Here’s to a
healthier you!
ELOY ELEMENTARY SCHOOL DISTRICT
Employee Benefits Guide 2022 - 2023
TABLE OF CONTENTS Enrollment Information.................................................................3
Disability Information...................................................................10
Qualifying Life Event........................................................................4
Life/AD&D Insurance......................................................................10
COBRA.......................................................................................................4
Employee Assistance Program................................................ 11
Medical Plan Information.............................................................5
AFLAC....................................................................................................... 12
Medical Plans........................................................................................6
Wellness Program........................................................................... 13
Telehealth................................................................................................7
Employee Rate Worksheet........................................................14
Dental Plan.............................................................................................8
Important Phone Numbers & Websites........................... 15
Vision Plan..............................................................................................9
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.
If you should have any questions:
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.
2. Contact Trina Masters by phone at 520.466.2100 or by email at trina.masters@eloyesd.net
Please take the time to read this information and ask questions so you can make the best benefits decisions for yourself and your family.
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1. Contact the carrier directly. Phone number and website information is on page 15.
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.
Enrollment Information OPEN ENROLLMENT
PRE-TAX VS POST-TAX DEDUCTIONS
Open Enrollment is from May 2nd through May 13th, 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.
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 enrollment form even if you are not making changes to your benefit elections.
Post-Tax Dollars: Some insurance premiums may be paid after taxes are deducted from your gross pay. Please contact Ed Sauceda for more information related to the specific premiums that are deducted post-tax. 
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.

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ELOY ELEMENTARY SCHOOL DISTRICT
Qualifying Life Event
COBRA
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.
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.
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
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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.
Medical Plan Information 1
The Trust that will provide medical insurance to Eloy Elementary School District.
2
The networks Eloy Elementary School District will use for hospitals and physicians.
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The company that will process Eloy Elementary School District’s medical claims.
1 ASBAIT
Eloy 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. 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
(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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ELOY ELEMENTARY SCHOOL DISTRICT
Medical Plans Classic Silver Banner
Copay Gold Banner
In Network
In Network
Aetna CPII
Banner
Aetna CPII
Banner
Unlimited Unlimited
Unlimited Unlimited
Unlimited Unlimited
Unlimited Unlimited
$500 $1,000 20%
$400 $800 20%
None None N/A
None None N/A
$4,500 $9,000
$3,600 $7,200
$6,350 $12,700
$5,080 $10,160
Inpatient Hospital
$250 Copay, then 20%
$200 Copay, then 20%
$250 Copay
$200 Copay
Outpatient Hospital
Deductible, then 20% Deductible, then 20% $50 Copay
Deductible, then 20% Deductible, then 20% $42 Copay
$75 Copay $120 & $32 Copays* $50 Copay
$60 Copay $120 & $32 Copays* $40 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
$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
Lifetime Maximum Calendar Year
Deductibles Individual Family Coinsurance
Out-of-Pocket Maximum Individual Family
Hospital Services
Emergency Room Urgent Care
Routine Services Office Visit Specialist Visit Preventive Care Lab & X-Ray Chiropractic Rehabilitation Therapy
Prescription Drugs Tier 1 Tier 2 Tier 3 Tier 4 Specialty Mail-Order Diabetic Medications
$15 Copay 20% ($25 min/$80 max) 40% ($40 min/$110 max) 20% Copay ($100 min/$150 max) 2x Retail $5 Generic, $15 Brand
$15 Copay 20% ($25 min/$80 max) 40% ($40 min/$110 max) 20% Copay ($100 min/$150 max) 2x Retail $5 Generic, $15 Brand
*members will pay a $120 copay for facility charges and a $32 copay for professional fees
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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. What can be treated? • Acne • Allergies • Asthma • Bronchitis • Cold & Flu • Constipation • Diarrhea • Ear Infection • Fever
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?
• • • • • • • • •
Headache Insect Bite Joint Aches Nausea Rashes Sinus Infection Sore Throat UTI And more!
• Nothing! Every consultation is free for you and all of your dependents
www.MyDrConsult.com 1.800.362.2667
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ELOY ELEMENTARY SCHOOL DISTRICT
Dental Plan
METLIFE
In Network Annual Deductibles 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%
Orthodontic Benefits Orthodontia Age Limitation
19 years old
Lifetime Maximum
50% to $1,000
Lifetime Deductible
N/A
Adult Orthodontia
N/A
Other Benefits Periodontic Coverage
80%
Endodontic Coverage
80%
The dental plan includes preventive services and office visits. 8
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/
$0 copay
depending on lens
Frequency
Every 12 Months
Every 12 Months
Frames
$150 Allowance
Reimbursed to $45
Frequency
Every 12 Months
Every 12 Months
Lenticular
Contact Lenses
$130 Allowance
Reimbursed to $130
(in lieu of frame and spectacle lenses)
Every 12 Months
Every 12 Months
Lasik Surgery
Discount up to 25% /$150
Reimbursed to $150
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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: Benefit Amount:
180 Days 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 this MetLife Group Term Life Insurance Plan. Coverage for each benefit eligible employee is $50,000.
VOLUNTARY LIFE / AD&DSchool INSURANCE Eloy Elementary District pays 100% of the cost of the Term Life and AD&D.
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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 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.
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 a 24-Hour Nurseline at 888-771-9116 for all medical questions and health issues. 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.
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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.
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 (Classic Silver) will be paid by the District at 100% if you participate in the wellness program. If 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, 2022, as well as several optional activities we recommend.
REQUIRED 1. Biometric Screening 2. Preventative Check-up • Prior to 12/01/2022 • 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
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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ELOY 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.
MEDICAL PLANS – PER PAY PERIOD (18 PAYS) WELLNESS PARTICIPANTS*
EMPLOYEE ONLY EMPLOYEE & SPOUSE EMPLOYEE & CHILDREN EMPLOYEE & FAMILY
COPAY GOLD
CLASSIC SILVER
$63.33 $546.00 $479.33 $797.33
$0.00 $420.00 $362.00 $638.67
*Those employees who have not completed wellness criteria by December 1, 2022, will be charged an additional $78 per pay for 10 pay periods starting January 1, 2023.
EMPLOYEE ONLY EMPLOYEE & SPOUSE EMPLOYEE & CHILDREN EMPLOYEE & FAMILY
DENTAL – PER PAY PERIOD (18 PAYS)
VISION – PER PAY PERIOD (18 PAYS)
$0.00 $44.38 $44.38 $44.38
$0.00 $3.78 $6.55 $9.84
SUPPLEMENTAL LIFE – MONTHLY RATES AGE RATE PER $1000 OF BENEFIT
0-29 30-34 35-39 40-44 45-49 14
$0.051 $0.064 $0.100 $0.145 $0.226
50-54 55-59 60-64 65-69 70-99
$0.370 $0.610 $0.951 $1.771 $3.469
EXAMPLE: A 45 year old enrolls in $10,000 of Supplemental Life insurance coverage. $10,000 x $0.226 = $2260 $2260 / $1000 = $2.26 Monthly Premium is $2.26
Important Phone Numbers & Websites ASBAIT
MetLife
Aetna Choice POS II or Banner 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
Alliance Work Partners EAP & Nurse Support 800.343.3822 (EAP) 800.334.8336 (Teen Line) 888-771-9116 (Nurse) www.alliancewp.com
Arizona State Retirement System
Select “PDP” network when searching for providers.
Avesis Vision 800.828.9341 www.avesis.com
MetLife Life Insurance 800.275.4638 www.metlife.com/mybenefits
Long Term Disability 520-239-3100 800-621-3778 www.azasrs.gov
AFLAC
Trina Masters
Teladoc
520.466.2100 Email: trina.masters@eloyesd.net
800.362.2667 www.MyDrConsult.com
Julie Kicker 602.799.8022
Pat Tarango 520.466.2100 Email: pat.tarango@eloyesd.net
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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 N230, Scottsdale, AZ 85254 Office / 480.347.0926 Fax / 480.360.6417
