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Employee Benefits Guide 2020 - 2021
TABLE OF CONTENTS Enrollment Information . . . . . . . . . . . . . . . . . . 2 How To Enroll . . . . . . . . . . . . . . . . . . . . . . . . . 3 Qualifying Life Event . . . . . . . . . . . . . . . . . . . . 4 Cobra. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Medical Plan information. . . . . . . . . . . . . . . . . 5 Medical Plans. . . . . . . . . . . . . . . . . . . . . . . . . . 6 Telehealth. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Dental Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Vision Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Flexible Spending Accounts. . . . . . . . . . . . . . 10 Disability Information. . . . . . . . . . . . . . . . . . . 11 Life / AD&D Insurance. . . . . . . . . . . . . . . . . . 11 Aflac. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Employee Assistance Program. . . . . . . . . . . . 13 Employee Rate Worksheet. . . . . . . . . . . . . . . 14 Important Phone Numbers & Websites. . . . . 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. Saddle Mountain 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 supplemental 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 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 Juanita Villa by phone at 623.474.5101 or by email at juanita.villa@smusd90.org This booklet highlights important features of Saddle Mountain 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 May 4th through May 22nd. 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. 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.
You will only need to login to HRConnection if you are making changes to your current elections. If you intend to keep your coverage the same, then you are not required to login to HRConnection this year.
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.
Post-Tax Dollars: Some insurance premiums may be paid after taxes are deducted from your gross pay. Please contact Juanita Villa for more information related to the specific premiums that are deducted post-tax.  
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 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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HOW TO ENROLL 1. Login to the enrollment site at www.hrconnection.com using your district assigned email address.
4. Click “Start Now” to make your elections.
2. Update any family or contact information under the tab titled My Information. Remember to add any family members who will be covered on your insurance as well as a beneficiary for the District-paid life insurance.
5. Each section will show you the plans that are available to you with the cost to cover you and your dependents. Simply click "Select" for the benefit you want to elect and indicate who will be covered on the plan. 6. After you have made your selections, you will be given a chance to review them again and click “Confirm Elections”.
3. Hover over the My Information tab and click on My Elections.
7. Once confirmed, you will see a confirmation page where you can download a summary of your enrollment to be saved or printed.
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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 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.
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 Somerton 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.
QUALIFYING LIFE EVENTS LIST Marital Status Changes
Covered Dependent Changes
• Marriage • Birth or adoption of • Death of spouse a child • Divorce • Death of dependent • Spouse gains or loses child coverage from • Dependent becomes another source ineligible for • Spouse employer’s coverage Open Enrollment
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MEDICAL PLAN INFORMATION 1
The Trust that will provide medical insurance to Saddle Mountain Unified School District.
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The network Saddle Mountain Unified School District will use for hospitals and physicians.
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The company that will process Saddle Mountain Unified School District’s medical claims.
1 ASBAIT
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Saddle Mountain USD
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. Saddle Mountain 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 Choice POS II and Banner networks, with claims processing and customer service being provided by Meritain Health Company. To contact Meritain, please go to www.mymeritain.com or contact them at 866.300.8449.
MERITAIN CONTACT
www.mymeritain.com 5
MEDICAL PLANS Value Gold
Classic Gold
Copay Gold
In Network
In Network
In Network
Aetna
Banner
Aetna
Banner
Aetna
Banner
Unlimited Unlimited
Unlimited Unlimited
Unlimited Unlimited
Unlimited Unlimited
Unlimited Unlimited
Unlimited Unlimited
$750 $1,500 25%
$600 $1,200 25%
$300 $900 15%
$240 $720 15%
None None N/A
None None N/A
$5,000 $10,000
$4,000 $8,000
$4,000 $8,000
$3,200 $6,400
$6,350 $12,700
$5,080 $10,160
Inpatient Hospital
$250 Copay, then 25%
$200 Copay, then 25% $250 Copay, then 15% $200 Copay, then 15% $250 Copay
Outpatient Hospital Emergency Room
Deductible, then 25% Deductible, then 25% Deductible, then 25% Deductible, then 25%
Deductible, then 15% Deductible, then 15% Deductible, then 15% Deductible, then 15%
$75 Copay $150 Copay
$60 Copay $120 Copay
Urgent Care
$55 Copay
$46 Copay
$45 Copay
$38 Copay
$50 Copay
$40 Copay
$35 Copay $45 Copay Covered in Full 25% $35 Copay $35 Copay
$28 Copay $36 Copay Covered in Full 25% $28 Copay $28 Copay
$25 Copay $35 Copay Covered in Full $25 Copay $25 Copay $25 Copay
$20 Copay $28 Copay Covered in full $20 Copay $20 Copay $20 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
Calendar Year Deductibles Individual Family Coinsurance
Out-of-Pocket Maximum Individual Family
Hospital Services $200 Copay
Routine Services Office Visit Specialist Visit Preventive Care Lab & X-Ray Fee Chiropractic Rehabilitation
Prescription Drugs Tier 1 Tier 2 Tier 3 Tier 4 Specialty Mail-Order Diabetic Medications
$15 Copay 20% Copay ($25 min/$80 max) 40% Copay ($40 min/$110 max) 20% Copay ($100 min/$150 max) 2x Retail $5 Generic, $15 Brand
$15 Copay 20% Copay ($25 min/$80 max) 40% Copay ($40 min/$110 max) 20% Copay ($100 min/$150 max) 2x Retail $5 Generic, $15 Brand
$15 Copay 20% Copay ($25 min/$80 max) 40% Copay ($40 min/$110 max) 20% Copay ($100 min/$150 max) 2x Retail $5 Generic, $15 Brand
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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. What can be treated? • Acne • Allergies • Asthma • Bronchitis • Cold & Flu • Constipation • Diarrhea • Ear Infection • Fever
www.MyDrConsult.com 1.800.362.2667
• 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 How much does it cost? • Nothing! Every consultation is free for you and all of your dependents
DENTAL PLAN METLIFE MAC In Network Annual Calendar Year Deductibles Individual Family Annual Plan Maximum
$50 $150 $1,500
Benefits Type I - Diagnostic & Preventive (no deductible) Type II - Basic Service Type III - Major Services
100% In / 80% Out 80% In / 60% Out 50% In / 40% Out
Orthodontic Benefits Orthodontia Age Limitation Lifetime Maximum Lifetime Deductible Adult Orthodontia
19 years old 50% to $1,000 N/A N/A
Other Benefits Endodontic Coverage Periodontic Coverage
80% In / 60% Out 50% In / 40% Out
The dental plan includes preventive services and office visits.
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VISION PLAN
All standard lenses are covered.
AVESIS VISION
Exam Frequency
In Network $10 Copay Every 12 Months
Out of Network Reimbursed to $35 Every 12 Months
Lenses Covered 100% Single/Bifocal/Trifocal/ after $15 copay Lenticular Frequency Every 12 Months
Every 12 Months
Frames
Up to $175 Allowance, after $15 copay
Reimbursed to $55
Frequency
Every 24 Months
Every 24 Months
Contact Lenses
$175 Allowance Every 12 Months
Reimbursed to $160 Every 12 Months
25% Discount, $150 Allowance onetime/lifetime
Reimbursed to $150 onetime/lifetime
(in lieu of frame and spectacle lenses)
Lasik Surgery
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Reimbursed: $25 to $80 depending on lens
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-of-pocket health care and dependent day care expenses with pre-tax dollars. Since these accounts are to be used f or predictable expenses, careful planning is required. Please Note: Employees will become eligible to participate effective July 1st following completion of an agreement (classified) or contract (certified) year.
HEALTH CARE SPENDING ACCOUNT (HCSA) How it Works: • You make before-tax deposits (via payroll deductions) to your HCSA. • You can deposit from $100 to $2,750 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 SMUSD’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 FSA debit card. • All expenses must be incurred between July 1, 2020 and June 30, 2021 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 maximum that can be rolled over to the next year is $500.
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 $100 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, 2020 and September 15, 2021. • If you do not use the money in this account during 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 4). • 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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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: 180 Days Benefit Amount: 66 2/3% of monthly base salary as determined by ASRS
Saddle Mountain Unified School District pays 100% of the cost of the Term Life and AD&D insurance.
LIFE / AD&D INSURANCE BASIC LIFE INSURANCE AND AD&D
VOLUNTARY LIFE / AD&D INSURANCE
Saddle Mountain Unified School District pays 100% of the cost of the UNUM Group Term Life Insurance Plan.
You can also elect to purchase additional life insurance for yourself, your spouse or your children.
Coverage for each benefit eligible employee is $30,000. 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.
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• Employee $10,000 increments to a maximum of $500,000, up to 5x your annual earnings. • Spouse $5,000 benefit increments to a maximum of $500,000, up to matching employee benefit. • Children $2,000 benefit increments to a maximum of $10,000. Note: If you were previously eligible for the voluntary life insurance but declined, you may be required to fill out a statement of health in order to enroll in the voluntary life benefit.
AFLAC American Family Life Assurance Company (AFLAC) is pleased to offer Saddle Mountain Unified 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 or short-term disability 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 Gregory Wimbley at 602.419.8569 for more information or to set up an appointment.
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.
HOSPITAL ADVANTAGE These plans pay a cash benefit for an individual for a hospitalization.
CRITICAL CARE INDEMNITY These plans pay a cash benefit for an individual for a specific diagnosis.
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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 or Banner | Aetna network. If appropriate, the program also provides access to a wide range of national and community resources.
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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.
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 next year.
MONTHLY INSURANCE RATES FOR 2020-2021 PLAN YEAR VALUE GOLD
CLASSIC GOLD
COPAY GOLD
DENTAL
VISION
$703.00
$778.00
$857.00
$45.05
$7.88
EMPLOYEE & SPOUSE
$1,406.00
$1,558.00
$1,714.00
$86.60
$14.89
EMPLOYEE & CHILDREN
$1,406.00
$1,558.00
$1,714.00
$90.74
$16.22
EMPLOYEE & FAMILY
$1,814.00
$2,013.00
$2,212.00
$134.39
$20.87
EMPLOYEE ONLY
Employees who waive medical coverage are eligible for a $1,500 allowance upon providing proof of other insurance. Dual Benefit: for married couples who are both district employees and cover eligible dependent children, the district contribution will be doubled and will apply to the total family premium listed above. The spouse who chooses to waive medical for the DUAL benefit will not receive the $1500 allowance.
DISTRICT’S CONTRIBUTION MONTHLY CONTRIBUTION
ANNUAL CONTRIBUTION
$703
$8,436
MEDICAL
COST CALCULATOR
INSTRUCTIONS
Medical Plan Rate
1. Write down the rates for each plan you have chosen.
Dental Plan Rate
2. Add up the rates for a Total Monthly Cost.
Vision Plan Rate
3. Multiply the Total Monthly Cost by 12 for Annual Cost.
TOTAL MONTHLY COST x12 MONTHS Annual Cost District’s Contribution
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COST PER PAYCHECK
5. Divide the Total Annual Cost by 20 (this is the number of designated paychecks for which benefit deductions will be taken during the school year). 6. You now have the approximate Cost per Pay Check for the 2020 - 2021 School Year.
TOTAL ANNUAL COST Divide by # of paychecks
4. Subtract the District’s Contribution from the Annual Cost for the Total Annual Cost
÷ 20 PAYCHECKS
7. All voluntary supplement benefits will be deducted over the same pays on a post-tax basis. Enrollment in any voluntary program is a separate deduction.
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IMPORTANT PHONE NUMBERS & WEBSITES ASBAIT Aetna Choice POS II or Banner | Aetna Network Medical 866.300.8449 www.aetna.com/docfind/custom/mymeritain Employee Portal: www.mymeritain.com  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 Long Term Disability 520.239.3100 800.621.3778 www.azasrs.gov Juanita Villa 623.474.5101 juanita.villa@smusd90.org
Avesis Vision 800.828.9341 www.avesis.com Wage Works / FSA 877.924.3967 www.wageworks.com UNUM Life Insurance 800.275.8686 www.unum.com AFLAC Gregory Wimbley 602.419.8569 Teladoc 800.362.2667 www.MyDrConsult.com
MetLife Dental PPO 800.275.4638 www.metlife.com/mybenefits Select “PDP” network when searching for providers.
ABOUT THIS BOOKLET This booklet highlights important features of Saddle Mountain 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.
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Capital Financial 14614 N. Kierland Blvd., Suite N230 Scottsdale, AZ 85254 Office / 480.347.0926 Fax / 480.360.6417
