Employee Benefits Guide 2024 - 2025 A healthier you starts here! ELOY ELEMENTARY SCHOOL DISTRICT
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.
Eloy Elementary 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 supplemental programs.
Please take the time to read this information and ask questions so you can make the best benefits decisions for yourself and your family.
1. Contact the carrier directly. Phone number and website information is on page 15.
2. Contact Leticia Jimenez by phone at 520.466.2100 or by email at leticia.jimenez@eloyesd.net
highlights important features of Eloy Elementary 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.
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INTRODUCTION
If you should have any questions:
This
TABLE OF CONTENTS Enrollment Information................................................................ 3 Qualifying Life Event 4 COBRA 4 Medical Plan Information ............................................................ 5 Medical Plans ....................................................................................... 6 Telehealth 7 Dental Plan 8 Vision Plan ............................................................................................. 9 Disability Information................................................................... 10 Life/AD&D Insurance 10 Employee Assistance Program 11 AFLAC ...................................................................................................... 12 Wellness Program .......................................................................... 13 Employee Rate Worksheet 14 Important Phone Numbers & Websites 15
booklet
Enrollment Information
OPEN ENROLLMENT
Open Enrollment is from April 29th – May 10th. This is your one time per year to make changes.
This year, open enrollment will be an active enrollment that will be done via an online enrollment form link that will be sent to you along with your current elections. This means that you will need to complete the online enrollment even if you are not making changes to your benefit elections.
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 date to complete your enrollment. All insurance coverage starts at the first of the month.
Remember, if elections are not made within the 31day 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.
PRE-TAX VS POST-TAX DEDUCTIONS
Pre-Tax Dollars: Your insurance premiums are paid with money deducted from your gross wages prior to any tax calculations. This reduces your tax liability and is a more efficient way to pay for premiums.
Post-Tax Dollars: Some insurance premiums may be paid after taxes are deducted from your gross pay. Please contact Trina Masters for more information related to the specific premiums that are deducted post-tax.
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ELOY ELEMENTARY SCHOOL DISTRICT
Qualifying Life Event
The elections that you make during Open Enrollment or at initial benefits eligibility will remain in effect for the plan year (July 1, 2024 – June 30, 2025). During that time, if your life or family status changes as per 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 which circumstances allow you to make changes to your benefits, which benefits you can change and what kinds of changes are permitted.
• 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 delete dependents, enroll or dis-enroll yourself or dependents, but not switch insurance carriers 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
COBRA
In most cases, if your employment ends, benefits will terminate on the last day of the month in which you stopped working. 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 an Eloy Elementary School District benefit plan immediately preceding the employee’s COBRA event has the right to continue his or her medical, dental or vision 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.
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Medical Plan Information
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2 3
SUMMARY
Medical benefits provide you and your family access to quality health care. Eloy Elementary School District offers you two 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 Aetna to use their Choice POS II and Banner networks
1 2
The Trust that will provide medical insurance to Eloy Elementary School District
The networks Eloy Elementary School District will use for hospitals and physicians.
3
The company that will process Eloy Elementary School District’s medical claims.
(you will pay less when using the Banner network) with claims processing and customer service being provided by Meritain Health Company.
To contact Meritain, please go to mymeritain.com or contact them at 866.300.8449
MERITAIN CONTACT
www.mymeritain.com
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ASBAIT Eloy ESD
Meritain Health Company
Aetna Choice POS II and Banner
Medical Plans
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Banner Classic Silver Banner Copay Gold In Network In Network Aetna CPII Banner Aetna CPII Banner Lifetime Maximum Unlimited Unlimited Unlimited Unlimited Calendar Year Unlimited Unlimited Unlimited Unlimited Deductibles Individual $500 $400 None None Family $1,000 $800 None None Coinsurance 20% 20% N/A N/A Out-of-Pocket Maximum Individual $4,500 $3,600 $6,350 $5,080 Family $9,000 $7,200 $12,700 $10,160 Hospital Services Inpatient Hospital $250 Copay, then 20% $200 Copay, then 20% $250 Copay $200 Copay Outpatient Hospital Deductible, then 20% Deductible, then 20% $75 Copay $60 Copay Emergency Room Deductible, then 20% Deductible, then 20% $120 & $32 Copays* $120 & $32 Copays* Urgent Care $50 Copay $42 Copay $50 Copay $40 Copay Routine Services Office Visit $30 Copay $24 Copay $30 Copay $24 Copay Specialist Visit $40 Copay $32 Copay $40 Copay $32 Copay Preventive Care Covered in Full Covered in full Covered in Full Covered in Full Lab & X-Ray $30 Copay $24 Copay $30 Copay $24 Copay Chiropractic $30 Copay $24 Copay $30 Copay $24 Copay Rehabilitation Therapy $30 Copay $24 Copay $30 Copay $24 Copay Prescription Drugs Tier 1 $15 Copay $15 Copay Tier 2 20% ($25 min/$80 max) 20% ($25 min/$80 max) Tier 3 40% ($40 min/$110 max) 40% ($40 min/$110 max) Tier 4 Specialty $200 Copay $200 Copay Mail-Order 2x Retail 2x Retail Diabetic Medications $5 Generic, $15 Brand $5 Generic, $15 Brand
*members will pay a $120 copay for facility charges and a $32 copay for professional fees
Telehealth
Teladoc-24/7/365 on-demand access to affordable, quality healthcare. Anytime, Anywhere.
Regardless of the plan you choose you should never be without Teladoc, the only 24/7 telehealth and wellness service designed for the modern family. Whenever you have an issue, simply connect with a Teladoc board-certified doctors, available by phone, video or chat. They are specially trained to diagnose, treat and prescribe medications for a wide variety of common medical conditions, helping you avoid the costly and time-consuming trips to the doctor or urgent care centers.
Talk to a real doctor, 24/7. No need to schedule an appointment or limit your visits.
• Save money and time, while avoiding costly trips to a doctor’s office, urgent care or ER.
What can be treated?
• Acne
• Allergies
Asthma
• Bronchitis
• Cold & Flu Constipation
Diarrhea
• Ear Infection Fever
MyDrConsult.com 1.800.362.2667
Headache
• Insect Bite
• Joint Aches
Nausea
• Rashes
• Sinus Infection
Sore Throat UTI
• And more!
When should I use Teladoc?
• Instead of going to the ER or an urgent care center for a non-emergency issue
• During or after normal business hours, nights, weekends and holidays
If your primary care physician is not available To request prescriptions (when appropriate)
• If traveling and in need of medical care
Are my children eligible?
Yes! Teladoc has pediatricians on call 24/7
How much does it cost?
Nothing! Every consultation is free for you and all of your dependents
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ELOY ELEMENTARY SCHOOL DISTRICT
Dental Plan
Annual Deductibles (Applies to Basic & Major Services)
Orthodontic Benefits
Orthodontia Age Limitation 19 years old
Lifetime Maximum 50% to $1,000 Lifetime Deductible
dental plan includes preventive services and office visits. METLIFE In Network
The
Individual $50 Family $150 Annual Plan Maximum $1,750 Benefits Type 1 - Diagnostic & Preventive (no deductible) 100% Type II - Basic Service 80% Type III - Major Services 50%
N/A
N/A Other Benefits Periodontic Coverage 80% Endodontic Coverage 80% 8
Adult Orthodontia
Vision Plan
Standard lenses are covered.
AVESIS VISION
Exam
Frequency
Lenses
In Network
$10 Copay
Every 12 Months
Covered 100%
Single/Bifocal/Trifocal/ $0 copay
Lenticular
Frequency
Frames
Frequency
Contact Lenses
(in lieu of frame and spectacle lenses)
Every 12 Months
$150 Allowance
Every 12 Months
$130 Allowance
Every 12 Months
Lasik Surgery Discount up to 25% /$150
Out of Network
Reimbursed to $35
Every 12 Months
Reimbursed: $25 to $80
depending on lens
Every 12 Months
Reimbursed to $45
Every 12 Months
Reimbursed to $130
Every 12 Months
Reimbursed to $150
Progressive Lenses will now be covered with only a $75 Copay for Level 1 and a $110 Copay for Level 2.
Youth Polycarbonate Lenses are also now covered in full!
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ELOY ELEMENTARY SCHOOL DISTRICT
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.
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
Life/AD&D Insurance
BASIC LIFE INSURANCE AND AD&D
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. You also have an opportunity to purchase Basic Dependent Life for Dependents in the amount of $2,000 for Spouse and $1,000 for child(ren).
Eloy Elementary School District pays 100% of the cost of the Employee’s MetLife Group Term Life Insurance Plan.
Coverage for each benefit eligible employee is $50,000.
VOLUNTARY LIFE / AD&D INSURANCE
You can also elect to purchase additional life insurance for yourself, your spouse or children.
• Employee
$10,000 increments to a maximum of $500,000 or 5x annual earnings.
• Spouse
$5,000 benefit increments to a maximum of $100,000 not to exceed 50% of the employee amount.
• Children
Flat Amount: $1,000, $2,000, $4,000, $5,000, or $10,000
Eloy Elementary School District pays 100% of the cost of the Employee’s Term Life and AD&D.
Note that if you were previously eligible for the voluntary life insurance but declined or if you select an amount above the Guarantee Issue, you may be required to fill out a statement of health in order to enroll in the voluntary life benefit.
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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 tollfree 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 Aetna Choice POS II or Banner Aetna network. If appropriate, the program also provides access to a wide range of national and community resources.
An EAP Teen Line 800-334-TEEN (8336) specializing in teen issues is an additional resource available as well as the main toll free number 1.800.343.3822 for all EAP questions.
To create a personal account: Go to www.awpnow.com:
Select “Access Your Benefits”
• Registration Code: AWP-ASBAIT-2811
• You will be prompted to create a unique username and password.
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ELOY ELEMENTARY SCHOOL DISTRICT
AFLAC
American Family Life Assurance Company (AFLAC) is pleased to offer Eloy Elementary School District employees and qualified dependents the opportunity to elect coverage under several AFLAC policies. A few things to remember about these policies:
• An AFLAC policy is separate from the other policies listed in this book. AFLAC does not replace your medical insurance coverage.
• AFLAC pays you directly, no matter what other insurance you may have.
• You can enroll in one or all of the policies and are eligible to participate in these policies the first of the month following date of hire.
To enroll in these policies, you must meet with an AFLAC representative. Contact Julie Kicker at 602.799.8022 for more information or to set up an appointment.
ACCIDENT INDEMNITY ADVANTAGE
This plan pays cash benefits in the event of an accidental injury that needs emergency treatment.
CANCER INDEMNITY PLANS
These plans pay cash benefits for an individual diagnosed with internal cancer.
SHORT TERM DISABILITY
These plans pay a percentage of your weekly income to you while you are not working.
CRITICAL CARE INDEMNITY
These plans pay a cash benefit for an individual for a specific diagnosis.
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Wellness Program
PARTICIPATION IN WELLNESS PROGRAM
Eloy Elementary School District has developed a wellness program that will offer participating employees the opportunity to reduce the cost of medical premiums.
The employee portion of the Base Medical Plan (Banner Classic Silver) will be paid by the District at 100% if you participate in the wellness program. If
REQUIRED
1. Biometric Screening
2. Preventative Check-up
Prior to 12/01/2024
Includes Well Man/Woman exam
Credit will also be given if completed in previous 4 months
OPTIONAL
• Onsite Flu Shot
• Onsite Mammogram
• Other Choices – Vision exam, dental exam and others
• Walking Club / Gym Membership
an employee would like to enroll in the Buy-Up Plan (Copay Gold), the employee will be responsible for the difference in premium.
There are two requirements that must be completed prior to December 1, 2024, as well as several optional activities we recommend.
NON-PARTICIPATION CHARGE
Non-participants will have a minimum increase in medical premium of $65 per month on the base plan plus the additional difference in premium if they elect the Buy-Up Plan.
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Employee Rates
Use this page and the worksheet provided to you to provide a general estimate of your benefits costs for the upcoming plan year. This is a great place to start planning for your, and your family’s, health and wellness for the next year.
Monthly Premium is $2.26 *Those
EXAMPLE: A 45 year old enrolls in $10,000 of Supplemental Life insurance coverage.
$10,000 x $0.226 = $2260
$2260 / $1000 = $2.26
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ELEMENTARY SCHOOL
ELOY
DISTRICT
employees who have not completed wellness criteria by December 1, 2024, will be charged an additional $78 per pay for 10 pay periods starting January 1, 2024.
MEDICAL PLANS – PER PAY PERIOD (18 PAYS)
PER
PERIOD
DENTAL –
PAY
(18 PAYS)
PER PAY PERIOD
VISION –
(18 PAYS)
COPAY GOLD AGE RATE PER $1000 OF BENEFIT CLASSIC SILVER $73.33 $632.00 $555.33 $923.33 $0.00 $44.38 $44.38 $44.38 $0.051 $0.064 $0.100 $0.145 $0.226 $0.370 $0.610 $0.951 $1.771 $3.469
SUPPLEMENTAL LIFE – MONTHLY RATES
ONLY EMPLOYEE & SPOUSE EMPLOYEE & CHILDREN EMPLOYEE & FAMILY EMPLOYEE ONLY EMPLOYEE & SPOUSE EMPLOYEE & CHILDREN EMPLOYEE & FAMILY 0-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-99 $0.00 $3.90 $6.75 $10.13 $0.00 $486.00 $418.67 $739.33 WELLNESS PARTICIPANTS*
EMPLOYEE
Important Phone Numbers & Websites
ASBAIT
Aetna Choice POS II or Banner Network
Medical
866.300.8449
aetna.com/docfind/custom/mymeritain
Employee Portal: mymeritain.com
Alliance Work Partners
EAP & Nurse Support
800.343.3822 (EAP)
800.334.8336 (Teen Line)
awpnow.com
Arizona State Retirement System
Long Term Disability
520-239-3100
800-621-3778 azasrs.gov
Leticia Jimenez
520.466.2100
Email: leticia.jimenez@eloyesd.net
Pat Tarango
520.466.2100
Email: pat.tarango@eloyesd.net
MetLife
Dental PPO
800.275.4638
metlife.com/mybenefits
Select “PDP” network when searching for providers.
Avesis Vision
800.828.9341 avesis.com
MetLife
Life Insurance
800.275.4638
metlife.com/mybenefits
AFLAC
Julie Kicker
602.799.8022
Teladoc
800.362.2667
MyDrConsult.com
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ABOUT THIS BOOKLET
This booklet highlights important features of Eloy Elementary 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
14614 N. Kierland Blvd., Suite N220, Scottsdale, AZ 85254
Office / 480.347.0926
Fax / 480.360.6417
