Employee Benefits Guide
2024
Table of Contents Introduction.........................................................................................2 Enrollment Information...............................................................3 Qualifying Life Event..................................................................... 4 COBRA.................................................................................................... 4 Frequently Asked Questions....................................................5 Medical Plan Information...........................................................6 2024 Medical Plans.........................................................................7 Colonial Life..........................................................................................8
Telehealth..............................................................................................9 Where to Turn for Health Care..............................................10 Dental Plan.......................................................................................... 11 Vision Plan.......................................................................................... 12 401(k) Tax-Sheltered Account................................................ 13 You’re Covered with ESI and AZPE....................................14 Important Phone Numbers.................................................... 15
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:
ESI is proud to offer a benefits package that includes medical, dental and vision insurance coverage for you and your dependents.
2. Contact ESI at 844-614-7784.
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.
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1. Contact the carrier directly. Phone number and website information is on page 15.
This booklet highlights important features of ESI’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 November 6th through November 17th. This is your one time per year to make changes.
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.
All benefit eligible employees are required to elect coverage via ESI’s electronic enrollment form. Any coverage not actively selected will be considered a waiver of coverage.
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 Annual Open Enrollment or until a Qualifying Life Event takes place. Late Enrollees may be required to satisfy a waiting period for the dental plan for certain services.
If benefits are elected, ESI will take payroll deductions for the appropriate premiums from your paychecks on a pre-tax basis. Variable-hour employees are required to work enough hours during the month to allow ESI to fully deduct the appropriate amount of premium from each paycheck. If you do not work enough hours to cover the full payroll deduction, then direct payments to ESI must be made timely and compliant with the billing instructions provided by ESI to keep the coverage in-force.
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Qualifying Life Event The elections that you make during Open Enrollment or at initial benefits eligibility will remain in effect for the plan year (January 1 – December 31). 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 the Benefits Department and providing the proper documentation.
QUALIFYING LIFE EVENTS LIST Marital Status Changes ■
Marriage
■
Death of spouse
■
Divorce
■
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.
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 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 an ESI benefit plan immediately preceding the employee’s COBRA event has the right to continue his or her medical, dental or vision plan.
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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
Frequently Asked Questions How do I enroll in ESI’s benefits? Once your new hire paperwork has been submitted to ESI, you will receive an email with instructions on how to complete our electronic benefit packet. The benefit packet will include information on each of the plans and the monthly cost for each plan available to you.
Can I use my ASRS premium subsidy to pay for ESI’s medical plan?
Am I required to enroll in all of the programs, or can I elect stand-alone programs?
It is important to remember that ESI is not an ASRS employer, so if you choose to enroll in either medical plan, you will be forfeiting your monthly ASRS premium subsidy during the time that you are enrolled. You can, however, use your ASRS premium subsidy to help pay for dental and/or vision coverage if you choose to continue to keep that coverage through ASRS.
The programs are offered un-bundled, so you can elect any combination of plan(s). For example, you are able to enroll in the dental plan only without enrolling in the medical plan, if desired.
How do I terminate my ASRS coverage? Can I reinstate my plan once I am no longer working with ESI?
When will my benefits begin? For full-time employees who are hired with the expectation of working at least 30 hours per week, the waiting period for benefits to start is the first of the month following your date of hire. For example, if you start with ESI on July 15th, your benefits will begin on August 1st. Substitutes, Part-Time and/ or Variable Hour employees may be eligible for benefits following a one-year measurement period, beginning on the date of hire, to determine the employee’s average hours worked. How long will I have coverage? You will be covered through the end of your ESI contract period. You may be invoiced for your premium over the summer if your contract spans two fiscal years or if you have subsequent year contracts with ESI. What happens to my coverage when my first contract ends? If I return to ESI, will I have to re-apply for benefits? You will be covered through the end of the month of the last month of your contract with ESI. After your contract expires, you can stay on ESI’s plan through COBRA coverage. If you decide to return to ESI for a second year, your coverage can be reinstated immediately upon returning your benefit election decisions to ESI’s Human Resources department.
If you have ASRS coverage, mail a letter of termination with your name, social security number and signature to the Phoenix office. ASRS coverage can be reinstated within 31 days of terminating your contract with ESI or during the ASRS annual open enrollment, which usually runs from mid-October to mid-November with coverage effective January 1st. What if I want to make changes to my benefit elections during the year? ESI’s benefit plan year runs from January 1st through December 31st. The benefits you select during your initial eligibility period will be in effect until the end of the plan year and can only be changed during ESI’s Open Enrollment period which takes place in December, or if you experience a Qualifying Life Event such as marriage, divorce, or birth/adoption of a child. Will my cost for coverage change during my contract? ESI’s benefits run on a calendar year basis and so rates may change starting in January. The cost for the new calendar year will be provided to you during Open Enrollment so you can plan your benefit elections accordingly. When will I receive my ID cards? You will receive an ID card from EMI Health if you enroll in the medical, dental or vision plan. If you enroll in a combination of these three plans, you will receive one card with information for each benefit.
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Medical Plan Information 1 1 NEW THIS YEAR
2
SmithRx
Blue Cross Blue Shield Educational Services, Inc.
company that will administer 2 The the pharmacy benefits for ESI.
EMI Health
3
company that will process 3 The ESI’s medical claims.
SUMMARY
SmithRx
Medical benefits provide you and your family access to quality health care. ESI offers five medical plans with different coverage levels from which to choose. All plans are provided through EMI Health. EMI Health contracts with Blue Cross Blue Shield of Arizona to use their PPO Network for the PPO and HDHP plans and First Health Limited Benefit Network for the MEC Enhanced plan. The Care Plus plans provide major medical coverage to include hospitalization, physician and emergency room visits, prescriptions and more, while the MEC Enhanced plan offers minimum essential coverage like preventive care and limited physician and lab visits.
SmithRx will be the new pharmacy benefit manager. This means that if you are currently using ExpressScripts for mail order prescriptions or you are on a specialty medication, you will need to work with SmithRx to help transition your prescription benefits. Their team will reach out to new members but you can also reach out directly at:
To search for a Blue Cross Blue Shield of Arizona PPO provider, visit emihealth.com or call 800.662.5851.
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The network ESI will use for hospitals and physicians.
NEW THIS YEAR
844.454.5201 help@smithrx.com smithrx.com
2024 Medical Plans PPO 3000
PPO 5000
HDHP 3200
HDHP 5000
MEC Enhanced
In Network
In Network
In Network
In Network
In Network
Network
BCBSAZ
BCBSAZ
BCBSAZ
BCBSAZ
First Health Limited Benefit
Lifetime Maximum
Unlimited
Unlimited
Unlimited
Unlimited
N/A
Calendar Year
Unlimited
Unlimited
Unlimited
Unlimited
N/A
Individual
$3,000
$5,000
$3,200
$5,000
$0
Family
$6,000
$10,000
$6,400
$10,000
$0
Coinsurance
0%
0%
0%
0%
N/A
Deductibles
Out-of-Pocket Max Individual
$5,000
$6,500
$3,000
$5,000
N/A
Family
$10,000
$13,000
$6,000
$10,000
N/A
Hospital Services Inpatient Hospital
0% After Deductible
0% After Deductible
0% After Deductible
0% After Deductible
No Coverage
Outpatient Hospital
0% After Deductible
0% After Deductible
0% After Deductible
0% After Deductible
No Coverage
Emergency Room
$250 Copay
$350 Copay
0% After Deductible
0% After Deductible
No Coverage
Urgent Care
$75 Copay
$75 Copay
0% After Deductible
0% After Deductible
$50 Copay; Maximum 3 visits per calendar year
Routine Services Office Visit
$30 Copay
$30 Copay
0% After Deductible
0% After Deductible
$20 Copay; Maximum 3 visits per calendar year
Specialist Visit
$60 Copay
$60 Copay
0% After Deductible
0% After Deductible
$50 Copay; Maximum 3 visits per calendar year
Preventive Care
Covered In Full
Covered in Full
Covered In Full
Covered In Full
100% of allowed amount; Maximum 1 visit per calendar year
Lab & X-Ray
$30 Copay
$30 Copay
0% After Deductible
0% After Deductible
$50 Copay; Maximum 3 visits per calendar year
Chiropractic
$60 Copay
$60 Copay
0% After Deductible
0% After Deductible
No Coverage
Prescription Drugs
2.5x Retail
Tier 1
$15 Copay
$15 Copay
0% After Deductible
0% After Deductible
10% Copay
Tier 2
$35 Copay
$40 Copay
0% After Deductible
0% After Deductible
50% Copay
Tier 3
$70 Copay
$80 Copay
0% After Deductible
0% After Deductible
No Coverage
Mail-Order
2.5x Retail
2.5x Retail
0% After Deductible
0% After Deductible
10% / 50% / N/A
ACA approved preventive list only
Both PPO and HDHP plans include out of network coverage at higher deductibles and out of pocket maximums. The MEC Enhanced plan does not provide coverage out of network. Please refer to the plan SBC for details on out of network benefits.
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Colonial Life Voluntary Supplemental Benefits Colonial Life is pleased to offer ESI employees and qualified dependents the opportunity to elect voluntary supplemental benefits. A few things to remember about these policies:
Medical Bridge Hospital Indemnity Plans
✓ A Colonial Life policy is separate from the other
Short Term Disability
policies listed in this book. Colonial Life does not replace your medical insurance coverage.
✓ Colonial Life 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.
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These plans can help with medical costs associated with a hospital stay.
This plan can provide a monthly benefit payment to help cover your ongoing expenses.
Telehealth Recuro – 24/7/365 On-demand access to affordable, quality healthcare. Anytime. Anywhere. If you choose to enroll in the medical plan, you will have access to Recuro Health. Whenever you have an issue, simply connect with Recuro 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.
WHEN SHOULD I USE RECURO?
✓ Instead of going of 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
✓ Talk to a real doctor, 24x7. 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.
ARE MY CHILDREN ELIGIBLE? Yes! WellVia has pediatricians on call 24/7.
WHAT CAN BE TREATED?
HOW MUCH DOES IT COST?
✓ Acne ✓ Allergies ✓ Asthma ✓ Bronchitis ✓ Cold & Flu ✓ Constipation ✓ Diarrhea ✓ Ear Infection ✓ Fever
Nothing! Every consultation is free for you and all of your dependents.
✓ Headache ✓ Insect Bite ✓ Joint Aches ✓ Nausea ✓ Rashes ✓ Sinus Infection ✓ Sore Throat ✓ UTI ✓ And more!
member.recurohealth.com 855.6RECURO
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Where to Turn for Health Care Save Money by Choosing the Best Service for Your Needs Where you receive medical services makes a huge impact on your costs. Choosing the right health care service can provide more appropriate care, more convenience, and more reasonable costs to you.
MINOR
$0
TELEMED TeleMed is perfect for minor aches and ailments. Some 70% of doctor visits can be handled over the phone. There is no cost for a consult and you can receive a diagnosis and prescription for many common illnesses. Call 855.6RECURO for the following ailments: ✓ Allergies ✓ Asthma ✓ Bronchitis
$$
✓ Cold or Flu ✓ Ear Ache ✓ Fever
✓ Heartburn ✓ Nausea ✓ Rash
✓ Sinus infection ✓ Sore throat
OFFICE VISIT Schedule a visit with a participating provider for non-life-threatening conditions. Sprains, back pain, minor cuts or burns, and minor eye injuries are good examples of conditions where a visit to your primary care provider is your best option. A convenience clinic would also work well with these types of care and cost of services.
$$$
URGENT CARE Visit an Urgent Care facility for non-life-threatening but urgent care needs. Urgent Care facilities give you the convenience of extended hours and a much lower cost for many medical situations. Stitches, x-rays, broken bones, and labs can be handled at most Urgent Care facilities.
$$$ MAJOR
EMERGENCY ROOM (ER) VISIT Visit the ER for serious and/or life-threatening conditions. ERs are not set up to care for routine illness and work on the most serious cases first. This means you may have to wait longer for your care and costs are very high. Visit the ER if you experience: ✓ Trouble breathing ✓ Sudden, unusual headache ✓ Signs of stroke ✓ Severe chest pain ✓ Heavy bleeding
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✓ Deep wound ✓ Seizure ✓ Head or spine injury ✓ Broken bone
Have questions? Give us a call at 800.662.5851 or visit emihealth.com.
Dental Plan EMI HEALTH • SUMMIT PLUS NETWORK In Network
Out of Network
Individual
$50
$50
Family
$150
$150
Annual Plan Maximum
$1,500
$1,500
Diagnostic & Preventive Services
100%
100%
Exams
100%
100%
Cleanings
100%
100%
Bitewing x-rays
100%
100%
Floride treatment
100%
100%
Basic Services
90%
80%
Amalgam & composite fillings
90%
80%
Root canals
90%
80%
Simple Extractions
90%
80%
Periodontal maintenance
90%
80%
Major Services
60%
50%
Crowns
60%
50%
Dentures
60%
50%
Bridges
60%
50%
Surgical extractions
60%
50%
Type I
Type II
Type III
Orthodontia Services Orthodontia Age Limitation
19 years old
Lifetime Maximum
50% to $1,500
Lifetime Deductible
N/A
Adult Orthodontia
N/A
12 month waiting
The ESI dental plan includes preventive services and office visits. 11
Vision Plan EMI HEALTH VSP PLUS NETWORK In Network Exam
$10 Copay
Reimbursed to $65
Frequency
Every 12 Months
Every 12 Months
Lenses
Covered 100%
Reimbursed to $30 to $100
Single/Bifocal/Trifocal/ Lenticular
after $10 copay
depending on lens
Frequency
Every 12 Months
Every 12 Months
Frames
$130 Allowance
Reimbursed to $80
Frequency
Every 12 Months
Every 12 Months
Contact Lenses
$130 Allowance
Reimbursed to $115
Every 12 Months
Every 12 Months
Lasik Surgery
All standard lenses are covered.
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Out of Network
15% off Retail
401(k) Tax-Sheltered Account Retirement Plan ESI is proud to offer a 401(k) retirement savings plan. Did you know that by contributing to a 401(k) plan, it may allow you to shelter income on a pre-tax basis, which lowers your current year taxable liability? We believe that saving for retirement is important, but we know it can be confusing. That’s why we want to ensure our employees understand our plan offering and have access to financial advisors who can help. There are two firms that support ESI’s 401(k) plan: Voya Financial is the 401(k) provider that holds your contributions for retirement. They assist with enrollment, fund changes, plan questions, and distribution requests. Voya also has a concierge team to assist with incoming rollovers. CuraFin Advisors provides financial planning, financial investment advice, and financial literacy, among the many programs they offer - free of charge to all 401(k) participants. Participants may also take advantage of additional programs through CuraFin such as mortgage discount programs, employee discounts on vehicles at Earnhardt Motors, and credit counseling. ESI’s 401(k) plan has a 30 day waiting period from your hire date and you must be at least 21 years of age to participate. Learn more about our 401(k): educationalservicesinc.com/employee-resources/employee-benefits
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You’re Covered with ESI and AZPE Exclusive Insurance, Legal Services and More The program is voluntary, however we encourage you to join so you can take advantage of exclusive insurance and other benefits.
✓ $2 million in professional liability and employee rights insurance Teaching can be one of the most rewarding careers out there, especially when you are a part of an organization that is focused on your job satisfaction. We have partnered with Arizona Professional Educators (AZPE), a leading teachers’ association dedicated to providing teachers the necessary resources to feel confident about their rights while on the job.
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✓ Discounted personal legal services ✓ Membership in The Employee Network, the nation’s premier employee discount program
✓ Classroom and Professional Development minigrants of up to $1,000 Although you may never need to use your insurance, it is better to be protected in the event that you do – saving you expensive and unpredictable legal fees and valuable time. Stay covered with ESI and AZPE, and see why AZPE has become the fastest-growing teachers’ association in the state.
Important Phone Numbers EMI Health Medical / Dental / Vision 800.662.5851 emihealth.com Medical Network: Blue Cross Blue Shield of Arizona Select “CarePlus” Dental Network: Select “Summit Plus” Vision Network: Select “VSP Plus“
Arizona State Retirement System Long Term Disability 520-239-3100 800-621-3778 azasrs.gov Recuro Health Telehealth 55.6RECURO member.recurohealth.com SmithRx Prescriptions 844.454.5201 help@smithrx.com smithrx.com
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About this booklet This booklet highlights important features of ESI’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.