plus Medical and Prescription Benefits Three plan comparison for Washington County Public Schools CommonServices Annual Deductible Individual Individual & Child(ren) Individual & Spouse Family Annual Out‐of‐Pocket Limit Individual Individual & Child(ren) Individual & Spouse Family Lifetime Maximum Preventive Services Well Child Care, Adult Physical Exam and Routine GYN Visit Cancer Screening (Pap Test, Prostate and Colorectal, Mammograms) Doctor's office visits Diagnostic Services, X‐ray and Lab Tests Allergy Testing and Shots Outpatient Physical, Speech and Occupational Therapy in office (limited to 60 visits per benefit period combined) OAP‐INLimitedPlan In‐Network Youpay OAPStandardPlan In‐Network Out‐of‐Network Youpay YouPay OAPPremiumPlan In‐Network Out‐of‐Network Youpay YouPay $100 $200 $200 $200 $200 $400 $400 $400 $400 $800 $800 $800 $100 $200 $200 $200 $200 $400 $400 $400 $1,000 $2,000 $2,000 $2,000 None $1,500 $3,000 $3,000 $3,000 $3,000 $6,000 $6,000 $6,000 $1,000 $2,000 $2,000 $2,000 $1,000 $2,000 $2,000 $2,000 No charge* No charge* No Benefit No charge* No Benefit No charge* No charge* No charge* No charge* 30% of Allowed Benefit, after deductible $20 per visit No charge* after deductible No charge* after deductible $20 per visit No charge* after deductible No charge* after deductible 30% of Allowed Benefit, after deductible No charge* after deductible 30% of Allowed Benefit, after deductible $20 per visit No charge* after deductible No charge* after deductible 30% of Allowed Benefit, after deductible 30% of Allowed Benefit, after deductible 30% of Allowed Benefit, after deductible $20 per visit $20 per visit 30% of Allowed Benefit, after deductible $20 per visit 30% of Allowed Benefit, after deductible None None Urgent & Emergency Care Physician’s Office and Urgent Care Center Hospital Emergency Room Ambulance (if medically necessary) $20 per visit $20 Physician; $50 Facility No charge* $20 per visit $20 Physician; $50 Facility No charge* $20 per visit $20 Physician; $50 Facility No charge* $20 per visit $20 Physician; $50 Facility No charge* $20 per visit $20 Physician; $50 Facility No charge* 10 Summary of Cigna Open Access Plus Medical and Prescription Benefits Three plan comparison for Washington County Public Schools CommonServices OAP‐INLimitedPlan In‐Network Youpay OAPStandardPlan In‐Network Out‐of‐Network Youpay YouPay OAPPremiumPlan In‐Network Out‐of‐Network Youpay YouPay Hospitalization Inpatient Facility Services Maternity Prenatal and Postnatal Office Visits Delivery and Facility Services Nursery Care of Newborn Miscellaneous Durable Medical Equipment $100 per admission copay $100 per admission copay 30% of Allowed Benefit, after deductible $100 per admission copay 30% of Allowed Benefit, after deductible No charge* after deductible $100 per admission copay No charge* after deductible No charge* after deductible $100 per admission copay No charge* after deductible 30% of Allowed Benefit, after deductible 30% of Allowed Benefit, after deductible 30% of Allowed Benefit, after deductible No charge* after deductible $100 per admission copay No charge* after deductible 30% of Allowed Benefit, after deductible 30% of Allowed Benefit, after deductible 30% of Allowed Benefit, after deductible No charge* after deductible No charge* after deductible No charge* after deductible No charge* after deductible 30% of Allowed Benefit, after deductible Pharmacy (all plans same coverage) Retail (30‐day supply) Generic Preferred brand Non‐preferred brand $10 Copay $30 Copay $50 Copay Home Delivery No out‐of‐network pharmacy benefits (90‐day supply) Generic $20 Copay Preferred brand Non‐preferred brand $60 Copay $100 Copay * No copayments or coinsurance. Members are liable for the difference between Cigna's allowed benefit and the providers charge for services rendered by a non‐participating provider. This summary highlights the most commonly used benefits and is not intended to address all conditions. For detailed information reference the summary plan description for the plan, contact Cigna directly at 1‐800‐244‐6224, or current members can reference their myCigna.com account. 11 you’ve got a goal. and you’ve got what it takes to reach it. Whether your goal is to lose weight, quit tobacco or lower your stress levels, you have the power to make it happen. Cigna Lifestyle Management Programs can help – and all at no cost to you. Each program is easy to use and available where and when you need it. And, you can use each program online or over the phone – or both. Weight Management Over the phone* • One-on-one wellness coaching • Convenient evening and weekend hours • Program workbook and toolkit Online • Secure, convenient support • Self-paced program • Educational materials, interactive tools and resources Reach your goal of maintaining a healthy weight – all without the fad diets. Create a personal healthy-living plan that will help you build your confidence, be more active and eat healthier. And, you’ll get the support you need to stick with it. Tobacco Get the help you need to finally quit tobacco. Create a personal quit plan with a realistic quit date. And, get the support you need to kick the habit for good. You’ll even get free over-the-counter nicotine replacement therapy (patch or gum). Stress Management Lower your stress levels and raise your happiness levels. Learn what causes you stress in your life and develop a personal stress management plan. And, get the support you need to help you cope with stressful situations – both on and off the job. Take the first step. Call 1 (800)Cigna24 or visit myCigna.com Offered by: Connecticut General Life Insurance Company or Cigna Health and Life Insurance Company. *Telephonic support based on plan design and may not be available to everyone. “Cigna,” the “Tree of Life” logo and “GO YOU” are registered service marks of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, Cigna Health Management, Inc., Cigna Behavioral Health, Inc., vielife Limited, and HMO or service company subsidiaries of Cigna Health Corporation. All models are used for illustrative purposes only. 12 848442 c 06/14 © 2014 Cigna. Some content provided under license. Dear Washington County Public Schools Associate, Your company has selected MDLIVE to provide you with 24/7/365 access to board-certified primary-care doctors and pediatricians by secure video, phone or e-mail. Simply pay the $20 copay at time of consult. Whether you are at home, at work, traveling, or simply want the most convenient way to see a you doctor, MDLIVE is easy to use and available on your schedule anytime, anywhere. Our service is secure, confidential and compliant with all medical privacy regulations. To get started and make an appointment call toll-free 1-888-726-3171 or visit mdlive.com/wcps Emergency medicine physician and TV host. When should I use MDLIVE? What can be treated? Who are our doctors? ■ If you’re considering the ER or urgent care for a non-emergency medical issue ■ ■ ■ ■ ■ ■ ■ ■ Our doctors practice primary care, pediatrics, family and emergency medicine, and have incorporated MDLIVE into their practice to provide convenient access to quality care. ■ Your primary care physician is not available ■ At home, traveling or at work ■ 24/7/365, even holidays! Allergies Asthma Bronchitis Cold and Flu Ear Infections Joint Aches and Pain Respiratory Infection Sinus Problems And More! GETGET STARTED TODAY! STARTED TODAY! 1 2 3 Register online or by phone Complete medical history Request a consultation Register online anytime by visiting Just complete your medical history during registration. Simply pay the $20 copay at time of consult. mdlive.com/wcps You will need to enter your first name, last name, gender, date of birth and your Cigna Customer ID#. You may also register over the phone by calling 1-888-726-3171 MDLIVE staff is available 24/7/365 by online video or phone! GET GETSTARTED STARTEDNOW NOW mdlive.com/wcps 1-888-726-3171 13 YOUR CIGNA PHARMACY BENEFIT Five ways to get the most out of your pharmacy benefit plan 1. Learn what medications are covered Save money by checking out the list of medications covered under your plan on myCigna.com. The amount you pay depends on whether your medication is listed as a generic, preferred brand, non-preferred brand or specialty medication. 2. Use the Prescription Drug Price Quote tool View medication cost based on your pharmacy plan, see if there are lower cost alternatives and compare prices between Cigna Home Delivery PharmacySM and retail pharmacies. 3. Use Cigna Home Delivery Pharmacy℠ Have the medications you take on a daily basis delivered right to your door at no additional cost. Because you can get up to a 90-day supply at one time, you may even be able to save money. You’ll get a reminder when it’s time to reorder, and have access to the CoachRx team for help with drug interactions, side effects and ways to lower your medication costs. 4. Get help with specialty medications Take advantage of TheraCare®. Your personalized team will help you better understand your chronic condition (like multiple sclerosis, hepatitis c or hemophilia) and medication, including common side effects and how to follow your doctor’s treatment instructions correctly. 5. Use myCigna.com Gives you 24/7/365 access to: › › › › › See your pharmacy claim history Read your benefit details See medication prices based on your plan Manage your Cigna Home Delivery Pharmacy orders Ask a pharmacist a question Questions? Call the toll-free number on the back of your ID card. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Tel-Drug, Inc., Tel-Drug of Pennsylvania, L.L.C., and HMO or service company subsidiaries of Cigna Health Corporation. “Cigna Specialty Pharmacy Services” refers to the specialty drug division of Tel-Drug, Inc. and Tel-Drug of Pennsylvania, L.L.C., doing business as Cigna Home Delivery Pharmacy. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. 838066 e 07/15 © 2015 Cigna. Some content provided under license. 14 DENTAL PLAN Dental coverage is offered through United Concordia. Using United Concordia’s PPO network will afford employees and their families the best coverage at the lowest cost. Utilizing dentists outside of the United Concordia network still provides reasonable coverage. If you enroll for dental coverage, we encourage you to establish a user ID and password on United Concordia’s website to review your benefits, claims, and to browse through the wealth of wellness information. They even have an app for kids to use to monitor their time brushing their teeth. Manage your benefits anywhere, anytime with MY DENTAL BENEFITS Most benefit inquiries can be handled conveniently online using our simple, self-service member portal. Create a My Dental Benefits account to better manage your insurance coverage! ENGAGING AND KNOWING YOUR BENEFITS Use your My Dental Benefits account to: CAN MAKE YOU Check claim status quickly See what your plan covers and how much we’ll pay HEALTHIER AND Print ID cards A SMARTER Find a dentist HEALTH CARE Evaluate your oral health with My Dental Assessment CONSUMER. After your plan’s effective date, you are able to create your account. Here’s how: Go to UnitedConcordia.com Click Create an Account Select Member (Group or Individual) Enter the ID number found on your insurance card and your birthdate My Benefits ID Card Flip JANE L. SMITH Subscriber’s Name 0123456789X CONCORDIA FLEX www.UnitedConcordia.com Web Site Address ADVANTAGE PLUS Identification Number MEM-0411-0316 My Dental Benefits provides access to a virtual ID card! Download our mobile app to have your ID card everywhere you go. Type of Coverage Network Name 16 Dental Benefits Summary for WASHINGTON COUNTY PUBLIC SCHOOLS Network: Advantage Plus Benefit Category1 CONCORDIA FLEX PLAN In-Network2 Non-Network2 Class I – Diagnostic/Preventive Services Exams Bitewing X-rays All Other X-rays Cleanings (1 additional cleaning during pregnancy) 80% 80% Fluoride Treatments Space Maintainers Palliative Treatment Class II – Basic Services Basic Restorative (Fillings) Simple Extractions Sealants Repairs of Crowns, Inlays, Onlays, Bridges & Dentures Endodontics 80% 80% Nonsurgical Periodontics Surgical Periodontics Complex Oral Surgery General Anesthesia Class III – Major Services Inlays, Onlays, Crowns 80% 80% Prosthetics (Bridges, Dentures) Orthodontics for dependent children to age 19 Diagnostic, Active, Retention Treatment 50% 50% Maximums & Deductibles (applies to the combination of services received from network and non-network dentists) $100/$200 Annual Program Deductible (per person/per family) Excludes Class I & Orthodontics Annual Program Maximum (per person) $1,200 Lifetime Orthodontic Maximum (per person) $500 Reimbursement Advantage Plus Advantage Representative listing of covered services – certificate of coverage provides a detailed description of benefits. 1. Dependent children covered to end of month in which they attain age 26. 2. Reimbursement is based on our schedule of maximum allowable charges (MACs). Network dentists agree to accept our allowances as payment in full for covered services. Non-network dentists may bill the member for any difference between our allowance and their fee (also known as balance billing). United Concordia Dental’s standard exclusions and limitations apply. 3. Coverage for posterior (back) resin (white) fillings is included. EEM-0142-0214 UnitedConcordia.com • 1-800-332-0366 17 VISION PLAN Vision coverage is offered through National Vision Administrators (NVA). Using NVA’s PPO network will afford employees and their families the best coverage at the lowest cost. Utilizing providers outside of the NVA network still provides reasonable coverage. If you should enroll, we encourage you to enroll on NVA’s website to review your benefits, claims, and to locate participating doctors. 18 Schedule of Vision Benefits Co-payment $15 Exam / $25 lenses Examination Once Every 12 Months Participating Provider Covered 100% After $15 copay Reimbursed Amount Up to $52 Standard Glass or Plastic Lenses Once Every 12 Months Single Vision Bifocal Trifocal Lenticular Standard Progressives Premium Progressives SV Polycarbonates (under age 19) Bi/Tri Polycarbonates (under age 19) Frame Once Every 24 Months Covered 100% After $25 copay Covered 100% Covered 100% Covered 100% Covered 100% Up to $34 Up to $50 Up to $66 Up to $100 Up to $40 Up to $100 U to $20 Up to $24 Retail Allowance Up to $130 Up to $47 National Vision Administrators, L.L.C. Non-Participating Provider Washington County Public Schools Summary of Vision Care Benefits National Vision Administrators, L.L.C. (NVA) has been contracted by your group to offer a comprehensive vision care plan to you and your eligible family members. Founded in January of 1979, NVA manages vision benefit services for approximately seven million lives nationwide. Group effective 07/01/2013 How Your Vision Care Program Works (20% discount off balance) Contact Lenses Once Every 12 Months Elective Contact Lenses In lieu of Lenses In lieu of Lenses Up to $130 Retail Up to $100 (15% discount (Conventional) or 10% discount (Disposable) off balance)* Medically Necessary** Covered 100% Up to $250 *Does not apply to Contact Fill locations **Pre-approval from NVA required Additional professional services related to contact lenses (also known as fitting fees) would be included in the contact lens allowance shown above. Lens options purchased from a participating NVA provider will be provided to the member at the amounts listed in the fixed option pricing list below: $10 Solid Tint $75 Polarized $12 Fashion / Gradient Tint $65 Transitions Single Vision Standard $10 Standard Scratch-Resistant Coating $70 Transitions Multi-Focal Standard $12 Ultraviolet Coating $25 Polycarbonate (Single Vision) 19 & over $40 Standard Anti-Reflective $30 Polycarbonate (Multi-Focal) 19 & over $20 Glass Photogrey (Single Vision) $30 Blended Bifocal (Segment) $30 Glass Photogrey (Multi-Focal) $55 High Index Options not listed will be priced by NVA providers at their R&C retail price less 20%. Insurance coverage provided by National Guardian Life Insurance Company (NGLIC), 2E Gilman, Madison, WI 53703. Policy NVIGRP 5/07. NGLIC is not affiliated with the Guardian Life Insurance Company of America, a/k/a The Guardian or Guardian Life. A full description of your coverage, its limitations, exclusions and conditions is contained in the Insurance Policy issued to your Plan Sponsor at its place of business. That full description in the form of a Certificate of Coverage can be made available to you by requesting it from your Plan Sponsor. For your convenience, at the start of the program, you will receive two identification cards with participating providers in your zip code area listed on the back. When scheduling your appointment, please notify the NVA participating provider of your choice that your vision coverage is administered by NVA. The provider will contact NVA to verify eligibility. At the time of your appointment, simply present your NVA identification card to the provider or indicate clearly that your benefit is administered by NVA. A vision claim form is not required at an NVA participating provider. The provider will inform you of your eligibility status prior to rendering services. Be sure to inform the provider of your medical history and any prescription or over-the-counter medications you may be taking. To verify your benefit eligibility prior to calling or visiting your eye care provider, please visit our website at www.e-nva.com or contact NVA’s Customer Service Department toll-free at 1.800.672.7723. Eligibility: Eligible members and dependents are entitled to receive a vision examination and one (1) pair of lenses once every 12 months and a frame once every 24 months or contact lenses once every 12 months from last date of service. Customer Service: To verify eligibility, locate a participating provider and receive answers to all your vision care related inquiries, please call NVA’s Customer Service Department toll-free at 1.800.672.7723 (TDD: 888-820-2990). NVA’s Interactive Voice Response (IVR) system is available twenty-four (24) hours per day, seven (7) days per week. The IVR allows you to locate a participating provider in your area, check eligibility as well as the status of your claim(s). An NVA Customer Service Representative can be contacted twenty-four (24) hours per day, seven (7) days per week. National Vision Administrators, L.L.C. ▫ PO Box 2187 ▫ Clifton, NJ 07015 Web: www.e-nva.com ▫ Toll-Free: 1.800.672.7723 NVA® is a registered mark of National Vision Administrators, L.L.C This document is intended as a program overview only and is not a certified document of the individual plan parameters. Iwf611 This document has been printed on recycled paper. 19 Benefits at Participating Providers: Highlights of your vision care benefit: The option of receiving services in- or out-of-network Extensive national provider network Enhanced in-network benefits: 100% covered Vision examination (after copay if applicable) 100% covered standard spectacle lenses (after copay if applicable) Frame allowance covers countless fashionable frames in full Allowance towards the cost of contact lenses and fitting fees No claim forms; providers will submit claims directly to NVA. Examinations: The comprehensive exam includes case history, examination for pathology or anomalies, visual acuity (clearness of vision), refraction, tonometry (glaucoma test) and dilation. Comprehensive eye examinations can aid in the early detection of ocular diseases and other serious medical conditions, diabetes and cardiovascular disease for example. Lenses: NVA provides coverage in full for standard glass or plastic eyeglass lenses. Frames: Select any frame from the participating provider’s inventory. Any amount in excess of your plan allowance is the member’s responsibility. Frame choices vary from office to office. Contact Lenses: The contact lens benefit includes all types of contact lenses such as hard, soft, gas permeable and disposable lenses. Medically necessary contact lenses may be covered with prior authorization when prescribed for: post cataract surgery, correction of extreme visual acuity problems that cannot be corrected to 20/70 with spectacle lenses, Anisometropia or Keratoconus. Discounts: In addition to your funded benefit you are eligible to access the SM EyeEssential Plan discount on additional purchases during the plan period. Non-Participating Providers: You will be responsible for one hundred percent (100%) of the cost at the time of service at a non-participating provider. To obtain direct reimbursement according to your plan design, you can print a claim form from www.e-nva.com. Please complete this form and submit along with an original or copy of the itemized receipt. If you cannot print the claim form you may submit receipts along with a letter containing the member’s full name, patient’s full name, address, ID# and sponsoring organization to NVA’s Clifton, NJ office. Remember, obtaining vision care services from a non-participating provider will result in greater out-ofpocket expense. Exclusions / Limitations: No payment is made for medical or surgical treatments / Rx drugs or OTC medications / non-prescription lenses / two pair of glasses in lieu of bifocals / subnormal visual aids / vision examination or materials required for employment / replacement of lost, stolen, broken or damaged lenses/ contact lenses or frames except at normal intervals when service would otherwise be available / services or materials provided by federal, state, local government or Worker's Compensation / examination, procedures training or materials not listed as a covered service / industrial safety lenses and safety frames with or without side shields / parts or repair of frame / sunglasses. Participating providers are not contractually obligated to offer sale prices in addition to outlined coverage. Regardless of medical or optical necessity, vision benefits are not available more frequently than specified in your policy. Iwf611 Valuable Member Discounts Laser Eye Surgery: NVA has chosen The National LASIK Network to serve their members. This network was developed by LCA Vision in 1999 and is one of the largest panels of LASIK surgeons in the U.S. Members are entitled to significant discounts and a free initial consultation with all innetwork providers. All providers are contracted to extend members discounts on standard prices or promotional prices, ensuring the member will pay less than the public. 15% off standard prices - or - 5% off promotional pricing All-Inclusive Discount All in network providers extend the discount on the entire cost of the procedure, maximizing member savings. Additional Member Value – Members are entitled to these additional benefits available exclusively at select providers (over 70 locations nationwide). Special “set prices” ranging from $695 to $1,895 per eye on select technologies. Free initial consultation and comprehensive LASIK exam Advanced laser technologies including Wavefront and IntraLase (All-Laser LASIK) Attractive financing options available The process is simple: Find a provider (Call 1-877-295-8599 or visit www.e-nva.com) Schedule a pre-operative exam to determine if laser vision correction is right for you Schedule a treatment Pay discounted member price directly to the provider Contact Fill: NVA provides you with the convenience and savings of Contact Fill, our mail order contact lens replacement service. You may access Contact Fill’s services online at www.contactfill.com or by calling them toll-free at 866.234.1393. Contact Fill provides contact lens wearers with significant savings packaged with the convenience of home delivery. Plan discounts applicable at participating retail locations do not apply to purchases made through Contact Fill due to the already low prices. Please enter NVAFSNEW for free shipping and handling on your first order. Expires 06-30-17 Plan Specific Details Online: The NVA website is easy to use and provides the most up to date information for program participants: Locate a nearby participating provider by name, zip code, or City/State Verify eligibility for you or a dependent View benefit program and specific details Review claims Print ID cards (when allowable) Nominate a non-participating provider to join the NVA network If you are not a registered subscriber, you can still search our providers online by selecting the “Find a Provider” link on our home page. Enter group number 8427000001 or the group number on the identification card you will be receiving prior to your effective date and enter in your search parameters. It’s that easy! 20 LIFE INSURANCE WCS offers a variety of life insurances to fit the needs of you and your family. Some of the premiums for these insurances are fully paid by WCPS and some are employee paid. The number of hours you work may determine how premiums are paid too. Coverage is provided by Minnesota Life Insurance Company. 21 m Washington County Public Schools Group Term Life and AD&D Insurance A Securian Company Classes 2, 3, 4 and 5 Buy affordable rk o at W Guaranteed coverage opportunity when newly eligible During your initial 31-day eligibility period, elect the following coverage amounts without providing evidence of insurability (EOI): • Employee Supplemental Life – 1-3x annual base pay, to a maximum of $350,000 • Dependent Life – Spouse $7,500 / Child $3,000 (packaged option) Any election / increase in Employee Supplemental Life after your initial eligibility period will require evidence of insurability (EOI) except after a qualified status change. Underwritten by Minnesota Life Insurance Company Look on the back for more details 22 Automatically enrolled coverage Prov i ded Basic Life and Basic Accidental Death and Dismemberment (AD&D) 1x annual base pay (rounded to the next higher $1,000) • • • • Minimum coverage: $10,000 Maximum coverage: $200,000 All coverage is guaranteed Includes matching AD&D benefit Elect the following El ec t El ec t Employee Supplemental Life Dependent Life 1-3x annual base pay • Maximum coverage: $600,000 (combined with Basic) • Electing or increasing coverage requires evidence of insurability (EOI); EOI may not be required if you are newly eligible or during a qualified status change Packaged option • All packaged dependent coverage is guaranteed • Children are eligible from live birth to age 26 • A spouse is not eligible if they are also eligible for employee coverage • A child may only be covered by one parent (rounded to the next higher $1,000) $7,500 Each eligible child:$3,000 Spouse: El ec t Voluntary Accidental Death and Dismemberment (VAD&D) $50,000, $100,000 or $200,000 • All coverage is guaranteed What is the cost of coverage? Additional features Please see benefits overview guide for the group life insurance rates. Beyond paying a benefit in the event of your death, your group life insurance has other important features: • Take your coverage with you – If you are no longer eligible for coverage as an active employee, you may port your group life insurance coverage (ported coverage ends at age 70) or you may convert your life coverage to an individual life insurance policy. Premiums may be higher than those paid by active employees. QUESTIONS? Contact your Benefits Office. • Early benefit payments if diagnosed as terminally ill – If an insured person becomes terminally ill with a life expectancy of 12 months or less, he / she may request early payment of up to 100 percent of the life insurance amount, up to a maximum of $1,000,000 (Basic and Supplemental combined). • No premiums if you become disabled – If you become totally disabled according to the terms of your certificate, life insurance premiums may be waived. Minnesota Life Insurance Company A Securian Company Group Insurance www.LifeBenefits.com 400 Robert Street North, St. Paul, MN 55101-2098 ©2015 Securian Financial Group, Inc. All rights reserved. F71364-1 Rev 4-2015 A01407-0315 This is a summary of plan provisions related to the insurance policy issued by Minnesota Life to Washington County Public Schools. In the event of a conflict between this summary and the policy and/or certificate, the policy and/or certificate shall dictate the insurance provisions, exclusions, all limitations, and terms of coverage. All elections or increases are subject to the actively at work requirement of the policy. Products offered under policy form series MHC-96-13180.19 and 02-30428.19. 23 FLEXIBLE SPENDING ACCOUNTS Employees can choose to participate in either a medical or dependent care savings account each calendar year. Total Administrative Services Corporation (TASC) administers WCPS’s flexible spending accounts (FSA’s). If you are unfamiliar with FSA’s and how they work, we encourage you to watch this short video for a good explanation of how they can be beneficial to you. FX_1074_090115 FlexSystem Enrollment_Med_DepCare 24 Advantages of a Flexible Spending Account (FSA) A valuable pre-tax benefit with innovative services! FlexSystem FSA increases your take-home pay by reducing your taxable income. A Flexible Spending Account (FSA) allows you to save up to 30% on your eligible healthcare and/or dependent care expenses every year by using pre-tax dollars. FlexSystem Healthcare FSA FlexSystem Dependent Care FSA Consider how much you spend on healthcare and/or dependent care expenses for you and your qualified dependents in one year: • prescription drugs/medications. Pre-Tax Savings Example • vaccinations. Gross Monthly Pay: • medical/dental office visit co-pays. • daycare tuition. • eye exams and prescription glasses/lenses. Why not reduce these expenses by using pre-tax dollars instead of after-tax dollars? With rising healthcare costs, every penny counts! By using pre-tax dollars, you are taxed on a lower gross salary, thereby saving money that would otherwise be spent on federal, state and FICA taxes, and thereby you increase your take home pay! Employee salary reductions to a medical Flexible Spending Account (FSA) are limited to $2,550 per Plan Year. Dependent Care Accounts are limited to $5,000 per Plan Year. The plan year begins January 1 and ends on December 31 each calendar year. Without FSA With FSA $3,500 $3,500 Pre-Tax Contributions Medical/Dental Premiums Medical Expenses Dependent Care Expenses TOTAL: Taxable Monthly Income $0 $0 $0 $0 -$125 -$75 -$400 -$600 $3,500 $2,900 Taxes (federal, state, FICA): -$968 -$802 Out-of-pocket Expenses: -$600$0 Monthly Take-home Pay: $1,932 $2,098 Net Increase in Take-Home Pay = $166/mo! For illustration only. Actual dollar amounts may vary. How FlexSystem Works FlexSystem FSA is offered through your employer and is adminstered by TASC. When you choose to enroll in a FlexSystem FSA Healthcare and/or Dependent Care, you choose the dollar amount you want to contribute to each account based on your estimated expenses for the upcoming Plan Year. Your contributions will be deducted in equal amounts from each paycheck, pre-tax, throughout the Plan Year. The more you contribute to these accounts, the more you save by paying less in taxes! Your total Healthcare FSA annual contribution amount is available immediately at the start of the Plan Year; Dependent Care FSA funds are available up to the current account balance only. Reimbursements and the TASC Card As you incur eligible expenses, simply swipe your TASC Card. The card automatically pays for and substantiates most eligible expenses at the point of purchase. If you do not use the TASC Card to pay for an eligible expense, simply submit a request for reimbursement via the MyTASC Mobile App, online Request for Reimbursement form in MyTASC, text message, fax, or mail. Your reimbursement is deposited in your MyCash account. You can access your MyCash funds in three ways: (1) swipe your TASC Card at any merchant that accepts major credit cards, (2) withdraw at an ATM using your TASC Card (with PIN), or (3) transfer to a personal bank account from MyTASC. 25 TASC • 2302 International Lane • Madison, WI 53704-3140 • 800-422-4661 • Fax: 608-245-3623 • www.tasconline.com FX-4245-090514-NOCO FSA Eligible Expenses 33 million Americans FlexSystem FSA funds may only be used for eligible expenses under your healthcare FSA and/or dependent care FSA. Some eligible expenses include: • Medical care services • Prescriptions • Dental care services • Certain over-the-counter medications • Vision care expenses • Daycare tuition More detailed lists can be found at www.irs.gov in IRS Publications 502 & 503. Please note insurance premiums are NOT eligible for reimbursement. save up to 30% every year by participating in an FSA. 2009 Nielson Consumer Research Multiple Methods for Account Management You may use any of the following self-service options to access your FlexSystem accounts and TASC Card transactions: • MyTASC Online: www.tasconline.com. • MyTASC Mobile App: Free download at www.tasconline.com/mobile. • MyTASC Text Messaging: Elect through your MyTASC account online. Online enrollment and account management. Online tax-savings calculator to help determine how much to contribute. Convenient pre-tax payroll deductions. Benefits debit card for eligible purchases. Mobile app for account access on the go. Multiple self-service tools. Important Considerations FSA Funds do not Rollover: It is important to be conservative in making elections because any unused funds left in your FSA at the close of the Plan Year are not refundable to you. You are urged to take precautionary steps, such as tracking account balances on the FlexSystem website and/or using the Interactive Voice Response System, to avoid having funds remaining in your account at year-end. Changing Elections During the Plan Year: You may change your FSA elections during the Plan Year only if you experience a change of status such as: • a marriage or divorce • birth or adoption of a child, or • a change in employment status Refer to the Change of Election Form (available from your employer) for a complete list of circumstances acceptable for changing elections mid-year. Fast reimbursements. Sign up for FlexSystem and keep more money in your pocket! 26 Flexible Spending Accounts (FSA) How to Enroll Online A convenient, paperless enrollment from home! Determine Your FSA Elections To enroll in FlexSystem FSA, you must first choose which Flexible Spending Account(s) you wish to participate in for the Plan Year (as offered by your employer). FlexSystem FSA Healthcare FlexSystem FSA Dependent Care Next, determine your elections to be contributed pre-tax into each type of FSA from your payroll over the course of the Plan Year. Your elections are specific to each FSA and may be used for expenses incurred for that account type only, meaning that dollars set aside for dependent care may be used for dependent care expenses only and not for medical expenses. Easy Online Enrollment Online enrollment into FlexSystem FSA is available 24-hours a day from the convenience and privacy of your own home. Once enrolled, you may access your FlexSystem accounts online at any time. Watch this helpful video to learn more about online enrollment: http://portal.sliderocket.com/BOORR/FX_1021_102313-FlexSystem-Online-Enrollment New Enrollees (new to the Plan): Go to www.tasconline.com/tasconline/flexsystem/enroll to establish your personal username and password. (Please note, a valid email address is required to authenticate your account. If you do not have an email address, you may set one up for free with an email hosting service such as Gmail, Hotmail, or Yahoo.) Follow the system prompts to enroll. You will enter 4303-4322-7497 as the Employer or Client ID. Renewing Enrollees: Enter your 12-digit TASC ID (located on your TASC Card or Request for Reimbursement Form) as your username along with your password. If you have forgotten your password, simply select the Can’t Access My Account link and follow the prompts. An email with your password will be sent to you. Steps to Re-Enroll Online: 1. Go to www.tasconline.com/tasconline/flexsystem/enroll or log in to your MyTASC account at www.tasconline.com and click the Enrollment tab in the top blue navigation bar. 2. Follow the prompts to make your election for the new Plan Year. For enrollment assistance, contact Customer Care via a MyService Request (from MyTASC, click Contact Us) or call 608-241-1900 or toll-free 800-422-4661. 27 TASC • 2302 International Lane • Madison, WI 53704-3140 • 800-422-4661 • Fax: 608-245-3623 • www.tasconline.com FX-4247-102114 Flexible Spending Accounts (FSA) TASC Mobile Tools Easily access your FlexSystem FSA while on the go! TASC Mobile offers a mobile app and text messaging capabilities to you as a FlexSystem participant, giving you quick and easy access to your account(s) from anywhere and at any time from your mobile handheld device. Now you can securely check real-time balances, request a reimbursement, upload receipts, view transaction details, and review plan information and contributions...all while on the go! MyTASC Mobile App The MyTASC Mobile App is a free download from Amazon, Apple App Store,® and Android Google PlayTM for smartphones and tablets. Once downloaded, securely log in using your current MyTASC username and password. Conveniently perform the following functions with the MyTASC Mobile App: • Submit a request for reimbursement for out-of-pocket FSA expenses. • Upload pictures of receipts with phone camera. • View real-time account balances and transactions for active and closing plans and your MyCash account. • Review FlexSystem Plan information and annual contributions. • Securely log in with MyTASC username and password. • Enable login memory for faster return access (per device). • Access a help screen for system assistance. Download the MyTASC Mobile App on your mobile phone today for easy, secure and convenient account access. It’s free! TASC Mobile is available for the following FlexSystem Accounts (where applicable): FlexSystem Healthcare FSA FlexSystem Dependent Care FSA FlexSystem Transit & Parking FSA MyTASC Text Messaging (SMS) MyTASC Text messaging (SMS) is available for convenient access to your FlexSystem account(s) from your mobile phone through instant two-way communication. • Request your current account balance. • Request a reimbursement. • Receive automated reimbursement status alerts. Activate MyTASC Text Messaging and/or email notifications online by logging in to your MyTASC account and clicking Set Notifications. To learn more about TASC Mobile, download the mobile app, and obtain texting instructions, please go to: www.tasconline.com/mobile. 28 TASC • 2302 International Lane • Madison, WI 53704-3140 • 800-422-4661 • Fax: 608-245-3623 • www.tasconline.com FX-4688-101414 Flexible Spending Accounts (FSA) FSA Eligible Expenses Healthcare expenses eligible for reimbursement. Below is a sample list of permissible expenses reimbursable through a full scope Healthcare Flexible Spending Account (FSA) that are incurred by you, your spouse, or qualified dependents. Please note, a limited purpose Healthcare FSA only allows dental and vision expenses. Medical Expenses • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Acupuncture Artificial limbs Bandages Birth control, contraceptive devices Birthing classes/Lamaze – only the mother’s portion (not the coach/spouse) and the class must be only for birthing instruction, not child rearing Blood pressure monitor Blood sugar test kits/test strips Chiropractic therapy/exams/adjustments Contact lens and contact lens solutions Co-payments Crutches (purchased or rented) Deductible and co-insurance Diabetic supplies Eye exams Eyeglasses, contacts, or safety glasses, prescription only (warranties are not reimbursable) Flu shots Hearing aids and hearing aid batteries (warranties are not reimbursable) Heating pad Incontinence supplies Infertility treatments Insulin Lactation expenses (breast pumps, etc.) Laser eye surgery; LASIK Legal sterilization Medical supplies to treat an injury or illness Mileage to and from doctor appointments Nasal strips Optometrist’s or ophthalmologist’s fees Orthopedic inserts • • • • • • • • • • • • • • • Section 125 Flexible Spending Accounts Physicals Physical therapy (as medical treatment) Physician’s fee and hospital services Pregnancy test Prescription drugs and medications Psychotherapy, psychiatric and psychological service Reading glasses Sales tax on eligible expenses Services connected with donating an organ Sleep apnea services/products (as prescribed) Smoking cessation programs Treatment for alcoholism or drug dependency Vaccinations Wrist supports, elastic wraps X-ray fees OTC Medicines and Drugs Over-the-counter (OTC) medicines and drugs, except for insulin, require a prescription from your physician to be reimbursable. The prescription will need to be included with each request for reimbursement. • • • • • • • • • • • • • Bengay, Flexall, pain relieving creams or gels Calamine lotion Canker/cold sore relievers Cold medicines Corn removal Diaper rash ointment GasX, baby gas drops Hemorrhoid creams and treatments Hydrogen Peroxide or rubbing alcohol Indigestion or anti-acid relievers Laxatives Nicotine patch Pain relievers (Tylenol, Advil, Aspirin, etc.) 29 TASC • 2302 International Lane • Madison, WI 53704-3140 • 800-422-4661 • Fax: 608-245-3623 • www.tasconline.com • • • • Sinus medicines Suppositories Teething gel Wart removal medication • • • • • • Dental Expenses • • • • • • • Braces and orthodontic services Cleanings Crowns Deductibles, co-insurance Dental implants Dentures, adhesives Fillings Ineligible Medical Expenses For the Disabled • Automobile equipment and installation costs for a disabled person in excess of the cost of an ordinary automobile; device for lifting a mobility impaired person into an automobile • Braille books/magazines in excess of cost of regular editions • Note-taker for a hearing impaired child in school • Seeing eye dog (buying, training, and maintaining) • Special devices, such as a tape recorder or typewriter for a visually impaired person • Visual alert system in the home or other items such as a special phone required for a hearing impaired person • Wheelchair or autoette (cost of operating/maintaining) Requiring Additional Documentation The following expenses are eligible only when incurred to treat a diagnosed medical condition. Such expenses require a Letter of Medical Necessity from your physician, containing the medical necessity of the expense, diagnosed condition, onset of condition, and physician’s signature. • • • • • • • • • • Ear plugs Massage treatments Nursing services for care of a special medical ailment Orthopedic shoes (excess cost of ordinary shoes) Oxygen equipment and oxygen Support hose Varicose vein treatment Veneers Vitamins and supplements Wigs (for mental health condition of individual who loses hair because of a disease) Dependent Care Expenses • Day camp (primary purpose must be custodial care and not educational in nature) • Dependent care expenses that are necessary for you (and your spouse) to work, actively look for work, or attend school full-time • Dependent care for children under the age of 13 or for elderly dependents who reside with you FICA/FUTA taxes of day care provider Late pick-up fees Nanny expenses attributed to dependent care Nursery school (preschool) Registration fees (allocated to dependent care services) Does not cover medical costs; use Healthcare FSA for medical expenses incrrred by you or your dependents. • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Athletic mouth guards Auto insurance providing medical coverage Chapstick/lip balm Contributions to state disability funds Cosmetic surgery, dentistry, or other cosmetic procedures Cosmetic supplies (makeup, cleansers, moisturizers, etc.) Deodorant Dental floss Diaper service Diet (cost of special foods taken as substitute for regular diet) Dietary and fiber supplements Divorce (when recommended by doctor or psychiatrist) Distilled water purchased to avoid drinking fluoridated city water or for use in medical equipment Domestic help (companion, babysitter, chauffeur who primarily renders services of a non-medical nature) Electrolysis/hair removal Exercise equipment and fees Eye drops for general comfort Eyeglass cases Hand sanitizer Health club or athletic club membership fees Herbal supplements Illegal treatment or medication Insurance premiums, all types Lanyards Lotions or skin moisturizers Marriage counseling Maternity clothes Mattress Medicare premiums Medicated shampoos, conditioners, and soaps Mobile telephone used for personal and physician calls Nursemaids or practical nurses who render general care for healthy infants Pajamas/slippers purchased to wear in hospital Personal use items (toothbrush, pillow, shampoo, mattress, etc.) Physical treatment unrelated to specific health problems (massage for general well-being, stress, depression, or chiropractic wellness) Premiums for coverage through other medical plans (spouse’s employer-sponsored plan or individual plan) Safety glasses (non-prescription) Special foods purchased to replace nutrition or for general health needs (such as diet foods) Sunglasses (non prescription) and sun clips Teeth whitening products Toiletries Toothbrush (includes prescribed electric ones) and toothpaste Vacuum cleaner purchased by an individual with dust allergy Vitamins and supplements for well-being Warranties Weight loss drugs/programs for general well being 30 TASC • 2302 International Lane • Madison, WI 53704-3140 • 800-422-4661 • Fax: 608-245-3623 • www.tasconline.com FX-4248-090914 LONG TERM DISABILITY WCS offers long term disability coverage (LTD) to all full-time permanent employees. WCPS pays some or all of the premium for this coverage based upon your bargaining group. Please reference the full-time rate sheet for details. Coverage is provided by Cigna. 31 Long-term Disability Insurance Overview Prepared for the employees of the Board of Education of Washington County Long-term Disability Insurance Coverage Eligibility – Active, full-time employees working a minimum of 30 hours per week, classified as one of the below are eligible after 5 calendar days of active service. Class 2 - Administrators Class 3 - Teachers Class 4 – Educational Support Personnel Forty-two percent of Americans live paycheckto-paycheck. CareerBuilder, 2011 Survey Monthly Benefit – This plan pays a benefit of up to 60% of your monthly covered earnings — to a maximum of: Class 2, 3, 4: $10,000 per month Your benefit amount will be reduced by any amounts payable to you by any of the sources listed under the “Effects of Other Income Benefits” section. 60 percent of Americans do not have a “rainy day” fund to cover three months of unanticipated financial whemergencies. FINRA Foundation State-by-state Definition of Disability – Disability means that, solely because of a covered injury or sickness, you are unable to perform the material duties of your regular occupation and you are unable to earn 80% or more of your indexed earnings from working in your regular occupation. After benefits have been payable for 24 months, you are considered disabled if solely due to your injury or sickness, you are unable to perform the material duties of any occupation for which you are (or may reasonably become) qualified by education, training or experience, and you are unable to earn 60% or more of your indexed earnings. We will require proof of earnings and continued disability. Covered Earnings – Covered earnings means your wages or salary, not including bonuses, commissions and other extra compensation. For teachers paid on an annual contract basis, the monthly rate of earnings is one-twelfth of the annual contract salary. Elimination Period – You must be disabled for 90 calendar days. Any sick pay will be treated as an offset to the policy. Benefit Duration – Once you qualify for benefits under this plan, you continue to receive them until the end of the benefit period shown below, or until you no longer qualify for benefits, whichever occurs first. Your benefit period begins on the first day after you complete your elimination period. And, should you remain disabled, your benefits continue according to one of the following schedules, depending on your age at the time you become disabled. 32 Age at Disability Duration of Payments (months) Age 62 or younger 63 64 65 66 67 68 69+ To age 65 or the date the 42nd monthly benefit is payable, if later 36 30 24 21 18 15 12 Cost – The Board of Education will continue to pay a portion of the cost of this benefit as outlined in your respective negotiated agreement or meet and confer agreement. Please indicate your decision to select or not to select disability coverage on your enrollment form. The monthly cost of this coverage is $0.29 per $100 of monthly covered earnings. Effects of Other Income Benefits – The disability benefit provided by this plan is a total benefit; that is, it will be reduced by any disability benefits payable on behalf of you or your dependents, or a qualified third party on behalf of you or your dependents, whether or not you are actually receiving them. Other income sources that may reduce your benefits under this plan include: - Any Social Security disability or retirement benefits you or any third party receive (or are assumed to receive) on your own behalf; or which your dependents receive (or are assumed to receive) because of your entitlement to such benefits. - Benefits payable by a Canadian and/or Quebec provincial pension plan. - Amounts payable under the Railroad Retirement Act. - Amounts payable under local, state, provincial or federal government disability or retirement plan or law as it pertains to the employer. - Employer-paid portion of company retirement plan benefits. - Amounts payable by company sponsored sick leave or salary continuation plan. - Amounts payable by any franchise or group insurance or similar plan. - Benefits payable under work-loss provisions of any mandatory “no fault” auto insurance. - Any amounts paid on account of loss of earnings or earning capacity through settlement, judgment, arbitration or otherwise, where a third party may be liable, regardless of whether liability is determined. - Amounts payable under any workers’ compensation (including temporary or permanent disability benefits), occupational disease, and unemployment compensation. This includes damages, compromises or settlements paid in place of such benefits, whether or not liability is admitted. Income sources that WILL NOT reduce your benefits under this plan are: - Benefits paid by personal, individual disability income policies. - Individual deferred compensation agreements. - Employee savings plans, including thrift plans, stock options or stock bonuses. - Individual retirement funds, such as IRA or 401(k) plans. - Profit-sharing, investment or other retirement or savings plans maintained in addition to an employersponsored pension plan. 33 Additional Plan Details Earnings While Disabled During the first 24 months that benefits are payable, benefits will be reduced if benefits plus income from employment exceeds 100% of predisability covered earnings. After that, benefits will be reduced by 50% of earnings from employment. Termination of Disability Benefits Your benefits will terminate when your disability ceases, when your benefit duration period is exceeded, or on the following events: (1) the date you earn from any occupation more than 60% of your indexed earnings. (refer to your plan’s definition of disability), or (2) the date you fail to cooperate with us in a rehabilitation plan, or transitional work arrangement, or the administration of the claim. Pre-existing Conditions Benefits are not payable for medical conditions for which you incurred expenses, took prescription drugs, received medical treatment, care or services (including diagnostic measures,) or for which a reasonable person would have consulted a physician during the 3 months just prior to the most recent effective date of insurance. Benefits are not payable for any disability resulting from a pre-existing condition unless the disability occurs after you have been in active for at least 12 months after your most recent effective date of insurance. Limited Benefit Period Disabilities caused by or contributed to by any one or more of the following conditions are subject to a lifetime limit of 12 months for outpatient treatment: Anxiety-disorders, delusional (paranoid) or depressive disorders, eating disorders, mental illness, somatoform disorders (including psychosomatic illnesses). Benefits are payable during periods of hospital confinement for these conditions for hospitalizations lasting more than 14 consecutive days that occur before the 12-month lifetime outpatient limit is exhausted. Once the 12-month outpatient benefits are exhausted, the plan pays no further benefits. Disabilities caused by or contributed to by any one or more of the following conditions are subject to a lifetime limit of 12 months for outpatient treatment: Alcoholism, drug addiction or abuse. Benefits are payable during periods of hospital confinement for these conditions for hospitalizations lasting more than 14 consecutive days that occur before the 12-month lifetime outpatient limit is exhausted. Once the 12-month outpatient benefits are exhausted, the plan pays no further benefits. Exclusions This plan does not pay benefits for a disability which results, directly or indirectly, from any of the following: Suicide, attempted suicide, or whenever you injure yourself on purpose; war or any act of war, whether or not declared; active participation in a riot; commission of a felony; the revocation, restriction or non-renewal of your license, permit or certification necessary for you to perform the duties of your occupation, unless solely due to injury or sickness otherwise covered by the policy. In addition, we will not pay disability benefits for any period of disability during which you are incarcerated in a penal or corrections institution for any reason. When Coverage Takes Effect Your coverage takes effect on the later of the program’s effective date, the date you become eligible, the date we receive your completed enrollment form, or the date you authorize any necessary payroll deductions. If you have to submit evidence of good health, your coverage takes effect on the date we agree, in writing, to cover you. If you’re not actively at work on the date your coverage would otherwise take effect, you’ll be covered on the date you return to work. Family Survivor Benefit If you die while receiving disability benefits, we will pay a survivor benefit based on 100% of the total of your last month’s benefit plus the amount of any disability earnings by which this benefit had been reduced for that month. This plan pays a single lump sum equal to 3 months of benefits. We pay this benefit directly to your lawful spouse, or to 34 your children in equal shares, if there is no lawful spouse. If you have no lawful spouse or children, we pay this benefit to your estate. Programs Included at No Additional Cost Cigna Healthy Rewards® Program Program provides you and your covered family member’s discounts on health programs and services like weight loss management, fitness, smoking cessation and more. Enjoy instant savings of up to 60% when you take advantage of this opportunity. Visit www.Cigna.com/rewards (Password: savings) or call: 800.258.3312. Cigna's Online Will and Health-related Legal Document and Funeral Preparation Program Offers you and your covered spouse access to a website that helps you build state-specific customized wills and other legal documents as well as create an end-of-life plan that spells out the handling of your estate and funeral arrangements. Visit www.Cignawillcenter.com. Cigna's Identity Theft Program Provides access to personal case managers who give step-by-step assistance and guidance if you have had your identity stolen. This information is a brief description of the important features of the plan. It is not a contract. Terms and conditions of life insurance coverage are set forth in Group Policy No. VDT-961168, issued in Maryland to Board of Education of Washington County. The group policy is subject to the laws of the jurisdiction in which it is issued. The availability of this offer may change. Please keep this material as a reference. Coverage is underwritten by Life Insurance Company of North America, 1601 Chestnut Street, Philadelphia, PA. As used in this brochure, the term Cigna and Cigna Group Insurance are registered service marks of Life Insurance Company of North America, a CIGNA company, which is the insurer of the Group Policy. Insurance products and services are provided by the individual CIGNA companies and not by the Corporation itself. © Cigna 2011 35 RETIREMENT WCPS offers a mandatory and a voluntary participation retirement program. The mandatory participation program is through the Maryland State Retirement Agency. All employees working more than 2.5 hours per day must participate and contribute to the plan. The voluntary participation program consists of a 403(b) plan and a 457(b) plan. Employees can choose from one of four investment companies, AXA, MetLife, PlanMember Services and Voya, to allocate pre-tax or post-tax contributions to. Advisors that work with WCPS staff are available to assist in signing up and maintaining your accounts. All transactions are handled under the realm of our third party administrator, TSA Consulting Group. Use the link to the WCPS plan specific page on the TSA Consulting Group website by visiting the wcpsmd.com/benefits page. 36 Service Retirement There are two types of service retirement: normal and early. Normal service retirement provides full benefits, while early service retirement provides a reduced benefit. Your eligibility for either type of service retirement depends on two factors: your service credit and age. Normal: At least 90 years of combined age and years of eligibility service. For example: l Age 57 with 33 years of service, l Age 60 with 30 years of service or l Age 63 with 27 years of service Active members with at least 10 years of eligibility service become eligible for normal service retirement at age 65. Early: Age 60 with at least 15 years of eligibility service. When you retire, you will be able to choose from a number of payment options. These options range from the Basic Allowance, which provides the highest monthly allowance for you alone, to options that reduce your monthly payment but provide varying degrees of protection to your beneficiary(ies) upon your death. Welcome to the based on your service at termination. If you withdraw any of your contributions at termination, you will forfeit the right to a future benefit. Employees’ & Teachers’ Pension System* If you are not vested at the time of termination and you don’t anticipate returning to membership, you should contact the agency to receive a refund of any contributions with interest you may have made. Resources Visit the State Retirement Agency online at sra.maryland.gov for newsletters, member handbooks, retirement benefit estimators, printable forms and updates on the System’s financial performance. To visit the office or write a letter: State Retirement Agency 120 East Baltimore Street Baltimore, MD 21202-6700 Email inquiries to sra@sra.state.md.us To speak with a retirement benefits specialist: 410-625-5555 or 1-800-492-5909 Baltimore Checkerspot Butterfly Maryland State Insect During Retirement As a retiree, once you have been retired one full year as of July 1, your retirement allowance may be adjusted each July to help your benefit payments keep pace with inflation. * For members enrolled on or after July 1, 2011 Maryland State Retirement and Pension System 120 East Baltimore Street Baltimore, MD 21202-6700 If You Leave Employment Before Retirement If you should leave employment once you have accrued at least 10 years of eligibility service, you are vested and have earned the right to receive a future benefit 410-625-5555 1-800-492-5909 Butterfly photo courtesy of Sue Muller Howard County Department of Recreation & Parks sra.maryland.gov sra.maryland.gov sra.maryland.gov 37 4/14 Welcome! The Maryland State Retirement and Pension System has a long history of providing retirement benefits to employees and teachers of Maryland state and municipal employers. This overview deals with the highlights of the Employees’ and Teachers’ Pension System for members enrolled on or after July 1, 2011. Please refer to the pension system handbook on our website at sra.maryland.gov for more details about any of these topics. A retirement coordinator, usually someone in your human resources department, can help you file enrollment forms and answer basic questions about your benefits. The Maryland State Retirement Agency also maintains a staff of retirement benefits specialists to answer questions from members and retirees. Enrollment Membership in the Employees’ and Teachers’ Pension System is mandatory. You must enroll by submitting an Application for Membership (Form 1), a Designation of Beneficiary (Form 4) and a valid proof of birth date. The forms are available from your retirement coordinator. If you have membership credit in another Maryland state or Maryland local retirement/pension system, you may be able to transfer that service credit to your new plan. To qualify for the transfer, your employment must be continuous and you must apply within one year of becoming a member in your new system. Contact a retirement benefits specialist if this situation applies to you. Employee Contributions You contribute seven percent of your annual compensation to the Pension System. Service Credit You earn service credit toward your retirement benefits each day you work and pay your required contribution. Your service credit and age determine when you are eligible for retirement and how much your retirement benefit will be. Eligibility service is used to determine when you are eligible for a benefit. You earn one year of eligibility service during any fiscal year when you work a minimum of 500 regular hours, excluding overtime. The amount of your retirement benefit is based on creditable service which is determined on the hours you work in a fiscal year. A full-time employee will earn one month of creditable service for each month of employment. Your Benefits The Pension System provides survivor, disability and service retirement benefits. More information on your benefits is available online at sra.maryland.gov. Survivor Benefits The Pension System provides valuable beneficiary protection for members who die during active membership. If a member dies after accruing at least one year of eligibility service, or dies in the course of duty, the beneficiary(ies) receives a one-time payment of the member’s annual salary plus the member’s accumulated contributions and interest. If a member is eligible to retire or has at least 25 years of eligibility service at the time of death, his or her sra.maryland.gov sra.maryland.gov surviving spouse may be eligible to receive a monthly benefit in lieu of the one-time payment if the spouse is the sole primary beneficiary. In lieu of the survivor benefits mentioned here, if a member of the Employees’ and Teachers’ Pension System is killed in the line of duty, a monthly allowance of two-thirds of the member’s average final compensation will be paid to the surviving spouse (if no spouse, to the member’s children under age 18. If no spouse or minor children, the benefit is paid to the member’s dependent parent for life.) Plus, a return of the member’s accumulated contributions with interest is paid to the designated beneficiary. Disability Benefits If you are permanently and totally disabled from performing your job duties, as determined by the System’s medical board, you may be eligible for a lifetime monthly disability retirement benefit. Types of Disability Retirement There are two types of disability benefits: Ordinary: Any permanently disabling physical or mental condition. Accidental: Any permanently disabling condition caused by injuries sustained from an accident on the job. To file for ordinary disability, you must have accrued five years of eligibility service. As an active member, you are eligible to file for accidental disability from your first day on the job provided you file within five years of the date of the accident. Your retirement coordinator can provide you with the necessary forms to file for a disability retirement benefit. sra.maryland.gov 38 39 40 EMPLOYEE ASSISTANCE PROGRAM WCPS realizes that you may have times throughout your employment when personal issues or demands can be challenging. WCPS has partnered with Inova Employee Assistance to offer employees and immediate family members resources that may be helpful to you and support you. Please know that EAP services are 100% confidential. In addition to access to counselors, Inova offers a multitude of services and online resources that can be useful in your everyday life. At www.inova.org/eap, use wcps as both the user name and password for the Member login. 41 Employee Assistance Program Inova Employee Assistance Creative Solutions for the Demands of Life and Work 42 Creative Solutions for the Demands of Life and Work Balancing the demands of work and life can be challenging. Since 1983, Inova Employee Assistance has offered support for personal, work and family problems. This service is free to covered employees and their household members. Confidential Counseling Our short-term counseling services can help you find solutions to problems ranging from family or workplace frustrations to alcohol or drug abuse. Professional counselors define the problem, provide support, and offer guidance and referrals. Legal Services Inova Employee Assistance offers a free 30-minute consultation with an in-network attorney and a 25% discount off the attorney’s hourly rate if you choose to retain that attorney. Access to wills, advance directives and other legal documents are available on our website at inova.org/eap. Financial Services Employees and their household members can speak with a financial professional at no charge regarding such issues as retirement planning, debt consolidation, funding a child’s college education, mortgage loan options and a variety of other financial concerns. Callers receive up to 60 minutes of telephonic consultation per issue. Financial information, tools and calculators are available on our website at inova.org/eap. Identity Theft Services Counselors provide telephonic screening and consultation to callers. If they determine that your identity has been stolen, a “recovery” packet containing everything that you need to resolve your identity-theft issue will be sent to you at no charge. Work Life Referral Services Our Work Life consultants will assess your needs, pinpoint appropriate resources, and suggest guidelines for evaluating those resources. We will also follow up to ensure your satisfaction with our service. Our consultants can locate resources in a variety of areas, including: • Child care and adoption including emergency back-up care, day care providers, nanny and 43 au pair agencies, summer camps, and more • Elder care such as adult day care, assisted living, home health, nursing homes, transportation services • Education information about schools, financial aid, scholarships and educational consultants • Health and wellness including holistic care, exercise classes, nutritional counselors, personal trainers, self-help programs • Pet services such as veterinarians, pet sitters, groomers and obedience trainers • Daily living services such as sporting event and entertainment tickets, grocery shopping, lawn maintenance, housekeeping services, tee times, restaurant reservations, and many other concierge related services On-line Resources Inova Employee Assistance offers an interactive Web service that provides 24-hour access to an extensive library of nationwide Work Life resources and interactive tools, including: • • • • • child and elder care locators savings discount center relocation center monthly interactive online seminars 24-hour instant messaging access to a Work Life consultant Contact us 24 hours a day at 1.800.346.0110 or online at inova.org/eap Inova Employee Assistance is here to help. Confidential assistance, 24/7 . . . . . . . . . . 1.800.346.0110 TDD# for the hearing impaired . . . . . . . . 1.877.845.6465 Access online resources and services . . . inova.org/eap Inova Employee Assistance 44 Inova Employee Assistance is here to help. Confidential assistance, 24/7 . . . . . . . . . . 1.800.346.0110 TDD# for the hearing impaired . . . . . . . . 1.877.845.6465 Access online resources and services . . . inova.org/eap Inova Employee Assistance is exclusively dedicated to serving the employer community with nationwide job performance improvement systems including employee assistance programs (EAP) and work life referral services. Inova Employee Assistance is part of Inova, a not-for-profit health care system that consists of hospitals and other health services. Governed by a voluntary board of community members, Inova’s mission is to provide quality care to improve the health of the diverse community we serve through excellence in patient care, education and research. G31466/7-12/40,000 45 INSURANCE COSTS The following pages contain employee contribution costs for both full-time and part-time employees. You will have to know your number of pay periods per year to determine your bi-weekly payroll contribution. All medical, dental, and vision premiums are pre-tax. Life insurance and LTD premiums are post-tax. While not reflected on the rate sheets, it’s important to note that Maryland State Retirement Agency plan contributions and FSA contributions are also made on a pre-tax basis. Voluntary retirement (403(b) and 457(b) plans) contributions can be made on a pre-tax or post-tax basis. 46 WASHINGTON COUNTY PUBLIC SCHOOLS FULL-TIME EMPLOYEES INSURANCE RATES FOR JULY 1, 2016 - JUNE 30, 2017 Bi-weekly payroll contribution amounts 12 Month Pay All groups 26 Deductions 11 Month Pay All groups 24 Deductions 10 Month Pay Teachers, A&S 22 Deductions 10 Month Pay ESP 20 Deductions WCPS's Monthly Share Actual Monthly Cost of Coverage Open Access Plus (OAP Premium) Employee Only Employee + Child(ren) Employee + Spouse Family $66.24 $101.49 $132.49 $167.74 $71.76 $109.94 $143.53 $181.71 $78.29 $119.94 $156.58 $198.23 $86.12 $131.93 $172.23 $218.06 $624.00 $955.97 $1,248.00 $1,580.04 $767.52 $1,175.85 $1,535.05 $1,943.47 Open Access Plus (OAP Standard) Employee Only Employee + Child(ren) Employee + Spouse Family $50.82 $77.86 $101.65 $128.69 $55.06 $84.35 $110.12 $139.42 $60.06 $92.02 $120.13 $152.09 $66.07 $101.22 $132.14 $167.30 $624.00 $955.97 $1,248.00 $1,580.04 $734.11 $1,124.67 $1,468.23 $1,858.87 Open Access Plus (OAP Limited) Employee Only Employee + Child(ren) Employee + Spouse Family $45.72 $70.04 $91.44 $115.77 $49.53 $75.88 $99.06 $125.41 $54.03 $82.78 $108.06 $136.82 $59.44 $91.06 $118.87 $150.50 $624.00 $955.97 $1,248.00 $1,580.04 $723.06 $1,107.73 $1,446.11 $1,830.87 $1.55 $3.32 $3.09 $6.53 $1.67 $3.60 $3.35 $7.08 $1.83 $3.93 $3.65 $7.72 $2.01 $4.32 $4.02 $8.49 $18.98 $40.80 $37.95 $80.19 $22.33 $48.00 $44.65 $94.34 $1.12 $2.13 $2.03 $3.29 $1.21 $2.31 $2.20 $3.56 $1.32 $2.52 $2.40 $3.89 $1.46 $2.77 $2.64 $4.28 $2.43 $4.62 $4.41 $7.13 $4.85 $9.24 $8.81 $14.25 MEDICAL/PRESCRIPTION DENTAL Employee Only Employee + Child(ren) Employee + Spouse Family VISION Employee Only Employee + Child(ren) Employee + Spouse Family *Rates may vary by a penny due to system rounding. 47 WASHINGTON COUNTY PUBLIC SCHOOLS FULL-TIME EMPLOYEES INSURANCE RATES FOR JULY 1, 2016 - JUNE 30, 2017 12 month pay 26 Deductions 11 month pay 24 Deductions 10 month pay 22 Deductions 10 month pay 20 Deductions SELF-PAY MONTHLY DEPENDENT LIFE INSURANCE $7,500 coverage on spouse and $3,000 coverage on each eligible child $1.29 $1.40 $1.53 $1.60 * $2.80 VOLUNTARY ACCIDENTAL DEATH & DISMEMBERMENT $50,000 $100,000 $200,000 $0.46 $0.92 $1.85 $0.50 $1.00 $2.00 $0.55 $1.09 $2.18 $0.57 $1.14 $2.29 * * * $1.00 $2.00 $4.00 *deducted from 21 pays OTHER RATES LIFE INSURANCE SUPPLEMENTAL LIFE INS BASIC ACCIDENTAL DEATH & DISMEMBERMENT LONG TERM DISABILITY Educational Support Personnel Teachers Administrators & Supervisors 1 x annual base salary rounded to the next thousand provided at no cost to eligible employees 1 x , 2 x, or 3x annual base salary rounded to the next thousand at full cost to eligible employees Cost is .234 per thousand per month Calculation - 1 x annual salary (rounded up to the next thousand) divided by 1,000 x .234 x 12 divided by the number of paychecks received 1 x annual base salary rounded to the next thousand provided at no cost to eligible employees .29% of annual base salary divided by the number of paychecks received No Cost - ESP working a minimum of 30 hours per week will pay 100% of the premium but then have their pay increased by 100% of the premium cost. Teachers working a minimum of 30 hours per week will pay 100% of the premium but then have their pay increased by 75% of the premium cost. Calculation: annual salary x .29% x 25% divided by the number of paychecks received Twenty-five (25%) of the premium cost will be deducted from their pay. *Rates may vary by a penny due to system rounding. For eligibility requirements for any of the benefits listed, please contact the Benefits Office 48 WASHINGTON COUNTY PUBLIC SCHOOLS PART-TIME EMPLOYEES INSURANCE RATES JULY 1, 2016 - JUNE 30, 2017 12 month 26 Deductions EMPLOYEES WORKING 20-29 HOURS WEEKLY A&S and Teacher 10 month 11 month 24 Deductions 22 Deductions ESP 10 month 20 Deductions EMPLOYEES WORKING 15-19 HOURS WEEKLY See notes below chart MEDICAL/PRESCRIPTION OPEN ACCESS PLUS - PREMIUM Employee Only $177.12 $191.88 $209.32 $230.26 $767.52 Employee + Child(ren) $271.35 $293.96 $320.69 $352.76 $1,175.85 Employee + Spouse $354.24 $383.76 $418.65 $460.52 $1,535.05 Family $448.49 $485.87 $530.04 $583.04 $1,943.47 OPEN ACCESS PLUS - STANDARD Employee Only $169.41 $183.53 $200.21 $220.23 $734.11 Employee + Child(ren) $259.54 $281.17 $306.73 $337.40 $1,124.67 Employee + Spouse $338.82 $367.06 $400.43 $440.47 $1,468.23 Family $428.97 $464.72 $506.96 $557.66 $1,858.87 OPEN ACCESS PLUS - LIMITED Employee Only $166.86 $180.77 $197.20 $216.92 $723.06 Employee + Child(ren) $255.63 $276.93 $302.11 $332.32 $1107.73 Employee + Spouse $333.72 $361.53 $394.39 $433.83 $1,446.11 Family $422.51 $457.72 $499.33 $549.26 $1,830.87 DENTAL Employee Only $5.15 $5.58 $6.09 $6.70 13.40 Employee + Child(ren) $11.08 $12.00 $13.09 $14.40 28.80 Employee + Spouse $10.30 $11.16 $12.18 $13.40 26.79 Family $21.77 $23.59 $25.73 $28.30 56.60 Employee Only $1.12 $1.21 $1.32 $1.46 2.91 Employee + Child(ren) $2.13 $2.31 $2.52 $2.77 5.54 Employee + Spouse $2.03 $2.20 $2.40 $2.64 5.29 Family $3.29 $3.56 $3.89 $4.28 8.55 VISION EMPLOYEES WORKING 15-19 HOURS WEEKLY Medical/prescriptions premiums will not be payroll deducted. Employees can pay for insurance at 100% of the actual cost on a monthly basis. Dental and vision premiums will be payroll deducted. Costs shown above are 100% of actual cost and based on 20 deductions * All rates may vary by a penny due to system rounding. 49 WASHINGTON COUNTY PUBLIC SCHOOLS PART-TIME EMPLOYEES INSURANCE RATES JULY 1, 2016 - JUNE 30, 2017 BASIC LIFE INSURANCE 1 x annual salary rounded to the next thousand at .116 per thousand per month The minimum policy amount is $10,000. Calculation - 1 x annual salary (rounded up to the next thousand) divided by 1,000 x .116 x 12 divided by the number of paychecks received SUPPLEMENTAL LIFE 1 x, 2 x or 3 x annual salary rounded up to the next thousand at full cost to eligible employees working 15+ hours per week .234 per thousand per month Calculation - 1 x annual salary, 2 x annual salary or 3 x annual salary (rounded up to the next thousand) divided by 1,000 x 12 x .234 divided by the number of paychecks received BASIC ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) 1 x annual salary rounded to the next thousand at .016 per thousand per month Calculation - 1 x annual salary (rounded up to the next thousand) divided by 1,000 x .016 x 12 divided by the number of paychecks received VOLUNTARY ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) DEDUCTIONS PER PAY $50,000 $100,000 $200,000 26 DED $0.46 $0.92 $1.85 24 DED $0.50 $1.00 $2.00 22 DED $0.55 $1.09 $2.18 21 DED $0.57 $1.14 $2.28 DEPENDENT LIFE INSURANCE $7,500 coverage on spouse and $3,000 coverage on each eligible child DEDUCTIONS PER PAY 26 DED 24 DED 22 DED 21 DED $1.29 $1.40 $1.53 $1.60 50 301-766-2800 wcpsmd.com 51