Moreno Valley Unified School District Benefits Overview 16-17 School Year

Employee Benefits Overview Eligibility Information and Rights Dependent Eligibility & Documentation Enrollment Process Plan Designs – Medical, Dental, and Vision Additional Benefits Employee Discounts Important Notices- Located in Benefit Guide Vendor Directory-Located in Benefit Guide

Eligibility Information and Rights When can I enroll or make change ?-As a new employee you must complete your benefit enrollment within 30 days of your first day at work. Changes to your benefits can be made during Open Enrollment which is usually July 27 to August 27 or when you have a life qualifying event. Qualifying life events include birth, marriage, new hire, loss of coverage, obtaining new benefits, change in hours and substantial change in income. Benefit Effective Date- your benefits become effective the first of the month following your first day in paid status. Changes during Open Enrollment will be effective on the next October 1. Benefit Termination- Benefits terminate the last day of the month when you are no longer in paid status, or no longer eligible. Classified employees who have a reduction in hours which resulted in the loss of benefit eligibility may be entitled to continue benefits at the current level for one year, contact the benefits office. Am I required to enroll in benefits with MVUSD? All full-time (90% FTE and above) are required to enroll in a Medical and Dental plan. The exceptions to this are employees who have medical coverage through the Tricare/Military Health System, Medicare Part A and Part B, Medi-Cal, or Covered California receiving a subsidy. Employees in one of these plans may voluntarily opt out with proof of the specified coverage and a signed waiver.

Eligible Dependents & Documentation Legal spouse (Required documentation = a copy of the first page of your prior year’s federal tax return, if you do not file jointly you will have to have a notarized marriage affidavit found on the District Benefit Web Page) Your California-registered domestic partner: A California-registered domestic partner is of the same gender or may be opposite gender if at least one partner is over the age of 62. (Required documentation=a certified copy of the Declaration of Domestic Partnership filed with the Secretary of State) Your child(ren): A natural child or step-child from birth to age of 26: or a child until the age of 18 for who the member has legal and physical custody/guardianship. A child who is in the process of being adopted is considered legally adopted when SISC receives legal evidence of (1) the intent to adopt, and (2) the members has either the right to control the health care of the child or assumed the full and legal responsibility for the child in anticipation of the child’s adoption. ( Required documentation=a birth certificate, adoption or legal guardianship papers.) Disabled Dependent over the age of 26: Information can be found at mvusd.net/benefit

Enrollment Process Complete forms by visiting www.mvusd.net/Benefits (New Employee). On the enrollment form click on the drop down boxes to choose Medical Group#, Dental Group#, Vision Group# . Anthem HMO Plans require the selection of a PCP or IPA, if you don’t choose one Anthem will auto assign one. To find a PCP or IPA number go to www.mvusd.net –Staff tab-Employee Benefits-Medical Benefit Information-Find a Medical Group/physician. Forms must be printed, signed and returned to the Benefits Office with required dependent documentation.

Anthem HMO Premier 20 No deductible except for $200 individual/$500 family deductible for name brand medications Maximum out of pocket-$1500 individual, $3000 employee. This means you will never pay more in copays including prescriptions than this amount in a calendar year. Copay-$20 office visits, $200 per hospital admission, $100 outpatient surgery, $100 emergency room visit, MRI/CT Scan $100 per test Chiropractic/Acupuncture $10/visit 30 per year combined. No referral needed. Prescription Drug Copays-$10 /30 day supply generics, $25/ 90 supply generics. Most generics can be filled at Costco for $0 for either 30 day or 90 day supply, exceptions to this are pain medications and cough medications. $35 / 30 day supply of Preferred Brand Name Drugs or $90 / 90 day supply. Must select a primary care physician to coordinate your health care.

Anthem Plan A No deductible except for $200 individual/$500 family deductible for name brand medications. Maximum out of pocket-$1000 individual, $3000 employee. This means you will never pay more in copays including prescriptions than this amount in a calendar year. Copay-$20 office visits, $00 per hospital admission, $00 outpatient surgery, $100 emergency room visit, MRI/CT Scan $00 per test. Chiropractic/Acupuncture $00 copay 5 visits per year then on will deemed medically necessary. Prescription Drug Copays-$10 /30 day supply generics, $25/ 90 supply generics. Most generics can be filled at Costco for $0 either 30 or 90 day supply, exceptions to this are pain medications and cough medications. $35 / 30 day supply of Preferred Brand Name Drugs or $90/ 90 day supply.

Anthem Plan L Deductible -$2000 individual/$4000 family deductible and $200 individual/$500 family deductible for name brand medications. Maximum out of pocket-$1000 individual, $3000 employee. This means you will never pay more in copays including prescriptions than this amount in a calendar year. Your deductible is on top of this. Copay-$30 office visits, 20% per hospital admission after deductible, 20% outpatient surgery after deductible, $100 emergency room visit and 20% co-insurance after deductible, MRI/CT Scan 20% after deductible per test. Chiropractic/Acupuncture 20% after deductible limit to 5 per year then medically necessary. Prescription Drug Copays-$10/ 30 day supply generics, $25/ 90 supply generics. Most generics can be filled at Costco for $0 either 30 day or 90 day supply, exceptions to this are pain medications and cough medications. $35/30 day supply of Preferred Brand Name Drugs or $90/90 day supply.

Anthem HSA PRESCRITIONS ARE NOT COVERED UNTIL DEDUCTIBLE ARE MET. Deductible -$3000 individual/$5000 family deductible Maximum out of pocket-$5000 individual, $10,000 family. This means you will never pay more in copays including prescriptions than this amount in a calendar year. Your deductible is on top of this. Copay-10% office visits after deductible, 10% per hospital admission after deductible, 10% outpatient surgery after deductible, $100 emergency room visit and 10% co- insurance after deductible, MRI/CT Scan 100% after deductible per test. Chiropractic/Acupuncture 10% after deductible limit to 5 per year then medically necessary. Prescription Drug Copays-$9/30 day supply generics, $14 /90 supply generics. $35/30 day supply preferred brand name drugs, $60/90 day supply preferred brand name drugs. PRESCRITIONS ARE NOT COVERED UNTIL DEDUCTIBLE ARE MET.

Anthem Priority Select No deductible except for the $200 individual/$500 family deductible for name brand medications Maximum out of pocket-$2500 individual, $5000 employee. This means you will never pay more in copays including prescriptions than this amount in a calendar year. Copay-$30 office visits/$40 specialist $500 per day 3 day max, $250 outpatient surgery, $150 emergency room visit, MRI/CT Scan $100 per test Chiropractic/Acupuncture $10/visit 30 per year combined. No referral needed. Prescription Drug Copays-$15/ 30 day supply generics, $40 /90 supply generics. $50/ 30 day supply of Preferred Brand Name Drugs or $135 / 90 day supply. Must select a primary care physician to coordinate your health care.

Kaiser Deductible-None Maximum out of pocket-$1500 individual, $3000 employee. This means you will never pay more in copays including prescriptions than this amount in a calendar year. Copay-$20 office visits, $0 per hospital admission, $20 outpatient surgery, $100 emergency room visit, MRI/CT Scan $0 per test Chiropractic/Acupuncture $10/visit 30 per year combined. No referral needed. Prescription Drug Copays-$10/ 100 day supply generics, $20/ 100 day supply Preferred Brand Name Drugs.

Payroll Deductions 2016-2017 Medical Plan Single Two Party Family Anthem HMO Premier $95.87 $211.34 $364.57 Anthem Plan A $221.32 $462.25 $722.59 Anthem Plan L $25.13 $76.34 $154.92 Anthem HSA $0.00 $0.00 $46.95 Anthem Priority Select $0.00 $32.73 $87.28 Kaiser $99.14 Payroll Deductions for Part-Time Employees are posted online @www.mvusd.net (Staff)

Delta Care Dental (Part-time employees only) Deductible - $00 Diagnostic Services – $0 Copay Preventative Services - $0 copay Amalgam Filings-$0 copay Oral Surgery –Routine Extraction $0, Removal Impacted Teeth $95-$115 copay Periodontic Services - $40 to $300 copay Prosthetic Services (Crowns-$285 copay, Denture $285 copay, Bridge $95-$335 Root Canal Therapy $95-335 copay Orthodontic Services Child(ren) $1150-1900 copay, Adult $1150-$2100 copay Premium credit up to $93.58 towards medical payroll deduction

Delta PPO Deductible - $0 Diagnostic Services – Covered at 100% Preventative Services – Covered at 100% Amalgam Filings-Covered at 100% Oral Surgery –Routine Extraction Covered at 100%, Removal Impacted Teeth covered at 100% Periodontic Services – Covered at 100% Prosthetic Services (Covered at 100%, Denture 50% copay, Bridge 50% copay Root Canal Therapy Covered at 100% Orthodontic Services –Not covered Coverage reduced to 50% of the contracted rate for non-contracted providers.

Delta Premier Deductible - $0 Coverage Level – 70/80/90/100 % (Level goes up every year until you reach 100% as long as you have one dental visit during the year) Diagnostic Services – 70/80/90/100 % Preventative Services – 70/80/90/100% Amalgam Filings- 70/80/90/100% Oral Surgery –70/80/90/100% Periodontic Services - 70/80/90/100% Prosthetic Services (Crown)-70,80,90,100%,( Denture/ Bridge) 50% Root Canal Therapy 70/80/90/100% Orthodontic Services Not covered Payroll Deduction $14.19 11thly

MES Vision Deductible : $10 Exam Every 12 months Lenses Every 12 months Polycarbonate Lenses Included for children Standard Progressive Lenses Included Frames Every 24 months Frame Allowance $130 Contact Lenses $130 allowance, Medically necessary covered in full. Payroll Deduction – Single $9.16 11thly, Two Party $11.50 11thly, Family $20.53 11thly

Flexible Spending Account (FSA) What is a Flexible Spending Account (FSA)? It allows you to save on eligible medical, dental, and vision expenses, dependent care, individual premiums such as disability and adoption expenses. Your election amount is available to you when your plan becomes effective for the Health/Medical Reimbursement FSA. The other plans require the money to be in the account before a claim can be processed. How does it work? When you enroll you will determine the options you desire, along with the amount of expenses you anticipate for the upcoming year. The benefits you elect are paid for with pre-tax dollars deducted from your paycheck each payroll. These dollars are subtracted from your gross earnings before taxes are taken out. Savings is simple. When you enroll in the program you set aside some of your pay before taxes to use on eligible expenses. Use it or Lose it Rule – You can roll over up to $500 for the Health/ Medical Reimbursement Account. Limits : Health FSA $250-2550, Dependent Care - $5000, Individual Premium $10,000, Adoption $12,970.

Basic Group Life $20,000 group life policy for classified and certificated $2.07 11thly $50,000 group life policy for management paid by the District Must enroll in this benefit at the time of hire, you are not give another opportunity.

Voluntary Supplemental Life If you enroll in the group life you can choose to elect additional life. Guarantee issue ( the amount of insurance you are guaranteed to be approved for without answering health questions) is 5 times your salary up to $200,000 within 30 days of your hire. Your spouse has a guarantee issue of $50,000 or 50% of your issued amount up to $100,000. Children have a guarantee issue of $10,000. It is a term policy after the age of 29 the rates increase every five year. If you retire or resign from the District before the age of 70 you can maintain the policy and pay the same rate as a District employee until the age of 80. Spouses of active employees pay are charged according to the age of the employee. Spouses of an employee who has retired or resign from the District pay according to their own age.

Mutual of Omaha AD&D Insurance This is to help provide you peace of mind against the risk of covered injuries or death. It can help cover the cost of hospitalization, rehabilitation, or to replace lost income in case of an accidental death. Limits available between $10,000 and $500,000 in increments of $10,000 Rate: Employee only .018 per $1,000 (Example $.18 for $10,000 coverage) Rate: Employee & Family .028 per $1,000 (Example $.28 for $10,000 coverage) Life, both hands, both feet, both eyes, speech, hearing, pays full coverage limit. One hand, one foot, one eye, partial speech or hearing pays 50% of coverage limit. Thumb and Index finger same had 50% of coverage limit. Hemiplegia 50% of coverage limit. Paraplegia 75% of coverage limit. Quadriplegia 100% of coverage limit.

Retirement Savings Accounts All MVUSD employees are eligible to participate in Retirement Savings Accounts. The District offers two pre-tax options, 403(b) and 457(B). Post –tax options for a 403(b) Roth Ira Savings Accounts are also available. Contributions are limited to a Maximum Annual Contributions Limit established by the IRS each year. Contributions limits for 403(b) and 457 (b) are separate. An employee wishing to participate in both plans is able to save up to the maximum amount in each plan. Once you have an open account you can establish payroll deductions any time online at https://pa.schoolfirstfcu.org. Schools First has been contracted to help employees if they do not have their own financial advisor. Schools First can be contacted at (800)462-8328 ext. 4727

Employee Discounts Employee discounts can be accessed by visiting www.mvusd.net (Staff Tab/Employee Discounts) Example of discount-amusement parks, gym membership discounts, etc.