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Casa Grande Union High School District

EMPLOYEE BENEFITS GUIDE 2013 / 2015 2014 2014


TABLE OF CONTENTS

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INTRODUCTION Whether you are a new employee enrolling into your benefits for the first time or considering your benefits during open enrollment, this guide is designed to help you through the process. Casa Grande Union High School District is proud to offer you a broad range of benefit options. You can choose from a number of plans including medical, dental, vision, life insurance and voluntary supplement programs. In addition, we provide health care and dependent care reimbursement accounts to assist employees in managing their out-of-pocket expenses with before-tax dollars. Please take the time to read this information and ask questions so you can make the best benefits decisions for both you and your family.

Enrollment Information Life Status Change / COBRA Medical Medical Plans Medical Coverage Examples Dental Plans Vision Plans Life Insurance Short & Long Term Disability Employee Assistance Program Rate Worksheet Enrollment Instructions Important Phone Numbers

If you should have any questions: 1. Contact the carrier directly. Phone number and website information is on page 14. 2. Contact Mary Ann Amerson, Director of Human Resources, at 520.316.3360 x 1104 or mamerson@cguhsd.org. This booklet highlights important features of Casa Grande Union High School District’s benefits for its benefit eligible employees. While efforts have been made to ensure the accuracy of the information presented, in the event of any discrepancies your actual coverage and benefits will be determined by the legal plan documents and the contracts that govern these plans.


ENROLLMENT INFORMATION OPEN ENROLLMENT

PRE-TAX VS POST-TAX DEDUCTIONS

Open Enrollment is from May 14 through May 23, 2014. This is your one time per year to make changes.

Pre-Tax Dollars: Your insurance premiums are paid with money removed from your gross wages prior to any tax calculations. This reduces your tax liability and is a more efficient way to pay for premiums. Remember, you must choose pre-tax deductions for all your benefits to participate in a flexible spending account. You may elect to opt-out of this method of paying.

If you do not login and make changes during Open Enrollment, your current benefit elections will carry over to the new plan year (with the exception of the FSA). However, you are required to re-elect medical/dependent FSA amounts for the new plan year.

NEW EMPLOYEES New Employees have 31 days from your hire date to complete enrollment in the group insurance program. If you have moved from a non-benefits eligible status to a benefits eligible status, you will have 31 days from the new benefits eligible status to complete your enrollment. All insurance coverage starts at the first of the month. Remember, if elections are not made within the 31-day initial period of eligibility, you will be required to wait until Annual Open Enrollment or until a Qualifying Life Event takes place. Late Enrollees will be required to complete an evidence of insurability form for voluntary life insurance. You may be turned down for these benefits if you do not enroll within your first 31 days as a new hire.

Post-Tax Dollars: You may elect to have your insurance premiums paid after taxes are deducted from your gross pay. If you would like to choose this option, please contact Mary Ann Amerson, Director of Human Resources, prior to enrollment. 


COBRA In most cases, if your employment ends, benefits will terminate on the last day of the month in which you worked. Benefits will end on the day of termination in cases of employee fraud. Through federal legislation known as the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), you may choose to continue coverage by paying the full monthly premium cost plus an administrative charge of 2% (if applicable). Each individual who is covered by a Casa Grande Union High School District benefit plan immediately preceding the employee’s COBRA event has the right to continue his or her medical, dental, vision, or Flexible Spending Accounts (FSA) plan. The right to continuation of coverage ends at the earliest of the date: • you, your spouse or dependents become covered under another group health plan; or, • you become entitled to Medicare; or, • you fail to pay the cost of coverage; or • your COBRA Continuation Period expires

QUALIFYING LIFE EVENT

• All changes must be consistent with the qualifying life event. • In most cases, you cannot change your benefit plan, but may modify the level of your coverage (in other words, you can add or de- lete dependents, enroll or dis-enroll yourself or dependents, but not switch insurance carri- ers or plans). Any changes in benefit levels must be completed within 31 days of the qualifying life event.

QUALIFYING LIFE EVENTS LIST Marital Status Changes

Covered Dependent Changes

• Marriage • Death of spouse • Divorce • Spouse gains or loses coverage from another source • Spouse employer’s Open Enrollment

• Birth or adoption of a child • Death of dependent child • Dependent becomes ineligible for coverage

The elections that you make during Open Enrollment or at initial benefits eligibility will remain in effect for the plan year (July 1, 2014 – June 30, 2015). During that time, if your life or family status changes according to the recognized events listed below, you are permitted to revise your benefits coverage to accommodate your new status. You may make benefits changes by contacting the Benefits Department and providing the proper documentation. IRS regulations govern under what circumstances you may make changes to your benefits, which benefits you can change and what kinds of changes are permitted.

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MEDICAL PLAN INFORMATION 1

The Trust that will provide medical insurance to Casa Grande Union High School District.

2

The network Casa Grande Unified School District will use for hospitals and physicians.

3

The company that will process Casa Grande Union High School District’s medical claims.

1 ASBAIT

CGUHSD 2

Blue Cross/ Blue Shield

Meritain Health Company

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SUMMARY

HEALTH SAVINGS ACCOUNT (H.S.A.)

Medical benefits provide you and your family access to quality health care. Casa Grande Union High School District offers three medical plans with different coverage levels from which to choose. All plans are provided through Arizona School Boards Association Insurance Trust (ASBAIT). ASBAIT contracts with BlueCross BlueShield of Arizona to use their PPO Network with claims processing and customer service being provided by Meritain Health Company.

If you choose to enroll in the HDHP plan, you will have the option of opening up a Health Savings Account (H.S.A.) provided by HealthEquity. An H.S.A. is a tax-advantaged savings and spending account that can be used to pay for qualified health care expenses.

To search for a BlueCross BlueShield of Arizona PPO provider please go to www.azblue.com. Click on the Search the Provider Directory. To contact Meritain, please go to www.meritain.com or contact them at 800.762.2234.

There are two components to an H.S.A.-based coverage plan: 1. A qualified health plan is the insurance component that provides medical coverage for you and your family. This health plan includes a deductible of $1,250 for individuals and $2,500 for family coverage. 2. An H.S.A. with HealthEquity which can be funded by pre-tax payroll contributions from you, the district, or both. Please visit www.healthequity.com or contact them at 866.346.5800 for more information.

MERITAIN CONTACT

www.mymeritain.com


MEDICAL PLANS

Lifetime Maximum Calendar Year

w/ Health Savings Account

Value Gold (C30)

Copay Gold (A25)

In Network

In Network

In Network

Unlimited Unlimited

Unlimited Unlimited

Unlimited Unlimited

$1,250 $2,500** 20%

$500 $1500 25%

None None N/A

$6,000 $12,000

$5,000 $10,000

$6,350 $12,700

$250 Copay, Deductible, then 20% Deductible, then 20% Deductible, then 20% $50 Copay, Deductible, then 20%

$250 Copay, then 25% Deductible, then 25% Deductible, then 25% $50 Copay, then 25%

$250 Copay $75 Copay $150 Copay $50 Copay

Deductible, then 20% Deductible, then 20% Covered in Full Deductible, then 20% Deductible, then 20% Deductible, then 20%

$35 Copay $45 Copay Covered in Full Deductible, then 25% $35 Copay $35 Copay

$30 Copay $40 Copay Covered in Full $30 Copay $30 Copay $30 Copay

Deductible, then 20% Deductible, then 20% Deductible, then 20% Deductible, then 20% Deductible, then 20%

$15 Copay 20% (min$25-max$80) 30% (min$40-max$110) 2x Retail $5 Generic, $10 Brand

$15 Copay 20% (min$25-max$80) 30% (min$40-max$110) 2x Retail $5 Generic, $10 Brand

HDHP*

Deductibles Individual Family Coinsurance Out-of-Pocket Maximum (Deductible Included) Individual Family Hospital Services Inpatient Hospital Outpatient Hospital Emergency Room Urgent Care Routine Services Office Visit Specialist Visit Preventive Care Lab & X-Ray Chiropractic Rehabilitation Prescription Drugs Tier 1 Tier 2 Tier 3 Mail-Order Diabetic Medications

**If you have Family coverage under the HDHP, the Family Deductible must be satisfied before the Plan will pay any benefits.

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MEDICAL COVERAGE EXAMPLES These examples show how each plan might cover medical care in given situations. Use these examples to see, in general, how much financial protection a sample patient might get if they are covered under the different plans available at Casa Grande Union High School District.

Example #1 – Having a baby (normal delivery) Hospital Charges (mother) Routine obstetric care Hospital charges (baby) Anesthesia Laboratory tests Prescriptions Radiology Vaccines, other preventive Total

$2,700 $2,100 $900 $900 $500 $200 $200 $40

$7,540

HDHP

Value Gold (C30)

Copay Gold (A25)

Deductibles Copays Coinsurance Limits or exclusions

$1,250 $250 $310 $150

$500 $270 $570 $150

$0 $970 $0 $150

Patient Pays

$1,960

$1,490

$1,120

HDHP

Value Gold (C30)

Copay Gold (A25)

Deductibles Copays Coinsurance Limits or exclusions

$1,250 $0 $800 $80

$500 $920 $290 $80

$0 $1,520 $0 $80

Patient Pays

$2,130

$1,790

$1,600

Example #2 – Managing a well-controlled condition Prescriptions Medical Equipment and Supplies Office Visits and Procedures Education Laboratory tests Vaccines, other preventive Total

$2,900 $1,300 $700 $300 $100 $100

$5,400


DENTAL PLANS

All dental plans include preventive services and office visits.

DELTA DENTAL PPO BUY UP OPTION

DELTA DENTAL PPO BASE OPTION

Annual Deductible

Annual Deductible

Individual Family Annual Plan Maximum

$50 $150 $2,000

Benefits Type 1 - Diagnostic and Preventive Type II - Basic Service Type III - Major Services

100% in / 100% out 80% in / 80% out 50% in / 50% out

* In & Out-of-Network Coverage Available

Type 1 - Diagnostic and Preventive Type II - Basic Service Type III - Major Services

100% in 80% in 50% in

Orthodontic Benefits 19 years old 50% to $1,500

Other Benefits Periodontic Coverage Endodontic Coverage

$50 $150 $1,000

Benefits

Orthodontic Benefits Orthodontia Age Limitation Lifetime Maximum

Individual Family Annual Plan Maximum

Orthodontia Age Limitation Lifetime Maximum

N/A N/A

Other Benefits 80% in / 80% out 80% in / 80% out

Periodontic Coverage Endodontic Coverage

* Stay In-Network

80% in 80% in


VISION PLAN

All lenses are covered. Lasik Surgery allowance.

AVESIS VISION OPTION AT A GLANCE

In Network

Out of Network

Exam Materials Frequency

$10 Copay $10 Copay Every 12 Months

Reimbursed to $45

Lenses Single/Bifocal/Trifocal/ Lenticular Frequency

Covered 100%

Reimbursed to $30 to $100 depending on lens

Every 12 Months

Every 12 Months

Frames

$50 Wholesale Allowance Every 12 Months

Reimbursed to $70

Frequency

Medically Necessary -Covered in Full Elective -$130 Allowance Every 12 Months

Medically Necessary -Reimbursed to $250 Elective -Reimbursed to $130 Every 12 Months

Lasik Surgery Frequency

$150 Allowance Every 12 Months

$150 Reimbursement

Frequency Contact Lenses

Every 12 Months

Every 12 Months

Every 12 Months

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LIFE AND AD&D INSURANCE

BASIC LIFE INSURANCE AND AD&D Casa Grande Union High School District pays 100% of the cost of the Reliance Standard Term Life Insurance Plan. Coverage for each benefit eligible employee is $50,000 Life and AD&D Benefit.

Life insurance provides protection for those who depend on you financially. Your need varies greatly due to age, number of dependents, dependent ages and your financial situation. Accidental Death and Dismemberment (AD&D) benefits provide a benefit to you or your beneficiary if you are seriously injured or die in an accident. VOLUNTARY LIFE INSURANCE AND AD&D You may purchase additional coverage through a term life insurance policy available from Reliance Standard. If you are a new hire and do NOT enroll within your first 31 days of hire, then choose at a later date to enroll, you must qualify for this benefit by completing an Evidence of Insurability form. If you have previously declined this benefit and would like to enroll during Open Enrollment, you must also complete an Evidence of Insurability form.

Employee

Purchase up to $300,000 in $10,000 increments not to exceed 5 times salary Guarantee Issue: $300,000

Spouse

50% of employee benefit to a maximum of $30,000 in $5,000 increments Guarantee Issue: $30,000

Child(ren)

Purchase up to $10,000 in $2,500 increments


Casa Grande Union High School District pays 100% of the cost of the Term Life and Short Term Disability Plan.

DISABILITY INFORMATION Disability coverage can be one of the most important benefits you have. It provides you and your family with financial protection if you are ever unable to work due to an illness or non-work related injury.

SHORT TERM DISABILITY Casa Grande Union High School District pays the entire cost of the Reliance Standard policy. 

Elimination Period: Benefit Amount: Benefit Duration:

30 Days 50% of pre-disability weekly earnings up to $750 22 Weeks

LONG TERM DISABILITY All employees who work 20 or more hours per week for 20 weeks per year will pay premiums through mandatory contributions to Arizona State Retirement System (ASRS) for Long Term Disability (LTD). Elimination period: 180 Days Benefit Amount: 66 2/3% of monthly base salary as determined by ASRS

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EMPLOYEE ASSISTANCE PROGRAM Alliance Work Partners - An EAP provides valuable services at no cost to employees and their families in the form of short-term counseling, legal and financial consultations through LawAccess, and worklife resources and referral through Work/Life Standard. Seven days a week, 24 hours a day, using one toll-free phone number, you can speak with registered nurses and master’s-level counselors who can help with almost any problem ranging from medical and family matters to personal legal, financial and emotional needs. If face-to-face resources are appropriate for your situation, a representative can refer you to a local professional in the BCBS of Arizona PPO Network. If appropriate, the program also provides access to a wide range of national and community resources.

EMPLOYEE ASSISTANCE PROGRAM CONTACT 1-800-343-3822 www.alliancewp.com

An EAP Teen Line 800-334-TEEN (8336) specializing in teen issues is an additional resource available as well as a 24-Hour Nurseline at 888-771-9116 for all medical questions and health issues. To create a personal account: Go to www.alliancewp.com Login using: email: asbaitmember@alliancewp.com password: AWP4me (Case Sensitive) You will be prompted to create a unique username and password.


EMPLOYEE RATE WORKSHEET Use this worksheet to provide a general estimate of your benefits costs for the upcoming plan year. This is a great place to start planning for you and your family’s health and wellness for next year.

MEDICAL PLANS HDHP 26 PAYS EMPLOYEE ONLY $0.00 EMPLOYEE & SPOUSE $160.62 EMPLOYEE & CHILDREN $135.23 EMPLOYEE & FAMILY $266.31

22 PAYS $0.00 $189.82 $159.82 $314.73

DENTAL PLANS BASE 26 PAYS $0.00 EMPLOYEE ONLY EMPLOYEE & SPOUSE $11.61 EMPLOYEE & CHILDREN $11.84 EMPLOYEE & FAMILY $23.62

22 PAYS $0.00 $13.72 $13.99 $27.91

VALUE GOLD 26 PAYS $0.00 $181.38 $151.85 $301.38

COPAY GOLD 22 PAYS $0.00 $214.36 $179.45 $356.18

26 PAYS $35.08 $253.38 $218.31 $397.85

22 PAYS $41.45 $299.45 $258.00 $470.18

VISION PLAN BUY UP 26 PAYS $8.20 $27.99 $32.63 $56.98

22 PAYS $9.69 $33.08 $38.56 $67.34

26 PAYS $0.00 $2.29 $3.37 $4.89

22 PAYS $0.00 $2.71 $3.98 $5.78

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LOGIN INSTRUCTIONS FOR EMPLOYEES The annual Open Enrollment Period for making benefit changes is May 14 through May 23. During this period, you may review and update your benefit elections online per the following instructions.

Benefit Fairs & Online Assistance

Online assistance will be provided at the Benefit Fair dates listed below.

Vista Grande High School Location: Computer Lab Wednesday, May 14 1:30 – 4:00

INSTRUCTIONS: Each screen contains step by step instructions to guide you through the enrollment process. Please read the instructions carefully before making your selection(s). There is a video tutorial/guide that will walk you through the process. The instructions and video are available in multiple languages. Please review your current elections to ensure accuracy of your enrollment and personal information. Go to: http://secure.commonbenefits.com/mars/ Click on “Select Company” Click on “C” on top of screen and choose Casa Grande Union High School. Click on “Employee Login” Enter “Account Name” and “Password”

An Aflac Representative will be available May 14-16 during the scheduled times below.

Casa Grande Union High School Casa Verde High School Location: Room D204 Thursday, May 15 2:30 – 4:30 Desert Winds High School District Office Location: Computer Lab Friday, May 16 2:00 – 3:30 Last opportunity for online assistance will be held at: Casa Grande High School Vista Grande High School Friday, May 23 9:00 – 11:00

Click “Login” ENTER YOUR BENEFICIARY INFORMATION Group Term Life AD&D - “View/Modify” and then “Edit” Voluntary LIfe & AD&D - “View/Modify” and then “Edit”

For account name and password help, please contact Julie Roden at 480.440.4116 or julie@cfplc.com

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IMPORTANT PHONE NUMBERS ASBAIT Blue Cross/Blue Shield Medical 800.762.2234 www.azblue.com Employee Portal: www.mymeritain.com HealthEquity Medical 866.346.5800 www.healthequity.com  Delta Dental Dental PPO 602.938.3131, option 1 www.deltadentalaz.com  Avesis Vision 800-522-0258 www.avesis.com  Alliance Work Partners EAP & Nurse Support 800.343.8822 (EAP) 800.334.8336 (Teen Line) 888-771-9116 (Nurse) www.alliancewp.com  Reliance Standard Basic & Voluntary Life AD&D Short Term Disability 800.351.7500 www.reliancestandard.com

Arizona State Retirement System Long Term Disability 520-239-3100 800-621-3778 www.azasrs.gov Mary Ann Amerson Director of Human Resources 520.316.3360 x 1104 mamerson@cguhsd.org FSA/COBRA/Retiree Inquiries Robert Amado Accounting Supervisor 520.316.3360 x 1105 ramado@cghusd.org Mary Jane Radel Payroll Clerk 520.316.3360 x 1114 mjradel@cghusd.org


ABOUT THIS BOOKLET This booklet highlights important features of Casa Grande Union High School District’s benefits for its benefit eligible employees. While efforts have been made to ensure the accuracy of the information presented, in the event of any discrepancies your actual coverage and benefits will be determined by the legal plan documents and the contracts that govern these plans.

Capital Financial 21819 N Scottsdale Road, Suite 100 Scottsdale, AZ 85255 Office / 480.440.4116 Fax / 480.794.1703

Casa Grande Employee Benefits Guide 2014-2015  

Casa Grande Employee Benefits Guide 2014-2015