Employee Benefits Guide 2023 - 2024
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.
Sierra Vista 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 savings accounts (HSA) to assist employees in managing their out-of-pocket expenses with before tax dollars for those electing either the HDHP 1500 or HDHP 2500 medical plans.
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.
If you should have any questions:
1. Contact the carrier directly. Phone number and website information is on page 16.
2. Contact Jamie Bennett in the Rothery Education Center HR/Business Office or at Jamie.Bennett@svps.k12.az.us
This booklet highlights important features of Sierra Vista 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.
2 TABLE OF
Enrollment Information...................................................................... 3 Qualifying Life Event 4 COBRA ............................................................................................................ 4 Medical Plan Information 5 Medical Plans 6 Health Savings Account (HSA) 7 Telehealth 8 Live Well, Work Well .............................................................................. 9 Dental Plans 10 Vision Plan ................................................................................................... 11 Disability Information 12 Life / AD&D Insurance ......................................................................... 12 Supplemental Life and AD&D 12 Employee Assistance Program 13 Unum 14 Employee Rate Worksheet 15 Important Phone Numbers ............................................................16
CONTENTS
Enrollment Information
OPEN ENROLLMENT
Open Enrollment is from April 3rd - April 14th, 2023. This is your one time per year to make changes.
All benefit eligible employees are required to elect coverages via the online portal this year even if you are not making changes to your current elections. Your current elections will NOT roll over into the 2023/24 plan 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 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 the Annual Open Enrollment or until a Qualifying Life Event takes place. You may be turned down for these benefits if you do not enroll within your first 31 days as a new hire.
PRE-TAX VS POST-TAX DEDUCTIONS
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.
Post-Tax Dollars: Some insurance premiums may be paid after taxes. Please contact Jamie Bennett for more information related to the specific premiums that are deducted post-tax.
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Qualifying Life Event
The elections you make during Open Enrollment or at your initial benefits eligibility will remain in effect for the plan year (July 1, 2023 – June 30, 2024). 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 Human Resources and providing the proper documentation.
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.
n All changes must be consistent with the qualifying life event.
n In some cases, you can change your benefit plan and modify the level of coverage (such as add or delete dependent).
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 a Sierra Vista Unified School District benefit plan immediately preceding the employee’s COBRA event has the right to continue his or her medical, dental or vision plans.
The right to continuation of coverage ends at the earliest of the date:
n you, your spouse or dependents become covered under another group health plan; or,
n you become entitled to Medicare; or,
n you fail to pay the cost of coverage; or
n your COBRA Continuation Period expires
QUALIFYING LIFE EVENTS LIST
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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
Medical Plan Information
The company that will provide medical insurance to Sierra Vista Unified School District.
The network Sierra Vista Unified School District will use for hospitals and physicians when in Arizona.
The company that will process Sierra Vista Unified School District’s prescription drug benefits.
SUMMARY
Medical benefits provide you and your family access to quality health care. Sierra Vista Unified School District offers you four medical plans with different coverage levels from which to choose. All plans are provided through Summit. Summit contracts with Blue Cross Blue Shield of AZ to use their network with claims processing and customer service being provided by Summit.
To contact Summit for questions about medical information and ID cards, please go to summit-inc.net or contact them at 888.690.2020.
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SUMMIT CONTACT summit-inc.net 1 2 Summit Sierra Vista USD SmithRx Blue Cross Blue Shield 1 2 3 3
Medical Plans
**If you have Family coverage under the HDHP 1500 or HDHP 2500 plans, 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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PPO 500 PPO 750 HDHP 1500** with Health Savings Account HDHP 2500** with Health Savings Account In Network In Network In Network In Network Lifetime Maximum Unlimited Unlimited Unlimited Unlimited Plan Year Unlimited Unlimited Unlimited Unlimited Deductibles (Plan Year) Individual $500 $750 $1,500 $2,500 Family $1,000/employee +1 OR $1,500/employee +2 or more $1,500/employee +1 OR $2,250/employee +2 or more $3,000** $5,000** Coinsurance 20% 20% 20% 20% Out-of-Pocket Maximum (Plan Year) Individual $4,500 $5,000 $3,500 $3,450 Family $9,000 $10,000 $6,550** $6,550** Hospital Services Inpatient Hospital Deductible, then 20% Deductible, then 20% Deductible, then 20% Deductible, then 20% Outpatient Hospital Deductible, then 20% Deductible, then 20% Deductible, then 20% Deductible, then 20% Emergency Room Deductible, then 20% Deductible, then 20% Deductible, then 20% Deductible, then 20% Urgent Care Deductible, then 20% $40 Copay Deductible, then 20% Deductible, then 20% Routine Services Office Visit Deductible, then 20% $20 Copay Deductible, then 20% Deductible, then 20% Specialist Visit Deductible, then 20% $40 Copay Deductible, then 20% Deductible, then 20% Preventive Care Covered in Full Covered in Full Covered in Full Covered in Full Lab & X-Ray Deductible, then 20% Deductible, then 20% Deductible, then 20% Deductible, then 20% Prescription Drugs Tier 1 $10 Copay $10 Copay Deductible, then $10 Copay Deductible, then $10 Copay Tier 2 $60 Copay $60 Copay Deductible, then $60 Copay Deductible, then $60 Copay Tier 3 $110 Copay $110 Copay Deductible, then $110 Copay Deductible, then $110 Copay Mail-Order (90-day supply) $25/$120/$220 $25/$120/$220 Deductible, then $25/$120/$220 Deductible, then $25/$120/$220
Health Savings Account (HSA)
If you choose to enroll in either of the High Deductible Health Plans (HDHP), you will have the option of opening an HSA provided by HealthEquity. An HSA 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 HSA-BASED COVERAGE PLAN:
1. A qualified health plan is the insurance component that provides medical coverage to you and your family.
2. An HSA with HealthEquity which can be funded by pre-tax payroll contributions from you, the District, or both.
HOW AN HSA WORKS:
1. Enroll in either the HDHP 1500 or the HDHP 2500 plans offered by the District
2. Contribute to your HSA by payroll deductions on a pre-tax basis:
n Up to $3,850 in 2023 for single coverage
n Up to $7,750 in 2023 if you enroll a dependent
n An additional $1,000 if you are age 55 or older
Questions? Visit www.healthequity.com or contact HealthEquity at 866.346.5800.
3. With your HSA debit card, use your HSA funds to pay for qualified expenses such as:
n copays
n deductibles
n chiropractor
n dental treatment
HSA ELIGIBILITY
To make tax-free contributions to an HSA, the IRS requires that:
n hearing aids
n glasses/ contacts
n prescriptions
n over the counter drugs and medications
n You are covered by an HSA qualified plan (such as the HDHP 1500 and HDHP 2500)
n You are not enrolled in any other plan that is not considered a High Deductible Health Plan.
n You are not enrolled in Medicare, medical FSA or have other military health benefits.
n You cannot be claimed as a dependent on someone else’s taxes.
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The money contributed to the account is yours to keep and will roll over year after year – no ‘use it or lose it’ rule!
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.
n Talk to a real doctor, 24/7. No need to schedule an appointment or limit your visits.
n Save money and time, while avoiding costly trips to a doctor’s office, urgent care or ER.
What can be treated?
n Acne
n Allergies
n Asthma
n Bronchitis
n Cold & Flu
n Constipation
n Diarrhea
n Ear Infection
n Fever
n Headache
n Insect Bite
n Joint Aches
n Nausea
n Rashes
n Sinus Infection
n Sore Throat
n UTI
n And more!
When should I use Teladoc?
n Instead of going to the ER or an urgent care center for a non-emergency issue
n During or after normal business hours, nights, weekends and holidays
n If your primary care physician is not available
n To request prescriptions (when appropriate)
n If traveling and in need of medical care
Are my children eligible?
n Yes! Teladoc has pediatricians on call 24/7
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Telehealth
teladoc.com 1.800.835.2362 Download the Teladoc app for easier access!
Live Well, Work Well
EMERGENCY ROOM OR URGENT CARE?
More than 10% of all emergency room visits could have been better addressed in either an urgent care facility or a doctor’s office. If you’re suddenly faced with symptoms of an illness or injury, how can you determine which facility is most appropriate for your condition?
Emergency Room (ER)
Emergency rooms are equipped to handle life-threatening injuries, illnesses and other serious medical conditions. An emergency is a condition that may cause loss of life or permanent or severe disability if not treated immediately. You should go directly to the nearest emergency room if you experience any of the following:
n Chest pain
n Shortness of breath
n Severe abdominal pain following an injury
n Uncontrollable bleeding
n Confusion or loss of consciousness, especially after a head injury
n Poisoning or suspected poisoning
n Serious burns, cuts or infections
n Inability to swallow
n Seizures
n Paralysis
n Broken bones
Patients at the emergency room are sorted, or triaged, according to the seriousness of their condition. For example, a patient with severe injuries from a car accident would likely be seen before a child with an ear infection, even if the child was brought in first.
Those who go to the ER with relatively minor injuries or illnesses often have to wait more than an hour to be seen, depending on the severity of the other patients’ conditions. Often they could have been seen more quickly at an urgent care facility.
Urgent Care
Urgent care centers are usually located in clinics or hospitals, and, like emergency rooms, offer after-hours care. Unlike emergency rooms, they are not equipped to handle life-threatening situations. Rather, they handle conditions that require immediate attention— those where delaying treatment could cause serious problems or discomfort.
Some examples of conditions that require urgent care are these:
n Ear infections
n Sprains
n Urinary tract infections
n Vomiting
n High fever
Urgent care centers are usually more cost-effective than ERs for these conditions. In addition, the waiting time in urgent care centers is usually much shorter. Choosing the appropriate place of care can not only ensure prompt medical attention but will also help reduce any unnecessary expenses.
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Dental Plans
METLIFE PPO PDP Plus Network
* In and out-of-network coverage available, however, you will pay more when using an out-of-network provider.
EMPLOYERS DENTAL SERVICES (EDS)
Pre-Paid Dental Discount Plan IN NETWORK Coverage ONLY
Coverage examples:
n Routine Office Visit: $5 Copay
n Oral Exam (Periodic): No Charge
n Routine Cleaning: $5 Copay
n Amalgam Restoration: $13 Copay
n Porcelain Crown: $285 Copay + Lab
Please refer to the materials provided by Human Resources for the complete schedule of benefits.
Plan Features
n Adult and Child Orthodontic coverage offered
n No Annual Maximum
n Must Use Your Selected Dentist within the EDS Network for you and any covered family members
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Annual
Individual
Family
Annual
Benefits Type
100%
Type
Type III
Major
50%
Orthodontic
Orthodontia
Child
Lifetime
50%
Lifetime Deductible N/A Adult Orthodontia N/A Other Benefits Periodontic Coverage 80%
Endodontic Coverage 80% In
80% Out
Dental HMO In Network
Deductibles
$50
$150
Plan Maximum $1,500
1 - Diagnostic & Preventive
In / 100% Out
II - Basic Service 80% In / 80% Out
-
Services
In / 50% Out
Benefits
Age Limitation
to Age 19
Maximum
to $1,500
In / 80% Out
/
The dental plans include preventive services and office visits.
Vision Plan
Standard lenses are covered.
METLIFE VISION
MetLife Vision PPO In Network Out of Network
Exam $10 Copay
Frequency Every 12 Months
Lenses Covered 100%
Reimbursed to $45
Every 12 Months
Reimbursed from up to $30 to up to $100
Single/Bifocal/Trifocal/ after $25 copay depending on lens
Lenticular
Frequency Every 12 Months
Frames $200 Allowance after $25 Copay (Costco, Sam’s Club and Walmart are $110 Allowance after $25 Copay)
Frequency Every 12 Months
Contact Lenses Medically Necessary
Every 12 Months
Reimbursed to $70
Every 12 Months
Medically Necessary
Reimbursed to $210 and lenses) Elective
(In lieu of frames Covered in Full after $25 Copay
Elective $200 Allowance
Frequency Every 12 Months
Reimbursed to $105
Every 12 Months
This plan includes a Second Pair benefit that gives you additional eyewear coverage. You can get two pairs of prescription eyeglasses OR one pair of prescription eyeglasses and an allowance toward contact lenses OR double your contact lens allowance.
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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
Sierra Vista Unified School District offers a voluntary benefit through Unum. Please refer to the materials provided by Human Resources and contained later in this benefits guide.
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
Life / AD&D Insurance
BASIC LIFE INSURANCE AND AD&D
Sierra Vista Unified School District pays 100% of the cost of a MetLife Term Life Insurance Plan. 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.
Please note that your life benefit will reduce by 35% at age 65, by 60% of the original amount at age 70 and by 75% of the original amount at age 75.
Supplemental Life and AD&D
Employee: Available in $10,000 increments. Maximum of $500,000 or 5 times base annual earnings
Spouse: Available in $5,000 increments. Maximum of $250,000 (not to exceed 50% of employee elected amount)
Child: $1,000, $2,000, $4,000, $5,000 or $10,000 (not to exceed 50% of employee elected amount)
Please note that if you currently have supplemental life, your existing coverage amount will continue with MetLife. If you are increasing your current amount, enrolling after you were initially eligible or requesting an amount above the Guarantee Issue, an Evidence of Insurability form will be required to be completed to obtain approval from MetLife for the requested amount.
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Employee Assistance Program
Coming
Sierra Vista USD has contracted with SupportLinc 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 counselor who can help with almost any issue ranging from medical and family matters to personal, emotional, legal or financial needs.
you to a professional in the Blue Cross Blue Shield Network.
July 1, 2022
Contact SupportLinc at 888.881.LINC (5462) 24 hours a day / 7 days a week
Emotional wellbeing and work-life balance resources for you and your family
Or, visit supportlinc.com
After 6 sessions, if additional face to face visits are needed, an EAP representative will assist in referring
Username: sierravistausd
SupportLinc offers expert guidance to help address and resolve everyday issues
In-the-moment support
Coming July 1, 2022
SupportLinc offers expert guidance to help address and resolve everyday issues
Reach a licensed clinician by phone 24/7/365 for immediate assistance.
In-the-moment support
Financial expertise
Emotional wellbeing and work-life balance resources for you and your family
Planning and consultation with a licensed financial counselor.
Financial expertise
Legal consultation
By phone or in-person with a local attorney.
Confidentiality
Legal consultation
Reach a licensed clinician by phone 24/7/365 for immediate assistance.
Short-term counseling
Access in-person or video counseling sessions to resolve concerns such as stress, anxiety, depression, relationship issues, work-related pressures, or substance abuse.
Short-term counseling
Access in-person or video counseling sessions to resolve concerns such as stress, anxiety, depression, relationship issues, work-related pressures, or substance abuse.
In-the-moment support
Reach a licensed clinician by phone 24/7/365 for immediate assistance.
Short-term counseling
Convenience resources
Planning and consultation with a licensed financial counselor.
Referrals for child and elder care, home repair, housing needs, education, pet care and so much more.
By phone or in-person with a local attorney.
Convenience resources
SupportLinc offers expert guidance to help address and resolve everyday issues
Referrals for child and elder care, home repair, housing needs, education, pet care and so much more.
Financial expertise
Planning and consultation with a licensed financial counselor.
Confidentiality
SupportLinc ensures no one will know you have accessed the program without your written permission except as required by law.
Legal consultation
By phone or in-person with a local attorney.
SupportLinc ensures no one will know you have accessed the program without your written permission except as required by law.
Confidentiality
Access in-person or video counseling sessions to resolve concerns such as stress, anxiety, depression, relationship issues, work-related pressures, or substance abuse.
Your web portal and mobile app
Convenience resources
Your web portal & mobile app
Convenient, on-the-go support
Convenient, on-the-go support
• The one-stop shop for program services, information and more.
n The one-stop shop for program services, information and more.
Referrals for child and elder care, home repair, housing needs, education, pet care and so much more.
• Discover on-demand training to boost wellbeing and life balance.
n Discover on-demand training to boostwellbeing and life balance.
• Textcoach®
Textcoach®
Personalized coaching with a licensed counselor on mobile or desktop
Personalized coaching with a licensed counselor on mobile or desktop
SupportLinc ensures no one will know you have accessed the program without your written permission except as required by law.
• Animo
Animo
Your web portal and mobile app
• Find search engines, financial calculators and career resources.
Convenient, on-the-go support
Self-guided resources to improve focus, wellbeing and emotional fitness
• The one-stop shop for program services, information and more.
n Find search engines, financial calculators and career resources.
• Textcoach®
Personalized coaching with a licensed counselor on mobile or desktop
• Virtual Support Connect
• Explore thousands of articles, tip sheets, self-assessments and videos.
• Discover on-demand training to boost wellbeing and life balance.
Self-guided resources to improve focus, wellbeing and emotional fitness
• Animo
n Explore thousands of articles, tip sheets, self-assessments and videos.
Moderated group therapy sessions on an anonymous, chat-based platform
• Find search engines, financial calculators and career resources.
• Explore thousands of articles, tip sheets, self-assessments and videos.
Self-guided resources to improve focus, wellbeing and emotional fitness
Virtual Support Connect
• Virtual Support Connect Moderated group therapy sessions on an anonymous, chat-based platform
Moderated group therapy sessions on an anonymous, chat-based platform
Support for everyday issues. Every day.
Support for everyday issues. Every day.
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Unum
Unum Insurance Company is pleased to offer Sierra Vista Unified School District employees and qualified dependents the opportunity to elect coverage under several Unum policies. A few things to remember about these policies:
n A Unum policy is separate from the other policies listed in this book. Unum does not replace your medical insurance coverage.
n Unum pays you directly, no matter what other insurance you may have.
n 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.
You are able to enroll in any of these benefits in the iVisions portal.
Your Unum plan pays a Be Well Benefit for one Be Well screening each year.
With Unum’s Be Well Benefit, you and other covered family members can receive a valuable incentive for important tests and screenings. Many of these tests are routinely performed, so it’s easy to take advantage of this benefit.
Your Critical Illness Be Well benefit is $50.
Your Accident Be Well benefit is $50.
Your Hospital Be Well benefit is $50.
ACCIDENT
Accident Insurance pays a set benefit amount based on the type of injury you have and the type of treatment you need. It covers accidents that occur on and off the job. And it includes a range of incidents, from common injuries to more serious events.
CRITICAL ILLNESS
If you’re diagnosed with an illness that is covered by this insurance, you can receive a lump sum benefit payment. You can use the money however you want.
HOSPITAL
Hospital Insurance helps covered employees and their families cope with the financial impacts of a hospitalization. You can receive benefits when you’re admitted to the hospital for a covered accident, illness or childbirth.
SHORT-TERM DISABILITY
If a covered illness or injury keeps you from working, Short Term Disability Insurance replaces part of your income while you recover. As long as you remain disabled, you can receive payments for up to 11 weeks. You’re generally considered disabled if you’re unable to do important parts of your job — and your income suffers as a result.
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Employee Rate Worksheet
2023-2024
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MEDICAL PLANS
DENTAL PLANS PPO 500 METLIFE PPO PPO 750 EDS HMO METLIFE PPO HDHP 1500 HDHP 2500 VISION PLAN EMPLOYEE ONLY EMPLOYEE & SPOUSE EMPLOYEE & CHILDREN EMPLOYEE & FAMILY EMPLOYEE ONLY EMPLOYEE & SPOUSE EMPLOYEE & CHILDREN EMPLOYEE & FAMILY 21 PAY PERIODS $62.00 $414.72 $326.41 $662.10 21 PAY PERIODS $4.79 $9.53 $11.59 $13.30 21 PAY PERIODS $28.49 $340.77 $262.57 $558.89 21 PAY PERIODS $18.91 $320.02 $245.01 $531.23 21 PAY PERIODS $4.03 $8.07 $8.63 $13.79 21 PAY PERIODS $74.24 $441.85 $349.82 $699.34 21 PAY PERIODS $15.48 $29.89 $36.61 $54.92
Important Phone Numbers
Arizona State Retirement System
Summit Member Services
Medical
888.690.2020
summit-inc.net
HealthEquity Health Savings Account
866.346.5800
www.healthequity.com
MetLife
Dental PPO, Life Insurance
800.GET.MET8 (800.438.6388) metlife.com
MetLife Vision
855.MET.EYE1 (855.638.3931) metlife.com/vision
SupportLinc EAP (CuraLinc)
888.881.LINC (5462) supportlinc.com
Username: sierravistausd
ABOUT THIS BOOKLET
This booklet highlights important features of Sierra Vista 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.
Long Term Disability
520.239.3100
800.621.3778
www.azasrs.gov
Jamie Bennett
Payroll / Benefits Specialist
520.515.2732
Jamie.Bennett@svps.k12.az.us
Teladoc
800.835.2362
teladoc.com
Unum
Voluntary Supplemental Insurance
800.635.5597
unum.com
Capital Financial
14614 N. Kierland Blvd., Suite N230
Scottsdale, AZ 85254
Office / 480.347.0926, Fax / 480.360.6417
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