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Guide To Your Benefits 2018 - 2019 EMPLOYEE BENEFITS GUIDE For your Benefit
Guide To Your Benefits2 0 1 8 - 2 0 1 9
EMPLOYEE BENEFITS GUIDE
For your Benefit
Sunnyside Employees,
The Sunnyside Unified School District believes in the importance of good health benefits
which is why offering innovative high-quality benefit programs remains among our
highest priorities as a district. As health care keeps changing, we continually evaluate
our benefit plans to be sure we are offering the right mix of quality, access and
affordability.
It is important for you to think carefully and actively about your insurance choices;
please review the information in this handbook and speak with our friendly Human
Resources Benefits Department regarding any questions or concerns that you may
have.
Our district utilizes the UnitedHealthcare network and MagellanRx as the pharmacy
benefit manager. These items will be administered through a third party administrator
(TPA) called UMR. All of these pieces will be located on your ID card. The partners
that have been selected have large nationwide networks, high experience and great
customer service.
As a valued employee, we want you to know that your health and well-being is
important to us and we encourage you to get your annual physicals and establish a
primary care physician, which are covered in-network at no cost to you.
We want to thank you for your contributions to SUSD. Your efforts play a pivotal role
in making the Sunnyside Unified School District a superior educational institution and
we sincerely hope that this information and the benefits that you have from Sunnyside
help you and your family to maintain a healthy future.
HR Department
Welcometo your benefits
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Eligible Employees & DependentsAll active employees and their dependents become eligible for benefits the first of the month following 30 days of employment. You must be a full-time employee and work at least 30+ hours per week, part-time and work 18.75 hours per week or 30 days BERP to be eligible for benefits. In order to become insured under the benefit plans offered by the District, you must complete the appropriate online enrollment process.
If you are a new-hire employee, you must enroll for benefits within 30 days of your date of hire. Failure to enroll by that date means forfeiture of benefit eligibility until the next annual open enrollment period, unless you experience a Qualifying Event.
Eligible Dependents Include: your spouse, domestic partner and children up to age 26.
Annual Open Enrollment for Benefit Eligible EmployeesWhen you first become eligible for benefits, you will have the opportunity to review all your benefit options and select those that best meet your needs. These benefit elections will remain in place until the end of the current plan year (which ends on August 31st) unless you experience a Qualifying Event. During the annual open enrollment period, you must elect or waive your benefits, and if participating, elect your Flexible Spending Account (Health Care or Dependent Care) deductions for the upcoming plan year. If you choose to waive benefits during your annual open enrollment period, you will not be able to elect benefits until the next annual open enrollment period, unless you experience a Qualifying Event.
Examples of a Qualifying Event:• within 30 days of marriage or divorce• within 30 days of a baby’s date of birth,• within 30 days if you experience a loss of other benefits
You must notify your HR department and complete the necessary paperwork within 30 days of your Qualifying Event. Failure to do so within this time frame means you will not be able to change your benefit elections until the next annual open enrollment period.
Section 125 Pre-Tax ProgramSection 125 of the Internal Revenue Code allows you to pay for certain insurance benefits before taxes, which saves you money. The amount you pay for premiums is deducted from your gross pay prior to taxes thus you save by not having to pay federal and most state and local taxes, as well as Social Security and Medicare taxes, on the amount you contribute. The taxes you save will increase your take home pay. This pre-tax benefit is available on employer sponsored benefits for which you pay a share of the premium cost. At the District, you can pre-tax your medical, dental, vision, flexible spending accounts and health savings accounts.
BENEFIT ELIGIBILITY & ENROLLMENT
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SUSD cares about your wellbeing--physically, emotionally and financially. We want to reward you for participating in activities that encourage your overall health. Beginning in June 2018 through March 2019, you will have an opportunity to earn 50 points by participating in your choice of activities listed below to earn a premium differential of $25 per pay period for the 2019/2020 plan year. That will be $25 off your health insurance premium during the 2019/2020 plan year every pay period – that’s a savings of $525 per year…just for participating in this program from June 2018 through March 2019.* Please look for the Sunnyside of Health logo and more details on how you can earn your points and participate! Here are ways to start accumulating points to earn the required 50 points for the 2019/2020 premium reduction.
SUNNYSIDE OF HEALTH WELLBEING PROGRAM!
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Remember to schedule your preventive
exam early in the plan year!
* The maximum points that will be tracked is 50 points for the $25 pay period reduction, however, you may participate in additional activities for continued health and wellbeing!
** You may participate in these activities a maximum of two (2) times to earn points toward you 50 point goal.
We advise you to plan your events as early as possible. Some activities may require extended participation or last several weeks. You must complete all activities by March 31, 2019 (preventive dental February 28th) to be eligible for the premium reduction beginning August 1, 2019.
Completing these two (2) activities will satisfy your 50 points to earn your premium reduction!
1. Complete a Biometric Screening through your physician, you will need to have your physician complete a Physician Lab Form (30 points)
• Download your personalized Physician Lab Form through the UMR.com website and take it with you to your annual preventive exam
2. Complete an Online Health Risk Assessment (HRA) through UMR.com (20 points) The results of your biometric screening will be used to complete a portion of your HRA
3. Participate in an online wellness challenge through UMR.com (20 points)**
4. Complete an Action Plan through UMR.com (20 points)**
5. Attend an Employee Assistance Program webinar through Deer Oaks at deeroakseap.com; log into UMR.com to report completion (15 points) **
6. Attend an on-site educational financial wellbeing seminar (15 points)**
7. Complete a preventive dental exam with MetLife PPO (10 points); Exam must be completed prior to February 28th , 2019. NOTE: Preventive coded screenings only; periodontics maintenance will not apply
8. Register and complete the health application for Teladoc at www.teladoc.com (5 points)
This tool allows you to compare your overall medical expenses and premium costs by plan, and will assist you in making the best health plan choice for you and your family. Go to www.umr.com for your plan comparison.
DECISION SUPPORT TOOL
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You can begin using the Decision Support Tool right away by logging onto the member page at umr.com and clicking on Plan Cost Estimator on the home page.
If you have not received your login information yet, you can access the tool on umr.com by selecting Member on the left navigation panel and selecting the Plan Cost Estimator tile.
Step 1 Enter the family members who will be covered
Step 2 Specify health care use for each family member
Step 3 Edit your financial information
Step 4 Enter your employee plan and health care usage costs by selecting “Add Your Own Plan Estimate”
Step 5 Enter your health care account contributions
Step 6 Review your plan cost summaries and per paycheck deductions
Step 7 View and compare plan cost estimates
Understanding How it WorksThe District believes it is in your best interest to fully evaluate the advantages of consumer driven health care available in the qualified High Deductible Health Plan with the option of a Health Savings Account (HSA). It is important for you to fully understand this plan before electing it.
This medical plan choice:
1. Will allow you to pay less in monthly premiums (your payroll deductions from your paycheck for medical insurance will be significantly less than the PPO 500 or PPO 1500 plans)
2. Allows you the ability to save for future health care needs; and 3. Allows you greater ability, and also greater responsibility in managing your health care dollars.
REMEMBER!By law, preventive care services such as routine well care visits, immunizations, labs, preventive screenings such as mammograms and colonoscopies (based on age and gender) and flu shots are covered at 100% under the HDHP so there is no need to use HSA funds for these services.
THERE ARE TWO COMPONENTS TO THE HDHP/HSA OPTION:
HIGH DEDUCTIBLE
HEALTH PLAN(HDHP)
• Lowest employee premiums• Premium savings can be put towards HSA• In-Network & Out-of-Network coverage• Annual deductible • Protection from major costs• 100% preventive care coverage• No upfront copays at doctor’s office
HEALTH SAVINGS BANK
ACCOUNT(HSA)
• Savings account with HSA Bank• Owned by you• Used for eligible medical & pharmacy
expenses, including deductibles• Triple tax advantage on contributions,
distributions and earnings• No “use it or lose it”• Like a 401(k) plan for medical expenses• Debit card linked to HSA - No reimbursement forms
HIGH DEDUCTIBLE HEALTH PLAN (HDHP) & HEALTH SAVINGS ACCOUNT (HSA)
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2018 IRS HSA Contribution Limits are $3,450 for an individual or $6,850 for families. These are the combined maximum limits for employee plus employer contributions. A $1,000 catch up contribution is allowed if you are 55 or over.
You can enroll in an HSA if:• You are covered under a qualified HDHP.• You are not covered by any other health plan that is not a qualified HDHP.• You are not enrolled in Medicare, AHCCCS or TRICARE.
♦ Contributions to an HSA must stop if you enroll in Medicare. However, you can keep the money in your HSA and use it to pay for medical expenses tax-free.
• You have not received VA benefits within the past 3 months.• You are not claimed as a dependent on someone else’s tax return.
How do I access my HSA funds?• The District’s and your HSA tax-free
contributions are deposited to HSA Bank.• When you enroll in an HDHP, you will need
to set up an HSA.• You will then be issued a HSA Bank debit
card which you can use to pay uncovered medical, dental and vision expenses from your HSA.
• You can also pay for an uncovered expense with personal funds and reimburse yourself from your HSA.
Qualified HSA Expenses• Medical, dental and vision plan deductibles, copays and coinsurance not covered under any plan (see IRS
Publication 502 at www.irs.gov for a complete list).• For you and your spouse, if legally married, and dependents, even if they are not enrolled in the District’s plan.• Per IRS rules, you cannot take a tax-free distribution from an HSA to pay for domestic partner expenses.
Non-Qualified HSA Expenses• Any funds used for purposes other than IRS qualifying medical, dental and vision expenses are taxable as
income and subject to a 20% tax penalty. • The penalty does not apply if you are age 65 or older, those who become disabled or enroll in Medicare.
www.hsabank.comHSA Bank Consultants available 24/7/365 1-800-357-6246• On-line access to all
account information.• Competitive interest rates
and investment options. • FDIC insured.• Access all claims payment history.
• If you fail to designate a beneficiary or name someone other than a spouse, the account ceases to be an HSA upon your death and becomes taxable in the year of your death.
• HSA Service Fee is $2.75 per month. If you maintain an average daily balance of $1,000 or more, the fee is waived.
• ATM/Debit Fee is $2.00 per use. Run your HSA card as “credit” to avoid this service fee.• You must contact HSA Bank directly at 800.357.6246 with any changes to your account including address
and/or beneficiary changes.• Per IRS rules, you cannot enroll in an HSA if you are enrolled in a regular Health Care FSA. You can enroll
in an HSA if you are enrolled in a “Limited Purpose” FSA for uncovered dental and vision expenses only. The District offers employees both regular and “Limited Purpose” FSAs.
• If you have unused rollover funds from your FSA and enroll in an HDHP with HSA in the new plan year, the District will automatically convert your rollover FSA funds to “Limited Purpose” FSA funds.
HIGH DEDUCTIBLE HEALTH PLAN (HDHP) & HEALTH SAVINGS ACCOUNT (HSA)
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The District understands your desire to make the most of your money and understands that everyone could use some help managing personal expenses. That’s why the District is offering you the opportunity to enroll in a Health Care and/or Dependent Day Care Flexible Spending Account (FSA).
FSAs can provide significant advantages, such as:• Immediate tax savings contributions to your FSAs are
made on a pre-tax basis, which lowers your taxable income. This may decrease the amount you pay in federal, state, local and FICA taxes.
• Increased spendable income because FSA contributions lower your taxable income and may reduce the amount you pay in taxes, your net income may increase every month.
If you wish to participate in one or both types of FSAs, you must decide how much to set aside annually. This annual election is divided into equal amounts each pay period, and the contribution is placed into your accounts. The dollars remain in your account until you request reimbursement for eligible expenses.
The amount you set aside may only be used for non-reimbursed healthcare and dependent care expenses. The Plan Year for the FSA is September 1, 2018 through August 31, 2019. You are able to carry over a maximum of $500 to the next plan year if necessary. Any amount exceeding the rollover at the end of the year will be forfeited.
Healthcare Annual Maximum Contribution = $2,650Dependent Care Annual Maximum Contribution = $5,000 (Single or Married and filing jointly), $2,500 (Married and filing separately)
Examples of eligible healthcare expenses:• Dental and orthodontic care• Deductibles and copayments• Hearing care• Routine physical exams
Eligible Daycare Expenses• Dependent day care expenses for your children• Qualified elder care
• Chiropractic Services• Vision care (exams, glasses, contacts)• LASIK Surgery, contact solution, eye drops• Certain over the counter medications (With a Prescription)
FLEXIBLE SPENDING ACCOUNTS (FSA)
THINGS TO CONSIDER• You are able to carry over a maximum of $500 to the next plan year if necessary• There is also a calculator that can help you determine your savings.
Visit https://www.mywealthcareonline.com/fba/ to calculate your savings
The money you would typically pay in taxes becomes part of your take home pay!
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HOW TO FIND A PROVIDER
UMR Online: www.umr.com - a site designed with you in mind
• Easy access - key information in two clicks or less
• Icons and charts make finding and understanding information easier
• Consistent navigation between mobile and desktop sites
Finding your Doctor OnlineUnitedHealthcare Choice Plus
• Go to: www.umr.com• Select Provider Network -
UnitedHealthcare Choice Plus
We’ve gone mobileAccess to your health benefits anywhere, anytime
TELADOC
Did you know you have access 24/7 to a doctor through the convenience of a phone, video or mobile app? This is a $45 charge if you are enrolled on the HDHP 3000 and a $20 copay if you are on one of the PPO plans. Enroll at teladoc.com or download the app today!
Talk to a doctor anytime, anywhere you
happen to be
Receive quality care via phone, video or
mobile app
Prompt treatment, median call back,
in 10 minutes
Prescriptions sent to pharmacy of choice if medically necessary
A network of doctors that can treat every
member of the family
Teladoc is less expensive than the ER
or urgent care
GET THE CARE YOU NEEDTeladoc doctors can treat many medical conditions, including:
• Cold & flu symptoms• Allergies• Pink eye• Respiratory infection• Sinus problems• Skin problems• And more
With your consent, Teladoc is happy to provide information about your Teladoc visit to your primary care physician.
Talk to a doctor anytime! Teladoc.com 1-800-Teladoc
UMR - UnitedHealthcareThe following is only a brief summary of the in-network plan benefits. A complete summary is available on the
Benefits Department websites.
Magellan Rx - Prescription Drug Plan Benefits
MEDICAL BENEFITS
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Benefits PPO 500 PPO 1500 HDHP 3000 Life3me Maximum Life%me Maximum Unlimited Unlimited Unlimited Plan Year Deduc%ble
Individual $500 $1,500 $3,000
Family $1,000 $3,000 $6,000
Out-‐of-‐Pocket Maximum
Individual $3,500 $4,500 $3,000
Family $7,000 $9,000 $6,000
Primary Care $30 copay $30 copay No charge aKer deduc%ble
Specialist $50 copay $50 copay No charge aKer deduc%ble
Preven%ve Benefits No charge No charge No charge
Outpa3ent Services Laboratory Services and X-‐rays (in physician’s office or independent free-‐standing facility)
No charge No charge No charge aKer deduc%ble
Outpa%ent Hospital Facility Services $75 copay + 20%* $75 copay + 20%* No charge aKer deduc%ble
Radiology (specialized scanning) $250 copay 20% aKer deduc%ble No charge aKer deduc%ble
Inpa3ent Services
Hospitaliza%on $300 copay per admission + 20%*
$300 copay per admission + 20%* No charge aKer deduc%ble
Emergency Services
Emergency Room $250 copay; waived if admiaed
$250 copay; waived if admiaed No charge aKer deduc%ble
Urgent Care $50 copay $50 copay No charge aKer deduc%ble
Teladoc $20 copay $20 copay $45 charge
*This applies aIer you reach your deduc3ble.
PPO Retail (30 day) PPO Mail Order (90 day) HDHP
Generic – Tier 1 $10 $20 No charge a3er deduc6ble
Preferred Brand – Tier 2 $25 $50 No charge a3er deduc6ble
Non-‐Preferred Brand – Tier 3 $50 $100 No charge a3er deduc6ble
Specialty (Pre-‐Authoriza6on required) $100 None Available No charge a3er deduc6ble
MetLifeYou may view the full benefits summary online for more detailed information or by contacting MetLife or TDA.
Predetermination recommended for services over $250.
Total Dental Administrators (TDA) Prepaid
* Dental services must be provided by a selected Plan Dentist. Members are responsible for paying the amount listed plus any applicable lab fees at the time the service is received, or in accordance with the selected Plan Dentist’s billing procedures.
EyeMed Vision
DENTAL & VISION BENEFITS
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In-‐Nework Out-‐of-‐Network Benefits Plan Year Maximum $1,500 $1,000 Plan Year Deduc6ble (Individual/Family) No deduc6ble $50 / $150 Services Exams, evalua6ons or consulta6ons (two in a benefit year) 100% 80% Cleaning (two in a benefit year period) 100% 80% X-‐rays (full mouth -‐ once in a 3-‐year period, bitewings -‐ two in a benefit year) 100% 80% Fillings (one per surface every two years) 80% 60% Root Canal 80% 60% Extrac6ons and surgical procedures 80% 60% Crowns, Bridges, Par6al Dentures 50% 40% Orthodon8cs Life6me Ortho Benefit Maximum $1,000 $1,000 Benefits for adults and children 8 years of age or older. Payable in two payments—upon ini6al banding and 12 months aYer. 50% 50%
Benefits Copay examples are provided below for rou8ne care, depending on procedure codes used, copays may vary. A full list can be found in the TDA Schedule of benefits. Plan Year Maximum No maximums Plan Year Deduc4ble No deduc4ble Services Exams – Once in a 6-‐month period $0 copay * Cleaning (two in a benefit year period) $0 copay * X-‐rays (full mouth -‐ once in a 3-‐year period, bitewings -‐ two in a benefit year) $0 copay * Simple Extrac4ons (non surgical) $40 copay * Orthodon8cs No deduc4ble or wai4ng period for adults and children 8 years of age or older See Schedule of Benefits
Descrip(on of Coverage In-‐Network Examina'on $10 Lenses/Examina'on/Frames Frequency 12 months Lenses $20 Frames $0 up to $130 allowance; 20% discount over $130 Contact Lenses -‐ FiDng Up to $40 Contact Lenses -‐ Standard $105 allowance; 15% discount over $105
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Magellan Rx
MagellanRx is the Pharmacy Benefit Manager for the retail and mail order programs. Under the MagellanRx plan, you have access to the MagellanRx pharmacy network with thousands of pharmacies nationwide. Present your medical/RX ID card to your pharmacist to ensure they enter the MagellanRx information on your card to verify benefits and coverage.
Your prescription drug benefits are based on the MagellanRx formulary. The formulary is a list of prescription drugs approved by the plan and is subject to change throughout the year. If your prescription is not on the MagellanRx formulary, you will pay a higher amount. Consult with your health care provider regarding changing to a medication on the MagellanRx formulary. Use the following website address to find a specific
medication, which tier it falls under on the precision formulary option and if any prior authorizations are needed: https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtNTg
Tier ZeroAllows employees to obtain certain over the counter drugs, like ulcer and allergy medications, at a much lower cost. Brand name drugs like Nexium, Prevacid, Zyrtec and Claritin are now available over the counter (OTC). Ask your physician to reference “OTC” on your prescription to save money or pay a $0 copay depending on your medical plan.
Glucose Monitor ProgramTo help you keep your diabetes in control, we are pleased to offer you the choice of several blood glucose meters. This program is offered to you at no charge. The meters and test strips available through this offer are:
Each meter from Lifescan comes with everything you need to begin testing. To order a new meter, contact the manufacturer using the information provided below. Be sure to identify yourself as a Magellan Rx Management member when you call and request a new meter. To receive one Lifescan OneTouch at no charge, follow these instructions:
*Required for online orders
If you have any questions about your prescription drug benefits please call customer service at the telephone number on your health plan ID card.
OneTouch Ultra 2, OneTouch UltraMini and OneTouch Veri0 IQ. Meters made by Lifescan, Inc.
® ®
Call toll free 866.355.9962; Insurance: Magellan RX Management*; Order/Brochure code: 594PRX100
or visit www.OneTouch.orderpoints.com; Insurance : Magellan Rx Management*; Brochure code: 594PRX100
PRESCRIPTION DRUG BENEFITS
®
Online Tools at magellanrx.com
Secure online connection, protecting your confidentiality and providing useful tools and information.
• Easy-to-use tools that allow you to view, refill, renew and transfer prescriptions
• Drug formulary & lookup tools
• Trusted drug information & education
• Real-time benefit information
• Access to view and download pharmacy claims
• A participating pharmacy locator tool
• Downloadable claim, prior authorization request and mail order forms
Questions? Contact Magellan Rx Customer Service 24/7 at 1.800.424.0472 with any questions about your prescription benefit.
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SUPPLEMENTAL BENEFITS
EMPLOYEE ASSISTANCE PROGRAM
Colonial
The District offers the following voluntary supplemental benefit plans. These plans can be purchased for an additional cost though Colonial. You can learn more about these supplemental insurance benefits including costs, by contacting the Colonial Member Services number at 602-284-2554.
• Educator Disability Insurance - offers accident and sickness benefits designed to help provide you and your family with the protection you need. Guaranteed issue available at your initial eligibility enrollment only!
• Life Insurance - helps provide financial security for family members. Colonial Life’s term, universal and whole life plans allow you to tailor your protection to help meet your individual needs, when you need it.
• Critical Illness Insurance - helps offset the out-of-pocket medical and indirect, nonmedical expenses related to critical illness treatment.
• Cancer Insurance - helps offset the out-of-pocket medical and indirect non-medical expenses related to cancer treatment that most medical plans may not cover.
• Accident Insurance - helps offset the unexpected medical expenses, such as emergency room fees, deductibles and co-payments that can result from a covered accident.
Deer Oaks
Employee Assistance Program (EAP) is a free, comprehensive and confidential resource that can help you sort through life’s difficult matters. The EAP benefit covers 8 confidential short-term counseling visits and is at no cost to employees and their families. The EAP benefit is free and confidential. Deer Oaks clinicians are well versed in helping clients of all ages. The EAP can assist with many different types of problems. Among these are stress, depression, anxiety, workplace difficulties, substance abuse, marital problems, family or parenting conflicts, grief, violence and unhealthy lifestyles.
In addition to the confidential counseling referenced above, Deer Oaks provides work/life services, such as a free 30-minute telephonic consultation with an attorney, financial counseling and education, ID recovering, Credit Karma, online will preparation, health and wellbeing programs and support as well as college assist. Visit their website or call 888-993-7650.
Mutual of Omaha
Employer Paid Life InsuranceThe District provides a 100% company paid life insurance and accidental death & dismemberment (AD&D) insurance. This coverage is provided by Mutual of Omaha, it is intended to provide you with peace of mind and your family and/or beneficiaries with financial security, in the event of your death.
Employees are covered with a District-paid life insurance policy of $25,000, with a reduction in benefits starting at age 65.
If your death is due to accidental causes (as defined by the plan), your beneficiary will receive an additional benefit equal to the death benefit. The AD&D also provides a portion of the benefit in the event of certain accidental injuries resulting in dismemberment, but not death.
It is important you review your current beneficiary arrangement to be sure it reads as you want it to. If your beneficiary changes due to a life event (e.g. marriage or divorce), please be sure to update this information online at https://visions.susd12.org/ess.
Supplemental Life InsuranceWhen you are first eligible for benefits, you have a one time opportunity to elect supplemental life insurance up to the guarantee issue amount without medical underwriting. This means you can purchase up to10x annual salary up to $150,000 without being medically approved. If you would like to purchase more than the guarantee issue amount you can elect up to the maximum benefit of 10x your annual salary up to $400,000, but you will need to complete an evidence of insurability (EOI) form and be approved.
If you declined this benefit when you were hired, you can still purchase life and accidental death & dismemberment coverage, however you will be required to complete an evidence of insurability (EOI). Maximum benefit amount is 10x annual salary up to $400,000.
In order to purchase for your spouse or your dependents, you will need to purchase coverage for yourself. Your spouse is eligible for coverage up to $50,000 with no medical questions. Maximum amount is $100,000. Child coverage is guaranteed up to $10,000.
Family Voluntary Accidental Death and Dismemberment (AD&D)This accidental death and dismemberment coverage can be purchased separately. This benefit pays if an employee (or dependent, if covered) is injured as a result of an accident, and that injury is independent of sickness and all other causes. Exclusions and limitations apply to this coverage.
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PAID LIFE INSURANCE
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Your Bi-Weekly costs for 21 pay periods are shown below. If you waive medical coverage for yourself and elect dental and/or vision coverage, the District will pay the employee only portion of these coverages. Please note: If you have waived medical coverage and are only electing dental or vision, your employee only cost will be $0. If you enroll your spouse and / or children, deduct the employee only cost from the amount shown below based on the coverage you elect.
*Full Time = 30+ hours per week*Part Time = 18.75 – 29 hours per week**Certain groups are not eligible: Part-time employees working less than 18.75 hours per week.
The District Contributions to your HSA• For full-time employees, the District will deposit $500 ($23.81 bi-weekly) to your HSA. • For part-time employees, the District will deposit $250 (11.90 bi-weekly) to your HSA.
♦ You must be enrolled in the HDHP 3000 plan to receive this contribution. ♦ These deposits are made on a bi-weekly basis. ♦ The District’s contributions are pro-rated for new hires based on date of hire.
Can I Also Contribute to My HSA?• You can make pre-tax contributions to your HSA up to the IRS annual limits each year. • In 2018, the maximum HSA contribution (including the District’s contribution) is $3,450/year for individuals and
$6,850/year for families.• Employees age 55+ and not entitled to Medicare benefits can make an additional $1,000/year “Catch-Up”
contribution.
BI-WEEKLY PREMIUMS & HSA CONTRIBUTIONS
BI-‐WEEKLY MEDICAL RATES Full Time Employees PPO 500 PPO 1500 HDHP
Employee Only $99.63 $79.54 $35.90 Employee + Spouse $431.45 $378.90 $257.39 Employee + Child(ren) $362.69 $316.85 $211.49 Employee + Family $596.59 $527.89 $367.62
Part Time Employees PPO 500 PPO 1500 HDHP Employee Only $204.38 $179.22 $121.13 Employee + Spouse $536.19 $478.58 $342.61 Employee + Child(ren) $467.43 $416.53 $296.71 Employee + Family $701.33 $627.57 $452.84
BI-‐WEEKLY DENTAL RATES TDA Prepaid MetLife PPO
Employee Only $6.31 $17.71 Employee + Spouse $10.69 $29.51 Employee + Child(ren) $14.82 $27.35 Employee + Family $17.49 $39.14
BI-‐WEEKLY VISION RATES
Employee Only $3.65 Employee + Spouse $6.47 Employee + Child(ren) $6.14 Employee + Family $10.23
About this Booklet. This booklet highlights important features of the District’ benefits for its employees. While efforts have been made to ensure the accuracy of the information presented, in the event of any discrepancies your actual coverage and benefits will be determined by the legal plan documents and the contracts that govern these plans. Benefit plans may be changed for any reason, to the extent allowed by law. Your participation in these benefits is not a contract of employment and does not guarantee future employment.
CBIZ Benefits & Insurance Services1765 East Skyline Drive
Tucson, AZ 85718 Updated April 16, 201815
UMRMember Services800.207.3172www.umr.com
Magellan RXCustomer Service800.424.0472www.magellanRx.com
MetLifeMember Services800.942.0854www.metlife.com/dental
TDAMember Services888.422.1995www.TDAdental.com
EyeMed VisionMember Services866.939.3633www.eyemedvisioncare.com
HSA BankMember Services800.357.6246www.HSABank.com
Mutual of OmahaMember Services/Claims800.775.8805www.mutualofomaha.com
Colonial Voluntary InsuranceCharlie [email protected]
Deer Oaks EAPIConnectYou Passcode: 110060888.993.7650www.deeroakseap.comUsername/Passcode: susd
Flexible Benefit AdministratorsFSA AdministrationMember Services800.437.3539www.Flex-admin.com
CBIZ Claims AdvocateAngela [email protected]
Please visit our websites below for information on your Benefit options, elections, costs and other useful information:
http://www.susd12.org/Human-Resources/benefits
Email - [email protected] • Phone - 520-545-2136, 2067 • Fax - 520-545-2128
ENROLLING IN YOUR BENEFITSLogin: http://visions.susd12.org/ess
In addition to enrolling online, you can also review your benefit information at any time throughout the year, make changes if you experience a change in status or a qualifying life event, access forms, documents and other communication items, print an online confirmation of your benefit coverage or change your beneficiary.
BENEFIT CONTACTS
