2019-20 DPS Benefits Enrollment Guide

DPS BENEFITS ENROLLMENT GUIDE PLAN YEAR: July 1, 2019 - June 30, 2020

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Table of Contents

Employee Benefits Overview ������������������������������������������������������ 6

EMPLOYEE WELLNESS ����������������������� 50 + DPS Wellness Champs ����������������������51

+ What’s New ����������������������������������������������������������� 6

+ Employee Assistance Program (EAP) �����������������������������������51

+ Benefits Eligibility Summary �������������������������������� 7

+ Well Aware Reward ���������������������������51

See How DPS Contributes ���������������������������������������������� 10 Compare Insurance Providers and Coverage Options ��������������������������� 12 + Benefits 101 Glossary ����������������������������������������� 14 + Understand the Benefits on Your Paystub ��������� 16 + Aetna Plan Details ���������������������������������������������� 18 + Kaiser Permanente Plan Details ����������������������� 20 + Plan Rates by Employee Association ����������������� 22

Consider Your Voluntary Options ������������������������� 44 + Dental Insurance ������������������������������������������������ 44

SAVING FOR RETIREMENT �����������������52 + 403(b) and 457(b) Voluntary Tax-Sheltered Retirement Options �����������������������������������������������52 + Colorado PERA ����������������������������������53 + Colorado PERAPLUS 401(k) Plan �����������������������������������������53

SUPPLEMENTAL BENEFITS ����������������54 + Auto and Home Insurance �����������������54 + Commuter Benefits ���������������������������54 + Group Life and Accidental Death and Dismemberment Insurance �������������������������������������������55 + Long-term Care Insurance ���������������55 + Long-term Disability Insurance �������������������������������������������56 + PERA Optional Life Insurance �����������56 + Pet Insurance ������������������������������������56 + Voluntary Payroll Protection Plan and Assistance Fund �����������������56

+ Vision Insurance ������������������������������������������������� 44

PLANS IN ACTION ��������������������������������58

+ Health Savings Account (HSA) ��������������������������� 45

BENEFIT PROVIDER CONTACT INFORMATION ������������������������������������� 60

+ Flexible Spending Account (FSA) ����������������������� 46 + MetLife ���������������������������������������������������������������� 48 + Sick Leave Bank ������������������������������������������������� 49

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YOUR ACTION IS REQUIRED. Newly-eligible employees (new employees or employees who have a change in employment status such as from a non-benefit-eligible position to a benefit-eligible one) must elect benefits online no later than 30 calendar days from your start date or date of status change. Health insurance coverage will become effective for newly-eligible employees on the first day of the month after your official start date.

If you work 30 or more hours per week, you must select or waive benefits online or you will be automatically enrolled in a medical plan and a Health Savings Account (HSA) for the 2019-20 benefits plan year. That means you will not choose your insurance provider or plan.

HERE’S HOW TO ENROLL OR WAIVE:

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3.

The cost of benefits — your premiums — will be automatically deducted from your paycheck beginning in July. The plan you will be enrolled in if you do not take action is the Aetna ConsumerDriven Health Plan (CDHP) with a $3,500 deductible (post-tax) with a Health Savings Account (HSA).

Visit thecommons.dpsk12.org/ benefits.

Click on “Benefits Enrollment Site” on the right (this website is not firefox compatible).

A login page will open in a window or a new tab in your browser. Log in using your DPS credentials and click the blue “Sign In” button.

*Your DPS credentials are the username and password that you use to log in to TruePay. To retrieve your username or update your password, visit iforgot.dpsk12.org.

4.

On the Benefits Enrollment Site, click the “Enroll Now” button to get started.

CONFIRMING YOUR BENEFITS ELECTIONS We highly encourage you to check your email for an enrollment confirmation email after you submit your benefit elections to ensure that your choices were made correctly. If you need to make corrections, this must be done during your enrollment period. Email HR_Connect@dpsk12.org or call 720-423-3900 if you need to have your enrollment reopened.

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SE REQUIERE SU ATENCIÓN. Los empleados que recién ahora reúnen los requisitos (empleados nuevos o que han tenido algún cambio en su condición laboral, por ejemplo, pasan de no tener derecho a los beneficios a sí tener derecho) deben elegir los beneficios por internet dentro de los 30 días calendario siguientes a la fecha de ingreso o fecha de cambio de condición laboral. Para estos empleados, la cobertura médica entrará en vigor el primer día del mes siguiente a la fecha de ingreso oficial.

Si trabaja 30 o más horas por semana, debe escoger o renunciar a los beneficios por internet; de lo contrario, se le inscribirá automáticamente en un plan de salud y una cuenta de ahorro para gastos médicos (HSA) para el año del plan de beneficios 2019-20. Esto significa que no elegirá ni su proveedor de seguro ni el plan.

El costo de los beneficios, es decir, las primas que debe pagar, se deducirá automáticamente de sus pagos de nómina a partir de julio. Si no actúa oportunamente, se le inscribirá en el plan CDHP de Aetna, con un deducible de $3,500 (luego de impuestos) y una cuenta de ahorros para gastos médicos (HSA).

CÓMO INSCRIBIRSE O RENUNCIAR A LOS BENEFICIOS:

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Visite thecommons.dpsk12.org/ benefits.

Haga clic “Benefits Enrollment Site” (sitio de inscripción de beneficios) a la derecha (este sitio no es compatible con Firefox).

Se abrirá una página de inicio en una ventana o en una pestaña nueva del navegador. Inicie sesión usando sus credenciales de DPS y haga clic en el botón azul “Sign In” para ingresar. *Sus credenciales de DPS son el nombre de usuario y la contraseña que usa para iniciar sesión en TruePay. Para recuperar el nombre de usuario o contraseña, visite iforgot.dpsk12.org.

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En el sitio de inscripción de beneficios, haga clic en el botón “Enroll Now” (inscribirse ahora) para comenzar el proceso.

CONFIRMAR LOS BENEFICIOS ELEGIDOS Confirmar los beneficios elegidos: luego de enviar las opciones de beneficios elegidos, consulte su correo electrónico; deberá haber recibido una confirmación. Lea el mensaje atentamente para cerciorarse de que sus opciones quedaron registradas correctamente. Si tiene que corregir algo, deberá hacerlo durante el período de inscripción. Envíe un correo a HR_Connect@ dpsk12.org o llame al 720-423-3900 si necesita que reabramos su inscripción.

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Employee Benefits Overview Denver Public Schools is committed to providing you and your family with high-quality, affordable benefit options.

We care about your health and well-being and want you to have the tools and resources to make the best choices for your medical care. This guide will walk you through the steps to enroll in benefits as a new hire and during annual benefits Open Enrollment. It will also provide information on enrolling in supplemental benefits, participating in Employee Wellness programing and more.

Who is eligible for benefits?

Employees who work 20 or more hours per week are eligible for benefits on the first day of the month following their start date. This includes part-time hourly, temporary and active retirees working at least 20 hours per week.

All benefits-eligible employees must enroll in or waive benefits within the first 30 days of their start date.

The Affordable Care Act requires that DPS provide affordable health insurance (as defined by the IRS) for employees working 30 hours or more per week. We have designed our employer contributions to ensure we meet this requirement. We are also required to offer affordable health insurance to employees transferring into a role that is under 30 hours per week, if they have worked an average of 30 hours or more per week in the prior year. If you plan to transfer to a part-time role with DPS and are unsure if you will be benefits-eligible, email HR_Connect@dpsk12.org for more information on your specific circumstances.

Eligibility for specific benefits may depend on how many hours per week you work.

When coverage starts: Coverage will become effective for newly-eligible employees on the first day of the month after your start date. Your benefits selections during annual benefits Open Enrollment are effective on July 1 of that year.

What’s New? MEDICAL PLANS Rates: Kaiser rates are decreasing by 1.46% and Aetna rates are remaining the same.

New Plan: We are now offering an Aetna 2700 Open Access CDHP plan.

An open access plan gives members access to a larger network than the other Aetna plans, including to more than 1,200 primary care doctors and 5,900 specialists, and 53 hospitals and 83 urgent care centers.

Auto-enrollment: Benefits-eligible employees working more than 20 hours per week who do not take action during Open Enrollment will be automatically enrolled in the Aetna 3500 CDHP plan (post-tax) and a Health Savings Account (HSA).

VISION PLAN Our vision plan now offers more coverage. Members will receive an increase of $30 annual frame allowance (up to $170 a year) and $20 annual contact lens allowance (up to $140 a year) and rates will only increase by 38 cents per month.

HEALTH SAVINGS ACCOUNTS The maximum contribution amounts are increasing for the 2019 calendar year to $3,500 for individuals (up from $3,450 in 2018) and $7,000 for families (up from $6,900 in 2018).

When coverage ends: Coverage ends the last day of the month in which your employment ends; this will either be your date of termination or contract end date, if you have a contract with DPS.

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ALL OTHER PLAN OFFERINGS AND RATES ARE STAYING THE SAME

Benefits Eligibility Summary BENEFIT TYPE

EMPLOYEE TYPE

EMPLOYEE TYPE Part-time Hourly Part-time Hourly

Full-time

Working less than 20 hours per week

Working at least 20 hours per week (.5 FTE), temporary and all active retirees working 20 hours per week or more (.5 FTE to 1.0 FTE)

Working at least 30 hours per week (.75 FTE)

Medical p. 12-43

No

Yes

Yes

Dental and Vision p. 44-45

No

Yes

Yes

Health Savings Account (HSA) or Flexible Spending Account (FSA) p. 45-47

No

Yes

Yes

MetLife Supplemental Life, Critical Illness, Accident, Hospital Indemnity and Legal Benefits p. 48

No

Yes

Yes

Sick Leave Bank (only if eligible for sick days) p. 49

No

Yes**

Yes

Employee Assistance Program (EAP) p. 51

Yes

Yes

Yes

Well Aware Reward (must be enrolled in a DPS medical plan) p. 51

No

Yes

Yes

Voluntary Retirement Plans: 403(b), 457(b) and 401(k) p. 52-53

Yes

Yes

Yes

Colorado PERA p. 53

Yes

Yes

Yes

MetLife Home, Auto, and Pet Insurance p. 54-56

Yes

Yes

Yes

Commuter Benefits p. 54-55

Yes

Yes

Yes

Basic Group Life Insurance p. 55

No

Yes*

Yes*

Accidental Death and Dismemberment p. 55

No

No

Yes*

Long-term Care p. 55

No

Yes

Yes

Long-term Disability p. 56

No

No

Yes

Voluntary Payroll Protection and Assistance Fund p. 56

Yes

Yes

Yes

* Coverage amount decreases with age beginning at age 65. ** Days in bank may be prorated.

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Benefits-Eligible Employees Must Enroll in or Waive Benefits New Employees

All benefits-eligible employees must enroll in or waive benefits within the first 30 days of their start date — this includes if you recently transferred to a benefits-eligible position from a nonbenefits-eligible position or if your employer benefit contribution changed by at least $50. Benefits are effective the first of the month following your start date. Please note, depending on your date of enrollment, you may see double deductions and double benefit credits on your first paycheck following enrollment.

Open Enrollment

All benefits-eligible employees must enroll in or waive benefits during the annual benefits Open Enrollment period. This includes employees who are currently enrolled in DPS benefits plans. Benefits Open Enrollment occurs annually in the spring and is the one time a year you can choose, change or waive your benefits selections for the next plan year. Plan years run annually from July 1-June 30.

WHAT HAPPENS IF I DON’T ENROLL IN OR WAIVE BENEFITS?

All employees working 30 or more hours a week who do not enroll in or waive benefits during their new hire enrollment window will be automatically enrolled in the Aetna 3500 CDHP plan (post-tax) and an HSA account.

All employees working 20 or more hours a week who do not enroll in or waive benefits during annual benefits Open Enrollment will be automatically enrolled in the Aetna 3500 CDHP plan (post-tax) and a Health Savings Account (HSA).

Your elections from the current plan year will not roll over to the new plan year. Current elections for medical, dental, vision, and Flexible Spending Accounts (FSAs) will not roll over to the new plan year.

WHO CAN I COVER ON MY PLAN?

You may also enroll eligible family members on your medical, dental and vision plans. Eligible family members include: • Your legal spouse.

• Your common-law spouse. You must email a common-law affidavit to HR_Connect@dpsk12.org. Common-law marriage is a legallybinding marriage in Colorado and requires the same divorce procedure as any other traditional marriage to dissolve. There is no common-law divorce.

• Your child(ren) up to age 26, regardless of student, marital or tax-dependent status. This includes stepchildren, legally-adopted children or a child for whom you are the legal guardian.

• Your mentally or physically disabled child(ren) age 26 and over. Email HR Connect at HR_Connect@dpsk12.org for more information.

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CHANGING YOUR BENEFITS OUTSIDE OF NEW HIRE ENROLLMENT AND ANNUAL BENEFITS OPEN ENROLLMENT

The following qualifying life events may make you eligible to enroll in, change or waive benefits outside of new hire enrollment or Open Enrollment: • • • • • • • • •

Marriage, divorce or legal separation.

Birth or adoption of an eligible child.

Death of your spouse or covered child.

Change in your spouse’s or child’s work status that results in his or her loss or gain of benefits.

Change in your child’s benefits-eligibility status.

Change in place of residence causing a loss of eligibility (i.e. moving outside of the service area).

Qualified Medical Child Support Order.

Enrollment in, or change in eligibility for, Medicare or Medicaid.

Internal job or position change at DPS (only if there is a change of DPS benefits contributions of more than $50 per month or if you move from a non-benefits-eligible to a benefits-eligible status).

You must complete a Benefits Change Form and submit it to HR_Connect@dpsk12.org within 30 days of the event in order to make changes to your benefits. Visit thecommons.dpsk12.org/benefitschanges for instructions and resources.

The effective date for all changes is the first of the month following the qualifying life event. For example, a qualifying life event on Sept. 10 would go into effect on Oct 1. The exception to this rule is for the addition of a child due to birth or adoption, in which case the effective date is the date of the birth or adoption.

SUMMER HEALTH CARE COVERAGE FOR HOURLY EMPLOYEES (PREVIOUSLY SUMMER COUPONS) What is it?

Eligible hourly employees who do not work during the summer can choose to enroll in or waive benefits for July during annual benefits Open Enrollment.

Benefit credits will be paid out over the summer to employees who are enrolled in medical insurance. If you are a paraprofessional and were hired before June 1, 2017, you will receive benefit credits even if you waive medical insurance. If you are a bus driver and were hired before Jan 1, 2019, you will receive benefit credits even if you waive medical insurance. Employees electing employee + family or employee + spouse medical coverage will be invoiced and asked to pay for their insurance by mailing a check in advance.

How do I keep my benefits?

Take action during Open Enrollment. Enroll in a health care plan and it will take effect July 1.

How do I waive my benefits?

If you’d like to waive health care coverage in July, you can waive during Open Enrollment. That will end your current health care coverage on June 30.

Can I enroll in benefits when I return to work?

Yes. Employees who return from unpaid leave qualify to change benefits, within 30 days of their retun date. If you choose to waive benefits for July, you can fill out the Benefits Change Form when you return to work, and your coverage will begin the first day of the month after you return to work. Note: If you waive coverage in July and do not return to work, you will not be eligible for COBRA. For additional information, Visit thecommons.dpsk12.org/ summerhealthcarecoverage.

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See How DPS Contributes

$56 million $47M

$3.7M

IN BENEFIT CREDITS

IN HEALTH SAVINGS ACCOUNT (HSA) CONTRIBUTIONS

$5M

$264K

IN CHILD, HMO, FELLOW AND MEDICAL SUBSIDIES

IN WELL AWARE REWARDS

When you enroll in medical, dental and vision plans, you pay a premium each paycheck for that insurance. DPS makes contributions to lower your out-of-pocket costs for health care premiums. We make contributions in the form of benefit credits, subsidies (premium discounts), contributions and Well Aware rewards for completing your preventive health visits and screenings.

Which contributions you receive and how much you receive depend on several factors, including your role at DPS, how many hours you work a week, and which type of plan and coverage level you choose.

These contributions will be automatically factored into your premium costs when you enroll.

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WHAT IS AN EMPLOYEE ASSOCIATION?

Most team members at DPS are represented by an employee association (also known as a bargaining unit or union). Your role at DPS determines which employee association you belong to. For example, a teacher is part of the DCTA employee association.

WHAT ARE BENEFIT CREDITS?

Benefit credits are what DPS contributes to offset your cost for premiums for medical, dental and vision plans. Most employees are eligible to receive them. The amount varies by employee association and how many hours you work a week.

Some DPS employees receive benefit credits even if they waive medical coverage. To identify if you are eligible to receive benefit credits even if you do not enroll in medical coverage, refer to the hire dates and employee associations listed below. If you were hired before the date listed next to your employee association, you are eligible to receive benefit credits, even if you waive medical coverage. If you were hired on or after the date listed next your employee association, you must enroll in medical insurance to receive benefit credits.

• All employees, except: DCTA, FMA, ATU: 6/1/2017.

• DCTA and FMA employees: 6/1/2018.

• ATU employees: 1/1/2019.

Note: Check the employee association rate pages (22-43) to see if you are eligible for benefit credits.

WHAT ARE MEDICAL SUBSIDIES?

Employees who do not qualify for benefit credits may qualify for a medical subsidy, which is a discount off the cost of your premiums for medical plans.

WHAT ARE HSA CONTRIBUTIONS AND HMO SUBSIDIES?

If you’re enrolled in a Consumer-Driven Health Plan (CDHP), DPS contributes $27.92 per paycheck to your Health Savings Account (HSA).

You must enroll in an HSA to receive the HSA contribution from DPS. See page 45 for more information.

If you’re enrolled in a Deductible HMO plan, DPS contributes $27.92 per paycheck toward the premium cost of your medical plan because DHMO plan members are not eligible for an HSA.

WHAT IS A CHILD SUBSIDY?

Most employees receive an additional $96.75 per paycheck to offset the cost of premiums for medical plans that cover children.

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Compare Insurance Providers and Coverage Options You have a choice between eight medical plans from two insurance providers: Aetna and Kaiser Permanente. Each insurance provider has three Consumer-Driven Health Plans (CDHPs) and one Deductible HMO (DHMO) plan.

COMPARE AETNA AND KAISER PERMANENTE About Aetna

Aetna provides access to more than 1,200 primary care physicians and 5,900 specialists in the Whole Health Colorado Front Range Network. In the Open Access Network, Aetna provides access to 2,000 primary care physicians and 10,000 specialists. Aetna plans also feature: • A partnership with Dispatch Health, an in-home health care provider.

• Virtual access to a doctor through Teladoc. Connect with a licensed doctor, dermatologist or therapist through this convenient and affordable option.

• An option to talk with a nurse at any time to discuss symptoms and get health information and advice.

• Aetna Mobile, a mobile application that allows you to manage your health on-the-go.

Check to see if your doctor is in-network: aetna.com/individuals-families/find-a-doctor.html *Based on your plan, select either: (CO) Aetna Whole Health - Colorado Front Range Health Network Only or Aetna Health Network Only (Open Access).

Questions?

Visit aetna.com or call 1-800-872-3862 (non-members), or the Member Services number on your ID card (members).

About Kaiser Permanente

Kaiser provides access to 1,300 providers at 22 medical centers throughout the Denver-Boulder region. Kaiser plans also feature: • Chat online with a Kaiser physician for immediate care with no copay, or email your doctor with non-urgent questions and receive a response within one business day.

• Video visits with a doctor, so you can save yourself a trip to your doctor’s office, and online wellness resources, including fitness videos and podcasts.

• 24-hour-a-day access to telephone advice and nurse line.

• Same-day, next-day, after-hours and weekend services with physicians and specialists at many locations.

Check to see if your doctor is in-network: healthy.kaiserpermanente.org/doctors-locations

Questions?

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Visit kp.org or call 303-338-3800.

ABOUT MEDICAID Free or low-cost health insurance may be available to you if your income is under a certain amount.

Medicaid can also help with food assistance, cash assistance, vouchers for shelters and other resources. For more information and to see if you, your family or your children qualify, please call the DPS Outreach and Enrollment Specialist at 720-423-3661.

WHAT’S THE DIFFERENCE BETWEEN A DHMO AND CDHP?

Deductible HMO (DHMO)

Consumer-Driven Health Plan (CDHP)

Higher monthly premiums (on average). DPS contributes $27.92 per paycheck to offset the cost of the premium.

Lower monthly premiums (on average).

DPS contributes $27.92 per paycheck for employees enrolled in Health Savings Accounts (HSAs).

Predictability of pre-set copays for routine office visits and most prescriptions.

You pay full cost for office visits and prescriptions until your deductible is met.

Option of contributing to a Health Care Flexible Spending Account (FSA).

Option of contributing to a Health Savings Account (HSA)

WHAT’S THE SAME? • Preventive care visits are covered at no cost to you.

• You pay out-of-pocket for procedures, diagnostic tests, hospitalization and outpatient surgery until your deductible is met.

• Once your deductible is met, you pay a coinsurance percentage for procedures or services until your out-of-pocket maximum is met.

• After your out-of-pocket maximum is met, your plan pays 100% of costs for the rest of the plan year.

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BENEFITS 101: WHAT DO I NEED TO KNOW? What’s a deductible?

Your deductible is the amount you pay out-of-pocket before your insurance provider pays a portion of the bill. If you enroll in a DHMO plan, there are certain benefits (i.e. office visits and prescriptions) where the deductible doesn’t apply.

What’s coinsurance?

After you meet your deductible, coinsurance is when you and your insurance provider share the costs of your medical care. You pay a percentage (usually 20-30%) and your insurance provider pays the remaining amount until you hit your out-of-pocket maximum.

What’s a copay?

A copay is a fixed payment you pay for a covered service. For example, if you have a DHMO plan, you may pay a $40 copay to see your primary care physician.

What’s an out-of-pocket maximum?

This is the maximum you pay out-of-pocket for medical care. Any charges above this amount are paid 100% by your insurance provider for the rest of the plan year. Deductibles, coinsurance and copays are all included in our plans’ out-of-pocket maximums.

What’s the difference between embedded and non-embedded deductibles and out-of-pocket maximums?

An embedded deductible or out-of-pocket maximum applies to all plans except the Kasier 1350 CDHP. That means: •

If you cover your family (spouse and/or children), all eligible medical costs for each family member will count toward meeting the family deductible. However, an individual will not have to pay more than the individual deductible.

•

Your insurance provider begins paying coinsurance for family members covered by your plan who meet their individual deductibles, or when you meet your family deductible.

•

The same is true for out-of-pocket maximums: your insurance provider begins paying 100% of your medical care costs for family members who meet their out-of-pocket maximums, or when you meet your family out-of-pocket maximum.

A non-embedded deductible or out-of-pocket maximum only applies to the Kaiser 1350 CDHP medical plan. That means:

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•

If you cover your family (spouse and/or children), the family deductible must be met either by one individual, or by a combination of family members, before the plan begins to pay.

•

This means one insured person might hit their $1,350 deductible, but your insurance provider won’t pay coinsurance until you meet your $2,700 family deductible.

•

This applies to the out-of-pocket maximum as well: you must meet your total family out-of-pocket maximum ($5,400) before your insurance provider begins paying 100% of your medical care costs.

What’s a 1095C?

A 1095-C form, also known as Employer-Provided Health Insurance Offer and Coverage Insurance, is an IRS tax form that provides all benefits-eligible employees with information about the health coverage offered by DPS. This form may help you to determine eligibility for tax credits.

What’s a Pre-Tax Benefit Deduction?

The cost of your benefits is deducted from your paycheck before taxes are calculated, and you are therefore only taxed on your remaining paycheck balance. You pay less taxes with this option.

What’s a Post-Tax Benefit Deduction?

The cost of your benefits is deducted from your paycheck after taxes are calculated. You pay more taxes with this option.

DUAL INSURANCE

If you and your spouse are both benefits-eligible DPS employees, you may want to consider a split enrollment arrangement. This arrangement may provide increased employer contributions through benefit credits, subsidies and HSA contributions.

For example, Mike and Mary are married with children. Instead of Mike enrolling in family insurance with Mary and the kids as dependents, Mike enrolls in employee+child insurance and Mary enrolls in employee-only coverage. This arrangement ensures that Mike and Mary both receive full benefit credits and subsidies and also means that the children are covered only under Mike’s policy, and not under Mary’s.

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UNDERSTAND THE BENEFITS ON YOUR PAYSTUB

2

3

4

5

3 6

1

7

8

9 11

* This is an example. Your individual paystub will vary.

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1

Benefit Credits Benefit Credits are what DPS contributes to offset your cost for premiums for medical, dental, and vision plans.

2

Pre-Tax Deductions These are the items that are deducted from your check before taxes are taken out.

3

Delta Dental and VSP Vision These are the per-paycheck medical premiums charged for dental and vision insurance.

4

Medical Insurance This is the per-paycheck medical premium charged for medical insurance. All eligible subsidies have already been applied (child, medical, and HMO).

5

HSA This is the per-paycheck amount contributed to a health savings account by the employee.

6

VAL-403B This is the per-paycheck amount contributed to a retirement account (voluntary) by the employee.

7

Pension Colorado PERA This is a required contribution that is taken out of your check. You pay into Colorado PERA instead of paying into Social Security.

8

After-Tax Deductions Post-tax deductions are the items that are deducted from your check after taxes are taken out.

9

Employer-Paid Contributions These are DPS contributions toward your benefits.

They are not included in your check amount.

10

Group Term Life Insurance This is the contribution DPS makes per-paycheck to all DPS employees’ life insurance policies.

11

Health Savings Account This is the HSA subsidy contributed by DPS to the employee’s HSA account.

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Aetna Plan Details for Denver Public Schools

SUMMARY OF COVERED BENEFITS

CDHP 3500 PLAN - Whole Health In-Network Only

CDHP 2700 PLAN - Whole Health In-Network Only

Plan Year, Embedded

Plan Year, Embedded

Individual

$3,500

$2,700

Family

$7,000

$5,400

Embedded, includes deductibles and coinsurance

Embedded, includes deductibles and coinsurance

Individual

$6,350

$4,000

Family

$12,700

$8,000

Primary Care Physician

After Deductible, you pay 30% coinsurance

After Deductible, you pay 30% coinsurance

Specialist

After Deductible, you pay 30% coinsurance

After Deductible, you pay 30% coinsurance

Child/Adult

100% covered

100% covered

Urgent Care

After Deductible, you pay 30% coinsurance

After Deductible, you pay 30% coinsurance

Inpatient

After Deductible, you pay 30% coinsurance

After Deductible, you pay 30% coinsurance

Outpatient/Ambulatory Surgery

After Deductible, you pay 30% coinsurance

After Deductible, you pay 30% coinsurance

Emergency Room (in-or out-of-network)

After Deductible, you pay 30% coinsurance

After Deductible, you pay 30% coinsurance

Diagnostic Lab/X-Ray

After Deductible, you pay 30% coinsurance

After Deductible, you pay 30% coinsurance

High Tech Services (MRI, CT scans, etc.)

After Deductible, you pay 30% coinsurance

After Deductible, you pay 30% coinsurance

Prescriptions

Preventive Rx 100% covered

Preventive Rx 100% covered

Tier 1 - Generic

After Deductible, you pay $20 copay

After Deductible, you pay $20 copay

Tier 2 - Preferred Brand

After Deductible, you pay $40 copay

After Deductible, you pay $40 copay

Tier 3 - Non-Preferred Brand

After Deductible, you pay $60 copay

After Deductible, you pay $60 copay

After Deductible, you pay 20% coinsurance

After Deductible, you pay 20% coinsurance

After Deductible, you pay 2x retail copay

After Deductible, you pay 2x retail copay

Combined 60 visits max per year

Combined 60 visits max per year

After Deductible, you pay 30% coinsurance

After Deductible, you pay 30% coinsurance

25 visits max per year

25 visits max per year

After Deductible, you pay 30% coinsurance

After Deductible, you pay 30% coinsurance

1 exam every 24 months with an in-network Optometrist or Ophthalmologist. (May also use DocFind to locate one through EyeMed)

1 exam every 24 months with an in-network Optometrist or Ophthalmologist. (May also use DocFind to locate one through EyeMed)

Discounts available to Aetna members

Discounts available to Aetna members

Annual Deductible

Out-of-Pocket Max

Physician Services

Preventive Care

Hospital Services

Lab/X-Ray

Tier 4 - Specialty Mail Order Therapies Therapies Annual or Plan Year Limits Physical, Occupational and Speech Therapy Chiropractic Annual or Plan Year Limits Chiropractic Care Vision Refractive Exam Eyewear

*Coinsurance for covered services received during a visit may apply.

18

New This Year: We are now offering an Aetna 2700 Open Access CDHP plan. An open access plan gives members access to a larger network than the other Aetna plans, including to more than 1,200 primary care doctors and 5,900 specialists, and 53 hospitals and 83 urgent care centers.

SUMMARY OF COVERED BENEFITS

Deductible, coinsurance and copays are included in the out-of-pocket maximums for all plans.

After you meet your deductible, coinsurance is the percentage you pay for medical care until you hit your out-of-pocket maximum.

CDHP 2700 PLAN - Open Access Health Network Only

COPAY DHMO 1000 - Whole Health In-Network Only

Plan Year, Embedded

Plan Year, Embedded

Individual

$2,700

$1,000

Family

$5,400

$3,000

Embedded, includes deductibles and coinsurance

Embedded, includes deductible, copays and coinsurance

Individual

$4,000

$3,000

Family

$8,000

$9,000

Primary Care Physician

After Deductible, you pay 30% coinsurance

$40 copay*

Specialist

After Deductible, you pay 30% coinsurance

$60 copay*

Child/Adult

100% covered

100% covered

Urgent Care

After Deductible, you pay 30% coinsurance

$60 copay*

Inpatient

After Deductible, you pay 30% coinsurance

After Deductible, you pay 30% coinsurance

Outpatient/Ambulatory Surgery

After Deductible, you pay 30% coinsurance

After Deductible, you pay 30% coinsurance

Emergency Room (in-or out-of-network)

After Deductible, you pay 30% coinsurance

After Deductible, you pay 30% coinsurance

Diagnostic Lab/X-Ray

After Deductible, you pay 30% coinsurance

After Deductible, you pay 30% coinsurance

High Tech Services (MRI, CT scans, etc.)

After Deductible, you pay 30% coinsurance

After Deductible, you pay 30% coinsurance

Annual Deductible

Out-of-Pocket Max

Physician Services

Preventive Care

Hospital Services

Lab/X-Ray

Prescriptions

Preventive Rx 100% covered

Tier 1 - Generic

After Deductible, you pay $20 copay

$20

Tier 2 - Preferred Brand

After Deductible, you pay $40 copay

$40

Tier 3 - Non-Preferred Brand Tier 4 - Specialty Mail Order

After Deductible, you pay $60 copay

$60

After Deductible, you pay 20% coinsurance

20% to $250 max

After Deductible, you pay 2x retail copay

2x retail copay

Combined 60 visits max per year

Combined 60 visits max per year

After Deductible, you pay 30% coinsurance

$40 copay

25 visits max per year

25 visits max per year

After Deductible, you pay 30% coinsurance

$40 copay

1 exam every 24 months with an in-network Optometrist or Ophthalmologist. (May also use DocFind to locate one through EyeMed)

1 exam every 24 months with an in-network Optometrist or Ophthalmologist. (May also use DocFind to locate one through EyeMed)

Discounts available to Aetna members

Discounts available to Aetna members

Therapies Therapies Annual or Plan Year Limits Physical, Occupational and Speech Therapy Chiropractic Annual or Plan Year Limits Chiropractic Care Vision Refractive Exam Eyewear

19

Kaiser Permanente Plan Details for Denver Public Schools

SUMMARY OF COVERED BENEFITS

CDHP 3500 PLAN In-Network Only

CDHP 2700 PLAN In-Network Only

Plan Year, Embedded

Plan Year, Embedded

Individual

$3,500

$2,700

Family

$7,000

$5,400

Embedded, includes deductibles and coinsurance

Embedded, includes deductibles and coinsurance

Individual

$6,350

$4,000

Family

$12,700

$8,000

Primary Care Physician

After Deductible, you pay 30% coinsurance

After Deductible, you pay 30% coinsurance

Specialist

After Deductible, you pay 30% coinsurance

After Deductible, you pay 30% coinsurance

Child/Adult

100% covered

100% covered

Urgent Care

After Deductible, you pay 30% coinsurance

After Deductible, you pay 30% coinsurance

Inpatient

After Deductible, you pay 30% coinsurance

After Deductible, you pay 30% coinsurance

Outpatient/Ambulatory Surgery

After Deductible, you pay 30% coinsurance

After Deductible, you pay 30% coinsurance

Emergency Room (in-or out-of-network)

After Deductible, you pay 30% coinsurance

After Deductible, you pay 30% coinsurance

Diagnostic Lab/X-Ray

After Deductible, you pay 30% coinsurance

After Deductible, you pay 30% coinsurance

High Tech Services (MRI, CT scans, etc.)

After Deductible, you pay 30% coinsurance

After Deductible, you pay 30% coinsurance

Prescriptions

Preventive Rx 100% covered

Preventive Rx 100% covered

Tier 1 - Generic

After Deductible, you pay $20 copay

After Deductible, you pay $20 copay

Tier 2 - Preferred Brand

After Deductible, you pay $40 copay

After Deductible, you pay $40 copay

Tier 3 - Non-Preferred Brand

After Deductible, you pay $60 copay

After Deductible, you pay $60 copay

After Deductible, you pay 20% coinsurance

After Deductible, you pay 20% coinsurance

After Deductible, you pay 2x retail copay

After Deductible, you pay 2x retail copay

Combined 60 visits max per year

Combined 60 visits max per year

After Deductible, you pay 30% coinsurance

After Deductible, you pay 30% coinsurance

25 visits max per year

25 visits max per year

After Deductible, you pay 30% coinsurance

After Deductible, you pay 30% coinsurance

1 exam per year

1 exam per year

Discounts may be available

Discounts may be available

Annual Deductible

Out-of-Pocket Max

Physician Services

Preventive Care

Hospital Services

Lab/X-Ray

Tier 4 - Specialty Mail Order Therapies Therapies Annual or Plan Year Limits Physical, Occupational and Speech Therapy Chiropractic Annual or Plan Year Limits Chiropractic Care Vision Refractive Exam Eyewear

*Coinsurance for covered services received during a visit may apply.

20

Deductible, coinsurance and copays are included in the out-of-pocket maximums for all plans.

SUMMARY OF COVERED BENEFITS

After you meet your deductible, coinsurance is the percentage you pay for medical care until you hit your out-of-pocket maximum.

CDHP 1350 PLAN In-Network Only

COPAY DHMO 1000 In-Network Only

Plan Year, Non-Embedded

Plan Year, Embedded

Individual

$1,350

$1,000

Family

$2,700

$3,000

Non-Embedded, includes deductible and coinsurance

Embedded, includes deductible, copays and coinsurance

Individual

$2,700

$3,000

Family

$5,400

$9,000

Primary Care Physician

After Deductible, you pay 20% coinsurance

$40 copay*

Specialist

After Deductible, you pay 20% coinsurance

$60 copay*

Child/Adult

100% covered

100% covered

Urgent Care

After Deductible, you pay 20% coinsurance

$60 copay*

Inpatient

After Deductible, you pay 20% coinsurance

After Deductible, you pay 30% coinsurance

Outpatient/Ambulatory Surgery

After Deductible, you pay 20% coinsurance

After Deductible, you pay 30% coinsurance

Emergency Room (in-or out-of-network)

After Deductible, you pay 20% coinsurance

After Deductible, you pay 30% coinsurance

Diagnostic Lab

After Deductible, you pay 20% coinsurance

Covered at no cost to member when performed in a KP medical center

X-Ray

After Deductible, you pay 20% coinsurance

After Deductible, you pay 30% coinsurance

High Tech Services (MRI, CT scans, etc.)

After Deductible, you pay 20% coinsurance

After Deductible, you pay 30% coinsurance

Annual Deductible

Out-of-Pocket Max

Physician Services

Preventive Care

Hospital Services

Lab/X-Ray

Prescriptions

Preventive Rx 100% covered

Tier 1 - Generic

After Deductible, you pay $20 copay

$20

Tier 2 - Preferred Brand

After Deductible, you pay $40 copay

$40

Tier 3 - Non-Preferred Brand

After Deductible, you pay $60 copay

$60

After Deductible, you pay 20% coinsurance

20% to $250 max

After Deductible, you pay 2x retail copay

2x retail copay

Combined 60 visits max per year

Combined 60 visits max per year

After Deductible, you pay 20% coinsurance

$40 copay

25 visits max per year

25 visits max per year

After Deductible, you pay 20% coinsurance

$40 copay

1 exam per year

1 exam per year

Discounts may be available

Discounts may be available

Tier 4 - Specialty Mail Order Therapies Therapies Annual or Plan Year Limits Physical, Occupational and Speech Therapy Chiropractic Annual or Plan Year Limits Chiropractic Care Vision Refractive Exam Eyewear

21

Plan Rates by Employee Association

ABGW: Association of Building, Grounds and Warehouse

Who is part of ABGW? Building maintenance, grounds maintenance, warehouse and truck drivers

DPS CONTRIBUTIONS PER PAYCHECK (TWICE PER MONTH) Benefit Credits • Full-Time (40 hours per week) employees only *Employees with a start date of 5/31/2017 or earlier will receive benefit credits whether they do or do not enroll in DPS medical coverage

Medical Subsidy • Employees working 30-39.99 hours per week at an hourly rate of less than $25

Child Subsidy • All employees are eligible • You must enroll in a medical plan that covers your children in order to receive this subsidy HSA or HMO Subsidy • All employees are eligible • You must enroll in a CDHP medical plan and an HSA during annual Benefits Open Enrollment or as a newly benefitseligible employee to receive the HSA contribution from DPS • You must enroll in an HMO medical plan to receive an HMO subsidy

22

$220.95 Benefit Credits will be listed as earnings on your paystub.

$100 The Medical Subsidy will not appear on your paystub, but will be automatically deducted from your premium rate.

$96.75 The Child Subsidy will not appear on your paystub, but will be automatically deducted from your premium rate.

$27.92 HSA Subsidies will be deposited directly into your HSA account and will appear on your paystub. HMO subsidies will not appear on your paystub, but will be automatically deducted from your premium rate.

WHAT YOU ACTUALLY PAY PER PAYCHECK (TWICE MONTHLY) PREMIUM

DPS CONTRIBUTIONS

(cost of plan, appears on paystub)

RATES BELOW

(applicable Benefit Credits/Subsidies)

A negative number below is money you can use toward other benefit costs, such as dental/vision premiums or supplemental benefits, or it will appear as a credit on your paystub.

ABGW FULL-TIME EMPLOYEE RATES Aetna CDHP 3500

Aetna CDHP 2700

Aetna CDHP 2700 Open Access

Aetna DHMO

Kaiser CDHP 3500

Kaiser CDHP 2700

Kaiser CDHP 1350

Kaiser DHMO

Employee Only

-21.63

48.43

95.45

13.00

-49.80

-16.16

16.57

12.83

Employee + Spouse

237.49

398.63

506.77

353.42

181.24

260.31

337.21

366.12

Employee + Child(ren)

41.08

167.19

251.82

125.74

21.17

87.79

152.58

172.54

Employee + Family

250.37

450.04

584.04

400.70

241.96

351.97

458.97

510.13

*All rates are subject to change.

23

Administrators and Protechs

Who is a an Administrator/Protech?

Non-union employees, including: principals, assistant principals, deans, managers, directors, extended learning, temporary employees, guest teachers, long-term substitutes, active retirees and protechs (analysts, specialists, coordinators, CTE instructors, EGC instructors, math fellows, athletic trainers)

DPS CONTRIBUTIONS PER PAYCHECK (TWICE PER MONTH) Benefit Credits • Eligible positions: principals, assistant principals, deans, managers, directors, and protechs *Employees with a start date of 5/31/2017 or earlier will receive benefit credits whether they do or do not enroll in DPS medical coverage

$171.50 prorated by FTE Benefit Credits will be listed as earnings on your paystub.

Medical Subsidy • Eligible positions: extended learning, temporary employees, guest teachers, active retirees, long-term substitutes

$100

• Extended Learning only: Employees working 20-29.99 hours per week at an hourly rate of less than $25

The Medical Subsidy will not appear on your paystub, but will be automatically deducted from your premium rate.

$65

Child Subsidy

$96.75

• All employees are eligible • You must enroll in a medical plan that covers your children in order to receive this subsidy

The Child Subsidy will not appear on your paystub, but will be automatically deducted from your premium rate.

HSA or HMO Subsidy

$27.92

• All employees are eligible • You must enroll in a CDHP medical plan and an HSA during annual Benefits Open Enrollment or as a newly benefitseligible employee to receive the HSA contribution from DPS • You must enroll in an HMO medical plan to receive an HMO subsidy

HSA Subsidies will be deposited directly into your HSA account and will appear on your paystub. HMO subsidies will not appear on your paystub, but will be automatically deducted from your premium rate.

WHAT YOU ACTUALLY PAY PER PAYCHECK (TWICE MONTHLY) PREMIUM

(cost of plan, appears on paystub)

DPS CONTRIBUTIONS

(applicable Benefit Credits/Subsidies)

RATES AT RIGHT

A negative number in the chart on the right is money you can use toward other benefit costs, such as dental/ vision premiums or supplemental benefits, or it will appear as a credit on your paystub.

24

EXTENDED LEARNING 20-29.99 HOUR RATES Aetna Aetna Aetna CDHP 2700 CDHP 3500 CDHP 2700 Open Access

Aetna DHMO

Kaiser CDHP 3500

Kaiser CDHP 2700

Kaiser CDHP 1350

Kaiser DHMO

Employee Only

134.32

204.38

251.40

168.95

106.15

139.79

172.52

168.78

Employee + Spouse

393.44

554.58

662.72

509.37

337.19

416.26

493.16

522.07

Employee + Child(ren)

197.03

323.14

407.77

281.69

177.12

243.74

308.53

328.49

Employee + Family

406.32

605.99

739.99

556.65

397.91

507.92

614.92

666.08

EXTENDED LEARNING 30+ HOUR RATES, GUEST TEACHERS, ACTIVE RETIREES, LONG-TERM SUBSTITUTES AND TEMPORARY EMPLOYEE RATES Aetna Aetna Aetna CDHP 2700 Open CDHP 3500 CDHP 2700 Access

Aetna DHMO

Kaiser CDHP 3500

Kaiser CDHP 2700

Kaiser CDHP 1350

Kaiser DHMO

Employee Only

99.32

169.38

216.40

133.95

71.15

104.79

137.52

133.78

Employee + Spouse

358.44

519.58

627.72

474.37

302.19

381.26

458.16

487.07

Employee + Child(ren)

162.03

288.14

372.77

246.69

142.12

208.74

273.53

293.49

Employee + Family

371.32

570.99

704.99

521.65

362.91

472.92

579.92

631.08

SCHOOL LEADERS AND ALL OTHER FULL-TIME PROTECH AND ADMIN RATES Aetna Aetna Aetna CDHP 2700 CDHP 3500 CDHP 2700 Open Access

Aetna DHMO

Kaiser CDHP 3500

Kaiser CDHP 2700

Kaiser CDHP 1350

Kaiser DHMO

Employee Only

27.82

97.88

144.90

62.45

-0.35

33.29

66.02

62.28

Employee + Spouse

286.94

448.08

556.22

402.87

230.69

309.76

386.66

415.57

Employee + Child(ren)

90.53

216.64

301.27

175.19

70.62

137.24

202.03

221.99

Employee + Family

299.82

499.49

633.49

450.15

291.41

401.42

508.42

559.58

*All rates are subject to change.

25

ATU: Amalgamated Transit Union

Who is part of ATU? Bus drivers, vehicle maintenance techs and parts clerks

DPS CONTRIBUTIONS PER PAYCHECK (TWICE PER MONTH) Benefit Credits

$193.06 $95.23 $216.84 $201.71

• Full-time bus drivers • Hourly bus drivers • Full-time mechanics • Full-time techs, parts and toolroom *Employees with a start date of 12/31/2018 or earlier will receive benefit credits whether they do or do not enroll in DPS medical coverage

Benefit Credits will be listed as earnings on your paystub.

$77.80

Medical Subsidy • Hourly bus drivers, only if enrolled in medical

The Medical Subsidy will not appear on your paystub, but will be automatically deducted from your premium rate.

Child Subsidy

$96.75

• All employees are eligible • You must enroll in a medical plan that covers your children in order to receive this subsidy

The Child Subsidy will not appear on your paystub, but will be automatically deducted from your premium rate.

HSA or HMO Subsidy

$27.92

• All employees are eligible • You must enroll in a CDHP medical plan and an HSA during annual Benefits Open Enrollment or as a newly benefitseligible employee to receive the HSA contribution from DPS • You must enroll in an HMO medical plan to receive an HMO subsidy

HSA Subsidies will be deposited directly into your HSA account and will appear on your paystub. HMO subsidies will not appear on your paystub, but will be automatically deducted from your premium rate.

WHAT YOU ACTUALLY PAY PER PAYCHECK (TWICE MONTHLY) PREMIUM

(cost of plan, appears on paystub)

DPS CONTRIBUTIONS

(applicable Benefit Credits/Subsidies)

RATES AT RIGHT

A negative number in the chart on the right is money you can use toward other benefit costs, such as dental/ vision premiums or supplemental benefits, or it will appear as a credit on your paystub.

26

ATU FULL-TIME BUS DRIVER RATES Aetna Aetna Aetna CDHP 2700 CDHP 3500 CDHP 2700 Open Access

Aetna DHMO

Kaiser CDHP 3500

Kaiser CDHP 2700

Kaiser CDHP 1350

Kaiser DHMO

Employee Only

6.26

76.32

123.34

40.89

-21.91

11.73

44.46

40.72

Employee + Spouse

265.38

426.52

534.66

381.31

209.13

288.20

365.10

394.01

Employee + Child(ren)

68.97

195.08

279.71

153.63

49.06

115.68

180.47

200.43

Employee + Family

278.26

477.93

611.93

428.59

269.85

379.86

486.86

538.02

ATU HOURLY BUS DRIVER RATES Aetna Aetna Aetna CDHP 2700 Open CDHP 3500 CDHP 2700 Access

Aetna DHMO

Kaiser CDHP 3500

Kaiser CDHP 2700

Kaiser CDHP 1350

Kaiser DHMO

Employee Only

26.29

96.35

143.37

60.92

-1.88

31.76

64.49

60.75

Employee + Spouse

285.41

446.55

554.69

401.34

229.16

308.23

385.13

414.04

Employee + Child(ren)

89.00

215.11

299.74

173.66

69.09

135.71

200.50

220.46

Employee + Family

298.29

497.96

631.96

448.62

289.88

399.89

506.89

558.05

ATU MECHANIC RATES Aetna Aetna Aetna CDHP 2700 CDHP 3500 CDHP 2700 Open Access

Aetna DHMO

Kaiser CDHP 3500

Kaiser CDHP 2700

Kaiser CDHP 1350

Kaiser DHMO

Employee Only

-17.52

52.54

99.56

17.11

-45.69

-12.05

20.68

16.94

Employee + Spouse

241.60

402.74

510.88

357.53

185.35

264.42

341.32

370.23

Employee + Child(ren)

45.19

171.30

255.93

129.85

25.28

91.90

156.69

176.65

Employee + Family

254.48

454.15

588.15

404.81

246.07

356.08

463.08

514.24

ATU TECHS, PARTS AND TOOL ROOM RATES Aetna Aetna Aetna CDHP 2700 CDHP 3500 CDHP 2700 Open Access

Aetna DHMO

Kaiser CDHP 3500

Kaiser CDHP 2700

Kaiser CDHP 1350

Kaiser DHMO

Employee Only

-2.39

67.67

114.69

32.24

-30.56

3.08

35.81

32.07

Employee + Spouse

256.73

417.87

526.01

372.66

200.48

279.55

356.45

385.36

Employee + Child(ren)

60.32

186.43

271.06

144.98

40.41

107.03

171.82

191.78

Employee + Family

269.61

469.28

603.28

419.94

261.20

371.21

478.21

529.37

*All rates are subject to change.

27

CFSSP: Colorado Federation of School Safety Professionals

Who is part of CFSSP? Patrol officers

DPS CONTRIBUTIONS PER PAYCHECK (TWICE PER MONTH) Benefit Credits • Full-Time (40 hours per week) employees only *Employees with a start date of 5/31/2017 or earlier will receive benefit credits whether they do or do not enroll in DPS medical coverage

Medical Subsidy • Employees working 30-39.99 hours per week at an hourly rate of less than $25

Child Subsidy • All employees are eligible • You must enroll in a medical plan that covers your children in order to receive this subsidy HSA or HMO Subsidy • All employees are eligible • You must enroll in a CDHP medical plan and an HSA during annual Benefits Open Enrollment or as a newly benefitseligible employee to receive the HSA contribution from DPS • You must enroll in an HMO medical plan to receive an HMO subsidy

28

$162.80 Benefit Credits will be listed as earnings on your paystub.

$100 The Medical Subsidy will not appear on your paystub, but will be automatically deducted from your premium rate.

$96.75 The Child Subsidy will not appear on your paystub, but will be automatically deducted from your premium rate.

$27.92 HSA Subsidies will be deposited directly into your HSA account and will appear on your paystub. HMO subsidies will not appear on your paystub, but will be automatically deducted from your premium rate.

WHAT YOU ACTUALLY PAY PER PAYCHECK (TWICE MONTHLY) PREMIUM

(cost of plan, appears on paystub)

DPS CONTRIBUTIONS

RATES BELOW

(applicable Benefit Credits/Subsidies)

A negative number below is money you can use toward other benefit costs, such as dental/vision premiums or supplemental benefits, or it will appear as a credit on your paystub.

CFSSP EMPLOYEE RATES Aetna CDHP 3500

Aetna CDHP 2700

Aetna CDHP 2700 Open Access

Aetna DHMO

Kaiser CDHP 3500

Kaiser CDHP 2700

Kaiser CDHP 1350

Kaiser DHMO

Employee Only

36.52

106.58

153.60

71.15

8.35

41.99

74.72

70.98

Employee + Spouse

295.64

456.78

564.92

411.57

239.39

318.46

395.36

424.27

Employee + Child(ren)

99.23

225.34

309.97

183.89

79.32

145.94

210.73

230.69

Employee + Family

308.52

508.19

642.19

458.85

300.11

410.12

517.12

568.28

*All rates are subject to change.

29

CWA: Communication Workers of America

Who is part of CWA? Custodian, crew leads and custodial helpers

DPS CONTRIBUTIONS PER PAYCHECK (TWICE PER MONTH) Benefit Credits • Full-Time (40 hours per week) employees only *Employees with a start date of 5/31/2017 or earlier will receive benefit credits whether they do or do not enroll in DPS medical coverage

Medical Subsidy • Employees working 20-39.99 hours per week at an hourly rate of less than $25

Child Subsidy • All employees are eligible • You must enroll in a medical plan that covers your children in order to receive this subsidy HSA or HMO Subsidy • All employees are eligible • You must enroll in a CDHP medical plan and an HSA during annual Benefits Open Enrollment or as a newly benefitseligible employee to receive the HSA contribution from DPS • You must enroll in an HMO medical plan to receive an HMO subsidy

30

$192.90 Benefit Credits will be listed as earnings on your paystub.

$100 The Medical Subsidy will not appear on your paystub, but will be automatically deducted from your premium rate.

$96.75 The Child Subsidy will not appear on your paystub, but will be automatically deducted from your premium rate.

$27.92 HSA Subsidies will be deposited directly into your HSA account and will appear on your paystub. HMO subsidies will not appear on your paystub, but will be automatically deducted from your premium rate.

WHAT YOU ACTUALLY PAY PER PAYCHECK (TWICE MONTHLY) PREMIUM

DPS CONTRIBUTIONS

(cost of plan, appears on paystub)

RATES BELOW

(applicable Benefit Credits/Subsidies)

A negative number below is money you can use toward other benefit costs, such as dental/vision premiums or supplemental benefits, or it will appear as a credit on your paystub.

CWA FULL-TIME EMPLOYEE RATES Aetna CDHP 3500

Aetna CDHP 2700

Aetna CDHP 2700 Open Access

Aetna DHMO

Kaiser CDHP 3500

Kaiser CDHP 2700

Kaiser CDHP 1350

Kaiser DHMO

6.42

76.48

123.50

41.05

-21.75

11.89

44.62

40.88

Employee + Spouse

265.54

426.68

534.82

381.47

209.29

288.36

365.26

394.17

Employee + Child(ren)

69.13

195.24

279.87

153.79

49.22

115.84

180.63

200.59

Employee + Family

278.42

478.09

612.09

428.75

270.01

380.02

487.02

538.18

Employee Only

CWA PART-TIME EMPLOYEE RATES Aetna CDHP 3500

Aetna CDHP 2700

Aetna CDHP 2700 Open Access

Aetna DHMO

Kaiser CDHP 3500

Kaiser CDHP 2700

Kaiser CDHP 1350

Kaiser DHMO

Employee Only

99.32

169.38

216.40

133.95

71.15

104.79

137.52

133.78

Employee + Spouse

358.44

519.58

627.72

474.37

302.19

381.26

458.16

487.07

Employee + Child(ren)

162.03

288.14

372.77

246.69

142.12

208.74

273.53

293.49

Employee + Family

371.32

570.99

704.99

521.65

362.91

472.92

579.92

631.08

*All rates are subject to change.

31

DAEOP: Denver Association of Educational Office Professionals

Who is part of DAEOP? Office support, bookkeepers, and other clerical employees

DPS CONTRIBUTIONS PER PAYCHECK (TWICE PER MONTH) Benefit Credits • Full-Time (40 hours per week) employees only *Employees with a start date of 5/31/2017 or earlier will receive benefit credits whether they do or do not enroll in DPS medical coverage

Medical Subsidy • Employees working 30-39.99 hours per week at an hourly rate of less than $25

Child Subsidy • All employees are eligible • You must enroll in a medical plan that covers your children in order to receive this subsidy HSA or HMO Subsidy • All employees are eligible • You must enroll in a CDHP medical plan and an HSA during annual Benefits Open Enrollment or as a newly benefitseligible employee to receive the HSA contribution from DPS • You must enroll in an HMO medical plan to receive an HMO subsidy

32

$161.50 Benefit Credits will be listed as earnings on your paystub.

$100 The Medical Subsidy will not appear on your paystub, but will be automatically deducted from your premium rate.

$96.75 The Child Subsidy will not appear on your paystub, but will be automatically deducted from your premium rate.

$27.92 HSA Subsidies will be deposited directly into your HSA account and will appear on your paystub. HMO subsidies will not appear on your paystub, but will be automatically deducted from your premium rate.

WHAT YOU ACTUALLY PAY PER PAYCHECK (TWICE MONTHLY) PREMIUM

DPS CONTRIBUTIONS

(cost of plan, appears on paystub)

RATES BELOW

(applicable Benefit Credits/Subsidies)

A negative number below is money you can use toward other benefit costs, such as dental/vision premiums or supplemental benefits, or it will appear as a credit on your paystub.

DAEOP FULL-TIME EMPLOYEE RATES Aetna CDHP 3500

Aetna CDHP 2700

Aetna CDHP 2700 Open Access

Aetna DHMO

Kaiser CDHP 3500

Kaiser CDHP 2700

Kaiser CDHP 1350

Kaiser DHMO

Employee Only

37.82

107.88

154.90

72.45

9.65

43.29

76.02

72.28

Employee + Spouse

296.94

458.08

566.22

412.87

240.69

319.76

396.66

425.57

Employee + Child(ren)

100.53

226.64

311.27

185.19

80.62

147.24

212.03

231.99

Employee + Family

309.82

509.49

643.49

460.15

301.41

411.42

518.42

569.58

DAEOP PART-TIME EMPLOYEE RATES Aetna CDHP 3500

Aetna CDHP 2700

Aetna CDHP 2700 Open Access

Aetna DHMO

Kaiser CDHP 3500

Kaiser CDHP 2700

Kaiser CDHP 1350

Kaiser DHMO

Employee Only

99.32

169.38

216.40

133.95

71.15

104.79

137.52

133.78

Employee + Spouse

358.44

519.58

627.72

474.37

302.19

381.26

458.16

487.07

Employee + Child(ren)

162.03

288.14

372.77

246.69

142.12

208.74

273.53

293.49

Employee + Family

371.32

570.99

704.99

521.65

362.91

472.92

579.92

631.08

*All rates are subject to change.

33

DCTA: Denver Classroom Teachers Association

Who is part of DCTA? Teachers and specialized service providers

DPS CONTRIBUTIONS PER PAYCHECK (TWICE PER MONTH) Benefit Credits • All employees are eligible *Employees with a start date of 5/31/2018 or earlier will receive benefit credits whether they do or do not enroll in DPS medical coverage

Child Subsidy • All employees are eligible • You must enroll in a medical plan that covers your children in order to receive this subsidy HSA or HMO Subsidy • All employees are eligible • You must enroll in a CDHP medical plan and an HSA during annual Benefits Open Enrollment or as a newly benefitseligible employee to receive the HSA contribution from DPS • You must enroll in an HMO medical plan to receive an HMO subsidy

34

$211.09 prorated by FTE Benefit Credits will be listed as earnings on your paystub.

$96.75 The Child Subsidy will not appear on your paystub, but will be automatically deducted from your premium rate.

$27.92 HSA Subsidies will be deposited directly into your HSA account and will appear on your paystub. HMO subsidies will not appear on your paystub, but will be automatically deducted from your premium rate.

WHAT YOU ACTUALLY PAY PER PAYCHECK (TWICE MONTHLY) PREMIUM

(cost of plan, appears on paystub)

DPS CONTRIBUTIONS

RATES BELOW

(applicable Benefit Credits/Subsidies)

A negative number below is money you can use toward other benefit costs, such as dental/vision premiums or supplemental benefits, or it will appear as a credit on your paystub.

DCTA FULL-TIME (.75-1.0 FTE) EMPLOYEE RATES Aetna CDHP 3500

Aetna CDHP 2700

Aetna CDHP 2700 Open Access

Aetna DHMO

Kaiser CDHP 3500

Kaiser CDHP 2700

Kaiser CDHP 1350

Kaiser DHMO

Employee Only

-11.77

58.29

105.31

22.86

-39.94

-6.30

26.43

22.69

Employee + Spouse

247.35

408.49

516.63

363.28

191.10

270.17

347.07

375.98

Employee + Child(ren)

50.94

177.05

261.68

135.60

31.03

97.65

162.44

182.40

Employee + Family

260.23

459.90

593.90

410.56

251.82

361.83

468.83

519.99

*All rates are subject to change.

35

DFPNSE: Denver Federation of Paraprofessionals and Nutrition Service Employees

Who is part of DFPNSE? Special education, general assignment, bus assistance and ELA paraprofessionals; campus safety officers and food service workers and managers

DPS CONTRIBUTIONS PER PAYCHECK (TWICE PER MONTH) Benefit Credits • Paraprofessionals and campus safety officers working 7 or more hours per day

$150.41

• Full-time food service managers

$148.64

*Employees with a start date of 5/31/2017 or earlier will receive benefit credits whether they do or do not enroll in DPS medical coverage

Benefit Credits will be listed as earnings on your paystub.

Medical Subsidy • Paraprofessionals working 6-6.99 hours per day • Food service workers working 6+ hours per day • Food service workers working 4-5.99 hours per day

$100 $110 $100 The Medical Subsidy will not appear on your paystub, but will be automatically deducted from your premium rate.

Child Subsidy • All employees are eligible • You must enroll in a medical plan that covers your children in order to receive this subsidy HSA or HMO Subsidy • All employees are eligible • You must enroll in a CDHP medical plan and an HSA during annual Benefits Open Enrollment or as a newly benefitseligible employee to receive the HSA contribution from DPS • You must enroll in an HMO medical plan to receive an HMO subsidy

36

$96.75 The Child Subsidy will not appear on your paystub, but will be automatically deducted from your premium rate.

$27.92 HSA Subsidies will be deposited directly into your HSA account and will appear on your paystub. HMO subsidies will not appear on your paystub, but will be automatically deducted from your premium rate.

WHAT YOU ACTUALLY PAY PER PAYCHECK (TWICE MONTHLY) PREMIUM

(cost of plan, appears on paystub)

DPS CONTRIBUTIONS

RATES BELOW

(applicable Benefit Credits/Subsidies)

A negative number below is money you can use toward other benefit costs, such as dental/vision premiums or supplemental benefits, or it will appear as a credit on your paystub.

DFPNSE PARAPROFESSIONAL FULL-TIME EMPLOYEE RATES Aetna CDHP 3500

Aetna CDHP 2700

Aetna CDHP 2700 Open Access

Aetna DHMO

Kaiser CDHP 3500

Kaiser CDHP 2700

Kaiser CDHP 1350

Kaiser DHMO

Employee Only

48.91

118.97

165.99

83.54

20.74

54.38

87.11

83.37

Employee + Spouse

308.03

469.17

577.31

423.96

251.78

330.85

407.75

436.66

Employee + Child(ren)

111.62

237.73

322.36

196.28

91.71

158.33

223.12

243.08

Employee + Family

320.91

520.58

654.58

471.24

312.50

422.51

529.51

580.67

DFPNSE PARAPROFESSIONAL 6-6.99 HOURS PER DAY EMPLOYEE RATES Aetna CDHP 3500

Aetna CDHP 2700

Aetna CDHP 2700 Open Access

Aetna DHMO

Kaiser CDHP 3500

Kaiser CDHP 2700

Kaiser CDHP 1350

Kaiser DHMO

Employee Only

99.32

169.38

216.40

133.95

71.15

104.79

137.52

133.78

Employee + Spouse

358.44

519.58

627.72

474.37

302.19

381.26

458.16

487.07

Employee + Child(ren)

162.03

288.14

372.77

246.69

142.12

208.74

273.53

293.49

Employee + Family

371.32

570.99

704.99

521.65

362.91

472.92

579.92

631.08

*All rates are subject to change.

Rate tables continued on next page...

37

DFPNSE: Denver Federation of Paraprofessionals and Nutrition Service Employees, continued DFPNSE FOOD SERVICE MANAGER RATES Aetna CDHP 3500

Aetna CDHP 2700

Aetna CDHP 2700 Open Access

Aetna DHMO

Kaiser CDHP 3500

Kaiser CDHP 2700

Kaiser CDHP 1350

Kaiser DHMO

Employee Only

50.68

120.74

167.76

85.31

22.51

56.15

88.88

85.14

Employee + Spouse

309.80

470.94

579.08

425.73

253.55

332.62

409.52

438.43

Employee + Child(ren)

113.39

239.50

324.13

198.05

93.48

160.10

224.89

244.85

Employee + Family

322.68

522.35

656.35

473.01

314.27

424.28

531.28

582.44

DFPNSE FOOD SERVICE WORKER 6+ HOURS/DAY RATES Aetna CDHP 3500

Aetna CDHP 2700

Aetna CDHP 2700 Open Access

Aetna DHMO

Kaiser CDHP 3500

Kaiser CDHP 2700

Kaiser CDHP 1350

Kaiser DHMO

Employee Only

89.32

159.38

206.40

123.95

61.15

94.79

127.52

123.78

Employee + Spouse

348.44

509.58

617.72

464.37

292.19

371.26

448.16

477.07

Employee + Child(ren)

152.03

278.14

362.77

236.69

132.12

198.74

263.53

283.49

Employee + Family

361.32

560.99

694.99

511.65

352.91

462.92

569.92

621.08

DFPNSE FOOD SERVICE WORKER 4-5.99 HOURS/DAY RATES Aetna CDHP 3500

Aetna CDHP 2700

Aetna CDHP 2700 Open Access

Aetna DHMO

Kaiser CDHP 3500

Kaiser CDHP 2700

Kaiser CDHP 1350

Kaiser DHMO

Employee Only

99.32

169.38

216.40

133.95

71.15

104.79

137.52

133.78

Employee + Spouse

358.44

519.58

627.72

474.37

302.19

381.26

458.16

487.07

Employee + Child(ren)

162.03

288.14

372.77

246.69

142.12

208.74

273.53

293.49

Employee + Family

371.32

570.99

704.99

521.65

362.91

472.92

579.92

631.08

*All rates are subject to change.

38

39

FMA: Facility Managers Association

Who is part of FMA? Facility managers

DPS CONTRIBUTIONS PER PAYCHECK (TWICE PER MONTH) Benefit Credits • Full-Time (40 hours per week) employees only *Employees with a start date of 5/31/2018 or earlier will receive benefit credits whether they do or do not enroll in DPS medical coverage

Child Subsidy • All employees are eligible • You must enroll in a medical plan that covers your children in order to receive this subsidy HSA or HMO Subsidy • All employees are eligible • You must enroll in a CDHP medical plan and an HSA during annual Benefits Open Enrollment or as a newly benefitseligible employee to receive the HSA contribution from DPS • You must enroll in an HMO medical plan to receive an HMO subsidy

40

$208 Benefit Credits will be listed as earnings on your paystub.

$193.50 The Child Subsidy will not appear on your paystub, but will be automatically deducted from your premium rate.

$27.92 HSA Subsidies will be deposited directly into your HSA account and will appear on your paystub. HMO subsidies will not appear on your paystub, but will be automatically deducted from your premium rate.

WHAT YOU ACTUALLY PAY PER PAYCHECK (TWICE MONTHLY) PREMIUM

(cost of plan, appears on paystub)

DPS CONTRIBUTIONS

RATES BELOW

(applicable Benefit Credits/Subsidies)

A negative number below is money you can use toward other benefit costs, such as dental/vision premiums or supplemental benefits, or it will appear as a credit on your paystub.

FMA EMPLOYEE RATES Aetna CDHP 3500

Aetna CDHP 2700

Aetna CDHP 2700 Open Access

Aetna DHMO

Kaiser CDHP 3500

Kaiser CDHP 2700

Kaiser CDHP 1350

Kaiser DHMO

-8.68

61.38

108.40

25.95

-36.85

-3.21

29.52

25.78

Employee + Spouse

250.44

411.58

519.72

366.37

194.19

273.26

350.16

379.07

Employee + Child(ren)

54.03

180.14

264.77

138.69

34.12

100.74

165.53

185.49

Employee + Family

263.32

462.99

596.99

413.65

254.91

364.92

471.92

523.08

Employee Only

*All rates are subject to change.

41

VTF: Vocational Teachers Federation

Who is part of VTF? Adult vocational instructors

DPS CONTRIBUTIONS PER PAYCHECK (TWICE PER MONTH) Benefit Credits • .5 FTE to 1.0 FTE employees only *Employees with a start date of 5/31/2017 or earlier will receive benefit credits whether they do or do not enroll in DPS medical coverage

Medical Subsidy • Employees working 30-39.99 hours per week at an hourly rate of less than $25

Child Subsidy • All employees are eligible • You must enroll in a medical plan that covers your children in order to receive this subsidy HSA or HMO Subsidy • All employees are eligible • You must enroll in a CDHP medical plan and an HSA during annual Benefits Open Enrollment or as a newly benefitseligible employee to receive the HSA contribution from DPS • You must enroll in an HMO medical plan to receive an HMO subsidy

42

$210.96 Benefit Credits will be listed as earnings on your paystub.

$100 The Medical Subsidy will not appear on your paystub, but will be automatically deducted from your premium rate.

$96.75 The Child Subsidy will not appear on your paystub, but will be automatically deducted from your premium rate.

$27.92 HSA Subsidies will be deposited directly into your HSA account and will appear on your paystub. HMO subsidies will not appear on your paystub, but will be automatically deducted from your premium rate.

WHAT YOU ACTUALLY PAY PER PAYCHECK (TWICE MONTHLY) PREMIUM

DPS CONTRIBUTIONS

(cost of plan, appears on paystub)

RATES BELOW

(applicable Benefit Credits/Subsidies)

A negative number below is money you can use toward other benefit costs, such as dental/vision premiums or supplemental benefits, or it will appear as a credit on your paystub.

.5 FTE TO 1.0 FTE EMPLOYEE RATES Aetna CDHP 3500

Aetna CDHP 2700

Aetna CDHP 2700 Open Access

Aetna DHMO

Kaiser CDHP 3500

Kaiser CDHP 2700

Kaiser CDHP 1350

Kaiser DHMO

Employee Only

-11.64

58.42

105.44

22.99

-39.81

-6.17

26.56

22.82

Employee + Spouse

247.48

408.62

516.76

363.41

191.23

270.30

347.20

376.11

Employee + Child(ren)

51.07

177.18

261.81

135.73

31.16

97.78

162.57

182.53

Employee + Family

260.36

460.03

594.03

410.69

251.95

361.96

468.96

520.12

*All rates are subject to change.

43

Consider Your Voluntary Options DENTAL INSURANCE DPS offers two Delta Dental insurance plan options. Visit deltadental.com/us/en/find-a-dentist.html to find a dentist near you and to see if your dentist is in the Delta Dental network.

What are the plan options?

The EPO plan provides in-network benefits only (you must see a Delta Dental PPO network dentist). You will pay copays for covered services, and there is no deductible or maximum annual benefit.

The PPO Plus Premier plan provides in- and out-of-network benefits, allowing you the freedom to choose any dentist, and the amount you pay varies based on the provider. There is a deductible of $50/$150 (individual/family) and a maximum annual benefit of $1,500.

What does it cost?

The amount you pay for your premium can be deducted from your paycheck on a pre-tax or post-tax basis.

DELTA DENTAL - PREMIUM COST PER PAYCHECK Employee Only

Employee + Spouse

Employee + Children

Family

EPO

$15.44

$30.65

$37.43

$52.62

PPO Plus Premier

$19.12

$36.26

$51.19

$68.35

Benefit Plan

Questions?

Visit deltadentalco.com, email customer_service@ddpco.com or call 1-800-610-0201.

VISION INSURANCE DPS offers a single VSP insurance plan. You choose your vision provider, but you maximize your plan benefits when you choose a vision provider in VSP’s network. If you choose an out-of-network provider, you may be responsible for paying in full at the time of service and submitting a claim to VSP for reimbursement.

Visit vsp.com to find a VSP vision provider near you and vsp.com/find-eye-doctors.html to see if your vision provider is in-network.

What does it cost?

The amount you pay for your premium can be deducted from your paycheck on a pre-tax or post-tax basis.

VSP - PREMIUM COST PER PAYCHECK

44

Benefit Plan

Employee Only

Employee + Spouse

Employee + Children

Family

Vision Service Plan

$4.08

$9.08

$9.37

$13.45

VSP PLAN Summary of Benefits

In-Network (Choice Network)

Eye Exam Contact Lens Exam

Out-of-Network

Covered in full

Up to $45 reimbursement

$60 copay

Not covered

Frequency

Every 12 months

Lenses Single

Covered in full

Up to $30 reimbursement

Lenses Bifocal

Covered in full

Up to $50 reimbursement

Lenses Trifocal

Covered in full

Up to $65 reimbursement

Frequency Frames

Every 12 months Up to $170 allowance

Frequency

Every 12 months

Contact Lenses Medically necessary Contact Lenses Elective

Questions?

Up to $70 reimbursement

Covered in full

Up to $210 reimbursement

Up to $140 allowance

Up to $105 reimbursement

Visit vsp.com or call 1-800-877-7195 to speak with Member Services.

HEALTH SAVINGS ACCOUNT (HSA) What is it?

A Health Savings Account (HSA) is a personal bank account that uses pre-tax dollars to pay for qualified expenses not covered by medical, dental or vision insurance. DPS offers one HSA option through WageWorks. You must be enrolled in a Consumer-Driven Health Plan (CDHP) to contribute to an HSA. Each year, the money in your HSA rolls over. There is no “use it or lose it provision.” In fact, even if you leave DPS, your HSA and the money in it is yours to keep.

Contributions, including DPS contributions and Well Aware money, cannot exceed the annual IRS contribution maximums. For a list of qualified expenses, visit wageworks.com/employees/support-center/ hsa-eligible-expenses-table/.

What does DPS contribute?

It pays to enroll in an HSA, even if you don’t make contributions with pre-tax dollars from your paycheck. When you enroll in an HSA, DPS automatically contributes $27.92 per paycheck into your account. You can also earn an additional $200 HSA contribution by completing Well Aware (see page 51). That’s a total of $870 a year that DPS contributes to your account. If you don’t enroll in an HSA, you forfeit those contributions. Don’t leave money on the table — if you’re enrolled in a CDHP, enroll in an HSA, too.

45

How do HSA contributions affect PERA?

Employee HSA contributions are PERA-includible, meaning they are included in your Colorado PERA-reported annual income. Your PERA pension is based on your taxable income over your three highestearning years. The more you make, the higher your pension payments will be. As you move closer to retirement, you may want to consider paying for benefits post-tax.

Pre-tax deductions for medical, dental, vision and FSA plans lower your taxable income. That lowers your pension payouts. Retirement plans — such as 401(k), 403(b), 457(b) plans and HSAs — are not included in this and don’t lower your taxable income, or your pension payouts.

Questions?

Visit wageworks.com or call 877-924-3967.

FLEXIBLE SPENDING ACCOUNT (FSA) What is it?

What FSA options does DPS offer?

A Flexible Spending Account (FSA) is a pre-tax benefit account used to pay for eligible medical, dental and vision care expenses that aren’t covered by your insurance plan. You will lose any unused balance, over $500, at the end of the plan year. In most cases, if you leave DPS you will lose your FSA unused balance. If you cancel your FSA due to a qualifying life event, you also will lose your FSA unused balance. DPS offers three FSA options through WageWorks.

Health Care FSA (not allowed if you are enrolled in an HSA) A Health Care FSA can be used to set aside money from your paycheck, before income taxes are withheld, to pay for eligible outof-pocket expenses, such as deductibles, copays and other healthrelated expenses that are not paid by medical, dental or vision plans.

You are able to access your full annual election amount starting on the first day of your plan year.

HSA-Compatible FSA (allowed only if you are also enrolled in an HSA) An HSA-Compatible FSA can only be used to reimburse dental and vision expenses. Funding an HSA-Compatible FSA may be a good idea if you anticipate significant out-of-pocket dental and vision expenses in the coming year. You are able to access your full annual election amount starting on the first day of your plan year.

Dependent Care Flexible Spending Accounts (allowed if you are enrolled in or not enrolled in an HSA) A Dependent Care FSA can be used to pay for eligible health care and dependent care expenses (such as child care) with pre-tax dollars. You are able to access your funds as they are deposited into your account each pay period.

Questions?

46

Visit wageworks.com or call 877-924-3967.

HEALTH SAVINGS ACCOUNTS (HSAs) AND FLEXIBLE SPENDING ACCOUNTS (FSAs) HSA

You are Eligible if:

Maximum Contribution per Year

You are enrolled in a DPS CDHP plan and do NOT have “other health coverage,” such as a non-CDHP plan, Medicare, Medicaid, TRICARE, a Health Care FSA or a spouse’s Health Care FSA. (HSA-Compatible and Dependent Care FSAs are okay) IRS 2019 calendar year maximums: • $3,500 single • $7,000 family • Age 55+ additional $1,000

Health Care FSA

Dependent Care FSA

HSA-Compatible FSA

You are not enrolled in an HSA

You pay for eligible dependent care services, such as preschool, summer day camp, before- or afterschool programs, and child or adult daycare.

You are enrolled in an HSA account.

$2,700 (whether single or family) per plan year July 1, 2019 - June 30, 2020.

$5,000 for married filing jointly/head of household. If you and your spouse are both eligible to contribute to a Dependent Care FSA through your respective employers, you and your spouse may not each claim $5,000.

$2,700 (whether single or family) per plan year July 1, 2019 - June 30, 2020

A wide variety of child and adult care services determined by the IRS.

Eligible dental and vision expenses only.

Not eligible for use on medical/prescription expenses.

Covered Expenses

Eligible medical, dental and vision expenses.

Eligible medical, dental and vision expenses.

Availability of Funds

The amount actually deposited in the account is available.

The amount actually Annual amount available deposited in the account once enrolled. is available.

Annual amount available once enrolled

Debit Card Provided

Yes

Yes

Yes

How Often Can I Make Changes to My Election Amount?

May change at any time throughout the year.

At Open Enrollment, or if At Open Enrollment, or if At Open Enrollment, or you have a qualifying life you have a qualifying life if you have a qualifying life event event. event.

Claim Filing Deadline

No deadline for filing for reimbursement.

Claims incurred by June 30, 2020, must be filed

by Sept. 30, 2020.

Claims incurred by June 30, 2020, must be filed by Sept. 30, 2020.

Claims incurred by June 30, 2020, must be filed by Sept. 30, 2020

No forfeiture — ­ unused funds carry over from year to year. The money is yours.

If expenses are incurred

by June 30, 2020, but not claimed by Sept. 30, 2020, funds will be lost.

The plan permits up to $500 carry over for unused amounts.

If expenses are incurred

by June 30, 2020, but not claimed by Sept. 30, 2020, funds will be lost.

No carryover of funds is permitted.

If expenses are incurred

by June 30, 2020, but not claimed by Sept. 30, 2020, funds will be lost.

The plan permits up to $500 carry over for unused amounts.

You own the account, so the account goes with you.

Can only submit for claims through termination date.

Otherwise, additional funds are lost. You do have up to 90 days from term date to submit claims.

Can only submit for claims through termination date.

Otherwise, additional funds are lost. You do have up to 90 days from term date to submit claims.

Can only submit for claims through termination date.

Otherwise, additional funds are lost. You do have up to 90 days from term date to submit claims.

Forfeiture of Funds

What if I Change Jobs?

No

47

METLIFE Who is eligible?

What plans are available?

All benefits-eligible employees are qualified to enroll in the following MetLife benefits.

• Supplemental life insurance: You can purchase supplemental life insurance for yourself, your spouse and your dependent children.

You must purchase coverage for yourself before purchasing coverage for your spouse and your dependent children. Rates are age-banded and follow a benefit reduction schedule (coverage decreases as you age).

• Critical illness insurance: Provides a lump-sum payment to cover copays, deductibles, child care bills and even mortgage payments if you experience a covered critical illness. It is designed to complement your medical and disability income coverage.

• Accident insurance: Provides a lump-sum payment to cover expenses for more than 150 covered accidents, including fractures, concussions, burns and eye injuries. It also provides benefits for covered medical services and treatments, including emergency care, outpatient surgery, physical and occupational therapy, X-rays and more.

• Hospital indemnity insurance: Provides a lump-sum payment to cover expenses, including your mortgage, car payment, child care or household bills if you experience a stay in the hospital.

• MetLaw: Offers you access to legal support for covered legal matters.

What do these plans cost?

Costs vary by age and coverage levels. For more information, visit thecommons.dpsk12.org/metlife.

How to I enroll?

You will have the opportunity to enroll during your new hire enrollment period and during annual benefits Open Enrollment, using the Benefits Enrollment Site.

Questions?

Metlife: Visit MetLife MyBenefits or call 1-800-438-6388.

MetLaw: Visit legalplans.com/metlaw/ (non-members) or members.legalplans.com (members), or call 1-800-821-6400.

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SICK LEAVE BANK What is it?

All benefits-eligible employees working 20 hours or more per week (.50 FTE) who accrue sick time will be eligible for 40 days (320 hours) of Sick Leave Bank prorated by FTE. The purpose of the Sick Leave Bank is to provide additional sick leave days (upon proper approval) to employees who are on an extended personal illness leave, have used all of their available time off balances and would otherwise be on an unpaid leave status. All members will be required to contribute one sick leave day annually in November to the bank.

How does it work?

You can only use Sick Leave Bank for your own personal illness or injury. You must be enrolled to use Sick Leave Bank. If someone else in your family needs medical care, please refer to the Family Medical and Leave Act (FMLA) policy. If you are out on maternity leave, Sick Leave Bank can only be used for the first six (traditional) to eight (cesarean) weeks of recovery from labor, not covered by your accumulated sick and vacation time. Sick Leave Bank time may not be used for baby bonding. Any time that you remain out after that does not qualify for Sick Leave Bank pay.

How do I enroll?

Newly hired employees eligible to accrue sick leave have 30 days from their start date to enroll in the Sick Leave Bank. Enrollment is done online through the Benefits Enrollment Site as part of the new hire benefits enrollment process. Sick Leave Bank will take effect on the first day of the month following the new employee’s official start date.

The annual benefits Open Enrollment period each spring is the only other opportunity for employees to opt-out of or enroll in the program with an effective date of July 1.

Questions?

Contact HR Connect at HR_Connect@dpsk12.org or 720-423-3900.

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EMPLOYEE WELLNESS

DPS EMPLOYEE WELLNESS What is it?

Questions?

All DPS employees have access to a comprehensive wellness program that supports physical, social, emotional, spiritual and financial wellbeing.

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Health coaching

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Online challenges

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Financial fitness courses

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Mindfulness classes

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Discounts on gym memberships and more

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Wellness Champions at most sites and departments

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For additional resources, visit the Well-Being Resource Center at: thecommons.dpsk12.org/wellbeingresources

Employee Wellness opportunities and discounts are featured in Team DPS Weekly delivered to your DPS email every Thursday and at thecommons.dpsk12.org/wellness.

Email staffwellness@dpsk12.org and check us out on Facebook, Instagram and Twitter @BeHealthyDPS.

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DPS WELLNESS CHAMPS Who are they?

A Wellness Champion is a staff member with a commitment and passion to health and well-being who serves as an ambassador for the Employee Wellness Program. They are messengers and motivators who assist in the implementation and coordination of wellness initiatives. They share information, engage friends and colleagues to participate in wellness programs, and create excitement around leading a healthy lifestyle. Email staffwellness@dpsk12.org for more information or to recommend a champion.

EMPLOYEE ASSISTANCE PROGRAM (EAP) What is it?

EAP provides all DPS employees and their families free and confidential: • Counseling • Legal support • Financial information • Guidance with work-life solutions • Referrals and resources: home repair, moving, child care, event planning and more • Free online resources on: nutrition, exercise, and quitting smoking

How do I access the EAP?

Call 855-327-1377 to speak with someone who can connect you to the appropriate services or visit guidanceresources.com and use the Company ID: DPS to create an account.

WELL AWARE REWARD What is it?

Prevention pays! If you are enrolled in a Consumer-Driven Health Plan (CDHP), DPS contributes $200 to your Health Savings Account (HSA).

If you are enrolled in a DHMO plan, DPS pays you a $200 taxable stipend on your paycheck.

How do I get my $200?

1. Visit thecommons.dpsk12.org/wellaware to see which preventive screenings are recommended based on your age and gender.

2. Visit your physician and complete all preventive screenings. Aetna members — make sure to have your physician fill out your form.

Questions?

3. Complete the online health assessment.

For more information about the Well Aware program, email HR_Connect@dpsk12.org or call 720-423-3900.

Aetna Members: To check that you have completed all of the requirements, please contact Staff Wellness at 720-423-3461 or email staffwellness@dpsk12.org.

Kaiser Members: If you have questions about meeting the requirements, please call 866-300-9867 or email rewardscustomerservice@kp.org.

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SAVING FOR RETIREMENT

403(B) AND 457(B) PLANS - VOLUNTARY TAX-SHELTERED RETIREMENT OPTIONS What are they?

Both 403(b) and 457(b) plans are voluntary defined contribution retirement plans available to all DPS employees. They offer DPS employees the opportunity to save additional money for retirement.

While all employees are automatically members of PERA and contribute a fixed percentage of their salary to PERA, participating in an AIG Retirement Services (formerly VALIC) 403(b) or 457(b) plan is completely voluntary. This means, you can choose to participate. Also, you decide exactly how much you want to contribute, and you can change the amount at any time.

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Why are they good to have?

Not every employee will work at DPS long enough to retire under PERA. In addition, PERA is not designed to replace your full pre-retirement income and you may want to save additional money for retirement. When you have pre-tax dollars deducted from your paycheck and put into a voluntary tax-sheltered retirement plan, you defer taxes on that money.

How much can employees contribute?

In the 2019 calendar year, you can contribute up to $19,000 into either account.

Employees over the age of 50, or who will turn 50 in 2019, can contribute an additional $6,000. You are responsible for following these guidelines. If you are enrolled in multiple accounts, you must be sure your total annual contribution doesn’t exceed the maximum. Note: an administrative fee of 50 cents will be deducted per paycheck for employees enrolled in voluntary tax-sheltered retirement plans.

How do I enroll?

For questions and information on enrolling, visit thecommons.dpsk12.org/403b or call the AIG Retirement Services helpline at 1-800-448-2542.

COLORADO PERA What is it?

Colorado Public Employees’ Retirement Association (PERA) offers retirement and other benefits (i.e., optional life insurance, 401K, short-term disability) to all DPS employees.

As a DPS employee, you do not contribute to nor do you build up years of credit in social security. Rather, all DPS employees are required to contribute a fixed percentage of your salary to the PERA retirement trust funds. DPS also contributes to employees’ PERA retirement funds.

Questions?

For more information, visit copera.org or contact PERA customer service at 303-832-9550 or 800-759-7372.

COLORADO PERAPLUS 401(K) PLAN What is it?

The Colorado PERAPlus 401(k) is a voluntary defined contribution retirement plan that offers DPS employees an opportunity to invest pre-tax paycheck dollars in a tax-deferred account — meaning it’s tax sheltered, or in a Roth 401(k), which is post-tax. In addition to choosing whether to participate, you also decide exactly how much you want to contribute, and you can change the amount at any time.

Questions?

Visit thecommons.dpsk12.org/pera401k, or visit copera.org or call PERA Customer Service at 303-832-9550 or 1-800-759-7372.

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SUPPLEMENTAL BENEFITS

AUTO AND HOME INSURANCE MetLife offers all DPS employees a discounted group rate on auto and home insurance.

How do I apply?

Call MetLife at 800-438-6388 Monday through Saturday for auto and home insurance quotes, to apply for coverage and for general customer service. Learn more at metlife.com/mybenefits. When you call for an auto insurance quote, have the vehicle identification number (VIN), and the Social Security numbers and driver’s license numbers of every person you want covered by the policy.

COMMUTER BENEFITS

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What are they?

Eligible employees who commute to work can have pre-tax dollars deducted from their paychecks to pay for parking or transit.

What’s a pre-tax parking account?

Eligible employees can set aside up to $132.50 pre-tax per paycheck to pay for parking costs they have for commuting to work. It does not include costs for residential parking. You can have a direct payment made to a parking garage; pay to park and get reimbursed by check or direct deposit; or use a WageWorks card to pay where credit and debit cards are accepted. Restrictions apply. Learn more at wageworks.com.

What’s a pre-tax transit account?

Eligible employees can set aside up to $132.50 pre-tax per paycheck to pay for public transportation to work. You can be reimbursed for passes, tokens, fare cards or vouchers for buses, trains and other types of public transportation. Restrictions apply. Learn more at wageworks.com.

Can I change my commuter benefits during the year?

Yes. You can add a commuter benefit, change your deduction or end your deductions throughout the year.

Use it or lose it

If you leave DPS or your employment is terminated, you forfeit any unused amount in your commuter benefits account. You cannot use these funds even if you are enrolled in COBRA.

How do I enroll?

If you already have a WageWorks account, log in and select “Enroll in Commuter.” If you do not already have an account, go to wageworks.com, create a new user name and password, and select “Enroll in Commuter.”

GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE What is it?

It’s a benefit that protects your income for your beneficiaries in the event of your death or dismemberment (loss of limb). Parttime employees are not eligible for basic accidental death and dismemberment insurance.

How does it work?

It’s automatically provided to all benefits-eligible employees at no cost through MetLife. If you die as a result of an accident, your beneficiary would receive both the life benefit and the accidental death and dismemberment benefit.

• For an active, full-time employee, the life benefit is two times the employee’s annual earnings (up to a maximum of $300,000).

• For an active, full-time employee, the accidental death and dismemberment benefit is two times the employee’s annual earnings (up to a maximum of $300,000).

• For a benefits-eligible part-time (hourly) employee, the life benefit is $2,500. Part-time employees are not eligible for accidental death and dismemberment insurance.

• These benefits reduce at age 65. You can confirm coverage on the Benefits Enrollment Site. See plan documents for more details.

Questions?

Visit metlife.com/mybenefits or call 800-438-6388.

LONG-TERM CARE INSURANCE What is it?

All benefits-eligible employees are eligible to purchase long-term care insurance through post-tax payroll deductions. Whether it’s due to a motorcycle accident or a serious illness, long-term care is the type of care you may need if you couldn’t perform basic daily activities (such as bathing, dressing and eating) or if you suffered severe cognitive impairment from a condition such as Alzheimer’s disease.

For more information and to enroll, visit w3.unum.com/enroll/ denverpublicschools.

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LONG-TERM DISABILITY INSURANCE What is it?

Long-term disability insurance is provided free to eligible employees defined as full-time by their employee association. It’s designed to help you meet your financial needs if you become unable to work due to a covered illness or injury.

You can receive up to 60% of your monthly earnings up to $5,000 per month.

You must wait 90 days after your illness or injury to file a claim. Payments continue as long as you are disabled or until you are 65. For more information, visit thecommons.dpsk12.org/ltd.

PERA OPTIONAL LIFE INSURANCE What is it?

It’s an optional, decreasing-term life insurance plan for all DPS employees.

That means you can choose to enroll, and your coverage decreases as you age. The plan provides accidental death and dismemberment (loss of limb) insurance and life insurance coverage for employees and their eligible dependents. For active employees, units of coverage start at $7.75 a month ($10.28 a month for retired DPS employees). You can pay for the coverage through post-tax paycheck deductions. For more information, visit copera.org/programs/life-insurance.

How do I enroll?

Visit thecommons.dpsk12.org/lifeandisabilityinsurance for information on how to enroll.

PET INSURANCE What is it?

MetLife provides employees a discount on pet insurance plans through Nationwide. A pet insurance plan covers thousands of medical issues and conditions related to accidents or illnesses — including cancer — for dogs, cats, birds, ferrets, rabbits, reptiles and other exotic pets. You can visit any licensed veterinarian anywhere — even when you’re out of town.

How do I enroll?

Visit metlife.com/mybenefits or call 800-438-6388.

VOLUNTARY PAYROLL PROTECTION PLAN AND ASSISTANCE FUND What is it?

The Payroll Protection Plan provides an extra $60 a day if you are sick or injured. Vested members can receive up to $6,000 in a year. The cost for this benefit is just $10 a month.

The DPS Assistance Fund lends non-personal, durable medical equipment to any employee of DPS — active or retired — for as long as you need it, free of charge.

How do I enroll?

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For questions or to enroll, contact Office Manager Teresa DeRose at 303-377-0222 or visit dpssbp.org to learn more.

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PLANS IN ACTION Meet Victor

Meet Amanda

Victor is a facility manager and has a chronic condition. He chooses the Kaiser $2,700 CDHP plan with family coverage. It works for his family because they see Kaiser doctors and the $96.75 child subsidy per paycheck helps keep his premium affordable.

Amanda is a systems analyst. She is relatively healthy and very active. She chooses a plan that works best for her lifestyle, then breaks her arm skiing. How does her plan work for her?

• Amanda chooses the Aetna $3,500 CDHP

and regular visits to a specialist to manage his condition until he reaches his individual $2,700 deductible.

plan, which works for her because it has a low premium and she likes to see her primary care doctor in the Aetna Whole Health Network.

• He will then pay 30% coinsurance until the

• Because she enrolls in a CDHP, Amanda

• Victor will pay all costs for his prescriptions

costs for his care reach his $4,000 individual out-of-pocket maximum or until his total family medical costs reach their $8,000 outof-pocket maximum (whichever comes first).

• Because Victor enrolls in a CDHP plan, he

opens a Health Savings Account (HSA), a personal savings account that he can fund with pre-tax dollars to pay out-of-pocket qualified health care expenses. Victor chooses to contribute $100 per paycheck to his HSA. In addition, DPS contributes $27.92 per paycheck to his HSA, for a total of $2,950 a year, giving Victor peace of mind that he is saving enough money to cover his annual individual deductible.

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also opens an HSA. Even though Amanda doesn’t make a contribution from her paycheck, DPS still contributes $27.92 per paycheck to Amanda’s HSA. The money in the account is always hers, even if she changes health plans or jobs.

• Amanda enrolls in the MetLife Accident

Insurance plan because she has an active lifestyle. Unfortunately, later in the year when Amanda breaks her arm, she has to pay out-of-pocket for medical expenses — such as emergency care and x-rays — until she reaches her deductible. Fortunately, her MetLife plan provides Amanda with a lumpsum payment that — in addition to her HSA — helps her pay for those expenses.

MEET VICTOR, AMANDA, JASMINE AND JIM AND SEE WHICH BENEFITS SELECTIONS THEY MADE THIS YEAR. They made their selections by reading the Benefits Enrollment Guide on thecommons.dpsk12.org/ openenrollment, scheduling one-on-one appointments with a benefits specialist and using the built-in plan selector tool on the Benefits Enrollment Site. The following scenarios are examples and are for general information only. Actual costs will vary based on individual circumstances.

Meet Jasmine

Meet Jim

Jasmine is a teacher and she is having a baby.

She elects the Aetna DHMO plan with individual coverage because she likes the predictability of pre-set copays.

Jim is a bus driver. He has worked at DPS for 20 years and is preparing to retire at the end of the year. As he is close to an age when he will be eligible for Medicare, he selects a CDHP medical plan with post-tax deductions.

He also opens an HSA account.

• When Jasmine has her baby, her medical plan will automatically increase to employee and child(ren) coverage. That means Jasmine’s baby will have his own individual deductible and out-of-pocket maximum.

• Jasmine’s prenatal visits have a $0 co-pay, but she will pay for diagnostic tests (such as blood work and ultrasounds) and for her baby’s delivery. After she meets her $1,000 individual deductible, she will pay 30% coinsurance until she hits her $3,000 out-ofpocket maximum.

• The average cost of a healthy delivery is over $20,000, but Jasmine won’t pay more than her and her baby’s individual $3,000 out-of-pocket maximums. That’s up to a maximum of $6,000 out of pocket for medical care during the plan year.

• Jasmine opens a Flexible Spending Account (FSA) and sets aside $2,600 on a pre-tax basis. She can use her FSA for her copays as well as her deductible and coinsurance costs when she delivers.

• The DPS Employee Assistance Program (EAP) helps Jasmine find affordable child care and manage her work-life balance.

• He has been saving for retirement by contributing to a VALIC 403(b) over the last 15 years.

• By selecting a plan with post-tax deduction, the cost of Jim’s medical coverage will be deducted from his paycheck after taxes are calculated. While he will pay more taxes with this option, his taxable income will be higher and will positively impact his Colorado PERA pension which is based on his taxable income over his three highestearning year.

• Jim also decides to open an HSA because contributions are PERA includable, and this way he will be able to receive an HSA subsidy from DPS and save for medical expenses he incurs during retirement.

• DPS Retirement Checklist which can be found at thecommons.dpsk12.org/ nearingretirement.

A B

C

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Benefit Provider Contact Information

Accident, Critical Illness and Other Voluntary Benefits MetLife 1-800-438-6388

DPS Employee Wellness 720-423-3756 thecommons.dpsk12.org/ wellness

AIG Retirement Services (formerly VALIC) 866-899-3512 aig.com/retirementservices

DPS Medicaid Department 720-423-3661 medicaid@dpsk12.org

Auto, Home, and Pet Insurance MetLife 800-438-6388 Colorado Medicaid 800-221-3943 medicaid.gov/Medicaid-CHIPPro- gram-Information/By-State/ colorado.html Colorado PERA 303-832-9550 800-759-7372 copera.org Connect for Health Colorado Health Insurance Marketplace 855-752-6749 connectforhealthco.com Dental Plans Delta Dental of Colorado 303-741-9305 deltadentalco.com DoTs (DPS Department of Technology Services) 720-423-3888 DPS Employee Services 720-423-3900 HR_Connect@dpsk12.org

DPS Payroll 720-423-3900 Option 2 Employee Assistance Program (EAP) Guidance Resources 855-327-1377 guidanceresources.com (Organization Web ID: DPS) Flexible Spending Accounts WageWorks 877-924-3967 wageworks.com Health Savings Account HSA BANK 877-247-1327 hsabank.com Health Savings Account WageWorks 877-924-3967 wageworks.com Legal-Metlife/Hyatt 1-800-821-6400 Life and AD&D Insurance MetLife 800-638-6420 metlife.com/mybeneďŹ ts

Long-Term Care Insurance UNUM 800-227-4165 Medical Plans Aetna 855-736-9469 aetna.com Medical Plans Kaiser Current Members: 303-338-3800 Prospective Members: 303-338-3990 kp.org Retirement Manager 866-294-7950 Vision Plan VSP 800-877-7195 vsp.com Voluntary Payroll Protection Plan and Assistance Fund Denver Teachers’ Club 303-377-0222 dpssbp.org