201 5-16 - The School District of Lancaster · 201 5-16 EMPLOYEE BENEFITS GUIDE ELIGIBILITY ... who...

2015-16EMPLOYEE BENEFITS GUIDE

for Leadership

Improving Our Wellness TogetherThe School District of Lancaster is pleased to provide a

comprehensive employee benefits program designed to keepyou healthy and to protect you and your family.

P r o v i d e r C o n t a c t I n f o r m a t i o n

MEDICALHighmark www.HighmarkBlueShie ld .com 800-345-3806

DENTALUnited Concordia www.Uni tedConcordia .com 800-332-0366

VISIONHuman Resources Of f ice jmducat [email protected] .pa.us 717-291-2011

LIFE, AD&D, VOLUNTARY LIFEThe Hart ford www.TheHart fordAtWork.com 800-741-4306

FLEXIBLE SPENDING ACCOUNTSAmeriF lex www.Flex125 .com 888-868-3539 ext .255

EMPLOYEE ASSISTANCE PROGRAMQuest EAP www.QuestBH.com 800-364-6352

403(b)TSA Consul t ing Group, Inc. www.tsacg.com 888-796-3786

Public School Employees’ Ret i rement Systemwww.psers .s tate .pa.us/ 888-773-7748

PLEASE NOTE: This booklet provides a summary of the benefits available but is not your SPD. The School District of Lancaster reserves the rightto modify, amend, suspend, or terminate any plan at any time, and for any reason without prior notification. The plans described in this book aregoverned by insurance contracts and plan documents, which are available for examination upon request. We have attempted to make theexplanations of the plans in this booklet as accurate as possible. However, should there be a discrepancy between this booklet and the provisionsof the insurance contracts or plan documents, the provisions of the insurance contracts or plan documents will govern. In addition, you should notrely on any oral descriptions of these plans, since the written descriptions in the insurance contracts or plan documents will always govern.

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2015-16 EMPLOYEE BENEFITS GUIDE

E L I G I B I L I T Y

You are eligible to participate in The School District ofLancaster’s Benefits Program if you are an active, full-timeemployee working at least 30 hours per week. Benefits willbegin on date of enrollment unless otherwise stated.

When can I enrol l or make changes?

Newly hired eligible employees may enroll the first day ofemployment. Eligible employees may also enroll or make changes totheir benefits during the annual open enrollment period. Onceelections are completed, no changes can be made until the nextannual enrollment unless you experience a qualifying change instatus such as:

• Change in employee’s legal marital status

• Birth, Adoption or change in custody of an eligible dependent

• Death of a covered dependent

• Change in your employment status (i.e., Full-Time to Part-Time)

• Change in your spouse’s employment status

• Gain or Loss of eligibility for a dependent due to age change

• Loss of other coverage (i.e., spouse’s health plan coverage ends orMedicare or Medicaid eligibility ends)

• Legal Decree, Judgment or Order (i.e., Qualified Medical ChildSupport Order–QMCSO)

Employees are responsible for reporting family status changes in atimely manner. Any changes to your elections due to the above mustbe done within 30 days of the event. If you do not make changeswithin 30 days of the “qualifying event”, you must wait until thefollowing annual enrollment period to make changes.

Eligible Dependents for Medical andPrescript ion Drug Coverage

Your eligible dependents include:

• A spouse to whom you are legally married.

• A dependent under age 26.

When do benefi ts end?The date the covered Employee ceases to be in one of the EligibleClasses. This includes death or termination of Active Employment ofthe covered Employee.

Notice Regarding SpecialEnrol lment

If you are waiving enrollment in the medicalplan for yourself or your dependents,including your spouse, because of otherhealth insurance coverage, you may in thefuture be able to enroll yourself or yourdependents in the medical plan, provided thatyou request enrollment before your othercoverage ending. In addition, if you have anew dependent as a result of marriage, birth,adoption, or placement for adoption, you maybe able to enroll yourself and yourdependents provided that you requestenrollment before the day of the marriage,birth, adoption, or placement for adoption.

Table of Contents

Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

Wellness Works Wonders Program . . . . . . . . .2

Medical Overview . . . . . . . . . . . . . . . . . . . . . .3

Highmark No Deductible Green Plan . . . . . . . .4

Highmark High Deductible HSA Plan . . . . . . . .6

Dental Benefits . . . . . . . . . . . . . . . . . . . . . . .8

Vision Benefits . . . . . . . . . . . . . . . . . . . . . . . .9

Life and AD&D Insurance . . . . . . . . . . . . . . . .9

Disability . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

Voluntary Life Insurance . . . . . . . . . . . . . . . .10

Flexible Spending Accounts . . . . . . . . . . . . .11

Health Savings Accounts . . . . . . . . . . . . . . .13

Employee Assistance Program . . . . . . . . . . . .14

403(b) Tax Sheltered Account Program . . . . .15

Public School Employees’ Retirement System . . . .16

COBRA . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

Annual Notices . . . . . . . . . . . . . . . . . . . . . . .17

W E L L N E S S W O R K S W O N D E R S P R O G R A M

Wellness Works Wonders is The School District of Lancaster’s voluntary employee wellness program. Itis designed to encourage your engagement in healthy behaviors such as preventive screenings, physicalactivity, good nutrition, healthy weight management, and stress management throughout the year.

Eligibi l i ty & Rewards

For all full-time benefit eligible employees who participate in the Biometric Screeningthis Fall, completes a Health Risk Assessment (HRA) and schedules a preventivewellness visit or physical with their doctor will receive a reward of $100. If you do notreceive a physical from your doctor, you will only be eligible for $75.

How to Quali fy for Rewards:

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Frequently Asked Quest ions

Who will be conducting/performing the screenings?The School District has partnered with Lancaster General Health,who will be conducting the worksite biometric screenings.What do I need to do to prepare for the screenings?The first step is to schedule an appointment via the LGwebsite. Then, the night before your screening you willneed to fast for 12 hours. You are permitted to takeprescribed medications the morning of the screening andyou may drink water. The blood draw will be performed byvenipuncture blood draw. What if I had blood tests performed by my doctor?If you have these tests performed between July 1, 2015 andJune 30, 2016, there is a Physician Screening Form availablefor your doctor to complete located on the intranet.What if I have health risks that are identified through thewellness screenings? You will be encouraged to follow up with your primary careprovider. What is a Health Risk Assessment (HRA) and why should Itake it?The Health Risk Assessment (HRA) is a questionnaire thattakes stock of your personal health status. The HRA takesabout 15 minutes to complete. After you take the HRA, youwill be presented with a personal health report that will

give you information about the areas of your health inwhich you are doing well and areas that could useimprovement.Is the information I provide in the Health Risk Assessmentsecure?Yes! You can feel at ease knowing that your healthinformation is safe. All of the information you provide inyour HRA is confidential by federal law and LG Health willnot share any of your personal health information with youremployer or with any third-party sources.Does anyone other than LG Health see my results or view myinformation?No, you are the only person who will see your results.Under the federal HIPAA laws, your health information isprotected by the most current, up-to-date security measuresavailable. Your employer will never see your results andwill never have access to your personal health information.LG Health will only disclose aggregate data to the SchoolDistrict of Lancaster.What if I have questions about how to complete the onlineHRA?No problem! If you have questions regarding the onlineHRA please call Donna Reinford, Health Educator, LG HealthWellness Center at 544-3286.

• Participate in a Biometric Screening (eitherworksite screening OR at your doctor office)

- Lipid panel (total cholesterol, HDL, LDL,triglycerides)

- Blood glucose

- Blood pressure

- Body Mass Index (BMI)

• Complete a Health Risk Assessment

- Assess your current health status and receivea personalized wellness report withrecommendations for improving your health.

- Available in English and Spanish

• Schedule a preventive wellness visit or physicalwith your doctor

The School District of Lancaster offers two medical plans. You can choose from a No Deductible planor the High Deductible HSA Plan. Both plans are administered by Highmark and are PPO’s, and utilizeproviders within the “Highmark” network.

M E D I C A L O V E R V I E W


Notice of Required Coverage Fol lowing MastectomiesIn compliance with the Women’s Health and Cancer Rights Act of 1998, the plan provides the following benefits to allparticipants who elect breast reconstruction in connection with a mastectomy, to the extent that the benefits otherwisemeet the requirements for coverage under the plan:

• reconstruction of the breast on which the mastectomy has been performed;

• surgery and reconstruction of the other breast to produce a symmetrical appearance; and

• coverage for prostheses and physical complications of all stages of the mastectomy, including lymphedemas. Thebenefits shall be provided in a manner determined in consultation with the attending physician and the patient. Planterms such as deductibles or coinsurance apply to these benefits.

No Deductible Green Plan (PPO)

As a member of a Preferred Provider Organization (PPO),you can use the doctors and hospitals within the PPOnetwork or go outside of the network for care. You do notneed a referral to see a specialist.

If you obtain care from a medical provider outside of thePPO network, you will pay more for the service.

Another advantage of the PPO is that the physicians whoparticipate in the PPO have agreed to accept the PPOcontracted amount as payment in full. This means youcannot be billed for the amount above the contracted rate.Your expenses will be limited to the co-insurance anddeductible, if applicable. This provision is valuable to youand offers important financial benefits when PPO providersare utilized for medical care.

Covered expenses for non-network providers will be limited tothe reasonable and customary charge for the area in whichthe services are rendered. You will be responsible for alarger portion of the eligible charges plus all of the costsabove the reasonable and customary allowance.

High Deductible HSA Plan (PPO)

A High Deductible Health Plan is a health insurance planwith lower premiums and higher deductibles than atraditional health plan. They are a form of catastrophiccoverage, intended to cover for catastrophic illnesses.

This plan is also a Preferred Provider Organization,meaning you have the choice to obtain care from medicalproviders inside and outside of the PPO network.

Since the deductible – or amount you must pay out-of-pocket before this plan begins to cover benefits – is high;establishing an HSA to pay for your out-of-pocket careexpenses may help you save money.

• HSA contributions and earnings are tax-exempt.

• HSA distributions are also tax-exempt as long as theyare used for eligible medical services.

• HSA balances may accumulate tax-free interest orinvestment earnings from year to year.

• HSA dollars are portable – they go where you go even ifyou leave your current employer.


H i g h m a r k N o D e d u c t i b l e G r e e n P l a n Group # : 25362-14

This summary is for descriptive purposes only and should not be relied upon to fully determine coverage. It is not an agreement or a contract. For more detailedinformation, refer to the Summary Plan Description.

Benefit Network Out-of-NetworkBenefit Period Contract Year (July 1 - June 30)Deductible (per benefit period)• Individual None $1,000• Family None $3,000Plan Payment Level – Based on the provider’s 100% 70% after deductible

reasonable charge (PRC)Out-of-Pocket Maximums (Once met, plan (Includes Deductible)

payment level becomes 100%)• Individual $6,350 $10,000• Family $12,700 $30,000Lifetime Maximum UnlimitedPrimary Care Physician Office Visits 100% after $15 copayment 70% after deductibleSpecialist Office Visits 100% after $25 copayment 70% after deductibleUrgent Care Visits 100% after $25 copayment 70% after deductiblePreventive Care

• AdultRoutine physical exams 100% 70% after deductibleAdult Immunizations 100% 70% after deductibleColorectal Cancer Screening

Diagnostic Services 100% 70% after deductibleMedical Surgical 100% 70% after deductible

Routine gynecological exams, including a 100% 70% (deductible does not apply)Pap TestMammograms, annual routine 100% 70% after deductible

• PediatricRoutine physical exams 100% 70% after deductiblePediatric immunizations 100% 70% (deductible does not apply)

Emergency Room Services 100% after $75 copayment (waived if admitted)Spinal Manipulations 100% after $25 copayment 70% after deductiblePhysical Medicine (60 visits/benefit period) 100% after $25 copayment 70% after deductibleSpeech Therapy (60 visits/benefit period) 100% after $25 copayment 70% after deductibleOccupational Therapy (60 visits/benefit period) 100% after $25 copayment 70% after deductibleAllergy Extracts and Injections 100% 70% after deductibleAmbulance 100% 70% after deductibleAssisted Fertilization Procedures Not CoveredDiagnostic Services

Advanced Imaging (MRI, CAT Scan, 100% 70% after deductiblePET scan, etc.)Basic Diagnostic Services (standard imaging, 100% 70% after deductiblediagnostic medical, lab/pathology, allergytesting)

Durable Medical Equipment, Orthotics and Prosthetics 100% 70% after deductibleEnteral Formulae 100% 70% (deductible does not apply)


H i g h m a r k N o D e d u c t i b l e G r e e n P l a n Group # : 25362-14

(1 ) Treatment includes coverage for the correction of a physical or medical problem associated with infertility. Infertility drug therapy may or may not be covereddepending on your group’s prescription drug program.

(2) State mandated minimum benefits may apply to a diagnosis of serious mental illness. (If the above grid does not show a limit, your mental health benefit days andvisits are unlimited.)

(3) Highmark Healthcare Management Services (HMS) must be contacted prior to a planned inpatient admission or within 48 hours of an emergency or maternity-relatedinpatient admission. Some facility providers will contact HMS and obtain precertification of the inpatient admission on your behalf. Be sure to verify that yourprovider is contacting HMS for precertification. If not, you are responsible for contacting HMS. If this does not occur and it is later determined that all or part of theinpatient stay was not medically necessary or appropriate, you will be responsible for payment of any costs not covered.


Benefit Network Out-of-NetworkHome Infusion Therapy 100% 70% after deductibleHome Health Care 100% 70% after deductibleHospice 100% after $100 copayment 70% after deductibleHospital Services – Inpatient 100% after $100 copayment 70% after deductibleHospital Services – Outpatient 100% 70% after deductibleInfertility Counseling, Testing and Treatment(1) 100% 70% after deductibleMaternity (facility & professional services) 100% after $100 copayment 70% after deductibleMedical/Surgical Expenses (except office visits) 100% 70% after deductibleMental Health – Inpatient(2) 100% after $100 copayment 70% after deductibleMental Health – Outpatient(2) 100% 70% after deductiblePrivate Duty Nursing 100% 70% after deductibleRespiratory Therapy 100% 70% after deductibleSkilled Nursing Facility Care 100% after $100 copayment 70% after deductibleSubstance Abuse• Inpatient Detoxification 100% after $100 copayment 70% after deductible• Inpatient Rehabilitation 100% after $100 copayment 70% after deductible• Outpatient 100% 70% after deductibleTherapy Services (Cardiac Rehab, Infusion Therapy, 100% 70% after deductible

Chemotherapy, Radiation Therapy and Dialysis)Transplant Services 100% 70% after deductiblePrecertification Requirements(3) Yes

None $300 Member Precert Penalty for non-emergency Out-of-Network IP Admission

Prescription Drug Deductible• Individual None• Family NoneGeneric Drugs – for daily maintenance drugs; plan Retail Pharmacy (34 day supply) $5.00 copay

allows initial prescription and one refill, then mail order Mail Order Pharmacy (90 day supply) $12.50 copayBrand Name Drugs – for daily maintenance drugs; plan Retail Pharmacy (34 day supply) $20.00 copay

allows initial prescription and one refill, then mail order Mail Order Pharmacy (90 day supply) $50.00 copayContraceptives (oral and injectible) Covered 100% - No CopayMandatory Mail Order Provision – Original script and 1 refill at retail pharmacy. All other maintenance drugs must be filled through the mail services.

2015 Employee Contributions for Highmark No Deductible Green PlanEmployee Only Employee + Spouse Employee + Children Family

$41.00 $318.00 $250.00 $421.00

Medicare Part D This prescription drug plan is creditable coverage. Medicare-eligible participants need not enroll in aseparate Medicare D drug plan.

H i g h m a r k H i g h D e d u c t i b l e H S A P l a n Group # : 25465


Benefit Network Out-of-NetworkGeneral Provisions

Benefit Period Contract Year (July 1 - June 30)

Deductible per benefit period (Applies to Medical and Prescription Drug benefits)

Employee Only Plan $2,000 CombinedFamily Plan $4,000 Combined

Plan Pays – payment based on the plan allowance 100% after deductible 80% after deductible

Out-of-Pocket Maximums (Includes prescription drug expenses, coinsurance andcopayments. Once met, plan pays 100% for the rest of the benefit period)

Employee Only Plan None $1,500Family Plan None $3,000

Office/Clinic/Urgent Care VisitsRetail Clinic Visits 100% after deductible 80% after deductiblePrimary Care Provider Office Visits 100% after deductible 80% after deductibleSpecialist Office & Urgent Care Center Visits 100% after deductible 80% after deductible

Preventive Care(1)Routine Adult Physical Exams 100% no deductible 80% after deductibleAdult Immunizations 100% no deductible 80% after deductibleColorectal Cancer Screening 100% no deductible 80% after deductibleRoutine Gynecological Exams, including a Pap Test 100% no deductible 80% no deductibleMammograms, Annual Routine 100% no deductible 80% after deductibleMammograms, Medically Necessary 100% after deductible 80% after deductibleDiagnostic Services and Procedures 100% no deductible 80% after deductibleRoutine Foot Care 100% no deductible 80% after deductibleRoutine Pediatric Physical Exams 100% no deductible 80% after deductiblePediatric Immunizations 100% no deductible 80% no deductible

Emergency ServicesEmergency Room Services 100% after deductibleAmbulance 100% after deductible 80% after deductible

Hospital and Medical/Surgical Expenses (including maternity)Hospital Inpatient & Outpatient 100% after deductible 80% after deductibleMaternity (non-preventive facility & professional services) Includes Dependent Daughter 100% after deductible 80% after deductibleMedical Care (except office visits)

Includes Inpatient Visits and Consultations 100% after deductible 80% after deductibleSurgical Expenses (except office visits) Includes Assistant Surgery, Anesthesia

and Sterilization 100% after deductible 80% after deductible

Mental Health/Substance AbuseInpatient Mental Health (4) 100% after deductible 80% after deductibleInpatient Rehabilitation 100% after deductible 80% after deductibleInpatient Detoxification 100% after deductible 80% after deductibleOutpatient Mental Health (4) 100% after deductible 80% after deductibleOutpatient Substance Abuse 100% after deductible 80% after deductible

Therapy and Rehabilitation ServicesPhysical Medicine 100% after deductible 80% after deductibleOutpatient 20 visits/benefit periodRespiratory Therapy 100% after deductible 80% after deductibleSpinal Manipulations 100% after deductible 80% after deductible

20 visits/benefit periodSpeech & Occupational Therapy 100% after deductible 80% after deductible

Outpatient 12 visits per therapy/benefit periodOther Therapy Services - Cardiac Rehabilitation, Chemotherapy, Radiation

Therapy, Dialysis and Infusion Therapy 100% after deductible 80% after deductible


H i g h m a r k H i g h D e d u c t i b l e H S A P l a n Group # : 25465

Other ServicesAllergy Extracts and Injections 100% after deductible 80% after deductibleAssisted Fertilization Procedures Not Covered Not CoveredDental Services Related to Accidental Injury Not Covered Not CoveredDiabetes Treatment 100% after deductible 80% after deductibleDiagnostic Services

Advanced Imaging (MRI, CAT, PET scan, etc.)100% after deductible 80% after deductible

Durable Medical Equipment and Prosthetics 100% after deductible 80% after deductible

Hearing Care Services Not CoveredHome Health Care (Excludes Respite Care) 100% after deductible 80% after deductible

90 visits/benefit periodHospice (Includes Respite Care) 100% after deductible 80% after deductible

Infertility Counseling, Testing and Treatment(2) 100% after deductible 80% after deductible

Oral Surgery 100% after deductible 80% after deductiblePrivate Duty Nursing 100% after deductible 80% after deductible

240 hours/benefit periodSkilled Nursing Facility Care 100% after deductible 80% after deductible

100 days/benefit periodTMJ & Transplant Services 100% after deductible 80% after deductiblePrecertification Requirements(3) Yes

Prescription DrugsPrescription Drug Deductible

Individual Integrated with medical deductible Family Integrated with medical deductible

Prescription Drug Program(5) Retail Drugs (31-/60-/90-day Supply)Plan pays 100% after deductible

Maintenance Drugs through Mail Order (90-day Supply)Plan pays 100% after deductible

Defined by the Premier 2012 Pharmacy Network - Not Physician Network.Prescriptions filled at a non-network pharmacy are not covered.

Non-Network Pharmacy Not Covered

(1) Services are limited to those listed on the Highmark Preventive Schedule and Women’s Health Preventive Schedule. Gender, age and frequency limits may apply.(2) Treatment includes coverage for the correction of a physical or medical problem associated with infertility. Infertility drug therapy may or may not be covered depending on your group’s prescription drug program.(3) Highmark Medical Management & Policy (MM&P) must be contacted prior to a planned inpatient admission or within 48 hours of an emergency or maternity-related inpatient admission. Be sure to verify that your provider is contacting MM&P for precertification.

If not, you are responsible for contacting MM&P. If this does not occur and it is later determined that all or part of the inpatient stay was not medically necessary or appropriate, you will be responsible for payment of any costs not covered.(4) This Plan will allow a 4 sessions/1 inpatient day exchange ratio. When using acute partial visits, the ratio will be 2 sessions for 1 inpatient day. (5) At a retail or mail order pharmacy, if your deductible has not been met, you pay the entire cost for your prescription drug at the discounted rate Highmark has negotiated. The amount you paid for your prescription will be applied to your

deductible. If your deductible has been met, you will only pay any member responsibility based on the benefit level indicated above. You will pay this amount at the pharmacy when you have your prescription filled.


Benefit Network Out-of-Network

Medicare Part D This prescription drug plan is not creditable coverage. Medicare-eligible participants need to enroll in aseparate Medicare D drug plan.

Preventative Prescription DrugsContraceptives (oral and injectable) Covered 100%, no deductibleAsthma Covered 100%, no deductibleBlood Pressure Covered 100%, no deductibleCholesterol Covered 100%, no deductiblePrenatal Vitamins Covered 100%, no deductibleFluoride Products Covered 100%, no deductibleSmoking Deterrents (prescription) Covered 100%, no deductibleOther Prescription DrugsMost other prescription drugs are covered at 100%, after deductible is met

2015 Employee Contributions for Highmark High Deductible HSA PlanEmployee Only Employee + Spouse Employee + Children Family

$5.00 $168.00 $110.00 $256.00



D E N TA L Group # : 900891

United Concordia

This United Concordia Dental Plan is part of the Advantage Plus network, meaning members can reduce their out of pocket expenses byutilizing a United Concordia Advantage Plus provider. Before receiving care, check with your dentist to see if they are part of the AdvantagePlus network. Please see the next page for the 2015 Employee Contributions for Dental Coverage.

In-Network Out-of-Network**

Deductible (plan year) $25/person; $75/family

Class I Services - No deductible 100% 100%Preventive - Routine oral exams; bitewing & full mouth x-rays; restorative & fillings;

fluoride treatments & space maintainers for dependents under age 19; emergencypalliative treatment for pain.

Class II Services - After deductible 80% 80%Basic - X-rays not included in Class A; oral surgery, periodontics; root canals;

extractions; recementing bridges, crowns or inlays.

Class III Services - After deductible 80% 80%Prosthodontic - Installation of crowns, installing partial, full or removable

dentures, initial installation of bridgework, repair of crowns, bridgework andremovable dentures

Class IV Services - After deductible 50% 50%Orthodontia

Maximum Benefit AmountPer person per Plan Year $1,500 $1,500Orthodontics - lifetime max for dependents up to age 19 $1,500 $1,500

** Out-of-Network paid at the 90th percentile

This summary is for descriptive purposes only and should not be relied upon to fully determine coverage. It is not an agreement or a contract.For more detailed information, refer to the Summary Plan Description.


L I F E , A D & D , A N D D I S A B I L I T Y

V I S I O N

2015 Employee Contributions for Dental & Vision PlanEmployee Only Employee + Spouse Employee + Children Family

$0.50 $1.00 $1.00 $1.00

Vision Reimbursement Plan

The School District of Lancaster provides a Vision ReimbursementPlan where each member is given a $300 allowance towardsvision care for their family each plan year. These funds coverqualified vision expenses such as exams, eyewear, and contacts;contact your Human Resources office for more information.

Li fe Insurance

Life insurance provides financial protection for your family in the event of your death. Term Life Insurance is available to allactive employees. This benefit is provided through The Hartford.

Benefi t Amount

Employee Life

Amount of Coverage: 2.5x Base Annual Earningsto maximum of $250,000

El ig ib i l i ty : Act ive ly work ing

Employee AD&D

Amount of Coverage: Accidental Death equals the full life insuranceamount.

Covered Loss: one limb or sight of one eyeequals ½ of the life insurance amount.

Covered Loss: Any two or more of the aboveequals the full life insurance amount.

El ig ib i l i ty : Act ive ly work ing

Disabil i ty Insurance

This plan pays 66 2/3% of your daily rate of pay with a maximum benefit amount of $3,000 per month. The benefit begins onthe fourth day of absence due to an illness or injury after exhausting all available sick and vacation days. The maximumbenefit period is 24 months.

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V O L U N TA R Y L I F E I N S U R A N C E

Voluntary Life Insurance is optional coverage available to you for a cost. It pays your beneficiary anamount in addition to your Life Insurance benefit provided by The School District of Lancaster if you diewhile you are covered.

Employee Voluntary L i fe Insurance

Eligibility You are eligible if you are an activefull time employee who works atleast 10 hours per week on aregularly scheduled basis.

Amount of Coverage You can purchase Voluntary LifeInsurance in increments of $10,000.The maximum amount you canpurchase cannot be more than$500,000.

Guarantee Issue $250,000 (new hires only)

Evidence of Insurability You may need to provide evidenceof insurability that is satisfactoryto The Hartford before the amountcan become effective.

Spousal Voluntary L i fe Insurance

If you elect Voluntary Life Insurance for yourself, you maychoose to purchase Spousal Voluntary Life Insurance.

Amount of Coverage You can purchase SpousalVoluntary Life Insurance inincrements of $5,000.The maximum amount you canpurchase cannot be more than$250,000

Guarantee Issue $100,000 (new hires only)

Evidence of Insurability Your spouse may need to provideevidence of insurability that issatisfactory to The Hartfordbefore the amount can becomeeffective.

Child(ren) Voluntary L i fe Insurance

If you elect Voluntary Life Insurance for yourself, you maychoose to purchase Child(ren) Voluntary Life Insurance.

Amount of Coverage You can purchase Child(ren)Voluntary Life Insurance in theamount of $10,000 per child – nomedical information is required.

• If your dependent child(ren) is confined in a hospital orelsewhere because of disability on the date his or herinsurance would normally have become effective,coverage (or an increase in coverage) will be deferreduntil that dependent is no longer confined and hasperformed all the normal activities of a healthy personof the same age for at least 15 consecutive days.

• Your child(ren) must be at least 15 days but not yet age26 to be covered.

• Child(ren) age 26 or older may be covered if they weredisabled prior to attaining age 26.

• Child(ren) at least 15 days but not yet age 6 months arelimited to a reduced benefit of $500.

F L E X I B L E S P E N D I N G A C C O U N T S

Flexible Spending Accounts :

Flexible Spending Accounts are designed to provide tax-free reimbursement of certain expenses that you normallywould pay out-of-pocket. These include unreimbursedmedical expenses and child/elder care expenses.

The IRS allows Flexible Spending Accounts to reimbursemany drugs that are purchased over the counter to treat aspecific medical condition and is generally accepted asfalling within the category of “medicine or drugs.”

Each year you must carefully estimate how much moneyyou expect to spend during the upcoming year. A portionof your weekly earnings may be set aside, tax-free, tocover these expenses. Careful planning is necessary sincemoney remaining in your account at the end of each yearwill be forfeited according to IRS rules.

Health Care:

Each year, during the enrollment process, you mustdesignate the amount of money you want to contribute toyour Health Reimbursement Account. Effective January 1,2015, you may contribute up to $2,500 maximum.

Please note: The IRS requires a doctor’s note or prescriptionfor over-the-counter (OTC) products purchased in order forthem to be reimbursed under the Health Care FSA.

Dependent Care:

Dependent Care Reimbursement Account: You maycontribute up to $5,000 tax-free ($2,500 if you are marriedfiling a separate tax return) to pay for care of your child orother dependents while you are working.

Note: Dependent expenses will not be tax-exempt unlessyou report your care provider’s name, address, and socialsecurity number (or taxpayer ID) to the IRS on your taxreturn for the year.

Consider your expenses carefully before you decide howmuch to contribute to your account. If your eligibleexpenses turn out to be less than the amount contributedto your account, federal law requires the unused balancebe forfeited (the “Use It of Lose It” rule). Do not contributemore than you are reasonably certain to use.

OTC Drugs and Medicines El igiblewith a Doctor 's Prescript ion

As of January 1, 2011, the IRS requires a doctor’s note orprescription for OTC products purchased in order for themto be reimbursed under the Health Care FSA.

Debit Card / Over-The-CounterEl igibi l i ty For Reimbursement

This provision will also impact the use of all healthcaredebit cards. As of January 1, 2011, merchants who areIIAS certified will need to modify the list of items eligiblefor payment due to the prescription requirement.Purchases of OTC drugs, medicines and biologicals willrequire another form of payment, and you will need torequest reimbursement by filing a claim. This changeaffects only OTC drugs, medicines and biologicals--bandages, home health aids and other OTC items will stillbe eligible and can be purchased using the card as normal.

Though the specific list of items affected has not beencompletely assessed, the following categories of itemswill require a doctor's prescription and thus cannot bepurchased using a healthcare debit card:

The following are examples of some of the items that willremain available without a doctor's prescription:

• Acid controllers • Allergy and sinus • Antibiotic products • Anti-diarrhea products • Anti-gas • Anti-itch and insect bite • Anti-parasitic treatments • Baby rash ointments/creams • Cold sore remedies • Cough, cold and flu

• Digestive aids • Feminine anti-

fungal/antiitch • Hemorrhoidal preps • Laxatives • Motion sickness • Pain relief • Respiratory treatments • Sleep aids and sedatives • Stomach remedies

• Band aids • Birth control • Braces and supports • Catheters • Contact lens supplies and

solutions • Denture adhesives • Diagnostic tests and

monitors • Elastic bandages and wraps

• First aid supplies • Insulin and diabetic

supplies • Ostomy products • Reading glasses • Wheelchairs, walkers,

canes

2 0 1 5 - 1 6 B e n e f i t s / T h e S c h o o l D i s t r i c t o f L a n c a s t e r / 1 1

AmeriFlex Convenience Card

With the Convenience card, participants pay qualifiedexpenses directly from their flex accounts. The use of thecard to purchase goods and services is treated as a claimagainst the participants reimbursement account. TheConvenience card is accepted only at qualified locationswhere debit cards are accepted. Some locations includehospitals, doctor’s offices, pharmacies, online drug stores,daycare centers, dentist offices, optical shops, etc.

What are the Benefi ts of theConvenience Card?

When using the card, participants won’t have to payqualified expenses upfront and then wait for areimbursement. Card swipes are approved using the same“real time” account balance that AmeriFlex uses to pay

paper claims. There’s nouploading or downloadingbetween card and administrationsystems because they aretogether in one system.

Learn More atwww.f lex125.com

• Get tips for using your take care card• View your account balance(s)• Look up qualified plan expenses• View card transactions• Print claim forms to get reimbursed when you don’t use

the card to pay!

Examples of El igible Health Care Expenses:(as defined in the US Master Tax Guide)

• Acupuncture• Alcoholism treatment• Ambulance• Artificial limbs• Artificial teeth (not cosmetic)• Autoette• Blindness, special educational aids to

mitigate condition• Braille books and magazines, cost in

excess of regular edition• Capital expenditures, primarily for

medical care, not including increase inproperty value

• Car, equipped to accommodatewheelchair passengers

• Car for the physically challenged• Care for a mentally challenged

individual• Chiropractor fees• Christian Science treatment• Coinsurance or co-payments for health

care• Contact lenses• Contact lens cleaners and solutions• Contraceptives• Cosmetic surgery, only if due to

congenital abnormality, accident ortrauma injury, or disfiguring disease

• Crutches• Deductibles for health care expenses• Dental fees• Dentures• Diagnostic fees• Doctor fees

• Domestic aid, type that would berendered by a nurse

• Drug addiction, recovery from• Drugs, prescription• Durable medical equipment• Eye examinations and glasses• First aid supplies, such as bandaids• Guide animals, cost and maintenance• Hearing aids, telephone, specially

equipped• Home improvement for medical

considerations• Hospital care, inpatient• Hospital services• Insulin• Laboratory fees• Laser Vision Correction• Laetrile by prescription• Lead paint removal, if child with lead

paint poisoning• Legal expenses, authorization of

treatment for mental illness• Lip reading expenses for the deaf• Medical supplies, prescription• Medical thermometers• Mentally challenged person’s cost for

special home• Nurse’s fees, including room, board

and Social Security tax if paid bytaxpayer

• Obstetrical fees• Operations• Orthodontia, non-cosmetic

• Osteopath fees• Patterning exercises for child with

disabilities• Personal kits for cholesterol,

colorectal cancer, home drug,ovulation indicators, & pregnancyscreening and testing

• Physician fees• Physical therapy• Psychiatric care• Psychologist and psychotherapist fees• Radial Keratotomy• Remedial reading and language

training• Routine physicals and other non-

diagnostic services or treatments• Schools or teachers, special relief of

disability• Sexual dysfunction, hospitalization for• Sterilizing operation• Surgical fees• Transplant, donor’s costs• Transportation/lodging cost incurred

essentially and primarily for medicalcare

• Vasectomy• Vitamins, prescription (medically

necessary)• Weight loss program under a

physician’s care• Wheelchair• Wig, upon physician advice for medical

reason• X-rays

F L E X I B L E S P E N D I N G A C C O U N T S


H E A LT H S A V I N G S A C C O U N T S

If you choose to enroll in the High Deductible HSA PPOMedical Plan, you will have access to a tax-shelteredHealth Savings Account. Since your plan deductible—amount you must pay before the plan covers benefits— ishigher, establishing an HSA lets you:

• pay for your out-of-pocket care expenses before yourdeductible is met to address your immediate care needs;or

• save money in your account for future care expenses.You can even use your HSA as a “medical nest egg” tohelp cover care costs in your retirement years.

How to Enrol l in the Account :

If your employer has not chosen to automatically enrollyou in the HSA, you can activate your account by loggingonto your Highmark website atwww.highmarkblueshield.com. Select Your Spending andStart a Health Savings Account and save! From thisHSA link, you will be able to check your account balance,view deposits and transactions.

How to Fund your Account :

You can contribute — either through payroll deduction orthrough direct payment to the account.

In 2015, the maximum amount that can be contributed toyour HSA is $3,350 for an individual and $6,650 for afamily. If you are 55 or older, you may also be able tomake an annual “catch-up” contribution of $1,000. (Theseamounts are adjusted yearly by the IRS for inflation andare displayed at your Highmark member website.)

How to Manage your Account :

Everything you need to manage your care spending is atyour Highmark member website. So in one convenient,central location you can:

• Contribute to your account

• Pay a care provider directly from the account

• Enter claims for reimbursement for out-of-pocket costs

• View deposits, transactions and claims

• Track your care costs

How to Invest in your Account :

If you’re like many people with a Health Savings Account,you want to maximize your savings year after year.

Highmark HSA is offered through a respected industryleader who serves as custodian: Bank of America. Onceyour HSA balance reaches $500 you may invest any portionof your HSA balance above this level. You have a wideselection of mutual funds*— from conservative optionssuch as a U.S. Treasury fund to more aggressive stockfunds. Your choice or choices depend on your risktolerance and time frame.

An Added Convenience— your OwnPersonal Health Care VISA® DebitCard!

Using your Highmark Health Savings Account to pay forhealth care services is now easier than ever.

When you enroll in your Highmark HSA, you will receive aVisa debit card that you can use exclusively for purchasesat:

• Doctors’ and dentists’ offices

• Pharmacies

• Discount chains and club stores

• Other merchants who sell health care products andservices and accept Visa


Further Supplement Your HSA Planwith a “Limited Purpose FSA”

Federal regulations do not allow participation in both aHealth Savings Account AND a Health Care FlexibleSpending Account.

However, you may participate in a Limited Purpose HealthCare FSA in addition to your Health Savings Account. Thisspecial FSA can only be used for Dental and Visionexpenses, but can provide additional tax-savings thatcan increase your annual take-home pay.

E M P L O Y E E A S S I S TA N C E P R O G R A M

The School District of Lancaster offers an EmployeeAssistance Program for all active employees, administeredby Quest EAP. Everyone experiences personal problemsoccasionally. Quest is here to help address and resolvethose issues before professional obligations and overallquality of life are disrupted.

Professional Counsel ing Services

Face-to-Face Counseling – Employees and immediatefamily members are eligible for three (3) free counselingsessions per contract year. Your benefits renew July 1st ofeach year. To access these free services, just call Quest at1-800-364-6352. The program is a professional, confidentialservice that helps employees and their immediate familymembers identify and resolve personal problems that maybe affecting them either at work or in their personal lives.

Financial and Legal Resources

These services are for employees, spouses and dependents22 years of age and younger living in the same household.

Financial – As a Quest member, you are entitled tobenefits surrounding financial consultation services. Eachmember and dependent family member is entitled to one(1) thirty-minute office or telephone consultation perseparate financial matter at no cost. There are severalavenues available to you, including professionals withexperience in accounting, banking and insurance; CPA’sand Certified Financial Planners (CFP’s); all of whom areavailable to provide Quest members with time and servicesto meet your needs. In the event that you wish to retain aparticipating financial advisor after the initialconsultation, you will be provided with a preferred ratereduction of 25% from the normal hourly rate.

Mediation - Each member is entitled to one (1) initialthirty-minute office or telephone consultation per separatelegal matter at no cost with a network mediator. In theevent that the member wishes to retain a participatingmediator after the initial consultation, they will beprovided with a preferred rate reduction of 25% from themediator’s normal hourly rate. Typical matters may includedivorce & child custody, contractual & consumer disputes,real estate & landlord/tenant issues, car accidents &insurance disputes, etc.

To schedule your free consultation with a qualified networkattorney, mediator or financial advisor, simply call 888-254-8104and give them your Company Code: qeap-sdl

Essent ials of Dai ly L i fe Management

Website - This website at www.worklifeservices.net isdesigned to provide you with a full spectrum of resourcesfor everyday living, including thousands of legal andfinancial topics, over 5,000 legal forms, more than 45financial calculators, professionally written articles,FAQs, videos, articles and quizzes to help you stayinformed and make educated choices. Main topics includemental and medical health, balanced life, financial, legal,stress, personal growth and small business. Our SolutionCenters offer resources that are tailored to specific lifeneeds, providing you with the right tools to help youthrough some of life's toughest challenges.

Elder Care Consul tants

Caring for elderly loved ones - The “aging of America” hasbecome a reality! As we live longer, healthier lives, thedemand for combining work along with care givingresponsibilities for older family members becomes agreater challenge.

Whether you need emotional support, counseling, orguidance, call Peggy McFarland, Ph.D. or Laura Enslen,LSW, of Senior Management Services, at 800-253-9236and tell them you are a member of Quest EAP. They canhelp you to obtain information on the following, as well asvarious other concerns related to caring for your elderlyloved ones:

• What to look for and ask when selecting personal carefacilities

• Medicare & Medicaid services

• Senior Transportation services

• Assisted Living facilities

• Nursing Home options

• In-Home Care services

• Senior Centers

• Adult Day Care facilities

• Alzheimer’s Disease and other forms of dementia

For a complete list of your EAP benefits, or if you have anyquestions or concerns, feel free to call Quest EAP benefitsat 1-800-364-6352.


What is a 403(b) Tax ShelteredAccount?

403(b) is a section of the IRS Code that permits theestablishment of Tax Sheltered Accounts (TSA) for schoolemployees to supplement their retirement income. A403(b) TSA allows you to voluntarily set aside money fromeach paycheck to be put into a tax-deferred account. It’scalled an “elective deferral;” you notify the payroll office,by completing the Salary Reduction Agreement at the backof this SPD, that you wish (“elective”) to have funds takenout of your pay (“deferral”) and contributed to your 403(b)TSA. You may begin your contribution, change the amountof your contribution, or stop your contribution at any time.All school employees are eligible to participate in thedistrict’s 403(b) TSA program, including substituteteachers, part-time employees and periodic employees.The funds withheld from your paycheck are then investedwith a 403(b) provider that you choose from our list ofapproved companies. You control how your funds areinvested by consulting with a representative from theinvestment provider you select. Saving for retirement witha TSA is convenient and easy to do!

Why should you part icipate in a403(b) TSA program?

First: It reduces your current income taxes. It is the firsttax shelter that nearly every tax professional recommends.

Second: It provides for tax-deferred growth. Instead ofpaying income taxes on your bank interest earnings, all ofyour contributions, and the earnings on thosecontributions, are tax deferred until you take out themoney. That will usually be after retirement when you willmost likely be in a lower tax bracket.

Third: It supplements other retirement benefits, like yourpersonal savings, Social Security and the PA SchoolEmployees Retirement System (PSERS). Who knows if any ofus will get all the Social Security we’re entitled to, given thebudget shortfall of Social Security and Medicare? And, eventhough PSERS is one of the best retirement systems, you stillhave to live on the amount of that check from PSERS for therest of your life. And many of today’s employees will livelonger retired than they worked. It is not uncommon forpeople to live to their late 80’s, 90’s or even 100. In fact, 20%of current PSERS retiree’s are 80 and above and nearly 200PSERS retirees are above 100. Considering future scientificand medical advances, that PSERS check may have to last you30 years or more. You need to supplement it with your TSA,which should reflect any economic growth during your careerand retirement years.

How does a 403(b) TSA work?

Here’s a simplified example of how a 403(b) TSA defersyour taxes. Let’s assume you’re married and your adjustedgross income is $70,000. By putting just $50 a pay intoyour TSA your Federal tax bill will be reduced by $325.And, any taxes on earnings are deferred until youwithdraw your money. You’ll have $1,300 (plus anyearnings) put away for retirement, and will have paid $325less to Uncle Sam. Because of the tax advantage,putting $50/pay into a TSA will only reduce take homepay by about $37.50.

How do you get your 403(b) s tar ted?

• Contact one of the investment providers listed below:

• Ameriprise Financial• AXA Equitable Life Insurance Company• Horace Mann Life Insurance Company• ING Life Insurance & Annuity Company• Kades-Margolis Corporation• Lincoln Investment Planning• Met Life Insurance of CT• Security Benefit Life• The Variable Annuity Life Insurance Company• Waddell & Reed, Inc.

• Complete the Salary Reduction Agreement which you candownload a copy of from the TSA websitewww.tsacg.com, or obtain a copy from your payroll office.

• Complete and turn in the Salary Reduction Agreement tothe district payroll office.

$50/pay in Bank $50/pay in TSA

Taxable Income $70,000 $70,000TSA: $50/pay x 26 -$1,300

Adjusted Gross Income $70,000 $68,700Income Tax $17,500 $17,175

-$325Assumes 25% Tax Bracket.Plus: For low and moderate income employees, the IRS offers theSavers Credit: a tax credit for contributing to a 403(b) TSA.

4 0 3 ( b ) TA X S H E LT E R E D A C C O U N T P R O G R A M


Important Notice

Under the Consolidated Omnibus Budget ReconciliationAct (COBRA) of 1985, COBRA qualified beneficiaries(QBs) generally are eligible for group coverage during amaximum of 18 months for qualifying events due toemployment termination or reduction of hours of work.Certain qualifying events, or a second qualifying eventduring the initial period of coverage, may permit abeneficiary to receive a maximum of 36 months ofcoverage.

COBRA coverage is not extended for those terminated forgross misconduct. Upon termination, or other COBRAqualifying event, the former employee and any other QBswill receive COBRA enrollment information.

Qualifying events for employees includevoluntary/involuntary termination of employment, and thereduction in the number of hours of employment.Qualifying events for spouses or dependent childreninclude those events above, plus, the covered employee’sbecoming entitled to Medicare; divorce or legalseparation of the covered employee; death of thecovered employee; and the loss of dependent statusunder the plan rules.

If a QB chooses to continue group benefits under COBRA,they must complete an enrollment form and return it tothe Plan Administrator with the appropriate premiumdue. Upon receipt of premium payment and enrollmentform, the coverage will be reinstated. Thereafter,premiums are due on the 1st of the month. If premiumpayments are not received in a timely manner, federallaw stipulates that your coverage will be cancelled aftera 30-day grace period.

If you have any questions about COBRA or the Plan,please contact the Plan Administrator.

Please note, if the terms of the Plan and any responseyou receive from the Plan Administrator’s representativesconflict, the Plan document will control.

P U B L I C S C H O O L E M P L O Y E E S ’ R E T I R E M E N T S Y S T E M

C O B R A

PSERS

The Public School Employees’ Retirement System (PSERS) is an agencyof the Commonwealth of Pennsylvania who administers the pensionplan for Pennsylvania’s public school employees. Under the InternalRevenue Service (IRS) Code, the PSERS pension plan is classified as a401(a), governmental defined benefit plan. A defined benefit planmeans that your retirement benefit is determined by a formula whichincludes a retirement factor, years of credited service, and the finalaverage salary. For more information, please visit the PSERS websiteat www.psers.state.pa.us.


A N N U A L N O T I C E S

(CHIP) Special Enrol lment Period

In 2009, gain or loss of eligibility for Medicaid or CHIPcoverage became a Special Enrollment Right. The Planwill permit an employee or a dependent of an employeewho is eligible, but not enrolled, to enroll under the PLANif either of the following two conditions are met:

(1) The employee or dependent is covered under aMedicaid plan or under a state child health plan andthe coverage is terminated due to loss of eligibilityAND the employee requests coverage under thegroup health plan no later than 60 days after theloss of eligibility.

(2) The employee or dependent becomes eligible forassistance for coverage under the group health plan,Medicaid plan or state child health plan AND theemployee requests coverage under the group healthplan no later than 60 days after the employee ordependent is determined to be eligible forassistance.

Newborns’ and Mothers ’ Heal th Protect ion Actof 1996 (Newborn’s Act )

Group health plans and health insurance issuers generallymay not, under federal law, restrict benefits for anyhospital length of stay in connection with childbirth forthe mother or newborn child to less than 48 hoursfollowing a vaginal delivery, or less than 96 hoursfollowing a cesarean section. However, federal lawgenerally does not prohibit the mother's or newborn'sattending provider, after consulting with the mother, fromdischarging the mother or her newborn earlier than 48hours (or 96 hours as applicable). In any case, plans andissuers may not, under federal law, require that aprovider obtain authorization from the plan or the issuerfor prescribing a length of stay not in excess of 48 hours(or 96 hours).

Notice of Pr ivacy Pract ices (HIPAA)

In compliance with the Health Insurance Portability andAccountability Act of 1996 (HIPAA), your employerrecognizes your right to privacy in matters related to thedisclosure of health-related information. The Notice ofPrivacy Practices (provided to you upon your enrollment inthe health plan) details the steps your employer has takento assure your privacy is protected. The Notice alsoexplains your rights under HIPAA. A copy of this Noticeis available to you at any time, free of charge, by requestthrough your employer.

Quali f ied Medical Chi ld Support Order(QMCSO)

QMCSO is a medical child support order issued under Statelaw that creates or recognizes the existence of an “alternaterecipient's” right to receive benefits for which a participantor beneficiary is eligible under a group health plan. An“alternate recipient” is any child of a participant (including achild adopted by or placed for adoption with a participant ina group health plan) who is recognized under a medical childsupport order as having a right to enrollment under a grouphealth plan with respect to such participant. Upon receipt,the administrator of a group health plan is required todetermine, within a reasonable period of time, whether amedical child support order is qualified, and to administerbenefits in accordance with the applicable terms of eachorder that is qualified. In the event you are served with anotice to provide medical coverage for a dependent child asthe result of a legal determination, you may obtaininformation from your employer on the rules for seeking toenact such coverage. These rules are provided at no cost toyou and may be requested from your employer at any time.

Pre-Exist ing Condit ion Noti f icat ion (HIPAA)

A group health plan may not impose a pre-existingcondition exclusion with respect to a participant ordependent before notifying the participant, in writing, of:

• The existence and terms of any preexisting conditionexclusion under the plan;

• The rights of individuals to demonstrate creditablecoverage (and any applicable waiting periods);

• The right of the individual to request a certificate froma prior plan or issuer, if necessary; and,

• That the current plan (or issuer) will assist in obtaininga certificate from any prior plan or issuer, if necessary.

Coverage Extension Rights under the Uniformed ServicesEmployment and Reemployment Rights Act (USERRA)

If you leave your job to perform military service, you havethe right to elect to continue your existing employer-based health plan coverage for you and your dependents(including spouse) for up to 24 months while in themilitary. Even if you do not elect to continue coverageduring your military service, you have the right to bereinstated in your employer’s health plan when you arereemployed, generally without any waiting periods orexclusions for pre-existing conditions except for service-connected injuries or illnesses.


The Women’s Health and Cancer Rights Act of1998 (WHCRA, also known as Janet ’s Law)

Under WHCRA, group health plans, insurance companiesand health maintenance organizations (HMOs) offeringmastectomy coverage must also provide coverage forreconstructive surgery in a manner determined inconsultation with the attending physician and the patient.Coverage includes reconstruction of the breast on whichthe mastectomy was performed, surgery andreconstruction of the other breast to produce asymmetrical appearance, and prostheses and treatment ofphysical complications at all stages of the mastectomy,including lymphedemas. Call your Plan Administrator formore information.

Health Information Privacy Rules

For purposes of the health benefits offered under thePlan, the Plan uses and discloses health informationabout you and any covered dependents only as needed toadminister the Plan. To protect the privacy of healthinformation, access to your health information is limitedto such purposes. The health plan options offered underthe Plan will comply with the applicable healthinformation privacy requirements of federal Regulationsissued by the Department of Health and Human Services.The Plan’s privacy policies are described in more detail inthe Plan’s Notice of Health Information Privacy Practicesor Privacy Notice. Plan participants in The School Districtof Lancaster-sponsored health and welfare benefit planare reminded that The School District of Lancaster’sNotice of Privacy Practices may be obtained by submittinga written request to the Human Resources Department.For any insured health coverage, the insurance issuer isresponsible for providing its own Privacy Notice, so youshould contact the insurer if you need a copy of theinsurer’s Privacy Notice.

Mental Health Parity and Addiction Equity Act of 2008

This act expands the mental health parity requirements inthe Employee Retirement Income Security Act, theInternal Revenue Code and the Public Health Services Actby imposing new mandates on group health plans thatprovide both medical and surgical benefits and mentalhealth or substance abuse disorder benefits. Among thenew requirements, such plans (or the health insurancecoverage offered in connection with such plans) mustensure that: the financial requirements applicable tomental health or substance abuse disorder benefits areno more restrictive than the predominant financialrequirements applied to substantially all medical andsurgical benefits covered by the plan (or coverage), andthere are no separate cost sharing requirements that areapplicable only with respect to mental health orsubstance abuse disorder benefits.

A N N U A L N O T I C E S

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