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Employee Benefits Guide 2020 - 2021
TABLE OF CONTENTS Enrollment Information . . . . . . . . . . . . . . . . . . 2 Qualifying Life Event . . . . . . . . . . . . . . . . . . . . 3 Medical Plan Information. . . . . . . . . . . . . . . . . 4 Medical Plans. . . . . . . . . . . . . . . . . . . . . . . . . . 5 Health Savings Account (H.S.A.) . . . . . . . . . . . 6 Medical Coverage Examples . . . . . . . . . . . . . . 7 Telehealth. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Dental Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Vision Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Disability Information. . . . . . . . . . . . . . . . . . . 11 Life / AD&D Insurance. . . . . . . . . . . . . . . . . . 11 Employee Assistance Program. . . . . . . . . . . . 12 Employee Rate sheet. . . . . . . . . . . . . . . . . . . 13 Important Phone Numbers & Websites. . . . . 14
If you should have any questions:
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. Joseph City 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 and voluntary supplemental programs. 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. 2. Contact Stephanie Farr, District Payroll & Benefits Specialist, by phone at 928.288.3307 x336 or by email at stephanief@jcusd.org. This booklet highlights important features of Joseph City 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.
ENROLLMENT INFORMATION OPEN ENROLLMENT
PRE-TAX VS POST-TAX DEDUCTIONS
Open Enrollment is from April 20th through May 10th, 2020. 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. You may elect to opt-out of this method of paying.
If you do not make changes during Open Enrollment, your current benefit elections will carry over to the new plan year.
NEW EMPLOYEES
Post-Tax Dollars: Some insurance premiums may be paid after taxes are deducted from your gross pay. Please contact Stephanie Farr for more information related to the specific premiums that are deducted post-tax. 
New Employees have 31 days from your hire date to complete enrollment in the group insurance program. If you have moved from a non-benefits-eligible status to a benefits eligible status, you will have 31 days from the new benefits eligible status date to complete your enrollment. All insurance coverage starts at the first of the month. Remember, if elections are not made within the 31-day initial period of eligibility, you will be required to wait until Annual Open Enrollment or until a Qualifying Life Event takes place.
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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, 2020 – June 30, 2021). 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 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 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 a Joseph City Unified 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 Joseph City Unified School District.
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The network Joseph City Unified School District will use for hospitals and physicians.
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The company that will process Joseph City Unified School District’s medical claims.
1 ASBAIT
JCUSD 2
Aetna Choice POS II
Meritain Health Company
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SUMMARY Medical benefits provide you and your family access to quality health care. Joseph City Unified School District offers three medical plans with different coverage levels from which to choose. All plans are provided through Arizona School Boards Association Insurance Trust (ASBAIT). ASBAIT contracts with Aetna to use their PPO Network, with claims processing and customer service being provided by Meritain Health Company.
To search for an Aetna PPO provider please go to www.aetna.com/docfind/custom/mymeritain. Click on the “Search the Provider Directory.” To contact Meritain, please go to www.mymeritain.com or contact them at 866.300.8449.
MERITAIN CONTACT
www.mymeritain.com
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MEDICAL PLANS Value Silver
HDHP1500/HSA
HDHP3000/HSA
In Network
In Network
In Network
Lifetime Maximum
Unlimited
Unlimited
Unlimited
Calendar Year
Unlimited
Unlimited
Unlimited
$1,000
$1,500
$3,000
Calendar Year Deductibles Individual Family
$2,000
$3,000**
$6,000
Coinsurance
25%
20%
20%
Out-of-Pocket Maximum Individual
$6,000
$5,500
$6,000
Family
$12,000
$11,000
$12,000
Hospital Services Inpatient Hospital
$250 Copay, then 25%
Deductible, then $250 Copay & 20%
Deductible, then $250 Copay & 20%
Outpatient Hospital
Deductible, then 25%
Deductible, then 20%
Deductible, then 20%
Emergency Room
Deductible, then 25%
Deductible, then 20%
Deductible, then 20%
Urgent Care
$60
Deductible, then 20%
Deductible, then 20%
Routine Services Office Visit
$40 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
25% (deductible waived)
Deductible, then 20%
Deductible, then 20%
Chiropractic
$40 Copay
Deductible, then 20%
Deductible, then 20%
Rehabilitation
Deductible, then 25%
Deductible, then 20%
Deductible, then 20%
$15 Copay
Deductible, then 20%
Deductible, then 20%
Prescription Drugs Tier 1 Tier 2
20% Copay ($25 min/$80 max)
Deductible, then 20%
Deductible, then 20%
Tier 3
40% Copay ($40 min/$110 max)
Deductible, then 20%
Deductible, then 20%
Tier 4 Specialty
20% Copay ($100 min/$150 max)
Deductible, then 20%
Deductible, then 20%
Mail-Order/90-Day
2x Retail
Deductible, then 20%
Deductible, then 20%
Diabetic Medications
$5 Generic, $15 Brand
Deductible, then 20%
Deductible, then 20%
**If you have Family coverage under the HDHP, the Family Deductible must be satisfied before the Plan will pay any benefits.
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HEALTH SAVINGS ACCOUNT (H.S.A.) If you choose to enroll in the High Deductible Health Plan (HDHP), you will have the option of opening an H.S.A. provided by HealthEquity. An H.S.A. is a tax-advantaged savings and spending account that can be used to pay for qualified health care expenses.
THERE ARE TWO COMPONENTS TO AN H.S.A.-BASED COVERAGE PLAN: 1. A qualified health plan is the insurance component that provides medical coverage for you and your family. You can choose either the HDHP 1500 or the HDHP 3000. 2. An H.S.A. with HealthEquity is the banking component which can be funded by pre-tax payroll contributions from you, the district, or both. The district contributes $1,500 annually to an employee’s
H.S.A. bank account when enrolled in the HDHP 1500 or the HDHP 3000. Employees with dependent coverage can choose whether the district’s contributions are funded to their HSA or to help buy-down the monthly medical premium. The employee can select whether $1500, $1,000, $500 or $0 will go in to their HSA. Any money not funded to the HSA will go toward the dependent premium.
HOW AN H.S.A. WORKS:
The money contributed to the account is yours to keep and will roll over year after year – no ‘use it or lose it’ rule!
1. Enroll in the HDHP 1500 or HDHP 3000 offered by the district 2. Contribute to your H.S.A. by payroll deductions: Up to $3,550 for an individual or $7,100 for a family
3. With your HSA debit card, use those funds to pay for qualified expenses such as: • copays
• hearing aids
• deductibles
• glasses/ contacts
• chiropractor
• prescriptions
• dental treatment
H.S.A. ELIGIBILITY To make tax-free contributions to an H.S.A., the IRS requires that: • You are covered by an H.S.A.-qualified medical plan (such as the HDHP 1500 or the HDHP 3000) • You have no other health coverage (such as other health plan, Medicare, military health benefits, medical FSA’s)
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MEDICAL COVERAGE EXAMPLES The following examples show how each plan might cover medical care in given situations. Use these examples to see, in general, how much financial protection a sample patient might get if they are covered under the different plans available at Joseph City Unified School District. Each example assumes self-only coverage.
Example 1 - Managing a Well-Controlled Condition
Total Charges
$7,460
Routine maintenance of Type 2 Diabetes. Value Silver
HDHP 1500
HDHP 3000
Deductibles
$1,000
$1,500
$3,000
Copays
$885
$0
$0
Coinsurance
$1,185
$1,437
$1,437
Limits or Exclusions
$55
$55
$55
Patient Pays
$3,122
$2,992
$4,492
Annual Employee Premuim
$630
$0
$0
Less HSA Funds
-$0
-$1,500
-$1,500
Total Employee Cost
$3,752
$1,492
$2,992
Total Charges
$12,840
Value Silver
HDHP 1500
HDHP 3000
Deductibles
$1,000
$1,500
$3,000
Copays
$390
$250
$250
Coinsurance
$3,100
$735
$735
Limits or Exclusions
$60
$60
$60
Patient Pays
$4,550
$2,545
$4,045
Annual Employee Premuim
$630
$0
$0
Less HSA Funds
-$0
-$1,500
-$1,500
Total Employee Cost
$5,180
$1,045
$2,545
Example 2 - Having a Baby The cost of a normal delivery including services for the obstetrician, hospital or birthing center, anesthesiologist and pediatrician.
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.
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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 Teladoc board-certified doctors, available by phone, video or chat. They are specially trained to diagnose, treat and prescribe medications for a wide variety of common medical conditions, helping you avoid the costly and time-consuming trips to the doctor or urgent care centers. • Talk to a real doctor, 24/7. No need to schedule an appointment or limit your visits. • Save money and time, while avoiding costly trips to a doctor’s office, urgent care or ER.
When should I use Teladoc? • Instead of going to the ER or an urgent care center for a non-emergency issue • During or after normal business hours, nights, weekends and holidays • If your primary care physician is not available • To request prescriptions (when appropriate) • If traveling and in need of medical care Are my children eligible? • Yes! Teladoc has pediatricians on call 24/7
What can be treated? • Acne • Allergies • Asthma • Bronchitis • Cold & Flu • Constipation • Diarrhea • Ear Infection • Fever
• • • • • • • • •
Headache Insect Bite Joint Aches Nausea Rashes Sinus Infection Sore Throat UTI And more!
How much does it cost? • Employees enrolled in the Value Silver plan will have no consultation fee for services. • Due to HSA regulations, employees enrolled in the HDHP plans will have a $40 consultation fee at the time of service.
Teladoc 800.362.2667 www.MyDrConsult.com
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DENTAL PLAN
ASBAIT DENTAL In Network
Out-of-Network
Individual
$50
$50
Family
$150
$150
Annual Plan Maximum
$1,500
$1,500
Annual Deductibles
Benefits Type I - Diagnostic & Preventive (no deductible) 100%
100% UCR
Type II - Basic Service
80%
80% UCR
Type III - Major Services
50%
50% UCR
Orthodontia Age Limitation
19 years old
19 years old
Lifetime Maximum
50% to $1,500
50% UCR to $1,500
Lifetime Deductible
N/A
N/A
Adult Orthodontia
N/A
N/A
Endodontic Coverage
80%
80% UCR
Periodontic Coverage
80%
80% UCR
Orthodontic Benefits
Other Benefits
UCR = Usual, customary & reasonable
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VISION PLAN
AVESIS VISION
In Network
Out of Network
Exam
$10 Copay
Reimbursed to $35
Frequency
Every 12 Months
Every 12 Months
Lenses
Covered 100%
Reimbursed: $25 to $80
Single/Bifocal/Trifocal/
after $10 copay
depending on lens
Frequency
Every 12 Months
Every 12 Months
Frames
$35 Wholesale allowance
Reimbursed to $45
Frequency
Every 24 Months
Every 24 Months
Contact Lenses
Medically Necessary
Medically Necessary
(In lieu of frames)
Covered in Full
Reimbursed to $250
Elective
Elective
$110 Allowance
Reimbursed to $110
Every 12 Months
Every 12 Months
Lenticular
Frequency
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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 Joseph City Unified School District pays the entire cost of the UNUM STD policy. Elimination Period:
30 Days
Benefit Amount:
662/3% of pre-disability weekly earnings up to $4,000
Benefit Duration:
26 Weeks
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
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LIFE / AD&D INSURANCE BASIC LIFE INSURANCE AND AD&D Joseph City Unified School District pays 100% of the cost of this UNUM Term Life Insurance Policy. Coverage for each benefit eligible employee is $25,000 Life and AD&D Benefit. 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.
EMPLOYEE ASSISTANCE PROGRAM Alliance Work Partners - An EAP provides valuable services at no cost to employees and their families in the form of short-term counseling, legal and financial consultations through LawAccess, and worklife resources and referral through Work/Life Standard. Seven days a week, 24 hours a day, using one toll-free phone number (800-343-3822), 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 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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EMPLOYEE RATE SHEET Use this sheet for your per-paycheck benefit costs for the upcoming plan year. This is a great place to start planning for your, and your family’s, health and wellness for next year.
MEDICAL PLANS* VALUE SILVER EMPLOYEE ONLY EMPLOYEE & SPOUSE EMPLOYEE & CHILDREN EMPLOYEE & FAMILY
EMPLOYEE ONLY EMPLOYEE & SPOUSE EMPLOYEE & CHILDREN EMPLOYEE & FAMILY
HDHP 1500
26 PAYS $24.23 $281.31 $238.38 $331.62
26 PAYS $0.00 $232.15 $191.54 $276.92
DENTAL PLANS
VISION PLAN
26 PAYS $21.60 $44.45 $46.25 $60.09
26 PAYS $4.62 $10.62 $10.62 $10.62
HDHP 3000 26 PAYS $0.00 $206.77 $166.62 $248.77
*The District pays $8,046/year toward the premium for each plan plus an additional $1,980/year toward Spouse, Children and Family plans. The District pays $1,500/year to the Health Savings Account (H.S.A.) for those enrolled in the HDHP 1500 and HDHP 3000 plans.
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IMPORTANT PHONE NUMBERS & WEBSITES ASBAIT Aetna Choice POS II Medical & Dental 866.300.8449 www.aetna.com/docfind/custom/mymeritain Employee Portal: www.mymeritain.com HealthEquity Medical 866.346.5800 www.healthequity.com  Avesis Vision 800.828.9341 www.avesis.com  Alliance Work Partners EAP & Nurse Support 800.343.3822 (EAP) 800.334.8336 (Teen Line) 888.771.9116 (Nurse) www.alliancewp.com 
UNUM Life and Disability 866.679.3054 www.unum.com Arizona State Retirement System Long Term Disability 520.239.3100 800.621.3778 www.azasrs.gov Stephanie Farr District Payroll & Benefits Specialist 928.288.3307 x 336 stephanief@jcusd.org Teladoc 800.362.2667 www.MyDrConsult.com
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ABOUT THIS BOOKLET This booklet highlights important features of Joseph City 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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