2015 Benefit Summary
It Pays to Think Ahead.
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Benefits Overview Aurora Public Schools is proud to offer a comprehensive benefits package to eligible employees. The complete benefit package is briefly summarized in this booklet. You will receive plan booklets, which give you more detailed information about each of these programs.
You share the costs of some benefits (medical and dental), and Aurora Public Schools provides other benefits at no cost to you (life, accidental death & dismemberment, EAP, and if you are not yet eligible for PERA, Long-Term Disability).
This document is an outline of the coverage proposed by the carrier(s), based on information provided by your company. It does not include all of the terms, coverage, exclusions, limitations, and conditions of the actual contract language. The policies and contracts themselves must be read for those details. Policy forms for your reference will be made available upon request.
The intent of this document is to provide you with general information regarding the status of, and/or potential concerns related to, your current employee benefits environment. It does not necessarily fully address all of your specific issues. It should not be construed as, nor is it intended to provide, legal advice. Questions regarding specific issues should be addressed by your general counsel or an attorney who specializes in this practice area.
Benefit Plans Offered � Medical � Dental � Life Insurance � Accidental Death & Dismemberment (AD&D) Insurance
� Flexible Spending Account (FSA) � Employee Assistance Program (EAP) � Long-Term Disability (for those not eligible for PERA)
Eligibility You and your dependents are eligible for Aurora Public Schools medical and dental benefits on the first of the month following date of employment if you are hired between the 1st and the 15th of the month or the first of the month following 30 days of employment if you are hired between the 16th and the end of the month. You are covered on your date of hire for Life, AD&D and if applicable, LTD.
Eligible dependents are your spouse or domestic partner, children under age 26, and disabled dependents of any age. Elections made now will remain until the next open enrollment unless you or your family members experience a qualifying event. If you experience a qualifying event, you must contact the Benefits office within 30 days.
IMPORTANT
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Medical Benefits Administered by United Healthcare and Kaiser PermanenteComprehensive and preventive healthcare coverage is important in protecting you and your family from the financial risks of unexpected illness and injury. A little prevention usually goes a long way — especially in healthcare. Regular preventive care provides a no cost review of your health. Small problems can potentially develop into large expenses. By identifying the problems early, often they can be treated at little cost.
Comprehensive healthcare also provides peace of mind. In case of an illness or injury, you and your family are covered with an excellent medical plan through Aurora Public Schools.
Aurora Public Schools offers you a choice of United Healthcare’s Navigate plan or Kaiser’s deductible HMO (DHMO) medical plan.
With both plans you must receive your medical services from in-network providers.
With the Navigate plan, you must select a primary care physician (PCP). Women may see a network OB/GYN for their annual exam without a referral from their PCP.
All care must be provided or coordinated by your PCP, with the exception noted above, if you are in the Navigate plan.
The Kaiser plan strongly recommends that you select a PCP, but it is not required.
MEDICAL BENEFITS
UHC Navigate Plan Kaiser DHMO Plan
Lifetime Benefit Maximum Unlimited
Annual Deductible(single/family)
$1,000/$3,000 $1,000/$3,000
Annual Out-of-Pocket Maximum (including deductible)
$3,000/$6,000 $4,000/$9,000
Coinsurance 10% 10%
DOCTOR’S OFFICE
Office Visit(PCP/Specialist)
$20/$40 copay $25/$50 copay
Wellness Care(routine exams, x-rays/tests, immunizations, well baby care and mammograms)
No charge No charge
PRESCRIPTION DRUGS
Retail—Generic Drug (30-day supply)
$15 copay $15 copay
Retail—Formulary Drug (30-day supply)
$30 copay $30 copay
Retail—Non-Formulary Drug (30-day supply)
$50 copay $50 copay
Mail Order—Generic Drug (90-day supply)
$37.50 copay $30 copay
Mail Order—Formulary Drug (90-day supply)
$75 copay $60 copay
Mail Order—Non-Formulary Drug(90-day supply)
$125 copay $100 copay
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MEDICAL BENEFITS
UHC Navigate Plan Kaiser DHMO Plan
HOSPITAL SERVICES
Emergency Room $300 copay $250 copay
Hospital Deductible No separate deductible No separate deductible
Inpatient Deductible / 10% Deductible / 10%
Outpatient Surgery Deductible / 10% Deductible / 10%
Ambulance Service Deductible / 10% 10% up to $500 per trip
MENTAL HEALTH SERVICES
Inpatient Services Deductible / 10% Deductible / 10%
Outpatient Services $20 copay $25 copay
SUBSTANCE ABUSE SERVICES
Inpatient Services Deductible / 10% Deductible / 10%
Outpatient Services $20 copay $25 copay
OTHER SERVICES
Maternity Services(Prenatal care)
Office copay applies to initial visit only Deductible / 10%
All other maternity hospital/ physician services
Deductible / 10% Deductible / 10%
Chiropractic Services$40 copay
20 visits per policy yearNot covered
Physical, Occupational and Speech Therapy Services
$20 copay20 visits per therapy type per policy year
$25 copay20 visits per therapy type per policy year
TMJ and Related Services Not covered Not covered
Private Duty Nursing Not covered Deductible / 10% if medically necessary
Other Services (Artificial limbs and other prosthetic devices; blood and blood components; leg, arm and neck braces; surgical dressings; casts and splints)
Deductible / 10% Deductible / 10%
Vision Services (Exam only)
$20 copay1 exam every year
$25 copay
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Dental BenefitsAdministered by Delta DentalGood oral care enhances overall physical health, appearance and mental well-being. Problems with the teeth and gums are common and easily treated health problems. Keep your teeth healthy and your smile bright with the Aurora Public Schools dental benefit plan.
In-Network Out-of-Network PPO
Annual Deductible(single/family)
$50/$150Combined in and out of
network
$50/$150Combined in and out of
network
Annual Benefit Maximum
$1,250Combined in and out of
network
$1,250Combined in and out of
network
Preventive Dental Services(cleanings, exams, x-rays)
100% 80%
Basic Dental Services (fillings)
80% 80%
Major Dental Services (extractions, crowns, inlays, onlays, bridges, dentures, repairs)
50% 50%
Orthodontic Services Not covered Not covered
New!Vision Coverage will become effective September 1, 2015. There will be a separate enrollment period for this line of coverage.
Vision
Administered by United Healthcare
In-Network Out-of-Network
EXAM / MATERIALS
Exam $15 copay $50 allowance
Single Vision Lenses $30 copay $50 allowance
Bifocal Lenses $30 copay $70 allowance
Trifocal Lenses $30 copay $100 allowance
Frames $120 allowance $70 allowance
Contacts (Medically Necessary)
$30 copay $210 allowance
Contacts (Elective) $120 allowance $110 allowance
BENEFIT FREQUENCY
Exam 12 months
Frames 24 months
Lenses 12 months
Life and Accidental Death & Dismemberment Insurance Insured by Cigna
Life InsuranceLife insurance provides financial security for the people who depend on you. Your beneficiaries will receive a lump-sum payment if you die while employed by Aurora Public Schools. The School District provides basic life insurance of 2 times your annual compensation to a maximum of $250,000 at no cost to you.
Accidental Death and Dismemberment (AD&D) InsuranceAccidental Death and Dismemberment (AD&D) insurance provides payment to you or your beneficiaries if you lose a limb or die in an accident. Aurora Public Schools provides AD&D coverage of 2 times your annual compensation to a maximum of $250,000 at no cost to you. This coverage is in addition to your company-paid life insurance described above.
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Flexible Spending Accounts (FSAs)Administered by TASCYou can save money on your health care and/or dependent day care expenses with an FSA. You set aside funds each pay period on a pretax basis and use them tax-free for qualified expenses. You pay no federal or state income taxes on your contributions to an FSA. (That’s where the savings comes in.) Your FSA contributions are deducted from your paycheck before taxes are withheld, so you save on income taxes and have more disposable income.
Healthcare Spending Limit $2,500
Dependent Care Spending Limit $5,000
TASC is the administrator of two individual Flexible Spending Accounts — one for health care expenses and one for dependent childcare and elder care expenses. You can enroll in one or both FSAs. You use each account separately, but they work similarly.
Here’s How an FSA Works1. You decide the annual amount (see above for the limit for each account) you want
to contribute to either or both FSAs based on your expected health care and/or dependent childcare/elder care expenses.
2. Your contributions are deducted from each paycheck before income taxes, and deposited into your FSA.
3. You can pay with the Health Care FSA debit card for eligible health care expenses. For dependent care, you pay for eligible expenses when incurred, and then submit a reimbursement claim form or file the claim online.
4. You are reimbursed from your FSA, so you actually pay your expenses with tax-free dollars.
Employee Assistance Program (EAP)Administered by Horizon HealthThe EAP can provide you with support for a variety of concerns ranging from coping with stress to relationship issues, finding child care, and help with legal and financial matters. All services are confidential and available 24/7 online or by phone.
Long-Term Disability InsuranceInsured by CignaMeeting your basic living expenses can be a real challenge if you become disabled. Your options may be limited to personal savings, spousal income and possibly Social Security. Disability insurance provides protection for your most valuable asset — your ability to earn an income. Aurora Public Schools provides Long-Term Disability insurance (LTD) coverage at no cost for those employees who do not have five years vested with PERA.
LTD coverage provides income when you have been disabled for 180 days or more. Your benefit is 60% of your monthly earnings, up to $1,500 per month. This amount may be reduced by other deductible sources of income or disability earnings. Benefit payments can continue to age 65 if you are under age 60 at the time of disability.
Contact InformationIf you have specific questions about any of the benefit plans, please contact the administrator listed below, or your local human resources department.
BENEFIT ADMINISTRATOR PHONE WEBSITE/EMAIL
Medical United Healthcare 855.828.7715 www.myuhc.com
Medical Kaiser 303.338.3800 www.kp.org
Dental Delta Dental 800.610.0201 www.deltadentalco.com
Vision United Healthcare 800.638.3120 www.myuhcvision.com
Life and AD&D Insurance Cigna 800.732.1603 n/a
Long-Term Disability Cigna 800.732.1603 n/a
FSA TASC 800.422.4661 www.tasconline.com
Employee Assistance Program Horizon Health 800.284.1819 www.horizoncarelink.com
Employee Contributions for Benefits — Full Time EmployeesBENEFIT PLAN MONTHLY
UNITED HEALTHCARE
Employee $30.72
Employee + Spouse $774.21
Employee + Children $522.28
Family $1,136.73
KAISER
Employee $23.44
Employee + Spouse $585.89
Employee + Children $398.39
Family $867.19
DENTAL
Employee $6.39
Employee + Spouse $33.64
Employee + Children $46.45
Family $68.71
Employee Contributions for Benefits — Part Time EmployeesHOURS PER DAY 4.0 4.25 4.5 4.75 5.0 5.25 5.5 5.75
UNITED HEALTHCARE
Employee $322.58 $304.34 $286.10 $267.86 $249.62 $231.38 $213.14 $194.89
Employee + Spouse $1,066.07 $1,047.83 $1,029.59 $1,011.35 $993.11 $974.87 $956.63 $938.38
Employee + Children $814.14 $795.90 $777.66 $759.42 $741.18 $722.94 $704.70 $686.45
Family $1,428.59 $1,410.35 $1,392.11 $1,373.87 $1,355.63 $1,337.39 $1,319.15 $1,300.90
KAISER
Employee $246.09 $232.18 $218.26 $204.35 $190.43 $176.52 $162.60 $148.68
Employee + Spouse $808.54 $794.63 $780.71 $766.80 $752.88 $738.97 $725.05 $711.13
Employee + Children $621.04 $607.13 $593.21 $579.30 $565.38 $551.47 $537.55 $523.63
Family $1,089.84 $1,075.93 $1,062.01 $1,048.10 $1,034.18 $1,020.27 $1,006.35 $992.43
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BENEFIT PLAN MONTHLY
VISION
Employee $4.12
Employee + Spouse $7.80
Employee + Children $9.15
Family $12.87
This benefit summary prepared by
15GBS25314A