Employee Benefits Guide 2023 - 2024
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.
Chino Valley Unified 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.
If you should have any questions:
1. Contact the carrier directly. Phone number and website information is on page 19.
2. Contact Shelly Dailey, Human Resources Coordinator at 928.583.5421 or sdailey@chinovalleyschools.com
This booklet highlights important features of Chino Valley Unified 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.
2 TABLE OF
Enrollment Information 3 Qualifying Life Event ............................................................................. 4 COBRA 4 Medical Plan Information 5 Medical Plans ............................................................................................. 6 Health Savings Account (HSA) 7 Telehealth ..................................................................................................... 8 Live Well, Work Well 9 Dental Plan – PPO 10 TDA Dental Insurance 11 Vision Plan 12 Disability Information 13 Life / AD&D Insurance 13 Flexible Spending Accounts 14 Employee Assistance Program..................................................... 15 Pet Insurance 15 MetLife Worksite Benefits................................................................16 Employee Rate Worksheet 17 Medical Coverage Example 18 Important Phone Numbers 19
CONTENTS
Enrollment Information
OPEN ENROLLMENT
Open Enrollment is from May 1st - 25th, 2023. This is your one time per year to make changes.
All benefit eligible employees are required to elect coverages via the new online enrollment tool - SIMON - this year even if you are not making changes to your current elections. Your current elections will NOT roll over into the 2023/24 plan year.
The district is pleased to offer some additional new benefits this year including a Dental HMO plan, Pet Insurance and new Short-Term Disability and Worksite Benefits offerings.
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 the Annual Open Enrollment or until a Qualifying Life Event takes place. 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 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.
Post-Tax Dollars: Some insurance premiums may be paid after taxes. Please contact Shelly Dailey for more information related to the specific premiums that are deducted post-tax.
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Qualifying Life Event
The elections you make during Open Enrollment or at your initial benefits eligibility will remain in effect for the plan year (July 1, 2023 – June 30, 2024). 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 Human Resources 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.
■ All changes must be consistent with the qualifying life event.
■ In some cases, you can change your benefit plan and modify the level of coverage (such as add or delete dependent).
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 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 Chino Valley Unified 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
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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
Medical Plan Information
The Trust that will provide medical insurance to Chino Valley Unified School District.
The network Chino Valley Unified School District will use for hospitals and physicians.
The company that will process Chino Valley Unified School District’s medical claims.
SUMMARY
Medical benefits provide you and your family access to quality health care. Chino Valley Unified School District offers you three medical plans with different coverage levels from which to choose. All plans are provided through Kairos Health Arizona. Kairos contracts with UnitedHealthcare to use their network with claims processing and customer service being provided by UMR.
To contact UMR for questions about medical information and ID cards, please go to umr.com or contact them at 844.212.6811.
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UMR
1 2 Kairos Chino Valley USD UMR United Healthcare Choice Plus 1 2 3 3
CONTACT umr.com
Medical Plans
**If you have Family coverage under the $2,500 HDHP, the Family Deductible must be satisfied before the Plan will pay any benefits (except for preventive/wellness care) and the Family out-of-pocket maximum will apply.
then $10 Copay
then $60 Copay
then $110 Copay
then $20/$120/$220
in Full
then 20%
then 20%
then 20%
then 20%
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Copay Plan HDHP $2,500* with Health Savings Account HDHP $5,000 with Health Savings Account In Network In Network In Network Lifetime Maximum Unlimited Unlimited Unlimited Calendar Year Unlimited Unlimited Unlimited Deductibles Individual $750 $2,500 $5,000 Family $1,500/employee +1 OR $2,250/employee +2 or more $5,000** $10,000 Coinsurance 20% 20% 20% Out-of-Pocket Maximum Individual $5,000 $3,450 $6,450 Family $10,000 $6,550** $12,900 Hospital Services Inpatient Hospital Deductible, then 20% Deductible, then 20% Deductible, then 20% Outpatient Hospital Deductible, then 20% Deductible, then 20% Deductible, then 20% Emergency Room Deductible, then 20% Deductible, then 20% Deductible, then 20% Urgent Care $50 Copay Deductible, then 20% Deductible, then 20% Routine Services Office Visit $25 Copay Deductible, then 20% Deductible, then 20% Specialist Visit $50 Copay Deductible, then 20% Deductible, then 20% Preventive Care Covered in Full Covered in Full Covered in Full Lab & X-Ray Deductible, then 20% Deductible, then 20% Deductible, then 20% Prescription Drugs Tier 1 $10 Copay Deductible,
Deductible,
2 $60
Deductible,
Deductible,
3 $110
Deductible,
Deductible,
Mail-Order
$20/$120/$220 Deductible,
Deductible,
Preventive
Covered
Covered
Covered
Ambulatory Surgical Center $250
Deductible,
Deductible,
$250
Deductible,
Deductible,
$75
Deductible,
Deductible,
Deductible,
Deductible,
then $10 Copay Tier
Copay
then $60 Copay Tier
Copay
then $110 Copay
(90-day supply)
then $20/$120/$220
Medications
in Full
in Full
Copay
then 20% Non-Hospital Infusion Center
Copay
then 20% Non-Hospital Radiology Center
Copay
then 20% Non-Hospital Lab/Pathology $25 Copay
then 20%
Health Savings Account (HSA)
If you choose to enroll in either of the High Deductible Health Plans (HDHP), you will have the option of opening an HSA provided by HealthEquity. An HSA 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 HSA-BASED COVERAGE PLAN:
1. A qualified health plan is the insurance component that provides medical coverage to you and your family.
2. An HSA with HealthEquity which can be funded by pre-tax payroll contributions from you, the District, or both.
HOW AN HSA WORKS:
1. Enroll in the $2,500 HDHP or the $5,000 HDHP plans offered by the District
2. Contribute to your HSA by payroll deductions on a pre-tax basis:
■ Up to $3,850 for single coverage in the 2023 calendar year
■ Up to $7,750 if you enroll a dependent for 2023
■ An additional $1,000 if you are age 55 or older
The District will contribute $2,040 annually ($170/ month) to your Health Savings Account if you enroll in the HDHP $5,000 as employee only.
Questions? Visit www.healthequity.com or contact HealthEquity at 866.346.5800.
The money contributed to the account is yours to keep and will roll over year after year – no ‘use it or lose it’ rule!
3. With your HSA debit card, use your HSA funds to pay for qualified expenses such as:
■ copays
■ deductibles
■ chiropractor
■ dental treatment
HSA ELIGIBILITY
To make tax-free contributions to an HSA, the IRS requires that:
■ hearing aids
■ glasses/ contacts
■ prescriptions
■ over the counter drugs and medications
■ You are covered by an H.S.A qualified plan (such as the HDHP 2500 and HDHP 5000)
■ You are not enrolled in any other plan that is not considered a High Deductible Health Plan
■ You are not enrolled in Medicare, medical FSA or have other military health benefits
■ You are not eligible to be claimed as a dependent on another person’s tax return
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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
■ 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
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Telehealth
teladoc.com 1.800.835.2362 Download the Teladoc app for easier access!
Live Well, Work Well
EMERGENCY ROOM OR URGENT CARE?
More than 10% of all emergency room visits could have been better addressed in either an urgent care facility or a doctor’s office. If you’re suddenly faced with symptoms of an illness or injury, how can you determine which facility is most appropriate for your condition?
Emergency Room (ER)
Emergency rooms are equipped to handle life-threatening injuries, illnesses and other serious medical conditions. An emergency is a condition that may cause loss of life or permanent or severe disability if not treated immediately. You should go directly to the nearest emergency room if you experience any of the following:
■ Chest pain
■ Shortness of breath
■ Severe abdominal pain following an injury
■ Uncontrollable bleeding
■ Confusion or loss of consciousness, especially after a head injury
■ Poisoning or suspected poisoning
■ Serious burns, cuts or infections
■ Inability to swallow
■ Seizures
■ Paralysis
■ Broken bones
Patients at the emergency room are sorted, or triaged, according to the seriousness of their condition. For example, a patient with severe injuries from a car accident would likely be seen before a child with an ear infection, even if the child was brought in first.
Those who go to the ER with relatively minor injuries or
KAIROS HAS DEDICATED NURSES TO HELP YOU!
Navigating the health care system and insurance can be complicated and leave you feeling overwhelmed. That’s where Kairos can assist.
Through their Clinical Advocacy Program, they have dedicated in-house nurses to help guide you and your family through the health care system, choose the best treatment, and keep costs to a minimum. You will have a champion in your corner with a clinical background, an understanding of the Kairos insurance coverage, a sensitivity to patient needs, and a genuine desire to help.
illnesses often have to wait more than an hour to be seen, depending on the severity of the other patients’ conditions. Often they could have been seen more quickly at an urgent care facility.
Urgent Care
Urgent care centers are usually located in clinics or hospitals, and, like emergency rooms, offer after-hours care. Unlike emergency rooms, they are not equipped to handle life-threatening situations. Rather, they handle conditions that require immediate attention— those where delaying treatment could cause serious problems or discomfort.
Some examples of conditions that require urgent care are these:
■ Ear infections
■ Sprains
■ Urinary tract infections
■ Vomiting
■ High fever
Urgent care centers are usually more cost-effective than ERs for these conditions. In addition, the waiting time in urgent care centers is usually much shorter. Choosing the appropriate place of care can not only ensure prompt medical attention but will also help reduce any unnecessary expenses.
Examples of ways our nurses can help you and your family:
■ acting as a liaison between the patient, doctor,and insurance;
■ facilitating the use of manufacturer’s medication programs;
■ finding assistance, if needed, through community assistance programs;
■ providing guidance through the prior authorization (PA) process; and
■ coordinating with health care providers when alternative site of care is needed. Ready to get started? Call 888.331.0222
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Dental Plan – PPO
DELTA
*In and out-of-network coverage available, however, you will pay more when using an out-of-network provider.
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DENTAL
In Network Annual Deductibles Individual $50 Family $150 Annual Plan Maximum $1,500 Benefits Type 1 - Diagnostic & Preventive 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
Lifetime Maximum 50%
Lifetime Deductible N/A Adult Orthodontia N/A Other Benefits Periodontic Coverage 80% In / 80% Out Endodontic Coverage 80% In / 80% Out
PPO
19; Banded prior to Age 17
to $1,500
The dental plan includes preventive services and office visits.
TDA Dental Insurance
Total Dental Administrators (TDA) provides comprehensive dental care on a predetermined fee schedule. There are no deductibles, no claim forms, and no annual or lifetime benefit maximums. Services are covered in the state of Arizona only.
NO ID CARD NECESSARY. TDA will issue an ID card to new enrollees. You don’t need your card, though, to receive dental care—your dentist will have your name on file once covered.
HOW TO USE YOUR PLAN
STEP 1: Access the TDA website prior to making an appointment. Select the general dental office for yourself and your dependents.
STEP 2: Select the DHMO dental plan network and enter your search criteria.
STEP 3: Make note of the provider code number listed to the right of the dental office. You’ll use this code number to identify your selection when enrolling for benefits or calling customer service.
Contact TDA customer service at the number at the end of this guide if you need to change your provider mid-year.
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DHMO PLAN BENEFIT OVERVIEW IN-NETWORK COPAY PREVENTIVE/DIAGNOSTIC Initial exam $0 Adult cleaning $0 Office visits $0 RESTORATIVE Amalgam (one surface) $13 Amalgam (two surfaces) $24 Resin (one surface) $29 Resin (two surfaces) $40 CROWN & BRIDGE Crown porcelain $495* Crown buildup $80 ENDODONTICS Root canal therapy (anterior) $195 Root canal therapy (molar) $399 ORAL SURGERY Simple extraction $40 Soft tissue impaction $90 PROSTHETICS Complete denture $615* Partial denture $550* PERIODONTICS Osseous surgery/quad $390 $390
Vision Plan
AVESIS VISION OPTION
In Network
Exam $10 Copay
Frequency Every 12 Months
Lenses Covered 100%
Out of Network
Reimbursed to $35
Every 12 Months
Reimbursed to $25 to $80
Single/Bifocal/Trifocal/ after $10 copay depending on lens
Lenticular
Frequency Every 12 Months
Frames $50 Wholesale Allowance up to $150 Retail Value
Frequency Every 24 Months
Every 12 Months
Reimbursed to $45
Every 24 Months
Contact Lenses
Medically Necessary
Medically Necessary (In lieu of frames Covered in Full
Reimbursed to $250 and lenses) Elective
Elective $130 Allowance
Frequency Every 12 Months
Standard lenses are covered.
Reimbursed to $130
Every 12 Months
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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
Life / AD&D Insurance
BASIC LIFE INSURANCE AND AD&D
Chino Valley Unified School District pays 100% of the cost of The Hartford Term Life Insurance Plan. Coverage for each benefit eligible employee is $20,000 Life and AD&D Benefit.
NEW this year!
Chino Valley Unified School District is pleased to offer this new voluntary benefit through MetLife via Kairos. This benefit can provide you and your family financial protection if you are ever unable to work due to an illness or non-work related injury. The benefit amount is 2/3 of your regular weekly earnings to a maximum of $1,500 per week. The benefits will begin to pay out after 14 days of disability due to illness or injury and will continue to pay up to 25 weeks of disability pending medical certification. Maternity is included and typically pays six weeks of benefits for a normal pregnancy.
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 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.
Please note that your life benefit will reduce by 35% at age 65, by 60% of the original amount at age 70 and by 75% of the original amount at age 75.
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-ofpocket 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.
HEALTH CARE SPENDING ACCOUNT (HCSA)
How it Works:
■ You make before-tax deposits (via payroll deductions) to your HCSA.
■ You can deposit from $500 to $3,050 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 CVUSD’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, 2023 and June 30, 2024 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 balance will be forfeited.
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 $500 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, 2023 and June 30, 2024.
■ 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 3).
■ 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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Use your HealthEquity Visa Healthcare Card to pay your provider, or pay online through the HealthEquity member portal.
Employee Assistance Program
KAIROS Health Arizona, Inc. in cooperation with the Trust has contracted with ComPsych to provide employees up to 6 face to face sessions per issue per year at no cost to you. Short-term counseling, legal/financial consultations and work-life services are are provided to employees and their families at no cost. You can speak to a master’s level counselor who can help with almost any issue ranging from medical and family matters to personal, emotional, legal or financial needs.
After 6 sessions, if additional face to face visits are needed, an EAP representative will assist in referring you to a professional in the UnitedHealthcare Network.
Contact ComPsych at 833-955-3386
24 hours a day / 7 days a week.
Or, visit guidedresources.com and login using the Web ID: KairosEAP
Pet Insurance
NEW this year!
WORK-LIFE SOLUTIONS
Also available through the EAP, get the everyday help you need with ComPsych’s Work-Life Solutions. Call the number listed on this page for assistance with topics including:
■ Finding child or elder care
■ Housing searches
■ Seeking financial assistance
■ Finding pet care
■ Sending a child off to school
■ Planning a major project or event
Pet Insurance reimburses you for eligible vet expenses, up to $7,500 per year.
The My Pet Protection plans from Nationwide help you provide your pets with the best care possible:
GET CASH BACK ON VET BILLS
Choose your reimbursement level of 50% or 70%.
SAME PRICE FOR PETS OF ALL AGES
Your rate won’t go up because your pet had a birthday.
EXCLUSIVE TO YOU
This offer is exclusive to Kairos members.
USE ANY VET, ANYWHERE
No networks, no pre-approvals.
To enroll your cat or dog, visit petinsurance.com/kairoshealthaz.
To enroll your bird, rabbit, reptile, or other exotic pet, call 877.738.7874
IMPORTANT: This benefit is not deducted from your paycheck. You will be responsible for paying the monthly premium directly to Nationwide.
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MetLife Worksite Benefits
MetLife is pleased to offer Chino Valley Unified School District employees and qualified dependents the opportunity to elect coverage under several MetLife worksite benefits policies. A few things to remember about these policies:
■ A MetLife policy is separate from the other policies listed in this book. MetLife does not replace your medical insurance coverage.
■ MetLife 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 your date of hire or during open enrollment each year.
You will be able to enroll in these policies via the new online enrollment portal this year - SIMON.
ACCIDENT
This plan pays cash benefits in the event of an accidental injury that needs emergency treatment.
CRITICAL ILLNESS
This plan pays cash benefits for covered critical illnesses.
HOSPITAL INDEMNITY
This plan pays cash benefits when an individual is confined in a hospital.
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this year!
NEW
Employee Rate Worksheet
DENTAL
PLANS
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MEDICAL PLANS
DEPENDENT LIFE COPAY PLAN HDHP 2500 HDHP 5000 VISION PLAN $5.02/MONTH EMPLOYEE ONLY EMPLOYEE & SPOUSE EMPLOYEE & CHILDREN EMPLOYEE & FAMILY EMPLOYEE ONLY EMPLOYEE & SPOUSE EMPLOYEE & CHILDREN EMPLOYEE & FAMILY MONTHLY $0.00 $790.00 $646.00 $1,437.00 MONTHLY $6.40 $11.18 $13.41 $16.61 MONTHLY $0.00 $432.00 $323.00 $923.00 MONTHLY $260.00 $1,331.00 $1,137.00 $2,212.00 MONTHLY $42.00 $85.00 $71.00 $110.00 MONTHLY $10.00 $20.00 $22.00 $25.00
2023-2024
The DELTA DENTAL
District pays $717/month ($8,604/year) towards the Copay and HDHP 2500 plans. The District pays $547/month ($6,564/year) towards the HDHP 5000 and $2,040/year ($170/month) to the Health Savings Account (HSA) when enrolled in the HDHP 5000 as employee only. If enrolling in HDHP 5000 with dependents, the district will contribute the $2,040 to the premium rather than the HSA (this has been accounted for in the rates shown above).
– PPO TDA – DHMO
Medical Coverage Example
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 Chino Valley Unified School District. Each example assumes self-only coverage and reflects CVUSD’s HSA yearly contribution for those that enroll in self-only coverage in the HDHP 5000 plan. You may contribute to your HSA if you are enrolled in either the HDHP 2500 or HDHP 5000 plans up the the yearly maximum (including any CVUSD contributions) on a tax-free basis to further reduce your costs.
Example 1
Managing a Well-Controlled Condition
Routine maintenance of Type 2 Diabetes.
Example 2 Having a Baby
The cost of a normal delivery including services for the obstetrician, hospital or birthing center, anesthesiologist and pediatrician.
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Total Charges $5,600
Copay Plan HDHP 2500 HDHP 5000 Deductibles $200 $2,500 $5,000 Copays $2,000 $800 $100 Coinsurance $0 $200 $100 Limits or Exclusions $20 $20 $20 Patient Pays $2,220 $3,520 $5,220 Annual Employee Premuim $2,856 $0 $0 Less HSA Funds $0 $0 $1,872 Total Employee Cost $5,076 $3,520 $3,348
Total Charges $12,700
Copay Plan HDHP 2500 HDHP 5000 Deductibles $750 $2,500 $5,000 Copays $200 $20 $20 Coinsurance $1,800 $900 $1,300 Limits or Exclusions $0 $0 $0 Patient Pays $2,750 $3,420 $6,320 Annual Employee Premuim $2,856 $0 $0 Less HSA Funds $0 $0 $1,872 Total Employee Cost $5,606 $3,420 $4,448
The information on this page should be used as an estimate and 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.
Important Phone Numbers
UnitedHealthcare / UMR Medical
844.212.6811
umr.com
HealthEquity
Health Savings Account
866.346.5800
healthequity.com
Delta Dental
Dental PPO
800.352.6132 deltadentalaz.com
Total Dental Administrators (TDA)
Dental HMO
888.422.1995
tdadental.com
Avesis Vision
800-522-0258
avesis.com
ComPsych EAP
833.955.3386
guidedresources.com
Web ID: KairosEAP
Arizona State Retirement System
Long Term Disability
520.239.3100
800.621.3778
azasrs.gov
Shelly Dailey
Human Resources Coordinator
928.583.5421
sdailey@chinovalleyschools.com
MaxorPlus
Prescription Drug Questions
800.687.0707
maxorplus.com
Flexible Spending Account (FSA)
HealthEquity
866.346.5800 healthequity.com
Teladoc
800.835.2362 teladoc.com
MetLife
Worksite Benefits and Short Term Disability
877.638.7868
metlife.com
Kairos Member Services
General plan questions
888.331.0222
Member Website - svc.kairoshealthaz.org
Nationwide Pet Insurance
877.738.7874
petsnationwide.com
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ABOUT THIS BOOKLET
This booklet highlights important features of Chino Valley Unified 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 N230
Scottsdale, AZ 85254 Office / 480.347.0926, Fax / 480.360.6417
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