Greater Clark County Schools Benefit Guide

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EMPLOYEE

BENEFIT GUIDE MAKING CONNECTIONS TO BUILD YOUR FUTURE.


WELCOME TO YOUR BENEFITS!

At Greater Clark County Schools, we understand the important role that our benefit programs play in the lives of our employees and their families. Please take time to learn about these benefits so you can make an educated decision. When you make well-informed decisions, you can best manage your out-of-pocket expenses and also help control the rising cost of healthcare. At Greater Clark County Schools, we offer the following benefits: Anthem medical benefits, PPO and HDHP Plans, Health Savings Account, Dental, Vision, Basic Life and AD&D, and Voluntary Life and AD&D, Short Term Disability and Long Term Disability to all full-time employees.

HSA OR PPO

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WHAT DOES THAT WORD EVEN MEAN? We admit it, benefits can be hard to understand. Here are some common benefit words and their definitions to help you as you read through this guide. TERM

DEFINITION

ANNUAL DEDUCTIBLE (JAN 1 THROUGH DEC 31)

The amount you are required to pay per calendar year before certain benefits are paid for by the plan. Once you meet the deductible amount, expenses are covered by the plan based on the coinsurance percentage. This deductible starts over every January 1st.

ANNUAL OUT-OF-POCKET MAXIMUM (JAN 1 THROUGH DEC 31)

The most you pay in a calendar year for covered services that are subject to coinsurance/copays. The deductible is included in this amount. If you reach the annual out-of-pocket maximum, the plan pays 100% of covered in-network eligible expenses for the remainder of the plan year. Office visits and prescription copays are included in the annual out-of-pocket maximum for our medical plans. This maximum starts over every January 1st.

BALANCE BILLING

When you are billed for the difference between the provider’s actual charge and the amount reimbursed under the medical or dental plan. This occurs when you go outside of the preferred provider network. Balance billing does not apply towards out-of-pocket maximum.

COINSURANCE COPAYMENTS OR COPAYS

The percentage you pay for covered expenses. The flat dollar amount you pay for certain in-network services.

EXPLANATION OF BENEFITS (EOB)

Provides information about how your claim was processed by the insurance company. The EOB details what portion of the claim was paid by the insurance company and what portion is your responsibility.

HEALTH SAVINGS ACCOUNT (HSA)

A special, tax-advantaged, interest bearing account to help plan and pay for qualified health care expenses (including plan deductible) while covered by a qualified high deductible health plan.

IN-NETWORK

A group of doctors, hospitals and other healthcare providers that contractwith a plan vendor to provide quality healthcare services at favorable rates.

PREFERRED PROVIDER ORGANIZATION (PPO)

A healthcare arrangement designed to provide healthcare services at a discounted cost for members to use designated providers (the network), but which also provides coverage (at a lower level) for services received from providers that are not part of the network.

USUAL, CUSTOMARY, AND REASONABLE (UCR) CHARGES

UCR charges are determined by your health plan vendor and are based on the range of fees charged by doctors with comparable training and experience for the same or similar service in your area. When you receive in-network care, UCR charges do not apply. You are responsible for amounts over UCR for out-of-network care.

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COVERING YOU AND YOUR FAMILY WHO IS ELIGIBLE

The plans allow you to cover your eligible dependents, which include:

Greater Clark County Schools is proud to offer a comprehensive benefits package to eligible, full-time employees who work at least 30 hours per week and/or meet the requirements for continuing eligibility during an approved leave of absence. Our company benefits package is briefly summarized in this booklet.

Legally married spouse

Children up to age 26

Disabled dependents of any age

WHO PAYS Carrier / Vendor

Greater Clark County Schools Pays

You Pay

Find it on Page

Anthem

6

American Fidelity

7

Medical Resources

Anthem

Dental

Anthem

10

Vision

Anthem

11

Basic Life and AD&D Insurance

OneAmerica

Voluntary Life and AD&D Insurance

OneAmerica

Long Term Disability

OneAmerica

BENEFITS OFFERED Medical Health Savings Account (HSA)

8-9

12 ✓

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HELP CONTROL HEALTHCARE COSTS

Visit the Emergency Room only in the case of a true emergency. Check your area for an Urgent Care location or utilize our FREE clinic.

Use Generic prescriptions, if available. Ask your doctor for a Generic or request the Generic equivalent when having your prescription filled. Call TrueScripts to find where to purchase your prescriptions at the lowest cost and use their mobile app for information about those drugs. More about this app on page 7.

Utilize In-Network Providers. Your medical costs increase greatly when you visit a provider who is not in the network. Always confirm your provider is in the Anthem Blue Access PPO Network, especially when being referred to another provider or facility for services.

Be sure you and your dependents receive routine annual physical exams and immunizations. Adults and children should have preventive health screenings recommended for their age for early detection of health conditions. All of these preventive services are covered at 100% on each of our plans.

IN-NETWORK PROVIDERS MEDICAL, DENTAL & VISION Anthem 1.

Select Find a Doctor in the top right

2.

Log in with either your Anthem login credentials or by using your Identification Number listed on your Anthem ID card

3.

Select a specialization and enter your zip code.

4.

You can then narrow your search event further and/or review details such as the expected cost of certain procedures and if they are accepting new patients.

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WHERE TO FIND CARE TIP: COMPARE COSTS WITH THE COST ESTIMATOR TOOL AT WWW.ANTHEM.COM/FIND-DOCTOR The more you know about the cost and quality of doctors and hospitals, the easier it is to make the best choices for you and your family. The online directory has plenty to offer, starting with simplified search tools that give you the results you need. You’ll also see integrated cost and quality information, helping you compare doctors and control health care spending. an MRI can cost anywhere from $400 TO $1,400, depending on where you go. Where you go for medical services can make a big difference in how much you pay and how long you wait to see a health care provider. Use the chart below to help you choose where to go for care.

USE TELEMEDICINE If your primary care doctor isn’t available, and you have a routine issue such as a sinus problem, rash, or pink eye.

An appointment with a physician is available from your phone or computer. LIVEHEALTH ONLINE

www.livehealthonline.com

$

GO TO YOUR PRIMARY CARE DOC If you do not have a life- or limbthreatening medical emergency, then go to your primary care doctor (PCP) if available.

GO TO AN URGENT CARE CENTER If you do not have a life- or limbthreatening medical emergency, nor have a PCP available, and don’t have a routine issue, then visit a local urgent care center.

For care during normal office hours, it’s usually best to go to your primary care doctor. He or she can provide followup care and refer you to a specialist, if needed.

Urgent care centers typically don’t require an appointment and are often open in the evenings and on weekends. Plus, innetwork urgent care centers are faster and much less expensive than the ER.

$$

$$$ 6

GO TO EMERGENCY ROOM If you do have a lifeor limb- threatening medical emergency then go to the emergency room. In the case of a true medical emergency, go to the ER. At the ER, true emergencies are treated first, and other cases must wait—sometimes for hours. And, it will cost you a lot more to get care at the ER.

$$$ $


SAVING ON PRESCRIPTIONS PRESCRIPTIONS ARE SO EXPENSIVE! Unless you have TrueScripts

Greater Clark County Schools is partnered with TrueScripts as their Pharmacy Benefit Manager, or PBM. A PBM works as the middle man, passing down discount from the manufacturer to your employer and you. Did you know there are many drugs out there that you’re OVER paying for? They might even be free as a member of the Greater Clark sponsored health plan. Don’t overpay for another minute! The next time you’re prescribed a medication, call Greater Clark's dedicated TrueScripts Member Care staff at (844) 257-1955. Have a question AT the pharmacy? Your pharmacist can contact your TrueScripts Member Care staff at (855) 326-2159.

TRUESCRIPTS MOBILE APP MyDrugBenefit

MyDrugBenefit is a web portal that empowers you and your family to get the greatest return on your pharmacy benefits. This includes getting the right therapy at the right time, from the right source, based on the help and considerations of a real person in real time! With MyDrugBenefit you can… •

Manage your medications

Look up your medications when at a doctor’s visit

Review doctor’s visit prep questions

Track immunizations

Review your refill history, doctor’s name, supply and quantity

Review details of your healthcare plan

Find potential savings with alternative medicines

Review labels and warning signs, common brand names and consumption instructions

MYDRUGBENEFIT IS AVAILABLE ON THE APPLE APP STORE AND GOOGLE PLAY.

DOWNLOAD TODAY AND START SAVINGS ON PRESCRIPTIONS TODAY!

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MEDICAL INSURANCE

HSA OR PPO

HSA PLAN OR PPO PLAN HSA PLAN

PPO PLAN

$1,500 |$3,000

$1,000 |$2,000

$4,500 |$9,000

$3,000 |$6,000

$1,500 |$3,000

$2,500 |$5,000

$15,000 |$30,000

$7,500 |$15,000

You pay 0% after deductible

You pay 20% after deductible

WHAT IS THE MOST I WILL PAY? In-Network Deductible Individual | Family Out-of-Network Deductible Individual | Family In-Network Out-of-Pocket Maximum Individual | Family Out-of-Network Out-of-Pocket Maximum Individual | Family

HOW DOES IT WORK AT THE HOSPITAL? In-patient Surgery Out-patient Surgery Major Imaging (Ex: MRI, CT, PET scan)

HOW DOES IT WORK AT THE DOCTOR’S OFFICE? Preventive Care

LiveHealthOnline Primary Care Physician Specialist

No Charge $59

No Charge NoCharge

You pay 0% after deductible

$35copay

You pay 0% after deductible

$100 copay

$50copay

WHAT IF I NEED EMERGENCY CARE? Urgent Care Emergency Room

$300 copay then you pay 20%

HOW MUCH DOES IT COST FOR PRESCRIPTIONS? RX Out-of-Pocket Max

Combined with Medical

$3,500 | $7,000

Retail (30-day supply)

You pay 0% after deductible

$10 | $30 | $50 Specialty: Contact TrueScriptsMember Care line

Retail (90-day supply)

You pay 0% after deductible

$25 | $75 | $125

*Deductibles and Out of Pockets: All of our plans have an individual deductible with one person never paying more than the individual limit with your family. Grandfathered

YOUR MEDICAL COST PER PAY (24)

Grandfathered

Cafeteria Cafeteria All other Staff 30+ Staff 20-29 employees Hours/week Hours/week

Cafeteria Cafeteria Staff 30+ Staff 20-29 Hours/week Hours/week

All other employees

Employee

$21.00

$53.50

$42.60

$23.00

$58.50

$68.20

Employee +Family

$464.50

$528.50

$238.40

$508.50

$578.00

$319.00

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HEALTH SAVINGS ACCOUNT IF YOU ARE ENROLLED IN THE HSA PLAN An HSA is a savings account that you can use to pay out-of-pocket health care expenses with pre-tax dollars.

WHO IS ELIGIBLE FOR AN HSA?

YOU HAVE CONTROL: • • • •

Anyone who is:

Unused money rolls over from year to year in an interest bearing savings account. You can use the funds on medical, dental and vision expenses for you and your family. You can even invest your funds for the future. There is no “use it or lose it” rule.

Anyone who is NOT: •

YOU SAVE ON TAXES: • • •

Enrolled in the HSA Plan which is a qualified High Deductible Health Plan (HSA $1,500 plan).

All money deposited is not taxed. Withdrawals for eligible expenses are exempt from federal income tax. You can earn interest tax free.

Covered under any other medical plan that has copays. Enrolled in Medicare, Medicaid, or TriCare or have received VA benefits in the last three months. Eligible to be claimed as a dependent on someone else’s tax return, such as a person under 26 who is still on their parent’s plan.

IMPORTANT CONTRIBUTIONS 2021 Contributions cannot exceed $3,600 for individual coverage and $7,200 for employee with dependent(s) coverage annually on a pre-tax basis for the 2021 tax year. Individuals age 55 and older are eligible to make catch-up contributions of an additional $1,000 annually.

HERE’S A QUICK VIDEO ABOUT WHY YOU MIGHT CHOOSE AN HSA PLAN:

http://bit.ly/HSAadvantages

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MEDICAL TOOLS LIVEHEALTH ONLINE PROVIDED BY ANTHEM AN AFFORDABLE OPTION- FOR QUALITY MEDICAL CARE. LiveHealthOnline gives you access 24 hours, 7 days a week to a U.S. board-certified doctor through the convenience of phone, video, or mobile app visits.

GET THE CARE YOU NEED. Many medical conditions that doctors can treat include: •

Cold & Flusymptoms

Bronchitis

Bladder infection

Allergies

Sinus problems

Sore throat

Pink eye

Stomachache

Rash

GET STARTED TODAY. Visit www.livehealthonline.com •

Download the apps from Google Play or the App Store

Be prepared with your health plan ID card, credit card, and pharmacy location when you register

Talk to a doctor anytime, anywhere you happen to be

Receive quality care via phone, video, or mobile app

Prompt treatment, median call back, in 10 minutes

A network of doctors that can treat every family member

Prescriptions sent to pharmacy of choice if medically necessary

LiveHealthOnline is less expensive than the ER or urgent care

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MEDICAL TOOLS SYDNEY HEALTH APP BY ANTHEM

Powered by:

Anthem’s app is simple, smart, and ALL ABOUT YOU With Sydney, you can find everything you need to know about your Anthem benefits -- personalized and all in one place. Sydney makes it easier to get things done, so you can spend more time focused on your health.

WITH JUST ONE CLICK, YOU CAN: Watch a video about what you can rely on Sydney to help you with in 2021.

Find care and check costs

Check all benefits

See claims

Get answers even faster with our chatbot

View and use digital ID cards

ALREADY USING THE ANTHEM APP? It’s easy to make the switch. Simply download the Sydney app and log in with your Anthem username and password. When you search “Anthem” in the app store, Sydney Health will be your first option! 11


DENTAL INSURANCE HIGH PLAN

MID PLAN

LOW PLAN

$50 | $150

$50 | $150

$50 | $150

$1,500

$1,500

$1,000

Preventive Services Cleaning and X-rays

These servicesare covered at 100%

These services are covered at 100%

These services are covered at 100%

Basic Services

You pay 20% ofthe charges

You pay 50% ofthe charges

You pay 50% ofthe charges

Major Services

You pay 50% ofthe charges

You pay 70% ofthe charges

You pay 100% ofthe charges

Endodontics

You pay 50% ofthe charges

You pay 50% ofthe charges

You pay 100% ofthe charges

Periodontics

You pay 50% ofthe charges

You pay 50% ofthe charges

You pay 100% ofthe charges

$1,500

$1,500

NA

You pay 50% ofthe charges

You pay 50% ofthe charges

NA

Employee

$13.56

$11.87

$6.01

Employee + 1

$27.05

$21.47

$12.26

Employee + Family

$48.59

$36.09

$26.14

BENEFITS In-Network Calendar Year Deductible (Individual | Family) Maximum Benefit (Per Person)

HOW DOES THE PLAN WORK?

Fillings and Extractions Crowns and Bridgework

RootCanals Gum Disease

ORTHODONTICS Lifetime Maximum Coinsurance

YOUR DENTAL COST - BI-WEEKLY (24 PAYS)

WHAT DOES A BALANCE BILL AMOUNT LOOK LIKE? Dr. Jonescharges $750 for a crown.

Anthem Dental Plan

Since Dr. Jones isn’t in the network, he has the right to bill you for the $150 difference - plus the 50% coinsurance you still have to pay.

The Anthem DentalPlan will only cover$600.

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On the other hand, if you visit an in-network dentist, he or she has already agreed to charge the $600 that the plan covers for crowns, so you would only owe 50% of that.


VISION INSURANCE VSP VISION PLAN Anthem Vision Plan In-Network

Anthem Vision Plan Out-of-Network

$25 Copay

Reimbursed up to $35

$10 Copay for each

Reimbursed up to $25 | $40 | $55

$100 allowance

Reimbursed up to $45

$110 allowance

Reimbursed up to $105

$110 allowance

Reimbursed up to $210

BENEFITS Eye Exam Eyeglass Lenses Single | Bifocal | Trifocal

Frames Elective Contacts In lieu of lenses

Medically Necessary Contacts

YOUR VISION COST - BI-WEEKLY (24 PAYS) Employee

$.97

Employee + Spouse

$1.95

Employee + Child(ren)

$2.00

Employee + Family

$2.96

Just for being a Anthem member, you are eligible for extra discounts and savings! You can find out more by visiting anthem.com.

GLASSES, SUNGLASSES AND CONTACTS •

Save up to 20% on Non-prescription sunglasses

Additional complete pair of eye-glasses - 40%

LASER VISION •

Discounts offered through Anthem's Special Offers Program

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LIFE AND AD&D INSURANCE Greater Clark County Schools offers employer-paid Life Insurance at no cost to you. We also provide all eligible employees the option of purchasing additional Life and AD&D insurance through OneAmerica. These benefits provide valuable peace of mind and give you the option of covering your dependents. If you elect coverage for yourself, you are eligible to elect coverage for your spouse dependent children as well.

EMPLOYER-PAID LIFE AND AD&D

THINGS TO KNOW

It’s important that our employees have some level of financial protection. That’s why we provide eligible employees with Basic Life and AD&D coverage through OneAmerica at no cost to you.

1. A “guarantee issue” amount is the dollar amount of coverage you can be approved for without completing a health questionnaire. Guarantee issue amounts only apply during the 31 days following your initial eligibility period when hired.

All eligible employees receive guaranteed coverage based on employee class. See your OneAmerica schedule of benefits for more information.

2. If you wish to enroll in the Voluntary Life and AD&D plan or increase your coverage after your initial eligibility period, you will be required to complete the Evidence of Insurability Form, which contains questions about your health.

VOLUNTARY LIFE AND AD&D LIFE BENEFIT

SPOUSE BENEFIT

CHILD BENEFIT AGE REDUCTION

or

3. Rates are based on your age and the amount of coverage you elect. Spouse rates are also based off of the employee age.

HOW MUCH

$10,000 increments up to a maximum of $500,000 Guarantee issue: $150,000 under age 70

DO I NEED?

When it comes to protecting the financial security of you and your family, nothing is more important than planning ahead. Even if you already have a life insurance policy in addition to the company-provided policy, it’s important to ask yourself:

$10,000 increments up to a maximum of $500,000 or 100% of employee’s election Guarantee issue: $50,000 Birth to 6 months: $500 Ages 6 months to 26: $5,000

“Do I have the protection I need to cover all of my financial responsibilities?” A few categories to consider:

50% at age 70 Daily Living Expenses

Mortgages / Loans

College Tuition

You must designate a beneficiary for Basic Life and AD&D and Voluntary Life and AD&D. You have the right to change the beneficiary at any time by written or electronic notice. You can change your beneficiary by contacting Human Resources. 14


DISABILITY INSURANCE Greater Clark County Schools offers Long Term Disability coverage at no cost to you! We believe it’s important to provide our employees income protection for those times of life when it’s needed most. The Basic LTDplan will pay 60% of your earnings up to $7,000 a month after the 90-day waiting period.

IMPORTANT BENEFIT CONTACTS Benefit

Provider

Phone

Website

Medical

Anthem

800-826-9781

www.anthem.com/find-doctor

Health Savings Account

American Fidelity

800-662-1113

www.americanfidelity.com

Dental

Anthem

1-866-947-9398

www.anthem.com/find-a-doctor

Vision

Anthem

1-866-755-2680

www.anthem.com/find-a-doctor

Basic / Voluntary Life and AD&D

OneAmerica

1-800-537-6442

www.oneamerica.com

Long Term Disability

OneAmerica

1-855-517-6365

www.oneamerica.com

Director of HR- Tricia Helton

Greater Clark County Schools

812-288-4802 ext. 50146

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The information in this Enrollment Guide is presented for illustrative purposes and is based on information provided by the employer. The text contained in this Guide was taken from various summary plan descriptions and benefit information. While every effort was taken to accurately report your benefits, discrepancies or errors are always possible. In case of discrepancy between the Guide and the actual plan documents, the actual plan documents will prevail. All information is confidential pursuant to the Health Insurance Portability and Accountability Act of 1996.