2015-2016 Benefits Enrollment Guide

303-776-6200 • 395 S. PRATT PKWY.• LONGMONT, CO 80501 • SVVSD.ORG

ENROLLMENT GUIDE

ST. VRAIN VALLEY SCHOOLS’

BENEFITS

STVRA.IN/LINKEDIN @SVVSD

SVVSD.ORG

TABLE OF CONTENTSEnrollment 3Eligibility 3Changing your Benefit Elections 4Medical Insurance Options Kaiser Permanente (DHMO) Plan 6CNIC HRA Plan 6Health Reimbursement Account 7Medical Plan Comparison Chart 8 Dental Insurance 10 Vision Insurance 11After-Tax Premiums 12Medicaid and CHP+ Healthy Kids Initiative 12Flexible Spending Accounts Health Care FSA 14Dependent Care FSA 14Saving for your Future Pension Plan (PERA) 16PERAPlus Optional Retirement Plans 16Basic Life and AD&D Insurance 17Supplemental Life Insurance 19PERA Disability 20Sick Leave Bank 20Voluntary Short Term Disability 21Employee Assistance Program 22Onsite Health Coach & Worksite Wellness 22Other Resources 23Monthly Premium Chart 24

Within this Benefits Guide, you will find important information on benefits available to you.

Benefits are an integral part of your compensation package provided by the St. Vrain Valley School District, so please take a few minutes to review your benefit plan options to determine which plans are best for you and your family.

Each year, the District completes a thorough review of our benefit plans to ensure they remain competitive and continue to meet employee needs.

This Benefits Enrollment Guide covers only the highlights of your benefits program. While every effort has been made to ensure the accuracy of the information contained in this booklet, if information in this document differs from the official documents, the official documents govern in all cases.

303-776-6200 • 395 S. PRATT PKWY.• LONGMONT, CO 80501 • STVRA.IN/BENEFITS

ENROLLMENTDuring the annual benefits open enrollment, all benefits-eligible employees must enroll electronically even if you are satisfied with your current benefit plan selections or wish to waive coverage. To enroll, log onto the Infinite Visions Employee Portal at:

stvra.in/ivenroll

Under the Employee Resources menu select “Benefits Enrollment”.

Because the District is making a number of changes which may impact you and your family for 2016, we encourage you to attend one of the many Open Enrollment informational meetings available.

If you miss Open Enrollment and are dis-enrolled, you will be unable to re-enroll, without a qualifying life event, until next year’s annual open enrollment period.

ELIGIBILITYYou are eligible for benefits if you are an employee regularly contracted to work 17.5 hours or more per week (unless otherwise noted) or if you qualify under ACA* requirements. You may enroll your eligible dependents in the same plans you choose for yourself.

Eligible dependents include:

• Your legal spouse;• Your children through age 25, regardless of student, marital or tax-

dependent status (includes a stepchild, legally-adopted child, a child placed with you for adoption or a child for whom you are the legal guardian); and

• Your dependent children of any age who are physically or mentally unable to care for themselves.

STVRA.IN/IVENROLL

*Affordable Care Act (also referred to as Health Care Reform, Obama Care, etc.)

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CHANGING YOUR BENEFIT ELECTIONSOnce you have finalized your 2016 benefit elections, you must wait until the next annual Open Enrollment period (typically in November) to change your elections. The only exception is if you experience a qualifying life event. Qualifying life events include:

• Marriage• Birth, adoption or placement for adoption• Divorce, legal separation or annulment• Death of a spouse or covered child • Change in your or your spouse’s work status that affects his/her benefits• Change in your child’s eligibility for benefits• Change in residence accompanied by a gain or loss of insurance coverage

as a result of the move, or• Qualified Medical Child Support Order

Your election change must be consistent with your life event. You are also eligible to make an enrollment change for yourself and your eligible dependents if either of the following events occur:

• You or your dependent loses Medicaid or Children’s Health Insurance Program (CHIP) coverage because you are no longer eligible.

• You or your dependent qualifies for state assistance in paying your employer group medical plan premiums.

To request a change due to a qualifying life event, you must contact the Benefits Department and provide documentation of the change within 31 days of the qualifying life event.

Change requests submitted 31 days after qualifying events cannot be accepted.

Unlike other qualifying events, you have 60 days from the date of the qualifying Medicaid/CHIP life event to request enrollment in the St. Vrain medical plan.

Contact the Benefits Office at 303-682-7341 or at [email protected] .4


MEDICAL INSURANCE OPTIONS

St. Vrain Valley Schools offer two health plan options to benefits-eligible employees and their eligible family members – Kaiser Permanente DHMO and CNIC HRA.

Through Delta Dental of Colorado and VSP, St. Vrain is also able to provide quality dental and vision coverage.

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CNIC HRA PLANThe self-insured CNIC Health Reimbursement Account (HRA) Plan is a Preferred Provider Organization (PPO) plan that offers a large network of contracted doctors and hospitals to choose from whenever care is needed. In Colorado, the Plan utilizes the Rocky Mountain Health Network and if you are outside of Colorado, you will want to access the Aetna Signature Network to maximize your savings. After you meet your annual deductible, you are responsible for paying a portion of remaining eligible expenses (your coinsurance).

When you enroll in the CNIC HRA plan, you automatically receive prescription drug coverage through NPS (National Pharmaceutical Services). You must use an in-network pharmacy to receive a benefit under the NPS pharmacy plan.

Most national pharmacy chains and local pharmacies participate in the NPS Network. (Please visit the NPS website at www.pti-nps.com to view the most up-to-date listing of pharmacy providers near you.)

KAISER PERMANENTE (DHMO) PLAN

Visit the NPS website at www.pti-nps.com to view up-to-date listing of providers.

The Kaiser Permanente plan is a non-profit Deductible Health Maintenance Organization (DHMO) plan that provides services through the Kaiser Permanente network of doctors, partner hospitals and other health care facilities.

There is no out-of-network coverage unless you experience a life-threatening injury or illness that requires ambulance and/or emergency room assistance.

Each time you visit a Kaiser Permanente pharmacy or other provider for care, you pay a copay or an amount based on your deductible and coinsurance responsibility. Your out-of-pocket costs for eligible expenses are capped annually at $2,500 for an individual or $5,000 for a family.

• Deductible – the amount of covered expenses you must pay before charges are paid by your medical plan

• Copayment – a fixed-dollar amount you pay for covered services through your medical plan

• Coinsurance – your share of the cost of covered services, calculated as a percentage (for instance, you pay 10% and the Plan pays 90%); typically payable after you have met your deductible

• Out-of-PocketMaximum - the maximum amount you pay in a calendar year for covered expenses under your health plan (once you or your covered dependent reach the OOP Maximum, the plan covers 100% of eligible expenses for the remainder of the year)

KEY DEFINITIONS

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When picking up your prescription at the pharmacy, show your ID card and pay your copay. It’s that simple! Your benefit will be processed onsite (no claim needed).

There are two ways you can receive your prescription drug benefits:

• Retail Pharmacy – You receive up to a 30-day supply.• Mail Order – If you are taking a maintenance medication (for a medical condition

that requires ongoing use of medications such as high blood pressure, diabetes or a thyroid condition), you may want to use the mail-order prescription service through Integrated HMO Pharmacy. When you order prescriptions by mail, you can receive up to a 90-day supply and you’ll typically save money.

Using in-network providers can save you money in several ways:

• You have a lower upfront deductible and the Plan reimburses at a higher level for in-network charges

• In-network providers have agreed to negotiated fees that are typically lower than out-of-network providers

• The Healthcare Bluebook, a service provided at no additional cost to all CNIC plan participants, provides online tools to help you identify the fair market price for thousands of medical procedures, tests, and other services. Check it out at: www.healthcarebluebook.com/cc/stvrain Password: hcbbstvrain

KEEP IN MIND

HEALTH REIMBURSEMENT ACCOUNT (HRA)

Refer to the coverage chart on the next page.

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The District contributes to a Health Reimbursement Account (HRA) for each employee who enrolls in the CNIC HRA Plan to assist you in paying the first portion of your deductible. A HRA is a type of health care account, funded entirely by the District, from which you can withdraw money, tax-free, to pay for eligible medical expenses. Per IRS guidelines, all medical expenses paid for with HRA funds must be substantiated. The funds carry over up to the maximum of your plan’s deductible and can be used in future years to pay for eligible medical expenses but are only available while you are actively employed at St. Vrain and while you are participating in the HRA plan.

For calendar year 2016, the District will contribute up to $750 into your HRA if you have “Employee Only” coverage and $1,500 if you cover yourself and your dependent(s) under the CNIC HRA Plan. The money will be deposited into your HRA at the beginning of the year and if you do not spend the money in 2016, you may carry it over to 2017 and beyond, up to the maximum allowed. (New hires qualify only for HRA deposits occurring after their benefits eligibility date. No retroactive contributions will be made.)

CNIC (HRA) IN-NETWORK CNIC (HRA) OUT-OF-NETWORKHRA Contribution (funded by SVVSD) $750 Individual; $1,500 Employee + Dependent(s) N/A

Deductible (excludes RX/Vision copays) $2,000 Individual/ $4,000 Employee + Dependent(s)

$4,000 Individual/ $8,000 Employee + Dependent(s)

$250 Individual/$500 Employee + Dependent(s)

Out-of-Pocket Maximum$2,500 Individual/ $5,000 Employee + Dependent(s)

(excludes RX/Vision copays; includes deductibles)



(includes copays and deductibles)

Lifetime Maximum Unlimited Unlimited

Preventive Care Covered at 100% 50% coinsurance* Covered at 100%

Women’s Preventive Care (includes contraceptive devices, drugs and services)

Covered at 100% 50% coinsurance* Covered at 100%

Office Visits 10% coinsurance* 50% coinsurance* $25 copay (PCP) / $40 copay (Specialist)

Diagnostic Lab/X-RayDiagnostic CT, PET, MRI

10% coinsurance*50% coinsurance*

Lab covered at 100%;Diagnostic x-ray, 10%* coinsurance;

CT, PET, MRI $100 copay per procedure

Chiropractic Care 10% coinsurance* 50% coinsurance* Not Covered

Outpatient Surgery 10% coinsurance* 50% coinsurance* 10% coinsurance*

Inpatient Hospital Services 10% coinsurance* 50% coinsurance* 10% coinsurance*

Ambulance 10% coinsurance* 10% coinsurance* 10% coinsurance, up to $500

Emergency Room 10% coinsurance* 10% coinsurance* $150 copay

Urgent Care 10% coinsurance* 50% coinsurance* $50 copay at a KP after-hours medical office

Outpatient Mental Health/Substance Abuse 10% coinsurance* 50% coinsurance* $25 copay

Therapies (PT/OT/Speech)• Inpatient• Outpatient• Chiropractic

10% coinsurance*10% coinsurance*10% coinsurance*


10% coinsurance*$25 copay

Not Covered

Durable Medical Equipment 10% coinsurance* 50% coinsurance* 10% coinsurance*

Routine Vision Exam $10 copay (one exam every 24 months)

Up to $100 allowance (one exam every 24 months)

$25 copay(one exam every 12 months)

Prescription Drugs (Retail Pharmacies)Up to a 30-day supply

$10 Copay Generic$45 Copay Brand Name, Formulary

$60 Copay Brand Name, Non-Formulary Not Covered$15 Copay Generic

$40 Copay Brand Name20% Coinsurance, Specialty

(max. $250 per fill)




$80 Copay Brand Name 20% Coinsurance, Specialty


MEDICAL SERVICES

8 *After plan deductible is met.

CNIC (HRA) OUT-OF-NETWORK KAISER (DHMO) IN-NETWORK ONLYHRA Contribution (funded by SVVSD) $750 Individual; $1,500 Employee + Dependent(s) N/A

Deductible (excludes RX/Vision copays) $2,000 Individual/ $4,000 Employee + Dependent(s)


$250 Individual/$500 Employee + Dependent(s)

Out-of-Pocket Maximum$2,500 Individual/ $5,000 Employee + Dependent(s)

(excludes RX/Vision copays; includes deductibles)



(includes copays and deductibles)

Lifetime Maximum Unlimited Unlimited

Preventive Care Covered at 100% 50% coinsurance* Covered at 100%

Women’s Preventive Care (includes contraceptive devices, drugs and services)

Covered at 100% 50% coinsurance* Covered at 100%

Office Visits 10% coinsurance* 50% coinsurance* $25 copay (PCP) / $40 copay (Specialist)

Diagnostic Lab/X-RayDiagnostic CT, PET, MRI

10% coinsurance*50% coinsurance*

Lab covered at 100%;Diagnostic x-ray, 10%* coinsurance;

CT, PET, MRI $100 copay per procedure

Chiropractic Care 10% coinsurance* 50% coinsurance* Not Covered

Outpatient Surgery 10% coinsurance* 50% coinsurance* 10% coinsurance*

Inpatient Hospital Services 10% coinsurance* 50% coinsurance* 10% coinsurance*

Ambulance 10% coinsurance* 10% coinsurance* 10% coinsurance, up to $500

Emergency Room 10% coinsurance* 10% coinsurance* $150 copay

Urgent Care 10% coinsurance* 50% coinsurance* $50 copay at a KP after-hours medical office

Outpatient Mental Health/Substance Abuse 10% coinsurance* 50% coinsurance* $25 copay

Therapies (PT/OT/Speech)• Inpatient• Outpatient• Chiropractic



10% coinsurance*$25 copay

Not Covered

Durable Medical Equipment 10% coinsurance* 50% coinsurance* 10% coinsurance*

Routine Vision Exam $10 copay (one exam every 24 months)

Up to $100 allowance (one exam every 24 months)

$25 copay(one exam every 12 months)




$40 Copay Brand Name20% Coinsurance, Specialty





$80 Copay Brand Name 20% Coinsurance, Specialty


ALL PREMIUMS ON BACK PAGE.

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DENTAL INSURANCEThe self-insured dental plan, administered through Delta Dental of Colorado, is designed to help you maintain a healthy smile through regular preventive dental care, and to fix any problems as soon as they occur. Because preventive dental care is so important, the plan covers these services in full with no deductible or copay when you visit a Delta Dental PPO dentist. Although you are free to visit any licensed dentist for your care, you will save money by visiting a Delta Dental PPO or Premier® dentist.

For in-network providers, visit www.deltadentalco.com and use the “Find a Dentist” search tool. See summary of dental benefits below:

Annual Deductible (waived for preventive services)

$50 Individual/$100Employee + Dependent(s)

Preventive Services (oral exams, x-rays, cleanings)

100% 80% after deductible 80% after deductible

Basic & Restorative Services (fillings, endodontics, periodontics)

80% after deductible 80% after deductible 80% after deductible

Major Services (dentures, crowns, bridges)

50% after deductible 50% after deductible 50% after deductible

Orthodontia (children up to 19 years of age)

50% up to $1,000 lifetime maximum. Deductible waived

Annual Benefit Maximum $1,500 per person

PPODENTIST 1

PREMIERDENTIST 2

NON-PARTICIPANTDENTIST 3

1 The PPO percentage of benefits is based on the PPO Schedule of Allowance 2 The Premier percentage of benefits is limited to the Premier Maximum Plan Allowance. 3 The Non-Participating percentage of benefits is limited to the non-participating Maximum Plan Allowance. You are responsible for the difference between the non-participating Maximum Plan Allowance and the fee charged by the dentist.

ID Cards are mailed after enrollment or visit deltadentalco.com to print your own.

DENTALSERVICES

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VISION INSURANCEThe VSP vision plan includes benefits for eye exams, eyeglasses, and contact lenses. When you visit a VSP provider, you must pay a copay to your provider at the time of service.

Your provider will file claims for you and will be reimbursed directly by the insurance carrier for allowable charges. No need to show an insurance card, simply tell your vision provider you have VSP.

To find a VSP provider, go to www.vsp.com. Reference the “choice” network to find an in-network VSP doctor.

When you visit an out-of-network provider for your vision care, you must pay your expenses in full at the time of service and submit a claim to VSP for reimbursement up to plan allowances, which are shown in the table below:

Discounts are available for non-covered services such as additional glasses and sunglasses, contact lenses and laser vision correction surgery.

Vision exam (every 12 months) $10 copay $45

Frames (every 12 months) Up to $140, then receive 20% discount $70

Lenses (every 12 months):Single vision lensesBifocal lensesTrifocal lenses

-$10 copay$10 copay$10copay

-$30$50$65

Elective contact lenses, fitting and evaluation (in lieu of glasses)

Up to $140 $105

IN-NETWORKYOU PAY

OUT-OF-NETWORKREIMBURSEMENT

VISIONSERVICES

ALL PREMIUMS ON BACK PAGE.

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AFTER-TAX PREMIUMSYour health, dental and vision insurance premiums are automatically deducted on a pre-tax basis which maximizes your net pay. However, if you are in your highest four years salary for PERA retirement (usually your last four years of employment), you may want to consider waiving participation in the Premium Only Plan (POP). By waiving participation in the POP, your insurance premiums will be deducted on an after-tax basis which may decrease your net pay but maximizes your PERA eligible salary. This choice can be made during your electronic enrollment as a new hire or during Open Enrollment. Each year you would like to waive POP participation, you must complete a new election.

If you opt to contribute to a Health Care and/or Dependent Care Flexible Spending Account, your contributions are always made on a pre-tax basis and may impact your PERA retirement if you are in your four highest salary years for PERA. Voluntary life and short-term disability premiums are always paid with after-tax dollars.

MEDICAID & CHP+ HEALTHY KIDS INITIATIVEIf you are uninsured or your health insurance premiums are unaffordable, Boulder County Healthy Kids Initiative (BCHKI) may be able to help. In a partnership with St. Vrain Valley Schools, The Healthy Kids Initiative helps families enroll in Medicaid and Child Health Plan Plus (CHP+). Medicaid and CHP+ are free or low-cost health insurance programs for children, parents and pregnant women.

For more information on these free and low cost health insurance options, please call (BCHKI) at 720-722-1454.

These benefits include:

• Prenatal, well-child and doctor visits

• Immunizations and prescriptions• Dental care (for children)• Vision services• Hospital services• Mental/behavioral health services

For more information on these free, low cost insurance options, call 720-722-1454. 12


FLEXIBLE SPENDING ACCOUNTS

A Flexible Spending Account (FSA) allows you to pay for eligible out-of-pocket medical and/or dependent care expenses with pre-tax dollars (a savings of 15-40% depending on your tax bracket). Health care expenses can quickly add up; and dependent day care or elder care expenses can be even more expensive. An FSA lets you pay these expenses with pre-tax dollars.

This means that the money you set aside is not taxed, so you save money. Each year that you would like to participate in the FSAs, you must elect the amount you want to contribute to either or both of the FSAs.

Your contributions will be deducted from your paychecks and deposited into your FSA

account(s). You may contribute up to $2,550 to the Health Care FSA and $5,000 ($2,500 if you are married and file your taxes separately) to the Dependent Care FSA.

Both accounts function separately. When you have eligible expenses, you may pay for them using your CYC-issued HRA debit card or you can pay via another method and request reimbursement by sending a copy of your itemized bill from CNIC, Delta Dental or VSP as documentation. You are unable to use the FSA debit card for dependent care expenses.

HEALTH AND DEPENDENT CARE FSA

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HEALTH CARE FSAEligible expenses for the Health Care FSA include medical, dental, and vision expenses not covered by health care plans, including (but not limited to):

NOTE: The dependent care tax credit may provide a greater tax break than the dependent care FSA for some employees; however, families with an income greater than $25,000 generally benefit by using the dependent care FSA.

DEPENDENT CARE FSAEligible expenses include daycare expenses that allow you and your spouse to work or attend school on a full-time basis. Eligible dependents include children under the age of 13, or dependents who are incapable of caring for themselves.

If you are divorced and are a non-custodial parent, seek financial advice as to whether or not you can take advantage of a Dependent Care FSA.

ELIGIBLE INELIGIBLE• Before and after-school care• Expenses for preschool/nursery school• Au pair and nanny services (amounts paid

for the actual care of the dependent)• Babysitting expenses• Day camp for your qualifying child under

the age of 13• Elder day care for a qualifying individual

• Expenses related to spouse/tax dependent living outside home

• Educational expenses• Tuition for kindergarten and above• Food and incidental expenses/charges

for special events or supplies (unless inseparable from care)

• Overnight camp• Amounts paid to your spouse, child

under the age of 19 or any individual for whom you or your spouse is entitled to a personal tax exemption as a dependent

• You cannot change your contribution amount unless you have a qualifying life change

• Funds cannot be transfered from one FSA to another

• SVVSD provides a 2.5 month “grace period” in which you can incur claims and use remaining funds in your FSA account

• Be sure you can use all the money you set aside in an FSA. The IRS has a strict “use it or lose it” policy

KEEP IN MIND

• Copays and deductibles• Hearing aids and exams• Physical therapy• Chiropractors• Acupuncturists• Alcohol/Drug

rehabilitation• Medication and supplies

prescribed by a doctor

• Ambulance/Special transport

• Vision exams, frames/lenses, Rx sunglasses, contacts, LASIK

• Dental exams, x-rays, fillings, caps, crowns and braces

• Mental health care expenses

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Planning for your future and the unexpected are important considerations when enrolling in benefits.

Let’s explore pensions, retirement plans, disability and life insurance.

SAVING FOR YOURFUTURE

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PERAPLUS OPTIONAL RETIREMENT PLANS

PENSION FUND (PERA)Instead of paying into Social Security, SVVSD employees participate in the Colorado Public Employees’ Retirement Association (PERA) defined benefit pension fund. You have a mandatory contribution of 8% of your monthly gross salary. You are always vested in your contribution plus interest. The District contributes an amount equivalent to 19.15% of your gross salary to help fund the PERA system. You are not directly entitled to these contributions, but they do indirectly benefit you by helping to fund retirement payments for current and future PERA retirees. After working five years under PERA-covered employment, you become vested in the pension plan and are eligible to receive retirement payments once you reach retirement age.

For additional information, contact PERA at 303-832-9550 or online at www.copera.org.

Because your PERA Pension retirement income may not be enough to meet your retirement income needs, you are also encouraged to participate in the optional PERAPlus 401(k) and/or 457(b) plans.

These plans allow you to save additional amounts up to the IRS elective deferral limit on a pre-tax basis (plus catch up contributions if you are age 50 or older) to invest and save for retirement. For more information, visit blogs.svvsd.org/retirementplan or contact PERA at 303-832-9550 or online at www.copera.org.

NOTE: You should consult with your own financial, tax, or legal advisor as to whether you should contribute to the Plan. Should there be any difference between the information in this Notice and the Plan, the terms of the Plan will control. The information in this Notice is not intended or written to be used, and cannot be used, for the purpose of avoiding penalties under the Internal Revenue Code or promoting, marketing or recommending to any transaction or matter addressed herein.

Contact PERA at www.copera.org or 303-832-9550 for details. 16


BASIC LIFE AND AD&D INSURANCEProviding economic security for your family if you die, become disabled, or experience an injury or illness is a major consideration in personal financial planning. SVVSD provides you with employee life and accidental death and dismemberment (AD&D) insurance coverage through The Hartford at no cost to employees who work at least 10 hours per week. You automatically receive life and AD&D coverage in the amount of $40,000 (APT coverage is $150,000). Benefits reduce by 35% at age 70, 55% at age 75, and 70% at age 80.

You can view your current beneficiary designation or make a beneficiary change through Infinite Visions (IV) at iv.svvsd.org.

As part of your life insurance plan with The Hartford, you have access to their Life Conversations suite of additional services, designed to help you and your loved ones make more informed decisions. Services include:

Funeral Planning and Concierge Services - (CODE = HFEVLC)These services include a suite of online tools to guide you through key decisions before a loss, including help comparing funeral-related costs. After a loss, this service includes family advocacy and professional negotiation of funeral prices with local providers, often resulting in significant financial savings. As a covered employee under The Hartford’s Group Life policy, you and family members have access to all the tools and resources available under the Life Conversations program. Learn more about The Hartford’s Funeral and Concierge Services by calling 1-866-854-5429 or by visiting everestfuneral.com/hartford. When prompted, use the code above.

Beneficiary Counseling ServicesThe Hartford’s Beneficiary Counseling Program is a free service available to assist your beneficiary in coping with the emotional, financial, and legal issues that can arise after a loss or in the event of a terminal illness. This service includes unlimited phone contact with a counselor, attorney or financial planner for up to a year and up to five face-to-face sessions.

>>NEXT PAGE >>

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*Employee and spouse coverage reduce by 35% when you turn 70, 55% at age 75, and 70% at age 80.You may also convert or port coverage if you leave employment with SVVSD. Amounts that exceed the guaranteed issue amount require Evidence of Insurability.

The toll-free number, 1-800-411-7239, is available 24/7 to access loss counseling and financial and legal professionals on a confidential basis.

Travel Assistance & ID Theft Protection and Assistance These services include pre-trip information that helps you feel safe and secure when traveling 100+ miles away from home for 90 days or less. The program can assist with pre-trip planning by providing visa and passport requirements, immunization requirements, foreign exchange rates and contact numbers for embassies and consulates in the country you will be traveling in. Once you are on the road, they can assist with medical referrals and evacuations, including travel arrangements for children or other traveling companions and, if the unthinkable occurs, arranging the return of remains. Another important service is ID theft protection, available 24/7, whether you are at home or away. Protection is provided two ways: educational materials to help prevent identity theft, and access to caseworkers who can help you resolve problems that result from identity theft. Services are available to you, your spouse and dependent children through age 25. To access services, call 1-800-243-6108 or call 1-202-828-5885 (collect) if you are outside the U.S.

Estate Guidance Will Services (CODE = WILLHLF)This online service helps you create a simple, legally binding will, quickly and conveniently. Services include online will preparation and online assistance from licensed attorneys.

Whether your assets are few or many, it’s important to have a will. Without a will, decisions regarding who will inherit your property, who will be the guardian of your children and who will manage your estate will be left to others.

Additional estate planning services are available for purchase, including the preparation of living wills and trusts, guidance about divorce proceedings and the creation of durable power of attorney. Visit www.estateguidance.com/wills and use the code above.

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SUPPLEMENTAL LIFE INSURANCEIf you work 17.5 hours or more and need additional life insurance coverage for yourself and, possibly, eligible family members, supplemental life insurance coverage is available at affordable group rates through The Hartford:

During open enrollment, you can:

• Cancel or decrease the amount of your voluntary life insurance• Enroll your children through age 25 with no “Evidence of Insurability”

(EOI) requirements• Increase the amount of your current voluntary life coverage by

$10,000 or your spouse’s voluntary life coverage by $5,000 with no EOI requirements (coverage cannot exceed the guarantee issue threshold)

Employee Purchased in $10,000 increments $100,000* $500,000

Spouse Purchased in $5,000 increments

$50,000*(cannot exceed 50% of the employee’s

approved amount of coverage)$250,000

Child(ren) through age 25

Purchased in $2,000 increments

$10,000(ages 6 months through age 25); $1,000

(ages 2 weeks through 6 months)$10,000

COVERAGE GUARANTEED ISSUE AMOUNT* MAX COVERAGE

1 One premium covers all eligible children

Employee/Spouse

Age Band

Rate per $1,000 of Coverage

Employee/Spouse

Age Band

Rate per $1,000 of Coverage Child(ren) Rate per $1,000

of Coverage 1

<29 $0.033 55-59 $0.374 Up to 26 $0.05

30-34 $0.039 60-64 $0.612

35-39 $0.060 65-69 $1.007

40-44 $0.108 70-74 $1.623

45-49 $0.154 75+ $2.894

50-54 $0.235

Employee and Spouse rates are based on employee age and individual level of coverage and increase the first of the year when the employee enters a new Age Band.

NOTE: To calculate your cost for coverage, take your desired insurance amount divided by 1,000 and multiply your age banded rate which equals the monthly premium. Example: 43 year old wanting $50,000 of life insurance: $50,000/1,000 = 50 x $0.108 = $5.40 rate per month.

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SICK LEAVE BANK

PERA DISABILITYAfter a five year vesting period, PERA provides short and long-term disability for the loss of income in the event you are unable to work due to a disability.

Contact PERA at www.copera.org or 303-832-9550 for details.

The Sick Leave Bank is a community pool of hours that Classified, Licensed and Professional/Technical employees may voluntarily join. The Sick Leave Bank may pay up to 60 days, in a single academic year, in the event of a personal extended illness or injury which renders the member incapable of working.

Eligible employees may join as a newly hired employee or during Benefits Open Enrollment with contribution(s) from their paid leave hours in the amount equal to the number of hours worked per day. You may request time for your recovery period if:

• You are a member of the Sick Leave Bank;• Your request is made no later than 30 calendar days after the member

returns to work;• You provide the Benefits Technician with a doctor’s note identifying the

illness/injury and expected recovery time;• You have exhausted all paid leave; and • If Licensed, you complete 20 days of Diff Dock (the difference between

your daily rate and the substitute’s daily rate, whether or not you actually need a substitute.)

• If Classified or Professional/Technical, you complete 10 days of unpaid leave.

The complete bylaws and procedures surrounding the Licensed Sick Leave Bank are published in the Licensed Master Agreement. The Classified/Professional/Technical Sick Leave Bank are published in the applicable Employee Handbooks.

All Sick Leave Bank requests will be reviewed by a board and any decision made by the board shall be final and not subject to grievance procedures. You are not eligible to apply for Sick Leave Bank while on workers’ compensation.

Contact PERA at www.copera.org or 303-832-9550 for more details. 20


VOLUNTARY SHORT TERM DISABILITYThis voluntary, employee-paid benefit is available to eligible Classified and Professional/Technical employees and replaces 60% of your salary, to a maximum of $1,500 per week, if you miss work due to a non-work-related accident or illness. Benefits begin on the 15th day of your disability and continue during the period of your disability (maximum 24 weeks). Because you pay the full premium cost with after-tax dollars, your disability benefit is not treated as taxable income. The District does not administer the program other than withholding your monthly premium for the coverage from your paycheck. Coverage and process questions should be directed to The Hartford at 1-800-549-6514.

If you do not enroll during your initial eligibility period, and decide to enroll at a later date, you are not covered by STD until the District receives notification that you have completed EOI requirements and are approved for coverage by The Hartford. If required, late entrants are responsible for the cost of a physical exam or other costs incurred as part of the late application process.

< 25 $1.11

25-29 $1.15

30-34 $0.913

35-39 $0.60

40-44 $0.363

45-49 $0.375

50-54 $0.425

55-59 $0.488

60-64 $0.525

65+ $0.588

AGE BAND RATE/$10 OF WEEKLY BENEFIT

EXAMPLE: 32 year old, making $40,000 per year. $40,000 / 52 weeks per year = $769.23 x 60% = $461.54 / $10 = $46.15 x $0.913 = $42.13 month.

1. Take your annual salary

2. Divide by 52 (weeks in a year)

3. Multiply by 60% (weekly benefit)

4. Divide by $10

5. Multiply your age banded rate

6. This is your premium

CALCULATEYOUR COST

21

HEALTH COACH AND WORKSITE WELLNESS

EMPLOYEE ASSISTANCE PROGRAMBecause unresolved personal issues can affect every aspect of one’s life, including work performance, SVVSD provides you with an Employee Assistance Program (EAP) through ComPsych at no cost to you.

Call the EAP at 855-699-6908 or go to www.guidanceresources.com for confidential assistance with nearly any personal matter you may be experiencing. Licensed counselors can provide you and all members of your household with face-to-face counseling (up to six visits per episode) and provide discounted rates or referrals thereafter.

SVVSD is committed to establishing a culture of health and wellness that encourages lifelong healthy behaviors and attitudes, fosters a healthy work environment, and improves the quality of life for our employees and community. The district offers a wide range of wellness initiatives for our students and staff. If you are interested in having better overall health for yourself and want to encourage those around you to do the same, please contact [email protected] to see how to get involved. We continue to roll out new projects in collaboration with LiveWell Longmont, Longmont United Hospital and the City of Longmont and are looking for members to join the wellness team.

The District also provides access to an onsite health coach who is a highly skilled, dedicated worksite resource who can help you achieve your personal

health goals by meeting one-on-one or in a group seeting. The health coach is available to assist with a wide range of wellness and lifestyle coaching, disease management support and chronic care outreach. Additionally, she can help you understand your health and how to improve or maintain it, refer you to the appropriate place for care, and help keep you on track with screenings and medication compliance. There is no cost to the employee to participate in coaching programs.

For health coaching, contact Jerri Mason at 303-702-7912 or [email protected]. 22


OTHER RESOURCES

Medical CNIC

Healthcare Blue Book

Kaiser Permanente

800-426-7453

800-426-7453

800-632-9700

cnichs.com

healthcarebluebook.com/cc/stvrain

password: hcbbstvrain

kp.org

PharmacyRetailMail Order

NPSIntegrated HMO Pharmacy

800-546-5677800-633-7928

pti-nps.compti-nps.com

Dental Delta Dental of Colorado 800-610-0201 deltadentalco.com

Vision VSP 800-877-7195 vsp.com

Flexible Spending Accounts (FSAs)

ConnectYourCare 877-292-4040 connectyourcare.com

Health Reimbursement Account (HRA)

Connect Your Care 877-292-4040 connectyourcare.com

Life and AD&D & Short term Disability

The Hartford 888-563-1124

STD Claims The Hartford 800-549-6514

Employee Assistance Program (EAP)

ComPsych 855-699-6908 guidanceresources.com

Retirement Public Employees Retirement Association (PERA)

303-832-9550 copera.org

On-Site Health Coach

Jerri Mason, RN, CHC 303-702-7912 [email protected]

HIPAA Secure Benefits Email

[email protected]

Medicaid and CHP+ Healthy Kids Initiative

Information and Employee Support

720-722-1454

SVVSD Benefits Department

Vicki Mair Benefits Specialist

303-682-7341 [email protected]

Lori Rose Benefits Technician


Delene Gunderson Benefits Technician


CONTACT PHONE WEB / EMAIL

LEARN MORE AT STVRA.IN/BENEFITS

23

MONTHLY PREMIUMSFULL TIME (100%) PART TIME (75%) PART TIME (50%)

EmployeeShare

District Share

EmployeeShare

District Share

EmployeeShare

District Share

CNIC HRA

Employee Only (EE) $15.00 $657.85 $166.18 $506.67 $317.36 $355.49

EE + Spouse $640.89 $710.98 $792.07 $559.79 $943.25 $408.61

EE + Child(ren) $508.57 $710.89 $659.75 $559.79 $810.93 $408.61

EE + Family $1,120.79 $710.89 $1,271.97 $559.79 $1,423.15 $408.61

Kaiser Permanente

Employee Only (EE) $5.00 $496.10 $129.03 $372.08 $253.05 $248.05

EE + Spouse $606.37 $496.10 $730.40 $372.08 $854.42 $248.05

EE + Child(ren) $405.88 $496.10 $529.91 $372.08 $653.93 $248.05

EE + Family $856.92 $496.10 $980.95 $372.08 $1,104.97 $248.05

Delta Dental of Colorado

Employee Only (EE) $0.00 $28.97 $7.24 $21.73 $14.49 $14.49

EE + Spouse $33.02 $28.97 $40.26 $21.73 $47.50 $14.49

EE + Child(ren) $50.67 $28.97 $57.92 $21.73 $65.16 $14.49

EE + Family $85.70 $28.97 $92.94 $21.73 $100.19 $14.49

VSP

Employee Only (EE) $7.63 $0.00 $7.63 $0.00 $7.63 $0.00

EE + Spouse $15.30 $0.00 $15.30 $0.00 $15.30 $0.00

EE + Child(ren) $16.09 $0.00 $16.09 $0.00 $16.09 $0.00

EE + Family $26.17 $0.00 $26.17 $0.00 $26.17 $0.00

Certified FTE 30+ hrs/wk = .857-1.0 FTE 23-29.99 hrs/wk = .657-.8568 FTE 17.5-22.99 hrs/wk = .50-.6569 FTE

Classified/APT 30+ hrs/wk = .75-1.0 FTE 23-29.99 hrs/wk = .575-.7499 FTE 17.5-22.99 hrs/wk = .4375-.5749 FTE

VISIT STVRA.IN/IVENROLL TO ENROLL IN YOUR BENEFITS PACKAGE, TODAY.

STVRA.IN/LINKEDIN @SVVSDSVVSD.ORG24

Date post:	23-Jul-2016
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2015-2016 Benefits Enrollment Guide

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