Feel Healthier. See Clearer. Smile More. Live Better.
Employee Benefits Guide 2021 - 2022
TABLE OF CONTENTS Enrollment Information . . . . . . . . . . . . . . . . . . 2 Qualifying Life Event . . . . . . . . . . . . . . . . . . . . 3 Medical Plan Information. . . . . . . . . . . . . . . . . 4 Medical Plans. . . . . . . . . . . . . . . . . . . . . . . . . . 5 Health Savings Account (H.S.A.) . . . . . . . . . . . 6 Hinge Health . . . . . . . . . . . . . . . . . . . . . . . . . . 7 skinIO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Telehealth. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Dental Plans. . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Vision Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Life & Disability Insurance. . . . . . . . . . . . . . . 11 Employee Assistance Program. . . . . . . . . . . . 12 Colonial Life. . . . . . . . . . . . . . . . . . . . . . . . . . 13 Core Benefit Rate sheet. . . . . . . . . . . . . . . . . 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. Tuba 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. In addition, we provide health care savings 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. 1
If you should have any questions: 1. Contact the carrier directly. Phone number and website information is on page 15. 2. Contact the Human Resources Department at 928-283-1005 or jrsmith@tcusd.org. This booklet highlights important features of Tuba 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 May 28th through June 9th, 2021. 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.
This year, the district will hold a passive enrollment, which means you do not have to complete an enrollment form unless you are making changes to your current elections. Your current enrollment will roll over to the new plan year.
NEW EMPLOYEES
Post-Tax Dollars: Some insurance premiums may be paid after taxes. Please contact Joey Smith 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 following 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.
WHO IS ELIGIBLE? Employees who work 30+ hours per week are eligible for benefits. Your eligible dependents include your legally married spouse and your child(ren) up to age 26.
2
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, 2021 – June 30, 2022 ). 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).
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 Tuba 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. 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,
Any changes in benefit levels must be completed within 31 days of the qualifying life event.
• 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
3
MEDICAL PLAN INFORMATION 1
The Trust that will provide medical insurance to Tuba City Unified School District.
2
The network Tuba City Unified School District will use for hospitals and physicians.
3
The company that will process Tuba City Unified School District’s medical claims.
1 ASBAIT
2
Tuba City Unified SD Aetna Choice POS II
Meritain Health Company
3
SUMMARY Medical benefits provide you and your family access to quality health care. Tuba 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 Choice POS II Network, 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 4
MEDICAL PLANS HDHP* with Health Savings Account Value Gold
Classic Silver
In Network
In Network
In Network
Lifetime Maximum
Unlimited
Unlimited
Unlimited
Calendar Year
Unlimited
Unlimited
Unlimited
Individual
$1,500
$750
$500
Family
$3,000**
$1,500
$1,000
Coinsurance
20%
25%
20%
Individual
$5,500
$5,000
$4,500
Family
$11,000
$10,000
$9,000
Inpatient Hospital
$250 Copay, Deductible, then 20%
$250 Copay, then 25%
$250 copay, then 20%
Outpatient Hospital
Deductible, then 20%
Deductible, then 25%
Deductible, then 20%
Emergency Room
Deductible, then 20%
Deductible, then 25%
Deductible, then 20%
Urgent Care
Deductible, then 20%
$55 Copay
$50 copay
Office Visit
Deductible, then 20%
$35 Copay
$30 copay
Specialist Visit
Deductible, then 20%
$45 Copay
$40 copay
Preventive Care
Covered in Full
Covered in Full
Covered in Full
Lab & X-Ray
Deductible, then 20%
25% (deductible waived at a freestanding laboratory)
20% (deductible waived at a freestanding aboratory)
Chiropractic
Deductible, then 20%
$45 Copay
$30 copay
Rehabilitation
Deductible, then 20%
Deductible, then 25%
Deductible, then 20%
Tier 1
Deductible, then 20%
$15 Copay
$15 copay
Tier 2
Deductible, then 20%
20% Copay ($25 min/$80 max)
30% Copay ($25 min/$80 max)
Tier 3
Deductible, then 20%
40% Copay ($40 min/$110 max)
40% Copay ($40 min/$110 max)
Tier 4 Specialty
Deductible, then 20%
20% Copay ($100 min/$150 max)
20% Copay ($100 min/$150 max)
Mail-Order
Deductible, then 20%
$30 / 20% / 40%
$30 / 20% / 40%
Diabetic Medications
Deductible, then 20%
$5 Generic, $15 Brand
$5 Generic, $15 Brand
Deductibles
Out-of-Pocket Maximum
Hospital Services
Routine Services
Prescription Drugs
**If you have Family coverage under the HDHP the Family Deductible must be satisfied before the Plan will pay any benefits.
5
$5 Generic, $15 Brand
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. This health plan includes a deductible of $1,500 for individuals and $3,000 for family coverage.
2. An H.S.A. bank account with HealthEquity which can be funded by pre-tax payroll contributions from you, the district, or both.
HOW AN H.S.A. WORKS: 1. Enroll in the HDHP1500 offered by the district 2. Contribute to your H.S.A. by payroll deductions: Up to $3,600 for an individual or $7,200 for a family
Tuba City Unified School District will contribute $1,250 annually into your HSA. This contribution counts toward the annual maximum.
3. With your HSA debit card, use those funds to pay for qualified expenses such as: • hearing aids • copays • glasses/ contacts • deductibles • prescriptions • chiropractor
The money contributed to the account is yours to keep and will roll over year after year – no ‘use it or lose it’ rule!
• 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 HDHP1500) • You have no other health coverage (such as other health plan, Medicare, military health benefits, medical FSA)
6
HINGE HEALTH When you enroll in an ASBAIT medical plan, you have access to Hinge Health which provides PT & Coach-led, digital program for chronic back, knee, hip, shoulder and neck pain. Once approved, you will have access to exercise therapy, behavioral support with 1:1 health coaching and physical therapy, and personalized curriculum. Employees are required to complete a health questionnaire with Hinge in order to be approved as Hinge is not a good fit for all chronic pain conditions. In order to complete the questionnaire go to:
Hingehealth.com/asbait or call 855-902-2777
skinIO SkinIO is available to all employees enrolled in one of the ASBAIT medical plans. It is the easiest way to get your annual skin screening – you can do it from home in just 15 minutes! It’s simple to use- download the skinIO app, upload photos or your skin and a board-certified dermatologist will review your images. The dermatologist will determine if there are any spots to be concerned about and will give you information on how to find a local dermatologist within the ASBAIT network.
7
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 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. • 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
• Headache
• Allergies
• Insect Bite
• Asthma
• Joint Aches
• Bronchitis
• Nausea
• Cold & Flu
• Rashes
• Constipation
• Sinus Infection
• Diarrhea
• Sore Throat
• Ear Infection
• UTI
• Fever
• And more!
MyDrConsult.com 1.800.362.2667
Download the Teladoc app for easier access! 8
DENTAL PLANS
METLIFE - PDP NETWORK
In Network Annual Deductibles Individual
$50
Family
$150
Annual Plan Maximum
$2,000
Benefits Type I - Diagnostic & Preventive 100% In / 100% Out Type II - Basic Services
80% In / 80% Out
Type III - Major Services
50% In / 50% Out
Orthodontic Benefits Orthodontia Age Limitation
19 years old
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
The dental plan includes preventive services and office visits. 9
VISION PLAN
All standard lenses are covered.
METLIFE - VSP CHOICE NETWORK
In Network
Out of Network
Exam
$10 Copay
Reimbursed to $45
Frequency
Every 12 Months
Every 12 Months
Lenses
Covered 100%
Reimbursed: $30 to $100
Single/Bifocal/Trifocal/
after $25 copay
depending on lens
Frequency
Every 12 Months
Every 12 Months
Frames
$130 Allowance
Reimbursed to $70
Frequency
Every 24 Months
Every 24 Months
Contact Lenses (instead of glasses)
$130 Allowance
Reimbursed to $105
Every 12 Months
Every 12 Months
Lenticular
Lasik Surgery
15% Off Retail or 5% Off Promotional Price
10
LIFE & DISABILITY INSURANCE 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: Benefit Amount:
180 Days 66 2/3% of monthly base salary as determined by ASRS
BASIC LIFE INSURANCE AND AD&D Tuba City Unified School District pays 100% of the cost of this MetLife Group Term Life Insurance Plan. Coverage for each full-time benefit eligible employee is $20,000. 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.
11
Tuba City Unified School District pays 100% of the cost of the Term Life and AD&D.
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 Employee Assistance Program Contact: 1.800.343.3822 www.awpnow.com All EAP services are 100% confidential and free to use.
The Employee Assistance Program provides Solution-Focused Counseling for issues such as: • Job Performance • Relationship Difficulties • Family Issues • Managing Depression/Anxiety • Anger / Stress Management • Grief & Bereavement
The EAP also provides resources for: • Child / Elder Care • Legal & Financial Issues • Substance Abuse • Will Preparation
12
COLONIAL LIFE Colonial Life & Accident Insurance Company is pleased to offer Tuba City Unified School District employees and qualified dependents the opportunity to elect coverage under several Colonial Life policies. A few things to remember about these policies: • A Colonial Life policy is separate from the other policies listed in this book. Colonial Life does not replace your medical insurance coverage. • Colonial Life pays you directly, no matter what other insurance you may have. • You can enroll in one or all of the policies and are eligible to participate in these policies the first of the month following date of hire. To enroll in these policies, you must contact a Colonial Life representative. Call 602.441.5357 for more information or to enroll.
ACCIDENT INSURANCE This plan pays cash benefits in the event of an accidental injury that needs emergency treatment.
CANCER INSURANCE This plan pays cash benefits for an individual diagnosed with cancer.
HOSPITAL INDEMNITY INSURANCE This plan pays cash benefits when an individual is confined in a hospital. It also provides HSA-compliant coverage.
LIFE INSURANCE These plans protect your family’s future by paying them a cash benefit in the event of your death. Both Term Life and Whole Life policies are available to those who qualify for coverage. Whole Life is guaranteed, permanent coverage that includes both cash value and a Long Term Care (LTC) policy.
13
CORE BENEFIT RATE SHEET Use this sheet to provide a general estimate of your monthly 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 - MONTHLY RATES
EMPLOYEE ONLY EMPLOYEE & SPOUSE EMPLOYEE & CHILDREN EMPLOYEE & FAMILY
EMPLOYEE ONLY EMPLOYEE & SPOUSE EMPLOYEE & CHILDREN EMPLOYEE & FAMILY
CLASSIC SILVER
VALUE GOLD
HDHP 1500
$109.50 $758.50 $571.50 $1,176.50
$72.50 $685.50 $508.50 $1,077.50
$0.00 $536.00 $381.00 $881.00
DENTAL PLAN
VISION
$0.00 $30.82 $37.44 $68.17
$0.00 $5.67 $3.94 $10.16
14
IMPORTANT PHONE NUMBERS & WEBSITES ASBAIT Aetna Choice POS II Network Medical 866.300.8449 aetna.com/docfind/custom/mymeritain Employee Portal: mymeritain.com HealthEquity / HSA 866.346.5800 healthequity.com  Alliance Work Partners EAP & Nurse Support 800.343.3822 (EAP) 800.334.8336 (Teen Line) 888-771-9116 (Nurse) alliancewp.com
Arizona State Retirement System Long Term Disability 520-239-3100 800-621-3778 azasrs.gov MetLife Dental PPO PDP Network 800.942.0854 or 800.MET.LIFE metlife.com/mybenefits MetLife Vision VSP Choice Network 800.877.7195 vsp.com
MetLife Life & AD&D 800.880.1800 metlife.com Colonial Life Voluntary Benefits 602.441.5357 – Enrollment 800.325.4368 – Customer Service ColonialLife.com Teladoc Telehealth 800.362.2667 MyDrConsult.com
ABOUT THIS BOOKLET This booklet highlights important features of Tuba 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.
15
Capital Financial 14614 N. Kierland Blvd., Suite N230, Scottsdale, AZ 85254 Office / 480.347. 0926 Fax / 480.360.6417
