Here’s to a
healthier you!
Employee Benefits Guide 2022 - 2023
TABLE OF CONTENTS Enrollment Information . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Dental Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Qualifying Life Event. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Vision Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
COBRA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Disability Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Medical Plan Information. . . . . . . . . . . . . . . . . . . . . . . . . . 5
Life / AD&D Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Medical Plans. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Employee Assistance Program . . . . . . . . . . . . . . . . . . . . 12
Health Savings Account (H.S.A.) . . . . . . . . . . . . . . . . . . . 7
Employee Rate Sheet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Medical Coverage Examples. . . . . . . . . . . . . . . . . . . . . . . 8
Important Phone Numbers & Websites . . . . . . . . . . . 15
Telehealth. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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. 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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If you should have any questions: 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 25th through May 11th, 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. You may elect to opt-out of this method of paying.
This year, the district will hold a passive enrollment which means you will only need to complete an enrollment form if you are making changes to your current benefit elections.
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 31day 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 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. 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 • Marriage • Death of spouse • Divorce • Spouse gains or loses coverage from another source • Spouse employer’s Open Enrollment
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Covered Dependent Changes • Birth or adoption of a child • Death of dependent child • Dependent becomes ineligible for coverage
COBRA 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. 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 Kairos
JCUSD 2
United Healthcare (UHC)
UMR
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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 Kairos Health Arizona. Kairos contracts with UnitedHealthcare to use their network with claims processing and customer service 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 To contact UMR, please go to UMR.com or contact them at 844.212.6811.
UMR CONTACT INFORMATION
UMR.com 844.212.6811
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Medical Plans Copay Plan
HDHP 1500*
HDHP 2500
In Network
In Network
In Network
Unlimited Unlimited
Unlimited Unlimited
Unlimited Unlimited
Individual Family
$750 $1,500/employee +1 OR $2,250/employee +2 or more
$1,500 $3,000**
$2,500 $5,000
Coinsurance
20%
20%
20%
$5,000 $10,000
$3,550 $6,550**
$3,450 $6,550
Deductible, then 20% Deductible, then 20% Deductible, then 20% $50 Copay
Deductible, then 20% Deductible, then 20% Deductible, then 20% Deductible, then 20%
Deductible, then 20% Deductible, then 20% Deductible, then 20% Deductible, then 20%
$25 Copay $50 Copay Covered in Full Deductible, then 20%
Deductible, then 20% Deductible, then 20% Covered in Full Deductible, then 20%
Deductible, then 20% Deductible, then 20% Covered in Full Deductible, then 20%
Tier 1 Tier 2 Tier 3 Mail-Order (90-day supply)
$10 Copay $60 Copay $110 Copay $20/$120/$220
Deductible, then $10 Copay Deductible, then $60 Copay Deductible, then $110 Copay Deductible, then $20/$120/$220
Deductible, then $10 Copay Deductible, then $60 Copay Deductible, then $110 Copay Deductible, then $20/$120/$220
Preventive Medications
Covered in Full
Covered in Full
Covered in Full
Lifetime Maximum Calendar Year
with Health Savings Account
with Health Savings Account
Deductibles
Out-of-Pocket Maximum Individual Family Hospital Services Inpatient Hospital Outpatient Hospital Emergency Room Urgent Care Routine Services Office Visit Specialist Visit Preventive Care Lab & X-Ray Prescription Drugs
**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.
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Health Savings Account (H.S.A.) If you choose to enroll in one of the High Deductible Health Plans (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 2500. 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 em-
ployee’s H.S.A. bank account when enrolled in the HDHP 1500 or the HDHP 2500. 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 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: 1. Enroll in the HDHP 1500 or HDHP 2500 offered by the district 2. Contribute to your H.S.A. by payroll deductions: The money contributed to the account is yours to keep and will roll over year after year – no ‘use it or lose it’ rule!
Up to $3,650 for an individual or $7,300 for a family These maximums include any money contributed by you and the district. 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 2500) • You have no other health coverage (such as other health plan, Medicare, military health benefits, medical FSA’s) • You cannot be claimed as a dependent on someone else’s taxes
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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.
Total Charges
$5,600
Copay Plan
HDHP 1500
HDHP 2500
Deductibles
$200
$1,500
$2,500
Copays
$2,000
$800
$800
Coinsurance
$0
$300
$200
Limits or Exclusions
$20
$20
$20
Patient Pays
$2,220
$2,620
$3,520
Annual Employee Premuim
$924
$0
$0
Less HSA Funds
$0
$1,500
$1,500
Total Employee Cost
$3,144
$1,120
$2,020
Total Charges
$12,700
Copay Plan
HDHP 1500
HDHP 2500
Deductibles
$750
$1,500
$2,500
Copays
$200
$30
$20
Coinsurance
$1,800
$2,000
$900
Limits or Exclusions
$0
$20
$0
Patient Pays
$2,750
$3,530
$3,420
Annual Employee Premuim
$924
$0
$0
Less HSA Funds
$0
$1,500
$1,500
Total Employee Cost
$3,674
$2,030
$1,920
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.
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!
TELADOC INFO
800.835.2362 teladoc.com
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Dental Plan DELTA DENTAL PPO 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
19; Banded prior to Age 17
Lifetime Maximum
50% to $1,500
Lifetime Deductible
N/A
Adult Orthodontia
N/A
Other Benefits Periodontic Coverage
80% In / 80% Out
Endodontic Coverage
80% In / 80% Out
* In and out-of-network coverage available, however, you will pay more when using an out-of-network provider.
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Vision Plan
SUPERIOR VISION In Network Exam
$10 Copay
Frequency
Every 12 Months
Lenses Single/Bifocal/Trifocal/Lenticular
Covered 100% after $10 copay
Frequency
Every 12 Months
Standard Progressive Lenses
Covered in Full after $55 copay
Youth Polycarbonate
Covered in Full after $40 copay
Frames
$35 Wholesale allowance
Frequency
Every 24 Months
Contact Lenses
Medically Necessary
(In lieu of frames)
Covered in Full Elective $120 Allowance
Frequency
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 Joseph City Unified School District pays the entire cost of the Equitable STD policy. Elimination Period:
30 Days
Benefit Amount:
662/3% of pre-disability weekly earnings up to $2,000
Benefit Duration:
26 Weeks
Life / AD&D Insurance BASIC LIFE INSURANCE AND AD&D Joseph City Unified School District pays 100% of the cost of this Kairos/MetLife Term Life Insurance Policy. Coverage for each benefit eligible employee is $50,000 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.
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
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.
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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
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* COPAY PLAN
HDHP 1500
26 PAYS $35.54 $266.31 $226.62 $312.92
26 PAYS $0.00 $196.15 $161.08 $236.77
EMPLOYEE ONLY EMPLOYEE & SPOUSE EMPLOYEE & CHILDREN EMPLOYEE & FAMILY
DENTAL PLAN EMPLOYEE ONLY EMPLOYEE & SPOUSE EMPLOYEE & CHILDREN EMPLOYEE & FAMILY
26 PAYS $18.46 $37.38 $30.92 $48.00
HDHP 2500 26 PAYS $0.00 $177.23 $143.54 $216.92
VISION PLAN 26 PAYS $2.55 $5.10 $5.99 $9.18
*The District pays up to $7,080/year toward the premium for each plan. The District pays $1,500/year to the Health Savings Account (H.S.A.) for those enrolled in the HDHP 1500 and HDHP 2500 plans. The Rates above for the Copay Plan and HDHP options include district contribution for spouse and/or dependent cost up to $185 per month.
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Important Phone Numbers & Websites UnitedHealthcare / UMR
Equitable
Medical 844.212.6811 umr.com
Short Term Disability 866.274.9887 equitable.com
MaxorPlus
ComPsych
Prescription Drug Questions 800.687.0707 maxorplus.com
EAP 833.955.3386 guidedresources.com Web ID: KairosEAP
HealthEquity Medical 866.346.5800 www.healthequity.com
Teladoc
Delta Dental
Arizona State Retirement System
Dental PPO 800.352.6132 deltadentalaz.com
Long Term Disability 520.239.3100 800.621.3778 azasrs.gov
Superior Vision Vision 800.507.3800 superiorvision.com
MetLife
800.835.2362 teladoc.com
Stephanie Farr District Payroll & Benefits Specialist 928.288.3307 x 336 stephanief@jcusd.org
Life Insurance 800.880.1800 metlife.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