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Benefits Overview July 1, 2015 – June 30, 2016
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Eligibility To be eligible for coverage you must be a full time active employee as defined by the District Your effective date for coverage is determined by your employment classification as outlined below: –Certified Employees – 1 st of the month following 30 days from date of hire –Support Staff – 1 st of the month following 60 days from date of hire –Administration – 1 st of the month following date of hire You have 30 days from your date of hire to enroll in benefits. If you do not enroll in benefits within 30 days of your date of hire you will need to wait until the next open enrollment period in May of 2016, unless you experience a mid-year qualifying event. –Marriage –Divorce –Birth of Child –Adoption/Legal Guardianship Awarded –Loss of other coverage
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7/1/15 Benefit Highlights Medical – Blue Cross/Blue Shield of Arizona (BCBS) –Employees have the choice of three medical plans PPO $1,000 PPO $2,000 PPO $3,000 Dental – Two plans to choose from –PPO Dental coverage through Cigna –Prepaid Dental coverage through EDS Vision – Coverage available through EyeMed Basic Life/AD&D and Voluntary Life (Minnesota Life) –Basic Life/AD&D is provided by the District at no cost to you –Voluntary Life may be purchased through payroll deductions
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7/1/15 Benefit Highlights Short Term Disability (Symetra) –Core plan provided by the District at no cost to you –Buy-up option available for purchase through payroll deductions Teladoc –Telephonic and Video medical consultations with Board Certified Physicians –Eligibility is based on enrollment in one of the District sponsored medical plans and paid for by the District Flexible Spending Account available through Sheakley –Health FSA –Dependent Care
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To access the Flowing Wells Schools Employee Benefit Website: www.flowingwellsschools.org Go to Employee Links and select Employee Benefits Section in the drop down menu Employee Benefit Website Select this tab to access the online enrollment portal
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Medical Plan Evaluator
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Medical Definitions Copayment: The fixed dollar amount you must pay directly to a physician at the time certain covered services, such as prescription drugs or office visits, are received. Deductible: The fixed dollar amount you must pay for covered services each plan year before the insurance company begins to pay benefits. Coinsurance: Sharing, between yourself and the insurance company, of the cost of covered services. Out-of-Pocket Maximum: The maximum dollar amount you have to pay under the terms of the insurance company’s contract in a plan year for covered services.
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Medical Plan Options Blue Cross/Blue Shield (BCBS) Plan OptionBCBS PPO $1,000 BCBS PPO $2,000 BCBS PPO $3,000 BenefitsIn Network Out of Network In Network Out of Network In Network Out of Network Lifetime MaximumUnlimited Deductible Individual$1,000$6,000$2,000$6,000$3,000$6,000 Family$2,000$12,000$4,000$12,000$6,000$12,000 Coinsurance20%*50%*20%*40%*30%*50%* Out-of-pocket Maximum Includes Deductible, Coinsurance, Medical copay and Rx copay Individual$4,000$9,000$5,000$9,000$4,500$9,000 Family$8,000$18,000$10,000$18,000$9,000$18,000 *After Deductible
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Plan OptionBCBS PPO $1,000 BCBS PPO $2,000 BCBS PPO $3,000 BenefitsIn Network Out of Network In Network Out of Network In Network Out of Network Hospital Services Inpatient Hospital20%*50%*20%*40%*30%*50%* Emergency Room$150 copay Urgent Care $75 copay50%*$75 copay40%*$75 copay50%* Routine Services Office Visit$20 copay50%*$25 copay40%*30%*50%* Specialist Visit$40 copay50%*$50 copay40%*30%*50%* Preventive Care Immunization Well Baby Physicals Well Woman $0 copay50%*$0 copay40%*$0 copay50%* Medical Plan Options Cont… * After Deductible
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Same Pharmacy Benefits on All Medical Plan Options Benefits In NetworkOut of Network Tier 1 - Generic$15 copay Copay + difference between In Network contracted rate and billed rate Tier 2 - Preferred Brand$35 copay Tier 3 - Non-preferred$60 copay Tier 4 - Specialty Drugs$60 copay Mail Order 2 x copayNot Covered
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1-800-Teladoc (1-800-835-2362) What is Teladoc? NO COST TO USE THE SERVICE!!! Telephonic or video/webcam physician consultations Board Certified physicians authorized to write prescriptions (you pay for cost of Rx) Available 24/7/365 English & Spanish speaking consultants and physicians Saves you time and money; NO COPAYS!!!
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1-800-Teladoc (1-800-835-2362) Examples of common calls to Teladoc….. Sinus Infections Common Cold Pink Eye Flu Allergies Bronchitis Ear Infections Bladder Infections UTI Upper Respiratory Infection Top 5 Prescriptions written 1.Antibiotics 2.Antihistamines 3.Cough suppressants 4.Anti-bacterial medications 5.Anti-fungal medications
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1-800-Teladoc (1-800-835-2362) Must be enrolled in one of the District medical plans. The District is paying 100% of the cost!!! There is NO copay or fee on your end to use Teladoc! You will pay for any prescribed medications. Dependents DO NOT have to be enrolled under your medical plan to use Teladoc. Who can use Teladoc?
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1-800-Teladoc (1-800-835-2362) Imagine this... You wake up with sudden cold-like symptoms: stuffy nose, cough, congestion. It’s the weekend, or the middle of the night, your doctor’s office isn’t open yet or they don’t have any available appointments. Then you call Teladoc to request a consultation. After reviewing your electronic health record (EHR), the Teladoc physician calls you back and discusses your symptoms. Turns out you have a sinus infection. The physician prescribes a generic antibiotic and you pick it up at your local pharmacy on the way to work. Problem solved in less than an hour, no office visit copay, AND you didn’t have to miss a day of work. How Does This Work???
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Pharmacy Discount Card 1.Present your medical ID card to pharmacist 2.Next present the Pharmacy Discount card 3.Determine which offers the best price 4.See the “Discount Program – RX Cut” tab on the employee benefit website for more information Excellent to use when: Your medication is not covered by insurance Insurance limits your supply MRI or lab work discounts No activation or expiration date Take a card for friends or family
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Prepaid Dental Employer Dental Services (EDS) Lower cost alternative to the Dental PPO options Must use a Dentist within the EDS Dental Network Fees for procedures listed in the copay booklet (copy of booklet can be found on Flowing Wells employee benefit website) No annual maximum
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Cigna Dental Carrier / PlanCignaHeallthcare Benefits In Network DPPO Advantage In Network DPPO Out of Network Basic Information Annual Deductible Individual$50 Family$150 Annual Plan Maximum$1,000 Benefits Type I - Diagnostic & Preventive0% Type II - Basic Services10%20% Type III - Major Services50% Type IV - Orthodontic Services50% Age LimitAdult & Children to Age 26 Orthodontic Lifetime Maximum$1,000
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Vision Carrier / PlanNEW VENDOR - EyeMed Overview of Benefits In Network Out of Network Reimbursement Eye Exam/Refraction $10 CopayUp to $40 Contact Lens Evaluation & Fitting Up to $40Not Covered Single Vision Eyeglass Lenses $10 copayUp to $30 Bifocal Eyeglass Lenses $10 copayUp to $50 Trifocal Eyeglass Lenses $10 copayUp to $70 Lenticular Eyeglass Lenses $10 copayUp to $70 Standard Frames $130 Allowance; 20% off balance Up to $91 Contact Lenses Medically Necessary Covered in fullUp to $210 Elective $130 AllowanceUp to $130 Frequency of Services Exams 12 Months Lenses 12 Months Frames 12 Months Contact Lenses 12 Months
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Life/AD&D Insurance 100% paid by the District for ALL Active Employees $25,00 Life & AD&D
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Voluntary Life/AD&D Insurance Voluntary Life AD&D Insurance is Available! Employee $10,000 increments to $500,000 not to exceed 5x basic annual earnings. Guarantee Issue: $150,000 Spouse $5,000 increments up to $250,000 not to exceed 100% of the employee elected amount. Guarantee Issue: $30,000 Children $10,000 (all guarantee issue) Guarantee Issue amounts are only available now. If you do not elect coverage, even a minimum of $10,000 for yourself you will have to wait until the next open enrollment period to elect coverage and you will be subject to medical review with a completed Evidence of Insurability form for ALL amounts of coverage!
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Short Term Disability Symetra Short Term Disability (STD) o After all paid leave is exhausted o 66 2/3% of your weekly earnings o $1,160 weekly maximum o Core Plan: 60 days Sickness or Accident o Buy Up Plan: 14 days Sickness or Accident o Post-tax deductions for Buy Up option for a tax free benefit o 18 week benefit duration Income Protection – Core plan 100% paid for by the District!!!
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Flexible Spending Account (FSA) Sheakley Financial Health FSA maximum $2,550 Debit Card available Dependent Care FSA maximum $5,000 Use it or lose it rule reminder Deductions taken on a pre-tax basis – this LOWERS your taxable income!
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YES. All new employees MUST complete enrollment forms for all available coverages either electing or declining coverage Flexible Spending Account requires employees to complete an enrollment form every year either electing or declining to participate, and if participating, confirming the amount to contribute for the plan year Deadline: All forms MUST be turned in to Human Resources within 30 days of your hire date. Do employees need to complete any paperwork???
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