Open Enrollment 2013-2014 For Full Time Employees and Families of J.O. Combs Unified School District

Which plans are affected by Open Enrollment? Medical Plan Dental Plan Vision Plan Short Term Disability Voluntary Benefits

Medical Benefits Medical/pharmacy benefits will be offered by Blue Cross Blue Shield of Arizona New ID cards will be mailed to all members for a October 1 effective date or 60 days following the first of the month when you are hired The provider network – BSBSAZ Preferred PPO network Will be referred to as the High Plan Will be referred to as the Low Plan

District will pay 100% premium for Low Plan for all eligible employees. There is the option to by up to the High Plan coverage which includes out-of-network benefits. There is a 3.5% increase to this plan. The Plan/PPO Network does not require the selection of a Primary Care Physician (PCP) nor are referrals required to receive medical services.

Accident Coverage Coverage is available for you, your spouse, and child(ren) Coverage lasts your life for any accidents that occurs outside of work Portable Helps with out of pocket expenses to your medical provider Some benefits under this plan include: Ambulance- you get $90.00 Dislocate a finger $90.00 Tear a tendon or ligament $465.00 Torn Knee Cartilage $185.00 Fracture a hand/ foot/ or wrists $465.00 Up to $100 back each year just for visiting your doctor New - Must schedule appointment with the call center 5

Critical Illness With Cancer Coverage Coverage is available for you, your spouse, and child(ren) Coverage lasts your life Portable Helps with major out of pocket expenses to your medical provider Covered conditions upon diagnosis: Heart attack, stroke, renal kidney failure, blindness, Lou Gehrig’s Disease, major organ transplant, paralysis of two or more limbs, and invasive cancer Partial benefit for coronary bypass surgery and carcinoma in situ $100 back each year just for visiting your doctor New - Must schedule appointment with the call center

Delta Dental of Arizona Voluntary Plan Basic & Preventive services provided at no charge No more wait periods for Basic, Major, and Ortho Services Pays 70% of restorative & extractions Pays 50% for Major services Annual Deductible: $50/Person, $150/Family Annual Maximum Benefit $1,000 per covered person Orthodontic Benefit pays 50% with a $1,000 maximum (separate from Annual Maximum Benefit)

Delta Vision-Voluntary Plan Features of EyeMed Benefits An Increase of 7.5% this year rates are in your packet Exams - $10 Co-pay In-Network Materials (Frames and Lenses) - $10 Co-pay In-Network Standard Spectacle Lenses - $75 Co-pay – Premium lenses - 80% of charge less $120 allowance, plus $75 Co-pay Frames – Up to $120 allowance plus 20% discount Contacts – once every 12 months; $80 allowance Exam & Lenses or Contacts – once every 12 months Please read enclosed benefit document for more details

Union Security – Short Term Disability Type of Coverage Non-Occupational, Employee paid, includes maternity benefit Max Benefit Percent Up to 66 2/3% of base pay up to $5,000/mo. Elimination Period Accident/Sickness 14/14 Day Benefit Period 6 Months Cost for this year has increased 5% see new rates in your packet

Section 125 – Pre-tax Deductions Your Medical and Dental premiums are taken on a pre-tax basis Lowers your taxable income May lower your taxes Elections cannot be changed during the plan year, unless you experience a “qualified change”.

Flexible Benefit Plan Medical & Dependent Care Reimbursement Set money aside for qualified expenses pre-tax Elections are made for the entire year and cannot be changed, except with a “qualifying event” Benefits must be used during the plan year May lower your taxes This is the plan that allows you to pay certain expenses with pre-tax dollars. You save taxes - more take home income left for you. The Diocese pay expenses of administering this for you.

Arizona State Retirement System The employee contributes 11.54% of income to the plan. District matches employee contribution. You must contribute 5 yrs. to become vested. Plan includes Long Term Disability benefits after 6 months of disability. The average employee saved $300 last year and every year going forward.

403(B)/457 Retirement/Savings Five vendors to choose from ING Security Benefits Hartford MetLife Valic Tax deferred annuity Employee contributions only As an employee in a "not for profit" organization you have a real advantage over those of us in the corporate world - make sure you understand and take advantage of this benefit.

Legal Coverage Coverage is available for you, your spouse, child(ren), your parents, and your spouse’s parents Portable 3 types of service categories: Free - initial consultations with a plan attorney, document reviews, simple wills, and more Flat rate - name change, traffic ticket, will with a minor trust, plus much more Discounted - anything that is not free or at a flat rate is discounted 25% New - Must schedule appointment with the call center

Basic Life and AD&D Insurance 100% paid by the School District 1 ½ times salary to $50,000 AD & D doubles death benefit

Universal Life Insurance Coverage is available for you, your spouse, and child(ren) Policy lasts to age 100 Cash value account- guaranteed at 4% Portable Long term care is built into your policy Can use long term care for nursing home, home health care, and adult day care Will provide a long term care benefit to you for 50 months and it will not deduct from your life insurance amount that you have assigned to your beneficiary New - Must schedule appointment with the call center

Benefit Election Form Employee Model WAIVE ABC Elementary Teacher Last Name First Name   Waive All Insurance Department Position 21 Pay Periods Effective July 1, 2012 BCBS of AZ Annual Cost Per Pay Period DENTAL PLAN C $30 Plan Low Option Employee Only ¨ 391.2 18.63 Employee + 1 $4,229.52 $201.41 Employee + Spouse $657.60 $31.31 Employee + Family $7,053.12 $316.57 Employee + Child(ren) $853.20 $40.63 B $15 Plan $1,267.68 $60.37 $1,105.44 $52.64 $6,440.40 $306.69 $10,008.96 $476.62 DELTA EYEMED $62.28 $2.97 Employee+ Spouse $126.48 $6.02 $121.44 $5.78 $189.96 $9.05 18 Pay periods beginning with the first pay in September and an October 1st effective date ** Effective July 1, 2012 Voluntary Insurance Short Term Disability** Transamerica Accident Critical Illness Universal Life Term Life Legal Access Insurance Medical Reimbursement Plan ($2,500 annual maximum) Dependent Care Reimbursement Plan ($5,000 annual maximum or $2,500 if married and filing separately) TOTAL EMPLOYEE PAID INSURANCE PREMIUM I understand that I may not change my election until the beginning of the next plan year - July 1, 2012, unless I have a qualified life changing event. Employee Signature authorizing the elections Date Employee Model WAIVE ABC Elementary Teacher √ √ √ √ PLS CANCEL √ Model Employee 5/17/2013 Benefit Election Form

Next Step Determine which Health Insurance Plans fits your needs. Low Plan at no cost to the employee High Plan at a cost to the employee (please review insurance rate in your packet).

Representatives are available Next Step Do you want to participate in any of the following voluntary benefits products? Accident Coverage Critical Illness with Cancer Coverage Legal Coverage Universal Life Insurance You must schedule an appointment with a benefits counselor at the call center for the above products Representatives are available Monday – Friday 7:00 am to 4:00 pm PDT 1-800-229-3642

Wednesday July 31st - NO EXCEPTIONS!! Final Step Review your personal options TURN IN BENEFIT ELECTION FORM Questions contact Human Resources at 480-987-5305 Contact the Call Center for additional voluntary benefits Please Remember, every employee is ACCOUNTABLE to complete their paperwork; otherwise, you run the risk of not securing insurance for the new school year (2013-2014). All paperwork must be turned in by Wednesday July 31st - NO EXCEPTIONS!!