Palo Verde ESD, Employee Benefits Guide 2022-2023

Here’s to a

healthier you!

Palo Verde Elementary School District

Employee Benefits Guide 2022 - 2023

TABLE OF CONTENTS Enrollment Information...............................................................3

Vision Plan........................................................................................... 11

Qualifying Life Event..................................................................... 4

Disability Information................................................................. 12

COBRA.................................................................................................... 4

Life / AD&D Insurance................................................................. 12

Medical Plan Information...........................................................5

Flexible Spending Accounts................................................... 13

Medical Plans......................................................................................6

Employee Assistance Program.............................................14

Health Savings Account (H.S.A.)............................................7

AFLAC..................................................................................................... 15

Medical Coverage Examples....................................................8

AFLAC Rates......................................................................................16

Telehealth..............................................................................................9

Employee Rate Worksheet......................................................18

Dental Plans......................................................................................10

Important Phone Numbers & Websites.........................19

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.

Palo Verde 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. 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 yourself and your family.

If you should have any questions: 1. Contact the carrier directly. Phone number and website information is on page 19.

2. Contact Sandi Wilson at swilson@pvesd.org, Jody Stanberry at jstanberry@pvesd.org, or either of them by phone at 623.327.3690.

This booklet highlights important features of Palo Verde 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.

Enrollment Information OPEN ENROLLMENT

PRE-TAX VS POST-TAX DEDUCTIONS

Open Enrollment is from April 25th through May 6th, 2022. This is your one time per year to make changes.

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. 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.

All benefit eligible employees are required to elect coverage this year using the online enrollment platform. If you do not want to make changes from the current plan year, you do not need to complete the online enrollment questionnaire indicating your desire to keep your current elections in-force as your current elections will roll over into the 2022/23 plan year.

NEW EMPLOYEES

Post-Tax Dollars: Some insurance premiums may be paid after taxes are deducted from your gross pay. Please contact Sandi Wilson or Jody Stanberry for more information related to the specific premiums that are deducted post-tax.

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 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.

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Palo Verde 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, 2022 – June 30, 2023).

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.

QUALIFYING LIFE EVENTS LIST Marital Status Changes • Marriage • Death of spouse • Divorce • Spouse gains or loses coverage from another source • Spouse employer’s Open Enrollment

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

• 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.

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 a Palo Verde Elementary School District benefit plan immediate-

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ly 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.

Medical Plan Information 1

The Trust that will provide medical insurance to Palo Verde Elementary School District.

2

The network Palo Verde Elementary School District will use for hospitals and physicians.

3

The company that will process Palo Verde Elementary School District’s medical claims.

1 ASBAIT

Palo Verde ESD 2

Aetna Choice POS II and Banner

Meritain Health Company

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SUMMARY Medical benefits provide you and your family access to quality health care. Palo Verde Elementary School District offers you 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 Aet-

na to use their Choice POS II and Banner networks 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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Palo Verde Elementary School District

Medical Plans HDHP 1500 In Network

Classic Gold

Copay Gold

In Network

In Network

Aetna

Banner

Aetna

Banner

Aetna

Banner

Lifetime Maximum Calendar Year

Unlimited Unlimited

Unlimited Unlimited

Unlimited Unlimited

Unlimited Unlimited

Unlimited Unlimited

Unlimited Unlimited

Deductibles Individual Family Coinsurance

$2,000 $4,000** 20%

$1,500 $3,000** 20%

$300 $900 15%

$240 $720 15%

None None N/A

None None N/A

Out-of-Pocket Maximum Individual Family

$5,500 $11,000

$4,500 $9,000

$4,000 $8,000

$3,200 $6,400

$6,350 $12,700

$5,080 $10,160

$250 + Deductible, then 20%

$200 + Deductible, then 20%

$250 Copay, then 15%

$200 Copay, then 15%

$250 Copay

$200 Copay

Deductible, then 20% Deductible, then 20% Deductible then $45 copay

Deductible, then 20% Deductible, then 20% Deductible then $40 copay

Deductible, then 15% Deductible, then 15% Deductible, then 15% Deductible, then 15% $45 $38

$75 Copay $150 Copay $50 Copay

$60 Copay $120 Copay $40 Copay

Routine Services Office Visit Specialist Visit Preventive Care Lab & X-Ray Chiropractic Rehabilitation

Deductible, then $25 Copay Deductible, then $35 Copay Covered in full Deductible, then 20% Deductible, then 20% Deductible, then 20%

Deductible, then $20 Copay Deductible, then $30 Copay Covered in full Deductible, then 20% Deductible, then 20% Deductible, then 20%

$25 Copay $35 Copay Covered in Full $25 Copay $25 Copay $25 Copay

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

$24 Copay $32 Copay Covered in Full $24 Copay $24 Copay $24 Copay

Prescription Drugs Tier 1 Tier 2 Tier 3 Tier 4 Specialty Mail-Order Diabetic Medications

Deductible then: $15 Copay 20% Copay ($25 min/$80 max) 40% Copay ($40 min/$110 max) 20% Copay ($100 min/$150 max) 2x Retail $5 Generic, $15 Brand

Hospital Services Inpatient Hospital Outpatient Hospital Emergency Room Urgent Care

$20 Copay $28 Copay Covered in full $20 Copay $20 Copay $20 Copay

$15 Copay 20% Copay ($25 min/$80 max) 40% Copay ($40 min/$110 max) 20% Copay ($100 min/$150 max) 2x Retail $5 Generic, $15 Brand

$15 Copay 20% Copay ($25 min/$80 max) 40% Copay ($40 min/$110 max) 20% Copay ($100 min/$150 max) 2x Retail $5 Generic, $15 Brand

**If you have Family coverage under the HDHP 1500, the Family Deductible must be satisfied before the plan will pay any benefits.

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Health Savings Account (H.S.A.) If you choose to enroll in the High Deductible Health Plan (HDHP), you will have the option of opening an 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.

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 $1,500 - $2,000 for individuals and $3,000 - $4,000 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.

The district contributes $2,022 annually to an employee’s H.S.A. when enrolled in the HDHP.

HOW AN H.S.A. WORKS: The money contributed to the account is yours to keep and will roll over year after year – no ‘use it or lose it’ rule!

1. Enroll in the HDHP 1500 offered by the district.

2. Contribute to your H.S.A. by payroll deductions: Up to $3,650 for an individual or $7,300 for a family 3. With your H.S.A. debit card, use those funds to pay for qualified expenses such as: • • • •

copays deductibles doctors, hospitals chiropractor

• • • •

dental treatment hearing aids glasses/ contacts prescriptions

H.S.A. ELIGIBILITY To make tax-free contributions to an H.S.A., the IRS requires that: • You are covered by an H.S.A.-qualified plan (such as the HDHP 1500) • You have no other health coverage (such as other health plan, Medicare, military health benefits, medical FSA) • You cannot be claimed as a dependent on someone else’s taxes

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Palo Verde Elementary School District

Medical Coverage Examples The following 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 Palo Verde Elementary School District. Please note that each example assumes employee-only coverage.

Example 1 - Managing a Well-Controlled Condition

Total Charges

$5,600

HDHP 1500

Classic Gold

Copay Gold

Deductibles

$1,500

$200

$0

Copays

$200

$600

$1,200

Coinsurance

$700

$100

$0

Limits or Exclusions

$20

$20

$20

Patient Pays

$2,420

$920

$1,220

Annual Employee Premuim

$0

$0

$972

Less HSA Funds

-$2,022

-$0

-$0

Total Employee Cost

$358

$920

$2,192

Total Charges

$12,700

Routine maintenance of Type 2 Diabetes.

(Banner Network)

Example 2 - Having a Baby

(Banner Network)

(Banner Network)

The cost of a normal delivery including services for the obstetrician, hospital or birthing center, anesthesiologist and pediatrician.

HDHP 1500

Classic Gold

Copay Gold

Deductibles

$1,500

$400

$0

Copays

$200

$10

$1,000

Coinsurance

$800

$1,800

$0

Limits or Exclusions

$60

$60

$60

Patient Pays

$2,560

$2,270

$1,060

Annual Employee Premuim

$0

$0

$972

Less HSA Funds

-$2,022

-$0

-$0

Total Employee Cost

$358

$2,270

$2,032

(Banner Network)

(Banner Network)

(Banner Network)

The information above should be used as an estimate and it is not a price guarantee. Coverage examples are not cost estimators. They are for comparative purposes only. Your own costs will be different depending on the care you receive, the prices your providers charge, and the reimbursement your health plan allows. Before seeking treatment we recommend that you call the provider to verify they are currently in your network and confirm their in-network price for healthcare services you need.

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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.

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

WHAT CAN BE TREATED? • • • • • • • • •

Acne Allergies Asthma Bronchitis Cold & Flu Constipation Diarrhea Ear Infection Fever

• • • • • • • • •

Headache Insect Bite Joint Aches Nausea Rashes Sinus Infection Sore Throat UTI And more!

www.MyDrConsult.com 1.800.362.2667 Download the Teladoc app for easier access!

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Palo Verde Elementary School District

Dental Plans METLIFE

*While benefits are available out of network, a non-contracted provider may balance bill for services. You will pay less when using an in-network provider.

In Network Annual Deductibles Individual

$50

Family

$150

Annual Plan Maximum

$1,750

Benefits

Type 1 - Diagnostic & Preventive (no deductible)

100% In / 100% Out

Type II - Basic Service

80% In / 80% Out

Type III - Major Services

50% In / 50% Out

Orthodontic Benefits Orthodontia Age Limitation

19 years old

Lifetime Maximum

50% to $1,500

Lifetime Deductible

N/A

Adult Orthodontia

N/A

Other Benefits Periodontic Coverage

80% In / 80% Out

Endodontic Coverage

80% In / 80% Out

The dental plan includes preventive services and office visits.

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Vision Plan

Standard lenses are covered.

AVESIS VISION

In Network

Out of Network

Exam

$10 Copay

Reimbursed to $35

Frequency

Every 12 Months

Every 12 Months

Lenses

Covered 100%

Reimbursed: $25 to $80

Single/Bifocal/Trifocal/

after $10 copay

depending on lens

Frequency

Every 12 Months

Every 12 Months

Frames

Up to $150 Allowance, after $10 copay

Reimbursed to $45

Frequency

Every 24 Months

Every 24 Months

Contact Lenses

$130 Allowance

Reimbursed to $130

(In lieu of all other lens and frame benefits)

Every 12 Months

Every 12 Months

Lasik Surgery

25% discount, to $150

Reimbursed to $150

Lenticular

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Palo Verde 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

Palo Verde Elementary School District pays 100% of the cost of the Term Life.

Life / AD&D Insurance BASIC LIFE INSURANCE AND AD&D

DEPENDENT LIFE / AD&D INSURANCE

Palo Verde Elementary School District pays 100% of the cost of this Lincoln Group Term Life Insurance Plan.

You can also elect to purchase life insurance for your spouse or children.

Coverage for each benefit eligible employee is $30,000.

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.

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• Spouse $10,000 • Children Age 14 days to 6 months: $500 Age 6 months to 19 years (to age 23 if full-time student): $5,000

Flexible Spending Accounts The Health Care Spending Account (HCSA) and the Dependent Care Spending Account (DCSA) allow you to reduce your taxable income by paying for out-of-pocket health care and dependent day care expenses with pre-tax dollars. Since these accounts are to be used for predictable expenses, careful planning is required.

Please Note: Employees will become eligible to participate effective July 1st following completion of an agreement (classified) or contract year (certified).

HEALTH CARE SPENDING ACCOUNT (HCSA) How it Works: • You make before-tax deposits (via payroll deductions) to your HCSA. • You can deposit from $100 to $2,850 per year.

• Eligible expenses for both you and eligible family members are covered. You or your family members do NOT have to be enrolled in PVESD’s health insurance to participate in the Health Care Spending Account.

• When you or an eligible family member has a medical expense, you pay for the expense via debit card.

• All expenses must be incurred between July 1, 2022 and June 30, 2023 while you are employed.

• If your employment terminates or you change to non-benefit-eligible status, your “plan year” will end effective the last day of the month in which the change occurred. Eligible expenses must be incurred before that date.

• If you do not use the money in this account through the plan year, the maximum that can be rolled over to the next year is $570.

DEPENDENT CARE SPENDING ACCOUNT (DCSA) How it Works: You make before-tax deposits (via payroll deduction) to your Dependent Care Spending Account. You can deposit from $100 to $5,000 per year. In some cases, your maximum allowed annual contribution may be less than $5,000.

For example: • If you are married and your spouse contributes to a similar account, your combined contributions may not exceed $5,000 per year.

• If you are married but file separate tax returns, your annual contribution is limited to $2,500.

• Your contributions cannot exceed the amount of your income or your spouse’s income, whichever is lower.

• Expenses for DCSA must be incurred between July 1, 2022 and June 30, 2023.

• If you do not use the money in this account through the plan year, the balance will be forfeited.

• For reimbursement of an eligible expense, you pay the bill and then submit a claim form for reimbursement.

You must include an original receipt from your dependent care provider and report the provider’s taxpayer ID. IRS RULES FOR ALL FLEXIBLE SPENDING ACCOUNTS • Your deposit amount cannot be changed, stopped or started during the year for any reason, unless you have a Qualifying Life Event (see page 4).

• Only those expenses that are considered tax deductible by the IRS, as listed in Publication 502, are eligible for reimbursement.

• IRS guidelines can be found at http://www.irs.gov/publications/p969/ar02.html

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Palo Verde Elementary School District

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.

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.

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 network. If appropriate, the program also provides access to a wide range of national and community resources.

• You will be prompted to create a unique username and password.

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TO CREATE A PERSONAL ACCOUNT: Go to www.awpnow.com: • Select “Access Your Benefits” • Registration Code: AWP-ASBAIT-2811

AFLAC American Family Life Assurance Company (AFLAC) is pleased to offer Palo Verde 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.

For the 2022/2023 plan year, you can enroll in these plans through the online enrollment system. Contact MaryAlyce Skree at 602.456.1208 for more information or to set up an appointment.

ACCIDENT INDEMNITY ADVANTAGE These plans pay cash benefits in the event of an accidental injury that needs emergency treatment.

CANCER INDEMNITY PLANS These plans pay cash benefits to 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 to an individual for a specific diagnosis.

HOSPITAL INDEMNITY PLANS These plans help with the expenses not covered by major medical if you are hospitalized.

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Palo Verde Elementary School District

AFLAC Rates ACCIDENT ADVANTAGE - 24-HOUR ACCIDENT OPTION 2 - SERIES A36000

Premium

Total

18-75

INDIVIDUAL

$17.29

$17.29

18-75

NAMED INSURED/SPOUSE

$24.57

$24.57

18-75

ONE-PARENT FAMILY

$29.25

$29.25

18-75

TWO-PARENT FAMILY

$38.22

$38.22

AFLAC HOSPITAL CHOICE - OPTION 1 BENEFIT AMOUNT 1000 - SERIES B40100

Premium

EBR

HSSCR

Total

18-49

$26.78

$11.57

$18.20

$56.55

50-59

$27.30

$13.00

$23.27

$63.57

60-75

$28.08

$13.26

$30.42

$71.76

18-49

$37.83

$24.18

$33.28

$95.29

50-59

$40.04

$27.17

$46.28

$113.49

60-75

$42.90

$27.43

$58.11

$128.44

18-49

$33.93

$23.01

$25.22

$82.16

50-59

$34.45

$23.53

$28.60

$86.58

60-75

$34.97

$24.05

$37.57

$96.59

18-49

$40.17

$29.38

$33.93

$103.48

50-59

$40.56

$29.90

$47.19

$117.65

60-75

$43.42

$31.20

$62.01

$136.63

INDIVIDUAL

INSURED/SPOUSE

ONE-PARENT FAMILY

TWO-PARENT FAMILY

EBR*: Extended Benefit Rider Premium (Available for ages 18-75) HSSCR*: Hospital Stay and Surgical Care Rider Premium (Available for ages 18-75) *Note – The Extended Benefit Rider and Hospital Stay and Surgical Care Rider are not available with Option H.

AFLAC HOSPITAL CHOICE - OPTION H BENEFIT AMOUNT 1000 - SERIES B4010H

Premium

Total

18-49

$31.46

$31.46

50-59

$32.37

$32.37

60-75

$37.96

$37.96

18-49

$45.76

$45.76

50-59

$53.56

$53.56

60-75

$63.70

$63.70

18-49

$36.40

$36.40

50-59

$37.05

$37.05

60-75

$39.13

$39.13

18-49

$46.28

$46.28

50-59

$54.08

$54.08

60-75

$64.22

$64.22

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INDIVIDUAL

INSURED/SPOUSE

ONE-PARENT FAMILY

TWO-PARENT FAMILY

AFLAC Rates (continued) AFLAC CANCER CARE PLAN SELECT - SERIES A78200

Premium

IDR* (5 units)

DCR*

SDR*

Total

18-75

INDIVIDUAL

$17.94

$5.85

$0.00

$0.91

$24.70

18-75

INSURED/SPOUSE

$28.99

$13.00

$0.00

$1.69

$43.68

18-75

ONE-PARENT FAMILY

$17.94

$5.85

$0.91

$0.91

$25.61

18-75

TWO-PARENT FAMILY

$28.99

$13.00

$0.91

$1.69

$44.59

IDR* = Optional Initial Diagnosis Rider (Series A-78050) premium 1-5 units DCR* = Optional Dependent Child Rider (Series A-78051) premium SDR* = Optional Specified Disease Rider (Series A-78052) premium

CRITICAL CARE AND RECOVERY LEVEL TWO - SERIES A71200 Individual Age

One Parent Family Premium

Total

Age

Premium

Total

18-35

$16.38

$16.38

18-35

$28.08

$28.08

36-45

$23.40

$23.40

36-45

$33.02

$33.02

46-55

$31.85

$31.85

46-55

$42.51

$42.51

56-70

$41.08

$41.08

56-70

$55.90

$55.90

Premium

Total

Insured/Spouse Age

Two Parent Family Premium

Total

Age

18-35

$31.59

$31.59

18-35

$35.88

$35.88

36-45

$41.08

$41.08

36-45

$45.50

$45.50

46-55

$55.25

$55.25

46-55

$60.84

$60.84

56-70

$76.96

$76.96

56-70

$83.59

$83.59

AFLAC-SHORT TERM DISABILITY - SERIES A-57600 Elimination Period Accident/Sickness - 0/7 DAYS Annual Income $20,000 $22,000 $24,000 $26,000 $28,000 $30,000 $32,000 $34,000 $36,000 Benefit Period 3 MONTHS

6 MONTHS

$38,000

Age

$1,000

$1,100

$1,200

$1,300

$1,400

$1,500

$1,600

$1,700

$1,800

$1,900

18-49

$28.60

$31.46

$34.32

$37.18

$40.04

$42.90

$45.76

$48.62

$51.48

$54.34

50-64

$29.90

$32.89

$35.88

$38.87

$41.86

$44.85

$47.84

$50.83

$53.82

$56.81

65-74

$36.40

$40.04

$43.68

$47.32

$50.96

$54.60

$58.24

$61.88

$65.52

$69.16

18-49

$36.40

$40.04

$43.68

$47.32

$50.96

$54.60

$58.24

$61.88

$65.52

$69.16

50-64

$39.00

$42.90

$46.80

$50.70

$54.60

$58.50

$62.40

$66.30

$70.20

$74.10

65-74

$49.40

$54.34

$59.28

$64.22

$69.16

$74.10

$79.04

$83.98

$88.92

$93.86

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Palo Verde Elementary School District

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 your, and your family’s, health and wellness for the next year.

MONTHLY INSURANCE RATES FOR 2022-2023 PLAN YEAR EMPLOYEE ONLY EMPLOYEE + 1 DEPENDENT EMPLOYEE & FAMILY

HDHP 1500

CLASSIC GOLD

COPAY GOLD

DENTAL

VISION

$0.00

$0.00

$81.00

$36.67

$6.15

$649.00

$822.00

$982.00

$71.88

$10.75

$1,031.50

$1,305.00

$1,514.00

$132.64

$15.97

If you choose the HDHP 1500, the district will contribute $163.50 monthly ($1,962.00 annually) to your HSA. Employees waiving health insurance must have other health coverage. For employees that waive health, PV will pay up to $1,000 per year toward other policies of your choice. If you waive health insurance, a maximum of $500 may be put into an FSA medical flexible spending account.

DISTRICT’S CONTRIBUTION MEDICAL

MONTHLY CONTRIBUTION

ANNUAL CONTRIBUTION

$821.00

$9,852.00

COST CALCULATOR

INSTRUCTIONS

Medical Plan Rate

1. Write down the rates for each plan you have chosen.

Dental Plan Rate

2. Add up the rates for a Total Monthly Cost.

Vision Plan Rate

3. Multiply the Total Monthly Cost by 12 for Annual Cost.

TOTAL MONTHLY COST

TOTAL ANNUAL COST

4. Divide the Total Annual Cost by 20 or 25 (this is the number of designated paychecks benefit deductions will be taken during the school year).

Divide by # of paychecks

5. You now have the approximate Cost per Pay Check for the 2022 - 2023 School Year.

x12 MONTHS

COST PER PAYCHECK

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6. All voluntary supplement benefits will be deducted over the same pays on a post-tax basis. Enrollment in any voluntary program is a separate deduction.

Important Phone Numbers & Websites ASBAIT

METLIFE

Aetna Choice POS II or Banner | Aetna Network Medical 866.300.8449 www.aetna.com/docfind/custom/mymeritain Employee Portal: www.mymeritain.com

Dental PPO 800.275.4638 www.metlife.com/mybenefits

HEALTHEQUITY / HSA

800.828.9341 www.avesis.com

866.346.5800 www.healthequity.com

ALLIANCE WORK PARTNERS EAP & Nurse Support 800.343.3822 (EAP) 800.334.8336 (Teen Line) 888-771-9116 (Nurse) www.alliancewp.com

Select “PDP” network when searching for providers

AVESIS VISION

AFLAC MaryAlyce Skree 602.456.1208

TELADOC 800.362.2667 www.MyDrConsult.com

ARIZONA STATE RETIREMENT SYSTEM

LINCOLN LIFE INSURANCE

Long Term Disability 520-239-3100 800-621-3778 www.azasrs.gov

800.423.2765 www.Lincoln4benefits.com

WAGE WORKS / FSA 877.924.3967 (FSA) www.wageworks.com

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ABOUT THIS BOOKLET This booklet highlights important features of Palo Verde 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. plans.

Capital Financial 14614 N. Kierland Blvd., Suite N230 Scottsdale, AZ 85254 Office / 480.347.0926, Fax / 480.360.6417