Open Enrollment 2012 For Full Time Employees and Families of J.O. Combs Unified School District

EOI Service Company2 Medical Plan Dental Plan Vision Plan Short Term Disability Voluntary Benefits Which plans are affected by Open Enrollment?

EOI Service Company3 Medical Benefits Arizona School Boards Association (ASBAIT) Plan contracts with Blue Cross Blue Shield of Arizona to use their PPO Network. This medical benefits plan is provided exclusively by ASBAIT and the member school district with claims being paid by Administrative Enterprises (AEI). BC BS of AZ is not the name of this plan nor is it the insurance carrier. Please refer to your ASBAIT Information pamphlet which is included in your insurance packet.

EOI Service Company4 District pays 100% premium for Schedule C $30 Plan for all eligible employees. You can buy up to higher levels of Medical coverage (Schedule B $15 Plan) which includes out-of-network benefits. There is a 7.6% 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 occur 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 $ –Torn Knee Cartilage $ –Fracture a hand/foot or wrist $ Up to $100 back each year just for visiting your doctor EOI Service Company 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 EOI Service Company 6

7 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)

EOI Service Company8 Delta Vision-Voluntary Plan Features of EyeMed Benefits 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

EOI Service Company9 Union Security – Short Term Disability Type of CoverageNon-Occupational, Employee paid, includes maternity benefit Max Benefit Percent Up to 66 2/3% of base pay up to $5,000/mo. Elimination PeriodAccident/Sickness 7/7 Day Benefit Period 6 Months

EOI Service Company10 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”.

EOI Service Company11 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

EOI Service Company12 Arizona State Retirement System The employee contributes 11.15% 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.

EOI Service Company13 403(B)/457 Retirement/Savings Five vendors to choose from –ING –Security Benefits –Hartford –MetLife –AIG Retirement Tax deferred annuity Employee contributions only

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% EOI Service Company 14

EOI Service Company15 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 EOI Service Company 16

Term Life Insurance Coverage is available for you, your spouse, and child(ren) Rate is locked in for 10 years Portable Terminal illness accelerated death benefit –Pays you 75% of death benefit if you are diagnosed with a terminal illness with less than 24 months to live –This money can be used however you see fit EOI Service Company 17

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EOI Service Company 19 Benefit Election Form Last NameFirst Name Waive All Insurance DepartmentPosition 21 Pay Periods Effective July 1, 2012 BCBS of AZ Annual Cost Per Pay PeriodDENTAL PLAN Annual CostPer Pay Period C $30 Plan Low Option Employee Only  00  Employee + 1  $4,229.52$201.41Employee + Spouse  $657.60$31.31 Employee + Family  $7,053.12$316.57Employee + Child(ren)  $853.20$40.63 B $15 PlanEmployee + Family  $1,267.68$60.37 Employee Only  $1,105.44$52.64  Employee + 1  $6,440.40$ Employee + Family  $10,008.96$ DELTA EYEMED Annual CostPer Pay Period Employee Only  $62.28$2.97  Employee+ Spouse  $126.48$6.02  Employee + Child(ren)  $121.44$5.78  Employee + Family  $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    21 Pay Periods Effective July 1, 2012 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 electionsDate EmployeeModel ABC ElementaryTeacher WAIVE √ √ √ √ √ Model Employee 5/10/2012 PLS CANCEL

Next Step All enrollment forms must be submitted –Set up an appointment with a benefits counselor to review your benefits –If there are no benefit changes from last year Sign, Date, and write NO Changes at bottom of form and submit to Human Resources by May 25 th –Any benefit changes including selecting a new medical plan or adding dental and/or vision require enrollment forms completed with changes EOI Service Company20

EOI Service Company21 Final Step Review your personal options TURN IN BENEFIT ELECTION FORM Complete enrollment Paperwork if changes have been made Please Remember, every employee is ACCOUNTABLE to complete their paperwork; otherwise, you run the risk of not securing insurance for the new school year ( ). All paperwork must be turned in by Friday, May 25 th - NO EXCEPTIONS!!