Gasconade County R-I School District 2019 - 2020 Employee Benefits

Open Enrollment Elections made during open enrollment will become effective on July 1, 2019. The School District offers you and your eligible family members a comprehensive and valuable benefits program. We encourage you to take the time to educate yourself about your options and choose the best coverage for you and your family. All enrollment forms must be returned to Sarah Hackmann by Wednesday, May 8, 2019.

Who is Eligible? Benefit eligible employees may enroll in Medical, Dental, Basic Life, Voluntary Term Life, Voluntary AD&D and Voluntary Vision plans. Spouses and dependent children of eligible employees may enroll in Medical, Dental, Voluntary Term Life, Voluntary AD&D and Voluntary Vision plans.

Plan Changes for Qualified Events Unless you have a qualified life event, you cannot make changes to the benefits you elect until the next open enrollment period. Qualified events include: Marriage Divorce Legal separation Birth or adoption of a child Change in child’s dependent status Death of spouse, child, or other qualifying dependent Change in spouse’s benefits or employment status If you experience a qualified event the change must be made within 30 days from the date of the event.

Medical – UHC In-Network Benefits Plan 1 – HSA $5,000 Plan 2 – HSA $4,000 Plan 3 – HSA $2,700 Plan 4 – PPO $2,500 Deductible Individual Family $10,000 $8,000 $5,500 $7,500 Out of Pocket Maximum $6,450 $12,900 $6,000 $12,000 Coinsurance 100% 80% Primary Care Physician Deductible then Coinsurance $30 Copay $0 Copay For Children Enrolled Under the Age of 19 Specialist $50 Copay Urgent Care Emergency Room $250 Copay Prescription Tier 1 Tier 2 Tier 3 Deductible then $10 Deductible then $35 Deductible then $60 $10 $35 $70

Medical – UHC Employee Monthly Payroll Deductions Plan 1 HSA $5,000 Plan 2 $4,000 Plan 3 $2,700 Plan 4 PPO $2,500 Employee Only $0.00 $64.95 School Board HSA Contribution $64.47 $33.33 $10.65 Not Eligible Employee & Spouse $438.49 $475.84 $503.05 $593.74 Employee & Child(ren) $346.92 $376.47 $398.00 $469.75 Employee & Family $785.41 $852.32 $901.05 $1,063.49 School Board Pays $430.00 For Insurance

Medical – UHC Retiree Monthly Cost Plan 1 HSA $5,000 Plan 2 $4,000 Plan 3 $2,700 Plan 4 PPO $2,500 Employee Only $365.53 $396.67 $419.35 494.95 Employee & Spouse $804.02 $872.51 $922.40 $1,088.69 Employee & Child(ren) $712.45 $773.14 $817.35 $964.70 Employee & Family $1,150.94 $1,248.99 $1,320.40 $1,558.44

Medical – UHC In-Network Benefits HSA – KIDZ Plan Deductible Individual Family $2,700 $5,500 Out of Pocket Maximum $5,000 $10,000 Coinsurance 80% Primary Care Physician Deductible then Coinsurance Specialist Urgent Care Emergency Room Prescription Tier 1 Tier 2 Tier 3 Deductible then $10 Deductible then $35 Deductible then $60 KIDZ Plan Monthly Cost - $167.74

IRS HSA Contribution Limits 2019 Individual Coverage $3,500 Family Coverage $7,000 Cath-Up (Age 55-65) $1,000 Medicare Eligible participants may not contribute to the Health Savings Account (HSA).

Pharmacy Benefits OptumRx® is your pharmacy care provider. To find a network provider: Access myuhc.com or the Health4Me® app Call customer service phone number located on the back of the UHC ID card Mail Order If you have medications you’re currently taking, be sure you have at least a 1-month supply to cover you through the transition. UHC offers a list of preventive drugs at $0 cost. An expanded list of preventive drugs is available for the HSA plan.

myuhc.com View or print ID cards Access Plan Information Virtual Visits Locate In-Network Physicians & Facilities Track your deductible and out-of-pocket maximum View Claims / Obtain Explanation of Benefits (EOB’s) Track Prescriptions / Order Refills / Research Lower-Cost Pharmacy Options Compare Costs

Health4Me ® App View ID cards Access Plan Information Locate Physicians & Facilities Track your Deductible and Out-of-Pocket Maximum View Claims / EOB Keep Track of Prescriptions / Order Refills / Research Lower-Cost Pharmacy Options Compare Costs

UHC Virtual Visits When you need care — anytime, day or night — Virtual Visits can be a great option. Lets you see and talk to a doctor from your mobile device or computer without an appointment. Most visits take about 10 -15 minutes. Conditions commonly treated: Visit uhc.com/VirtualVisits or myuhc.com and choose from provider site. Virtual Visit Cost: HSA – $49 (credited towards deductible) PPO – $10 Copay Allergies Cough / Cold Bronchitis Pink Eye Rash / Poison Ivy Sinus Problems

myHealthcare Cost Estimator Innovated online tool to better manage health care. Procedure – Learn more about procedure and compare treatment options Provider – Review provider quality rating information Price – Quickly estimate out-of-pocket costs for specific procedures Place – Locate providers based on geographic search criteria

Medical ID Card

liveandworkwell.com Behavioral health benefit provides confidential support. Get help 24/7 for: Alcohol and drug use recovery Coping with grief and loss Depression, anxiety and stress Relationship difficulties If you need behavioral health support, visit liveandworkwell.com or call the toll-free member phone number on your UHC ID Card

Dental – Lincoln Financial In-Network Out-of-Network Deductible (Applies to Basic & Major Services) Individual Family $50 $150 Preventive Services Oral Evaluations, X-Rays, Cleanings, Sealants 100% Basic Services Fillings, Periodontics, Endodontics, Oral Surgery 80% Major Services Implants, Crowns, Dentures, Bridges 50% Orthodontic Annual Maximum $1,000 Ortho Maximum UCR 90th Percentile

Dental Max Rewards Members covered under the dental plan may be eligible to rollover unused benefit to the next year. Claims Threshold is $600 Rollover $250 or $350 (Preferred Providers) Maximum Rollover Account Balance is $1,000

Dental Employee Monthly Payroll Deduction Employee Only $0.00 Employee & Spouse $27.35 Employee & Child(ren) $32.82 Employee & Family $62.90

Dental Monthly Payroll Deduction Retirees Employee Only $27.34 Employee & Spouse $54.69 Employee & Child(ren) $60.16 Employee & Family $90.24

Dental ID Card

LincolnFinancial.com

Lincoln Dental Mobile App

Basic Life Lincoln Financial The District provides a $25,000 basic life policy for all full-time active employees. This amount was increased this year! Now is a great time to review your beneficiary designation. To update please contact Sarah Hackmann. Voluntary Term Life is available for purchase for Full-Time Active Employees, Spouse and Children

Lincoln Financial Voluntary Life Benefits

Lincoln Financial Voluntary AD&D Benefits

Vision – Principal VSP Choice Network In-Network Out-of-Network Exam $10 Copay Up to $45 Materials $25 Copay Lenses: Once Every 12 Months Single Lenses 100% after Copay Up to $30 Lined Bifocal Up to $50 Lined Trifocal Up to $65 Lenticular Up to $100 Frames Frequency Once Every 24 Months in Lieu of Contacts Frames $130 Allowance + 20% off amount above frame allowance Up to $70 Contacts Frequency Once Every 12 Months in Lieu of Lenses and Frames Contacts (Up to $60 Copay for Fitting and Evaluation) Up to $105

Vision Monthly Payroll Deduction Employee Only $8.29 Employee & Spouse $15.00 Employee & Child(ren) $16.89 Employee & Family $25.31

Sample Medical Enrollment Form

Sample Ancillary Enrollment Form

1424 W 5th Street Washington, MO 63090 Scott Schroepfer Jessie Patke Jenni Marquart Kasey Owens President & Broker Group Installation Enrollments Individual Broker Nancy Brown Jodie Miller Doug Hendrix Claims Advocate Medicare Broker Account Management 1424 W 5th Street Washington, MO 63090 636-239-7781

All enrollment forms must be returned to Sarah Hackmann by Wednesday, May 8, 2019. Refill your prescriptions prior to July 1, 2019. Review your beneficiary designation. Please feel free to contact our office at 636-239-7781 with questions. Nancy Brown (nancy.brown@sbins.net) Jessica Patke (jessica.patke@sbins.net) Important Reminders

Questions