1. Gasconade County R-I School District
Employee Benefits

2. 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,

3. 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.

4. 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.

5. 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

6. 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 $ For Insurance

7. 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

8. 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

9. 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).

10. 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.

11. 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

12. 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

13. 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 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

14. 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

15. Medical ID Card

16. 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

18. 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

19. 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

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

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

22. Dental ID Card

23. LincolnFinancial.com

24. Lincoln Dental Mobile App

25. 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

26. Lincoln Financial Voluntary Life Benefits

27. Lincoln Financial Voluntary AD&D Benefits

28. 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

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

30. Sample Medical Enrollment Form

31. Sample Ancillary Enrollment Form

32. 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

33. 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 with questions.
Nancy Brown
Jessica Patke
Important Reminders

34. Questions